How I Cured My SIBO

If you’ve got SIBO, you’re probably wondering how you can treat it and keep it away for good. While it’s possible to reduce the level of bacterial overgrowth in your small intestine and address your symptoms, to give yourself the best chance of beating SIBO you need to dig a bit deeper. We recommend working with a practitioner who will look at your symptoms in the context of your whole health history, advise you on the right gut health tests to take and shine a light on the root causes of your SIBO symptoms.

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What is SIBO? 

If you have too many bacteria living in your small intestine, you have SIBO. Because your small intestine is meant to only house a limited number of bacteria, unlike your lower intestine, or colon, it can cause uncomfortable symptoms like diarrhoea, constipation and bloating.

Your small intestine is very different to your large intestine, with specific jobs to do, like helping your body to absorb nutrients from your food. Your large intestine is more of a fermenting machine than an absorption machine, so it needs over 1000 times the bacteria of your small intestine to do its job properly. When those bacteria migrate to your small intestine, you get SIBO.

The communities of bacteria in your small intestine are tiny compared to your large intestine, but they’re essential. The microbiome in your small intestine: 

• protects against potentially pathogenic bacteria and yeasts
• helps your body absorb nutrients
• produces several nutrients (such as short chain fatty acids) and vitamins like folate and vitamin K
• maintains the normal muscular activity of your small bowel, pushing your food along

SIBO can get in the way of all these things.

SIBO symptoms 

SIBO symptoms are different for everyone. Some people have SIBO with no symptoms at all, and others have all the symptoms of SIBO but no evidence of bacterial overgrowth. 

The symptoms of SIBO overlap with many other gut conditions, like Crohn’s disease, coeliac disease and IBS. In fact, many experts think that SIBO and IBS are really the same condition, because so many people with a diagnosis of IBS test positive for SIBO.

Because IBS is a set of symptoms, the diagnosis tells us nothing about the root cause of those symptoms. Twenty people with IBS could all have different sets of root causes, but we know from research that for 85% of them, SIBO will be one of those root causes.

The most common symptoms of SIBO we see at IBS Clinics are::

• abdominal pain
• belching
• bloating
• brain fog
• constipation
• diarrhoea
• fatigue
• fatty stools
• flatulence
• nausea

Most of us have probably had all of these at some point in our lives. It’s when they become chronic that we suspect SIBO could be at play. Because SIBO symptoms aren’t specific, we always recommend taking a SIBO test before you start any treatment.

If you do have SIBO, you’ll need to eat a special diet and take a course of antimicrobial supplements for six to ten weeks. The diet can be inconvenient and the supplements can deplete the microbiome in your large intestine, so you need to be sure you have SIBO first.

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How I cured my SIBO 

While some people appear to ‘cure’ their SIBO with one round of treatment, most people find that they need to keep an eye on their diet and lifestyle to keep SIBO at bay for good.

For that reason, we avoid using the word ‘cure’ when we talk about SIBO.

We don’t know why, but some people are more prone to SIBO than others. You may get a great result from your treatment but find the symptoms creeping back after an indulgent Christmas or holiday. It’s also crucial that you find and address the reasons why you got SIBO in the first place, because if you don’t, treatment will only give you temporary relief.

Can SIBO be completely cured?

It’s impossible to say that SIBO can be completely cured because there’s currently no evidence that SIBO can be eradicated forever. To do that, a group of people would need to take part in a research study that measured their symptoms and gas levels for the rest of their lives, after successful treatment.

However, it’s definitely possible that SIBO can go away and stay away. We just can’t prove it. At IBS Clinics, we see severe cases of SIBO that get better with treatment and still haven’t recurred after a number of years. We also see some stubborn cases that take a while to shift, perhaps needing several rounds of antimicrobials and an extended eating plan. Some clients find they need to change their eating habits for life to keep SIBO at bay.

We simply don’t know why some cases are easier than others, but finding and addressing the root cause of your SIBO definitely bumps up your chances of beating it for good.

Find the root cause

SIBO has an up to 80% rate of recurrence, according to research. The precise reasons why are unclear, but it makes sense that if you don’t address the reasons SIBO happens in the first place, it’s only a matter of time before your symptoms come back.

A healthy gut keeps SIBO away through a variety of ways:

Hydrochloric acid

Your stomach acid kills almost all bacteria on contact. It’s your antibacterial barrier between the outside world and the inside of your body.

