Bloating. It is one of the most common complaints in GP surgeries and yet most people who have it regularly — not just after a large meal, but persistent daily bloating — are told it is normal or given a leaflet about IBS and sent away. It is not normal, and there are specific things driving it that are worth investigating properly.
Small Intestinal Bacterial Overgrowth
Your small intestine is supposed to have relatively few bacteria compared to your large intestine. It is the organ responsible for absorbing nutrients, and bacterial overgrowth in this area interferes with that absorption. SIBO — small intestinal bacterial overgrowth — is a condition where bacteria that should normally live in the colon migrate upward into the small intestine, where they ferment carbohydrates and produce gas as a byproduct. That gas is what causes the bloating, often within an hour of eating.
The conventional diagnostic test for SIBO is a breath test that measures hydrogen and methane gas after a sugar drink. The problem is that this test is not widely available on the NHS, and many private labs charge £200 or more for it. Without the test, SIBO is frequently missed and patients are told they have IBS, which SIBO frequently is misdiagnosed as. The distinction matters enormously because SIBO is a treatable bacterial overgrowth, not a functional gut disorder with no clear cause.
Why SIBO Is More Common Than You Think
SIBO develops when the normal protective mechanisms that keep the small intestine sterile are disrupted. The migrating motor complex — the wave-like contraction of the small intestine that occurs between meals — is supposed to sweep bacteria downward toward the colon. If this MMC is impaired, bacteria accumulate in the small intestine. The MMC is disrupted by proton pump inhibitor use, by low stomach acid, by poor gut motility, and by structural abnormalities in the small intestine. Addressing these underlying drivers is part of effective SIBO management, not just treating the bacterial overgrowth itself.
What You Can Do Today
If you have persistent bloating, particularly if it is worse after eating carbohydrate-rich foods, SIBO is worth investigating. A practical first step is a trial of garlic or oregano herbal protocols, which have reasonable evidence for reducing SIBO bacterial overgrowth. Probiotics specifically tested for SIBO — particular strains of Lactobacillus and Bifidobacterium — can help restore the correct bacterial ecology in the small intestine. And addressing low stomach acid with betaine HCl supplementation (under guidance) can restore the gastric barrier that prevents bacterial migration upward.
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Why SIBO Is More Common Than You Think
SIBO develops when the normal protective mechanisms that keep the small intestine sterile are disrupted. The migrating motor complex — the wave-like contraction of the small intestine between meals — is supposed to sweep bacteria downward toward the colon. If this MMC is impaired, bacteria accumulate in the small intestine. The MMC is disrupted by proton pump inhibitor use, by low stomach acid, and by poor gut motility. Addressing these underlying drivers is part of effective SIBO management.
What You Can Do Today
If you have persistent bloating, particularly if it is worse after eating carbohydrate-rich foods, SIBO is worth investigating. A practical first step is a trial of garlic or oregano herbal protocols. Probiotics specifically tested for SIBO — particular strains of Lactobacillus and Bifidobacterium — can help restore the correct bacterial ecology. And addressing low stomach acid with betaine HCl supplementation (under guidance) can restore the gastric barrier that prevents bacterial migration upward.
Prokinetic agents are an important part of SIBO management that most people do not know about. These are compounds that stimulate the migrating motor complex — the normal wave-like contractions of the small intestine that sweep bacteria toward the colon. Low-dose naltrexone, ginger root, and Iberogast are all prokinetic agents used in SIBO protocols. Without adequate motility, even effective antimicrobial treatment tends to result in relapse within a few months, because the underlying motility problem that allowed SIBO to develop in the first place remains unaddressed.
FODMAPs deserve mention in any honest discussion of bloating. Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols — the FODMAPs — are a group of carbohydrates that some people cannot digest properly, and their fermentation by gut bacteria produces gas as a byproduct. The low-FODMAP diet has strong evidence for IBS symptoms including bloating. But it is a diagnostic tool, not a permanent diet — cutting out FODMAPs long-term reduces microbiome diversity, which is itself harmful. The correct approach is an elimination and reintroduction protocol, not permanent restriction.
Low stomach acid is one of the most common and least discussed contributors to bloating and gut discomfort. It is counter-intuitive — surely high stomach acid causes the burning associated with acid reflux? But the reality is that low stomach acid is more commonly associated with bloating, gas, and the sense of food sitting in your stomach after meals, because without adequate acid, the mechanical digestion of food in the stomach is impaired. Stomach acid also provides a barrier against bacteria entering from the mouth and oesophagus, and without it, bacterial overgrowth in the stomach can occur — a distinct condition from SIBO but producing similar symptoms.
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