Dr. Paul Deglmann
Meghan Feir Walker
Throughout America, gut health problems are running rampant, and SIBO and IBS are two of the most common gut conditions people are suffering from. But what differentiates SIBO vs. IBS and other gut problems? In this article, we’ll delve into what SIBO and IBS are, their symptoms, potential causes, how to know if you have either, and how you can address these two issues effectively.
What are SIBO and IBS?
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 travel up into the small intestine.
The bacteria then begin to feed on the food in our small intestine, creating a fermentation process that can lead to significant symptoms.
What is IBS?
IBS stands for irritable bowel syndrome, which is a condition considered to be a functional bowel disorder in standard medicine. This simply means there is abnormal functioning of the GI tract, but all results of the standard GI tests conducted come back “normal.” These tests may include CT scans, ultrasounds, colonoscopies, endoscopies, blood tests, etc. In other words, “Your bowels are irritated and you have symptoms, but we don’t know why.”
Symptoms of SIBO vs. IBS
While there are many overlapping symptoms between SIBO and IBS, such as bloating, abdominal discomfort, bowel changes, and others, there are some distinctions that set SIBO apart from the catch-all digestive distress of IBS.
Main symptoms of SIBO
- Gas/bloating, especially after eating
- Constipation or diarrhea
- Acid reflux/heartburn/GERD
- Nausea
- Abdominal pain and/or cramping
- Food sensitivities
- Irritable bowel syndrome (IBS)
- And more
Main symptoms of IBS
- Abdominal pain
- Gas/bloating
- Constipation (IBS-C)
- Diarrhea (IBS-D)
- Mixed (IBS-M)
- Combination (IBS-C)
What causes SIBO and IBS?
SIBO and IBS are both gut conditions, but are their causes similar as well?
Causes of IBS
In traditional Western medicine, IBS is considered to be an idiopathic condition, meaning they don’t know why it occurs.
However, in functional medicine, where discovering the root cause is imperative to successfully treating patients, some causes of IBS have been identified, which has helped thousands of patients experience relief.
In functional medicine, we believe there is a combination of causes contributing to IBS, depending on the individual. We find that food allergies/food sensitivities, imbalance or dysbiosis of the microbiome from bacterial overgrowth, yeast/candida/fungal overgrowth, parasitic overgrowth, lack of beneficial bacteria, low stomach acid, low digestive enzyme output, poor gallbladder function, chronic infections, toxicity, stress, having a dysfunctional brain-gut axis, and other factors can potentially contribute to IBS.
Causes of SIBO
Typically, the main causes of SIBO include:
- Low stomach acid
- Medications such as antibiotics
- Alcohol consumption
- Chronic stress
- Consuming a highly processed/inflammatory diet
- History of GI surgery
- Suppressed immune system
- Slow motility issues
Along with SIBO, additional factors may be present that can contribute to symptoms, including food sensitivities, lack of beneficial bacteria, yeast/candida overgrowth, parasite overgrowth, low stomach acid (as mentioned above), low digestive enzyme output, poor gallbladder function, and other issues.
How SIBO and IBS are identified
When it comes to testing for SIBO, there are two tests that may be used.
Aspirate and culture test
The gold standard test for diagnosing SIBO is called the aspirate and culture test.
During this test, a sample of fluid is taken directly from the small intestine (usually the jejunum) via endoscopy and cultured to quantify bacterial growth. It’s considered the gold standard for SIBO testing because it provides a direct measurement of bacterial load in the small intestine.
However, this test is invasive, expensive, and not widely available, so it’s not commonly used in clinical practice.
SIBO breath test
The most common test used to diagnose SIBO is the breath test. This breath test measures hydrogen, methane, and sometimes hydrogen sulfide gas levels from the breath at different time intervals after drinking a sugar solution.
Unfortunately, this test is only considered to be moderately accurate and reliable.
Functional medicine tests
While many functional medicine practitioners do use the breath test to help in the diagnosis of SIBO, there are also other testing methods that can help identify whether SIBO is present or not.
At RHS, we like using tests, such as an organic acids test (OAT), to check the levels of bacteria and other microorganisms in the microbiome. This test, paired with the patient’s symptoms, can often give us an accurate picture of what’s happening in their gut.
There are currently no tests for IBS
Because IBS is more of a catch-all, we-don’t-know diagnosis, there aren’t any tests used to diagnose it. IBS is diagnosed based on the patient’s symptoms and history, and after other conditions are ruled out. Some of the conditions often tested for before an IBS diagnosis is given include Celiac disease and inflammatory bowel diseases, like Crohn’s disease and ulcerative colitis. If these tests are all negative and the patient has IBS-like symptoms, an IBS diagnosis may be given. IBS is known to be a diagnosis of exclusion.
SIBO vs. IBS: How are they addressed?
As with most conditions, functional medicine takes a different approach toward helping patients recover from gut health issues than standard Western medicine often does.
How SIBO is addressed
In Western medicine, SIBO is typically treated with antibiotics and a low-FODMAP diet.
