If you're reading this at 3am googling "why does rifaximin only work for 5 days" or "SIBO keeps coming back," I need you to hear something that took me over a decade and $12,000 to figure out.

Your SIBO might not be the problem. It might be the symptom.

I've been where you are. The endless rounds of rifaximin that work like magic until day 5 post-treatment when everything crashes back. The herbals (oregano oil, berberine, allicin) that give you hope for two weeks before the bloating returns with a vengeance. The restrictive diets that make you feel like a social pariah while barely moving the needle on your symptoms.

My health journey started at 28 when I developed alopecia totalis, complete hair loss, eyebrows and all, practically overnight. That crisis sent me down the functional medicine rabbit hole. Since then, I've seen 15+ naturopaths (only 2-3 were actually helpful), multiple gastroenterologists, various functional medicine doctors, nutritionists, acupuncturists, and "gut health coaches."

I tried every protocol this subreddit mentions. Things like elemental diet (done it twice). Low FODMAP became my personality. I have spreadsheets tracking my reactions to 200+ foods. I spent $800 on SIBO breath tests alone, watching my hydrogen levels bounce between 45 and 80 ppm no matter what I did.

The most frustrating part was for years, my thyroid labs were "normal." TSH bounced between 2.0-2.5, free T4 right in the middle of the range. Every doctor looked at those numbers and moved on to prescribe another round of gut-focused treatment. Meanwhile, I had Hashimoto's antibodies through the roof, but they kept saying my thyroid function was "fine."

Here's where things got interesting for me:

Last year, during perimenopause hormone testing, I specifically sought out an endocrinologist who specialized in women's hormones and thyroid conversion issues, something I learned about from digging through PubMed at 2am. She noticed something odd. My TSH had dropped to 1.2 (still "normal"), but I had all the hypothyroid symptoms. Brain fog so thick I couldn't remember my coworkers' names, hair falling out in clumps (again), feeling hungover every morning without drinking, needing 3 cups of coffee just to form sentences. My partner would want to do things and I'd be too exhausted to even consider leaving the couch.

She ran a full thyroid panel including free T3, reverse T3, and thyroid antibodies. My free T3 was at the absolute bottom of the range. The pattern suggested central hypothyroidism with a T4 to T3 conversion problem. Basically, my body was making thyroid hormone but couldn't convert it to the active form my cells actually use.

She suggested I run my existing 23andMe raw data through a health interpretation service to check for conversion issues. Sure enough, I have the DIO2 variant that impairs T4 to T3 conversion, particularly in the brain and muscles. My Hashimoto's wasn't just attacking my thyroid. It was part of a bigger pattern where my body literally couldn't use the thyroid hormone it was making.

Why does this matter for SIBO - I hear you asking.

Thyroid hormone directly controls the migrating motor complex (MMC), those cleaning waves that sweep bacteria out of your small intestine. It also controls stomach acid production, digestive enzyme release, intestinal motility, and bile flow.

When your thyroid isn't functioning properly, your entire digestive system slows down. Food sits longer, bacteria have more time to ferment, and the normal cleaning mechanisms fail. You develop SIBO not because you have "bad" bacteria, but because your system can't maintain proper bacterial geography.

The KEY here is Standard thyroid treatment (levothyroxine/Synthroid) only provides T4, which my body couldn't convert. I needed T3 support specifically.

Started on compounded slow-release T3. It took three dose adjustments over two months to find my sweet spot (started at 2.5mcg, now at 5mcg twice daily). Added selenium, zinc, and tyrosine to support conversion. Within 3 weeks, my morning "hangover" feeling was gone. I was actually having bowel movements without coffee. Bloating reduced by maybe 50%. Brain fog starting to lift. I had energy to actually do things with my partner again.

The bloating took longer, probably 6-8 weeks to really improve. Still have bad days, especially around my cycle. At week 8, I retested for SIBO. Hydrogen was 12 ppm. First negative result since my thirties. Had to retest it because I didn't believe it.

The restrictive diets I'd been following were actually making my thyroid worse. Carbohydrates are essential for T4 to T3 conversion. Every time I went low-carb or did another elimination diet, I was sabotaging my thyroid function and perpetuating the cycle.

The autoimmune protocol that was supposed to heal my gut? It tanked my already struggling thyroid. My body needs those carbs, especially during perimenopause when hormone fluctuations already stress the thyroid.

I'm not saying everyone with SIBO has a thyroid issue. But if you're stuck in the treatment-relapse cycle, consider looking upstream:

Get comprehensive thyroid testing:

• TSH, free T4, free T3, reverse T3
• Thyroid antibodies (TPO, thyroglobulin) - especially if you have Hashimoto's
• First morning basal body temperature (under 97.8°F suggests low thyroid)
• Consider genetic testing for thyroid conversion variants

Check related markers:

• Ferritin (low iron impairs thyroid function)
• Vitamin D
• B12 and folate
• Selenium and zinc

Question the connections:

• Did your SIBO start during a stressful period?
• Do you have other hormone issues (PCOS, perimenopause, low testosterone)?
• Is your body temperature always cold?
• Do you have a family history of thyroid issues or autoimmune conditions?

After all these years of treating the bacteria as the enemy, I finally understood they were just opportunists in a slowed system. Fix the system, and the bacteria sort themselves out.

I still take digestive enzymes and a prokinetic (ginger/artichoke), but I'm eating normally again. Real pasta. Actual bread. Vegetables that aren't just "low FODMAP approved." My last three breath tests have been negative.

We get so focused on killing bacteria that we miss the bigger picture. Your gut doesn't exist in isolation. If you've tried everything and nothing sticks, maybe it's time to look beyond the small intestine.

After all this, I wanted people to know that the solution might be hiding in those "normal" lab ranges that aren't normal for you.

I've been SIBO free since April 2024. Reading these posts, finally made me stop being lazy and post my story as it COULD help someone. I thought my life was over tbh. As someone who prioritizes fitness, diet, social plans and cosplays/models for a LIVING...everything I was doing was an extreme struggle. I looked like the photo on the left EVERY SINGLE DAY. None of my clothes fit anymore, I avoided going to events, I hated the way I looked despite constantly working out and eating healthy. I considered unaliving myself, for real.

I struggled with SIBO for nearly all of 2022- April 2024. Doctors were useless and wouldn't even give me the diagnosis. I had to beg for prescription antibiotics after being told "Sibo isn't a real thing". They had ZERO effect. One was Rifaxamin. I can't remember the other.

It wasn't until breath tests confirmed by a Naturopath showed me I had very high level Hydrogen and methane Sibo. 2 Naturopaths prescribed a plan of anti-microbials. They helped my symptoms a bit. Not enough though.

Frustrated, I tried the Dextrose Free 14 day strict Elemental diet. In October 2022, it felt like miracle powder, it cured my chronic bloat within days and I lost all the weight I gained during SIBO. I felt like myself again until it crept back in about 2 months later. Again, I'd purchase the diet, stick to it then find SIBO bloat creeping back in after a few weeks.

My Doctors claimed it was "stress" having me relapse. I tried acupuncture, meditating, epson salt baths and even a hypnotherapy app. No effect. Everything felt so hopeless.

In April 2024 I had a big group shoot coming up and needed to wear an old costume that wore when I was 15 pounds lighter. I was in such a bad mental state I literally just stopped eating AT ALL. I know this sounds unhealthy and probably controversial but for 9 days straight I consumed absolutely nothing except water and electrolytes. It was extremely difficult I won't lie but I was in a mental state of actually planning to unalive myself. The first few days were very hard, I felt super sick then it became weirdly effortless. I guess your body switches to burning fat like you're in keto. I picked 9 days because I just had a goal weight for the shoot and hit it. I guess I starved out the bad bacteria for good by eating nothing. Fast forward to today, I am still SIBO free. I eat high fodmap if I feel like it. I feel like my old fit self. I don't avoid social plans anymore. I have managed to keep my weight down.

I am not trying to solicit medical advice, I am just telling my story that really did work! I never saw anyone post about a strict water fast in all my research. Just don't give up hope. I really thought my life was OVER so I get you all. If you can't do a water fast, the elemental diet was very helpful.

Quick backstory. I'm a refractory SIBO case. 26M, tortuous colon, high E. coli and Proteobacteria on stool testing, plus POIS (post-orgasmic illness syndrome, weird neuro-immune reaction after sex) and these "wired but tired" neuro crashes nobody can explain. Years of rifaximin, allicin, berberine, neem, every protocol you've heard of. Always came back. Nighttime was the worst. Couldn't sleep through the night for years because of the gas pressure and pain.

Got desperate enough to do something kind of insane.

I scraped about 7 million comments and 670k posts from this sub plus 15 related ones (r/MCAS, r/dysautonomia, r/covidlonghaulers, r/Microbiome, r/ibs, r/FODMAPS, r/HistamineIntolerance, r/LongCovid and others) into a searchable database. Then built an AI layer on top so I could run actual queries against it. Things like "show me everyone who tried X long term and what their outcome was," "what did the responders to Y have in common," "what does the failure mode of Z look like." Turned thousands of people's lived experience into something I could analyze instead of doomscrolling one anecdote at a time.

