36 thoughts on “The SIBO Saga: Part 1

  1. Annika

    Hi Angie,

    I'm just now reading a bunch on sibo.
    I was diagnosed with severe crohns about 11/2 years ago, so it's still newish. I have the problem with C. And the methane connection is interesting, ill have to read more on it. I was treated with the correct antibiotic at some point, but not for that reason. I just started seing a new naturopath that has a background in Ayurveda, and I have a really good feeling that he can help me with all the things that my gastroenterologist isn't so focused about in treatment. But I just asked him on sibo and testing me and he said, well, he believes that everyone has sibo on some level....I'm not sure what to make of that statement, but I'll ask him again. I was wondering though, is there no alternative treatment for sibo than drugs/antibiotics? Thanks for writing up the info, I look forward to reading more :-)!

    Reply
    1. Angie Alt

      Post author

      Hi Annika! Thanks for reading. There are some alternatives, which I will write about soon, but they tend to be much longer protocols. For many, getting relief of SIBO symptoms as quickly as possible is important. It is great you've connected w/ a good naturopath & it sounds like you will gain alot from him. However, I would disagree w/ him just a bit about "everyone" having SIBO. SIBO is very well connected to AI, esp. AI's like Crohn's, if his patient population is a large number of AI folks it may very well seem like "everyone has SIBO," but I don't think it is true that all of us do. Keep in mind that SIBO is not really an infection, but an overgrowth. It isn't really so much that these organisms do not belong in our digestive tract, but that they are far too many of them & they have grown into areas they do not belong (like into the small intestine, instead of staying in smaller numbers in the large intestine), hence the name Small Intestine Bacterial Overgrowth.

      Reply
      1. Heddi

        My functional medicine/chiro said the same thing about "everyone has SIBO". they must have heard/read that somewhere.

        Reply
  2. Berenice

    Hi, thanks for your article. I have Been fighting SIBO for almost a year. I was treated with Xifaxan the first time, got better and it came back and now I am on Xifaxan again and another gastro, question, how long does the treatment should be? I know everybody is different, but how long after feeling better should I stop the Xifaxam? After the first treatment I followed low FODmAps diet but it came back anyway, so I am wondering if maybe should had a longer period with Xifaxam the first time. Thanks in advance.

    Reply
    1. Angie Alt

      Post author

      Berenice, I can't really comment on how long an antibiotic course should be. That is really up to the prescribing doc's best judgement.

      Reply
  3. Tara

    Wow. Angie. You may have just unlocked the final piece of my puzzle. I might just have to go purchase this series. I tested high in methane the last time I was tested. I am not eating low fodmaps and I definitely have C. Plus, I have proven my IBS-C is a result of low motility, just not what was causing it. You, as always, are awesome. Thanks for posting!

    Reply
    1. Angie Alt

      Post author

      Tara, I am going to try to write about it more later, but sometimes the motility issue is bigger than the methane. During the symposium they talked about low dose Naltrexone in this case. If you think that might be the case for you, look into it. Kresser definitely has good things to say about low dose Naltrexone & I believe Siebecker has stuff on her site about it too.

      Reply
  4. Kenny

    Angie, it is interesting that you mentioned crying while taking Flagyl / Metronidazole. It crosses the blood-brain barrier and although highly effective for many with SIBO. It can be at times mentally and psychologically difficult to take Metronidazole for many people because the gut-brain connection is VERY powerful with this drug. The drug, for me, induced a condition called Akathisia which is a nightmare. I constantly had the "urge to move" and cried often! The doctors all told me the Akathisia could only be caused by anti-depressants. Don't believe that!! I thought I would lose my mind before I got the symptoms under control which took 6 months. I know Metronidazole can be a great combo drug for SIBO, and I wish I could take as I am sure it would be great for the bugs in my small intestine, but I am now petrified of the drug! I am the moderator of the SIBO facebook support group. If you are not already a member, we'd be thrilled to have you. https://www.facebook.com/groups/470628319710443/

    Reply
    1. Angie Alt

      Post author

      Wow! Kenny that is nuts! Yes, Metronidazole was very tough on me, but nothing like it was for you. I totally understand your hesitation at this point. Funny enough, while I was in W. Africa folks took regular "cleanses" using Flagyl. As you can imagine, the parasite issue is a bit more pronounced in the developing world. Another problem? Very depressed or seemingly "crazy" expats. Maybe those Flagyl doses did not help mental/emotional health??? As to the FB group, I had no idea you guys existed!! I will join today. Thanks for the invite.

      Reply
  5. Hi Ange,

    Awesome post, I can't wait for the other posts in the series to come!

    I am certain that SIBO is playing a large part in my chronic illness. I am very confident that I have methane dominant SIBO as I tend towards constipation. I am working with a practitioner in the US (I'm Australian) and we have ordered the organic acids test for SIBO. I don't know a lot about the test. Do you know if it will be able to tell me whether the SIBO is methane or hydrogen dominant (I suspect not)? I have been reading Dr Siebeker's work (she is a frecking genius) and as you mention she says that diet alone will not cure SIBO in adults. Therefore it's going to be important for treatment that I know which form of SIBO I have.

    Keep up the great work!

    Reply
    1. Angie Alt

      Post author

      Thanks so much Rory!! I don't know alot about the organic acids test to detect the SIBO. Since the breath test is measuring gas, you can find out whether it is methane or hydrogen, but I'm not sure how that works w/ the acids?? Oh, and I agree, Dr. Siebecker is a genius!!

