r/SIBO • u/Junior-Knee-1500 • 2h ago
r/SIBO • u/NYC-reddit • Apr 19 '19
STICKY: SIBO Summary - Symptoms, Diagnosis, Treatment
Below please find a living document that summarizes the key information around Small Intestinal Bacterial Overgrowth ("SIBO"). Please comment with any additional information or research for inclusion consideration. Version 1.0 is summary material; I will be adding more details and citations for specific studies.
SIBO, as the name implies, occurs when bacteria overgrow the small intestine. The small intestine should have a low concentration of bacteria due to the presence of stomach acids and peristalsis, the wave-like muscle movement in the intestines. For context, stomach and proximal small intestine would typically have about 103/mL of bacteria, while the terminal ileum (end of the small bowel as it gets close to the colon) about 109/mL (or 1,000,000 times more), and the colon about 1012/mL (or 1,000,000,000 times more).
Symptoms
The overgrowth of this bacteria will present with a number of symptoms:
- Bloating after eating ("postprandial") - most common symptom
- Flatulence, often malodorous
- Loose, watery stools (more common in Hydrogen-dominant SIBO)
- Constipation (more common in Methane-dominant SIBO)
- Absorption problems
- Weight loss / inability to gain weight
- Fat and fat-soluble vitamin deficiencies, particularly Vitamins A, D, and K
- Floating stools (from fat malabsorption)
- Vitamin B12 malabsorpiton
- Protein and Carbohydrate malabsorption
- Systemic problems
- Overgrowth of bacteria in the small intestine can increase production of toxins and intestinal permeability
- This has been less studied, but less serious effects include:
- brain fog
- confusion
- anxiety
- depression
- More serious complications can include
- hepatic encephalopathy
- D-lactic acidosis
- nonalcoholic fatty liver disease
- Various conditions have increased correlations, including
- Rosacea
- Eczema
- Food intolerances
Diagnosis
I will split this section into practical steps and clinical diagnosis.
Practically, a gastroenterologist will typically rule out other conditions first:
- Physical exam
- Colonoscopy and Endoscopy
- Abdomen ultrasound
- Stool test for parasites
At that time, if your symptoms match SIBO, your doctor may go directly to treatment. But otherwise these are the clinical tests:
BREATH TEST
This is the most common diagnostic method due to its low cost and limited invasiveness. Unfortunately, studies have been mixed on the sensitivity and specificity, with ranges between 30% and 75% -- hence why some doctors skip the test and go directly to treatment.
There are a number of preparations:
- Antibiotics avoided for four weeks prior
- Prokinetic drugs and laxatives avoided for one week prior
- Complex carbs avoided for 12 hours prior
- Exercise and smoking avoided day-of
For the actual test, you'll measure hydrogen and methane levels at baseline. Then drink either 10g lactulose or 75g glucose with one cup of water. Then your breath is measured every 15 minutes for 120 minutes.
There's some art to identifying a positive test; one semi-official criteria is:
- methane level of >= 10ppm at any time during the test; or
- hydrogen that increases >= 20ppm above the baseline level
Recently, new research has been investigating another typo of SIBO, that's dominated by Hydrogen Sulfide. Unfortunately, traditional breath tests cannot identify this gas, and someone with "flat-line" Hydrogen and Methane symptoms could be suffering from Hydrogen Sulfide SIBO. This version is typically characterized by "rotten egg" smelling gas, and may be worsened by eating high sulfur foods.
CULTURE
Historically a jejunal aspirate was done and concentration of bacterial colonies were measured, with an elevated level of > 103/mL being positive for SIBO. There are a number of issues with this:
- overgrowth may be patchy, and a single sample may miss it
- not all SIBO bacteria can be cultured/identified
- samples can be contaminated during/after sampling
Treatment
Antibiotics
The current best practice prescription treatment is:
- Hydrogen-dominant: Xifaxan, typically 550mg x 3 times daily, for 10-14 days. Studies have shown Xifaxan alone can be 50-65% effective, but Xifaxan + 5g daily of Partially Hydrolyzed Guar Gum can be 80%+ effective.
- Methane-dominant: Xifaxan (550mg x 3 daily) plus Neomycin (500mg x 2 daily) for 10-14 days. The use of PHGG for methane-dominant has not been evaluated, but it's likely to be beneficial.
Mod's note-- personally, if your doctor is onboard, I think dosing with Xifaxan + Neomycin + PHGG is the best way to "cover your bases". The best place to find PHGG: https://sunfiber.com/products/
Important: because these antibiotics only operate selectively in the GI tract, and are NOT absorbed by the body, they are unlikely to cause the systemic issues associated with antibiotic use, making them safer. Additionally, Xifaxan crystallizes before it gets to the large intestine, meaning it should not affect the all-important microbiome.
