by Jenny Lelwica Buttaccio
Posted 8/21/20

Does your belly feel bloated more often than not? Is abdominal pain disrupting your life to the point where you have to curb your activities, change up the foods you eat, or trade button-up pants for stretchy ones with a comfy, elastic waistband?

If you answered “yes” to these questions, you’re not alone. However, that doesn’t mean constant bloating and an irritated digestive tract are normal, even for those of us living with chronic Lyme disease or another chronic illness. Instead, these persistent gut symptoms are a sign you may be impacted by a distressing gut problem known as small intestinal bowel overgrowth (SIBO).

To manage and heal from this condition, it’s important to have a better understanding of the factors that foster SIBO, the inner working of your digestive tract, and how the balance of microbes in your body can be tipped from having mostly microorganisms that typically aid in digestion to favoring those that cause an onslaught of symptoms. Here’s what you need to know to restore a healthy gut and get your life back again.
SIBO, Defined

Your gut or gastrointestinal (GI) tract — which consists of the mouth, esophagus, stomach, pancreas, liver, gallbladder, small intestine, colon, and rectum — is home to trillions of microbes known as the microbiome, most of which are bacteria. Bacterial microflora can be beneficial to you because they aid in such functions as digesting food, enhancing immunity, and managing inflammation.

When good bacteria reside in the right locations of your GI tract, you’ll likely have a relatively easy digestive process that you may not even have to think twice about. But if you have an overgrowth of bacteria specifically in the small intestine, conditions are hospitable for the development of SIBO and subsequent disrupted digestion.

Intestinal bacteria, Gut flora

The small intestine is the place where your digestive juices break down the food you consume. From there, nutrients and minerals are absorbed through your gut walls into your bloodstream and delivered to your body’s tissues.

Typically, the small intestine contains very few bacteria because your stomach acid and the speed with which substances move through the small intestine make it an unwelcome environment for most microbes to survive. But there are some exceptions.

“People who have gut dysfunction like SIBO usually have poor gut motility,” says Dr. Bill Rawls, Medical Director of RawlsMD and Vital Plan. “That means that food is slow to make its way through the digestive tract, so it sits in the small intestine where it ferments, produces gas, and irritates the gut.” In short, the inability of food to move swiftly through the GI tract, combined with low concentrations of stomach acids, creates a hotbed for myriad bacteria to flourish.

Unfortunately, in a world filled with gut disruptors like high-carbohydrate foods and acid-reducing stomach medications like Tums or Pepcid, SIBO may be more common than many people realize. However, all roads lead back to the health of your immune system: “If your immune system is disrupted, you’re going to have less ability to keep the microbes in the small intestine or elsewhere in the gut in check,” says Dr. Rawls.

Let’s take a look at some of the symptoms, causes, and natural solutions to improve and alleviate SIBO and support your immune system.

Symptoms of SIBO

The symptoms of SIBO tend to be similar to those experienced with irritable bowel syndrome (IBS). In fact, bacterial overgrowth in the small intestine may be the cause of IBS in some individuals. However, not everyone who has IBS has SIBO and vice versa, suggests a review in the journal Gut and Liver. Estimates vary widely, with anywhere between 4% and 78% of people with IBS also having SIBO.

woman curled up in bed, holding stomach, stomach pain

The biggest symptoms that are attributed to SIBO are gas, bloating, and abdominal pain. The reason? “When bacteria in the small intestine ferments, there’s really nowhere for that air or gas to go, so it becomes trapped, causing intense pressure in your belly,” says Dr. Rawls. “It takes a long time for that gas to get out. Meanwhile, it causes cramping and discomfort.”

The list of top symptoms that might occur as a result of SIBO include:

  • Gas
  • Bloating
  • Abdominal pain
  • Diarrhea
  • Constipation
  • Feeling full
  • Decreased appetite
  • Nausea
  • Fatigue

In more severe cases, SIBO could result in involuntarily weight loss, anemia, or malnutrition.

Causes of SIBO

The three main contributors to SIBO are gastrointestinal dysfunction, low stomach acid production, and poor gut motility, says Dr. Rawls.

“Gastric dysfunction starts in the stomach, and if you don’t have good acid production, you’ll have poor digestion and an ample supply of undigested food to fuel the bacteria in your small intestine,” says Dr. Rawls. Structural issues, like those caused by intestinal scar tissue or diverticulosis (when small, bulging pouches form in the lining of the digestive tract), certainly contribute to gut dysfunction, as do autoimmune diseases such as Crohn’s disease, celiac, and multiple sclerosis.

