SIBO is becoming more of a common issue and often masks itself as IBS.
In this post, I am going to share my client’s story on how we helped solve her SIBO. Please note, I would never normally share information like this but she has kindly agreed.
Table of Contents
Stage 1 – Client History
During the program she had followed all the advice and had some relief. But found that when she reintroduced FODMAPs, she reacted to nearly all of them, having very little tolerance.
Although there is no cure for IBS, it sends alarm bells ringing to me that someone would follow all my advice for their ‘IBS’ and then have zero tolerance to FODMAPs. Very strange.
So I started my assessment.
Firstly, I reviewed Erika’s medical tests – she had, had all the tests required for an IBS diagnosis as per NICE guidelines. You can read about this here.
She had also had some IgG testing but I explained how this was not accurate.
I then looked at the onset of her symptoms. This is important as IBS symptoms tend to start with things like stress, antibiotics or a stomach bug. Instead, Erika’s started around the same time she was put on proton-pump inhibitor medications. This is for acid reflux.
We then looked at other supplements and medications. Erika had been taking some chinese medications. We were unable to find the exact content of these.
There was nothing really substantial in her diet to be concerned over. She was pretty much following a low FODMAP diet, ate regularly, potentially a slightly high fibre intake, no caffeine and no alcohol. Again, very strange to still get symptoms.
The same thing was apparent in her social life. She exercised regularly, slept pretty well and had regular stress levels.
So given this history I immediately thought she must have SIBO as she didn’t have a typical IBS history and had been on long term PPIs which can cause SIBO.
- Breath test for SIBO – to discuss with GP
- Probiotics and meditation – to optimise own gut health further
- To track fibre content – if it is too high then can aggravate symptoms
Weekly Email Reviews
As part of the VIP package, clients get weekly email reviews. In this, they send across a food and symptom diary. This also details mood, sleep and exercise.
Over the coming weeks Erika explained that due to Corona Virus she was unable to get a SIBO breath test.
Despite the inability to get a test, it was still important to optimise Erika’s gut. Failure to do this would only result in any SIBO coming back when it was finally treated.
We therefore continued to optimise gut health and found that her optimal fibre intake was around 25g a day.
I knew Erika had been unable to get the SIBO testing due to circumstances, but this wasn’t a huge deal.
I explained that whilst the breath test is best test we currently have, it isn’t actually that accurate. Many doctors will therefore treat SIBO based on clinical history, with a diagnosis coming from the patient’s condition improving on antibiotics.
Other than the above, we had found that 25g of fibre a day seemed to improve stool consistency and also bloating slightly.
- Continue with around 25g a day of fibre
- Continue with lifestyle measures and probiotics
- Discontinue Chinese herbs (we were unable to find out what these contained).
- Discuss antibiotics with GP.
Weekly Email Reviews
Following the second consultation, Erika was able to arrange a course of antibiotics through a phone consultation with her GP.
Erikas symptoms did improve on this antibiotic but the symptoms then came back. This is very classic of SIBO which often takes several courses to kill off.
Erika’s GP (happy that her symptoms responded to the antibiotics), then prescribed a longer, more specific antibiotic.
At the final consultation, Erika’s symptoms had almost all resolved and she was happy with the outcome.
- To organise a referral to a GI surgeon to discuss a Nissen Fundoplication (a permanent solution for her acid reflux).
- Continue with around 25g fibre / day.
- Continue with probiotics.
- Continue with lifestyle gut optimisation – looking at sleep, movement and stress.
- Continue with PPIs as per the doctor recommendations (this may sound crazy because they are still the lesser of the 2 ‘evils’ in comparison to recurring acid reflux which can result in a lot of inflammation and potentially cancer).
- To trial reintroductions of FODMAPs again (as these would have been reacting to the SIBO originally).
Erika is a classic case of SIBO caused by PPIs.
When treating SIBO we need to take a holistic approach and consider both the treatment (antibiotics), optimising gut health and then preventing to from coming back.
Without this approach it is likely that SIBO will keep coming back or may not even go away in the first place.
Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.