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The short version: SIBO stands for small intestinal bacterial overgrowth. Your small intestine is meant to hold a fairly small number of bacteria. In SIBO, too many move in, often the wrong kinds, and they ferment your food before you've had the chance to absorb it. The result is gas, bloating, pain and changes in how often you go. SIBO is one form of dysbiosis, which just means your gut microbes are out of balance.

Is there a SIBO test in South Africa?

We get asked this a lot, so here's the straight answer. There are two standard ways to test for SIBO, and neither is easy to get here.

We kept hearing from people who had SIBO, or thought they might, and had nowhere to get tested. So we went looking for a breath test to offer and asked the laboratories. It had been discontinued. That left a real gap: lots of people looking for a SIBO test in South Africa, with bloating and no clear way to find out what was going on.

That's when we realised our gut health test could help. It isn't a breath test, and it doesn't pretend to be one, but it answers many of the questions people with SIBO are asking.

The alternative: a gut microbiome test

To be clear up front: a stool test can't diagnose SIBO on its own, because stool mostly reflects your large intestine rather than your small intestine. What it can do is answer the question underneath the bloating: is my gut out of balance, and which way?

That's useful because it:

• Shows your balance. You see your beneficial and harmful microbes side by side, so you can tell whether the good ones are low, the bad ones are high, or both.
• Checks for the SIBO usual suspects. Klebsiella pneumoniae, pathogenic E. coli, Enterococcus faecalis, Staph aureus and Candida are all on the panel.
• Rules other things in or out. Parasites like Giardia, infections like C. difficile, and H. pylori can all cause SIBO-like symptoms, and they're all on the panel.
• Gives your doctor something to work with. Instead of guessing, they get a map.
• Tracks progress. Test again after treatment or a diet change and see whether your good bacteria actually bounced back.

There's also Gut Essentials at R2,500, a 17-target probiotic screen (good for tracking your beneficial bacteria, but it doesn't include the harmful ones), and Gut Deep Dive at R5,950, which adds a Disease Association Report linking your results to IBS, IBD and metabolic markers. All three are on the gut testing page.

Our gut panels were developed and are overseen by Prof Veron Ramsuran, our head of laboratory.

Prices are 2026 cash rates including VAT and may change; in-store pricing applies.

Too many guests in the wrong room: what SIBO is

Think of your gut as a long house with different rooms.

SIBO is what happens when the party spills into the study.

The American College of Gastroenterology defines SIBO as having too many bacteria in the small bowel, enough to cause gut symptoms. How many is too many? A healthy small intestine usually holds fewer than about 100,000 bacteria per millilitre of fluid. The colon holds vastly more. Newer research using direct samples from the small intestine suggests that even 1,000 per millilitre of the wrong type is enough to cause symptoms.

Once they're in there, those extra bacteria get first dibs on your food. They ferment carbohydrates and make gas (hydrogen, methane and hydrogen sulphide) in a part of your gut that isn't built to handle it. Hence the balloon.

What does SIBO feel like?

The common SIBO symptoms:

• Bloating after eating, often within an hour or two
• Gas and burping
• Tummy pain or cramping
• Diarrhoea, constipation, or a confusing mix of both
• Feeling full quickly

And the less obvious ones:

• Tiredness and pins and needles. Bacteria in the small intestine can use up your vitamin B12 before you absorb it. Low B12 shows up as weakness, fatigue, and tingling or numbness in your hands and feet.
• Weight loss without trying. In more serious cases, SIBO can get in the way of absorbing nutrients properly.
• Brain fog and low mood. These get reported a lot, though the evidence is less solid than for the gut symptoms.

One exception. Unexplained weight loss, blood in your stool, vomiting or difficulty swallowing are not things to test for first. See a doctor promptly rather than waiting for a result.

What causes SIBO?

Your body has a few built-in bouncers that keep the small intestine quiet. SIBO usually happens when one of them stops doing its job.

SIBO is also strongly linked to IBS. Researchers are still arguing about which comes first, but many people with IBS symptoms turn out to have signs of overgrowth.

Which microbes contribute to SIBO?

This is where the research has got a lot more interesting in the last few years.

For a long time, SIBO was just a number: too many bacteria, full stop. Then a large US study called REIMAGINE started sampling fluid directly from people's small intestines and sequencing what was in there. What they found was surprisingly specific.

In people with SIBO, two groups of bacteria took over: Escherichia coli and Klebsiella. Both belong to a family called Enterobacteriaceae, the “coliforms”. In one analysis, just two E. coli strains and two Klebsiella species made up about 40% of all the bacteria in the small intestine of people with SIBO. The more of them there were, the worse the bloating, pain and diarrhoea.

Other studies have found more of these in people with SIBO too:

And here's the part people miss. When the harmful ones went up, the helpful ones went down. The same REIMAGINE research found that SIBO came with a clear drop in the Firmicutes group, the family many of your beneficial bacteria belong to, and less variety overall. SIBO isn't only about too much of the bad stuff. It's about losing the good stuff too.

Is SIBO the same as dysbiosis?

Close, but not quite. Dysbiosis is the big umbrella. It just means the community of microbes in your gut is out of balance: too few beneficial ones, too many harmful ones, or not enough variety. SIBO is one specific kind of dysbiosis, where the imbalance shows up as overgrowth in the small intestine.

A useful way to think about it:

When the good tenants move out, the troublemakers have more room. That's dysbiosis. When it happens in the small intestine, that's SIBO. Our gut health guide has every organism on the panel if you want to meet the full cast.

Before you collect the sample

• Wait 2 weeks after finishing any course of antibiotics. They knock your gut bacteria flat for a while, so testing too soon gives a distorted picture.
• Stop probiotics 2 weeks beforehand. Otherwise you're measuring the supplement, not you.
• Don't stop any prescribed medication without speaking to your doctor first.

Collect the sample at home or pick up a kit at a branch, get it back to us the same day or the next, and keep it in the fridge until then. Results take 14 working days.

What if my results show dysbiosis?

Then you've got a starting point, which is more than most people with bloating ever get.

SIBO itself is usually treated with a prescribed course of treatment, alongside sorting out whatever caused it (slow movement, low acid, medication). That's a conversation for a doctor. We're a laboratory: we test and we report, and we don't diagnose, prescribe or treat. We can put you in touch with independent partner doctors, with no obligation to use them.

For the bit you can control, our guide on how to improve your gut health covers which foods feed which bacteria.

Where to test

Collect at home anywhere in South Africa, or pick up a kit at any of our three branches. No doctor's referral.

Common questions

What these words mean

SIBO

Small intestinal bacterial overgrowth. Too many bacteria in the small intestine.

Dysbiosis

An imbalance in your gut microbes: too few beneficial ones, too many harmful ones, or not enough variety.

Coliforms

A group of gut bacteria that includes E. coli and Klebsiella. The main players in SIBO.

IMO

Intestinal methanogen overgrowth. Overgrowth of methane-making microbes, usually linked to constipation.

SIFO

Small intestinal fungal overgrowth. Too much yeast, such as Candida, in the small intestine.

Stool PCR test

A lab test that finds microbes in a stool sample by their DNA, so many organisms can be checked from one sample.