Tag: ibs

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How To Tell If You Have SIBO or IBS?

Irritable bowel syndrome, also known as IBS, is the most common gastrointestinal diagnosis.

How common is IBS?  Scientific tests show that 10%-15% of Americans suffer from IBS. IBS is more common in women with almost twice as many women having it than men.  IBS is characterized by a cluster of symptoms, including recurrent abdominal discomfort, as well as a change in the frequency and/or consistency of bowel movements. Diagnosis is based on these symptoms; there is no official test for IBS. 

Due to this broad definition, at times ‘IBS’ is considered a catch-all term for anyone suffering from digestive symptoms who does not have inflammatory bowel disease. When assigned too broadly, it can provide a diagnosis without adequate investigation into the root cause of symptoms, and treatment may focus solely on providing temporary symptom relief rather than permanent resolution. Additionally, IBS is often falsely determined to be solely psychogenic, denying patients access to further investigation while reducing the cause of their suffering to ‘all in their head’. 

Changing Tides in Digestive Health

 Thankfully, our understanding of gut health – and gut disease – is changing rapidly.  Recent research indicates that the development of IBS is multifactorial, and is largely influenced by the health of the gut microbiome, the complex microbial ecosystem that houses fungi, viruses, and bacteria within the gastrointestinal tract. This is most evident when chronic IBS symptoms begin following acute gastroenteritis due to exposure to a pathogen. The introduction of a pathogenic microbe can create both the acute symptoms associated with acute gastroenteritis, such as vomiting, diarrhea, and fever, while creating a long-term shift in gut motility that sets the stage for chronic IBS.  

Alterations to the microbiome also appear to underlie the two main categories of IBS: diarrhea-predominant IBS (IBS-D) and constipation-predominant IBS (IBS-C). IBS-D has been associated with increased levels of hydrogen-producing bacteria, while IBS-C has been associated with increased levels of methane-producing bacteria; both of these microbial imbalances are collectively known as small intestinal bacterial overgrowth (SIBO).

Does IBS = SIBO?

The gold standard for diagnosing SIBO is small intestinal aspirate, though it is rarely used clinically. Instead, lactulose breath tests are utilized to measure both hydrogen and methane levels; these measurements are indicative of bacterial levels within the small intestine. Research values vary but indicate that anywhere from 33-78% of patients diagnosed with IBS actually test positive for hydrogen and/or methane SIBO.  There is now a trio-smart test that also tests for sulfate gas.  An additional study of patients who tested positive for SIBO found a 7-8 fold increase in both Escherichia/Shigella and Klebsiella bacteria compared to non-SIBO patients.  An additional study in patients with IBS-like symptoms showed roughly 25% of them had an excessive number of fungal organisms within the small intestine, known as small intestinal fungal overgrowth or SIFO.   Recently, a large-scale study at Cedars Sinai has identified elevations of a third gas, hydrogen sulfide, in cases of IBS-D, indicating elevation in hydrogen sulfide-producing bacteria as both an additional type of SIBO, and another possible root cause of IBS.  Several therapeutic trials that aimed to treat gut microbes with antibiotics have shown favorable improvements in IBS-symptoms, further supporting the theory that microbial imbalances play a key role in the development of IBS.

All of this research indicates that for a huge percentage of IBS-sufferers, microbial imbalances, either in levels and/or locations of bacteria (as in SIBO) or fungi (SIFO), or a combination of both, are largely to blame for their symptoms. These findings are essential in providing relief for IBS patients, as these complex imbalances in the microbiome will not be corrected simply by following the typical treatment recommendations for IBS, such as stress management, increased fiber intake, laxatives or anti-diarrheals, or pain medications. 

IBS: A Way Forward To Healing

The diagnosis of IBS simply labels the symptoms as a syndrome, without providing any answers as to why a patient may be experiencing those symptoms. Without a root cause, it is difficult to provide the correct treatment methods. But with a correct diagnosis, the correct treatment methods can be applied.

Depending on symptomatology, it may also be helpful to test for Celiac disease, lactose intolerance, and food sensitivities, in addition to completing imaging to evaluate for inflammatory bowel disease such Crohn’s or Ulcerative colitis. While we have yet to gain access to testing methods for SIFO or hydrogen-sulfide SIBO, a comprehensive stool analysis can provide insight into the body’s ability to breakdown and absorb nutrients, as well as the health of the gut microbiome.  It is through these testing methods that specific imbalances in the gut can be identified; once they are identified, targeted treatments can be applied. For patients previously diagnosed with IBS, particularly if they have seen no resolution in their symptoms following the standard IBS treatment methods, identifying the root cause of their symptoms can be life-changing.

