What Are The Best Ways To Manage Recurring SIBO?


If you’ve had small intestinal bacterial overgrowth (SIBO) and treated it — only to see your symptoms flare up again a few months later — you’re not alone.

“SIBO can be a challenging condition to treat, and even the best treatments are not always associated with the highest success rates,” admits Ryan Barish, M.D., a functional medicine physician at Henry Ford Health. “Up to two-thirds of patients can have a SIBO recurrence within several months and may require additional treatments.”

How Do You Know SIBO Is Back?

After diagnosing you with SIBO, your doctor probably prescribed a course of antibiotics to help get rid of the bad bacteria in the small intestine. A standard course of antibiotics typically clears out the bacteria and helps relieve your SIBO symptoms.

But even after treatment, some people’s symptoms don’t completely go away. For others, symptoms improve, but return again shortly. Since many people experience recurrent SIBO, be alert to a return or worsening of SIBO symptoms such as:

  • Abdominal pain
  • Bloating
  • Constipation
  • Diarrhea
  • Gas
  • Indigestion
  • Nausea

Why Is SIBO Recurrence So Common?

“Our bodies have mechanisms in place to protect us from bacterial overgrowth and prevent SIBO,” says Dr. Barish. “For people with recurring SIBO, those preventive mechanisms may be compromised.”

When doctors treat SIBO, it’s important to look beyond symptoms — and beyond just fixing the bacterial overgrowth. “During SIBO treatment, we also strive to identify and manage the underlying reason why the overgrowth occurred in the first place,” says Dr. Barish.

Common underlying causes include a history of food poisoning, long-term use of antacids and proton pump inhibitors or structural problems in your digestive system. “Any of those factors can slow down motility, affect the acidity in your gut and give bacteria the chance to replicate and overgrow,” says Dr. Barish.

When an underlying cause isn’t effectively treated, bacterial overgrowth can become a chronic problem. “If we can identify and manage the cause, we can more successfully prevent SIBO,” says Dr. Barish.

What Can You Do When SIBO Won’t Go Away?

Even if the underlying cause remains a mystery, there are steps you can take to more effectively manage SIBO and reduce how often it recurs. If SIBO symptoms return after treatment, it’s important to talk to your doctor about what might help.

SIBO management strategies include:

  • Dietary changes: Restrictive diets (like a low FODMAP diet) should be temporary fixes during a SIBO flare up and may help reduce symptoms. For long-term gut health, Dr. Barish recommends a diet rich in plant-based foods and healthy, whole-grain carbohydrates. You can also include fermented foods that contain gut-healthy probiotics. Try to avoid processed foods, artificial sweeteners and refined carbohydrates.
  • Timing of meals: “You may need to be strategic with meal timing to keep things moving smoothly through your digestive system,” says Dr. Barish. That’s why he recommends not eating too close to bedtime. “You also need several hours between meals to optimize motility, which can further help prevent SIBO from recurring.”
  • Antibiotics: Prescription antibiotics may be the first line of SIBO treatment in most cases. But repeated antibiotic use can also mess with your gut health. “You need to weigh the risks and benefits of antibiotics for treating SIBO,” says Dr. Barish. Another option may be herbal antibiotics — plant-based supplements (such as berberine and oregano) that have antimicrobial properties.
  • Stress reduction: When your body is in stress mode, it slows down the motility of your digestive tract. And that slowdown allows bacteria a chance to overgrow. Practice relaxing techniques such as yoga, mediation and breathing exercises to help you better manage stress.
  • Acupuncture: You can use acupuncture to help reduce stress and also improve the movement and overall health of your digestive system.

To find a doctor at Henry Ford, visit henryford.com or call 1-800-436-7936.

Dr. Ryan Barish is a functional lifestyle medicine physician with Henry Ford Health. He sees patients at Henry Ford Medical Center in Novi.

Categories: FeelWell