Can a Short-Term Elemental Diet Help Treat SIBO?

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This is a guest post written by staff nutritionist Kelsey Marksteiner, RD. Click here to read her blog or join her newsletter!

For those with small intestinal bacterial overgrowth (SIBO), the symptoms can sometimes be unbearable. Bloating, gas, diarrhea, constipation…the list goes on. While simply getting diagnosed in the first place is half the battle, when it is diagnosed, how do we treat it? If you’ve tried some of the options out there like rifaximin or herbal antimicrobials with no luck, what’s left?

What is SIBO?

Before we talk about treatment options, it’s important to know exactly what SIBO is. Small intestinal bacterial overgrowth is exactly what it sounds like – an overgrowth of bacteria in the small intestine. Normally, the small intestine has very little bacteria compared to the large intestine, which houses most of our gut bacteria. However, bacteria from the large intestine can translocate to the small intestine under some circumstances, leading to the development of SIBO. There are many underlying factors that relate to this translocation, including low stomach acid, pancreatic enzyme insufficiency, and intestinal motility disorders, among others. (1)

The usual treatment of SIBO can include diets like the Specific Carbohydrate Diet (SCD) or the GAPS diet (usually in combination with a low-FODMAP approach), antibiotics or herbal antimicrobials. (2) The SCD and GAPS diets help reduce the bacterial load of SIBO, but it can take a long time for dieters to feel significant improvement in their symptoms without the addition of other helpful treatments such as antibiotics or antimicrobials.

Rifaximin, the the antibiotic most commonly used to treat SIBO, is expensive, thus many patients cannot afford treatment. These patients may choose to forgo antibiotics completely and opt for natural antimicrobials such as oregano oil or berberine. These can be very useful in eradicating SIBO, especially in combination with a low-FODMAP SCD or GAPS diet.

However, I’ve had more than one client claim that they can’t tolerate the herbal antimicrobials. For these people, waiting months to over a year for relief with the SCD or GAPS diet can seem like eternity, yet they feel as though they don’t have any other options to try. Others have tried antibiotics or antimicrobials and failed. This is where the short-term elemental formula can be helpful.

What is an elemental formula?

In the simplest terms, an elemental formula is one that contains pre-digested carbohydrates, proteins, and fats. This means that it is absorbed very quickly from the digestive system. This is key for those with SIBO as we don’t want food sitting in the small intestine, where it would be used as fuel for the unwanted bacteria living there. Instead, an elemental formula provides a way to nourish the patient while starving the bacteria. When implementing the elemental diet, the patient will drink the formula instead of their regular meals for two to three weeks, depending on their case.

How effective is it?

In a study using the elemental formula Vivonex Plus, patients were instructed to consume only the formula for 14 days. On the 15th day, they were re-tested for the presence of SIBO. Remarkably, 80% tested negative. Those who were still SIBO-positive were instructed to continue the formula for another 7 days, after which the cure rate went up to 85%. (3)

So how does this compare to the other SIBO treatments I discussed above (rifaximin, herbal antimicrobials)? Though figures vary for the efficacy of rifaximin, the majority of studies I’ve seen estimate it to be around 50% effective, but some studies show even lower rates. (4) One study in particular showed the cure rate for rifaximin to be 34%, while herbal antimicrobials were more effective at 46%. (5)

An 85% cure rate for a three week elemental formula diet is impressive and should certainly be considered as a treatment option for those with SIBO. However, that doesn’t mean that it’s for everyone.

What are the drawbacks?

There are definitely some downsides to the elemental formula. First, and probably most important in terms of compliance – it tastes pretty nasty. A patient has to be willing to stick it out for at least two weeks (where we get the 80% cure rate) and potentially up to 3 three weeks to see results. While this doesn’t sound that long, it can  be tough to stick to when the drink doesn’t taste so good! This means that anyone about to try this treatment has to be very committed.

Second, typical elemental formulas are not what we’d call “real food”. Vivonex, produced by Nestle, contains the following ingredients:

Screen Shot 2014-07-14 at 5.34.12 PM

That said, you can make your own elemental formula if you choose. If you’re interested to see what goes into a homemade formula, check out this recipe from SIBO researcher, Dr. Allison Siebecker. Both homemade and commercial elemental formulas are expensive (though less expensive for most than a course of rifaximin), which is also a barrier.

Also, for those who are underweight already, embarking on a two to three week elemental diet can cause them to lose even more weight. This is potentially dangerous, thus an elemental diet should be very carefully implemented or not implemented at all in those who are underweight. Whether you’re underweight or not, an elemental diet should always be implemented under the supervision of a medical professional.

An elemental diet is also a short-term fix. SIBO is a condition that recurs frequently, thus during and after any type of treatment for SIBO, it’s imperative that the patient addresses these underlying factors to prevent future SIBO episodes. This means that those looking to an elemental diet to solve their problem forever still have a long road ahead of them after completing the diet.

