Finding a SIBO Doctor: A Comprehensive Guide for Patients

At Dignity Integrative, we've recently seen a number of patients seeking help for persistent gastrointestinal symptoms that haven't responded to conventional treatments. In one case, someone had spent more than a year dealing with debilitating bloating and abdominal pain. If they go to see their gastroenterologist, maybe the result is a diagnosis of irritable bowel syndrome, a prescription for antispasmodics, and a recommendation to reduce stress. Then they're sent home with a pamphlet about the low FODMAP diet.

This story repeats itself in my practice frequently. And many of these cases point to Small Intestinal Bacterial Overgrowth (SIBO), a condition for which functional and integrative medicine doctors are increasingly a wise choice if you are seeking a more comprehensive, sustained approach that goes beyond just a course of antibiotics.

I've spent the past three years specializing in SIBO treatment after completing fifty hours of intensive training under Dr. Nirala Jacobi, one of the world's leading SIBO experts. What I've learned is this: finding the right SIBO doctor makes the difference between years of suffering and genuine recovery.

This guide will help you understand why you might need a SIBO specialist, what to expect from traditional and integrative approaches, and how to make informed decisions about your care. Wherever you are in your SIBO journey, it’s important to understand how to navigate the process of seeking effective care for SIBO-related symptoms.

Why Seek a SIBO Doctor?

People often begin their search for a SIBO doctor when they experience a constellation of gastrointestinal symptoms that don't respond to standard treatments. Common symptoms that may indicate SIBO include:

1. Bloating and abdominal distension

2. Excessive gas

3. Abdominal pain or discomfort

4. Diarrhea, constipation, or alternating between the two

5. Nausea

6. Fatigue

7. Nutrient deficiencies

8. Food sensitivities

9. Skin issues like rashes or acne

These symptoms don't exist in isolation. What makes SIBO particularly frustrating is how it compounds over time. The bacterial overgrowth damages your intestinal lining, which leads to nutrient malabsorption, which weakens your immune system and energy levels, which affects your mental health and resilience. It becomes a cascading system of dysfunction.

I've seen patients who've been struggling for five, ten, even fifteen years before getting proper SIBO testing. During that time, they've accumulated multiple diagnoses—IBS, chronic fatigue syndrome, fibromyalgia, anxiety, depression—each treated separately with different medications by different specialists. What they needed was one doctor who understood that all these symptoms might trace back to bacterial overgrowth in the small intestine.

The Gap Between Gastroenterology and SIBO Treatment

What most people don't realize is that traditional gastroenterology training includes minimal education about SIBO.

Most gastroenterologists receive perhaps a few hours of training on SIBO during their entire residency. The condition is mentioned, the breath test is described, rifaximin is listed as treatment—and that's essentially it. There's no deep dive into the categories of underlying causes, no discussion of why some patients relapse repeatedly, no training in the comprehensive diagnostic testing that reveals the full picture.

This training gap explains why so many patients describe similar experiences: they see a GI doctor, get diagnosed with IBS based on symptoms alone, receive prescriptions that provide temporary relief at best, and end up back where they started within months. The traditional approach to treating suspected SIBO typically involves:

1. Antibiotic treatment: The primary tool used by most gastroenterologists is a course of antibiotics, usually rifaximin. This approach aims to reduce the overgrowth of bacteria in the small intestine.

2. Initiation of a low FODMAP diet to reduce gas producing microbes. Duration of this is often not clearly defined.

3. Limited testing: Many traditional GI doctors will not perform comprehensive gut microbiome testing. They might rely on symptom assessment in combination with a breath test to diagnose SIBO.

4. Symptom management: Focus is often placed on managing individual symptoms rather than addressing the root cause of the bacterial overgrowth.

5. Follow-up care: After antibiotic treatment, follow-up care may be limited, with patients often left to manage recurring symptoms on their own.

6. The doctor isn't incompetent—they're simply working with the tools and knowledge their training provided, which in the case of SIBO, is insufficient.