Slow motility — originating from factors like vitamin deficiencies, medication side effects, and inflammation — along with eating high-carbohydrate and processed foods are chief offenders as well, says Dr. Rawls. Essentially, motility problems hinder digestion, while processed foods feed the bacterial overgrowth.

woman analyzing pills and instructions while laying in bed

Also, if you’ve taken antibiotics for Lyme disease, you may be wondering how likely they are to cause SIBO. Yes, antibiotics disrupt your microbiome’s flora, says Dr. Rawls, but it’s not the only driving agent. Other things that perpetuate gut dysfunction include chronic stress, poor sleep, immune dysfunction, as well as the compromised gut flora and highly-processed dietary considerations already mentioned. In short, it’s often difficult to pinpoint an exact cause for SIBO because there are a multitude of factors that affect gut health.

How to Test for SIBO

An evaluation for SIBO may involve breath or fluid testing. However, testing runs the risk of not being very reliable.

“I’ve found evaluating the symptoms to be most useful,” says Dr. Rawls. “If your belly is taut like a drum, and you have all kinds of cramping, you probably have SIBO.” However, if you’re not able to get a proper diagnosis, or if treatment isn’t producing positive outcomes, testing might be a logical step.

Typical SIBO tests include:

  • Breath test: This test is non-invasive and measures the amount of gas — such as hydrogen or methane — that you exhale after consuming a sugar-water solution. An increase in hydrogen or methane could be indicative of SIBO, though the test lacks some specificity for bacterial overgrowth.
  • Small intestinal aspirate: A sample of fluid is obtained from your small intestine by inserting a tube down your throat and maneuvering it through the upper portion of your digestive tract. Then, the fluid sample is cultured in a lab to watch for the growth of bacteria. There’s a chance this test could yield false positive results in some people, but it is indicated as the gold standard for SIBO testing. However, because of the invasive and expensive nature of it, the breath test is quickly becoming a popular alternative.

Natural Ways to Improve SIBO

There are a variety of natural tools to manage SIBO while also — and most importantly — working to address the underlying causes. It’s crucial to do these two things simultaneously, because the problem will likely come back if you choose an intervention that focuses solely on symptom management.

That’s why the primary conventional treatment for SIBO — antibiotics — really isn’t a great solution. Yes, antibiotics might help decrease the number of bacteria in your small intestine, but they don’t address the underlying reasons for bacteria being there in the first place. And once you stop taking the antibiotics, bacteria will make their way back to the small intestine and continue stirring up painful symptoms if you haven’t dealt with root causes.

While you can’t eradicate every threat to your digestive system, you can work to implement strategies that foster the health of your microbiome and immune system, curtail fuel sources to harmful bacteria, and decrease gut irritation. Luckily, with the right combination of diet, lifestyle modifications, and some herbal therapies, you can combat the discomfort associated with SIBO and restore your overall gut health.

1. Take Gut-Supporting Herbs and Foods.

“When trying to recover from SIBO, it’s important to enhance gut motility and digestion,” says Dr. Rawls. Notably, herbal therapy is well suited for this task, because plants have a variety of built-in antimicrobial, antioxidant, and detoxifying qualities that support the health of your microbiome by shifting the balance in favor of beneficial microorganisms. Additionally, herbs help to normalize immune function, keeping gut microbes in check and managing unpleasant symptoms.

picture split in grid. berberine, dandelion, bitters, ashwagandha, apple cider vinegar

Dr. Rawls’ preferences for herbal therapy for the gut are as follows:

