Although some of these takeaways are not new information for seasoned SIBO folks, I believe they are important reminders (such as #s 1-7). For those who are newer to SIBO, some of the terms used may seem like a foreign language. I encourage any and all questions in the comment section. There is no such thing as a dumb question as we are all at different stages in the healing process. So please do not hesitate to speak up!
- SIBO diets are intended for symptom control, not cure.
- If a large amount of foods show up on a food sensitivity test, leaky gut should be suspected. SIBO can cause leaky gut.
- Cocoa (such as in dark chocolate) is usually well-tolerated with SIBO. Additionally, I have learned elsewhere that cocoa may be supportive for individuals with autoimmune conditions. Yay for chocolate…but don’t go overboard with the sugar (since it weakens the immune system)!
- SIBO is a chronic condition. For the majority of people, it cannot be cured, but the symptoms can be greatly relieved both short-term and long-term.
- “Once not tolerated doesn’t mean never not tolerated.” This applies to food, supplements, exercise, etc. The goal should be on trying to introduce new items in a strategic manner, not fearing food.
- Probiotics do have a place in SIBO treatment and prevention of relapse. The different probiotics on the market are highly variable.
- Environmental toxin overload is something to consider in chronic relapsing SIBO.
- Probiotics have been shown to be anti-biofilm agents (especially lactobacilli species).
- Curcumin (found in turmeric) has anti-biofilm properties and is also commonly used to help heal the intestinal lining (leaky gut) that can be caused by SIBO.
- Slow transit time/constipation can cause SIBO, but SIBO can cause constipation. It is a double-edged sword.
- Rifaximin has an anti-inflammatory, not just antibiotic, effect.
- Generic forms of Rifaximin have equal efficacy to brand name Rifaximin, but their safety is a concern in regard to creating bacterial resistance.
- Cardiac side effects from Resolor (Prucalopride) would require a dose 100 times more potent than what is typically prescribed as a prokinetic.
- The effectiveness of low dose naltrexone (used as a prokinetic) is dependent upon having adequate vitamin D levels.
- Rifaximin continues working in the gut two weeks after it is discontinued.
- It may be warranted to consider chronic lyme disease in continually relapsing SIBO that involves multi-organ symptoms and neurological issues.
- In patients with inflammatory bowel disease (IBD) who present with a flare of symptoms but normal IBD markers, SIBO may be causing the onset of symptoms.
- After treating SIBO, approximately 45% of patients relapse within 9 months if they do not use a prokinetic. Use of a prokinetic delays, but does not necessarily evade relapse.
- Lactulose (the solution often used for a SIBO breath test) increases motility, which may cause diarrhea. It is my opinion that presence of this symptom while taking the breath test should be considered when interpreting the test results.
- Above all, trust your own body (and gut!).
For those of you who would like to view the 2016 symposium recordings, they will be available for purchase in the next few weeks from the NCNM website. If you have not seen the 2013, 2014, and 2015 recordings, I would highly recommend you browse through the talks and consider purchasing and watching the ones that interest you.
If you would like to read a more in-depth analysis of information from some of the talks, check out this thorough post by Tim Harris.
Did they mention how some have worse symptoms after finishing rifaximin ? I am worse now then when I started – all food causes lain now ! 30 days of rifaximin which I felt great on but after it’s been pure hell
I do not remember them mentioning anything about Rifaximin worsening symptoms. The closest thing I can think of is they mentioned that if treatment isn’t working, perhaps SIBO is not the correct diagnosis and more exploration needs to be done to discover other causes.
From what I understand via Digestive Disease Week, after taking Xifaxin, when symptoms do return they are LESS severe. I believe the research that indicates this finding was in the Target 3 Trails.
Trials* 🙂
Interesting, thanks for sharing that tidbit from Digestive Disease Week!
What environmental toxins were referred to in #7? Can you explain this a bit more? Also #16, can you explain more about considering Lyme disease for chronic relapsing SIBO? Thanks.
Specific environmental toxins that were mentioned include BPA such as from receipt paper, plastics, some dental fillings, personal care products. Other toxins mentioned were heavy metals and exhaust. The idea is that these put extra burden on the body, preventing it from being able to function properly. Specifically, they create reactive oxygen species (free radicals) that can damage mitochondria (powerhouses of our cells).
The physician who spoke about lyme was Dr. Farshid Rahbar. He mentioned that he sees a lot of overlap between SIBO and lyme disease and that tick-borne infections can cause neuropathy of the nerves around the intestines as well as have all sorts of impact on the immune system.
Did they really say the majority of people cannot be “cured”? Do you mean will have to take prokinetic for life? Did they mention difference between constipation and diarrhea types? Mark Pimentel was saying on Twitter that some evidence is starting to show that perhaps diarrhea/hydrogen is autoimmune whereas methane may not be?
