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Common Causes of IBS: SIBO

Statistics show that at some point, nearly 75 percent of women will be diagnosed with irritable bowel syndrome at some point in their lives. Irritable bowel syndrome (IBS) is a disorder that affects the intestines and causes symptoms such as cramping, abdominal pain, bloating, gas, diarrhea, and constipation.

Symptoms of IBS often occur when bacteria from the large intestine encroaches on the small intestine where foods are digested. FODMAPs—Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols—are the food molecules that the intestinal bacterial like best and are poorly absorbed by some people, creating an environment for IBS to thrive.

SIBO—Small Intestinal Bowel Overgrowth—is an imbalance in bacteria that has migrated into the small intestines to colonize. At this point the bacteria ferment complex sugars (FODMAPs) and this process produces excess hydrogen sulfide and methane gas. Depending on which bacteria phylums (think of this a species like cats or dogs) have overgrown and how they interact with your foods, you will get diarrhea or constipation or both.

FODMAPs are carbohydrates (sugars) that are found in foods. Not all carbohydrates are considered FODMAPs. They are osmotic (meaning they pull water into the intestinal tract) and may not be digested or absorbed well leading to fermentation by bacteria in the intestinal tract. When consumed in excess, symptoms such as diarrhea, constipation, gas, bloating and/or cramping may occur.

What foods are FODMAPs?

Foods/sugars that are considered FODMAPs include: fructose (fruits, honey, high fructose corn syrup (HFCS), etc), lactose (dairy), fructans (wheat, garlic, onion, inulin, etc), galactans (legumes such as beans, lentils, soybeans, etc), and polyols (sweeteners containing isomalt, mannitol, sorbitol, xylitol, and stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc). These foods should be avoided while you work to change the bacterial balance in the small bowel and alleviate symptoms. If you suffer from SIBO, eating these foods will make your symptoms worse.

What should you eat?

A low FODMAP diet limits foods that are high in fructose, lactose, fructans, galactans and polyols. And may help reduce symptoms. The low FODMAP diet is often recommended for those with irritable bowel syndrome. It may also be beneficial for people who have similar symptoms from other digestive disorders such as inflammatory bowel disease.

There are various FODMAP diet recommendations, most look similar to the Paleo diet, and are high plant-based foods, low-glycemic fruits, and animal proteins. Onion and garlic should be avoided on the FODMAP diet as they easily ferment.

If symptoms improve after a few days on the FODMAP diet, it is generally assumed that SIBO is the cause of IBS. Testing today involves a breath test to detect changes in methane and hydrogen levels after eating a sugar load. This test has limited accuracy and takes up to two weeks to get results. I prefer to start with the diet. If symptoms improve, it is likely you have SIBO.

Balancing the intestinal bacteria can take a few weeks to several months and involves the FODMAP diet, treatment for the bacterial overgrowth, improving probiotic balance, and suffers may also need digestive support such as enzymes as well. Most people are able to reintroduce some of the FODMAP foods once balance has been achieved, although some people are never able to eat FODMAP foods without symptoms. Maintaining intestinal balance and preventing symptoms of IBS is possible with a well-balanced diet and taking probiotics to keep the gut in balance.

Betty Murray, CN, IFMCP, CHC is a Certified Nutritionist & Certified Functional Medicine Practitioner with the Institute for Functional Medicine, Founder of the Dallas-based functional medicine clinic Living Well Dallas and Executive Director of the the Functional Medicine Association of North Texas. A master of the biochemistry of the body, Betty teaches her clients how to utilize nutrition for autoimmune diseases, digestive disorders and weight loss. Connect with Betty on Twitter, Facebook, and Pinterest. Click here to get your free Guide to Going Gluten Free – everything you ever needed to know to Go Gluten Free!

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