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?
Hi Kris, I seem to be doing much better concerning my SIBO,
But I also need to find a more knowledgeable gastroenteroligist, or dietician. I live in Calabasas, California, just a few miles north of Los Angeles. I also have pudendal nerve Nueralgia (I think). I’ve been to tons of doctors for this condition, which started immediately after a colonoscopy, 16 years ago. My new concierge doctor is trying to get me an appointment with Dr. Pimmentel, at Cedars Sinai in L.A., but I don’t know if that will be any time soon. I’m following the Fodmap diet, but would be happier if I could eat cooked onions & garlic. Can you suggest a doctor who can help me now. How do I know when I can go back to a regular diet? The SIBO has been contributing to my biggest problem, chronic Rectal pain. (Pudendal Nueralgia)).. I got the SIBO about 6 months ago. I’m 73 year old female, & was managing my pain using a fentynal patch, which isn’t working very well anymore. I got off opioids, but still couldn’t sit & my pain Dr. Put me on them again after a 3 month break.iI also need to find a good pain Dr. Near my home. I can’t sit at all, & my health in general is suffering. Can I do a private consultation with you? My quality of life has become pretty poo, the past 2 years, since the opioids stopped working for my rectal pain.
Any suggestions are welcome. Now that my stomach has settled down, I thought my rectal pain would subside. I thought there was a connection. All my blood tests are normal, except low on B12, & getting weekly B12 shots. Have you ever heard of pudendal pain (Rectal)? What are your thoughts? Would be fine if you don’t want to print this, either way OK. Maybe we could PM or talk. [email protected] Thanks for your help, Adele Casden
I need to find a SIBO specialist STAT! Can you recommend one in the Illinois/Wisconsin area? If not, I will travel to find someone/anyone who knows what they’re doing? Someone who has a track record with success in treating SIBO.
My tendency to this is definitely inherited with many in my family garlic, onion, radish and other vegs / grains sensitive. I understand the logic of what this article says, but I don’t think adding any of that will be a happy thing for me – just one small cookie, even homemade from quality organic flour, is enough to create an increase in ‘weight’ of almost 2 lbs within hours – all gas, of course!, which hangs around for days on end. I’ve been zero grains zero fibrous veg zero pulses for years now and never felt better. It’s a real tricky thing, SIBO is, because there’s still a ton of info that remains unknown on the workings of the gut. And it’s a *^%$#@ nuisance, but there are worse things in life.
Soraya I was just wondering about the foods that you do include and some meal examples because I to do not do well on any starches whatsoever. I’ve been treated for SIBO a couple of times and whenever I try to add in starchy vegetables, beans or fruits it always returns.
Does anyone know a good gastroenteroligist or dietician, near Calabasas, California. Is a dietician more capable of helping me deal with sSIBO? I live on the northern edge of Los Angeles.
Hi Dr. Kresser, I’ve been diagnosed with SIBO over a year ago. I have been on a carb-free, dairy-free, nut-free, sugar-free diet for a while. But only the symptoms are better, and that’s because I don’t eat. I’m miserable. I have 4 rounds of Xifaxin. Things were better while on the 14day treatment, but miserable soon after. Tried probiotics, L-glutamine, digestive enzymes, fish oil….. but nothing works.
I live in Chicago. Ihave visited many GI doctors already. Any suggestions ????
Thank you so so much
I have SIBO for about 6 months. I’ve had 3 doses of Xifaxine & have been on the SIBO diet. I’ve lost about 37 pounds (which I needed to loose). I also have pudendal nerve neuralgia (Rectal pain)., which has become severe the past 2 years. I think there’s a connection between the 2. I got the rectal pain after a colonoscopy, (the next day). After going to many doctors I was told I had levator syndrome, there was no cure, & put on Fentynal patch. I’ve been on it for 10 years, & it stopped working 2 years ago. Before I was happy & healthy.
I was 57 then, & im 73 years old now.
This is to Dana, I too am in the Chicago area and cannot find a good FM doc. Have you had any success finding someone?
My husband has all the SIBO symptoms (bloating, cramping, gas, burning in upper stomach, low iron, ferritin & B12, constipation & food sensitivities), but when he took the Hydrogen Lactulose Breath Test (twice) they were flatlined. The 1st test only checked the Hydrogen level. The 2nd test checked both Hydrogen & Methane. He’s seen 3 Gastroenterologists and has had every test under the Sun and the only thing they’ve said is he has mild Gastritis. We’ve been following the low FODMAP diet the last 8-9 months and doesn’t seem to bring any relief. He tried to take XIFAXIN, but he said it felt like it was burning a hole in his stomach so stopped after 1 day. Should we assume he “DOES NOT” have SIBO if the Breath Tests were negative? If he DOES have SIBO, why wouldn’t the Breath test show something…even a little blip? Are there other ways to verify whether it’s SIBO? Thank you.
