This post is the second in a three-part series on Small Intestine Bacterial Overgrowth focusing on SIBO natural treatments, antibiotics, herbal supplements and lifestyle changes. You can see Part 3 on SIBO diet, on-going healing and recovery here. And brush up on see Part 1 on SIBO symptoms and testing here. For a more up-to-date and thorough resource, check out my new book SIBO Made Simple.
When I finished my SIBO treatment, I was convinced I still had critters.
Even though I had been taking herbal antibiotics for nearly 6 weeks, my system still felt off. My stomach continued to bulge, my digestion was pokey. I was burping during meals, no matter how many FODMAP’s were on my plate. And despite these symptoms (which I laid out in Part 1 of this series) having gotten a little better, their persistence seemed to be evidence that whatever hodgepodge approach I had taken to ridding my small intestine of its bacterial burden, had failed.
This SIBO-style paranoia seems to be common among sufferers I’ve spoken to. And for good reason. The first being that treatment options are complicated, varied, and often take doctors a few tries to tailor to the individual. The second being that even if one works the first time, SIBO is a chronic condition that often relapses within 3 weeks of finishing treatment.
In case that thoroughly bummed you out, I’ll share with you the little piece of news that I received this week that put a pin in my SIBO stress balloon (and, the one slowly deflating in my abdomen): after two months in the weeds, I’m officially SIBO free!
If you want more info on what SIBO is and how I navigated my diagnosis, hop back to PART 1 of this series, or better yet, read the whole story (with LOTS of practical advice) in my new book, SIBO Made Simple. And if you’re worried that you may be suffering from Candida vs. SIBO, I have a whole post on that as well.
As I waited for the results, which came 3 weeks after I finished my course of herbal antibiotics (the Biotics protocol discussed below), I planned for the worst and continued to diligently research other treatment options, debate which route I would try for the next round, and question whether I would ever end up desperate enough to get my meals in the form of a medical liquid (i.e. the elemental diet).
Today’s post is a result of that deep dive. In it I lay out the three main phases of SIBO treatment, the three primary approaches to killing your bacteria, and the many many herbal supplements and lifestyle changes that are recommended to treat symptoms and aid in the process.
One prong of the treatment plan that’s not discussed as often is optimism. I can’t stress enough how bad stress is for any chronic condition, even though chronic health conditions are some of the most stressful life forces on the planet.
As hard as it may seem, try to stay positive.
My guiding light throughout this process was knowing that my experience with SIBO could help others navigate it down the line. And you don’t have to be a blogger with a platform to embrace that silver lining. I got some wonderful emails from friends who took meticulous notes (and created fabulous spreadsheets) during their year-long battles with SIBO.
I’m so grateful I can now just point people towards my book, SIBO Made Simple, for all these resources. It truly is the book I wish I’d had when I was trying to figure out SIBO treatment. Hell, the one I wish my doctor had too!
Remember that dealing with SIBO is a wellness project in and of itself. Embrace the trial and error. And even if the road feels long, once you take the scenic route up Health Mountain, you’ll be that much better equipped to guide others on the journeys that lie ahead.
With health and hedonism,
Phoebe
THE 3 PHASES OF SIBO TREATMENT
Though doctors are becoming savvier about testing for SIBO, they often focus on just the kill phase and don’t always appreciate the full breadth of what it takes to eradicate it for good.
Here is how I break down the timeline:
1. The Kill Phase (2 – 4 weeks)
This phase lasts as long as the medication protocol prescribed, most commonly a generic antibiotic like Rifaximin or one of the herbal protocols. There’s a debate as to whether a low FODMAP diet is beneficial during the kill phase, which I will discuss briefly at the end of this post. For those with severe symptoms, beginning a low FODMAP elimination diet protocol will help jump start the healing phase and provide some relief, but you don’t want to be so strict that the bacteria go into hibernation because they’ve fully lost their food source.
2. The Healing Phase (2 – 3 months)
It’s recommended that you retest for SIBO exactly two weeks after the antibiotic protocol is complete. Some people who are feeling better will continue onto the next phase regardless since the test is expensive. Others will wait until a negative result is achieved, and then proceed with some diet modifications that aim to heal the intestinal lining and rebuild the immune system, followed by the slow reintroduction of high FODMAP foods.
3. The Recovery Phase (On-Going)
SIBO is a chronic condition. If it comes back, it’s not an indication that the treatment plan didn’t work, but rather, that the root cause hasn’t been dealt with properly on an on-going basis. This is where a lot of the lifestyle modifications come into play, and in some cases, where it’s necessary to continue certain supplements, specifically the ones that improve motility (i.e. those that make sure you’re pooping properly).
Today’s post will mostly focus on the kill phase, though some of the lifestyle recommendations pertain to phase 2 and 3, which will be discussed in the last part of this series.
Personally, I find the biggest challenge to be what to do after a round of medication. The gap between a SIBO diet and healing your gut for good can feel so big. Bridging that for you (with recipes!) and giving you a road map is the primary reason I wrote my book, SIBO Made Simple.
THE BEST ANTIBIOTICS AND HERBAL TREATMENTS FOR SIBO
The options for treating SIBO during the Kill Phase fall into three categories: regular antibiotics, herbal antibiotics, and The Elemental Diet. With the exception of the latter, which is a full package approach, there are still plenty of dietary and lifestyle changes, and additional supplements, that will help the medication do its job. I’ll get to those later. For now, let’s talk about the pro’s and con’s of natural treatments versus the pharma route.
The first thing that your physician should keep in mind is that the treatment for SIBO is different depending on whether it is methane or hydrogen producing, and presenting symptoms as constipation (SIBO-C) or diarrhea (SIBO-D). There is usually a strong correlation with these symptoms and which gas is present (methane-C, hydrogen-D), but not always. Make sure to discuss both with your doctor to ensure you choose the right protocol.
1. Antibiotics (2 weeks)
There are several pharmaceutical antibiotics which are commonly prescribed for SIBO: Neomycin (better for Methane dominant), Metronidazole, and Rifaximin. The benefits of antibiotics top out after 3 weeks, so a 2 week course is the sweet spot.
Rifaximin (generic: Xifaxan) has the best reputation of the group, even among naturopaths, as it’s an antibiotic with “eubiotic effects.” It specifically targets the area we need to eradicate—only killing bacteria in small intestine. According to studies, the side effects are mild and the die-off of beneficial species of bacteria in the colon is minimal. For those who are wary of antibiotics, this isn’t a bad one.
However, the main problem with Rifaximin (and all other pharma options in this category) is that with repeat use, you increase the likelihood of becoming resistant. Meaning, it might be worth one try, but you don’t want to get into a cycle of use, especially when there are other natural options that have been proven equally effective with fewer long-term risks.
2. Herbal Antibiotics (4 – 6 weeks)
People don’t necessarily gravitate towards herbal options just because they’re more “natural.” Rather, certain combinations of herbal antibiotics have been proven in studies to be just as effective as their pharma counterparts.
The downside: more pills, for longer, with the possibility of GI side effects. Just because herbs are natural doesn’t mean they’ll be tolerated by everyone. I certainly experienced discomfort and an increase in my constipation symptoms while on the Biotics formula.
The upside? You can purchase these herbs without a prescription and experiment on your own. Which, considering you can now take a SIBO test at home, is an affordable option for those who aren’t able to invest in the helping hand of an integrative doctor.
So what are the best protocols for herbal antibiotics? The two data-backed protocols are:
- Metagenics Candibactin-AR + Candibactin-BR (this is the most studied option)
- Biotics FC Cidal + Dysbiocide (the one I used!)
Typical dosing is: 2 caps, twice a day, for 4 weeks. For what it’s worth, I did the Biotics system for 6 weeks.
The two protocols above combine several individual herbs that are thought to be helpful, including berberine herbs, ginger and oregano. There’s definitely a big pro to having a formula already sussed out for you. But another route is to design your own treatment using a combination of the below herbs. Dr. Allison Siebecker recommends 1-3 in combination, for 4 weeks, at highest dose suggested on product labels.
- Allicin: Though it’s derived from garlic, this strong antimicrobial doesn’t contain the FODMAP’s found in other parts of the clove. The highest potency formula is Allimax. This is the only single use herb that’s been studied with SIBO, and was found to be effective for methane-dominant SIBO. It can be added to one of the above protocols, or used in conjunction with Berberine and Neem.
- Berberine Complex: these herbs are also found in the Metagenics formula. It’s derived from Goldenseal, Oregon Grape, Barberry, and other herbs. Many use this in conjunction with oil of oregano and neem for hydrogen-dominant SIBO.
- Neem Plus: Neem is a tropical evergreen tree and is said to enhance the positive effects of the two herbs above.
- Oil of Oregano: This herb has been known as a longtime antifungal, antimicrobial, antiviral powerhouse. During my Biotics protocol, I habitually added two drops to my water or took a veggie capsule of it with my other pills.
3. The Elemental Diet (2 weeks)
If all else fails, there’s always the elemental diet. It is thought of as a last resort because of the extreme unfun-ness of the protocol, which involves drinking a medical solution for all meals for a 14 day period. I can’t imagine ever doing this, but it’s a relatively quick strategy that’s proven 85 percent effective at starving out the bacteria, while, on a purely elemental level, feeding the person.
The mixture includes liquid nutrients in an easily assimilated form that is used in hospitals on GI patients whose system needs to heal. The nutrients get absorbed quickly and easily in the first leg of the digestive labyrinth, meaning they never make it to the area of the small intestines where unwanted bacteria congregates in SIBO patients.
The protocol is suggested for 14 days, with a retest taking place on the 15th day. Overnight results should be requested so that you can immediately start the diet for an additional week if there’s still a positive.
Again, this is if all other protocols fail. It’s not recommended to take antibiotics or herbs during the elemental diet because the bacteria, without food sources, will essentially be hibernating or die off on their own, as intended by the diet.
For more information, recommended formulas and important tips on this protocol, click here.
