Why Diet Alone Is Not Enough to Treat SIBO

by Kelsey Kinney, RD

Last updated on

SIBO diet

If you’re using a low-FODMAP diet to keep your small intestinal bacterial overgrowth (SIBO) under control, you’re not alone.

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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.

Can you get relief for your symptoms by following a SIBO diet? While diet is an important part of healing your gut, it’s not enough to really treat the condition. Check out this article to find out what works for SIBO.

What Is a SIBO Diet?

Are you dealing with SIBO? If so, you may be looking for a way to treat the condition without antibiotics. In most cases, that means adopting a SIBO diet that limits your carbohydrate intake and removes carbs that are difficult for your body to digest or absorb. Some common SIBO dietary protocols are:

  • Low-FODMAP diet
  • Specific carbohydrate diet (SCD)
  • Gut and Psychology Syndrome (GAPS) diet
  • Elemental diet
  • Low fermentation potential (FP) diet
  • Low-starch or even no-starch diet

While these specific diets differ from each other, their general goal is similar: limiting the types of carbs you consume to avoid feeding the bacterial overgrowth in your small intestine that’s driving your SIBO. The low-FODMAP diet, for example, limits FODMAPs, or short-chain carbohydrates that aren’t completely absorbed in the gastrointestinal tracts. FODMAPs can linger in the gut and feed bacteria, resulting in a variety of digestive symptoms.

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What Is Considered the Best Diet for SIBO—And What’s the Problem with It?

The low-FODMAP diet is a common choice for SIBO (and other digestive disorders like irritable bowel syndrome). This diet has been shown to provide at least short-term relief by reducing bacterial overgrowth in the small intestine. (1)

If you’ve tried a low-FODMAP diet for SIBO and noticed significant improvements in your symptoms, 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). (2)

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/low-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 before 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.

What Is SIBO?

The large intestine contains the majority of the digestive system’s bacteria. The small intestine is typically relatively sterile (compared to the large intestine), so when bacteria translocates and overgrows in the small intestine, it causes problems. If there are changes in the number or type of bacteria present in the small intestine, SIBO occurs. For many people, this is caused by an overgrowth of a variety of bacteria that should be in the colon. (3)

SIBO impacts the structure of the small intestine and its ability to function. The condition often causes damage to the mucosa lining the small intestine, which can impair nutrient absorption and lead to leaky gut—a condition where protein molecules can pass through the intestinal barrier into the bloodstream, causing an inflammatory response.

Symptoms of SIBO

SIBO doesn’t always cause symptoms (some studies suggest that up to 15 percent of healthy people are experiencing SIBO without any symptoms). (4) However, some of the most common signs of SIBO include:

  • Diarrhea
  • Constipation
  • Abdominal pain and discomfort
  • Bloating
  • Gas and belching
  • Weight loss and vitamin deficiencies (in severe cases)

SIBO is, unfortunately, an under-diagnosed condition. Many people aren’t aware that SIBO could be causing their symptoms, and many doctors don’t realize how common this condition really is. Some of the most commonly used testing methods (breath tests) have some issues with accuracy. All those factors play a role in making SIBO difficult to diagnose and treat.

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 that show 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.

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 percent in this study), along with a decline in bacteria that produce butyrate (a beneficial substance made when probiotics feed on fermentable fibers). (5) While this particular study did not show a decrease in the probiotic strain Bifidobacteria, another study has. (6) 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.

What to Use as an Effective SIBO Treatment

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

Rifaximin

Rifaximin is the most commonly used antibiotic for the treatment of SIBO, and has been shown to be safe and well-tolerated. (7) Figures vary on its efficacy (with rates as high as 87 percent in one study), but on average, it is about 50 percent effective. (8) 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 percent effective. (9) 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

Herbal antimicrobials have been shown to be at least as effective as rifaximin, and about 57 percent of those who fail on rifaximin will succeed on herbal antimicrobials. (10) 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!

Healing from digestive disorders can be a long and difficult process. Many people with these disorders get frustrated with doctors who don’t understand the problem, solutions that don’t work, and chronic discomfort. Where can people with this experience turn for answers? Functional Medicine practitioners are a great option, and they can help diagnose and prescribe treatment. Health coaches are another great source of support, and they can actually be the key to unlocking improved digestive health.

ADAPT-trained health coaches have a background in Functional and ancestral health, and they understand the root causes and range of treatments for digestive disorders. Although they can’t diagnose or treat these disorders directly, health coaches can often refer clients to a trusted Functional Medicine practitioner, help clients understand a diagnosis or follow a treatment plan, and support clients in dealing with the frustration that comes with digestive disorders.

Want to know more about digestive disorders and what you can do to help people overcome them? Learn about the ADAPT Health Coach Training Program.

Diet during and after SIBO Treatment

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

If you listened to Chris’s 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 starve them, as they will “hide” and become more difficult to eradicate. Eating FODMAPs and carbohydrates is exactly what you want to do!

Your Diet during SIBO Treatment

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 percent (rifaximin alone) to 87 percent (rifaximin plus guar gum). (11)

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 does not interrupt their life or cause pain, the more FODMAPs or carbohydrates they can eat, the better.

Your Diet after SIBO Treatment

As many sufferers of SIBO know, SIBO has a high rate of recurrence, which begs the question: what should you eat 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
  • Poor diet
  • Stress

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 do to heal from SIBO with the knowledge we have now.

Additional Resources on SIBO:

533 Comments

Join the conversation

  1. 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.

  2. 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.
    Thanks

    • 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!

  3. 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?

  4. 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,,,
    Vishva

  5. 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

  6. 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!

  7. 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!

  8. 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.

  9. 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)?

    • Marie! I have tried Candibactin AR/BR you must be in Canada too, as I believe those are metagenics products. Also tried the Rifaximin, and the Iberogast too! … I wonder if its the same functional doc! … Anyhow, curious to know what type of SIBO you have hydrogen and or methane? … I found Candibactin helpful but when I stopped it came back. I do think my underlying cause is a liver/gall bladder issue, so I am addressing that first, and then will be using different herbs i.e. Uva-Ursi, Plant Tannins, Berberine, and maybe Oregano oil.

  10. Which herbal antimicrobials may be the most effective? Would mastic gum be useful in treating SIBO?

  11. 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.

  12. 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.

      • I agree wholeheartedly. I took the related Levaquin and it messed me quite badly.

  13. 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!

  14. 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.

  15. 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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