How to prevent a relapse
I’ve written about small intestine bacterial overgrowth (SIBO) in my last four posts. To catch up, start at the beginning, or read the previous post. This fifth and final post is about how to prevent SIBO relapse once it’s been treated. This is perhaps the most important post of the five. It is the missing piece for many people.
Unfortunately many people relapse easily after SIBO treatment. Approximately two-thirds of people treated for SIBO relapse either right away or over the course of the next year. This is when Functional Medicine clinicians fill the gap that conventional gastroenterologists may not provide: preventing SIBO relapse after treatment.
Immediately after you complete your antimicrobial treatment, go on a prevention plan tailored to you. Stay on your prevention plan for three to six months, and then taper off, with the risk that it may return. If it does return it can be retreated.
Figure out the root cause.
SIBO happens for a reason. Currently, the causes are believed to be:
- Medications
- Food poisoning
- Structural issues
Medications:
Acid-blocking medications, such as PPIs and H2 blockers reduce your stomach acid. Stomach acid keeps your stomach the right pH to kill bacteria that shouldn’t go beyond your stomach. Acid-blocking medications are not meant to be used long-term. They can lead to small intestine bacterial overgrowth, and nutrient deficiencies.
Weaning off acid-blocking medications is possible with the help of a clinician. Acid reflux is often caused by small intestine bacterial overgrowth. So SIBO can exist before acid reflux starts, and then acid blocking medication makes the SIBO worse.
Opiate medications that are used on a long-term basis completely shut down your small intestine motility. This can lead to bacterial overgrowth, which ferments and causes bloating. Opiate medications also slow down peristalsis in your large intestine, which can cause reflux of large intestine bacteria up into your small intestine. Ideally these medications should be used only on a short-term basis.
Many people become dependent on opiates without awareness. When people are in a lot of pain they are unlikely to be cognizant of the long-term side effects, and potential dependency, of the medications they are prescribed by trusted physicians. Fortunately there are programs to wean off opiate medications. Acupuncture is a wonderful solo or adjunct therapy for opiate withdrawal symptoms.
Food poisoning:
Bacteria from food poisoning secrete a toxin called CDT (cytolethal distending toxin). A portion of this toxin can damage your small intestine nerve cells. This impairs your intestinal motility, which is dependent on these nerves. Impaired motility leads to bacterial overgrowth. If you have SIBO, think back to when it started and you may remember an incident of food poisoning. There is a new test that exists that can tell you if your SIBO is caused by food poisoning. This condition is also called post-infectious IBS.
Structure and strictures:
After abdominal surgery, scar tissue forms. This can cause strictures, or narrowing, of your intestines. This is especially true in the case of ruptured appendix surgeries. Any abdominal surgery can result in strictures, including C-sections, laparoscopies, bariatric surgery, and hernia surgeries. Endometriosis can cause strictures.
You may have structural issues not related to surgery, such as a blind loop in your intestines. When there are strictures, blockages or narrowing of the intestines, it can cause bacteria to stagnate and move up into your small intestine.
Fix the cause
If the cause is medication, it’s important to reduce or wean off the medication with the help of a clinician.
If the cause is from food poisoning, a prevention plan may be enough to prevent relapse, if your nerve damage is not significant. In these cases the use of a motility agent to regulate your small intestine migrating motor complex (MMC) is important (more on this later).
If the cause is structural, a manual or physical therapist who specializes in releasing abdominal strictures can be very helpful. Acupuncture with the addition of microcurrent can also be effective.
Sometimes the cause is unknown. Whether or not the cause can be determined, once antimicrobial treatment is complete, it’s important to be on a prevention plan.
Prevention plan
- Restore your migrating motor complex (MMC)
- Eat appropriately for you, with tolerated fermentable carbohydrates and prebiotics to feed good bacteria
- Probiotics may help
Restore your migrating motor complex (MMC)
This is essential for preventing SIBO relapse. Most people with SIBO have a dysfunctional MMC, which may be why the bacterial overgrowth occurs. Your MMC is a wave of movement through your stomach and small intestine, that occurs when you are fasting. It occurs every 90 minutes, only when your stomach is empty. The sweeping action moves bacteria and food through your small intestine.
With SIBO the MMC may be dysfunctional because of nerve damage. The MMC can be dysfunctional in both cases of constipation-type or diarrhea-type SIBO.
How to restore your MMC?
Take a prokinetic immediately after finishing antimicrobial treatment. A prokinetic is an agent that restores function of your MMC. Pharmaceuticals include low dose eurthemycen and low dose naltrexone. There are many herbal motility agents as well.
