What is SIBO?

SIBO occurs when bacteria overgrow in the small intestine, where bacterial populations are supposed to be low. This overgrowth interferes with normal digestion and nutrient absorption. The bacteria ferments food and produces gas, bloating and irregular bowel movements that occur with SIBO.

SIBO is often a downstream consequence of something else: slowed gut motility, prior infections, stress or structural issues. Treating SIBO requires treating the root cause, otherwise recurrence is common.

Common Symptoms

• Bloating, especially after meals

• Excessive gas

• Abdominal pain or discomfort

• Diarrhea, constipation, or alternating patterns

• Nausea

• Food sensitivities

• Nutrient deficiencies (B12, iron, fat-soluble vitamins)

• Fatigue and brain fog

• Unintentional weight changes

How I Assess SIBO

A detailed history of your digestive pattern, diet, prior gut infections, surgeries and motility is the starting point. From there, your SIBO assessment may include:

• Detailed food log and reactions

• Lactulose breath testing

• Comprehensive stool analysis

• Investigation of underlying contributors (including H. pylori, low stomach acid, motility issues, and prior food poisoning or gut infections)

My Approach to Treatment

I treat SIBO as a three-part problem: clearing the current overgrowth, restoring normal gut function and addressing whatever allowed it to develop.

• Reducing the overgrowth: botanical antimicrobials or other targeted approaches based on your case and SIBO subtype (hydrogen, methane and/or hydrogen sulfide) as well as addressing biofilms

• Supporting digestion: addressing stomach acid, enzyme function(including exocrine pancreatic insufficiency) and bile flow

• Restoring motility: impaired motility is one of the most common reasons SIBO occurs or recurs

• Reintroducing foods thoughtfully: building back dietary variety once the gut has stabilized

FREQUENTLY ASKED QUESTIONS

How is SIBO diagnosed?

The most common method is breath testing, which measures gases produced by bacteria after you drink a lactulose solution.

Why does SIBO keep coming back?

Recurrence usually means an underlying driver hasn't been addressed (impaired motility, a prior gut infection or biofilms). Part of my approach is identifying that driver rather than re-treating the same overgrowth repeatedly.

Is the low FODMAP diet necessary?

It can be a useful short-term tool for managing symptoms, but it isn't a treatment on its own and isn't meant to be permanent. We use it strategically as part of a broader plan.

What are biofilms and do they affect SIBO treatment?

Biofilms are protective layers that bacteria build around themselves to shield against treatment. In the context of SIBO and gut dysbiosis, biofilms are one of the reasons that standard antimicrobial protocols sometimes don't fully clear an overgrowth. During your treatment, we will address biofilms to improve the efficacy of treatment.