The Real Cause of SIBO — Why Everything You’ve Been Told Is Incomplete — Why Current Treatments Are Structurally Incomplete

Rifaximin and antibiotics reduce bacterial load and create a temporary window of improvement. They do not restore the MMC. They do not repair the vinculin-ICC axis. They do not reverse PPAR-&#947; downregulation. They do not address MCAS-driven ENS disruption. They do not fix ICV laxity. They do not eliminate biofilm communities. They do not correct iron economy disruption. The environment that invited the bacteria remains intact when the course ends. Herbal antimicrobials show equivalent eradication rates to rifaximin &#8212; confirming that the limiting factor is not killing power but the structural environment. Same fundamental limitation, different bottle. Low-FODMAP diet reduces fermentable substrate and temporarily reduces symptoms. It does not eradicate SIBO. Long-term very low FODMAP intake may worsen dysbiosis by starving beneficial anaerobes and further reducing butyrate production &#8212; worsening the oxygen economy failure it was meant to address symptomatically. Elemental diet achieves approximately 80% eradication by starving bacteria of complex substrates. It is extremely difficult to sustain, does not restore MMC or mucosal integrity, and has high relapse rates when normal eating resumes. Prokinetics are the most mechanistically sensible addition because they address one of the primary structural causes &#8212; MMC failure. When combined with antimicrobials, th