So it\u2019s time to take a closer look: What do we currently know in 2026 about SIBO, how can the condition be treated – and how can the ancient volcanic mineral zeolite, now increasingly used in the form of PMA zeolite for prevention and as a scientifically sound additional treatment option, be effectively applied here as well?<\/p>\n
What Is SIBO? Bacteria in the Wrong Place, in the Wrong Number, and in the Wrong Form<\/h2>\n
Our digestive tract is anything but germ-free – and it\u2019s not supposed to be. As is well known, the large intestine in particular is home to vast quantities of microorganisms that, together with us, form a fascinating microcosm. In the small intestine, which connects directly to the pylorus, however, the situation is different: microorganisms live here as well, but normally in significantly lower densities and, above all, in a completely different composition.<\/p>\n
The body has also developed a whole arsenal of protective mechanisms for this part of the gastrointestinal tract. Stomach acid, bile, and digestive enzymes keep microorganisms in check; the so-called \u201cileocecal valve\u201d acts as a sort of valve between the small and large intestines; and the immune system also plays a major role. However, intestinal motility is particularly important.<\/p>\n
During periods between meals, a sophisticated movement program is activated in the small intestine – the so-called \u201cMigrating Motor Complex,\u201d or MMC for short. In simple terms, it could be described as the body\u2019s own cleaning crew: wave-like muscle movements transport food residues and microorganisms further along, thereby preventing bacteria from becoming too comfortable in places where they shouldn\u2019t actually be present in large numbers.<\/p>\n
SIBO and Medications: Not Only Antibiotics, but Also Proton Pump Inhibitors Play a Role<\/h3>\n
If this system no longer functions properly, problems can arise. These motility disorders are therefore among the known risk factors for SIBO, along with anatomical changes\u2014such as those following surgery\u2014certain metabolic and systemic diseases, or reduced stomach acid production. This brings us to the term \u201cproton pump inhibitors,\u201d and this is where it gets interesting:<\/p>\n
A 2025 meta-analysis comprising a total of 29 studies and 6,589 participants examined the association between the use of proton pump inhibitors (PPIs) and the development of SIBO. These so-called acid-blockers are among the most commonly used medications of all. SIBO was detected in 36.8 percent of PPI users, compared to 19.9 percent in the control groups. The pooled risk was thus approximately doubled. Additionally, a correlation with the duration of use was observed.<\/p>\n
Of course, this does not mean that proton pump inhibitors inherently cause SIBO or that they should be discontinued on one\u2019s own initiative from one moment to the next. They are medically appropriate and necessary for certain conditions. However, the data clearly show how closely the various protective mechanisms of our digestive system are interlinked and how much medications of all kinds can influence them – see, for example, what antibiotics can do to our gut: Antibiotic Therapies Cause Massive Damage to the Gut and Microbiome<\/a>.<\/p>\n The biggest problem with the overall topic of SIBO, however, is that it is difficult to identify based on symptoms alone. This is no surprise, as many of these symptoms are nearly identical to those of irritable bowel syndrome. SIBO and irritable bowel syndrome can therefore not only look or feel confusingly similar\u2014they can also, and most importantly, occur simultaneously.<\/p>\n A very recent, remarkable meta-analysis from 2026 shows just how large this overlap might be. The researchers evaluated 81 studies involving 6,017 patients with functional gastrointestinal disorders and 1,826 control subjects. Overall, SIBO was diagnosed in 39 percent of the patients, compared to 11.5 percent in the control groups. Among people with irritable bowel syndrome, the prevalence was even around 40 percent.<\/p>\n This is a figure that demands attention. However, the study also brought to light a problem that runs like a common thread through all SIBO research: depending on the testing method used, the results varied considerably. When lactulose (a synthetically produced disaccharide) was used as the test substance, the studies found SIBO in 45.7 percent of the patients examined; when glucose (i.e., a monosaccharide or grape sugar) was used, however, the rate was only 28.7 percent. And that brings us to one of the most important questions of all: How should SIBO be diagnosed beyond a shadow of a doubt?<\/p>\n This is because SIBO has an unpleasant characteristic: it tends to come back. Studies show recurrence rates of approximately 40 to 45 percent within nine to twelve months after initially successful treatment, and the longer time passes, the higher the recurrence rate becomes.<\/p>\n Why does this happen? The answer is simple, though somewhat more profound: because if impaired intestinal motility, anatomical changes, certain medications, or other conditions have created the conditions under which microorganisms were able to multiply excessively in the small intestine in the first place, reducing these microorganisms does not automatically eliminate the underlying cause. Moreover, eliminating bacteria is not the same as eliminating the conditions under which they established themselves. However, treatment must address the underlying causes, not just the symptoms.