The Case: Melissa is 35 woman experiencing daily stomach discomfort. As each day progressed she got more bloated, gassy, and uncomfortable belly distention. She tried elimination diets and even antibiotics but the bloating kept coming back. The Investigation When Melissa came to me she had already been diagnosed with SIBO (Small Intestine Bacterial Overgrowth). Her doctor prescribed antibiotics and that worked, at first. But, the symptoms came back so I knew we had to get to the root of the problem if we were going to help Melissa stop feeling like she was 4 months pregnant. SIBO is an excessive amount of bacteria in the small intestine. This can cause a variety of symptoms and if left unchecked can lead to more serious concerns. SIBO can also be caused by more serious health concerns. Once considered to be rare, SIBO is now easier to diagnose and it is estimated to affect up to 15% of otherwise healthy people. Dr. Seth Osgood is a board certified family nurse practitioner and Institute of Functional Medicine Certified Practitioner. He specializes in Autoimmune Disorders with specific emphasis on digestive health. It was his own family’s chronic gut issues that swayed him from his traditional medicine path to a functional medicine approach. Bacteria Belongs in the Large Intestine There is a lot of talk about healthy bacteria in the gut. This flora should mainly  live in the large intestine. When it moves into the small intestine, the body is not set up to deal with it and so it ferments and produces gases. This is what causes bloating and that sense that you feel or look pregnant because of the distended belly. Symptoms Range Melissa’s main complaints are common symptoms of SIBO - gas, bloating, and an uncomfortable distended belly. Additional symptoms include diarrhea, constipation, belching, skin irregularities (eczema, rosacea, acne, and weird rashes), abdominal discomfort (sometimes diagnosed as IBS), and weight loss or weight gain.   SIBO is Seldom the Primary Issue A more holistic approach to SIBO will look for the root cause of the bacterial overgrowth. A common cause is low stomach acid (creating an inability to breakdown food). A low functioning thyroid, stress, impaired vagal nerve dysfunction (parasympathetic response), autoimmune issue or nutritional deficiencies can also contribute to the development of SIBO. Low levels of pancreatic enzymes can also make it difficult to breakdown food which leaves the food to putrefy and breed bacteria. Some Pharmaceutical Use Can Lead SIBO Chronic use of antibiotics, non-steroidal anti-inflammatories (like aspirin and ibuprofen) can lead to dysbiosis (a microbial imbalance.  PPI (proton pump inhibitors) is a commonly prescribed acid blocker that decrease the amount of acid in the stomach, so extended use of these can also contribute to SIBO. How to Diagnose SIBO There are a few tests that can be done to confirm SIBO. The gold standard is a three-hour hydrogen breath test. After consuming a sugary water (fuel for the bacteria), the time it takes to produce methane and hydrogen indicates where the bacteria are living - in the large or small intestine. The concentration of the gases is also telling. Additionally, an organic acid test will help determine if the issue is bacterial or fungal or both. A stool test may also help provide a bigger picture of digestive issues. You Can’t Fix SIBO if You’re Not Pooping Failure to clear your bowels on a regular basis leaves too much fuel for bacteria in your small intestine. For some, low motility is a symptom of SIBO but it can also be a contributing factor. In order to solve the gut imbalance, the bowels need to be moving regularly. Options for Treatment Once you have the whole picture and understand (and have dealt with) the root cause, there are several options for treatment. Dr. Osgood and I prefer an herbal approach. There are several combinations but the right one for you is going to be based on what’s working for your body. There is