SIBO Symptom Relief

While the best way to handle SIBO symptoms long term is to treat SIBO with antibacterials and address the underlying cause(s). Both diet (see SIBO Diets here) and supplements (listed below with shopping links for convenience), can offer helpful symptom relief in the meantime.   
There are many situations where symptom relief is needed and useful, such as: while waiting to see a doctor; while waiting for breath test results to come back; taken along with  SIBO antibacterial treatment  until it starts to help (symptoms may not relieve with the first round of antibacterials); when food aggravate symptoms; when traveling; for an ongoing stubborn symptom; and especially for chronic SIBO symptom management. 
As an affiliate for many products and services linked on this site including Fullscript and Amazon, I earn qualifying commissions when you purchase through my links.
​All Fullscript and Amazon links are affiliate links. ​​Note that creating an account through our Fullscript does not make you a patient or client of Dr. Siebecker.
Exclusive Supplement Pricing
Those in the U.S. are welcome to order supplements with exclusive pricing, through my Fullscript Dispensary. Fullscript carries 20,000+ professional-grade supplements and body care items. No code needed.  

Amazon carries some items that Fullscript doesn't, and is available outside the U.S. (links are below), however, I am unable to add a discount/special pricing to supplements at Amazon (I wish I could!). 

Bloating

Abdominal swelling from gas is the #1 most common symptom in SIBO. The gas physically distends the abdomen like air in a balloon. Because SIBO patients have slow small intestine motility or obstruction, the gas can stay put and doesn't move out normally. Therefore, anything that helps move gas out of the small intestine (prokinetics) or adsorbs gas (charcoal) is helpful.

Charcoal - adsorbs gas [1] [2] [3]
Take 30 min before or 1 hour after medicines/supplements and meals, because it absorbs nutrients as well as gas. Note that it can cause darkened stools, and if more than the label dose is taken, constipation. Can be paired with magnesium (see below) to reduce the chance of constipation. Dose: 2-4 caps (up to 1,120mg), repeat every 1-3 hours (max 4 g/day). Iberogast - prokinetic moves gas out [4] [5] [6] [7]
Dose: 20 drops as needed, or daily.
Iberogast changed from 9-herbs to 6-herbs in 2024. IBShield and Gut Motivator are similar to the 9-herb version. Prokinetics - moves gas out [46] [8] [104]
Dose: 2 caps as needed Simethicone [9] - breaks gas into smaller bubbles to facilitate passage
Dose: follow label dose.
  • Gas-X/generic options (Amazon)
For the sensation of bloating (not the physical swelling) - smooth muscle relaxantsProbiotics - various probiotics help bloating in SIBO. See Diarrhea or Constipation sections below.
“Activated charcoal significantly reduced breath hydrogen levels … and symptoms of bloating and abdominal cramps [pain]”[2] “Activated charcoal is an effective anti-gas medication”[1]

Abdominal Pain

SIBO abdominal pain is typically caused by muscle contraction against gas in the intestines. Anti inflammatory NSAID’s (ibuprofen, acetaminophen, aspirin) and narcotics, don't usually help this type of pain. Smooth muscle relaxants/antispasmodics, such as peppermint oil, work better. Also, anything that adsorbs gas (charcoal), or helps moves it out of the small intestine (prokinetics).

Peppermint - antispasmodic/smooth muscle relaxant [10] [11] [12]
Tea or tincture is better for pain that is high up, while IBgard/enteric coated pills are better for mid to low abdominal pain. Note that peppermint can worsen or cause acid reflux by relaxing the lower esophageal sphincter (this is less likely with IBgard [13]/enteric coated pills). Dicyclomine or Hyoscyamine [14] - prescription smooth muscle relaxants/antispasmodics

Charcoal - adsorbs gas [1] [2] [3]
Take 30 min before or 1 hour after medicines/supplements and meals, because it absorbs nutrients as well as gas. Note that it can cause darkened stools, and if more than the label dose is taken, constipation. Can be paired with magnesium (see below) to reduce the chance of constipation. Dose: 2-4 caps (up to 1,120mg), repeat every 1-3 hours (max 4g/day). Iberogast - prokinetic, studied for GI pain relief [6] [7] [15]
Dose: 20 drops as needed or daily Simethicone - breaks gas into smaller bubbles to facilitate passage [9]
Dose: follow label dose
  • Gas-X/generic options (Amazon)
Probiotics - varying strains help relieve SIBO pain over time (such as 1 month) [16]
Dose: follow label dose. The following strains have been shown to relieve pain in IBS or SIBO. Position - lie face down, propped up on forearms, to allow gas to exit more easily through burping

Heat - hot bath, heating pad or hot water bottle, to relax the smooth muscles

Submerge in water - to equalize the pressure of the gas (bath, hot tub, pool etc...)
“STW5 (Iberogast) has multiple effects and acts on different structures (muscle, enteric neurons, epithelial cells, immune cells, and afferent nerves)”[20] “It significantly improves quality of life and reduces abdominal pain in IBS patients”[18]

Diarrhea

SIBO diarrhea is caused by water secretion into small intestine or fast large intestine motility. Therefore, anything that absorbs water (charcoal, fiber) or slows large intestine motility (loperamide) helps to reduce diarrhea. Due to the loss of body fluids diarrhea causes, oral rehydration/electrolytes are also imp0rtant.

