Do you have intestinal distress (constipation, diarrhea, frequent urination), excessive bloating or cramping after meals, food intolerance, anxiety, skin disruptions (eczema, rosacea), chronic pain, or recurrent UTI/bladder/strep infections?
Or do you have a sour stomach if you miss meals, wake up feeling nauseated, get heartburn after certain foods, or have unusual patterns of hair loss (alopecia)?
You may have a bacterial overgrowth in your intestinal tract that is igniting inflammation and silently wrecking your health.
Our intestinal bacterial story starts at our birth. When we are born our intestines are colonized with a bacterial blend from our mothers, with the exceptions being people born by C-Section or if we spent time in intensive care.
In our first year our bacteria matures and is influenced by a number of things, including whether we are breast-fed and when we start eating solid foods. It is particularly influenced by medications.
A single course of antibiotics in our first year seems to permanently change intestinal bacteria so much it can be detected 7 years later. Repeated exposure to antibiotics during childhood continues the changes.
During our lives our intestinal bacterial blend changes with our diet, medications, anesthesia, surgeries, vaccines, and infections.
Once our bacterial balance is disturbed many of us do not regain our healthy balance, we live with an altered blend that may be detrimental to our health. Many of us now develop Small Intestinal Bacterial Overgrowth (SIBO).
SIBO may start after damage to the Autonomic Nervous System slows our intestinal tract and allows bacterial migration from the lower regions of the colon upwards into the small intestines.
Autonomic damage may happen after a physical injury (sports, concussion), an emotional trauma, or after the use of products that alter the movement of our intestinal tract (medications, anesthesia, vaccines).
In a twist, studies have shown that the bacteria themselves can directly impair Autonomics. The bacteria have learned to send signals to the brain via the Vagus Nerve. These signals alter our Autonomics and slow digestion.
The bacteria have learned the first rule in real estate; location is everything.
The bacteria move up to a better neighborhood (small intestine) where nutrients help them replicate and survive. The invading bacteria digest the nutrients and release gases, toxins, and waste products that give us symptoms.
Those symptoms of the bacterial overgrowth are heartburn, food intolerance, ‘low blood sugar’, morning nausea, excessive hunger, intestinal distress (cramping, bloating, constipation, diarrhea), eczema, and hives. The bacterial overgrowth may also trigger recurrent strep infections, bladder and urinary tract infections.
SIBO may also cause the Autonomic disturbances of frequent urination, fatigue, lightheadedness, insomnia, and anxiety.
SIBO is one of the major factors in the development of Autism and Attention Deficit Disorder.
We are accustomed to temporary fixes for those symptoms. But taking antacids for heartburn, fiber for constipation, or anti-spasmodic drugs for intestinal cramping only mask the surface symptoms of SIBO.
Some dietary changes like gluten-free products and paleo style eating, or products like probiotics, temporarily shifts the available nutrients for the invading bacteria but people may lose the benefits once the bacteria can replicate and continue their migration upward.
None of those temporary fixes solve the underlying bacterial imbalance and thus none decrease the resulting systemic metabolic inflammation.
The bad news is that the metabolic inflammation is our real problem. The bacterial overgrowth damages our intestinal wall and leaks a substance (LPS; lipopolysaccharide) into our tissue. Our white blood cells react to the LPS and release inflammatory cytokines into our blood. We call this “Leaky Gut”.
Researchers have also demonstrated that elevated LPS can lead to Type 2 Diabetes and obesity in mice. Depression and hypertension are also associated with elevated LPS and inflammation.
Those studies demonstrated that rebalancing the intestinal bacteria reverses the brain dysfunction and normalizes hormone production.
In my medical practice I see that SIBO contributes to almost every modern disease we face today.
By treating SIBO and repairing Autonomic dysfunction, I have facilitated the improvement, remission, or reversal of not just common ailments like diabetes and hypertension, but also autism, heart failure, cerebral palsy, anxiety, PTSD, POTS, PCOS, ADD, dyslexia, seizure disorders, narcolepsy, and Takotsubo cardiomyopathy.
I have found that in order to maintain healthier bacteria one must also restore neurological control over the intestinal tract. You must repair and maintain both the intestinal tract and repair and maintain Autonomic function.
SIBO and Autonomic treatment often involves short-term medications to restore a better bacterial blend, core nutritional changes to support neurological repair and stem cell production, and long-term dietary changes.
Controlling SIBO and maintaining Autonomic Nervous System balance is not easy, but it is also not impossible. The process takes work and it is your personal health marathon; each day your efforts, foods, and medications either support or endanger your recovery and your health.
I am an internal medicine physician and my private office is located in the greater Phoenix, Arizona area.
For more information on SIBO and the Autonomic Nervous System you may call my office at 623-208-4226 or learn from my website www.DrBuckeye.com.
