SIBO keeps coming back for a lot of people cus they only address the overgrowth, not the motility. The migrating motor complex sweeps bacteria out of the small intestine between meals. Only runs in fasted state. What impairs MMC: - ↓ vagal tone (stress, B1, B5, choline deficiency) - Constant snacking (MMC needs fasting to activate) - Hypothyroidism (low motilin receptor sensitivity) - Post-infectious nerve damage (vinculin/CdtB antibodies - this will actually lead to long term issues unfortunately) In fact, most people should optimize motility before touching antimicrobials, sometimes they aren't even needed.