There’s a lot of talk nowadays about the importance of the inner gut ecosystem. It influences your health in a myriad of ways, from digestive and immune health to inflammation and even body weight and mood.
This ecosystem needs the correct food to flourish, so it makes sense to eat a wide range of fibre-containing plant foods. But what happens if eating fibre causes unpleasant digestive symptoms? It can be mystifying to understand why something supposedly so beneficial can cause so much trouble.
It’s all about where the organisms exist in the digestive tract. Enter SIBO, otherwise known as small intestinal bacterial overgrowth, and the new kid on the block – IMO. Frequently overlooked, understanding these conditions could give you the answer you’ve been looking for.
Read on to learn about SIBO and IMO and how Functional Medicine can help.
After food leaves your stomach, it passes into your small intestine. This is where most nutrient absorption takes place. Eventually, the contents pass into your colon, where water is absorbed and stools formed. The bacteria forming your microbiome are present in vast numbers in your colon. Here they ferment undigestible fibre and produce a myriad of chemicals benefitting your health. The small intestine, on the other hand, does not naturally contain as many bacteria as the colon, and only certain species.
In SIBO, bacteria migrate from the large intestine up into the small intestine. Once they encounter carbs and fibre they reproduce rapidly, producing gases in the process, causing bloating and wind. Over time, this can damage and inflame the delicate lining of the small intestine. It can even become excessively permeable, a condition known as leaky gut. This damage can in turn lead to food sensitivities and intolerances, nutrient deficiencies, and a permanently triggered immune system.
Some bacteria present in SIBO produce hydrogen, while others create hydrogen sulphide gas. Therefore, SIBO is classified as hydrogen-dominant or hydrogen-sulphide dominant, with both types tending to cause diarrhoea.
On the other hand, IMO, standing for intestinal methanogen overgrowth, involves a different type of microorganism called an archaea. Although similar, it’s not a bacterium as such. As well as fermenting fibre, it uses hydrogen to produce methane gas, earning it the name of a methanogen. IMO is more strongly connected with reduced intestinal motility and constipation. As well as flourishing in the small intestine, to further complicate matters, these microbes may overgrow in the colon, too.
Up until a few years ago, IMO was known as methane-dominant SIBO. However, this is a misnomer because it’s not the bacteria causing the issue, but the archaea. This is why recently you might have seen references to IMO, to help clear up this distinction.
Both conditions occur when micro-organisms move from where they would traditionally live, to higher up in the digestive system. They then thrive on fibre – but being in the wrong place, cause all sorts of issues from bloating, burping, and wind to diarrhoea and intestinal pain. Some people experience constipation, feeling sick, low mood, or fatigue. Symptoms tend to occur soon after eating and can worsen as the days wears on. Because symptoms are very varied, they might be blamed on IBS.
Many people affected by these conditions feel frustrated because they have tried to do the right thing for their health, but nothing seems to work.
You might be wondering why bacteria might move away from their traditional home in the colon. A number of factors can be to blame, such as slow intestinal transit time. If food moves slowly through the digestive system, it provides a breeding ground for bacteria. Slow transit time can occur if your stomach produces too little acid, or the acid is neutralised with antacid medications. Stress, antibiotic use and sugar consumption can contribute, too.
Although related, SIBO and IMO are not the same condition, so how they are approached is different, too. And of course, both conditions can coexist.
To understand whether SIBO or IMO is behind your health issues, practitioners use a Breath Test. The test measures the gases – hydrogen or methane – exhaled after a dose of a test substance. This is a drink containing either glucose or lactulose, fermented by the bacteria in the small intestine.
The test will reveal the specific types of bacteria causing problems and enables our practitioners to pinpoint which antimicrobials will be most effective. Some cases may benefit from targeted antibiotic administration, while others respond to natural antimicrobials like oregano oil or berberine.
High-FODMAP foods are those containing the types of plant fibres known to exacerbate SIBO and IMO symptoms. These fibres are known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Many high-FODMAP foods, including garlic, onions, cabbage, lentils, and pulses would normally form part of a healthy diet. After all, they provide nourishment to healthy gut microbes and contain a huge range of beneficial plant chemicals. However, in SIBO and IMO, it is often helpful to reduce or exclude these foods for a short period while the digestive system rebalances itself. Because a low-FODMAP diet is very restrictive, however, it should never be a seen as a cure, but a short-term strategy, and is best done with the guidance of one of our practitioners.
Leaving a decent gap between dinner and breakfast, and avoiding evening snacks, can help a process known as the migrating motor complex. This helps propel food along the intestines and prevents stagnation.
Karen and Lottie are experts in SIBO and can guide you towards better digestive health. They can help navigate through your persistent symptoms towards better digestive and overall health by recommending nutritional and lifestyle interventions specific to your wellness journey.
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