Everything You Need to Know About SIBO (Small Intestine Bacterial Overgrowth)

by Jordan Reasoner


As the real food movement continues to grow, more and more people are beginning to focus on the health of their gut by eating fermented foods and taking probiotics.

According to Global Industry Analysis, probiotic supplement sales have and will continue to raise about 6.8% for the next 5 years, which means sales growth will soar from $27.9 billion in annual earnings to $44.9 billion. (1)

But what if your probiotic is actually hurting you?

Because… if you have Small Intestine Bacterial Overgrowth (SIBO), taking certain types of probiotics could be aggravating your gut symptoms.

And SIBO is much more common than you might think. In fact, a study from The American Journal of Gastroenterology published in 2003 showed that 84% of IBS (irritable bowel syndrome) sufferers have SIBO. (2)

What is SIBO?

We have over 100 trillion bacterial organisms in our gut. The range and species vary depending on the area of the gastrointestinal tract. While the large intestine has around 10-100 billion bacteria organisms per teaspoon of fluid, the small intestine only has around 100 thousand organisms. It’s when there’s an overgrowth of bacteria that is prevalent in the small intestine (where there isn’t supposed to be much bacteria) when problems arise.

So, it’s more a case of bacteria growing in the wrong place… and it could be good bacteria or it could be bad bacteria.

How does this happen?

The majority of SIBO is most likely due to chronic stress. (3,4,5)

There’s also research pointing to acute gastroenteritis from things like H. pylori, food poisoning, or plain gut irritation causing changes in gut nerves, altering motility (how things move), and triggering bacterial overgrowth. (6,7).

Signs You Have SIBO

In Chris Kresser’s new book, “Your Personal Paleo Code,” he cites a study that suggests, “Irritable Bowel Syndrome (IBS) affects between 10 and 15% of the population and is the second leading cause of missed work days, behind only the common cold.”

That’s a popular call-in excuse!

The primary symptoms of SIBO are similar to IBS symptoms, including:

  • Abdominal bloating
  • Belching
  • Gas
  • Abdominal pain
  • Cramping
  • Constipation
  • and Diarrhea

Leaky gut symptoms are also a big sign of SIBO. These can range from food sensitivities to headaches, fatigue, skin issues, mood issues, asthma, and joint pain.

In addition, fructose malabsorption, anemia, weight loss, and steatorrhea (fatty stools) can also be red flags for SIBO.

Watch this video for more in-depth info on the signs and symptoms of SIBO:

Testing for SIBO

Unfortunately, there isn’t a perfect test for SIBO, because the small intestine is so difficult to reach with modern equipment.

But right now the gold standard for most practitioners is a 3-hour lactulose breath test.

These type of tests involve drinking a prepared glucose or lactulose solution and measuring the presence of methane and hydrogen gases within 2-3 hours after. This type of test relies on the fact that hydrogen and methane gases found in the body are produced by bacteria, not humans. So if we measure the amount of gases produced after consuming the solution, higher levels of gas indicate the solution was consumed by bacteria in the small intestine. (8)

There’s another test from Genova we’ve used with our private clients that measures specific Organic Acids present at high levels in the urine if bacteria are overgrown in the small intestine.

Knowing whether or not you have SIBO is only the beginning. The treatment is the next step… and the one that can be the most difficult.

Treating Small Intestine Bacterial Overgrowth

Step 1: Starve the Bugs

The Specific Carbohydrate Diet (SCD Diet) is the foundational diet to begin fighting SIBO. The SCD Diet is a group of foods which are grain-free, sugar-free, starch-free, and unprocessed. Not only does it remove many foods that are toxic and harmful to the gut, but it also removes many of the complex sugars that the bacteria can feed on.

The SCD diet is often recommended to those with Irritable Bowel Syndrome by leading experts in the field. In our experience, though, it isn’t enough to beat SIBO on its own… but it’s the first place to start.

Step 2: Kill the Bugs

There are two primary ways to kill SIBO: drugs and herbs. Or in some cases, an interesting combination of the two…

Clearly we’re not doctors, but our good friend (and siboinfo.com expert) Allison Siebecker is.

Watch this interview with Dr. Siebecker to learn more about how she treats SIBO:


– Antibiotic SIBO treatment

The most common antibiotic used to kill SIBO is Rifaximin. It’s easy to use; however, using powerful antibiotics can also have a negative impact on the good bacteria in the gut. With that in mind, many people choose to try an herbal first. Dr. Siebecker has more specific protocols and dosages published here:


– Herbal SIBO treatment

There are many different herbal treatments that can work, and some even prove to be as effective as rifaximin. The most critical component of any herbal protocol is to include a biofilm buster. Biofilm is the plaque bacteria create to protect themselves in our bodies. Klaire Labs Interfase is a good one to start with.

Many practitioners use specific formulations of some or all of the following: cat’s claw, olive leaf extract, goldenseal, garlic, cinnamon, barberry, wormwood, and oregano oil. Although, it’s important to know that oregano oil should be used alongside a skilled practitioner, as it’s extremely powerful and can cause harm if used too long.

