A few years ago I had the experience of a ruptured appendix requiring emergency abdominal surgery. This was followed by an abscess and sepsis with high doses of antibiotic therapy. Since this experience I have had continued symptoms of bloating, abdominal pain, and overall energy issues. One of the possibilities of an explanation for these symptoms was small intestinal bacterial overgrowth or SIBO.

Jeff Hunter NP, a Nurse Practitioner and owner of Upstream Functional Medicine, gives us an overall perspective of this condition, as well as causes and treatment.



Symptoms of SIBO


Symptoms of SIBO are bloating 30 minutes after eating, gas and diarrhea. You can also have other associated symptoms that improve after the treatment of SIBO. Abdominal pain, fatigue, brain fogginess, and symptoms stemming from inflammation have been documented as well. Rosacea around the nose can be an indication of SIBO. IBS can be mistaken for SIBO as the symptoms are similar.


Bloating 30 minutes after eating

Abdominal pain



Association between hypothyroidism and SIBO


Over 50% of hypothyroid patients in this study had positive testing for SIBO. An interesting finding was that treating the SIBO did not normalize thyroid function. The researchers were looking for a causative link. It would not appear that the findings suggest SIBO causes hypothyroidism but there is a connection as the control group had ~5% positive testing for SIBO compared to 54% of the hypothyroid group.


Testing for SIBO

Lactulose Breath Test 

This test takes work. You need to be on a specific diet for 24 hours prior to the study. The following morning it will take 2 ½ hours to complete.


Causes of SIBO


Abdominal surgery

Eating food with exposure to pesticides

Gastroenteritis or stomach flu


Treatment of SIBO

Nutritional changes to decrease the ‘feeding’ of the bacterial overgrowth

Elimination diet


Visceral Therapy or Manipulation


Visceral Manipulation


Visceral Manipulation is a manual therapy technique usually performed by Physical Therapists to work on releasing adhesions or scar tissue that is binding the viscera in the abdomen and even to the surrounding fascia such as the psoas muscles. While we can only surmise that we may be improving iliocecal valve function through visceral manipulation as we work in this area, improving abdominal pain as well as seeing the post-treatment benefits of better bowel function do occur. I can tell you from first hand experience that this can be painful, and gentle, slow pressure, working into the areas of restricted movement, is what you want to be successful.


SIBO and Headaches


There is an association of headaches with SIBO but it is felt that this is related to inflammation stemming from dietary or food sensitivities. A post on 'How to End Migraines' , a response to Mark Hyman’s post of the same title, looks at diet and inflammation and how headaches can be treated when the diet is cleaned up and appropriate supplements are prescribed.