Skip to main content

The naturopathic approach to treating irritable bowel syndrome (IBS) commonly involves a gut healing protocol which typically includes removing food sensitivities, repairing the intestinal lining, and replacing any deficiencies such as digestive enzymes, or hydrochloric acid. In many instances, this approach works wonderfully as a treatment for IBS and often corrects other secondary problems such as acne, skin rashes and frequent headaches as well.

A problem arises, however, when symptoms such as bloating, abdominal pain, constipation and diarrhea do not go away, even with drastic dietary changes and supplementation. If this sounds like you, you may want to talk to your naturopathic doctor about considering testing for Small Intestine Bacterial Overgrowth.

What is SIBO?

Bacteria are found abundantly on our skin and in our digestive tracts. In most instances, this bacteria is beneficial to our health and well-being. However, when a large amount of bacteria overgrow in the small intestine, this can result in a syndrome known as Small Intestine Bacterial Overgrowth (SIBO).

SIBO is thought to be involved in over half the cases of IBS; in fact, one study suggests that this number may be closer to around 84% of individuals with this condition! The same study found a 75% reductions in IBS symptoms with SIBO treatment.

of IBS cases may be related to SIBO

10 Signs You May Have SIBO

  • Bloating or abdominal gas
  • Heartburn
  • Constipation and/or diarrhea
  • Abdominal pain or cramping
  • Food intolerances
  • Chronic illnesses (e.g. hypothyroidism, Crohn’s disease, celiac disease, fibomyalgia, acne rosacea, etc.)
  • Nausea
  • Malabsorption of fats and nutrients
  • Diagnosis of IBS or IBD*
  • Systemic symptoms (e.g. headaches, fatigue, rosacea, joint pain, etc.)

* Inflammatory Bowel Disease

What are the Symptoms of SIBO

The bacteria that overgrows in SIBO include both anaerobes (Bacteroides, Lactobacillus, and Clostridium) and aerobes (Streptocccus, Escherichia coli, Staphylococcus, and Klebsiella). These bacteria produce both hydrogen and methane gasses which cause the typical bloating and flatulence associated with the condition. Often the volume of gas produced by the bacteria is sufficient enough to result in significant abdominal pain.

Hydrogen and methane gas also have an effect on motility within the bowel; hydrogen gas typically causes diarrhea whereas methane gas typically causes constipation. An individual with bacteria that produces both hydrogen and methane gasses will often experience alternating constipation and diarrhea, the typical presentation for people with IBS. The volume of gas produced is typically correlated with the severity of the symptoms of the disease.

The small intestine is where all the nutrients from our food are absorbed into the bloodstream. Bacterial overgrowth in the small bowel will also typically impair digestion and absorption of nutrients, occasionally leading to secondary disorders such as anemia.

Testing for SIBO

The hydrogen and methane gasses produced by the bacteria that overgrow in the small intestine are not produced by human cells. These gasses, rather, are a metabolic byproduct of fermentation of carbohydrates by the bacteria. We are able to detect these gasses using a breath test; if there are elevated levels of either methane or hydrogen gas using breath testing, you have SIBO.


I hope you enjoyed this article on Small Intestine Bacterial Overgrowth. If you are concerned about the possibility that you may have SIBO, speak to a knowledgeable healthcare provider about breath testing for methane and hydrogen gas. You don’t have to live your life chronically bloated and in pain!

Yours in health,

Dr. Nicole Hartman

About Dr. Nicole Hartman

Dr. Nicole Hartman is a naturopathic physician, a world traveler, a hiker, and a blogger. She focuses her practice in digestion, women's health and weight loss and takes an integrative, evidence-based approach to healthcare.