Evidence-Based, Simplified Nutrition and Lifestyle Strategies


What Is Small Intestinal Bacterial Overgrowth (SIBO)

what is sibo

What Is Small Intestinal Bacterial Overgrowth (SIBO)

what is sibo


SIBO Background

Have they ever heard of good bacteria or harmful bacteria? This discussion will focus on the harmful bacteria related to Small Intestinal Bacterial Overgrowth (SIBO). If you need good bacteria support or you recently took antibiotics, my gut support article and my probiotic restart kit will give you a lay of the good bacteria-land.


Although we do our best to stay healthy by watching the kind of substances we ingest or by keeping certain parts of our bodies clean, the truth is our body and organs still inhabit bacteria. A lot of bacteria. But bacteria can be a good thing. We’ve grown along with bacteria to help thrive in a bacteria-rich environment. The problem is when we have fewer or the less than ideal ones (or when we continue to use sanitizing agents to rid ourselves of any bacteria).


In the entirety of the human digestive tract, the small intestine has the lowest bacteria levels. Part of the reason is that the stomach should have killed most of the pathogens entering our body before entering the small intestine. The small intestine is where we house most of our immune system, and it’s where we should be absorbing our nutrients into the bloodstream.


The large intestine is where we house the microbiome: the good bacteria.


The term Small Intestinal Bacterial Overgrowth (SIBO) suggests the overgrowth of resident bacteria in your small intestine.


SIBO is different from Irritable Bowel Syndrome (IBS), although they have similar symptoms. IBS is a functional gastrointestinal (GI) disorder associated with abdominal pain, constipation and alternating loose stools. IBS is also known as irritable colon, mucus colitis, spastic colon and spastic colitis. Often, IBS is a generalization used for many gut imbalances.


When SIBO imbalances occur, nutrient malabsorption is common. The small intestine is where food (now called chyme) fuses with additional digestive juices and where the majority of nutrients are absorbed into the bloodstream. The presence of SIBO is often associated with nutrient malabsorption, particularly fat-soluble vitamins and iron. SIBO also exacerbates the endothelial lining of the gut.


Do you suffer from SIBO?

(SIBO) Small Intestinal Bacterial Overgrowth sibo treatment


Most people go years before an official SIBO diagnosis is made. Too often, people are diagnosed with IBS or some other gut imbalance. An estimated six to fifteen percent of healthy, asymptomatic people, and roughly eighty percent of people diagnosed with Irritable Bowel Syndrome (IBS), actually suffer from small intestinal bacterial overgrowth.


SIBO Diagnosis Testing

There are three options available for SIBO testing. Each option has different pros and cons. Unfortunately, false negatives can result from all three. False positives can also occur due to poor test preparation. All testing methods also fail to test for hydrogen sulfide SIBO, one of the three types of SIBO.


  • Small intestine aspirate: During an endoscopy, some bacteria are sampled from the small intestine through aspiration. The sample is grown in a petri dish for SIBO diagnosis. This is considered the gold standard of SIBO testing but does have a few challenges. The results can become skewed due to large intestine bacteria contamination of the sample. They can also result in a false negative as some bacteria can’t be grown in a petri dish. This option is extremely expensive, not practical, and isn’t commonly used for SIBO diagnosis.
  • Organic acids: The urine test looks for a biomarker called 4-hydroxyphenylacetic acid. If levels are elevated, this indicates SIBO. This is a much easier option compared to small intestine aspirate. However, the results of this test can also be skewed.
  • SIBO breath test: The most accessible, easiest option for SIBO testing is a lactulose or glucose breath test (that you can conveniently test from your home). Before taking the test, you may have to follow a special diet for a couple of days. The test is run for a two- or three-hour duration. If your test is positive, you can determine if hydrogen, methane, or both gasses produce bacterial overgrowth in your small intestine.


I am a firm believer in the body’s innate wisdom. If you don’t feel like you have SIBO, I wouldn’t get the test. If you feel constant bloat and imbalanced stools and have tried different elimination diets, you may need to get the SIBO breath test. No test is perfect- if you receive a negative result, remember that false negatives can happen and always listen to your body. Working with a trusted practitioner is critical for navigating SIBO treatment, especially for those who have SIFO as well.



