Small Intestinal Bacterial Overgrowth (SIBO)

Small intestinal bacterial overgrowth (SIBO) is defined as the presence of excessive bacteria in the small intestine which causes production of excess abdominal gas. SIBO is frequently found to be the cause of chronic diarrhea and malabsorption.  

Patients with SIBO may also suffer from constipation, weight loss, nutritional deficiencies, and osteoporosis.

SIBO is an important and under-recognized clinical syndrome in the elderly. It is the most common cause of malabsorption among older adults.

Functional medicine management of SIBO


Assessment is usually based on clinical symptoms and the results of hydrogen and methane breath testing, a fully-validated test for SIBO. Breath testing (which can be done at home) is non-invasive, inexpensive, simple and safe.



In healthy people SIBO is avoided by:

  • Actions of gastric acid
  • Pancreatic enzyme activity
  • Small intestinal motility
  • Normal activity of the ileocecal valve

Functional Medicine assesses these body functions in the individual and supports them when deficient.

The following nutritional interventions are usually used:
  • Digestive enzymes
    Digestive enzymes are used to improve digestion and absorption of nutrients and decrease progression of bacterial overgrowth.
  • Dietary intervention
    Diet is critical in the SIBO patient. Identifying and eliminating problem foods from the diet, such as high-sugar foods and foods that contain short-chain carbohydrates such as lactose, fructans and galactans, is an important part of recovering from bacterial overgrowth.  A list of foods to consume and to avoid is identified during this process.
  • Probiotics
    Patients with bacterial overgrowth conditions can benefit from the use of strain-specific probiotics. In some cases, a symptom-free condition may be reached with probiotics alone.
  • Antimicrobials and biofile busters
    In cases of chronic SIBO, antimicrobial herbs are used to reduce unwanted bacteria.  Biofilm-degrading enzymes and other compounds are also effective in the breakdown of stubborn biofilms.

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