Comments

Good Morning... I just started taking the study antiobiotic Aemcolo. I'm in a clinical study to see if Aemcolo will work to cure my Sibo overgrowth. (https://clinicaltrials.gov/ct2/show/NCT04501380) I took a breath test and was surprised to see that I have full Methane overgrowth - no hydrogen at all!

Before this - after years of suffering with sibo and other issues, (all of which have largely healed except for the Sibo issues), i started taking a large dose of probiotics geared toward repopulating the gut with healthy bacteria and crowding out the bad. My stinky gas and bloating went way down. I still would have issues if i ate certain foods but overall I feel I was seeing improvement so i was surprised to see the Methane overgrowth when I took the test. My bowel movements vary from diahrrea to mild constipation. There seems to be no rhyme or reason to them.

So based on what i've read on this thread and in your article, I've laid out a plan to take the Aemcolo in the morning, in the afternoon and then before bed take my probiotics. Does this sound like a plan? I also take Motility Activator as I was diagnosed with slow gut motility.

It was recommended that I not change the way I eat which btw I eat very healthy but I'm afraid to really dive into things like bananas which really seem to bring on a bout of tummy issues.

What are your thoughts on diet when a person is on a sibo antibiotic and probiotic regime?

Thank you for your time and response. I appreciate any suggestions.

Hi Angela I am unable to eat more than white rice and choko due to sibo and I’m desperately looking for a probiotic but I have an IgE mediated yeast allergy. How do I tell please which probiotics are free of yeast?

Hello, Angela!

I am a RD from Romania (EU). First of all I would like to express my gratitude for the content on the website and your availability to answer questions!
My question is regarding probiotic treatment for my 6 years' old daughter, who diagnosed with SIBO. Fortunately, she was diagnosed early stages, and she is currently heading towards the end of her antimicrobial treatment. I purchased Sibiotica and Megasporebiotic, which were easier to get hold of. She is currently doing very well after being on Saccharomyces B. (in adjunction to the antimicrobials) for 3 weeks now. Could you please expand on the order in which I should introduce these other 2 probiotics? And an aspect on which I found no information no matter where I looked for it - for how long should probiotic treatment go on either with Sibiotica or Megaspore? Or in terms of the minimum required period, after which re-evaluate ? Our GE is not skilled in probiotics, but agrees with me giving them a try. Thank you for your answer!
I wish all the best, Alexandra

Hello,

I was suffering with extreme anxiety and panic attacks for nearly a year. I started having stomach pains few months ago and I got tested for H Pylori and diagnosed. I was treated with triple therapy treatment with ppi included. Towards the end of the treatment, I started getting ringing ears and of course I was a hot mess from insomnia and anxiety. I'm just discovering I most likely have methane dominant SIBO, I'm constantly constipated. I got a breath test from my GI doc but haven't been able to take it because I'm on colace constantly and I'm afraid of being backed up to the point of intestinal blocking. So I cant take the test and I can't get treated for SIBO. I'm losing weight very fast. 150 to 135 lbs in a month. What do I do?

Hi Angela,
Have you worked with people who developed SIBO after taking a round of Augmentin and seen positive results? My GI doctor just wants me to take xifaxan but I am unsure about this. I feel like I've tried just about every probiotic, herbal antibiotic, and diet out there and have seen no progress. I'm currently on the elemental diet but see no difference. Thank you for all the information you share.
Sharleen

Thank you so much for your response. Financially, I’m not sure I’ll be able to swing it, considering all the medical bills and expenses I’ve aleeady thrown away from dealing with this. Which is unfortunate because I really could use some guidance so I can get back to my healthy, vibrant self that was just a couple months ago.

Thought I would come here since my docs and gastro is of very little help. Long story short, I developed sibo after a round of augmentin and acid reducers for silent reflux (i regret that with my whole being and should've trusted my gut---no pun intended). This protocol severely messed up my gut when I never in my life had digestive issues, or reflux for that matter. Gastro prescribed rifaxamin for a 10 day course, which i am finishing up in a couple days. I asked him what do I do afterward. His reply---take probiotic, align or florastor, and no other protocol. See you in 6-8 weeks to see if it worked. Big help. So I'm left to my own accord.

I wanted to know what possibly should be the next step. I plan on taking align extra strength and florastor, which i have been taking already. But do I get any other supplements for the next phase? Can I eat fermented foods again? And do I have to continue this low fodmap that I've been on because it's tiring eating this way everyday.

Thanks in advance!

I am so confused!! I have been doing a herbal treatment for SIBO for two weeks now. I have also daily been taking a soil based probiotic. Should I be taking the probiotic while doing the herbals or wait till I am finished with the herbals? Help

Hi there,

Ive been dealing with a gut issue for over a year now. Ive done a GI Map test and most of it came out pretty normal. However, i had real high numbers on a SIBO lactulose breath test, methane dominant. Ive been on Allimed, oregano and berberine for a month now. Doesnt seem to help really. I have trapped gas all hhe time and are emotionally stessed every day. Any suggestions? Thank you.

Hi. Do you recommend the megasporebiotic leaky gut protocol to help SIBO/leaky gut?

Hi. I have been struggling to diagnose my gut pain for over a year and finally was diagnosed with SIBO, gives a 2 week preceiotion for Xifaxan, and now that my 2 weeks of Xifaxan is over I am told to purchase VSL3 and follow the Low FODMAP diet. I just want this over with. And the vsl3 is $70 and I can’t afford that right now. What do I do.

Hello,
I had a C diff problem a couple months ago, and I took antibiotics three times for it. I believe it has now turned into SIBO, and the C diff is now in my small intestine.
Is there a way to get rid of it from in there? I don’t want it to keep coming back :(. It’s been a hard few months.
If it is possible to get C diff out of the small intestine, how do I do it?
If I eat anything with sugar or dairy I start hyperventilating, I get really nauseous, I burp and pass gas a lot, and my muscles spasm, and joints start to hurt.
Would rifaximin help?

Hi Angela,

I’ve had a rough 4 months.. started with gas, bloating... then escalated to constipation, mind fog, fatigue, lost 30 lbs, took lactulose breath test showed sibo with high hydrogen 30-40 and methane around 8-9. A lot of inflammation and fructose test - showed malabsorption and lactose test showed malabsorption. Also went to a nutrition who ran tests and showed candida overgrowth. Finally I am about to start Xiafaxin and diflucan. The doctor says I don’t need neomycin with it.. do you think I do? Also, am I supposed to take a probiotic while taking the antibiotics or after I finish??? If during what do you recommend I take? Thank you

Hi Angela I was told that I have Sibo in March of 2018. I really didn’t want to take antibiotics because my stomach is extremely sensitive. I took a herbal supplement that I found online. For awhile I felt great relief however now I am having all my symptoms. I think I would like to start the Xifaxan that was prescribed to me but also take the right probiotic. May I make a phone consult with you?

