I’ve struggled with gut issues for over a decade and a half. With hindsight, I believe that I may have had SIBO (Small Intestinal Bacterial Overgrowth) this entire time without realizing it. I’m going to describe the history of my gut issues and the testing process in case this helps you finally get a diagnosis too.
A History of Gut Pain
When my gut pain first started, I was experiencing sharp pains in my abdomen, as well as spasms. My bowel movements felt urgent, but incomplete. I would run to the bathroom thinking that pooping would make me feel better, but it never did. And – too much information warning – my stools had a lot of mucus in them.
I went to doctor after doctor looking for help, but none of them had any clue on what was going on, and none offered any useful remedies.
I had recently started a new job and my first marriage was going through a difficult time. So, I thought it was perhaps stress causing my problems.
My severe gut pain continued for three years, during which time I was given the diagnosis of IBS. My marriage ended, and the stress I had been experiencing disappeared, but my gut pain was still there.
So I kept exploring different avenues until I finally managed to identify a food sensitivity – corn. Removing this food from my diet stopped the worst of the pain, though I still experienced occasional and unexplained GI issues and discomfort.
Several years later, I tried removing gluten from my diet, and this also seemed to help my gut somewhat, but not completely. As a bonus side effect of my gluten free diet, the dandruff I’d had since I was a teenager disappeared. I took this as a definitive sign that gluten was not my friend.
And then in 2020 my health took a giant snowball roll downhill. In the previous couple of years, I had developed acid reflux, frequent heartburn, allergy symptoms, and insomnia – all of which got really bad in 2020. All of these symptoms turned out to be part of my as-of-yet undiscovered histamine intolerance.
It was after I self-diagnosed my histamine intolerance and started turning to medical practitioners for help that it was suggested to me that I might have SIBO, since it can cause histamine intolerance. SIBO was something I knew nothing about.
Small Intestinal Bacterial Overgrowth
Well, I may have started my SIBO journey clueless, but I spent a couple of months using all my spare time to educate myself.
Small intestinal bacterial overgrowth, or SIBO, as it’s commonly called, is a condition in which the amounts and types of bacteria in your gut get unbalanced. It’s a type of dysbiosis.
A normal digestive system has just a little bacteria in the small intestine, the part of the gut that food travels to after the stomach. Ideally, most of our gut bacteria are located in our large intestine (also known as the colon), the place our food moves to after being digested in the small intestine.
In the large intestine, our populations of gut microbes finish breaking down the remains of our foods. This is how the microbes get fed, and in exchange for their meals, they do us the favor of many surprising services. Our gut microbiome can influence our moods and whether we are obese or not, for instance.
When our bacteria break down our foods they produce gas – which is why we fart. And the more fermentable carbohydrates we eat, the more gas is produced, because that means more food for the bacteria.
But sometimes the gut doesn’t function normally – food can remain too long in the small intestine before moving down to the large intestine, a problem referred to as “impaired motility.”
When motility is impaired, the bacteria populations in the small intestine get more time at the all-you-can-eat-buffet, and their populations can grow.
Since bacteria produce gas when they digest our food, when you have more bacteria and more slowly moving food you get more gas. This gas can build up in the small intestine where it doesn’t have the same natural escape route (the rectum) as the large intestine.
So this gas produces bloating, and can result in a person who burps a lot but farts rarely, or the gas can simply feel as though it is trapped in the abdomen. This bloating can be particularly painful.
I remember a conversation with a gastroenterologist during the early days of my gut problems. He showed me an x-ray of my abdomen and said, “There’s nothing wrong with you, you just have gas.”
I told this story to my current functional medicine doctor. Her response? “Yes, but the small intestine is very small – gas in the small intestine can cause a lot of pain!”
The Medical View on SIBO
I dealt with that gastroenterologist about 15 years ago. You would think that in the intervening time, he might have updated his knowledge and might be able to diagnose my problem now. Don’t bet on it.
Unfortunately many doctors, and even many gastroenterologists are still not up to date on SIBO. Some don’t even believe that it’s a real thing, sadly. Luckily, there are some conventional doctors who do know what the research on SIBO says, and are able to test and treat their patients.
One of the leading gastroenterologists working with SIBO patients is Dr. Mark Pimentel, who is, thankfully, doing a lot of research that should make SIBO better understood and accepted within conventional medicine.
Functional medicine doctors and naturopathic doctors have been on the forefront of working with SIBO patients and in general, may have more experience diagnosing and treating SIBO than their conventional counterparts.
As for me, I consulted with a functional medicine doctor, and she is the one who recommended I get tested for SIBO, based on my histamine intolerance, and my GI symptoms.
