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Most Common Symptoms of SIBO Die Off

Are you being treated for SIBO and it seems as though your SIBO symptoms are getting even worse? Take heart, those symptoms you are experiencing are likely not from the SIBO itself, but from the treatment of it. 

Some of the most common symptoms of SIBO die off include nausea, bloating, loose stool and abdominal cramping. Read on to learn about other symptoms of SIBO die off as well as what to do about it.

Though the term “SIBO die off” may sound somewhat scary, it needn’t be. It’s a normal part of being treated for SIBO. BUT it may seem scary if you experience symptoms of SIBO die off without anticipating it or fully understanding it.

What is SIBO Anyway?

For a quick background, SIBO stands for small intestinal bacterial overgrowth. We all have normal and healthy gut bacteria living in our digestive system called our gut microbiome. Most of these bacteria should be living in our large intestine with the exception of a small amount living in the tail end of our small intestine. 

SIBO occurs when these bacteria populate your small intestine in higher numbers than they should. It is not necessarily the overgrowth of harmful bacteria or a bacterial infection in the traditional sense. Think of it more as a displacement of your typical gut bacteria. 

Road sign that says "no parking any time" with green trees in the background

However, once these bacteria become “overgrown” in the small intestine, an imbalance occurs within the gut microbiome. Some bacteria grow to be larger in numbers than they should. Additionally, some are diminished and exist in smaller numbers than they should. Our gut microbiome should be in harmony with each other and this imbalance disrupts this harmony.

Symptoms of SIBO

SIBO can cause some pretty unpleasant symptoms including:

  • bloating 
  • bowel changes 
  • excess gas 
  • food sensitivities
  • possible nutrient malabsorption 
  • weight loss 

SIBO requires a treatment protocol. Treatment options include pharmaceutical antimicrobial treatment, herbal treatments or the elemental diet. While undergoing your SIBO treatment, however, you may experience a variety of symptoms (SIBO die off) that may confuse you a bit. 

You may think, “hey I thought I was getting rid of this?” Right? But once we understand what is actually happening, it not only makes sense, it’s almost a welcome phenomenon.

What is SIBO Die Off?

SIBO die off is exactly what it sounds like – the dying off of this overgrowth of bacteria. This is also referred to as a jarisch-herxheimer reaction or herx reaction for short. It is sort of a detoxification process if you will, but one that can cause various symptoms. 

During treatment for SIBO, these microorganisms are literally dying inside of your digestive tract. As they die, they release toxins in the gut. This release of toxins is a large part of what causes the symptoms we experience in SIBO die off. 

These toxins will cause an immune response in your body, almost like an allergic reaction. In general, your gut bacteria release a relatively small amount of toxins whether you have SIBO or are in SIBO die off or not.

But when many are dying within a short time frame, there is a larger toxic build up than your body usually experiences at any given time. This can trigger the immune system to get involved.

Really, any time there is a change, especially suddenly, to your gut microbiome, you can experience symptoms. When you are being treated for SIBO, there is a SIGNIFICANT change to your gut microbiome.

Symptoms of SIBO Die Off

The most common symptoms of SIBO die off include: 

  • bloating
  • nausea
  • loose stool 
  • abdominal pain or cramping
  • Skin rashes
  • low grade fevers 
  • flu-like symptoms 
  • muscle aches
  • fatigue 

Of course everyone may experience the above symptoms differently. Be mindful of your body during this time and take note of what you’re feeling.

The good news is that these symptoms generally only last for a few days while the toxins and dead bacteria are flushed out of your system. Again, this will be different for everyone but generally, symptoms will be at their worst for a day or so and then start to subside. 

It is important to understand this process if you are a SIBO sufferer. If you don’t, and you are undergoing treatment for SIBO, you may think that the treatment is actually making your SIBO worse. How disheartening would that be? 

A woman with long dark hair wearing a white shirt looking upward with a puzzled look on her face and her hand on her chin.

However, this would be reasonable to think. After all, many of the symptoms of SIBO die off are similar to ones you may have experienced in the first place BECAUSE of the SIBO. So don’t let this confuse you. It should pass relatively quickly and it actually indicates that the treatment is working.

