March 26, 2015

Should Probiotics be Part of SIBO Treatment?

If you are looking at SIBO, like I am – that SIBO is a symptom of an extreme imbalance in the gut and not a primary condition, or infection, then probiotics must be part of your SIBO treatment therapy. Otherwise there is no way that you will be able to get your gut back into balance. Probiotic therapy must be a pillar of SIBO treatment. But, what should you take?

Which probiotics, when to include these during the treatment phase and how much to use, are all questions that should be asked as it pertains to your exact case. I do not use the same probiotics with each of my SIBO patients. But, at some point during the therapy, I do include probiotics as part of every patient’s SIBO treatment protocol.

I spoke at length about why probiotics should be included in a previous video; you can watch the video here: http://siboguru.com/sibo-why-probiotics-are-a-necessary-part-of-treatment/

Some doctors are recommending probiotics to their patients, but often times, they are recommending the wrong ones. Direct to consumer probiotics market directly to doctor’s offices. Yes, some do have studies showing that they can benefit the gut. But, we cannot infer that if these benefit the average gut, or if they benefit a person with an inflammatory bowel disease, that they will benefit a person who has SIBO.

"Should probiotics be part of SIBO therapy Reading a great post on SIBO Guru"

Tweet This

Whenever I work with a new patient, I have them line up their supplements and take a picture of what they have tried and what their experience was with the supplement. This is where these pictures came from. One patient had tried each of these products.

SIBO Guru Probiotic

SIBO Guru ProbioticsSIBO Guru Probiotic Use

There are ingredients in these products that WILL trigger a SIBO response:

Jarro Dophilus – maltodextrin, tapioca starch, contains dairy (milk) and soy (if an issue)
Florastor - has 33 mg of lactose!!!
Align - has lactose (milk) and sucrose (latter isn’t an issue for most SIBO, but good to know)
Culturelle – has inulin
Jarrow Ideal Bowel Support - has potato starch and soy (if an issue)
Pears YB – has pectin
Probio Pure's – has tapioca starch
Prescript -Assist - has prebiotics (this may work well for some - having prebiotics doesn't cross this product off the list, yet, this should be disclosed from the start when trying to find a probiotic that will work well when SIBO is present).

VSL3 – has maltose (this is glucose, and SIBO patients do not usually react to this). Each 2 capsule serving has 225 billion lactic acid producing flora, the sachets have 450 billion, and this will trigger a reaction in the small intestine – this is too high a dose – when it comes to probiotics, more is not better. VSL3 has some studies showing that it is beneficial in study subjects with various inflammatory bowel conditions. For those patients, with an inflammatory bowel disease (in their colon) treatment would include 150-225 billion flora. You would need to target the large intestine with this dose.

Introducing any of these direct to consumer probiotic lines will work again SIBO treatment. Aside from VSL3, there are ingredients in each of these that should not be introduced until flora balance has been restored. These ingredients will continue to fuel the overgrowth of organisms in the small intestine and make it harder to knock out long term.

For patients with SIBO, I often start with less than 1 million dose of flora, taking targeted probiotic strains at 1/4 of a million dose. My patients are instructed to open the capsule and take a partial dose as we begin the introduction of probiotics into their SIBO treatment regimen.

Angela Pifer | Functional Medicine Nutritionist

SIBOGuru.com

Enjoying this content? Sign up for updates... It's FREE!



Comments

from 131 people

Angela Pifer

Hi Tab,

I like Gastro-ULC, Apex to work on stomach healing post ulcer treatment. I do like bacillus coagulans by Thorne, this is a good one! I respectfully do not recommend a juice fast/ cleanse with SIBO. Fermentable compounds are water soluble and you will be drinking (offering a very quick and large load) of these at one time and this will likely aggravate symptoms. Honey needs to be clover (or North American) and has a lot of fructose, which might also trigger symptoms and same with fructevia. I would work on eating a FOMDAP plan, treating SIBO more (herbals - you may not have used the right combination, duration, etc...) and re-testing to actually see what was accomplishes with the herbals. How much did these knock this down. If you had 80ppm hydrogen on the first test and 45ppm hydrogen post herbal treatment, then you still have SIBO that needs to be treated longer. This was working, you and you doctor just didn't see this through long enough.

I hope that this helps!

Angela

Angela Pifer | August 21, 2016

Hi Angela,
I've had SIBO for 2 years now, as well I've also been dealing off and on with candida. I just recently got diagnosed with H. Pylori and an ulcer, however the GI doctor gave me antibiotics which actually got rid of the H. Pylori with a breath test to confirm. I also have Hypothyroid and Hashimotos Disease and a genetic mutation/error called MTHFR. To treat SIBO my previous doctor put me on berberine, neem, and garlic for an 8 week protocol which did not cure my SIBO - it seemed to aggravate my stomach a bit. Where I am currently is that I'm taking Digestzymes from Designs for Health and Interfase Plus from Klaire Labs. I'm thinking about including Formula SF722 and Bacillus Coagulans both by Thorne to help with any candida, yeast , or pathogens - do you think this is a good idea? I'm on my 8th day of a food cleanse, I'm only eating and juicing fruits and vegetables - trying to stick with the approved SIBO foods. I'm also drinking 100% pure coconut cream & milk, and oil. I'm basically eating salads, homemade soups with homemade chicken bone broth and coconut cream base with SIBO approved added vegetables, smoothies, fresh homemade juices (kale, cucumber, apple, lemon, ginger, and turmeric), steamed and raw veggies and instead of coffee I've replaced it with a coconut cream, 100% pure raw chocolate powder with either honey or fructevia (fruit fructose & stevia), and of course drinking lots of pure water. My question is that I feel a bit stuck because I don't know which supplements to take together and how much and for how long. I tend to only add in one supplement at a time as to see how my stomach responds. I'm also thinking about taking Young Living essential oils to help with SIBO - oils like oregano, ocotea, peppermint, and Digize. Do you have any advice or recommendations for me? Thank you for taking the time to read this and I hope to hear back from you. Have a great day!

Tab | August 15, 2016

Angela Pifer

Hi Mark,

I am sorry to hear about your daughter! SIBO doesn't immediately mean that probiotics should be pulled and antibiotics are the only option. Especially at her age, I feel like this would be a very slippery slope. If she is tolerating the probiotic (does not have any gut or body symptoms from taking it - notably in the first 1-3 hours after taking it), then it might be fine. I like to have a lot lighter hand with millions versus billions - when treating SIBO and especially when treating kids. You might want to cut the dose in half.

For d-lactate to contribute to d-lactic acidosis, there must be carbohydrate malabsorption (present with SIBO), ingestion of a lot of carbohydrates (diet), colonic microbiotia is dominated by d-lactic producing flora, reduced gut motility and impaired d-lactate metabolism in the gut. Probiotics CANNOT cause this on their own. Also, not to confuse the matter, but to also share that this is not all black and white - bifidobacterium reliably makes l+lactate and there are a couple of lactobacillus and clostridium strains that will convert this to d-lactate.

Prior to stepping into SIBO treatment - again, especially with her age, work on motility (meal timing and perhaps magnesium to keep her bowels moving, if trending towards constipation), get her walking/ active daily, reduce (DO NOT remove carbohydrate intake), consider digestive enzymes, and gentle mitochondrial support.

I like Sibiotica, by Apex - for her I would recommend approximately 1/4 capsule once a day. You'll find this on my site/ shop to review the strains.

I hope that this helps!

Angela

Angela Pifer | August 21, 2016

Angela,

Just found your site, and am glad I did. Our 5-yr old daughter has been told she has SIBO. She's been on Florajen4Kids probiotic for a while now, which has 4 strains:

Bifidobacterium lactis Bi-07—over 3.5 billion
Bifidobacterium lactis HN019—over 1 billion
Lactobacillus acidophilus NCFM—over 1 billion
Lactobacillus rhamnosus HN001—over 0.5 billion

But this evening I read on another blog (chriskresser.com) the following:

"Probiotics are actually a mixed bag with SIBO because SIBO often involves an overgrowth of D-lactate-producing probiotic species, and that causes a buildup of D-lactate in the gut, and a lot of the symptoms associated with SIBO are caused by that. So, you want to avoid in many cases taking any probiotics that have D-lactate-forming species like Lactobacillus acidophilus, which is, of course, one of the most common probiotics that people take."

Since we have been giving our daughter a probiotic with Lactobacillus acidophilus, his post concerns me. Is he accurate? The last thing we want to do is worsen her condition; we need to improve it! She is regularly distended, and is on laxatives because she suffers from functional constipation (and X-rays have shown stool throughout her colon), and we've been told, as I noted above, she very likely has SIBO.

And if you have any specific probiotic recommendation based on what I wrote, that'd be a bonus!

Your input would be GREATLY appreciated! I can't tell you how lost we feel and how much we appreciate people like you who care enough to help from afar.

Thank you,
MDB

Mark Bernstein | August 11, 2016

Angela Pifer

Hi Camille,
The h pylori breath test is a different test. The breath test for SIBO is a glucose or lactulose breath test. The body swelling - look at electrolyte levels and immune triggers (latter if swelling is inflammation) and rash points to inflammation, immune as well.

Warmly
Angela

Angela Pifer | August 11, 2016

After reading more on your site, others said they confirmed SIBO with a breath test. Is this the same as the H Pylori breath test? I've had many tests done, including the H Pylori breath test, and of course it was negative. However my symptoms continue...horrible heartburn, horrible low back pain and leg pain, stomach pain and digestive issues, dizziness, head pressure, body swelling mainly face, and body rash. Thanks again Angela.

Camille | August 8, 2016

Angela Pifer

Of course there is (they should know this)! Glucose or Lactulose Breath Test is how you test for this. The lactulose is the one that I prefer. I like seeing the full three hour test.

Warmly
Angela

Angela Pifer | August 11, 2016

Hi Angela. Thank you for this article. I am again researching SIBO since I haven't found a doctor that will help me. I did have a Naturopath doctor say yes you have SIBO and I was given strong antibiotics Xifaxan but they didn't help. I asked if there is a test to confirm SIBO and I was told no. Since others are saying they've been tested, please tell me how this is confirmed? I'm dealing with many symptoms. Thank you.

Camille | August 8, 2016

Angela Pifer

Hi Jessica,

I list the ones that I use under my shop: http://siboguru.com/product-category/probiotics/ Please review these with your doctor. The main goal here is to figure out why this happened and to address that as well.

Warmly
Angela

Angela Pifer | August 11, 2016

Which probiotic would you recommend for my five year old son with SIBO? All the ones his doctor recommended have things in them that cause SIBO. He just finished the antibiotic treatment, he is on the SIBO/GAPS diet. Can you help? I want this to never happen to him again.

Jessica | August 4, 2016

Angela Pifer

Hi Suzy,

No an antibiotic doesn't treat a yeast issue. You also need to know what kind of SIBO you have - whether methane dominant or just hydrogen, to know if you are treating this correctly with rifaximin alone.

Best of luck to you!
Angela

Angela Pifer | August 3, 2016

Hi

I currently have sibo and candida and I am taking rifaximin antibiotic. Will this antibiotic treat both conditions or will I still need to treat the candida once I have finished the antibiotics?

Thanks

Suzy | August 3, 2016

Angela Pifer

Hi Megan,
I haven't any experience with these. They would never be a product that I recommend and I haven't had a patient who has tried these in the past to offer a response here. I did review them. They are making a lot of claims that aren't true and I don't recommend supplements sold at Walgreen's (kind of like Activia and that one a day will help to regulate you - they were in a lot of trouble after making these claims). The probiotics I use in my practice are listed under my shop (I also recommend Prescript Assist - but I don't carry this).

Warmly
Angela

Angela Pifer | August 3, 2016

Hi Angela,

Thank you for all of the information on SIBO. I have read in many places that prebiotics are not good for people with SIBO. However, I recently heard about a new supplement, called GoodGut. It contains a natural polyphenol prebiotic, not prebiotic fiber. Do you think this would be helpful for people with SIBO or should it be avoided?

Thanks,
Megan

Megan | August 2, 2016

Angela Pifer

Hi Ashley,

I am sorry to hear that you are struggling with these issues. I am assuming you've tried seeking out another provider in your area? If your doctor can't help you, get a second opinion. You might look for 'functional' or 'integrative' as key terms to a doctor who treats more holistically. I really do appreciate budgeting. I offer payment plans - I really get that once a person seeks me out, they have often been dealing with these issues long term and it can be quite draining on the budget. SIBOInfo.com is a great site, all content is free. The SIBO Symposiums may also be purchased and viewed online. Honestly, I only recommend the first one. The last two haven't added much more in the way of content and the first one is a lot more descriptive.