Not an exact quote, but an underlying theme. In Dr. Siebecker’s first talk she said that SIBO is chronic in about 2/3 of patients and therefore requires long-term management. What I would like to emphasize is that there is a difference between “cure” and “recover”. Symptoms CAN absolutely recover, but management (prokinetics, probiotics, diet, lifestyle modifications) is often needed long-term. I just want to help set realistic expectations because I feel like in the SIBO community there can sometimes be this “white elephant in the room” where people believe that they can magically take a pill and will never have any digestive (or other) issues again. For those who do say they are “cured”, I like to encourage people to check back in with them in a week, a month, a year, several years to see whether their symptoms resurfaced. If the symptoms did relapse, that is what I consider as they had “recovered” not been “cured”. Many people, such as myself, are able to stay in “recovery” by making changes to their lifestyle and knowing how to prevent relapse for themselves.
Thanks. That makes sense. I feel like I’m nearing the end of my treatment phase, and returning to a fairly normal diet, but wouldn’t be surprised if I have to be on a prokinetic for life to keep it away. We shall see. Would love to eventually be able to get off medication and rely solely on probiotic, but not sure if that will be possible.
I think and hope it is possible because I have the same goal. I have been able to refrain from prokinetics for up to one month at a time while relying on probiotics, so I am hopeful!
Hi.
I had 3×14 days treatment with Xifaxan. I wasn’t aware of the difference between Xifaxan and Rifaximin …felt like an other woman when on it but now I am off of it .
Did not understood the fact that this IS a chronic disease. I am to repeat stool test and then start with digestzymes and Berberine. Anything else I can take to improve my healing process. I am following the low Fodmap diet, taking Ibergast daily.
Is there anything that I can do to improve this condition? ( finished antibiotic 5 days ago already bloating with / after meals had return.
Thanks
I wish I could provide more insight, but it would not be responsible for me to make recommendations without fully understanding your health history. I would recommend that you schedule with a practitioner (naturopath or nutritionist w/ SIBO specialty) for personalized recommendations.
Yes I am doing all that. Thank you for your input .
PS I thought it was more like 50/50…about half are able to recover…it’s harder for those who had it for a long time..five or six years plus…
What SIBO diet were they referring to? SCD, Low fodmap, elemental? Oh my.
All of those diets were discussed at different times. Which diet is best will be unique to the individual and how they feel at a particular moment in time. Additionally, the diets are intended to be used as a starting place and then be tailored to individual tolerances under the care of a practitioner such as a nutritionist or dietitian.
Hi Riley,
Could you please tell me have you ever heard someone on SIBO symposium to mention something about pancreatic insufficiency and clostridium bacteria as a cause for sibo? I think this is the main cause of sibo but very difficult to diagnose.
Yes, I have heard of pancreatic insufficiency as being a contributing factor to SIBO (since food doesn’t get broken down properly). I haven’t heard c diff necessarily, but I could see where it could have potential to be a cause.
Thank you for sharing your takeaways! I just got diagnosed with SIBO and have been sturggling with the treatment period. I eat a great diet and have made more changes to help with the SIBO. I also took the Rifaximin for 2 weeks and I did not notice any benefits. I became constipated, more bloated and more gassey. 🙁 My doctor has just started me on homeopathics (one for intestinal distrss thats filled with all different bacterias and one to support my ileocecal valve). What is your thought on homepathics for helping treat SIBO? Have you heard of that before? I have heard of herbal antibiotics but I have not taken those yet. I am just curious to hear your thoughts! I just started 2 days ago so I have not had any results yet to date. Any feedback would be great! 🙂
That’s frustrating that the Rifaximin made you feel worse! I am a skeptic of homeopathics because I have not noticed a difference from them in the past, but I have never been given one specifically for SIBO. The doctor I work for is a huge proponent of them and is a brilliant guy, so I want to remain optimistic about their role in healing! I would love to hear if you notice any difference.
I will keep you posted! I am so hoping to feel better! Oh and I am also taking silver which my doctor tells me it acts like an antibiotic because of its antimicrobial properties. I will let you know if I notice any relief! I am staying positive!
How did it go with the silver treatment? Any improvements on your breathe test?
Hi Ann,
I will be done that protocol on Thursday and then I will repeat the breath test. I feel like every time I increase the dose of the silver I immediately get die off. I am currently doing 1 tsp 2x a day and I can add a 3rd tsp if I want to. Overall though I am still having a lot of symptoms. I may need another round of Rifaximin even though I really don’t want to repeat that. Have you had any breakthroughs?
Thanks for this summary Riley! Very interesting.
