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What Causes SIBO (Small Intestinal Bacterial Overgrowth) and Why It’s so Hard to Treat

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While bacteria are an essential part of a healthy small bowel and perform important functions, small intestinal bacterial overgrowth can lead to leaky gut and a number of other symptoms. Learn what puts you at risk for SIBO.

sibo info
SIBO (small intestinal bacterial overgrowth) is a complex issue. istock.com/frentusha

The normal small bowel, which connects the stomach to the large bowel, is approximately 20 feet long. Gut microbiome bacteria are normally present throughout the entire gastrointestinal tract, but in varied amounts. Relatively few bacteria normally live in the small bowel (less than 10,000 bacteria per milliliter of fluid) when compared with the large bowel, or colon (at least 1,000,000,000 bacteria per milliliter of fluid). And, the types of bacteria normally present in the small bowel are different from those in the colon.

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Why You Should Thank Your Small Bowel and the Beneficial Bacteria That Live There

The small bowel plays an important role in digesting food and absorbing nutrients. It is also an important part of the immune system, containing an impressive network of lymphoid cells (cells of the immune system that help fight infections and regulate the immune system).

Are you at risk for small intestinal bacterial overgrowth? Find out what the most common risk factors and symptoms are.

The normal (beneficial) bacteria that are an essential part of the healthy small bowel also perform important functions. These beneficial microorganisms help protect against bad (i.e. pathogenic) bacteria and yeast that are ingested. They help the body absorb nutrients, and also produce several nutrients (such as short chain fatty acids) and vitamins like folate and vitamin K. These bacteria help maintain the normal muscular activity of the small bowel, which creates waves that move the contents of the intestine, like food, through the gut.    

What is SIBO?

SIBO, small intestinal bacterial overgrowth, is defined as an increase in the number of bacteria, and/or changes in the types of bacteria present in the small bowel. In most patients, SIBO is not caused by a single type of bacteria, but is an overgrowth of the various types of bacteria that should normally be found in the colon (1). Less commonly, SIBO results from an increase in the otherwise normal bacteria of the small bowel. 

SIBO has been shown to negatively affect both the structure and function of the small bowel. It may significantly interfere with digestion of food and absorption of nutrients, primarily by damaging the cells lining the small bowel (the mucosa). Additionally, this damage to the small bowel mucosa can lead to leaky gut (when the intestinal barrier becomes permeable, allowing large protein molecules to escape into the bloodstream), which is known to have a number of potential complications including immune reactions that cause food allergies or sensitivities, generalized inflammation, and autoimmune diseases (2).

These pathogenic bacteria, whether too many or the wrong types, can lead to nutritional deficiencies on top of those due to poor digestion or malabsorption. In particular, the bacteria will take up certain B vitamins, such as vitamin B12, before our own cells have a chance to absorb these important nutrients. They may also consume some of the amino acids, or protein, that we’ve ingested, which can lead to both mild protein deficiency and an increase in ammonia production by certain bacteria. (We normally produce some ammonia daily from normal metabolism, but ammonia requires detoxification, so this may add to an already burdened detoxification system.) The bacteria may also decrease fat absorption through their effect on bile acids, leading to deficiencies in fat soluble vitamins like A and D.

What Causes SIBO?

The body has several different ways of preventing SIBO. These include gastric acid secretion (maintaining an acidic environment), waves of bowel wall muscular activity, immunoglobulins in the intestinal fluid, and a valve that normally allows the flow of contents into the large bowel but prevents them from refluxing back into the small bowel. (This is called the ileocecal valve because it’s located between the ileum, or terminal end of the small intestine, and the cecum, a pouch forming the first part of the large bowel.)

The cause of SIBO is usually complex, and likely affects more than one of the protective mechanisms listed above.  A number of risk factors for SIBO have been identified, with some of the more common risk factors listed below.  For a more complete discussion of associated diseases and risk factors check out this study and this study.

Risk Factors for SIBO

  • Low stomach acid
  • Irritable bowel syndrome
  • Celiac disease (long-standing)
  • Crohn’s disease
  • Prior bowel surgery
  • Diabetes mellitus (type I and type II)
  • Multiple courses of antibiotics
  • Organ system dysfunction, such as liver cirrhosis, chronic pancreatitis, or renal failure

Moderate Alcohol Consumption and Oral Contraceptive Pills (OCPs) Also Increase the Risk for SIBO

Heavy alcohol use has long been recognized in association with SIBO (3). This study also found an association between SIBO and moderate alcohol consumption, defined as up to one drink per day for women and two drinks per day for men. Alcohol appears to have effects on several of the normal protective mechanisms, including causing injury to the small bowel mucosal cells, contributing to leaky gut, and decreasing the muscular contractions. Additionally, alcohol may “feed” a few specific types of bacteria contributing to overgrowth (4).