The most important aspect of restoring MMC function is to allow it to happen! If you are a constant snacker, you never allow time for your migrating motor complex to work. You need to wait four or more hours after eating to give it a chance. Often, I will recommend patients extend their night fast for 12 – 14 hours. This allows for a 10 – 12 hour “feeding time” during the day. Eat enough at meals so that you can go four hours before eating again. If you can’t wait that long, it’s either because your meal wasn’t sufficient, or you have blood sugar issues. If this applies to you, working on these issues will help your MMC improve as well.
Sugary drinks, or any calories between meals, will completely thwart your MMC. If you hear gurgling noises, that’s your MMC at work. Many people with SIBO never hear these noises. If your MMC is shut down, this wave process will not occur. You will feel your food stagnate, and not digest properly. Alternately, you may feel like you need to run to the bathroom with urgency and diarrhea. It tends to be one or the other, although some people have both or neither!
Determine your tolerance for fermentable plant foods and prebiotic fiber
Some people need to be on a special diet that reduces, but not eliminates, fermentable carbohydrates. The most nutrient dense carbohydrates are from vegetables and fruit, and they are important to include in your diet. Some of them are more fermentable as compared to others. Here is a great list.
In general, we clinicians do not want people to be on highly restricted diets long-term. However, there may be certain foods that trigger symptoms. These foods are often in the “avoid” column on this list. Foods to avoid are individual. Explore by trial and error, or get help from a clinician.
There are low fermentable diets such as the Specific Carbohydrate diet (SCD), the low FODMAP diet, and the Fast Track Digestion diet.
These diets are meant to be short term in my opinion, and only followed long-term if absolutely necessary, like in stubborn cases of frequent relapse. The goal is to handle fermentable plant fiber in order to feed the beneficial bacteria in your large intestine.
If you do follow a restricted fermentable food diet, you can still add prebiotic fiber supplements which can help normalize your gastrointestinal bacteria. This post describes fermentable foods. This post describes them more in depth, and describes the various prebiotic fiber supplements.
Probiotics
Choosing the right one is highly important. Many of the lactobacillus strains available in stores exacerbate SIBO! Strains that are designed to stay intact until reaching your large intestine are helpful. Soil-based organisms, which we used to get naturally from dirt and animals, make up a large part of the colonies in your large intestine. These are usually safe in the treatment of SIBO. They also have antimicrobial properties so they push out less-desirable strains.
Fermented foods such as 24 hour homemade yogurt, or fermented vegetables like sauerkraut, miso, and pickles, provide rich sources of lactobacillus strains. However, not everyone with SIBO can tolerate fermented foods. If you add a little bit per day, starting with one spoonful, you can usually grow your tolerance. These foods are far greater in probiotic content than capsules. They are also less expensive.
If you find you cannot tolerate fermented foods, it could be that you are sensitive to histamine, which is high in lactobacillus fermented foods. If that’s the case, use lactobacillus strains that decrease histamine rather than produce histamine. One of these is a strain of lactobacillus plantarum contained in Ideal Bowel Support.
If you are on a restricted diet that eliminates fermented foods or fermentable carbohydrates, it’s a good idea to include probiotics and/or prebiotic supplements. Again, this varies by individual and you will benefit from working with a clinician who can test your microbiota and gear things towards what’s optimal for you. This is not an exact science; however, we are learning more each day.
In summary, if you suspect you have SIBO:
- Get tested through a Functional Medicine clinician or gastroenterologist
- If positive, work with your clinician to develop an appropriate treatment plan (from two weeks up to four months)
- When treatment is finished, retest
- If clear, move to a prevention plan
- If not clear, troubleshoot and treat again
Thank you for sticking with me through these five posts on the same topic! Many of my patients, friends and family members have no idea that their symptoms are highly suggestive of SIBO. As I wrote in posts one and three, these are not only digestive symptoms, they include other inflammatory symptoms such as aches and pains, depression and anxiety, and high cholesterol. Many people have told me they were treated once for SIBO but they know they have it again, they can tell from their symptoms. This is why I wanted to include this fifth post on preventing SIBO relapse.
Join in the conversation with your comments!
One possible cause of SIBO, which you don’t address, is low stomach acid. Not only does low stomach acid allow for bad bacteria to enter through the stomach but low acid levels result in incomplete digestion, particularly of carbohydrates. Thus, when the chyme enters the small intestine that portion representing more complex carbs are never properly prepared for absorption and present as a food source for bacteria and eventual overgrowth.
