IBS doesn’t have to control your life. Learn how a client overcame chronic bloating, constipation, and SIBO through root-cause healing and evidence-based nutrition strategies — and how you can, too.

When “It’s Just IBS” Isn’t Enough

Shlomo*, a 43-year-old father of four, came to me exhausted — not from lack of sleep, but from the relentless discomfort that had taken over his days. He described bloating, crampy trapped gas, constant belching, and long, unproductive sessions sitting in the bathroom.

“I can’t get to minyan on time. I’m late for work. I spend half the morning just trying to feel normal,” he told me. Shabbos afternoons were especially miserable, often followed by painful Sunday mornings. Occasionally, he’d swing the other way — bouts of diarrhea without rhyme or reason.

After several GI visits and a full workup ruling out anything serious, he was told, “It’s just IBS. Try the low FODMAP diet.”

Understanding IBS and the Low FODMAP Diet

IBS (Irritable Bowel Syndrome) is a functional gut disorder — meaning the digestive tract looks normal, but how it functions is off balance. It’s one of the most common digestive issues I see in my functional nutrition practice, often presenting with symptoms like bloating, constipation, diarrhea, and abdominal pain.

The low FODMAP diet, frequently prescribed for IBS, limits specific fermentable carbohydrates (found in foods like wheat, dairy, beans, apples, onions, and garlic) that can feed gut bacteria and create excess gas.

While this plan can be helpful for short-term symptom relief and identifying food triggers, it’s not designed for lifelong restriction. Because high-FODMAP foods provide essential fuel for the protective gut microbiome, the goal should be to address the root cause of FODMAP intolerance — not to avoid these foods indefinitely.

Before consulting with me, Shlomo assumed the low FODMAP diet was his only solution for IBS and that he’d have to follow it indefinitely. He gave it a sincere two-month effort and noticed about a 50% reduction in symptoms, but the strict limitations made it difficult to sustain. “It helped, but not enough to live like that,” he said, frustrated.

Step One: Restore Regularity

The first step in Shlomo’s IBS treatment plan was simple but powerful — regulate his bowels. When the bowels don’t empty daily and on a predictable schedule, no other gut-healing intervention will truly help.

We started with a high-fiber but low-FODMAP diet — a balance between symptom control and creating a “gravity push” to promote motility. I also recommended a gentle, non-habit-forming stool softener: magnesium citrate (400 mg nightly) and psyllium husk fiber twice daily.

To further stimulate gut movement, we added 10–15 minutes of cardio exercise daily and reinforced consistent hydration. I also ordered a SIBO test kit to be sent to his home to rule out an underlying infection contributing to his symptoms.

SIBO and IBS: When Gut Bacteria Wander Upstream

SIBO (Small Intestinal Bacterial Overgrowth) occurs when bacteria that normally live in the large intestine migrate into the small intestine — where they don’t belong. These bacteria ferment food prematurely, leading to gas, bloating, abdominal pain, and irregular bowel movements.

Constipation is one of the most common risk factors for SIBO, as slow stool transit gives bacteria more opportunity to move upward in the GI tract.

Shlomo’s test came back positive for both methane and hydrogen gases, explaining his mix of constipation, bloating, and unpredictable diarrhea.

Functional Nutrition Approach to SIBO Treatment

I advised Shlomo to return to his GI doctor to discuss antibiotic options. The standard SIBO treatment is rifaximin, a non-systemic antibiotic that acts locally in the small intestine and spares the beneficial bacteria in the colon. For methane-positive cases, neomycin is sometimes added — though I use it cautiously due to potential side effects.

At our second follow-up, I recommended a combined integrative approach:

• Rifaximin, as prescribed by his GI doctor (keeping neomycin as a backup last-resort option)
• Berberine, a natural antimicrobial compound that inhibits methane-producing microbes — often used in place of neomycin
• Targeted probiotics, formulated to crowd out SIBO-related bacteria and support microbiome balance
• A biofilm disruptor, used for 4–6 weeks to help break down the mucus-like protective coating bacteria form to hide from antibiotics and the immune system

(A biofilm is a thin layer that allows bacteria to shield themselves from treatment. Disrupting this layer is crucial for SIBO recovery.)

We continued his high-fiber, low-FODMAP diet with a goal of reaching 30 grams of daily fiber, while tracking both bowel movements and symptoms through logs.

Six Weeks Later: A Gut Transformed

At our six-week follow-up, Shlomo was practically glowing. “It’s the first time in years I feel normal,” he told me. He was meeting all bowel goals, having effortless daily movements, and the gas, bloat, and discomfort were a thing of the past.

His energy was back. His mornings were predictable. He could get to minyan and work on time — and actually enjoy Shabbos without pain.

Shlomo was clearly SIBO-free and ready to transition off dietary restrictions. We began reintroducing high-FODMAP foods without adverse effects and planned to wean off stool softeners and fiber supplements by the four-month mark.

I encouraged him to check in every few weeks for small tweaks — though at that point, he had truly reclaimed his gut health and quality of life.

The Functional Medicine Takeaway

IBS isn’t “just IBS.” It’s a message from the gut that something deeper is off — whether due to microbial imbalance, sluggish motility, or SIBO. With the right testing, nutritional strategy, and functional medicine approach, symptom management becomes root-cause healing.

Shlomo’s journey is a reminder that with patience, persistence, and proper guidance, the gut can heal — and life can feel normal again.