I think I have a good grasp on what life after SIBO antibiotics looks like.

I always knew, deep down, that after this, my 3rd round of SIBO antibiotics, I would be calling it quits on that front for quite some time. And guess what? I still maintain this position. 

Third Time Likely Still Not the Magical Charm

My 3rd round of antibiotics began on Sunday, June 5. It was a 28-day course of the antibiotics.

I feel better overall. But I had severe doubts up until day 14 because up until that point, I was bloating daily and felt miserable.

But then, like a miracle, in a matter of a day, it all turned around.

That has always been my experience with Rifaximin, though.

These past two weeks have been really lovely, and I have been pushing all the FODMAP foods. My stomach feels great, I have energy and I’m going to the bathroom 100% normal.

So why, then, do I say that the third time was likely still not the magical charm?

Antibiotics Don’t Fix Underlying Problems

I am still taking 8 HCL pills with higher protein meals, which means that I still do not have adequate levels of stomach acid to help break food down.

Click HERE to see if you have low stomach acid.

My main issue with SIBO returning has always been motility caused (mostly) by low stomach acid, which I have developed over the years from many things, namely chronic dieting, and stress.

So while I might be feeling 100% right now, the tank of gas will empty quickly if I don’t work really hard on increasing the stomach acid.

Life After SIBO Antibiotics

Click HERE to save this post for later.

Life After SIBO Antibiotics agutsygirl.com #guthealth #supplements #sibo

I am on a mission to live life.

Healing is a double-edged sword because you could eat whatever you want and reverse progress or you could take on a rigid gut healing diet, feel stressed and also reverse progress.

For me, these options, during these last few years have suffocated me.

The emotional side of illness has now far outweighed the physical side.

I have two main options for moving forward:

  1. Tried, tested and true. Low-FODMAP mixed with SCD (i.e. starving gut bacteria) for suppressing all symptoms. I know this to be tried, tested and true because that’s what I was doing for a week or two prior to the antibiotic, and I was feeling great.
  2. Pick my battles, diet-wise, and add in as many of these 11 ways to naturally improve stomach acid production.

I am choosing a mish-mash of both options in order to preserve my sanity and keep stress levels (physically and emotionally) at bay.

Life After SIBO Antibiotics Plan of Attack

Click HERE to save this post for later.

I keep no secrets.

Here is what I am doing:

  1. A fairly strict diet of Low-FODMAP + SCD + Paleo/Primal

    Just writing those words makes me feel stressed, and until you’ve lived with a past that includes major disordered eating and then a present that forces eating with restriction for healing, you really can’t understand. I don’t want to do this, not by any measure. But my doctor told me when I relapsed this past time that because I didn’t pay enough attention to diet after the last round, my gut was not able to get to the healing place it should have.

    And I am tired – so, so, so tired of living with the fear of being sick forever. Low-FODMAP is absolutely proven for SIBO treatment. The rest are still, in my opinion, debatable. That said, my plan is to include a specific form of starch 1-2 times per week (likely in the form of plantains, white rice, yucca or sweet potatoes). I do not believe my body has ever reacted that negatively to them (like it does with the FODMAP foods). If, after 3 months, I’m still making progress, I’ll begin adding in foods. (Is it 3 months yet?!)

  2. Siebecker Herbs

    While I was on Rifaximin, I also did the Siebecker herbal protocol. The supply is out, and my doctor has shipped one of the herbs to Minnesota for me. I have to get the other 2. Once I have all 3 refilled again, I will take them for another 4 weeks.

  3. HCL, HCL, HCL

    8 pills until I can get to 7, then 6, then 5, then 4, then….

  4. Apple Cider Vinegar every chance I get

    Along with many of the other things to increase stomach acid production. If you’re wondering how you can increase your stomach acid production naturally, check THESE out.

  5. Digestive Enzymes mainly if I eat starch.

  6. Tracking

    I’m still adamant that tracking via a food journal is the best way to understand health and healing. 

  7. Misc. supplements

    I’m trying a few new ones to continue the gut healing process.


I believe.

I believe I’m going to beat this.

Wait, you want the truth?

This isn’t about beating SIBO.

This is about beating all the underlying things that come with SIBO.

It’s about beating stress and working really hard to live normally without fear clouding that focus.

And it’s about not believing every single damn day that I wake up that “today might be the day my stomach bloats.”

It’s about believing that things can change. Things do change. And things will change.

(And they did change!) Updated in 2020: I am healed.