Thanks for your comment Dennis!
You bring up a great point.
I do actually bring this issue up, under medications as the first cause of SIBO. Specifically “Acid-blocking medications such as PPIs and H2 blockers reduce stomach acid. Stomach acid keeps the stomach the right pH to kill bacteria that shouldn’t go further than the stomach into the small intestine. Acid-blocking medications are not meant to be used long-term because they can lead to small intestine bacterial overgrowth as well as nutrient deficiencies. Weaning off acid-blocking medications is possible with the help of a clinician. Acid reflux is often caused by small intestine bacterial overgrowth. So SIBO can exist before acid reflux starts, and then acid blocking medication makes it worse.”
The reduction on stomach acid can contribute to SIBO in more than one way, as you brought up. In the stomach, bacteria are not “killed” by stomach acid and food (especially protein) is poorly broken down. Additionally the “bolus” of food that enters the small intestine from the stomach is not the correct pH to trigger the release of pancreatic enzymes and bile for further digestion. Much research has been done to demonstrate that acid blocking medications, such as PPIs, can cause SIBO. One of the most recent papers is here.
Acid blocking medications are one of the most common over the counter meds in the U.S., and people need to understand the consequences of long term use!
Thanks for your input,
Laura
Hi Laura: Thanks for the information. Possibly you can provide some input regarding an experience I’ve had that might be related to SIBO. About four months ago I was diagnosed with LPR (silent reflux). Symptoms included hoarseness, post nasal drip, asthma and frequent throat clearing. The ENT Doc gave me a PPI prescription that did nothing to relieve the symptoms and I stopped taking the PPI after a couple of weeks. I started researching LPR which led me to test myself for low stomach acid. It was low so I started taking supplemental HCL/w/pepsin and were taking five 648mg caps with most meals involving protein. Within a week, all my symptoms vanished. I am now down to taking only three or four caps as my stomach is starting to produce its own acid. The puzzling thing is that another seemingly unrelated problem has subsided as well. I have suffered with pelvic floor dysfunction for over 20 years and experience pain when sitting for too long or after any type of exercise. This problem has also mysteriously abated. It is my understanding from reading a few article that there could be a connection between SIBO and pelvic floor issues. Do you have any insight regarding this?
Regards
Dennis
Dennis, it sounds like you did fix your GERD symptoms yourself, by increasing your HCl instead of decreasing it. Bravo! Ideally your stomach will “learn” to produce more HCl so you don’t have to take that supplement long-term.
As far as the connection between SIBO and pelvic floor pain, I can think of at least a couple of mechanisms that would connect the two. One of them is that if there is SIBO, then bacterial toxins called LPS leak through the intestinal wall and create muscle pain, which could be anywhere in the body. This is often the cause of mysterious pain, like fibromyalgia. These bacterial toxins create inflammation as well. Another reason would be if there is SIBO, there can be bloating, which puts pressure on the lower abdominal organs and potentially the pelvic floor. Lastly, if there is an overgrowth of small intestine bacteria, there could be an irritating overgrowth of pelvic floor bacteria. Often this is E. coli.
Thanks for stopping by!
Laura
Hi Dennis I have the same pelvic floor issues, would love to speak further my email is bekkihumble@outlook.ie
Hi Laura,
I am trying to figure out my sudden onset of gastrointestinal distress that has been going on now for 2.5 months. At first I thought it was food poisoning or a bug. Symptoms were there for a week, then seemed to get better, only to return about 6 days later. Now they are on and off. Some days are better some are worse. Some blood work showed my bilirubin high and my stools were yellow so I got a CT scan of my gut to check my gallbladder. Everything looked ok with my digestive organs. I got a comprehensive stool test through my ND (Genova) and I had high levels of commensal bacteria and of(potential pathogens) Klebsiella Pnemonae, and a yeast. I thought that these were the cause, so I started taking herbal antimicrobials. Oregano oil, wormwood. Seemed to help a little. I went to a Nurse Practitioner and she suggested I start taking the antibiotics recommended by Genova since the herbals looked like they could be not as effective. I waited to talk to my ND. He put me on an H Pylori type of treatment with digestive enzymes, antimicrobials (Berberine), and a gut healing supplement. Did this for 3 weeks. Still had problems. Searched the internet and found out about SIBO and we are going to do the home test as soon as 2 weeks pass since I took my last antimicrobial. Another thought I had was possibly Giardia, but it did not show up on 2 stool tests, but heard that maybe doing more tests could find it.