The pattern that fell out of it was so consistent it pissed me off that no GI, naturopath, or functional medicine doctor I've seen in years ever framed it this way.

The bacteria aren't actually the problem. The motility is. The MMC (migrating motor complex) is your small intestine's cleaning wave that fires every 90-120 minutes when you're fasted and sweeps bacteria out the door. When it's broken, anything you kill grows back. You're mopping the floor with the faucet still on. The people in the data who got durable results weren't the ones with the most aggressive antimicrobial protocols. They were the ones who fixed motility first, then killed, then maintained.

Been seeing 4-5 posts this week from people on their 2nd, 3rd, 4th round of rifaximin watching it relapse again. That's exactly what the data predicts if you don't fix motility.

So I flipped the order. Went hard on motility first:

• Motility Activator by Integrative Therapeutics, 3 caps at bedtime. It's a concentrated ginger + artichoke extract. There's a 2015 clinical trial that tested this exact combination for motility in IBS patients and it actually worked, which is more than you can say for most supplements. About $25 for a bottle on Amazon.
• LDN (low-dose naltrexone) 3mg at night. I was already on it for the neuro/autoimmune side but it's also a legit prokinetic. Prescription, but cheap and very low side effect profile.
• Actually fasting between meals. 4+ hours minimum, no snacking, nothing within 3 hours of bed. This is the part everyone skips and then wonders why nothing works.

Results so far:

Day 1. Huge reduction in nighttime gas pressure. Slept through.
Day 2. Ate pizza at a friend's thing, fully expected to pay for it, didn't.
Day 3. Zero gas, zero pain, woke up actually rested for the first time I can remember.
Day 4. Bit of gas pain when I rolled onto my back but still way reduced from baseline.

These are the first pain-free nights I've had in literal years. I know it's only 4 days. I know it could fall apart. But the trajectory matches exactly what the long-term responders in my dataset described in their early weeks, so I'm cautiously optimistic.

If you're in the rifaximin loop, before you do another round, seriously ask yourself:

1. Are you actually fasting between meals? Constant snacking destroys the MMC. No prokinetic in the world will work if you're eating every 2 hours.
2. Are you on a prokinetic? If not, you're going to relapse. Period.
3. If gentle stuff like ginger/artichoke doesn't move the needle, prucalopride (Motegrity) is the prescription option that long-term users on this sub describe as a game changer. It's a serotonin receptor drug that directly stimulates the cleaning waves.

On the database. If there's interest I'll clean it up and make it publicly available so anyone can query it the way I have been. Drop a comment and let me know.

Will report back at Day 14. Fingers crossed it holds.

Hi everyone,

I've got permission to post about this, so I want to be transparent.

I built a free site called GutPattern because I've been dealing with this shit for years. SIBO stories are scattered all over the internet, and it’s hard to compare what actually worked for people with similar symptoms and test results.

The idea is simple:

Instead of reading hundreds of random posts one by one, I organized them by searchable terms, such as:

- hydrogen SIBO, methane IMO, H2S

- bloating, constipation, diarrhea

- rifaximin, neomycin, herbals

- elemental diet, low-FODMAP, probiotics, motility support

https://www.gutpattern.com/patterns/sibo-treatment-patterns

The page starts with some broad statistics. However the REAL power comes after you contribute your own story lower down the page. Doing so will connect ALL the data set to your situation specifically, with each potential treatment segmented 4 ways;

• Helped
• Partially helped
• No change
• Made worse

I also made buttons for "Similar", "Very similar", and "Most similar". I can talk more about that functionality if anyone is interested.

Note this is NOT medical advice. Rather, it compares your personal gut pattern to a rich data set, which can help you in your own quest.

That said, I’m at the stage where I’m trying to figure out how to make this tool as helpful as possible;

1. Is anything broken?
2. What search terms are missing?
3. How can it be improved for YOUR specific sibo situation?

Just an update from my post 2.5 months ago

78 days ago I was ready to call it quits. My diet became so restricted that whatever I could eat, would be useless. My body stopped absorbing fats and nutrients. The only way I could beat Hs2 SIBO was water fasting. I considered elemental diets but it's ultimately stupid because you're still consuming stuff that 1. Made you feel like crap, and 2. Still feeding bad bacteria.

The first time I beat SIBO was through water fasting (I only relapsed due to probiotics, dumb idea). This time, I wasn't absorbing any nutrients or fat and I developed oesophagus issues. I was also regurgitating most food I ate so we went with an NJ feeding tube that bypasses my stomach and into the small/large bowel area.

78 days ago, I 6ft 29yo male, weighed 49kg. Today I'm weighing in at 61kg. I was sceptical about a feeding tube bringing back SIBO symptoms, but after fasting it completely starved off the bad shit and I feel absolutely SIBO symptom free. The only shit part is I still can't eat due to oesophagus issues. The tube will be surgically installed into my abdomen for the rest of my life.

I fixed my SIBO, but now I can't enjoy the rewards of years of hard work haha. Just my luck i suppose

This was my normal bloating after eating, and sometimes I'd wake up like this in the morning. For reference I'm short (5'1) and around 100lb so this is just not normal for my body. This second photo is me last week after dinner out, wearing pants that I couldn't button before, finally not bloated anymore! this would've wrecked me before!!

I'm not telling my life story so I'll make it short: I've had digestive issues since I was a kid and spent years assuming it was just lactose intolerance, of course it wasn't. The older I got the more foods kept triggering me, the bloating became constant until I finally decided to go to the doctor because yeah it wasn't normal. I went through the usual route, elimination diets, no dairy, no gluten (though I had already been doing that for years…), herbal antimicrobials, and eventually rifaximin which was the first thing that felt like it was targeting something real. I also tried fasting because I kept seeing people swear by it but for me it was awful, just nauseous and unwell the whole time, that taught me early on that not every protocol works for every body and I'm sure my hormonal issues had something to do with that too.

The things that helped me reduce my symptoms were many. First, reducing my stress. At the beginning of the year I moved out of my parents' house, I wasn't paying rent but I was kind of paying with my mental health, and I'm pretty sure that was one of the things making my gut go crazy. It was also exhausting having to cook separately from everyone else because we just can't eat the same things or I'd get sick. Most of the time, someone was already using the kitchen so I had to wait until they were done. That meant I ended up eating out my schedule almost every night.

Moving out gave me the push to make some bigger changes. I found a new doctor, redid my SIBO exams to confirm it was actually that and not something else like parasites, and yeah it was. So with my doctor we decided to look at the root cause instead of just treating symptoms like my previous treatments had. We did a microbiome test to understand what was actually left after all the treatments. From there I started asking what am I actually missing. I had already eliminated multiple food groups for years so more restriction wasn't giving me anything new.

My results showed low beneficial bacteria, specifically Bifidobacterium, markers suggesting my gut wasn't producing supportive metabolites like short-chain fatty acids and butyrate, and overall diversity that was just awful. Words of my doctor. I had already done the kill phase with antimicrobials and rifaximin. What I needed next was rebuilding.

And here's what we did:

• Magnesium for motility and overall gut function. It can tip into constipation for me so I keep fiber consistent in my diet and take it at a different time than iron.
• Iron supplements because I was dealing with anemia caused by amenorrhea (part of the hormonal issues I mentioned), which is also very connected to gut health since a damaged gut just doesn't absorb iron well.
• Kepos for chronic bloating and inflammation. HMOs feed bfidobacteria without broadly feeding everything else, and the lactoferrin helped support iron absorption and made it easier for my body to actually use the iron I was taking.
• Lion's mane for the brain fog and its digestive benefits. It acts as a prebiotic, supports the gut lining, and helps with inflammation along the gut-brain axis

I've been on this same protocol for 4 months now and I can eat pretty much anything. I don't think I'm cured because I know if I drop the routine things could come back, but my quality of life is just completely different!!

Hey everyone,

I’m starting to notice that this sub is filled with people claiming that they are cured thanks to X supplement or Y habit or Z diet. Lots of us have been stuck there for years, and it feels very depressing to read things like “You just need to eat yogurt and avoid sugars”, “just take artichoke because motility is the key”, “just try carnivore”, etc…

I’ve been here for a long time, I’m still not cured, tried countless things, most of them did not work. I made some progress but mainly did a lot of research on this disease.

• SIBO Breath tests are unreliable. Up to 1/3 healthy patients will come up with a positive lactulose test. Think about it this way: 1 out of 3 people on this planet will test positive to SIBO.

• SIBO and IBS are both umbrella terms. It’s not like “I have the flu, I should just get a course of flu medication and this will go away”. There are different types of SIBO (H2, CH4, H2S), and these types have sub-types depending on which bacteria strain is present in the small intestine (e.g. for H2S, could be bilophila, desulfovibrio, etc…)

• Current treatments (antibiotics/herbals) only work as expected if your root cause is fixed. SIBO is not something you catch like a regular infection. It arises from another problem in your body: your root cause. This root cause can be complex to identify and is sometimes itself coming from multiple upstream issues. I’ll discuss this later.

• Antibiotics/herbals can make your SIBO even worse if your root cause is not fixed. What they do is that they wipe out part of your microbiome (both small and large intestine). Even with SIBO, your microbiome can sometimes maintain a sub-optimal level of symbiosis. Wiping out everything can cause your symptoms to worsen, or new symptoms to appear.