In contrast, SIBO specialists, whether trained through integrative medicine, functional medicine, or dedicated SIBO certification programs, approach the condition completely differently. We understand that SIBO is almost never just about bacterial overgrowth—it's a symptom of underlying dysfunction that must be identified and addressed for lasting recovery.

Testing for SIBO

The primary tool used by most gastroenterologists to diagnose SIBO is the hydrogen breath test (HBT). This non-invasive test measures the levels of hydrogen and methane gases in the breath, which are produced by bacteria in the small intestine when they ferment ingested carbohydrates. 

The type of gas detected determines which kind of SIBO you have.

There are three main types of breath tests commonly used for SIBO diagnosis:

• Lactulose Breath Test (LBT): This test involves ingesting lactulose, a non-absorbable sugar, and measuring the gases produced as they pass through the intestines. It is particularly useful for detecting bacterial overgrowth in the distal small intestine, as lactulose is not absorbed and can reach the distal parts of the small intestine.

• Glucose Breath Test (GBT): In this test, glucose is ingested, and breath samples are taken to measure gas production. Glucose is absorbed in the proximal small intestine, making this test more suitable for detecting overgrowth in the proximal regions. However, it may not detect distal overgrowth as effectively as the lactulose test.

• Trio-Smart Breath Test: This is the first breath test capable of measuring hydrogen sulfide, alongside hydrogen and methane. It offers a more comprehensive view of the gases produced by intestinal bacteria and can help identify cases of SIBO that might be missed by traditional tests that do not measure hydrogen sulfide.

Breath testing will reveal whether your SIBO is hydrogen, methane, or hydrogen sulfide predominant. Methane-predominant SIBO is now called Intestinal Methanogen Overgrowth (IMO). This is due to the fact that the methane-producing organism (Methanobrevibacter smithii) is not actually a bacteria but something called archaea. These are ancient organisms distinct from bacteria and generally cause more complex gastrointestinal issues than SIBO. 

Beyond breath testing, an integrative medicine approach to SIBO often involves more comprehensive diagnostics. A thorough, comprehensive diagnostic stool analysis can offer valuable insights into your overall gut health, potentially identifying imbalances or pathogens contributing to your symptoms. 

Depending on your specific situation and medical history, an integrative medicine doctor might recommend additional tests to rule out other conditions or pinpoint underlying causes. These could include a small bowel follow-through to check for structural issues, motility testing to assess your digestive system's functionality or tests for nutritional deficiencies. 

By working with an integrative medicine physician, you're more likely to receive this kind of comprehensive testing, which can be crucial in developing an effective, personalized treatment plan. This holistic approach ensures that your care is tailored to your unique needs and addresses the root causes of your symptoms, not just their surface manifestations.

Underlying Causes of SIBO

Integrative or functional medicine doctors offer a more comprehensive approach to treating SIBO, whose causes generally fall into four categories, courtesy of THE SIBO DOCTOR:

Motility Dysfunction: When Your Digestive System Stops Moving Properly

Your small intestine has a natural cleaning mechanism called the migrating motor complex (MMC) that sweeps bacteria downward during fasting periods. If this mechanism fails, bacteria accumulate where they shouldn't be. Motility problems can result from food poisoning (which triggers autoimmune damage to the MMC), hypothyroidism, diabetes, traumatic brain injury, or conditions like dysautonomia.

Structural Issues: Physical Obstacles to Normal Flow

Sometimes the problem is mechanical. Adhesions from abdominal surgery, endometriosis creating blockages, dysfunction of the ileocecal valve (which prevents backflow from the large intestine), or conditions like Ehlers-Danlos Syndrome that affect intestinal structure can all create environments where bacteria accumulate.

These structural issues often require different interventions than other SIBO types. I've referred patients for manual visceral manipulation, worked with surgeons to address adhesions, and developed specialized dietary protocols that work with rather than against structural limitations.

Digestive Deficits: When You Can't Break Down Food Properly

If you're not producing adequate stomach acid, pancreatic enzymes, or bile, undigested food sits in your small intestine, becoming fuel for bacterial growth. Chronic stress suppresses digestive function. Certain medications—particularly proton pump inhibitors taken long-term—create conditions ripe for SIBO development.

