constipation

Could SIBO or Thyroid Issues Be the Root Causes of Your Constipation?

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Do you often feel bloated, uncomfortable, and struggling with constipation? You're not alone. Millions worldwide grapple with these issues daily, often without realizing the root causes.

Constipation is a common health issue, and many people labeled with IBS (Irritable Bowel Syndrome) are told to accept this symptom as their fate. Still, constipation can be a sign of dysfunction or imbalance, and it can be disruptive and uncomfortable, affecting your overall health.

That's why I've created this essential blog post—to help you uncover the common hidden causes of constipation and take the first step towards reclaiming your health. From Small Intestinal Bacterial Overgrowth (SIBO) to thyroid issues, explore how these health conditions might be the unexpected culprits behind your discomfort.

Let's discover how to manage these conditions to relieve constipation symptoms effectively. By understanding the root causes, you can make targeted diet and lifestyle changes that provide lasting relief.

3 common causes of constipation, SIBO, hypothyroidism

What does constipation mean?

Constipation is a digestive condition characterized by infrequent bowel movements, meaning that you have three or fewer bowel movements per WEEK.

But even if you go to the toilet daily, you can still be constipated. If you strain on the toilet, have difficulty passing stools, or your stool comes out in pellets (and not smoothly and in a long shape) and is hard and lumpy, there is a high chance of being constipated.

Need help identifying your stool type? Check out the Bristol Stool Chart for more information. Types 1 - 2 indicate constipation, while type 3 is considered as tending towards constipation.

But constipation may also be accompanied by other symptoms such as abdominal discomfort, bloating, gassiness, or a feeling of incomplete evacuation. Some people may also experience reflux symptoms, as gas and bloating push up acid to the esophagus. (1)

Constipation is a common digestive problem affecting around 16% of the general population, and women are more likely to suffer from constipation than men. (2)

Constipation may be acute or chronic, lasting many months or even years.

Why should you care about constipation?

Because your bowels are designed to eliminate toxins and waste.

When you have slow transit in the intestines, toxins, and waste get stuck in your body too long, reabsorbed into the bloodstream, and waste putrefies in the colon, feeding pathogenic bacteria and fuelling inflammation. This process can put extra pressure on the liver to work hard on elimination. Consequently, you may experience additional symptoms like hormonal imbalances, skin problems (like acne), brain fog, and headaches.

3 Possible Causes of Constipation (3)

1. Poor lifestyle choices (4)

  • Dehydration: Inadequate fluid intake is one of the most common causes of constipation. When dehydrated, your body draws water from stools to maintain hydration, making them harder and more difficult to pass. Excess caffeine or alcohol intake can also lead to dehydration.
  • Lack or excess dietary fiber intake: A diet low in fiber can contribute to constipation. Fiber adds bulk to your stool, helping it move more efficiently through your digestive tract. But in some cases, eating too much raw foods, veggies, and fiber can contribute to slow digestion, especially in people with SIBO.
  • Sedentary Lifestyle: Physical inactivity can slow your digestive system, leading to constipation. Regular exercise can stimulate intestinal muscles, aiding digestion.
  • Ignoring the urge to defecate.

2. Small Intestinal Bacterial Overgrowth (SIBO):

SIBO is a condition where an excessive amount or abnormal type of bacteria are present in the small intestine, where their numbers should be relatively low compared to the large intestine. (The large intestine house the highest number of bacteria). These bacteria in the wrong place can interfere with normal digestion and absorption of food by fermenting carbohydrates and fibers and creating byproducts, like gases, leading to symptoms like:

  • changed bowel movements: constipation and/or diarrhea,
  • constant bloating, gassiness,
  • abdominal pain,
  • nausea,
  • fatigue, brain fog,
  • skin issues (acne, Rosacea),
  • joint and muscle pain, etc. (5)

 

 

One of the primary reasons revolves around the role of the Migrating Motor Complex (MMC). The MMC is a pattern of electrical activity that occurs in the smooth muscle of the gastrointestinal tract during the periods between meals. It's often referred to as the "housekeeper" of our gut because its function is to sweep residual undigested material through the digestive tract. The MMC operates in a cyclical manner, approximately every 90-120 minutes during fasting periods. (This is one of the reasons why constant snacking is a bad idea with SIBO!)