Could you expand upon #6? Are any probiotics being tested for efficacy in treating SIBO patients? Or, is there any way of knowing which strains would be best given certain symptomatic history/breath test results?
Absolutely! I find that people with more severe SIBO often have a difficult time tolerating probiotics before they go through treatment. However, for those with more mild cases or who have undergone treatment with antibiotics or antimicrobials, probiotics can serve as a way to reduce and/or prevent relapse as well as increase tolerability to various foods and heal the intestinal lining. In regard to the research, there are more articles looking into the effects of probiotics on IBS than SIBO, but I don’t think it is far fetched to extrapolate them to SIBO since the two conditions may be one in the same. Looking at specific strains used for certain conditions and whether they drive a Th1 or Th2 immune response can help guide decisions about which product to use for someone.
Thanks, I’m past the worst of the illness so it might be worth trying probiotics again. Could you expand upon that last point at all about immune responses?
Yes, I would be happy to expand. Th1 and Th2 refer to T helper cells 1 and T helper cells 2. These are immune cells that are associated with either an autoimmune response (Th1) or allergen response (Th2) when they are overactive or out of balance. There are also Th3 cells which help calm the overactive Th1 or Th2 cells. Certain bacterial strains found in probiotics can either drive a Th1, Th2, or Th3 response.
This recent study in Russia for probiotics that improve SIBO looks promising: http://www.ibsgroup.org/forums/topic/282218-florasan-d-probiotic-effective-for-ibs-and-eradicates-sibo/
I also read that Pimentel recently worked with a group of GI researchers on clinical trials for a “non-antibiotic” treatment for methananic SIBO (usually SIBO-C). It’s possibly a probiotic with the same or similar strains, but don’t know the details.
Thanks for sharing! The non-antibiotic treatment Dr. Pimentel has studied for methane is actually a statin drug. He shared about it at the Global Outreach Symposium on IBS and SIBO
I think if someone want to kill all bacteria in the intestines the most effective way is to do salt water flush – where he drink 1 TBSP pink salt dissolved in 1 liter of water – first thing in the morning. In this case i dont see how bacteria can be resistant to this – no biofilm will help them – the problem is that there is no money to be made with this method so it will never be mentioned by people like Pimentel or Siebecker – this will make all so called practitioners that treat SIBO unemployed 🙂 . If you use Rifaximin bacteria can and will become resistant , if you use natural anibacterials – they dont kill all bacteria or they can be absorbed before reaching bacteria but with salt water – this problems does not exist.
Is this something you have tried personally and found to be successful? How long did the bacteria stay away? I find that reducing the bacterial load is easier to do then preventing it from returning. The underlying cause must be addressed in order to prevent relapse. I would not consider it safe to do a salt water flush on a regular basis which is what it seems would need to happen if the reason for relapse was not or could not be addressed.
Hi Riley,
I have not tried salt flush personaly because i am not convinced that we have to kill bacteria but there are many posts online for people having sucess with salt – this is the next thing i will try i am not experimenting with pancreatin because i read this from one of Pimentel’s patent applications:
Example 9b Treatment of SIBO-Related IBS with a Supplemental Pancreatic Enzyme
Supplementing food with pancreatic enzymes facilitates more efficient absorption and digestion of food nutrients, thus allowing ingested food to be absorbed higher up in the small intestine than otherwise. This leads to a relative deprivation of nutrients to the bacteria involved in the SIBO condition. An example of this treatment modality occurred in the case of a 19-year-old male who had longstanding history of altered bowel habits, bloating, gas, distension and significant urge to evacuate. All of these symptoms were consistent with irritable bowel syndrome (IBS). The patient was diagnosed as having SIBO based on the results of LBHT. Subsequent to treatment with antibiotics, the patient had significant improvement in his symptoms. However, his SIBO condition became difficult to manage due to antibiotic resistance. An alternative treatment regimen was prescribed, which involved the addition of a pancreatic enzyme to the patient’s food (10,000 Units human pancrease in capsules ingested immediately before each meal). With this therapy, the patient reported that his gastrointestinal complaints have improved by approximately 30-40%, corresponding to partial eradication of his SIBO condition. Treatment was continued for at least eight months with a continuation of the improvement in symptoms during that period.
I am taking 50 000 units with each meal and theoreticaly i don’t see a reason this method to not work for 100% cure of SIBO – it just works as elemental diet – the only problem is the quality of pancreatin used
Hi Peter,
Glad to hear that you have found something to try. Yes, pancreatin can be helpful for those who have insufficient production of digestive enzymes, which is likely many individuals with SIBO. However, I do not believe it is a 100% cure for everyone because there are many reasons for SIBO. Those whose issues stem from gallbladder dysfunction or those who have hypochlorhydria may not receive adequate symptomatic improvement from digestive enzymes.