Lastly, we’re not sure how it affects the rest of our gut bacteria. Does it starve the bacteria in the large intestine? If so, to what extent? We just don’t know, and only future research can tell us.

Chris’s experience

I asked Chris to share his experience with elemental formulas with me for this article. He responded:

“I created my own elemental formula, back when I was still struggling with my own gut issues. While it did reduce bacterial overgrowth, it seemed to exacerbate the fungal overgrowth problem I was also dealing with. I developed a thick, white coating on my tongue and the symptoms I associated with fungal overgrowth worsened. I also experimented with it in my work with patients with SIBO early on, but I found that compliance was low (because even the homemade formulas are pretty gross) and the SIBO tended to return soon after the patient started eating real food again. Nevertheless, elemental diets may have a place for patients that don’t respond to anti-microbial treatments (whether botanical or pharmaceutical).”

When to consider an elemental formula

There certainly are benefits to an elemental formula, namely its short duration (2-3 weeks). This is equal or one week longer than a course of rifaximin (14 days), and potentially up to four weeks shorter than a course of herbal antimicrobials, which are usually given for 4 to 6 weeks. Its effectiveness is also quite good (80-85%) compared to other treatment options. It might be worth considering for someone who doesn’t want to take antibiotics but wants a short treatment period, or for someone who has tried antibiotics and herbal antimicrobials and failed. It certainly wouldn’t be my first choice of treatment if I was going through it (mostly due to the taste and lack of real food), but if I had trouble with some of the other options, I’d certainly consider it. It’s a careful decision that one should make with their medical team and not something to take lightly, but its 80-85% cure rate deserves a look. Hopefully reading this article has made you think about the pros and cons of an elemental diet and allows you to make this decision more easily!

Now I’d like to hear from you. What do you think about elemental diets for SIBO? Do the positives outweigh the negatives or vice versa? Have you tried an elemental diet?

 

kelseyrd03This is a guest post written by Kelsey Marksteiner, RD. Kelsey is a Registered Dietitian with a Bachelors degree in Nutrition from NYU and a Master’s in Human Nutrition and Functional Medicine. She works in private practice and recommends individualized dietary therapy focusing on biologically appropriate diet principles to aid her clients in losing weight, gaining energy, and pursuing continued health. She is a firm believer that everyone is different, and she tailors her plan for each and every individual. Through her work, she aims to meld the dietary wisdom of traditional cultures with the latest science in integrative and functional medicine to create plans for her clients that work in the modern world. You can learn more about Kelsey on her staff bio page, or by visiting her private practice website. Join her newsletter here!

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Categories

Digestion

Comments Join the Conversation

  1. says

    I’ve used the AbsorbPlus Elemental Diet shakes to address my IBD before I found the Autoimmune Paleo Protocol. These shakes have a very clean ingredient list and are also pretty tasty. You can add in MCT oil for extra nutrients/calories, too. The book “The IBD Remission Diet” by Jini Patel Thompson has helpful info about a healthier elemental diet.

  2. Nicky says

    The “it’s temporary” part is nestled in there like an afterthought. How long does it last before symptoms come back?

  3. says

    In attempt to save money would it be possible to do some sort of protein restricted fast with protein shakes? That way maybe you can save yourself some dollars by only buying maybe one or even two supplements to mix into your concoction. Just wondering if this would be feasible as long as the protein had a minimal amount of crap in it and assuming you don’t have an allergy to it i.e. whey protein.

  4. Marian Gain says

    Just reading the first line of the ingredients of Vivonex is enough to turn me off, and make me angry. I was considering purchasing lysine in supplement form, and yesterday discovered that most chemically made supplements at the health store that I was at were derived from corn. Not GMO-free, or pesticide free.
    And from Nestle, a company we can all trust!? RIGHT.
    First they create the problem, then they get rich off their garbage solution, and create a whole new raft of problems.
    I am exploring Functional medicine solutions, but now wonder about vested interests.

    • penelope says

      Wow, thanks for this reminder! Are capsules also likely to contain corn? is it the filler or the actual active ingredient. Did you find some clean lysine? I have been using NOW (brand).

      • Marian Gain says

        Penelope, There were 4 or five different brands at my local store, and all were derived from corn. Lysine is in lots of different foods, so that’s probably where I’ll get mine.
        This whole temporary fix, instead of determining cause and eliminating all possible triggers is just another rabbit hole ( to get lost in).
        Are we 100% sure that it’s bacteria? What about viruses?

  5. Simas says

    I know some people get constipated after this kind of treatment. Also, I believe it is possible for SIBO to be so high up in the intestine that it could still feed it. And you did not mention those with insulin problems. One would consume huge ammounts of starch, and that doesn’t sound too good. I’m also struggling because I can’t tolerate herbals… That’s a huge problem….

