Alright, here it is – a SIBO Q&A with A Gutsy Girl.
Why? Well, despite the fact that I have already written a ton on the subject, I still get questions daily on it. And I like that about you. You are always asking and inquiring, and I am more than happy to share.
If you search SIBO on agutsygirl.com, you’ll find pages upon pages filled with information.
But if not, then this is your place.
pssst…..the brand new version of Reasonable SIBO has released. Get your copy today!
SIBO Q&A with A Gutsy Girl
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Here are some of the questions I am frequently asked about SIBO.
Please make note that this is not an exhaustive list.
If you have your own SIBO-related question, please leave it in the comments below so I can address and add it to this post.
Do you think antibiotics were the most important factor in clearing your SIBO?
Yes and no.
Yes because, for me, without them the initial bacterial overgrowth was not likely to go away on its own.
I tried both a stringent diet and the natural antibiotic route; I could never fully get rid of it.
And guess what? Those routes won’t always get rid of SIBO for everyone. No shame in Rifaximin and/or Neomycin and/or another antibiotic to help rid the overgrowth.
That said, the antibiotics played no part in keeping it gone for good.
How do you know if you have SIBO / what kind it is?
The way you know is by getting tested. Then, once you get tested, your levels will tell you if you’re methane, hydrogen (or both) dominant.
A word of caution, though, the current SIBO tests do not detect a hydrogen sulfide dominant form of SIBO.
Here are some resources on agutsygirl.com for knowing if you have SIBO and what kind it is:
- How to Do the SIBO Breath Test
- Beginner’s Guide to Digestive Health Testing
- Do You Smell Like Rotten Eggs
Just found out I have SIBO. Started antibiotics recommended by doctor. Now what?
Great question! I think my 28-Day Rifaximin and Neomycin SIBO Journal will help.
Additionally, there is a lot of controversy over what we should be eating while on the antibiotic(s). You’ll see in my journal above that I have done it all – no FODMAPs, some FODMAPs, all the FODMAPs.
I do not think that doing the full course of antibiotics FODMAP-free is the answer. In fact, I did that during round one (I’ve done four rounds total), and it clearly was not the right answer; I relapsed fairly quickly.
I believe the answer is that you must eat some FODMAP foods, even though it will not make you feel great. In fact, I felt miserable. But I believe, deep down, that by eating FODMAPs as much as you can tolerate is best for the long run.
Again, though, everyone is different. I just learned to trust the process.
Does Atrantil help to get rid of Methane SIBO?
In 13 Natural Antibiotics for SIBO I stated,
According to Atrantil, “It is formulated by a board certified gastroenterologist to naturally and safely disrupt the the methane production by removing the unwanted bacteria from the small bowel and send them to the colon, where they belong.”’
I did use Atrantil, for the record.
Many have great success with it, some do not.
Also, many take it in addition to the antibiotics and/or other herbal supplements.
Broccoli
Someone asked,
Small servings of cooked broccoli are low-FODMAP, but why does it give me so many tummy problems?
First, ask yourself if this is exactly how you’re eating the cooked broccoli (in these quantities). (Taken from Reasonable SIBO.)
If your answer is, “No,” then try no more than 3/4 cup to see how you do.
But if the answer is “Yes,” then consider these things:
- What else are you eating with the broccoli? Other high-FODMAP foods? Maybe it’s just an overload.
- What is your emotional state while eating the broccoli? If you’re stressed about it going into the meal, your body knows, can, and will react. Remember, how you eat is many times as important as what you eat.
- Have you tried taking a digestive enzyme before eating it?
What happens if you are on a SIBO protocol and eat something high FODMAP?
Nothing. You just keep moving forward as if you had not eaten anything high FODMAP. The more you stress about it and dwell on it, the more it will impact you.
A SIBO protocol doesn’t mean you must be 100% compliant.
You deal with it and move forward.
Do antibiotics temporarily or permanently damage the gut?
Temporarily.
But if taken chronically, then more damage happens over time.
That being said, the SIBO antibiotics stay localized to the intestines.
