SIBO & Crohn's combined? Step-by-step guide
- Carmela Pengelly
- 3 days ago
- 6 min read
If you have SIBO, you could also be living with Crohn’s disease without even realising it. The reverse is also true: Crohn’s significantly increases your risk of small intestinal bacterial overgrowth (SIBO).
If you’re stuck in a cycle of gut issues that won’t clear up, these two conditions working together might be exactly what’s stopping your recovery.
In this post, I’ll explore the connection between the two and provide step-by-step guidance on what to do if you suspect you have both. I'll also go into the best way to handle Crohn’s flare-ups.
Crohn's & SIBO combined: Why They Co-exist
As a gut health specialist, a common scenario is that a client comes to see me for help with SIBO, only to find that Crohn’s is the underlying factor. Research shows that over a third of people with Crohn’s also have SIBO.
It can also work the other way since SIBO elicits the body's immune response and in genetically predisposed people can then trigger the inflammatory cascade that is Crohn's. This inflammatory bowel disease is not considered an auto-immune condition but is an immune-mediated disease, where your immune system attacks bacteria. Your gut suffers collateral damage as a result.
Research indicates that having SIBO can more than double your risk of getting Crohn’s. |
Key Symptoms and Red Flags
If you have SIBO and find that you’re not improving or never getting fully better, Crohn’s may be the culprit. While symptoms can be similar, I find that clients with both tend to experience:
Much more severe or explosive diarrhoea
Intense gut pain.
If you have acute symptoms or symptoms that won't go away it is important to get checked out at the doctor. Also, seek medical help if you experience any red flag symptoms including unexplained weight loss, blood in the stool or persistent fever. |
How does Crohn's cause SIBO?
I've described how SIBO can trigger Crohn's but the reverse can also occur for two main reasons:
Structural changes, such as damage close to the ileo-caecal valve (the valve that separates the small and large intestine) make it more likely that bacteria can migrate up into the small intestine.
Crohn’s can cause decreased motility. Decreased motility can seem counter-intuitive since Crohn’s is characterised by diarrhoea. This type of motility refers to dysfunction of the migrating motor complex, which is the sweeping action that keeps the digestive tract clear of bacteria and food residue. When this "cleansing wave" fails, it results in SIBO.
Step-by-Step Guide
If you have SIBO and Crohn's, SIBO needs to be addressed as soon as is possible, otherwise it will perpetuate your Crohn's symptoms. However, there are certain aspects of Crohn’s that must be considered first. This is because antimicrobials used to overcome SIBO results in bacterial die-off, and this can contribute to the inflammatory cascade in the gut. Toxic debris from dying bacteria, known as lipopolysaccharides (LPS), triggers your body's immune response, potentially making your Crohn's worse.
Working on restoring the health of the gut lining as much as possible and rebalancing the immune system helps to reduce the effects of LPS.
While you should always discuss new supplements with your doctor first, I often recommend using the following natural supports alongside your medical treatment.
Many of these are available in our shop pages, but some are practitioner-only and require a quick consultation with me first. Click here if you would like to book a quick chat with me for advice, or book a full nutritional therapy consultation here.
My step-by-step guide is as follows:
1. Reduce inflammation
Practitioners call this "putting the fire out". Inflammation from Crohn’s disrupts gut function, making it difficult to overcome SIBO and increasing the likelihood of relapses.
Consider using fish oils or Specialised Pro-resolving Mediators (SPMs).
SPMs are derived from fish oils but are powerful anti-inflammatories because of their ability to resolve inflammation, as opposed to regular fish oils which can only dampen inflammation.
Turmeric: An excellent anti-inflammatory and is particularly useful in Crohn's and SIBO as it also helps to restore healthy gut flora. I would recommend using a good quality curcumin supplement as it is far more potent and better absorbed than food sources.
Pharmaceutical interventions for Crohn's target NF-kappa B, a protein complex that prompts inflammation as part of its immune response. Natural anti-inflammatories, such as turmeric has the same therapeutic action.
Microbiome Labs Mega IgG2000 are immunoglobulins which support the immune system by neutralizing LPS toxins (produced by dying bacteria, as we mentioned earlier). This helps to calm down the immune system in Crohn's helping to put out the fire and reduce damage to the mucosa.
2. Protect the mucin layer
The mucin layer (the mucous protecting your gut lining) is damaged in Crohn’s.
Vitamin A supports immune balance and promotes the growth of Akkermansia bacteria, which play an important role in regulating mucous production.
Akkermansia have recently become available in probiotic supplement form and recent scientific research shows promise in its ability to improve the mucin layer in Crohn's.
Berberine promotes mucin production and has the added bonus of supporting liver health and reducing hydrogen-producing bacteria in SIBO.
Zinc Carnosine, The zinc in this formulation balances the immune system and when combined with carnosine acts as an effective gut healer.
Butyrate provides fuel for healthy gut cell production and so are key to a healthy gut lining. The good bacteria that normally produce butyrate are often depleted in Crohn's. Butyrate also promotes healthy gut flora proliferation.
3. Restore gut flora
Microbiome Labs MegaSporeBiotic are spore-based probiotics that help to restore healthy gut flora balance, reduce inflammation and damage to the mucosa. They have the added bonus of being well tolerated by people with SIBO.
4. Address the SIBO
Once your Crohn's issues are stabilised, you can move move on to using antimicrobials to tackle SIBO bacteria.
Why test?
I would strongly recommend using SIBO breath tests before and during your SIBO protocol for two reasons:
Testing at the beginning helps by to assess the type of microbes causing the bacteria as well as the severity of the overgrowth. This means the antimicrobial programme can be much more targeted and precise with the right natural products and doses, which means you can minimise their use, rather than a using a machine gun approach.
Test again to assess progress, so that you know how much longer the protocol should continue for and if the antimicrobials are working.
SIBO breath tests are available as at-home test kits in our online shop. Samples are assessed by SIBOTest laboratories. |
Use the SIBO diet
I use a specific SIBO diet, developed by Dr Nirala Jacobi. This is also generally helpful for Crohn’s as well.
As a starting point, you can download my free 7-day SIBO meal plan on the website pop-up.
Managing flare-ups
If you experience a Crohn’s flare-up, temporarily stop any SIBO antimicrobials.
During this time, consider using the Elemental Diet. This is a specialised, highly nutritious drink absorbed early in the digestive tract.
It has two main benefits:
It allows your gut to rest and recover during flare-ups
It simultaneously starves the SIBO bacteria. The elemental diet is a practitioner-only product, available in my online shop. Its use does need to be properly guided by a practitioner such as myself. Please contact me for a chat if you would like to know more.
Optimise
If you are receiving medical treatment for Crohn’s, don't stop there. Optimising your gut health, especially in the large intestine, helps you manage your condition better, reduces the likelihood of future flare-ups and also helps prevent SIBO relapses.
This is a complex subject, and you don't have to navigate it alone. Book here for consultations.
Hansson G. C. (2012). Role of mucus layers in gut infection and inflammation. Current opinion in microbiology, 15(1), 57–62.
Goździewska, M., Łyszczarz, A., Kaczoruk, M. & Kolarzyk, E. (2024). Relationship between SIBO and other bowel diseases and a common eating pattern for them. Part III. Ann Agric Environ Med., 31(3), 322–328.
Zheng, M., Han, R., Yuan, Y., Xing, Y., Zhang, W., Sun, Z., Liu, Y., Li, J., & Mao, T. (2023). The role of Akkermansia muciniphila in inflammatory bowel disease: Current knowledge and perspectives. Frontiers in immunology, 13, 1089600. https://doi.org/10.3389/fimmu.2022.1089600
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