Author: Michaela Falkner, NMD and Joan Haynes, NMD

Is it IBS or SIBO?  A New Look at Old Symptoms

It has been estimated that 60-70% of people diagnosed with IBS instead have SIBO (Small Intestine Bacterial Overgrowth). Common symptoms of SIBO are bloating, gas, constipation, diarrhea, restless leg syndrome, interstitial cystitis, brain fog, increasing food sensitivities, hair loss, and anemia.  Sometimes we think of SIBO when patients report that the more fiber and healthy foods they eat, the worse their bloating and gas is or if they try to eat onions or garlic, its like a bomb went off.

What is SIBO?

Simply put, Small Intestine Bacterial Overgrowth is a chronic bacterial infection of the small intestine. The bacteria that normally reside in the large intestine have abnormally grown in the small intestine.

Why is Overgrowth Bad?

The small intestine is made to absorb our nutrients and food but is not made to tolerate bacteria. As bacteria grow in the small intestine, they cause inflammation to the small intestine lining as well as they get first dibs on all our nutrients before we can absorb them. The bacteria also emit gas as they feed on our nutrients. This leads to increasing food sensitivities, deficiencies of iron and B12, increased gas and bloating, and changes in your bowel movements.

What causes SIBO?

We aren’t completely sure of the cause of SIBO; however, we do know that certain conditions are likely to result in SIBO. Any condition that slows the movement of the GI system (constipation, hypothyroid, surgeries, antibiotics, etc) can make the conditions ripe for SIBO to occur. Another common cause is food poisoning.

How do we Test?

In the past, testing was not as reliable or complete as it is now. There are 3 types of SIBO: hydrogen, methane, or hydrogen sulfide. You can have only one type, or up to all three! There is now a test that can look for all 3 types of SIBO, called TrioSmart. You drink a lactulose solution and then blow into small bags every 15-20 minutes for 2 hours. TrioSmart then measures the amount of the 3 gasses in your breath and gives us results.

How do we Treat?

SIBO is treated by in a stepwise fashion: kill the bacteria in the small intestine, ensure motility of the GI system and do our best to prevent relapse, and then repopulate if needed.

Oftentimes a combination of a unique antibiotic (Rifaximin) plus herbs has the best outcomes. Some herbs often used are oil of oregano, garlic extract, berberines, and multiple others. Treatment protocols usually last 1-3 months, depending on severity and how long these symptoms have been present. Then we shift to relapse prevention and motility via herbs and diet.

Info from,, 2020 Advanced Application in Medical Practice conference