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How to Reduce SIBO Die-Off Symptoms +Prevention

SIBO die off symptoms can be a sign of healing from this uncomfortable condition. So if you don’t feel well right away on your journey to ditching SIBO, no need to despair.  

In other words, if your symptoms get a little worse when healing SIBO, don’t give up!  This can be true of many gut healing regimens.  You can feel a little worse before you start to feel better. 

Learn about SIBO die off symptoms, treatment options, and how to help prevent SIBO from coming back. 

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What is SIBO?

Just so we are all on the same page, SIBO is small intestinal bacterial overgrowth.  

In a healthy gut, bacteria don’t grow easily in the small intestine, but they do grow well in the large intestine. With SIBO, bacteria grow more readily in the small intestine, and this causes symptoms like gas pain, bloating, and abnormal bowel movements. 

SIBO is becoming a widely recognized condition, with over a third of people with irritable bowel syndrome who can present with this condition [R]. 

Usually diagnosed with a breath test that measures hydrogen and methane, SIBO is relatively easy to diagnose, yet somewhat challenging to treat.

This is because the aim of treating SIBO symptoms is to kill off the bad bacteria living in the small intestine and avoid killing the healthy bacteria in the large intestine. 

The goal is to also prevent it from coming back, which can require some sleuthing. 

SIBO treatment options

As research continues to grow related to how to treat SIBO, so do the tools for patients to recover. 

Standard treatment includes a course of antibiotics like rifaximin (Xifaxan).  Use of herbal antimicrobials also is as effective as triple-therapy antibiotics for treating SIBO [R]. These herbal therapies include FC Cidal and Dysbiocide as well as Candibactin AR. 

Depending on the presence of methane, the treatment may also include neomycin. 

Research is also emerging to suggest that adding guar gum, a type of fermentable fiber from beans, to the therapy enhances the effectiveness of the antibiotic treatment [R].

Another important fact is that probiotics are likely to help improve SIBO recovery because the healthy bacteria can help ward off the imbalance of SIBO [R]. 

Related: Best Probiotic for SIBO and Histamine Intolerance

Diet factors for SIBO treatment

Some people follow a low FODMAP diet for symptom relief, but it’s important to know that this diet, in fact, has never been researched in the treatment of SIBO.  

These diet restrictions may also serve to cause further imbalances in the long term, especially if done without the guidance of healthcare providers who specialize in this condition. 

An elemental diet does seem to have merit based on research, but is very challenging to follow [R].

Someday, we may be able to fine-tune the SIBO diet so that minimal other treatments are needed. Sadly, the research isn’t quite there yet. 

One thing for sure that is true: you will want to fix the underlying causes of SIBO and provide healing nutrients so that your immune system has a fighting chance of keeping SIBO from coming back.

These underlying causes can be low stomach acid, medication side effects, low nutrients, constipation, and an altered microbiome.

What is SIBO die off?

So, you are on the path to treating SIBO by killing off the bad bacteria; why can you all of a sudden feel worse with SIBO treatment?

This is because the bacteria dying off is temporarily causing some imbalances in the body. This is referred to as SIBO die off.

As you might imagine, your symptoms may not feel better right away.  In fact, they can get worse before they get better. 

SIBO die off symptoms

The goal of healing from SIBO is to kill the bacteria in the small intestine that don’t belong there and to also heal the gut so that it doesn’t recur again. 

But, as these bacteria die off, they can release toxins into the body in the short-term.  This release, as you can imagine, can cause some worsening of symptoms.  One of the reasons it can cause symptoms is because it creates an inflammatory response in the body. 

Known in healthcare circles as a Herxheimer reaction, if you have SIBO die off, you don’t need to be alarmed.  This is because the symptoms may worsen, but only should be mild and last a few days and up to a week. 


These die off common symptoms include:

  • Gas
  • Bloating
  • Belching
  • Indigestion
  • Constipation
  • Diarrhea
  • Aches
  • Fatigue
  • Low grade fever
  • Mood swings
  • Skin changes

Let’s face it; the use of antibiotics and herbal antimicrobials isn’t always pleasant either, and it can result in some of these unpleasant side effects itself. 

How to minimize SIBO die off symptoms

If you are taking antibiotics or herbal therapies for your SIBO, you can do some things to help minimize dying off symptoms.  