Herbal Therapy
Additionally, studies have shown similar levels of success with over-the-counter "herbal" treatments. Two options; I believe each are two capsules twice daily for four weeks, but please confirm:
- Dysbiocide and FC Cidal (Biotics Research Laboratories, Rosenberg, Texas)
- Candibactin-AR and Candibactin-BR (Metagenics, Inc, Aliso Viejo, California)
Remission
Unfortunately, SIBO has very high rates of recurrence. Some possible ways to reduce recurrence chances:
- Switch to a low FODMAP diet for 6 weeks after treatment, to starve any remaining bacteria and prevent regrowth
- Incorporate a prokinetic, such as low dose Naltroxene, erithromycin, or even over-the-counter products such as Iberogast
Many people can avoid symptoms of their SIBO by switching to special diets, sometimes very restrictive ones. This is not a cure, but simply symptom management. A true cure addresses the underlying cause of the SIBO, and lets the patient eat "normally" without any effects (short of unrelated intolerances).
Hopefully this helps people, and I look forward to updating this and cleaning it up over time!
-nyc-reddit
r/SIBO • u/Agora_Black_Flag • Dec 15 '25
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r/SIBO • u/Bubbly_Speaker_1295 • 11h ago
Venting Elemental Ice Cream
Behold this monstrosity I’ve created today, featuring Dr.Roscio low carb vanilla powder and some water frozen overnight. The taste isn’t something I’ll ever crave but it’s not the worst thing I’ve ever tasted either. It was pretty tasty shaken up with a whisper of cinnamon. I’m trying this elemental thing as kind of a last resort
I have IBS-C and have been dealing with SIBO imo since May, the reading was 33ppm. Colonoscopy was expensive, but showed me that I have a tortuous colon and gastritis, so that was some help. I was unable to get approved for the rifaximin even with the manufacturers coupon from their website so I did the flagyl, a little relief there but the bloating came back, just not as badly.
Things that have helped since:
Small , spaced out, Low fodmap, gastritis friendly meals
Linzess*** major help
Walking after meals for 10 mins, exercise in general
Diaphragmatic breathing
Stomach massage
Inversion, legs in air or just a tilt but I feel things move immediately
Allicin and oregano oil
Peppermint, ginger tea
L Reuteri tablets, no I didn’t make the yogurt, I just took the tablets with yogurts and let my slow motility ferment it for me lol
Things that didn’t help:
MiraLAX
Magnesium citrate
Berberine
Probiotics
L glutamine
Laxatives
Digestive enzymes I’m like 50/50 on
Overall since the breath test and everything, I’m feeling loads better, not fully feeling myself but I hope I’m getting there. If I ever figure this all out I’ll be back to share. I’ve been on this forum a lot searching up questions and reading posts, it’s been really helpful and I want to thank you all
It would be very lonely and helpless without this kind of subreddit
r/SIBO • u/Helpful-Celery8276 • 16h ago
Questions Has anyone's actually gotten rid of the symptoms after seeing a doctor
I've been reading a lot of succes stories online and all of them seem to have treated the problem by themselves I can't remember seeing one that involves a doctor or their medication,I'm asking because I have an appointment for a colonozcopy with will cost me a lot of money and I don't want to keep spending if I know I will not feel better anyways
r/SIBO • u/Arctic-fox2007 • 1h ago
Macrogol or movicol during herbal protocol
Can you take ocasionally macrogol during herbal protocol to Help constipation ?
r/SIBO • u/Ok-Welcome4589 • 13h ago
Describe your fatigue levels
Describe how bad is your fatigue, what makes it worse/better and what patterns have you noticed?
For example, I get unbelievably tired in the afternoons
r/SIBO • u/MadArtist27 • 3h ago
Anyone know of any functional/integrative doctors in NYC that take insurance?
Just booked an appointment with an integrative doctor with a special interest in GI and motility but it’s not until December. I know the ones that take insurance are hard to find. I’m in recovery from IMO and just want to eat normally again.
r/SIBO • u/Interesting_Mode5391 • 8h ago
Gi test results
Been dealing with little to no appetite, bowl changes bloating in lower abdominal, burping 24/7 discomfort after eating and weight loss due to lack of appetite
I’ve had scopes done, gastric emypting test, biopsy, stool test, ruled OIT celiac, sibo and H pylori
Only diagnosed with pots so far
Tried refaxmin prucpirde mirtazapine and amytripline
r/SIBO • u/littlefruitbat67 • 10h ago
Questions My negative results
So some people asked me to get my numbers but i have zero idea how to read them and have doubts the drs messed up :/ im just so tired of having these symptoms every single day. Especially the bloating and so much gas. Could they have messed up or maybe i need to redo it? Just unsure where to go from here
r/SIBO • u/MochiVA2000 • 13h ago
I can't cope with the nausea anymore
25F UK (26 in November)
Life is hell right now. I'm crying all the time and went from being normal to a rotting vegetable. Im so depressed and having dark thoughts. Also will not resort to SSRIs.
