Do you have gas, bloating, or stomach pain that doesn’t seem to be going away on its own? In fact, some days, it seems it’s getting worse. How do I know if I have small intestinal bacterial overgrowth (SIBO) or something else? After all, SIBO may resemble other gut infections such as IBS or leaky gut.
Many people chalk up digestive drama to something bad they ate. They think it’ll go away on its own. This is why many people fail to get a diagnosis. The truth is that SIBO doesn’t go away on its own. What’s worse, untreated SIBO can trigger autoimmune disorders or worse. Early detection can save you a lot of time, energy, and discomfort. It can also help you reverse it before it turns into something much worse.
I struggled with gut health issues for years and understand how distressing it can be. I’m not alone, either. On my podcast, I talk with best-selling author Danielle Walker about her journey with Ulcerative Colitis — it’s a conversation you don’t want to miss! In this article, I’m going to help guide you through signs, symptoms, and ways to test for SIBO. I’m also going to help you reverse it for good using a systematic approach. This approach will also help you if you’re wondering how to prevent SIBO from coming back. Before I get into that, you may be wondering how common SIBO actually is.
How Common Is SIBO? Who Is at Risk?
It may surprise you to know that SIBO is way more common than you think. SIBO affects millions of people every year, even if they don’t show any symptoms right away. Studies estimate that 6-15% of healthy individuals and up to 80% of IBS sufferers may have SIBO (1).
Certain risk factors can increase your risk for SIBO. For example, if you’re a woman over the age of 35, you’re more likely to experience hormone changes that lead to gut imbalance. Menopause and perimenopause can begin as early as your mid-30s. Lower estrogen levels can cause a disruption in the normal recycling patterns of certain gut bacteria (2). Stress and mood changes can also impact the gut-brain axis.
Another risk factor is the presence of existing gut conditions. People with IBS, IBD, or candida overgrowth already have a dysregulated microbiome. This imbalance can encourage harmful bacteria to take over the small intestine.
Medication use can also have a detrimental impact on your gut. If you’ve taken antibiotics or acid-reducing medications for a long time, you likely have a microbiome imbalance. This can easily promote SIBO.
Stress, medication, and candida can slow gut motility. This can contribute to feelings of constipation, gas, and bloating. Stress and trauma can even affect cellular function, which is a topic Dr. Susan Blum and I discuss in this podcast episode.
What Are the First Signs of SIBO?
Occasional digestive discomfort happens for all kinds of reasons. However, persistent, chronic symptoms can indicate a major problem.
Digestive Symptoms (most common indicators)
When it comes to digestive discomfort, symptoms can point to several different conditions. Symptoms of SIBO can also be symptoms of other gut infections. Again, this is why you need testing down. That said, you can confidently suspect SIBO if you experience:
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Chronic bloating: any amount of bloating indicates something is going on in your gut. If you feel bloated even after small meals, that’s a tell-tale sign you have SIBO.
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Excessive gas: it's normal to pass gas several times per day. However, if it contains a sulfur-like or foul-smell, that means there is excess fermentation going on in the gut.
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Abnormal bowel movements: A healthy gut produces one to two firm bowel movements each day. However, SIBO can disrupt this process. Hydrogen-based SIBO can cause diarrhea as it draws moisture in from other parts of the body. Methane-based SIBO can contribute to constipation. You may have both and experience alternating patterns.
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Feeling full quickly and abdominal discomfort: Low stomach acid and bloating can make you feel full quickly, even if you haven’t eaten very much food.
In functional medicine, we see the whole person. While SIBO is a digestive disorder, it affects more than just your gut.
Non-Digestive Symptoms
You’ve probably heard that gut health affects mental health. The same can be said about gut health and energy levels, skin, and metabolism. SIBO affects the whole body:
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Fatigue and brain fog: An overgrowth of harmful bacteria can interfere with mitochondrial function and cellular health. This can slow down energy production, leaving you feeling tired. Research suggests SIBO can also contribute to brain fog, likely through the gut-brain axis (3).
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Skin issues: Similarly to the gut-brain axis, there’s also a gut-skin axis. Dysbiosis in the gut often triggers an inflammatory response, leading to rosacea, acne, or eczema (4).
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Unexplained weight loss or gain: Those with SIBO may also have biofilms, a thick sticky substance that attaches to the gut wall lining. This can prevent nutrients from passing through, leading to malabsorption. Over time, this can cause metabolic changes.
