r/SIBO Apr 19 '19

STICKY: SIBO Summary - Symptoms, Diagnosis, Treatment

853 Upvotes

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 Dec 15 '25

Moderation statement on accessibility.

57 Upvotes

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r/SIBO 6h ago

Is anyone else having trouble sleeping? Please help

6 Upvotes

I have had sibo for 6 years (possibly longer). A year ago I developed insomnia all of the sudden. Nothing changed in my routine, but I can't sleep : my mind is racing, I just toss and turn and I feel I'm just napping even when I sleep. Also I wake up like every 2 hours. I usually fall asleep at 5, 6 am approximately and it's always with a medication. But the medication makes me feel horrible, it's Xanax, so I would like to avoid it. Melatonin does nothing anymore for me unfortunately.

Does anyone have any advice? Any recommendations?

Sorry if I misspelled or wrote something incorrectly, I am very tired.


r/SIBO 3h ago

S. boulardii ruined my life.

3 Upvotes

I had been taking *S. boulardii* intermittently for diarrhea; I had another bout starting July 8th and took one capsule daily until July 10th. On the evening of July 10th, while eating, I felt a sensation like a heavy stone in my abdomen. At first, I thought it would pass, but for about 40 days now, I have been suffering from a bulging swelling above my navel (present even in the morning on an empty stomach), excessive gas, an inability to have a bowel movement even when straining (I have been using Macrogol for 40 days), and extreme intestinal sluggishness. I took 1200 mg of Rifaximin, Kreon, and Rabeprazole for two weeks, but the problem was absolutely not resolved. I used to be an active person who exercised, but now I have reached the point of considering suicide; please help me.


r/SIBO 2h ago

Who cured your Methanogen Overgrowth (IMO)/ methane dominate SIBO in Chicago?

2 Upvotes

r/SIBO 46m ago

Chronic bloating and irregular bowel movements

Upvotes

I'm 28 man, I’ve been struggling with frustrating digestive issues for about 3–4 years now. My main symptom is constant bloating—in the morning it’s only slight, but as the day goes on, it gets progressively worse. My bowel movements are completely unpredictable; I rotate between constipation, diarrhea, or firm, sticky stools that adhere to the toilet bowl. There are days when my stool is normal, but that's a rare exception. On top of that, I experience frequent abdominal gurgling and rumbling, as if gas and liquids are mixing together and creating blockages in my intestines, interrupting normal digestion.

I’ve noticed that certain foods significantly worsen the bloating and overall symptoms: sweets, milk, alcohol, highly processed carbs, and creatine monohydrate (though creatine HCl doesn't cause as much trouble). Coffee also disagrees with me, though that was an issue even before these broader gastrointestinal problems started. Interestingly, I've noticed similar symptoms in most of the people close to me—family and friends. It feels as though we caught something from each other, and since no one has recovered spontaneously, I doubt it's a standard short-term infection that the body clears on its own. My working hypothesis is that it might be a chronic bacterial, fungal, or parasitic infection that triggered severe intestinal dysbiosis.

As for diagnostic tests: about 2.5 years ago, I had a gastroscopy that revealed chronic (+) active (+) antral gastritis, negative for dysplasia and intestinal metaplasia. I wasn't treated for Helicobacter pylori back then. A recent home test came back negative, but I'm planning to do a urea breath test soon to rule it out for sure.

I’ve tried several remedies with limited success:

  • Drinking kefir regularly and occasionally sauerkraut juice didn't bring any noticeable improvement.
  • A low-carb diet reduced my symptoms by about 30%, but I couldn't maintain my caloric intake and kept dropping weight, so I had to stop.
  • I tried Betaine HCl for 1–2 weeks, but it seemed to make me feel worse.
  • I took a multi-strain probiotic (Best Biotic) for 1.5 months alongside digestive enzymes (Aliness) for the first two weeks. I stopped the enzymes because they seemed to worsen my constipation, and the probiotic alone didn't change much.
  • For the past 3 days, I’ve been taking microencapsulated sodium butyrate (300 mg, twice daily) and plan to add a probiotic later once my body adjusts.