Learning Everything You Need to Know About Handling SIBO

Treating SIBO is a unique process that requires fine-tuning.

Luckily, our friend Sylvie from Hollywood Homestead (who personally battled a severe case of SIBO and kicked it to the curb) has put together an incredible resource.

It’s called The SIBO Solution and it’s a comprehensive guide for those treating SIBO.

If you’re seeking to understand the complexities, eliminate SIBO, and most importantly, make sure it never comes back, this is an amazing resource for you.

Click here to learn more about The SIBO Solution and get your copy.



1. https://www.cdc.gov/features/dssleep/index.html

2. http://www.ncbi.nlm.nih.gov/m/pubmed/15316000/

3. http://www.ncbi.nlm.nih.gov/pubmed?Db=pubmed

4. http://www.iffgd.org/store/viewproduct/211

5. http://ajpgi.physiology.org/content/280/4/G519

6. http://www.ncbi.nlm.nih.gov/m/pubmed/21637276/

7. http://www.ncbi.nlm.nih.gov/pubmed/23649377

8. http://www.ncbi.nlm.nih.gov/m/pubmed/21240630/

Note: We earn a small commission if you use the product links in this page to purchase the products we mention. We only recommend products we would use or have used in the past. Your purchase helps support our site and ongoing research.

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About the author

Jordan Reasoner Jordan Reasoner is a health engineer and author. He was diagnosed with celiac disease in 2007 and almost gave up hope when a gluten-free diet didn’t work. Since then, he transformed his health using the SCD Diet and started SCDLifestyle.com to help others naturally heal stomach problems. You can check out his story here and find him on Google+, Facebook or Twitter.

The Specific Carbohydrate Diet Works

{ 70 comments… read them below or add one }

James Carter October 23, 2017 at 12:10 pm

Could SIBO lead to a “sluggish” bowel? I have always blamed my medication for this, but unless I take some form of stimulant laxative (Senna, specifically), I can’t defecate. It developed quite suddenly, and it’s as if my bowel has just “stopped” and needs to be stimulated in order for me to pass stools. Could SIBO do this? I also experience indigestion after eating, belching and flatulence, bloating, stomach aches and cramps, heartburn, nausea, and sometimes diarrhoea. These symptoms are usually worse after eating.

Lori Jo Berg October 23, 2017 at 1:46 pm

HI James – yes while it is less common, SIBO can cause constipation as well. Our best suggestion is herbal antimicrobials and diet to get rid of the SIBO – also there is the SIBO summit! You can check it out here: http://smpl.ro/al/8kNgDkZ29Sqs1Mmgzr3oaGHH/10357-SCDLifestyle

Sandy July 25, 2017 at 5:55 pm

I would like to try the SCD diet but I am a type 1 diabetic and I shouldn’t eat a lot of carrots. Can you recommend something to substitute?

Lori Jo Berg July 26, 2017 at 3:44 pm

HI Sandy – no problem! You can try zucchini instead:)

Katrina September 20, 2016 at 10:43 pm

I have SIBO, but a multitude of other issues as well and i need your advice. I am vegetarian (not necessarily by choice, but now within 15 minutes of eating chicken, turkey, or beef I double over with stomach cramps). My most recent allergy now is also an adverse reaction to eggs…my legs swell up like tree trunks. I tried going gluten-free only to find out that I’m violently allergic to rice and tapioca – the cassava plant makes me very sick…severe gastrointestinal symptoms minutes afterwards. I also suffer from fructose intolerance, so I can’t eat any fruits or vegetables – I am unable to break down the fructose…so any vegetables (which I always loved) such as spinach, olives, strained carrots, or pumpkin (all of which kill yeast) – I cannot have. I started eating yogurt…but it only exacerbated the condition…I don’t think my system realizes it is “good” bacteria. I also tried mozzarella cheese thinking I could tolerate it because it does not have time to form mold as other cheeses do, but the after-effects 2 days later were a nightmare. Then I made the mistake of eating white cheddar aged cheese out of desperation and was sick for 8 hours straight 3 days later…no cramping when I first ate it, only after the transit time and it reaches the small intestine…but meanwhile, I used to “live” on cheese – never had any problems and never had to monitor anything I ate! I know that starch feeds SIBO, but it is all I have left to eat now…I have no idea what is happening to me…so I bake muffins with unbleached flour that is not fortified with vitamins which irritate my GI tract, and I buy imported pasta form Italy – I use a dab of ghee on the pasta so I don’t have any casein and I use a mixture of gelatin/water as an egg replacement in the muffins (I can’t use any egg replacer products on the market because they contain cellulose powder which is a wood pulp derivative). I cannot tolerate soy milk or tofu- instant stomach issues, plus nuts and fiber I cannot digest – I bloat and double over in pain. I can’t have coconut despite its antimicrobial properties – unfortunately, it acts as a laxative for me. I also can’t have olive oil, palm oil, palm sugar, canola oil…all huge triggers for me. I tried avocados, bananas, and olives for several days last month just to get away from the starches- but I was so sick 48 hours later from the high fiber content that I was housebound sick in the bathroom for the next 12 hours – laxative effect again….a nightmare. SO what am I living on? Penta water (highly purified with all minerals removed), muffins I bake, pasta with no seasonings, and a one-inch square of dark chocolate daily (that is a allowed even for those who are fructose intolerant). I tried Greek yogurt and my reaction to it was even worse than regular yogurt – the effects on me were devastating. I know to avoid carageneenan, citric acid (made from aspergillus mold), sodium pyrophosphate. sorbitol, xylitol etc. etc.- I know every preservative and additive – and their side effects…I avoid them all. I know I am not supposed to have sugar – but starch is all I have left to eat. I am depressed beyond belief – I used to be to eat normally and eat anything I wanted…egg salad, chicken, pizza, lasagna, sandwiches, peanut butter and jelly, cereals, rice of any kind, vegetables, fruits, hamburgers…I was normal!!…but now in the past 8 months, I am deteriorating – my kitchen drawer is filled with internet printouts and lists of foods that make me sick and cause me to suffer for 6 to 8 hours a day…essentially, the list has now become “everything” right across the board. Please, can you help me? I do not believe in pharmaceuticals and put no credence in doctors. The only approach I follow is all natural – I do take cinnamon bark tablets…and I’ve already tried Mastica, bentonite clay holy basil, DGL…and the list goes on…nothing is helping me!

