What do you do when SIBO keeps relapsing? Perhaps the better questions is, “Why does SIBO relapse?


SIBO is real, and it’s popularity (not the good kind of popular) is growing.

I have been saying it for such a long time now, but I have to say it again. My prediction is that SIBO diagnoses are only going to rise. 

With the rise in diagnosis, two main problems will remain:

  1. There will be a high percentage of people who will relapse.
  2. Of those who do or don’t relapse, they will not know how to heal. And by heal, I mean, for good, not just take a course of Rifaximin and/or Neomycin and call it a day. (This, of course, will typically lead back to #1, and the cycle will continue.)
When SIBO keeps relapsing agutsygirl.com #SIBO #smallintestine small intestine

And why is this whole SIBO issue such a big deal? (Enter sarcasm) I mean, it’s not even a digestive disease. It’s “just” an overgrowth, right?

Know this….90% of nutrients are absorbed in the small intestine.

When SIBO is present, it affects every last thing about you.

The signs and symptoms of SIBO can translate in harsh ways for the everyday life. 

Why Does SIBO Relapse

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When SIBO keeps relapsing agutsygirl.com #SIBO #smallintestine

This is the main question I posed once to Dr. Schweig,

Why does SIBO relapse? And more importantly, “Why do I keep on relapsing?

His answer?

That’s a great question. And it’s the hardest one to answer.

But he didn’t stop there.

We discussed the many reasons why I might be relapsing. My favorite part was when he told me,

You have relapsed so many times that I know it’s nothing you are or are not doing. It’s not your fault.

Here’s the deal, barely anyone gets through SIBO without relapsing, but most people don’t relapse this many times.

The difference is why SIBO was present to begin with. Sometimes it’s something mild. In those cases, I believe you relapse a time or two and if you do all the right things from a diet and lifestyle, medication and supplementation standpoint, you are able to fully heal and move on with your life.

But for me, and according to Dr. Schweig, there must be something underlying that is keeping the SIBO around. Everyone is different, but here are the two main things he thinks could be my underlying conditions:

  1. Mold
  2. Lyme Disease

And here are the additional tests (all via blood) I’ll be doing:

  1. HNK1 (CD57)
  2. Bartonella Antibody Profile
  3. Lyme Disease AB, Total and IgM, w/ Reflex to Western Blot
  4. C6 Borrelia burgdorferi w/Reflex to Western Blot
  5. VCS Test
  6. Shoemaker VCS Test (this is actually a vision one done at home)

What Do You Do When SIBO Keeps Relapsing?

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When SIBO keeps relapsing agutsygirl.com #SIBO #smallintestine #hydrogen

So, then, what do you do when SIBO keeps relapsing?

The answer is two fold and it includes one part simple, and the other part simple, but not easy.

  1. The simple part is that you make sure you have a doctor as good as Dr. Schweig to keep seeking answers with further testing.
  2. The simple, but not easy, part is that you re-evaluate prior SIBO protocols and adjust, if need be.

For me, the antibiotics are staying the same as the last round. I’ll be on Rifaximin for 4 weeks, and Neomycin for 2 weeks (the first two weeks of Rifaximin).

That combination has always cleared the current “ickies” I have going on in my small intestine, and after the course, I have always felt incredible. 

Right now, that relief will be lovely.

But we are doing something different with diet this time. 

Their ideas around SIBO during the course of the antibiotic(s) have changed from a diet standpoint. I’m still not sure if I fully agree, but I am going to give it a shot.

Wondering what it is? You’ll find it HERE.

Updated in 2022 to add: I’m healed. I have had zero SIBO relapses or SIBO symptoms since July, 2018. And then I wrote an e-book to share it all with you. Grab Reasonable SIBO HERE.

If you liked this post, you might also enjoy:

  1. SIBO Made Simple {Episode 17 with Phoebe Lapine}
  2. DIY Elemental Diet for SIBO
  3. Buyer’s Guide to SIBO Tests


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  1. I’m hoping that you find this response helpful, but I’m currently fighting SIBO. Findings are that most people who hit SIBO with antibiotics will relapse. I won’t touch antibiotics with a 10 foot pole, and instead am rebalancing my gut using the Gut Thrive program from Christa Orrechio. http://www.thewholejourney.com

    My functional medicine doctor also gave me a round of herbal remedies (FC Cidal & Disbiocyde- check my spelling) which you can find additional info about on http://www.siboinfo.com

    It’s a long process to first starve the overgrowth, then eliminate pathogens, then re-seed your gut so that the biome is balance. This is done with diet & supplements over a period of about 12 weeks. The minute you do antibiotics, you may be killing the bad bacteria, but you are also everything in your gut that you need for a healthy biome and possibly allowing candida to overgrow, or parasites to take over, etc. This is why the bacteria overgrowth relapses because you don’t have the biome in your gut to stop overgrowth from happening again.