THE BEST STRATEGIES FOR MANAGING MOTILITY AND SUPPORTING DIGESTION
Since antibiotics and herbal alternatives can be used interchangeably as killing mechanisms, what really gives you an extra edge is how you support your treatment through lifestyle changes and supplements that treat the root cause of your SIBO.
As you may remember from lesson 1, one of the biggest underlying problems that contributes to SIBO is a screwy, slowed Migrating Motor Complex (MMC). Luckily, there are several easy changes you can make to your diet to help your digestive system catch up. We will talk about these more in the next installment.
For now, some quick tips:
- Try meal spacing: leave at least 3-4 hours in between meals and avoid snacking.
- Drink lots of water.
- Sip bone broth before bed.
- Eat slowly and chew your food until it’s mush.
- Add lemon juice to your water before meals to get your stomach acid flowing. This will help prevent more bacteria from making its way into the small intestines and aid in digestion.
Sometimes the MMC can’t be stimulated properly through diet alone, which is where prescription medication and additional supplements come in. This list may seem overwhelming, so remember that this is not an “all of the above” suggestion. Rather, some of these supplements can be used as added strategies down the line or to treat discomfort throughout the process as needed.
- Digestive Enzymes: Bacteria could be becoming trapped in the small intestines for a few reasons. But the problem escalates when said bacteria are being fed all too well. While you can employ some of the good habits mentioned above, a strong digestive enzyme taken at each meal will help break down food so that it isn’t hanging out as a resource for bacteria. I like this brand. I took 2 capsules with lunch and dinner (I skipped breakfast). More info on digestive enzymes as a treatment for IBS here.
- Prescription Prokinetics: These pills, which stimulate the MMC, are an essential part of prevention and on-going support after you’ve finished a course of treatment. Many doctors will advise waiting until after the kill phase/antibiotic protocol to start a prokinetic. This is likely because you don’t want the antibiotics to be moving through your system too fast – the pills need time in your small intestines to do their job! So you’re better off choosing from some of the natural suggestions below and then switching to one of these prescriptions after your first course of treatment if you’re still feeling backed up. Low Dose Naltrexone and Low-dose Erythromycin are the most common. You can find dosing advice on Dr. Siebecker’s site but keep in mind your doctor will have to advise.
- Non-Prescription Motility Supplements/Prokinetics: These herbal formulas help keep things moving without the need for a prescription, and are also used in conjunction with antibiotic treatment, especially if you’re experiencing constipation from the medication. Start with one strategy and layer as needed.
- Motilpro – Made from ginger and quite potent. Take 3 caps before bed and 2 caps between meals.
- Smooth Move Tea – This tea has been my last resort laxative ever since I was a child. Half a cup before bed is enough to make me explode. For those who doubt the medicinal potency of herbs, just give them this tea! I drank this a few times during my treatment when I was feeling particularly backed up.
- Psyllium Husk – A prebiotic fiber, the powder from this seed helps cleanse the colon and produce more even, predictable poops. It’s been studied as a positive supplement in treating IBS symptoms. Though I haven’t experimented myself, I wanted to add as an option. 1 cap before bed.
- Natural Calm – This product is made of magnesium and calcium. It’s marketed for stress and a good night’s sleep (two bonuses) but can also help keep you regular if you add a tablespoon or two to your water before bed. I like the fizzy, tart taste and the gentle effect it has on my insides.
- Supplements for Reducing SIBO Symptoms: As I shared from my experience, symptoms of bloating, gas, and GI distress don’t go away overnight, and can sometimes be exacerbated by the “kill treatments.” If diet alone doesn’t help alleviate, one or more of these supplements can be added to your regimen.
- Iberogast – 20 drops with each meal to help with bloating.
- GingerMax – Take 1 with each meal.
- Enteric Coated Peppermint Oil: a drop or two of the essential oil in a glass of water prior to a meal can help reduce bloating and gas, as well as other symptoms of digestive upset, or you can take a capsule.
- Supplements to Breaking-Up Biofilm: These pills are added value for your kill treatments as they help breakdown the cell walls of bacteria (biofilm) and allow antibiotics to access their intended target. I took 2 capsules of Interfase by Klaire Labs between meals when I could remember. It’s unclear though whether it was necessary.
- Visceral Mobilization: This strategy for removing blockages to the small intestine isn’t discussed enough. It’s essentially a targeting intestinal massage and you can try to find a practitioner in your area who is trained in VM. Here’s advice for how to give belly a self massage to help it operate properly.
There are SO many different options out there to add to your medicine cabinet for various symptoms and SIBO treatment elements. I put them into a really easy to use / reference chart in my book SIBO Made Simple. Honestly, it’s worth owning for this section alone!
For more information and links to the brands I keep on hand for managing symptoms, travel, healing leaky gut and increasing the efficacy of treatment, I put together this post on the best SIBO Supplements.
DO PREBIOTICS OR PROBIOTICS WORK FOR SIBO?
Most people who talk about SIBO treatments take the starve and kill strategy: switch to a diet that’s low in foods your bacteria like to eat (fermentable carbohydrates) to try to reduce them, and add in a medication that will further the extermination. Usually this involves either the low FODMAP Diet and/or the Specific Carb Diet, and also means eliminating fermented, probiotic foods, and inulin-rich prebiotic foods that have long been touted as a healthy gut’s best friend.
There is another school of thought, however.
And that is to use probiotic and prebiotic supplements as a means of righting your overall bacterial imbalance.
The research is much more sparse for this line of treatment, but there have been several small studies that indicate using probiotics doesn’t hurt, and its ability to help is strain specific.
The argument for probiotics, as Dr Jason Hawrelak explains in this episode of my podcast, is that they can speed transit time, stimulate the MMC, help heal leaky gut by regrowing villi, and ease gut hypersensitivity which is common with SIBO.
I don’t bring this up to confuse you, though of course offering up a mode of treatment that is in direct conflict with the ones I just mentioned above, does seem downright confusing! The point is that every body is different. There are many solutions and ways to tackle the problem of SIBO, and there’s not a single approach yet that has been proven to be “right.”
If adding rather than taking away seems like a better approach, you can do more research on probiotics and SIBO, and/or experiment with prebiotics like Allicin, Partially Hydrolyzed Guar Gum, and GOS’s.
As Dr Jason Hawrelak argues, SIBO sufferers react to high FODMAP foods because there’s something wrong with their gut not because the FODMAPs are harmful. And using probiotics to shift the bacterial ecosystem usually means an overall smaller population of bacteria in the small intestine.
Here is more information on the best probiotics for SIBO treatment and healing afterwards.
The low FODMAP and SCD diets target carbs because that’s what bacteria like. They are also a great tool for reducing symptoms and giving patients a sense of control. But the ultimate outcome you want is to be able to eat all the beneficial vegetables and treat the underlying cause to get you there.
And that dietary part of the debate–both what to do during treatment and afterwards to prevent relapse–is where we are going to pick up next time!
OTHER SIBO RESOURCES
- The SIBO Made Simple book (now on shelves everywhere!) takes all the learnings from 50+ interviews with practitioners and distills the advice into a 350 page practical roadmap with 90+ Low FODMAP recipes.
- The SIBO Made Simple Podcast covers each puzzle piece of SIBO and breaks it down into easily digestible terms. Here are some topics we cover:
- SIBO Breath Testing
- The Elemental Diet
- Post-Infectious IBS & Food Poisoning
- Methane & Hydrogen Sulfide SIBO
- Candida & Yeast Overgrowths
- Leaky Gut & Autoimmune Disease
- SIBO & Hypothyroidism
- SIBO & Celiac Disease
- Mast Cell Activation Syndrome
- Heavy Metals, Mold & Other Toxins
- CBD Oil & SIBO
- The Low FODMAP Diet
- The Bi-Phasic Diet
- SIBO & Intermittent Fasting
- Skin Issues and SIBO
- Probiotics and Prebiotics for SIBO Treatment
- Healing Structural Issues
- Fertility & SIBO
- Histamine Intolerance & SIBO
- How SIBO Effects Depression and Anxiety
- Acupuncture for SIBO Healing
- Busting Biofilms
- Dr Allison Siebecker’s site is hub of amazing information, SIBOinfo.com
- SIBO 2.0: How to Find the SIBO Treatment That’s Right For You
- SIBO 3.0: The Best Diets and Lifestyle Changes to Treat, Heal and Prevent SIBO From Recurring
- My FREE Low FODMAP Weeknight Meal E-Book
- The Best SIBO Supplements for Managing Symptoms, Healing Leaky Gut, and More
Get more SIBO info right in your ear…
SUBSCRIBE and LISTEN to the SIBO Made Simple Podcast!
Disclaimer: this website offers health, wellness, and nutritional information for educational purposes only. Information provided is not intended as a substitute for the advice provided by your physician or other healthcare professional. Always speak with your physician before trying any new treatment.
I don’t suffer from SIBO but occasional constipation. I used to use some of your remedies such as senna teas (Smooth Move is one of them) but have come to favor Aerobic Life Mag 07 Digestive System Cleanser, 1-2 caps at bedtime for two or three days. It’s magnesium, which is the laxative part, with the addition of the extra-oxygen molecule, and extra oxygen is anathema to bacteria. The purge is very gentle and, over several days, quite thorough. No skid marks.
yes – how could i forget! i like natural calm, which is a similar product. just added to the list. this one sounds very good though. will try! xo
Thank you for this. I have been recently diagnosed…. suffering for years. It gets so bad I even struggle to breathe normally. I just came across this post tonight. I will certainly read your blog un more detail in the morning.
Did Senna give you skin growths?
Congrats again! Ugh, I can’t wait to declare the same thing. Scheduled for Endoscopy/Colonoscopy (just finished Rifaximin for the third time) whiiich my GI doesn’t think will be conclusive- hooray! Going to try your method, just bought the Biotics…crossing my fingers! Had you considered Atrantil at all? Another one I wish there were more tests on!
