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Home arrow Health arrow Gut Health arrow SIBO Die-Off Symptoms: Tips, Treatments, and Preventions

SIBO Die-Off Symptoms: Tips, Treatments, and Preventions

Written by Edibel Quintero, RD
Fact checked by Rosmy Barrios, MD
Last update: July 25, 2023
6 min read 959 Views 0 Comments
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SIBO treatment sometimes causes side effects called die-off symptoms. We have taken a closer look at them and ways how you can ease SIBO die-off symptoms.

SIBO die off symptoms

If you’re having treatment for your small intestinal bacterial overgrowth (SIBO), then you may have heard the phrase ‘SIBO die-off symptoms.’

In this article, we are going to get to the bottom of what this phrase means, what these die-off symptoms are, and how to tell if what you are experiencing isn’t normal. Take a look below to learn more now.

An Extended List of SIBO Die-off Symptoms

SIBO die-off symptoms include the following:

  • Bloating
  • Chills
  • Fatigue
  • Gas
  • Abdominal pain or discomfort
  • Brain fog
  • Headaches
  • Fever
  • Weight loss
  • Joint stiffness
  • Rosacea
  • Diarrhea
  • Constipation
  • Flu-life symptoms
  • Sore throat
  • Sweating
  • Body aches
  • Flushing
  • Congestion

It is important to note that some of these are common SIBO symptoms that can be exacerbated when treating the condition. Symptoms of SIBO die-off can be severe, so keep this in mind when considering treating SIBO.

What Is SIBO Die-off?

SIBO die-off is associated with an antimicrobial treatment protocol. The symptoms occur due to an inflammatory response in the small intestines. This response happens due to the toxins released from dying bacteria and is known as a Herxheimer reaction.

If your body does not get rid of these toxins quickly enough, they will be reabsorbed back into your bloodstream, causing you to feel the above symptoms. The body has many functions to get rid of toxins, though, so rest assured it will do its job eventually.

SIBO, or small intestinal bacterial overgrowth, is when bacteria are growing in the wrong place. Bacterial overgrowth in the small intestine causes symptoms like bloating, gas, and irregular bowel movements.

How Long Does SIBO Die-off Last?

SIBO die-off symptoms should only last for a few days. If you experience severe symptoms for longer than a few days or less severe symptoms for a few weeks, then you need to reach out to your doctor to reevaluate your SIBO treatment.

In most cases, if SIBO die-off symptoms have not subsided within a few days, it is an indicator that the method you have chosen to treat SIBO is not suitable for your body. When you speak with your doctor, they may look into other options for treatment.

While most SIBO die-off symptoms occur in the first two weeks of treatment, you may find that you get symptoms later in your plan due to dosage changes.

Is It Possible To Prevent SIBO Die-off Symptoms?

It is possible to reduce SIBO die-off symptoms, but fully preventing them may be challenging. The good news is that you’re unlikely to experience all the symptoms we have listed. Below are our top tips for reducing SIBO die-off symptoms as much as possible.

Note that some of these remedies may not work for everyone and you will need to find the one that works best for you and your body.

#1 Slowing or pausing your treatment protocol

To allow your body to get used to the changes, you could lower your daily dosage of treatment, or pause treatment for a while. You could also discuss treatment alternatives with your doctor.

#2 Make dietary changes

Promoting healthy digestion will help to get rid of the small intestinal bacteria and help your body to fight these symptoms. Try eating foods that are good for the digestive system and consider adding digestive enzymes for even more support.

Alternatively, you could consider a low-FODMAP diet. This diet is commonly used for people with SIBO and those who suffer from IBS. It involves cutting out high-FODMAP foods, including wheat, dairy, beans, lentils, onion, and garlic. The diet is thought easier on the gut.

You can speak with your doctor about the best foods to eat for good gut health during SIBO treatment.

#3 Ensure you’re having healthy bowel movements

The body is incredibly efficient at getting rid of things it doesn’t want or need, so to ensure the unwanted gut bacteria are flushed from the system, make sure you are doing everything in your power to promote regularity in your bowel habits.

Drinking enough water, eating enough fiber, and considering a fiber supplement can all help to get your bowels moving and reduce symptoms of SIBO die-off. Additionally, getting regular exercise, like going for a walk each morning, can also help.

