Why Do I Still Have Symptoms After Treating SIBO?

Experiencing lingering symptoms after treating Small Intestinal Bacterial Overgrowth (SIBO) is not uncommon, and several factors may contribute to this phenomenon. In this blog, we’ll explore in-depth the common reasons why symptoms persist after SIBO treatment and what we can do about it.

SIBO is a condition characterized by an overgrowth of bacteria in the small intestine, and while treatment aims to reduce bacterial overgrowth, certain challenges can hinder the resolution of symptoms such as bloating, discomfort and food reactions. Why is this? Firstly, the underlying cause of SIBO, such as impaired gut motility or structural abnormalities, may persist even after initial treatment, leading to a higher likelihood of recurrence. Secondly, SIBO treatment may not fully address the associated gut dysbiosis or leaky gut, both of which can contribute to ongoing symptoms such as food sensitivities. Additionally, the presence of scar tissue or adhesions (from endometriosis or surgery) in the intestines may impair normal digestive function and lead to persistent discomfort. Moreover, the gut may require time to heal and regain its optimal function, especially if there has been long-standing inflammation and damage to the gut lining. Lastly, individual variations in the response to treatment and dietary factors can also play a role.


10 Reasons Why You Still Have Symptoms After Treating SIBO


1. The incorrect treatment was used.

Taking the correct treatment and dosage for treating Small Intestinal Bacterial Overgrowth (SIBO) is vitally important to achieve effective results and promote overall gut health. The treatment typically involves antibiotics or antimicrobial herbs, prokinetics and prebiotics to target and reduce the excess bacteria. It is crucial to follow the prescribed dosage and duration of treatment to ensure that the overgrowth is adequately addressed. Additionally, dietary modifications, such as a low-FODMAP diet, can complement the treatment by reducing fermentable carbohydrates that feed the bacteria. Properly treating SIBO not only alleviates symptoms like bloating, gas, and abdominal pain but also helps restore the balance of the gut microbiota, improving overall digestive health and nutrient absorption.



2. Multiple rounds of treatment are sometimes needed to treat SIBO.

While the initial treatment may be effective in reducing bacterial overgrowth, it is common for some bacteria to persist or regrow quickly. Multiple rounds (2-3) of treatment are often needed to effectively treat SIBO. Additionally, underlying factors such as motility disorders, structural abnormalities, or dietary habits may contribute to SIBO recurrence or inadequate treatment. Therefore, a single treatment round might not always be sufficient to fully eradicate the overgrowth and address the root causes. Multiple rounds of treatment, often with different antibiotics or a combination of antimicrobial herbs and prokinetics, may be necessary to target the bacteria more comprehensively and achieve better results. Furthermore, treating SIBO effectively often involves addressing concurrent issues such as gut dysbiosis, leaky gut, or food intolerances. Each treatment round should be followed by careful monitoring of symptoms and retesting to assess the success of the treatment and ensure that SIBO is adequately managed.


3. You have carbohydrate malabsorption as a result of SIBO.

Small Intestinal Bacterial Overgrowth (SIBO) can lead to carbohydrate malabsorption due to the disruption of the normal digestive process within the small intestine. In a healthy gut, carbohydrates are broken down into smaller, absorbable molecules by digestive enzymes, and then absorbed through the intestinal lining into the bloodstream. However, in the case of SIBO, the excess bacteria in the small intestines ferment carbohydrates before they are fully digested, producing gas and other byproducts. This fermentation process not only hinders the proper breakdown of carbohydrates but also damages the intestinal lining, causing symptoms such as bloating, gas, discomfort and malabsorption of essential nutrients, all of which can linger long after treating SIBO. Resolving carbohydrate malabsorption requires a gut healing protocol consisting of dietary modifications and supplements that aid in the repair of the gut lining.