When the MMC is functioning correctly, it helps control the bacterial population in the small intestine by regularly clearing it out, pushing bacteria into the large intestine, and preventing any significant accumulation. However, certain conditions like stress, medications (especially opioids), certain diseases (like Scleroderma), or other underlying causes (>>check out the SIBO Root cause Masterclass for more information) can disrupt the MMC's functioning, leading to a slowdown or stoppage of this cleaning wave. This disruption can allow bacteria to multiply excessively in the small intestine, leading to SIBO. (6)

Once SIBO has been established, the overgrown bacteria can interfere with normal digestion and nutrient absorption. Moreover, they can produce large amounts of gas (methane, hydrogen, hydrogen sulfide) as they ferment the food that you eat.

Particularly, methane-producing archaea have been linked to constipation, defining it as Intestinal Methane Overgrowth (IMO) since they are technically not bacteria. They have been identified as Methanobrevibacter smithii in the gut and stool tests.

Methane gas can slow down the transit time, leading to constipation. It's a bit of a vicious cycle - the slower transit time allows more time for bacteria to ferment carbohydrates, leading to more methane production and further slowing down gut motility. (7)

3. Thyroid dysfunction

The thyroid gland, a small butterfly-shaped organ located in your neck, plays a pivotal role in your body's metabolic functions. It produces vital hormones – triiodothyronine (T3) and thyroxine (T4) – that regulate metabolism, influencing how your body uses energy and processes food. When the thyroid is underactive, a condition known as hypothyroidism, it can significantly affect your digestive health, particularly leading to constipation.

In individuals with hypothyroidism, the production of thyroid hormones is insufficient, resulting in a slowdown of metabolic processes, including gut motility - the speed at which food moves through the digestive tract. With reduced gut motility, the digestive tract takes longer to process and move stools, often resulting in constipation. (8)

Hypothyroidism and SIBO

The connection between hypothyroidism and SIBO comes back to the gut motility issue. The slowed gut motility in hypothyroid individuals can disrupt the functioning of the Migrating Motor Complex (MMC), the mechanism that sweeps residual undigested material and bacteria through the digestive tract.

As discussed in the previous section, proper MMC function is crucial to preventing bacterial overgrowth in the small intestine. When MMC function is compromised, as in hypothyroidism, it can result in an accumulation of bacteria in the small intestine, leading to SIBO. (9)

Thyroid, Liver Function, and Constipation

The thyroid also has a crucial connection with liver function. The liver is the primary site where T4 is converted into its active form, T3. In cases of hypothyroidism, this conversion process can be compromised, exacerbating the symptoms of low thyroid function. Furthermore, the liver plays a vital role in digestion by producing bile, which helps break down fats. If liver function is affected due to impaired thyroid activity, it can lead to constipation. (10)

Low Stomach Acid and Hypothyroidism

Another digestive issue linked to hypothyroidism is low stomach acid or hypochlorhydria. Studies estimate that around 30% of people with hypothyroidism have low stomach acid. (11) Adequate stomach acid is necessary for breaking down food, absorbing nutrients, and preventing harmful bacteria from entering the gut. (12) Individuals with hypothyroidism often produce less stomach acid, slowing digestion and contributing to constipation. (13)

Other contributing factors

The list is not complete, as there can be many different reasons (4) for being constipated. Here are some other examples:

  • Food allergy/intolerance
  • Stress, anxiety, depression
  • Dysbiosis (imbalance between the beneficial and pathogenic gut bugs in the gut), including bacterial, parasitic, and fungal overgrowth
  • Sluggish liver function
  • Heavy metal toxicity
  • Lack of stomach acid
  • Nutrient deficiencies
  • Metabolic disorders (Diabetes)
  • Structural problems
  • Side effects of medications (anti-histamines, opioids, NSAIDs, antacids, PPI's, antidepressants, etc.), overuse of laxatives
  • Neurological disorders (Parkinson's, Alzheimer's, Multiple Sclerosis, etc.)
  • History of eating disorders (Anorexia Nervosa or Bulimia)
relieve constipation naturally

How to Relieve Constipation Naturally

Understanding the potential causes of constipation can provide effective strategies for overcoming this common digestive issue.

