Small Intestinal Bacterial Overgrowth (SIBO) Specialist in Boca Raton, FL

This may come as a surprise, but did you know that your gut contains trillions of microorganisms, including 300 to 900 million distinct species of bacteria? These bacteria that make up what’s known as your microbiome are largely responsible for your overall health and well-being, including your immune function and the health of your thyroid, bones, heart and brain. When there is an imbalance in your gut bacteria, unfortunately, your entire body may feel the effects.

Small Intestinal Bacterial Overgrowth (SIBO) occurs when there is excess bacterial growth within the small intestine. It throws off your digestion, interfering with motility and causing uncomfortable symptoms. If you are experiencing increased cramping, bloating, diarrhea or even severe gas, SIBO may be the underlying cause. In some patients, related gas patterns may also point to Intestinal Methanogenic Overgrowth (IMO), which is commonly associated with methane and constipation, or Intestinal Sulfide Overproduction (ISO), which involves excess hydrogen sulfide gas and may be associated with diarrhea, bloating, abdominal pain and foul-smelling gas.

At Manhattan Integrative Health in Boca Raton, FL, we work with patients experiencing SIBO, IMO and ISO symptoms to uncover the root cause of their digestive concerns and create a tailored treatment plan to help restore motility and achieve an optimal state of health.

To find out more information about SIBO, IMO and ISO and see how Dr. Borenstein can help alleviate your symptoms, call today to schedule your consultation! Call (754) 247-0122 or contact us online.

What is SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) is a GI disorder where excessive bacteria, often from your large intestine, abnormally colonizes your small intestine. There can be a number of complications that cause SIBO. If your food is not adequately digested due to motility issues, it can ferment and produce hydrogen. This byproduct of fermentation, hydrogen gas, primarily feeds opportunistic or “bad” bacteria, rather than beneficial bacteria. This type of SIBO will often cause diarrhea, while methane-dominant SIBO – now more commonly known as IMO – generally causes constipation. A third pattern, hydrogen sulfide overproduction, is now commonly referred to as ISO and may be suspected when symptoms include diarrhea or loose stools, bloating, abdominal pain and gas that smells like rotten eggs.

Symptoms of SIBO

The overgrowth of opportunistic bacteria in your small intestine causes fermentation of food, resulting in symptoms like chronic diarrhea, gas, bloating or abdominal pain, along with potential nutrient malabsorption. It is vital to find the underlying cause of your symptoms by working with a doctor who specializes in treating GI conditions like SIBO.

Signs and symptoms to look out for that may be indications of an unhealthy gut include:

• Abdominal distension, fullness and bloating
• Abdominal cramping
• Watery diarrhea that is chronic or urgent
• Abdominal pain
• Nausea
• High levels of fat in the stool indicating fat malabsorption
• Unintentional weight loss, signs of malnutrition or vitamin deficiencies
• Brain fog and other cognitive symptoms
• Weakness or fatigue
• Alternating constipation and diarrhea
• Foul-smelling gas or stool, which may occur when hydrogen sulfide is overproduced

If you are experiencing any of the symptoms above, don’t wait to seek medical advice from our leading SIBO experts. Let us help you alleviate your discomfort and find a solution that will lead to long-term relief and healing.

How To Test for SIBO

At Manhattan Integrative Medicine in Boca Raton, we offer the latest in medical diagnostics to ensure we get to the root of your health concerns. Dr. Borenstein will start with a physical exam and may further recommend any of the following diagnostic tests:

Breath test: This diagnostic tool measures hydrogen and methane gases in your breath to detect SIBO or IMO. It involves drinking a sugar solution (glucose or lactulose) after fasting, then collecting breath samples over 3 hours to check for bacterial fermentation in the small intestine and measure gas levels.