4. You have a leaky gut caused by SIBO.

Small Intestinal Bacterial Overgrowth (SIBO) can contribute to the development of leaky gut and food intolerances through various interconnected mechanisms. In SIBO, an overgrowth of bacteria in the small intestine leads to the production of excessive amounts of harmful byproducts and toxins. These substances can damage the delicate lining of the small intestine, causing it to become more permeable than normal. As a result, the intestinal barrier, which is responsible for selectively allowing nutrients to pass through while keeping harmful substances out, becomes compromised. This condition is known as leaky gut, where undigested food particles, toxins, and bacteria can leak into the bloodstream. This triggers an immune response, leading to inflammation and the development of food intolerances. The immune system may start to recognize these leaked particles as foreign invaders, mounting an immune reaction whenever they are encountered, even if they are harmless food molecules. Over time, this can lead to food intolerances and sensitivities, where certain foods trigger adverse reactions, exacerbating gut issues and other systemic symptoms. Addressing SIBO through proper treatment, along with following a personalized elimination diet and gut-healing strategies after SIBO treatment, can help restore the integrity of the intestinal lining, reduce food intolerances, and improve overall gastrointestinal health.


5. You may have another gut imbalance such as candida overgrowth.

Metronidazole, an antibiotic commonly used to treat methane SIBO, can inadvertently contribute to candida overgrowth in the gut by disrupting the balance of the gut microbiota. While metronidazole is effective against certain bacterial overgrowths, it is a broad-spectrum antibiotic, meaning it can target a wide range of bacteria, including beneficial ones that maintain a healthy gut environment. As the antibiotic works to eliminate the methane bacteria, it may inadvertently kill off beneficial gut bacteria that play a crucial role in keeping candida (yeast) levels in check. Candida albicans is a naturally occurring yeast in the gut, but when the balance of the gut microbiota is disrupted, candida can overgrow and lead to a condition called candidiasis. This overgrowth can cause a variety of symptoms, such as digestive issues, bloating, food intolerances and skin problems. To mitigate the risk of candida overgrowth while taking metronidazole, it is essential to take prebiotics and probiotics or consume fermented foods rich in beneficial bacteria to support the restoration of a healthy gut microbiome after completing the antibiotic course. Antifungal herbs may be required to target any candida overgrowth that has developed.



6. Poor digestion could be to blame.

Poor digestion can lead to symptoms such as bloating and discomfort due to the accumulation of gas and undigested food in the gastrointestinal tract. When the process of digestion is impaired, such as by inadequate enzyme production, lack of stomach acid or bile production, food remains in the stomach and intestines for longer periods. As a result, beneficial gut bacteria may start to ferment the undigested carbohydrates, proteins, and fats, producing gas as a byproduct. This gas buildup leads to abdominal distension and discomfort, commonly known as bloating. Additionally, poorly digested food can also cause water retention in the intestines, further contributing to the feeling of bloating and abdominal fullness. Addressing the underlying causes of poor digestion, such as adopting a balanced diet, eating mindfully, managing stress, and addressing any underlying digestive disorders, can help alleviate bloating that may linger long after SIBO treatment.



7. You’re in a chronic fight/flight response.

Stress triggers the well-known “fight or flight” response, a physiological reaction designed to prepare our bodies for perceived threats. During stressful situations, the body releases stress hormones, such as cortisol and adrenaline, which increase heart rate, blood pressure, and redirect blood flow away from non-essential functions, including digestion. This shift in blood flow diverts resources away from the digestive system, leading to decreased enzyme production and reduced motility in the gastrointestinal tract. As a result, digestion becomes less efficient, and the process of breaking down food is compromised. Additionally, stress can disrupt the delicate balance of the gut microbiota, leading to an overgrowth of harmful bacteria and a decline in beneficial bacteria, which are crucial for maintaining gut health and combating SIBO. This imbalance can contribute to ongoing issues like bloating and abdominal discomfort. Chronic stress may impair the proper resolution of SIBO and may have long-term effects on gut health and digestion, highlighting the importance of stress management techniques, such as meditation, exercise, and mindfulness practices, to support overall gastrointestinal well-being and SIBO successful SIBO treatment.