Mariel Heiss September 21, 2016 at 3:47 pm

Wow Katrina – I’m so sorry to hear what you’re going through. It sounds like this could all have a root cause like a gut infection or parasite – especially because it all came on so suddenly. We want to encourage you to see your doctor – you don’t have to take his or her word as law, but they may be able to help you. We also highly suggest you find a functional medicine practitioner who can help you heal and get more foods back in your diet ASAP. You shouldn’t have to feel this way and you need to reach out to someone who can help you one-on-one, even if it is your regular MD as a starting place.

Info on practitioners: http://www.functionalmedicine.org or a Kalish-certifed practitioner here: http://kalishinstitute.com/practitioner-directory/

Julie August 25, 2016 at 2:07 pm

Hi There…

You quote Xifaxan as being cheap, but this is definitely not the case… check out this website with prices… http://www.goodrx.com/xifaxan?gclid=CjwKEAjwrvq9BRD5gLyrufTqg0YSJACcuF81ncpNmdFIdMpQ3VGQvy6RebZe_VIKPGGE4dvi2E_q8BoCNWLw_wcB

Mariel Heiss August 25, 2016 at 2:29 pm

Hi Julie – you’re right! Today Rifaximin/Xifaxan is one of the more expensive antibiotics (especially as its use has skyrocketed!!)

Rae Morgan June 5, 2016 at 4:50 pm

Have been diagnosed with a positive SIBO test with both high elevations in methane and hydrogen. I also have symptoms of leaky gut with the joint aches. My doctor wants to treat with both Xifanan and neomycin. My concern is with the neomycin being more absorbed due to leaky gut thereby causing a heighten side effect causing hearing loss.

rob staunton May 12, 2016 at 5:43 am

i have being diagnosed with Sibo, bacterial overgrowth and leaky gut and started a protocol of sealing the gut with your recommended products. I seemed to have low greade fever and alot of strange symptoms but they have settled after using some herbs. I also have very high cortisol and my nutrionist advised me that I needed to get cortisol down before going on a major killing spree. He said I could go on Graefruit seed extract as a fallback before fixing the adrenals.. That seemed a bit counter intututive to me. What are your thoughts on this?

many thanks


Mariel Heiss May 12, 2016 at 2:19 pm

Hi Rob – we’re really glad to hear you’re working with a practitioner and we agree dealing with your adrenals will be an important step in healing your gut. Our Gut-hormone program might be able to help: http://energyhelp.scdlifestyle.com/

Reine September 18, 2015 at 9:01 pm

Hi – I recently had the 3 hour breath test and am positive for SIBO. Just prior to that (about 4 weeks ago) I started the SCD diet – and can’t really get past the intro phase without problems. I have two questions:

1. In the SCD intro phase I am eating meat, homemade pear and apple sauce and pureed carrots along with coconut oil and creamed coconut and honey. I just read another article by Dr. Gerard Mullen that specifically says to avoid honey, pears and apples with SIBO. Is it better to try another diet until the SIBO is under control?

2. The doctor prescribed Xifaxin and I just found out yesterday that my insurance denied it stating that it isn’t “shown to be a safe an effective in the treatment of SIBO”. It costs $700, and I can’t purchase it on my own so the doctor prescribed Doxycycline instead. Do you have any insights into whether that is as effective as Xifaxin?

Thank you for your insight 🙂

Mariel Heiss September 21, 2015 at 12:47 pm

Hi Reine – thanks so much for reaching out to us!