Overall there appears to be a moderate association between OCPs and inflammatory bowel disease (IBD) such as Crohn’s disease (5). Though no studies to date specifically correlate the use of OCPs with SIBO, given the known relationship between IBD and SIBO, it is likely that this association holds true for SIBO as well. However, once patients stop taking OCPs, this risk appears to reverse.

How Do You Know If You Have SIBO?

The number of people with SIBO in the general population remains unknown. Some studies suggest that between 6 to 15% of healthy, asymptomatic people have SIBO, while up to 80% of people with irritable bowel syndrome (IBS) have SIBO (6). 

SIBO is largely under-diagnosed. This is because many people don’t seek medical care for their SIBO symptoms, and because many doctors aren’t aware of how common SIBO is.

Complicating this, the most commonly used tests (breath tests measuring levels of hydrogen and methane gas) still have fairly high rates of false negatives (meaning the test results come back as negative but you actually do have the disease) (7).

The most common symptoms of SIBO include:

  • Abdominal pain/discomfort
  • Bloating and abdominal distention
  • Diarrhea
  • Constipation (generally associated with methanogens as Chris discussed in his recent podcast)
  • Gas and belching
  • In more severe cases, there may be weight loss and symptoms related to vitamin deficiencies.

Is SIBO Contagious?

Unlike many other bacterial infections of the gastrointestinal tract, SIBO is not contagious, and there is no evidence that exposure to any single microorganism increases the risk for developing SIBO. SIBO occurs due to a complex interplay of many different factors and is not passed on between individuals.

Why SIBO Can Be Difficult to Treat

Antibiotics are often used to treat SIBO. However, studies show that despite treatment with antibiotics, recurrence develops in almost half of all patients within one year. One study comparing treatment with rifaximin (the most commonly used antibiotic for SIBO) and botanical antimicrobials showed slightly better outcomes with the botanical protocol, but still with successful treatment in close to only half of all patients after one course of treatment.

These finding suggests that treatment of the overgrowth alone is not enough for most people. An additional piece of successful treatment must include addressing the underlying cause, or predisposing factor.

Though there are many identified associations between SIBO and other diseases as described above, abnormalities in gut motility are recognized as one of the most common associations. One study published this month demonstrated that patients with SIBO do have significant delays in small bowel transit time (the amount of time it takes something to move through the small bowel). This finding suggests that patients with SIBO, who do not recover after a standard course of antibiotics, or botanical antimicrobial protocol (which we prefer), may benefit from the addition of a prokinetic agent, which increases the muscular contractions of the small bowel. Octreotide and low dose naltrexone are two such options that are being investigated, and may help treat some cases of SIBO that don’t respond to antimicrobials alone.

As research into SIBO continues, we are increasingly understanding the complexity of this disease, and how treatment must be tailored to each individual to maximize success.

Now we’d like to hear from you. Have you had SIBO requiring more than one round of antimicrobial therapy? What helped you recover from SIBO?

Amy NettAbout Amy:  Amy Nett, MD, graduated from Georgetown University School of Medicine in 2007.  She subsequently completed a year of internal medicine training at Santa Barbara Cottage Hospital, followed by five years of specialty training in radiology at Stanford University Hospital, with additional subspecialty training in pediatric radiology.

Along the course of her medical training and working through her own personal health issues, she found her passion for functional medicine, and began training with Chris in June of 2014.  She has recently joined his clinical practice to work with patients through a functional medicine approach, working to identify and treat the root causes of illness.  Similar to Chris, she uses nutritional therapy, herbal medicine, supplements, stress management, detoxification and lifestyle changes to restore proper function and improve health.

1,226 Comments

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  1. I have been struggling with health issues for too many years. I’m waiting results for tests for SIBO at present. How significant are problems with methylation, does anyone think there is a connection. Personally I have had some awful side effects from foods/supplements that are supposed to be healthy mainly sulphur products. Just would like to now if anyone else has anything similar?

    • Hi Lorraine,

      Methylation is an incredibly complex topic, but there is a connection between methylation and gut issues, and often, both of these need to be addressed. More specifically, if impaired methylation is present, and not addressed, this may limit the body’s detoxification and elimination, making it difficult to treat SIBO. So in that sense, impaired methylation may make SIBO more difficult to treat.

      You can also look at how SIBO or dysbiosis may affect methylation. These gut issues may lead to nutrient deficiencies, including B vitamin deficiencies which can then slow methylation.

