Dysbiosis- #1 Overlooked Cause of Weight Gain - Dominick Hussey

Dysbiosis – #1 Overlooked Cause of Weight Gain

According to Statscan one in four adult Canadians are obese or carry excess weight. For some of these people, the cause of their weight gain is due to diet and lifestyle. For others, the reason seems less obvious. They eat well and do a right amount of exercise but still the pounds roll on. Some of these people visit their family physician for a medical explanation. Their doctor checks their thyroid but after testing that everything appears normal. Read on to learn about the #1 overlooked cause of weight gain that may be stopping you lose those unwanted pounds.

Dysbiosis – The Cause of Weight Gain for Susan

Susan, 44, came to me complaining of bloating, constipation, abdominal pain and weight gain. The digestive symptoms began one year previously shortly after a round of antibiotics. Her doctor gave the antibiotics for a chest infection. Susan had never before had digestive issues and so being health conscious went back to her doctor. Her doctor said that she was reacting to the antibiotics, which would resolve itself and in the meantime prescribed Laxaday (a laxative) for constipation and acetaminophen for the pain.

Susan took the medication for a month, but each time she tried to stop them her symptoms returned. Again she went back to her doctor who suggested she may have irritable bowel syndrome (IBS) and referred her to Gastroenterologist (GI) consultant for a proper diagnosis. After waiting two months for her appointment, she spent 10 minutes with the GI consultant who agreed with the diagnosis and advised her to manage her symptoms with her current medication. During the same consultation, Susan asked the consultant about some recent weight gain. She had put on 10 pounds in a month. The consultant replied that it was not their area of expertise and told her to ask her family physician.

Keen to find answers she went back to her doctor for an explanation for her weight gain. She told her doctor that her mother had a low thyroid and wondered whether that might be causing her weight gain. Her doctor agreed and sent her for blood work, but the results came back as normal.

For the next seven months, Susan put on another 20 pounds despite being careful with her calorie intake and increasing her exercise. Nothing would help, and she was becoming depressed about her weight. It was at this point after speaking to a friend who was a client of mine that she came to me for a functional medicine consultation.

As a functional medicine practitioner, I am trained to take a very in-depth case history and spend a long time (45 minutes) listening to our client’s story. This process allows me the best opportunity to identify the root cause of my client’s health issues.

After hearing Susan’s story, I told her that the cause of her weight gain might be the result of her poor digestion. More specifically I was suspicious she had dysbiosis.

Dysbiosis is an imbalance of bacteria that live in your intestines.

Research on Weight Gain and Dysbiosis

There is a growing amount of scientific evidence that there is an association between the makeup of the microbiota and weight gain. In studies of twins who were both lean and obese, researchers found that the thinner twin had a much more diverse microbiota compared to the fat twin.

The fact that we associate microbiota diversity with weight gain does not mean one affect the other – cause and effect. To demonstrate cause and effect researchers devised a novel experiment where they bred two same bacteria-free mice. Then they populated their guts with bacteria collected from obese women and their lean twin sister. The mice ate the same diet in equal amounts, yet the animals that received bacteria from an obese twin grew heavier and had more body fat than mice with microbes from a thin twin. As expected, the obese mice also had a less diverse community of bacteria in the gut.

In my practice, the #1 cause of dysbiosis is from medication most commonly antibiotics but also birth control medicine.

Dysbiosis is present in certain gut infections including small intestinal bacterial overgrowth (SIBO), candida and parasites.

To identify the cause Susan did a breath test for SIBO and a stool test to look for candida and parasites.

Susan was positive for SIBO.

To treat the SIBO, I put Susan on low FODMAP diet and various antimicrobial supplements to help balance and reduce her bacteria.

After two weeks, Susan reported 90 percent improvement in her digestive symptoms. After four weeks, she had lost 8 pounds. After ten weeks she had lost a further 10 pounds.

After 15 weeks her SIBO was gone (after retesting), and she was back to her healthy weight.