At Blum Center for Health, our team of practitioners and health coaches can work with you to heal your digestive distress. Whether you have an existing condition, are experiencing symptoms, or simply want to prevent future complications we are here to support you on the journey. Book an appointment by calling 914.652.7800.  

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FODMAPs Chart for treating SIBO and IBS

FODMAPs Chart for IBS and SIBO

As I discussed recently on Facebook Live, Small Intestinal Bacteria Overgrowth (SIBO) is an all too common gut ailment that can lead to many uncomfortable symptoms like chronic diarrhea or constipation, bloating, lots of gas, and abdominal cramping. SIBO is caused by an overgrowth of gut bacteria in the small intestine, crowding this area in high numbers where they don’t belong (only 10% should be in the small intestine, and 90% in the large intestine) and is particularly common in those with Irritable Bowel Syndrome (IBS).

Because all your nutrients are absorbed in this part of your gut, SIBO can cause malabsorption and lead to deficiencies of vitamins, minerals, fats and amino acids. Fortunately, herbal supplements and dietary changes can provide quick relief.  For instance, our Gut Cleanse Packets are designed to clear out the overgrowth of bad bacteria and yeast, but dietary changes can help, too, and may be necessary especially if you have lots of symptoms.

One category of food should stand out for those with SIBO and IBS – Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols (FODMAPs). FODMAPs are foods that are fermented by the bacteria in your bowels. When you have SIBO, there are lots of bacteria that are exposed to these foods very soon after you eat, and the fermentation creates excessive amounts of painful gas. Thus, foods high in FODMAPs are more painful to digest and foods low in FODMAPs are easier to digest for those with this condition.  

But, temporarily eating a restricted FODMAP diet won’t just reduce your digestive symptoms, it also reduces the gut bacteria’s access to food and thus assists in rebalancing your gut microbiome for optimal health. If you have IBS and aren’t sure if you have SIBO, you can often diagnose yourself by following the low FODMAP diet.  If you feel much better, then you likely have SIBO.  So what is the low FODMAP food plan? The food lists won’t necessarily be intuitive. Bananas and blueberries are some of my favorite low-FODMAP foods, while delicious fruits like apples and mangoes can actually cause acute pain!

Rather than trying to guess what foods should be high or low in FODMAPs, use this handy FODMAP Chart.

Once you’ve taken a moment to review the chart you may be shocked at how many foods could pose a problem for you. A FODMAP diet is a very restrictive diet, that’s why I don’t recommend it as a long-term solution. But, switching to a FODMAP diet could give you quick relief and the control to permanently improve your gut symptoms. Then once you’ve got a handle on your symptoms you can begin to progressively introduce foods back into your diet seeing what works for you.

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3 Simple Steps To Great Gut Health

By Susan Blum, MD

If you have gas or bloating after you eat, or if you experience constipation and/or loose stools, or any type of intestinal discomfort, you have a problem with how your gut is functioning. While this is commonly labeled irritable bowel syndrome, or IBS, the diagnosis doesn’t tell you why you’re having this problem.

Usually, the issue is something called dysbiosis, which means your gut flora isn’t healthy. You might have an overgrowth of harmful bacteria, yeast or parasites, or you might not have enough of the good stuff: those probiotics you find in yogurt and cultured foods.

But who cares about a little gas or bloating?

You should! Your gut flora needs to be fixed, because the symptoms you’re having could just be the tip of the iceberg. A whopping 70% of your immune system is located in your gut and if the flora are out of balance, you have an increased risk of something called Leaky Gut Syndrome, and this can lead to autoimmune disease.

Here are my tips to heal your gut, which will treat your symptoms and keep your immune system happy, too.

  1. For your digestive symptoms, find out whether or not you’ve got food sensitivities, which could be causing the problem. Check yourself for gluten and dairy by removing them both from your diet at the same time for three weeks, and then reintroduce each one at a time, four days apart and monitor how you feel.
  2. For your flora, eat cultured food every day, like coconut or almond milk yogurt and kefir, sauerkraut or kimchee, and consider taking a probiotic supplement.
  3. If the above doesn’t do the trick, consider a gut-cleansing program using herbs like berberine or oregano to remove the harmful microbes. Our new HealMyGut program will help you do just that!