Can a Short-Term Elemental Diet Help Treat SIBO? | Chris Kresser
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Can a Short-Term Elemental Diet Help Treat SIBO?

by Chris Kresser

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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!


Join the conversation

  1. There’s no getting around it. Vivonex is disgusting. Chris is right that you have to be really committed (i.e. really desperate) to do this. I can only stomach at most 2 glasses a day, which is way fewer calories and fat than ideal. But I can’t do more because of the taste. I did it the first time for 2 weeks. My SIBO didn’t go away. I did it a second time for 3 weeks and the SIBO did go away. Because I have been less than diligent with the Fodmap, SCD diet, some of my symptoms have returned. Constipation, slow metabolism (weight gain) and some bloating with certain foods have recurred. So I’m resetting again with the Vivonex and then going to try and be more strict with my food selections. As I’m sure most people here understand, it’s just really hard. I find that my energy level on the Vivonex is pretty normal for most of the day. I had headaches for the first 2 days. I’m tired at night and go to bed earlier than usual. I’m still constipated and expecting the lovely die-off diarrhea will kick in after the first week. My tip for consuming the Vivonex…I put it in the blender with exactly 1 cup of water. After I mix it, I let it sit for a few minutes. Then I pour it into a cup through a strainer to get rid of the foam. I have a cup of sparkling water on stand by. I pinch my nose and chug the Vivonex as fast as I can over the sink. Then I rinse my mouth out several times (still with nose plugged). Then I drink the sparkling water and swish it around (still with nose plugged). I usually end up with a couple moments of the nasty taste, but this seems to be the best system I’ve found. Good luck to all. It’s hard. I dream about food and only when you can’t have it do you realize it’s every where – all day every day…

  2. Hi, Has anyone tried the elemental diet for just a week? Also, how did you get rid of the die off? My skin is pissed off and I haven’t had a bowel movement in 4 days. I think the bacteria is dead and needs to leave my intestines. Thoughts? My doctor is out of town.

    • I do coffee enemas to clear intestines but it also cleanses the liver – Dr. Max Gerson used coffee enemas on his cancer patients when they would have life threatening die off from his treatments… Google for more information 😀 You will be amazed how this will help you through a healing crisis!

  3. Dear all SIBO fighters,

    I am on day 7 homemade elemental diet (the standard one) and I burp a lot. I notice no symptom relief so far. I use 21 pure blend, dextrose, L-glutamine and coconut oil in tea. I noticed that I burp after eating fats specifically. Any fat really, even fish oil in capsules. VB2005 mentioned that if one has SIBO it’s likely that the small intestine is damaged and you can’t digest fat. Can this be the reason for burps? How can I get the fat in while fighting SIBO if I can’t digest it?

    Also, it is not clear to me, how can glucose be used in elemental diet, if there is a glucose-based SIBO test. I understand glucose is absorbed quickly so bacteria don’t have time to ferment it. But then, glucose SIBO test would be highly ineffective which is not the case, as bacteria manage to ferment glucose and produce the gas that we measure. Does this mean that we feed bacteria with dextrose during the elemental diet??? *CONFUSED*

    If anyone could clarify this for me – Thank you! 🙂
    Best of luck to everyone.

    • I also really would like to know this as dextrose seems like my only possible carb source (really don’t want to go back into Ketosis, does not work well for me). Please can someone in the know clear this up for us because it is a very suitable question as there is lots of mixed info out there. I am not doing elemental just yet but am on a SIBO diet, however am very sensitive to carbs as there activate my GERD. Cheers

    • Hi Yulia,
      Happy to clarify this for you since I learned the hard way. I had SIBO 10 years ago and it was treated quickly with a course of Xifaxan, followed by 2 weeks of Vivonex Plus. It worked and I was SIBO-free for the next 10 years until I got Norovirus and again ended up with SIBO. This time Xifaxan was ineffective so I went straight to an elemental diet (Dr. Siebecker’s homemade version) for 2 weeks. I was shocked to see that my gas levels doubled. I figured it had something to do with the honey portion of the diet. So then I did Vivonex for 2 weeks. You can imaging my horror at finding out afterwards that my levels this time had tripled. What I eventually learned was that I had proximal overgrowth, which is overgrowth located in the upper reaches of the small intestine. In this instance, an elemental diet will actually feed the bacteria and your levels will increase. The glucose hydrogen breath test can rule in or out proximal overgrowth. Many practitioners think distal overgrowth is more common and, therefore, only use the lactulose test. Hope that explanation helps.

      • Ally, how did you find a doctor that could help you? My son is 21, non verbal and in excruciating intermittent gas pain daily. I have tried vivinox and xifaxin but without success. I THINK the die off was so painful with the xifaxin, he couldn’t stand it. The gas got worse with the Vivonex. I MUST find a physician who can help me trouble shoot.


        • Hi Amy, So sorry to hear about your son. Hang in there, though. Sometime it takes time a long time to heal these issues. I’m in LA and fortunately have Dr. Pimentel as my doctor. Try to get a referral to someone who is a true SIBO specialist. Best of luck.

  4. I need some help. I just finished a month of Neomycin and Xifaxin. My doctor emailed me Dr. Siebecker’s food list but not an elemental diet list. I was unable to have an appointment because of a snowstorm but I’m losing weight. I’m less than 100 lbs and I’m 5’5. My SIBO symptoms have continued while eating low FODMAP foods. Are Dr. Siebecker’s measurements on the food list per meal or per day? Any advice to gain weight and stay low FODMAP?

  5. I need to know where and how to test for SIBO no doctor so far believes in it, they say we all have bacteria in our guts, I have had many testsl, egd/colonoscopy barium swallows, ct scans, blood work, blood work, blood work, hair analysis, urine analysis everything normal but I have rapid dumping syndrome and mild gastritis, but my symptons are off the chart for these diagnoses I did the home spit test for yeast and candidas, looked like a jelly fish was in the cup and about an 1/8 inch of sandy grit on bottom do candidas yeast and SIBO co exist? Help I feel helpless

    • Hello Donalee! Conventionally trained doctors can become very complacent in their med-school knowledge and many don’t keep up with the latest studies in my experience. I’m certain most of the people on this thread have felt just as you’re feeling, including me! Commonwealth Laboratories will sell the glucose SIBO breath test directly to the patient without a doctor’s signature. I think they may even help with interpretation of results. Go here:

      • I clicked the Commonwealth Lab link, and it says that they are going out of business. Is there another lab that sells directly to the patient?

  6. Hello all! Is anybody interested in trying Dr. Siebecker’s homemade elemental formula at a discounted price? Back in July, I purchased the Black Label Pure form 21 Blend indicated on the ingredient list of the homemade formula shown here-

    With shipping, it cost me $168.75. Unfortunately, I have never been tolerant of drinking any kind of oil/fat, so when I made the first shake with the coconut oil, it was difficult for me to stomach and I had to forego the whole elemental diet after paying all that money. I literally only used 1 serving of the Black Label Pure form 21 Blend, and it’s been sealed up and untouched since July. I will sell it to anyone who is interested for $85- half price. Shipping included.

    On the site I originally purchased it from- – it states that the shelf life can be 3-5 years if well sealed in a cool dark place, or at least 2 years, so you definitely won’t be getting a less potent formula.

  7. Would eating meats really help maintain SIBO, especially if taken with Betaine HCl, pepsin, and pancreatic enzymes? Shakes are so not satiating.

    • Hello, I am starting the elemental diet next week… I am most nervous about the die off that will occur. I don’t deal with herxheimers well. I get severely depressed (ND says it is neurological inflammation …possibly). Anyone else had this with the elemental diet? Any other ways to deal with it?

      • Activated charcoal helps to bind to toxins. If you’re doing an elemental diet idk if you are able to do colonics, but they do help flush out your intestines of bacteria/die off and toxins

      • Shelly, did you get this answered?
        The Elemental Diet is powdered vitamins, minerals, amino acids, dextrose and fats. There is no food involved. You mix the formula into water and drink it. It is easy to digest and has no FODMAPs.

    • Physicians elemental diet from integrative is great!!!! I’ve been living on it for about 6 months due to chronic vomitting (all foods) from a case of sibo caused by EPI (lack of pancreatic enzymes). It is straight up paletable and I feel so nourished! Starting to reintroduce foods but so grateful for physicians formula. Couldn’t keep down the homemade version.

      • How does it taste?? I’ve had SIBO for a long time now and I’ve been through so many different antibiotics and diets that haven’t worked and I’m desperate. I can feel the bacteria getting worse each day and I can’t just sit here doing nothing about it but I’ve been pretty picked for all my life. It is better now but I’m not sure if I would want to put so much money into it if I am unable to stomach it.

    • I have this product, the physicians elemental diet, and it’s FANTASTIC. i blend it with water and ice and it tastes like a weird coconut slushy .

  8. Follow up post: This past year has been interesting to say the least. Here is what I have discovered……I have adrenal fatigue syndrome. For me, this means that it has shut down my stomach acid production, among other irritating symptoms, but it was the basis for my SIBO. I’m slowly improving with the AFS but it takes a long time, and the symptoms can seem like very unrelated conditions. As far as the SIBO goes…..stomach acid triggers intestinal motility. I have very little or no motility so I’ve been taking supps for that. But the bloating persisted and I can’t even begin to describe how chronically dry my skin is (low/no stomach acid does this). Long story short, I figured out because the adrenals shut down the stomach acid. The release of stomach acid causes intestinal motility. Low or no motility sets the stage for SIBO.

    The symptoms were very similar to the SIBO in a lot of ways too…..anything I ate made me bloat to unreal levels. As soon as I started supplementing with HCI, raw apple cider vinegar, digestive bitters, and enzymes, the problem went away in a matter of 24 hours. My skin has improved drastically but I’m not healed, just trying to turn things around.

    Antibiotics are NOT the answer, I’m convinced. It may help when things are really out of control, but the condition is going to return quickly. You have to find the underlying cause. So for those of you with fatigue, sluggish thyroid, dry skin, anxiety, depression, and some other random “conditions”, you may want to look into adrenal fatigue syndrome.

    Here’s the thing, don’t get roped into thinking you need certain herbal supps for adrenals, meds, prescriptions… need to eat clean, rest, ditch any and all caffeine, and research this until you’re blue in the face and research more after that. The best resource I’ve found thus far is Dr.Michael Lam. Look his articles up online, and get a copy of his book “Adrenal Fatigue Syndrome”. Basically anything that is governed by hormones is bound to get all jacked up if the adrenals aren’t working right. They work together with the thyroid, reproductive organs, pancreas, and pituitary. When they are out of balance, your whole world is out of balance. Everyone is different, and nobody has the same exact symptoms. It’s hard to diagnose and regular doctors won’t recognize the condition at all, they just hand out prescripts for symptoms and that will hose you up worse.

    Basically, if you have had test after test after test and nothing shows anything wrong, and you still feel rotten with low energy, look into this. I can’t stress enough how much you have to read and research this on your own. I don’t trust holistic docs, I feel their knowledge is hit or miss at best with this condition. I went to one who said she was highly knowledgeable and she assigned adaptogenic herbals that made me worse. Why? Because you cannot generalize the treatment. Herbs that are healing in earlier stages are very damaging in later stages, and I was easily at a stage 3C, which is pretty advanced.

    If this happens to be the cause of your SIBO, then just treating the SIBO isn’t going to work. It will always return if you don’t heal what’s needing to be healed. And this can take up to 2 years. It’s far from instant.

    Just my 2 cents worth. Again, this isn’t going to apply to all of you, and this is just bare min. info, but when the adrenals aren’t functioning correctly, your entire endocrine system gets thrown out of whack horribly. In some case the body stops making stomach acid and then you get the SIBO symptoms. As an example, I had all kinds of problems with this. However, I have a close friend with the same condition way worse than I had it and she produces stomach acid just fine. So here again, it’s not going to apply to everyone and there are other causes for SIBO. But this is definitely worth looking into.

    I did the elemental diet last summer and it did wonders, then I continued to look into why certain things were happening and just kept digging until I found answers. Dr.Lam’s info was what got me on track.

    I hope this helps at least one person out there.

    • You hoped to help at least one person out there with your informative post. And though I am just at the beginning of my path to heal my various issues and not yet a success story, this post has indeed helped me if for no other reason than offering a respite of common ground. I too have SIBO, extremely low stomach acid, and adrenal fatigue. I will keep digging! Thank you for sharing <3

      • For the adrenal fatigue I cannot stress enough to get ahold of Dr.Michael Lam’s book. It’s a tad pricey but the most comprehensive book I’ve found yet. His articles online are good too. Good luck, it’s so frustrating but if you’ve identified the adrenal fatigue, you’re on the right path!

    • Hi Shasta and everyone, great post and thanks for the info. I feel like most of the people in our bloated community could write for days about our stories. I’ve been struggling for 20 years and have tried Everything. I tested positive for SIBO and tried multiple rounds of antibiotics and antimicrobials with no luck.

      My bad luck started 15 years ago when the doctor didnt know what was wrong with me so he put me on Nexium. I was taking double the normal dosage every day. So it was pretty safe to say I didnt have any stomach acid which was a major issue. Other doctors added on more meds to mask the symptoms but never tried to fix anything. I finally started all the research on my own and found some holistic help.

      Sadly i’m at the point where I can’t eat anything without the bloat and discomfort. For a couple years now I haven’t had gluten, dairy, eggs, corn, soy, sugar, garlic, onions, and many others. Basically all I eat is meat, rice, some veggies, and gluten free breads.

      My big question to you and the group is about the HCI and enzymes. The first time I tried this it was HEAVEN for two weeks. I felt what could be normal for the first time in my life – high energy, no bloat, food digested, weight gained, and hungry. However, after 2 weeks it was all gone, poof back to my crappy normal. Then I waited a month and tried it again…it was fantastic for 3 days, then nothing. I’ve tried it multiple times with dosage variations within the past year to figure out why and I cant get anywhere. Have you or anyone else come across this?

