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What Causes SIBO (Small Intestinal Bacterial Overgrowth) and Why It’s so Hard to Treat


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Reviewed by Vanessa Wong, MD

While bacteria are an essential part of a healthy small bowel and perform important functions, small intestinal bacterial overgrowth can lead to leaky gut and a number of other symptoms. Learn what puts you at risk for SIBO.

sibo info
SIBO (small intestinal bacterial overgrowth) is a complex issue. istock.com/frentusha

The normal small bowel, which connects the stomach to the large bowel, is approximately 20 feet long. Gut microbiome bacteria are normally present throughout the entire gastrointestinal tract, but in varied amounts. Relatively few bacteria normally live in the small bowel (less than 10,000 bacteria per milliliter of fluid) when compared with the large bowel, or colon (at least 1,000,000,000 bacteria per milliliter of fluid). And, the types of bacteria normally present in the small bowel are different from those in the colon.

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Why You Should Thank Your Small Bowel and the Beneficial Bacteria That Live There

The small bowel plays an important role in digesting food and absorbing nutrients. It is also an important part of the immune system, containing an impressive network of lymphoid cells (cells of the immune system that help fight infections and regulate the immune system).

Are you at risk for small intestinal bacterial overgrowth? Find out what the most common risk factors and symptoms are.#SIBO #SIBOsymptomps

The normal (beneficial) bacteria that are an essential part of the healthy small bowel also perform important functions. These beneficial microorganisms help protect against bad (i.e. pathogenic) bacteria and yeast that are ingested. They help the body absorb nutrients, and also produce several nutrients (such as short chain fatty acids) and vitamins like folate and vitamin K. These bacteria help maintain the normal muscular activity of the small bowel, which creates waves that move the contents of the intestine, like food, through the gut.    

What Is SIBO?

SIBO, small intestinal bacterial overgrowth, is defined as an increase in the number of bacteria, and/or changes in the types of bacteria present in the small bowel. In most patients, SIBO is not caused by a single type of bacteria, but is an overgrowth of the various types of bacteria that should normally be found in the colon (1). Less commonly, SIBO results from an increase in the otherwise normal bacteria of the small bowel. 

SIBO has been shown to negatively affect both the structure and function of the small bowel. It may significantly interfere with digestion of food and absorption of nutrients, primarily by damaging the cells lining the small bowel (the mucosa). Additionally, this damage to the small bowel mucosa can lead to leaky gut (when the intestinal barrier becomes permeable, allowing large protein molecules to escape into the bloodstream), which is known to have a number of potential complications including immune reactions that cause food allergies or sensitivities, generalized inflammation, and autoimmune diseases (2).

These pathogenic bacteria, whether too many or the wrong types, can lead to nutritional deficiencies on top of those due to poor digestion or malabsorption. In particular, the bacteria will take up certain B vitamins, such as vitamin B12, before our own cells have a chance to absorb these important nutrients. They may also consume some of the amino acids, or protein, that we’ve ingested, which can lead to both mild protein deficiency and an increase in ammonia production by certain bacteria. (We normally produce some ammonia daily from normal metabolism, but ammonia requires detoxification, so this may add to an already burdened detoxification system.) The bacteria may also decrease fat absorption through their effect on bile acids, leading to deficiencies in fat soluble vitamins like A and D.

What Causes SIBO?

The body has several different ways of preventing SIBO. These include gastric acid secretion (maintaining an acidic environment), waves of bowel wall muscular activity, immunoglobulins in the intestinal fluid, and a valve that normally allows the flow of contents into the large bowel but prevents them from refluxing back into the small bowel. (This is called the ileocecal valve because it’s located between the ileum, or terminal end of the small intestine, and the cecum, a pouch forming the first part of the large bowel.)

The cause of SIBO is usually complex, and likely affects more than one of the protective mechanisms listed above. A number of risk factors for SIBO have been identified, with some of the more common risk factors listed below.  For a more complete discussion of associated diseases and risk factors check out this study and this study.

