I have previously discussed how, if certain telltale signs of small intestinal bacterial overgrowth, SIBO, are present, then you can be certain that you have it.
In other words, if you experience gas, bloating, or diarrhea within the first hour after consuming a prebiotic fiber, you can be virtually 100% certain that you have SIBO. Or if you have fibromyalgia or see evidence of fat malabsorption in the toilet with a bowel movement, you can be highly confident that you have SIBO. You can be so certain that I believe that empiric management (i.e., management based on your best judgement) can and should be pursued without further confirmation.
But this question came up on a recent Undoctored Inner Circle Virtual Meetup: Can you have SIBO in the absence of any telltale signs, in the complete absence of any gastrointestinal symptoms? Yes, you absolutely can.
In clinical studies, for instance, in which participants with a health condition such as ulcerative colitis or irritable bowel syndrome are assessed for breath hydrogen gas vs. “healthy controls,” 12-40% of the healthy controls test positive for SIBO. In other words, healthy controls are hardly healthy controls. Yes, the people with ulcerative colitis or other condition typically have higher, more severe levels of breath hydrogen, but the healthy controls still show at least some evidence of upper intestinal bacterial colonization. In our latest Virtual Meetup, attendee Michael shared his experience of never having any of the telltale signs, not having any gastrointestinal symptoms, but testing severely positive for breath hydrogen with the AIRE device that required weeks of effort to normalize. (See the detailed Undoctored Protocol for SIBO in our Inner Circle.)
If you do not have any of the telltale signs of SIBO, you should still consider it if any of the following are present:
- ANY food intolerance—Especially if the food intolerance is new. Eating eggs for the first 40 years of your life without problems, then finding yourself intolerant with stomach aches or skin rashes should prompt a search for SIBO. Intolerance to fructose, sorbitol, histamine, FODMAPs, nightshades, lectins, or new intolerance to lactose should all prompt a SIBO question.
- Persistence or emergence of an autoimmune condition despite following all the components of the complete Wheat Belly or Undoctored programs–because the increased intestinal permeability and metabolic endotoxemia of SIBO can trigger autoimmune processes.
- Persistence of joint pain or swelling while on the complete programs
- Persistence of skin rashes while on the complete programs—and here you should also strongly consider fungal overgrowth, SIFO
- Persistence of fatigue while on the complete program—And, once again, strongly consider fungal overgrowth, too.
While milder cases of SIBO can reverse with our basic efforts at cultivating bowel flora, such as a high-potency multi-species probiotic, fermented foods, and prebiotic fibers, more severe cases—which are common—may not. This is where confirmation and specific additional efforts are therefore required.
The way things are going in which SO many people are proving to have SIBO, I’m heading in the direction of believing that everyone has SIBO unless proven otherwise. If you breathe air, eat food, or pay taxes, give serious consideration to exploring/considering SIBO. Yes, it’s that important.