Could SIBO Be Behind Your Symptoms?

SIBO, short for small intestinal bacterial overgrowth, is one of those conditions many patients live with for years before they ever hear the name.

I know because I diagnose it frequently.

People are relieved to hear that they have SIBO because now they know why they feel off.

Often, by the time it comes up, people are exhausted, bloated, food-fearing, and frustrated by normal test results that don’t explain how terrible they feel.

That’s not because SIBO is rare.

It’s because it lives in a diagnostic gray zone, at the intersection of gastroenterology, motility, microbiology, and metabolism, and modern medicine tends to compartmentalize those systems rather than view them as a coordinated whole.

Basically, not many physicians are looking for it, even though it’s a problem millions of people deal with.

When you understand what SIBO actually is and why it develops, it becomes much easier to see why integrative approaches can be especially helpful, not as replacements for medical care, but as ways to support the underlying biology that determines whether treatment holds.

What SIBO Is, and Why Most Docs Don’t Address It

When you hear about probiotics, you think “good bacteria.”

What most people don’t realize, and even what many doctors don’t think about, is that while it’s beneficial to have probiotics (and trillions of them at that), your small intestine is not where you want them proliferating.

Ideally, your small intestine would contain relatively few bacteria compared to the colon.

Ideally, the small intestine maintains a low bacterial level through a combination of stomach acid, bile flow, immune signaling, and coordinated intestinal movement.

But when things get out of hand, SIBO occurs.

This is when the balance of bacteria is out of whack, and bacteria that normally reside primarily in the colon accumulate in the small intestine (gross).

When they are overpopulated in the small intestine, they cause carbohydrates to ferment prematurely, producing gas and metabolic byproducts in a place that was never designed to handle them.

The result can include bloating, abdominal pain, diarrhea, constipation, excessive gas, reflux-like symptoms, nutrient deficiencies, fatigue, and brain fog.

SIBO can get so bad that some people look six months pregnant by the end of the day.

Others don’t look sick at all, but just know they’re not well.

One reason SIBO isn’t more widely recognized is that it mimics many other conditions, particularly irritable bowel syndrome (IBS).

Research suggests a substantial overlap between IBS symptoms and SIBO, though the relationship is complex and not one-to-one.

Basically, you can’t rule out either until testing is done, but many doctors won’t do that testing because IBS is a more common diagnosis, and SIBO is still not a widely recognized condition.

Here’s Why It’s Increasing Quickly

That exact reason SIBO is increasing is difficult to pin down because diagnostic testing is imperfect.

That said, studies suggest SIBO may be present in a meaningful subset of people with IBS, particularly those with bloating-predominant symptoms.

SIBO is also increasingly recognized in people with autoimmune conditions (this is likely one of the leading issues), as well as conditions that impair gut motility, along with more common diseases like diabetes, hypothyroidism, connective tissue disorders, prior abdominal surgery, or chronic use of acid-suppressing medications and antibiotics.

I also believe that modern environments and the SAD (Standard American Diet) are also causing the uptick.

These factors work against normal small-intestinal regulation, including ultra-processed diets, frequent snacking, reduced microbial diversity, medication exposure, chronic stress, and disrupted circadian rhythms.

None of these causes SIBO in isolation. But together, they can weaken the systems that normally keep bacterial populations in the right place.

Why Many “Modern” Treatments Don’t Work Well

The most common medical treatment for SIBO is antibiotics, particularly rifaximin, which is minimally absorbed and acts primarily in the gut.

Randomized controlled trials show that rifaximin can improve symptoms in certain populations, especially those with diarrhea-predominant IBS.

In practice, antibiotics can be extremely helpful, sometimes life-changing. But relapse rates are high.

Many patients improve temporarily, only to see symptoms return weeks or months later.

That pattern tells us something important: bacterial overgrowth is often a downstream effect, not the root cause.

The Integrative approach is to identify why SIBO took root in the first place.

When we fix the root cause, we can address the overgrowth without having to go scorched earth on the gut.

In integrative medicine, I spend less time asking what kills bacteria and more time asking what allows them to accumulate in the first place.

I often ask patients to imagine the small intestine like an airport conveyor belt. Its job isn’t to store luggage, it’s to keep things moving. When the belt slows or stops, bags pile up.

Killing bacteria without restoring movement is like removing the bags without fixing the belt.

One of the most important protective mechanisms in the small intestine is the migrating motor complex (MMC), a coordinated wave of activity that sweeps residual material through the gut between meals.

Research suggests impaired MMC function is associated with SIBO, particularly in post-infectious states and certain metabolic conditions. 

Supporting motility is one of the things we can do.

This includes 

• Meal spacing

• Circadian rhythm alignment

• Dietary adjustments to less fermentable foods

• And in some cases, prokinetic agents

Diet Could Be the Root Cause (and Fix)

Knowing what I know about health, I usually chalk SIBO up to diet.

Eating foods that aggravate SIBO is a big reason it can become so debilitating.

This is why dietary approaches such as low-FODMAP or carbohydrate-modified diets can reduce symptoms by limiting foods that ferment in the gut.

This is well supported for symptom control, particularly in IBS populations.

What most diets do not do is eradicate SIBO. It changes bacterial behavior more than bacterial presence.

You still have to change the balance of bacteria back to the appropriate levels.

From an integrative perspective, diet works best as a symptom-management and stabilization tool, not as a cure. Overly restrictive approaches can backfire over time by reducing microbial diversity and actually inducing something known as “food fear” (where people get anxiety around the food they eat, thinking it will make them feel awful).

Sometimes SIBO is viewed as a probiotic deficiency, but the science is far more nuanced.

Introducing bacteria into an already overcrowded small intestine may help some people and worsen symptoms in others.

It’s…complicated

Clinically, this means probiotics are tools, not defaults. Timing, formulation, and individual tolerance matter too.

You can’t just diagnose yourself, take a probiotic, and expect it to work.

Don’t Forget - Stress Causes Issues Too!

One of the most consistent patterns I see is that SIBO symptoms flare during periods of chronic stress. 

This is not psychological; it is physiological.

Stress doesn’t just appear in the brain; it manifests in the body as well.

Stress alters gut motility, visceral sensitivity, immune signaling, and secretion. If you’ve ever traveled and become constipated, you can see stress at work on gut motility in real time. 

Mind–body strategies do not kill bacteria. What they can do is restore how your body sends signals (and responds to them), and this can lead to improved conditions under which normal motility and digestion can resume.

How to Knock It Out For Good

Assuming you’ve been tested and diagnosed with SIBO, there are ways to knock it out for good (this is the first and most important step)

None of them is fast, which is a bummer

The thing is, long-term improvement usually requires addressing motility and meal timing, metabolic and hormonal contributors, medication effects, stress physiology, and digestive capacity.

Sadly, there’s not a ton of research on SIBO “cures.”

I’ve had success attacking it systematically with patients, but the strategies depend on each person…as each person’s SIBO originated in a unique way.

The good news is that there are ways to tackle it, and the relief from knocking out SIBO is significant!

If you are dealing with SIBO, something simply disrupted a finely tuned system, and the symptoms are the result, not the cause.

Conventional treatments matter. Integrative strategies matter. The most effective care respects both, using medication when appropriate, while rebuilding the biological conditions that make relapse less likely.