Why Clearing SIBO May Not Totally Eradicate Your Gut Symptoms and Endo Belly

Okay, so today we're talking about why you may have cleared SIBO, but you still have gut symptoms and endobelly.

So let's first start off with what SIBO is, in case you're new to the show.

SIBO stands for small intestine bacterial overgrowth, and is an overgrowth of specific bacteria in the small intestine.

We now have intestinal methanogen overgrowth, and intestinal sulfide overproduction.

They still come under the SIBO umbrella, so when I'm talking about SIBO in general, I am including all three gases, the hydrogen, which is the standard SIBO in the small intestine, the methane, which is the small intestine and the large intestine, and the hydrogen sulfide, which is the small and large intestine.

Just so you know, you've got SIBO, IMO and ISO, but they're kind of under the same umbrella.

Now, the large intestine should house the majority of our bacteria with only small amounts in the small intestine.

And in the large intestine, there should only be a very small amount of methane being produced and hydrogen sulfide, if any.

Just like the microbiome in the large intestine, these bacteria eat the carbohydrates and fiber that arrive there and release gas, a process called fermentation.

The small intestine shouldn't be hosting these bacteria.

It is not designed to host this fermentation process, and the resulting symptoms are bloating, gas, abdominal pain, constipation and diarrhea, to name just a few.

Så, if this sounds familiar, there's a reason.

A small 1998 study found that 80% of endoparticipants had SIBO, with 100% of participants showing altered small intestine motility, which is a possible risk factor for SIBO development.

And then in 2025, a case control study found that 91.9% of endoparticipants were positive for SIBO or intestinal methanogen overgrowth.

They didn't do an ISO test in this, so they didn't test for intestinal sulfide production, so we don't have that info yet.

And in this study they found 49.4% were positive for both, 34.8% were positive for hydrogen alone, and 15.8% were positive for methane alone.

They also found that 85.8% had altered transit versus 71% in the control group.

67.8% suffered constipation versus 44.7% in the control group, and those with hydrogen SIBO were more likely to develop diarrhea, and those with emo were more likely to develop acid reflux.

Now, as we've discussed many times on this show, research has also shown that people with endo are three times more likely to also have IBS.

And the latest studies are finding that SIBO is the root cause of around 60-70% of IBS cases.

So, it's reasonable then to wonder if SIBO is behind our endobelly woes.

And in my experience, about 90% of my clients who I test for SIBO are positive for SIBO.

And in fact, I literally can only remember one.

Maybe two, like my brain is like stretching to find if there's a second in there.

Yeah, so one or two coming back as negative.