Hello Angela,
I would like to thank you for all the comments and the help you have been providing to everyone. I am very grateful. It is very difficult for some of us who live with SIBO.
I have chronic SIBO for many years now. I feel very sick, tired, can t breath and I get mast cell activation every time I eat. My biggest worry is that I am extremely low weight 38 kg and measure 170 cm. I eat at least 2500 calories and usually up to 3500 a day. Doctors can not find an explanation for not being able to gain weight, I believe when I feed SIBO I just can not gain weight at all in fact the more I eat the more I loss weight. I am on prokinetics since 1 year, I am extremely constipated even though I have Hydrogen SIBO and when I eat meat or fish I get severe hypoglycemia. The FODMAP doesn’t work for me only a combination of FODMAP and Specific carbohydrate diet and low fat seem to work better but still after a while it seems the bacteria just feeds on anything. I feel quite lost and I am about to start the elemental diet and thinking which probiotics I should take. One week flat from optibac seemed to work for me in the past but it has FOS so was wondering which ones to take and if you had any suggestions for my case in general?

Hello Angela,
I would like to thank you for all the comments and the help you have been providing to everyone. I am very grateful. It is very difficult for some of us who live with SIBO.
I have chronic SIBO for many years now. I feel very sick, tired, can t breath and I get mast cell activation every time I eat. My biggest worry is that I am extremely low weight 38 kg and measure 170 cm. I eat at least 2500 calories and usually up to 3500 a day. Doctors can not find an explanation for not being able to gain weight, I believe when I feed SIBO I just can not gain weight at all in fact the more I eat the more I loss weight. I am on prokinetics since 1 year, I am extremely constipated even though I have Hydrogen SIBO and when I eat meat or fish I get severe hypoglycaemia. The FODMAP doesn’t work for me only a combination of FODMAP and Specific carbohydrate diet and low fat seem to work better but still after a while it seems the bacteria just feeds on anything. I feel quite lost and I am about to start the elemental diet and thinking which probiotics I should take. One week flat from optibac seemed to work for me in the past but it has FOS so was wondering which ones to take and if you had any suggestions for my case in general?

Hi Angela,
I am one of the most complex cases of gut dysbiosis! 20 years ago, I had a ND experience where a dr. Accidentally cut my jujenum! Which gave me ARDS & sepsis...planting all kinds of bacteria & pathogens in my gut. How I ever survived the exploratory repair, who knows??? I have suffered ALL the gut issues you can describe. Worst yet, I have acute abdominal PAIN episodes 4-9! With too many visits to ER/Hospital! For the past 3 yrs. I am barely able to nourish myself! Due to weakness, weight loss 110/ 5'8" & food intolerances, etc... I did 18 months on baby food, just to survive. Then I found FODMAPS...which prevented me from having a perenteral port out in! I am disciplined and carful about my diet...no cheating!
But sometimes I feel hopeless because of high pain!
My doc has put me in Rifaximin for 4 months now and it probably saved my life. I was able to function again/less pain. I realize I have SBS, adhesions, bowel loop, PTSD, depression & probably SIBO/ leaky gut.. brain fog, VERTIGO, headaches,."functional disorder"! I should go on the Oprah show-as I Usually have a positive attitude despite my afflictions! Ha. I still believe in healing!!!

Ok, the basics; I can't tolerate; probiotics (although I liked VSL3) no gluten(celiac) no corn, peanuts, milk, soy, most raw foods, all processed foods of any kind/chemicals or additives. I supplement GofLife vitamins, use iberigast, Creon, antispasmodic, various nutrients..etc... I guess I am wondering IF there is any hope for me to ever have a more normal life. I am so incredibly fatigued (CFS? EBV?) it's so difficult to know how to proceed. I am so incredibly grateful for your healing wisdom that you share so freely!! It gives me new hope. Any insight? Have you ever worked with such a complex case.....could you even help me?

Hi Angela,

I just finished my Rifaximin treatment on Friday, and I ordered probiotics to get here by Tuesday. Is 4 days too long in between the antibiotics and the start of my probiotic treatment?

Yes dr put me on vsl #3 . I am stopping it made me break out ! I believe I have sibo & candida, going for test for sibo , how do u test for candida ? Don't know why he put me on the probiotic , see him tomorrow will ask ! I wish u were closer , so I could be your patient . Thanks

Hi Angela,

I am currently on my second round of Xifaxan for my Sibo. Do u recommend taking a probiotic while on the antibiotic? My doctor suggested VSL 3. Or should I wait until I am off the antibiotic? Any insight is greatly appreciated.

Hi Angela- Can infants develop sibo? I ask because my 10 month old has had digestive issues. At 2 months there was some blood and mucus in her stool. At 5 months, I gave her 3 days worth of klaire labs infant probiotics with inulin base and things just got so bad after that, continuos blood and mucus, alternating diareaha and constipation... She is breastfed. I just wonder if the inulin and high dose 10 strain infant probiotic couldve overwhelmed her little system and the "good" bacteria could be causing a bad effect. Traditional md ped gi docs are not familiar with this and Im desperate for answers. Thank you.

Hi

I saw some studies that showed that glutamine can increase bacterial overgrowth. Thoughts?

Hi, I was diagnosed with IBS over 20 years ago. Currently, I am very limited to what I can eat: only meat and fish and some well cooked low FODMAP vegetables - very little fibre, no fruit, carbs, dairy or sugar. Even then, I still experience severe bowel cramping most days; otherwise I am very healthy and physically fit. I strongly suspect I have SIBO but because of where I live, I don't have access to health resources to confirm it. I start my day with a probiotic- (12 billion) and take 3 drops of oil of oregano after meals. Any suggestions?

No, the organisms will not spread to the lungs. I would seek out a visceral manipulation therapist to work on your diaphragm and digestive organs and I would also consider that this might be a small intestinal fungal overgrowth as well. The SIBO breath test is one test and though it may identify an issue, it is only one part of the equation. Even if you are not constipated, if you have methane dominant SIBO, xifaxan will not fix this. I would also work to heal the reflux (the therapist can see if you have a hiatal hernia) while you are taking the acid lowering medication, then work to get off that quickly. This will create more issues down the road. I just opened my practice again for new patient appointments. If you want to get in sooner - starting next week, reach out to scheduling@sg.siboguru.com. Warmly, Angela

Hello! Xifaxan alone will not treat methane SIBO. This needs to be either a combination antibiotic therapy for methane, or an herbal approach. There is no reason to do xifaxan for two weeks to 'see what happens.' I recommend calling your doctor now to get the full protocol - pairing this with neomycin or metronidazole. Otherwise, you will not knock down the methane and over time, I have seen this make the gut even more resistant to recovering. I can't recommend a specific probiotic to you over a blog post. I do list the probiotics that I work with under my shop on my site. Look through these and then discuss these with your health care provider.

Thank you for the compliments on the video!

Warmly, Angela

Hi Frank,
"I feel as if each individual is so unique that hard and fast rules are the most common mistake made in medicine full stop." - I couldn't agree with you more.

SIBO is an overgrowth of organisms in the small intestine. SIFO is a fungal overgrowth in the small intestine. Candida is a fungal overgrowth in the large intestine.