Risk Factors for SIBO

  • Low stomach acid
  • Irritable bowel syndrome
  • Celiac disease (long-standing)
  • Crohn’s disease
  • Prior bowel surgery
  • Diabetes mellitus (type I and type II)
  • Multiple courses of antibiotics
  • Organ system dysfunction, such as liver cirrhosis, chronic pancreatitis, or renal failure

Moderate Alcohol Consumption and Oral Contraceptive Pills (OCPs) Also Increase the Risk for SIBO

Heavy alcohol use has long been recognized in association with SIBO (3). This study also found an association between SIBO and moderate alcohol consumption, defined as up to one drink per day for women and two drinks per day for men. Alcohol appears to have effects on several of the normal protective mechanisms, including causing injury to the small bowel mucosal cells, contributing to leaky gut, and decreasing the muscular contractions. Additionally, alcohol may “feed” a few specific types of bacteria contributing to overgrowth (4).

Overall there appears to be a moderate association between OCPs and inflammatory bowel disease (IBD) such as Crohn’s disease (5). Though no studies to date specifically correlate the use of OCPs with SIBO, given the known relationship between IBD and SIBO, it is likely that this association holds true for SIBO as well. However, once patients stop taking OCPs, this risk appears to reverse.

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How Do You Know If You Have SIBO?

The number of people with SIBO in the general population remains unknown. Some studies suggest that between 6 to 15% of healthy, asymptomatic people have SIBO, while up to 80% of people with irritable bowel syndrome (IBS) have SIBO (6). 

SIBO is largely under-diagnosed. This is because many people don’t seek medical care for their SIBO symptoms, and because many doctors aren’t aware of how common SIBO is.

Complicating this, the most commonly used tests (breath tests measuring levels of hydrogen and methane gas) still have fairly high rates of false negatives (meaning the test results come back as negative but you actually do have the disease) (7).

The most common symptoms of SIBO include:

  • Abdominal pain/discomfort
  • Bloating and abdominal distention
  • Diarrhea
  • Constipation (generally associated with methanogens as Chris discussed in his recent podcast)
  • Gas and belching
  • In more severe cases, there may be weight loss and symptoms related to vitamin deficiencies.

Is SIBO Contagious?

Unlike many other bacterial infections of the gastrointestinal tract, SIBO is not contagious, and there is no evidence that exposure to any single microorganism increases the risk for developing SIBO. SIBO occurs due to a complex interplay of many different factors and is not passed on between individuals. However, some evidence suggests that there is an association between Helicobacter pylori and methane production, suggesting that H. pylori plays a role in gut dysbiosis. (8)

Why SIBO Can Be Difficult to Treat

Antibiotics are often used to treat SIBO. However, studies show that despite treatment with antibiotics, recurrence develops in almost half of all patients within one year. One study comparing treatment with rifaximin (the most commonly used antibiotic for SIBO) and botanical antimicrobials showed slightly better outcomes with the botanical protocol, but still with successful treatment in close to only half of all patients after one course of treatment.

These finding suggests that treatment of the overgrowth alone is not enough for most people. An additional piece of successful treatment must include addressing the underlying cause, or predisposing factor.

Though there are many identified associations between SIBO and other diseases as described above, abnormalities in gut motility are recognized as one of the most common associations. One study published this month demonstrated that patients with SIBO do have significant delays in small bowel transit time (the amount of time it takes something to move through the small bowel). This finding suggests that patients with SIBO, who do not recover after a standard course of antibiotics, or botanical antimicrobial protocol (which we prefer), may benefit from the addition of a prokinetic agent, which increases the muscular contractions of the small bowel. Octreotide and low dose naltrexone are two such options that are being investigated, and may help treat some cases of SIBO that don’t respond to antimicrobials alone. Other options may include prucalopride and low-dose erythromycin, as well as lubiprostone. (9)

As research into SIBO continues, we are increasingly understanding the complexity of this disease, and how treatment must be tailored to each individual to maximize success.

