Diagnosed with IBS or SIBO?

IBS, SIBO, Leaky Gut, Dysbiosis, what do these terms mean and what is the difference?

Most patients today have some sort of digestive or gut issue. Whether it’s heartburn, bloating, constipation, diarrhea, or nausea, these symptoms can interfere with your daily life and cause more health issues.

The good news is that these GI issues are reversible. They do not cause structural damage to the colon and do not increase the risk of colorectal cancer.

Why should you know about these disorders?

• It's estimated that 60 to 70 Millions Americans are suffering from GI issues.
• Having a better understanding of your Gastrointestinal (GI) symptoms can save you a lot of time and unnecessary treatments.
• Heartburn (Acid Reflux, GERD), for instance, which is usually treated as an upper GI problem (at the level of the stomach), may also occur as a result of lower GI issues (in the intestines). This explains why, in many cases, anti-acid drugs only provide temporary relief rather than an actual cure.
• You will notice that many of the SIBO symptoms overlap with IBS, Leaky Gut, and Dysbiosis. Therefore, self-diagnosis may be misleading and self-treatment result in further issues so make sure to have a thorough clinical evaluation and appropriate testing. For instance, a colonoscopy or endoscopy may be recommended to rule out more serious issues. Or, in case you test positive for SIBO, you may need initial antibiotic treatment to prevent complications. 

THE GUT-BRAIN AXIS

     Let’s have a special parenthesis to address a very important aspect of gut health.

The more we understand the mind-body connection and the effects of stress on the body, the more the origin of gut disturbances becomes clear.

Stress doesn’t only gives you an “upset stomach”, it triggers the gut imbalance that can, for instance, lead to Leaky gut and IBS.

     The gut has an intelligent and well organized “microbiome”, the gut microbiota, made of different bacteria, viruses, fungi, and other microorganisms, that all together help producing essential substances for your physical and mental health.

When the mind gets out of balance due to stress, so does the microbiome, and eventually your health. Under stress, your breathing accelerates and becomes more superficial. Your sympathetic nervous system is taking over, affecting your digestion and the blood flow to your intestines. Over time, this causes imbalances in your gut flora.

Vice versa, when the gut gets out of balance, the mind gets affected. As a result, you can experience Brain Fog, Depression, and possible other mental health issues.

GUT AND IMMUNITY

     Your immune system is highly influenced by the health of your gut and the balance of your microbiome. We can definitely identify a correlation between allergies and dysbiosis and we can also trace the source of some autoimmune conditions to gut issues. Autoimmune disorders treatments should include GI testing and gut rebalancing treatments.

     So let's take a closer look at IBS, SIBO, Leaky GUT, and Dysbiosis, the implications they have onn your heath and their diagnoses and treatments.

These four conditions overlap, and many of the symptoms and treatments are similar. However, the subtle differences may help you gain more clariy about your diagnosis.

      1- IBS

What is IBS?

PS: IBS is not to be confused with more serious intestinal disorders called IBD (Irritable Bowel Disease), which includes Crohn’s disease and Ulcerative Colitis.

Irritable Bowel Syndrome (IBS) is a chronic condition, and its symptoms can vary in severity and duration from person to person.

Imbalance and inflammation in the large intestine (colon) causes a variety of disgestive symptoms. IBS can occur at any age, and affect people of all ages and backgrounds.

Certain factors may make individuals more susceptible to developing this condition:

• Gender: IBS is more common in women than in men, with women being two to three times more likely to be diagnosed with IBS.
• Age: IBS often first presents in late adolescence or early adulthood, but it can affect people of all ages.
• Family history: Having a family history of IBS or other gastrointestinal conditions may increase the risk of developing IBS. 
• Psychological factors: Stress, anxiety, and depression can be associated with the onset and exacerbation of IBS symptoms (Gut-Brain Axis)
• Diet: Certain dietary factors and food sensitivities can trigger or worsen IBS symptoms in susceptible individuals.
• Infections: Gastrointestinal infections or a history of severe gastrointestinal infections may be a risk factor for IBS.

What are the most common symptoms of IBS?