The right practitioner will assess your labs, symptoms and look at what you have tried - what worked, what hasn't and gleam some very relevant information from this and then create a customized ADAPTABLE plan that starts the treatment process. We need to constantly evaluate progress and be able to adapt the plan as we move forward. I have not used the same treatment protocol on any two of my patients. It really does have to be that customized and unique to the individual to work.

We really have to look to the underlying reasons that SIBO was set up. If these can fully be addressed, then I expect full recovery. If these need to be managed, then a modified plan might be in order. What we can't expect is SIBO diagnosis + SIBO treatment = SIBO full recovery. SIBO is much more complicated than this.

The 'SIBO diet' is only meant to help alleviate symptoms. The diet doesn't treat SIBO. Our goal with the diet is to keep as much variety as possible and to modify the fermentable 'load' only in people who need it. Treat correctly, then work on gut healing and immune modulation, then start to test and expand the diet. There is a very sensitive period after treating SIBO, where the diet needs to remain modified. Yet, after this, we really do have to start to expand the variety, so the patient isn't 'nutritionally challenged' by the diet. It may be Frank, that there is more to still address here for you. I appreciate your question. Best of luck to you!

Warmly,
Angela

Yes, here are studies:
http://www.ncbi.nlm.nih.gov/pubmed/21381407
http://www.ncbi.nlm.nih.gov/pubmed/18763284
http://www.ncbi.nlm.nih.gov/pubmed/23244247 this one shows lactobacillus used after antibiotic
http://www.ncbi.nlm.nih.gov/pubmed/25579140
http://www.ncbi.nlm.nih.gov/pubmed/25244414
http://www.ncbi.nlm.nih.gov/pubmed/23653934
http://www.ncbi.nlm.nih.gov/pubmed/17378388

Warmly,
Angela

Hi Ondina,
VSL3 doesn't have any prebiotics in it. It is a high potency lactobacillus probiotic. Most all the probiotics that I use are listed under my shop https://siboguru.com/product-category/probiotics/ you don't need to purchase these from me. This is just a good reference so you see what I use with my patients.

Warmly,
Angela

Hi Bharat,

I am so sorry to hear about your situation. The symptoms can be so overwhelming and debilitating. I appreciate that you have been to a very good doctor and that you have identified that this is SIBO. There is much more to be done here to address your symptoms and to treat this. I do work long distance, both nationally and internationally. If you find that you would like further help with this, please reach out to scheduling: https://siboguru.com/contact/ You definitely can't live off cucumber water (I say this with empathy, I know how hard you are trying to not have symptoms).

I also appreciate all the research that you are done. There is a LOT out there. It is good to be educated, and you need to find someone to work with who really knows that and can help to treat you as an individual.

Warmly,

Angela

Hi Steph,

Yes, here are studies:
http://www.ncbi.nlm.nih.gov/pubmed/21381407http://www.ncbi.nlm.nih.gov/pubmed/21381407
http://www.ncbi.nlm.nih.gov/pubmed/18763284http://www.ncbi.nlm.nih.gov/pubmed/18763284
http://www.ncbi.nlm.nih.gov/pubmed/23244247http://www.ncbi.nlm.nih.gov/pubmed/23244247 this one shows lactobacillus used after antibiotic
http://www.ncbi.nlm.nih.gov/pubmed/25579140http://www.ncbi.nlm.nih.gov/pubmed/25579140
http://www.ncbi.nlm.nih.gov/pubmed/25244414http://www.ncbi.nlm.nih.gov/pubmed/25244414
http://www.ncbi.nlm.nih.gov/pubmed/23653934http://www.ncbi.nlm.nih.gov/pubmed/23653934
http://www.ncbi.nlm.nih.gov/pubmed/17378388http://www.ncbi.nlm.nih.gov/pubmed/17378388

And really common clinical sense, SIBO is set up because of an imbalance in the system - this is set up because of immune dysfunction (at the mucosal level), dysbiosis, motility dysfunction, etc. Probiotics help with immune modulation. This is really why we take them.

Warmly,
Angela

Hi Jennifer,

First, let me apologize here. Your question was a bit more timely here and I have been really busy this past month with my clinic. It may be that 1/8 pinch is your dose. If 1/4 doesn't work for you, but 1/8 did, then stick with 1/8 pinch longer. Once this sits well, then try 1/8 pinch twice a day. I definitely would not push through symptoms. I would evaluate why they are happening and make some adjustments.

If you find that the Sibiotica does not work at this time, set it aside (tightly sealed, in the refrigerator) and consider trying Bacillus coagulans next.

Warmly

Angela

Hi Melissa,

Thank you! Once a negative SIBO test is reached, people don't always feel immediately better. The next steps are gut healing, immune modulation and then working to rebalance the gut flora. You may need to be on a modified diet this entire time, then, after this (maybe 2-3 months after treatment) you may challenge some fermentable 'loads' to see what you can handle at that point. There are some supplements that might help with cramping (please discuss these with your health care provider - Iberogast, enteric coated peppermint, Gentian and Skullcap...)

It sounds like you know what this isn't - it isn't a parasite, fungal overgrowth that was missed and you don't see a level of pathogenic bacteria. I would look more at rebalancing the dysbiosis and healing up the gut. I also recommend visceral manipulation (type of body work) and biofeedback.

Warmly,

Angela

Hi Stephanie,
You are using a probiotic that is much too strong. It also has FOS (fructooligosaccharides in it) which are prebiotics. They made a very wrong recommendation for you. I would pull these immediately and focus on a lower fermentable plan to calm your gut down.

Diflucan (anti-yeast medication) is a bit too strong for my liking. We do need a good yeast balance to keep the bacteria at bay (same can be said for the opposite - when an antibiotic is taken and this knocks down too much bacteria, then people can get a yeast overgrowth). This needs to be more of a balancing act and this is why I prefer herbal antimicrobials and antifungals. We can use herbs that exhibit both properties so we can address these (SIBO/ SIFO/ Candida) at one time. For a yeast issue, saccharomyces boulardii is a good probiotic to use.

Warmly,

Angela

Hi Tawnya,

Yes, the information is different for anyone who has had a bowel/ stomach surgery. It is likely that you have SIBO because of the surgery and that you are experiencing an overgrowth of your innate flora (flora that is supposed to be there, yet is there in too large of number). Since you have had a bowel/ stomach surgery, I recommend doing everything possible to avoid antibiotics. You are going to be more prone to a recurrence because of the surgical juncture that was made. Instead, look to treating this with herbs and addressing symptoms to best manage this long term. I say this because, I antibiotics should be a last resort and it isn't a good idea to use multiple rounds over the course of your lifetime. I do understand that symptoms can get so debilitating sometimes, that the antibiotics seem like the only option, yet there may be more to be done here to get you comfortable first, treat this more gently with herbs and then work on a maintenance plan over time.

The root cause here is complicated because of the surgery. I don't know your case personally, so I don't know if there are additional issues contributing here (sluggish thyroid adding to motility issue, past food poisoning, adhesions from the surgery).