My main symptoms in the beginning were chills, sour stomach, sick stomach, stomach pain, malaise, burping, farting, some yellow diarrhea. Now I am constipated, burping, farting, sour stomach, nausea, stomach pain, intestinal pain gurgles. Sometimes it is barely there, and then other times is in full force.
Not sure what started all of this. Not sure why it keeps going on. I have Gilbert’s. I was on Cholestyramine for 2 months for treating mold illness. Had been on other supplements including curcumin (which I read can cause gastrointestinal distress). It seemed to start after eating a caramel apple, also there was a trip to a hot spring two weeks earlier.
I have never had anything go on like this with my guts ever….for short times yes…but not this long.
I hope I find the answer soon. It is all so confusing with all the possibilities. Your articles hold a lot of information and I am grateful for them.
Cara,
I’m sorry for your suffering! It sounds very uncomfortable, frustrating, and mysterious. You seem to be in good integrative medical care, and I hope you find resolution soon. A history of mold illness can certainly complicate things. Many people do stool testing from 2 different labs, as no one lab “catches” everything. Something to think about. Thank you for sharing, I’m glad these posts are helpful, and keep us posted! Your self-education and determination are impressive.
Warmly,
Laura
Hi Laura,
Thank you for responding. Does it sound to you like I am on the right track? Does the overgrowth of commensal and a few bad bacteria and yeasts in the stool lean towards SIBO? Also my fecal fatty acids were really high. Does retesting for Giardia sound like a good idea? I have also set up an appointment with a Gastroenterologist just to see if they can come up with anything. My ND said he thought I would be disappointed, but I am going to try anyhow. Any testing that they can do that could be helpful? What they should look for?
Also I keep reading about natural antimicrobials for SIBO but no one ever says what they are. Not even in the scientific study that showed this. I am guessing it depends on the type of gas producers the test finds. Not sure my ND is up to speed on the whole SIBO thing so I may have to find this information, if I have SIBO.
And….. If I have SIBO then trying to figure out what caused it. I have some theories but nothing is provable. Cholestyramine possibly slowing my digestion down. Eating tons of refried beans every day, and not many veggies. Possible food poisoning. Recently eating a little more sugar and refined carbs. The curcumin? Maybe it was the perfect storm? A year ago my stool test from Genova was pretty much fine. Just a lack of diversity in my bacteria. This was all before the mold illness treatment began.
How do you feel about antibiotics vs natural antimicrobials to kill off bacteria? Especially in SIBO. Especially with something like Klebsiella or an overgrown yeast. Genova said that Klebsiella is not super susceptible to the antimicrobials they tested.
I have been using Dr. Siebecker’s SIBO diet to see if it helps with the symptoms and I do think it may a little. Not sure if it is much good though since I am not actively treating anything at the moment while waiting to take my SIBO test.
This whole thing has been driving me nuts, and I am the type that won’t stop searching for answers until I feel better. I now really feel for anyone who has symptoms like these, I never understood how draining they can be.
Thanks for listening and offering any insights.
Cara,
I understand how draining and frustrating your situation is! When our guts are off, everything is off. Unfortunately I can’t answer all your questions here – I can’t legally give medical advice here on the blog. One thing I can say is I do think if curcumin causes digestive symptoms, they would stop once the curcumin stops. I wish you the best, and keep us posted on your progress if you desire.
Laura
My wife has been suffering from chronic nausea and fatigue for years. The medical professions has run numerous tests (brain mri, ect, heart lung, tyroid, blood work ups, 7 trips to ER) at a cost of $200M and have found no identifiable cause for her symptoms. Their recommendation is I go to the Mayo Clinic. So I went to the Mayo Clinic web site to research chronic nausea. I took what I learned and went to the GI doctor. He told me he had run every possible test and he want to know what I wanted him to do. My wife now became my patient.
Since a resent endoscopy found nothing wrong I by passed a repeat of that test. I bought a glucose meter and ruled out low blood sugar as a cause. I next asked for a gastric emptying test be performed with the results showing her stomach emptying in 21 minutes signifiying GDS. Going on the assumption the stomach acids were not doing their job, the small intestine being asked to do some of the work of the stomach, I asked that a hydrogen breath test be performed. I was informed the GI practice could not find a local lab to do such a test so the practice didn’t do the test. So I went on line and found a lab that does the testing, got the kit, had her perform the test and withing 24 hours had the results back. The results, PRESENCE OF BACTERIAL OVERGROWTH IS SUPPORTED. I was then asked how I wanted to teat it and I prescribed Xafaxan 550mg x 3/day x 14 days at a cost of $1550, The nausea continued for the first week, but then she had five days with no nausea. It appeared that in two weeks at a cost of $175, I was able to make a diagnosis the medical profession couldn’t make in three years.
