Small Intestinal Bacterial Overgrowth (SIBO)

Small Intestinal Bacterial Overgrowth (SIBO)

Paul A. Goldberg, MPH,DC,DACBN,DCBCN

As a Practitioner of Clinical Nutrition and Functional Gastroenterology, I’ve discussed small intestinal bacterial overgrowth conditions (SIBO) with students and my patients for over thirty years. It has only been in the past couple years, however, that the topic has become popular and can now be found in ads and articles across the Internet written by various SIBO “specialists”.

What is SIBO?

SIBO is a relatively common condition in which the first portion of the small intestine i.e. the duodenum, normally absent of bacteria due to the periodic washing of this area with hydrochloric acid (HCL) from the stomach, becomes overgrown with bacteria. The bacteria change the environment of the duodenum leading to a host of detrimental alterations including digestive and absorptive issues, impaired immune function and often a serious decline in well-being. Patients may in turn be medically diagnosed with various digestive diseases, chronic skin conditions, autoimmune diseases, chronic fatigue syndromes and emotional disorders stemming from the SIBO and treated with drugs missing and complicating the underlying issue(s).

Problems with Antacids and Antibiotics

The massive number of antacid preparations written by gastroenterologists and other medical physicians has assured this problem’s proliferation (see our video “How Ant-Acids Wreck Your Health”). In neutralizing hydrochloric acid (HCL) production, which prevents bacteria from entering the duodenum, they have opened a Pandora’s box for the creation of health havoc. The neutralization of stomach acid creates great difficulties in protein digestion leading to a reduced ability to utilize them for nutrients while increasing the entry of undigested protein molecules through the intestinal membrane into the bloodstream triggering allergic reactions. Mineral imbalances are also likely to occur, as they are dependent in part on HCL for their solubility. Digestion suffers as the pancreas no longer receives stimulation from the HCL Acid Flow (due to the taking of Antacids) which is required to release sodium bicarbonate i.e. the “alkaline tide”.

The digestion of fats and carbohydrates is also hindered with further adverse side effects. The haphazard prescription of antacids has widespread detrimental effects, which patients rarely associate. Prescription and over the counter antacids lead to complex problems for which the patient seeks help from more physicians who in turn prescribe more drugs creating more side effects.

Antibiotics also play a role in the development of SIBO, especially when repeatedly prescribed as is often seen in the patient’s history. Overeating, lack of sleep, poor diet, surgical procedures, emotional stress and other drugs also play important roles in the creation of SIBO.

“The massive number of antacid prescriptions written by gastroenterologists and other medical physicians has assured this problem’s (SIBO) proliferation.”

SIBO Testing

SIBO is a common functional disorder leading to potentially serious consequences. It has traditionally been tested for medically by acquiring samples of duodenal fluid and checking for the presence of bacteria. At the Goldberg Tener Clinic, we conduct a less invasive testing procedure that has the patient utilize a home testing kit, collecting breath samples in tubes over two hours after ingesting a small amount of sugar solution. The air samples are sent to a lab to be analyzed for the presence of hydrogen and methane gases. If little or no gas is revealed, the test is negative. The presence, however, of rising amounts of hydrogen and/or methane gas after the ingestion of the solution is indicative of bacterial colonization of the upper small intestine, an abnormal condition found increasingly in the population. See sample test report to the right indicating Bacterial Overgrowth of the Small Intestine.

Medically, antibiotics are commonly given for this condition. While this can produce short-term improvement, long term this is a slippery slope, particularly as antibiotics were often the reason the problem began. See the video interview below with one of our patients who experienced this all too common scenario.

The approach taken with the patient must not be based solely on a single test result, but determined individually as to what causal factors led to the issue. Cookie cutter protocols for a positive SIBO test are to be avoided, as the results from such a limited approach will rarely be satisfactory as legions of our patients found out prior to coming to our office.