I wish you the best with your healing journey....

Angela

Angela Pifer | July 27, 2016

Angela,
I really appreciate your blog and site. Thank you for providing this information. It is evident that you care about people getting better. I have been suffering from gastrointestinal problems for 14 years. Last year I got c diff and things improved after (diy)FMT but my new normal is very very sad. I'm nearly certain I have Sibo. I have been so discouraged and in despair. I often am overwhelmed with hopelessness about the possibility of ever regaining gut health. I would really like to work with you, however I really can't afford it. Do you have a book outlining suggestions or can you recommend some resource for me? My doctor is so clueless. Thank you!

Ashley | July 26, 2016

Angela Pifer

Hi Betsy,
I recommend 24 hour yogurt to my patients, if they have no issue with dairy (protein/ immune reaction). SCD yogurt is the same thing. It is cultured for 24 hours to use up all the lactose. White Mountain makes a commercial brand that is free of sweeteners and thickeners.

Warmly,
Angela

Angela Pifer | July 23, 2016

Also, is SCD yoghurt acceptable during or after treatment?

Betsy | July 6, 2016

Angela Pifer

Hi Betsy,
I am sorry to hear about your continued symptoms. Your stool test - though your lactobacillus is zero on the culture this does not mean that you do not have any lactobacillus. Lactobacillus is extremely hard to culture. I really like Doctor's Data stool testing. I also like Genova - Genova offers one stool test where they culture and also look at PCR levels (this is a DNA probe to identify the presence of lactobacillus species by their DNA alone). When the culture is negative, the PCR RARELY every is. I have seen levels on the PCR down in at the 25% detected level but never, never zero. I wouldn't use any supplement (probiotics included) that trigger a gut response like that. You may need to wait longer to introduce these. This has more to do with where SIBO is in your small intestine, why it was set up and to what degree it is there. After the correct treatment (you are negative for SIBO and you have addressed the underlying issues that set this up in the first place) you would then work more on gut healing and immune modulation. For my more sensitive patients, I might start them on 1 tsp sauerkraut juice 1-2 times a day.

Warmly,
Angela

Angela Pifer | July 23, 2016

Hi Angela,
I've had distension for 2 years now.
My stool test revealed 0 Lactobacillus and 0 Bifidobacterium and a gram negative bacteria along with systemic candida. I am working with a functional medicine clinic treating the SIBO with 14 days of Rifaximin. When i introduced Lactobacillus single strain my belly blew up. I see you recommend Sach Boulardi first, then Bifidus, then Lactobacillus. Would you still suggest this sequence based on my history? And only after a round of antimicrobials if the breath test is still positive correct? The clinic suggested Ther-Biotic Complete. Thanks

Betsy | July 6, 2016

Angela Pifer

Hi Joebent,
It sounds like the treatment was not successful and that you will need to find a treatment that will help address SIBO directly, while at the same time addressing the underlying reasons that SIBO was set up in the first place. I prefer to not do multiple rounds of antibiotics. I prefer to use an herbal antimicrobial approach, mainly because people always need more than one round to fully treat SIBO. If one of my patients opts to start out with antibiotics, I would then shift them immediately to herbs after the initial antibiotic round (and we would use the initial SIBO test to see how many herb rounds we would need - this is based on the parts per million level present, and type of organisms present).

I respectfully do not recommend the probiotic that you are taking - mainly due to the high number of organisms in it. When you are trying to evoke change with the small intestine, we need to have a much lighter hand and look at millions, not billions of flora. You might try opening the capsule and taking a tiny amount of it.

I hope you find some recovery with your symptoms soon!

Warmly
Angela

Angela Pifer | July 23, 2016

I tested positive for SIBO a few months ago. Took Xifaxcin for a few weeks. No obvious relief and no re-test. Have had multiple tests including endoscopy and colonoscopy. All negative. Currently take this probiotic:

https://www.amazon.com/gp/product/B001LIW11Q/ref=oh_aui_detailpage_o00_s00?ie=UTF8&psc=1

Is this a good option?

joebent | June 22, 2016

Angela Pifer

Hi Kb,

Please discuss this directly with your practitioner. This depends - on what set SIBO up, your level of symptoms, which treatment protocol you are on, how long you will be on it, etc.

Warmly
Angela

Angela Pifer | July 23, 2016

DEar Angela,
I am beginning a protocol soon to eradicate sibo again. IS it ok to take small probiotics at night away from antimicrobials?

kb | May 21, 2016

Angela Pifer

Hi Michael,

I do recommend that you work directly with a health care provider while taking any herbal regimen. I also respect that you are trying to do this and that your doctor and GI doctor (although very good doctors) may not understand the alternative approach to treating SIBO.

When treating SIBO, each herbal round should reduce your parts per million gas (from your SIBO test) by 20-30 ppm each month. I do not use berberine and neem alone for this. They are part of a more comprehensive protocol. The goal is to find the right protocol to do this and then reduce your numbers, retest to confirm, address symptoms that come up along the way, address the underlying reason SIBO was set up in the first place and then work on gut recovery, immune modulation, etc.

Once your SIBO test is negative, then we start the healing process and we would add in a good motility agent. Even if you have loose stool, this means that you are shifting water (dumping through osmotic effect) into your small intestine and bowel and matter is moving too quickly. A prokinetic is targeted at the migrating motor complex (which sweeps the small intestine clear of debris).

I can't speak to why you are having looser stool on the berberine and neem. I would need to look at your full case to be able to help more with this. I don't usually see looser bowels when using berberine and neem.

Whenever reducing SIBO organisms, there will be less to uncouple bile acids, which will allow you to better absorb your fat.

If your bowel movements are darker in color, really odorous and they float, then this might mean fat malabsorption. If simply looser, you may want to look at what you are eating to see if you are triggering this eating too high of a fermentable load at one time (this triggers an osmotic effect and draws water into the bowel).

I hope that this helps!

Warmly

Angela

Angela Pifer | July 23, 2016

Hi Angela,
I just wanted to follow up on the previous message. I mistakenly wrote 3x day with the metronidazole dosage when it was 4x a day. I've switched primary doctors, however the earliest appointment available to see the doctor is May 20th. I did see the physician assistant on March 17th and discussed my condition with her. She had never heard of sibo, and when I asked of the possibility of getting the suggested labs on your site she deferred to the doctor who didn't feel comfortable with ordering the tests, instead I've been referred to another GI doctor. To my disappointment the earliest appointment available is in late June. I was given another prescription of metronidazole but I decided to order the berberine complex, and neem on your website and have been taking 900mg of the berberine 3x a day and the neem 2x a day. I've experienced a reduction in gas and gut distension indicating its effectiveness, however I have been experiencing a regression of my bowel movements to loose and at times watery. Could this be a side effect of the berberine or neem? I've had a stool analysis years ago indicating a higher fat content which would explain this, however when I've used metronidazole my bowel movements would revert more to a normal state. I've read that damage to the intestinal lining from inflammation could cause malabsorption but why would the malabsorption of fat subside,(or at least improve) when treated with the metronidazole? I know I need to eradicate the bacteria first before proceeding with a repair and replenish phase but how do I get to that point, and know what to use if I can't get cooperation from doctors to perform the tests I'll need? I've started reading a little into the vagus nerve and the role it plays in digestion and have even started OM chanting, deep breathing exercises, and even cold water face immersion, all of which i've read seem to stimulate the vagus nerve. Can this start a healing process and improve motility?, I'd appreciate any insights you may have on this topic.
Sincerely,
Michael

Michael | April 17, 2016

Angela Pifer

Hi Dave,

Prescript Assist is a spore forming probiotic. It does not have any prebiotics in it, even though it lists ‘prebiotics and probiotics’ on the label. I use this often times with patients, with very good results. Please discuss this with your provider.

If you are reacting 2 minutes after you eat, I would look further at h pylori, low stomach acid, ulcer/ gastritis, bile reflux, etc. You might also have a very hypersensitive gut response, where you are feeling an osmotic shift into your bowels (water shift) from merely putting something in your mouth.
After two minutes of eating, food has not had time to work its way out of the stomach and into the intestinal tract to then come across and overgrowth and trigger a SIBO reaction. Something else is going on here.

If your SIBO is fully addressed, then it sounds like you still have a good degree of dysbiosis and perhaps more gut healing to do to help improve your ability to tolerate more foods.

After dealing with SIBO and gut imbalances in general, your gut is likely hypersensitive and hyper-responsive to eating and drinking anything. Though some gut sounds and movement are normal (borborygmus is gut sounds/ gurgling for anyone else reading this) it is the degree that they are uncomfortable that would be more concerning for me. You might try enteric coated peppermint, Iberogast or gentian and skullcap to settle your gut down a bit.

Best of luck to you Dave!

Angela Pifer | July 23, 2016

Just found your good article on HCL thanks and it reminded me of the possible root causes for low HCL.

It looks like my original comment disappeared? Here it is again:

---

Hi there. I have what seems to be a somewhat mild case of IBS/SIBO and have had it off and on for probably 15 years maybe more.

To give you a little background, I have been suffering 30 years in total from multiple ailments, where Brain Fog has always been my worse symptom (of many) and my Gut/Immune system like many other people was wrecked by Antibiotics and other toxins when I was a teenager, never knew, and struggled ever since, which brought on other issues like Adrenal Fatigue etc

After 40+ Doctors, 5 Specialists & 5 Naturopaths, I finally figured out 3 years ago (on my own) I had Candida and Leaky Gut, changed diet and treated it and had some good success for 3-4 months but then regressed and did not know why, later I would discover Adrenal Fatigue was an issue in regression with toxic Copper levels and more issues like Methylation issues, Sulfur intolerance etc that were also plaguing me.

Many years ago I also looked at IBS thinking I might have it, but I didn't seem to suffer very much from some of the more tell-tale symptoms so dismissed it, my mistake. Back in Oct last year the wife and I ate at a restaurant and we both got some kind of bug, she recovered in 2 weeks or so, I STILL have not (and this is when I looked deeper at IBS/SIBO and put it together for me since getting a bug like this can trigger SIBO as you must know).

My current symptoms, which are typical for me, are: Diarrhea(was very volatile for a month or two, has settled now I don't go right after eating), occasional heartburn, occasional gas/belching, occasional cramping (sometimes from gas building up like in public or friends house etc), occasional Brain Fog (seems to only happen when a lot of food is fermenting and gas building up), and quite a lot of intermittent Borborygmus (stomachs gurgling).

==========

QUESTION 1 - I am a little confused about your take on Prebiotics, since on one hand you seem to say they are not a good idea for SIBO, but on the other you sometimes recommend Prescript -Assist, and state having Prebiotics doesn't cross it off the list?????

I ask this too, because part of me thinks that Probiotic might help me, yet I know Prebiotics cause me issues. Let me further validate why I am saying this. FODMAPS as you know are proven to be issues for SIBO people (of which Prebiotics fall under) and for me they cause me HUGE Borborygmus, which is usually followed by Gas at minimum, it is actually the Prebiotics that feed the Bacteria that really cause my GI to act up, and then once "activated", just about anything I eat causes symptoms. Its fast too, there are times where it happens within 2 mins or so, and if active, just the food going in the mouth can stir those buggers up.

Having said that, the reason I am still considering SBO's for me is Boulaardii seems to be good for me, and has curbed the Diarrhea in the past a few times, the last time I took it 4 months ago I was veering into constipation so I had to stop, then eventually Diarrhea came back. Do you think in my case I should try the Prescript-Assist???

It is interesting because there is some conflicting info online from some of the more knowledgeable people on SIBO. Norm Robillard from Digestive Health wrote a good book that details why anything Fermentable is bad, which I agree with and is missed from some of the other prominent diets, yet he ignores some of the Fodmaps like Onions, Garlic etc which to me is a BIG mistake (just because they are not very fermentable, he thinks that IS everything, I disagree as would other knowledgable people but he is right they are a BIG issue).

QUESTION 2 - I am not totally convinced the Borborygmus itself is bad, though it seems highly irregular and not normal the amount I have for sure. If I eat the wrong things, my GI can be rumbling for hours after, all kinds of funny noises coming from there etc. As I think I said, the Prebiotic things are what REALLY get this going the most (Sweet potatoes and Plantains are big ones too), it almost makes me think that feeding some of the "good wars" is getting a WAR going with whatever "bad ones" are there (though I do realize SIBO is considered to be "good guys in the wrong place", but who knows what else is in my GI...).

What is your take on Borborygmus in general, and concerning it and SIBO, and how about in my own case where Prebiotics are a big trigger???

