One of the most common things that I see in my practice is people suffering with Irritable Bowel Syndrome (IBS). If you’ve got IBS, I’m sure you don’t need me to define it, but for those of you that are unsure, IBS is the complex interplay between a whole host of annoying (and sometimes debilitating) digestive symptoms that can include bloating, nausea, pain, altered bowel movements (think diarrhoea and/or constipation), gas, reflux, burping, changes to your appetite, feeling full quickly despite not eating all that much and pretty much everything in between!

Once upon a time, a diagnosis of IBS was given to patients and told that they just had to ‘live with it’. In my experience as a naturopath specialising in gut and digestive health, I have come to learn that this is certainly not the case and once we have identified what the driver is, we can work on bringing your body back into balance so that it can start doing what it should be doing!

A growing area of interest that I’m becoming more and more fascinated by is something called SIBO, or Small Intestinal Bacterial Overgrowth. When you dive into the scientific literature, we see that there is more and more evidence suggesting that SIBO might be one of the main drivers behind IBS-type symptoms and one study found that up to 85% of those people with IBS actually had SIBO! Let me explain what happens…

The job of your small intestine

Your small intestine is the part of your digestive system that is mainly associated with absorbing and metabolising food and nutrients. Food passes in from your stomach and takes about 2 – 4 hours to pass through to your large intestine (in normal, healthy circumstances). The body will work to continue breaking food down into the smallest possible components so that these nutrients can make their way out into the blood stream and then be used by the body. To give our body the best possible chance at absorbing as many nutrients as possible, the small intestine is full of nooks and crannies, twists and turns! This provides multiple sites for absorption to take place – It’s a cleaver little design, if it’s working properly!

The small intestine also has an inbuilt housekeeper called the Migrating Motor Complex. This is where the body will activate a series of wave-like contractions in the small intestine every 90 – 120 minutes (when in a fasted state) to sweep its contents on to the large intestine. This is a really important step in the digestive process because it also means any bacteria that have survived the stomach acid also get passed out. A key player in ensuring that this process works well is also influenced by a specialised ‘gate’ called the Ileocecal Valve. This is the section where the small intestine and the large intestine meet and this gate should only open one way (from small intestine to large intestine). Sometimes though, this gate gets stuck and bacteria that live or have been moved into the large intestine start making their way back up into the small intestine. This is NOT what we want!

When things go wrong

For a whole host of reasons, bacteria can sometimes get trapped in the small intestine. The main drivers behind this are usually to do with:

  • Infection! Bouts of gastro, food poisoning or an ‘upset tummy’ are usually driven by bacterial infection. These bugs like the warm, nutrient-rich environment of the small intestine and they don’t want to leave.
  • A reduction in stomach acid meaning more of the ‘bad bugs’ we might ingest make their way down into the small intestine.
  • Alterations to the migrating motor complex, meaning the bugs that get there, stay there for too long.
  • Medications like antibiotics are a big player in SIBO development as are Proton Pump Inhibitors (things like Nexium and Somac) due to the role they have on stomach acid levels and the survival of ingested bacteria.
  • Underlying imbalances or diseases that affect the Ileocecal Valve mean bacteria from the large intestine have free reign to move on up into the small intestine even when they don’t belong there.

What happens next?

A couple of things actually…Let me explain further with a diagram!

In short, bugs get trapped in the small intestine – a place where they shouldn’t actually be! They begin secreting toxins that make their way out into the blood stream and affect a whole host of things. Additionally, they release lots of different gases as they are munching away on your food that then get trapped in your tummy! These toxins have been specifically correlated and cited in the scientific literature to be associated with mental health conditions, rosacea, restless leg syndrome, psoriasis, thyroid problems, joint pain, hormonal problems, fatigue, nutrient deficiencies especially iron and B12 (especially when these levels don’t respond to oral supplementation), weight issues and that’s just what we’re seeing at the moment!).

So, what do we do?

The simple answer here is we need to kill the bugs! But figuring out the best way to do this can take a bit of detective work! Sometimes we need to start by increase stomach acid, other times we need to manage the stress response and other times it might be about the immune or endocrine systems. Other times we need to use probiotics, sometimes herbal medicine, sometimes it’s antibiotics and sometimes nutrients are a better option. Despite what google will tell you, addressing SIBO is not as simple as popping a few oil of oregano capsules – if anything this can be quite detrimental! (So please, please don’t do this!) If you’ve been diagnosed with SIBO, it’s best to get in touch with a practitioner who has experience with SIBO and can take a thorough case history to work out where you need to start.

What’s next then?

Once the SIBO is eradicated, it’s important to correct the underlying drivers to make sure that it doesn’t come back! Unfortunately, these bugs can be tenacious and can go on living in the small intestine even when you feel well and are symptom free. This is a very big reason behind the high relapse rate with SIBO, so you might have to redo the kill phase a couple of times to ensure you get rid of them all. Once this is done though, your small intestine can get back to absorbing nutrients and helping you feel energised and happy!