      It’s a complex interplay, and most often both SIBO and methylation should be addressed, particularly if there is a known genetic predisposition to impaired methylation.

      Regarding your reaction to sulfur containing foods, many of the sulfur-rich vegetables are also high in FODMAPs, so I wonder if it was the FODMAPs or sulfur you were reacting to?

    • Lorraine,

      Yes! I have SIBO and also issues with sulfur foods. I also have a heterozygous A1298C gene mutation that my doctor believes predisposed me to impaired sulfur detoxification. I have been told that molybdenum can help clear sulfur pathways and will be starting on that protocol soon. If you would like updates on my progres, feel free to check out my blog: sibowithhope.wordpress.com

  2. I was diagnosed with SIBO seven months ago, and after two rounds of antibiotics (Xifaxan & Metronidazole the first round) and (Xifaxan & Neomycin the second round after retesting positive) my last test was negative for SIBO. I had predominant constipation. Treatment also included Dr. Siebecker’s SCD/Low FodMap Diet protocol. I am sticking with that protocol for at least a year in hopes I will remain SIBO free.

    • I’m not aware of any long term consequences specifically related to appendectomy. However, most patients who have an appendectomy are also prescribed antibiotics, and the antibiotics of course increase the risk for SIBO or dysbiosis. It could be helpful to work towards rebuilding a healthy gut with a combination of probiotics and prebiotics.

  3. The trouble starts with an inflamed ileocecal valve

    Try Black Spanish Radish from Standard Processing and silica or a good source of Calcium,

    Eat cooked food during winter months.

    It should heal in about two weeks

    This is step No. 1
    The other ideas follow when this valve is healed.

    Nick

  4. The missing piece in this article is diet. SIBO can be controlled (and gut bacteria to some extent rebalanced) by reducing the amounts of fermentable foods you eat and introducing more probiotics into your digestive system. Norm Robillard has done groundbreaking research on the diet-SIBO link, and I’m so surprised this article doesn’t mention it. http://digestivehealthinstitute.org/2012/08/17/sibo-diet-and-digestive-health/

    The Fast Tract Diet Norm pioneered brought my SIBO under control and eliminated my reflux and IBS-type symptoms.

    • Yes, I did not go into diet too much in this article – and food as medicine is one of my favorite topics, so it was difficult to leave out, but I felt like there was too much to address and it would have made the article too long. But perhaps I’ll do another post soon on our dietary approach to SIBO.

      In treating SIBO we generally recommend that people follow a low FODMAP version of the Paleo diet. This seems to be effective for most people without being overly restrictive. And yes, daily probiotics are another important piece in that.

      I’m glad to hear that you’ve successfully managed your gut issues with what sounds like a very similar dietary approach!

      • What is considered safe in low-FODMAP paleo? I’ve been working on my SIBO for ages, and starches all seem so bad for me. Sweet potatoes are an issue for FODMAPS, though technically a tiny serving should be safe. I haven’t ever tried them when I’ve had my SIBO moderately under control, though. (It seems no matter what I do, it comes back very quickly.)

  5. Interesting that there is no mention of Grapefruit Seed Extract, Grape Seed Extract, and Oil of Oregano, all things my holistic doctor recommended for SIBO. I do take Low Dose Naltextrone, and that, combined with many supplements, including the ones I just mentioned, have left me feeling better than I ever have in years.

      • If you can find a compounding pharmacy in your area, ask them if they get prescriptions for low dose naltrexone, and the name of the doctor writing them.

  6. I completed a course of Rifaximin about 6 months ago and I can comfortably say I am now cured. BUT…it is so important to make permanent changes in lifestyle to avoid recurrence.

    I blame poor diet and uncontrolled long term stress for getting my body into a weakened state giving SIBO an opportunity.

    Before I stumbled upon SIBO I was treating my symptoms through diet. Paleo help, then I found low fodmaps, which really helped, then I kind of figured I had SIBO.

    I took the lactulose test and it came back negative. I decided to try a course of rifaximin anyway. So that’s another example of don’t take a test if it doesn’t impact your next step, just a waste of money.

    I had nasty die off for about 3 days, then I would say I was back to my old symptoms. I was definitely discouraged but it turns out I was slowly improving.
    Around 1 month out from treatment I started eating yogurt (I’ve read mixed opinions on yogurt after treatment, some say necessary, some say will cause recurrence). I think it really helped me.

    Now 6 months later, I’m still paleo (with some dairy and rice). I can eat all the fodmap foods I want (except beans, still makes me gassy).

