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!"
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.
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.