The problem now is that since going off the Xafaxan the nausea has returned. I am awaiting the results of a new breath test to see if the bacteria that may have been eliminated has returned. She has also just started taking a probiotic hoping to build up any good bacteria that may have been destroyed by the Xafaxan. My question is that with her having “gastric dumping syndrome” can SIBO ever be eliminated going on the basis the stomach acid is not having sufficient time to aid the small intestine in the digestive process? With two thirds of SIBO patients relapsing, what can be done, short of Xafaxan at $35 a pill, to control the SIBO and the associated nausea?
Hello Beth,
It’s impressive how you have determinedly become your wife’s primary health practitioner! I hear your frustration about not getting the right diagnoses and treatment from the various practitioners and hospitals she has been to. Many doctors and gastroenterologists are not yet familiar with SIBO; however there are many who are! I’m not entirely sure your prescription for her did the job, for many reasons. One, Xifaxin alone is usually only effective with hydrogen producing bacteria. Methane producers often require a second antimicrobial. Also the treatment length may not have been sufficient. In addition, there are other factors that help such as prebiotics to draw out the bacteria, biofilm disruptors, and in some cases specific diets. I believe it’s also important to examine and treat any large intestine microbial factors simultaneously, as well as testing for H. pylori in the stomach. All that being said, I find the most useful approach for preventing relapse is to find the cause if possible – and it sounds like you may have done that with figuring out the gastric dumping. If the SIBO is a manifestation of the gastric dumping, it makes sense to target that is the primary cause. Unfortunately these complex gastrointestinal conditions take persistence to resolve. Don’t give up! I wish you the best of luck. -Laura
Hello everyone.
I had some problems in the recent months, I used to follow a high protein diet (I like body building) and i’m also celiac.
It all started this may with a bit of reflux (solved with gaviscon) and some acne under my eyes (not really acne, i’m 30), but that were not a real problem.
Then I got a food poisoning and there all has gone so bad. Vomiting all night and diarrhea, for 3 days I couldn’t touch food, started to have GERD with nausea and air in stomach, after 2 months the doctor gave me PPI and gaviscon, but I had no relief.
In september I had a gastro, where they found Esophagitis and bile in the stomach, continued with PPI and changed a few other meds but got no improvements.
So I changed doctor, who touching me found out that my liver was a bit too big, sending me to do an ecography (which resulted in nothing bad, just a bit of fat liver) and prescribing prokinetics.
I’m now one month in to the new cure and still feeling bad after every meal, I dont smoke, I dont drink, my diet is good.
Do you think I should do a SIBO breath test? Any advice?
This thing is also ruining my social life cause I feel ill at ease everytime my friends ask me out for dinner.
Andrew, I am sorry about your suffering! When the gut is off, it can affect all aspects of health and life – as you mention even your social life is affected. It sounds like you’re a good candidate for a SIBO test. However, it sounds like there’s other things going on, as you mention fatty liver. Sometimes it takes a while to get better, and I’m glad you’re in the care of a practitioner to help you. Hang in there!
Laura
Hi Laura,
I was curious if black coffee or matcha green tea would interrupt the MMC inbetween meals? I like to have coffee in the AM 2 hrs before breakfast and the matcha green tea inbetween lunch and dinner.
Also, do supplements stop the MMC as well?
One more question, is eating 2 hours before bed enough time or should more time be allowed for food to digest?
Thanks for any advice!!
Amber
Amber, good questions, and probably no one knows for certain…. but I would guess black coffee or green tea would not affect the MMC. Supplements – it depends what they are. I think a good target is 12 hours of not eating. Two hours before bed is certainly better than eating right before bed. Thanks for your questions!
