Diana Price - Dietitian Nutritionist
What is SIBO?
Do you suffer from gut problems, skin issues, mood issues, and pain? Maybe you’re wondering about SIBO or maybe you’re questioning if it’s just the latest internet buzzword. For starters, SIBO is a real condition!

SIBO, or small intestinal bacterial overgrowth, is excess gut bacteria in the small intestine, which might not seem like that big of a deal considering bacteria are a natural part of the entire digestive tract {mouth to tail}. But in a healthy gut, the colon has the highest concentration of bacteria while the small intestine shouldn't have many bacteria. In this blog, I will share common symptoms, related conditions, diagnosis strategies, treatment options, plus diet and the 5R Protocol.
To start, let’s look at common symptoms and conditions that make you susceptible to SIBO to start.
Common Symptoms of SIBO:
Abdominal bloating and pain
Belching and gas
Diarrhea
Constipation
Food sensitivities
Skin issues
Mood issues
Joint pain
Weight loss
Nutrient deficiencies
Anemia
Malnutrition
Decline in cognitive function
Digestive Conditions Associated with SIBO:
IBS
Stomach flu or food poisoning
Low stomach acid
GERD
Pancreatitis
Gastroparesis
Celiac disease
Small intestinal obstruction
Crohn’s disease
Fistula
Previous ileocecal resections
Abdominal surgery
Chronic GI tract conditions
Other Conditions {not clearly linked to digestive imbalance} Associated with SIBO:
Aging
Rosacea
Diabetes
Nerve damage
Hypothyroidism
Scleroderma
Some medications {immunosuppressants, PPIs, H2 blockers, narcotics}
Does SIBO Need to be Treated?
Aside from all the annoying symptoms that impact your quality of life, if SIBO is left untreated, it can cause health complications by damaging your small intestine. The small intestine is the longest piece of the digestive tract and is where food and digestive juices mix allowing nutrients to be absorbed into the bloodstream. SIBO damages your digestive tract making it dysfunctional. Malnutrition can be a result and involves poor absorption of essential nutrients and macronutrients {protein, carbohydrates, and fat}, causing deficiencies related to iron, vitamin B12, fat-soluble vitamins {A, D, E, and K}, and calcium. Vitamin B12 deficiency is of particular concern, especially for vegetarians or vegans. B12 can be an issue for those who have inadequate stomach acid or take medications that suppress stomach acid {PPIs, H2 blockers, and other antacids). Long-term vitamin B12 deficiency can lead to permanent nerve damage.
How is SIBO diagnosed?
A SIBO breath test can help diagnose SIBO. This noninvasive test measures the amount of hydrogen and methane you breathe out after drinking a mixture of glucose and water. A rapid rise in exhaled hydrogen or methane may indicate bacterial overgrowth in your small intestine. A breath test entails:
Eating a low-fiber, low-fermentable diet for 24-48 hours and an overnight fast before the test
Drinking a predetermined load of glucose and water
Collecting samples at baseline and then every 15-20 minutes for a total of 3-5 hours
The test measures how much hydrogen and methane have been produced by the bacteria in your small intestine.
A breath test is just one piece of the puzzle. Other factors that need to be considered are:
medical history
history of medications
risk factors
symptoms
diet
Treatment options
Treatment often involves eliminating the overgrowth with antibiotics, herbal supplements, and/or a specialized diet.
Antibiotics
SIBO is often initially treated with antibiotics. Antibiotic treatment helps to remove poor bacteria from the gut but also removes beneficial bacteria necessary for digestive function. However, even with antibiotic treatment, SIBO has been found to have a high recurrence at approximately 45%.
Herbal Therapy
Alternatives have proven to be as effective as three courses of antibiotic therapy and include herbal therapy {oregano oil, berberine, neem, allicin, and others}.
Diet
Diet plays a significant role in the management of symptoms. By reducing the load of fermentable carbohydrates {FODMAPs} through an elimination diet, symptom relief and healing may occur.
What are FODMAPs?
Simply put, FOMAPs are fermentable carbohydrates. With normal gut function, these foods are easy to digest. FODMAPs stand for:

With compromised gut function, these carbohydrates tend to ferment in the gut resulting in gas, diarrhea, constipation, bloating, and/or cramping. A low FOMAP diet is a key component to the 5R Protocol for SIBO - Remove.
There are 3 steps to a Low FODMAP Diet – elimination, reintroduction, and personalization. A strict Low FODMAP Diet is not a forever diet, but a process that allows you to personalize your diet. To create a sustainable solution, foods that are tolerated should be added back into the diet.
5R Protocol for SIBO
Remove Stressors & Irritants
Microbes via antibiotic treatment {Rifaximin, Metronidazole, Neomycin, or a combination to name a few}
Snacking between meals
Fermentable carbohydrates {FODMAPs}
Artificial sweeteners
Replace Digestion Facilitators
Replace hydrochloric acid if low
Consider using digestive bitters
Supplement with betaine HCL
Address nutrient deficiencies
Repair the Intestinal Wall
Supplementation {omega-3 fatty acids, zinc}
L-glutamine
Bone broth
Reinoculate with Probiotics & Prebiotics. Or do you?
Probiotics are controversial when it comes to SIBO treatment. Adding to the bacterial load may make symptoms worse.
What are prebiotics? Prebiotics are food for beneficial gut bacteria. Sunfiber is a low FODMAP prebiotic.

Rebalance Stress Management & Lifestyle
Eat at regular intervals every 3-5 hours
Gradually re-introduce foods and assess tolerance
Yoga/deep breathing/meditation to stimulate the vagus nerve and promote healthy parasympathetic nervous signaling
Bottom Line
SIBO is a real condition. It can cause digestive conditions and conditions that seem unrelated. SIBO can disrupt digestive function and even cause malnutrition. Treatment is multifactorial and is best treated with the 5R Protocol – Remove, Replace, Repair, Reinoculate, and Rebalance.
To learn more about SIBO, treatment, and the low FODMAP diet, book a free discovery call with a dietitian obsessed with optimizing digestive health.