SIBO causes some people to experience relapses after their protocols are finished.

Here are 10 reasons why relapse is common on people with SIBO. 

1. You’re focused on “managing,” not healing SIBO.

Many people start a “gut healing” protocol without the full broad spectrum of both supplemental and nutrient supports to eliminate the bacterial overgrowth. Beyond just taking a probiotic and eating sauerkraut, SIBO protocols require specific nutrients and supplements. Specifically, antimicrobials– that help eradicate bacterial overgrowth.

2. You’re not treating it long enough.

woman in bed suffering from SIBO

Standard protocols have a treatment length of 4 weeks. However, this can be effective in some cases. But, more severe small intestinal bacterial overgrowth may require 8–12 weeks of continuous antimicrobial treatment to fully resolve.  Your small intestinal bacterial overgrowth protocol length (30-90 days) depends on your hydrogen levels (H2) on your SIBO Lactulose Breath Test results. 

Hydrogen H2 @80-90 minutes Sum of H2 @80-90 minutes Treatment Protocol Length

>45 ppm <160ppm 30 Days

45-70 ppm 160-250ppm 60 Days

>70 ppm >250ppm 90 Days

3. You are not eating a SIBO-healing diet.

Food is like medicine for small intestinal bacterial overgrowth healing. Many people go on a “low FODMAP” diet, known as the “SIBO diet” of choice. Unfortunately, once they start their supplement protocol, low FODMAP may not be the best for healing. Other people don’t think about diet at all. They figure that once they are taking supplements or using antibiotics, they can eat anything they want.

4. You’re using the wrong herbs. & supplement supports for your body.

There is no one-size-fits-all approach for small intestinal bacterial overgrowth treatment. Dr. Google may swear by berberine or oregano oil.  Nonetheless, your body may require something different. It is important to know the type of SIBO you have in order to treat it properly with herbs. You may have methane or hydrogen dominant, hydrogen sulfide, or mixed type.

Types of SIBO

  • Hydrogen SIBO usually causes diarrhea, so hydrogen SIBO responds best to a broad spectrum blend of herbals, along with biofilm disruptors (like Interfase Plus), probiotics, probiotics and immune boosting supports (like Monolaurin).
  • Methane SIBO usually causes constipation, so methane-based small intestinal bacterial overgrowth responds best to, not only the herbal protocol for hydrogen-based SIBO, but also additions like peppermint, conker tree, and quebracho (found in Atrantil), as well as Lactobacillus plantarum probiotics and prokinetics (like Iberogast or MotilPro by Pure Encapsulations).
  • Hydrogen Sulfide SIBO should be eliminated by first-pass liver detox. Therefore, consider liver support with liver nutrients along with the basic botanical protocol (such as Seeking Health, or liver GI detox from Pure Encapsulations).

5. You’re not using biofilm disruptors.

Bacterial biofilm is the term given to gut bacteria that adhere to each other and form a strong shield—like steel armor—making the gut bacteria much more difficult to destroy. There is strength in numbers, and Bacterial biofilm is infectious in nature. The more biofilm that builds up in your gut bacteria, the more resistant bacteria is to herbals, probiotics and other gut supports. Biofilm disruptors compose a blend of enzymes that help breakthrough biofilm so your SIBO protocol can work.  

6. You’re not incorporating soil-based probiotics

 daily probiotic helps address SIBO

Many protocols for small intestinal bacterial overgrowth ban probiotics for SIBO sufferers, claiming probiotics make it worse. Other conventional protocols prescribe that patients take a daily probiotic or eat fermented foods (like yogurt, sauerkraut or kombucha), without regard to the types of bacteria in the formula. While probiotics are essential for encouraging healthy gut bacteria to reside in your GI tract, too much of a good thing is not a good thing. As you eliminate unhealthy and overgrown bacteria—but the right types.

SIBO sufferers generally best tolerate soil-based organisms. Primarily, because these bacteria mimic the flora of our ancestors, found in traditional diets, reducing the risk of overgrowth of strains you already may have enough of (i.e. lactic acid bacteria) that can irritate small intestinal bacterial overgrowth symptoms more. Soil-based organisms also have a seed-like structure of the microflora, allowing them to survive the stomach acid when swallowed and “root” in the gut.

7. You’re not incorporating pre-biotics.

Pre-biotics are fibers found in foods and supplements that serve as the essential “superfoods” that feed probiotics—helping the “good guys” to stick around in the gut. Without pre-biotics, you might as well flush your probiotic money down the toilet. However, not all pre-biotics are created equal. For SIBO sufferers, several fibers can flare symptoms or make the condition worse (SIBO bacteria thrive off fibers, sugars, starches and carbs). Partially, hydrolyzed guar gum powders, citrus pectin powder, glucomannan powders and resistant starch foods (found in cooked and cooled potatoes/sweet potatoes, green tipped bananas/plantains, cooked and cooled white rice) tend to be the best tolerated fibers.

8. You’re not boosting stomach acid and enzymes.

Problems with digestion define small intestinal bacterial overgrowth. Hydrochloric acid (stomach acid) and digestive enzymes are natural essentials found in your gut that aid in digestion. However, for the small intestinal bacterial overgrowth sufferers, these two components are typically deficient. The good news? You can boost both with HCL + Pepsin/Betaine tablets and/or apple cider vinegar (1 tbsp. In water with meals), along with taking 1-2 digestive enzymes with meals. The result: Less bloating, less undigested food in your stool and/or decreased constipation. 

9. You’re not looking for yeast overgrowth, fungal overgrowth, parasites, SIFO (small intestinal fungal overgrowth), toxic burden or low stomach acid

SIBO is often not the only gut pathology at play in a SIBO diagnosis. Since it is the presentation of bacterial overgrowth in the small intestine and the majority of gut bacteria reside in the large intestine/colon, small intestinal bacterial overgrowth is often a byproduct or symptom of another underlying gut pathology. Stool testing, bloodwork, urine organic acids testing, and/or hair testing may be beneficial in addressing and ruling out any other underlying issues at play.

10. You’re stressed out. 

man stressed and worried about his SIBO

You cannot eat or supplement your way out of a stressful lifestyle. Gut bacteria thrive upon stress. SIBO will not heal if you’re stressing your body out. Even if you eat lots of kale salads you eat, drink apple cider vinegar or have digestive enzymes you pop. 

Stress goes far beyond mental: It also includes circadian rhythm dysfunction, poor sleep, low fat or nutrient-deficient diets, overtraining or sedentary lifestyles, antibiotic use, environmental toxins and beyond.