SIBO – Can You Recover?

Depending on what you read, and where you read it, you can get very different opinions on SIBO.  Some paint SIBO as a condition one can never recover from, while others call it a fad.  Let’s discuss a reasonable and evidence-based take on SIBO recovery.

Dr. R’s Fast Facts

SIBO stands for Small Intestinal Bacterial Overgrowth

  • An overgrowth of bacteria in the small intestine that can cause gas, bloating, abdominal pain or distention, and either constipation, diarrhea, or both.
  • Food poisoning can initiate an autoimmune process in the gut that damages the Interstitial cells of Cajal (these cells help with motility or the movement of food through the digestive system).
  • When motility is interrupted, it can lead to bacterial overgrowth in the small intestine.

Can you recover from SIBO? Yes

  • Theoretically, we evolved from highly omnivorous hunter-gatherer scavengers, so it’s likely our ancestors were exposed to bad food and were able to recover from it.
  • The Interstitial cells of Cajal are neuromuscular cells. Muscle has a strong ability to heal and regenerate, though nervous tissue does not. However, nervous tissue is really great at rewiring itself to make up for damage.

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SIBO – Can You Recover?

Dr. Michael Ruscio: Can you recover from SIBO?

Hi, this is Dr. Ruscio, and recently someone asked a question on my Facebook page that I thought was worth repeating and doing a video on. Essentially the question was, can I recover from the autoimmune damage that occurs against the intestinal cells called the interstitial cells of Cajal that allow SIBO to occur?

In short, the answer, in my opinion, is yes. Now, before I jump into that, let me just give a quick recap on what SIBO is if you’re unfamiliar. SIBO is small intestinal bacterial overgrowth, and as the name implies, it’s an overgrowth of bacteria in the small intestines that can cause gas, bloating, abdominal pain or distention, and either constipation, diarrhea, or both.

Now, what causes SIBO? Well, the way we think SIBO occurs—right now, anyway—is if you ever suffered a bout of food poisoning or what’s called acute gastroenteritis, so you had a stomach bug or food poisoning, you had a bout of either throwing up, diarrhea, or both, that can then initiate an autoimmune process in the gut, and this autoimmune process damages these cells called the interstitial cells of Cajal that help regulate motility or movement of food through the small intestines. When these cells are damaged, motility is damaged. And when motility of food is interrupted, if food doesn’t move through the intestinal tract at an appropriate pace, quickly enough, and it gets stagnant, then bacteria can overgrow. Kind of like flowing water is safe to drink because it doesn’t allow bacteria to overgrow, but stagnant water does foster bacterial growth, the same thing happens here.

Again, small intestinal bacterial overgrowth, or SIBO, causes gas, bloating, abdominal pain or distention, and constipation or diarrhea, and it’s very common. We’re now realizing that it’s caused after you have an acute bout of gastroenteritis or food poisoning, and that bout causes autoimmunity in the gut against these cells called the interstitial cells of Cajal that are needed to help keep food moving through the intestines. When food doesn’t move through the intestines, you can have this small intestinal bacterial overgrowth.

Then the question is, can you recover from this? I think this is a really great question, because sometimes when people learn that they have an autoimmune condition, they get really scared, there’s a lot of fear, they think they have to manage it for the rest of their life—and in some cases, they do—but in this case, I don’t think that that’s the case, and I want to, hopefully, prevent people from going to a very fearful place, because again, in my opinion, yes, you can fully recover from SIBO and regain function of these ICC, or interstitial cells of Cajal.

Now, here’s why I say so. There are a couple of philosophical reasons why, and there are a few more peer-reviewed medical research reasons why.

From a theoretical or a philosophical perspective, we evolved from highly omnivorous hunter-gatherer-scavengers, and living that sort of dietary lifestyle, if you will, it’s very likely we were occasionally exposed to bad food, rotting food, contaminated food and got food poisoning on occasion. To think that we never evolved any kind of mechanism to cope with that is silly, and to think that as the proverbial caveman, if you ever had food poisoning, you’d be suffering with SIBO or IBS for the rest of your life just doesn’t make any sense, right? So that’s one.