Susan was, of course, was thrilled and at the same time was amazed how treating her digestion had reversed her weight gain.


This article is not intended to provide medical advice, diagnosis or treatment.

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SIBO Die Off Symptoms and Treatment Reactions - Dominick Hussey

SIBO Die Off Symptoms and Treatment Reactions

When taking treating SIBO with either herbs or medication, you may experience SIBO Die Off symptoms. This phenomenon is known medically as a Jarisch-Herxheimer reaction, or “Herx,” for short.

Read on to learn about SIBO die off symptoms, why they occur, and the difference between die off symptoms and treatment reactions.

8 Common SIBO Die Off Symptoms

  • Fever
  • Muscle Aches
  • Chills
  • Headaches and Migraines
  • Rashes
  • Excess Mucus
  • Brain Fog
  • Increased Diarrhea, Constipation, Bloating and Gas

What is the cause of SIBO Die Off Symptoms?

This cause of SIBO die off symptoms depends somewhat on the specific mechanism of the herb or medication antimicrobials, but in many cases, the antimicrobials work by destroying the cell membrane of the bacteria.

When that happens, the bacteria release toxins known as lipopolysaccharides (LPS) into the intestines. If the lining of the gut
is permeable or leaky, the poisons will pass into the bloodstream.

The toxins will travel around the body resulting in the SIBO die off symptoms. This is the reason why you will often feel worse before they feel better or may alternate between feeling better and worse throughout the SIBO treatment protocol.

SIBO Die Off Symptoms Versus Treatment Reactions

Of course, not every adverse reaction to a SIBO treatment is a Herx response. In some cases, you may be reacting to the antimicrobial itself, perhaps a filler in the drug or a component of one of the supplements.

Unfortunately, it’s not always easy to determine the difference between a Herx and a reaction to the treatment, but there a couple of general pointers.

Herx reactions should pass or at least shift after a few days. You will start to feel better a few days after the die off symptoms, or you may alternate between feeling bad and feeling better than they felt before the treatment.

With a reaction to the treatment itself, patients usually feel bad continuously and do not improve even after several days or go back and forth between better and worse.

In my opinion, if you are experiencing SIBO treatment symptoms, it is crucial that you immediately discontinue treatment and contact the practitioner managing your case.



This article is not intended to provide medical advice, diagnosis or treatment.

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5 Supplements To Reduce The Christmas Dinner Bloat - Dominick Hussey

5 Natural Supplements That Help Reduce The Christmas Dinner Bloat (Today)

Have you ever felt bloated and sleepy after Christmas dinner?

As a young lad after eating my grandmothers Christmas dinner, I would look like I had swallowed a soccer ball and would soon be sound asleep on the sofa.

Dial forward some 45 years after learning I have celiac disease I can understand why young body reacted in such a way to a meal full of wheat.

My solution is simple I just avoid wheat and can then sit comfortably on the sofa and watch the Christmas day movie without falling asleep.

Have you felt bloated after Christmas dinners?  Do want to avoid the same experience this year? If you do feel bloated, read on to learn more about which supplements I recommend.

Supplements to reduce the Christmas dinner bloat

Increase your stomach acid production

One of the most common reasons for bloating after eating is due to a lack of acid production in the stomach. Stomach acid helps break down protein-rich foods such as turkey. If you have low stomach acid, then the turkey will not be broken down sufficiently and will cause bloating. Reduced stomach acid related bloating occurs 5-10 minutes after eating.

To help increase stomach acid production, I suggest the following supplements:

  1. Braggs Organic Apple Cider Vinegar – take one tablespoon in some warm water 5-10 minutes before eating.
  2. St Francis Canadian Bitters – take one teaspoon 5-10 minutes before eating.
  3. Betaine HCL capsules – take one capsule during the meal.

