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The Orenda Clinic & Apothecary - Toronto Naturopath Clinic focused on Hormone Support, Cancer Care and Fertility


Small Intestinal Bacterial Overgrowth



Acne is a sign of an internal imbalance within the body. The key to clear skin really lies in identifying and targeting the underlying cause, as well as ensuring foundations of health are in place

What is SIBO?

Small intestinal bacterial overgrowth, also known as SIBO, is an overgrowth or damaging change to our small intestine gut bacteria, leading to chronic digestive problems. SIBO impacts a lot of people, and may be the culprit behind common digestive complaints such as IBS. It’s been estimated that up to 78% of cases of IBS are actually due to SIBO. 

Common symptoms of SIBO include the following: 

  • Abdominal bloating after meals

  • Abdominal pain or discomfort after meals 

  • Excessive gas or burping

  • Nausea 

  • Heartburn 

  • Chronic sensation of fullness 

  • Constipation

  • Diarrhea 

  • Rosacea, acne, and eczema

  • Food sensitivities or triggers

What Causes SIBO?

There are a number of conditions and lifestyle factors that have been shown to cause, and/or increase the risk of SIBO. Risk factors for SIBO include the following: 

  • History of head injuries and concussions

  • History of gastroenteritis (stomach flu/traveller’s diarrhea) 

  • Use of oral contraceptive pills 

  • Low stomach acid

  • Enzyme and/or bile insufficiencies 

  • Regular, moderate alcohol consumption

  • Structural changes in the abdomen 

  • Standard North American diet

  • Celiac disease 

  • Ulcerative colitis 

Associated conditions

Our intestines are one of the most important immune centres of the body. As a result, there are also a number of conditions that have been associated with SIBO. Associated conditions include the following:

  • Autoimmune conditions including psoriasis, rheumatoid arthritis, and multiple sclerosis

  • Eczema, allergies, and asthma 

  • Hormonal imbalances including reproductive and urogenital complaints, type 2 diabetes, and thyroid disorders 

  • Migraines 

  • Chronic joint pain

  • Increased risk of cardiovascular diseases including high blood pressure and atherosclerosis

  • Skin complaints including acne, rosacea, and eczema

  • Digestive complaints including GERD, leaky gut, fat malabsorption, impaired liver detoxification pathways 

  • Nutrient deficiencies including vitamin B12 and iron deficiency

Naturopathic Treatment of SIBO

When it comes to SIBO, the goals of naturopathic treatment are as follows: 

  • Rule out other possible conditions that may look like SIBO. This includes conditions such as H.pylori, low stomach acid, enzyme deficiencies, celiac disease, other infections, and autoimmune disorders

  • Identify and correct the root cause of SIBO 

  • Eradicate overgrowth of bacteria in the small intestine and balance the microbiome 

  • Optimize enzyme, stomach acid, and bile secretions for improved digestion

  • Heal the gastrointestinal lining, which may be damaged as a result of SIBO 

  • Optimize digestive regularity, to prevent relapse of SIBO

  • Promote a healthy, sustainable diet

  • Support immune function & chronic stress 

Treatment is customized to each individual case and will vary for each person. We take into account your unique risk factors, contributors, and digestive patterns. 


Depending on your case, testing may or may not be recommended. In some cases, testing may be indicated. Here are some tests we may consider in our SIBO patients: 

Nutrient Testing

Often individuals with SIBO are suffering from vitamin B12 or iron deficiency. If we suspect this might be the case, we will recommend testing to ensure your nutrient levels are corrected. 

SIBO Breath Testing

We do offer SIBO breath tests at our clinic, however we do not recommend them for all patients. SIBO is often diagnosed by ruling out other conditions, and recognizing symptom patterns. In complex cases, we will suggest SIBO testing to confirm a diagnosis.

Stool Testing

We offer Comprehensive Stool Analysis, GI Mapping, stool culture & sensitivity, and stool ova & parasites. These tests can be used to rule in other factors or conditions that may be contributing to your digestive disturbances.


Treatment looks different for everyone, and will depend on your unique health contributors. With SIBO we take both a short- and long-term approach. Our goal is to get you feeling better as quickly as possible, while implementing long-term strategies to reduce the risk of relapse. SIBO has been associated with a very high risk of relapse, so we will do everything possible to prevent this from occurring. Our naturopathic doctors are guided by the best available evidence for recognizing and treating SIBO.  

SIBO: What to Expect from Treatment

If you are struggling with SIBO, here’s a rough outline of what you can expect from naturopathic treatment: 

Month 1: Initial Appointment, 60 - 90 Minutes in Length

  • We complete a thorough social and physical health assessment to identify barriers to digestive health. This helps us to understand your unique contributors to health, and gives us clues into what the underlying cause of your SIBO may be, A social intake, as well as physical exams will be completed.

  • We will requisition lab work to get a baseline understanding of your inflammatory response, blood sugar, general health, and nutrient levels. Depending on your unique case, specialized labs such as SIBO testing, or stool testing may be recommended. 

  • You will be sent home with an environmental impact questionnaire, to assess your level of environmental exposure.

  • An initial treatment plan will be provided to get you started on your road to recovery

Month 2: First Follow-up Appointment, 45-60 minutes in length

  • We review your lab results together, so you fully understand how your body is functioning 

  • We will go through an even more detailed, and customized treatment plan that is specific to your physiological needs and based upon your symptoms and lab results

  • This is the point where we start tracking your progress. Digestive conditions such as SIBO can often take anywhere from 4-12 months to treat.

Months 4-8: Third, Fourth, Fifth Follow-up Appointments 45 Minutes in Length

  • Every one-two months of customized treatment, we reassess your progress, and reevaluate your goals

  • We troubleshoot any problems you might be having with treatment or compliance with treatment 

  • We often tweak treatment as needed based on your results. We formulate treatment to further propel you towards your health goals.  

  • By 6-9 months, our goal is that you are feeling much better at this point, and you no longer need us! 

  • We provide you with long-term strategies to help you maintain your digestive health on your own, and prevent your risk of SIBO relapse.

Of course, we can’t guarantee results or how you will respond to treatment. While most patients do feel better by 6 months, this may take longer for some people, whereas others feel better even faster. SIBO can be very complicated to treat, and does have a high relapse rate. Depending on your case, it’s possible we may recommend follow up visits closer together to ensure you’re on the right track. 

Ultimately, our goal is that you don’t have to keep seeing us, because you no longer need us! We aim to have you feeling your best within 5-6 appointments. At this point, we begin to schedule bi-annual or annual check ups to ensure you’re staying on track, and continuing to feel your best. 

If you’re suffering from SIBO, our digestion support team is here to help answer your questions and provide safe, effective care. If you would like to learn more, please don’t hesitate to contact us or book a complimentary 15 minute meet-and-greet with one of our doctors. 



Looking for Support?

dr. alessia milano, nd

Dr. Alessia Milano is our clinic co-founder and our chief Naturopathic Doctor focusing on digestive and hormonal health. You can learn more about her practice here, or book a complimentary meet-and-greet with Dr. Milano.

dr. hayhlee clarence, nd

Dr. Hayhlee Clarence is our clinic co-founder and our chief Naturopathic Doctor focusing on digestive health and integrative cancer care. You can learn more about her practice here, or book a complimentary meet-and-greet with Dr. Clarence.


dr. almir alicelebic, nd, RN

Dr. Almir Alicelebic is a Naturopathic Doctor and registered nurse. His practice is focused on treating IBS/SIBO, and digestive health. You can learn more about his practice here, or book a complimentary meet-and-greet with Dr. Alicelebic.

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