How to Heal Small Intestinal Bacterial Overgrowth (SIBO)
- Britta Van Dun
- 7 days ago
- 5 min read
Small Intestinal Bacterial Overgrowth (SIBO)
Small Intestinal Bacterial Overgrowth (SIBO)—and its sibling, intestinal methanogen overgrowth (IMO) and Small Intestinal Fungal Overgrowth (SIFO) —occurs when excessive bacteria (or fungus) inhabit the small intestine, a place they don’t belong. Understanding how the gut moves food along explains why this happens and how to fix it. This post is not a substitute for personalized medical advice. Always consult a licensed or certified healthcare provider before starting or changing any treatment or supplement strategies.
Common SIBO Symptoms (and How They Differ by Type)
SIBO shows up differently depending on the dominant gas produced, but most people experience some overlap. Common symptoms include bloating, abdominal distention, gas, discomfort after eating, fatigue, and food sensitivities and intolerances (commonly interpreted as allergies).
Hydrogen-dominant SIBO often presents with loose stools or diarrhea, urgency, bloating soon after meals, and a “gurgly” or active gut.
Methane-dominant overgrowth (IMO) is more often associated with constipation, slow transit, hard stools, bloating that worsens throughout the day, and a heavy or backed-up feeling.
Hydrogen sulfide SIBO may involve bloating with less visible gas, nausea, brain fog, headaches, sulfur-smelling gas or stools, and reactions to sulfur-rich foods
Across all types, symptoms often worsen with fermentable foods, stress, poor sleep, or irregular eating patterns. Importantly, symptom severity does not always correlate with test results — nervous system tone, motility, and gut integrity matter just as much as microbial load.
The Role of the Migrating Motor Complex (MMC)
After you eat, food moves from the stomach into the small intestine, where nutrients are absorbed. Roughly 3–5 hours later—between meals—the migrating motor complex (MMC) sweeps residual food and microbes out of the small intestine and into the large intestine.
If that sweeping action is weak, irregular, or interrupted—or if the “gate” between the small and large intestine (the ileocecal valve) doesn’t function well—bacteria can linger and overgrow. These microbes may generate gases such as hydrogen, methane, or hydrogen sulfide, driving key symptoms like bloating, distention, discomfort, and altered bowel habits.
(Note: MMC activity is most active during overnight fasting, which is why nighttime prokinetics are often emphasized during treatment.)
Common Contributors to SIBO / IMO
Past food poisoning (post-infectious changes)
Low stomach acid (hypochlorhydria)
Hypothyroidism
Diabetes
Scleroderma
Celiac disease
Gallbladder dysfunction / poor bile flow
IBS or IBD (Crohn’s, ulcerative colitis)
Physical obstructions or adhesions (e.g., ileocecal valve dysfunction, strictures, post-surgical adhesions)
Medications that slow motility (e.g., opiates/narcotics) or reduce acid (e.g., PPIs)
First things first: identify and address the root cause to avoid relapse, which is otherwise fairly common. Work with a knowledgeable clinician and get a breath test, targeted blood work, stool testing, imaging, and/or motility assessments.
A Comprehensive SIBO Treatment Plan
Dietary Support — Food as Medicine
The goal is to neither overfeed nor starve the overgrowth. Many people trial a Low-FODMAP diet short-term; others do better with a Low-Fermentation approach. Diet is a tool—not a cure—and its importance rises if motility isn't fully restored.
During antibiotic courses, some clinicians recommend not overly restricting fermentable foods, as extreme restriction may reduce treatment effectiveness. Diet alone rarely “cures” SIBO. If motility is restored—especially overnight with the aid of a prokinetic—many people can liberalize food choices without symptom return.
If motility remains impaired or an underlying condition persists, a Low-Fermentation or similar plan may be more important long-term. Personal experimentation, guided by symptoms and professional input, is your best bet.
Motility Support (Prokinetics)
Many clinicians view SIBO as a consequence of impaired motility or another upstream issue—not the root cause itself. You can “kill” your way to temporary relief, but fixing motility and addressing the underlying driver (thyroid, adhesions, vagal tone, post-infectious changes, structural issues, etc.) is what sustains remission.
Even after the root cause is addressed, the MMC may remain sluggish. Gentle belly massages, walking or light exercise after meals can go a long way. So too can acupuncture and regularly massaging specific acupressure points.
Prokinetics are supplements and medications that help improve motility or movement of the digestive tract. There are over-the-counter options like ginger, artichoke extract, Iberogast, or clinician-prescribed medications, which help maintain forward flow—especially overnight and between meals.
If you go the prokinetic route, be sure to:
Evaluate gallbladder status before using artichoke.
Avoid 5-HTP with serotonergic medications.
Use prescription prokinetics only under medical supervision.
Antimicrobials or Antibiotics
To reduce the initial overgrowth, clinicians may use herbal antimicrobials or prescription antibiotics (e.g., rifaximin for hydrogen; combinations such as rifaximin with neomycin or metronidazole for methane). Discuss risks, benefits, and dosing with your provider.
Herbal Antibiotics Used for SIBO
Some clinicians start with botanicals and report outcomes comparable to rifaximin in practice. Common options include combination formulas (e.g., FC Cidal + Dysbiocide or Candibactin-AR or Candibactin-BR or Atrantril) or single-herb strategies using allicin, oil of oregano, berberine, neem, or cinnamon.
Choice and dosing depend on type of SIBO, tolerance, and medical history. Antibiotics are commonly used for 2–3 weeks; botanicals often 4–8 weeks or longer. Many extend herbs briefly after symptoms resolve to ensure stability. Definitely work with a professional if you're going the antimicrobial
Managing Die-Off During SIBO Treatment
During microbial die-off, toxins and gas can temporarily worsen symptoms. Hydration, rest, bowel regularity, and binders such as activated charcoal (taken at least 2 hours away from medications/supplements) or gas-binding products can ease the discomfort of this phase.
Disrupt Biofilms to Clear SIBO
Once overgrowth is present, microbes may form biofilms—protective layers that reduce the impact of antimicrobials and normal MMC waves. N-acetylcysteine (NAC) and other clinician-guided disruptors, taken 30–60 minutes before antimicrobials or meals, can help expose microbes to treatment.
The “Golden Rules” for Relapse Prevention
Space meals and avoid snacking (4–6 hours between meals).
Consider a Low FODMAP or Low Fermentation or Elemental Diet.
Use a prokinetic as directed, often at night and/or between meals.
Once gut motility is restored, introduce antimicrobials & take as directed.
Be sure to address biofilms. Only introduce 1 supplement at a time to determine tolerance.
Continue prokinetics 3–6 months (or longer) after symptom resolution, when appropriate.
Consider probiotics after antimicrobial treatment. Specific spore and low histamine probiotics are most often recommended.
Additional Holistic Approaches to Heal SIBO and Stay SIBO-Free
Sleep, stress regulation, vagal toning, chewing thoroughly, walking or light exercise after meals, bowel regularity, gut lining support, and selective probiotics following antimicrobials - if tolerated.
This article is not a substitute for personalized medical advice. Always consult a licensed or certified healthcare provider before starting or changing any treatment or supplement. I’m here for you in-person in Tucson AZ and worldwide offering multi-dimensional healing with acupuncture, Chinese Medicine (TCM), reiki, distance energy healing, somatic and craniosacral therapy, and intuitive coaching. Virtual sessions are available by Zoom, FaceTime and phone.
Xx
Britta
Licensed Acupuncturist, Intuitive, Healer, Coach, Energy Medicine Practitioner
📞 917-519-2432
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