by Dr. Rhea “Doc Rabbit” Abbott

shutterstock_315152636Let’s talk a minute about everyone’s favorite topic: bowel dysfunction.

There are hundreds of things that can cause constipation or diarrhea, but if all the usual suspects (giardia, food poisoning, celiac, hypothyroidism, etc) have been ruled out, some docs are stumped and just call it IBS (irritable bowel syndrome).

If you’ve been told you have IBS and then sent on your way without further investigation, your doctor has let you down.

A diagnosis of IBS is like a diagnosis of “sore throat” – it’s just the name of a symptom, not the cause of your troubles. Understanding why you have IBS is key to curing you, but getting to the root of the problem can be tricky if you’ve already determined it isn’t caused by the most likely suspects. So, when we know there are no horses around, it’s time to put on your safari hat and start looking for zebras.

digestive systemRecently there have been awesome advances in our understanding of the gut ecosystem, including a condition called SIBO (small intestinal bacterial overgrowth). You probably know that your colon is filled with beneficial bacteria, but the small intestine is only supposed to have a small amount of two kinds of bacteria. When non-native species take up residence here, or when the locals get out of hand, you’ve got SIBO. It’s important to note that SIBO is an imbalance – too much of a good thing!

Now, I know what you’re thinking. Doc Rabbit, isn’t SIBO just naming the symptom rather than the cause, just like IBS? After all, what’s the cause of the overgrowth? And you’re right! Excellent critical thinking. We don’t know everything there is to know about SIBO yet, but we’re learning more every day and here is the theory in a nutshell:


Guts are messy places. Our digestive tracks try to keep things tidy using something called a “cleansing wave”. 1-2 hours after eating, contractions start at the stomach and sweep down the GI tract, moving any undigested debris or unwelcome bacteria toward the exit. The cleansing wave is absent or disordered when the nerves that make it happen are damaged, or when we prevent the wave by grazing all day rather than fasting between meals.  Without the wave, the wrong bacteria may find themselves in the small intestine long enough to start reproducing. They change the pH and start making waste products that are responsible for our symptoms.


By definition, SIBO is either too many bacteria, or the wrong kind, so our immune system gets involved in an attempt to correct the situation. That means in addition to bacterial by-products causing problems,   intestinal inflammation is wreaking havoc too. Because SIBO is classified as a cause of IBS, the most famous symptoms are diarrhea, constipation, or both. But ailments can also include poor digestion and absorption, flatulence, abdominal pain, obesity, fatigue, joint pain, brain fog, muscle pain, and bloating/distention that is worse after meals and better in the morning. Notice that many of these symptoms are not digestive in nature, even though they’re caused by intestinal bacteria!

Conditions that can be associated with SIBO include Crohn’s, ulcerative colitis, fibromyalgia, Type 2 diabetes, chronic fatigue syndrome, restless leg syndrome, prostatitis, interstitial cystitis, Lyme disease, rosacea , endometriosis,  and non-alcoholic fatty liver. Chronic use of PPIs (proton pump inhibitors like Prilosec, Prevacid, and Omeprazole), low stomach acid, and use of opioids (Vicodin, Oxycodone, Codeine) increase your risk of developing SIBO.


Determining whether you have SIBO can be a challenge. Getting the most direct answer involves inserting a needle into the small intestine through the abdomen to collect bacterial samples and a biopsy of the intestinal lining. Painful, invasive, and expensive! A much better way is through a breath test. Sounds gentle and easy, right? It is! The bacteria in question like a particular kind of sugar, and give off a particular kind of gas when they eat it. If you drink this medically-prepared sugar solution, wait a bit, then measure the gas produced, you can get a good idea of which bacteria are in there, and how many. It’s a little like determining the size of a city and how many cars it has by measuring air pollution. Not as exact as a biopsy, but certainly enough to get us the information we need to move forward.


fish dinner, fats, purchasesThe cause of SIBO usually involves many factors, and no two patients have the same factors out of whack in the same way. That makes treating SIBO a delicate (and usually lengthy) process because it needs to be tailored to you. 44% of SIBO patients who are treated with conventional pharmaceuticals alone will have a relapse of their infection;  this is why we must get many different therapies on-board: pharmaceuticals, herbs, hydrotherapy, dietary changes, probiotics, establishing healthy eating patterns, managing stress, and facilitating movement (both internal and external). It’s intense, but it dramatically increases cure rate without relapse. (It is also important to acknowledge that there are Chinese and Ayurvedic  approaches to treatment, though these are beyond my scope of practice.)

So don’t let a diagnosis of IBS be the end of the discussion! Ask “why IBS?” and team up with the knowledgeable doctors at AIM to get to the bottom of your… “bottom” problems!