After three months of studying, I’ve completed my small intestine bacterial overgrowth (SIBO) training and can now coach my clients through their SIBO journey. As endometriosis is a risk factor for SIBO, I find discussion of the condition is becoming increasingly common with the clients and people I speak to.
So far, at least 60% of my clients are testing for SIBO if they can afford to do so. Two sets of results have come back — both positive. These results are no surprise, given the link between SIBO and endometriosis.
How do you know whether you should spend the money on a SIBO test?
Let’s consider when to get tested. In my training with naturopathic doctor Allison Siebecker, we were advised to consider testing after what she calls “first-line therapies” (such as removing common GI aggravators, using probiotics, etc.) have failed or not worked as well as expected. You can listen to my episodes on gut health here and here to get a better understanding of the initial steps to gut healing, which range from chewing properly to eating a whole foods diet.
In many cases, our gut health problems can be improved with simple lifestyle and dietary changes. Regardless of any underlying conditions, a healthy lifestyle and diet are the foundations for good gut health and nutrient absorption.
If symptoms worsen or don’t improve, this is when a gastrointestinal (GI) doctor, trained coach, or even the patient may consider a few tests, including a SIBO breath test. Other tests include a stool test, such as the GI Map, and blood tests for nutrient deficiencies and malabsorption.
There are a couple of signs to look for that might raise suspicion of SIBO, and call for testing.
First, we’d look for typical symptoms. The signature SIBO symptom is a bloated, distended stomach, which is often dubbed in the endometriosis community as the “endo belly.” This symptom is caused by the gas produced from fermentation of bacteria as they feast on the food we eat. As we eat throughout the day, this gas builds and gets worse. Often, the gas is produced at a rate far quicker than the rate it can exit the body, and so we end up having pockets of air that create a swollen stomach, which usually gets worse by evening.
Most of my clients experience this. By the end of the day, they have a belly that is reminiscent of the early stages of pregnancy, and tend to have a lot of gas and perhaps an upset stomach.
Some of my clients have constant bloating, a common sign of severe SIBO in which a lot of bacteria and archaea are present in the small intestine.
Other symptoms include diarrhea, constipation, nausea, acid reflux or gastroesophageal reflux disease, burping, gas, abdominal pain, brain fog, fatigue, anxiety, depression, tingling in the hands and feet, bladder pain, joint pain, headaches, and skin reactions.
Not all of these symptoms are from the SIBO directly, but are caused by the gases and toxins that are produced from the bacteria and the inflammatory reactions of the immune system in response to leaky gut (often a result of the damage caused by SIBO).
We’d also look for signs of malabsorption and nutrient deficiencies, especially in vitamins A, D, E, K, and B12, ferritin, and omega 3 fatty acids. Sometimes people show low protein levels, though this is much more unusual. Deficiencies can be determined with various tests, including blood tests and an organic acids urine test.
Other conditions commonly associated with or are risk factors for SIBO are considered, such as interstitial cystitis, rosacea, and restless leg syndrome. You can read more about risk factors and associated conditions on Siebecker’s website.
Additional tail-tale signs include feeling like you can’t eat anything without a reaction; reacting particularly badly to carbohydrates such as fruits and veggies, or GI-healing foods, herbs, and drinks such as bone broth, collagen, chamomile tea, and aloe vera; or having a history of food poisoning (a common cause of SIBO).
Not everyone has all of these symptoms, and often the type of symptoms depend on the type of SIBO you have. Therefore, don’t rule out SIBO if you’re not constipated or don’t have bladder pain, for example.
If you recognize yourself in some of what I’ve described, if you have endometriosis, and especially if you’ve also experienced food poisoning, it’s worth doing some further investigation to find out if you have SIBO.
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