Tag Archive: IBS

  1. Could SIBO be causing your IBS?

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    SIBO – Some of you may have heard of this but most may not and it has become important in identifying one of the underlying causes of irritable bowel syndrome (IBS).  In recent years SIBO has also been linked with fibromyalgia, acne rosacea and other health problems which is why it is a fascinating condition to diagnose and treat. Before you rush out to your GP, getting tested is not simple and it is not widely available on the NHS. SIBO is currently mostly diagnosed privately, some GP’s have never heard of the condition and some consultants are dubious as to it’s relevance in relation to IBS and other related health issues. In essence it is still quite controversial but if you would like to find out more, please read on as it may be one of the answers to your unanswered health problems.

    What is SIBO? 

    Small Intestinal Bacterial Overgrowth is a chronic bacterial infection of the small intestine. The infection is due to bacteria that normally live in the gastrointestinal tract but have abnormally overgrown in a location not meant for so many bacteria. The bacteria can interfere with our normal digestion and absorption of food. It can also lead to deficiencies in iron and vitamin B12, causing certain anaemias.

    After eating food, the bacteria produce gas within the small intestine which in turn can cause abdominal bloating, abdominal pain, constipation, diarrhea or both. This can get confusing because of course these are the symptoms of irritable bowel syndrome (IBS).  SIBO has been shown to exist in up to 84% of IBS patients. However for my part, I have not seen this higher percentage and I find about 30% of IBS patients have a positive SIBO test. Apart from IBS, SIBO has been linked controversially to a whole host of other conditions. These include:

    Other symptoms

    • Heartburn (Reflux or GERD)
    • Weakness
    • Weight loss
    • Nausea
    • Food Sensitivities
    • Headaches
    • Joint Pain
    • Fatigue
    • Skin symptoms (such as eczema or rashes)
    • Respiratory symptoms (such as asthma)
    • Mood symptoms (such as depression)
    • Steatorrhea (fatty stools)
    • Anaemia (Iron or B12)

    How do I get SIBO?

    The gastrointestinal tract is a continuous muscular tube which digesting food travels along on its way to the colon. Normally, the coordinated action of the muscles of the stomach and small intestine propels the food from the stomach, through the small intestine and into the colon. This muscular action also sweeps bacteria out of the small intestine and limits the numbers of bacteria in the small intestine. However when a condition interferes with the normal activity in the small intestine this can result in SIBO. By allowing bacteria to stay longer and multiply in the small intestine the lack of normal muscular activity also may allow bacteria to spread backwards from the colon into the small intestine. Possible causes are:

    Long term use of PPI’s (proton pump inhibitors eg omeprazole)

    • Batriatric surgery
    • Chronic pancreatitis
    • Blind loop syndrome (after stomach surgery)
    • Scarring from previous surgery and crohns disease.
    • Diverticuli (small pouches) of the small intestine that allow bacteria to multiply inside diverticuli.
    • Disorders of the immune system can cause bacterial overgrowth

    “It is mandatory to consider SIBO in all cases of complex non-specific dyspeptic complaints (bloating, abdominal discomfort, diarrhea, abdominal pain), in motility disorders, anatomical abnormalities of the small bowel and in all malassimilation syndromes (malabsorption, maldigestion).”J.Bures et al 2010.

    Getting Tested for SIBO

    SIBO is measured by a breath test. This measures the hydrogen and methane gas produced by bacteria in the small intestine that has diffused into the blood, then lungs, for expiration. The gas is graphed over a transit time of 2 or 3 hours and compared to a baseline. Patients drink a sugar solution of lactulose after a 1 or 2 day preparatory diet. The diet removes much of the food that would feed the bacteria, allowing for a clear reaction to the sugar drink. The test is performed either at home with a take home kit or a breath testing machine in hospital, doctors office, or lab. It takes 1-3 hours in the morning after a 12 hour fast the night before and a special diet needs to be adhered to the day before the test.

    Who should get tested?

    If you have IBS symptoms that have not got better despite seeing your GP and are also suffering from a range of unexplained symptoms, acne rosacea, fibromyalgia etc it may certainly be worth ruling SIBO out as a cause for your symptoms.

    Breath tests are available- these are priced  £150. – Please call me on 01323 737814 for more information.

    What happens if the test is positive?

