Why Diet Alone Is Not Enough to Treat SIBO

Why Diet Alone Is Not Enough to Treat SIBO

by Chris Kresser

Last updated on


If you’re using a low-FODMAP diet to keep your SIBO under control, you’re not alone. However, diet on its own does not cure SIBO. In fact, eating a higher-FODMAP diet in combination with your antibiotic protocol leads to more successful eradication of the bacteria.

Are you dealing with SIBO? If so, you’ve probably tried a low-FODMAP diet and noticed significant improvements in your symptoms. Once you’ve noticed such an improvement, it’s easy to think that this must be the answer—a low-FODMAP (or low-carb) diet has cured you!

Unfortunately, this is not the case. A low-FODMAP (or low-carbohydrate) diet will keep symptoms under control simply by starving the bacteria in your small intestine. When these bacteria don’t have food to eat, they aren’t able to metabolize that food and produce gas as a result. This gas is what causes the common symptoms of SIBO—bloating, abdominal pain, diarrhea (in the case of hydrogen gas), and constipation (in the case of methane gas) (1).  

But starving the bacteria over the short term does not eradicate the bacteria, which is what we’re trying to accomplish, as the small intestine is not supposed to contain much bacteria. If you continue this restriction for a long period of time in an effort to kill the bacteria, you’re also starving the bacteria in your large intestine that should be there and that play a vital role in your health.

Simply put, a low-FODMAP or low-carb diet does not eradicate an overgrowth in the small intestine in a short period of time, and continuing on a long-term low-FODMAP/carbohydrate diet in an effort to starve the bacteria to death has potential detrimental effects on the bacteria in the large intestine. I have had clients who have been on long-term low-FODMAP diets prior to working with me who still have positive breath tests for SIBO despite their restricted diet. There is a difference between controlling symptoms and actually clearing the bacteria. We want to do the latter, which has the added benefit of improving symptoms as well.

The Negative Impact of a Long-Term Low-FODMAP Diet

There have been limited studies on the long-term impact of low-FODMAP diets on microbial balance in the large intestine. The studies we have showing the impact of short-term FODMAP restriction on the microbiome, however, do not bode well for the long-term implications.

FODMAPs are fermentable carbohydrates that help to feed the beneficial bacteria in the large intestine. When you begin to think about them this way, it becomes a lot easier to understand why adhering to a diet low in the substrates that our healthy gut bacteria thrive on may not be a great idea.

Is your SIBO diet controlling your symptoms or actually clearing the bacteria? #sibo

Indeed, the studies to date on the effects of FODMAP restriction show exactly what we would imagine would happen when restricting these beneficial substrates: the overall amount of bacteria was decreased (by 47% in this study), along with a decline in bacteria that produce butyrate (a beneficial substance made when probiotics feed on fermentable fibers) (2). While this particular study did not show a decrease in the probiotic strain bifidobacteria, another study has (3). In my clinical experience, it is very common to see low levels of both the bifidobacteria and lactobacillus strains in my client’s stool tests if they’ve been on long-term low-FODMAP diets.

While these bacteria would likely thrive once again with the addition of prebiotic substances, staying in a chronically diet-induced altered microbiological state is likely not a healthy choice when you start to think about the importance of our microbiome and its effect on our health.

Clearly, more research needs to be done in this area if patients are going to be on long-term low-FODMAP diets. However, after reading this article, it is my hope that you won’t need to be on a long-term low-FODMAP diet to keep your symptoms under control.

Treating SIBO

So if you’re not treating your SIBO with diet, what is used to treat it?

Rifaximin is the most commonly used antibiotic for treatment of SIBO and has been shown to be safe and well-tolerated (4). Figures vary on its efficacy (with rates as high as 87% in one study), but on average it is about 50% effective (5). However, this may not take into account the necessary difference in treatment for those with methane-positive SIBO. A study on those with methane-positive SIBO shows that when rifaximin is combined with another antibiotic, neomycin, it is about 85% effective (6). If you’re getting tested for SIBO, make sure you’re getting tested for both methane and hydrogen. These tests will guide your practitioner in treating you more effectively.

Herbal antimicrobials have been shown to be at least as effective as rifaximin, and about 57% of those who fail on rifaximin will succeed on herbal antimicrobials (7). I have personally seen this the other way around as well; those who fail on herbal antimicrobials usually do well with rifaximin. Others may need to do multiple rounds of either herbal or pharmaceutical antibiotics to clear the overgrowth.

Whether you choose herbal or pharmaceutical antibiotics, the important thing is that you are using something that will eradicate the bacteria instead of covering up the symptoms with diet change. You’re getting to the root cause of your symptoms!

Diet during SIBO treatment

Now that you’re being treated with herbal or pharmaceutical antibiotics, what should you eat?

If you listened to Chris’ recent podcast with Dr. Pimentel, you’ll know that having happy and fed bacteria is a good thing when treating SIBO—this is not the time to be starving them, as they will “hide” and become more difficult to eradicate. Eating FODMAPs and carbohydrates is exactly what you want to be doing!

In my own practice, I recommend that clients undergoing treatment eat as many FODMAP foods as they can tolerate and that they do not go on a low-carb diet. (I like to see a minimum of 100 grams of carbohydrates daily, and more, if tolerated.)

I also will typically add some kind of prebiotic if the client can tolerate it. A study that compared rifaximin alone versus rifaximin treatment plus partially hydrolyzed guar gum supplementation showed that providing fermentable carbohydrate along with the antibiotic improved success rates from about 62% (rifaximin alone) to 87% (rifaximin plus guar gum) (8).

Of course, I don’t want my clients to be miserable with digestive symptoms during this time, so treatment is always personalized to each client. Some may have no problems whatsoever eating FODMAPs or high-carbohydrate foods, while others may be very sensitive. I encourage clients to eat the maximum amount that they are comfortable with and remind them that in the end, feeding these bacteria is a good thing. They may experience some uncomfortable symptoms like bloating or gas during this time, but as long as it is not interrupting their life or causing pain, the more FODMAPs or carbohydrates they can eat, the better.

Diet After SIBO Treatment

As many SIBO sufferers know, SIBO has a high rate of recurrence, which begs the question: what should you be eating after treatment to prevent another overgrowth? In my eyes, that’s the million dollar question right now, and it’s a question we don’t have the answer to quite yet.

For now, I have my clients eat whatever they can tolerate on a healthy, real-food, ancestral diet. If they need to restrict FODMAPs slightly or eat rapidly digested carbohydrates to keep symptoms under control, that’s okay. (However, if you can’t tolerate FODMAPs or complex carbohydrates after your treatment, you’ll definitely want to retest to make sure that you’ve completely eradicated the overgrowth in the first place.) We’ll also investigate any potential underlying causes of their SIBO, such as low stomach acid, pancreatic enzyme insufficiency, intestinal motility disorders, and so on. I know from speaking with Chris that he has come to believe that SIBO—and especially recurring SIBO—is often a symptom of a deeper problem. The solution in that case isn’t just to keep treating the SIBO, but to address that root cause.

There’s a lot we still don’t know about SIBO. As we learn more, some of these protocols may change, but I hope this article has given you a better idea of what you should be doing to heal from SIBO with the knowledge we have now.

Now I want to hear from you: What has been your experience with SIBO?

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


Join the conversation

  1. My doctor wants me to eat a low FODMAPS diet while taking Rifaximin? I thought you shouldn’t do that because then the bacteria go into hiding and it’s harder for the antibiotic to kill them. I would appreciate any advice.

    • Elizabeth, Do Not eat a Low FODMAP diet on Rifaximin (Xifaxan). You are right; the bacteria go into hiding, are harder to kill. Do start Low FODMAP diet After you finish Rifaximin. This info comes from The primary M.D. involved w/ SIBO treatment, Mark Pimentel (Gastroenterologist). Read Here: kresserinstitute.com/RHR: SIBO Update – An Interview With Dr. Mark Pimentel. *They also discuss that you should take partially hydrolyzed guar gum while on Rifaximin to help kill the bad bacteria. I’m not sure of the dose/ frequency, so if it isn’t stated in the link I gave you, you can look up the study they talk about.

  2. Here is How to get off of antacids & proton pump inhibitors (like Prilosec & Nexium): Buy Jarrow D-Limonene (Orange oil) capsules from Amazon or a health food store. (Not expensive). Take 1 capsule every a.m. for 20 days. *During this 20 days, do Not eliminate your antacid “routine”. After 20 days on the D-Limonene, you Then stop the antacids. I know, the thought of stopping antacids can be scary. Be assured, this works. There are 60 capsules of D- Limonene in the bottle, so take one if/ when you get breakthrough heartburn. This regimen works for ~ 5-6 months. If heartburn starts to come back, start the 20 day regimen again. *If you take acid reducers, You can’t properly digest your food or absorb the nutrients from food or supplements. Another helpful item for constipation And problems sleeping is “Natural Calm”, which is ionic magnesium citrate: 2 Tsp. w/ water before bed, tastes great, no carbs. When having SIBO symptoms, these help me: Oregano oil capsule (510 mg.), Black Cohosh root capsule for abdominal cramping (540 mg.), & 2 Peppermint oil gels (stated as total of .4 mL/ 362 mg.). You can do this 3 X day.
    The foremost expert on SIBO is Dr. Allison Siebecker (same 1st name, not me). Definitely google/ visit her website! Much of what I have learned is from her & C. Kresser’s sites & Lots of research. Also, remember to Drink plenty of liquid (When bloated, regular sipping helps “fit” the water. Move your body, even walking around the house @ a good pace if you can’t be far from a bathroom. We all know these last 2, but forget/ don’t feel like it when in SIBO mode. Make yourself do it anyway, to help gut peristalsis… I hope this helps any of you. <3

  3. My husband was out on a SIBo diet with no mushrooms or probiotic foods such as sauerkraut or yoghurt. I do not understand the relationship here. Is this not counter productive or am I missing something? Very grateful for insight. Michelle (Ba HSc (Nut. Med)).

    • Hi Michele,
      I’m no expert, and I ended up not having SIBO, though I have been interested in gut health for a few years so it’s on my radar…I think with SIBO bacteria that is in the large intestine, like beneficial bacterias, as well as bad ones, have entered the small intestine, where there isn’t meant to be any at all, which ais the issue, and the idea is to starve or eradicate (such as with antibiotics and hebal remedies). It’s meant to be very difficult.

  4. Hi, all with SIBO symptoms should check out Atrantil developed recently by Dr Ken Brown, a Gastro. I have read 100’s of reviews on that website plus Amazon and listened to podcasts he has done with several functional Dr’s (including Chris Kresser) Many, many have found quick relief. i have learned so much through his podcasts and am now following several Dr’s podcasts that are so enlightening. Good luck to all!

    • I checked out this product, “Atrantil ” and found it to be not only pricey, but you have to take 2-3 tablets before each meal daily. It would cost approx. $180.00-200.00 per month once you start. I wish the cost was not so high, but thanks for sharing.

  5. Hi guys, I know this forum is a little bit old but I’ve just got a few things to ask! Im 16 years old and about 7 months ago I started to get really badly constipated, bloated and I just felt rotten. I had some food allergies, my glands are constantly swollen and I am depressed and have anxiety. I eat a really poor diet and I think this is why it could be SIBO. I also have symptoms of b12 deficiency which I know canned caused by sibo. My doctor isn’t much help and he just says stop worrying it’s just ibs and anxiety. But I’m not happy with that. I think it could be sibo. It started after I ate a lot of junk food for birthdays in September, and I still feel pretty much the same now. My question is, is there an underlying cause do you think? Or just to do with my diet that I eat? I eat so much sugar and carbs and hardly any healthy foods….. I don’t think it’s crohns or something because I haven’t had any blood. I’m just worried because I’m 16 and this shouldn’t be happening to me. I know it’s my fault for eating poorly, but I just want it to go……. ?☹️

    • Hi bud!
      Sorry to hear that you feel so unwell. If you can, please try another doctor- and get a thorough assessment, just in case. Also, maybe a dietician, esp. one who deals with allergies and intolerances. Coeliacs has a relationship to b12, I think. Have a look at the Monash Uni FODMAPS APP, which is like $10, heaps of info, and gives a guide to a 2 week diet trial to see if your intolerant to FODMAPS, after which you can see a dietitian, or if you can’t afford it, there is heaps of good info online. Magnesium will help you to go, lots of water, soft foods like fruit and veggies, fibre, pscyillium husks. Terrible it got this far but you will feel better with time. It’s not your fault this modern society encourages us to eat so much junk.
      Good luck!

      • Hi there, so do you not think that it’s methane sibo then? I’m not sure wether it’s SIBO or candida or what. So do my symptoms sound more like candida?

        • Hi Dylan. It’s hard to tell which type of SIBO it is. I do know however that a large percentage of IBS patients have SIBO. I’m not saying that you do, but you might have it as well. Anxiety has also been linked to iBS. Can you get a doctor to run a SIBO test?

  6. I have read quite a lot of the comments here and as yet haven’t read of anyone using Kefir.
    I am 71 years and have had SIBO all my life, I think my SIBO is inherited from my Father. I have exactly the same build as him and noticed when looking recently at several photo’s of him that he has the typical swollen stomach of a SIBO sufferer.
    I didn’t know anything about SIBO until about seven years ago when I read an article in a newspaper giving the symptom’s .
    After reading the article I visited my GP and took a course of Anti-Biotics (AB) which worked very nicely, although after 12 months I needed another course of AB and every 12 months since then the same.
    I also supplement this with drinking three tablespoons of Kefir every morning approximately 30 minutes before eating my breakfast. Since using Kefir I never get any indigestion and can eat anything I want and I eat big meals although I make sure to masticate all food well.
    On the subject of Kefir, sellers of kefir seed state that it should only be used for approx 15 times before throwing out and using renewing.
    I have been using the same Kefir for over 12 months and have found that it has become more potent i.e much thicker. Be aware, if considering kefir that it is very easy to overdose and that if one does overdose the results can be very embarrassing, you will get very little warning!

    • What were your sibo symptoms and what AB did you take to cure it
      Did you have a reaction from the AB? How long were you on it?

      • I’ve taken Zifaxin anti biotic about 4 times in the past year, & it always goes away, but a few weeks later it’s back. I asked my doctor about adding neomyiacin,?but he says they neomycian can cause you to loose your hearing. My gastroenteroligist is not very knowledgeable about SIBO. I’m going to see as doctor at Cedars Sanai clinic, where Dr Pimintel trains the Drs on SIBO. I’m on the Fodmap diet. They have ice cream w no lactose, but that makes me sick. I either have diahrea or I’m constipated.

        • Hi Adele ! My Gastro sent me to cedars as well but the wait time
          To see a doctor is crazy. Can you post about your experience once you go? I’m seeing a different Gastro in my area (San Diego ) this week. Hopefully I have better luck

          • Absolutely Go to Cedars. Call daily for cancellations. You will get in earlier. My daughter got in next day instead of MAY! They are fantastic. Biofeedback is practically curing my daughter’s IBS type constipation and helping prevent reoccurring SIBO

            • That’s awesome! Gives me hope… I have an appointment st cedars as well on march 7th for my sibo. Already tried different doctors in San Diego that did not help.

  7. Hi, and thank you for investigation and help.

    Is it possible to have an overgrowth on bugs that feed on proteine and fat? I have huge problems with longchain carbs AND also proteins and fats too. Thats why SCD Diets fails in my case. I cant even take aminoacid capsules or hydrolized proteine (both highly digestible) without have immediate reaction. How could these bugs (l presume some clostrids and entercocus family members) be diagnose in the SMALL intestine? And how can they be eradicated? Rifaximine and Neomycine? I am struggling since 6 horrific years and have tried many approaches with dietchange and herbal antibiotics. But I have zero changes in the condition.
    Would be amazing having answers.
    Thank you

    • Hi Carole,

      Could you please tell me what reaction do you have?
      I know your question is to Kelsey but – maybe you have histamine intolerance. Bacteria can digest protein and fat but i guess only if you dont digest it – aminoacid capsules or hydrolized proteine. Does your amino acids contain histidine?

      • hi Peter
        Reactions like: heartrate increasing, white furry tounge, constipation, brainfog, all mucus lining in mouth and nose drying out, bloating, headache, fatigue, nightly relux…etc.
        I used to have Histamineintolerance, but this was before developing SIBO. I know that my Diaminoxidase is ok again. ALso because the reactions I used to have were exclusively to the list of specific food which cause the Histaminose. ALso the migraene was predominant in the symptoms. But now I have reactions to ALL Proteins and Fats. Yes, all you do not digest. Thats why I think the bugs sit now in the upper digestive system – in the small intestine. The food has less time to be digested. The aminocaps did not contain histidine. Regarding the different proteinpowders I cant tell. I^ve tried different. But the reaction is the same to all proteines. Can be a piece of chicken or a almondflour f.e.
        What experiences with therapy do you have?

        Thank you

        • Hi Carole,

          I think your proteins are not so easy to digest as you think – i have a book about Leaky Gut from Case Adams
          /The Science of Leaky Gut Syndrome/
          and there is a chapter about hydrolisation and it explains in more details the problem – not only hydrolized protein is a problem but also enzymes used in its production. If you really want to test if your bacteria is the problem /i think there is 99% chance it is not/ you can try to eat raw eggs or at least raw egg yolks, or sashimi – raw fish or steak tartare – raw meat or coconut oil that you made – because there is no raw coconut oil on the market – all say cold pressed but it is not cold processed. Olive oil may be raw but it needs bile for digestion.

          • Hi Peter
            what should happen with the sort of proteins you listed? And if you dont think its bacterias what should then cause those problems? I `ve had several test on colon bacteria confirming I have too much of putrifying bacterias in my colon (like enterococcuss spec. /e.coli)

            • Hi Carole,

              When you eat meat,eggs etc. it will putrefy if you dont digest it – if you have low HCL or pancreatic enzymes – if you take enzymes this will maybe help 10-20% – but when you eat eggs and fish raw they have enzymes and will be absorbed even if your enzymes are not working. There are several diets that recommend raw animal foods- way diet, primal diet, raw paleo, Seignalet diet.
              I think your symptoms are caused by your immune system – i mean the bowel does not want to absorb this molecules and then maybe bacteria digest them. If you check this article – it explains similar thing with fats:Do Refined Oils Cause Leaky Gut?
              I have read in some forums about people eating only meat and coconut oil and have no success healing their gut – because the meat is cooked and the coconut oil is heated. Also some people say beef is not easy to digest even raw – unlike eggs or fish.

              • Thank you for the informations. I never ate raw meat. But I did the paleo diet which excludes refined oils. I use raw coconut oil already a couple of years now. Fortunately we have it available in every supermarket.
                You might be right about the bowels refusing molecules. My immunesystem is all steared up by this immense stress.

                • Hi Carole, I know its been a while since you posted your issue about trouble with proteins but I’ve only just read it. I have trouble processing proteins and I often get some of the same symptoms you do, especially the racing heart, but I often get fevers and chills, anxiety and insomnia with it too. If I eat meat twice in one day, this can happen. I think it may be caused by Ammonia permeability which can kill you if it gets too high. Certain bacteria/viruses produce too much ammonia and when protein is ingested, it can add to that load if the body can’t eradicate it. I take Yucca every day now to reduce ammonia load. It works well and if I get a flare up, I take 3 a day to eliminate it.

    • Hi Carole! I get emails on most of the conversations on this page and Interestingly so I was reading today about a condition called SIFO. Same symptoms as SIBO but this is an overgrowth of fungus in the intestines that rarely gets discovered. Might be worth looking Into. I plan on doing the same since my symptoms haven’t improved either.

      • Hi thank you for your suggestion.
        I did have candida tested a couple of times. Looks like I am not suffering from fungus. (luckily)

  8. Hi Kelsey,

    My doctor ordered me rifaximin in Canada it is zaxine to treat symptoms of sibo without testing as it isnt available. I have yeast marks on my body could this get worse on antibiotics and what are the chances of getting c. diff on rifaximin. Also when and how much guar gum do you recommend taking?

    • Nat, 5 grams hydrolysed Guar Gum per day. (See blue footnote 8: It will take you to the study. It tells you near the top, in the Abstract (summary) section.

  9. FODMAP is all researchers’ concensus

    Dont think you would be any chance more brilliant than those reseachers

    Sibo = stay away from FODMAP for least 6 months

    • Avoid FODMAPS Except when on Xifaxan (Rifaximin) or the Herbal Protocols. Otherwise, the bacteria you want to eradicate goes into hiding, so to speak, & isn’t as effective.

  10. Hello Everyone! I have read through all these post seeing if anyone has symptoms in common with me and many do. Since a hiatal hernia repair I have suffered from the most sever stomach pain that puts me in the ER many times. Has anyone had issues with the bio-mesh used for a hernia? I am on the fodmap diet, tried everything in the blogs, will be doing SIBO test this weekend but as of now nothing has helped this pain, it’s so extreme. I just have a feeling if the SIBO test comes back positive it’s just one of other issues going in the abdomen and putting me on an antibiotic is not going to cure it all that is happening. Please let me know if anyone out there has experiencing this terrible pain has had a hernia repair and did they seek help? Did the bio-mesh play a role? I am SO desperate for answers, I can’t imagine a life with this continued pain, it’s unbearable

    of course you see the commercials from the attorneys for the bio mesh issue but I don’t want to be taken advantage of by people seeking to create a class action suit so they can profit and the victims are left with nothing.

    Thank you! This is a wonderful forum and I have learned a lot by everyone’s posts.


    • I’m in a group where people have nerve pain (Pudendal pain). Many of these people have had procedures using the mesh, & they’ve gone thru extensive surgeries to get rid of the mesh, which is causing them horrible pelvic pain. It has traveled all over their pelvis & done awful nerve damage & is causing them horrible pain. You need to get it removed. I don’t understand why they are using it. It should be outlawed in my opinion.

  11. I’m kind of confused and a little frustrated. My gastroenterologist just put me on the SIBO diet and told me to stay on it two weeks while taking an antibiotic to kill bad bacteria, then follow up with the GAPS diet after. This article seems to say that might be wrong because the bacteria will hide if I do that. What should I do? Help! Thanks!

  12. Solutions for my SIBO:
    (Before I found this combination, I was flat on my back for weeks at a time with SIBO)

    When I feel it coming on / bloating:
    – Oregano oil: “Oreganol” brand found at natural grocer. Put about 5 drops in a couple of ounces of water, drink before going to bed. Stuff is amazing! It kills off excess bacteria for me overnight. Tried other brands, like this one the best.
    – Garlic: “Kyolic Extra Strength Reserve” brand. I take 3 capsules along with the oregano oil before bed. Combination of the garlic and oregano seems to work the best.

    – Intestinal cleanser: “Perfect 7” brand by All One. http://www.all-one.com. Fantastic at keeping my stomach and intestines working properly. Use before bedtime.
    – Miralax: I use generic from Costco. Add to Perfect 7 routine if I’m feeling a bit “stuck”.

    Other: No gluten! I eat spelt bread. No dairy – except raw or good quality yogurt.
    – Daily routine / work back to normal
    – Once a week, able to eat pizza, ice cream, popcorn. I just don’t overdo it.
    – Able to eat anything at special events: buffet, super bowl party, etc. I just be real careful what I eat for several days before and after.
    – Occasional flare ups: real bad one this week, but its the 1st bad flare up in over a year. Had to take 3 days off work. 1st day I rotated the oregano oil / garlic and the Perfect 7. Last 2 days for recovery (flat on my back, watching movies). Back to the SIBO diet for a few weeks, then I will be fine again.

    Elapsed time: Felt better within days, even better in a few weeks. Tons better in a couple of months. 6 months later I literally forgot about the SIBO (except for watching what I ate).

    I still have SIBO, but it is (almost) completely in control.
    Hope this helps! Ask questions if it doesn’t make sense.

    • I have SIBO as a result of a small bowel resection including cecal valve caused by Crohn’s disease. I take xifaxan about every other month and it seems to help but not great. I need to change my diet.

    • Hi, I’m planning to start on low FODMAP foods and really confused about garlic. It’s listed as the number 1 food to avoid along with onions, yet it’s touted as the number 1 supplement to take to kill bacteria. Should I take it or not?

      • Onions and garlic are of the same family. They are high in fructans. Apparently humans do not have the right enzymes in our systems to break down this type of fructo-oligosaccharide, according to several articles and the creator of the FODMAP diet. Once you begin the diet and have it established for about 6-8 weeks, you can begin to add things back into your diet one at a time so you can see if you have reactions to that item.

          • Many use oregano. It all depends on your body, what type of SIBO you have, and the interaction with other foods you may be eating. Truthfully it’s a crap shoot but keep trying because one day you will find what’s right for you. Neem has also worked well for some people and you can buy it to use as tea. It’s somewhat bitter so I combine it with other teas such as white peony or lavender or even chamomile.

          • even though you should avoid garlic, you can still take allicin, it is extracted from garlic so it is not the same as taking a garlic supplement. I’ve taken allimax pro, that combined with oregano oil and some others is what my dr. Prescribed

  13. Treatment hasn’t really helped my case. I am experiencing excessive body odor and not sure that it’s due to the bacteria anymore. I noticed whenever I don’t fully empty (go to bathroom due to lack of intestinal waves) everyone around me can smell something. They can’t stand being around me.

      • I’m not sure why the odor. I am in the process of seeing a motility expert since I know the odor is being caused by the slow movement (or break down) of the food. I am hoping something soon will help. It’s ruining my life

  14. I am currently on my second round of rifaximin treatment. What I really wanna know is what is the bottom line problem that caused this and my suspicious is low stomach acid due to low thyroid problem. What other tests should I suggest my Gastro as he seems a bit out of ideas

  15. Does anyone else have trouble sleeping due to the stomach pain/bloating? Some nights I am awake all night, and I was wondering if anyone has found any type of remedy that helps in this situation.

    • Your issues could be parasites… I’d look at a good herbal cleansing protocol. It really help with SIBO but you may find that it clears you from more than just unwanted bacteria in your small intestines.

    • I’ve had help recently with two Kavinace (kinda expensive) per night, plus a melatonin. Now brands GABA is a cheaper alternative, just started it.
      So far, in a few years of research, I have seen NOBODY who has cured SIBO.
      I’ve had results recently, and this sounds odd, by massaging my stomach, a lot and vigorously. And, I don’t make money off this suggestion, I’m an engineer.

      • I haven’t tried those, will look into them. I agree, massage helps… and yes, I have tried one supplement/remedy after the other, all very expensive, none effective. There is not a lot of incentive for anyone to solve this problem as you say, since it affects so few people, and since if there was a solution we would stop paying all this money for these ineffective products we hope will cure us. I think I am going to lay off the cures for a while, stop going to doctors, and just focus on finding a way to live with this awful condition. I have had it for six years now and it does not seem to be alleviated by anything I’ve tried. Have you heard of any support groups for people with this?

        • Hey Lauren and Sibo Warriors

          I almost teared up when I saw your posts I’m feeling the same right now (just 2 years though…). I think there are some support groups on FB or the forum ibsgroup.org where Sibo is also discussed (but not really understood…).

