Why Do I Still Have Symptoms After Treating SIBO?

Experiencing lingering symptoms after treating Small Intestinal Bacterial Overgrowth (SIBO) is not uncommon. Despite treatment to reduce bacterial overgrowth, in some cases, symptoms can persist, leaving many individuals puzzled and disheartened about the reasons behind their ongoing discomfort. In this blog, we delve into the various factors contributing to this phenomenon and explore strategies for effective symptom management after SIBO treatment.


Understanding the Persistence of SIBO Symptoms after SIBO Treatment


1. Inadequate Treatment Approach:

The choice of treatment and its execution are critical. Insufficient dosage or duration of antibiotics/antimicrobial herbs, along with the absence of prokinetics (which support bowel regularity) and prebiotics (to support the growth of healthy bacteria during treatment), can hinder effective bacterial reduction and successful treatment.


What to do: If you suspect your treatment was insufficient, consult with your health practitioner. Ensure you’ve been prescribed the appropriate dosage and duration of antibiotics or antimicrobial herbs. If you’re not sure what is the correct dosage and duration for either antibiotics or antimicrobial herbs for SIBO, you can check out my SIBO Masterclass which covers the tried-and-tested SIBO treatment protocols for successful treatment. Additionally, consider incorporating prokinetics (either herbal or prescription) and prebiotics into your treatment regimen to optimize effectiveness. My SIBO Masterclass covers these components in precise detail too.


2. Need for Multiple Rounds of Treatment:

SIBO’s complex nature often necessitates multiple treatment rounds to comprehensively target bacterial overgrowth, especially considering the high relapse rate (45%) and underlying factors like motility disorders and dietary habits that can hinder successful treatment. Some individuals need 3-4 rounds of treatment. You can gauge whether you need a further round of treatment by doing a SIBO re-test or assessing symptoms.


What to do: Carry out a SIBO breath test again to see how much your gas levels have come down. If you still have a positive breath test result, discuss with your health practitioner the possibility of undergoing additional rounds of treatment. Consider alternative antibiotics or antimicrobial herbs and prokinetics to address any persistent bacterial overgrowth. Additionally, focus on dietary modifications that support gut health and reduce the risk of recurrence. Check out my SIBO Diet Support Bundle for in-depth guidance on a SIBO-friendly diet that supports long term gut health.


3. Carbohydrate Malabsorption:

SIBO disrupts normal carbohydrate digestion, leading to fermentation and subsequent malabsorption. Resolving this requires a targeted gut healing protocol post-treatment involving dietary adjustments and supplements.


What to do: Adopt a lower FODMAP diet and lower carbohydrate diet (aka a SIBO-friendly diet) to reduce fermentable carbohydrates that feed bacteria. Incorporate gut-healing supplements such as glutamine, zinc carnosine, and deglycyrrhizinated licorice (DGL) to support the repair of the intestinal lining and digestive support such as digestive enzymes to help with digesting and absorbing carbohydrates.




4. Leaky Gut:

SIBO-induced damage to the intestinal lining can result in leaky gut, triggering inflammation and multiple food intolerances. Addressing this entails a combination of proper treatment, personalized diet modifications (monitoring your specific trigger foods), and gut-healing strategies.


What to do: Eliminate potential trigger foods such as grains/gluten, dairy, alcohol and processed foods that may exacerbate inflammation and worsen leaky gut. Incorporate gut-supportive nutrients such as omega-3 fatty acids, quercetin, glutathione and curcumin to reduce inflammation and promote gut healing.


5. Potential Candida Overgrowth:

Certain antibiotics used to treat SIBO (Metronidazole and Neomycin) can inadvertently promote candida overgrowth in the gut by killing off our healthy gut bacteria which keeps candida under control. Mitigating this risk involves supporting the restoration of a healthy gut microbiome post-treatment.


What to do: Consider a comprehensive stool test such as GI 360 by Doctor’s Data to find out if you have intestinal candida overgrowth. Consider probiotic supplements post-treatment containing strains like Lactobacillus, Bifidobacterium and Saccharomyces Boulardii to restore microbial balance. Alternatively, carry out a round of antifungal herbal treatment after your SIBO treatment. Herbs and spices such as cinnamon, black walnut, clove, rosemary, olive leaf extract and grapefruit seed extract are all potent anti-fungal agents.  Incorporate prebiotic-rich foods such as berries, kale, spinach, carrots, lentils, chia and flaxseeds to feed beneficial gut bacteria and support their growth.


6. Digestive Disorders:

Poor digestion, characterized by conditions like bile acid malabsorption, pancreatic insufficiency, and hypochlorhydria, can contribute to persistent symptoms such as bloating and discomfort.


What to do: Work with your health practitioner to identify and address underlying digestive disorders. Consider digestive enzyme supplements to support proper digestion of carbohydrates, proteins, and fats. Experiment with dietary modifications such as smaller, more frequent meals, mindful eating and chewing food thoroughly to aid digestion.


7. Chronic Stress:

Stress disrupts gut function, affecting enzyme production, motility, and the gut microbiota. Stress management techniques are crucial for supporting successful SIBO treatment and long-term gut health.


What to do: Incorporate stress-reducing practices such as mindfulness meditation, deep breathing exercises, and yoga into your daily routine. Prioritize self-care activities that promote relaxation and reduce stress levels, such as spending time in nature, engaging in hobbies, and connecting with loved ones.


8. Unaddressed Root Causes:

Underlying issues like impaired gut motility and structural abnormalities in the digestive tract can perpetuate symptoms even after SIBO treatment. A comprehensive approach is necessary to tackle these factors effectively.


What to do: Consult with a gastroenterologist or nutritional therapy practitioner to assess for underlying gut motility disorders or structural abnormalities. Explore treatment options such as prokinetic medications/supplements, physical therapy, surgical interventions and personalized supplement and dietary programmes to address these root causes and optimize digestive function.


9. Potential Inflammatory Bowel Conditions:

Conditions like Crohn’s disease and ulcerative colitis can mimic SIBO symptoms due to chronic inflammation and gut damage. Managing these conditions is essential for symptom relief.


What to do: Collaborate with a gastroenterologist or inflammatory bowel disease (IBD) specialist to confirm diagnosis and develop a personalized treatment plan. Incorporate anti-inflammatory foods such as fatty fish, leafy greens, and turmeric into your diet. Explore complementary therapies such as acupuncture or herbal medicine to alleviate symptoms and support gut healing.


10. Persistent Gut Dysbiosis:

Imbalances in the gut microbiota can lead to ongoing symptoms post-SIBO treatment. Restoring microbial balance through diet and targeted interventions is key to symptom management.


What do do: Consider undergoing comprehensive stool testing to assess your gut microbiota composition and identify gut dysbiosis. Work with a health practitioner (such as a nutritional therapist or functional medicine practitioner) to develop a personalized gut-healing protocol incorporating dietary modifications, probiotics, and prebiotics. Monitor symptoms closely and adjust interventions as needed to promote microbial balance and improve gut health.




In conclusion, persistent symptoms after SIBO treatment can be multifaceted. To effectively manage these symptoms, a holistic approach involving further investigation, treatment re-evaluation, and personalized dietary/lifestyle adjustments is paramount. Seeking guidance from a health practitioner experienced in managing SIBO is crucial for developing a tailored plan to promote long-term gut health and well-being.