If you liked this post, you might also enjoy:

  1. Food Fear and Gut Healing
  2. Natural SIBO Antibiotics
  3. Reasonable SIBO e-book


Life After SIBO Antibioics. sarahkayhoffman

Similar Posts


  1. This is very helpful for me, Sarah. My stress right now is insane….I have been living siebecker herbs (can’t take one because of med interaction) but found it even more helpful than the last round of antibiotics. This is a reminder for me to work on the stomach acid thing too! Happy 4th, love!

    1. I have learned that the stress level is CRITICAL. If you can’t manage it, you will also likely never manage SIBO. This is why I’m moving more from “managing food” to “managing life.” xo

      1. Hi Sarah! I know this is so long after you wrote this post, but I just stumbled upon it and thought it could help you to ask, have you tried a prokinetic medication so that you don’t have to worry about the HCl pills or even the SIBO coming back?

  2. I am sitting here in tears right now because of ongoing stomach issues. I feel like I can’t live s normal life and be there for my kids because I have to be near a bathroom. The frustration is unbearable. Feeling your pain!

    1. Hi, Kristi! What you’re feeling is very real. I hope you had the chance to read another recent post I wrote about “The Emotional Side of Illness.” Hang in there. xo

  3. My heart goes out to you and I admire you for sharing all of this. No one will ever know how hard it can be to have to eat in a way for healing when you don’t want to, unless they have been there. I get it. You can do this, Sarah! My prayers are with you and I totally get it. All my best!

    1. I’d be lying if I didn’t tell you how scared I am to have to restrict again for awhile, but I am going to beat this, and then never look back:) xo

  4. I began consulting with a functional medicine clinical nutritionist in February. One of the biggest, most life changing things told to me is, “remove ‘I have fibromyalgia’ out of your story. Don’t repeat it. It’s no longer part of who you are.”

    Her words blew me away because I realized the times I have felt the best have been the times I was living my life, not focusing on how bad I felt, how to fix my fibro and thyroid, and just worked on my heart and life. I still had some days where I needed to manage my life, as you so awesomely out it, and take a rest day. Nevertheless, I was mostly symptom free until I moved cross country to another climate and culture. Then life changed immensely, and I felt insecure, unhappy, and at unrest. That’s when my symptoms flared up and I began consulting with her.

    I have since realized I wasn’t making space in my life, gratitude was missing, and stress was ruling my heart instead of peace and trust in the promises of Christ. I’m not saying “name it, claim it.” (If that makes sense??.) But I do believe our beliefs shape our perceptions and interpretations of so many things.

    It can feel so hard at times but we don’t climb our mountains in one step. I’m so excited to see where you go next!! Praying for you, that there would be light in your path as you journey forward to peace and freedom! xoxo

    1. Oh I love this, Keturah! Thank you for sharing. I always say that I have SIBO, Colitis, etc, but THEY do not have me NOR do they DEFINE me. Hang in there….xo

  5. Have you cured your SIBO? Is it even possible? I was told I had it about a month and half ago but have had symptoms for over 3 months. I feel I’ll never get better or being able to eat “normally” again. I was treated with antibiotics and felt great for a few weeks after but within this last week I’ve gotten symptoms back. Any incite and encouragement would be greatly appreciated.
    Xoxo Jessica

    1. Hi! I am so sorry to hear that. I’m not sure what could be going on, but it’s definitely **not** normal. You’ll want to ask your doctor about it. Are you taking anything (supplements or otherwise) in addition to the Xifaxan?

  6. I’ve taken Rifaximin and herbals to treat SIBO. It took 3-4 waves of antibiotics to knock it out, and it’s been 3 years with no remission. The first few waves did nothing and seemed to just make me worse, so you have to hang in there. The last course was (from memory) 2000mg/day and I combined it with herbal antibiotics, biofilm busters (like lactoferrin) followed by around 3 months of 2-4 tablespoons of date syrup per day (which is anti-bacterial and anti-fungal) and Manuka Honey.

    On the bright side, I got whatever bug(s) were slowly killing me. On the downside, my gut microbiota was wrecked (not just from the antibiotics) and it took me around 2 years to recover it. I had a lot of gut inflammation after the antibiotics, but at least I could eat without being in massive gut pain or having massive waves of upper GI gas+inflammation.

