EP.397/ Why Clearing SIBO May Not Totally ERADICATE Your Gut Symptoms and Endo Belly
Okay, so let’s first start off with what SIBO is.
SIBO stands for Small Intestine Bacterial Overgrowth and is an overgrowth of specific bacteria in the small intestine.(1)
The large intestine should house the majority of our bacteria, with only small amounts in the small intestine.
Just like the microbiome in the large intestine, these bacteria eat the carbohydrates and fibre that arrive there, and release gas, a process called fermentation.
The resulting symptoms are bloating, gas, abdominal pain, constipation and diarrhoea to name just a few.(2)
Sound familiar?
Well, there’s a reason.
A small 1998 study found that 80% of endo participants had SIBO, with 100% of participants showing altered small intestine motility, a possible risk factor for SIBO development(3).
And then in 2025, a case-control study found that 91.9% of endo participants were positive for either SIBO or IMO (Intestinal Methanogen Overgrowth).(4)
In fact, they found that:
49.4% were positive for both
34.8% were positive for hydrogen alone
15.8% were positive for methane alone(4)
They also found:
85.8% had altered transit vs 71% in the control group.
67.8% suffered with constipation vs 44.7% in the control group.
Those with hydrogen SIBO were more likely to develop diarrhoea, those with IMO were more likely to develop acid reflux.(4)
Now, as we’ve discussed many times on this show, research has shown that people with endo are three times more likely to also have IBS,(5) and the latest studies are finding SIBO is the root cause of around 60-70% of IBS cases.(6)
So, it’s reasonable then, to wonder if SIBO is behind our endo belly 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, coming back as negative.
So, it’s easy for us to hope that treating and eradicating the SIBO, will solve our endo belly issues.
And whilst it certainly can have a huge impact, and I’ve seen eradicating SIBO changes the lives of many clients, it’s not always as dramatic as we’d hope.
So today, I want to talk about why that might be.
When we are treating SIBO, Dr Siebecker recommends we aim for negative, or 90% better, if the client can’t retest. Why? Because she expects her patients to feel 90% better, as she has observed there is usually about 10% of symptoms left over that are caused by other issues, which could be as simple as rushing your food and not chewing enough, to something like low stomach acid or FODMAP intolerances.
Now, that’s when she’s talking about SIBO in the general population, after seeing thousands of patients.
But let’s now look at the endo population specifically.
In my experience, in the endo demographic, we can expect an improvement of symptoms by about 50%-70%, but it may be lower or higher, depending on the individual.
This is because unfortunately, we are also prone to microbiome alterations that can cause symptoms (outside of SIBO)(7) and conditions that can also affect gut function, such as hypermobility or hEDS,(8) POTS,(9) coeliac disease,(10) hypothyroidism(11) and MCAS,(12) to name a few. These conditions cause alterations in motility and how well digestion works, for example, one study found that people with POTS had poor muscle coordination when trying to pass stools which led to longer and more difficult bowel movements. Additionally, these patients also had a weaker lower esophageal sphincter (the valve between the oesophagus and the stomach) allowing for acid reflux, and weak, uncoordinated muscle movement, resulting in difficulty getting food down to the stomach.(13)
To add to that, we often have the presence of adhesions and/or pelvic floor dysfunction, which can cause issues like bloating, fecal urgency or constipation.
So, when I work with clients on their endo belly and IBS-type symptoms, I am not just looking at SIBO and thinking that treating that will fix it all. I am looking at whole body symptoms that could suggest the presence of other conditions, which may also be contributing to my clients digestive difficulties.
And then, either before, during or after addressing SIBO, depending on the conditions, I work on these as well, supporting my clients to get the right diagnoses and treatments.
Now, this might sound overwhelming, but it’s a gradual, step by step process, only addressing the issues my clients feel like they can take on, and for the rest, we can use symptom management tools until they feel ready for further diagnosis.
So, if you’ve worked on your SIBO, you’re negative but you still have symptoms, don’t despair that this is forever. It’s possible you have one or more other factors, contributing to your symptoms, that also needs some support, for you to see significant improvements.
If you want to learn more about the root causes of endo belly and IBS in the endo demographic, and you’re keen to understand the SIBO, MCAS, POTS and hEDS connection too, I am running a free workshop on Thursday July 23rd, 6pm British Summer time, live on Zoom. If you can’t attend it live, you’ll be able to watch the replay. You’ll learn what the emerging evidence is showing us about endometriosis and the gut microbiome, some of the key root causes behind endo belly, co-conditions to look out for, and what kind of treatments you might need to consider.
To sign up, go to: https://www.theendobellycoach.com/free-endo-belly-workshop and I’ve put the link in my show notes.
