Over time, in addition to bowel discomfort, gas production leads to poor fat, carbohydrate, and protein absorption by damaging the intestinal wall lining, creating what’s called “leaky gut.” This also causes vitamin deficiencies, the most acute of which are B-12 deficiencies, leading to weakness and fatigue (and in advanced cases, mental confusion). In addition to bloating, fermentation can create a range of IBS issues: usually diarrhea from hydrogen and hydrogen sulfide production, and constipation from methane, although there can be both or neither. Certain bacteria can also produce another gas, hydrogen sulfide, but this type of SIBO does not have its own name. Although SIBO has served as the umbrella term for both kinds of overgrowth, experts now prefer to differentiate between them and refer to archaea excess as intestinal methanogen overgrowth, or IMO. In the fermentation process, the bacteria release hydrogen, and the archaea release methane, creating the appearance of bloating. Instead of allowing the small intestine to digest food and release nutrients into the bloodstream, the bacteria or archaea get there first and ferment the food. The bacteria or archaea interfere with normal digestion by competing with patients for food. SIBO is the abnormal and prolific growth of either bacteria or archaea-a single-celled organism older than bacteria-in the small intestine. “I still hear from patients every day that they go to the gastroenterologist and it’s still not being recognized,” says Jacobi. ![]() ![]() But although Jacobi and others have led an awareness crusade, many practices fall short when it comes to SIBO diagnosis and treatment. Nirala Jacobi, a naturopathic doctor whose online platform “The SIBO Doctor” offers courses on the disorder for both practitioners and patients. “People were relegated to ‘learn to live with it.’ When SIBO came along, it really offered some cures and solutions,” says Dr. Their symptoms can be managed through diet and a handful of supplements and medications, but for a long time, a cure was considered to be out of the question. Approximately 11% of people worldwide suffer from IBS, a “wastebasket diagnosis” many patients with an array of digestive issues are given when doctors can’t pinpoint a more precise cause. SIBO is a notoriously underdiagnosed condition, despite research suggesting it may be a chief cause of irritable bowel syndrome (IBS). She answered the first few notes, but when the avalanche didn’t let up, she set up an automatic response with links to online resources. They reach out from all over the world and are like, ‘No one here where I live knows what this is,’” Lapine says. “I’ve gotten many, many messages and emails from really sick, desperate people. ![]() That’s when she learned how lucky she’d been. Lapine, a food and health writer and chef, chronicled her SIBO journey and shared SIBO-appropriate recipes on her blog and podcast in early 2018. It would take six weeks of antimicrobial medicines and another six months of a restricted diet for her digestion to feel normal again, and for the bloat to finally go away. But treatment proved to be an odyssey in and of itself. The diagnosis was a relief: “It’s not all in my head the bloating is just sticking to my body like an inner tube,” Lapine, now 36, remembers thinking. Lapine, who lives in New York, had never heard of it, nor had her endocrinologist warned of the possibility of developing it. She turned to a functional doctor who quickly gave her a diagnosis: small intestinal bacterial overgrowth (SIBO), a gut condition not uncommon for hypothyroid patients. ![]() She was following a gluten-free diet, drinking kombucha and taking prebiotics, and finally feeling her best when she noticed peculiar gut symptoms starting to rear their head: burping during meals, stomach discomfort, and a bloated belly that simply would not deflate. In 2017, shortly after she turned 32, Phoebe Lapine had just spent the previous three years overhauling her health to make up for her ailing thyroid, the result of unchecked Hashimoto’s thyroiditis.
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