SIBO: what is it, and how do I know if I have it?

There may be something lurking in your gut, when and where you least expect it.

You’re probably pretty in tune with keeping the large intestine or the bowels healthy, balanced and well-populated with good bacteria (got probiotics?).

In this post we are referring to the small intestine which precedes the large intestine. This is really where issues can begin to arise and cause debilitating symptoms not only in the digestive tract but also throughout the body.

The truth is, this is where the serious business of nutrient absorption happens, and as you can imagine, there’s quite a domino effect that can happen when the flora in this critical stretch of digestive highway gets disturbed.

Move over IBS - we’re talking about SIBO or Small Intestinal Bacterial Overgrowth! What is it, how do you know if you have it, and most importantly - what can you DO about it?

What is SIBO and what are the symptoms?

At its most basic level, SIBO or Small Intestinal Bacterial Overgrowth is when bacteria or other microorganisms, good or bad, grow out of control in the small intestine - an area that would normally have a very low bacterial count, as compared to the large intestine.

Microorganisms setting up shop in this area (colonization) end up damaging the cells lining the small intestine. This is otherwise known as leaky gut or an increase in intestinal permeability.

This, in turn, impairs the digestive process and overall absorption of nutrients which exacerbate nutritional deficiencies, allow toxins, pathogens and undigested protein molecules to enter the bloodstream that then cause widespread inflammation, food sensitivities, autoimmune disorders and other immune reactions.

The most common symptoms of SIBO are:

  • Malabsorption issues and malnutrition
  • Weight gain or loss
  • Nausea and/or vomiting
  • Abdominal bloating or distention
  • Abdominal pain or discomfort
  • Acid reflux or heartburn (GERD)
  • Excessive gas or belching
  • Constipation and/or diarrhea
  • Fatigue
  • Skin issues like rashes, acne, eczema and rosacea
  • Aches & pains, especially joint pain
  • Brain fog

As mentioned, one of the biggest concerns with SIBO is that essential nutrients, protein, carbohydrates and fats aren’t being properly absorbed, causing deficiencies of iron, vitamin B12, calcium and in the fat-soluble vitamins: A, D, E and K.

What causes SIBO?

According to experts, the causes are not clearly defined but contributing factors to being diagnosed with SIBO can include:

  • Aging
  • Metabolic disorders including diabetes
  • Chronic pancreatitis
  • Diverticulosis
  • Injury to the bowel
  • Recent abdominal surgery

Celiac disease is also associated with an increased risk for developing SIBO, and can be of concern, as it disturbs gut motility leading to poor functioning of the small intestine.

Another common condition associated with SIBO is Irritable Bowel Syndrome. As a matter fact, studies have found that SIBO occurs simultaneously in 84% of cases of IBS.

It has even been reported that successful elimination of bacterial overgrowth in the small intestine resolve’s symptoms of IBS as well.

The use of certain medications, including immunosuppressant medications, and proton pump inhibitors (acid reflux medications) as well as heavy metal toxicity, low stomach acid, inflammatory diets, and yep, you guessed it, stress - are all thought to be contributors as well.

How can you test for SIBO?

It is typically diagnosed using a breath test in which the patient drinks a sugar-containing drink and exhaled gases are measured.

If there are too many bacteria, excess gases (hydrogen, methane or both) will be produced. It should be noted that the reliability of this test is considered less than ideal, but it’s one of the only methods available at this time.

Take the SIBO Quiz

adopted from the SIBO Diet Plan, Kristy Regan, MScN

  1. Do you have chronic IBS symptoms such as diarrhea, constipation, bloating and or abdominal pain?
  2. Did your symptoms start or worsen after one or more episodes of food poisoning or stomach flu incidents?
  3. Do you have to use medications or supplements such as high dose magnesium, high dose vitamin c or laxatives to have regular bowel movements.
  4. Did your symptoms start or increase after surgery?
  5. Do you have a history or frequent antibiotic use, opiate or proton pump inhibitors?
  6. Have you adopted a restricted diet to limit symptoms?
  7. Do you have anemia or low ferritin that cannot be attributed to other causes?
  8. Does a high fiber or high FODMAP diet increase your symptoms?
  9. Has a gluten free diet made little or no discernable differences in your symptoms?
  10. Have you noticed an improvement in your symptoms when taking antibiotics for a different reason?
  11. Have you experienced unwanted weight loss or gain even though you eat the same amount?
  12. Do you now react to foods you used to be able to eat without any discernible symptoms?

If you answered yes to even one of these questions, it is possible that SIBO is an underlying factor. Book an appointment with Dr Cobi to be evaluated for SIBO.

What’s the treatment for it?

Most holistic health practitioners advise adhering strictly to the “SIBO diet” for at least 2 weeks - which may include any (or all) of the following protocols:

  • Herbal antibiotics
  • An Elemental Diet
  • A low FODMAP, GAPS and/or AIP diet
  • Stress management; yes, this can help heal your gut!
  • Repopulating the good bacteria using probiotics, and then feed with prebiotics

In more severe or persistent cases, a prescription antibiotic may be needed to get the overgrowth under control.

Book your appointment with Dr Cobi to determine if SIBO is an issue for you.


World Journal of Gastroenterology: “Small Intestinal Bacterial Overgrowth Syndrome”
World Journal of Gastroenterology: “Irritable Bowel Syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype?”

Journal of Clinical Gastroenterology: “Gastrointestinal motility disturbances in celiac disease”