Small Intestine Bacterial Overgrowth is not IBS


Intestinal disorders, in their myriad forms, plague tens of millions of people in the U.S. There’s leaky gut syndrome, celiac disease, irritable bowel syndrome (IBS)…and a new bad kid in town, small intestine bacterial overgrowth (SIBO). SIBO isn’t really new, but it’s bad, and we see it increasingly often, especially when there’s underlying IBS.

What Is SIBO?

SIBO is characterized by an overload of bacteria—beyond the normal, healthy count—in the small intestine.  The small intestine is where food mixes with digestive juices and good bacteria, and the resulting nutrients are absorbed into the bloodstream.

But when you have SIBO, as food passes through the small intestine, the bacterial overload interferes with healthy digestion and absorption processes.

Results? Malabsorption, especially of essential fat-soluble vitamins and iron. Next stop on that train—malnutrition. Serious damage to the stomach lining is another predictable risk.

Increasing the risk of malabsorption, and adding insult to injury, SIBO bacteria don’t just keep you from breaking down and absorbing your food. They also take it for themselves, before your small intestine can even get to work on it.

It’s like the schoolyard bully who pushes you down, then steals your sandwich.

When the bully isn’t stopped

SIBO, left untreated, can cause serious health complications. It’s vital to get rid of the bacterial overgrowth as soon as possible.

Consider the malabsorption problem.  SIBO means you get less nutrition from just about everything you consume.  That includes essential nutrients, which aren’t called essential just to make them sound important. They are, in fact, absolutely essential to life itself.

We’re not talking about a sudden collapse of every moving part of your body.

We’re talking about gradually starving them—and yourself. And each step down that road opens a new door to every additional disease in the book—or to making current health problems worse.

Whatever the pace, it’s a dangerous, downhill trajectory.

Symptoms of Small Intestinal Bacterial Overgrowth

The markers for SIBO are similar to those of the many other gastrointestinal disorders, including IBS.  And when SIBO symptoms appear, it’s frequently when IBS is already in place as an underlying condition. So teasing them apart is difficult.

Common to both IBS and SIBO are:

  • Nausea
  • Bloating
  • Vomiting
  • Diarrhea
  • Malnutrition
  • Weight loss
  • Joint pain
  • Fatigue
  • Rashes
  • Acne
  • Eczema
  • Asthma
  • Depression

Of course, no one presents with all of these at once—and many of them could be caused by something not even gastro-related.

So how do we narrow the diagnosis down to SIBO, not IBS?

Although, as I said, the distinction can be difficult, I simply treat the symptoms I find as best as I can.  Similar conditions often respond to similar interventions.

So I look first for food allergies.  Depending on their severity, they can be hard to find without a series of tests that include a carefully monitored diet.

But if allergies are present, that’s a SIBO contra-indication, and it sends us off to intervene by excluding allergenic foods from the diet and substituting healthy foods for bad.

If food allergies aren’t the culprit, I look next for those predisposing underlying conditions I mentioned above.

If these can mostly be ruled out, then SIBO slides down the list of suspects again. Some medications, including immune-suppressants and proton pump inhibitors, are also associated with increased risk, as are immune system disorders and recent abdominal surgery.  So I watch for them as possible causes of SIBO, as well.

SIBO Breath Test:

If there’s still no clear diagnosis, I order tests for worms and parasites, along with SIBO-specific lab tests. These include simple breath tests that can detect and measure hydrogen and methane in the small intestine—which we humans can’t produce, but SIBO bacteria can. Unhealthy bacterial overgrowth signals SIBO.

These tests, by the way, represent a significant advance in our detection capabilities. The small intestine can be examined from the top by endoscopy, and the bottom by colonoscopy. But those tools can’t reach the middle 17 feet of this vital organ. The various breath tests give us a biochemical picture of what’s going on there—or not—that we’ve never had before.

What Causes SIBO?

