I Think I Have SIBO; Now What?
When someone quietly says, “I think I have SIBO,” they’re rarely just talking about bloating. They’re often describing months or years of confusion, food fear, half-answers and a sense that their gut has become something to manage rather than trust. In this interview, we step away from the oversimplified narratives around SIBO as a condition to “eradicate” and instead explore how experienced practitioners actually think about it in clinic. From diagnostics and testing nuance to gut motility, nervous system regulation and recovery timelines, this is a grounded, science-led look at what SIBO really is, why it so often returns, and how a more considered, whole-body approach can change the outcome. This is what gut health specialist, Marilia Chamon said.
Diagnostic
1. When someone says “I think I have SIBO”, what are you really listening for first?
“When someone tells me they think they have SIBO, I’m not jumping straight to testing. I’m listening to the story first. I want to understand their symptoms in detail – bloating, pain, bowel changes, food reactions – but just as importantly, how and when those symptoms started. Was there a clear trigger like food poisoning, a stomach bug, surgery, or a particularly stressful period? I’m also paying close attention to their health history, current diet, lifestyle, and any patterns they’ve noticed over time. SIBO rarely appears out of nowhere, so those early clues are often far more informative than a test result alone.”
2. What are the biggest misconceptions about SIBO right now?
“One of the biggest misconceptions is seeing SIBO as simply a bacterial overgrowth that needs to be killed. In reality, SIBO is usually a consequence of something else, most often impaired gut motility. Many people focus entirely on antimicrobials or antibiotics, without addressing why the bacteria were able to overgrow in the first place. That’s why relapse rates are so high. A successful SIBO approach needs to be multifactorial, addressing digestion, biofilms, gut barrier health, nervous system regulation, and motility. Addressing just one piece of the puzzle rarely leads to lasting results.”
3. How often is SIBO the root cause versus a symptom of something else?
“In most cases, SIBO is not the root cause, it’s a downstream effect. Reduced gut motility creates the perfect environment for bacteria to overgrow where they shouldn’t. That reduced flow can happen for several reasons, food poisoning is one of the most common triggers, but it can also result from abdominal surgery and adhesions, certain medications, low thyroid function, or chronic stress. Identifying what impaired gut motility in the first place is key. Without that understanding, results tend to be short-lived.”
Assessment
4. What do you always assess before considering SIBO testing?
“Before testing, I always start with a thorough health history and symptom assessment. Testing should confirm or clarify a clinical picture, not replace it".”
5. When is breath testing useful and when can it be misleading?
“Breath testing can be useful when symptoms, history, and clinical judgement all point in the same direction. It can help identify gas patterns and guide the therapeutic approach. However, it can be misleading when it’s used in isolation or interpreted without SIBO knowledge. Reading a breath test isn’t as straightforward as it seems, and interpretation varies depending on guidelines, which differ between the US and Europe.”
The practitioner approach
6. How do you calm fear and nervous system dysregulation around a SIBO diagnosis?
“A SIBO diagnosis can feel overwhelming, especially for people who have been unwell for a long time. I focus on reassurance and education. I explain that SIBO is manageable, but that it’s not usually an overnight fix. One round of antibiotics or antimicrobials is rarely the full solution. Progress takes time, patience, and a layered approach. Helping clients feel understood and supported is just as important as the strategy itself.”
7. What does a good support plan actually prioritise in a clinic?
“A strong support plan follows the natural stages of SIBO management. That may include antibiotics or antimicrobials, but it doesn’t stop there. Digestive support is essential – things like enzymes, bile flow, biofilm disruptors, and gut barrier support. Gut motility and nervous system regulation are also prioritised throughout. The goal isn’t just symptom relief, but creating an environment where SIBO is less likely to return.”
8. Why is gut motility so central and so often missed?
“Gut motility is central because it’s one of the body’s main defence mechanisms against bacterial overgrowth. Between meals, the migrating motor complex (often described as the gut’s “housekeeping wave”) helps sweep bacteria out of the small intestine. If this process is impaired, bacteria linger and multiply. Many strategies focus on reducing bacteria without restoring this cleansing mechanism, which is why SIBO so often comes back.
In my opinion, gut motility is missed simply because SIBO is often viewed as an infection to eradicate, rather than a consequence of impaired gut flow.”
“In my opinion, gut motility is missed simply because SIBO is often viewed as an infection to eradicate, rather than a consequence of impaired gut flow.”
Food & restriction
9. How do you use diet without creating unnecessary restriction or fear?
“Most clients come to me already eating very restrictively, trying to control symptoms. In those cases, diet becomes a tool to expand food choices, not shrink them further. I often use a low fermentation approach, which has two key principles: limiting foods high in fermentable carbohydrates that humans can’t digest, and spacing meals four to five hours apart to support gut motility. What many people don’t realise is that this approach still allows a wide range of foods, helping clients feel nourished, less fearful around food, and more socially flexible, while still managing symptoms.”
10. What are the most common mistakes you see with self-treatment?
“The most common mistakes I see in clinic are overuse of antimicrobials and excessive food restrictions. Another frequent issue is taking generic probiotics, which often leads to increased bloating and discomfort rather than improvement. Mistakes often stem from trying to manage SIBO without proper guidance. SIBO is complex, and protocols that work for one person can worsen symptoms in another. Working with a practitioner who is specifically trained in SIBO helps ensure that protocols are tailored to each individual and SIBO sub-type.”
Treatment & recovery
11. How do you decide between antibiotics, herbals or supportive care only?
“This is always a collaborative decision. I discuss the options with the client, weighing the pros and cons of each. Antibiotics can be extremely effective and absolutely have a place in SIBO treatment. Others prefer a herbal approach, which can work well but often takes longer. The right choice depends on the individual, their history, and their preferences.”
12. What does real recovery look like, and how long does it usually take?
“Recovery is highly individual and depends largely on the underlying cause. Someone who developed SIBO after food poisoning and has elevated anti-vinculin antibodies may need long-term management because gut motility has been chronically affected. The same applies to people with adhesions or ongoing medication use that slows down gut flow. For others, recovery can be more straightforward. That said, for many people, meaningful improvements in quality of life typically take around three to four months when strategy is done properly and holistically.”
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