Foods like honey, apple and pear sauce are SCD legal (but shouldn’t be used on the intro diet, which only lasts 2-5 days – they can be introduced later on in Phase 1)

Steve and Jordan warn that too much sugar even in SCD legal foods is one of the four horsemen of SCD and can stall your progress – read more about that here: http://scdlifestyle.com/2011/03/what-to-do-when-the-scd-diet-isnt-working/

The best place to start is by reading this article to best understand the ins and outs of SIBO: http://scdlifestyle.com/2014/01/everything-you-need-to-know-about-sibo-small-intestinal-bacterial-overgrowth/

From there I recommend this podcast on how to modify SCD for a low-FODMAP plan: http://scdlifestyle.com/2012/09/dr-siebecker-explains-the-art-and-science-of-the-fodmap-diet-podcast-45/

Both our SCD Lifestyle eBook and our Solving Leaky Gut program can help with SIBO, but the Solving Leaky Gut program also contains a Gut Infection supplement protcol shown to be effective in treating SIBO – a great option aside from antibitoics like Xifaxan. Because we aren’t doctors, we really can’t comment on the effectiveness of doxycycline as a treatment for SIBO.

You might be able to find out more about that over at Dr. Siebecker’s site – siboinfo.com

We highly encourage you to sign up for one of our free webinars on Solving Leaky Gut, as this will help you understand the product and how it can treat SIBO on a whole new level: http://solvingleakygut.com/webinar/live/

I hope this information helps! If you have more questions you can reach out to us at [email protected]

Marisa September 14, 2015 at 5:19 pm

On your recent podcast you talked about pan fx digestive enzymes. Are you now suggesting those over klaire Labs vital zymes? What would be the better digestive enzyme to use if you have Sibo?

Mariel Heiss September 15, 2015 at 8:49 pm

Hi Marisa – thanks for asking!

Both digestive enzymes are good and the best way to know which one is right for you is to try them each out and see how you respond.

The best digestive enzymes are the ones that provide symptom relief for you. We don’t recommend a specific type for SIBO.

eric September 4, 2015 at 9:35 am

great artical thank you! i have a question if anyone has had similar experiences?

i developed severe nausea, diarrhea and bad pains in my lower right side a week or so after taking some antibiotics for a uti. i was tested for c diff, had a ct scan, multiple stool samples, endoscopy and colonoscopy. they didnt find anything and told me it was just irritable bowel and would go away on its own?

two months later i knew it wasn’t going away, i tried Seibeker’s herbal antibiotics for a month (3x a day of oregano, allicin and oregon grape) and stayed with a strict SCD diet.

after a month my diarrhea is totally gone (i have two regular bowel movements everyday) however i get night time nausea pretty bad and still have shooting pains in my side occasionally (usually followed by bad gas). is this normal and should it go away with time if I stay on the SCD diet? should i have kept on Seibeker’s herbal antibiotics longer? any advice would be helpful, thanks!

Mariel Heiss September 4, 2015 at 6:00 pm

Hi Eric, thanks so much for reaching out!

After reading your history, it sounds like you’ve made great progress but may need some more support on your healing journey.

The best place to start is by taking the personalized quiz, which will help you sort through some of your issues and give you direction: http://solvingleakygut.com/myquiz/

We also highly recommend you register for one of our free Solving Leaky Gut Webinars, where the following will be addressed and much more:

-Why your digestion is often the root cause behind problems like brain fog, bad skin, hormone problems, food sensitivities, autoimmunity, and more

-Your top digestive risk factor – what it means and how to fix it

-The 19 triggers that poke holes in your gut wall

-The 3 step process to rebuilding your gut

-Specific anti-inflammatory foods to eat (and not eat) to stop suffering

-2 game-changing supplements that can fix your digestive complaints tomorrow

Link to register: http://solvingleakygut.com/webinar/live/

Veri August 29, 2015 at 10:18 am

I would like to know what it means when the elemental diet doesn’t work. Is there any SiBo cause we can suspect/rule out? Ive tried antibiotics and then Elemental for 18 days and the resut was worse then before 🙁

Mariel Heiss August 31, 2015 at 6:29 pm

Hi Veri, I’m o sorry you’re still feeling bad even after trying the elemental diet.

Infections can re-occur sometimes. A practitioner can help you make sure you’re other body systems (like your adrenals, detox systems, etc.) are also in good shape so that your body can fight off re-infections once you treat your SIBO.

We have two recommended practitioners, if you’re looking for someone to guide you on your journey to better health. Learn more here: http://scdlifestyle.com/practitioners/

Kayla August 19, 2015 at 1:27 pm


I first realized SIBO might be an issue when I read a very interesting article by an ND in Vancouver, BC (http://yaletownnaturopathic.com/what-is-sibo/) Dr. Dinsmore says that the antibiotics for SIBO can be quite costly but you mentioned that it is cheap. Are there different kinds of antibiotics that work for SIBO?

I was told I have IBS 2 years ago and have had digestive issues for many years prior (about ten now).. I now think that it is SIBO as I have some very typical symptoms – bloating, anxiety, asthma, eczema (very recent) I found your article very interesting. I was wondering what specific Organic Acids are picked up in the urine to tell for SIBO as I have been curious about having one done but wasn’t sure if I needed to test for SIBO separately or not.

Mariel Heiss August 20, 2015 at 10:03 pm

Hi Kayla – for SIBO Steve and Jordan recommend the 3-hour Lactulose-Mannitol breath test (must be ordered by a doctor) as it’s the most reliable test for SIBO.