Oral Rehydration/Electrolyte replacement - replaces lost fluids (doesn't stop diarrhea) [19]
Oral rehydration solution contains electrolytes, plus a source of glucose (sugar, dextrose, honey, orange juice). The glucose is needed to absorb electrolytes into the cells. If an electrolyte product only contains non-calorie sweeteners like stevia, it will not work for oral rehydration (but does provide electrolytes). Alternatively, mix electrolytes without glucose, into juice or add sugar. The following contain glucose:
  • Homemade World Health Organization Recipe (single serving): 8 oz water + ¼ tsp salt + ¼ tsp baking soda + 1 Tb honey/sugar/dextrose + Optional: ¼ cup orange juice (or carrot, pineapple)
  • Electrolyte/Energy Formula, Hydration IV or Electrolyte Stamina (exclusive pricing at Fullscript)
  • SOS Rehydrate (packets or tub)
  • Liquid IV packets (Amazon) 
  • Pedialyte liquid (Amazon)
"Glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine; sodium and potassium are needed to replace the body losses of these essential ions during diarrhoea (and vomiting); citrate corrects the acidosis that occurs as a result of diarrhoea and dehydration." - Oral Rehydration Salts, World Health Organization, 2006.
Loperamide - slows transit and fluid secretion [21]
Charcoal - adsorbs intestinal water [22]
Take 30 min before or 1 hour after medicines/supplements and meals, because it adsorbs nutrients as well as water. Note that it can cause darkened stools, and if more than the label dose is taken, constipation. Can be paired with magnesium (see below) to reduce the chance of constipation. Dose: 2-4 caps (up to 1,120mg), repeat every 1-3 hours (max 4g/day).
Bismuth subsalicylate - promotes intestinal fluid absorption, anti-secretory, adsorbent [23] [24]
Possible side effects: constipation, black stool and/or tongue, Tinnitus.
  • Kaopectate (Amazon) (no sugar alcohols)
  • Pepto Bismol (Amazon) (all forms, even pills, contain sugar alcohols which may aggravate SIBO symptoms)

Fiber - absorbs intestinal water, stimulates water absorption out of intestines, regulates motility [34] [35]
Possible side effects: bloating, intestinal irritation/pain. Partially Hydrolyzed Guar Gum may have extra benefits including reducing bloating and pain.[38] Dose: start low, then increase to label dose over 3-7 days if tolerated.
Immunoglobulin G - improves frequent and chronic loose stools, bloating, abdominal discomfort, and urgency [31] [32]
Available as serum bovine immunoglobulins (as patented formula "ImmunoLin"), which is carried by many brands, or vegetarian option of colostrum (amount of IgG varies by brand). Dose: 2-4 g/day. Probiotics - regulate motility [25]
Note: avoid probiotics that contain prebiotics (FOS, GOS, MOS, Inulin, Chicory, Arabinogalactan) as a main ingredient with a "mg" listing, as they may aggravate symptoms. However, prebiotics in the "other ingredients" are often tolerated due to the small amount.

Probiotic FOODS - Commercial: i.e. “Green Valley”, "Fage lactose free", "White Mountain 24 hour" or non-dairy yogurt
  • Lactose Free Kefir: i.e. “Lifeway”, "Green Valley"
  • Real fermented sauerkraut juice or other fermented vegetable juice (from the jar): i.e. "Bubbies", "Firefly", "Cleveland"
 
Probiotic SUPPLEMENTS
Short Chain Fatty Acids: by-product of probiotics that regulate motility [28] [29]
Note that butyric acid has a strong cheese-like smell.

