Episode 87: SIBO Isn't One Condition: What My New Published Review Says

My literature review on SIBO has been published in the Journal of the Australasian College of Nutritional and Environmental Medicine for Gastrointestinal Awareness Month, and in this episode I unpack what it means for anyone stuck in the SIBO treatment cycle. The big idea: SIBO isn't one condition. It's three gas phenotypes, hydrogen, methane (IMO) and hydrogen sulfide, each driven by different organisms, picked up by different testing, and needing genuinely different treatment. Treat them all the same, and relapse is almost predictable. There's also a short segment near the end for the practitioners listening.📄 READ THE FULL PUBLISHED REVIEW: ⏱️ Chapters00:00 — Welcome00:55 — Something a little different today (the news)03:01 — SIBO is not one condition: the three phenotypes07:12 — Why this changes everything: testing, treatment and relapse12:54 — For the practitioners listening22:14 — Closing thought + where to from hereKey TakeawaysSIBO isn't one condition. It's three gas phenotypes: hydrogen, methane (now called IMO) and hydrogen sulfide.Different gas, different organism. Hydrogen points to bacteria, methane to archaea, hydrogen sulfide to sulfate-reducing organisms, and they don't respond to the same treatment.Testing has to match. A breath test that only measures hydrogen can miss the other two, which is how you can be told you're "fine" while you're still struggling.Phenotype mismatch drives relapse. Treating every SIBO the same way is a major reason symptoms keep coming back.Eradication isn't the finish line. Lasting results come from restoring how your gut actually works, not just clearing the overgrowth. Restoration over restriction.For the PractitionersThree phenotypes, three organisms: hydrogen (Proteobacteria, ~50–60%), IMO (the archaeon M. smithii, ~25–30%), and hydrogen sulfide (sulfate-reducers, least studied).Recurrence is the core problem: reported as high as 44% within nine months of antibiotic eradication in unstratified cohorts.Motility is the throughline: the MMC is the principal defence against overgrowth, and the evidence supports prokinetic support alongside antimicrobials, not after.Post-infectious autoimmunity: ~1 in 5 develop anti-CdtB antibodies cross-reacting with vinculin after gastroenteritis. Anti-vinculin testing is not currently available in Australia.Phenotype-specific evidence: hydrogen, berberine-containing protocols ranked highest in the 2025 network meta-analysis; IMO, rifaximin–neomycin or stabilised allicin; hydrogen sulfide, bismuth subcitrate and emerging Codonopsis evidence.Combination over monotherapy carries the strongest evidence, with mucosal terrain addressed alongside eradication._________________________________________________________________________WORK WITH KARLY Ready to stop managing symptoms and start rebuilding? Karly takes a limited number of one-on-one clients each month through the Nourished Gut Program — applications are open: https://www.nourishedgutclinic.com/nourishedgut FREE RESOURCE Not ready for that yet? Start here. Grab Karly's free 3-Day Bloat Fix — a short, practical protocol targeting the most common drivers of daily bloating: https://www.nourishedgutclinic.com/bloat VISIT US ONLINE Gut health support for clients → https://www.nourishedgutclinic.com Mentoring & clinical education for practitioners → https://www.karlyraven.com FOLLOW ALONG @karlyravennaturopath — clinical insights, gut health education & behind the scenes @nourishedgutclinic — the clinic page, client wins & what's on ENJOYING THE PODCAST? A rating and review takes 30 seconds and helps more people find the show who really need it. Thank you. DISCLAIMER Content shared on the Nourished Gut Podcast is for educational purposes only and is not medical advice. Always consult a qualified health practitioner before making changes to your health or treatment plan....