Could SIBO be the cause of your sore stomach?

Could SIBO be the cause of your sore stomach?

SIBO – Small Intestinal Bacterial Overgrowth – Causes, Symptoms, Treatments and Diet

Dealing with the challenges of digestive issues and their consequences to health can be

socially isolating and emotionally taxing. You might be at your wits’ end trying to figure out what to eat to alleviate your symptoms. Nothing seems to be working.


Many are told it’s simply stress!


We know that stress and worry can play a role, but the latest research has now irrefutably demonstrated that there are other possible causes of your digestive troubles. With proper functional testing and assessment, a whole heap of causes can be found.


In this article, I am going to explore SIBO (Small Intestinal Bacterial Overgrowth), one of the most common causes of digestive complaints that I see in the clinic.



What is SIBO?

Bacteria are present throughout the entire gastrointestinal tract. However, very few bacteria normally live in the small bowel as compared to the large bowel.


SIBO is a condition in which certain species of bacteria in the small intestine have overgrown causing an imbalance of its ecosystem.[1] The overgrowth is actually of microorganisms that normally inhabit the gastrointestinal tract, but have abnormally overgrown in a location that is dedicated to digestion and absorption of nutrients.


Why is this a problem?

The small intestine is where we digest our food, and bacteria being present there interfere with that process. Bacteria consume some of the by-products of our digestion and this over time can lead to deficiencies such as iron and B12.


When bacteria ferment carbohydrates in our gut an excess of gases, such as hydrogen, methane and/or hydrogen sulphide build up. As a result, many people experience nausea, bloating, abdominal pain, excessive belching, sulfur-like, rotten egg smelly gas, constipation, diarrhea or both.


The small intestine is also an important part of the immune system, containing an impressive network of lymphoid cells (immune cells that help fight infections and regulate the immune system). When the lining is disrupted, larger particles which are not fully digested can leak through the gut wall and trigger severe immune responses. This is the cause of food sensitivities and allergies.


Bacteria themselves can enter the bloodstream and overburden the liver and other organ systems. The immune reaction to bacteria and their cell wall (endotoxin) can cause headaches, chronic fatigue, fibromyalgia and pain in the joints.


What are the common symptoms in SIBO?

The signs and symptoms of SIBO are similar to those of other digestive disorders, such as IBS (Irritable Bowel Syndrome) or lactose intolerance. In fact, SIBO is highly prevalent in IBS. [2] As a consequence, SIBO and IBS share a myriad of symptoms including:

  • Bloating, distended abdomen
  • Abdominal pain/discomfort
  • Excess gas – belching, flatulence
  • Feeling of fullness
  • Indigestion
  • Diarrhea
  • Constipation
  • Acid reflux
  • Nausea
  • Unintentional weight loss or weight gain


The severity of symptoms varies in intensity and may present differently in different people, depending on the type, and the amount of bacteria found in the small intestine.


For example, if bacteria that break down bile salts are predominant, diarrhoea is a common symptom. In contrast, if methanogens take over, constipation and bloating will be the predominant symptom, due to overproduction of methane gas.


Different types of gram-negative bacteria, such as Klebsiella species can produce toxins that could lead to mucosal damage and decreased absorptive function. This can lead to vitamin and electrolyte abnormalities, protein deficiencies, and fat malabsorption.


If you experience these symptoms occasionally, it is very unlikely to be SIBO. However, if you experience them on an ongoing basis for more than two months, then SIBO may be causing your symptoms.


Why are the bacteria overgrowing in the small intestine?

The small intestine is naturally equipped to clean itself during periods of fasting, while we sleep and in between meals. Through a cyclical pattern of muscular contractions, that kicks in 90-120 minutes after a meal, leftover intestinal debris, including bacteria and food residues are swiped away into the colon. Several studies have demonstrated that abnormalities of this mechanism may predispose to the development of SIBO.


The most common risk factors are:

  • Impaired motility due to enteric nervous system damage
  • Adhesions or scar tissue formed after surgery (gallbladder removal, appendectomy)
  • Endometriosis
  • Diverticulosis
  • Food poisoning, exposure to contaminated water
  • Medication, including multiple courses of antibiotics, long term use of acid blockers, antidepressants, oral contraceptive pill
  • Impaired digestion – gut dysbiosis, deficiency of pancreatic or brush border enzymes, poor bile flow or low stomach acid
  • Various underlying medical conditions – chronic infections, IBS, fibromyalgia, hypothyroidism, diabetes, Celiac disease, Chron’s disease, neurological conditions
  • Moderate to heavy alcohol use


How do you know if you have SIBO?