Any illness or disease that kicks the immune system into play puts you at risk for SIBO.   Factors include a lack of necessary stomach acid, damage to the intestine by toxins like alcohol, or a slowdown in transferring materials from the small intestine to the colon.

Backflow, or reflux, from the colon into the small intestine can also introduce harmful bacteria.

Other underlying conditions that predispose SIBO include:

  • Aging
  • Chronic pancreatitis
  • Diabetes
  • Diverticulosis, a structural defect in the intestine
  • Injury
  • Fistula
  • Intestinal lymphoma
  • Scleroderma
  • Celiac disease

Worms and parasites can also be a contributing factor.  No, they’re not a third-world-only phenomenon—they’re everywhere, including here. And they’re far more common than most folks realize leading to chronic ailments from leaky gut and adrenal fatigue to cancer.

How to treat SIBO?

I’m not a fan of antibiotics; they’re overprescribed for problems they can’t fix (like viruses) or in situations where your own immune system is about to kick in and take care of the problem. In this case, bacteria are the problem, so antibiotics are the best solution. Your doctor will decide the regimen.  Just make sure she or he understands that antibiotics wipe out most of your immune system’s good bacteria along with the bad, leaving you vulnerable to countless health threats, gastrointestinal and otherwise.

Which leads me to the vitally important second leg of the anti-SIBO intervention: probiotics.

It’s essential that your doctor immediately get you on heavy-duty probiotics to replace the good bacteria the antibiotic takes out. An excellent place to start is with a high-quality probiotic supplement.

Look for a formulation with at least these strains of good bacteria:

  • Lactobacillus salivarius: quells gas and stop the growth of bad bacteria
  • Lactobacillus acidophilus: resistant to the digestive process, this strain can help prevent vaginal infections and support healthy cholesterol
  • Lactobacillus casei: helps kill bad bacteria and may help prevent antibiotic-associated diarrhea
  • Lactobacillus plantarum: reduces gas and the symptoms of IBS
  • Lactobacillus fermentum:  helps prevent urinary tract infections and protect against food-borne infections
  • Bifidobacterium longum: helps support the immune system and reduce inflammation

SIBO Probiotics:

I recommend also piling on other naturally probiotic foods—you can’t overdose on probiotics.  Add these to your diet:

  • Yogurt (plain, organic, full-fat)
  • Sauerkraut
  • Dark chocolate (the higher the cacao content the better)
  • Micro-algae like chlorella or spirulina
  • Miso soup
  • Pickles
  • Tempeh
  • Kimchi
  • Kombucha tea

Probiotics are not all the same, so read labels carefully.

Naturally Treatment For SIBO?

Essential oils are high on my list of gut-restorative healers. With a massage, in a bath, or as aromatherapy, they’re proven effective in restoring balance in the gut overall, including in the small intestine.  I recommend:

  • Peppermint
  • Thyme
  • Lemon balm
  • Lavender
  • Cumin
  • Ginger
  • Rose

What a wonderful way to heal. The delicious scents alone are a proven mood booster. Who doesn’t feel calm and relaxed inhaling lavender?

You may also see good results by having herbal teas based on these plants.

Finally, I add colostrum to the healing regimen. An FDA approved formulation from specially vaccinated, super-healthy cows, called hyperimmune bovine colostrum, contains enormous stocks of proteins, carbohydrates, fats, vitamins, minerals, and proteins (antibodies) that protect against the bacteria linked to SIBO.

Hang in there

Be aware that SIBO is a stubborn, ornery, chronic disease. Antibiotics aren’t a silver bullet—relapse rates are high. But a full cure is possible, with patience, perseverance, and a diet rich in healing foods and avoidance of unhealthy foods. The Mediterranean diet and a Paleo diet both work wonders for overall health. A healthy diet is the most important step you can take to get your gut back in balance, and get SIBO out of your life.

Take good care.



Last Updated: May 20, 2021
Originally Published: May 8, 2017