The first step for many people leads through conventional medicine. Doctors may suggest colonoscopy or other testing options based on the symptoms and health history, but unfortunately, I commonly see that many patients end up with laxatives in their hands.

Laxatives have many forms, but they will just treat the symptom, serving as a band-aid approach rather than a long-term solution. Not to mention that laxatives may also come with side effects if used long-term. (14)

Taking a holistic approach could be a better strategy for long-term resolution. Functional Medicine and Nutrition focus on the root causes and treating the body as a whole. Specific functional testing options like gut microbiome testing, SIBO breath test, mineral testing, complete thyroid panel, hormonal testing, etc., can provide a clearer picture of the imbalances happening on a deeper level.

As we've discussed, poor lifestyle choices, Small Intestinal Bacterial Overgrowth (SIBO), and thyroid dysfunction, particularly hypothyroidism, can all contribute to constipation.

Here are some natural strategies to help manage constipation, taking into account these three primary causes:

Improve Lifestyle Choices

Dietary guidelines (15):

  • Increase Fiber Intake: Fiber adds bulk to your stools, making them easier to pass. Include fiber-rich foods such as whole grains, fruits, vegetables, and legumes in your diet. Psyllium, oat, and chia bran can also be a great addition (careful if you have SIBO!). Fiber intake should be increased gradually to at least 30 g/day for men and 25 g/day for women.
  • Decrease sugar, alcohol, and processed foods that have a negative impact on the gut microbiome
  • Bitter foods like radicchio, dandelion greens, arugula, artichokes, and endive can help stimulate digestion
  • Ginger is excellent for stimulating gastric emptying and gut motility
  • Stay hydrated: Adequate hydration can prevent stools from becoming hard and difficult to pass. Aim to drink at least 8 cups of water daily, especially if consuming more fiber. Despite drinking enough water, our cells can still be dehydrated and miss essential minerals like magnesium, potassium, sodium, etc. Adding a pinch of Celtic sea or Himalayan salt can be a great way to replenish minerals for the body.

Other lifestyle changes:

  • Regular Exercise: Physical activity stimulates your digestive system and can help maintain regular bowel movements. Even light activities like walking, yoga, or Qigong can be beneficial. (16)
  • Manage Stress: Chronic stress can exacerbate digestive and thyroid symptoms. Stress management techniques such as meditation, yoga, and deep breathing can be helpful.

Address SIBO to relieve constipation

If you suspect you have SIBO, getting a diagnosis from a healthcare provider is essential. They can order a SIBO Breath test to determine the types of SIBO and the amount of overgrowth you may have.

Addressing SIBO and restoring the normal functioning of the MMC is crucial in resolving constipation linked to this condition.

Dietary modifications, like temporarily limiting fermentable foods: certain carbohydrates, known as FODMAPs, can exacerbate SIBO symptoms. A low-FODMAP diet might be recommended for SIBO-related constipation and bloating. While the low-FODMAP diet can help MANAGE THE SYMPTOMS in the short term, it will not solve the underlying reasons that are possibly causing your SIBO! (17)

Mindful Eating is crucial for overall digestion: eating slowly and chewing your food thoroughly can improve digestion and absorption, reducing the workload on your small intestine. (There is a reason why you have teeth and saliva in your mouth.)

Since MMC is often dysfunctional, prokinetic agents (medications that help increase the motor activity of the gastrointestinal tract) and targeted antibiotic or antimicrobial therapy are common strategies used in treating SIBO. (18)

One particular probiotic strain: Lactobacillus reuteri (DSM 17938), has been shown to decrease methane production and chronic constipation significantly. (19)

Manage Thyroid Dysfunction

Proper testing for thyroid dysfunctions: If you suspect you may have thyroid dysfunction, asking for a FULL thyroid panel is essential. The full panel should include TSH, free T4, free T3, Thyroid Peroxidase Antibodies (TPO Ab), and reverse T3.