And if you feel like you might need some extra, tailored support, I am looking for 5-10 people who would like help with their endo belly and suspect SIBO.
After the success of using probiotics for SIBO in endo clients these past nine months, and the recent practitioner training I ran on endo and SIBO, where I presented the latest research and my experience with endo+SIBO clients over the past several years, I would LOVE to now take this further to a larger group of endo peeps to begin gathering more data on the impact of SIBO on endo, and how addressing it affects IBS symptoms, endo symptoms and endo belly.
I am particularly keen to work with anyone interested in trying the probiotic protocols I’ve been testing, as this is where we have the least data and yet are seeing good success rates, BUT I’m also happy to work with anyone who would like to explore other avenues i.e. elemental diet, herbs, etc.
To keep this affordable and also to help manage my caseload, the programme will consist of three one to one sessions, delivered over six months (nine months if needed, some cases require longer), with email support in between (in contrast to my usual coaching, which is 12 sessions). SIBO is tough to treat, so there will of course be room for extension if required.
Prior to starting, we’ll order you a SIBO test and go over your symptom history to help me identify any SIBO co-conditions or root causes we need to address.
Then we will meet for two initial sessions to get started, covering:
Test results
Protocol options and creating a plan (including retesting)
Dietary options
Die off preparation and management
Symptom management
You’ll then be able to move forward with the protocol, with email check ins and support from me.
The third session will cover prevention of relapse and microbiome rebuilding, or chronic SIBO management if you have a root cause that causes continual relapse i.e. hEDS. It’ll be booked in based on when you’re near completion of the protocol.
Whilst I would love this to be free, I can’t work with that many people on two such tough conditions for no fee - it would simply take up so much time, I wouldn’t have enough spare time to earn a living! But the programme is significantly cheaper than my typical 1:1 coaching programme, with the option of 3-6 month payment plans if needed.
In return for the discounted price, I’d love to use your experience to gather information on which protocols were most helpful, which management strategies you responded best to, SIBO success rates, impact on endo, etc. I won’t be sharing any personal information like names, etc. It’ll simply be quantitive data (maybe some qualitative if there’s any quotes that you’re happy to share).
My hope is that I can use this info to learn more about the endo + SIBO connection, develop better and more effective protocols and eventually present all of this in an accessible course or book, that’s budget friendly for everyone.
Because this is a condensed version of my usual work, we won’t be directly targeting/discussing endo, but I will take into account your endo history and symptoms, and this will all be considered in the SIBO protocols, and they will be tailored to support your endo symptoms i.e. certain prokinetics for SIBO can also treat endo pain, certain SIBO dietary changes have also been shown to help endo symptoms, etc. If you’d like one or more targeted endo sessions, they can be booked in, in addition.
If you’re interested in learning more, please email me at hello@thisendolife.com
2) https://www.gastrojournal.org/article/S0016-5085(19)38954-1/pdf, https://pmc.ncbi.nlm.nih.gov/articles/PMC3607857/, https://pubmed.ncbi.nlm.nih.gov/29915215/
4) https://pubmed.ncbi.nlm.nih.gov/39959963/
5) Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses - PMC, https://pubmed.ncbi.nlm.nih.gov/32949284/, https://pubmed.ncbi.nlm.nih.gov/32004880/, https://pmc.ncbi.nlm.nih.gov/articles/PMC10316551/, https://pubmed.ncbi.nlm.nih.gov/18715239/
6) The relationship between small intestinal bacterial overgrowth and irritable bowel syndrome - PubMed, Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study - PubMed, The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome - PubMed, Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype - PubMed
7) https://pmc.ncbi.nlm.nih.gov/articles/PMC12942269/, https://www.mdpi.com/2076-2607/11/8/2089
8) https://pubmed.ncbi.nlm.nih.gov/39990556/
9) https://pmc.ncbi.nlm.nih.gov/articles/PMC3413773/
10) https://pubmed.ncbi.nlm.nih.gov/21840904/, https://pubmed.ncbi.nlm.nih.gov/40262193/
11) https://pubmed.ncbi.nlm.nih.gov/39990556/
12) https://www.theendobellycoach.com/podcast/mcas-and-endo-belly, https://www.theendobellycoach.com/podcast/what-does-mcas-have-to-do-with-endo?rq=MCAS
Need more help or want to learn how to work with me?
Ways to work with me:
One to one coaching info and application - £500 off this July.
Endo Sessions: Single and mini-package one to one endo coaching
SIBO Sessions: Single and mini-package one to one SIBO coaching
Live and Thrive with Endo 2.0 DIY online course
Masterclasses in endo nutrition, surgery prep and recovery and pain relief
This EndoLife, It Starts with Breakfast digital cookbook
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