If you haven't found the answers you are looking for, I am happy to work with you. Reach out through my scheduling: https://siboguru.com/contact/

Warmly,

Angela

Hi Anne,

It sounds like there is still more here to address. That SIBO and possibly, the underlying condition, or possibly the dysbiosis after SIBO hasn't been addressed fully. The probiotics that I use in my practice are listed on my site: https://siboguru.com/product-category/probiotics/ this is a good reference to talk with your practitioner about. I find that a low fodmap plan is the best regroup diet, yet I only alter the diet to reduce symptoms (not as part of the treatment plan).

You may need further treatment, but since you are breastfeeding (please don't let this interrupt your plans for breastfeeding) you should wait until after you are done breastfeeding to treat this again. You could use a low fodmap plan to help make your symptoms manageable during this time.

I hope you feel better soon Anne!

Warmly

Angela

Hi Joni,

I would look at two things - if there is a histamine issue present, and if you are having an immune reaction to some of the foods that you are eating. I would also look at blood sugar regulation and adrenals.

I find that some people have histamine reactions after having SIBO chronically and that once this is addressed, they can recover from this. I see that these reduced after addressing SIBO, yet there may have still been more dysbiosis to address and heal.

I would also look at a possible mold/ mycotoxin exposure to see if you are carrying a mycotoxin load that is affecting your system.

There are food sensitivity tests that I do not recommend and one that I do. Cyrex Array 10 has been right every time I've run it.

I hope that this helps Joni!
Warmly
Angela

Hi Heather,

It really depends on the patient, SIBO, symptoms, additional conditions, if LOW diversity (seen on a stool test) etc., so unfortunately it is hard to answer this question as a yes or no.

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. https://siboguru.com/product-category/probiotics/https://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

Hello, I would say that it is one person's view on what worked for them. They also mention yogurt and eating this and they feel that this added to their relapse. I do like the reply comment right below the post "HiI am afraid i TOTALLY disagree, I have been working with bacteria for more than 12 years in a professional capacity and know from first hand experience that reintroduction of targeted bacteria in to the GI tract as a whole is vital for the efficient treatment and recovery in the long term for SIBO of all kinds. telling people not to take probiotics and other supplements is extremely narrow minded and may prevent people from finding some relief." I completely agree with this.

Warmly
Angela

Hi Kristen,
Do probiotics make him worse? I really wish I could help with further advice here, but this is an age group that I do not work with. Please seek out a pediatrician in your area.
Warmly
Angela

Hi Mia,

I am going to repost a summary from Klaire Labs monograph on d-lactate - it is quite eye opening.

SUMMARY: Organic acid testing may reveal the presence of the isomer D(-)-lactate. Confusion exists among clinicians on how to interpret this result and what to do about it. Humans produce only very small amounts of D(-)-lactate, but normally metabolize this isomer efficiently. Microorganisms can make mostly D(-)-lactate, L(+)-lactate or a mix of the 2 isomers. Elevated urine D(-)-lactate levels are often confused with D(-)-lactic acidosis, an extremely rare condition occurring almost exclusively in patients with short-bowel syndrome and an overgrowth of certain Lactobacillus or Enterococcus species. D(-)-lactic acidosis has never occurred in a person with an anatomically intact bowel. Elevated urine D(-)-lactate levels may be due to a gastrointestinal microbiota predominated by species that produce high amounts of D(-)-lactate. Increased Enterococcus and Streptococcus populations are the most likely culprits. However,
elevated levels also imply a diminished mitochondrial capacity to metabolize D(-)-lactate. Factors that may impair metabolism of D(-)-actate include elevated acetyl-CoA levels, high oxalate concentrations, and thiamine deficiency as well as high intakes of high fructose corn syrup. When elevated urine D(-)-lactate levels are encountered the most effective approach is to resolve gut dysbiosis with pre- and probiotics, optimize digestion with enzymes, restrict excessive carbohydrate intake, provide nutritional mitochondrial support, and reduce elevated oxalate levels.

Hi Brenda,

Yes I have seen this. Dyslipidemia (high cholesterol) is a results of oxidative stress, inflammation and/ or an autoimmune reaction. I have seen a few otherwise healthy people, with very high cholesterol and oxidative patterns that have been traced back to asymptomatic dysbiosis (some SIBO and some not) and once the gut was healed, the cholesterol recovered.

Angela

Hi Rachel,
I would work with her on learning how to blow into a tube -practice this with a straw and then take the test. I would not treat this without really knowing what you are treating. I also recommend using a lab that also measure CO2 at each interval (Common Wealth Labs do this) so you can make sure that the collection was done properly and you are getting an accurate reading. This might be SIBO and it might not. I would hate to treat these and then it turns out it is something else, she is so young. I know you understand this, otherwise you wouldn't be posting here and asking this question. Warmly, Angela

Hi Stephen,

I am so sorry to hear about your symptoms and continued health concerns. Have you been assessed for Lyme, mycotoxins, heavy metals... it definitely sounds like there is something else going on here than 'just' SIBO.

Here are some sleep support suggestions to discuss with your health care provider: 3 grams of glycine; Sleep Well Drops from Herban Wellness in Kirkland, WA (they will mail this to you, request their 'hawethorne' formula); 1 scoop of PurePaleo protein at bedtime (this is hydrolyzed beef protein/ no fermentable compounds); Magnesium Chelate, Designs for Health. Take all of these at bedtime. Also adrenal support and calming - I like Apex products for this. Epsom salt bath, sleep hygiene makeover.

You could add calcium-d-glucarate to indirectly lower the gut ammonia levels.

There is a lot more to do to this, but I hope that this helps!

Angela

Hi Olga,

I often use l-glutamine, slippery elm and DG licorice along with other supplements and compounded bismuth as adjunct care to address acid reflux. I find them highly effective!

warmly,
Angela

What strains of probioics produce d-lactate or even both d and l lactate so I can avoid the buggers? I just went through two courses of xifaxan clearing much brain fog, then tried some probiotics to replenish my good guys and stave off c diff only to have the tying to think though mud can't remember recent information return.

i could cry.

or scream.

going to see my gi dr asap but in the mean time I am trying to learn what I can to talk to her about - and make sure she knows what she is talking about.

There is a real dearth of information on the internet or at least that I can find. My google fu has failed me.

Hi Alyce,

I definitely recommend that you work with a qualified practitioner to help you determine the best course of action with your treatment. Once there has been a re-sectioning, this brings up new issues that need to be assessed and addressed. Depending on which sections are re-sectioned, adhesions (high risk after surgery), and how you are healing, you will be more prone to having an overgrowth of beneficial flora (like lactobacillus or bifidobacterium) - so taking a lactobacillus or bifidobacterium probiotic may not be the best approach for you. It is important to know what is contributing to SIBO (if SIBO) and formulate a plan that addresses this - the approach is different if lactobacillus overgrowth, something like klebsiella or methanogens (organisms that migrate up from the large intestine). One treatment does not treat SIBO - unfortunately.

Warmly,
Angela

Angela,
Thanks for the great information on d-lactate. What do people take who are sensitive to the build up? Thanks so much for answering my question, I have also learned a lot from your responses to others.

