SIBO, Bile and Gallbladder Problems: What’s the Connection?

If you struggle with gallbladder problems or you’ve had your gallbladder removed, you’re more susceptible to developing Small Intestinal Bacterial Overgrowth– otherwise known as SIBO.

Unfortunately, SIBO can lead to a variety of digestive symptoms– as can most gallbladder-related complications

As an integrative nutritionist, I’ve helped countless clients navigate the challenges of SIBO, and rediscover how to feel their best in their bodies.

When you’re educated on gallbladder complications, you’ll be more equipped to manage any symptoms that present themselves along the way. And don’t worry, I’ve got plenty of tips for you about easy and natural ways to help you overcome your symptoms! 

Let’s first dive into what SIBO is, and why it’s more common in those with gallbladder issues.

SIBO, Bile and Gallbladder Problems: What's the Connection?

What is SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) is a condition characterized by an excessive growth of bacteria in the small intestine. Normally, the small intestine has less bacteria compared to the large intestine. 

In a healthy digestive system, the small intestine contains about 104 bacteria per mL, while the large intestine holds up to 1012 bacteria per mL.1 This balance is necessary for optimal digestive health.

With SIBO, bacteria from the colon or large intestine migrate up into the small intestine where they proliferate. This throws off the balance of bacteria in the gut, leading to uncomfortable digestive symptoms.

Symptoms of SIBO

Symptoms of SIBO can vary, and they often overlap with other gastrointestinal concerns. 

The most common SIBO symptoms include:

    • Abdominal cramps
    • Indigestion one to three hours after eating
    • Fatigue after eating
    • Lower bowel gas
    • Alternating constipation and diarrhea
    • Diarrhea
    • Roughage and fiber causes constipation
    • Mucous in stools
    • Stools poorly formed
    • Shiny stool
    • Three or more large bowel movements per day
    • Dry, flakey skin and/or dry brittle hair
    • Pain in the left side under the rib cage
    • Acne
    • Food allergies
    • Difficulty gaining weight
    • Foul- smelling stool 
    • Probiotics make you feel worse
    • Bloat gets worse by the end of the day looking 6 months pregnant. 

SIBO, Bile and Gallbladder Problems: What's the Connection?

These symptoms are the product of the fermentation of carbohydrates due to the overgrown bacteria. Because of this, people often experience gas and irritation in the small intestine.

Why SIBO Is More Common in Post-Gallbladder Removal

If you’ve had gallbladder problems, or you’ve had your gallbladder removed, you’re a more likely candidate to develop SIBO.

But WHY is this?

Let’s talk about bile. Your gallbladder plays a pivotal role in storing and concentrating bile formed from the liver. Bile is mostly made of water but it also contains bile acids, bilirubin, phosphatidylcholine, water, minerals and cholesterol.

While bile’s main function is to aid in the digestion of fats, bile also contributes to maintaining a healthy microbiome in your digestive system. 

Your large intestine holds tons of beneficial gut bacteria. And conjugated bile acids are abundant in the small intestine, where they typically inhibit bacterial growth.

But when you have poor bile flow to the small intestine due to gallbladder dysfunction or absence, the antimicrobial activity decreases…leading to an increased risk of bacterial overgrowth.

SIBO occurs when bacteria overgrowth in the large intestine moves into the small intestine.

How Bile Flow Issues Can Lead to SIBO

Bile acids are needed for nutrient absorption and preventing bacterial overgrowth. They help regulate small and large intestine motility.

If you have issues with bile flow into the small intestine, it can lead to lower motility and lower antimicrobial activity– meaning a greater chance of SIBO.

Bile acids also regulate and initiate the Migrating Motor Complex (MMC) which is responsible for cleaning the intestines between meals. If your MMC is impaired due to low bile, you’re more susceptible to developing SIBO. 

Lastly, as mentioned at the start, bile includes an essential component called phosphatidylcholine which constitutes 96% of the phospholipids in bile.3 This helps thin the bile, preventing it from becoming sludgy or forming gallstones.

Unfortunately, when you have gallbladder issues, you usually have a deficiency in phosphatidylcholine. This deficiency leads to a reduced bile output, therefore increasing the risk of developing SIBO, gallstones, or fatty liver disease.

