Why Didn't My SIBO Treatment Work? | Dr. Allison Siebecker, Part 2

Dr. Allison Siebecker ran a center that saw only SIBO patients, testing before and after every treatment for years. That is where most of what follows comes from.

Part one covers what SIBO is, how food poisoning may trigger it, and how testing works: Read Part 1

Why Your Gas Type Decides the Treatment

The elemental diet works across all the types. Antibiotics and herbal antimicrobials are chosen by type, so knowing yours matters.

Hydrogen is SIBO. Methane has its own name now, intestinal methanogen overgrowth, because the organisms are archaea rather than bacteria. Hydrogen sulfide is intestinal sulfide overproduction.

Dr. Siebecker explains that hydrogen is the one to target either way, because where there is methane or hydrogen sulfide, other organisms are converting hydrogen into it. Missing that is common.

Why Rifaximin Is Not the Antibiotic You Are Worried About

Plenty of people are wary of antibiotics, and some feel theirs brought the SIBO on. Dr. Siebecker's point is that rifaximin behaves differently. It has been shown not to harm the microbiome of either intestine, and to increase beneficial bacteria after use. It is also anti-inflammatory.

Where methane is present, neomycin or metronidazole is added, and those are standard antibiotics. Rifaximin alone is not very effective against methane.

What Happens to Your Microbiome Afterwards

This is the part I find most freeing. Dr. Pimentel's mapping work suggests that when the overgrowing organisms are cleared, the good ones come back on their own. You do not have to reseed it.

Dr. Siebecker calls that revolutionary, because the assumption has been that probiotics or fermented food are required afterwards. We are both fine with probiotics where they suit you. You have a snowflake microbiome, and what works for her may not work for me.

How Herbal Antimicrobials Are Chosen

Herbs are matched to gas type in the same way. For hydrogen, Dr. Siebecker names berberine, neem and oregano. For methane, allicin, an extract from garlic, and a studied three-herb combination. For hydrogen sulfide, bismuth or oregano.

They typically use two herbs, because more than two has not produced a better result. Herbal rounds run four to six weeks against two to three for antibiotics, and she considers all three equally effective.

She also flags the popular studied formulas. They work primarily on hydrogen, which the study did not spell out, and some doses are too low. That is why people take them, get disappointing results, and conclude herbs do not work.

Why One Round Is Rarely Enough

Most people need more than one round to get a negative breath test and feel substantially better. She puts the average at three or four.

A treatment has its effect over those weeks, then it peters out. You stop, reassess, and if it is not gone you move to the next round. What usually happens is that someone does one round, feels little different, and decides it failed. On a retest they might see gas down from 100 to 65, which is real progress that has not finished.

Her line on this is blunt. Without a retest you cannot say a treatment did not work.

The gas number and the severity of symptoms match about half the time. Someone can feel terrible on a barely positive test. What the number is useful for is estimating how many rounds you will need.

Where Diet Actually Helps

Diet is for managing symptoms. SIBO diets restrict carbohydrates so there is less for the bacteria to ferment, and less gas.

Her advice is to pick one of the SIBO diets and customize it. You will end up eating some things it says you should not, because you tolerate them, and dropping some it permits, because you do not.

Diet matters most where the underlying cause is chronic, whether that is post-food-poisoning damage, scleroderma, a resected bowel or endometriosis. Treatment can still get you to a good place, and diet holds the rest.

The Step Most People Skip

Prokinetics stimulate the migrating motor complex, and they are what prolongs remission. Prucalopride is the prescription one Dr. Siebecker calls the star of the category. Others include low dose erythromycin, low dose naltrexone, ginger root and herbal formulas. She finds the prescription options generally stronger, though natural ones can work well.

In one study, adding a prokinetic gave between five and eight extra months of remission. She starts them right after the first round, keeps the gap between rounds under two weeks, and once someone is clear she wants at least three months on one, because relapse commonly shows up around two and a half months.

You will not feel a prokinetic working. It is not a laxative, and that confusion stops people taking it.

None of this is a protocol to run alone. It is what to bring to a practitioner who knows the condition, so you can ask better questions than I could.

I spent about ten thousand dollars before I found Dr. Siebecker, and I hyperfixated because it was confusing and I felt awful. The hypervigilance and anxiety that come with SIBO are real. Once I relaxed, a lot got better. A chronic condition that is properly managed can feel far better than one that is not. Be your own detective. There is hope, and there are answers.