Dr. Paul Deglmann
Meghan Feir Walker
Many patients who have had to deal with SIBO have likely had issues with it coming back after treatment. Unfortunately, SIBO recurrence is a common experience, but there are measures that can be taken to minimize its chance of returning.
SIBO can be a frustrating condition to manage and overcome, but it’s doable when you have the right protocol and plan in place. It requires patience and lifestyle changes, but focusing on the small, sustainable changes you can make can contribute to your long-term wellness.
Understanding SIBO
As a little refresher, small intestinal bacterial overgrowth (SIBO) is a condition that occurs when bacteria that are supposed to stay in the large intestine/colon begin to travel upward into the small intestine. These bacteria then begin to feed on the food in our small intestine, creating a fermentation process that can lead to significant symptoms.
Is it common for SIBO to recur?
Even after following a SIBO diet for a time and following protocols, the SIBO recurrence rate is extremely high. It’s estimated that between 30-60% of SIBO cases will recur within the first year of treatment, according to the most recent research. But why does SIBO so easily come back after treatment?
Many factors can play a role in SIBO development and recurrence. For example, if a patient has yeast/candida overgrowth, low stomach acid, and SIBO, they may treat the SIBO, but the other conditions can cause it to return if not addressed properly. These other underlying conditions can also be the sole cause of these SIBO-like symptoms.
Top reasons why SIBO returns:
- Low stomach acid or chronic use of PPIs
- Motility issues
- A history of GI surgery
- Suppressed immune system
- Additional factors that may be present along with the SIBO that can contribute to very similar symptoms: Food sensitivities, yeast/candida overgrowth, parasite overgrowth, low stomach acid, low digestive enzyme output, poor gallbladder function, etc.
- And more
Please note: Mold exposure is a common cause of stubborn SIBO-like symptoms, but in this case, the symptoms are caused by mold/fungi, not bacteria. The symptoms can be extremely similar, even though it is technically not SIBO.
Symptoms of SIBO coming back
The most common SIBO symptoms range from stomach to brain issues, even playing a role in mood.
Common SIBO symptoms:
- Bloating/gas (especially after eating)
- Abdominal pain
- Constipation
- Diarrhea
- Heartburn
- Indigestion
- Nausea
- Fatigue
- Brain fog
- Malnutrition
- Sense of fullness after eating
- And more
What are the symptoms of SIBO die-off?
When we are trying to eliminate the bacterial overgrowth in a SIBO protocol, some people can experience Herxheimer or die-off detoxification symptoms. This is when the bacteria release toxins (endotoxins), which cause the immune system to go into overdrive and also make your liver work harder to detoxify and excrete the toxins.
Due to this process, you may see a temporary increase in your SIBO symptoms (whether that’s bloating, gas, constipation, diarrhea, abdominal discomfort, etc.) or you can feel flu-like symptoms (body aches, headache, fatigue), irritability, etc. This response typically lasts a few days up to about two weeks, depending on the person.
What causes SIBO flare-ups?
SIBO flares are very common and can occur for several different reasons.
Causes of SIBO flare-ups:
- Low stomach acid (from chronic stress, H. pylori, use of PPIs, etc)
- Motility issues
- Exposure to food triggers
- Exposure to contaminated food/water
- Suppression of the immune system after stress
- Incomplete eradication of the bacterial overgrowth
- History of GI surgery
- And more
Can you ever fully recover from SIBO?
Yes, you can recover from SIBO!
There is always a reason why SIBO started and why it may keep coming back, so discovering and addressing the root cause(s) is the most important thing you can do to improve symptoms and prevent SIBO from returning.
While remission may be short-lived for many patients, it doesn’t have to be this way. Testing for various contributing causes and appropriately addressing them can keep SIBO at bay. This is why individualized protocols are so important for each patient.
Every patient, including you, has unique needs that must be addressed for long-term success and health. The functional health approach can support gut rebuilding and resilience, leading to a healthier life.
How long can a SIBO recovery take?
In my experience, SIBO recovery can take anywhere from 3 months to over a year, depending on the individual case.
Sometimes, recovering from SIBO can be a slow process. It’s all dependent on how many other components are influencing your health, how long the SIBO symptoms have been around, how sensitive you are to foods, supplements, medications, etc., and other factors. But there is always hope! We have seen many SIBO patients recover and regain health and vitality.
Managing recurring SIBO: Functional health strategies
It’s important to build a strong foundation for your health. From supporting gut motility to eating a healthy diet, various lifestyle choices can aid you in your quest toward health and overcoming SIBO.
Lifestyle tips:
- Eat a clean, healthy diet that the body tolerates well
- Get regular, quality sleep
- Daily bowel movements/good motility
- Provide digestive support, if needed (stomach acid support, digestive enzyme support, gallbladder/bile support)
- Manage stress and support adrenal health
- Regularly spend some time outdoors and try to get some morning or evening sunlight
- Retest using a high-quality stool test on a maintenance basis (every 6-12 months)
Along with implementing those lifestyle changes, it’s important to find a practitioner well-versed in SIBO and gut health who can create an effective protocol for your specific case.
As always, be sure to consult with your functional medicine or healthcare practitioner to know what’s best for you.
SIBO recurrence
Remember, SIBO recurrence is often a symptom of deeper digestive or systemic issues. It doesn’t mean you’ve failed when you get it back after treatment, but it means your healing journey isn’t over. It’s a sign that you need to look deeper and understand and address other underlying causes of SIBO or SIBO-like symptoms.
A holistic approach to gut balance
Improving your gut health often requires patience, persistence, and time. Whatever protocol you get placed on, be consistent and remember that you can start feeling much better if you stick with it. Your daily habits make a huge difference in the long run for your gut health and beyond.
At RHS, we offer a personalized approach for a helpful and effective path to healing. If you’re ready to learn more about your gut health and how you can improve it, schedule your free 15-minute consultation with me, Dr. Paul.
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