Patient 7: Resolving Hydrogen SIBO, Brain Fog, and Carbohydrate Intolerance in a Young Man
Patient Background
This is the case of a 24-year-old man who presented with bloating, gas, brain fog, and poor carbohydrate tolerance — symptoms that had persisted for over three years. He reported feeling increasingly sensitive to a wide range of foods, particularly grains and dairy.
His symptoms began during a high-stress period in graduate school and included:
- Bloating and abdominal discomfort
- Post-meal fatigue and brain fog
- Bowel irregularity alternating between constipation and loose stools
- Poor tolerance of carbohydrate-rich foods
He had previously undergone an endoscopy and colonoscopy, which were unremarkable. A duodenal biopsy to rule out celiac disease was negative. General stool tests were also normal.
Eliminating dairy and grains improved his symptoms significantly, but he had ongoing difficulty reintroducing grains into his diet without triggering bloating or discomfort. His typical diet included bone broth, ground turkey, avocado, chicken, zucchini, salmon, cabbage, pickles, and homemade dark chocolate for dessert.
Notably, his gastroenterologist had prescribed a course of the antibiotic Xifaxan empirically, which led to temporary improvement for three months, but symptoms recurred.
At the time of consultation, he was using a natural laxative called Triphala to manage his bowels, but still experienced persistent bloating, abdominal pain, and cognitive sluggishness.
On physical examination, his abdomen was moderately distended and had mild diffuse tenderness to palpation.
Treatment: Dr. Rajsree’s 4 Phase SIBO Protocol
Phase 1-2: Promote Motility and Reduce Gas Levels
- Essential Magnesium (bedtime)
- Motility Activator (bedtime)
- Digestive Enzyme Pro (2 capsules after each meal)
These measures led to an initial 30% improvement in symptoms.
Upon adding Betaine and Pepsin (1–2 capsules after meals), he experienced significant relief, describing that food previously felt like a "brick" in his stomach — a sensation that greatly improved with enhanced stomach acid support. However, brain fog and bowel inconsistency persisted, prompting further investigation.
SIBO Breath Testing
Lactulose breath testing revealed:
- Hydrogen (H₂): 61 ppm
- Methane (CH₄): 17 ppm
Hence, he had a dual type of SIBO, which helped explain his alternating bowel habits ranging from diarrhea to constipation.
IgE food allergy testing revealed several low-level class 1 allergies and a class 3 allergy to oats.
Phase 3-4: Reduce Inflammation and Targeted Herbal Antimicrobials
In the next phases of the protocol, we introduced Spore Probiotics and targeted herbal antimicrobials to address bacterial and methanogen overgrowth:
Addition of:
- Spore Probiotic IgG (3 capsules) in AM one empty stomach
- Berberine Pro, Oregano Oil, and Allicidin (1 capsule of each after meals) for 6 weeks
Dietary Strategy:
He continued a low FODMAP / low lectin SIBO diet, with specific instructions to practice meal spacing:
- Avoid snacking between meals
- Maintain 4–5 hours between meals
- Maintain a 12-hour overnight fast between dinner and breakfast
Treatment with the herbal antimicrobials lasted for 6 weeks.
Outcomes
Repeat SIBO breath testing showed:
Hydrogen (H₂): reduced from 61 → 1 ppm
Methane (CH₄): reduced from 17 → 9 ppm
Symptomatically, he reported:
- Complete resolution of bloating
- Normalized bowel function
- Clear, consistent energy and elimination of brain fog
Maintenance Plan
He successfully transitioned to Probiotic 100 Billion for microbiome support and remained on Essential Magnesium, Motility Activator, Digestive Enzyme Pro, and Betaine and Pepsin long term for digestive support.
At a follow-up visit two years later for an unrelated issue, he reported that his gut health remained completely stable, with no recurrence of his previous symptoms.
Key Insights
This case underscores the importance of:
- Addressing low stomach acid with Betaine and Pepsin, especially in patients reporting heaviness or sluggish digestion
- Recognizing that SIBO can underlie both GI and cognitive symptoms, including brain fog
- The effectiveness of Dr. Rajsree’s 4-Phase Herbal Protocol, particularly in patients who experienced relapse after Xifaxan
By treating the root cause of SIBO, this patient regained full digestive function, improved mental clarity, and long-term gut stability without reliance on pharmaceutical interventions.
