Small Intestinal Bacterial Overgrowth (SIBO)

Understanding SIBO: A Naturopathic Perspective on Small Intestinal Bacterial Overgrowth

Small Intestinal Bacterial Overgrowth (SIBO) is an increasingly recognized condition that affects millions of people worldwide—often without them even realizing it. As a naturopath, understanding and addressing the root causes of SIBO is essential in guiding patients toward lasting digestive health and systemic balance.

What Is SIBO?

SIBO occurs when bacteria that normally reside in the large intestine migrate and proliferate in the small intestine, where they don’t belong in significant numbers. This imbalance can interfere with nutrient absorption and lead to a host of symptoms including:

  • Bloating and abdominal discomfort

  • Excessive gas or belching

  • Diarrhea, constipation, or alternating bowel habits

  • Fatigue and brain fog

  • Nutrient deficiencies, particularly of B12, iron, and fat-soluble vitamins

Causes and Contributing Factors

SIBO rarely develops in isolation. It’s typically a symptom of an underlying issue that affects gut motility, structure, or immune function. Common root causes include:

  • Ileocecal valve dysfunction

  • Post-infectious IBS

  • Hypochlorhydria (low stomach acid)

  • Chronic stress

  • Long-term use of proton pump inhibitors or antibiotics

  • Structural issues such as adhesions or diverticula

A naturopathic assessment often reveals multiple layers that contribute to SIBO, including lifestyle, diet, stress, and microbial imbalances.

Diagnosis: Testing for SIBO

The most common method for diagnosing SIBO is a breath test, which measures hydrogen and methane gases produced by bacteria in the small intestine. These gases are exhaled and measured after consuming a fermentable sugar solution (usually lactulose or glucose).

Hydrogen dominance tends to be associated with diarrhea-predominant SIBO, while methane dominance (now sometimes reclassified as IMO – Intestinal Methanogen Overgrowth) is often linked to constipation.

A Naturopathic Approach to SIBO

The conventional treatment for SIBO often includes antibiotics such as rifaximin. However, many naturopathic protocols offer an effective and gentler approach that can address root causes and support long-term healing.

Here’s a typical naturopathic roadmap for SIBO:

1. Reduce Bacterial Overgrowth

  • Herbal antimicrobials (e.g., berberine, oregano oil, garlic extract, neem)

  • Specific protocols tailored to the type of gas produced (hydrogen, methane, or both)

2. Support Digestive Function

  • Promote healthy stomach acid levels (bitters, HCl supplements if needed)

  • Address bile flow and pancreatic enzyme support

  • Optimize motility with agents like ginger or prokinetic herbs

3. Restore the Gut Environment

  • Address underlying dysbiosis in the colon

  • Use probiotics cautiously—some patients may not tolerate them during the active phase of SIBO

  • Consider gut-healing nutrients (L-glutamine, zinc carnosine, aloe, etc.)

4. Dietary Adjustments

  • Low FODMAP or SIBO-specific diets can reduce symptoms, though they are not long-term solutions

  • Reintroduction phases are key to restoring microbial diversity

  • Individualized plans are crucial—some patients do better with elemental diets in severe cases

5. Address Root Causes

  • Treat underlying conditions like hypothyroidism, Ehlers-Danlos Syndrome, or post-infectious IBS

  • Work with stress, circadian rhythms, and nervous system regulation

  • Ensure long-term prevention by maintaining healthy motility and gut terrain

The Bigger Picture

SIBO is not just a digestive issue—it can affect systemic health, mood, immunity, and quality of life. As naturopaths, our role is to go beyond symptom management and partner with patients in understanding the why behind their imbalance.

With the right tools, education, and support, patients can overcome SIBO and develop a stronger, more resilient digestive system. A comprehensive, compassionate, and individualized approach makes all the difference.

Interested in exploring your digestive health or learning more about how naturopathy can support SIBO? Contact me here to schedule a consultation.