Dr. Paul Deglmann
Meghan Feir Walker
SIBO. It’s been a hot topic over the last few years, but why? And why is SIBO testing so important?
It’s estimated that 10-15% of adults in the United States have irritable bowel syndrome (IBS), affecting around 25-45 million people. However, the numbers are likely much greater because many people go undiagnosed. When you consider that some studies estimate up to 78% of those with IBS also deal with small intestinal bacterial overgrowth (SIBO), you can see why accurate SIBO testing and helpful protocols are important topics to address.
Before diving into the ins and outs of testing, let’s briefly go over what SIBO is.
What is SIBO?
Small intestinal bacterial overgrowth (SIBO) is a condition that occurs when bacteria that are supposed to stay in the large intestine/colon begin to travel up into the small intestine.
This bacteria then begins to feed on the food in our small intestine, creating a fermentation process that can lead to significant symptoms.
SIBO symptoms:
- Bloating/gas (especially after eating)
- Abdominal pain
- Constipation
- Diarrhea
- Heartburn
- Indigestion
- Nausea
- Fatigue
- Brain fog
- Malnutrition
- Sense of fullness after eating
- And More
The importance of accurate SIBO testing
As with any disease or infection, you need to know exactly what you’re fighting. If you’re just guessing, there’s a high chance your treatment will miss the mark, potentially even causing additional problems.
SIBO symptoms often overlap with other gastrointestinal issues, making it possible to misdiagnose someone with SIBO or miss the presence of SIBO altogether.
As always, we encourage all our patients to test and not guess. Guessing and throwing supplements or antibiotics at a mystery condition has a high failure rate. But how can you know which test is the most accurate?
Overview of SIBO testing methods
The most common tests: Hydrogen, methane, and hydrogen sulfide breath tests
Hydrogen, methane, and hydrogen sulfide breath tests are non-invasive tests where you drink a sugar solution (either lactulose or glucose) and provide breath samples every 15-20 minutes for 2-3 hours.
- The test measures hydrogen (H₂), methane (CH₄), and sometimes hydrogen sulfide (H₂S) gases in your breath.
- These gases are produced when bacteria ferment carbohydrates in the small intestine, are absorbed into the blood, and are exhaled through the lungs.
The SIBO breath test is only considered a “moderately accurate test” due to false-positive and false-negative test results. The upside is that the test is non-invasive and is relatively inexpensive.
One downside of this test is that rapidly drinking the glucose mixture is unenjoyable and can mess with blood sugar levels, especially for those with reactive hypoglycemia.
Another concern about relying solely on a SIBO breath test is that several other issues can cause the same or very similar symptoms, such as:
- Yeast/fungal overgrowth
- Parasites
- Food sensitivities
- Low stomach acid
- Low digestive enzyme production
- Poor gallbladder function
- More
Small intestine aspirate and culture
The gold standard test for diagnosing SIBO is the aspirate and culture test. In this test, a sample of fluid is taken directly from the small intestine (usually the jejunum) via endoscopy and cultured to quantify bacterial growth. This test is considered the most accurate because it provides a direct measurement of bacterial load in the small intestine.
However, since this test is invasive, expensive, and not widely available, it is not commonly used in clinical practice.
Can I test myself for SIBO?
While there are now at-home breath test kits that provide convenience for patients, the accuracy may be questionable. You need to make sure these tests are done correctly to provide as accurate results as possible. You will also still need help from a doctor to interpret the results.
What does SIBO stool look like?
Almost everyone with SIBO can attest to having issues with their bowels, whether they’re regularly having diarrhea, constipation, or a combination of the two problems.
It’s common for those with SIBO to see floating stools due to issues digesting and absorbing fats in the diet. Fat is buoyant, so the stools will typically float.
Foul-smelling stools due to bacterial overgrowth, the presence of mucus in the stools, and other issues are also common experiences.
In hydrogen-dominant SIBO, diarrhea and loose stools are most common.
In methane-dominant SIBO or IMO SIBO, constipation is most common along with slow transit time. With constipation, the stool is typically dry and hard, and due to the dehydration in the stool, it often resembles small rocks.
Stool analysis, in conjunction with other diagnostic methods, can help you identify some of your issues.
SIBO treatment and testing
At RHS, we take a functional medicine approach toward SIBO. Along with testing, we look at your history, symptoms, and other factors that point toward accurate diagnoses.
If you’re interested in discovering whether you are dealing with SIBO or another digestive disorder, you can start by giving our office a call and setting up your free 15-minute consultation.
Whether it’s at our clinic or somewhere else, please consult with a healthcare professional to come up with a personalized plan.
RHS view on the breath test
The breath test is the most common test used for diagnosing SIBO. However, we believe this test is limited because it solely focuses on bacterial overgrowth in the small intestine. The only information you get is the levels of hydrogen, methane, and sometimes hydrogen sulfide gas production through the breath. But there are so many other factors to consider beyond testing those levels.
Due to the overlap in symptoms with so many other potential causes, we prefer getting more information and taking a much deeper look by doing the following tests:
- Food testing (genetic testing for gluten sensitivity predisposition), food allergy, and food sensitivity testing
- Stool/microbiome and organic acids testing (OAT) to get a much more detailed picture of the health of the microbiome
- Cortisol/adrenal/hormone panels
- Nutritional deficiencies/micronutrient test
We also look at various factors that can influence gut health, such as food sensitivities, allergies, intolerances, microbiome health, cortisol/adrenal panels, hormone panels, nutritional deficiencies testing, and more.
At RHS, we want to figure out why someone got SIBO in the first place. It is extremely common to have persistent SIBO, recurring SIBO, or difficult SIBO cases, but why? This is where thorough testing and a detailed patient history are commonly needed to help answer questions.
Remember, “Test, don’t guess!”
As always, consult with your healthcare or functional medicine practitioner to find out what approach and testing are right for you.
Schedule your free 15-minute consultation
At RHS, we offer a personalized approach for a helpful and effective path to healing. If you’re ready to learn more about your gut health, how to discover and overcome SIBO, and the RHS approach, schedule your free 15-minute consultation with Dr. Paul. After running through your health history and symptoms, we test and look at your test results before making a specific protocol with specific dietary and lifestyle recommendations.
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