    I’m really encouraged to see the discussion on SIBO becoming more common and rounded out. I feel like this is so common if everyone just knew about it.

    I’d like to see more pediatricians understand this topic so they can identify it in children. I’m convinced I see it in my friends kids.

    good luck everyone

  7. I have gut issues went to Functional med doctor who did blood and stool samples: I was already gluten free for 2 years so that test won’t show up. Am allergic to milk, whey, eggs, casein casomorphin. no parasites no cryptosporidium, no Diardi lamblia, no entamoeba histolytica.. Bacteriology culture +1 for Lactobacillus, +4 Escherichia coli, +1 Bifidobacterium, +3 gamma haemolytic streptoccus. Mycology culture ng.
    Gastrointestinal microbiome: H Bacteroides vulgatus low lactobacillus 1.6, low bifidobacterium low collinsella aerofaciens, low firmicutes/bacteroidetes 7which he put me on probotic with those in. Escherichia coil 7.7 H

    So he has me on BioMatrix support mucosa, and Metagest digestive support., paleo diet. I don’t know if this means I
    have SIBO. I am still in pain especially upper left shoulder pain at times, bloating, gas pains. Don’t have a clue what to eat anymore. I used to have diarrhea IBS before I stop gluten, now more constipation issues and when I go every other day….major pain. I have had doctors do CAT scan, test upper GI, Colonopsy, and gallbladder ultrasound. Regular doc wants to put me on antidepressants( I AM NOT DEPRESSED) nor do I want meds to hid the problem. Want to fix it.

    • Hi Tencie,

      It sounds like this has been a long struggle for you. Looking at your stool culture results, with the low Lactobacillus and low Bifidobacterium, those findings are suggestive of dysbiosis. The bloating and gas pains could certainly be due to SIBO, and we would generally recommend taking a breath test that measures both hydrogen and methane gas. Given your dysbiosis, you might want to consider working with a practitioner who uses an herbal antimicrobial protocol along with carefully selected probiotics to start healing your gut. Digestive support alone may not be enough in the setting of dysbiosis. You may also want to try a low FODMAP diet. If you feel better on the low FODMAP diet that is more evidence that you may have SIBO.

      • Amy,

        Thanks for your comment. I would gladly travel across the country to see you but it looks like you are not taking new patients.

        Hope you can clarify the most recent comment: If I have confirmed SIBO, which is more important: treat SIBO first, and then the dysbiosis? Or vice versa?

    • Tencie:

      This sounds identical to me. I was gluten free for five years, went through immense stress, lost all motility and SIBO developed. I had extreme bloating and constipation for 4 months without relief from Xifaxan/Neomyacin, strict Paleo, or any probitiocs at all. Laxatives wouldn’t work any longer either.

      I got so frustrated with food that I fasted for 72 hours with just caffeine free tea, coconut oil for fats, vitamins, and amino acids. After that period I was able to have a BM on my own, my distension and 3 month pregnant belly was gone. I’ve stayed strictly Paleo since and will supplement Vitamin, Magnesium Glycinate, Lugol’s 5% Iodine, Neem, and Biofilm Defense. I don’t feel ready yet to add back probiotics.

      Fasting for three days was the break my digestive track needed to starve all the bacteria in my Small Intestine. I was still getting nutrition and was never once hungry, it was strategic liquids that would be fully digested before making it to the small intestine. I suggest this, great relief for the first time in 4 months.

      • Jenna,
        I’m wondering about your protocol and fasting. I have the 3-month pregnant belly size from bloating. It’s constant, no matter what I eat or don’t eat. I feel if I can get a head start, like the 3 day fast, I might have a chance of my good eating habits actually helping.
        What kind of teas did you have during your fast? What supplements do you take?
        Has the bloating recurred or are you fine now?
        Thanks!

        • Feel for you. Bloat is on. So frustrated. Feel like an alien. So hard for family too I think because they don’t understand. Over 40 years of ibs and have never spoken to a dietician. Drs just preach on fiber!!! It hurts and gives me diarrhea. Just keep pushing it. Feeling alone.

  8. Obviously this is different than an overgrowth of Candida, but wouldn’t doing an herbal cleanse (or two) that speeds up motility and kills candida be worth trying IOT help diagnose/fight SIBO? Any experience with that from the crowd?
    Thanks for the great article Amy. I look forward to reading more. Robb Wolf’s 30 day paleo eating plan from his book “The Paleo Solution Diet” helped me personally, and I recommended Chris’ “Beyond Paleo” series to all my friends.

