If you regularly deal with bloating, gas, diarrhea, or unexplained weight loss, you might assume it’s irritable bowel syndrome (IBS), a condition that affects roughly 10% to 15% of U.S. adults. Those same symptoms can also point to small intestinal bacterial overgrowth, or SIBO, a gut condition that doctors say is far more common than once believed.
SIBO was long considered rare, mostly seen in people with diabetes or rheumatic conditions, according to Lisa Ganjhu, D.O., a gastroenterologist at NYU Langone. “But there’s more awareness now, and it can be seen in people without those conditions,” she explains. The condition is now diagnosed in a growing number of patients, including those with no obvious underlying disease.
What causes SIBO?
“We all have billions of bacteria in our digestive tract,” Dr. Ganjhu says. SIBO occurs when too much bacteria builds up in the small intestine, or when bacteria normally found in the large intestine ends up in the small one. The root cause is often a problem with “gut motility” — the muscle contractions that move food through the digestive tract. When those contractions fail, bacteria get stuck and start to multiply.
That overgrowth interferes with nutrient absorption. “In people with SIBO, the nutrients in food aren’t absorbed,” Dr. Ganjhu notes. This can lead to weight loss, vitamin deficiencies, and even osteoporosis over time. Many factors can impair gut motility, including chronic conditions like diabetes or Crohn’s disease, previous bowel surgeries, and medications. Experts now recognize that everyday disruptions — alcohol, stress, travel, antibiotic use, and NSAIDs — can also throw off the microbial balance.
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For patients who have been misdiagnosed with IBS for years, a SIBO diagnosis can feel like a breakthrough. The symptoms overlap so heavily that many people never get the right test. They might spend months or years managing IBS with diet changes and stress reduction, when the real problem is a bacterial overgrowth that could be treated with a short course of antibiotics. The confusion means a lot of people are living with a condition they do not know they have.
Diagnosing and treating SIBO
If you suspect SIBO, Dr. Ganjhu advises seeing a doctor before trying to self-diagnose. Bloating can be caused by ovarian cancer or certain medications. “It’s always good to see a gastroenterologist or your primary physician first because you don’t know if the bloating is from SIBO or something else,” she says. Gastroenterologists typically use a breath test to diagnose SIBO.
“The mainstay of therapy is either antibiotics, probiotics, or a combination of the two, along with removal of the offending agent that causes SIBO,” Dr. Ganjhu says.
Dr. Ganjhu also recommends working with a registered dietitian to follow a low-FODMAP diet, which has been shown to help with IBS and SIBO symptoms. The diet restricts certain carbohydrates like beans, onions, garlic, dairy, and apples that can cause gas and bloating. Patients typically eliminate high-FODMAP foods for a period, then slowly reintroduce them to identify triggers. The benefits extend beyond digestion. “By supporting a healthy gut, you’ll also see improvements in other areas of your health since the gut is connected to major bodily functions,” she says. Eating nuts lowers diabetes risk, adding another reason to focus on gut health.
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