Small Intestine Bacterial Overgrowth: Signs, Symptoms, and the IBS Connection

6 Signs That SIBO Might be the Root Cause of Your IBS

If you’re constipated or struggle with gas or bloating you’ve probably already done your fair share of googling things, such as,What foods cause bloating?”, “How to stop diarrhea”, or “Will taking probiotics stop gas?”

But now you’re confused—you’ve cleaned up your diet, stopped taking antibiotics, and are taking probiotics regularly, but the symptoms aren’t getting any better. In fact, you actually think your irritable bowel syndrome (IBS) symptoms are getting worse.

It may be that the cause of those symptoms is not IBS, but an underlying gut imbalance called SIBO or small intestinal bacterial overgrowth. Studies show that over 70% of patients diagnosed with IBS actually have SIBO, and there’s a good chance you fall into this camp if healthy diet and probiotics aren’t clearing up your symptoms.1,2

 

What is SIBO?

You’ve probably heard before that our gut houses both beneficial and pathogenic bacteria. The beneficial bacteria aid in digestion and, when in balance, work to keep us regular. When your gut microbiome is in balance, you shouldn’t have problems with gas, bloating, indigestion, diarrhea, or other digestive problems.

However, those helpful bacteria only maintain good gut health if they live in the right portion of our gut and if they are in correct proportion to other bacteria. The majority of our gut bacteria should be in the colon. When the bacteria migrate backward into the small bowel, or when there is low stomach acid or poor pancreatic enzyme production, bacteria in the small bowel can overgrow and cause those yucky bathroom symptoms you’re sick of dealing with, such as diarrhea, gas, or bloating. That imbalance, or bacterial overgrowth, is known as SIBO.

So how do you know for sure if you have SIBO?

 

Eight Signs and Symptoms of SIBO

  1. Eating fiber makes your symptoms worse.4 If your doctor recommended upping your dietary fiber, but you find that your cramps, diarrhea, or other symptoms haven’t improved, this could be a sign of bacterial overgrowth in the small intestine. 
  2. Antibiotics actually seem to improve your IBS.5 This is a compelling sign that you might be suffering from SIBO. The antibiotics are actually helping to fight the excess amount of bacteria in your gut, so you probably experience some relief when taking antibiotics. 
  3. Your gas and bloating increase when you take probiotics, especially if they contain prebiotics.6 Prebiotics stimulate the growth of bacteria which is why those with leaky gut are often encouraged to supplement with them. However, if you already have an overabundance of bacteria in the wrong places (like your small intestine), prebiotics will exacerbate your symptoms. 
  4. You eat a gluten-free diet, but the symptoms still persist.7 If you have celiac disease or suffer from non-celiac gluten sensitivity, your doctor may have recommended a no-gluten diet. This should help your IBS symptoms dramatically— but if it doesn’t lessen your symptoms, it’s time to test for SIBO. 
  5. You suffer from chronic symptoms of gas, bloating, constipation, or diarrhea after recently taking medication.8,9 If the symptoms appeared after a recent surgery, or you were on pain medication (such as opiates) lately, ask your doctor about being tested for SIBO, as these medications often lead to bacterial overgrowth. 
  6. You can’t shake your “brain fog.”10 Maybe you’ve improved your diet, are getting adequate amounts of sleep, and have learned to manage or reduce the stress in your life. But you still can’t seem to concentrate, have difficulty with short-term memory loss, or just feel “foggy.” Recent studies have found that patients with SIBO have a higher likelihood of struggling with brain fog. 
  7. You’re losing weight but aren’t sure why.11 Weight loss, malnutrition, and nutrient deficiency are all connected to SIBO. Due to bacterial overgrowth in your small intestine, absorption of critical nutrients and calories is stunted which can cause unexplained weight loss or lead to a serious nutrient deficiency. 
  8. Your blood work shows chronically low iron or ferritin with no known cause.12 Anemia is known to be one of the clinical manifestations of SIBO. If your doctor can’t pinpoint the root cause of your low iron levels and you are experiencing other symptoms of bacterial overgrowth, it could be SIBO.

 

How Do I Know This Isn’t Just Leaky Gut?

While SIBO usually manifests with local gastrointestinal symptoms, a leaky gut will manifest with systemic complaints that affect the immune system. Keep in mind that it is not uncommon to have both SIBO and leaky gut simultaneously and having SIBO for a long period of time often leads to a leaky gut.13

Systemic signs of a leaky gut include:

  • Multiple food sensitivities
  • Skin rashes, acne, or rosacea
  • Respiratory symptoms, such as asthma
  • Allergic symptoms or increase in seasonal allergies
  • Fatigue
  • Brain fog or poor concentration, especially after meals
  • Any autoimmune disease
  • Joint pain or arthritis
  • Headaches or migraines

Remember, SIBO can cause leaky gut syndrome, but not everyone with SIBO has leaky gut. Usually, once the overgrowth is treated and the patient continues to follow a healthy diet, the leaky gut will heal itself!

 

Conditions and Disorders Linked to SIBO

These conditions predispose you to have small intestinal bacterial overgrowth:14,15 

  • Hypochlorhydria (low stomach acid)
  • Vagotomy (surgical procedure often used for gastric ulcers)
  • Surgical bowel resection or bariatric surgery
  • Food poisoning (post-infectious IBS)
  • Nerve damage that affects the GI tract
  • Drugs, such as opiates
  • Pancreatic insufficiency
  • Decreased motility in the small intestine (food not passing through properly)
  • Bowel obstruction
  • Gastroschisis (organs growing outside the body at birth)
  • Diverticula (weak places in the wall of the colon or intestinal tract)
  • Any disease that slows motility (diabetes, hypothyroid)

Other disorders that may be associated with SIBO include:16

  • Lymphoma
  • Rheumatoid arthritis
  • Fibromyalgia
  • Short bowel syndrome
  • Ankylosing spondylitis
  • Scleroderma
  • Hashimoto’s thyroiditis
  • Rosacea
  • Restless legs syndrome
  • Pancreatic insufficiency
  • Non-alcoholic steatohepatitis
  • Liver cirrhosis 
  • Diabetes
  • Crohn’s disease
  • Celiac disease
  • Kidney failure
  • Diverticulosis

 

Digestive Health Testing: Diagnosing SIBO

Testing for SIBO doesn’t have to be hard or time-consuming. In fact, it can be as easy as asking your doctor to order a breath test.17 Popular breath tests include the lactulose breath test and glucose hydrogen breath test, which measure the gases produced by bacteria in your gut to determine if there is an overgrowth.18,19 

You can also ask for a comprehensive stool analysis and urinary organic acids analysis. While this won’t directly test for SIBO, it will help the doctor pinpoint other causes of your symptoms and can help narrow down the root of the problem. 

 

How Do We Treat SIBO?

Treatment of small intestine bacterial overgrowth must be thorough and address all causes and symptoms. If you have SIBO, your therapy will need to be individualized, and your doctor will need to help you find out what underlying disease led to the overgrowth in the first place. 

From there, the doctor will work with you to treat the original disease through nutritional support, and possibly antibiotics, before your SIBO symptoms can fully be addressed. 

 

SIBO Diet and Nutrition: What to Eat If You Suspect a Bacterial Overgrowth

Once your doctor has confirmed the overgrowth of bacteria in your small intestine, you’ll want to look at your diet to eliminate any foods or medications that could be contributing to the imbalance.

Low carb diets like the paleo diet or low-FODMAP diet can improve SIBO symptoms by eliminating the carbohydrates most bacteria feed on while maintaining proper nutrients in the patient's diet.20 Following these type of diets has been shown to improve stool consistency, gas, bloating, and diarrhea in patients suffering from bacterial overgrowth.21

Foods to avoid (for the time being):

  • Alcohol, including probiotic drinks, such as Kombucha
  • Probiotics and prebiotics, except those authorized by your doctor
  • Fermented foods, as they can increase histamine

My favorite antimicrobial herbs to supplement with include:

  • Oil of oregano, which has powerful antioxidant and intestinal cleansing benefits
  • Biocidin, which support microbiome balance and promotes healthy elimination

 

 

SIBO Recurrence: Stopping the Cycle and Staying on Track

Treating SIBO successfully is not always easy and may involve major dietary changes, medication, or herbal treatment for an extended period of time. However, achieving a healthier gut microbe balance will likely prove to be the most important step in regaining your health and vitality! 

This was especially true for me—if you’ve read my story, you know that gut health was one of the first things I focused on when healing myself. Maintaining a healthy gut is truly transformative!

As you work through your symptoms, diagnosis, and treatment, please know that SIBO recurrence is not only possible, it’s common. There are two main ways you can fight SIBO recurrence in your gut:

  • Retest, using the same breath test you used before, a few months after your symptoms subside or at the direction of your doctor. 
  • Follow through with the dietary recommendations, at least for a few months.
  • Take probiotics only as recommended by your doctor. Remember, probiotics could actually be causing some of your bacterial overgrowth, so ask your doctor before incorporating probiotics or prebiotics back into your diet. 

By following the diet, nutritional advice, supplement recommendations, and lifestyle changes I list above and any recommended by your doctor, you’ll have your SIBO kicked in no time!

Now it’s your turn—have you had SIBO? Do these symptoms sound all too familiar? Let me know in the comments if SIBO is a health concern for you. If you’d like more great resources and articles like this one, subscribe to my newsletter by typing your name and email in the form at the top of this page. We’d love to have you join our community of like-minded individuals who are on the path to health and wellness!

 

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949258/ 
  2. https://www.ncbi.nlm.nih.gov/pubmed/28274108
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752184/ 
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467063/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819138/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705355/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413021/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838757/
  9. https://www.ncbi.nlm.nih.gov/pubmed/31008737
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006167/
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256157/ 
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5988153/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027334/,
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890937/
  17. https://www.ncbi.nlm.nih.gov/pubmed/21860825 
  18. https://www.ncbi.nlm.nih.gov/pubmed/24443065
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175689/
  20.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843040/ 
  21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693479/

* These statements have not been evaluated by the Food and Drug Administration. The product mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease.   The information in this article is not intended to replace any recommendations or relationship with your physician.  Please review references sited at end of article for scientific support of any claims made.

The views and opinions expressed on Dr. Jill LIVE! do not necessarily reflect the official policy or position of the host. Any content provided by guests is their opinion and are not intended to malign any religion, ethnic group, organization, company, or individual nor do they necessarily reflect the views or positions by the host.

502 Comments

  1. Thank you for this article! I was the one who commented on the other article you wrote, and you recommended this article. I have been trying to figure out what diet changes I need to make. We already eat the best quality meat I can source where I live. I am sugar, dairy, gluten, free and low histamine. I eat salad and fruit and eggs in the morning to detox my liver. (My liver enzymes are sometimes elevated on my blood tests.) And I also feel the liver is key to some of the symptoms I have left (pms, sometimes waking too early, bloating). I still eat white rice because I had years of struggle with my adrenals and feel I do need carbs, although I always eat carbs with protein and fat so that I have even blood sugar. I am considering taking one of the antimicrobials above. Which would you recommend for me with reactions to histamines, trouble with the liver, and feeling worse and worse the longer I am on antimicrobials? I was recently on samento, and banderol, and I got feeling worse and worse. I eventually developed diarrhea. I stayed mostly on them for about a month. I am also a Christian, and was very encouraged by your story. Thank you!

    • Hi Kristie,
      Thanks for your nice note! Unfortunately, I cannot give you specific medical advice online but you may try some of the herbs and see how you do. I also suggest finding a functional doctor in your area to help you out by testing and treating for SIBO or other imbalances that might be contributing to your symptoms.
      warmly
      Dr Jill

  2. Hi again! I was wondering if you usually recommend probiotics after the antimicrobial herbs. I know probiotics can be tricky with sibo and histamine intolerance. I have seen some recommendations for prescript assist. I would love to know your opinion!

    • Hi Kristie,
      Probiotics really depend on the patient’s underlying microbial imbalance and type of SIBO organisms. I wish I could give you an easy answer but every patient responds differently, so I individualize the treatment protocols as well…
      warmly
      Dr Jill

      • Hello Dr Jill,
        I had small range of Typhoid Fever in this year May month and My Dr gave me 15 days antibiotic and i was finding small amount of puffy stool and when i reported to my Dr he added another antibiotic for another 6 days, which is 21 days of antibiotic and after that my blow started making noise and i tried taking Probiotics for 2 weeks and i was feeling bit better and a few days i fell down from my bike and leg muscle got injured and again Dr gave me another 5 days antibiotic and from then till now about 3 months i am feeling bowel movement sound and more noise in early morning before i pass stool and once i pass stool the noise will go way, but … if any little stool is left in my large intestine i feel that noise until i pass that and the noise most of the time comes large intestine in the left side N back of stomach and also i have gastric which it was give pain in chest and now from few days the chest pain is not coming. But i feel very disturbed and worried about this kind of disturbance. Cas before i used to get gastric but i never used feel my stomach…. But after this fever and antibiotic.. i feel like i am not who iam…iam totally different … and also when i had this fever i took many blood test to find if i have something else.. but blood and stool reports were normal and i had become physiologically disturbed and worried at the time of fever. So need your suggestion to come of this mentally and strong stomach like before. Please help… I have started taking Kefir and Pre & Probiotic now from last week and i feel little better but not like before…i want my good stomach back ….

  3. Hi Dr. Jill,

    My husband has recently been told that he has SIBO, though he hasn’t taken the breath test – he is scheduled to do that in a couple of weeks. The only thing that confuses me is that he has never had diarrhea or constipation at all. He just has mild upper abdominal pain, plus a feeling of his stomach being unsettled (not quite nausea) – all day – then usually anytime he eats, bloating, and fullness. This has been going on for nearly 7 months as we’ve tried to figure out what’s happening. He had complete bloodwork, all normal – an abdominal ultrasound all normal except what they called an unrelated “slightly enlarged liver” – which they said was not really an issue because his bloodworm looked good. And he ended up having an endoscopy – so no ulcer or any other notable stomach issue is happening. He is a 31 year old vegetarian yogi surfer – so VERY active and healthy eater. Anyway – I guess I’m just trying to discern – can you have SIBO without ANY constipation or diarrhea? If you happen to get this and know the answer I’d appreciate it. Thanks.

    • Hi Natasha,
      It is quite possible to have SIBO with no change in bowel function. The other possibilities that could cause pain and bloating would be malabsorption, pancreatic insufficiency and hypochlorhydria. You should have him see a functional doc who can order more comprehensive testing to determine the cause, such as organic acids and stool profile.
      warmly
      Dr Jill

      • I too question whether or not I have SIBO. How common is it for someone to have only one or two of the “symptoms”, from the six you mention?

        I have Hashimotos, and my sluggish digestion improved amazingly when I went on an AIP/Paleo diet. The only symptom that makes me question whether or not I should be tested, is bloat.
        (Also, recently did a really in depth Candida cleanse as I knew that was an issue for me. The cleanse was very successful.)

        • Hi Audra,
          Hypothyroid is a risk factor for SIBO as poor motility is one underlying cause. If you are curious, I suggest asking your doctor to order a methane/hydrogen breath test.
          best
          Dr Jill

  4. Dear doctor,
    I am kumar,male aged about 55 years.I am residing in chennai,india.I have been suffering with giardiasis and associated digestive issues such as gastritis,chronic loss of appetite,indigestion,chronic malabsorption of food, underweight,constipation,falling of mucus from stools,and hair is getting gray.Is there a good treatment for giardiasis?Can taking probiotics will cure above nerrated problems?If so,kindly suggest some cure remedy for which act of kindness I shall be ever grateful.Also,what will be the long term effects of this ailment.
    With kind regards,
    kumar

  5. I have chronic constipation. Doctors have done colonoscopy and endoscopy no major issues. I feel dryness in all parts of the body, eyes, hands and feet. My stools are very try and have anal fissures now. I take thyroid medication as well. I get acid reflux and constipation on a daily basis. I go to bathroom each day but stool are dry and not as moving. I eat fiber from fruits and vegetables and drink 1.5 liter of water each day. Still not consistency in stool. My anal fissure are bleeding really bad. I have gained 20 lbs in one year. I take really good RAW probiotics but that initially did wonders but does not seem to help anymore.

    All GI doctors think its Idopathic Constipation and give me meds for stool softener. I dont want to cure just symptoms but actually cure my chronic constipation. Please help!!

    PS: could this be SIBO?

    Thanks

    • Hi rtirt,
      I suspect you have SIBO or fungal dysbiosis or both. I suggest seeing a functional medicine doctor to get a comprehensive stool test and a breath test to determine the underlying cause and then get treatment. In the meantime, you might try Thorne Magnesium Citrate at bedtime to help with constipation.
      Warmly
      Dr Jill

  6. Thank you Dr. Jill,
    I know someone who is a Naturopath doctor. Would you suggest I work with a ND or Functional medicine doctor? is there a difference in care? If you know someone personally in GA area could you please email me in the email address submitted in this request.

  7. Hi Jill,

    Do you recommend taking all those herbals together for sibo ? I know biocidin already has goldenseal and oregano oil in it.. It’s safe to take all the ones together that you listed? Thnx!

    • Hi Kristen, I don’t recommend treatment with all of the herbs. Best to consult with your functional medicine doc and decide best course of action.
      warmly
      Dr Jill

  8. Hi im lady 40 diagnosed with Graves Disease or Hypothroididm the meds Oroxine Throxine they perscibe me causes many side affects including Osteoarthritus, i used to ve able to walk run go to tge gym now i find it hard to move. Do you know of NDT i have been advised to go on this, hearing many great reviews and what herbs or diet is best for this condition. Thank you

  9. Hi,

    My son was diagnosed with SIBO and given antibiotics but unfortunately symptoms has returned . He is currently in China but maybe do you know any good SIBO doctor near Ithaca,NY ?
    Thanks

    Dana

  10. why am i losing muscles entirely in thighs, hands, legs, calves.. bloating in stomach… menopausal…all tests ok.. incl endometrial biopsy, PAP smear, blood tests. I wasso healthy and plumpy.. how to regain weight back… wat shud i do doctor…

    • Hi Sonia,
      Please find a functional medicine doctor near you to assess your hormones, including thyroid and adrenal function.
      The treatment depends on what the underlying imbalance turns out to be.
      warmly
      Dr Jill

  11. Hi Jill,

    Thank you for your reply. Unfortunately Dr. Mullin is not taking any new patients, so do you know anybody in Upstate NY who is dealing with SIBO problems ?
    Thanks

    Dana

      • Hi Jill,
        Your articles seems to be so informative.
        I really salute your spirit of healing others.
        I am having stomach pain since last 3 months, my endoscopy just showed gastritis and then i have been on lots of medicines and tests since then but nothing seems to be improving my symptoms. My blood work did show raised ESR levels(30) pointing to inflammation.
        It started with excess gas and burping and stomach pain and then the stoamch pain has continued. It happens mostly after/before eating, one more symptom is wheverever the stomach pain is, that spot is tender to touch when pressed. There are days when i have excess gas( feels like gas is trapped under my ribcage) it stays for a day or 2.
        My bms are normal and I seem to be losing weight.
        I am in India and here we do not have functional medicine practitioners unfortunately.
        I would be obliged if you could help me diagnose my symptoms.
        Can SIBO cause pain and tender to touch stomach too?
        Please help!