Conventional medicine typically considers the TSH level normal between the range of 0.5 - 4.5 mIU/L. However, in functional medicine, a narrower range is preferred for optimal TSH function:  1.0 - 2.5 mlU/L.

Follow a nutrient-rich diet: Certain nutrients, including iodine, selenium, magnesium, and zinc, are essential for thyroid health.

Here are some examples of foods rich in these essential minerals (20):

  • Iodine:
    • Sea vegetables like kelp, nori, and kombu
    • Fish and seafood, especially cod and shrimp
    • Dairy products like milk, cheese, and yogurt
  • Selenium:
    • Brazil nuts (they are exceptionally high in selenium)
    • Seafood, poultry, and eggs
    • Whole grains, like brown rice and oats
  • Magnesium:
    • Green leafy vegetables, whole grains (quinoa and brown rice)
    • Nuts and seeds, like almonds and flaxseeds
    • Legumes, including black beans and lentils
    • Dark chocolate
  • Zinc:
    • Meat, particularly beef, and lamb
    • Shellfish, especially oysters, are a top source of zinc
    • Legumes like chickpeas, lentils, and beans
    • Seeds, such as pumpkin seeds and sesame seeds, and nuts, including cashews and almonds

The bottom line

In conclusion, while constipation can be a disruptive and uncomfortable issue, understanding its causes can guide effective strategies to manage and overcome it. Improving lifestyle choices, addressing underlying conditions like SIBO or thyroid dysfunction, and maintaining a healthy diet can significantly improve digestive health. Your journey to improved gut health and relief from constipation starts with understanding and addressing these key factors.

 

This post is only for informational purposes and is not meant to diagnose, treat or cure any disease. I recommend consulting with your healthcare practitioner always before trying any treatment or dietary changes.

Could SIBO or Thyroid Issues Be the Root Causes of Your Constipation? Read More »

SIBO and Thyroid dysfunctions

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Gut SIBO thyroid dysfunctions hypothyroidismAre you suffering from symptoms such as fatigue, brain fog, mood swings, dry skin, slow bowel movement, and even weight gain? These could also be a sign of thyroid dysfunction. (1, 2, 3, 4, 5, 6) Your thyroid is responsible for controlling your metabolic processes. If it is under-functioning (in the case of hypothyroidism), it pushes the brake pedal and slows down the body's metabolic processes. In the case of hyperthyroidism, it pushes the gas pedal and makes the process run faster.

Even though you may have thyroid dysfunction, your thyroid-like symptoms can actually stem from your gut. On the other hand, low functioning thyroid could also be a risk factor for Small Intestinal Bacterial Overgrowth (SIBO). It means that SIBO can lead to a hypothyroidism state, but hypothyroidism can also result in bacterial overgrowth.

The gut-thyroid connection

Some studies have found that thyroid symptoms improved after treating the gut. These gut issues can come from Helicobacter pylori (7,8), parasites (9), fungal infection (Candida) (10), SIBO (11), or food intolerances (12), etc.

Studies estimate that around 30% of people with hypothyroidism have low stomach acid (13). Stomach acid is essential to kill pathogens and prevent the overgrowth of bacteria. If this protective mechanism fails, then it can easily lead to SIBO. (14) This is why using stomach acid blockers (Proton-pump inhibitors) unnecessarily can be problematic and may also lead to SIBO. Here you can read more about the types of SIBO.

The other reason is that overgrowth of bad bacteria can lead to issues with the conversion of thyroid hormones, namely T4 (inactive form) to T3 (active form). (15) Much of the thyroid hormone is released by the thyroid gland in the inactive type known as T4 (thyroxine), but it must be converted to an active form known as T3 (triiodothyronine) for the cells to use it. (16) Around 20% of T4 can be converted to T3 in the gut by good gut bacteria.

