In our Functional Medicine practice, I see lots of patients with digestive, hormonal, and autoimmune issues.

Many patients are stressed to the max and have struggled with symptoms for years.  They are left thinking that living with symptoms is the new normal.

For example, many patients struggle with excess gas and bloating after a meal and they think that’s just what’s normal.

They live with brain fog and depleted energy. As such symptoms become progressively worse, they seek answers from Functional Medicine.

All this to say that most patients have lived with symptoms for years. They’ve gone from doctor to doctor, leaving undiagnosed for years before finally deciding to do something about it.

The problem with SIBO, or small intestinal bacterial overgrowth, is that many people are undiagnosed and it is much more common than we’d like.

Left untreated, it can cause autoimmune conditions, endocrine disruptions, nutrient deficiency, and neurological degeneration.

Bacteria in the Body

We now understand that bacteria is part of our physiology. 

But did you know that for every one of our human cells, there are 10 bacterial cells?  We are outnumbered by bacteria 10 to 1.

We also understand that we have good and bad bugs within us, especially in our gut.  Both in the small and large intestine.  

This is why Functional Medicine practitioners often prescribe prebiotics and probiotics to promote healthy microbiota in the gut. 

Prebiotics and probiotics help our immune function, especially for those of us with autoimmune and/or inflammatory conditions.

Effects of Medications

Conventional medical doctors often prescribe PPIs, or proton pump inhibitors, for acid reflux. 

Patients who’ve been on PPI’s long term have no HCL in their stomach to digest their foods and are at higher risk for SIBO.

Also, patients who’ve taken corticosteroids, antibiotics, or other meds are more prone to an imbalance of good and bad bacteria.

This has an impact on the health of their gut.

Importance of the Gut

Traditional Chinese Medicine, Ayurvedic Medicine, and Acupuncture consider the gut to be the most important part of the body.

This is because our gut serves as the first line of defense against pathogens.

Also, it is part of our enteric nervous system, which modulates our brain function. This means that our brain is intimately connected to our gut.

As for digestion, the stomach breaks down food. The food then moves into our small intestine.

The small intestine absorbs the vitamins and minerals in the food for use throughout the rest of the body.

Anything leftover goes down to our large intestine to make feces so we can eliminate toxins and waste.

The problem is when there’s an overgrowth of bacteria in our small intestine.

These bacteria cause fermentation of starches or carbohydrates we eat, which causes abdominal distension (bloating).

Then the ileocecal valve, which is the door from the small intestine to the large intestine, opens up and further promotes bacteria to be transferred into the small bowel.

This is an issue because that bacteria should only be in the large intestine.

All of this is what’s known as SIBO.

Clinical Presentations of SIBO

Some people are completely asymptomatic, but many begin to have bloating after meals.

Some may have malnutrition, bloating, and constipation. These may then eventually lead to nutritional deficiencies.

When patients have severe symptoms, they can have bloating, anemia, decreased albumin, decreased cholesterol, weight loss, chronic diarrhea with malabsorption, slowly wasting away.

As we get older, the problem gets worse as it begins to affect our brain deterioration, leading to dementia and Alzheimers.

Doctors are beginning to consider SIBO as an important, underrecognized clinical syndrome in the elderly.

It’s the most common cause of malabsorption among older adults.

Symptoms of SIBO

  • Bloating after meals
  • Belching after meals
  • Constipation or diarrhea
  • Brain fog
  • Abdominal distension
  • Severe gas
  • Anemia
  • B12 anemia
  • Steatorrhea (fat in stools)
  • Decreased serum albumin

Prevalence of SIBO

According to the Journal of Clinical Gastroenterology, 2009, SIBO was found in

  • 9.3 % of patients with celiac disease
  • 66% patients with celiac disease with persisting symptoms
  • 15% of elderly population
  • 53% of patients with antacid use
  • 78% patients with IBS
  • 33% patients with chronic diarrhea
  • 34% patients with chronic pancreatitis
  • 90% of alcoholics

Testing for SIBO

It’s hard to assess SIBO, so it’s mostly done case by case, by symptoms, by risks, etc.

Breath tests are available as well as hydrogen/glucose and Methane testing. You’ll want to get treated even if you just suspect you may have SIBO.

SIBO Treatment

Non absorbable antibiotics, elemental diet such as FODMAP, and pro kinetic drugs are also available on case by case basis.

However, the problem with conventional treatments is that reoccurrence is high, even with antibiotics and pro kinetic drugs.

According to the Journal of Pediatric Gastrointestinal Nutrition, inadequate or incomplete response to antibiotic therapy is common.  

On the other hand, using probiotics has more efficacy, according to the Journal of Gastroenterology of Latin America (3)

There are specific strains to consider for probiotics.  These include probiotics with Bifidobacterium and Lactobacillus strains.

Underlying Causes of SIBO

It’s not enough to know you have SIBO. It’s also important to understand the underlying mechanism for your condition.

For example, if you have excess stress, take acid reflux meds, have taken corticosteroids or antibiotics, or have an autoimmune condition, you should get yourself checked and treated.

I have lots of hypothyroid patients. It is understood that over 90% of hypothyroid patients have an autoimmune condition.

And if you have hypothyroidism, there’s an increased chance of SIBO due to the intestinal peristalsis dysfunction. 

This is because hypothyroidism affects the vagus nerve, which controls peristalsis and motility during digestion.

As a result, there is not only risk for interference of thyroid medication absorption, but also less receptiveness to thyroid medications.

So as you can see, this can affect many systems down the chain.

If you or anyone you know has issues that may indicate SIBO, we are glad to help you find appropriate treatments to not only reverse your symptoms but to prevent this issue from becoming a medical condition.

Call us today, 678-335-5566.

For more information on Alkaline Nutrition Therapy, click here.

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See you next week.


  1. Prevalence of small intestine bacterial overgrowth diagnosed by quantitiative culture of intestinal aspirate in celiac disease.  J Clin Gastroenterol. 2009 Feb;43(2):157-161

2. Small intestine bacterial overgrowth: a comprehensive overview.  Gastroenertology Hepatol (NY). 2007 Feb;3(2):112-122

3. Acta Gastroenerol Latinoam

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