SIBO, a common cause of IBS – what can be done?

Mindd Foundation


It is estimated that the global prevalence of IBS (irritable bowel syndrome) is 11% in many populations. And it’s SIBO that may be responsible.

Dr. Nirala Jacobi, BSHc, ND (USA) – Director, shares essential information about SIBO diagnosis and treatment…

The most common cause of IBS is small intestinal bacterial overgrowth (SIBO)—in fact, a whopping 60-80% of IBS is due to this common condition, totaling a possible 500 million people worldwide.

The Quest for Answers on SIBO

Many cases remain undiagnosed, and patients are actively searching for answers online.  According to Google search trends, Australians seem to be at the leading edge of this quest for answers on SIBO – second only to the USA.

The Need for Quality Information on SIBO

Although awareness is growing, there is still a lot of misinformation as to the proper diagnosis, treatment, and management of SIBO.

Importance of Avoiding Relapse

This is a complex condition with a relapse-rate of greater than 60%. The cause of relapse can be multifocal, meaning that in many cases Small Intestine Bacterial Overgrowth is caused by an underlying driver and failure to identify and successfully treat this cause can lead to a revolving door of treatment for many patients.

Common SIBO Patient Statements…

“Doc, I still have symptoms” or “the medicine worked for a while but now I’m back to square one”

Multiple causes of SIBO

The underlying drivers can be many, but one of the leading causes, for many patients is “post-infectious IBS.” Groundbreaking research led by Dr. Pimentel and his team at Cedars-Sinai Hospital in Los Angeles have shown that the usual cleansing mechanism of the small intestine (known as the migrating motor complex) is impaired in patients with this type of IBS due to the presence of auto-antibodies which arise after food poisoning in many people.

This impairment leads to the improper sweeping out of bacteria, resulting in bacterial fermentation in the small intestine. Like a stagnant river leading to algae blooms, a slowed or impaired flow in the small intestine gives rise to bacterial blooms. Patients with IBS symptoms following a case of gastroenteritis are at much high risk of SIBO relapse after treatment without proper management.

Besides post-infectious IBS, other underlying factors in developing SIBO are manifold. The functions of the small intestine can be affected in many ways:

  • Adhesions
  • Other chronic diseases
  • Medications
  • Digestive deficits

Simple Home Test Can Support SIBO Diagnosis

Bacterial fermentation produces hydrogen or methane gas which can be captured with a simple breath test easily done at home. Besides understanding the absolute risk of a gas, breath testing is also essential so that the type of gas can be identified.  Methane dominant patients tend to be constipated, whilst hydrogen dominance can cause diarrhea or constipation in patients.

Treatment of SIBO is highly specific

SIBO treatment varies with the type of gas produced, and usually includes the use of specific antibiotics or herbal antimicrobials followed by prokinetic medication to restore normal motility in the small intestine,  as well as a low fermentation diet.

Research has increased exponentially over the past few years, leading to better understanding and improved clinical outcomes. Many patients are actively looking to find “SIBO-literate” practitioners who understand the nuances of treatment and management.

Practitioners can meet and hear Dr. Jacobi at the MINDD Forum

At the MINDD conference, Dr. Nirala Jacobi will be presenting on how to diagnose and treat SIBO for best patient outcomes properly. It will be great to see Australian practitioners be able to meet the growing public demand for effective treatment.



nirala-jacobiDr. Nirala Jacobi, BSHc, ND (USA) is a researcher, practicing clinician and director of

Mindd Foundation