          I’ve also laid back the supplements they made me nothing or got even worse (probiotics & HCL caps…) and now try to go on with life.

          About insomnia I have had it especially after eating “not recommended” foods like onions, or being on the computer too late at night. There should be some plants that help insomnia too, or deep breathing (which is hard with a pregnant-like belly :s).

          • That is one of the worst parts of this condition: I cannot breathe deeply because my diaphragm seems to have no space to move. I also get a vertigo when I lie still for too long with my bloated stomach. Does that happen to anyone else? The massage helps, and yoga helps, but it’s just a problem when I need to lie still so I can fall asleep, and I am not able to do that. Last night I was up most of the night. I am not sure which foods to eat or not, everyone says something different and I don’t seem to notice much difference in my condition regardless of what I eat.

            I am reading a good book called “How to be Sick.” It applies Buddhist wisdom to dealing with a chronic untreatable illness which I am starting to think this is. The practices are great. I need to remember to do them more.

            • You have to do a really low carb diet do see benefits. I have been doing keto (under 20 net carbs). Feel like a million bucks right now, stomach distress gone, memory coming back, sleeping better. It’s a drastic diet but it works! (Well at least it does for me). I feel your frustration with not know what works, the answer for everyone is different. Keep tying!

              • Same here, only keto diet has worked for me. I only eat SIBO-approved foods on keto and remove what I can’t tolerate (dairy products, nuts, seeds).

                • Do you count carbs from vegetables like cucumbers for example or only starches and fructose from fruits?
                  Cucumbers have some fructose but it should not be malabsorbed and will nod feed bacteria?

          • Oh also, regarding support groups, I am part of that FB group and I know the ibsgroup also – but I am starting to feel like being online complaining about symptoms that will not go away is not helping. I am not sure what type of support group I am looking for to be honest, maybe there could be some kind of group with a positive focus, like things we can do to feel better such as massage, yoga, or just talking to someone who understands?

            • I totally agree with attempting to gain positive insight. I have suffered with this for many many years, trying multiple products that have done nothing really. Sometimes just knowing that someone else is rooting for you to have a good day can boost your mood!! I am sick of hearing myself complain so to go to one of those sites where everybody is complaining would be overwhelming for me. You have a super idea there!

              • Thanks Pam, I am rooting for YOU to have a good day today : )

                If you are interested in picking up the book I mentioned in my above post, maybe we could have something like a book group where we discuss a chapter at a time and try to relate it to what we are going through and how to cope with it.

                • Lauren, would love to say yes to the book, but I am in the middle of 2 other books right now. One is related to the mind, the other is “fun”. 🙂 I appreciate you rooting for me today! I have had a fairly good day, so thank you! Rooting for you as well! Staying on my diet usually helps. I have tailored several of the diets, combined what I have gleaned from them, and I try throwing in a few odd items every week so my body doesn’t get sick of the same thing all the time. What is something that helps you?

                • Thanks Pam! What kind of diet do you follow? I haven’t found a diet or anything that helps… I kept extensive journals for years and did not see any connection between what I eat or do and how I feel, the pain comes at random and I can’t predict when it will be more mild or when more severe.

                • Lauren, I have had issues since I was young, and I’m 57 now. So it’s been difficult to say the least. However, about 5 years ago, I made some changes according to the FODMAP diet. Dr. Sue Shepherd developed it. I started there, then cut out all dairy, all sugar, gluten, and chicken and turkey. I eat steak (I know that’s really weird because it’s supposed to be hard to digest) every day and sometimes I can eat ham. I use only coconut oil to cook with as olive oil seems to aggravate my gall bladder for some reason. I, too, have good days and bad days and sometimes it seems to have absolutely nothing to do with what I eat. I do know that if I vary my diet by adding dairy or gluten or sugar, I pay for it. Maybe not the same day, but it can be days later. They (doctors) say that can’t happen, but it does. So I’m sure you’ve been on this wonderful roller coaster as well. I started by eliminating most everything and I keep trying to work things in that work well with my system. I certainly hope that you can find something that works well for you. Last evening was a bad belly evening, but this morning seems a bit better, but belly is LOUD today! LOL. Hope you have a terrific day today! Make the most of every good minute! 🙂

                • Thanks Pam! Wow, you have been living with this for a long time! What gives you the motivation to keep going?

                  My belly gets very LOUD at times too… But I almost prefer that, because when it is quiet it seems that no movement is happening and I tend to get headaches then.

                  I have slept well for two nights in a row, that is a treat. I have a very tough week at work coming up. I’m trying to remember to keep things in perspective. Coffee helps me, I am going to go get some right now! I hope you have a wonderful day…

                • Lauren, so glad to hear you have slept well for a few nights! Sleeping issues wear us out, for sure. I get headaches when the “stuff” slows down as well! Feels like my system is being poisoned, at least that’s what I tell my husband I feel like. Then things speed up again and the noise comes back :). I am wondering if there’s any way we can exchange emails so we can get off this blog? My doctor is having me try a new medication and it does seem to be helping a bit. Only on day 2 so we’ll see. Do some deep breathing today to prep for your stressful week. And I will be sending you positive vibes as well!

                • Ladies look into ATRANTIL and also look into a motility supplement – you need to keep things moving otherwise if it gets stagnant it leaves you open for bacteria to grow.
                  Also doing a round of kill sups may help – along with butyrate – many are low in this and when you are it leaves our guts open for bad bacterial growth.

                • Tanya, just tried Atrantil two weeks ago. Very strange side effects and they told me to stop taking it. Another one down.

                • Your side effects could have been die off – it can cause that when you start it. It did for me and for my daughter – but 30’days into it you can start to see the benefits – these supplements can sometimes create a flu like die off – the question is can you handle it ? The only way to get rid of this bad bacteria is to overcrowd it and this can cause die off. You will not heal unless you go through die off.

                • Tanya, thank you for the information regarding the die off. I am all too familiar with all of this as I have had it for about 25 years. I had extreme nightmares, and I don’t usually even dream. I stopped it for two nights and did not have nightmares. I began it again, and had nightmares. It’s not even supposed to break the brain barrier, however, it obviously did with me. I have many strange reactions to medications and supplements. That’s why the actual maker of the Atrantil told me to discontinue it and not take it at all. Weird, yes. Abnormal for me, no.

                • I totally get it …I am super sensitive myself to many things – I like you have had similar reactions to many protocols – so I understand your hesitancy to continue. How do you react to fermented foods? Have you tried the fast tract diet ? Many have success on this plan.

                  i hope we can all heal going forward ….it takes time and patience and persistence …..

                • Thanks, Tanya. There are times when I can do limited fermented foods, but very rarely. I do apple cider vinegar periodically to help balance all the antacids I take. That seems to be the only thing I can tolerate right now. About twice a year I may have a few sips of wine, but I only do it when I am feeling OK. For some reason, the colder weather (I am in Michigan, brrrr) seems to make everything worse. Most likely having to do with the muscle spasms since we tend to stiffen up more with the freezing temps. I am dairy free, gluten free, and sugar free. I don’t even do “fake” sugar. And I try to get as much organic as I can. What have you found that works for you?

                • Sorry Pam for my delay in post.
                  You asked what works for me – well I have been on every diet imaginable and every combination as well – I decided a year ago to forgo the cookie cutter diets of low histamine, gaps, fodmaps, AIP, fast tract diet, etc and find a middle ground to what works for me. Over the years I’ve done them all.

                  What I realized after much research and gut podcasts etc – The key to healing the microbiomme is diversity. Introducing different greens and coloured veggies ….different fruits and coloured fruits …etc to help create a strong microbiome.

                  If there are certain foods I don’t tolerate I take them in small amounts ….even a tsp will do. So for example if a food is particularly high histamine but low in fodmaps ….I will take a small amount of it ….because it does carry health benefits ….high oxidant rich foods – anti inflammatory foods etc are all healthy and beneficial for us, but maybe they are high fodmaps or higher histamine….so I try and balance the rest of my plate out with lower histamine foods and lower fermentable foods etc.

                  I have been able to expand my diet this way. I always take a digestive enzyme with each meal. To help with absorption and break down of foods. I am dairy free, gluten free, etc and have been for 8 plus years.

                  I don’t believe in a cookie cutter approach and I have taken on many protocols. We can get nutritionally depleted if one continues to limit their scope of foods to a handful items. Then this will lead to other health issues with thyroid and adrenals etc.

                  I do ok with certain grains. I believe my body needs fibre, and I do well with it. I am able to eat buckwheat, amaranth etc. I feel we need these fibres to clear estrogens and detox. For me meat is not a huge part of my diet. For example a typical breakfast for me is 2 egg yolks, a bunch of fried kale in olive oil and real salt, two pieces of my allergin free buckwheat bread with sprouted pumpkin butter on it, all of this on a plate drizzled in more olive oil and lots of real salt.

                  Also I take larch ….this helps feed the good bacteria. I do take a few other things as well, but for me I try to gather my vit and minerals via my foods. My body works better this way.
                  I am trying quercitin to help lower the histamine load. I tried DAO but I didn’t notice much difference.

                • Sounds like you have really done it all. And figured out at least a somewhat balance for yourself. I also believe it is an individual thing, that we are all made differently inside as well as the outside, and there are some things that are tolerated differently in our systems. I also have given up on the cookie cutter diets, figuring out what works and doesn’t work for me. There is so much variety out there, I don’t want to limit myself, or my body, to ultimate nutrition.
                  I also do minimal grains, mostly oatmeal and ground flaxseed every morning. But I do granola, an organic one by Bob’s Red Mill. And I add in cacao bits for a treat. I do love kale and eggs, but not in the morning 🙂 And real salt is my friend as well!! I use lots of it. Olive oil is a bit heavy so I do all my cooking with coconut oil. Lighter and has a higher heat tolerance and doesn’t taste like coconut at all. I have a very low tolerance for spices and am allergic to onions and garlic which makes me sad because I would love to spice up my foods a bit more. I do oregano, mostly fresh from my garden, and dry it for the winter so I still have some throughout the year. Periodically i will do oregano oil as well.
                  What is larch and where do you find it? I will do some research on it! I cannot take vitamins in any form as supplements because they irritate my stomach and intestines. So I also get all from fresh foods.
                  I’m feeling a bit like I’m on the mend from my last awful bout of feeling sick, was down to 89 lbs 2 years ago and have gained back about 15. Making headway but it’s always so slow to get it back.
                  Let me know how the quercitin works for you!

                • Hi Pam,

                  Is Atrantil the new medication? I just tried that for 30 days, it did nothing – if anything made the constipation a bit worse – though that might have been from the low-carb diet which they recommend, giving me less fiber than usual.

                  I used to live in Michigan! I am curious whereabouts you are… Yes, I would love to exchange contact info and be able to be in touch without this site; perhaps we could do this by ‘friending’ each other on facebook first – then we can message each other our contact info privately. If you have fb, look me up under the SIBO-C support group. I live in NY. If you have trouble finding me there, lmk and we’ll figure out another way.

                  I hope your day goes well today


              • PAM.
                you mentioned in a later comment that you are taking antacids?! Your stomach acidity is the foundation for proper bacteria in your gut. You understand that right? Can’t get rid off SIBO taking antacids, unless you know something I don’t know.

                • Craig, yes, I totally understand that antacids aren’t the way to go, however, it is the only way I can function, even a little bit. Many days I am so nauseous I can’t do much of anything. The antacids make my life bearable. And the bloating actually hurts me, to the point that I look and feel 6-8 months pregnant after a meal, even a small one at times. So until I find a way to get this SIBO to cooperate (and it does at times and then I don’t even have to take antacids) and so I can live my life as a half-way normal individual, I will take them as needed. So yes, I know they aren’t an answer, but they are a relief to me. Thanks!

          • Hi Dorbe. I’m sorry you are struggling with this too. For me, focusing my energy on how to deal with this problem rather than how to fix it is working right now, since most of my attempts to fix it were costly, time consuming, and seemed more likely to make the problem worse than better. I am reading some great books about chronic illness and getting through difficult situations in life that give me inspiration and helpful tips. Regarding the insomnia, my brother suggested an over the counter product called “Z-Quil.” It is like the ingredient in “Ny-quil” that helps you get to sleep, without the cold-symptom relieving elements. It is not heavy-handed, but it does help me get to sleep when my stomach is hurting. It makes me drowsy enough that I can ignore the pain briefly and fall asleep. You have to make sure to take it early enough though, so you can still get a full night’s sleep. If you take it too late you may still feel drowsy in the morning.

      • Pain and bloating during the night indicates you are likely eating foods that are feeding a small intestinal bacterial overgrowth (SIBO). When SIBO is the primary driver for insomnia (anxiety is often common), the degree of the overgrowth will determine how aggressive you need to be about sleep support. Early onset SIBO often needs only a little support; e.g. 3mg melatonin, 100mg 5-HTP, herbal teas, etc.

        Progressively worsening SIBO will often require “stronger” support, including the product Kavinace; which I recommend to patients often. As SIBO growth worsens and your body’s sensitivity to it become for sensitive even strong sleep medications like Ambien and Klonopin become ineffective.

        SIBO diagnosis and treatment is critical to a hand on insomnia. I also recommend urinary neurotransmitter testing to identify your circulating neurotransmitter levels to determine if your overall nutritional needs and create a brain-balancing strategy.

  16. This doesn’t make sense, sorry. Being a holistic health coach and someone who is trying to solve sibo for herself, this theory does not make sense. I wonder if the author ever had to deal with this herself or is she just going after the latest theories?

  17. To say FODMAPS are high carbs is a bit misleading- they are short chain carbohydrates that 30-40% of people lack enzymes to digest. FODMAPPERS can eat lots of high carb foods! Otherwise, interesting article, though I think you need to read up on FODMAPS- try Sue Shepherd/Monash Uni/Box Hill Hospital…

  18. what a [edit] overly simplistic article. rifaximin doesnt work most of the time, and to imply that the treatment is as simple as oh just have some rifaximin and you’re good gives off a vibe of ignorance on your part.

    • Rifaxin is temporary relief, and expensive, hence it is a big money maker for big pharma. Ceylon liquid cinnamon or GSE kill everything. This is a great disease for big pharma, no real cures stated by anyone that you have read about….correct? We each have 100 different supplements and no cure, but lots of profit.

  19. Im not sure I understand. So we are supposed to eat ‘normally’ during the time we are trying to get rid of the SIBO?
    It’s so confusing, there are so many diets and opinions and guidelines out there .. I’m 20 years old and trying to get rid of SIBO. I’ve just finished 14 days of antibiotic and now am planning on taking Atrantil with Oil of Oregano capsules and Digestive Bitters as well as Biotics IPS. But I am very at most as to how to eat. Do I eat “normal” food like said in the article above or do I follow some kind of low fodmap etc? I’m going to stay gluten and lactose free but besides that, I don’t understand what I have to eat.. 🙁

    • Hey Alix, I am also 20 and trying to fight off this crap thats controlling my life. I took Rifaximin while eating a low carb/no sugar diet, although it helped I relapsed within a week. I am now on oil of oregano and trying the route of eating lots of carbs and sugar during the treatment. It is not fun I can tell you that haha. I believe as long as you are taking an antibiotic you want to be eating the bad stuff. Once you are off of them you want to avoid them until your stomach heals and you can tolerate them. Another option I have heard of is taking something called Interface plus which makes it easier to kill the bacteria. I have not tried it yet.

      • This doesn’t make sense…people who can’t digest FODMAPS lack the necessary enzyme- and there is no ‘cure’ for that except to restrict FODMAPS…no biggie, there is a wide variety of foods you can eat…when FODMAPS are eaten, the gasand bacteria from undigested carbs can spill over into the small intestine- hence, why FODMAPPERS are prone to SIBO. Simple. Not restricting so that they can’t ‘hide’ sounds totally wrong. Restricting FODMAPS to reduce the problem- well, that’s not really rocket science.

        • Avoiding fodmaps for a long period of time is not good for you. The problem here isnt that we are having a hard time digesting fodmaps, but that we have too much bad bacteria. Fodmaps feed the bacteria, so once they are eliminated then fodmaps can be reintroduced

          • The real FODMAPS diet has an elimination phase and a reintroduction phase, so its not about total avoidance, but it is about reducing by-product gasses until symptoms such as SIBO reduce. People who lack the enzymes learn what their tolerances are, and experts such as Monash University recommend reintroduction, to your own level of tolerance.

        • THAT doesn’t make sense! I went from being able to eat anything I wanted with no gas, taking a normal poo every day, to gas & bloating with every meal and chronic constipation. I have SIBO, it was caused by taking probiotics. I have a hard time believing that it’s just normal to not be able to digest FODMAPs.

          • Hi- No it’s not ‘normal’ to not be able to digest short chain carbohydrates, AKA Fodmaps, but there is a lot of expert advice such as the names I posted above. IBS is however extremely common! I get your frustration. Also, in the day and age of bloated guts, aisles and aisles of ‘digestive aids’, type 2 diabetes epidemics, obesity becoming the new normal- what is ‘normal’?

            • Hi- No it’s not ‘normal’ to not be able to digest short chain carbohydrates, AKA Fodmaps, but there is a lot of expert advice such as the names I posted above. IBS is however extremely common! I get your frustration. Also, in the day and age of bloated guts, aisles and aisles of ‘digestive aids’, type 2 diabetes epidemics, obesity becoming the new normal- what is ‘normal’? PS if the probiotic is inulin it’s highly FODMAP- no way could I tolerate it, at all…

    • it is all very confusing. I have been researching again today how to get some control over the bacterial issue. Crazy as it seems I can take vegetarian gel capsules, fill them with cinnamon and take 3 capsules a day for 3-4 days and usually the SIBO symptoms go away. This time I had to follow it with a round of xifaxin. I get the SIBO intermittently and prefer to treat everything I can with natural remedies. I have no large intestine and that seems to cause part of my problem. I found a good probiotic which seems to help but apparently I need to step up my game and be more careful what I eat. problem is different web sites tell yes and no to the same foods. I use a heating pad on my abdomen while I lay down and I get relief that way. I have Crohn’s, IBS and several surgeries have left me with side effects that are less than wonderful. Stress aggravates the Crohn’s and SIBO stresses me, hello merry-go-round. I think the best anyone can do is research when you need to, don’t be afraid to argue with your Dr. if you disagree, and Be Your Own Advocate! You are the one living in your body and you know more about how it works or reacts than the Dr. does. Stand up for yourself. since I have done this I feel much less like a victim. No my GI Dr. does not always like it but he isn’t sick, I am. I never know from one day to the next if I can even leave the house. He is healthy and does not have the same low quality of life as I do. If I am lucky an appointment with him lasts 10-15 mins, every 3-6 months and he’s gone so I speak up!! Nobody is going to fight for you but you. Question every treatment option, test, med, whatever they throw at you. By the way I do this as nicely as I can but I get my point across. I was sick last year for 9 months, barely able to eat, on the couch, I pain. GI Dr. tested me every way he could think of and all the tests came back normal. I lost 25 lbs and was scared and angry. My Husband and I finally looked at what happened right before I got sick and realized I had started taking Lexapro for anxiety and depression. when I got off the Lexapro I immediately got better. Why do we tell them all the meds we are on if they do not pay attention. I researched the Lexapro and eventually came upon an article that described exactly what was happening to me as a possible side affect. I should have been more proactive earlier but I thought one of the tests would show the problem. just saying, take care of yourself!

    • Eating “normally” doesn’t not mean eating gluten, dairy, soy or other foods you have a true sensitivity to or are gmo etc. She means eating some fodmap foods, because the bad bacteria are easier to kill with the treatments when they are feeding, not dormant. So when you eat fodmaps during treatment as opposed to avoiding them completely the bad (and good) bacteria feed on them and become active so the antimicrobial treatments have a higher success rate. Even tho this may mean a temporary worsening of symptoms. Plus the more good bacteria are needed to combat the bad. Not feeding on any fodmaps for long periods isn’t good.

  20. Hello,

    I’m a 30 years old from Romania and after the hp treatment with ( amox + claritom + pantoprazole – 7 days and continues ipp treatment for 4 weeks ) started to feel better but in a short while i developed some symptomes that “killed” me. After attending a weeding, one morning, after breakfast ( bread, eggs, cheese ) i felt really bad – headache, abdominal pain, muscle fatigue/pain, palpitations. I had no problem with bread before, in my HP/gastritis i was eating butter with toast without any problem. Then i noticed that after eating chocolate, or drinking coffee, i feel leg muscle fatigue. So.. i have this intolerance which is clear after the treatment for HP ( which was eradicated – stool test confirmed )… after eating those maccarons cookies, i got very bloated, palpitations. bromazepam and trimebutine maleate is helping a lot !
    in romania GI are not familir with this problem, i asked 3 of them, they said that my symptoms have nothing to do with bacterial overgrowth. The herbal medication is not available in Romania, but i found them in UK and i can you them – Candibactin-AR and Candibactin-BR …. the LBT is not available soooo.. what should i do? any advice !

    p.s. with the sibo diet, i feel very good, energic, no joing pain, no tension allergy … otherways, if i eat 2-3 slices of bread, or pizza, chocolate, my status changes, i can not sleep, palpitations and joint pain.

  21. Thanks for this article! I’m researching SIBO for my final presentation of my Dietetic Internship. I knew that the low FODMAP diet was more an indicator than a solution to the condition, but I wasn’t sure about recommendations. This is the info, and journal articles, I needed.

  22. I have been struggling with SIBO (methane) for almost six years now. I have been to five well-respected gastroenterologists in the NYC area, as well as numerous dietitians, biofeedback therapists, acupuncturists, holistic doctors, you name it… I have tried numerous rounds of antibiotics which only made me feel sicker, and many diet changes including all raw vegetables, no raw vegetables, gluten free, low FODMAPS, vegan, vegetarian, grain-free, nut-free, low-residue (mainly chicken, eggs, and broth)… nothing has helped. At this point I am losing hope that anything ever will help. I am trying to learn to live with this condition. However, I feel like I have died and at the same time I keep living. It is a very strange condition. My social life has diminished, because due to my symptoms of bloating, dizziness and stomach pain (not to mention all the burping, farting, and loud stomach gurgling) it is not pleasant to be around other people. I also am extremely fatigued much of the time. I feel like everything I’ve ever loved has been torn from me, yet I am still here… not sure how to go on. I’m not even sure why I’m writing this, but perhaps because I don’t know anyone personally who suffers with this condition yet I know others are out there and would like to connect and find out how others are going on with their lives despite this condition. If anyone would like to write me back maybe we can somehow support each other through this nightmare ? Thank you…

    • Lauren, have you given Atrantil a try? Non-prescription, I’ve heard it’s helped some SIBO methane cases. It deals with archae rather than bacteria. Sorry to hear you’ve had such a long road with SIBO. I’ve been trying her al antibiotics forrecurran e of hydrogen type, but tomorrow will call the GI MD and hope they can help figure out the reason for recurrence. Anyone had success using Iberogast or Motilpro to prevent recurrence?

      • I have used both Iberogast and Motilpro with patients. I have seen Iberogast working better than Motilpro. Motilpro typically works for people with low serotonin activity, but taking straight 5-HTP is a lot more cost effective way to do this. If Iberogast is helpful, it is important to also determine if Betaine HCL before meals is needed. Also, enteric coated peppermint oil can improve Iberogast’s activity.

        • Hi Lauren, I’m so sorry for you. I’ve been feeling exactly the same as you! I’ve tried so many different things but finally I’ve found that giving up sugar and white carbs has made my symptoms completely disappear! I don’t know if it’ll help you but thought I’d share. xx

    • Lauren … I feel your pain. I have been through all that “trying everything” over about 26 years of chronic illness. I even ended up doing a PhD in the Vagus Nerve and Mindfulness and qualifying as a hypnotherapist. My latest thing is starting my own blog, on the vagus nerve and the conditions I have – just did a 4 part on SIBO after attending (via webcast) two conferences run by holistic and main stream SIBO experts. You might find something you like here
      http://www.wellbeingatworkdr.com. The 3rd one is on all the diets I found or tried and a bit of a where they conflict thing … because boy do they.

    • I have been feeling the same way lately…..I have given up all my favorite foods…and have been reduced to broths….smoothies….watered down coffee…..and water…..and still….my stomach is swollen and painful…..tried to do yoga with my daugther this morning and became so dizzy I had to stop…then fell and hurt my knee and right arm….I am angry…because I’ve been eating healthy for years….drinking water and became a runner several years ago…..I began suffering from fatigue…and stopped running…then depression….then laid off from my job resulted in eating unhealthy…and then the swelling and painful belly began creeping up on me…I’m down right angry about it…it has been debilitating…..and nobody around me understands…..so I get it…..right there with you….very difficult to be positive when you’re always hungry and tired and bloated…..

      • Hi Linda,
        Thank you for responding. I have felt the same way, after eating healthy for so long, it is depressing to be so ill and have to give up so much of what you like, both in terms of food and in terms of the activities that can no longer be done. For a while I did what you were doing and ate a very limited diet, but now I am starting to expand what I eat again. It honestly doesn’t seem to make a difference what I eat, the swelling and bloating are bad nonetheless. However, the dizziness improves for me when I eat more heartily.

        How long have you been living with this condition?

        I hope we can keep in touch and support each other, like you said most people don’t understand because they have never experienced such a thing, and I would never have imagined either until it happened to me. I try to maintain hope that I can heal from this some how, and maybe we can share ideas about things we are trying and how they work out.

    • Hello Lauren;
      This year I started getting the severe symptoms you described with the methane type of SIBO….bloating, etc…not being able to process anything….however, I discovered the Antratil and discussed the product with my Functional Medicine practitioner and am now on day 28 of using it and have experienced a huge turn around….my constipation is much relieved…..my digestion is vastly improving…..look up Atrantil at atrantil.com….study it….Chris Kessers website has some info about it……call up the company……it has a high success rate!!…..Blessed Be your journey…

      • Thank you for writing to me Susanne! Someone else had also just told me about Atrantil and I already have 3 packages of it on its way to me! I hope that it will help me too. I am curious about the recommendation to eat a “low carbohydrate” diet while using it – can you give me an idea of what your diet is like while you’ve been taking it? I want to make sure I do everything possible to increase its chances of working. Thanks again for the recommendation!

    • Wow Lauren..I wish you and my mom could talk by phone. She is 94, has this condition and its making her miserable. She only weighs 85 lbs..and dreads …truly dreads eating. She lives with us.

      Dianne Templeton Gardner

      • I’m sorry to hear about your mom. Has she been sick with this for a long time? I used to weigh about the same, but I have since found ways of eating that allow me to have more of a healthy life in spite of my condition.

    • Hi Lauren,

      My son is currently experiencing Sibo. The psychological and social aspects of this disease worry me. I think you certainly have a role to play and could provide some solutions for how to deal with SIBO beyond the physical. I would be interested to hear more advice if your able to share it.

