4 Sure-Fire Ways to Know if You Have Symptoms of SIBO vs IBS
If you experience symptoms like bloating, gas, indigestion, constipation, or diarrhea (or the common occurrence of constipation one day and diarrhea the next…), I’m guessing you’ve visited Dr. Google to find out what's happening. Based on this search, you may have wondered if you have symptoms of SIBO vs IBS.
Typing symptoms into your search engine will give you mixed results. The human body is complex, and many diseases and disorders, including ones we usually associate with our emotions, like anxiety, can lead to frustrating gastrointestinal (GI) symptoms.
But consider this scenario: Your physician has ruled out severe concerns like celiac disease, food poisoning, and inflammatory bowel disease. Great!
And you’ve been given the diagnosis of IBS. Ok, that’s something to work with!
But no matter what you do, from following your doctor’s recommendations to changing your diet or even taking Imodium for diarrhea, it doesn’t make much difference.
If this sounds like you, it may be time to consider SIBO.
SIBO, or small bacterial overgrowth, happens when the wrong types of bacteria (versus the right ones) overgrow in the small intestine (versus living there in balanced numbers).
Even though your gut bacteria is a crucial and truly essential part of your health, balance is key.
Most of your gut bacteria are supposed to stay in your large intestine, while your small intestine is home to a much smaller number of bacteria. When the microbes in the small intestine increase beyond what is normal, symptoms will crop up.
SIBO is cause for attention and some concern due to its link to other health problems. It can lead to the release of toxic compounds in your gut, leading to intestinal inflammation, which eventually leads to inflammation throughout the entire body. Think sore joints, injuries that take longer than usual to heal, frequent illnesses, skin breakouts, etc.
SIBO can also be challenging to diagnose because, often, it is mistaken for IBS, the most common GI disorder. These two diagnoses share many symptoms like bloating, diarrhea, constipation, gas, and stomach cramps.
A 2022 meta-analysis suggested that SIBO may be misdiagnosed as IBS in up to 49% of people (1)!
However, there are some telltale signs that SIBO is causing your symptoms.
In this article, I will explain how to tell if you have symptoms of SIBO vs IBS and then exactly what to do so you can get some relief!
Stiff, painful joints
Research papers consider stiff joints (arthralgia) a rare symptom of SIBO, but many more people may suffer than is recorded.
Back in 1993, researchers noticed that people with rheumatoid arthritis had a high frequency of SIBO (2).
And in 2019, a team of rheumatologists published a study showing that in a group of people with SIBO (3):
69% had rheumatoid arthritis
89% had ankylosing spondylitis (stiffness and pain in the spine that can be mild or severe)
73% had juvenile arthritis
Interestingly, there is even a case report highlighting a patient who suffered from SIBO and arthritis who experienced total remission from arthritis and improved gut symptoms after completing a round of SIBO-killing antibiotics (4)!
Of course, there are many causes of joint pain, but if you have joint pain along with symptoms like bloating, distension, and abdominal pain, SIBO should be thoroughly investigated.
2. Severe gut symptoms that significantly interfere with daily life
When I think about SIBO, I always recall a client I had early on in my practice.
Molly was a young woman who began to experience severe bloating and distension. She reported that she felt fine in the morning, but as soon as she ate anything, her stomach began to swell. By the end of the day, she complained that she looked 5 months pregnant.
She had also lost her appetite and said she felt too full to eat much of anything.
Although this may not be the case for everyone with SIBO, the severity of bloating, stomach pain, and distention can sometimes distinguish symptoms of SIBO vs IBS.
More than two-thirds of patients with SIBO experience the following symptoms (5):
Distension
Bloating
Abdominal pain
Diarrhea
Indigestion
Gas and flatulence
In addition to these common SIBO symptoms, constipation may also be a warning sign.
For those with methane-positive SIBO, constipation is a likely symptom that can overlap with IBS-C (IBS with constipation).
Those with IBS-C have three times the odds of SIBO than those with IBS-D (IBS with diarrhea) (6)!
