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6 Signs Your Digestive Issues Might Actually Be SIBO

Jill C. Carnahan, M.D., IFMCP
Written by Jill C. Carnahan, M.D., IFMCP

Studies show that over 50% of patients diagnosed with IBS actually have an underlying imbalance called small intestinal bacterial overgrowth (SIBO). The majority of our gut bacteria should be in the colon. When the bacteria migrate backwards 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 symptoms, such as diarrhea, gas, or bloating.

Here are six signs you might have SIBO

1. You notice that fiber worsens your constipation.

2. You notice an improvement in IBS symptoms when taking antibiotics.

3. You feel more gas and bloating when you take probiotics that contain prebiotics.

4. You are celiac or gluten intolerant and do not have 100% resolution of symptoms on a gluten-free diet.

5. You develop chronic symptoms of gas, bloating, constipation or diarrhea after taking pain medications, like opiates.

6. Your blood work shows chronically low iron


Here are the top 6 symptoms of SIBO

1. Abdominal bloating and distension

2. Constipation

3. Diarrhea

4. Abdominal pain or discomfort

5. Acid reflux or heartburn

6. Excessive gas or belching

How do I know this isn’t just leaky gut?

While SIBO usually manifests with local GI symptoms, a leaky gut will manifest with complaints that affect the immune system throughout the body. Keep in mind that it is not uncommon to have both SIBO and leaky gut simultaneously. And very often, if you have SIBO for a long period of time, you will develop a leaky gut. About half of the patients diagnosed with SIBO will also have leaky gut. Most of the time if SIBO is treated, leaky gut will heal itself!

Here are the ways you can diagnose SIBO

1. Ask your doctor to order the Lactulose Breath Test.

2. You may also need to check a comprehensive stool analysis and urinary organic acids.


How do we treat SIBO?

1. Diet options

  • Paleo diet or autoimmune paleo diet
  • Low FODMAP diet
  • GAPS Diet
  • Avoid all alcohol
  • Use caution with probiotics/prebiotics
  • Use caution with fermented foods as they can increase histamine

2. Antimicrobial herbs

  • Oil of oregano
  • Berberine

3. You can speak to your healthcare provider about use of medication or antibiotics, if necessary.

Treating SIBO successfully is not always easy and may involve major dietary changes and medication or herbal treatment for an extended period of time. However, getting the balance of your gut microbes healthy will likely prove to be the most important step in regaining your health and vitality! I know it was in my case!

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