How We Treat SIBO

Digestive health · SIBO and IBS

By Brehan Crawford, L.Ac., MAcOM · Licensed acupuncturist, Crawford Wellness · Updated October 2026

“How do you treat SIBO?” is the question that follows anyone living with the discomfort and disruption of small intestinal bacterial overgrowth. SIBO, often the hidden culprit behind digestive trouble and frequently tangled up with irritable bowel syndrome, needs a layered approach. Here are the simple, evidence-based strategies we actually use in clinic.

The single habit I ask every SIBO patient to change first.

Understanding SIBO

SIBO, small intestinal bacterial overgrowth, arises when excessive bacterial growth occurs in the small intestine, where bacterial counts are meant to be low. The overgrowth disrupts the balance of gut flora and gives rise to bloating, pain and changes in bowel habit. There are three subtypes, hydrogen, methane and hydrogen sulfide, and each behaves differently; I explain them in The Three Subtypes of SIBO.

The IBS and SIBO connection

Irritable bowel syndrome and SIBO share strikingly similar symptoms: abdominal discomfort, bloating and changes in bowel habit. Some studies suggest that as many as 80% of people diagnosed with IBS may also have SIBO. The connection deepens when you look at what aggravates both. Slowed gut motility creates an environment where bacteria overgrow, and certain dietary choices feed those bacteria, intensifying discomfort and complicating management of both conditions.

Diet and food for SIBO

A well-considered diet plays a central role. The goal is to restore or maintain a balanced community of gut bacteria. Elemental diets and low-FODMAP diets have shown promise for symptom reduction, but they are not ideal long-term solutions. In my practice I advocate a different emphasis: the thermal nature of foods. The premise is simple. Favour warmth over cold dampness. Choose foods and drinks that warm the digestive system and help keep bacterial populations in check.

“I often advocate for a different approach that focuses on the thermal nature of foods.”

— Brehan Crawford, L.Ac., MAcOM

The low-FODMAP diet

The low-FODMAP diet is one of the most extensively studied diets for SIBO and IBS. It reduces fermentable carbohydrates that aggravate symptoms. Typical choices include meat, fish, eggs, gluten-free crackers, oatmeal and unsweetened cereal from low-FODMAP grains, with fruits like blueberries, grapes, oranges and strawberries.

The elemental diet

The elemental diet is a distinctive strategy used primarily for SIBO. Unlike the others, it is not for long-term management. It involves consuming pre-digested nutrients in liquid form, effectively starving the bacteria in the small intestine for a short, defined period.

The thermal diet

Alongside these approaches, the thermal nature of food matters. To reduce SIBO symptoms, steer clear of foods that are “cold and damp” and opt for warming foods and drinks, which help maintain a favourable environment in the digestive tract.

Warm water

One of the most straightforward and effective strategies is what you drink and how you drink it. Put aside the habit of slowing your digestion and chilling your insides with ice. Drink warm water. Overlooked in most routines, it is a cornerstone of how we work with SIBO. (More in Surprising Benefits of Warm Water.)

Warm water studies

It sounds simple, but the evidence is not trivial. Studies on water temperature, gastric motility and energy intake help explain why it works. One finding is unequivocal: consuming water at 2°C (35.6°F) significantly reduces energy intake, and the reduction is closely linked to a decrease in gastric motility (read the study).

Abdominal massage

Abdominal massage, usually associated with comforting colicky infants, offers real benefits for adults with SIBO. Research points to its usefulness for constipation, diarrhea and abdominal pain. I demonstrate the technique in a short video on how to rub your tummy correctly.

Tummy rub for constipation

Research has shown abdominal massage to be an effective remedy for constipation, a common SIBO symptom. The gentle rubs help retrain the muscles responsible for bowel movements, reducing constipation and associated pelvic and abdominal discomfort. Massage promotes contractions in the large intestine, moves waste through the gut and shortens transit time.

Tummy rub for diarrhea

If diarrhea is your main concern, there is evidence here too. A study titled “Abdominal massage alleviates functional diarrhea in immature rats via modulation of intestinal microbiota and tight junction protein” found that massage significantly eased functional diarrhea by modulating the microbiota and tight junction proteins, increasing beneficial bacteria and decreasing harmful strains. Research in rats with IBS-D showed that continuous abdominal massage reduced stool consistency scores and improved visceral hypersensitivity by regulating the PI3K-Akt pathway.

