Ep. 105: You are positive for SIBO, now what?

If you’ve ever been told you have SIBO (small intestinal bacterial overgrowth) and immediately felt overwhelmed by what to do next, this episode is for you. Because while a diagnosis can feel like a relief after being told “everything is normal,” it often leads to more confusion: antibiotics, elimination diets, supplements… and still no clear plan. In this episode, Dr. Heather is breaking down what actually matters after a SIBO diagnosis and why so many people stay stuck in the cycle of temporary relief and recurring symptoms.

We’re shifting the focus away from just “killing bacteria” and toward understanding why the overgrowth happened in the first place, so you can take a more strategic, sustainable approach to healing.

You’ll learn:
 • The biggest mistake people make right after a SIBO diagnosis
 • Why antibiotics alone often don’t prevent SIBO from coming back
 • The different types of SIBO and why that changes treatment
 • How restrictive diets can keep you stuck longer than you think
 • The key systems that need to be supported for lasting results

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Transcript

Dr. Heather Finley 0:50

Welcome to the Love Your Gut Podcast. I'm your host, Dr. Heather Finley, registered dietitian and gut health specialist. I understand the frustration of dealing with GI issues because I've been there and I spent over two decades searching for answers for my own gut issues of constipation, bloating, and stomach pain. I've dedicated my life to understanding and solving my own gut issues. And now I'm here to guide you. On this podcast, I'll help you identify the true root causes of your discomfort. So you can finally ditch your symptoms for good. My goal is to empower you with the knowledge and tools you need so that you can love your gut and it will love you right back. So if you're ready to learn a lot, gain a deeper understanding of your gut and find lasting relief. You are in the right place. Welcome to the love your gut podcast.

