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SIBO
SIBO is bacteria growing where they do not belong. We ask why they got there: motility, stomach acid, the vagus nerve, and the brain to gut connection.
What you may be noticing
Your belly is flat in the morning and looks pregnant by evening. Fiber, garlic, onions, and even healthy vegetables make it worse. You may swing between constipation and loose stools, feel full after a few bites, and battle fatigue and brain fog after meals.
Why it is rarely one thing
SIBO is not simply too many bacteria. It is a failure of the systems that keep the small intestine clean. Treating the overgrowth without restoring those systems is why SIBO so often returns.
The question is not only what is growing, but why the defenses fell.
Your small intestine is designed to hold relatively few bacteria. Several layers protect it: acid in the stomach, bile and enzymes, a valve at the end of the small intestine, an immune lining, and a rhythmic cleansing wave that moves between meals. When one or more of these layers weakens, bacteria migrate upward and ferment your food before you can absorb it. The gas they make produces the bloating, and the inflammation they create can reach the brain. Over time, malabsorption can quietly lower iron and other nutrients.
Patterns we look for
- The migrating motor complex, the cleansing wave between meals, coordinated by the gut nervous system and the vagus nerve.
- Vagal tone, which drives motility, stomach acid, and enzyme release.
- Stomach acid, bile, and pancreatic enzyme output, which keep bacterial numbers in check.
- The ileocecal valve, which separates the colon from the small intestine.
- Gas type: hydrogen, methane (often called IMO), and hydrogen sulfide each behave differently.
- Prior food poisoning, which can trigger an autoimmune response affecting gut nerve function (a recognized mechanism under ongoing study).
- Antibiotic history, hormonal birth control, and long seasons of stress.
- Hypothyroidism, which slows motility.
- Adhesions and structural factors after surgery.
- Concussion and brain injury, which can impair the brain to gut signal.
How I evaluate it
Your comprehensive functional neurological exam evaluates vagal function directly: the gag reflex, palate elevation, heart rate variability, and autonomic responses. These tell me whether the gut is receiving its signal from the brain.
Functional testing may include a lactulose or glucose breath test that measures hydrogen and methane, and where available hydrogen sulfide, along with comprehensive stool analysis, a thyroid panel, ferritin and nutrient status, and markers of inflammation and permeability.
Blood in the stool, unintended weight loss, persistent vomiting, or fever need conventional evaluation first.
How we address it
Order and timing are everything, so the plan follows my gut healing sequence:
- Open drainage first: daily bowel movements, bile flow, and lymph, so the body can clear what is released.
- Support motility and the vagus nerve with daily exercises and abdominal massage over the ileocecal valve and the turns of the colon.
- Reduce the overgrowth with natural antimicrobial categories matched to the gas type, with binding support spaced afterward, sometimes alongside an elemental phase.
- Restore digestive acid, bile, and enzymes, and repair the gut lining.
- Rebuild the terrain only after clearance, then follow a strict low-fermentation elimination and reintroduce foods one at a time, every few days, so your gut tells us what it welcomes.
The gut does not heal in isolation. It heals when the nervous system leads it again.
Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.