by Dr. Joseph Debé
A test that analyzes breath samples for specific gases can identify an important underlying cause of irritable bowel syndrome, many debilitating chronic conditions, and suboptimal health. What the test actually identifies is an overgrowth of bacteria or archae in the small intestine.
It is estimated that about 20% of the U.S. population has irritable bowel syndrome. This condition is characterized by some combination of abdominal pain, diarrhea, constipation, gas, bloating, distention, and bathroom urgency. Irritable bowel syndrome is usually a diagnosis of exclusion; when no cause can be found to explain the symptoms, it is called irritable bowel syndrome. With no known cause, treatment is strictly symptomatic, often involving medication. As an example, “Sarah” came to see me with a 5-year history of abdominal pain, diarrhea, constipation, gas and bloating. She also complained of depression, cognitive impairment, acne, poor appetite and weight loss. In Sarah’s own words, she had “seen countless doctors, taken herbal supplements,” and “…had many tests.” A medication by the name of Lotronex had helped her diarrhea but made her constipation worse. Lotronex was subsequently pulled from the market because of toxicity.
I disagree with the belief that the cause of irritable bowel syndrome cannot be uncovered. I believe there are a number of common causes, which differ from case to case. Finding the causes necessitates using the right tests. Some of the more common causes include: the presence of toxic organisms within the intestinal tract, inadequate digestion, food sensitivities, and stress. One common cause of irritable bowel syndrome is an overgrowth of bacteria within the small intestine. Normally home to a relatively small number of bacteria, when bacteria overpopulate in the small intestine, problems arise. Small intestine bacterial overgrowth (SIBO), identified very effectively with breath analysis, turned out to be a problem for Sarah. Since appropriate treatment, Sarah’s irritable bowel syndrome is basically gone and she has had great improvement in her energy, mood, cognition, appetite, bodyweight and acne.
Bacterial overgrowth in the small intestine negatively impacts health in several critical ways. Bacterial overgrowth interferes with digestion and absorption. Resulting malnutrition can undermine all of the body’s (and mind’s) functions. Excess bacteria can damage the cells lining the intestine, leading to a condition called “Leaky Gut Syndrome”. In this condition, toxins, inadequately digested food particles and even organisms, pass from the intestines into the bloodstream. The end result is a poisoning of the body (including the brain) and activation of the immune system, leading to inflammation. Leaky Gut Syndrome is implicated in systemic conditions like fatty liver disease, arthritis, allergic conditions, autoimmune disease, brain dysfunction, congestive heart failure,…the list goes on and on. Leaky Gut Syndrome is even implicated in biological aging.
Typically, people with small intestine bacterial overgrowth experience more and more abdominal bloating as the day goes on. Bloating, distention, gas, diarrhea, and abdominal pain are usually experienced within a few hours after eating. Sugary, starchy foods and/or fiber usually worsen symptoms. Sometimes, small intestine bacterial overgrowth does not manifest with intestinal symptoms but may still contribute to other conditions like anemia, schizophrenia, ADHD, weight loss, “failure to thrive syndrome” seen in the elderly, fatigue, headaches, joint pain, kidney stones, rash, and, according to a recent study, osteoporosis. Again, when digestion and absorption of food are impaired, virtually any condition of body or mind may result. SIBO interferes with normal bile acid metabolism with local and systemic consequences.
Breath analysis to diagnose bacterial overgrowth in the small intestine takes advantage of the fact that these organisms feed upon carbohydrates. Basically, the test involves collecting breath specimens before and after drinking a carbohydrate solution. As the bacteria in the small intestine feed upon the carbohydrate, they produce hydrogen and methane gases. These gases are absorbed into the bloodstream, travel to the lungs, and are present in exhaled air. Excessive levels of hydrogen or methane in expired air are evidence of overgrowth. Hydrogen excess seems to be produced by a number of different bacteria and is more associated with diarrhea. Methane is connected to archae, which are microorganisms distinct from bacteria. Excess methane is associated more with constipation. A breath analysis study performed on 202 people with irritable bowel syndrome found bacterial overgrowth in 157 of them. In 47 of these people who were available for follow-up evaluation, treatment of the overgrowth resulted in partial or complete resolution of symptoms along with the improvement or normalization of breath test results.
When bacterial overgrowth is diagnosed, treatment must be instituted to eradicate the bacteria. Options include medications and herbs that have anti-bacterial activity. A study published by a gastroenterologist found herbal products to be at least as effective as medication. One comprehensive herbal product is Atrantil Pro. Even more effective than medication in eradicating bacterial overgrowth is a 2 week course of an elemental diet, called mBIOTA Elemental.
Another important thing that needs to be done is to identify and correct the conditions that allowed for the bacterial overgrowth, so that it does not recur. Some of the predisposing factors include stress, inadequate hydrochloric acid production by the stomach (a condition that can result from acid-blocking medication), insufficient pancreatic enzymes, slow movement of food through the digestive system, and weakened immunity. Disruption of the normal bacterial intestinal diversity by antibiotics is a common contributor. Hypothyroidism, which often goes undiagnosed, is strongly associated with SIBO. Hypothyroidism slows movement of food and bacteria through the gut. Autonomic neuropathy from diabetes and other causes can slow motility, as can even stress. Some medications also affect gastrointestinal motility.
Most cases of SIBO/IMO happen sometime after food poisoning. The immune system’s response to the bacterial poisoning can result in a cross-reaction with cells lining the intestine (Interstitial cells of Cajal) that regulate muscular contractions. Damage to these pacemaker cells slows intestinal transit, allowing bacteria to multiply high up in the small intestine, rather than being swept down into the colon by muscular contractions. Restoration of normal intestinal motility is essential when antibodies to the protein vinculin, which is found in the pacemaker cells. are identified with a blood test. The Candidia + IBS Profile measures antibodies to vinculin and more. SIFO (Small Intestinal Fungal Overgrowth) is excessive fungal growth (primarily Candida species) in the small intestine, causing bloating, gas, belching, nausea, diarrhea, abdominal pain, fatigue, and brain fog—symptoms mimicking SIBO or IBS. The Candida +IBS Profile measures antibodies to these organisms, potentially implicating fungal overgrowth as a contributor to the individual’s symptoms.
The most meaningful clinical test for determining if SIBO or IMO are present is the Trio-Smart. This is the only 3 gas breath test. In addition to hydrogen and methane, Trio-Smart also measures hydrogen sulfide. Adding this third gas measurement significantly improves accuracy and reduces false-negative results. Importantly, it can influence treatment decisions. I respond to findings of elevated hydrogen sulfide with different dietary restrictions. Hydrogen sulfide SIBO is associated with bloating, diarrhea, urgency, and systemic symptoms (fatigue, brain fog) via toxicity and inflammation. Learn more about Trio-Smart.