If you need support in dealing with SIBO, consider working with the California Center for Functional Medicine. CCFM offers a membership-based health transformation service that excels at helping people with chronic conditions make the changes necessary to reclaim their health. Find out more about what CCFM has to offer.
Amy Nett

About Amy:  Amy Nett, MD, graduated from Georgetown University School of Medicine in 2007.  She subsequently completed a year of internal medicine training at Santa Barbara Cottage Hospital, followed by five years of specialty training in radiology at Stanford University Hospital, with additional subspecialty training in pediatric radiology.

Along the course of her medical training and working through her own personal health issues, she found her passion for Functional Medicine. She works with patients through a Functional Medicine approach, working to identify and treat the root causes of illness. She uses nutritional therapy, herbal medicine, supplements, stress management, detoxification and lifestyle changes to restore proper function and improve health.

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    • Hi – I have read that some people think it might, but if you want to be sure, it seems to me like people have more success with taking pure L-Glutamine (which is a component of gelatine, I believe). It’s an amino acid that a lot of people use for this purpose. Alternatively colostrum have been shown in studies to reduce gut permeability significantly.

  1. I have tested positive for dysbiosis and have no lactobacillus in my stool samples. I will be starting on protocols for these. My question is whether or not there is a relation between these and the bowel obstructions for which I have been hospitalized 4 times. The doctors don’t know the cause but suggest it relates to previous surgery for appendix and a fibroid, triggered by high fiber foods. I can’t help thinking SIBO or other gut health issues are contributing factors.

    • If you had your appendix out, your ileocecal valve will not be as functional as normal, and according to one of the posts above yours, this allows some migration of colon bacteria into the small bowel. Rough fiber will cause the valve to spasm. I have this and I can’t eat rough nuts or coconut, but I can eat coconut cream and coconut milk. Many seeds are too rough and will cause spasm, like raspberry and strawberry seeds and flax seed. If you get a sharp pain a few hours after eating, around the area of the right ovary, that can be the valve spasm. Find the center of the painful spot and press in and up, hold for a while, then lie on your left side. If necessary repeat a couple of times. You can get the contents to move through the area this way. Some chiropractors gave me this advice. I have to do it many times a week. I use a shaving cream can to get more leverage, and put a wash cloth over it to pad it. Also, stimulate a reflex point on your right shoulder. Do some research for more guidance. Ileocecal valve syndrome. The SIBO diet has helped my valve calm down.

  2. Amy, thank you for your article and commitment to helping those of us who suffer with SIBO! I am a 35 year old female who was diagnosed with SIBO over one year ago. I have never had the “best stomach,” but I experienced terrible diarrhea, gas, bloating, and stomach pain (felt like someone was twisting my insides) after a C-section—including antibiotics (after I developed a UTI from the catheter) and opiate pain meds. Like another responder, I noticed my symptoms got much worse as the day went on. Breath test showed hydrogen levels at about 100. I was treated with Rifaximin and changed my diet (SCD + low Fodmaps), and my gas was reduced significantly. However, I still suffered with bloating and loose, orange stools.

    I took another round of Rifaximin last spring and repeated the breath test 2 days after finishing the course. It showed that my bacteria levels had barely been reduced. 🙁 I also developed Rosacea on one side of my cheeks around this time.

    I should also mention that I have lichen sclerosus, both on my vagina and anus. This was diagnosed probably 8 years ago via biopsy after literally 9 years of being on an antibiotic/diflucan merry-go-round to treat suspected chronic vaginal infections. I treat the LS periodically with topical estrogen creams but try to stay away from long-term steroid use. I am currently suffering from a debilitating flare.

    Next Chapter: This fall, I have unwittingly become my own internet naturopath (natural medicine is not covered at all by my insurance). I started with a parasite cleanse (Scram). In the last month, I have been taking Interfase Plus, Lactoferrin+Colostrum, L-Glutamine, HCl (can only tolerate 1-2 pills), high doses of berberine/goldenseal (5g, per Allison Siebecker’s site), Kyolic Garlic + Ginger, coconut oil, and using Iberogast before bed as a pro kinetic. I am still continuing to eat SCD/lowFodmaps/very low sugar/fruit, but have tried kefir lately. I have been suffering terrible diarrhea since I started herbal meds. If I fall off the wagon in my diet, I go right back to my symptoms. I am really lost and not sure where to go next. I am scared to try probiotics after treatment. I have tried Align and VSL #3 before without change in symptoms. I am thinking of Prescript Assist because I have read it is well-tolerated with SIBO, but I also fear un-doing any progress I’ve made.

