You go to your doctor, tell them about your digestive woes, and they might run tests to rule out Celiac and Inflammatory Bowel Disease (IBD). Tests include blood work, physical exam, and most intensively, tubes put into your body (colonoscopy and endoscopy). Once those tests come back “normal”, as they often do, your doctor may say, “Well, we found nothing wrong with you, so it’s probably IBS and it’s all in your head.” That’s the last thing you want to hear. That’s the last thing you deserve to hear.
Fortunately, now there are actual tests you can run that will give you more insights into your gut health. These tests results you can take to your doctor and say, “See! Something is actually going on with me.”
Diagnosis of Exclusion
Irritable Bowel Syndrome (IBS) affects between 4–10% of people globally. Many of us may experience the hallmark symptoms of IBS from time to time, including gas, constipation, diarrhea, pain, and bloating (1). IBS is mainly a diagnosis of exclusion which, as we discussed to open up this article, means ruling out more severe conditions first. Once more severe conditions are ruled out, something called the Rome IV criteria is applied, which is based on the timing of the symptoms you’re experiencing. Hence, there is a need for a reliable, validated testing method for IBS.
Up to 78% of people with IBS also suffer from Small Intestinal Bacterial Overgrowth (SIBO) (2). While many people believe they may have SIBO because of bloating, it takes an actual test to diagnose SIBO. One of the ways in which SIBO is diagnosed is via breath testing. You drink a substance, either glucose or lactulose, and then you breathe into a bag that collects gases, specifically CO2, methane (CH4), and hydrogen (H2). Human cells don’t make methane or hydrogen, so their presence on the test tells you bacteria are also present.
Why is all this important?
There is currently no reliable, validated testing method for IBS.
Since there are more reliable testing methods for SIBO, and the majority of IBS cases are related to SIBO, testing for SIBO could be a good surrogate for IBS.
The faster a diagnosis is known, the faster, and more specific, the treatment approach can be and the faster your gut can heal.
Diagnosis on Paper
What happens when we use SIBO testing in those with IBS?
Studies have looked at using breath testing in those with IBS and found that breath test results are 4.5x more likely to be abnormal in individuals with IBS compared to healthy people (3). This is an interesting and hopeful finding. I take away two big things from this finding. 1)This means people with IBS may finally have a reliable method to test for their issues. 2) If the breath test is abnormal, then that means bacteria are at play, specifically more problematic bacteria.
The next question is if we treat the bacteria involved in the abnormal breath test, does IBS get better?
Rifaximin, an antibiotic that selectively acts in the gut, can improve GI symptoms and quality of life in those with diarrhea-predominant IBS (IBS-D)(4). The big caveat to this study, improvements were seen in people with concurrent SIBO, but also in those without SIBO.
What does that mean?
Antibiotics, or herbal antimicrobials, kill bacteria, and if people with IBS take antimicrobial agents and feel better, that means bacteria are at the root of the problem. The fact that not having SIBO still resulted in positive results says that not all IBS cases can be attributed to SIBO. This is where it takes the knowledge and critical thinking skills of a good practitioner to understand when one’s IBS may be related to SIBO, versus when it’s related to digestive enzyme insufficiency, post-food poisoning complications, or unresolved trauma.
If you’re looking for a practitioner who understands the nuances of IBS, head on over to The HIVE Natural Health Center.
As always, Trust in Your Gut.
Disclaimer: The contents of this article are for educational purposes only, and are not intended to diagnose or treat any condition. Do not apply any of the information in this article without first speaking with your doctor.