Shawna
Ah Shawna, hang in there girl! I actually had a friend who recommended Atrantil. You can take it without changing your diet, which is great. Apparently helps the bloating too. If you try it report back! I’m considering adding to the options above, but like you I wish i knew more!
I have suffered with all sorts of gut issues including SIBO and Candida (toss in some mold toxicity) and I have used Antrantil as a relief option for a few weeks prior to working with either antibiotics or natural remedies. What an amazing product! Very gentle yet very helpful with bringing the bloating down. I have also used it when I’m feeling ‘off’ to reset for a couple weeks. Made SUCH a difference.
Did you heal it?
I have SIBO and find your articles very informative. I am about to start the Biotics protocol but not sure if I should take them with meals. Did you take them with food or on an empty stomach ? Thanks ahead for your help.
I haven’t gotten a definitive answer on this, but I did usually take on an empty stomach. first thing in the morning and then before bed. I don’t know that it matters though.
Hi Phoebe, thanks for your response. I am almost done with the six week Biotics treatment and I feel great ! This is the first time in two years that I actually feel like myself again. I am so glad I find your website. Quick question, do you suggest taking probiotics after the treatment ? My doctor suggested it but I read opposite opinions online.
so glad you are feeling good! yes, once you confirm that SIBO test comes back negative, then begin your healing phase, which can include slowly reincorporating fermented foods and taking a robust probiotic. At least, that’s what i did!
What probiotic did u take please ?
I am on day 2 of the Biotics. Question…you mentioned above that you don’t want to go so extreme with the diet that the bacteria hibernate. So did you Sophie or Amie change your diets at all during the 4-6 weeks Biotics treatment? Also, my doctor recommended Antratil to help with the die off symptoms, but another friend recommended simply activated charcoal. Any thoughts on these? Thanks! Just starting my SIBO journey….I am struggling with optimism. 🙁
Ooops, I meant, Sophie and Phoebe! Thanks!
I would like to know the answers to these questions too! Update please!
Hi,
I was recently diagnosed with SIBO by my doctor and was told to go low FODMAP for 2 months and they we would rerun my blood work. He didn’t do the breathe test but all my symptoms and issues point in that direction. Do you think I should wait the 2 months to reassess with my doctor or try the herbal supplements? Now that I’m learning about the “kill phase” and all of the specifics of the diet it feels like a waiting game. My doctor is not a specialist by any means, he’s just an internal medicine doctor that actually listens to my complaints and looks for solutions.
Thanks!
hi jami! if you weren’t tested, it’s not really a diagnosis, just a suspicion. Some people feel better just going low FODMAP for a little while. But if you have SIBO, and a bad case, then it’s probably not going to eradicate it on its own. The diet lessons symptoms but doesn’t clear the bacteria. I would recommend getting tested so you can see exactly what you’re dealing with (methane vs hydrogen dominant) and choose the best herbal or conventional protocol to deal with the beast you’ve got. You can definitely go low FODMAP tomorrow though to help your symptoms!
Hi Phoebe! I’m so happy that I found your blog, I’ve been all over the internet (I’m sure like anyone with a SIBO diagnosis) and I just get SO discouraged. And nobody had any solutions to help constipation during the kill phase ahhh! I find that if I’m reallt constipated it affects my mental health so much! Anyways thank you so much for you words, they are clear and conscious and easy to understand!! I’m on my second treatment of herbals (nobody can figure out my root cause) and added Neem and took out probiotics. I’m struggling right now but eager to try some of those symptom relievers and constipation one’s as well. Last time I stuck with the lowfodnap diet so symptoms weren’t as bad… but I think I needed the bacteria to be more present. We will see. Congrats on your cleaner gut haha!
thank you maggie. so glad you’ve found the series helpful. good luck with the next phase of treatment! keeping my fingers crossed for you xo
Hello Maggie Johnson,
I have SIBO, was constipated for 5 days, tried everything! Fermented cabbage, 2 & a half day fast, Coconut oil, apple cider vinegar. Anyway it wasn’t until I tried ginger that I exploded. I would like to have a support system pls text me first @ 718-569-8676 or email [email protected]
Anyone else interested pls reach out to me.
Hi there. Can you tell me how much ginger you used ? Thank you!
Hi Phoebe. I’ve been trying to get my SIBO C under control for four years. The protocols make me worse so I’ve always given up after a few days. How long did your C worsen for on your successful go? I need to know from someone who’s been through it!
to be honest, I didn’t start feeling better until a few weeks into the protocol. but the low fodmap diet helped with other symptoms like the bloating and belching.
Do you take the dysbiocide and fc-cidal with or without food 2X a day?
This is very interesting. My question is, if you’re treating the small intestine with antibacterial, won’t these then continue to have antimicrobial action in the colon? I wouldn’t want to disrupt the biome in the colon.
When you did the biotics herbal protocol, did you take 2 capsules of EACH the dysbiocide and the FC cidal twice a day or did you take 2 capsules total (1 dysbiocide and 1 FC cidal twice a day)?
2 of each, 2 times a day
What brand did you use ?
Thanks for all your helpful information. I really appreciate it! So just to be clear, I should take the dysbiocide and the FC cidal together at the same time, right? I don’t have to take one on an empty stomach and then wait before I take the other one, correct?
Thanks for all the info. I was wondering if there was a liquid alternative to the herbal antibiotic supplements listed. I cannot swallow pills. I have the oregano oil in liquid form. I also have grapefruit seed extract oil and goldenseal oil. I read those were good for sibo but I do not know for sure. I have only been taking them for a few days but have not noticed an improvement. My main symptom is the belching and bloating, Do you know how many weeks it would take to notice improvement?
I have been dealing with these symptoms for about 20 years . I have just been confirmed after 4 years of testing that I have sibo. Iv had at least 6 rounds of antibiotics in the last few years recently for 28 days straight . In that process was rushed to the hospital numerous times due to dehydration and what they thought was a stroke or heart condition but all test came back normal which led them to blame the sibo. What do you recommend
I’m not a doctor. My recommendations are many and they are housed in the three posts on the subject. There are a lot of different options depending on whether you are Hydrogen or Methane and what your symptoms are.
I feel you Dana, isn’t it crazy how Sibo ABSOLUTELY affects pulmonary & cardiac systems.
There were nights I thought it was going to die of a heart attack when my SIBO was at it’s worse.
I’m noe dealing with it a second time & I feel the chest tightening & the anxiety is back.
Don’t worry by BP & HR is better than it’s been in years.
Starting back low FODMAP & going with Oil Of Oregano along with Berberine this time.
I absolutely loathe SIBO……FYI mine is Hydrogen dominant.
You mentioned peer mint oil for Gases and thats fine, but if you also have acid reflux the peppermint makes the acid reflux worse. I have an Autistic child that suffers from SIBo and Reflux.
thanks for sharing gisel!
It can make matters worse if you take peppermint during or after meals.. I find it;s ok on an empty stomach at least half hour before a meal.. or use the Entric coating ones, but again way before meals 🙂
I’m curious if anyone else has had the same experience with SIBO as me…. I accidentally discovered I had it after taking a round of Augmentin when I had a sinus infection and my symptoms resolved (hair loss stopped a few months later and digestive issues stopped almost immediately). However, since then, my digestive symptoms have not really returned but my hair loss has continued for YEARS. Is it possible to have subclinical SIBO where I still have some symptoms but my digestive symptoms are not present.
I’m not a doctor, but when I hear hair loss, I usually think of autoimmune issues….many of which are risk factors for SIBO. I would have your thyroid checked and rule out Hashimoto’s along with some other things that could be causing the hair loss. And feeding your gut with probiotic-rich foods can’t hurt!
Thanks for responding Phoebe. I actually do have Hashiomoto’s thyroiditis but have been on thyroid medication for more than a decade and continue to get my levels checked regularly. Despite the normal T3 and T4 levels, I still have had hair loss for almost 4 years. Twice the hair loss stopped for a few months and both times I had taken antibiotics about 3 months prior. Do you know of any autoimmune reason why the antibiotics would have resolved my hair loss temporarily?
that’s above my pay grade, Ashley. Sorry! Try messaging someone like Will Cole or Amy Meyers.
Is there a protocol to treat sibo for people who have difficulty swallowing pills that cant be crushed or opened?
elemental diet or herbs in tincture form
May I know why u can’t swallow I am feeling the same way
Hey there! Thank you for all the fantastic advise. I was just diagnosed with SIBO. Does anyone know if you can take the antibiotics (Xifaxan) and the herbal remedies mentioned above at the same time?
It’s an either or, except for in the case of methane if you want to swap neomycin for allicin garlic and do a hybrid herbal/antibiotic approach. PHGG can help increase efficacy of xifaxan so that’s something to explore if you want added ammo.
Hi Phoebe,
Thank you so much for sharing your experience. I’ve been unable to eat a single thing without looking like I’m full term for almost a year now. I was really happy to find your blog and know that I’m not alone in this!! I was wondering if for the two Biotics pills you took, you alternated between the two or if you just took them at the same time. Were you working with a functional medicine doctor or were you able to beat this on your own? Thanks for mentioning different options well. This was super informative! And congrats on beating the beast!
Glad to hear it’s helpful H. It’s 2 of both pills, twice a day. I worked with a functional medicine doctor and he was very helpful but I also did a lot of my own research. If you’re in NYC, check out my list of holistic practitioners. If not, there’s a wonderful MD Alison Siebecker who has an online program: https://bit.ly/2PxKayg
Great, thanks 🙂 Did you rotate these pills at all or were you able to continue them without building resistance?
I only needed one treatment, so no resistance. If I ever have to treat again I might rotate to something else just to hedge my bets. But knocking on wood that the occasion doesn’t arise for quite a while!
Thank you so much for sharing! This is life changing for me since I cannot find a doctor who will even talk to me about Sibo. I have a question regarding dosage. Should one take the Biotics, Prokinetics, Iberogast, and Interfase at the same time? Meaning… all in one day. Or, are the Prokinetics for after the 6 week treatment?