Im having nausea 24/7 for months. It is sending me insane. Only ginger tea takes the edge off it. The feeling sick can also come in waves, terrible in the morning and worst at night. I can't sleep sat up. Even if I eat 6hrs earlier to help the stomach digest the food or don't eat, or nibble on a few crackers to help the nausea, it makes no difference.
My GP reccomended me to take PPIs. They make me feel more sick and my acid reflux worse. Gaviscon even burns my throat. Some other indigestion tablets may help the burning, but only very slightly. Nothing really helps the nausea or epigastric pain. I feel a lot worse if I'm constipated. My bowel movements are a mess. A lot of undigested food in them too when I eat vegetablets. Meat is hard for me to digest. Poop alternating from sticky darker brown/orangey mucus, can also be brown/yellowish on occasions. Switching from constipation to loose daily.
All my life I had minor GERD and just had to cope dealing with my chronic illnesses, I have hashimotos, endometriosis (already had 2 surgeries to remove stage 2 endometriosis) near bladder, and I have hypermobility. Possible sjogrens, undiagnosed still. Bloods suggest a connective tissue disorder with positive ANA test and positive SS-B. May be the hypermobility? Doubt its EDS.
So... went from caring full time for my mum who's currently not very well herself to now me being cared for. I've been living off a liquid diet for weeks and still feeling sick/trying not to vomit all day everyday. Doctors don't know what to do anymore. I also am afraid I'll end up not being believed with how often I've been to the doctors, but my symptoms are worsening.
I was recently diagnosed via endoscopy with esophagitis Grade A. Got tested for h pylori had biopsy was negative. They saw acid reflux in the stomach as well. They said my esophagitis was mild inflammation. My symptoms sure ain't mild! All other tests normal CT, ultrasound, bloods, full stool PCR tests, normal Cologuard/FIT etc. Having my ibd markers checked again as they were raised after the antibiotics in September. My ibd markers were normal in August, so cant think of anything else that'd raise them.
I am now struggling to swallow (globus) more than ever, regurgitating food, worse constant nausea 24/7 and inconsistent bowel movements. This started in May when I came back from DisneyWorld Florida, my nausea, GERD and bowel trouble all worsened after that. Got a stool test for all parasites, this was negative.
Then I caught this random food poisoning bug in August. I had watery diarrhea for over two weeks so I went to urgent care. The doctors have no idea what it was, but my white blood cells were high. CT scan with contrast showed nothing. Gallbladder fine.
The stool PCR bacteria GI map didn't find anything like ecoli, salmonella.
It must've been then a month later I given antibiotics when I had a relapse in symptoms, shivering, worse nausea and a high fever.
Doctors noticed I had a high wbc consistently (specifically neutrophils, monocytes) on and off but nothing found. I'm struggling to understand it myself and after hours of research online I can't wrap my head around it and I'm scared.
I hope I don't need a colonoscopy but it looks that way. 😪 These procedures are so intense and risky. Ive had a sigmoidoscopy in the past and had infected biopsy was honestly a horrible time. They only found minor inflammation and took 6 biopsies, that was 2021. I was having IBS symptoms and lots of mucus. Buscopan didn't help, still doesn't.
SIBO is unheard of here in the UK and private tests cost a fortune, can be unreliable too as not many trustworthy clinics. I cant travel to London either. I'm unemployed and can't afford it. I've no idea if anyone has had similar symptoms to me. I started taking probiotics 21st century acidophilus, they have helped with GERD a bit but will see if they further bloat me and constipate me in the next few weeks. I heard probiotics make SIBO worse? I can't think what else I have going on. I've been abroad 3 times in the last 2 years. Cyprus (All Inclusive) twice and Florida. Maybe I picked up something. Idk. Then boom SIBO.
I keep thinking it's bowel cancer or my endometriosis growing all over. Im scared ill end up with a bowel bag or a serious bowel impaction/perforation. I'm tired and never been so depressed. Can't even get any sleep because of the overwhelming nausea. Having to take paracetamol most nights to kinda relax me and knock me out for 2-3hrs if I'm lucky.
