Functional Gastrointestinal Disorders

Do you suffer from IBS- Irritable Bowel Syndrome or SIBO?

Small Intestinal Bacterial Overgrowth (SIBO)

Small intestinal bacterial overgrowth (SIBO) is a chronic intestinal disorder characterized by excessive amounts of bacteria in the small intestine.  It is estimated that between 60-80% of all IBS cases are due to SIBO.

The majority of bacteria in our gut lives in the large intestine. When the bacteria in the small intestine becomes more like the bacteria in the large intestine one has developed SIBO.

Overgrowth from SIBO may contribute to increased intestinal permeability inflammation and alterations in gut function.

The current gold standard for diagnosis is the Hydrogen Breath Test.


SIBO results are defined by Sub-types

  • IBS-C (Constipation dominant)
  • IBS-D (Diarrhea dominant), 
  • IBS-M (Mixed type) 
  • Hydrogen Sulfide SIBO.

Signs, symptoms, and complications

Symptoms of SIBO, which may vary between individuals, can be non-specific and often overlap with a number of other associated disorders, making it difficult to recognize or diagnose if the practitioner is not well trained in this disorder.

SIBO typically presents with a number of gastrointestinal symptoms, such as abdominal pain, abdominal distension, bloating, flatulence, chronic diarrhea or constipation.

SIBO may result in malabsorption of micro- and macronutrients leading to nutrient deficiencies, and other complications over time.

Complications and extraintestinal manifestations (outside of the gut) may include:

● Anemia
● Arthralgias (joint pains)
● Chronic prostatitis
● Hypoproteinemia/hypoalbuminemia (Low protein)
● Interstitial cystitis
● Neuropathies
● Osteoporosis
● Restless legs syndrome
● Rosacea
● Steatorrhea (Fatty Stools)
● Weight loss

Causes and risk factors

The development of SIBO can be attributed to a disruption in the homeostatic mechanisms that regulate the intestinal microbiota. Inadequate gastric secretion (hypochlorhydria) and small intestine dysmotility (impairment in mobility) are the two most common factors that predispose individuals to bacterial overgrowth. Other factors that have been shown to increase an individual’s susceptibility to SIBO include:

● Age, resulting in increased risk in the elderly population
● Anatomic alterations or abnormalities of the GI tract, such as diverticula, strictures, fistulas, surgical loupes, and gastric or ileocecal valve resection
● Vagotomy, surgery that affects or removes part of the Vagus nerve
● Impairment of systemic and local immunity, immunodeficiency states
● Motility disorders, such as small intestine dysmotility, Celiac disease, and gastroparesis
● Irritable bowel syndrome (IBS)
● Certain metabolic conditions, such as diabetes (enteropathy) and hypochlorhydria
● Dysfunction of certain organs, such as cirrhosis, renal failure, pancreatitis, scleroderma, and Crohn's disease
● Certain medications, such as antibiotics, proton pump inhibitors for reflux (GERD), and antimotility agents
● Alcoholism

Intake of FODMAPs, fiber, prebiotics, and probiotics have also been shown to alter the intestinal microbiota and may, therefore, increase the risk of developing SIBO or exacerbate its symptoms.

Addressing SIBO

SIBO treatment typically involves:

1. Identifying any underlying causes (See: What caused my SIBO?)

2. Treating the bacterial overgrowth with antibiotics or antimicrobial herbs, such as oil of oregano, wormwood, Coptis root, thyme, red thyme, field horsetail, olive leaf, and berberine extracts etc. (Self-treatment not advised).

3. Correcting nutrient deficiencies common in cases of SIBO, such as deficiencies in calcium, magnesium, vitamin B12, Iron and fat-soluble vitamins A, D, E, and K.

4. Preventing recurrence Diet and SIBO In cases of SIBO, carbohydrates, such as fructose, lactose, and fermentable oligo-, di-, monosaccharides and polyols (FODMAPs), may be fermented by bacteria in the small intestine leading to increased digestive symptoms, such as abdominal pain, bloating, and flatulence. Some individuals may experience improvements in bacterial overgrowth and associated symptoms by following a carbohydrate-restricting diet, such as the elemental diet, the low-FODMAP diet, the SIBO Biphasic diet and its variants (See attached diets), the Specific Carbohydrate Diet (SCD), and the Gut and Psychology Syndrome (GAPS) diet. My good friend Dr. Gerard Mullin MD, associate professor of gastroenterology, Johns Hopkins University published this study on the botanical treatment of SIBO.

Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth


SIBO and SIFO, whats the difference?

SIBO stands for Small Intestinal Bacterial Overgrowth and SIFO stands for Small Intestinal Fungal Overgrowth.

Many of the symptom of SIBO which are bloating, gas, constipation/diarrhea, abdominal pain, belching and or flatulence, nausea and symptoms of leaky gut such as rashes and food allergies and steatorrhea (fatty stools) can also present with small intestinal fungal overgrowth.

Dr. Satish Rao, a prominent gastroenterologist and researcher states that 24% of patients with SIBO have concurrent SIFO. One may have SIFO alone but it’s quite interesting to know that one quarter of all SIBO patients have an overgrowth of yeast in their intestines. It is also important to understand why conventional treatments may fail with antibiotic treatment alone when both conditions are present.

Breath testing is the gold standard to diagnose SIBO, but that test cannot determine the presence of SIFO. The truth, is that other than culturing a sample from the small intestine that would be performed by a gastroenterologist in special circumstances, there are no direct tests available. The GI-Map which is stool test, does contain markers for some species of fungi, however, we cannot rely on this alone to identify it because fungal organisms tend to burrow into the mucus layer in the intestine known as a bio-film to evade detection. There is a special urine test known as an OAT test (Organic Acids Test) that captures the metabolites of the fungus, so despite its stealth nature, we can see it’s by-products which would indicate its presence.

There are some specific botanicals that can be used to treat both SIBO and SIFO effectively, but it’s imperative to understand that diet and lifestyle play a key role to eradicate and prevent reoccurrences.

A low sugar diet is mandatory, followed by a lower simple carbohydrate diet, but if you follow the SIBO Bi-phasic diet, you will starve out the dietary constituents that contribute to its overgrowth.

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