Gastrointestinal symptoms are one of the most common complaints among Americans, and it seems that more and more people are developing digestive conditions as the years go on. Our digestive systems as a whole are under attack, and no one knows exactly why. However, working in functional medicine I have to wonder if it has to do with the foods consumed in modern day society, the tremendous amounts of pharmaceuticals that come on the market every day, and the daily stress life brings to the table. More and more patients are coming to my practice with SIBO symptoms looking to get to the bottom of what is causing their digestive health issues.

While there are more common digestive conditions such as IBS, Celiac disease, and leaky gut that I frequently see in my practice, SIBO is becoming more prevalent as well. This condition is on the rise as well and may be occurring in those with already diagnosed digestive conditions such as IBS.

What is SIBO?

So, what exactly is SIBO? SIBO stands for small intestinal bacterial overgrowth. This condition occurs when there is excessive bacteria in the small intestine. (1) Our digestive tracts are home to many different bacterium however, the small intestine is not supposed to contain as much bacteria as the colon. When bacteria build up occurs, SIBO may be to blame and SIBO symptoms can occur.
The small intestine is where food combines with digestive juices and then where nutrients go on to be absorbed into our bloodstream. With SIBO, malabsorption can occur. This is especially true for fat-soluble vitamins as well as iron. This malabsorption occurs due to bacteria imbalance which can even lead to damage to the stomach lining if SIBO goes untreated. The bacteria overgrowth can even consume essential nutrients your body needs to thrive.

SIBO Symptoms

There are many symptoms associated with SIBO, and many of them can mimic other gastrointestinal disorders. For this reason, if you have any of the following symptoms it’s best to get tested for SIBO using a SIBO breath test.

  • Nausea
  • Vomiting
  • Diarrhea
  • Bloating
  • Malnutrition
  • Weight loss
  • Joint pain
  • Fatigue
  • Skin conditions such as acne, eczema, and rashes
  • Asthma
  • Depression

Causes of SIBO

While there is no one exact cause of SIBO, the following conditions are thought to be underlying causes of small intestinal bacterial overgrowth:

  • Aging
  • Chronic pancreatitis
  • Diabetes
  • Diverticulosis
  • Structural defect in the small intestine
  • Injury
  • Fistula
  • Intestinal lymphoma
  • Scleroderma
  • Recent abdominal surgeries
  • Immune system disorders
  • Celiac disease: Can be a major trigger as it leads to poor small intestinal functioning
  • The use of certain medications: Immunosuppressant’s, PPI’s

Celiac disease is of particular concern when it comes to SIBO. In fact, a study from the American Journal of Gastroenterology found that 66% of patients who had Celiac disease but followed a gluten-free diet still tested positive for SIBO.

If you have Celiac disease, it may be best to be tested for SIBO as well.

SIBO Complications

Just like with any condition, if SIBO goes untreated, complications could arise. When the bacteria is left to run rampant, malabsorption could occur, as well as deficiencies, especially B12 deficiency. Many people are already at risk of developing a B12 deficiency such as vegetarians, vegans, and those who take proton pump inhibitors or other antacids. SIBO increases the risk even further.

Megaloblastic anemia has also been directly linked to SIBO. It’s critical to treat the bacteria overgrowth as soon as possible to prevent any of these complications from occurring.

Sibo Treatment Options

The most common way to treat SIBO is with antibiotics. However, proper dietary and lifestyle changes are also required for long-term healing. The issue with antibiotic treatment is that antibiotics not only kill the bad bacteria, but they take the good bacteria with it. Treating SIBO only with antibiotics can be difficult.

There are many dietary and supplemental approaches that have been successfully shown to help treat this complex gastrointestinal disease, including:

  • A Low-FODMAP diet (not done at the same time as the antimicrobial supplements)
  • Consuming small amounts of food at meal times
  • Enjoy 5-6 small meals per day
  • Avoid overeating
  • Antimicrobial supplements
  • Probiotic rich foods
  • Probiotic supplementation

SIBO Lifestyle Changes

There are certain lifestyle changes someone with SIBO can make to help jumpstart the healing process. Some of these changes include chewing your food thoroughly. It’s important to remember that digestion begins in the mouth so the better you chew your food, the better you assist your body in properly digesting the food you consume.

Next is hydration. With SIBO it’s critical to stay hydrated and to manage your stress levels. Regular exercise, yoga, and meditation are excellent ways to help balance the stress that comes with life. The digestive system is significantly impaired with high-stress levels, so stress reduction is a key component when dealing with SIBO.

The SIBO Diet

One of the best ways to treat SIBO is with dietary changes. There is a specific diet approach used to help treat this bacterial overgrowth. The diet is a FODMAP elimination diet.
FODMAPS are foods that are not completely absorbed in the body. These foods can then start fermenting in the digestive tract. This fermentation can lead to more bacteria which can exacerbate SIBO symptoms. Here are some of the foods avoided when first starting the FODMAP elimination diet:

  • Fructose
  • Lactose: Conventional dairy products
  • Fructans: Wheat, garlic, onions, broccoli, cabbage, asparagus, artichokes
  • Galactans: Brussels sprouts, soy, legumes, cabbage
  • Polyols: Xylitol, erythritol, sorbitol, maltitol

During the first phase of the FODMAP elimination diet, some of the foods to enjoy include:

  • Grass-fed beef
  • Wild caught salmon
  • Free range eggs
  • Almond milk
  • Coconut milk
  • Leafy greens
  • Squash
  • Bananas
  • Blueberries
  • Grapes
  • Cantaloupe
  • Pineapple
  • Strawberries

While the low FODMAP diet is a relatively restricting diet, as the SIBO goes into remission you can add more and more foods to your diet. You would be surprised how much better you will feel once your diet is designed to help your body heal from the bacterial overgrowth.

With that being said, it’s important to understand that diet alone is not always all that’s required to treat SIBO. While a FODMAP diet helps to keep SIBO symptoms under control by starving the bacteria, it does not completely eliminate the bacteria overgrowth. (2) FODMAP diet’s over time can also starve the good bacteria in your large intestine which could cause other health complications.

While treating SIBO, a combination of diet, antimicrobial supplements, probiotics and lifestyle changes are often necessary. At the time of treatment with the antimicrobial supplements, I recommend following a lower carb diet that is not a low FODMAP diet. When using the supplements, you do not want the bacteria to hide because it can be harder to kill. After SIBO treatment, dietary changes will also need to be adapted for a long-term approach to achieving health and wellness. After treating the SIBO, adding some complex carbohydrates back into your diet is often well tolerated, but certain foods may need to be avoided long term. It’s all about finding the right balance for you for long term health.

If you are suffering from any health related issues, I am currently accepting new patients. To start the testing process and discover what is driving your health issues and to get on the road to recovery call our office at +1 (866) 498-1958 to schedule your initial consultation. If it is after our normal hours of operation you can click here to leave us a message. Please only leave a message if you would like a call back to schedule a consultation.


Dr. Axe. Do You Have SIBO Symptoms? Here is ALL You Need to Know!
Chris Kresser. 2015. Why Diet Alone Is Not Enough to Treat SIBO.