8. You haven’t addressed the root cause of your SIBO such as impaired gut motility, structural abnormalities and poor digestion.

Despite treating Small Intestinal Bacterial Overgrowth (SIBO), symptoms may persist due to various factors, including slow gut motility, poor digestion, and structural abnormalities in the digestive tract. Slow gut motility can impede the movement of food and waste through the gastrointestinal tract, leading to the stagnation of contents in the small intestine. This prolonged retention creates an environment conducive to bacterial overgrowth, even after initial treatment. Poor digestion, caused by insufficient enzyme production or impaired absorption, can result in undigested food reaching the small intestine, providing a substrate for bacterial fermentation and gas production. Additionally, structural abnormalities in the digestive tract, such as strictures or adhesions, can disrupt the normal flow, causing pockets where bacteria can thrive and evade eradication. Despite successfully reducing bacterial overgrowth, these underlying issues can perpetuate ongoing symptoms, emphasizing the need for a comprehensive approach to address both SIBO and the contributing factors to achieve long-term relief and improved gastrointestinal health.


9. You could have an undiagnosed inflammatory bowel condition that needs to be taken into consideration.


Inflammatory Bowel Disease (IBD), which includes conditions like Crohn’s disease, Coeliac disease and ulcerative colitis, can cause SIBO-like symptoms such as bloating, discomfort and diarrhoea due to chronic inflammation and damage to the gastrointestinal tract. In IBD, the immune system mistakenly attacks the digestive tract, leading to inflammation and ulceration in various parts of the intestines. This ongoing inflammation disrupts the normal functioning of the gut, impacting digestion and nutrient absorption. The damaged intestinal lining may not be able to properly process and absorb food, leading to a buildup of gas and undigested material in the intestines. Additionally, the inflammatory response can alter the balance of the gut microbiota, leading to an overgrowth of certain bacteria that produce excessive amounts of gas during the fermentation of undigested carbohydrates. The combination of inflammation, impaired digestion, and gas production contributes to abdominal distension and bloating, which are common symptoms experienced by individuals with IBD and SIBO. Managing IBD through medical treatments, dietary modifications, and lifestyle changes can help reduce inflammation and alleviate gastrointestinal symptoms.


10. You still have gut dysbiosis.

Gut dysbiosis, which refers to an imbalance in the gut microbiota, can lead to ongoing symptoms even after SIBO treatment due to the altered composition and function of the gut bacteria. In a healthy gut, there is a delicate balance between beneficial and harmful bacteria, which plays a crucial role in maintaining proper digestion and overall gut health. However, factors such as a poor diet, stress, medications, and other lifestyle choices can disrupt this balance, leading to an overgrowth of harmful bacteria or a decline in beneficial ones. This dysbiosis can impact the fermentation of undigested food in the gut, causing an increase in gas production, inflammation and bloating. Addressing gut dysbiosis through a balanced diet, probiotics, prebiotics, and other gut-healing strategies can help restore microbial balance, improve digestion, and reduce symptoms after SIBO treatment.





In conclusion, experiencing persistent symptoms after treating Small Intestinal Bacterial Overgrowth (SIBO) can be a frustrating and common issue. Several factors contribute to this occurrence, including underlying causes of SIBO that may not have been fully addressed, the persistence of gut dysbiosis and leaky gut, digestive impairment, the presence of scar tissue or adhesions in the intestines, and individual variations in response to treatment. Time may be needed for the gut to heal and regain its optimal function after prolonged inflammation and damage. To effectively manage post-treatment symptoms, a comprehensive approach is crucial, involving further investigation, reevaluation of treatment strategies, and personalized dietary and lifestyle adjustments. Seeking guidance from a healthcare professional experienced in managing SIBO is essential to develop a tailored plan for addressing these lingering symptoms and promoting long-term gut health and well-being.