© 2015. Dr. Patrick Nemechek and Jean R. Nemechek. All Rights Reserved
Hello Dr. Nemechek. Is there any chance to control SIBO in adult using inulin only? I don’t have too many GI symptoms, and inulin seem to agree with me, just started 3 days ago. Are there any symptoms which could tell that inulin is not working and I need a course of rifaxinim instead? I definitelly have ANS dysfunction.
Hi Dr. Nemechek, My 11 month old has many food allergies, GERD, chronic diarrhea (leaks stool all throughout the day) and a recent scope revealed chronic gastritis. Doctors have him on Ranitidine and a few weeks ago, we started him on a spore-based probiotic that has helped immensely. Less spitting up, no more diarrhea or intestinal distress, and far fewer food intolerances. I just found your protocol yesterday, and learned about how damaging probiotics can be – but this particular probiotic has helped SO much! My question is – are all probiotics bad? Even spore based which are proven to… Read more »
Hi Dr. Nemechek,
What is your opinion about and/or experience with herbal antibiotics (such as Metagenics and Biotics Research from the 2014 study) in comparison to rifaximin? I need to do a round of antibiotics for SIBO, but am not sure that my insurance will cover rifaximin.
I have better results using rifaximin
Dear Dr. Nemecheck,
My son is 3.7 years completely nonverbal. We started the protocol 2 months ago. We got his OAT test done couple of months back and we found out he has yeast overgrowth . Also he has zero concentration (attention) in any activities. Please help. Dosage: 1/4 inulin, 2ml FO, 5ml evoo in his cooking.
Stick with the protocol.
The results from the OATS test are meaningless and your son doesn’t have yeast overgrowth (no such thing).
My aunt is on long-term antibiotics for a lung condition. Can someone on long-term antibiotics go on the protocol?
I don’t recommend treatment with rifaximin while taking other antibiotics. On the other hand, fish oil and olive oil are generally compatible will all other medications.
My daughter is 10 weeks pregnant and is having a SIBO flare: foul smelling stool, gas and bloating after eating and drinking, cramping and intestinal pain. What can she take while pregnant, as Rifaximin is not an option while pregnant?
Inulin is generally considered safe dusting pregnancy. Have her get her obstetrician’s clearance before starting it.
Hello Dr. Nemechek,
My son is 3.5 years old. Its been 15 days since we started the protocol. Inulin 1/8, EVOO – 5ml , Fish oil – 1ml.
Three days back we started giving him 1ml EVOO directly to drink. Now from last two days he has extreme Diarrhea (10 times a day). We are bit worried. Please suggest / advise if we have stop the protocol for few days and what could be the underlying issue. We have read your book but thought we will post here to get some clarity.
Thanks in advance,
Just stop the EVOO and use it only for cooking.
I have just two weeks ago done rifaximin.
I have been battling am ear infection for about 6weeks and have to have antibiotics.
Usually my stomach gets so sore. Obviously they suggested probiotics. Could I use inulin while on the anti biotics. It’s going to be a long healing for my automatic system as I suspect that is what my tummy issues are rooted in. I’m feeling bummed as I do think want a set back.
Don’t use inulin or probiotics with the antibiotics. They can make thing worse.
Dr. Nemechek, I just finished your book, ordered inulin and fish oil, and I’m hoping your protocol will help my 6 year old speech delayed son as well as the rest of my children who suffer from eczema and food allergies. I have 2 questions. Firstly, it appears that my children must have inherited their issues from their parents to some extent. I have suffered from anxiety and insomnia that I keep under control with anti inflammatory supplements like tumeric. My symptoms seem pretty mild. Would you suggest I try inulin first or does every single adult you’ve treated need… Read more »
I recommend rifaximin for all adults because eventhough inulin might help with some digestive issues, I cannot get autonomic recovery in adults by just using inulin to control SIBO.
In addition, I have not seen asthma improve unless it was actually just reactive airway disease from acid reflux (GERD).
Hi! I have a son who is 18 years old. He has Downs syndrome and with Global developmental delay and borderline Asperger Spectrum Disorder. He has a lot of medical issues like hypothyroidism, asthma, hidradenitis supperativa, juvenile idiopathic arthritis, low TCELL, eczema, psoriasis. Has OCD, challenging behaviour and hearing sensitivity. Can i use inulin, evoo and omega3 for him? UK doesnt prescribed rifaximin. Also, is omega 3 ok to use ? I introduce omega to him twice his joints becomes inflammed. He is also has constipation and walking on toes on occassions which Rheumatology team cannot give me any rationale… Read more »
The protocol should help with many of these conditions but the rifaximin instead of inulin is much more effective in a 18-year old.
Since he is probably on several medications, run the protocol elements by your managing physician.
