What is SIBO?

Small Intestine Bacterial Overgrowth is chronic overgrowth of bacteria in the small intestine. These bacteria normally live in the gastrointestinal tract, but not in such abundance.

Why is SIBO a problem?

The bacteria interfere with normal digestion and absorption of food and are associated with damage to the lining or membrane of the small intestine.

What are some common SIBO symptoms and signs?

Note people dealing with SIBO sometimes only have one of the below, you do not need more to flag it is a possibility:

  • Bloating
  • Fatigue
  • Belching
  • Skin rashes
  • Cramps
  • Respiratory symptoms
  • Constipation
  • Mood symptoms
  • Diarrhea
  • Brain symptoms
  • Heartburn (reflux or GERD)
  • Eczema
  • Flatulence (Gas)
  • Steatorrhea (fatty stool)
  • Abdominal pain
  • Iron deficiency anemia
  • Nausea
  • Vitamin B12 deficiency
  • Food Sensitivities
  • Headaches
  • Joint pain

How is the test done?

It’s a take home breath test! Breath testing measures the hydrogen and methane gas produced by bacteria in the small intestine that has diffused into the blood, then lungs, and expired.

These gases are produced by bacteria, not by humans.

The gas is graphed over three hours and compared to a research-derived baseline measurement.

Patients drink a solution of lactulose after a 1-2 day preparatory diet.

The diet removes much of the food that would feed the bacteria, allowing for a clear reaction to the sugar (lactulose) drink.

Why a breath test, can’t I find this out through “regular” tests (stool or scopes)?

Sampling the contents of the small intestine is challenging. Endoscopy only reaches into the top portion, and colonoscopy only reaches the last portion. The middle portion (about 17 feet) is not accessible, other than by surgery. Stool testing predominantly reflects the large intestine. False

positives are rare and caused by improper preparation or collection. False negatives are avoided by measuring methane in addition to hydrogen.

What does SIBO treatment look like?

There are 2 phases (see below):


Antimicrobial Medicines:

Prescription Antibiotics* (2weeks) or Botanicals (4-6weeks)

As an ND, I have Prescriptive Rights in BC


Diet: LOW FODMAPS, SCD or SIBO Specific – 1 month max.

Motility/ Prokinetic agents

Heal Leaky Gut/Intestinal Permeability

Why are both phases necessary for a successful SIBO treatment?

· Something in the system must go wrong first before SIBO can develop.

· The treatment not the same as treating a bacterial infection like strep throat

· Successful treatment involves restoring the proper function of the GI system and addressing the underlying root cause that allowed SIBO to take develop in the first place.

What are some Associated Syndromes and Conditions with SIBO:

  • Acne Rosacea
  • Chronic Fatigue Syndrome
  • Fibromyalgia
  • IBD (Crohn’s, Ulcerative Colitis)
  • Interstitial Cystitis
  • Restless Leg Syndrome
  • Rheumatoid Arthritis

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