    Be sure to follow up the antibiotics with tons of strong probiotic yogurt (make it yourself from probiotic capsules and add a little bit of sugar to the coconut or lactose free milk to make it stronger). You must repopulate as the antibiotics will damage your good biota. Also, you can’t use the low FODMAP diet forever, because it starves your biota. If you can’t handle FODMAP’s you need to keep working on your gut.

    As your digestion and absorption will be greatly impacted and inefficient during this process, I highly recommend you take a good multivitamin and especially watch your B vitamin and omega 3 status closely. If your labs say your fat absorption isn’t good, then you must supplement with *lots* of extra omega 3’s (at least 1.5 grams day). You must also prevent any inflammation in your gut from spreading to your brain, so I would take bioflavionoids (like Rutin, Apigenin, etc.) and/or things like very absorbable curcumin such as Theracurmin (10-30mg/day as it’s strong stuff). I would treat inflammation in your gut like a “forest fire” outbreak and do your best to calm it down before it spreads (because if it lasts long enough – it will).

  7. Also, I see your taking 8 tablets of HCL a day. You must be *extremely* careful with Betaine HCL. This sounds like a dangerous amount of HCL depending on the dose. If you over do it you will damage your stomach lining and then be battling gastritis/deodenitus on top of SIBO.

    Personally, I would never take HCL again, it’s just too dangerous (you are dumping extra acid into an already acidic stomach).

    1. Just so it’s clear, you won’t notice how extra HCL is damaging your stomach lining until it’s like 95% damaged. It’s too dangerous and I’m surprised it’s sold over the counter. If it feels warm down there, it’s way too much and you should *always* take it with lots of protein.

  8. In your “Life After SIBO Antibiotics Plan of Attack”, it’s doesn’t look complete and missing some key things:

    – After antibiotics your gut microbiota is going to be wrecked from the lack of Lactobacillus and Bifidobacteria. (Get gut testing on ubiome.com and find out.) You should slowly work on adding in specific prebiotics — especially Inulin (Prebiotin) and Arabinogalactan (Larch Tree Fiber). Both can be found on Amazon and will feed the good bacteria in your gut (and hopefully not any bad bacteria – if it does your biota isn’t healthy yet and you need to work on it more).

    Raw fermented foods are awesome. Raw fermented sauerkraut is an awesome prebiotic.

    – You need to repopulate with good bacteria. VSL #3, lots of probiotic yogurt, etc. You need to add in more “good guys” to your gut.

    To prevent remission you must keep your motility up, feed the “good guys” in your gut and keep feeding them every day. They will do the work for you of preventing a new overgrowth.

    1. I Rich – I wrote this post a long time ago. I agree with a lot of what you said; just not everything:) I just want to clarify that 8 HCL was at the recommendation of my functional MD. I have almost no stomach acid, so we’ve been working on it since I was diagnosed with SIBO in 2014. For me, the jury is still out on all the probiotic and prebiotic stuff. You make so many great points, though, so thank you for all the thoughts!

  9. Wow wow wow. I know this post is a couple years old but I just stumbled on it while doubled over in pain because I think my SIBO is back. Everything you said resonated with me. I despise doing the low FODMAP diet, especially since I’m a few years on the other side of disordered eating too. I got better and told myself I’d never portion out or track food again…and yet now I HAVE to for my health. It really messes with your mind. There truly is a lot of fear surrounding everything when you deal with SIBO. I’ve done a few rounds of herbals and I’m almost done with one round of xifaxan now. I’ve done SIBO probiotics and enzymes. And spent a LOT of money. I think my ND means well…I don’t think she’s negligent or anything, I just think it’s such a misunderstood condition even still with all the research that’s been done.
    I hope you are better after these past couple years since this was published!

  10. Did you take Neomycin for 28 days also along with the Rifaximin? The standard protocol is 14 days of Rifaximin and Neomycin if you have methane showing up. If no methane and just hydrogen then just Rifaximin is used. Thanks.

  11. Hi Sarah,
    I know that the post is a Long time ago But maybe you read this nethertheless.
    At First sorry for my Bad english, i‘m from germany.
    The praktioner said my breathtest was positiv for Methan But very low, the Labor said negative. My stomac is bloated all day long an i have Histamin and Fructoseintoletanzes. The FODMAP diet is with these very very heavy.
    How long it takes that you realize a improvement at your stomac under the antibotics?Did you really absolute no carbohydrates and starch?
    Im already sooo so skinny a without all carbohydrates i will loose more weight.
    And I use to be a Person who could eat all an didnt put more weight on.


Leave a Reply

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