      • Hi Dave,
        I am not sure if I have much to offer in that regard. My mom just gave me a book that seems helpful so far, it is about living with a chronic medical condition. It’s got rather a gloomy title: “How to Be Sick” by Toni Bernhard, but it applies Buddhist wisdom to the predicament of living with a chronic illness. If your son is looking for someone to write to, or is interested in reading that book and discussing it with someone, please reach out to me. All best,

    • Hi Lauren, I totally relate. It’s been 10 years for me and I’ve tried numerous diets and doesn’t seem to matter how I eat I still get the same symptoms. It’s so frustrating and confusing. For me I have just been trying to figure out all the possible things that contribute to this. I found diy health blog by Angela has given me helpful information. She suggests some tests you can do at home – like for instance I know I have low stomach acid and that can lead to SIBO. It’s just so confusing and complicated when it can be more then one thing causing/contributing to my symptoms. But I am still hopeful. I am about to start a round of herbal antibotics – allimed, berberine and neem to get rid of SIBO. Considering trying an elemental diet too. Let me know how you get on with your antibotics. Goodluck 🙂

      • Thank you, good luck to you too! I am about to try Atrantil, I have heard it has a good success rate. I will let you know how it goes, and would be interested to hear your experience with the things you’re trying too.
        All best,

    • Hi Lauren, You could have been writing about me as well. I can empathize easily.

      That said, one of the leaders in Functional Medicine is located in Sandy Hook, CT. I would highly recommend working with her. She really knows her stuff and will help you get to the root cause of your issue. (I just began working with another Functional Medicine MD closer to my home.) Keep us posted if you would. Here is the doctor’s info. I would call the office: drkarafitzgerald.com

      • Day 29, still no change… so disappointing. I don’t know what else to do from here. This condition rules my life, I rarely go out, don’t keep in touch with my friends, I just want to sleep all the time. I need to find some way to live with this.

  23. I am a registered naturopathic doctor in Stillwater, Minnesota (www.stillwaternatural.com) and treat/manage SIBO on a daily basis. SIBO cases come in many varieties, but we find a combination of herbal antibiotics, prescriptive antibiotics and lifestyle changes most effective in reducing SIBO activity and improving quality of life.

    Rifaximin is a great antibiotic (97% of t stays in the GI tract), but as research points out, it is not the ultimate solution. Many insurance companies also require treatment failures with lower-cost antibiotic before approving Rifaximin. Metronidazole (Flagyl) better than most. Neomycin can also be used. Neomycin is typically prescribed along with Rifaximin in methane producing (diagnosed through lactulose breath testing) cases. Metronidazole has good research supporting its use for Rifaximin resistant SIBO; it is also used to treat C. diff which is an unfortunate side effect of antibiotic.

    In order to keep C. diff at bay and to help maintain a health gut lining I recommend patients using antibiotic to take Saccharomyces boulardii 2.5 billion twice daily with antibiotics and a quality probiotic at bedtime.

    It is very important to always use herbal antibiotics before using prescriptive antibiotics! 1.) Herbal antibiotics will start the SIBO die-off. 2.) They also kill yeast (Candida) which is always overgrown when you have SIBO. 3.) You can dial the treatment intensity up or down, which you can not do with prescriptive antibiotics. This is important because the die-off reactions can be intense, including lots of diarrhea, so its nice to adjust so you can function in life. 4.) 25% of the time, herbal antibiotics are more effective than prescriptive antibiotics.

    It is also critical to follow up your 1-2 courses of prescriptive antibiotics with 1-3 months of herbal antibiotics. Relapse is so common with SIBO and herbal antibiotics will continue to reduce the SIBO population.

    Prokinetics are vital to help maintain a healthy mass motor complex. Other things to consider include: betaine HCL challenges and supplementation if needed, food sensitivity testing, hiatal hernia assessment and treatment, rule out intestinal adhesions and address any with massage, etc.

    Our clinic is getting a QuinTron breath analyzer in-house to better support our GI patients. This will help us test (lactulose breath testing for hydrogen and methane) more people by reducing out-of-pocket costs and getting results quicker.

    Due to being located in a Lyme disease endemic area, we typically diagnose SIBO in over 65% of our Lyme patients with SIBO being the only thing causing patient symptoms in 33% (1 in 3) patients. Check out my blog on this topic. http://www.stillwaternatural.com/single-post/2016/04/24/Do-you-have-Lyme-Disease-or-SIBO

    Finally, I personally did the homemade Elemental Diet this past year for 2 weeks. I am a naturopathic doctor and have done many intense treatments on myself over the years, but nothing was more challenging than the Elemental diet. This is defiantly contraindicated in most of my patients and should never be done if you are under weight or ever had an eating disorder. I am experimenting using it in shorter time periods prior to Rifaximin treatment and periodically along with herbal antibiotic for 3-4 days.

      • Hi Katie,

        I initially use the classic herbal approach: oregano oil containing gel caps (Metagenics), Berberines (Thorne Research) 1000mg BID and I add in Neem (Himalayan). I later switch to an enteric coated gut product from MediHerb that contains oregano oil, berberines and andrographis. Methane produces must use a freeze dried garlic supplement in addition to other herbals.

        Some people who can not tolerate this approach or did and still have problems can try a couple months of nano-silver spray (Results RNA).

        Other things to consider are partial Elemental diets and food rotations.

  24. Hi Kris, I seem to be doing much better concerning my SIBO,
    But I also need to find a more knowledgeable gastroenteroligist, or dietician. I live in Calabasas, California, just a few miles north of Los Angeles. I also have pudendal nerve Nueralgia (I think). I’ve been to tons of doctors for this condition, which started immediately after a colonoscopy, 16 years ago. My new concierge doctor is trying to get me an appointment with Dr. Pimmentel, at Cedars Sinai in L.A., but I don’t know if that will be any time soon. I’m following the Fodmap diet, but would be happier if I could eat cooked onions & garlic. Can you suggest a doctor who can help me now. How do I know when I can go back to a regular diet? The SIBO has been contributing to my biggest problem, chronic Rectal pain. (Pudendal Nueralgia)).. I got the SIBO about 6 months ago. I’m 73 year old female, & was managing my pain using a fentynal patch, which isn’t working very well anymore. I got off opioids, but still couldn’t sit & my pain Dr. Put me on them again after a 3 month break.iI also need to find a good pain Dr. Near my home. I can’t sit at all, & my health in general is suffering. Can I do a private consultation with you? My quality of life has become pretty poo, the past 2 years, since the opioids stopped working for my rectal pain.
    Any suggestions are welcome. Now that my stomach has settled down, I thought my rectal pain would subside. I thought there was a connection. All my blood tests are normal, except low on B12, & getting weekly B12 shots. Have you ever heard of pudendal pain (Rectal)? What are your thoughts? Would be fine if you don’t want to print this, either way OK. Maybe we could PM or talk. [email protected] Thanks for your help, Adele Casden

  25. I need to find a SIBO specialist STAT! Can you recommend one in the Illinois/Wisconsin area? If not, I will travel to find someone/anyone who knows what they’re doing? Someone who has a track record with success in treating SIBO.

  26. My tendency to this is definitely inherited with many in my family garlic, onion, radish and other vegs / grains sensitive. I understand the logic of what this article says, but I don’t think adding any of that will be a happy thing for me – just one small cookie, even homemade from quality organic flour, is enough to create an increase in ‘weight’ of almost 2 lbs within hours – all gas, of course!, which hangs around for days on end. I’ve been zero grains zero fibrous veg zero pulses for years now and never felt better. It’s a real tricky thing, SIBO is, because there’s still a ton of info that remains unknown on the workings of the gut. And it’s a *^%$#@ nuisance, but there are worse things in life.

    • Soraya I was just wondering about the foods that you do include and some meal examples because I to do not do well on any starches whatsoever. I’ve been treated for SIBO a couple of times and whenever I try to add in starchy vegetables, beans or fruits it always returns.

  27. Does anyone know a good gastroenteroligist or dietician, near Calabasas, California. Is a dietician more capable of helping me deal with sSIBO? I live on the northern edge of Los Angeles.

  28. Hi Dr. Kresser, I’ve been diagnosed with SIBO over a year ago. I have been on a carb-free, dairy-free, nut-free, sugar-free diet for a while. But only the symptoms are better, and that’s because I don’t eat. I’m miserable. I have 4 rounds of Xifaxin. Things were better while on the 14day treatment, but miserable soon after. Tried probiotics, L-glutamine, digestive enzymes, fish oil….. but nothing works.
    I live in Chicago. Ihave visited many GI doctors already. Any suggestions ????
    Thank you so so much

    • I have SIBO for about 6 months. I’ve had 3 doses of Xifaxine & have been on the SIBO diet. I’ve lost about 37 pounds (which I needed to loose). I also have pudendal nerve neuralgia (Rectal pain)., which has become severe the past 2 years. I think there’s a connection between the 2. I got the rectal pain after a colonoscopy, (the next day). After going to many doctors I was told I had levator syndrome, there was no cure, & put on Fentynal patch. I’ve been on it for 10 years, & it stopped working 2 years ago. Before I was happy & healthy.
      I was 57 then, & im 73 years old now.

    • This is to Dana, I too am in the Chicago area and cannot find a good FM doc. Have you had any success finding someone?

  29. My husband has all the SIBO symptoms (bloating, cramping, gas, burning in upper stomach, low iron, ferritin & B12, constipation & food sensitivities), but when he took the Hydrogen Lactulose Breath Test (twice) they were flatlined. The 1st test only checked the Hydrogen level. The 2nd test checked both Hydrogen & Methane. He’s seen 3 Gastroenterologists and has had every test under the Sun and the only thing they’ve said is he has mild Gastritis. We’ve been following the low FODMAP diet the last 8-9 months and doesn’t seem to bring any relief. He tried to take XIFAXIN, but he said it felt like it was burning a hole in his stomach so stopped after 1 day. Should we assume he “DOES NOT” have SIBO if the Breath Tests were negative? If he DOES have SIBO, why wouldn’t the Breath test show something…even a little blip? Are there other ways to verify whether it’s SIBO? Thank you.

      • Stacey, Yes he’s had 2 Endoscopes and neither one found any Ulcers, HPylori, Celiac or Cancer. It showed mild Gastristis, but Dr’s didn’t make a big deal about it based on his symptoms. HIDA scan checked out normal too. We recently started seeing an Internal Medicine MD with some functional/integrative bkground. They seem to want to help, but so far haven’t seen any positive results. They are having him start with a Probiotic Enema (with water) 3 x week. He said it may have helped a little with cramping the first few times, but now he’s getting the severe burning in upper and mid-stomach area. His typical symptoms are: bloating & cramping 1 to 1-1/2 hr after eat, which causes pain. Now he’s getting the burning sensation along with stomach soar to the touch. The burning doesn’t seem to go away anymore. He hasn’t had a single day without some kind of pain for months. His diet is so restrictive. Never know when to try and introduce new foods since symptoms never any better. He’s also deficient in B12 & iron so this is being treated via shot or infusion therapy. Does SIBO cause burning like this? He’s been down the Nexium route, which we think may have contributed to SIBO (assuming this is what he has). I think his Gut Flora is so messed up and we can’t seem to find a Dr that knows about SIBO and/or how to correct his Gut. He’s so discouraged and wants his life back! Did you have SIBO yourself, Stacey? If yes, how did you tackle it? Thanks!

          • Hi Dee, no substantial improvements. Still doing probiotics 3 x week (colonically with a little water and then retains it). May help some with daily bowel. Dr. having him do another round of Xifaxan. This is the 3rd round within 6 months. So far, 7 days in out of 10, no real symptom relief. Experiencing terrible nausea, weakness and no appetite. Also said experiencing brain zaps. Hard to explain other than he said feels like brain just stops. Burning still an issue. Sometimes 1 Tbl of Apple Cider Vinegar provides a little relief. This has been the worst thing that has ever happened to him. After 1 yr still don’t feel any closer to getting better. Getting real scared at this point for his health. Had a consult with a Clinician at John Doulliard’s HealthSpa in Colorado. They use Ayurveda for healing (yoga, herbs, meditation, etc). Not sure at this point if will help, plus can’t afford . Getting desperate for help!!

                • Hi Sheby, I have had “brain zaps” myself, had them over the course of a year or so. No one was ever able to pinpoint a cause BUT they stopped after I began an aggressive B vitamin supplementation routine due to another symptom. In particular I was deficient in Thiamin! People these days say only chronic alcoholics suffer from this issue but that was not the case with me. It was only caught by accident when I described another bizarre symptom (nystagmas) that I had experienced a handful of times. That led to extra Thiamin supplementation on top of the B-complex and no more “brain zaps”! My suspicion is that people with intestinal issues like ours often also suffer from undiagnosed malabsorption issues. B12 is well known but what about less common ones? In the case of Thiamin, unless you stumble into the ER drunk and confused for the fourth time in a week no one will even consider it as a possibility. Bottom line, some extra thiamine won’t hurt anyone other than those with an allergy. I took 300mg/day of thiamine tetrahydrofurfuryl disulfide spread out over six doses for one week (you must take with fat as its fat soluble), then 100mg/day for another week and now take 50mg/day as a maintenence dose plus a B-complex and mineral complex. No more weird unexplained symptoms, dizziness, brain zaps, etc. I recognize that, as regards my intestines, this supplementation is only masking the problem, but at least it keeps me feeling better while I work on the real problem. OH, and if you are taking any significant Thiamin you must supplement with Magnesium as it is needed for proper utilization.

            • Please check out Lyme disease. It can cause every symptom you can imagine. It is hard to diagnose and most doctors miss it. I have Lyme and SIBO.

      • He did a Stool test for parasites/bacteria/virus, etc and all came back negative. I know these tests aren’t 100% conclusive. Dr. didn’t run any tests for yeast, but she did a visual exam on him to try and rule out…checked tongue for white coating, examined fingernails/toenails, checked eyes for yellowing and all were fine so she didn’t pursue anymore tests for it. Are there other visual symptoms for it?

        • my yeast was discovered during endoscopy……….if it was in my throat it is most likely in my intestines. Sure is is from all the asthma inhalers………….

    • Shelby, I just watched two different SIBO conferences via webcast. One Dr went over breath testing and said flatlined tests indicate hydrogen sulfide gas production. This is lesser known than hydrogen and methane and I don’t know the treatment protocols. But it might be a lead for you.

    • check out the facebook group on Magnesium. It sounds as though it may be connected. Low mag is tied in with all these factors.

  30. I have found this article very interesting, thank you. I have a 21 month old with SIBO. She has been on antibiotics twice in 5 weeks, after the second dose of antibiotics she seems worse. How do I tackle this in a toddler. It affects her sleep and keeps her awake for 2-4 hrs every night. Would you recommend the herbal route?

  31. Have a couple questions: 1) If someone has Methane SIBO and will be treated with traditional antibiotics, should they still follow a low FODMAP/SIBO diet while taking the antibiotics? I’ve heard you should try and eat normal during this process so the antibiotics will kill the bacteria while it’s feeding. Is this true? 2) Should you take a probiotic while going through the antibiotic process or wait until the SIBO is gone before starting any? Thanks.

    • Hi Shelby,

      It depends. Some docs are allowing small amounts of FODMAPs during treatment as well as probiotics. If one does not tolerate either one of these or both too well, then they should avoid while treating. Yes, also a more liberalized diet while treating.

  32. I’m being treated with Xifaxine for the 3rd time for SIBO, in past 6 months. I’m on the FODMAP diet. My Gastroenteroligist said I can eat COOKED ONIONS. Is he correct? Also I have a condition that started after a severe reaction to the clean out preparation, EXTREME diahrea (16 years ago.) I have debilitating rectal pain. It took me 2 years to be able to eat normal food (diahrea). Could the rectal pain, especially after a BM, be caused by years of SIBO?

  33. Hi Kelsey,

    I just found out I have SIBO. Do you know of any homeopathic doctors in the Chicago area that you’d recommend who have experience with this? I’d prefer not to go on multiple antibiotic regimens as I am also facing more pressing health issues than SIBO. Thanks!

  34. Love the next to last paragraph, SIBO may be a SYMPTOM of some deeper underlying problem. Can’t wait to see what you guys come up with for a post-SIBO treatment diet. I’m beginning treatment with Michael Ruscio now. This info was super helpful!

    • Hello! I am interested in any information or input from any SIBO sufferer who subsequently developed Fructose malabsorption/intolerance. At this time I think my SIBO is back, can’t deny the symptoms anymore 🙁 Should I be taking prebiotics with the Xifaxan, and then once I complete the treatment course resume my probiotics?

  35. Does anyone know of a good Dr. or Nutritionist in the Tampa Bay area (Florida) that knows something about Digestive Diseases and Nutrition. My husband has Gastritis and we think SIBO again and need some guidance for proper healing. We’ve tried to educate ourselves, but only get more confused.

    We actually live in the Crystal River, FL area, but willing to go 50 miles or so to talk to someone. Thank you.

    • shelby,

      Please check out Dr. Erika Bradshaw in Brandon, Fl. I live in Brooksville, and see her several times a year. Check out her website, and call/email her office. She is worth the drive.

    • Shelby

      Check out Dr. Erika Bradshaw in Brandon, Fl. I live in Brooksville, and see her several times a year. After being ill for two years, she has done more for me than the three other doctors I saw combined.

      You need someone who thinks outside the box.

      • Thank you, Maggie. There was another person that replied (who also lives in Brooksville) that recommended Dr. Bradshaw as well. Maybe you two know each other? We’ll check her website out. Appreciate the feedback. -Shelley

    • Try Absolute Health in Ocala. The doc there is an integrative doctor who will look at all aspects of the illness. I live in Dunnellon & after trying many doctors, including specialists, I found this practice. I do a lot of research myself, so I can tell when a doctor isn’t up on the latest info.

  36. In response to Eugenia above re the statement “IMHO, what we need for curing SIBO is the right kind of probiotics, possibly in high doses, of the right kind (casei and others). These would create the right kind of stomach acid and other conditions that would reduce the causal factors for bacteria colonizing the small intestine.”

    What specific probiotic & dosage would you recommend then?

    I’m so confused after reading everyone’s suggestions for treating SIBO. Do this…don’t do this…take this…don’t take this, eat this…don’t eat this. Makes me want to scream! We’ve spent a fortune trying diff supplements/methods based on all these recommendations and husband (64) still not well after 9 months. He’s very sensitive to supplements so can’t seem to take vits/minerals or probiotics – hurts stomach. Could be due to Gastritis, which is the only diagnosis Dr has ever given him. SIBO isn’t in their vocabulary it seems.

    We’ve seen 3 gastritis Dr’s. All just say Gastritis. He’s lost so much weight. All skin & bones now. Has all SIBO symptoms (bloat, gas pain, discomfort in small intestine w/constipation). Did Hydrogen breath test (only hydrogen tested…cannot find anyone here that has methane piece). Hydrogen was basically flatlined, which I wasn’t surprised since don’t have diarrhea. Dr didn’t think was SIBO but agreed to try Xifaxin. Helped tremendously after 2 rounds so seemed like the Gastritis was the remaining issue…stomach burning & nausea, but now the other symptoms have returned after 1 month!! Diet has been & still is mainly (B) Oatmeal w/2 slices toast, (L & D) Chicken, Turkey burger (plain), or fish w/rice or potatoe (white or sweet) & low fodmap veges. I’m so worried. He’s lost all hope! Gastro Dr’s have given up on him.

    Any suggestions are appreciated and can someone please clarify whether probiotics are a goog/bad thing to take if have SIBO and which one to take. Also the same question for digestive enzymes. I’m desperate for some menu planning too so anyone that can share what they typically ate/eat in a day for SIBO is appreciated. Hubby is so tired of same stuff. Thank you.

    • Have you looked into the Specific Carb Diet (SCD)? The oatmeal, bread, rice, etc are not part of a SCD and my understanding is they contribute to SIBO returning and allowing the overgrowth in the 1st place. My Dr recommended ProBiotic, specifically this one, Florajen 3 Capsules. I have been doing well by eating nothing but Meat, Vegetables (Low FODMAP) and fruit. I do not eat any processed food, and when I eat out I review the nutrition information and allergy information to make sure there is nothing in their food that I can’t have. For example, many places use milk in their meat preparation, ie Qdoba. What is your alcohol intake like, # of drinks per day? I was told Red Wine, Bourbon, Whiskey, no beer and no sweet alcohol like Brandy etc due to the sugar. Hope this helps 🙂

      • Sean, Thanks for commenting. Yes we have looked into the SCD diet. My husband did this for 2-3 months initially. He’s lost so much weight now that it scares me to think of him going back on the SCD diet. It’s so limiting. He’s gotten so use to his Oatmeal and Rice now, that it’s hard for him to even think about going back to SCD. Breakfast is the hardest.

        What do you typically eat for Breakfast and snacks? My husband is so underweight, he’s always looking to eat something. Do you eat 3 regular meals a day or many small ones?

        We don’t drink Alcohol so that’s not a problem. He tried FloraJen 3 a couple times and, unfortunately, they really hurt his stomach. Thanks.

        • Hi,
          I lost 20lbs in 2 months and it was great! It has plateaued, so that’s good. During the week I eat cantaloupe, pineapple, strawberries and a banana for breakfast along with an breakfast bar called, RX Bar, check them out on Amazon. They are a bit different and chewy, but I get a good dose of protein. When I cook, I will have eggs, vegetables, and meat, only difference is no potato’s and bread; I miss bread a lot!! When I snack I eat beef jerky from our butcher, so extra sugar etc, I have a grapefruit every night after dinner sometime, I eat almonds, hard cheeses, and vegetables.

          • Sean, Are you eating your fruit raw or pureed? As far as vegetables, are you pretty much eating those on the low FODMAP list? Wish we had a local butcher here to get jerky. Thanks.

            • I eat all my fruit raw and I look for organic and choose that over all others. I also look for organic meats, vegetables, etc when ever possible. I am staying on the low FODMAP for vegetables, I regularly eat, green pepper, onion, mushroom, spaghetti squash, cucumber, zucchini, & carrots.

              • Onions must not have been a problem for you then when you had SIBO? May I ask you what protocol (meds/herbs/etc) you used to rid your SIBO? Do you currently take any other vitamins today along with your Probiotics? Thanks.

                • I use to take a lot more supplements before and I am going to work them back into my diet eventually. For now, its a probiotic and Alive, the chew able, multi-vitamin as I can have them on an empty stomach and it doesn’t irritate it, and its all natural 🙂 I was breath tested and they discovered the sibo so I was on 2 antibiotics at the same time for 10 days. I actually think it might be creeping back as I have had a few things that are not allowed, some bread, little ice cream, etc, which makes me thing SIBO is a slow creeper which means stick to the diet religiously. At least that is what I am assuming at this point. I have read a lot and its inconclusive if it will ever go away, or can be treated without antibiotics, if diet is really the way to go. So who knows LOL

                • Diet alone and probiotics and Meds will not eradicate SIBO or any gut dysbiosis – you need to address your root issue.

                  Look into motility – make sure your bowels are emptying fully. If not take a supplement like triphala or lax formula by integrative.

                  Make sure your diet has an array of foods – sticking to the same foods over and over – will only lead to worse symptoms.

                  Look into the book the gut health protocol by John Herron. He explains many things in detail – if you do a kill stage without biofilms you will not eradicate gut issues.

                  My diet was super restricted – I expanded it – game changer for me! Eat nutritious prebiotic and probiotic rich foods and build the microbiome !

                • Tanya, Thanks for your comments. That’s the million $ question….root cause! My husband would love to know the root cause. He’s been to so many Dr’s, several tests done and only thing that’s come is Gastritis. He had a Gastric Emptying Test for motility and “supposedly” passed. He only had 9% left in stomach after 3 hrs. Normal they say is 10% or under. Dr. put him on PPI’s, which may have caused the SIBO. 2 rounds of XIFAXIN helped a lot, but seems to be back after 2 months. My husband would love, love, love to expand his food selection, but between Gastritis, which he tries to eat foods with ph 5.0 or above and SIBO, low-FODMAP, it doesn’t leave you too many options of food to pick from. I’ll look into the book you recommended, but if you have any other ideas that might help, would love to hear more. Thanks.

                • Sean, Sorry for all the questions. I really appreciate you responding back to me. So sorry your SIBO might be coming back. Arg!!

                  Did you have the methane SIBO? What antibiotics did the Dr. have you on, if you don’t mind me asking? Also, how much time has passed since you last had SIBO until now (if it’s coming back)? Thanks a million!

                • It was a hydrogen breath test and I believe it tested for methane as well. The antibiotics were Xifaxan 550mg and Metronidazole 500mg both 2x a day. I finished the antibiotics May 20th so less than 3 months. Not sure if its coming back or not, still trying to see if it was just something funky this week or?

                • Shelby, I was just reading through all these comments and I know this was a few months ago but I am sure that you are still battling with this.
                  It is still a question if I have SIBO or not but I sought out a Naturopathic Dr. and she has been really helpful in exploring my symptoms and causes and trying some gentle treatments. She also referred me to a Dr. in the area who actually has her roots in Chinese medicine (both of her parents are Chinese physicians) and she sent me with a list of items to discuss so that we could test for some specific things. I am seeing her right now so that we can do blood work and in my case an ultrasound of the area I am having pain in.

                  I wanted to encourage you to try seeking out a Naturopath/Holistic Dr in your area that could help you to really look into whats going on and hopefully find a root cause. Sometimes trauma to the internal organs can make them overly sensitive and definitely even something as simple as a stomach virus can throw off out gut bacteria. If everything is burning his stomach it could be that he isn’t producing enough stomach acid. Though when i first started down this path I restricted my self to basically bone broth, rice and cooked carrots for like a month and I never felt any better and I still felt acid and upper GI burn all the time. That was most likely because I was so hungry all the time. I started by adding in plain chicken and leafy lettuce. No dressing but a squeeze of lemon.

                  With any individual there are a lot of variables from lifestyle and diet to your natural body chemistry and genetic disposition. Holistic medicine treats whole health rather than just a symptom, and a good Naturopath will know what to specifically ask for if they do need to send you to a Dr. for something like blood work or an ultrasound.

                  I also encourage you to get a notebook and write down everything he eats or drinks and anything else that happens from how it makes him feel to other things happening, like things are particularly stressful with the family or neighbors. It will show you patterns and you can take it with you when you see anyone for treatment.

                  If you don’t know where to start looking. I called a wellness center in my town that holds yoga classes, reiki classes, the teach about essential oils and herbs. The Naturopath I see doesn’t work there but they did give me her contact info. I wish you the best of luck, I will be praying for you two!

                • Sarah, Thank you for all the encouraging info. We just started going to an Internal Medicine Dr who uses Functional/Integrative methods, but after 2 sessions, not too impressed. May have to seek out what you did. Just hesitant, I guess, due to cost. May I ask you whether you still have the burning in upper GI area and if not, what helped? Are you tackling your SIBO via natural supps? Don’t know what State you are in….would it happen to be Florida? This is where we live. Appreciate your prayers. We’ll keep you in our prayers too.

