You’ve been due for a SIBO update from me. I last shared an update about my symptoms back in September of last year, so it’s definitely time again.
In my previous update, I mentioned that I was going to start an antibiotic treatment, Rifaximin. I did exactly that at the end of October last year. Unfortunately, it did not affect my symptoms.
During the treatment, my symptoms got worse, which is normal when you’re on antibiotics, but afterward, they returned to the level they were at before the treatment. After that, I put my attempts to improve my symptoms on hold for a while.
My boyfriend Matic and I got engaged during our vacation in the US, and we’re getting married this year, so in the past few months, we’ve been very busy with wedding preparations. That’s where my focus has been lately, and it’s been really nice and fun!
I took a SIBO breath test
Recently, I have been taking some action again with my SIBO. For me, actually, SIBO had never been officially confirmed with a test. But two dietitians independently concluded, based on my symptoms, that it was probably SIBO.
Since I had already tried quite a few different treatments and nothing had really worked, I decided I wanted to do a SIBO breath test to be sure it was SIBO that was causing my symptoms.
I did the test via an orthomolecular gut therapist. The test costs €100, and you receive a breath test kit to use at home. Since I didn’t know much about this myself, and it might be interesting for others suspecting SIBO, I’ll briefly explain how it went.
How a SIBO Breath Test works
For two days before the test, I had to follow a modified (very limited) diet. You also can’t have taken antibiotics in the four weeks before the test.
48 hours before, you can’t:
- Take pre- or probiotics
- Drink alcohol
- Eat fiber
- Eat sugar
- Only eat easily digestible foods
My therapist advised only eating chicken, rice, and egg. I could drink water, tea, and black coffee (no milk or sugar).
So for two days, I ate three times a day a plate of boiled rice with cooked chicken breast and boiled or fried egg. Very boring, haha, but manageable for those two days.
12 hours before the test, you stop eating completely (after dinner the day before), and you also can’t use toothpaste or chewing gum.
On test day, you start by taking a baseline breath sample. You blow into a bag from the kit; at the top is a spout where you insert a tube. Your breath is collected, and the tube seals automatically.
After the first sample, you drink a lactulose solution. You then can’t drink anything for one hour to avoid affecting the results. Then, over the next 3 hours, you take a breath sample every 20–30 minutes.
Those tubes go in an envelope, and you send them to the lab. Then you can eat and drink again.
It was quite a bit of prep to do the test properly, and I was a bit nervous about doing it right. But thankfully, it all went smoothly.
The test that I did tested for hydrogen and methane levels.
The test results
Two weeks later, the results were in: I have methane SIBO.
There are two variants of SIBO:
- Hydrogen-dominant SIBO, where the overgrown bacteria in your gut produce hydrogen gas.
- Methane SIBO, nowadays called IMO (Intestinal Methanogen Overgrowth), is where methanogen-producing archaea (not bacteria, but related) overgrow.
In hydrogen-dominant SIBO, you often see faster bowel movements. Possible symptoms include:
- Diarrhea
- Bloating (often after eating)
- Gas
- Cramps or gurgling in the gut
- Nausea
- Weight loss
With IMO, you often see:
- Constipation (hard, dry stools)
- Bloating (sometimes all the time)
- Belly pain or heaviness
- Gas and/or burping
- Trouble losing weight or weight gain
I recognize several of the IMO symptoms, so I am not surprised that I have IMO.
How is IMO treated?
IMO is known to be persistent and difficult to eliminate. Several treatment methods are currently used for IMO, including:
- Antibiotics: For IMO, the recommended treatment is Rifaximin + Neomycin or Metronidazole.
Rifaximin works best for hydrogen-producing bacteria; the others target methanogens. That explains why Rifaximin alone did little for me. - Elemental diet: A 14‑day liquid-only diet with special meal-replacement formulas that starve the SIBO/IMO-causing microbes.
- Phytotherapy: Herbal antimicrobials are also used in SIBO treatment. These include things like oregano extract and berberine, which have shown results comparable to antibiotics.
I tried phytotherapy before, but reacted strongly to oregano extract and couldn’t complete the treatment. You can read about that in my earlier SIBO updates.
I’ve tried antibiotics already, but not in the right combination for the IMO I now have. In the Netherlands, SIBO/IMO isn’t very well known yet, so practitioners often lack awareness of it and its treatment methods.
In the US, antibiotics are commonly prescribed for SIBO/IMO, but in the Netherlands, doctors are not readily prescribing antibiotics, and since SIBO/IMO is not yet well understood, it is often difficult to obtain treatment with antibiotics for this condition.
What’s working for me right now: eating less often
I am still going to consult with my gut therapist on what the best way to move forward is. I only recently got the test results.
One main thing that I am doing right now, and that I feel already impacts my symptoms a little is eating less frequently. I eat 3 main meals and try to stick to a maximum of 1 or 2 snack moments.
I’m a bit of a snacker, and when I didn’t pay much attention to what I ate, I noticed I was snacking randomly throughout the day. Including my main meals, I was maybe putting some food into my mouth about 10 to 15 times a day! Often very small amounts, but still a lot of eating moments. Once I became aware of that, I noticed that my digestion reacts better when I’m not eating all day long.
What I am doing now
I try to eat three proper meals a day. Before, I often had dinner and then would have a snack or dessert one or two hours later. Now I combine them: if I want dessert, I eat it shortly after my meal (within an hour). I do the same at lunch: I have a bigger lunch, so I don’t need a snack afterward.
I still have something in between sometimes (life should still be enjoyable), but now I can much more often stick to 4 or 5 eating moments a day. That gives me peace of mind (because I’m always thinking about food) and it gives my gut a break too.
That way, I give my body a few hours to digest and “clean up” after that meal before the next one.
Why eating less frequently can be beneficial for SIBO/IMO
For people with SIBO or IMO, often the Migrating Motor Complex doesn’t work properly.
The MMC is like your gut’s “clean-up crew.” It’s a pattern of waves of muscle contractions that happen in your small intestine between meals. These waves help sweep out leftover food, bacteria, and waste, moving them into the large intestine.
For people with SIBO/IMO, the MMC often doesn’t work properly or often enough, which lets bacteria build up in the small intestine. Giving your gut longer breaks between meals helps the MMC do its job better, reducing bacterial overgrowth and improving symptoms.
Eating less frequently also:
- Prevents constant food supply for bacteria: Eating too often feeds the bacteria in your small intestine continuously, helping them grow and worsen symptoms.
- Supports gut rest and repair: Longer gaps between meals give your digestive system time to rest and heal, reducing inflammation.
- Improves digestion efficiency: When you eat too frequently, your gut may not fully digest and absorb nutrients well, which can worsen symptoms.
- Reduces fermentation: Less frequent eating means less fermentation by bacteria, so fewer gas and bloating symptoms.
This is something I am already trying to do now. I will soon meet with my therapist to see what the next steps are that we can take and then I’ll continue from there.
If you have experience with the treatment of methane dominant SIBO or IMO, I am very curious what helped for you to get rid of the IMO. And if you managed to get rid of it fully or had to go through several cycles of treatment.
I will keep you updated on how things are going!