Constipation

SIBO constipation is caused by slow large intestine motility and water absorption out of the stool and intestines, back into the body. As stool sits, it dehydrates, forming balls or pellets. Therefore, anything that increases water into the intestines (osmotic laxatives) or increases large intestine motility (stimulant laxative) helps constipation. Because daily bowel movements are needed for best health, ongoing constipation should be treated.
SIBO constipation
CONSTIPATION
Osmotic Laxative - draws water into the intestines [36]
Less likely to cause cramping vs stimulant laxatives. OK for long-term use. Stimulant Laxative - stimulates large intestine motility [36]
More likely to cause cramping. Not recommended for long-term use. Iberogast - regulates motility, prokinetic [30]
Dose: 20 drops with meal or as needed, and/or 20-60 drops at bed Short Chain Fatty Acids: by-product of probiotics that regulate motility [28] [33] 
Note that butyric acid, has a strong cheese-like smell. Fiber - regulates motility, bulks stool [34] [35] [37]
Possible side effects: bloating, intestinal irritation/pain. Partially Hydrolyzed Guar Gum may have extra benefits including reducing methane, bloating and pain.[38] [39] Dose: start low, then increase to label dose over 3-7 days if tolerated. Diet
- Increase Fat Intake - stimulates large intestine motility
  • Oil, fish oil, butter/ghee, egg yolks, lactose-free whole milk or yogurt, sour cream, home made 24- hour yogurt from cream or half and half
- Warm Water in Morning - stimulates gastro-colic reflex/ large intestine motility
  • drunk slowly/ "chew it"
- Combination Method
  • upon arising take liquid cod liver oil/other oil, and probiotic with warm water drunk slowly/chewed
- Increase Potassium intake - helps muscle contraction
  • Juice (homemade or fresh is best): orange/melon/cucumber/tomato/carrot/spinach/chard
  • Food: avocado, banana, cantaloupe/honeydew, kiwi, chard, lactose-free yogurt
  • Supplements: Potassium Citrate (Amazonor exclusive pricing at Fullscript). Electrolyte supplements may also be used as a source of potassium (see Diarrhea above for brands). Take only as label directs.
Stool softeners - increases water and slipperiness of stool Enema 
  • Water (flushes stool out), Saline or Phosphate (osmotic laxative - draws water into intestines), Coffee (caffeine increases intestinal motility) [40]
Probiotics - regulate motility [25] [41] 
  • Note: caution with probiotics containing prebiotics (FOS, GOS, MOS, Inulin, Chicory, Arabinogalactan) as a main ingredient with a "mg" listing, as they may aggravate symptoms. However, prebiotics in the "other ingredients" are often tolerated due to the tiny amount.
Probiotic FOOD
Homemade 24 Hour Yogurt Recipe
or "SIBO Yogurt" Recipe
Probiotic SUPPLEMENTS

Nausea/Indigestion

Nausea and indigestion in SIBO can be caused by slow stomach and small intestine motility, as well as excess gas and the upward pressure it creates (when in the upper GI tract).
Ginger - increases stomach and small intestine motility, reduces nausea [44] [45] [46] [47] [48]
Available as capsules, tincture, syrup, tea, and candy. Can cause burning sensation from ginger (treat by drinking water or diluted baking soda - see “Acid Reflux” below).
Ginger for Nausea in SIBO
Ginger for Nausea in SIBO
 Iberogast - helps stomach and small intestine motility (prokinetic), studied for nausea [49] [30]
Dose: 20 drops as needed Ginger Prokinetic Formulas - helps downward stomach motility and nausea  Peppermint + Caraway, Fennel or Ginger

Acid Reflux

Acid reflux in SIBO is caused by pressure from gas in the small intestine pushing up on the stomach and diaphragm.
Baking Soda Solution - neutralizes acid for immediate relief of burning sensation
  • ½ tsp baking soda mixed into 4 oz water up to every 2 hrs (max: 7 doses/24 hrs
  • Alka Seltzer (contains aspirin)
  • Alka Seltzer Fizzy Melts or Picot (no aspirin)
Calcium Carbonate - neutralizes acid for immediate relief of burning sensation Iberogast - helps motility (prokinetic) for immediate relief
Dose: 20 drops when needed Preventative - increase lower esophageal sphincter tone to prevent reflux:
HERBAL BITTERS
  Also called “Swedish” or “Digestive” bitters. Dose: 15 minutes before meals  APPLE CIDER VINEGAR
   1 Tablespoon in 1 cup of water, 15 minutes before meals

BETAINE HCl
  1-2 caps at the start of protein containing meals (may increase to 6 caps/meal). Discontinue if burning, heaviness, or pressure occurs and treat with calcium carbonate or diluted baking soda (see above). Most brands contain pepsin (protein digesting enzyme) which is not vegetarian.

General Digestive Complaints

Digestive Enzymes - support digestion by breaking down food, especially helpful for those with enzyme deficiencies, which is common in SIBO
- Full spectrum (helps break down protein, fat and various carbohydrates) - Full spectrum, with a focus on food intolerances - Not full spectrum, but with a focus on digesting high FODMAP foods, including fructans Stomach Acid Support - corrects stomach acid deficiency, which is widespread, especially in those with digestive complaints. Stomach acid is needed for the breakdown of food and signals digestive enzyme release.
HERBAL BITTERS
  Also called “Swedish” or “Digestive” bitters. Dose: 15 minutes before meals APPLE CIDER VINEGAR
   1 Tablespoon in 1 cup of water, 15 minutes before meals

BETAINE HCl
  1-2 caps at the start of protein containing meals (may increase to 6 caps/meal). Discontinue if burning, heaviness, or pressure occurs and treat with calcium carbonate or diluted baking soda (see above). Most brands contain pepsin (protein digesting enzyme) which is not vegetarian. Colostrum - helps leaky gut (epithelial growth factors) and immune system (IgG) Probiotics - helpful for the microbiome and many digestive symptoms Probiotic Foods

SIBO Symptom Relief Handout (Free)

​For a printer friendly PDF version of the information on this page,
​download my SIBO Symptomatic Relief Handout HERE.
More Resources: Symptom playlist on my YouTube  

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