Thank you again. I look forward to exploring more of your site.
Thank you so much for sharing! This is life changing for me since I cannot find a doctor who will even talk to me about Sibo. I have a question regarding dosage. Should one take the Biotics, Prokinetics, Iberogast, Motilpro and Interfase at the same time? Meaning… all in one day. Or, are the Prokinetics for after the 6 week treatment?
Thank you again. I look forward to exploring more of your site.
Hi Sharon!
The prokinetics are usually for after first treatment, though I think if you require a second round, the doctors I’ve spoken with recommend continuing the prokinetic you’ve started. I would just choose one or two and see if they help. You don’t want to overload your system with pills!
From my research and personal experience, it’s my understanding/belief that prokinetics are the most essential part of SIBO treatment, even moreso than the antimicrobials. Low gut motility is the root cause of SIBO in most cases – therefore, relapse is highly likely even after antimicrobials or antibiotics without restoring gut motility through stimulating the MMC with prokinetics. I went the natural route and am taking Haritaki and Artichoke Leaf for my MMC. I think that taking the prokinetics should not wait until after the 6 weeks of treatment, but that’s just my opinion. Check out this article which is an interview with a prominent gastroenterologist about this: https://medium.com/@stkirsch/insights-from-mark-pimentel-on-the-treatment-of-sibo-c091bb5aa00
Hi Nisa,
Prokinetics are more commonly discussed as a means of prevention, as they are in this article. “While you can get rid of SIBO with ONLY a good prokinetic, you may be able to get rid of SIBO faster by starting with a 2 week antibiotic regimen.” Pimentel’s practice usually starts with antimicrobials then uses a prokinetic after treatment, since that is the quickest way to recovery. My guess is that taking both at the same time would defeat the purpose: you don’t want antimicrobials to move through your SI too quickly if they are supposed to be there killing things. However, since some of the prokinetics take an adjustment period, Dr. Siebecker says she does not remove people from them if they require a second round of treatment (i.e. antimicrobials).
Thanks for sharing this Phoebe. I didn’t consider that a prokinetic could decrease the effectiveness of the antimicrobials. And I did re-read the article to see that Pimentel’s protocol is to begin the prokinetic at the end of the antimicrobials, as you say. Thanks for the clarification.
Hi Phoebe,
I think I have some sort of SIBO with quite important reactions to garlic and inulin.
You mention allicin does not contain any FODMAP (i.e. inulin, a prebiotic fiber). Yet, you then cite allicin as potential prebiotic. Are you sure about that? Which fiber would it contain if not inulin?
Also, funny you mentionned Triphala as a laxative… Throughout my “research”, it seems that a lot of laxatives are also prebiotic fibers..Made a quick check and seems to be the case for Triphala! I’ll add it to my collection of prebiotics.(also antibacterial btw..)
Hi Phoebe! I am glad to have stumbled upon your page. I am a little over halfway through a 14-day round of Rifaximin, and I haven’t felt all that much better yet. I also have been eating a mixture of low and fodmaps. I’m worried that this means the treatment isn’t working – could this be the case or is it normal to still feel bloated/crampy/etc during the killing phase? Thanks again. I have definitely become a bit neurotic over the past few months.
Try not to stress! It makes symptoms worse and healing harder 🙂 I didn’t do the rifaximin, so can’t speak to that, but I didn’t feel better until after my treatment. Any antimicrobial is hard on the body, and you could be experiencing symptoms of “die-off.” I need to write a post just about that!
Hi Phoebe,
I will start the Kill Phase this week with Metagenics Candibactin-AR + Candibactin-BR.
I also bought GutPro – Probiotics Capsules.
Should I wait with the Probiotics until the end of the Kill Phase ?
Thank you
Yoav
I would wait until after! Good luck!!
Hi Phoebe,
A few years ago I was diagnosed with M.E / Chronic Fatigue Syndrome. I believe I have had this condition for over 30 years in varying degrees but about 18 months ago I was heading towards the “crash stage”. I found a very good clinic which specialised in M.E / CFS who approached this from two angles, Physiological and Psychological.
Since then I have had various tests which have highlighted a number of issues including infections, bacteria, low adrenals, high mycotoxin levels and poor liver functionality, to name a few.
As a result I have been on a number of supplements over the last 18 months and although I was improving I recently reached a plateau and was not progressing any further. My nutritionist suggested taking a SIBO breath test (lactulose) which subsequently showed high levels of both Hydrogen and Methane.
I have recently started an antimicrobial protocol with A.D.P oregano (Biotics) and Allicin Max. I am taking one capsule of each at meal times whilst incorporating a low FODMAP diet. I am also taking a Digestzyme capsule before meals and 20 drops of Iberogast with each meal and 60 drops at bedtime. The only other supplement I am taking is a Liver GI capsule twice daily. I have to follow this protocol for 6 weeks, have 1-2 weeks off and then have a second round.
I am almost 3 weeks into this and am feeling awful at the moment with very low energy levels and my immune system at a low ebb. I would be interested to hear if you have heard of any other M.E / CFS sufferers who have been diagnosed with SIBO and any helpful thoughts or advice you may have?
P.S. Keep up the good work on your webpage as it is interesting and written in a way that makes it easy to understand the complex issues around this condition.
I had the same problem, fatigue, and I was diagnosed (using breath test) with SIBO (after 10 months of misery). There is a MD/professor in New York (forgot his name) who found the link between SIBO and Fatigue, and presented it in a conference, and I stumbled online on the abstract of his work. I took antibiotic Xifaxan for 10 days and felt noticeably improved. But I knew I needed to treat the root cause of SIBO in order to prevent SIBO from relapsing. Cause is not certain, so was not treated, so SIBO fatigue relapsed. I couldn’t afford Xifaxan again (i had used a manufacturer’s discount coupon the first time and bought medication for $10— but coupon not available anymore, and Xifaxan cost $600, no generic available, and insurance does not cover it if your doctor writes diagnosis as fatigue or SIBO, but will cover it your Doctor writes traveller’s diarrhea).. For me, the SIBO seems to cause leaky gut downstream, which compounds the fatigue. The link between the two is production of lecithin in small intestine (impaired by SIBO) within the mucus, which coats the gut, forming a component of the gut-blood barrier. I controlled leaky gut with lecithin enema (after bowel movement), or oral lecithin+Alli, and one time with Protectyn (pricey at sufficient dose). Certainly, the more upstream you treat the problem, the better. I think the cause of my SIBO is lack of MMC. I am going to confirm/exclude that by trying the Iberogast you described + ginger (or ProMotilin) and see..
Thanks for your reply Dr F.
Interesting to note that you knew you needed to treat the root cause of SIBO but I guess that is a difficult thing to do. Having read various articles I feel that my root cause was linked to taking PPI’s on maximum dosage for over 5 years.
In February this year I managed to get a prescription for Rifaximin following a consultation with a Gastroenterologist. Following this I took another SIBO breath test which showed a marked decrease in Hydrogen and Methane levels.
I am now following a new supplement protocol which includes adrenal and magnesium supplements and in the last week I feel that my energy levels are very slowly increasing.
Keeping my fingers crossed that this progress continues.
Good luck with your journey.
Hi phoebe,
I’ve been sick for 6 months, after many test they said I have Sibo, I’ve asked for the result numbers several times and still waiting for them, I was just told I tested positive. I was put on flagyl and I only made it 12 days , I was so sick I couldn’t take another pill. I suggest Xifaxan to the doctor after reading info online, it looked like the more high success rate, my doctor said ok but most insurance don’t cover them or need a pre- authorization , my insurance did cover them. Now I’m on Xifaxan, today is day 10, the meds aren’t making me sick like the other did, but I’m still sick, I’m sick after eating all the time, I’m trying to eat good for the most part, banana for breakfast, salad or chicken for lunch, rice and chicken for dinner or fish, not to much else, maybe a decaf tea sometimes. I’m so tired of being sick , I have discomfort on the left side of my stomach and intergestion or sick feeling in my Esophagus, I even have tension in my neck on the left side , could be stress related, I guess , I’ve had extremely anxiety since all this started, my doctor has put me on meds for it because I was falling apart. My doctor wants to follow up with me in 6 weeks, this was the first opening, so if this hasn’t worked, i guess I’ll know soon, I have to wait 6 weeks to see him ???? I’m sick hello !! I’m done waiting for anything, I’m considering getting a second opinion in Boston, I’m on the right track I guess but I’m still sick and confused what to do next. I’m going to work sick all the time, not pleasant. I have some good days but more bad, if the meds didn’t work, should I try the natural stuff after I’m done the Xifaxan? I’m getting desperate enough to try the liquid diet for 14 days, whatever it takes. Any suggestions would be appreciated, thank you for all the information you’re putting out here, I felt helpless to a point and your info has given me some hope, I’ve been read as much about sibo online as I can, and I’m wondering if I now know more about sibo than the GI MD.
Hi John. My name is Maria. I have sibo and the same chronic neck pain on my left side as you. I struggle each day. Please help me if you get any answers on how to get better.
Hi, I was wondering with the biotics that you took I know you said 2 pills twice a day. Did you mean 2 of each pill twice a day ( so 8 pills total a day( or one of each pill twice a day(so 4 pills total a day)?
correct 2 of each twice a day. 8 total.
Hello Phoebe,
What na amazing source on Sibo you have created here. Just what i was looking for. I was on ADP Biotics and Berberine as per functional doc recommendation but i do not think it did me any good.I feel even worse a year after treatment. I presume i had methane sibo as i was constipated all the time..Organic Acid Test just indicated bacterial overgrowth. I do not spend my money on private vists to functional medicine doctor anymore and started looking for another treatment option myself and found all you wonderfull Articles. One thing i wanted to ask was whether you considered coffee enemas during sibo treatment…or even afterwards?It was one good advise i managed to stick to as at the moment i do not have to use laxatives to help with regularity….many thanks for all your advice which i am going to useand my best wishes to you. Monika
I haven’t explored coffee enemas personally, but I do hear interesting things. Will definitely investigate in regards to SIBO. thanks!