• Dysbiosis test: This urinalysis test detects yeast or bacteria.
• Comprehensive stool test: A stool sample can help to analyze the levels of flora in your large intestine.
• Intestinal imaging tests: CT scan and/or MRI are tests that can observe your intestinal function.
• IB smart blood test: This test is used to detect anti-vinculin and anti-CdtB antibodies of IBS.
• SmartPill: This ingestible capsule measures pH levels, transit time, pressure, and temperature throughout your GI tract.
• Trio-Smart: This breath test measures the levels of hydrogen, methane, and hydrogen sulfide in your breath. Elevated levels of gases can indicate small intestinal bacterial overgrowth (SIBO), intestinal methanogenic overgrowth (IMO), and/or intestinal sulfide overproduction (ISO). Because conventional two-gas breath tests may not measure hydrogen sulfide, this three-gas testing option can be especially helpful when hydrogen sulfide overproduction is suspected.

Treatment Options for SIBO

As one of the top SIBO clinics in Florida, we offer the most effective treatments to heal your digestive tract and bring back in balance your healthy gut flora. Some of these integrative treatment options may include:

Repairing the Migrating Motor Complex

Making nutrition and lifestyle changes as well as taking promotility medications can help restore and regulate your Migrating Motor Complex (MMC). Repairing your MMC is an essential step in achieving proper digestive function. To regulate your MMC, making necessary lifestyle changes and different food choices – together with taking promotility medications like Motegrity (Prucalopride) – can help bring restoration and regulation.

Removing Excess Bacteria with Antibiotic Therapy

When your gut becomes unbalanced and has an overgrowth of unhealthy bacteria - and not enough healthy bacteria - disease often results. Restoring that delicate balance in your microbiome can be the first step toward healing SIBO and other digestive complaints. Dr. Borenstein will create a customized treatment plan for your specific health concerns, choosing antibiotics or other more natural remedies such as Microb-Clear to kill off bad bacteria in your gut. When ISO is suspected or confirmed, the treatment plan may also take hydrogen sulfide-producing organisms and sulfur metabolism into consideration.

Making Dietary Changes

By removing certain foods such as sugar, alcohol, legumes, bread, and other products containing refined sugar, we can starve out the overgrown bacteria. Replacing those foods with healthy fats, leafy greens, non-starchy vegetables, high fiber options and lean proteins are better choices for healthy gut bacteria to thrive – and they also can help with SIBO.

Some of the specialized diets we may recommend include:

• Low FODMAP Diet is a temporary, three-step eating plan that restricts specific, poorly absorbed fermentable carbohydrates (FODMAPs) found in common foods like dairy, specific fruits, onions, garlic, etc. It also helps identify individual food triggers through elimination and reintroduction.
• Specific Carbohydrate Diet (SCD) is a strict, grain-free elimination diet designed to starve bacterial overgrowth in the small intestine by removing complex carbohydrates, reducing fermentation, and lowering gut inflammation. It focuses on easily digestible foods like meats, vegetables, and fruits. SCD is often combined with Low FODMAP diet.
• Low Fermentation Diet is a nutritional approach that does not eliminate but rather simply limits carbs that ferment in the gut, reducing bacteria-driven bloating. Unlike more restrictive diets, it allows white rice, potatoes and refined carbs but stresses strict meal spacing (4-5 hours).

Low-sulfur dietary adjustments may be considered for select ISO patients when hydrogen sulfide symptoms are present, but this should be supervised by a knowledgeable clinician to avoid unnecessary restriction and nutritional imbalance.

Improving Digestion

It is oftentimes necessary to optimize stomach acid, enzymes, and short chain fatty acids (SCFAs) for improved digestion. Promotility medications, as discussed above, can also help heal and regulate your digestive system.

Taking Low Dose Naltrexone (LDN)

Dr. Borenstein sometimes utilizes Low Dose Naltrexone (LDN). Naltrexone has been shown to help lessen inflammation in the bowels and reduce uncomfortable symptoms caused by SIBO and other digestive disorders.

