Irritable Bowel Syndrome (IBS)

There is currently no established cure for IBS. However, many patients experience meaningful improvement in their symptoms and quality of life with appropriate treatment.

Not everyone with IBS requires a colonoscopy. Your practitioner will consider your symptoms, age, medical history, colorectal cancer screening eligibility and any warning signs.

No. IBS is a complex disorder involving the digestive tract and nervous system. Stress can influence symptoms, but it isn’t the sole cause.

Not necessarily. Low-FODMAP therapy is one evidence-supported option, but it isn’t appropriate or necessary for everyone. When recommended, it should include structured food reintroduction.

Not necessarily. Evidence for probiotics in IBS varies by product and clinical outcome. We don’t routinely recommend them to everyone.

No. SIBO testing is not routinely necessary for IBS. We consider it selectively when symptoms and clinical history suggest it may provide useful information.

Our nurse practitioners can assess and prescribe appropriate medications within their scope of practice. We also collaborate with other medical providers when needed.

No. You can book directly with our team.

We can review your previous investigations and treatments, reassess your diagnosis, identify potential gaps in management and discuss additional evidence-based options.

No. Irritable Bowel Syndrome (IBS) and Small Intestinal Bacterial Overgrowth (SIBO) are different conditions, although they can share symptoms such as bloating, abdominal discomfort, gas and changes in bowel habits.

IBS is a disorder of gut-brain interaction, while SIBO involves an excessive number of bacteria in the small intestine.

Some patients may have both conditions, but having IBS does not automatically mean you have SIBO.

At Sage, we assess your symptoms and medical history to determine whether investigating SIBO is appropriate rather than assuming it is the cause of your digestive concerns.

No. Routine SIBO testing is not recommended for everyone with IBS.

Breath testing may be useful in selected patients, particularly when symptoms and clinical history suggest an increased likelihood of SIBO or intestinal methanogen overgrowth (IMO).

However, breath tests have important limitations, including the potential for false-positive and false-negative results.

We consider whether testing is likely to change your treatment before recommending it.

Our approach is to test when clinically justified, not simply because bloating or IBS symptoms are present.

SIBO refers to bacterial overgrowth in the small intestine.

Intestinal Methanogen Overgrowth (IMO) involves an increased presence of methane-producing microorganisms called archaea, which may be found in the small intestine or colon.

IMO is particularly associated with constipation and slowed intestinal transit.

Although SIBO and IMO are often discussed together, they are not the same condition and may require different treatment considerations.

Not necessarily.

Breath test results should always be interpreted alongside your symptoms, medical history, risk factors and the limitations of the test itself.

A positive result doesn’t automatically establish that SIBO is responsible for all your symptoms.

When treatment is appropriate, we discuss the available options, expected benefits, potential adverse effects and strength of the supporting evidence.

Treatment depends on the clinical situation.

Antibiotics, including rifaximin in selected cases, have evidence supporting their use for certain SIBO presentations. However, treatment decisions should account for diagnostic uncertainty, the possibility of recurrence and other potential causes of symptoms.

Herbal antimicrobial protocols are sometimes used in naturopathic practice, but the clinical evidence supporting their effectiveness and safety is considerably more limited.

We don’t believe that every patient with bloating needs antimicrobial treatment.

When medication is appropriate, our nurse practitioners or collaborating medical providers may be involved in treatment planning.

Recurrent symptoms after SIBO treatment can have several explanations.

These include underlying motility disorders, anatomical or medical risk factors, medication effects, or an alternative diagnosis such as IBS.

Importantly, the return of bloating or abdominal discomfort doesn’t necessarily mean bacterial overgrowth has returned.

At Sage, we reassess persistent or recurring symptoms rather than automatically repeating antibiotics or antimicrobial supplements.

Usually not.

Although research into the intestinal microbiome is advancing rapidly, commercially available microbiome tests generally lack sufficient clinical validation to guide routine IBS treatment.

Some specialized stool tests make claims about bacterial imbalances, yeast overgrowth or digestive dysfunction that have not been adequately demonstrated to improve patient outcomes.

We may recommend validated stool investigations when clinically indicated, such as fecal calprotectin to assess for intestinal inflammation.

More testing doesn’t necessarily mean better answers or better treatment.

We don’t routinely recommend commercial IgG food sensitivity panels for IBS.

These tests have not been shown to reliably diagnose food intolerances, and positive results may reflect normal exposure to foods rather than a clinically meaningful problem.

Instead, we focus on a careful dietary history, established testing for conditions such as celiac disease when appropriate, and structured dietary interventions.

When food elimination is necessary, our goal is to identify relevant triggers and reintroduce foods wherever possible.

No.

We don’t believe that effective IBS treatment requires an extensive supplement regimen.

Some supplements may be helpful for specific symptoms, but many products marketed for gut health have limited or inconsistent clinical evidence.

Taking multiple supplements can increase costs, create potential interactions, cause adverse effects and make it difficult to determine which treatments are actually helping.

At Sage, we consider each supplement individually, including its evidence, safety, cost and expected benefit.

Our goal is to recommend what is necessary and useful, not simply add more products to your routine.

Not necessarily.

Although some studies suggest that certain probiotics may help IBS symptoms, research findings are inconsistent, and benefits cannot be generalized across all products or bacterial strains.

Some patients may also experience increased gas or bloating with particular formulations.

We don’t routinely recommend probiotics for every patient with IBS. If a trial is appropriate, we select a product thoughtfully, establish a reasonable trial period and reassess whether it is providing meaningful benefit.

Not usually.

Digestive enzymes are frequently marketed for bloating and digestive discomfort, but there is limited evidence supporting routine broad-spectrum enzyme supplementation for IBS.

Specific enzymes, such as lactase for lactose intolerance, can be useful in appropriate circumstances.

We assess whether there is a clear indication before recommending digestive enzymes.

Yes.

Some supplements can contribute to bloating, gas, diarrhea, constipation or abdominal discomfort.

For example, certain magnesium formulations can cause diarrhea, some prebiotic fibres may increase gas, and some botanical products can irritate the digestive tract or interact with medications.

Using several products simultaneously can also make it difficult to identify which intervention is helping or aggravating symptoms.

We regularly review patients’ existing supplements and may recommend simplifying their regimen.

Not necessarily.

Some patients benefit from reducing specific dietary triggers, but eliminating multiple food groups without a clear reason can make eating unnecessarily restrictive and may compromise nutritional adequacy.

A structured Low-FODMAP diet can help some people identify their individual triggers, but the strict elimination phase is intended to be temporary.

Our dietitians can guide you through food reintroduction and personalization so that your diet remains as varied and enjoyable as possible.

Many patients come to Sage after trying multiple diets, supplements, medications or treatment protocols without lasting improvement.

We begin by reviewing what you’ve already tried, what helped, what didn’t and whether your diagnosis or treatment approach needs to be reconsidered.

Sometimes the next step isn’t another supplement or test. It may be optimizing constipation management, addressing gut sensitivity, working with a dietitian, considering prescription treatment or incorporating gut-brain therapies.

Our goal is to simplify your care, identify meaningful treatment opportunities and help you make sustainable progress.