      • I too have been following the SCD and healing with Dr. Axe bone broth protocol, and low fomap foods. After a year of daily diarrhea, constant fatigue and recently diagnosed with diverticulitis I have had enough of suffering. I have been doing this for 6 weeks and I have my life back! After the 3rd day my energy level shot up. I make chicken or beef bone broth, I can eat eggs, bananas, carrots, some cooked fruit, peeled/seeded zucchini and acorn squash.
        I eat a low residue diet also. I eat a whole lot less food, I have dropped 18 lbs and feeling better every day. No longer in a panic going out and about in the morning hours.

      • Hello, April.
        I found this article and read your comment. I have a lot of stomach problems. I treated candida before, felt good for few days, then back again to the bloating and gas. I was also treated for H. Pylori. The stomach discomfort still there. Now, somebody mentioned the word SIBO, I haven’t tested yet. But I am researching on my own. I would like to know what foods are allowed during the SCD. I get bloated just by smelling grains. I eliminated them 100%. I am on protein, nuts, vegetables. I don’t eat fruits. Should I?
        I appreciate your time and help with this issue. Thanks.

    • Shelby,
      While I don’t know yet how to eradicate SIBO, I’ve come across a way for me to at least start digesting the food I AM eating properly and start to find safe foods, at least in the short-term.

      1) Start with Aglaee Jacob’s Elimination Diet as outlined in her book “Digestive Health with REAL Food”.
      2) Slowly (she outlines the re-introduction process, well, too) introduce one food and one spice, etc. at a time, using Dr. Siebecker’s SIBO Diet guide (you can google it to find it) to give you a starting point for reintroducing foods that will be less likely to cause problems for those with SIBO – absolutely no grains or starch carbs whatsoever.
      3) Using Diane Sanfillipo’s book “Practical Paleo”, you can find a page that lists out supplement and herbs to consider to help with healing gut lining and repairing a leaky gut.

      I know that it is not a permanent solution, but at least it can help alleviate current symptoms and help the body to begin the healing process. Good luck!

    • Hi Shelby,

      There is a product called Amino Acids Platinum – it is patented – its inventor – dr Vickery claims that it can restore stomach acid – which seems is the root cause of SIBO and many other diseases. I think the same can be achieved by another product called Seacure – which is hydrolyzed white fish protein. In order to produce HCL the body needs zinc , vit. B6 and amino acids . Of course you can directly take HCL + pancreatic enzymes but i think producing you own enzymes is better.

    • Hi Shelby,

      I have a severe case of SIBO (methane) ridiculously persistent with absurd motility issues. I don’t know if I will ever recover and have been on this journey forever. I have been sick most of my life (I am 38), but have been focused on SIBO for about 7 years now. Prior to that, I hadn’t heard of SIBO and was working on the diagnoses of IBS and Gastritis.

      I can’t second enough that you need to get him off of oatmeal, potatoes, etc… Have you considered using Jasmine rice as a substitute? It does not feed the bacteria. I understand we each need to decide if we wish to starve the bacteria or maintain- while we aim to eradicate. Whatever you do, you need to strike a balance and not overfeed it (while you are not on an antibiotic).

      Jasmine rice can be used to make a breakfast porridge with coconut milk, in place of oatmeal. I know you know this, but just to reiterate, when this sick, we have to adapt and give up things- like oatmeal. Though it is hard at first, we have to remember that over time, taste buds actually change- literally. They are all replaced within 6 months. So what he doesn’t like now, well, he may be OK with or even truly like, in 6 months time!!! I hope this is encouraging. I have found this to be very true in my case.

      Recipe would look something like:
      Cooked Jasmine rice, add lots of coconut milk/cream (cook some more), cinnamon, an acceptable sweetener e.g. stevia, limited molasses, or Manuka honey, and a few berries (fresh or dried) or nuts (if you wish).

      I use coconut milks without guar gum*- but based on the article- that’s depended on your preference and where you are in your treatment, etc…
      *Hard to find, but can be done! [“Foco” (cheap) and “Natural Value”(expensive)]

      Since loosing weight is an issue, I think Dr Robillard’s FP List would be a handy thing to live by. I bought the book and cut out the list, put brads in it and highlighted it up, and put it in my purse. I lived by it for about a year. It really helped me a ton and I didn’t lose weight when I was on it- I actually gained 15-20 lbs!

      Narrowing down to the type of SIBO’er he is- Yes, this matters.
      Dr. Josh Axe- though he may seem gimmick-y or whatever, I think there is a lot of value here. He has mainstreamed what he is offering, and that isn’t necessarily bad. I have purchased a membership and think it was a small amount of money very well spent. You can take questionnaire tests to help determine which kind of “gut” you have, helping to customize for things like “gastritis” which I also have, and it spits out a more customized diet. SIBO isn’t just SIBO- we are all a little different- there are different types of SIBO’ers, right? So this narrows it down a little further. I, for example, have been tested (I paid a lot for this) and have a VERY leaky gut. Due to this testing, I can eat a few fruits that are good at repairing the wall of my stomach, like blueberries. Though this testing was not done through this website (Josh Axe), the questionnaire I did through his site, DID in fact pick that up. It was impressive.

      I hope this was helpful and I wish you both luck.

      Kind regards,

      • Thanks for your input Myra. That recipe sounds good. Does that simple rice oatmeal work for you with no noticeable side effects? And does that coconut milk not bother you?

        Do you have any other recipes you’ve found that work well for you like that? I am not underweight but I am on the thin side so am on the hunt for good food that won’t cripple me either. Any input by anyone is appreciated! Thanks!

      • Myra, Thank you for responding back with a lot of good advice. I’m so sorry that you’ve had to struggle for so long with gut issues. Were the Dr’s not able to help you at all? Do you mind me asking a few more questions. You had a lot of good advice/recommendations on this subject so really appreciate any other info you can provide that might help my husband. 1) Did antibiotics not help your SIBO? 2) Do you take anything to help with motility issues? 3) Do you currently take any vits/sups/probiotics? 4) Do you still follow the SCD or Low FODMAP diet? 5) Did you have to count points when you were on Dr. Robbillard’s diet…this part seems confusing? 6) Where did you get your Leaky Gut test done?

        Thanks again.

    • All gluten and grains should be stopped. Google the SCD Diet and stay off foods which are known to irritate the gut and cause inflammation in the body..which is what he is eating. No wonder he stays sick.

      • I disagree with you about stopping all grains. When I have SIBO flare-ups the only thing I can eat is jasmin rice and meat. Jasmin rice has high amylopectin content and low amylose which allows it to digest quickly and get absorbed in the upper area of the small intesine. It is a low fermentation grain. Depending on each person’s bacterial and enzyme composition some people will do great on rice while others can’t tolerate any type of grains. We are all different and require individual approach. For me, eating any kind of vegetables during flare-up will exacerbate the situation dramatically. Some people are able to eat only veg and meat.
        Making blanket recommendations across the board (by practitioners who think they are experts) will only make people lose faith in them. There are a lot of things to consider like oxalates, phenols, histamines etc. Every person’s causes for SIBO are unique.
        The majority of us need some kind of concentrated carb source to be able to function properly. Otherwise thyroid and adrenals will suffer. Once again, what works for one person will not necessarily work for another with the same symptoms and disease manifistation.

        • I totally agree with you Dila. There are over 400 different bacterial species that make up the SIBO category. General SIBO guidelines are just that, general. Every person is unique, just like their gut bugs or dysbiosis. SIBO patients must reintroduce foods, including grains, back into their diet at some point. It is not uncommon to discover that certain grains, vegetables and fruits are now tolerable, but others are not. I will share my own case: After undergoing an Elimination Diet, 4 Whole30 diets, months of botanicals, two rounds of antibiotics I am now perfectly fine with eating rice (I even tolerate gluten, but still avoid). What I have found to still cause a dramatic reaction are apples, avocados, beets, cherries, zucchini, millet, sorghum and legumes.

          I refer to a local SIBO-brilliant RD who helps patients reintroduce foods back into their diets. This is critical, because long-term food avoidance can also lead other forms of gut dysbiosis and even eating disorders.

    • Dear Shelby,
      I am very sorry for your husband and I deeply sympathize. I have been there and done it all. I refuse to spend any more money on doctors, tests and tons of supplements. What worked the best for me after all these years and brought immediate relief was laughably (sp?) simple. Drinking celery, cabbage or cucumber juice first thing in the morning on empty stomach. Or green powder drink (barley, wheatgrass, etc). I also went on a two week diet of only raw fruits and vegetables. It was great. All my bloating, constipation, aches and pains went away after a few days. High doses of vitamin C powder cut with half baking soda several times a day. Essential oils of oregano, clove, thyme, frankincense sipped in a water bottle through the day. Now eating only when hungry and not too much, of course no processed foods of any kind and enough fiber. When in distress, I took a couple of charcoal capsules. All these things are not pricey, and they work remarkably well. I am tired of all the expensive doctors and their unending tests and stupid diets. Never felt better.
      I with you the best. Kathy

    • I would read up on info from “FIX your gut”, you can read his website and get book on Amazon. The author discusses choice with herbal vs antibiotics and diet during treatments. Another great book is Fast Track Diet, there are menus with it and was written by microbiologist with extensive knowledge about how foods break down.
      The key is to kill off excessive bacteria, heal gut, and support motility… I personally choose to not introduce more bacteria with probiotics during treatment. Top natural dr in the field, Dr. Allison Siebecker has great info at siboinfo.com

    • Shelby, I have SIBO / Post-Infectious IBS after a bout of gastroenteritis in March 2016 so I truly sympathize with what your husband is going through. I’ve been reading your thread and it sounds absolutely horrible and scary.

      I don’t know if you are aware of Dr Norman Robillard. Please check the info at his website https://digestivehealthinstitute.org/ for diet ideas per the Fast Tract Diet (which he developed). He is a PhD microbiologist, not an MD. He himself suffered from severe GERD which is now in remission due to FT Diet. Tons of info on his website and blog. He is also available for consultations by phone.

      Also see the very detailed comment by Dila (Oct 21, 2014 at 1:44 pm) at http://theancestralrds.com/2014/08/28/episode-4-recommendations-for-sibo-and-paleo-alcohol-choices/

      Her sister suffered horribly, tried everything, felt like she was dying. Sister was able to overcome her problem, Dila still has chronic digestive probs but symptoms are controllable with the Fast Track Diet. FTD treats both GERD/reflux as well as IBS.

  37. Hi,

    I have been tested positive for SIBO through a breathing test a few months ago after months of suffering post food poisoning.

    I have gone through 2 rounds of 2 weeks of Xifaxan and just finished my 2nd round 4 days ago. I started doing Sibo Specific Diet immediately, but my stomach hasn’t been feeling too comfortable. So I ordered Herbal Antibiotics (Metagenics Candibactin-AR with Metagenics Candibactin-BR) on my own, and started taking them today along with MotilPro for prokinetics. If anyone can help answer my questions below, I’d really appreciate!

    1. Can I eat fruits raw during first 2 weeks of Sibo Specific Diet or do I have to cook everything?

    2. Can I start herbal antibiotics 4 days after the end of Xifaxan treatment?

    3. Can I stick to Sibo Specific Diet during herbal antibiotics treatment or should I eat food that feeds bacteria?

    4. Can I take prokinetics while doing herbal antibiotics?

    Any help would be appreciated!

    Thank you!

  38. Kelsey, Looks like I possibly have Methane SIBO. I have been dealing with this for a long time…years and years…I went to Taymount clinic and had FMT for IBS symptoms and now am realizing that I should have treated the SIBO first. argh. So, I was going to do the Antibiotic Rifaximin because I know it absorbs as it moves through the small intestines , sparing the bacteria in the large intestines… But after reading this I see that Methane producers have a different protocol. I am wondering if the neomycin or the herbal protocol spares the bacteria in the large intestine? I am unwilling to kill off my new biome in a rush to get the SIBO under control and you have validated my concerns about starving the large intestine’s biome with a CSD. Any insight? Thank you, Olivia

    • Olivia,

      I saw that you visited Taymount for your IBS and have only now discovered you have SIBO as well. I was wondering about FMT and if it worked its way up to the small intestine to correct/balance things. However, based upon your comments, it would seem not. Can you please elaborate on your experience at Taymount and what it has done for you thusfar?

  39. Does anyone know if it’s okay to take bentonite clay while on rifaximin (to help slow my diarrhea)? I’ve heard the clay help clear out the gunk causing malabsorption, but I want to make sure it won’t interfere with the effectiveness of the antibiotic.

  40. How is taking multiple rounds of antibiotics any better than a long-term FODMAP diet? Either way, you’re going to kill some portion of the bacteria in your large intestine.

    There is a gap of logic here…

    • Kim, you dont have all the info – thats why you think there is a gap of login – please check the price of Rifaximin and you will get your answer. Also there is absolutely no reason for antibiotics with sibo. here is some proof:
      Acta Gastroenterol Latinoam. 2010 Dec;40(4):323-7.
      [Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study].
      [Article in Spanish]
      Soifer LO1, Peralta D, Dima G, Besasso H.
      Author information
      Patients with intestinal bacterial overgrowth (SIBO) are usually treated with different antibiotics. Certain probiotics have proved to be clinically effective in patients with abdominal distension.
      To compare the short-term clinical efficacy of metronidazol vs. a probiotic in patients with SIBO and functional chronic abdominal distension. Patients and methods. This was a randomized prospective pilot study. The study population consisted of 50 patients with chronic abdominal distension (Rome III criteria) and diagnosis of SIBO made by a lactulose H2 breath test. Patients were consecutively randomized to receive either metronidazol or a probiotic. The metronidazol group consisted of 25 subjects (23 women, median age 49 +/- 19 years old), who received metronidazol (Flagyl), 500 mg bid for 5 days. The probiotic group consisted of 25 subjects (20 women, median age 58 +/- 19 years old). The probiotic administered to the latter group contained Lactobacillus casei (3.3 x 10(7) UFC), Lactobacillus plantarum (3.3 x 10(7) UFC), Streptococcus faecalis (3.3 x 10(7) UFC) and Bifidobacterium brevis (1.0 x 10(6) UFC) (Bioflora) and 5 ml bid were administered for 5 days. Both groups went on the same diet, which consisted in reduced consumption of alcohol, legumes, dairy products and leafy green vegetables. Response to treatment was assessed by an independent questioner 15 days post treatment. A five-level overall response questionnaire was used. Responses included much better, better, the same, worse, and much worse. Better and much better were considered positive responses.
      Thirteen (52%) subjects receiving metronidazol and 20 (82%) receiving the probiotic referred clinical improvement after the treatment. A statistically significant difference favoured the use of the probiotic (P = 0.036). All the study patients completed treatment. No adverse events leading to treatment discontinuation were observed.
      Based on this pilot study results, we can suggest that the probiotic herein used has a higher efficacy than metronidazol in the early clinical response of patients with chronic abdominal diistension and SIBO.

      You see people get significant improvement after only 5 days with some probiotics – can you imagine what will happen if they try sauerkraut which is much more powerful that any probiotic – unfortunately there is no money is selling sauerkraut so people suffer and nobody is giving them the correct information how to cure.

      • Would love to be able to eat fermented foods unfortunately they cause histamine as well as histamine producing probiotics

    • My understanding is that the Rifaximin is absorbed by the time it goes through the small intestines so it does not affect the large intestines… I don’t know about the herbal protocol though.

  41. Kelsey,
    In your article you recommending eating high FODMAP foods that can be tolerated. Certainly there must be a spectrum of those foods that are high in carbs and low in carbs in this group. If attempting to start incorporating these into my current low FODMAP diet which would you recommend?

    Also, I have reviewed this site, http://www.breakingtheviciouscycle.info/legal/listing/A/
    listing legal and illegal foods and there seems to be some overlap in FODMAPS, most are low, some are high, is this due to the carbohydrate being only monosaccarides?

    And finally, what is the difference between a prebiotic and a probiotic and how it help SIBO?

  42. Interesting article. One of my sons and I tested positive to the FODMAPS breath testing but were told that neither of us had SIBO. We have been low FODMAPS for a couple years now which helps us both enormously until of course we eat something we shouldn’t. I’m wondering how we treat our gut bacteria issues if we don’t actually have SIBO but still react immediately to FODMAPS and how do we treat this problem as it’s obviously not a great option to be low FODMAP indefinitely? Thx

  43. My doctor has me on a new regimen for persistent SIBO and candida overgrowth. She prescribed hydrolyed guar gum, but I only found a jar of regular guar gum. Are they the same thing or is the hydrolyzed special? If so, does anyone know where I can find it for purchase?

  44. I like your approach to SIBO. Seems like a good balance of traditional and alternative approaches. Do you know of any practitioners in Orange County, CA that follow a similar approach?

    • It can be all so very confusing. I’m learning to take it one step at a time and not be so hard on myself for “breaking the rules. ”

      I lived in San Diego for a long time and had great practitioners there. Don’t know any in orange county but has to be a lot. Try functional medicine MD website. Need to network with like minded people for referrals. I now have a great one in Raleigh, NC.

      Sending you high vibrations of healing!

        • Dr. Dishman at Bloomington Integrative Health. Her own business. 21 page intake & 2 month wait for new patients. $$$. She doesn’t upsell you on supplements & her prices are competitive. I do have a lot I’m taking now tho. She’s sharp, intuitive & takes her time. Insurance doesn’t cover it & very pricy. Highly recommended her. Contact me if you more info.

        • I see Dr. Dishman of Bloom Integrative Health. Very good, difficult to get first appt, $$$, acupuncturist, worth it all. Send me a private msg on FB. I’d love to have a local support partner to heal with!

        • Hi Amanda. I saw Dr Daily at the Center for Health and Well Being in Hillcrest. Fairly good but probably wouldn’t recommend him. Not compared to the one I have now in Raleigh. There’s a good one in Encinitas I heard of but don’t know his name. Google some there. Check out ND David Getoff’s website. Took a class of his years ago. He’s very knowledgable & passionate. Contact me if I can help further.

      • Jenn,
        Will you please recommend the doctor you used in San Diego. I am in terrible pain and spinning my wheels here.
        Thank you,

        • Reeny,

          I saw Dr. David Daily at Jeanettes Gray’s wellness center in Hillcrest. Since he falls under her as an MD most insurance covers it which was really helpful and rare. He took a while to diagnose me and I moved before we finished. His downside is he up sells you a lot of unnecessary (in my opinion) herbs and vitamins. After I moved to Raleigh & found an excellent ND I found him not to be as good as expected but would recommend him. I would not recommend going to Dr Gray as your MD. Let me know if I can answer any more questions.

  45. OneHi,
    I’m confused and I would like clarification regarding guar gum since I’ve already started taking Xifaxan.
    It seems like there is contradictory information. One, there are instructions that you want to keep fiber content low to keep things moving (and yet feed the bacteria so they can be killed off in the active state)…but guar gum is a fiber and known for expanding in the intestine and slowing down passage of food. Is guar gum something only to supplement with during xifaxan treatment, then stop? If yes, how much should be taken and when?

  46. A disease that slows the passage and digestion of food through the gut and ends in the fermentation of food and resulting bacterial overgrowth should be easy to treat if you use your logic:

    What you want to do is quicken the passage of food through your gut, so you need to eat lots of fresh fruit and vegetables and cut out the meat and processed carbs like white rice and white pasta, which will dehydrate you (anything that’s not wet enough will sit in the large intestine for longer, especially animal sinew, and slow the passage of food higher up).

    You also want to move every day, for at least half an hour or an hour split up into two parts. Exercise helps move food down the digestive passage.

    You also want to eat a lot of sprouts. Baby plants are new life. Bacteria don’t like new life, especially H. pylori, which I suspect most sufferers of SIBO have, so they will move on out when those living plants come their way. Bacteria thrive in dead zones where decay is present. Why, then, would you go and eat already-fermented foods? It doesn’t make sense. You need to eat as new foods as possible which are easy to digest. Sprouts, with their high water and vitamin content, are perfect for SIBO sufferers because they provide you with all the nutrients which are absorbed quickly, while hitting the H. pylori and getting rid of them. This is important because until you get rid of the H. pylori, your stomach will have low acid (H. pylori produce antacid in the stomach) and you won’t be able to kill any new bacteria entering your duodenum efficiently. Thus, your half-digested food will be passing through your small intestine leaving snail-trails of active bacteria in its wake. So the problem can come from both ends; both the large intestine and the stomach.

    Lastly, a quick word of common sense: All good things are created gently and gradually – the planting of gardens, the building of homes, the raising of children. All bad things, however, are brought about rapidly and violently – war, destruction, death. Your health is a good thing and, as such, it must be brought about gently and gradually. You can’t wage war on your gut bacteria and expect to come out of it a healthier person. You must gently give them a prod toward the Exit by changing the way you eat and live. Don’t give them a chance to revolt; just let them know there isn’t much fun to be had where they’re at, and they’ll soon be on their way, grudgingly but quietly.

    • Hi Oenone, may I ask a few questions?
      Im not sure if I have SIBO, recently had duodenal pain and suspected an ulcer and been taking Mastic Gum/slippery elm/DGL for a week and that area seems slightly subsided but my small intestine area aches and has ached for about a year as well as my duodenal area, I have made a link in my mind when i had outbursts of emotion/anger my duodenum got worse last year, also when drinking coffee, junk foods etc and when I decreased my anit depressant medication my duodenum starts to hurt so I thought ok I must have had a duodenal ulcer and those things recur, but the small intestine aches I link in my mind to having taken Prilosec for 20yrs now for GERD/Sliding Hiatal Hernia – low stomach acid for 2 decades may have allowed bad bacteria to develop and migrate to the small intestine and now cause my aches, I do have leaky gut cause about 2 yrs ago I suddenly starting having terriby allergy symptoms like sneezing my brains out, red itchy eyes, night sweats, roof of my mouth aching, runny nose and for two years suffered cause I thought I had dust allergy, when I took away gluten/soy/dairy my sneezing and all allergy symptoms stopped.
      In the last 8 yrs did coffee enemas and maybe overdid them (between 1 to 4 a day, average maybe 2) – last year started having pain in my uodenum area and liver and my shoulder blade on my right side, had ultasound and was diagnosed with cholesterolosis (gallbladder polyps) and have to have them checked every 6 months as they may become malignant if they grow more than 1cm.
      So I stopped doing the coffee enemas cause I thought they may have ‘done in’ my gut (possibly sucking out good bacteria and bad but then having a situation were bacteria are somewhat vacant?)
      After about 8months was diagnosed with fatty liver and so I thought I should taper off the two meds Im taking (Paxil and Prilosec) so I dont tax my liver/gallbladder, changed my diet to liver friendy diet, artichokes, milk thistle, low carb only good fats like omega 3, fish, chicken.
      Looking online I found the various gurus, MD’s, followers and their scientific studies and success stories, basically you have the paleo guys verses vegetarians and I tried Mcdougal diet but when eating potatoes my left ear became so red that it hurt and this happened when I had coffee and sugar on another occasion and stress I linked to this symptom (it seems this is an auto-immune symptom – Relapsing Chondritis I think seeing as nly the cartilaage gets red and not the whole ear) I did the paleo with meat, bone broth, few veggies and I end up having night sweats, and really hot (Yang – inflammation?) Meat causes inflamation as Dr Greger says in his studies, and so Im at a bind either kind of diet doesn’t work and so I have been looking at Fodmaps, SCD, GAPs, and confused, I even did Keto and obviously (low stomach acid) made me feel as if a brick was in my stomach, the meat and fat didnt digest, just stayed there for hours.
      I did find a woman who reversed her Relapsing Chondritis by adopting the Mcdougal diet but he suggests to eat high starch foods such as potatoes/sweet potatoes/yams/ etc exactly the foods you’re not supposed to eat for leaky gut/SIBO etc, if auto-immune diseases like RC, arthritis, allergies etc are linked to a leaky gut then how does one heal leaky gut? Do I just ‘ride’ the heat symptoms of night sweats and general hot feelings, red hot ear and do the paleo type diet and eventually they will subside OR do a modified Mcdougal or vegetarian diet including carbs that are least likely to cause problems such as low Fodmaps, SCD, another woman on youtube told me she also had RC Relapsing Chondririts and she also adopted the Mcdougal diet and her symptoms went away and its been over a year or two, and yet when I started eating a few bowls of organic bioled potatoes BANG ear became red and hot as hell and small intestine ached, so then I did search and found that some people do not do well with their small intestine with nightshades such as potatoes and so to end my message – it seems that my choice of foods is becoming smaller and smaller, I feel that going on juice fast of some sort will help rest my digestive system and eliminate any foods that hurt me, then introduce foods like boiled marrow or courgette without the skins, maybe cooked pears etc.
      Finally Id like to stop taking prilosec so that I can get my acid levels back to normal, the problem is that when i started to reduce the prilosec my proton pumps waken and I get rebound acid reflux and the duodenal area is easy to get hurt and irritate and previously ulcerated area, also cause of hiatal hernia cid comes up my throat and so have to address the GERD problem, I did try stopping prilosec and adding HCI and ACV and ended up in hospital after 10 days with a tube down my throat thats when I was told I had a sliding hiatal hernia and my esophgus was burnt, was put on Nexium 40mg for a month to heal my 10 days of acid hell, then went back on prilosec.
      How do I cure my problems and get my health back?
      There are many MD’s now and docs that practise ‘funtional medicine’ but they seem to be biased on way or the other, they either subscribe to the paleo or vegan direction and dont seem to see people/patients as individuals with complicated and unique situations, my situation defiately seems complicated to me, and so I ask for an objective opinion, thankyou in advance.

    • Are you speaking from personal experience (as someone who has cured their digestive problems using your logic)?

      I ask because I find your hypotheses intriguing, but wonder if they have actually worked in reality. Sometimes logic sounds nice but fails in practice, so I’d like to know if you’ve seen actual success in reality with your prescribed logic.

      • Hello Issac,
        I wasn’t sure if you were talking to me, so forgive me if I answer. Yes this is my own personal experience, still not sure what to do and thought of fasting, there is something called the Breuss fast or veggie juice fast, I’m wondering whether autophagy (via low protein intake, fasting and exercise) can shrink the tissue that isnt useful for the body and the body I hope once glycogen store are depleted then would start munching useless tissue? i.e. a kind of self cannabalism.
        Judging by the kind of therapies above and Gerson, that are used to hep starve cancer, Im just thinking it could be used for the polyps too, anyway, nobody has any answers for me, so far.
        Thanks for asking mate

    • Please don’t try to mislead people, I got a huge SIBO from eating raw fresh fruits and vegetables :/. Raw fiber is the worst. Also excesse fructose = fermentation

      • It is not so simple – motility does not explain everything. What exactly was your diet – for example it is one thing to eat bananas or granny smith apples. It is one thing to eat a lot of soluble fiber and completely different to eat a lot of insoluble fiber. Maybe you have fructose malabsorbtion and the problems was fructose and not fiber?

