IBS?

Think you're bloated by IBS? It could just be Small Intestinal Bacterial Overgrowth and it's easier to manage

By PATRICK STRUDWICK

Last updated at 10:03 PM on 21st January 2012


Patrick Strudwick was told he had IBS but turns out it was SIBO

Patrick Strudwick was told he had IBS but turns out it was SIBO

For ten years I looked pregnant. Between 1997 and 2007 my bloated belly peered over my waistband as I tried to hold it in. I wasn’t overweight or malnourished. Instead, doctor after doctor gave me the same diagnosis: irritable bowel syndrome.

About one in ten people have – or think they have – this horrible condition. Its chief symptoms, apart from bloating, are constipation and diarrhoea, with pain, fatigue and sometimes depression joining in.

It is hardly taboo – several celebrities have revealed they suffer from IBS: actress Kirsten Dunst and model Tyra Banks to name a few. But are we being told the truth? Do we all really have IBS?

Four years ago, I began to suspect not. All my symptoms had intensified, in particular, the pain. I tried cutting out some of the known triggers: wheat, alcohol and cheese. I tried yoga and meditation – stress is thought to worsen the condition. But still I looked pregnant, and I grew suspicious something else was wrong. Desperate and fed up, I went to my GP and begged to be referred to a gastroenterologist.

He prodded at my protruding belly in search of cysts or tumours. He asked about my symptoms and how long I had suffered from them. He ran blood and urine tests to check for diabetes or signs of various cancers. Crucially, he took me seriously.

Having eliminated the most serious possible causes, he referred me for two tests at London’s St. Thomas’ Hospital: one for lactose intolerance and one for something called Small Intestinal Bacterial Overgrowth (SIBO).

The first test involved drinking a sugar solution and every 15 minutes for three hours breathing into a tube to measure the hydrogen levels in my breath. The second was the same except I drank a lactulose solution – a type of glucose also used as a laxative.

The first test – which was looking for a lactose (milk sugar) intolerance – came back negative, but the other, for SIBO, was positive. I had never heard of it. So back at home, I plundered Google in search of answers. The same symptoms kept coming up as for IBS: constipation, diarrhoea, bloating, pain and fatigue. Why had none of the doctors I had seen ever mentioned this condition?

‘Most GPs have never heard of it,’ explains Dr Ian Penman, a consultant gastroenterologist at Edinburgh’s Western General Hospital.

Small Intestinal Bacterial Overgrowth makes men look as though they are pregnant - a problem Patrick suffered with for 10 years

Small Intestinal Bacterial Overgrowth makes men look as though they are pregnant - a problem Patrick suffered with for 10 years

So what is it? And how many other IBS sufferers could in fact have SIBO? ‘SIBO is a condition whereby the small intestine, which normally has very few bacteria in it, becomes colonised with too many bacteria. In healthy people, stomach acid and the waves of muscular contraction in the small intestine flush most bacteria into the bowel. But with SIBO that doesn’t happen.’

Why? Mostly, Dr Penman says, it is because of four different types of underlying conditions. The first is when stomach acid is not produced because of gastric surgery, such as a bypass, or old age.

Another vulnerable group is people who’ve had multiple operations on their intestines with parts cut out or joined together, such as those with Crohn’s disease. Thirdly there are people who have other gut disorders. And, finally, people who have had multiple courses of antibiotics.

A huge proportion of those who think they have IBS actually suffer from SIBO

‘People with recurrent chest or urinary infections may have had lots of antibiotics,’ says Dr Penman. ‘This can upset the delicate ecosystem in the bowel – the balance of different types of bacteria – which then allows certain bacteria groups to proliferate.’

In my early 20s I had a succession of antibiotics for tonsillitis – eventually they were removed – which may explain my diagnosis. But, says Dr Penman, there are also those who do not fall into any of these categories who think they have IBS but test positive for SIBO, with none of the underlying factors.

‘We get into the area of could SIBO be the cause of IBS?’ he says. ‘The answer is that it is unclear. It’s difficult to tease out – the causes of IBS are multi-factorial: stress, food intolerances, and in some cases, bacterial overgrowth.’

A 2005 study published in the journal of Alimentary Pharmacology and Therapeutics found a staggering link between the condition: 98 IBS sufferers were given the hydrogen breath test for SIBO and 64 tested positive. This suggests a huge proportion of those who think they have IBS actually suffer from SIBO.