  9. I struggled with SIBO for years before receiving the diagnosis via a breath test. Symptoms began after traveling to South America and getting very sick there. I came back and had tons of new GI symptoms. I read everything I could and went to several different GI doctors. I went to a functional medicine doctor and took a couple of rounds of herbal meds which were very difficult to tolerate and produced little results. I went to a GI physician and started Xifaxan. I thought this had cured me but the symptoms came back so I had to do 3-4 more rounds to gain any relief. Each time symptoms returned. My GI suggested a new product called Enteragam. I think it’s what’s called a medical food product but it does require a prescription. It is taken in powdered form and dissolved in water. After so long, I was very skeptical but it has been a tremendous help to me. I honestly haven’t read much about it and after so long in so much distress, I don’t feel the need to. I just know it has helped me and perhaps it could someone else.

    • I have had Celiac for 13+ Years, and SIBO recurring for the last 2 years. Today, I am finishing up another round of treatment for SIBO and my dr recommended EnteraGam for me to try also. I am finding mixed results – but am excited to try SOMETHING that may help. Are you still having a positive response from using EnteraGam? What dosage are you using or did you use?

      • I’ve been on Enteragam for over a year. It helps the symptoms but doesn’t fix the problem. It’s a good band aid while you work on eradicating SIBO. If your insurance won’t pay, contact Foundation Care. I get 2 boxes/month for $75.

  10. I am finishing a protocol w/ Cindibactin AR and BR. I am a type I diabetic, w/ Cfids and thyroid problems so I know the odds aren’t in my favor.
    I was not tested. I responded well to a low FODMAPS diet, but last summer it seemed like I got sick no matter what I ate. My doc just suggested I try the protocol. It did help a lot, but I got overconfident and ate too many FODMAPS. I scaled back and ate cauliflower (one of my worst) 2 nights ago with no problem. So challenging when you already have a limited diet and get sick on “helathy food”
    I am seeing my doc today to get a prescription for LDN to use as a prokinetic. Hoping we can dose it correctly as I am one of those “sensitive patients”. Any thoughts on this??

  11. I was diagnosed with SIBO in April this year through Gastrolabs in Australia. I had to get a home test as I don’t live in a metropolitan area, and it’s almost 3 x the amount to pay for a home test, so not cheap.
    I did try 6 weeks on Allicin and Oil of Oregano ADP but while I had a few positive days in there it really didn’t make a lot of difference. My GP didn’t even know what SIBO is, and I didn’t really want to take a drug company antibiotic.
    I have never ever had food poisoning that I can recall. I guess that theory is out.
    I’ve done an paleo elimination diet, but have not been able to determine any particular food intolerances. I do eat paleo/keto style most of the time, I prioritise eating well in my budget and buy cheaper cuts of grass fed meats to try and keep my expenses down, buy what I can organically vegetable wise but there’s not a lot of variety in my area. It didn’t make a difference for me that I could tell being fodmap free or eating fodmaps.
    I’ve been sugar free for more than 3 years, and that has made a massive difference to my health in regards to PCOS, energy, weight loss, water retention (swelling) etc. But I’ve found myself getting frustrated trying to fix every little thing in my health, for instance, my SIBO digestive symptoms. I feel like I’ve been chasing cures for the last 2 years, and have spent lots of money I don’t really have on supplements, attending webinars, purchasing programs like Paleocon, Real Food Con etc.
    I think I’ve finally come to the conclusion that enough is enough. I can manage the symptoms that worry me the most (constipation) by supplementing with magnesium, either chelated or glycinate, and periodically with probiotics, digestive enzymes, Betaine HCL, etc. I have so much that I’m trying to balance, hormones, work, health, life. I have years of damage I did to my body before I woke up and as much as I would like to be one of those people who get it all, perfect body and health, I need to be content with what I’ve achieved. I continue to eat whole foods, I’m sure I’ll still experiment with some things but no more chasing the elusive cure.

    • Did you do a retest after 6 weeks on antimicrobials? It’s possible that you may have lowered the gas levels, but that was not enough to clear all the overgrowth and experience all symptom relief. Often people need few round of antimicrobials. What were your gas levels on a SIBO test?

    • I feel your pain and frustration. At some point one has to make the admission that they have done the best they can to manage all these areas and still have a life that isn’t overly consumed with “getting it right”. There are so many people who have different takes on what is right, the quest has made me live in a crazy manner. I’m done with trying to figure it out so I hope you and others can get some peace about the best and most livable path to take and rest and live peacefully. Life is short and stress, even stress at trying to figure things out is too stressful at times. What helps me the most is thinking of my 93 yr old mother in law. She doesn’t know anything about any of this stuff and she’s healthy and peaceful.
      Best to you and thanks for your comment about the weariness of the quest.

