Comments

Hi Charlene, I hope that you are feeling better! When gastritis is present, I start from the top down - treating the throat, stomach and then the small intestine and so on. A probiotic alone won't fix this. It is really more about targeting the immune system, finding the triggers and healing up the lining. This will all help once SIBO is the target as well. It will help the correct treatment have a better chance at overcoming SIBO. Warmly Angela

I would love to be able to comment with more specifics on your case Alejandro, but I would need to work with you directly to recommend a change to the protocol. S. boulardii is recommended along with antibiotics (to reduce/ reverse diarrhea triggered by antibiotics) and it is also widely used with candida treatment. I am happy to work with you, please reach out to scheduling@sg.siboguru.com

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!

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

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.

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.

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.

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

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

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!

Also, is SCD yoghurt acceptable during or after treatment?

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

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?

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

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

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

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

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!

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!

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

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?

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

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.

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.

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?.

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.

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?

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?

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?

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?

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.

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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?

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?

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.

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.

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.

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.

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

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.

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!

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!

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.