8 Signs You Have SIBO & How to Heal it Naturally

This amazing article was written by my good friend, Aviva Romm who is incredibly talented and specializes in SIBO with her patients.

Aviva Romm, MD is a Yale-trained, Board Certified Family Physician, midwife, herbalist, and award-winning author, she is the internationally respected authority on botanical and integrative/functional medicine for women and children. Aviva combines her backgrounds to guide women in transforming their health and their lives, and do the same for their kids. She is a leader in the revolution to shift the medical system into one that respects healing capacities of the body and nature.  She practices Functional Medicine at The UltraWellness Center with Dr. Mark Hyman in Lenox, MA. Visit her website www.avivaromm.com for a FREE GIFT and updates on transforming your health.

One of the symptoms my patients find most troubling is belly bloating. Especially my women patients. After all, who wants to look pregnant when she’s not! Sometimes my patients bring pictures to their first appointment of their bellies looking 5 months pregnant after eating a meal just to prove how bloated they get! They tell me they sometimes have to leave open a pants’ button or two…

One common cause of bloating is a condition called SIBO (small intestinal bacterial overgrowth). Read on to learn more…

What is SIBO?

SIBO is an overgrowth of gut bacteria in the small intestine, the part of the gut that is the connection between the stomach with the large intestine, or colon. The small intestine is the place where much of your nutrient absorption occurs. While there are various bacteria naturally present throughout the digestive system, most of it is supposed to be in the large intestine, not the small intestine.

8 Signs that You Could Have SIBO

  • Do you feel bloated, especially after eating and up under your ribs or in the middle of your gut?
  • Do you get full really fast when you start eating?
  • Do you belch a lot or have indigestion?
  • Do you feel you have slow digestion?
  • Do you have food intolerances?
  • Are you gassy?
  • Do you have diarrhea or oily looking bowel movements?
  • Do you suffer from abdominal discomfort, cramping or pain?

If you answered yes to any (or many!) of the above questions, you might be suffering from SIBO.

What Causes SIBO?

Digestion and the maintenance of healthy gut flora rely on a delicate orchestration, from mouth to opposite end, of enzymes, hormones, nerves and muscles that break our food down and move nutrients and waste through the digestive tract. SIBO is sometimes caused by serious or permanent conditions like scarring or strictures in the digestive tract from Crohn’s disease, radiation, or surgery, or small intestinal diverticulosis, or motility problems from nerve damage, scleroderma, or diabetes. However, it can also be caused by common medications and lifestyle habits that disrupt this balance, such as low stomach acid due to diet, age or antacid medication use, recent or frequent use of antibiotics throughout your life affecting healthy gut flora, stress affecting gut motility, blood flow to the gut walls, and digestion – all of which can be improved.

Is SIBO Dangerous?

While having SIBO is not dangerous, it can sometimes lead to significant health problems if severe or left untreated. Nutritional deficiencies, including vitamin B12, vitamin D, calcium, and vitamin A can cause health consequences, and for women, perhaps the most serious of these is osteoporosis. Additionally, fat malabsorption is common, and stool testing may in fact show increased fecal fat.

Can I Get Tested for SIBO?

Yes, you can get tested for SIBO. The most common test is the Breath Test, which is used by conventional and integrative/functional medicine doctors alike. After fasting for 12 hours you are asked to breathe into a little device with a balloon. You are then given a preparation containing either lactulose or glucose to ingest, after which the breath test is repeated every 15 minutes for several hours. A rise in hydrogen to a specific level is considered indicative of SIBO. While it is a bit of a nuisance, this is currently considered the most reliable test. Some conventional and integrative/functional medicine physicians will treat on the basis of symptoms without requiring confirmation from testing, as long as other digestive conditions (for example, Crohn’s disease or Ulcerative colitis if there is chronic diarrhea) are ruled out.

How Can I Get Rid of SIBO?

Getting rid of SIBO requires getting your gut health back in balance. Here’s how you can do just that in 6 simple steps!

  1. Get rid of the bad guys

There are 2 ways to get rid of unwelcome bacteria, and even the overgrowth of some of the good guys, which can cause symptoms, too. In integrative and functional medicine practices, we commonly use a medication called rifaxamin. It is an antibiotic that does not get absorbed by your system, so just hangs out in the gut, doing the work it needs to do there. It is typically taken from 10-30 days depending on symptoms and response, and sometimes even a second course of treatment is needed to fully clear out the SIBO.