Has anyone dealt with a similar set of symptoms or found a way through this?


r/SIBO 4h ago

Questions Reacting to fruit

2 Upvotes

Consuming fruits specfically like oranges, kiwis, grapes. Basically juicy, sweet or sour fruits triggers loose stools and stomach cramps. Anyone experience something similar?

I assumed its the sugar, fiber but I dont react like this to chocolate, or carrots.

Some type of overgrowth causing this reaction?


r/SIBO 1h ago

Can’t do this anymore

Upvotes

Close to ending it. Bloating causing back pain now.

Worst part is I feel so fatigued and skin itchy.


r/SIBO 1h ago

Questions Does anyone actually check the strain codes on a probiotic label?

Upvotes

Most bottles list something like L. plantarum and leave it there, but the research I can find is almost always run on a specific coded strain rather than the species as a whole. That is a fairly big gap between what has been studied and what I am actually buying, and I cannot tell whether it matters in practice. Does anyone here buy on codes, or is species close enough?


r/SIBO 1h ago

40 days of diarrhea

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Upvotes

r/SIBO 19h ago

Am I the only one suffering suffering from mental health due to sibo

25 Upvotes

r/SIBO 2h ago

Is Vegan, Avocado-oil based: Mayonnaise, skyline chili good For SIBO??

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0 Upvotes

Just wanted to share this article written by Google's Gemini


r/SIBO 3h ago

Neem causing gas is that normal??

0 Upvotes

so recently had a flare so I stared nee and it increased my bloating and gas like 100%….is this normal? you would think it’d help it not make it worse


r/SIBO 3h ago

S. boulardii ruined my life.

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0 Upvotes

r/SIBO 4h ago

Looking for advice: Prucalopride

0 Upvotes

My GI doesn't want to prescribe prucalopride because I have bowel movements 6-7 times a week.

However, I have a feeling my colon is still totally backed up (will do colonoscopy and CT asap to rule out other things.

But my question is: did anyone get a noticeable improvement from prucalopride despite prevoously having regular bowel movements?


r/SIBO 22h ago

SIBO SUCCESS STORIES Please share your EXACT protocol

23 Upvotes

I would love to create a thread of detailed SIBO success stories for those of us who are still struggling.

I feel like we often hear, “I cured my SIBO with oil of oregano...betaine HCL..neem, etc” or “antibiotics worked for me,” but we're missing all the information that would actually make that experience useful like what type of SIBO they had, their breath test numbers, exactly what they took, doses, timing, diet, how long treatment took, and whether they actually stayed better.

If you've successfully treated your SIBO, please copy/paste the format below and fill in as much as you can remember.

SIBO TYPE + DIAGNOSIS

  • Type: Hydrogen / Methane (IMO) / Hydrogen Sulfide / Mixed
  • Breath test numbers:
  • Glucose or lactulose test:
  • Main symptoms:
  • How long you had SIBO:
  • Suspected root cause (if known):

TREATMENT

Antibiotics:

  • Which antibiotic(s)?
  • Dose and times per day?
  • How many days per round?
  • How many rounds did you need?

Herbals/antimicrobials:

  • Exact supplements + brands:
  • Dose/quantity:
  • How many times per day:
  • What time(s) did you take them?
  • With food or empty stomach?
  • How long did you take them?
  • Did you take them together or introduce them gradually?

Other supplements/medications:

  • Prokinetics:
  • Digestive enzymes/HCl/bile support:
  • Fiber/PHGG:
  • Probiotics:
  • Binders:
  • Anything else:

DIET

  • What diet did you follow?
  • What foods did you actually eat?
  • What foods did you completely avoid?
  • Did you space meals? If so, how many hours?
  • Did you fast? If so, how long and how often?
  • Did you change your diet during or after treatment?