      • I’m quite similar…..took the HCl for a bit and then bloat was back. More digging. You need to look into the symptoms of a chronically congested liver, happens with any kind of hormone imbalance, toxins, meds, etc over the years and tests will NOT reflect this. A congested liver means you probably aren’t producing bile correctly. Is your skin always dry no matter what you do? It’s one of the biggest symptoms. I started taking ox bile with any foods containing fats and that has helped a lot. Got this lead from one of Dr.Lam’s articles so just do a google search for “congested liver Dr.Michael Lam” and you should bring up his article. Then research the topic til your eyes bleed. I’ve been taking 100% apple juice and raw apple cider vinegar daily and going to do a liver cleanse soon, I’m pretty sure I’m full of gallstones. The apple products soften stones to help my kick them out during the cleanse. I’m also doing other things (all natural) to help detox my liver, could take up to 4 or 5 months. I do a LOT of juicing, almost all veggies in it, and that really makes me feel better and delivers nutrition the body can instantly absorb and will help the body repair any damage. Juice typically makes at least two of my daily meals and I feel WAY better. It heals, detoxes, and delivers extreme nutrition that your body may not be absorbing otherwise. I wish I’d known about juicing when I did the elemental diet, as I feel the basic elemental diet was nutritionally incomplete.

        And for those of you who think it (juicing) will contribute to SIBO, it won’t. At least not in my experience. Use 90% veggies and the rest fruit, but don’t use fruit with much sugar. I only use lemon, lime, or green apples. A little carrot or yam helps flavor but my body prefers bitter juice. I strain out a lot of the pulp, but when I leave the pulp in I find it has no bearing on SIBO and just gives you a bit more fiber so don’t be afraid of it. Try and add a good handful of dandelion leaves/stems/flowers but be sure they’ve never been sprayed or given chemical fertilizer. They detox and are good for digestive issues and help bloating. Be sure to take in a lot of water daily. Do your research as to what is going to help the most with bloating, inflammation, detox, hormone balance, and nutrients when it comes to what veggies to juice. Start with less, maybe only 4-6 ounces. You may be running for the potty the first couple days because it will release a ton of toxins. I’m up to around 40 ounces of juice daily split into two meals. Anyway, I’m similar in symptoms and this has helped the most. I also do a lot of protein shakes from an organic vegan protein powder and that seems to digest very well since plant based nutrition doesn’t require stomach acid for digestion. My body is slowly getting back on track, it does take a lot of time, but I feel is a better approach. Hang in there and keep doing all the research you can on holistic approaches. Research adrenal fatigue until you can’t stand it anymore and use Dr.Lam as a resource for that. I know this doesn’t apply to everyone, but from what I have learned, SIBO is a very common result of poorly functioning adrenals. Shuts down a lot of hormonal responses, and that includes intestinal motility shutting down, stomach acid production shutting down, and a congested liver that also has a bad effect on digestion. Once healing starts, things should start coming back online for you, but again, healing properly does take time. It took years to get this bad, will take up to a couple years of die-hard persistence and patience to get back on track. Rest a lot too, and eliminate stress from your life. And get as much sunshine as possible. Good luck!

    • Hey Shasta,
      Thanks for your inspiring hope with your posts. The adrenal aspect lit up for me with the low motility. In my case, ll cascaded down from emotional trauma and resulting massive high stress to digestive issues to adrenal dysfunction to this damn SIBO. Reading many stories, such as yours, and seeing the same common bases for provoking SIBO, it gives me much hope that as these things are corrected, my life will be back on trace to health. Am considering the elemental along with the xifaxin and Allimed.
      II want this thing resolved after 10 years of frustration

      • You know, I’m not convinced that any kind of antibiotic is beneficial for SIBO at all. Seems it kind of relieves symptoms a little bit and then it comes back because the problem is still there. If you have motility issues, you need to address that. If you have adrenal issues, you need to address that. It does take time, but when the problem is balanced, you will be SO HAPPY! I do recommend juicing, motility supps, learn about adrenal issues, look into Dr.Michael Lam’s book Adrenal Fatigue Syndrome as well as his online articles. Last, I want to say that I did that liver cleanse and OMG……that made a world of difference!! No joke, I did the cleanse in early November and I have not had any bloating since. I’m ramping up for another cleanse at the end of the month, as this really needs to be done every six weeks until the body stops kicking out gallstones. All I know is that after that cleanse I was better than I had been in over 3 years. No joke.
        Hang in there, and try to avoid antibiotics or drugs. I really feel its the wrong approach and will only drain the bank account. Find the cause, then you will eliminate the symptoms. Good luck!!

  9. I can say that orange extract (Simply Organic brand “Orange Flavor”–ingredients: sunflower oil, orange oil) is a very good flavoring to add, if you’re making the homemade elemental recipe on Dr. Seibecker’s site. The shake is not delicious, but it is palatable and doesn’t make me want to gag at all like other commenters mention. Yesterday was my first day on the diet and I did get a fair amount of nausea, that worsened the more drinks I consumed, followed by very watery diarrhea. I don’t know whether this is die-off already, or if my gut is sensitive to the formula. I did mix a probiotic capsule into my last drink of the day, as recommended on, and this morning had a formed poo. So I’m going to stick with it, take some gut-soothing supplements, and see how it goes. I began this because I was just too tired of recurrences, and I’m not throwing in the towel!

    • Hi Heather! I’m very curious as to how it turned out for you. Were you able to follow through the entire 2 or 3 weeks? Did you retest and find your overgrowth had improved or resolved completely? Eager to hear as I am considering starting ASAP. Thanks!

      • After 6 days, I noticed candida symptoms cropping up, so I stopped. I was doing herbal antibiotics along with elemental, and continued them for another three weeks. Even 6 days was very effective; my symptoms were greatly reduced and I felt even the short run was worth it. I stuck to strict low-FODMAP AIP afterwards and felt pretty great. My breath test was last week and I’m waiting on numbers.

        • I also added in iberogast when I went back on food. The elemental made my stools very loose (I’d had c prior to that), and the d continued once on food. I did a couple probiotic enemas, a couple weeks apart, since I was scared of putting probiotics back into my small intestine! The d gradually faded and currently I’m regular.

          • Heather, if you were “c” dominant, were you also methane dominant? I am terribly ill (25 years of symptoms). Would you be able to privately email me offline to share stories if you were methane/constipation? [email protected].

            • Mary (and anyone else with SIBO): Join the SIBO discussion group on Facebook to find a community where there are lots of ideas and treatments shared for SIBO and related gastro issues. I am SIBO-C methane dominant and am on day 21 of elemental diet. It has helped significantly this time. I am combining with “Heavy Duty Mullen protocol.”(you can find on google.) In april I did 14 days with candibactin AR & BR and my symptoms did not significantly improve. I didn’t want to waste the money on retesting at that point.

              • Tess and/or others doing the elemental diet: do you have an MD or other health care professional supervising your elemental diet?

                • My doctor wasn’t familiar with the elemental diet until I told him about it. He offered rifaximin initially, but I’d like to avoid that if possible. I will keep him updated throughout if I feel his input would be helpful, but his involvement will really depends on my communication.

              • I would like to join the Sibo community on Facebook. My daughter has been diagnosed with this and treated with antibiotics, but still has debilitating symptoms. We are looking for answers. I don’t know anything about sibo-c methane dominant so I’d like to be more educated as this is severe and affects our whole family. Thank you!

  10. Hi. I was wondering what one eats after coming off the elemental diet. Do you follow low FODMAPS, GAPS, SCD or a combo?

  11. To be honest, I think we are doing a disservice to people with SIBO by overemphasizing the negative aspects of the elemental diet, especially taste–we are discouraging people from even considering it, when so far it is the most effective and shortest therapy available.

    After reading all the blogs, I was really afraid that I wouldn’t be able to do it–the taste was described as horrible, the regimen difficult, etc. But what I find is that it is a very personal thing, and it really depends on your mental attitude and experiences going in–I don’t find it bad at all! I have taken numerous Chinese herbal concoctions for giardia that were far worse tasting than this. I make the homemade recipe from Allison Siebecker’s website (low carb/higher fat). Maybe the amino acid formula has improved since others did this, but I find the taste relatively bland. I mix the aminos with the dextrose and salt, throw in 2T liquid coconut oil, and then add some flavor–cinnamon is the best so far–and it actually tastes quite fine to me. I may not win any Michelin stars with it, but don’t let the taste scare you! Sure, the oil congeals in a cold drink, but it improves the taste immensely–just keep swishing it around and eventually it will melt at the end. I down a tablespoon or so of olive oil beforehand–I find it soothing–and then eat the encapsulated vitamins with the drink. I have every confidence I will make it through three weeks of this with no problem–for me, it is far better than continuing to suffer with my SIBO symptoms. I don’t feel hungry after drinking one of these–I am actually consuming more calories than I was before this! I also try to remind myself that this is a very small problem in a world of very large ones–I know there are many starving people on the planet who would literally kill to have an amino acid/dextrose shake right now, and I am grateful that I have access to one.

    I have suffered from SIBO for almost 20 years, and it took me 15 years to get a diagnosis (thank you, Allison Siebecker!), so maybe I am more desperate and ready to try anything! I have been on the SCD for three years, taken multiple rounds of rifaximin and neomycin, and up until the time I got another gastroenteritis in Indonesia a year ago, I was well on my way to recovery. After that bout, though, I have gone back to where I started, with my highest H2 number >130 in my small intestine. I took one round of Candibactin AR and BR and cut out all foods that were irritating my leaky gut (eggs, nuts, dairy, most fruit, alcohol)–that got rid of the methane producers. But in consultation with my docs, I decided to go for the elemental diet and kill these things off quickly! I am not done with the diet yet, but feel confident this will get me back to a much better place, if not entirely better. In retrospect, it would have saved me a lot of time and money if I had taken the plunge after the first six months of SCD and rifaximin, so my words of encouragement to others out there is YOU CAN DO IT!

    • Did the elemental diet help you with methane production? I am methane / constipation dominant and would like to share stories.

    • Thanks so much for sharing and encouraging. I start this week on 2 week protocol… I am nervous about giving up food! I am a mom and spend hours everyday in the kitchen preparing food for my family. This is going to be difficult but you are right…after 17 years of pain and bloating this will be worth it. Thank you

    • Thank you so much for sharing your perspective. It is hard to quit food but remembering how lucky I am, compared to millions of starving people around the world, well, it helps make this process more doable – regardless of the taste.

  12. On Day 1 of the home made elemental diet made from the recipe on I tried low FODMAP, which helped, then Paleo, which helped a lot. I still had a residual SIBO and couldn’t tolerate herbal antibiotic so tried Augmentin which my integrative Doctor recommended and felt worse. I thought I would try this diet before the Rifaximin and really cannot imagine going through it for 2 to 3 weeks. First of all, I chose the high fat/low carb option since I have a bit of yeast problem too and found out that the fat just doesn’t blend at all with the rest of the drink so I had to eat it separately. Second of all, the taste of the drink is so gross! I had to suppress my gag reflex every time I drank my drink. I usually can eat just about anything. I am an integrative pediatrician and I don’t think I’ll be recommending this to anyone.

  13. Hey!

    2 questions:

    1) Why not get a feeding tube?

    2) I have stockpiled a bunch of things that I’ve read are good to take – but now trying to ingest them all is difficult. Here is a list of what I have:

    -Interfase plus
    -candibac br
    -olive leaf extract
    -oregano oil
    -peppermint oil
    -saccharomyces boulardii
    -probiotic (doctor recommended)

    Can someone please recommend a good way to stagger these so that I am using them beneficially/not contraindicating things? I was taking peppermint oil at the same time as interfase for a few days and realized that it might be counterproductive to try to break down biofilm while consuming gelatin and oil… Also not sure about using probiotics / saccharomyces boulardii while on the interfase regiment.. should I wait until finished with it? Thank you for your thoughts.

    • Another quick question- If I were going to try the elemental diet but take the vitamins separately – in capsule form – how significant would the change in efficacy be? Thank you

  14. Dear Kelsey and Chris.
    I am trying not to get frustrated here so I wonder if you can help me. My girlfriend has horrible stomach issues. She’s been in numerous surgeries removing masses of bacteria, parts of her colon, it’s horrible. She’s been a vegetarian all her life eating cereal grains mostly because she doesn’t like to cook. I also have SIbo and struggled with stomach issues but I’ve embraced animal products and gut healing foods (eliminating fodmaps, AIP diet etc) which is helping me but meanwhile I can’t convince her. IN fact she’s wanting to go vegan with another surgery coming up. I realize I can just let it go and give her support as a friend, however I thought I would reach out to you and try my luck:

    Is there anything, any studies or research that specifically show that excluding animal foods is not going to improve the state of a compromised stomach? Is there studies that prove that including animal products gives far better results?

    thank you.

    • Just my two cents worth but if someone is dead set against eating meat, then it’s going to be very difficult to convince them otherwise. If she’s not getting enough protein in her diet from a vegetarian lifestyle then eventually she will have other health issues from that, the body needs protein. Logically speaking, meat doesn’t provide food for the bacteria and overloading with grains is going to be a bad thing with a bacterial overgrowth. I’m no expert but everything I’ve read about SIBO and similar issues generally says to avoid all grains, she needs to do her homework. But, really, I think you hit the nail on the head… may have to just be a supportive friend if she has her mind made up and is being stubborn. Maybe a holistic expert would be someone she would listen to?? I honestly don’t believe doctors steer people in the right direction with diet simply because they aren’t taught this stuff in medical school, they are only taught how to write prescriptions. Good luck to your friend, maybe some others on this page will have better advice than I do.

      • Hi Shasta, Thanks

        Yeah I just hardly have the energy myself to try to convince her. IT’s strange. We talk at length sharing our health journeys and she keeps saying to me, “I want to learn from you, tell me more… ” I send her emails with menus for SIBO of course containing bone broth and explanations why it’s important, why animal products are easy on the stomach, that grass fed ethically raised meat is available, links to articles (to this site as well) and still nothing gets through to her.

        I think we both know the right thing is to just be supportive but most of all I can’t allow myself to get upset or stressed out. This is only taking energy from me, and she’s not truly wanting to learn if she insists she’s going to become a vegan anyways.

        I’m just going to let it go and focus on myself. Thanks for the input. I’m totally done with trying to convince her. She’s on her way to I think her 6 or 7th surgery in a couple weeks. I can only wish her good luck and bring balloons as chicken soup would be useless to her.

