Diagnosing SIBO + Dysbiosis

Diagnosing SIBO + Gut Dysbiosis

Testing for SIBO

There are a few different and controversial methods of diagnosing SIBO. None are 100% accurate or conclusive. Even if you have a severe chronic case of SIBO, it’s not guaranteed a test will unveil the infection(6). Accurate sampling is a challenge as the bacterial populations are anaerobic, hard to reach, protected by a biofilm barrier and methods can be contaminated, influencing the results.

The breath test is the most common test for diagnosing SIBO as its simple, safe and non invasive. The breath test works because bacteria produce hydrogen and methane when they break down carbohydrates (such as lactulose, glucose, sucrose, or xylose) in the gut. These hydrogen and methane molecules enter the bloodstream, travel to the lungs, and leave the body in the breath. Thus, in theory the presence of overgrowth can be better identified through this method of testing. However, there is no consensus regarding a gold standard for diagnosing SIBO(1). This sugary solution can also make the SIBO worse so in chronic cases where a secondary AID has developed - such as our cases - this often inconclusive test isn’t worthwhile.

Thus, diagnosing SIBO usually requires a series of tests and is more a process of elimination, ruling out other possible gut conditions. Malnutrition and vitamin deficiencies may also help direct testing to find the diagnosis. Other tests to determine the presence of SIBO include - jejunal aspiration (the most accurate but invasive), stool tests, blood tests or a fresh urine broth test. It's a good idea to have multiple digestive organs checked via your GP/doctor also, including liver, pancreas and gallbladder health, as SIBO can affect the whole GI digestive anatomy and functions.

Dysbiosis Diagnosis

Gut dysbiosis and SIBO share many similar symptoms, see our Home page or the Gut Dysbiosis/SIBO In Depth page. There are at least 400 species of bacteria found in the gut microbiome and they are all essential for our health and wellness. They aid digestion, fight off pathogenic microorganisms, and synthesise and help us absorb vitamins and minerals. When these bacteria become imbalanced, and there is an overgrowth of pathogenic (bad) bacteria, they can override the beneficial bacteria and cause illness(2).

See here for a few testing methods. Not mentioned on this site however, is stool testing, which is how we both got our SIBO/dysbiosis diagnosed. There are reasonably priced stool tests you can buy online and if you go through a Nutritionist or holistic/functional medicine practitioner, they can sometimes offer discounts with companies they have deals with.

MD/Practitioner Appointments

On Visiting Doctors + Practitioners

“The single biggest problem in communication is the illusion that it has taken place.” - George Bernard Shaw

When it comes to both preparing for a consultation with a GP/specialist or functional practitioner, and the face to face meeting itself, organisation and communication are everything! Think of the meeting as an interview - you only have a short amount of time to communicate a large amount of specific data in order to receive a positive outcome (hopefully in the form of tests, specialist referrals, solutions or a diagnosis). Presenting your case clearly, calmly, methodically and without being overly emotional is important vital. Because emotions warp our sense of perspective and judgements, the more calmly and clearly you come across, the more sincerity the MD/practitioner will weigh on your words. We learned this the hard way! But this doesn’t mean that you should be a robot, but you should be aware that crying - as hard as it can be to hold it in - uses up precious time when you could be discussing the riddle of your health condition. Don’t get me wrong - we have both cried many times in doctor’s surgeries and when seeing consultants. Take deep breaths and remember that you’re there to get some practical help from someone willing and who is able to give you that help, or refer you to someone who can.

Preparing for a health appointment -

Draw up a timeline, starting at the very beginning with your first signs and symptoms and ending as close to the current date as possible
List all your medications + supplements - some supplements can interfere with the absorption of meds so it’s important to list both
Diet. Write down all your food intolerances, including how your body reacts and to which foods (for us this list was very long!) and “safe” foods.
List your symptoms. Again, for us this list was very long but it’s important to include symptoms which come and go as well as those which have the biggest impact on your life every day.

All of the above it useful for your own records too and will help you keep track of changes.

The Right Attitude + Expectations

The importance of having the right attitude when entering any surgery/clinic cannot be understated. It’s best to go in with an open mind and ready to listen. Going in with guns blazing, an arrogant attitude and fixed ideas means that neither you nor the doctor will get the most out of your brief time together. You know your body better than they can, but at the end of the day they do have years of medical training and may be able to suggest possible diagnoses and have ideas that you hadn’t thought of, or didn’t know about previously. Once you have listened to their ideas, then you can tell them your ideas about what you believe may be going on in your body and the next steps you’d like to take - testing etc. UK-based peeps - be warned - you will have to go through the long-winded NHS system and certain tests which are just standard procedure. It may take time but having any kind of results, even negative ones, will make the wait worth it. And it’s free!

Also - make sure your expectations aren’t too high. Try to keep them realistic and grounded.

