SIBO.

Why bacteria overgrow in the first place

Your small intestine has built-in defenses that keep bacterial populations in check — stomach acid, digestive enzymes, and the migrating motor complex, the wave-like contractions that sweep bacteria downstream between meals. SIBO develops when those defenses fail.

The usual mechanical drivers: impaired gut motility (a slow migrating motor complex), structural abnormalities like adhesions or strictures, low stomach acid — frequently from chronic proton pump inhibitor use — post-surgical changes to GI anatomy, and systemic conditions like diabetes or hypothyroidism that affect the gut's nerve function. Immune dysfunction can contribute as well.

Why it's so often mislabeled as IBS

Standard gastroenterology workups rarely look for fermentation at all, so the overgrowth that defines SIBO goes unmeasured. Patients get an IBS label — which describes the symptoms without identifying the cause — and cycle through diets and medications that manage rather than resolve the problem.

That matters because SIBO is treatable in a way that a vague IBS diagnosis is not. Identifying the specific gas pattern points to the right antimicrobial and the right dietary strategy, which is the difference between chasing symptoms and actually clearing the overgrowth.

Preventing relapse after treatment

Clearing the overgrowth is only half the job. Because the underlying motility problem is usually what allowed bacteria to accumulate in the first place, SIBO has a real tendency to return if that root cause is ignored.

This is why prokinetic support to restore the migrating motor complex, plus attention to stomach acid and diet, is built into the plan from the start. A gut-healing phase then rebuilds the lining and microbiome so the improvement holds rather than fading within a few months.

What a SIBO evaluation looks like

A SIBO evaluation starts with organic acid testing, a urine panel that measures the metabolic by-products your gut microbes release as they ferment food. It tells us not only whether overgrowth is present but whether bacteria, yeast, or oxalate handling is driving it — and that distinction shapes the entire protocol.

Alongside testing, we take a detailed history: prior abdominal surgery, PPI use, thyroid function, and the timing of your bloating all help explain why the overgrowth took hold. Comprehensive lab panels round out the picture where nutrient deficiencies or thyroid involvement are suspected.

From diagnosis through resolution, our team guides each phase — confirm the pattern, clear the overgrowth, restore motility, then reseed and repair — so you're never left guessing what the next step is or why it matters.

You were told it is IBS. It might be SIBO.

SIBO mimics IBS almost perfectly — the same bloating, pain, diarrhea, and constipation. The difference is that IBS is a description of symptoms while SIBO is an identifiable, treatable cause. Research suggests up to 78% of people diagnosed with IBS actually have bacterial overgrowth driving the picture.

If you have spent years on fiber supplements, peppermint capsules, and a low-FODMAP diet that helped for a while and then stopped, that plateau is the tell. Managing IBS without lasting improvement is a reason to test for what might actually be underneath it.

How bacteria end up where they do not belong

Your body has built-in defenses to keep bacteria in the colon and out of the small intestine. SIBO develops when those defenses fail. The most common failure is an impaired migrating motor complex — the cleaning wave that sweeps bacteria downstream between meals. Low stomach acid from PPI use, aging, or chronic stress also lets bacteria survive and climb.

Other drivers include structural issues such as surgical adhesions or ileocecal valve dysfunction, nerve damage from a bout of food poisoning (post-infectious IBS), hypothyroidism slowing gut transit, and chronic stress reducing digestive secretions. Understanding which one applies to you is the key to preventing recurrence.

Why probiotics sometimes make it worse

One counterintuitive clue: you tried probiotics because someone said they would help, and instead you felt worse — more bloating, more gas. When bacteria are already overgrown in the wrong place, adding more can aggravate the problem. That reaction is a red flag that points toward SIBO rather than away from it.

This is why sequence matters. Reintroducing beneficial bacteria has a place, but only after the overgrowth is cleared and motility is restored — not before.

How long SIBO treatment takes

An antimicrobial round typically lasts 4 to 6 weeks, and some patients need a second round. Motility support then continues for 3 to 6 months after clearance to prevent relapse.

We re-evaluate at day 10 and retest to confirm the overgrowth is actually clearing — not just that symptoms improved. Confirming it objectively is what keeps you from cycling back into the same problem a few months later.