SIBO – SIBO: When your bloating isn't "normal"

In short: With SIBO, too many bacteria live in the small intestine. This can cause bloating, fullness and changing bowel habits. A lactulose breath test shows whether SIBO plays a role – treatment depends on what's behind it.

Constant bloating, fullness or digestive problems? SIBO could be the cause.

Many people live for years with a bloated stomach, digestive problems or food intolerances – and keep hearing that “everything is normal”.

But often there's more to it. One possible cause is SIBO – short for Small Intestinal Bacterial Overgrowth.

I see this regularly in my practice. Many people have already tried numerous diets, supplements or therapies without knowing the actual cause of their symptoms.

What is SIBO?

With SIBO, too many bacteria are present in a place where they don't belong: the small intestine.

Normally, most of our gut bacteria live in the large intestine. If they multiply excessively in the small intestine, they start fermenting carbohydrates and other food components too early. This produces gases such as hydrogen or methane – and symptoms right after eating.

Typical symptoms

• Bloating, often worst in the evening
• Fullness even after small meals
• Pressure in the abdomen
• Constipation, diarrhoea or alternating between the two
• Food intolerances
• An IBS diagnosis without lasting improvement
• Tiredness after eating, poor concentration
• Skin problems such as acne or rosacea are sometimes linked to it as well

Many people report that their stomach is fairly flat in the morning and becomes noticeably bloated over the day.

Why does SIBO develop?

SIBO is rarely the actual problem – it's usually the result of a deeper imbalance. Possible causes include:

• slowed gut motility
• chronic stress
• gastrointestinal infections
• low stomach acid
• hormonal imbalances
• chronic constipation
• dysbiosis
• nutrient deficiencies
• previous antibiotic use

That's why simply cutting out certain foods or “fighting the bacteria” is often not enough. The cause needs to be understood.

How is SIBO diagnosed?

The key test is the lactulose breath test. You drink a test solution and give several breath samples over about two to three hours – at home. The lab measures hydrogen and methane. An early rise points to overgrowth in the small intestine.

Why many SIBO protocols fail

Online you'll find countless SIBO protocols, diet plans and supplement recommendations. The problem: not every SIBO is the same.

Some people mainly have hydrogen-producing bacteria, others methane producers. Some also have histamine issues, dysbiosis, fungal overgrowth, hormonal imbalances or impaired gut motility. A standard protocol can work well for one person and do little for another.

The advantage of targeted lab testing

Alongside the breath test, I work with functional lab tests to narrow down possible causes. Depending on the situation, these can include:

• gut microbiome
• digestive function
• inflammatory markers
• metabolic products of the gut flora
• yeasts and potentially harmful microbes
• hormone status
• mineral and micronutrient status

This gives a clearer picture of what is actually happening in the body.

My approach to SIBO

I don't look at SIBO in isolation. Several factors often play a role at the same time: gut health, nervous system, nutrition, hormones, stress, mineral status and lifestyle. That's why I create individual therapy and nutrition plans.

The goal is not just short-term relief, but lasting stability of your digestion.

When should I see a doctor first?

Blood in the stool, unintended weight loss, fever, symptoms at night or severe pain should be checked by a doctor first. Where needed, I work with a GP.

Do you suspect SIBO?

If you suffer from chronic bloating, digestive problems or IBS symptoms, it's worth looking closely at the causes. How I work: Bloating assessment.

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