Addressing the Root Causes

Addressing the Root Causes + the Importance of Mental Health

“Why do (behavioural) patterns translate into illness? ...because as traditional medicine has always understood and as Western science has now confirmed, mind and body are inseparable…the emotional sections in the brain are connected with the immune system, hormonal apparatus and the nervous system.”(7) - Dr Gabor Maté

In our body-conscious society, we often focus far more on fitness and diet than mental wellbeing. But we neglect our mental health to the detriment of our physical and emotional health. Traditional medicine has long-since been treating patients holistically, believing mental, physical, emotional and even spiritual health to be entwined. Scientific studies are now revealing that our mental and physical states are indeed linked and that one profoundly affects the other - as those who have suffered from a mental disorder such as anxiety of depression will know intimately after having experienced first-hand the physiological symptoms.

Stress manifests itself physically in the body, wreaking havoc with our internal systems(3), (4), (5) and we now know that there is a fundamental link between our thoughts and the stress levels we experience(6), (7). Our thoughts can have a profound influence our physical wellbeing(8), (9).

“The greatest discovery of my generation is that human beings can change the quality of their lives by changing the attitudes of their minds.”(22) – William James

As mental health is so paramount to our overall health, we’ve dedicated 4 pages on this site to the subject - Mental Wellbeing, Meditation, Happiness and Creativity + Art as Therapy. But in many cases there is more than one cause and assessing the full picture - your holistic health - is essential to understanding where you are now and what’s going on in your body.

Chronic Illness - What to Get Tested

Chronic Illness - What To Get Tested

“Inflammation appears connected to almost every known chronic disease — from heart disease to cancer, diabetes to obesity, autism to dementia, and even depression.”(3)

“Autoimmune conditions are connected by one central biochemical process: A runaway immune response also known as systemic inflammation that results in your body attacking its own tissues.”(3)

Detecting Chronic Inflammation

Inflammation is not easy to detect - it can hide in specific tissues and systems and can be present on a microscopic level. There are accessible blood tests that are quite sensitive to various signs of inflammation, but because biology is messy they are not super reliable, and even people with serious inflammatory diseases do not always get a positive result(5).

Nevertheless, ask your doctor to get your “CRP” (C-reactive protein) levels checked. This is a common and easy test to get done, and you might discover that you have not-so-low-grade inflammation which is potentially chronic!

Testing For Autoimmunity

There is no single test which can diagnose most autoimmune diseases. Your doctor will use a combination of tests (a process of elimination) and a review of your symptoms and physical examination to diagnose you. The antinuclear antibody test (ANA) is often one of the first tests that doctors use when symptoms suggest an autoimmune disease(4). There are now 80+ recognised autoimmune conditions, each with their own specific symptoms. However, there are a few uniting symptoms which they seem to share.

The early symptoms of many autoimmune diseases are very similar, and include the below(4) -

Fatigue, body heaviness and weakness
Achy muscles
Swelling and redness
Low-grade fever
Trouble concentrating (brain fog)
Numbness and tingling in the hands and feet
Hair loss/thinning
Skin rashes/Eczema and other skin issues

Addressing the Root Causes Of AI

It has been recognised that there are a few underlying and significant factors which seem to be playing a major role in causing autoimmunity. Dr Jockers has highlighted 12 areas to address for autoimmune disease(5), many of which we discuss the in depth elsewhere on our site -

It is common to have more than one factor as the cause. Explore SIBO + Autoimmunity to read more.

Complications of SIBO

Gut Dysbiosis + SIBO Complications - What to Get Tested

This chronic, complex health condition can cause many more potentially serious health issues. Be vigilant, stay informed and get tested regularly. We list some of the major common health complications which can arise as a direct consequence of SIBO and gut dysbiosis below. Some tests can be bought cheaply online but most can be done via the NHS and a quick trip to your local GP.