  12. I have been diagnosed with SIBO but as I live in Australia, antibiotic treatment with rifaximin is not available. Instead, have treated it with gut de-sensitising treatment (Endep), as restricting foods was inadequate (reacted to just about everything and couldn’t stabilise pain). Also have Hashimoto’s thyroiditis, long history of food intolerances (lactose, fructose, polyols, sugar and grains), poor general immunity, adrenal fatigue, hormonal imbalances and transverse myelitis. Currently treating with Endep to stabilise, plus diet of no sugar, fruit, grains, low lactose and minimal carbs, mostly starchy vegetables. Did achieve a good stabilisation over the past year but a significant trauma this year caused a return to super sensitivity. Now managing to do weights, yoga, bike riding and perhaps a little weight loss. Always interested in the journeys of others and how long they need to persist to be able to reduce the severity of eating restrictions. Quitting sugar has been the most significant benefit for me so far and hope to be able to maintain in the longer term

    • I assume you must have tried to heal your leaky gut using LGlutamine, probiotics plus Sacchromyces Boylardii and liquorice root for your adrenals…. If not please take a look at my blog as this is the root cause of all symptoms including Hashimotos Autoimmune thyroiditis.

        • Ive had similar problems due to antibiotics use,bread/wheat,sugar,refined foods,ect.It got so bad i was.in pain,discomfort 24/7,bloating,cramps,ect.I was so bad that the bacteria/Candida had eaten through my intestinal wall and into my blood stream(leaky gut to extreme).I had roaming heat,pain,numbness,nausea,irratibilityand felt like i was dying
          I found a product called Candex and used it for 2 months initially ,but within 2-3 weeks had huge improvement.Candex is a life saver,miracle product.It destroys bad bacteria,candida by feeding on the organisms themselves.Taken regularly works better than anything out there(garlic,coconut,dyflucan).Give this product a try and you’l not be sorry.Take it on an EMPTY stomach.No eating 2 hrs before or after taking.It will change your life.Take care,James

  13. Hi – I had undiagnosed celiac for most of my life, had 3 incidents of food poisoning (a major risk factor for SIBO according to Dr. Pimentel). AFter going on the paleo diet, my bloating got much worse because of the FODMAPS. I finally figured out I had SIBO – pos. breath test. Decided on the herbal strategy using Interfase Plus and then Parabiotic. Drank Cat’s claw tea as well which caused a die off 2 weeks before I started the botanicals. Unfortunately I added too much starch and fodmaps too soon and ended up with a recurrence. I did the same treatment about 8 months ago and have been very strict with the diet and am now adding more fodmaps and fiber and am doing well. Apple cider vinegar before meals helps too. When the SIBO was gone I took VSL #3 and Prescript Assist for months. I read that Rifaximin has a 40% success rate and a 30% placebo.

  14. My son had terrible SIBO, acid reflux and belching you would not believe (along with food intolerances, development of digestive autoimmune disease, leaky gut, major nutrient deficiencies and CFS and brain fog) – fantastic dr Richard Schloeffel at Pymble Grove Sydney Australia gave him Vancomycin for 40 days and ongoing nilstat to counteract bad yeast growth – cleared up SiBO – saved his life – no side effects with the Vancomycin – apparently large molecule doesn’t cross gut wall. We are now working on other symptoms with low fodmap and Palaeo diet.

    • That’s great to hear. I’m so glad your son improved. It’s almost impossible to get in to see Dr Schloeffel though. I believe he only takes new patients that are under the age of 24.

  15. Great post, Amy.
    I just (last week) did a SIBO test and now i’m waiting for the results. I have high LDL-P (2500) and wanting to find the root cause of this. I just got my comprehensive Genova GI test back and I’m free of parasites, HP, but have high levels of commensal bacteria (Barnesiella, Odoribacter, Pseudoflavonifractor). Fecal secretory IgA was high (890) so some bowel inflammation going on, likely of the bacterial imbalance. I had HP last year which I cured naturally. Microbiome is normal. Thyroid is normal. No other abnormalities on tests.
    How accurate are the SIBO tests..? I did mine through NCNM clinic and had to blow in a bag 10 times over 3 hours. Next will be leaky gut test to establish if endotoxemia is causing the high LDL-P. Any other thoughts..?

    • Andy – great questions and I’m going down the same road. Chris K mentioned in a old post about 5 things that cause high LDL-P, so I’m doing SIBO test and leaky gut also.

    • Andy,
      I also have LDL-P above 2500. Do you have a source linking high LDL-P with either SIBO or leaky gut? Is this based on Kresser’s High Cholesterol Action Plan which states in general that infections can increase Cholesterol levels, or do you have additional info? If so, please provide a link if possible.