Thank very much for sharing your thoughts here

Dave | April 12, 2016

Angela Pifer

Hi Carla,

Some people with SIBO can have lactose. Eating lactose containing foods - cheese, milk, yogurt... do not cause SIBO. I do not find ever that one round of antibiotics fix SIBO. If your test did indeed come back as positive still, YOU DID NOT CAUSE SIBO TO COME BACK (not yelling, merely for emphasis because I not want you to feel that this is your fault :).

I always find that people need to full rounds of treatment for low levels of SIBO. If higher, then you may need more.

Warmly
Angela

Angela Pifer | July 23, 2016

Hi Angela, I recently completed a ten day course of Metronidazole and did a second SIBO breath test. I do not know the results of the second SIBO breath test yet. I took one one dose of Florastor only to discover that it contains lactose. Is the lactose in the one dose of Florastor enough to cause a SIBO relapse?

Thank you, CC

CC | April 10, 2016

Angela Pifer

Hi Sarah,

I like all the products that you listed here - no issues with adding these in. White rice and rice flour is not a high fodmap. Similase is fine, I often use this one with my patients. I like a curcumin and resveratrol. Really, what we are looking for is overall system support, immune modulation and reducing inflammation. Even though some supplements may not seem like they are directly targeting the gut, they can be helpful at supporting the system as a whole.

I list the probiotics that I use with my patients in my shop - it is easiest to reference this and then to discuss these with your practitioner to find the right one. http://siboguru.com/product-category/probiotics/ You can open any probiotic and take a small amount of it to start. You don't need to purchase a powder probiotic to start.

Warmly
Angela

Angela Pifer | July 23, 2016

Hi Angela,
Firstly,thanks so much for your knowledge and website! It has been helpful in a lonely journey healing from SIBO! I just finished herbal treatment and am starting on the prokinetic, gut healing, low fodmap for 3 months, with prayers for no relapse! It was suggested I consider Robert's Formula from Integrative Therapeutics, and L-glutamine. I'm wondering about the other ingredients in the RF that could possibly be high fodmap? (rice flour, and some of the other herbs?) Additionally, Similase enzymes from Integrative Ther. contains other herbs I'm curious about (marshmellow and slipper elm, DGL, and Gamma-Oryzanol (rice bran).

I've also read Resveratrol can be a part of the gut-healing protocol, and I'm curious if that is for everyone? The description states cardiovascular and immune health, and I was wondering what specifically it would do for SIBO patients?

There are mixed messages out there whether probiotics should be introduced (and which ones), leaving many of us confused, and I understand it can be a case by case basis. Reuteri Pearls from Nature's Way was suggested, but I'm also concerned about the soy lecithin and trace amounts of milk protein (especially with more research showing AI disease and SIBO links). Some say starting with a powder to reintroduce them slowly? Would that be your Klaire Labs powder on your page?

Thanks!

Sarah | April 4, 2016

Angela Pifer

Hi Jennifer,

I am sorry for the delay in answering your question. I see that time was of the essence here. I have been working 10 hour days in my clinic and haven't been able to answer questions from my site in a while.

I definitely do not recommend any of the Pharmax probiotics for SIBO. They all have prebiotics in them. I use them for other conditions and really love them, that is why they are on my site. I would start with bacillus coagulans first, then saccharomyces boulardii, then Prescipt Assist or MegaSporeBiotic. Please discuss these with your practitioner. I ALWAYS recommend opening up the capsule and starting slowly with this. Microdose up over a week or two. If you handle 1/2 capsule, but not a full capsule, then you dose is 1/2 a capsule.

Yes, Iberogast is good for SIBO, dysbiosis, calming the gut, as a bitters digestive aid and as a prokinetic.

Warmly
Angela

Angela Pifer | July 23, 2016

I am at the end of a 2 week treatment with Rifaximin and my doctor had told me to start use of Iberogast and Pharmax HLC Intensive as soon as I was done with the antibiotic. That would be today, but I am now seeing that you pointed out this probiotic is not a good choice for SIBO. I am trying to get something to replace it with ASAP and can get Klaire Labs Therbiotic Detox by Monday - can't seem to find anything else from your recommended probiotics at a local brick and mortar store and nothing ships faster. Is this an appropriate choice? Do you have dosage hints since you seem to recommend lower dosages for SIBO? Is Iberogast okay? Thanks!

Jennifer | April 2, 2016

Angela Pifer

I am so, so sorry Michael. The doctor that put you on rifaximin should have followed that up with further treatment, or herbals and then worked on gut healing, immune modulation, helping you heal – addressing the underlying issue. An antibiotic is not going to fix (with one round) a situation as complicated as SIBO.

I still to this day see ‘Add fiber’ on colonoscopy reports and it simply makes me cringe. Adding fiber may work for some (without SIBO) but just as you experienced, things became 10 times worse.

After your SIBO breath test, you should have been treated until you came to a negative breath test – retested to make sure that the treatment was effective.

You are absolutely right about the IBS statement – it is like saying your arm is itching because you are scratching it. I am so frustrated for you!!!

I would love, love to work with you Michael. Let’s really get to the bottom of this and treat this and get a plan in place so this doesn’t recur.

I do like to see basic blood work when we start – CBC, comprehensive metabolic panel, iron panel (total iron, TIBC, UIBC and ferritin, thyroid panel (TSH, Total T4, Total T3, Free T4 and Free T3, T3U and rT3), serum B12, serum magnesium and urinalysis.

If we need any functional labs done, including breath testing, I can order these for you. I do apologize for the delay with my reply to you. I was consumed with my patient load and have just recently graduated a few patients and opened my practice to new patient appointments. http://siboguru.com/contact/

I look forward to meeting with you, when you are ready.
Warmly
Angela

Angela Pifer | July 23, 2016

Hi Angela,
I would like first to thank you for providing hope to all sufferers, and a forum to with which to reach out. My symptoms began over 8 years ago and back then there was very little info on sibo, but what was available seemed to match all of my symptoms. I suffered with abdominal bloating(distension), flatulence, bouts of diarrhea, nausea, nasty sulfur smelling burps, etc. For the next 6 years I visited my primary care physician and 3 gastroenterologist specialists. Upon my first visit with each of the 3 specialists I inquired about sibo as a possibility and being tested for it, but each quickly dismissed this as a possibility. In fact, the 2nd specialist upon my next visit asked me If I was familiar with sibo and prescribed rifaximin for 10 days. Even though I reported positive effects he dismissed sibo, explaining rifaximin would have cured me had sibo been the source of my problems. I went through an upper GI, 3 different types of blood work, 2 stool tests, a gastric emptying test, 2 abdominal scans, an endoscopy, and a colonoscopy. The last specialist I visited 2 years ago was sure I had IBS and treated me as such with fiber and a probiotic, when my condition worsened with the treatment he put me on a subscription fiber as he explained that some people have a sensitivity to fiber. My condition became 10x worse. I spent 3 days almost entirely back and forth to the bathroom with diarrhea, and nausea and just an overall unwell feeling. The specialist as a last resort was putting me on the specific carbohydrate diet. I was OK if that's what it would take to feel better, but I asked if I was going to make this kind of life change if I could at least take the lactulose breath test for my own peace of mind to test for sibo. Despite his assurance that I didn't have sibo he agreed to set up the test, if it would at least get me to move passed that line of thinking. The test came back positive for sibo and I was prescribed 250mg of metronidazole 3x a day for 14 days. I was in tears that day. 6 years of testing for everything else, and all 3 specialists didn't take my thoughts of sibo seriously, and not one even wanted to test me for it. For the 1st time in 6 years I started to feel like myself again, but after 2 months the symptoms started to return. The specialist refused another prescription because in his own words I was successfully treated and just needed to continue taking a probiotic, his last words to me were, "I still believe you have IBS". Maybe I'm wrong, but isn't that like telling someone with a sinus infection that they have a headache? I consulted with my primary care doctor who didn't have a problem with another round of antibiotics. This time the symptoms didn't return for about 6 months, a 3rd round another 6 months, and finally last april I was given a 10 day prescription with a 10 day refill that I used consecutively. It wasn't until 9 months later that I've started having the symptoms return. I've been reading up on sibo treatment over the last a couple of months and have learned quite a bit thanks in great part to your site. My experience with the healthcare system, or at least the practitioners I've been engaged with, have left me somewhat jaded. I no longer have a primary doctor, and i'm not sure where to begin again in regards to asking for specific labs as it would seem to me that doctors within the healthcare industry seem to have a much narrower focus than is required to diagnose and treat sibo. I would like to follow up with you for treatment at some point, but do you know how I can acquire the necessary labs if I run into resistance. Do you have any suggestions that may help. Thank you in advance Angela for any advice or insight you may have, and for being that source of hope.

Very sincerely,
Michael

Michael | March 14, 2016

Angela Pifer

Hi Jamie,

If you have a redundant colon (there is more colon present anatomically - this does not always result in a twisted colon, yet there is always more colonic fermentation) then the SIBO testing is not accurate. I would go more off of symptoms to treat this. Xifaxan also doesn't work on the colon, it only works in the small intestine. Bile acids help activate it and these are neutralized in the large intestine. If you have had your appendix removed, or appendix burst, then you could have an adhesion form in this area. In that same area is also your ileocecal valve. If this is stuck open, then this can be quite painful.

If you are going to take an antibiotic, I do recommend taking it for the full duration. It was unclear if you are saying you took one day of xifaxan or one round of xifaxan. It sounds like there is more to evaluate here to then figure out the correct course of treatment. Talk with your GI doctor to see if they will refer you to imaging to get screened for an adhesion and also seek out a good visceral manipulation therapist (this is a form of body work) - they can help evaluate this.

Warmly
Angela

Angela Pifer | July 23, 2016

I am currently on my second round of xifaxan 550mg 3x/day for 14 days. This was prescribed after a colonoscopy fixed a twisted colon, but I also found out it is redundant. I got the colonoscopy due to being constipated for about 6 weeks, and that is when they found the twist. I went back in with pain after the colonoscopy and that is when the Dr started with the xifaxan. The first dose made an improvement so I didn't take it for two weeks. The pain came back so the Dr. told me to do the second dose.

Currently there is no improvement. I have just started eating very minimal carbs with this round of the antibiotics.

All of my pain seems to be in the exact location of where my appendix was. It was removed about a year and a half ago. Is there damage in that area from the appendectomy? Is the xifaxan a waste of time?

Jamie | February 28, 2016

Angela Pifer

Hi Tracey,

I use water kefir and not coconut water kefir, as part of my replenishment protocol (depends on the patient). I don't use coconut water nor do I recommend it since it has some fermentables in it. I don't really find a lot of reasons to use coconut water. Respectfully, I think that there is too much hype around it.

Warmly, Angela

Angela Pifer | February 15, 2016

I make my own coconut water kefir - do you think this would be ok to take as part of my SIBO treatment?

Tracey | February 15, 2016

Angela Pifer

Hi Anne,

Thank you for your post. It sounds like you are working very hard to try to heal the gut and get on the right protocol. I pair low dose naltrexone (LDN) with Iberogast OR Motilpro, but not both. If the LDE isn't effective enough, I'd pick one of these motility agents, not both. There would be other reasons to use Iberogast too, but I don't know enough of her case to comment here.

I would not add in lactobacillus acidophilus. That I can comment directly on. I can't say specifically which probiotic to take, when and which dosage. This is really by a case by case basis and I would nee to be working with her directly to make this recommendation. Getting to a negative breath test is the first step, and really at that point, she is about 1/3 of the way to healing (if the treatment portion is over). Next is gut healing, immune support, then gut rebalancing (and the latter takes a lot of time). I am happy to help and yet, time is of the essence. I recommend that you contact Sophie at scheduling(at)SIBOGuru.com to schedule an appointment. I might be able to get her in fairly quickly... there are other combination therapies that will address hydrogen sulfide. I have worked to clear hydrogen sulfide SIBO before. If she is still experiencing sulfur smelling flatulence, then this has not been addressed.

I hope that this helps!