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Another test is the Comprehensive Stool Test. This test inspects the flora of the large intestine to see if there are elevated levels of bacteria. The comprehensive stool test can be used to test for multiple gut infections, such as Candida overgrowth, parasites, worms, H.pylori, blood in urine, gut inflammation and more.


| stool test | gut infections | Candida overgrowth | gut inflammation |


A SIBO-Free System

With SIBO present in the body, the bacterial overgrowth interferes with healthy digestion and absorption processes, whenever food passes through your small intestine. The immune system is compromised and this bacterium then consumes the food and nutrients meant to support the body. These bacteria then cause symptoms like gas, bloating, and pain.


After eating, many SIBO sufferers go from having a flat stomach to a very painfully distended stomach.


While SIBO is not the same as irritable bowel (IBS), they share similar symptoms that link the two gastrointestinal disorders. These symptoms range from a simple imbalance to chronic illness and autoimmune conditions.


| gut bacteria | Signs and symptoms of SIBO | Probiotics |


Symptom of SIBO:

  • Asthma
  • Brain fog
  • Chronic illnesses including Fibromyalgia, Chronic Fatigue Syndrome, Diabetes Type 2, Neuromuscular imbalances, and Autoimmune conditions.
  • Deficiencies of minerals and vitamins A, B12, D and E
  • Depression
  • Fat malabsorption, signified by pale, bulky and malodorous stools
  • Gas, cramping, bloating, diarrhea, constipation, nausea, vomiting (diarrhea or constipation depends on the gas type)
  • Intolerance to foods like gluten, casein, lactose, fructose, and histamines
  • Joint pain
  • Malnutrition
  • Skin imbalances: rashes, acne, eczema, rosacea
  • Weight loss


Eradicating SIBO will take time and perseverance, as relapses can often occur. Changing your diet is critical to long-term SIBO success. The Carnivore Cure elimination diet and avoiding certain foods is required to achieve a lasting balance in the gut flora. You don’t want to eat foods that are chronic attacks on the small intestine, like grains and wheat. You can learn more about antinutrients in my article about the dark side of plants.


The Carnivore Cure elimination diet starts with a meat-only baseline to help reduce the assault of specific foods on the gut and helps to reduce overall inflammation. Once the immune system can focus on something other than food toxins, foods feeding harmful bacteria, and inflammation, the body can begin to heal.


Carnivore Cure Book

Causes of Small Intestinal Bacterial Overgrowth (SIBO)

Food is moved by our gut through the digestive tract from the stomach to the small intestine and then the colon. The digestive system is designed to protect us from pathogens and bacteria. But when the assault is too often, the harmful bacteria proliferate.


| SIBO Causes and Risk Factors |


Some of the risk factors that can lead to SIBO include:

  • Medications: Certain medications influence or disrupt the normal gut flora. These include antibiotics, immunosuppressant medications, proton pump inhibitors, levothyroxine medication (hypothyroid), acid-blocking drugs, and steroids.
  • Abdominal adhesions or intestinal injury due to radiation or recent surgery
  • Slow gut motility or chronic constipation from all causes
  • Small intestinal disease, including Inflammatory Bowel Disease and Celiac Disease: Celiac disease can cause an increased risk of SIBO development because it disturbs gut motility and can lead to improper small intestine functioning. According to a study, sixty-six percent of patients with celiac disease who maintained a strict gluten-free diet tested positive for bacterial overgrowth.
  • Irritable Bowel Syndrome Diagnosis: Due to the close association between IBS and SIBO, a recent meta-analysis suggests that more than one-third of IBS patients may also be positive for SIBO. IBS patients are nearly five times more likely to test positive for SIBO than healthy controls.
  • Blind Loop Syndrome: The small intestine can form a loop that causes food to circumvent parts of the digestive tract. The food then moves more slowly through the system, allowing bacteria to breed.
  • Rosacea: This skin condition can be a symptom of SIBO. Rosacea causes redness and rashes on the face, and studies have shown that patients with rosacea have a higher tendency towards having SIBO. Other studies show eradication of SIBO can stop symptoms of rosacea.
  • Aging: The more we age, the more our digestive tract slows, which is another risk factor for developing SIBO. Studies show that over thirty percent of disabled older adults have SIBO. Non-hospitalized adults over 61 have a fifteen percent prevalence rate of SIBO compared to just under six percent in individuals 24 to 59 years old.
  • Metabolic Disorders: If left uncontrolled, metabolic disorders, including Type 2 diabetes, contribute to certain gastrointestinal disorders. A study published in Diabetes and Metabolism indicates that SIBO was present in forty-three percent of diabetics.
  • Unhealthy Diet: Diets high in sugar, refined carbohydrates, alcohol and other high-carb food, can contribute to the development of SIBO. Think of non-natural foods as small assaults on the digestive system.
  • Physical Obstructions in the gut, such as scars from surgery, Crohn’s or diverticula, form tiny pouches in the small intestinal wall and then collect pathogenic bacteria.
  • Damaged nerves or muscles in the gut can result in leftover bacteria in the small intestine. Conditions like Diabetes Mellitus and Scleroderma can affect the muscles in the gut leading to the development of SIBO.


