Hannah Boyd
Naturopath, Herbalist, Nutritionist, BA, Adv Dip Nat, Nut, WHM.
Certified Microbiome Analyst & Healthy Gut Practitioner
As a naturopath I’m always thinking “Could your gut-related symptoms be SIBO?” Most people who end up being diagnosed with Small Intestinal Bacterial Overgrowth (SIBO) didn’t walk in asking about it. They come to us for bloating that won’t settle, energy that’s dropped off, skin that’s stopped behaving, or a digestive system that’s felt “off” for longer than they can pinpoint, often after months, sometimes years, of being told it’s just stress, just IBS, or just something to manage. It’s rarely SIBO itself that brings someone through the door. It’s what SIBO’s been quietly causing.
This is where thorough case-taking earns its keep. Rather than treating symptoms in isolation, we look at the full pattern: timing, triggers, history, what’s already been tried and didn’t work. It’s often that deeper investigation that uncovers SIBO as the missing piece other approaches have overlooked. If any of this sounds familiar, it might be worth asking the question directly.
Common Symptoms of SIBO
SIBO doesn’t always look like classic digestive trouble; it can show up in ways that seem unrelated to your gut at all, which is part of why it’s so often missed or misdiagnosed as IBS. Symptoms to watch for include:
- Bloating, especially soon after eating
- Excessive gas or burping
- Abdominal pain or discomfort
- Diarrhoea, constipation, or alternating between the two
- A feeling of fullness that lingers long after meals
- Reflux or heartburn that hasn’t responded well to standard treatment
- Fatigue or brain fog
- Nutrient deficiencies, particularly iron or B12, that don’t have another clear cause
If several of these sound familiar, particularly if you’ve already been told “it’s just IBS” and standard treatment hasn’t shifted things, SIBO is worth investigating properly rather than continuing to manage symptoms alone.
Causes of SIBO:
Your SIBO symptoms may seem totally random to you, but it will have started somewhere.
- Impaired Motility: Conditions that slow down the movement of food through the digestive tract, such as intestinal dysmotility or structural abnormalities, can predispose individuals to SIBO.
- Anatomical Abnormalities: Certain anatomical factors, such as intestinal strictures or surgical alterations, can contribute to the development of SIBO.
- Medications: Some medications, particularly those that affect gut motility or stomach acid production, may increase the risk of SIBO.
- Underlying Conditions: Conditions such as Irritable Bowel Syndrome (IBS), coeliac disease, or diabetes can be associated with SIBO.
Diagnosis and Treatment:
- Breath Testing: Hydrogen and methane breath tests are commonly used to diagnose SIBO by detecting gases produced by bacteria in the small intestine. We recommend doing a test checking against all three possible sugars, which is a frustrating test to do, but it really removes false negatives AND false positives, which narrows our treatment options and helps you recover quicker.
- In Australia mainly use Steam Diagnostics for a 2-sugar test of Lactulose & Fructose get great results. We also recommend purchasing a FoodMarble (which we can get with a discount for patients) – which means you can keep retesting as your treatment progresses.
- Antibiotics: Treatment can involve a course of antibiotics to reduce bacterial overgrowth, with rifaximin being a commonly prescribed option. However, research shows that the impact of this treatment is often short-lived and more additional support is needed.
- Dietary Changes: Following FODMAP diets is really popular for SIBO, however, we find that there is less need for dietary changes and restrictions in managing SIBO, as new research shows that dietary changes alone do not remove the SIBO.
- Prokinetics: Medications that improve gastrointestinal motility may be prescribed to prevent bacterial regrowth.
- Probiotics: Certain probiotic strains may help restore a healthy balance of gut bacteria, although their efficacy in SIBO treatment is still being studied.
- Targeted Herbal Antimicrobials: We are cautious about the herbal medicines we prescribe to treat SIBO – they need to be specific and selective to reduce compromising digestive microbiota even more.