    My questions are:
    -Is there some underlying medical issue that may be causing all these conditions (SIBO, rosacea, lichen sclerosus)?
    -Orange stools seem to be a constant. Is this indicative of something?
    -What should be my next step, since I’m due to finish 1 month of the herbal treatments in about a week. Should I treat longer? Maybe try something else? What are the best herbs for SIBO-D? What about Lauricidin?
    -Does anyone know of a specialist in these conditions (naturopath or otherwise) in North Carolina? Accupuncturist? Chinese Medicine? Since I know it will be very expensive, I’m not willing to just go to any alternative doctor without a vetted recommendation.

    Thank you so much for reading this lengthy post. I really appreciate any insight and guidance anyone can offer. Thank you, and I wish everyone the best of health.

    • I could almost cry this is the first time I have seen lichen schlrocis, written on any site,one morning I woke up my vagina was glued shut I I was afraid I would not urinate i saw 2 conventional drs they gave me cortisone clobert lipoderm.
      $140.00 what causes this condition? I have had 4 c sections now my vaginal opening in about the size of a almond.
      I really need help to understand all of this HELP

      • Carol,

        I know how you feel; it is often very scary and isolating for me to think about my lichen sclerosus. In my experience/reading, it is important to regularly use topical steroids to maintain the condition, so that the skin does not fuse. I have found clobetasol ointment to work the best for me. I’ve had a doctor tell me that I could/should also manually “stretch” the skin in the shower daily. Once you are able, it can help to have a regular sex life as well. I have found that Estrace cream (prescription estrogen cream) helps with the irritation too. I once saw a specialist who thought weak pelvic floor muscles contributed to my condition, and she recommended pelvic floor therapy, which I have not tried yet. I have had years where it seemed to be cured (particularly during pregnancy, when the immune system is suppressed) but then flares. I also know that surgery is an option to widen the vaginal opening if it gets too narrow.

        Hopefully it helps to know that you are not alone. Please know even though there is no cure, it is possible to maintain and have a healthy sex life.

        Take Care,

  3. My 14 year old daughter was just diagnosed with SIBO. Our Naturalpath put her on Betaine HCL & Pepsin, Berberine Complex, Vitamin A, K2-D3, B12-Active, and MotilPro (she is allergic to Macrolides).
    Should I be worried to start her on all of these at once? I read that SIBO is associated with an underlying illness…how do we find out what that is? She has scoliosis…could that cause nerve damage to the stomach/small intestine area?

    • Hi Lori, I just wanted to mention that I was diagnosed with scoliosis as a teen, too, and found out at age 38 that I had celiac disease and it’s probably long-standing. In all my research, I’ve found there is an association between scoliosis and celiac. (I’m being tested for SIBO right now b/c I’m having continuing digestive problems). Has your daughter been tested for celiac disease? Best of luck. 🙂

      • Yes, my daughter was tested for celiac disease. She was found to be gluten sensitive, not celiac’s. This all started when she was in 3rd grade. She would get heartburn/acid reflux all the time and even the dentist said she lost a lot of enamel from behind her bottom front teeth because of the reflux. I also think that her scoliosis has affected her stomach nerves causing most, if not all of her problems. The doctor found her scoliosis when she was 8 1/2 years old, which was in the 3rd grade when all her stomach problems began.

        • I just wanted to point out that this is not how scoliosis works – if your spinal cord and nerves were being affected by scoliosis, you would most likely need to go to hospital straight away. Signs that this is happening are a complete loss of bowel control, paralysis, and other very serious problems. I know because I also have scoliosis and have been told to look out for these signs by my doctor. Your naturopath sounds like they know what they are doing – berberine is strongly antimicrobial.

