🌿 SIBO Management Protocol: A Step-by-Step Guide to Healing Your Gut
- OlaKrawczyk
- Sep 17
- 2 min read
Small Intestinal Bacterial Overgrowth (SIBO) is a condition where bacteria build up in the small intestine, leading to uncomfortable and often debilitating symptoms such as bloating, abdominal pain, reflux, diarrhoea, constipation, fatigue, and nutrient deficiencies.
Managing SIBO effectively requires more than a quick fix.
A structured, phased approach can reduce symptoms, address the root cause, and support long-term gut health.
🔎 Step 1: Testing & Diagnosis
The first step in managing SIBO is proper testing. A lactulose or glucose breath test is the most common method to detect hydrogen, methane, or hydrogen sulfide gases produced by bacteria in the small intestine.
Hydrogen SIBO: often linked to diarrhoea
Methane (IMO): often linked to constipation
Hydrogen Sulfide: can present with mixed symptoms, sometimes foul-smelling gas
A correct diagnosis ensures that treatment is targeted and effective.
🌱 Step 2: Phase 1 – Calm & Prepare the Gut
Before jumping into antimicrobials or antibiotics, it’s important to calm the gut environment:
Dietary adjustments: A modified low-fermentation or SIBO Bi-Phasic Diet can reduce bloating, gas, and discomfort by restricting fermentable carbohydrates that bacteria feed on.
Support digestion: digestive enzymes, bile support may be introduced to aid nutrient absorption.
Reduce inflammation: nutrients like glutamine, zinc carnosine, and omega-3s help repair the gut lining.
This stage lowers inflammation and prepares the body for treatment.
💊 Step 3: Phase 2 – Active Treatment
Once the gut is more stable, targeted treatment can begin. This stage is about reducing bacterial overgrowth through one of the following:
Antibiotics such as Rifaximin (Xifaxan), sometimes combined with neomycin for methane cases.
Herbal antimicrobials such as berberine, oregano oil, neem, or allicin.
Prokinetics to improve motility and prevent bacteria from stagnating in the small intestine.
This phase usually lasts 4–8 weeks, depending on individual needs and test results.
🌿 Step 4: Phase 3 – Repair & Restore
SIBO management isn’t complete after killing the bacteria. Healing and restoring the gut environment is key:
Rebuild the microbiome: gradually reintroduce fibre and prebiotic foods to feed beneficial bacteria.
Repair the gut lining: nutrients such as glutamine, collagen, zinc, and antioxidants support the intestinal barrier.
Balance the diet: diverse, whole foods, polyphenols, and probiotic foods (sauerkraut, kefir, yogurt) help create a resilient gut ecosystem.
🔄 Step 5: Relapse Prevention
Unfortunately, SIBO has a high relapse rate if underlying causes aren’t addressed. Long-term strategies include:
Supporting gut motility (prokinetics, stress management, meal spacing)
Correcting structural issues (e.g., adhesions, low stomach acid, or sluggish bile flow)
Managing lifestyle factors (stress, sleep, and movement)
📌 Final Thoughts
SIBO can feel overwhelming, but with the right protocol, it is manageable. A phased approach allows the gut to heal step by step, addressing both the bacterial overgrowth and the root imbalances that contributed to it.
As a Clinical Nutritionist trained in SIBO management, I work with clients to create tailored, evidence-based nutrition strategies that complement medical care and support long-term gut health.
💚 Want to explore if SIBO testing and management is right for you?
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