My belly had become a liability, prone to swelling up like a balloon and making a spectacle of itself at the most inconvenient moments. When I was chief bridesmaid at my best friend’s wedding, I was congratulated by three different people on my pregnancy. I felt awkward having to tell them that I wasn’t pregnant, just very, very bloated.
This six months pregnant bump was just one of a cluster of symptoms I’d been experiencing for over a year, along with severe abdominal cramping, groan-inducing body aches, extreme tiredness, smatterings of nausea and constipation.
My immediate thought was that it must be a women’s health issue because I’d had twins two years prior. Maybe there was some collateral damage. The cramps felt a lot like period pains, which is probably what set me off down this particular rabbit hole, but they were daily. I would also doom-scroll all the cancers.
My GP referred me for ultrasound, which revealed that my ovaries and my womb were fine but still the cramps and bloating continued. I couldn’t shake the thought that there was a problem, so I booked to see a private gynaecologist, who couldn’t find anything wrong either and asked if I’d considered that it could be IBS.
IBS? It literally hadn’t crossed my mind. I thought of several of my friends who suffer with this terribly vague, seemingly untreatable “syndrome” and went home feeling deflated, still no closer to a solution.
Enlightenment came from an unexpected source. My skin is prone to angry red flare-ups of rosacea that had become progressively worse over the previous two years. After the usual creams had failed to work, I booked an appointment with a skin expert. Dr Geoff Mullan is a former NHS surgeon and the co-founder of Human People, a health-screening company which uses diet and lifestyle to treat health issues. After asking me a lot of questions about my health he said: “I think you might have SIBO.”
The symptoms I was describing; the bloating in my upper abdomen, the cramps, the aching joints, the exhaustion, combined with rosacea, were all classic symptoms of SIBO, which stands for small intestine bacterial overgrowth. I’d never even heard of it.
What is SIBO?
“SIBO is an excessive proliferation of bacteria in the small intestine, the tube-like organ that connects our stomach to the colon,” says Dr Mullan. “Unlike the large intestine, where we need bacteria for the health of the gut microbiome, in the small intestine they can cause a lot of trouble.”
These bacteria feast on fermentable foods and then release hydrogen and methane gases that cause bloating and cramps. They also interfere with what Dr Mullan calls “the housekeeping wave” of our digestive process, slowing down digestion and interfering with the absorption of nutrients.At its worst, this can lead to malnutrition and other long-term health issues.
Then you’ve got the food and waste and bacteria hanging around, causing various digestive issues – constipation and diarrhoea are common – and non-digestive symptoms, like tiredness, brain fog and rosacea.
The good news though is, as grim as it sounds, SIBO can be definitively diagnosed and treated, unlike its catch-all gut sister, IBS.
Dr Mullan’s suspicions were confirmed when, after following a very restrictive diet for 24 hours, a breath test revealed high levels of methane and hydrogen coming from my small intestine. “A small amount of these gases are normal in the colon,” says Mullan, “but not in the upper part of the digestive tract.”
How is SIBO treated?
The treatment plan is two-fold – with a special highly restricted diet and either a two-week course of traditional antibiotics, or – the route deemed most appropriate for me – “herbal antibiotics/antimicrobials”, such as berberine and allicin, together with probiotics and – once the treatment is over – a stash of supplements to help repair the gut wall (glutamine) and decrease inflammation (glutathione).
This phase is affectionately known as the “kill phase” and I can confirm it is not fun, despite the action movie-sounding name. I had headaches, nausea and felt exhausted. Apparently, all of which is good – a sign that the bacterial overgrowth is being annihilated, so it was strangely satisfying too.
The low FODMAP diet
As for the diet, it’s another acronym I’m afraid, in the form of the low FODMAP system, devised at Monash University in Melbourne. FODMAPs (which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are a group of carbohydrates that are either poorly absorbed in the small intestine or impossible to digest. Within these four groups, there’s a whole host of food no-nos, ranging from fructans – found in wheat, onions and garlic; lactose – found in dairy products; fructose, found in some fruits; galactans – found in legumes, such as beans, lentils; and polyols – found in some fruits and vegetables like apples, avocados and mushrooms.