  4. I was diagnosed with SIBO almost a year ago. 3 rounds of Rifaximin/Neomycin and when I am not doing that I am on an herbal abx protocol. Been following an SCD/low FODMAP diet the entire time, only cheating little bits when I am conventional abx. 2 rounds of homemade elemental diet (just seemed to make dysbiosis worse). Got rid of the Blastocystis Hominis but the SIBO hangs on like mad. It seems like you go round and round (especially with the methane type) unless you can get rid of the biofilm. Have used both Interfase Plus and Lipophos EDTA, the latter of which has seemed more effective for me. On low dose Erythromycin as prokinetic, which I hate, but don’t feel like I’ll see any progress if I’m not moving stuff out! It’s a long road and hard to stay the course at times. I do yoga, tap, meditate, anything to help me stay positive. Skyping with an ND at the SIBO center at NCNM has been helpful to make sure I’m on the right track. As far as I can tell I got SIBO after a c-section (scarring) and 2 bouts of food poisoning in a year, plus I’ve always had slow motility due to undiagnosed dairy allergy.

  5. I just listened to an interview with Dr Datis Kharrazian by Sean Croxton as part of the Digestion Series—where Dr Kharrazian talks about the Brain to Gut axis and the risk of SIBO related to lowered gut motility due to brain neurodegeneration of the Vagus nerve which is necessary for gut motility. This is something that can effect migration of the bacteria from the large intestine into the small intestine. Worth listening to—google Digestion Series–Sean Croxton which is available now on line

  6. My partner was diagnosed with SIBO in May of this year. His symptoms peaked after an experimental period of very low carb eating (about 50 grams of carbs/day). He was having 10-15 bowel movements/day cycling between constipation and diarrhea. He was prescribed Rifaximin, which was only a small part of his healing.

    The most helpful aspects of the protocol he followed were:
    • Removing FODMAPs for a period of time
    • Botanical antimicrobials (high dose Peppermint oil, Oregano oil)
    • Bone broth, L-glutamine, DGL, marshmallow root for gut soothing/rebuilding

    Then after the intense round of antibiotics, followed by the botanicals:
    • High doses of soil-based probiotics to try to reinoculate with good bacteria (Prescript Assist, Primal Defense Ultra)
    • Gradual reintroduction of FODMAPs and fermented foods to help feed the good bacteria

  7. Hi, i enjoy reading all of Chris’ essays. I have been experiencing nausea for approx 8 months now. i have had every test the gastro enterologist could devise and they have found nothing. I also have IBS but the Drs don’t think they are related. I saw a Naturopath who thought the cause could be Low stomach acid but the HCL made the nausea worse. Has anyone else had a problem with constant nausea? I sure would appreciate any information anyone could give me. My quality of life has been compromised by this problem.

    • I suffer regular nausea,subsequent to oral surgery/post-operative infection;I don’t have any digestive problems,so perhaps your nausea is related to something else.
      n.b.,the article is by Amy Nett.

    • A magnetic wrist band over Acupuncture point p6 helps alleviate nausea. You can purchase one online. Obviously, this is not treating the root cause but may make life easier while you address the deeper seeded issues.

    • I too suffered from IBS and SIBO with nausea – worse in the mornings for years. I tried Rifaximin w/out relief. I also tried herbal antibiotics. It was only a consistent use of Pro Thera labs ABx support probiotic that made a difference. A tremendous difference. I also drink Kevita probiotic drinks, very little coffee (due to chronic stomach inflammation), and have cut out dairy and gluten from my diet. After suffering for fifteen years I feel 98% better. Very few bad says. No more extreme stomach pain and running for the bathroom. I feel like I have my life back, which is amazing after all the tests, drugs, etc. I’ve been through. One more note. If you think you might have SIBO, run from High fructose corn syrup like the plague. It only fuels the piranhas in your gut. Good luck and hope that helps!

    • I recently went through a period where I was constantly nauseated and lost my appetite. It was so bad, I had trouble grocery shopping for my family because I didn’t like looking at or thinking about food. I had other crazy symptoms like chest pains, muscle cramps, extreme anxiety which led to panic attacks, and head aches.

