IBS and SIBO
Irritable bowel syndrome is one of the most common diagnoses gastroenterologists give, and one of the least satisfying ones to receive. It describes a pattern of symptoms: abdominal pain, bloating, and altered bowel habits that are not explained by a structural disease. What it does not explain is why. The conventional approach manages symptoms with diet modification and medication. The functional medicine approach looks for the reason the gut is behaving this way in the first place.
The SIBO connection
Small intestinal bacterial overgrowth is present in a significant proportion of IBS cases, some estimates put it above 50 percent. SIBO occurs when bacteria that belong in the large intestine migrate into the small intestine and ferment food there before it can be properly digested. The result is gas, bloating that often comes on quickly after eating, and bowel changes. Because the bacteria are fermenting carbohydrates in the wrong place, symptoms often worsen with foods that feed them, including fiber, starches, and sugars, even healthy ones.
SIBO is confirmed with a breath test that measures hydrogen and methane gas produced by the bacteria. The treatment protocol depends on the type of overgrowth: hydrogen-dominant, methane-dominant, or both, since each responds to different interventions.
Other IBS drivers we look at
When SIBO is not the primary issue, we look at gut motility, stomach acid production, digestive enzyme sufficiency, the integrity of the gut lining, dysbiosis in the large intestine, and the nervous system regulation of the gut. The gut has its own nervous system, the enteric nervous system, that is closely tied to the central nervous system. Stress, anxiety, and trauma history directly affect gut function in ways that are real and measurable, not imagined. Addressing the nervous system side is often as important as addressing the microbiome.
How we treat it
The protocol follows the test results. For SIBO, treatment typically involves a specific antimicrobial protocol followed by gut lining repair and steps to reduce the likelihood of recurrence, which often means addressing motility and the underlying factors that allowed the overgrowth to develop. For other IBS patterns, the approach is built around what the stool analysis and clinical picture show. Acupuncture works directly on gut motility, pain, and the nervous system regulation of digestion and is an effective adjunct to the functional medicine protocol. Read more about acupuncture.
Common questions
How is SIBO diagnosed?
With a breath test. You drink a solution of lactulose or glucose and breathe into a collection device at intervals over two to three hours. The gases produced by bacteria in the small intestine are measured. We can arrange this test as part of a functional medicine workup.
Does low-FODMAP diet fix IBS?
It reduces symptoms for many people because it reduces the carbohydrates that feed bacterial overgrowth. But it does not address the overgrowth itself. People often find that symptoms return when they widen their diet again. It is a management tool, not a resolution.
I have had IBS for years. Can it still be treated?
Yes. Chronic IBS often has identifiable causes that have simply not been looked for. The duration of the problem does not mean it is untreatable, though longer-standing cases can take more time to resolve.
Is IBS all in my head?
No. The gut-brain connection is real and bidirectional, which means stress and anxiety genuinely affect gut function, but gut dysfunction also affects mood and mental state. Neither direction is imaginary, and neither is the primary cause in most cases. Both need to be addressed.
Related: Gut health and leaky gut, food sensitivities
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