Bloating after eating isn’t normal. In fact, it is your body signalling that an overgrowth of bacteria and inflammation is present in your digestive tract. Often this is caused by food intolerances, which can be determined by specialised testing and/or an elimination diet. Sometimes though there is more to it. This is especially if you’re one of those people that wakes up with a flat belly only to end the day looking pregnant. If this does sound like you, you might want to get tested for SIBO.
SIBO stands for….?
SIBO stands for Small Intestinal Bacterial Overgrowth. As the name suggests, it occurs when an overgrowth of both good and bad bacteria occurs in the small intestine (in healthy guts the large intestine has around 10-100 billion bacteria organisms per teaspoon of fluid, and the small intestine only has around 100 thousand organisms).
You may be wondering by now what causes this to happen? Science says the SIBO may be triggered by:
- Chronic stress, which decreases the output of HCL (normal acid levels are needed to kill bacteria)
- Gastroenteritis, with SIBO developing after bouts of food poisoning or a h. Pylori infection (common with stomach ulcers).
- Adhesions: endometriosis, appendix, etc.
- Diabetic enteropathy.
- Irritation of the gut nerves, which then alters the way the gut moves (motility) to excrete waste material.
- Overconsumption of carbohydrates.
- Altered anatomy: malformation of the ileocecal valve, surgical intervention causing scarring and adhesions altering the normal anatomy of the small intestines.
- Medications such as narcotics, proton pump inhibitors (Nexium is a popular one often prescribed for reflux), morphine, opiates, calcium channel blockers and beta blockers.
- Initial colonisation of bad bacteria: caesarean birth, no breast-feeding.
Just to confuse things more, SIBO and IBS share a lot of common symptoms
- Alternating Diarrhea/ constipation
- Belching/ burping
So how do you know if you have SIBO or IBS? Apart from specialised testing (see below), here are some big red flags for SIBO:
- The bloating comes directly after eating meals.
- Your symptoms (above) suddenly started after a bout of gastro. For e.g., I commonly hear clients describe to me that they went overseas, got food poisoning and their guts have never been the same since.
- You blow up with gas and get to look pregnant after meals. This is particularly after eating starches, fibre and FODMAP foods, which with SIBO ferment in the small intestine, creating methane, hydrogen and hydrogen sulfide gas.
- You particularly can no longer digest garlic and onions.
- Fermented foods you thought were good for your digestion (such as yogurt, fermented vegetables [like sauerkraut], kefir, kombuchas, etc) bloat you straight away.
- Probiotic supplements may actually aggravate you symptoms rather than ease them.
- When you go to the toilet, your poo often sticks to the toilet bowl (this is called steatorrhea, which means fatty stool).
- You are anemic despite eating plenty of iron-rich foods and taking an Iron supplement.
- You are Vitamin D deficient despite getting plenty of sun, eating animal products and taking a Vitamin D supplement.
- You experience unexplainable joint pain and skin rashes.
Testing for SIBO
The gold standard for SIBO testing is the Hydrogen Breath test. Back in the day if you were a Sydney-sider you had to fly to Melbourne to do it. Now it is available to do in the comfort of your own home under the supervision of a qualified practitioner. For more information, please check out sibotest.com. There is a great little video on the homepage too which is definitely worth a watch.
NB: As SIBO often starts from a bout of gastroenteritis, it is wise to also test the stool for underlying parasites that may be hiding in the large intestine. If they are present they need to be treated concurrently.
Treating SIBO and banishing the bloat for good
Treating SIBO is a six to twelve week process that involves starving the bugs with a semi restricted diet, and killing them off with specialized herbs and nutritional supplements. It also involves removing other factors that could be worsening symptoms, such as stress and certain medications (as per above). Twelve weeks might sound like a long time to go off certains favourite foods, but not looking pregnant after every meal is most definitely worth it.
NB: Approximately 30% of SIBO patients do not respond to herbal medicine requiring specialised antibiotics such as rifaxamin.