Small Intestinal Bacterial Overgrowth (SIBO)

Paul A. Goldberg, MPH,DC,DACBN,DCBCN

As a Practitioner of Clinical Nutrition and Functional Gastroenterology I’ve discussed small intestinal bacterial overgrowth conditions (SIBO) with students and my patients for over thirty years. It has only been in the past couple years, however, that the topic has become popular and can now be found in articles and ads across the Internet.

SIBO is a relatively common condition in which the first portion of the small intestine i.e. the duodenum, normally absent of bacteria due to the periodic washing of this area with hydrochloric acid (HCL) from the stomach, becomes overgrown with bacteria. The bacteria change the environment of the duodenum leading to a host of detrimental alterations including digestive and absorptive issues, impaired immune function and often a serious decline in well-being. Patients may in turn be medically diagnosed with various digestive diseases, skin issues, autoimmune diseases, chronic fatigue syndromes and emotional disorders stemming from the SIBO and treated with drugs missing and complicating the underlying issue(s).

The massive number of antacid prescriptions written by gastroenterologists and other medical physicians has assured this problem’s (SIBO) proliferation.

The massive number of antacid prescriptions written by gastroenterologists and other medical physicians has assured this problem’s proliferation (see our video "How Ant-Acids Wreck Your Health"). In neutralizing HCL production, which prevents bacteria from entering the duodenum, they have opened a Pandora’s box for the creation of health havoc. The neutralization of stomach acid creates great difficulties in protein digestion leading to a reduced ability to utilize them for nutrients while increasing the entry of undigested protein molecules through the intestinal membrane into the bloodstream triggering allergic reactions. Mineral imbalances are also likely to occur, as they are dependent in part on HCL for their solubility. Digestion suffers, as the pancreas no longer receives stimulation from the HCL Acid Flow, neutralized by Antacids, which is required to release sodium bicarbonate i.e. the “alkaline tide”.

The digestion therefore of not only proteins but also fats and carbohydrates dependent on adequate enzymatic activity, is hindered, with further adverse side effects. The haphazard prescription of antacids has widespread detrimental effects, which patients rarely associate. Prescription and over the counter antacids lead to complex problems for which the patient seeks help from more physicians who in turn prescribe more drugs creating more side effects.  

Antibiotics also play a role in the development of SIBO, especially when repeatedly prescribed as is often seen in the patient’s history. Overeating, lack of sleep, poor diet, surgical procedures, emotional stress and other drugs also play important roles in the creation of SIBO.


SIBO is a common functional disorder leading to potentially serious consequences. It has traditionally been tested for medically by acquiring samples of duodenal fluid and checking for the presence of bacteria. Less invasive is a testing procedure we conduct that has the patient utilize a home testing kit, collecting breath samples in tubes over two hours after ingesting a small amount of sugar solution. The air samples are sent to a lab to be analyzed for the presence of hydrogen and methane gases. If little or no gas is revealed the test is negative. The presence, however, of rising amounts of hydrogen and/or methane gas after the ingestion of the solution is indicative of bacterial colonization of the upper small intestine, an abnormal condition found increasingly in the population. See sample test report to the right indicating Bacterial Overgrowth of the Small Intestine. 

Medically, antibiotics are commonly given for this condition. While this can produce short-term improvement, long term this is a slippery slope, particularly as antibiotics were often the reason the problem began.

The approach taken with the patient must not be based solely on a single test result, but determined individually as to what causal factors led to the issue. Cookie cutter protocols for a positive SIBO test are to be avoided, as the results from such a limited approach will rarely be satisfactory as legions of our patients found out prior to coming to our office.

The Internet is full of sales pitches, often touted by young doctors barely out of school (and/or by supplement companies) in the business of selling products based on trendy health interests. Products such as Bone Broth Powders, Essential Oils, Soil Based Organisms, Collagen Proteins, “Super Greens” etc., are hawked to address the latest popular condition. This practice has a long history to it, including selling products for hypoglycemia, candidiasis, food allergies, adrenal fatigue, etc. over the past several decades. Now comes SIBO for yet another round of product marketing.

