If severe gas, bloating, cramping and diarrhea have been disrupting your life for too long it may be time to get tested for SIBO (Small Intestinal Bacterial Overgrowth).

Patients struggling with this inflammatory gut biome imbalance have often been diagnosed with IBS (Irritable Bowel Syndrome) or IBD (Inflammatory Bowel Disease).

SIBO presents with:

  • vitamin A, B12, D, and E deficiencies
  • intolerances of gluten, casein, lactose, fructose, and histamine
  • fat malabsorption (presents with pale, bulky, malodorous stools)
  • chronic autoimmune dysfunctions (fibromyalgia, chronic fatigue syndrome, diabetes)
  • leaky gut
  • rosacea and other skin rashes

Your gut microbiome – made up of 1,000 different species of bacteria with over 3 million genes — helps regulate your whole health: immunity, thyroid function, bone health, even cardiovascular and brain health.

That means the root cause may lie in any of systems. Is it chronic stress, immunodeficiency, hypothyroidism, stealth infection, scar tissue, or excess estrogen that stimulated your SIBO?

Dr. Borenstein at Manhattan Integrative Medicine is New York City’s top SIBO specialist. Like a gut detective, he will use all available diagnostics to determine the root cause of your SIBO, then resolve your symptoms with the least invasive treatment possible. Call him at ☎ (212) 262-2412 or contact him here.

What is SIBO?

This bacterial imbalance is set off by poor gut motility. It disrupts your Migrating Motor Complex MMC – the electromechanical pattern of gastrointestinal muscle movement that cleans out your small intestine between meals. Waves clear your intestine of undigested waste every 45–180 minutes. But if your MMC is weak, trash gets left behind.

Undigested carbohydrates ferment and produce hydrogen, which feeds single-celled organisms that produce methane. Hydrogen-dominant SIBO typically leads to diarrhea. Methane-dominant SIBO is usually associated with constipation. It can take some trial and error to efficiently detect the type and underlying root cause of your unique SIBO imbalance.

How to test for SIBO

After physically examining and listening to your stomach, Dr. Borenstein may administer a breath test. You’ll drink a sugar solution, then he’ll measure the gases it releases. Then he may move on to these diagnostics:

  • dysbiosis test: urine analysis detects by-products of yeast or bacteria
  • comprehensive stool test: analysis of large intestine flora; elevated levels of exclusively good bacteria may indicate SIBO
  • intestinal MRI and CT scan: observation of intestine function
  • smartPill: ingestible capsule that measures pressure, pH, transit time and temperature
  • IB smart blood test: detects the anti-Cdtb and anti-vinculin antibodies of IBS

How to treat SIBO

One medication and one diet at a time, Dr. Borenstein will work through these steps:

Flush out or kill off the bacteria

Antibiotics may be required to kill the pathogenic bacteria causing your symptoms – Xifaxan attacks hydrogen-dominant SIBO and Neomyacin attacks methane-dominant SIBO.

Then, he’ll enable your body to flush out remaining bacteria long term with a low dose prokinetic like Prucalopride, followed by a 12 hour biome stabilizing fast.

If a gentler approach is required you may take Microb Clear – a blend of magnesium caprylate, berberine, and extracts from tribulus, sweet wormwood, grapefruit, barberry, bearberry, and black walnut which kill off the bad bacteria naturally.

Starve overgrown bacteria

Removing foods that feed in your small intestine bacteria – sugar, alcohol, bread, cookies, cake, whole grains, and legumes – is critical. Dr. Borenstein will encourage you to enjoy non-starchy vegetables, leafy greens, lean proteins, and healthy fats instead.

Restore MMC

To optimize your MMC, nutrient absorption, and immunity you’ll adopt a low-fermentation diet. Digestible foods will be supplemented with L-glutamine, collagen, bone broth, or bovine colostrum. Once you’ve rebalanced your gut biome, you’ll need to avoid NSAIDS, PPI’s, prescription steroids, birth control pills and antibiotics to prevent a relapse.


LDN's prokinetic properties have been studied in treatment of SIBO and related conditions. LDN has interactions with immune system, permeability, secretion and bacterial translocation which may also play a role in treatment of SIBO.

Schedule your consultation

SIBO treatment takes time, patience, and expertise – which Dr. Borenstein has been cultivating for decades. He will continue to test and treat, until all or your symptoms have been resolved and their root cause addressed. Call him at Manhattan Integrative Medicine today at ☎ (212) 262-2412 or contact him here.

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