This was an enjoyable read with lots of great information. Just curious - have you ever seen people with Sibo that they're only symptom is extreme nausea? I tested positive in the hydrogen breath test, and I am on rifaximan now. It's making me quite sick though (just intensifying the nausea, no other symptoms), just like the initial antibiotic that I took that started all of my symptoms (augmenting). So again, I'm curious if you ever seen people with Sibo that they're only symptom is nausea. I tested positive in the hydrogen breath test, and I'm on day 3 of the rifaximan. It's making me quite sick though, just like the initial antibiotic that I took that started my nausea in the first place. I spent four months trying various probiotics (including florastor and prescript-assist) with no luck, and that is when they told me I needed the antibiotic.

Are high d lacate levels from bacteria considered to be SIBO or just dysbiosis? My Organic Acid test showed a very high level of d-lactate which was attributed to acidolphilus. Not sure why it was was specified as that particular kind since it is not the only one that can produce d lactate, however all my other bacterial markers were low.

Would an overgrowth of l acidolphilus (or any other d lactate producing bacteria) produce hydrogen where it would even show up on a breath test? Would rifaximin kill acidolphilus since it is considered a good bacteria?

Thank you very much if anyone can help me piece this information together, there is not much that I could find regarding d lactate.

Hi there,
What great info! I have both candida and sibo coming off 15 years of nexium (I weaned myself off). I am struggling to digest food. I eat only meat and veggies. I'm on rifaximin ...round two and have taken antifungals daily for years. My digestion is so poor I'm unsure how to get out of this vicious cycle. What steps would you recommend first? I've tried diestive enzymes and betaine hcl to no real avail.

Hi Angela,
Appreciate your good work. I'm a bit lost and would appreciate your view. Not too confident in my naturopath so maybe I should consider working with you long distance (I'm in Ireland). An abbreviated summary:
- 36 year old male
- chronic antibiotic use & sugary diet until 23 years old (no abx since) and 8 amalgam fillings (removed 2010)
- multiple food intolerances (originally grains/dairy)
- did multiple rounds of "anti candida" cleanses with wholeapproach.com (2009-2012) and experienced improvement but could not get through die off of their broad spectrum herbal anti microbials
- GAPS diet from dec 2014 made me histamine intolerant and pushed me into anxiety/depression With diet now very difficult to manage (low carb/low protein??!)
- currently being treated for under methylation (high histamine) but having difficulties with protocol which is under review
- did Genova CDSA 2.0 with parasitology recently which showed no lactobacillus growth, bifido and ecoli ok, low gut ph and elevated beta glucuronidase. Candida/klebsiella/citrobacter/rhodotorula all "non pathogen" but just below "potential pathogen" marker.
- secretory iga over 1000 (max normal 471).
- have not done SIBO test.
- currently taking 20 billion lactobacillus GG and 250mg s boulardii per day.
- I experience brain fog and sinus inflammation from eating grains/starch.
- no abdominal discomfort whatsoever now or at any point in my history. Keep bowels moving with payllium/magnesium.
- I have been taking probiotics for years and years but still no lactobacillus growth and off the charts SIGA level.
- do I need to do a biofilm treatment to help my lactobacillus colonise the gut wall?
- have been working so hard on my gut health for years and feel I am falling down the rabbit hole now and it has taken over my life and I am feeling worse than ever.
Thanks for reading
Paul

What probiotics do you recommend? What brand?

hi there ,
I have basically been through he** and back since January with digestive issues. I am beginning a 6 month parasite, fungus, bacteria treatment on Friday. My acupunturist is treating me for gu syndrome with thunder pearls. Would you recommend taking probiotics during or after? What kind is best? Currently I am taking florify because my husband seems to think the good can outnumber the bad bacteria if I stick with it, but this week has been awful. I look 6 months pregnant. Thank you!!!

Some practitioners are using Prescript assist, others are using Lactoprime, I often use Sibiotica - it all depends on the person, what their digestive stool test shows (levels of good flora, unbeneficial... etc). and then we micro-dose this over time. I wouldn't take probiotics during antibiotic treatment for methanogens. 24 hour yogurt (which is lactose free) has some cultures, but not the level that would offer a therapeutic dose. You would likely tolerate the yogurt well (if you can have dairy).

Warmly,

Angela

You'll need to be off the probiotics for the test - stop them a week before. When you do start probiotics, micro-dosing is the best approach. Best of luck with your breath test!!

Angela

Hi Gordon,

I would retest the breath test to see what kind of recovery (the reduction in ppm, parts per million, resulted from taking the xifaxan). This is likely 12 ppm - 30 ppm from one round. There is much more to be done when treating SIBO than simply taking the antibiotic. You and your practitioner need to figure out what set this up in the first place and address it, address gut motility (diarrhea does not mean that you have good/ fast gut motility - it means that there is a trigger that is drawing water into the lumen and literally flushing your small intestine), address digestive insufficiencies, continue to treat SIBO until the breath test is normal, then SLOWLY start to reintroduce the fermentable food categories over time...

Angela

Thanks Marge!!

Hi Melody,

Combining low FODMAP and low histamine is incredibly challenging! If you can't take l-glutamine, then I would try slippery elm, Hist-Dao, consider adding in a good amino acid complex (even though has 'histidine' in it - all animal proteins have this in it - take this with Hist-Dao). There is more of course, but these may help. Consider Quercetin and Nettles to reduce mast cell levels.

For the low FODMAP plan - I work with each patient to customize an eating plan, address the SIBO and then we start to work on reintroduction. The goal is zero bloat, so this takes time to work through, as we test out each fermentable food group and continue to work on gut healing. For histamine help I would look up Heidi Turner - she is a dietician in Seattle and works long distance. Find her through her private site and email her directly.

Angela

Hi Kristie,

That you are bloating when you haven't eaten is interesting - this symptom isn't likely due to SIBO. I would look at bile reflux issues, parasites... look for another cause for this. I would retest for SIBO to test your progress and consider a Digestive Stool Analysis x 3 day stool collection with parasitology to gain more insight as to how the gut is functioning. If you are still bloating, there is more that needs to be addressed before you move fully into gut healing and rebalancing.

Licorice sometimes sets SIBO symptoms off. There are a lot of options with adrenal support, so you can rotate through to find one that works for you. One insight here - you cannot heal the gut in the face of adrenal fatigue. It simply will not happen. If in adrenal fatigue, the goal is to minimize symptoms with diet and some supplement support, full force focus on adrenals and then once these are recovered then you can refocus on the gut.

Warmly,
Angela

Hi Tamara,

I don't usually recommend kefir to my SIBO patients until they are 2-3 months post treatment and gut healing phase. I do recommend 24 hour yogurt (plain full fat) during treatment if they can handle dairy. Again, this is to address SIBO. Kefir (plain, full fat) could be added in with pretty much every other treatment protocol (other than candida).