However, Dr Penman points out: ‘A more recent study found that some people with IBS give false positive results for the SIBO breath test. The reason is that what they really have wrong with them is the time it takes for stuff to go from the stomach to the bowel is too fast. So when we give them lactulose for the breath test, it reaches the bowel too quickly, which causes them to excrete hydrogen in their breath, so we get a positive result. My estimate would be that in fact no more than 10 per cent of IBS sufferers actually have SIBO.’

Kirsten Dunst is believed to suffer with IBS
Tyra Banks is believed to suffer with IBS

Actress Kirsten Dunst and model Tyra Banks are both believed to suffer from IBS

But if ten percent of Britons have IBS and even five percent of those in fact have SIBO, that would mean 300,000 people with a chronic undiagnosed intestinal disorder.

There is no cure. Instead, the condition is managed. If it is not it can lead to vitamins such as B12 and folic acid not being absorbed by the body. This can cause infertility, depression, and chronic fatigue. What then is the treatment?

‘Firstly, we look for any underlying case – are they making no acid, do they have Crohn’s or have they had surgery?’ Says Dr Penman. ‘If we can treat those factors we will. But otherwise the treatment is cyclical courses of antibiotics to reduce the number of bacteria in the small intestine.

‘We rotate several different antibiotics one after the other to try and prevent resistance or side effects. Another strategy would be four weeks on antibiotics and then four weeks off.’

A change in diet is also essential. ‘I recommend small, frequent meals, making sure you get a good intake of vitamins, and a reduction in intake of carbohydrates.’

Dr Penman advises SIBO patients to take a multi-vitamin supplement and peppermint capsules to help with bloating. ‘I’m also a fan of pro-biotics,’ he says. ‘Not so much the yoghurt-y drinks from the supermarket but a dried formulation of acidophilus from a pharmacy.’

The treatment works. After a few courses of antibiotics my symptoms all but vanished. Concerned about taking them long-term, however, I started taking probiotics instead every day, and only taking antibiotics every year or so. The most potent, and therefore helpful, probiotics I could find are called VSL3, and are available over the internet from this country. I also take vitamins pills and peppermint capsules.

Sticking to the dietary guidelines are not easy when - as I do - you have a problematic cupcake obsession. But, annoyingly, limiting carbohydrates has proved to be the most effective way of managing the condition. Although I give in now and again, cutting out cake, I can report with some sadness, is the only way to avoid looking like I’m in my second trimester.


Diabetes!

Lack of sleep to skipping breakfast: The less-known factors that can give you diabetes

By PAT HAGAN

Last updated at 9:49 PM on 9th January 2012


More than a million people are affected by type 2 diabetes and don’t even know it.

And the risks they face are high: left untreated, the condition can raise the risk of heart attacks, blindness and amputation.

Shocking new figures suggest 24,000 people die every year in England because of poorly managed diabetes.

if you regularly get less than five hours' sleep, your risk of getting diabetes is double that of someone who gets seven to eight hours

if you regularly get less than five hours' sleep, your risk of getting diabetes is double that of someone who gets seven to eight hours

Yet if doctors catch the condition, it can be controlled with diet and medication.

Type 2 is the most common form of diabetes, accounting for 90 per cent of cases.

Diabetes occurs when the pancreas does not produce enough insulin — the hormone that converts glucose into energy — or the body stops responding to insulin, triggering high levels of glucose in the blood.

This causes symptoms such as fatigue, thirst, frequent urination, recurrent thrush and wounds that are slow to heal.

Most people associate type 2 diabetes with being overweight, eating junk food or a couch-potato existence.

Diabetes occurs when the pancreas does not produce enough insulin or the body stops responding to insulin, triggering high levels of glucose in the blood

Diabetes occurs when the pancreas does not produce enough insulin or the body stops responding to insulin, triggering high levels of glucose in the blood

Yet research suggests that modest weight gain, or even relatively minor disruptions to normal dietary patterns, could be enough to cause it.

So how do you know if you are at risk? Here, we reveal the less well-known factors that can increase your chances of developing this serious condition.

HAVING AN APPLE SHAPED BODY

You don’t have to be obese to be at risk. Just carrying a few extra pounds around the waistline can be enough to cause the condition. Diabetes UK says a woman is at risk if her waist reaches 31.5in (80cm).

For a white or black man it’s 37in (94cm), and 35in (90cm) for South Asian men.

This means people who may appear relatively slim but have a ‘pot belly’ or apple shape could be more at risk than someone who looks larger but deposits fat around their upper body, buttocks or thighs.

This is because visceral fat, the type of fat that lies around the organs in the abdomen, is thought to pump out molecules that disrupt the normal balance of glucose and insulin, and also leads to damaging inflammation in blood vessels.