1:42

Let's talk about the moment after you get diagnosed with SIBO or small intestinal bacterial overgrowth. Maybe this has happened to you, which is why you are listening to this episode, or maybe you think you have sibo, which is also common. We have a lot of clients that come to us that are like, I don't know if I have it, but I think I do'cause I have all the symptoms. So you finally get the breath test results back and it says positive. And at first there's a little bit of relief'cause you're finally like, okay, yeah, now we finally know what's going on. Because maybe for months or even years you've been dealing with bloating, constipation, stomach pain, food reactions, and every time you brought it up, you were told something like, your labs are normal. It's probably just IBS try to eat more fiber. Maybe it's stress. So when you see the word positive on that test result, it can feel so validating like, okay, I am not crazy. There's actually something going on, but then the next question shows up almost immediately, which is now what? Do you take antibiotics? Do you start the low FODMAP diet? Do you buy a bunch of supplements? Because if you spend about five minutes researching SIBO online. You will find hundreds of protocols, and that's where a lot of people get stuck in that overwhelm. You get stuck in this freeze state of like, there's so much information, I don't know what to do. Or panic buying things and almost approaching it from like a fight or flight stress state and doing everything and just starting to throw stuff at yourself. One of the biggest mistakes that people make after a SIBO diagnosis is jumping straight into a. Strict protocol before asking One more important question, which is why? Why did the bacteria overgrow in my small intestine in the first place? I like to use this analogy to explain sibo. You all know that I love analogies. I think they're the easiest way to understand different concepts. Related to gut health. So you can think of your small intestine like a highway. Food is supposed to move through that highway, smooth and organized. Cars enter, they move through, they exit. But if traffic slows down or the exits are blocked, maybe there's construction cars start backing up. And when cars back up long enough, eventually you're going to get into a traffic jam. So SIBO is essentially a traffic jam of bacteria in the small intestine, and most treatments are gonna focus on clearing that traffic jam, which is great. Antibiotics, herbal antimicrobials, maybe even elemental diets. But if we clear the traffic jam without fixing the traffic flow. The congestion just comes right back, which is exactly why so many people say things like, I treated SIBO three times and it kept coming back. So in this episode, I wanna walk you through what I recommend doing after a SIBO diagnosis so that you're not just treating symptoms and you're actually fixing the environment that allowed the overgrowth to happen. So once you get that diagnosis, the next thing you're usually told is great. We'll just treat it with antibiotics. And to be clear, antibiotics can absolutely play a role in treatment. We have many clients that use that. You might be given a medication like Rifaximin or Xifaxan. And those have been shown to reduce bacterial overgrowth in the small intestine. And many people do find temporary relief when they take them, but the important distinction that often gets missed is antibiotics remove the overgrowth. They're not fixing the conditions that allowed it to happen. It's the same thing as like taking peppermint pills for bloating or temporarily eliminating certain foods for bloating. You can think about it like mold in a house. I know this story resonates with so many people. If you see mold growing on your wall, you can spray something on it to remove it and it's gonna go away. But if the roof is still damp, if there's still a leak, if the environment is still perfect for mold growth, then the mold's gonna come back, right? And that's essentially what happens with SIBO for so many people. The bacteria are reduced. Symptoms improve for a while, and then a few months later, the bloating, constipation, food reactions slowly start creeping back because the environment in your gut never actually changed another. Important piece that is helpful to understand is which type of SIBO you actually have. Most people think SIBO is just one big umbrella term, but there are actually different types of gas patterns that can show up on breath testing. There are three main gas patterns, so some people mostly produce hydrogen gas, which is often associated with diarrhea. Others produce methane, which tends to slow the gut down. It's more commonly associated with constipation. And then methane is particularly important to understand because technically it's not even produced by bacteria. It's produced by organisms called methanogens, which is a whole nother topic for another day. But that means that if someone has methane. SIBO or intestinal meth and overgrowth IMO, and they're only given one antibiotic. It doesn't fully address the problem, and we see that a lot. So before jumping straight into treatment, it's really important to slow down for a moment and ask a bigger question, why did this happen? Now, the last piece of SIBO or type of SIBO is hydrogen sulfide. I have another episode that's pretty popular. It's one of my most downloaded episodes, actually, on hydrogen sulfide. So you can search for that. So once we understand that treatment becomes a lot more strategic. So once you pause for a moment before rushing into treatment, I know it's so easy when you're like, oh, finally I know what's going on. I just wanna feel better. It's so easy to wanna just do that, but please pause. The next important step is to make sure you understand what type of SIBO you have. Because otherwise, if you aren't treating the correct gas pattern, then you're gonna end up in the same place that you started. So like I said, there's three different types of gas patterns. We've got hydrogen, we've got methane, and we have hydrogen sulfide. So many people are prescribed rifaximin. That's a common one. And while rifaximin can work well for hydrogen dominant sibo, it's a. Often not enough on its own for methane, like I mentioned. That's why you need combination treatment for methane. And then if you have hydrogen sulfide sibo, this is a whole different ballgame. When you have hydrogen sulfide sibo, most likely you have symptoms like gas, diarrhea, just gut irritation, that classic like rotten egg smells. Some people notice, sometimes even burping that smells like rotten eggs. So the key takeaway here is that it's not a one size fits all condition or treatment. And if the type of SIBO isn't clearly identified. Then we're gonna end up on this rollercoaster that you never wanna, that you can't get off of and you wanna get off of. So next is we've identified the sibo. We want to pair the treatment with the right effective treatment for that type of sibo. And another mistake is immediately jumping to really restrictive elimination diets. Many people are told to start the low FODMAP diet, or maybe you already avoid garlic, onions, beans, fruit, grains, dairy, the list can get so long of foods that you avoid. And to be clear, the low FODMAP diet can absolutely help reduce symptoms in the short term. That's because FODMAPs or FODMAP foods are fermentable carbohydrates. So if there are bacteria overgrown in the small intestine, those carbohydrates. Can be fermented too early in digestion, which leads to gas, bloating, and discomfort. So temporarily reducing those foods can sometimes slow your symptoms down. But here's where things can go wrong when low FODMAP becomes a long-term strategy versus a temporary tool. Going back to the mold analogy, you can cut the foods out and slowly keep like spraying cleaner on the mold, but the food is not the problem. Because the same foods that can trigger symptoms during SIBO are the ones that feed many of the beneficial bacteria in our colon. So when those foods are removed for months or even years, we've seen people on low fodmap, they come to us five, six years, your beneficial microbes begin to decrease, and your diversity of beneficial bacteria drops and your gut ecosystem is going to become less resilient. You can think of it like a garden. If you stop watering certain plants because they're struggling, those plants are gonna die off and over time, your garden is gonna become less diverse and overgrown with weeds. So the same thing can happen in the gut. The goal is not to permanently reduce these foods because they help. The goal is to restore the digestive environment so your body can tolerate those foods again. Another piece that often shows up that I don't think is talked about enough is when diets become. Very restrictive. It can be so normal to develop food, fear. People start getting really anxious around eating, out, traveling, trying new foods. They worry that one ingredient is a major symptom, and over time eating becomes more stressful instead of enjoyable. So instead of thinking of. SIBO as a condition that requires eliminating more and more foods. You wanna shift your focus to something different. Instead of asking, what foods do I need to remove? A more helpful question is, what systems in my body needs support so I can tolerate food better? Because if we can support those systems, well again, your food tolerance improves. And that's exactly what we're gonna talk about next. What do we do instead? So if jumping straight to antibiotics or limiting more foods isn't the solution. Then the next question should be, well, what should you actually focus on? You're thinking, okay, I can't take antibiotics and I don't eliminate food, so what do I actually do? When we work with clients dealing with sibo, most of the time when clients come to us, they have addressed SIBO three plus times. It's always such a relief when we get a client that's like, oh yeah, I got diagnosed with SIBO and before taking the antibiotics, I wanted to make sure I had the whole picture. I'm like, oh, thank goodness. You're not gonna drive yourself insane on this rollercoaster, right? But even if you have done it three times, I'm so glad you're listening to this because I know you're looking for something different. So we can look at all the systems, how well digestion is functioning overall, because remember the analogy from earlier, SIBO is like a traffic jam in the gut. So the goal isn't just clearing the cars, the goal is figuring out why the traffic is slowing down. And there are a few systems that play a big role in that. Number one is digestion, and that's the first place that we have to start. Because if food isn't being broken down properly, it becomes fuel for those bacteria in the wrong part of the digestive tract. And digestion starts much earlier than most people realize. It actually begins with your thoughts and stress patterns, and then salivation and then stomach acid. So stomach acid helps break down protein, activate enzymes and signal the rest of the digestive process to move forward. Pancreatic enzymes, bile, et cetera. And when digestive processes aren't working well, larger pieces of food will move down to the small intestine. And they, that undigested food becomes fuel for bacterial fermentation, which is one of the reasons that bloating often happens after meals. The next step is supporting motility. So this is the second system, and it's one of the most overlooked root causes of sibo, especially. Methane. Your digestive tract has something called the migrating motor complex. This is essentially a housekeeping wave that sweeps through the small intestine between meals. I like to describe it like the cleanup crew that comes through the office. After everybody leaves, it clears away trash it vacuums, it, cleans the countertops, et cetera. But when that cleanup crew isn't working well, things start accumulating and food sits longer than it should. And it compounds, especially if it isn't digested. Well, bacteria have more time to ferment and eventually the conditions become perfect for overgrowth. And there are a number of things that can disrupt motility Food poisoning is one of the most common triggers. Food poisoning is one of the most common triggers of IBS and sibo. Stress can slow digestive signaling as well. Thyroid issues are a big trigger, and then mineral depletion, especially things like potassium, magnesium, these impact muscle contraction and the digestive tract. So when motility slows, the system essentially loses its natural ability to keep things moving. Another piece of the puzzle is bile production and liver health. So another piece of the puzzle is bile production and liver health. And all my