The patient: Elise, a 43-year-old esthetician and salon owner.

Why she came to see me: Elise appeared fit and strong but turned to the side to reveal the distension of her stomach. Claiming she’d been “wracked with digestive misery” for the last few months, she ticked off a litany of symptoms that ranged from excessive gassiness to joint pain. “The bloating is what bothers me the most,” she said, going on to say that eating even small amounts of food left her with a swollen tummy, rendering her unable to wear some of her clothes and leaving her fatigued, glum and “achy.”

How I evaluated her: As with all of my patients, we began with a thorough and candid discussion about her health and lifestyle. Months earlier, Elise left the salon that had employed her for the last several years to start her own. While her new studio was “positively thriving,” she was, admittedly, running herself to the ground—staying up late to handle the bookkeeping, marketing and orders, and rising early to ensure the salon was in tiptop shape before it opened. To save time, she often ate on the fly, downing energy bars and muffins on her morning commute and opting for the convenience of sandwiches, pasta dishes and fast food for lunch and dinner.

At the same time, persistent anxiety over the opening of her own place had left her with equally persistent nausea, which she tried to remedy with antacids (“I’ve been tossing them back like Altoids,” she confessed). She also liked to end her late nights with a glass of wine in “an attempt to relax.”

While Elise had always been active, fit and slender—thanks in part to the physical nature of her profession—she found herself feeling frumpy and unenergetic…so much so she was turning to coffee, caffeinated sodas and candy to get through her long days.

Meanwhile, she said that everything she ate turned to gas. Her stomach was bloated, and she was suffering from constipation. She had a constant feeling of tightness in her abdomen and a conspicuously enlarged bloated tummy that only grew more inflated throughout the course of the day.

To get to the bottom of Elise’s intestinal distress and other symptoms, I ordered a complete thyroid panel and a blood test. I also had Elise fast for 12 hours before doing a lactulose hydrogen breath test to check for bacterial overgrowth in her digestive system.

What my evaluation revealed: To our relief, Elise’s thyroid panel ruled out the possibility of hypothyroidism, a condition that can result in bloating, exhaustion and digestive disharmony. Her blood test also came back normal with no indication that she had celiac disease—an autoimmune disorder that frequently leads to chronic bloating and requires the complete elimination of gluten to treat.

The lactulose hydrogen breath test, however, demonstrated what I’d suspected: That Elise was suffering from Small Intestinal Bacterial Overgrowth. Often referred to as SIBO, the condition, whose symptoms not only overlap with Irritable Bowel Syndrome (IBS) but may be an underlying cause of it, occurs due to a proliferation of gut bacteria in the small intestine. I have so many female patients coming in with this issue, it’s actually quite an epidemic!

While bacteria can be a good thing—a healthy gut is defined as being comprised of a balance between friendly and unfriendly bacteria—the number of bacteria ought to be highest in the colon and much lower in the small intestine. When balanced, the bacteria in our guts assist our bodies with digestion and nutrient absorption. When bacteria overrun the small intestine, it becomes compromised and disrupts digestion as food passes through the small intestine, resulting in the very symptoms that led Elise to my office.

Left untreated, SIBO may lead to more than bloating and discomfort, including malnutrition, a fatty liver, anemia, intestinal-lining damage causing leaky gut syndrome, and the aforementioned IBS.

How I addressed her problem: While some conventional physicians may prescribe antibiotics to treat SIBO, I resist doing so because antibiotics are notorious for further disrupting intestinal balance. Rather, I began Elise’s treatment to eradicate the bacteria in her small intestine with herbal antimicrobials: Allimed (a high-potency form of Allicin, which is derived from garlic) and Berberine Complex, a digestion-boosting combination of herbs that includes Oregon grape, goldenseal and barberry, and oregano oil. To this protocol I also added in selected probiotics to replenish friendly flora.

Next, and just as importantly, we addressed Elise’s diet…

  • First, I asked her to toss her antacids in the other direction—long-term use of them has been linked to SIBO.
  • Second, I suggested she give up the high-carb foods she’d come to depend upon in her busyness, as carbohydrates fuel the growth of unfriendly bacteria. Instead, I recommended that she fill her plate with lean proteins (such as eggs, low-mercury fish and organic chicken), leafy greens and healthy fats like almonds, nut butters and avocadoes. I also recommended that she reach for stevia or monk fruit-sweetened keto snacks when her sweet tooth struck or she felt a dip in her energy.
  • I also recommended that she eat several small meals throughout the day…and to eat slowly.
  • I further recommended that she give up her daily glass of wine—alcohol only exacerbates SIBO—and to replace it with savvier stress-coping strategies such as gentle stretching, “tuning out” with a magazine or novel or a great movie, and savoring a cup of tea.
  • Finally, I urged Elise to hire additional help at her new venture. Unrelenting stress, after all, may lead to less-than-stellar lifestyle choices that can be detrimental to our immediate health—and our future.

The patient’s progress: Within two months of my recommended treatment plan, Elise bounced into my office and promptly turned to the side to show me that her belly was anything but distended. While bouts of bloating still emerged when she ate poorly—“progress, not perfection,” she said with a wink—she was mostly symptom-free. What’s more, her new way of eating left her feeling full for longer and she was no longer craving sugar, carbs or caffeine. And with a new assistant who was handling the smaller details of the salon, she was able to rest more, exercise more—and, above all, enjoy the fruits of her labor.

To learn more, visit Dr. Laurie Steelsmith’s website,, or click her to read her most recent book, Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.

Related Articles