  6. Joel Thiessen says

    Surprised to see such low figures for the effectiveness of the antibiotic approach – Siebecker (whom you mention in your post) touts a success rate of 80-94% for different antibiotic regimens.

    I noticed this since I’m currently taking rifaximin for exactly this reason, having already tried the elemental diet. The diet was effective but made me too sick to continue for the full 2 weeks.

    • says

      Perhaps she’s referring to her own success rates in her practice (which includes dietary changes as well), while studies that study just rifaximin treatments (no dietary changes) may have lower rates. Not sure, but that’d be my guess.

    • Fiona says

      Shouldn’t we all be extermely careful about becoming resisitant to antibiotics except where they are essential for lifesaving conditions?

    • Simas says

      Dr Siebecker is probably refering to the studies by Dr Pimentel, which I’m pretty sure he gets such rates, because they always adjust for methane producers, meaning that they give rifaximin+neomycin. Which significantly increases succes rates, in people who produce methane gas. Rifaximin does not work for methane.

  7. Caitlin says

    Good summary of a complicated subject matter!

    Wondering if you have experience with using both Rifaximin and elemental diet at the same time? Or would that be too much? Or do one first and then follow up with the other treatment: ie. Rifax first for 2 weeks then elemental protocol for 2-3 weeks.

    Thanks Kelsey!

    • says

      I don’t have experience with that (not a doc, so don’t deal with prescriptions!) but my guess it it would be a bit overkill. I’d go for rifaximin first if that’s what you wanted to try.

    • Simas says

      If I remember correctly, according to Dr. Pimentel antibiotics work best, while the bacteria is still feeding, meaning that you have to eat real food, and that also means no SCD diets while on treatment.

    • Deb says

      In his book, Pimental says that the Rifax only works on bacteria that are replicating (ie eating/thiving) so doing the elemental diet at the same time is contraindicated.

  8. John Es says

    As you mention, http://www.siboinfo.com is a great resource, full of detailed information and references.

    Listening to many functional medical practitioners, they talk a lot about stool testing, and the prevalence of false negatives. It doesn’t seem like many of them use the lactulose breath test, which might be more reliable in detecting the bugs in the small intestine that often don’t get into the stool samples.

    At this point, I am using betaine HCl and digestive enzymes to try to overfeed myself, and get my weight up before trying some combination of elemental diet, SCD, and possibly even fasting. Getting tested should probably be part of the plan.

  9. Jean Tuthill says

    Can the elemental diet be helpful if you dedicate a few days a week to it and then eat “clean” foods other days.. grass fed protein, organic greens etc. Maybe even doing this in combo with herbal anti-parasitic supplements or to try to prepare the gut before or after an anti-parasitic regimen?

    Or even do a few days a week when trying to heal a leaky gut?

  10. Risa says

    My 10 year old daughter has SIBO (my diagnosis). It has been extraordinarily difficult to get any information about SIBO in children and testing is virtually impossible. Per Chris’s advice, we started her Prescript Assist in addition to a FODMAP/Paleo diet. In less than a month she had significantly improved. Now, about 5 months later, she has the bowel function of a normal child. However, it can still be a challenge to maintain a FODMAP/Paleo diet with a 10 year old. I can’t even imagine trying to get her to follow an elemental diet. I wish more discussion would focus on kids with SIBO. My guess is there are many parents with SIBO kids who have no idea what to do with them. My daughter is from China, so we tried a lactose free diet, an auto-immune protocol, and strict Paleo. Nothing helped her at all until we combined FODMAP and Paleo.

    • Caitlin Russell says

      Risa,

      Did your daughter work directly with Chris? I have a 9 year old with SIBO and feel the same frustration with lack of guidance for children. Perhaps we should start a Facebook support group?

    • Andrea says

      Hi Risa,

      I have been diagnosed with SIBO and my 5 year old son. We both took Xifaxan b/c we have been doing Paleo for 5 years and not getting better. He did allergy testing recently and is allergic to many of things. Although allergy tests can yield funky results, we knew they were accurate b/c his mouth and throat swell and GI starts getting super upset after eating certain foods. He has eosinophilia and allergies to nuts, dairy, gluten, oats, peanuts, corn, soy shellfish, citrus EGGS (that one is super hard to give up since Paleo’s reliance on it for most foods) That said, have some allergy testing done. If your daughter’s gut is super inflamed by things such as nightshades, or eggs, Paleo diet can be a nightmare. So we are on GAPS diets and see more success with strict diet over anything else.

      My son did fine on Xifaxan and we were very happy to see improvement but his allergies will persist until gut is healed. (For me it is a longer road.) His pediatric GI doc also has him drink oregano tea (literally oregano steeped in water) This is a new territory for GI docs and I have been working very hard with them to get things right. (we see docs at Stanford who actually seem very open to alternative healing)

      I did the elemental diet for two days… that was enough and I was super super committed to do it… however i just vomited it up and really sick. Not the best solution in my experience. Probably not a good idea for little ones.

