Why Does SIBO Keep Coming Back After Treatment? | Dr. Allison Siebecker, Part 1

Dr. Allison Siebecker is a SIBO specialist and the practitioner whose work changed everything for me. She has spent years treating this condition and teaching people how to test for it.

What SIBO Actually Is

Dr. Siebecker describes SIBO as an overgrowth of particular bacteria, or similar organisms called archaea, in the small intestine. They interfere with digestion and absorption.

Those symptoms are the symptoms of IBS. Bloating or distension, abdominal pain, and constipation, diarrhea or a mixture. Then flatulence, belching, nausea, anxiety, fatigue, brain fog and acid reflux.

The distinction matters because it changes what can be done. The options used to be aimed at each symptom. Once bacteria are known to be involved, the bacteria can be targeted.

The Housekeeper Wave in Your Gut

Peristalsis is the churning movement that happens after you eat. The migrating motor complex is different. It runs when you are fasting, between meals and overnight.

Dr. Siebecker calls it the housekeeper wave. It arrives with bile and enzymes that act like soap and water, then sweeps what is left down and out. It is the body's main protection against overgrowth in the small intestine.

When it becomes deficient, and that is common, overgrowth can follow. She uses the picture of a river that stops flowing and becomes a swamp.

How Food Poisoning May Set It Off

The most common thing that impairs it is food poisoning. Acute bacterial gastroenteritis, traveler's diarrhea, or what most of us call a stomach bug.

Dr. Siebecker explains the mechanism as an autoimmune one. The toxin from those bacteria closely resembles a protein on a nerve cell in the small intestine, so the immune system attacks its own cell while going after the toxin. Those cells run the migrating motor complex.

Not everyone who gets food poisoning develops SIBO. She puts it at roughly 10 to 11 percent of cases. The delay is what makes it hard to spot. It can be one to six months, and a mild episode may not be remembered at all.

There is a blood test, IBS Smart, that looks for the antibodies. In coaching we hear people say they have had no food poisoning, and then the test comes back positive.

Why Symptoms Alone Cannot Tell You

You cannot diagnose SIBO from symptoms. The definition asks for both symptoms and a test showing the overgrowth. A positive test with no symptoms is not SIBO, and neither are symptoms with a correct negative test.

Around forty other conditions can produce the same picture. Candida, parasites, adhesions, endometriosis, and in one case I heard about, ovarian cancer. That is not common, and it is a cautionary tale. Dr. Siebecker also points out that these treatments are antibacterial, and none of us want to use those when they are not called for.

What a Breath Test Involves, and Why Interpretation Matters

It is a breath test. One day of a prep diet that reduces carbohydrates, an overnight fast, then a sugar solution the next morning. Dr. Siebecker prefers lactulose. You sample your breath every 15 or 20 minutes for three hours and send it to a lab, which measures the gases the overgrowth produces. Hydrogen, methane and hydrogen sulfide give the different types of SIBO.

Interpretation is where this falls down. She is clear that you should not rely on the lab's own analysis alone, because the industry has not fully standardized and it is common for a test to be reported negative when it is not.

That happened to me. When we finally looked at the paper rather than the report, it had positive written down, crossed out, with NEG next to it. I lost 18 months to that.

Where the Elemental Diet Fits

There are three antimicrobial treatments. Prescription antibiotics, herbal antimicrobials, and the elemental diet, which Dr. Siebecker suggests might be better called an elemental formula, because people confuse it with what they eat.

It is a medical food. Nutrients in their most broken down form, taken as a drink, absorbed quickly enough that the overgrown bacteria do not get to ferment them. The protocol typically runs fourteen days, with a test after two weeks.

It is a heavier lift, because you are not eating solid food for that stretch. The concern people raise most is weight loss, and Dr. Siebecker's answer is that when the recommended intake is met, most people see a little water weight early on that returns once they eat again. Any of this belongs in a conversation with your own practitioner.

Why Prokinetics Come Up So Often

A prokinetic helps harmonize the migrating motor complex, and it may help prevent relapse. It is not a laxative, and that gets missed a lot. I ask people in coaching so often that Dr. Siebecker had a t-shirt made for my birthday with the question on it.

If you have spent years being told it is just IBS, the useful next step is not another supplement. It is finding out whether there is an overgrowth at all, and making sure whoever reads that result knows how to read it. Be your own detective. There is hope, and there are answers. I'm glad we found each other.

Part two covers the treatments in more depth, including prescription antibiotics and herbal antimicrobials, in Episode 03.