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What is SIBO? (4 × 3 in)

What is SIBO?

Do you suffer from gut problems, skin issues, mood issues, and pain? Get all the details about SIBO including symptoms, related conditions, diagnosis strategies, treatment options, plus diet and the 5R Protocol.

SIBO, or small intestinal bacterial overgrowth, is excess gut bacteria in the small intestine, which might not seem like that big of a deal considering bacteria are a natural part of the entire digestive tract {mouth to tail}. But in a healthy gut, the colon has the highest concentration of bacteria while the small intestine shouldn’t have many bacteria.


To start, let’s look at common symptoms and conditions that make you susceptible to SIBO.

Common Symptoms of SIBO:

  • Abdominal bloating and pain
  • Belching and gas
  • Diarrhea
  • Constipation
  • Food sensitivities
  • Skin issues
  • Mood issues
  • Joint pain
  • Weight loss
  • Nutrient deficiencies
  • Anemia
  • Malnutrition
  • Decline in cognitive function

Digestive Conditions Associated with SIBO:

  • IBS
  • Stomach flu or food poisoning
  • Low stomach acid
  • GERD
  • Pancreatitis
  • Gastroparesis
  • Celiac disease
  • Small intestinal obstruction
  • Crohn’s disease
  • Fistula
  • Previous ileocecal resections
  • Abdominal surgery
  • Chronic GI tract conditions

Other Conditions (not clearly linked to digestive imbalance)

  • Aging
  • Rosacea
  • Diabetes
  • Nerve damage
  • Hypothyroidism
  • Scleroderma
  • Some medications {immunosuppressants, PPIs, H2 blockers, narcotics}

Does SIBO Need to be Treated?

Aside from all the annoying symptoms that impact your quality of life, if SIBO is left untreated, it can cause health complications by damaging your small intestine. The small intestine is the longest piece of the digestive tract and is where food and digestive juices mix allowing nutrients to be absorbed into the bloodstream. SIBO damages your digestive tract making it dysfunctional.


Malnutrition can be a result and involves poor absorption of essential nutrients and macronutrients {protein, carbohydrates, and fat}, causing deficiencies related to iron, vitamin B12, fat-soluble vitamins {A, D, E, and K}, and calcium.


Vitamin B12 deficiency is of particular concern, especially for vegetarians or vegans. B12 can be an issue for those who have inadequate stomach acid or take medications that suppress stomach acid {PPIs, H2 blockers, and other antacids). Long-term vitamin B12 deficiency can lead to permanent nerve damage.

How is SIBO Diagnosed?

A SIBO breath test can help diagnose SIBO. This noninvasive test measures the amount of hydrogen and methane you breathe out after drinking a mixture of glucose and water.  A rapid rise in exhaled hydrogen or methane may indicate bacterial overgrowth in your small intestine.

A breath test entails:

  • Eating a low-fiber, low-fermentable diet for 24-48 hours and an overnight fast before the test
  • Drinking a predetermined load of glucose and water
  • Collecting samples at baseline and then every 15-20 minutes for a total of 3-5 hours
  • The test measures how much hydrogen and methane have been produced by the bacteria in your small intestine.

A breath test is just one piece of the puzzle. Other factors that need to be considered are:

  • Medical history
  • History of medications
  • Risk factors
  • Symptoms
  • Diet

Treatment Options

Treatment often involves eliminating the overgrowth with antibiotics, herbal supplements, and/or a specialized diet.


SIBO is often initially treated with antibiotics. Antibiotic treatment helps to remove poor bacteria from the gut but also removes beneficial bacteria necessary for digestive function. However, even with antibiotic treatment, SIBO has been found to have a high recurrence at approximately 45%.

Herbal Therapy

Alternatives have proven to be as effective as three courses of antibiotic therapy and include herbal therapy {oregano oil, berberine, neem, allicin, and others}.


Diet plays a significant role in the management of symptoms. By reducing the load of fermentable carbohydrates {FODMAPs} through an elimination diet, symptom relief and healing may occur.

What are FODMAPs?

Simply put, FOMAPs are fermentable carbohydrates. With normal gut function, these foods are easy to digest.  FODMAPs stand for:

FODMAP acronym

With compromised gut function, these carbohydrates tend to ferment in the gut resulting in gas, diarrhea, constipation, bloating, and/or cramping.  A low FOMAP diet is a key component to the 5R Protocol for SIBO. The low FODMAP diet controls your symptoms like bloating, gas, and elimination issues.  


There are 3 steps to a Low FODMAP Diet – elimination, reintroduction, and personalization.  A strict Low FODMAP Diet is not a forever diet, but a process that allows you to personalize your diet.  To create a sustainable solution, foods that are tolerated should be added back into the diet.

5R Protocol for SIBO

Remove Stressors & Irritants

  • Microbes via antibiotic treatment {Rifaximin, Metronidazole, Neomycin, or a combination to name a few}
  • Snacking between meals
  • Fermentable carbohydrates {FODMAPs}
  • Artificial sweeteners

Replace Digestion Facilitators

  • Replace hydrochloric acid if low
  • Consider using digestive bitters
  • Supplement with betaine HCL
  • Address nutrient deficiencies

Repair the Intestinal Wall

  • Supplementation {omega-3 fatty acids, zinc}
  • L-glutamine
  • Bone broth

Reinoculate with Probiotics & Prebiotics. Or do you?

  • Probiotics are controversial when it comes to SIBO treatment. Adding to the bacterial load may make symptoms worse.
  • What is prebiotics? Prebiotics are food for beneficial gut bacteria. Sunfiber is a low FODMAP prebiotic.

Rebalance Stress Management & Lifestyle

  • Eat at regular intervals every 3-5 hours
  • Gradually re-introduce foods and assess tolerance
  • Yoga/deep breathing/meditation to stimulate the vagus nerve and promote healthy parasympathetic nervous signaling

Bottom Line

SIBO is a real condition. It can cause digestive conditions and conditions that seem unrelated. SIBO can disrupt digestive function and even cause malnutrition. Treatment is multifactorial and is best treated with the 5R Protocol – Remove, Replace, Repair, Reinoculate, and Rebalance.


To learn more about SIBO, treatment, and the low FODMAP diet, book a free discovery call with a dietitian obsessed with optimizing digestive health.

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