      I still struggle with SIBO daily and it is just a chronic dysfunction until the root of the issue is better understood. I don’t think doctors or other healers have a handle on this issue so until then, you are your best doctor when you listen to your body.

      Andrea

  11. says

    Monolaurin works well, I think the issue with tolerance to herbal antimicrobials is the “die-off” or Herxheimer reactions. I have seen practitioners manage this with things like activated charcoal, proteolytic enzymes, reduced glutathione, testing for MTHFR mutations, general liver/biliary support

    • Andrea says

      Hi Alex,

      Could you elaborate more on the MTHFR mutations please and how it relates to SIBO treatment? I have Factor 5 leiden, and SIBO, and not once have doctors said those relate. Curious about your thoughts?

      Thanks
      Andrea

  12. Andy says

    I’ve done the elemental diet multiple times.

    I actually have an article from pubmed where they tested gut flora levels each day someone was on an elemental diet.

    In summary, it appears to affect Lactobacillus spp. after one week, but other levels in the colon were not statistically significant.

    Maybe if it was longer, one would see a big change, but 2-3 weeks may not be long enough to have this effect.

    Thanks for the article

    • Andrea says

      Andy,

      Could you please post the link to this article… just curious about how they obtained samples of the flora from the small GI each day? That is not easy to do. I would love to present this to my GI doc.

      Thanks
      Andrea

      • Andy says

        The name of the article is ” Effects on an Elemental Diet on the Faecal Flora in Patients with Crohn’s Disease”

        it should be easy to find

    • shari says

      Nutrients have to be predigested so I would say no. Having things predigested insures that your body will absorb them quickly and leave nothing for the bacteria to feed on.

  13. Rene says

    I’m wondering if you’ve ever used calcium bentonite clay to treat SIBO. I’ve had gut issues ever since I had Cushing’s syndrome and afterward took steroids and statins for about 6 years. I have been drinking hydrated clay four times a day on an empty stomach for about a month now and have experienced a great improvement. In particular, most of my bowel movements are normal, and my intolerances to most all foods have disappeared. Would be interested in your reaction to this therapy.

  14. John Havey says

    I have that white coating on my tongue that Chris described. So maybe my problem is fungal, and I am hoping you will also do a write-up on symptoms, mechanisms, and treatments for fungal issues.

  15. Anon says

    I once inadvertently did a VERY thorough gut microbe cleansing when I inadvisedly swallowed a whole garlic clove like a pill. Near as I could tell from the results afterward, I killed off all my gut flora. My bowel movements were just some nasty liquid, not even really diarrhea. I didn’t start getting normal/solid feces again until I started taking some probiotics. So I have been leery about eating garlic ever since! I still eat it, but try not to overdo it.

  16. Bee says

    Would a juice feast work to solve sibo and yeast overgrowth? (veggie juices, little or no fruit)? Perhaps supplements with Thorne Mediclear plus, aloe, and probiotics, systemic enzymes, and oregano and cats claw? That’s a plan I’m considering

    Another thing that keep in mind is hcl levels, and also a sluggish or faulty motor complex. So, addressing adrenals and thyroid can help too, as well as b12/d

  17. Honora says

    Reading about the elemental diet treatment reminded me that I have met inflammatory bowel patients who were on a study where they consumed ‘ensure’ type formulas as their only source of nutrients. Surprisingly they were able to be compliant. I found that amazing in itself.

  18. Jason says

    I did a juice fast, (carrots/celery only) for 11 days along with clay and other anti-bacterial, anti-parasitic supplements. I did feel great and went from bad to good bowel movements but the problem is the loss of weight and adherence to the program. Also while the gaps/scd diets do help people, there is such adherence which is crazy. I would not recommend all the Nestle elemental diet things. That’s just toxic in itself. I believe juicing with carrots/ginger/celery/cabbage/greens are very beneficial to the body and should be part of a health diet to heal. I was eating a lot of sushi and feel I went backwards in my program. I believe too many bugs/parasites/viruses hitting my body and if the body is slightly weak at the time, then they will take hold. Also the mercury is definitely a no no. I’m off the sushi for good now. I read too much about the ill effects on thyroid and mercury. Once your thyroid and or adrenals are impacted, then you are going to put your body in a vicious cycle. I’m back on the mend though and doing much better.

  19. Bonnie says

    Hello:
    I would like to say that I suffered for 8 years with nausea and bloating after meals which caused a weight loss of 70 lb. during that time. After much reading I realized I had a small intestinal bacterial overgrowth (SIBO) and completely eliminated all my symptoms within a month by taking several drops daily of Lugol’s Solution 5% and fixed a few other problems I had as well.

