Understanding Small Intestinal Bacterial Overgrowth (SIBO)
Small intestinal bacterial overgrowth, or SIBO, happens when too many bacteria grow in the small intestine. This causes food to break down improperly and produce extra gas. Symptoms can include:
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Bloating and excess gas
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Pain around the belly button
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Nausea and indigestion
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Constipation or diarrhea
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Weight loss, fatigue, and joint pain
SIBO has many causes. Problems with stomach or bowel movement, digestive anatomy, immune function, low stomach acid, and other health issues can increase the risk.
Some common factors include:
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Low stomach acid from long-term proton pump inhibitors (PPIs)
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Low bile from gallstones or gallbladder removal
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Low digestive enzymes from pancreatitis
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Weak ileocecal valve, allowing colon bacteria to move into the small intestine
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Delayed bowel emptying due to small intestinal diverticulosis, strictures, post-surgery adhesions, or gastric bypass with blind loops
Low secretory IgA, which protects the gut lining, also increases SIBO risk.
SIBO can make it hard to absorb nutrients. Fat malabsorption can cause weight loss, diarrhea, and low vitamins A and D. Carbohydrate malabsorption can lead to bloating, gas, and acidic stools. Protein absorption may also decrease. Vitamins B12, B1, and B3 are often low, while vitamin K and folate may increase.
Diets high in sugar, processed carbs, or alcohol increase SIBO risk.
It is hard to know how many people have SIBO. Its symptoms overlap with other conditions like celiac disease, lactose intolerance, fructose malabsorption, IBS, or inflammatory bowel disease. Women and older adults are more often affected.
SIBO and IBS are closely linked. Some studies suggest 50–80% of IBS cases may involve SIBO. IBS causes recurring belly pain at least one day a week for three months. Symptoms often include changes in stool, bloating, constipation, diarrhea, and incontinence. Stress and anxiety can also make IBS worse. Women and people under 40 are more likely to have IBS. No test can confirm IBS.
SIBO can be diagnosed. The gold standard is taking fluid from the small intestine. This is invasive, expensive, and needs a skilled gastroenterologist. A simpler option is a breath test, which measures hydrogen, methane, or hydrogen sulfide in the breath. Compassion Primary Care offers at-home breath kits through All Clear, a CLIA-certified lab. These tests make diagnosis and treatment easier.
Treatment can include antibiotics like Rifaximin, sometimes with neomycin or metronidazole for two weeks. Other approaches include low-carb diets (low FODMAP), elemental diets, or herbal antimicrobials like oregano, berberine, allicin, or neem.
SIBO is often diagnosed late. Recurrence is common without proper treatment. Many people suffer from undiagnosed SIBO. Conditions linked to SIBO include diabetes, autoimmune arthritis, rosacea, interstitial cystitis, restless leg syndrome, and hypothyroidism. Medications such as PPIs, narcotics, and antibiotics increase risk. Untreated SIBO can cause serious problems like osteoporosis, anemia, and kidney stones.
If you have symptoms of SIBO, call Compassion Primary Care. Schedule an appointment and complete an at-home test. Today can be the start of your recovery. Call or text 813-669-3084.
