a proper diagnosis for SIBO matters

Small intestinal bacterial overgrowth (SIBO) is a condition in which there is increase in bacteria in the small intestine, it is also associated with motility problems. Prognosis is poor, dependent upon the underlying condition that led to SIBO.

The pathogenesis of irritable bowel syndrome (IBS), once thought to be psychogenic in origin, is now thought to be caused by multi factors. One of the reasons for this paradigm shift is the realization that gut dysbiosis including SIBO causes IBS symptoms. Between 1% and 78% of IBS patients may have SIBO which is generally misdiagnosed and under diagnosed.

SIBO has many underlying, overlapping and co conditions many of which are serious. SIBO results in the production of many toxins such as H2S, ammonia and other dangerous metabolites. SIBO is also associated with a range of other diseases including obesity, diabetes and heart disease making SIBO a very costly condition.

SIBO affecting both infants and the elderly disproportionately leads to even higher age associated inherent health care costs.

Hydrogen Sulfide (H2S) SIBO

Hydrogen Sulfide (H2S) is a colorless gas that, owing to its sulfur content, smells like rotten eggs and is referred to as “sewer gas.”H2S affects the gut, liver, immune system, nerves, heart, and brain simultaneously. H2S is highly poisonous and the small intestine is much less efficient at detoxifying this gas.

  • H2S is pro inflammatory

H2S affects the gastrointestinal smooth muscle cells and has a pro inflammatory effect. Donation of H2S contributes to chloride secretion, which aggravates certain types of gastritis. An increase in the steady state H2S levels is thought to play a role in the etiology of inflammatory bowel disease and related cancers. H2S has been termed rocket fuel for cancer in some leading university studies. H2S is also a byproduct of dietary sulfate metabolism by gut bacteria. Inflammatory bowel diseases such as ulcerative colitis are associated with an increase in the colonization by sulfate reducing bacteria along with an increase in H2S production.

  • H2S as a gasotransmitter producing oxidative stress
  • H2S can paralyze nerves and has an inhibitory effect on the ileum

Other health effects of SIBO

SIBO can produce a mild chronic encephalopathy.

SIBO related immunodeficiency syndromes – IgA Various immunodeficiency syndromes, such as IgA deficiency, common variable immunodeficiency, AIDS and others, are complicated by miscellaneous infection complications, including SIBO.

SIBO can cause severe malabsorption, serious malnutrition and deficiency syndromes.


Before SIBO was termed SIBO

Serum levels of folate and vitamin B12 may be used to support evidence of bacterial overgrowth in pediatric settings. This ratio was one of the first testing methods used to diagnose SIBO.

Infants who are not breastfed are at an early stage with SRB and with methane-forming bacteria settled.

Due to the difficulty in diagnosing SIBO, emerging molecular techniques in bacterial ‘fingerprinting’ may offer a more reliable way to define microbial populations in intestinal samples.

Cedars-Sinai investigators unveiled a new four-gas breath test device in 2018.

Cedars-Sinai investigators have identified a gas produced in gut that could improve the diagnosis and treatment of patients with two common intestinal illnesses—small intestine bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS). Now a large-scale clinical trial has identified the presence of another gut gas—hydrogen sulfide—among these patients who experience diarrhea. Hydrogen sulfide appears to be linked to diarrhea,” said Mark Pimentel, MD, executive director of the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai.

today 2023

Two bacteria are now known to be the causative agents in SIBO.

E coli and Klebsiella

While both are normal inhabitants of intestinal flora in both humans and animals both are also considered to be contaminants and are associated with poor sanitation. Klebsiella can be a source of hospital outbreaks and food contamination. Both bacteria can be found on various produce, in baby formula and can occur as the result of processing various materials such as wood, paper, or other types of manufacturing. Sewage treatment and soil run off can also contribute to contamination.

E coli shown to be causative agent in SIBO (2023)

date nut muffins

Date Nut Muffins are a classic British teatime treat made with sweet dates and toasted walnuts.

Date nut muffins are a handy variation on date nut bread, which originated in Great Britain (specifically Scotland) as a tea time treat. This recipe uses a small amount of brown sugar.

Recipe link

When it is not SIBO

Dysbiosis may contribute to development of symptoms in a subset of IBS patients. Though SIBO is a form of quantitative alteration of small bowel microbes, altered microbiota (dysbiosis) does not necessarily mean SIBO only. These gases may also be produced in the colon among patients without SIBO in presence of carbohydrate malabsorption.

The fastest way to neutralize H2S – SIBO Recipe how and why it works

A basic chemistry approach to neutralizing H2S helped me understand the powerful and long term effects of this dangerous toxin and its relationship to both SIBO and SAM. Read more….


Intrinsic factors include:

  • Secretion of gastric juice and bile, which have antibacterial effect. 
  • Peristaltic movement preventing adherence of bacteria into the intestinal mucosa.

Extrinsic factors include:

  •  Infants who are not breastfed are at an early stage with SRB (and with methane- forming bacteria).
  • Gastric acid suppressants such as proton pump inhibitors (PPIs), H2 blockers, and antibiotics and drugs altering motility (anticholinergics, and opioids).

a healthy microbiome is necessary to prevent SIBO

Diet is NOT the cause of SIBO


Remember, no more than 6 teaspoons (25 grams) of added sugar per day for women and 9 teaspoons (38 grams) for men. The AHA limits for children vary depending on their age and caloric needs, but range between 3-6 teaspoons (12 – 25 grams) per day. Children under two should have zero grams of sugar per day.

If you like natural health tips like the ones above you can learn more in Immune For Life