SIBO Be Gone: An Update Blog

SIBO (Small Intestine Bacterial Overgrowth) is a really hop topic these days, not just among my Facebook fans, but all over.  It is becoming more and more clear that SIBO is strongly linked to lots of health problems, especially autoimmunity.  In fact, I was recently listening to a Balanced Bites podcast where Chris Kresser said this, "I recently saw a study that suggested that over 80% of patients with Fibromyalgia have small intestinal bacterial overgrowth & that treating SIBO can significantly improve the symptoms."  I've had other health practitioners tell me that almost all of their AI patients have SIBO.  Today, I wanted to write a follow-up to a post I wrote SIBO almost nine months ago.

I talked about my initial diagnosis with SIBO in approximately June of 2012 and my first crack at treating it (super harsh antibiotic).  I then shared about the resurgence of my SIBO troubles, which happened in April of 2013 (the point at which I wrote the first blog).  I finished that post up talking about what my plan of attack was for Round Two with SIBO. Below is a summary update of my experience in finally "getting over the hump" with dreaded SIBO.

What Did NOT Work*
1)  Botanical Blend
My second bout with SIBO was much, much more intractable than the first (took me months to treat it).  I did not, initially, want to use antibiotics though, so my GI doc prescribed me an antimicrobial botanical blend, or as Dr. Alison Siebecker (SIBO authority, check her out) refers to it, an "herbal antibiotic."  The blend I took included well-known medicinal herbs like, berberine, barberry, and wormwood, along with a few other herbs.  I was instructed to take one capsule, twice a day for 30 days.  Well, let me tell you . . . botanical does NOT always mean "gentler."  We tend to favor these "natural" approaches as a way to avoid over- or ill-advised use of harsh antibiotics, which is smart.  However, we should not be fooled into thinking that botanicals come at no risk.  They can be just as harsh.  Such was my experience.  I was reduced to a blubbering mess with a severe headache with each dose, but with no discernible effect on the SIBO.  Needless to say, I had to stop the herbal antibiotics after the first week.

2)  Oil of Oregano
I do not think it is a wise idea to mess with this powerful stuff without some professional guidance.  I am sure it helps clear the body of some of the unwanted bugs, but it is quite powerful.  I had an intense die-off reaction while using it and ended up using lots of detoxing baths to help calm that reaction.

What Did Work
1)  Low FODMAP
By far and away, the most effective thing I did to combat my second bout of SIBO was to add a low FODMAP approach to my AIP regimen.  This approach limits or completely removes certain foods that are high in fermentable sugars; sugars the overgrown bacteria feed on.  Within a day or two I noticed a huge amount of relief and the longer I stuck to it, the less trouble I had with painful bloating and constant belching.  A low FODMAP & AIP diet is really tough, but after 30 days the results were well worth it.  This is basically a bacteria starvation method.  Imagine a maniacal laugh as I shout, "Die bacteria.  Die!"

2)  Antibiotics
After some struggle, I did end up deciding to take antibiotics.  My doctor and I discussed the best option currently out there for treating SIBO, an antibiotic called Rifaximin.  It worked great, but I had some symptoms return within two weeks of ending the course.  This is where to the low FODMAP approach really took effect and stopped the SIBO from flaring out of control again.  My experience is that antibiotics were needed to kill the bacteria enough to allow dietary approaches to take hold.

3)  Probiotics
I did not take probiotics while taking the antibiotics, as I was advised against that by my doctor (I have recently read alot of information that says doing both at once may be beneficial though).  The second I was done with the antibiotics and sure I had good control of the SIBO, I added a very high-quality probiotic.  This really tipped the scale and within a month or two I noticed my ability to eat FODMAP rich foods was normalized and no longer lead to severe SIBO symptoms.

4)  Yoga for Digestion
This was really effective when I was struggling with constipation or a general feeling that the muscular activity of my gut (motility) was not working well.  I can't say that it was critical to getting over SIBO, but it definitely helped with symptom relief.

SIBO is much more common than many of us realize and very difficult to treat.  It is normal for it to recur over and over in those of use with AI and/or digestive system diseases and often requires on-going prevention steps.  For me, this means watching the quantity of high FODMAP foods in any given meal and supporting my digestive processes as thoroughly as possible.  I feel like I have made it beyond the worst of this bacterial overgrowth though and know just how to approach it now.

*For the record, all of this is not to say that these approaches don't work at all, just that they were not the best, most effective route for me.  I think bio-individuality plays a role in everything from what we eat to how best to treat our illnesses.  Information about what worked and what didn't for others is a good road map for you, but shouldn't be taken as the last word.

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16 thoughts on “SIBO Be Gone: An Update Blog

    1. I focused on all avoiding all the FODMAPS listed as "avoid" & then experimented w/ the "be cautious" column until I knew which ones were specifically a problem for me.

  1. Gundega

    Dear Angie,

    You mentioned that Rifaximin really helped, but I was wondering - did you also have "die-off" reaction while taking it? Currently I can't afford to see a Naturopath or a SIBO specialist (as the consultations are very expensive) & I was wondering which doctor could prescribe me Rifaximin to cure my SIBO. I am currently taking herbal antibiotics but like you mentioned the "die-off" acne is worse than before. Please advise if maybe you could also prescribe me Rifaximin, or does one have to be a doctor?

  2. Cheryl Keeney

    Over the years, I had been on various diets trying to help myself and my undx'd SIBO was under control although I had many illnesses that stemmed from the stomach issues and malabsorption. Anyway, I had an Upper Endoscopy/Colonoscopy and the aspirate they took diagnosed me with SIBO. Two days after that procedure, I experienced horrible stomach pain after eating wheat, (I still think it was the anesthesia that set it off) and even on the antibiotics I stayed a little bloated but I could eat ANYTHING and felt pretty good! However, after the antibiotics, I was in worse shape than before the antibiotics so now I am really suffering. The only thing that really helps me is fasting, but with being sensitive to so many things , juice fasting is hard to do and water fasting is plain torture.