Thank you for your time. Just ordered the Nemcheck Protocol Book. My son has aggressive behaviour, self harm and been very destructive couple of times since mid June 2018. I am scared with the awakening ….
Read the book and watch my YouTube video on aggression and anxiety.
I got my xifaxan prescription from my gut doctor yesterday, insurance denied it so i paid cash, $686.00, with coupon. I got 30 550mg tablets, 3 a day for 10 days , your book states 2 a day for ten days, should i follow your dosage and save 10 tablets for another partial treatment if i relapse ?
I’m sorry I can’t give advise about medication doses online.
Hello Dr Nemecheck,
I started the protocol for my 7 year old ASD son a month back. I currently give 1.5 tsp inulin, 15 ml EVOO and 2 NOW DHA capsules. Even before starting the protocol, my son hysterically laughs and touches his penis area while urinating as if he has discomfort there. He is non verbal. I assume he has pain there. We checked for UTI but the result is negative. This issue is still there. Any reason for this? Is this also ANS dysfunction?
Could be something related to ANS but it is hard to say.
Since there is not UTI, there is no harm in waiting and I bet this resolves.
Dr Nemecheck I write you from Spain. I would like to know how to recovery the Autonomic Nervous System. Also, can i find out if my sibo comes from gastroenteritis episode or «emotional trauma»? I have no possibility to do the IBScheck from Pimentel (a blood trst) because it is not available in my country. And a last question, do you know any person who has cured its sibo permanently?
Thank you very much.
Thanks for writing. Unfortunately the publication of our adult autonomic recovery book is behind schedule because of the overwhelming positive effect our protocol has on children with autism and developmental issues.
I recommend reading the autism book to understand the mechanisms behind the development of chronic autonomic dysfunction and how SIBO plays a role in this. The adult autism treatment protocol is the same protocol I start my adults with autonomic dysfunction on.
There is no permanent cure for SIBO at this time.
What do you use for SIBO if your insurance company will not pay for Rifaximin?
Some of our patients have bought the Rifaximin overseas.
Thank you so much for replying so soon, when you say adjusting the dose- do you mean add a bit more and try that out?
Hi Dr.N, We have been doing your protocol for 2 weeks now. My son is 2 years 10 months and ASD. We are on 1/8 inulin in the am and 1/8 in the afternoon. 1/2 capsule of now dha omega 3 (recommended dose) and we use evoo for every meal. My son has a ton of inflammation and his stomach is still very distended. Do you think that maybe inulin is not enough for him or is it too soon to be thinking that. I want his stomach to be flat and I was wondering if maybe rifaximin might be… Read more »
You might consider adjusting the inulin dosage.
Hi Dr. Nemechek,
Thank you for this article. I am breastfeeding my 11 month old son. I want to put him on the the protocol. My concern is if I, myself have SIBO do you think he will continue to be reinfected with SIBO from my breastmilk even if he follows the protocol? Do I need to take refaximin to avoid “reinfecting” him with SIBO via breastmilk. Note- I avoid omega 6 oils in my diet.
Thank you so much for your time!
There is no evidence that you can trigger SIBO in a child by breast feeding.
Also, the inulin in the protocol will control bacterial overgrowth and prevents relapses as long as the child continues to receive inulin.
Hello Dr Nemechek, I have been doing the protocol since the second week of January. My overall symptoms are digestive problems(diarrhea), and the bigger ones are brain fog, lack of focus, spaced out feeling and possible related depression and fatigue. At 1/16tpsp inulin, 1.5 to 2 tbsp evoo with cooking in coconut oil and 3g FO(ProDHA 1000 in the past few weeks after NOW for the first 8 weeks or so. I did Rifaximin and finished it a couple of weeks.back. My symptoms keep coming and going, the one positive being that I have gained weight. I feel very spaced… Read more »
I don’t recommend inulin in the treatment of SIBO in adults.
Hello Dr Nemechek!!
Will it be useful to take Partiallly hydrolyzed Guar Gum with Rifaximin as per this paper?
Also, the dosage recommended by the GI was 550 mg, thrice a day for 15 days? Should I limit myself to twice a day for 10 days?
Thank you in advance, and thank you for answering the questions and helping all of us out!!
Rifaximin alone works fine with my patients, and dosing for twice daily for 10 days or three times daily for 14 are both acceptable regimens.
Hello Dr Nemechek,
With the Rifaximin, would it be beneficial to take natural probiotics(without extra added strains), like kefir(to have some good, even if transient strains) or kombucha(to prevent yeast overgrowth) or saurkruat?
I am doing SIBOFix, the Rifaximin generic from India.
Naturally fermented foods will not increase the natural bacterial biodiversity of your intestinal tract nor will they help prevent relapse in the future from something such as antibiotic or general anesthesia.