Keeping SIBO at Bay

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  • An anti-inflammatory diet that removes all foods which feed bacterial overgrowth. This includes process foods, sugar, alcohol, and most carbohydrates. Carnivore Cure’s meat-only elimination diet is the most stringent baseline but can help reduce all food sensitivities.
  • Intermittent fasting
  • Consume smaller meals: Refrain from overeating because this can cause food to spend more time in the stomach and overwhelm gastric juice production. Try to spread meals into smaller protion than having one or two large meals. Having smaller meals will cause less stress on the body and provides more changes of nutrient absorption.
  • Stay Hydrated: Drink plenty of freshwater throughout the day to stay hydrated. Adding a pinch of salt helps the water be better absorbed. Try some sole water.
  • Ensure you have enough digestive enzymes and stomach acid. Often, SIBO can stem from low stomach acid and even H.pylori.
  • Probiotics: To eradicate SIBO, start taking probiotic supplements and remove all foods that compete with health microbiome balance. These are the foods that usually exacerbate SIBO. Removing almost all processed foods and plant-based foods with heavy antinutrients is a great start.
  • Antimicrobial herbs or targeted antibiotics, like Rifaximin: Antibiotics such as Rifaximin help to reduce the problem bacteria, but there is a grave trade-off. These antibiotivs also kill off healthy bacteria necessary for proper digestive function and optimal health.
  • Herbal remedies such as oregano oil, berberine extract, wormwood oil, lemon balm oil, Indian barberry root extract and others can be used. Work with a practitioner as incorrect herbal usage can adversely affect the body.
  • Dieting: The Carnivore Cure or a meat-only elimination diet can reduce SIBO imbalances. You can listen to the results of a SIBO + Carnivore diet study on YouTube. These diets have shown efficacy with SIBO (but still contain some plant-based foods):
    1. The low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet is an elimination diet low in fermentable carbohydrates and starches that bacteria like to consume
    2. The Specific Carbohydrate Diet (SCD) is more restrictive compared to the low FODMAP. The SCD removes all grains and complex carbohydrates.
    3. The Elemental Diet is a complete nutrition liquid meal replacement. It removes all fiber and solid food, giving the digestive system a rest and reducing exposure to irritants.
    4. The Gut and Psychology Syndrome (GAPS) diet is a gut-healing, nutrient-dense diet and uses targeted supplements designed to repair the gut lining.
    5. The FastTract diet is a special elimination diet that removes all fermentable carbohydrates, including simple and complex sugars, starches and fiber.


SIBO issues | gut health problems



Understanding SIBO helps you to start correcting the root-cause imbalance. SIBO is tricky as it takes some to heal. Diet is the most powerful way to support SIBO. Sometimes lifestyle stressors can hinder healing so focus on reducing stressors and always practice patience.


Remember, healing is possible but you also need to believe it is possible. The body is resilient, and if you fuel the body with the right foods, the body can heal.


Before jumping into the breath test, I always recommend trying basic gut supports and a Carnivore Cure meat-only elimination diet. After a month, if that doesn’t help you get better, you probably want to take the SIBO test.


Remember, the SIBO test is either two hours or three hours in duration. I usually recommend the three-hour SIBO test as it provides gas levels over a more extended period. It gives further insight for people with slower GI transits and who may struggle with constipation. Make sure to watch the YouTube Carnivore and SIBO study as it provides a lot more context around meat-only diets and the efficacy with SIBO.


You can find my gut healing supports at the NwJ store. I only carry practitioner-grade supports, and I like the Biotics brand because it’s a family-owned company that small-batch produces in Texas.


Always remember that no supplementation protocol will beat a proper nutrient-dense diet and healing is possible.



w️ith ♥ and hope for healing,


DISCLAIMER: The content is for educational purposes only. While I am a nutritional therapy practitioner, I am not providing medical advice. Whenever you start a new diet or protocol, always first consult with your trusted practitioner.

Nutrition with Judy


  • Kelsey Hasse
    September 7, 2023 at 9:35 pm

    Can you sadly treat SIBO while breastfeeding? I’m 6 months PP and really need to heal my gut. I can do carnivore elimination but curious if the herbal remedies will be harmful to my baby

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