  47. I’ve struggled with SIBO for a year, but am in remission currently. I tried the antibiotics – except Neomycin, which I was reluctant to do because of the potential side effects to one’s hearing. They didn’t work. I first went Low Fodmap with limited effectiveness. I tried the Vivonex protocol for 2 weeks and it didn’t eradicate the bacteria. Then I started taking Resolor for motility and did 3 weeks of the Vivonex protocol. After that, I did a combination of the SCD and Low Fodmap diet. That seems to have done the trick. My last SIBO tests were negative. I’m checking for Fructose intolerance now. I’ve mostly stuck to the Low FodMap/SCD diet, but have added back some lactose and white bread without any problems.

  48. I was told I have SIBO. I have battled the stomach issues for 20 months before finding someone to believe what all I have been going through. Dr. has prescribed Rifaximin. Has anyone used that for their treatment. I noticed one side affect is diarrhea and that is my biggest problem now. Any other suggestions to fight SIBO…diet would be appreciated. Thanks

    • Hi Ann, I just finished the herbal protocol and Dr. Siebecker’s SIBO diet (SCD/Lowfodmap) It is different than the diet being recommended here, by Chris Kresser.
      I have respect for his research and insights and what he says makes sense to me.
      My doctor (Functional Medicine, MD) treats many patients with digestive disorders and recommended I go with Dr. Siebecker’s plan. I am due to retest any time now and would agree that the SIBO is likely not eradicated but only reduced in number using this method.
      My suggestion would be to keep a journal and really tune in to your gut for the answers.
      I kept a “loose” journal and it was still helpful.
      I also had serious food sensitivities (leaky gut) that are since much improved from treating the SIBO. I have an autoimmune component and follow an AIP (autoimmune Paleo) diet for that as well as the Low Fodmap/ SCD diet. This leaves me with very limited food choices.

      Has anyone eradicated SIBO using Dr. Kressers suggested protocol from Dr. Pimental?

      I would love to know more about these results. I haven’t seen any information regarding
      how many people eradicate SIBO using this protocol.

      Thank you, Susie

      • Susie, thank you for your post!! I’m in the overlap of the AIP/SIBO-tuned diet myself… so utterly limiting! ReallyREALLY appreciative of you taking the time to speak up.

        To address SIBO, did you use an herbal antimicrobial or a prescription antibacterial at all? Or were you flying with diet alone to address the SIBO? If herbal, what did you select?

        • Hi Rachael, I used an herbal protocol from my Functional medicine doctor who is an MD.
          As follows;
          CandiBactin AR & BR 3 X day between meals
          Interface Plus 3 X day between meals
          Prescript assist 2 X day with meals

          I followed this protocol with the diet I mentioned above for two months.
          I used very small plastic bags to divide up my daily doses of med’s. I did this on a three day rotation so they would be ready for whatever the day had in store.

          Let me know if you want to be in touch about AIP/ SIBO food ok?
          Best wishes.

        • I used the herbal protocol –
          Candibactin AR & BR
          W/ Interface plus 1 ea. 3 x day between meals.
          Prescript Assist 2 x day with meals.
          Also Pharm. Grade fish oil w/ D
          (Amazon) 3 x day.

          I see Dr. Kresser’s idea has merit but I have not seen numbers of those it has worked for posted. The “cure” for SIBO
          is still not certain. It does make sense that when it is reduced you need to feed the good bacteria. I am too nervous to add prebiotic a like sweet potatoes back in. Still following
          the Siboinfocom diet for now.
          I am taking megasporebiotic with good success. My digestion is normalizing and I am able to add some foods back in now. Hope this is helpful. 🙂

        • Hi Ann, I am feeling 85-90% better now that I have cleared the SIBO. The challenge is keeping it cleared. I stay on my diet and supplement regimen and do not falter from these.
          This is challenging when you start to feel better.
          I do take LDN which I believe is helping with the autoimmune component. 54%’of people with Hashimoto’s have SIBO.
          I also learned that having calcium levels in range and
          keeping them there can be a factor as calcium affects the tone of the Ileocecal valve.
          If you haven’t started a journal I highly recommend this.
          If you would like to know specifically what I take you are welcome to send me a private email and we can share information. [email protected]; please put on the subject line, SIBO questions. Best wishes on your journey too 🙂

    • Hi Anne, there is a SIBO Facebook page that may interest you. I think you will find many answers there, be aware that
      the people that post are not medical professionals but speak from their own experience. We are all different.
      Best wishes on your health journey, it is possible to eradicate SIBO.


  49. I am almost positive I have methane sibo. I have tried every alt treatment under the sun and am in constant pain. My diet is so restricted at this point. It goes way beyond fodmaps. But getting a diagnosis has been a nightmare. I have lost all gut motility and most of the things that should help make things worse. The only way I can void at all is through using at at home colonic twice a week. This is terrible for so many reasons. One of the things I noticed was probiotics and fermented foods have a very very bad reactions. Many sites claim this will help and it made my symptoms so much worse just within days. It’s been months of me just trying to get back to where I was before I introduced them and still I’m not even back to my baseline. I would never suggest someone with bacteria add more bacteria. All these different strains and I even went with the ones that are suggested specifically for sibo. Even made my own coconut kefir to avoid dairy. Acv another thing sometimes suggested again had terrible effects. I have tried so many things that mostly made it worse or didn’t work. I’m out of solutions. I am going to the dr tomorrow to beg for the antibiotics despite the lactalose test. Only one company does it here and they don’t take my insurance. I pray every day I’ll find a cure for this. Like someone else noted I don’t want to live anymore. My life has become so restricted and I am in so much pain and discomfort I barely leave the house.

    • Bonnie, find yourself a local or nearbly ‘intergrative’ or ‘holistic’ doctor with a medical degree so that can test for and get you on the right track. I know exactly how you feel and its horrible, but don’t give up because there are doctors out there with the solutions to your problems.

    • You may have histamine intolerance. For example if you have sibo and eat cheese this will not feed bacteria but if you also have histamine intolerance and eat cheese especialy hard cheese you will get bad reaction. I think this is the reason stupid diets like gaps and scd and fast tract destroy people’s health because they concentrate only on bacteria but the problem with digestion is much more complicated. You can try to eat white fish instead of other meats and not eat leftover food.
      When i was trying to use the above diets i was eating a lot of aged raw cheeses – then i found out i have problems with histamine.

    • Message for Bonnie hello. I am in the UK and I am in the same situation as yourself my life is very restricted
      I feel as if I can’t go on so I understand when I read your words please don’t despair you are not alone I know this message will not offer a cure but I’m hoping it makes you feel more positive knowing that there are others exactly the same as yourself stay strong stay positive

    • Make sure you are getting your vitamins and minerals regardless of what you cannot eat. You need minerals to make enzymes which help digest your food. We just started Whole Approach bentonite/psyllium protocol. Just 1 drink before bed, well after any food consumption. Really tiny doses 1/4 tsp each in water,and lots of water to get my daughters BM’s going. This helps clean the intestines out so you can proceed with arranging bacteria to the correct balance. We did not begin the capryol. Just the 2 ingredient drink for now to get things moving. We’ll work on killing the bad bugs once things are clear. Go s l o w. She woke up in the night to have a bowel movement. I was never so happy!!

    • This is for Bonnie. You probably would do well on Dr. Seibecker’s SIBO diet with the antimicrobial she recommends. Allimed for the first month followed by Candibactin AR/BR for another. Use Iberogast or Ginger capsules as a prokinetic.

    • Bonnie I felt a tear in my eye reading your story, you aren’t alone, Im a grown man and have cried on many occasions, my diet is very restrictive also and thinking of doing a juice fast cause I take meds if I didnt take meds Id do a water fast, have you thought about increasing your water intake also? How about other supplements such as vitD3 at high doses som say it is miraculous, also diatomaceous earth seems to kill bacteria by killing them internally as the bacteria ingest it if im not mistaken, a kind of trojan horse.
      Let me know what you do an your progress please.

    • Hi Bonnie,
      I feel with you reading your post. I am in a similar situation, I have had this condition for 6 years and nothing has worked to eradicate it. I am struggling to live with this, and as you said I don’t really even want to live at all, it is so miserable to be in pain every day and have such difficulty leaving the house. I went on this site because I feel very alone in dealing with this condition (I had never heard of it before, and I don’t know personally anyone else who has it). Anyway, at least on this site I find others who are dealing with this too (not that I would ever wish this on anyone!) and feel a little less isolated. How have things been going for you since you posted this originally? All best to you…

      • Ladies look into homeopathic remedies along with taking Atrantil to help with SIBO.
        I have struggled like you both and am finally seeing results !
        lycopodium and arsenicum are my go to along with nux vomica

        Look up Joette calebrese ….homeopathic remedies …..

  50. its good to keep in mind that even Fodmap legal foods such as nuts and corn cause people trouble, this is due to leaky gut – which most SIBO people have, meaning we must maintaine a very simple and easy to digest diet I.E. vegtables very well cooked. no matter how low fodmap corn is, if your not digesting it, then bacteria will.

    i higly recomend the low fodmap SCD diet and only include; well cooked vegtables, unlimited fats, average protein and probiotic suppliments to keep the sibo in check.

    • Which protein would you suggest? Im soy/dairy intolerant and eating meat seems to increase inflammation and which fats? The seeds oils like flax/chia and olive oil OR the more saturated lard, coconut etc?

  51. Hi, great article, what are your thoughts on pulsing (cycling) antimicrobials (natural or antibiotics)? also what are your thoughts on resistant starch such as Organic Green banana flour and the fabulous fermented apple cider vinegar as part of a SIBO diet?

  52. Hi Kelsey, I hope you’re still responding to comments. I’ve been diagnosed with SIBO and failed to respond to the first course of rifaximin/neomycin (taken along with Interphase) and followed by glutamine, low-dose naltrexone, digestive enzymes, and a probiotic prescribed by my integral medicine N.P.

    Six weeks on a strict low SIBO diet (which combines the low FODMAP and SCD diets, organized by Dr. Siebecker, and is thus far more strict than either and allows for no grains at all) and this protocol, and I was still having bloating and also strange throat soreness I couldn’t recall having before the protocols. Then, I had to travel and couldn’t do the SIBO diet as easily, ate some carb foods (oatmeal, breads, probably sugars in foods I couldn’t check the ingredients of) and felt HORRIBLE, worse than before the protocol, not just bloating but lots of throat pain, like a lump in my throat and swelling, though I could still breathe. I worked harder (while still traveling) to return to SIBO and the worst of the symptoms disappeared.

    I’ll be home tomorrow and then back on the antibiotic protocol for two weeks, and I asked my N.P. about the high-fodmap/carb recommendations I discovered on this and related websites. I was thinking about trying the meds with your food recommendations.

    I’m curious about the type of carbs you would recommend, and by “a healthy, real-food, ancestral diet,” do you mean Paleo? If so, does this mean that there should be no grains at all, and the carbs should just be from fruits and veggies? If so, I’m not sure how those carbs are different than the carbs on the SIBO, except for some things like corn or peas. Or are grains ok because technically, the low FODMAP allows grains like oatmeal and the like? And no diary or added sugar? I already do the latter, though I eat some aged cheeses according to the SIBO diet mainly because I am in need of protein and calories as I keep losing weight and definitely don’t need to lose anymore weight.

    I ask for guidance because my N.P., while well-researched, is not familiar with the “feed the bacteria” approach you recommend, and I am desperate because I feel crappy–swollen, sore, tired, bloated, and with odd throat symptoms (I’ll be seeing a gastroenterologist next month on my N.P.’s recommendation).

    • Wow. Anthony William totally explains what’s happening to you in his book The Medical Medium. I’m really recovering after following his unusual instructions and heal-yourself-through-diet approach. Good luck either way.

        • This is from the book Medical Medium:

          Rebuilding Hydrochloric Acid The way to fix ammonia permeability (which, as we’ve just discussed, is often mislabeled as leaky gut syndrome or intestinal permeability)— and the first step in addressing virtually any other gut health issue— is to rebuild your stomach’s supply of hydrochloric acid and strengthen your digestive system. There’s an amazingly simple and effective way to do this: daily, on an empty stomach, drink a 16-ounce glass of fresh celery juice. This may not be the answer you were expecting. It may not seem like celery juice could be that beneficial. But take this very seriously. It is one of the most profound ways, if not the most profound way, to restore digestive health. It is that powerful. And keep in mind: while there are many juice blends out there nowadays that are fantastic for your health, you need to drink your celery juice straight if your goal is to restore proper digestive function. Do not be derailed by the simplicity of this. Think of it like being assigned a ten-page paper on one specific aspect of daily life in a certain historical time period. If you hand in a paper that’s an overview of the era, with only two lines about that one part of daily life, the teacher won’t be impressed by all the extra facts. She’ll wonder why you didn’t go in-depth on the one topic she assigned.

          • Hi thanks for replying! Isn’t celery a high fodmap? Maybe if I tried ginger Lemon & celery then add 20 drops of Swedish bitters on an empty stomach & see how that goes? Has juice helped worked for your treatment & are you SIBO free? Thanks again

            • Hi Inga,

              Celery maybe high fodmap but celery juice probably not – there is fiber and not much carbs in it to be high fodmap. I bought the book 2 days ago – i am now looking for celery stalks to buy. I guess you have to choose who to believe: on one side you have – Antony WIlliams, dr Mc Doughal with his starch solution diet, dr Grace Liu, dr hiromi shinya – they say carbs are good, proteins if undigested are bad on the other side you have – Norman robbilard, Alison Siebecker and Pimental – claiming that carbs feed bad bacteria and you should eat proteins – but they dont see the fact that people with digestive problems can not digest proteins well. Take for example the author of this article – she correctly state that the root cause of sibo is low HCL and lack of pancreatic enzymes and she still treat the SIBo with antibiotics

              • I would be careful with any recommendations made by Antony Williams “Medical Medium”. He is a self proclaimed spiritual medium with no medical/science education. I read his book and according to him all health issues stem from the Epstein Barr virus and the cure for everything is always blueberries and celery juice! I went on a low FODMAP diet and Rifaxaman a few years ago and it really helped my stomach issues. After 6 months I was able to reintroduce a few high FODMAPS like onions and broccoli but I’m still unable to consume raw beets without getting nauseous immediately. Good luck and I hope you are able to heal soon.

    • You sound like me, Allison. The throat symptoms sound like LPR, and SIBO is likely the cause. I am in a similar situation to you and am about to try Siebecker’s Allimed (garlic) rec. You may be dealing with fungal overgrowth which often coexists with SIBO. Siebecker’s website gives the Johns Hopkins protocol for SIBO and it includes an herbal antibiotic along with an herbal anti fungal. I omitted the antifungal and have not seen relief with just the herbal antibiotic.

      I have the Medical Medium book and might revisit it too, out of desperation.

      • Lucy,
        I am having trouble finding the herbal anti-fungal you are referring to on Siebecker’s website. Is it one of these, Dysbiocide, FC Cidal, Candibactin-AR, or Candibactin-BR? Or something else?

        • It is called Allicillin it is a natural antibiotic. I found the best to have the brand name Designs for health. I did good on this. My question is do you take it while on the Rifaximin, or is this to much, both the herbal and the pharmcutical . This is infused garlic. Garlic that is whole will actually make Sibo worse.

          • It is called Allicillin it is a natural antibiotic. I found the best to have the brand name Designs for health. I did good on this. My question is do you take it while on the Rifaximin, or is this to much, both the herbal and the pharmcutical . This is infused garlic. Garlic that is whole will actually make Sibo worse.

  53. Hi everyone! I will try to make a long story short. After one weekend of drinking alcohol i had a meal and had an enormous amount of abdominal pain after and loud digestive noise and extreme bloating. This continued and I got down to 87 pounds because I would avoid eating because of the pain. My pain got worse and worse and I would scream and cry and my parents took me to the er and I got put on hydromorphone which is five times stronger than morphine. I gained some weight because I could eat again and it just really felt like my digestive system was not working. I have had every test and doctors say I just have severe ibs. The pain is so bad I really don’t want to live anymore. At Cleveland clinic I got a positive test for sibo but the doctor said it shouldn’t cause that much pain and to just take probiotics. A doctor mentioned my slow motility they kept seeing was because of adhesions I needed removed. I have had surgery to remove my adhesions and I still have the extreme pain. I am now thinking something needs to be done about my sibo because there is nothing else left. I have taken antibiotics before but I think I need long term use. Can someone tell me please, can sibo cause extreme abdominal cramping? Mine is around my belly button and the pain killers barely work anymore 🙁 I am so sad.

    • I hope they checked your kidneys? I had waves of excruciating pain in that same spot as you, throwing up and feeling like I was going to pass out for 2 days. I thought I was dying. I was on my way to the ER.

      Never would have thought of kidney stones because that’s normally pain on the side of my waist and nothing else. Once we realized that, I took HerbPharm’s Stonebreaker and was better in 20 min. I did take it several times for the next 2 days as well just to make sure.

    • Girl, you have been thwarted by your docs. Pain killers stop mobility…which contributes strongly to SIBO. Then they gave you probiotics which at your stage would make SIBO…which is an overgrowth…worse. have you looked at SIBOinfo.com? You might try two weeks of the elemental diet and her herbal protocol including Allimed for methane. You might start to turn around quickly.

  54. After replying to a couple other posts, I’d like to add my own two cents: there is some wonderful information here. For everyone still suffering with SIBO, I would say it is mandatory that you follow a gluten free and dairy free diet. There are so many helpful suggestions here, and antibiotics may work for some, but if you continue to eat dairy and gluten, I believe it will undermine your progress! I had chronic digestive issues and other symptoms for years (burning stomach, gas, severe bloating, chronic constipation with alternate diarrhea, leaky gut). I went eleven days without a bowl movement once! These issues have resolved from eating mostly Paleo AIP and following the Gut Repair diet. I have discovered I am gluten intolerant with cross reactions to dairy and soy (Cyrex Array 4). I do include some brown rice from time to time, and beans every blue moon. I also run borderline hypothyroid and that is probably what contributed to my digestive issues in the first place, but even with a perfectly functioning thyroid, I would say it is still very important to avoid gluten, dairy, and soy for me. I hope this helps someone!

    • In reference to the gluten intolerance, I read just the other day that a new study has shown that unless you have celiac disease, it is most likely the chemical (roundup-weedkiller) that the farmers spray on the crops prior to harvest to increase the crop yields. So we could actually be poisoning ourselves every time we eat grain.

      • can you provide a link? been hearing a lot about the dangers of glyphosate lately, but eradicating an invasive species in our backyard, the arborist really went to town with that stuff, makes me nervous so i want to know more…

  55. My wife is having many issues with her gut after massive doses of antibiotics. We are hoping that you can refer us to a Doctor with a similar practice/approach here in the Dallas area to help her to regain her gut and overall health.

  56. Kelsey and the whole Kresser team, thank you for this info. I had a hard time parsing that study, but it actually covered TWO different herbal protocols. Would be nice to see more info comparing the two, however if one doesn’t work for someone, perhaps the other will.

    I’ve been struggling with sudden lactose-intolerance, gas, bloating, diarrhea after being on pharmaceutical antibiotcs and antimalarials treating chronic borrelia and babesia infections. I’ve been on a herbal protocol for both for a few months, but my gut has not only not bounced back even with high quality probiotics, a little cheese takes me down. I also get *very* sick if I eat just two tablespoons of fermented sauerkraut, which is frustrating because everyone always says to eat it to repopulate gut flora. I’m really hoping I can tamp the SIBO down and reintroduce these foods slowly. As someone with gluten-intolerance who used a gut healing/GAPS/autoimmune paleo diet to heal with success in the past, not improving has been very depressing. I hope SIBO is the key for me right now.

    These kinds of articles with citations and continued research are so helpful, I cannot thank you enough.

  57. I am a vegan. I eat like FullyrawKristina during the day and like Mcdougall at night. High Carb, Low fat, while food, no grains except corn. So are you saying it is possible to cure SIBO and continue to eat my raw vegan diet?? That would be wonderful news!! I have been so discouraged that I would have to eat meat in order to heal and I do not want to do that because I’m religiously a vegan. I get so bloated/stomach distention after every meal. Even water does it. Can I take oil of oregano or some type of charcoal or something that has antibiotic properties to rid of the bacteria and still continue to eat high carb while addressing the underlying symptoms like taking HCL, etc? Thanks so much.

    • Hi! I am vegan too. And was recently diagnosed with hydrogen dominant SIBO. I think what triggered it (besides high amounts of stress) was eating a lot, and I mean A LOT of high sugar fruits. Like persimmons, dried figs, dates etc. My gi was compromised about 2 years ago after 10 antibiotic course.
      I’m currently on sibo herbal protocol, and trying to figure out how to adjust my vegan diet so it doesn’t interfere with herbals. Basically despite eating low fodmaps (and generally little food) for a week, I’m still constantly very nauseous, somewhat acidic, and super bloated. And additionally very depressed (which is a symptom of SIBO). Might be a herx reaction, of course. But I wonder how crucial it is to follow any specific diet protocol during the treatment for SIBO.
      I don’t have any answers for you, just wanted to share my experience, as a fellow vegan.

    • Check out the book Medical Medium. Anthony’s totally saving me with his unorthodox protocols. He’s prob vegan himself tho he helps everyone to find what works for them.

  58. I am starting treatment with Rifaximin tomorrow and am wondering if I should eat gluten again? I have a mild intolerance to gluten and have had little/no gluten in the 3 months. Thanks!

  59. Whether it’s herbal antibiotics or regular, you are still killing off all the bacteria, good or bad. When I was tested for SIBO, they took a culture and there was not one single bad bacteria according to the lab report. Of course we know now that the organisms called Methanogens (in constipation predominant cases) are what feeds off the bacteria and causes methane inside the small intestine and causes slow transit, which at least shows slow transit is the effect, not the cause. To me you would have to take antibiotics on a regular basis to keep this at bay. I did eat high fodmap while I was on the antibiotics too but it didn’t help. I’m so fed up with dieting but I have so much health damage from all of this, including food allergies. I hope one day this is cured…my daughter has Hashimoto’s and a learning disability…she is only 19 and I worry for her sake.

    • Cheryl, look at the Hacking Hashimoto’s site and the book The Root Cause. I am close to putting my Hashimoto’s in remission. Best wishes.

  60. Thanks for this post. I’ve been dealing with SIBO for about a year now. I have Crohn’s disease and have had resections, one of which was removal of the ileo-cecal valve. I believe this history likely will make my chances of recurring SIBO even more likely. I have so far done 4 rounds of the herbal antibiotics. I started doing the SIBO diet – SCD and low FODMAP, for the last month I’ve been adding back some higher fodmap foods – mostly avocado, garlic, onion. I’m not having trouble. I also started managing some adrenal problems I was having. I feel so much better than I did a year ago. Is it safe to stay on SCD with moderate FODMAP consumption, given that I don’t have all my plumbing?

  61. My problems started about 30 years ago when I went to bed one night and woke up later with a growling intestinal tract and a huge desire for sugar….I actually went to the kitchen and started eating sugar cubes due to the craving. I started having diarrhea and gas problems and within a few days a white growth on my tongue, severe tiredness, especially after eating, very sore eyes, rashes. I had such a craving for sweets that I would go to the store and load up with cake, pie, ice cream….couldn’t get enough of it and I just got sicker and sicker. I think the problem was caused by taking high protein powder drinks mixed with large amount of bananas, ice cream, and milk while lifting weights. Doctors weren’t much help. Finally I decided I just had to resist the sugar cravings and restrict my diet……my symptoms improved considerably but after a few weeks of diet restriction resulting in significant weight loss (I’m skinny to begin with) I would return to a “normal” diet and all hell would break loose again. I started taking digestive enzyme tablets along with 80 billion caps of probiotics which helped considerably but I still wasn’t anywhere close to normal. This went on for many years until I hit on a doctor about 2 years ago who ran the hydrogen breath test and diagnosed SIBO. She prescribed drugs for it but the problems would return. A few weeks ago I went to the VA for an annual checkup, explained the issues to this doctor and he thought the previous drug treatment was insufficient in length and amount so he prescribed 150mg caps of clindamycin, 3/day for 10 days along with 500mg tabs of metron/dazole, 3/day for 10 days. I stopped taking the probiotics while on the drug treatment and had loose stools while taking the drugs. As soon as the drugs were finished I started taking the probiotics again, at the doctors recommendation, and now diarrhea started worse than ever. At first I thought taking the drugs messed up my system. I stopped taking the probiotics and as soon as I did this the diarrhea stopped! Figure that out! Right now I would say I am better than I have been for 30 years, tiredness after eating is gone, no tongue/mouth symptoms, no bad taste in my mouth in the morning like I used to have……virtually all the bad symptoms are gone! And no sugar cravings. It’s only been about a week so I sure hope the problems don’t return. I’m a good example of what severe SIBO can do to a person….just wish it hadn’t taken so long for a doctor to diagnose. Thanks for the article.

    • Hi Mike,
      It sounds like you’re in the right path. I’d keep an eye out also for digestive candida. It can cause the white tongue and sugar cravings too, along with a lot of other issues.
      At the moment I have problems with both, once I’d treated the sibo with antibiotics, it caused my candida to flare up again quite bad
      I hope you are still feeling better

    • Hi Mike – Just wondering if you’re still feeling good and if so what you are able to eat these days. Hope your health continues to improve!
      Best wishes,

  62. Hello,

    I recently had the hydrogen breath test and it was positive, so my GI doc put me on Rifaximin. I began the pills today, but am wondering what type of diet I should be eating in conjunction with the meds?? Should I avoid FODMAPS or eat them if tolerated? Also, should I be eating lots of veggies and fruits? When I went on the fasting protocol for the breath test, I felt amazing, not a single gut disturbance (I’m usually bloated all the time). But then I wonder where I get nutrients from? I also have MS and according to the Terry Wahls protocol, it is essential to eat large amounts of raw, green leafy veggies. If anyone has any insight, it would be greatly appreciated!!

      • Hi Melissa,

        Please check the comment on this page from – Tayo – i think what he/she suggest will fix simultaneously your celiac, SIBO and MS – according to dr Pimentel SIBO is also autoimmune desease.

  63. As faith would have it, two of children where diagnosed with fructose and lactose intorelence and SIBO. Our youngest ten and oldest college age. They have been on the Low FODMAP diet since December. We have kicked the SIBO with the help of R twice. We are extremely proud of our daughter who is choosing this diet while living at college. She has been able to discern what does and doesn’t bother her, nuts are ok. BUT IT IS REALLY HARD FOR HER AND OUR SON TO KEEP WEIGHT ON. Our son complained of not feeling well about 60 times a day, now it’s more like 4 times a day. He also doesn’t carry a bowl around with him anymore or have sensory issues like before. I am so done, it is so hard not cooking with onions, garlic, honey, nuts, blah, blah, blah. We were so happy eating Paleo before this. I feel guilty switching back because I tried it and he complained more. I think we had his stomach acids tested. It has been a long hard road, one I really wish we could get off of. Any ideas?

  64. Hoping someone can help with this issue…!

    Are high d lacate levels from bacteria considered to be SIBO or just dysbiosis? My Organic Acid test showed a very high level of d-lactate which was attributed to acidolphilus. Not sure why it was was specified as that particular kind since it is not the only one that can produce d lactate, however all my other bacterial markers were low.