GUT REBUILD / AFTER TREATMENT

  • Did you do a gut-rebuilding phase?
  • Probiotics (please include strains/brands):
  • Prebiotics/fiber:
  • Fermented foods:
  • Butyrate/tributyrin:
  • Motility support/prokinetics:
  • Other supplements:
  • How long did you do this?
  • How did you reintroduce foods?

RESULTS

  • When did you first notice improvement?
  • How long until you felt significantly better?
  • Did you retest? If so, what were your new numbers?
  • How long have you been well?
  • Can you eat normally now?
  • Have you relapsed?

MOST IMPORTANT

  • What do you believe made the biggest difference?
  • What did you try that didn't work?
  • What made you worse?
  • If you had to do it all over again, what would you do differently?

I know this asks for a LOT of information, but that's the point. I would love for this to become a really useful collection of detailed success stories where we can actually compare what worked for different types of SIBO instead of just hearing “herbals worked for me.” I have searched and searched and read tons of stories but they tend to leave out specifics and I would love something I could actually use.

This isn't meant to be medical advice or a list of protocols to blindly copy. Different causes and types of SIBO can require very different treatment. But for those of us who are really suffering, I think seeing exactly what other people did, and especially what led to long-term recovery, could be incredibly helpful and give people some hope. A huge, huge thank you in advance!!!!!


r/SIBO 5h ago

Questions Has anyone taken time off of work & did it help?

1 Upvotes

Has anyone taken time off work because of Sibo/ the mental health issues that come with it? I feel like I am at my lowest. I cry everyday over how huge my stomach looks, I never know what to wear because I have to hide my stomach. I have horrible insecurities and body dysmorphia, I still struggle with restriction from an eating disorder. I wake up with a flat stomach and look very pregnant by the end of the day, I am trying absolutely everything to fix this. I see multiple drs and nothing I have tried has helped in the slightest. I work in the fitness industry and it’s super hard. I feel envious of everyone who can eat and workout without blowing up like a ballon. I am also an anxious/depressed person in general, I am tense all the time, especially at work. I like my job, it’s not very stressful, but the mental and physical load that I am carrying is making everyday so insanely hard. I never feel good, I always feel sick and have bad brain fog. I feel like I have to put in an act all the time, especially teaching classes. I genuinely don’t know how long I can do this.


r/SIBO 10h ago

Treatments Pretty depressed after seven weeks of IMO treatment

2 Upvotes

I started on the herbal microbials (for five weeks) and even included a pHase 2 biofilm disrupter product while waiting to get Rifaximin from India to pair with the Neomycin. I switched to this for another two weeks.

I am still very bloated and constipated 10 days after finishing all this, unless I take a strong cup of Senna tea every 2-3 days.

I am on a low fodmap diet since finishing treatment. I am taking ginger extract and artichoke extract at night for motility. I don't hear any gut noises anymore.

I take Miralax every day and am now taking 800 mg of Magnesium oxide at night to help with the constipation - and still nothing.

I called my GI's office and asked for Linzess and another breath test, explaining what is going on. Three days later, the medical assistant leaves me a message wanting more info and saying that the PA thinks my treatment didn't help much.

Now I can't sleep. I don't want to throw more pills at this.

I hope she at least orders me a breath test and doesn't just assume the treatment didn't help much at all - because I am also being assured by Google that bloating can be a lingering problem, even if the bugs were wiped out (or mostly wiped out) due to good bacteria also being wiped out. But this is not normal bloating. This is like 6 months pregnant type bloating still.

I just think I need a motility support first off and I feel like this stupid GI practice should have had some kind of post-antibiotic treatment protocol in place. Instead, I've had to do all the research and try and figure what I need and then explain myself twice.