Our Solving Leaky Gut program has a specific Gut Infection protocol designed to treat SIBO and other gut infections and heal the digestive symptoms of IBS – you can learn more about the program here if you’re interested: http://solvingleakygut.com/webinar/live

In this free webinar, Steve and Jordan will discuss all the testing they recommend (and it’s limitations) and their suggestions for how to treat SIBO.

Hope this helps, Kayla!!

Kim July 31, 2015 at 5:15 pm


I have severe Chronic Fatigue Syndrome; it was recently moderate-to-severe until I had a flu from which I am unable to recover.

I’m being seen by Dr. Kaufman at the Open Medicine Institute. He believes that Leaky Gut could possibly be the cause of CFS, and treats his patients based on that notion. I took the Lactulose Hydrogen Breath Test (even though it gives false positives and I would have rather had the Glucose test). My baseline was 10 ppm (it should be 20 ppm, correct?) and within 75 minutes I was at 128 ppm. The test was stopped at that time. So, I don’t know if I have SIBO. Even though I’m incredibly ill with CFS, I have no gut symptoms. I suspect my CFS is not related to SIBO, but to other factors (which I won’t go into here for your sake…)

Regardless, I’ve started taking Rifaxamin and Neomycin.

I’m writing to ask you this: Have you ever heard of anyone with Chronic Fatigue Syndrome improve their energy levels? One often cited paper by Mark Pimentel stated that some symptoms of CFS improved with antibiotic treatment of SIBO. However, fatigue scores DID NOT improve. Fatigue is my primary complaint. It is a relentless, crushing exhaustion that has robbed me of my life.

Please let me know what you think. Any anecdotal stories of people with CFS recovering from fatigue after eradication of SIBO? Thanks so much.

Mariel Heiss August 3, 2015 at 7:57 pm

Hi Kim , thanks so much for commenting. I’m so sorry you’re struggling so much with CFS. We have seen many people with your same symptoms do incredibly well and improve their overall health by healing leaky gut (and its underlying causes like SIBO). Not everyone (or even most people) with leaky gut have overt digestive issues like diarrhea, gas, or bloating. Many people’s symptoms are things like fatigue, joint pain, rashes, irritability, and autoimmune disorders.

We recommend our Solving Leaky Gut program for those with SIBO – it includes a gut infection supplement protocol to eradicate the infection as well as a Masterclass hour-long interview with Dr. Siebecker. It teaches you how to eat and what to do (and avoid) for life so that the infection doesn’t come back when you stop medicating.

You can learn more by signing up for a free webinar here: http://solvingleakygut.com/webinar/live/

Let me know if you have other questions 🙂

Karen Cope July 5, 2015 at 3:37 pm

Hello, I was diagnosed with a mild case of SIBO and at 13 I was diagnosed with IBS. I have been very sick to the point of almost dieing many times since I was diagnosed with hashimotos thyroiditis disease, hypothyroidism, leaky gut, neurological disorder after a dentist gave me an epinephrine shot that almost killed me in 2000. I have been diagnosed with infections, IBS, mild SIBO, epstein bar, viruses unknown and had severe infantigo which is streptococcal infection as a child, I also had chicken pox, measles and mumps plus after my first child was born the placenta was ripped out leaving me with a infection and put on iv antibiotics for 5 days. With all this and only mild SIBO, is it possible that SIBO diet and treatment can make a difference in my situation. ? As a child it all began with severe stomach pain and now gas bloating and pain and I’ve tried antinflammatory diet and supplements with no change. The only thing I haven’t tried is killing the infections. Thanks

Mariel Heiss July 6, 2015 at 2:06 pm

Hi Karen, thanks for reaching out to us. After reading your history and questions, it sounds like you need a comprehensive program that will address diet, lifestyle, supplements, and root causes. Our Solving Leaky Gut program addresses root causes like SIBO with a targeted Gut Infection protocol. While we are not doctors and can not give medical advice, we have seen many do well with this program that are in your same shoes.
The best place to start is by taking the personalized quiz, which will help you sort through some of your issues and give you direction: http://solvingleakygut.com/myquiz/

posicionamiento web June 15, 2015 at 11:51 am

I want to to tank you for this wonderfjl read!! I absolutely enjoyed every bit of it.
I have got you book-marked to look aat new stuff you post…

Nancy June 3, 2015 at 5:59 pm

Had 3 fundoplications and liquid gastroparesis and recurrent sibo. What can I try to reduce bad bacteria ? Need liquid. Not many teeth left. Help. Suffering so.

Lori Jo Berg June 7, 2015 at 3:48 pm
Matt Smith February 26, 2015 at 1:22 pm

Hello, I started the SCD diet a fortnight ago. I’ve got chronic gastrointestinal complaints since 2011 now. Starting off with Helicobacter, the numerous courses of powerful antibiotics I was put on to combat this ailment eventually eradicated it, but left me in a worse condition with heavy bloating/belching, Gerd and IBS like symptoms. I went to see a bioresonance practioner about 12 months ago who diagnosed bacterial and yeast overgrowth and put me on a diet similar to the SCD diet. It worked very well initially but only to a certain degree. This lead me to go a step further and try out the SCD diet.