    Would an overgrowth of l acidolphilus (or any other d lactate producing bacteria) produce hydrogen where it would even show up on a breath test? Would rifaximin kill acidolphilus since it is considered a good bacteria?

    Thank you very much if anyone can help me piece this information together, there is not much that I could find regarding d lactate.

  65. Closing the iliocecal valve that prevents normal bacteria from flowing back up into the small intestine from the large intestine seems like a critical adjunct treatment for SIBO.

    Dr. Datis Kharrazian said this about it:

    ” The standard treatment for SIBO is non-absroable antibiotics and fodmap diet. Unfortunately, the re-occurance with conventional treatment is nearly 100%. The actual mechanisms is really bacteria translocation. With lack of neurological input to the ileocecal valve bacteria moves from the large intestine into the small intestine and ferments sugars. You will need to continue to re-kill the bacteria in the small intestine until neurological control the intestines and the valve are normalized.

    “Our approach involved the fodmap diet with brain-gut exercise. Some can restore their brain-gut axis plasticity and some cannot. It is hard to say without a trial period of treatment. Also remember every time you eat sugars that then cause bloating from small intestine bacteria fermentation the gas opens up the valve and continues to promote bacterial movement from the large intestine to the small intestine. That is why strict fodmap diet with brain-gut exercises is important. Antibiotics can be used to treat symptoms however neurological integration into the intestines is critical”.

    This statement from Dr. Kharrazian came within his brain health webinar last week. In this course the health of the brain to gut connection is considered in relation to overall brain health.

    To me this means it’s most important to deal with motility and closing the iliocecal valve when dealing with SIBO since all the treatments to kill the bacterial overgrowth will not prevent the return of the bacteria from the colon. It almost seems like getting the iliocecal valve closed and upping your transit time through the small intestine should be addressed BEFORE taking anti-microbials. or at least at the same time.

    I would add that the IC valve is meant to open one way to allow the flow of contents from the small intestine into the large intestine and that this should happen in a rhythmic fashion – opening and closing and opening and closing etc – in conjunction with normal cleansing peristalsis motility moving digesting food through the whole GI tract. It’s not the goal to keep the IC valve closed but rather to return it to a normal pulsing action.

    • Hi Angela, thanks for the helpful info, if your SIBO remains in the Ileum area, would that be an indication that you may have ileocecal valve issues? .. what types of ways can you stimulate this valve? … vagus nerve exercises?

      • Hi Vivek,
        yes neurological activating exercises for the Vagus nerve and coffee enemas are what Dr. Kharrazian recommends in his book on Brain health. The coffee enemas are not aimed at cleansing they are aimed at stimulating the nerves in the colon to activate peristalsis. The exercises for activating the Vagus nerve include intense gargling for several minutes several times a day, loud singing, and inducing the gag reflex (minus actual vomitting of course) numerous times a day. Some people also include certain yogic breathing techniques that stimulate the vagus nerve. I wouldn’t be surprised if there are other ways too.

        In general the small intestine should be free of bacteria (good or “bad”). So yes it’s likely if you have bacterial growth in the anywhere in the small intestine then the IC valve is not closing properly. However there could also be problems with motility where the nerves in the intestine are damaged and cannot move the contents through (peristalsis) in a normal manner. So it could be one or the other or both IC valve and migrating motor complex.
        Dr. Alison Seibecker also talks about these issues at her great site sibo.com

        • wow thanks again, and for being quick 🙂

          Great! I am already doing the coffee enemas, to help with liver detox. Actually, my Nutritionist believes the reason for all my lethargic motility and other symptoms I am having ( low thyroid function, cold hands/feet, hair loss, intense itching/rash) is related to heavy metal toxicity.

          • Yeah, I’m noticing that different practitioners have different ideas as to what causes what. I see a lot of different views of what is the root cause of something and often they contradict each other.

            Lets hang in there together and keep exchanging info….that’s what the microbes do (hee hee)

          • I totally agree with the heavy metal toxicity angle. I too am suffering from that and until all of my amalgams are finally removed, in addition to possible chelation therapy, I really don’t think my 20+ years of digestive woes will be cured.

          • Hi,
            What did she say to do about that and did it work. I too have hair loss and cold hands and feet. I have hasimotos but my thyroid levels are fine.

    • Strange, seeing as I thought coffee enemas where partly to blame or the thing that did me in, I did coffee enemas for 8yrs and stopped when I started having pain in my right side and was diagnosed by ultrasound with cholesterolosis (Gallbladder polyps) I stopped them and 8 months later was diagnosed with fatty liver and so maybe my body got used to the bile flushing and then stopping this helped to create my fatty liver?
      I did over 8000 coffee enemas and can tell you they are addictive, I found that in the last few months and when I do them occasionally that I have to baby my stomach and intestines, I mean it takes a lot out of them maybe sucks out all bacteria, i.e. creates a vacuum and this IC valve area possibly weakens? Thus allowing bad bacteria in the colon to migrate to thee small intestine, bad bacteria also may be migrating from my stomach cause \i have low stomach acid due to 20yrs taking prilosec for GERD/Hiatal Hernia.
      I don’t know what the heck I should do to heal from this, I tried reducing the prilosec a few weeks ago and started having duodenal ulcer pains and small intestine ache and so upped my dose again.
      Had some bone broth today with cauliflower and carrots, cherries and apricots, had banana mixed with slippery elm but it seems thaat hurts my intestines, probably cause it is too sweet.
      How the heck do I heal or get ured from this?
      I know the answer must be to stop the low acid situation, which means stopping prilosec without getting a duodenal ulcer in the process as rebound acid will occur and without burning my esophagus and so I have to heal the hiatus hernia also by losing weight and massaging the hernia area down and abdominal breathing/stretching exercises.

      • Hi Bonnie, I feel for you. I understand that some people with SIBO do well on fermented foods and for others the undesirable bacteria in your small intestine use the probiotics as a meal. I would not take fermented foods. My gut therapist advised olive leaf capsules and colloidal silver against SIBO. EFT (Emotional Freedom Technique) may also help, since all physical symptoms have an underlying emotional cause.
        Lots of videos on EFT on YouTube. Good luck!

        • I agree with the emotional component to all of this. My spiritual counselor feels all my gut issues are a manifestation of something emotionally deeper. For me it may be unreleased anger. My naturopath has suggested EMDR counseling. I am in process of seeking a certified therapist. Remember- it’s body, mind, soul.

        • Thanks for that, I did read something about EFT and autoimmune disorders, I’ll have to give it a real go! Had potatoes and breaded chicken (Chicken and chips) from a greasy takeaway place (junk food) yesterday and this morning loads of mucus, sneezing, had night sweats, itchy red eyes and there I was cursing and telling myself never again – the bread on the chicken did me in (gluten) but also the potatoes (nightshades) and probably that toxic fried oil. I’m going to be juicing today and for 2 months – the intention is there but then cravings come and I cave in, how to stop cravings?

    • I am surprised that dr Kharrazian dont mention what is causing the illeo cecal valve problem – here is info from John Matsen:

      Your ileocecal valve can become weak when your calcium levels are low for more than five days – calcium helps to strengthen this valve. Increasing your calcium intake doesn’t necessarily solve the ileocecal valve problem, because the solution depends on whether the calcium is being absorbed by your body. Vitamin D is required for calcium absorption: it stimulates your intestinal cells to make a calcium-binding protein that dramatically increases your absorption of calcium. Vitamin D is made by your skin when exposed to the ultraviolet (UV) rays of the sun, and then it is stored in an inactive form in your liver.

      When vitamin D is released from liver storage, your liver converts it into a weak form of vitamin D, which then activates calcium absorption to a small degree. This might be sufficient activation if you were out in the sun regularly, when your skin can make a lot of vitamin D. Your kidneys convert this weak form of vitamin D into a much stronger form that can improve calcium absorption up to 1,000 times. This strong activation of vitamin D is especially crucial for wintertime when there is little sun around to make vitamin D directly through the skin.

      Your kidneys are in charge of regulating calcium levels by altering the activation of vitamin D with the changes in the seasons. Because the kidneys can’t see outside to know what the weather is like, they monitor the ions in the foods and the beverages you’re consuming. The sodium/potassium ion ratio tells the kidneys what to do with regard to the activation of vitamin D.

      Your blood contains 3 percent sodium, a percentage similar to that found in the ocean and in animals. Your kidneys maintain a 50/50 ratio of sodium and potassium at all times. Excess sodium in the diet is eliminated through the kidneys, giving a warming effect to your body and making you more active, while an excess of potassium has a cooling effect, which slows you down.

      All plants contain potassium; generally, the more sun they’re exposed to, the more potassium they contain. Eat a banana, which has lots of potassium, and your kidneys will think that you’re in Hawaii, and that your skin must be roasting in the sun – making vitamin D – so they stop activating vitamin D. if you’re not actually out in the sun, you could quickly lose your calcium absorption – and within five days, your ileocecal valve could be weak enough to allow your billions of good bacteria to stampede into your small intestine, where they could become Bad Guys.

      A vegetarian animal on a high-potassium diet needs access to salt, while a carnivorous animal gets its salt from the 3 percent sodium found in the vegetarian animal that it eats. In the winter, an Inuit would be on a high-sodium animal-protein diet, which would tell the kidneys that the weather is not sunny, so his kidneys would activate the vitamin D much more vigorously.

      If your skin is going brown from the sun, you can eat a slight excess of potassium; otherwise you should eat a slight excess of sodium. This is the basis of the concept in Asian medicine of “yin and yang” – warming and cooling. Even though most Asians don’t have high-calcium dairy products in their traditional diets, they generally have much lower incidences of dental cavities and osteoporosis than do Westerners who use dairy – and who also eat a lot of fresh fruit, juices, and salads, even in winter.

      The ileocecal valve problem is commonly seen in PEOPLE WHO EAT TOO WELL! That is, they consume too many foods and drinks high in potassium, and don’t consume enough sodium in the form of animal protein or salt. This confuses the kidneys into assuming they are in the hot sun of mid-summer, so they deactivate vitamin D.

      While the kidneys’ activation of vitamin D is crucial to getting calcium from the gut to the blood, it is vitamin K that delivers calcium from the blood into the bone. Vitamin K also prevents calcium from sticking in the arteries – thereby reducing the risk of heart disease and stroke. Vitamin K is found in leafy greens; cooking them slightly and salting them will help prevent ileocecal valve problems when you’re not actually out in the sun.


      Vitamin D is crucial for the absorption of calcium. If you’re out in the sunshine and your skin is exposed to the UV rays of the sun, it will make vitamin D. If you’re unable to get regular sun exposure, take vitamin D as a supplement – one capsule of halibut or cod liver oil per day. These sources of vitamin D seem to be more active than the irradiated yeast used in vegetarian vitamin D supplements.

      Vitamin D is relatively passive until it’s activated by your kidneys, which change the activation of vitamin D as the weather changes. Sodium in the diet tells the kidneys it’s not sunny, so they activate vitamin D – while potassium tells the kidneys it is sunny, so they don’t activate vitamin D. So, eat according to the climate in which you are living.

      If you eat animal products, you get adequate sodium; if you eat vegetable products, you need to add salt. Unrefined sea salt carries myriad trace minerals that buffer the potential side-effects of pure sodium chloride. Salt, however, including most sea salts, has had these important trace minerals stripped off and sold to the industrial mineral market.

      now the question is if this theory it correct or not.

  66. The real cause of sibo

    Research has shown hypothyroidism, or low thyroid function, severely affects the structure and function of the digestive system by decreasing peristaltic movement, and the production of digestive enzymes, essential to the breakdown of protein, carbohydrates, and fat.

    A common example of this would be the effects of low thyroid on the recirculation and absorption of estrogen back into the small intestine. This interferes with proper detoxification and can lead to estrogen dominance and progesterone deficiency. Low progesterone causes a lack of regeneration of the microvilli in the small intestine, which then leads to a decrease in digestive enzyme production and a decreased ability to absorb nutrients such as lactose. So the question now becomes, is lactose intolerance really just another symptom of low thyroid function and its effects on the GI system?

    Note: Take it from someone who was never able to drink dairy and can now drink a good 10-12oz a day (this is not including yogurt, cheese, butter, etc.). The more attention you place on healing your metabolism, and away from trying to “fix” your gut, the more successful you will be long term.

    What contributes to SIBO?

    As we have mentioned, a decrease in peristalsis and digestive enzyme production interferes with the body’s ability to breakdown and absorb nutrients from the food we eat.

    If we are consuming foods the body cannot break down, whether it due to low digestive juices or because we are eating foods we humans were not designed to eat, what is going to happen?

    Bloating, gas, constipation, diarrhea, abdominal pain, fatigue, vitamin and mineral deficiencies…anyone familiar with these symptoms?

    Foods such as grains, beans, an excessive consumption of cruciferous veggies and leafy greens (particularly raw), lentils, breads, nuts and seeds, and alcohol are some of your leading offenders when it comes to foods responsible for increased bacterial overgrowth in the gut. This is where the whole question of “what’s healthy?” can get very obscured.

    Prepared properly, and in a body with optimal digestive function, these foods might not be such huge offenders, but in a body with compromised digestion these foods are facilitating chronic inflammation and metabolic destruction.

    We have an entire population of people willing to do anything to heal their gut. Supplements, labs, detoxes, elimination, as well as consuming a large amount of these offending, so called, healthy foods. What would happen if we began taking some of these foods out of the diet and replacing them with foods the body can digest, so we can increase nutrient absorption, reduce stress and inflammation and normalize gut bacteria?

    What can you do to begin balancing your ecosystem?

    To begin, we suggest you avoid the foods mentioned above or at least, greatly reduce the amount you are consuming and make sure your veggies are thoroughly cooked.

    Limit the intake of polyunsaturated fats from nuts, seeds, nut and seed oils, fish oils.

    Consume ripe, tropical fruits and/or seasonal ripened fruits.

    Consume well-cooked root veggies in combination with healthy fats and proteins.

    Increase consumption of bone broth.

    Include a raw carrot or bamboo shoots into your daily regimen.

    Eat regularly to help balance blood sugar.

    • I thought it was the other way around, low thyroid function was secondary or caused by something like SIBO. I am having issues with detoxification and liver/ gall bladder problems, combined with low thyroid, where do you see that in the equation?

      • I think it can go both ways if I look at my wife and I.

        My wife has been hypothyroid pretty much all her life (it shows on pictures of her as a small child already). As a consequence, after many years of hypothyroid, she started to develop belly problems (probably due to lack of energy and slow bowel movement). I, on the other hand, have had belly problems pretty much all my life (with lightning fast digestive tract movement) and only recently has my thyroid function started to be in trouble (probably due to malnutrition).

        • Thanks Chibs,

          I think you are right! I just reviewed this http://chriskresser.com/subclinical-hypothyroidism-what-you-need-to-know/ and it said it could go both ways. really curious about the liver problems though. My nutritionist believes I could have heavy metal/ candida issues that is causing it all. I guess it truly is a long process and have to try one thing at a time. The next step would be getting a thyroid panel done. (I have hair loss, SIBO, and cold sensitivity * cold hands / feet)

          • Vivek – the next question then is what causes candida – many people say – hypothyroidism again.
            And many other say that candida cause problems with thyroid. I think both are wrong – it seems to me that there are other factors that cause both thyroid problems and candida – heavy metals for example

            • Thanks for connecting Pet!

              I am definitely focusing on that heavy metal as the cause, and doing a serious detox. I have been going for 2.5 months, but still a ways to go. But I am making improvements. What about you, what type of issues have you been battling? in conjunction with the SIBO of course/

                • Thanks for sharing pet, I will ask my Nutritionist about the zinc increase, right now I am taking about 10 mg with my supplement protocol but maybe it needs to be bumped up. Although, I don’t have any amalgam fillings It does appear I have a toxicity /metal toxicity of sorts.

                  That is strange you are not able to do any tests, most of the kits though you get via mail, so that still may be an option? if you find a practitioner who is near you and can assist. If you want to connect further feel free to email me: [email protected] …. and here is my blog as well: https://www.tumblr.com/blog/sufferin-sucka … all the best to you 🙂

  67. Dear Kelsey,

    thank you so much for this brilliant post! I really learned something 🙂 I’m a RD working in Switzerland and it’s hard to find a like-minded RD here… so I really enjoy reading your articles. And by the way, your recommendations are working well with the swiss population too 😉

    Best wishes


  68. At this point i’m very confused and completelly hopeless.

    My problem is that i’ve been suffering from GERD, stomach pain everytime i eat (and i dont), lack of energy and most importantly Chronic Urticaria (Dermatographism) every single day for the last 3 years.

    I have tried taking betaine HCL (because I read that during the early 20th century chronic urticaria was linked to hypochlorhydria) but i feel dizzy, nauseous, bloated and GERD becomes worse after a few days of taking it.

    I can’t do Gaps or SCD because too much meat/eggs also gives me acid reflux and lots of pain so i’m only able to eat some meat at lunch and maybe an egg for dinner (even sauerkraut gives me acid reflux and pain), everything else has to have carbs or dairy in it (i’ve been off gluten for more than a year)

    Last week i tried to do a whole30 combined with Gaps and had to stop and eat some starch to calm the urticaria, the reflux and the stomach pain.

    A couple of years ago i had a full course of antibiotics to treat h pylori. I got rid of it but didn’t feel better at all. The doctor told me i had gastritis and put me on Omeprazol but since it wasn’t doing a thing i stopped 3 weeks after finishing the antibiotics.

    The thing is that in my country i wouldn’t dream of finding a doctor that knows about SIBO. This year we have had serious shortage of medicines so is probably out of the question i’ll be able to find Rifaximin; and i haven’t been able to find any herbal antimicrobial here.

    Has anyone been succeful with diet alone? or at least got some improvement? maybe i should put up with the pain and do GAPS with the hope the pain will lessen as i get used to the diet?

    Or maybe is the gastritis that i have to solve first? but how?

    • If I were you, I’d first try to fix the stomach problem and work down from there. If things already have problems in your stomach, that can upset everything that follows.

      Have you checked stomach acidity? Too low or too high can cause problems with meat and fat.

      I thought there was a very basic test you could do yourself by having baking soda on an empty stomach.

      I’ve had trouble with meat and fat just sitting in my stomach for hours and giving me minor acid reflux when I lie down (my esophagus is a bamf). It helps for me to drink fizzy water or have something acidic with the meat or fat. May not work for you, but if you haven’t tried, worth a try.

      I hope you’ll be able to fix this soon because I can only imagine how horrible it is to be nauseous a lot :-/.

    • Please try using NOW foods Ulcetrol or another brand of zinc l carnosine for at least two months-I was exactly the same as you but now I am much better stomach pain wise ! I had h pylori as well as candida and SIBO and I had gastritis like you but the burning has finally stopped and I can move on to treating the next stage good luck!!

    • I just watched on Netflix the documentary, Fat, Sick and Nearly Dead in which two people cured their Chronic Urticaria. The second film made 5 years later tells of this one guy who cured his Chron’s Disease that he had since he was a teenager. They all did a juice fast.

      http://www.nutritionfacts.org featured one study (or more) showing how intermitent fasting reversed diabetes. The rice diet (similar to fasting) done in the 1940’s reversed retina degeneration, hypertension and diabetes.

      I have been researching the microbiome for three years and now believe this is the cause of bad health. Feeding one’s microbes an unhealthy diet or being exposed to pharmaceuticals even in the drinking water causes the microbes that keep us healthy to diminish.

      http://www.thepowerofpoop.com is an informative website.

      My SIBO was under control for 2 years after a FMT and herbal treatment (the one in the study). I could eat and drink anything. I drank beer and alcohol a couple of times a week. The SIBO returned full force after taking pain pills. I no longer will take any drugs! They all seem to affect the microbiome.

      • I think I’ll do a juice fast, but what juices could a person use that won’t affect the small intestine, are pineapples/mangoes allowed? I think according to Gaps, SCD etc they may not be allowed, I think Dr Mcdougal also shows how people with arthritis have been put on fasts and then back on limited diets, when they were fasting their RA had gone for a large percentage of people.

  69. I was diagnosed in July with SIBO. The things I read about doing antibiotics to take care of it weren’t good. Said many got it back within 6 months, and it was worse. So I’m doing the SCD( specific carb diet), but still having problems. Should I do the antibiotic route?? My weight has dropped from 127 to 117 and I’m still dropping. Please weigh in if you have any advice. Thanks!!

    • Hi– I struggled with SIBO, IBS, diverticulitis and H. Pylori alternately for over a decade. After Low Fodmap and then 3 days of Rifaximin (yes only 3 days) a year and a half ago my symptoms have not returned. Best thing I ever did. Wish i had know about rifaximin sooner! I still maintain a paleo diet avoiding dairy becuase it gives me acne but if I inadvertently eat a bit of dairy or grains I don not have terrible stomach pain like i did before the Low Fodmap and rifaximin.

      • Hi Jennifer,

        Happy that you are enjoying a life free of IBS. It is my first time hearing about this Rifaximin thing. I live in Europe (Denmark) and I have suffered for the last 10 years (it is just a year ago that was told it is IBS). How is it possible to get Rifaximin? And I am currently taking vitamin D (because my vitamin was lowered due to the IBS). Is there any side effects. My main problem with IBS is constipation and stomach pain and a very large bloating.

        • Hi- your problem sounds similar to mine as I also suffered with constipation. Rifaximin is an antibiotic which acts only in the gut. It is not systemic so targets only the harmful bacteria on your gut. You will have to get a prescription with a Dr. I would imagine you can get this on Denmark as well. I got my prescription in the Bahamas where I live. I suffered no side effects at all. I hope you are able to try this and get the fantastic results that I did!

          • Hi Jennifer,
            I have started the medicine (11th day now) and the impact is similar. starting from fourth day, I was back to a complete normal situation and continuing my thesis work for Masters. The main problem I faced was mental. Now, the appetite I have before I eat is completely different. As you said, I wish I know this medicine earlier. But, still if this cure works after now, I will not regret the last ten years I lost due to IBS. I wonder how I lived with IBS. Now, I appreciate more the sufferings I went through.
            It is my wish that others suffering from IBS also have a life with out IBS.

    • I just began 2 weeks of Xifaxan after having lost 45 pounds. I have had nausea, diarrhea and extreme fatigue. I am also taking Capryllic Acid and am doing a little better, although I am not through the treatment yet.

  70. I was on GAPS and low FODMAP for a year and whilst that reduced the pathogenic load I also ended up with very low numbers of anything! Looks like I really starved everything…a fecal transplant, fibre supplements and lots of FODMAP later and I’m a lot better! I wish I had known all of this earlier… So thanks for all the great work and putting the info out there!

    • Did you do a DIY fecal transplant? I was thinking of doing that with my childs fecal material, yuk! – I suppose one could do it DIY, how many fecal transplants did you have and is the fecal transplant mixed with other material? Interesting!

      • A doctor I saw in Oakland, Ca says that fecal transplant is not the treatment for cibo. We are already loaded with bacteria and should not introduce more. It is used for C def successfully.

  71. I’m just curious, as I am looking for some relief for my mother – I suspect that she has SIBO – long story I won’t go into.

    I’m of the understanding that Silver Water will kill the bad bacteria and leave the good. If this is so, would it help in SIBO and GERD?

  72. Could colifirm in my well water cause SIBO? Our water just tested positive for coliform bacteria (not E. coli). I have been experiencing what I believe to be SIBO symptoms since April, along with losing 10lbs. I have been seeing a GI doctor since then, and have not been able to pinpoint anything else it could be. My second question is: We are treating our well water now, to eliminate the coliform, but will that be enough to help my body out or am I now stuck with SIBO?!

    • Did you find any relief? We have been suffering with the symptoms as well, and our well water actually also tested positive for coliform. We shared this with the doctors and they are no help.

    • I’ve had FMT for SIBO but after I’d already done low FODMAP, herbal antibiotics and elemental diet. I’m generally a lot better but my digestion is still rough. But I can slowly tolerate more and more prebiotics. So from my experience and what I’ve heard from others FMT doesn’t seem to be a quick cure all for SIBO and it’s very individual. It does seem to improve things though…

  73. Haven’t been hydrogen/methane tested for SIBO but it’s pretty clear I have one or both: long-term intestinal struggles due to long-term prophylactic antibiotic use for chronic UTIs that I realized were fungal-caused in a vicious cycle.

    FODMAP worked well enough at first (did it 3 years ago) but as the article said, I realized it wasn’t fixing the root issue as I developed other symptoms. Have eaten only organic since 2006, had filtered my drinking/shower water up until Nov 2014 when I started distilling the drinking water in order to substantially reduce exposure to fluoride and chlorine because of thyroid issues (hypo symptoms, probably a T3/T4 conversion issue).

    Grain-free ancestral diet since June 2014 with much improvement overall (especially the eradication of joint pain), low/er carb (50-150mg/day, adjusted upward when arrhythmia started after about a year of around 50mg/day), and herbal antimicrobials, NAC, glutamine, and enzymatic biofilm disruptors off and on, but still seemed not to be able to get the combination of protocols right.

    It’s only in the last couple of months after stopping probiotics and fermented foods, stopped “starving” the bad bacteria/fungus to keep it from going dormant since discovering that it could be making it intractable and have been experimenting with previously verboten foods, like dark chocolate infused with peppermint candy among other things in order to keep the bacteria/fungus active/happy, and this approach gives no stomach/upper intestinal pain and I have tons of energy. In fact, if I have stomach/intestinal pain, that peppermint chocolate stops it immediately. Guess I’ll just have to keep on eating it… 😀

    Now I only need to take HCl after eating meat (not bone broth but actual meat – I used to have to take it after eating anything at all but if there’s no actual meat eaten, the HCl causes burning so it’s not necessary) and still take digestive enzymes with every meal, have started eating natto daily altho had to stop the shirataki noodles because they caused inflammation and joint pain (due to the high water-soluble fiber content?), and am about to add lumbrokinase to the biofilm disruptor arsenal. The bulk of carbs come from cooked potato starch (figured out a way to make crepes with it since it wasn’t tolerated as uncooked resistant starch), small amounts of sweet potato, raw carrot, 2/3 Brazil nuts daily, and 2 dates daily in the morning bulletproof coffee. No dairy except grass-fed butter. No oils except olive, coconut, and sesame. No gums although am considering experimenting after reading this article.

    HOWEVER and not least importantly, I recently stopped all supplements except Vits C, D, B12, and CoQ10, and after reading about how some biofilms are known to use magnesium, calcium and iron as building blocks, it’s quite possible if not probable that my long-term daily supplementation with magnesium and possibly sulfur (via MSM), and an intense love affair with fresh chopped parsley and cooked spinach (high in iron) might be key culprits in not being able to eradicate this SIBO/fungal situation, so it’s been a couple weeks of avoiding those nutrients for the time being, and after the new year when my Health Savings Account is replenished I’ll have the SIBO breath tests and candida testing done with several months of this new protocol underway plus continuing with the rotating herbal anti-microbials so it should be interesting to see what’s what at that point.

