Small Intestinal Bacterial Overgrowth (SIBO)

Frustrated with daily bloating, alternating bowel movements, gas and indigestion?

It may be worthwhile to screen for small intestinal bacterial overgrowth (SIBO).

The gastrointestinal tract is home to a diverse community of microbes including bacteria, yeasts, viruses, etc. Most of these species reside harmoniously in the colon or large intestine, and share the goal of fortifying the gut related immune system, lowering systemic inflammation, and improving digestion. When the balance between these species is disturbed, certain microbes seize the opportunity to overgrow and inflict digestive disturbances. This process is known as dysbiois. 

SIBO occurs when this dysbiosis presents in the small intestine, where large quantities of overgrown bacteria are not meant to be. 

Like us, microbes need resources such as carbohydrates to thrive. When microbes feast on sugars (ie. Prebiotics), they produce gas a byproduct of their digestive process. Different bacteria are capable of producing different gases including methane, hydrogen and hydrogen sulfide gas. Methane gas has been associated with a higher risk of constipation, and hydrogen gas can constitute to a loose stool. Any rotten egg scented gas? That’s likely the result of hydrogen sulfide producing bacteria. (1)

What are the Symptoms of SIBO?

When trapped in the small intestine, this gas can cause significant discomfort and often produces symptoms including:

• Abdominal Bloating

• Flatulence

• Excessive belching

• Nausea

• Diarrhea

• Constipation

• Indigestion & Dyspepsia

• Fatigue

• Weight Loss from Malabsorption of nutrients

Why Does SIBO Occur?

SIBO is a complex, functional disorder that can result from:

• Changes in GI structure (ie. Bowel resection surgeries, diverticula, obstructions, or adhesions)

• Poor bowel motility (ie. Hypothyroidism, gastroparesis, etc.)

• Low stomach acid production (aka hypochlorhydria)

• Systemic conditions (ie. Diabetes, SLE, celiac, IBD, pancreatitis, etc.)

• Medication Use (ie. Antibiotics, antacids, narcotics, etc.)

• Traveler’s diarrhea or food poisoning

How do you Test for SIBO?

Suspected SIBO can be confirmed through a positive breath test. 

As a first step in the collection process, an individual will blow into a tube with a collection device affixed in order to establish baseline gas production without provocation. After this baseline level is taken, a sugary drink containing either glucose or lactulose will be consumed. Once the sugars are absorbed and fermented by the gut bacteria, gasses will be excreted through the breath. The consumption of this solution will then be followed by breath samples taken every 20-minutes over the course of 2-3 hours. The goal of this is to track for surges in gas production at the time that the sugar is projected to reach the small intestine (approximately 90-120 minutes after consumed). If a surge in either methane (>10 ppm) or hydrogen gas (>20 ppm) is detected, SIBO is very likely. (1)

How do you Treat SIBO?

There are three key approaches to treating SIBO:

1. Antibiotics 

2. Antimicrobial herbs

3. Elemental Diet

From what we know of the available literature, antibiotics and antimicrobial herbs have near equivalent efficacy in treating SIBO. (2)

Treatment will differ depending on the type of gas produced as well as the suspected bacterial load. Be sure to collaborate with your provider by discussing which option may be most effective and suitable for your needs and circumstance. (3)

Given SIBO has a high likelihood of recurring, it is important to seek guidance from a SIBO literate provider who can develop both a nutritional and supplemental maintenance protocol with you after treatment is complete.

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Resources:

• Sorathia SJ, Chippa V, Rivas JM. Small intestinal bacterial overgrowth. StatPearls. 2025

• Chedid V, Dhalla S, Clarke JO, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014;3(3):16-24. doi:10.7453/gahmj.2014.019

• Min M, Nadora D, Chakkalakal M, et al. An Oral Botanical Supplement Improves Small Intestinal Bacterial Overgrowth (SIBO) and Facial Redness: Results of an Open-Label Clinical Study. Nutrients. 2024;16(18):3149. Published 2024 Sep 18. doi:10.3390/nu16183149