• Digestive issues such as bloating, gas, constipation, and diarrhea. 
• Food sensitivities or allergies.
• Joint pain.
• Skin problems like acne or eczema.
• Unexplained weight changes.
• Mood disturbances, including anxiety and depression.
• Autoimmune reactions.   

How is IBS diagnosed?

IBS is diagnosed based on a combination of clinical criteria and the exclusion of other possible conditions:

• Clinical Evaluation: A healthcare provider will assess your symptoms, medical history, and family history to determine if they are consistent with IBS.
• Rome Criteria: Doctors often use the Rome criteria, a set of specific guidelines, to help diagnose IBS based on the nature and duration of your symptoms.
• Exclusion of Other Conditions: To confirm an IBS diagnosis, other gastrointestinal conditions, such as inflammatory bowel disease (IBD) and celiac disease, must be ruled out through various tests like blood tests, stool tests, colonoscopy, or endoscopy.
• Symptom Persistence: IBS is diagnosed when symptoms like abdominal pain, bloating, and changes in bowel habits have persisted for at least six months.

What are the treatments for IBS? 

The management of IBS includes dietary and lifestyle changes, stress management, and, in some cases, medications to alleviate specific symptoms. It is also essential to address constipation. 

• Dietary modifications: Identifying and avoiding trigger foods is key to relieve symptoms initially. The low FODMAP diet, which restricts certain types of carbohydrates can help relieving IBS symptoms. 
• Fibers: Increasing dietary fiber (especially soluble fibers found in fruits, vegetables, whole grains, and legumes) can help regulate bowel movements.
• Probiotics: Some people find relief from probiotic supplements, as they may help balance the gut microbiota. However, when SIBO is present, the use of probiotics needs to be careful monitored.
• Supplements: A combination of Enzymes, Probiotics, and Glutamine is often sufficient to relieve IBS discomfort. Constipation can often be addressed efficiently with Fibers, Magnesium, and Triphala, but sometimes require the use of laxatives. Just keep in mind that laxative can only be used for a short time because they can cause irritation to the colon.  Aloe Vera, Butyrin Licorice, Slippery Elm, and Cat’s Claw are often included in supplement preparations to help resolve IBS.
• Antispasmodic and Anti-diarrheal Medications: Diarrhea can be very dehydrating and in chronic cases needs to be addressed with medications while having an adequate intake of fluids and electrolytes.
• Lifestyle changes: Managing stress through relaxation techniques, regular exercise, and improving sleep can greatly help reduce IBS symptoms.
• Cognitive-behavioral therapy (CBT) or other psychological treatments may be recommended for those with IBS-related anxiety or depression.
• Acupuncture: uses meridian pathways and specifics points in the body to relieve symptoms of IBS and relax the nervous system.

      2- SIBO

What is SIBO?

     SIBO stands for Small Intestinal Bacterial Overgrowth, an excessive amount of bacteria in the Small Intestine which can lead to various digestive symptoms and health problems. SIBO is frequently the cause of chronic diarrhea and malabsorption.

Patients with SIBO may also suffer from unintentional weight loss, nutritional deficiencies, and osteoporosis. 

     SIBO can be caused by a variety of factors that disrupt the normal balance of bacteria in the small intestine. Some common causes and risk factors include:

• Impaired motility: Conditions that slow down or disrupt the normal movement of the small intestine, such as gastroparesis, intestinal strictures, or certain neurological disorders, can lead to SIBO.
• Anatomical abnormalities: Structural issues in the small intestine or a history of abdominal surgeries can promote the growth of bacteria where it shouldn't be.
• Medications: Some medications, particularly those that affect stomach acid production (Proton Pump Inhibitors) or slow down intestinal motility, can increase the risk of SIBO.
• Low stomach acid (Hypochlorydria) which can result from B12 deficiency, H Pilory infection or the use of acid reducers can contribute to SIBO.  
• Chronic illnesses: Conditions like Crohn's disease, Celiac disease, and irritable bowel syndrome (IBS) can be associated with SIBO.
• Dietary factors: Diets high in sugar or refined carbohydrates can promote bacterial overgrowth. Immune system dysfunction: A weakened immune system or autoimmune diseases can make the body less capable of controlling bacterial overgrowth.
• Prior infections: Gastrointestinal infections can alter the composition of gut bacteria and increase the risk of SIBO.

