Small Intestinal Bacterial Overgrowth (SIBO) occurs when an excess of bacteria, normally found in the large intestine, colonizes the small intestine, leading to symptoms like bloating, gas, diarrhea, constipation, nutrient malabsorption and generalized feelings of fatigue, brain fog, and irritability.
For SIBO, I like to recommend a 14-day “Gut Reset” protocol that includes simple dietary and lifestyle changes along with targeted supplementation that includes probiotics, prebiotics, digestive enzymes, and herbs to enhance gut motility…
A critical aspect of reversing SIBO – and keeping it from coming back (which is very common), is to change the gut “environment” (including the microbiome balance, gut integrity, and pH level).
The products that I recommend can be found in my “SIBO Protocol” at Fullscript (see link below). These are “professional level” products that utilize the very best science-supported ingredients – and are available to you at a 20% discount. This product mix doesn’t include absolutely “everything” that I outline in the protocol below, but rather strikes a balance between effectiveness and cost – which is intended to give you the biggest bang for your buck.
https://us.fullscript.com/plans/stalbott-sibo-protocol
Step 1 – “Weed” – Reduce Bacterial Overgrowth (Kill or Suppress Bacteria)
Sometimes, antibiotics are used to “kill” the “bad” bacteria – such as Rifaximin (for hydrogen-dominant SIBO) or Rifaximin + Neomycin (for methane-dominant SIBO), but I prefer to use herbal anti-microbials such as berberine, allicin (garlic extract), oregano oil, thyme oil, peppermint oil, neem, and rosemary. Use them as directed by the specific product (dosages may vary) for at least 1 week, while also removing problematic foods that are “feeding” the SIBO (see below for more on that).
Dietary changes during this 1 week period involve simply reducing your intake of processed foods and also reducing your intake (temporarily) of fermentable carbohydrates (sometimes referred to as a “low FODMAP” diet). FODMAP stands for “Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols” – and refers to carbohydrates that (in some people) are poorly absorbed in the small intestine and can cause digestive discomfort such as bloating, gas, diarrhea, and pain – but these are precisely the types of foods that also nourish the “good” bacteria in your lower GI tract (large intestine or colon).
The problem is that these foods will also nourish the “bad” bacteria (and potentially yeast) that are the problem in SIBO – so we need to remove them temporarily to “starve” the SIBO – and then add them back into the diet to nourish the microbiome.
What the heck is a FODMAP? (avoid these foods for at least 1-week):
1. Fermentable – these carbohydrates are fermented by gut bacteria, producing gas and digestive symptoms (processed foods, bread, muffins, potatoes).
2. Oligosaccharides – found in wheat, onions, garlic, legumes (e.g., beans, lentils).
3. Disaccharides – found in dairy products containing lactose (e.g., milk, soft cheese, yogurt).
4. Monosaccharides – found in foods high in fructose, like apples, honey, and mangoes.
5. Polyols – sugar alcohols found in certain fruits (e.g., cherries, peaches) and low-calorie and low-carb sweeteners (e.g., sorbitol, xylitol, erythritol).
Step 2 – “Seed” – Rebuild a Solid Foundation for On-Going Gut Health
Once the bacterial overgrowth in the small intestine is solved, then we need to re-establish a diverse bacterial ecosystem in the large intestine. But, before we do that (by “seeding” with a broad array of probiotic bacteria), we need to “prepare the soil” metaphorically. This involves a period of Intermittent Fasting, digestive enzymes, and herbal motility enhancers to ensure that the bacteria grows only where we want it (lower large intestine) and not where we don’t (small intestine):
- Intermittent Fasting – activates a gut motility process known as the “migrating motor complex” that helps to “push” the bacteria into the lower portion of the GI tract (and away from the small intestine where SIBO occurs). The easiest way to do this, is simply to not eat breakfast for a week, and consume all of your meals within an 8-hour window from Noon to 8pm each day (you might like eating this way so much that you continue it on most days like I do).
- Digestive enzymes – a broad array of digestive enzymes (e.g. protease, peptidase, betaine HCl, bromelain, papain, amylase, lipase, lactase, cellulase, etc), taken with your largest meal of the day and again right before bed, will help to maintain a “slightly acidic” environment in the gut, which is hospitable to “good” bacteria and inhospitable to “bad” bacteria.
- Herbal motility enhancers – also taken right before bed – such as ginger root, artichoke leaf, chamomile, and peppermint – will help to “move things along” (different than laxatives), which also supports proper pH levels and microbiome balance (and can also significantly help with bowel regularity, heartburn/GERD, and bloating).
- Probiotics and Prebiotics should only be introduced ONLY when the gut is “ready” (after steps 2.1, 2.2, and 2.3) – which will take about one week.
Step 3 – “Feed” – Nourish the Rebalanced Microbiome
Now that the SIBO (and candida/yeast) is gone, and the lower GI tract is “prepped” (we took 1-week to “kill” the bad guys and another week to “prepare” the gut) – we are ready to “add back” the good bacteria Step 2.4 above) – but we also want to include a range of support nutrients for both the microbiome and the gut lining itself, such as L-glutamine and zinc-carnosine (both to prevent leaky gut) as well as specific foods to help grow the protective mucous lining (beans, oatmeal, apples, asparagus, onions, etc).
This is also where choosing the right “strain-specific” probiotics and “structure-specific” prebiotic fibers can make all the difference – and where choosing “generic” probiotics/prebiotics can lead your client (or you!) right back to a recurrence of SIBO. There are so many good “broad spectrum” probiotic products these days – so remember to look for specific strains contained in each formula. For example…
• Lactobacillus reuteri (DSM 17938 & ATCC PTA 6475) – Stimulates gut motility and promotes oxytocin release.
• Lactobacillus casei (Shirota) – Helps regulate gut transit time and prevents stagnation.
• Bifidobacterium lactis (HN019) – Reduces transit time and supports digestion.
• Bacillus subtilis (HU58 & PXN21) – Produces antimicrobial compounds that inhibit harmful bacteria.
• Bacillus coagulans (GBI-30, 6086) – Resilient, supports gut balance, and reduces bloating.
• Saccharomyces boulardii (CNCM I-745) – Beneficial yeast that prevents harmful bacterial overgrowth and supports gut barrier integrity.
• Bifidobacterium longum (1714 & NCC3001) – Supports stress resilience and cognitive function.
• Bifidobacterium infantis (35624) – Enhances serotonin production and supports mood stability.
• Lactobacillus plantarum (299v) – Supports immune function and reduces intestinal inflammation.
• Bifidobacterium breve (BB-03) – Modulates inflammation and helps rebuild microbiome diversity.
• Lactobacillus salivarius (UCC118) – Helps with gut barrier protection and immune regulation.
Same goes for specific types of prebiotic fibers, with some of the best research-supported prebiotics being Wellvine (chardonnay grapes), Benicaros (carrots), Sunfiber (guar beans), and Bimuno (lactose), etc.
In summary – alleviating SIBO – and rebuilding a diverse and resilient gut microbiome – is really quite straightforward – with the right plan of “Weed-Seed-Feed” – but it takes about 2-weeks of consistent attention as described above – and is WELL worth the effort in terms of the improvements in both physical health and mental well-being that will result.
Here again is the (discounted) product regimen: https://us.fullscript.com/plans/stalbott-sibo-protocol
Hope this helps – and please let me know any questions in the comments section below…
