“The best treatment for SIBO, like other forms of bacterial imbalance – or dysbiosis – is rehabilitating your microbiome.”


The small intestine typically contains much less bacteria than the colon, the main living quarters for gut bacteria and the place where dysbiosis most often occurs.


Symptoms of SIBO:

  • Abdominal pain/cramping
  • Bloating
  • Constipation
  • Depression
  • Diarrhea
  • Excessive gas
  • Fatigue
  • Food cravings
  • Headaches
  • Nutritional deficiencies (gut bacteria may affect absorption of nutrients or consume them themselves)
  • Rashes

Antibiotic use is a major cause of SIBO, but impaired bowel motility and partial bowel obstruction that result in stasis of intestinal contents, and acid suppression that creates a hospitable environment for bacteria to overgrow, are also risk factors.

Onset of SIBO often occurs following a severe GI infection, in the setting of antibiotics and acid suppressing drugs.


SIBO is tested by administering a hydrogen breath test (during which a solution is consumed containing glucose, which pathogenic bacteria breakdown into hydrogen and methane gases; hydrogen levels are measured to determine bacterial overgrowth). Although breath tests can be useful, they can be unreliable.

A clinical diagnosis based on history, physical exam, and signs and symptoms is the best way to diagnose SIBO.



Some physicians treat SIBO with an oral antibiotic called Rifaximin (also known as Xifaxan). The theory is that because Rifaximin has activity against a broad spectrum of bacteria that are overgrowing in the small intestine, using it to reduce their populations should lead to an improvement in symptoms. And it frequently does. Unfortunately, Rifaximin, like all antibiotics, also has activity against essential bacteria and diminishes that population, too. The result is usually an initial amelioration followed by relapse a few months later.

Rehabilitate Your Microbiome

The best treatment for SIBO, like other forms of dysbiosis, is rehabilitating your microbiome, (removing medications, practices, and foods that are damaging to your microbiome; replacing the essential bacteria that you’ve lost with a robust probiotic; and restoring the health of your gut with appropriate nutrients, supplements, and medicinal foods) using diet and lifestyle modifications in conjunction with a robust probiotic.