5 SIBO Treatment Mistakes Everyone Makes

Prefer to hear me discuss this article in a video? See video below!


If you are a health practitioner and you want to know my exact step-by-step process that I use when it comes to treating clients with SIBO, check out my 3-Part A-Z SIBO Series. Check out Video 1!


Small Intestine Bacterial Overgrowth is an incredibly common infection that I am finding in the majority of my clients who are struggling with chronic digestive issues.


A study undertaken at Cedars-Sinai Medical Center used 448 subjects who were referred by their doctors for detection of SIBO.


After completing a questionnaire, the researchers determined that 202 subjects could be considered as having irritable bowel syndrome according to standard symptom criteria (see sidebar). Of these, 157 (78%) were positive for bacteria overgrowth using the lactulose Hydrogen Breath Test.


What is SIBO?

SIBO is a condition where normal bacterial flora from the large intestine migrate up into the small intestine where they aren’t supposed to be. Compared to the large intestine, the small intestine is relatively sterile when it comes to microflora. With an overgrowth of bacteria in the small intestine, food that is eaten is fermented and acted upon by the overgrowth, rather than digested for your nourishment.


The result is SIBO infected individuals tends to have a lot of gas, bloating, belching and abdominal pain. Depending on the type of SIBO present, individuals may have chronic diarrhea or constipation. I have also seen many SIBO clients presenting will extreme fatigue or even chronic fatigue.


SIBO is gaining some attention lately and more and more people struggling with IBS are looking to SIBO as the potential cause of their GI issues.


A journey full of trial and error, getting rid of SIBO can be HARD work. With our scientific and clinical understanding of the condition continuing to grow, protocols and recommendations are constantly evolving and as with any gut condition. This means that what works for one person may not work for the next.


It also means that the medical community is starting to catch on. In Canada, we are starting to see SIBO labs popping up which is a great thing. Unfortunately, many practitioners are testing their patients for SIBO without having adequate knowledge of the complex protocols involved in successfully treating the condition.


The result is that many SIBO sufferers try over and over to clear the infection and they either fail to get rid of it or they get re-infected.


I want to discuss some of the most common mistakes I have seen when it comes to treating SIBO. If you are someone struggling with SIBO, you need to read this. There are many practitioners who claim to understand SIBO but they have no kept current with their research. Make sure you or your practitioner aren’t making these SIBO treatment sabotaging mistakes.


1. Not knowing which type of SIBO you have

Not all SIBO is created equal. In the future, what we currently call SIBO may actually be categorized into many distinct conditions. Our knowledge of SIBO is new and we are learning more about it every single day. The type of SIBO you have entirely affects the protocol you decide to do. Currently, we know of three different types of SIBO; methane dominant, hydrogen dominant and hydrogen sulfide dominant.


We have the ability to test for methane and hydrogen but not for hydrogen sulfide. In order to effectively remove your SIBO and experience results, you need to know which one you have or if you have both.


The best testing method is a 180 minute lactulose breath test. Labs that I use for this are Biohealth Labs, Commonwealth Labs and Sage SIBO Lab in Canada.


2. Other gut infections are also present

This is a very common one. SIBO is not a lone ranger. In most cases is does not travel alone. Parasites are often one of the primary causes of a SIBO infection. How? An acute parasite infection, such as traveller’s diarrhea or gastroenteritis, can paralyze the Migrating Motor Complex (MMC). The MMC is a flowing motion that occurs multiple times in a day that essetially “flushes” bacteria back down the intestine and prevents it from moving upwards. In a healthy person the MMC occurs up to 40 times per day. If the MMC has been paralyzed it may only occur a few times a day.


Since parasites are often the cause of SIBO, they need to be addressed first. This is one of the more common reasons that SIBO continues to come back after treatment.


I have encountered many clients who have been tested for SIBO and are currently doing multiple SIBO protocols but their practitioner never ran testing for other GI infections. They are unlikely to have success.


Additionally, the symptoms of SIBO are often identical for other GI infections. If you don’t address these infections, your symptoms will persist and you may never get rid of the SIBO.


Don’t agree to a SIBO test before testing the large intestine first. My favorite test is the Diagnostics Solutions Lab GI-MAP which is fantastic for identifying parasite and other infections.