Warmly,
Angela

Angela Pifer | February 15, 2016

Dear Angela,
Thank you for your site! It contains a wealth of information that I couldn’t find elsewhere. We will probably set an appointment to meet with you one on one via Skype, but meanwhile we have some very, very,pressing questions that we are hoping you can answer ASAP.
First, my daughter’s condition: She has tested positive for SIBO. We believe the type is hydrogen sulfide because of the terrible smelling flatulence and a flatline test result. (Or perhaps a fructose intolerance?) She has been on the Cedars Sinai protocol (two weeks of Rifamin plus Neomycin – neomycin discontinued after she presented with side effects – then 30 days more Rifaximin. She continued to have symptoms (cramping, bloating, extreme smelly flatulence) though they were slightly improved. She has been on a gluten free, sugar free, dairy free diet for several years and continued on it through her treatment.
I should tell you that she works in LA in a job that requires many dinners out, travel and working in close proximity to others. You can imagine that the embarrassment is overwhelming and that her work (as well as social life) is severely compromised, as she has to get up and leave dinners, bear comments from peers, and flying… well, its total stress and embarrassment.
She is more than frustrated and getting very distraught and depressed, so she decided to be done with this once and for all, and went on the elemental diet for two weeks. She is retesting this week and will continue for an additional week if the test doesn’t show clear.
One way or another, we are desperate for some answers of what to do next as Dr. Pimentel’s protocol leaves you hanging after antibiotics/elemental, except for going on more antibiotics, ad infinitum.
When she finishes the elemental she plans to go on a soft diet for a few days (bone broth, soup, well cooked vegetables), then follow up for two weeks with a intro SIBO specific diet, then on to the SIBO specific diet (with no eggs, cruciferous veggies or beef – due to the hydrogen sulfide assumption).
Our pressing questions are these:
She is on a low dose of Erithomycin for motility, and we ordered MotiliPro and Iberigast to add to these. Too much? To facilitate digestion we read that Doctor’s Best Digestive Enzymes would be helpful and ordered these and have them on hand, as well.
In addition to the bone broth we ordered and planned on using a L-Glutamine and Zinc Carnosine supplement and Aloe Vera juice, once we are sure symptoms were under control. Do you think these would be helpful?
The most pressing and important question involves probiotics. We had planned to start with Lactobacillus Acidophillus for two weeks, then add PrescriptAssist (soil based organism) for another week, then add 24 hour yogurt as it is tolerated. I have read your blogs and answers to your visitor’s questions and they only make it all the more clear how critical the timing, selections and dosing of probiotics are. Help!! After all she has been through, we don’t want to get this wrong and have all of the antibiotic treatment (which in retrospect was probably ill-advised – but we hadn’t found you yet) and time on the elemental diet be for naught. We understand that she can relapse in no time if we do not get her flora in balance immediately. Please, please, give us some insight/direction on how to time and administer the probiotics as we are clueless and afraid to do something wrong.

Anne | February 13, 2016

Angela Pifer

Hi Jo,
Respectfully, you have listed here the far reaching effects to taking full dose erythromycin (this isn't low dose erythromycin taken as a prokinetic to address SIBO) - massive microbiome imbalance - and from here, many symptoms, conditions and diagnosis can follow. I am sorry to hear that you are experiencing such wide spread symptoms. I don't think that the erythromycin caused your gut motility to slow, but this definitely could contribute to SIBO and to get SIBO there has to be a gut motility issue present (or very large trigger that kicked this off - like if you take pain medication after surgery, this slows gut motility and if ripe for SIBO can kick off SIBO). Once you have SIBO, no amount of gut motility support will clear it. This has to be treated AND gut motility reinstated. I am happy to help you figure this out. Reach out to scheduling if you want more one on one support. I love the discourse that I get to have on my blog with so many people dealing with SIBO, yet there is only so much that I can recommend through a blog response.

Warmly,

Angela

Angela Pifer | February 15, 2016

Hi Angela,

You mention far reaching effects of Erythromycin in one of your responses, can you elaborate on those pls and how you would address these in SIBO treatment ?

I was on erythromycin for 3 years for adult acne until middle of last year. I suspect this caused massive micro biome imbalance that explains my constant & debilitating digestive issues. In the past 3 years, I have developed gluten and nut intolerances, hydrogen SIBO (3hr lactulose breath test), constipation with hemorroids. Things in the past 2 months have gotten really bad with daily bloat/fatigue/headache/joint pains from meals despite low FODMAP diet, Rifaximin,and liver function & digestive supplements. I have had to stop working for the past month (I'm self-employed) and am seriously concerned about my ability to hold my wedding in 6 months or how I can go travelling for my honeymoon.

The only thing that helps is Iberogast : it makes me pass stool within 1-2hrs. Which immediately reduces symptoms from 8/10 to 0-2/10. Again, that points me to slow gut motility in response to erythromycin overuse. But so far, all my doctors have dismissed this theory and you're the only one I found in my online research to seemingly have views on that drug.

Jo | February 12, 2016

Angela Pifer

Hi Gerard,
The probiotics that I use in my practice are all listed under my shop at http://siboguru.com/shop/ I can't share which I would specifically recommend to you over a blog post or email, but take a look at these and discuss them with your doctor.

Angela

Angela Pifer | February 15, 2016

Hi Angela

i am not sure what my issue is but i have alot of smelly wind and sometimes bloating..I am about to take probiotics, but can you tell me which is best?.

gerard | January 29, 2016

Angela Pifer

Hi Lel,
I am not sure what you mean by SBO going pathogenic. Depending on the organism that is SIBO, in your case, this could be an overgrowth of lactobacillus (native healthy inhabitant, but this can over grow in specific situations), klebsiella (if this is the organism, then this causes a lot of gut symptoms, actually damages the lining) or methanogens (migrate up from the colon). I wouldn't ever state that a current SIBO case can go 'pathogenic.'

It sounds like you are reacting to Prescript Assist. I would discontinue use and look for another protocol to help support and balance your gut.

Candida is completely separate than SIBO. Candida of the gut, usually stays in the gut. It can, on rare occasion cross over the barrier and become a systemic issue (getting into the blood and organs).

For the stool test that you had done, the labs have a very hard time culturing (growing - it needs to be live when it gets to the lab) lactobacillus and an easier time culturing bifido and beneficial e coli. I would definitely keep trying to find the right probiotic and SLOWLY, over time, expand your diet. The brands of probiotics that I use are on my site. I can't recommend a specific one to you over a blog post, but hopefully these will offer you some direction.

Make sure that candida and SIBO are both truly gone- that these have been treated as much as they need to be treated, before you start the long road of gut healing, immune support, gut rebalancing etc.

Warmly,
Angela

Angela Pifer | February 16, 2016

Hi there,
Thanks for all the helpful SIBO tips.
Can you please tell me, what does it look like if SBOs go pathogenic?
Each time I take Prescript Assist (in tiny doses) my face totally breaks out in a very bright itchy rash with random pustules. I also itch all of. I have tried it about 5 times now and each time the same thing happens.
Is this candida going crazy (trying to get out) from the SBOs or the SBOs going pathogenic? The area where it gets the worst is the skin above the sinus area where I've had a chronic sinus infection.
I'm really nervous about taking both lacto and bifdo bacteria as I haven't done well with them in the past, particularly the lactobacillus. Symptoms were GERD, bloating, diarrhea, SIBO, anxiety. Most are gone now, except for food intolerance, so I don't want to trigger issues but need to replace, and rebalance as my CDSA shows 'no growth' for lacto, bifido, and e coli. Would very small doses of VSL#3 be appropriate?
Thanks in advance for your thoughts.

LEL | December 5, 2015

Angela Pifer

Hi Cindy,

Those two antibiotics are not the ones widely used to effectively treat SIBO. Rifaxmin and neomycin or metronidazole are the ones that are widely used. I feel that many people are trying to treat with antibiotics, then go to probiotics and then they are fixed. I know you are trying to do the right thing here! There is a lot more to the healing and recovery process than antibiotics and probiotics. I would first confirm that SIBO is gone with a breath test and symptom assessment. Then transition on the antimicrobial herbs, then immune and gut healing support then gut rebalancing.

When addressing the large intestine, then HIGH dose probiotics make sense. With SIBO the focus is on the small intestine and I feel that less is more - very low dose of the right probiotic (yes, a loaded question - I recommend this on a case by case basis and don't use a standard protocol for probiotic strain, dosage, duration, timing).

It may be that has not been fully addressed. You might be reacting to something else in the probiotic. I don't recommend the baby formula. You need an adult formula, just the right one. Most of the probiotics that I use are under my shop on my website, but again, I choose the right one based on the patient's needs and dose each person a bit differently.

Warmly

Angela Pifer | February 15, 2016

Hi Angela,
I am very impressed with your website and was hoping you can help me.
I recently did a round of antibiotics for sibo(14 days on amoxil and clavulin mix). I am trying to introduce probiotics but have failed evry time that I've tried them so am following your suggestions and starting really slow. I am taking Ultra Flora baby by Metagenics...only 6 drops which is giving me billion Flora. After 5 days I have brain fog, My body and genitals itch like crazy at night. My face gets puffy and my eyes get red. My sleep is horrible. What do you suggest?

Cindy Bishop | December 3, 2015

Angela Pifer

Hi Heather,

If methane positive, the correct antibiotic treatment is combination rifaximin with neomycin OR flagyl (metronidazole). Taking one at a time, will not address this. It is likely (and I hear this so often) that you felt some relief from rifaximin, but since this wasn't coupled with the other antibiotic, you didn't reduce your level much. You might have found relief of some symptoms, but SIBO is not gone. It needs to be continually treated until you see a negative breath test (all the while supporting the system, addressing symptoms.... etc).

There are other brands of allicin and I there are a lot of different herbs that can be tried. It does get tricky though, because methane needs a fairly comprehensive approach and again, taking just one herb isn't going to likely knock this down.

One thing that I will caution here (and I know that you are trying a lot of things here and working hard to figure this out) - as quickly as you can, I would try to find a protocol that you can ramp up on and stay on it until you get a negative breath test. Right now, you have so much going on that I am concerned that you are going to get something even harder to remedy, like interstitial cystitis. If you can't find the right herbal blend, that I would talk with your doctor about getting onto the combination antibiotics (doing these together, not separately).

I am happy to help with this - feel free to reach out to scheduling when you are ready: scheduling(at)SIBOGuru.com

Angela

Angela Pifer | February 15, 2016

Hi Angela,
I have a positive high methane breath test with Constripation. Tried Candibactin Ar and BR protocol but caused vaginal burning side effect and berberine complex causes lower abdominal pain. So resorted to Antibiotics Xifaxan which have helped pretty well but my restless leg symptom still remained and now my latest co-infection is a vaginal Bacterial infection as a result of stripping my gut/vaginal flora. PCP now has me on Metronidazole. Also taking digestzyme and l-glutamine for my suspected leaky gut.

I also have tried Allimed, that makes sibo worse I'm told from my natural path that it's due to the Maltodextrin. Some people can tolerate I'm unfortunate that I'm unable.
Among this I have a MTHFR gene deficiency, multiple food sensitivies and low abdominal pain (womens probiotics do help), carpul tunnel, creepy crawly feeling in my legs, Low vitamin levels including Vitamin A deficiant. Lactose and fructose intolerance.

I also know that I need a womans probiotic to help with my gyn problems based on my relief of symptoms but i'm unable to find one that works for both this and Sibo. Femadophilus is my go to normally but it too contains starchs.

I'm also working on detoxing with bi-weekly 40 min sauna, stress management. Would prokinects work while on a treatment protocal or only after treatment?

Heather Heitman | November 20, 2015

Angela Pifer

Hi Lynn,
I am thrilled that you are also seeing a functional neurologist. Through your work with this doctor, you'll greatly reduce your likelihood of a reoccurrence with SIBO. I would first make sure that the SIBO is truly gone - with a breath test. I always recommend transitioning to herbal antimicrobials post antibiotic treatment. Focus much of your attention on gut/ brain communication and gut motility and then start to look at gut healing. This will include a probiotic. I can tell you over a blog/ email when to include this. I do this based on what I see with each patient. When you do add this in, start with a 1/4 to 1/2 a capsule at a time and slowly titrate this up over time.
Best of luck to you!
Angela

Angela Pifer | February 15, 2016

I have battled SIBO for 1.5 years. 2 years ago I had a serious concussion, followed by mono and SIBO (possibly brought on by prescriptions of anti-acid (mono misdiagnosed as acid reflux!) and gabapentin for TBI migraines) . I am currently seeing a functional neurologist to help with the brain injury and a GI doctor who put me on my first dose of rifaxiam last week. I want to get my gut flora balanced so I won't have to repeat the rifaxiam. I have a cabinet full of probiotics but don't know what to take. Can you clarify if I should take APEX Sibotica at the same time I take the antibiotic, or do I wait to take that as soon as I finish the antibiotic. Any other probiotics I should or should not take?

Lynn | November 17, 2015

Angela Pifer

Hi Chris,

Though many people feel an improvement with their symptoms on an autoimmune plan, autoimmune paleo may have increased your protein too much and created a more constipative state. This may not have had anything to do with the colonics. I do like colonics if we are working towards detox with a patient that has gone through something extreme, like chemo/ radiation. I don't recommend them at all to address dysbiosis (I want to do that from the top down).