        • Hi Deb,
          Unfortunately I cannot diagnose or treat you online. You may want to start with a lactulose breath test to determine if you have SIBO or not. warmly
          Dr Jill

  12. Hi,
    Great Detailed Article! I have a question for you. Can chronic astral gastritis (not H. Pylori, verified by tests) be caused by SIBO or Candida? My M.D. Is not interested for looking for the cause; wants to put me on omeprazole or ritinidine, but I want to tackle the root cause. Also, does chronic gastritis cause hypochlorhydria/insufficient enzyme deficiency or is it the other way around? Over 4 years ago, while in labor with my 4th child, my docs put me on heavy antibiotics…vancomycin, magnesium sulfate(for hypertension), causing 4 days of painful constipation (not able to go to the bathroom), and since than, my digestion has never been the same daily. I Suffer from halitosis too. I’ve noticed that when my stomach is in pain my blood pressure fluctuates high to elevated. Could this be from the Gastritis, or food irritating my stomach gut? Thanks.

    • Hi Kay,
      It’s unusual for SIBO to cause gastritis but atrophic gastritis could cause SIBO. I would get a lactulose breath test to determine underlying cause and treat. It’s common to have halitosis present with SIBO.
      warmly
      Dr. Jill

  13. Hi doctor, quick question. My GI doctor had me tested for fructose malabsorption which turned out positive. Ha also found small peptic ulcers and small inflammation in my colon. My symptoms are weight loss, and upper abdominal pain. Ive been taking probiotics which aren’t really helping much. And been following a low fodmap for 6 months, but My abdominal pain is still there. Could all of this be from sibo?

    • Hi Sam,
      Yes, it could be SIBO and diet alone will not cure you. I suggest getting a lactulose breath test to determine if that is the cause and then treat with antibiotics if it is.
      warmly
      Dr. Jill

  14. Hi Jill,
    Thanks so much for your article. I have had IBS since 1994. I was infected with cocci mycosis after northridge earthquake. After a long period without diagnosis I started dyflucon for nine months. My IBS symptoms started soon after the course was completed. I’m currently on paleo diet. NIH recommends Rifaximin and Neomycin together. I see you recommend Xifaxan and/or Tindamax. First off what kind of doctor is going to take my symptoms seriously? Where should I start?

    • Hi Paul,
      Most cases of SIBO start as post-infectious IBS so your experience, sadly, is quite common. Search for a functional medicine trained doc in your area to help you at http://www.functionalmedicine.org. Xifaxan is best for H2 predominant SIBO and Xifaxan + tindamax/metronidazole OR neomycin best for methane predominant SIBO.
      blessings,
      Dr Jill

  15. Hello Doctor,

    I really appreciate your site here. I have been struggling for ten plus years with symptoms of brain fog, lack of concentration, anxiety, panic attacks, sweating, all before a bowel movement or a large bout of intestinal gas. This is horrible and has completely controlled my life during this time frame. Does any of this sound familiar to you? And if so, is there anything I could do about it? Anything information would be a blessing………

    Thank you,
    Joseph

    • Hi Joseph, It certainly sounds like you have SIBO. Have your doctor to a breath test to determine if that is the cause of your symptoms and then get treatment.
      warmly
      Dr Jill

    • I have same issues, its a nightmare! Nobody understands! Brainfog, heartflutter, anxiety caused by constipation or trapped gas! Especially hard being a bloke!! Ive had a colonoscopy that showed healthy gut. But I think its all to do with gut bacteria or infection in small intestine. Ive started taking probiotics from holland and barrett with 3 billion cultures. Will see if it makes a difference!!

      • Hi Kebba, in the case of some SIBO patients probiotics will make symptoms worse. You have to treat the bacterial overgrowth first.
        warmly
        DR Jill

  16. Dr. Jill

    Thank you so much for the information. I will request the test and post the findings in the future.

    Thank You
    Joseph

  17. Hi, I was given many rounds of antibiotics, starting from infancy, and I know that I now suffer from systemic candida from all that, with both physical and mental signs of it ( sensitive to dairy, gluten, and eggs, acne, fungus toenail, horrible brain fog, horrible fatigue, underactive thyroid). But, I have found that I need to eat a lot of fiber through legumes and GF grains in order to keep my bowels regular. I tried eating paleo for a while and I felt horrible during that time, and I was getting very constipated with hard and dry stools. I also would get horrible stomach pains during this time, possibly because I was consuming too much protein with low hydrochloric acid. It is weird to me, though, that since adding in more complex carbs and fiber, my bowels are much more regular and I don’t get stomach upsets anymore. I do however notice worse brain fog and more bloating and gas at times. I am working with a practitioner and she wants to treat me for both fungus and bacteria overgrowth, without testing me for SIBO. I am wondering if it is likely that I have SIBO even though I don’t show all the GI symptoms of having it.

    • Hi Natalie,
      It is very likely you also have methane predominant SIBO and may be worthwhile to do a breath test to confirm.
      warmly
      Dr Jill

  18. Hi Natalie,
    It is very likely you also have methane predominant SIBO and may be worthwhile to do a breath test to confirm.
    warmly
    Dr Jill

    • Yes, the damage to the microvilli from SIBO may create decrease in secretion of pancreatic enzymes….

  19. Hello Dr Jill.
    I am suffering from constant burping and bloating, extreme brain fog, feeling drunk all the time, extreme cravings and extreme fatigue. I have been diagnosed with Candida but wondering if these symptoms corrolate with SIBO. My Organic Acids test revealed very high l. Acidophilus bacteria. What is the best treatment for this? Blessings!
    Rosie

    • Hi Rosie,
      Yes, many patients have both fungal dysbiosis and SIBO. SIBO weakens the immune system and candida is opportunistic and takes advantage of the situation to become a problem. I did outline treatments in the article but you will need to work with your functional doctor to get the best regimen for you. I cannot give you specific recommendations or medical advice.
      Best to you!
      Dr Jill

  20. Hello Dr Carnahan, good summary of SIBO. While researching I have found some information about bacteria building biofilms, which can be destroyed using Lactoferrin, Xylitol or pancreatic enzymes taken on an empty stomach. I have found Lactoferrin has helped me tremendously in eradicating my SIBO and boosting my immune system. I recommend you look into that topic to stay up to date with recent research on bacterial overgrowth. Unless you have different opinion on biofilms?

    • Hi Anna,
      Thanks for your comments. Although biofilms must sometimes be addressed, they are also part of the normal mucosal lining of the enterocytes of commensial bacteria so my view is that we must use caution in indiscriminately trying to eradicate biofilms as it may also disrupt your bio-diversity and healthy microbes. I appreciate you adding to the conversation.
      warmly
      Dr Jill

      • I have had constant diahorrea for past 7 year burping gas stomach pain inflammation mucus weight loss I’m sure I have sibo will my doctor take me seriously I had helI bacteria pyory and cat scratch fever I’ve never been right since cant go out unless there’s a toilet on hand I can use loo up to 20 times a day I’m exhausted

  21. Hi Dr Jill,

    My 8 year old daughter is being treated for a bacterial and candida overgrowth. She was having terrible tummy pains (in the belly button area), headaches, nausea and really bad heart burn. My daughter is allergic to the antibiotic that the bacteria is susceptible to (Trimethoprim/ sulfa). So, her doctor put her on Biocidin and GI Detox. She was taking 1 drop of Biocidin twice a day and 1 GI Detox daily. Every time I gave Lilly GI Detox she would have tummy pain so, we stopped using it. We increased Bicocidin to 2 drops twice a day for a week and half now, Lilly is experiencing terrible heartburn again. Lilly is also taking Dr Mercola’s probiotic. Any info or advice would be greatly appreciated.

    Thanks so much,
    Jen

    • Hi Jen,
      Biocidin is quite potent and some patients react adversely to it. Talk to your doc about using an alternative such as oregano, garlic or berberine.
      warmly
      Dr Jill

  22. Glad to find this article. I have not seen constipation as a symptom ever, which has kept me from pursuing testing ….thank you!

    My son has been on a diet avoiding all foods that he tested sensitive too, so many, for over 1 year and is no better. He has bowel pain, hiccups after every meal, fatigue, heart burn, episodes of diarrhea, acne and brain fog, huge sized stools for nearly 4 years now. . He was on anti biotics nearly all school year, for 4 years due to chronic sinus infections and Asthma. The hassles with school ..learning difficulties, arguing with staff and being charged with Truancy, even with Dr’s notes became so severe, that i had to pull him out. Once out of school, the infections stopped.. I think the stress made him ill, in part.

    I have Hashimotos that has not responded to my sensitivities diet, not responding to thyroid meds, i don’t convert well and am on t3 only, yet getting worse. Weight in midsection, blood sugar issues and another flare up of self diagnosed Gastritis with episodes of Gastroparesis and diarrhea and cramping with any food intake. I am severely tired and have been ill and homebound since 2010, when i suddenly gained 11 lbs in 1 week and 30 lbs in 3 months, while barely able to eat and too tired to get out of bed. I had Acne all over my body and lost much hair etc..My doctor responded by sending me to a dietitian and dermatologist. . . I also have low Cortisol..another story. I have been to 3 GI doc’s and scoped 3x..no one checks for anything like SIBO. I have been to 4 Endocrinologists for help. I am done with conventional medicine at this point for my son and i . We stay home ill. Can’t go on like this.

    Excuse the misspellings and lack of caps. Any opinions here would be so appreciated.

    Thanks again, thanks for listening.

    • Wow, Emily – sorry to hear about your ill health! Check the gut with a SIBO breath test, GI stool profile and urinary organic acids to figure out what is going on. I also suggest a whole food, gluten-free, grain-free, sugar-free, dairy-free diet and avoid all processed foods. You may also have to check for toxic exposures, like chemicals, molds or heavy metals – you sudden weight gain makes me think you had some toxic exposure in your home.
      Wish you the best in healing
      Dr Jill

    • Hi Emily, I too am in the cinci area and dealing with SIBO and looking for a doctor, preferrably holistic that actually has experience in helping people with SIBO heal. Did you have any luck finding one? I do hope you are on the path to healing.

  23. Hi there!
    I have suffered from SIBO for many years I think (i’m only 21 though) but diagnosed only a couple of months ago. I also recently found out I have lactose intolerance through BT. I am in Italy and I can’t find functional doctors and doctors in general here dpn’t really get SIBO. They give me priobiotics. What could be the underlying cause? I didn’t have surgery nor poisoning nor parasites.. I have excess vitamin B6 and abdominal distention (permanently look 4 months pregnant…) and pain in right side abdomen… I don’t know what to do :/

    • Hi Laura, i have the same!!!!! my understanding is the elevated B6 is because the pathways are blocked from the SIBO… you’re basically B6 deficient, even though you have high blood levels… you need P5P… which will bring it all back into line. Also, the B6 out of whack may have even contributed to the SIBO, because low B6 (which is what you have, even though bloods are high) cause protein/carbohydrate malabsopriont, which leads to feeding the SIBO bacteria more. How are you going – your post was made circa June 2015…. have you found out more?

      • dear Matt,
        this is very interesting. I also have SIBO and elevated B6.
        What do you mean by the pathways are blocked from the SIBO?

        In my understanding the has to convert vitamin B6 into P5P, which is the final phone that the body can utilize, and in order to do the conversion, the body needs vitamin B2. So it might be interesting to do a blood test if you have a deficiency in vitamin B2.

        But what do you mean by the pathways are blocked?
        And how would giving P5P bring everything back into line? Is that adding more vitamin B6 to the system?

        Or is the idea here that if you give P5P, the body will utilize it, then you just wait, that the body is flushing out the unused vitamin B6 with water?

        can you test for P5P in the urine? Then you could compare it to the vitamin B6 blood test and see that in the blood B6 is elevated, in the urine P5 P is low. Is that the idea?

          • Hi WW,

            Did you find out anything about the subject?

            I have the same thing: SIBO and elevated B6 in the blood. Just like you, I stumbled on that site and concluded that since I have the MTHFR mutation, I was actually suffering from a DEFICIENCY in B6.

            My 1st reflex was also to supplement on P5P, however I don’t see how that would fix my methylation, which converts regular B6 to P5P (the activated form). Does treating the SIBO clear the pathway?

            Since my symptoms appeared after a B complex vitamin, I suspect that I have a methylation block. I don’t know if the methylation block caused the SIBO or the opposite, but I definitely know I suffer from both

  24. I have two questions:
    What has been your experience with including kefir in a daily routine – even if it is not homemade?
    If taking herbs, antimicrobials and antifungals what signs might there be that they are breaking through the biofilms and working? Thank you.

    • If someone has SIBO or yeast, fermentation is a problem and fermented foods and probiotics may need to be avoided until it is treated

  25. Hello Dr Carnahan

    Have you read Dr Mullin’s new book? I was wondering if it is also directed at people who have had serious SIBO for many years? I have to take xifaxan every couple of months and have been on FODMAP diet for 4 years now, also have done 14 weeks of elemental diet but SIBO always comes back 🙁
    In Dr Mullin’s first phase it is recommended to not only eat low FODMAPs but also go low carb in the first month. But I am really dreading the second phase when fermented foods and prebiotics are introduced. So far prebiotics have caused so much bloating and mucus in my case, so I am really afraid to follow these advices. What is your opinion about the approach presented in the book? On top of that, I am trying to gain on weight, not lose weight so I am not sure whether all his advices fit also my case…
    Thank you

  26. Hi! I’ve been reading your weblog for some time now and finally got the bravery to goo ahad and give you a shout out from
    New Caney Texas! Just wanted tto say keep upp the good work!

  27. Hi, you said use caution with probiotics. So what kind of strains and in which dose are best? Bifidobacteria or lactobacillus? Can they actually help treat sibo?
    How about e.coli nissle 1917? Any good for sibo/ ibs? Thanks

    • Hi Jin,
      It depends on what is going on, whether the patient has lactic acid forming bacteria in the bowel (in which case they will not tolerated lactobacillus probiotics or fermented foods) or not. I usually avoid all probiotics until the SIBO is treated and then try spore forming probiotics first, like Thorne Bacillus Coagulans.
      warmly
      Dr Jill

  28. I live in Maryland and I believe I have SIBO/dysbiosis. I found a Licensed Nutritionist, Kasia Kines, MS, MA, CN, CNS, LDN in my area who deals with SIBO and is on the Functional Medicine website. Would you suggest I see her even though she is not an MD?

    • Hi Sandi, I don’t know Kasia but many functional nutritionists are quite knowledgeable and a good alternative if there is no functional MD nearby – best to you!
      Warmly
      Dr Jill

  29. Thank you for your Article on SIBO! I am in the midst of treatment, using a Naturopath on this journey. I do have a question. When you say awhile to treat what is the average time to get the gut clean?

    • Hi Kristine
      It depends but gut issues can take from 6months up to several years to heal.
      warmly
      Dr Jill

  30. I have had SIBO-C for 9 long years. I have tried just about everything under the sun. Multiple herbal combonations, the elemental diet, several rounds of antibiotics and many other things to no avail. I finally tried the herbal formula Biocicin and have had some true meaningful relief for the first time. Nothing else works. Can I get away with using this miracle formula indefinitely? It is a complex formula. I don’t know what else to do because when I don’t use it I feel pretty sick. Any advice would be greatly appreciated.

    • Hi Michael,
      You should not take Biocidin indefinitely as it contains some harsh pro-oxidative ingredients but you might get away with rotating every 2 weeks or similar. I also suggest you work with a functional medicine doctor to figure out why it keeps coming back and address root cause (motility, obstruction, immune dysfunction, etc) You can search for someone in your area at http://www.functionalmedicine.org.
      warmly
      Dr Jill

        • Jason,
          The mechanism of action of artemesinin involves pro-oxidation so I do not recommend it long term. This is quite different from saying a supplement is unsafe.
          warmly
          Dr Jill

    • Hi Tom,
      I use Commonwealth labs SIBO breath test to determine if there is SIBO present in patients along with clinical symptoms of gas, bloating and constipation or diarrhea.
      warmly
      Dr Jill

  31. Hi Dr. Carnahan,

    I’m 31 and in the middle of my third IBS-D flare in three years. They usually take about 6-8 months to heal without medication. They come on in times of extreme stress/anxiety at work, which leads me to get away from my usual workout routine and clean eating habits. I end up eating out a lot and the symptoms begin after about 2 months of this drastic lifestyle/dietary change.

    I’m determined to find the root cause this time thought as I’m positive that stress alone isn’t the issue. I also have adult acne which gets worse and itchy skin after eating certain foods but I haven’t been able to identify which ones exactly. Part of the confusion is that I am symptom-free when in remission and can eat just about anything with no digestive issues whatsoever. Flare symptoms are multiple loose bms, cramping during, and mild abdominal discomfort from time to time.

    I have an appointment with my GP on Friday and would like to ask her for a breath test for SIBO and a food allergy/intolerance test. Are there other tests I should ask for?

    Thanks for taking the time to post on here!

    Chris

    • Hi Chris,
      You can get a SIBO breath test through Commonwealth labs or Genova Diagnostics – I would ask your doc to order this for sure. Sometimes it can also be done at a medical center through your gastroenterologist so if you cannot get him to order one of the labs above, ask for GI referral.
      Best in healing!
      Dr Jill

  32. I was diagnosed with SIBO (test with lactulose), with gastritis and chronic duodenitis. I am in this picture almost two years. Can you imagine what can be the cause of gastritis? I used drugs (proton pump inhibitors) a long time, but I think my stomach is acidic today, even stopping to take a long time. And yet the SIBO test came back positive.
    OBS: I have done all kinds of tests and has been ruled Crohn, etc.

