A Step-by-Step Guide to Lasting Relief

What Is SIBO?

SIBO stands for small intestinal bacterial overgrowth. Normally, relatively few bacteria live in your small intestine. In SIBO, excessive bacteria build up there and ferment the food you eat—especially certain carbohydrates—producing gases (hydrogen, methane, or hydrogen sulfide) that cause bloating, pain, diarrhea, constipation, and other digestive symptoms.

SIBO is very common. Studies suggest it may be the underlying cause in 60–70% of people diagnosed with irritable bowel syndrome (IBS). Unfortunately, standard treatments have high relapse rates—up to 44% within nine months. That’s why a systematic, step-by-step approach matters.

Our Treatment Approach: Start Simple, Build as Needed

Rather than throwing multiple treatments at SIBO all at once, we follow a principle called Occam’s Razor—start with the simplest, most effective intervention first, then add complexity only when necessary. This stepwise approach consistently yields better outcomes with fewer side effects.

Step 1: Remove the Fuel

The bacteria causing your symptoms feed on certain carbohydrates that are poorly absorbed in the small intestine. The first and most important step is to reduce these “fuel sources.” By starving the overgrowth of its food supply, many patients experience significant improvement before any other treatment is needed.

Dietary Options

Elemental Diet (First Choice) — A specially formulated liquid diet where nutrients are pre-broken down so they are absorbed high in the small intestine, leaving nothing for the overgrown bacteria to ferment. Research shows this approach normalizes breath tests in about 80% of patients after just 14 days—significantly better than the roughly 50% success rate seen with antibiotics alone. A 2025 study confirmed 83% symptom improvement with good tolerability.

Low Fermentation Diet

The Low Fermentation Diet was developed by Drs. Mark Pimentel and Ali Rezaie at Cedars-Sinai Medical Center, two of the world’s leading SIBO researchers. This approach focuses on reducing the specific types of carbohydrates that are most likely to be fermented by bacteria in the small intestine—while still allowing you to eat regular, solid food. One of its most important features is meal spacing: you eat only 3 meals per day, spaced 4–5 hours apart, with no snacking in between. This spacing is critical because it allows your gut’s natural “cleaning wave”—called the migrating motor complex (MMC)—to activate and sweep excess bacteria out of the small intestine between meals. The MMC only turns on during fasting periods, so frequent snacking can actually prevent your gut from clearing itself. Many patients find this diet easier to follow long-term than the elemental diet while still achieving meaningful symptom relief.

Fast Tract Diet

The Fast Tract Diet was developed by Dr. Norm Robillard, a microbiologist who specializes in digestive health. What makes this approach unique is its use of a numerical scoring system called “Fermentation Potential” (FP). Rather than simply listing foods as “allowed” or “not allowed,” the FP system assigns each food a score based on how likely it is to feed bacterial overgrowth—taking into account factors like fiber content, starch resistance, sugar type, and serving size. This gives you much more flexibility and control: you can still enjoy a wide variety of foods as long as you keep your total daily FP points within a target range. Many patients appreciate this approach because it feels less restrictive than a strict elimination diet and helps them understand why certain foods trigger their symptoms. The Fast Tract Diet is available as a book and a companion mobile app that makes tracking FP points straightforward. Like the Low Fermentation Diet, this is a sustainable long-term option if the elemental diet isn’t the right fit for you.

Step 2: Test When Symptoms Are Controlled

Once your symptoms have been stable for at least three weeks, we perform comprehensive GI testing. Testing while you’re still experiencing active symptoms can produce unclear results. Waiting for a period of stability gives us a much clearer picture of what’s actually going on.

We typically use the GI-MAP test, which provides detailed quantitative information about your gut microbiome, and may add additional testing based on your individual situation.

Step 3: Target Treatment Based on Your Results

With clear test results in hand, we can identify exactly what needs treatment and choose the right intervention—rather than guessing. Depending on your results, treatment may include:

• Antimicrobials (herbal or pharmaceutical) for specific infections
• Digestive enzymes if pancreatic function is low
• Targeted probiotics for specific dysbiosis patterns
• Antiparasitic treatment if parasites are identified

This precision approach replaces “shotgun therapy” with targeted, evidence-based interventions.

Step 4: Individualize and Adapt

Every patient is different. While the step-by-step approach works well for most people, some patients—especially those with severe symptoms, other medical conditions, or previous treatment failures—may benefit from a more aggressive approach with multiple interventions at the same time. We will work together to determine the best path for you.

Low-Dose Naltrexone (LDN): A Helpful Tool for SIBO

LDN is a medication I frequently use as part of SIBO treatment. At standard doses, naltrexone is used for addiction medicine. But at very low doses (typically 1.5–4.5 mg), it works quite differently—modulating the immune system and reducing inflammation.

How LDN Helps with SIBO

• Supports immune balance in the gut, which is one of the body’s most important immune-nervous system interfaces
• Reduces gut inflammation through regulation of microglial cells
• Acts as a prokinetic—helping restore the gut’s natural “cleaning wave” (migrating motor complex) that sweeps bacteria out of the small intestine between meals
• This prokinetic effect is especially valuable for preventing SIBO relapse, which is one of the most frustrating aspects of this condition

What Results Can You Expect?

With this systematic approach, we achieve sustained remission in over 90% of patients—compared to the roughly 50% response rate reported with antibiotics alone. The key difference is that we address root causes rather than just suppressing bacterial populations that will inevitably return.

Questions? Contact Us

Dr. Yoon Hang Kim, MD, MPH 

Clinical Website: www.directintegrativecare.com

MD/Independent Practice NP 1:1 Mentorship Program: www.yoonhangkim.com