It may be that you aren't going to do well on a really high protein plan. You may need further digestive support to get your bowels moving and to help you break down the protein. I don't feel that everyone will benefit by going grain free - this simply may not work for you. I do not recommend pulling grains for SIBO methane - this will cause more constipation and make things worse overall.

I greatly respect the work that you are doing with your ND. I would discuss with them the need to use Allimax Pro450 and higher dose berberine complex to combat methane producing SIBO. PLEASE do not add these in on your own. This is a discussion to have with your ND and you really need to be under the care of a provider when you are taking this level of herbs/ supplementation.

While you have SIBO and you are going through treatment - you have SIBO and extreme dysbiosis and I do understand how hard this can be and feel. I would work on gut motility with prokinetics and supplementation to help you move your bowels, address diet to keep your symptoms at a dull roar (manageable) and retest at the 1-2 month mark with the breath test to see what kind of movement you are getting.

I see that you reached out to be added to my waiting list. I'll have my office assistant reach out to schedule with you shortly.

Warmly
Angela

Angela Pifer | November 14, 2015

Hi Angela.

Ive always had Asthma, allergies, and eczema my whole life Im 32 now.In june of this year i decided to go on the autoimmune paleo diet. To kick start it I did a colonic (hydro colon cleanse). After the first visit I Realized I could not go number 2 for about 3 days. I called the place where I got it done, they told me It's normal to keep coming back. I had about 6 of them done. Im thinking that I already had major dysbiosis and these colonics just made it worse. I was diagnosed to SIBO the methane kind from my naturpath. She put me on bernerine complex, oregano oil, and NEEM 3 times a day, along with a high intensity probiotic called HCL Synbiotic Intensive. Why would she put me on all these at the same time? I FEEL LIKE IM BEING POISONED. She said these herbal antimicrobials are selective and it is ok?! I feel like IM dying no joke. My test for SIBO said i had no lactobacillicus. Could you please help?

Chris Contreras | November 12, 2015

Angela Pifer

Hi Doug,

SIBO is not a result of taking probiotics. If you have a short bowel, blind loop or gastroparesis then commensal flora native to the small intestine can pose an issue. SIBO is a motility issue, imbalance issue, immune insufficiency issue... it often has many contributing factors that need to be addressed. There are studies published on Pubmed showing that probiotics were as effective at addressing SIBO and SIBO symptoms as antibiotics. I recommend starting with spore forming probiotics like BioSPora, Prescript Assist or MegaSporeBiotic (and go SLOW when introducing one of these).

Angela

Angela Pifer | November 14, 2015

Im a bit concerned about probiotics. My GI doctor told me that SIBO can be caused by an overgrowth of bad OR good bacteria, and that probiotics could make the situations worse, if the cause of my SIBO was due to an overgrowth of the good bacteria.

Doug | November 12, 2015

Sorry- I would also like to add that 2 weeks after the diagnosis of h pylori I had an endoscopy done that showed no signs of anything. The doctor wrote in the report that everything looked fine and he saw no reason to do a biopsy. Thank you

Christa | November 4, 2015

Angela Pifer

Hi Christa,

My heart goes out to you!! Sometimes it takes going to multiple doctors until you can find the right one who will really listen and who will look at this from a different perspective. Can you search for an 'Integrative Medicine' doctor or a 'Functional Medicine' doctor in your area? This may be SIBO and it may be something else. SIFO (small intestinal fungal overgrowth) has the same symptoms. I really for testing to help pinpoint what this is (and what this isn't - both are equally as important). I will have scheduling reach out to you to offer you an appointment time.

Angela

Angela Pifer | November 4, 2015

HI Angela- My story is about a month and a half ago after going to my GP for upper abdomen pain I was diagnosed with H Pylori through a blood test. I was immediately put on Flagyl and Clymetheracin (I know I spelled that wrong). I took them for 11 days even though I could feel they were making me feel worse. I told my GP 3 days in that my body was changing but she just said stay the course and it will all get better. Well it did not it only got worse. Now I have bloating and can't go to the bathroom as often (though I am not eating a lot either) foods give me issues. I have lost 30 pounds in the last month. My Gastro told me it was IBS and sent me on my way. I was a perfectly normal person before all of this. Very regular bathroom habits and no food reactions at all. I want to do a stool test but can't go to the bathroom enough to do one. Is there anything you can suggest to help me with that. I assume they can test even loose still if that is how it comes out. This is a nightmare and I need to know what I am fighting so I can start working on it. I would love any advice from you on how to talk to and find a doctor that cares and will listen. I am currently fighting for a SIBO test but after all I am reading I am afraid it will come back with a false negative. I also have white stuff on my tongue so I'm not sure I don't have a yeast overgrowth too. I am going to a new doctor tomorrow to have a culture done. Please help me. My life is being ruined. I was a happy (ok somewhat stessed) bride to be 6 weeks ago and now I am a shell of myself. Thank you.

Christa | November 4, 2015

Angela Pifer

Hi Kristyn,

It sounds like the antibiotic may be knocking it down a bit, but it is not taking it to a low enough level that you can then overcome it with gut healing, motility support, diet... etc. If your initial SIBO test showed that your ppm hydrogen was 80 (for example), one round of xifaxan might reduce that to say 40 or 50 ppm. You might feel better, but there is still too many hydrogen producing microbes in your gut. You still have SIBO and because of this, it will very quickly rear its head at times of stress, diet shifts, ...

SIBO must be reduced in numbers under 20 ppm hydrogen and 3 ppm methane, to then step into gut healing and rebalancing. Otherwise you will feel like you are stuck in this cycle for a very long time.

Regarding probiotics - more is not better, when it comes to probiotics. The right strain, dose, use is much more important than the load. I find that most will react to Ultimate Flora. I recommend other probiotics (all of which are listed on my site, under the 'shop' link - you can review these and discuss these with your doctor to see which is the best approach for you). It sounds like there needs to be further treatment with SIBO. I recommend herbal protocols over antibiotic use.

Warmly,
Angela

Angela Pifer | November 2, 2015

Hi Angela,

I just came across your site and am so relieved to find someone that has so much information on SIBO. I have been suffering SIBO relapses over the last 2+ years. I was a year without relapse, then it's been every few months now that I am back on antibiotics again (which I can't stand). I've been treated with both xifaxin and flagyl, but neither seems to 'knock it out' completely. Unfortunately I feel like my doctor(s) aren't super knowledgable about SIBO, and so we just keep running back to the antibiotics to solve the problem. They've never mentioned taking a probiotic as a reparative after taking the antibiotics. I am on flagyl again right now and this is the 5th time I've been treated this year! What do you think about the probiotic Ulitomate flora critical critical colon? It's an 80 billion count...

Kristyn | October 1, 2015

Angela Pifer

Hi Connie - I don't work with Teralac directly. I like spore forming probiotics, and, when the time is ready, adding in resistant starch as the first prebiotic introduction.
Angela

Angela Pifer | November 2, 2015

Does anyone take Theralac? An ND recommended it, but it has prebiotics and I'm afraid to take it.

connie | September 29, 2015

Angela Pifer

Hi Sherry,

It sounds like SIBO has not been fully addressed. Methane SIBO is definitely harder to address. Beyond methane SIBO affecting bowel motility, the other factors that are contributing to sluggish bowel motility need to be identified and addressed as well. I do often introduce probiotics during treatment, but I can't speak to your direct case. I prefer spore forming probiotics (BioSpora, MegaSporeBiotic, Bacillus Coagulans - all are on my site, under the 'shop' link. Discuss these with your doctor. If you do not feel that the neomycin/ xifaxan combo (if done correctly - dose, timing and duration) was not effective at helping to address SIBO (best to test this before and after with a breath test) then I would consider the herbal protocols (working with a practitioner to help create a custom protocol for you and reassessing progress at a monthly interval). If you initial ppm gas production for methane was at 80 ppm, it will likely take around 4 rounds (months) of herbs to overcome SIBO.

Angela

Angela Pifer | November 2, 2015

Can I take probiotics? I have SIBO with high methane. I have felt well since taking Neomycin and Xifaxin in June. Constipation is helped with Magnesium oxide. I have no food intolerances so have not been put on any diet.

Sherry | September 29, 2015

Angela Pifer

Hi Jennifer,
I recommend looking at the spore forming probiotics on my site, under the 'shop' link. MegaSporeBiotic or Bacillus Coagulans or BioSpora are all good choices. Prescript Assist is another - I don't offer this on my site. Xifaxan alone will not fix a methane issue. This needs to be coupled with Neomycin at the proper dosages, for the proper duration. I see you reference a positive hydrogen test, but that you may have methane breath/ taste in your mouth. If you do not see at least 20 ppm reduction in hydrogen with each round, and your symptoms aren't improving, then I would reassess which type of SIBO you have and consider switching to herbal therapy, which can address both.

In my experience, the gut cannot be balanced or healed in the face of anemia (you can't carry enough oxygen on your red blood cells to help with healing), low Secretory IgA (this is a risk factor for SIBO) or adrenal fatigue. The anemia needs to be addressed to help with this process.

Angela

Angela Pifer | November 2, 2015

Hi, I've been treating SIBO well over five years, with xiafaxin for 30 days six times so far after two separate positive hydrogen breath tests. I want to take a probiotic, but I don't know which one to take. I was taking align, but saw ingredients I can't have. I have a nasty rotting food taste, methane. I have the bloating, no gas however, I have gross tasting burps instead. I had severe anemia that has been better since my diagnosis, but that's the only thing better since I started this.

Jennifer | September 28, 2015

Angela Pifer

Hi Shane,
Thank you - I appreciate it! I list the probiotics that I use on my SIBO website, under the shop. I always customize this for each patient, sometimes using lower fermentable fiber supplements to start, transitioning to resistant starch at some point and bringing in probiotics along the way. I am favoring spore forming probiotics at this point. Starting SLOWLY with each of these (even 1/4 cap a day is a GOOD therapeutic dose) and then ramping up over the course of months. The gut healing plan needs to be three months at minimum and really comprehensive. I realize that this has taken time to move through each phase and it is really important to understand that rebuilding flora and healing the gut will often take just as long of time as it took to knock SIBO microbes down (this is often three months, at minimum).

All the supplements that I work with are on my shop - please use these under the care of your licensed practitioner.

Best of luck to you!

Angela

Angela Pifer | November 2, 2015

Hello Angela, you have a fantastic website and seem quite knowledgeable regarding SIBO; so I feel out of anyone you'd be the best person to address this question to. I have had digestive issues since I was very young, I took a heavy strength general antibiotic at nine-months old for food poisoning and then had a pretty unhealthy diet growing up. These two factors led to dybosis, leaky gut, the works in both the large and small bowel. I also have developed chronic fatigue, a foggy mind, and chronic muscle pain. I've developed a comprehensive and thorough plan which treats the entirety of my digestive system in order to resolve my issues, but there is one part I'm missing. After treating SIBO and fungal overgrowth using a mix of herbal protocol + apple cider vinegar + kirkman labs biofilm defense + cinnamon + organic virgin coconut oil I'm not sure how to re-balance the flora in my small intestine. I have a perfect way to re-balance my large bowel but that method sadly will not reach to my small bowel. So, with that, I either have to turn towards a probiotic or fermentable foods (which I prefer).

With all that said, the information I'm asking you to give me isn't much, but it is absolutely critical to my success. What Probiotic do you recommend as the best possible solution to re-balancing the gut flora in the small intenstine, and if possible is there a fermented food (dairy-free yogurt, perhaps) that would work just as well in this process? Do you recommend healing the gut before rebalancing the flora, or the other way around? Any information regarding the re-balancing would do me great justice; thank you so much!

Shane | September 27, 2015

I am using GUTPRO probiotics and it is a lifesaver! Best ever. No fillers just powder, with tiny little measuring spoons. I highly reccomend

Dawn Z. | September 23, 2015

Angela Pifer

Hi Kathleen,

I highly recommend that you seek out another practitioner who will offer a methane and hydrogen test. If you contact my office, I can arrange for you to get the Genova 90 minute hydrogen/ methane test. Can you see a naturopath through your insurance? Many ND's would be able to order this test for you. If you are exhibiting methane/ constipation symptoms and you only take xifaxan (when taken alone, only addresses hydrogen) then you will likely not see any improvement. It must be combined with Neomycin (at the right dosage, duration) to start to knock SIBO down. Once you get your breath test in hand, you can then look at the levels of parts per million gas production and start to formulate a plan on how long this will take to knock SIBO down. The proper antibiotic therapy (14 day treatment) and the proper herbal therapy (one month) knocks SIBO down by around 20 parts per million with each round.

I prefer herbal protocols, but I also understand why someone might want to start out with antibiotics sometimes (they just need to be the right combinations to do the job).