    Sooo ready to be done with this…. 😉

      • It seems your sibo is caused by Hypo – if you have problems converting T4 to T3 you probabpy are deficient in selenium – if you change the meat with sea fish this can fix the problem fast.

  74. Is it “safe” to use herbal antimicrobials without knowing if a person has SIBO? Where I live in Europe you can´t basically get a breath test because the doctors don´t know about it and it´s very hard to find a functional parctitioner around here also. I work as a functional nutritionist and it feels frustrating not being able to test clients to know if they actually have SIBO. What herbal “antibiotics” would you recommend to try when you suspect but can´t be sure it is actually SIBO?

    • Testing is obviously ALWAYS going to be the better route to go, but for some clients who can’t get breath testing for whatever reason (typically they’re in different countries), I do sometimes use some herbal antimicrobials like oregano, garlic, berberine, etc and just see how they respond.

      • What response are you looking for? I took some Allacin and got a lot of gas- does that mean the bacteria is dying? or does that mean it doesn’t work for me?

  75. I am curious if you have had anyone with adverse side effects from neomycin either early or late? My doctor afraid to use rifaximan neomycin together due to side effects from neomycin. Also what is your recommendation for herbal treatment?

  76. Hi. My doctor has me doing a 10 day diet. I can only have green vegetables and wild caught fish, grass fed all natural meat and chicken. Water, weak green tea and supplements to kill bacteria and lysine and Taurine plus lots of gluamine. That’s it. I am starving it feels like. Was 124 lbs. Now 120 in just 5 days. At 5′ 7″. I’m not sleeping due to restless leg syndrome recently it began. I am as weak as ever, can barely prepare food. Today I felt so bad I stayed in bed.
    Is this the right protocol or not, I have 4 more days to go and have an appointment with him after.
    thanks so much, please I am suicidal and in a bad place mentally. Have been forever due to MTHFR polymorphisms.
    thank you.

    • Hi Rebecca,

      In my experience only raw eggs make me feel good.
      Please check the book – “we want to live the primal diet”
      You dont feel good because your diet is not good – all those people recommending cooked low carb diets have no idea what they are doing – they are just trying to make money.
      Also cooked protein is very hard to digest if you have low stomach acid and or leaky gut. Try raw eggs for 1 -2 days and you will see the difference. Bacteria is very important for digestion – when you cook the egg or milk you kill bacteria and enzymes.

    • also what is the idea of this diet – if you try to starve bacteria – then vegetables can feed bacteria – fibers can feed bacteria.

    • I can help. I am a functional medicine trained dietitian that reversed SIBO after a 3 yr battle. I know how terribly frustrating it is but it takes an open mind to heal and I think most here have already tried so much. Please see my website at threecupsofwisdom.com for contact info. I have a small practice but do have a few openings for remote clients.

    • Rebecca, I just read your post so I hope you’re doing better. I was alarmed by two things in your post: that you’re suicidal and you have MTHFR issues. If you are being treated with methylated supplements you could be one of those people like myself (estimated at 20% of those taking methylated B vitamins) who have significant “over methylation” side effects. I was suicidal for six months (!!!) before I found, quite by accident, that the methylfolate I’d been on for most of that time was responsible for severe anxiety, nausea and a major host of other symptoms, including increased inflammation. Google “over methylation” or check out Methylfolate side effects on Dr. Ben Lynch’s website. Another good discussion can be found on the website for Amy Neuzil, ND. If nothing else, taking a break from these supplements would tell you fairly quickly if they’re the cause. Dr. lynch suggests 24 hours, but it took much longer for me as my body is not detoxing. Please take care! I hope you’ve hung on and are doing better.

  77. i was hoping to learn something new but i guess it’s all the same still. i have an incurable form of sibo and it seems nobody has any information on it. my doctor said the key is to go to the bathroom 2 or 3 times per day so the bacteria dont spend time traveling back up my small intestine.

    • Hello Joanna,

      Don’t give up. I’ve been fighting this for years now.

      Take what you can from the Internet and Dieticians. (Frankly, I think the advice here is patently absurd. A 100 gram carb ancestral diet? Nuke the bacteria in your digestive treatment while feeding the “happy” bacteria? What does that even mean?)

      In one of Chris’s ebooks I read perhaps one of the two useful things I’ve ever read on the topic, three if you count a failed experiment I tried. He recommended a probiotic that I call “dirt pills” because they are capsules that look like dirt. They’yre called Prescript-Assist and they don’t contain L. acidophilus, the most common strain in other probiotics. For some reason that’s important.

      The other piece was the Specific Carbohydrate Diet, which seems to have been stolen by someone in the Internet Age and repurposed as the FODMAPs diet, which is being dismissed in this article. Contrary to what I’m reading here, it actually works quite well, as long as you don’t take it like gospel and take the time to “play” with it (which the authors insist you should not do). The key is to play one variable at a time. You actually can deduce quite a lot from that. It helps to have an open partner and not to eat socially. Luckily, I don’t socialize much, at least not with food.

      The third thing is interesting because I’ve never heard anyone anywhere mention Rifaximin, outside of where I first read about it, in some PubMed reference. This was when I was first reading about celiac disease (I’m lucky enough to have some bad alleles on chromosome 6, and I say that not sarcastically because failure to discover this on my own would have kept me morbidly obese and very unhappy). The article suggested treatment with this antibiotic, which restricts itself to action only within the digestive system. It was extremely expensive and gave me a rash, so I discontinued it. (Note, my doctor is great. I handed her the article and she said, “huh, thanks for sharing,” wrote me the script.) Anyway, I thought I’d give it a shot because I’d noticed dramatic improvements in my condition on rare occasions when I’d been having antibiotic treatments.

      Another excellent symptom-reducer includes opiates; however, that’s not really sustainable, for obvious reasons.

      The answer: a permanent food-based solution. And, yes, it happens to be low carb, which is not to say yours (or anyone’s) needs to be. My answer is, in fact, highly idiosyncratic, and I’ve been working at it for years.

      This dietician does the topic a real disservice and I’m shocked to find it on this website.

      William Jones

      • The low FODMAP diet was developed by scientists T Monash University in Australia. That diet along with only 3 days of RiFaximin saved my life. Yeah, I was becoming suicidal from stomache pain and discomfort. It’s all relative and very personal so I wouldn’t dis this article as I followed this exact protocol unknowingly about a year and a half ago and I’m proof that it works. Maybe not for every individual but it’s not an absurd theory. And BTW, Chris book is called your PERSONAL paleo code….may you find health and peace always.

        • Jennifer,

          I don’t dismiss antibiotics or GAPS/FODMAPS-related diets. Amoxicillin did the trick for me, as did SCD. Don’t want to niggle, but SCD is pretty much the same thing.

          The quackery comes in the statement that someone with SIBO can follow this regimen and then, eventually, get to eat whatever he/she wants. This isn’t stated specifically, but it’s implied.

          And 100 grams carbs (or whatever) may be fine for some people, but for others it’s a get out of jail ticket that can really mess them up.



          • Interesting. After reading all these comments, it’s really just listening to how your body responds to everything. William, I was on the scd diet a few years and lost too much weight and flares kept happening. Steve and Jordan put fear in their info that carbs will destroy you. I don’t like that about them. After testing positive for SIBO and reading Chris’s article about how you do NOT need to test positive for ketone in urine tests, I changed things up. I did test positive for Ketone. Amoxicillin wrecked me. It was awful. Now I’m on a low fodmaps diet, off the scd diet and taking Berberine and Uva Ursi to rid the SIBO. Bringing some carbs in slowly and the supplements has made a huge difference. Carbs are important to restore balance in the gut. But it’s a slow process and being aware of what works and what doesn’t.

            I feel like it’s just a trial and error for everyone to get their health balanced again. There’s no straight forward answer to heal you gut and stomach. And hopefully there will be one day. Good luck to everyone out there on this roller coaster ride. I’m not off it and it’s been a long miserable one. But these articles and comments help a lot along the way.

  78. You mention the root cause behind SIBO? It implies there is a deeper level to go to in order to solve the SIBO problem. Can you provide a link to a discussion about that. I have diagnosed SIBO and my family doc would only give me 3 days worth of rifamaxin (sp?) because she said insurance wouldn’t pay for more than that and then I would have to take some other antibiotics. I took them for 3 days and didn’t see a marked change. I need to find someone who really specializes in SIBO in Denver so will check PrimalDoc.com

    Thanks for the info.

    • Debbie,

      I too am in the Denver area, desperately seeking a doctor with a fair amount of Sibo knowledge. I am currently seeing a GI doc that prescribed me rifamaxin for ten days, twice a day dosage. I felt great for roughly four weeks, and my symptoms returned. It’s such a roller coaster ride. I also have Celiac, and try really hard to stick to a Paleo based diet, but when I had the hydrogen breath test and did the prep the day before of only eating rice and chicken, I felt amazing! But if you find someone who is worth going to in the Denver area, please let me know! Thanks!

  79. I have SIBO and tested positive for both a parasite and fungal infection. I was told to go Paleo and avoid FODMAPS.funny enough, that’s when I got much worse and develop a whole new host of symptoms. Probiotics give me terrible reactions and cannot tolerate proteins even with Hcl and enzymes. Trying to find a diet that works for me while treating all these infections herbally. If one has SIBO and parasites is there anything diet wise that should be done differently?Thanks for article!

  80. For a tough case of SIBO (as in years + a few rounds of treatment) when do you like to add in probiotics?

    Also, have you seen people fail a round of rifaxamin+ neomicin, try herbs with some success, and return to rifaxamin + neomicin and succeed?

    Lastly, does anyone know how to get Resolor (a prokenetic) from Canada?

  81. Has an RD who works with G.I. patients and University medical Center, this article is a summation of what I’ve been preaching to the doctors I work with. Thank you for putting in a concise way and for emphasizing that we don’t know what the best diet is after SIBO/sifo erraditation happens or what the best diet is to prevent recurrence. I wish we had message board for like-minded practitioners to discuss such things. Call me sometime 619-543-3784. #rdsthinkingoutsidethebox

  82. I have had poor digestion coupled with gas my entire life, and have been gluten free for 10 years. I suffer from chronic fatigue and thyroid symptoms (low energy/always cold). I was treated for SIBO last year with Rifaxim followed by 10 weeks of berberine. Unfortunately I am no better. I have been on a paleo and low fodmap diet. I can tolerate moderate amounts of polyols, though fructose and fructans are a problem. No lactose. I follow a paleo diet, so no grains. I am trying to eat white potatoes cooked and cooled but they seem to be causing me trouble as well. Celiac and Type 1 diabetes run in my family. My naturopath has recommended I try WEDO (?) Thank you for this informative article.

    • I went to doctors for years to try and solve my problems then started doing my own research. My symptoms led me to gluten so I did a DNA gluten sensitivity test and discovered I carried the celiac genes so gave up gluten. I improved but I was still not 100% so found a naturepath doctor who thought I may have leaky gut. I did the test which came back postive so he tested for SIBO and that was positive too. He did not know too much about how to treat SIBO as its relatively new so I did my own research. I took Oregano oil, Berberine, Alacin and Neem leaf oil twice a day for one month to kill the bacteria. I cut out all fermented foods and pre and probiotics and followed the Fast tract digestion diet which I found on the Digestive Health institute website. This diet is based on the fermentation potential of food and is not the same as the FODmap diet. I retested for SIBO after 4 months and got a negative test. I have not yet retested for leaky gut but my liver enzymes which have been raised for the past 7 years are now normal and I am now absorbing vitamin D3 and zinc, my levels were low before, despite taking supplements. I now have reintroduced probiotics back into my diet and am eating a diet based on fruit, vegetables, fish, some meat but no grains apart from rice and restricted dairy and I feel great.

      • Hi Corinne,

        I myself am on the Fast Tract diet and it works great for me too, but if I were to deviate all my symptoms would return within 12 hours.. Your experience with the Naturepath doctor sounds brilliant, but unfortunatly they don’t seem to exist in the United Kingdom. Could you add some more detail about the Oregano oil, Berberine, Alacin and Neem leaf oil twice a day for one month.
        It would be great to know the amounts of each.


        • I took 2 caps of Berberine after breakfast and dinner, 2 caps of Allacin, also after breakfast and dinner, 1 capsule of Oregano oil after breakfast and dinner and 7 drops of Neem leaf liqud in water also after breakfast and dinner. During this time I cut out all pre and probiotics. Took the capsules for a month while following the Fast tract diet. Once I stopped taking them I started taking Iberogast before meals and Betaine HCl and Pepsin as my Dr thought i might be low on stomach acid. All are available on iherb. I am still taking the Betaine HCI.

      • Wow, you destroyed the overgrowth in a matter of months! Gives much hope to correcting this issue in others.

        I second the request for what amounts you used: mg of each capsule/quantity of herbs you used for your protocol?

        Thank you for posting what helped you!

    • Your story sounds similar to mine. I believe one of my root causes was mercury. You can check out my story here-http://familyhomeandhealth.com/2015/04/how-i-recovered-from-mercury-poisoning.html. I am not saying that mercury is a problem for you. I researched and thought for probably a year or two (and also saw an integrated doctor) before I decided to have my fillings replaced. But, you may want to look at my website and articles. I know I have been greatly helped by reading other people’s stories even if I decided not to follow the path they did. I hope you soon find the answers for you!

  83. I get so confused with so many things to try I suffer severe chronic acid continually in pain. I have just read fast tract diet and think I probably need to try low carb diet as I am eating plain bland food and it’s not working I am also taking prescription drugs that help but not anywhere enough. I don’t know it’s all very confusing. I just want some relief

  84. I think that *(many) people/”experts” in the field Love to hear when somebody has Sibo. All I keep reading about (since I found out I had sibo 9 months ago) is how treatment needs to be tailored or individualized to the person. Well that means that they have to keep going back to the doctors and it takes hundreds of dollars to get help. I completely understand that every BODY is different. I also understand that pharmaceutical drugs sometimes don’t help people. I also know from experience that herbal products don’t necessarily or won’t necessarily help as well (not for me at least). All are SIBO diets vary. It seems to be utterly confusing? I just don’t understand how to heal from this bacteria?? Personally I feel great when I’m following the diet to the T but I just don’t know how to stick with it for a lifetime? I have gone on it about 100 times and I’ve also gone off of it 100 times…. I don’t know if I felt worse or better before I ever knew I had SIBO!!!!

  85. Kelsey,
    I’ve had bloating, fluid retention, constipation etc for years and years. Horrible, ugly, embarrassing, stressful, worrisome. Less than a year ago I did a breath test that was positive for SIBO, as I had expected.( I am also suspicious of h pylori, which I’ve been treated for but feel has recurred.)

    Bottom line is, after eating a diet informed by Norm Robillard’s charts I’ve felt great. I realize that subsisting on white bread and foregoing most vegetables would not be seen as ideal by most, but here’s my question: I have undergone the treatments and dietary modifications (and many more!) that you suggest for many years, all manner of synthetic and herbal antimicrobials included, and am continuously using two prokinetics (LDN and d-limonene, erythromycin did not work for me at all) but nothing but eating carbs that are absorbed quickly and high in the GI tract and avoiding fiber and other kinds of more difficult to digest carbs has brought relief. Is there any evidence that eating in a way that keeps severe symptoms at bay is truly worse than eating food that feeds the colonic microbiome but at the expense of significant symptoms from intractable SIBO? I am aware of and concerned about the long-term effects of limiting fermentable foods, but not convinced of the superiority of continuing to suffer in order to feed bacteria where they belong (LI).
    Thanks for any thoughts!

    • Webraven,
      I just want to say that I appreciate your comment and question and how you write. It articulates things that i’m interested in too. Thanks

    • No expert here, just want to say that.

      In reference to your comment that you doubt the need to eat the foods that exacerbate your symptoms, I would counter that since you are already suffering symptoms from your food, it’s quite certain that you are suffering from nutritional deficiencies already. I would think that with continued lack of nutritional support from food (you didn’t mention vitamin, mineral, or herbal supplementation) your immune and endocrine systems will continue to struggle. I’m sure you’re well-aware that the simple carbs present in the highly refined foods that digest quickly have little to offer in the way of nutrition.

      I guess that’s the question – are you getting adequate nutrition in what you’re eating, or are you simply eating to feel full?

      • Hi Ann,
        thank you for commenting!

        I’ll assume that you are referring to micronutrients (vitamins, minerals) and not to macronutrients (protein, fat, carbohydrate). I agree with you that limiting your diet puts you at risk for deficiencies in micronutrients, and am taking steps (supplementation, eating small amounts of certain vegetables I seem to tolerate, such as tomato and cucumber) and supplementing vitamins C, Bs, K, A, D, E and trace minerals and Magnesium. I also use herbal supplements, hormones (Pregnenolone in minute doses to support adrenal and brain function) etc.

        I’m not sure if you had a suggestion or just agreed with the obvious negatives of having to restrict ones diet? if what you meant is that I am experiencing my current symptoms due to having a bad diet I’m afraid you have it backwards; I have been forced to stop eating a conscientiously “healthy” diet due to my symptoms, which have gradually worsened over the years.

    • I followed the Fast tract diet but made my own recipes using the tables. I took natural antibiotics for a month and cut out all pro and prebiotics. I then took Iberogast and Betain HCI and pepsin. I re tested and the SIBO has gone. Now I eat a more normal diet but tend to choose vegetables and fruit that score lower on the fermentable index. I eat rice and potatoes but only the low scoring ones so avoid Indian food for example, which uses Basmati rice. I have introduced probiotics back into my diet and I eat a lot of coconut products. While I am not following the strict Fast Tract diet I try not to eat too much of the forbidden foods as i don’t want a recurrence of the SIBO. I still take the Betaine HCI and pepsin and i obviously have low stomach acid as I take 5 capsules per meal without any side effects.

    • Webraven, I completely relate to your situation!

      Listen to your body and it will tell you what to eat or not to eat at any given moment. It has a wisdom that none of the so called nutritional experts will ever be able to obtain.
      We are all different and one-size-fits-all approach is an outdated model.

      I followed advice of many “nutritional experts” only to become worse.
      Lots of people nowadays react to foods considered healthy. And by react I don’t mean just suffer an occasional bloating or acid reflux, but actual damage to their mitochondria and in some cases even autoimmune attack.
      It has been proven that a lot of high oxalate foods like nuts, spinach, healthy grains like buckwheat, quinoa, seeds like chia etc actually damage the gut and mitochondria in people that are sensitive to them.
      Some phenol (salicilate) rich foods like grapes, almonds, apples cause pain, brain-fog, mood issues in some people.

      Histamines and other amines in bone broths, fermented vegetables, yogurts wreck havoc on some people’s bodies and minds.
      Foods like spinach and tomatoes can launch an autoimmune attack.
      Nightshade family (tomatoes, peppers, eggplant and potatoes) cause joint pain, brain fod, fatigue and other nasty symptoms in some people.

      When are we going to finally acknowledge that each person has a unique situation and what is considered healthy for some might be downright poisonous for the others.
      Once again, listen to your symptoms and your body will tell you what you can tolerate.

      I myself am in love with the Fast Tract diet approach. Excessive fermentation in the small intestine for me means not only unpleasant bloating but inflammation in the gut, constipation, low energy, mood issues and heart palpitations.

      If I continue eating so called healthy foods I will never get off my couch because being bloated makes me lethargic and ill.

      You don’t need some expert telling you what to eat. Number of diets equals number of people.

  86. Hi everyone,

    I was wondering if there are any Fructose Malabsorbers out there who are also suffering from SIBO? I have both and a low FODMAPs diet seems essential for me at the moment to avoid the nasty symptoms of FM but I agree it’s not healthy to do it long term. I am yet to begin treatment for the SIBO. Could it be possible that the FM might be reversed if and when the SIBO is cured? I hear mixed information about whether FM is reversible or not….


  87. I am 53 and suffered with Helicobator Pyloris, IBS, Constipation, Duodenal ulcer, SIBO and Diverticulitis off and on all my life —to the he point where I was becoming suicidal. I started a paleo diet at the end of 2013 and although i felt clear minded and had more energy my stomach pain persisted. In early 2014 I discovered the low FODMAP diet and found research on Rifaximin. I followed the low FODMAP diet for 6 months and took one round of Rifaximin (very expensive, it cost me about $600) prescribed by my Naturopath. My symptoms were gone in 2 weeks! I quit drinking alcohol completely, maintain a dairy free and gluten free diet ( I can eat a few grains with out problems) and I’ve never felt better!

  88. This is a risqué post for kresser.com and I like it!

    From my own research, I’ve come to believe that starving infections can lead to them evolving into cystic forms or worse, burrowing into tissue in search for food. I think there are too many bodily and enzymatic processes that we need and food can help us get our fuel for these. We may feed infections this way, but I do think keeping immunity up, as well as getting adequate nutrition to keep metabolism strong, are vital for your fight against chronic infections. That said, the guy is an immune power house, so an infection there will undermine immunity. I get uneasy thinking about how many years some Lyme patients are on antibiotics. However, I do think, in my own n=1 experience, that I have stayed in remission for so long because even though I am “off” of anti-microbials, I take them every now and again. We are germs creatures! A good immune system can keep the good and bad balanced. An okay immune system might need some anti-microbial help, but it also needs breaks from antimicrobials and focus on nutrition and healing.

  89. Why cant we just wipe out the bacteria with megadosing of antibiotics and then imediately start a combined Protocol of a healthy, carbreduced, paleoinfluenced, diet, + digestive enzymes, prokinetics, and Faecal therapy?
    //. Patrik

  90. SIBO is a constant recurring factor in my life. I have Gastroparesis (delayed stomach emptying) and sluggish intestinal contractions so I keep ending up with SIBO and taking Rifaxamin to “cure” it approximately every three months for the past 6 years. Any suggestions for my situation?

      • Corrine, Thank you for pointing out the Iberogast. It’s a prokinetic! Encourages the peristaltic mechanism to empty food faster and may really help in clearing out the settled SIBO of the upper GI. I can positively see that this along with the herbals you mentioned, may be the solution to turning things around…..and specific targeted diet of course.

        I love the internet and the chances to connect with people who help others. Thank you!

      • Corrine–did you test positive for hydrogen or methane? I tested positive for hydrogen. After 7 days for Rifiximin I got C. Diff for the second time. I’m looking for how to treat SIBO that won’t cause another reassurance of c. diff. Your natural treatment sounds interesting. Thank you for sharing.

        • Somewhere I read that c. diff [colitis], due to c. diff overgrowth, is, in turn, possibly due to the *absence* of other species of clostridium. This is hard to google. It makes sense, though, seeing as *adding* species via FMT is an effective treatment to knock c. diff back in balance.

          I have also heard that some generic rifaximin can affect colon bacteria, where the brand, Xifaxan, does not.


          You can jump to the 58 minute mark to the discussion of antibiotics.

  91. I wonder if this theory can be applied to candida overgrowth. I have one ND telling me to go on a low-carb starch and sugar free diet, and another ND telling me that is re worst thing to do because the yeast will become dormant. Both of these suggestions with diet are for following during a 3 month treatment with herbal antifungals and probiotics.

    • Mikel
      I was wondering the same thing! I didn’t follow a strict diet when I took my Rifaximin for two weeks and I feel about 80% better. I can eat carbs that I had so much trouble with before. I still deal with Candida to this day and when I tried to eradicate my Candida, I followed a very strict diet for 4 months and took herbal supplements to kill it off. I think I will try this time around not to be strict and see what happens.

  92. Nuking both the small and large intestine with antibiotics is not a solution. The solution is to heal the large intestine both mechanically and with the right probiotics, so the various microbes don’t have to migrate to the small intestine.

    • That’s certainly part of the long-term solution.

      However, leaving an overgrowth of bacteria in the small intestine is a not a good idea, and the way to get rid of it is herbal/pharmaceutical antibiotics.

      • The idea is that they will migrate back to their natural environment if the large intestine is healed. I still maintain that nuking the whole system with antibiotics is not a solution, it’s a disaster with effects that last a lifetime.

        • Eugenia,
          I’m guessing you have not done much research on this subject or even suffer from sibo by the sounds of your comments. Rifaximin is NOT a broad spectrum antibiotic. That means it will NOT travel to the rest of the body. This antibiotic is made to stay in the small intestine and do it’s job. It does not cause yeast infections nor does it kill off any of the good bacteria already present. Contrary to your belief, the bacteria will NOT migrate back to the large intestine! I speak from experience! I cleared my sibo by about 80% with the use of Rifaximin!

          • I do have SIBO and I have taken Rifaximin. It only worked for the few days I got it. Diarrhea stopped while taking it. After that, the same thing ensued. The strategy doesn’t work.

            • Eugenia, I’m sorry to hear it didn’t work for you but to comment that the strategy doesn’t work is a negative comment when it has worked for others. Maybe try another round and make sure you have the proper dosing and right amount of time to take it.
              Or it could be you never had sibo in the first place. This has happened to some. Maybe it’s Candidiasis and/or parasites along with sibo and you are still suffering from parasites and/or candida. When I had my systemic candidiasis and almost died, I remember some of the symptoms were the same as sibo. I had diarrhea back then and at that time was only suffering from candida and parasites not sibo. Sibo only showed up years later. I hope you can find what is causing your distress. Good luck.

    • Personally, I don’t like to see someone on a strict low FODMAP (meaning they’re cutting out all classes of FODMAPs) for more than a few months (if they even need to do that). I always try to keep it as un-restricted as possible; even if they need to cut out one or two classes of FODMAPs, they’re still eating others.

  93. Wow, what an incredible and timely article! I was diagnosed with SIBO 6 months ago and have found a combination of low FODMAP and SCD diet helpful in managing symptoms. But, I was extremely miserable on such a restrictive diet and the moment I deviated from it my symptoms would return so I agree that it isn’t a cure – but rather just a way to manage symptoms.

    I didn’t know walking 60 minutes a day helps SIBO symptoms. Does jogging/running havd the same effect? Apologies if it sounds silly but just want to clarify if it’s just walking or other exercise which can help too?

    I’m based in the UK and under the care of a functional medicine practitioner but she cannot prescribe antibiotics. Are there any practitioners you can recommend in the UK who understand the points you have made in this article? E.g. carbs are actually required along with antibiotics

    Many thanks!


    • I have been dealing with these issues for years and no matter what other situations may be in play at any given time, my daily 25 minute walk makes a profound difference.

      A couple years ago I had the privilege of attending the first SIBO conference at the Naturopathic College of Natural Medicine which featured Dr. Mark Pimentel and Dr. Allison Siebecker (along with Dr.Leonard Weinstock and Dr Steven Sandberg-Lewis). They repeatedly emphasized that the fundamental component of SIBO is poor gastrointestinal motility which both results from the bacterial presence and in turn enables those bugs to keep hanging around. (which comes first, the cause or the effect and which is which?!)

      Where the healthy human digestive tract has about eleven complete peristaltic cleansing waves per day, the SIBO experiencer—with methanogens present—has only three!

