Why do I have so much Gas and Bloating?

By Dr. Alicia McComas

Gas and bloating are common and uncomfortable symptoms many people experience, often prompting a trip to the pharmacy for over-the-counter remedies like antacids or gas relief medications. When these don't work, a visit to the doctor might result in prescriptions such as proton pump inhibitors (PPIs) or antibiotics. While these treatments can temporarily alleviate symptoms, they often fail to address the root cause and may even worsen the condition.

The Hidden Culprit: SIBO

Small Intestinal Bacterial Overgrowth (SIBO) might be the underlying reason for persistent gas and bloating. SIBO occurs when bacteria, typically found in the large intestine, overpopulate the small intestine, leading to the fermentation of undigested food. This fermentation produces excess gas and bloating that tends to worsen throughout the day.  SIBO isn’t just about gas and bloating. It can also manifest as abdominal pain, diarrhea, constipation, fatigue, nutrient deficiencies, and even systemic symptoms like joint pain. About 6-15% of healthy individuals and up to 80% of people with irritable bowel syndrome (IBS) may have SIBO​.

How Do You Get SIBO?

SIBO often develops due to impaired gut motility, structural abnormalities, or dysfunction in the gut's protective mechanisms. Conditions such as diabetes, hypothyroidism, a history of food poisoning, or previous surgeries can increase risk. Although a clinical diagnosis can be made based on symptoms, a breath test measuring hydrogen and methane gases is the standard diagnostic tool.

Conventional Medicine Treatments and Their Drawbacks

Conventional medical doctors typically prescribe antibiotics like Rifaximin or neomycin to target SIBO. While Rifaximin boasts up to a 91% success rate in reducing bacterial overgrowth, recurrence is common without addressing the underlying causes. Furthermore, antibiotics can disrupt gut microbiota, potentially leading to new digestive issues​.  PPIs, often used to reduce gas and bloating, can exacerbate SIBO by reducing stomach acid, which is essential for preventing bacterial overgrowth. Over-reliance on such medications risks masking symptoms rather than resolving the root problem​.

Naturopathic Treatment Options for SIBO and Success Rates

Naturopathic approaches to SIBO aim to address both symptom relief and the root causes to prevent recurrence. Treatment options include:

1. Herbal Antimicrobials: These plant-based remedies, such as berberine and oregano oil, achieve success rates of up to 85%, comparable to antibiotics but with fewer side effects and minimal disruption to the gut microbiome​.

2. Elemental Diet: This nutritionally complete liquid diet starves bacteria in the small intestine while providing essential nutrients. Its success rate matches antibiotics, ranging from 80-85%, but adherence can be challenging due to its restrictive nature​.

3. Dietary Modifications: A SIBO-specific diet, often low in fermentable carbohydrates (e.g., the Low FODMAP or Specific Carbohydrate Diet), helps alleviate symptoms and supports recovery. While not curative alone, dietary changes enhance the effectiveness of other treatments.

   
   

Comprehensive Naturopathic Protocol

To effectively manage SIBO, a systematic approach is essential:

1. Remove the Cause: Identify and address underlying factors such as motility disorders, structural abnormalities, or conditions like diabetes or hypothyroidism.

2. Eliminate Overgrowth: Use herbal antimicrobials or the elemental diet to reduce bacterial populations in the small intestine.

3. Restore Gut Balance: Heal the intestinal lining, optimize digestion, and rebuild the gut microbiome with dietary changes, supplements, and probiotics.

   
   

TakeawayIf persistent gas and bloating have disrupted your life despite using over-the-counter medications or prescriptions, it may be time to consider SIBO as the underlying cause. Treating SIBO effectively requires more than symptom management—it demands addressing the root causes. A naturopathic approach, which emphasizes resolving the overgrowth, healing the gut, and preventing recurrence, offers a promising pathway to long-term relief. While it may take dedication and multiple treatment rounds, this holistic protocol can significantly improve digestive health, alleviate discomfort, and restore balance, empowering you to reclaim your well-being.

References:

• Pimentel, M., et al. (2011). Rifaximin treatment in small bowel bacterial overgrowth: A double-blind, placebo-controlled trial. American Journal of Gastroenterology, 106(11), 2045–2053.

• Roberfroid, M., et al. (2017). Prebiotics and probiotics in SIBO treatment: A review of alternative therapies. World Journal of Gastroenterology, 23(23), 4109–4119.

• Pimentel, M., et al. (2012). The elemental diet is an effective treatment for small bowel bacterial overgrowth. Digestive Diseases and Sciences, 57(4), 978–983.

• Ghoshal, U. C., et al. (2017). Elemental diet and rifaximin in the treatment of SIBO in patients with IBS. American Journal of Gastroenterology, 112(7), 1100–1107.

• Horvath, A., et al. (2012). SIBO and IBS: Overlap and therapeutic approaches. European Journal of Gastroenterology & Hepatology, 24(4), 391–395.

• O'Keefe, S. J. D., et al. (2017). Gastrointestinal motility and SIBO: Pathophysiology and therapeutic considerations. Journal of Clinical Gastroenterology, 51(4), 321-329.