    If the SIBO test is positive the best approach is antibiotic therapy taken over 7-10 days. The antibiotics will vary but this is usually enough to stop the problem and will mean you will be able to eat a normal diet again, if you have been eliminating suspect foods. Antibiotics used  can include: tetracycline, amoxicillin, metronizadole, neomycin, cephalexin, and trimethoprim-sulfamethoxazole.

    There is only one study using herbal “antibiotics” for the treatment of SIBO, which used enteric coated peppermint oil (ECPO). Besides this, herbal antibiotcs have not been studied for the reduction of SIBO. The question is whether they will target the bacteria that is overgrown. However, it has been suggested that some herbal antimicrobials do not kill our beneficial bacteria, certainly a unique and desirable quality. Herbal antibiotic formulas abound in the supplement industry. These include: Garlic, Cinnamon, Oregano, Goldenseal, and Barberry.

    What about special diets?

    Patients who come to me with suspected SIBO issues are already on severely restricted diets – avoiding wheat, gluten, dairy, lactose, large amounts of carbohydrate and all manner of different variations of elimination diets. It is advisable to eradicate SIBO quickly and get back to eating as normally as possible rather than staying on restricted diets long term which may lead to different health issues. It is commonplace for patients to think they have multiple food intolerances and lists of foods they cannot eat when in fact it may be only a few foods and the problem they are suffering from is SIBO not from the food itself. Often people with SIBO tell me it does not matter what they eat – even a glass of water can make them feel bloated. This should ring alarm bells, if it’s not the food there is something going on in the gut. Time to get tested. There are a few diets that can help symptoms of SIBO and IBS as well. These include the Specific Carbohydrate Diet and Low FODmap diet which I will be discussing in the next issue as well as the GAPS diet which has found huge popularity recently.

    For more details on tests and consultations visit www.katearnoldnutrition.co.uk or call Kate Arnold on 01323 737814 for more details.


  2. IBS workshops coming soon!

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    Irritable Bowel Workshop
    Come and join me, Kate Arnold, on Tuesday 16th August 2011 at 6.30pm Physio Plus, 18 Gildredge Road, Eastbourne, for a
    beginners workshop on Irritable Bowel Syndrome.
    What is IBS?
    What are the causes?
    How can I manage the symptoms?
    How can diet help?
    Why is it so common?
    The workshop will start at 6.30pm prompt and finish at 8pm. There will be time for loads of questions!
    As places are strictly limited, please book places in advance. If there are spaces left it may be possible to pay on the night. The cost is £10 per person.
    To book your place please contact Kate Arnold on
    01323 737814 or Debbie at Physio Plus on 01323 430803for further information
    For more information on Kate Arnold, Nutrition Consultant
    go to www.katearnoldnutrition.co.uk

    Irritable Bowel Workshop

    Come and join me, Kate Arnold, on Tuesday 16th August 2011 at 6.30pm Physio Plus, 18 Gildredge Road, Eastbourne, for a beginners workshop on Irritable Bowel Syndrome.


    • What is IBS?
    • What are the causes?
    • How can I manage the symptoms?
    • How can diet help?
    • Why is it so common?

    The workshop will start at 6.30pm prompt and finish at 8pm. There will be time for loads of questions!

    As places are strictly limited, please book places in advance. If there are spaces left it may be possible to pay on the night. The cost is £10 per person.

    To book your place please contact Kate Arnold on 01323 737814 or Debbie at Physio Plus on

    01323 430803 for further information

    For more information on Kate Arnold, Nutrition Consultant go to www.katearnoldnutrition.co.uk

  3. More IBS

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    I’ve just had a spate of clients with IBS again. If you are suffering and have seen your GP and are getting nowhere do give me a call. There are many reasons for IBS, finding the cause is paramount and not that difficult. A stool test can often help diagnose the root course of the problem, often with a change of diet as well. The problem is everyone is different so no two people will respond the same to the “one size fits all” mentality.

    I’d be happy to chat to you about this – call on 01323 737814 to make an appointment.