Hello Phoebe,
I am suffering from constipation, bloating. There is no SIBO test in my country. Based on my research, I suspect that I have methane dominant SIBO.
I ordered Dysbiocide, I use it for 10 days but I dont see any change.
Did you experience hydrogen-vs-methane SIBO? Is Dysbiocide used for hydrogen or methane SIBO?
I am not looking for medical advice but I really need information. As I said, there is no test for SIBO in my country.
I took the dysbiocide for my hydrogen sibo, but I believe you can take it for either. You can also try the metagenics protocol which I believe was studied for both hydrogen and methane.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/
Hey Pheobe,
I am commenting because i like the way your site flows and is well written. I have been suffering for 10 years from everyday bloating and fatigue I have hasimotos. I have had breath tests at the docs office that most times have been positive. And sometimes spike pretty early. I stopped taking the tests and assume I still have SIBO.
Your explanations make sense to me. I really struggle with SIBO diet. But I don’t eat horrible. I get sugar cravings tho for gummi bears. I just stumbled across Flagyl last week as I was taking it for something else and while I was on it i had relief from everything including reflux. Started culturelle this week after the antibiotics to colonize my gut. Had bloating issues in the past starting probiotics and quit. I spent $$ on these and even with the discomfort that has not subsided I am going to keep taking them. I have no idea if SIBO is back or what or it is just the probiotics. Reflux is back too. Not sure what to do along with the probiotics. Thanks
sorry to hear you’re struggling Nicole. Hang in there xo
Hi, Phoebe! Thank you for the great info! I am currently treating SIBO with the Biotics protocol along with Allicin. It was hard to find information on the SIBO-C herbal treatment. I have just been taking 2 caps of Allicin twice a day with the Dysbiocide and FC Cidal (10 pills a day total). Do you happen to know if the Biotics and Allicin is sufficient for SIBO-C? Thank you for your time 🙂
Hi! I’m wondering if this protocol worked for you? And if you used the Biotics Lactozyme per recommended on the Biotics webpage. I presently am finishing with the Dysbiocide and FC-Cidal, which I found to work well! I am hoping to start the Rebuild Protocol but am not finding much research on it!!
Great site! Some comments and a question for others here.
I have had IBS-Constipation for over 20 years, and I was just diagnosed with methane-dominant SIBO through the breath test. High levels of methane slow motility, so the SIBO seems to be a contributor to the constipation. Today I’m beginning the Rifaxamin + Neomycin one-two punch combo that has been show most effective for methane SIBO. Please send good vibes!!!
There is no clear post-kill path, however. It’s clear I’ll need some kind of pro-kinetic/pro-motility agent – the doctor is encouraging me to take Linzess for the constipation, but I’m very concerned about all of the side effects and explosive diarrhea people experience on it. HAS ANYONE WITH IBS-C AND/OR SIBO-METHANE USED LINZESS? I’ll also need to change my diet to move away from most of the healthy things I love to eat, at least for some time, and the diet advice out there is also very confusing, especially regarding fiber and pro-biotics. It seems that the drug, supplement, and diet treatments for SIBO only partially overlap and in fact diverge quite a bit for methane/constipation and hydrogen/diarrhea dominant forms, making things even more confusing.
I’m working with a functional MD in addition to a traditional GI specialist – I think the functional MD will be most helpful for the post-kill phase. I’ll share what I learn!
I tried Linzess and it took a few adjustments to the dosage to get it right. I did experience diarrhea and had to lower the dose quite a bit. Sending you good vibes, it’s a tricky thing to heal.
Hey!
I was tested for sibo (breathe glucose test) and it came back unditerminable?! My base levels were high ( I got a last minute appt and had pizza the day before so this could have something to with it) but by the end of the test everything was negative and my levels only rose slighting after drinking the glucose. I have all the symptoms and I’m curious if trying the antibiotics are a good idea and will help. I’ve had some fodmaps in my diet but not many( mainly asparagus and garlic powder) and I’m still bloated after meals. Thanks!!!!
My son has been diagnosed with IBS with abdominal migraines and he has been put on amitrypitline and colestid. He has had endoscopy, colonoscopy and MRI to rule out crohns and ulcerative colitis. The endoscopy showed multiple small ulcers of his stomach and superior small intestine but nothing showed on the colonoscopy or MRI. I asked for a test to rule out SIBO because he was on amoxicillin for quite some time for acne treatment and I believe his flora is out of balance but the MD did not want to go that route. He did test him for H.pylori via stool sample and this also came back negative. A friend pointed me to the low FODMAP diet because our GI specialist didnt even suggest dietary changes. Although we have been On the low FODMAP diet for 3 weeks, there has been no change in his pain, or bowel habits. He has diarrhea at least 8 times per day with constant ache and the feeling of incomplete evacuation. I am at such a loss right now. It feels like nothing we do is helping. Despite having chronic diarrhea, he seems to be blowing up. In the last year he has gone from being underweight to obese. He has chronic fatigue and is now depressed because he has missed his entire senior year of high school. He has gone from a funny active teen to basically home bound. I dont know if I am asking for advice or a listening ear. I am just at a loss and have no idea what to do for my child. I’m an RN and feel like the medical community has failed us. Without the Dr doing a test for SIBO (which in all honesty might be the only thing he hasn’t been tested for) I feel like we are just stuck living this life of chronic pain and hopelessness.
Sorry to hear of your frustration. Definitely find a doctor who will test and take your concerns seriously. You can pay out of pocket for the test on your own, but it takes someone with knowledge to interpret. Try Dr. Will Cole – I love him.
Hello,
Did you take Motilpro how many hours later after meal?
please let me know
I didn’t take this one, sorry! there should be dose info online somewhere if you google.
Emine, I taking Motilpro and it is recommended to take before bed. 🙂
I have sibo-d, hydrogen. My issue is 2-3 urgent diarrhea stools every morning for the past 7-10 years. It’s hard for me to even remember, anymore…. I had a small bowel follow through and my system is not slow. Are prokinetics still recommended for those with diarreah/loose stools? Also, what are the herbal protocol differences for those with hydrogen vs methane?
yes prokinetics post treatment are really dealing with the small intestine and D is usually something going on with the large. i.e. you can still have a SI motility issue and have D. Methane you will need to add Allicin for herbal or a second antibiotic.
Hi Which SIBO did you had, SIBO C or SIBO D?
mixed
Hi,
Thanks for all the great information? Did you take both Fc cidal and dysbiocide two times a day every day for 6 weeks? I have tried so many different protocols and I am desperate to get rid of SIBO at this point 🙁
correct.
Hi, were you methane or hydrogen SIBO? After your 4 week kill phase were you still bloated? I tested positive for methane SIBO. Did 3 rounds of kill phase (first herbal with Allicin and Berberine, then Xifaxan with Metronidazole, and then another round of Allicin and Berberine). (Never tried oregano) Retested after first protocol and results of SIBO were minimal. But did the other 2 rounds because bloating was constant and never went away. Still bloated all the time, never goes away. 🙁 What reduced your bloating? The kill phase of herbals or the diet after? I follow the FODMAP diet but eat a lot of high fiber foods (Bananas; spinach;carrots etc). Wondering if high fiber diet is feeding the bacteria?
I have 24/7 bloating and stomach distention too. I was diagnosed with SIBO and did so many different treatments but I cant get rid of the bloating…..its so uncomfortable and embarrassing. Have you had any luck with anything?
Thank you so much for all this info. I have a quick question. My SIBO started with a food poisoning. Dr is definitely recommending antibiotics. What made your pick natural over the other?
I was tested for sibo this last Monday and it returned positive for both gases. The doctor prescribed me both antibiotics Xifaxan and Neo for a 28-day cycle. I don’t want to take pharma’s and would prefer the natural way but didn’t know which ones to take for both gases. Any help on this would be great. Thank you so much for this site.
Just add Allicin for methane. It’s always something plus an additional when you’re dealing with methane.
My 8 year old daughter tested positive for SIBO. She had stomach pain, constipation and or diarrhea for almost three months after 25 days on antibiotics after an ear infection. So scare about putting her on antibiotics again. She has been symptom free for over one month. With my own research she has been: no dairy, minimum red meat, no onion, no garlic, gluten free pasta and gluten free bread. No broccoli, no coliflower. I guess very close to the low food map diet and she feels great. Are antibiotics absolutely necessary? Also I gave her probiotics a few times in the last two weeks Can that affect the result?
Hello! A nutritionalist recently put me on Berberine & Oregano for SIBO and I’m getting a lot of side effects. Bloating, intense pain, and having to go to the bathroom a lot. Is there anything I can do about this? I have places to be and it’s very hard to go anywhere with my stomach acting like this, but I want to continue since I can potentially get better.
Hello! My Naturopath Dr. put me on Berberine & Oil of Oregano for my SIBO as well! It’s only been about 5 days, but my stomach is H U G E (as in 9 months pregnant bloated)! I also started to have more frequent bowel movements (vs. 1 to zero times a day) and periods of nausea. I’m ok with the side affects because I’m assuming the supplements are working and getting the bad bacteria out. I’m going to keep taking the supplements until my Dr. tells me to stop. I’ve had chronic gut issues for over a decade so I’m willing to accept the side affects for as long as it takes if it means it’s going to make me better in the long run. Hang in there, WE ARE ON THE ROAD TO RECOVERY!!!
Hi there! I am starting the herbal route for killing SIBO-C… the Dysbiocide and FC- Cidal… it is recommended between meal. I usually fast breakfast. Would you think taking it between coffee and my first meal is ok? Then again mid afternoon? I don’t want to take it too late. Some of the reviews mentioned insomnia as a side effect.
Thanks!
Hi Phoebe,
Did you take the Biotics pills with food or on an empty stomach?
Thanks,
Nick
it doesn’t matter!