Two is these ICC cells, or these interstitial cells of Cajal, are neuromuscular cells. Muscle, we know, has a very good ability to heal and regenerate. Nervous tissue, however, does not. Yikes. Does that mean that you’re in trouble? Well, not necessarily, because while nervous cells can’t necessarily regenerate, nervous tissue has an incredible amount of what’s called plasticity, meaning if one nerve or neuron is damaged, all the adjacent nerves or neurons can compensate to help you regain full function. This is why, in some cases, when people suffer traumatic brain injuries, they can have a full recovery, because essentially the neural circuits, if you will, rewire themselves to allow the person to get back to full function. Nervous tissue, while it can’t necessarily or isn’t necessarily great at regenerating, is very good at rewiring.

And then thirdly, just from an observational perspective, every day myself and other clinicians that treat SIBO see people treat SIBO, clear SIBO, make a full recovery, and have minimal to no issues in the long run.

Those are the theoretical and philosophical reasons why I say I think, yes, you can make a complete recovery.

The more research-based reasons: We do have some great animal-model data where we’ve either surgically removed these ICC cells or damaged or destroyed them via exposure to certain toxins and chemicals, and what we’ve observed is that these cells can, yes, either regenerate and/or they can rewire themselves, so to speak, and the intestinal function can go back to 100 percent.

To the question, ‘because I have SIBO and we’re learning that’s caused by autoimmunity in the gut, does that mean I have a lifelong condition that I’m going to have to manage and may be an annoyance for the rest of my life?’, in my opinion, no. You can make a full recovery and get on with your life and be very healthy. Some cases are easier than others to get to that full recovery, but I think it’s absolutely possible.

This is Dr. Ruscio, and I hope you’ve found this helpful. Thanks.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

76 thoughts on “SIBO – Can You Recover?

  1. Thank you for this uplifting podcast. I’ve been trying everything to heal my gut and had some negative experiences with contemporary medicinal doctors who think antibiotics, mirilax and more fiber are the answer to curing SIBO….but only made me worse. I’m trying the herbal approach and plant-base diet. My docs haven’t retested me for SIBO, but I know it’s still there based on my symptoms. That’s why I’m tuning into you…hoping to learn what I can do to heal myself. Thank you for the info you put out!

    1. Hi Ashley,
      There is a lot info here on the site that can help. If you are still struggling after that you can always contact my office if you need more support. Good luck!

  2. My understanding is that not all SIBO is from food poisoning. In my case, it’s believed to be abnormal gut anatomy after surgery and then there are others who claim it’s from antibiotics.
    Whatever the etiology, I hope that I can recover from it but the motility issue is the big one for me., Are you going to go into ways to increase motility? Or, maybe you already have in another episode.

    thanks for bringing this great knowledge to us Dr!
    Terrie

    1. Hi Terrie,
      That correct, there is more than one cause of SIBO. We have discussed SIBO and motility in many of the podcasts. We have also discussed abdominal adhesions. There is a lot of SIBO info on the site, if you search around a bit you will have lots to look at 🙂 Happy to share Terrie!
      Hope this helps!

  3. So what is the treatment. I went though herbal treatment and low FODMAPS and it didn’t work. If I stray at all from the low FODMAPS I will get bloating , pain and distension very soon after.. I really would like to be able to eat with others or go out to eat, without having pain, bloating and distension.

    1. Hi Karen,
      There are a number of ways to treat SIBO which we have discussed in various podcasts and articles on the site. There is even one where I detail a SIBO case from start to finish. Have a look and I think this will help 🙂

  4. Hello Dr. Ruscio,

    I’d like to know what you think about LDN (low-dose Naltrexone) as a kinetic? I can’t recall what you use and why.
    Thanks for your insights.

  5. Thank you for this uplifting podcast. I’ve been trying everything to heal my gut and had some negative experiences with contemporary medicinal doctors who think antibiotics, mirilax and more fiber are the answer to curing SIBO….but only made me worse. I’m trying the herbal approach and plant-base diet. My docs haven’t retested me for SIBO, but I know it’s still there based on my symptoms. That’s why I’m tuning into you…hoping to learn what I can do to heal myself. Thank you for the info you put out!

    1. Hi Ashley,
      There is a lot info here on the site that can help. If you are still struggling after that you can always contact my office if you need more support. Good luck!

  6. My understanding is that not all SIBO is from food poisoning. In my case, it’s believed to be abnormal gut anatomy after surgery and then there are others who claim it’s from antibiotics.
    Whatever the etiology, I hope that I can recover from it but the motility issue is the big one for me., Are you going to go into ways to increase motility? Or, maybe you already have in another episode.

    thanks for bringing this great knowledge to us Dr!
    Terrie

    1. Hi Terrie,
      That correct, there is more than one cause of SIBO. We have discussed SIBO and motility in many of the podcasts. We have also discussed abdominal adhesions. There is a lot of SIBO info on the site, if you search around a bit you will have lots to look at 🙂 Happy to share Terrie!
      Hope this helps!

