What Is SIBO & How Do You Fix It?

Do you feel bloated, or like your digestive system just isn’t working right?

Do healthy foods or supplements, maybe even probiotics, make you feel worse, not better?

You’re not crazy, but you might have SIBO!

What is SIBO?

SIBO, which stands for small intestinal bacterial overgrowth, is a digestive condition that can cause a host of unpleasant symptoms and discomfort. It occurs when bacteria from the large intestine, including good probiotics, end up proliferating in the small intestine where they don’t belong. This is known as

Too much—or any amount—of a good thing where it doesn’t belong can have negative health consequences. SIBO can lead to brain fog, pain, diarrhea, nutrient imbalances in the body, and more. (1)

SIBO has not been widely studied and is still not completely understood. It can happen based on physical changes or problems, like structural abnormalities in the intestine itself or poor gut motility that struggles to move food efficiently through the digestive tract. (2)

SIBO can also be triggered in response to immune problems, Celiac disease, hypothyroidism, infections, irritable bowel disease (IBD) like Crohn’s or colitis, or having low levels of stomach acid. Gastric bypass procedures or surgeries that lead to adhesions can be causes of SIBO, too. People who have diabetes, diverticulosis, and other gastrointestinal disorders may also be at risk. (1)

10 Symptoms of SIBO

The symptoms of SIBO are mostly gastrointestinal, but a few can impact other areas of the body. Most SIBO symptoms can be caused by something else, so be sure to keep your doctor updated on your health.

Common symptoms of SIBO include: (1, 3)

1. Bloating
2. Constantly feeling full
3. Nausea
4. Belching, indigestion, or acid reflux
5. Diarrhea and/or constipation
6. Feeling gassy or passing gas
7. Fatigue 
8. Stomach pain or cramping after meals or between meals
9. Abdominal pain
10. Weight loss, in more severe cases

It is not known how common SIBO is or how many people are affected. (4, 5)

How is SIBO Diagnosed?

If you have symptoms of SIBO, check in with your doctor. The primary test for assessing SIBO is called a lactulose breath test. You’ll breathe into a tube after fasting overnight and then drink a sugary substance. A series of breath tests over the next few hours will follow. These tests measure specific gases—like methane and hydrogen—which can show up in higher volumes when bacteria are overproducing in the small intestine. (1)

To diagnose SIBO, physicians may also run blood and stool tests, along with a physical exam.

How SIBO Can Lead to Other Health Problems

It’s important to address SIBO because the problem won’t go away on its own. Left unattended, it can lead to additional health issues with long-term consequences.

SIBO has a major impact on the small intestine’s role in digestion, which is where the bulk of foods are broken down and nutrients absorbed. SIBO can lead to problems digesting and absorbing fats, carbs, and proteins due to the rapid breakdown of digestive bile salts by the excess bacteria. This can also interfere with the absorption of fat-soluble vitamins A, D, E, and K. When your body isn’t able to absorb or use these crucial nutrients, your immune system can be especially vulnerable. (1)

SIBO can also damage the small intestinal mucous lining, further harming the gut’s ability to absorb or make nutrients. The gut plays a key role in synthesizing as well as using B12, so if you already have methylation issues, SIBO can further complicate the matter, leading to B12 deficiency known as megaloblastic anemia. (5)

Irritable bowel syndrome, or IBS, may also be associated significantly with SIBO. Research found that SIBO is more common among IBS patients than not, and is now being studied for its potential roles in triggering IBS in the first place. (6) One study found that 84 percent of IBS patients also had SIBO, compared to only 20 percent of the control group. (5) Frequent bouts of diarrhea occur with SIBO because the bacteria affect how food breaks down in the gut, often leading to rapid transit time. This can cause potential malabsorption, malnutrition, and weight loss.

While most people don’t think of the gut when it comes to bone health, any element of compromised gut health like SIBO, leaky gut, or Celiac disease can lead to poor bone density and osteoporosis. Your gut is responsible for absorbing the nutrients needed to keep bones strong: calcium, vitamin D, trace minerals, and magnesium. Since your body prioritizes balance, it will withdraw these nutrients from bone stores to keep blood levels stable, but eventually, your stores will run short. (1)

SIBO has also been associated with other conditions like restless leg syndrome, kidney stones, chronic fatigue, nonalcoholic fatty liver disease, leaky gut, and fibromyalgia. (5) Even your diet can contribute to SIBO if you eat a carb-heavy food plan that includes a lot of grains, garlic, onions, and fruits. (7)

5 Things To Do If You Think You Have SIBO

If you have symptoms of SIBO or a related condition, don’t wait around to see if things can get worse. Follow these five steps to get your health back on track.