<\/p>\n Therefore, depending on the individual situation, genuine treatment of SIBO also includes identifying underlying medical conditions and motility disorders, correcting potential nutrient deficiencies, implementing nutritional therapy measures as needed, and addressing the overall condition of the gut and its intestinal barrier.<\/p>\n When it comes to diet, the low-FODMAP diet is frequently recommended today. This involves temporarily reducing certain fermentable carbohydrates (found, for example, in rye, wheat, garlic, sugars such as lactose or glucose, and many others). This approach has been relatively well studied in the context of irritable bowel syndrome (IBS); however, the evidence specifically regarding the treatment of SIBO is currently much more limited.<\/p>\n Probiotics must also be considered with a similar degree of nuance. \u201cGood bacteria versus bad bacteria\u201d sounds wonderfully simple, but it does not reflect the complex dynamics within the gut. The effects of probiotics depend on the strain, dose, and indication, and particularly in cases of SIBO, some patients may react sensitively to additional fermentative activity. Furthermore – and this applies to all intestinal disorders in which the intestinal barrier is compromised – these probiotics can only colonize the gut if they find the appropriate environment; otherwise, they simply \u201cpass right through\u201d the entire organism.<\/p>\n The crucial underlying issue is another: SIBO should not be understood exclusively as an accumulation of \u201cwrong bacteria.\u201d Rather, the disease arises in a biological system that has lost its balance – and this system deserves at least as much attention as its microbial inhabitants.<\/p>\n \u201cThe pathogen is nothing, the environment is everything\u201d – this idea, often attributed to the French physiologist Claude Bernard, is well over 100 years old. Even if today\u2019s scientists would certainly phrase it in somewhat less absolute terms, it addresses a point that also plays a central role in SIBO: the intestinal environment itself. That is why the ancient volcanic mineral zeolite, in its modern, optimized form known as \u201cPMA zeolite,\u201d is just as relevant in the treatment of SIBO as it is for conditions such as irritable bowel syndrome or \u201cleaky gut syndrome.\u201d<\/p>\n This is because SIBO rarely – if ever – occurs in a perfectly balanced, functioning digestive system. Moreover, excessive colonization of the small intestine by unsuitable bacteria doesn\u2019t just happen \u201cout of the blue\u201d; rather, like all intestinal disorders, it is linked to imbalances, pre-existing conditions, and stressors throughout the entire gut – stressors we absorb from our environment in the form of heavy metals, toxins, pesticides, chemicals, the aforementioned medications, and above all through our highly processed food – regardless of whether we follow a low-FODMAP diet or not.<\/p>\n PMA zeolite works differently than antibiotics, probiotics, or a SIBO-specific diet: It doesn\u2019t target individual \u201cculprits,\u201d but rather helps restore balance to the gut environment, relieve strain on the gut, and stabilize the intestinal barrier (to learn how important the intestinal barrier actually is, read here: Gut Health and the Microbiome: Without a Healthy Intestinal Barrier, Nothing Works<\/a>) and thus restore its function. How does PMA zeolite relieve the gut? This volcanic rock consists of a microporous crystal structure with a vast internal surface area (around 4,000 square meters per gram of PMA zeolite!), which possesses high adsorption and ion-exchange properties. This allows harmful substances in the gastrointestinal tract to be bound and excreted. This clears the way for further treatment – whether for SIBO or irritable bowel syndrome.<\/p>\n Clinical studies on the effects of PMA zeolite in irritable bowel syndrome have already shown that not only do the typical symptoms of IBS subside, but inflammation and intestinal barrier parameters also improve. In medical practices and clinics that use PMA zeolite, this volcanic mineral is therefore also used as an adjunct treatment for SIBO.<\/p>\n The high relapse rates associated with SIBO in particular demonstrate why this more comprehensive approach is so important. Even if antibiotic treatment initially succeeds in reducing bacterial overgrowth, it often returns if we do not improve the underlying conditions by reducing stress on the entire gut. Within a comprehensive therapeutic approach, PMA zeolite can serve as the \u201ccleansing and relief team.\u201d Not as a treatment for SIBO, but as fundamental support for the gastrointestinal tract.<\/p>\n However, the benefits of PMA zeolite extend even further, specifically in the form of simple prevention, which can ultimately save us all a great deal – in both senses of the word. After all, anyone who only starts taking care of their gut once they\u2019re already experiencing severe symptoms is starting quite late and usually has a long road to recovery ahead of them. Maintaining as stable a gut environment as possible, a functioning intestinal barrier, and a balanced microbiome is therefore fundamental to our health and should be a core element of our daily preventive routine.<\/p>\n Sources:<\/span><\/p>\n Proton Pump Inhibitors Increase the Risk of SIBOKhomeriki N. et al. (2025):<\/span><\/p>\n The Duration of Proton Pump Inhibitor Therapy and the Risk of Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 14(13), 4599.