SIBO, Bile and Gallbladder Problems: What's the Connection?

Poor bile secretion from gallbladder due to biliary dyskinesia or a gallbladder full of gallstones causes reduced bile output and risk of SIBO.

Finally, loss of concentrated bile from gallbladder surgery, also leads to reduced bile output, increasing risk of SIBO. 

So as you can see there are several mechanisms that can increase risk of SIBO with a history of gallbladder issues. 

How to Address SIBO

If you’ve been struggling with SIBO symptoms, I’ve got you covered. You can do a lot from home naturally to prevent and manage this condition.

The focus for overcoming SIBO symptoms involves:

  • Improving gut motility. Specifically bile and stomach acid.
  • Restoring a healthy balance of gut bacteria
  • Reducing bacterial overgrowth

Dietary adjustments, lifestyle modifications, and supplements are among my top recommendations for resolving your symptoms.

1.    Adjust What and How You Eat!

As a integrative nutritionist, this is always a good start. However, JUST changing your diet alone won’t solve all your problems. If you’re struggling with SIBO, a good step towards symptom relief is choosing a SIBO supportive diet. In some cases you may need to restrict fermentable carbohydrates. 

Make sure to include plenty of fruits, vegetables, and lean protein in your meals. For my top gallbladder-friendly recipes, grab my grocery list and meal guide HERE!

SIBO, Bile and Gallbladder Problems: What's the Connection?

I also always recommend practicing mindful eating, meaning taking deep breaths before meals, eating slower, and eating without distractions. All of these methods help reduce bloat and other uncomfortable SIBO symptoms!

 2.    Support Bile and Stomach Acid Output!

If you’ve undergone gallbladder removal, or your gallbladder issues are causing bile acid insufficiency, bile acid supplements can help aid in digestion.

Ox Bile or TUDCA supplements help support a healthy gut microbiome. Check out my Top Supplement Recommendations here! And again, remember to consult your physician before trying new supplements.

Stomach acid helps protect from pathogens, bacteria overgrowth. It is also very important for bile release. Try sipping on ginger water or 1 tsp apple cider vinegar in water before meals. Consider the use of betaine HCL.You also need adequate sodium, potassium, zinc and magnesium to improve stomach acid levels. 

3.   Address Your SIBO with an Integrative Nutritionist

SIBO can be a challenge. But when you address the underlying causes and symptoms of SIBO, you can improve your digestive health– and your overall well-being!

I’ve overcome my own struggles with gallbladder disease. Ever since, I’ve helped thousands of people improve their gallbladder symptoms and digestive symptoms such as SIBO after gallbladder surgery as a gallbladder-focused intregative nutritionist.

So I’d love to do the same for you!

If you’re dealing with SIBO, gallbladder disease, post-gallbladder removal complications, or other gallbladder issues… I’m here for you. Click here to connect with me and let me know your concerns. I can’t wait to help you feel like your best self again!


  1. Brown, H., & Esterházy, D. (2021). Intestinal immune compartmentalization: Implications of tissue specific determinants in health and disease. Mucosal Immunology, 14(6), 1259-1270.
  2. Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small Intestinal Bacterial Overgrowth: A Comprehensive Review. Gastroenterology & Hepatology, 3(2), 112-122.
  3. Gauss, A., Ehehalt, R., Lehmann, D., Erben, G., Weiss, H., Schaefer, Y., Kloeters-Plachky, P., Stiehl, A., Stremmel, W., Sauer, P., & Gotthardt, D. N. (2013). Biliary phosphatidylcholine and lysophosphatidylcholine profiles in sclerosing cholangitis. World Journal of Gastroenterology : WJG, 19(33), 5454-5463.
  4. Chedid, V., Dhalla, S., Clarke, J. O., Roland, B. C., Dunbar, K. B., Koh, J., Justino, E., Tomakin, E., & Mullin, G. E. (2014). Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth. Global Advances in Health and Medicine, 3(3), 16-24.
    Your Cart
    Your cart is emptyReturn to Shop
      Calculate Shipping
      Apply Coupon