      The symptoms escalated to the point that I called 911 one night in August because I was certain I was having a heart attack. Doctors were useless (even the ND I saw). Then, after sitting and thinking about my symptoms, I suddenly realized that everything that was happening to me could be from a magnesium deficiency. I literally jumped up and ran out the door to buy some magnesium. Within hours, all my symptoms resolved. It’s been three months since I started magnesium supplements and I’m still symptom free.

    • Re nausea, in that same Digestion Sessions summit Dr Daniel Kalish was talking about H. Pylori, another infection that’s frequently under the radar/missed from diagnosis, and persistent nausea was the main symptom he referenced. The good thing if it’s H Pylori is that it’s easy to treat. Good luck!

  8. I tested positive for SIBO and have done an herbal treatment through SCD lifestyle practitioners. I am nearly done with the two month treatment. I also follow a Paleo diet with low FODMAPs. As I slowly add in a few fodmaps, my main SIBO symptom (gas) is coming back. Can I still react to high FODMAP foods and no longer have SIBO, or could it mean I still have SIBO.

    I am thinking I will just do the Refaximin and neomycin to be on the safe side, yet antibiotics are what got me here in the first place. I have had chronic LYME for over 13 years, so I have taken ALOT of antibiotics. Am I crazy to add more antibiotics, when that could be why I have SIBO in the first place?

    Will I ever be able to eat FODMAPS without gas?

    • I think you might be able to. I was able to – I supplemented with enteric coated peppermint oil, lactoferrin, zinc and l-glutamine to deal with SIBO/Leaky Gut.

      Peppermin oil to eradicate the bacteria, lactoferrin to disrupt the bio-film and zinc/l-glutamine to address leaky gut.

      I ran with this for 2 months and am much better.

      Good luck!

      I tried another SIBO protocol earlier with reflaxmin and it didn’t clear it up. The one I just mentioned did though.

      Maybe it requires some level of experimentation?

      • Hi Vikram… Hope you are able to answer.

        1. Did you work with a practitioner?
        2. What brand of peppermint oil did you use? Everything I found is cut with fennel which isn’t the best for SIBO.

        Thank you.. looking forward to your response!

    • Hi Kathleen,

      I’m not familiar with the specific treatment protocol used by SCD lifestyle practitioners, but many of our patients do require treatment for much longer than two months, particularly in severe cases of SIBO. And given that you still experience symptoms with FODMAPs, I would be concerned that you do still have SIBO, and may require longer/additional treatment. Can you repeat the SIBO breath test to see if it’s still positive?

      Based on studies, I don’t think rifaximin and neomycin necessarily have better treatment outcomes than appropriate botanical protocols, so you could consider longer treatment with botanicals, but it is certainly a discussion to have with a practitioner.

      And yes, you should one day be able to again enjoy some FODMAPs without significant gas. Hang in there!

  9. Heya,

    I went to my doc with a good many of the conditions for and the symptoms of sibo only to be told it is an internet myth, does not exist and no treatment for this existed. I was told to stick to a low fat high fiber diet and let my imaginary IBS symptoms go. He suggested an anti depressant/ anti anxiety for the ibs.

    sigh…. Since I never tested positive for celiac, all of this is in my head say the doc.

    • Check fodmap foods, if high fodmap foods make you worse and you feel better with low fodmap foods you’ll know it’s SIBO. If that’s the case also do the sodium bicarbonate test to see if your stomach acid is enough, as eplained in scdlifestyle website and also read about SIBO at fixyourgut.com

    • RJ,

      That’s wild, man! I can’t believe the doctor just blew it off completely…. and then tried to drug you!
      Good luck with trying to fix the problem, I bet you could do it yourself by following a very low sugar diet (no sugar,no below ground veggies or fruits) and eating high quality organic foods.

      Hope this helps!

    • RJ,

      I am so sorry you are dealing with this. I was told the same thing four years ago. After years of treating symptoms but never getting extended relief I decided to reach out to mainstream medical care again. Having recently moved to the Bay Area I thought I might find more informed doctors. I was right. Today I saw an insurance taking GI by UCSF. I was very careful not to mention SIBO. This doctor brought it up to me! Blew my mind. I said “well, it seems we have more information now…” And she replied, “Yes, before IBS just meant “you are crazy.” We both laughed. Such honesty! I could have hugged her. What I am trying to say RJ is don’t give up. Somewhere there is an MD who is up to date and can help. Things are changing.

  10. I have not been diagnosed with SIBO but have many of these symptoms. I was treated for chronic Lymes disease with 18 months of antibiotics, often two at a time. I believe this destroyed my digestive system. I am now treating with a naturopath who does not use pharmesecuticals. We discover a large part of my digestive issues where caused by my IC valve getting stuck open. The contents of my large intestine were backing up into my small intestine. The problem was so severe that the valve would go out after only a few days and I would have to go back and have it adjusted. Eventually my doctor taught me how to adjust it myself. I now do it twice a day and I finally am starting to see some improvement in my digestive issues. I did some research and discovered this is a common problem that few docs know about.

    • Kate, thank you for introducing IC valve into discussion. I’ve never heard of it before but now I think I might be sufferring from the same thing. Can you describe the type of adjustment that you do yourself to correct it? Or maybe point to a good instructional video, if possible.

      Thank you.
      Stay healthy.

    • Would really like to know more about self adjusting the IC valve. Can you point us in the direction of description of how to do it please?


  11. I’ve suspected I’ve had SIBO for some time even though the only symptom I have is bloating & that’s after I eat & gets worse as the day goes on. I use to drink heavy but haven’t had a drink in 5 years.

    I’m pretty lean all over but this makes me look fat.

  12. I recently suffered 2 heart attacks ands was hospitalized for 3 weeks. After my release I had intense abdominal pain that I thought was diverticulitis with abdominal bloating, gas , acid reflux and sudden weight loss of 40 pounds. I have gone on like this for 2.5 months with numerous Cts, ultrasounds, x rays, blood tests, colonoscopies, endoscopies all with normal results. Then it was proposed that I have SIBO. I am on xifaxan now for 2 weeks and have shown some improvement. What herbal treatment can I get while being on blood thinner of effient from my recent stents? I have gone to several gastroenterologists who are clueless and when told of SIBO they look at me like I am from another world. I have lost faith in all physicians at this point. Any suggestions. I am on protonix, and sucrafate as well. I dont want to be on protonix long term since it lowers your stomach acid level and propagates SIBO as a results. I am on a modified SCD diet.

  13. I have excessive bloating and foul-smelling gas and stool, constipation. I tried the GAPS protocol for 1 month and there is no change, constipation has got worse, I have lost 8 lbs. and migraines have got worse. I refuse
    to go on drugs and so I am at a loss what to do right now. Maybe I will try FodMaps protocol. Any suggestions? Thanks.

  14. I’ve wondered for a long time if I have SIBO. I don’t have any typical symptoms except for bloating especially after I eat & it gets worse later in the day. I’m a recovering alcoholic 5 years clean. I’m pretty lean all over but this makes me look fat.

  15. If SIBO is commonly caused by low stomach acid, can it not be treated simply by supplementing with Betaine HCL?

    • Hi Jo,

      Though low stomach acid may predispose people to develop SIBO, treating the low stomach acid alone is not enough to treat the SIBO. But yes, a period of supplementation with Betaine HCl during the treatment period, and during investigation for the underlying cause of low stomach acid is often an important piece of treatment.

      You might think of it this way: Low stomach acid creates a more favorable condition for the development of SIBO. But once bacterial overgrowth has occurred it needs to be treated, generally with a combination of antimicrobials and diet (specifically we use a low FODMAP diet). The low stomach acid is a related, but separate piece, and should be addressed in order to increase the likelihood of successful treatment, and also to decrease the chance of recurrence after treatment.

