Table of Contents
SIBO Diet | What Is SIBO? | Low-FODMAP Negative Impact | Effective Treatment
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.
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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!
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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:
- What Causes SIBO (Small Intestinal Bacterial Overgrowth) and Why It’s so Hard to Treat
- RHR: A New Understanding of SIBO and IBS, with Mark Pimentel
- RHR: Unanswered Questions About SIBO
- RHR: New Treatment for SIBO and IBS-C—with Dr. Kenneth Brown
- RHR: SIBO Update—an Interview with Dr. Mark Pimentel
- RHR: SIBO and Methane—What’s the Connection?
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?
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
Katie
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,
Julie
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!!
More background info…I also have Celiac Disease.
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.
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?
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.
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.
Thank you, Angela, for this information! I have not heard it before.
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.
RECOMMENDATIONS
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.
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now the question is if this theory it correct or not.
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/
Hi Vivek,
I have digestive problems but dont know what exactly – where i live there are no tests available for sibo, leaky gut etc.
If you read those 2 articles
– http://www.ithyroid.com/hypot_recovery_story.htm
and
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231515/
and you will see the connection between thyroid, sibo , leaky gut, heavy metals etc. I plan to take minerals – zinc, selenium, calcium, iodine etc.
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 🙂
What are you doing to detox the metals? Are saunas and Epsom salts good for that? Thanks
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
Diana
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?
Sorry you’re going through that, Clair. Sounds quite rough. Have you been tested for hiatal hernia?
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.
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.
My doctor mentioned that neomycin is not tolerated well and has serious side effects. Would appreciate any feedback.
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.
Thanks Peggy, I think they may have to be done again after a month or so
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?
What I have learned is that silver kills both good and bad bacteria and is contraindicated for SIBO.
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.
Hello. I was hoping you could please recommend some of the herbal antibiotics you refer to. Thank you.
Check here:
http://www.siboinfo.com/
I recommend Dr. Ruscio Radio for those wanting more info. I think most episodes are worthwhile, and several focus on SIBO.
http://drruscio.com/podcasts/
http://drruscio.libsyn.com/rss
what do think about fecal transplant for curing sibo?
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…
What are your thoughts on elemental diets?
Kelsey? 🙂
I’ve written about it here: http://chriskresser.com/can-a-short-term-elemental-diet-help-treat-sibo/
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…. 😉
Also important to note: just finished two rounds of lufenuron over the last month or so and might go for a third.
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.
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?
Hi Sofie
Are you in the UK?
Regenerus Labs in the UK conduct SIBO breath testing.