by Dr. Joseph Debé
A test that analyzes breath samples for specific gases can identify an important underlying cause of irritable bowel syndrome, many debilitating chronic conditions, and suboptimal health. What the test actually identifies is an overgrowth of bacteria in the small intestine.
It is estimated that about 20% of the U.S. population has irritable bowel syndrome. This condition is characterized by some combination of abdominal pain, diarrhea, constipation, gas and bloating. Irritable bowel syndrome is usually a diagnosis of exclusion; when no cause can be found to explain the symptoms, it is called irritable bowel syndrome. With no known cause, treatment is strictly symptomatic, often involving medication. As an example, "Sarah" came to see me with a 5-year history of abdominal pain, diarrhea, constipation, gas and bloating. She also complained of depression, cognitive impairment, acne, poor appetite and weight loss. In Sarah's own words, she had "seen countless doctors, taken herbal supplements," and "…had many tests." A medication by the name of Lotronex had helped her diarrhea but made her constipation worse. Lotronex was subsequently pulled from the market because of toxicity.
I disagree with the belief that the cause of irritable bowel syndrome cannot be uncovered. I believe there are a number of common causes, which differ from case to case. Finding the causes necessitates using the right tests. Some of the more common causes include: the presence of toxic organisms within the intestinal tract, inadequate digestion, food sensitivities, and stress. One common cause of irritable bowel syndrome is an overgrowth of bacteria within the small intestine. Normally home to a relatively small number of bacteria, when bacteria overpopulate in the small intestine, problems arise. Small intestine bacterial overgrowth, identified very effectively with breath analysis, turned out to be a problem for Sarah. Since appropriate treatment, Sarah's irritable bowel syndrome is basically gone and she has had great improvement in her energy, mood, cognition, appetite, bodyweight and acne.
Bacterial overgrowth in the small intestine negatively impacts health in several critical ways. Bacterial overgrowth interferes with digestion and absorption. Resulting malnutrition can undermine all of the body's (and mind's) functions. Bacterial overgrowth results in production of carcinogens that contribute to colon cancer. Excess bacteria can damage the cells lining the intestine, leading to a condition called "Leaky Gut Syndrome". In this condition, toxins, inadequately digested food particles and even organisms, pass from the intestines into the bloodstream. The end result is a poisoning of the body (including the brain) and activation of the immune system, leading to inflammation. Leaky Gut Syndrome is implicated in systemic conditions like arthritis, allergic conditions, autoimmune disease, brain dysfunction and congestive heart failure.
Typically, people with small intestine bacterial overgrowth experience more and more abdominal bloating as the day goes on. Bloating, gas, diarrhea, and abdominal pain are usually experienced within a few hours after eating. Sugary, starchy foods and/or fiber usually worsen symptoms. Sometimes, small intestine bacterial overgrowth does not manifest with intestinal symptoms but may still contribute to other conditions like anemia, schizophrenia, ADHD, weight loss, "failure to thrive syndrome" seen in the elderly, and, according to a recent study, osteoporosis. Again, when digestion and absorption of food are impaired, virtually any condition of body or mind may result. Bacterial overgrowth can also lead to higher estrogen levels, which cause PMS and increased risk to breast cancer.
Breath analysis to diagnose bacterial overgrowth in the small intestine takes advantage of the fact that these organisms feed upon carbohydrates. Basically, the test involves collecting breath specimens before and after drinking a carbohydrate solution. As the bacteria in the small intestine feed upon the carbohydrate, they produce hydrogen and methane gases. These gases are absorbed into the bloodstream, travel to the lungs, and are present in exhaled air. Excessive levels of hydrogen or methane in expired air are evidence of bacterial overgrowth. A breath analysis study performed on 202 people with irritable bowel syndrome found bacterial overgrowth in 157 of them. In 47 of these people who were available for follow-up evaluation, treatment of the overgrowth resulted in partial or complete resolution of symptoms along with the improvement or normalization of breath test results.
When bacterial overgrowth is diagnosed, treatment must be instituted to eradicate the bacteria. Options include medications and herbs. Medications may work more quickly but carry the risk of imbalancing intestinal flora, leading to overgrowth of other opportunistic organisms. Another important thing that needs to be done is to identify and correct the conditions that allowed for the bacterial overgrowth, so that it does not recur. Some of the predisposing factors include inadequate hydrochloric acid production by the stomach (a condition that can result from acid-blocking medication), insufficient pancreatic enzymes, slow movement of food through the digestive system, and weakened immunity.