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SIBO Die-Off Symptoms: What You Need to Know

There is no one answer to this question as the length of die-off will vary depending on the individual, but typically SIBO die-off lasts anywhere from a few weeks to several months. Many people experience intense gastrointestinal distress as their gut bacteria are killed off. Others suffer from decreased appetite, weight loss, flu-like symptoms, and skin problems such as rashes.

What is SIBO?

The condition known as small intestinal bacterial overgrowth (SIBO) involves an excessive amount of bacteria in the small intestine. It contains millions of intestinal bacteria that digest our foods. However, bacteria can sometimes get out of hand and can deplete the body’s nutrients, resulting in malnutrition.

As a result, the small intestine is unable to cope with the huge number of bacteria that have colonized it. When a person consumes food, these bacteria begin to ferment it, which creates symptoms in some people.
microvilli rendering of the inner walls of the small intestine

What are the symptoms of SIBO?

  • Abdominal pain/discomfort
  • Bloating and abdominal distention
  • Diarrhea
  • Constipation (generally associated with methanogens), gas, and belching
  • Loss of appetite
  • An uncomfortable feeling of fullness after eating
  • Indigestion
  • Passing a lot of gas
  • Fatigue
  • Weakness

7 important factors that contribute to SIBO

  1. Age

    Since older adults produce less of the gastric acid that breaks down food, they are at a higher risk. Diverticulosis is also more common among them.
  2. Low motility (Intestinal Muscle Contraction)
    The intestinal muscles must contract properly to keep food moving through the body. The bacteria can grow out of control if food is left to sit, causing SIBO.
  3. Hypochlorhydria (low stomach acidity)
    Besides lack of motility, acid is another root cause of SIBO. Acid from the stomach, which starts the digestion process, is vital to the small intestine. In the absence of sufficient stomach acid, bacteria can move further up the digestive tract than usual, since the surrounding environment is not acidic enough to destroy them.
  4. Structural differences (Your unique structure)
    The digestive tract can sometimes be responsible for SIBO due to anatomical variations. The shortest colon, fistulas, and diverticulosis of the small bowel are examples.
  5. Anatomy (Shape of your body)
    You might have an abnormally shaped small intestine. Due to physical conditions in your stomach, food may travel more slowly than it should, allowing bacteria to multiply.
  6. Medical Condition (Past & Present)
    • Diabetes
    • Lupus
    • Connective tissue disorders such as scleroderma
    • Weakened immune system because of HIV or an immunoglobulin A deficiency
    • Inflammatory bowel diseases like Crohn’s and ulcerative colitis
  7. Medications (Past & Present)
    • Narcotics
    • Drugs that treat irritable bowel syndrome
    • Proton pump inhibitors that curb acid in your stomach
    • Antibiotics that affect the bacteria in your intestines

What is SIBO die-off?

Treatment for SIBO results in a die-off of bacteria. In the process of killing bacteria, toxins are released. Our bodies can be exposed to a high concentration of toxins when many bacteria die within a short time.

We may experience inflammation in our bodies as a result of these toxins. All SIBO patients do not experience die-off periods. However, The inflammatory response is called the Herxheimer reaction

Although it can cause discomfort, it is a good sign for those who do, and these symptoms indicate that the treatment is working and that the bacteria in the small intestine are being eradicated.
SIBO joint pain in the hands - blog - conscious medicine

Symptoms of SIBO Die-Off

Typical symptoms include:
  • Flu-like symptoms
  • Headaches
  • Skin eruptions/rashes
  • Constipation
  • Congestion and runny eyes/nose
  • Muscle & joint pain
  • Body aches
  • Chills
  • Sore throat
  • Malaise
  • Fatigue
  • Indigestion
  • Nausea
  • Brain fog
  • Sweating
  • Fever
  • Worsening of SIBO symptoms
The die-off symptoms can be worse if there is a co-infection, such as fungal infection or parasites.

When do SIBO die-offs occur?

