SIBO Treatment Considerations 2023 Guide

SIBO Treatment

Before we discuss SIBO treatment you may find these blog posts and podcast episodes also helpful:

What Is SIBO?

SIBO stands for small intestine bacterial overgrowth and, as the name suggests, is when you have an overgrowth of bacteria within the small intestine. The small intestine is home to far fewer bacteria than the large intestine but for reasons discussed in this blog post, what causes SIBO, an overgrowth can occur.

It is also possible however to have an imbalance of bacteria in the small intestine rather than an overgrowth per se.

What Are The Different Types Of SIBO?

Often people ask this question due to the fact there are three primary gasses that can contribute to symptoms, two which we can currently test for:

  • Methane
  • Hydrogen
  • Hydrogen sulfide

The term ‘methane SIBO’ has been used to deescribe a positive breath test when methane levels are elevated.  This has been associated with constipation in the research.

If hydrogen comes back positive in a SIBO breath test then this confirms small intestine bacterial overgrowth. This can be referred to as hydrogen positive.

Hydrogen sulfide is the third gas, that currently doesn’t have a validated test to assess it (word on the street is its coming soon!). It is thought that when we get a flat lining SIBO breath test (i.e when gas levels for hydrogen and methane are both flat lining) that it may indicate excessive hydrogen sulfide production. This has been associated with both constipation and diarrhoea, fatigue, brain fog and other symptoms.

Each type of SIBO needs a different SIBO treatment.

How Do You Test For SIBO?

You test for SIBO via a hydrogen breath test. This is a three hour test which requires a 12 hour fast before hand, and a restrictive diet foe 12 hours before starting the test. The good news it that these days the test can be completed at home. When I did my first SIBO test back in 2015 I had to go to a clinic in London and fast for 24 hours!

Common questions I get asked are:

Can I treat SIBO naturally?

The short answer is, yes! I have spent a decade supporting people improve their gut health, including those with confirmed SIBO.

What Is The Best SIBO Treatment?

There is no one size fits all approach for successfully treating SIBO. The most important question to ask, which influences treatment, is what caused the overgrowth to occur? Read my blog SIBO: What causes it? to learn more. The four main categories however are:

  • Motility issues due to such things as an under active thyroid or chronic stress
  • Medications such as proton pump inhibitors
  • Digestive deficits – meaning suboptimal production of stomach acid or digestive enzymes
  • Inhibited flow of gut contents due to adhesions from abdominal surgery

Which Probiotics Are Best For SIBO Treatment?

Based on the research the best probiotic is a broad spectrum blend which includes both Bifidobacteria and Lactobacillus. We can also consider specific strains of probiotic for specific situations. For example the probiotic known as Culturelle can be helpful in diarrhoea and abdominal pain, where as Clinical GI by NOW may be helpful for those with constipation. Dr. Ruscio recommends triple probiotic therapy for SIBO which includes:

Other Options For SIBO Treatment

So all this needs to be explored. In regards to the actual eradication of the overgrowth, while there is an argument that (at least for some) healing the underlying imbalance (when possible) may lead to natural radiation there are some evidence based recommendations that are almost always going to be considered:

  • Antimicrobials: Herbs such as oregano oil can be used to help lower the overgrowth.
  • Probiotics: The highest quality evidence indicates that probiotics can be helpful in “decontaminating the small intestine”.
  • Prebiotics: Probiotics such as GOS, and partially hydrolysed guar gum have been shown to be helpful in lowering methane levels, and improving the microbiome.
  • Micronutrients: Vitamins A and D are essentially for a healthy mucosal immune system which helps maintain a healthy microbiome.
  • Prokinetics: such as ginger and 5-HTP. A product some find helpful is MotilPro.

Please please please do not forget the fundamentals though:

  • Effective breathing (more on this soon)
  • Stress management – stress is a deal breaker when it comes to healing from any chronic health condition, especially the gut. I have seen clients where this is the key factor in their healing having tried all avenues including antibiotics.
  • Exercise – physical activity is essential for a healthy and diverse microbiome.
  • Healthy sleep patterns


SIBO References

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