We’ve all heard the words Irritable Bowel Syndrome before, but what exactly is it? Irritable Bowel Syndrome (IBS for short) is a common gastrointestinal disorder characterized by abdominal pain, bloating, gas, diarrhea, constipation, or alternating bouts of diarrhea and constipation. It can be caused by one or more factors, such as impaired gut motility, food sensitivities, stress, or overgrowth of certain bacteria or fungi in the digestive tract.
As I was writing this post, I ran an internet search for “IBS” and found several websites claiming, “there are no specific tests for it” and suggesting that the condition can be managed, but not necessarily cured. Such statements are misleading.
Although there is no test specifically for Irritable Bowel Syndrome, there are tests for a common cause of IBS — bacterial or fungal overgrowth in the digestive tract. In addition, we can test for food sensitivities through an elimination diet. Effective treatments are available to repair the gut and restore balance to the microbiome.
This post explores one of the most common causes of Irritable Bowel Syndrome — small intestinal bacterial overgrowth (SIBO) and small intestinal fungal overgrowth (SIFO) — along with the treatment options we often use with our patients at PROVOKE Health.
SIBO and SIFO — What’s The Difference?
Your digestive tract contains trillions of microorganisms that aid digestion and help your body in countless ways, including by providing nutritional support. This community of microorganisms is referred to as the microbiome. To function effectively, the microbiome must be balanced. An imbalance, referred to as dysbiosis, can lead to various health problems, including digestive disorders, allergies, and even mood disorders.
Dysbiosis can be categorized into two types:
- Small intestinal bacterial overgrowth (SIBO) — an overabundance of one or more types of bacteria in the gut
- Small intestinal fungal overgrowth (SIFO) — an overabundance of one or more types of fungi in the gut
SIBO and SIFO can be caused by one or more of the following factors:
- Poor diet: Diets high in sugar and refined carbohydrates and low in fiber and other essential nutrients are especially prone to fueling SIFO, but can also fuel SIBO.
- Certain medications: Antibiotics can kill beneficial bacteria, providing opportunities for fungi and/or other bacteria to proliferate. Acid-reducers — proton pump inhibitors (PPIs) such as Prilosec (omeprazole), Prevacid (lansoprazole), and Nexium (esomeprazole) — reduce the concentration of acid in the stomach, allowing infectious bacteria to survive the stomach and pass into the intestines where they can flourish. Long-term use of corticosteroids can also cause problems.
- Compromised immunity: If the immune system is stressed for any reason, its ability to defend against SIBO and SIFO can be reduced.
- Other health conditions: For example, diabetes can cause high blood sugar, which can promote fungal overgrowth. Intestinal motility disorders (slow movement of food and waste through the digestive track) provide an environment suitable for overgrowth.
IBS and the Connection to SIBO/SIFO
Dysbiosis can result in inflammation, malabsorption of nutrients, excess gas, and irregular food processing. If left untreated, it can damage the thin protective lining of the gut, resulting in leaky gut — a condition in which molecules that should be kept inside the intestines are released, triggering an immune response. This immune response can create a state of systemic and chronic inflammation, and may lead to autoimmune conditions, such as allergies, asthma, rheumatoid arthritis, Hashimoto’s thyroiditis, and others. When inflammation strikes the intestines, it can result in IBS.
Diagnosing SIBO/SIFO
Specific tests can determine whether you have SIBO or SIFO (or rule it out as a likely cause):
- Breath test: We use the Trio-Smart Breath Test, which checks for SIBO, intestinal methanogenic overgrowth (IMO), and excess hydrogen sulfide. This is an at-home test. You drink a sugar solution, breathe into a hermetically sealed bag, and then send it to a lab for testing. Breath samples are taken over time to evaluate changes and make treatment decisions.
- Urine test: We use the Microbial Organic Acids Test (MOAT) to check for overgrowth of potentially harmful bacteria and yeasts, levels of beneficial bacteria, and metabolic issues. MOAT measures the waste products or metabolic waste from yeast in the digestive tract that is ultimately excreted from the kidneys into the urine.
