SIBO, or Small Intestinal Bacterial Overgrowth, refers to an excessive proliferation of bacteria in the small intestine. It is a disease that has only recently been registered in the international register of diseases as a sub-category of irritable bowel syndrome, and is still very little known in France (though much less so in the US, where the main research teams have been working on the subject for 2 decades, notably under the direction and impetus of Dr Mark Pimentel). So don’t be surprised if your doctor or gastroenterologist raises an eyebrow if you mention this term in a consultation. But don’t panic, because SIBO will become more and more widely known, thanks in particular to the many practitioners (doctors and non-doctors) who are training on the subject to support the many people who suffer from this disorder (See my profile as an expert on SIBO and Microbiota).
So what is this disorder?
Although the bacteria of the intestinal microbiota are essential for healthy digestion, in particular, the vast majority of them must be confined to the colon. In the case of SIBO, these micro-organisms multiply excessively where they shouldn’t, causing a series of chronic digestive disorders. This imbalance can be linked to a number of factors, such as impaired intestinal motility, low production of gastric acid, or prolonged use of certain drugs, notably antibiotics or PPIs (proton pump inhibitors).
This disorder is often under-diagnosed and confused with other digestive disorders such as irritable bowel syndrome (IBS) or functional colopathy. However, although these conditions share certain symptoms, it is essential to understand that SIBO has a specific characteristic – the abnormally excessive presence of bacteria in the small intestine – and therefore requires special treatment. However, it is also important to know that, as with all disorders and dysfunctions, in naturopathy and functional medicine it is imperative to understand the origin of the dysfunctions in order to address them and thus restore the normal and optimal functioning of the body.
In the case of SIBO, it should be noted that treatment with anti-microbials or antibiotics alone is very often ineffective in the long term. In fact, if the cause(s) are not identified and addressed (corrected), there is a good chance that your SIBO will recur. That’s why I’ve created a unique programme that identifies and treats the causes of SIBO to get rid of it in a real and lasting way.
What are the symptoms of SIBO?
SIBO sufferers often report symptoms similar to those of other digestive disorders, which can complicate diagnosis. The most common signs are:
- Bloating: Many people experience a sensation of abdominal bloating, often after meals. This symptom is due to the fermentation of food by bacteria present in excess.
- Abdominal pain: Cramps and pain in the intestinal region are common, especially after eating.
- Diarrhoea or constipation: SIBO can affect the regularity of bowel movements, causing either frequent episodes of diarrhoea or, on the contrary, stubborn constipation.
- Excessive gas: Excessive gas is often linked to the fermentation of carbohydrates by bacteria in the small intestine.
- Malabsorption: Bacterial overgrowth can disrupt the absorption of essential nutrients, leading to vitamin deficiencies (particularly B12) and associated health problems, such as chronic fatigue or unintentional weight loss.
- Fatigue: Many SIBO sufferers experience general fatigue, often linked to nutrient malabsorption and digestive disturbances.
It is common for these symptoms to persist despite standard treatments for irritable bowel syndrome, which often leads us to think that the problem lies elsewhere.
How is SIBO diagnosed?
If you are experiencing any of the above symptoms, it is essential to seek a proper diagnosis. SIBO, although increasingly recognised, remains difficult to diagnose by the standard methods used for other digestive disorders.
Here are the main diagnostic techniques:
- Hydrogen and methane breath test: This is the most common method for diagnosing SIBO. It consists of ingesting a solution (generally and preferably lactulose, but also glucose), then measuring the gases produced by respiration (mainly hydrogen and methane). When there is an excess of bacteria in the small intestine, they ferment the sugars more quickly, producing higher quantities of these gases.
- Small intestine aspiration and culture: Although more invasive, this method involves taking a sample of fluid from the small intestine to look for abnormal bacterial concentrations. The problem is that it is never performed in practice.
- Analysis of symptoms and medical history: An experienced practitioner will be able to recognise the characteristic symptoms of SIBO, especially if you suffer from bloating, gas or chronic diarrhoea for which there is no clear explanation. However, only the respiratory test will tell whether you have SIBO H2 (bacterial overgrowth in the small intestine with excess H2) or IMO (intestinal methane overgrowth). I invite you to follow my social networks or reread my publications on the 3rd SIBO (SIBO H2S).
Here is a list of places where you can have the SIBO breath test:
In a home kit
- Ibiote.com: with a prescription from your doctor, you can get partial reimbursement. This is the Alphabio laboratory in Marseille. Price €130 without a prescription and €50 after coverage with a prescription. Please note that you will need to fill in a questionnaire to find out whether you fall within the symptoms defined by the laboratory and are eligible for the test.
- Sibolab.de: click on the link for the page in French. There is no selection process to access the test. Price between: €98 and €129
Face-to-face, on site :
- At the Alphabio laboratory in Marseille. To make an appointment, contact the lab at ibiote.com
- At the European SIBO Institute, make an appointment with a gastroenterologist from the institute, who will give you an appointment at the Alphabio laboratory to do the test
- In many university hospitals in France, ask the gastroenterology department of the university hospital you are visiting. The problem: most use glucose as a substrate, whereas lactulose should be used as the first line of defence. The 2nd problem: most are not trained in SIBO, and the interpretation of results (when there is one) is not always reliable or relevant. So if you have a test done at a university hospital, I strongly recommend that you call in a SIBO expert to confirm the interpretation and, above all, to ensure that the test is managed properly. As I said at the beginning of this article, most doctors are not (properly) trained in the management of SIBO. And I strongly urge you to look into the causes of your SIBO, which you can explore and address using my SIBO-Net online training course.
In conclusion
If you’ve been suffering from digestive problems for months, or even years, without any real relief, despite treatment for irritable bowel syndrome or functional colopathy, it’s possible that you have SIBO. This disorder is still often misdiagnosed, but more and more healthcare professionals are becoming aware of it. It is crucial to consult a specialist who is familiar with SIBO and who can guide you towards the right tests and appropriate treatment. The key to regaining balanced digestion and a better quality of life is to recognise the real cause of your symptoms. Don’t let SIBO go unnoticed.