Patient Background
This is the case of a 24-year-old man who presented with bloating, gas, brain fog, and poor carbohydrate tolerance — symptoms that had persisted for over three years. He reported feeling increasingly sensitive to a wide range of foods, particularly grains and dairy.
His symptoms began during a high-stress period in graduate school and included:
- Bloating and abdominal discomfort
- Post-meal fatigue and brain fog
- Bowel irregularity alternating between constipation and loose stools
- Poor tolerance of carbohydrate-rich foods
He had previously undergone an endoscopy and colonoscopy, which were unremarkable. A duodenal biopsy to rule out celiac disease was negative. General stool tests were also normal.
Eliminating dairy and grains improved his symptoms significantly, but he had ongoing difficulty reintroducing grains into his diet without triggering bloating or discomfort. His typical diet included bone broth, ground turkey, avocado, chicken, zucchini, salmon, cabbage, pickles, and homemade dark chocolate for dessert.
Notably, his gastroenterologist had prescribed a course of the antibiotic Xifaxan empirically, which led to temporary improvement for three months, but symptoms recurred.
At the time of consultation, he was using a natural laxative called Triphala to manage his bowels, but still experienced persistent bloating, abdominal pain, and cognitive sluggishness.
On physical examination, his abdomen was moderately distended and had mild diffuse tenderness to palpation.
Treatment: Dr. Rajsree’s 4 Phase SIBO Protocol
Phase 1-2: Promote Motility and Reduce Gas Levels
- Essential Magnesium (bedtime)
- Motility Activator (bedtime)
- Digestive Enzyme Pro (2 capsules after each meal)
These measures led to an initial 30% improvement in symptoms.
Upon adding Betaine and Pepsin (1–2 capsules after meals), he experienced significant relief, describing that food previously felt like a "brick" in his stomach — a sensation that greatly improved with enhanced stomach acid support. However, brain fog and bowel inconsistency persisted, prompting further investigation.
SIBO Breath Testing
Lactulose breath testing revealed:
- Hydrogen (H₂): 61 ppm
- Methane (CH₄): 17 ppm
Hence, he had a dual type of SIBO, which helped explain his alternating bowel habits ranging from diarrhea to constipation.
IgE food allergy testing revealed several low-level class 1 allergies and a class 3 allergy to oats.
Phase 3-4: Reduce Inflammation and Targeted Herbal Antimicrobials
In the next phases of the protocol, we introduced Spore Probiotics and targeted herbal antimicrobials to address bacterial and methanogen overgrowth:
Addition of:
- Spore Probiotic IgG (3 capsules) in AM one empty stomach
- Berberine Pro, Oregano Oil, and Allicidin (1 capsule of each after meals) for 6 weeks
Dietary Strategy:
He continued a low FODMAP / low lectin SIBO diet, with specific instructions to practice meal spacing:
- Avoid snacking between meals
- Maintain 4–5 hours between meals
- Maintain a 12-hour overnight fast between dinner and breakfast
Treatment with the herbal antimicrobials lasted for 6 weeks.
Outcomes
Repeat SIBO breath testing showed:
Hydrogen (H₂): reduced from 61 → 1 ppm
Methane (CH₄): reduced from 17 → 9 ppm
Symptomatically, he reported:
- Complete resolution of bloating
- Normalized bowel function
- Clear, consistent energy and elimination of brain fog
Maintenance Plan
He successfully transitioned to Probiotic 100 Billion for microbiome support and remained on Essential Magnesium, Motility Activator, Digestive Enzyme Pro, and Betaine and Pepsin long term for digestive support.
At a follow-up visit two years later for an unrelated issue, he reported that his gut health remained completely stable, with no recurrence of his previous symptoms.
Key Insights
This case underscores the importance of:
- Addressing low stomach acid with Betaine and Pepsin, especially in patients reporting heaviness or sluggish digestion
- Recognizing that SIBO can underlie both GI and cognitive symptoms, including brain fog
- The effectiveness of Dr. Rajsree’s 4-Phase Herbal Protocol, particularly in patients who experienced relapse after Xifaxan
By treating the root cause of SIBO, this patient regained full digestive function, improved mental clarity, and long-term gut stability without reliance on pharmaceutical interventions.
