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SIBO- Small Intestine Bacterial Overgrowth. This is a condition in which the microbiome (bacterial population) in the digestive system is damaged and an overgrowth of pathogenic (harmful) bacteria in the small intestine begins. It is important to note, that this is a symptom of a deeper, multifactorial problem that occurs in the digestive tract, causing these bacteria to get out of control. It is now known that Irritable Bowel Syndrome (IBS) in  4-8% of its cases is caused as a result of it SIBO.

SIBO Doctor Approved

Certified by "SiboDoctor", the international center for the treatment of Sibo by Dr. Nirla Jacobi.

The main causes for SIBO:


 Our colon contains billions of bacteria. Ideally, the small intestine inhabits "Gram-positive" bacteria (such as Blautia, Rumminococcaceae, etc.),  that we live with in peace, and even enjoy their beneficial effect on our health. In a state of imbalance, a proliferation of "Gram-negative" bacteria (such as Enterobacteriaceae, escherichia coli, klebsiella, etc.) begins in the small intestine, as well as "Gram-positive" bacteria that should not be inhabited (such as the Enterococous species, Staphylococcus Streptococcus, etc.).

Some of these bacteria are naturally found in the colon as well as in our mouth, but their presence in the small intestine can certainly be detrimental to our health. This unwanted bacteria usually finds its way from the colon and mouth to the small intestine due to stasis (intestinal immobility), a condition in which there's no normal and smooth movement of food from the small intestine to the large intestine, which naturally raises the level of bacteria in the small intestine. This also causes the migration of bacteria from the large intestine to the small one. 

Stasis can be caused by several conditions:

  • Gastroparesis - a disease in which there is a slow gastric emptying process.

  • Celiac disease (wheat allergy)

  • High levels of LPS - which are toxins that secrete Gram-negative bacteria. These toxins penetrate the brain and impair intestinal motility through the secretion of TNF alpha pro-inflammatory protein. Study 1, Study 2, Study 3. (Read more about LPS).

Sub acidity in the stomach

Every day trillions of bacteria flow from the mouth into the stomach through ingestion of food and saliva, but most of them are eliminated by the hydrochloric acid secreted in the stomach. Hydrochloric acid is a powerful antibacterial acid that protects us from bacteria and infections that enter our mouths. 

When there is an impairment in the production mechanism of the acid, a state of sub acidity is created in the stomach, i.e. an environment that allows bacteria to survive in the stomach and not move on to the small intestine. The main reasons for Hypochloridria are:

  • The presence of the bacterium Helicobacter pylori which secretes ammonia and raises the pH of the stomach (reduces acidity). Study 

  • Antacids pills.

  • Stress.

  • Magnesium and zinc deficiency.

Lack of adequate flow
of bile.

Bile is a fluid that is produced in the liver and stored in the gallbladder. When food reaches the small intestine, the gallbladder secretes bile to help break down food and neutralize the acid that comes from the stomach. Naturally, due to the antibacterial and antimicrobial quality of bile, its proper flow is supposed to eliminate bacteria and infections that manage to survive in the stomach environment. The reason why bacteria that invades the body still manages to survive in the small intestine is an insufficient amount and flow of bile. 

The main causes of וmpaired excretion of bile juices are:

  • Liver diseases, like fatty liver, hepatitis, or any other liver damage.

  • Bile duct obstruction or gallbladder resection.

Impaired flow of bile into the small intestine produces a vicious cycle - an overgrowth of Gram-negative bacteria, which causes the secretion of LPS, their leakage into the bloodstream, damage to the liver and to the bile production what leads to impaired flow of bile into the small intestine and so forth.

Types of SIBO

​There are three types of SIBO. Each type depends on the gas which is been produced by the bacteria in the small intestine.

The main gases produced by gut bacteria include nitrogen, carbon dioxide, hydrogen, and methane. Apart from producing gases, bacteria also consumes gases, mainly hydrogen. During hydrogen consumption, the bacteria releases methane and hydrogen sulfide gases. Hydrogen sulfide is the one with the unique smell of rotten eggs (it is also found in nature in crude oil, volcanoes, and hot springs). Hence, the three existing types of causes are:

01 Hydrogen SIBO - (the most common).

02 Hydrogen sulfide SIBO.

03 Methane SIBO.

Stomach Ache

Symptoms of SIBO:

All types of Sibo have common symptoms that are very similar to those of Irritable Bowel Syndrome, such as gas, bloating, abdominal pain, cramps, diarrhea/constipation, gluten, lactose and fructose intolerance. In many cases, Sibo may also cause other chronic health problems, such as fibromyalgia, chronic fatigue, diabetes, vitamin and mineral deficiencies, skin rashes, allergies, hormonal dysbalances, and brain fog.

However, some symptoms are unique to each type of Sibo:

  • Hydrogen SIBO is more characterized by diarrhea.

  • Hydrogen sulfide SIBO is characterized by diarrhea and gas with a strong sulfur odor.

  • Methane SIBO can also form in the colon and it is characterized by constipation, a very extreme abdominal swelling, it may also affect the stomach, causing reflux and heartburn.​

The similarities between IBS and SIBO are so alike that it explains why so many cases of SIBO are diagnosed as IBS.

If you have tried to treat IBS and have not felt any improvement, the reason might be that you are dealing with SIBO!


Currently, a breath test is the most effective diagnostic test for SIBO, and its purpose is to examine the type and amount of gas produced in the small intestine. 

The test measures the hydrogen gas produced by the bacteria in the small intestine after drinking 50 grams of lactose or lactulose solution dissolved in a glass of water. A breath sample is taken every 15 minutes for a period of 90 minutes. After collecting  the samples, the difference between the gas level at the beginning and at the end of the test is measured. 

Medical Text
Herbs and Spices

Conventional treatment

SIBO is a very challenging phenomenon to treat. The classic conventional treatment for Sibo is antibiotic treatment. The most common Antibiotics which are given are Rifaximin, Ciprofloxacin, and Amoxicillin.

Natural treatment

The natural treatment of the cause in the clinic focuses on a strict dietary change that is adapted to the person's health condition and the type of cause diagnosed. The goal of treatment is to restore the balance of the good bacteria in the gut by "starving" the harmful bacteria, reducing inflammation caused by the secretion of LPS toxins, improving intestinal motility, and addressing the symptoms while nourishing and strengthening the patient.


Medical herbs are a very powerful tool as part of treating SIBO. I see amazing results with medical herbs. The herbs which are the most suitable for Sibo condition are antibacterial, anti-inflammatory, pro-kinetic, and carminative herbs that reduce gas, bloating, and pain and support the immune system.

Sibo is a condition that tends to relapse, hence, as part of preventing its recurrence, it is very important to work on restoring the intestinal mucosa, strengthening its immune function, and supporting the bacteria along the entire gastrointestinal tract. This is done by properly balanced nutrition, herbs, supplements, and healthy lifestyle. Awareness of the main personal triggers which caused Sibo outburst is an essential key in preventing its relapse.

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