Beyond Bloating: The Essential Guide to Diagnosing SIBO and Taking Back Your Health
Small intestinal bacterial overgrowth(SIBO)
Your gut symptoms aren’t just in your head - they might be in your small intestine.
Are you living with unexplained bloating, fatigue, or gut discomfort? You’re not alone - and your symptoms might not be “just IBS.” Small Intestinal Bacterial Overgrowth (SIBO) could be the hidden culprit, quietly disrupting your digestion, draining your nutrients, and hijacking your quality of life.
What Exactly Is SIBO?
SIBO happens when too many bacteria grow in the small intestine - a part of your gut that’s normally low in bacteria. These unwanted guests ferment food too early, leading to gas, bloating, diarrhea, and nutrient loss. Over time, this imbalance can trigger widespread issues throughout the body.
Spot the Signs: Could It Be SIBO?
If these symptoms sound familiar, you might be one of the many undiagnosed cases:
- Persistent bloating and abdominal distension
- Excessive gas or flatulence
- Abdominal cramps or discomfort
- Chronic diarrhea or constipation
- Unexplained weight loss
- Fatigue, weakness, and brain fog
- Vitamin deficiencies (B12, iron, fat-soluble vitamins)
- Foul-smelling or fatty stools
SIBO or IBS? Understanding the Difference
SIBO is often misdiagnosed as Irritable Bowel Syndrome (IBS). Nearly one-third of IBS patients present with SIBO positive. While they share symptoms, they’re very different in cause and treatment:
| Feature | SIBO | IBS |
|---|---|---|
| Root Cause | Bacterial overgrowth in the small intestine | Functional gut-brain interaction disorder |
| Nutrient Malabsorption | Common | Rare |
| Response to Antibiotics | Often dramatic | Variable |
| Diagnosis | Breath test or aspirate | Diagnosis of exclusion |
| Associated Conditions | Diabetes, surgeries, motility disorders | Stress-related or post-infectious |
Did you know? In many patients diagnosed with IBS, treating underlying SIBO can lead to significant relief.
Why Does SIBO Happen?
SIBO isn’t random - here’s what raises your risk:
- Motility issues (e.g. scleroderma, diabetic gastroparesis)
- Structural changes in the gut (adhesions, surgery)
- Chronic use of proton pump inhibitors (acid blockers)
- IBD, Crohn’s, celiac disease
How Is SIBO Diagnosed?
There’s more than one way to confirm SIBO:
- Breath Tests: Measures hydrogen/methane after sugar ingestion
- Small Bowel Aspirate: Lab culture from upper intestine (gold standard)
- Emerging Tech: Capsule-based microbiome testing is on the rise
SIBO Treatment: A Multi-Step Strategy
1. Target the Bacteria
- Antibiotics, generally rifaximin, are the first-line , especially for hydrogen-producing SIBO
- Others (e.g. metronidazole, neomycin) may be used in methane or mixed cases
2. Adjust the Diet
- Low-FODMAP diet to reduce fermentable carbs
- Elemental diet (for severe cases) - pre-digested nutrition
- Ensure repletion of lost nutrients (B12, iron, fat-soluble vitamins)
*FODMAP = Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Restricting them helps with gas, bloating and other digestive issues.
3. Support with Probiotics
- Results vary - specific strains may help; broad-spectrum use is still under research
- Meta-analysis suggests selective benefit with certain Lactobacillus and Bifidobacterium strains
4. Fix the Root Cause
- Correct anatomical issues where possible
- Address motility problems (e.g. prokinetics)
- Review medications that slow the gut
5. Holistic & Alternative Approaches
- Herbal antimicrobials (e.g. berberine, oregano oil)[Insufficient evidence]
- Emerging therapies using gut-stimulating probiotics
Let's Revise!
| Aspect | Details |
|---|---|
| Symptoms | Bloating, gas, diarrhea, pain, malnutrition |
| Diagnosis | Breath tests, aspirate, capsule testing |
| Risk Factors | Motility disorders, surgery, PPIs, IBD |
| Treatment | Antibiotics, diet, probiotics, root cause repair |
| IBS vs. SIBO | SIBO = bacterial; IBS = functional |
Ready to Take Charge of Your Gut Health?
Don't let vague symptoms ruin your life. If you’re constantly battling bloating, fatigue, or digestive distress, ask your doctor about SIBO. Early recognition and targeted treatment could help restore your health and comfort - and get you back in control.
Written by Dr Jonty Gill
Published: July 18, 2025
Last updated: July 19, 2025
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