Small Intestine Bacterial Overgrowth

Dr. Kolotinsky’s Naturopathic Medicine approach to Small Intestine Bacterial Overgrowth (SIBO) can help you understand what’s happening in your body on a root-cause level and give you the tools, education, and treatment options you need to manage your condition, keep it under control and even thrive.

What is Small Intestine Bacterial Overgrowth (SIBO)?

Small Intestine Bacterial Overgrowth (SIBO) is characterized by an abnormally high concentration of bacteria in the small intestine. Some bacteria are always present in the small intestine; however, with Small Intestine Bacterial Overgrowth (SIBO), there is a problematic pathogenic bacterial overgrowth and normal flora from another bodily region, such as the large intestine, interfering with the proper digestion, absorption, and assimilation of the small intestine.

What are the Symptoms of Small Intestine Bacterial Overgrowth (SIBO)?

Small Intestine Bacterial Overgrowth (SIBO) symptoms can include:

  • Gas & Bloating 
  • Abdominal pain & cramps
  • Indigestion & acid reflux
  • Nausea
  • Diarrhea 
  • Constipation 
  • Fatigue
  • Hiccups

There are additional symptoms of Small Intestine Bacterial Overgrowth (SIBO) that may seem unrelated to the gut, including:

  • Acne, eczema, rosacea, & other skin conditions
  • Nutrient malabsorption 
  • Weight loss 
  • Joint pain 
  • Mood changes: Anxiety & Depression
  • Restless legs syndrome
  • Hair loss
  • Endometriosis & other gynecological conditions
Woman bloated lying on sofa

What are the Causes of Small Intestine Bacterial Overgrowth (SIBO)?

Stress can be a significant factor in developing Small Intestine Bacterial Overgrowth (SIBO). The gut-brain axis, the biochemical communication system between the gastrointestinal tract and the central nervous system, explains how stress affects the digestive system. When a person is stressed, the brain sends messages to the stomach to slow down digestion. Specifically, stomach acid production drops, and colon motility slows down. In addition, stress has been shown to negatively affect immune function and increase inflammation, thus creating an ideal environment for Small Intestine Bacterial Overgrowth (SIBO).

Excessive Antibiotic Usage

Antibiotics kill both pathogenic bacteria and the body’s normal, healthy flora. When antibiotics are taken frequently, especially without probiotics, the opportunity exists for typically non-invasive bacteria to create new homes and crowd out the normal flora. This allows harmful bacteria to overgrow, which can lead to Small Intestine Bacterial Overgrowth (SIBO).

Low Levels of Hydrochloric Acid
The stomach’s function of producing hydrochloric acid helps break down proteins and absorb vitamin B12. The resulting acidic environment also serves another purpose: inhibiting the growth of bacteria that would otherwise be harmful. However, when too much acid is produced or insufficient acid is produced (such as in the case of stress, advanced age, prolonged vegetarian or vegan diets, or use of proton pump inhibitors), the pH level of the stomach rises, and bacteria can survive, enter the small intestine and lead to Small Intestine Bacterial Overgrowth (SIBO).

Compromised Immune Function

Usually, our gut’s immune system keeps out invading bacteria by secreting mucus containing immunoglobulins to control bacteria in the small intestines. However, if our immune system is compromised due to stress, taking immune suppressive drugs (e.g., steroids), nutrient deficiencies, or poor sleep habits, the beneficial bacteria that keep harmful bacteria in check can become out of balance.


Dysmotility occurs when the digestive system muscles become impaired and no longer move food waste efficiently. This allows bacteria to attach to the wall of the small intestines and proliferate. Supporting motility is crucial for recovering from Small Intestine Bacterial Overgrowth (SIBO) and preventing relapse. The migrating motor complex (MMC) emits cleansing sweeps along the colon, which are controlled by rhythmic contractions. Other underlying conditions, such as hypothyroidism, diabetes, and lupus, can lead to dysmotility.

Progressive Muscle Relaxation

An Naturopathic Medicine Approach to Treating Small Intestine Bacterial Overgrowth (SIBO)

Conventional doctors will most commonly prescribe antibiotics to treat Small Intestine Bacterial Overgrowth (SIBO). Antibiotics work to kill off harmful bacteria, but they also kill off good, and over time this can lead to further issues with your gut and digestive systems and even more health complications.

Dr. Kolotinsky takes a naturopathic medicine approach to treating Small Intestine Bacterial Overgrowth (SIBO), looking past your symptoms and addressing your health issues from the root.

From Dr. Kolotinsky’s personal experience with Small Intestine Bacterial Overgrowth (SIBO), extensive education, and clinical practice, he recognizes that the best approach to treating Small Intestine Bacterial Overgrowth (SIBO) is through a naturopathic medicine approach that focuses on the whole person, not just the presenting symptoms.

Dr. Kolotinsky considers each individual’s health history, diet, and lifestyle to determine the root cause of their Small Intestine Bacterial Overgrowth (SIBO) diagnosis and how to address it from the inside out.


Herbal antibiotics may be just as effective as conventional antibiotic treatment for the treatment of Small Intestine Bacterial Overgrowth (SIBO), and they have fewer side effects and relapse rates.