Hi Laura,
I have had similar problems that I’d like to get your feedback. It has been four months of trauma for both my family and I. It all started with a light flank pain in the rear left from which I ended up in ER where they did a non-contrast CT scan. They did not find any abnormalities just some microscopic blood in urine which they believed to be gravel. I was under a lot of stress of course because the next few days, I was now having pain just below/under left rib. That pain began shooting in the left mid back and that led to more anxiety to thinking I could have Pancreatic Cancer. My GI pushed me for another CT scan but this time with double contrast. I did all kinds of blood tests, vitamin deficiencies, stool elastees for Pancrease, hormone testing since I had lot 15lbs in month and a half due to loose greenish stools. All came back normal. I began having a lot of bloating, even when drinking water. I was so bloated that my skin in the left side of the abdomen was hurting (those fat strings like muscle fibers). The GI then ordered Endoscopy where after 6 biopsies, they found h pylori. After a 10 day triple antibiotic treatment, I did a breath test which came back negative. I continues having bloating and pain by left rib which changed a bit in nature since I begin having some numbness at times in that area. Since this all started, my tongue has developed a white coating which a dental pathologist thinks it’s hairy tongue. All this time, it feels like I have a tennis ball inside there. Because of continued problems but a little better digestion, I was not loosing weight any longer but still not able to gain any. GI wanted me to do a SIBO breath test which came back positive for hydrogen bacteria overgrowth. Now they want me to start Xifaxan for 10 days. I have never taken antibiotics since I was a kid and I’m very hesitant to do so because I just don’t believe that the pain I have is associated with SIBO. Granted, nausea at times, alternating loose stool and constipation, less bloating are still signs of SIBO but not so much of that pain under left rib and back (at least based on my research). This is all done at Cedars Sinai where Dr. Climentel discovered SIBO!
Sorry for the lengthy description but this has terrible effected my life in so many ways. Even though the pain is not constant and maybe only a 4 out of 10, it has effected me mentally. I have become very irritated, highly anxious, unfocused, unsocial, restless and depressed. I’ve lost hope that I will ever get out of this and I’m always worried that maybe the CT scan just did not pick up any issues with Pancreas (even though I’m a little early for that – I’m 33).
Your feedback is much appreciated. I understand you are limited on what you can suggest but any thoughts would be highly appreciated.
Thank you in advance!
Wow it sounds like you’ve been through a lot! It sounds like you’re wanting feedback about whether or not to take Xifaxan for the hydrogen SIBO, and that you think there is something else going on. What I’m “hearing” in your message is your stress and worry. Understandable! While I cannot give medical diagnoses or advice on this format, stress does exacerbate many conditions, and that might be a great place to “work.” There could be many different causes of the kind of pain you describe, and I suggest getting more opinions if you think there’s more to uncover. Some folks prefer to treat SIBO with botanicals, however Xifaxan IS the gold standard antibiotic, and it IS a smart use of an antibiotic, because it’s a crystal form that is not systemically absorbed, it only affects the small intestine lumen, and doesn’t destroy the large intestine beneficial bacteria. It’s good to fill in the other pieces I write about when treating SIBO – finding the cause if possible, preventing relapse, building a good microbiome and gut lining. Each person is unique, as is your case. I hope you get the right help! There are always second and third opinions… Best, Laura
HI Laura,
Do you know if taking supplements/ medication during the MMC cycle interrupts it? Also, what about black coffee and tea… Does that stop it?
Thanks, Amber
Amber,
These are great questions! I believe that drinking fluids can interrupt the MMC. This is because the sensation of stomach distention and fullness is what interrupts it. So I try to educate people to drink closer to meals. So coffee and tea, if black and zero calorie, slow the MMC, it would be because of this reason. I don’t know for a fact about supplements or medications, but it probably depends (on quantity, fillers, additives). I would guess that minimal amounts would not affect it. My best recommendation is if you are wanting to promote MMC activity, to do your best to minimize intake of anything for as many “slots” as you can. So daytime, 4 hours is great, and night time up to 12-14 hours. However, don’t obsess about it. Just getting one longer stretch of time on board within 24 hours can make a difference, in my opinion.
Hi Laura,
I’ve been diagnosed with SIBO and am treating with herbal antimicrobials so far with success. But it believe that I have possible nerve damage to my MMC. Have you seen something like that ever resolve or is it feasible to need a prokinetic very long term?
Thanks for your articles!
Tatia
There can be nerve damage to your MMC, however this is not easily measured or tested! It can be feasible to need a prokinetic long-term. There’s confusion about the term prokinetic because it doesn’t have a clear definition. People think prokinetic means something that stimulates peristalsis. If there’s nerve damage, a prokinetic is meant to be a regulatory agent, not a stimulant, it’s for people with both diarrhea or constipation type SIBO. I’m not satisfied with the choices and the literature/research about prokinetics at this point. I also do not like to take the viewpoint that there is irreversible nerve damage in the MMC, unless it’s proven. If we are making that assumption, then one’s thinking can become down or negative about the possibility of getting better. But to answer your questions specifically, in theory it is possible to have nerve damage, and I don’t know if it completely resolves because I don’t have a way of testing the MMC, but I have certainly seen people get better! And yes, taking a prokinetic long-term is feasible.
