SIBO stands for “small intestine bacterial overgrowth.” It is currently popular in some parts of the IBS (Irritable Bowel Syndrome) medical community to view SIBO as the primary cause of irritable bowel syndrome, and to use special testing and special antibiotics to treat SIBO. This article will explore the facts and science behind this approach to IBS.
A bacterial overgrowth of the small intestine is the concept that the wrong kind of bacteria have colonized and over-run the small intestine. This means that bacteria other than Lactobacillus (acidophilus) and Bifidobacter have set up shop and are wreaking havoc with your ability to properly digest your food.
In order to figure out whether or not you are suffering from SIBO a physician may have you undergo a breath test. Breath testing is of course not a direct measurement of the bacteria, but an indirect measurement. The idea is that when you are given something to digest, then you will produce more hydrogen or methane in your breath if you have bad bacteria in your digestive tract.
This may sound plausible, but there is significant research indicating that having the gases at increased levels in your breath does not indicate bacteriological imbalance. Most of the published research on successfully using this type of testing is by, or associated with, one individual doctor who has reported financial connections that pose a potential conflict of interest. That doctor has a financial relationship with the pharmaceutical company that makes the specific antibiotics most often used in SIBO studies.
Independent studies that included a control group have been very helpful in understanding the value of this kind of testing. In these studies, people with IBS and people without IBS all underwent breath testing. Studies by Bratten et. al in 2008 and Ford et al in 2009 have concluded that the control group was as likely to have elevated levels of these gases as IBS patients. Essentially, the studies found that breath testing results were no different for people who have IBS than for people who don’t have IBS. People without digestive problems have a positive breath test just as often as people with digestive problems, meaning that breath testing doesn’t necessarily have anything to do with your symptoms.
In fact, a link between the components of your breath and the type of bacteria in your gut has never been directly proven. No one has actually measured the bacteria in the gut and compared it to the types and amount of gasses in your breath. It is based on an assumption.
However, once you have tested positive to the breath test the proponents of SIBO recommend a “special” treatment. The “special” treatment is an antibiotic known as Xifaximin or Rifaximin. These “special” antibiotics used to treat SIBO do not kill bacteria any better than the average antibiotic. The only difference between these antibiotics and other antibiotics is that these antibiotics only work in the digestive tract. They are not absorbed into the body. As mentioned above, the person responsible for all of the initial scientific studies on SIBO has a large financial interest in these antibiotics (reported here).
Please remember that all antibiotics work in the digestive tract. And it is important to note that if you have taken antibiotics while you have had IBS, regardless of the initial reason that you took antibiotics, then based on this theory you should have already treated your IBS.
In our clinic, where we examine and test for hundreds of variables, not just one (bacterial overgrowth), we find that relatively few people are suffering from a bacterial overgrowth. It is far more likely that someone with digestive problems is suffering from a food allergy, yeast infection (Candida, which can be related to the use of antibiotics), or even parasites. And there are many other conditions that can cause IBS symptoms as well.
Summarizing the SIBO approach to IBS is simple – take antibiotics. That’s what the entire program comes down to. And if the testing is negative, take antibiotics anyway, because that is still the only option. If that approach doesn’t work for you, then come see us. We’ve got a few hundred more potential solutions supported by good research.