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SIBO (Small Intestine Bacterial Overgrowth) is a condition that presents differently in each individual based on their unique microbiota and life experiences. SIBO is characterized by an overgrowth of commensal bacteria in the small intestine.


Commensal is characterized by a symbiotic relationship in which one species is benefited while the other is unaffected. In the large intestine bacteria create essential vitamins and short chain fatty acids.


Small intestine bacterial overgrowth usually occurs due to a disruption in the cleaning action wave known as the migrating motor complex (MMC.)


When bacteria (and/or archaea) either do not properly move through the small intestine or they might ‘reflux’ from the large intestine into the small intestine. The bacteria may then overpopulate and produce gas/es that lead to the multitude of unpleasant signs and symptoms of this condition.


Common digestive signs and symptoms present as changes in bowel function such as constipation, diarrhea or mixed stool consistency. It may also be unexplained mild to severe abdominal pain and / or abdominal bloating and distention, passing gas and / or burping or even very minor gastrointestinal distress.




  • Abdominal Pain
  • Abdominal bloating and distention (visible or nonvisible)
  • Acid Reflux (GERD) or Neutral Reflux
  • ADHD
  • Bad Breath
  • Belching
  • Brain Fog / Difficulty Concentrating
  • Cyclic Vomiting
  • Constipation
  • Diarrhea
  • Easily satieated / Feeling of fullness
  • Excessive Hunger or Thirst
  • Gas – Passing Wind or Foul Smelling ‘like rotten eggs’
  • Nausea
  • Weight Gain / Inabilty to lose weight
  • Weight Loss / Cachexia


SIBO is associated with a variety of common chronic conditions such as gastroesophageal relfux disease (GERD), elevated blood pressure, cholesterol and / or blood sugar levels.


It is also associated with chronic conditions such as Fibromyalgia, Systemic Exertion Intolerance Disease (previously known as Chronic Fatigue Syndrome), Diabetes, Hashimoto’s, Lyme, Autoimmune conditions and many more.


Allergies, asthma, eczema, food sensitivities and ‘leaky gut’ are also associated with SIBO.


The staggering increase in cesarean section births has lead to an increased propensity to develop SIBO in both the mother and child!


A variety of associated conditions are commonly present in individuals with SIBO and/or risk factors for having an altered migrating motor complex (MMC.)


Although patients typically come to me with digestive complaints as their primary concern, they are often pleasantly surprised by the resolution of other conditions post SIBO and continued MMC risk factor management.


Below you will find a list of some of these associated conditions that can be improved or resolved by addressing SIBO.


  • Anxiety
  • Allergies
  • Autoimmune Diseases
  • Backache
  • Fatigue
  • Headache
  • Celiac Disease
  • Constipation
  • Crohn’s Disease
  • Depression
  • Diarrhea
  • Difficulty With Weight
  • Frequent Infections
  • IBS – Irritable Bowel Syndrom
  • Lactose, Fructose, & Sucrose Malabsorption
  • Nutrient Deficiencies
  • Post Radiation / Post Surgery
  • Heart palpitations (feeling like your heart skips a beat or is fluttering)
  • Sexual problems, such as pain during intercourse or reduced sexual desire
  • Sleeping problems (insomnia)
  • Urinary symptoms (frequent or urgent need to urinate, trouble starting the urine stream, trouble emptying your bladder).
  • Unpleasant taste in the mouth



The current best diagnostic testing involves consuming a lactulosesolution, a non-digestable synthetic sugar.


Lactulose is not to be confused with lactose, a disaccharide sugar derived from galactose and glucose found in dairy products such as milk.


Lactulose requires a prescription from a physician.


Gases from the person’s breath are measured at baseline and after drinking the lactulose solution at set times over three-hours during this non-invasive breath test. Hydrogen and/or methane are produced by the microorganisms bacteria and archaea and are measured in the patient’s breath.


In the future, more gases may be measured, ensuring better outcomes.


Contrary to popular belief, SIBO cannot be detected by an colonoscopy, or stool testing. The gold standard assessment is via an endoscopic aspirate. However that only detects bacterial overgrowth in the first 6 inches of the duodenum. The entire small intestine is compose of the duodenum, jejunum and ileum collectively and the length is 15 – 20+ feet depending on the person.



Did you know that the latest research has shown food poisoning and / or traveler’s diarrhea to be a leading cause of damage to the migrating motor complex (MMC) and subsequent development of SIBO?


Symptoms often do not present immediately after the incident, but instead, can occur years later.


Additionally, a variety of other risk factors and underlying mechanisms can lead to an individual developing SIBO. This is where treating SIBO truly requires clinical art as well as understanding of the cutting edge science. Treatment of SIBO requires addressing the overgrowth and preventing recurrence.



Typically, a variety of strategies for dealing with Small Intestine Bacterial Overgrowth must be utilized including:


  • Pharmaceutical antibiotics, elemental formula or botanical antimicrobial treatment.
  • Customized strategy based on your genomics to optimize the correction of nutrient deficiencies and ‘leaky gut’, evaluate eating plan and enhance lifestyle changes.
  • Uncover and process potential mental and emotional triggers.
  • Properly address small intestine motility, leaky gut and more!


To determine the risk factors that may be pertinent to your unique microbiome and speak with Dr. Keller today!

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Schedule with Dr. Melanie Keller today!

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