The patient: “Clara,” a 39-year-old mother of two.

Why she came to see me: Clara came into my office complaining of intestinal distress, primarily in the form of excessive gas production and alternating constipation and diarrhea.

How I evaluated her: Clara and I began our work together by covering her personal and medical history. “Hardly a fanatic” about her health, as she put it, she nonetheless strived to take care of herself by refraining from alcohol and taking Spin classes four times a week. As the mother of two young children, her time away from work was spent chasing after her daughter and son, who she “never had a problem keeping up with” until she started to not feel well.

Three months earlier, however, she experienced a bout of food poisoning. While it resolved itself within a few days, shortly thereafter she began experiencing a host of symptoms that not only depleted her energy but also caused her incredible intestinal discomfort. In addition to the gas, constipation and diarrhea she initially described, I learned that she suffered from acid reflux, nausea, intestinal bloating and stomach pain, as well as bouts of exhaustion and the blues. Clara had tried a number of “remedies” aimed at mitigating her stomach troubles, including snacking on Saltine crackers, drinking ginger ale, avoiding cruciferous vegetables and lentils, following the BRAT diet (bananas, rice, applesauce, toast) and using Alka-Seltzer. These, unfortunately, provided her only a modicum of relief.

To get to the root of her intestinal discomfort, I asked Clara to conduct a breath test from the comfort of her home. The test, called The Lactulose Breath Test for SIBO, gathers a three-hour illustration of intestinal gasses that are produced by resident bacteria. As I explained to Clara, when bacteria digest food, they produce gasses that travel through your intestinal walls, into your bloodstream, and ultimately to your lungs, which one then breathes out. Samples from this breath test reveal the amount of hydrogen and methane gas being exhaled, which shows that bacteria are fermenting as well as how much gas they are generating.

What my evaluation revealed: The results from Clara’s breath test confirmed what I suspected: She was suffering from Small Intestinal Bacterial Overgrowth. The condition, also known as SIBO, describes imbalanced bacterial growth in one’s small intestine.

This means that, in the simplest terms, one has too much bacteria growing where it shouldn’t be. These bacteria aren’t necessarily a pathogen, or “bad bacteria.” It just shouldn’t be thriving in the small intestine. When it does set up house there, it can create systemic inflammation and the release of lipopolysaccharides (LPS), which can lead to fatty liver disease, fatigue, symptoms of bladder pain (called interstitial cystitis), joint pain, migraines, skin rashes, mood changes (such as depression and anxiety), acne rosacea, and even restless leg syndrome. In fact, many symptoms have been associated with SIBO, and getting rid of it can not only resolve the cause of them but also help a person have a much healthier future.

There are a number of reasons why people develop SIBO. Food poisoning—such as in Clara’s case—is one of them. Other causes include adhesions after abdominal or intestinal surgery and medications such as opiates, antibiotics, and antacids (or proton-pump inhibitors). Diet and excessive alcohol can also contribute to SIBO. Some people have autoimmune conditions that could contribute to it as well, such as scleroderma and Crohn’s disease. Furthermore, SIBO can develop in those who have had a traumatic brain injury, immune suppression, or who are immune compromised. Other possible contributors include having Parkinson’s disease, Ehlers-Danlos Syndrome, hypothyroidism, diabetes, parasites, and Lyme or other tick-borne diseases. Having a biotoxin illness related to mold exposure could also contribute to the development of SIBO.

As I told to Clara, the constipation and diarrhea she was frequently experiencing from the condition was the result of the gases the bacterial overgrowth was producing—gases that were damaging her migrating motor complex, which helps keep stools moving through the intestines at a steady rate. I also explained that, because the health of one’s microbiome (the microbial world living in a person’s intestines) has a direct effect on one’s mood, SIBO can contribute to fatigue and depression—the very tiredness and “blues” she was experiencing.