This category represents a huge percentage of the SIBO patients I see. They've often been on acid-blocking medications for years for reflux, not realizing those medications are contributing to their worsening digestive symptoms. Treatment requires careful work to restore normal digestive function while managing the SIBO, which traditional approaches rarely address.

Medications: When Your Prescriptions Create the Problem

Opioid pain medications, antispasmodics for IBS, certain antidepressants, and the proton pump inhibitors mentioned above all increase SIBO risk through various mechanisms. This creates a terrible catch-22: the medication prescribed for one condition creates or worsens another.

Identifying the underlying cause isn't academic—it's essential. You can kill the bacterial overgrowth with antibiotics or herbal antimicrobials, but if you don't address why the bacteria overgrew in the first place, you'll relapse. This is why patients who work with SIBO specialists have dramatically better long-term outcomes than those who simply take rifaximin and hope for the best.

The Integrative Medicine Approach to SIBO

Here's why patients might consider a more integrative approach to SIBO treatment:

1. Root cause analysis: Integrative doctors aim to identify and address the underlying causes of SIBO, which may include motility issues, structural problems, or immune dysfunction.

   
   

2. Comprehensive testing: Beyond the standard breath test, integrative doctors use more extensive gut microbiome testing to get a complete picture of your digestive health.

   
   

3. Personalized treatment plans: Treatment is tailored to the individual, often combining conventional methods with natural approaches. The 4R gut healing approach is standard.

   
   

4. Dietary interventions: Specific food plans, such as the low FODMAP diet or elemental diet, may be prescribed to starve out the overgrown bacteria and promote healing.

   
   

5. Supplements and herbs: Natural antimicrobials, probiotics, and supplements to support gut healing are often incorporated into treatment plans.

   
   

6. Lifestyle modifications: Stress management, sleep optimization, and exercise recommendations are typically part of the integrative approach.

   
   

7. Long-term support: Integrative doctors often provide ongoing support, often by partnering with an experienced nutritionist, to prevent recurrence and maintain gut health.

Should You Treat SIBO Yourself?

I understand the impulse to treat SIBO yourself. Information about SIBO is everywhere online—protocols, supplement recommendations, success stories from people who've healed without doctors. Treatment with a SIBO specialist can be expensive if insurance doesn't cover integrative medicine. And after years of doctors who didn't help, the idea of taking control yourself feels empowering.

Here's what I tell patients who ask about self-treatment: yes, some people successfully treat SIBO themselves. But the ones who succeed share certain characteristics—they're highly motivated, they have simple SIBO without complicated underlying conditions, they're skilled at research and protocol implementation, and often, they've already done extensive testing with practitioners so they know exactly what they're treating.

For most people, self-treatment creates more problems than it solves. Here's why:

You can't treat what you haven't properly diagnosed. The symptoms that seem like SIBO might actually be SIFO (fungal overgrowth), parasites, exocrine pancreatic insufficiency, or any number of conditions with overlapping symptoms. Treating the wrong thing wastes time and money while the actual problem worsens.

Breath test interpretation is nuanced. The pattern of gas production throughout the three-hour test provides crucial information about where in your small intestine the overgrowth exists and what type of organisms are involved. Misinterpreting results leads to choosing wrong protocols.

Herbal antimicrobial protocols aren't universally safe. Natural doesn't mean harmless. Some herbs interact with medications, some are contraindicated in certain health conditions, and some can cause significant side effects if used incorrectly. I've seen patients create new problems through well-intentioned but misguided herbal protocols.

You probably won't identify the underlying cause alone. Let's say you successfully kill the bacterial overgrowth using an online protocol. If you haven't addressed why the bacteria overgrew—the motility issue, the structural problem, the digestive deficit, or the medication causing it—you'll relapse. I see patients all the time who've done multiple rounds of self-treatment, feeling better temporarily each time, then watching symptoms return because the root cause remains.