Die-offs occur when toxins from dying bacteria are released simultaneously during the elimination process. It is possible to experience temporary discomfort at this time.

Increased bloating and abdominal discomfort, mild fatigue, muscle aches, and even a low-grade fever are common symptoms of the die-off process.
  • Fatigue
  • Cold intolerance
  • Constipation
  • Dry skin & hair
  • Puffy face
  • Muscle & joint aches
  • Brain fog
  • Insomnia
  • Low mood or depression
  • Irregular or heavy periods
  • Slow heart rate
  • Enlarged thyroid gland (goiter)

How long do SIBO die-off symptoms last?

These symptoms can vary by person, but we find that the more you improve digestive function before having a SIBO treatment, the more you can reduce the likelihood or severity of die-off symptoms.

SIBO die-off can occur in the first several days after starting treatment, and patients expect to feel worse for the first 1-10 days of a SIBO protocol. Die-off can also occur anytime the treatment protocol is adjusted by adding another supplement or medication or making changes to dosage.
Hashimoto's Flare up - fatigued woman falling asleep - Blog - Conscious Med

Tips on how to minimize the symptoms of SIBO die-off

The following tips may help minimize die-off symptoms if you take herbal therapy for SIBO:
  • Keep hydrated
  • Keep your bowels moving
  • Get enough sleep
  • Ensure proper digestion
  • Pull back or pause your protocol
  • Support your body with additional supplements
  • Relax by soaking in Epsom salt baths
  • Reduce stress
  • Work up a sweat
  1. Diet

    A healthy diet can stimulate your hormones, brain, and gut, reversing immune dysfunction and inflammation.
  2. Emotional & Physical Stress
    The impact of stress on your body is far-reaching, affecting everything from your hormone production to your immune system.
  3. Viral Infections
    One environmental factor triggering an autoimmune outbreak is viral infections (like rubella, mumps, or Epstein-Barr virus), and a virus causes inflammation as a defense mechanism. Conditions of any kind can put a strain on your body, making it susceptible to disruptions.
  4. Lack of Sleep & Lack of Exercise
    Thyroid health can improve by getting enough sleep. If you struggle to fall asleep, stay asleep, or get low-quality sleep, your immune system will have a difficult time building up its forces.
  5. Bacterial Infections (Acute or Recurrent)
    Bacterial infections can also stress the immune system, leading to Hashimoto's exacerbations.
  6. Parasites
    Parasites can also trigger outbursts. There have been reports that some cases of Hashimoto's are associated with blastocystis hominis infections.
  7. Exposure to Endocrine Disrupting Chemicals
    Chemicals that disrupt hormones are classified as EDCs. EDC chemicals like these either block or mimic native hormones in the body. Moreover, they make thyroid lab tests appear better than they are, thus interfering with thyroid diagnosis. These chemicals are found in plastics, receipts, drinking water, clothing, lotions, creams, etc.
  8. Leaky Gut
    A leaky gut means that your body's protective barrier (intestinal lining) is not as effective, and toxins may enter your bloodstream unintentionally. You may experience inflammation in your gut, or your immune system may react to the toxins, two factors that can cause a flare-up.
SIBO die-off symptoms can be uncomfortable but are typically short-lived. If you are experiencing any of these symptoms, it is important to drink plenty of fluids, eat healthy foods, and get adequate rest. If the symptoms persist or worsen, be sure to consult with a functional medicine professional.
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Functional medicine is an approach to healthcare that focuses on identifying and addressing the root causes of disease. Unlike traditional medicine, which often treats symptoms without addressing underlying problems, functional medicine seeks to understand the body and identify imbalances contributing to illness. Functional medicine practitioners use various tools, including nutrition, lifestyle changes, and supplements, to help their patients achieve optimum health. The root cause is a term used in healthcare to refer to the underlying cause of a disease or condition. A root cause may be genetic, environmental, or lifestyle-related. Identifying and addressing root causes is a key component of functional medicine.

I’m not sick. Should I still schedule a consultation?