Hello,
Has it been explored that he may have ulcers? Has he had an endoscopy?
Stacey, Yes he’s had 2 Endoscopes and neither one found any Ulcers, HPylori, Celiac or Cancer. It showed mild Gastristis, but Dr’s didn’t make a big deal about it based on his symptoms. HIDA scan checked out normal too. We recently started seeing an Internal Medicine MD with some functional/integrative bkground. They seem to want to help, but so far haven’t seen any positive results. They are having him start with a Probiotic Enema (with water) 3 x week. He said it may have helped a little with cramping the first few times, but now he’s getting the severe burning in upper and mid-stomach area. His typical symptoms are: bloating & cramping 1 to 1-1/2 hr after eat, which causes pain. Now he’s getting the burning sensation along with stomach soar to the touch. The burning doesn’t seem to go away anymore. He hasn’t had a single day without some kind of pain for months. His diet is so restrictive. Never know when to try and introduce new foods since symptoms never any better. He’s also deficient in B12 & iron so this is being treated via shot or infusion therapy. Does SIBO cause burning like this? He’s been down the Nexium route, which we think may have contributed to SIBO (assuming this is what he has). I think his Gut Flora is so messed up and we can’t seem to find a Dr that knows about SIBO and/or how to correct his Gut. He’s so discouraged and wants his life back! Did you have SIBO yourself, Stacey? If yes, how did you tackle it? Thanks!
Any luck Shelby? Symptoms sound exactly the same as mine… keep me posted please!! x
Hi Dee, no substantial improvements. Still doing probiotics 3 x week (colonically with a little water and then retains it). May help some with daily bowel. Dr. having him do another round of Xifaxan. This is the 3rd round within 6 months. So far, 7 days in out of 10, no real symptom relief. Experiencing terrible nausea, weakness and no appetite. Also said experiencing brain zaps. Hard to explain other than he said feels like brain just stops. Burning still an issue. Sometimes 1 Tbl of Apple Cider Vinegar provides a little relief. This has been the worst thing that has ever happened to him. After 1 yr still don’t feel any closer to getting better. Getting real scared at this point for his health. Had a consult with a Clinician at John Doulliard’s HealthSpa in Colorado. They use Ayurveda for healing (yoga, herbs, meditation, etc). Not sure at this point if will help, plus can’t afford . Getting desperate for help!!
Shelby, what kind of B12 infusions is your husband getting – cyancobalamin, hydroxycobalamin or methylcobalamin?
His B12 shots are Methylcobalamin. He’s also had 2 iron infusions so far as well. Iron & Ferritin levels have been low.
Hi Sheby, I have had “brain zaps” myself, had them over the course of a year or so. No one was ever able to pinpoint a cause BUT they stopped after I began an aggressive B vitamin supplementation routine due to another symptom. In particular I was deficient in Thiamin! People these days say only chronic alcoholics suffer from this issue but that was not the case with me. It was only caught by accident when I described another bizarre symptom (nystagmas) that I had experienced a handful of times. That led to extra Thiamin supplementation on top of the B-complex and no more “brain zaps”! My suspicion is that people with intestinal issues like ours often also suffer from undiagnosed malabsorption issues. B12 is well known but what about less common ones? In the case of Thiamin, unless you stumble into the ER drunk and confused for the fourth time in a week no one will even consider it as a possibility. Bottom line, some extra thiamine won’t hurt anyone other than those with an allergy. I took 300mg/day of thiamine tetrahydrofurfuryl disulfide spread out over six doses for one week (you must take with fat as its fat soluble), then 100mg/day for another week and now take 50mg/day as a maintenence dose plus a B-complex and mineral complex. No more weird unexplained symptoms, dizziness, brain zaps, etc. I recognize that, as regards my intestines, this supplementation is only masking the problem, but at least it keeps me feeling better while I work on the real problem. OH, and if you are taking any significant Thiamin you must supplement with Magnesium as it is needed for proper utilization.
Please check out Lyme disease. It can cause every symptom you can imagine. It is hard to diagnose and most doctors miss it. I have Lyme and SIBO.
How are you treating Lyme and SIBO? I have the same…
Try testing for a yeast infection and parasites
He did a Stool test for parasites/bacteria/virus, etc and all came back negative. I know these tests aren’t 100% conclusive. Dr. didn’t run any tests for yeast, but she did a visual exam on him to try and rule out…checked tongue for white coating, examined fingernails/toenails, checked eyes for yellowing and all were fine so she didn’t pursue anymore tests for it. Are there other visual symptoms for it?
my yeast was discovered during endoscopy……….if it was in my throat it is most likely in my intestines. Sure is is from all the asthma inhalers………….
