Got IBS? Why It Might Really Be Small Intestinal Bacterial Overgrowth (SIBO)

Part two of How to Fix Your Gut Problems

To recap: we are on a journey through your digestive tract, looking at everything that could go wrong on this perilous voyage.

We started off in your stomach, where I previously discussed how hypochlorhydria – insufficient stomach acid – could be the start of all your problems.

We have now left the stomach region and entered the small intestine, the longest part of the gastrointestinal tract. At about 20 feet long (7 metres), it’s really not that small. This is the industrial hub of food digestion and absorption. Food is broken down into particles small enough to pass through the gut lining and enter the bloodstream. Carbohydrates are reduced to simple sugars, such as glucose. Proteins become amino acids, fat is reduced to fatty acids and glycerol.

With all this metabolic activity, the potential for mayhem is immense.

Irritable bowel syndrome is defined as a common disorder affecting the digestive system, with symptoms that include cramping, bloating, excessive gas, constipation and diarrhoea.

But the truth is that IBS is not so much a disorder as an umbrella term. It means: there’s something wrong with your gut, but we don’t know what. All your tests are negative, but you’ve still got all the symptoms. It’s a mystery.

I probably see more clients with IBS than anything else: approximately 10%-20% of people are affected. Despite having had a battery of tests, including colonoscopy, endoscopy, and blood assays for various diseases such as coeliac and Crohn’s, these people have rarely been offered a test for small intestinal bacterial overgrowth (SIBO). Yet up to 80% of people with IBS are estimated to have SIBO. If you don’t look for it, you won’t find it. So what is it?

Know your nemesis

Your colon is teeming with life, an invisible city of microorganisms that thrive on the remnants of your meals. But the small intestine, where almost all digestion takes place, is quite another matter. It has few microbes; it’s not sterile, but it’s a pretty rural location, compared to the colon.

Here, things can and do go wrong. With SIBO, abnormally large colonies of microbes settle and breed in the intestines, where they don’t belong. The food supply is excellent, and they feed themselves by fermenting the carbohydrates that are passing through, producing gasses. They also steal your nutrients before they can be absorbed into the blood.

The symptoms you are most likely to experience with SIBO are remarkably similar to those of IBS:

  • Bloating
  • Pain
  • Constipation
  • Diarrhoea
  • Bad breath
  • Burping
  • Gurgling noises
  • Indigestion soon after eating
  • Feeling overly full after eating

There are a few clues in that list: symptoms often arise higher up the abdominal region, and may appear within an hour of eating. There are also similarities with hypochlorhydria (see previous Substack here).

What causes SIBO? There are several possibilities, so let’s look at the most likely.


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