Angela

Angela Pifer | November 2, 2015

Hi,

I was just diagnosed with SIBO. My dr said they can only do the hydrogen test, not the methane part. I don't have any diarrhea- just severe constipation. My health food store I go to suggested Ultimate Flora Critical Colon 80 Billion 1x a day plus IntestiNew 2x a day. I'm supposed to start taking Rifaximin if my insurance approves it. My GI dr said NOT to take probiotics while on the antibiotic but wait until the antibotic is completed. I've been researching SIBO and it seems there are a lot of different treatments but one thing I'm noticing is there are 2 different types of SIBO. A diarreha and a constipation type. If I can't find a place who can do the methane part of the test, should I start the Rifaximin and take the probiotic and IntestiNew? I'm having horrible body pains, can't sleep at night, on a limited diet, but having abdominal pain from the constipation so I can't eat a whole lot. Trying to see a functional medicine dr is financially difficult so I've been trying to research it online and if you could help, it would be much appreciated.

Kathleen Sheldon | September 22, 2015

Angela Pifer

Hi Linda,

You have a very unique situation, that doesn't have a simple answer. Since you do not have a colon, then you are not taking a probiotic to help support colonic microbes. Probiotics are still a good idea, as they are immune modulators and they help to fuel the healthy flora that resides along the entire intestine. With your doctors blessing, I would try one of the spore forming probiotics and/ or a try Sibiotica (VERY low doses of either - if 1/4 capsule a day (with a meal) this is still a therapeutic dose).

Angela

Angela Pifer | November 2, 2015

I have a jpouch (total colectomy) and SIBO what probiotic would you recommend please? I have slot diahorrea. I also take Creon, predisolone, calcium etc

Linda | September 19, 2015

Hi Angela,

What about Megasporebiotic? Is that safe to take?

I've tested positive twice for sibo. Just finished another round of Xifaxan and am currently using herbal antibiotics. I know I am not cured as I am still bloated but much better than I was!

Joanne | September 15, 2015

Angela Pifer

Hi Casey,

This is really dependent on the person. Once SIBO is addressed (negative breath test) then I usually do two weeks of gut healing, introduce probiotics (If I didn't already do this) and then we start to challenge the fermentable categories to see which foods you tolerate.

Angela

Angela Pifer | September 12, 2015

Hi Angela,

Thanks for the great info. I can't find anywhere online that talks about how long to alter the diet after a SIBO diagnosis. I did the two weeks of antibiotics, and the Specific Carbohydrate Diet. Still taking a pinch of VSL3 daily. How long do I keep up a SIBO-specific diet? Thx!

Casey | September 10, 2015

Angela Pifer

Thanks Maddie! Feel free to take this with a little water. Cold or room temp water or food will work, you can't add this to anything hot. Take this with a meal. You might even try sprinkling it in one little spot on the back of your hand and licking it off. It is a very tiny amount.

Warmly
Angela

Angela Pifer | September 7, 2015

Hi Angela,
Love your website. I have SIBO and have been working on it with herbs. I am getting ready to take Sibiotica probiotics. I see where you say to start slowly with 1/4 of the capsule. What can I put that in to take. Food??? Water??
Thanks for your help.
Maddie

Maddie | September 7, 2015

Angela Pifer

Hi Mark, There isn't a perfect supplement for methane and for hydrogen producing SIBO. Use of probiotics is more about figuring out a way to support your healthy colonies when the time is right. Sometimes this is from the beginning and sometimes not - depending on what is being addressed. I haven't seen 'just' probiotics reverse methane producing SIBO, nor heal it. These would need to be taken in conjunction with a foundational plan that will heal your gut. I would also note that healing SIBO takes time (especially with methane producing SIBO. If you are tolerating the probiotic I would count this as a win and continue with I. I would also look at the rest of the protocol to see what else needs to be adjusted to see continued improvement over time.

Warmly,

Angela

Angela Pifer | September 7, 2015

Hello Angela,

Great article! I have SIBO that produces methane gas which causes me constipation, bloating, rashes on my legs, joint pain, acid reflux and lots of other unpleasant conditions. I was very acidic for a while and got off probiotics for over a year, but I started back on them again, but this time a D-Lactate Free probiotics. While my gut seems to be accepting them ok, I have not seen any real change. Is there a different probiotic that you can recommend for methane producing SIBO?

Thanks,
Mark

Marj | August 29, 2015

Angela Pifer

Hi Candace,

Your ppm levels are so low - even with 5ppm methane. Were you also seeing constipation, bloating (to fermentable foods)? Other classic SIBO methane symptoms? If so, and at 5ppm your doctor is diagnosing methane producing SIBO, then the prescription should have been rifaximin TID with neomycin or metronidazole for 14 days. Erythromycin will not/ does not address SIBO. AND this is where I get really frustrated (respectfully) with how SIBO is being treated with antibiotics that are the wrong ones, wrong dosages, or simply the wrong combinations (or lack thereof). Here's the issue - one reason that you have SIBO is because you have dysbiosis - a very large imbalance going on in your small intestine. Then you were put on erythromycin which has far reaching effects both in the small intestine and in the large intestine. It will, in a nutshell, not address SIBO AND create even more imbalance.

Have your symptoms improved? Have you retested? Have you had a digestive stool test looking at parasite or gastrointestinal yeast issues? Are you taking something to address gut motility? I don't mean these questions to overwhelm you. They are questions that need to be worked through with your doctor/ practitioner.

Saccharomyces Boulardii by Klaire Lab is a good probiotic, try Kirkman Lab CD Biotic. If Prescript Assist was working for you (you tolerated it and you noticed a difference over time, and you do not have an inflammatory bowel condition, then stick with it. I simply don't think that it is a cure all probiotic for everybody). BEST of luck to you.

Warmly
Angela

Angela Pifer | September 7, 2015

Hello,

I was diagnosed with SIBO in Jan. with methane at 5ppm and Hydrogen at 2ppm (I could only eat carrots, lettuce, cucumbers and meat at this point). After two rounds of herbs I was retested and my levels were just under the 'too high' level. So I was then put on Erythromycin for one month and Gluatamine which I am still taking. I had some improvements and added a few veggies to my diet without pain (no FODMAPS). I've been on Nystatin and Candibactin BR for six weeks and now I have a vaginal yeast infection and Group Step B (I'm not pregnant). I can eat about ten veggies and meat (no pork). I am 34, 5' 7" 120lbs. I've been taking Prescript probiotic the whole time which I see now is bad. I am at a loss at what to do other than taking a different probiotic.

Candace | August 21, 2015

Angela Pifer

Hi Nicole,

Sometimes antibiotics are necessary. I definitely can't go against what your doctor is recommending with regard to an antibiotic for strep. The goal is to minimize the imbalance. Can you get a shot, instead of taking and oral? In light of SIBO, is there an antibiotic that they can recommend that will still be effective against strep, yet more gentle on the gut?

I would take S. Boulardii along side it and make sure that you take another probiotic as well (Sibiotica or CD-Biotic are good choices).

Angela

Angela Pifer | September 7, 2015

Hi Angela,

If you have an infection (such as strep) for which you are prescribed an antibiotic like penicillin, but you already have SIBO, any advice?

Should you/can you take probiotics during the antibiotics treatment?

Having SIBO seems to add a whole new layer to taking antibiotics for other reasons, and as many people know, taking antibiotics themselves can cause an already disrupted gut to become even more compromised.

Thank you!

Nicole | August 21, 2015

Angela Pifer

Hi Jay, If Xifaxan was at the right dose and taken three times a day for 14 days, to treat hydrogen producing SIBO, then the next step is to do the breath test again to see how many ppm (parts per million) reduction is seen from this treatment. With each round of treatment (whether antibiotic or herbal) expect 20-30ppm reduction in gases. So, if you start out at 85 hydrogen, then one correct dose/ duration of treatment should help you reduce the gases to around 55-65 ppm. One round rarely fixes SIBO. If you do opt to use the antibiotics, then I recommend the first round be done correctly, retest, then shift to herbals.

VSL#3 may help and it may not. It depends on the person. It isn't my go to probiotic that I would use within a protocol. Probiotics are only part of the treatment protocol.

Angela

Angela Pifer | September 7, 2015

I'm a little late to this discussion but I am so confused. I was diagnosed with SIBO and took a round of Xifaxan which had zero positive results. I currently have another RX for it but, to be honest, it just bloated me up, made me super gassy and actually made my symptoms worse. This was back in March. Today I had a really bad episode of bloating and flatulence. I'm not sure what to do and after tons of conflicting treatment opinions, I opted to buy and take some VSL#3. Was this the right move or am I going to make it all worse? The hardest part is the extreme flatulence for me. I can't be getting up from my work desk every 5 minutes to release these loud bursts. It's very uncomfortable as well.

Jay | August 19, 2015

Angela Pifer

Hi Martin,

I appreciate your post! I prefer the three hour test and here is why - we are looking for a SIBO reaction at the 90 minute mark. We are also looking for the telltale sign on the test that the solution has entered the colon. Practitioners who are reading these tests, do not look at the test as positive, if there is only a spike a the end three hour mark. If the test is flat lined during the entire three hour test, this also tells me that either the test was done incorrectly, lab error, there is a transit time issue (too slow - entrance into the colon isn't showing up in three hours after administering a liquid substrate that should move rather quickly) or that this may be a hydrogen sulfide issue (the labs do not pick this up - hydrogen sulfide uses up hydrogen, so the test can be flat lined with respect to this happening).

We should also be treating the patient and not the lab.

I personally prefer the lactulose test versus the glucose test. Glucose is a substrate that simply absorbs too quickly along the small intestine. This would then miss a SIBO issue further down the small intestine.

Angela

Angela Pifer | September 7, 2015

If you use the common 2 to 3 hour hydrogen breath test for detecting SIBO you will have a large number of false positive results. The reason is that the oro-cecal transit time of a liquid dose (either lactulose or glucose) is less than 90 minutes. This fact, which has been conveniently ignored by the SIBO guru’s, has been established science for years. In spite of the obvious problem with a 2 -3 hour SIBO test no one has demonstrated the impact of transit time on the hydrogen breath test until now. A new publication in Clinical Gastroenterology and Hepatology titled “Scintigraphy Demonstrates High Rates of False-positive Results from Glucose Breath Tests for Small Bowel Bacterial Overgrowth” is a must read for clinicians using the hydrogen breath test.

Martin B. | August 11, 2015

Angela Pifer

Hi Laura,

Lactulose is not absorbed, so it shouldn't affect hypoglycemia symptoms/ blood sugar. I would call the lab to see if there are any other foods that they approve for you to eat prior to the test. I have had a couple labs approve quinoa (don't take my word for it - the labs/ prep needs to be done their way).

A white tongue doesn't mean thrush/ yeast. The roof of your mouth and throat would also have white patches on it. White tongue may mean 'sick' tongue. It might mean a b vitamin and/ or zinc deficiency. Check with your doctor.

I would not stay in ketosis if you are trying to heal your gut. Ketosis will feed candida and it will prevent gut healing overall. Ketosis works for some conditions but not when you are trying to heal your gut.

Have you looked into lectins being the issue with your burning rectum reactions? There is a product called Lectin Lock or Lectin Control that you could try. I don't know if they would let you take this during the test.

I really prefer that the test is done - if SIBO is suspected and this is the path that will be treated. Knowing a starting point is a must with this.

Angela

Angela Pifer | September 7, 2015

Hi Angela,
Are there any other ways to diagnose SIBO besides the lactulose breath test? I'm afraid I won't be able to handle it. I can't eat all the foods the day before the test since all animal proteins cause muscle twitches and cramping in my legs, white rice or potatoes cause burning in my rectum and vaginal area, and painful lymph nodes in the groin. I'm also hypoglycemic so prolonged fasting and then drinking sugar solution can crash me. My stool test showed no dysbiotic bacteria, no yeast, no parasites, low fecal pH, high butyrate, normal sigA, lactobacillus count 1+, Bifido 3+, enterococcus 3+, bacteroids 4+ Urine Organic acid test for yeast and bacteria is normal.
I have white coated tongue every day, bloating and burning in my rectum after eating dairy, starch, grains, fruits. My liver is also reacting to any fats with dull pain under right ribs.
I'm very underweight on this diet and in ketosis. I would very much appreciate your advice.

Laura | August 7, 2015

Angela Pifer

Thank you for your post - I am sorry to hear about your journey. Dr. Siebecker is currently writing a book and offers a lot of wonderful information on her site. I am currently putting together a program that will (video, manual, recipes, protocols) that should go live next year. All this being said, I wholeheartedly feel that each person must find a practitioner to work with who can help them with this. Even with my experience working with this, although I have a core plan that I pull from, there are so many differences from one patient to the next and these need to be addressed. I wish you the very, very best of luck with your journey.