        • Hi Lisa,

          If Your friend was vegan she is probably zinc deficient – she will feel bad from eating meat – i know this from experience. She probably have low stomach acid – zinc is needed to produce stomach acid. There is a study that shows that zinc deficiency is the root cause of most gut problems here is the link
          If you open any site that sell zinc supplements and read comments under zinc supplements you will see that it works. I think she have at least 2 options:
          – to take Betaine HCl supplements and to eat meat
          – to take zinc supplements
          The problem with zinc is that grains prevent it’s absorption because they contains phytates – she have to change wheat with potatoes or tapioca products or masa harina flour instead of white flour – all of those dont have phytates.
          Actually i think most vegans avoid meat because they can not digest it – there are many people that are born deficient in zinc – without zinc many digestive enzymes are simply not produced in the body. So meat is rich in zinc but they can not digest it – it’s catch 22 situation. She can also take other digestive enzymes too – not only HCL.I personally think that one can also cure sibo with digestive enzymes.

        • Maybe instead of focusing on getting her to eat meat you could try to get her to cut out the gluten-containing grains. Concentrate on rice, low-FODMAP vegetablesnd a good multivitamin pill. See if that helps.

    • Hey Lisa, I know this is a few months later, but if your friend is still experiencing digestive issues and is a hard vegan/vegetarian, give her the book “Tissue Cleansing through Bowel Management” by Bernard Jensen. There are different ways to heal. She’ll resonate more with this book than the SCD or other meat-centered gut-healing diets.

    • Dr Ritamarie Loscalzo is a functional medicine/nutritional endocrinologist who offers an online course called GRAND (Gut Repair and Alkalizing Nutrition for Digestion). It is extremely thorough, highly specialized and customizable, and very good for healing all kinds of gut issues, including the most serious ones. Most importantly for your girlfriend, Dr. Ritamarie is plant-based and offers plant-based options for every nutritional intervention, including the SCD and low FODMAPS diets. It is a really thorough and time-consuming program but it works, and your girlfriend might resonate a lot better with this approach. It actually really isn’t necessary to consume animal products to heal the gut, though you need to be willing to eliminate all the foods that harm it, particularly all processed foods (including all refined grains and flour products, refined oils, etc.).

  15. So…..I’m about 2 1/2 months since I completed the elemental diet. I definitely have motility issues, if I slack on my motility supplement I get really backed up but a little SmoothMove tea will correct the issue in a day or two. Just this last weekend I had a horrible SIBO flair up and I’m still bloated, the tea did nothing, and I suspect that event though I’ve been very careful with diet, I’ve still had to take in carbohydrates, maybe it’s been a tad too much in conjunction with the motility? I’ve also slacked off on the Lugol’s iodine so back on that, starting to see a difference in two days. For a couple few weeks I’m gonna be on high protein, high fat, low carb and back on my herbals to try and get back on track.

    Here’s my questions for anyone who wishes to offer their opinion on the matter: I’m seriously considering the elemental again for about two weeks and doing the antibiotic……what antibiotics have people had the best luck with? Also, I honestly don’t know what is in it or why it helps but Monster Lo-Carb Energy drinks (I have one a day) seem to help considerably. I’m guessing that either the taurine, the L-Carnitine, or the B vitamins help somehow? Any ideas why? All I can say is that they definitely make a difference. I don’t really think it’s the best habit to be in but if I get positive results and they make my life easier, bring ’em on! So if there is an expert on this list, I’d love to hear your opinion on why Monster Lo-Carbs seem beneficial??

    I’ve been having luck addressing my estrogen dominance with a progesterone cream, happy with that. Been taking selenium and the iodine liquid for thyroid, unsure if I’m having progress but getting back on iodine after a good month and a half of blowing it off seems to help, but I’m also back on herbals and have cut out carbs for the time being. So a little unsure which action is helping, or if it’s a bit of everything combined. Bloating is reducing fairly quickly though, compared to what I had dealt with before I did the elemental, I’d be bloated for days/weeks/months with no relief. Anyway, my point to this post is just a follow up to say that if you slack off, this condition can and will flare up in no time flat! I guess it can be trial and error as to what happens since we’re all different. I plan to stay low carb for a while and then slowly introduce things back in one at a time in tiny quantities to see what does and doesn’t work. And I do plan on having dextrose in my post workout shakes, so I will be getting some fast action carbs at any rate, I won’t cut them out totally. Cucumbers and greens don’t seem to be a problem but they don’t lend much in the way of carbs. White rice seems to work too but avoiding it for now.

    Just my two cents and two questions worth. Your turn….opinions anyone?

    • Hi Shasta – I’m in the midst of a 10-day course of antibiotics. I’m following one of the protocols outlined on for constipation dominant SIBO. Rifaximin + Metronidazole Dosing: Rifaximin 1600 mg per day + Metronidazole 750 mg per day x 10 days. I’m on day 7 of the protocol. I have had loose stools, more gas and am tired but no other side effects. The abdominal pain has improved though I still have it at times. It’s the constipation and gas that cause the pain for me. I’ve had terribly dry skin that no amount of lotion or oil was helping at all. Since I’ve been on the antibiotics my skin is not nearly as dry. And, it was almost painfully dry and hot. I recently started seeing a new doctor – a very traditional osteopath – that doesn’t have experience with SIBO but is willing to work with me on this. I have worked with a pharmacist that studies functional medicine as well. The protocol on is the protocol that is being recommended by functional medicine practitioners at conferences as well. After I finish the antibiotics, it’s recommended that I do 6 weeks of herbal antibiotics. I’m starting with Oregano Oil and will rotate through a couple of other herbals as well. I may also try one of the motility meds suggested on too. It depends how I do after I finish the antibiotics. I ate more fruit than I have in a long while yesterday and am paying the price with bloating today. My bad. I thought I could get away with it since I’m on the antibiotics. I won’t do that again. The pharmacist that I’ve worked with said that it’s not unusual to have to repeat the antibiotic protocol several times. I’m really hoping one round will be enough for me. I think that being very disciplined with food is going to be important. Note, if you do decide to do the antibiotics, don’t stay low-card. You need the bacteria to be active. Listen to the interview Chris Kresser did with Dr. Pimentel to learn more on that. Reading about your experience helped me a lot. I was feeling too crummy to do the elemental diet which is why I decided on the antibiotics. I was very resistant to trying the antibiotics since I’m not a fan of meds. Let me know if I can answer any questions for you. I am not a medical practitioner. I’m just someone that reads a lot to try and figure out what I need to do to get healthy. I do yoga, walk, and eat clean food and have for years. It’s speculated that a parasite is what caused the issues I’m trying to sort through now.

      • Sorry to interject. Did antibiotics cause your SIBO to begin with? It is what caused mine. I was healthy and happy before antibiotics destroyed my GI. I recently tried to start up Xifaxin at 550 mg a day and it was unbearable, completely shredded my intestines.

        • Could we share stories about your xifaxan response? I just failed it for the 2nd time, and it left my methane dominant sibo issues even worse than before I started taking the drug!

          • It made me more bloated, felt worse overall and it hardly did a thing while I was on it. Have you done the elemental diet? There really isn’t a safer way than that, if you ask me. But it does cause yeast so if that is a concern (or histamine issues), then herbs might be the most route. Look up the Dr. Gerard Mullin protocal. Or do Biocidin + Neem Plus + Allimed 3x a day for a couple of weeks. That should take down your methane levels.

          • I have done three rounds of Rifaximin/Xifaxan.

            Prior to the SIBO diagnosis, I was vegan for about a decade. It took me a year to prepare to bring bone broth into my diet. I now eat fish, chicken, and turkey for protein. I don’t eat it for every meal, but can’t sustain on a plant-based diet given all the foods that I am unable to tolerate.

            1) First was 550 mg TID for two weeks.
            Felt slight improvement, but never fully better.

            2) Second treatment. I ate high FODMAPS to build the bacteria.
            * Rifaximin – 550 mg TID for 30 days
            Following for 60 days:
            * Interfase Plus – Three capsules BID on empty stomach
            * Lauricidin – One scoop TID with meals
            * PHGG – a fiber supplement – Five grams/day with or without food
            * Prescript-Assist: probiotic – One capsule BID taken away from antimicrobials
            * Lactobacillus plantarum: probiotic -10 billion CFU/d
            * MegaSporeBiotic: Two capsules just after a meal
            * Metagenics Candibactin-AR – 2 caps 2 x day x 4 weeks
            * Metagenics Candibactin-BR – 2 caps 2 x day x 4 weeks

            Initially, I felt better, but had a really hard time tolerating the Candibactin and Lauricidin. They made me sick to my stomach, resulting in lethargy.

            Breath test was positive again, high methane.

            3) Third treatment of Rifaximin – 550 mg TID for 30 days.
            I couldn’t tolerate the herbals, so I ditched them all. Kept doing probiotics. I added NAC and liposomal glutathione to help with detoxification. I also drank about 16 oz of bone broth daily for L-glutamine. Given my vegan past, animal welfare and moral consciousness in regards to animals is very important to me. I am unable to bear making my own broth, so I buy it – made locally from farms that grass feed their cows and use sustainable practices. Do note ** a lot of bone broth is made with vegetables, then strained. I do better with straight broth, no veggies or spices. It took me a while to realize this, at first I thought it was all the same. Nope,

            Retested two days after I finished. Breath test numbers were still off the charts. The lab had to use their “high” numbers for calculations.

            * I just finished 7 days of Diflucan 200 mg
            * In 10 days I will take a stool sample for:

            4) * I am starting the homemade Elemental Diet tomorrow. I plan to do it for three weeks.
            * Rifaximin 550 mg TID for 14 days
            * Flagyl 750 mg BID for 14 days

            My plan for re-entry to food
            * Resolor at bedtime to help with motility
            * bone broth the first few days off ED
            * colostrum 8-10 caps/day
            * Great Lakes Collagen – every day
            * consult with HCL doctor to get levels tested
            * use SIBO app to add one low FODMAP item at a time:

            Other contributing factors of impact:
            – I have both genes for celiac, but have not had the biopsy to confirm
            – I am positive for both methylation factor mutations (MTHFR)
            – Magnesium oil on feet every night
            – Mag/Cal/Zinc 3 tabs QD
            – I am on 4.5 mg of Naltrexone to help with sympathetically-mediated pain; I also hear Naltrexone can help with motility. This has not been the case with me. I still have slow motility.
            – I am a 41 year old female, positive with a strong desire to feel awesome again.
            – I could not exercise while on the herbals. In fact, I had to change jobs and move out of a busy/hectic city because I couldn’t tolerate the demands of high external stress. I am not three weeks in to a 5-7 day/week exercise regimen. I think it’s really important to raise the body temperature – this is a priority for me.
            – Get at least 7.5 hours of sleep a night. Being on Naltrexone kind of requires this; I feel best on 8 hours of sleep.

            Both my iron and b-vitamin levels have tanked because of SIBO. I am supplementing for iron, and taking MethylGuard until injection methyl folate and b12 arrive from:

            Thanks to D’Arcy for the positive encouragement about the Elemental Diet. If I could have circumvented all the expense (meds, supplements, doctors) and feeling awful and just done a diet for three weeks – even if it’s unpleasant – I certainly would have.

    • Has anyone’s weight gone up despite low carb clean eating. I have gained over 30 lbs after a year of deep keto diet. Lost weight to 105 now I’m up 30++ lbs after keto and skin conditions that I never had rosacea cysts etc..I am guess too low carb acrewed up flora, the antibiotics after that even more. Currently there is not one kind of veg meat or fat I dont react too. What baffles me is the huge weight gain despite eating similar ans even less..very depressing

      • Hi Jen- I have noticed the last few weeks since I’ve been on Rifaximin, that my weight seems to be slightly increased, and seems more difficult to lose than it had previously. My guess is that it has a lot to do with the bacteria having consumed so much of my food- I was starving constantly. By the time I finally got help for the SIBO, it was really really bad. Extreme symptoms that had been going on a full year after I had been on 2 rounds of antibiotics for a bad UTI. I’m about to finish the Rifaximin and hoping I don’t go back to how things were before.

    • Have you looked into the Fast Tract Diet? It is designed for SIBO and differs from a low FODMAP approach in that it measures the potential of carbs to ferment in the gut. Foods with high fermentation potential are the ones to limit or avoid. It is also a quantitative approach in that it recommends consuming below a certain amount of fermentation potential points. Meat, fish and eggs have 0 points. Although I am not naturally a “counter,”this diet has helped me with SIBO. I use the Fast Tract Diet app, which makes it easier to track. Initiallly I have had to go below the recommended 25 points per day to see results, but a gradually gaining a tolerance to include higher levels in my diet.

      • Yes, I’m actually the first one to have posted about the fast tract diet on this discussion board. I don’t seem to have much issues with SIBO at this point so much as motility problems. As long as I take supps to help with that, I’m fine. There are a couple problem foods that I react to so I stay away from those and don’t seem to have problems other than that. What I HAVE learned, is that this all ties back into my adrenal glands, which have compromised my thyroid, which is probably one of the biggest reasons I had SIBO and gut problems. If you only address the SIBO, you will always have it, you absolutely HAVE to find out what the underlying causes are, SIBO in many cases is just a symptom, not the actual problem. Not always, but if you have thyroid issues, you may be having problems with adrenal fatigue. And that is hard to fix since the adrenals are constantly being hammered by every day life. Crazy stuff. I’m now working with a holistic doc to get healed up and back on track. It’s slow going.

  16. I managed to do Dr Siebeckers homemade elemental version for two weeks and it was the absolute most horrible thing I’ve done in the name of health so far! From day 5 onwards I just felt nauseous and just the sight of the stuff made me want to vomit! I didn’t retest straight away but some of my symptoms were better but not cured. I then had a fecal Microbiota Transplant and have since been quite a bit better. The good bacteria was almost not present pre FMT and I’m not sure how much more damage the elemental did! A recent hydrogen (but not methane) breath test confirmed that the SIBO seems to be gone. But what did it in the end I’m not entirely sure…

  17. I did the Elemental Diet for 4 days (Dr. Siebecker’s homemade) just to see ‘test’ and see if it would be tolerable or do any damage. Well it has!! 🙁 I haven’t been able to have a bowel movement without laxatives since I did it 3 weeks ago. I’m concerned that I killed off ‘too much’ good bacteria while doing this! Does anyone know if this can happen?? I do also have yeast overgrowth in my GI and I took Nystatin while doing the elemental but the yeast seemed to get far worse afterwards despite that! I also went very very light on the honey. Anyone have any suggestions? I’m at a loss.

