The prevalence and severity of Small Intestine Bacterial Overgrowth (SIBO) is evergrowing. SIBO has been linked to intestinal permeability along with being a contributing factor to many other health conditions. Those who experience SIBO report symptoms such as bloating, nausea, headaches, joint pain, fatigue and overall discomfort. 

When a patient enters the office projecting these symptoms, a SIBO test is one of the first actions taken. SIBO occurs in the small intestine which is a difficult place to test. The small intestine is roughly the size of a tennis court, with the middle being no-mans land. The first and last few inches of the small intestine can be tested via endoscopy, however, the bacteria needing to be tested for SIBO resides primarily in the dark center. 

SIBO Testing

The most accurate way to test and asses the flora levels in the small intestine is via a breath test. Generally speaking, there are three breath tests. H Pylori, Lactose, and Sorbitol or Fructose intolerance. In order to test for SIBO, the best results come from a lactose breath test. The primary reason this is the gold standard of testing is based on the fact that lactose can not be digested by humans. In fact, the microorganisms in the small intestine break down lactose and convert it into gas. 

This test takes place over a 2-3 hour time frame with frequent specimens. Two days before this test is performed, patients are instructed to follow a “prep” diet where virtually no carbohydrates are consumed. The day of the test, the patient will give a baseline breath. After these numbers are recorded, a solution is consumed. Throughout the next 2-3 hours, another specimen will be collected. 

Ideally, within the first two hours, we want to see the hydrogen and methane levels rise. It is important to consider all medications the patient is taking before performing the test. If the patient is taking magnesium, any form of a laxative, or a high dose of vitamin C it is critical the patient stop taking these medications 4 days prior to the test in order to reduce the risk of a false negative. 

Treating SIBO 

All treatments vary and depend on the individual compared with their specific lab results. However, the three main goals when creating a SIBO treatment protocol are generally the same. 

  • Reduce the bacteria 
  • Biotransform and support brush border healing 
  • Prevent relapse 

SIBO can be treated using prescription or herbal supplementation. We focus on herbal supplements as a study performed by John Hopkins revealed that herbal supplementation was 12% more effective at normalizing the breath test when compared to antibiotics. 

All-natural supplements that may be considered to treat SIBO include Berberine, Azadirachta Indica, and Origanum Vulgare. The prevention plan to keep SIBO from returning is just as important as reducing SIBO. Studies show that if the improper or no prevention plan is in place SIBO can return in as little as 2-4 weeks. When creating a prevention plan, the diet should always be a factor, and supplements should be taken for a minimum of 90 days. 

Genova Diagnostics:


SIBO causes uncomfortable symptoms and can be the cause of many other health conditions. Evaluating your gut health is very important as a healthy gut leads to a reduced risk of autoimmune disease and further health complications. -Kenna Vaughn, Senior Health Coach 



Sandberg-Lewis, Steven. “Small Intestine Bacterial Overgrowth (SIBO) (Part 2).” 7 May 2020, .

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The information herein on "Testing & Treating SIBO" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.

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