Success Treating SIBO

Today I sat down with Robert, who had already been diagnosed with small intestinal bacterial overgrowth (SIBO).  He

Today I sat down with Robert, who had already been diagnosed with small intestinal bacterial overgrowth (SIBO).  He was suffering from weight loss, constant bloating, stomach pressure, belching, and constipation. He had been working with his gastroenterologist and seeing some results, but still had room for improvement.  We used herbal medicines, digestive enzymes, and made a few dietary changes.  Bob did very well with this approach, he gained weight and saw his digestive symptoms improve.

  • If you need help with SIBO, click here.
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Success Treating SIBO

Dr. Michael Ruscio: Hi, this is Dr. Ruscio. I’m here with Robert. And Robert was a really interesting case. He came in pre-diagnosed with SIBO and had a pretty progressed case of it. And when you had come in, what were some of the chief symptoms that you were having? I know weight loss was one of the big ones.

Robert: Right. Right. I think the major symptom was what I call constant stomach discomfort.

Dr. Ruscio: Right.

Robert: And belching and, really, pressure in my stomach were the major symptoms that I had.

Dr. Ruscio: With that burping.

Robert: Yeah, right.

Dr. Ruscio: Yeah, yeah.

Robert: And it, at various times, was very severe.

Dr. Ruscio: Sure. Yeah, when you came in, though, it was your typical presentation of SIBO, where the weight loss was getting to a point where he was getting concerned about it. And a lot of upper GI discomfort.

And SIBO, for those of you who don’t understand it, is small intestinal bacterial overgrowth. And it’s where the bacteria in the colon can overgrow into the intestines and cause bloating, gas, constipation, loose stools, burping, bloating, pain, things like that—and also weight loss because it can actually damage the intestinal lining and interfere with nutrient absorption.

So he had come in, and you had been through a whole bunch of endoscopies through both ends and testing. He had had a good workup. And you had had some response, but you weren’t really all the way there.

Robert: Yeah, I’m not sure I got to the point where I felt like I was in control of it. But I was pretty much at wit’s end because I think I did every test known to man and some of them twice and a couple of them with so-called experts in the field.

Dr. Ruscio: Right.

Robert: So I was diagnosed as creating a lot of excess methane gas.

Dr. Ruscio: Sure.

Robert: And that was the primary culprit for the discomfort.

Dr. Ruscio: Right.

Robert: So methane production was the element that we couldn’t get a handle on.

Dr. Ruscio: Sure. Sure. And usually SIBO will present as one of two ways—either a hydrogen predominant, a methane predominant, or a mixed type. And so that was methane predominance, what we saw with Robert.

And we built upon some of the stuff he had done in the past. We went through a course of herbal antibiotics to help beat down the methane SIBO a little bit more.

Also, I think one of the key things for you is using the hydrochloric acid, because I don’t think you were making nearly enough hydrochloric acid. And he had a lot of burping.

And a lot of times, burping and gas in the upper half of the intestinal tract is an issue of not having enough hydrochloric acid. And if you don’t have enough hydrochloric acid, that can actually feed SIBO. And some of the studies have shown that if you use long term acid suppressing medication, that’s one of the risk factors for SIBO.

So we were looking at that in the opposite where we needed to get more acid in the stomach. That combined with—we did find Epstein-Barr virus was reactivated as well as another bacteria in conjunction with that. This one, we had to work with it.

Robert: Right.

Dr. Ruscio: Some cases are quick. But this one, we had to work at it for a little bit. And we had a fairly intensive middle stage of therapies there where we were using a lot of different antimicrobials and different things.

But you’ve been on some weight.

Robert: Yeah, yeah.

Dr. Ruscio: What has it been? About 10 pounds now?

Robert: Yeah, I lost about 30 pounds. I got 10 of it back. And I’ve plateaued. I still need a little bit more weight. But I seem to be getting back to what I should be.

Dr. Ruscio: Right. Right. And then the GI distress is much less?