Stimulate Digestive Enzymes

Digestive enzymes are mainly produced by the pancreas and by the cells that line your small intestine. These enzymes help to break down your food’s macronutrients such as protein into micronutrients such as amino acids. If you have reduced enzymes and foods are left in their macronutrient form this can lead to inflammation and bloating. This inflammation and resulting bloating can be much worse if you have a sensitivity to a particular food protein such as gluten or casein. Pancreatic deficiency bloating becomes apparent 30 minutes after eating.

To help increase production of pancreatic enzymes, I suggest the following supplements:

Reduce Gas Production from Small Intestinal Bacterial Overgrowth

Small Intestinal Bacterial Overgrowth or SIBO is condition occurs when bacteria that normally live in the large intestine overgrow onto the small intestine. A common symptom of SIBO is bloating that occurs roughly 30 minutes after eating. I find SIBO in the vast majority of my clients with or without digestive symptoms such as bloating.

To help reduce bloating from SIBO, I suggest the following supplement:

What supplements should I take?

If you are unsure what supplements to take, I suggest the following:

Determine when your bloating starts after eating. If it starts 5-10 minutes after eating, then you probably have inadequate stomach acid. I would then begin with the apple cider vinegar.

If the bloating starts later, then consider starting with the Bitters. If the bloating continues, then try the probiotics.



This article is not intended to provide medical advice, diagnosis or treatment.

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SIBO breath test preparation: Best Practices - Dominick Hussey

SIBO breath test preparation: Best Practices

To obtain the best possible results from your SIBO test, you should be aware of the correct guidelines on SIBO breath test preparation. Instructions may vary from lab to lab which is a little confusing.

However, read on to learn about the current (at the time of writing) best practices for preparing for a SIBO breath test.

Two weeks before the test:

  • You must stop taking any antibiotics or antimicrobials herbs.
  • You must not have done a colonoscopy or barium enema.

You should not be experiencing any atypical diarrhea.

Four days before the breath test, you would instruct the patient to stop all laxatives including medications, herbs and high-dose vitamin C and magnesium.

48 hours before, you should avoid all high-fibre and lactose-containing foods, condiments, spices and herbs.

Twenty-four hours before the test, you should stop all non-essential medication.

Between 24 and 12 hours before the test, you should only eat meat, fish, or poultry, plain steamed jasmine rice, eggs and clear meat broth, no bone broth, small amounts of fat and oils, salt and pepper, and maybe weak black coffee and tea.

12 hours before you should begin a water fast, where you avoid everything except for water.

On the day of the test, you should awake at least one hour before the test.

You may brush your teeth and no smoking or vigorous exercise within one hour before the collection.



This article is not intended to provide medical advice, diagnosis or treatment.

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Fundamental Elements For A Natural SIBO Treatment Protocol - Dominick Hussey

Fundamental Elements For A Natural SIBO Treatment Protocol

Because of the complicated nature of SIBO, no definitive natural SIBO treatment protocol works for everybody.

That said, in my opinion, we should consider four fundamental elements in a natural SIBO protocol. These elements include :

  • Antimicrobial Herbs and Probiotics – to kill the bacteria
  • Biofilm Disruptors – to break down bacterial biofilms
  • Bacterial Activator – to encourage

Read on to learn about some of the supplements that I use in my practice that encompass the above four elements within a natural SIBO treatment protocol.

Antimicrobial Herbal Supplements

There are two approaches to treating SIBO with antimicrobial herbs. Some health practitioners use a single herb supplement while the others use combination product.

Currently, there is no scientific evidence to show that one approach is better than the other. I use combination products in my practice purely by convenience and cost.

Due to lack of accessibility in Canada, there is only one antimicrobial formula I use in my natural SIBO treatment protocol.

GI Microbe X is antimicrobial formula produced by Designs for Health. The product is a blend of antimicrobial, antifungals and anti-parasitic herbs.

If you live in the United States, a product that is similar to GI Microbe X is GI-Synergy. GI-Synergy is a blend of three products from a company called Apex Energetics.