  • Stay well-hydrated
  • Don’t crash diet, but avoid processed sugars and processed foods
  • Make sure you keep your bowels moving-this helps with toxin removal
  • Take time for calming activities like meditation, yoga, or using a sauna
  • Add fermented foods if you can tolerate them and consider soil-based probiotic therapy as well
  • Get around 8 hours of good sleep
  • Add some guar gum to your daily routine or other soluble fibers

By eating nourishing foods, you stand a better chance of keeping the nasty SIBO bugs at bay.  Good choices are a balance of protein, complex carbs, healthy fats, and some fermentable carbohydrates, as many as you can tolerate (except gluten grains).

Emerging research shows that adding FODMAPS can help improve the rate of recovery from SIBO.  This goes in the face of standard thinking for SIBO treatment. In fact, FODMAP teas may also be beneficial for SIBO symptoms.

Fibers and FODMAPS like guar gum help the bacteria to come out of spore form, making them more responsive to oral antibiotics or herbal therapies [R]. 

My favorite foods for SIBO are homemade chicken and vegetable soup with bone broth, sauerkraut salad, lemon blueberry muffins (no processed stuff), Reuben-style meatloaf, and salmon salad.  You can find all of these recipes in my new book the Whole Body Guide to Gut Health.

Tips for preventing SIBO recurrence

One of the biggest challenges of SIBO is that it has a high chance of recurrence. In order to have your best chance of keeping SIBO from coming back, there are some important lifestyle tips to consider. 

Normalize your bowel movements

Make sure to nurture your digestive health as you are coming off of medications.  And keep your poop schedule daily and at a snake-like consistency.

This can take some professional help, so seek out help from those like Sarah Kahn Nutrition

Probiotics, digestive enzymes, and betaine HCL can help prevent constipation. Address magnesium deficiencies as well, which are quite common with SIBO. 

Adding fiber-rich foods like chia seeds and guar gum may also be helpful in bulking up the stools.

Heal your gut

You may benefit from adding healing foods, probiotics, prebiotics, nutrients, and consider adding in some soluble fibers to help with bowel movements. 

By healing the gut, you are strengthening your immune response to SIBO bugs.

Replace nutrients

The body absorbs most of its nutrients in the small intestine, so if you have been living with SIBO for a long time, you are very likely to have many vitamin deficiencies and mineral deficiencies.  

Make sure to add in the best natural vitamins so that your body can use them best. 

Immune support

Also, consider supporting your immune system to keep those nasty SIBO bugs at bay by healing your leaky gut.  This may include vitamin D3 and other immune-boosting nutrients.

Bovine colostrum is a supplement I recommend frequently for immune health because it can have some great healing properties for the gut.  Colostrum is very low in lactose, but if you have a true dairy allergy, you will need to avoid using colostrum.

Infographic with tips for treating and preventing SIBO die off symptoms including adding nourishing foods, replacing nutrients, adding digestive enzymes, adding betaine HCL if stomach acid is low, using soil based probiotics, adding fermented foods, including guar gum, adding FODMAP foods, staying adequately hydrated, and keeping bowels moving by The Healthy RD

Buy natural SIBO treatments

Not sure where to find the best natural SIBO treatments? Here are some good options:

Keep in mind, FC Cidal and Dysbiocide are meant for short-term use and may cause some SIBO die-off symptoms as would antibiotic therapy. 

Some research shows that adding in some betaine HCL or diluted apple cider vinegar helps to treat or prevent SIBO too by normalizing stomach pH [R]. This strategy only works if your stomach is producing too little acid. Low stomach acid can lead to SIBO in some people.

Digestive enzymes can help reduce constipation, gas, bloating, and even heartburn in people with SIBO. They do so by helping to break down the food you eat into digestible components. You can simply take these enzymes with meals and see if they are right for you.

I listed a lot of options to help SIBO and some may work better for you than others because you are unique. Some trial and error may occur. The important thing to know is that you have many options to help you manage your SIBO symptoms. You also have tools to help minimize SIBO die off symptoms.

The information on this website has not been evaluated by the Food & Drug Administration or any other medical body and is shared for educational purposes only. Consult your doctor or healthcare provider before making changes to your supplement regimen or lifestyle.

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  1. Pingback: Best probiotic for SIBO and Histamine Intolerance

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