    • Dang! Unsure but it shouldn’t have made the yeast worse….there’s nothing in it for the yeast to feed on and the carbohydrate source is very fast absorbing so it doesn’t sit in the intestines to feed anything. I suggest seeing a holistic expert on all this. Also, with constipation I wouldn’t use laxatives…..get yourself some SmoothMove herbal tea, much better for you and helps move things along naturally.

      • Thanks for your reply! 🙁 Yeah, it is a bummer for sure. Bowels still aren’t back in working order. Elemental diets are notorious for causing yeast infections but I don’t know why. Chris does say that when you go Ketogenic (which in effect, is what is happening with an Elemental) those Ketogens can feed yeast. The AbsorbPlus diet is the WORST because it has Maltodextrine and that is a huge yeast-feeder. Smooth Move doesn’t work for me anymore unfortunately. I have to use Linzess or MOM. Even high doses of Senna or Cascara Sagrada stop working after a few days. At least I’m not going down the ex-lax or dulcolax road. I hope to never have to. 🙁

  18. You can make an almost-elemental diet that tastes pretty good by using whey protein hydrolysate instead of synthetic amino acids. I mixed that with glucose, and at first, MCT oil. Later I skipped the MCT oil because I was doing better without it. (Of course you need to make sure you get all the other nutrients except phosphor and maybe iron, copper and calcium, depending on your body’s stores.) Since a lot of glucose is required to meet the caloric needs, I drank some of the mix every hour instead of having “meals.” This, in combination with essential oils as natural antibiotics, worked very well for me, not only against SIBO, but also to improve insulin sensitivity.

    • I am doing similar experiments – i mix dextrose and cocoa butter and or coconut oil – it is almost like white chocolate. But i think i have problem with all fats. My next experiment will be dextrose or glucose and gelatin – similar recipe like gummy bears. Gelatin should be healing for the gut. Some people say that gelatin can feed bacteria but i dont believe it.

      • It may not be true for everyone but cartiledge and gelatin are high in FODMAPS and I get horrible symptoms after just a sip or two of broth. I have to lay off the chicken foot and bone-knucle broth for now. Just know that it has been documented scientifically as a trigger for for SIBO, it just may not be a problem with you. Good luck! 🙂

    • I was becoming sensitive and having issues digesting whey, so when I did the elemental I cut way back on the aminos (but I did keep them in the mix, just lower amount because it tastes so hideous) and I used non-GMO pea protein powder for a protein source. Tastes like cardboard, it’s far from delicious, but I could drink it down and it’s a fast absorbing protein as well. Worked well for me. Isn’t expensive either. I used the NOW brand, been using it for bodybuilding for a couple years now and will continue to use it. I also use a vegan protein powder that is non-soy and a mix of various plant proteins. I have wanted to test the waters with whey again but just haven’t gotten up the nerve to try it, don’t wanna risk the bloating and misery involved if I still can’t digest it! LOL!

    • What brand of Whey did you use? So many are loaded with soy or milk. I would need something lactose-free. The Amino Acid blend that Siebecker recommends is definitely making me worse. I can’t stop throwing up after drinking the stuff!

      • I don’t have a brand to recommend but as a bodybuilder I can say that if you want to try whey, make sure you get whey protein isloate. Since I can’t use it I really don’t have any recommendations but you may want to try a bodybuilding site like or You should be able to get a high quality whey protein there, but again, be sure that it is whey protein isolate. This means that the proteins are islolated and there isn’t any other “stuff” going on like lactose or whatever. And a good whey would never contain soy.

  19. Hello All,

    I have gone 13 years with the on and off symptoms of IBS, reflux, bloating and what some doctors thought was gallbladder pain. Numerous tests and medications have not fixed this problem. About three years ago I was finally diagnosed with H-Pylori and did a 14 day treatment of 2 strong antibiotics which seemed to make some what of a difference but recently I had to start taking new medications for a pinched lumbar nerve which then seemed to stir up some stuff in my gut again. With a recent negative test for H-Pylori I find myself wondering what is going on in there and now I am sicker then ever. I cant or don’t feel like eating much and when I do get my appetite back for a day and eat I become very sick again. Went to a new gastro and he basically said he had no clue and didn’t think we would ever resolve my issues. So I have taken it upon myself to self diagnosed this SIBO and am going to try this diet to see if it helps. I was wondering if anyone else has skin problems due to this condition? I get hives and extreme dry skin. I am also planning to try the iodine because I have a thyroid condition as well. Any advice or positive outcome stories are much appreciated and I will keep you all updated on my progress as well. Thank you all for your info on here it may have changed my life!

    • I feel your pain! Try contacting a naturalpath doc that specializes in SIBO. Unfortunately I had contacted three and never got responses from any of them so I self diagnosed, which for me was my only option but it’s better if you can get professional help. I’m convinced that regular docs and gastro docs won’t help much. I don’t think they have the training and knowledge but this is my opinion only. I tried contacting a gastro and they wanted to charge me vast amounts of money for consultations to decide if I needed a SIBO test. Then were going to charge me again to come in and take the test. So I just ordered my own and skipped the doc! Also ordered my own stool test that showed overgrowth of three bad strains of bacteria. Also addressing estrogen dominance and I started taking the iodine as well as selenium for the thyroid. In my case, everything is coming together but your case may be vastly different. I do think you should try a natualpath that specializes in SIBO, they just have more knowledge and look into underlying issues, not just treat symptoms.

      This discussion list has been a huge help to me so use it! Keep us posted and do your homework until you are sick to death of reading about SIBO! Also check out this website and the IBS version of the book they refer to (Fast Track Digestion IBS). I got the book used on amazon and the diet approach is a lot better than the popular diets recommended for SIBO. I’m having very good success with it so far and it seems like it’s been the best approach, the other popularly recommended diets like FODMAP and the carb specific diets aren’t quite right for the condition. If you have an Amazon Prime membership you can “borrow” an e-copy for free too. Also, the FAQ section on that website will answer a lot of questions not addressed in the book.

      • Ok so here we go today is day one on the elemental diet. I hope this works. My plan is to do this for 3 weeks. I will keep you all updated on how I am feeling in a few days. 🙂

        • Good luck and stick with it! It’s hard at first but worth it. And be sure you are taking a biofilm disruptor and the right herbals, rotate the herbals every four days to prevent resistance. If you start feeling flu-ish and sick, drink lots of water, this is toxins from killing off bacteria and it’s not fun! But stick with the diet! It’s a sign that it’s working! Get plenty of sleep too. Keep us updated on your progress!

          • So I started my first day on the 21st, took the first drink of my mixture and then threw up 4 x. I realized I wasn’t going to be able to drink that stuff unfortunately. I waited till after the weekend and started my own fasting diet. I consumed one to two cups of chicken broth with coconut oil added to it and tons of water. I also have also been taking the multivitamin’s I purchased for that god awful drink. Now I am on day four and I feel horrible. I cant drink anything but water and I feel exhausted. I hope this will work still because I cant go on living with these stomach issues like I have for 13 years. I am going to try to do this fast for 14 days but if I don’t start feeling better soon I fear I wont make it that long. Also Shasta I am not familiar with the biofilm disruptors or herbals you are talking about. If they are costly its going to be hard for me to get them because I already wasted $160 on stupid amino acid powder I will never use. How long were you extremely sick for? I am really hoping this gets easier tomorrow or the next day. Any other advise is much needed and welcomed.

            Thanks Again!

            • Hi Shayna,

              Have you tried dextrose or glucose – according to Fast Tract Diet for sibo – it is rapidly absorbed and bacteria dont have time to feed on it – it rises blood sugar rapidly but can be taken in small doses. It tastes very good and gives you carbs – without carbs your thyroid will slow down. I think dextrose is the main source of energy in some elemental formulas. Also if you have sibo probably your small intestine is damaged and you can not digest fats – so maybe coconut oil make you feel so bad.

              • Hi VB,

                I am on day 5 now of basically fasting because I have been so sick to my stomach I don’t want to eat or drink anything but water. I thought by now some of my gas and nausea would subside but I am still having a lot of both. I am trying really hard to just stick to this fasting till next Friday and then I am going to start introducing some food back into my diet. I think I am going to try fish and veggies that are low carb and don’t cause gas. I find the more I read about SIBO the more complicated it seems and I feel really down because I think I will never feel better, maybe I feel that way because of the lack of food but it is a real fear for me. I desperately want to feel like I used to when I didn’t have all these issues. If this doesn’t work I am going to go back to the doctors to see what they can do but I don’t have much faith in them either as I have been dealing with this for 13 years with no resolutions.

                Thank you for checking on me all of you 🙂 and happy Friday!

                • Hi Shayna,
                  If you have SIBO/IBS-C there is a supplement that was developed by a GI based in Plano, TX that you might try. It’s called Atrantil. It was just released this summer. You might check it out. I’ve been on it 6 days. I felt worse after I started it but am a bit better now. SIBO is so overwhelming on so many levels. The Dr.’s just don’t know enough yet.
                  I do hope you feel better.

                • Not feeling better at all and I am getting very discouraged. Going to wait another week before I call my Dr. 🙁

                • Shayna,
                  You WILL feel sick for a couple weeks, depending on how much bacteria was overgrown in your small intestines. You’re probably experiencing die-off, which is all the toxins released from killing those nasties off. Hang in there. I was knocked on my butt for a full two weeks when I did the elemental. Hang in there. It means it’s working. Are you taking herbals to help kill stuff off?

                • I am really trying and I am going to try to make it through the week and see how I feel but the pain I’m getting in my diaphragm area through to my back is getting so bad. Does anyone else get his pain? I am not taking any herbals but a friend of mine gave me the name of a specialized herbal store in my area and she said the guy that works there is very knowledgeable so I am going to try to get over there sometime this week and see what he says. I just really need to start feeling better because this is starting to ruin my life 🙁

                  Thank you for the pep talk Shasta. I am going to try my hardest.

                • Try to find a doc familiar with SIBO before setting an appointment. I had to see a doc on Friday for a different issue and mentioned the SIBO and he looked at me and said “What’s that?”. Never heard of it in his life. I suggest a naturalpath, they seem to know more. Ask questions before going though, make sure they know what they’re doing. The medical industry doesn’t seem to recognize the condition yet. As for the herbals, do your homework. I rotated herbals every four days, and used two at a time. This helps keep bad bacteria from adapting to it.

                • Shasta,

                  I just feel exhausted by all this my head is spinning from all the info I have read and talked to you all about. I don’t understand why there isn’t a easier way to get better 🙁

                  I will definitely take your advice about the dr because I went to one who was a complete moron and tried to get me to take a stronger antacid that cost $195 a month, after insurance, even thought I told him I wasn’t having reflux symptoms. I will never go back there.

                  Thanks again!

        • hi shayna you must be on day 7 of the elemental diet (vivonex?)
          my niece is starting it today for SIBO that didn’t respond to antibiotics very well.
          We are doing it through a tiny nasogastric feeding tube to avoid the taste.

          how are you doing so far?

          • I have suspected that I have SIBO for some time – frequent digestive problems, food sensitivites and arthritis – so I recently tried the Absorb Plus Elemental diet for about a week to see if it would alleviate the symptoms. I felt great, lots of energy, clearer skin – but by the 3rd or 4th day I started to get constipated and can’t figure out how to alleviate it. Has anyone else noticed an onset of constipation when doing an elemental diet?

            • I did the elemental for 4 days as a trial run. I ended up having constipation for a good month afterwards. It was tough! The elemental is basically starving out bacteria in your small intestine. It’s only supposed to starve the ‘bad’ bugs but we know that’s not the case. It starves out the good as well. You will have to take something to get things ‘moving’ for quite awhile after.

    • Check out FODMAPS- Monash Uni and Sue Shepherd are the best sources- there is a lot of misinformation on the internet, they scientifically test

  20. Hi All,
    I’m currently on the elemental diet and herbals for SIBO….self treating because of money. Test confirmed SIBO and I’m seeing a difference already, although this is the most disgusting nutrition I have ever consumed in my life. I’m going to stick this out for four weeks, I have a pretty damn good case and also wish to heal leaky gut. With that said, can anyone give me some advice on how to reintroduce solid foods back into the diet when the time comes? I’m one week into this so far. Other than the extreme exhaustion, initial feeling rotten from die-off, and not being able to lift weights while I heal up my gut, I am happy with how things are going. I have decided to add organic bone broth on a daily basis as it is excellent for healing leaky gut. Anyway, really want to know how to reintroduce solids and I know I’ll have to be a bit careful….how did you all do it? Any advice is much appreciated. –Shasta

    • Shasta I did the Elemental fast a year ago. I did it for two weeks under my Naturopath’s supervision.
      It is important that you use some sort of intestinal stimulator afterward as well as a very good probiotic. I use a soil based formula I heard about on this site. I really truly notice the difference when I stop using it (due to forgetfulness mostly). I actually notice the difference when I restart because of the tapering off effect, once I restart everything works better.
      If you do not follow up with these digestive helps you are more likely to have regrowth. Most likely due to my sloppiness I had a regrowth and am facing another fast.
      I was very conscientious about food intake. As well as following the limited diet suggested on siboinfo(dot)com, meals must be spaced 4-5 hours apart. This is 90 minutes for digestion and another 2-3 hours for an intestinal flush. Your body does this flush if it has enough time and it is very beneficial for gut health. Yes, you may be hungry. You need a lot of water anyway and drinking it between meals helps with hunger. Sarah Ballantyne’s Auto-immune protocol is very helpful and the cookbook is annoted for different dietary needs, including low FODMAP.
      Good luck and don’t be too discouraged by the frustrating diet. You aren’t alone and many people are sharing recipes online now.

      • I did the elemental for 4 weeks and had amazing success with it! Yes, I’m still on something for motility and doing all the right things, even still on a very small amount of the herbals and medical grade manuka honey once a day (and a biofilm disruptor) just as a preventative measure and I rotate the herbals and honey every four days so any bad bacteria has less chance of building resistance.