Biofilm Disruptors

Biofilms are composed of extracellular polymeric substances (EPS). Bacteria in the gut surround themselves with biofilms as a protective measure. Within a natural SIBO treatment protocol, we use biofilm disruptors to break down the biofilms.

Within my practice currently, use one supplement as a biofilm disruptor.

Acetylcholine is an organic chemical that functions in the brain and body of many types of animals, including humans, as a neurotransmitter—a chemical released by nerve cells to send signals to other cells. Supplemental acetylcholine has been shown by researchers to be effective in breaking down biofilms.

Another well-researched biofilm disruptor is Lauricidin, which is monolaurin. Lauricidin is a particular form of monolaurin, which is an extract of lauric acid.
You can find Lauric acid in coconut oil and mother’s milk.

Lauricidin has activity against yeast, viruses, and bacteria, and also some action against biofilm.

A recent study tested the activity of 15 phytochemicals against Borrelia burgdorferi, which is the bacterium that causes Lyme disease. Monolaurin was one of the four most effective botanical compounds and only one of two that affected Borrelia biofilm. Importantly, it did not cause toxicity to human cells.

Interface Plus is also a biofilm disruptor.

Bacterial Activator

A bacterial activator is a compound that encourages bacterial cell division. When treating SIBO with antimicrobials bacteria go into survival mode by becoming dormant and stop dividing.

Hydrolyzed Guam Gum or PHGG is a supplement I use a bacterial activator. PHGG is a type of guar gum that has a lower molecular weight. It dissolves completely in water and has no taste, and it’s straightforward to
consume for that reason.


In a natural SIBO treatment protocol probiotics are used for their antimicrobial properties.

Currently, I use two probiotic supplements, Prescript-Assist and MegaSporeBiotic.

Prescript Assist

Prescript-Assist is a blend of 29 strains of soil-based organisms. Soil-based probiotics mimic the flora in traditional diets, ancestral Paleo type of diets.

The benefits of Prescript assist include:

  • It is shelf-stable when stored at a temperature below 98 degrees Fahrenheit.
  • The bacteria are highly resilient to stomach acid.
  • It has been supported by peer-reviewed, published, long-term studies.
  • It’s better tolerated than most probiotics I’ve worked with, especially for people with SIBO who don’t tend to tolerate probiotics very well.
  • The bacteria species in Prescript-Assist secrete antimicrobial peptides, which is one of the main reasons that I use it.


The bacteria in MegasporBiotic are known as transit commensal organisms that use an environmental vector, the soil, in this case, to gain exposure to hosts.

These organisms spend about 21 to 27 days in the gut, and they perform a variety of essential functions. One of these is secretion of antimicrobial peptides or antibiotics. Like Prescript-Assist, MegaSporeBiotic is shelf-stable and well tolerated.

MegaSporeBiotic contains an organism called Bacillus clausii, which is the most frequently prescribed probiotic in the world. Bacillus clausii has been shown to help SIBO.

In one study participants diagnosed with SIBO using a glucose breath test were given Bacillus clausii for one month. One month later researchers found that 47 percent of the subjects had a normal glucose test.

Other Useful Supplements to include in a Natural SIBO Treatment Protocol

Depending on presenting symptoms there are five additional supplements that, in my opinion, are worth considering within a natural SIBO treatment protocol.


Iberrogast is a blend of nine herbal bitters that stimulate both bile production and gut motility. Because Iberogast helps with gut motility, I will tend to use it in patients who have constipation.

I will use Iberogast in patients who have significant gas and bloating because it helps with that a lot.


MotilPro is a prokinetic supplement, which means it stimulates gut motility, but it does it in a different way than Iberogast.

MotilPro contains 5- HTP, which is a precursor to serotonin, and serotonin stimulates gut motility.

Betaine hydrochloric acid (HCL)with pepsin

Betaine HCl is stomach acid, and pepsin is an enzyme that helps with protein digestion, which is often impaired in SIBO patients. Including this supplement in the protocol often make patients more comfortable and helps with their symptoms.