The aim with the diet is to starve the bacteria by reducing fermentable starches and fibres (their fuel), which will help reduce the unpleasant digestive symptoms, too. It’s a bit like not feeding a gremlin after midnight: don’t fuel the bacteria.
I hadn’t heard of FODMAP and the whole thing was a bit of a headache, especially for someone like me who pathologically hates restricting my diet. I felt like I was doing my GCSE biology again, just to be able to eat.
What’s confusing is the fact you can eat some fruits, but not others – kiwi OK, apple not OK, for instance. Likewise, vegetables. Don’t eat cauliflower and sugar snap peas but carrots and potatoes are absolutely fine. With dairy, milk and some soft cheeses are problematic but butter and hard cheeses are okay.
Fortunately, I had help from Kirsty Thompson, a BANT Registered nutritional therapist, who is part of the Human People team. Plus, Monash University also has a handy (and free) app with a traffic light system to indicate high and low FODMAP foods so you can always keep checking that.
Two of the most difficult foods to avoid are onions and garlic – they’re in so many things. Also, cutting out wheat was tough because I had to say goodbye to pasta and bread. For the short term at least. Before finding out I had SIBO, I was definitely a sandwich kind of girl. I could easily have a smoked salmon bagel for breakfast and then a ham sandwich for lunch. Dinner would lean heavily on pasta, so spag bol or penne with mozzarella. Takeaway-wise, I would have a weekly curry, or we would have pizza with the kids.
During the low FODMAP diet phase, I traded my bagel for boiled or scrambled eggs without toast. For lunch, sandwiches were pretty much out, but I’d have a jacket potato with tuna and salad. For dinner, I could have any variation of meat or fish with potatoes and the right vegetables. If I wanted pasta I would opt for gluten-free, which is not particularly tasty but sometimes satisfied that urge.
The good news with low FODMAP, though, is that it’s said to reduce unpleasant symptoms in 75 per cent or more of people suffering with SIBO and IBS.
The diet only needs to be followed short-term, until the “kill phase” is complete.
Once the bacteria have been killed off, you then start the final phase: recovery. This is when you begin to re-introduce high FODMAP foods (hello carbonara!) to see if they trigger any reactions. “The recovery stage is absolutely key to preventing recurrence,” says Dr Mullan.
I didn’t have any issues with the foods I reintroduced. So, the restrictive diet had been worth it. This was easily confirmed by doing another breath test. If you do have an issue, all is not lost. “You can pause on that food and retry on another day, or introduce it back in a smaller quantity,” says Thompson. “Most people can go back to a full and varied diet pretty quickly.”
Now, I’m back on bread and pasta, thank goodness. But I’ll make sure that it’s balanced with plenty of protein and fibre. So, for breakfast, I might have a slice of sourdough toast with scrambled eggs and avocado. Or blueberries and yoghurt are a big favourite. If I have a pasta dinner (carbonara is a big hit in my house with the kids), I’ll make sure we have it with green beans or a salad, to help the digestion along.
After all this, I’m happy to say my bloating, cramping, aching and rosacea have gone. And I’m eating healthily but without the annoying restrictions that come with following low FODMAP.
I was interested to learn from Dr Mullan that half or more of the diagnosed cases of IBS are probably SIBO. In other words, they could be diagnosed and treated, not a life sentence. “A paper from Dennis Poon at Lincoln University published in Nature estimated that 49 per cent of IBS cases are probably SIBO,” says Dr Mullan. “That correlates with my experience and is likely an underestimation as we find around 70 per cent of IBS patients who come to us test positive for SIBO.”
An estimated 13 million people suffer from IBS in the UK, so that’s an awful lot of people who are needlessly suffering. I wish more people had heard of SIBO and could get help for it through the NHS. If you manage to get a referral to a gastroenterologist via your GP, some NHS trusts do offer SIBO testing, but not all.
I for one am hugely grateful that I’ve found the solution to my uncomfortable symptoms – and I can finally ditch the maternity wear.