Angela

Angela Pifer | September 7, 2015

Three years ago, i stepped into a perfect storm of modern medicine hell that set off a chain reaction of health problems that now has me on my death bed. There are many of us out here that have been ruined and are fighting for our lives. I have SIBO and candida and i watched your videos. I believe you are very knowledgeable and truly want to help people, but unfortunately there are not enough people like you to go around. I know you have to earn a living, but there is nowhere for so many of us to turn. It would be nice if you could write a book with some details of how you treat intestinal dysbiosis. I realize every case is different so that may not be possible. But thank you for helping those that can reach out to you in person. I wish i was one of them. God Bless

The Lobstah Guy | July 3, 2015

Angela Pifer

Hi Eric,

I hope the treatment is successful! You'll need to retest the breath test with each monthly round of herbals. You'll need to see how many ppm (parts per million) you recover each month (this ranges anywhere between 12ppm and 30ppm) and continue with a few different rotations until you see success - that methane is under 3ppm and your symptoms have recovered. I would add a prokinetic in now - I wouldn't wait on this. Talk with your doctor. You want your bowels moving to start the healing process (and this isn't just a laxative effect with magnesium - like a lot of people use). BEST of luck to you - I realize how debilitating this can become...

I would get your bowels moving 1-2 times a day first, then continue treatment, then look to a probiotic next... I like Sibiotica.
Angela

Angela Pifer | June 25, 2015

Hi Angela,

I've had bad digestive issues for three years now, and being halfway through college I can say that having these issues almost completely eliminates the possibility of going out or doing anything really with friends. In the past couple months, after introducing more potatoes to my diet, I started having constipation, and one day I had very bad gas buildup in my stomach and a foul odor to it. Since then I cannot have any food with fiber without having symptoms, leaving me on chicken and white rice for 4 months or so. I was tested for sibo, cane back methane positive, and am currently a week into treatment with herbs like allimax and NEEM plus. I feel a bit better, but I'm still extremely weary of adding different foods into my diet for symptoms returning. I will be adding a prokinetic soon as well. What probiotic would you recommend, and is there anything else I can do? Here's hoping I can go back to school an actually live my life!
Thank You,
Eric

Eric | June 12, 2015

Angela Pifer

Hi Jen,

If there aren't any other ingredients in GutPro, then you could try it. I prefer to start under 1 million (a tiny pinch). VSL3 could also work - again, a TINY pinch of a dose to start. I prefer to treat yeast with herbal antifungals and not with medications. You need a balance of yeast (we all have healthy yeast strains/ levels in us) to keep the your flora in check. If you wipe the yeast out then it will be easier for pathogenic/ imbalanced flora to take over. Also - during yeast treatment, be careful not to swing to far into full paleo/ keytone production. Your body will have a harder time fighting off candida when it is in ketosis.

Angela

Angela Pifer | June 21, 2015

Angela,
I was recently diagnosed with SIBO and will be starting Rifaximin, and Difflucan for yeast. My doctor recommended VSL3 but everywhere I read it seems to be too much. Have you heard of or recommend GutPro? Any thoughts on that brand? Here are the ingredients: Lactobacillus plantarum, Lactobacillus gasseri, Lactobacillus salivarius, Bifidobacterium bifidum, Bifidobacterium infantis, Bifidobacterium longum, Bifidobacterium breve, and Bifidobacterium lactis. Thanks for your advise!

Jen | June 9, 2015

Angela Pifer

Hi Amy,
Gas production can vary a bit - neomycin should never be used to treat SIBO by itself. Rifaximin TID in combination with neomycin BID taken for 14 days is how methane is treated. Some people are not responsive to the dual therapy, but the dual is how it is treated. Neomycin alone will not reduce ppm gases. I also don't find that everyone responds well to the FODMAP plan. It still has some fermentable compounds in it and this needs to be customized for each person. Bad breath wouldn't necessarily come from low FODMAP. I would look at h pylori or that you may have hydrogen sulfide type SIBO that isn't detected on the test, look at yeast/ thrush... a probiotic won't 'fix' this, it is part of the treatment protocol though. You will likely need to look at the dual therapy or address this with herbal antimicrobials.

Angela

Angela Pifer | June 21, 2015

Hi I was recently diagnosed with SIBO. I took the breath test and my methane levels never changed but the hydrogen levels escalated up to 150ish. I was prescribed neomycin for 14 days and saw no change. Now they have me on the FODmap diet for 70 days. I'm confused. Everything I have read suggests taking rixafrin and suggests the neomycin for methane. I've been on the diet for several weeks and not much change. One of the symptom that I have is bad breath. Is there a probiotic or anything you can recommend to help me? I would truly appreciate any advise. I've been struggling for so long.

Amy | June 3, 2015

Angela Pifer

Hi Catherine,

If the were testing for SIBO there is a breath test available that can test for hydrogen and methane production in the small intestine. What will skew the results is that he has had surgery on his small intestine and that it may be difficult to read as it is looking at transit time as well. I am assuming that they are assessing him for an infection. If it isn't that, then SIBO seems like the next likely culprit. They will likely want to use antibiotics to treat it and since there is an ileostomy present, this may be the best route. The colon is bypassed AND the faster that he can have the ileosectomy reversed the quicker the colon can start to heal and come back on line.

Best of luck to you both!

Angela

Angela Pifer | June 21, 2015

Dear Angela,

my husband had an ileostomy three months ago and has been unable to have it reversed because the small intestine is still widely dilated, apparently filled with air or gas -- maybe from fermentation caused by SIBO? It seems like it would be easy enough to test directly for bacteria in the stool since there is ready access to the small intestine. Is there such a test?

Catherine

Catherine | June 3, 2015

Angela Pifer

Hi SS,

I would insist on a SIBO Lactulose breath test that will assess hydrogen and methane producers and get a digestive stool analysis done (three day stool collection) plus parasitology. This would be a very good starting point. Also test for celiac. The gut cannot be healed if anemia is present or if there is adrenal fatigue present. If I can describe it this way - healing the gut is like running a marathon. It won't heal if you aren't able to transport oxygen (anemia) and have adrenal fatigue (no endurance and resources available to run the race).

The protocols that I put together are different for each patient - each person has their set of 'needs' and their conditions, symptoms, day to day experiences really shape the protocol. I am not able to offer suggestions on specific protocols via email. I do like both Sibiotica and l-glutamine.

Warmly,
Angela

Angela Pifer | June 21, 2015

Hi Angela,

Thank you for providing such helpful information about SIBO on your website; I much appreciate your candor and specificity regarding this disease.

I'm 33, have always been a healthy eater, and never suffered from any GI problems before. But I have been experiencing escalating GI symptoms over the last few months that are making me suspect that I might have SIBO. I do have another autoimmune condition; perhaps it has played a part.

Currently, I'm not under the best, most comprehensive health plan, so I'm unfortunately having to work harder than I'd like to convince my doctors to have me tested so I can either rule out the possibility of SIBO or confirm a diagnosis.

I suffered from loose, sometimes mucus-rich stools (sorry!) and extreme abdominal cramping for several weeks until my doctor finally prescribed a low dosage of Bentyl to quell my bowels. My doc doesn't think it's parasites, but has hinted at IBS. Post-Bentyl usage, my symptoms have mostly calmed with a restrictive diet, but my abdomen is always unnaturally distended and I cannot eat anything anymore. Plus, I'm uncharacteristically gassy. For the last several weeks, I have been consuming nothing but small amounts of chicken and veggie broths, pureed veggie soups, certain soft-cooked veggies, rice cakes, Lifeway kefir, and some types of berries. I've lost weight, ache all over, and am beyond exhausted. Having battled my other autoimmune condition for the last many years, this new complication has me quite distressed.

I understand from having read through much of your website that this condition does not have a one-size-fits-all treatment plan. And I know that without an official diagnosis, you might find it difficult to answer the question that I pose here. But as I work on getting things squared away with my doctors, and set myself up to hopefully collaborate with you in the near future if indeed I do test positive, would you possibly be able to provide me with any very general suggestions for supplements, etc. to at least keep things at bay and heal the gut lining a bit? (E.g., Sibiotica? Glutamine?) Forgive me if you've specifically disclosed this info somewhere on your site and I missed it; if so, please feel free to direct me to it.

Thank you so very much for your time.

SS | June 3, 2015

Angela Pifer

Hi Janice, Sibiotica is one of my go-to probiotics. I would start with a very small dose, usually 1/4 of the capsule, once a day. Probiotics must be a part of treatment, but when, which and what dose really depend on the symptoms. I really like to have a digestive stool analysis in hand to look at current flora levels. If you have low growth lactoB and/ or another commensal flora then there additional steps to be taken to bring these levels up. I really like to think of this in this way - the gut must be an active participant in its recovery. Recolonizing with probiotics, supporting digestion, the immune response, lowering inflammation - all necessary parts of treatment. Some people have added histamine issues, pH issues - there is a lot to address here.

Warmly,
Angela

Angela Pifer | June 2, 2015

Hi Angela,
I've had IBS very well managed with fiber and probiotos(several in your photo!) with good results. Last September I caught some kind of gastro bug that now has been diagnosed as Sibo. Since February I've been on and off xifaxin. While on( without diet change.. Ie I love bagels) I do well. As soon as I taper down, explosive diarrhea ( my main embarrassing symptom along with bloating) returns. My GI dr says I should stay off all probiotics which I have done since February. Do you feel a small dose of sibilotica would help? Obviously I will re discuss with him but the more research I do, besides now doing my best to follow fodmap diet, it seems adding some natural products would help.
Thx
Janice

Janice | June 2, 2015

Hi Angela,
I've a history of IBS but very managedlast 20 years with fiber and last 6 yrs with various probiotics. Last September got some kind of bug, had ongoing diahreeah. My gastro dr had me do Fodmap diet. I was miserable on that diet and it didn't markably improve things. Went to new dr in February and he put me on xifaxin after diagnosing SIBO. Took me off all fiber and probiotic. So for over 3 months I've been off and on 500mlg of xifaxin with he reassuring me it only affect small intestine so it's fine. For first 2 weeks 3x daily. Remarkably better. No major diet change( I love bagels!) Then totally off. Then symptoms(explosive diarrhea) resumed. 2 xifaxin 2 weeks.
Again did well. Then diarrhea returned...not daily but bad episodes. Back on 2 xifaxin daily. Then better and back to one daily. This weekend another diarrheal episode..ugh! Decided time to branch out to other options. I'm going back to horrible fodmap diet. found your view that mild probiotic is needed to help stop Sibo even if on xifaxin. So, you would be ok with me( rest of my health excellent at 64!) starting with a small dose of sibiotica? I do a lot of traveling and this is no way to live! Thx!
Janice

Janice | June 1, 2015

Angela Pifer

Hi Jerri,

I would start by addressing adrenal fatigue - if your adrenals are taxed, then you won't be able to fully recover and rebalance your gut. I recommend something difference for each person, so it is hard for me to recommend an exact supplement dose for you. To start, you could try 1/4 of a capsule.

We do need to meet face to face/ video for our first visit. I wish you luck!

Angela

Angela Pifer | May 26, 2015

How much sibotica should I start with? I haven't done any abx or herbals for SIBO. I have only used Nystatin for candida and still have it along with leaky gut and adrenal fatigue. Thank you. I still need to see if I can find a tablet or laptop. What do I do if I can't borrow one?

Jerri Arrant | May 23, 2015

Angela Pifer

Hi Cindy, I really like Pharmax probiotics. If this is SIBO this won't work well for you. It has prebiotics in it. I prefer Sibiotica, some of the UltraFlora line and s. boulardii for starting probiotics. LactoPrime is another good one by Klaire lab. Not sure if it was the prebiotics that triggered your SIBO that triggered the symptoms that you were feeling? They are also fairly high potency and this is not the dose (let alone two a day) that I would use with SIBO treatment.

When addressing digestion, I work from the top down. Address h. pylori first (what you are using will help but it won't knock it down). You don't really eradicate h pylori. You knock it down so you can work on gut healing and the protective lining of the stomach is reinstated and protects the stomach from h pylori attaching to the stomach lining again. I would start with this and follow a lower fermentable plan until you get h pylori addressed.