    • Bee says

      Bonnie, can u elaborate more on the iodine protocol? What time of day did u take it? With food or empty tummy? Did u use other supplements (some say adrenals need to be addressed first or Selenium and other minerals need to be added too)….? Lastly, what did u use for ur thyroid to address motility issues? My doc recommended triquench iodine

      Did u have any side effects, like anxiety, from iodine? How intense was the die off and are u still on iodine?

      • Bonnie says

        Bee:
        About 3 years ago I thought that if all this discomfort could be caused from having too much bacteria in my gut then I had to figure out how to get rid of it. I was diagnosed with Gastroparesis and given a drug which worked really well but I wanted to do it without drugs or antibiotics, so I surfed the net.
        I read many articles and joined an SIBO list at yahoo I think. These people had various conditions which caused SIBO and dealt with it by drastically changing their diets, taking drugs and/ or antibiotics several times a year but never really getting rid of it.
        I don’t know how Iodine came into the picture for me but I remembered when I was a kid how iodine killed germs on cuts and scrapes, so why couldn’t it kill germs in my gut? I had read where people took it internally so I found an iodine list, joined and began asking questions.
        I could see that people were having Detox issues by their bodies getting rid of Bromide, Flouride and Chlorine ( while taking iodine) so I planned to go very slowly. So being very worried, I started off with only one drop daily of Lugol’s Solution (5%) and the following week (every Friday) I would increase it by one more drop. On the 3rd week – wow, the nausea was completely gone.
        I still continued to increase weekly until at 16 weeks I was taking 16 drops per day, in the morning on an empty stomach. I didn’t want food to be in the way. I stayed at this dose (100 mg) for a year. During that 16 weeks I had some amazing health issues disappear which I could list in another posting.
        My digestion was still slow and someone mentioned my thyroid, so I looked into testing and sure enough the numbers were low but my doc thought they were just fine, so I got a new doc and a prescription for Erfa. After fixing my Adrenals, things went well but I reacted to the fillers in the Erfa and had to have it compounded. After increasing the thyroid meds my digestion is now
        fabulous.
        I am still taking the iodine and I never had any detox side effects, doing it that slowly.

        • Peggy says

          Bonnie, this is fantastic! I’ve been fighting SIBO for a long time. I was hyperactive when I was four years old and given radioactive Iodine to kill some of my thyroid cells. Now at age 58, I’m a bit hypo with brain fog and other issues. Can’t wait to see if Iodine will get my health back. I’m underweight as it is and was only able to stay on the Elemental Diet 10 days. I tried both the antibiotic and the herbal antibiotics and used prokenetics before bed to try and keep it from returning, but the SIBO still returned.

          • Bonnie says

            Peggy:
            I would be interested to hear how Iodine helps you and how exactly you proceeded with this Protocol. You can write me directly if you wish, with questions. I have posted several times here, with more information for you to read. I have yet to stir up very many people who probably don’t believe this can help them. I think it is just too simple. After 8 years of nausea and bloating, Iodine worked for me within 3 weeks and only at 3 drops per day, but of course I continued increasing and had more benefits.

  20. Bill Lemke says

    Hello Kelsey,
    nice article.
    One question:
    Wouldn’t fasting be ideal for strarving those bacteria?
    (And even fungus)

    • Bonnie says

      Bill:

      You can kill the bacteria and fungus and still eat whatever you like with a couple drops of Iodine daily. Very simple.

  21. Linda Barrett says

    After doing a year of several antibiotics with only occasional short-term relief, I went Paleo/low FODMAP. After three very long strict years with an occasional cheat (for which I suffered greatly each time), I am able to add back a few fruits and “clean” ice cream occasionally. Probiotics, L-glutamine, and peppermint capsule each day also help me feel great. As a teacher, being away from school in the summer helps bloating for sure as well!

  22. PC says

    Would a ketogenic diet not help SIBO? I would imagine it to have a similar effect as an elemental diet if done for a long enough period?

  23. Evan E says

    What would a 7 day fast achieve I wonder? All the SIBO critters would be starved by then, right? Why even bother with Nestle’s GROSSLY overpriced concoction (have you seen the prices on Amazon? It’s like $13 a packet!). Perhaps follow the fast with a SCD diet and colostrum and l-glutamine supplementation?

    I am assuming this little meal idea was used just because fasting is not given much attention. But a week without food is not a big deal for most people (even those underweight). It kicks the body over to ketones for fuel and all sorts of other interesting things begin happening (hunger is typically gone by day 3). Seems like a simple experiment that could be done. But if the SIBO returns it’s critical steps be taken to curb that, otherwise what is the point long term?

    • einstein says

      those critters will survive longer than you. no fast beyond 3 days shoud be undertaken without medical supervision.

      • Evan E says

        And you say that because? Have you ever fasted? Have you seen how long humans can survive without food (as long as water is available?). I have personally witnessed a man do 40 days. The body can draw upon stores, the bacteria cannot. How would they survive longer, ‘einstein’?