Your migrating motor complex (MMC)
Your MMC is what pushes food through your small intestine. If it’s not working properly, food will hang around too long and feed your bacteria, instead of you.

Pancreatic juices and bile
These also stop bacteria from fermenting and multiplying.

Your ileocecal valve
The ‘door’ between your small intestine and large intestine lets food in but stops it from flowing back into your small intestine. When that happens, the trillions of bacteria in your large intestine can set up home in your small intestine.

Antibodies
A healthy gut produces a range of antibodies (immune system soldiers) that destroy too many bacteria in the wrong place.

To get SIBO in the first place, something could have gone wrong with one or more of these mechanisms. If you keep getting it back again, the chances are even higher that a number of the above factors are at play.

It’s overwhelming to work all this out on your own. If you want to solve your SIBO mystery, we recommend that you work with a health practitioner who can dig deep into your gut health, uncovering and addressing imbalances in your gut and the rest of your body.

Three ways to stop SIBO from coming back

While we can’t guarantee that SIBO won’t ever come back, there are some things you can do that definitely keep it at bay:

• Minimise sugars and starches in your diet
• Address the use of some long-term medications 
• Identify and address any underlying conditions

Sugars and starches

Sugar comes under many guises: whether it’s raw sugar, agave nectar, coconut sugar or any of the trendy natural sugars that people think are healthy. Watch out for dried fruit because it’s very high in natural sugars, and even apples and bananas are potentially problematic if you’re healing SIBO. Stick to low-sugar fruits like berries.

Alcoholic drinks are usually trouble. Wine is often the worst offender because it’s packed with fruit sugar and it’s fermented too. Most people with SIBO or IBS symptoms such as bloating, gas, abdominal pain, constipation and diarrhoea need to avoid or minimise wine. Beer and/or spirits with a sugar-free mixer is usually a better bet.

They’re staples in our modern western diets, but your body immediately converts starches like bread, rice and pasta into sugar. If you’re susceptible to SIBO, you might find you feel better on a long-term paleo style diet that focuses on animal proteins, fats and non-starchy vegetables.

We can’t prove it, but we see a lot of people who have had SIBO and get it again if they don’t keep an eye on your sugar, starch and alcohol intake. That doesn’t mean that you can’t have any of these things, it just means that if you go crazy on holiday with pasta, wine and bread, you might see a return of your symptoms. Make vegetables the star of your meals rather than grains or potatoes.

Long term medications

If you’re on long-term medication, your doctor has prescribed it for you and you shouldn’t stop taking it. However, sometimes you don’t need to continue taking them, so always check with your doctor if you take something regularly. Most medicines have side effects that mean if you don’t have to take them, it’s better to stop.

Antibiotics

Unfortunately, antibiotics do not ‘know’ the difference between the good bacteria and bad bacteria. They kill indiscriminately, so taking them repeatedly destroys huge amounts of all your bacteria, and research isn’t clear on whether they ever come back. Your microbiome needs diversity. A less diverse population of microbes is bad news for the health of your gut and your whole body and mind. Research shows that an unbalanced microbiome can lead to SIBO. 

Antihistamines 

Ironically, using antihistamines long-term can lead to a histamine intolerance as your body ‘forgets’ to do the job itself.  If you have a runny nose, itchy eyes, or sinus headaches it’s a sign that your immune system has become oversensitive to your environment. You need to find and address the root cause, rather than take antihistamines to cover the symptoms. Pharmaceutical antihistamines can create a histamine intolerance which in turn can allow certain types of bacteria to overgrow in your small intestine. 

NSAIDs

Non-steroidal antiinflammatories or NSAIDs have been shown to increase your intestinal permeability (leaky gut) making SIBO more likely. They’re an easy and cheap fix to reduce pain and lower fevers, so they’re one of the most popular drugs in the world, but too many people rely on them at the first hint of pain.

Underlying conditions

If you have SIBO or IBS symptoms like constipation, diarrhoea or bloating, your doctor has probably tested for more serious conditions that cause similar symptoms. There are a number of conditions that can make you more susceptible to SIBO. Here are some examples:

Crohn’s disease

People with Crohn’s disease have a disrupted immune system and an inflamed gut environment. They may also have strictures or blockages that prevent the smooth passage of food through their gut. Steroids that people with Crohns often have to take lower the immune response in the gut, leaving it open to bacterial growth. 

