My Battle With Bloating
I turned to the side and looked in the full-length mirror of my hotel room, surveying myself in profile. Instantly, my heart sank: something was very wrong.
My stomach, bloated and inflamed, protruded to such an extent that I could have easily convinced someone I was pregnant. In my third trimester.
Seemingly overnight, I went from enjoying meals and having visible abs to feeling full and uncomfortable all the time. It took nearly two years and multiple appointments, practitioners and tests to determine a potential culprit. Hearing me describe my symptoms, various health experts—from my nurse practitioner to my Traditional Chinese Medicine acupuncturist to my naturopath—told me it sounded like I was suffering from SIBO. But the truth is actually a lot murkier than that.
What is SIBO?
SIBO stands for small intestinal bacterial overgrowth. As its name suggests, it occurs when there is too much bacteria in the small intestine.
“Our small bowel has less bacteria in it than other areas of our gut,” says Dr. Colleen Parker, staff gastroenterologist at the University Health Network’s Division of Gastroenterology and Hepatology, as well as an assistant professor of medicine at the University of Toronto. “It’s not zero bacteria, it’s just less bacteria. And what happens in SIBO, essentially, is that the amounts of bacteria in the small intestine begin to multiply.” This overgrowth can lead to a number of health problems.
What are the symptoms of SIBO?
The most common SIBO symptoms are changes in bowel habits—particularly diarrhea.
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“SIBO disrupts digestion and nutrient absorption,” says Dr. Allana Polo, a naturopath and the founder of Polo Health + Longevity Centre in New Westminster, B.C. (She is also my cousin-in-law, and has been on the receiving end of many panicked texts from me throughout my battle with bloating.) “It leads to a lot of symptoms inside the gastrointestinal system, but also systemically throughout the whole body.”
Parker expands on this. “Other symptoms patients can have are bloating or feeling very, very full or gassy, or like there’s a bubble in their abdomen,” she explains. “They can have abdominal pain or discomfort.” If SIBO becomes more severe, she says, patients can also experience weight loss and changes to their body’s ability to absorb nutrients.
What causes SIBO?
According to Parker, development of SIBO usually stems from a slowdown in gut motility—the process of moving liquid, food and waste through the gastrointestinal system. “One of the protective factors to keep our bacterial levels normal or low in the small intestine is the motility of the gut,” she says. “It’s really triggered by other things that are impairing the gut and its digestion functions. Any insult to the gut.”
Conditions that slow gut motility, according to Parker, include connective tissue diseases like scleroderma (an autoimmune disorder that makes the body produce too much collagen, leading to thick, tight skin); diabetes; neurologic conditions such as Parkinson’s; opioid use; and operations like abdominal surgery.
I don’t have any of those risk factors. Given this, I wonder aloud to Parker if it’s even possible that I have SIBO. “There is a smaller proportion of patients who don’t have those traditional risk factors,” she acknowledges. “We’re still trying to understand why those people may develop SIBO.”
At the same time, Parker says that SIBO is often given as a quick answer to digestive issues, and as a result can be incorrectly labelled as a person’s bloating culprit.
“SIBO is blamed for a lot of gastrointestinal symptoms,” she says, “when it may not be the underlying cause.” By way of example, Parker points to irritable bowel syndrome (IBS).
“If you look in the media and on social media, a lot of people say SIBO is the major cause,” she says. “But when you look at the studies, it’s probably 10 to 20 percent of patients with IBS who have underlying SIBO. The vast majority of IBS patients don’t have SIBO, and have a different cause for their presenting symptoms.”
How is SIBO diagnosed and treated?
This is where things get complicated.
“We don’t have a great and reliable way of diagnosing [SIBO],” explains Parker. “The other tricky thing is that it presents with a lot of symptoms that can be seen in a lot of other conditions with a lot of other causes, which is often what makes it [difficult] for care providers to firmly make the diagnosis—especially in the absence of those traditional risk factors.”
I worked with a naturopath who suspected I had SIBO, so she had me administer an at-home breath test (which I had to pay nearly $300 for). This procedure involves ingesting a sugar substrate such as glucose or lactulose, and then breathing into tubes every 20 minutes over the span of three hours. My test results came back positive, but Parker cautions against using this as a concrete diagnosis.
“There are some issues with breath testing,” she says. “What kind of sugar you were given can really affect the results. It can give us a sense if we think SIBO might be what’s going on, but there are a lot of issues where it can give you false positives.”
My heart sinks at this: Was my test a false positive?
“I see this not infrequently, where people have symptoms that could certainly be SIBO-related; they get the breath test and it’s positive; and then traditional treatments don’t help,” Parker says. “And then that really makes me wonder, ‘Hey, is this really SIBO, or is there something else going on?’”
Parker says that in the absence of a reliable test, she focuses diagnosis on a combination of risk factors, symptoms and reactions to treatment.
“If a patient came to me with the typical risk factors and had diarrhea, bloating and abdominal pain, then I would try treating them with antibiotics,” she says. “And if they responded well, I would say, ‘This is likely SIBO, and that’s how we’ll move forward.’ If they don’t respond, then we will look for alternate explanations.”
I suspect that I’m in the latter camp. I went through two rounds of Rifaximin—the go-to antibiotic for treating SIBO—and felt no better. My bloating didn’t go away, and neither did the constant feeling of fullness that I carried around even when I haven’t yet eaten anything that day.
If it’s not SIBO, what is it?
Conditions with similar symptoms to SIBO include celiac disease, irritable bowel syndrome (IBS), irritable bowel disease (IBD), abdominophrenic dyssynergia (where the diaphragm and abdominal muscles are not coordinating properly, resulting in visible abdominal distention or bloating), and hormonal issues and changes such as polycystic ovary syndrome and menopause. Because so many conditions manifest themselves in our bodies in similar ways, it’s crucial to see a doctor, who can whittle down the likely culprit from a list of overlapping possibilities.
Can SIBO be prevented?
It’s never a bad idea to focus on promoting healthy gut motility. Polo says that means drinking lots of water, eating plenty of fibre and avoiding pro-inflammatory foods like caffeine and alcohol. She also suggests making sure to chew food properly and to sit down while eating (as opposed to eating on the go), so that the digestive system is not working under duress.
“It’s a lot of the things that I would just tell a person to do to support a healthy gut microbiome,” she says, “which most of us are not doing anyway.”
What should you do if you think you have SIBO?
Anyone experiencing SIBO-like symptoms should speak to their family doctor or nurse practitioner as a starting point. From there, a patient might get referred to a gastrointestinal specialist or sent to a naturopath.
In my case, the journey is far from over. My nurse practitioner tried to get me in with a gastrointestinal expert, but because my symptoms aren’t considered serious, the referral was rejected (oh, the joys of our overburdened healthcare system). The next step for me is a stool test that can help indicate if I have IBS or IBD, which will at least get me in a better position to identify possible treatments. In the meantime, I’m focusing on eating small portions of whole foods and drinking lots of water in an attempt to give my digestive system as much time as possible to rest and recover. I wish I knew how this story ended, but I don’t. For now all I can do is be gentle with myself.
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Sara Harowitz is a freelance editor and writer based in Vancouver. Her work has appeared in publications including The Globe and Mail, Maclean's, Conde Nast Traveler, CBC, Canada's National Observer and The Tyee.
