Small Intestinal Bacterial Overgrowth (SIBO) means there are too many bacteria in the small intestine, where levels are normally low. These bacteria ferment food early, disrupt digestion and absorption, and can trigger bloating, pain, and fatigue.​

Common symptoms include bloating, abdominal distension, gas, changes in bowel habits (constipation, diarrhea, or both), and abdominal discomfort. Many adults also notice food sensitivities, fatigue, and brain fog that do not match how “healthy” they eat.​

Yes. Symptoms are driven by where bacteria live and how they ferment carbohydrates, not just by food quality. Even nutrient-dense foods can cause gas and bloating if they are fermented in the small intestine instead of the colon.​

As meals build up over the day, more fermentable carbohydrates reach the bacteria, increasing gas. If gut motility is slow, gas and fluid can accumulate, so bloating is often worse in the afternoon or evening.​

SIBO often follows problems with motility, anatomy, or gut defenses, such as prior infections, abdominal surgery, structural changes, or certain medications. If these underlying issues are not addressed, overgrowth and symptoms can return after treatment.​

It is usually both. There is an overgrowth of microbes, but impaired motility, structural issues, or nervous system changes often allow that overgrowth to develop and persist.​

The most common test is a breath test that measures hydrogen and methane (and sometimes hydrogen sulfide) after you drink a sugar solution like lactulose or glucose. Results are interpreted with your symptoms and history because breath tests are helpful but not perfect.​

Yes. Breath tests can miss some cases, depending on the test type, timing, and which gases are measured. Your clinician will also consider other diagnoses and how you respond to treatment, not just a single test result.​

These gases reflect different dominant microbes and patterns. Hydrogen is often linked with looser stools or diarrhea, methane (from archaea) with constipation and slow transit, and hydrogen sulfide with mixed or more sensitive presentations.​

Choice of treatment depends on your symptoms, gas pattern, medical history, prior therapies, and preferences. Some patients do best with prescription antibiotics, some with herbal protocols, and some with a combination plus motility and diet support.​

Yes. Constipation-predominant cases usually need targeted motility support and bowel regimen alongside antimicrobials. Attention to hydration, fiber tolerance, pelvic floor function, and medications that slow transit is also important.​

Some probiotics increase fermentation in the small intestine and can worsen gas and bloating in susceptible people. Strain, dose, delivery, and timing matter, so probiotics are used selectively and often later in treatment.​

Yes, in some patients. Overgrowth can drive inflammation and nutrient deficiencies, and can alter gut-brain signaling, which may affect mood, energy, and cognition. Because these symptoms are not specific to SIBO, other causes are evaluated as well.​

Stress and autonomic dysregulation can slow the migrating motor complex and change gut sensitivity. This can make it harder to clear bacteria between meals and can amplify pain and bloating.​

Effective care usually combines antimicrobials with motility support, individualized nutrition, and gut barrier and microbiome repair. Addressing structural issues, medications, metabolic conditions, sleep, and stress improves long-term outcomes.​

Initial antimicrobial phases often last a few weeks, but rebalancing motility, food reintroduction, and relapse prevention can take several months. Timing depends on severity, underlying drivers, and how you respond.​

Yes. Some patients notice temporary flares when antimicrobials or diet changes shift the gut ecosystem. Your plan is adjusted to keep treatment tolerable while still moving toward symptom relief.​

Relapse prevention focuses on motility, structural and metabolic drivers, and sustainable nutrition. Ongoing work on stress, sleep, bowel regularity, and appropriate movement supports more durable results.​

Yes. Many patients seek care after partial or short-lived responses. Care includes reassessing diagnosis and drivers, then sequencing treatments instead of repeating the same protocol.​

Indigo is an out-of-network, self-pay practice and does not bill insurance for SIBO treatment. You will receive itemized receipts for office visits and in-clinic lab draw fees, which you may submit to your insurance for out-of-network reimbursement if your plan allows.