        FODMAP is popular for SIBO but isn’t quite correct. Check out this website and get the IBS version of the book, this is what I’m on for my meal planning and so far it’s amazing… approach to eating for SIBO and is way better than the other popular/recommended diets out there.
        I got a used copy of the book off for $8 and if you are a Prime member you can “borrow” an e-copy if you wish to read it first at no cost. This diet concept allows certain carbohydrates based on their fermentation potential in the gut and the approach has proved to be WAY better than FODMAP and carb specific diets, etc. Makes total sense to me and so far is working very well.

        I’m a bodybuilder so I have to eat between 5-7 times a day anyway…..right now I’m still ramping up on food intake and being very careful so I don’t do anything to relapse but as it stands, all systems are go! I lost a lot of muscle mass on the elemental since I didn’t workout while I was on it and allowed my body to just focus on healing, but I’m back in the gym and seeing results in less than a week. I honestly thought my bodybuilding was over because so many SIBO diets just eliminate the necessary carbs that are important to bodybuilding. So needless to say, I’m overjoyed! Will be in a sort of ramp up mode for a couple weeks but I’m ok with that. And really, this book I mentioned touches on athletes like myself and carb intake……the intensity of my fitness may actually help me with all this because once I’m back to 100% my body will process food much differently than the average person and digest things faster, less to sit in the intestines. Talk about win-win! WooHoo!

          • Hi Jen
            I found that Iberogast made me a bit hyper and that might be from the Licorice that feeds the Adrenal glands. Guess how I increased motility? A THYROID PILL did it for me and noticeably within a few weeks as I increased. After 8 miserable years with bloating and nausea, I’m very happy now.

          • I’m using a product I get off called MotilPro made by a company called Pure Encapsulations. It’s ginger extract. Been working for me very well. In fact, I had sort of slacked off on taking it a little, not stopped entirely but had spaced a few doses and the SIBO seemed to be acting up again. Upped the dosage and literally in 24 hours I was back to normal. It sorta burns a tad if you don’t drink enough water when and after you take it, but up the water intake and no issues. I had read reviews and people had good luck with it, found the reference to it on a different SIBO site I believe. So I think I definitely have a motility problem.

        • Hi Shasta,
          Thank you for all that you have shared. Would you mind sharing exactly what ingredients you used on the elemental diet? Did you follow the recipe on I know in one of your posts you mentioned adding pea protein so you wouldn’t lose so much muscle. It’s so great to hear that you are feeling better! I think that unless one is lucky enough to live near a doctor that understands SIBO we are dependent on what we can learn from others on blogs like this. Thanks so much for sharing your journey. If you’ve had good luck with some specific supplements I’d love to hear about them as well.

          • Yeah, I’d do two scoops (teaspoons) of the nasty amino blend, a scoop of pea protein, and about 20 grams of dextrose. Oh, and 5 grams of L-glutamine per shake. As cold as you can get the water. Chased with some MCT oil and a spoon of honey. Tasted a lot less like vomit that way, the amino blend is brutal on the taste buds…..seriously gross. Most people aren’t going to need quite as much protein as I used but it won’t hurt you, I needed it.

            For supps I rotated herbals every four days: neem, peppermint, grapefruit seed extract, berberine, oregano oil, and allibiotic. Pick two and only did those two for four days then rotated to another two. This keeps the bacteria from adapting to it. Also, I always took a biofilm disruptor 15-30 min prior to the herbals. I took a ginger extract supp three times a day for motility. And I took a spoonful of medical grade (16+) manuka honey at night. This stuff will kill the MRSA virus and every other nasty under the sun and helps with digestion and healing. (also used manuka to heal an infection from a cut that my dog had, it cleared up the infection in 18 hrs by applying it topically with a bandage, really good stuff!)

            I’m also doing 4-5 drops of the Lugol’s iodine that was suggested on this page and selenium. I have continued the herbals but just once a day, still with a biofilm disruptor.

            Last, for leaky gut I drank a big cup of beef bone broth every night before bed. I get mine at a local organic butcher shop that makes it to standard for gut problems.

            I stayed on the elemental diet for four weeks and the bloating, swelling, inflammation, and water retention that I’d been experiencing for two years (really bad this past year) totally vanished! I recently slacked off on the motility supplement and started bloating again, but got that under control in a matter of 24 hours with the supp so I won’t be making that mistake again! I occasionally go to a sushi restaurant and buy the pickled ginger and munch on that as much as I can or use it on meats.

            Last, I’m telling everyone about the Fast Track diet I discovered. It’s way better suited for SIBO than the other popular diets like FODMAP or GAPS or that carb specific diet. check out this link:
            There are two books referred to on that link, you want the IBS book, it can be “borrowed” for free with an amazon prime membership and I bought a used copy for $8. It’s had a huge level of success with SIBO sufferers and it’s working for me very well. The theory on carbohydrates is the fermentation potential of a particular food….in other words, how long it’s gonna sit in the digestive tract. I can eat carbs!! This means I can still bodybuild!! Other diets are like “cut out carbs!” and I can’t do that if I want to bodybuild so it was causing me high levels of depression thinking I had to give up something I dearly love. Gotta have that fuel for my level of workouts! Further, I don’t think it’s healthy to cut out all carbs and green veggies aren’t enough for me when it comes to this area of nutrition. What can’t be found in the book can be found on that website under the FAQ section
            Serious life saver! This allows more variety for sure!

            • P.S. Just for the record, what I did NOT anticipate with the elemental diet was how sick I got the first week in particular. The flu-like symptoms from die off was wretched! But I had a bad case. I’m very lean…..less than 15% body fat and I looked close to 7 months pregnant most days. It was bad. My belly is now flat but I do suggest that anyone who does this plan for it better than I did, I should have stayed home that first week. Also be prepared for bouts of very low energy and be sure to get enough sleep at night. You’ll also get horrible brain fog. Maybe if someone’s case isn’t all that bad the die off won’t be either but mine was horrible. Stay as stress free as possible while you heal. Get moral support for the depression you could experience and stick with it! Drink a lot of water and listen to positive, uplifting music. I was alone on this journey, friends abandoned me (it’s all good when things are positive and fun but some friends vanish when you need moral support). I think these aspects were the hardest part of the diet, they literally made the nasty shakes the easy part. At least for me.

              • P.S. again. I keep forgetting one critical “supplement” that I started using. I don’t know why this works but it did. Monster Lo-Carb energy drinks. Somewhere around the 3rd week on the diet I started to crave those things horribly, which is out of character for me. I was off caffeine so I knew I wasn’t craving that but I HAD TO HAVE A MONSTER DRINK! No kidding, within the first two days all my remaining/residual bloating and inflammation vanished almost overnight and I felt WAY better. So I’ve had one every day. At this point I really don’t want them anymore so I’m tapering off but still have them a little. I had also noticed this about a year ago….a couple times I fasted and had a Monster lo-carb and felt WAY BETTER. I don’t know what’s in them that makes a difference for me but I suspect it’s either the taurine or the B vitamins. I’m now on supps for both those and maybe that’s why I don’t crave the Monsters anymore. Yeah, I know they aren’t the best for a person but for whatever reason they most definitely helped me. If anyone has any ideas why, I’d be interested in hearing your take on the matter.

                • Shasta,
                  Thanks so much for all this great information! I appreciate you taking the time to post so many details.

        • Prescript-assist Broad Spectrum Probiotic Prebiotic Complex. I bought it online from a couple of different sites. I like to price compare. I am currently getting it from amazon but am too busy to shop and amazon is easy. (Tightly closing the moral dilemma amazon marketplace can of worms)

    • Hi,

      Can you tell me:
      What you are taking to increase gut motility?
      What do you take to be a biofilm disrupter and herbal aid?

      I am pretty desperate with SIBO and bad IBD (both). I am awaiting the results of my Genova stool test this week as well to clarify what bug is really in here! I am not sure if Ishould do Lugol’s or an elemental diet.

      thank you.

      • Jen, why not give Lugol’s Iodine a chance? I had at least 3 pathogenic bacteria on a stool test in high amounts and wanted to get rid of them fast. I was so sick for 8 years and within 3 weeks at 3 drops per day, I noticed all nausea left and never returned and that was 4 years ago.

        • I am willing to try Lugol’s. I have had constant weight gain for two years where my DHEA and cortisol and female hormones went all over. I have UC and Crohn’s and leaky gut etc. I feel I cannot eat and veggies anymore–im down to meat and fat..You think I would lose some weight!! All i crave is grassfed meat and butter and coconut oil I am not sure why? I am on Armour thyroid already but have seen zero change…sill all FreeT’s are low normal and my TSH went from 1 to 2.1?? So odd,

  21. Bonnie –
    Thank you so much for mentioning Your Thyroid in your post. My husband has been suffering with what seems to be extreme SIBO for the last 8 months, he has lost over 40 pounds and has been lethargic, extremely fatigued, depressed, had anxiety and is constantly in a brain fog, we saw 3 different physicians (MD) had tons of blood tests and procedures done and we saw one naturopath (ND) We were able to get the SIBO diagnosis from the naturopath dr and Justin started the very strict diet and herbal antibiotics (berberine, garlic) but after re-testing 3 months later his results barely improved. We just went to the MD again this week and asked them to please test his thyroid after reading your post. We could not believe they had not tested it before with how sick he has been, he was even hospitalized at one point, you would think they would have checked everything while he was in the hospital but I guess not. The results came back from his Dr. Appointment this week and he has Hypothyroidism. Now we just need to find a good quality endocrinologist to work with to get it regulated, but I am confident that once we are able to do that the SIBO is going to be a lot easier to deal with. Thanks again for your post and all of your valuable information. It really could be the key that helps get him back on the road to recovery.

    • Brooke, I’m thrilled to have helped in some way AND surprised again that this can happen to people. Once you make that connection (or someone makes it for you) life returns to normal but not for everyone. To me this is just the beginning.
      Hopefully your doctor won’t just test the TSH as mine did. I had to go to another who does all three thyroid tests. And also I was prescribed Armour in the beginning, a commercially made product. I didn’t want to take a synthetic like Synthroid. I then could not tolerate the FILLERS in Armour so had to have it compounded with Glycine at a Pharmacy. Then the capsules they used (Avicel) which is made from WOODPULP was a problem. Finally they switched to a Vegi capsule and all is finally well.
      I never saw an Endo, this was done with my GP who was okay with leaving me at one Grain. I asked to have a requisition sent to me, got the results from a blood test, put my results online with a thyroid group and was told the numbers were too low. Increased again, waited 6 weeks, did another test, still too low. I am now taking two grains and testing once more next week. You will have to be a big part in this process to get his test results where they should be and maybe that is where an Endo can help. Not sure but in the beginning before I found Thyroid I had such a load of bacteria, that the nausea was overwhelming. Thankfully I found Lugol’s 5% iodine and within 3 weeks at 3 drops per day, that was gone, but I still take it for all the other benefits. If you have any questions, be sure and write and good luck. Bonnie

    • Hi Brooke

      I just happened to see your reply here, looks like I missed it. I am very pleased to have been some help to just one person, since I’ve been writing here about Iodine KILLING bacteria in the gut for close to a year now with little success. I think your husband would feel better FASTER with a bit of Iodine to get the bugs killed off, even before the Thyroid kicks in.

      • Ho Bonnie,

        I wonder is there any special reason to take Lugol for iodine – why not take kelp for example? It seems one drop of 5% Lugol have 5.0 mg iodine so – i have a bottle with Kelp capsules – each one capsule have 360 mcg of iodine – if i begin with one and get to 10 -15 capsules par day – this makes 3.6 mg 5 mg per day it should work. I mean kelp seems more natural to me but iodine fans seems to use Lugol.

        • Hi:
          I would NOT take any form of seaweed with all the Radiation that is now in the ocean from that Japan spill. It is all polluted, it reached the shores of California 2 years ago, so it is now EVERYWHERE. I don’t know how you can say that is natural. Lugol’s 5% Iodine is made in a lab, the same way it was made in 1818 (or thereabouts) by Jacques Lugol and before antibiotics in 1936, Lugol’s Iodine was the only thing available to doctors and fixed a lot of problems. One drop of Lugols 5% is 6.5 mg. For a year I took 16 drops per day and had the most amazing results which I’ve written about before. If you want to take 20 capsules of seaweed per day, you may be disappointed but with Lugol’s you get results.

  22. What if you have sibo and slow motility but keep gaining weight despite lowering calories and doing exercise/sweating daily?

    • Hi Jen:
      This was me exactly a couple of years ago with SIBO for 8 miserable years and a very slow motility. It took 13 hours to digest a meal. My doctor thought I had Gastroparesis, but I didn’t. My slow motility went away when I started to take a Thyroid Pill, I was very surprised. I had no idea that this would make such a HUGE DIFFERENCE in my digestion. And this slow motility is what caused the SIBO. Make sense?


      • Hi Bonnie,
        It seems thyroid is the root cause of sibo – you can heal sibo temporary using antibiotics, elemental diet maybe fasting – but it will return if you dont fix the underlying problem – thyroid. So i dont understand – when you fixed your thyroid/ motility – this should cure SIBO – why you needed iodine? Maybe you need iodine for thyroid – not to kill bacteria?

        • Hi Jen:
          I had to go and look this up. I’ve never heard of Thyroid causing SIBO and will have to go back and read the whole page. What is there in the natural thyroid hormone that can cause such a devastating problem. No the Iodine came first because I wasn’t given the Thyroid for months after. I joined the Iodine Group at Yahoo which was run by Dr. Brownstein’s patient and he is the author of the Iodine book. So I started off with Lugol’s Solution 5% and took only 1 drop per day for a week and the 2nd week, 2 drops per day and 3 drops per day by the 3rd week and what left first was the overwhelming nausea after meals. That was gone but I still had slow motility but NO NAUSEA. Once I got on the Thryoid pill all digestion issues left. Before I could NOT eat after 12 noon, now I can even eat in the evening. I’m very happy about that but didn’t know about Thyroid CAUSING IT. Thanks a lot, but if more people would at least give Iodine a try, it might help.

          • Hi Bonnie,

            Do you know what king of hypothyroid is yours – maybe Hashimoto?
            There is definite link between slow thyroid and sibo. Here are some studies:


            There is study from: Gut, 1971, 12, 172-177 called Thyroid hormones and the gut?

