Part 1 Why Treating SIBO Requires More Than Diet

Understanding SIBO and Its Root Causes

If you’ve been managing your SIBO with a restricted diet like low-FODMAP, you’re not alone. Many people turn to elimination diets to find relief from symptoms like bloating, discomfort, and digestive distress. But if your symptoms keep returning—or you’ve found yourself stuck in a cycle of cutting out more and more foods—you might be wondering: Is there more to the solution? The answer is yes.

First, if you haven’t already, consider getting a SIBO breath test and working with a practitioner who can provide targeted treatment. At Steddy Health, we treat SIBO using botanicals and create a customized approach tailored to your SIBO breath test results while addressing the root causes of your SIBO. If you prefer antibiotics, consult your primary care doctor or a gastroenterologist to prescribe the appropriate protocol. Addressing SIBO isn’t just about symptoms; it’s about understanding and managing its underlying causes. And yes, it’s “causes,” plural—not a singular issue.

FODMAPS - fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are short-chain carbohydrates that can ferment in the small intestine, triggering symptoms in individuals with SIBO. While these foods are highly nutritious, they can be challenging for those with gut imbalances.

The Limits of Diets Like FODMAPs

Many people find temporary relief by cutting out foods like onions, garlic, or wheat. But if you’ve been stuck in an endless cycle of elimination without real progress, it’s worth asking: Is there more to healing SIBO? The answer lies in looking beyond dietary restrictions.

Elimination diets like the low-FODMAP diet are often recommended for SIBO because they reduce fermentable carbohydrates that feed bacterial overgrowth. While this can provide significant symptom relief, they are not designed to treat the underlying issues causing SIBO. Although these foods are commonly associated with triggering symptoms, they are not the root cause of SIBO. Here’s why relying solely on dietary restriction to manage SIBO has its limits:

1. Symptom Management, Not Root Cause

FODMAPs and other restrictive diets help by temporarily starving bacteria in the small intestine, reducing fermentation and gas production. However, eliminating these foods entirely from your diet also deprives the beneficial bacteria in your large intestine of the nutrients they need to thrive. Many FODMAP foods, such as onions, bananas, and asparagus, are rich in prebiotics for the survival of the good bacteria in your large intestine. While FODMAPs can provide symptomatic relief, they do not address the underlying reasons for bacterial overgrowth in the small intestine.

2. The Risk of Food Fear

Elimination diets can unintentionally foster a fear-based relationship with food. When people associate certain foods with symptoms, it often leads to the mistaken belief that these foods are the root cause of the problem. This simplification of association into causation can create stress and anxiety around eating. The resulting hypervigilance during meals—constantly monitoring for bloating or discomfort—ironically disrupts digestion further and negatively impacts gut health.

3. Long-Term Impact on Gut Resilience

For many SIBO patients, the discomfort and bloating that occur after meals can lead to heightened sensitivity around eating. This often results in progressively cutting out more foods that seem to precede symptoms. Social media further fuels this cycle, offering quick fixes and extreme measures like elemental diets, which promise to eliminate bacteria in the small intestine. While these approaches may offer short-term relief, restrictive diets can reduce the diversity of gut bacteria over time. This loss of microbial diversity can exacerbate dysbiosis (imbalances in the gut microbiome), making it even harder for the gut to fully recover and regain resilience.

Feeling the Pressure: How Stress and the Gut-Brain Axis Impact Your Digestive Health at Work.

What Causes SIBO? Root Causes Beyond Diet

SIBO isn’t just about food—it’s a symptom of deeper issues in the gut. To truly address SIBO, it’s essential to understand the root causes that allow bacterial overgrowth to develop and persist. Here are some key factors:

1. Stress and the Gut-Brain Axis

During periods of stress, the body prioritizes the "fight and flight response," which causes digestion to slow down and blood flow to be diverted away from the gastrointestinal tract. This can disrupt the delicate balance of gut bacteria, contributing to symptoms like IBS. If the stress becomes chronic, this disrupts the gut-brain connection, impairing vagus nerve function and slowing gut motility. Stress also affects stomach acid production, immune function, and the balance of gut bacteria, all of which contribute to SIBO.

2. Motility Issues and the Migrating Motor Complex (MMC)

Motility issues can stem from structural problems such as scarring, growths, or vagus nerve damage caused by infections or trauma. Chronic stress can also lead to vagus nerve dysfunction, further impairing motility. Additionally, functional gastrointestinal conditions like IBS often disrupt normal motility patterns. The MMC (Migrating Motor Complex), which serves as your gut’s natural housekeeper by sweeping bacteria and debris from the small intestine during fasting periods, begins to fail. When the MMC is not functioning properly, bacteria accumulate in the small intestine, creating the conditions for SIBO to develop.

Have you struggled with managing SIBO? Share your experiences or questions in the comments below, and don’t forget to check out Part 2 for holistic solutions to SIBO recovery.

Why Does SIBO Keep Coming Back?

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:

1. 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.

2. Motility Disorders

• Conditions like IBS, gastroparesis, or systemic sclerosis can slow the MMC, causing food and bacteria to linger in the small intestine.

3. 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.

4. Structural Abnormalities

• Adhesions, diverticula, or blind loops in the intestines can create pockets where bacteria thrive, bypassing the MMC’s cleaning function.

5. Chronic Inflammation

• Inflammatory bowel diseases or low-grade inflammation from food intolerances can disrupt gut motility and MMC regulation.

6. 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.

7. 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.

8. Gut Dysbiosis

• Imbalances in gut bacteria (e.g., in the large intestine) can affect overall gut health and disrupt the MMC.

9. 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.

“Have you struggled with recurring SIBO? Share your experience or ask your questions below—I’d love to help!”