Hey Riley,
I was looking at your blog last night and noticed you used resolor. How did you find it? I’ve been using LDN, which has been great, but I think it’s losing its efficacy, unfortunately. Was it difficult to get a prescription? And where did you order it from? How long did it take to arrive? I think they’re conducting trials for it to be approved in the U.S.?
Lilly
Hey Lilly,
I find Resolor to be highly effective, but I have not tried LDN so cannot make a comparison. It was not difficult for me to get a prescription at all. My doctor provided a hand-written prescription and then I ordered it online from canadadrugs.com. It took about two weeks to arrive.
Hi Riley,
Lilly here again. I am waiting for Resolor to arrive from Canada drugs. A few more questions, if you don’t mind: What dosage did you start at? I ordered the 1 mg, but not sure if to take that much or 1/2 the dose. Did you split the pills? Have a feeling the lower dose might be enough for me. My highest methane level on my last breath test was an 8. Have been trying to bring that down to 3 or lower but feel like I need a good prokinetic to help.
Also, how long did you take Resolor before you were able to stop? And did you experience any side effects from the drug?
By the way, did you ever take the IBSchek test being offered now? I took it and tested negative for the antibodies. It’s looking like a lot of methane sufferers test negative for the test, which is interesting since methane seems so prone to relapse. One would think that if there isn’t an autoimmune reaction going on, or any nerve damage, then once the methane/gas is down, one should be able to recover their motility?
Thanks for your help!
Hi Lilly,
I started at 0.5 mg nightly and used a pill cutter to create that dose. Your physician should have indicated on the Resolor prescription what dose they would like you to use and how to titrate up.
I still take the Resolor periodically. When I first started taking it, I used it for about 6 months, then switched to low dose erythromycin for 9 months, then started it again consistently for probably another 6 or so months before being able to quit for over a month and then just use it periodically.
I did not ever do the IBSchek since it is so expensive and it would not change how I go about things. However, I would definitely be fascinated to see my result. I was hospitalized in 2012 for a severe case of food poisoning so I wouldn’t be surprised if my result was positive.
In theory, what you described about if it isn’t autoimmune then it should go away once methane gas is down makes sense. However, I wouldn’t say I have seen this clinically with people. Instead, I think the cause for that person needs to be discovered and address. Definitely a possibility though since it tends to be so individual.
Hi Riley,
Isn’t it more safe to use 5 -htp than Resolor? What you say about mitochondria is very interesting – i did organic acid test and my mitochondria markers are very bad but i was thinking that toxins from bacteria are causing this. Do you know there is a product called Platinum Plus Amino Acids invented by dr Vickery – it seems this simple product is working for people with Lyme disease – the idea is that this amino acids restore digestive enzymes and help the body to detox cells – i will try them for a month. SO it seems to me what happens with many people is – for some reason they stop to produce HCL then they can not extract amino acids from proteins and then they can not produce gluthathione and other enzymes and then cells mitochondria gets damaged by environmental toxins and then comes sibo or other disease. This can also explain why people taking HCL have cured all kind of deseases including cancer.
I think a common belief is that natural is always safer than pharmaceutical. However, I would urge caution in this viewpoint. In regard to 5-HTP vs Resolor, 5-HTP is not specific for the receptors in the intestine, while Resolor acts on 5HT-4 receptors (located in the intestines). So if someone was interested in promoting intestinal motility, Resolor would in theory be more effective than 5-HTP.
I am not familiar with the product by Dr. Vickery, so cannot really comment on its effectiveness.
Hi Riley,
I have had SIBO for about 4 years with many relapses. My first few forays into healing were a disaster so I’m trying to learn as I go. I’m working with a dietician who knows about SIBO – at least that’s what I thought. Today she told me that at a recent SIBO symposium and I’ll quote her…”We are not trying to reduce carbs. That is no longer the recommendation…every doctor who spoke agreed on this.” Can that possibly be true? I try to keep up with the latest and I certainly don’t want to start eating lots of carbs. Your thoughts please and thank you.
Hi Felice, I would not say that it is a 100% consensus that carbohydrate restriction should be avoided, but I can understand why your dietitian and the physicians she spoke with feel that way. Carbohydrates are important for thyroid health, mood, and all sorts of other functions in the body. I will be writing a post on the importance of carbohydrates in the near future. Healthcare practitioners have begun to see the impact that low carbohydrate SIBO diets can have on various parts of the body. Carbohydrate restriction can be a useful tool for gut health, but when other parts of the body start to break down, it makes it challenging to overcome the underlying issue. I hope that clears up any confusion!
Thank you so much, Riley, for your prompt and helpful response. That does clear up some confusion.