The emotional toll of failed self-treatment is significant. When you work with a practitioner and treatment doesn't work, you can pivot to a new approach with professional guidance. When you treat yourself and fail, it often feels like personal failure, which adds psychological burden to the physical symptoms you're already managing.

None of this means you shouldn't be informed and involved in your care—you absolutely should. But there's a difference between being an educated, active participant in treatment guided by a knowledgeable practitioner and trying to navigate complex digestive pathology alone using information pieced together from blogs and forums.

Finding the Right SIBO Doctor

Start with training and certification. Look for doctors who've completed specialized SIBO training through recognized programs. The most respected is Dr. Nirala Jacobi's SIBO training, which I completed—it's fifty hours of intensive education covering diagnosis, treatment protocols, underlying causes, and prevention strategies.

The Institute for Functional Medicine and the School of Applied Functional Medicine also offer solid SIBO education. Doctors who've invested in this specialized training understand SIBO at a level general practitioners and even many gastroenterologists simply don't.

Consider practitioner type strategically. SIBO specialists come from various backgrounds: integrative medicine physicians like myself, functional medicine practitioners, naturopathic doctors specializing in digestive health, and occasionally gastroenterologists with additional functional medicine training. Each brings different strengths. Integrative MDs can prescribe conventional medications when needed while also using natural approaches. Naturopathic doctors often excel at herbal protocols and dietary intervention. Gastroenterologists bring valuable ability to rule out structural problems through endoscopy.

Read reviews, but read them critically. Look for reviews that discuss the doctor's thoroughness, communication style, and whether patients achieved lasting results rather than just temporary improvement. Be somewhat skeptical of either universally glowing reviews or entirely negative ones—most experienced practitioners have a mix because medicine doesn't work perfectly every time, and sometimes patients and doctors simply aren't good matches.

Have a consultation conversation before committing. Many SIBO specialists, including Dignity Integrative, offer brief initial consultations to determine if you're a good fit for their practice. Use this time to ask about their training, their typical treatment approach, how they handle cases where initial treatment doesn't work, and what kind of follow-up support they provide. A good SIBO doctor will welcome these questions.

Consider the full practice model. Do they partner patients with nutritionists or health coaches? At Dignity Integrative, every patient works with our nutrition coach because I've learned that dietary implementation is where many SIBO patients struggle. Doctors who build comprehensive support into their practice model generally achieve better outcomes than those who only see patients for appointments then send them home to figure out the rest alone.

Insurance coverage is important, but not the only factor. Some SIBO specialists accept insurance; many don't. While cost absolutely matters, also consider that investing in the right practitioner from the start often costs less long-term than years of partially effective treatment, as I discussed earlier. Many practices offer payment plans or sliding scale options worth asking about.

For Maryland and Washington D.C. Area Patients

If you're searching for a SIBO doctor in Rockville, Bethesda, Germantown, Gaithersburg, Olney, or anywhere in the Maryland and D.C. region, Dignity Integrative offers both in-person and telehealth consultations. I completed Dr. Nirala Jacobi's comprehensive SIBO training, we use advanced Trio-Smart breath testing, and every patient partners with our nutrition coach for ongoing support. We offer free fifteen-minute consultations to determine if we're the right fit for your situation.

Final thoughts

Finding the right doctor to treat your SIBO is an important step in reclaiming your digestive health and overall well-being. While traditional gastroenterology can offer important insights and treatments, an integrative medicine approach provides a more comprehensive, personalized path to healing. 

By combining the best of conventional and natural therapies, addressing root causes, and providing ongoing support, integrative medicine offers SIBO sufferers hope for long-lasting relief and improved quality of life. Remember, your journey to digestive health is unique, and working with a knowledgeable, experienced SIBO specialist can make all the difference in your recovery.

Looking for a SIBO doctor? Dignity Integrative offers functional and integrative medicine services in-person in Maryland and communities surrounding Washington D.C., including Rockville, Germantown, Gaithersburg, Bethesda, and Olney. Contact us today for a free 15-minute consultation.