The SIBO Struggle: What the Heck is SIBO?

For the past several years, I've been struggling with "stomach issues". If that sounds vague, that's because the symptoms of said stomach issues are vague and difficult to explain, which is probably why the underlying condition went undiagnosed for so long.

The problem started back in 2007, though it's possible it started even earlier but I only began to take notice in 2007. That year I started experiencing unbelievably painful bouts of acid reflux. They would usually come on in the middle of night while I was sleeping, though there were some notable exceptions, including an agonizing day spent wandering the streets of Seattle by myself (this was prior to moving here; my partner and I had checked out of our hotel and I had a few hours to kill until he finished a work-related training, so I ended up going to see Bridesmaids by myself just so I would have somewhere to sit down). It's hard to explain the pain, but it felt as though my esophagus was on fire. It was difficult to breathe and my stomach was tender to the touch and distended. Lying down only worsened the pain, which made falling back asleep nearly impossible. Often these episodes would strike at 3 or 4 in the morning and left me absolutely wrecked the next day.

Through trial and error I discovered that famotidine was the only thing that helped at all during these episodes, and I learned to take it at the first sign of trouble. Eventually I started noticing warning signs that an episode was about to strike, such as a burning pain that radiated from my solar plexus through to my back. I went to countless doctors over the years, who diagnosed me with a myriad of contradictory conditions: GERD (Gastroesophageal Reflux Disease), too much stomach acid, too little stomach acid, poor diet, etc. None of these diagnoses really matched what I was experiencing, and there didn't seem to be any rhyme or reason to when the episodes would strike. I started paying attention to my diet, but foods that I thought were triggers would sometimes cause problems, and at other times be completely fine. As far as I can tell the aforementioned Seattle episode was brought on by a drool-worthy dinner of Dungeness crab macaroni and cheese, but I've eaten macaroni and cheese countless other times without incident. The same can be said for pizza, spaghetti, beer, etc. Admittedly these things are far from healthy (and I'm sure the grease and fat and alcohol didn't help matters much), but the point that I'm trying to make is that there were no consistent triggers, which made it difficult to avoid whatever was causing these problem. Eventually I just gave up on trying to get to the root of things and just made sure I always had famotidine on hand.

Photo courtesy of The Commons.

Over time the episodes decreased in frequency, from at least once a month to only one or two episodes a year. This was a welcome reprieve, but I began noticing other seemingly unrelated symptoms. I was gassy all the time, which usually manifested as flatulence, though sometimes the gas seemed to build up inside of me to the point that I would double over in pain. I also began experiencing a sensation that I can only describe as a "gurgle" in my esophagus: not quite a burp, but more of an involuntary sensation and noise, not unlike the gurgle pot! This was embarrassing, but not life-threatening, so I just accepted it as another one of my body's quirks and went on with my life. Then I began experiencing frequent bouts of diarrhea, often after eating romaine lettuce, cabbage, or apples. But much like the acid reflux episodes, these food triggers weren't at all consistent, only causing problems intermittently.

Interestingly enough, my diagnosis came quite by accident. At about the same time as my acid reflux episodes started, I developed what was later diagnosed as perioral dermatitis. I was also experiencing frequent flushing of my chest, to the point that the skin was not only bright red, but also hot to the touch. After many unsuccessful treatment attempts by dermatologists, I discovered a local naturopathic dermatologist and thought it was worth a shot. Not long into my first appointment, my naturopath suggested that my perioral dermatitis and flushing (possibly a form of rosacea, according to her) might be caused by my previously undiagnosed stomach issues. My naturopath thought I might have SIBO: Small Intestinal Bacterial Overgrowth.

Small intestinal bacterial overgrowth (SIBO) is a condition marked by an overgrowth of bacteria in the small intestine, where the body continues to digest food after it exits the stomach.The small intestine should be relatively free of any long-term housing for bacteria—even the good kind, the ones you find in probiotic foods. Your residential bacteria and yeast mostly live in the colon, or large intestine. SIBO occurs when food and microbes stagnate—or do not move—through the small intestine. Signs of SIBO range from heartburn and cramping in the upper gastrointestinal tract to constipation and diarrhea. SIBO makes the small intestine leaky. Over the long term, this affects the small intestine’s ability to absorb nutrients from food. An inflamed and leaky small intestine can lead to anemia from iron deficiency or from vitamin B12 deficiency. Other long-term affects of SIBO may include fibromyalgia or chronic fatigue syndrome.

My naturopath sent me home with a hydrogen breath test. After detoxing from antibiotics and probiotics for 2 weeks, I devoted a weekend to the test. I ate a strict diet of (unseasoned!) rice, eggs, and meat for 12 hours, fasted for 12 hours, and then took the three hour breath test (and then promptly went out to brunch with my partner and treated myself to biscuits and gravy). A few weeks later I had a follow-up appointment with my naturopath and she shared my test results, confirming that I do indeed have SIBO. Together we came up with a plan to treat it, which warrants a post in and of itself.

After 8 years and countless consultations with doctors, it is a relief to finally have a diagnosis and a treatment plan. But the treatment of SIBO isn't a cakewalk; in fact, it's been one of the most physically and psychologically challenging experiences of my life. I hope that blogging about this journey will help me maintain my sanity, and maybe even help a few some people in the process! Stay tuned for more updates on my struggle against SIBO.