        • einstein says

          Hi Evan,
          my comment was meant to be a bit sarcastic. Sorry about that. I do fast regularly but never went beyond 36 hours. I don’t doubt you’d survive longer than for 7 days if you had to, but I do doubt that it would benefit yours or anybody else’s health unless you have a very good reason for it (pre-chemotherapy fasting comes to mind) and are under medical supervision. From what I read more than 3 days mean muscle wastage, zero energy, metabolic slowdown, inability to focus and not much ability left to anything meaningful (work etc.). And I doubt that sheer willpower can get a man to do a 7 days fast. I might be wrong about this, because I’d be munching tree bark by then if nothing else was available and consider myself to have quite a lot of willpower :-)

  24. einstein says

    Here is a fast, efficient and cheap method I learned fm Andre Van Lysbeth. Get his Yoga book to check the exact method with pictures. I used this before a colonoscopy to make my large intestine ready for inspection and the doc said he never saw such a clean one before. Use at your own risk.

    Prepare 3 liters of moderately salty water (1 tablespoon for 1 liter).
    1-Drink three to five 200ml cups of this water.
    2-Stand with your legs slightly spread and raise your hands above your head. Bend four times to the left and right (starting out to the left side) in succession so that the water gets into the small intestine. This exercise opens up the valve between the stomach and the small intestine.
    3-Stretch your hands out in front of you and twist your torso four times to the left & right side alternatingly. During this exercise, the water advances in the small intestine.
    4-Place the palms of your hands on the ground, with the body stretched out and only the tips of the toes touching the floor. Look four times in succession across your shoulders, at the opposite heel. This moves the water from the small intestine to the large intestine.
    5-Squat down and (4 times alternatingly), put one knee down on the floor in front of the other knee. This will press the thigh of the knee which is NOT down on the floor at that moment to the left and right halves of the lower abdomen. With this movement we push the water in the large intestine all the way to the anus.
    Repeat exercises 2 – 5 a few times till you feel the urge to go to the toilet.
    After the first toilet session, continue like this:
    Drink one cup of salty water, do 1 series of exercises 2 to 5, go to the toilet.
    Repeat.
    By the time the 3 liters of salty water are spent, nothing but clean water will be coming out of the anus. The digestive tract will be perfectly clean.
    Be ready to go to the toilet a few more times after you stop drinking the salty water.
    Once the regular water flow fm the anus stops or nearly stops, eat a normal meal (paleo/primal of course :-).
    This will close the still open valve between the stomach and the small intestine.
    Do not drink for at least 1 hour after the meal. Then small amounts of water can be taken. A few hours later all will be back to normal. Don’t expect any stool for a day or two.

    Once you start this cleansing procedure, there is no way to interrupt it safely. The salty water needs to be pushed through the digestive tract before it gets a chance to be absorbed into the bloodstream. It is a pretty gross method and holding your nose, fighting throw-up reflexes etc. are a normal part of it. I have no idea about its effects on people with chronic conditions like high blood pressure, diabetes etc. I would recommend it for otherwise healthy individuals without acute digestive problems.

    • Scott says

      Hi EInstein,

      can you please tell me the exact name of the Yoga book, I’ve found several books from this author.

      thanks!

      • einstein says

        Hi Scott,
        I’m afraid I don’t know the exact title of the book, because it was a Czech edition, which I had in the beginning of the 80′s, orange cover, just titled Joga. Must have been published around 1984. I lent it out to someone like 20 years ago and never saw it again. I still remember the technique because I did it a few times (the last time was 6 years ago) and wrote it down so I won’t forget it.

      • einstein says

        Hi Scott,
        after a bit of googling I found the following:

        http://www.centrejaya.org/spip.php?article694
        Quote
        This description of the postures can be consulted more in detail in the book of Andre Van Lysebeth: “I improve my Yoga”.
        Unquote

        The description of the technique is the same as mine, with different words. Hope it helps. Cheers!

  25. Balázs says

    Chris, how the elemental diet compares to VLC specially in GERD? How long a VLC should be followed to get similar result?

    Thanks

  26. says

    I feel like I once heard that structural misalignments could cause SIBO on a podcast. Was wondering it the person knew what they were talking about or not. Could going to a chiropractor help to relieve SIBO symptoms? If anyone knows about this let me know just seems like another avenue maybe worth exploring.

    • John Es says

      In the context, the vagus nerve is usually discussed. I think it could be a underlying factor, affecting digestive enzymes, motility, for some. Do a little googling, and you’ll find plenty of stuff.

      • Bonnie says

        John

        The Vagus nerve can be a big problem and I was given Domperidone, thinking that I had Gastroparesis. But I thought why take a drug for slow motility when Iodine will kill the bacteria and the slow motility can be addressed with a thyroid pill.

        • John Es says

          I’m a little hypothyroid, and living in the Western world, so, chances are good that I have Hashimoto’s.

