What to Expect During a SIBO Protocol
I remember when my previous naturopath gave me a handout titled “SIBO Protocol”, told me to purchase and follow the supplement instructions and get started on the diet.
I figured this will be easy, I’ll follow the protocol for 6 weeks and then get back to my normal life…no big deal.
Boy was I wrong!
My 1st and 4th SIBO protocol kicked my ass!..the middle two weren’t a walk on the park either. I had soo many questions every day about if what I was feeling was normal.
Is it normal to have watery diarrhea?
Is it normal to have lost my appetite?
How much longer until I can expect to feel better?
There are so many things I look back on now that I wish I was told before starting a SIBO protocol so I knew before hand what to expect and if what I was experiencing was normal.
Having gone through 4 rounds myself and now mentoring my clients through the process, I wanted to provide a resource that outlines everything you need to know before starting a SIBO protocol so you’re not left wondering the following:
How should I prepare my body before starting a protocol?
What to expect during a SIBO protocol?
SIBO die off symptoms you could experience?
What to eat during a SIBO protocol and the best SIBO diet to follow
How long until I feel better?
Is it normal to need multiple rounds of treatment?
My purpose is writing this is not to scare you but to provide you with a realistic expectation and easy to implement steps so that you can best support your body through the process and make a strong recovery!
Preparing for a SIBO Protocol
This is one of the most important steps that’s often overlooked in conventional treatments but can play a huge role in reducing the severity of die off symptoms (more discussion on this below) you might experience!
In order to understand why this is such a critical step, we need to review what exactly the lymphatic system is and the role it plays in a SIBO protocol.
The lymphatic system is a system of lymph vessels and nodes (kind of like blood vessels in your cardiovascular system) and is where the majority of your immune system lies. It plays a key role in your immune system defending the body against infection as well as elimination of both bacteria and toxins that are released when SIBO bacteria die.
If this system is clogged up and not draining properly, the increased toxin load is going to overwhelm your system which could make your die off symptoms worse. Think about what happens to a clogged sink. The water can’t get through and the sink overflows. This can overwhelm your body if it’s not prepared properly for the overflow.
The liver is also another important organ of detoxification and similar to the lymphatic system, needs to be supported before a SIBO protocol is started to ensure it’s working the best it can.
A good practitioner will prepare you before a SIBO protocol by including liver and lymphatic supplements as part of your prep stage so that you’re not just jumping into the killing phase of a SIBO protocol. This is the first step I take with all my clients after their first session in The SIBO Turnaround Method.
Your Lymphatic System
Your mindset and mentally preparing for a SIBO protocol can also make a big difference!
If you go into it thinking “I can’t eat anything…this is going to be so hard…I can’t do this” it is going to feel like the toughest thing ever!
One of the biggest re-frame’s that I learned from my SIBO mentor was around food as that was the toughest part for me. Instead of saying “I can’t eat this food”, switched it up with “I choose not to eat this food because I’m supporting my body’s healing”.
Every time you catch yourself saying I can’t eat a food to your friend, spouse, coworker or whoever, correct it (even if it’s a mental correction). This brings positivity and optimism around each meal you eat instead of hate, shame and feelings of self doubt. Your mind plays a powerful role in what you’re able to overcome and accomplish.
You need to be your own cheerleader and tell yourself you can do anything, you are worth it and deserve to feel better, especially during the toughest days! If you feel like this type of thing is tough for you, I offer daily text support in The SIBO Turnaround Method to be your #1 supporter throughout the entire process! I don’t think anyone should have to go through it alone and want to be here for you to encourage you all the way through. If you’re ready to get started book your free discovery call below.
You can also support your body in many other ways before starting a protocol:
Steps you can take at home to prepare your body for a SIBO protocol:
Ensure you’re pooping at least once a day!: If you’re hydrogen dominant I’m sure you’re thinking “LOL this is definitely not an issue for me”…but if you have methane dominant SIBO (or IBS type C) I can’t stress enough how important it is that you’re having regular bowel movements. Your bowel movements are your body’s main way to eliminate toxins. When the bacteria die, they produce by-products that are toxic to your body. If you’re not pooping every day, these toxins can be reabsorbed into your body, making your die off symptoms worse. Magnesium citrate is the best way to ensure regularity and your practitioner will provide the best dose for you. You should be going regularly for a week before starting the protocol.
Eliminate inflammatory foods: including dairy, gluten, alcohol, poor quality oils and sugar. The purpose in doing this is to reduce any additional stressors to the body.