The Internet is full of sales pitches, often touted by young doctors and “SIBO specialists” barely out of school (and/or by supplement companies) in the business of selling products based on trendy health interests. Products such as Bone Broth Powders, Essential Oils, Soil Based Organisms, Collagen Proteins, “Super Greens” etc., are hawked to address the latest popular condition. This practice has a long history to it, including selling products for hypoglycemia, candidiasis, food allergies, adrenal fatigue, etc. over the past several decades. Now comes SIBO for yet another round of product marketing.

SIBO is a real condition that we see commonly, but it is not the cause of itself nor is it caused by a deficiency of any product. The causes behind SIBO must be identified and specifically addressed. The test results should be viewed by the practitioner with other testing procedures combined with an extensive, carefully taken, patient history and physical examination. Each patient requires an individualized plan along with guidance for carrying the plan through in a structured manner to assure long lasting results.

No health restoration program should be based on one factor alone. Practitioners should not be mere showmen selling products; there should be evidence that the practitioner has a high degree of clinical success in working with patients on an individual basis with such issues.

SIBO does not exist in a vacuum. Every patient with this condition has specific reasons for having developed it, their own biochemistry and their own detailed history. All these factors must be considered and acted upon in bringing the patient back to health. When causes are addressed in each case, a high state of reliable health and vitality is achieved and Bacterial Overgrowth is successfully reversed as evidenced by before/after SIBO test results from our Clinic below.

The following are before/after SIBO test results from patients at the Goldberg Tener Clinic. The improvements seen came by addressing causal factors and without the use of drugs or other treatments/therapies. To view more before/after SIBO test results from the Goldberg Tener Clinic archives, click here. 

Before/After: Crohn’s Disease


Before/After: Severe Eczema and Digestive Issues (see case #3)


Before/After: Rheumatoid Arthritis and Digestive Issues


Before/After: Ulcerative Colitis


Before/After: Diabetes, Chronic Indigestion, Chronic Muscular Pain


Before/After: Depression, Chronic Gas and Bloating


Before/After: Rheumatoid Arthritis, Chronic Indigestion


To view more before/after SIBO test results from the Goldberg Tener Clinic archives, click here. 

  • Adam
    Posted at 18:57h, 03 May Reply

    I like the challenge of mainstream treatments of SIBO but I feel that it is not enough to just say that you’re doing it differently to everyone else. It would be good to have some ideas of what you recommended specifically. I appreciate you’re a business and you have a desire to encourage clients to come to you for a consult rather than just see another practitioner who read your protocol examples from case studies. Or just DIY at home. However if you feel people are making mistakes then you cannot see every client in the world. I find myself both inspired and disappointed by your case studies and articles because they never provide information. Only that you know what works and no one else does. There’s an international community of natural practitioners out there looking for more than supplement sales pitches and quick fix protocols. And as someone who is very natural hygiene influenced but feels little choice but to work in a more "modern" naturopathic interventions like supplements and herbs when cases require something extra, I feel like you’re teasing. I would love to know how a modern day natural hygienist successfully maintains that philosophy and still gets results with issues as hard to manage as SIBO.

  • Susie
    Posted at 19:23h, 03 May Reply

    Adam, I am a patient of the Goldberg Clinic and I do understand why they don’t give much information as to the treatment for conditions like SIBO. My SIBO was very severe and I have an extremely sensitive system, so while there were probably some standard approaches to my treatment, it was definitely tailored specifically for me, my body type, and my environmental challenges. For me, diet and supplementation (and supplementation was trial and error for awhile) was a big piece but only got me half way there. I had a severe dust mite allergy that was thwarting my success that needed addressing. I also live in Maine and my body doesn’t tolerate cold well at all, so I was either losing ground or halting progress every winter. Managing these issues as well as my stress levels (adding in massage, meditation, moving to a more pleasant area) all played a significant role. We had to peel the layers away to get there though. In my case, it was just too complicated to give a standard protocol. I had tried standard (natural) protocols before the Goldberg Clinic and many of them made me worse; none made me better. It truly is very individualized. Hope this helps.

    • Jini
      Posted at 20:24h, 03 May Reply

      Thanks so much for sharing the details Susie – your response makes it very clear why each healing journey is individualized. I really benefited from hearing your story – thanks!