Hi Phoebe! I’m trying the Biotics protocol for Methane-dominant SIBO and IBS-C. I just added Oregano oil to my protocol, but I was thinking it might be good to add in Allicin and/or Berberine. Is that too much? I don’t see any contraindications and the Metagencis protocol has a Berberine complex included in theirs, so it seems like it would be okay. I also and considering the possibility that I have some sort of parasitic infection thrown in the mix (TBD- waiting for a doc appointment) and both garlic and Berberine are known to help with parasites. Black Walnut Hull is also known as a anti-parasitic herb, so I could try that instead of the Berberine or Allicin. So much to consider, so I would love your thoughts!
Hi Phoebe,
Do you know the dosage for Amy Myers Microb-Clear formula? It says 1 a day on the container but that wouldnt seem enough for treating SIBO?
ask her. i have no experience with this product.
she recommends 2 a day (one with each meal)
Hi, I love your podcasts!! I live in Manhattan and would like to find a visceral manipulation person after listening to your episode 7. Can you recommend one for me??
So glad you liked it! I see Delia at Manual Therapy NYC. She is wonderful.
When using the herbal antibiotics Metagenics or Biotics which one is best for methane gas vs hydrogen gas? How about if you have both gases? Is it best not to be on the FODMAP diet when doing the herbal antibiotics? Or not so that the bacteria are in full force instead of hiding? Then after doing herbal antibiotics go on FODMAP diet and do other things listed, as needed? Thank you much.
I have hydrogen dominant SIBO which initially presented as SIBO-C. Now I’m more prone to diarrhea after unsuccessfully trying two rounds of antimicrobials recommended by two different practitioners. It’s been a year since my diagnosis and I’m at a point where I want to give up. I’ve lost so much weight, I’ve developed histamine intolerance and I don’t have much left to eat that’s I don’t react to. I’m so depressed. I don’t know how to proceed. Which supplement protocol would you recommend?
Thanks.
Ask your doctor for a prescription called Hyoscyamine 0.375. It really helps with stomach pain and diarrhea. First time in two years i’ve been able to eat without pain! Side effects is dizziness. I find if I cut a pill in 1/4 and eat before a meal I have less dizziness and still get stomach relief. Not sure if it’s a cure, but sure is a relief.
Good luck!
Hi Phoebe! Love your blog, it was very helpful! Im trying the natural supplement path and I’m wondering how many capsules of each (Berberine complex, oil of oregano, allicin and neem) I should be taking a day.
Thank you! I hope this path works!
Did you ever find out how many neem capsules to take?
I am currently on a regimen of Allimax Pro, Neem Plus & Berberine – one allimax pro 3x/day, 3 neem plus capsules 2x/day & 3 berberine caps 2x/day. Lactoprime plus probiotics 2 caps 1/xday (lunch time – only with the allimax pro)!
Thanks for sharing your protocol. How long were you on those dosages and what were your results?
Hello, thank you for taking the time to share this information. I am currently on Day 3 of Xifaxan and curious which natural remedy(s) would be best to pair it with to assist with the extreme bloating. I have discontinued my use of pre and probiotics.
Hey Phoebe!
Is there anything that I can take with Candibactin-AR + Candibactin-BR besides Allicin? I take aspirin daily, so I don’t think I can use it. My gastroenterologist won’t prescribe Neomycin either. He said it can cause hearing loss.
Hi there,
I am taking a combination of the antimicrobials right now for sibo. One of them is neem plus. The dosage on the bottle says take one capsule per day or as directed by health care professional. Is it best to take one capsule per day or a higher amount?
Thanks!
You should ask your doc, but I take 3 capsules a day with food
Have you tried the Amy Myers MD Microb Clear? It is less expensive, but I don’t know if it’s worth trying.
https://store.amymyersmd.com/collections/sibo-support/products/microb-clear
Hello Phoebe,
Thank you for very sharing with us your research and guiding through each step – I found it very helpful. During kill phase/antibiotic protocol, do you recommend not to follow the diet so the bacteria will stop hiding and medication can attack them all to kill it? Or should I follow the diet during this phase as well?
Thank you kindly in advance!
Natasha.
Hi,
I have hydrogen based Sibo. Treated with antibiotics but still think I have it. Would you recommend biotics or metagenix for hydrogen based? Do both have Berberine? Can you take berberine separately if necessary?
Thanks.
I have the same SIBO, my main symptom is extreme bloating/distention
Did you have any luck with treatment?
Hi phoebe, thanks for much for this article. It was helpful for me to hear that you were still having symptoms after your protocol but tested negative. I have been taking antimicrobials for over 6 weeks now but still have intense stomach bloating any time I stray at all from a strict low FODMAP diet. I’m curious how long you were having symptoms after the protocol until they subsided?
Hi Phoebe.
I’m currently on Candibactin AR/BR and have been for a while through my ND. We had to work our way up slowly since I’m so sensitive. As I got up to full dose I notice I feel sick and my SIBO symptoms seem exacerbated. Is that normal even though I should be done with treatment soon?
Hello, thank you for taking the time to share this information. I am currently on Day 3 of Xifaxan and curious which natural remedy(s) would be best to pair it with to assist with the extreme bloating. I have discontinued my use of pre and probiotics.
What to do for gas buildup in the colon? Severe right sided gas. I’ve tried iberogast but just gives me severe right sided lower abdominal pain (the area of gas build up
listen to episode 6 of the podcast on probiotics.
Hello,
I see that the recommended dosage for the Biotics FC-Cidal is “1 capsule 2 times each day” for a total of 1,000 mg per day. I see that you recommend twice that amount. Am I interpreting this correctly or has something else changed? I did also notice that my bottle has 120 capsules, while the one in your photo only shows 100.
Thanks in advance.
There are no recommendations here. Simply sharing what I did under the care of my doctor. As is stated in the disclaimer, please work with a health professional on creating the right treatment plan for you.
Hi there,
I did a GI map test and found out I have overgrowth of opportunistic bacteria. I was suggested to go on Biocidin but don’t know if it’s strong enough because I was also told it’s mild. In your healing journey did you ever try that product? Or just the Dysbiocide
Is it possible to have SIBO without constipation or diarrhea? I poop every morning at the same time, But for he last 6 months I have had severe bloating. I’ve been on Zpack twice, did nothing. I went on a full keto diet, did nothing, I get bloated every just drinking water.
I went to a gastroenterologist, had my colon examined and an endoscopy, he said I look very healthy. I workout 4 days a week , but feel like posture has something to do with it. When I used to stand more for work, as opposed to sitting all day, I used to never get this.
I took Dysbiocide and FC CIdal for months… they seem to help with gas a bit for about an hour after taking them, but over all nothing. Why do people even get SIBO out of the blue. I am 55 years old and have always had great health.
I think you’d benefit from reading the feedmephoebe blog about how she treated, and cured, her dysbiosis. If that’s what you have, it’s quite likely there’s an underlying cause like low stomach acid (which might explain why water bloats you) and poor motility in the small intestines. Neither of these things would show up on a endoscopy or colonoscopy.
Please, please help me, I don’t understand what happened. I took Biotics Research supplements and now my IBS-D is so much worse. I can’t even take my medicine for Lupus. I went to see a gastroenterologist and he didn’t listen to me and made me feel like I was crazy. Please help me. I’ve also tried the regular stuff like oregano oil that used to work before but this time it did nothing. I’m not sure what to do anymore, I’m pretty much house bound. I don’t want to keep on living like this. I’m so devastated and desperate, that I rather have my usual IBS-D back. Please, please someone help me :'(
Hi Phoebe – thank you so much for posting such thorough information here. It has been so so helpful.
I have been diagnosed with SIBO-d after dealing with a parasite contracted while travelling. My UCSF GI specialist prescribed Rifaximin, but I went with the FC-Cidal/Dysbiocide combo for a more natural/affordable treatment. Just wondering when you started to see your symptoms clear. I am on week 2 and my diarrhea is still getting worse. Thank you!!
Danielle, Did your symptoms ever get better?
Hi, I’m about to start the biotics herbs fc Cidal & dysbiocide. I have also brought biotics A.D.P oregano. Do I take all these at the same time ? Also will it get rid of sibo if don’t use a biofilm disruptor ?
Is it normal for Candibactin to cause upper bloating? I’ve been on it for a while through my ND.
“Hi,
I have a nephew who was diagnosed with SIBO (Small Intestine Bacterial Overgrowth) I don’t know how my sister treated her son, but still, I will recommend your post to my sister perhaps this may help to reduce the SIBO issue on my nephew. I found this post earlier it seems interesting to read too, the other alternative remedy that mentioned on the topic perhaps this may help the other readers to learn as well https://nucific.com/antifungal-herbs/ thank you for sharing your post, hope to read more from your piece soon”
Hi, what made you choose the Biotics over the Metagenics?
thanks, Heidi
My doctor prescribed it
Dysbiocide is currently out of stock. Is there an alternative that you can recommend..
This podcast and your website is so incredibly helpful!!!! THANK YOU! However, I am about to start my 2nd round of treatment for SIBO (first time did herbals, and hoping to be able to get antibiotic this time), and I’m still so confused on what to eat during treatment. So what was your diet like during your SIBO treatment? Did you follow low fodmap or did you just eat whatever?
I detail my diet approach in the third post in this series. I did low FODMAP but fairly loose towards the second half of treatment
Hello! So happy to find your blog- it’s the most informative I’ve seen and I’ve read a lot!
My problem is that is I’m in NZ and it looks like the herbal alternatives to the antibiotics are not available here. I can get the antibiotics but it costs about $1000. Is there anyone from NZ who has managed to get the herbal treatment or a close alternative? My doctor is only familiar with the antibiotics.
Thanks in advance!
Im curious about why you choose biopics over magnetics? Thank you. Very informative Phoebe.
sorry Metagenics vs.
Biotics.
HiPhoebe,
Thank you so so much for all these detailed information!