  4. Food neurosis

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    Sadly more and more often I am seeing clients who come to me with what I term as “food neurosis”. I will take the example of a 34 yr old woman (let’s call her Jane) who came to see me late last year. She had IBS, and no one had been able to help her. She had been through endoscopies, colonoscopies, barium x-rays, drugs, hypnotherapy etc and got precisely nowhere. During this time, which was about a year she had become more and more anxious about what she was eating – eliminating more and more food groups until she was barely eating anything. She had convinced herself that she was allergic to nearly everything: red meat; wheat; gluten; yeast; all dairy foods; too much carbohydrate. She had diagnosed herself as having candida (a yeast infection that can occur in the vagina, mouth and bowel). She had read a book that said she couldn’t eat fruit, or nuts (as they had mould on). She was literally eating ricecakes with some foul nut butter on, water, vegetables, chicken and rice.

    It took a long time to convince this girl that she had it all wrong. So often people with food neurosis blame allergy/intolerance for their symptoms. She agreed to a stool test with me and in fact she had 3 parasites which responded really well to antibiotics. Her IBS went, she went on a course of probiotics. I then convinced her she wasn’t allergic to gluten or cows milk by doing a coeliac and lactose tolerance blood test – both were negative. She is now eating pretty much anything she wants. She still doesn’t eat red meat and avoids cows milk, but the variety of her daily diet has increased substantially. She began to enjoy her food and realise that it was not the enemy and freely admits now that she had become totally neurotic.

    It is vital to enjoy your food. It’s one of life’s amazing pleasures. The 80/20 rule pretty much works for everyone, i.e. 20% you eat what you want, and 80% you eat well. Do not eliminate large groups of food unless you have proof that they are definitely the cause of your problem. Food neurotics become boring. You can’t invite them round to dinner and you can’t go out to dinner with them!!

    Having said that I am genuinely lactose intolerant, and allergic to msg and mushrooms so I find dining out hard however it doesn’t stop me going out to eat – I find my way around those menus somehow!

  5. Fibre bad for IBS

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    As most of you suffering from IBS know, too much insoluble fibre can make symptoms worse. This includes bran flakes, all bran, wholegrains, and too much fruit and vegetables. For some a bowl of bran in the morning is like eating razor blades for the gut and can cause inflammation. Find the cause of your IBS first. Eat temperate foods ie not too hot or cold, choose soluble fibre like porridge. Try probiotics and keep a food diary to see if there are any obvious foods causing the pain. If you are still worried, get referred to a gastroenterologist, rule out coeliac disease, lactose intolerance and see a nutritionist for a stool test to test for gut flora, parasites, yeasts and candida which may be the initial cause anyway.

  6. What’s causing my IBS?

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    It is a rarity in my clinic to have someone who doesn’t complain about bloating in one form or another. I would say 70% of people I see have gut problems, ranging from IBS to more serious conditions like crohns disease but the overall complaint is nearly always bloating. Bloating is one of the main symptoms of IBS consisting of alternating constipation/diarrhoea, pain and gas. Apart from the physical symptoms, it also can leave people extremely incapacitated and in extreme cases can ruin the quality of people’s lives. The confusion over IBS leads people to self diagnose and eliminate gluten and dairy from their diet – this is not the full story and the problem may be the gut itself rather than the food you are eating. However, even more confusingly it can be both the food you are eating and your gut.

    If you have seen your GP/consultant and they have found no obvious cause of your symptoms and you have been diagnosed with IBS then read on…

    Causes of IBS

    The most common causes of IBS are

    Prolonged levels of stress decreasing the immunity and making the gut more vulnerable to opportunistic bacteria, yeast and parasites

    Low levels of gut flora leading to gut dysbiosis. This happens after stress, a bad diet, or after a course of antibiotics

    A higher than normal level of candida or yeasts in the bowel usually after antibiotics, bad diet or high levels of stress

    Parasite infections – with the amount of people travelling now, nearly 30% of people I see have undiagnosed parasites in the bowel

    Too much food creating gas i.e. indigestible carbohydrates like onions, garlic, leeks, and vegetables in general

    Too much sugar in the diet leading to severe bloating and trapped wind. If the bowel has an overgrowth of yeast, the sugar will feed it. The patient will often describe this as feeling nine months pregnant!

    Food intolerances or allergies i.e. wheat, gluten, cows milk etc

    Undiagnosed lactose intolerance, coeliac disease, ulceratative colitis or crohns disease – if you are in any doubt, see your GP and ask for a test.

    How do you find out if you have any of the above?

    A simple stool test and allergy test will sort out the cause of your symptoms.
    Click on IBS clinic for more information.