They are almost completely non-absorbable which means they stay in the intestines, having a local action and don’t cause systemic side effects, such as urinary tract infections. (source)
What to eat when everything, even healthy things, hurt your stomach?
Go back to the drawing board.
- Why is everything hurting your stomach?
- Is it for sure SIBO?
- Anything else?
- Have you been keeping a detailed food journal?
If you still react to high FODMAP foods after treatment, does that mean you still have SIBO?
Likely. But also keep in mind how much of said food you’re eating. Just because you clear SIBO doesn’t mean you can eat 5 cups of raw broccoli.
Think practically. If a food become high FODMAP at 1/2 cup and you’re eating a smidge over that, perhaps the overgrowth has not cleared itself.
Can you tell me more about the Elemental Diet?
Yes, see number 2 below.
I know there are far more questions, so please, ask away in the comments below.
If you liked this post, you might also enjoy:
BTW. I started doing some of my IGTV Coffee Chats around SIBO. I’ll drop them in here as I record.
SIBO Q&A Part 1
View this post on Instagram
Xox,
SKH
You will heal. I will help.
What fodmaps did you eat? And did you do strict meal spacing and intermediate fasting? What was a typical day of eating for you?
There are several different SIBO tests. I think I have methane dominant SIBO. Will all of the tests listed give me the result or is one better than the other?
Thank you so much for this information, Sarah. I truly appreciate it as a navigate digestion issues. Question for you, I just got my results back from the GI MAP test. Did you have this done? I am wondering if there are markers on this test that could be indicative of SIBO. I’ve hit so many walls with my treatment and am wondering if Rifaximin could be what I need to kick these gut issues I’ve had for over a decade.
I just did my first GI Map. I’ll be writing about it soon 🙂
Did you find Atrantil helpful? Do you do the maintenance dose of it as I heard them discussing this in a recent podcast with Chris kesser. When did you incorporate HCL? After sibo meds? I’m on my third round of meds and feeling pretty awful. The doctor said after this round to take out garlic and onion and other fod maps but not to be extreme. I don’t feel like that is super helpful and want to be prepaid for after this round of medication. Open to trying HCL, a motility med or Atrantil. Thank you for all of your great info!
Which is more effective method to get rid of sibo either Rifaximin/neomycin or the elemental diet that you drink for 2 or 3 weeks that’s created by Allison Siebecker?
Great question, but I don’t believe there is a clear cut answer. People have had success by using both. I have only ever done the Rifaximin / Neomycin.
I have done two rounds of natural antibiotics and Sibo keeps coming back. I am seeing a naturopath so I’m waiting to see what my next step will be. My biggest symptom is my stomach bloat. It’s so uncomfortable it feels like my stomach is going to explode. Any tips to help with the bloat?
Hopefully this will help! https://agutsygirl.com/2019/10/28/why-you-might-be-bloated-and-constipated/
Hi Sarah, I have had gut issues for 10 years and despite seeking out numerous professionals to get to the bottom of it (pardon the pun), I have only now been diagnosed with SIBO. I’ve suspected it for years as there have been several times I was put on strong antibiotics for other things (sickness, post c section, gastro etc) and symptoms reduced only to return a few weeks later (which makes me think it has reoccurred already several times). I have exactly what you did- mixed type but all symptoms alike methane dominant and my archaea is very high via ubiome testing. The weight gain is annoying despite a very healthy diet but what’s most frustrating is the lack of weight loss when I exercise daily and cut calories. When I read your blog sibo- weight gain connection it all made sense and I feel my sibo mimicks yours! Just wondering where I can start with your resources and how to access your blogs to follow what you did to heal? I’m currently on a herbal gut protocol and felt instantly better (and lost 1 kg in the first week) but after 2 weeks on the protocol, my bloat has returned and the constipation. Did you have symptom relapse even whilst eradicating and on a protocol? I was never told to eat a certain way, just to Avoid all highly processed white flour goods, candies, cakes, pies, table sugar,honey, rice malt, maple syrup,and soft drinks, to avoid snacking, to avoid alcohol and to not eat foods that I know cause symptoms. Thanks for your info and help. Chloe
Hi. I wondered how long you had symptoms of SIBO before being diagnosed and then treated with antibiotics. I’ve been bloated for about 14 months and was diagnosed three months ago. I had one round of Xifraxin which didn’t work, then tried the antimicrobials, including Atrantil. Those didn’t work either. I also tried the low FODMAPand SIBO Bi-Phasic diets and found not symptom improvement with either.Now I will be starting a protocol of Xifraxin and Neomycin and I’m excited but trying to not to get my hopes up. Your journaling of your experience with this combination of antibiotics is very helpful.