Shelby, I just watched two different SIBO conferences via webcast. One Dr went over breath testing and said flatlined tests indicate hydrogen sulfide gas production. This is lesser known than hydrogen and methane and I don’t know the treatment protocols. But it might be a lead for you.
Try checking out the Atrantil at atrantil.com…..it is over the counter…..
check out the facebook group on Magnesium. It sounds as though it may be connected. Low mag is tied in with all these factors.
I have found this article very interesting, thank you. I have a 21 month old with SIBO. She has been on antibiotics twice in 5 weeks, after the second dose of antibiotics she seems worse. How do I tackle this in a toddler. It affects her sleep and keeps her awake for 2-4 hrs every night. Would you recommend the herbal route?
Have a couple questions: 1) If someone has Methane SIBO and will be treated with traditional antibiotics, should they still follow a low FODMAP/SIBO diet while taking the antibiotics? I’ve heard you should try and eat normal during this process so the antibiotics will kill the bacteria while it’s feeding. Is this true? 2) Should you take a probiotic while going through the antibiotic process or wait until the SIBO is gone before starting any? Thanks.
Hi Shelby,
It depends. Some docs are allowing small amounts of FODMAPs during treatment as well as probiotics. If one does not tolerate either one of these or both too well, then they should avoid while treating. Yes, also a more liberalized diet while treating.
I’m being treated with Xifaxine for the 3rd time for SIBO, in past 6 months. I’m on the FODMAP diet. My Gastroenteroligist said I can eat COOKED ONIONS. Is he correct? Also I have a condition that started after a severe reaction to the clean out preparation, EXTREME diahrea (16 years ago.) I have debilitating rectal pain. It took me 2 years to be able to eat normal food (diahrea). Could the rectal pain, especially after a BM, be caused by years of SIBO?
Hi Kelsey,
I just found out I have SIBO. Do you know of any homeopathic doctors in the Chicago area that you’d recommend who have experience with this? I’d prefer not to go on multiple antibiotic regimens as I am also facing more pressing health issues than SIBO. Thanks!
Homeopathic?
you mean naturopathic I hope.
Homeopathy has NO BENEFIT above placebo. Its water…
Homeopathic remedies helped me a ton.
Not sure why you are slamming this approach.
Do you know anyone in New Hampshire or Vermont that works with Sibo?
Would coffee enemas help?
Dr. Michael Stadtmauer at the Vermont Naturopathic Clinic.
Dr Bert Mathieson in Bedford, NH.
Coffee enemas help me. I have Lyme disease and SIBO. They especially help with die off and methane SIBO. They cleanse your liver and help constipation. Lots of info about them online.
Love the next to last paragraph, SIBO may be a SYMPTOM of some deeper underlying problem. Can’t wait to see what you guys come up with for a post-SIBO treatment diet. I’m beginning treatment with Michael Ruscio now. This info was super helpful!
Is there a good SIBO Fructose Doctor in the Cedar Rapids, IA area?
Hello! I am interested in any information or input from any SIBO sufferer who subsequently developed Fructose malabsorption/intolerance. At this time I think my SIBO is back, can’t deny the symptoms anymore 🙁 Should I be taking prebiotics with the Xifaxan, and then once I complete the treatment course resume my probiotics?
I’m on Victoza and have had an illeostomy for 32 years. Would these things have an affect?
Does anyone know of a good Dr. or Nutritionist in the Tampa Bay area (Florida) that knows something about Digestive Diseases and Nutrition. My husband has Gastritis and we think SIBO again and need some guidance for proper healing. We’ve tried to educate ourselves, but only get more confused.
We actually live in the Crystal River, FL area, but willing to go 50 miles or so to talk to someone. Thank you.
shelby,
Please check out Dr. Erika Bradshaw in Brandon, Fl. I live in Brooksville, and see her several times a year. Check out her website, and call/email her office. She is worth the drive.
Thank you, Kelly. I will check her website out. Appreciate the feedback.
Shelby
Check out Dr. Erika Bradshaw in Brandon, Fl. I live in Brooksville, and see her several times a year. After being ill for two years, she has done more for me than the three other doctors I saw combined.
You need someone who thinks outside the box.
Thank you, Maggie. There was another person that replied (who also lives in Brooksville) that recommended Dr. Bradshaw as well. Maybe you two know each other? We’ll check her website out. Appreciate the feedback. -Shelley
Try Absolute Health in Ocala. The doc there is an integrative doctor who will look at all aspects of the illness. I live in Dunnellon & after trying many doctors, including specialists, I found this practice. I do a lot of research myself, so I can tell when a doctor isn’t up on the latest info.