Thank you, Laura! I’m actually looking at making my own mix called Daikenchuto from Japanese medicine. It’s a mix of ginger, ginseng and szechuan pepper. It’s supposed to be stronger than many of the options I’ve looked at.
I have also just discovered I probably have parasites, which could contribute to things not moving through me! It seems to get so complicated and can’t be something straightforward with our bodies.
I guess whether it’s stimulating or actually being the agent that moves things, as long as it gets it done seems to be really important to help the body heal and move past SIBO or parasites or anything else. I appreciate you helping me understand that!
That remedy sounds interesting. I am more often approaching large intestine (your parasite), stomach, liver/gallbladder, and general gut/microbiome health before “tackling” the SIBO – the SIBO grew there for a reason. Then if the SIBO still needs to be knocked down, bodies are better able to keep it down. So if it goes with constipation, important to have motility first – motility is different than prokinetic, which is regulating (at least in the SIBO lingo). Ginger and ginseng are both regulating, or can be.
Hi, I was on 2 rounds of heavy antibiotics for h-pylori last summer. It was awful but I had tried other natural supplements before h- pylori and I knew I needed medication. I felt ok after my stool sample came clear. A couple months ago I started to feel awful again so I asked my gastrointestinal specialist if I could have h- pylori again. I did another stool sample and it came back negative. Question, why am I still having issues. Bloated after I eat anything, burning feeling in my stomach, dry cough, acid reflux, uncomfortable tight feeling in my stomach, sleep issues, diarrhea on an off. Explosive poop issues at times. Misery period. So I’m currently on day 11 of 14 of niacycin. It has not been as awful as my experience with the 3 does for h/ pylori but.. I’m still having issues stomach pain , some bloating, some acid reflux. I just requested a stool kit to test for worms parasites I’ll see how that turns out. My doctor wants me to do a breath test which I’m waiting to get scheduled. The h-pylori was diagnosed through an endoscopy. Everything else was clear. My doctor did say I could have SIBO and IBS. I never had stomach issues. I’m just not sure if this will ever go away. I’ve tried oils, many supplements with no relief.
I sometimes feel like I’m doomed. Any ideas on natural homeopathy would be appreciated. I have researched and have spent money on stuff that sits unopened in my cabinets
Sorry about your suffering! I would be happy to help you, and the steps are to first schedule a new patient appointment.
Hi Laura,
I was diagnosed with Sibo last year through a nature path. I have just finished four months of a natural antibiotic (tincture) and now I take a probiotic and lactulose to help with the constipation. Only issue is, couple of weeks ago (I exercise daily and with intense training so I am used to the rhythm) After my exercise class, I was extremely sore. I thought, maybe it is just the training and change of diet which has made me feel less energetic, but now after some weeks my muscles are aching, I wear the proper shoes and I have a good bed, (maybe a pillow could be the cause) but my back is becoming tense and sore more than usual and I have had some constipation again. My nature path has me on a natural tincture for sore muscles and magnesium but the pain is still there especially in the middle of my back. I am not sure what to do or what it could be, but it feels like it could be coming from my gut
The LPS endotoxins from bacterial overgrowth can certainly cause widespread pain.
Hi! Thanks very much for the information you give in this web. Sorry if my English is bad, i am not an Anglosaxon person.
I suffer digestive problems since several years and every year I felt worse. In 2015 i did the breath test twice and the results were positive. From these moment i take Rifaximin three months (sometimes during six months) and then i rest two months. My sympthons do not disappear and i feel my life is a horrible hell, I can not work, i can’t go out, I can’t eat almost nothing (I only eat meat, fish , eggs, rice and potatoes).
I would like to do the SCD diet and besides I am looking for a naturopath doctor, do you know how to look for a doctor who understand sibo in Spain? Do you know someone? Some naturopaths doctors have said to me that they understand but when I talk with them I realised they have no idea about sibo because they only talk to me about stress and natural pills (but they do not know about oregano oil, antimicrobials, disruptor film, prokinetic…). They are too “spiritual” (iin my opinion). So I need a doctor who really knows about SIBO… In Spain conventional doctors asked to me: What is SIBO? And I only feel I want to cry when they ask me…
When I read your writings and things from Pimentel, Siebrecker… etc… I think I have a problem with my MMC, but… what is the reason? Is possible that only stress can damage the SNC and therefore the MMC? Do you think the nerves are responsible of the problems of person who has IBS/SIBO?