            It is clear that excess or deficiency of thyroid hormone may affect all levels of
            the gastrointestinal tract and that the resultant changes may have clinical
            as well as biochemical relevance.

            Another one:
            Hindawi Publishing Corporation
            Gastroenterology Research and Practice
            Volume 2009, Article ID 529802, 7 pages
            Research Article
            Does Hypothyroidism Affect GastrointestinalMotility?


            Hypothyroidism prominently decreases gastroesophageal
            motility, and as such, thyroid functions should be evaluated
            in patients admitted with complaint of dyspepsia.

            • Elaine
              I called around and found a pharmacy in the city that carried a brand from Xenex Labs that are both here in Canada and also in Ferndale, Washington and that is the brand I use. It is distributed thoughtout Canada to various Pharmacies, so you would have to call ahead and see if they can get it in for you. In the US I would call the company to find out where it is available. My 4 oz bottle was $8.00 and lasts about a year. I was once taking 16 drops per day to shrink some fibroids. Here in Canada Iodine is not restricted like it is in the US. not sure if there is an S in there or not. If it doesn’t work, take the S out.

      • Bonnie! I too have horribly slow motility and tested negative for gastroparesis. I am on a low dose Armour Thyroid that I had to plead my Dr to give me. My TSH and free T3/4 are all low normal nothing drastic but my Thyroglobulin # is sky high. Are you taking anything for your thyroid besides Lugol’s??

        • Hi
          I don’t have any Thyoid Antibodies, I think my gut (FINALLY) is working normally now. While my Free T’s were low normal, I did not feel very energetic, so I went to the online Thyroid Group who looked at my numbers. They gave me guidelines for the numbers that I should have, so i increased my dose again. WOW, that did it. Now I feel like Wonder Woman. LOL

          • That is great. I have NO antibodies either but my levels and cortisol and estrogen are all low normal and my DHEA was lowest it could be. It registered as a 88 yo when I am in early 40s. I am wondering if I need a higher dose of Amour and iodine. At this point the Autoimmune Paleo diet for two years did not even help much. I am feeling a bit hopeless today–tomorrow I know I will be different.

            • Hi
              I take DHEA (a tiny amount) topically every single day to support hormone production (downstream) and my Adrenals as well. I take a tiny amount of Pregnenolone to make Progesterone for me, rather than simply taking Progesterone as I once overdosed on it. I feel much stronger with the DHEA. To help support leg vein circulation I take Grape Gold from Primary Source in Connecticut. I would not be where I am today if I stayed at the Thyroid dose,I was given initially. I listened to what the Thyroid Group had to say and increased from 1/2 grain that,the doctor put me on very slowly to the 2 grains, I’m taking right now. This is all determined by blood tests of course. In another 6 weeks, I will do another test and if the numbers are not where they should be, I will increase again. If doctors,insist on using ONLY the TSH, we will all remain unwell as the Range is way too big. At my Lab it is 0.5 to 5. So if your test is 4.9 they won’t do anything. Where I live in a remote village this is the way it is done here, so I had to find myself a smart doctor in the city. A LONG drive but worth it. All I have to do is phone and ask for a blood requisition to be mailed to me and go to a lab locally. You need to be in chargemof your own health, right?

  23. I just completed the Vivonex T.E.N. elemental diet. I drank on average 5 per day at 1500 calories. I did the breath test at my doctors office on the morning of day 15. My numbers came back all ZEROS across he board!! According to this the SIBO is gone. So, now what to eat?? My doc said to follow the Low Fermentation Diet SIBO/Diet as outlined by Dr. Mark Pimentel, but also said to stay away from fruit and veggies the first 4 weeks. He said the bacteria not only feed on sugar but also fiber. Seems this is a complicated area. I believe more research needs to be done in the area of Post-SIBO diet with at least a year of follow up with patients. To me that is the key to lasting success. Good luck to all!

    • I did the same, couldn’t confirm it was SIBO. Did it anyways. I had an extra packet or two here and there to keep from being to lethargic and lose to much weight. The study was done using 1500 calories though, if I remember correctly.

      Did you end up tossing it in the freezer to reduce the taste? It was the only way I could bare it. Whatever though, desperate times call for desperate measures. Success rate is super high, its just the whole adherence lol.

      There is also a high chance that within the year it may come back. If it does and you kept with the diet, the next time around you may want to try a prokinetic, it should stimulate the migrating motor complex.

      • I had the breath test earlier this year that confirmed SIBO, so this was great news for me. I have been taking Erythomycin 50 mg. and 9 Moltipro a day for motility although the gut is still sluggish. Presently my doc wants me to stay away from fruits and veggies (fiber) for the next 4 weeks. Problem is it makes it harder to poo.
        I just had my Vivonex on the rocks and added more water to dilute. In fact I’m still drinking about 3 a day to supplement my calories. Surprisingly even though it doesn’t taste that great, I’m able to drink it down just fine.

  24. mu gastro doc wants me to have a capsule endoscopy done…I am afraid his will get caught and not come out…also have had this gassy crampy feeling for close to two years
    Have lost about 15 lbs as eating makes me feel worse…I live on chicken,turkey eggs
    I tried the xifaxan once and it worked well. Came back and didn’t work. I am at. Y wits end to find some relief. I go to the bathroom frequently also…some days it is hard to get out of the house
    Does anyone know of a doctor who specializes in sibo in New Jersey?
    Any other info would be greatly appreciated
    Thank you

  25. Question on the elemental diet… biggest problem with this is the protein content. Can a person increase the level of protein and what can be used? I’m a bodybuilder and I’m fairly certain I can handle this liquid diet for three weeks (I’m very used to extremely strict diet regimens of stuff that tastes terrible, my will power with food is thru the roof) but I need above average amounts of protein, and calories, really. But I’m mostly concerned on protein. What can anyone tell me about this? And can something like pea protein be used? No carbs in that, I’m more than happy to have dextrose as a carb source in that homemade version. I hope someone can answer. Thanks in advance.

    • Hi Shasta,

      I don’t know about protein but if your bacteria are in the upper part of small intestine dextrose will feed them – dextrose is just powdered glucose and they use glucose to diagnose sibo.
      Dextrose is not working for me but raw eggs give me great improvement – i think this is the most easy to digest food existing that does not feed bacteria – but only if they are raw.
      If they tasted better i would eat only raw eggs – they definately help with building muscles too.

      • Hello
        Liquid Iodine (Lugol’s Solution 5%) will kill bacteria, anywhere in the GI Tract. I did for me. And took only 3 weeks.


      • The homemade elemental diet calls for dextrose as a carbohydrate source so it must work for this application? I’m guessing it wouldn’t be suggested in the recipe if it caused issues, maybe it’s used because it absorbs almost instantly? I don’t believe it stays in the gut very long at all, particularly if disolved in water. Also, with bodybuilding, protein is very important but so are carbohydrates so going without can be a problem. I’ll probably opt for the low carb version of this elemental diet.

      • The homemade formula calls for dextrose….it absorbs almost instantly so I doubt they’d recommend it if it was horribly problematic. I started this diet nine days ago and I’m mostly using organic honey, but I do mix a small amount of dextrose in with the aminos so I can choke the stuff down. Ugh….tastes wretched. Couldn’t hang with that so reduced the aminos and have been using pea protein. I think eggs were causing a reaction so until I heal the leaky gut I won’t be trying eggs. So far so good, I’m doing this for four weeks.

  26. “Seniors often have unreqognized SIBO resulting in malabsorption and subsequent B 12 deficiency. SIBO has been reported to affect 15 to 50 percent of older adults. B12 deficiency in this disorder is caused by the uptake of B12 by microorganisms in the small intestine.”

    Taken from Sally Pacholok’s book, could it be B12.

  27. On April 6 th Elizabeth asked me a question, but beneath her email was NO REPLY BUTTON, so I cannot figure out how to contact her.

    I want to say that the Iodine Protocol is not MY protocol and wanted to give her instructions on where to go. So if you read this Elizabeth, write me again?

  28. Hi I have sibo for almost 7 years I live in the UK an find the doctors useless when treating this condition had antibiotics buy they didn’t work have followed the scd fo about 6 months was going to try either vivonox or absorbplus it is expensive and I cannot find a supplier in the UK has anyone had a permanent cure from either of these or know of a supplier in the UK
    Thank you

    • I had SIBO for an agonizing 8 years but got rid of the Pathogenic bacteria from using just 3 drops daily of Lugol’s Iodine and 3 weeks fixed it.

      Then I was prescribed a Thyroid pill which increased digestion speed which was the cause of the SIBO in the first place. When Digestion is very slow, the food rots and causes all that bacteria.

      Easy to figure out.


      • Hi Bonnie,
        Did you work with a practitioner that recommended the use of iodine? Would love to know more.
        Thank you,

        • Hi Kim
          The MD (in Michigan) that wrote the iodine book, saved the life of Stephanie who had Thyroid Cancer. She later became an ND, took over the Iodine Group at Yahoo and I worked with her starting 4 years ago.


    • Hi Janice, I have done my 14days elemental diet using Nutricia’s Fortisip (Nutridrink). You can buy it online in the UK but it is quite expensive. I bought mine through a Polish online pharmacy and paid 3 times less than in the UK, the 14days treatment incl. shipping would be around 150pounds. But you will need to ask someone Polish to help you order them since their website is only in Polish.
      The elemntal diet cured by sibo for around a year but then it came back. I have now bought a book The Gut Balance Revolution and just began following Dr Mullin’s protocol for SIBO. good luck

  29. Instead of having a liquid only diet that is super expensive, can’t one eat some actual foods or does everything impact what’s in the small bowel? I know if I am not full and lose too much weight (can only spare 5lbs max) I will become very aggressive.

    • I think, as usual, everyone is different, but in my experience, my methane SIBO is diminishing with a steady course of real food diet and some supplements (Allimed, berberine, L-glutemine, probiotics) and pharma antibiotics (rifaximin…but CAUTION I’ve for sure become more sensitive to more foods due to this use…I now experience oxalate overload after finishing my last round and so I won’t do that again). I eat autoimmune paleo, low FODMAPS and low oxalate.

    • You may try just bone broths if you like. That was the initial suggestion or diet I was given by the Boucher Naturopathic Institute in Vancouver BC..

  30. I have been on the elemental diet for 8 days. My vision is worsening. I take vitamins for my eyes and have continued while on the elemental, but I wonder if they are getting absorbed with just the liquid food?
    I do not know if I should continue to the 14 days given my eyes.
    Any ideas?
    I am considering the option of eating a piece of meat at night and taking the vitamins with that.
    I know this sounds kind of crazy, but I am worried.

    • My gastroenterologist suggested adding in an elemental formula to my diet. For the first time in years I felt happy.& functional as something had kicked in brainwise. However my eyesight worsened within a few days and my eyes were itchy and becoming sticky.and cloudySo I wonder if the formula was feeding the Klebsiella overgrowth I have. I’m taking antibiotics 🙁 and they are improving.

  31. I started with botanical antimicrobial. After three months of trying different herbal formulas including Biotics FC Cidal with Biotics Dysbiocide, Microcidin, Allicin and other herbal concoctions. ,
    In addition to following a very limited SCD/FODMAP diet, grass fed beef bone broths, supplements Prescript Assist, Pure Encapsulation 950 Multi Vitamin, Fermented Cod Liver Oil, Saccharomyces Boulardii, Enzymedica Digest Gold, HCL,Magnesium Citrate,Iberogast,5-HTP,MCT Oil, etc. Unfortunately my SIBO symptoms did not improve with the SCD diet, herbal antimicrobial and supplements. What surprised me the most is that with such an arsenal I still have motility issues.
    Out of desperation I started a week ago Dr. Allison Siebecker’s elemental diet. The mixture is pretty disgusting and borderline nauseating. I am having a hard time meeting the dosage requirements. I usually drink it twice a day instead of 3 times a day. On the positive side, my sleep quality has improved and my SIBO symptoms have diminished. I think candida might be creeping in since my tongue has a white coating but unsure.
    Note: It has been a long and exhausting journey that started with parasitical infections combined with mercury toxicity, H Pylori, Candida and now SIBO.

    • Interested to know how you do. I have a theory that the people who actually heal don’t ever need to visit these sites again and so we’re left guessing. I finished many many months of prescription and botanical antibiotics and while my SIBO methane measurement went down by half, I’m now even more intolerant to more foods. I believe the ABX wiped out more essential bacteria. I’m going to try homeopathy and then either elemental or FMT. thx.

      • mvarrin,
        Sure, I will keep you posted. I am in the same boat high methane producer. Chris Kresser has said on a previous podcast that methane producing archaea is to blame. These prokaryotes are hard to eradicate or reduce their numbers. It may take more than 6 months to have symptoms improve. I am also interested in FMT but can’t afford the 10000 $ procedure. In addition, apparently remission rates are debatable. Best course of action is to remove, rebuild and reintroduce. It seems unfair that the medical industry is so caught up with curing cancer but autoimmune diseases fall by the wayside. When you have an auto immune issue it seems like a life sentence of poverty.
        Good Luck and keep me posted on The FMT.

          • Denis please accept my apology for misspelling your name. Just to be a little more clearer on my earlier question, i am referring to the FMT procedure that costs $10,000. Thanks.

            • Denis, 10k for fecal transplant. That’s outrageous. How many transplants does that include and who are you going to for that price?

                • Sorry for the long absence. I managed to sustain the STED diet for 2 weeks. My SIBO symptoms were greatly improved while on the diet but other symptoms worsen (dermatitis and insomnia).

                  After 2 weeks I could no longer stand the pain from the dermatitis. I spoke to my doctor and we concluded that either it is candida that is worsening or liver detoxing or both. I don’t know if it is scientific fact but toxins may have been released from such a restrictive diet.

                  I am still having issues,unfortunately it did not work. On a positive note cholesterol levels have improved from the Fodmap Paleo diet.
                  I am currently supplementing
                  540 mg of Allimax 2 times a day
                  2 Integrative Therapeutics Berberine Complete 3 times a day
                  sometimes diatomaceous earth
                  Pure encapsulation Multi 950
                  3000-4000 fish oils epa/ dha
                  and liver support l glutathione and 600 mg of milk thistle

                • I forgot to mention that my blood panel revealed that my white blood cell eosinophil are chronically high. That is interesting to note because they are involved in combatting parasitical infections yet my doctors data stool test was negative.