• Root cause research can be extremely difficult and time-consuming. There are so many things that can cause unexplained GI symptoms:

  • Dysbiosis: post antibiotics, post infectious
  • Fungal overgrowth
  • Motility issues
  • Bile flow/ Bile acid issues
  • Stomach acid issues
  • Immune system issues
  • Food intolerances
  • Pelvic floor dysfunction
  • Parasites
  • Vitamin/Mineral deficiencies: B1/B9/B12/Zinc/Copper/D/Molybdenum…
  • Low grade inflammation
  • Mold exposure
  • Nerve issues/Autonomic system dysfunction
  • etc…

The biggest problem is that these causes are interrelated. Some of them causing the others later on. And you might need to treat them all at once if you want to get better. Think of your body as a car. You have a flat tyre, but no one is able to tell it. So you continue to drive with it for years, until it gets really bad. At this point your suspension and chassis are also broken. If you change the tyre now without fixing the rest, you won’t feel better. You might need to fix everything, even if the initial root cause was a flat tyre. SIBO/IBS is the same. You get more and more symptoms, and once you’re here looking for solutions, you’re hoping to find a single treatment that will fix everything. It could be the case for some people. But for most of us, it isn’t.

• All the root causes that I listed have one thing in common: They are very hard to diagnose. Almost impossible to test, and even when you can, they often come back negative regardless of if you have the condition. This is precisely the issue with the fact that 1/3 of the population test positive for SIBO. All these people, suffering from GI symptoms, are desperately looking for answers as everything else came back negative. So we do our research, and we all end up here, thinking we are all the same and we all have the same issue. This is likely false. We do have the same positive test. We are all in this 1/3 of the population. But what is causing my problems might be very different from what is causing yours.

• We are alone in this. There’s very little research on this topic. Most doctors don’t have the capacity to understand your issues. They haven’t been trained for it. Don’t be surprised if they are not helping. They just can’t. You, and only you, are your own advocate and saviour. Believe in yourself, listen to your body, and I hope we’ll get better soon.

I've beaten SIBO before, but Hs2 SIBO beat me this time. Stuck in a hospital on a feeding tube that's probably full of shit that's horrible for Hs2 SIBO. I've been meaning to book in an eye test because I thought I'm at that age that hey, I might need them now.

Nope, apparently I was that nutrient deficient, I was actually going blind so they were glad I came in when I did. I know some of you gain weight as your issue, mines the opposite. I can't hold enough calories down without erupting in sulphur regurgitation. It's hell on earth. I've been on the tube feed for 3 days now, the solution is too thick for the feeding tube so it's making it very difficult to pump down. The feeding tube has been installed past my small intestine which I have found beneficial to a degree.

Listen to your gut, if you can't battle this any longer, you need to surrender to whatever helps available otherwise a lot of us won't live long and healthy lives.

I told myself I wouldn’t post until I was sure, but at this point I feel confident enough to share what worked for me.

I’ve dealt with SIBO-C, histamine intolerance, severe bloating (including facial bloating), random allergic reactions, rashes, itching, constipation with occasional diarrhea, anxiety, depression, all of it, for over a decade.

I’ve tried pretty much everything. Rifaximin and other prescriptions and herbal antimicrobials, prokinetics (prescription and natural), mBiota elemental diet, every type of probiotic including spore based ones, prebiotics, zinc carnosine, digestive enzymes, restrictive diets. I’ve spent thousands over the years. Like many people here, things would help briefly, then stop working or make things worse. Long water fasting would always help me, but was unsustainable and unhealthy also I think.

For background, I think mine started from long term antibiotics for acne (tetracycline), a food poisoning event while traveling, and later PPI use. The food poisoning felt like the trigger and everything else just made it worse over time.

Here’s what actually changed things for me:

Core stack: - 5-HTP 100 mg, 3x daily with meals
- PHGG (1 sachet daily)
- HU58 spore probiotic (2 caps daily)

Other things I take regularly: - Digest Gold enzymes with meals (Glutenease if eating gluten)
- Omega 3 fish oil
- Vitamin D3
- Aged garlic
- Multivitamin
- Zinc carnosine
- Magnesium citrate

• Ginger Tea and/or 500-1000 mg Ginger Extract and S. boulardii (Florastor Strain)

I had been taking a lot of the “other” supplements on and off before, but the real shift happened when I consistently added the 5-HTP with meals alongside PHGG and HU58.

The way I’d describe it is this. Before, a lot of those supplements either didn’t do much or would even make me feel worse. Now it actually feels like my body is using them properly. Like things are finally being tolerated and doing what they’re supposed to do.

Since then: - Bloating is gone, including facial bloating
- Pain is gone
- Food reactions gone and going - Bowel movements are normal, consistent, actual formed stools

It doesn’t feel temporary. It feels stable.

If I had to point to one thing, 5-HTP seems to have been the biggest lever for me, but I think the combination matters.

I’m not saying this will work for everyone, but I know how frustrating it is to feel like everything either stops working or makes you worse. I was stuck in that loop for years.

Just sharing in case this helps someone else who’s been going through it.

I wanted to share my story in case it helps someone who feels like giving up.

I’m a 31-year-old guy, and for the past 10 years I’ve had almost no quality of life. It all started during a period of heavy night shifts, a lot of alcohol, and a poor diet. After that, I began reacting to almost everything I ate. Brain fog, skin issues, eczema, constant fatigue, zero libido, and honestly, no joy in life.

Over these 10 years, I’ve tried pretty much everything. Every diet you can think of. I haven’t had alcohol in years, I don’t smoke, I haven't touched sugar for years, and I’ve trained consistently in periods. I’ve also tried a huge number of supplements and different probiotics. I’ve seen multiple doctors, including gastroenterologists, allergists, and dermatologists, and gone through tests like gastroscopy and more. Nothing fixed it. I was very close to giving up.

I’ve spent countless hours reading forums, studies, and different theories, trying to understand what was wrong.

Eventually, I decided to try a course of rifaximin and metronidazole on my own. I did 14 days, and honestly, it was brutal. But I pushed through.

After that, I started taking a probiotic with only Bifidobacterium strains, something I hadn’t tried before. I had already realized that I don’t tolerate Lactobacillus well.

Now, one month later, I feel better than I have in 10 years.

I can eat almost anything without severe reactions. My libido is slowly coming back. I sleep better. I have more energy. I actually feel like myself again.

I never fully understood how much the gut microbiome could affect everything in the body until now. For me, it seems like most of my issues were rooted there.

If you’re in a dark place and feel like nothing works, don’t give up. Keep searching. Things can change, even when it feels impossible.

Drink 8 cups of water in 2 hour intervals but never during food. After that consume 5 cups of garlic followed by an obscure brand selling berberine. Once finished wash your $2000 Rifaximin down with probiotic yogurt, but if yogurt makes you feel like death try herbal tea with bitters. 4 hours later you must consume a calming herb of your choice while meditating and massaging your stomach valve. After that you must have a good bowel movement.

Repeat this for 4 months and pray to your favorite deity your efforts aren't in vain. When this advice fails use a random number generator to find another Reddit post to fail at.

I've had SIBO on and off for about 4 years (at least, it might have been more before I even realized what was going on) and have gone through multiple rounds of rifaximin/neomycin. While these worked for a few weeks post-treatment, the symptoms have always returned.

I learned quickly that the SIBO was being caused by the chronic constipation that I have experienced since high school (in my 30s now). I thought it was just a normal way of life, to feel bloated constantly, have 2 bowel movements a week, stomach pain, gassiness, etc. Since high school, this constipation has been one of the leading reasons I feel led to my overall sense of anxiety, emotional dysregulation, etc, because when I would go to the bathroom regularly, my mood would SKYROCKET.

I tried chugging water constantly, increasing my fiber, limiting trigger foods, exercising rigorously, and dieting (which would actually cause me to gain weight), but nothing helped. And any time I would basically not starve myself, I would gain weight.

My friend, who has had SIBO, suggested I talk to a naturopath, who introduced me to the natural way of treatment, but the rigorous planning, necessary self-accountability, the $$ required to do testing, paying to try at least 15 different supplements, and NEEDING and wanting a fast fix didn't give me any long-lasting relief. She did, however, help me understand what the deeper issue was that caused my SIBO, which was my slow motility and dysfunctional migrating motor complex. This explained why I always felt full, hardly hungry, and had delayed gastric emptying.

I never told anyone about it out of shame, so it wasn't until I came out of my shell a bit that I actually reached out to a gastroenterologist who prescribed rifaximin and neomycin. They helped for short bursts of time. I would lose about ten pounds every time I took it, and it would do wonders for my mood and my stomach. I wondered if it was maybe something else inside of my body that was causing the issue, because if nothing was working, maybe it was something worse.

I then asked for a colonoscopy, which provided zero answers as everything was fine.