Warmly,
Angela

Hi Lisa,

Most herbs are both antimicrobial and antifungal - this is usually the best approach at treating SIBO and SIFO. I absolutely recommend an antifungal along with Xifaxan, if there has been an identified fungal issue. That said, I don't recommend antifungal medications. These are too strong and will also knock down beneficial yeast, which help to keep gut flora in check. Whether treating with antibiotics or herbal antibiotics, gas production is recovered at 20-30ppm with each round. This may give you an idea of how many rounds it will take to get full recovery (negative breath test) and then the process begins with gut rebalancing.... etc. I don't recommend multiple rounds of antibiotics, that is why I prefer the herbals. Go to PubMed.gov and type in 'SIFO' - it is quite interesting how classic SIBO symptoms can present with SIFO as the issue. You might also type in 'SIBO Probiotic' to find the study that showed probiotics were as effective at helping SIBO symptoms recover as Rifaximin. I highly recommend probiotics, but you'll need to target the right kind to her case/ care/ recovery.

Best of luck to you...

Angela

Hi Kristie,
I usually rotate probiotics every few months - you can find single strain probiotics, but usually only at the pharmaceutical supplement level (the really good brands). One round of herbals will not take care of SIBO. You may find that your symptoms have recovered a bit, but the underlying issue wasn't addressed to the degree that it needed to be. Look up 'histamine probiotic' on pubmed.gov - I found some interesting articles on there that histamine production lowers inflammatory markers in the gut. This is not going to be true for the person that is histamine sensitive - but interesting all the same. The jury is still out on which probiotic strains increase histamine in the gut - there really isn't enough data to substantiate this. I say to listen to your body and go from there...

Angela

I have learned so much from your website! Thank you!! I have 2 questions-
Are there certain brands of probiotics where you can try only one strain of bacteria at the time? And, do you recommend to switch to another strain after that bottle runs out? I was thinking of trying a probiotic with only bifido bacterium first but haven't been able to locate one. I have a long medical history, but I recently treated sibo with a herbal protocol (allimed). I still have some bloating and food sensitivities and would like to find a probiotic that is low histamine, helps with constipation, and will not cause any more bacterial imbalance. My testing showed that I didn't have the bifido bacterium. I would love to hear your opinion. Thank you!!

Which powdered probiotic is best? There are so many and as you said you should slowly increase the amount. Should you start with one such as lactobacillus or the other one or both at the same time?
Thanks so much, you are great.

Thanks for your video Angela - vert informative. I have recently been diagnosed with Candida and SIBO along with a MTHR genetic issue. I have been on myriad supplements for years but was told that until the chronic infections are addressed, they will not be absorbed.
I just started a 2-week treatment of Nystatin and then an antibiotic in conjunction with a low FODMOPs diet has been recommended. I welcome your thoughts on this protocol.
Thanks in advance,

Jamie in LA

Please note that those who have CFS may not be able to tolerate lacto based probiotics. I was taking them for awhile and began feeling very bad. When I saw this article: http://www.ncbi.nlm.nih.gov/pubmed/19567398, I stopped taking them and felt much better by the next day. I now take only bifido based probiotics, which definitely help me, and are hard to find. But Walgreens carries a branch called 4X: http://www.walgreens.com/store/c/walgreens-4x-probiotic-dietary-supplement-caplets/ID=prod6112392-product
Here is the abstract of the study mentioned above:

In Vivo. 2009 Jul-Aug;23(4):621-8.
Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome.
Sheedy JR, Wettenhall RE, Scanlon D, Gooley PR, Lewis DP, McGregor N, Stapleton DI, Butt HL, DE Meirleir KL.
Author information

Abstract
Patients with chronic fatigue syndrome (CFS) are affected by symptoms of cognitive dysfunction and neurological impairment, the cause of which has yet to be elucidated. However, these symptoms are strikingly similar to those of patients presented with D-lactic acidosis. A significant increase of Gram positive facultative anaerobic faecal microorganisms in 108 CFS patients as compared to 177 control subjects (p<0.01) is presented in this report. The viable count of D-lactic acid producing Enterococcus and Streptococcus spp. in the faecal samples from the CFS group (3.5 x 10(7) cfu/L and 9.8 x 10(7) cfu/L respectively) were significantly higher than those for the control group (5.0 x 10(6) cfu/L and 8.9 x 10(4) cfu/L respectively). Analysis of exometabolic profiles of Enterococcus faecalis and Streptococcus sanguinis, representatives of Enterococcus and Streptococcus spp. respectively, by NMR and HPLC showed that these organisms produced significantly more lactic acid (p<0.01) from (13)C-labeled glucose, than the Gram negative Escherichia coli. Further, both E. faecalis and S. sanguinis secrete more D-lactic acid than E. coli. This study suggests a probable link between intestinal colonization of Gram positive facultative anaerobic D-lactic acid bacteria and symptom expressions in a subgroup of patients with CFS. Given the fact that this might explain not only neurocognitive dysfunction in CFS patients but also mitochondrial dysfunction, these findings may have important clinical implications.

Hi Chris,

High S IgA means that there is chronic inflammation going on in your gut, that hasn't been addressed. This could be leaky gut, SIBO, dysbiosis, parasite, celiac... could be a combination of these as well. To address this, the root cause will need to be determined. If SIBO (and not the rest), then you'll need to address SIBO (I prefer to do this with herbs and diet) and then you would start the process of gut healing (l-glutamine would be part of this) and addressing flora balance (lactobacillus, bifido and s. boulardii are all part of this - but we need to focus on the right strains). Large doses of l-glutamine won't heal leaky gut. This is part of the equation, but this can only be addressed when the root cause for why leaky gut is present is also addressed.

Angela

Sorry for the typing errors my phone is auto correcting to what it wants to put lol my siga levels were very high. And would l glutamine bring my siga levels down??

Hi Chris,

Stress and lack of Lactobacillus are both big contributors to SIBO. If you don't have healthy colonies of flora, then you won't be able to keep the balance/ gut homeostasis.

Did you have the breath test to identify SIBO?

On the stool test, was your Secretory IgA low or high? I just did a post on this regarding its implications with SIBO. With such low Lactobacillus, it wouldn't surprise me if these was low.

Angela

Cd da stool assessment

Hi Angela

I found your article while looking specifically into 'archea' species and Sibo, as It's what I suspect I'm mostly dealing with due to the fact I have more problems on the constipation side, that isn't to say I don't go enough, usually three to five times every morning with painful gas/cramps preceding and following, usually becoming steadily worse as the day continues. This has been the case for a year, having become steadily worse since it began in 2012. I was tested for Sibo last year, tested positive, numerous antibiotic treatments, none of which lasted if they helped at all. I turned to natural antimicrobials and only ended up feeling worse from those, so had to discontinue. Have tried probiotics, I recently tried a bifido specific mix, and just ended up making things worse, tried for two weeks and just couldn't handle it. Recently had an endoscopy and found gastritis, prescribed rifaxamin, have not taken due to worrying over further worsening things, as well prescribed nexium. I want to see a naturopath doctor but can't afford right now as the initial visit is really really expensive. I've tried other probiotics but they never seem to really help, including align and a lacto bifido mix, very frustrated and tired of living from day to day having to deal with these issues that consume every waking moment, I never have any ambition to do anything and some days don't even want to get out of bed. I'm just not sure what to do, I've been taking slippery elm to help stomach heal, I have dgl licorice, sugar and stevia free but am afraid to start, I've tried using betain and digestive enzymes but only aggravate stomach, suspect they caused the gastritis. I'm just seeking advice, or curious about your consolation prices, as I'm just out of ideas on what to do to treat myself, I barely eat and have lost so much weight, no matter how healthy or little or much I eat I still struggle with painful gas and cramping. Any help is appreciated.

