Bothered by bloating? Do probiotics make you feel worse? These could be signs of SIBO.

By Sangita Pedro, ND

Many of my patients tell me they wake up with a flat stomach and by late afternoon they look six months pregnant.  The bloating is sometimes accompanied by sharp, stabbing pains, but rarely gas or burping.  

Small Intestinal Bacterial Overgrowth, or SIBO, occurs when bacteria that should be in the large intestine find their way into the small intestine and set up shop.  A history of frequent antibiotic use, chronic constipation or diarrhea, and past intestinal infections such as traveler’s diarrhea or food poisoning can predispose a person to developing SIBO. A poor diet will help maintain the overgrowth once it is established. 

The standard Western diet with its high levels of sugar, salt, caffeine, alcohol, bad fats, and abundance of processed carbohydrates does little to support healthy microbial balance while feeding all types of intestinal overgrowth including SIBO. 

Once in the small intestine the bacteria take over, causing localized inflammation, leaky gut and various systemic symptoms such as skin rashes, rosacea, fatigue, allergies, difficulty regulating blood sugar, weight gain, nutrient deficiencies and fatigue. 

Bacteria in the small intestine ferment the food you eat, especially starches, fruit, sugar, fiber and alcohol, and produce hydrogen and methane gas as by-products. The build-up of gases causes excessive bloating and pain and dysregulates the muscular contraction of the small intestine

 ‘Good’ bacteria such as Lactobacillus and Bifidobacterium species can also overgrow in the small intestine, causing or worsening SIBO. The normal, rhythmic movement of the small intestine slows down or becomes irregular with SIBO. This causes everything, including probiotics, to linger in the small intestine where they can get ‘stuck’ and start to proliferate.  

Signs and symptoms of SIBO:

·      Constipation and/or diarrhea

·      Chronic reflux/heartburn

·      Abdominal bloating worse after eating (this can be excessive and painful)

·      Abdominal bloating, cramping and pain after taking probiotics

·      Excessive burping and/or gas after eating

·      Food allergies/sensitivities especially gluten, diary, lactose, fructose, and histamine intolerance.

·      Weight loss or weight gain (especially an increase in belly fat)

·      Fatigue


How is SIBO diagnosed?

The standard diagnostic test for SIBO is a lactulose breath test.  The test measures hydrogen and methane gas produced by the bacteria in the small intestine after they ingest and digest the lactulose. Breath samples are taken every 15 minutes for two hours.  

It is also helpful to look at standard lab values for select vitamins, minerals and total Immunoglobulins to get a sense of how well, or not well, the small intestine is breaking down and absorbing food.  

How do I treat SIBO?

There are five basic tenets of SIBO treatment that I follow in my practice:

·      Break down biofilms (protective coverings the bacteria use to hide from the immune system)

·      Decrease the number of bacteria by limiting their food supply

·      Kill the bacteria with antimicrobial herbs or pharmaceuticals

·      Detoxify the body

·      Reestablish a healthy digestive rhythm


If SIBO recurs after 3 months of diligent treatment, following these basic tenets, then further testing may be necessary to determine what is in the way of complete healing and recovery.