- Stool test: The GI Map Stool test provides a comprehensive study of bacteria, viruses, parasites, and digestive function to check for leaky gut, inflammatory bowel disease, gluten sensitivity, blood loss, and pancreatic enzymes.
- Blood tests: We may order one or both of the following two blood tests: Quest Diagnostics’ Candida Albicans Antibody Test checks whether the immune system has created antibodies to fight a Candida fungal infection. The myMyco lab test looks for circulating mycotoxin antibodies found in a patient’s body from possible exposure to mold toxins (mycotoxins), which are often present in a water-damaged home or building. Mold exposure can contribute to SIFO.
- Endoscopy: An endoscopy and a small intestine biopsy may be recommended in specific circumstances.
Treating IBS Caused by SIBO/SIFO
IBS can be unrelenting and tenacious. Treatments to control symptoms may work for a time and then stop being effective. Some doctors are unaware that the root cause may be small intestinal bacterial overgrowth (SIBO) and small intestinal fungal overgrowth (SIFO) and may not even test for those conditions. It takes time to find and understand the cause, time that a doctor on a typical day does not have, due to constraints in the current healthcare system. And even when a doctor provides an accurate diagnosis and has treated the patient, the problem often recurs, due to lack of long-term solutions.
IBS diagnosis and treatment does not need to be so uncertain and frustrating. Tests and treatments are available to diagnose and address the root cause, restore balance to the microbiome, and build resistance. While SIBO/SIFO can be difficult to treat or eradicate, it is possible with the correct plan of care over time.
Our approach targets the root cause, and each of our patients’ treatment plans is personalized to meet their unique needs, typically including several of the following components:
- Antibiotics and antifungals: These medications or supplements may be used to control overpopulation of fungi or specific bacteria.
- Dietary adjustments: While we do not recommend one specific diet for combating SIBO or SIFO, we do recognize that modifications in diet can impact people differently, requiring an individual approach. Some patients may benefit from a diet low in sugar, processed carbohydrates, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). FODMAPs are short-chain carbohydrates that are poorly absorbed in the small intestine and ferment in the colon. Others may need to reduce high-fat foods or excessive amounts of protein. In some cases, food may not even be the issue. That’s why we also test for any food sensitivities that could trigger an immune response and cause inflammation.
- Probiotics and prebiotics: Probiotics help to colonize the gut with healthy bacteria, while prebiotics provide food and environment for those bacteria and other healthy bacteria to thrive. Together, these two supplements help to restore balance to the gut’s microbiome and enhance resiliency.
- Gut-support supplements: Glutamine, zinc carnosine, and other minerals can help reduce inflammation, heal the gut, and improve resiliency.
- Lifestyle and stress management: Stress-reduction techniques, including mindfulness, exercise, and getting enough sleep are essential for alleviating the root cause of dysbiosis and enabling the body to repair the gut.
For more information about Small Intestinal Bacterial Overgrowth, read my post “What Is SIBO and What Can I Do About It?” here on the PROVOKE Health blog.
Get Help for IBS, SIBO and SIFO
Understanding and treating small intestinal bacterial overgrowth (SIBO) and small intestinal fungal overgrowth (SIFO) can significantly improve your quality of life and help you manage IBS and perhaps even move past it. But you need to act. We encourage you to consult with a qualified Functional Medicine practitioner who has success diagnosing and treating the root causes of Irritable Bowel Syndrome, whatever they may be.
If you are in or near Tampa Bay, are planning a trip here, or are interested in having us work with your primary care physician (PCP) or gastroenterologist on your medically supervised plan of care, contact us at PROVOKE Health. We’re here to help!
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Disclaimer: The information in this blog post about Irritable Bowel Syndrome (IBS) diagnosis and treatment, is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this blog post should be construed as medical advice from Dr. Matthew Lewis, Functional Healthcare Group, PLLC, or PROVOKE Health, nor is this blog post intended to be a substitute for medical counsel on any subject matter. No reader of this blog post should act or refrain from acting on the basis of any information included in, or accessible through, this blog post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.
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About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP® specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing at PROVOKE Health in Tampa, Fla. Dr. Lewis has 20 years of experience practicing nutritional and holistic medicine. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), Dr. Lewis has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa and elsewhere.
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