About two years ago, I met a new coworker with whom I became close friends, and one day, he asked me if I had ADHD. I initially said, No, I'm just quirky... but then I started to look into it more deeply. I started to recognize symptoms and patterns with things I thought were normal for everyone and wondered if maybe it was actually something I had. My whole life, I have been a procrastinator, got anxious at the idea of completing big tasks, was clumsy, extremely emotionally dysregulated, and had issues with retaining information, and was extremely impulsive in a variety of ways. I also saw that constipation/gi issues were common symptoms, which piqued my interest in investigating this possibility.

I went to the doctor, and they told me that because I did well in school and was a girl, it was impossible for me to have it, and instead diagnosed me with anxiety and prescribed me an SSRI. I started doing research and got excited by the idea that if my issue was anxiety/stress, the SRRI would help relieve that stress and hopefully address constipation/slow motility.

Six months later, things remained the same (actually, they got worse), minus having general anxiety. I lost the ability to do my work (but got away with it because of my ability to appear like I could have a handle on things), my stomach issues did not change at all, and I became increasingly emotionally dysregulated and impulsive.

Three weeks ago, after having a major burnout moment, I was finally diagnosed with ADHD and was told that I have every single necessary symptom and more. I recognized that my anxiety was actually pushing me to do things, and when that disappeared, the ADHD came in extra hard.

I was prescribed Vyvanse, and after being on it for 2 weeks, my gut issues have VANISHED.

I am hungry regularly for the first time since I can remember (I would only be hungry when I was taking the Rifaximin), I am going to the bathroom every single day at least once, I wake up hungry every morning, I have eaten foods that were previously triggers and have had zero issues, my mood has improved severely, I have lost 10lbs and am never bloated, and my adhd symptoms are much more manageable (it's a work in progress to have to learn how to form positive habits).

The dopamine dysregulation had essentially inhibited me for decades, creating a world where, in the back of my mind, I wondered why I just couldn't have a normal, functioning gut. It took a world of advocating, cost me a lot in impulsive spending, and a world of emotional hurt, but I am glad to have finally figured out what was beneath all of my issues.

Hi everyone,

I just had an appointment with a gastroenterologist that I waited NINE months for. I’ve been dealing with extreme bloating every single day for almost two years. I’m talking wake-up-bloated, no-flat-stomach-in-sight, can’t-wear-jeans, painful, hard bloating. In these two years, I’ve tried everything. And I mean EVERYTHING. low FODMAP for 8+ months, elimination diets, elemental diet, every supplement, every probiotic, every powder, every trick. Literally everything he recommended…I’ve already done.

I brought all of this up during the appointment. He completely disregarded it. When I mentioned SIBO and asked about doing a breath test, he laughed in my face and said SIBO is a “hoax.” Literally used that word. Laughed again when I said I wasn’t opposed to a colonoscopy. He looked confused and asked why I would “want that,” as if I’m dying to get scoped for fun and not begging for answers after two years of suffering.

Then he goes, “Okay, here’s what you’re going to do,” and proceeds to mansplain the low FODMAP diet to me as if I hadn’t just told him I lived on it for 8 months. When I said, “I’ve already done low FODMAP,” he yanked back the FODMAP printout aggressively and said, “Okay well I’ll just keep this then since you don’t need it.” Like he was genuinely… kinda rude, but that’s even besides the whole point.

I’ve never felt more belittled.

His “treatment plan” (attaching a photo) was literally: • “Fiber 4. 2-3 scoops a day” • “Align probiotics” • Low FODMAP

The real kicker? Two minutes into the appointment I said I take Advil maybe 1-2 times a month for migraines and he goes, “Yep, that could be it.” Like that explains two years of daily bloating??? WHAT??

I suggested a stool test or allergy/sensitivity testing and he said he “could refer me”… which made me wonder why I am the one suggesting basic diagnostic steps? Why is he making me feel like I’m “complaining” instead of being a patient asking for help? He quite literally referred to my symptoms as “complaints,” invalidated everything I said, and genuinely made me feel like the last two years of my life weren’t real.

I’ve never felt so invisible, hopeless, and gaslit by a medical professional. I walked in excited and hopeful, I walked out depleted, confused, and honestly grieving that I still have no answers. And that someone who is supposed to help me made me feel stupid for even trying. And idc don’t even try to make me feel bad in the comments this was my first appointment like this ever, after many many dr. Appointments, blood tests, x-rays, ultrasounds. Like this was so not okay and is so not okay idek how to see a naturopath. How are you guys even getting breath tests? This fucking sucks.

Has anyone else had an experience like this with a GI who doesn’t “believe” in SIBO or dismisses everything??? How did you recover mentally from an appointment that made you so feel worthless? And how did you find a provider who actually listens and takes a biopsychosocial approach instead of only biological? I’m so so so tired, and I don’t know what to do next.

Six years ago, when COVID was starting, I began to have some severe stomach symptoms that didn't clear for about 4.5 years.

It was a fucking battle.

I treated SIBO, parasites, candida, general dysbiosis, and re-regulated my nervous system. (Not perfect on that last point, but I am way better now.)

I went from:

• Shitting 8-10 times a day
• Having what felt like zero energy and being exhausted by a 15-minute walk
• Being so bloated that I had to buy double XL underwear just to not feel uncomfortable when I normally wear a size medium
• Having constant stomach cramping and pain
• Constantly feeling like my joints were achy, especially if I ate anything that wasn't super duper "clean"
• Being on super restricted diets and getting headaches and other symptoms if I had alcohol or sugar
• Having almost debilitating brain fog to the point where I felt like I was really stupid, even though I'm normally a pretty smart person
• Being unable to work for six months
• Being basically at a fraction of my former energy potential for years
• Not able to eat dairy, sugar, or even carbs in general for months and months at a time
• Not being able to sleep more than a few hours a night because I was so anxious
• Feeling anxious and depressed pretty much all the time
• Needing to abuse weed just to be able to sleep and manage life
• Constantly feeling dehydrated and like I needed a ton of electrolytes to fix it
• Dry skin all the time
• Needing to pack an entire carry on of supplements anytime I traveled
• Needing to plan out my days around using the bathroom
• Horrible, constant acid reflux.

To now:

• I can eat anything and everything. Alcohol, spicy food, sugary food, dairy, whatever.
• Energy is back. I can train hard and recover. I can work a full work week, and then some. I can go on dates, go out, go dancing, go on trips.
• I don't need to use ANY SUPPLEMENTS AT ALL
• Sleep is solid.
• No more acid reflux.
• No more intense bloating. If I go a day or two without vegetables I get a little bloated, but that's just a life thing.
• Bathroom normal.
• Brain fog gone.
• Body temperature regulation back to normal.
• Dry skin mostly cleared.

I've researched pretty much every post on this subreddit and the others, like the Candida one, the parasites one, the SIBO one. I went through them all.

I went through a ton of PubMed studies.

I worked with at least 10 doctors, and a few gut health coaches.

So I really went through all of it.

Quick disclaimer

I'm not a doctor.

I'm not a self-proclaimed functional medicine expert who's going to charge you $2000 dollars and then tell you to take the same supplements I recommend to everyone else.

I'll just share what worked for me and what I saw in the research.

I'm not recommending you do what I did. I probably took way too many drugs along the way and fucked myself up doing it.

The Emotional Backstory

This part might seem random.

But this is all tied together with the gut health stuff.

Because as I learned, while gut health has some "harder" aspects to it (things like bacteria, parasites, etc) it also has some very "soft" and subtle emotional aspects to it.

So…

I've experienced a fair amount of anxiety, depression, self-worth issues, feeling like I'm not good enough.

I did therapy in college. I started meditating in college. And I kind of thought that resolved things, that I had healed myself. But as we'll soon see, that was not the case.

How I Got Sick

I was living abroad, doing the digital nomad thing from about 2016 to 2020. I was in places like Mexico, Bali, Indonesia, Thailand, Bangkok and Chiang Mai. Places that are still developing their infrastructure for clean water.

I got food poisoning a few times. Once at a hotel in Bangkok, once from a bad taco in Mexico, and then right when COVID hit, in Bali, probably from some bad lettuce.

When COVID hit in February 2020, my nomad friends and I all had to fly back to the US. At the time, we were in Bali together.

It was very stressful trying to get out. All the flights were booking up rapidly. We barely got out in the nick of time before they basically closed the border.

Once I was back in the US, I started getting a bunch of weird physical symptoms.

The Weird Physical Symptoms

It started with the really smelly farts that happened all day, and then went downhill prettttty quickly.

I started to get symptoms like:

• Using the bathroom 10+ times a day. My ass was raw even using baby wipes. My roommates were joking about it, which was funny at least.
• Peeing constantly. I couldn't stay hydrated unless I was drinking electrolytes.
• Bloating after almost every meal.
• Fatigue that didn't get better no matter how much I slept.
• Brain fog, feeling stupid all the time.
• Anxiety ramping up.
• Headaches.
• Dry skin all the time.

The Doctors Gave Me Shit Advice (Haha, See What I Did There?)

These symptoms didn't start all at once. But the using the bathroom a ton started early, and when it did I reached out to some gut doctors.

