Why Florida Doctors Keep Missing SIBO

If you live in Florida and you've been bounced from doctor to doctor with bloating, diarrhea, constipation, or a gut that just stopped working right, I want you to know something: it's probably not you. Since opening my West Palm Beach office, I've been hearing the same story over and over, and it's time somebody said it out loud.

Most doctors are not testing for SIBO. Many have barely heard of it.

Here's what that looks like in real life. One of my clients spent months asking her doctor to dig deeper into her constipation. The answer, every single visit, was MiraLAX. When she kept pushing for more testing, the practice told her not to come back. Another client picked up food poisoning while traveling overseas for work. Her digestion was never the same after that trip. She saw three doctors. Not one of them asked about the food poisoning, and not one of them ordered a SIBO breath test.

Stories like these land in my inbox every week. So let's talk about what's actually going on.

Here's the issue: MiraLAX treats the symptom, not the cause

MiraLAX is an osmotic laxative. It pulls water into your colon so stool moves. That can be genuinely useful for short-term relief, but it doesn't answer the only question that matters: why is your gut slow, bloated, or unpredictable in the first place?

If the underlying cause is SIBO, small intestinal bacterial overgrowth, then a laxative is a bucket under a leaky pipe. You can keep emptying the bucket forever. The pipe is still leaking.

And if your problem is the opposite, urgent, unpredictable diarrhea, the same logic applies to Imodium. Slowing your gut down doesn't answer why it's misbehaving. It just quiets it for a few hours.

Diarrhea, constipation, or both: it can still be SIBO

Here's something most people, and honestly a lot of doctors, don't realize. SIBO doesn't have one look.

With SIBO, the picture is usually constipation, diarrhea, or both. Many of my clients cycle between the two: constipated for a stretch, then a run of diarrhea, then constipated again, around and around. That back-and-forth pattern is one of the biggest clues that something more than "sensitive stomach" is going on.

The gas being produced matters too. When methane-producing organisms take over, a related condition called IMO, intestinal methanogen overgrowth, the methane actually slows the gut down, and you get stubborn constipation that laughs at fiber and laxatives. When the overgrowth produces hydrogen sulfide, the typical picture is a lot of diarrhea, though not always.

This is exactly why testing matters. A proper breath test doesn't just say "overgrowth, yes or no." It tells us which gases are being produced, hydrogen, methane, or hydrogen sulfide, and each one calls for a different treatment approach. Guessing gets you MiraLAX. Testing gets you a plan.

The food poisoning connection almost nobody checks

This is the part that makes me want to shake the exam table. Food poisoning is one of the most well-documented triggers of SIBO and IBS, and it's exactly the kind of history a five-minute appointment never uncovers.

Here's the mechanism in plain language. A bad case of food poisoning can damage the nerves that run your gut's "housekeeping wave," the sweeping motion that clears bacteria out of your small intestine between meals. When that wave slows down, bacteria that belong in your colon start setting up camp where they don't belong. The result can be bloating within hours of eating, constipation or diarrhea, reflux, and food sensitivities that seem to multiply by the month.

I didn't learn this from a weekend webinar. Early in my career I worked at Cedars-Sinai Medical Group alongside Dr. Mark Pimentel, the researcher who put SIBO on the map, and I was one of the first people to take a SIBO breath test. This field grew up around me. So when a client tells me her gut "was never the same after that trip," my ears perk up, because that one sentence often explains years of symptoms.

If you came back from a cruise, a vacation, or an international work trip with a stomach bug, and your digestion never fully recovered, that history matters. Bring it up. If your doctor waves it off, that tells you something.

Why is this happening so much in Florida?

Honestly, it's not only Florida. SIBO is under-tested everywhere. But Florida has a perfect storm: a huge population of retirees and travelers, a medical culture that leans on quick fixes for constipation, and very few clinicians with real training in the low-FODMAP diet or SIBO protocols. The breath test is simple and non-invasive, yet most patients I meet have never been offered one.

The result is thousands of people from Palm Beach to Boca Raton to Jupiter to Naples who've been told their labs are "normal" while they quietly plan their lives around a bathroom.

What actually works

You don't have to choose between MiraLAX forever and giving up. A real plan looks like this:

Get the right test. I work alongside your gastroenterologist to recommend SIBO breath testing and make sure the results are interpreted correctly. If your current doctor won't order it, that's a solvable problem, not a dead end.

Treat the cause, not just the symptom. Hydrogen, methane, and hydrogen sulfide results point to different treatments, so your plan should depend on what your test actually shows. That can mean targeted treatment through your physician, plus the low-FODMAP diet done properly, all three phases, not the permanent-restriction version people find on Google.

Protect your motility so it doesn't come back. SIBO loves to return when the housekeeping wave stays sluggish. Preventing recurrence is where most plans fail, and it's where my clients and I spend real time.

One of my clients said it best after we finished her reintroduction phase: for years she was told to manage her IBS, and within months she finally had an answer instead. That's the difference between coping and fixing.

You deserve a real answer

If any of this sounds like your story, the MiraLAX merry-go-round, the trip your gut never recovered from, the "everything looks normal" conversation, I'd love to help. I'm a Monash-certified low-FODMAP dietitian and SIBO specialist, and I see clients in person in West Palm Beach and virtually across Florida and nationwide.

Apply to work together, and let's find out what's actually going on in your gut.

Fix your gut, fix your life.