gut practitioner gals know that bile is the MVP of digestion, especially in the context of digesting fats, but also with sibo, because bile is antimicrobial, it is your dishwashing detergent of your digestive tract. It helps regulate microbes. It keeps bacterial populations balanced in the small intestine, and when it's sluggish, fat digestion becomes more difficult. The microbiome becomes less, less regulated, and certain bacteria can thrive in those environments. And then the caveat here with hydrogen sulfide is some sulfur producing. Bacteria actually bile tolerant, meaning that bile doesn't always do the trick. It's not always as antibacterial for them. So supporting bile flow and liver function will play an important role here. The next step, which is overlooked, especially if you've done elimina elimination diets and low FODMAP is rebuilding fiber tolerance over time. Many people with SIBO end up avoiding fiber almost completely because it triggers symptoms, and while reducing certain fibers can temporarily help calm symptoms, long-term avoidance can make the gut become less resilient. So fiber is actually one of the primary sources of fuel for beneficial bacteria, like I mentioned earlier. So we don't wanna avoid it forever. The goal becomes reintroducing it gradually and strategically. This is where a dietician who is an expert in this can be so helpful for you. This might start with looking at fibers that are easier to tolerate, such as partially hydrolyzed gorg gum, or increasing small amounts of polyphenols resistant starches from foods Over time as digestion and motility improve, most people will find that their ability to tolerate fiber improves as well. And then when we finally zoom out and look at the whole system, this is step five, because SIBO doesn't start in the small intestine. And you probably understand that by now, most often it's the result of something upstream in the body that stopped working. And that can include mineral depletion, nervous system stress, blood sugar, instability, thyroid function, chronic stress, keeping the body in a fight or flight. State, so we have to support those systems as well, so digestion can work more efficiently and motility can improve, and the environment in the gut becomes less favorable for bacterial overgrowth. So instead of thinking of SIBO as a condition that needs to be aggressively eliminated, I often encourage people to think about it a little bit differently. It's just a signal. A signal that the digestive system needs support. So it can function the way it is designed to, to make this more real and connect the dots for you. Let me just share an example of how often, how this often plays out. We worked with a client. And this is a very common scenario, but this specific client, she had been treated for SIBO four times. She had taken antibiotics, various combinations. She had also done herbal protocols like Candibactin, Biocidin, um, I think FC Cyl as well. And she had followed the lo FODMAP diet very strictly like multiple years, and each time she treated her sibo, her symptoms would improve for a little while, and then within a few months, her bloating and constipation would come back. By the end of the day, her stomach was so distended she could barely button her pants. She was really down in the dumps, just feeling like I am getting nowhere. And a lot of this was also nervous system related too. Just that feeling of will I ever get better? Kind of bracing herself for waiting for when her symptoms were gonna come back, which was a big piece of like allowing herself to believe that she could heal. Um, but when we step back and look at the bigger picture, it became clear that SIBO was not the full story. Her digestion was super weak, her motility was slow, her microbiome was so depleted, and we saw that on the stool testing that we do with our clients just from the years of repeated low FODMAP and restrictive diets. So. We actually did not target the bacteria. Again, we spent a couple months focusing on rebuilding the systems that control digestion. We supported stomach acid enzyme production, really heavily focused on nervous system support with. Helping her to get through what the actual limiting beliefs were of, will I get better? And it was such an interesting process for her. She also worked with our nervous system coach, that we bring in. We worked on improving gut motility and then gradually reintroduced fibers that her gut could tolerate. And once those systems started working better, it was so interesting. The bloating that was happening every single evening started improving, and this was without any herbal treatment. Her digestion was a lot more predictable, and her symptoms that kept cycling started to settle down. Then we addressed the sibo. Because we cleared the traffic jam and fixed the flow, I heard from her later. That usually at the point, couple months after treatment where she would start to get bloated, she wasn't. And that is what she had worked so hard to get to, and we were just so proud of her. So if you're listening to this and thinking that sounds exactly like what I've experienced, maybe you've treated SIBO before and it keeps coming back, or maybe you were just diagnosed and you're trying to figure out what to do next. That's exactly what I'm teaching in my training called SIBO Unlocked. I will walk you through why it keeps coming back in more depth, the five systems that control gut function, and then how to really identify your root causes so that you know exactly what to do to prevent this cycle from continuing. Because my goal for you and your goal for yourself isn't to just temporarily reduce these symptoms. It's to rebuild your digestive tract. And have a gut that can function well long term. So if you'd like to join us, you can reserve your seat using the link in the show notes. And remember, even though this training will be recorded, you do need to register in order to receive the replay. I am really excited for this one because. It pulls together so many things that we've talked about on the podcast, but in more depth and in a step-by-step approach when you come live, you'll also get access to my SIBO supplement guide, which is worth the cost of admission alone. So thank you so much for listening today. I will see you at the training or on the next episode of the Love Your Regret podcast. Thanks for joining.