In functional medicine, along with a treatment plan that includes a low-FODMAP diet or low-fermentation diet for a time, our main goal is to figure out why someone developed SIBO in the first place. This is why individualized testing, incorporating specific dietary plans, removing food triggers, encouraging patients to eat whole, organic, nutrient-dense foods, and correcting any imbalances within the microbiome (by using herbs and natural supplements) are almost always part of a functional medicine protocol.
We also support digestion, if needed. This may be due to low stomach acid production, low digestive enzyme output, or poor gallbladder function/bile flow. We also need to ensure motility is optimal because slow motility can lead to SIBO. In some cases, there are other factors to consider as well, such as toxicity and nutritional deficiencies.
How IBS is addressed
In traditional medicine, IBS is typically treated with antidiarrheals for IBS-D, laxatives for IBS-C, sometimes anti-spasmodic medications, cognitive behavioral therapy (CBT), and other methods.
In functional medicine, we want to know why the bowels are irritated.
As in the case of SIBO, for IBS, we will specifically look at the diet, remove dietary triggers and inflammatory foods, encourage eating whole, organic, nutrient-dense foods while balancing out the microbiome, optimizing motility, and using good stress-management strategies.
It’s also important to support the adrenals through diet, lifestyle, and nutritional supplementation since stress can be a trigger for some people with IBS-like symptoms.
There are other factors that may need to be considered in some cases as well, such as toxicity and nutritional deficiencies.
Key differences between SIBO and IBS
SIBO vs. IBS: What they are
SIBO
- SIBO describes an overgrowth of bacteria in the small intestine, where they should normally be low in number.
IBS
- IBS is a functional GI disorder involving chronic abdominal symptoms without clear structural or biochemical abnormalities.
Symptoms
Both conditions are similar and often have overlapping symptoms. While SIBO can cause diarrhea and constipation, the main way to categorize IBS is by the type of bowel movements the patient is struggling with, whether that’s constipation, diarrhea, a mix of both, or an alternating issue between the two.
Causes
SIBO
- SIBO can have many causes, but it occurs because of bacterial overgrowth in the small intestine. This can happen because of poor motility, adhesions, low stomach acid, a history of antibiotic use, anatomical issues, and many other reasons.
IBS
- IBS is typically caused by many factors combined and can be a symptomatic response to food sensitivities, dysbiosis in the gut microbiome (overgrowth of yeast/candida, bacteria, parasites, and/or low beneficial bacteria), altered motility, brain-gut dysregulation, stress, post-infection changes, and/or other issues.
Testing approaches
SIBO
- Aspirate and culture test
- Breath test
- Checking levels of bacteria and other aspects of the microbiome through a stool test
IBS
- There are no specific tests for IBS.
- It may be diagnosed after other tests come back negative
- It can often be alleviated or minimized by addressing other issues in the body
When to seek help
In order to heal, you have to understand the specifics of what your body is facing. Everyone is dealing with a unique set of circumstances, genetic makeup, and other particulars that influence gut health. Finding a functional health practitioner who is willing to delve into your specific symptoms, history, lifestyle factors, and other conditions is such an instrumental part of the healing process.
Whether you’ve had chronic gut health issues for months or years, if you’re still struggling and don’t know why, or you know why and just can’t seem to find the right solutions, using our “Test, don’t guess” approach can help you discover what you’re dealing with and how you can start feeling better.
At RHS, we offer a free, 15-minute phone consultation to see if we’re a good fit for your situation. From there, we conduct an initial functional medicine consultation to thoroughly go through your history and decide what testing may be best for your unique situation.
In our clinic, we often test our patients in several categories when investigating the root cause(s) of gut health issues. Some of these test categories may include:
- Food
- Genetic testing for gluten sensitivity
- Food allergy testing
- Food sensitivity testing
- Microbiome Imbalance/Infections
- Stool
- Organic acid test (OAT)
- Toxicity
- Mold/mycotoxin testing
- Heavy metal testing
- Environmental toxins testing
- Nutritional deficiencies
- Intracellular micronutrient testing
- Stress/cortisol/adrenals
- Adrenal/cortisol testing
- Hormonal imbalance
- Anemia
- Blood sugar imbalance
No matter what gut-related condition you’re experiencing, your lifestyle choices will always either help or harm your health progress. From the foods you eat to the level of stress you encounter each day, small choices make a huge impact on your overall gut health.
Next steps to take when dealing with SIBO or IBS
Whether you’re dealing with SIBO, told you have IBS, or have another gut-related condition, understanding what you’re facing and the root cause(s) is imperative to your healing. By learning more about your conditions and the reasons they developed, you can take proactive steps toward enhancing your digestive health, whole-body health, and overall quality of life.
Are you ready to learn more about your gut health and how to improve your digestive health? Read more on our blog about gut health, or schedule your free 15-minute consultation with Dr. Paul to explore a personalized approach for a helpful and effective path to recovery.
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