Tamara Duker Freuman, MS, RD, CDN
The Bloated Belly Whisperer

Bloated Belly Q&A Index

How can I alleviate bloating from SIBO?


"Dear BBW,

I have SIBO [Small Intestinal Bacterial Overgrowth] and I've tried to cure it through diet to no avail.  I am so tired, weak, and defeated that I don't know what else to do.  I know that rifaximin may help and I've been given a prescription, but I'm scared it may make things worse and I've read online that my SIBO will come back anyway even if I do take it.  Is there any advice you can give me? I feel like I'm starving to death, bloated and in pain all the time.

-PK, Canada"

Dear PK,

Real antibiotics are the only way to rid yourself of SIBO... no diet and no supplements (including so called “herbal antibiotics”) have been shown to cure it... no matter what you read online. In my experience, any side effects patients may get from antibiotics are far preferable to the ongoing misery of SIBO.. and are temporary. And most people tolerate the meds just fine. Rifaxamin typically works for hydrogen-predominant SIBO but is less effective for methane predominant SIBO. If it doesn’t work, ask your doctor for a different drug the next time around! There are several other medications that the doctors I work with commonly prescribe.

Once you are cured, you’ll want to avoid ever taking a probiotic supplement again (to avoid re-seeding your small intestine that’s prone to overgrowing even “good” bacteria) and talk to your doctor about exploring the underlying cause of your SIBO so that you don’t get it again.  I suspect that the notion circulating online about SIBO always coming back is related to several factors: (1) Not treating it successfully the first time around-- sometimes the medication is mismatched to the critters you're overgrowing; (2) re-seeding your SIBO with probiotic use-- remember, your small intestine is prone to overgrowing even 'good' bacteria, and that includes those in probiotic pills; and (3) failing to identify and address the underlying cause of the SIBO-- such that the predisposing factor persists and your risk of recurrence is high.

In the meantime, a low FODMAP diet helps most people manage their symptoms to a reasonable degree until the SIBO is treated.