Yes, it can knock out some of the good guys, too, but with step 2, you’ll bring those back in! A major disadvantage of this medication is cost – and the fact that it has to be prescribed by a doctor in your community. A functional or integrative MD should be familiar with this approach. In fact, even a conventional gastroenterologist would usually use this medication for SIBO treatment.

Another more natural option is to use antimicrobial herbal medicines – those that help to fight off these bacteria. The most widely used of these include goldenseal, and oregano oil, both of which can be found in a product I commonly use in my practice called Candibactin BR. I generally recommend 2 capsules, 2-3 times daily for 4-6 weeks. I also recommend discontinuing alcohol, sugar, and going on a low starch diet during treatment.

  1. Bring back the good guys

Encouraging good gut flora to populate your gut is one of the best things you can do for your overall lifelong health. Eat a wide variety of vegetables, especially dark leafy greens, as well as fermented (naturally pickled) vegetables such as sauerkraut and kimchee.

  1. Please, feed the flora!

Take a good quality probiotic that contains a variety of flora including Lactobacillus, Bifidobacter, and Saccharomyces species. Also, eat good quality fermented foods and high fiber vegetables – gut flora thrive on these!

  1. Keep up your natural defenses

Our gut has natural defenses – especially the stomach acid that helps to break down our food effectively and keeps a lid on bacterial overgrowth in the adjacent first part of the small intestine where the food is dumped into from the stomach. Taking antacid medications from TUMS to Zantac to Prilosec suppresses this important stomach acid, rendering you more vulnerable to developing SIBO. Stomach acid is also low in some folks, for unclear reasons, and also gets lower as we age. Instead of antacid medications, talk with your doctor about using DGL licorice to soothe your stomach without squelching the acid, and consider taking a supplement called Betaine HCL to supply needed acid if yours is low (check with your doc if you have stomach or duodenal ulcers before using). Usually, 1-3 tablets with meals does the trick.

  1. Take out the garbage daily

Keeping your bowels moving means that bacteria that are supposed to live in the lower segments of the gut don’t have a chance to get backed up and migrate into the upper areas of the gut where they can cause problems. Also, a healthily moving colon is a better nursery for healthy gut flora than a constipated gut.

  1. Don’t worry, be happy!

Stress can lead to decreased stomach acid, slower gut motility, and less blood flow to the gut lining, all having a negative impact on digestion. Having a moment of gratitude before you eat, practicing mindfulness around food and in your life, and finding happiness can go a long way to improving digestive health!


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  1. Having read this I thought it was really enlightening. I appreciate you finding the time and energy to put this short article together. I once again find myself personally spending a lot of time both reading and commenting. But so what, it was still worth it!

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  5. I have the symptoms, but not truly diagnosed by a medical Dr. There is not one close to me as be to tell you the truth, I don’t know how to find one. I have been using a Dr. By phone as be she said I have symptoms, but not really aggressive and gives food list that I know causes problems. I have searched the internet trying to find solutions. My recent problem is with severe Gerd, my GI Dr. Just keeps changing antacids , none really work well. I am my wits end, do know a Dr . I could contact? I see I need a test, but don’t know how to get it or who would do one. I would so love help!!! I thought fermented foods were good for me and now I read they cause more gas! Please help if possible. I live in rural Alabma.

    1. Hi Judy,
      I am so sorry to hear you are having these health issues. Please visit the Services Page on my website for more information to schedule a session. Xx.

  6. I’ve just been diagnosed and I’m sad to learn this might be a lifestyle adjustment. I’m saddened that my GI doctor is not so proactive with an after plan. I’m also saddened with giving up a lot of favorite fruit: apples and mangos. I find it interesting that this page is called the healthy apple. How did you go about finding a professional you can trust?

    1. Hi Liane,
      It’s not easy! It’s trial and error and finding someone who gets it. I had to leave doctors to heal and find help outside of medicine! xx

  7. Thank you for the article. I have been battling this illness for 6+ years, five of which were undiagnosed. My chief complaint was intense abdominal pain and swelling. This illness can be debilitating. There is also a high recurrence rate. SIBO causes damage to the intestinal lining, which can lead to excruciatingly painful intestinal adhesions. It can also lead to more serious illnesses such as Colitis. A SIBO specific diet is necessary for healing. I recommend a doctor of functional medicine.

    1. Thank you Alicia; so nice to hear from you. Yes I agree completely. You must work with a Functional MD to get to the bottom of gut issues. xx