    Thanks for helping us.

    • Hi Michel,
      Stomach acid is your first barrier against microbial infection and overgrowth. If you have been on PPIs in the past this puts you at risk for developing SIBO. If you currently are producing too little stomach acid, that contributes to the problem as well. Work with your functional doctor to test for hypochlorhidria and treat if necessary. The SIBO will continue to come back if you do not address the underlying causes (low stomach acid, poor pancreatic function, slow motility, etc) after treating.
      Wish you the best in healing,
      Dr Jill

  33. Hi there

    I am just wondering as I have been diagnosed with a leaky gut ( as per the cyrex test) gastritis and SIBO which one I should attack first. Leaky gut protocols all seem to use probotics and lots of bone broth which I have read you shouldn’t have if you have SIBO , Just want to make sure I get the best chance of recovery and get the order right.

    Any suggestions please?

    • hi lara,
      Don’t even attempt to heal a leaky gut until you deal with the dysbiosis, SIBO. It’s nearly impossible to heal intestinal permeability issues until you address the root cause (parasite, yeast overgrowth, SIBO, etc…)
      Warmly
      Dr Jill

    • Hi Lara,
      FMT is a powerful therapy that is being used fairly successfully for cases of intestinal dysbiosis, Crohn’s disease, colitis and c-diff infection in Europe. However, here in the US the only current indication is c. diffile colitis.
      warmly
      DR Jill

  34. Hi,

    I was diagnosed with SIBO and am treated right now with XIFAXAN 1800mg for 14 days. I have a couple of questions:

    1. Is SIBO caused by IBS or vice versa – IBS causes SIBO? I’ve been suffering from IBS for many years (I’m 42) so I’m wondering which came first

    2. Can SIBO lead to emotional symptoms such as anxiety? I’m having anxiety for 13 years and always been wondered whether the underlying problem is some sort of systemic inflammation in the body/brain. Might the SIBO cause a brain-gut dysfunction that in turn lead to imbalance in the brain’s chemistry? or might SIBO cause a constant stress on the body due to that inflammation that stimulates various receptors in the brains (such as NMDA) and place the body/mind out of control? if this is true, can the antibiotic treatment cure those things?

    Thanks

    • Hi yuval,
      Most IBS is caused by SIBO. IBS is a “waste-basket” diagnosis that doesn’t explain root cause. Since we know know that post-infectious IBS is most often related to SIBO, it’s the SIBO that caused your IBS.
      Yes, indeed gut-brain are quite connected and SIBO can contribute to both anxiety and depression. Read more in my article on Mind Altering Microbes here
      Warmly
      Dr Jill

      • Thanks for the quick answer

        I’m taking Celexa to control my anxiety and I notice that the bowel movement is significantly improved, reducing the IBS symptoms. I was told that SSRI often has an impact on the motility of the guts which lack of it can cause IBS. So I’m wondering whether the root cause is actually the motility problem due to some nerves defect that in turn caused the infestation of bacteria in the guts and over time to SIBO. This hypothesis tries to explain the opposite: nerve problem -> IBS -> SIBO. So the SSRI fixes the bowel peristaltic movements and hence help fixing the issue.

        The trouble is that I don’t know which direction is the truth. My hope is that eliminating the SIBO will help fix the emotional symptoms I’m having and hence I won’t need the Celexa anymore. But if the underlying cause is that nerve issue which causes a motility dysfunction in the guts, then looks like that I’m bound to this type of medication for good…

        Thoughts?

        • Hi Yuval,
          The small bowel’s motility complex, called the migrating motor complex (MMC) if usually affected and this lack of peristalsis leads to SIBO. In fact that’s the connection with post-infectious IBS… after an episode of gastroenteritis, the body may create antibodies to CDT (cytolethal distending toxin) which cross react and cause problems with the MMC. You will likely need to treat SIBO but also address the motility issue with your doctor.
          warmly
          Dr Jill

  35. Dear Dr Jill
    I have been suffering from IBS for more than 20 years. Now I am 33. The condition keeps increasing now am at critical stage bloating continuously hence affecting my social and work life. In 2002 when I was at my advanced level secondary school, I went to the physician and they told me it can not be cured so I have to get used to this life.
    I attended university with this condition and graduated in 2008. Now am an engineer employed by the government. My condition is very serious due to continuously passage of gas. It really affecting my working and social life. Now I think that it is not going to be easy to be promoted as the whole office knows I am smelling, others even laugh at me. Honestly I am a hard working woman and love my professional but now i have been experienced poor thinking ability and lack of concentration.
    I visited a specialist in digestive system and he suggested I need to take a videoscope. The results showed that I have a lot of bacteria at the small intestine hence the dr told me that those bacteria are responsible for gas production in my stomach and prescribed two antibiotics.
    At first before videoscope he gave me duspatulin and clavomid and flagyl.
    After videoscope results he give me Nitazoxamide, Albendazole and Moxifloxacin.
    I finished the dose one week ago but the symptoms still the same.
    While discussing about the result i asked him to check if the sphincter muscles are not working hence causing the situation and he showed me the picture and told me that the only problem detected is at the small intestine.

    Please Dr Jill help to rescue my situation as now am living in a very lonely life and worried to destoroy my carrier and my whole life.

    • Dear Happy,
      I am sorry to hear about your troubles… Please search for a functional medicine doctor in your area to test and treat you for the microbial disturbances that are causing your symptoms. You can search at http://www.functionalmedicine.org. It IS possible to heal and feel much better.
      warmly
      Dr Jill

  36. Sorry Dr Jill
    I am also Anemic experiencing weight loss.
    I have done a lot of tests including blood tests, Ultra sound and nothing serious was found.

  37. Hi Jill
    I was given a diagnosis of SIBO from the breath test by my GI and was out on 2 rounds of Xifaxan 550 for 14 days. I was nearly symptom free for about a month and then my symptoms came back although I have eliminated dairy, gluten, all processed foods, grains, most fruits. I now bloat with nearly everything I eat and suffer constipation. I’ve lost nearly 15 pounds and I’m frustrated and scared. Is it time to see a Naturopath? If so do you know of any in the Philadelphia area or Pennsylvania?
    Thanks in advance

  38. Hi Dr. Jill,

    I have had digestive/intestinal issues for quite some time and feel i I have classic SIBO symptoms – bloating, discomfort after eating and constipation.

    I’m wondering why you said to take caution with using probiotics and fermented foods as I thought that this is important to help with rebalancing the gut??

    • Many patients with SIBO have excess lactobacillis species in the small bowel. These patients do not tolerate probiotics until they are treated

  39. Hi Dr. Jill,

    I am currently working with a great functional medicine doctor here in California, but was hoping you might answer as I’ve read through all the comments here. I have tested positive for klebsiella pneumoniae and candida overgrowth (no H. Pylori) and so I am taking herbal antimicrobials and on a very strict diet.

    My worst symptoms are 24/7 bloating and burping up acid. The pain at the top of my throat has become constant from all of the acid.

    Do you have any suspicions past SIBO?

    Thank you!

    • Hi Jen,
      I would check for h. pylori but I frequently see klebiella in conjunction with SIBO so I think you need to get a breath test.
      warmly
      Dr Jill

      • Dr Jill,

        I appreciate your quick response! I have had two tests for H. Pylori – both came out negative. I will ask for a breath test next.

        I notice that most people with SIBO express some sort of stomach discomfort or pain. Mine is just the acid/bloating and I was sure HCl would help but I got up to 5000mg with no luck.

        Thank you for your input.

    • Hey Jen. Do you got rid of the 24/7 bloating/burping? I am now on the antimicrobials too and paleo auto-immune diet. I cleared a lot of symptoms this last months but I am still left with the constant bloating followed by burping and belching. I even have to get up at night to burp and then go to sleep again. This is stupid. I’ve done every thing in my 2 year long research and still have this problem…My tests showed Klebsiella species too, clostridium species overgrowth and some candida. Thank you, hope you’r well

  40. For severe weight loss during SIBO, which carbs are okay to add in in moderation? I try to do Jasmine rice and a small potato. I can’t cut them out completely because I am losing too much weight.

    • Hi Meredith,
      White rice and white or red potatoes are ok on the low-FODMAP diet. I often have patients on the combination of FODMAP/SCD diet which does not include these starches but in the case of weight loss, they are fine to add. You should also check pancreatic elastase as you may have significant malabsorption and pancreatic insufficiency.

  41. Thank you Jill. My iron is also at 23 and I am frustrated that my pcp says that is in range. What is a safe iron supplement with SIBO?

    • Hi Meredith, I do not recommend taking iron with SIBO. Gut bacteria preferentially uses iron so you’ll be feeding the wrong thing. Fix the SIBO and malabsorption instead.
      warmly,
      Dr Jill

        • Hi Meredith, Low pancreatic elastase signifies pancreatic insufficiency but high or normal is ok. The SCFAs are related to your micro biome. Stool test cannot diagnose SIBO
          warmly
          Dr Jill

  42. my son diagnosed with hasimotos in last year 2014–

    can navy beans
    green coconut kefir
    green coconut curd
    potatoes
    avacodeos
    increase tsh or antibody

  43. Thanks for the article. I was wondering if there is any connection between gut bacteria and hypertension. I recently started having high blood pressure despite the fact that I eat healthy and I run 30-40 miles per week. After a year on ACE inhibitors, calcium channel blockers and diuretics, I experienced nothing but the side effects of each drug and no symptom treatment. I decided to stop the mess and tried eliminating different foods. It seems that grains are the cause but not only gluten containing ones. Things like corn and quinoa and soy seem to cause BP spikes. Other things like starches and maltodextrin are also causing spikes. At first I thought it was a food sensitivity but as the list grows I’m suspecting I’m “feeding” something in my gut that is producing toxic metabolites or at least things that could be causing high BP. Tyramine for example is something that bacteria produce in cheese and causes vasoconstriction. Thoughts?

    • Hi Mark,
      LPS is perhaps the most potent inflammatory immune trigger and has been linked to diabetes, cancer, autoimmunity and cardiovascular disease. LPS is a bacterial coating and in the case of leaky gut may cross over into the immune system and cause damage and inflammation. So bottom line is dysbiosis and SIBO may definitely contribute to inflammatory issues. We know that underlying CV disease are oxidative stress, inflammation and autoimmunity.
      warmly
      Dr Jill

      • So are you saying that his BP spikes etc. could be caused by SIBO ??? I was just diagnosed with SIBO by the Lactulose Breath Test and will start treatment for it on Monday. I was always 120/80 and also ate 95 % gluten free, then August of last year out of nowhere my blood pressure starting doing spikes all over the place. Some days pretty normal or not too bad and other days are terrible. Dr. put me on HP pills and diuretic-with no difference in readings, so I also went off the pills and have insisted that you don’t just go from near perfect readings to all over the place, without something else going on. I hope once I get this SIBO treated that the BP issue will go away.

          • Really bc i have sibo and i have the weird blood pressure spikes too!!!! For the life of my cardiologist he cant figure it out and my bp was always perfect!!!! I have these episodes with g.i symptoms from the sibo and my heart will race, ill get all flushed and then my bp goes through the roof!!! Just kind of amazing to hear someone else say that they noticed elevated bp since getting sibo bc i was starting to think i was crazy!!!

    • Hi Kemal,
      Methane SIBO is resistant to many herbal regimens and drugs. You must you Xifaxan plus neomycin or metronidazole or the allicin form of garlic. The one I’ve found to work best is Allimax Pro.
      Warmly
      Dr Jill

  44. Hi Jill,

    I was diagnosed with SIBO (through breath test) back on 8/4/2015. I have since gone through two different ten day rounds of Xifaxan (round one = 2x per day; round two = 3x per day), and I am still not feeling better. I have also been taking one Nutrition Now P8 Acidophilus probiotic pill per day at the recommendation of my GI Doc and integrative physician. I have to wait 4 weeks to see my GI Doc for a follow-up. What tends to be the course of treatment for patients who don’t get better after Xifaxan treatment? I am staying away from starches, sugars and dairy in my diet. Lastly, I had an endoscopy a few months ago that turned out well (no ulcers, non-celiac, etc,), but there are some family members who say that despite only being a 42 year old male, that I should also get a colonoscopy. I am not sure if a colonoscopy could reveal anything about why I have SIBO. I need to avoid unnecessary medical costs right now. Money is tight.

    • Hi Benito,
      You need to work with your doctor to look for upstream causes of SIBO and treat those (low HCl, pancreatic insufficiency, adhesions, poor motility, etc) If you treat SIBO but don’t treat the root cause, it will keep coming back. You likely also need to follow a strict SIBO/SCD diet with no grains, and no FODMAP foods. If you don’t improve, I think a colonoscopy to rule out other issues is important.
      warmly
      Dr Jill

  45. Hello, my toddler has been constipated for nearly a year. We have been on gaps diet since shortly after he became constipated from eating solid foods. He’s been chronically constipated for over a year. We had his stool tested and he had higher than normal numbers for lactoferrin, lysozyme, and secretory IgA plus dysbiotic bacteria proteus mirabilis as well as high numbers for all beneficial bacteria. He was on antibiotics at birth and for UTIs later. Hi mainstream GI doc did not seem concerned about the numbers, so we are working with a functional med practitioner who suspects SIBO and recommended low fodmap diet, allimed, berberine, prokinetic, bitters, and lactobacillus probiotic for 4-6 weeks. In addition, he recommends erythromycin for 2 weeks. Is this what you would recommend for a child of 19 months and have you seen this type of treatment cure constipation? Do you think SIBO could have caused the high inflammation markers that showed up on his stool test? Do you think the antibiotics caused SIBO in him? Thank you!

    • Hi Margaret,
      Yes, I think it could very likely be SIBO or SIFO (small intestinal fungal overgrowth) or both. With a toddler, I would recommend working with your functional doc for a gentle healing approach, including anti-microbial herbs and gut healing supplements and a clean diet, certainly free of gluten.
      Warmly
      DR Jill

  46. Hi doc
    For the past three years I have been having pains in my lower abdomen with gas movement that is relieved a bit when I pass stool..it all started with me feeling tingling sensation like worm movement on my body after which I started feeling pain on both sides of my penis below my abdomen which later I started feeling inflammation on my lower abdomen. But right now.. my lower abdomen still gets inflamed with gas movement that is hard to get out after which it moves to my eyes and then to my brain and to my legs and it causes me a hell of a headache..i recently had a hernia operation….i don’t know what the problem might be..doc pls help me out cuz i’m dying slowly..

    • Hi Raymond, Please find a functional medicine doctor to help you by testing to see what is causing your symptoms.
      Warmly
      Dr Jill

  47. I was having very strong IBS C symptoms for almost a year but then after I took an antibiotic called Clindamycin two months ago for something unrelated, my symptoms have improved pretty drastically. I wonder if SIBO could have been the cause?

  48. Tenho diarréia diariamente, sempre depois das refeicoes,exames de endoscopia, colonoscopia normais , coprologico normal exceto de elastase fecal 176 e meu médico pediu o teste de respiração para ver se tenho sibo.SE meu teste der positivo como tratar a sibo e a insuficiência pancreática?

  49. Hi Jill,
    My husband has been feeling all these symptoms and has been to so many Dr’s and everything comes back normal. It’s so frustrating not to get answers, you seem to know what’s going on. Please let me know of a Dr in Chicago that can help him.

    Thank you for giving him hope!

  50. Hello,

    I was misdiagnosed with LPR and went on PPIs for two weeks before I was pulled off of them. Prior to taking the PPIs, I did not have any symptoms of LPR (ie: sinus issues, cough, flem in throat, sore throat, etc).

    During the course of my PPI treatment, I started to develop a very bad sore throat (the pain was so bad, this is what initiated a review of my test results, which were misread). I have been off of them for about 2 weeks. I still have the sore burning throat. This is best in the morning and worse after I eat sometimes. I also do not have any appetite – I am never hungry and never full. In fact, we were eating out last weekend and I had to force myself to stop eating because I actually forgot about this. Thankfully, my wife is making sure I eat.

    I have looked around and determined I may be a good candidate for SIBO due to the low stomach acid that I encountered on the PPIs. I do have a tiny bit more stomach discomfort of late and maybe a tiny bit more gas after eating. I also cannot stop burping for awhile after eating or drinking. I normally rarely burped unless I gorged myself prior to taking the PPIs.

    Do you think the above is enough justification to get a breath test done at my local doctor?

    Thanks for your time.

    • Hello again,

      I also forgot, that I started taking probiotics for the first time right when I went on the PPIs for about 8-10 days straight. I previously never had any in my life before.

      • Hello Dr. Jill.

        Thanks a lot! I will go get these tests done next week. In the mean time, I am going to try to cut out as many carbs as possible. I was feeling good today and decided to try a piece of cheese and that set my throat on a 1000 suns. Sometimes you just have to learn the hard way. But at least now I know!

        Thanks!

  51. I just saw my doc today- he suspects I have SIBO. I have gained 20 pounds in the last 6 months- (4 pounds in one month just because I went to the movies and ate some popcorn!) Could this be from SIBO? I only read about SIBO causing weight loss. last year I was losing weight slowly but surely but had a huge bloated belly every night, this year no matter what I do the weight hasn’t come off and I STILL have the belly! Theres not much fat there to grab either!

    • Hi Stephanie! I have had the EXACT same problem as you. Last year I lost a lot of weight despite eating so much and would have a huge bloated belly every night. I suspected SIBO and restricted grains and starch for 4 months which helped a little. But then I started eating grains again and then over a period of 6 months I have gained 20 pounds. No matter what I do (whether I eat grains/fat or not), I keep gaining. I was wondering how are you doing now and if you have found any answers?? Thank you so much

  52. Hello, I am a 23 year old female and I have been seeing ND Mary Shackelton in Boulder, CO (you may know her …) since March. It’s been a very slow process and lots of testing, diagnosed with wheat allergy/gluten sensitivity, low-thyroid, adrenal fatigue, low progesterone, malabsorption, 1 bad guy in my stool test and now SIBO. I have been taking Xymogen Berbermycin for 6 weeks, but haven’t seen much improvement in SIBO symptoms (intermittent C&D, bloating, belching).

