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May 30, 2025

What Is SIBO? Causes, Symptoms, and Long-Term Treatment Strategies

Small Intestinal Bacterial Overgrowth (SIBO) causes chronic bloating, gas, and digestive issues that often mimic IBS. Discover what leads to SIBO, how to test for it, and how to treat and prevent it using a root-cause approach that includes supplements, peptides, and lifestyle changes.

What Is SIBO? Causes, Symptoms, and Long-Term Treatment Strategies

SEO Optimized Blog Post: Understanding SIBO (Small Intestinal Bacterial Overgrowth): Causes, Symptoms, Risks, and Long-Term Treatment Strategies

Introduction

Small Intestinal Bacterial Overgrowth (SIBO) is a frequently overlooked yet incredibly disruptive gastrointestinal condition that affects millions of individuals—often without a clear diagnosis. Characterized by an abnormal increase in the population of bacteria in the small intestine, SIBO contributes to digestive dysfunction, nutrient malabsorption, systemic inflammation, and chronic symptoms like bloating, diarrhea, and fatigue.

In this comprehensive guide, we’ll explore what SIBO is, what causes it, how it presents, the complications it can lead to, and the most effective treatment strategies to eliminate it—and keep it from coming back.

What Is SIBO?

SIBO stands for Small Intestinal Bacterial Overgrowth. Under normal conditions, the small intestine contains a relatively low number of bacteria compared to the large intestine. In SIBO, this balance is disrupted, and excessive bacteria—often colonic-type species—accumulate in the small intestine.

These bacteria ferment carbohydrates, produce gas, disrupt digestion, and interfere with nutrient absorption. The result is a range of digestive and systemic symptoms that mimic other gastrointestinal disorders such as IBS, celiac disease, or food intolerances.

Common Symptoms of SIBO

SIBO can present with a wide range of nonspecific symptoms, many of which overlap with other GI conditions. Common symptoms include:

  • Chronic bloating and abdominal distension

  • Excessive gas (flatulence or belching)

  • Abdominal pain or cramping

  • Diarrhea, constipation, or alternating bowel habits

  • Nausea or early satiety

  • Malabsorption of nutrients (especially B12, iron, and fat-soluble vitamins)

  • Fatigue or brain fog

  • Unintentional weight loss

  • Symptoms worsened by probiotics or high-fiber foods

Because of its vague presentation, SIBO is frequently misdiagnosed as irritable bowel syndrome (IBS)—yet up to 80% of people with IBS may actually have SIBO.

What Causes SIBO?

SIBO is rarely caused by a single factor. Rather, it is typically the result of multiple underlying issues that impair the normal motility, anatomy, and antimicrobial defenses of the small intestine.

Major contributing factors include:

1. Impaired Gut Motility

The migrating motor complex (MMC) is a wave-like pattern of contractions that clears bacteria and debris between meals. Conditions that impair MMC function—like diabetes, hypothyroidism, or opioid use—can allow bacteria to linger and overgrow.

2. Structural Abnormalities

  • Adhesions from previous abdominal surgery

  • Small bowel diverticula

  • Strictures or partial obstructions

  • Crohn’s disease or surgical resections

These can physically trap bacteria in sections of the small intestine.

3. Low Stomach Acid (Hypochlorhydria)

Stomach acid acts as a first line of defense against pathogens and bacteria. Conditions such as aging, chronic PPI use, or H. pylori infection can lower stomach acid levels and increase SIBO risk.

4. Dysfunctional Ileocecal Valve

A weak or incompetent ileocecal valve allows colonic bacteria to reflux into the small intestine, promoting overgrowth.

5. Immune Dysfunction

Chronic infections, autoimmune conditions, and low secretory IgA levels can reduce immune surveillance in the gut, allowing bacterial overgrowth.

6. Other Contributing Factors

  • Chronic stress (affects motility and secretions)

  • Pancreatic enzyme insufficiency

  • Diets high in fermentable carbohydrates (FODMAPs)

  • Frequent antibiotic use (disrupts microbiome balance)

How Is SIBO Diagnosed?

The gold standard for diagnosing SIBO is the lactulose or glucose breath test, which measures hydrogen and methane gases produced by bacteria in the small intestine. These gases diffuse into the bloodstream, travel to the lungs, and are exhaled.

Key points:

  • Hydrogen-dominant SIBO is more likely to cause diarrhea.

  • Methane-dominant SIBO (now often referred to as IMO - intestinal methanogen overgrowth) is more often associated with constipation.

  • Hydrogen sulfide SIBO is a newer category, typically associated with foul gas, sulfur odor, and a mix of symptoms.

Breath testing helps determine both the presence and type of overgrowth, which can influence treatment choice.