But most of the conversion is done by the liver, which can also be sluggish for many reasons. A sluggish liver and gallbladder cannot remove hormones efficiently, such as estrogen. Elevated estrogen levels can also negatively influence the conversion rate of thyroid hormones. (17)

The other issue can be when T4 converts to reverse T3 (rT3), the inactive form. A higher level of reverse T3 can be produced if someone went through a major life event, a trauma (emotional or physical stress like a surgery), or having chronic stress (illness, inflammation). (18,19) In some cases, other factors such as diet, not just a diet high in sugars and processed foods, but also a ketogenic or very low carb diet, can cause elevated levels of rT3. (20, 21)

So making sure that you have a well-functioning gut and liver, the gallbladder is vital to ensure proper conversion of thyroid hormones.

The immune system-thyroid connection

There are 70% of the body's immune cells located in the gut. The immune response in this part of the body is called GALT, or gut-associated lymphoid tissue. The GALT contains several forms of immune cells, such as T and B cells, that detect and respond to antigens as potential threats that trigger immune system reactions.

Problems arise when any one of these intestinal barriers is weakened. When the small intestine's tight junctions loosen (in case of "leaky gut syndrome"), undigested food particles, microorganisms, toxins, or larger proteins enter the bloodstream. The immune system sees these particles as unwanted intruders and starts an inflammation process to rid of them. Leaky gut can be one of the underlying causes of autoimmune diseases, such as Hashimoto-Thyroiditis, an autoimmune form of hypothyroidism. If you have a leaky gut, the immune system can keep attacking the thyroid and cause continued problems. (22, 23)

What might help to support your body?

Focusing on gut health is an essential part of any treatment process as it is also connected to your immune system and thyroid autoimmunity, and thyroid functions. But concentrating on the thyroid function is also crucial.

If you are experiencing symptoms of thyroid dysfunction and SIBO, you can do the following steps:

  1. Do the necessary testing to find out what the issue is behind your symptoms: ask for a SIBO breath test and a full thyroid panel from your Practitioner
  2. Taking thyroid medication may help with motility and considering eliminating SIBO or other infections if present
  3. Choose a customized diet that eliminates inflammatory foods such as sugar, processed foods, gluten, refined carbohydrates, refined oils, artificial sweeteners, etc.
  4. Eat a whole food diet – including organic meats, vegetables, fruits, nuts, seeds based on your tolerance
  5. Apply lifestyle changes that help you manage your daily stress
  6. Take intestinal lining healing nutrients, boost motility

 

 

*This post is only for informational purposes; and not meant to diagnose, or treat any disease. I advise consulting with your healthcare practitioner regarding any treatment options or dietary changes.

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10 alarming SIBO symptoms (and not just IBS)

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SIBO Symptoms

SIBO symptoms?

You cannot fit into your jeans anymore because you feel so bloated? You wake up with a flat belly in the morning, and in the evening, you look like six months pregnant? These may sound a bit extreme, but they are not exceptional cases. Many clients experience constant gas or bloating, and some of them already have the popular diagnosis of IBS.

I want to emphasize that bloating is not normal, especially when it happens constantly. It is always a sign of gut inflammation and irritation and is one of the leading SIBO symptoms.

What is SIBO?

SIBO stands for Small Intestinal Bacterial Overgrowth. It means an increase in the number of bacteria and/or changes in the types of bacteria present in the small intestine. SIBO symptoms and SIBO are commonly caused by an overgrowth of various bacteria that should generally be found in the large intestine. (1)

Classic SIBO symptoms are similar to IBS symptoms (Irritable Bowel Syndrome). These include abdominal pain, discomfort, cramping, gas, bloating, reflux, diarrhea, and/or constipation.