How I addressed her problem: We took a multi-pronged approach to Clara’s recovery. Known as the “5Rs” in natural medicine, it consisted of the following:

1) Remove

To remove the overgrowth of bacteria from Clara’s microbiome, I urged her to take these botanicals: 500 mg of Berberine (from Golden Seal root) three times a day and 100 mg of oregano oil three times a day. I also prescribed an antibiotic called Rifaximin (550 mg three times a day for 21 days). Additionally, I encouraged her to take what’s known as a biofilm buster. Consisting of ingredients such as bismuth, lipoic acid and black cumin seed, this “buster” does precisely what its name implies: It helps break up the “house” the bacteria is residing in inside one’s intestines.

In addition, I encouraged her to remove foods that feed unfriendly bacteria. These are known as high FODMAP foods, which stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. The list of high-FODMAP foods include processed foods that contain high fructose corn syrup, sorbitol and other artificial sweeteners…fruit juices…agave and honey…and condiments such as jam, jelly and relish.

What’s more, I asked Clara to “remove” her Standard American Diet. Also called SAD, this diet has an excess of sugar, refined carbohydrates, saturated fats and trans fats—many of the foods she was also giving her children.

2) Replace

After the first step was complete, I asked Clara to replace her typical diet with low FODMAP foods that are unprocessed and organic whenever possible.

I also urged her to replace her poor eating habits with healthy habits. This meant that, instead of snacking off her children’s plates while cleaning up after meals, she would have to sit down and eat—preferably in a serene environment—and thoroughly chew her food. I suggested that she eat three meals per day and avoid snacking in between, which would allow her small intestine to fully empty before she consumed more food. I encouraged her to drink warm lemon water before meals (this “primes” the stomach for digestion by increasing stomach acidity) but to abstain from drinking copious amounts of liquids while eating, as fluids can dilute digestive juices. To further support healthy digestion, I recommended she take digestive enzymes with meals and a carminative, or “anti-gas,” tea comprised of fennel and caraway seeds.

3) Re-inoculate

Next, I encouraged Clara to introduce her microbiome to more of what she needed: Good bacteria. To this end, I urged her to take small amounts of probiotic foods such as kimchee and sauerkraut, and supplement with probiotics (50 billion organisms) with high amounts of lactobacilli and bifidobacteria. Good bacteria need healthy food to eat so I also encouraged her to eat foods high in prebiotics, which help friendly bacteria flourish. These foods include Jerusalem artichoke, cabbage, leeks, chicory root, and garlic. After eradicating the undesirable overgrowth of bacteria in her small intestine,  she is now able to tolerate some of the forbidden FODMAP foods and prebiotics. Taking “friendly” flora supports a healthy biome and regularity, which in turn can help prevent a recurrence of SIBO.

4) Repair

As I explained to Clara, her chronically irritated gut wall had led to what’s often called leaky gut syndrome. To repair it requires not only the first three steps in the “5R” process but also supplements that organically foster a more resilient gut mucosa. I prescribed one scoop per day of a product called GI Revive. This consists of a blend of ingredients including L-glutamine, N-acetyl glucosamine, Aloe Vera, slippery elm and zinc carnosine, and works towards naturally encouraging a healthier gut.

5) Rebalance

I made it clear to Clara that there is life after SIBO—and that a person can prevent it from becoming a chronic condition by cultivating a life that supports health on all levels. With this in mind, I encouraged her to practice self-care, continue going to her Spin classes (and engaging in other forms of exercise), find ways to quiet her mind and relax her body, and eat the best food around.

The patient’s progress: Within three months, Clara was feeling healthier than she ever had. By practicing the “5Rs,” her symptoms subsided to the point that intestinal distress of any kind was infrequent. Her commitment to whole, organic foods transformed her family meals from chicken nuggets on the run to home-cooked, creative dishes that incorporated nutrient-rich foods—and longer, more satisfying dinners with her husband and children. As for that energy to keep up with her kids? She had it in spades.

Click here to buy Dr. Laurie Steelsmith’s books, Natural Choices for Women’s Health, Great Sex, Naturally and Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.