    I was also tested for lyme and had a low CD57 count, but negative Western blot; also very high human growth factor beta 1.

    I just received instructions to take berberine, oregano oil and tricyclene (she was gone today when i called to check what this is and they thought it may have been misspelled for 3 weeks, followed by 1 week of S. Boullardi for 3 months. However, she did not give me any dietary modifications or instructions. Is it imperative to go on a low-FODMAP diet to cure SIBO, or is a Paleo diet enough (low-carb and natural sugars)? If my food allergy test showed small reactions to dairy, but no reaction to casein, could I go back to eating dairy? Also – is it possible to still be able to drink alcohol when following a strict diet – much of a 23 year old’s social life involves having a few drinks.

    Just curious to get another opinion. I noticed in one of your other articles that high diversity of bacteria in a stool test should be a clear indication of of SIBO (she said she had never seen diversity so high), but we did not make the SIBO connection until now.

    • Hi Lois,
      You must address underlying causes of SIBO for success. This could include poor motility of migrating motor complex, adhesions, low stomach acid or pancreatic insufficiency. Yes, if there are many commensial organisms present in stool, this can be an indicator of SIBO but you really need to do a 3 hour breath test to find out if you have methane or hydrogen SIBO. Berberine alone, especially in doses less than 5 grams daily will not eradicate SIBO by itself and low-FODMAP/SCD diet is critical for success.
      warmly
      Dr Jill

  53. Symptoms, started with loose ish stools with undigested foods & weakness. Was put on omoprazol with no change, then developed stomach burning & reflux, neausea & body fatigue! Stopped omoprazol, constipation&diareah in same movement, heartburn, gas & beltching, still body fatigue, grumbling stomach, hair loss & now bones aching, stomach burning lots & ust generally feeling tired & unwell for a year could this be Sibo?

    • Hi Natasha,
      Yes it could be SIBO but also could be other infection or dysbiosis. Suggest getting comprehensive stool testing and organic acids and breath test for SIBO to determine root cause
      warmly
      DR Jill

  54. Hi Dr. Carnahan,
    How do you know if you have a candida problem or a SIBO problem? What is the difference? I am going to a functional doctor this week and want to make sure I know the difference.

    • Hi Jean,
      You need to test, not guess. SIBO is determined by lactulose breath test, not stool testing. Candida can be determined by combination of stool testing, urine organic acids and Ig serum. Remember if candida/yeast is in the small bowel, it will not show up on stool test.
      warmly
      Dr Jill

  55. Hey everyone i have SIBO, Candida, parasites and leaky gut syndrome. I don’t really know what to do because it’s out of control ! I can’t go on the Candida diet ( can’t eat veggies, fruit or brown rice without throwing up ) due to a weak digestive system – it seems like i can only eat easy-to-digest foods like white bread… white pasta.. fast food. I know the more of those foods i eat the worst that all 4 of those problems will get but I’ve had severe problems with eating healthy foods as it doesn’t digest at all – if only there was a restart button in life hey ( sarcasm )

    Any tips or wisdom on how to tackle this problem? I can’t take many supplements since a lot of them can’t pass through my digestive system well… Went to the hospital and they did ultrasound on all of my organs and said everything was fine :S :S I’m not sure what to do at this point : (

    Like I really don’t want to eat junkfood since it’s making everything way worst but I can’t possibly afford to attempt to eat healthy foods again since I’ve had to go up to the hospital 3 times now cause of huge stomach pains – so lost!

  56. Dear Dr.Jill
    I think you are 100 % right about sibo and Ibs ,infact In my opinion I think Ibs does not really exist, I have been diagnosed about 100 times that I had ibs and was given all types of medication that existed on this earth, after reading a article about sibo I decided to take a chance and tried Flagyl antibiotics and from that day on I have never had a bout of this so called IBS.

    regards
    Joe
    ( Malta )

  57. Hi Jill! After starting a high dose of probiotics for over a month I now have leaky gut/celiacs issues that I never had before. Have you ever heard of this? I think I have a Sibo overgrowth. Please advise if you think this is possible or not. I took the probiotics preventatively and had none of these issues before!

    • Hi TL,
      That is unusual but patients who do not tolerate high dose probiotics often do end up having SIBO
      warmly
      Dr Jill

  58. Dr. Jill-
    I have been battling abdominal issues since I was about 17-years-old. I thought all of the issues would be resolved when my gallbladder was removed when I was about 24. Far from it! Now, a 33-year-old mother of 2 my battle continues. I have been going to doctors for an inconsistent pain in my right upper quadrant since 2014. Nothing glaring was found in the biliary area (pancreatitis, sphincter of oddi, liver issues, etc.) so I was diagnosed with IBS, GERD, gastritis and ulcers. I have recently been suffering from months of excruciating abdominal pain and bowel issues. After being sent for so many blood tests, the phlebotomists at my doctors office were running out of places to take the blood, ultrasound, x-ray, mri, mrcp, endoscopy and soon colonoscopy I was diagnosed with Shigella. I’ve been treated and finished the necessary antibiotic, but things slowly went from bad to worse. I’m still suffering from horrendous abdominal pain wrapping around the entire circumference of my body under my rib cage. The upper right quadrant pain is unbearable. I’ve also had auto immune reactions to the Shigella bacteria and have been battling muscle aches, migraines, foggy memory and thinking and skin rashes. No abnormalities other than the Shigella bacteria have shown up in my blood work or any of the tests that have been run. I have been doing as much research as possible and trying to be my own advocate to help prove to doctors that I’m not “hysterical and/or post-partum” and that my pain and symptoms are very real and need to be treated. Considering my history of antibiotic treatment, acid suppressing medications, oral contraceptives, and dietary issues, I am strongly believing that SIBO and/or leaky gut could be a great deal of the issues. All the doctors are telling me it wouldn’t cause upper right abdominal pain. I would appreciate any thoughts you may have on these issues (specifically the right abdominal pain). Thank you so much!
    Sincerest regards,
    Debbie O

  59. Dr. Jill,

    Last year I was diagnosed with SIBO (bloating, discomfort and pain in the stomach). Treated with xifaxan and other antibiotics (which made me feel worse), PPI, had endoscopy (which was normal). Doctors just dismissed me saying it’s IBS.

    Over the year the SIBO progressed. So after doing research I decided to take VSL#3 probiotics. Took 1.5 sachets over a period of 3 days and then I started feeling sick – dizzy, heavy head, like hungover, feeling pressure around my head, extremely gassy and belching every minute a lot, dry mouth, dehydrated, cold hands and feet, stiff / numb facial muscle feeling, pale, anxiety, sporadic rashes, burning face / ears and more (interestingly my stomach became better and my tinea versicolor on the skin improved).

    I went to a functional MD. Blood test showed B12 at 224 and lower D3. Genova Diagnostics breath test showed SIBO in ileum (H2 at 57 and CH4 at 11). Genova GI Effects stool test showed low diversity, low good bacteria count and no growth of Lactobaccilus and E Coli at all. Showed no candida (although I find it strange that my tinea vercicolor improved initially after VSL. But it’s back now). Now 3 months later I have B12 and D3 at normal levels after supplements.

    2-3 weeks ago started taking Candicid Forte (berberine, ginger, oregano, pau d’arco and more) and Saccharomyces Boulardii. But many of my symptoms still exist with dizziness, brain fog, cold hands / feet and stiff facial muscles being the most bothering.

    Can SIBO take a long time to be cured with Candicid? Could it be candida even though Genova stool test showed no growth?

    Thank you very much!

    Dimitri.

    • Hi Dimitri,
      You could still have significant candida or fungal dysbiosis with a negative stool test. The stool test shows colonic dysbiosis only but if you have candida in small bowel (SIFO) then it may not show up at all. Candicid will not treat SIBO. You need a much stronger herbal regimen or Xifaxan
      warmly
      Dr Jill

      • Thank you so much for your answer, Dr. Jill!

        Is there any way to figure out whether it’s SIBO or candida?

        While taking Xifaxan (and after) last year it made me more bloated, painful and I started having incomplete bowel movements. My dosage was even lowered from 3 to 2 pills / day (10 day course). Then the doctor told me that my stool test showed C Diff and prescribed me Flagyl then switched to Vancomycin (although I didn’t have any symptoms). I went to another doctor and he told me to stop after 5 days of taking it since I showed no symptoms. Now I have tinnitus.

        Now I’m taking 1 capsule of Candicid twice / day and same for Sacchromyces. Started getting a lot of anxiety shortly after taking them. If it’s SIBO and not candida, what stronger herbs would you recommend?

        I have called your office back in August to make an appointment when I first got all the bad symptoms but was told by your staff that you didn’t have any room for new patients. I am still struggling to find the protocol that helps me. I’m young and exercise almost every day but I’ve been paralyzed for the past 3 months.

        Thank you so much, Dr. Jill!

          • Thank you, Dr. Jill – I appreciate your help very much.

            The breath test did show SIBO in ileum (H2 at 57 and CH4 at 11). I will take the organic acids for yeast. If that shows yeast then I’d have both SIBO and yeast or could just be yeast?

            Thank you again, Dr. Jill!

  60. Hi,
    I am 55 year old male and have never really had any digestive issues before, except for some acid reflux about 13 years ago, where I took Nexium for a couple of months.

    I have been dealing with digestive issues, intense intestine cramps, belching when eating, etc for about 3 months now. I have l also have a pain in my RUQ just below my ribs and now, in the last week or two, this pains know seems to extend to my left below my ribs.

    I did the breath test about 2 weeks ago and I am positive for SIBO. Could these upper stomach pains be from SIBO? I had an upper Endoscopy, Abdominal Ultrasound and all blood tests are normal. One GI mentioned pancreas, which has me very concerned. Dr.’s office also told me my insurance will not cover the Rifaximin for SIBO. I assume this is the best way to first get rid of the bacteria. Are there specific dosages that will eradicate this the first time? Are there herbal supplements that can also be used in conjunction to better ensure the bacteria is completely removed? I know I also have to make big diet changes to also ensure this stays away and find out the root cause of this to begin with.

    I have also lost nearly 20 pounds since the start of the year. I feel like I am not even sure what to eat anymore. One SIBO diet says rice another says no carbs, another says brown rice. What carbs can one eat, while trying to eliminate the bacteria? Do I also have to go off dairy? Sorry for all the questions and ramblings this digestive nightmare and SIBO is very new to me and I have so many more questions that answers. 🙂

    Also can you recommend a good doctor in the Palo Alto, CA area.

    Thanks! I appreciate any help.

  61. Hello,
    I was diagnosed with SIBO by a doctor “with a high degree of suspicion- bloating, weight gain with restricted calories and a lot of exercise (~2 hrs/day), excessive fouling smelling gas, hiccups and burping after meals, appearing “pregnant” by the end of the day because I am so bloated. They did not test. They prescribed Xifaxan 550mg TID x 14 days. I am two days in and not having any relief yet. I am worried because I did not know that I needed to be tested, and now feel the test could have a false negative. I don’t know what to do- stop antibiotics? Also, what is best for diet- low FODMAP or SCD? Do probiotics need avoided during SIBO treatment? Thank you.

    • Hi Jen,
      A combination SIBO/SCD diet works best (details at siboinfo.com) and probiotics must be individualized depending on what you tolerate. I like Thorne Bacillus coagulans, which can be ordered from thorne.com by setting up patient account and using code: HCP1004064. I agree that “test don’t guess” is the best way to go. You should see if your doctor can order a comprehensive stool test and a breath test.
      warmly
      Dr Jill

  62. I am on day 4 of 14 of Xifaxan 550mg three times daily for SIBO. My bloating seems to have gotten worse. Is this to be expected? I am starting to get discouraged.

    • Hi Elizabeth,
      You may also have fungus or yeast (SIFO) in the small bowel. Have your doctor do testing to determine if that is the case.
      warmly
      Dr Jill

    • Elizabeth,

      I had a similar response to Xifaxan when I took it last year. I was more bloated and had stomach aches. It also made my bowel movements worse. I even had a dose reduced to twice daily instead of three times.

      Dr. Jill suggested that I could have SIFO and I have strong suspicion of that as well.

      Dimitri.

  63. Dr. Jill,

    I’ve read online people saying that they struggle with candida for years. I don’t know how aggressively they’re treating it but I was wondering if candida overgrowth is well curable if treated with the right herbal regimen. It seems to take me a while and I don’t see a significant improvement yet (I can feel better one day and worse another). I’m on Candicid Forte for about a month (but I started with just half a capsule / day and now on 1 capsule twice daily; trying to bring up to 2 caps twice a day). I’m also on paleo diet as you’re suggesting in your post and already lost about 15 pounds since the onset of myriad of symptoms. I just want to get rid of it and lead a normal life again. Is candida overgrowth well curable if treated with the right herbal regimen?

    Thank you very much, Dr. Jill.

    Dimitri.

  64. For the past few years, no matter what I ate by the end of the day i looks 6 months pregnant. I lost a lot of weight at the time so it looked really bad. I was just diagnosed with SIBO and prescribed Xifaxan and Neomycin at the same time. The first two days I was so nauseous and sick I couldn’t take all the antibiotics I was supposed to. Now I only have a few days left and if anything my symptoms are WORSE than before! My doc told me to follow the FODMAPS diet but cheat here and there to make the bugs come out so they can be killed. I feel like I’m doing that so I have no idea why my symptoms (mostly bloating) are worse. Anyone have a similar experience? or does it get worse while on the antibiotics and better afterward?

  65. Hello,
    I am being treated for SIBO, methane and hydrogen with metronidazole and xifaxan. I have noticed my stool is mottled light and dark colored. is this a good or bad sign, or unrelated? I don’t know if I should be concerned, or happy the treatment is working.

    • Hi Matthew, You should discuss these changes with a doctor as it’s impossible to tell you exactly what the cause might be without knowing your complete history.

  66. Dr. Jill,

    I’m taking Candicid for SIFO and finally see some progress. However, it triggers and worsens my reflex (I have a little granuloma in the throat due to LPR) now to a degree that I sometimes see blood in my saliva. I think I have a little ulcer in the throat and will go to ENT to check it out. Is there any other herbal regimen that I can follow that doesn’t affect LPR / GERD that much? Maybe Allimed would be better?

    Thank you very much.

    Dimitri.

  67. Hello,
    I have several issues. The first being fecal smelling, foul breath that could fill a room, literally. I brush my teeth approximately 5 times a day, floss after each meal, never had any cavities. I go to the dentist every 4 to 6 months. Performed a DNA oral swab that came back negative for concerning bacteria. Visited Ent specialist to control allergies, but still persistent breath that I believe is gut related. I have had bb for as long as I can remember but recently it has gotten exponentially worse along with new issues that have risen. Abdominal and chest discomfort x 3 months, worse after eating. Used peptobismol and tried nexium for 6 weeks. Only mild relief. I also use zantac and have elimated tomatoes, spicy foods, citric acid, and chocolate from diet. I also have belching and flatulence, sometimes I belch and pass gas at the same time. Abdominal distension, bloating, fullness. This month I have exeperienced 3 episodes of what seemed like food poisoning (although I have never had food poisoning symtoms before and my family ate same meals but did not experience similar symptoms)# abdominal spasms, diarrhea, painful painful passing of stools, and bowel urgency. In the past 2 days have had 13 episodes of diarrhea. In my stool I pass corn nut appraring objects and other object I cant identify (even if I dont eat corn). For the past few days my stool has been green secondary to chlorophyll tablets (take 1 po per day). Other supplements incude probiotics.

    Last, I have been more lethargic than usual and with 13 episodes of diarrhea, I have had an insatiable appetite.

    • Hi Michelle,
      Yes, it very well could be SIBO – I suggest asking your doctor to get the breath test to see if that is the root cause of your symptoms.
      warmly
      Dr Jill

  68. Dr. Jill,
    I also failed to mention that I was on several courses of antibiotics as a teenager for acne treatment. I have a gi appointment coming up. What should they test for other than SIBO and maybe h pylori. Any other suspicions?

    Thanks

    • Hi Rob,
      That’s tricky… SIBO can be cured with a 2 week course of antibiotics, while candida overgrowth generally requires persistent effort for at least 3-6months. However, some SIBO is resistant and requires multiple courses of antibiotics and longer duration.
      warmly
      Dr Jill

  69. Thank you, Dr. Jill. What causes SIBO and candida overgrowth? Is the cause for candida different than for SIBO? Lastly, why don’t traditional doctors don’t recognize SIBO and especially candida? This seems to be on the rise among population now if I understand it correctly.

  70. Hey Jill,

    Love the blog post. Just a quick question. I have Hydrogen type Sibo but I have constipation. Is that common? Ive read that constipation is from Methane. Also my main concern is brain fog. I’ve done a leaky gut test which shows no leaky gut. So could Sibo be causing my brain fog? Thanks!

    • Hi JJ
      You may also have SIFO. Have your doctor check urinary organic acids and a stool test to see what else is going on.
      Warmly
      Dr. Jill

  71. That is the clearest most logical and comprehensive explanation I have ever read. Thank you so much for sharing such important information. I wish I wasn’t 2000 miles away … I would love to become a patient.

    Best, Joe

  72. I was just diagnosed with both SIBO and pancreatic insufficiency. My fecal elastase was 199 (so borderline) and the SIBO was positive for both methane and hydrogen (way higher for hydrogen) I also have Hashimotos and Celiac Disease. I am scared about the pancreatic insufficiency. Are the SIBO and pancreatic insufficiency related or is one caused by the other and if I heal the SIBO, will the pancreatic insufficiency improve or is that lifelong?

      • I have upper abdominal pain RUQ and LUQ as well that gets worse with food. I am having an endoscopic ultrasound to look at my pancreas, Chronic Pancreatitis is my fear.

        • Aren’t Chronic Pancreatitis and SIBO related? And how does SIBO cause PE if SIBO is an issue with small bowel and PE is with the pancreas. Would SIBO and/or PE cause stomach tenderness in epigastric RUQ LUQ regions?

    • I don’t know of any evidence that FMT would be effective for SIBO. Dysbiosis is abnormal microbial populations anywhere in the gut. SIBO is overgrowth of commensial organisms in the small bowel

  73. I am being treated for IBSC but I strongly suspect I have SIBO based on my symptoms (trapped gas and constipation are the most common) for the past 10 months. What other diagnostic testing for SIBO besides an Endoscopy and Lactulose breath test are there? I have had an endoscopy recently and am waiting for biopsy results. Can probiotics be harming me if I have SIBO?

