How to solve chronic SIBO, bloating and constipation? An integrative gastroenterologist explains.

If you’re like our many of clients, you have likely felt overwhelmed, frustrated and confused with your gut-healing journey. You may be struggling with how to solve chronic SIBO, bloating or constipation and not sure what to do next.  Because you’ve seen numerous doctors and have tried “all of the things”.  Yeah, we’ve had the same experience, too.  And it blows.

We feel so privileged to be able to refer our NY based clients to Dr. Elena Ivanina, an integrative gastroenterologist with Northwell Health in New York City.  Dr. Ivanina and I share the same mission, which is to help address the root cause of digestive conditions so you can heal as quickly as possible.  We both strive to provide evidence-based information that can help your healing journey. 

I recently interviewed Dr. Ivanina and can’t wait to share as much of her wisdom as possible, especially as it relates to harder to address chronic conditions like IBS, SIBO, bloating and constipation.   There are SO many good nuggets here, so be sure to bookmark this page so you can show your doctor.

Here’s what we cover:

  • The TOP reasons for chronic bloating and abdominal distension
  • The 3 things you MUST do to resolve SIBO for good
  • The connection between SIBO and COVID
  • The relationship between IBS and histamine intolerance
  • The key for long term good gut health after resolving GI issues
  • And much more!

Before we dive in, let’s meet Dr. Ivanina…

Get to know Dr. Ivanina, an integrative gastroenterologist in New York City

Dr. Elena Ivanina, SIBO specialist

Dr. Ivanina was interested in a more holistic approach to medicine and therefore attended the New York College of Osteopathic Medicine where she was exposed to more nutrition and complementary & alternative medicine education than in traditional allopathic medical school.

Afterward, she completed her internal medicine residency at Maimonides Medical center in Brooklyn followed by another residency in preventive medicine and public health at the New York City Department of Health, where she received a prestigious American Cancer Society grant for her work in cancer prevention.

At the same time, she pursued a Masters degree in public health at Columbia University and also completed additional training in functional medicine. She then went on to complete a fellowship in gastroenterology at Lenox Hill Hospital in NYC and was asked to stay on as faculty and Director of Neurogastroenterology and Motility.

As you can see, Dr. Ivanina has had SO. MUCH.TRAINING. along with incredible professional and personal experiences that inform her approach to gut health. 

Now on to the interview where we cover the top questions sourced from our clients and gut-health community!

Sara Kahn:

I feel so lucky to be able to refer my clients to you, in part, because you are a unicorn.  You are an integrative gastroenterologist who understands we are seeking out the root cause.  How did you find yourself taking this unconventional approach… and while working for a large healthcare company? 

Dr. Ivanina:

I am lucky to be raised by a family from outside the U.S. that believes in understanding one’s health and optimizing diet and lifestyle and not just medicating.

With that upbringing and then taking my own journey to understand gut health issues I was suffering from and fixing them, I understood that the patient really does hold the power of healing in their own hands, in many cases.

Therefore, I completed the traditional GI training but understanding that my goal was going to be to help patients understand their gut health on a deeper level and give them the tools to heal.

What are the TOP reasons for bloating?

Sara Kahn:

Bloating and abdominal distension are the top symptoms we see in our practice.  What are the main causes and how can someone be bloated even when they are not eating?  

Dr. Ivanina:

The number one cause of bloating and distension that I see is constipation and sluggish gut motility.

This can be due to a low fiber diet, lack of exercise, dehydration, stress, lack of routine, poor sleep, medication side effects, autoimmune disease, pelvic floor dysfunction and more.

There is a laundry list of other causes of bloating but the other most common root case is SIBO (Small Intestinal Bacterial Overgrowth) which is a type of microbiome imbalance caused by an underlying issue such as previous infection, most commonly being COVID these days.

Some conditions such as abdomino-phrenic dyssynergia (APD) may not be as food dependent. APD is a paradoxical abdomino-phrenic response to increased intraluminal gas where the diaphragm contracts (descends) and the anterior abdominal wall muscles relax (normally the diaphragm relaxes and the anterior abdominal muscles contract).

How do you get rid of SIBO… for good?  

Sara Kahn:

How do you approach stubborn cases of SIBO?  We have many clients who have been treated numerous times but don’t respond. 