Digestive Enzymes

Digestive enzymes help with the breakdown of protein, carbohydrates, and fat and can be useful for patients with severe gas and bloating.


Phosphatidylcholine is useful for patients with fat malabsorption and impaired bile metabolism.


This article is not intended to provide medical advice, diagnosis or treatment.

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Guidelines for Treating SIBO with Xifaxan - Dominick Hussey

Guidelines for Treating SIBO with Xifaxan

When considering using antibiotic treatment of SIBO, Xifaxan is the most well known and researched. Xifaxan is the treatment of choice for the majority of medical doctors for SIBO. As a non-prescribing health practitioner, I predominantly recommend botanicals, but I do see a place for using Xifaxan in the treatment of SIBO.

In this article, I outline the benefits and disadvantages of Xfaxan, Xifaxan versus Refaximin, Xifaxan versus a herbal protocol and common Xifaxan treatment protocols.

Advantages of Xifaxan over other antibiotics

Xifaxan is a unique drug with some unusual properties that mean it has some benefits over other antibiotics.

  1. 99.6 percent of Xifaxan remains in the gut. Because of this localised activity, it has risks compared to other antibiotics.
  2. Xifaxan has very low potential for drug interaction
  3. Xifaxan does not have a significant impact on the colon and the microbiota. On the contrary, some studies have shown that Xifaxan increases numbers of beneficial species including Bifidobacterium and F. prausnitzii.
  4. Rxifaxan is remarkably safe for an antibiotic. In a study published in 2014, Researchers found that when subjects took Xifaxan for up to two years at a dose of 1,100 milligrams per day, there was no increase in the rate of infections, including with Clostridium difficile, or development of bacterial antibiotic resistance.

Disadvantages of Xifaxan

There are two main disadvantages of Xifaxan

  1. Xifaxan is very expensive. Xifaxan cots between USD 1,000 and 2,000 for a month-long course.
  2. There is no approval of Xifaxan for the treatment of SIBO in the United States. I am not sure about in Canada.

Xifaxan versus Refaximin

It is important to realise that Xifaxan and Refaximin are technically not the same drugs. Xifaxan is the brand name while Refaximin is the generic name of the drug. Because Refaxamin is generic by definition, it is much cheaper to buy. However, regarding research, the majority of the studies that have been looking at the efficacy and safety of the medication were using Xifaxan.

Xifaxan versus a Herbal protocol

In my practice, two situations lead me to consider recommending Xifaxan.

  1. If a patient has tried a botanical protocol and failed
  2. If the patient is hypersensitive to the herbs or suspects that they won’t tolerate a botanical protocol

Common Xifaxan Treatment Protocols

From research, there are two chief Xifaxan dose regimens commonly in use for adults. Rifaximin comes in 200 milligrams and 550-milligram quantities.

  1. 400 milligrams three times a day, which is a total of 1,200 milligrams a day for 10 to 14 days
  2. 550 milligrams three times a day, which is 1,650 milligrams a day for 10 to 14 days

Th second dose is what’s more commonly used by specialists who treat SIBO at this point.

For children, studies have used different protocols including:

  1. 600 milligrams per day for seven days that led to a 64 percent normalisation of lactulose breath test in kids ranging from three to 15 years of age that are an average of 10 years old.
  2. Other studies in kids with IBD who were treated with rifaximin. They used dosages ranging from 10 to 30 milligrams per kilogram of body weight and achieved a 61 percent symptom relief.



This article is not intended to provide medical advice, diagnosis or treatment.

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Guidelines For Using An Elemental Diet For SIBO - Dominick Hussey

Guidelines for Using an Elemental Diet for The Treatment of SIBO

An elemental diet is a liquid formula consisting of powdered nutrients in pre-digested, easily absorbed form.

