One of the many gut issues that’s becoming increasingly more common in athletes and those who are overstressed is small intestinal bacterial overgrowth (SIBO). SIBO occurs when bacteria that’s normally supposed to be in the colon makes its way into the small intestine and/or the bacteria in the small intestine changes. Symptoms are bloating, gas, distension, abdominal pain, etc. SIBO also impairs food digestion and nutrient absorption, causes constipation in many cases, and plays a role in leaky gut. If this gets bad enough, leaky gut that is, an immune reaction occurs and autoimmunity can develop, as was the case with me. For some, it may never get to the level of autoimmunity, so don’t fret just understand the risks.
If you’ve had SIBO you know it is absolutely horrible to deal with day in and day out, and all you want is relief. As an athlete it can severely impact training and you can only workout certain times of day and/or on an empty stomach—which is not realistic or wise long term. You can test for SIBO using certain types of breath tests, but those aren’t always reliable (I screwed one up the first time I did it), and sometimes qualified practitioners will diagnose by symptoms and other biomarkers, avoiding the breath test route.
Thankfully there’s hope. I’ve personally overcome SIBO and I’ve helped coach athletes through it as well—successfully alleviating their SIBO symptoms and getting rid of their SIBO all together. It’s not necessarily easy; it requires diligence, dedication and a smart protocol. Research and case studies have shown that SIBO can be healed using all-natural herbs and botanicals, instead of resorting to antibiotics for relief. Of course, antibiotics are shown to be effective for SIBO as well, and in some people this more aggressive protocol may be needed. But because research shows herbs and botanicals can be just as effective without negative side effects, and I’ve seen this work even in tough cases (like mine was), I say, if you’re faced with SIBO go the all-natural route first and there’s a good chance you’ll have success—saving your body from antibiotic hell.
That said, not one protocol is guaranteed to work for SIBO; every body and every case is slightly different so you have to find what works for you. Working with an expert is key—don’t try to take on this task alone. Sometimes this means trial and error and giving protocols a chance. I went through several protocols before finally nixing it for good. That said, there are certain supplements, diet plans and lifestyle tweaks that are usually pretty dang effective, and that’s what is in this post…
Below is a SIBO healing protocol I developed that eradicated SIBO in less than six months. The client for whom I developed this particular protocol saw his symptoms dramatically decrease through the course of the protocol, and ultimately his followup breath test came back negative AND his stool test improved showing his was once again absorbing nutrients and fats better!
As you read over the protocol, a few words of caution:
- Do not start new supplements or a new protocol without consulting with a professional first.
- Do not try to cure SIBO on your own.
- Seek the help from a naturopath, functional practitioner, health coach, or doctor.
PHASE 1 — 6-8 weeks
Recommended Supplements:
| SIBO Killing Phase
6-8 weeks |
Bottles to buy | AM | Lunch | PM | Notes |
| Iberogast | 1 | 20 | 20 | 20 | Aids in gut motility; amounts shown are # of drops, mixed in water, before meals |
| Andrographis | 1 | 2 | 0 | 1 | |
| Boswellia | 2 | 1 | 1 | 1 | |
| Goldenseal Extract | 2 | 1 | 1 | 1 | |
| Oil of oregano | 2 | 2 | 2 | 2 | |
| GSE | 1 | 1 | 1 | 1 | Grapefruit Seed Extract |
| Allimax Pro | 2 | 2 | 1 | 2 | |
| Adrenal assist | 1 | 1 | 0 | 1 | Only use if adrenal issues also present |
| NAC | 1 | 2 | 0 | 1 | Antioxidant |
| Prescript Assist | 2 | 1 | 0 | 1 | Probiotic |
| Thorne D3/K2 liquid | 1 | 10 | 0 | 10 | Amounts are # of drops, mixed in water, with meals |
| Dipan 9 | 1 | 1 | 1 | 1 | Digestive enzyme; take before eating meal |
| Betaine HCL | 1 | 2 | 2 | 2 | Before eating meal |
| GI Revive (optional) | 1 | 1 serving with water when you want it |
Elimination Diet
- Avoid:
- Gluten/wheat
- Dairy
- Soy (including edamame, tofu, and soy sauces)
- Nuts and peanuts
- Grains
- Added sugars (but some natural sugar in tolerated fruit/foods is ok)
- Alcohol
- Caffeine (decaf coffee or tea is ok)
- Corn
- GMO including conventional meats raised on GMO feed
- High FODMAP intake (see more in next section)
- Optional eliminations: Egg whites, nightshades
Adhere to low-FODMAP intake
- FODMAP = Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.