According to studies, 84 % of IBS cases are caused by SIBO. (2)

 

10 typical SIBO symptoms:

  1. You have constant bloating and gas – you may have difficulty figuring out which foods cause flatulence because you are bloated all the time, or bloating just increases as the day goes on.
  2. You have persistent diarrhea or constipation – hydrogen-dominant SIBO usually causes diarrhea, while "methane-dominant SIBO" (or precisely IMO- Intestinal Methanogen Overgrowth) mostly causes constipation, but this is also not always true! Mixed types are also common. (3)
  3. Your symptoms get worse when you eat fiber – You may have heard that the daily value for fiber is around 25 grams per day on a 2,000-calorie diet for adults (4). You still try to complete this challenge, but your symptoms have gotten worse. In that case, SIBO can be the culprit. Typically, a healthy gut needs fiber to feed the good bacteria and support normal function. However, your symptoms get worse if you feed the overpopulated bacteria. 
  4. You have several food intolerances, such as gluten, lactose, fructose, and histamine intolerance. – You lack enzymes, which are needed to break down certain foods, triggering a digestive response. (5)(6)
  5. You are already diagnosed with IBS – the majority of IBS patients have SIBO symptoms – you should not be satisfied with the IBS diagnosis; dig deeper!
  6. You feel worse after eating – You get full quickly after eating a normal-sized meal, which can happen when you have low stomach acid. (7) Slow stomach emptying when the food stays in your stomach for long hours, causing nausea, can contribute to SIBO. Damage to the migrating motor complex (MMC), which is usually responsible for sweeping food and bacteria through the digestive tract and gets activated when you don’t eat, is one of the most common underlying causes of SIBO. (8)
  7. You don’t do well with probiotics—do you get abdominal pain and cramping after eating fermented foods such as kefir, sauerkraut, and kimchi? Maybe you tried random multi-strain probiotics that just made everything worse. These could also be a sign of SIBO. 
  8. You have chronic illnesses such as chronic fatigue syndrome and autoimmune diseases - Leaky gut can also be a culprit if your gut remains “leaky,” and food particles, among others, can get into your bloodstream. These will activate your immune system, which will begin attacking foreign invaders, triggering inflammation. A long-term defense can lead to damage to your organs and food intolerances, as these foreign invaders may look similar to your own body’s cells, and the immune system gets confused, overloaded, and starts attacking your tissues. (9)
  9. You suffer from skin rashes and rosacea – an impaired gut (SIBO symptoms) can also cause skin problems.
  10. You have malabsorption issues, such as fat (which can also cause floating stools) and/or vitamin and mineral deficiencies, especially fat-soluble vitamins (D, E, K, A).

You can read more about SIBO symptoms and the SIBO testing options in my previous blog post.

 

This post is only for informational purposes and is not meant to diagnose, treat, or cure any disease. I recommend always consulting with your healthcare practitioner before trying any treatment or dietary changes.

10 alarming SIBO symptoms (and not just IBS) Read More »

Consider SIBO testing if you suffer from constant bloating

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SIBO testing

What is SIBO & SIBO testing?

First of all, what is SIBO? SIBO stands for Small Intestinal Bacterial Overgrowth. It is defined as the presence of excessive bacteria in the small intestine. The problem is that there are too much bacteria and/or the wrong type of bacteria present in the wrong place.

Symptoms can be excess/trapped gas, bloating, diarrhea and/or constipation, abdominal pain or cramping, food sensitivities, chronic fatigue, brain fog, and the list goes on. (1)(2)

Before getting tested

Before getting to SIBO testing, many people try different methods to relieve their symptoms. These approaches may include lifestyle changes (e.g., reducing sugar/junk and processed food consumption; stress; getting more sleep) or eating more fiber, prebiotic foods, and herbs. However, if these changes don’t bring the expected results or make the current symptoms worsen, then it might be time to visit the GI doctor to have some tests.

Although having the symptoms mentioned above doesn’t mean that you have 100% SIBO. It is crucial to rule out other diseases (like endometriosis, Crohn’s/ Colitis) and get a proper diagnosis by your healthcare practitioner. There can be many different diseases, which could cause the same symptoms.

Suppose you have already been diagnosed with IBS (Irritable Bowel Syndrome). In that case, it is definitely worth getting SIBO testing because, according to a study, up to 84% of patients with IBS actually have SIBO. (3)

It may also happen that a person thought SIBO was causing the symptoms, but then the culprit turned out to be Celiac disease. (4) If you start using an antimicrobial treatment for assumed SIBO without any proper diagnoses, then it may cause more harm than good. So testing is essential, which can help define the treatment plan.

