Small Intestinal Bacterial Overgrowth // Complete Guide

Do you suffer from symptoms like mysterious bloating, gastrointestinal issues, brain fog, or even fatigue?

These are just a few of the countless symptoms in people with Small Intestinal Bacterial Overgrowth (SIBO). 

SIBO is the pesky little condition that is affecting 84% of IBS patients and non-IBS patients alike. It’s a condition in which you have excess bacteria in the small intestine (rather than rightly being in the large intestine). It can cause many of those IBS-type symptoms, although the symptom list looks pretty vast among SIBO patients:

• Bloating
• Constipation
• Diarrhea
• Abdominal Pain
• Vomiting
• Nausea
• Gas
• Distended Stomach
• Acid Reflux
• Depression
• Anxiety
• Fatigue
• Rashes
• Eczema
• Psoriasis
• Malabsorption
• Insomnia

But I think all SIBO patients can agree that the worst symptom of all is… THE BLOAT.

Oh, the bloat. It’s somewhat of a mixture between feeling 7 months pregnant and also like you’ve eaten too much Thanksgiving dinner. And every time you get to burp or pass gas it is a relief because you’re letting a little bit of “air” out.

And I’m not just trying to be funny, you really are!

There are two main kinds of gas that are present in those with SIBO:

Hydrogen and Methane.

(And recently being discussed is Hydrogen Sulfide.)

Now, this isn’t anything to be crazily alarmed about. Individuals with Small Intestinal Bacterial Overgrowth have an excess amount of these gases being emitted. The higher the gas levels (in parts per million), usually the more severe your case of SIBO tends to be.

For example, my numbers were very low, even what some doctors may consider borderline, and I never experienced the frequent stomach distention that so many with SIBO deal with. I definitely suffer, but due to underlying causes, rather than SIBO itself.

So, how do you even end up with this strange “condition” that most people have never heard of?

Causes and Risk Factors

Bacteria is a great thing for our tummies. We need it to survive, thrive, fight off infections, and… you get the gist. The problem comes in when we have TOO much bacteria in the wrong place. We usually see most bacteria in our large intestine, not in the small.

Here are some ways we can see our bacteria count going up TOO much:

• Stress. It’s my personal opinion that this is the most underestimated cause of SIBO (in addition to unmanaged chronic stress and trauma).
• Prolonged use of antibiotics. Antibiotics are a wonderful tool for serious illnesses, but they’re not necessary every time we have a fever or infection. Antibiotics destroy your good bacteria along with bad bacteria. And now we’re seeing bacteria that have become resistant to antibiotics and the rise of chronic illness is higher than ever before. As someone who took antibiotics annually, this was definitely a factor for me.
• Low stomach acid. 20-44% of the U.S. population is suffering from gastroesophageal reflux disease (GERD). And if you’re like me, you’re one of the lucky few suffering from Laryngopharyngeal Reflux Disease. Most doctors will prescribe Proton Pump Inhibitors (PPIs), a medication that reduces stomach acid, (and a risk factor for SIBO) which may alleviate symptoms for some, but long-term is damaging because you NEED stomach acid to properly break down and digest your food.
• Dysmotility. When the muscles of your digestive system slow down or malfunction, you’re going to experience some issues with being “regular”. And if food waste sits in your small intestine, instead of being eliminated, your bacteria count can go up as it feeds on the waste.
• Poor functioning Migrating Motor Complex. This is a system in your body that “sweeps” out food that doesn’t kick in until 1.5 hours after you’ve last eaten. If not working properly, you can run into dysmotility.
• Autoimmunity or disease. Conditions like Celiac, Crohn’s, and other autoimmune diseases can set up poor digestive function and make it easy for SIBO to occur on top of already existing issues.
• Structural alterations. This could be anything from obstructions in the intestines to backward migrations. Listen to SIBO expert Alison Siebecker speak more on that here.

Really, there’s a whole slew of risk factors that can contribute to someone’s SIBO. It is always important to do some reflection to figure out what your risk factors may be, but I wouldn’t sweat what you can’t change. Knowledge is always key–so you’re not making poor health choices, but the best thing to do is move forward with this knowledge!