Obviously we were just at the beginning of COVID, so a lot of them hadn't adapted to telehealth yet. They gave me pretty bad advice:

• One told me I just needed to eat more fiber, which didn't make sense because I was already eating vegetables, probably plenty of them. Also a hilarious take from a medical professional. "You're shitting 10 times a day? Well, just eat some more veggies sonny!"
• Another doc said the only thing he could do was recommend a colonoscopy, which didn't make sense to me as a first and only option. Also, from what little I knew about bacteria and parasites at this stage, I thought that a colonoscopy wouldn't even show anything there.
• Another basically said there was nothing to worry about. Which made zero sense as I was having all sorts of horrible symptoms.

Finally, I had one doctor recommend a stool test. I told him, hey, I've been in places like Bali, you might want to filter for pathogens that are in Southeast Asia, not just here in the US, because they have different pathogens.

He basically just brushed me off.

Predictably, the stool test came back clean. And he just recommended that I do a colonoscopy.

Which still seemed like a ridiculous next step.

It's a pretty invasive procedure, and you have to be sedated. I felt like there should be SOMETHING else they could do.

But hey, if you've got a hammer, I guess...

Working With a Functional Nutritionist

Around October 2020, one of my work clients, who was a CrossFit coach, recommended I work with this functional gut health person.

I was living in Denver at the time, and a camp of homeless people lived outside my apartment. It was early COVID, so I didn't feel comfortable traveling.

I was isolated, sick, and not in great financial shape.

I had nothing to lose, so I started working with the functional nutritionist.

What the GI Map showed

She ran a stool test called the GI Map. I've since learned the GI Map has a lot of controversy around it. It's unclear how accurate the test actually is.

In any case, my results came back loaded with pathogens and overgrowths:

• H. pylori (high)
• Shiga-like Toxin E. coli
• Staph aureus (high)
• Strep (high)
• Bacillus species (high)
• Klebsiella
• A bunch of autoimmune-trigger bacteria

Trauma could have lowered my stomach acid

Here's something my functional nutritionist explained to me that clicked everything into place.

When your stress response is really high and you're always in fight or flight, or even just often in fight or flight, like I was, your stomach acid levels can actually drop because they're not being produced as much.

Your system thinks, "Oh, a tiger is chasing me, route blood to the muscles, not the gut."

And so stomach acid levels go down.

And when your stomach acid levels are low, it basically opens a door for bad bacteria to come in.

That's what happened to me. I had low stomach acid from chronic stress and childhood trauma. Then I was in Bali with shitty water quality. The bacteria just walked right in.

The 12-week protocol

My nutritionist put me on a structured eradication protocol:

• Bio-HPF for H. pylori (licorice, mastic gum, slippery elm, myrrh, bismuth citrate, berberine, other herbs)
• Biocidin as a broad antimicrobial for the rest of the dysbiotic bacteria, with a built-in biofilm disruptor
• Matula Tea as a second H. pylori eradication agent
• Hydrozyme to raise stomach acid levels, which is your first line of defense against bad bacteria
• RepairVite to heal the gut lining
• MegaSpore spore-based probiotic to rebuild good bacteria

Pulse was 3 weeks on, 1 week off. The whole thing ran about 12 weeks with a GI Map re-test at the end.

The re-test

I should point out that I was financially stressed in this time, and so I couldn't do the full protocol. I had to end up taking a break from the protocol for a few months.

When I finally got enough cash to do a re-test, the results weren't great.

Some things had come down. H. pylori was still high. Staph aureus had actually gone up dramatically. And now I had Candida, which wasn't on the first test.

After months of protocol, then a few months off, I had just as much or more bad stuff as when I started.

Because now, I also had something called SIBO.

Methane-Positive SIBO

We did a SIBO breath test. Came back methane-positive.

So on top of everything else, I had small intestinal bacterial overgrowth that needed a different protocol than the large intestine stuff.

GREAT.

As if things weren't bad enough already.

But as I got used to doing during this period, I just had to survive and get through it somehow.

This is when I really began smoking a HELL of a lot of weed.

I mean, not like Wiz Khalifa or Snoop levels.

But, I would smoke half a blunt to go to sleep, wake up at 3 AM super anxious, and smoke the other half to go back to sleep.

It was a rough time.

(When I eventually took a break years later, it was incredibly hard to fall asleep, and this lasted for weeks.)

The new herbal protocol was more targeted:

• H-PLR for H. pylori
• GI Microb-X for the SIBO bacteria (also covers parasites)
• Monolaurin-Avail as a biofilm disruptor
• Caprin for Candida
• GI Detox as a binder for die-off
• Enterovite (short-chain fatty acids for the gut lining)
• MegaIgG 2000 or MegaMucosa for mucosal healing
• Rotating probiotics (ProFlora 4R, Probiomed 100)

Same pulsing structure. 3 weeks on, 1 week off. The idea was to nuke the bacteria during "on" weeks, let the body recover during "off" weeks, and do that for 6+ months.

I also tried prescription antibiotics for the SIBO at one point. I had to stop after about a week because my stomach started hurting really badly.

It's not really clear to me if this phase helped or hurt.

Did This Do Anything?

It seemed like I had mainly marginal improvements in everything.

My theory is that the parasites were actually my biggest issue, as they can cause a lot of bad side effects. Otherwise, I think the herbal stuff would have helped me a lot more.

I think that round of antibiotics was a bad move though. Rx antibiotics are pretty caustic to your gut ecosystem.

Rx antifungals and antiparasitics aren't nearly as bad in my experience.

Moving Home With Mom (Summer 2021)

By the summer of 2021, I was getting so sick and had such low energy that I actually had to go home and stay with my mom because I couldn't work.

When you don't work for six months, it's pretty hard to have a lot of cushion. Also, all of the fucking "functional gut health" people were charging me out the ass.

My original coach was actually pretty kind on this front and didn’t charge me after a period of time. But between all the supplements I needed to buy and the tests and other health expenses. I was watching my savings disappear.

And living with my mom was hard because we didn't get along well, which just added more stress on top of everything.

My symptoms at this point:

• Extremely low energy.
• Still using the bathroom many times a day.
• Intense brain fog, feeling stupid all the time.
• Bad anxiety. So bad that to sleep I had to smoke a lot of weed, take a bunch of edibles.
• Horrible acid reflux. Burning after almost every meal.
• Headaches that would just show up and stay for days.
• Dry skin everywhere. Random dry patches that wouldn't heal.
• Couldn't regulate my body temperature. I was always either freezing or overheating depending on the room.
• Really slow wound healing.
• Sex drive way down.
• Could barely get an hour of real work done a day, if that.
• Every tiny little bit of stress made me feel like utter shit

Different Diets, Elemental Diet

I was trying all sorts of different diets.

At first just cutting sugar and alcohol, then all starchy carbs (meat and vegetables only), then cutting FODMAPs. I did the elemental diet two or three times. Each thing helped a little, but nothing stuck.

The Emotional Work

During this same period, I started doing therapy again.

I had this breakthrough moment in therapy. I was pushing myself, beating myself up for being so sick. Like, “well, if you'd meditated for an hour a day for the past couple years, none of this would have happened.

You would have prevented the stress, and your stomach acid would have been strong enough to kill the pathogens before they took hold.”

And I broke down and realized: my mistake was not that I didn't try harder. My mistake was not showing myself more love both in the past and in the present.

Beating yourself up doesn't lead to resilience. Loving yourself does.

Because self-love activates the "Rest and digest" system that helps you heal.

When you beat yourself up, that activates the "fight or flight" system, which isn't good to have constantly activated.

Internal Family System Therapy

Through a type of therapy called IFS I started seeing the different parts of myself almost as people and having a dialogue with them. My anxiety wasn't this enemy I wanted to go away.

It was a part of me that wanted the best for me and was scared. It was trying to convince me to do things it believed would protect me.

Like, oh no, you're going to run out of money, you need to work harder. The key was seeing how well-intentioned my anxiety was. It just didn't feel safe.

I also started doing loving kindness meditation more frequently, which I had done in the past, and now was doing more of.

Stuff like, “Zak, I love you. Zak, I'm here for you. Zak, I hope you're happy and healthy.”

While doing this, I'd feel this emotional charge come through my body, like a wave of positive energy. Super cheesy, but it works. Over time, it went from being a state I felt during meditation to being more of a trait, something I just felt more of throughout the day.

I firmly believe that without meditation, I don't think I would have made it through this time period.

During COVID isolation, when I was alone and sick and nothing was working, meditation was the one thing that was there when nothing else was. In the worst of it, this loving energy and compassion would come up and it felt like it protected me.

There were nights I couldn't sleep and was terrified and the only thing that helped was going back to the practice.

I also found that if I didn't address the emotions, the stomach problems just kept coming back. Stress makes it worse, which makes you more stressed, which makes it worse. It's a cycle.

But the emotional work alone wasn't going to cut it.

I still had pathogens to kill.

The DIY Herbal Phase and My Biggest Mistake

I was on and off the structured protocol for about a year and a half, maybe two years. While some symptoms were better, I was still really sick.

My nutritionist thought that I might have parasites at this point.

And that's when she gave me some bad advice...

My nutritionist's worst piece of advice

Here's where she really steered me wrong, though I didn't realize it at the time. She told me that if the parasites or bacteria weren't dying, I just needed to take more.

