The basics of SIBO


Normally, bacteria are found in the trillions in the LARGE INTESTINE, where they perform various symbiotic functions for the human body.

SIBO is a condition where bacterial overgrowth occurs in the absorptive area of the body the SMALL INTESTINE.

Watch our short, informative video

SIBO Webinar Update with International Expert


Are you a health professional who is compelled to uncover the root cause of digestive and systemic disease processes for your patients?

Join Dr Nirala Jacobi for the latest updates from the Portland SIBO symposium.

Topics covered include:

  • What causes SIBO?
  • The role of SIBO as an underlying causative factor in common digestive issues, such as IBS, leaky gut, coeliac disease, and more.
  • The connection between SIBO and other conditions such as fibromyalgia, gallstones, acne rosacea, and malabsorption syndromes, to name a few.
  • SIBO: a possible link with Lyme disease?
  • Biofilms and their role in SIBO Environmental toxicity.
  • Natural treatment protocols and maintenance strategies.
  • Dr Jacobi’s personalised and updated Biphasic Diet Approach to SIBO treatment.
  • SIBO When Berberine fails: new herbal considerations
  • A summary of cutting edge SIBO research and information.

Register now for the SIBO Update Webinar 2016

Investment: $50 AUD

Presenter: Dr Nirala Jacobi BHSc ND.
Date: 14 July 2016 7pm AEST
Go2Webinar Link will be sent before the Webinar.
A recording will be sent afterwards to all who register.

BONUS gift

Visit our registration page and you will also receive free access to Dr Jacobi’s 2015 SIBO Webinar.

Key learning objectives:

  • Updated SIBO assessment and treatment
  • New information on the autoimmune link to SIBO
  • Key herbal and conventional strategies
  • Adhesions and restrictions; often a key element in the development of SIBO.

Join Dr Jacobi and expand your patient care with this powerful information.

The SIBO Doctor podcast

Practitioner education and collaboration is the vision of The SIBO Doctor podcast.


SIBO is a condition with multiple causes and contributing factors. Leaky gut, environmental toxins, motility issues, as well as genetic factors, adhesions, and dysregulation of the autonomic nervous system are examples of these factors.

The effective treatment of SIBO often requires the practitioner to understand and integrate a model of interrelated systems.

SIBO may just be one issue in a patient’s overall case – how can we as practitioners understand and prioritise a patient’s treatment appropriately?

The overarching aim of The SIBO Doctor podcast is to be a reservoir of inspirational content to practitioners of integrative medicine.

A place they turn to for new insights, tools and confidence to embrace new paradigms of healing by blending the best of science, and tradition for optimal patient outcomes.

With this Podcast and the website, together with our social media platforms, we hope to cultivate and connect a community of health professionals with the best available information to make sound therapeutic decisions.

Subscribe for The SIBO Doctor Podcast updates from Dr Nirala Jacobi ND so you won’t miss a single episode.

Dr Nirala Jacobi ND – The New SIBO Bi-Phasic Diet Approach

a commentary for practitioners by Dr. Nirala Jacobi ND
Medical Director,

Thai Fish Cakes
As most SIBO practitioners know, the diet for SIBO patients can be very restrictive due to its low fermentable fibre content. Often, patients come in to my office for the first time having self-prescribed the low FODMAP diet and still suffer from SIBO symptoms.

For the past 3 years I’ve been promoting what I call the “SIBO Bi-Phasic diet” in my Webinars, Presentations and Master Classes.  Now I’ve updated the diet, and we’ve added a brand new handout to our website. (Free access, SIBO kit purchase or practitioner registration required).

This diet, as the name implies, has two distinct phases, each lasting an average of six weeks.

Phase One is further divided into restricted and semi-restricted groups to allow for some movement within this phase. Patients typically start with the most restrictive diet and moving through the phases as their symptoms improve.

In the past, I’ve recommended the use of antimicrobials in phase 1 for an average of six weeks, depending on the patient’s hydrogen or methane gas levels.

Though a tough diet to follow, this dietary approach has very successful in the treatment of SIBO for hundreds of SIBO sufferers.


So what is the NEW SIBO Bi-Phasic diet?

SIBO diet handout

My rethinking of this diet has come about through my pondering on Dr Pimentel’s stance on “feed the bacteria whilst you kill them” as well as through a lengthy conversation I’ve had with Dr. Allison Siebecker – both renowned SIBO experts.

“Feed the bacteria whilst you kill them” – is an older concept based on the belief that bacteria go into a state of senescence or hibernation when deprived of a food source. Dr Pimentel therefore advises his patients to not follow any particular diet whilst on Rifaximin or other antibiotics to affect maximum kill rate.

Whilst this argument makes perfect sense, I have not seen this be an effective strategy when using herbal antimicrobials.   The reason may be due to the fact that the average herbal treatment will typically last 4- 6 weeks and I just have a hard time telling gut-sensitive patients to eat a high fermentable fibre diet. In my experience this leads to symptom exacerbation in most of them.

Furthermore, I have never needed to do this whilst treating any other gut infection be it candida, H.pylori, or parasites in my almost 20 years in practice—natural medicine practitioners typically use the highly successful dual approach of diet and antimicrobials in all of these cases. Why would SIBO be different?

In my conversation with Dr Allison Siebecker of the SIBO Centre in Portland USA we both pondered this conundrum of feeding vs starving whilst treating. The solution? Tweaking the biphasic treatment to accommodate a little of both. I’ve seen encouraging results so far. You may want to download a copy of this protocol, especially for your highly sensitive patients [free registration is required].

The SIBO Bi-Phasic Diet:


Reduce: The first phase of the diet focuses on reducing fermentable starches and fibres which is necessary to starve bacteria of their preferred fuel so they’ll begin to die-off.

Repairing the damage to the integrity of the intestinal lining as well as repairing proper digestion is another key element of this phase.

Patients may benefit from digestive support, gut healing nutrients and targeted probiotics to repair the intestinal lining and digestive processes during this phase

This phase is divided into two groups to be able to adjust the strictness of the diet.

  • Phase 1 restricted diet — everyone starts with this diet. Some have to stay on this diet for the entire six weeks. How quickly the patient can move to the semi-restricted diet depends on how quickly their symptoms improve. If symptoms are greatly improved after the first week, patients move to the semi-restricted diet and go back to the restricted diet if they suffer a relapse of symptoms at any point during treatment.
  • Phase 1 semi-restricted diet – this diet builds on the restricted diet but allows for some starches such as rice and quinoa. The practitioner may recommend starting at this level if the patient is prone to rapid weight loss or need more energy from starches.


Remove: remove remaining overgrown bacteria and fungi from the small intestines: In this phase of the protocol, antimicrobials will be prescribed. Even though still a low fibre diet, the protocol becomes a bit more lenient to allow for some bacterial growth so that antimicrobials may be more successful.

Restore: the restoration of the normal motility of the small intestines is important to prevent relapse of SIBO. In this phase you may want to recommend pro-kinetic medication or supplements.

This phase builds on the allowable foods from phase one.

With this new approach of not starting herbal antimicrobials until the patient is on a less restrictive diet serves two purposes:

  1. The restrictive nature of Phase One will reduce some bacterial load already, resulting in less “die-off” when antimicrobials are started
  2. Starting the herbs during Phase Two will ensure a little feeding of bacteria as this diet has slightly increased fermentable fibres from phase 1

Practitioners can download the New SIBO Bi-phasic diet through their free online account at

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