Thank you Eleanor. I looked at their website and they seem to provide a lot of different services. We will definitely look into them. Appreciate the feedback!
Hi is there anyone who knows of a dr who will test for sibo in New York area? Long Island ? I have been suffering with this for 3 years and I’m at my wits end. I feel horrible. Please let me know.
Thank you
Thank you again
Dr Raphael Kellman – 7 W 45th – 212-717-1118
I just did the test myself last week….
In response to Eugenia above re the statement “IMHO, what we need for curing SIBO is the right kind of probiotics, possibly in high doses, of the right kind (casei and others). These would create the right kind of stomach acid and other conditions that would reduce the causal factors for bacteria colonizing the small intestine.”
What specific probiotic & dosage would you recommend then?
I’m so confused after reading everyone’s suggestions for treating SIBO. Do this…don’t do this…take this…don’t take this, eat this…don’t eat this. Makes me want to scream! We’ve spent a fortune trying diff supplements/methods based on all these recommendations and husband (64) still not well after 9 months. He’s very sensitive to supplements so can’t seem to take vits/minerals or probiotics – hurts stomach. Could be due to Gastritis, which is the only diagnosis Dr has ever given him. SIBO isn’t in their vocabulary it seems.
We’ve seen 3 gastritis Dr’s. All just say Gastritis. He’s lost so much weight. All skin & bones now. Has all SIBO symptoms (bloat, gas pain, discomfort in small intestine w/constipation). Did Hydrogen breath test (only hydrogen tested…cannot find anyone here that has methane piece). Hydrogen was basically flatlined, which I wasn’t surprised since don’t have diarrhea. Dr didn’t think was SIBO but agreed to try Xifaxin. Helped tremendously after 2 rounds so seemed like the Gastritis was the remaining issue…stomach burning & nausea, but now the other symptoms have returned after 1 month!! Diet has been & still is mainly (B) Oatmeal w/2 slices toast, (L & D) Chicken, Turkey burger (plain), or fish w/rice or potatoe (white or sweet) & low fodmap veges. I’m so worried. He’s lost all hope! Gastro Dr’s have given up on him.
Any suggestions are appreciated and can someone please clarify whether probiotics are a goog/bad thing to take if have SIBO and which one to take. Also the same question for digestive enzymes. I’m desperate for some menu planning too so anyone that can share what they typically ate/eat in a day for SIBO is appreciated. Hubby is so tired of same stuff. Thank you.
Have you looked into the Specific Carb Diet (SCD)? The oatmeal, bread, rice, etc are not part of a SCD and my understanding is they contribute to SIBO returning and allowing the overgrowth in the 1st place. My Dr recommended ProBiotic, specifically this one, Florajen 3 Capsules. I have been doing well by eating nothing but Meat, Vegetables (Low FODMAP) and fruit. I do not eat any processed food, and when I eat out I review the nutrition information and allergy information to make sure there is nothing in their food that I can’t have. For example, many places use milk in their meat preparation, ie Qdoba. What is your alcohol intake like, # of drinks per day? I was told Red Wine, Bourbon, Whiskey, no beer and no sweet alcohol like Brandy etc due to the sugar. Hope this helps 🙂
Sean, Thanks for commenting. Yes we have looked into the SCD diet. My husband did this for 2-3 months initially. He’s lost so much weight now that it scares me to think of him going back on the SCD diet. It’s so limiting. He’s gotten so use to his Oatmeal and Rice now, that it’s hard for him to even think about going back to SCD. Breakfast is the hardest.
What do you typically eat for Breakfast and snacks? My husband is so underweight, he’s always looking to eat something. Do you eat 3 regular meals a day or many small ones?
We don’t drink Alcohol so that’s not a problem. He tried FloraJen 3 a couple times and, unfortunately, they really hurt his stomach. Thanks.
Hi,
I lost 20lbs in 2 months and it was great! It has plateaued, so that’s good. During the week I eat cantaloupe, pineapple, strawberries and a banana for breakfast along with an breakfast bar called, RX Bar, check them out on Amazon. They are a bit different and chewy, but I get a good dose of protein. When I cook, I will have eggs, vegetables, and meat, only difference is no potato’s and bread; I miss bread a lot!! When I snack I eat beef jerky from our butcher, so extra sugar etc, I have a grapefruit every night after dinner sometime, I eat almonds, hard cheeses, and vegetables.
