Are You Bloated Most of the Time? (originally published in Maine Women Magazine Early April 2020)

Does your belly feel bloated or distended most days? Do you wake up with a flat tummy but by mid-day feel like you’re five months pregnant (and you’re not)?

Digestive symptoms are not always things we discuss around the water cooler or even with our closest friends. But know that if you have been living with digestive discomfort, you are certainly not alone.

My naturopathic medical speciality is digestive health. This means that people seek me out when they are suffering from indigestion, heartburn, constipation, diarrhea, as well as ulcerative colitis and Crohn’s Disease. But bloating may be the complaint that brings people in more than any other.

It is not uncommon for a new patient to come into my office complaining of chronic bloating with a previous diagnosis of Irritable Bowel Syndrome (IBS). Unfortunately it’s also not uncommon for her to relay stories of seeking out care from primary care providers and/or gastroenterologists and being told “it’s all in your head” or if not in so many words still feeling dismissed and not heard. And yes, it’s usually women who have been treated this way.

When someone describes a scenario like this, with symptoms such as bloating, abdominal pain and distension, diarrhea, constipation, sometimes fatigue and weight loss , it’s a red flag for something called SIBO (Small Intestine Bacterial Overgrowth).

SIBO is an under-diagnosed condition with a variety of the symptoms listed above.

There is up to a 75% overlap with IBS. This means that a large majority of people previously handed the diagnosis of IBS tested positive for SIBO in research studies.

So what exactly IS going on with SIBO?

Most of us have heard of the microbiome- the “good” bugs in our intestines that provide digestive and immune function (as well as mood regulation, but that’s a topic for a different time). Most of these bacteria are in the large intestine, a smaller percent is in the small intestine.

Various risk factors - a past episode of food poisoning, chronic use of antibiotics as a child, chronic use of antacids as an adult, and many others - can lead to an overgrowth of normal non-pathogenic bacteria in the small intestine.

These bacteria “out-gas” hydrogen and methane gases and when there is an overgrowth, it leads to symptoms of bloating, and sometimes constipation and/or diarrhea.

There is an at-home breath test to test for this and it can also be what’s called a “clinical diagnosis,” meaning a medical practitioner can make the diagnosis based on your symptoms.

I don’t have space in this article to dive into more details on treatment, but I can tell you that a high percentage of my patients experience a significant decrease in bloating and an improvement in bowel function within 1-2 months of treatment. Their “IBS” symptoms resolve. There are both pharmaceutical and herbal treatment options as well as dietary changes and other supplements to heal the gut after the bacterial overgrowth has been managed.

I know that many of you will finish this article and Google SIBO, which you should. Do your research, see what people diagnosed with it are saying. I do caution against trying to treat it yourself. It is a medical condition and needs to be treated by a licensed specialist.