So...what is SIBO?

Exploring in Florence this past summer and enjoying the freedom of  not worrying about my stomach :).

Exploring in Florence this past summer and enjoying the freedom of not worrying about my stomach :).

If you've read my post on gut-health, you know that I was (unfortunately) not properly diagnosed with SIBO even though my results were positive. While I think this is probably an anomaly, I feel strongly about sharing the SIBO knowledge I've researched over the past couple of years. So let's back up a second and chat about what SIBO is, what the testing entails, and treatment options.  (Note - I am by NO MEANS a doctor or medical professional.  This post is purely based on my experience over the past decade dealing with gut issues.). 

What is SIBO?: SIBO is an abbreviation for Small Intestine Bacterial Overgrowth -- in essence, your small intestine has an excess of bacteria that are normally only found in the colon. Sexy, right? The symptoms that I personally experienced with SIBO were severe bloating and stomach pain which got progressively worse throughout the day. These symptoms persisted despite diet modifications I tried such as eliminating gluten, dairy and experimenting with a low-FODMAP diet. Symptoms that others may experience are similar to IBS and include (but probably aren't limited to): Nausea, vomiting, diarrhea, constipation, malnutrition, weight loss, fatigue, depression -- and the list goes on. 

Testing: Testing for SIBO is relatively non-invasive and straightforward, other than the three hour commitment required for the testing.  Essentially, you can only eat a very limited diet the day before the test (think: nothing but eggs, white rice, plain protein, etc.) and then you fast for the twelve hours immediately prior to the test.  It is also really important to make sure that you have not taken any form of antibiotics in the month prior to the test.  On the day of the breath test, you can expect to drink a small cup of liquid (a specific laculose solution), and then breathe into a tube periodically over the course of three hours to measure the release of hydrogen gas.  A positive SIBO test shows a rise in hydrogen gas of greater than 20ppm in the first 90 minutes of the test.  Personally, my test showed a rise of 22ppm within the first 90 minutes -- however, I hadn't educated myself on what constituted a positive test. Very frustratingly, I was untreated for an additional year until I reviewed my results with Kate Scarlata RDN (who is absolutely amazing and a pioneer in this area).  Point being -- if you are experiencing any of these unpleasant symptoms, make sure you are both educated and advocate for yourself. The test itself is not invasive so my personal opinion is: if you have any of the symptoms outline above that are negatively impacting your daily activities get yourself tested to rule SIBO out.

Treatment: The treatment for SIBO is a two-week course of Rifaxamin (three doses a day); or a two-week course of Rifaxamin AND Neomycin if there is also a rise in methane gas shown in your breath test.  I personally do not have experience with Neomycin as my test did not show the presence of methane. It's important to note that sometimes a singular two-week course of Rifaxmin isn't enough to clear SIBO.  I personally found this to be true: about two months after my initial treatment, my symptoms returned.  This time, I went to a different G.I. doc (Kate-approved!), armed with the appropriate background and knowledge.  My doctor agreed that a second round of treatment was appropriate (even without retesting) - this was extremely reassuring and such relief that I was on the right track. I took a second course of Rifaxmin, and this time didn't notice an immediate difference in my bloating and cramping. However, symptoms slowly but surely resolved over the course of the following months.  I think Rifaxamin in combination with reduced stress load (post-wedding honeymoon and less hours spent at work) worked its magic, and I'm feeling better today than I have in years.  I'm also considering being retested again to be completely sure that my SIBO has cleared up and to have a baseline understanding of how I feel right now, in case it ever comes back in the future. 

Prevention: Preventing SIBO from returning is a whole other ballgame - I will do an additional blog post on that topic soon, including thoughts on diet modification and applicable lifestyle changes.

Again, I'm not a health professional, so definitely consult with your doctor if you are struggling with digestive/gut health.  It's SO important advocate for yourself to get the necessary treatment,  and I sympathize with how much it can negatively impact your life in the meantime.  You truly have nothing to lose (other than three hours!).  Honestly, I think that there is still a lack of understanding and research on SIBO in the medical community -- but I'm hopeful that as more and more individuals are diagnosed, there will be less cop-out "IBS" diagnoses and more specific recommendations for treatment.   Feel free to reach out with any questions or thoughts on my personal experience - I know how challenging this can be! 

Have you ever struggled with digestive issues? What tips/methods have you used to improve your symptoms?



Kate Scarlata's amazing blog and resources: 


Informational posts:

Kate's in-depth SIBO informational guide:

Additional SIBO Background Information: