# Treatment plan

## Overview

| Phase | Duration | Focus |
| --- | --- | --- |
| Phase 1 | Weeks 1–6 | SIBO yogurt + motility support + biofilm disruptors from week 2 |
| Phase 2 | Weeks 7–8 | Biofilm disruption continues (pre-load for antimicrobials) |
| Phase 3 | Weeks 9–14 | Biofilm disruptors + herbal antimicrobials |
| Phase 4 | Week 15+ | Retest breath test + assess |

## 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).