SIBO is a real condition that we see commonly, but it is not the cause of itself nor is it caused by a deficiency of any product. The causes behind SIBO must be identified and specifically addressed. The test results should be viewed by the practitioner with other testing procedures combined with an extensive, carefully taken, patient history and physical examination. Each patient requires an individualized plan along with guidance for carrying the plan through in a structured manner to assure long lasting results.

No health restoration program should be based on one factor alone. Practitioners should not be mere showmen selling products; there should be evidence that the practitioner has a high degree of clinical success in working with patients on an individual basis with such issues.

SIBO does not exist in a vacuum. Every patient with this condition has specific reasons for having developed it, their own biochemistry and their own detailed history. All these factors must be considered and acted upon in bringing the patient back to health. When causes are addressed in each case, a high state of reliable health and vitality is achieved and Bacterial Overgrowth is successfully reversed as evidenced by before/after SIBO test results from our Clinic below. 

The following are a few before/after SIBO test results from patients at the Goldberg Clinic. The improvements seen came by addressing causal factors and without the use of drugs, herbs or other treatments/therapies. To view more before/after SIBO test results from the Goldberg Clinic archives, click here. 

Before/After: Crohn's Disease

Before/After: Rheumatoid Arthritis and Digestive Issues (see case #12)

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Before/After: Severe Eczema and Digestive Issues (see case #1)

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Before/After: Diabetes, Chronic Indigestion, Chronic Muscular Pain

Reversing Crohn's Disease

Case Study: Crohn's Disease | April 2017

Roberta came to the Goldberg Clinic in November 2016 after being hospitalized and diagnosed with Crohn's Disease by a Medical Gastroenterologist. Her lab work at the time showed a C-Reactive Protein of 123.5 (see below) which indicates a very high level of inflammation (normal <10.0). The Gastroenterologist recommended Immuno-Supressant drugs but Roberta declined.

After 6 months of care at the Goldberg Clinic, Roberta is asymptomatic, drug free and reports feeling well overall. Her C-Reactive Protein (see below) is now normal and her recent MRI (see below) from February 2017 shows a "resolution of colonic inflammation" and "no active inflammatory changes."

MRI Report: February 2017

C-Reactive Protein: Before

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High Sensitivity C-Reactive Protein: After

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Case Study: Overweight, High Blood Pressure, High Cholesterol, Fatigue

Weight Gain, High Blood Pressure (Hypertension), High Cholesterol, Fatigue | March 2017

Faith came to the Goldberg Clinic in October 2016 with medical diagnoses of High Blood Pressure and High Cholesterol. She was overweight and experienced significant fatigue. In this video, Faith shares her experience at the Goldberg Clinic and the significant improvement she has made while under our care. She lost 16 pounds and her energy has improved greatly. 

Blood Pressure Before: 160/100
Blood Pressure After: 120/78

Total Cholesterol Before: 248
Total Cholesterol After: 189

Lipid Profile: Before and After

Lipid Profile: Before and After

Bio-Identical Hormones and Anti-Aging Medicine: Quick Fix or Slippery Slope?

Paul A. Goldberg, MPH,DC,DACBN,DCBCN

As the baby boomers reach advanced ages, there has been an upsurge of interest in “anti-aging medicine” and supposed fixes for aging. This has set off a flurry of new products and services to capture the marketplace of a public intent on restoring their youth. A mob of “anti-aging, functional medicine, integrative medicine, complimentary medicine” practitioners are eager to take advantage of them.

I spoke at a conference a few years ago where another speaker gave a speech on “anti-aging medicine,” primarily the topic of "correcting" hormonal imbalances/deficiencies of both women and men by giving Bio-Identical Hormones. I was not impressed. Seminars of this type pushing estrogen like compounds to women, testosterone to men and other glandular compounds including the very widely mis-utilized Thyroid Hormones have now attracted many practitioners looking to expand their practices.

I am concerned that many medical and “alternative” doctors are pushing exogenous hormones without understanding the very serious repercussions that may result. This is being done without addressing the core reasons for premature aging, impaired health and the causal factors needing to be addressed.

I am concerned that many medical and “alternative” doctors are pushing exogenous hormones without understanding the serious repercussions that may result. This is being done without addressing the core reasons for premature aging, impaired health and the causal factors needing to be addressed.

At The Goldberg Clinic we contend that the deluge of hormone based creams, injections and pills being readily taken by an age fearing public consumed with wrinkles, age spots, erectile dysfunction, lack of sex drive and other associated signs of aging, pose potentially serious negative effects to an unsuspecting public clamoring for a quick fix.