A fortnight in, and all I have experienced is intensified symptoms that I already have. First week was diarrhoea, that subsided, this week it’d been heavy, constant belching.. One after the other with scarcely a break between them, .. Is this the normal path of starting this diet?

Lori Jo Berg March 11, 2015 at 3:28 pm

Hi Matt, your body is certainly going through alot, so we suggest giving it some time to adjust. We also suggest supplements to go along with the diet part, as diet alone is not enough. http://scdlifestyle.com/recommended-products/ If you have a gut infections, you will need to see a practitioner as well: http://scdlifestyle.com/practitioners/

Dara February 8, 2015 at 9:50 pm

Hi Lori,

I am currently on GI Microb-X and a slew of other things to treat SIBO. I have heard from several different nutritionists that in order to kill SIBO, it has to be feeding, at least a little bit. I have found that the only diet that works for me right now is eating pretty much only meat, oil, and eggs. I have been incorporating some cooked greens but even too much of that makes my symptoms flare. My question for you is: have you heard of intentionally feeding SIBO (with little bits of things such as white rice or sweet potato) while on an herbal antimicrobial or antibiotic to treat it? Do you think there is any validity to this idea?

Thanks for your opinion,


Lori Jo Berg February 10, 2015 at 12:03 pm

Hi Dara, thanks for reaching out! There are many different approaches to attacking SIBO and each practitioner is different. I highly suggest listening in here with Dr. Siebecker, as she is one of the most well recognized pioneers in this area: http://scdlifestyle.com/2012/09/dr-siebecker-explains-the-art-and-science-of-the-fodmap-diet-podcast-45/ Also, please read this article here: http://scdlifestyle.com/2014/01/everything-you-need-to-know-about-sibo-small-intestinal-bacterial-overgrowth/

Mel January 31, 2015 at 2:09 am

I have the symptoms and was thinking of doing the oregano and probiotic route, but obviously not take them the same time. Is one better with food or between meals? I was thinking of taking the oregano between meals and the probiotics at meals? Is this a good idea?

Lori Jo Berg February 1, 2015 at 12:19 pm

Hi Mel, thanks for reaching out! In general, probiotics are advised to be taken away from meals. However, there are many different protocols out there and we encourage you to not only focus on supplements, but diet and lifestyle as well and working with a trusted practitioner is always a good idea.

Michael January 30, 2015 at 10:28 pm

I think what I have is SIBO or even leaky gut. I was diagnosed with IBS-C 8 years ago and it only got worse within the last 2 years. I changed my diet from just gluten and dairy free (allergic to them) to basically the Paleo lifestyle with low-Fodmap foods. The main issue I’m having is trapped gas 5-6 hours after meals. I can feel completely empty and then “wham” bloating and gas that doesn’t want to move. It really kills my appetite and my mood. I had a breath test (lactulose) done about 1½ years ago that came back negative but I was still consuming probiotics (water kefir, soy yogurt) at the time so I’m not entirely sure it was totally accurate. I take digestive enzymes and ox bile with every meal as well. I feel like if I can fix my digestion and gas then my IBS will go away or at least be more manageable.

Lori Jo Berg February 1, 2015 at 12:21 pm

Hi Michael, thanks for reaching out! We encourage you to focus on healing your leaky gut by focusing on diet, lifestyle, and supplements. If you would like to learn more, you can go here: solvingleakygut.com

ruth fialla December 16, 2014 at 2:28 pm

I’ve been suffering with what I suspect is SIBO on and off all year – low Fodmaps does not help or Kefir…..I need to be careful with eliminating too many things as my weight is on 80lbs – well under what it s hould be at 5″ 4″
Please help with food suggestions I’m trying to make more meat and chicken stews but taste for fish is diminishing!

Lori Jo Berg December 17, 2014 at 10:24 pm

Hi Ruth, thank you for reaching out! Attacking SIBO requires a multifaceted approach of diet and lifestyle changes, as well as the addition of supplements. We really suggest getting on a program that addresses all of these three things for the best results. If you are in need of help in this area, please see our Solving leaky gut program which addresses SIBO and other gut infections as well: solvingleakygut.com

Christina November 12, 2014 at 8:04 pm

I just received a call from my GI doc and said I tested positive for SIBO. Prescribed the typical antibiotic. I asked him if my stomach pain is from SIBO. He said he did not know.

My only symptoms are:

Bad pains above belly button along with some “gallbladder” pain. (Gallblader had been ruled out)
Sometimes they are stabbing or just a dull ache. Do not last long but come off and on.
No C or D
Occasional headaches
Occasional joint pains

This all started with really bad heartburn which would not go away with the prilosec I was taking. Took it for 5 years. Now off of the PPIs and cured my self of heartburn.
Then upper adominal pain started.
Also, just stopped taking birth control.

Basically, I am wondering of anyone has had sharp upper pains from SIBO?
I am on a good diet and have lost 40lbs.