Dr. Ivanina:

Rethink the root cause and understand if we are missing something. SIBO treatment is only successful if three things are addressed:

  • Root cause
  • Antibiotics or antimicrobials and
  • Maintenance prokinetics and motility optimization

Often patients do not have all three of these issues addressed. But if they do and still don’t have treatment success, then I consider other overlapping diagnoses such as SIFO (Small Intestine Fungal Overgrowth) or MCAS (Mast Cell Activation Syndrome). 

What’s the relationship between COVID and SIBO, IBS or GERD?

Sara Kahn:

We have had a lot of shared clients who never had GI issues prior to developing COVID.  What’s the connection between COVID and GI issues?   

Dr. Ivanina:

COVID certainly takes a toll on the gut. In general, about 11% of people develop chronic gut issues following a gut infection but it seems to be even higher with COVID. We know that COVID changes the gut microbiome. In long COVID, people seem to develop disorders of the gut-brain interaction and mast cell activation.

What does IBS have to do with histamine intolerance?

Sara Kahn: 

Many clients have some degree of histamine intolerance?  What is the connection to GI issues like IBS and why don’t other gastroenterologists understand this can be driving many symptoms? 

Dr. Ivanina:

Gastroenterologists mostly practice “by the book” and there has not been much published in the GI literature about histamine intolerance. But things are changing.

Now there are publications supporting the role of mast cells, which secrete histamine, in IBS. Within the gut, mast cells regulate permeability, secretion, peristalsis defend against and expel parasites, and play a key role in food allergy. Compelling evidence has shown that mast cells are involved in the generation of IBS symptoms, particularly visceral hypersensitivity and food intolerance.

How do you “fix” chronic constipation?

Sara Kahn:

Chronic constipation seems to be particularly challenging.  How do you address this in patients who are doing “all the things” like eating enough fiber, hydrating, exercising, etc. 

Dr. Ivanina:

Dig deeper. Anorectal manometry and Smart Pill whole gut transit testing as well as SIBO testing are all a good first step to understanding your gut on a deeper level, in order to heal.

Is “leaky gut” real?

Sara Kahn:

Why does conventional medicine ignore issues like increased intestinal permeability (aka “leaky gut”)?

Dr. Ivanina:

The traditional medical world is usually taking their orders from a text book and it is very difficult for people to think outside the box when they have 15 minutes with a patient.

I am very lucky in that I spend a lot of time with patients to really understand their history and exposures. I think that medicine will embrace increased intestinal permeability as more is published on it as an inciting factor in IBD.

What is the key to long-term gut health?

Sara Kahn:  

What is the key to long term gut health for those who have a history of IBS, SIBO, bloating, reflux and don’t want to relapse?

Dr. Ivanina:

Long term health and prevention of relapse comes down to two things: optimizing gut motility and preventing risk factors for recurrence.

For example, only taking antibiotics when medically necessary and discussed thoroughly with a doctor and not in desperation for a “quick fix” to treat what may likely be a virus.

Optimizing gut motility is key and avoiding constipation and stagnation that leads to bacterial overgrowth and other things such as diverticulosis, which is in itself a risk factor for methane overgrowth!

How to find the right gastroenterologist and what tests can they run?

Sara Kahn:

How should a client outside of NY find a gastroenterologist who will be open to finding the root cause? 

Dr. Ivanina:

It is not easy to find a doctor that gives you more than 20 minutes of their time.  I would research online, social media, as well as look into additional training they have completed such as functional medicine. Ask for referrals from friends, family and the internet. 

Sara Kahn:

How can a client advocate for themselves with their gastroenterologist?  What tests do you find to be the most helpful? 

Dr. Ivanina:

Education is the most powerful tool! Read to understand more about gut health and what could be going on and missed. That is why I created, a home for all things gut health with NO misinformation.

And an emphasis on natural healing.

Helpful tests that not all gastroenterologists order are:

  • Trio Smart SIBO test
  • Fructose intolerance and sucrose intolerance tests
  • Tryptase screening test for MCAS
  • Food allergy and sensitivity testing
  • Inflammatory markers such as CRP and fecal calprotectin

Thank you so much to Dr. Ivanina for sharing SO much insight on how to navigate stubborn gut health issues!  We hope you have found this interview helpful and empowering with actionable next steps to take on your road to improving uncomfortable symptoms from SIBO, bloating, IBS, and more.

For more evidence-based gut-health education, please follow Dr. Ivanina on Instagram at @gut_love and be sure to subscribe to her weekly email at

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