    Thanks,

    James

    • Hi James
      SIBO is diagnosed with a lactulose breath test for hydrogen and methane. Stool testing will not show if you have SIBO or not. If you have excess lactic acid producing organisms, then taking lactobacillus probiotics prior to treatment may do more harm than good.
      warmly
      Dr Jill

  74. Hello doc im suffering from upper rigth abdominal pain and all may scan is normal im sensitive with sugar products like chocolate,and my bowel movements is change also always constipated sometime loss and ill experience nerve pain also is it possible that i have sibo

    • Hi Rey,
      You may have SIBO – best to test, don’t guess. SIBO is diagnosed with a 2-3 hour lactulose breath test.
      warmly
      Dr Jill

  75. Hi Jill,
    I am 24 and I had IBS-D for around 10years now…I am from Greece but i live in China for 2 years. I struggle with my diet so much.Even bananas or supoosedly safe foods for IBS will still give me symtoms. I have tried few things that didnt work for me. Recently I met a woman who told me about Doterra’s essential oils that suppose to heal your gut.I am trying oregano and peperrmint oil and feeling a bit better but I was wondering how long do you think it takes to actually heal your gut..and if there is any test I can do to check if that is the cause or if the cause is SIBO?

    • Hi Vasilina, I am sorry to hear of your struggles! If you have SIBO or other infection, you will need to treat the infection before you can heal the intestinal lining.
      warmly
      Dr Jill

  76. Hi Jill,

    I think I may have Sibo. Will a regular GP test me for it if I ask ? ( I am in uk). I have fibro and bloating , occasional constipation . I recently weened myself of all my drugs, cut out suger and began eating more nutrition. I began juicing, but after my stomache would churn and become bloated so I stopped. I also want to do a full body cleanse in the future , so do I heal the Sibo first and then cleanse ? do I need a break in between ? and how long does it take to heal Sibo ? I know I have asked many questions but after years of illness and pills I am really trying to regain my health and learn as much as possible, just a bit confused ??? Much appreciation x

    • Hi Lara, You can ask your GP or gastroenterologist to order a lactulose breath test to diagnose. Follow low-FODMAPS or SCD diet to help your symptoms
      warmly
      Dr Jill

    • Hi Lara

      Did you have any success in getting tested for SIBO in the UK? We are also in the UK and having immense difficulties. My son had a Lactulose breath test (at my request) and it was positive – hydrogen 40ppm above base at 90 minutes but they didn’t test for methane! The hospital said they could only measure hydrogen. So far neither GP nor GI consultant has acknowledged that this is SIBO or how to treat it and it has taken us a year to get this far. So frustrating…

  77. I am a strict vegan and I have symptoms of SIBO. I just want to know if it is possible to treat and cure SIBO without having to eat meat, dairy, or animal products? I am so stressed out about seeing the diet treatments when I’m a vegan. I cannot see myself taking a bite of meat. Me eating meat is like someone else eating a live big or something. Can’t do it. Eggs make me feel sick so can’t do that. I eat whole foods raw vegan with some cooked starches mostly. Lots of fruit and vegetables, nuts and seeds. I have bloating and distention, and chronic partial diarrhea. Lately more nausea and pain. It feels like it takes forever for food to move through my system and it gives me gas. I eat a lot of grapefruit and dates. Please help me with the whole vegan thing. Is there any hope of me remaining vegan if I have SIBO? What do I do if I’m vegan and have this?

    • Dear Emily
      I will be honest with you, I have not had good success treating SIBO for patients who remain on a vegan diet. Many patients need to eat closer to a grain-free, legume-free diet or SCD diet and you just cannot cut out that many foods and still keep nourished. I usually talk to patients adding fish and chicken to your diet at the very least….
      Warmly
      Dr Jill

  78. Hi Dr Jill
    I was encouraged to read of your personal journey of healing through diet and faith. I live way down under I New Zealand and 2 yrs ago a stress situation turned my insides out … Two yrs previous to that I had a bad parasite infection that required some repetitive antibiotic treatment to clear. Drs put two and two together and came up with IBS from a textbook perfect storm. I now suffer chronic constipation and very broad food and drug intolerances that have, along with anxiety, curtailed my career and much of my lifestyle. Currently use fodmaps/paleo type diet (very restricted) which has eliminated much of the food intolerance issue but is very narrow. Pain and anx seem to be my greatest issues so long as I don’t eat bad foods . Anx meds tried (citalopram) but gut reacted badly.
    Anyway I would love to get my body back to a more normal place!! I am 55yr male who spent time with a naturopath who took me on a bit of a trip but got nowhere! GP is wonderful but unable to or unaware of moving outside the medical model box…
    My main question is can this be reversed to get my life back??? ie to overcome the constipation and to be able to eat more normally again. Watching your presentation on the functional forum and seeing your efforts on the hard cases left me with more hope.
    Thanks for your time
    Walter

    • Hi Walter – it sounds like you may have methane-predominant SIBO or other dysbiosis. By treating this you may return to a more normal state with less symptoms. Unfortunately methane bugs are much more resistant and may require antibiotics. Talk to your doctor to find the best course of treatment.
      warmly
      Dr Jill

  79. So my name is Ashton and i am an 18 year old female. I have been struggling with chronic pain for the last 4 years. But heres the thing it is only in the morning and rarely another time. For the past four year i have had approximately 20 test all coming back negative. My dad does have Chyrons. After getting as many test as we thought possible (I did not get the breath test though) my mom took me to a CRA doctor. Who diagnosed me with SIBO. Even though i do not have diarrhea or constipation. I have been on the PAELO diet and taking medicine for about 2 months which has been somewhat working. Do you think that there could be some other reason for this pain? Or another tests or procedures? Because I am only 18 and i do think that living PAELO for the rest of my life is what i want to do, but if its the only thing that can be done I understand that

    • Hi Ashton,
      Find a functional medicine doctor to help you treat and heal the gut. Many people feel better on a long-term grain-free diet.
      warmly
      Dr Jill

  80. Hi,doctor! I have all signs of SIBO. I had breath test and it came negative. Before the test i eat only rice and red meet for 5 days to calm down my diarrhea and bloating. Also my eyes and mouth red and irritated.Is it can be because of methane in my breath?

  81. Hi Jill, I have been suffering from IBS for a few years now. Changing my diet and using herbs to address leaky gut and suspected candida has helped yet I know I am not fully better. I have been researching SIBO and it makes sense to me given my history. I don’t have severe gut symptoms at the moment, but I know there could be more improvements. I have been on a long-term low FODMAP diet and have read that for people who can prevent relapse of SIBO, they can try to reintroduce those higher FODMAP foods again and see how they go. So my question is, I don’t know whether to look into treating the suspected SIBO despite managing my symptoms at the moment (but still unable to eat high FODMAP foods)? I would I’d have SIBO-C subtype. Any thoughts? I’ve read that poor gut motility is a big contributor to SIBO, which I’d say I experience. I’ve also read an article about low FODMAP diets long-term not being beneficial. Thanks for your time.

    • Hi Megan,
      I would test don’t guess… get your physician to order a lactulose breath test and then treat accordingly. I agree that extreme low FODMAP diet is not a good idea long-term. Better to treat the SIBO and expand your diet so you don’t starve the good microbes.
      warmly
      Dr Jill

  82. Dear Carnahan,

    I’ve been diagnosed with both SIBO and yeast overgrowth. Treatment given by the functional medicine doctor is Biocidin (5 drops, 3 x/day), Neem Plus (1 capsule 3 x/day), Oil of Oregano (1 capsule 3x/day). What is your opinion about this treatment because I read in one of your earlier responses that you would not recommend all three of these treatments at once?

    Thank you.

  83. Hi Jill! First just want to say big thanks for what you are doing and sharing with everyone, I discovered you a few months ago and have been following along and heard talk at Gut Summit 🙂 I am definitely a fan of Functional and Naturopathic Medicine (and detest Western for anything other than broken bones, bleeding to death or an actual failing organ) and I plan to try and see a Functional Medicine Doctor in my area soon as I have not to date.

    My story is long and complex and spans 30 years of suffering, but bottom line Brain Fog has always been my worse symptom (of many) and my Gut/Immune system like many other people was wrecked by Antibiotics and other toxins when I was a teenager, never knew, and struggled ever since, which brought on other issues like Adrenal Fatigue etc etc

    I finally figured out 3 years ago I had Candida and Leaky Gut, changed diet and treated it and had some good success for 3-4 months but then regressed and did not know why, later I would discover (Adrenal Fatigue was an issue in regression with toxic Copper levels and more issues like Methylation issues, Sulfur intolerance etc that were also plaguing me) that I have also been suffering on and off with SIBO induced IBS for as long as I can remember which is at least 10 years.

    My question revolves around SIBO as there is some conflicting info online. I am currently suffering a relapse of SIBO/IBS and probably Leaky Gut brought on by a bad restaurant meal (which I guess had some bad bacteria in it, wife also got diarrhea etc and it took her 2 weeks to recover, I am on 4 months now) and it seems to be giving me intermittent Brain Fog. My main symptoms of IBS/SIBO other than BFog is diarrhea, gas, occasional heartburn, occasional cramping (sometimes from gas building up like in public or friends house etc) and “stomach gurgling”.

    The stomach gurgling is a bit of the confusing part for me, that, and eating things like fermented foods, probiotics, prebiotics, and things like Resistant Starch (which is gaining a lot of traction online since 2013 or so as it significantly feeds the Biome). So this is a 2 part question I hope you will please answer best you can 🙂

    1. Stomach Gurgling – I have seen people say this is good, and that it is bad. I suppose it depends on the context of it maybe, why/how it was brought on, not sure?? For me, it seems to happen when I eat things like Inulin, Oat Bran, Corn Bran, I think Sweet Potato & other simple carbs etc still in progress of figuring out all triggers and is sometimes hard as once stomach is “acting up” it seems to react to everything and anything. So do you think the Gurgling is good, and a sign of increased Motility, and/or good bacteria fighting with the bad OR is it mostly bad and bad bacteria have just been fed and are wreaking havoc?

    2. Feeding Bacteria – obviously vital for everyone, except maybe a person with active Sibo it would seem. I just hope you cold comment on each of these, whether or not you think they should be avoided or not until someone has the Sibo more under control: Insoluble Fiber, fermented foods, probiotics, prebiotics, Resistant Starch.

    I hope this is not asking too much and would love to know your opinions on these 2 questions.

    Thank you again!

    P.s. – (sry) one more, is there anything I can take (like Molybdenum for Candida Die-off toxins) to alleviate Sibo induced Brain Fog when it happens I assume from the bacteria omitting toxins?

    • Hi Dave
      Borborygmus by itself does not indicate anything but it could be related to undigested food in intestines or increase in peristalsis. Usually I use a restrictive diet, like LOW FODMAP or SCD to help with SIBO but I do not like to limit foods, like probiotics long-term.
      There are many things to help with die-off – see this blog article
      Warmly
      Dr Jill

      • Thanks Dr. Jill. It really seems my Borborygmus is directly related to Sibo, as I mentioned eating the things that are known to trigger a Sibo response seem to promote it the most. For example yesterday my GI was fairly calm, I ate some Plantains and the Gurgling was completely over the top, honestly like 8 hamsters were let loose in the Intestines, that was the most “active” I have ever seen them and Plantains are a known “good food” for bacteria. The response is VERY fast too, like literally 2 minutes or less after eating something, and once all the gurgling has gone on for a good 20-25 minutes, the end result is usually Gas so it seems fermentation is what is going on, and only certain foods trigger it (unless it already activated then it seems anything gets it going) and since the response is so fast, it would seem to be in the upper GI tract. I’m just trying to put the pieces together with this, I know I should go get the breath test done to try and confirm a current infection, or not, and will call a local F Doctor today to try and get an appointment.

        Thanks for the link about Herx help, I have used many of those in the past for Candida, are you saying then that those SAME things will work for SIBO released toxins? I find Moly especially effective for the acetaldehyde from Candida, but I have no idea which toxins are released by SIBO and how to neutralize them. Thanks again

  84. Hi Dr. Jill,
    I have been experiencing really bad IBS symptoms in the last 2 years. Ever since I had a surgery which required me to take antibiotics for 10 days. My symptoms include bloating, nausea, vomiting, extreme belching, binging urges. I never feel hunger, as I always feel full. I started getting headaches after meals, and my head is pounding, and I feel constipated, though my BMs are regular. I feel extremely depressed as well. I am 25, weigh about 105 pounds, 5’3″
    I currently temporarily live in Paris for studies, and it’s impossible to find english speaking naturopath doctors, who know anything about SIBO. I’ve been to multiple doctors already, and all they do is prescribing anti-nausea and anti-anxiety meds after a 5 minute consultation. I have been told that SIBO doesn’t exist, it’s made up, and breath tests are a hoax. It’s been very frustrating, and I’ve decided to treat in on my own, using Allicin, Berberine etc. I am also vegan, and gluten free, and I need to figure out what I can eat during the treatment therapy, as many plant foods are high in fodmaps. i’ve searching internet for eating plans, and they are all meat/eggs heavy, almost exclusively.
    I will be taking a breath test this week, but I am almost 100% positive I have SIBO. Also, I took a blood test, and my Iron levels are a little high (i take blood tests every 6 months, and they never were high before). And in the past 3 months i’ve had the worst flare up I’ve ever had.
    Can iron be too high with SIBO?
    I now started feeling like I have a big lump in the throat after eating, and it pushes on my chest, and makes my head pound.
    Do you have any advise, or resources that I can use to help me treat myself? I will appreciate it very much.
    Could you also clarify about taking biofilm disruptors during antibiotic (herbal) treatment?

    • Hi Kristina,
      There is good evidence for SIBO and the validity of breath test. High ferritin or iron may be related to inflammation. Talk to your doctor about best treatment option but sometimes Xifaxan works better than herbal combinations.
      warmly
      Dr Jill

  85. Hi Dr. Jill,
    thanks for this article. I have had chronic diarrhea for over 10 months now (have had IBS like symptoms my whole life but recently worsened( and have also in the last year developed rosacea. Recently my rosacea had become so severe that I started taking doxycycline (40 mg -oracea) daily. It has helped my rosacea (although redness still present, acne associated with it has cleared for the most part) but now I am constipated and severely bloated. Although I had bloating before, it wasn’t this bad. Plus I am not having diarrhea anymore nor watery stool – now my stool is firm when I do have a BM. Anyway, I am starting to suspect that I might have SIBO. I have an appointment with a gastroenterologist at the end of the month, in addition to bringing this possibility to their attention (hoping to have both a colonoscopy and endoscopy ordered to be sure so I can exclude other possibilties) I will be asking for the breath test to be done. I am wondering if whether being on this antiobiotic will interfere with diagnosis of SIBO or confound the breath test – I just want to do everything I can to figure this out and provide a good baseline for the doc, so willing to go off the antibiotic if it will interfere with diagnostic measures like the breath test. Any other helpful info you could pass my way? thanks a million times over!

    • Hi Cat,
      In order to do a SIBO breath test, you will need to be off antibiotics for at least 2 weeks prior.
      warmly
      Dr Jill

  86. Hi Dr Jill, thank you so very much for your work and for sharing your understanding and for this article. You have an amazing story and are a true inspiration. I’m on the path back to wellness, but it is such a puzzle how to help myself! I’ve been 3 months on an strict autoimmune /paleo diet. My fatigue, body ache and brain fog really improved, After a positive lactulose breath test for hydrogen and methane, I completed two weeks of Rifaximin and Metronidazole. The gas, pain and bloating symptoms have increased considerably and don’t seem to be subsiding. It has been three weeks since I finished the antibiotics and all I can tolerate without reaction is bone broth. Fodmaps are out of the question and I was tolerating moderate amounts before. In your recent talk on the Microbiome Summit I heard you recommend bacillus probiotics after treatment for SIBO. I’m not sure when to reintroduce them. I’m nervous because of prior reactions to probiotics and histamine reactions to cultured vegetables. One other strange point, lose dose Erythromycin seems to slow my bowels down, not speed it up! I’m not doing anything to aid the MMC at this point. A few weeks prior to antibiotics, a GI Effects test showed nothing pathogenic, but IgA was 1700 (high). Do you have any ideas or suggestions? Anything would be greatly appreciated!

    • Hi Cinda
      If you are having SIBO symptoms that keep returning after treatment, there may be a deeper issue, like altered motility, autonomic dysfunction, chronic infection, and toxic exposure….
      warmly
      Dr Jill

  87. Dear Doctor thank you so much for your article , I have a colonic gas distension which appeared in abdominal scan I took 10 days antibiotics like amoxicillin and flagyl and brufen painkiller and now I have bloating and gases but my blood picture show low iron and stool analysis donot show any signs of mucous or blood and my stool is normal brown color and i donot have diarrhea .I am just asking how to release that much gases from my body.

    • Hi Ahmed,
      You may have something else going on… best to do a comprehensive stool test to see what is causing your symptoms
      warmly
      Dr Jill

  88. Hi there! I have every symptom of sibo and have been diagnosed with the breath test but I have a question regarding abdominal pain. My pain is so severe and is cramp like. It has gotten worse over time and is worse when I eat anything but fruit seems to make it worse. Can pain with sibo be very severe? I take hydromorphone for pain and it’s five times stronger then morphine and it doesn’t take the pain anyway anymore. Is this much pain possible and is the location around the belly button? Answers would be very appreciated. Thank you

    • Best to see a gastroenterologist to diagnosis why you are having such severe pain, that is unusual with SIBO

  89. Hi jill! Thanks for getting back to me! I did read that sibo causes abdominal pain and cramping and some people commented that they couldn’t work because of it. I have seen a GI doctor a couple actually and they are at a loss to why I am in so much pain, they just said IBS. My pain is always in the same spot and I just find it hard to believe for almost three years the same extreme a abdominal cramping is IBS, I feel so hopeless. I really thought it was sibo.. 🙁

  90. Thank you for the interesting article. Do you know of any good functional medicine experts in Europe who treat SIBO? Appreciate your help.