SIBO testing method #1: SIBO breath test

The three-hour lactulose or glucose breath test is generally used for diagnosing SIBO, which detects the different types of gases that bacteria produce in the small intestine. It checks for hydrogen and methane gas. (5) There is now a new test available in the US: the TrioSmart test that can detect the third type of gas: hydrogen sulfide. (6) I wrote about the different types of SIBO.

The bacteria in our intestines ferment specific carbohydrates, and they produce gases as a byproduct. The breath test involves drinking a sugar solution (lactulose or glucose, a type of carbohydrate) that feeds the bacteria in the gut, and they start making gases. Then these gases are absorbed in the intestines and get into our blood, from where the gases are delivered to our lungs and exhaled in our breath. That is what the breath test intended to capture.

The breath test is done for 3 hours, while breath samples are taken at 20-minute intervals. The first two hours represent the small intestine, and the last hour is usually the large intestine. Measuring the level of those gases is also important to determine how severe the bacterial overgrowth is and what treatment would suit the best.
Be aware that a prep diet is required to be followed before SIBO testing. It involves following a low-fiber diet and fasting for 14 hours. (When you order a test, you should receive instruction on the prep diet). (7)

A hydrogen breath test is also used for testing carbohydrate malabsorption issues when dietary sugars are not absorbed well, such as lactose (sugar in milk), fructose (sugar in fruit), sorbitol, and sucrose. (8)

 

Can you trust the SIBO breath tests?

While the breath test is considered the most practical SIBO testing method, it certainly has its limitations.
A meta-analysis of the breath test accuracy showed that lactulose substrate might provide a higher number of false-positive results than the glucose test. Glucose breath test seems to work better than lactulose breath test for diagnosing SIBO. It seems glucose testing has better sensitivity and specificity. (9) (10) In this case, clinicians may need to evaluate the results more carefully before giving out a diagnosis, and it would be worth doing a test for both types of substrates.

Other problems can be:
• the missing consensus on the interpretation of breath test results
• Individual’s motility can influence the test results – transit time may differ from person to person (11)

Other types of tests

If you have IBS-D or IBS-M/SIBO-D, you experience mainly diarrhea symptoms; then an IBS-SMART test is available to diagnose post-infectious IBS (PI-IBS). It is a blood test that looks for the markers of food poisoning (one of the leading causes of SIBO), which is the result of auto-antibodies forming in a lot of people and starting an auto-immune process. The antibodies measured in the blood are anti-CdtB toxin and anti-vinculin. These antibodies can attack the nerves of the gut and impair the cleaning wave, the Migrating Motor Complex. (12)(13)

What tests are not suitable to diagnose SIBO?

  • Stool tests because the results represent mainly the end of the large intestine, although they might indicate some issues in the small intestine but cannot diagnose SIBO. Overgrowth of bacteria in a stool can show dysbiosis.
  • Organic Acid Tests (OAT) check the urine for byproducts of yeast or bacteria in the small intestine, which can be very useful but cannot tell whether your SIBO is hydrogen/ hydrogen-sulfide or methane-dominant. (14)

Conclusions

Using SIBO testing (a breath test) has its advantages and disadvantages, but it can still be the most practical approach to diagnosing SIBO. Metanalysis showed that a glucose breath test might provide a more accurate diagnosis than a lactulose breath test. Having a SIBO diagnosis can be crucial as it can define the best treatment options (each type of gas requires different strategies).

Bear in mind that diagnosing SIBO might be just the first step because it will not tell you what caused SIBO in the first place. However, finding the underlying cause is crucial to prevent relapsing.

If you have questions regarding SIBO or need help finding out your root cause and support on your healing journey, then feel free to book a free consultation call!

 

 

* This post is only for informational purposes and not meant to diagnose or treat any disease.  I advise consulting with your healthcare practitioner regarding any treatment options or dietary changes.

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