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SIBO Die Off Symptoms [Ultimate Guide]

Have you been diagnosed with SIBO (small intestine bacterial overgrowth) or suspect that you have it? If so, chances are you’re being treated with medication, supplements or a special diet.

You should start feeling better on the treatment, right? If you are, great! If not, and in fact, you’re feeling worse, you could be experiencing SIBO die off. While true die-off reactions are quite rare, it’s important to understand what die off is, what to expect, and when to see your doctor.  

The concept of SIBO die off is based on something called the Herxheimer reaction, which we’ll explore below. There isn’t currently much research related specifically to SIBO die off. Most of the research relates to the Herxheimer reaction in the context of treating other diseases.  

This comprehensive guide will explain the science behind SIBO die off, help you determine whether you’re experiencing it, how to minimize symptoms, and when to see your doctor.

Let’s start off with an overview of SIBO itself.

SIBO Overview

What is SIBO?

The small intestine accounts for 56% of our entire digestive tract (from mouth to anus), absorbs 90% of calories consumed, and contains the largest amount of immune cells in the body. Clearly, it’s a small organ with a BIG job! 

In order to pull all this off effectively, however, the small intestine needs a low bacteria count. When bacteria grow and multiply in the small intestine, it interferes with the breakdown and absorption of food. These bacteria feed on the contents of the small intestine, and produce gas and other byproducts, resulting in unpleasant symptoms.

SIBO can have a number of underlying causes, including:

  • Infection, such as food poisoning or “tummy bug”
  • Poor gut motility 
  • Use of antacids, such as PPI, Nexium, and Prilosec

Whatever the cause, SIBO means there is a high level of bacteria present in the small intestine, where there should be very little.

SIBO Symptoms

Symptoms of SIBO can vary from person to person. The most common ones include:

  • Gas
  • Bloating
  • Abdominal distention
  • Diarrhea
  • Constipation

Less common symptoms, which usually occur with one more of the above, include:

  • Skin issues, such as breakouts
  • Brain fog
  • Abdominal pain

SIBO Treatment

If you received a SIBO diagnosis from your doctor, it most likely came with a prescription for Rifaximin, an antibiotic used to stop the growth of bacteria in the gut. 

You can also opt for an herbal antimicrobial, such as oregano or grapefruit seed extracts. It’s important to work with a licensed health practitioner, such as a doctor or registered dietitian, when using this treatment method. 

Lastly, you can attempt to starve off the bacteria with a low carb or low FODMAP diet, along with a probiotic regimen. It is best to work with a registered dietitian who specializes in gut health if you are foregoing antimicrobial treatments in favor of a diet-based approach. 

Whatever form of treatment you’re using, there is a chance that before you start to feel better, you’ll end up feeling worse because of the problem we’re here to discuss, SIBO die off.

What Causes SIBO Die Off Symptoms?

As mentioned previously, the theory of SIBO die off is based on the Herxheimer reaction, and comes from the study of syphilis patients. Basically, when syphilis patients in these studies were treated for their disease, a worsening of symptoms was observed. This research was carried out from 1895-1902. Today, this reaction is sometimes seen in patients being treated for Lyme

The bacteria that cause Lyme and Syphilis are both known to release endotoxins upon death. The release of these toxins upon treatment of the disease results the Herxheimer reaction,which includes symptoms, such as:

  • Fever
  • Chills
  • Headache
  • Muscle pain
  • Anxiety

The theory of SIBO die off assumes that this type of reaction can occur during SIBO treatment due to the rapid die off of bacteria in the small intestines. 

The endotoxins contained inside bacteria don’t usually don’t cause problems because they stay safely stored inside of living bacteria. However, when bacteria are killed off on a large scale, as in the case of SIBO treatment, a person’s system can be overwhelmed by this release of endotoxins, due to a cascade of inflammatory responses that result in the symptoms of SIBO die off, as described below.  

SIBO Die Off Symptoms

As with the symptoms of SIBO itself, the symptoms of SIBO die will vary, and should be short-lived.

The most common symptoms are:

  • Bloating
  • Fatigue
  • Nausea
  • Chills
  • Muscle and joint pain
  • Diarrhea

How Long Does SIBO Die Off Last?

These symptoms, if they occur, would mostly start within hours of beginning your SIBO treatment. SIBO die off symptoms should be short-lived, only 2-4 days in duration. If symptoms last longer than this you may be experiencing something other than SIBO die off, and you see your doctor. 

How to minimize SIBO Die Off Symptoms

Diet for SIBO

The primary way to minimize the severity of a die off reaction is to address your SIBO with diet and lifestyle first before starting antibiotic treatment. A low FODMAP or low carb diet will begin to starve the bacteria in the gut. Probiotics can be taken while following either of these diets and will help to re-balance the gut in advance of an antibiotic treatment.

Rest and Fluids

If you’re using an antibiotic treatment (whether a medication or herbal treatment), minimizing your symptoms is similar to home treatments for the flu or other viral infection. It’s important to consume adequate fluids in order to aid in detoxifying. Rest will also allow the body to use energy and resources to further detoxify during the treatment.

Key Take-Aways

SIBO is an overgrowth of bacteria in the small intestine, which causes a variety of symptoms, including gas, bloating, diarrhea, constipation, and/or abdominal distention. 

When treating SIBO, it is possible for release of endotoxins from the bacteria being killed to cause SIBO die off symptoms, which include a worsening of SIBO symptoms, in addition to fatigue, chills, muscle and joint pains, and nausea. 

SIBO die off symptoms will only last 2-4 days. You should see your doctor or health practitioner if symptoms last longer than 2-4 days.. 

If you are struggling with unresolved gut issues, working with a dietitian is a good idea. Contact MEM Nutrition & Wellness to book a free consultation.

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