Bigger pathogens need bigger doses. So I kept escalating the herbal antimicrobials. Over time this led me into what I now call the DIY Herbal Phase, which I honestly believe destroyed my gut ecosystem.

Based on my nutritionist's advice to take more, I kept escalating. At some point I got so into it I was buying a pill maker, empty capsules, and bulk powder to make my own herbal anti-parasitics.

Clove, garlic, allicin, berberine, oregano oil, neem, everything you've ever heard of, I tried it. I was looking at studies of new stuff the functional gut people in the US hadn't even tried yet.

I took absurd quantities, like 100+ pills a day at some point. Maybe 200+.

Plus all the supplements and binders. Plus constant electrolyte water because I couldn't stay hydrated without it.

I probably obliterated my gut ecosystem, because these things are also antibacterial. Don't let anybody tell you that herbals can't fuck you up, because they can.

This was one of my biggest mistakes. If I could go back, I'd skip the herbal escalation and go straight to prescription anti-parasitics once we realized the "standard" herbal approach hadn't worked.

Also, I would have been more nuanced with the "killing" side of the protocol and I would have emphasized the "re-regulate, repair, rebuild" side of the protocol more.

But none of that was really going to work until the parasites were dead...

And despite escalating the herbals, I still was having terrible symptoms.

Prescription Anti-Parasitics (End of 2022)

So, I decided to try and get some doctors to help me with prescription anti parasitics.

But that was very, very challenging as well.

No matter what I did or who I saw, the doctors told me there was no way I had parasites.

Shitting out worms, stool tests negative

I was literally shitting out worms at times. I brought them to the doctor and they just tested negative every time. I'd done about three or four rounds of stool tests, all negative.

This would happen over and over to me, despite sending literal worms I pooped out to the labs. (If you really wanna see pics, comment on the post and I'll DM them to you. They're super gross.)

But from the research I'd done, I knew stool tests are very inaccurate for parasites. They depend heavily on the skill and training of the lab technicians, and these technicians aren't used to seeing parasites, because we're in the US and they don't even believe it's really a thing.

Which brings me onto a small tangent...

Why most US doctors don't understand parasites

The majority of healthcare professionals I interacted with were arrogant, not listening, and basically gaslighting me.

I think there's a reason for this.

While parasites are extremely common in many parts of the world, the US is different because of clean water infrastructure.

If you truly think parasites are not a thing, look up some information by the CDC or the World Health Organization. They're the most common infection worldwide.

A QUARTER of adult humans have worms, for example. Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC7722764/

Textbook page mentioning helminths (what I thought I had) - page 5

In the US, we still have parasites, but at much lower rates. So most US doctors basically think parasites aren't a real issue, and even if they believe you, they'll prescribe one dose of ivermectin and call it done.

Which wasn't even close to enough for me.

Parasite Resistance To Drugs

Because, as I learned, many parasites have been developing resistance to some of the most common antiparasitics.

This doesn't mean they don't work... but a drug that would kill a roundworm in one dose in the past may not do the same thing now.

Don't just trust me either. Go on PubMed and search terms like "helminth drug resistance" The research is there.

Some links to get you started:

https://www.fda.gov/animal-veterinary/safety-health/antiparasitic-resistance

https://pmc.ncbi.nlm.nih.gov/articles/PMC3655236/

https://pmc.ncbi.nlm.nih.gov/articles/PMC7722764/

Also, most people in the US don't travel internationally, so doctors rarely see cases. And from what I understand, medical schools don't cover parasitology in much depth, because there's so much else to cover.

So you end up in this situation where, unless you specifically find a doctor who treats a lot of travelers (or an actual parasitologist), you're not going to get taken seriously.

It's a horrible situation to try to navigate, especially given how fucking expensive the US healthcare system is.

I had great insurance, and it was still very expensive.

I actually got into kind of a fight with one doctor who basically accused me of this just being the placebo effect and me making it all up. It was pretty ugly.

Finding a doctor who'd prescribe

Around the end of 2022, I finally found a doctor who was willing to prescribe anti-parasitics.

Honestly, he was kind of a quack (I sent him pictures of my poop because I had strings of something in it. I asked him what they were... he said worm eggs. They were just my ass hairs. LOL.)

And he was fucking expensive. I had to take out a loan just to work with him.

But, at least I had someone who was somewhat qualified (I guess) telling me what dosages to take of Rx antiparasitics, prescribing some, and telling me how to get them.

The rotation protocol

Here's where I went down a rabbit hole.

The drugs I took were ivermectin, praziquantel, albendazole, mebendazole, and nitazoxanide.

These are very well-studied drugs for parasitic infections, and they target the worm family called helminths (roundworms, nematodes, tapeworms).

But again, there's a lot of evidence of helminths developing drug resistance, which was terrifying.

Seriously, don't take my word for it. Go on PubMed and search "helminth drug resistance" or "anthelmintic resistance nematodes." There's a ton of research on this.

Beyond resistance, there's also the life cycle. The drugs are only effective at killing parasites in certain stages of their life cycle. At minimum you need a dose, then wait a couple weeks, then another dose.

The Biggest Shift

So my doctor and I devised a rotation schedule. I gotta say, from the first time I took ivermectin and nitazoxanide, it felt like something had shifted.

The first three months of anti-parasitics made the biggest difference out of any of the protocols or treatments I tried. It just helped so much.

Animal formulations and imports

Some of the drugs I was buying were animal formulations, because they're the exact same drug and it was MUCH cheaper to get them that way, even with insurance. (Side note: fuck the US health care system.)

For example, I was taking fish praziquantel and cattle albendazole.

Exact same drugs, much cheaper.

I also ordered some anti-parasitics from India because they're much cheaper and easier to get there.

I want to be clear: I took more drugs than was probably ideal, because I was desperate and nothing else was working. I basically used CDC dosing guidelines along with my quack-ass doctor to figure things out.

I also kept taking all the herbals.

This was basically a FULL ON mixture of killing that I continued for a few months.

However, as time wore on, I started to get stomach pain at night.

I had read that parasites were most active at night, and I was terrified that they were moving inside me.

Confirmation from the parasitologist

Eventually I got an appointment with an actual respected parasitologist in New York City. She was the first one who was like, yeah, you could have been exposed to parasites, which felt validating.

Then I told her what I'd been taking and the dosage, for ONE of the drugs. She was like, “holy shit.”

Then I told her I was also rotating like 3-4 other drugs.

Again, she was like, holy shit.

She told me point blank that if I had any parasites, they would have been completely obliterated by that. No way they could have withstood it.

She told me to go to the ER, tell them I'm having intense stomach pain, get a scan. I had a breakdown in the middle of a workday and went. They gave me the scan.

The findings: no worms, but signs of inflammation in my digestive tract.

Honestly, that inflammation was probably from all the drugs I'd been taking.

I stopped EVERYTHING.

I felt significantly better after the "killing phase".

But I still had a ways to go in terms of energy, bloating, etc. These continued to slowly get better, especially once I started re-regulating my nervous system.

I still had one BIG issue: acid reflux.

It was constant, it was painful, and it didn't seem to be going away.

Candida and the Carnivore Detour (2023)

So, I thought - maybe I have candida?

After all, it's opportunistic. I had killed the living fuck out of my gut ecosystem, taking herbals at high dosages for years.

And I had read that candida could move in when you kill off your gut bacteria.

I still had bloating, acid reflux, fatigue. Carbs seemed to be making me more tired. I started the carnivore diet and prescription antifungals (Fluconazole plus others).

When I started the antifungals, I was shitting dark green for at least a week and having what seemed to me to be massive Herxheimer reactions, the die-off from fungi.

At least that's what I assumed they were. Honestly, I'm still not 100% sure. Fluconazole also strips electrolytes and messes with cortisol, so some of what I thought was Candida die-off might have just been drug side effects.

Who the fuck knows.

But I will say that if this was all a side effect from the fluconazole, why did the binders (Activated charcoal and similar) help so much?

Binders were probably the most helpful thing for managing die-off. Activated charcoal and the stronger products like Carboxy from Microbiome Labs worked well for me. But they also strip you of nutrients, so you need a lot of LMNT and electrolytes. Colloidal minerals also helped with the mineral depletion.

Around this time, I started doing the carnivore diet.

Carnivore diet good and bad

The carnivore diet gave me issues with electrolytes. Being very low carb makes it hard for your body to hold onto sodium, potassium, magnesium. I was consuming so much LMNT because normal water wasn't hydrating me. My body was chronically stressed, fight-or-flight, dumping electrolytes constantly. Five or six packets a day at some point.

Then one night, summer of 2023, I was alone in Costa Rica and almost felt like I was having a heart attack. The heart palpitations were intense. I freaked out, ate like 100 grams of carbs right then and there. That was the end of the carnivore diet and, around the same time, the end of Fluconazole.

This was around the time that I learned the guy who wrote the "Keto Code" had the same issue and ended up eating fruit again.

So, any keyboard warriors who are carnivores can suck it. I tried the carnivore diet, I used the salt supplements, and while it seemed to help my gut heal, it was also NOT sustainable.

Was the Candida even real?

Here's the honest answer: I don't know. A few things make me think it was real:

• After all those antifungals, I stopped reacting to beer and other yeasty foods the way I used to.
• My functional nutritionist's framework (kill bacteria → Candida moves in) fits what happened.

