Treating SIBO and Its Comorbidities

The overgrowth of bacteria in the small intestine can be caused by many factors and is associated with several health issues. Small intestinal bacterial overgrowth (SIBO) can be detected with a simple hydrogen breath test, but which food plans work best for restoring balance in the gut microbiome?

Restoring normal flora populations may dramatically improve health and eradicate a range of symptoms.1,2 In a small study of obese children with SIBO, there was an increased risk for developing non-alcoholic fatty liver disease.3 The study concluded that the relationship between intestinal dysbiosis and diet can influence the gut-liver axis.3 In a study of adults undergoing gastric bypass surgery, SIBO was found in 15% of patients before surgery and up to 40% afterward in Roux-en-Y gastric bypass (RYGBP) patients. 4 It was also associated with lower weight loss.4

Small studies have found SIBO present in populations with pediatric obesity,5 papulopustular rosacea,6 spinal cord injury with deep vein thrombosis,7 active H. pylori infection,9 and chronic pancreatitis.9 In an interesting contrast, researchers who found a lower prevalence of SIBO in type 1 diabetes patients suggest this may be due to nutritional interventions in the management of the disease.10

Nutritional interventions that reduce the fermentation of carbohydrates in the gut can help restore a healthy balance among gut bacteria. Because of the diverse comorbid conditions associated with it and response to therapy, properly addressing SIBO may require individualizing interventions and tailoring treatment to address lifestyle factors and nutritional needs.

In this video, IFM educator Thomas Sult, MD, discusses nutritional interventions for depriving bacteria that cause SIBO of fermentable foods:

IFM Educator Thomas Sult, MD, describes how he thinks about diet for patients with SIBO.

Join IFM at the GI Advanced Practice Module (APM) to learn clinically useful techniques for addressing all types of gastrointestinal issues. In addition to the latest research, you’ll also learn about how to develop individualized treatment protocols using lifestyle, diet, nutraceuticals, pharmaceuticals, and botanicals to help restore gut health.

Register for the GI APM


  1. Leventogiannis K, Gkolfakis P, Spithakis G, et al. Effect of a preparation of four probiotics on symptoms of patients with irritable bowel syndrome: association with intestinal bacterial overgrowth. [published online March 5, 2018]. Probiotics Antimicrob Proteins. doi: 1007%2Fs12602-018-9401-3.
  2. Krajicek EJ, Hansel SL. Small intestinal bacterial overgrowth: a primary care review. Mayo Clin Proc. 2016;91(12):1828-1833. doi: 1016/j.mayocp.2016.07.025.
  3. Belei O, Olariu L, Dobrescu A, Marcovici T, Marginean O. The relationship between non-alcoholic fatty liver disease and small intestinal bacterial overgrowth among overweight and obese children and adolescents. J Pediatr Endocrinol Metab. 2017;30(11):1161-1168. doi: 1515/jpem-2017-0252.
  4. Sabate JM, Coupaye M, Ledoux S, et al. Consequences of small intestinal bacterial overgrowth in obese patients before and after bariatric surgery. Obes Surg. 2017;27(3):599-605. doi: 1007%2Fs11695-016-2343-5.
  5. Guercio Nuzio S, Di Stasi M, Pierri L, et al. Multiple gut-liver axis abnormalities in children with obesity with and without hepatic involvement. Pediatr Obes. 2017;12(6):446-452. doi: 1111/ijpo.12164.
  6. Agnoletti AF, DE Col E, Parodi A, Schiavetti I, Savarino V, Rebora A, Paolino S, Cozzani E, Drago F. Etiopathogenesis of rosacea: a prospective study with a three-year follow-up. G Ital Dermatol Venereol. 2017;152(5):418-423. doi: 23736/S0392-0488.16.05315-3.
  7. Cheng X, Zhang L, Xie NC, Xu HL, Lian YJ. Association between small-intestinal bacterial overgrowth and deep vein thrombosis in patients with spinal cord injuries. J Thromb Haemost. 2017;15(2):304-311. doi: 1111/jth.13583.
  8. Enko D, Kriegshäuser G. Functional (13)C-urea and glucose hydrogen/methane breath tests reveal significant association of small intestinal bacterial overgrowth in individuals with active Helicobacter pylori infection. Clin Biochem. 2017;50(1-2):46-49. doi: 1016/j.clinbiochem.2016.08.017.
  9. Therrien A, Bouchard S, Sidani S, Bouin M. Prevalence of small intestinal bacterial overgrowth among chronic pancreatitis patients: a case-control study. Can J Gastroenterol Hepatol. 2016;2016:7424831. doi: 1155/2016/7424831.
  10. Adamska A, Nowak M, Pi?aci?ski S, et al. Small intestinal bacterial overgrowth in adult patients with type 1 diabetes: its prevalence and relationship with metabolic control and the presence of chronic complications of the disease. Pol Arch Med Wewn. 2016;126(9):628-634. doi: 20452/pamw.3501.

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