Four decades of focusing on patients with chronic disease conditions has made me aware of the numerous factors behind chronic health problems and premature aging. It is of importance that these factors be addressed as opposed to simply applying medical treatments carrying with them potentially harmful side effects. Are we looking to market quick fixes that pose potential health risks to patients or take the time and make the effort to understand and address the causes of our declining health? To put it another we go for the illusionary magic or for the real?

Is Aging Something to be Treated?

Aging is a natural process… not a disease to be treated. Taking hormones of any type can be hazardous to your health by throwing the endocrine system in disarray, whether they be standard or “Bio-identical Hormones,” an enticing but deceptive name. A hormone is a hormone and assuming that tossing hormones into our bodies will restore youthfulness can open a pandora’s box of ill effects.

Repeatedly we have seen women and men with chronic complaints including fatigue, lack of sex drive, aches and pains, depression, etc. and found their histories to include having gone to so called “Functional, Integrative, Alternative, Naturopathic, Complimentary, Holistic” Practitioners or so called “Progressive Medical Centers” and received hormone creams, pellets or injections only to discover that within a short time not only do their symptoms get worse but that others appear as a result of the disarray the exogenous hormones throw their bodies into. See video interview to the right in which a patient discusses some of the problems she experienced taking Bio-Identical Hormones.

Some side effects we have seen patients develop from taking hormones include the patient’s glands decreasing or even halting production of their own hormones resulting in an amplification of the symptoms they started with. In the case of female hormone administration, a greater propensity towards the development of estrogen dependent cancers including breast, ovarian, uterine, and cervical cancer can occur. Taking hormones can present a threat to our well being whether they are called "Bio-identical" or not! 

When we test estrogen derivative ratios (which we often suggest for women), we find that those women with a history of taking Bio-identical Hormones tend to have significantly increased imbalances contributing to the potential development of an estrogen dependent cancer.

Men taking testosterone rarely achieve the results they seek (despite slickly produced advertised claims to the contrary) and often experience side effects, including not addressing the causes of the low testosterone levels. When testosterone or other hormone levels are low, the overall health needs to be looked at carefully and the causes for poor health identified and addressed. When we have the opportunity to do this and the patient follows through, hormone levels tend to normalize, blood sugar levels improve, weight balances, depression lifts, vitality soars and the patient’s appearance looks dramatically younger and fresher…all this in our clinic assessed and documented by both laboratory evaluation and patient reports. (see video interviews to the right)

Our method? An evaluation including an extensive case history looking at all aspects of a patient’s health, a physical examination and appropriate standard and functional laboratory analysis to determine individual needs followed by guidance and monitoring as the patient puts their plan into action. Causes Identified, Causes Addressed…Health Restored. Going for the real rather than quick and dangerous “treatment” fixes. Is there effort on the part of the patient involved? Of course...but the long lasting results are well worth it.

Keeping on top of our hormones and taking appropriate steps as we age to keep them balanced and retard the aging process requires addressing individual factors that influence health rather than fixes and fads. Reasonable methods of health evaluation and sensible ways to address hormone levels that have become imbalanced due to aging, stress, chronic illness or improper use of hormones and other drugs are available. Improve and protect your health by identifying and addressing causal factors and then taking the appropriate steps to achieve a high state of vitality.

The Goldberg Clinic

Allergies: Obtain Real Improvement Rather than Treating Symptoms

Paul A. Goldberg, MPH, DC, DACBN, DCBCN
The Goldberg Clinic For Chronic Disease Reversal

For those with allergy/immune/autoimmune related issues, the additional burden posed by a cascade of pollens has the potential for stimulating their immune systems and exacerbating problems such as inflammatory bowel diseases, rheumatoid problems, asthma, chronic fatigue issues, etc., to the point that they can be the “straw that broke the camel’s back.

An assault has begun in the U.S. that causes significant hardships to millions of us. This threat comes in the form of trillions of grains of tree, grass and flower pollens that have already begun this year to place many people in a sea of misery.