The main ingredients of an elemental diet include:

  • Amino acids
  • A carbohydrate, typically maltodextrin in commercial formulas
  • Fat, which is industrial seed oils in commercial formulas
  • Vitamins and minerals

Studies show that an elemental diet has an 80 to 84 percent success rate in eradicating SIBO.

So an elemental diet is arguably the most effective treatment for SIBO and has been shown to be safe without risks and complications.

Disadvantages of the Elemental Diet

However, there are some disadvantages of using an elemental formula including:

  1. They are expensive
  2. They taste awful!
  3. They are they are high in sugar like maltodextrin
  4. The fats in commercial formulas are industrial seed oils
  5. The patient can’t eat solid food for two to three weeks
  6. They can lead to significant weight loss if the patient is underweight already
  7. Many people that do an elemental diet develop a thick white coat on the tongue, which could be indicative of oral thrush or candida overgrowth.

Elemental Formulas

Vivonex Plus

The main formula used in studies to test the efficacy of elemental diets is Vivonex Plus which is made by Nestlé.

As I mentioned above the ingredients are not very healthy. The main constituent in the Vivinex Plus formula is maltodextrin made from corn. The formula also includes modified corn starch and soybean oil.

Absorb Plus

Fortunately, there are some alternatives to Vivinex Plus including Absorb Plus.

Absorb Plus is formulated by Jenny Patel-Thompson, a nutritionist that suffered from severe IBD and healed herself with an elemental diet.

Absorb Plus uses whey protein in addition to freeform amino acids. The carbohydrate source is maltodextrin as well, but it is derived from tapioca.

Absorb Plus does not contain any fat, so you can add your fat using coconut oil or medium-chain triglyceride (MCT) oil.

Two downsides off Absorb Plus are that it never been tested in a study, and it’s not technically a pure elemental formula.

Absorb plus contains whey protein which is not an amino acid, so it may not be as readily digested as amino acids.

Dr Alision Siebecker’s DIY Elemental Diet Formula

Dr Allison Siebecker is a naturopathic physician in Oregon who specialises in treating SIBO. She has a do-it-yourself elemental diet formula recipe which is freely available on her website.

Bear in mind, and this formula has also never been tested in a study.

General considerations for using an Elemental Diet

Duration of Use

Two weeks is standard duration, although you can go as long as three weeks. In my opinion, people should be closely supervised by an experienced health practitioner.

Combining treatments

In my opinion, I would not recommend mixing an elemental diet with herbal or antibiotics treatments.

When to use an Elemental Diet for SIBO

Typically, in my opinion, you should consider an elemental diet as a last resort treatment if herbal and rifaximin therapies have failed and test results have continued to be unequivocally positive.

These types of people will often relapse, unfortunately, and usually will require periodic retreatment.

Retreatments may take the form of an elemental diet, botanical or drug protocols.

If you are the type person who is continually experiencing recurrence, then it is crucial that you are your health practitioner continue looking for the underlying cause or mechanism.



This article is not intended to provide medical advice, diagnosis or treatment.

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Why and When to do a SIBO Retest - Dominick Hussey

Why and When to do a SIBO Retest

Once you have treated SIBO it is essentially important to do a SIBO retest. This is probably the number one mistake practitioners make when dealing with SIBO.

Read on to learn about the reasons why it is vital to retest after treatment and the best time to do a SIBO restest.

Why a SIBO Retest is so important

Retesting is a crucial component in the successful treatment of SIBO.

If you do not do a SIBO retest will not know if the treatment was successful.

You need to remember that symptom improvement occurs before the breath test normalizes. If you stop the treatment when symptoms improve, there’s a very high likelihood of recurrence.

If you do not improve from treatment, it doesn’t mean the treatment didn’t work. It could mean it did work, but the symptoms you were experiencing, despite being symptoms consistent with SIBO, were not actually related to SIBO.

We know from research that 20 percent or more of controls that don’t have symptoms have SIBO. So it is possible that if you have SIBO, it may not actually be causing their symptoms.