What are the symptoms of SIBO:

• Abdominal pain or discomfort, often in the lower abdomen
• Bloating and distension of the abdomen
• Diarrhea 

• Constipation 
• Excessive gas
• Fatigue 

• Unintended weight loss 

• Nausea 

• Malabsorption of nutrients, leading to deficiencies

How is SIBO diagnosed? 

The most common method for diagnosing SIBO is a BREATH TEST. The diagnosis usually involves a complete evaluation:

• Clinical Assessment: A healthcare provider will review your medical history and ask about your symptoms. It's important to provide detailed information about your digestive issues. 
• Breath Testing: During this test, you will consume a solution containing a sugar (usually lactulose or glucose) and then breathe into a specialized device at set intervals. Elevated levels of certain gases in your breath, such as hydrogen or methane, can indicate the presence of excess bacteria in the small intestine.
• Blood Tests: Blood tests may be conducted to check for nutritional deficiencies or markers of inflammation that can be associated with SIBO.
• Imaging: In some cases, imaging studies like small bowel X-rays, CT scans, or MRI scans may be performed to look for structural abnormalities in the small intestine.
• Endoscopy: In certain situations, an endoscopy may be recommended to directly visualize the small intestine and take tissue samples for analysis.
• Stool Tests: Stool tests may be performed to assess for malabsorption or other gastrointestinal issues that can be related to SIBO.

What are the treatments for SIBO?

• Antibiotics: Antibiotics are often prescribed to reduce the overgrowth of bacteria in the small intestine. Rifaximin is a commonly prescribed antibiotic for SIBO.
• Dietary Changes: Modifying your diet can help manage SIBO. A low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet or a specific carbohydrate diet may be recommended. These diets aim to reduce the intake of carbohydrates that can feed the overgrown bacteria. 

• Digestive enzymes (Amylase, Cellulase, Lactase, Lipase, Protease): They help break down fats and carbohydrates supporting healthy digestion. The enzyme Papain found in papaya also has great digestive properties. 

• Probiotics: Along with digestive enzymes, they help restore a healthier balance of gut bacteria. However, the use of probiotics in SIBO can be complex and should be guided by a healthcare professional. 
• Nutritional Support: Addressing any nutritional deficiencies caused by malabsorption is essential, particularly for nutrients like vitamin B12 and iron which deficiency can cause anemia.  
• Motility Agents: Medications that improve small intestinal motility can be used to help prevent the recurrence of SIBO. 

• Lifestyle Changes: Lifestyle factors like stress management and regular physical activity play a major role in managing SIBO symptoms. Successful management of SIBO often involves a commitment to long-term dietary and lifestyle changes.   

     3-  LEAKY GUT

Leaky Gut is a main cause of IBS. 

    Leaky gut, is also known as “increased intestinal permeability”, meaning that the lining of the small intestine becomes more permeable than normal.

     The mucous lining of your intestines is designed to absorb water and nutrients from our food into our bloodstream. Increased intestinal permeability means that the gut is letting more than water and nutrients through and allows toxins to pass through the intestinal barrier and enter the bloodstream.

These toxins may trigger an inflammatory response that can lead to certain diseases.

     In addition to IBS, leaky gut is thought to be at the source of several inflammatory and autoimmune diseases including Inflammatory Bowel Disease (IBD) and Celiac disease. This chronic inflammation in the intestines, could also be a factor in many other diseases, including metabolic disorders such as obesity, diabetes, arthritis, asthma, chronic fatigue, and fibromyalgia. 

What causes Leaky Gut?

• Diet: A diet high in processed foods, sugar, and low in fiber may negatively affect the gut lining. 
• Chronic stress: High stress levels influence gut health per the Gut-Brain Axis. 
• Microbiome imbalance: An imbalance of beneficial and harmful gut bacteria can disrupt the gut barrier.
• Medications: Some medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), may contribute to gut issues.
• Infections: Infections or overgrowth of harmful bacteria in the gut can damage the intestinal lining. 

• Environmental factors: Toxins and pollutants in the environment might affect gut health. 

What are the treatments for Leaky Gut?

