Treatment plan

Overview

Phase 1 — SIBO Yogurt + Motility Support (Weeks 1–6)

Goal: Establish yogurt probiotic strains in the gut. Their bacteriocins (natural antimicrobials) kill SIBO bacteria. Prokinetics support MMC to sweep dead bacteria out. Biofilm disruptors from week 2 strip protective shields off bacteria, giving bacteriocins better access.

Week 1: SIBO yogurt + prokinetics only. Ramp up yogurt dose gradually (2-3 tablespoons → ¼ cup → ½ cup). Confirm tolerance before adding biofilm disruptors.

Week 2 onward: Add NAC + serrapeptase (biofilm disruptors). These don't kill bacteria — they strip biofilm shields, making the yogurt's bacteriocins more effective. Safe alongside yogurt.

Week 6 Assessment

Assess: bloating, post-nasal drip, tinnitus, reflux, sugar/inflammatory reactions.

Tracking method: Score bloating, reflux, ears, and post-nasal drip out of 10 at baseline, end of week 2, week 4, and week 6. Comparing snapshots shows trends better than daily observation.

Optional home testing: The AIRE device (~$200 AUD) is a personal breath hydrogen meter that lets you track SIBO levels at home without booking a formal breath test.

If significant improvement: Continue yogurt + prokinetics as maintenance. Consider booking a breath retest to confirm. May be able to maintain on yogurt + Iberogast + LDN alone.

If minimal or no improvement: Move to Phase 2.

Expected Timeline for Symptom Changes

• Week 1-2: Possible die-off symptoms (increased gas, bloating, skin reactions, acne) — can be a good sign that bacteriocins are active. Or nothing noticeable yet.
• Week 2-3: First subtle changes — reduced bloating after meals/water. Possibly better energy or mood (L. reuteri oxytocin effect).
• Week 3-4: Reflux should start improving. L. gasseri clinical studies showed symptom improvement at 4 weeks.
• Week 4-6: Systemic inflammatory symptoms (post-nasal drip, blocked ears, tinnitus) — these are furthest downstream from the gut and improve last. The gut has to heal first, then systemic inflammation calms, then mucus production reduces, then existing mucus drains.

Phase 2 — Biofilm Disruption Pre-Load (Weeks 7–8)

Goal: Continue stripping biofilms in preparation for herbal antimicrobials in Phase 3. If NAC + serrapeptase were started in week 2 of Phase 1, you already have 4 weeks of biofilm disruption done — the bacteria are already exposed and vulnerable.

SIBO yogurt can continue during this phase — biofilm disruptors don't kill bacteria.

Phase 3 — Herbal Antimicrobials + Biofilm Disruptors (Weeks 9–14)

Goal: Kill remaining SIBO bacteria with herbal antimicrobials while continuing biofilm disruption.

STOP SIBO yogurt during this phase. Antimicrobials kill yogurt strains and SIBO bacteria indiscriminately. Berberine specifically blocks the yogurt's benefits (confirmed by Davis's Inner Circle). Resume yogurt after this phase.

Weeks 9-12: Berberine + Allicin (primary antimicrobials) + NAC + serrapeptase (biofilm disruptors) + prokinetics.

Weeks 13-14 (if symptoms persist): Rotate to Oregano Oil + Neem. Rotation prevents bacterial adaptation. Continue NAC + prokinetics.

Phase 4 — Retest + Reassess (Week 15+)

1. Stop all antimicrobials and biofilm disruptors
2. Resume SIBO yogurt (½ cup daily)
3. Continue prokinetics (Iberogast + LDN + ginger)
4. Breath retest — wait at least 2 weeks after stopping antimicrobials before testing

Results Interpretation

• Normalised + symptoms resolved: Continue yogurt + prokinetics for 3 months, then trial stopping everything except meal spacing. If symptoms return within 3 months, add back Iberogast as minimum maintenance.
• Improved but not normalised: Second antimicrobial round with rotation herbs (oregano + neem if not yet tried, or vice versa), or consider elemental diet.
• No improvement: Elemental diet or prescription prokinetics (low-dose erythromycin, prucalopride).