Robert: Much less. I do have to watch what I eat. I continue to watch what I eat and try to balance the hydrochloric acid.

Dr. Ruscio: And you’re very, very FODMAP sensitive.

Robert: Right. Right.

Dr. Ruscio: Which is something that can be an important part of managing—especially a chronic form of SIBO—trying to limit the FODMAP foods, because these high FODMAP foods feed it. I think you found that firsthand where you’ve tried to test the waters. And it hasn’t gone too well.

Robert: Right. You do, and then you know you shouldn’t.

Dr. Ruscio: Right.

Robert: But sometimes, you’ve got to do it before you know it doesn’t work.

Dr. Ruscio: Yeah. You’ve got to burn your hand on the stove a few times.

Robert: Exactly. Exactly.

Dr. Ruscio: Cool. So yeah, I think that’s a pretty good synopsis.

Robert: Yeah, yeah. Yeah, we’re in a maintenance mode right now. And hopefully, we’ll keep tweaking it until we get the right combination.

Dr. Ruscio: Yeah, and I think we’ve got you pretty much out of the woods. A few little tweaks going forward for Robert. But luckily, we got some weight back on.

Robert: Right.

Dr. Ruscio: And most of the chief symptoms out of there and a couple little things maybe that we can get going in the future. But I think overall you’ve done really well. And I’m happy to see that we were able to help you.

Robert: Right. Good.

Dr. Ruscio: Well, thank you for talking to us.

Robert: Okay. All right.

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

  • If you need help with SIBO, click here.
  • To be notified when my print book becomes available & get a free gut health eBook, click here.
  • If you are a healthcare provider looking to sharpen your clinical skills, click here.

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!

32 thoughts on “Success Treating SIBO

  1. I enjoyed the couch talk with Dr. Anna CaBecca. I have been looking for a functional medicine doctor and information about fatty liver disease. I have slightly elevated enzymes this past year after beginning a few supplements. My gastroenterologist just says watch your fat intake. My lipid panel is good my triglycerides are low. I have wondered about all the detoxes that I hear about. Would love to see an interview about the liver.

    1. Hi Rebecca,
      Problems in the gut can impair liver health. This is probably why probiotics have been shown to help fatty liver and why SIBO is associated with fatty liver.
      Feel free to contact my office if you need more help here

  2. I enjoyed the couch talk with Dr. Anna CaBecca. I have been looking for a functional medicine doctor and information about fatty liver disease. I have slightly elevated enzymes this past year after beginning a few supplements. My gastroenterologist just says watch your fat intake. My lipid panel is good my triglycerides are low. I have wondered about all the detoxes that I hear about. Would love to see an interview about the liver.

    1. Hi Rebecca,
      Problems in the gut can impair liver health. This is probably why probiotics have been shown to help fatty liver and why SIBO is associated with fatty liver.
      Feel free to contact my office if you need more help here

    1. Hi Pam and GJ,
      Good question. There is a big difference between a commenting that HCl could feed methane and that HCl supplementation causes methane SIBO. There is a lot to this answer and I will address it in a listener question podcast soon. For now I would simply say that if someone improves from HCl use it, if they don’t seem to need it don’t use it. Sorry if this is soberingly practical 🙂

      1. Hi Dr. Ruscio,
        In November I felt pretty good, SIBO-wise; but my digestion was terrible: massive constipation and everything I ate turned into a heavy stone in my upper belly as if no digestion took place at all, despite digestive enzymes. Constant burping, fatigue etc. I assumed that the PPIs I took 2012-2014 affected my acid production… So I took HCl (at my own recommendation since I can’t find a doctor here in Germany who is knowlegeable about SIBO and related issues) and immediately felt awesome: great digestion, a feeling of lightness, wonderful!

        But after 10 days or so, constipation and burping returned, which I wasn’t able to fix by increasing the HCl dose. Things got worse and now it feels like severe SIBO again! Learned that HCl feeds the methanogens…
        So, a lack of stomach acid leads to increased bacteria in the small intestine. But to increase stomach acid by using HCl is not recommended because it feeds the methanogens. Sounds like damned if you do, damned if you don’t…
        How else to increase stomach acid when bitters are not sufficient?

        Thanks a million for your relevant and serious information! I Can’t wait to read your book!! It is not out yet, is it?

        1. Hi Tina,
          Book is on pre-sale now, but in the US only. It start on sale, everywhere via Amazon, on Feb. 15th. The book will answer your question in more detail than I can do here 🙂

    1. Hi Pam and GJ,
      Good question. There is a big difference between a commenting that HCl could feed methane and that HCl supplementation causes methane SIBO. There is a lot to this answer and I will address it in a listener question podcast soon. For now I would simply say that if someone improves from HCl use it, if they don’t seem to need it don’t use it. Sorry if this is soberingly practical 🙂

      1. Hi Dr. Ruscio,
        In November I felt pretty good, SIBO-wise; but my digestion was terrible: massive constipation and everything I ate turned into a heavy stone in my upper belly as if no digestion took place at all, despite digestive enzymes. Constant burping, fatigue etc. I assumed that the PPIs I took 2012-2014 affected my acid production… So I took HCl (at my own recommendation since I can’t find a doctor here in Germany who is knowlegeable about SIBO and related issues) and immediately felt awesome: great digestion, a feeling of lightness, wonderful!

        But after 10 days or so, constipation and burping returned, which I wasn’t able to fix by increasing the HCl dose. Things got worse and now it feels like severe SIBO again! Learned that HCl feeds the methanogens…
        So, a lack of stomach acid leads to increased bacteria in the small intestine. But to increase stomach acid by using HCl is not recommended because it feeds the methanogens. Sounds like damned if you do, damned if you don’t…
        How else to increase stomach acid when bitters are not sufficient?

        Thanks a million for your relevant and serious information! I Can’t wait to read your book!! It is not out yet, is it?

        1. Hi Tina,
          Book is on pre-sale now, but in the US only. It start on sale, everywhere via Amazon, on Feb. 15th. The book will answer your question in more detail than I can do here 🙂

  3. First off – thanks for all of your podcasts and research. It’s great to read about your real-life cases and hear from other experts in the field. Your work is much appreciated.

    I read about the Nemecheck protocol and it suggests inulin as a way to feed the “good bacteria’, which will then crowd out the bad bacteria. It also says to NOT take probiotics, as this will feed all of the bacteria. My questions are 1) Have you heard of the Nemecheck Protocol for eliminating SIBO? And 2) What are your thoughts on inulin as a way to treat SIBO and not taking probiotics?

    Background: I have been on the Low/Med FodMap Diet for 2 years and do not eat grains to help with what I thought was a SIBO relapse (after fixing it with Xifaxin about 4 years ago). The diet did not help the SIBO and so I finally took Xifaxin for 2 weeks. It helped but then I slowly started to have trouble again. I did Xifaxin again for 2 weeks and felt better. But once again, I slowly started to have trouble again. Then I did Xifaxin for 2 months to really clear this out. I felt much better. But I think I’m relapsing again after a month off of the antibiotics. I will have to retest for SIBO but it’s been my pattern, so I think that is what’s happening. I also have a documented imbalanced microbiome. My body has a hard time with keeping the balance. (I eat super clean with no processed foods. I make my own milk, eat grass fed beef, organic everything. I exercise, and am healthy in every way. It’s just my tummy that bloats from eating anything. No gas. Just bloating.)

  4. First off – thanks for all of your podcasts and research. It’s great to read about your real-life cases and hear from other experts in the field. Your work is much appreciated.

    I read about the Nemecheck protocol and it suggests inulin as a way to feed the “good bacteria’, which will then crowd out the bad bacteria. It also says to NOT take probiotics, as this will feed all of the bacteria. My questions are 1) Have you heard of the Nemecheck Protocol for eliminating SIBO? And 2) What are your thoughts on inulin as a way to treat SIBO and not taking probiotics?

    Background: I have been on the Low/Med FodMap Diet for 2 years and do not eat grains to help with what I thought was a SIBO relapse (after fixing it with Xifaxin about 4 years ago). The diet did not help the SIBO and so I finally took Xifaxin for 2 weeks. It helped but then I slowly started to have trouble again. I did Xifaxin again for 2 weeks and felt better. But once again, I slowly started to have trouble again. Then I did Xifaxin for 2 months to really clear this out. I felt much better. But I think I’m relapsing again after a month off of the antibiotics. I will have to retest for SIBO but it’s been my pattern, so I think that is what’s happening. I also have a documented imbalanced microbiome. My body has a hard time with keeping the balance. (I eat super clean with no processed foods. I make my own milk, eat grass fed beef, organic everything. I exercise, and am healthy in every way. It’s just my tummy that bloats from eating anything. No gas. Just bloating.)

  5. Hi Dr. Ruscio

    I have a general question as my doctors can’t seem to answer. Can you have SIBO without bloating? i do have lots of belching, stomach and intestinal growling, flatulence, nausea, loose bowels, reflux symptoms.

    I did a take home breath test and it was positive, brought it to my GI doctor, but he doesn’t believe in it, as he thinks it is unreliable, and because i dont have the classic symptom of bloating, so its making me wonder. Your help is appreciated. thank you.

  6. Hi Dr. Ruscio

    I have a general question as my doctors can’t seem to answer. Can you have SIBO without bloating? i do have lots of belching, stomach and intestinal growling, flatulence, nausea, loose bowels, reflux symptoms.

    I did a take home breath test and it was positive, brought it to my GI doctor, but he doesn’t believe in it, as he thinks it is unreliable, and because i dont have the classic symptom of bloating, so its making me wonder. Your help is appreciated. thank you.

  7. Dr. Ruscio, I am fascinated to here how you slayed the Epstein Barr Virus! Can you please give insight here? I know I had mono after my 5th or 6th pregnancy–I have 6 kids :-). So I understand it can wreak havoc on and off. I have SIBO, OLP/LP, and am trying the B12 shots (hopefully doc will give me the script). Thank you for any advice on the Epstein Barr Virus!
    Jeannie Heredia

  8. Dr. Ruscio, I am fascinated to here how you slayed the Epstein Barr Virus! Can you please give insight here? I know I had mono after my 5th or 6th pregnancy–I have 6 kids :-). So I understand it can wreak havoc on and off. I have SIBO, OLP/LP, and am trying the B12 shots (hopefully doc will give me the script). Thank you for any advice on the Epstein Barr Virus!
    Jeannie Heredia

  9. Doctors say lowfodmap is not good for long time for microbiome. But doctors (your case) say about maintenance in a low fodmap diet in chronic sibo cases. So… what must we do? Low fodmap all life?

  10. I think is not a success if people have to eat low fodmap diet all life, or another kind of limit and strict diet. This is not a successful. I think the title of this post is misleading.

    1. Hi Ubr,

      I agree, it’s not ideal to have someone eating low FODMAP forever. The goal is to add back in a wide array of foods as soon as possible, but the timeframe when that’s possible varies for everyone.

  11. Doctors say lowfodmap is not good for long time for microbiome. But doctors (your case) say about maintenance in a low fodmap diet in chronic sibo cases. So… what must we do? Low fodmap all life?

  12. I think is not a success if people have to eat low fodmap diet all life, or another kind of limit and strict diet. This is not a successful. I think the title of this post is misleading.

    1. Hi Ubr,

      I agree, it’s not ideal to have someone eating low FODMAP forever. The goal is to add back in a wide array of foods as soon as possible, but the timeframe when that’s possible varies for everyone.

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