  91. Hi Jill,

    After having stomach issues off and on for 2015 and then getting a bad case of gastroenteritis in November I have had many tests and working with GI to get my stomach back to normal. I have been on the Low FODMAP diet since January and have seen significant improvement. I have had flare ups when introducing back in mango, honey and garlic, but have been fine with onions, beans, lentils so far. However, I have also had flare ups on nights that I haven’t eaten any high fodmaps or anything beyond my normal diet. I will get burning knot in my stomach and nauseous with extra need to belch and this always happens in the evening. It usually keeps me up till 4/5 am and also feel hot/sweaty. In the morning I feel tired, but stomach feels normal. Should I get tested for SIBO or do a stool test?
    Thanks!
    Caitlin

  92. Very good information here, thank you. I am struggling with a gastric specialist at the hospital here in the Netherlands that refuses to listen to my complaints. I am quite convinced I have SIBO, especially as ive been taking Esomeprazole (40mg!!) for the better of 20 years now. And now its coming to bite me in the ass.
    The only thing that counts against it is that i from time to time have dark red bloody stool. Nothing found in sigmoidoscopy and Colonoscopy. But my doc just insist on sending me to proctoscopy. This doesn’t make sense so i’m doing allot of research trying to find non antibiotic options for SIBO.

    Just to be safe I am going to a MRI just to check for more serious causes (the bleeding), though I have to travel abroad to have that done as my doc doesn’t see it warranted. (*^&%*^)

    In essense:
    – Last 4-5 months pain that comes and goes and moves around my abdomen.
    – Last year, periodic dark red stool
    – Always had very inconsistent stool varying from constipation, diarrhea, undigested food (especially raw veggies), and ichy stool that sticks to the toilet like glue.
    – Have purposely lost close to 50kg over the last 3 years.
    – Periodic extreme gas reaction to starchy food, sugars and fibers. Bloated and gassy.
    – Bi-polar tendencies (im sure its connected to my gyt health)

    Have you heard anything about Dysbiocide and FC Cidal (by Biotics Research) or
    Candibactin-AR and Candibactin-BR (by Metagenics).

    According to the results of a new study. Physicians at John’s Hopkins and the University of Pittsburgh concluded:
    “SIBO is widely prevalent in a tertiary referral gastroenterology practice. Herbal therapies are at least as effective as rifaximin for resolution of SIBO by LBT. Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders. Further, prospective studies are needed to validate these findings and explore additional alternative therapies in patients with refractory SIBO.”

    I can also add I generally eat a high fat low card diet.

    Im I crazy to take all these supplements?

    • Hi Tore,
      I cannot give you medical advice here but I wish you the best in healing! I am quite aware of this combo to treat SIBO of the hydrogen type
      warmly
      Dr Jill

  93. Just to add, I also started taking MCT oil in the morning that is very high in Caprylic Acid which is supposed to be good to kill of yeast like candida. (Along with oregano oil)

  94. Hi Jill,

    Great article! I have Lyme, Mold and my bloating persists despite using CSM for months and treating lyme. Bloating is my only symptom left. I am on Nystatin for about a month, and also Diflucan every other day.

    I think I also might have Sibo. What are the symptom differences between Sibo and Sifo.
    I have bloating, Dry skin, watery loose stools, hair loss, muscus in throat, sometimes ear pressure.

    • SIBO and SIFO may be identical in symptoms -get your doctor to order a lactulose breath test to see if you also have SIBO

  95. Hi Dr. Jill,

    This is long … because I am 49 and have had intestinal problems all my life!!

    Started when I was in 3rd grade and I don’t even know what the results were from the 3 days I spent in the hospital with several enemas!! That’s all I remember.
    University came along and I did some nice damage to my metabolism by become borderline anorexic (if you can call it that). Somehow I managed to keep my weight at 118 (competitive synchronized swimmer) but I did starve myself with eating low calorie and laxative abuse. I always had “nervous diarrhea” back then, and I still do.
    Since university, I have had very good periods in my life and travelled a lot to very poor ones with depression and panic attacks, and afraid to leave the house because my heart was racing. I hate crowded places and buildings with no windows.
    I have been living in Florence, Italy since 2005. In 2008, I kind of hit rock bottom and finally decided to do some testing. I had diarrhea for months. Bloated, nausea, fatigue. I went off gluten and removed many other foods from my diet after having a vega test done. I didn’t believe it though.. I didn’t feel much better. I had an endoscopy. No Celiac disease.
    I am still off gluten though. I don’t eat potatoes and avoid the nightshades as much as possible; and hard boiled eggs bother me.
    I have SIBO which I found out in 2013. I did a series of the Rifaximin and probiotic treatment in 2013 and 2014. Followed a low carbohydrate diet. This not really helping me, I went to another gastroenterologist in Bologna in November 2014 (the 4th doctor). (In between all this I had an MRI on my neck and have a herniated cervical disk which I was treated with physiotherapy that helped the hernia but it has left me with painful trapezius muscles and pain that radiates from my ears down to my upper back) I went in hospital for a week in March 2015. They did tons of testing: blood tests galore!, MRI of abdomen, ecograph of organ, endoscopy and colonoscopy. I need to mention that I had a bout with swollen eyes and dry eye that I think was a cosmetic reaction.

    The final results from this: chronic microscopic colitis lymphocitic, chronic erosive gastritis, diverticolosis and vitamin D deficiency. I had a urinary infection with Escherichia Coli. I also have an elevated prolactin.

    So, that said, I didn’t follow the treatment given: Pentacol (mesalamine) 800 mg 1 every evening. I was feeling so much better after I found out what was wrong with me. I just thought that it was stress and psychological because up until about 2 months ago I was doing well. No diarrhea and more constipation, but still going regularly.

    Something new is happening now, however, and it’s my skin. I have an appointment with a dermatologist at the end of April to find out if I have rosacea. I wanted to start the SIBO treatment but think I need to wait until I get the skin examination results.

    Nothing life threatening, I know. But I have chronic pain and still lots of intestinal issues: bloating, diarrhea, constipation, weight gain (not much but it is definitely bloat) when I have these symptoms and weight loss when they calm down. My weight is under 120 and I am 5’6″.

    My question. Treat the SIBO or treat the Chronic Microscopic Colitis??? Should I be seeing a gastroenterologist or an endocrinologist??? I just don’t know where to turn anymore.

    Thank you
    Regards
    Carol

    • Hi Carol, there is a link in the literature to SIBO and rosacea and microscopic colitis. I suggest testing and treating if necessary
      warmly
      Dr Jill

  96. Thank you for responding, Dr. Jill. I am not quite sure what link you are referring to. Is there a “literature to SIBO” section on your blog where I can find this information?
    Regards
    Carol

  97. Hi!

    I went to see a friend today that was not feeling well and she told me she was diagnosed with SIBO. Whe describing her symptoms, I realized that I had been suffering from the same sickness and unaware of the symptoms. Loss of weight, constipation, abdominal pain, bloating and fatigue.
    I am currently taking Probiotics but it does not help!
    What should be my next move?

    • Probiotic will not help SIBO and may make it worse. You can have your doctor order a lactulose breath test to determine if that is the issue and if positive proceed with treatment.

  98. Hi Dr. Jill

    I can see you’ve done a great job answering so many questions, so I wondered if I might ask a moment of your time to answer mine? would be most grateful.

    I’m not sure which path to take in terms of tests/diagnosis. I have long bouts of very soft stools (which may sound nice and easy but they’re anything but!), sometimes infrequent movements (can go 2-3 days sometimes), lots of flatulence. Burping after meals. Recently got Rosacea, which progressively gets worse, plus my dermatitis got suddenly worse at around the same time, plus got Interstitial cystitis following on from that, then chronic haemorrhoids. Feel like it’s all linked. What would you suggest I do?

    Thanks!

  99. I was diagnosed with SIBO with a breath test. However, I am still having the loose/sticky stools. Nothing seems to help firm them up. Can a bile binder prescription help firm stools?

    • You can get a comprehensive stool test to check for pancreatic insufficiency and malabsorption and have your doctor treat any abnormalities

  100. Hi dr. Jill,

    Thank you for all the hard work! Much, much appreciated.

    Do you recommend any lab for stool testing to address sibo and leaky gut and possible co-infections?

    Or even a microbiome genetic testing (done by saliva)? I’ve seen a few labs (such as ubiome and smartdna) offer the latter; I wonder how reliable are those and if it helps at all to figure out the best approach to heal our very specific gut flora.

    Do you know if one should take a break from herbal therapy (such as ADP etc) and probiotics before doing a GI/stool panel or only before the breath test? Can excessive hydrogen sulphide gas production be also detected in a stool or breath test?

    I wonder why extreme hunger between meals could be a symptom of SIBO as some people report feeling full while having sibo. Maybe the hunger is related to methane sibo or another co-infection? Any research exploring the relationship between satiety levels, gut bacteria, modulating serotonin in the GI tract and low stomach acid?

    At last, why people with SIBO often have low vitamin D levels? I understand why sibo suffers have multiple vitamin and mineral deficiencies, specially B-vitamins and iron but I still quite don’t get where poor absorption of vitamin D comes from.

    Many thanks!

    • Hi Kat, I highly recommend a stool test to rule out other pathogens but that will not diagnose SIBO so you still need a breath test. You must be off herbal antimicrobials for at least 14 days prior to testing. SIBO can cause villous atrophy and malabsorption of fat-soluble vitamins.
      Warmly
      Dr Jill

  101. Hi Dr. Carnahan,

    I am a 29 year old female with classic IBS/SIBO symptoms. I am also a GI dietitian. I had a lactulose breath test this week and both h2 and ch2 were completely flatlined the whole two hours. I think I am still going to treat empirically for hydrogen sulfide with Biocidin and GI Detox. Does this sound like a good plan? my functional MD also suggested OxyPowder. Anything else you think I need to add to be most successful? I would like to do this once, properly. I started SIBO diet from Dr. Siebecker’s site this week.

    Thanks so much!
    Alexandra

  102. Hi Dr. Jill…. I am picking up the test for SIBO today, but am pretty sure I have it, I have all of the symptoms, the worst being upper gut bloating and chronic constipation (I’m 52 yo old with no gallbladder, have had chronic gut issues my entire life, was previously treated for SIBO without testing.) I’ve been following another online doctors protocol for leaky gut, but continue to have the bloating and constipation. My question for you is about probiotics. I’m currently taking Dr. Axe’s Live Probiotics (50 billionis, which includes prebiotics). I’m reading such contradictions about what is best for SIBO, I would love some of your thoughts and input. If this has been discussed before, please feel free to link me to those posts. Thank you so much!

    • Probiotics with prebiotic are not well tolerated in SIBO. Instead I recommend Align or Thorne Bacillus Coagulans.
      warmly
      Dr Jill

      • Thank you!! So you don’t feel I need the mega strains? Which strains are most important with SIBO and chronic constipation. I feel like so many of these products make me more constipated. Thanks!

        • One last question. What is the accuracy of the lactulose breath test? Is it possible to test negative and still have SIBO if a person has all the symptoms? Thanks again!

        • Lactic acid strains may make SIBO worse… SIBO is overgrowth of normal bacteria in wrong location so adding probiotics before treating may simple add to the problem

      • One last question. What is the accuracy of the lactulose breath test? Is it possible to test negative and still have SIBO if a person has all the symptoms? Thanks again!

        • There is one type of SIBO, hydrogen sulfide, that will not show up on breath test. Neither will SIFO

  103. Hi,
    Does the antibiotic Bactrim treat SIBO and how long would I need to be on it for it to go away? Will it make my Candida worse? I’ve made all the proper diet changes and I’m allergic to the antibiotic that is typically used to treat SIBO.
    Thank you!

    • Hi Taylor,
      I do not use Bactrim to treat SIBO. Antibiotics will likely make candida worse. You may talk to your doctor about best options to treat the SIBO.w
      Warmly
      Dr Jill

  104. I was diagnosed with pancreatic insufficiency in September and started on Pancrelipase with meals. My diarrhea, bloating and other g.i. symptoms resolved but then about 5 months later returned. I have started taking Thorne Berberine which seems to resolve the bloating and gas issues but my doctor says that many of the herbal antibiotics block liver pathways and since I am on Cartia, I should not take the herbals. I have been on Rifaximin and it caused severe, watery diarrhea and cramping and did not make any difference in g.i. symptoms. Is it true that herbal antibiotics are contraindicated with BP meds? Thanks for your help.

    • Hi Janice
      Best to discuss with your doctor. I cannot give specific medical advice online.
      Warmly
      Dr Jill

  105. Hello Dr. Jill Carnahan,

    I am a 22 year old female, who last June went to the gi doctor after experiencing constant pelvic pain and nausea for 3 months. I was tested for both sibo and lactose intolerance, which were positive. My doctor insisted I was depressed, which I am not. At the time I was under immense stress preparing for the MCATs. Initially, I was put on Augmentin and Flagel for 2 weeks. Afterwards, the symptoms did not subside and my breath tests still returned positive. I was then put on 2 rounds of Xifaxin, 2 weeks 3 pills at a time. Although my nausea subsided, I now am constantly burping since. My breath tests after the Xifaxin are still positive. I believe that I have developed IBS from the SIBO, for now it is very uncomfortable to use the restroom due to pelvic pain and soft stool. I have also noticed that my PMS symptoms have intensified starting one week prior to menstruation, including fibromyalgia and nausea. I do notice after ovulation, the IBS also intensifies, and I experience a chronic dull pelvic pain until the first day of my period. I have seen 3 gi doctors now, with little guidance on how to navigate symptom management. I have been suggested to try a SSRI, but I feel uneasy starting what is essentially a low dose antidepressant. I was put on a protein supplement enteragam for one month by one physician, with no change in symptoms. One doctor suggested to check if perhaps the pelvic pain and PMS stems from endometriosis, yet my periods come regularly with a normal amount of blood loss. I have had a pelvic and transvaginal ultrasound to check for cysts, fibroids, and thickening of uterine walls, but reports were returned clean.

    Should I take Culturelle? Should I follow through on the laproscopy? Should I see a naturopath? Should I start FODMAPs? I don’t quite know how to proceed forward, I am getting frustrated with my body which is taking a mental toll. I have tried to see a M.D. pain management doctor who performed acupuncture, but alas no avail. I am running out of ideas. I appreciate any advice you can provide. Thank you.

    • Hi Myra,
      It does sound like you have SIBO. You need to have your doctor determine if you have methane or hydrogen SIBO as they are treated differently. In addition, you must address any underlying root causes of SIBO or it will not resolve – adhesions, poor motility, inflammation, other infection, hypochlorhydria, pancreatic insufficiency or others…
      warmly
      Dr Jill

  106. Hello Dr. Carnahan,
    I’ve been having severe bloating and distention. I look like I’m 6 months pregnant at times. I have very low ferritin and I look extremely malnourished. I struggle to gain weight. I don’t have any of the other symptoms of SIBO you mentioned. I’m really worried because I know how hard SIBO is to treat. I have been diagnosed with Candida overgrowth through a blood test and a stool test but I just haven’t heard of Candida overgrowth causing very low ferritin or making someone look very malnourished and although Candida overgrowth can cause bloating, I haven’t heard of it giving someone a 6 month pregnant belly. I’ve also read it causes weight gain, whereas SIBO causes weight loss. So I’m just really concerned and worried I could have SIBO. Have you seen Candida cause these symptoms or does it sound like I have SIBO?

  107. Hi there,

    Is it possible that a negative Lactulose Test will not tell the whole truth concerning SIBO? I had such a test one month ago here in Munich which was negative according to the doc. It showed however slow Transit (>90 min) which is a major sign of constipation according to the doc. I am facing constipation or better said incomplete BMs since november 2015 , sth that ruins my life. I am facing also lower abdominal pain ,distention every night before i go to bed , sign that i ll run to the bathroom the next morning, sth that relieves the discomfort. The whole mysery has become a routine in my life and i am still trying to find the root cause. The root cause may be the microbiom imbalance with over 10^8 enterobacter cloacae and less than 10^4 lactobacilus which came out after my last stool analysis. I have taken every kind of good probiotics since last january(1st stool analysis) when i first found out this imbalance but i havent seen any improvement in the last stool analysis i had last month. I was literally taking air or i dont know what happened. I took last march Ciprofloxacin in order to kill that enterobacter but to no avail. The whole symptoms am facing apart from the GI are also sometimes fatigue. However i do believe that i have SIBO, so my question is again does a Lactulose Test say the whole truth? I havent still tried Rifixamin (Xixafan) but as i read , Rifixamin is better used for IBS-D. Thanks in advance for any comment.

    • You may have hydrogen sulfide SIBO which does not show up on breath testing or SIFO or another type of dysbiosis

  108. By the way i have already tried botanics like Biocidin for 2 months ( 2 bottles of 30 ml each) without any improvement and thats why my doc suggested ciprofloxacin but even that one dint do anything.

  109. Hi Dr. Jill!
    What causes low stomach acid? Is hypothyroidism typically the cause in someone who has Hashimoto’s?

    • Low stomach acid can be caused my many underlying conditions, infection, inflammation, autoimmunity, dysbiosis, age, etc… Hashimoto’s thyroiditis is an autoimmune form of hypothyroidism.

  110. Hello Dr. Jill Carnahan,
    I was wondering if eating all your meals at once can cause SIBO? I sleep all day due to exhaustion from health problems and as a result, I eat breakfast at 3-4pm, lunch at 7pm, snack at 8:30, dinner at 10:30, and snack at 12:30. I know this eating schedule isn’t circadian rhythm and is not healthy for my body but can it actually lead to SIBO?
    Thank you!

  111. Hello! I know you’re not allowed to give medical advise. Let’s say you have a patient who has:
    1. SIBO
    2. Fructose Malabsorption
    3. Candida
    4. Leaky Gut

    In which order would you start treating your patient (1-4) and why? Thank you for
    Your time.

  112. Hi Jill,
    Thank you for sharing your story of hope! We needed it. And the verse in John where the Lord will use these trials to bring great good-you are living that truth out! I pray my daughter will do the same.

    My question is-having been diagnosed by different doctors with cyclical vomiting syndrome, POTS, Ankylosing spondylitis, and cluster migraines-is it plausible these could all be related to SIBO and or leaky gut? Ankylosing spondylitis and migraines and nausea and autonomic dysfunction are all listed various places online as being possible related disorders or symptoms of both. And if so, by implementing the SIBO diet, how long would one need to expect to remain on the diet before experiencing any symptom/pain relief?