Celiac disease

Celiac disease often comes alongside leaky gut and an inflammatory response to many foods that stresses your gut and leaves it more open to dysbiosis and SIBO (it’s also possible that the SIBO and dysbiosis came before the Celiac disease).  

Diabetes

If your diabetes has damaged nerves in your gut, it’s less able to move food along and out.  That means it hangs around, fermenting and feeding bacteria in your small intestine. 

Leaky Gut

It’s not clear what comes first, leaky gut or SIBO. It’s likely they come as a package, each one gradually making the other worse. Toxins, microbes, and undigested food particles are supposed to stay inside your gut. When they escape, it causes an inflammatory response and your immune system is overwhelmed. Over time, this can cause and/or exacerbate SIBO.

What is the fastest way to cure SIBO?

Treating SIBO isn’t really a quick job. First you need to take a test, then you need to follow a low-carbohydrate diet and take antimicrobials for around 6 to 10 weeks. At that point, your symptoms should be more manageable, but you’ll need to keep an eye on your diet and look after your gut health for the foreseeable future if you want to keep SIBO at bay long-term.

Initially, though, these are the two main tools: 

Follow a low carbohydrate diet

Carbohydrates are food for bacteria. Depending on the type, they can eat anything, but overall, carbs are by far their favourite food. Some types are a lot more appealing than others, and working out which types your collection of bacteria enjoy can take some trial and error. It’s a good idea to cut down on specific types of carbohydrates for six to eight weeks. 

The low-FODMAP diet, the Specific Carbohydrate Diet and the Bi-Phasic Diet are popular choices to start off with. They all work in the same way, but with slight differences. 

Take antimicrobials

You may choose to take pharmaceutical antibiotics like Rifaximin for healing SIBO, but you’ll need a prescription from your doctor. The good news is that herbs have been shown in research to work just as well.

Different herbs work better for different types of SIBO: hydrogen, methane or hydrogen sulphide-predominant SIBO all react in different ways to each kind of antimicrobial, although individual cases vary. Common SIBO herbs are oil of oregano, berberine, neem and garlic, but there are many others.

SIBO diet 

The most famous, and the best-evidenced diet for IBS symptoms and SIBO is the low-FODMAP diet, which restricts certain types of carbohydrates but not others, so it’s not a low carbohydrate diet. 

But it’s not the only diet that can reduce SIBO symptoms by starving the bacteria. There’s also the ‘elemental’ diet, which is a liquid diet where you only consume the nutrients and calories you need, without feeding the bacteria in your gut, the specific carbohydrate diet (SCD) that restricts complex carbohydrates, and the GAPS diet that was invented by a doctor to address her daughter’s autism. 

The low FODMAP diet is well known and heavily backed up by research because scientists at Monash University in Australia invented it and then carried out the studies to prove that it works and why. 

FODMAP is an acronym that describes the carbohydrates that some people have trouble digesting. The ‘F’ stands for fermentable.

The sugars are:

Oligosaccharides 

Disaccharides 

Monosaccharides

Polyols 

It’s common to react to some FODMAP foods more than others. For instance, some people find they can’t eat any polyols but are fine with the others.

It might seem overwhelming to work out where to start with the low-FODMAP diet, but we recommend you start by cutting out all the high-FODMAP foods (which leaves you with a lot to play with) and go from there.

Here are some examples:

High FODMAP foods

• Artichoke
• Apple
• Garlic
• Leek
• Onion
• Mushrooms
• Cauliflower
• Wholemeal bread
• Rye bread
• Wheat pasta
• Kidney beans
• Split peas
• Falafels
• Baked beans
• Soft cheeses
• Milk
• Yoghurt

There are plenty of foods on the lower-FODMAP lists that you can enjoy in large amounts. For example:

Low FODMAP foods

• Aubergine
• Beans (green)
• Bok choy
• Green pepper
• Carrot
• Cucumber
• Lettuce
• Potato
• Zucchini
• Orange
• Pineapple
• Almond milk
• Hard cheeses
• Lactose-free milk
• Eggs
• Meats/poultry/seafood
• Corn
• Oats
• Quinoa

How to heal SIBO naturally

If you don’t want to take antibiotics for SIBO, herbal antimicrobials are a great alternative.