Hi Michelle,

That this was such a recent diagnosis and you are treating this with herbs and trying to rebalance the gut, really increases the likelihood of you being able to cure this for good. Regarding your weight - I wonder what set SIBO up in the first place? Stress, illness... etc, and if is just your body reacting to the increased immune reactions (added stress) going on in your system. From the foods you are listing you are still including a lot of fermentable sources of carbohydrates (that would feed these organisms). I would look more into low FODMAPs while treating this, but I go beyond this - none of the specialized diets were created to address SIBO. We really need to adapt them further...

I wouldn't expect the herbs or probiotics to trigger weight gain. I would talk with your doctor about your current symptoms - yes, these can be 'die off' and then can be something else. Check back with them since they know your case well. I don't find that everyone feels die off on the protocol - in fact, some people feel better taking it - BUT everyone is different. SIBO is a condition that warrants consistent support to really tease all the variables out.

Thanks for reading!

Angela

Angela, I have been diagnosed with sibo. Trying to attract it from every end. Sadly I am getting nowhere. Taking digestive enzymes, Hcl, herbal antibiotics. Took xifaxan for two weeks,it did nothing. Taking a biofilm buster, interface plus. Changed probiotics,taking prescript assist.without probiotics I don't go to the bathroom. Following a scd diet. Eating basically protein and veg. I am five two ninth four lbs and going down. I am in constant pain. Trying to see if motility issues are the cause. Scheduled for atest called the smart pill. Found out the test has gluten in it. I am celiac. The dr. Has not returned my calls. Working with a holistic dr, and had hoped for some results. So far none. Was told an antidepressant drug may help. I am desperate. I have no life. This is consuming me twenty four seven. Help

Hi Angela. I have SIBO and high levels of candida due to years of prescription antiobiotics and natural antibiotics. However, whenever I try any probiotics, either the capsules or in yogurt or kombucha, I get terrible brain fog and the worst depression from the fog. I can't think straight or concentrate, and whenever I cut the probiotics out the brain problems and depression go away. I also get extremely irritable and angry on probiotics, even very small amounts. Do you have any advise?
Thanks! Kristin

Dear Angela,
I am desperately in need of help. Not only do I have SIBO I also am highly sulfur sensitive (sulfur producing thiols). I also have MCS with all sorts of accompanying food and chemical reactions. One doc told me I have candida, another did a blood test that came back neg. Right now I am living on chicken, turkey, Jasmine rice, millet, (both 1/4 c. raw) carrots, beets, bone broth, and some vegetable juices (cuke, carrot, beet, celery, ginger). I throw in a buffalo burger once in a while for variety. I had very high levels of mercury which I am told are now down to normal. I question that testing as it was not done by hair testing. Both docs I am seeing right now are discouraging me from taking supplements that would help with the detoxing such as selenium and molybdnum. That is a brief history. I really need ideas of what to eat. Am hoping you can give suggestions or other places to try. All of the diets I have looked at so far emphasize much in the way of sulfur (thiol producing foods) which leave me about where I am now. Thank you for any help you can offer

Hi Izzy,

I recommend starting with Saccharomyces Boulardii first and then shifting into other probiotics - no prebiotics now, non soil organism probiotics and stay away from lactobacilli strains that have the propensity to form D-lactate instead of L-lactate. I am offering suggestions here to chat with your health care provider about. I can't offer exact protocols over email or in this comment section - each SIBO patient that I work with is complex and my approach is different with each one. It is best to work with a health care provider to get targeted support. I usually run a digestive stool test to look at beneficial/ unbeneficial flora levels as well as assessing the mucosal immune response...etc. Assess past and current factors, conditions, symptoms... this is a complex issue that needs to have targeted therapy to successfully address.
Angela

Hi Jen,

Wow - they really came at the skin condition with all they had. Sometimes antibiotics are necessary - I am definitely not anti- antibiotics. I simply want to keep them handy for the scary stuff and not for things like SIBO. Were you also on steroids? It is possible that the antibiotics shifted your gut flora to a large degree, but I would expect you to see changes in your health over time from this and not within one year. I wonder what else changed for you at the time? It may have been the stress of the situation, strong antibiotic use, plus? that triggered this.

SIBO tests are always good to try, but it everything else has been ruled out and you still have classic SIBO symptoms (even with a negative SIBO test - these are not affective on everybody) then I would work with your health care provider to treat this empirically. That said PLEASE do not look to address this with more antibiotics. Antibiotics do not cure SIBO. They never have. We have to look at this as an extreme imbalance that needs to be rebalanced and not an infection that is wiped out by an antibiotic.

I you don't find the support that you need to address this, I work long distance.
Best of luck to you!
Angela

Hi Izzy - do the probiotics that you are taking, have prebiotics in them? Do they have FOS, MOS or DOS or inulin or list an 'added fiber'? I would start with Saccharomyces Boulardii - one of my favorites is by Klaire Labs.

If probiotics make symptoms worse and/ or if added fiber makes symptoms worse, these are two telltale signs that SIBO has not been fully addressed. I would get evaluated to see if SIBO is still present and then put a plan in place to address the with herbs, rebalance the gut, address the factors that set this up in the first place and rebalance flora. Antibiotics never balance gut flora. Never. They will knock things down and often times, make things worse. To the degree that SIBO will be harder to address long term and that it will be harder to balance the flora after their use. That said, probiotics will not fix 95% of SIBO cases. The small intestine houses a delicate ecosystem that needs to be addressed on many levels.

Warmly,
Angela

Also have lost a lot of weight and can't seem to gain. All tests (Endoscopy, EUS, Tumor markers) all come back just fine.

Breath test for SIBO was positive. Was put on Flagyl and Cipro for 10 days. Felt better while I was on the antibiotics but now am having a lot of stomach discomfort. No appetite and nausea. Pill for nausea helps somewhat. Quality of life is greatly diminished. Take one probiotic capsule a day and also eat Activia. Dr. doesn't want to "overuse" antibiotics. Help!

I just found you today! Thank you for telling us something I, for one, did not know: that more [probiotics] is not automatically better. Countless thanks, Angela. - Elizabeth

Cipro x 2 round, xyfaxan x 4 rounds, metrinidazol x1 round, norofloxan X 1 round, 3 positive H2 breath tests, FodMap, elimination, low/no carb, every probiotic available to humankind, the entire healthfood store's herbals, accupuncture, yogo, Balinese healer, many doctors, fecal transplant... yeast treatments, fluconazole, nystatin, and the many varied herbal antifungals..

20 years now...

And you would suggest?