  7. So what is the treatment. I went though herbal treatment and low FODMAPS and it didn’t work. If I stray at all from the low FODMAPS I will get bloating , pain and distension very soon after.. I really would like to be able to eat with others or go out to eat, without having pain, bloating and distension.

    1. Hi Karen,
      There are a number of ways to treat SIBO which we have discussed in various podcasts and articles on the site. There is even one where I detail a SIBO case from start to finish. Have a look and I think this will help 🙂

  8. Hello Dr. Ruscio,

    I’d like to know what you think about LDN (low-dose Naltrexone) as a kinetic? I can’t recall what you use and why.
    Thanks for your insights.

  9. I have SIBO, but not sure I ever had food poisoning.. I believe it is due to structural damage from an eating disorder or surgery for cecal volvulus, of which I have had both. I am very thankful for your knowledge and have created a “healing diet” for myself.
    However, my liver enzymes are skyrocketing, and I have not found a way to get rid of the SIBO or figure out the extent of the structural damage, and how to fix it. This podcast gives me hope, but HOW do you recommend that we regenerate the muscle/rewire the nerves? Through food, supplements, prokinetics…??

    1. Hi Karma,
      This is a great question. Successful treatment of SIBO requires the guidance of a skilled clinician. This is because there are several different treatments but not all patients respond to them to same. A good clinician can help guide you through finding the treatments that will work best for you. Healthy diet, removing SIBO, probiotics, prokinetics and supplements can all help with muscle/nerve repair – but when and how to use them is a bit complex which is why I say to work with a clinician. There is one podcast on the site where i detail a patients SIBO case start to finish which may help too. 🙂

  10. I have SIBO, but not sure I ever had food poisoning.. I believe it is due to structural damage from an eating disorder or surgery for cecal volvulus, of which I have had both. I am very thankful for your knowledge and have created a “healing diet” for myself.
    However, my liver enzymes are skyrocketing, and I have not found a way to get rid of the SIBO or figure out the extent of the structural damage, and how to fix it. This podcast gives me hope, but HOW do you recommend that we regenerate the muscle/rewire the nerves? Through food, supplements, prokinetics…??

    1. Hi Karma,
      This is a great question. Successful treatment of SIBO requires the guidance of a skilled clinician. This is because there are several different treatments but not all patients respond to them to same. A good clinician can help guide you through finding the treatments that will work best for you. Healthy diet, removing SIBO, probiotics, prokinetics and supplements can all help with muscle/nerve repair – but when and how to use them is a bit complex which is why I say to work with a clinician. There is one podcast on the site where i detail a patients SIBO case start to finish which may help too. 🙂

    1. Actually, you’re wrong. Most of the time he does but that may not last as he’s getting busier and busier.
      Answering relevant questions – and not necessarily personal ones – can only add to the article.

    1. Actually, you’re wrong. Most of the time he does but that may not last as he’s getting busier and busier.
      Answering relevant questions – and not necessarily personal ones – can only add to the article.

    1. Hi Kali,
      There area variety of treatment options available, many that are natural, but this is way more than can be detailed here. This site has a wealth of info on SIBO, try to search box for more 🙂 There is a good chance SIBO treatment will help with diverticula. If you need personalized care you can contact my office about becoming a patient. Hope this helps

    1. Hi Kali,
      There area variety of treatment options available, many that are natural, but this is way more than can be detailed here. This site has a wealth of info on SIBO, try to search box for more 🙂 There is a good chance SIBO treatment will help with diverticula. If you need personalized care you can contact my office about becoming a patient. Hope this helps

  11. Hi Dr. Ruscio,
    My daughter has IBD in remission for several years, then developed IBS earlier this year with no food poisoning in between. I am suspicious this is caused by low stomach acid. When I stopped eating wheat, my stomach acid corrected but she didn’t experience the same improvement. Do you think that low stomach acid could be the cause of her IBS and any suggestions? thanks for a great topic!

  12. Hi Dr. Ruscio, My doctor diagnosed me with SIBO from a breath test. I don’t have abdominal pain, or feel any gut issues or symptoms of SIBO.. But I do have chronic skin rash and pain. My treatment for SIBO, which included herbal antimicrobials, did not clear the rash or pain. I’m wondering if I really do have SIBO. Can you tell me if the NUNM breath test for SIBO is an accurate test? Center for digestive health in Portland.

