Why Does SIBO Keep Coming Back?
“Why Does SIBO Keep Coming Back?”
Struggling with recurring bloating and SIBO? You’re not alone. While treatments like antibiotics or herbal remedies might offer temporary relief, they don’t always address the root causes. SIBO is often a symptom, not the core issue. Learn about the role of gut motility, the Migrating Motor Complex (MMC), and other factors driving recurrence—and discover practical strategies to break the cycle for good.
Understanding Recurrence and How to Break the Cycle
Do you ever let your meals decide what you wear?
Abdominal bloating and distension affect nearly 40% of the general population, with levels suspected to be higher among individuals diagnosed with other functional gastrointestinal disorders, including IBS, functional constipation, and dyspepsia. While bloating is often transient after a heavy meal or eating foods that don’t agree with us, it becomes a more pressing concern when it’s persistent and interferes with daily life. At this stage, many seek testing, and one common diagnostic tool is breath testing to rule out an overgrowth of bacteria in the small intestine, known as Small Intestine Bacterial Overgrowth (SIBO).
Though it’s debatable whether SIBO is on the rise, it is being diagnosed more frequently thanks to increased awareness among healthcare providers and the influence of social media. If you’ve been diagnosed with SIBO or suspect you might have it, you may have been prescribed a protocol of antibiotics or natural agents to reduce the overgrowth. However, a frustrating reality for many patients is that SIBO often recurs, leading to repeated cycles of treatment.
But what if SIBO isn’t the root cause of bloating? What if SIBO is merely a symptom of a larger issue that needs to be addressed? What if SIBO is not the problem but the messenger?
Understanding the Small Intestine’s Ecosystem
Let’s take a quick science lesson. Your intestines are home to 100 trillion microbes, with the large intestine housing the majority—about 39 trillion microbes. A healthy small intestine, by contrast, contains fewer than 100,000 bacteria, with numbers increasing only as it approaches the large intestine. Several factors help maintain this balance:
Rapid flow of food through the small intestine.
Digestive juices such as stomach acid and bile, which impede bacterial growth.
The Migrating Motor Complex (MMC): This physical process, often referred to as the "housekeeper" of the small intestine, sweeps undigested food, bacteria, and debris out of the small intestine into the colon during fasting states.
Meet your gut’s housekeeper: the Migrating Motor Complex (MMC). Sweeping out bacteria and debris to keep your small intestine clean and healthy—your ultimate defense against SIBO!
The MMC activates every 90 to 120 minutes during fasting and pauses when food is eaten. It is controlled by the enteric nervous system (the “second brain” of the gut) and modulated by the central nervous system. Unfortunately, this process is beyond our conscious control, meaning we cannot “will it on.” When the MMC is off or slowed, it often results in the hallmark symptom of SIBO: bloating.
What Causes Dysregulation of the MMC?
The MMC’s role in preventing bacterial overgrowth is critical, but various factors can disrupt its function, setting the stage for SIBO to develop and recur. These include:
Gut-Brain Axis Dysregulation
Chronic stress, anxiety, or other disruptions to the gut-brain connection can impair the vagus nerve, which helps regulate MMC activity.
Motility Disorders
Conditions like IBS, gastroparesis, or systemic sclerosis can slow the MMC, causing food and bacteria to linger in the small intestine.
Post-Infectious Changes
After a bout of gastroenteritis (food poisoning), inflammation or damage to the nerves and muscles of the gut can impair MMC function. This is a common precursor to SIBO.
Structural Abnormalities
Adhesions, diverticula, or blind loops in the intestines can create pockets where bacteria thrive, bypassing the MMC’s cleaning function.
Chronic Inflammation
Inflammatory bowel diseases or low-grade inflammation from food intolerances can disrupt gut motility and MMC regulation.
Low Stomach Acid
Stomach acid acts as a natural barrier to bacterial overgrowth. Chronic use of proton pump inhibitors (PPIs) or conditions like atrophic gastritis reduce this defense, increasing the risk of SIBO.
Immune Dysfunction
A weakened immune system—whether from chronic illness, autoimmune diseases, or medications—can impair the body’s ability to regulate bacterial populations in the gut.
Gut Dysbiosis
Imbalances in gut bacteria (e.g., in the large intestine) can affect overall gut health and disrupt the MMC.
Lifestyle Factors
Sedentary behavior, poor sleep, and irregular eating patterns can weaken gut motility and MMC function.
Breaking the Cycle of Recurrence
To prevent SIBO from recurring, addressing these root causes is essential. Strategies might include:
Improving Gut Motility: Supporting gut motility is crucial for maintaining a healthy digestive system. Prokinetic agents—both pharmaceutical and natural options like ginger—can enhance the Migrating Motor Complex (MMC) function and prevent bacterial stagnation in the small intestine.
In addition to prokinetics, physical activity plays a significant role in stimulating the muscles of the abdomen and encouraging natural gut motility. Some effective techniques include:
Walking: A gentle walk after meals aids digestion and reduces bloating by promoting the movement of food through the intestines.
Yoga: Specific poses, such as seated twists, child's pose, or cat-cow, gently massage internal organs and improve circulation, which enhances gut motility.
Core Strengthening Exercises: Activities like Pilates or gentle core workouts help strengthen abdominal muscles, supporting intestinal movement and overall digestive health.
Enhancing Digestion: Supporting stomach acid levels and bile production may improve gut defense mechanisms and reduce bacterial overgrowth. Foods like umeboshi plums or a small glass of water with apple cider vinegar consumed prior to meals can aid digestion.
Dietary Changes for SIBO: Reducing fermentable carbohydrates (low-FODMAP diets) can limit bacterial overgrowth and ease bloating symptoms. Additionally, eating to support gut healing by avoiding substances toxic to friendly bacteria, such as food additives and alcohol, can make a significant difference.
Treating Gut Dysbiosis: Using probiotics, prebiotics, or targeted antimicrobials to restore a healthy gut microbiome may provide long-term relief.
Addressing Stress: Chronic stress impacts vagal tone and gut-brain communication, so incorporating mindfulness, yoga, or vagus nerve stimulation techniques can restore balance.
Mindfulness isn’t just a practice for your mind—it’s a remedy for your gut. Regular meditation calms the gut-brain axis, reduces stress, and supports optimal digestion.
SIBO isn’t just a condition to manage—it’s a signal to investigate deeper issues. By addressing the factors that disrupt MMC function and gut health, we can move beyond treating symptoms and toward lasting solutions.
Frequently Asked Questions About SIBO Recurrence
Why does SIBO keep coming back? Recurrence often happens because the underlying causes—such as slow motility, low stomach acid, or gut-brain axis dysregulation—haven’t been addressed.
How can I stop SIBO from coming back? Supporting gut motility, managing stress, and maintaining a balanced diet are key steps to prevent recurrence.
Is SIBO a chronic condition? While it can feel chronic, SIBO often indicates an unresolved imbalance that, once addressed, can lead to long-term relief.