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Can a Short-Term Elemental Diet Help Treat SIBO?

by Kelsey Kinney, RD

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elemental diet for sibo, elemental diet
SIBO symptoms can be debilitating. The elemental diet may provide relief. istock.com/Heiko119

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.

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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!

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Kelsey Marksteiner
Kelsey Kinney, RD

Kelsey Kinney, RD, is devoted to helping the world achieve great digestive health through her blog, private practice, and prebiotic & probiotic drink mix company Gut Power Drinks. Check out her blog, Gut Power Drinks website, or visit her on Facebook for more.

Kelsey is a registered dietitian specializing in digestive and hormonal health. She graduated from New York University with a Bachelor of Science degree in Nutrition and Dietetics and went on to complete her dietetic internship at Milford Regional Medical Center in Milford, Massachusetts. She also has a Master of Science degree in Human Nutrition and Functional Medicine from the University of Western States.

Kelsey loves helping people find their unique, personalized diet that will help them heal, not anyone else. She has always been interested in nutrition and health, and is honored to now help people find a diet that brings them happiness and longevity.

Professional website: https://kelseykinney.com

Gut Power Drinks website: https://gutpowerdrinks.com

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Join the conversation

  1. 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.

  2. 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.

  3. 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

  4. 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.

  5. 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.

    • Also, consider something like a squatty potty for proper function of the ileocecal valve.

      • 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?

  6. 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?

      • Hi Ken:
        If you have Psoriasis and if you KNOW that it is related to Gut Health (I don’t know myself), then Iodine would certainly help.

    • 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 siboinfo.com? 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.

  7. 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.

            • Bonnie YOU’RE AWESOME! I just ordered some and I’ll update as I go along with treatment. THANK YOU!!!!

                • 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! Can you please tell me how to find the iodine yahoo group? I am going to try the iodine! Thank you for posting!!!!

        • 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.

  8. 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.

  9. 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?

  10. 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.

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


  12. 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!

  13. 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 🙂

  14. 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?

  15. 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!

  16. 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.

  17. 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.

  18. 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.