  13. Hi Dr. Ruscio,
    My daughter has IBD in remission for several years, then developed IBS earlier this year with no food poisoning in between. I am suspicious this is caused by low stomach acid. When I stopped eating wheat, my stomach acid corrected but she didn’t experience the same improvement. Do you think that low stomach acid could be the cause of her IBS and any suggestions? thanks for a great topic!

  14. Hi Dr. Ruscio, My doctor diagnosed me with SIBO from a breath test. I don’t have abdominal pain, or feel any gut issues or symptoms of SIBO.. But I do have chronic skin rash and pain. My treatment for SIBO, which included herbal antimicrobials, did not clear the rash or pain. I’m wondering if I really do have SIBO. Can you tell me if the NUNM breath test for SIBO is an accurate test? Center for digestive health in Portland.

  15. I’m fascinated with the idea of the IIC recovering and what would encourage them to recover. Chemical, mechanical influences ? Lowered systemic stress from feeling better? ( so many questions! Fun!) Thanks bunches

    I had hormone and 2 year sleep deprivison driven SIBO. Complexed with diastisis recti and avoidant Movement/non movement.

  16. I am curious if you know anything about toxic mold exposure being a precursor to SIBO/Candida issues. I’ve been struggling with digestive issues for two years and the majority of my symptoms started after my office flooded and the ventilation system in our building broke. I also likely have low stomach acid and slow motility since I have Ehler’s Danlos Syndrome. My symptoms started, but were very mild in April of 2015 and then exploded following a few rounds of antibiotics in the fall. Can there be multiple pathways to developing SIBO/Candida? I’m trying to get to the underlying cause so it doesn’t come back again.

    1. Hi Dawn,
      Did you see our episode on mold? Type mold into homepage searchbox. It’s important to address this in some cases so give that a look/listen. I have found occasional use of elemental diets can help those with EDS also. My book will lay out an elemental diet protocol if you need guidance http://www.drruscio.com/resources. Good luck 🙂

  17. I’m fascinated with the idea of the IIC recovering and what would encourage them to recover. Chemical, mechanical influences ? Lowered systemic stress from feeling better? ( so many questions! Fun!) Thanks bunches

    I had hormone and 2 year sleep deprivison driven SIBO. Complexed with diastisis recti and avoidant Movement/non movement.

  18. I am curious if you know anything about toxic mold exposure being a precursor to SIBO/Candida issues. I’ve been struggling with digestive issues for two years and the majority of my symptoms started after my office flooded and the ventilation system in our building broke. I also likely have low stomach acid and slow motility since I have Ehler’s Danlos Syndrome. My symptoms started, but were very mild in April of 2015 and then exploded following a few rounds of antibiotics in the fall. Can there be multiple pathways to developing SIBO/Candida? I’m trying to get to the underlying cause so it doesn’t come back again.

    1. Hi Dawn,
      Did you see our episode on mold? Type mold into homepage searchbox. It’s important to address this in some cases so give that a look/listen. I have found occasional use of elemental diets can help those with EDS also. My book will lay out an elemental diet protocol if you need guidance http://www.drruscio.com/resources. Good luck 🙂

  19. Hi doc my name is Edwin I haven’t taken the breath test yet it I’m goings-on the 11 the of this month I went to see an gastrointestinal doctor because I wasn’t feeling all that good but he gave me a colonoscopy and an endoscope both of them were clear my blood test excellent now he has wrong diagnoses first he diagnose me with I open splinter valve then acid reflux then gastroparesis and now I’m with another gastrointestinal that’s doing this breath test on the 11 this month they got me going crazy I don’t no what to think anymore all I have is constipation issues and hi blood pressure I’m so confused

  20. Hi doc my name is Edwin I haven’t taken the breath test yet it I’m goings-on the 11 the of this month I went to see an gastrointestinal doctor because I wasn’t feeling all that good but he gave me a colonoscopy and an endoscope both of them were clear my blood test excellent now he has wrong diagnoses first he diagnose me with I open splinter valve then acid reflux then gastroparesis and now I’m with another gastrointestinal that’s doing this breath test on the 11 this month they got me going crazy I don’t no what to think anymore all I have is constipation issues and hi blood pressure I’m so confused

  21. Dr Ruscio – I developed severe Sibo after Cdiff. I have had 3 relapse Cdiff and many high SiBO tests. Have you ever had any patients benefit from a protocol curing Sibo after Cdiff? My main symptoms are nausea, gas, diarrhea and many food intolerances. Thank you for your work .