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Food intolerances: When your gut bacteria is out of whack, it can make it difficult to digest certain nutrients such as fiber, dairy, or gluten.
These symptoms can be uncomfortable and downright annoying. What’s worse, SIBO can trigger autoimmune conditions and may even lead to cancer. Learn more about how inflammation and chronic illness go hand-in-hand in this podcast episode with Dr. Will Cole.
How do I know if I have SIBO or something else? This is where testing comes in.
How to Diagnose SIBO: Testing Options
Conventional medicine fails us when it comes to solving complex gut issues. Thankfully, functional medicine offers tests that go beyond the standard scope of diagnostic care.
Hydrogen & Methane Breath Test
The most common way to test for SIBO is with a breath test. By breathing into a special balloon or glass tube, your physician can measure the amount of hydrogen and methane produced by your breath.
Here’s how it works: Two days leading up to the test, you change your diet. Eat only white rice and lean protein, either cooked chicken or fish. No fats, fruits, vegetables, or starches. On the second day, you fast for 12 hours. On the day of the test, you drink a sugar solution made up of glucose, fructose, and lactulose. For the next three hours, you breathe small amounts into the balloon or glass tube. High levels of hydrogen on a test tend to correlate with diarrhea-type SIBO. On the other hand, high levels of methane are common with constipation-type SIBO.
You can also get a comprehensive stool test. These test for several types of pathogens in the gut, including parasites or bacterial infections.
Blood tests can also detect certain vitamin deficiencies that point to SIBO. Ask your doctor to check your B vitamin levels, as well as fat-soluble D, E, A, and K (5). As for a mineral panel, be sure to check your iron, magnesium, and zinc levels. SIBO can deplete your body of these vital nutrients.
The most accurate way to test for SIBO is an aspiration and culture of the small intestines. This procedure takes a sample of small intestine tissues and cultures it to check for bacterial growth (6). This approach is rarely used since it’s more invasive. Still, experts argue it yields the most accurate results.
If you have persistent bloating, gas, or gut issues that don’t improve with diet changes, it’s time to get tested. Additionally, those who’ve recently been diagnosed with an autoimmune disease or other gut condition such as IBS or IBD should consider testing.
How to Prevent SIBO from Occurring (or Reoccurring): 8 Unique Tips:
Now that you know how to get rid of SIBO, it's time to consider prevention strategies. Some advice seems more obvious, such as changing your diet. Other tips, however, may surprise you. Here are eight unique ways to help you prevent SIBO relapse.
#1 Support Your Migrating Motor Complex (MMC) with Prokinetics
The smooth muscle in your small intestines uses a cyclical pattern of electromechanical activity to help move food down the gut. Think of the MMC as a broom or natural "housekeeping wave" that clears bacteria from the small intestine between meals.
Studies suggest up to 70% of SIBO patients have slow or impaired MMC function (7). The good news is that you can support a more efficient MMC by:
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Waiting 4-5 hours between meals
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Strengthening your vagus nerve
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Reducing your stress levels
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Supporting healthy blood glucose levels
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Optimizing thyroid function
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Taking Lion’s mane to repair nerve damage to the GI tract
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Adding Bifidobacterium probiotic strains to your diet
Speaking of Lion’s mane, there’s a whole host of benefits you can receive from medicinal mushrooms. This type of mushroom contains compounds that even fight cancer, as I discuss with Dr. Robert Rountree in this podcast episode.
Herbs such as ginger and artichoke extract also promote healthy MMC function. On the pharmaceutical side, your doctor may recommend low-dose naltrexone (LDN).
#2 Optimize Your Stomach Acid Levels
Low stomach acid is another common problem I see in people with SIBO. Not having enough stomach acid allows bacteria and other pathogens to overpopulate the small intestine.
You can increase stomach acid levels in a few different ways. First, try drinking warm lemon water or drinking apple cider vinegar before meals. This stimulates bile production to help break down foods. Additionally, you can supplement with Bile Builder Complete to help break down fats. This next-level digestive support features ox bile, dandelion, and artichoke extract to support optimal liver function.
#3 Check for Underlying Thyroid or Hormonal Imbalances
Studies show hypothyroidism can slow gut motility. It also slows stomach emptying, which contributes to SIBO (8). Getting a full thyroid test can help determine whether there are other issues at play. This can be especially helpful if you experience fatigue, weight gain, or constipation.
Since SIBO depletes important nutrients such as zinc, talk with your doctor about supplementing with selenium, iodine, and zinc. I created The Myers Way® Multivitamin specifically with hypothyroidism in mind.