Before you can begin to do that, if you’re beginning to think these symptoms sound like you and you’ve experienced some of these risk factors, it’s time to test for SIBO.

Testing for SIBO

Currently, the most accurate way to test for SIBO is a breath test (either Lactulose or Glucose).

A health professional may request a blood antibodies test on rare occasion, but SIBO can’t currently be diagnosed through a stool test.

That is the consensus across the board for every SIBO expert in the field. So, if your health professional is suggesting something else, it may be worth bringing up.

It is a fairly non-invasive test. Typically, you’ll eat a very bland diet for 24-48 hours, prior to testing, that won’t cause any of those hydrogen or methane gases to skyrocket. Then, on testing day you’ll drink some sort of sugar solution. Usually, it is lactulose or glucose. Lactulose seems to be the more popular and effective testing method.

Standard SIBO Prep Diet Meal – Eggs + Ground Turkey.

Warning: The lactulose solution may/may not cause a reaction in some people. It is often prescribed as a laxative for those suffering with constipation. I did fine with it during the test, but had explosive diarrhea (lol) once when I was taking it weeks prior to testing for SIBO.

After drinking the solution, you’ll provide breath samples into 10 different tubes about every 20 minutes (while still fasting) and the test lasts about a total of 3 hours.

You’ll need a doctor to be able to order the test for you (and you’ll need one to help you accurately determine the results).

This is where I ordered mine from. The test is $180.

Then, the results take around 2-3 weeks to get back.

Treatment Options

Now, the reason you’re probably reading this is post is because you either suspect or just found out you have SIBO and you want to get rid of it and you need to know how.

There are three traditional routes that you can take for treatment, but before we get into them, there’s something important I want you to hear:

SIBO is NOT a diagnosis. It’s not even your main problem. There is an underlying reason you’ve developed SIBO in the first place.

This is important to understand because as we begin to talk treatment options and you scour the internet for information, you’ll find that people go through rounds upon rounds of different antibiotics only to find themselves relapsing with SIBO again and again. It can be extremely disheartening for someone newly “diagnosed” because they think they will have to live with this forever when that is NOT the case.

Many people have asked what I’ve done to address my SIBO. I did one round of traditional SIBO treatment and after that, I stopped–because I wanted to make sure I took care of the reason I ended up with SIBO in the first place, rather than doing a course of treatment every time SIBO reared its head.

No option is “right”. Everyone is different. If I had a more severe case of SIBO, I may have done more rounds of treatment to alleviate my symptoms until it was time to begin doing further digging. This is just something to note before you go down this road and question why you aren’t getting better and your SIBO continues to come back up.

Let’s take a look at the most common treatment options for SIBO.

• Pharmaceutical antibiotics. You may be wondering why this would be a solution when a risk factor for SIBO is antibiotics. Rifaximin, the most common antibiotic prescribed for SIBO, is actually a little bit different than most antibiotics. It is non-systemic, meaning it stays in the intestines and doesn’t carry into the bloodstream. Neomycin, the drug prescribed when methane is present, also has this effect. A normal course is about 2 weeks. No matter how “gentle” these antibiotics are, this will still affect your good gut flora, so make sure you understand this before you decide to go this route.
• Herbal antibiotics or antimicrobials. This is a more natural alternative to antibiotics. I, personally, decided to take herbal antibiotics for my SIBO. For this treatment option, you could be taking supplements like Allicin (garlic), Berberine, Oregano, Neem, and even Cinnamon to treat your SIBO. A course of herbal antibiotics lasts about 3 weeks and are more affordable than pharmaceuticals (unless your insurance covers pharmaceuticals). This option is just as effective and herbal antibiotics are less prone to antibiotic resistance. However, even herbal antibiotics can still kill off those good gut bacteria. Something to think about as you are deciding the protocol that is right for you.
• The elemental diet. Often a “last result” for those that are desperate, this is a 2-3 week protocol where you ingest nothing but a liquid formula of predigested nutrients. The idea is to starve the bacteria, but keep you alive. It is one of the more effective treatment options and tempting for people like myself who aren’t having great results with other treatment options–however, it can be very difficult for people post-treatment to re-introduce food. Many patients also end up with a yeast overgrowth afterward. So, talk to your health professional to see if they think this is a good option for you or not.