<\/p>\n The systematic review and meta-analysis published in 2025 examined the association between the use of proton pump inhibitors (PPIs) and SIBO. The study included 29 studies with a total of 6,589 participants, of whom 3,682 were PPI users and 2,907 were control subjects. SIBO was diagnosed in 36.8 percent of PPI users, compared with 19.9 percent in the control groups. Overall, the use of proton pump inhibitors was associated with a risk of SIBO that was more than twice as high (OR 2.14). In addition, a correlation with the duration of use was observed: the risk was particularly significantly elevated when the medication was used for more than six months. However, due to the high heterogeneity of the included studies, a simple causal relationship cannot be inferred from these findings. PubMed Central (PMC)<\/p>\n Link: https:\/\/pubmed.ncbi.nlm.nih.gov\/40649078<\/a><\/p>\n<\/div>\n SIBO and irritable bowel syndrome overlap surprisingly often. Systematic review and meta-analysis of the prevalence of small intestinal bacterial overgrowth in patients with functional gastrointestinal disorders (2026).<\/span><\/p>\n The recent meta-analysis from 2026 evaluated 81 studies involving 6,017 patients with functional gastrointestinal disorders and 1,826 control subjects. SIBO was diagnosed in 39.0 percent of the patients, compared to 11.5 percent of the control subjects. People with functional gastrointestinal disorders thus had a significantly increased risk of SIBO. The overlap was particularly pronounced in irritable bowel syndrome: here, the estimated SIBO prevalence was 40.4 percent, and 41.3 percent for diarrhea-predominant irritable bowel syndrome. At the same time, the study shows how strongly the results depend on the diagnostic method used: Lactulose breath tests yielded a prevalence of 45.7 percent, while glucose breath tests yielded only 28.7 percent. This is precisely why SIBO diagnoses should never be made based solely on a single test result.<\/p>\n Link: https:\/\/pubmed.ncbi.nlm.nih.gov\/42402885<\/a><\/p>\n<\/div>\n Rifaximin is often effective\u2014but SIBO frequently recurs. Gatta L. et al.: Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth.<\/span><\/p>\n This meta-analysis included 32 studies with a total of 1,331 patients. In the intention-to-treat analysis, the SIBO eradication rate with rifaximin was 70.8 percent. However, the included studies were highly heterogeneous and often methodologically weak, which is why the authors explicitly called for further high-quality randomized trials.<\/p>\n Link: https:\/\/pubmed.ncbi.nlm.nih.gov\/28078798<\/a><\/p>\n<\/div>\n Lauritano E. C. et al.: Small intestinal bacterial overgrowth recurrence after antibiotic therapy. American Journal of Gastroenterology, 103(8), 2031\u20132035.<\/span><\/p>\n This study clearly explains the statement used in the article, \u201cSIBO tends to come back\u201d: 80 SIBO patients successfully treated with rifaximin were followed up. After three months, the glucose breath test was positive again in 12.6 percent of patients; after six months, in 27.5 percent; and after nine months, in as many as 43.7 percent. Advanced age, a history of appendectomy, and chronic use of proton pump inhibitors were associated with an increased risk of recurrence.<\/p>\n Link: https:\/\/pubmed.ncbi.nlm.nih.gov\/18802998<\/a><\/p>\n<\/div>\n PMA Zeolite for Irritable Bowel Syndrome: Insights into the Intestinal Barrier, Inflammation, and MicrobiomePetkov V. et al. (2021): PMA zeolite can modulate inflammation-associated markers in irritable bowel disease \u2013 an exploratory randomized, double-blind, controlled pilot trial. Neuroendocrinology Letters, 42(1), 1\u201312.<\/span><\/p>\n In this prospective, randomized, controlled, double-blind pilot study, 41 patients with irritable bowel syndrome were monitored over a three-month period. Participants received either three grams of PMA zeolite twice daily or microcrystalline cellulose as a control. In addition to symptoms, various blood and stool parameters as well as changes in the gut microbiome were examined.<\/p>\n IBS symptoms improved significantly in both groups, suggesting a strong placebo effect or study participation effect. Therefore, the more objective parameters are of greater interest to our argument: Among other things, \u03b11-antitrypsin levels in stool decreased significantly with PMA zeolite; in addition, changes in hsCRP and certain bacterial groups were observed. The authors interpret the results as evidence of potential effects on inflammation-associated processes and the intestinal mucosa. However, due to the small number of participants, this is explicitly an exploratory pilot study, and its results must be confirmed in larger studies.<\/p>\nSIBO or Irritable Bowel Syndrome? The lines are becoming increasingly blurred<\/h2>\n
Antibiotics, Diet & More: Why SIBO Keeps Coming Back<\/h3>\n
![\"SIBO](\"https:\/\/www.zeolith-wissen.de\/wp-content\/uploads\/2026\/10\/SIBO-Antibiotika-Behandlung-Ernaehrung.jpg\")
If SIBO requiring treatment is diagnosed, conventional medicine often turns to antibiotics as a first line of treatment. \u201cRifaximin\u201d is particularly well-known; it is an antibiotic that is absorbed only to a small extent by the body and therefore acts primarily locally in the gut. The success rates are quite impressive. Meta-analyses report eradication rates – that is, the elimination of the pathogens – of about 70 percent for rifaximin. That could actually be the end of the story. But it isn\u2019t!<\/p>\nPMA Zeolite for SIBO: The Pathogen Is Nothing, the Environment Is Everything<\/h3>\n
Getting rid of SIBO is one thing – preventing a relapse is another<\/h3>\n