So the key principle here is “test, don’t guess.” and this is what separates a good treatment from a poor treatment.

When to do a SIBO Retest

In general, I recommend retesting two weeks after the end of treatment.

During that period, you should not take any antimicrobials and probiotics.


This article is not intended to provide medical advice, diagnosis or treatment.

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SIBO Relapse Causes and Management - Dominick Hussey

SIBO Relapse Causes and Management

SIBO relapse is a common occurrence. According to research SIBO relapse rate ranges from 44 to 50 percent.

Those high figures are probably due to using doses that are high enough or durations that are long enough.

One study found a SIBO relapse rate of 13 percent at three months post-treatment, 28 percent at six months, and 44 percent at nine months. The significant caveats of that study, though, were that the probability of recurrence was increased with older age, constipation, a history of appendectomy, and chronic PPI use.

That said SiBO relapse is a significant issue.

Read on to learn about the number one reason why SIBO relapse occurs and some strategies to manage and prevent reoccurrence.

SIBO is as much a symptom as it is a cause.

The authors of the above study wrote that without correcting underlying mechanisms that lead to bacterial colonisation of the small bowel, SIBO would recur.

So, this highlights the point that SIBO is as much a symptom as it is a cause.

The key takeaway here is that if SIBO continues to recur, it probably has to do with not correcting an underlying mechanism.

Not dealing with the underlying cause, in my opinion, is the #1 reason why SIBO relapse occurs.

Guidelines for managing a SIBO Relapse

If you have a relapse of your SIBO symptoms, it is essential you get a retest.

If this is your first follow-up test, then you should try a different treatment.  If you did a botanical protocol, you could try a  treatment with Xifaxan. If you took Xifaxan, you could try a herbal protocol.

You could also consider extending the duration of the treatment depending on the test results.

If the test results were relatively low, a shorter duration is fine, but if they were elevated, you might try a more extended period.

If trying a different treatment fails to produce a negative test result, you may consider an elemental diet.

If your test results repeatedly test positive, you need to start considering the potential underlying mechanism that may be causing the SIBO.

Possible causes of SIBO include gut dysbiosis, parasites, infections, heavy metal toxicity, mould, biotoxins, or other chronic infections like Lyme Disease as well as HPA axis dysregulation (aka Adrenal Fatigue) and past emotional trauma.

If you have ruled out all of the above or if the mechanism cannot be addressed, for example, you have a disease or a mechanical problem that impairs gut motility, and you may need periodic retreatment with botanical or Xifaxan protocols.

Additional steps to reduce the likelihood of recurrence


The first is using a prokinetic, which is an agent that increases gut motility. One theory on why SIBO recurrence is common is that SIBO involves the dysfunction of the migrating motor complex or MMC.

The MMC has a cleansing function in the intestine. A dysfunctional MMC can lead to bacterial overgrowth. Prokinetics stimulate the MMC which would counteract this tendency.

There are three types of prokinetics, herbal, nutritional and Medications.

Iberogast is a herbal prokinetic which has a been shown in research to be clinically valid. It has also been used in Europe for many years.

MotilPro is a nutritional type prokinetic. Motil Pro contains 5-HTP which is a major neurotransmitter in the gut that affects motility.

Drug type prokinetics include a low dose of Naltrexone or a low dose of Erythromycin.

The recommended duration you should take prokinetics is between 3-6 months.


Limiting fermentable carbohydrates is not good during the treatment with antimicrobials, however, it may be a useful measure to prevent recurrence of SIBO.

Possible diet options here would be a low FODMAP diet, or a low fermentation potential diet, which is a diet introduced by Dr Norm Robillard.

One downside to using these diets is that studies show that long-term low FODMAP diets can lead to reduced diversity in gut flora in the colon.

A kind of middle ground approach might be better by doing a low-FODMAP diet and using a soluble fibre like partially hydrolysed guar gum to continue to feed the beneficial gut bacteria.


This article is not intended to provide medical advice, diagnosis or treatment.

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