Malnutrition. Get a blood test to measure your serum protein levels checked - albumin, prealbumin (PAB), transferrin, and retinol-binding protein (RBP). They sometimes measure this against your height and weight also. You can easily keep an eye on your own weight at home too
Thyroid health (see hormonal balance below). There are a lot of factors which can influence the vital functioning of this small butterfly-shaped gland. Not only that - the thyroid can wreak havoc in 2 different ways - it can be either overactive or hyperthyroid or under active or hypothyroid. According to Dr Jockers; “The thyroid gland is the most common site for the development of an autoimmune disease.”(6) and he suggests ways to rebalance the thyroid naturally as well as how to gain balance from hyperthyroidism naturally. Either online via MediChecks or your local GP, be sure to get your thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels checked via a simple blood test. Also read interpreting your blood results - very helpful
Immune health. It’s a good idea to also get your white blood cell count taken. Though high levels can indicate various happenings in the body - injury, fighting of an infection etc. it’s still worth your while getting this tested
Iron Deficiency and B12 Anaemia. Another common symptom of SIBO and these two levels are easily tested for and treated also. Make sure they check your ferritin levels - these are your body’s iron stores
Leaky gut + autoimmune conditions. These 2 complications are much more difficult to test for, but we’ve written extensively on both, including the symptoms which you should be vigilant of, on the SIBO + Autoimmunity page
Chronic fatigue. There are tonnes of underlying factors which can contribute to this symptom. We both have suffered from this, and fatigue is far more than just tiredness. Healthline sums up fatigue well, and lists some of the major causes - which can be linked to physical and mental health conditions and lifestyle factors - and some of the best ways to manage fatigue
Mild cognitive impairment (MCI) AKA brain fog! There are many causes of this complication also, some of which are listed by Mayo Clinic. Lifestyle factors which can contribute include lack of mental stimulation, depression (and anxiety) and lack of physical exercise. Brain fog can also be caused by levels of toxicity in the body and SIBO, as we explain on the Gut Dysbiosis/SIBO In Depth and Living Clean + Green pages. MCI can lead to dementia.
Impaired digestion in the forms of lowered gastric acid production and GI motility dysfunction, as well as other digestive-related complications(7).
Hormonal imbalance + toxicity. This is a huge topic. There are about 50 hormones in the body, each with a vital job to play. They control everything from mood to weight by acting as messengers, controlling and coordinating activities throughout the body. Although hormones circulate throughout the body, each type of hormone influences only certain organs and tissues - some affect only one organ but others have far-reaching influences throughout the body(8). “Estrogens play a significant role in the physiology and pathology of the gastrointestinal (GI) tract, including the regulation of motor and sensory function.”(9) Hormonal imbalance and toxicity can be a causative factor in the development of SIBO, but like the chicken or the egg scenario, the bacterium themselves also influence and disrupt hormonal balance(10).
Skin conditions. Eczema and urticaria (rashes) among other skin issues are a major symptom of SIBO. This relates to the autoimmune aspect of SIBO but also directly to the skin-gut connection, as anyone with a gut disorder will be aware
Hair Loss. The 2 main SIBO-influenced causes of hair loss are hormonal imbalances and a lack of dietary amino acids from having a restrive diet and decreased absorptive capacities.

“...forgetfulness about little things such as names or grocery lists could indicate hypothyroidism, or low levels of thyroid hormone.”(10) - just one of many symptoms of hypothyroidism to watch out for.

“If there’s not enough cortisol there is development of gut inflammation. And that’s a problem because from gut inflammation we can lose our protective mucus lining, we can start changing our microbiome, we can start breaking away the IGG immunity there and start reacting to what would necessarily shouldn’t react to and so forth.”(9)

“An absent or disordered migrating motor complex pattern is almost always invariably associated with SIBO.”(11)

Associated Conditions

SIBO + SIFO (small intestine fungal overgrowth) coexist in 34% of SIBO patients; many antibiotics (a prime treatment for SIBO) can increase fungal overgrowth.
SIBO + IBS: There is 5x more prevalence of SIBO in IBS compared to healthy controls(11).

Reading the Signs

Know + Trust Your Body

We are all unique as our fingerprints and microbiome profiles, and at the end of the day, we know our bodies better than any medical professional can. But learning to read the signs that your body is giving you can take time and some signs can be misleading. We read many signals incorrectly because of cultural conditioning/myths and below we bust a few mainstream beliefs -

Stomach growling = hunger. We are taught from a young age that when our stomachs growl or grumbles it means we are hungry and should eat. The stomach and SI doesn’t just growl when we are hungry and hunger pangs don’t necessarily mean we are hungry. They are simply consequences of the digestive process. More info about the whys and hows here.
Mistaking hunger for thirst. It’s easy to confuse these 2 most basic cravings and the reason why is fascinating - hunger and thirst and influenced by our environment. So the fact that we seem to be the only mammal confused and unable to tell the difference between these 2 urges, could be because we live so out of step with our natural environment. We often satiate both hungers at meal times to save time and the types of foods we tend to eat today can also affect our thirst mechanism, making it less reliable as a cue to drink(12). If we drank when we were thirsty and ate when we are hungry, we probably wouldn’t experience this phenomena. But not so long ago, the agricultural and industrial revolutions altered our way of living and perhaps the biggest life-changing factor, was that it forced us out of our natural feeding, fasting and drinking routines, making us eat and drink at specific, scheduled times of the day. Suddenly, adults and children could only eat and drink when it suited factory and company owners or the agricultural clock.“European(s)...changed the biological demands of eating and turned it into a forced food farce. Ignore the manmade routine and follow your own appetite for a healthier life.”(13) More about this topic on the Fasting page.
Pain. As painscience.com states; “Pain Is Weird.” Pain is a complex, unreliable, exaggerated and overly protective warning measure which is commonly non-specific - there is rarely a single cause or cure, making it hard to know what’s actually going on. Chronic inflammation, even if its low-grade, can be a major culprit and inflammation itself is a mysterious creature. We know it’s just a part of life - everything is inflammatory to some extent (except fasting) - and the result of having a dynamic defence system(14). But in a nutshell, pain is a hard signal to read and if persistent, see a medical professional to get to the bottom of the problem. Nerve pain is even weirder - it can cause a huge range of sensations like numbness and tingling. Neurologists specialise in these issues, investigating and treating disorders of the nervous system.