As one of the top digestive doctors in Florida, Dr. Borenstein offers the most effective integrative treatment options for SIBO, IMO and ISO. Lifestyle changes, like incorporating more movement into your life and changing what you eat, are just some of many effective treatment options available for digestive overgrowth patterns. Dr. Borenstein also takes into consideration the connection between thyroid hormone levels and digestion, as well as the importance of optimizing stomach acid and digestive enzymes.

What Is Intestinal Methane Overgrowth (IMO)?

Intestinal Methane Overgrowth (IMO) is a GI condition characterized by an abnormal increase of methane-producing microorganisms. Unlike SIBO, which involves excess growth of bacteria in the small intestine, IMO is caused by the excess growth of single-celled organisms called archaea and can occur within either the small or large intestines. IMO is interchangeably referred to as Intestinal Methane Overgrowth, Intestinal Methanogen Overgrowth or Archaea Overgrowth.

Differentiating classic hydrogen-dominant SIBO from IMO is essential in treating these two disorders that can occur in your small intestine. It’s important to understand that:

• Excess hydrogen gas not only feeds the bad bacteria implicated in SIBO, but also feeds archaea, leading to IMO.
• The methane overgrowth that you see with IMO is produced by archaea, not bacteria, so IMO is different from classic SIBO.
• Constipation is the hallmark symptom of methane overgrowth, with almost half of IMO sufferers reporting it as a symptom.
• Other common symptoms like bloating, gas, abdominal discomfort, and slowed gut motility occur with IMO.
• Up to 30 percent of SIBO patients may exhibit concurrent IMO.
• Methane breath testing is important when constipation-predominant symptoms are present.
• Methane overgrowth can be more difficult to resolve and may require addressing both overgrowth and motility.
• Improving motility may help reduce recurrence of IMO.

Constipation is not only the telltale symptom for IMO, but it’s also the most common gastrointestinal complaint GI doctors see among all their patients, making it critical to properly diagnose its cause. Not only can severe constipation be accompanied by mild to severe pain or cramping, but it can also sometimes lead to a blockage or other dangerous symptoms if left untreated.

While the most common cause of constipation is not enough water or fluids to help move your stools, other common causes of constipation can range from lack of fiber and not enough exercise to digestive conditions like IMO or SIBO, IBS, Crohn’s Disease, Leaky Gut, Celiac Disease or even Metabolic Syndrome. Certain medications used for pain (especially opioids), seizures, high blood pressure, allergies or depression may also be at the root of constipation, as can thyroid disorders, pregnancy, certain autoimmune diseases or even intestinal blockages from damage or injury, tumors or fecal buildup.

If IMO is diagnosed, conventional treatment involves a 14-day course of targeted antibiotics to reduce methane-producing archaea. Natural protocols commonly used to manage symptoms and prevent recurrence include:

• Microb-Clear or other herbal antimicrobials (e.g., allicin, oregano, etc.)
• Prokinetics for motility support
• Specialized diets (Low FODMAP and SCD, often combined)

Dr. Borenstein also takes into account the connection between thyroid hormone levels and digestion, as well as the importance of optimizing stomach acid and digestive enzymes in treating IMO as well as SIBO.

What Is Intestinal Sulfide Overproduction (ISO)?

Intestinal Sulfide Overproduction (ISO), formerly referred to by many practitioners as hydrogen sulfide SIBO, is a digestive overgrowth pattern involving excessive production of hydrogen sulfide gas in the intestines. Hydrogen sulfide is naturally produced in the gut in small amounts, but when it is produced in excess, it may contribute to uncomfortable digestive symptoms and make standard SIBO testing or treatment feel incomplete.

ISO may overlap with classic SIBO symptoms, but it is often discussed as a distinct pattern because the dominant gas is hydrogen sulfide rather than hydrogen or methane. Hydrogen sulfide overproduction may be associated with diarrhea or loose stools, bloating, abdominal pain, urgency, nausea, brain fog, fatigue and gas or stool that has a sulfur-like or rotten-egg odor.