    Thank you!

    • Hi Courtney,
      The diet alone may not completely receive symptoms without treatment but if it does, you should notice some difference in 2 weeks
      warmly
      Dr Jill

  113. I was diagnosed with SIBO by breath test. I stopped dairy products and eat more fruits and vegetables.
    However, I am losing significant weight, 20lbs in last 5-6 months. PCP ran tests and they were fine.
    I am not convinced my diet can lead to this loss. Could malabsorption be the reason? What could be done to diagnose weight loss? Thanks

  114. Hi Dr. Jill,
    I have long standing fatigue, chronic pain, headaches and stomach problems. I finally had a 2 hour lactulose breath test done which came back negative (measurements every 30 minutes for 2 hours and no increase at all at 2 hours). Stool testing came back with 4+ E.coli and 4+ Citrobacter freundii, + H. Pylori. Then had organic acid testing done and D-Arabinitol was normal but D-Lactate was elevated. So am wondering if this does mean I do have SIBO after all. Where would you go from here? Would doing a 3 hour breath test be important or treat presumptively for SIBO?
    Thanks!
    Chris

    • I am also interested in whether that would be considered SIBO. I have had a 4+ E.coli result, with a positive H. pylori antigen. I also have elevated D-Lactate according to my Organic Acids testing, and have had a negative lactulose breath test as well.
      If it is SIBO, which do you treat first? The H. pylori or the E.coli? What would the order of operation be in this case?

      • Hi Nat,
        SIBO is diagnosed based on lactulose breath test, not stool or organic acids. However, with those results, I would certainly not be surprised to find SIBO. I would try to treat them both at the same time.
        warmly
        Dr Jill

  115. Hi Dr.. Just trying to figure out my GI problems as it has been 2 years and I am withering away to nothing. Then I came across this page. It started at the end of march 2015. I dropped my post pregnancy weight and my doc didn’t adjust my levo down from 100mcg. I then became hyperthyroid. No one knew what was wrong and just told me I was constipated. Enema after enema with no BM. I prety much completely stopped eating for an entire month. Ever since, I have not been able to have a normal functioning bowel. I pretty much live off of toast these days. I weigh a whopping 100lbs and am still losing weight. The only thing drs are doing for me is bentyl and miralax. Which only helps some. Even when I have D it is still constipated. Cannot have anything made from corn. No sesame seeds. Basically anyrhing that doesn’t digest completely stops my bowels. But now im at a point where no matter what I eat I have constipated diarrhea and trapped gas. Anyway this could possibly be sibo? I was on cipro for a uti before having to switch meds. And I had the most normal bowel movement I’ve had in years. Just curious as to your thoughts before I wither away to nothing.

    • Hi Mandy
      Please get testing to determine the root cause and treat it! A comprehensive stool test and lactulose breath test would be a good place to start.
      warmly
      Dr Jill

  116. Pingback: 6 Signs That SIBO Might be the Root Cause of Your IBS – Daily Records
  117. Hello dr jill.
    i have such a noisy stomach.mean that it makes so much sounds sometimes people around can hear it.. othr signs are abdominal pain. some discomfort after eating. feeling full of gas in abdominal and stomach region. looking like my digestive system is under such a great pressure.(that is my diagnosis)

    i also have terrible breath which even comes out out of my nostrils. got from 2years ago and im 24.

    i did the hydrogen breath test. baseline was 1ppm. highest was 19ppm at 100min. (they only do hydrogen type of lactulose breath test in here as i am in praque.
    i have so much anxiety and depression.
    please help me. i need your advise

    yours sincerely

    • Hi Armin,
      You may have another type of SIBO or other form of dysbiosis like SIFO. I suggest doing a stool test and urinary organic acids to determine the cause.
      warmly
      Dr. Jill

  118. Dr. Jill;
    At this time I am ins short. For 3-4 months I have had pain mostly on L side and back. All blood, CT and cystogram came back negative (I was having chronic UTI’s. Mostly pain throughout my gut and pelvic area. Any comments? I know that is not much info, but any input would help.

  119. Hello,
    If someone can’t afford the SIBO breath test, how can you tell if their bloating and low iron is SIBO or Candida? Is there a way to distinguish it? If you treat the Candida and the bloating goes down, does that mean for sure you don’t have SIBO?

    • Hi Jennifer,
      It’s hard to tell without testing… my motto is “test don’t guess” but many herbs work for both bacterial and fungal overgrowth.
      warmly
      dr Jill

  120. Hi Jill,
    My symptoms (bloating, gas, feeling of incomplete bowel movements, and ALWAYS after moving bowels the pain starts!) began after I came off Prednizone prescribed for 3 years to treat Sarcoidosis. I am also celiac. No doctor has ever told me about the after effects of Prednizone which I fear is a toxic and useless drug.
    I feel that SIBO or Candida could be my problem? Have you any experience with people coming off Prednizone?
    I have been living with this for 4 years!
    Thank you so much.

  121. Hi Dr Jill,
    I have severe bloating and distention. Can I rule out SIBO since I have no diarrhea, no abdominal pain, and no belching?

  122. Hi,
    My dr wanted to do a stool test, organic acids test, and SIBO breath test. I couldn’t afford all 3 so I didn’t get to do the SIBO breath test. I have read it’s the best test for SIBO and determining what type it is, but I have also read the organic acids test can hint toward SIBO by showing bacterial byproducts in the small intestine like high DHPPA if you have it. I have read it’s a crude test for SIBO. Is this true? Can I use this test since I can’t afford the breath test right now since I spent my money on the other 2 tests?

  123. Pingback: SIBO – A Basic Guide – Noodlechips
  124. Hi Dr. Jill!
    When you state above that probiotics are sometimes not recommended in the treatment of SIBO, do you generally mean that they are never recommended for those you are referring to or would they be recommended once treatment is completed? Depending on the answer to this question, could you also elaborate a bit on what would be the determining factor to point to or away from the use of probiotics with a given patient?

    Thank you for clarifying!
    Annie

    • Hi Annie
      if a patient has excess lactic-acid producing bacteria and fermentation, they may not tolerate a probiotic with lactobacillus species until after treatment…
      warmly
      DR Jill

  125. Hi Dr. Jill!
    After reading your articles, I asked my doctor for an OAT for my severe bloating after eating sugar. When I went over the results with her, she said there appears to be no yeast or SIBO. I’m confused. Something has to be causing my severe bloating after eating sugar.
    Under bacterial dysbiosis markers, my DHPPA and 3-hydro Acid are normal. Both are in green. My 4-hydro Acid is in yellow. Benzoic Acid is very high in red, but my doctor acted like this can be high if you eat a lot of foods that are high benzoate foods. I don’t know what that means though. And hippuric Acid was so low it wasn’t detected.
    And then under yeast/fungal dysbiosis markers, arabinose is normal in green but close to yellow. And citramalic Acid is yellow but just barely. And tartaric Acid is so low it wasn’t detected.
    So she said it’s normal and I’m about to cry because I bloat so bad and I can’t get any answers. I paid a lot of money for this test and didn’t get any answers. Please help 🙁

    • The best test for SIBO is a lactulose breath test for hydrogen and methane. If you have SIBO an organic acid test may not show it.

  126. Dr. Jill,

    I’ve been battling GI issues for 10 months now. I had a sudden onset of symptoms ie. constipation, pain, head/ear ringing, etc. I have been doing the autoimmune paleo diet the last few months and feel a bit better, but I haven’t been able to feel normal yet. I don’t sleep well and still have constant ringing in my head, bloating if I eat the wrong foods and headaches. I also was diagnosed with Hashimoto’s.

    My doctor recently had me do a cortisol test along with Cyrex Array 2,4 and 10. I came back as having stage 2 adrenal fatigue which seems logical based on how I’m feeling. The Cyrex tests are a little confusing. I already knew before I was gluten sensitive but knew nothing about anything else. Based on the most recent symptoms I would experience after eating (runny nose, increased ringing and watery eyes in the morning), I figured I may have developed histamine intolerance.

    Anyway, my Cyrex test came back showing I had significant antibody development to pretty much everything I ate. However, my zonulin and leaky gut tests came back completely normal. My doctor says not to worry about the food sensitivities for the most part for right now. She says my immune system is overactive and causing the issues. She suspects either a pathogenic (SIBO?) issue, or just stress (which I’ve had a tremendous amount in the recent past that I’m working to deal with).

    Have you seen extreme food intolerances (IgG) with no leaky gut? I trust my doctor, but she even seems a bit surprised by the results so I’m looking for other people’s experiences. We are going to try a low histamine diet and do a SIBO treatment. Could SIBO be causing this, or have other things that you’ve seen possibly be the root cause? I find it odd that I reacted to several foods that I’ve never eaten so it makes me question the validity of the results somewhat.

    • Any inflammatory issue or dysbiosis in the gut could cause severe food sensitivities. You cannot develop IgG food reactions without some degree of permeability regardless of what Array 2 showed…

      • Thanks Dr. Carnahan! I appreciate the extremely quick response. Hopefully this SIBO treatment will move me in the right direction.

  127. Hello,
    My daughter has been experiencing severe bloating for almost a year now. She also looks emaciated. I have seen people who have SIBO and it doesn’t look like she has a SIBO bloat, but not to say it couldn’t be. It is mainly a lower belly bloat, not an upper belly bloat and it gets huge after eating what appears to be a lot of sugar like potatoes. I noticed one day we had potatoes with dinner and she didn’t bloat too bad and then the next day she had a lot more mashed potatoes and got really bloated. Her bloat appears to be worse at the end of the day which I know is a symptom of SIBO. But I’m not sure if maybe it could just be because the bloating is building up during the day, and dinner tends to be her largest sugar meal. She doesn’t have belching. She has been having a lot more gas than usual, but it’s not constant. She had an OAT done that showed mild SIFO (yeast/fungal dysbiosis markers were borderline). But the thing that throws me off is she looks very malnourished, very pale, losing her hair, exhausted beyond what I can even describe, muscle weakness, and just looks emaciated. And I haven’t heard of SIFO causing so much malnutrition although I could be wrong. I know the breath test is the gold standard and we tried to get it done, but the liquid drink made her sick from the taste and she couldn’t do it. And what I also found odd was she looks so emaciated and malnourished but yet her OAT didn’t show that. It showed her lacking in a few vitamins but most of them being normal in green. She does have low ferritin and low B12. Her B12 is 400 but yet the OAT showed it in green which makes me question the validity of the results. A stool test showed 3 types of her commensal bacteria were high, and 3 of them were low. I’m not sure if this points to SIBO or gives any type of clues to it? Would you be able to email me with your thoughts? I’m not sure where to go from here because nobody seems to be able to give us any answers as to what is going on. This has been going on for a while, and my poor baby is sleeping her life away. Thank you in advance.

    • Dear Linda
      You should find a good functional medicine doctor to test and find the root cause… it could be a combination of dysbiosis or malabsorption or even toxic exposure or other infection causing malnutrition. You can search by zip code at http://www.functionalmedicine.org
      Warmly
      Dr Jill

      • Dear Dr. Jill,
        My tests came back negative for SIBO, H.Pilory, leaky gut and parasites; but I have acute duodenitis and I’m on 30mg of Lansoprazole per day. My gastro didn’t give me any diet instructions. I’ve tried paleo, gluten free, low fodmap, low GI, low Oxalate foods, and now I’m surviving on banana, oat porridge, coconut milk, chia seeds, rice porridge, salmon, eggs, kale and broccoli. That’s my meal plan daily for 30 days. No improvements. I’m very bloated and windy after eating kale & broccoli, but if I don’t eat them, I get constipated. there’s no books for duodenitis diet, and my doctor will only see in February 2017. I need help with my diet bc I can’t sleep, and my dilated stomach is very uncomfortable. Do you have any advice on what other foods would be better for my condition? Much appreciated your help in advance. Best, Jonas

        • Hi Jonas
          Just because the testing came back negative doesn’t mean you don’t have dysbiosis or SIBO. I would work with your doctor and find the root cause so you can treat it and get better. There are types of SIBO that do not show up on traditional testing. You may need to try treatment with your doctor.
          Warmly
          Dr Jill

          • Thank you for your prompt reply, Dr Jill. My doctor assured me that I don’t have SIBO or dysbiosis, but my symptoms screams YES! I’ll wait for our consultation to press him for further tests. Thank you!

  128. Dear Dr. Jill – I am so glad to have found your site. My GP referred me to a gastroenterologist due to extreme bloating after eating, gas and alternating constipation and diarrhea. I believe I have SIBO. I am insulin resistant (not diabetic) and believe I have been for 25+ years, as that is when I first noticed what was later diagnosed as acanthosis nigricans. I was not diagnosed until 2010 and have been taking metformin since with no stomach issues other than the initial adjustment 6 years ago. My body makes plenty of insulin but uses it very poorly. My bloating, gas, etc. got much worse after being treated for a kidney infection in March and a UTI in April. The bloating got so bad in one instance it impacted my ability to breathe normally. I have had a negative celiac test, negative wheat allergy test and a normal endoscopy. The Gastro said he can’t find anything wrong and advised me to avoid dairy and gluten , although for 48 of my 49 years I have been eating those things. I tried the low fodmap diet and it helped. Last week my doctor told me he “is not sure SIBO even exists,” but he would prescribe xifaxin if I wanted to try it and see if it helped. While considering this I got non-lactating mastitis and began taking doxicillin for that infection. In two days my symptoms have disappeared but I suspect they will come right back when this course of antibiotics is over. . I do not need more proof of SIBO. I need a new doctor! Can you please refer me to a doctor experienced in treating SIBO in the Las Vegas area?

  129. Pingback: Is SIBO Causing Your IBS? - Ask Dr. Maxwell
  130. Pingback: Today I Start SIBO Treatment… And A Lot Is Changing – Honest Body Fitness
  131. Hi dr.Jill, thank you for really good article and advice!

    as a long time sufferer I would like to share that this is true >> find the root cause
    not all bloating burping and stuff are SIBO/SIFO or at least not the main issue.
    I picked up h.pilory and giardia protozoan years ago and got undetected for years. the IBS mambo jumbo.
    years of undigested food malabsorption lack of vitamins B12 chronic fatigue foggy brain etc.

    I also developed overgrowth of enterococcus and streptococcus and clostridium
    (which ruin my life for years of never-ending gallbladder pancreas sinus infection and constipation
    all of them “of course” are part of the normal flora is not necessarily to treat them ?!)
    these guys produce ALOT of H2s and histamine and lactic acid…its a nightmare…

    what would you treat first dr.jill ? thank you
    (sorry but in my country gastro people are useless, no functional)

    • Hi Dave,
      I try to find an herbal combination that would treat all things at once. There are several potent combos like Biocidin that may work for you.
      warmly
      Dr Jill

  132. Hi Jill,
    I was suspected as having SIBO 3 years ago but did not deal with it until it couldn’t be ignored. Both gasses were present so I finished a month of antibiotics and am now on what I would call a restricted Paleo diet. It’s Dr. Siebecker’s SIBO diet and I have been very strict following it. While I feel better, I am fighting a losing battle with weight loss. My Dr added in jasmine rice and encouraged consuming more healthy fats. I can consume what feels like very large quantities of food and I still weighed 99 lbs this morning (I’m 5’5). Is this typical? Any suggestions? (You probably know my Dr. I live in CO, too).

    • Hi Katie
      What is common with SIBO is malabsorption due to villous atrophy in the small bowel. You may need to treat the malabsorption first in order to regain the weight.
      warmly
      Dr. Jill

  133. Hi,

    I have sibo. My doctor gave me xifaxan 550 3x a day. I am waking up with bad stomach pains and naseau which usually calms down around 10:00a.m. I no this isn’t the Rifaxim because I had this before taking the antibiotic. So my question is is it normal to have stomach pain and naseau upon waking when you have sibo? How long do I have to be on xifaxan to feel good again. i am also lethargic.

    Thank you in advance

    • Hi Debby
      If SIBO is the only issue, you should be fine once treatment is over. You may have gastroparesis which is a cause of SIBO and that would cause nausea/vomiting
      warmly
      Dr Jill

  134. Hi Dr Jill,
    It was nice to read your article.
    I am based in India and have had IBS/SIBO for over 17 years now. I am 41 now.
    Can you recommend a Functional Med expert in India/New Delhi please?
    Thanks in advance
    Devender

  135. Hi Doc I have a problem that I eat a lot of food but continue to not be able to put on weight. What should I do?
    I also would like to ask you if it is safe me to have one tablespoon of apple cider vinegar in water before meals in order to improve my digestion?

    • Hi Ali
      you may need to address your digestion to see if this is affecting your ability to gain weight.
      warmly
      Dr Jill

  136. Dear Dr. Carnahan,

    Have you ever heard of MALS syndrome associated with SIBO? I’m positive for SIBO and Gastroparesis, which I’ve read SIBO can cause. I am pursuing testing for MALS syndrome because there are indications that I could have it. I was just wondering if the three could all be connected, or if I was just coincidentally got 2 different diseases at the same time.

    Thank you,
    Rachel

  137. Hi, I read that SIFO is just Candida and SIBO. Is this true? Does this mean if you have Candida/SIFO, you for sure have SIBO?

    • SIFO is small intestinal fungal overgrowth. SIBO is small intestinal bacterial overgrowth. You can have one or both of them…

  138. If you have esophageal cancer do you have to get surgery or is their a natural body healing alternative?

  139. I have been having a warm feeling in my neck for a few weeks. Could you give some advice on how to solve it?

  140. Hello Dr. Jill:
    I was diagnosed with Sibo, it took a while before they figured it out. After going through several stool tests an an ultrasound for my belly and pelvis, the gastroenterologist finally sent me to get a breath test and I might add, that I’m with Medicare and Secure Horizon, I’m 73 years old and the insurance had the nerve to deny me that test, we said we’d pay for it out of pocket, so I got the results as being positive. Since I don’t do well with antibiotics, I am going to try to do this on my own along with my holistic office to help me. What confuses me is that in one article, it stated to take fermented vegetables but when I tool the Kimche yesterday, I had a lot of gas and diarrhea again, so one person says to use those and the other one will say not to add more bacteria into the small intestines, can you shed some light on this. I’m taking Prescript Assist, Ther-Biotic complete probiotics, Lauricidin, IPS for the gut, Zinc and one that I’m waiting for to arrive is called Biocidinc, ADP and Berberine. The Gastroenterologist office wants me to take Flagyl and Ryfaximum.
    Barbara

  141. Hi Dr Jill!

    I recently listened to a podcast you were interviewed for about MCAD/HIT, and you mentioned that the gut healing supplement restore may worsen symptoms for those with SIBO. I have taken two breath tests for SIBO and they both came back flat lined, however one of my doctors is convinced it may be a false negative because I have all of the symptoms, plus HIT and MTHFR. I am currently on my 4th day of taking restore (starting with just 1/4 tsp, 3x/day), and I have noticed increased indigestion and reflux. Do you find that it is common for people to experience symptoms from restore during their first week or so and then they go away, or would you recommend i look further into treating a hidden SIBO infection? Any input would be greatly appreciated! Thanks for sharing all of the info that you do – incredibly helpful!!!

