SIBO 101

By Maggie Ney, ND

Remember when the thought of bacteria in the gut would make you cringe with disgust. The current research about the importance of gut bacteria is prolific and exciting. We are now recognizing that there is a solid link between the gut microbiome and our mood, brain health, immune system, and hormones. But while bacteria are no longer seen as universally “bad”, more is definitely not better, and, where bacteria are found along our digestive system, plays a pivotal role in our health.

What is SIBO?

Small Intestinal bacterial overgrowth (SIBO) is a bacterial infection of the small intestine. With SIBO it is not so much the presence of bacteria in the gut which is the problem but rather how much bacteria are present and the location of that bacteria. 

What Causes SIBO?

Bacteria can overgrow in the small intestine when bacteria that should be in our large intestine gets into our small intestine or when there is a problem with our gut motility – which describes how food and bacteria move through our digestive system. We all have a Migrating Motor Complex which helps to sweep bacteria and food out of the small intestines into the colon. When this motor complex in compromised, bacteria and food can linger, ferment, and cause uncomfortable symptoms. What can affect gut motility? A number of conditions can contribute to a slower motility and an increased chance of developing SIBO:

  • Past history of food poisoning
  • Past history of a gut infections (like Travelor’s diarrhea)
  • Past history of abdominal or pelvic surgery
  • Genetics
  • Diabetes
  • Hypothyroidism
  • Autoimmune Conditions
  • Inflammation of the intestines which can be due to stress or poor diet.

GI symptoms of SIBO

  • Bloating
  • Gas
  • Diarrhea
  • Constipation
  • Burping
  • Easy fullness
  • Nausea

Other symptoms and conditions associated with SIBO

  • Fatigue
  • Brain fog
  • Depression
  • Anxiety
  • Restless leg syndrome
  • Interstitial Cystitis
  • Rosacea
  • Acne
  • Body aches and pain
  • Malabsorption of nutrients 
  • Poor immunity

Properly diagnosing and treating SIBO can treat each of the conditions listed above. 

Diagnosing SIBO

At Akasha we diagnose SIBO with a lactulose breath test. For this test, you swallow a drink containing the sugar lactulose. You then breath into a balloon every 20-minutes over the course of almost three hours.  If there is an overgrowth of bacteria in the small intestine, the bacteria would feed off the lactulose and produce the gases hydrogen and, sometimes, methane as a byproduct. The gases get absorbed through our gut into our blood stream and travel to our lungs for us to breath them out. The amount of hydrogen and methane in our breath can indicate whether you have an overgrowth of bacteria in the small intestine. 

Treating SIBO

Effective SIBO treatment not only addresses the overgrowth of bacteria with antimicrobials (either prescription antibiotics, herbal antimicrobials or both) but also addresses the root cause, so SIBO is unlikely to come back. Treatment is also different depending on whether there is a predominance of hydrogen or methane gas. When SIBO is only treated with an antibiotic for 2-weeks, it is likely to return and become a chronic issue. Akasha’s multifactorial approach also includes addressing gut motility, supporting methylation and detoxification pathways, and making dietary and lifestyle changes to prevent SIBO recurrence for the long term. 

If you are experiencing uncomfortable gut symptoms or other health issues that are not improving, consider the possibility of SIBO as potential contributor. Our doctors can help decide whether testing for SIBO is appropriate and help to develop an individualized and effective treatment protocol to eradicate SIBO and prevent reoccurrence.

Dr. Maggie Ney is Co-Director of the Women’s Clinic at Akasha Center For Integrative Medicine and specializes in healthy aging and bio-identical hormones. You can make an appointment with her by calling 310-451-8880 or emailing us at