3. Expecting one round of antibiotics or antimicrobials to be all you need

 SIBO is hard to to get rid of in many people. Some studies have shown that relapse rates for SIBO are as high as 50%. Expecting a single round to be all you need may lead to disappointment, depending on the severity of your condition.


SIBO is about getting the levels of bacterial down to a point where they are no longer an ‘overgrowth’. The amount of treatment you need will depend on the level of gas being produced and how well you respond to treatment.


It is crucial that you re-test immediately after treatment. If you still have an overgrowth but your gas levels have decreased,  that’s a sign that your treatment protocol is working and you just need to do it for longer.


If you don’t see an improvement in your gas levels, you need to change course. If you have been doing a herbal protocol, antibiotics or an elemental diet may be a better choice.


Stick with the protocol until the test tells you the SIBO is gone.


4. Following a FODMAPS diet during the treatment Protocol

This is most common among clients trying to treat themselves without the help of a skilled SIBO practitioner. Many people know that the FODMAPS diet is the most commonly used diet to treat SIBO.


What many people don’t realize is that you need to be strategic with the FODMAPS diet. Most people consume a FODMAPS diet during their treatment protocol. This is a huge mistake.


Eating a low FODMAPS diet essentially starves the overgrowth. Starving the SIBO bacteria can make them go dormant which means that the herbs or antibiotics you take don’t work. Treatment will not work on dormant bacteria.


For this reason it is important to consume some fermentable carbohydrates during the treatment protocol. The FODMAPS diet should be employed after the SIBO has been eradicated In which case it will need to be followed for at least 3 months.


5. Failure to Address the Root Cause of SIBO

SIBO is a much more complex condition than simply too much bacteria in the small intestine. By treating SIBO like other infections, many practitioners fail to address the reason a person became infected with SIBO to begin with.


In my experience there are three things that need to be addressed in order to prevent re-infection:

  • Structural causes. These include intestinal valve issues, abdominal adhesions or misaligned organs
  • Parasites. We discussed this above. Parasites need to be identified and removed before one considers addressing SIBO
  • Migrating Motor Complex. A prokinetic supplement needs to be taken for multiple months after the SIBO is eliminated to stimulate the MMC and prevent bacteria from traveling back up into the small intestine and causing SIBO all over again.


If you are a health practitioner and you want to know my exact step-by-step process that I use when it comes to treating clients with SIBO, check out my 3-Part A-Z SIBO Series. Check out Video 1!



Click Here to Leave a Comment Below

Nicol - May 5, 2018

You talk about not doing the SIBO diet, but what diet do you recommend when treating SIBO?

    Nicol - May 5, 2018

    I meant the FODMAP diet. 🙂

    Kendra Perry - May 8, 2018

    I usually recommend a Paleo-style diet 🙂

Kim Reese - June 3, 2018

Hi Kendra;

I have done the testing. No parasites but methane 179 level. Also cortisol low AM and Mid-day, but high in the evening. I am following low FODMAPS. I want to try the 2 week liquid and herbal program. How can I learn more?

    Kendra Perry - June 5, 2018

    Hey Kim!

    Have you tried the herbal therapy? I would recommend trying this first as the elemental diet can be incredibly hard and lead to other issues. I only recommend it if nothing else works.

Emily - June 5, 2018

Hi Kendra,

I just had SIBO testing done and my GI said that my hydrogen levels were high but methane stayed “low and stable” during the 3 hour breath test, but my main symptom is constipation, which seems to go against these results. Can you have SIBO-C without high methane? If so, how do you treat it? Should I be looking into other causes of the constipation? Thanks!

    Kendra Perry - June 5, 2018

    Hey Emily! Can I ask what your methane results were? Many practitioners will say methane isn’t an issue if it’s below 9 but I would say anything 3 and above is positive for methane, especially when coupled with constipation. But the high hydrogen levels alone could account for constipation, as everyone is different. So while it isn’t the typical presentation, it depends on the person. Additionally, have you had your gut tested with a PCR test, like the GI-MAP? Any other infection (parasite, bacteria or yeast can cause constipation). As can poor hydration and thyroid issues. There are many causes.