  • Berberine: As an excellent antimicrobial herb, berberine helps knock back pathogens throughout the small intestine and the digestive tract. Found in the stems, bark, roots, and rhizomes of a range of herbs, berberine helps to soothe irritated intestines and normalize bowel movements.
  • Bitters: Bitter herbs stimulate the production of saliva, enzymes, and bile we need for motility and gut function. Bitters that promote digestion include burdock, dandelion, fennel, and ginger. Fresh bitter herbs can make an excellent addition to salads and cooked dishes. However, the herbs are typically available in combination in many digestive support supplements as well.
  • Ashwagandha: This adaptogenic herb has antimicrobial, anti-inflammatory, and immunomodulating properties. Ashwagandha has been used as a medicinal herb in traditional Indian and African medicine for thousands of years. One of the reasons for its appeal is that it’s a multi-use herb that reinforces your resistance to stress, allowing you to cope with stressful circumstances and get a better night’s sleep — two areas of concern that are essential to address healing from SIBO.
  • Hydrochloric Acid (HCL): The less stomach acid you produce, the more trouble you’ll have digesting your food. A supplement containing HCL can be a cost-effective way to augment normal gastric activity and break down your food.
  • Apple Cider Vinegar (ACV): Taken at mealtime, ACV increases the stomach’s acidity for better digestion. ACV contains acetic acid, an antimicrobial agent that may be effective at quelling pathogenic microbes in the gut and reducing inflammation. However, the taste of ACV can be a bit shocking. To make it more palatable, Dr. Rawls recommends consuming 2 tablespoons of ACV in 6 ounces of water with a drizzle of honey.

2. Cook Your Food.

When SIBO (or chronic Lyme!) symptoms flare and you’re uncomfortable or in pain, toiling away in the kitchen over a hot stove might seem like the last activity on your mind. But eating cooked food gives your body a head start on digesting meals, allowing your gut more time to heal and repair.

To make cooking a less stressful part of your day, be sure to stock up on healthy staples (think: quality proteins, vegetables and greens, and healthy fats), have a go-to meal handy for your most challenging days, and prepare in bulk whenever possible. All it takes is a few simple tricks to make cooking a more pleasant experience for you.

3. Reduce Your Eating Window.

Digesting food places significant energy demands on your body. If your eating schedule is such that you’re grazing or snacking throughout the day, you’re not giving your irritated digestive tract a break and might be aggravating SIBO.

antique clock on white plate, beside for and knife

Reducing your eating window and trying to eat less often prevents your small intestine from being inundated with more bacteria, and it allows time for it to empty, take a break, and starve the bacteria of the nutrients they need to flourish,” says Dr. Rawls.

To give your gut ample time to rest, Dr. Rawls recommends a 12- to 16-hour window without consuming food, a method similar to intermittent fasting or mini-fasting. For example, eating all of your meals between 10 am and 6 pm would allow you to have a window of 16 hours where your body can work on digesting the contents of the day and empty the small intestine. A schedule of 7 am to 7 pm would give your body 12 hours to complete the act.

However, a rigid schedule isn’t going to work for everyone, and if you’re really ill, you may not tolerate altering your eating times until you’re further along in your healing. “If you can keep your window at 12 to 16 hours, that would be great. But you have to find what works best for you,” suggest Dr. Rawls. “You have to enjoy life.”

4. Make Time for Sleep.

Sleep is a vital step to improving gut motility, normalizing immune function, and recovering from SIBO. The digestive process takes 6 to 8 hours to move food from the stomach through your small intestine. Therefore, the later you eat, the more your body will divert resources to the process of digestion late into the night, and all that activity can keep you awake.

But it’s also a catch-22: “If you have bad sleep, your body won’t be able to do what it needs to do, including facilitating the digestive process,” says Dr. Rawls.

woman asleep in bed, dark room

So how do you improve your sleep? In addition to reducing your eating window, the following sleep hacks can help:

  • Stick to a sleep schedule, so your body learns the rhythms of day and night.
  • Avoid using electronic devices after 9 pm to cut down on your exposure to stimulating blue light that can interrupt your ability to produce melatonin.
  • Tone down your nervous system and prepare for sleep by doing a calming activity such as gentle yoga, a warm bath, or breathing exercises.
  • Maintain a cool temperature in your bedroom — 67° to 72° is usually conducive to sleep for most people.
  • Wear a sleep mask to block out excess light that can keep you awake at night.

Though SIBO resides in the small intestine, it takes a whole-body approach to care for your gut. “Healing depends on getting things moving again, enhancing digestion, and restoring healthy immune function,” says Dr. Rawls. Support your gut and overall health with soothing herbs, cooking your food, reducing your eating window, and getting enough sleep to jumpstart your recovery.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.
You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.


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3. Rubio-Tapia A, Barton SH, Rosenblatt JE, Murray JA. Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol. 2009;43(2):157-161. doi: 10.1097/MCG.0b013e3181557e67
4. Small intestine aspirate and culture. MedlinePlus website.,of%20bacteria%20or%20other%20organisms.