The New Leaf Way with Naturopathic SIBO Treatment
SIBO is a complex gastrointestinal disorder that can significantly impact a person’s quality of life. Prompt diagnosis and appropriate management, including herbal antibiotics, dietary adjustments, and other interventions, are essential in effectively managing this condition and alleviating its symptoms. If your symptoms seem like SIBO, consult with a naturopath at New Leaf for proper evaluation and treatment.
Supporting gut health is the starting point for managing so many conditions, so it’s a special area of interest for us. That’s why Hannah has gained her certification as a Microbiome Analyst and Healthy Gut Practitioner.
Don't like smoothies, or berries or yogurt - chat to us about how we can fix your gut with food!
A few more important SIBO-related questions
Is rifaximin available in Australia for SIBO?
Yes. Rifaximin is available here and is one of the more commonly prescribed antibiotics for SIBO, largely because it stays in the gut rather than getting absorbed into the bloodstream. It’s prescription-only, usually from a GP or gastroenterologist, and isn’t currently subsidised on the PBS for SIBO specifically. And it’s worth asking about cost before you commit to a course.
Can a naturopath treat SIBO, or do I need a GP or gastroenterologist?
Yes, a naturopath can diagnose and treat SIBO. But sometimes patients see both. Antibiotic treatment usually sits with a GP or gastroenterologist. As naturopaths, we treat SIBO effectively using herbal antimicrobials (ones that are targeted without causing more bacterial damage to your gut). With a more holistic approach, naturopaths can support you through that process, working alongside antibiotics if you need them, and handling the bit that often gets skipped: why this happened in the first place, and the follow-up plan to stop it coming straight back.
What's the difference between SIBO and IBS?
IBS is a diagnosis of exclusion, basically, “your gut isn’t working properly and we’ve ruled out anything more sinister.” SIBO is one of the actual, testable causes hiding underneath a lot of IBS diagnoses. If you’ve been told “it’s just IBS” and never actually been tested for what’s driving it, that’s exactly the gap this closes.
What are the side effects of SIBO antibiotics?
Rifaximin is generally well tolerated since so little of it gets absorbed systemically, but nausea, bloating, or changed bowel habits can still happen, and some people notice a brief flare before things improve as bacteria die off. Run any side effects past your prescribing doctor rather than Dr Google.
Do I need a breath test to diagnose SIBO?
Pretty much, yes. Breath testing measures the hydrogen and methane gases bacteria produce in your small intestine, and it’s currently the standard way to diagnose SIBO. In Australia we use providers like Steam Diagnostics for a two-sugar (lactulose and fructose) test, and FoodMarble for at-home monitoring. Not a perfect tool, but the best one we’ve got.
Can SIBO cause constipation, or just diarrhoea?
Both, annoyingly. SIBO gets talked about as a “diarrhoea thing,” but methane-dominant SIBO is strongly linked to constipation, and plenty of people swing between the two. If your bowels don’t fit neatly into one box, that’s not you imagining it, it’s actually pretty typical.
What is IMO (intestinal methanogen overgrowth), and is it different to SIBO?
IMO is SIBO’s less famous cousin. Instead of bacteria overgrowing, it’s methane-producing organisms called archaea. It’s picked up on the same breath test, tends to show up as constipation-dominant, and often needs a slightly different treatment approach. If your SIBO test came back clear but your symptoms haven’t budged, this is worth asking about specifically.
Do I need antibiotics for SIBO, or can it be treated naturally?
Depends on severity and what’s actually driving it. Antibiotics like rifaximin work well for a lot of people, but they don’t fix whatever caused the overgrowth, which is why SIBO has a frustrating habit of coming back. Targeted herbal antimicrobials can be a genuine alternative or follow-up here. But “natural” doesn’t mean “gentle” or risk-free, so it’s worth doing under guidance rather than winging it with whatever’s trending on TikTok.
What are mild or easy-to-miss SIBO symptoms?
Not everyone with SIBO has dramatic gut symptoms. Fatigue, brain fog, reflux that won’t respond to the usual treatment, and nutrient deficiencies (especially iron or B12) with no clear cause can all be SIBO quietly doing its thing in the background. If your bloodwork’s “fine” but you don’t feel fine, it’s worth digging further.