    • Hi Jennifer,
      Restore enhances the microbiome naturally but if patients have underlying SIBO, they may not tolerate it. I suggest looking at testing again for SIBO or bacterial dysbiosis and treat before using Restore.
      warmly
      Dr Jill

  142. if after an elimination diet you find you are sensitive to gluten does mean you have to exclude gluten and other grains for the rest of your life?

    • if you have been diagnosed with gluten intolerance does it mean you can not eat it for the rest of your life?

      • Patients who have celiac disease cannot eat gluten for the rest of their lives… some patients with non-celiac gluten intolerance cannot either.

  143. is it true that you have an increased risk of heart disease if you eliminate gluten from your diet for good?

  144. Hi Dr. Jill,
    I am experiencing severe bloating. I have no pain, constipation, or diarrhea. An organic acids test showed that I have yeast overgrowth. But the thing that worries me is my bloating didn’t come on gradually. It’s like I was a little bloated and then I got majorly bloated out of nowhere. I never have a flat stomach at any point during the day. But I wake up significantly less bloated than when I went to bed, still bloated though. But then I get more bloated after each meal and after eating dinner I get majorly bloated whether it’s spaghetti or chicken, peas, and rice. My bloat is more of a soft bloat. It looks like fat, only it’s a 6 month pregnant soft bloat and I’m only 115 pounds. I’ve thought about SIBO but I see on here that the Low FODMAP diet is a good diet for SIBO and some of the foods allowed on that diet like potatoes I bloat really bad with those foods. So does that mean it wouldn’t be SIBO if I bloat after eating foods on that diet? Thank you!

  145. Hello,
    Is drinking a glass of celery juice on an empty stomach every morning a safe and effective way to raise stomach acid levels?

  146. I am fasting for 30 days as part of the fasting month of ramadan. Could you give me advice on the best foods to eat when breaking my fast at sunset to deal with the heartburn I had been experiencing in the daytime.

  147. is a gerd diet for life? Or can one get better from this illness and reintroduce foods they were told to eliminate as part of that diet?

  148. is it safe to consume apple cider vinegar because some people say if you have pepsin in your throat it will be activated by consuming apple cider vinegar which is acdic and therefore eat up your throat.

  149. can you tell me of natural ways to coat the esphogaus from stomach acid which constanly comes up and damages the esphogaus?

    • You might try Thorne GI Encaps 1 with meals. You can order from thorne.com using physician code: HCP1004064

  150. i am scheduled to have an endoscopy to test for coeliac disease. However I read on the internet about some complications that could happen from the procedure such as bleeding and getting some infections from the scope going down the throat. should I cancel the endoscopy and have an mri scan instead?

    • Hi Adam
      best to discuss with your physician… endoscopy can show things that an MRI will not show
      warmly
      Dr Jill

  151. Have you heard of biocidin causing diarrhea in patients??? Started taking it to kill bacteria overgrowth… stopped taking it two weeks ago but the symptoms continue. What is something I could take to alleviate this? Thank you.

    • Hi Mary,
      Yes, Biocidin is harsh and can bother some people. If you have this effect I suggest stopping it immediately
      warmly
      Dr Jill

  152. i am scheduled to have an endoscopy to test for coeliac disease later in the week. I would also like to know if I have barretts esophagus . Do I need to tell them to also take a biopsy of my throat to see if i have barretts?

  153. is it possible to have a biopsy for celiac disease and barretts esphogaus in one day? or would you need to make another appointment for the other biopsy.

  154. if you have cancer can you keep an eye on it by doing regular ct scans or is it only possible to know by having regular biopsies?

  155. if you have a hital hernia and you refuse the fundoplication surgery because you do not want it is that a risk to your health?

  156. Hi, I’ve been struggling with SIBO on and off for a few years. I can’t seem to find a knowledgeable Doctor in my area. I live in Orange County, CA and the GI doctor I had seen knew very little this condition. Do you know anyone in the area that you might be able to refer me to? Thank you

    P.S.- your personal story is very inspiring

  157. Hey Dr. Jill,
    Great post on SIBO. I have personal experience with the condition as I was a super difficult case to treat and have to manage the condition. I’ve used my health journey as a learning experience and created a website to help other people who are struggling with the same issues at sibosurvivor.com. I’m wondering if you have much experience treating patients with Hydrogen Sulfide gas? If you have any experience or tips I’d love your input for those microbes. That is a portion of SIBO patients and research that I plan on diving into more in the near future. Thanks for your great content.

    • Hi Josh,
      Thank you for your insightful comments… Yes, I have experience with Hydrogen sulfide.
      warmly,
      Dr Jill

  158. Hi Dr ,
    Can SIBO cause dizziness / light headedness or headaches ?
    Does chronic sinusitis relates to SIBO in anyway ?
    Thank you

    • Hi Mohannad,
      SIBO endotoxemia may cause headaches… some of the gut microbiome may be shared with the sinuses…
      warmly
      Dr Jill

  159. Hi Doctor I want to ask you is it possible to have a biopsy of your small intestine for coeliac disease without sedation?

  160. Hi Dr. Jill,
    If someone can’t get the SIBO breath test done because of severe gagging from the solution and being unable to keep it down, could they do Cyrex Array 22? Is this an accurate test to check for SIBO?

  161. Thank you a lot Dr. Jill for sharing such useful information about SIBO. I really amazed to read that SIBO is one of the main causes of Irritable Bowel Syndrome.

  162. Hi Dr. Jill,
    If SIBO goes untreated can it lead to swelling in other areas (besides the stomach), specifically the thighs, arms, and breasts?

  163. Hi Dr. J,

    I’ve been following this thread for sometime. Nice of you to check back and respond to questions. I now have chronic SIBO. As of last breath test -after 1year+ of on and off treatment- I appear to still have bacterial overgrowth (Hydrogen Sulfide in this case, although I formerly tested positive for hydrogen producing bacteria, then methanogens). I’m quite certain I read (or heard) Dr. Pimentel speculate that SIBO might be difficult to treat in some patients due to the autoimmune component of the disease. I understood him to mean that in susceptible individuals with autoimmune tendency, there might be a continuous attack on the vinculin protein in ICC-MY causing an ongoing problem with the function of the migrating motor complex and, thus, chronic SIBO. Given the strong association between a number of autoimmune diseases and SIBO (I myself have Hashimoto’s) and the fact that those of us who have had SIBO for some time undoubtedly have leaky gut as well (which is difficult, if not impossible to address with ongoing bacterial overgrowth) this makes sense to me. I’d like to know if you have come across anything in the literature, or in practice that supports this theory, as I need to find better tools to guide my treatment.

    Best,

    Chris C

    • Hi Chris, yes, you are absolutely right…. but unfortunately treatment is still the same. Treat the overgrowth, address upstream contributing factors, like pancreatic insufficiency, hypochlorhydria, and motility
      Warmly
      Dr Jill

      • Thanks for the insight. And again, many thanks for returning to this thread over and over and kindly addressing concerns.

        Best,

        Chris C

  164. my d2 biopsy revealed intraepthilial lymphocytosis.Doctor has prescribed rifaximin 400 mg even I have no diarrhea.
    my symptoms
    chronic loss of appetite , bloating , thick coated tongue and feels feverish all time.
    widal test for typhoid positive since 6 years..
    plz help me out

  165. Pingback: I just didn't feel right! I had stopped listening to my body.
  166. IS Aloe Vera Jucie safe to consume because I was hearing warnings about bad side effects associated with it on the internet?

  167. Hey Dr. Jill,
    Great post on SIBO. I was on the low FODMAP diet and found it to be extremely worthwhile. My question to is how long do you recommend people to stay on the diet?

    Thanks!

  168. I have chronic constipation. It all started after i took a probiotic after clindamycin after a nose surgery. Caffeine helps it but i got tested for abdominal disorders and all came back negative. My GI doctor thinks it’s not SIBO. I don’t know whats causing my constipation. I am only 30 years old and never had this problem before until i took that probiotic. Fiber seems to make it worse.

  169. Hi,

    I’m wondering if SIBO or any gastrointestinal ailment can be linked with slightly elevated liver enzyme levels. I’ve had gastro issues for years but my blood work has always been fine, but the last blood test I got after going to the doctor with abdominal pain, showed I had elevated ALT. Any thoughts? I have never been officially tested for SIBO but strongly suspect I have it.

    • Hi Kelley
      LPS induced Endotoxemia can cause stress on the liver. Other infections can cause elevated liver enzymes but pure SIBO usually doesn’t cause elevation in liver enzymes. There may be more going on besides just bacterial overgrowth in your gut.
      warmly
      Dr Jill

  170. Hi,

    I was just wondering if SIBO can also happen to children? If it does, what are the possible treatments we can do?

    Thanks!

  171. I live in New Zealand. I started having upper right ab pain (under the rib cage) with excessive sliva after getting colonoscopy and gastroscopy done as part of my health check up end of last year in Korea. Bloating and non stop burping (even with drinking water only in the morning), tummy extension, indigestion, joint pain, palpitations, muscle twitching and spam, rib cage and back pain, then developed Raynard syndrome. I had h pylori treated during the time and it was confirmed that I don’t have it anymore. No issue with constipation and diarria. I had many other test done and came back normal and was told it must be just gas so was put on lowfodmap diet but it didn’t help and I ended up with losing weights too much. My sleep was deteriated and was given antidepressants and told to just not think about pain and all (I still have pain in the similar right upper ab after eating) then I suffered from insomnia also developed autonomic system issue, abnormal sensation and ear ringing. My brain wasn’t working properly with terrible emotional changes and I decided to go back to Korea to get further investigation done. My condition was so bad that I had to leave my young kids behind in New Zealand. : ( That was three months ago and I’m still in Korea, so far it was found that I have gut dyblosis, leaky gut from the organic acid test, and my mercury level was a bit high from the hair mineral test. Recently I learned my DAO level is low as well. It seems SIBO breath test is not common in Korea, drs here are just telling me I do have SIBO. I have started getting chelation done for mercury and took some antibiotics for SIBO but I don’t feel my gut symptoms improved that much yet, if I don’t take enzymes. I’m staying away from wheat/ gluten, all dairy, eggs, sweet fruits and any food including lectins. Do you think my symptoms really indicate SIBO? I feel my symptoms are very extreme. I guess I’m afraid if something else is going on. I’m due to go back to New Zealand soon and unfortunately I don’t know who to see there. I know I can be tested for SIBO there but I will appreciate if you can recommend anyone who can oversee this complicated case.

    Thank you!

  172. Thanks Doctor Jill! I have read so many articles about intestinal or stomach conditions and this is the first time I have learned about SIBO and leaky gut. I was diagnosed with Peptic Ulcer and Gastroenteritis few years back and until now I am suffering with so much pain. I have almost all the symptoms you wrote. After learning this, I think i need to see my doctor or talk to another Physicians to check if I have this one. Again, thanks!

  173. Hi Dr. Jill, this is one awesome post! I just found your blog while looking for information on IBS.

    I’ve been on the low FODMAP diet for 2 weeks now since I was diagnosed with IBS. Thanks for this helpful post! Some of these information I had not even read even in some great IBS sites I also read like casadesante.com, thanks!

    Thanks for sharing!

  174. Hi Dr. Jill….Do you take patients who are on Medicaid and cannot work since they have a Disability? I looked at your webpage and there is no way I can pay this even if I lived in Colorado.
    Please let me know. Thankyou.

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  176. This is a very informative article, Dr. Jill. Are there certain symptoms or signs we should observe first before taking the lactulose breath test or consulting with a doctor?

  177. Dr Jill,

    I’ve been experiencing severe GI problems for 3 months. Onset pretty acutely with a flu-like incident. GI symptoms now include: Abdominal pain, lack of appetite, intestinal noises, black specks in the stool (almost like pepper flakes on the toilet paper, not visible in stool from eye level), incredibly foul-smelling loose stool, malabsorption (often see food debris in the stool), and gassy stool (can see the gas bubbles from the stool when it’s in the water). I also get on/off lymph node enlargement or swelling (mesenteric & neck/jaw).

    I did travel to Hawaii about 4 weeks prior to the acute onset. USA of course, but still tropical, and ate a lot of local meats / outdoor activities.

    Traditional GI workup has all come back clean. Upper endoscopy (with duodenal biopsy), ultrasound, CT scan, 2 stool tests, and a plethora of bloodwork. Infectious Disease visit sent me home packing. I have not had any serum antibody testing etc.

    1) Does abdominal pain from SIBO/SIFO tend to be generalized, or can it be localized? My pain 95% of the time is the RUQ. Almost where you’d expect to have biliary or liver pain. Either near the rib cage or even sometimes under it. I’d think this is strange based on organ locations.

    2) I also had an eyelid infection during this time. Related possibly? Can SIBO spread to other body part?

    I will be seeing a functional medicine doctor in 2 weeks. Based on what I see here, I will request a comprehensive stool test, organic acid test, and the breath test. Will also ask about toxic exposure and deficiencies. I am thinking I have SIBO/SIFO now. I’ve always had minor GI issues (they tell me visceral hypersensitivity / neuromodulation issues). I’ve been on a PPI for 9 years. Was also on a motility agent for 4-5 years, due to some slightly slow motility, but discontinued the drug during the past 9-10 months since I improved and did not need it. Until now, I did consume a lot of refined carbs since easier to digest.

    Does this sound like SIBO/SIFO to you? Also, would appreciate any insight on my 2 specific questions! Thanks!

    • Hi Tony
      RUQ pain may be due to other factors so best to get an ultrasound and full work up for this. The eyelid infection may be unrelated.
      Warmly
      Dr Jill

    • Hi I’m having the same exact symptoms and have been for a month. Got a colonoscopy yesterday and came back clean. Was this ever resolved for you?

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  188. Hi Jill,

    Thank you for all of your work and resources. I recently had a stool sample come back with a high level of citrobacter freundii amount. Have you had success with caprylic acid or lauricidin for that particular bacteria by chance? Thanks for any insight on that.

    Eric

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  190. SIBO is pretty well excluded as having a role in IBS. When the gold standard method for detecting are use it was found to occur at the same rate in IBS and non-IBS Individuals – about 4%. The breath tests (lactulose and glucose hydrogen/methane) used to detect it have been shown to be unreliable

    Conclusions: The data do not support an important role for SIBO according to commonly used clinical definitions, in IBS. However, mildly increased counts of small-bowel bacteria seem to be more common in IBS, and needs further investigation. Motility alterations could not reliably predict altered small-bowel bacterial flora.

    https://gut.bmj.com/content/56/6/802

  191. Hi Jill,

    I live in Northern California and am suffering from LPR (silent reflux) and many food intolerances. Do you know of a functional doc in my area? Chris Kresser’s practice is down the street, however he is cutting back and doesn’t really see patients. Any insights would be appreciated. Your posts have a wealth of information. Thanking you in advance.

  192. I have had stomach issues for about 3 months (stomach discomfort worse when empty) and pain around the belly button.
    No nausea, vomiting or weight loss.
    I did an H. pylori stool test which was negative.
    What next? Not sure how to proceed.
    Thank you.

    • Hi Gabriella
      Best to find a functional medicine doctor who can do stool and breath and organic acid testing to determine the cause.
      warmly
      Dr Jill

  193. Dr. Jill,
    I have had a negative breath test for sibo. My main complaint is severe bloating to the point where I don’t leave the house anymore. I had a GI Map test that I ordered myself……it did not show any candida which was one of my concerns. It did show dysbiotic bacteria (Streptococcus, Pseudonoma spp, Enterococcus Faecalis and Bacillus ssp). I just completed 14 days of Rifaximin and Candibactrin AR/BR that my functional doc recommended. I am still bloated and I feel like the meds may have made it worse. I had a round of Augmentin two months ago for an ear infections and while on it my bloating was the best it has been in years. I feel like my functional doc is stumped as well. I am open to ideas.

    • you may have fungal dysbiosis … discuss antifungals for 2-3 months with your doctor and see how you feel

  194. I’m trying to figure out the underlying cause of my upper GI pain, laryngopharyngeal reflux, shortness of breath/asthma symptoms and persistent bloating. All lung tests were normal; my PCP put me on PPIs but I cannot tolerate any of them – they make me feel flu-ish and have more chest pain. I also don’t have any bowel symptoms, so not sure if it could be SIBO, or like something else you mentioned, hypochlorhydria. Can a traditional GI doctor test for these?

    • Yes, best to start there but you may eventually need a functional medicine doctor to evaluate you if you are not finding answers…

  195. Hello Dr. Jill,

    I appreciate your insights and good information on this website. I am just beginning my journey, and going to see a functional MD tomorrow. She ordered stool tests and food intolerance tests and strongly suspects I have SIBO (burping after eating, burning mouth, carb intolerance etc.), but says I won’t be able to do the breath test because it uses lactulose and I’m lactose intolerant. Is there another way to test for SIBO w/C? I also have silent reflux as a result of the SIBO. I’m following a high Ph, low fodmap diet and losing a lot of weight. Thank you in advance for any advice you can provide.

  196. Hello Dr. Jill,

    Have you ever seen SIBO occur after taking dulcolax and miralax for three days for constipation episode associated with IBS-C? After this, constipation worsened to point where BM was possible only with dulcolax. Thank you!

  197. Hi Dr. Jill,

    I’m wondering if you’ve heard of olive oil as a successful treatment for SIBO. I’ve been reading about its antibacterial (and anti-fungal) properties and wanted to know if you have any knowledge of people using olive oil for SIBO.
    Thank you!