BURNING THE MIDNIGHT OIL

if you regularly get less than five hours’ sleep, your risk of getting diabetes is double that of someone who gets seven to eight hours.

Scientists at Boston University in the U.S. studied 1,500 volunteers aged over 50, recording their sleep patterns and testing their levels of glucose.

Five hours or less a night more than doubled the risks, while six hours was linked with a 60 per cent rise in risk.

It’s thought the danger arises because lack of rest upsets the body’s circadian rhythm, the internal clock that regulates natural sleep and wake cycles.

‘Being awake when we should be asleep increases the release of the stress hormone cortisol, which promotes the generation of glucose (to provide energy to the body to keep it going),’ says Julian Halcox, professor of cardiology at Cardiff University.

OVARIAN CYSTS

Up to 15 per cent of women in the UK suffer with Polycystic Ovary Syndrome (PCOS), a condition where tiny cysts grow on the ovaries, preventing them from working properly.

But many do not realise the condition can also lead to type 2 diabetes — at least ten per cent of sufferers develop it. This is because, like diabetes, PCOS is linked to an insulin imbalance.

As well as controlling blood sugar, insulin also stimulates the ovaries to make the hormone testosterone in women.

If there is too much insulin in the blood, the ovaries produce excess testosterone, resulting in symptoms such as excess hair growth, acne, weight gain and depression.

Once insulin levels begin to rise, damaging both the ovaries and the pancreas, a woman is well on her way to diabetes.

SNORING

Research showed the more severe the snoring problem, the greater the chance of high blood sugar levels. Men were more affected than women

Research showed the more severe the snoring problem, the greater the chance of high blood sugar levels. Men were more affected than women

Heavy snorers are up to 50 per cent more likely to develop diabetes.

Scientists at Yale University studied 1,200 patients with sleep apnoea, the snoring condition in which night-time breathing is interrupted by the airways temporarily closing.

Each patient underwent tests to measure blood sugar levels for signs of diabetes. The results showed the more severe the snoring problem, the greater the chance of high blood sugar levels. Men were more affected than women.

One of the main risk factors for sleep apnoea is being overweight, which is also a marker for type 2 diabetes.

But scientists think the closing of the airways may cause a rise in cortisol levels, driving glucose levels up.

PREGNANCY

Scientists are not sure if gestational diabetes causes changes in the body, or whether it just acts a marker for those already at risk

Scientists are not sure if gestational diabetes causes changes in the body, or whether it just acts a marker for those already at risk

Around one in 20 pregnant women develops temporary gestational diabetes.

Here, the body produces extra sugar to help the foetus grow, upsetting the normal insulin-glucose balance, and usually results in a large baby.

Although the diabetes normally resolves itself after the birth, experts fear affected women are unaware they are at a much higher risk of developing it again when they are older: statistics from the U.S. show that such women are seven times more likely to develop the type 2 form later in life.

Scientists are not sure if gestational diabetes causes changes in the body, or whether it just acts a marker for those already at risk.

Dr David Haslam, chairman of the National Obesity Forum, says: ‘We have no system in the NHS for following up women who’ve had gestational diabetes.

'They should have annual blood tests to check their glucose and insulin levels, and be given advice on diet and lifestyle,’ he says.

SKIPPING BREAKFAST

Recent Australian research found those who skip breakfast are likely to experience a sudden drop in blood sugar levels in the late morning, making them crave a sugary treat.

This leads to a sudden surge in blood sugar and, in time, the over-stimulation of insulin.

This increases the likelihood of the body’s cells becoming resistant to the effects of the hormone, allowing diabetes to set in, possibly at an early age. The excess insulin is also thought to boost the storage of visceral fat, the dangerous kind which gathers around the organs in the abdomen.

WORKING SHIFTS

Around 3.6 million Britons work shifts. Evidence is emerging that regularly changing shifts over long periods can increase the risk of type 2 diabetes by up to 50 per cent.

A recent study at Harvard University found workers who mix day and night shifts are most at risk.

As with sleep loss, the reason is thought to be the effect that disrupted lifestyles have on circadian rhythms.

DRINKING FRUIT JUICE

A study of 70,000 women found those drinking about 180ml of fruit juice a day were 18 per cent more at risk of diabetes. In contrast, eating whole fruits instead reduced the risk.

Natural sugars in fruit are absorbed very quickly through the stomach, causing a surge in blood sugar levels.

But by eating the fruit itself, the absorption is slowed down by the fibres that take longer to digest.