Angela

Angela Pifer | May 26, 2015

I was diagnosed with H.Pylori and SIBO (also leaky gut, celiac by Dr K's blood testing, and Hashimoto's). I don't recall a food poisoning months back, but a chiropractor put me on a theraputic dose of Pharmax HLC High Potency (is that a good brand?) She had me on 9 a day at 10billion (90bill a day!) It threw my balance off and threw me into the hospital for testing of what was wrong with me. I am able to do 2 a day and no more, but I don't do any right now because of how upset the balance is. Had either food poisoning or stomach flu just 5 days ago. Threw up 11x in one day, then I've had diarrhea since. Today I had bone broth and basmati rice - a life saver. Finally, food that didn't upset my stomach. I am using Matula tea for the H.Pylori and hoping it is erradicating it. I was told to go back on 3 probiotics a day and my body wisdom says no. Thoughts? Should I even attempt at this point?

Cindy | May 22, 2015

Angela Pifer

Hi Marietta, One thing that we know to look for is SIBO, if celiac symptoms don't clear up after pulling gluten. I really appreciate your question and yet can't offer direct advice without working with you one on one. I personally would be a bit weary of treating urgent diarrhea with antibiotics. I would have first worked to get the bowel movements slowed down. You could look at histamine issue, stress, make sure you are cooking all your foods, eating slowly, removing stimulants... probiotics should definitely be part of recovery/ treatment, yet, I don't recommend VSL#3. I would have started with saccharomyces boulardii first - this is helpful firming up loose stool.

SIBO, if SIBO - not sure if you had this tested? This can be treated empirically, simply pointing this out that may not be SIBO - is a symptom of a gut imbalance plus motility issue plus?? There are underlying issues that need to be addressed. A prokinetic will help, but antibiotics/ herbal antibiotics and a prokinetic do not fix this.

Angela

Angela Pifer | May 26, 2015

I just joined your blog and I am finding good information. I have Celiac disease "discovered" 4 years ago after an infection of uko in the Dominican Republic. 9 doctors later...Celiac Dx.
But I also feel like I have SIBO because my sympotms wont completely clear up. I have been STRICTLY following SCD for 18 months with decent results until 5 weeks ago. I began having urgent diarrhea daily only in the morning until about 10am. non stop for 5 weeks. My PCP prescribed Xifaxan 200mgTID x10 days. My Functional medicine doctor prescribed VSL#3DS. Ive had stool test,the only conclusive result was Very High Fecal Leukocytes. And no lactobacillus was seen. What should I do? Should I take the VSL during the xifaxan as my FM doc suggested or wait? Also what about the prokinetics? That hasn't been mentioned to me! I am very frustrated!!
Thank you so much for your blog.

Marietta | May 16, 2015

Angela Pifer

Hi Jerri,

I don't recommend soil based probiotics when there is an inflammatory issues (whether full condition like Crohn's or SIBO) - they have the ability to go pathogenic. Stick with Sibiotica :)

Angela

Angela Pifer | May 15, 2015

I have candida, SIBO, leaky gut and hormonal issues. I know you told me that you have used Sibiotica on your clients. What is your opinion on MegaSporebiotic?. I also have a compromised immune system. A while back I ordered Prescription Assist but read the SBOs can cause sepsis if you have a bad immune system so I stopped them.
Thank you in advance for sharing your knowledge and look forward to working with you hopefully soon.

Jerri Arrant | May 15, 2015

Angela Pifer

Hi Joanne, It is quite soothing to the gut, I use it within some protocols, but it isn't a direct gut repair agent like l-glutamine and zinc caronsine...

Angela

Angela Pifer | May 15, 2015

Hi Angela,

Do you recommend Slippery Elm to help repair the gut? If yes, how much and do you prefer powder vs pill form?

Thank you.

Joanne | May 15, 2015

Angela Pifer

Hi Rebekah,

I choose probiotics based on the patient, symptoms, conditions... etc. I don't always recommend an exact brand. Each person is different - same goes for dosages. The acid blockers definitely contributed to SIBO. There is a very clear link between them. The best thing that you can do is to address stomach acid production, HCL betaine, bitters, zinc, digestive enzymes with HCL and then work on digestion and gut motility from the top down. During the protocol and beyond pull fermentable foods - any bloating is holding the ileo-cecal valve open and this allows organisms to migrate up from the large intestine and further aggravate SIBO.

Angela

Angela Pifer | May 14, 2015

Hi! I have been diagnosed with SIBO. I've been reading your advice but can't seem to find an article on the kind of probiotic that you recommend and when you recommend beginning it. I begin the antibiotic xifaxan tomorrow and want to do everything in the right order. Also, how do I get my stomach acid back to normal? I was in ranitidine for two years until my doctors learned that my issues were gallbladder related. I now, gallbladder less, wonder if the acid blockers contributed to my SIBO issues. Any advice is appreciated.

Rebekah | May 13, 2015

Angela Pifer

Hi Jon, I would get a confirmation on SIBO (with a breath test). GERD can definitely be a result of candida, h. pylori, food sensitivities, sphincter issues, low stomach acid and sometimes SIBO. With candida present I don't recommend kombucha or dairy during treatment. I recommend a digestive stool analysis that will assess your candida and test which antifungal herbs/ medicines (I prefer herbs) will be most affective at knocking your strain out. Doctor's Data or Genova, are both great tests. It must be a three day stool collection, also looking at parasitology as well. Best of luck to you!

Angela

Angela Pifer | May 7, 2015

hi, i am fairly confused. i have seborrheic dermatitis, leaky gut, candida and i believe SIBO because i get gerd. i drink a lot of kombucha, and raw goat dairy kefir, probly consume upwards of a trillion probioitics a day. i am wondering if consuming too much kefir and kombucha is contributing to my sibo, and if it is, if i can use these as the probiotics i need but back down on them? thanks for your time

jon | May 6, 2015

Angela Pifer

Hi Jerri, Thank you for posting. Sibiotica is one that I use - but again, my approach is different with each person. I don't recommend that you start to take large dosages of probiotics, Align isn't a good choice! It contains sucrose (not usually an issue with SIBO, but is with candida), contains 'milk' - so if a milk allergy, not a good idea and it contains 'sodium caseinate' among all of these other items that you don't need to consume on a daily basis: "microcrystalline cellulose, hypromellose, sucrose, magnesium stearate, sodium caseinate, titanium dioxide, trisodium citrate dihydrate, propyl gallate (antioxidant preservative)" Sodium caseinate is another name for the animal protein casein, in milk - this will be inflammatory (I am not against dairy, but casein is the part of the protein that, if sensitive to milk, it is to casein).

For comparison, let's look at the additional ingredients in Sibiotica: Other ingredients: Cellulose, acid-resistant vegetable capsule (HPMC).
It is REALLY important to use pharmaceutical grade supplements, so all the extraneous ingredients are cleared off.

We do need to change the perspective here on the gut. You don't have SIBO because of an abundance of flora in the wrong spot, you have SIBO because of a lack of the right innate/ beneficial flora in the small intestine, lack of good immune response in the gut, lack of good motility in the gut, too much stress impacting the gut... If your stool test is showing NG no growth of lactobacillus and/ or bifidobacterium, then this has to be replaced. If these levels are not brought back up (along with addressing everything else) SIBO will not recover. Probiotics have been studied some - here is a study on Pub Med: http://www.ncbi.nlm.nih.gov/pubmed/25579140

I would be more cautious using probiotics with gastroparisis, methane positive... BUT they will come in. I will use them and they HAVE to be part of the recovery process. Every time you have a bowel movement it is 50% flora (yeast, microbes... etc) by weight. This fascinates me - think of how much the flora in your gut has to reproduce to be able to dump this much on a daily basis. Recovery of the balance of flora - the right strains, the right levels, is a must.

See if you can find a friend that has a laptop of a tablet that you might borrow for an initial Skype call. I am booking into the start of June at this time (just so you know the timing). I am also going to post these comments (without your name) on the FB string. It is a conversation that will help others.

Warmly,

Angela

Angela Pifer | May 2, 2015

My naturopath doctor told me to take Sibiotica but I am leary of taking any probiotics since I have SIBO (readings for lactulose breath test methane - 5 and hydrogen - 129 towards the end of 3 hours). I have taken Align in the past before I got Sibo but since starting having candida, Sibo and leaky gut I get acid reflux if I take Align. I had a one day stool test that revealed I didn't have any good bacteria in my gut. I currently don't have C or D just not good BMs like I used to. Are you able to suggest anything since I haven't seen you? I would love to Skype on my HTC if I knew how to set it up.

Jerri | May 2, 2015

Angela Pifer

Hi Brit,
Thrilled that you are enjoying the site! I am so sorry to hear about everything you have been going through - and that this all started so young. GERD is a symptom and the underlying triggers need to be addressed versus trying to stick a Band-Aid on it with a PPI. That said, GERD and ulcers are really the reason to use a PPI for 14 days... but not beyond. There is a black label on these medications now that warn people of long term use. I absolutely work long distance and I am happy to work with you one on one. You may contact scheduling@SIBOGuru.com to arrange an appointment. Check out 'Work with Angela' to learn more about the programs that I offer. I can help you figure this out.
Warmly,
Angela

Angela Pifer | April 24, 2015

Hi, I have just come across your site and this article and am finding it so helpful. I have a host of health issues and am really in need of help as things have been getting worse.

I have had GERD (and a hiatal hernia) since the age of nine and was put on PPI's such as Aciphex, I have been on acid blockers now for over 20 years as I just turned 30. I was recently diagnosed with havinf Gastroparesis and shown that my motility is about four hours behind the normal digestion rate. I also have Endometriosis and Fibromyalgia, allergies and chronic anemia.

I recently started having worse gut issues and the bloating is unbearable. I am wondering if you could recommend supplements for motility issues as I believe this is contributing to the SIBO and I believe this is all due to the acid blockers, which I cannot seem to get off of no matter how hard I try. I am desperate for help... I've been so sick and am so confused on what to eat, what to take for supplements and your site just gave me hope. I really hope to hear back from you and was also wondering if you work one on one with people? Thank you!

Brit | April 23, 2015

Angela Pifer

Hi Denise - this is a good probiotic. Two concerns - it has billions per capsule and the capsule is acid resistant. I prefer to start with a low dose million and that probiotics be taken with food to buffer their transit through the stomach and into the GI tract. I recommend opening the capsule, take 1/4 dose with water at meal time. I don't want the probiotic to make it through the small intestine without opening up.

Warmly,
Angela

Angela Pifer | May 4, 2015

Hi Angela,
I have been taking botanical anti-microbials for Sibo for the past 3 weeks & was going to start taking xymogen probioMax DF probiotics as soon as I have completed 4 weeks of anti-microbial treatment. I am also on a low FODMAP diet. I was just recently diagnosed with ulcerative colitis & was diagnosed with Rheumatoid Arthritis a couple years ago. I have had GIRD & digestion issues starting from my throat to my....well...the lower exit. As a teenager I was constantly on antibiotics for chronic tonsillitis & then in 2009 I went through 6 months of high doses of antibiotics for Lyme disease. Since then I was treated for sinus & ear infection last year. I am now 48 years old. I believe my autoimmune diseases are linked somehow to my gut issues. Anyway my question for you is should i be taking the probiMax DF. This was recommended to me by a Naturopath. Thank you!

Denise | April 20, 2015

Angela Pifer

I don't recommend VSL3 - this is only showing effective in inflammatory bowel disease. I use s. boulardii, Sibiotica K97 is also a good one... Klaire Labs puts out a couple of SCD compliant probiotics that I like, among others (again, this needs to be tailored to each person).

If you have SIBO and you have shifted from loose stool to constipation, I would start working with a practitioner asap. Constipation SIBO is much harder to get rid of long term. When loose stool is present, this doesn't mean that gut motility is working correctly. This simply means that there is too much fluid (osmotic effect) being drawn into the small intestine.

I don't feel that HCL is a mistake - that would shift you into constipation. It sounds like there is something else going on. Probiotics should be part of the protocol, but you should also be screened for bowel motility issues, SIBO - methane related and get a stool test (three day collection looking at parasitology as well) to start to see the whole picture that needs to be supported. I use a blend of supplements to support bowel motility (probiotics isn't a part of that)...

Best of luck to you!
Angela

Angela Pifer | April 17, 2015

My take on your comments re probiotics is that VSL3 starting with a partial capsule is beneficial for SIBO -- right? Does that apply to D or C dominant equally? Is there any other probiotic you recommend?
I currently use only fermented foods as probiotics.

I have gotten to the point where most of my symptoms (I dealt with D) seem to be better after taking a 2.5 months of herbal abx, but I am now dealing with C (no bloating). I started using HCI to address low stomach acid thinking it might also help with the C, but maybe that was a mistake (hydrogen in HCI). I will switch to ACV for now. Years prior to being diagnosed with SIBO I dealt with chronic C and the doctors never figured out why. Do you feel adding more probiotics will address the C?

I am going to retest soon to see what is going on with the SIBO.

JWeav | April 14, 2015


Leave A Comment