Complications of Untreated SIBO

If left untreated, SIBO can lead to significant complications, including:

  • Nutrient deficiencies (vitamin B12, iron, magnesium, zinc, and fat-soluble vitamins)

  • Weight loss and malnutrition

  • Leaky gut (increased intestinal permeability)

  • Systemic inflammation

  • Mood disturbances (due to gut-brain axis disruption)

  • Worsening of autoimmune or chronic disease

The longer SIBO persists, the more damage it can do—not just to your gut, but to your overall health.

How to Treat SIBO Effectively

SIBO treatment must be comprehensive and address both the overgrowth and the root causes to prevent recurrence. Most treatment protocols include three phases: clear, repair, and rebuild.

Phase 1: Clear the Overgrowth

This step involves reducing the bacterial load using antibiotics, herbal antimicrobials, or elemental diets.

Options include:

  • Prescription antibiotics:

    • Rifaximin (for hydrogen SIBO)

    • Rifaximin + Neomycin (for methane SIBO)

  • Herbal antimicrobials:

    • Oregano oil

    • Berberine

    • Neem

    • Garlic extract (allicin)

    • Candibactin-AR and Candibactin-BR (Xymogen)

  • Elemental diet:

    • A liquid diet of pre-digested nutrients that starves bacteria while nourishing the host

Recommended Supplements:

  • Berberine: Antibacterial, antifungal, and improves gut barrier function

  • Digestive Enzymes: Help break down food and reduce fermentation

  • Immuno-30: Immunoglobulin G binds toxins and reduces inflammation

Phase 2: Repair the Gut Lining

After reducing bacterial load, the focus shifts to repairing damage to the gut lining and restoring the mucosal barrier.

Key nutrients and supplements:

Phase 3: Rebuild and Restore Function

This phase focuses on restoring healthy digestion, gut motility, and microbiome diversity.

Strategies include:

  • Prokinetics:

    • Support the migrating motor complex and prevent relapse

    • Examples: Ginger, MotilPro, low-dose erythromycin, prucalopride

  • Probiotics (cautiously):

    • Spore-forming strains like MegaSporebiotic may help without worsening symptoms

    • Use only after clearance and once tolerated

  • Dietary reintroduction:

    • Begin with a low-FODMAP or Specific Carbohydrate Diet (SCD)

    • Gradually reintroduce fermentable fibers as tolerated

  • Lifestyle optimization:

    • Stress reduction (mindfulness, breathwork, vagal stimulation)

    • Meal spacing (4-5 hours between meals to allow MMC activity)

    • Quality sleep and circadian rhythm alignment

How to Prevent SIBO from Coming Back

Recurrence of SIBO is common without addressing the underlying causes. Long-term prevention includes:

  • Identifying and correcting root causes (e.g., hypothyroidism, adhesions, poor motility)

  • Using prokinetics for at least 3–6 months after treatment

  • Maintaining a balanced diet without excess sugar or fermentable carbs

  • Supporting digestive function with Digestive Enzymes

  • Ongoing gut-healing support (e.g., BPC-157, Curcumin Complex)

In recurrent or refractory cases, further testing for mold toxicity, Lyme disease, H. pylori, and heavy metals may be warranted.

Conclusion: SIBO Can Be Treated—and Prevented—With the Right Strategy

SIBO is a complex but manageable condition when addressed with a root-cause, functional medicine approach. A phased strategy that clears the overgrowth, repairs the intestinal lining, and restores gut function is the best way to treat SIBO effectively and reduce the risk of recurrence.

If you're struggling with chronic digestive symptoms, don’t settle for a band-aid solution. Comprehensive SIBO testing and treatment—using evidence-based supplements, peptides, and lifestyle interventions—can help you regain your health from the inside out.

Schedule a consultation with the team at Revolution Health & Wellness to get tested and start healing your gut today.

References:

  1. Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011.

  2. Rezaie A, Pimentel M, Rao SS. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Curr Gastroenterol Rep. 2016.

  3. Ghoshal UC, Shukla R, Ghoshal U. Small intestinal bacterial overgrowth and irritable bowel syndrome: A bridge between functional organic dichotomy. Gut Liver. 2017.

  4. Lauritano EC, Gabrielli M, Lupascu A, et al. Small intestinal bacterial overgrowth recurrence after antibiotic therapy. Am J Gastroenterol. 2008.

  5. Leiby A, Mehta D, Gopalareddy V, Jackson-Walker S, Horvath K. Elemental diet is effective in reducing SIBO and symptoms in children with intestinal motility disorders. J Pediatr Gastroenterol Nutr. 2015.

  6. Rao SSC, Rehman A, Yu S, Andino NM. Brain fogginess, gas and bloating: a link between SIBO, probiotics, and metabolic acidosis. Clin Transl Gastroenterol. 2018.