    • Hi Andy,

      I’m so glad to hear that you’re looking at your gut to help manage your cholesterol! I think the link between gut issues and high cholesterol is under appreciated. About two weeks ago Chris and I saw a patient in our Clinic who initially came to us for help with his cholesterol. He had no gut symptoms. We did some gut testing, treated him for his SIBO (positive breath test), and at this last visit his labs showed a decrease in his LDL-P from about 2,500 to 1,770! So I hope you are also on the right track with this.

      Regarding accuracy of SIBO breath tests, it’s difficult to know for each lab, and I’m not familiar with the NCNM test. We most often use Genova Labs for the SIBO breath test, and overall the results seem to be consistent with symptoms. However, because no test is perfect, we also run an organic acids (urine) test, which also looks for markers of dysbiosis and bacterial overgrowth. So you could consider an organic acids test – I think of it as looking at the gut from a different vantage point.

      We rarely test for leaky gut because leaky gut is more often a sign of underlying dysfunction rather than an entity in itself. So knowing someone has leaky gut doesn’t necessarily tell me what underlying cause I need to treat. It might be enough for you to do a SIBO breath test, stool test (culture including look for parasites), and organic acids test to look for more specific gut issues. If you see problems on any of those, then treat those gut findings and that should heal a leaky gut.

      • Amy – thanks very much for the response.
        Please can you share the treatment protocol that you used to treat this patient’s SIBO? I’m still waiting for results, but I’d like to be ready in case I am positive. My doc thinks I may have SIBO as my stoll culture came back with some high bacterial markers but no Ova or Parasites (thankfully). Also, what was the timeline to reduce the LDL-P..? Weeks/months..? I will consider the organics acid test.
        Just FYI, Even with high LDL and LDL-P, my IMT showed zero plaque, but VA was 15 years over my biological age. Any thoughts on how to manage this?

        • Hi Andy,

          Specific treatment protocols are individualized, somewhat depending on specific lab results. I’m reluctant to provide a specific treatment plan without having all the information.

          The particular patient I mentioned showed improvement after a few months of treatment.

          The absence of plaque on the IMT scan is certainly a favorable sign. I’m not familiar with the abbreviation VA?

      • HI Amy,
        My SIBO results came in and I am “clear of SIBO”, however, after 120 minutes my readings on H2 shot up to over 60 so they say now I’m a methane producer. I don’t have the constipation symptoms or anything else, really. Just high LDL-P. What the heck is going on.?
        Any thoughts I can discuss with my healthcare provider?
        Thanks
        Andy

  16. Do you have any natural suggestions of a prokinetic agent. I have heard ginger is ok, but I am struggling to find any evidence on this subject. Thanks!

    • Iberogast
      MotilPro
      Ginger
      My MD said some of the mitochondrial support supplements can help with motility as well, ie CoQ10, Acetyl-L-Carnitine, etc.

      Low dose naltrexone is an Rx, but often recommended by functional medicine practitioners & NDs.
      Erythromycin (Rx) is most commonly used.

      These can be found on http://www.siboinfo.com

      The natural prokinetics may not be strong enough. You could try them all together perhaps.

      Also beware those with an autoimmune disease, especially Hashimotos:
      – iberogast contains licorice root, a known Th1 immune stimulant. This could cause a flare.
      – if using LDN, Hashi patients may need to start very low & slow. Steven Dixon of Glasgow (pharmacist specializing in LDN) recommends starting at a dose of 0.1mg and titrating up weekly by 0.1mg until you reach a dose of 1.5mg. Then you may double it, or continue titrating if you are sensitive.

  17. Btw, why nobody’s talking about Iberogast? It has research behind it, and it could be a safe long term treatment for people with SIBO. I know Allison Siebecker is trying it in her clinical practice. It’s strange that other nathuropatic/functional doctors haven’t tried using it, or maybe I haven’t heard about it. It’s herbal and is used since 1961, and seems pretty safe.

    • I can attest to the Iberogast. I was diagnosed with slow gastric motility (gastroparesis) – mild case but along with the reflux and the food triggers I’ve identified, now know that I have SIBO from the evidence. Iberogast, along with dietary changes and natural probiotics, has helped clear up my problems – Iberogast is a natural prokinetic herbal formula. You can buy it on iherb.com for about $40. Also, if you have digestive problems PLEASE go do acupuncture 1-2x/week for at least 6 weeks (or longer for maintenance). This helped me tremendously and others that have slow motility. Not cheap but cheaper than spending money on things that don’t work.