Abbey Turpin - June 28, 2018

Hello- how can you be tested for structural causes?

P.s. Great articles you have here!

    Kendra Perry - July 6, 2018

    Thank you for the feedback! So the best way to get assessed for structural issues is to get assessed by an Osteopath or a massage therapist who is trained in visceral manipulation 🙂

Vladimir - July 2, 2018

I was thinking about the root cause you were saying, and how important it is to find out and prevent from reoccurring. In that sense, I want to know, is it possible that a helicobacter that I got it from my mother back since I was a child can be at the root cause, I think I have read somewhere such a connection. But if that so, killing that harmful bacteria is usually not productive alone in itself, it won’t fix SIBO or whatever damage has been done afterwards, like leaky gut or parasitic overgrowth. Can you help me grasp this logic better and point me some things I’ve been missing?

Also, what’s your point on not doing cellular detox as a reason of symptoms recurrence, or do you even believe in deep cellular cleansing as something you can easily do?

One more thing to ask is, what about MTHFR mutation or some genetically predefined stuff like that, what do you think real % of cases people having this are actually out there?

A, yes, and finally, how different really is the treatment depending on the type of SIBO, is it really that drastic and crucial, or there’s some kind of mid point to all 3 types?

Thank you for such a great info! I might be out of my line here, but I have to mention that I haven’t seen such a clean energy as the one coming from your eyes on the video, even the way you speak gives you out. Mostly people are selling something so aggressively that they are not themselves anymore if they ever were.

Nice one!

    Kendra Perry - July 6, 2018

    Hey Vlad,

    Thanks for the comment. Unfortunately, there is no way to know what would have caused SIBO, as there are often multiple causes. I would say it is possible that H.pylori could have played a role but there is no way to tell for sure. When healing SIBO, or any infection, you need to address the whole system. This means you not only need to address the gut but also the other systems of the body as everything is connected.

    I don’t put much weight on genetics as they only tell you about possibilities. Just because you have a mutation, does not mean that you will have that issue. Additionally, many things affect methylation, including minerals, metals, chemicals, gut infections and stress.

    The treatment protocols are 100% different for the different types of SIBO, so it is very important to know what you are dealing with. They require different antibiotics and supplements.

    Thanks so much for saying those kind words. My mission is to serve those who need helps!


christine - August 3, 2018

Hello. I have very high methane (90) and no hydrogen after 3 round of Xifaxin and neomycin. I do not have constipation, stool are normal. I have fatigue, lots of burping, stomach pain, acid reflux. I was doing Fodmap diet during treatment, and I been on fodmap for a year. Your video “5 SIBO treatment mistakes people make” ts very informing. Thank You,

    Kendra Perry - August 3, 2018

    No problem! Glad you enjoyed the information!

Cortney Persiani - September 19, 2018

Quick question! Got my SIBO results ladt year and the GI told me they were negative but now the functional medicine doc is saying I have methane dominant SIBO. If my methane levels range between 12 and 19, would you consider that positive for methane dominant SIBO?

    Kendra Perry - September 19, 2018

    I would! Anything over 3 should be considered as methane dominant. 12-19 is pretty elevated 🙂

      Cortney Persiani - September 21, 2018

      Thank you! So frustrating the G I didn’t recognize this a year ago, but grateful to finally have some sense of what’s going on! Rewatching all 3 of your sibo videos now that I know what type I have! Thank you for all the great info!

        Kendra Perry - September 21, 2018

        Yah, it’s such a newer condition so many Docs and practitioners are not up to date. Are you considering my upcoming group program? I think you would really benefit from having some support from me with this 🙂


Nicole L Steinruck - September 20, 2018

Hello, thank you very much for this article. I am currently on day 3 of Xifaxan for SIBO. I took the lactulose hydrogen breath test and these were my results:

Baseline 0
35min – 8ppm
50min – 31ppm
65min – 46ppm
80min – 79ppm
95min – 68ppm
110min – 91ppm
125min – 82ppm
140min – 72ppm
155min – 86ppm
170min – 59ppm
185min – 49ppm

I have not been evaluated thoroughly for a root cause of my sibo. My gastro believes this is the root of my problems. I believe there is more to it.