1. Get tested. Your doctor can order a breath test to confirm SIBO as a cause of your symptoms.
2. Adopt a lower-carb diet. Cut back on carbs to see if your bloating or other digestive symptoms improve.
3. Chew food thoroughly. When food enters your stomach that is poorly chewed, or you eat in a state of stress, your digestive system has to work harder. This can open the door to poorly digested foods “feeding” SIBO bacteria in your small intestine.
4. Clean up your lifestyle. Adopt healthy habits like a regular bedtime and exercise routine, both of which can support good digestion and intestinal motility.
5. Support your gallbladder. SIBO interferes with your body’s ability to break down fat properly, so supplementing with enzymes that can support optimal digestion can help.

What To Do If You Have SIBO

If you’ve tested and confirmed SIBO, there are targeted ways to get your health back on track.

SIBO Treatment

Because SIBO is a condition of bacteria ending up where they don’t belong, it’s often treated with antibiotics. In many cases, this is the only way to restore normal levels of bacteria in the small intestine. Common antibiotics used for SIBO are rifaximin, cephalexin, or neomycin. In addition to these, antimicrobial herbs or supplements can be used to treat SIBO and prevent recurrences, but are often not enough to work alone in the fight against small intestinal bacterial overgrowth. (8) However, some research has shown that in SIBO patients with mild cases or in those experiencing antibiotic resistance, targeted herbal therapy can have a similar result to some antibiotics. Potent herbs that may have a medicinal effect include yarrow, stemona, wormwood, dill, pau d’arco, stinging nettle, and olive leaf. (9)

SIBO Diet

Following the right kind of therapeutic diet plan during SIBO treatment is critical. Certain types of foods will continue to feed the bacteria that are thriving where they shouldn’t be. By cutting those off, and following through with other treatment, the small bowel can be restored to normal order.

A SIBO diet is often based on a low FODMAP plan or a GAPS diet. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Basically, it’s a way of managing specific types of carbohydrates that you eat. A GAPS diet is another protocol that focuses on addressing digestive health. Both will manage the types of carbohydrates that could be wreaking havoc on your digestive system.

Because carbohydrates are the primary driver of SIBO, your protein and healthy fat intake are not influenced by a low FODMAP diet.

• Wheat and gluten
• Most other grains, including gluten-free grains
• Sugar
• Most dairy products, including cottage cheese, milk, and cream cheese
• Garlic and onions
• Most fruits
• High FODMAP vegetables like asparagus, Brussels sprouts, cauliflower, mushrooms, and leeks
• Legumes
• Coconut and coconut water

• Low FODMAP fruits like unripe bananas, papaya, pineapple, strawberries, oranges, and kiwi
• Low FODMAP vegetables like carrots, kale, eggplant, zucchini, spinach, and tomatoes
• Quinoa
• Oats
• Brown rice
• Certain dairy products like low-lactose milk
• Black coffee or tea

You’ll continue eating healthy proteins like grass-fed beef, wild-caught seafood, and pasture-raised poultry as well as healthy fats like avocado oil, olive oil, tallow, lard, and grass-fed butter.

Supplements for Digestive Health

You can support digestive health and overall wellness with specific supplements. You should always work with your doctor to determine what course of treatment, diet, and supplements are right for you.

There are two factors to consider when supporting your SIBO treatment with a healthy supplement regimen. First, it’s important to replenish nutrients that may be deficient due to bacterial interference. Second, focus on optimizing your digestion to improve the body’s ability to break down nutrients.^†

The following supplements help support a healthy digestive system:^†

• Fish oil to support healthy omega-3 levels
• Fat-soluble vitamins A, D, E, and K to promote normal nutrient levels
• Vitamin B12 to support healthy levels and methylation
• Gallbladder nutrientsto promote general digestive wellbeing and normal fat breakdown
• Ox bile to support the healthy digestion and absorption of fatty foods and nutrients in a more targeted way

When it comes to probiotics and SIBO, your healthcare provider will have to weigh in. Some probiotics can initially worsen SIBO by adding more bacteria to an already overpopulated small intestine. However, following treatment with antibiotics or during herbal therapy, those with SIBO may benefit from low-dose probiotic support.^†

The Bottom Line

SIBO is a digestive condition that can cause unpleasant symptoms like bloating, diarrhea, nausea, gas, and more. You can’t diagnose it at home, so you’ll need to work with your doctor to get answers. Once you know what you’re dealing with, SIBO can respond to targeted treatment supported by a healthy dietary plan.

References