  22. Dr Ruscio – I developed severe Sibo after Cdiff. I have had 3 relapse Cdiff and many high SiBO tests. Have you ever had any patients benefit from a protocol curing Sibo after Cdiff? My main symptoms are nausea, gas, diarrhea and many food intolerances. Thank you for your work .

  23. I had a negative breath test but was still diagnosed with SIBO after a horrible mold and Lyme journey. I also have developed a hiatal hernia from it and I’m belching over a hundred times a day. I look pregnant everyday. I also have low acid. Can someone have SIBO and test negative?

  24. I had a negative breath test but was still diagnosed with SIBO after a horrible mold and Lyme journey. I also have developed a hiatal hernia from it and I’m belching over a hundred times a day. I look pregnant everyday. I also have low acid. Can someone have SIBO and test negative?

  25. Dr i hve a lot of gas sometimes diahrea also in my stool there is mucus for more than a month and i ho to toilet more than 4 per day there is no other pain pls what sign it might be tell me thank you a lol

  26. Dr i hve a lot of gas sometimes diahrea also in my stool there is mucus for more than a month and i ho to toilet more than 4 per day there is no other pain pls what sign it might be tell me thank you a lol

  27. Hi Doc, my partner has necrotizing pancreatitis and believe he contracted sibo after a 3 month stay in hospital and lots of antibiotics He lost stone during this time but gradually managed to put a stone back on before his appetite started to tail off and sibo symptoms began His pancreas flared up and he spent 10 days in hospital but was still unwell and unable to eat solid foods I was looking online to find any supplements to help him and sibo kept cropping up .Trouble is, docs don’t seem to recognise this as a condition here in the UK, they keep blaming his pancreas, leaving me to help him by homeopathic means whilst they are faffing around doing more blood tests He’s had 10 good days now and is gradually getting his appetite back and most of his sibo symptoms are diminished .He’s still got a way to go but I feel like we are climbing out of a dark hole that we’ve been down for the past year with the help of garlic caps, bovril, fortisip complan, soup with no lumpy bits, tea and as much water as possible

  28. Hi Doc, my partner has necrotizing pancreatitis and believe he contracted sibo after a 3 month stay in hospital and lots of antibiotics He lost stone during this time but gradually managed to put a stone back on before his appetite started to tail off and sibo symptoms began His pancreas flared up and he spent 10 days in hospital but was still unwell and unable to eat solid foods I was looking online to find any supplements to help him and sibo kept cropping up .Trouble is, docs don’t seem to recognise this as a condition here in the UK, they keep blaming his pancreas, leaving me to help him by homeopathic means whilst they are faffing around doing more blood tests He’s had 10 good days now and is gradually getting his appetite back and most of his sibo symptoms are diminished .He’s still got a way to go but I feel like we are climbing out of a dark hole that we’ve been down for the past year with the help of garlic caps, bovril, fortisip complan, soup with no lumpy bits, tea and as much water as possible

  29. I meant to say he lost 25 kilos during this, his weight now is 50 kilos Hope this is helpful to other sufferers of this evil thing

  30. I meant to say he lost 25 kilos during this, his weight now is 50 kilos Hope this is helpful to other sufferers of this evil thing

  31. Have you tried using Lion’s Mane (or SIBO Rebuild from Priority One) to help with long-term goal treatment of nerve regeneration? If so, what can patients expect from it? It says to take 3 capsules twice a day, which is a lot. Can it be taken less to make it last longer?

  32. Great article! Myself and a friend in college both strongly believe we have contracted SIBO. We have been living with it for about a year now. I’ve had every test including a colonoscopy and endoscopy but everything has been negative. I have a breath test scheduled for March. I’ve had one round of antibiotics in the past but it wasn’t enough. Would long term antibiotics be helpful? And has enough time gone by that I may be too damaged to eat normal food again? I’ve tried to stick to low FODMAP but in college it’s nearly impossible.

    1. Hi Tori,

      So sorry to hear you’re dealing with this. I would definitely recommend checking out a copy of Dr R’s book “Healthy Gut, Healthy You” as it walks through a DIY plan to improve gut health (and help with SIBO) and lays out specific instructions for supplements/antimicrobials and diet. You can find it here: https://www.drruscio.com/getgutbook Good luck!

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