The Right Tests for IBS and SIBO

December 9th, 2016 by admin

I bet you know someone with Irritable Bowel Syndrome. Maybe you’ve got it yourself. I talk to a lot of people who have suffered with it for years–even from childhood–and just keep going, because they’ve never found a solution that works, even from their PCP or GI specialist. 

I know I personally lived with IBS from my early childhood years, into my early thirties. I had been experiencing these issues for so long that it had become normal to me. I never thought to even mention it when getting check-ups. Maybe you can relate. 

For clarity’s sake, Irritable Bowel Syndrome is defined as a common disorder that affects the large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. The Mayo Clinic states that IBS is a chronic condition that you will need to manage long term.

While that’s true, because gut health is something that we have to pay attention to every day, it’s not true that you should have to deal with the symptoms long-term–IF you identify and treat the root causes, that is.

Testing, Testing…

You may have gone through testing with your regular doc to check for pathogens in your stool (although most of my IBS clients have not), but what I have found is that the tests that conventional practitioners use to check for GI infections are looking for bugs that cause acute infections, like Salmonella, Shigella, enterohemorrhagic E. coli, Campylobacter and Clostridium difficile. That’s great if you have sudden-onset diarrhea and are sick as a dog (ie., you have an acute infection), but if you have a CHRONIC digestive issue, like IBS, which can be characterized by diarrhea and/or constipation, run of the mill testing that checks for acute infections is a mismatch.

Functional testing is where it’s at for IBS. A Functional stool analysis, like the one I use from BioHealth Labs, the BioHealth 401H, checks for bacterial overgrowth of any kind and lets us know what bug is overgrown, including but not limited to, Citrobacter, Enterobacter, Enterococcus, Escherichia, Klebsiella, Proteus, and Pseudomonas. It looks specifically for antigens to H. pylori, Giardia lamblia and Cryptosporidium parvum (I’ve seen debilitating IBS completely disappear upon treating this common parasite that people are exposed to in working with animals). H. pylori is a common cause of heart burn, gastritis and ulcers, as well as autoimmune diseases like Hashimoto’s Thyroiditis, and can be a factor in Irritable Bowel Syndrome, as it compromises proper digestion of food and leads to bacterial overgrowth in the gut. The test also checks for parasites and their eggs via a 3-day collection.

A major difference between Functional Medicine and Conventional Medicine is their focus on and ability to treat chronic vs acute conditions, respectively. The differences in chronic- versus acute-oriented testing are often subtle and not commonly recognized by patients and conventional practitioners; however, these differences, along with the differences in treatment modalities, are precisely why so many people are not able resolve chronic issues with conventional care. This is also why so many conventional practitioners are left wondering what in the world to do with some of their toughest chronic patients.

There is a great opportunity for people find relief, if we just realize which practitioners are best for whom. Got a high fever and mysterious symptoms, or a broken leg? Go to the ER, and make sure to follow up with your PCP. Got chronic IBS or migraines, for instance? Find a Functional Medicine-trained practitioner who can help you identify and treat the root causes.

Testing for bugs known to be associated with chronic issues like IBS, in my experience, is often key to healing from IBS, along with some key diet and lifestyle changes. 

That said, sometimes after the BioHealth 401H, we find that we need to go further with testing.


Bacterial overgrowth found with the GI Pathogen Screen or other functional comprehensive stool analysis, along with symptoms, can indicate a condition called Small Intestine Bacterial Overgrowth (SIBO). SIBO occurs when bacteria that normally inhabit the large intestine find their way into the small intestine and overgrow. Up to 84% of IBS sufferers have SIBO, meaning that SIBO is the root cause of IBS for many.

The stool analysis reflects what is going on in the colon (the large intestine) as far as microbial overgrowth and pathogens; however, it does not clearly assess overgrowth in the small intestine. It just gives us clues. An Organic Acids Test (OAT) can show elevated markers of metabolites that indicate bacterial overgrowth in the small intestine as well.

To confirm SIBO diagnosis, the Lactulose Hydrogen Breath Test is used. I use BioHealth Lab’s SIBO Breath Test. This test measures levels of certain gases produced only by bacteria (hydrogen and methane), which are diffused from the small intestine into the blood stream and into the air that we breath out. It’s  important to understand which gases are elevated, as this lets us know what type of bacteria we are dealing with and what the best method of treatment will be.

Eradicating SIBO can take some time and does require re-testing after each round of treatment. Treatment options range from specific antibiotics, diet + herbs, or a liquid elemental formula for 14 days (the most effective, but the most difficult to do). Again, the best treatment option is determined based on the gas levels measured.

Once SIBO has been eradicated, a diet low in fermentable carbohydrates is followed for 3 months, after which, eliminated foods are methodically re-introduced.

Treating Infections: Order Matters

It’s important to start with a GI Pathogen Screen, as certain bacterial pathogens and parasites, if present, must be treated before SIBO. If yeast is an issue, it is best treated after SIBO. The OAT is the best way to determine yeast overgrowth, as well as Clostridia infections, which are a common root cause of digestive issues, as well as psychiatric and mood disorders/dysregulation.





Finding and treating the root causes of IBS can take some unraveling and some time, and it is best to work  with a practitioner trained in Functional Medicine. Conventional practitioners are very adept when it comes to acute, life-threatening conditions, but for chronic issues, a Functional practitioner is your best bet.

Chronic diseases develop over time in response to Stress (both physiological and psychological), Toxicants, Allergens/Antigens (this is where food sensitivities and elimination diets come in) Infections (most often underlying, not acute) and Nutrient Deficiencies (caused not only by poor diet, but compromised digestion and genetic variations).

It’s important to note that some chronic issues can seem acute, such as autoimmune diseases.

Autoimmune diseases periodically flare up acutely, but the disease persists over many years. It is also developed over many years, before the apparent onset. And guess what? It starts in the gut.

Just in the last couple of months, I have spoken to two physicians who treat people with autoimmune diseases–a rheumatologist and a gastroenterologist. Both were very candid about the fact that they hate having to prescribe toxic medications to their autoimmune patients for long periods of time. Both are very eager to have their patients try gut-healing diet and lifestyle changes to help shut off the autoimmune response;however, neither have the time, nor the expertise to help their patients in this way.

This is where I come in, as a Functional Nutritionist. I not only help you, but your doctor as well. 

If you’d like to know more about the Functional Medicine/Functional Nutrition approach to unraveling disease, whether it’s IBS, heartburn, chronic fatigue, migraines, autoimmunity or anything chronic in nature, check out this FREE webinar that I hosted a few months back as a preview call for my group program, Root Cause Reset. I’ll be launching another Root Cause Reset in the Spring, so keep your eyes peeled.

I also work individually in 6 month programs, if one-on-one is a better fit for you, or if you’d like to get started healing yourself, like yesterday. 🙂

Healing IBS is possible. You need not live with it and “manage” it forever. You just have to identify and treat the root causes, and Functional Nutrition allows you to do just that. 

Here’s to wellness beyond the status quo!

Be Well,