Those who do not suffer from seasonal allergies can have trouble appreciating the extent of suffering those with these problems endure, ranging from mild discomforts to life threatening issues. For those with allergy/immune/autoimmune related issues, the additional burden posed by a cascade of pollens has the potential for stimulating their immune systems and exacerbating problems such as inflammatory bowel diseases, rheumatoid problems, asthma, chronic fatigue issues, etc., to the point that they can be the “straw that broke the camel’s back.” The relationship between pollen/environmental sensitivities and autoimmune issues is well illustrated by the following case study from the Goldberg Clinic, "A Hard Won Recovery from Crohn's Disease."

In the Southeast U.S. where pollens are particularly high throughout the year, the assault has begun (started in January this year!) and will generally continue at an elevated level till mid-June when a lowering of the tree pollens normally occurs. For many the reprieve will be short as soon afterwards come grass and weed pollens. I have noted, along with other practitioners, an increase in illness and even hospital admissions during the pollen season among those with immune system problems exacerbated by the pollen’s arrival.  

A number of things can be done to help patients with seasonal allergies or with conditions aggravated by them. Most important and often overlooked, is to take steps to improve the general health both prior to and during the allergy season. Behaviors which support the immune system & the gastrointestinal tract  (in which 75% of the immune system resides) and the endocrine system are important in this regard. Those with allergies who enter the pollen season in good health will fare far better than those who enter into the season run down or exhausted. If you have entered the season in poor health, however, there are still measures that can be taken to help you get through the season more easily.

Measures for Patients to Take

1)  Sufficient sleep: Few things will more quickly run down the immune and endocrine systems and make the allergic patient more susceptible to allergic influences, than a sleep deficit. A well-rested person finds their ability to withstand pollens much greater than those who burning the candle at both ends.

2)  Dietary Measures – All nutrients, including fatty acids, protein, vitamins and macro and trace minerals work together in supporting immune, gastrointestinal and endocrine function. Particularly important in allergy support is to maintain stable blood sugar levels and support the endocrine system. Avoiding refined carbohydrates is critical along with maintaining an adequate but not excessive protein intake. The right fats, focusing on the omega six to omega 3 ratio is important. A fatty acid analysis done through The Goldberg Clinic can assess if a patient is at risk in regards to their fatty acid cellular status and then take appropriate steps to correct. Also important is efficient digestion, which we look at carefully from a functional perspective.

3)  Overeating puts additional stress on the liver and overburdens the GI tract making allergic responses more apt to occur and should be avoided.

4)  Supplementation - this should be based on the individual. A hypoallergenic multiple vitamin mineral supplement, extra Vitamin C, appropriate digestive enzymes, and supplements to help stabilize overactive mast cells are worthy of consideration.

5)  Environmental Measures – Avoid being outside during the heaviest pollen periods and shower thoroughly (including washing of the hair) after pollen exposure and prior to bedtime. The use of a room or whole house air filter suitable for removing pollen is often helpful.

6)  Avoidance of Toxins – Alcohol, tobacco, junk foods and many drugs further complicate the body’s ability to deal with the stress of environmental allergens.

7)  Rest, Relaxation and Stress Avoidance – Emotional stressors, particularly when prolonged can deplete our adrenal reserves, further imbalance the immune system, throw blood sugar levels into a tizzy…in short, make us more susceptible to the ravages of the pollen season.

8)  Professional Care – This is the time of year when those patients with allergies are most apt to benefit from spinal adjusting, massage, dietary advice, specific supplement recommendations and general health counseling.  

If over the counter or prescription anti-histamines or steroids are employed, the need for an excellent nutritional program with supplemental protective nutrients becomes much more important as these drugs place additional burdens upon the health of the body. 

The Goldberg Clinic performs comprehensive biochemical analyses including both complete Food and Inhalent Allergy Testing to develop workable solutions to resolving Allergic/Immune issues. See before/after pictures to the right and Allergic/Autoimmune case studies here. Problems with allergies are not just a matter of identifying the allergies, but importantly also addressing the root causes of allergies so that in the future the patient is able to be exposed to allergens without having significant abnormal reactions. Much of this involves improving the patient's general health including digestive and immune functions.

The suggestions discussed can go a long ways in promoting your well being and obtaining additional protection to make the allergy season much more tolerable and both entering and exiting it with a higher level of vitality.  

Paul A. Goldberg, MPH, DC, DACBN, DCBCN
The Goldberg Clinic