Start increasing your intake of water: water helps flush out toxins an ensure your drainage system can work properly. Aim for 12-15 cups a day (add 2 cups more per 1 cup of caffeine)
Consume liver supportive liquids: The liver as most people know is an organ of detoxification. It can become over burdened by the foods you eat, the chemicals you’re your environment, alcohol consumption and much more. A great way to provide some extra liver support is to drink lemon water (steeped overnight with the rind) or herbal tea like dandelion, milk thistle and turmeric (if you’re on any medication check with your health care provider first)
Support lymph drainage: invest in a dry brush and get into a brushing routine for the duration of your protocol. The bristles on the dry brush help stimulate the lymphatic system, improving overall flow, function and circulation needed to detoxify the bacterial die off.
Walk 45 min a day (or as much as you can!): exercise stimulates circulation which helps support your lymph flow, ability to eliminate bacterial die off toxins and improves overall digestion.
Prepare for the SIBO diet: finish up any foods in your house that you won’t be able to eat during the diet and review the list of foods that you’re able to eat. Make a shopping list and do a big grocery shop so you’re well stocked for when you start the diet.
Walking is the best form of restorative exercise during a SIBO Protocol
What to Expect During a SIBO Treatment
Everyone’s body is unique which means what you will go through during a SIBO protocol will likely be different than the way others may experience it.
How long you’ve had SIBO for, how severe your symptoms are, if you’ve prepared your body properly, the method for killing the bacteria you choose or if you have any other underlying conditions or diseases will all determine how you feel during a SIBO protocol.
Some people may only have a few minor symptoms like low energy or a headache while others may feel like they’re experiencing a bad flu. It’s important to remember to not push yourself and rest as much as possible.
You may have heard the term “die off symptoms” before. When any type of pathogen (bacteria, parasites, yeast) in the body is killed (either through supplements or dietary changes), they rapidly produce harmful toxins which are released and circulated throughout your body. Your immune system responds and has to detoxify these toxins, which can result in inflammation and various symptoms.
This is where your liver and lymphatic system work hard to process and get rid of the them and why the prep stage is so important! If your body gets overwhelmed during this process and struggles to keep up, you may experience a variety of full body symptoms.
SIBO dieoff symptoms could feel like:
Brain fog
Joint/muscle aches
Headache
Nausea
Flu like symptoms including fever or chills
Fatigue
Worse SIBO symptoms (diarrhea, constipation, bloating etc.)
Die off symptoms generally occur at the beginning of a dietary or antimicrobial/antibiotic protocol and should last for about a week. If you experience symptoms past a week it’s best to let your health care practitioner know.
How do you feel during a SIBO Treatment?
Once you get past that first week and for the remainder of the protocol, you may also feel experience some of the following:
Fatigue/low energy
Nausea/upset stomach
Loss of appetite
Sugar & carb cravings (preparing large batches of meals can help
Bowel movements:
Watery diarrhea (it may be yellow if taking berberine)
Increased bowel movement freequency
It may alternate between diarrhea and constipation
Weight loss (it’s important to eat lots for the entire duration!)
Dizziness when standing (berberine can impact blood pressure in some individuals)
Poor sleep
Stomach cramping
Moodiness and irritability
It’s possible to experience only one or two or a combination of many of the above symptoms. These changes in your body may seem a little scary or make you anxious but just know that there is light at the end of the tunnel and you are strong enough to make it through!
In some sensitive people, it is possible that the dosages of antimicrobials are too high so if symptoms persist and are unbearable, let your health care practitioner know.
How to best support your body during a SIBO protocol:
What to Eat during SIBO treatment- Follow a SIBO specific diet: this is a SIBO specific diet (different from a low FODMAP diet) which limits small amounts of FODMAP foods, eliminates inflammatory foods and re-introduces foods in different stages depending on how far along in the protocol you are.
If figuring out what to eat during a SIBO protocol feels overwhelming to you, I got you covered! I’ve created a 3 week meal plan bundle (below) to take the stress out of meal planning.
If you’re super sensitive with a lot of food sensitivities I also provide customized meal plans for my clients during every stage of the diet in The SIBO Turnaround Method.
Get lots of rest: your body is working over time to deal with toxin overload from the bacteria dying off. Rest as much as possible!
Clear your social schedule: the last thing you want to do is commit to social activities when you feel like absolute garbage. Hold off on any commitments that aren’t super necessary to allow your body time to rest.
Work from home (if you’re able to): It’s a good to talk to your manager before starting and letting them know you may not be functioning at full capacity during the protocol and may need to take sick days if needed. If they’re able to accommodate, working from home may be more comfortable, allow you to rest more and be easier for irregular bowel movements.