          If that is truly the case, iodine would probably be contraindicated. I wouldn’t take it without having my antibodies checked. I believe iodine can cause a Hashimoto’s flare, and promote destruction of the gland.

          Plus, if I can find the root cause of my hypothyroidism, maybe it could be corrected, and I wouldn’t need supplemental thyroid hormone.

          I’m still in the early stages of investigation, and I actually suspect that I have a T4 -> T3 conversion issue, and neither Hashimoto’s, nor iodine deficiency.

          I appreciated your information, and will add iodine to my list of options.

          Thanks,

          • Bonnie says

            John:
            If you took a look around on the Iodine list at yahoo, you would get information from others who have successfully used Iodine to treat Hashimoto’s. The list is run by a Naturopath who was a patient of Dr. David Brownstein ( who wrote the iodine book and 10 others) and cured her of Thyroid Cancer. We now have over 8,000 members and you would find all your answers there. Very few of us users of Iodine haver ever tested.

  27. Lynette Schmaltz says

    Does anyone know of any Dr’s in the St. Paul/Minneapolis area that can help me test for SIBO and understand the Paleo Approach?

  28. Schmemilypie says

    Can someone explain to me… If SCD is supposed to reduce the bacterial load of SIBO by removing sugars that bacteria can feed on, how does the Elemental Diet work differently (and faster) than SCD? Is some ingredient in the Elemental Diet working to destroy bacteria? I know this must have been explained somewhere, I just can’t seem to find it in the article or comments.

    • John Es says

      The nutrients are more broken down, and thus absorbed higher in the small intestine. Elemental diets are typically amino acids, fatty acids, vitamins, and simple sugars – nothing more complex.

  29. Bonnie says

    On July 19th I posted my success in killing off all my gut bacteria (after suffering nausea for 8 years) within only 3 weeks. I should have said I used IODINE instead of Lugol’s Solution which is the real name.

    It is so simple but no one seemed to notice. Why go through years of a special diet, when IODINE (a couple drops a day) will kill the bugs, bacteria, fungus, viruses and treat many other conditions as well such as fibroids, hypothyroid, ADHD, etc.?

    • Emily says

      Bonnie, Can you tell us what kind of dosing you used? I’ve searched all over and can’t find specific info from anyone who has actually tried this method. Thanks!

      • Bonnie says

        Emily:
        Today I posted a long explanation of how I did it (above) but just one drop per day of iodine (Lugol’s Solution 5%)
        and increase another drop each week. You will know where to take the dosage, by how well it is working for you.
        My problem is getting people to listen. I joined the SIBO list at yahoo simply to tell everyone what worked for me and what MIGHT work for them. No replies.

        • Theresa says

          Thank you Bonnie for your suggestion on using iodine. I have been taking a small dosage of iodine for about a year because I believe my diet is deficient in it. Now my 88 year old mother is suffering from SIBO and losing weight quickly. She is seeing a western medicine doctor and just recently started taking Flagyl. She is also trying to stay on a FOMOP diet but this has been difficult for her. So far, not seeing too much improvement. I think we will give Lugol’s solution a try.

        • Emily says

          Bonnie, Thank you for all the info! I’m very curious about any other symptoms or conditions you have treated with iodine.
          Thanks!

          • Bonnie says

            Emily:

            Here are the health issues that disappeared during that first 16 weeks on Lugol’s Solution (5%) as mentioned above:-
            Breast fibroids gone
            Sinus infections gone
            Uterine fibroids gone
            Endometrium thickness back to normal after 13 years
            Bladder infections gone
            Diabetes gone
            Nausea caused by slow motility gone
            What else is there left to fix?

            Everyone should read the book, IODINE, Why You Need It and Why You Can’t Live Without It by Dr. David Brownstein.

  30. Bonnie says

    We now know that skin health is closely related to gut health, so I would bet that many people with SIBO (Celiac Disease or Gastroparesis etc.) will also have a skin condition of some kind.

    So according to Dr. Jonathan Wright (near Seattle) you treat Eczema with Culturelle probiotic and Rosacea with extra Hydrochloric Acid.

  31. Julia says

    I have done the 2 weeks Rifaximin/Neomycin and then had 10 FMT treatments and still have SIBO symptoms!! What are the recommendations for after treatment diet/care/protocol? I was told after FMT to introduce more safe starches to feed the good guys, but still have SIBO bacteria…that I should be starving? I tried the GAPS/SCD diet before treatment, I am extremely underweight and can’t do such low carb anymore? What should I do now for diet, treatment etc?

    • John Es says

      Might you have bacteria hiding out in biofilm, a periodontal pocket, or an infected tooth?

      Is your migrating motor complex sufficient to keep SIBO from recurring?

      “Eat more safe starches” seems like pretty non-specific advice, and I’d want more detail. Different safe starches are going to provide different prebiotics or perhaps none at all.