Lori Jo Berg November 15, 2014 at 11:19 pm

Hi Christina, thank you for reaching out! It is very hard to say, but we urge you to be in communication with a trusted practitioner if you have any concerns about the stomach pains and it’s possible causes.

Ann February 27, 2016 at 6:59 pm

Hello Christina I have all the symptoms you have. Had all kinds of test on my gall bladder. They found nothing I have recently been put on Xifaxan I hope it helps, this pain in my side have been going on for years along with heartburn , headaches, and joint pain

Joyce September 27, 2014 at 12:25 pm

I can’t believe you say Rifraximin is cheap! My insurance won’t cover it (and it’s a pretty good insurance plan) and even with all the coupons I can find, it’s still going to cost me $850+, which I can’t afford. I’m thinking of trying neomycin instead, but I’m nervous about it (especially the potential side effect of permanent hearing loss).

Amarie September 17, 2014 at 12:28 am

Just wondering if it’s wise to take probiotics (and which ones) during the antibiotic treatment. Anyone have any information?

Brent Kovacs September 18, 2014 at 1:12 pm

Hi Amarie,

Yes it’s a good idea to do so. Just make sure you take them away from taking the antibiotics by an hour or so.

Michele Dye August 14, 2014 at 12:58 pm

I was diagnosed with SIBO in june I have had two rounds of antibiotics and have taken the probiotic Align. Also I am following the diet. I am getting no better. How long before I should start to feel better? I am really frustrated. I keep thinking maybe it is something else? Any suggestions? This is just consuming me and I am sure worrying about it isn’t helping. Thanks for listening.

Lori Jo Berg August 14, 2014 at 7:36 pm

Hi Michele, thank you for reaching out! It is hard to put a time frame on when a person should feel better, as we are all so different. However, you may have something else going on, in which a case an appointment with a functional medicine practitioner would be a great idea: http://scdlifestyle.com/practitioners/

We also have a program designed to kill gut infections, such as SIBO, and it is called Solving Leaky gut. You can find more here: http://www.fixmygutnow.com

Janet July 20, 2014 at 12:47 pm

I was recently diagnosed with SIBO and because I suspected it, I started the SCD. I am taking rifaximin and immediately I noticed a difference in my body. Gone are the aching joints and massive fatigue I dealt with on a daily basis, as well as the gas, bloating and constipation. I believe we all have to tailor our diets to what our bodies will handle. For me, it is a smoothie for breakfast, bone broth soup for lunch and an all cooked dinner. I cannot eat a salad or any raw vegetables to save my life. They make my constipation worse. Before I was diagnosed, I suddenly became intolerant of almost all squash, zucchini, spaghetti, patty pan, etc. I get extreme cramping, bloating and constipation. I try them every few weeks, but I still cannot tolerate them. Is this something that will change as my gut heals? As you know, when you cannot eat gluten, squash is a huge part of the diet replacement for many things and having to remove this from my diet is bothersome. Is this just a time/wait and see type of thing or can my gut really not handle these foods?

Lori Jo Berg July 22, 2014 at 1:15 pm

Hi Janet, Thank you for reaching out! As you begin to heal, your gut will begin to tolerate a broader spectrum of foods. I suggest reading this article, to help you understand what is going on inside your body: http://scdlifestyle.com/2014/01/everything-you-need-to-know-about-sibo-small-intestinal-bacterial-overgrowth/

Jeremy John July 10, 2014 at 5:10 pm
Paula July 7, 2014 at 7:05 pm

Where can I get the herbal protocol in Australia?
I’ve been diagnosed with SIBO through Organic Acids test, and am on SCD diet and take a multitude of supplements.
Thank you.

AP July 5, 2014 at 4:19 am

DT Can you also share your routine with me
Too please – I have stopped my probiotics as it contains inulin and my symtoms don’t seem to be improving yet I’m on a very low sugar diet of just a banana and some
Blueberries daily. I seem to have tried everything and it’s all so confusing.

DT June 14, 2014 at 11:18 pm

You should really look into nutritional balancing science that was developed by Paul Eck at Analytical Research Labs. It’s all about balancing the body’s biochemistry and detoxing using hair as a soft tissue biopsy to guide supplementation of very specific minerals and vitamins, and therefore increase the body’s vitality and metabolic energy at a cellular level, and replaces toxic metals with beneficial minerals. The diet is very low sugar, and even excludes fruit. It also includes a supplement called GB3 from Endomet labs that is ox bile, pancreatin, and russian black radish that is a super powerful digestive enzyme and can clear out the intestines over time. It is a systems based approach to healing, not simply an allopathic, symptom based approach, so it doesn’t just focus on one part of the whole. It focuses on rebalancing the whole human system to make it so vital that pathogens can’t even exist in the body any longer. I’ve been doing this healing regimen for 6 months, and have been excreting biofilm daily for 4 months now. Sometimes the pieces are 6-8 inches long. In no way am I focusing specifically on clearing biofilm, it’s just happening in an incredibly powerful way because my body is becoming so much healthier again and naturally excreting toxins and parasites without the use of chemical chelators and such. Something to look into. Had to throw it out there for the open minded because it is miraculous stuff.