- These are the main foods not absorbed in cases of SIBO, worsening the bacterial overgrowth problem since they linger in the GI tract.
- Excessive fructose, fructans, lactose and polyols are the big offenders.
- Do avoid any FODMAPs or other trigger foods that cause significant gut disruption—this adds to gut inflammation which we’re trying to decrease.
- Don’t fully avoid all FODMAP foods on list—light FODMAP intake that doesn’t elicit a reaction may help in the “killing” phase, plus some FODMAPs may be ok for you.
- Do be mindful of portions and dosage (i.e. 3 Brussels sprouts may be ok, but 8 or more is bad)
- Don’t have any FODMAPs before workouts
“Addition” Diet (more of these!)
- Fermented foods and low-sugar kombucha *IF* tolerated
- Colorful vegetables — taste the rainbow (without the skittles)
- Organic, pastured, grassfed meats
- Wild fish and high-quality fish oil — I like Nordic Naturals
- Bone broth — Our guide to making broth here.
- Collagen powder — I like Vital Proteins (also comes in bone broth)
- Psyllium husk (fiber) — start small with 1 tsp a day, and build to 1 tbsp a day
- Psyllium does not work in all people, and if it irritates your gut stop taking right away
- Whole food carbs that are tolerated — root veggies, tubers, starchy whole foods and fruits
- Egg YOLKS — option to limit/avoid egg whites, which can be allergenic and irritating to the gut
- Teas with marshmallow or slippery elm
- Ghee (instead of butter), organic lard, healthy fats
- Hydration — Up to 2 L of non-caffeinated sugar-free fluids a day (that includes fluids FREE of artificial sweeteners)
Diet “Others”
- No intermittent fasting (eat every 3-4 hours)
- No low carb and no ketosis (have at least 90g/day)
- No skipping meals
Exercise
- Aim for 10,000 steps a day (walking preferred)
- Nothing over MAF heart rate in workouts
- No more than 10 hours a week
- Low-stress, low-intensity activities are fine (mellow SUP, hiking, etc.)
- Best to avoid structured training and racing until healed (but some exercise encouraged)
- Avoid extreme exercise (as it relates to volume and/or intensity), examples:
- No Crossfit-style workouts
- No runs longer than 90 minutes
De-Stress/Decrease Anxiety
Mental stress and anxiety directly impact gut function and can exacerbate SIBO so this is a key area that needs attention!
- Top faves: Meditation, yoga, mindfulness, tai chi, acupuncture, massage
- Activities to increase vagal tone (thus decrease stress) — 15 ways to do this here.
- Avoid extreme emotions
- Adopt tools & habits that attenuate worry and anxiety, and promote more calm thoughts
- Rest, nap, and sleep at least 8 hours a night as much as you can
- Social connections/support
- Laughter
- Spirituality (does not necessarily have to be religion)
- Sauna — preferably infrared
- Nature hikes and forest bathing
PHASE 2 — 4 weeks
New recommended supplements to add in red; others in this list are being continued from Phase 1.
| Liver Cleanse
4 weeks |
Bottles to buy | AM | Lunch | PM | Notes |
| Liposomal Glutathione | 1 tsp | Take on empty stomach and wait 20min before food. | |||
| LV-GB Complex | 3 | By Designs for Health. Take with meal. | |||
| Zinc Citrate | 1 | ||||
| Activated Charcoal | 3 | Avoid taking with other supps because it will bind to micronutrients and expel as waste.
