Is It Really IBS… or Is It SIBO? (Most People Never Get Tested)

Summary

The video explains that some people diagnosed with irritable bowel syndrome (IBS) may instead—or also—have small intestinal bacterial overgrowth (SIBO). Because the conditions can cause similar symptoms, the presenters argue that persistent symptoms should not automatically be assumed to be IBS, particularly when usual dietary approaches have not helped.

What SIBO is and who might be at higher risk

SIBO stands for small intestinal bacterial overgrowth: an excessive amount of bacteria in the small intestine. The video associates it with bloating, gas, abdominal pain, diarrhea, constipation, and belching.

The presenters cite a 2023 review reporting SIBO in 34% of people with gastrointestinal complaints who underwent breath testing, and a French study in which 36.4% of 247 people with IBS tested positive.

Factors the video says may be associated with a greater likelihood of SIBO include:

• Persistent bloating or abdominal pain
• IBS with diarrhea
• Previous food poisoning
• Use of proton pump inhibitors (PPIs)
• Low iron or anemia
• Older age, particularly over 65

These figures and risk factors are presented as reasons to consider testing, not as a way to diagnose SIBO based on symptoms alone.

Testing and interpreting results

The presenters recommend testing rather than guessing, since the type of gas detected may affect treatment.

1. Prepare for the test. Follow the test provider’s specified diet beforehand to reduce fermentable food remaining in the gut.
2. Complete a breath test over about three hours. In the example shown, the person drinks lactulose, a poorly absorbed sugar.
3. Measure gases over time. The example test checks for hydrogen and methane. The speakers note that hydrogen sulfide is another possible gas, but not every test measures it.
4. Interpret the pattern with a practitioner.
   • A hydrogen increase of more than 20 parts per million above baseline within the first 90 minutes is described as positive for hydrogen SIBO.
   • Methane of more than 10 parts per million at any point is described as a positive result.
   • Borderline results—such as methane readings of 3–9—may need clinical interpretation, especially if symptoms are significant.
5. Consider the gas pattern as part of the clinical picture. In the example case, hydrogen remained below the stated threshold, while methane was markedly elevated, including at baseline. The dietitians interpreted this as methane-positive and hydrogen-negative. They also explain that methane-producing organisms can consume hydrogen, so the gas pattern may change after treatment.

The video uses a traffic metaphor to describe the gases: hydrogen is associated with faster movement and diarrhea, methane with slower movement and constipation, and a combination may involve changing symptoms. The key point is that symptoms alone cannot identify the gas type.

Recurrence and follow-up

The speakers say SIBO can return or may not be fully cleared after initial treatment; they cite an estimated recurrence rate of roughly 30–40%.

They stress the importance of retesting when appropriate, especially if symptoms persist or return. Without follow-up, someone may assume ongoing symptoms are simply IBS when SIBO may remain or have recurred.

The likelihood of recurrence and difficulty of treatment may depend on the underlying cause. The speakers contrast potentially manageable contributors, such as chronic constipation, with factors that may be harder to address, such as the effects of abdominal surgery.

Treatment approaches described

The video presents two main treatment routes and emphasizes that the choice should depend on test results, symptoms, medical history, and the likely cause.

• Antibiotics: Typically prescribed by a gastroenterologist; the example treatment lasts about two weeks. The presenters say some antibiotics act mainly in the gut, while others affect the body more broadly. They caution against unnecessary or repeated antibiotic use.
• Antimicrobials: Described as a potentially gentler option, often used for longer—around six to eight weeks in the video. They are not presented as automatically preferable; treatment choice is individualized.
• Dietary support: A temporary low-FODMAP diet may be used to reduce symptoms during treatment. Once symptoms improve, the person should gradually reintroduce foods to identify triggers and restore dietary variety.
• Other support: The dietitians discuss a suitable probiotic and, in some cases, supplements intended to support gut recovery. These depend on the individual situation.
• Addressing contributors: The video emphasizes identifying and managing factors that may be contributing to SIBO or symptoms, rather than focusing only on initial treatment.

The speakers’ broader message is that treatment is not simply about reducing bacteria once. Follow-up, symptom management, addressing contributing factors, and a planned food reintroduction process are presented as important parts of recovery and recurrence prevention.

Concerns about care

Joe Leech says SIBO may be missed when persistent symptoms are labeled IBS without further assessment. The video also criticizes prescribing antibiotics without testing or appropriate dietary and follow-up support.

It encourages people with ongoing unexplained symptoms—especially when usual approaches have not helped—to discuss testing and treatment with a qualified healthcare professional rather than self-diagnosing or self-treating.

Speakers and sources featured

• Joe Leech — qualified dietitian and video presenter.
• Victoria — dietitian on Joe Leech’s Digestive Disease team; explains breath-test interpretation and treatment options.
• Emily — dietitian on the same team; discusses retesting, recurrence, dietary support, and gut recovery.
• Research sources cited by Joe Leech — a 2023 review reported in the video as finding SIBO in 34% of tested people with gastrointestinal complaints, and a French study of 247 people with IBS reported as finding SIBO in 36.4%.