When your IBS is SIBO and what to do
- Carmela Pengelly
- 2 hours ago
- 8 min read
What I cover in this blog:
If you are living with an IBS diagnosis you are likely in despair and wondering if true relief is ever possible. Irritable bowel syndrome (IBS), as the name implies, is a generalised medical term for a syndrome—a collection of symptoms—that provides you with a label but leaves you in the dark as to how to fix it. The good news is that a significant number of IBS cases are caused by small intestinal bacterial overgrowth (SIBO), which can be overcome with the right help.
While study results vary, research indicates that up to around 80% of people with IBS have SIBO. |
How do you know when your IBS is SIBO?
IBS can be caused by several issues, ranging from bile acid malabsorption and nervous system dysfunction to imbalances in the gut microbiome.
As the name suggests, SIBO specifically relates to microbial overgrowths in the small intestine. So, in a nutshell, your IBS is SIBO when bacterial overgrowths occur in the small intestine.
There are some clues that can help you to decipher whether the predominant problem resides in the small or large intestine.
Typical Symptoms | Onset and Timing | |
Small Intestine (SIBO) | Belching, bloating, feeling uncomfortably full. Discomfort or pain usually occurs around the navel or upper abdomen. Nausea. Fatigue. | Bloating usually starts soon after eating (within 30 minutes to 2 hours) and affects the entire belly. |
Large Intestine (Colon) | Flatulence, urgency, pain localised to the lower abdomen (e.g., left or right side). | Symptoms can occur anytime of the day and are often relieved by defecation. |
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Telltale signs and symptoms
There are also several other very distinctive signs and symptoms that I often see in my SIBO clients. These include:
Feeling very bloated and gassy after eating starchy carbs such as bread and pasta.
Probiotics make you feel worse.
Antibiotics relieve your symptoms.
You have vitamin deficiencies, such as B1, B3, B12, and fat soluble vitamins A, D, E and K.
These signs and symptoms give you a general guide, but you cannot always be sure as symptoms vary and can present differently in each individual.
If you have SIBO, you won’t necessarily experience all of these symptoms and may not fit the official IBS diagnosis. For example, for many of my clients, abdominal pain is not a significant issue.
Red Flags
It is very important to also be aware of other specific, serious conditions that can be causing your symptoms, and these warrant immediate medical attention.
These include:
Unexplained weight loss.
Iron deficiency anaemia.
Blood in your stool (visible or occult - detected in tests).
Persistent vomiting.
Symptoms that wake you up from sleep.
Swallowing difficulty (dysphagia).
Consult a medical professional immediately to rule out any possible causes, such as coeliac disease, inflammatory bowel diseases (Crohn's disease and ulcerative colitis), or cancer.
If you do not suffer any of these symptoms but your issues persist and/or are severe also visit your medical professional.
How to test for SIBO
The best way to determine the underlying cause of your symptoms is through functional testing. Functional testing differs from tests such as blood tests, since they specifically look at how particular systems in the body are functioning.
The SIBO breath test is one such test that I often recommend to clients after I have assessed signs and symptoms.
The test involves drinking a sugar solution (lactulose or glucose). You then breathe into collection bags every 15–20 minutes for up to three hours. If microbes in your small intestine are present in high numbers, they will ferment the sugar and produce hydrogen and/or methane gas, which is then measured in your breath.
We offer functional at-home test kits, including the SIBO breath test, in our store (please click here). You can order a stand-alone test kit and I send you the lab results when I receive them, or you can choose a test kit/consultation package where I can interpret the results for you and create an action plan for recovery. |
What if My SIBO Test is Negative?
If the test is negative, don't despair, as you can at least rule out SIBO as the cause of your problems. You can then move on to investigating possible dysfunction in other areas of the digestive system, especially the large intestine. It’s just a matter of further testing, finding patterns of symptoms, and understanding what systems in the body might be at play.
Once you have discovered the underlying cause, you can fix it.
Bear in mind that no test is 100% foolproof and false negatives sometimes occur, meaning that the test has falsely indicated that you don’t have the condition.
It helps to work with an experienced gut health expert to properly assess results and advise you on your options.
When to use stool tests
Stool tests are extremely useful for two main reasons:
If your SIBO test is negative a functional stool test is a good next step towards finding out the root causes of your IBS.
If you have SIBO, it is highly likely that you also have imbalances in your large intestinal microflora as well as issues with digestive function.
Stool tests can identify:
Large intestinal dysbiosis: Imbalances (overgrowth or deficiency) of normal gut flora (bacteria, yeast and other microbes).
Pathogenic bacteria, viruses, yeasts and parasites in the large bowel.
What antimicrobials will be effective in killing any specific overgrowths or pathogenic microbes.
Inflammation: Markers like calprotectin indicate possible inflammatory bowel diseases, namely Crohn’s disease or ulcerative colitis, as well as infections or cancer.
Digestion Markers: Indicating how well you can digest fats and protein, and digestive enzyme output.
I recommend first taking the SIBO test and addressing any overgrowths that are detected. Then, it is well worth using a stool test to determine any issues in the large intestine or with digestive function. Investigating and correcting these problems means that your digestive health is optimised and you are significantly less likely to suffer relapses or gut issues in the future.
