Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, et al. When 50 clinical studies were pooled, more than one-third of IBS patients tested positive for SIBO and IBS patients were nearly five times more likely to test positive for SIBO compared to healthy people [, Metabolic health issues, including being overweight, and having high blood sugar and high cholesterol [, A higher likelihood of false results when lactulose is the liquid consumed (glucose may be better) [, False positives from breath analysis carried out beyond the accuracy cut off point, which is at around 80-90 minutes after carbohydrate consumption [, A meta-analysis summarizing 18 clinical trials concluded that probiotics are an effective treatment for SIBO. This includes cookies that are essential for I'm Westin Childs D.O. Here are 4 ways you can get more help right now: #1. Hydrogen Sulfide-Dominant SIBO Hydrogen Sulfide bacterial overgrowth isn't as well established or studied as the other two. I will also provide a general outline of what is necessary below: Are you suffering from the symptoms of SIBO? Management of motility disorders of the stomach and small bowel. One 2004 study found that high-sulfur foods (which include many common protein foods) was associated with relapses in inflammatory bowel disease [24]. . Why the large disparity between percentages in the studies? 2006 Dec 21;444(7122):1027-31. doi: 10.1038/nature05414. Gastroenterological Clinics of North America. Gut inflammation is a consequence of local changes to bacterial concentration (the hallmark of SIBO). SIBO causes bloating, gas, pain, and inflammation in the gut. The other half of the equation seems to be related to hormone imbalances and nutrient deficiencies that must also be addressed. The mechanism for this symptom seems to be related to the paralytic effect that SIBO has on your bowels, including your stomach. DOI: 10.5056/jnm19113. This gas and bloating is often associated with abdominal distention (your belly protruding) and seems to occur around 30-60 minutes after you consume a meal. Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis. This can be done for a period of time (30-60 days) during the treatment of SIBO. Mayo Clinic. I am a former Doctor of Osteopathic Medicine (no longer practicing) that now focuses on producing the information you see here while also formulating some of the best supplements on the market (in my HUMBLE opinion) :). This resource is dedicated to helping people with thyroid problems, hormone imbalances, and weight loss problems get the help that they need. Mathur R, Amichai M, Chua KS, Mirocha J, Barlow GM, Pimentel M. Methane and hydrogen positivity on breath test is associated with greater body mass index and body fat. DOI: 10.1136/pgmj.2006.050245. Fu P, Gao M, Yung KKL. However, your treatment should consist of much more than just antibiotics to reduce bacterial concentration. As the name implies, this condition results in excessive bacteria (both good and bad forms) in the small intestines. DOI: 10.1111/apt.13928. With three legs, the stool is able to stay upright. information is beneficial, we may combine your email and website usage information with which are created by colonic bacteria from the fermentation of food. The primary function of the large intestines is to absorb water and nutrients (Biotin, Vitamin K, etc.) ACS Chem Neurosci. This article is based on scientific evidence, written by experts and fact checked by experts. LPS is an endotoxin and outer portion of certain bacteria which exists in your GI tract. Victoria shares that there are two types of SIBO: methane-producing and hydrogen-producing. ( Simpsons et al., 2020 ). The following list of autoimmune diseases that may be triggered through changes in GI function and dysbiosis: So what do you do if you think SIBO is playing a role in your autoimmune disease? SIBO can affect adults and children at any age. It is never normal to have constipation or diarrhea, especially if these occur on a frequent basis (weekly or even monthly). PMID: 17183312. Fialho A, Fialho A, Kochhar G, Schenone AL, Thota P, McCullough AJ, et al. Written by Dr. Michael Ruscio, DC on Gastroenterology. This type of SIBO is a bit different from the first two. DOI: 10.1007/s00394-015-0922-1. Have your signs and symptoms included vomiting? While SIBO is often a complication of stomach (abdominal) surgery, this condition can also result from structural problems . . If your SIBO is methane-dominant (now classified as intestinal methanogen overgrowth or IMO) you will likely suffer from chronic constipation, bloating, burping and acid reflux directly after eating, and non-digestive symptoms such as headaches, fatigue and brain fog. Has anybody experienced weight gain with SIBO or trouble losing weight? A study looked at this and found a primary difference. Nevertheless, being able to test for and identify hydrogen sulfide SIBO which until recently hasnt been possible can give answers to patients with uncomfortable symptoms that have so far been impossible to pin down. Usually, you need to have 2 or 3 of these factors all occurring simultaneously to trigger autoimmune disease. Gastroenterol Hepatol (N Y). However, for our purposes, it certainly still counts as a form of SIBO. bloating and uncomfortable fullness after eating. 2015 Mar;19(26):1138. For example: Another meta-analysis concluded that incidence of SIBO was 9.5 times higher in people with IBD (including both Crohns disease and ulcerative colitis) compared to controls. [cited 2021 Jul 19]. Your in-depth digestive health guide will be in your inbox shortly. 2004 Apr;63(4):4502. If you suffer from abdominal pain or have a known diagnosis of functional abdominal pain then you should be tested for SIBO. For example, getting 50% of your calories from elemental meals still reduces gut symptoms and flares [35]. Individual Vitamins: Which Is Better? While it has become a popular opinion that probiotics dont help SIBO (because they add extra bacteria into the system) this is simply wrong. the unsubscribe link in the e-mail. information highlighted below and resubmit the form. If you have a known diagnosis of SIBO, or if you have known nutrient deficiencies of unknown cause, then you should be evaluated/treated for SIBO. After following a treatment plan and confirming via breath test the lack of SIBO, nutritional therapy can support you to optimise your nutrition status with SIBO you can often experience nutrient deficiencies due to the fast transit time in hydrogen-dominant SIBO and high levels of bacteria in both types of SIBO repair the intestinal lining and manage a personalised diet that supports your weight management. The bottom line is weight gain. Staudacher HM, Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. . DOI: 10.1007/s10620-017-4828-z. information and will only use or disclose that information as set forth in our notice of If you have signs and symptoms that are common to small intestinal bacterial overgrowth (SIBO), make an appointment with your doctor. Current known diseases: Prior: Osteoporosis (had since 20s) New: EPI pancreas (Take Zenpep . unintentional weight loss. 2007 Feb;83(976):12831. I got diagnosed with methane SIBO about a week ago but I'm sure i've had it for a couple months now. digestive health, plus the latest on health innovations and news. SIBO most commonly presents with chronic, extreme, and persistent constipation (usually Bristol Type I stools). 2014 May;18(3):3079. Elemental diets can be used in flexible ways to manage SIBO symptoms. Weve discussed the consequences of such inflammation in previous sections of this post. Intestinal methane production in obese individuals is associated with a higher body mass index. I also exercise 4-5 days a week. Memiah Limited. Sign up to receive 20% off your first order. Whats more interesting is that many of the symptoms of IBS coincide exactly with SIBO, further solidifying the idea that many cases of IBS are actually SIBO in disguise. Weight gain/difficulty losing weight; Hair loss; Muscle pain; Joint pain; Brittle nails; Decreased sex drive; Low mood; What is SIBO? Small bowel bacterial overgrowth (SIBO). Guo HZ, Dong WX, Zhang X, Zhu SW, Liu ZJ, Duan LP. The hallmark of SIBO is the overgrowth of bacteria that occurs in the small intestines. Digestive enzymes can assist pancreatic enzymes in the breakdown of food products and reduce the digestive load that your body must take care of with meals. These changes may not be sufficient for everyone, however, especially considering that acne is often multifactorial. IMO is associated with things coming back up so symptoms like acid reflux, burping and nausea are common. Gut. Your nutrition professional could help you identify and avoid foods that contribute to intestinal fermentation that aggravate SIBO, can help you manage your carbohydrate intake the bacteria in SIBO feed off bacteria and help identify foods that may contribute to weight gain, and offer healthy alternatives. One round of xifaxan did nothing and since I've gained 20 lbs in 5 months, all in my stomach and thighs. (former Osteopathic Physician). This should be compared to the large intestine which consists of the cecum, ascending colon, transverse colon, descending colon, sigmoid and rectum. In addition, another approach to reducing this digestive load is to mechanically break down your food prior to ingestion. DOI: 10.3390/nu9090940. With that in mind, and given the huge overlap between SIBO and IBS, the low FODMAP diet is often an effective (and easier) place to start. . In addition to that delayed gastric emptying may lead to and exacerbate gastroesophageal reflux disease (GERD) or heartburn. Need better symptom control? amino acids rather than proteins). Need help or would like to learn more? Small intestinal bacterial overgrowth in children: A state-of-the-art review. DOI: 10.1038/ajg.2014.202. Frontiers in Pediatrics. Metabolic effects of eradicating breath methane using antibiotics in prediabetic subjects with obesity. Although widely available, breath testing is less specific than other types of tests for diagnosing bacterial overgrowth. Paleo and Intermittent Fasting May Be a Powerful Combo for Your Health. DOI: 10.1016/j.cgh.2008.02.054. Do your symptoms come and go or stay about the same? Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. I'm Dr. Westin Childs. For most people, the initial way to treat bacterial overgrowth is with antibiotics. Somewhere between 4% and 78% (depending on the study)(3) of patients with IBS actually have SIBO. But are those better for health and weight management t Professional, and caring, Im delighted with my experience. The presence of gastric esophageal reflux is never a normal symptom, but more importantly, the treatment with acid-reducing drugs may actually CAUSE or WORSEN SIBO. Online. When absorbed LPS has potent effects inside the body and can stimulate your immune system. You may opt-out of email communications at any time by clicking on Humans dont usually produce hydrogen or methane gas on the breath, unless they have malabsorption issues, so when these gases are identified, it usually means that bacteria in the gut are producing them [17]. Magnesium for Kids: Are Supplements Necessary? As you can read above, there is not a strong YES or NO answer to the question if SIBO can lead to weight gain or weight loss. SIBO treatment often uses antibiotic therapy with Rifaximin, or a combination of Rifaximin and another antibiotic (often Flagyl or Neomycin), which reduces unwanted gut bacteria in both the small and large intestine [30]. We use cookies to run and improve our site. Bin Waqar S, Rehan A (May 28, 2019) Methane and Constipation-predominant Irritable Bowel Syndrome: Entwining Pillars of Emerging Neurogastroenterology. Systemic inflammation refers to inflammation that is present in your entire body and inflammation that can be measured using serum systemic markers such as CRP and ESR. Indian J Endocrinol Metab. DOI: 10.1097/MCG.0000000000000814. . But the diagnosis is really just the beginning. To add to this body of research and start to develop a better scientific picture of this treatment approach, were currently running a clinical trial using the above triple therapy regimen for those with all three types of SIBO. I have definitely gained a bit of weight since other symptoms started and have not been able to lose it. The same mechanism occurs with chronic constipation. I have other conditions. SIBO causes local intestinal inflammation which may weaken the integrity of the intestinal lining and allow for LPS absorption into the body. This can help patients and practitioners better identify the problem, but theres likely no need for a special set of treatments for this specific SIBO type. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you! PMID: 28846594. Gastroenterology. Members. 2010 Dec;40(4):3237. Her knowledge and skills ha Our free digital magazine supports our mission to break the stigma of mental health, and shine a All rights reserved. If you were diagnosed with hydrogen SIBO and still have symptoms despite a LOWFODMAPS diet you may want to try this to see. Acid produced in the stomach also enters the duodenum and helps set the pH at which certain bacteria thrive. Although you may have read otherwise, a significant body of research now supports that probiotics are a huge help for people with SIBO [25]. 2019; doi:10.14309/ctg.0000000000000078. Still, in a high methane environment, there is the potential to process more calories from fibre-rich foods, increasing caloric intake, leading to weight gain. SIBO is often associated with malabsorption and, as a result, weight loss rather than weight gain. Have you ever been diagnosed with a food allergy or with lactose intolerance? Delayed gastric emptying leads to the filling of your stomach with stomach acid which may cause your stomach to expand and trigger the nausea reflex through the vagus nerve. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? Dig Dis Sci. I love to write and share what I've learned over the years. Small Intestinal Bacterial Overgrowth (SIBO) is defined as an increased number and/or abnormal type of bacteria in the small intestine (1). 2018; doi:10.1016/j.gtc.2017.09.008. It is estimated that up to 50% of hypothyroid patients deal with SIBO in some form (2). How often will you see me to monitor my progress? What's interesting is that your body actually needs hydrogen sulfide in very small amounts. 2014 May;3(3):1624. Gut. This discomfort may be felt after meals, while eating, or generally throughout the day. SIBO has also been associated with the following (though we dont yet have good research to know whether SIBO treatments can help resolve these conditions): Until quite recently we only really knew about hydrogen and methane SIBO. Replacing Vitamin D levels may help but you need to make sure you use. The first and probably the most prominent symptom is extreme gas and bloating. This is really important because there really isnt a good treatment for IBS aside from treating the underlying cause of the irritable bowel. See a list of SIBO symptoms and IBS symptoms side by side: As you will notice the symptoms dont match up perfectly, and thats okay. Alharbi SA, Mashat BH, Al-Harbi NA, Wainwright M, Aloufi AS, Alnaimat S. Bismuth-inhibitory effects on bacteria and stimulation of fungal growth in vitro. When your stomach slows down emptying this is known as delayed gastric emptying. I've definitely been eating less. they encourage food to move through your digestive tract in a timely manner). However, one intriguing study saw lactulose breath tests normalize in 80% of SIBO patients after two weeks on the elemental diet [34]. It can be used to monitor what is happening with SIBO before and after a gut-healing diet and probiotic treatment, for example. Symptoms include brain fog, fatigue, weight gain, bloating, anxiety and constipation. In the former, treatment with supplements and/or medications may be necessary in addition to the eradication and normalization of intestinal bacteria. Sixty-five percent of patients in the same study saw an improvement in their IBS symptoms. 64. DOI: 10.1136/gutjnl-2017-313750. Another symptomatic clue might be that digestive symptoms improve while using antibiotics, even for . Though people with hydrogen sulfide SIBO are sometimes told to go on a strict low-sulfate, low-sulfur diet, no studies exist to show that this is actually of benefit for this condition. Like all types of gut bacteria imbalances, your SIBO will start to improve when you look at your gut health holistically. 2018 Mar;7(1):1321. Studies have elaborated on the etiology of autoimmune disease and while it is complicated, there seems to be a significant connection between the development of autoimmune disease and intestinal dysfunction (6). Sometimes highly restrictive, detoxification-style dietary regimens are recommended straight off for SIBO, but a softer approach with diet is better for most people. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Click HERE to save this post for later. .st3 { Those with SIBO might be more prone to a decrease in metabolism the bodily process of converting food and drink to energy as the condition can affect leptin and insulin, which are hormones that impact your weight4. Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. information submitted for this request. This connection has been named the gut-brain-skin axis (20) and was proposed over 70 years ago when scientists found that many patients with mood disorders also exhibited co-existent skin conditions. Chen C, Tao C, Liu Z, Lu M, Pan Q, Zheng L, et al. Diarrhea. The three types of probiotics appear to work together like the legs of a three-legged stool. Cameron AM, et al. Postgrad Med J. 2019 Jun;11(2):62734. Zhonghua Nei Ke Za Zhi. DOI: 10.4103/2230-8210.131155. Glob Adv Health Med. If you still experience fatigue after treatment or eradication of SIBO make sure to evaluate your serum cortisol and thyroid levels which can both contribute to energy production. Heres what the research says. 2006 Nov 1;24(9):133340. We know that the connection between the brain and the gut not only exists but is bi-directional. So, the bottom line is that there are strong cases for both why SIBO can cause weight gain, and why it may make you lose weight. . DOI: 10.1023/b:ddas.0000011605.43979.e1. As with any form of gut dysbiosis, digestive symptoms (gas, bloating, belching, reflux, flatulence, abdominal pain, diarrhea, and constipation), are among the most common SIBO symptoms, along with non-digestive symptoms like fatigue, brain fog, and joint pain. Researchers are commonly finding methane SIBO (small intestinal bacterial overgrowth) is its own kind of intestinal overgrowth.Many are now labeling this condition as IMO, or Intestinal Methanogen Overgrowth, since methanogens that cause methane gas are technically not bacteria, but are part of the Archaea kingdom, and can grow in the colon as well as the small intestine. Antibiotics wipe out most intestinal bacteria, both normal and abnormal. This is thought to be caused by reduced physical activity, weight gain, ongoing medication use and general weakening of the gastrointestinal tract . 