The SIBO Breath Test
Although some gastroenterologists will take aspirate samples to check for SIBO during an endoscopy, there is a much easier way to test for this condition – a breath test.
My doctor ordered me a breath test kit, which I was able to do from home, a convenience I was especially grateful for during the COVID pandemic.
The test consists of several tubes designed to catch the gasses from your breath, as well as a lactulose solution.
I prepared for the test by eating a simplified diet for 24 hours – boiled chicken and white rice without anything else. Vegetarians have the option of replacing the chicken with plain tofu.
After this day of prep, the next morning I filled my first tube, as a baseline, prior to drinking the lactulose solution.
I then drank the solution, and begin to the fill the tubes, with 20 or 30 minutes between each tube.
The purpose of the lactulose solution is to feed the bacteria in your gut. If you experience a rise of hydrogen or methane gasses within 90 minutes, this is supposed to show that the lactulose is feeding bacteria in your small intestine, indicating a positive SIBO diagnosis.
Results of a SIBO Test
I finished my test, sent in my results, and waited for a few weeks.
Here’s what my results looked like:
Both my hydrogen and methane gasses were high. According to some of the specialists, very elevated gas levels seems to indicate a long-standing case of SIBO. And when tests show gasses in these severe ranges, SIBO can be much longer to treat.
Based on everything I’ve learned recently, I look back on my first GI issues a decade and a half ago, and I believe that I was experiencing my first SIBO symptoms then. Those sharp pains I was feeling was gas trapped in my small intestine, gas which likely, was created by bacteria in the wrong place.
If I had treated my SIBO fifteen years ago, perhaps I wouldn’t have developed histamine intolerance. Perhaps my life would have been a bit different, freed from the constant problem of unpredictable GI issues.
While I may have missed a chance to get properly diagnosed back then, at least I’ve got my diagnosis now, and am undergoing an herbal antimicrobial treatment. Because I’m dealing with not only SIBO, but also histamine intolerance and oxalate overload, my treatment is a bit trickier, and I’m having to take it a bit slower. I’ll be sharing more on that in another post.
The Importance of Being Proactive
My experience trying to get help for my gastrointestinal issues 15 years or so ago taught me that I really had to be my own advocate when it came to health issues.
Unfortunately my subsequent dealings with conventional medical doctors have pretty much only reinforced this belief – I have so many stories of disappointing interactions with doctors.
My primary care provider – and even any specialists I may consult – may not have time to do the extra research that is needed in my particular case. They may not be able to connect the dots between my weird symptoms. When we can do our own research, it might help get us on the right path towards healing more quickly.
Do You Need to Get Tested?
Because of my own experience, I would highly encourage anyone who has received a diagnosis of IBS to go ahead and do a SIBO test.
If you need help finding a SIBO-savvy practitioner, I would recommend choosing a practitioner who has completed Dr. Nirala Jacobi’s practitioner course. A functional medicine doctor or naturopath may also be able to help.
The test you should ask for is a Trio Smart test, which will test you not only for hydrogen and methane gasses, but also for hydrogen sulfide. You will, however, need to get your doctor to order this test for you.
If you can’t afford to work with anyone, you can get a hydrogen and methane SIBO breath test from Direct Labs without working with a doctor.
My sources for the information in this article are largely the following:
If you want to learn more about the gastrointestinal system, I highly recommend the book Gut by Giulia Enders. It’s informative, but also extremely entertaining, and contains hilarious drawings to lighten up the subject matter even more. I had already learned most of what is included in this book by the time I read it, but it was a great synthesis of that learning and helped me understand things even better. You can watch one of Giulia Enders Ted Talks and see some of those great drawings here.
If you get tested for SIBO, and your test turns out positive, I recommend taking a video course called the SIBO Success Plan from Dr. Nirala Jacobi. After initially watching some other practitioner’s videos and reading articles online for free, I finally decided to go for Dr. Jacobi’s course and learned so much from it. It is extremely well organized and will give you an excellent overview of your treatment options, as well as help you focus on the possible causes of your SIBO, which can be imperative to a successful treatment. At the time of writing this article, this course is also incredibly affordable. For me, it has been an incredibly valuable resource and gave me great peace of mind before launching into my treatment.
Now that I’ve spilled my guts on my guts – what about you? Are you a fellow long time sufferer of GI problems? Do you suspect SIBO? Has this article encouraged you to get tested? Let me know in the comments, I’d love to hear from you.
Do you have SIBO too? Here are some of my favorite SIBO-friendly recipes:
Rice Salad with Beef, Lime, and Herbs