The real reason why you feel bloated and gasless – and how you can tackle it forever: dietician and scientist Dr. Emily Leeming

Do you often feel painfully blown up at the end of the day? Are you often Gassy? If the answer is yes, then there is a good chance that you are told that the irritable bowel syndrome (IBS) is – but there may be another underlying reason for your symptoms that is often missed.

Research, such as a study published in the Journal of Gastroenterology in 2020, has shown that no less than half of the IBs diagnosis also has bacterial overgrowth of thin intestine (SIBO).

Just like IBS, Sibo can cause a bloated abdomen, abdominal cramps, diarrhea and constipation. Part of the problem is that the difference in the symptoms between the two disorders can be so subtle that it is difficult to keep them apart.

But if your symptoms do not improve with typical IBS management, it may be that Sibo is the fault – and it is worth checking with your doctor if you have it, because the two conditions are managed very differently.

As the name suggests, SIBO occurs because of an overgrowth of bacteria in the small intestine – a place where there are usually not many. Most microbes in your intestine (together known as your intestinal microbiome) live further in the colon.

In a healthy intestine, every food that you have not broken down and absorbed into the small intestine, such as fiber, continues to your colon. There it nourishes your intestinal bacteria, which in turn make useful molecules for your health, together with gas as a natural side effect.

Problems can start when these bacteria begin to colonize in the small intestine, where they do not belong. As a result, they start to ferment food too early – especially carbohydrates – and this produces gas in the small intestine.

This can in turn lead to symptoms such as bloating, pain and diarrhea.

People with IBS are more likely to have Sibo, but it is still unclear whether SIBO is a cause, or a result, or just a co -existing condition. You don’t have to have IBS to have Sibo, although it is less common if you don’t have irritable bowel.

The overgrowth of bacteria can occur for all sorts of reasons – but the cause may not always be clear. For example, it can happen after every intestinal operation, because this changes how fast or slow food moves through the system, giving bacteria more time to grow.

Some drugs, such as proton pump inhibitors (PPIs), which reduce stomach acid, are also linked to a higher risk of Sibo. With less sour it is easier for bacteria to survive and reach the small intestine.

And circumstances that slow digestion, such as a complication of diabetes called diabetic enteropathy (where high blood sugar leads to nerve damage in the intestine) and hypothyroidism (where an underactive thyroid gland slows the mutipeline body processes) can also increase the risk.

There is no known cause of IBS – theories include changes in how the intestine and brain communicate, increased bowel sensitivity or an imbalance in intestinal microbiome.

But unlike Sibo, there is no clear, measurable overgrowth of bacteria in the small intestine.

And this is how you can check if you have Sibo.

Doctors usually use a breath test, where drinking a sugar-like solution and then breathes in a tube every 15-20 minutes.

The point is to measure hydrogen and methane mirrors – gases made by intestinal microbes.

If the gas levels nail too quickly after drinking the sugar -like solution, this can suggest that bacteria grow in the wrong part of your intestine.

It is a simple test, but not always 100 percent reliable, because other factors can influence the results, such as what you ate in advance.

So the day before the test, stay away from foods that cause gas (such as beans, onions, garlic and whole -grain) – then fasting for eight to 12 hours for the test (water only is allowed).

If Sibo is diagnosed, a brief course of antibiotics to kill the bacterial overgrowth is normally the first -line treatment.

And this can make a difference and an overview in the Journal of Neurogastroenterology and motility in 2024 it turned out that people with Sibo were almost three times more likely to feel better and have a significant improvement in the intestinal-related symptoms when they received antibiotics compared to weaving ones who received a placebo or no treatment.

However, it can return and further antibiotics courses may be needed.

Probiotics – supplements of ‘good’ bacteria – that are often recommended to fulfill your intestinal microbioma after an antibiotics are not necessarily useful for Sibo.

Although the theory is that the ‘good’ bacteria can prevent overgrowth of the problematic bacteria, the research is mixed.

Some small studies show that certain tensions can help, but others suggest that probiotics can worsen symptoms by adding more bacteria to an already unbalanced system.

A better option-so-your treatment is completed and your symptoms are established is to concentrate on adding back into the food such as beans, whole-grain, nuts and seeds, fruit and vegetables, to help restore your intestinal microbiome.

There are many diets who promise to repair Sibo, but although some people feel better to cut certain foods, only diet is not enough to erase Sibo. Most diets focus on reducing foods that can easily break down intestinal bacteria, such as fiber and sugar alcohols (found in products such as gum and protein bars), and prebiotic supplements such as inulin – because this can worsen the symptoms in people with sensitive intestines.

Some studies do show that eating fewer FODMAPS (a group of fermentable carbohydrates such as onions and apples) leads to less gas produced in the intestine, but this really requires the help of a professional and I would not advise you to try it alone. It is a limiting approach and is not intended to be followed in the long term.

My last warning is only for the Overhype. An assessment from 2024 in Neurogastroenterology and motility warned that Sibo has become a catch-all diagnosis in private clinics it is very easy to diagnose incorrectly and to treat too much.

If you use unnecessary treatment thanks to a wrong diagnosis, this can disrupt your microbiome and may make a bowel problem worse.

Ask Emily …

‘My daughter, 24, has only drunk oat milk for the past five years. Do I have to worry about her bones? ‘

Dietician and microbioma scientist Dr. Emily Leeming answers: You are right to check – many people do not realize that switching to plant milk can mean that losing nutrients that Dairy would usually offer.

We build most of our bone strength against our mid -20, which is why it is especially important that your daughter now regards her bone health.

Unlike cow’s milk, oat milk is not naturally rich in calcium or vitamin D – the two important nutrients for strong bones. In the UK, dairy products is the source of almost half of our calcium intake, so cutting without replacement can leave an opening.

Nowadays, however, many oat milk brands have been strengthened (organic and barista style that are not). Search for one with at least 120 mg calcium per 100 ml (approximately the same amount as in cow’s milk) and added vitamin D.

You have not said whether your daughter eats other dairy products or calcium -rich food, such as yogurt and cheese. If she does, I would encourage her to strive at least three parts a day to reach the recommended 700 mg of calcium.

There are also vegetable options that naturally contain a lot of calcium, such as beans, leafy vegetables, nuts and seeds, especially sesame seeds (one tablespoon contains 148 mg of calcium).

It is possible to get enough calcium through plants, but without dairy it is not easy.

If your daughter does not eat these foods, I would like to imagine that she is taking a supplement to be on the safe side. But make sure you consult her doctor before you make large changes.

Vitamin D is difficult to get from food alone. Because we mainly trust in sunlight to make our own vitamin D, a daily supplement of 10 mcg is recommended in the winter for most people in this country, because the sun’s rays are not strong enough to make enough. I hope that helps.

Answers must be taken in a general context; Consult your general practitioners with health care.