Sean, Are you eating your fruit raw or pureed? As far as vegetables, are you pretty much eating those on the low FODMAP list? Wish we had a local butcher here to get jerky. Thanks.
I eat all my fruit raw and I look for organic and choose that over all others. I also look for organic meats, vegetables, etc when ever possible. I am staying on the low FODMAP for vegetables, I regularly eat, green pepper, onion, mushroom, spaghetti squash, cucumber, zucchini, & carrots.
Onions must not have been a problem for you then when you had SIBO? May I ask you what protocol (meds/herbs/etc) you used to rid your SIBO? Do you currently take any other vitamins today along with your Probiotics? Thanks.
I use to take a lot more supplements before and I am going to work them back into my diet eventually. For now, its a probiotic and Alive, the chew able, multi-vitamin as I can have them on an empty stomach and it doesn’t irritate it, and its all natural 🙂 I was breath tested and they discovered the sibo so I was on 2 antibiotics at the same time for 10 days. I actually think it might be creeping back as I have had a few things that are not allowed, some bread, little ice cream, etc, which makes me thing SIBO is a slow creeper which means stick to the diet religiously. At least that is what I am assuming at this point. I have read a lot and its inconclusive if it will ever go away, or can be treated without antibiotics, if diet is really the way to go. So who knows LOL
Diet alone and probiotics and Meds will not eradicate SIBO or any gut dysbiosis – you need to address your root issue.
Look into motility – make sure your bowels are emptying fully. If not take a supplement like triphala or lax formula by integrative.
Make sure your diet has an array of foods – sticking to the same foods over and over – will only lead to worse symptoms.
Look into the book the gut health protocol by John Herron. He explains many things in detail – if you do a kill stage without biofilms you will not eradicate gut issues.
My diet was super restricted – I expanded it – game changer for me! Eat nutritious prebiotic and probiotic rich foods and build the microbiome !
Tanya, Thanks for your comments. That’s the million $ question….root cause! My husband would love to know the root cause. He’s been to so many Dr’s, several tests done and only thing that’s come is Gastritis. He had a Gastric Emptying Test for motility and “supposedly” passed. He only had 9% left in stomach after 3 hrs. Normal they say is 10% or under. Dr. put him on PPI’s, which may have caused the SIBO. 2 rounds of XIFAXIN helped a lot, but seems to be back after 2 months. My husband would love, love, love to expand his food selection, but between Gastritis, which he tries to eat foods with ph 5.0 or above and SIBO, low-FODMAP, it doesn’t leave you too many options of food to pick from. I’ll look into the book you recommended, but if you have any other ideas that might help, would love to hear more. Thanks.
Hi Shelby, You can contact http://www.nourishingtherapies.com.au/, Genevieve is
very helpful with diets and gut issues. Also a website called SimplySibo.com has
been started that may be helpful. Best wishes for healing. Susie
Thanks Susie for the additional information. I will check them out.
Sean, Sorry for all the questions. I really appreciate you responding back to me. So sorry your SIBO might be coming back. Arg!!
Did you have the methane SIBO? What antibiotics did the Dr. have you on, if you don’t mind me asking? Also, how much time has passed since you last had SIBO until now (if it’s coming back)? Thanks a million!
It was a hydrogen breath test and I believe it tested for methane as well. The antibiotics were Xifaxan 550mg and Metronidazole 500mg both 2x a day. I finished the antibiotics May 20th so less than 3 months. Not sure if its coming back or not, still trying to see if it was just something funky this week or?
Shelby, I was just reading through all these comments and I know this was a few months ago but I am sure that you are still battling with this.
It is still a question if I have SIBO or not but I sought out a Naturopathic Dr. and she has been really helpful in exploring my symptoms and causes and trying some gentle treatments. She also referred me to a Dr. in the area who actually has her roots in Chinese medicine (both of her parents are Chinese physicians) and she sent me with a list of items to discuss so that we could test for some specific things. I am seeing her right now so that we can do blood work and in my case an ultrasound of the area I am having pain in.
I wanted to encourage you to try seeking out a Naturopath/Holistic Dr in your area that could help you to really look into whats going on and hopefully find a root cause. Sometimes trauma to the internal organs can make them overly sensitive and definitely even something as simple as a stomach virus can throw off out gut bacteria. If everything is burning his stomach it could be that he isn’t producing enough stomach acid. Though when i first started down this path I restricted my self to basically bone broth, rice and cooked carrots for like a month and I never felt any better and I still felt acid and upper GI burn all the time. That was most likely because I was so hungry all the time. I started by adding in plain chicken and leafy lettuce. No dressing but a squeeze of lemon.