Hi Denise! I think I went undiagnosed for YEARS! This is also why I think it took me so long to get rid of it. Good luck with the antibiotics. They absolutely worked for me 🙂
Maybe you can help me, please. I’ve been bouncing from one doctor to another, hospital to hospital. On paper I seem fine. I’ve had maany tests done. No one can help me. Stuff I struggle with the most:
– LOTS OF GAS, sometimes it’s trapped and I get bloated, sometimes I pass wind all day/night long… literally, so much of it.
– Nausea, and eventually vomiting. It doesn’t seem to correlate with anything I eat. It generally seems that when I’m gassy, especially when it’s trapped, I get nauseous, but not always
I’ve been tested for candida, parasites, coeliacs & crohns (blood tests, gastroscopy 2x, colonoscopy once), food intolerances, breath test for glucose, thyroid hormones – a bit low but not significantly, vitamin d3 – again, a bit low. But overall, nothing wrong.
Lactulose hydrogen breath test: I started with 8ppm at 1:53pm, at 2:33pm it was 22ppm, 2:53pm – 50ppm, at 3:13pm it reached 104 ppm. I hit the peak at 4:13pm with 149ppm. I was diagnosed with sibo, got a few rounds of xifaxan, did not help at all. Unfortunately the test didn’t measure methan. [Photo of my breath test results: https://ibb.co/CKGdfd3%5D
Currently I am taking mirtazapine which I will stop because for the entire duration (2 months) I’ve been having vivid nightmares nearly each night, waking up 2-3 times per night.
My current doctor said she doesn’t suspect sibo because xifaxan didn’t help. Instead she prescribed me probiotics. It doesn’t help. I don’t know what to do anymore. I am 23 and I have no life because I barely leave house due to my issues. I’m becoming very depressed and I hold no hope in doctors anymore
How soon did you start introducing probiotics after the antibiotics? Do you have any tips for the days/weeks after antibiotics? Your journal is really helpful!
As soon as my gut was feeling good!
Also, would you recommend taking L-Glutamine while on antibiotics?
I did, but ask your doctor!
I have had undiagnosed SIBO for about 3 years. I have been (mostly!) LOW-FODMAP for 8 months. I just finished my second round of Rifaximin. I felt like the first round helped with the consistency and regularity of my movements but I don’t feel like the 2nd round did anything. I have been trying to slowly reintroduce foods with no luck. I still have bloating/diarrhea/gas. I remained on the LOW-FODMAP diet throughout both rounds. What would your next step be? I know you had 4 rounds of antibiotics. Do you recommend I take a prokinetic now? I feel like motility is generally fine. I have been taking a probiotic, and atrantil as needed. I am feeling a bit discouraged and would appreciate any guidance you have. I am a bit skeptical of intermittent fasting but of course will be willing to try if that is you recommendation. Thank you!
I also wanted to add that I was diagnosed with SIBO about 3 months ago with a breath test.
If I suspect SIBO do I need to be treated in order for it to go away or can I start thrive probiotics and hope that will do the trick?
No, you should be tested. The probiotic is NOT a cure. Test, don’t guess. Find out for sure 🙂
Are prokinetics the key? I have tried antibiotics and my results so far have been very frustrating. I relapse very quickly! I think I sould move on Prokinetics.
They have been instrumental for my healing!
My functional medicine practitioner has given me candicid forte for 4 weeks. Is that enough to kill bad bacteria’s? Of course I am dairy free Keto too