SIBO (Small Intestinal Bacterial Overgrowth)

siboDo you suffer from bloating, burping, farting (gas), stomach aches, abdominal pain, nausea or acid reflux, constipation, diarrhea or both?  Perhaps you have been diagnosed with IBS (Irritable Bowel Syndrome). You may have SIBO.

When there are too many bacteria in the small intestine (they are supposed to be in the large intestine) these bacteria feed on carbohydrates (grains, beans, sugars, nuts and seeds, fruits, and vegetables) producing hydrogen gas and methane.  The bacteria also disrupt normal absorption of nutrients, like B12, and may create changes to the villi and mucous in the intestines causing leaky gut and immune system issues. At the bottom of this blog are some great links to more information on SIBO.

How do we get SIBO? 

  1. Anything slowing the intestinal motility (PPI’s- Proton Pump Inhibitors like omeprazole, pain medications like opiates, being hypothyroid).
  2. Anything blocking movement through the intestines (adhesions from surgeries, constipation, damage to the migrating motor unit that sweeps intestines)
  3. Reduced stomach acid, bile acids, or digestive enzymes from the pancreas which all typically inhibit bacteria in the small bowel.
  4. Failure of the oleo-cecal valve such that bacteria from the colon enter the small intestines.


How do you know if SIBO is what you have?

The lactulose breath test that measures hydrogen and methane.  Your doctor can order this for you and you either do this at home with a kit, or at a doctors office or lab where they do this test. Read more about this test here…


How do I treat SIBO if I have it?

Treatment might include antibiotics using Rifaximine +/- neomycin or metronidazole (read more about antibiotic treatment here… ). Herbal approaches that have been helpful include Berberine- up to 5 gms a day, and Allicin (allimed is the strongest), cinnamon, and oregano.  Two combination formulations that have been used at a dose of 2 caps twice a day for 4 weeks include:

  • Biotics FC Cidal with Biotics Dysbiocide
  • Metagenics Candibactin-AR with Metagenics Candibactin – BR  (you can learn more about this here… )


After eliminating the bad bacteria, it is important to keep the intestinal motility so that the SIBO doesn’t return. Low dose Naltrexone has been used with some success but lacks extensive testing. You can read more about this here…

Long term prevention is most likely maintained by a diet low in carbohydrates and starches. Several diets have been proposed to be beneficial and are reviewed nicely by Dr Allison Siebecker on her very educational web site ( )

Diets that can be helpful include:

  • SCD (Specific Carbohydrate Diet)
  • GAPS (Gut and Psychology Syndrome Diet)
  • LFD (Low Fodmap Diet)
  • SCD + LFD
  • Cedars-Sinai Diet of Dr Pimentel


You would think that doctors would know about this, right? Sadly, we doctors are often slow to learn new information.  When new knowledge is introduced it is met with skepticism or just dismissed. I know that was my initial response when I heard SIBO.  It then gets published and eventually gets considered by those doctors who are searching for answers. It can take decades before the majority of doctors even hear about new innovative approaches. I remember my MD peers dismissing probiotics for a couple decades before the volume of published data became undeniable. I feel SIBO is one of these areas to consider for those suffering from the symptoms of SIBO and getting labels like IBS (irritable bowel syndrome), or no answers at all.


SIBO-The Finer Points of Diagnosis, Test Interpretation, and Treatment

The Second Opinion Series- The Digestion Sessions


SIBO Symposium


Dr. Paul




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