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?
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
Abstract
INTRODUCTION:
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.
OBJECTIVE:
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.
RESULTS:
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.
CONCLUSIONS:
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.
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?
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
Great question!
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?
Get Bob’s Red Mill Hydrolyzed Guar Gum from Amazon or any health food store. Not expensive.
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!
thank you! i will look into functional medicine MDs.
Jenn,
Could you please share who do you have in Raleigh?
Dr. Dishman at Bloomington Integrative Health. Her own business. 21 page intake & 2 month wait for new patients. $$$. She doesn’t upsell you on supplements & her prices are competitive. I do have a lot I’m taking now tho. She’s sharp, intuitive & takes her time. Insurance doesn’t cover it & very pricy. Highly recommended her. Contact me if you more info.
Thank you very much, Jenn. I appreciate your time to reply.
Jenn – I’m in Raleigh as well and suffer from SIBO and other GI issues. Can you tell me what Dr you see here?
I see Dr. Dishman of Bloom Integrative Health. Very good, difficult to get first appt, $$$, acupuncturist, worth it all. Send me a private msg on FB. I’d love to have a local support partner to heal with!
Who do you know of in San Diego?? Thats where I live!
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
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.
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?
Anyone have any thoughts on this?
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?
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.
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
Rifaximin was a life saver for me! I was better after 3 days. I did not have diarrhea from taking it.
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 I’m also following AIP & following FODMAPS seems very confusing! Any advice and are you still struggling?
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 Susie,
By calcium levels do you mean calcium in blood test?
Yes, I checked my calcium levels with blood work labs.
Hi Inga, I hope you saw my email reply. I accidentally typed in “Ann”.
Susie
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.
Susie
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.
Go to Dr. Allison Siebeckers website siboinfo.com she lists treatments that can be purchased online. She is very thorough.
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 …..
Thank you, I will!
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?
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?
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.
Hi. A friend mentioned that book to me a while ago. What’s his approach and are you SIBO free?
Oops I just had to add pls notify to msg so if you reply can you pls reply to this msg
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.
Ok thanks for that!
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.
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.
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…
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.
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.
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.
Hi can you please explain a bit more about his approach. Have heard of his book. Thank you
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!
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.