SIBO (Small Intestine Bacterial Overgrowth) is an alteration in the intestinal microbiota that causes an abnormal increase in the bacterial population in the small intestine and can lead to abnormal abdominal swelling, poor digestion, heaviness, nausea, or changes in bowel habits. Despite the fact that little has been said about this disease up to now, “SIBO has existed for a long time and many people have traveled around the world seven times with digestive problems without having been diagnosed and, therefore, treated,” explains María Dolores de la Puerta, an expert in microbiota and author of the book A Happy Intestine. it is known, it is not taught in universities and therefore it is not treated. At most antibiotics are prescribed, which are not always the solution,” says De la Puerta.
These days the SIBO has been the subject of controversy on social networks, starting with TikTok and continuing on Twitter. It all started with the complaints from numerous users (the vast majority of them young women) showing photos of their swollen abdomens, detailing the symptoms associated with it and, on occasions, denouncing the lack of diagnosis and the absence of tests in the Social Security. Bearing in mind that a positive SIBO is easily diagnosed with a breath test and treated relatively easily with antibiotics, it seems justified a priori for those affected to claim their right to a rapid diagnosis that puts an end to a series of discomforts that can be profoundly disabling. The responses to this series of messages were not long in coming and many users (some of them health professionals) questioned these self-diagnoses with arguments such as that bad digestions have always existed and that, ultimately, SIBO is nothing more than a fashionable disease that influencers and tiktokers have brought to the fore.
What happens on Twitter and Tik Tok is not so far from what, to a greater or lesser extent, occurs generally in medical consultations. This is explained by María del Mar García-Calvente, doctor of Medicine, specialist in Public Health and director of the specialization diploma in Gender and Health from the Andalusian School of Public Health and the University of Granada: “It is curious that people, in this case women, are criticized for self-diagnosing SIBO based on the analysis of a series of symptoms, when precisely self-diagnosis occurs in all diseases based on the description of a series of signs and symptoms reported by the patients themselves”. According to García-Calvente, to make good diagnoses “the first thing is to always believe what the patients report, which is not always the case. And it is not just a matter of respect, equity or justice: believing what the patient says helps to provide quality care, since minimizing the symptoms makes the diagnoses worse.”
However, when it comes to diffuse complaints, such as those that affect the digestive tract, it is more common than it seems to leave the office with a prescription for anxiolytics and without referral to any specialist. According to the Professor of Preventive Medicine and Public Health at the University of Alicante, María Teresa Ruiz Cantero, “any disease that presents with non-specific symptoms, discomfort or tension is usually immediately labeled, in the case of women, as mental health problems, so that interest in continuing to investigate potential diagnoses automatically decreases”. This situation “fosters the sexist stereotype of women with psychosomatic problems, which causes a delay in diagnoses and therapies.”
“This does not mean -continues Ruiz Cantero- that self-diagnoses should be carried out without having the opinion of a professional, but of course there is nothing wrong with detailing the symptoms and highlighting the problems”. In many cases, however, self-diagnosis ends up being a desperate solution that comes after “a journey, sometimes of many years, through the health system, with discomfort that worsens over the years until sometimes they end up being very difficult to treat, something that would not happen with an early diagnosis,” says De la Puerta.
For his part, Ruiz Cantero points out that the healthcare pressure received by medical professionals contributes to aggravating the situation. “When you only have four minutes to treat each patient, you tend to neglect the supposedly mild to give time to the emergency patient,” explains the professor. It is a fish that bites its tail: a public system saturated with urgent cases, with little or no attention to mild or incipient cases and the consequent despair of the people affected.
For his part, García-Calvente points out other factors that influence many cases of SIBO to be diagnosed late and poorly or simply not diagnosed, which can end up leading many patients with discomfort to end up wondering on Twitter with the aim of finding similar cases. “We need family and community medicine that really fulfills its function, which would make it possible to speed up and refine diagnoses. For a family doctor who knows our medical history, including some details of our life, it is easier to make a correct diagnosis even when the consultation is punctual and only a few minutes are available. To do this, medical care should be organized in a more patient-centered way, avoiding rotation and lack of continuity”, says the expert.
Dr. De la Puerta, specialized in microbiota and SIBO, points out, for her part, that even when there is a diagnosis, the treatments applied are not always adequate. “SIBO requires a global therapeutic approach, which is neither taught in the career nor practiced in hospitals. In public health it is usually treated with antibiotics and the matter is shelved. The result is an alarming number of recurrences and even a chronification, which causes many patients to come to my office having bumped and bumped through the system without having noticed an improvement”, explains the doctor.
This is due to the fact that SIBO is an imbalance in the intestinal microbiota that, although it is temporarily resolved with antibiotics, can occur again if those triggering factors continue to be maintained. “I myself started treating SIBO exclusively with antibiotics, but seeing the number of recurrences I decided to approach the treatment holistically. This does not mean that antibiotics are not prescribed when necessary, but rather that these have to be accompanied by changes in diet, stress management, exercise and sleep”, explains Dr. De la Puerta.
The perception that SIBO is fashionable is due, in part, to the fact that in recent times the disease has become known and diagnoses have multiplied. “Currently there are more tests, they are simpler, cheaper. SIBO is easily detected through a lactulose test”, explains the doctor and nutritionist Núria Monfulleda, from the Loveyourself center in Barcelona, ??who insists that a positive SIBO can only be diagnosed through a test and not through an analysis of the symptoms, since it can be confused with other pathologies. “Abdominal swelling, even accompanied by other symptoms, can also indicate lactose, fructose, gluten, sorbitol or helicobacter pylori intolerance,” he says. Dr. Diego Sánchez Muñoz, a specialist in the Digestive System and medical director of the Digestive Institute of Seville (IDI), agrees with her: “Some laboratories market simple tests to detect SIBO, but it is best not to use them, because they are not yet scientifically validated and can lead to errors.
For Sánchez Muñoz, it is important not to be excessively alarmed by an intestinal imbalance that “has always existed and can occur at different times in life, such as after certain infections, in specific moments of stress or in any circumstance in which bacterial overgrowth occurs and, to put it simply, the bad bacteria in the intestine occupy a place that should be occupied by the good ones. This should not be worrisome if it is not maintained over time”.
Monfulleda recalls, for his part, that swelling is common in diets rich in carbohydrates. “Carbohydrates swell, cause gas and this occupies as much space as possible in the digestive system until it is stressed to the maximum. The same happens if we eat foods that generate gas, from cruciferous vegetables to legumes, without this implying that we have any problem.”
In any case, what does not seem optimal in order to obtain good diagnoses is to question the story of an affected person neither from Twitter nor from a medical consultation. “This commotion with SIBO takes us back to the so-called “women’s malaise”, which feminists denounced in the 70s and which refers to the fact that when there are diffuse symptoms it tends to be interpreted, in the case of women, as emotional problems, depression, anxiety or nerves. This gives rise to the overuse of psychotropic medications, such as anxiolytics or antidepressants, which are prescribed much more frequently to women than to men”, points out García-Calvente, who concludes that “in clinical matters, we should try to reproduce what is already done in the field of justice: ‘sister, I do believe you'”.