With any individual there are a lot of variables from lifestyle and diet to your natural body chemistry and genetic disposition. Holistic medicine treats whole health rather than just a symptom, and a good Naturopath will know what to specifically ask for if they do need to send you to a Dr. for something like blood work or an ultrasound.
I also encourage you to get a notebook and write down everything he eats or drinks and anything else that happens from how it makes him feel to other things happening, like things are particularly stressful with the family or neighbors. It will show you patterns and you can take it with you when you see anyone for treatment.
If you don’t know where to start looking. I called a wellness center in my town that holds yoga classes, reiki classes, the teach about essential oils and herbs. The Naturopath I see doesn’t work there but they did give me her contact info. I wish you the best of luck, I will be praying for you two!
Sarah, Thank you for all the encouraging info. We just started going to an Internal Medicine Dr who uses Functional/Integrative methods, but after 2 sessions, not too impressed. May have to seek out what you did. Just hesitant, I guess, due to cost. May I ask you whether you still have the burning in upper GI area and if not, what helped? Are you tackling your SIBO via natural supps? Don’t know what State you are in….would it happen to be Florida? This is where we live. Appreciate your prayers. We’ll keep you in our prayers too.
I too have been following the SCD and healing with Dr. Axe bone broth protocol, and low fomap foods. After a year of daily diarrhea, constant fatigue and recently diagnosed with diverticulitis I have had enough of suffering. I have been doing this for 6 weeks and I have my life back! After the 3rd day my energy level shot up. I make chicken or beef bone broth, I can eat eggs, bananas, carrots, some cooked fruit, peeled/seeded zucchini and acorn squash.
I eat a low residue diet also. I eat a whole lot less food, I have dropped 18 lbs and feeling better every day. No longer in a panic going out and about in the morning hours.
Hello, April.
I found this article and read your comment. I have a lot of stomach problems. I treated candida before, felt good for few days, then back again to the bloating and gas. I was also treated for H. Pylori. The stomach discomfort still there. Now, somebody mentioned the word SIBO, I haven’t tested yet. But I am researching on my own. I would like to know what foods are allowed during the SCD. I get bloated just by smelling grains. I eliminated them 100%. I am on protein, nuts, vegetables. I don’t eat fruits. Should I?
I appreciate your time and help with this issue. Thanks.
Shelby,
While I don’t know yet how to eradicate SIBO, I’ve come across a way for me to at least start digesting the food I AM eating properly and start to find safe foods, at least in the short-term.
1) Start with Aglaee Jacob’s Elimination Diet as outlined in her book “Digestive Health with REAL Food”.
2) Slowly (she outlines the re-introduction process, well, too) introduce one food and one spice, etc. at a time, using Dr. Siebecker’s SIBO Diet guide (you can google it to find it) to give you a starting point for reintroducing foods that will be less likely to cause problems for those with SIBO – absolutely no grains or starch carbs whatsoever.
3) Using Diane Sanfillipo’s book “Practical Paleo”, you can find a page that lists out supplement and herbs to consider to help with healing gut lining and repairing a leaky gut.
I know that it is not a permanent solution, but at least it can help alleviate current symptoms and help the body to begin the healing process. Good luck!
Thanks Amanda. I will look into these books.
Hi Shelby,
There is a product called Amino Acids Platinum – it is patented – its inventor – dr Vickery claims that it can restore stomach acid – which seems is the root cause of SIBO and many other diseases. I think the same can be achieved by another product called Seacure – which is hydrolyzed white fish protein. In order to produce HCL the body needs zinc , vit. B6 and amino acids . Of course you can directly take HCL + pancreatic enzymes but i think producing you own enzymes is better.
Hi Shelby,
I have a severe case of SIBO (methane) ridiculously persistent with absurd motility issues. I don’t know if I will ever recover and have been on this journey forever. I have been sick most of my life (I am 38), but have been focused on SIBO for about 7 years now. Prior to that, I hadn’t heard of SIBO and was working on the diagnoses of IBS and Gastritis.
I can’t second enough that you need to get him off of oatmeal, potatoes, etc… Have you considered using Jasmine rice as a substitute? It does not feed the bacteria. I understand we each need to decide if we wish to starve the bacteria or maintain- while we aim to eradicate. Whatever you do, you need to strike a balance and not overfeed it (while you are not on an antibiotic).
Jasmine rice can be used to make a breakfast porridge with coconut milk, in place of oatmeal. I know you know this, but just to reiterate, when this sick, we have to adapt and give up things- like oatmeal. Though it is hard at first, we have to remember that over time, taste buds actually change- literally. They are all replaced within 6 months. So what he doesn’t like now, well, he may be OK with or even truly like, in 6 months time!!! I hope this is encouraging. I have found this to be very true in my case.