                  Yes I do follow a very restrictive low FODMAP diet. I am conscious about histamine producing foods and try to limit its consumption.

        • There’s an FMT clinic in Portland OR that has more reasonable rates and they have their own donor bank too so you don’t have to ask friends or family for “donations”. Ew! I can’t recall the name of the place but maybe it’s worth looking into?

      • Denis–hope you’re doing better. curious, did you do low FODMAPS? And how much bone broth? I try to get 3-5 mg. of L-glutamine a day via broth and powder supp. These are the only elements you don’t have in your list that I do and I think I’m on a slow, but steady healing path.

        • I do supplement with Jarrow L glutamine between 1-2 tbsp a day. In addition I will add 1 tbsp of collagen in my tea or coffee. SCD type gelatine seems to upset my stomach. Maybe it is the Welch grape juice, I don’t know or I am just hyper sensitive to sugars in general.

          No raw vegetables just soups, meat and fat.
          I have concocted great recipes through the years. I don’t feel I am missing out.
          It is ironic how much saturated fat I am eating and yet my cholesterol is improving.
          Go figure, I am a believer that it’s the sugar that is making people sick and fat.
          Deep fried foods are not the greatest either but I do like my oven broiler and Ronco”s rotisserie cooker. I can’t live without.
          I make my own fresh young coconut yogurt, I take 1 oz everyday. I use to eat home made sauerkraut. I follow recipes and use their jars. You can make your own jars quite easily. Wine store carries the air lock and window/glass store can drill the hole in the glass lid and the silicone grommet can be bought online or a Lordco or other automotive parts store.

          Fermenting is important for replenishing good bacteria but some of us are sensitive to the histamine they contain.

          I digress, I do supplement with many antioxidants but I cycle and did not want to add to much to my list and scare off some readers. Ubiquinol Coq10 is another supplement I take with my fish oils

    • Hi Kiki:

      Yes, I cured my SIBO using Iodine 2 – 3 years ago. And I keep it away, by still using it every day. It was very simple and worked within a month. Thank goodness, I’m rid of that after 8 years of suffering nausea and bloating. Now I can eat whatever I like. You can read all my posts about how I did it in July 2014.

      • Bonnie – can you tell me where to find what you are talking about from 2014? Thanks. I have a friend who has had recurring bladder infections as well as sinus problems (and prob other things) – I want her to know about iodine.

        • Sharon, SCROLL DOWN till you come to July 2014 and you will see 3 or 4 Posts of mine with my name BONNIE in dark letters. You can’t miss it.

        • Sharon:

          Did you find my posts about Lugol’s Solution 5% (Iodine) and do you have any questions? I’m thinking of just cancelling this subscription about the SIBO problem. No one is listening. It’s NOT that complicated, you have too much bacteria in certain places, in the body and Iodine kills bacteria. Works quickly too, but it looks like people would rather try special diets, antibiotics and whatever instead.

          • Hi Bonnie,

            The situation with iodine is not so simple. I for example am very thankful to people like you who share such valuable information. But iodine sound too dangerous to me and after some research i found that you have to be very careful what you take for thyroid. Here is some info from Mercola com:
            In fact, I don’t generally advise taking iodine supplements like Lugol’s or Ioderol, because your thyroid only transports iodine in its ionized form (i.e. iodide). Your thyroid reduces iodide (I-) into iodine (I2) for use in formation of thyroglobulin. Your body doesn’t utilize iodine directly. It has to split the I2 into two I- ions, which is an oxidative reaction that causes oxidative stress.
            So if you tell people that you used some food rich in iodine to heal your sibo i am sure much more people will try it. But most people are not experts in iodine and i guess they are just afraid to try it.

            • Yes, of course. I was afraid too. But I was so sick of being nauseated, bloated and tired and thought about it for a year beforehand. The Iodine group has over 9,000 members and we’ve cured a lot of our problems. Have you seen my list that I posted on July 19th, that made such a difference for me? Our list owner is a former patient of Dr. David Brownstein that wrote the Iodine Book – Why You Need it and Why You Can’t Live Without it. She is now a Naturopath. Dr. B cured her of Thyroid Cancer using Iodine (Lugol’s Solution) and every 3 mo I did Thyroid blood tests to see what was happening there. I went VERY SLOWLY with one drop per day. I’m very glad I did.

            • Hi, don’t see your name anywhere. Don’t believe what Mercola says, there are still people out there that “don’t get it.” We have over 9,000 members on the Iodine List at yahoo(even some with Hashimoto’s) RUN by a Naturopath that was cured of Thyroid Cancer by the doctor that wrote the IODINE BOOK, and we are ALL BETTER NOW. Come and take a look.

        • Hi Dale:

          What Iodine DOES DO very well, is it KILLS OFF the Bacterial Overgrowth which causes so many symptoms.

          As for being expensive, It costs me about $10. for a bottle that lasts about 18 months. Since I live in Canada, Iodine is not restricted here, like it is in the US.

          I think this Forum (unless I’m wrong) is ALL ABOUT BACTERIA, right?

          I think it is just too simple for people to grasp.

          • Bonnie,

            Do you know if iodine kills only bad bacteria or all bacteria? If it kills only bad bacteria and it works this means that the whole theory of SIBO is total BS /that SIBO is good bacteria in the wrong place/

            • Hi
              Our chemistry- whiz on the iodine Group explained the other day how Mercola has it wrong. If you write me directly I can pass that on to you. Also Iodine does not kill good bacteria.

      • Hi Bonnie,
        I’m glad that taking iodine worked well for you. My elderly mother was battling SIBO so on my recommendation began using iodine. It wasn’t doing helping so we went to a functional medicine doctor. Among other things, testing revealed Hashimotos and, of course, high thyroid antibodies. When we removed the iodine the antibodies lowered considerably. Her SIBO was treated with a product called Microb-Clear plus a strict diet. I recommend taking iodine only under the guidance of a professional who can do testing to make sure you aren’t causing other problems with it. I am glad that it worked in your case.

        • Shasta
          You get yourself a bottle of Lugol’s Solution 5% (Iodine) and put 2 or 3 drops of the Iodine in water or juice each day. Give it at least 3 weeks.


    • i tried Iodine for 4 weeks. Didnt do much really. I stopped bc I got gastritis back. Im going resume lugols iodine in 2 weeks again, skipping a full 4 weeks. I’ll come back and update this thread.

  32. Anyone have experience treating Ankylosing Spondilitis (Klebsiella bacteria implicated) as SIBO? Have been on no starch diet for 6months, able to reduce meds, but am still too uncomfortable without then entirely. Also doing probiotics daily, tried grape seed suppliment, gave up on garlic. The slightest mistake with a food sends me backwards in terms of pain and stiffness for approx 1 wk or more. Planning to try Biotics Research herbal formula.
    Would be willing to do elemental diet but no access to product where I live out of the US. Is there a way to just make your own without commercial products?
    Any suggestions welcome.

    • I also have ankylosing spondylitis. I have been low-starch for 3 years (thanks to Carol Sinclair’s IBS Low-Starch Diet) and that by far has helped the most. No iritis flare-ups in that time frame, however, the stiff morning back comes and goes as does other various body pains. If I go full paleo minus all starch my pain declines nearly all the way after a couple of weeks. However, I start to lose weight (I am already too skinny) because I cannot eat enough no matter how hard I try (I REALLY miss potatoes as they were something I ate all the time growing up and were a great source of calories, even more so than bread). I did about 45 days of the Biotics Research dysbiocide and fc-cidal and didn’t notice much of a difference taking those (except I got a headache about every other day). I am also curious if the klebsiella reside in the small intestines or if they are in the large. I am about ready to try the Marshall Protocol next.

  33. I had recently got blood results back that said I have a high level of vitamin B12, and I also have Peripheral Neuropathy. After doing research, I found that most likely I have Sarcoidosis and pain caused by small-fiber neuropathy. I would like to know what diet, supplements, and probiotics, ect. would I most likely benefit from. Please help, Greatly Appreciated!!

    • Have you checked for MTHFR gen mutations? Basically your body doesn’t use the B12 so it builds up in your liver. I have this mutation and have to take supplements in order for my body toget the B12.

  34. I have recently been diagnosed with Sibo in the past two weeks & I’m doing as much independent research as possible, thank you all for the lively discussion! I am still debating whether or not to go ahead with my doctor’s 10 day Neomycin & Flagyl protocol, followed by at least 90 days of Dr. Pimentel’s New IBS Solution Sibo diet. I have pretty much eaten some variety of keto with the occasional cheat for the past few years & I don’t even miss things like bread, rice & potatoes… I miss pizza & pasta occasionally, but hey, I’m half Italian >;-).

    I learned from one of my doctor’s staff members that she has only begun treating Sibo in patients a matter of months ago, & given how long I’ve suffered misdiagnosed, never really knowing what was causing my symptoms for years on end, I would like to put a final end to it & live life from full health! I prefer to put my trust in a doctor with a good track record with healing Sibo. So I am looking for recommendations in the NY/NJ area, though my current doctor is in CA, so I’m not opposed to elsewhere as long as the doctor has a good track record. Thank you in advance!

    • The diets in Dr. Pimentel’s book are outdated and unhealthy. Try the low SCD or low fodmap diet. These are specifically for sibo.

        • Yes! Yes! Yes! I found this diet and it’s working well for me in the very short time I’ve been on it! Fast digesting carbs don’t seem to cause problems. As a bodybuilder it was depressing me to think I had to cut out all my starches and carbs and give up bodybuilding (veggies alone won’t provide enough energy for this and won’t fill out the muscle bellies). This Fast Tract diet is a lifesaver, provides variety, and makes WAY more sense…..and SIBO sufferers have had really good results.

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

  36. According to 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. 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.

      • I am doing better than I was then. I had the Endoscope. It was not cancer. Nothing showed up but mild GERD. I went on the Xifaxan for a month and improved a lot. The brain fog diminished considerably and my SIBO symptoms also. I was able to gain the ten lbs. back I had lost. But I am not doing as well again. The SIBO has come back though not intensely, probably because I continue to eat nothing but chicken, turkey, carrots, beets, Jasmine Rice, bone broth, and drink a hemp protein drink. I am suspicious of the drink being a cause of the extreme brain fog and fatigue I am now experiencing. I have cut it out to try to see if there is less fatigue and brain fog. But to have that limited a diet and not a lot of improvement is very discouraging. I have been living on special diets most of my adult life. I have had Chemical Sensitivities for over 35 years, and have taken extreme care with foods during that time including elimination of wheat, dairy, nuts, carbs, sugar, fruits. I am also sulfur sensitive and that has eliminated most vegetables. I have mercury I have been trying to get out for years. The mercury has done in the adrenals and the thyroid. For the chemical sensitivities I wear a mask when out and have a filtration system going 24/7 in the house. I am ready to be rid of it all and am desperately searching for some answers. Yes, I tried iodine, too. Not for SiBO but for my thyroid. Learned that in some people it lowers the thyroid production. I am one of them. That was another bad experience.

  38. 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.

  39. 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.

    • 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.

      • I’ve been suffering with SIBO for 2.5 years. I’ve seen 12 health professionals both Western and Eastern practices and still having incredible distension 2 hours post meal. I’m hoping some information on his site will guide me to treatment that will work. I am considering elemental diet.

        • Kim:

          I have posted several times on KILLING OFF Gut pathogens using Lugol’s Solution 5% (Iodine) look at July.

          I can’t seem to get anyone to listen. Is it just too simple?


          • Hi, Bonnie, are u referring to the ‘descaling’ solution for coffee makers? I’ve suffered from SIBO since 2007 and will try almost ANYTHING at this point, but this seems a bit out there! But, then, so is SIBO and it’s symptoms.
            For those whose primary sibo symptom is constipation, PLEASE look at ldn (low dose naltrexone). Some remarkable results there.

            • No I am not referring to descaling a coffee maker. I am referring to KILLING OFF GUT PATHOGENS with Iodine that has been in use for almost 200 years. I had Nausea and Bloating for 8 years and life was awful at times. Within 3 weeks all that LEFT ME after starting a couple of drops daily of Iodine – Lugol’s Solution 5% Does it sound TOO SIMPLE? Maybe, but it works.. No one is listening either.

                • I started off with one drop DAILY of LUGOL’S Iodine 5% and after a week, started with 2 drops daily and by the 3rd week I was taking 3 drops per day and that is when all the NAUSEA left me after 8 years of suffering.

              • HI BONNIE,


                • Where you buy Lugol’s 5% Iodine Solution depends on what country you live in.

                  So let me know and I’ll try and help you.

              • Hi Bonnie,
                Did you take the iodine on an empty stomach, or does it matter?
                Do you eat a normal diet now or do you do anything specific to avoid recurrence? Do you continue iodine use, if so, what’s a safe maintenance dose?

                • Hi Amber:
                  Sorry I must have MISSED this email of yours. You can take Lugol’s Solution 5%, with or without food. I would suggest that you join the Iodine Group at yahoo where they have experts and a Naturopath to guide you. Let me know if you have trouble finding this Forum. Write me and I’ll help you.

                • Bonnie, well you convinced me to try it.. I have started a mulit- herbal antimicrobials, the soil bacterias, and the non lactate acidophilus pre and probiotis. I have problems with constipation most of my life and have been on a Paleo diet for almost 2 years. Was doing much better until I had a 1 alcoholic drink when out with friend 2 months ago and things have gotten worse since then.. Was down to 99 lbs before they finally took out my Gall bladder which had given my pancreatitis. This resolved and gained 20lbs. I now have lost 8 lbs again.. just because I am afraid to eat very much.. I live on Organic Chicken and Bone Soup.. so other meat and cooked greens.. with a few carrots, yams and butternut squash with my soup.. So I am going to start the iodine today… I had already bought it when I bought all my herbs for the Sibo treatment.. So will see if the iodine will make a difference.. I haven’t been tested for SIBO but have been tested for everything else and when your bowels just stop working I think it is a good sign, it is a bacterial overgrowth. Will let you know if this works and how well it is tolerated

  40. 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.

