SIBO Diagnosis and Treatment

Do you feel annoyed you can’t eat/drink/live with digestive freedom like your friends/family?

You might have SIBO…

This is the second of two articles all about Small Intestinal Bacterial Overgrowth (SIBO), so first check out the first article: Got SIBO?

How do I test for SIBO?

The best test for SIBO available now is the 3-hour lactulose breath test. 

SIBOHow does it work?

Because humans do not absorb lactulose, it remains in the digestive system all the way through the small intestine.

When there is overgrowth of hydrogen-producing bacteria in the small intestine, these bacteria will eat the lactulose and produce hydrogen.  And, when there is overgrowth of methane-producing bacteria, these bacteria will eat the hydrogen and produce methane.

The test measures concentration of both of these substances in the breath every 20 minutes for 3 hours to diagnose bacterial overgrowth throughout the entire small intestine.

It is important to test for both hydrogen and methane because a hydrogen-only test could be falsely negative if there are methane-producing bacteria that consume all the hydrogen (leaving little to none left in the measured breath).

It is also important to test for 3 hours to ensure that cases of SIBO in the distal (furthest part) of the small intestine are not missed.

How can I treat SIBO?

Every patient is different, so treatment and long-term resolution of SIBO involves tailoring a treatment plan to you.  To get the most out of treatment while expending the least time, effort, and money, it is important to work with a Naturopathic Doctor trained to diagnose and treat SIBO who can monitor you properly.

Treatment consists of 3 phases:

SIBO1. Preparation Phase

The Preparation Phase is 2 weeks long initially (then continues through the next phase) and involves preparing the body to handle the eradication of bacteria.

When active SIBO treatment begins, it is not unusual for patients to experience “die-off” symptoms, such as fatigue, irritability, nausea, headaches, muscle aches, etc.

During this phase we use dietary recommendations, herbs, and nutritional supplements to support the body’s elimination and detoxification mechanisms in order to minimize adverse effects during the next phase.


2. Eradication Phase

The Eradication Phase is 4-6 weeks long and involves the use of antimicrobial herbs to eradicate bacterial overgrowth in the small intestine.

Patients are often surprised to learn that during this phase, you DO NOT have to follow a restrictive diet!  It is in fact better to be eating a diverse diet, including foods that may irritate you during this phase in order to be able to observe how well eradication is working via improvement of symptoms.

During this phase, I follow up with patients every couple of weeks to assess efficacy and manage any adverse effects of treatment.

3. Recovery Phase

The Recovery phase is 6-8 weeks long and is the MOST IMPORTANT of the 3 phases because it is during this phase that we restore the normal function of the digestive system to prevent relapse in the future.

This phase involves following the Anti-SIBO diet while using nutrients and herbs to improve function of the migrating motor complex (MMC), heal the gastrointestinal tract, and resolve other digestive issues such as low stomach acid, gallbladder insufficiency, and yeast overgrowth if necessary.

Check out my short video on SIBO:


What come next after treating SIBO?

Once SIBO has been successfully treated and symptoms alleviated, patients gradually return to a healthy diet, including food choices and eating habits that support normal digestive function.

Other basic digestive support via herbs and/or nutrients may also be indicated to maintain digestive health.

Think you might have SIBO?

Contact me at one of my clinic locations to get tested!


  1. Got SIBO? - Dr. Kate Whimster, Toronto Naturopath - October 19, 2016

    […] This is the first of two articles all about Small Intestinal Bacterial Overgrowth (SIBO), so also check out the second article: SIBO Diagnosis & Treatment. […]

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