Ask for help (You don’t always have to be super human!): if you feel overwhelmed with multiple duties at home with kids, talk to your partner about how they can provide extra support or take on more responsibility during the early stages of a protocol.
Practice daily stress reduction: stress increases inflammation, adding another layer inflammation when you’re body’s trying to focus on clearing bacterial infection. Deep breathing is an easy and effective stress reducing practice to incorporate into your day. Alternatively guided meditation is another great option. Here are some of my favourite guided meditations you can explore.
Avoid high intensity exercise: high intensity exercise, especially cardio activities, increase the stress hormone cortisol, increasing inflammation. It’s best to focus on restorative exercise throughout the duration of a SIBO protocol. Walking, yoga, chi gong, and Pilates are all great alternatives.
Drink ginger tea: nausea and loss of appetite can be a common side effect. Sipping on fresh ginger tea throughout the day can help ease the stomach. Peel and chop a full ginger rood (4 inch piece) of ginger and add it to a medium size pot. Boil the water on low for 20 min.
Continue with walking and dry brushing to support circulation and lymphatic function
Work from home if possible during a SIBO protocol
How Long does it Take to Feel Better After a SIBO Protocol?
The most common question I get asked is “how long until I feel better?”
This again depends on your unique situation. How long you’ve had SIBO for and how high your bacteria levels were (based on your SIBO test), the method you chose to kill the bacteria (antibiotic or herbal antimicrobial), your body’s response to the herbs or antibiotics, if there’s other underling issues or diseases and if your practitioner recommended the proper herbs or antibiotics (many don’t use the right ones).
A successful SIBO protocol would look like an 80-90% improvement in your symptoms shortly after stopping the herbal antimicrobials or antibiotics (within a week or so).
If you had diarrhea before, this means your bowel movements should be formed now for the majority of the time. If your bloating was a 9 out of 10 and you experienced it after every meal, your bloating should be about a 2 or 3 out of 10 and maybe only happening once or twice a week. You should be able to eat foods that previously gave you heartburn. Again, this will look different for everyone.
It's important to note that many people who have SIBO also have other underlying digestive issues which is why some symptoms may still be there. Just because you still have symptoms does not mean you should panic or that it didn’t work!
This is why testing after a protocol is so important. You may still be bloating because of an imbalance of bacteria in your large intestine for example or still experience heartburn because your stomach acid is low. If you’re still experiencing symptoms with a negative SIBO test, further work or testing may be needed to help eliminate the remaining symptoms.
Rebuilding your microbiome is also the last important step (primarily through dietary measures and what I teach all my clients) which may also improve your remaining symptoms and helps reduce your risk of relapse and future gut issues.
YES, Is it Normal to Need Multiple Rounds of SIBO Treatment
The dreaded positive test….ugh this happened to me 3 times.
I was SO disappointed. All that hard work for nothing! (or so it felt like). I felt so isolated, ashamed and thought there was something wrong with me.
They called me a “stubborn SIBO case” and my naturopath wasn’t quite sure what to do with me next which made me lose hope. If only some one had told me THIS WAS NORMAL.
If you’ve struggled with positive test after positive test, you are not alone!!...and it doesn’t mean you’re going to have SIBO forever.
It’s actually quite normal to need multiple rounds of treatment. One of the leading SIBO experts Dr. Allison Siebecker noted in a webinar that the average rounds of SIBO treatment required is around 3-5!
Again, it depends on the type of SIBO you have and the levels you have. Methane dominant SIBO generally takes longer to get rid of than hydrogen. High levels also may take a few rounds to knock down the bacteria (I like to think of the hammer and nail analogy. You may need to hit the bacteria a few times to get it down to a flat level!).
It might just take a few more rounds (which I know isn’t what you want to hear!). It’s likely you’ve had SIBO for years or even decades so it may be unrealistic to expect a full recovery in just 3 months! The body takes time but it is possible to make a full recovery. Remember, the body wants to be healthy and balanced. It doesn’t want to stay sick.
When you follow the proper protocol and diet with the right support and food re-introduction, you’ll be able to experience a bloat free life where you can enjoy social outings again, eat the foods you love and have confidence in your body again!
Ready to start!? Book your free discovery call below to learn more about the program and if it’s a good fit for you!
During the discovery call I get to know a little more about you and discuss a strategy to help you get rid of your SIBO for good!
By Krista Znebel, R.H.N.©
March 1, 2024