    • Dr. Paul Goldberg
      Posted at 04:39h, 04 May Reply

      Thank you for sharing your experience with us Susie!


      Paul A. Goldberg, MPH,DC,DACBN,DCBCN

  • Dr. Paul Goldberg
    Posted at 04:36h, 04 May Reply

    Dr. Goldberg to Adam:

    Thanks you for your comments Adam. I understand your frustration but I think you missed the major thrust of the article which is that SIBO is a symptom representing a range of potential causes and it is those causes that need to be identified if we are to get to the root etiological factors of why each person is ill.

    If you look at the laboratory examples presented, none of those patients had the same causal factors involved and thus each one received a different program to follow. We’ve seen patients with cancer with SIBO, patients with Lupus, RA, Ulcerative Colitis and Crohns, etc., all with SIBO, but none them had the same factors causing it.
    I mention contributing factors e.g. antibiotic and antacid usage. Clearly for those patients getting off the antibiotic and antacid train is critical and for them that is part of the specifics required. For others it might be addressing emotional stress, other drugs, sleep patterns, lack of sunlight, companionship, stressful marriage, excessive work, alcohol or a combination of these and other factors which patient and doctor need to sort out and address.

    If you are a student of Natural Hygiene I suggest you read Dr. Tilden’s "Toxemia Explained" in which he goes over many of the causal factors involved in the genesis of disease. Dr. Herbert Shelton’s excellent works also delve into why we become ill. Ms. Jini Patel of" Listen To Your Gut" has written a number of excellent books and articles along with a great website that delves into causal factors involved with digestive related Issues and offers insights that are used by many people to great practical advantage.

    As a University Professor of Clinical Nutrition and Gastroenterology for thirty seven years I have given long, detailed lectures on numerous digestive/nutrition/immune/endocrine related issues going to great length to help students ascertain the dynamics contributing to them and general approaches regarding their resolution. Nonetheless, a common complaint I received is that I had not "told the students how to fix it". The answer to that is that humans are complex beings and not simply disease entities and while we can learn about diseases affecting people we only learn about the individual with the disease by working directly with that person. The "treatment of disease" in my opinion is generally a losing proposition…we must build health and to do that we must address the causal factors involved and these differ tremendously with each person due to their individual nature and background.

    We do not simply hear the name of a person’s medical diagnosis or the name of a syndrome or symptom they have e.g. SIBO, Candidiasis, Hypothyrodism, IBS, IBD, Psoriasis, Asthma, etc. and go to our file cabinet for a prepackaged program by the same name. Yes, some practitioners do and some patients therefore expect the same from us, but I have found that approach to be sorely lacking.

    The best health care is self care and we try to empower each patient with the tools they need not only to get well but to stay well in the future with minimum reliance on any doctors including us. Initially, however, guidance is needed to ascertain and address the patient’s needs…to help them view their situation objectively and guide them on a program designed to meet their diathesis (genetic background) as well as the lifestyle factors they have immersed themselves in.

    If it sounds like we are trying to "tease" our readership Adam, that is not our intent. We are a clinic and a clinic is indeed a business, but we do our best to empower our patients to get well as quickly as possible and to have the knowledge to stay well after achieving their goals.

    Again thank you for your comments Adam. I hope I helped you to understand our perspective.

    Paul Goldberg

  • Jocelyn Isaza
    Posted at 14:24h, 05 May Reply

    Hello,I was actually given this link via a holistic doctor that I can’t afford to go to, but he feels that this is the issues that are going on with my body as far as sibo. I have had some issues with my stomach & body for sometime now & I would like to speak to you if possible to try to fix what’s been going on for several months with the overuse of antibiotics & what’s been going on since 2013 with the fibromyalgia & what’s been going on with acid reflux/gastritis for years now. I could use a step in the right direction in healing.

    • David Tener
      Posted at 19:03h, 06 May Reply

      Dear Jocelyn:

      We would be glad to assist you. You can email me directly at and I will send you more information about becoming a patient at our clinic. You can also call the clinic at 770-974-7470. Our office manager, Susan, will be glad to discuss the details with you and arrange for an appointment if you wish.


      Dr. David Tener

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