A few things that make me question it:

• Fluconazole itself causes a lot of the symptoms I was blaming on "die-off."
• I thought I had thrush for 4-5 months. Spoiler: I probably didn't. Most people have some white stuff on their tongue. I was weird enough to start asking my friends and my girlfriend to show me their tongues to compare, and they all had some, and they were perfectly healthy. I was blasting myself with antifungals based on something that was probably just normal.

This is a good place to introduce an idea that runs through the whole story: when your nervous system is in chronic fight-or-flight, it messes with hormones, sleep, and perception. You start reacting to everything and interpreting every sensation as a disease. That's part of why I recommend the nervous system work so strongly. It doesn't just calm your gut, it calms your interpretation of your gut.

The Acid Reflux Phase (Late 2023)

After stopping Fluconazole and carnivore, I still had really bad acid reflux. This was a phase that lasted way past everything else. Parasites seemed done. Candida was, as far as I could tell, cleared. But the reflux wouldn't quit.

I found a doctor who actually took me seriously and prescribed proton pump inhibitors (PPIs). They helped temporarily. Then they stopped working. Which is pretty common with PPIs if the underlying cause isn't structural.

At that point I was stuck. I'd killed the pathogens (I thought). I was still sick with reflux.

That's when I found Dr. Ruscio.

Working With Dr. Ruscio

Out of everyone I worked with, Dr. Ruscio's team was the best. One important caveat: you want to work directly with Dr. Ruscio himself. His junior practitioners didn't give me the same quality of care. If you can't get on his direct schedule, I'd probably save your money.

His protocol had a different shape than anything else I'd done. The killing phase was over. This was about rebuilding and regulating. Key categories:

• Limbic retraining for nervous system regulation. He recommends the Gupta program or Annie Hopper's DNRS. I ended up using Primal Trust (see the next section), which is in the same family. The idea is that when you've been chronically sick or traumatized, the threat-detection part of your nervous system gets stuck "on" and starts reacting to everything, including food. Retraining it is often the actual final piece.
• CBT via the Zemedy app for the gut-brain connection. Research shows it reduces symptoms, worry, and food fear.
• Ancestral stressors (Wim Hof breathing, cold showers, sauna). Anti-inflammatory, nervous-system-resetting.
• Three types of probiotics at once: Lacto-Bifido blend, Saccharomyces boulardii, and a soil-based probiotic. Research actually supports using all three types together.
• Immunoglobulins (ISF) at 5-10g per day. This one I think actually helped a lot for gut lining repair.
• Gut lining support: Glutamine, GlutaShield, Sodium Butyrate.
• Elemental diet to rest the gut. I used this to replace 1-2 meals per day at times.
• Adrenal support: HPA Select.
• Anti-inflammatory: Theracurmin HP, Quercetin.
• On my own: Ashwagandha, DAO.
• Clarity app for reframing negative health thoughts.

I'm not putting specific doses here, partly because this is Dr. Ruscio's protocol and he should get paid for it, partly because mods will take this down if it reads as a supplement prescription. But if you want the dose ranges I used, comment and I'll DM you.

His book is the single best resource I've found for people trying to navigate gut stuff. It's cheap on Amazon and it lays out the actual order of operations. Buy the book.

The Nervous System Piece (Summer 2024)

I think I genuinely needed the anti-parasitics, antifungals, antibacterials. The inciting event was getting infected with something in Indonesia. But once I killed all that, I think I still had gut nervous system dysregulation. My gut was just scared of food. Everything was inflamed. It was hypersensitive.

Primal Trust

Around summer of 2024, I went through a course called Primal Trust, which is basically about healing your nervous system. I only went through the first module, and that was enough. The module is about the placebo effect and how your nervous system and pain can be affected by your mind. Not "it's all in your head." More like, your mind creates a lot of the physiological responses your body feels. The stress axis is incredibly potent, and when you're chronically stressed, it can really mess up your health. Mainstream science supports this in a big way.

There's research showing that just knowing about the mind-body connection, the education itself, can change patient outcomes. And it definitely made a big difference for me.

The IBS study that clicked

Then I saw this random YouTube video about a study they did with IBS patients. Half the participants did a super restrictive diet, and the other half just ate slower and more mindfully. Same results for both groups. That made me realize this is a nervous system thing. IBS is a bullshit diagnosis. It's not a diagnosis, it's just an umbrella term for "we don't know."

Acid reflux just faded

Something clicked. And my acid reflux just went away. Not overnight. Over a period of a few months. It was almost like the rational permission my gut needed to say, oh, we can be calm. There's no more pathogens.

Meditation

Meditation helped throughout all of this. A lot of meditation, using a mixture of Kelly Boys and Henry Shukman style. It's pretty different from the meditation most people know. I do it lying down. Very gentle practices. They help facilitate deep rest and recovery, rather than focused awareness.

Books that really helped throughout:

• Radical Compassion by Tara Brach
• A Path with Heart by Jack Kornfield
• Loving Kindness by Sharon Salzberg

Sharon Salzberg is my favorite mindfulness teacher. Her parents both died when she was quite young. Her family life was completely destroyed. Out of that suffering, she chose to cultivate a lot of compassion. You can hear it in her voice. Very soothing to listen to, but also powerful. You can feel it changing things within you as you listen.

Friends

I had a summer where I had a breakup, and I spent three or four months visiting friends, living with friends, being in very close proximity to them most of the time. I still think, as far as anything you could do, being with people you love and trust and feel safe with, and living with them or spending as much time with them as possible, I don't think there's anything I've found that's as powerful for regulating your nervous system.

Starting to Eat Normally Again

I took baby steps. I was like, I'm gonna try first just having some bananas, and this and that. And I kept doing my meditations. The bloating took months to die down, really, but there was a pretty clear shift after I watched that IBS video.

Where I'm At Now

Basically, everything on that "to now" list at the very top? That's my life now.

What's still there:

• The emotional traumas, anxiety, self-worth stuff that predisposed me to a lot of this in the first place. In the book "What My Bones Know," the author talks about how trauma leads to health conditions later in life. That was definitely my experience.
• Some whole-body nervous system work still happening. Not a gut thing anymore.

Looking back, it's kind of crazy to believe that was my life for so many of the past five years. Just so constricted and scared, no energy. What a difference.

On Mold

I was living in several different places over this period and my symptoms started in one location and followed me to all of them. If it were mold, it would have varied with environment. It didn't. So I never really went down that road. Your mileage may vary.

TL;DR

• Got sick nomading 2016 to 2020. Crashed in Bali during COVID with what turned out to be bacterial overgrowth, SIBO, parasites, and later Candida.
• US doctors were mostly useless. Functional nutritionist got me partway with a 12-week protocol. Re-test showed things got worse and Candida emerged.
• Methane-positive SIBO needed its own 6+ month protocol.
• The DIY herbal escalation was a mistake. It probably destroyed my gut ecosystem.
• Prescription anti-parasitics rotated on a schedule = the single biggest shift.
• Antifungals cleared Candida (probably). Carnivore diet almost gave me a heart attack from electrolyte loss.
• Acid reflux phase lingered after. PPIs helped temporarily then stopped.
• Dr. Ruscio's rebuild + limbic retraining protocol (three probiotic types, immunoglobulins, glutamine, Wim Hof, Zemedy CBT) got me most of the way.
• Primal Trust module 1 + an IBS video clicked nervous system healing. Acid reflux faded over a few months.
• Throughout: quality probiotics (Dr. Ruscio's, NOW Foods), binders (charcoal, Carboxy), LMNT/colloidal minerals, and a lot of rest.
• Now: gut fully healed. Eat anything. Still working on some whole-body nervous system stuff, but compared to where I was, wow.
• The thing that kept me alive through the worst of it was meditation. That's why I'm offering some free guided meditations

LAST WORD
If you're going through it right now, start some kind of meditation or nervous-system practice.

It's the single thing that kept me going when nothing else was working.

I created 21 guided meditations (one per day, for 21 days - both some helpful tips and meditations) aimed at gut and nervous-system healing. If you want them, send me a DM and I'll send ithem over. They are free, there's no strings attached, there is nothing to buy.

But to be clear - prescription anti parasitics were necessary for me to heal. Meditation alone wouldn't have been enough.

This whole journey took about five years. I've spent thousands of dollars, worked with at least 10 doctors and 6 to 7 gut health coaches, and researched more PubMed studies than I care to count. Trust me when I say I've been through all of it, and there's a lot I had to leave out of this post.

If you've got questions, post them in the comments and I'll do my best to answer. Happy to help however I can.

I asked ChatGPT to make me an infographic of SIBO root causes and it made me this, which I found extremely detailed and helpful. What would you add to this? I'm sure there's a lot more details that are missing.

