The Sad SIBO Storyline: When IBS Isn’t the Real Diagnosis

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Think your bloating and constipation are just “IBS”? Learn how undiagnosed SIBO (Small Intestinal Bacterial Overgrowth) can cause chronic digestive issues—and how to finally heal the root cause.

When “IBS” Isn’t the Full Story

Yael*, a 32-year-old mother of four, began experiencing digestive issues after the birth of her second child. Though she’d always had a “sensitive stomach,” things took a sharp turn postpartum—constipation, post-meal bloating, burping, and heartburn became constant companions.

Two GI doctors diagnosed her with Irritable Bowel Syndrome (IBS) and recommended the usual: Metamucil, a low FODMAP diet, and medication. Nothing helped. Frustrated, Yael came to see me to find out what everyone had been missing.

The Initial Assessment

Significant findings:

Current medications: None (“Nothing works anyway—I stopped everything.”)
Past diets: Gluten-free, dairy-free, and low FODMAP (no improvement)
Weight history: Mild unintentional weight loss over three years due to fear of eating
Main symptoms: Severe bloating, constipation, reflux, and burping

Yael’s case followed the classic SIBO storyline—years of symptoms labeled as IBS, but never addressed at the root.

What Is SIBO, and How Does It Happen?

SIBO (Small Intestinal Bacterial Overgrowth) occurs when bacteria from the large intestine migrate upward into the small intestine. Once there, they ferment carbohydrates and fibers, producing excess gas that causes bloating, pain, and altered bowel habits.

Poor digestion and slow intestinal motility create the perfect environment for this bacterial overgrowth. Chronic constipation, low-fiber diets, or sluggish gut movement can allow bacteria to settle in and thrive.

Different bacteria produce different gasses—methane-producing bacteria often cause constipation, while hydrogen-producing bacteria may lead to diarrhea or alternating patterns.

The Diagnosis: Finally, Some Answers

I suggested a three-hour SIBO breath test, which came back positive for both hydrogen and methane gas.

Yael felt relieved—finally, a diagnosis that made sense. “So if I take antibiotics, I’ll be cured?” she asked hopefully.

While antibiotics like Xifaxan can help, I explained that SIBO is usually secondary—a symptom of deeper issues like poor motility, low fiber intake, dehydration, and lack of physical movement. Without fixing those underlying causes, SIBO nearly always comes back.

Why SIBO Keeps Coming Back

In conventional settings, many patients go through a “revolving door” of SIBO recurrence because they’re never taught how to maintain long-term gut health after antibiotics.

Common mistakes that lead to relapse include:

Relying on a low FODMAP diet for too long (which reduces fiber and slows motility)
Avoiding all fiber, mistaking temporary gas for harm
Trying gluten-free diets unnecessarily, which can lower fiber intake even more

Low fiber may bring short-term relief but worsens the very problem that caused SIBO—slow motility.

The Two-Part SIBO Treatment Approach

I explained to Yael that lasting SIBO recovery requires two steps:

1. The “Kill Phase”

Targeting the overgrowth with either antibiotics (like Xifaxan) or herbal antimicrobials such as berberine and garlic extract.

We combined Xifaxan from her GI doctor with natural antimicrobials for six weeks and added specific probiotics and fiber powders shown to reduce recurrence.

2. The “Repair and Restore Phase”

After the bacterial overgrowth is cleared, the goal shifts to stimulating gut motility and retraining the intestinal muscles.

We gradually increased her fiber intake from 20g to 35g per day while using a motility supplement and Miralax for support. This phase was essential in preventing SIBO from returning.

Yael summed it up perfectly:

“It’s like the only way out is through—after antibiotics kill the SIBO, I have to get over my fear of fiber to really heal.”

The Results: From Frustration to Freedom

Initially, Yael’s bloating only improved slightly during the antibiotic phase. But as she progressed into the restoration phase, focusing on high-fiber foods, hydration, and motility, her symptoms dramatically improved.

She finally understood that SIBO treatment isn’t just about killing bacteria—it’s about rebuilding function.

Looking back, she realized that her earlier constipation and restrictive eating habits after pregnancy likely triggered her gut imbalance. With the right education and strategies, she now has the tools to prevent SIBO from ever returning.

The Takeaway: Heal the Root, Not Just the Symptoms

Yael’s journey highlights a truth I see every day: SIBO rarely develops out of nowhere. It’s usually a reflection of slow motility, stress, dietary imbalances, and poor gut tone—all of which can be reversed with the right plan.

If you’ve been diagnosed with “IBS” but still struggle with bloating, gas, constipation, or discomfort after meals, it might be time to explore whether SIBO is the missing link.

Healing SIBO isn’t just about wiping out bacteria—it’s about restoring the rhythm and flow of your digestive system so your gut can finally do its job again.

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