Hi, my daughter Tatum is three and she has all the symptoms of SIBO. I have been to her pediatrician who diagnosed her with SIBO and then her GI that said this was something that every other person has and downplayed it. I am so frustrated!! I have one Dr telling me to change everything in her diet and give her supplements and the GI dr saying to not worry about diet and give her probiotics and prebiotics. The pediatrician says no prebiotics. Her tummy starts out flat and by the end of the day it looks like it's going to pop!! She has never had a normal bowel movement since I stoped breast feeding her at one. She lives in a loving stress free home, what do you think is causing this? I am so at a loss. Amber :(

Hi Angela, I have spent two years battling SIBO after testing positive to a hydrogen breath test. I am 35, otherwise in perfect health, 120lbs and exercise regularly. I have spent hundreds of hours reading everything available online & in bookstores, been to 5 separate Gastroenterologists and tried almost every GI-prescribed antibiotic and probiotic (including Align & VSL3) with no reduction in symptoms, including Rifaximin & Metronidazole. I have a big plastic crate filled with herbal supplements & digestive emzymes that have done nothing. My GI even prescribed Tetracyclic antidepressants, which did nothing except give me a very dry mouth. The only drug I have not tried is Neomycin, as the often-permanent side-effects of hearing loss & kidney damage look scary. Fructose & wine seems to make symptoms worse so I avoid all fruit/ wine & follow a low FODMAP diet but foods I can tolerate one day causes massive bloating the next. I am 'lucky' in that extreme bloating is my only symptom (no pain, diarrhea or constipation). I wake with only minor to moderate bloating, but I can go up 2 jeans sizes in 20 mins after breakfast after eating a boiled egg with a glass of plain warm water. By diner-time every single day I have a pronounced '5 month's pregnant' pot belly which looks ridiculous on my slim frame. I am getting married soon and the only way I'll be able to fit onto a wedding dress is by going on a water fast for 3 days beforehand. I'd love to book a private email or phone consultation with you if you are available. Thank you so much for reading this.

Hi Angela,

I just wanted to say thanks for everything that you do. I actually have some questions about SIBO and I would like to ask you some questions offline.

Also, I do not take PPI's at all. I felt they hurt more than they help. I have not taken PPI's for over 1 1/2 - 2 1/2 weeks. I think I took them in a grand total including both the nexium and prolisec (not together but seperately taking 1 then just nexium when it was prescribed to take over the prollisec) of 8-10 days

What are the red flag signs of SIBO? Like what can I check off to confirm it? My parents haven't taken me to a g.i My most consistent symptoms If you will are 1.twitching in my legs and sometimes in my jaws (for the last month) 2. Very slight, feint but noticeable headaches 3. Just as I lay down to sleep or right as I wake up, lots of stomach rumbling and sometimes gas. 4. Lots of gas at those 2 points of the day. I was diagnosed with ibs and was put on prolisec the went to personal doctor and also said ibs and put me on nexium. I stopped using the nexium because I noticed I felt the absolute worse when I took it. I take a brand of Probiotics now, now called Nature Probiotics. My mother wants me to take it daily. It could be a placebo but I feel there is improvement since I started taking it. But I still have problems.

For approximately two years ive been experiencing massive bloating, gas, and "noisy" gut. I feel like im walking around in someone else's body. I have no control over my gut and how it feels. I can go days without eating and still be bloated as if i'm four months pregnant or ate an entire Thanksgiving turkey by myself. I had a hydrogen breath test which indicated I have sibo. I took riflaximin first which did nothing. I am currently taking doxycycline hyclate. My GI suggested a low FODMAP diet if this antibiotic doesn't work. I am halfway through the antibiotic and feel no different. I've been researching low FODMAP diet restrictions. But I feel as if no one can tell me why I have sibo and how to prevent it. Should I be on a probiotic after my antibiotic?! I want to see a nutritionist, but that is not covered under my ins of course. Money is extremely tight. Any advice on probiotics or FODMAP or SIBO would be so ver appreciated. I cannot live this way. It's so uncomfortable.
Thank you for your time.

I'm interested in a consultation with you. Dealing with horrible SIBO issues. Still breastfeeding. I think I know the root of my issue. Multiple Antiboitic rounds after recurring breast infections in one year. 8 to be exact!

Hello,
Can you give a recommendation for a good probiotic? I was diagnosed with SIBO and was put on Cipro and Flagyl and ws told to follow the treatment with a Probiotic but there are so many.

Thank you!

Hello Angela,

I've heard conflicting things about SIBO and it's difficult to decide who to listen to when it comes to something like my health.

I was under the impression that even too much lactobacilli or bifidobacteria can overgrow in the SI? This is just what I've read from forums like Mark's Daily Apple and such, so i doubt it's that accurate...

I believe my SIBO originated from weak peristalsis, so I feel like no amount of antibiotics or probiotics will stop it from coming back.

Great video by the way.

I have been battling methane-type SIBO with numerous rounds of antibiotics and natural antibiotics for a year. After fearing taking probiotics for a long time, I now feel that probiotics are the missing link to my healing. You mentioned a probiotic powder would be a good option. Can you let me know more specifics about obtaining this type of probiotic please?

So glad I found this! Last week my doctor diagnosed me with SIBO. My insurance won't cover Riflaximin and it would be over $900 out of pocket, so I've been told to try the antibiotic Neomycin instead. My doctor said I should continue taking probiotics, but up my dose to 6 times what I normally take for 30 days, then go back down to my regular dose. She said this is the current theory of thought for SIBO treatment. But I'm confused by that because how do the doctors know what anyone's "regular" dose is? Does that sound rational to you that I should multiply my current dose by 6 (spread throughout the day)?

Hello Angela,

I found you through Chriss Kresser's site. I am a devote of his and truly respect his research and advice.

I have had what I call "IBS" for my whole life. It has been a life altering problem. I have had to withdraw from many social opportunities and could never take any group classes because of this problem. The biggest symptom of my IBS is debilitating gas. I mean, clear the room, 4th of July fireworks noisy gas & constipation.

Of course, certain foods make it worse ie: whey protein and things like cabbage, broccoli etc... (insoluble fibre makes it worse) but it can last weeks and keep me house bound carrying air freshener with me and blaming the dog. I joke, but actually it's been a horrible experience. I can't go dancing, I often took enema's so I could go on a date, I would often not eat just so I wouldn't be noisy and smelly, I'd eat nothing but rice and chicken broth and egg whites some days ... I'd call in sick to work b/c I was just unable to walk or stand up without it bursting out of me.

Now that I have read a few articles on SIBO, I'm wondering if this is what I have been dealing with for over 30 years? I'd like to get to the bottom of this problem so I can have a full life and not live it wondering when my "IBS will flare up" again and if I can be apart of any group activities ever again.

IS this something you feel you could help me with and we could actually cure?

Jacqueline from Niagara-on-the-Lake, Ontario Canada

This video was very interesting- I have been hearing for years now that probiotics should be avoided at all costs, but I always seemed to improve slowly but surely after using VSL #3. Quick question though: why not megadose with probiotics? And what do you consider a megadose? Thank you for your time.