Recipe would look something like:
Cooked Jasmine rice, add lots of coconut milk/cream (cook some more), cinnamon, an acceptable sweetener e.g. stevia, limited molasses, or Manuka honey, and a few berries (fresh or dried) or nuts (if you wish).
I use coconut milks without guar gum*- but based on the article- that’s depended on your preference and where you are in your treatment, etc…
*Hard to find, but can be done! [“Foco” (cheap) and “Natural Value”(expensive)]
Since loosing weight is an issue, I think Dr Robillard’s FP List would be a handy thing to live by. I bought the book and cut out the list, put brads in it and highlighted it up, and put it in my purse. I lived by it for about a year. It really helped me a ton and I didn’t lose weight when I was on it- I actually gained 15-20 lbs!
http://digestivehealthinstitute.org/
Narrowing down to the type of SIBO’er he is- Yes, this matters.
Dr. Josh Axe- though he may seem gimmick-y or whatever, I think there is a lot of value here. He has mainstreamed what he is offering, and that isn’t necessarily bad. I have purchased a membership and think it was a small amount of money very well spent. You can take questionnaire tests to help determine which kind of “gut” you have, helping to customize for things like “gastritis” which I also have, and it spits out a more customized diet. SIBO isn’t just SIBO- we are all a little different- there are different types of SIBO’ers, right? So this narrows it down a little further. I, for example, have been tested (I paid a lot for this) and have a VERY leaky gut. Due to this testing, I can eat a few fruits that are good at repairing the wall of my stomach, like blueberries. Though this testing was not done through this website (Josh Axe), the questionnaire I did through his site, DID in fact pick that up. It was impressive.
I hope this was helpful and I wish you both luck.
Kind regards,
Myra
Thanks for your input Myra. That recipe sounds good. Does that simple rice oatmeal work for you with no noticeable side effects? And does that coconut milk not bother you?
Do you have any other recipes you’ve found that work well for you like that? I am not underweight but I am on the thin side so am on the hunt for good food that won’t cripple me either. Any input by anyone is appreciated! Thanks!
Myra, Thank you for responding back with a lot of good advice. I’m so sorry that you’ve had to struggle for so long with gut issues. Were the Dr’s not able to help you at all? Do you mind me asking a few more questions. You had a lot of good advice/recommendations on this subject so really appreciate any other info you can provide that might help my husband. 1) Did antibiotics not help your SIBO? 2) Do you take anything to help with motility issues? 3) Do you currently take any vits/sups/probiotics? 4) Do you still follow the SCD or Low FODMAP diet? 5) Did you have to count points when you were on Dr. Robbillard’s diet…this part seems confusing? 6) Where did you get your Leaky Gut test done?
Thanks again.
Shelley
All gluten and grains should be stopped. Google the SCD Diet and stay off foods which are known to irritate the gut and cause inflammation in the body..which is what he is eating. No wonder he stays sick.
I disagree with you about stopping all grains. When I have SIBO flare-ups the only thing I can eat is jasmin rice and meat. Jasmin rice has high amylopectin content and low amylose which allows it to digest quickly and get absorbed in the upper area of the small intesine. It is a low fermentation grain. Depending on each person’s bacterial and enzyme composition some people will do great on rice while others can’t tolerate any type of grains. We are all different and require individual approach. For me, eating any kind of vegetables during flare-up will exacerbate the situation dramatically. Some people are able to eat only veg and meat.
Making blanket recommendations across the board (by practitioners who think they are experts) will only make people lose faith in them. There are a lot of things to consider like oxalates, phenols, histamines etc. Every person’s causes for SIBO are unique.
The majority of us need some kind of concentrated carb source to be able to function properly. Otherwise thyroid and adrenals will suffer. Once again, what works for one person will not necessarily work for another with the same symptoms and disease manifistation.
I totally agree with you Dila. There are over 400 different bacterial species that make up the SIBO category. General SIBO guidelines are just that, general. Every person is unique, just like their gut bugs or dysbiosis. SIBO patients must reintroduce foods, including grains, back into their diet at some point. It is not uncommon to discover that certain grains, vegetables and fruits are now tolerable, but others are not. I will share my own case: After undergoing an Elimination Diet, 4 Whole30 diets, months of botanicals, two rounds of antibiotics I am now perfectly fine with eating rice (I even tolerate gluten, but still avoid). What I have found to still cause a dramatic reaction are apples, avocados, beets, cherries, zucchini, millet, sorghum and legumes.
I refer to a local SIBO-brilliant RD who helps patients reintroduce foods back into their diets. This is critical, because long-term food avoidance can also lead other forms of gut dysbiosis and even eating disorders.