The last thing you want to do is stop a SIBO treatment prematurely because you think it is making the condition worse. This could bring the SIBO right back and you would be back at square one. 

I’m not Experiencing SIBO Die Off – Is the Treatment Working?

Now, some people may not experience symptoms of SIBO die off at all. Or, some may experience such mild symptoms that they really don’t notice them. However, if you don’t experience SIBO die off symptoms, don’t assume the treatment isn’t working. 

There is a number of reasons you may not experience SIBO die off symptoms. It might be that your SIBO was fairly minimal or at least not to the extent of some others’ cases. It also could be due to your treatment plan.

With both the pharmaceutical and herbal antibiotic treatment options, dosing and type of medication could make a big difference in the severity of die off symptoms. And as we know, each individual has different reactions and tolerance levels to different medications. 

Differences in die off symptoms could also simply be related to each person’s perception of these symptoms. Just as some people have a higher pain tolerance than others, some may have a higher tolerance to die off symptoms and not perceive them as severe. 

Managing Symptoms of SIBO Die Off

If you experience symptoms of SIBO die off, there are some things you can do to help manage them. For example, you can utilize ginger if you are feeling nauseous. Ginger also helps increase motility in your GI tract which can be helpful in both treatment and prevention of SIBO. You can try ginger root capsules, ginger tea, hard candy or chews. 

In addition, peppermint oil may help if you are experiencing abdominal cramps. Peppermint helps to relax the smooth muscles of the GI tract and can help reduce this cramping and discomfort. You can try peppermint oil capsules like IBgard or peppermint tea. Be wary of using peppermint if you tend to have acid reflux symptoms as peppermint can trigger these symptoms for some. 

Close up of peppermint leaves

If you are experiencing loose stools, you can try over the counter anti-diarrheal medications like Imodium. These can come in handy if you have an event, working or need to be out and about. 

Worth mentioning, however, is that sometimes it is best to let your body flush stool out if it needs to. Your body is trying to get rid of those extra toxins and dead bacteria. If you are in a position to do so, riding this out naturally can be helpful. It is a good idea to make sure you stay hydrated, however, by drinking plenty of water and even adding some electrolytes to your beverages if possible. 

Also, if you are having excessive gas or bloating, you could try taking activated charcoal or some type of simethicone based gas reliever. As with loose stools, depending on your personal tolerance level and severity of symptoms, you could also let this symptom ride out on it’s own. This too shall pass… pun intended.

The Low Fodmap Diet

Lastly, you could try making some temporary changes to your diet. To be clear, diet does not cause SIBO, nor does it cure it. BUT, our gut bacteria help us digest some components of the food we eat. This is typically the parts of food that we are unable to absorb.

This is the reason that most of our gut bacteria should be living in our large intestine. We absorb much of our nutrients in our small intestine and the leftovers continue on to our large intestine. There, our gut bacteria digest, or ferment, some of this. This is a good thing.

Table top with a small chalkboard with the word "fodmap" written on it surrounded by a variety of foods like steak, tomatoes, kiwi, eggs, apples and nuts

However, if your gut bacteria are living throughout your small intestine, they will be fermenting foods there and this is what causes many of the symptoms of SIBO. The low fodmap diet may help alleviate symptoms while you are getting treated for SIBO. The reason for this is that fodmaps are sugars and carbohydrates that our gut bacteria are able to ferment very rapidly. 

This rapid fermentation causes even more symptoms, especially if this process is occurring in your small intestine. Therefore, limitng high fodmap foods ONLY while you are being treated can be helpful in minimizing symptoms of both SIBO itself and the diet off process.

Generally, once treatment is completed, you should be able to comfortably liberalize your diet again without problems. The low fodmap diet is not a long term solution, but certainly could be helpful temporariliy. 

Some other related posts that you may find helpful if you are a SIBO sufferer: 

Hopefully this has given you a better understanding of the symptoms SIBO die off and how to manage it. So if you, or a loved one, experiences these symptoms while getting treated for SIBO, you can rest assured that it likely is nothing to worry. It actually probably means the treatment is working as it should! 

As always, thanks for reading!