Simply by taking a breath test. By testing, you can get answers, beat the bloat and return to normal.


A hydrogen and methane breath test is the simplest non-invasive diagnostic tool that can accurately predict SIBO and guide a targeted evidence-based dietary approach.

Can SIBO be treated?

In managing patients with SIBO our approach is first to detect and eliminate, where possible any underlying causes and, secondly, to correct any resultant nutritional deficiencies.


Currently conventional medical treatments are limited to antibiotics such as Rifaxamin, Ciprofloxacin and Metronidazole. However, recent studies have shown that similar or better results can be achieved by using specific herbal extracts, and combinations, with strong antimicrobial and anti-inflammatory properties.[3] This is fantastic news for those who cannot tolerate antibiotics or are resistant to them, or simply prefer an alternative approach to pharmaceuticals drugs. In our clinic we use some of these herbal extracts in conjunction with Chinese herbal medicines.


Is Acupuncture effective for digestive health & bowel diseases?

Acupuncture and Chinese herbal medicine have long been used safely to help patients with various digestive complaints, without the adverse effects that are often presented with invasive procedures and pharmaceutical uses.


Although there is still much to learn and understand about the mechanism of action, a number of promising studies, both in humans and animals suggest that acupuncture has the potential to regulate the brain-gut axis, gastrointestinal motility and mucosa, and decrease visceral sensitivity.[4]


The specificity and stimulation of acupuncture points, duration and frequency of treatments are all important factors for the success of the therapy. Therefore, all patients in our care receive a thorough initial consultation that helps us evaluate their health status and design a comprehensive treatment plan which will include multiple courses of acupuncture.


The treatments will reflect your initial diagnosis as a baseline but will constantly evolve to reflect your current presentation at each follow up visit. The selection of points and prescription of herbal medicine will be tailored to your individual needs.


Is diet important in tackling SIBO? What is FODMAP (Fermentable Oligosaccharides Disaccharides Monosaccharides Polyols)?

You may have heard of FODMAP diet from friends or the internet. When people say “FODMAP diet” they usually refer to a diet low in certain sugars that are poorly absorbed and have the potential to ferment in the gut and cause intestinal distress.


Monash researchers have presented evidence from a long-term study that a diet low in FODMAPs – fermentable oligosaccharides, disaccharides, monosaccharides and polyols, effectively reduces symptoms of irritable bowel. Published in the leading and most influential journal in the field – Gastroenterology, the study supports the low FODMAP diet as first-line therapy for IBS and SIBO sufferers.


All our digestive protocols include a dietary component which combines Chinese dietetics principles with low FODMAP guidelines in a multi-step process of elimination, restriction, reintroduction and personalization. If you have a diagnosis of SIBO or IBS ask our SIBO and FODMAP trained practitioners to help you navigate the intricacies of this process and optimize your health.



Written by Dr. Carlea Stan (TCM)

Carleta is Acupuncturist & Chinese Herbalist at Balanced Life Health Care who has an interest in treating digestive complaints including SIBO. She is also is currently undertaking additional training in gastrointestinal health with the Australian College of Nutritional and Environmental Medicine and endeavors to apply functional medicine principles to her practice.


To Book An Appointment with Carleta 


  1. Leite G, Morales W, Weitsman S, et al. The duodenal microbiome is altered in small intestinal bacterial overgrowth. PLoS One. 2020;15(7):e0234906. Published 2020 Jul 9. doi:10.1371/journal.pone.0234906
  2. Takakura W, Pimentel M. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Front Psychiatry. 2020;11:664. Published 2020 Jul 10. doi:10.3389/fpsyt.2020.00664
  3. Chedid V, Dhalla S, Clarke JO, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014;3(3):16-24. doi:10.7453/gahmj.2014.019
  4. Guo Y, Wei W, Chen JD. Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia: A systematic review. World J Gastroenterol 2020; 26(19): 2440-2457 [PMID: 32476804 DOI: 10.3748/wjg.v26.i19.2440]

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