Most published research on reducing SIBO bacteria uses antibiotics like Rifaximin for hydrogen-dominant SIBO and Rifaximin with Neomycin for methane-dominant SIBO, but there are some studies to support the use of various herbs.

We know that herbs like oregano oil work very well to clear SIBO. One particular study used the SIBO breath test to measure the gas levels of one group of patients after a course of Rifaximin, and another group after a course of a herbal supplement. Rifaximin was found to be slightly less effective than the herbal supplement.

This is great news if you don’t want to tackle SIBO through your GP, as doctors in the UK don’t prescribe herbal supplements, although they sometimes recommend them.

Sometimes antibiotics or herbal antimicrobials aren’t necessary. Some clients find that a SIBO diet and some lifestyle changes are powerful enough to rebalance their microbiome and get to the root of their SIBO symptoms for good. 

Antimicrobial herbs for SIBO

There are hundreds—perhaps even thousands—of antibacterial herbs.

People have been using them for thousands of years for healing and to fight infections without knowing why they work or the chemical constituents in them, but now science has told us the active ingredients in each one.

There are three main groups of active constituents: Berberine, polyphenols and volatile oils. Most antibacterial herbs fall into one of these groups.

Berberine
Philodendron
Coptis chinensis
Goldenseal
Oregon grape root
Barberry 

Polyphenols
Pomegranate husk
Propolis
Cloves
Oregano leaf 

Volatile oils
Oregano oil
Thyme oil
Clove oil
Peppermint oil 

How do you starve SIBO bacteria?

You starve bacteria by depriving them of their food source. While you can never starve them completely, you can take away their favourite foods: specific types of carbohydrates.

Something that may help is to reduce the types of foods you ate a lot of before you got SIBO. A lot of people get SIBO after a period of drinking a lot of alcohol or eating a lot of junk food. That will have encouraged certain types of bacteria to overgrow in your gut, so if you carry on eating those foods, you’re adding fuel to the fire. So if you spent a week in Italy eating nothing but pasta, pasta-loving bacteria could be overgrowing in your small intestine.

Sometimes ‘healthy’ foods might be causing your problems. Fibrous foods like vegetables—especially cruciferous ones like broccoli and Brussels sprouts—could be exacerbating your bacterial overgrowth. A lot of high-FODMAP foods are very healthy and cause no symptoms for people with no digestive ailments.

It could be that the opposite of the diet you ate before is the most effective SIBO diet for you.

It’s important to remember that SIBO diets are designed to reduce symptoms rather than treat SIBO. While you might find relief with just the diet, you could find that without antimicrobials, you’ll have to stay on the diet long term, which we don’t generally recommend.

The FODMAP diet—or any SIBO diet—can be difficult to navigate and it’s important to make sure you’re getting enough nutrients and calories, so we recommend you work with a health professional to guide you through it.

SIBO and leaky gut diet

We know that there’s a correlation between SIBO and intestinal hyper-permeability (leaky gut). Researchers have found that leaky gut syndrome is a lot more likely in people with SIBO. We can’t be sure which leads to which, though.

We also know that diet has a huge and direct effect on gut bacteria. A large study on the links between diet, inflammation, and leaky gut was published in 2021. It showed that a high-FODMAP diet activates specialised cells in your gut known as ‘mast cells’, leading to leaky gut. 

A diet high in FODMAPs increases bacterial fermentation, increasing levels of a toxin in your cell wall called lipopolysaccharide (LPS). LPS crosses through the walls of your gut, activating mast cells. In the study, a low-FODMAP diet reduced mast cell activation and improved the observable signs of leaky gut.

Based on this study, and what we see with our clients at IBS Clinics, we can conclude that a low-FODMAP diet is a great tool for healing SIBO and leaky gut. However not everybody responds well to a low-FODMAP diet. For some people with SIBO and/or leaky gut, another option like the SCD or the Bi-Phasic diet works better.

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SIBO success stories

SIBO can be difficult to treat, but we have a lot of success stories at IBS Clinics. If you have the willpower and perseverance to stick to the diet and the treatment plan for six to ten weeks, you have a good chance of feeling a lot better.

