Is It a Food Sensitivity or Is It SIBO?
Do you experience gas and bloating after nearly every meal? Or daily abdominal discomfort no matter what you eat or how much of it? I see this complaint constantly in my practice, and this my approach to diagnosing and treating it.
Food Sensitivities vs. SIBO
Abdominal pain, gas, bloating, nausea, indigestion, constipation and diarrhea are all very common digestive symptoms many people that come to see me experience. These symptoms can be prominent with patients who have food sensitivities, SIBO, or even other digestive conditions.
Food sensitivities are not food allergies. Allergies are an immune reaction that occur in the body in response to a certain food. Symptoms of allergies are typically rashes, itching, swelling, coughing, wheezing, and even difficulty breathing sometimes. Food sensitivities, in contrast, involve the digestive system and do NOT cause anaphylaxis. Symptoms tend to be more milder with the aforementioned gas, bloating, nausea, indigestion, and changes in stool form. Although sensitivities are not as severe as allergies, symptoms can definitely be uncomfortable and treatment should be initiated.
SIBO stands for Small Intestinal Bacterial Overgrowth which occurs as a result of excess good bacteria building up in the small intestine. This imbalance of microorganisms in the gut can lead to improper digestion. SIBO can occur due to many etiologies, ranging from slow motility or low stomach acid to metabolic, anatomic, or immune disorders. SIBO is more common in females and its incidence increases with age, secondary to hypochlorhydria and intestinal dysmotility. The most common symptoms I see in clinical practice that makes me think a patient has SIBO over a food sensitivity or other GI condition is extreme abdominal bloating after eating ANYTHING.
How To Diagnose Each Condition
Diagnosis for each of these conditions is fairly straight forward. Food sensitivities can be diagnosed via an IgG blood test, looking at 100+ foods that the body could be experiencing a reaction toward. Now, food sensitivity tests are not accurate and they don’t really tell you much clinically, other than foods you may be sensitive to. You will find some practitioners don’t bother ordering this test because there is not much research to support it, but I have noticed that patients find it beneficial to know exactly what foods to eliminate during an elimination diet, if that’s what they are planning on doing.
A SIBO test is a breath test that measures the amount of hydrogen or methane in your breath to detect abnormal gut bacteria growth. The test involves drinking a mixture of glucose and water and then providing breath samples every 15 minutes for over two hours. A rapid increase in the amount of hydrogen or methane you exhale may indicate bacterial overgrowth. Most often what I see is that hydrogen-dominant SIBO patients experience diarrhea as a symptom, while methane-dominant patient experience constipation. This breath test is used in allopathic and naturopathic medicine as the gold standard of SIBO testing. Insurance may cover this, depending on the carrier.
The images above are sample reports of a SIBO breath test (left) and IgG food sensitivity test (right).
I often have patients coming into my office asking for a food sensitivity test because they’re experiencing a lot of digestive discomfort. But, doing a food sensitivity test doesn’t provide you with a diagnosis, and most of the time, digestive issues occur as a result of a much larger concern, not just a food intolerance. If a patient presents with abdominal bloating, pain, gas, and constipation or diarrhea, I typically lean towards testing for SIBO, especially since insurance is more likely to cover it.
How Are These Conditions Treated?
First off, when we have food sensitivities (which most of us do to some extent) we aren’t really treating anything, we’re just trying to minimize the symptoms you’re experiencing. Which is why I typically like to do more comprehensive testing (like a SIBO breath test) before sensitivity testing, because it will get us to an actual diagnosis and treat the cause of your GI symptoms.
The best way to go about minimizing symptoms that may be due to food sensitivity is to eliminate all foods that came up positive on the panel for about 4-6 weeks. During this time, I like to provide my patients with gut healing supplements containing glutamine, aloe vera, marshmallow, DGL, slippery elm or peppermint, depending on what the initial symptoms are.
After 6 weeks is over, the re-introduction phase consists of re-introducing each of the foods back into your diet one by one. During this time, I always encourage patients to write down how they feel minutes, hours, and even days after eating a certain food to see if thy experience adverse side effects.
Another reason why certain practitioners don’t favor food sensitivity testing is because elimination diets can be done without knowing exactly what foods to eliminate (and again, IgG food sensitivity tests are not 100% accurate). Most of the time, there are certain food groups, like gluten, dairy, nightshades, high histamine foods, etc. that we can eliminate for a period of time to see if there are positive changes from doing so.
Treating SIBO is a whole different ballgame because this time, there is an actual diagnosis and there is something that we’re actually treating. If we look at it from a conventional standpoint, Rifaximin is a semi-synthetic antibiotic, and the most commonly prescribed medication for SIBO. It has an overall eradication rate of approximately 70%, meaning that sometimes, patients need to do multiple rounds of the medication before they start feeling better.
As a naturopathic doctor, I typically like treating SIBO with herbs. One reason for this is because one (and especially multiple!) round(s) of an antibiotic can wreak havoc on your gut and immune system. We definitely want to lower the amount of bacteria in the gut, but not completely eradicate them all. Another reason is because clinically, I have found my herbal protocol to work a lot better, although it does take a lot longer than the simple 2 week course of antibiotics.
Herbs I typically use in the first phase of treatment are oil of oregano, caprylic acid, neem oil, and berberine, along with others as necessary. This herbal phase is designed to eradicate the bacteria in the small intestine, without causing too much damage to our gut and immune system. In the second phase of treatment, we do a low FODMAP diet for 4-6 weeks. The diet restricts fermentable carbohydrates and prebiotics, which are the fuel for gut bacteria. When there's less fuel, the bacteria either die off or move back to the large intestine, where they should naturally be. This can help reduce bacterial overgrowth in the small intestine. After completion of the low FODMAP diet, patients can slowly start incorporating their normal foods back into the diet. At this point I also introduce motility agents and digestive enzymes to make sure the gut is functioning properly and to minimize the recurrence of SIBO.
How Do I Know Which Treatment I Need?
The easiest way to know is to see a naturopathic doctor! Also remember this post is not an exhaustive list of all GI conditions that exist - it just focused on the similarities and differences of food intolerances and SIBO. Other conditions still need to be ruled our if you’re experiencing symptoms, so it is best to seek help from a licensed provider who can evaluate which testing and treatment options are best for you.