I had a patient who told me he had three sets of pants with different waist sizes to wear because he never knew how bloated he would be. It turns out instead of changing pants sizes, he needed to start making changes in his health plan. He had a condition known as SIBO.

SIBO is the acronym for “small intestinal bacterial overgrowth,” excessive bacteria in the small intestine.  It’s showing up now more than ever and is a sign of intestinal inflammation and often occurs in many people suffering from IBS.

Here’s how it happens: bacteria naturally appear throughout the digestive tract and the small intestine usually has lower levels. Most digestive bacteria are supposed to be in the colon. In certain occasions the bacteria invades and overwhelms the small intestine and becomes SIBO.  This leads to symptoms like gas and bloating, poor nutrient absorption and when prolonged can eventually lead to damage of the stomach lining.

SIBO symptoms are similar to other gastrointestinal disorders and needs to be diagnosed to create a proper treatment plan. Symptoms of SIBO include:

  • Acne
  • Asthma
  • Bloating
  • Depression
  • Diarrhea
  • Eczema
  • Fatigue
  • Joint pain
  • Malnutrition
  • Nausea
  • Rashes
  • Vomiting
  • Weight loss


There are many conditions that can contribute to small intestine bacterial overgrowth, including chronic pancreatitis, diabetes, diverticulosis, structural defects in the small intestine, injuries and aging. Immunosuppressant medications, proton pump inhibitors, immune system disorders, recent abdominal surgery and celiac disease are also associated with an increased risk for developing SIBO.

With SIBO, essential nutrients, protein, carbohydrates and fats aren’t properly absorbed. It can also cause deficiencies of iron, calcium, vitamins A, B12, D, E and vitamin K. This can lead to other symptoms like weakness, fatigue, confusion and damage the central nervous symptom. Megaloblastic anemia, a blood disorder that causes the loss of red blood cells, is directly related to SIBO. This is due to the malabsorption of vitamin B12.

Testing for SIBO include a breath test, urine tests and comprehensive stool tests. The breath test is the most comprehensive and the most difficult, requiring a fast for 12 hours, breathing into a small balloon, ingesting a precise amount of sugar, and repeating breath samples every 15 minutes for 3 or more hours. An abnormal breath tests can also signify pancreatic insufficiency and celiac disease.

SIBO is most often treated with the antibiotic rifaximin. The problem is that it is not always effective, usually isn’t covered by insurance and is very expensive on its own.

The most effective treatment for SIBO is a healthy diet, nutritional supplements and lifestyle changes necessary to get the body back in balance. To start, consume smaller amounts of food during meals. Eat smaller portions throughout the day rather than large meals. Eating smaller meals allows you to digest foods more quickly which helps. Overeating causes food to sit longer in the stomach. This also slows gastric juice production and is one of the main contributing factors of SIBO because stomach acid kills off bacteria in the upper GI regions.

Use probiotic supplements and eat probiotic-rich foods. Avoid all grains, processed sugars, high-starch foods, processed foods, and non-organic meats and dairy. The goal of the SIBO diet is to repair the intestinal lining, ease inflammation and get rid of the bacterial overgrowth. It also helps repair leaky gut syndrome, rebalance bacteria throughout the digestive tract and prevents toxins entering the bloodstream. It also helps reduce food sensitivities, improves neurological function and boosts the immune system.

Other SIBO diet tips include drinking bone broth regularly, use coconut oil for cooking and

consume probiotic-rich foods. Essential oils are beneficial when treating SIBO including oregano oil, tarragon oil, frankincense oil, clove oil and others. Use only high-quality, food-grade essential oils. A drop or two in a glass of water prior to a meal can help reduce bloating and gas, as well as other symptoms.

It is important to make a comprehensive plan with your doctor to treat SIBO. If guidelines are not followed strictly, the SIBO tends to return, sometimes at a higher level.

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