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SIBO – Small Intestinal Bacterial Overgrowth

What is it?

While the large intestines have trillions of bacterias in them, the small intestines have relatively few. SIBO is as the name implies: the small intestines have an overgrowth of bacteria when they shouldn’t.

Contributing factors to SIBO can be NSAIDs, chronic stress, inflammation, constipation, bowel surgery, and more. For some of us, SIBO can be a co-condition of endometriosis and contribute to our abdominal bloating (the beloved endobelly), digestive problems, or non-digestive problems (as I saw in my own case with my histamine intolerance.)

With SIBO, it’s important to work with a qualified doctor who has experience with SIBO. This could be a local gastrointestinal doctor, in which case hopefully the consults, testing, and/or treatment would be covered by insurance. Some people also see naturopaths or functional medicine doctors. There is often a lack of evidenced-based medicine with naturopaths and functional medicine doctors, so make sure to research before choosing one of those doctors should you go down that path.

Testing for it

The most common way to diagnose SIBO is typically through a breath test which measures levels of different gases such as hydrogen and methane. There are multiple breath tests, such as lactulose or glucose. Unfortunately, these tests are not always reliable and can be falsely negative at times, which means that you could still actually have SIBO even if the test shows as negative. Because of this, some doctors will treat based on symptoms, even if the test is negative.

In my own individual case, because of this and the fact that I had symptoms associated with SIBO as well as many of the common contributing factors that may lead to it, my doctor didn’t do any SIBO testing on me and instead we did a treat-and-see approach. When the first round of treatment reduced my symptoms, she gave me a working diagnosis of SIBO and we did several rounds of treatment until my symptoms were significantly reduced.


Generally, there are 3 treatments for SIBO: antibiotics, antimicrobials, or an elemental diet. Some doctors may also put the patient on a low FODMAP diet while treating with antibiotics or antimicrobials. Note: it’s not recommended to follow a low FODMAP diet for more than a few months. Cutting out FODMAPs long term can hurt gut health, so goals for using the diet should also include reintroducing a variety of foods after a period of time.

While each treatment type has been shown to reduce SIBO, they have different pros and cons, costs, accessibility, etc. Some doctors find antimicrobials to be a helpful first-line treatment, because these can also address gut dysbiosis in the colon as well.

Unfortunately, SIBO may need multiple rounds of treatment, as it can often recur in patients.

For more info

  • SIBO Info“The place for all things SIBO”, an educational website by Dr. Allison Siebecker, ND, MSOM, LAc, a leader in the field of SIBO.

  • Low FODMAP diet -This diet has been beneficial to many people with IBS or SIBO and may be worth researching if you have digestive problems, although it’s not recommended to follow this diet more than a few months. Cutting out FODMAPs long term hurt gut health. Monash University is one of the leaders in this diet and their app is helpful!