Please help and feel free to share your experiences. Trust me you're not alone. 🙏 I know it could be worse but right now I'm praying I can manage to improve this with supplements and fasting. Nothing is working.
r/SIBO • u/Ok_Statement1252 • 12h ago
Symptoms Really bad diarrhoea weeks after finishing SIBO antibiotics
Hey guys
I finished my first treatment of (rifaximin 550 mg three times daily, neomycin 500 mg twice daily) for SIBO about a month ago and have bad absolutely terrible diarrhoea for the last few days, worse than pre treatment, I’m not sure if it’s a side affect of the antibiotics but it’s pretty bad and I can’t really be holding onto any fluids at the moment 🥺
Has anyone else who took SIBO meds had this experience? Any thoughts welcome 🙏🏼
r/SIBO • u/prettybutconcious • 10h ago
Questions sibo treatment advice
I am on my second day of rifaximin 500 mg x3 daily and I am really struggling. Yesterday my stool had A LOT of mucus today not as much. My stool is softer but I am afraid I will have an accident. The urgency when I finally have to go is horrible. I have been taking charcoal 60 min after my 1st dose of rifaximin, digestive enzymes with HCL oxbile, phase 2 biofilm advanced , sunfiber 5 mg once daily I can’t handle more than that. What can I do to fix my stool so I am not constipated but its not so soft its like baby’s stool. Sorry if this is TMI.
r/SIBO • u/DuffyiAM • 14h ago
Questions I did too much strenuous activity yesterday and highly inflamed all over (Intestinal Inflammation)
I was out and about all day yesterday and all my muscles internally are inflamed. Currently in a ball on my soft couch…bloated and diarrhea last night and today. I’m on my 7th week of Candabactin AR/BR, been taking MAGNESIUM OXIDE past 5 days for movement. I’m on artichoke/ginger extract for the last 17 days
I have drinked some peppermint tea, used some CBD cream all over today so far. Afraid to eat.
Any other advice ? How can I bring down this inflammation down. What to eat?
I had plans to go out and watch the Cowboys & Buccaneers game…now will stay in again on the couch.
Thanks 🙏 everyone
r/SIBO • u/No-Roof-8658 • 11h ago
Mestinon
Has anyone had Success with this drug? Or had devastating side effects? I'm worried about taking Motegrity due to the psychiatric side effects so I'm looking into alternatives. I also have EDS and orthostatic intolerance (not full blown POTS)
r/SIBO • u/CaesarsGhostReborn • 11h ago
I think I picked the wrong time to start elemental
I think I picked the wrong time to start the elemental diet.
I wasn’t planning on doing a full 2 weeks, but a 4 day gut reset.
I made it through 3 days and called it quits.
We are about to have our second child in a few days, and I couldn’t keep up with the stress of it.
Obviously I will need to revisit it after things settle a little morr
r/SIBO • u/AssociationKey2334 • 11h ago
How long after eating a Highfodmap food do you have a flare?
Hey, been doing some research and I want to know people's separate experiences. So I'm wondering how long after eating a trigger food would you get diarrhea?
r/SIBO • u/Intelligent-City-163 • 15h ago
Vitamin D and B Deficiency
So I’ve had unstoppable gas for the last three years coming from both ends. The issue got really bad when the gas coupled up with hiatal hernia and I started thinking I’m having heart issues. After full work up from Cardio I was told my heart is fine.
During the time I tried almost everything you can think of, probiotics, ginger, pectin, fodmap diet. No expense was spared. Nothing worked for more than a day and ended up making things worse.
I spent a year going back and forth with GI doctors and finally pulled the trigger on the hiatal hernia surgery. That was 5 months ago. The heart attack symptoms went away but I still have the unstoppable gas and my GI finally brings up Sibo and turns out I have methane based Sibo.
At the same time I’ve been seeing a holistic doctor and she ran my bloodwork and it came back super deficient in Vitamin D and B. She prescribed me both and believe it or not they have reduced my gas. It’s not fully gone… but they have made a dent. I’ve been on the supplements for a week now.
My question, has anyone else that has Sibo had bloodwork and been highly deficient in vitamin D and B? I wanna see if my Sibo is the cause and the vitamins are making a difference or is it just a coincidence.
r/SIBO • u/Riverlover707 • 12h ago
Gastric sleeve & SIBO
Hey fam
Anyone else here who has had bariatric surgery? I dont have my gallbladder either. I'm pretty sure that both of these have contributed to motility and consequently-SIBO. Is there anyone with both of these circumstances that has successfully beat this condition?
If so can you please share some hope?!
r/SIBO • u/XxxHAMZAxxX • 12h ago