What you should know about SIBO

Small intestinal bacterial overgrowth (SIBO) occurs when there is an overgrowth of bacteria within the small intestine, resulting in a range of uncomfortable symptoms. These symptoms include bloating, diarrhea or constipation, and others. 

Symptoms of SIBO

Understanding the symptoms of SIBO plays an important role in management. Symptoms include:

  • Chronic bloating
  • A sensation of fullness despite minimal eating
  • Gas
  • Abdominal discomfort 
  • Constipation
  • Diarrhea
  • Heartburn
  • Nausea
  • Acid reflux
  • Brain fog
  • Exhaustion
  • Nutrient deficiency
  • Joint pain

Causes of SIBO

Factors contributing to or causing SIBO could be:

1. Low motility: this occurs when the Migrating Motor Complex (MMC)- the system that sweeps your digestive system while you’re not eating- stops working correctly. This results in prolonged food and bacterial residence in the small intestine.

2. Dysbiosis: an imbalance within the gut microbiome is often characterized by the presence of detrimental bacteria anywhere in the gut.

3. Low stomach acid: an environment with diminished stomach acid promotes bacterial colonization.

4. Food Poisoning: the aftermath of foodborne illnesses can weaken the gut’s protective mechanisms, allowing for bacterial growth in the small intestine.

5. Adhesions: the presence of post-surgical adhesions or scar tissues within the abdominal cavity physically obstructs the natural movement of the intestines. These adhesions impede the normal passage of both food and bacteria, contributing to bacterial overgrowth.

6. Obesity: although the precise connection between obesity and SIBO remains a subject of ongoing investigation, emerging evidence suggests that adipose tissue and metabolic factors may play a role in promoting SIBO development in overweight individuals.


The most common SIBO test is the SIBO breath test. This non-invasive test provides a look into the microbial activity within the small intestine by measuring the levels of hydrogen and methane gasses in a patient’s breath. 

The test involves ingesting a specific “carbohydrate substrate”, such as lactulose or glucose- otherwise known as sugar. This is not typically absorbed in the small intestine. However, if there is an overgrowth of bacteria, they will ferment these substrates, producing hydrogen and/or methane gasses. These gasses are then absorbed into the bloodstream and eventually exhaled through the breath. 

By analyzing the levels of these gasses over a specific time period, your practitioner can diagnose SIBO and determine the type of bacterial overgrowth.

(Hey- have you asked yourself these questions: do I have SIBO? Why, when, and how should I get tested? What’s the dealing with retesting? Our Ultimate Guide to Testing for SIBO will help you gain clarity around this important topic to navigate the maze of SIBO/IMO testing and create an action plan to resolve your symptoms. 

Testing is the first step to seeing recovery and results. You’ll learn the importance of testing and how it can guide your treatment, the 3 ways to be tested for SIBO, what a breath test is, how to choose the right test, do and donts for testing mornings, and how to interpret your results. Get the guide now!)


SIBO treatment involves a comprehensive approach aimed at addressing the underlying causes of Small Intestine Bacterial Overgrowth and alleviating its symptoms. Several strategies are used depending on your specific symptoms and plan with your practitioner. 


Antibiotics are often prescribed to target and reduce bacterial overgrowth. Rifaximin, a commonly used antibiotic, targets hydrogen-dominant SIBO. Neomycin may be effective for methane-dominant cases. These antibiotics work by killing the overgrowth of bacteria in the small intestine. 

While some patients choose to use SIBO-specific pharmaceutical antibiotics, using herbal antimicrobials (below) is an alternative.

Herbal Antimicrobials

Herbal antimicrobial supplements are a more natural approach to targeting bacterial overgrowth. Compounds like berberine, oregano oil, and garlic extract have proven effective in reducing bacterial populations in the small intestine. While less harsh on the gut flora compared to antibiotics, herbal treatments still require supervision and guidance from your practitioner.


Probiotics are beneficial bacteria that can help restore the balance of gut flora. However, selecting the appropriate strains with your practitioner is extremely important, as certain probiotics can exacerbate SIBO symptoms by introducing more bacteria into an already overpopulated environment. 

SIBO Diets

Implementing a healthy diet plays a pivotal role in managing SIBO symptoms. There are many different SIBO diets depending on your symptoms and body, including diets like the low FODMAP diet (used temporarily), a range of diets used by Dr. Allison Siebecker (long term), or the Elemental Diet (a short-term SIBO treatment).

If you’re looking for more diet information, read about the 6 most common SIBO diets. Or, check out our SIBO Diets Masterclass with Dr. Siebecker to learn all about SIBO diets, why they work, and how to use them. 

Gut Motility Agents

Medications that enhance gut motility and the Migrating Motor Complex (MMC) such as prokinetics can be utilized to improve the movement of food and bacteria through the digestive tract. Prokinetics can help prevent the buildup of food and bacteria in your digestive system that often contributes to SIBO development.

Addressing Underlying Conditions

Successful SIBO treatment involves addressing the underlying conditions that contribute to bacterial overgrowth. This might include balancing your stomach acid, addressing structural problems like adhesions, working to get rid of Candida overgrowth or parasites, and treating any other health conditions or habits that may be affecting your digestive health.

Lifestyle Modifications

While treating your SIBO, lifestyle changes like stress management, physical activity, and restful sleep can make all of the difference!

SIBO treatment plans should be tailored to each patient’s unique situation, with a focus on both holistic and pharmaceutical remedies along with lifestyle changes. Make sure to follow a SIBO specialist’s recommendations to make sure you’re getting the best treatment.

SIBO SOS®, founded by patient advocate Shivan Sarna and SIBO specialist Dr. Allison Siebecker, is here as a resource for any SIBO patients looking for up-to-date, comprehensive, and actionable information. 

If you’re looking for a step-by-step guide to treating and beating SIBO, you’ve come to right place. Click here to learn more about the SIBO Recovery Roadmap® Course– the course that’s helped thousands of SIBO patients achieve a full, happy recovery.

Or, if you already know your SIBO stuff but are looking for the latest SIBO, IBS, and gut health news, you’re in luck!

Dr. Mark Pimental, head of the Pimentel Laboratory & executive director of the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai (the doctor who discovered Small Intestinal Bacterial Overgrowth or SIBO!), has dedicated his life to researching SIBO and IBS. Each year, he joins us during Digestive Disease Week for a livestream to discuss all of the new research updates over the past year. These sessions are a wonderful way to keep updated on cutting-edge treatments bringing joy and hope to SIBO/IMO, IBS, and other gut condition patients. 

Watch the new research update here.

Never miss a live class! Get transformational health tips with Shivan from IBS, SIBO/IMO and the best minds in the digestive health world! Register here to receive class notifications (and more!) through your email


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