What is SIBO and why does it occur?

Small intestinal bacterial overgrowth (SIBO) occurs when bacteria — normally concentrated in the large intestine — proliferate in the small intestine where they are not suited. The migrating motor complex (MMC), the intestinal "housekeeping wave" that sweeps the small intestine between meals, normally prevents this. SIBO develops when the MMC is impaired (by hypothyroidism, low stomach acid, diabetes, or opiate medications), the ileocaecal valve is incompetent, or following abdominal surgery that affects gut anatomy.

What are the symptoms of SIBO?

SIBO commonly presents with bloating (particularly after meals), excessive gas, abdominal distension, abdominal discomfort or pain, altered bowel habits (diarrhoea or constipation), fatigue, and sometimes nutrient deficiencies — particularly B12, iron, and fat-soluble vitamins. Symptoms overlap significantly with IBS, and SIBO is found in an estimated 30–85% of IBS patients. Breath testing (hydrogen and methane) is the standard diagnostic test.

What treatments are used for SIBO?

Antibiotic treatment — most commonly rifaximin (a non-absorbed antibiotic) — has the strongest evidence for SIBO eradication. Herbal antimicrobial protocols (combinations of berberine, allicin, oregano oil, and other herbs) have some evidence as alternatives. Elemental diet (a liquid formula approach that starves bacteria) shows efficacy but is challenging to sustain. Addressing the underlying cause of SIBO (low stomach acid, impaired motility, dietary patterns) is essential to reduce recurrence, which is common without prokinetic support.

Does diet help with SIBO management?

Diet does not treat SIBO but can reduce symptom burden and recurrence risk. Low-FODMAP, Specific Carbohydrate Diet (SCD), and Bi-Phasic Diet approaches reduce fermentable substrates that feed bacteria and may reduce symptoms during treatment. Spacing meals to allow the MMC to function (not snacking between meals) supports bacterial clearance. Prokinetic agents — including low-dose erythromycin, prucalopride, or natural prokinetics like ginger and 5-HTP — help restore the MMC and reduce relapse.

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Reviewed by Dr. Ciara Magee · Integrative Midwifery26 March 2026Emerging evidence

Quick answer

SIBO (small intestinal bacterial overgrowth) and gut dysbiosis involve abnormal bacterial populations in the digestive tract, contributing to bloating, digestive discomfort, and systemic symptoms. Naturopathic and functional approaches address diet, gut motility, and microbiome rebalancing alongside conventional treatment.

Do any of these feel familiar?

Bloating and abdominal discomfort that may be worse after certain foods or times of day
A sense that gas is trapped and uncomfortable to release
Diarrhoea, constipation, or both — often triggered by high-FODMAP foods
Fatigue and brain fog following meals
Undigested food particles in stools
Widespread symptoms beyond digestion — joint pain, skin issues, mood changes — that may reflect systemic microbiome effects

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Related Conditions

IBS

Bloating

Constipation

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