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 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.

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!

345 Comments

Join the conversation

  1. 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…..new approach to eating for SIBO and is way better than the other popular/recommended diets out there. http://digestivehealthinstitute.org/2012/08/17/sibo-diet-and-digestive-health/
        I got a used copy of the book off amazon.com 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!

        • What did you use to increase your motility? My GI Dr suggested Iberogast which did not do much for me?

          Thanks,

          • 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 amazon.com 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 SIBOinfo.com? 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:
            http://digestivehealthinstitute.org/2012/08/17/sibo-diet-and-digestive-health/
            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 http://digestivehealthinstitute.org/fast-tract-diet-qa/
            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,

            • It was fine! As well as my antibodies…My reverse T3 was 9. (insert head scratching) BUT my thyroglobulin was high at 149 when range was 10-40

  2. 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.

  3. 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?

      Bonnie

      • 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?

            Conclusion
            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
            doi:10.1155/2009/529802
            Research Article
            Does Hypothyroidism Affect GastrointestinalMotility?

            Conclusion

            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. http://www.xenexlabs.com 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?

  4. 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.

  5. 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
    Barbara

  6. Question on the elemental diet…..my 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.

        Bonnie

      • 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.

  7. “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.

  8. 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?

  9. 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.

      Bonnie

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

        • 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.

          Bonnie

    • 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. http://www.cefarm24.pl/
      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

  10. 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..

  11. 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.

  12. 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.

        • Hello Dennis. I just starting learning about sibo a few months back so please tell me what is fmt. Thanks.

          • 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
                  Zeolite
                  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 http://www.pickl-it.com/ 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.

      • There is no cure yet for SIBO. Iodine especiallly has no role in erasing SIBO but it can erase your pocketbook

        • 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.

          Bonnie

    • 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.

  13. 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. http://mpkb.org/home/patients

  14. 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.

    • High levels of B12 are common in people with SIBO even if they aren’t consuming enough. See research confirming this.

  15. Hi
    Did anyone try vital HN instead of Vinonex plus for sibo. I hear that it is the same as vivonex plus and taste much better.

  16. 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.

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

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

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