One client, Alex, 41, told us about her experience:

‘My SIBO wasn’t easy to beat. I had been on several treatment plans in Australia when I lived there, and they were only temporarily effective, because I didn’t follow a diet alongside them. I had also tried various herbs which didn’t really work.

When I moved back to the UK I saw Tracey, who asked me to do a SIBO test. I hadn’t done one before, previously the naturopaths I saw had just gone on my symptoms. I was surprised to see a flatline, which I assumed to be a negative. But Tracey explained that this could indicate that my SIBO was the hydrogen sulphide type. 

Another test confirmed that was likely the case, so I started a special diet that was a version of low-FODMAP but with some special tweaks. I also took a combination of herbal supplements that included oregano, and some others to support my gut health. After a week, my SIBO symptoms had gone down signficantly, and after eight weeks they had almost gone.

However a few months later, over Christmas I drank a lot of wine and ate a lot of sweets. I felt like I had undone all my hard work but I saw Tracey again and she gave me a shorter course of some other herbs, and recommended I go back on the diet for a while, gradually adding foods back in to see how I react to them. I’m pleased to say that my SIBO has stayed away now for over a year! I discovered that I was reacting to garlic, onion, gluten and soy, so if I keep those out of my diet, I’m fine.’

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Life after SIBO

While some people find that they can return to a typical Western diet after SIBO treatment, it’s more common for people to change their eating habits—to some extent—forever. You might find that your SIBO diet made you feel so good that you don’t want to go back to your old ways. 

We don’t usually recommend that you stay on a SIBO diet long term, because you may deplete the microbiome in your large intestine. We also don’t recommend taking antimicrobials for extended periods, for the same reason.

Life after SIBO should be the same as life before SIBO, except perhaps with a closer eye on your gut health!

Methane SIBO foods to avoid

SIBO diets appear to work equally well for healing both methane SIBO and hydrogen SIBO. The only difference you may want to note is that most SIBO diets can reduce your fibre intake if you’re not careful. While they don’t aim to do that, it’s easy to find the foods that you like and stick with them. 

So, if you’re just eating meat, fish, and salad, you’re not getting much fibre. If you have methane SIBO, that’s bad news, as you’re more likely to suffer from constipation. Without enough fibre, constipation can get worse.

The good news is there are lots of fibre-filled foods on the low-FODMAP diet. For example:

• Flax seeds
• Berries
• Nuts and seeds
• Brown rice
• Quinoa

Monash University, who created the FODMAP system, has some great resources. Check out this advice on getting enough fibre on a low-FODMAP diet.

How long does it take to heal from SIBO?

Most people start to feel better a week or two into treatment. You may get some ‘die off’ symptoms at the start, as the bacteria die and activate your immune system. This usually feels a bit like flu.

For other people, healing takes a bit longer. Some people need a longer course of antimicrobials, or a few courses with some time in between, to get significant relief from their symptoms.

While we don’t necessarily recommend another test to check your gas levels after treatment, people who choose to take another test after a six-week course of antimicrobials usually see a big reduction in their SIBO gases.

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Conclusion

There are many ways you can get SIBO, but only one way to treat it: a course of antimicrobials along with a special diet to starve the bacteria. While you will probably feel better with just changing your diet—and some people choose to just do that, without the supplements—it’s usually only controlling the symptoms, rather than tackling their cause (the bacteria).

SIBO and/or IBS symptoms are a sign you need to address the health of your whole gut, and the rest of your body and mind too. While we recommend that you take a test to confirm or rule out SIBO, at IBS Clinics, we look at those results in the context of your health history and your symptoms. Then we can make a plan to treat your symptoms, and help you begin your journey back to health.

Author

Alexandra Falconer MA (Dist) DipCNM mBANT is a Nutritionist and Registered Nutritional Therapist. After graduating from Brighton’s College of Naturopathic Medicine in 2018, she set up her nutrition practice specialising in gut health, IBS, IBD and related conditions.

Before becoming a nutritionist, Alex was a journalist and copywriter. Now, she combines her two great loves—words and natural medicine—to help bring vibrant health to everyone who needs it.

Reviewed by: Tracey Randell

Tracey Randell is a fully qualified Nutritional Therapist specialising in IBS and other gut-related issues. Tracey is also an IFM Certified Practitioner, so she uses Functional Medicine throughout her work. You can read more about Tracey here and you can read more about IBS Clinics here.