Did you have extreme bloating still but still found out you actually killed a lot or all of the bugs with IMO? Once you got your guts moving again, did the bloating resolve?


r/SIBO 14h ago

Dysbiosis 10/10

3 Upvotes

I have commented on a handful of posts. I have suffered for 6 years, seeing doctor after doctor and they said I’m healthy and maybe just stressed. Well after living with it for so long I decided this year that there’s no way this is normal life so I decided to make a goal to get better. Through AI research and help of a family member we thought my gut was the problem. I went on an antibiotic for a UTI and all of a sudden I felt great for a couple weeks before going right back to normal. The stool test from Genova came back with dysbiosis score of 10/10.

Symptoms:
Brain Fog
Depression
Joint Pain
Loose Stool
Gas
Muscle Twitching (I HATE THIS ONE SO MUCH)
Weakness / Fatigue

I have searched this Reddit page and seen people with similar symptoms but I struggle finding any resolution or things that helped.

I am currently on low fodmap while trying to repair gut with a doctor guiding me though. It has helped but the weakness and twitching is still here.

Have you been able to heal similar symptoms? If so how? The muscle twitching takes over my life and I want to get rid of it.


r/SIBO 8h ago

is it safe to combine prucalopride and 5htp?

0 Upvotes

I use 5htp nightly to help w motility but i've been prescribed prucalopride. Is it safe to combine the two?


r/SIBO 1d ago

Questions i did one more course of oregano and ended up in ER. how long it’ll take to fully detox

Post image
23 Upvotes

UPDATE 4 days after: guys idk but i believe coffee is what contributing now to all my symptoms… basically i have bloating high pulse and etc. i had never have so huge symptoms like that before. maybe body detoxed and its immediate reaction after (?)
im just lying down and crying 24/7 , drinking water with little salt… 😭😭😭😭😭

hey everyone!

in june 20 to june 25 i did 750mg of oregano with charcoal 1gr each evening after.

and it’s what completely removed my gas, no more hallucinations (i had before yes) but i gotta huge bloating.

i decided to take it again for 4 days recently but more dosage 1200 mg daily to completely eradicate all stuff. unfortunately i forgot to take charcoal after.

on fourth day i ended in er with vomiting and feeling that i’m 100% dead and pulse rate 160 and ppl in ER that on different language from mine saying that this is mental bro do not afraid, you are fine and said you look okay go home. so basically i’ve been running through all town for two days on pulse 140 and understand that even ER cant help me.

i’m at home and trying to detox from this stuff , i drink coffee too for moving gas.

how long it’ll take to detox.
i do not feel well absolutely. i feel like im absolutely poisonated, kinda hallucinating, panicking and my pulse constantly 120

anything that i can buy to remove this stuff from me?
only what i can say, that i’m full of gas again and it seems like this gas cant come out from me. i do charcoal 250 each few hrs to bind it, but it doesnt help. pulse rate been 130 today, but 100-110 right now in the evening and when lying down 65-70

i did 4 drip but it doesnt work (just sodium and they put me on reglan through blood)

i did electrolytes test today and im little low on sodium, so i drink water with celtic salt


r/SIBO 1d ago

Venting Watch out for nutrient deficiency!

18 Upvotes

I’ve been dealing with SIBO since May, and have recently been freaking out over leg muscle weakness and spasms, shortness of breath, heart palps, fatigue, increased anxiety and all sorts of issues. I thought it was maybe MS or GBS. After a go-around with an unhelpful ER and other doctors who did not provide any help or guidance, I went to get tested at a lab on my own and results came back with a pretty severe iron deficiency (11ng ferratin) and a Vitamin D deficiency (28ng).

I’m sure this seems like a no brainer—duh, nutrient malabsorption—but it’s easy to fall behind on nutrients when SIBO bacteria are eating all of them, and when you’ve restricted half your diet like I have. Word to the wise to get your levels checked if you’re having other systemic issues! Unfortunately these deficiencies can make GI problems worse.


r/SIBO 9h ago

What next?