Dear Shelby,
I am very sorry for your husband and I deeply sympathize. I have been there and done it all. I refuse to spend any more money on doctors, tests and tons of supplements. What worked the best for me after all these years and brought immediate relief was laughably (sp?) simple. Drinking celery, cabbage or cucumber juice first thing in the morning on empty stomach. Or green powder drink (barley, wheatgrass, etc). I also went on a two week diet of only raw fruits and vegetables. It was great. All my bloating, constipation, aches and pains went away after a few days. High doses of vitamin C powder cut with half baking soda several times a day. Essential oils of oregano, clove, thyme, frankincense sipped in a water bottle through the day. Now eating only when hungry and not too much, of course no processed foods of any kind and enough fiber. When in distress, I took a couple of charcoal capsules. All these things are not pricey, and they work remarkably well. I am tired of all the expensive doctors and their unending tests and stupid diets. Never felt better.
I with you the best. Kathy
I would read up on info from “FIX your gut”, you can read his website and get book on Amazon. The author discusses choice with herbal vs antibiotics and diet during treatments. Another great book is Fast Track Diet, there are menus with it and was written by microbiologist with extensive knowledge about how foods break down.
The key is to kill off excessive bacteria, heal gut, and support motility… I personally choose to not introduce more bacteria with probiotics during treatment. Top natural dr in the field, Dr. Allison Siebecker has great info at siboinfo.com
He can eat gluten?????
Shelby, I have SIBO / Post-Infectious IBS after a bout of gastroenteritis in March 2016 so I truly sympathize with what your husband is going through. I’ve been reading your thread and it sounds absolutely horrible and scary.
I don’t know if you are aware of Dr Norman Robillard. Please check the info at his website https://digestivehealthinstitute.org/ for diet ideas per the Fast Tract Diet (which he developed). He is a PhD microbiologist, not an MD. He himself suffered from severe GERD which is now in remission due to FT Diet. Tons of info on his website and blog. He is also available for consultations by phone.
Also see the very detailed comment by Dila (Oct 21, 2014 at 1:44 pm) at http://theancestralrds.com/2014/08/28/episode-4-recommendations-for-sibo-and-paleo-alcohol-choices/
Her sister suffered horribly, tried everything, felt like she was dying. Sister was able to overcome her problem, Dila still has chronic digestive probs but symptoms are controllable with the Fast Track Diet. FTD treats both GERD/reflux as well as IBS.
What specific types of carbohydrates do you allow your clients to eat during SIBO treatment?
Thanks,
Jen
Hi,
I have been tested positive for SIBO through a breathing test a few months ago after months of suffering post food poisoning.
I have gone through 2 rounds of 2 weeks of Xifaxan and just finished my 2nd round 4 days ago. I started doing Sibo Specific Diet immediately, but my stomach hasn’t been feeling too comfortable. So I ordered Herbal Antibiotics (Metagenics Candibactin-AR with Metagenics Candibactin-BR) on my own, and started taking them today along with MotilPro for prokinetics. If anyone can help answer my questions below, I’d really appreciate!
1. Can I eat fruits raw during first 2 weeks of Sibo Specific Diet or do I have to cook everything?
2. Can I start herbal antibiotics 4 days after the end of Xifaxan treatment?
3. Can I stick to Sibo Specific Diet during herbal antibiotics treatment or should I eat food that feeds bacteria?
4. Can I take prokinetics while doing herbal antibiotics?
Any help would be appreciated!
Thank you!
Kelsey, Looks like I possibly have Methane SIBO. I have been dealing with this for a long time…years and years…I went to Taymount clinic and had FMT for IBS symptoms and now am realizing that I should have treated the SIBO first. argh. So, I was going to do the Antibiotic Rifaximin because I know it absorbs as it moves through the small intestines , sparing the bacteria in the large intestines… But after reading this I see that Methane producers have a different protocol. I am wondering if the neomycin or the herbal protocol spares the bacteria in the large intestine? I am unwilling to kill off my new biome in a rush to get the SIBO under control and you have validated my concerns about starving the large intestine’s biome with a CSD. Any insight? Thank you, Olivia
Olivia,
I saw that you visited Taymount for your IBS and have only now discovered you have SIBO as well. I was wondering about FMT and if it worked its way up to the small intestine to correct/balance things. However, based upon your comments, it would seem not. Can you please elaborate on your experience at Taymount and what it has done for you thusfar?
Does anyone know if it’s okay to take bentonite clay while on rifaximin (to help slow my diarrhea)? I’ve heard the clay help clear out the gunk causing malabsorption, but I want to make sure it won’t interfere with the effectiveness of the antibiotic.