• Dietary changes: Eliminating processed foods and avoiding sugar, gluten, and dairy helps reducing inflammation.
• Probiotics: Probiotic supplements or probiotic-rich foods help keeping a healthy gut microbiota, which plays a role in maintaining gut barrier function.
• Gut-healing supplements: The goal is to stop the inflammation process and restore the lining of the intestine. Supplements like Glutamine and Aloe Vera which are commonly used to support gut health can be very helpful.
• Stress management: Monitoring your response to stress and reducing stress through relaxation techniques and practices like mindfulness has great benefits for gut health. 

     4- DYSBIOSIS

     Dysbiosis is a form of SIBO and also a main cause of IBS. It is an imbalance in the composition or function of the Microbiome, which consists of various microorganisms, including bacteria, viruses, fungi, and other microorganisms.

This imbalance can involve changes in the diversity, quantity, or types of microorganisms in the microbiome. Dysbiosis can lead to either an overgrowth of harmful bacteria (causing SIBO) or a reduction in beneficial bacteria, that can result in digestive disorders, autoimmune diseases, and even mental health conditions.

How do you know you have Dysbiosis?

Those are common signs and symptoms of Dysbiosis:

• Gastrointestinal issues: Frequent bloating, gas, diarrhea, or constipation.
• Food intolerances: Difficulty digesting certain foods or experiencing discomfort , bloating, flatulence, or diarrhea after eating.
• Autoimmune conditions: Some autoimmune diseases have been linked to dysbiosis.
• Frequent infections: A weakened immune system due to dysbiosis can lead to recurrent infections.
• Mental health issues: There is a connection between gut health and mood disorders. Therefore not all mental health issues originate in the mind and should be treated with psychiatric drugs.

How is Dysbiosis diagnosed? 

     It is important to accurately diagnose Dysbiosis to get the right treatment.

A stool test is the way you can find out whether Dysbiosis is due to a lack or an excess of bacteria. An excess of bacteria sometimes needs antibiotic treatment, whereas a lack of bacteria can be happening due to antibiotic treatment. So in order to recreate balance, you need to have a clear picture of what is causing the imbalance.

• Stool Testing: A comprehensive stool analysis can assess the composition of the gut microbiome, looking for imbalances in the types and amounts of bacteria present. It can also rule out an infection from a parasite, a bacteria or Candida. 
• Breath Tests: These tests can help diagnose conditions like Small Intestinal Bacterial Overgrowth (SIBO), which is a form of dysbiosis. Breath tests measure gases produced by bacteria in the gut.
• Blood Tests: Some blood markers, like elevated levels of calprotectin or antibodies, may indicate inflammation or immune responses related to dysbiosis.

What are the treatments of Dysbiosis?

• Dietary and lifestyle changes: Avoiding sugar which promotes the growth of bad bacteria, processed food, gluten and dairy. Also decreasing alcohol consumption which can cause imbalance in the gut bacteria. 
• Probiotics: Probiotic supplements contain beneficial bacteria that can help restore a healthy balance in the gut microbiota. It is especially recommended when Dysbiosis is due to a lack of good bacteria secondary to the use of antibiotics.
• Prebiotics: Many foods can act as prebiotics, artichokes, apples, bananas, berries, flaxseeds, cocoa, and even coffee. Prebiotics contain substances that promote the growth of beneficial gut bacteria and help activate probiotics.
• Digestive enzymes: These enzymes can help improve the digestion and absorption of nutrients in the presence of dysbiosis and significantly relieve symptoms of bloating and indigestion.
• Butyrate: This short-chain fatty acid is produced by beneficial gut bacteria and contributes to gut health. It is sometimes added as a supplements when probiotics and enzymes are not sufficient.  

     For consultations on Gut Health, you can request a consultation with me:

     https://evelyneleone.com/contact/

     As always, I want to remind you that stress is a major contributor to any health imbalance and illness. As highlighted by the Gut-Brain Axis, it is essential to manage stress levels to help gut issues.

     For stress management, you can try my Highbe Breathing and Meditation program :)

     https://www.highbe.org/programs

In Vibrant Health,

Dr Evee

Evelyne Leone, DO, Faarm, Abbarm