Now that you’ve gotten things under control, it’s back to normal, right? Wrong. Bacterial imbalances in the intestines have a nasty tendency to relapse.

A 2008 study looked at SIBO relapse rates after successful antibiotic treatment. This graph shows the results.

Source: Lauritano, E. C. et al. Small intestinal bacterial overgrowth recurrence after antibiotic therapy. Am. J. Gastroenterol. 103, 2031–5 (2008). https://www.ncbi.nlm.nih.gov/pubmed/18802998

The relapse risk increases further when one or more of the protective mechanisms aren’t working properly.

Some factors that protect against SIBO:

• Gastric acid (stomach acid)
• Bile acids
• Pancreatic enzymes
• Motility (the migrating motor complex)

Gastric and bile acids kill bacteria in the stomach and the small intestine. Pancreatic enzymes reduce the amount of fermentable carbohydrates by speeding up digestion. The migrating motor complex clears undigested food and bacteria from the small intestine. Other factors, such as the gut immune system, also protect against SIBO but aren’t relevant to our discussion as there’s not much you can do to affect them.

Our effort to stabilize and prepare your digestive track to return to normal diet includes:

• Prokinetics to support motility. This is by far the most important step.
• Digestive support. One or more of the following: stomach acid, herbs that support digestion, digestive enzymes. The purpose of these is to ensure the food you eat gets digested as quickly and completely as possible to minimize the residue available for fermentation in the small intestines.
• Diet. We’ll start introducing more fermentable fiber into your diet while monitoring gut function and bowel movements.