Tummy rub for IBS and MCAS

For people with mast cell activation syndrome alongside SIBO, abdominal massage may help stabilise mast cells. A study titled “Abdominal massage improves the symptoms of irritable bowel syndrome by regulating mast cells via the tryptase-PAR2-PKCε pathway in rats” found that massage reduced mast cell recruitment and improved IBS symptoms.

Gentle abdominal massage every day is a soothing, evidence-based practice that puts some control back in your hands.

Further reading: Abdominal massage therapy for chronic constipation · The effect of abdominal massage on constipation (Gastroenterology Nursing) · Effects of abdominal massage in management of constipation: RCT · Abdominal massage, constipation and quality of life in older adults: RCT · Experiences of abdominal massage for constipation · The use of abdominal massage to treat chronic constipation · Abdominal massage, constipation and quality of life

Herbal teas for SIBO relief

Ginger and peppermint take centre stage here. Two kitchen herbs with real properties for SIBO symptoms, and chai brings both together.

Ginger

Ginger is more than a culinary delight. The study “Pharmacological basis for the medicinal use of ginger in gastrointestinal disorders” lays out the science. Ginger has prokinetic effects: it enhances gastric motility, which means better movement of food through the digestive tract and less opportunity for bacterial overgrowth. Ginger tea, or fresh ginger in your cooking, is an easy way in.

Peppermint

Peppermint is another ally. The study “The effect of peppermint oil on peristalsis during gastroscopy” found that peppermint oil significantly increased the frequency of peristalsis in the stomach and duodenum, the wave-like contractions that move food along. For SIBO that matters, because stagnant food is a breeding ground for bacteria. (Peppermint is also one of the 16 botanicals in Chorus; see Relief from IBS-C with Peppermint.)

Chai tea

Chai often contains ginger, peppermint and other gut-friendly herbs, warm and flavourful. Ginger leads as a digestive aid. The black tea base has its own evidence for digestive health. And the spices, cinnamon, cardamom and clove, support digestion, ease bloating and settle nausea. (Background: Healthline on chai and Pacific College on chai for digestion.)

The power of Chorus

When it comes to managing SIBO and IBS, the right support changes everything. For about 90% of my patients with these digestive challenges, that support is a formula called Chorus, sold today as Gut Harmony: a blend of 16 herbs, each chosen for a specific digestive job. Here is what makes it a standout for SIBO.

• Breaking down biofilm. SIBO often involves stubborn biofilms, protective layers bacteria build that make treatment difficult. Chorus includes herbs that loosen these films, opening the path to relief. (See What is Biofilm?.)
• Calming the gut-brain axis. The gut-brain connection is real, and the calming herbs in Chorus address the tension that turns a stressful week into a flare.
• Nourishing your microbiome. Chorus includes herbs rich in prebiotic fibre and polysaccharides that feed your beneficial gut bacteria.
• Easier digestion. One of its most appreciated qualities is helping break down foods that are typically hard to digest, so everyday meals stop being a gamble.

The complete herb list, grouped by job, is in the Gut Harmony ingredient journal.

“I've learned that simple lifestyle changes complement the benefits of Chorus. A short walk after meals has improved my digestion significantly. Opting for warmer foods and drinks, instead of cold ones, has made a noticeable difference in my comfort.”

— Tasha, Chorus customer

Tasha describes what changed for her.

Questions people ask

Do I need a SIBO breath test first?

It helps. The hydrogen, methane and hydrogen sulfide subtypes respond differently, and knowing which one you have shortens the road. If testing is not available, the thermal diet, warm water and massage are safe to start regardless.

Is low-FODMAP forever?

No. It is a symptom-reduction tool, not a long-term diet. Use it to calm things down, then rebuild variety as motility and the microbiome recover.

How long before Chorus helps?

Many people notice digestion changes within one to two weeks. For SIBO, plan on three months with the diet and habits above alongside it.

More on SIBO

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