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Small Intestinal Bacterial Overgrowth


If you suffer from IBS you may have come across a condition called SIBO (Small Intestinal Bacterial Overgrowth)

This occurs when an elevated number of bacteria are found in the small intestine. Since the small intestine is meant to contain a low number of bacteria, an overgrowth of organisms can lead to symptoms of IBS.

These are symptoms such as:

  • bloating
  • cramping
  • altered bowel patterns (constipation or diarrhoea)
  • unpredictable food reactions

Clues it may be SIBO

In addition to the symptoms of bloating, cramping, abdominal pain and constipation or diarrhea there are additional indicators that SIBO may be present.

  • You feel worse with prebiotics or probiotics.
  • Your bloating starts within 1 hour of eating.
  • Your symptoms started following a case of food poisoning or travellers diarrhoea.
  • The symptoms improved temporarily while on antibiotics for an unrelated problem.
  • Fibre worsens bowel movements.
  • You’re Coeliac yet continue to have symptoms whilst on a gluten-free diet.

Additional symptoms and conditions associated with SIBO

An increasing amount of food sensitivities

Impaired vitamin absorption

Maldigestion of fats

Histamine intolerance

Brain fog

Restless leg syndrome

Acne rosacea


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Underlying Causes of SIBO

Impaired Digestion

Microbiome dysfunction, chronic stress, sIgA deficiency, poor bile flow, low stomach acid.

Altered Motility

Hypothyroidism, diabetes, chronic infection, MMC damage, scleroderma, traumatic brain injury.


Opiates, proton pump inhibitors, tricyclic antidepressants.

Impaired Flow Through the Intestines

Ileocecal valve dysfunction, endometriosis, abdominal surgeries/adhesions, EDS.

Road to resolution

Once we have established the likelihood of an overgrowth of bacteria in the small intestine the approach is 3 fold:

Lower the bacterial load in the small intestine

Support the healing of the gut lining

Address the underlying cause of the overgrowth

Testing for SIBO

The small intestine is a particularly tricky place to get to.  However, one test we can use is the SIBO breath test.

  • The test is performed by drinking a sugar solution which acts as a food source for the bacteria in the digestive system.  When the bacteria come into contact with this sugar solution, fermentation takes place.
  • The gases produced during the fermentation process are then absorbed into general circulation, transferred into the lungs, and then exhaled.
  • Elevated levels of these gases found in breath samples can indicate the presence of SIBO which can then help guide your protocol.
  • These tests can be carried out in your own home with results typically back from the lab within 10 working days.

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IBS is an umbrella term that describes someone’s symptoms. Within this, there are 4 subtypes of IBS.  IBS with diarrhoea, IBS with constipation, IBS with a mix between the 2 and IBS with unclassified bowel movements.

Even though these subtypes give a clearer indication of someone’s symptoms, they go no further to inform us what the underlying issue is.

If you have a diagnosis of IBS we will work to identify and address the underlying issue with the aim of resolving your symptoms.

The SIBO tests measure 2 types of gas, hydrogen and methane. If there are elevations in 1 of these gases, we can name that Hydrogen or Methane SIBO. It’s also possible to have elevations in both gases.

The type of gas that is elevated helps to guide supplement protocols to target the specific organisms that produce that type of gas.

A third type of gas, hydrogen sulfide, can also be produced by gut bacteria. However, it is not currently possible to test for this gas in the UK.

There are 3 components to a supplement protocol to address the elevated bacteria in SIBO.  These can include a combination of probiotics, prebiotics, and antimicrobial herbs.

Depending on the underlying issue (eg. the reasons why the bacteria are there in the first place), additional supplements may be suggested.

SIBO is a bacterial overgrowth in the small intestine with several underlying causes. If we address the underlying cause we are aiming to fully resolve symptoms.

This SIBO test may be offered through the NHS, however, it’s not uncommon for the waiting time for this test to be several months.

By ordering directly from the laboratory, we are able to have the test sent to your home within 3-5 days. The results will be back 7-10 days after the laboratory has received the samples.

To read more about the tests that we often consider, click here.


Supplements are not always needed and their requirement depends on your individual case.

We will discuss appropriate options with you at your first consultation.

The duration of a supplement protocol will vary on your symptoms, the underlying imbalance and any additional factors that may be contributing to your digestive issues.

Generally speaking, 8 weeks is an average time to be on a specific supplement protocol. Following this, a maintenance protocol may be recommended.

The supplements we recommend vary depending on your specific situation and set of symptoms. Common recommendations include probiotics, specific herbal extracts to help rebalance and modify the gut bacteria as well as beneficial, gut-friendly prebiotics.

We direct you to the specific supplements and brands that we know and trust.


We are not doctors and can therefore not officially diagnose your condition.

However, as with the diagnosis of IBS, labels may not always be helpful. By digging deeper and identifying and addressing the underlying imbalances we aim to bring symptoms under control.

We are fully insured Registered Nutritional Therapists with membership through BANT and CNHC, the main governing bodies within the UK.


The initial consultation is 90 minutes long. Here we talk about your symptoms in depth, how and when they started, other contributing factors as well as your current diet and lifestyle.

From this consultation, you will receive your health plan. This will include detailed dietary suggestions, a supplement protocol, recommendations for further testing as well and appropriate lifestyle recommendations.

From this point, we suggest a follow-up appointment every 4-6 weeks to monitor progress and update your health plan.

We find many people can have questions about the approach we take. This is why we offer free 15-minute consultations which can be booked by clicking here.

It is also possible to book for the first in-depth consultation without booking the 15-minute consultation by clicking here.

For more information on the consultations and what is included please click here.

We understand this can feel like a big step and you might not be sure if this is the right approach.

To watch interviews with previous clients click here.

We also offer free 15-minute consultations. This is an initial assessment with one of the team where we will explain our consultation process and answer any questions you may have. You can book this here.

Without knowing more about your specific symptoms this is a hard question to answer.

However, generally speaking, the majority of those that we support typically need 3 consultations, over a 2-3 month period. In more complex cases, longer-term support is also provided.

There are several approaches that often offer symptom relief over a matter of days. While these are not long-term approaches, they can be a way to help ease symptoms and help you feel more comfortable as the underlying issues are identified and addressed.

Alongside these short-term interventions to calm symptoms, we are working to address the underlying issues.

The metric of progress that we use is wanting to see a significant improvement over the treatment window (the time being consultations).