I think I have SIBO – what can I do?

In last week’s blog I provided an explanation of SIBO- Small Intestinal Bacterial Overgrowth. A situation that can develop and create huge discomfort, pain and long-term problems. 

I explained why it can- or perhaps not- be linked to the more conventional and well recognised IBS (Irritable Bowel Syndrome).

I think I have SIBO - what can I do?

SIBO isn’t something that was really known about twenty years ago. Now there are numerous online groups trying to help potential sufferers as few people find they can get adequate relief through the conventional medical route.

In this week’s article, I’ll explain why it can be so difficult to obtain a reliable diagnosis. I’ll explain the processes that can be used to help assess for SIBO. And of course the steps I guide clients on towards resolution.

No time to read? Watch my latest Video or listen to the podcast – I think I have SIBO, what can I do?

Listen or download to the SIBO Podcast HERE

You think you have SIBO?

You first need to ask yourself what digestive symptoms you have. As I explained last week, common symptoms are bloating and distension of the abdomen (from 2 minutes to 3 hours after eating); increased wind; abdominal discomfort and pain; pain under the sternum; burping; nausea; diarrhoea and /or constipation.  

But I also explained in my last blog post, this may not be a problem with bacteria residing in the wrong place (small intestines). 

So how can you assess for SIBO?

Can you test for SIBO?

Let’s start with the bad news. There is no single test that has been validated as a gold standard for an accurate SIBO diagnosis. 

Most clinicians suggest breath testing. This is a non-invasive test using a sugar solution and assessing the rise in certain gases (methane and/or hydrogen) in fifteen minute intervals over the following 90 minutes. If bacteria are present in the small intestines, it feeds off (ferments) the sugar and gives off one of the two gases which are passed out via the lungs. Hence it can be collected through a breath sample. It sounds easy.

I wish I could say this was reliable and simple but I’m afraid it isn’t!

There are three types of breath tests available: glucose, lactulose and fructose. The medical community often like to use glucose and yes it can be reliable. But it’s only reliable if the bacteria is really high up in the small intestines. Last week I explained that the small intestines is about 20 feet long. So if the bacteria is in the middle to bottom section of the small intestines it won’t be detected by a glucose breath test.

Lactulose breath testing is something I have used before. It detects bacteria high up and much lower down the small intestines. So that’s good. But it can travel through quite quickly and reach the colon too fast so the timings of positive gas readings may not be reflective of bacteria in the small intestines.

There is a third breath test using fructose. It is more slowly absorbed and all microbes eat fructose so this test can be helpful but not 100% reliable.

The best solution when it comes to breath testing? Conduct all three tests and assess the different results but of course this is an expensive option and still not 100% accurate for SIBO. But it is more accurate than conducting just one of the breath tests.

The Test I use the most

Now the good news. I’m most interested in understanding what is happening along the whole gastro-intestinal tract.  What is the health of the gut barrier? What about the diversity and levels of beneficial bacteria? What types of pathogenic bacteria are present? 

The test I find most accurate is a comprehensive stool test using PCR DNA technology (not cultured). And I use only one test for this: Invivo’s GI EcologiX.

Colonic strains of bacteria are the ones most recognised to cause SIBO symptoms. The stool test will detect these hydrogen, methane and hydrogen sulphide bacteria. High levels of these may suggest that some are in the small intestines causing SIBO and not just in the colon.

Amongst the 72 gut markers measured in the test, it also detects a number of factors that together with the presence of these specific bacteria can also be a sign of small intestinal bacteria overgrowth: poor bile flow, poor digestive ability, intestinal permeability (“leaky gut”) and poor immune defences.

I think it’s SIBO- What next?

Don’t go rushing in with really strong anti-microbial products. I’m afraid this may do more harm than good.  Just like antibiotics, strong herbal anti-microbials also destroy the friendly good bacteria that we need to protect.

If you’ve carried out the stool test I mentioned above, you’ll have a really good understanding of the balance between good bacteria and pathogenic ones. It’s no good trying to wipe out the bad guys if you’re lacking plenty of good guys.

Think of it as a car park. If every car parking space is full then you can’t eradicate the bad bacteria without increasing levels of good bacteria.

Yes, gentle anti-microbials – relevant to the type of bacteria detected is important but for short spells not long-term. Think one month on, 2 weeks off. Or 2 days a week only. 

Combine these prebiotic fibres and probiotics.

What about diet?

It is important to remove the food that feeds these SIBO bacteria but only for short spells at a time. A FODMAP diet can be helpful but remember that if it’s followed for too long it also removes the fuel for the good bacteria. It’s a topic I’ve covered in another video and blog.

You may start with a strict approach initially but don’t continue this for more than 2 months at a time.

There are other SIBO style diets but the same approach applies- don’t continue with it long-term. If you feel the diet isn’t helping, there are other aspects that are missing from your approach.

Intermittent Fasting 

Since SIBO can be due to slow transit time through the small intestines, avoiding snacking and giving the gut a 12-16 hour break overnight can be very helpful. This allows time for the sweeping action to occur clear debris through the gut.

Stress Reduction

Stress is implicated in slowing the digestive ability and transit time. Looking into stress-relieving techniques is an important aspect of SIBO therapy. Deep breathing, meditation, yoga are all helpful. Look at your sleep and review your evening routine. Avoid intensive exercise.

Can I beat SIBO?

Yes, you can, but I won’t pretend it is easy.  It really is best to work with an experienced practitioner who understands the different testing techniques; and who also has an excellent understanding of the gastrointestinal system and digestive function. In the right hands, there are a number of supplements and protocols that can be extremely helpful to alleviate symptoms.

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Again, thanks for reading. 

Keep your eye out for more articles and Peyton Principles in the media.


Caroline is a Professional Nutritionist, Naturopath based in Wiltshire.

A little more about me…

Providing expert, personalised, health advice utilising 10 years of nutritional therapy and naturopathy experience with a strong emphasis on digestion and gut health. Zoom or face to face Consultations.

I also develop and deliver wellbeing in the workplace workshops.

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