4 Pillars of SIBO Support
Jannika is a Functional Nutrition Counselor specializing in gut health and chronic digestive issues like bloating, constipation, IBS, SIBO, and IBD. Through personalized, holistic care and functional lab testing, she helps women take control of their health and overcome debilitating symptoms once and for all.
If you’ve been struggling with chronic bloating, constipation, diarrhea, or unexplained digestive distress, you may have heard of Small Intestinal Bacterial Overgrowth (SIBO). SIBO is a complex condition that occurs when bacteria that should primarily reside in the large intestine migrate to the small intestine, leading to uncomfortable and often debilitating symptoms. If you want to learn about the most common (and overlooked) symptoms, as well as co-conditions linked to SIBO, I talk about this in my last article which you can read here.
While everyone’s experience with SIBO is different, it is widely regarded as one of the more challenging conditions to treat, with relapse affecting up to two-thirds of SIBO patients. If SIBO returns after treatment, it’s a sign that the underlying cause wasn’t fully addressed. That’s why working with someone who takes the time to assess your full health history is crucial in identifying the root cause and preventing recurrence.
Healing from SIBO requires a comprehensive approach, one that goes beyond just food and supplements. In this article, I’ll walk you through the four foundational pillars of SIBO support that need to be addressed so you can approach healing in a way that actually works.
Pillar 1: Diagnosis
There are many things you can do right now to start supporting your gut, but if you’ve been dealing with symptoms for any length of time, the first step is getting a proper diagnosis. Without an accurate diagnosis, you can’t make the right changes to truly heal.
I don’t recommend blindly treating SIBO based on symptoms alone for several reasons.
Misdiagnosis Risk: Your symptoms may resemble SIBO, but another condition could be at play, requiring a different approach. Many digestive conditions mimic SIBO symptoms, including Candida overgrowth, pancreatic insufficiency, and dysbiosis in the large intestine. Treating for SIBO when another condition is at play can lead to ineffective results and prolonged discomfort.
Different Treatment Protocols: There are multiple types of SIBO—methane-dominant, hydrogen-dominant, and hydrogen sulfide-dominant, each requiring a specific treatment strategy.
Overlooking the Underlying Cause: SIBO is often a secondary condition caused by something else (e.g., poor motility, low stomach acid, chronic stress, mold exposure). If you only target bacterial overgrowth without identifying the root cause, relapse is highly likely.
The gold standard for diagnosing SIBO is the SIBO Breath Test. You can order this test from your gastroenterologist. Here’s how to prepare for it:
12 hours before the test: Follow a prep diet consisting of eggs, roasted fish or chicken, and white rice. Only minimal seasonings (salt, pepper, and olive oil) should be used.
12 hours of fasting: After the prep diet, you’ll fast overnight.
Test morning routine: Brush your teeth as usual but wait at least an hour after waking to begin the test.
Breath collection: The test itself involves breathing into a test tube with a straw every 15 minutes for a total of 2 hours and 15 minutes.
Results: Expect to receive results within a week.
Once you have a confirmed SIBO diagnosis and understand whether you have methane-dominant, hydrogen-dominant, or hydrogen sulfide-dominant SIBO, you can take the correct treatment approach.
Pillar 2: Diet
Diet is often the first thing people focus on when trying to manage SIBO, but it alone will not eradicate the condition. While food can be a helpful tool, restrictive elimination diets can easily backfire, putting people in a downward spiral of fearing food and worsening gut dysfunction. So, of the four pillars I would say this is the least important.
Instead of obsessing over elimination, the goal should be finding balance and removing the most aggravating foods while ensuring you’re still nourishing your body. If you need to follow a SIBO-specific diet for symptom relief, it should be temporary while you work on deeper healing strategies.
Diet plays an important role in SIBO recovery, but it should be seen as a supportive tool rather than a standalone solution. A well-structured diet can help reduce symptoms and provide relief while antimicrobial treatment is in progress. Since antimicrobials can take time to work, diet helps manage discomfort and improve quality of life during the healing process. In some cases, where no other treatment is pursued, dietary modifications alone may provide adequate symptom relief for certain individuals.
