Understanding SIBO: Symptoms, Causes, and Natural Support

SIBO stands for Small Intestinal Bacterial Overgrowth, which occurs when bacteria that normally belong in the large intestine migrate into the small intestine and multiply there. The small intestine is designed for digestion and nutrient absorption, not bacterial fermentation. When bacteria are present in excess, food begins to ferment too early in the digestive process, leading to uncomfortable and often persistent symptoms. 

Under normal conditions, the body prevents this overgrowth through stomach acid, bile, digestive enzymes, and healthy gut motility. When one or more of these protective mechanisms are compromised, SIBO can develop. 

Common Symptoms of SIBO 

SIBO symptoms vary from person to person and often overlap with IBS, food intolerances, and hormone-related digestive concerns. Many people feel confused because they “eat well” but still feel unwell. 

Common symptoms include: 

• Bloating, especially after meals 
• Excessive gas or belching 
• Abdominal discomfort or cramping 
• Diarrhea, constipation, or alternating bowel habits 
• Feeling overly full after small meals 

Less obvious symptoms may include fatigue, brain fog, nutrient deficiencies (especially iron and B12), histamine intolerance, skin issues, and worsening PMS or hormone imbalance. These systemic symptoms occur because bacterial overgrowth interferes with proper digestion and nutrient absorption. 

How Is SIBO Diagnosed? 

SIBO is most commonly diagnosed using a breath test, usually with lactulose or glucose. After consuming the test solution, breath samples are collected over several hours to measure gas production. 

The test looks for elevated levels of: 

• Hydrogen, typically associated with diarrhea-predominant symptoms 
• Methane, more often linked to constipation 
• Hydrogen sulfide, which may cause urgency, inflammation, and foul-smelling gas 

Identifying the dominant gas type helps guide treatment decisions and improves outcomes. 

Why SIBO Is Difficult to Treat 

SIBO is rarely just a bacterial issue. It is often driven by underlying problems that allow bacteria to accumulate in the small intestine in the first place. 

Common contributing factors include: 

• Impaired gut motility 
• Low stomach acid 
• Poor bile flow 
• Chronic stress and nervous system dysregulation 
• Prior abdominal surgery, adhesions, or endometriosis 
• Long-term restrictive dieting 
• Repeated antibiotic use 

If these factors are not addressed, treatment may provide temporary relief but symptoms often return. 

Why SIBO Frequently Comes Back 

One of the most frustrating aspects of SIBO is its high recurrence rate. This often happens when treatment focuses only on eliminating bacteria without supporting the underlying causes. 

SIBO is more likely to return when: 

• Motility support is not included after treatment 
• Diet remains overly restrictive for too long 
• Stress, sleep, and lifestyle factors are overlooked 
• Digestive secretions and gut lining health are not supported 

Preventing recurrence requires a broader, more supportive approach rather than targeting symptoms alone. 

The Role of Diet in SIBO 

Certain carbohydrates ferment easily and can worsen bloating and discomfort when bacteria are present in the small intestine. 

Dietary strategies may include: 

• A short-term low-FODMAP or SIBO-style diet to reduce symptoms 
• Gradual food reintroduction to prevent long-term restriction 
• Individualized adjustments based on tolerance and nutrient needs 

Diet should support healing, not become a long-term survival strategy. 

The Elemental Diet: When Is It Used? 

The elemental diet is a liquid nutrition protocol where nutrients are broken down into their simplest, most absorbable forms. Because these nutrients are absorbed high in the digestive tract, they leave little fuel for bacteria in the small intestine. 

An elemental diet may be considered when: 

• SIBO is severe or recurrent 
• Symptoms are triggered by nearly all foods 
• Previous treatments have not been effective 

This approach is intensive and should always be used under professional supervision. It is not appropriate for everyone. 

Here are a few options your practitioner may recommend in this case: 

Bioclinic Naturals ElementAll™ Biological Diet 

VitaAid Elemental Nutrition 

VitaAid KT-Elemental Nutrition 

Antimicrobials for Different Types of SIBO 

Antimicrobial therapy can include herbal or pharmaceutical options and is selected based on the type of gas produced and individual tolerance. 

General approaches include: 

• Hydrogen-dominant SIBO: typically responds to targeted antimicrobial protocols including garlic, oregano, berberine. (VitaAid Microcidin) 

• Methane-dominant SIBO (also called IMO): often requires combination therapy and longer treatment duration including neem extract, berberine and olive leaf  (VitaAid Microcidin AF) 

• Hydrogen sulfide SIBO: usually needs a more gentle, carefully structured approach including activated charcoal and low doses of berberine and garlic 

Antimicrobials are most effective when paired with motility support, digestive support, and appropriate dietary guidance.  

Supporting Long-Term Recovery 

Long-term SIBO resolution focuses on restoring normal digestive function and preventing relapse. This includes supporting stomach acid, bile flow, gut motility, and the nervous system, as well as repairing the gut lining and expanding food variety over time. 

For many women, especially those over 35, hormones, stress, and digestion are deeply interconnected. Addressing these factors together often leads to more sustainable results. 

SIBO is complex, but it is manageable with a thoughtful, individualized approach. If symptoms persist despite “doing all the right things,” it may be a sign that the root causes of SIBO need to be addressed - not just the bacteria themselves. 

Working with a practitioner who understands the full picture can help move beyond symptom management toward long-term digestive health. 

Disclaimer: The information in this blog is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider before making any changes to your diet, supplement routine, or managing a medical condition.