The reason to address SIBO first is that diets and supplements used for overcoming other gut issues are generally contra-indicated for SIBO and would often worsen your symptoms. A classic example is using probiotics to correct gut flora imbalances. Probiotics very often add to the unwanted bacterial population in the small intestine, exacerbating the overgrowth.
Microbiome Mapping or CDSA?
In my clinic, I often use either the microbiome mapping tests or the comprehensive digestive stool analysis (CDSA). These are done using at-home test kits available here. It is as simple as collecting stool samples and posting to the lab for analysis.
The fundamental difference between the two is that the Microbiome Mapping test uses advanced DNA technology (PCR) to give a highly sensitive and precise breakdown of the microbes present, while the Comprehensive Digestive Stool Analysis (CDSA) traditionally relies on culture-based methods and microscopy. This is where the lab will take a sample and encourage the growth of microbes to detectable levels. A powerful microscope is used to detect microbes, including parasites.
The microbiome mapping test is the most advanced test but the CDSA provides more information about digestive function, such as how well you can digest fats and carbohydrates. Also, the microbiome mapping tests have the advantage of measuring the biomarker for leaky gut (zonulin).
The table below gives you a comparison of the tests, including approximate costs.
If your budget allows, I would recommend the Complete Microbiome Mapping test to give a more accurate picture, and, ideally the newer Advanced Microbiome Mapping test. The major advantage of the latter is that it tests the sensitivity of any overgrowths and pathogenic organisms against a panel of common natural and pharmaceutical antimicrobials. This means that you know how effective an antimicrobial will be for your particular microbial population and takes the guesswork out of creating an effective protocol to overcome your gut issues.
Please contact me here if you would like to discuss whether a test would be advisable and which tests are most suitable.
Comparison of functional stool tests (*at time of publishing in AUD)
CDSA 3+ (2006)
*$430
| Complete Microbiome Mapping (2206) *$435 | Advanced Microbiome Mapping (2211) *495 | |
Method for detecting microbes | Culture, Microscopy | DNA-based PCR/Sequencing | DNA-based PCR/Sequencing |
Bacterial Phyla/Commensals | Limited (Culturable species) | Extensive (Diversity, Phyla, Individual Strains) | Extensive (Diversity, Phyla, Individual Strains) |
Pathogenic Bacteria/Virulence | Limited (Culture only) | Specific PCR detection of pathogenic genes | Specific PCR detection of pathogenic genes |
Parasites (Protozoa & Worms) | Microscopy/EIA (limited sensitivity) | Highly Sensitive PCR detection | Highly Sensitive PCR detection |
Yeast & Fungi | Culture (limited sensitivity) | Specific PCR detection | Specific PCR detection |
Digestive Function (Fat/Starch/pH) | Yes (Quantitative) | Limited | Limited |
Digestive enzyme output | Yes | Yes | Yes |
Zonulin (leaky gut marker) | No | Yes | Yes |
Inflammatory Markers (Calprotectin & M2PK - colorectal cancer marker) | Yes | Yes (calprotectin only) | Yes (calprotectin only) |
Immune Markers (sIgA, Transglutaminase IgA - coeliac marker) | Yes | Yes | Yes |
Metabolic Markers (SCFA Profile) | Yes | Yes | Yes |
Beta-glucuronidase (indicates hormone imbalances and detox issues) | Yes | Yes | Yes |
Antimicrobial Sensitivity Testing (antimicrobial agents tested against detected overgrowths) | Yes (only against cultured micro-organisms) | No | Yes (against all overgrowths detected through PCR-technology) |
Fixing your gut issues
Once you have determined what is causing your gut issues, overcoming your symptoms is very doable. Many people believe that IBS is a condition for life, but in my experience of helping clients over the last 13 years, the majority of cases can be addressed. The key is to follow a specific diet and supplement plan consistently.
I recommend working with a qualified gut health nutritionist or naturopath to help you. Click here for a free discovery call with me or click here for a consultation.
As a general guide, a gut health protocol should include:
A specific diet that addresses overgrowths in the small and/or large intestine (e.g.low FODMAP, SIBO-specific diet).
Supplements that kill SIBO or large intestinal overgrowths naturally. I use high-grade products such as Panaxea Berberine Complex or Biomedica Phytaxil, which are very effective if used at the correct dose. These products are available in our supplement store but require either a prescription from a practitioner (click on this link to upload: https://www.wixforms.com/f/7404011858996233260) or a short free consultation with me to gain access.
Healing the gut to ensure proper functioning of the digestive system, to reduce die-off reactions, and help maintain a healthy microbiome.
Building the microbiome.
Supporting healthy digestion and motility.
Preventing Relapses
These strategies are the key pillars for restoring a healthy gut and, most crucially, preventing relapses.
Antibiotics for SIBO and IBS
Some people choose to use prescription antibiotics (like Rifaximin and neomycin) to kill bacterial overgrowths. This can be an effective strategy and generally works more quickly than natural products. However, it is important to find the right medical professional who can prescribe the right antibiotics at the correct dose.
It is a shocking statistic that the relapse rate for SIBO after antibiotic therapy alone can be as high as 45% within a few months post-treatment.
One of the main reasons for relapse is that antibiotic use alone does not address the underlying causes (e.g poor gut motility). With any antibiotic protocol, I strongly recommend working with a gut health nutritionist such as myself to help support digestive system function and address the root causes
Otherwise, there is a high chance that your condition will return.
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