Testing matters because traditional SIBO breath tests commonly measure hydrogen and methane, while ISO requires hydrogen sulfide measurement. A three-gas breath test such as Trio-Smart may help identify whether hydrogen, methane and/or hydrogen sulfide are contributing to symptoms, allowing Dr. Borenstein to personalize treatment more precisely.

Treatment for ISO should be individualized. Depending on the patient’s history, testing and symptom pattern, Dr. Borenstein may consider targeted antimicrobials, motility support, digestive support, gut lining support and carefully supervised dietary changes. Because sulfur-containing foods can be very nutritious, a low-sulfur approach should not be started without guidance from an experienced clinician. The goal is not simply to restrict foods, but to identify the underlying cause of the overproduction, reduce symptoms and support long-term digestive balance.

SIBO, IMO, ISO and IBS

SIBO has been identified as a contributing factor and an underlying cause in a high percentage of Irritable Bowel Syndrome (IBS) cases. Some studies showed up to 78 percent of IBS sufferers also test positive for SIBO. While they do both involve nearly identical symptoms (e.g., constipation, diarrhea, bloating and pain), SIBO is caused by excessive bacteria in the small intestine, while IBS is a functional GI disorder involving gut-brain dysfunction.

IMO is highly associated with constipation-predominant IBS (IBS-C), while ISO may be considered in patients with diarrhea-predominant symptoms, sulfur-like odor, excessive gas, bloating or incomplete response to standard SIBO care.

Trying to differentiate between SIBO, IMO, ISO and IBS requires professional testing and diagnosis by a physician experienced in working with all of these conditions. Because they share symptoms, they are best identified as follows:

• SIBO (bacterial overgrowth) by high hydrogen levels on breath tests
• IMO (methane overgrowth) by high methane levels on breath tests
• ISO (hydrogen sulfide overproduction) by elevated hydrogen sulfide levels on three-gas breath testing
• IBS as diagnosis of exclusion based on chronic symptoms

What to Expect from a Digestive Care Visit

Our approach always involves seeing the human body as a single entity rather than as individual organs or metabolic processes. Since every part of the body is interconnected with every other part, any illness that affects one specific part of the body has a profound impact on the rest.

At Manhattan Integrative Medicine in Boca Raton, FL, we offer the most up-to-date testing and diagnostics, along with a cutting-edge functional and integrative medicine approach and a powerful focus on prevention, so you can avoid illness, injury and disease and maintain renewed health and freedom from troublesome digestive symptoms and conditions like SIBO, IMO and ISO.

We recommend that you prepare a list of your current symptoms – whether or not they are related to your digestive complaints - prior to your first consultation. On your first visit, Dr. Borenstein will discuss your family medical history, personal medical history, lifestyle, daily stressors, diet, exercise habits, and current medications. He may also conduct blood, saliva, urine or even imaging tests, as necessary.

Dr. David Borenstein is a top functional medicine practitioner in Florida who recognizes that each individual patient requires a prevention and treatment regimen tailored to an individual health profile and specific medical and family history. Dr. Borenstein has an established history of helping his patients heal from illness and restore overall health and longevity.

Request Your Consultation Today!

If you have been living with SIBO, IMO or ISO symptoms or suspect that you may be dealing with gut issues, know that you are not alone. Dr. Borenstein and his team of highly trained professionals have helped many patients in the Boca Raton area resolve digestive symptoms, allowing them to improve their quality of life and overall health.

We utilize only the most advanced diagnostic and treatment options that functional medicine has to offer. We promise to take the time that is needed to find the underlying causes of your health problems and guide you down the path to a symptom-free, healthier version of you!

Call today to schedule your consultation! Call (754) 247-0122 or contact us online.

Serving patients in Boca Raton, West Palm Beach, Jupiter, Boynton Beach, Delray Beach, Parkland, Deerfield Beach, Pompano Beach, Coconut Creek, Coral Springs, Fort Lauderdale, Weston, Hollywood, Pembroke Pines, Aventura, Miami and the surrounding Palm Beach, Broward and Dade County, Florida communities.