      Digestive systems have made use of locomotion to aid in its motility since before there was life on dry land and we are not exceptions to that. But extended running and jogging are too hard on internal organs (shaking and jostling) to be recommended by me; they also seem to require too many costume changes. With walking though, I can just head out and am half done before I even start thinking about it. I am lucky enough to have a hill that I include in my route. Also.. six or seven days a week!

      • Hey Peter,

        Seems like you learned a lot about SIBO, I see to have some issues with a liver detox and a sluggish gall bladder/ low bile acid. Do you think that this may be a cause for my recurrence of SIBO? (I tried Candibactin AR/BR & Rifaximin and it came back)

        I have both methane & hydrogen, I don’t have too much bloating, and no mild constipation i.e. I have 1 bowel movement a day (not sure if that qualifies as constipation) ? .. would love to hear your thoughts!?

    • Ash, Any body movement helps because it increases intestinal mobility + gets blood/ oxygen moving well to all parts of body. So, jogging would help too. What matters is what kind of activity motivates You to get moving daily. It doesn’t have to be the same thing each day. I like to swim, but paying for a gym membership + the time to & from the gym is a negative for me, but maybe not for someone else. I like walking (or jogging on dirt, not hard pavement) because I put on my shoes & I’m good to go. You can also ride a bike, & don’t forget to lift weights now & then (I think any aerobic exercise is more effective for SIBO, but everyone should fit in some strength training). : )

  94. Thank you for the very helpful article, Kelsey. Could you tell me which herbal antibiotics you recommend to your patients for SIBO (hydrogen gas type)? After having problems for almost two years I’ve now developed a histamine intolerance. All symptoms go away when I supplement with bio available quercetin. But I’d like to deal with the original problem which I suspect is SIBO.

  95. Thank you so much for sharing updated information on the subject. I have one question: has there been done any research on how long one can safely be on herbal antimicrobials? What could be possible side-effects of being on herbal antimicrobials (f.ex. oregano) for a long time? Thanks a lot in advance, Best Regards.

  96. 100 carbs a day, eaten at least 5x a day (20g each time) would even out your BG levels. Just dont inhale all 100g at once and eat protein with the carbs. And take some time to get back up to 100g daily. A few weeks.
    If youve just started the very lowcarb WOE tho, I d still do it for 6-12 mos to heal lots of disorders caused by the out of control BG so your body can handle the additional carbs eventually.

  97. Great article, lots of good information. Thanks. For the post treatment diet, Dr Siebecker recommends low fodmap/SCD for a year after treatment. Do you think that seems overly restrictive? Also can you recommend an herbal over-the-counter prokinetic agent? All of the one Siebecker recommends are by prescription. Does exercise improve the condition of the migrating motor complex?

  98. Kelsey, have you checked into Turmeric? I have been having a lot of improvement taking this 2x per day. I have tried the probiotics, diet, antibiotics, low fodmap, etc. This has given me the most improvement.

  99. Thank you Kelsey!
    I have tested positive multiple times for SIBO (high methane and hydrogen), and at first we tried CandiBactin AR/BR then Rifaximin with no luck. After organic acids testing it appears I am having a really sluggish liver/gall bladder, and serious need for Glutathione. I am curious would this be a reason why my SIBO would have come back? …

    Now that I am addressing the liver/gall bladder issues, I am keen to try kicking the SIBO again, this time with Uva-Ursi, Plant Tannins, Berberine , and maybe Oregano oil.


    • I got rid of my SIBO with a month on Oregano oil, Berberine, Allacine and Neem leaf oil twice a day. I then started using Iberogoast and Betaine HFC and Pepsin while following the Fast Tract Diet.

  100. You folks gather and translate great research.

    Please, more research on what fixes or upregulates both peristalsis and the migrating motor complex, as well as how to diagnose a vagal nerve problem.

    Give us hardcore SIBO sufferers who’ve tried it all some daily exercises, some things that address the mechanical aspect of this disorder, besides what to eat, what not to eat, how much and more supplements. It’s a merry-go-round.

    • Listen to Chris’ interview with Dr. Pimentel. They talk about the new test for antibodies to the bacterial toxin thought to be responsible for the damage to the migrating motor complex. I think it’s commercially available as IBSChek but I could be wrong about that.

    • The best test to diagnose a vagus nerve problem would likely be the R-R interval study. I have yet to find a doctor to perform one, but Dr. Richard K. Bernstein also recommends searching for tests for cardiac autonomic neuropathy.

      His recommendation is in regards to diagnosing gastroparesis, an almost guaranteed complication of longstanding, uncontrolled diabetes. I suspect this is what caused my case of SIBO.

  101. I have had Sibo on and off for years. When I get a bad gut infection. It goes and kills my nerves and I have no phase 3 movement. Dr. Pimentel says it will come back in 10 years, but the chance you will get a bug in 10 years is high!? for me the only way I could remain healthy enough to think of solutions (brain fog and abdominal pain) was to be on a SCD/lower FODMap diet (Dr. Seibecker has a good handout) In most cases a whole foods diet isn’t completely FODMAP free. That was my case. I found some that I tolerated. What brought me out of the pit of propetual Sibo demise? Taking care of negative emotions in my life. And they rack up even faster when you are sick. Finding the genetic nutrient deficiency problems and supplementing. And getting a handle on a prokenetic. I used ginger EO and 5-HTP. Lately I have been using this special water to flush out the years of toxic build up from a total body system breakdown and 7 years to figure out what it is. Praise the Lord I am coming out of this Health Pit. Thanks for this article. The fast people can get this information the faster they will feel better. I had to become a Nutrial Theropist to solve my problems, because no one wanted to be better more then me. ? and it is such a new field that it is hard to find information. Blessings all and don’t give up!

    • What is the special water? I am doing a major detox and would appreciate! Also, what are the best herbal microbials

  102. Hi and thank you for the article. Trying to figure out what to do for SIBO and Crohn’s has been extremely difficult. Currently in a flare. Was on the scd diet for way too long. These articles helped me switch to a low fodmap diet just recently. Great to have carbs again. My system is very fragile. This flare has me reacting to everything. My functional doctor has recommended me taking monolaurin, cytistatin and cat’s claw drops. These are to kill off H. Pylori and SIBO. Also taking prescript assist. What are pro kinetics? Will these supplements help that I am to take? My breath tests results say I have a mild overgrowth. I have low stomach acid. And am more constipated than having diarrhea. Was hoping to start protocol not in a flare, but can’t seem to get out of it. Been in it about 4 months. Any suggestions would help. Thank you so much.

  103. After 4 months of rotating herbal antibiotics and a very restricted diet with little improvement, I am now feeling like I’ve wasted so much time and money.

    Yes, my extremely low-FODMAP diet controlled my symptoms quite well, but I also had no energy at all. When I started trying to add a few FODMAPS back my symptoms came back with a vengeance.

    I feel like I am starting over again, and am feeling pretty defeated. I am miserable when I eat those fermentable starches, but I also know I cannot sustain the restricted diet for the rest of my life.

    I’m so grateful to my doctor, and to everyone who is doing research that relates to SIBO. I realize that information is still limited at this point and treatments are still somewhat experimental. Thank you for this article!

  104. Just purchased the book by Dr. Mullin- have not read it but just from the gist of it- he does eliminate FODMAPS but it appears t be in phases that he integrates foods back in. How does this differ from your point of view and experience?

  105. I’ve tested positive for SIBO, including increased methane production. I’ve been on lo carb diet and lo FODMAP to control symptoms.
    Can you say more about the natural antimicrobial protocols…especially timing…when and what to take (I’ve been taking Oregano Oil (2 caps) and Nattokinase (200mcg) to break-up biofilms once per day, a few hours after my evening meal, and Interphase soil bacteria (2 caps) in the morning with my am meal. I’ve been eating a small amount of carbs to feed the bacteria, (carrots, sweet potato, winter squash) at every meal. My symptoms are under control, but I don’t know if I’m timing my protocols correctly. Do you think my present protocol is sufficient to eliminate the SIBO? Can you direct me to more information on how/when to use the antimicrobials and soil probiotics? –thanks!

  106. Kelsey, I know this is a problem for me and I am wondering, in a small, rather isolated town, how I find medical assistance or make progress without it? The naturopaths I’ve seen here haven’t had exposure to SIBO and current treatments. Any suggestions?

    • There are lots of great practitioners that help people online! If you need an antibiotic though, that’s where it can get tricky because of course someone needs to prescribe that to you and that is only done in person. Check out primaldocs.com

  107. I’d suggest a 30 day dose (3 capsules/2 x per day / x30 days) of a probiotic that contains Saccharomyces boulardii and Lactobacillus reuteri……..anything that has acidolphilus would be best to avoid (I know…..they “all” have that….acidolphilus is only needed in children up to 2 years old and can be detrimental to the descending colon in adults)….also PREbiotics are needed (eg inulin/ guar gum/ glucomannan)
    FLORASTOR from CVS has the S.boulardii, but only that. The best ( and only) source I know of with all the above ingredients is called IMMUNO-SYNBIOTIC. References for the above statements can be found at NUTRI-SPEC.NET.
    I’ll be glad to share what I know if contavted
    Dr Z [email protected]

  108. Thank you for this article. I have also read Chris’ recent articles and interviews on the subject and took what I learned to my GI doctor, who’s extremely well trained and thoughtful. So much depends on diagnosis, it seems, and according to his experience, the breath test is highly unreliable, giving both false positives and negatives. I’m wondering if there are any other diagnostic tests for SIBO that have a better track record? I’m very sensitive to drugs and, while he’s prepared to put me on a course of Rifaximin based on symptoms, I’m loathe to do so without a more accurate diagnosis. a) Are there other diagnostic tests? b) Which herbal anti-microbials might be worth a try – and do they have fewer side effects than Rifaximin? Thank you so much.

    • Vagus nerve exercises include aggressive gargling (to the point of tears), stimulating the gag reflex by sticking a tongue depressor to back of throat (6x/day for these), coffee enemas.

  109. Thanks for a great article.
    I was diagnosed with SIBO two years ago and have found the SCD diet helpful whilst I’ve searched for someone who’s knowledgeable in this area (I’m not based in the U.S.) who can help me. I’ve just found out I’m pregnant! Other than continuing on the diet, is there anything else I can do? I’m now worried about the long term effects of eating this way.

    • Bianca,

      I’m in a similar place. What did you end up deciding to do? Did you end up finding some good advice? If so, I’d love to hear it!

  110. Thanks for this update, Kelsey! Interesting insights! What I’m still unsure about is if you have both SIBO and GERD, which one of the two would you tackle first or consider to be more of a root cause, and what would be your treatment strategy?

  111. Great article, thank you, could u say something about how to know if u suffer candida ,sibo, or parasites,?? is the breath test for sibo the only good test?
    thanks again,,,

  112. Dr Kharazzian suggests that treating intestinal motility and the iliocecal valve is important in treating SIBO. If material from the colon keeps backing up into the small intestine that will defeat anything you do with diet, probiotic or herb/med antibiotic treatment. What do you think about adding work on intestinal motility to your protocol here. (vagus nerve stimulation for example)

    • Angela what is suggested to stimulate the vagus nerve? Maybe taking in digestive bitters ? And massage of vagus nerve ?

      • Dr. Kharrazian suggests exercises to activate the vagal nerve that is responsible for intestinal motility. That makes sense to me. It’s a lot of work to incorporate exercises into daily life. But I also can’t afford to keep adding supplements, like the prokinetics, and don’t want to add pharmceuticals if possible.

        I was just surprised that you didn’t mention the role of the vagus nerve and motility in treating SIBO.

          • Is there anyone out there who took Victoza and had these SIBO/IBS symptoms — SEVERE abdominal cramping, burning pain, and SEVERE flatlence after eating? For me, ANY vegetable intesifies the symptoms and I am a meat and veggie lover. I also ate complex carbs like oats and wheat and never had ANY digestive issues. I took Victoza for three months, been off for two months, and the only things I can eat and be able to go in public are things like eggs, meat, bagels, bread, and pizza without veggies. I still have the symptoms, but are milder than when eating veggies. I only eat veggies at home. I am taking a higher dose of probiotics and hoping it will help eventually. Does anyone know what this drug did to me based on its chemistry and such and know a way to help me? This has drastically affected my life. My integrative doctor suggested the high does of probiotics, but I thought that should have helped by now. I am terrified of going to a mainstream doctor, will likely just put me through thousands if dollars in tests with no results. I went through hell for 30 years with a misdiagnosis of lupus when I really had Hashimotos. I was finally doing better and just needed to get my A1C lowered for diabetes and listened to the diabetic doctor and tried Victoza.It actually made my A1C INCREASE from 7.2 to 8.7!!!! Please Dr. Kresser can you recommend something or someone in the Cleveland, Ohio area that might help me??

          • to Kelsey Marksteiner
            I’m back with a further comment about the neurological connection to the iliocecal valve in relation to healing SIBO. Sorry I don’t have a link as this quote comes from a closed webinar course currently going on with Dr. Kharrazian on Brain health.

            Closing the iliocecal valve that prevents normal bacteria from flowing back up into the small intestine from the large intestine seems like a critical adjunct treatment for SIBO.

            Dr. Datis Kharrazian said this about it:

            ” The standard treatment for SIBO is non-absroable antibiotics and fodmap diet. Unfortunately, the re-occurance with conventional treatment is nearly 100%. The actual mechanisms is really bacteria translocation. With lack of neurological input to the ileocecal valve bacteria moves from the large intestine into the small intestine and ferments sugars. You will need to continue to re-kill the bacteria in the small intestine until neurological control the intestines and the valve are normalized.

            “Our approach involved the fodmap diet with brain-gut exercise. Some can restore their brain-gut axis plasticity and some cannot. It is hard to say without a trial period of treatment. Also remember every time you eat sugars that then cause bloating from small intestine bacteria fermentation the gas opens up the valve and continues to promote bacterial movement from the large intestine to the small intestine. That is why strict fodmap diet with brain-gut exercises is important. Antibiotics can be used to treat symptoms however neurological integration into the intestines is critical”.

            This statement from Dr. Kharrazian came within his brain health webinar last week. In this course the health of the brain to gut connection is considered in relation to overall brain health.

            To me this means it’s most important to deal with motility and closing the iliocecal valve when dealing with SIBO since all the treatments to kill the bacterial overgrowth will not prevent the return of the bacteria from the colon. It almost seems like getting the iliocecal valve closed and upping your transit time through the small intestine should be addressed BEFORE taking anti-microbials. or at least at the same time.

            I would add that the IC valve is meant to open one way to allow the flow of contents from the small intestine into the large intestine and that this should happen in a rhythmic fashion – opening and closing and opening and closing etc – in conjunction with normal cleansing peristalsis motility moving digesting food through the whole GI tract. It’s not the goal to keep the IC valve closed but rather to return it to a normal pulsing action.

            • Angela, does he mention something about autoimmune condition where the nerves of the bowel are damaged by autoimmune process? I think Pimentel have this theory – but if this is true then walking or exercises i dont think will help a lot.
              Maybe similar thing happen to illeo cecal valve – maybe the nerves are damaged by our own immune system.

              • Pet
                I don’t remember. But Dr. K is a big on autoimmunity issues.

                Please remember that I’m not talking about walking exercise when it comes to engaging the Vagus nerve which activates the intestinal action. Walking is great exercise but Dr. K is talking about exercises that stimulate a major nerve that is responsible for getting the intestines moving. This is very different than walking for aerobic health and wellbeing. But walking for health is SO so important too.

                Nerve damage and nerve activation are the topics here and I don’t know much. I’m sharing what I am learning from Dr. Kharrazian.

                Good luck to you on your health ventures

                • I have just recently been diagnosed with SIBO. I am 56 years old and have suffered with this since I was a teen. Two years ago I had physical therapy for the pain I was having in the gut. They called it visceral therapy. Best thing I ever did. They could tell my ileocecal valve was not functioning properly, along with several other valves in the digestive tract. They gave me massages to help to close the valves. It is not hard, I do it every day. BUT – they were not able to provide the link between the digestive valves and the vagus nerve. I am still looking for that missing link as I believe it will help with keeping the bacteria out of my small intestine and then I can heal properly. When somebody finds that link, I want to know about it!!

        • Lot of work? That’s not the case at all! Anyone can add 60 minutes of brisk walking daily and that would be enough to fix most motility issues in a month. Yes, it takes some planing and determination, but would you rather spend those 60 minutes behind the wheel or in front of a screen (TV, PC, phone…). It’s all about priorities. Walking works – period. 8 to 10 thousand steps a day is the minimum, tho. Add another 30 minutes of exercise a day – yoga, weights, rehab – and you are a winner. If you don’t have time – then make some. Choices, choices, choices.

          • I’m not really sure what you’re referring to when you say: “lot of work?”

            We’re in total agreement that walking is an easy thing to add in, so not sure what you’re getting at unfortunately.

          • Konstantin,
            please kept in mind that nothing “works, period”. There are many reasons for SIBO, decreased motility etc, and those varied reasons play out differently in individual people due to genetics, epigenetic, alterations in physiology etc. While I agree that 1 1/2hrs of movement per day is great, your tone in assuming that *everyone* has that time isn’t rooted in reality. Be grateful that you do, and go easy on those that don’t due to work, caring for other individuals (young children, old parents) school combined with work, being ill etc.

            • As a single mom who has at various times done in home hospice care, in home dementia care (living with the patients, relatives), gone to college, worked fulltime all while homeschooling…YES, making time daily to exercise can happen. Somethng else cant happen when you’re exercising, but you are not irreplaceable.
              If I can walk daily and lift some wgts, anyone can.

          • @ Konstantin,
            The exercises I’m referring to are specifically for activating the vagal nerve – Loud singing, yogic breathing, gargling and gagging. Dr. Kharrazian explains these in his book on brain health. He is talking about how the brain to gut connection is involved in SIBO.

            I think all kinds of exercise is great. I personally dance, do Tai Chi and Chi Kung, yoga, gardening and walking every day. But these exercise forms do not necessarily stimulate the vagal nerve for the purposes of healing SIBO.

        • Angela- It always amazes me that people are critical to people who share free information to everyone. I am so thankful when experts share their knowledge and experiences. Be more thankful instead of complaining about what wasn’t discussed in the article. Kelsey Marksteiner is way too generous!

          • Cheyenne,
            Wow I didn’t feel like I was being critical. I was bringing up a topic that seems relevant to this article and asking what Kelsey thinks about it.
            I am grateful for the article and simply didn’t have time to write everything I was feeling.

      • I’m curious do you feel motility supplements are needed even if one has sibo diareah?
        Also what are your thoughts on biofilm disrupters ? Should they be taken when one is on herbals ? Or after ?
        And what supplements do you feel should be taken after herbal and meds are done ? To rebuild gut health ? What do you suggest ?
        Thank you

      • Interestingly, Dr. Kharrazian does not recommend using herbal or pharmaceutical antibiotics, but rather relies on starving the SIBO, aiding digestion, using SCFAs and using vagus exercises. Have you ever tried or seen success without using Rifaximin/herbals?

        • I’ve seen success–me.

          Anyone who says you need a specific herbal or expensive antibiotic is nuts.

          The process is arduous but most of the vocabulary I’m reading is from bizarre-land.

          Do cashews mess with you ? Sucks but don’t eat them. That’s my life. Broccoli’s good for you? Fine, not for me.

          There’s an occasional bit of health wisdom here and there but dietations/naturalists/authors will not help you. Take what you can and follow your path. And feel free to hate me for this advice.

          My real name is William Jones and I have a real story.

          Where are all the success stories, from all these great sage practitioners? Write up the case studies and I’ll take you seriously.

          Amoxicillin works just as well as Rifaximin, in my case better. Costs pennies. Not a long term solution, if you don’t solve diet, though. And the idea that everyone “deserves” to eat anything they want is asinine.

          Luckily, for me, vodka is still cool. I’m ok without broccoli or spinach.

          I really do wish the best of health for all.

          William Jones

  113. Hi Kelsey!
    Thanks for your article.
    I’ve just done the breath test after years of avoiding foods that cause symptoms. I know that I have definitely been on a long term low FODMAP diet to my own detriment. Looking forward to treating and reintroducing (eventually) many foods 🙂 and being symptom free. Thanks again!

  114. Great article! What kind of herbal antibiotics would you recommend? And are there any other tests besides the methane and hydrogen tests that could diagnose SIBO? These tests aren’t available in Mauritius 🙁 Thanks!

  115. How long is considered long-term? Did I read correctly that the study you reference was a 21 day period? Is that considered long-term. My doc recommended the low-fodmap diet for at least 6 to 8 weeks, possibly longer. Which would be much longer than 21 days.

    Thank you.

  116. Well I’m definitely struggling with SIBO. Been on the AIP diet for a while, over a year, when I started experiencing SIBO symptoms from using a protein powder. I’m seeing a great functional med dr but I’ve had SIBO since April. Tried Rifaximin twice (once with diflucan, once with candibactin AR and BR), now I’m rotating Candibactin AR and BR, and Biocidin. Also taking ginger between meals and Iberogast during meals. Supplementing with probiotics. I tried lowering fodmaps too but that lead to not enough carbs and I started loosing weight. To compound matters, I also stuggle with musculoskeletal pain and I’m taking an NSAID, which I know is bad, but it helps with pain. The weight loss then lead to more pain, so I upped my carbs. I totally agree with you on not doing FODMAP diet long term, especially for those with lower weights to begin with. So…. for me, it’s been a battle, trying to find the right combination of herbals or even Rifaximin combo to beat this. My question is, could the NSAID I’m taking contribute to SIBO and leaky small intestine? Would taking a low does opiate be a better option or do those also contribute or exacerbate SIBO? Also, have you seen people eliminate SIBO while taking other meds (like pain relievers: NSAIDS or opiates)?

  117. I don’t agree with the usage of antibiotics and I find this suggestion preposterous.

    Antibiotics also strip the large intestine from the good microbes, so you end up in square 1 again. In my experience with Rifaximin and other antibiotics throughout the 2000s, I would get BETTER for about 8 days: as long as I would take the antibiotic. When the prescription was over, the diarrhea would return almost the next day, like clockwork.

    So from direct personal experience, no, I don’t agree that antibiotics is the solution.

    The only thing I would agree with the article is that low carb and dieting is not enough (at least, not with the kind of ultra-selected, low-nutrition veggies we have in the West — even if organic and whole). These help immensely, but they don’t fix the problem 100% (especially if the patients don’t drink enough *home-made* kefir). That, I agree.

    IMHO, what we need for curing SIBO is the right kind of probiotics, possibly in high doses, of the right kind (casei and others). These would create the right kind of stomach acid and other conditions that would reduce the causal factors for bacteria colonizing the small intestine.

    Basically, to fix SIBO, you need to fix the causal factors that created it, and the main cause for it, is bad dysbiosis in the LARGE intestine. So, get some HIGH doses of PRObiotics, fix your LARGE intestine, and SIBO will go away on its own.

    What is proposed here with killer antibiotics is not different than what run-of-the-mill doctors are prescribing for the various ailments: managing the symptom, and not curing the CAUSE. And the cause is: microbes migrating because their natural environment is diseased. So fix their natural environment instead of trying to kill the migrants. All you do by killing the migrants, is clearing the way for more migrants!

    Now, think if Greece (my own country) and European Union, which has seen millions of migrant people in the last 2 years, were to start shooting on sight these people in order to stop the migration. Do you find that a proper solution? NO, it’s not a proper solution and it’s politically, financially and socially proven to NOT WORK.

    The solution would be to help them FIX their own country (peace, economic growth etc). Then, I can tell you with great assurance, that the vast majority of these migrated people, will RETURN to their homeland.

    Microbes here are the same. They wouldn’t want to be in the small intestine, which is not their natural environment, any more than you want them to be, but they have no alternative, since your LARGE intestine is a freaking warzone!

    Ok, this above analogy was a bit too much, but I think it explains why antibiotics is the wrong solution. You don’t kill the migrants, you help them get back to a fixed home!

    I’m surprised that Chris would agree with this article and let it published here. It boggles my mind actually.

    • How refreshing that somebody finally spoke a word of common sense. Good health is simple – only a few practitioners will advise that. The millions of healthy people around the world who live to be old age are not eating complicated diets, getting expensive tests and eating more expensive supplements. They move, breath fresh air, eat a simple diet of the land and live in harmony with that nature. Wake up, people!

      • That is a great point Katarin, I think it is important to address the stress component in SIBO as well. I don’t know about all of you but stress definitely played apart with me developing health issues. I think if the mind is strong, the body will follow. Not to mention, there can be an added stressors we try so hard to adhere to a diet. That is why people who are happier are healthier, and can get away with eating things us SIBO sufferers would frown at.

        I have been slowly changing my perspective, and although it is still early and veeeeeerry slow, I am making a bit of progress.

        much love to all of YOU

        • Agreed. After at least five years of family stress, hospice, caregiver role and deaths, my health took a dive. A few months after the death of my father I wound up with intractable constipation. 7 year’s later, diagnosed with h. pylori infection, probably from changes to my GI climate and dysbiosis that took place shortly after the emotional trauma. I’ve been dealing with this for close to a decade, but, am overjoyed that this problem is slowly becoming better understood and that there are protocols that truly help.

          This article gives another facet to the problem and pushes forward more experiences to what can correct the cascade of ills that this condition creates.

          It definitely plays a role in opening the door to pathogenic growth of flora.

          • Vivek, I’m exactly at the same point in life as you.

            Stress doesn’t go away, but how we view the challenges can go a long way to preventing further damage to our health.

            May you find health on your path as I hope to find in mine.

  118. My doctor would like to treat my SIBO with Cipro and Flagyl, have you heard of this being an effective protocol? I told them about the preferred AB’s but they like to use the Cipro and Flagyl. I am methane dominant.

    • DON’T take Cipro for SIBO (that rhymes)? Cipro is one of the most dangerous antibiotics and I seriously messed up my body and system after taking Cipro. I had to follow the AIP protocol just to function normally after 3 rounds of Cipro from a UTI infection that turned out to be fungal, not bacterial (not needing antibiotics) in the first place.

  119. Hi Kelsey, thanks for the excellent article. It’s good to know that it’s not necessary to follow a super-restrictive FODMAPs diet when treating SIBO. I’m about to do a SIBO test and wasn’t looking forward to following that diet if the test comes back positive!

  120. Great read! It is interesting to see how treatment plans are starting to evolve as more research is coming out and as practitioners are learning from working with clients. I like the idea that we are moving away from the starve mentality and focusing more on the rebalancing/changing the environment.

  121. Well, 100 carbs a day would not work for me, it would send my blood sugar into the stratosphere. Tested positive for SIBO 3 months ago and using herbal supplements + lower carb diet.

    • Are you eating some FODMAPs? Would definitely recommend that you include some if possible (many are non-starchy veggies).

      Like I mentioned in the article, everything needs to be personalized since all clients are not the same. As a general recommendation, though, I do like to see carbs at least around 100g.

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