Only take 1-2x a week to bind to toxins, preferably have during sauna or also if eating meals that you didn’t prepare. |
|||
| Magnesium baths | As needed. | ||||
| Boswellia | 1 | ||||
| D3/K2 | 8000IU | ||||
| Prescript Assist | 1 | ||||
| Dipan-9 | 1 | With meals | |||
| Betaine HCL | 2 | With meals |
*You may also want to keep around Iberogast in case you get “backed up,” as well as NAC and oil of oregano.
Liver Detox Support
This protocol focuses on Phase 2 liver detox, the phase that basically gets the toxins out of the body. But it also includes some Phase 1 liver detox aid; Phase 1 transforms toxins into a form that can be properly eliminated (but doesn’t eliminate). In addition to the new supplements above (new supplements in red font), certain foods and nutrients are also key in liver detoxing:
Specifically, we’re targeting specific amino acids you can get from food (only have foods that you tolerate):
- Glyceine — get from gelatin, collagen, bone broth, connective tissues in meats, organ meats, crustaceans, etc.
- Glutamine — get from grassfed beef, pork, chicken, seafood, organ meats, parsley, spinach.
- Glutathione — get from avocado, walnuts, asparagus, natural foods rich in Vitamin C.
- OPTIONAL: Sulfur-rich foods (cysteine, methionine) – get from broccoli, Brussels sprouts, onions, garlic, red peppers, eggs, fish, same meats listed above, plus Brazil nuts.
- *The category includes FODMAPs and may be OFF LIMITS if they trigger the SIBO – you may be sensitive to all these, so small doses only or avoid all together. Worst offenders may be garlic and onions.
- Taurine (also rich in sulfur) — get from meat, fish, shellfish, eggs or get in supplement form.
- Eat liver (preferably organic), options:
- Liver pate recipe
- Desicated liver supplements (Vital Proteins),
- “Hide it” in other foods e.g. mix with ground beef or
- Try uswellnessmeats.com’s beef-braunschweiger. Mmm.
- Other foods to eat in abundance — dandelion (cook in veg stir fry), turmeric, beets, etc. For turmeric – try to get the fresh root and use in cooking or juice it. I personally take weekly shots or fresh juiced turmeric with lemon.
Avoid
- High caffeine — you can reintroduce some if it’s tolerated, i.e. 3-4 oz clean coffee a day
- Environmental toxins as much as is in your control (personal care and home products especially!). No pesticides in the yard.
- No tap water
- No soy
- Limit flaxseed
- No alcohol, or at least no more than once-a-week drink for now (and avoid domestic wines—either distilled alcohol like vodka or dry Italian red wine).
Sweat it Out
- Sauna — Ideally get to a sauna at least 2x a week and stay in for at least 30min; infrared saunas are optimal.
- Moderate exercise — at least 3x a week to where you get a good sweat, no extreme endurance or strength training though. Some is good, more is not when healing.
- Daily movement — in addition to exercise, DAILY movement is encouraged so as walking, gentle yoga, mobility sessions, etc.
- Read more on sweating’s role for detox.
Other Recommendations
- Slowly increase psyllium husk to 2 Tbsp. 5-7x a week, with plenty of water/fluids
- Snacks, food timing and portions:
- Don’t go too long without food if it leads to huge meals and/or overeating—this is a surefire way to trigger SIBO by putting too much stress on the gut. Aim for 3 reasonable meals and 2 snacks a day, or 4-5 smaller meals is fine
- If you’re worry about blood glucose regulation with more frequent eating, don’t. Research shows as long as food intake is healthy and not metabolic disorders present, you will still manage blood glucose well (sometimes even better) with more frequent feedings. Just space food apart by a few hours and that’s good enough to ensure proper digestion.
- Snack ideas here.
- Eating too much in one sitting (generally >1,000 calorie meals and/or heavy veggies) can put more of a burden on gut and digestion, and cause blood glucose to skyrocket which we don’t want.
Comment below and let me know if you have questions!