I’ve been struggeling with constant lower-belly bloat for some time now and just started a herbal SIBO treatment with berberin, allicin and oregano oil.
Unfortunately i cannot find any ressouces that tell me how much to take of each supplement,.. do you have any details in milligram?
When did your symptoms clear? How long after starting the treatment?
Again thank you so much for sharing, its soooo appreciated!!
I have SIBO bloat 24/7
I was wondering if you had any success with your treatment?
I suspect I may have SIBO and/or leaky gut- I am constantly bloated, am a bit constipated with pebble like stools, don’t feel satiated no matter how much I eat and have fungal acne. If I do in fact have SIBO and leaky gut, is it better to heal one before the other?
Hi Phoebe – Thanks for these great posts! Can you share more information about the bacteria going into hibernation? I can’t tell if that’s the step before die-off, or if that’s some other weird thing that can happen with them. Thanks!
Thank you so much for all your insight. My biggest struggle has been the nausea. Did you experience this? Any suggestions?
Hello,
2 years ago I was generally healthy, had a bit bloating from time to time but usually fine. I was then diagnosed with a hiatal hernia and prescribed nexium. As soon as I started taking the nexium life got bad/my digestive system was ruined. I got off the drug and symptoms improved in some areas but mostly not overall.
Recently I took a stool test and was told I had sibo. The test also showed I had low stomach acid (from the drug) and also lacked 2 key bacteria’s: Bifidobacterium and lactobacilli. Now that I finally know the answer to my problem I started taking antimicrobials and following a low fodmap diet in which I felt worse (always bloated from day to night).
I am interested in taking rifixamin to see if this would help “restart” my gut issues i.e kill the bacteria, then after 1 course of the antiobiotics,, take probiotics and digestive enzymes for digestion and gut flora and apple cider vinegar to increase the stomach acid.
My questions:
A) considering my only gut issues are not severe, just bloating after high fiber foods and slight reflux is rifaxamin a good idea? As it seems like it has a high success rate in scientific trials and as my sibo case is not severe (no diarrhea no constipation, just problem digesting food and taking into nutrients), would one course of Rifaximin help? I am time constricted as my wedding is in 2 months and I want to be able to enjoy myself.
B) would the antiobiotics make things worse, if so how. Would it kill of all bacteria.
C) because it was a stool test and not breath test how can I know what type of sibo I have.
Thank you kindly
Hi Phoebe,
I have referred to your post on multiple occasions and have been trying your recommended Biotics protocol. In combination with eating low FODMAPs, my stomach has been feeling MUCH better after 6 weeks, I have ordered the Lactoenzyme that is recommended in the Rebuild Protocol on the Biotics website. I am wondering if this is what you did following the Kill Phase, and if so, how you often/ long you followed such! Thank you!
I’m so glad to hear it! I didn’t try that, sorry. But report back 🙂
Little bit of false information here, though not a big deal.
Bacteria do not build up tolerance to Rifaximin, in general, and the very few that do lose it very quickly (within weeks.) So, you can return to using Rifaximin again in the near future. A good couple of studies on this.
Biolfilm disruptors are not intended to break down the cell walls of bacteria, they are intended to break down the film that colonies of bacteria produce in sections of the intestines in order to “hide” within.
Overall the material is sound in concept but I think it’s important to be accurate about specifics because people, for example, would shy away from Rifaximin usage as an extended option, even though it’s completely viable, based on the information you provided.
Hello,
My dietitian told me that I have SIBO, based only on my simptoms.
He prescribed me a meal plan and natural antibiotics for 2 weeks.
The meal plan excludes all vegetables, fruits and legumes. I can only eat fish/meat/eggs with white rice.
My question is: Is it safe to follow this plan even without confirmed SIBO? Also, i find it very strange to not eat any fruit or vegetables, not even low FODMAP.
I really want to feel better, but I’m very concerned about the lack of vitamins and if it’s not SIBO. Are there any problems if I go with the plan?
Thank You!
This is not only inaccurate, it’s dangerous. A conventional gastrointestinal doctor can order you a very simple and straightforward breath test to confirm for SIBO. Then you can partner with an INFORMED and EDUCATED nutritionist or naturopathic practitioner to treat it. The treatment protocol is not a change in diet. What he told you to do will simply sends the bacteria into hibernation, and it also will make you feel terrible with a lack of proper nutrition. Please find a new nutritionist or functional medicine specialist right away.
agree 100 percent.
Thank you for your help. I felt like I needed to ask for someone opinion. 🙂
Thank you for Phoebe for this website. It’s really helpful!
I’m definitely going to find another doctor!
Hi Phoebe, I am currently taking FC Cidal and Neem Plus, 3 pills each, 2 x/day for 3 weeks to treat my SIBO. Based on my test results, I was hydrogen dominant. I’m about a week into treatment, and while I may be a little better, I still have some abdominal discomfort and the same level of gas. Do you suggest continuing with treatment longer to see if it works? I am really trying to avoid antibiotics if at all possible – I have taken way too many in the past for chronic ear/sinus infections. Also, do you know the difference between Neem Plus and Dysbyocide? I’m curious why my naturopath may not have put me on Dysbiocide, the one you took.
Thanks!!
You may also need to supplement with digestive enzymes to pick up the slack since your guts may have been invaded (and thus downregulated their enzyme production [this is what invading fungus and bacteria do to make your gut more pleasing to live in for themselves]) and impaired. Are you taking digestive enzymes before (15 min) and after (45min-1hr later) meals? You want to make sure you are taking a complete digestive enzyme, like the one from Klaire Labs.
I am not. I have a bottle of Biotics Hydro-Zyme from my previous holistic doctor in DC, but never used them regularly. My new doctor in Seattle suggested lime/lemon water prior to all meals to naturally stimulate digestive enzymes before I eat. Of course, I haven’t been doing that religiously either as I’m currently following Dr. Thomas Rau’s Swiss Detox Diet. I probably need to incorporate one or the other now.
I cant find where to purchase the klaire labs digestive enzymes? do i have to have dr order it? the website doesnt have a purchase tab?
Hi
I have been a SIBO sufferer for almost a decade. The main symptoms I suffer from is extreme bloating/distension. I dont eat meat so the paleo diet is not in the cards for me. I was trying to read through all this but got a bit overwhelmed and confused where to start? I would absolutely love and appreciate any help or advice. PLease feel free to email me. Thank you
Just wanted to thank you for the informative article. It is a great summary and really helped me understand the treatment options.
I tested positive for SIBO in November and although a fourteen-day course of rifaximin did help me, my symptoms returned about a month later. I am finishing up an 8-week course of the FC-Cidal and Dysbiocide but also added Atrantil since my test indicated methane dominant SIBO. My symptoms are pretty much gone at this point but for me, it took a good four weeks to see a difference.
Did you need to get the FC-cidal and Dysbiocide from a doctor?
No, I ordered them off of amazon.
would you mind telling me what your symptoms were and how the treatment helped? i feel like ive tried almost everything and im at my wits end. my main symptoms have always been extreme bloating/stomach distention.
Hi
I have been a SIBO sufferer for almost a decade. The main symptoms I suffer from is extreme bloating/distension. Its always there. I dont eat meat so the paleo diet is not in the cards for me. I was trying to read through all this but got a bit overwhelmed and confused where to start? I would absolutely love and appreciate any help or advice. would the Iberogast treatment help? Maybe paired with something else? If anyone has suggestions please feel free to reply/email me. Thank you!
I got your book and am loving reading it! Thank you for writing it. I love your practicality!
I came across someone who used essential oils to help heal her SIBO and contacted her. I have been working with Nancy Knudson, a functional nutritionist (newdaywholehealth.com) using food and essential oils to help heal my gut. Her Eater’s Digest and Warrior Strong oil blends are helping me. Hope that can be of help to someone out there.
PS On the subject of constipation mentioned I used to use all kinds of magnesium supplements and depended on them or did not have a bowel movement. Since using the essential oils and drinking a mixture of ground flax seed & chai seeds soaked overnight(I keep a small jar always soaking in the refrigerator as easier on the digestive system to soak all seeds, nuts, grains before consuming) Can add psyllium husk if you can tolerate also. Now I am able to take magnesium as a treat to have a deeper sleep and to supplement with when I feel needed, but do not have to depend on it to move my bowels)
Hi Phoebe,
I love your website and how you beat sibo and are helping others with it. It’s incredible. I have actually been having sibo symptoms and it sucks, sometimes, I wonder if I will ever get back to being normal. I actually don’t mind being on a diet for long term, and maintaining my health in multiple ways that you have mentioned, but I was wondering, once you completely healed and got better, were you able to have ice cream sometimes, here and there, or a bag of chips, or sometimes could you have Starbucks? Or even after being healed, people can’t really go back and enjoy those treats? I’m so confused and lost.
Has anyone heard of the product: Gut Connection Digestive Balance? its from the brand Country LIfe. I was wondering if it helps with the SIBO bloat?
Hi Phoebe,
Great podcast. It wasn’t clear at the end whether he recommended taking anti microbials and probotics during the elemental diet. I assume if you were to take probiotics it would be sacromyces boulardi and soil based ones, as the lacto/bifido could potentially recolonise the gut.
About to do a 2 week element and then a 2 week FMT. Praying August will be my comeback month 🙂
Hi phoebe,
i hav acid reflux and symptoms (foul smell leaks thought the day )of SIBO ( not tested) and following LOWFODMAP diet for 4 weeks , helps me a lot. but how to get cure use of ANTIBOITICS or Herbs like NEEM alone ?
please any one reply ?
Hi
I have been a SIBO sufferer for almost a decade. The main symptoms I suffer from is extreme bloating/distension. Its always there. It is affecting my mental health now too.I dont eat meat so the paleo diet is not in the cards for me. I was trying to read through all this but got a bit overwhelmed and confused where to start? I would absolutely love and appreciate any help or advice. would the Iberogast treatment help? Maybe paired with something else? If anyone has suggestions please feel free to reply/email me. Thank you!