      Reply
  6. Nicole

    Eagerly awaiting the write up on hydrogen producers and not fixing it with diet!!! I suffer from Crohn's and suspect SIBO. I'm trying to fix it with diet but your tiny tid bit on adults not being able to rid it without the antibiotics has me on the edge of my seat. I'm currently on week 4 of a no fodmap, low carb, no cruciferious, no sugar elimination diet to help produce "normal" stools, instead of the diaherra that has become a part of my everyday life.

    Reply
  7. Alyson Wissinger

    Thank you! I had discounted SIBO as a possibility for my symptoms but after reading this, I have changed mind!

    Reply
  8. Nancy

    This was an incredibly timely post since my new practitioner mentioned that he thought SIBO might be part of my complex health picture. A lot of puzzle pieces snapped into place with the one sentence "M. smithii, is responsible for the constipation associated with Methane-Dominant SIBO, because methane changes our intestinal muscle motor function" This goes a long way toward explaining my long history of SIBO, even despite a healthy, balanced diet. Thanks for this post and keep 'em comin'.

    Reply
    1. Vladimir

      Yep. M. Smithii is the one ! I just got my Genova Comprehensive Stool test done and it's to the roof . p!us the breath test... All the good guys in the gut were down to 0 pretty much. Big problem is restoring the balance especially now that Xifaxan didn't do much to drop the Smithii number.

      Reply
  9. Analiesa

    Thanks so much for posting such relevant information. I scour the internet each day trying to figure out things like this. SIBO test (methane would be my answer) is on it's way for me. Thank you for helping me try to figure out this thing!

    Reply
  10. R

    I was treated with Xifaxam and it worked so well for about 6 months.. Now the symptoms are returning.. Time to get serious again 🙁

    Reply
  11. Pingback:

  12. Elle

    Hi Angie,
    My doc is recommending the test for SIBO as well as one for fructose malabsorption. She told me no probiotics for 2 weeks before the testing and each tests needs to be done 2 weeks apart. That would mean a month without probiotics. I eat raw kraut daily as well as take candex to keep my stomach issues as well as my joint pain at bay. One day without either and I was flaring horribly, not sure what to do.

    Reply
    1. Angie Alt

      Post author

      Elle, the breath tests are very sensitive, so you want to follow your docs instructions. The probiotics, esp. will mess w/ the results & if you are going to do this, you might as well have reliable results, right? I'm sorry about the flares, but the info you get from testing will be really valuable for you.

      Reply
  13. Zizzy

    I am fairly certain I have hydrogen-dominant SIBO. I'm doing the Genova Labs home test tomorrow morning, after being off probiotics for months, and no fiber for a couple of days. Three reasons I suspect it: My colitis symptoms always disappear when I take antibiotics. Pepto bismol tabs erradicate all odor from my BMs. I had a SIBO breath test in 2009 that was equivocal (and hadn't prepared, was shortly after colonoscopy, etc), and a recent organic acids urine test suggested I had yeast and bacterial (clostridia) overgrowth. I'm on low-dose Naltrexone which has dramatically helped my autoimmune skin disease, but has done nothing for the D. Autoimmune paleo diet also hasn't stopped the D, but drinking Water Kefir did. One question: Do some people think water kefir, saurkraut and other probiotics make SIBO worse, by adding to the bacterial load in the small intestine?

    Reply
  14. Lindsay

    Great info! Did you happen to learn anything at the conference about those with SIBO who can't tolerate ferments or highly concentrated probiotics? It's such a hard battle without those healing foods and bacteria!

    Reply
  15. Pingback:

  16. Amy

    Thank you for posting this. Since getting SIBO (with methane-producing bacteria) in June this year, I have been following these researchers' work and trying to get my doctors to take it (and me) seriously for four months. I have finally been diagnosed with a 'strongly abnormal' case of SIBO. I'm 21 years old and just graduated from university. The more I read about it, the more I feel like I have just been handed a life sentence. I hate meat, and was thinking about vegetarianism before this happened - now I have no choice, and can't do most of the things me, my boyfriend and my friends love to do (cook, bake, go out for meals, eat in general). On top of that, my doc has given me oxytetracycline which is not the best antibiotic for this condition, and it is not working very well. He said I would be able to go back to normal, and I got the impression he meant in the next few months. Now it seems like this is going to be my life. I don't know how to deal with it mentally - it goes against everything I enjoy.

    Reply
    1. Angie Alt

      Post author

      Hi Amy-
      SIBO can be successfully treated, it just take dedication to the process & the right treatment courses. The antibiotic choices of your doctor are not regarded as the gold standard for SIBO, so I would start by finding a practitioner that can guide you more correctly in that area. And remember, modifying your diet temporary for better health is not a life sentence. It is a brief change meant to promote your best health. Good luck!!

      Reply
  17. Heather

    Excellent and timely article! I am taking it to my next doctor appointment to discuss. I'm looking forward to your article on Herbal Antibiotics and Diet for SIBO. I signed up for your newsletter hoping I'll catch them when they are posted.
    Thank you!!

    Reply
  18. Pingback:

  19. Hi Angie,

    Great info on SIBO. Dr. Pimentel is definitely an expert on this topic. Just finished reading his book, "A New IBS Solution"- Very easy to read and understand!

    Reply
  20. Pingback:

  21. Pingback:

  22. Kristy

    I just found out I have SIBO and leaky gut, but also have a bacterial infection that's systemic and my doctor wants me to do twice a week antibiotic IV therapy for 5 weeks to clear it up. (I've had it for 4 years) I am worried that doing the antibiotics while I have a leaky gut and SIBO infection will make my gut even worse. In your opinion would you work on the SIBO and gut integrity before adding the antibiotics? My plan was to do everything at the same time, including an elemental diet. I can't find any answers to this question and my doctor doesn't think it matters.... thanks for sharing your personal experience, it is so helpful to know I'm not alone!

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *