Swedish Egg

Swedish Egg

Saturday, April 11, 2015

Treating SIBO with an herbal antibiotic protocol

Fresh oregano, a potent antimicrobial.
Because I am the kind of person who always prefers to use natural medicine whenever possible and because research indicates that herbal antibiotics may be as effective as prescription antibiotics in the treatment of small bacterial overgrowth, I decided to treat my SIBO with herbs.

After reading a ton of articles on SIBO treatment strategies and microbiome structure/function, I developed a protocol for myself. This was largely based on the recommendations of Allison Siebecker, ND (from her siboinfo.com website) and on a 2014 paper entitled Herbal Therapy is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth by Victor Chedid, MD, et al.

My program incorporated a biofilm disruptor and a variety of herbal antimicrobials. I also used a 2-part rotation protocol to keep the minions guessing. SIBO bacteria are smart little buggers. As sessile creatures (meaning stay-put surface colonizers vs free-living planktonites) they live within a self-generated biofilm: a flexible, slippery matrix composed of proteins and polysaccharides. Intestinal biofilm adheres to the gut lining and resists dislodgement (so that you don't 'evacuate the premises' every time you poop). Unless you break it down, you can’t get through to the bugs.

Biofilms aren’t all bad, mind you. They are what allow friendly flora, for instance, to reside happily in the colon and do their good work there—breaking down fiber, making butyrate, contributing to intestinal barrier function, etc. It's just that when you have SIBO, you’ve got biofilm-embedded flora in the wrong place.

To kill the overgrowth, you first need to disrupt the defensive biofilm shield, and for that, there are some excellent products. My favorite is InterFase™ by Klaire Labs, a potent enzyme formulation clinically researched to help degrade biofilm matrix and to degrade bacterial and yeast cell wall structures. InterFase basically breaks down the biofilm wall so that antibiotics can access their intended target, the SIBO bugs. You just gotta have it.

To kill the bugs themselves, I used two different herbal strategies. Bacteria are so damned good at mutating to develop tolerance to antibiotics. A rotation protocol cycling multiple products can help to inhibit their adaptive abilities.

Consider oregano, one of our best botanical antimicrobials. Even in its most concentrated form, Oil of Oregano, this powerful bactericide has been reported to “only work” for the first month of treatment—indicating to me that if you want to avoid developing a tolerance, a solid month of oregano may be too long. For enhanced efficacy, my thinking is to do a bait and switch, known clinically as a rotation protocol. Example: use Oil of Oregano for two weeks, then replace it with a different herb or comprehensive formula and cycle it back in at a later date if needed.

This is what I did. For a total of 30 days of treatment, I used InterFase™ all the way through, plus two different herbal antibiotic strategies for two weeks each. (The prescription antibiotic Rifaximin only requires two weeks of use, but studies suggest herbal ABx treatment requires double the length of its prescription counterpart to be effective, hence my 30-day program.)

I also took digestive enzymes plus Betaine HCl with every meal and followed a strict Level One SIBO diet. (No grains. No starchy vegetables. No high-FODMAP foods. Limited seeds and nuts. Chicken soup up the wazoo.) And I did everything I could to keep my bowels moving, using magnesium citrate, herbal motility support and an enema here and there, as necessary. C people: your bowels MUST move if there is ever to be healing.

That being said, here’s an outline of my herbal ABx program.

Sexy Sibo Herbal Antibiotic Protocol

Note: Take products together on an empty stomach, 20 minutes before food.

Week Zero: Preloading Titration Phase
Days 1-3                               1 cap, once per day: InterFase

Days 4 & 5                            1 cap each of the following, once per day:
                                                InterFase, Berberine, Oil of Oregano

Days 6 &7                             1 cap each of the following, twice per day (AM and PM):
                                                InterFase, Berberine, Oil of Oregano

Week One - Take the following, TWICE daily (AM and PM):
2 caps InterFase
2 caps Berberine
1 cap Oil of Oregano

Week Two - Take the following, TWICE daily (AM and PM):
2 caps InterFase
3 caps Berberine
1 cap Oil of Oregano
1 cap Allicillin (garlic macerate) or AlliMax

Week Three - Take the following, TWICE daily (AM and PM):
2 caps InterFase
2 caps CandiBactin-AR
2 caps CandiBactin-BR

Week Four + 2 extra days (for 30-day treatment total) -
Continue taking the following, TWICE daily (AM and PM):
2 caps InterFase
2 caps CandiBactin-AR
2 caps CandiBactin-BR

For at-a-glance products checklist, scroll to bottom of page.*

Please Note: For most of the time I was on the herbs, I felt like crap. Antibiotics are not known for causing gut ecstasy in general, but still, it was discouraging, especially since I continued to feel bloated, even on my ‘perfect’ diet. 

I will say, however, that for once in my life, I wasn’t farting up a storm. Basically I was having no burps and farts whatsoever. Even at night. Miraculous.

Finally on day 27, I started feeling better. (Day 27 out of 30, mind you!!) But at long last, feel better I did. This was a breakthrough.

It worked!

After 37 days (30 plus the preloading titration week) I was so happy to get off the pills. I stayed off them for two whole weeks. But I know from the way my gut feels now that I am not altogether cured. So a few days ago, I started again.

I’m still mixing it up. Keeping on top of the situation, which I believe is firmly entrenched, but not forever. I expect to need a few cycles of herbal treatment. And I expect to keep working with my diet, hydration and motility support for as long as it takes. Probably for life.

The GI doc I saw last winter told me that “refractory SIBO is VERY common” in her patients taking Rifaximin and other prescription drug treatments. Refractory means “it comes back.”

This makes sense. Unless you address the slow motility and reduce the starches, FODMAPs and anything else that caused the problem in the first place, your SIBO will come back. Guaranteed.

You just gotta keep fighting, is all. Be a calm belly warrior. Stay in it for the duration, for victory. To arms!


*Sexy Sibo Herbal ABx Products Checklist

o InterFase (Klaire Labs)
o CandiBactin AR & BR (Metagenics)
o Berberine Select (Moss Nutrition) or Berberine Synergy (DFH) - 400 mg capsules
o Oil of Oregano - 150 mg softgels (Moss Nutrition)
o Allicillin (DFH) or AlliMax or other high allicin garlic cap - 200+ mg capsules

Note: These products are all professional brand supplements, meaning they are intended for use only by practitioners and their patients. I like them because they are formulated by clinicians, based on research, manufactured in tightly controlled, GMP-compliant facilities and rigorously tested for purity and potency. (Safety first!) For details on how to access to these products, to schedule a FREE 15-minute Supplement Consult or to become my client, email me at eat2evolve@gmail.com.

68 comments:

  1. Thank you so much for sharing. I am honestly going to try this! On a scale of 1 to 10 how much better are you?

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  2. Thank you so much for sharing. I am honestly going to try this! On a scale of 1 to 10 how much better are you?

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  3. And when you day no starches... What about acorn or butternut squashes?

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  4. Hi Bethany! Thanks for your comments and questions. On a scale from 1 - 10 in terms of the bloating having improved on the diet, I would say 7. This is after about 2 months, so I'm still "starting out". It's a tremendous improvement!

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  5. Bethany - acorn and butternut squash are allowed but better start with just a half cup serving to test. That is the recommended serving size. :)

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  6. hey! my doctor said you should not be on a sibo diet during treatment because the sibo will create a barrier while in starvation mode and the treatment wont be able to reach it.

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    1. Hi Katie, Thanks for your comment! Yes, it's true: some practitioners recommend the approach you mention. I understand the theory but I have not seen the research to confirm it's the best or only way to go. I recommend taking Interfase or Monolaurin to break through the biofilm barrier and using a low-carb diet to reduce microbial numbers and control symptoms. Unless you go on a Zero-carb, total ketogenic diet there will always be something for the SIBO bugs to eat. Low-carb, low fermentation potential dietary treatment is the key to reducing symptoms and finding relief. :)

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  7. Why is Berberine Synergy included in your protocol?

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    1. Hi Unknown! A quality berberine supplement is included in my protocol because berberine (naturally found in herbs such as Goldenseal, Oregon Grape and Barberry) is a researched antimicrobial herb used in the treatment of SIBO.

      Berberine itself is also useful for treating blood sugar issues and Berberine Synergy, which contains alpha lipoic acid as well as berberine, is actually designed for that purpose. Recently I've switched to a different product that didn't yet exist when I did my protocol: Berberine Select from Moss Nutrition (where I work as the Product Development Manager—just saying).

      Berberine Select contains 500 mg of berberine per capsule, so it's a bit more potent and ideal for SIBO treatment than the DFH product I used last spring when I created and followed the protocol described in this post. See http://www.siboinfo.com/herbal-antibiotics.html for more info on herbal treatment of SIBO.

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  8. Hey!
    I am starting the exact same protocol. It is a small GUT world. Although I am scared to try oregano oil... My theory is that while the interfase/lactoferrin biofilm disruptor is crucial, I also want to get soil-based organisms, and probiotics into the gut because these organisms release toxins to destroy the pathogens. After all, bacteria will always reside within the small intestine, just not colonic bacteria. These bugga's are responsible for the upper gut fermentation. So perhaps less antimicrobials and more ancestral, symbiotic organisms. Or else the bad guys will just come right back!

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    1. Hey Owen, Thanks for your thoughtful comment. Oil of Oregano is very effective and works best in pulsed schedule treatment, as microbes can build up a tolerance to it. But if your instinct is "No" then don't take it! I know many people in this community who work strictly with diet to reduce SIBO numbers—no antimicrobials at all— for the very reasons you mention. Since every body is different, I think it's important to do what really feels right for you. Look for the internal "Yes" feeling—it's your best and truest guide. See more thoughts on probiotics in my comment below. :) Diana

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  9. Owen, you bring up such a great point. We don't want a sterile gut! Nor one overrun with pathogenic microbes. Good or bad, we do want to reduce bacteria numbers overall in SIBO, though. Once that is achieved, it makes sense to start replenishing "the good guys" to encourage a healthy microbiome environment.

    A few months ago I had the good fortune to see Dr. Natasha Campbell-McBride (creator of the GAPS diet) speak at the NOFA conference, here at UMASS-Amherst. Afterwards I asked her about using probiotics in SIBO treatment. Her take was that after a period of straight-out killing, as with this 30-day protocol, one should start introducing probiotic foods and/or supplements. (Specifically, she told me I should start doing this!)

    As for which probiotics to take, I am not sold on the soil-based organisms—at least not in practice. In theory, I like the idea. Products-wise, I haven't found a company I trust, but I am certainly open to learning more. Currently I like the Innate Flora 20-14 Ultra Strength product and Klaire Labs TherBiotic Detox Support. Both are high potency, multi-strain formulas made without inulin, a prebiotic fiber that potentially might feed SIBO (although likely not much in such small amounts).

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  10. Okay I am on the same page. I took an Organic Acids Test recently, it showed a high level of SIBO and possibly a parasite. I will find out in less than a week when my Stool Test (PCR) comes back.
    As for my success with IBS-D.. Supplemental fibers have changed things dramatically. I ate Zero Carbs for months, starving the bacteria greatly, but I believe the ketones fed other pathogens in the small intestine (yeast and parasites can utilize ketones) because I still rarely had a formed stool. Adding in fibers, my neck pain quickly lifted and I have perfect bristol 4s. However, before my OAT, I greatly increased my sugar intake and stopped all supplemental fiber. Therefore, I became bloated, pained and high levels of dysbiosis became apparent.
    So I am much more in control of my symptoms (from diet of course) but I greatly appreciate the information of a proper KILLING protocol. Do you ever notice any tenderness from the herbal cleanse formulas, for instance my upper gut feels a bit sensitive to the touch. I believe it is because the strength of the herbs, like Black Walnut.
    So to summarize. I NEED fiber to feed my low diversity of beneficial colon bacteria, which also doesn't cause bloating. Fiber from whole foods, DOES cause some bloating if I eat too much but I like some carbs to feed my immune system. I have read studies that white blood cells utilize glucose and ketogenic states suppress the immune system. Lastly, I need to get pathogenic overgrowths/parasites out of my small intestine where the lack of competition allows them to thrive. That would allow my permeable gut to seal up and lower the other leaky gut symptoms, skin, mood issues. Easier said than done... As far as probiotics, the only SBO I tried was prescript assist. Didn't really do much. AOR-3 is next and I will let you know. It has natural biofilm busting ability.
    Keep up the good work! :) Owen/Mitch

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    1. Thank you, Mitch/Owen - I hope things are continuing to improve for you!

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  11. Hello -- How could you tell your protocol was working? Have you added FODMAP foods back in yet? Would you say your SIBO is gone? Thank you.

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    1. Iatrogenia, Thanks for your comment. I based my progress on symptom relief - by the end of the protocol, bloating was reduced significantly. To me, that means it worked.

      I have tested some FODMAPs and get mixed results. I can handle very small amounts here and there but otherwise, no, I have not added them back in on a regular basis. I don't think my SIBO is gone. It is under control, and I'm satisfied with that.

      There is a lot of "coming to terms" in this journey. I need to accept that I will never be able to eat starches, sugars, juices, smoothies, dates, nuts, etc again like I once could before SIBO. Last summer I had a couple of fresh peaches and they tasted so delicious! But I can't gorge on peaches, or any other fruit...at least not without having to deal with the pain and distension that inevitably follows.

      It's always a tradeoff. So each day, we get to make our choices. What is very helpful is to know what foods are safe, what works for you, and to be able to drop back to baseline/get back on track if things go awry.

      I wish you the best in your journey! ~Diana

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  12. Current thinking, per Dr. Siebecker and others, is that the enzymes (Interfase) are not necessary. (Personally, I found Interfase to be very constipating -- reduced motility is exactly what you don't want in SIBO!)

    As near as I can tell, the suggestion that enzymes break up SIBO biofilm was originated by Klaire Labs to promote their Interfase products. This is the sole source of such information.

    I've asked ProThera, which owns Klaire Labs now, what the evidence is that enzymes such as those in Interfase get into the small intestine and break up biofilm. I've gotten nothing but the runaround from them about this, which is a red flag for me when it comes to supplement makers. If they won't be forthright, they're taking advantage of the consumer.

    From what I can find on PubMed, there is evidence enzymes will break up biofilm on plastic, glass, and in the test tube, but nothing regarding whether enzymes taken orally will be active in the mammalian small intestine. I think there's a good chance the enzymes act within the stomach and don't get to the small intestine, which is where the SIBO is.

    If you want to believe that enzymes can do something for SIBO, I would take only enteric-coated enzymes, and definitely not Interfase.

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    1. Interesting comment, Iatrogenia, thank you for sharing! I spoke with Klaire, too. They supplied me with good research on Interfase and Candida biofilms but you are right, they don't have anything on SIBO yet. So yes, speculation is involved as to the effectiveness of the product for us. The same goes for glycerolmonolaurate (Monolaurin, Lauric Select) from coconut oil, a compound which also has shown effectiveness against other biofilms. It makes sense to me that if it could work, it may be worth trying—although not if it makes your symptoms worse, of course, motility-wise or otherwise. I didn't experience increased C from Interfase and think it's a great product, but maybe not for everyone...

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  13. Hi, Diana! Been battling sibo for several years & its horrible. Have done several rounds of Xifaxin but less effective each time. Garlic is not a low fodmap so how does the allicin help, not to mention how expensive it is?

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    1. Hi! I'm sorry to hear of your troubles with the refractive SIBO—the GI doc I saw (once) warned me about that. She was very discouraging. Diet is The Key for maintenance— it's tough but worth it.

      About the garlic extract - FODMAPs are contained in the fiber or starch/sugar of the plant, not the volatile oils; therefore, they should be absent from Allicillin, which is an extract. (Similar thing to "garlic-infused oil" which is allowed on low-FODMAP diet, just not garlic itself.) That being said, yes, it is expensive! I think the Allicilin product can be skipped in my protocol; I included it at first, but we are getting good results with just the Berberine and Oregano now. Hope that helps.

      Best wishes! Diana

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  14. Hi dianna
    I have sent you an email keep up the great work with this stubborn disorder
    regards
    will perth western australia

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    1. Thanks, Will. I don't think I got your email! Try resending? eat2evolve@gmail.com :)

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  15. I am following your protocol and starting week 2. If you take supplements 20 minutes before food when would you take digestive enzymes with HCL

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    1. Digestive Enzymes and HCl should be taken at the beginning of a meal or midway through. They are specifically to help you digest your food, so you want to take them with food! (The HCl helps break down protein and also helps to kill pathogens in the stomach, such as H. pylori.)

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  16. How long its takes you to be sibo free, is quinoa, lentils, white beans and oatmeal, brocolli, allowed ?

    thanks
    Meryem

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    1. Hi Mereyem, Good question!

      I think that to be really, truly SIBO-free, it takes "a while"... let's put it that way! Very individual, but I think probably for most people who are following the diet, we're talking months to years.

      Grains and beans are not allowed with the exception of Jasmine Rice, and the occasional gluten-free "cheat", so no on quinoa, oatmeal, etc. I had a quinoa soup recently and it did me in, and I would not go near lentils or white beans, either! Broccoli should be okay once in a while in small amounts, say a 1/2 cup serving, cooked. Be careful with all those cabbage family vegetables, though, including cauliflower and kale. I generally avoid them with the exception of Bok Choi, which is less gas-provoking. Zucchini, spinach, chard and green beans are all better choices.

      :) Diana

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    2. Hi Diana, I am interested in the mention of the Jasmine Rice. I have not seen this as an allowed food on Alison Siebeckers site or on the SCD diet,or any other SIBO diet for that matter, they appear to not allow any rice. Could you please tell me why Jasmine Rice is different and in your opinion why it is safe to eat with SIBO or gut problems. Is it to do with the fermentation being different?
      Thank you for a great and informative site.
      Trudy x

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    3. Hi Diana, I am very interested in the Jasmine Rice you mention as an exception to all other grains. Can you please tell me why this is, as all the other SIBO sites I have been on (SCD, Alison Siebecker etc) do not appear to allow any rice at all. Is it to do with the fermentation being different and if so how is it different please. Any advice and help you can give on this one please would be very much appreciated.
      Many Thanks for a great and informative site, very much appreciated.
      Trudy x

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    4. Hi Trudy. Great question!

      I think Dr. Siebecker does mention Jasmine Rice somewhere in the fine print on her dietary treatment handout, but anyhoo, yes: it's a funny exception to the "NO Grains" rule. I discovered it through the work of Dr. Norm Robillard and his Fast Tract Digestion: IBS book (highly recommended reading).

      Jasmine rice is a white rice that contains no fiber and little nutritional value, has a high glycemic index and is absorbed very quickly, in the early small intestine. For this reason, a small serving (1/2 cup cooked) is unlikely to reach the part of your intestines where gut microbes reside. That's why it does not cause symptoms or gas. It just kind of dissolves before it can feed microbes and be fermented.

      That being said, I wouldn't suggest eating Jasmine rice every day (I don't) and certainly not more than once time per day. Nor should you eat it during a flare. Give it a try when you are non-symptomatic and see how it goes...

      Good luck and thanks for visiting!
      Diana :)

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    5. Hi Diana
      Thank you so much for responding to my question! That is very helpful, thank you so much, it is so much appreciated.
      Trudy x

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  17. Can you take b12 sublingual supplement while having sibo?

    thanks

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    1. Yes, depending on the "other ingredients" used to sweeten and bind the tablet.

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  18. Hi!! Is there a oregano oil capsule that can be taken instead and would it work? i have done several ABX courses. Good while on it. But back to the same afterwards. I have Sibo/Methane. I have been making my own peppermint water (1 week) and been drinking it so much so it is making me constipated. I am trying desperately to find a new remedy, one that will address my motility issues (I think that is my underlying cause of SIBO) and keep digestion good. I am so tired of this! Thanks for any help. I am going to try your remedy but wondering about a capsule (like peppermint, does it get absorbed in the stomach? From what I understand peppermint capsules are better to deliver it to the small intestine, so I am wondering it the same is true for oregano oil). Jeannie in WV

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    1. Hi Jeannie,

      Sorry to hear that the SIBO keeps coming back following antibiotics. This is not uncommon, sadly. Are you working with your diet, too? I feel the diet is key to at the least, minimizing the symptoms to improve quality of life.

      I don't know of a good oregano in dry capsule form. The oil of oregano needs to be in a softgel since it is liquid oil; however, it will surely deliver in the small intestine, even if it begins to melt in the stomach. The stomach does not absorb, only the intestines absorb.

      I haven't heard of drinking peppermint water, do you mean iced tea? If you have GERD, peppermint can be a problem unless it is enteric coated, because it relaxes the esophageal sphincter. This is not the case with oregano though!

      Warmly, Diana

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  19. Thank you Diana for your reply! Yes, about the diet. I am vigilant about eating the low fodmap foods. Mostly meat/fish, fats, and I love salads, so I have been growing Arugula so I eat a salad with mostly that with some homegrown radishes/ a few sliced carrots, and celery.. I typical would only eat cooked carrots. But trying this for now. But I know I need to basically stay away from high fiber-grains and veggies. But Arugula is considered a low fodmap food. I don't have much problem with that. Last December (my SIBO started in Sept/ Oct.). (I don't want to bore you with the long story but know I have had EVERY test/procedure to rule out anything else i.e. cancer/diverticulitis etc. But finally went to Gastro doc. and had a proper SIBO test and tested positive for Methane SIBO.) But before the SIBO test I had a colonoscopy in December and after that I immediately started with the GAPS doing broth only with some meat. I had the awful distention after the broth--let me tell you i was SO hungry b/c I basically didn't know WHAT to eat so I didnt eat!!!! It was a horrible time, so when I started gaps with the broth I think I ate too much. Anytime I ate too much, I would get horrible distention. I am 105 lbs and I never overeat and I take my time eating ( I am ALWAYS the last one at the dinner table b/c I ate at a very relaxed pace). So A>I can't eat large (normal sized meals, I mean!!!!) amounts, B>I can't eat large amounts of high fiber veggies -salads I mean, C>I can not graze all day, makes my tummy unhappy to snack, D>Must stick to eating only every 4-5 or more hours.E> I use a digestive enzyme (DIGESTIN) it has the necessary HCL BETAIN plus the IBEROGAST with meals. Anyway, I am going to try the herbal ABX remedy. I only have liquid oregano oil-not the gel capsules. So I was unsure how much to use and when (before -during -after meal? I just got the berberine synergy in the mail this week and am waiting for the Interfase product. I am debating about the Allimed product ($130) which is recommended by Siboinfo.com Dr. Siebert. Anyway. God help us all with this SIBO. It is so depressing. Like you, I am resigned (almost) to that I will be dealing with this for the rest of my life. The low fodmap seems to work for me as long as I don't eat too much and not too often. And as long as I take the enzymes. Thanks again for your response. I am grateful to talk to someone who has this problem finally. Jeannie Heredia

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    1. Hi Jeannie, I get it. It's NO FUN with the bloating. So uncomfortable, I know!! UGH.

      Couple things. Salads are not always the best choice - cooked veg are way easier to digest. Even if you just lightly blanch the arugula, that might help—at least for a few days, let things calm down.

      I've heard of bone broth being hard for some people, meat stock may be better. Recipe is in the GAPS book. I don't know of liquid oregano oil, is it a tincture? Softgels are easy to take, and best away from food but fine with food too. On an empty stomach it bothers some people, but that would be the ideal.

      I can get you 20% off on the Allimax (and other supps) if you order on emersonecologics.com. Just use my name Diana Allen as your practitioner, and when prompted: zip 01351 & access code: evolve ... Product will "only" cost $104 then :) Best of luck with the protocol, D.

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  20. oh, the mint that grows in my garden, I take HUGE amount, pour boiling water over it, add ice, and drink it. Last two weeks I was doing this (I over do every remedy sometimes b/c I am so anxious to git rid of this crap!!) but I noticed constipation setting in after a week of doing this!

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  21. Yes, I meant home grow mint, pour boiling water over, add ice and drink. I was doing lots of it, and then after a week I notice constipation setting in.

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    1. Interesting...I have not heard of peppermint being constipating. I wonder if the iced aspect had an influence; cold drinks and foods can be contracting vs relaxing... -D

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  22. Hi Diana, just wanted to share my experience trying this protocol. I was feeling fine up until I added the oregano oil. After that I started going to the bathroom up to 10x a day. After continuing the oregano oil for 2-3 more days I started throwing up after eating any food, while still having liquid stools all through the day.

    I felt like I had been poisoned and stopped all the meds. Also while taking the oregano oil I was physically unable to go to work, and slept upwards of 12-16 hours a day. I was pretty close to going to the ER, but today I woke up feeling a bit better. All in all, one of the worst experiences of my life.

    My Dr. is on vacation right now or I would ask him what to do. It doesn't seem like a typical reaction what I experienced. Do you have any advice?

    Thanks

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    1. Hi - no, that is not a typical reaction at all, and I'm sorry it happened to you. Please phone the company who made the oil of oregano you took and let them know you had an adverse reaction. You were very wise to stop taking the product. One should always stop taking anything that seems to be causing issues, whether it's a food, herb, tea or supplement. I hope you continue to feel better as the days go on...I would say don't try oil of oregano again, just leave it out, you may have an allergy. Best wishes to you, and please let me know if you have more questions or concerns.

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  23. I am going to try your treatment immediately. My question is... once you treat for a month, do you take a break and begin treatment again?

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    1. I would say treat for a month, and then work with your diet, very sincerely, for at least 6 months before you consider trying antimicrobials again. Maintaining a low fermentation diet is the key to lifelong management of SIBO. The herbal Rx is helpful to get a head start, but it does not offer a forever cure. Management of SIBO is more of a "recovering" approach. A low carbohydrate SexySibo-style diet will be critical to your success!

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  24. Diana,

    I also have SIBO-C - since 2009. Tried everything, been everywhere including Cedars Sinai. My safe foods are almost identical to yours. Your blog is really helpful. I have also tried many of the same things with varying results. One thing I'd recommend you might pick up on are nauli yoga exercises for motility. Also I think the Fast Track Diet by Norm Robillard is the most relevant diet to focus on; I've come to believe total cumulative fermentation is more important than anything else. I had an amazing symptom-free period of a few months after following Fast Track for several months. During this symptom free period I was able to tolerate anything including things forbidden by GAPS, FODMAPS, SCD etc. This confused me at the time. I relapsed when I began to eat everything in sight as I figured I must be cured. I'm convinced the relapse came as a result of the cumulative effect of too much food with high fermentation potential. I am just starting one of the Johns Hopkins herbal regimes now to try to get back to feeling fine but still better than I'd been for years.

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    1. Hi! Thank you for visiting SexySibo and for sharing your experience with the Fast Tract Diet (FTD). I am a huge fan of Dr. Robillards work and have gotten good results keeping my daily FP low, but I have not been able to eat the high-FODMAP veggies and fruits that are allowed on low-FP (onions, garlic, etc) and still get good results with symptom reduction. Sounds like that's what happened to you—we think we are "cured" and then BOOM! Think again. Back to the healing safe foods, and start fresh. Wishing you all the best success with the new herbal protocol. :) Diana

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  25. Hi Diana, about to start the herbal antibiotic protocol with Oregano, Barberine and InterFase, et al. Just wondering to myself, what if I have a negative reaction right off, how do I know the offender? Any issues with starting with one at a time, say for several days each, and then after a week or whatever, then combining them all? Just seeking your thoughts...thanks...

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  26. Hi KSN ~ Yes, if you are concerned about a negative reaction, it's fine to introduce each supplement individually, and use for 3-5 days to test. There is no harm in going slow with this; it's a slow process altogether! Best wishes and success, Diana :)

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  27. Wow, Diana, started out with the InterFase, did not seem to be an issue. Added the Barberine and the Oregano slowly, one at a time per day. After 6 days, tried one of each twice a day. Yikes, 2-3 days later still feeling the effects. Getting prompted for multiple BM's per day, a lot more than normal (for me). Gas and bloating to boot. Just feel awful. About ready to abandon this trial on the herbal antibiotics. One question though, I obviously cannot take these products daily, might there be an efficacy into spacing out the herbs to every other day or even every third day (or more)?

    It just seems like you would not be getting much oomph from the herbs like you would need to knock out the SIBO?

    By the way, I have used Rifaximin twice in the past 5 years, helped me a bit but the impact never lasted. I will say this though, the Rifaximin did not rip my stomach up like the herbs. Thanks....ken

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    1. Hi Ken, I'm so sorry for your distressing response described here. It sounds like either you have a super sensitive system and the protocol is simply too strong, or perhaps one (or both) of the herbs (Berberine or Oregano) does not agree with you. Trial and error is the only way to find out.

      I might suggest choosing one of the two, let's say the Oregano Oil, and just taking that, once per day, along with the InterFase. Sure, there's less oomph with a lower dose. But it's no problem to go slowly...A small reduction in microbes is better than none!

      As you know from your experience with Rifaxamin, SIBO easily comes back if we are prone to it. Antibiotics, pharma or herbal, don't seem to be a forever "cure" in my view. They can certainly help. But it seems the only way to minimize symptoms over the long haul is via dietary avoidance of fermentable carbs and sugars.

      I do hope you feel better soon! Best, Diana

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  28. Diana, loved your sound and balanced response, helped me a lot at least emotionally. As to the "long-term" and the fermentable, yes, I think you have the link. Have you ever gone for weeks or months at a time with any sugar? And while you have done that, let's say, for sure you avoided gluten but what other carbs did you avoid, and what others were you able to eat to keep up your weight/strength? Would appreciate that...

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    1. Hi Ken, You're welcome! Sugar and gluten has never been a big draw for me, my weakness is spicy tortilla chips ;-) I use the low-FODMAP carbs when I go in that direction: Lundberg brown rice cakes, rice noodles or jasmine rice are the most common for me. I tend to keep my weight up with fats rather than carbs.

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  29. Hi I have been on a herbal sibo protocol for a couple months now. Found it interesting that you mentioned to take the antibiotics on a empty stomach before food. My naturopath told me just to take with food. Is there any difference?

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    1. Hi! Your naturopath is not wrong, but the general reasoning behind taking herbs on an empty stomach is this: When you eat a meal, stomach acids and digestive enzymes are secreted. These are needed to break down food into amino acids, fatty acids, etc, but they also may break down the herbs and cause them to be digested as food. So to help increase the medicinal value of herbal supplements, they are best taken on an empty stomach, in the absence of all those digestive enzymes and acids. However, the risk of stomach upset is higher if strong antimicrobial herbs are taken on an empty stomach, and that is a deterrent. If you get digestive distress from herbs like Oil of Oregano, I think it's better to take them with a meal. You'll still get results, just perhaps at a slower rate due to the breakdown issues noted above. Does that make sense? :) Diana

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  30. I have had SIBO since about 1982, long before there was a diagnosis. I was treated for food allergies for 25 years until I stumbled across SIBO information a couple of years ago. I took the information to my gastroenterologist who agreed that SIBO might be my problem. I took Riflaxin several times but didn't notice any marked improvement. Then I began to experiment with the herbal anti-microbial. It has been a long road of feeling quite ill for months and weeks at a time as I tried different diets and herbal concoctions. I tried FODMAP, GAPS, SCD and finally the Low Fermentation diet by Norm Robillards. The Robillards diet is definitely the best for me. However, Norm's book does not recommend the herbal anti-microbial, but they are essential for me. I have been taking 5 or 6 different kinds daily for more than 2 years. I certainly agree with Diana that going slow in the beginning is VERY important because the die-off can be quite severe initially. If you start feeling quite sick then you need to back off for a day or so and then start again with smaller doses for a week or so. Regarding the Allicin, it really works but I had to give it up entirely because it caused blood blisters on my arms, which is somewhat common reaction because garlic is a blood thinner. Personally, I don't think that any particular anti-microbial is better than any other, but it is important to take several different types because you want the broadest coverage possible. And, obviously, you must GIVE UP THE SUGAR AND STARCHES. One more thing, my gastro doc has me take a liver test every 4-6 months to make sure that the herbal anti-microbials are not over taxing my liver. However, the test has been normal for 2 years now. May the Force with You. Carolyn

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    1. Hi Carolyn, Thanks for sharing your story, including your experience with bacterial die-off and the need to go slow with the herbals. No doubt they are powerful medicine, and on top of that, some people's systems are extremely sensitive. I've never heard of the garlic-induced blood blisters——that sounds unpleasant and potentially quite scary if one did not know the cause! Very glad to hear that you finally got the right diagnosis for your condition, and are doing well now. Blessings, Diana

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  31. Diana, yesterday I wrote a long post and tried to publish it. I got a message that it had to be reviewed. How long does the review take? It's been about 20 hours.

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    1. Hi Carolyn, Generally it takes me a few days to review and respond to comments, as I am not a full time blogger, although that would be nice...maybe one day!

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    2. Diana, I was wondering about your choice of beginning the protocol with a biofilm disrupters. I know that there are mixed opinions about using biofilms disrupters and there is very limited research about this. BUT, I do have a bottle of Interfase and thought that I would give it another try. (Tried in the past and suffered increased die-off reactions.) But I'm interested in your theory about beginning FIRST with biofilm disrupters.

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    3. Hi Carolyn,

      You are right about the dearth of research; seems like we are all part of figuring this out together, which is pretty exciting if you look at it that way.

      My idea for using a product like Interfase or Lauric Select at the beginning is to open up the biofilm, so that the antimicrobials can access their target. Some people suggest continuing to eat starches and sugars while taking antimicrobials but personally, that would just make me bloat terribly and feel awful.

      If you tend towards a strong die-off reaction, it might help to use smaller doses and go slow...After all this time with SIBO, what's the hurry? lol

      ;-)Diana

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  32. This is similar to my process with Lymes. Most people don't realize you have to break down the biofilm. I used Kirkland (not the costco brand) Biofilm Defense. Thanks for the info!!!

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  33. Hey, Carolyn. I went through a round Xifaxamin and now am on to the herbal protocol. I'm using Interphase with Oil of O, Berbaine, Allicin, FC Cidal, Max dose of HCL. Low HCL is clearly an issue with me. And Gut Motility Pro. I'm really strict on the Sibo diet too.

    Some of my symptoms have been improving. Gas is def better. BMs def better. My big issue is loud gut noises. Mostly later in the afternoon and in the middle of the night if I wake. No gas or bloating really associated with them. Sibo probably causing malabsorbtion. Have you encountered a lot of issues with gut noises?

    I will say, my gut motility has gotten way better.

    Thanks!

    -michael

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    1. Wow, Michael, you are really making a serious effort. The one thing that comes to mind that was VERY helpful for my motility is IBEROGAST. Just in case that you have not heard about it, it is a brown herbal liquid that has been widely used in Germany for IBS and other gastro symptoms. I have been using it for about 3 years. I ran out once and paid the big price. Now I order 3 large bottle at a time and reorder when I open the last bottle. Dr Allison Siebecker recommends taking 20 drops with each meal and also 20 drops at bedtime. I order from a Canadian pharmacy since it is cheaper than Amazon. I like it much much better than Motility Pro. Pro gave me cramps and burning in the gut.
      May the Force be with You.

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  34. Hi Michael, Thanks for sharing your story, and glad to hear the protocol is working. Loud gut noises => "borborygmi" ~ I did a post on that very topic a while back! Check here: http://sexysibo.blogspot.com/2015/04/sexy-sibo-word-of-day-borborygmi-and.html

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  35. I just wanted to add a comment here to mention thanks for you very nice ideas. Blogs are troublesome to run and time consuming thus I appreciate when I see well written material. Your time isn’t going to waste with your posts. Thanks so much and stick with it No doubt you will definitely reach your goals! Have a great day!
    Herbal Incense

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    1. Thank you!! Appreciate the kind comment. ;-)

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  36. How long should you wait between rounds of antimicrobials? I am about a month in and noticing some improvement but not much. I want to try more but am not sure if I should do 2 months straight or take a break for a few weeks and then do another month?

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    1. Hi Natalie, Are you being followed by a health care practitioner or doing this all on your own? If you can retest after Round 1, that will give you an idea of how effective the treatment was. Some people relapse in a matter of days, and sometimes there are other things going on besides SIBO. I would not recommend doing two rounds of antimicrobials back-to-back without supervision. I do recommend working with someone to develop a comprehensive, whole body approach to your individual case. Best wishes, Diana

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    2. Natalie, I have been taking antimicrobials for 2 1/2 years without a break with agreement with my gastro doc. I do get my liver tested every 6 months but everything is always fine.

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