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Updated: Apr 7

Irritable Bowel Syndrome or IBS has multiple different root causes, one of which is Small Intestinal Bacterial Overgrowth or SIBO.

What is SIBO?

The GI tract is teaming with biodiversity, with different organisms each having its native habitat. As with all life forms, these organisms are mobile and can relocate to another area of the GI tract - one in which they do not belong. Bacteria that normally reside in the colon can migrate into the small intestine and begin to grow in large numbers. SIBO refers to an overgrowth of colonic bacteria that have taken up residence in the small intestine where they do not belong.

The job of the small intestine is to digest and absorb nutrients from our food and the employees that do this work include our digestive enzymes, bile and small intestinal bacteria. The normal small intestine is home to approximately 10,000 bacteria per milliliter of fluid!! The bacteria here have additional responsibilities which include producing nutrients, supporting gut immunity and protecting the host (us) from invading organisms.

In contrast to the small intestine, the colon houses approximately 1 trillion bacteria per milliliter of fluid - a significantly more abundant population!! These bacteria primarily function to ferment non-digestible carbohydrates to form short chain fatty acids. The result of the fermentation process is either hydrogen or methane gas.

When colonic bacteria migrate to the small intestine, the normal functions of digestion and absorption are replaced by fermentation. This is what leads to the significant symptoms associated with SIBO.

What are the symptoms of SIBO?

The most common symptoms of SIBO include:

  • Bloating - generally worse as the day goes on

  • Abdominal fullness

  • Abdominal pain or cramps

  • Diarrhea or Constipation

  • Alternating between diarrhea or constipation

Additional symptoms can include

  • Belching

  • Passing gas

  • Acid reflux

  • Nausea

Conditions that are associated with SIBO include:

  • Irritable bowel syndrome

  • Leaky gut syndrome

  • Chronic fatigue syndrome

  • Rosacea

  • Fibromyalgia

What causes SIBO?

There are many causes of SIBO, so please keep in mind that your unique situation may not be reflected in the most common causes listed here. With that said, we are aware of conditions which have a high association with SIBO. These can include:

  • Overuse of antibiotics

  • Overgrowth of candida

  • Use of acid blocking medications

  • Presence of H. Pylori

  • Chronic constipation

  • Gall bladder disease

  • Excessive carbohydrate/sugar/fructose in the diet

  • Parasitic infections

In addition to the above conditions, we know that there are additional circumstances that can lead to SIBO such as surgery, liver disease and diverticulosis. Additionally we know that certain disease states can contribute to small intestinal bacterial overgrowth such as hypothyroidism, diabetes, depressed immunity, excess estrogens and chronic stress.

What are treatment options for SIBO?

The treatment focus for SIBO includes identifying and treating the overgrowth, supporting digestion, repairing the lining of the gut and addressing the root cause. The treatment process if often a multi-phase approach, with an initial focus on addressing the root cause and removing the overgrowth then repairing the lining of the gut. Other treatment considerations are determined during your visit with a trained functional medicine provider.

Diet - I often recommend that individuals start by trying a low FODMAP diet. A reliable resource for this is the Low FODMAP app offered by Monash University. This diet is effective for a majority of SIBO sufferers - but not all. A ketogenic diet also eliminates many of the fermentable carbohydrates that are removed from the low FODMAP diet.

Antimicrobial therapy - either through antibiotics or herbal blends. It is always recommended to know what is being treated, so meeting with a functional medicine provider and having Gut Health testing is highly recommended.

Supporting digestion - remember that when colonic bacteria invade the small intestine, a disruption occurs in the digestion and absorption of nutrients. Temporary digestive support support may aid in relieving the symptoms of SIBO and improve nutrient status. One of my favorite digestive supplements can be found here. Remember to only take this with meals and never on an empty stomach.

Repairing the gut lining - the displacement of small intestinal bacteria and the resulting inflammation and permeable gut lining require direct intervention. One of my go to recommendations for restoring mucosal barrier and function can be found here.

Stress management - whether or not your initial SIBO was triggered by chronic stress, the result of SIBO symptoms can create chronic stress. An integrative approach to SIBO treatment must include stress management techniques in addition to diet and supplement support. General techniques can include deep breathing exercises, meditation, epsom salt baths and yoga. Working with your functional medicine provider, you can discuss the types of stress management techniques that are most suited to your personality and lifestyle.

What should you know prior to doing a gut health test?

If you think you may be suffering from SIBO, getting started with functional gut health testing is key to personalizing your treatment plan. There are a few considerations to keep in mind prior to submitting your gut health testing.

Antibiotics - wait a minimum of 14 days following a course of antibiotics - preferably a full 30 days.

Probiotics - stop all probiotic and fermented foods (Kim chi, yogurt, kefir, saucer kraut, etc) for at least 7 days.

Digestive enzymes - stop digestive enzymes supplements for at least 2 days.

Acid reducing medications - directions can vary based on your personal history - discuss this with your provider prior to testing.

Ready to get started?

If you are ready to get started, call and schedule your visit and testing today.


  1. <> how to interpret hydrogen breath test by Uday C. Goshal.

  2. Siebecker, A., ND. Retrieved April 25, 2016 from <> Semrad CE. Approach to the patient with diarrhea andmalabsorption. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed.Philadelphia, PA: Saunders Elsevier; 2011:chap 142.

  3. 48 hour Nutrition Certificate Program – 2016 / Charles Sefcik, DC, DACNB, CCN

  4. “Lets Get Specific with Dysbiosis and SIBO Diagnosis and Treatment” Bradley Bush, ND

Gina Ditta-Donahue is a certified Family Nurse Practitioner and Anti-Aging Medicine provider. She is the author of "Josh's Smiley Faces: A Story About Anger," a children's book aimed at helping young children and their parents navigate anger management and build adaptive life skills. She is also co-owner of Elevate Functional Medicine.

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