Additionally, diet can reduce die-off symptoms during antimicrobial treatment. Starting a SIBO-friendly diet before beginning antimicrobials can help lower the bacterial load, making the die-off reaction less intense. This proactive approach makes the treatment phase more tolerable and reduces the risk of worsening symptoms.
Beyond symptom management, diet is essential in preventing relapse, especially when combined with a prokinetic (a medication or supplement that supports gut motility). Together, these strategies are crucial in tougher cases where SIBO is persistent or recurrent. Lastly, dietary changes can also decrease extra-intestinal symptoms associated with SIBO, such as brain fog, fatigue, and joint pain, further contributing to overall well-being.
Pillar 3: Lifestyle
Healing from SIBO requires attention to your daily habits and environment. This includes:
Sleep quality: Poor sleep disrupts digestion and gut motility.
Environmental toxins: Your skincare, cleaning products, water, and even air quality impact gut health.
Supplements & medication: While some medications can worsen gut dysfunction, targeted supplementation can help restore balance.
The small things you do every day add up. If you’re not addressing lifestyle factors, no amount of diet changes will be enough to fully heal.
Pillar 4: Nervous System Support
If there’s one pillar that determines long-term success in healing SIBO, it’s nervous system support. This means prioritizing emotional health, mindset, and stress reduction. This is the one area of healing that never truly ends.
Here’s why: your body cannot heal if it doesn’t feel safe. A regulated nervous system signals safety to the body, allowing it to function optimally. This means your body can seamlessly adapt to stress. A healthy stress response looks like this: you experience a stressor, your body responds in an adaptive way, and then it returns to parasympathetic mode, the rest-and-digest state where healing occurs.
But when stress becomes chronic, when you’re constantly bombarded by one stressor after another without proper recovery, your body stays in a state of dysregulation. I see this all the time in my clients. Many arrive feeling trapped in stress cycles, worrying about symptoms, fixating on what they can and can’t eat, and developing food fear.
This emotional distress directly impacts digestion. It suppresses gut function, weakens motility (which is already compromised in SIBO), increases inflammation, and keeps the body stuck in fight-or-flight mode. You could take all the right supplements and follow the perfect diet, but if your nervous system is stuck in locked in stress, healing will always feel like an uphill battle.
One of the most powerful shifts you can make? Start viewing your symptoms as messengers rather than frustrations. If every flare-up sends you into a spiral of stress and fear, your body will perceive that emotional distress as a threat, triggering cortisol spikes, increased inflammation, and slowed digestion. This stress response creates a vicious cycle—symptoms worsen, stress increases, and healing stalls.
Mindset is everything. You have to trust in your body’s ability to heal and in the process you’re following. Beyond shifting your mindset, incorporating mind-body practices into your daily routine can make a significant difference. Breathwork, meditation, visualization, and journaling are all simple yet powerful tools that support nervous system regulation and, ultimately, your gut healing journey.
You’re Invited: SIBO Solution Masterclass on March 20th!
In this 60-minute class, I’ll walk you through my complete, step-by-step strategy to address SIBO from every angle — mind, body and gut. You’ll leave with a clear plan, a fresh perspective, and the confidence to take the next step on your healing journey.
Here’s what will be covered:
Testing with clarity: which diagnostic and functional tests truly matter
Root causes revealed: why SIBO happens (and keeps coming back)
Thyroid and SIBO connection: what your hormones have to do with it
Targeted treatment options: hydrogen, methane and hydrogen sulfide each require a unique approach
The right order of operations: the essential step-by-step protocol for lasting results
Emotions & energetics: how unresolved stress impacts your gut healing journey
Diet & lifestyle support: practical strategies to nourish your body
Relapse prevention: How to stop the cycle of SIBO for good
See you there!