SIBO – A Common Cause of Bloating and Stomach Pain.

If you have bloating, abdominal pain, feelings of fullness after eating or frequent diarrhea you may have SIBO!

Gut health is frequently ignored by both patients and doctors until symptoms become unbearable. Our approach at OHH is to screen everyone for gut permeability and listen for any symptoms that make us concerned for additional issues like SIBO. If you have bloating, abdominal pain, feelings of fullness after eating or frequent diarrhea you may have SIBO! This post will take a deep dive into what SIBO is, what role it plays in total gut health, and how to find out if you might have it.

WHAT IS SIBO or Small Intestinal Bacterial Overgrowth?

If you’re reading this post you probably have heard of the gut microbiome and know that everyone has bacteria in their gut. however, having a proper balance is crucial for normal digestion and optimal health, but it’s a fragile ecosystem. Most healthy gut bacteria reside in your large intestine, but when lifestyle, functional issues like slow motility, or surgery create an opportunity for bacteria to migrate into the small intestine and populate, SIBO occurs. This leads to what feels like chronic digestive issues with symptoms of intense bloating, diarrhea, gas, abdominal pain, and sometimes lack of appetite.

Risk factors for SIBO include (not an exhaustive list):

  • Slow motility and frequent constipation
  • Poorly tolerated diet
  • Gastric Bypass Surgery
  • Crohn’s Disease
  • Diabetes and metabolic disease
  • GERD (acid reflux) with use of PPI medications (Nexium, Prilosec)

How do you know if you have it?

The first step in SIBO treatment is knowing if you have it! Unfortunately the symptoms can overlap with other gut issues and extensive testing is not an uncommon approach. The traditional test is a “breath test” that involves drinking a unique fluid and breathing into a special test tube that is sent to a functional lab for analysis. However, there are issues with this approach including challenges in testing and high rates of both false negatives. Newer techniques of blood immune testing can help to make the diagnosis but are difficult to interpret without expert help. A comprehensive stool test may be the best option as it can can indicate if there are high levels of common SIBO-causing bacteria in the colon plus help determine gut function and identify other possible causes of symptoms.

I think I have it can I just fix it with diet?

The hydrogen-producing bacteria that contribute to SIBO feed off simple carbohydrates and their digestive byproducts. Many people try start a low carbohydrate diet to starve off the bacterial overgrowth, which can be helpful, but if you transition back to carbohydrates or eat them occasionally your symptoms will likely return. A special type of low carbohydrate diet call a “Low FODMAP” diet reduces foods that these bacteria like the most. It can be a helpful intervention that will improve total gut health and reduce symptoms. However, there are likely other contributors to your dysfunctional gut like food sensitivities, low stomach acid, and inadequate digestive enzymes that will also need to be treated to prevent recurrence of SIBO.

Even though diet is a key factor in SIBO treatment, you’ll need a comprehensive approach to remove triggers, replace missing digestive components, reinoculate your gut with specific bacteria, repair the gut and its lining, and rebalance your lifestyle to prevent relapses and flares. We use the functional medicine “5R” approach to achieve these goals in two steps that typically takes 3-6 months to complete.


When it comes to general gut health there are several things you can do on your own to promote a healthy gut! However, gut is a fragile ecosystem, and making too many unnecessary changes on your own can cause additional symptoms and worsen dysbiosis. SIBO in particular is a multifaceted condition and treating it on your own could be both counterproductive and leave you restricted and malnourished. We encourage self-experimentation and empower you to push yourself, however, when it comes to SIBO and gut dysbiosis working with a team who will address all aspects of your health is the quickest and most reliable way to find symptom relief and start living your optimal life.


Achufusi TGO, Sharma A, Zamora EA, Manocha D. Small Intestinal Bacterial Overgrowth: Comprehensive Review of Diagnosis, Prevention, and Treatment Methods. Cureus. 2020;12(6):e8860. Published 2020 Jun 27. doi:10.7759/cureus.8860

Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol (N Y). 2007;3(2):112-122.

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