#4 Address Structural or Scar Tissue Issues in the Gut
Abdominal surgery can increase your risk for SIBO. C-sections or abdominal adhesions can physically restrict the intestines and encourage bacterial overgrowth.
If you’re concerned this may be the cause for you, work with a physical therapist. They can provide visceral manipulation if you have any adhesions or troublesome areas. You can also try gentle abdominal massages at home to promote movement and circulation.
#5 Balance Your Bile Flow for Proper Digestion
Promoting optimal bile production can help maintain the delicate balance of gut bacteria. I recommend AMMD’s Bile Builder Complete. This well-rounded supplement supports several digestive systems at once.
The ox bile and burdock support healthy digestive function. While dandelion and artichoke for liver support. Bile from the liver helps kill harmful bacteria and supports fat digestion. If you’ve had your gallbladder removed or you experience sluggish bile flow, consider ox bile supplements.
Other ways to naturally improve bile flow include eating beets and bitter greens. Fenugreek, dandelion, arugula, and artichokes help stimulate bile production.
#6 Improve Nasal & Sinus Health to Reduce Gut Bacterial Contamination
Allergies or chronic sinus infections can cause post-nasal drip. This can introduce unwanted bacteria into the digestive system.
To prevent this, try using a neti pot or saline rinse to keep nasal passages clear. Additionally, it’s always a good idea to address undiagnosed mold exposure or environmental allergens that contribute to chronic sinus issues. If you live in hot, humid regions, this is especially important. I share about my own toxic mold exposure here on this unique podcast episode.
A good supplement to have on hand when dealing with gut toxins is Charcoal Binder Complete. Instead of one single detoxifying agent, this goes above and beyond with a potent blend of zeolite, chlorella, and spirula to eliminate unwanted toxins, pathogens, etc.
#7 Identify & Treat Hidden Gut Infections or Parasites
Many people don't realize that SIBO can develop after food poisoning. If you eat spoiled or undercooked meat, you can easily introduce harmful bacteria into your gut. Other gut infections such as H. pylori, candida, or parasites can make it harder for your immune system to fight back.
I recommend getting a stool test to check for bacterial or parasitic infections. If you have a positive result, follow a targeted protocol such as the SIBO Support Protocol.
This all-inclusive protocol takes you by the hand as you heal and reverse your SIBO. It includes an arsenal of herbs and botanical extracts that kill off harmful bacteria, detoxify it from the gut, and heal your mucosal lining. The Microb-Clear® and Coconut Charcoal work together to break down bacterial biofilms and cleanse toxins from your gut. Next up comes ImmuneIG and Leaky Gut Revive®, a dynamic duo in gut lining repair. The Paleo Protein powder and Primal Earth Probiotic provide clean, quality nourishment as you replenish and repair the intestines.
#8 Monitor Your Fiber Intake—Too Much or Too Little Can Trigger SIBO
Fiber is important for healthy digestion. However, too much fiber can feed SIBO and make it worse. Stay away from fermentable fibers like inulin, chicory, or raw vegetables and opt for non-starchy vegetables instead.
On that note, too little fiber can slow gut motility and lead to constipation. This can contribute to fermentation and methane-dominant SIBO.
An easy way to balance your fiber intake is to start with cooked vegetables and gradually add raw versions. See how your body tolerates it. Stay hydrated and drink plenty of water. Avoid caffeine and other diuretics. You can also use apps to track your fiber intake if you prefer. This can help you avoid excessive fermentation in the small intestine.
Take the Next Steps to Find Out If You Have SIBO
If you find yourself asking, ‘How do I know if I have SIBO?’, then it’s time to get tested. Knowing whether you’re dealing with SIBO or not is critical if you want to get to the bottom of your gut health issues. Testing is a surefire way to save a lot of time, money, and energy. Ask your functional medicine doctor about the pros and cons of a breath test, stool test, or dysbiosis test for your specific situation.
Gut health ties into so many other aspects of well-being. Your skin, mood, cognitive function, and even immunity depend on it! That’s why I advocate taking a holistic approach. Diet changes paired with lifestyle modifications are the true recipe for success in reversing and preventing SIBO recurrence.
Probiotic supplements and SIBO supplements are also critical. Nature contains some of the most potent antimicrobial and antibacterial compounds around. These help you as you learn how to prevent SIBO. Find your perfect match when you explore some of my best-selling gut health supplements, designed to support you on your gut health journey.
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