      I’d figure out whatever calories help you gain weight while having minimal aggravation of symptoms, and journal diet, bowels movements, symptoms, and exercise until you can get more professional help.

      Did you get FMT at a clinic of some sort? What country?

      • Julia says

        Thanks John Es

        What helps the migratory motor complex? I read I think on the seibeckers website that LDN helps with this? I actually just started taking it. Do you know if it does or then what else would help with it?

        I did get FMT out of country. I went to the Taymount clinic in the UK and had 10 treatments!!

        I don’t know what to do now…diet, did I just into sweet potatoes and plantains too soon and should stick to SCD/paleo longer? but want to feed to the good guys and put on weight as well? and then how would I treat the SIBO now at this point….again?

        • John Es says

          Julia,

          I thought your treatment combo of antibiotics and FMT sounded brilliant. I’m sorry it didn’t work out.

          I wish I could be of more help, but, I am not anything like an experienced practitioner.

          Chris explained the mechanics of LDN in an old podcast. The context was different, but, I’ll try to track that down and see if it’s informative. Seems like it had something to do with opioid receptors and autoimmunity.

          Thanks for your follow-up.

        • John Es says

          Another thought on MMR. I’ve read where people have used activated charcoal to measure their transit times. Another thing to journal. :^P

          • Julia says

            Yes I heard the podcast on LDN and have started it for auto-immune issues. But also thought I read on dr. Seibeckers site that it helps MMC. Do you know of anything else that helps the MMC?

            • John Es says

              Off the top of my head, I think I heard Dr. Siebecker mention probiotics to help MMC.

              Another thing that comes to mind is the stuff typically mentioned by functional and integrative practitioners, starting with thyroid function, and including HPA axis regulation, and liver function. Gut pathogens and barrier function, are typically covered by their testing.

              My current plan is to see a practitioner, probably an FDN person, or, perhaps a Kalish method person.

      • Shari says

        Try putting your feet up on a step stool or even a box, that’s what we do in our house. At least that way you’ll know if it’s beneficial for you before you spend the $$ on the squatty potty.

        • John Es says

          I guess I could have mentioned, my take on the squatty potty is that it is “better than nothing”. I find it fairly awkward, and still getting used to it, after several weeks. I would rather just put a newspaper on the floor, and squat, but, the clean-up is a bitch.

          Looks like you might get the cheap model for about $25. I didn’t pay much more than that, at Bed, Bath, and Beyond in the US.

          http://www.squattypotty.com/

  32. Shari says

    I have done 2 rounds of Rifaximin and have been on herbal abx since January to treat Methane dominant SIBO. I did 2 weeks of the homemade elemental diet in June, it seemed to clear the bacteria from my upper small intestine but concentrated it in lower small intestines (those numbers were higher than ever). Starting round 2 of the homemade elemental diet today. It’s not that bad or expensive considering the cost of everything else I’ve done. My ND from the SIBO Center in Portland says you can substitute protein (eggs, beef, chicken, etc) for one elemental meal a day and do the diet longer, 3-4 weeks. Protein must be prepared the same you do during breath test fast, plain with only salt and pepper for spices.

  33. Bonny Thomason says

    I have been diagnosed with sibo 3 yrs ago. I am so gassy I can’t live with myself. I live in Minneapolis mn and I would like help to guide me what to do.

    • Bonnie says

      Hi Bonny, to see how I got rid of my SIBO, (and more) go back up this list and start reading my posts beginning at July 19th.

  34. Tanya says

    I took one round of Xifaxan for SIBO after a breath test came back positive for hydrogen, which didn’t do anything for my chronic bloating and constipation issues. Oddly, the only thing it did was eradicate the foul rotten egg smell from my gas (which is great in and of itself, but I need my other symptoms to go away!). My subsequent breath test came back negative for both hydrogen and methane; however, my doctor thinks I should take Xifaxan/Neomycin for 14 days, as he believes I may have bacteria that produce hydrogen sulfide, which the breath test doesn’t measure. Is anyone else in a similar predicament? I’m really nervous to take the Neomycin as I don’t have a confirmed positive breath test, and I would hate to make matters worse by further reducing my gut flora.

  35. Rita says

    What is the possibility of using the elemental diet and food? I desperately need help. I have lost a pound a week for the last 5. I have an Endoscope scheduled for this coming Monday and am thinking at this point it is probably cancer. I feel horrible. I am concerned about a regular protein shake messing up my Sibo, but need to gain some weight. Any thoughts? Thank you for any help.

  36. vb2005 says

    According to raypeat.com if you drink strained orange juice – it will not feed bacteria because it is rapidly absorbed – anyone tried this? I tried it but dont feel better – but this can be due to other problems related to fructose.

  37. Brock says

    Kelsey, the amino acids that Dr. Siebecker recommends, taste horrible in powder form, can I put the powder in a capsule? Thanks

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