And the “secret sauce” to any treatment option is…

Diet

Your diet can’t “cure” your SIBO, but it certainly can alleviate symptoms and reduce inflammation. Inflammation is the root of most disease, so why not try a less inflammatory diet?

When SIBO is present, excess bacteria feeds on carbohydrates. Most of the diets that are suggested to alleviate SIBO symptoms focus on monosaccharides, simple sugars, and foods that are very easy to digest. There is no “right” diet or one-size-fits-all. It all depends on you, what you feel led to, your unique macronutrient needs, and how you do on the diet.

These diets are all meant to be temporary. 

Please don’t stay on these diets for months or years to come. That’s not what they’re meant for. I understand if you can’t afford to work with a nutritionist right now, but I’d highly recommend becoming your own health advocate and experimenting with reintroduction. Keep a food journal (the app Cara is great for that) and document your food intake and symptoms.

A large variety in our diet is what helps our gut microbiome and good bacteria thrive. So don’t restrict too long!

As someone who has been dealing with chronic health issues over the last 4 years, these are the most popular diets I have seen in regards to alleviating SIBO symptoms:

• The Low FODMAP Diet. Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. That’s what FODMAP stands for! But you don’t have to remember all that. This is probably the most popular diet amongst IBS patients, probably due to it being one of the least restrictive. Here is a great grocery list and resource if you decide to try Low FODMAP.
• The Specific Carbohydrate Diet. This diet is near and dear to my heart because there was a cool God story behind it. I felt very led to this diet and found it less restrictive than other suggested diets. It was during this diet that I documented and learned as much as I could about listening to my body. There are several great resources for this diet including Facebook groups, the “SCD bible”, and a host of websites.
• The SIBO Specific Diet. This diet was created by SIBO expert, Dr. Allison Siebecker. It is a combination of Low FODMAP + SCD. Personally, I found this diet too restricting and tedious for me to follow, but others I’ve spoken to have followed it with success. Here is the food guide she has created.
• The Biphasic Diet. This diet was created by SIBO expert, Dr. Nirala Jacobi. It has had large success with her patients in Australia and Rebecca Coomes has some phenomenal cookbooks out that follow the biphasic diet.

You are, of course, not limited to these diets. I have firsthand seen others who have had large success with the Fast Tract diet, AIP, Paleo, GAPS, etc. Just pick one and try it!

There are other factors involved in treatment, such as taking a prokinetic to stimulate proper motility functioning in your body. But for the sake of keeping this overview general and not TOO overwhelming, we’ll leave it here.

If you are wanting to learn more about Small Intestinal Bacterial Overgrowth (SIBO), here are some wonderful resources you can start using and listening to today:

1. The Healthy Gut Podcast. One of my favorite podcasts in regards to health and SIBO. Rebecca Coomes interviews loads of health experts and it is worth a listen.
2. Dr. Allison Siebecker’s Website. This gal is my favorite. She is the leading SIBO expert, along with Dr. Mark Hyman and she’s got some great resources lying around on her site.
3. The SIBO Solution. One of the first books on SIBO I ever read–I love this comprehensive guide to SIBO. It is so easy to read and understand. It is excellent for anyone struggling with SIBO, but especially for newbies!
4. Healthy Gut, Healthy You. This is more of a comprehensive gut guide by Dr. Michael Ruscio. It is huge and might be overwhelming for a beginner, but this addresses so much more than just “SIBO”. Dr. Ruscio speaks to gut health, meta-analyses, studies, and how to have a healthy gut. I am such a fan of this book and would say it is definitely worth the read.
5. The SIBO Summit. This is one of THE BEST resources available. Shivan Sarna gets all SIBO and gut health experts get together to talk SIBO. I have learned so much from these valuable summits and would encourage you to check out the talks. They’re FREE for 7 days and available for purchase afterward.

I hope these resources begin to help you on your journey back to health. Where are you at in your journey with gut health? Are you new to SIBO? Did you beat it? Please share your experience in the comments below. It’s great to learn from each other and share ideas.