JJ June 28, 2014 at 11:29 pm

Can you share your overall routine that you’ve been using for the past 6 months? Interested in a solid bio-film disrupting routine for kicking a tough case of SIBO. thx

Brad July 19, 2015 at 12:56 pm

Wow–I guess I’d be a believer too if I were excreting biofilm.

Nathan Spinelli June 9, 2014 at 11:52 am

Just a quick comment on rifaximin (xifaxin). I’m not sure where you can get that medication inexpensively. I’m a pharmacist and the least expensive treatment with the rifaximin at 550mg three times daily for 10 days (from Dr. Siebecker’s site and for an adult) came out to be around $500. Do you know of another way to get the medication for less money? I know one reason its expensive is because rifaximin is still branded and there is not generic available, at least in the U.S.

S.Walsh June 19, 2014 at 12:24 am

Get a pre auth from the dr to the insurance and it will be the normal Rx cost, mine was about $3.00 but it took about a week.

geri c. July 28, 2014 at 9:19 am

It took me 6 days to get a pre-auth (over july 4 wkend) & my co-pay was $389.00!!!!!!!!

Jennifer W June 30, 2015 at 12:52 pm

I just got the price quote from my pharmacy and if my pre-auth doesn’t go through, I’m looking at $1500.00. $389 sounds great to me at the moment!

Skip July 4, 2016 at 1:06 pm

There is an agency that helps pay for this but I forgot name now. I kept appealing with my insurance they finally agreed to cover the Xifaxin.

Ask your GI dr they know the resource for help.

nancy graham May 3, 2014 at 5:41 am

I have SIBO diagnosed through breath testing. xifaxin is expensive, but samples I took did help just did not have enough to last. I am trying

Amber Williford April 3, 2014 at 8:15 pm

Great article! I’m loving your podcast and am learning so much from them! I’m a health coach myself and I’ve been doing GAPS intro for close to 2 months but am stuck on the intro because I’m reacting to most all vegetables, fruit, honey, ghee, ect. I get extreme bloat from just about everything. I started GAPS because I have a soy allergy, and am intolerant to dairy, eggs, sweet potato, kabocha and acorn squash, and all non gluten grains. Do you have any suggestions for someone who has a reaction to egg whites other than the Klaire Labs InterFase Plus? I notice that egg whites are an ingredient.

lotis April 6, 2016 at 5:44 pm

As said some probitics are not a good idea for several reasons. vsl#3 would be my first line of defense plus a fodmap diet. This means you have to hand prepare ALL your meals. Throw out everything that comes in a box jar or can except olive oil, salt. Best of luck. This is a good start. You sound like you at the end of your road.

Tom C March 20, 2014 at 10:39 am

Down to three foods eat anything else get unbelievable painful trapped gas, must lay down rest of the day. Have given up on medical community their really uninformed or disinterested or both. Probiotics give similar problem, had most of colon removed but still constipated. Any suggestions ?

Betsy Demny February 28, 2014 at 4:45 pm

I have SIBO in addition to Type 1 Diabetes, Fibromyalgia, Lupus, Hashimotos, Gastroparesis, plus several more auto-immune diseases. I have a hydogen breath test scheduled for Monday, March 3rd. What can I expect my blood sugars to do? I use an insulin pump and I will be lowering my Basal rates from 8 P.M. Sunday, through the duration of the test. Needless to say, I am a bit nervous about all of this.

Bee February 20, 2014 at 12:06 pm

Are ferments foods like coconut kefir and is prescript assist sbo probiotic helpful for beating Sibo?

Tracy January 18, 2014 at 8:19 am

HELP! I’m having SIBO Breath Hydrogen Analysis on Tuesday, Jan 21. The lab says ‘eat easily digested food’ for 2 days prior to test (Sun & Mon), but they won’t tell me what that includes (or excludes). Should I start your Intro Diet? I’ve been Gluten-Free, Dairy-Free, and Paleo for almost a year and don’t really have any GI symptoms, but do have gut dysbiosis per Genova CDSA test. What should I eat next 2 days? Thanks for any suggestions!

Melissa March 22, 2016 at 7:09 am

I know it’s past the date of your test but your doctor should’ve given you a big list of what not to eat. I just had the test done last month. Basically, the only thing I could eat the day before was white rice, broiled chicken, turkey, and some kind of fish (I don’t like so I can’t remember what it was).

David January 15, 2014 at 1:42 pm

Jordan, what are your thoughts on SIBO being the cause of GERD/LPR in some cases?

Caroline January 14, 2014 at 3:02 pm

Hi guys, ok I am totally confused. I am not sure if my problem is candida or sibo, but if I take an antibiotic for sibo will that not exaggerate candida??? I thought it was antibiotics that make gut issues worse as they wipe out everything and allow harmful ones to take over no???

lindsay gopin January 14, 2014 at 11:53 am

If you have all the symptoms of Sibo (and it showed up in the Organix test) but Sibo Breath test comes clear……what should you do? Search for other infections via more stool testing?