SIBO (Small Intestinal Bacterial Overgrowth)

SIBO is an excess of bacteria in the small intestine, where bacterial counts should be low. Those bacteria ferment carbohydrate before it can be absorbed, producing hydrogen, methane or hydrogen sulphide gas. The result is bloating that worsens through the day, distension that can be dramatic, and altered bowel habit. SIBO is strongly associated with IBS — a substantial share of people diagnosed with IBS have demonstrable overgrowth — and it is frequently the missing explanation for someone who has been told their extensive GI workup was normal.

Symptoms

• •Bloating and visible abdominal distension that worsens as the day goes on
• •Excessive gas, belching, and abdominal discomfort after meals
• •Diarrhoea, constipation, or an alternating pattern between the two
• •Feeling full very quickly, nausea, or reflux
• •Fatigue and brain fog, often disproportionate to the gut symptoms
• •Nutrient deficiencies — particularly iron and vitamin B12 — from impaired absorption
• •Reacting badly to foods that are otherwise healthy, especially fibre and fermented foods

Causes & Risk Factors

• •Impaired migrating motor complex — the wave that sweeps the small intestine clean between meals
• •Post-infectious IBS following food poisoning, which can damage motility signalling
• •Low stomach acid, including from long-term proton pump inhibitor use
• •Structural factors: adhesions from prior surgery, strictures, or an incompetent ileocaecal valve
• •Hypothyroidism, diabetes, and connective tissue disorders that slow gut transit
• •Chronic stress and vagal tone problems that suppress digestive motility

Naturopathic Approach

Naturopathic treatment of SIBO follows a sequence, and skipping steps is why so many people relapse. Diagnosis comes first: a three-hour lactulose or glucose breath test measuring hydrogen and methane identifies whether overgrowth is present and which gas predominates, which in turn determines treatment, since methane-predominant overgrowth behaves differently and responds to different agents than hydrogen-predominant. Botanical medicine is the primary treatment tool — berberine, oregano oil, neem, allicin and similar antimicrobials have evidence comparable to rifaximin in head-to-head work — and Dr. Sanika refers for prescription antibiotics where that is the better option. Clinical nutrition is used as symptom control during treatment rather than as the treatment itself: low-FODMAP and similar approaches reduce fermentable substrate and make people considerably more comfortable, but starving bacteria indefinitely is not a cure and long-term restriction narrows the microbiome in ways that cause their own problems, so the diet is deliberately time-limited and food is reintroduced systematically. The step that determines whether SIBO stays gone is the prevention phase: prokinetic support to restore the migrating motor complex, spacing meals so that the cleaning wave can actually run, addressing low stomach acid, treating hypothyroidism if present, and vagal and stress work where motility is being suppressed by the nervous system. Functional lab testing checks iron, B12 and fat-soluble vitamin status, which are commonly depleted by the malabsorption that overgrowth causes.

Related Modalities

Frequently Asked Questions