  3. Shelley

    I tried the Antibiotic treatment for SIBO last week, and after a couple of days, the side effects were so horrible I had to stop taking them. It took a few days to feel ok again, but I'm still not quite right. So my question is: how long does the die off (if that's what it is) take? I've tried probiotics before and had awful die-off (basically keel over and sleep for hours, feel weak and lots of chills too) and that didn't wear off after over a week. I want to treat this thing so badly (I've had IBS for 30 years, and finally some kind of proper 'diagnosis' was like a ray of sunshine) but I can't be in bed for 10 days every time I need to do the antibiotics. Help!

    1. Angie Alt

      Post author

      I would consider working w/ a health coach or nutritionist to help you over the hump. It sounds like the dysbiosis in your gut is quite serious & some dietary support might help. It also might be the case that you do need to take a "SIBO vacation" so you can concentrate on healing. I have had clients who do that.

  4. Myra Breunig

    I am reaching out to whoever I can for an answer to my question, so that I may start my SIBO treatment. Perhaps you can help. I am wondering if you know if the herbal antibiotics (Allimed, Berberine and Neem) recommended by Dr. Siebecker are to be taken with or without food. I can not wait to consult with her- apparently she is booked at least 2 months out. Any advice is appreciated.

  5. Andie Goudie

    Thank you for doing this blog Angie,
    I am currently applying the "what did work" protocol as outlined... having just added in FOMAD which I had not heard of before. Can I please get a response for :
    a) how do you know you have conquered SIBO?
    b) for how long does one need to adhere to the FOMAD diet

    Thank you so very much in advance.

  6. Shawn

    Hi Angie! I don't know if you are still checking this, but thanks for the blog post. I am getting ready to start a 6 week cycle of herbal antibiotics and not sure what to expect. I started the FODMAP diet last week, and think I am already experiencing some die-off symptoms from that, but I'm curious if you or anyone else here would mind listing your die-off symptoms?

    Anyone experience dizzyness or lightheadedness as a SIBO symptom? I've had issues with that for a while, but I don't know if it is part of SIBO or something else. I have diarrhea dominant SIBO and it lists weight loss as a symptom, but I don't have that problem. Anyone experience weight gain, or inability to lose weight with SIBO-d?

    I was just diagnosed last week, but based on my symptoms I have probably had SIBO for years and years. I am so hopeful of regaining my health, but I read about so many people who have done all of the treatments and not been successful. Any stories with good endings would be appreciated :)

  7. Nicole Luman

    Angie, I just recently entered the AIP world after completing a Whole 30. I, like many others, have endured multiple doctor visits where I just left more frustrated and with more questions than I had before going in. I have IBS with SEVERE constipation (going more than 2 weeks without having a bowel movement) and abuse laxatives every day just so that I can clear my bowels. I use miralax and senna every day in addition to Linzess ( a motility drug that my doctor prescribed to me). I discovered the low fodmap diet last october (on my own I might add…my doctor doesn't even know what a fodmap is!) and it seemed to help with the bloating (I would blow up like I was 6 months pregnant prior to eating low fodmap) But things are getting worse again and I think it's bc of the laxative abuse that may have caused a leaky gut, or that I've had a leaky gut all along, or SIBO. I have dark circles under my eyes, depression, anxiety, chronic stress in my life that seems very difficult to overcome (both of my children are in drug rehab/sober living houses and every day it seems like I'm just waiting for the "other shoe to drop", joint pain that I've been prescribed an immunosuppressant drug for treatment of, NO SEX DRIVE, fatigue (even with 8+ hours of sleep, hypotension (especially orthostatic), insomnia (I take things like GABA, melatonin, L-tryptophan, tyrosine, MG glycerinate, and STILL have to take 1/2 Unisom to get me to sleep), pain on my left side under/on my ribs (Radiologist diagnosed costchondritis), and an 18 pound weight loss from October 2014 to present day. I try to eat more to gain weight but I feel so full when I eat and rarely get a "hunger" feeling. I have found a functional medicine doctor who I have an appt with next week and want to ask him to do food sensitivity testing, as well as a SIBO breath test, and also blood work to check for adrenal fatigue. Do you think I'm on the right track? Sorry to be so long winded…but I have one more question, and that is about probiotics. Did you take a soil based probiotic as well as a probiotic that contained lactobacillus and bifidobacterium?

  8. Joe

    At my wits end with SIBO. Tried peppermint capsules, lead to horrible diarrhea. Same with oregano. I took rifaximin several times. The most effective was when I took it with flagyl antibiotic. It's been 3-4 months and SIBO has returned. Going back on these two. I think we need to focus on what we share in common, as far as food. I use a lot of Splenda, nicotine gum, 2-3 cups of coffee a day. I also often get urinary irritation. Anyone else? I'm so tired of SIBO. I barely overrate today at 12pm and now I can't eat the rest of the day. I made the mistake before and the rotten egg burps come back, diarrhea, bloating, etc

  9. Kayla

    I was told I have IBS and have classic SIBO symptoms - bloating, constipation, anxiety. I have been on antibiotics in the past for other issues (2 courses last year) and am really hesitant to do another course and mess up my gut bacteria even more. Is the antibiotics crucial for healing SIBO?

    I read in an article by Dr. Dinsmore that the antibiotics can run quite high as well

    He also says that there are herbs and probiotics that can help with SIBO. Are you aware of some of the herbs?


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