  16. I burped constantly for two years before it got so bad I was having chest pain from the pressure in my gut. The chest pain finally got the attention of the doctors who had been shrugging their shoulders at my complaints about the burping that was driving me crazy and was so uncomfortable. They ran every test known to man and everything was normal. I finally asked the gastroenterologist if it could be SIBO. He said yes, it could be but that the tests were unreliable so he just gave me a course of antibiotics and it worked! It started helping within just a couple of days. Insurance wouldn’t cover Xifaxan so I was prescribed a different antibiotic which I can’t remember the name of right now. The doctor warned me it would probably reappear down the road. I was good for six months and then had a recurrence. A 2nd round of antibiotics got rid of it again. Then it reared it’s head again this summer but this time I managed it with some low FODMAP. I just cut out the triggers I’ve been able to identify for myself.

    I’m thinking food poisoning was the cause for me. I didn’t have any of the other risk factors but I did have food poisoning three times before my symptoms started. I seemed to become very susceptible to food poisoning. No one else got sick but me.

    • During this time I was also under a great amount of stress. So I can see where this might have made me vulnerable.

  17. I am starting to come to the conclusion that SIBO, from which I have suffered and continue to suffer, and many other conditions are at their core stress related. I have had Chronic Fatigue for the past 2 years, which has been resistant to treatment. I suffer from immune dysfunction, digestive disorder, severe pain, multiple chemical sensitivity, food allergies and intolerances, severe fatigue, adrenal fatigue etc. I follow a Paleo diet, look after myself really well, see a naturopath and take mega amounts of supplements. I have seen minor improvements, but I am not well. I am about to attend a training course called The Lightning Process, which teaches that people with these sorts of issues have become stuck in a stress cycle which affects all aspects of our body functions and can leave the immune system open to infections, wears down the adrenal glands and affects digestion etc. I haven’t even done the course yet, but I am already seeing improvements in my stress levels and digestion purely from learning about it! I think for many people who are resistant to treatment and who suffer from chronic conditions, stress could be the key. I guess I will find out for sure next week when I attend the course!

    • Lily,

      Thank you for sharing your experience, and yes, I think stress is absolutely a contributing factor to SIBO and other gut/digestive issues. The gut-brain connection is so significant, it’s hard to talk about physiology without talking about emotions or the HPA axis. We often discuss stress management with our patients since this is such an important piece of well being. There are a number of great options to help balance the HPA axis in addition to a daily meditation practice. One of our most common recommendations for patients is to try progressive relaxation techniques such as Jon Kabat-Zinn’s guided body scans. This is an incredibly powerful tool.

      Hopefully you can post an update to this comment to let us know how your experience with The Lightening Process affects your healing.

      • Along similar lines, I was very intrigued by a recent interview with Datis Kharrazian: http://digestionsessions.com/dr-kharrazian-preview/ . I’m not sure if this link will continue to work, but the basic gist of the interview is that Kharrazian feels strongly that the gut-brain axis works both ways. And while pro-kinetic drugs are often proscribed for the treatment of SIBO, he thinks that this particular element of SIBO – the lack of sufficient motility to move food downsteam and prevent microbes/etc. from moving upstream – is largely dictated by the brain itself.

        Therefore…Kharrazian’s got interesting ideas on stimulating brain function (using simple exercises, such as gargling and vagal nerve stimulation), and he thinks that this is really necessary in order to prevent the reoccurance of SIBO after antimicrobial treatments. Basically: he thinks it can’t be just food/dietary treatments alone.

        I’m curious what you think of these ideas, Dr. Amy! Thanks for your article…

        • Hi Sarabeth,

          I agree with you, this is a very intriguing interview, and Dr. Kharrazian provides some wonderful evidence about the significance of the brain to gut axis. Based on some of the scientific literature, as he describes, some people do experience gut issues secondary to neurologic, or brain, dysfunction, of varied etiologies. Based on our clinical experience, I’m not yet certain that all patients with SIBO have brain dysfunction, or more specifically impaired vagal nerve firing, but it seems reasonable that many people might. And, given that his recommendations, specifically aggressive gargling and eliciting a gag reflex, have no serious adverse effects, I think these are very reasonable options to try.

          • How could so many symptoms and diseases improve or disappear with magnesium supplementation?

            Magnesium is involved in almost 400 reactions in the body and its deficiency is often the cause or part of the cause in the above mentioned conditions.