When SIBO Isn’t Just SIBO: What One Case Taught Me About Complexity

Her name isn’t really Sarah, but that’s what I’ll call her here. She was in her early forties, gentle and articulate, with that particular mix of clarity and fatigue I often see in people who have done a lot of their own research. She had been living with digestive symptoms for more than a decade — bloating, pain, brain fog, and what she described as a permanent low hum of anxiety in her gut.

She had seen other practitioners. She had tried every version of the SIBO protocol you can imagine. Antimicrobials, prokinetics, elemental diets, fasting windows, a dozen probiotics. The works.

Her test results told a clear story. Hydrogen sulphide SIBO.
Her body told a more complicated one.

The first thing I noticed

What stood out to me in our first session wasn’t her symptom list. It was how tightly she spoke about food. Every meal had become a calculation. She had become afraid of vegetables. She ate the same five things on repeat, not because she believed they were helping her heal, but because she was terrified anything else would make things worse.

She wasn’t chasing wellness anymore. She was surviving.

And in that first moment of meeting, I felt the pull of what so many clinicians feel, the urge to fix it. I wanted to help quickly. I wanted to give her relief.

But what I’ve learned, and what Sarah taught me again, is that speed rarely serves complexity. What she needed was not a new antimicrobial or a tighter dietary plan. What she needed was someone to help her slow down, zoom out, and take a breath.

Why the usual approach wasn’t working

Sarah’s test results were clear, but her nervous system was not ready for another round of kill-phase treatment. She was depleted. Not just nutritionally, but emotionally. Her digestive system was under-functioning, her sleep was fractured, and her capacity for new inputs was incredibly low.

We had to start somewhere else. Somewhere gentler.

Instead of jumping into eradication, we focused first on reducing reactivity. We used simple nervous system practices, trace nutrients, and support for digestive function. We worked on softening rigidity around food and introducing one or two new ingredients each fortnight. We also paused testing for a while. Not because it wasn’t helpful, but because it had become a source of stress.

What shifted wasn’t just her symptom picture. It was her relationship to her body. She stopped asking, “What should I cut out next?” and started asking, “What does my system need to feel safer today?”

What this case taught me

I still use protocols. I still find testing valuable. I still believe targeted SIBO treatment has a place. But what Sarah’s case taught me — and reminded me — is that our job as practitioners is not to follow a flowchart. It is to listen deeply, choose timing with care, and offer support that includes the whole person, not just the pathogen.

For clients reading this: If you’ve been stuck in a loop of restriction and relapse, it might be time to try a different approach. One that centres your nervous system and respects your lived experience, not just your lab results.

For practitioners: If you’re finding yourself frustrated with slow progress or unclear outcomes, know that it doesn’t mean you’re doing it wrong. Sometimes, the most important intervention is helping someone feel safe again — with food, with their body, and with the process of healing.

A gentle reminder

SIBO is not just about gas. It’s about motility, immunity, microbial diversity, and emotional resilience. It’s about how we digest food and how we digest experience. It can’t be fully treated with supplements alone.

Sarah and I worked together for more than a year. Slowly, carefully. She eats more now. She sleeps better. Her bloating is occasional, not daily. And most of all, she trusts her body again. That’s not always what shows up on a test result, but it is what matters.

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