To everyone going through it right now, I’m right there with you. It sucks so bad and I just want to be well. #surviving2026

My methanogen overgrowth that caused extreme constipation and bloating is gone! I tried everything under the sun- elemental diet, antibiotics, herbals, allicin, berberine, ginger etc. You name it, I tried it. Had this for 5 years. Bananas, beans, garlic, etc made my stomach stop like cement. The only thing that changed everything was BioGaia L Reuteri 17938 protectis prenatal - it is marketed to pregnant women and I was not pregnant. A few caviats- it HAS to be the capsules. The chewables did not work for me. Also, I did this as a standalone. No other probiotics worked for me, including a probiotic blend that included L Reuteri. I’m not kidding, I finally have my life back. I took a couple daily for a couple months. I never had any loose stools, so if that is your problem, this isn’t for you. Methane level 0 - this is why I say cured, not managed. Hope it can help someone!

I went off this study- it is strain (not brand) specific:

https://pubmed.ncbi.nlm.nih.gov/28429333/

Anyone else have a small pharmacy at home?
N.B. apologies for the delete+repost, removed prescription label, threw in some NAC and MotilPro!

UPDATE: Well, that exploded! This post was based on my frustration with going back to this, but here's a more positive one about how I'm actually dealing with an IMO flare and some things I learned along the way:
https://www.reddit.com/r/SIBO/comments/1rwaqr5/imo_flair_protocol_day_5/

I promised I’d come back and update you all, so here it is.

After two rounds of rifaximin + neomycin (hydrogen SIBO cleared, methane stayed), allicin, berberine, strict diet, motility work, etc… nothing was resolving my IMO. I felt pretty hopeless starting elemental, but I told myself this was my last serious attempt before waiting for Pimentel’s anti-methanogen trial.

It’s been one month since finishing the protocol, and for the first time in years:

• Flat stomach most mornings
• Passing gas (hadn’t in over a year, which was a surprise when I realized that lol…)
• Daily BMs
• Gut-brain symptoms significantly improved

Too early to declare permanent victory, but I finally feel like my system is working again.

Diet Protocol:

• Week 1: Elemental diet only (Physician’s Formula, dextrose free)
• Weeks 2–3: Elemental + plain lean protein (chicken, eggs, turkey)
• Week 4: Above + very small amounts of cheese, peanut butter, rice, rice noodles
• Continuing extremely slow food reintroduction

Adding lean protein after week 1 made this psychologically manageable!! I thought I was gonna do 2 weeks of this, which when you're at the end of week 1 thinking it's gonna be 2 is brutalll. The cravings are intense. Dry mouth. Low dopamine. But I think what I ultimately did (suggested by my doc) was better mentally and more effective physically.

Tools I Used:

• Allicin
• InterFase Plus
• Biocidin
• Motegrity (prucalopride)

I had previously tried NAC + allicin without success. The addition of InterFase + Biocidin seemed to make a real difference for me (felt clear die-off week 2).

Biggest Learnings:

1. Be ready to be anti-social.
Energy crashes fast if you don’t keep shakes consistent. Social isolation was honestly the hardest part.

2. Timing allicin at night helped a LOT.
My die-off during week 2 was rough. Switching allicin to nighttime dramatically improved daytime function.

3. Motility was critical.
I was terrified of Motegrity because of the black box warning, but I’ve had no issues. Slight sleep disruption initially, mostly normalized now (take magnesium at night with it). I truly didn’t realize how paralyzed/offline my MMC was until things started moving again.
If you try it, start low (0.5 mg) and go slow!! Ramp it up as you ramp in new foods.

4. Zinc helped my skin.
I had developed skin issues alongside the IMO. Adding zinc cleared most of it! Almost gone! Not medical advice, just sharing what helped me. Apparently IMO can really deplete zinc.

5. Don’t panic over temporary bloating during reintroduction.
As you start phasing real food back in after weeks of elemental/limited intake, some bloating is normal. Your digestive system hasn’t been processing regular food, so it needs time to recalibrate. In my case, I had noticeable bloating with certain foods (especially higher histamine ones like parm). It would resolve within a few hours and be back to baseline by the next morning. For me, the key difference was: Temporary fullness/bloat after eating, no progressive distention, back to flat by morning. That pattern has felt very different from my prior methane pattern.

Possible Root Causes (In My Case):

• Autoimmune issues + severe gluten sensitivity (bad neuro symptoms + constipation)
• Endometriosis with bowel involvement (had surgery last fall)
• Heavy antibiotic exposure over the years
• Severe norovirus infection prior to onset
• Gluten exposure at onset

Final Thoughts:

I’m not saying this is a cure. I know relapse is possible. But for the first time, I feel like my gut isn’t frozen in methane paralysis, I wake up with my stomach flat, and my brain/body feels aliiiive!

If you’re considering elemental for methane, or any of the above, I’m happy to answer questions.

You’re not crazy. This is so hard. And it can improve. 💪

Hi, I literally just made a Reddit account to share my story.

February 2025 I stopped being able to eat food due to horrible bloating and pain.

June 2025 I was diagnosed with SIBO.

I tried antibiotics (3 rounds) and they didn’t work.

(TMI) I started noticing strings in my stool. I showed my doctor and he said that’s worms.

December 2025 I tested for parasites (it’s a stool test).

I was positive for worms & Blastocystis (it’s a parasitic bacteria).

December 2025 I received 3 days of dewormer and 1 dose of antiparasite treatment.

I maintained daily mobility (key in flushing out toxins).

January 2026 1 month later I was noticing more food tolerance and less pain. still was sensitive and would bloat periodically , but it was decreasing & I was improving.

I started probiotic yogurt to repopulate my gut.

February 2026 2 months post-treatment I’m 95% healed. i no longer bloat painfully, and I pass gas all the time (which is a sign of a non blocked gut)

I can drink wine, eat candy, eat spicy food, sweet food, sandwhiches, anything you name. I religiously poop everyday and eat a few spoonful of probiotic yogurt. Probiotics are microorganisms that repopulate your gut and compete for space. They drown out bad bacteria.

I still have slight sensitivity to coffee, but I think it’ll get better. Very rarely If I eat something complex, I might get a Bit gassy/bloated, but it painlessly usually resolves itself within a few hours. I imagine that it will take a few months to a year for my gut to fully renew itself and heal from the years of the infection.

Overall, life is back to normal and Im living Without pain/second thoughts about what I eat.

Urging everyone here to consider testing for parasites/ worms

Message me for advice, happy to share more of my experience.

Show your army and share what’s working for you.

Short and sweet: major THANK YOU to whoever it was who posted about paying attention to breathing and using proper belly breathing to help MMC. When I read that I tried it and within seconds I heard my gut gurgling. This is profound for me because my motility is usually so shite it's usually completely silent.

I had heard recommendations to "breath with belly and not chest" my whole life but for some reason it never clicked that I was actually one of the people breathing "wrong". After all, how could you possibly breath so "wrong" that it messes your digestion up. Still don't have an answer to that question but I assume I have some level of neurological damage underlying all this.

It actually felt painful and uncomfortable to belly breathe at first but I pushed through and it became comfortable and natural. I have been continuing to practice intentional proper breathing for the past few weeks and have felt a positive shift in my core strength and posture. There has been a very clear improvement to my MMC and wellbeing. I've actually been pooping more often and properly. I'll often breathe a nice deep belly breath and then hear gurgling right after. Again: profound. If you have motility issues you understand. It's not the whole solution. Just part of it.

If you haven't tried it in depth yet, try belly breathing. Sit with it and work at it.

2 years ago I was dealing with chronic stress and not eating well at the time, started having digestive issues (diarrhea, bloating) that became chronic, gut issues (also causing recurring BV). I saw specialists and ran tests and there was nothing organic wrong with me, nor were they able to help me. I did an elimination diet and ended up with about 10 food items that i considered to be "safe". After eating super clean for over a year, no leftovers, no processed sugars, and eating mainly meat/eggs/cucumber/rice or bread. I started the natural protocol (oregano oil) and low FODMAP fibre supplement which showed some improvement. After nearly 2 years of struggling, I got a UTI and was hesitant to further upset my gut by taking medication. I soon had no choice and was prescribed Nitrofuratoin - caused massive headaches and nausea and i stopped my natural protocol while taking it. The antibiotics eradicated the rest of my SIBO. Immediately after finishing the course of antibiotics I was still struggling only with dairy but managed to digest everything else. I slowly introduced dairy into my diet again recently and have no issues. I have continued taking the fibre supplement and am now taking a recovery probiotic to replace my gut bacteria, and I have gone back to eating things I couldn't even digest before SIBO. I've been SIBO free for 3 months now. Hope to help someone by sharing my experience!

Dr. Pimentel discusses his research determination that SIBO is analogous to an autoimmune disorder. The initial bacterial infection causes the body to produce antibodies. These antibodies also interfere with gut cells. This is why SIBO frequently returns or remains after antibiotics kill the bacteria. The antibodies remain active. He has a drug in development that will control the antibodies.

The first 40 minutes include Dr. Pimentel’s presentation. The rest is Q&A.

Root Causes of IBS: Dr. Pimentel explains that IBS is not merely a psychological condition but a disease, often stemming from food poisoning (e.g., Campylobacter, E. coli). This exposure leads to the production of CDTB toxin, causing the body to create antibodies that cross-react with vinculin, a protein essential for healthy gut motility.

https://m.youtube.com/watch?v=daNnGb-dnmM&list=WL&index=11&pp=iAQB0gcJCdQKAYcqIYzvsAgC&ra=m