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Do I Have Small Intestinal Bacterial Overgrowth (SIBO)?

Last time in this series on digestive health, we looked at Irritable Bowel Syndrome (IBS). This week, we’ll look at “small intestinal bacterial overgrowth” – commonly referred to as “SIBO” – one of the leading causes of IBS and digestive problems.

Over the past few years, the number of people being diagnosed with SIBO seems to be on the rise. This may be due to our modern lifestyle, or it could be that more people are learning about the condition and asking their doctors to test them for it. Despite this, I still find that many people suffer with SIBO without knowing they have it, and many doctors fail to diagnose it.

In this article, I will share the fundamentals about small intestinal bacterial overgrowth, so you can feel confident and informed if you wish to discuss diagnosis and treatment options with your doctor or naturopathic physician.

What Is SIBO?

Our bodies have a symbiotic relationship with gut bacteria. Having the right types in the correct balance is essential to our health. Gut bacteria play many roles in our overall health, helping our bodies:

Bacteria are present in our stomach, small intestine and large intestine. Under normal conditions, the majority of gut bacteria are housed in the large intestine, while only trace amounts of bacteria live in the small intestine.

Although small intestine bacteria are fewer in number, they still play an important part in producing regularity signals to the intestinal cells. If those bacteria become imbalanced, it can disrupt the normal functioning of the entire digestive system. Such an imbalance could arise from foreign, invasive bacteria entering the gut OR from an abnormal increase in native intestinal bacteria in the small intestine. The result is “small intestinal bacteria overgrowth” – SIBO.

What Are the Symptoms of SIBO?

You may suspect you have SIBO based on symptoms such as:

People who have gone untreated for SIBO a long time may also exhibit symptoms of malabsorption of vitamins and minerals, which can lead to some of the “generalized, nonspecific symptoms” above. For example, low calcium can lead to muscle spasms, selenium deficiency to skin rashes and dermatitis, and vitamin B-12 deficiency can cause nerve pain, anemia and fatigue.

How Is SIBO Diagnosed?

At present, the only reliable way to diagnose SIBO is a hydrogen breath test, in which multiple breath samples are collected at timed intervals. In each sample, the levels of hydrogen and methane gas (normal by-products of gut bacteria) are recorded. If the test indicates these gas levels are higher than normal, a diagnosis of SIBO can be confirmed.

How Do I Treat SIBO?

Currently, there are four main approaches to the treatment of SIBO:


Antibiotics are drugs that kill bacteria in the body. Doctors often treat SIBO with a course of pharmaceutical antibiotics, such as Rifaximin or Metronidazole. However, natural botanical antibiotics can often be just as effective as pharmaceuticals. Possible options include:


Probiotics are supplements that can help the intestines repopulate with healthy bacteria. Determining the best brand and strain of probiotic for you can be done via a stool culture under the guidance of your physician.


Originally developed by a research team at Monash University in Australia, the Low FODMAP diet was designed to treat and manage the symptoms of IBS and SIBO. “FODMAPs” (“Fermentable, Oligosaccharide, Disaccharide, Monosaccharide and Polyols”) are short-chain carbohydrates that are poorly absorbed in the small intestine. A diet rich in these foods is likely to produce excess gas and bloating in the small intestine. Therefore, avoiding such foods can help bring your bacteria back into balance.

NOTE: The low FODMAP diet will be the topic of the next article in this series on gut health. Be sure to subscribe to A Path to Natural Health to receive it and all future articles on this blog. You’ll find the subscription form at the top-right side of your screen.

Intestinal Biome Treatment

Sometimes bacteria will produce a slimy coating to protect themselves. Think of it as a kind of biological “house”. We call this house the “biome” or “microbiome”. If your gut biome becomes too thick and impenetrable, antibiotics or probiotics will have little effect on SIBO, as they won’t be absorbed. In such cases, it may be necessary to treat the gut biome directly, by breaking through the protective layer surrounding the bacteria. We will look at the gut biome and possible treatment options in a future article in this series.

How Can I Prevent SIBO from Recurring?

Unfortunately, many people who are treated for small intestinal bacterial overgrowth can experience a reoccurrence. In my experience, the most typical reason for recurrence is that the original cause that led to the condition was never identified and addressed. Thus, the best way to ensure SIBO stays out of your life for good is to work with your physician to understand what caused it in the first place, and then devise an appropriate treatment regimen.

Once the underlying cause has been addressed, there are many other pro-active steps you can take to help prevent SIBO from troubling you again.

Healthy Eating

A healthy diet is the backbone to maintaining intestinal health. While specific dietary needs are highly individualized, the fundamentals of healthy eating are the same for everyone:

Gut Ecology

Healthy gut ecology is imperative to preventing an overgrowth of bacteria in the small intestine. If you need to take antibiotics, you should always follow them with a course of probiotics to repopulate the digestive system with good bacteria. Bear in mind that some people have difficulty growing good bacteria in the gut (we call this “seeding”). If this is the case with you, you may need to take supplemental probiotics on a regular basis.

Identify Food Allergies and Sensitivities

Inflammation in the intestinal environment can create a breeding ground for non-beneficial bacteria. Addressing food allergies and food sensitivities is key to reducing inflammation at a cellular level in the intestines. By identifying food sensitivities and allergens and eliminating them from your diet, you automatically reduce the chances of SIBO recurring.

Address Leaky Gut Issues

Leaky gut is the common term for increased intestinal permeability. It occurs when there is inflammation of the intestinal cells, which can create gaps between the normally “tight” cellular junctions. While leaky gut can lead to a variety of health issues, SIBO can also trigger leaky gut by altering the healthy flora in the small intestines, thus increasing potential damage to the healthy intestinal cells.

Manage Your Stress

I cannot emphasis enough how great a role stress plays in causing poor health and disease. Temporary stress is a normal part of everyday life; but when stress becomes chronic, it is crucial to integrate stress management techniques into our lives. Exercise, meditation, counseling, massage, walking in the woods, journaling, quiet time, regular sleep, and balancing meals and blood sugar are just a few suggestions to help manage and minimize stress.

Do a Cleanse Once a Year

When I work with patients who have been diagnosed with SIBO, I often recommend they make an intestinal cleanse anannual practice, using herbal medicine and specific nutraceutical supplements designed to optimize the micro-ecology of the gut. For digestive issues, I typically recommend candida cleanses, as they can help repopulate the gut with good bacteria, and wipe out yeast and potentially dangerous bacteria.

Closing Thoughts

Small intestinal bacterial overgrowth can be a major contributor to irritable bowel syndrome, chronic gas and bloating, abdominal pain, diarrhea and constipation. The good news is that SIBO can be diagnosed, treated and prevented. Moreover, many patients who successfully eliminate SIBO from their gut will also find their IBS symptoms have been resolved.

If you or someone you know suffers with chronic gut issues, I invite you to drop me a line on the contact us” page on this site and request a free initial consultation to discuss your needs. I treat patients locally at my practice in Issaquah, Washington, and worldwide via phone or Skype.

Next time, we’ll look in detail at FODMAPs – what they are and how they play a role in IBS and SIBO. I hope you’ll subscribe to this blog, so you can receive that article and all future articles on A Path to Natural Health.

Dr. Maura Scanlan

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