I had a ct scan done of my abdomen a few weeks ago but I am almost certain they saw 27 year old female with abdominal pain and only paid attention to my lady parts. I have the images and although I’m not a radiologist, I see what looks like a bulge in a specific spot in my lower left diagonal-ish from my hip bone. It looks like my intestine has a bulge on it. I had a ct scan with contrast and in that bulge it looks like the contrast didnt flow through that whole spot either.

This spot continuously causes me pain especially when I have excess gas. I can push on it, it’s rather gross…. lol… sometimes when I go on a walk this spot starts really cramping and I have to almost push it in and hold it to make it back home.

It’s also hard to feel in my abdomen because I have a lot of excess skin. I lost 100lbs (on purpose) but still have that flab.

I am lost on what to do. I feel like I’m being only half heard by doctors and I feel like I am not going to cure my sibo with just these antibiotics. Do you have any advice on how I can act next?

    Kendra Perry - September 20, 2018

    Hey Nicole!

    Thanks so much for your comment! Unfortunately, I cannot legally give advice regarding test results over a website comment chat and without the proper paperwork. What I can say is that you definitely need to work with a SIBO literate practitioner. SIBO can be really tricky to reverse. You would need to test for the possibility of other infections with something like a GI-MAP. Bigger infections, like parasites, can be the cause of SIBO. So those do need to be addressed or the SIBO just may come back. It’s too bad but women are way more likely to get disregarded by their Doctor’s than men. Please email my team if you would like support. I am currently taking clients for my programs but not for single tests. But I do have a group membership coming up that will give you access to coaching calls and you can have a protocol developed for the tests that you have. If that makes sense. You can get on the wait list for that if interested 🙂


Senta - September 25, 2018

Hello Kendra,

Is the GI-Map test the same as GI Effects through Genova Diagnostics?

Thank you!

    Kendra Perry - September 25, 2018

    Hey Senta!

    Those two tests are like comparing apples and oranges. They use entirely different technologies so will show you two entirely different things. The GI-MAP is a more sensitive test but may miss things that the GI Effects picks up and vice versa. I would use the GI-MAP over the GI Effects every single time. It’s more sensitive, more affortable and has better markers 🙂


Melanie - September 26, 2018

Where are you located? Do you have an office? Can we make an appointment to see you?

    Kendra Perry - September 26, 2018

    Hey Melanie!

    Thanks so much for your comment! I am located in British Columbia, Canada but I work with all my clients online. My clients live all over the world. The best way to go about working with me is to apply to be a client by booking a free Discovery Call. That way we can chat more, I can learn more about your health challenges and goals and then we can both determine if working together feels like a fit 🙂 Here is the link for you to do that: https://bit.ly/2JV2ZJe

    I look forward to speaking with you 🙂


Melanie - September 26, 2018

Does the Dutch Hormone Testing require you to be off birth control for several weeks before urine is collected? I am on BC continuously to control terrible monthly cramping.

    Kendra Perry - September 26, 2018

    It doesn’t require you to be of Birth Control but it will affect your estrogen and progesterone markers. Since Birth Control suppresses natural hormone production, both your estrogen and progesterone will be in the post-menopausal range. So with those two hormones, there is nothing we can do to balance them. There are many other markers on the test which will be helpful. We can also see the metabolism of estrogen which can give insight into how damaging those birth control pills may be for your body and for your long-term health. I hope that helps!


Rosania Chacon - December 11, 2018

Hi Kendra. My name is Rosa I was just diagnosed with Sibo I have a rash all over my body for year I get cramping bloating fatigue digestive problem I was thinking of Candida every Time to take a test comes out negative because of my rash I believe I have it can you please help me, thank you

    Kendra Perry - December 11, 2018

    Hey Rosa!

    Thanks for your comment. I am sorry to hear about this but I can help you with this. The best way to access my support and have me create a customized protocol for you is to join my HIGH on Energy Group Membership program. You can access support from me here, plus support from a bad-ass group of women. Once in the program, you can upgrade and have me go over your test results and design a protocol for you. You can get more info here: https://bit.ly/2OZ4kxQ or shoot an email to my team support@kendraperry.net


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