Prevention is the best medicine, especially regarding your health. Most people believe that illness occurs in the body when you get older; this is not true. By taking steps to prevent disease and injury today, you can stay healthy and avoid costly medical bills later on down the road. Unhealthy habits create chronic inflammation in the body, leading to later illness.

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We do not accept insurance. You can pay by credit card, debit card, HSA/FSA debit card, or care credit. You are welcome to submit the superbill for possible reimbursement from your insurance company. This document itemizes the services rendered and provides the insurance company with the information they need to process your claim. Many of our patients get up to 70% reimbursed.
We do not take any part in submitting claims or calling insurance companies, which is 100% the patient’s responsibility. We do not bill or participate in Medicare for any of our services.

Why don’t you accept insurance?

Unfortunately, insurance companies often dictate patients' care, limiting the effectiveness of treatments and time spent with our patients. Reimbursement rates are often too low to cover quality care costs. The administrative burden of dealing with insurance companies can be significant, which takes away from time that could be spent providing care to patients. We believe in providing the best possible care to our patients by spending as much time as necessary with each patient with personalized treatment plans to ensure their needs are met.

Who is a typical patient you see?

We see various individuals looking to upgrade their health and well-being. Our patients vary from complex health issues to the average person who doesn’t feel right. We help patients with chronic diseases such as autoimmune disease, heart disease, fatigue, insomnia, diabetes, arthritis, high cholesterol, ulcerative colitis, thyroid disease, anxiety, depression, brain fog, mood disorders, and more. Dr. Truc assists patients in getting off medication safely and healthily that is best suited for the individual.
Our advanced diagnostic testing, combined with Dr. Truc’s Functional Integrative approach, reveals the root cause of these issues. We see a variety of individuals looking to upgrade their health and well-being. Our patients vary from complex health issues to the average person who doesn’t feel right. We help patients with chronic diseases such as autoimmune disease, heart disease, fatigue, insomnia, diabetes, arthritis, high cholesterol, ulcerative colitis, thyroid disease, anxiety, depression, brain fog, mood disorders, and more. Dr. Truc assists patients in getting off medication safely and healthily that is best suited for the individual.
Our advanced diagnostic testing, combined with Dr. Truc’s Functional Integrative approach, reveals the root cause of these issues.

What can I expect in a wellness consultation?

We see various individuals looking to upgrade their health and well-being. Our patients vary from complex health issues to those who don’t feel right. We help patients with chronic diseases such as autoimmune disease, heart disease, fatigue, insomnia, diabetes, arthritis, high cholesterol, ulcerative colitis, thyroid disease, anxiety, depression, brain fog, mood disorders, and more. Dr. Truc assists patients in getting off medication safely and healthily that is best suited for the individual.
Our advanced diagnostic testing, combined with Dr. Truc’s Functional Integrative approach, reveals the root cause of these issues.

Where can I get my lab testing done?

Our most commonly recommended lab test for stress management is a non-invasive test done in the comfort of your home with ease.

Some labs may require bloodwork which we offer at our Conscious Medicine office. If the distance is an issue for lab testing, we are happy to assist you in finding a facility closer to where you live. At Lab Corp, you can schedule an appointment directly with their facility.

*To follow CDC sanitation and safety protocols, we only accept one patient at a time in our office, wear proper PPE, and disinfect them.*

Does insurance cover lab tests?

Lab tests are not covered by insurance. Many insurance plans, especially those provided by employers, only cover tests considered "medically necessary." You can check with your insurance supplier to see if they will reimburse you for out-of-network labs.

Lab tests are necessary because they can help diagnose many conditions, from uncomplicated infections to more severe diseases. They can also tell us how well your organs work and help us monitor your overall health.

How do I schedule an appointment?

Dr. Truc offers a complimentary 15-minute phone consultation to answer any patient's questions or concerns regarding their health ailment and go over the services provided at Conscious Medicine. We look forward to connecting with you and scheduling a call today.

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