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Gut Check Part 3: SIBO


Do you feel like you’re doing all the right things to improve your gut health, but not getting results?

You could be dealing with SIBO.

Small Intestinal Bacterial Overgrowth.

Let’s talk about what it is, how to get tested and how to remedy it.

Most traditional doctors – primary care or GI specialists are not talking about SIBO. Some don’t even recognize it as a real condition.

However, I can tell you first hands it’s very real and functional medicine is making a lot of progress in diagnosing and remedying it.

One of the biggest signs of SIBO is severe bloating. You can wake up with a flat belly but by the end of the day, you look six months pregnant… and you ate a 100% clean diet – no pasta, bagels or desserts.

When I was diagnosed with SIBO, I was eating the healthiest but feeling my worst.

Some days the bloating and pain was so severe, I couldn’t get out of bed. And the fatigue that accompanied it made everything worse.

I had all the traditional tests done with a GI specialist and they came back with only minor concerns – nothing that explained the severity of my symptoms – so I was basically told I was fine, it’s likely just stress.

I went for a second opinion, where I was tested for SIBO. Then returning back to my traditional GI doc, she said, well we don’t test for it very often especially in someone who eats as well as you, but you’re a perfect example of why we need to change that. All your tests came back fine, but you’re off the charts for SIBO.

What is SIBO

In part two of this Gut Check series we spoke about the microbiome – the trillions of microorganisms that live on and in our body that play a vital role in our health.

For a variety of reasons – diet, alcohol, stress, toxins, medications, poor oral hygiene – the balance of good versus bad microbes can get out of balance. The bad guys can start to dominate. That is known as gut dysbiosis.

SIBO is similar in that the bad guys are often dominating but what’s different here is where the bacteria is located in the body.

Bacteria that should be in your large intestines gets into your small intestines. In the small intestines it has access to the food you’re eating and feds on carbohydrates – including many vegetables. Ultimately this process will produce an excess of gas in the form of hydrogen, methane or both.

If you’re methane dominate, you tend to experience constipation.

If you’re hydrogen dominate, you tend to experience diarrhea.

But you could also be one of the lucky ones that experiences both.

How to Test

The gold standard of testing for SIBO is a breath test this can be performed in a hospital or with an at-home test.

It’s a pretty involved test because you need to eat a restricted diet 24 hours prior to the start of the test, fast 12 hours prior, and then breathe into a tube every 15 minutes over the course of three hours.

The first sample gets your baseline, then you drink a solution that would feed the bacteria. So, by testing every 15 minutes, you’re able to see an increase in the levels of hydrogen and/or methane and based in the time stamp when those levels increase can determine where it’s happening in the digestive tract.

You then send the tubes to a lab and wait for the results. It can take up to two weeks, which isn’t a fun wait, but testing is so helpful if you’re struggling to identify persistent SIBO.

How to Remedy

Once you have the results, there are several ways in which to address SIBO. The following is a very high-level overview of several approaches.


You essentially want to starve the bacteria by removing carbohydrates, sugar and alcohol from your diet. This includes not only the obvious cookies, bread and pasta, but also high sugar fruits and even some cruciferous vegetables.

Time Restricted Feeding

Time restricted feeding can also be incredibly beneficial for killing off the bacteria. Eating three meals a day without snacks in between can be a helpful dietary approach.

Prescriptions & Supplements

In most cases diet alone cannot kill of SIBO – it’s far more effective to include a prescription and/or herbal supplements.

Xifaxan is an antibiotic that is most often used for SIBO. This antibiotic does not cause the same disruption to your microbiome that a traditional antibiotic does and can be incredibly effective to eradicating SIBO.

There are also many herbal antimicrobial supplements that can be helpful in addressing SIBO. It’s important to connect with a healthcare provider to guide you through this process, because these supplements need to have proper guidance to be effective and not disrupt your overall microbiome.

Elemental Diet

When all else fails, an elemental diet can be helpful for persistent cases of SIBO. This too definitely needs to be done under medical supervision. It includes a fast for two or more weeks with often a medically prescribed shake that will provide your body with the nutrients that it needs to get through the fast.

How to Recover

Once SIBO has been eliminated, you want to begin repopulating your microbiome with the good bacteria. It’s important however that this is done in a gentle and mindful way as to not trigger a reoccurrence. In time however, you can and will get past SIBO and return to a healthy thriving gut.

This is truly just a snapshot of SIBO.

There is far more detail to it as there are with any health issues.

Bottom line, if you suspect you may have SIBO, it could be helpful for you to connect with a practitioner who can order the test for you so you know for certain and can begin your healing and recovery.

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