#4 Get enough sleep

Sleep is an integral part of good health, and when your body is undergoing SIBO die-off treatment, it is even more important. During sleep, your body has a chance to recharge, reset, and fight off bad bacteria.

Getting the recommended 7–9 hours of sleep each night will help to flush out the bacterial overgrowth in your small intestine.

In addition to getting enough sleep, you should also rest as much as possible. When you can, take the time to relax or even squeeze in a nap. Your body needs all the rest it can get when you’re treating SIBO.

#5 Get sweaty

Sweating is another way that the human body detoxifies and flushes out anything that it doesn’t want. Engaging in HIIT workouts, going for a daily run, or even just a brisk walk can help you to get sweating and support the detoxification process in the body.

#6 Use Epsom salt baths to ease body aches

Aches and pains are common symptoms of SIBO, and soaking in Epsom salts have been used for centuries to help soothe and ease aches. It is thought that the high magnesium content can relax the muscles and help with recovery.

#7 Manage your stress levels

Stress has a profound effect on the gut. Indeed, chronic stress can cause flare-ups in irritable bowel syndrome, imbalances in the gut microbiome, and even alter immune function. For this reason, it is incredibly important that you manage your stress levels when receiving treatment for SIBO.

Managing stress can feel like an uphill battle, but there are things you can do. You could try practicing mindfulness, meditation, and yoga, or you could try prioritizing exercise and taking walks in nature. If you are feeling overwhelmed, there is no shame in reaching out for professional help. Speaking with a therapist can do wonders for your overall stress levels.

#8 Try fermented foods

Another way to ease symptoms of SIBO die-off is to add fermented foods to your diet. Fermented foods include sauerkraut, kimchi, kefir, and tempeh. They all contain probiotics, which are live microorganisms that improve and support good gut health.

If getting fermented foods in your diet is difficult, speak with your doctor about adding a probiotic supplement to your diet. In some cases, probiotics can be extremely beneficial to people suffering from SIBO, but you need to get the right dosage and the correct strains of probiotics to make it work.

Be aware that taking probiotics can also come with some side effects, including constipation and bloating.

How To Tell if SIBO Die-off Symptoms Aren’t Normal

If you are experiencing severe symptoms for longer than a few days, or gentler symptoms for longer than a few weeks, you need to speak with your doctor as soon as possible.

SIBO symptoms are to be expected as the bacteria die in the small intestine, but sometimes a treatment just isn’t right for your body. In these cases, the symptoms will be worse, last much longer, and will be a side effect of the wrong treatment. You can discuss changes with your doctor to find a different way of removing these bacteria without unmanageable symptoms.

A Word From an MD

SIBO treatment can involve antimicrobial treatments, the elemental diet, a low FODMAP diet, or herbal supplements. SIBO die-off is common with antimicrobial treatment and occurs when dying bacteria release toxins.

These toxins cause many symptoms, including fatigue, muscle aches, pains, headaches, weight loss, and brain fog, and may even exacerbate SIBO symptoms. While you cannot totally prevent this reaction, there are things you can do to ease symptoms.

You can begin by eating a gut-friendly diet and getting enough sleep while going through treatment. In addition, you can try slowing down your treatment if it’s causing severe side effects or changing the treatment if it is not working for you.

If the symptoms you are experiencing don’t subside within a few days, then it is important you speak with a doctor.


SIBO die-off symptoms can be debilitating but should only last a few days. Symptoms can be wide-ranging and may even mimic SIBO symptoms.

You can ease the symptoms with some lifestyle changes, but you should speak with your doctor if you continue to have problems. Sometimes, SIBO die-off symptoms may be indicative that your body is not responding well to treatment, so other options need to be explored.

Written by Edibel Quintero, RD
Edibel Quintero is a medical doctor who graduated in 2013 from the University of Zulia and has been working in her profession since then. She specializes in obesity and nutrition, physical rehabilitation, sports massage and post-operative rehabilitation. Edibel’s goal is to help people live healthier lives by educating them about food, exercise, mental wellness and other lifestyle choices that can improve their quality of life.
The article was fact checked by Rosmy Barrios, MD
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Written by Edibel Quintero, RD
Fact checked by Rosmy Barrios, MD
Last update: July 25, 2023
6 min read 959 Views 0 Comments

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