Bacteria Hibernation and Elemental Diet / Herbal
I’ve tried a few things and was wondering if you could provide more clarity on the bacteria going into hibernation. We are evaluating an elemental diet if the herbals do not work this round against SIBO. My doctor has me on the Biocidin protocol which I did for 4 weeks last year and brought some relief but not enough. My diet is more keto oriented with fat being the fuel source and that helps minimize flare-ups. However, even keto is limited on fruits/veggies. So my question is how do you avoid hibernation what are the minimum requirements to keep bacteria from hibernating so the Biocidin/Metagenic herbal products can kill the bacteria? Thank you,
Hi Phoebe,
What a great comprehensive article! I really learned a lot from it. I was wondering if you could be so kind and share a bit more as to what diet you did while going through the kill phase? Was it a low fodmap diet? Gaps? Keto? Thanks in advance!
Hi! You say you took FC Cidal and Dysbiocide for methane, and I was just wondering how high your numbers were if you don’t mind me asking. Thank you!
I didn’t have methane, sorry.
Hi Phoebe, are you gluten free and dairy free now? Or can you eat those foods?
i haven’t eaten gluten in 10 years because of my hashimotos.
Wow, thank you so much for all of this great info!
I think I am going to go for the elemental diet and see what happens! I’ve fasted before, so I think I can do this! 🙂
Thank you for sharing your experience. This has been so very helpful!
Dacia
How did it go? Did you do elemental and get rid of your SIBO?
Thank you for your help. I felt like I needed to ask for someone opinion.
Thank you for your help.
That’s amazing information. I have to save it in my wall. Thanks for sharing!!
Love your site Phoebe! It was very informative and helpful to me! Hope everything will better to out path!
Low stomach acid is important to cover as well. Good info.
it’s the subject of last week’s episode!
That was very helpful, as I had seen bits and pieces, but not a comprehensive guide. Where do I loo9k for your updates from the conference in Australia last fall, please? Thank you.
Unfortunately, I cannot get the Dysbiocide. It is not offered on Amazon and if I try to get through the company’s website, they don’t allow you access unless you register with a provider’s information. How disappointing. I’m not sure if the FC-cidal will be helpful on it’s own and I don’t want to waste >$50 if it doesn’t.
Any thoughts?
Thank you for this article! And all of your work around SIBO. I’ve spent roughly $60k over 4 years, lost work, and was convinced it was all in my head by my former doctors, who incorrectly diagnosed me 5 times, with everything from MS to needing to have my colon removed.
From LGS to now SIBO, the breath test finally put SIBO on my radar. Your post confirms all of the research I’ve done thus far : )
Sadly, I tried the ED before the supplement path, and found I was intolerant to the sugars. Currently waiting on delivery of several supplements you mention, plus some more. Plan to rotate protocols for as long as supplements last, while maintaining oregano and peppermint (enteric coated) throughout, and maintaining a colostrum daily dose (the only thing thus far that has seemed to help in any meaningful way).
Doctors where I’m from won’t even look at the medical literature I bring them, or the fact that several prestigious medical associations, doctors, and universities acknowledge and treat SIBO.
I wish you the best of luck bringing SIBO awareness to the world: so many people suffer needlessly with poor medical professionals, forever on anti-depressants and other pills.
Hello
Do chlorophyll and quercetin make Sibo worse? I cannot take glutamine.I am looking for gut healing supplements that do not make Sibo worse. Thanks.
Haven’t made it worse for me. Best supplement I’ve found and noticed working (and take all the time) is sovereign labs colostrum.
Hi,
I am about to finish Cidal+Dysbiocide but see no change at all. I purposely haven’t started FODMAP during the treatment as most of the places I have learned it’s better to start after. I still have all the symptoms – GERD, bulging, burping, etc.. I am about to start FODMAp but I guess by now I should see some kind of improvement from the antibiotics? I am a bit lost about how to proceed. Any suggestion more than welcome on how to get rid of this. Thanks
Hi,
I’m about to start taking allimed, bitoics oregano oil, & neem. Could somebody please tell me if they should be taken together and wether it’s best to take them with or without food?
Thank you,
John.
Hello Phoebe,
Do you have any experience with chlorophyll? What is its effect on SIBO?
I have struggled with SIBO for years. Initially was misdiagnosed as acid reflux. The tried several antibiotics such as rifaxamin and herbal ones. Nothing worked. Consumption of sugar was the main culprit. Then my ND suggested I may have a SIFO. He prescribed a anti-fungal and that made a HUGE difference. My symptoms are 80% reduced. They come back only with heavy consumption of sugar.
Thanks for this great article, and all you share! I’ve been on this Biotics protocol for 5 days now. I had quit taking Prilosec awhile before that. But the heartburn is so bad the peppermint ginger capsules aren’t helping. Would it undo the work of these herbs if I took the Prilosec at the same time?
Thanks again!
So informative and helpful to me. I did learn much from your post and comments. Thank you much for taking time sharing this.
you’re so welcome. the book is even more useful!
Thank you much, I found what I am seeking this time. Love your sharing much. Keep doing it!
Hi there,
Did you take the biotics along with interphase plus? If so, are they taken together?
Hi Phoebe,
Thank you so much for this very thorough set of articles!
My SIBO developed 5-6 years ago when I was on an 80% raw, mostly fruitarian diet (I could do it because I’m very much a sugar person) and didn’t subside with the return to a normal diet. Do you know if this can point to the type of SIBO? My test result didn’t specify the type.
I’m also towards constipation but my weight is normal and almost unchanging, although I eat a lot and very frequently (emotionally and cravings).
Nothing has helped one bit: low fodmap, refaximin, elimination of foods I’m intolerant to according to the blood test, peppermint oil…
Hi Phoebe,
I have already started taking some of the natural anti-microbials for SIBO for about a week, but didn’t actually take the SIBO breath test. I suspect that I have SIBO based on all of the symptoms that I’ve had for years. Do you suggest I stop taking the supplements and get the test done right away? I’m concerned that giving the bad bacteria a “break” may make things worse and/or make them stronger? Appreciate any feedback. Thanks!
Phoebe,
I’m sorry if you may have already answered this. Did you take the antimichrobials with meals along with digestive enzymes? Or did you take them away from each other? Taken together, do digestive enzymes affect the efficacy of antimichrobials?
Hi Phoebe, great post and very informative. I now have hope of a couple of treatments to try and cure my hydrogen sibo. I was recently diagnosed but my doctor is just an internal medicine doctor. I have seen two gastroenterologist and they are not fluent in treating sibo. So it’s super frustrating. But I am going to try the metagenics protocol first. Question should I take atrantil during treatment and do I also take a digestive enzyme as well during treatment? I noticed these two protocols (biotics and metagenics) and activated charcoal all have the California 65 warning formally known as to cause reproductive harm and certain cancers. Are you aware of this? Do you know if it is true?
Hi Phoebe – I have your book and am using it to help me through my SIBO and Candida treatment. I have a couple of questions that I can’t seem to get clear answers to anywhere. First, I should say my SIBO numbers are not terrible. Something like 41 for hydrogen and 17-19 for methane. I also have low grade esophageal Candida.
1) Should I be doing a restrictive low-FODMAP/Candida diet during the antimicrobial phase? I’ve heard yes and no.
2) What about probiotic containing foods like yogurt and kefir during the antimicrobial phase?
Thanks!
There is no one answer! Practitioners all have different approaches. That chapter of the book should help you decide for yourself. It’s really a matter of your own comfort if you want to reduce symptoms.
Hello!! My question has to do with the fact that I’ve been tested and diagnosed with slow motility (gastroparesis), which contributed to my Hydrogen Sibo and I currently take Motility Activator and it’s great. I sitll have SIBO and I’m going to go with the Biotics Protocol your article suggests to rid myself of this issue. I’m so glad you had success! that gives me so much hope.
But in this post (copied and pasted below), you mention stopping the motility supplements while on the Biotics Protocol and starting them up after one is done with the protocol. However at the end of the post you mentijon Dr. Siebeckers not removing people from the motility supps if they require a 2nd round of treatment. Well I have had two rounds of rifaximin and the sibo came back… so I guess I would fall in that category of not stopping the prokinetic while on Biotics Protocol? I would sincerely appreciate your feedback and thoughts on this! thank you kindly!
“Prokinetics are more commonly discussed as a means of prevention, as they are in this article. “While you can get rid of SIBO with ONLY a good prokinetic, you may be able to get rid of SIBO faster by starting with a 2 week antibiotic regimen.” Pimentel’s practice usually starts with antimicrobials then uses a prokinetic after treatment, since that is the quickest way to recovery. My guess is that taking both at the same time would defeat the purpose: you don’t want antimicrobials to move through your SI too quickly if they are supposed to be there killing things. However, since some of the prokinetics take an adjustment period, Dr. Siebecker says she does not remove people from them if they require a second round of treatment (i.e. antimicrobials).”
During the kill phase do you recommend cutting out fodmaps? I’ve read conflicting articles .. some say you should to weaken them. But others say you shouldn’t, and eat as normal during to prevent the bacteria from hibernating. I have my pills but don’t want to start taking until I know 🙁
There is no one right answer, but my book in Chapter 2 goes into the full explanation for the pro’s and cons.
Have you read about the partial elemental diet b ing as effective as the original? Not sure if you’ve come across anyone who’s done this with success but it seems like a good option to supplement with if you don’t want to give up all food.
Hi Phoebe!
First off, thank you so much for everything! I have your book and it’s been instrumental in getting me through my first SIBO relapse. I have a question that nobody seems to answer and I’ve received two conflicting answers between my ND and my regular physician: what’s the scoop on vitamins while on antimicrobials? My ND says it’s a waste of money to take them while treating and to wait for the gut healing phase, and my doc says definitely take them during treatment to avoid even further deficiencies. Any insights? I’m currently starting on FD Cidal and Dysbiocide with a biofilm disruptor for my hydrogen SIBO relapse if that’s useful.