I know that it is unknown if is possible restore or not the MMC… And the million question… is really possible to cure SIBO, a really cure (forever) ? Do you know someone who has cured forever?
Sorry if I ask many questions but I don’t know nobody who knows about this problem. I feel I died some years ago, when this problem appeared in my life.
Thanks you very much.
I’m sorry for your suffering, and can understand your frustration. I don’t know of anyone in Spain, although you could look up on the Institute for Functional Medicine’s site, they train people worldwide. Also the Kresser Institute. Many of us in the U.S. do work remotely. Yes, SIBO can be eradicated. In some people there’s a greater chance for recurrence so finding the underlying causes (SIBO is a symptom not a diagnosis) plus working on prevention/relapse is KEY.
I’ve SIBO and I am on Rifaximin right now but unfortunately, I have gastritis right now as well. I think it’s not acute. we can say it’s intermediate and I am aware of life style changes and foods for gastrits. But I do not know what to do. I am afraid of taking H2 blockers or PPI’s because I know it contributes to SIBO. What should I do? I am thinking of taking h2 blockers 150mg i.e like Zantac at night and Maalox plus after meals at daylight? Or just take 300mg every day?
Hi! Please consult your practitioner on this one.
Best,
Laura
Hi Laura,
I tested positive for overgrowth of Klebsiella. Any recommendations on herbal antimicrobials that kill this bacteria and probiotics ? I also read they feed heavily on starch (which is in a lot of foods). Any diet recommendations for this type of bacteria?
Thanks
Jenny
So I can’t give personal medical advice in this venue. That being said, I would not chase down a single bacteria in your GI tract with antimicrobials (which always have collateral damage) without evaluating the larger picture of your whole tract, and other aspects of your health. So pull back and look at the larger picture – if there is dysbiosis, what type and why? Ask the practitioner who tested you – balancing gut flora is a fine art and it’s best to have guidance. Hope these thoughts help.
Hi Laura, I’ve been sick for 4 months , discomfort in my stomach, pain under my ribs, and lately some tension in my neck left side, I don’t know if it’s related to the stomach thing or just stress, I’ve had an ultrasound on my stomach, so fat on the liver, I’m not that big 190, 5-10, but not much else, had a colonoscopy and endoscopy and they said high white cell count in the lower intestines , so now waiting on a test mailed to me, for sibo, I haven’t been able to eat a lot without it getting worse, so I have found bananas, yogurt, white rice and sweet potato, and salmon, and chicken about it, if I eat to much or much else, I feel the dis comfort and a burning in my throat, the GI told me to take Gavagone, which works great and fast, but very tied of being sick, I’ve been sick so long I thought I had cancer, thank god wasn’t the case. I feel like I’ll never be normal again, my axiety is so bad I’m having a time working. I’m 49, and never been this sick, friends call me the phantom gourmet because I’m such a big foodie, I miss food, I was 210, when this started and now 190, I’m doing what I can , following doctors orders, taking the test they tell me to but I’m tied of this, even after this next test it seems people are sick for a long time even after meds, I want my life back, any advice?
My advice is to work with a qualified practitioner and you will get your health back! Sorry to hear about your suffering.
Hi Laura,
I tested positive for Sibo – hydrogen via a 3-hour glucose test. My gastroenterologist then did a gastric emptying test and it said I had rapid transit, or dumping syndrome. My doc believes this is my root cause of the sibo. She is putting me on rifaximin for 14 days and then a low fodmap diet. But don’t you have to “fix the cause” of the sibo before treating it? The diet for dumping syndrom varies greatly from the low fodmap diet.
My question is: everything I read by Pimentel and Siebecker say to definitely use a prokinetic after treatment to restore MMC . My doctor disagrees and says I don’t need it because I have rapid transit. Does this make sense to you or should I push for the “all Sibo people need a prokinetic” method?
Kathy,
I have not found that everyone needs a prokinetic, no. Prokinetics are in theory supposed to regulate the MMC while taking, not restore. But I personally do not use them with everyone, in spite of what those docs say. I like to take a broader picture that SIBO is more of a symptom not a disease in itself, and can be resolved. It sounds like that may be how your doctor is approaching it…. so ask how she/he thinks the underlying cause (“dumping syndrome”) is then resolved as the root cause of your SIBO?