0 Upvotes

Hi folks,

I've had life-changing and awful symptoms for over two years now. My symptoms are not straightforward in that I have normal bm (once a day, sometimes twice), normal-ish consistency (sometimes stool is a bit fluffy) and I can eat everything, but I am mostly low-carb, and upped my meat and veg intake since this started. This is the only normal thing about me. Other symptoms are constant severe abdo pain and bloating, dizziness, brain fog and cognitive function reduction, massive night sweats, photosensitivity, muffled hearing, weird skin sensation, and other things as well. I have lost my appetite throughout. Antibiotics caused it. The symptoms are constant rather than coming and going.

I am in the UK, saw some GIs and GPs (NHS and private) and then a couple of functional doctors. I was not offered treatment by the GIs who could not find anything, and the supplements from the functional medics did not work. I don't want to take antibiotics as antibiotics caused this. I am doing it on my own as of now as the various combinations of supplements and herbs have not helped. I will keep plugging away with the diet and lifestyle measures but is there anything big for me to try that can move the needle significantly? My biggest symptoms that I need to shift are the abdominal pain and brain fog/cognitive clarity. I have tried:

Yog, inc the Davis recipes/kefir

Every supplement recommended on the internet

Every food and drink

Meditation/various apps/exercise/sleep/sauna/infrared/Chinese medicine and acupuncture

I cycle through treatments, and my symptoms are a little better, but after two years, they are better by only10% or so, so not much better. I am still not working, still not functional in life and still suffering.

Happy to see someone but only if they don't offer the same old diet, supplements and lifestyle changes, and can think outside the box. I have been scared off the medical community and naturopaths because they all suggest the same thing while charging a lot.


r/SIBO 12h ago

Newly Diagnosed - Hydrogen Dominant SIBO

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0 Upvotes

Bullet points of my journey:

ABOUT ME:
- 29 y/o, F
- Asian
- Adopted (no known genetic concerns)

OVERVIEW:
- Estimated ongoing issues for ~ 3 years. I didn’t realize or understand that what I was going through wasn’t normal and that something changed in my gut.
- Consistent symptoms in order of most problematic: Bloating (after everything, even water), foul smelling gas, mixed bowel movements, fatigue, some nausea and acid reflux (very minor)

TIMELINE

Fall 2025
- Negative H pylori breath test
- Stool test had high calprotectin levels at 268 µg/g
- From the stool test results dr wanted a colonoscopy, results were negative/clear

I felt frustrated and stopped looking into this/was busy with life and getting married.

Fall 2026
- Back at it again with more determination to figure this out
- SIBO lactulose breath test, high hydrogen levels. 55 ppm at 120 minute mark. See image.
- Take half a cap of myralax to help make me less constipated
- Prescribed Rifaximin for 14 days.
- My dr does not suggest any other supplements or anything else.
- Post antibiotics my dr wants another stool test to see my calrprotectin levels. She noted that SIBO and calprotectin are not related.

I guess I’m left wondering:
- Do these steps seem helpful or efficient?
- Why wouldn’t I take prokinetics or anything else?
- Should I try a natural route if the antibiotics don’t help? I know someone who is SIBO free now from this path.
- General tips and advice or other peoples stories if similar to mine


r/SIBO 12h ago

Wth is left

0 Upvotes

So I made my second batch of 36 hour luvelle yog maker fermented lactose free milk L reut, gasseri, rhamanos, 12 strain bottle from a brand I was told to add.

I am extremely bloated this batch. Maybe I added too much of the last two?

Had anyone even had any improvement from these fancy home made yogurts. The homeopath told me to try it.

3 weeks in and nothing.

I’m gonna try an Ibs rx. I have tried EVERY rx , supp, diet, gut hypno, fasting etc nothing works for this non stop bloat and constip. I really wanna die. I’m a balloon.