  41. 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?

    • 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?

      • 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?

        • 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.

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

          • 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?

            • 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.

      • 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.

        • 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.

    • Hi, you made me feel sad after reading your protocol, i was planning to also do excacty that,2 weeks Rifaximin and Neomycin and then 10 FMT treatments, i thought this is all it would take, i cant believe it failed for you:((im sorry)
      I have heard some people claim that taking probiotics puts sibo in relapse after antibiotics treatment because the natural MMC(migrating motor complex)of the body is still recovering and might take 3 months, so the probiotics dont get flushed down to the lower colon and bring SIBO back, my plan is to do FMTs which will put the probiotic bacteria only in my lower colon and take MMC tablets every night before bed for 3 months to push the bacteria from the FMT out the small intestine if they try to move upwards.
      Have you tried a full anti parasitic herbal treatment?
      have you been diagnosed with SIBO or are you treating it based on symtoms?

    • I read your post and am in a similar situation..
      Many rounds of RIFAX – 5 FMT treatments;
      Eat Carbs to grow the good bacteria – and the SIBO returns – or perhaps comes out of hiding.
      I’m not sure what the path forward is…
      Perhaps we ate carbs to soon. Did you do bottom up or top down FMT – I wonder if top down does a better job?

  42. 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.

    • What about psriosis?

      I never read about correlations in regards to that and sibo, which I have both of unfortunately. Is there something specific for that as well?

    • I agree with the gut-skin connection. I’m hoping if I can manage to treat my intestinal issues, that my bouts of acne will stop.
      Has anyone here successfully resolved their skin problems via fixing their gut?

      • I’m currently on the elemental diet and I’m on Day12. I decided to go for 4 weeks on this. It sucks pretty bad but seems to be working. I have noticed my skin is definitely improving the further into this diet I get. My skin was dry as anything and NOTHING helped. Also had skin fungus patches that NOTHING helped. Both are improving. I hope it continues to go this way.

        • Hi Shasta,
          Did you make your own Elemental Diet formula or did you purchase it? If you made your own, did you follow the formula on Any details you could share would be appreciated.

          • Yes, I’m doing the homemade version. After seeing the ingredients and price tag on the pre-made stuff I was like “no way!” And no, I’m not following it exactly. I’m a bodybuilder and I have higher protein requirements and didn’t want to lose any more muscle mass than necessary so I added a non-GMO plain pea protein powder, which also helps dull the wretched vomit-like taste of the amino blend. Using a combination of honey and dextrose for the carb source…..a little dextrose in the shake, also to help improve the taste, and a spoonful of honey a couple times a day. Also using medical grade manuka honey to help kill off bad bacteria. For fats I rotate between MCT oil, coconut oil, and macadamia nut oil.

            I ordered a stool test that revealed I have overgrowth of three bad strains of bacteria so pretty sure that’s what the problem was, probably due to antibiotic use in the past.

            I’m rotating herbals every four days for maximum effectiveness and utilizing a biofilm distruptor. Plan to stay on this a total of four weeks. So far things are working well, I’m not feeling hungry, I must have my calories correct because weight is staying on target, I have ceased all workouts while I heal this problem so my body can focus on healing. Also, I know I have leaky gut syndrome so I’ve added L-glutamine (a bodybuilding supplement I use regularly and always have on hand!) and my last “meal” of the day is a big cup of hot organic beef bone broth that I get at a local butcher shop that makes it to standards for digestive tract disorders. Supposed to really help the healing process.

            I’m on Day 16 and seeing/feeling a big difference, the extreme bloat has gone down as well as the overall water retention I was experiencing. Trying to address a hormone imbalance and possible sluggish thyroid while I do all this. I do have some belly bloat but that may be a side effect of the elemental diet and should subside once I start eating solid food again. I will say one thing, I have willpower of steel when it comes to food, so sticking to this isn’t a problem for me but it’s been hard, the die off symptoms at first were no less than brutal and the lack of energy was horrible. Right at the two week mark this past weekend I felt a huge shift and started feeling WAY better. Still got a couple more weeks but happy I’m doing this, very hopeful this will be effective, but I still plan to watch the diet for quite a while just in case. I eat super clean anyway so this isn’t an issue.

            • Hi SHasta,

              Here is another source of protein – i think it is not protein but keto acids:

              First juice raw potatoes with juicer – after 10 minutes the starch will go to the bottom of the cup with the juice. Then move the juice without starch in different cup and boil until most water evaporates – what is left is protein of potatoes – i think 1 kg of potatoes have 30 grams proteins. It tastes bad but with salt is better – this is called Ray Peat potato protein soup – Ray Peat say it boosts thyroid also

              • Very interesting! I’d try it if I had a juicer, but I don’t and don’t plan on purchasing one anytime soon. The pea protein powder is working great, the cost is low, and I use it as a regular bodybuilding supp anyway since I react to whey protein isolate. They do have flavored pea protein now but the sodium content is much higher so I stick with plain. Pea protein digests quickly and rarely do people have reactions to it, it’s not hard on the digestive tract at all so although it tastes sorta like cardboard, it works for me.

  43. 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.?

    • 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!

      • 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.

        • 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.

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

          • 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.

                • Hi Bonnie,
                  I suspect I may have some low thyroid issues due to impaired gut function and sibo. Would following your iodine protocol actually harm my thyroid function?
                  I am excited by the prospect of such a great simple cure but don’t want to do more harm than good. Thanks for all of your helpful information!

        • How do you take iodine?? In water or a liquid? Can you get more specific on your regimen please??

        • Hi Bonnie, I know that taking iodine has worked for you, but some of these problems are very complex. I have been using Lugol’s for over two years and while it did improve some major symptoms of Hashimotos it has by no means provided a cure-all for me. In fact I have recently experienced a Sibo flare up despite taking Lugol’s regularly. If you check the many experts working in the field you will realize that there are many different things going on for different people who have sibo that may also need to be dealt with.

    • I noticed! And I got my bottle of Lugol’s today. Started with two drops and will gradually increase to five as you had suggested. Hoping I see the same difference you did with this product.

  44. 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.

    • 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.

  45. 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?

  46. 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.

    • 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.

      • 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.

        • 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.


          • 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.

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


  48. 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.
    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.

    • Hi EInstein,

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


      • 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.

      • Hi Scott,
        after a bit of googling I found the following:
        This description of the postures can be consulted more in detail in the book of Andre Van Lysebeth: “I improve my Yoga”.

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

  49. 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?

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

      • 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’?

        • 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 🙂

  50. 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?

  51. 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!

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

    • Bill:

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

  53. 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.

    • 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?

      • 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
        I am still taking the iodine and I never had any detox side effects, doing it that slowly.

        • 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.

          • 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.

  54. 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.

  55. 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.

  56. 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

  57. 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.

  58. 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.

  59. 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.

    • 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.

  60. 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

    • 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.


      • 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

  61. 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

    • 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?


  62. 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.

    • 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?

    • 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.


      • Hi Andrea. Can u email me please ASAP about sibo and symptoms. I’m looking for someone to talk to and share my experience with

  63. 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?

  64. As you mention, 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.

  65. 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!

    • 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.

    • 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.

    • 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.

  66. 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.

    • 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.

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

    • 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.

  67. 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….

  68. 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.

    • 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).

      • 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?

  69. 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.

    • I’m doing the elemental and could NOT hang with the vomit flavor of the amino acids, and I’m a body builder so I wanted to preserve muscle mass and I have higher protein requirements than the average person. So what I’ve decided to do is reduce the amount of aminos to half what I was using (reduces cost too) and added plain pea protein powder (tastes like cardboard). Makes the aminos a tad less disgusting to and the protein is fast digesting and doesn’t cause me any problems or irritation. I don’t know what others would have to say about this but it’s working for me.

      • Hi Shasta,
        Checking to see how you are doing. Did you finish the elemental diet? Any details you could share is appreciated!

        • YES! With great success! I’m still on a supplement for motility, addressing a hormone imbalance and taking some iodine and selenium for the thyroid. My belly fat is melting off as a result of this!!! I found the book Fast Track Digestion IBS with an eating plan for SIBO that has been hugely successful, most of the other diets (FODMAP, etc) aren’t quite right for SIBO but this one goes by the fermentation potential of various foods and rates them. So far it’s working for me very, very well and allows for more variety in the diet. My belly is flat for the first time in over two years, and inflammation and water retention are down to a human level. I’m back to bodybuilding and feeling better than I have in a very, very, very long time. Plan to do everything in my power to prevent this from relapsing but so far I can eat gluten free white bread, certain types of rice, certain fruits, and red potatoes (among other assumed “forbidden” carbohydrates) with no issues….amounts have to be watched but it made no sense to me that traditional SIBO diets eliminated carbs to the degree they did. The depression of thinking I wouldn’t be able to bodybuild was overwhelming….you HAVE to take in carbs to bodybuild!! So I’m overjoyed that I can make this work since this is my passion. I’m also still taking a small amount of herbals once a day that I’m rotating just in case I still have some bad bacteria in there. I refuse to let this become a problem again!!! And I really do recommend that book, if anyone is interested the website is

          There are links to the book, but I got a used copy off for $8…..if you have amazon prime you can “borrow” an e-copy at no charge to see how you like it first. This diet approach makes WAY more sense than the other popular SIBO diet approaches for sure. There are two different books, the IBS version of the book is the one you want for SIBO problems, it sort of encompasses IBS as a whole and the various conditions that cause IBS. There is also a small section that addresses athletes and their need for carbs so I have to say, this book literally brought tears to my eyes when I found it! Happy, happy, happy girl here!

          I stayed on the elemental diet for a full four weeks and also addressed my leaky gut syndrome at the same time. So far I can eat eggs with no problems at all. I’m not really willing to test the water with other foods that were causing problems but I have a hunch that I healed up a ton of damage in there on the elemental diet! I rotated my herbals every four days so that the bad bacteria wouldn’t be able to adapt. I also religiously took a biofilm disruptor about 15-30 min prior to taking any herbals, and I also used medical grade manuka honey to help kill off bacteria (this stuff kills the MRSA virus, people! Use it to your advantage! I took it 15-30 min after the biofilm disruptor and would just take 1-2 teaspoons. But order off amazon and get a higher medical grade and read up on the stuff! It’s astounding in it’s capacity to heal and also kill infection!)

          Will my SIBO come back? I don’t know. But I am hopeful that I have this beat and that my current approach will prevent relapse.

          • So what was your recipe for elemental diet, I also do bodybuilding and had exact same idea to take protein isolate instead of amino acids. Did you used simple sugars? I am so curious how are you now. Thanks!!

            • Zack2 – HANG IN THERE!! It is TOTALLY WORTH YOUR EFFORT!! You can do it!

              I just finished 10 days of the Elemental Diet. I did the homemade version (21 free form aminos, honey, MCT coconut oil, mineral salt).

              I had intended to go the full 21 days, but ended up having a huge detox reaction (rash, fever) on day 10 and had to stop. I reintroduced food by starting with bone broth (chicken, no vegetable or spices in the broth). I was really glad to have something savory instead of sweet. The excessive sugar was a lot for my system to handle. Had I not gotten the herx, I would have stayed on for the full 21 days. I felt good on the diet. No bloat, no pain, no brain fog. It was quite a blessing!

              My tactics for the diet varied. I would mix the 2 tablespoons of aminos with a small amount of water, stir it well and shoot it down, then chase it with water. Separately, I would mix the honey, oil, salt. Sometimes I would add food grade orange or mint essential oils, or vanilla extract to the sweet oily mixture. Other times I would put dextrose, oil, and vanilla in the blender and make a liquid drink out of it. I also used different kinds of honey – whipped vs. liquid, and liquid MCT oil vs. dense coconut oil. I tried to keep it interesting and enjoyable.

              Honestly, I never thought I’d want to go back to the diet after being off it or eat honey again… though I don’t feel that way now at all. It’s been a week since I stopped the Elemental Diet and since then I’ve had a few meals of just the amino acid powder. My body really likes it, and the break from food feels good to my system.

              In the past week I’ve been sensible about what food to eat. I use the SIBO app to track which foods are supportive to my system or otherwise. I also bought an autoimmune paleo cookbook (which has been difficult to [literally] stomach, after being vegan for over a decade).

              I now eat smaller meals and don’t snack. I also feel WAY better if I go to bed on a relatively empty stomach.

              Supplements: 3 colostrum when I wake up and 3 some other time during the day on an empty stomach; 2 Nutrient 950 with NAC three times a day with meals; 3 cal-mag-zinc a bedtime. I also have both MTHFR mutations, so I take supplements for those.

              I am still free from boating and I have multiple BMs throughout the day. These were two major problems for me (massive bloating and severe constipation) before the Elemental Diet.

              If I were to do the diet again – and it is very likely I will because my system seems to like intermittent fasting, I might use bone broth instead of the honey.

              • I’m also still on Xifaxan and Flagyl. My methane numbers were off the chart for the last three breath tests I did.

                I think the key to ridding myself of SIBO is multifactorial and will take effort. I don’t mind these things, but they will require lifestyle changes on multiple levels.

                Including but not limited to:
                1) Daily exercise to raise heart rate and body temperature, as well as build muscle for increased metabolism
                2) Reduction in stress of all types – whatever that means to you. For me, I have to reduce the number of hours I work, which folds into changing the way I live and spend money. These are difficult changes, but it’s my choice. I’m O-V-E-R feeling sick. I’ve had enough.
                3) Choosing the better feeling thoughts regarding what I’m focusing on in life/day/work/relationships. Again, this is a mindset shift.
                4) More meditation for reducing cortisol.
                5) More time in the sun. I know I need more sun on my skin. I have to make this a priority.
                6) Mindful eating. Box breathing or 5 slow breaths before I eat food. This gives the brain a chance to start making digestive enzymes and for digestion to come online.

                _For ME_, SIBO isn’t only a bacteria that’s camped out where it’s not supposed to be. It is a physical indicator that I need to make changes in my life. This may or may not be the case for you. _For ME_, my physical symptoms are not isolated from my mental, spiritual, and emotional state.

                I am an investigative methods scientist by formal training and higher education. I do best when there’s logical reasoning behind what I’m doing – this includes matters of my own health.

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

  71. 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.

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