Herbal antibiotics used most commonly in treating Small Intestine Bacterial Overgrowth (SIBO) include allicin, berberine, neem extract, wormwood, black walnut, olive leaf, and oregano. Dr. Kolotinsky creates individualized herbal prescriptions for each patient, considering whether your Small Intestine Bacterial Overgrowth (SIBO) is Methane-dominant or Hydrogen-dominant.


Treatment for Small Intestine Bacterial Overgrowth (SIBO) often involves a combination of the Low FODMAP diet and the Specific Carbohydrate Diet (SCD) Diet. The Low FODMAP diet was initially developed as the dietary treatment of Irritable Bowel Syndrome (IBS) and restricted the number of fermentable sugars/sugar alcohol-containing foods, thus reducing intestinal fermentation.

Dr. Kolotinsky uses his nutrition expertise and his knowledge of naturopathic medicine for digestive health to help patients understand what foods they need to eliminate, which ones they can reintroduce, and how to find a balance between the two. In addition to helping patients with the diet plan, Dr. Kolotinsky also works with them on finding ways they can still enjoy their favorite foods while ensuring they stay on track with their treatment plan.

Stress Reduction

Stress management techniques, such as breathing and meditation, are essential for managing and treating Small Intestine Bacterial Overgrowth (SIBO). Stress can be the number one cause of Small Intestine Bacterial Overgrowth (SIBO) by inhibiting recovery and causing relapse.

The “gut-brain axis” refers to how our gut is connected to our brain; it is commonly referred to as “the second brain.” During stress, chemicals in the brain signal our gut to slow digestion by reducing stomach acid production and decreasing colon motility (movement). This combination of changes can create an environment where bacterial overgrowth thrives.
Dr. Kolotinsky works with each patient to create a stress reduction protocol for home use consisting of meditation, breathing exercises, and mindfulness. These protocols are designed to help patients learn how to control the autonomic nervous system and reduce the body’s response to stress. Each protocol includes:
  • A detailed explanation of how these techniques work
  • Instructions on how to practice these techniques at home
  • A list of resources you can use to learn more about SIBO and the mind-body connection
Senior man performing breath test to diagnose SIBO

Lab Testing

There are many different ways to test for SIBO, and while stool testing is common, it cannot diagnose Small Intestine Bacterial Overgrowth (SIBO) because the results of this test mainly reflects the large intestine as opposed to the small intestine.
The most common form of lab testing for Small Intestine Bacterial Overgrowth (SIBO) is the hydrogen breath test (HBT). This test measures the number of hydrogen bacteria produce in your small intestine when they digest lactulose—a sugar found in milk products—and produces gas as they do so. The gas then travels into your lungs, where it can be detected by a machine that measures its concentration over time.
Dr. Kolotinsky stays up to date with the latest Small Intestine Bacterial Overgrowth (SIBO) research and utilizes lactulose breath testing in his practice, the gold standard for Small Intestine Bacterial Overgrowth (SIBO) diagnosis. He will work with you to formulate a treatment plan that’s right for you based on your symptoms, test results, and medical history.
What to Expect
Dr. Kolotinsky offers individual treatment plans tailored to the needs and goals of each individual. During your first appointment with Dr. Kolotinsky, you will fill out paperwork, upload recent labs, and discuss your current state of health. He will thoroughly review your medical history, discuss symptoms, and perform a physical exam to help identify any underlying imbalances and potential health concerns.

Dr. Kolotinsky believes education is key to your healing journey. While working together, you’ll learn how to heal, better listen to your body, understand the signals it sends you, and manage your health through simple and achievable lifestyle changes.

Your Custom Care Plan
Depending on what is uncovered, Dr. Kolotinsky might recommend more comprehensive testing and help devise a treatment plan that includes a custom treatment schedule, supplements, herbal recommendations, dietary modifications, and lifestyle support such as stress management techniques.

In Small Intestine Bacterial Overgrowth (SIBO) patients, Dr. Kolotinsky recommends a combination of probiotics, nutraceuticals, and herbs to replenish the good bacteria in your gut to keep it balanced while fighting the harmful bacteria to reduce inflammation in your digestive tract.

Dr. Kolotinsky also works with you to adopt positive habits to help you feel better overall, help you identify and eliminate foods that may be worsening your symptoms, and incorporate specific recommendations based on your unique needs.
Healing is a process, and Dr. Kolotinsky will be with you every step of the way. The goal is to empower you with the tools you need to thrive. Throughout your ongoing healing journey, Dr. Kolotinsky will recommend regular appointments to provide targeted, personalized, and effective care. You’ll also have ample time to ask questions and voice your needs and concerns, as it’s essential that you’re an active participant in your healing journey.
Dr. Kolotinsky knows what it’s like to feel at a loss, to struggle with agonizing symptoms, and to deal with constant anxiety about finding the nearest restroom. When working with Dr. Kolotinsky, you will learn to see your symptoms as opportunities to become more connected and in-tune with yourself and your body and access the tools to heal and become self-reliant.

Begin the journey of treating your Small Intestine Bacterial Overgrowth (SIBO) naturally.

Book a free 15-minute discovery call with Dr. Kolotinsky to discuss your options for care.
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