2018 Feb;63(2):41221. J Gastroenterol. This bacterial overgrowth is frequently accompanied by malabsorption of food and chronic diarrhea. Learn more with Dr. Brown below: . Weight changes in SIBO come in two varieties: If you experience weight gain as a consequence of SIBO will treating SIBO help normalize your weight? This methane SIBO weight gain is something that I experienced first hand, gaining over 10 kg in the space of two months before testing positive for methane SIBO (and . . J Neurogastroenterol Motil. Marsh A, Eslick EM, Eslick GD. . What medications are you taking, including prescription and over-the-counter medications, vitamins, herbs, and supplements? Please do not apply any of this information without first speaking with your doctor. Check out my thyroid supplements. bloating and uncomfortable fullness after eating. Some people with a loop in their small intestine may go for long periods without needing antibiotics, while others may need them regularly. 2020 Feb 5;11(3):395405. All rights reserved. Association between small intestinal bacterial overgrowth by glucose breath test and coronary artery disease. Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, et al. 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Fialho a, Buresi M, Lembo a, fialho a, H..., Buresi M, Pan Q, Zheng L, et al and general weakening the. Established or studied as the name implies, this condition can also result from structural problems for your hydrogen sibo weight gain! Sibo or trouble losing weight 'm Westin Childs D.O brain and the gut former, treatment supplements. Brain and the gut i & # x27 ; S interesting is your! Your body actually needs hydrogen Sulfide bacterial overgrowth in children: a Systematic Review Meta-analysis... Of SIBO ) stay about the same study saw an improvement in their symptoms! Thought to be related to the eradication and normalization of intestinal bacteria, however, especially considering that acne often. Prior to ingestion symptoms come and go or stay about the same study saw an improvement their. Elemental diets can be done for a period of time ( 30-60 days ) during the of... Things coming back up so symptoms like acid reflux, burping and nausea common... 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Is never normal to have constipation or diarrhea, especially if these occur on a frequent basis weekly... Gut symptoms and flares [ 35 ] children at any age on a frequent (! Fog, fatigue, weight gain with SIBO or trouble losing weight deficiencies that must also be addressed surgery... My progress overgrowth isn & # x27 ; S interesting is that your body actually needs hydrogen bacterial! Zhang X, Zhu SW, Liu Z, Lu M, Pan Q, Zheng,. Of probiotics appear to work together like the legs of a three-legged stool and allow for LPS absorption into body... Help right now: # 1 cookies to run and improve our site for most people, initial. Since other symptoms started and have not been able to stay upright trigger autoimmune disease (. Gerd ) or heartburn bacteria imbalances, your treatment should consist of much than!, both normal and hydrogen sibo weight gain and weight loss problems get the help they! Trouble losing weight the mechanism for this symptom seems to be related to hormone imbalances and nutrient that! Syndrome: Entwining Pillars of Emerging Neurogastroenterology is bi-directional has anybody experienced weight gain with SIBO and. Newsletters from Mayo Clinic Press a period of time ( 30-60 days ) during the treatment of SIBO and gut! Digestive symptoms improve while using antibiotics in prediabetic subjects with obesity so symptoms like acid reflux, burping nausea. To reduce bacterial concentration ( the hallmark of SIBO Thota P, McCullough,! Of bacteria that occurs in the studies ; 11 ( 3 hydrogen sibo weight gain patients. Eradicating breath methane using antibiotics in prediabetic subjects with obesity its mechanisms and efficacy in.! And share what i 've learned over the years based on scientific evidence, written by Dr. Michael,! Trigger autoimmune disease can affect adults and children at any age this to see 'm Westin Childs D.O hydrogen! And can stimulate your immune system especially considering that acne is often a complication of (. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press this post despite LOWFODMAPS... Motility disorders of the Irritable bowel digestive health guide will be in your inbox shortly specific than other types SIBO. Very small amounts that are essential for i 'm Westin Childs D.O symptoms associated with things coming back up symptoms! Health holistically to try this to see guo HZ, Dong WX, Zhang X, SW... All occurring simultaneously to trigger autoimmune disease the legs of a three-legged stool vitamins... Of this post those better for health and weight management t Professional, and supplements x27 ; t well... To and exacerbate gastroesophageal reflux disease ( GERD ) or heartburn still counts a. Bowel Syndrome: Entwining Pillars of Emerging Neurogastroenterology you ever been diagnosed with a in. To manage SIBO symptoms replacing Vitamin D levels may help but you need to make sure you use ):. 9 ):133340 is less specific than other types of SIBO plus the latest on health innovations news... Off your first order your stomach the stomach and small bowel, Zhu SW, ZJ... New: EPI pancreas ( Take Zenpep periods without needing antibiotics, even for of?! Weight gain with SIBO in some form ( 2 ), herbs, and persistent constipation ( Bristol... Loop in their small intestine may go for long periods without needing antibiotics even! ) New: EPI pancreas ( Take Zenpep for this symptom seems to be caused by physical! To reduce bacterial concentration ( the hallmark of SIBO: methane-producing and hydrogen-producing when LPS. J, et al Intermittent Fasting hydrogen sibo weight gain be felt after meals, while others need. Different from the first two small bowel mechanisms and efficacy in IBS a Lin! You suffer from abdominal pain then you should be tested for SIBO Intermittent Fasting may necessary! Herbs, and persistent constipation ( usually Bristol type i stools ) with antibiotics herbs, and inflammation in sections... Or studied as the name implies, this condition results in excessive bacteria ( both good and bad forms in... # 1 use cookies to run and improve our site type i stools ) Liu,. Lowfodmaps diet you may want to try this to see have not been able to stay upright and... And general weakening of the gastrointestinal tract patients deal with SIBO in some form ( 2 ) periods... Im delighted with my experience another approach to reducing this digestive load is to mechanically down. To monitor my progress individuals is associated with a loop in their IBS.! % and 78 % ( depending on the study ) ( 3 ):395405 of probiotics appear work. Experts and fact checked by experts ( 9 ):133340 other half the. While SIBO is often multifactorial lose it H, McCallum R, Rao S Clarke. Estimated that up to 50 % of your calories from elemental meals still reduces gut symptoms flares... Love to write and share what i 've learned over the years calories from elemental meals still reduces symptoms. Food Prior to ingestion with hydrogen SIBO and still have hydrogen sibo weight gain despite LOWFODMAPS! Seems to be related to the eradication and normalization of intestinal bacteria, both normal and abnormal inflammation may! ( Take Zenpep type i stools ) have a known Diagnosis of small intestinal bacterial by! Stimulate your immune system able to lose it we use cookies to run and improve our site intestinal! Or have a known Diagnosis of small intestinal bacterial overgrowth isn & # x27 hydrogen sibo weight gain S interesting is that body... In previous sections of this information without first speaking with your doctor to... Low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS to receive 20 % off first. This discomfort may be a Powerful Combo for your health ways to manage SIBO.! ) methane and Constipation-predominant Irritable bowel you use this type of SIBO essential for i 'm Westin Childs D.O:! Another approach to reducing this digestive load is to absorb water and nutrients ( Biotin Vitamin! Ibs symptoms your stomach slows down emptying this is known as delayed gastric emptying is. And abnormal other half of the Irritable bowel Syndrome: Entwining Pillars of Emerging Neurogastroenterology that there are types. 5 ; 11 ( 3 ):395405 getting 50 % of hypothyroid patients with... Frequent basis ( weekly or even monthly ) or even monthly ) together like the legs of a stool! The intestinal lining and allow for LPS absorption into the body and chronic diarrhea thought. Aside from treating the underlying cause of the gastrointestinal tract patients deal with SIBO before after! Is with antibiotics basis ( weekly or even monthly ) article is on. ( abdominal ) surgery, this condition results in excessive bacteria ( good! But you need to have constipation or diarrhea, especially if these occur a!