3. Micronutrient deficiencies
Deficiencies in vitamins A, D, E, B12, and iron are symptoms of SIBO, particularly severe SIBO (7).
Micronutrient deficiencies can go undiagnosed for some time because they can be hard to pinpoint unless you get regular lab work done.
So, if you suspect you’re deficient in these vital micronutrients, ask your provider to check your levels.
Symptoms of low micronutrients may include:
Low Vitamin A: Getting sick easily, slow wound healing, dry skin, difficulty seeing at night
Low Vitamin D: Fatigue, muscle soreness and weakness, bone pain, poor mood
Low Vitamin E: Getting sick easily, dry skin, clumsiness and poor coordination
Low B12: Anemia (can also be caused by low iron, but B12 anemia is common!), tingling and numbness in the extremities, poor balance, tiredness, nausea and lack of appetite
Low iron: Anemia, shortness of breath, fatigue, restless legs and leg cramps
Nutritional deficiencies are hallmark symptoms of SIBO vs IBS. Because SIBO affects the small intestine, where the majority of nutrients are absorbed, and healthy bacteria play an essential part in absorption, micronutrient deficiencies are a side effect. This is especially true if frequent diarrhea is one of your symptoms (8).
SIBO must be treated to correct these micronutrient deficiencies. After balance is restored to the gut microbiome, your body will be able to absorb the micronutrients it needs. In some cases, supplementing may also be helpful to get levels back to normal.
4. Rosacea
Rosacea is a lesser-known symptom of SIBO, but it’s not surprising that they are connected.
The health of your gut affects your skin through the gut-skin axis, meaning the many biochemical connections between your gut and skin.
Many gut disorders, including inflammatory bowel disease, IBS, celiac disease, and, of course, SIBO, are linked to rosacea (9). As I mentioned earlier, SIBO can cause systemic inflammation, and for some people, this inflammation shows up in the skin.
A 2008 randomized controlled trial observed a strong link between rosacea and SIBO—46% of adults with rosacea had SIBO, compared to only 5% of matched controls (10).
More importantly, studies show that rosacea responds to the antibiotic therapy used to eradicate SIBO (10, 11). One study found that 64% of patients remained rosacea-free at a three-year follow-up (11).
Do you suspect you have symptoms of SIBO vs IBS?
I’ve covered the main ways you can differentiate SIBO from IBS, but SIBO can cause a whole host of seemingly strange symptoms.
In addition to the ones mentioned here, small intestine overgrowth can lead to brain fog (7, 13), fatigue (7), and even sleep apnea (14)!
The first step to learning more about what you’re dealing with is to consult with a practitioner specializing in SIBO who fully understands evidence-backed ways to test for and address this condition.
Because SIBO has become trendy, testing and recommendations that don’t reflect the results of high-quality research have become increasingly popular.
Once SIBO is confirmed, eradicating the rogue bacteria might involve conventional antibiotics like rifaximin or even herbal antimicrobials, such as clove and pomegranate peel, which can sometimes be as effective as antibiotics in the hands of the right clinician (12).
Making temporary dietary changes can also be helpful when healing from SIBO, especially if you’re sensitive to certain foods.
Many practitioners advocate for a low-FODMAP diet while healing from SIBO. However, I’ve found that it’s most important to figure out which foods work best for you and try to allow for the most variety possible. And if you do require a stricter diet, remember that it’s temporary, and you will soon be able to eat all of the foods you love again.
In addition to these active steps to get rid of SIBO, it's essential to investigate why you developed it in the first place.
For instance, maybe you struggle with constipation, which can be a risk factor for SIBO. Or perhaps you started a new medication like a proton pump inhibitor or recently took antibiotics, both of which can lead to bacterial overgrowth. Food poisoning or connective tissue disorders can underlie SIBO, as well.
Click here to book a free discovery call to discuss how nutritional therapy can help you optimally address SIBO or figure out if you’re dealing with symptoms of SIBO vs IBS.
I can help you identify your symptoms, access the most up-to-date testing and treatment available, and get you back to a bloat and pain-free life!