    If you keep relapsing, I recommend avoiding antibiotics. It’s a slower process, but the success rate is much higher, and then of course there is the maintenance diet.

    I hope this helps!

  2. Anyone who doubts the reality of SIBO is uneducated or irrational. The gut biota is very real and fragile. Most MD’s and so-called specialists are utterly clueless IMO and can actually do damage. It is definitely possible to heal from SIBO and not relapse. I predict sometime in the future that there will be medical specialists who deal specifically with optimizing and healing the gut microbiota.

    I’m a survivor of a particularly bad case of SIBO. My biota became very toxic, and my body’s health and my weight massively declined between 2013-2015. I took several breath tests to confirm this. I was in constant pain from the inflammation, very constipated, with lots of upper intestinal gas after eating for most of 2015. In 2015 my gut lining started to degrade and I developed a bad case of leaky gut, and I was reacting to proteins (like milk and corn) I could formerly handle. I was literally on death’s door. My weight went from 155 to 116 pounds. No diet or protocol worked, I tried them all (like low/no FODMAP, SCD, etc.).

    The only thing that saved me were several large doses of Rifaximin+herbal antibiotics (Allimax, oregano oil, etc.), combined with anti-biofilm agents, followed by large amounts of pharmaceutical probiotics, probiotic yogurt, and prebiotics (Inulin and arabinogalactan). I had to closely follow a no FODMAP diet for ~6 months, then I slowly introduced various fibers starting with fermented Sauerkraut. Even after the antibiotics I was still in a large amount of inflammation but as my gut healed I returned to normal.

    It took several rounds of antibiotics because the gut microbiota is surprisingly strong. Whatever bacteria that grew into my small intestine and lower stomach was extremely resilient. I think I took 3 or 4 courses over a period of a year, with the 4th course lasting around 6 weeks. After the pharma antibiotics I switched to around 2-3 months of herbal antibiotics along with 4 tablespoons of “Date Lady” date syrup/day which is surprisingly antibacterial and antifungal. (I actually ordered a box of the stuff.) I was still in pain from the gut inflammation, but at this point when probiotics started working as a pain/inflammation reliever I knew I had to stop anything antibacterial and start the pro/prebiotics.

    I followed the treatment protocol here, but I combined the pharma and herbal protocols and it took several tries: https://www.siboinfo.com/

    It was a dangerous protocol, but I had no choice as I was dying. I wouldn’t recommend anyone do this without having no other options. I suspect most cases of SIBO aren’t nearly as bad as mine was, and it wouldn’t take nearly as much antibiotics to help correct.

    After this was over, I felt like a poison left my body. It was the hardest thing I’ve ever done, and I haven’t regressed. I am now more or less dependent on daily probiotic yogurt and I must eat lots of vegetables along with prebiotics to keep my gut healthy. If I don’t do this I’ll feel some background inflammation and my motility slows down.

    My nutritional status declined during all this from malabsorption. I developed a severe omega 3 deficiency (which one of my doctor’s caught indirectly) and B vitamin (especially folate) deficiencies which I’m still correcting.

    Most of the immune system is in the gut. If your biota gets unbalanced the immune system has to take over to prevent your biota from literally eating you alive. When the immune system gets upregulated from a weak or unbalanced biota all sorts of downstream effects all over your body can occur. If you gut is messed up and you develop acne and bad allergies out of the blue it could mean that your immune system has become upregulated due to an unbalanced gut biota.

    I would recommend to anyone with SIBO or IBS to find an experienced doctor or naturopath for help – they do exist. Treating SIBO involves purposely and forcefully “reshaping” your gut biota, which isn’t easy and takes time and patience. You must keep your motility up and become closely attuned to your body (especially inflammation). I tracked my gut biota over time using ubiome.com.

  3. Just found your blog after doing some research . I was just diagnosed with Sibo and was looking into the elemental diet. Just curious why you would never do it? Thanks!

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