      • Thank you for relating your experiences. Am glad you had a positive outcome and relief from this disease. Good to see there is hope.

    • is Iberogast different from herbal laxatives? Kind of the same question about “prokinetic”….is that another word for laxative?

  18. I was diagnosed with SIBO and I’ve been through 4+ antibiotic treatments for SIBO over the past 6 months and still fighting it. Unsure of the underlying cause but making progress and the good days are starting to outnumber the bad.

    The two biggest things that I’ve found will reduce my symptoms are a low FODMAP diet and supplementing with L-Glutamine (half teaspoon mixed with water a couple times per day). Low FODMAPs will reduce the bacteria colony and the L-Glutamine helps heal the gut.

    I discovered that stress/anxiety is a big component with my illness (either the SIBO causing anxiety / sensitivity to stress or visa versa). Kresser’s article on stress and the gut explains further: http://chriskresser.com/how-stress-wreaks-havoc-on-your-gut.

    I tried the “body scan” guided meditation (mp3) in the stress article and it has helped me become more mindful about stress…highly recommended.

  19. I find it rather interesting that you don’t give enough credit to post-infectious(food poisoning) IBS, and the research behind it, because as time goes by, it is becoming more and more clear that it is probably the most common cause, and may prove in the future to be the only, or almost the only one. At least when talking about IBS I think it’s pretty clear that food poisoning is the underlying cause. Keeping in mind that IBS is caused by SIBO, and the more time one get’s food poisoning, the more likely one is to develop IBS, I think it’s pretty safe to assume that SIBO is actually caused by the same food poisoning and subsequent gut nerve damage.
    Maybe I’m a bit too quick to draw conclusions, but I would say this article is outdated, sorry.

    For those who are actually interested in the latest research, I highly recommend this conference:
    https://www.regonline.com/builder/site/Default.aspx?EventID=1510950

    • Simas, thank for the info. I will definitely check it out. Perhaps you are right, but also, perhaps you could be more gracious about it. Not everyone knows everything.

      • Perhaps, you’re right. It’s just that I’m so tired of seeing people struggling with this condition following some kind of advice and getting nowhere. People have a right to know the truth. It’s not some kind of mythical condition anymore. It has a cause which in most cases is food poisoning. Which means you are damaged for life unfortunately, and need some kind of medication or follow a more strict diet, and keep 4-5h between meals to avoid relapse. It can also be caused by other diseases like scleroderma, adhesions, diverticuli, obstructions and I think some other also, but these are not nearly as common as food poisoning. I’m saying this not to let people down, but because I think people need to know what it really is, and especially what they need to do to prevent relapse. That’s why I think herbal prokinetics should the aim of the future studies and practitioners trial and error. Because there’s too little info, and nobody wants to take erythromycin for life.

        • I’m going to be blunt here, and call BS on this. CAN SIBO be caused by food poisoning? Probably. Is it usually or always? I highly doubt it. For most of us, the cause it probably much less obvious and acute. (I KNOW there was no notable occasion of food poisoning around the time mine started up.)

          It seems likely that not-so-easily-noticed issues like parasites or slow intestinal motility play a larger role in the majority of cases.

          • I had SIBO for 8 miserable years and it came on so slowly that I wasn’t aware when it started. I was nauseated which just got worse. One day I ate lunch and immediately left for an app’t, as usual I felt unwell. After 45 minutes driving on a bumpy road, I felt fine when I arrived and that got my attention. So this drive must have moved the food along and it did.

            Then I started paying more attention to my digestion. If I ate at noon, I could not eat again that day, it took about 13 hours to digest a meal.

            After much research I found it was called SIBO and was caused by Gastroparesis, slow motility and that I had an overload of Pathogenic bacteria which showed up on a stool test and they all had names.

            I wondered how I could kill that off? I thought why not try Iodine? So I found a Lab in Fearndale, Washington called Xenex Lab and called them asking how I could get their Lugol’s Solution 5%, delivered to my Pharmacy here in Canada? They arranged it and when it arrived here at my Pharmacy, no one knew what it was, not even the Pharmacist and everyone was asking me about it.

            I had no idea what or how to do this, so I thought I would go slowly and started with one drop per day in water on a Friday and the next Friday, two drops per day and then, 3 drops per day. By the end of the 3rd week at 3 drops per day, all nausea and bloating was gone. Amazing but since Lugol’s Iodine has been in use for 200 years, why not give it a try? It kills bacteria, fungus and viruses. Turns Cancer Cells back into Apoptotic Cells, feeds the Thyroid, Prostate and Ovaries. I have told this story many times online but no one believes it.

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