{"product_id":"patient-11-a-43-year-old-woman-with-mixed-ibs-ibs-m-hormonal-flares-and-mixed-type-sibo","title":"Patient 11:  Mixed IBS (IBS-M) and Mixed-Type SIBO","description":"\u003cp\u003e\u003cspan style=\"color: rgb(43, 0, 255);\"\u003e\u003cstrong\u003ePatient Background \u003c\/strong\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-start=\"353\" data-end=\"657\"\u003eThis is the case of a 43-year-old woman who presented with a long-standing history of irritable bowel syndrome dating back to 2005. Her symptoms initially began as IBS-D, later shifted toward IBS-C, and ultimately evolved into IBS-M with alternating diarrhea and constipation.\u003c\/p\u003e\n\u003cp data-start=\"659\" data-end=\"1109\"\u003eOver time, her symptoms became increasingly severe and disruptive to daily life. She reported a notable worsening following a major lifestyle and career change—from a highly active profession as a dancer and choreographer to a significantly more sedentary and stressful role as a second-grade teacher. In parallel, she noticed that her IBS flares became strongly associated with her menstrual cycle, with predictable exacerbations around her periods.\u003c\/p\u003e\n\u003cp data-start=\"1111\" data-end=\"1474\"\u003eShe described episodes of severe abdominal pain that were so intense that even sound or vibration worsened her symptoms, forcing her to lie completely still. These attacks lasted anywhere from 15 minutes to 2 hours. Between episodes, she continued to experience daily bloating and abdominal distension, often describing herself as “looking pregnant” when bloated.\u003c\/p\u003e\n\u003ch3 data-start=\"1476\" data-end=\"1499\"\u003e\u003cstrong data-start=\"1480\" data-end=\"1499\"\u003eSymptom Profile\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-start=\"1501\" data-end=\"1523\"\u003eHer symptoms included:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli data-start=\"1527\" data-end=\"1577\"\u003eSevere abdominal bloating and visible distension\u003c\/li\u003e\n\u003cli data-start=\"1580\" data-end=\"1627\"\u003eAlternating diarrhea and constipation (IBS-M)\u003c\/li\u003e\n\u003cli data-start=\"1630\" data-end=\"1670\"\u003eEpisodic severe abdominal pain attacks\u003c\/li\u003e\n\u003cli data-start=\"1673\" data-end=\"1718\"\u003eHormonal symptom flares around menstruation\u003c\/li\u003e\n\u003cli data-start=\"1721\" data-end=\"1764\"\u003eFood-triggered symptoms, particularly with:\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003col\u003e\n\u003cli data-start=\"1769\" data-end=\"1776\"\u003eDairy\u003c\/li\u003e\n\u003cli data-start=\"1781\" data-end=\"1790\"\u003eOatmeal\u003c\/li\u003e\n\u003cli data-start=\"1795\" data-end=\"1825\"\u003eSuspected gluten sensitivity\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cul\u003e\n\u003cli data-start=\"1828\" data-end=\"1914\"\u003eSensation of phlegm in the throat, later suspected to be related to low stomach acid\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp data-start=\"1916\" data-end=\"2015\"\u003eDuring menstrual flares, she noted that eating cucumbers helped calm her gastrointestinal symptoms.\u003c\/p\u003e\n\u003ch3 data-start=\"2017\" data-end=\"2045\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong data-start=\"2021\" data-end=\"2045\"\u003ePast Medical History\u003c\/strong\u003e\u003c\/span\u003e\u003c\/h3\u003e\n\u003cul\u003e\n\u003cli data-start=\"2049\" data-end=\"2056\"\u003eIBS-M\u003c\/li\u003e\n\u003cli data-start=\"2059\" data-end=\"2104\"\u003eThyroid nodule (monitored by endocrinology)\u003c\/li\u003e\n\u003cli data-start=\"2107\" data-end=\"2159\"\u003eIgE testing positive only to kidney bean (Class 1)\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch3 data-start=\"2161\" data-end=\"2196\"\u003e\u003cstrong data-start=\"2165\" data-end=\"2196\"\u003ePrior Dietary Interventions\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-start=\"2198\" data-end=\"2492\"\u003eShe had previously followed a low-FODMAP diet in an effort to control symptoms. While this reduced some bloating, it led to an unintended 9–10 lb weight loss and did not fully resolve her IBS. Due to ongoing symptoms, she felt increasingly restricted in her diet and anxious about food choices.\u003c\/p\u003e\n\u003cp data-start=\"2198\" data-end=\"2492\"\u003e\u003cmeta charset=\"utf-8\"\u003eOn physical examination, her abdomen was moderately distended and had mild diffuse tenderness to palpation. \u003c\/p\u003e\n\u003cp data-start=\"2198\" data-end=\"2492\"\u003ePatient was underweight weighing 100 lbs at 5'3\", with a BMI of 17.\u003c\/p\u003e\n\u003ch3 data-start=\"2494\" data-end=\"2521\"\u003e\u003cspan style=\"color: rgb(43, 0, 255);\"\u003e\u003cstrong data-start=\"2498\" data-end=\"2521\"\u003eSIBO Breath Testing\u003c\/strong\u003e\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp data-start=\"2523\" data-end=\"2557\"\u003eLactulose breath testing revealed:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli data-start=\"2561\" data-end=\"2584\"\u003eHydrogen (H₂): 24 ppm\u003c\/li\u003e\n\u003cli data-start=\"2587\" data-end=\"2610\"\u003eMethane (CH₄): 36 ppm\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp data-start=\"2612\" data-end=\"2740\"\u003eThese findings were diagnostic for \u003cstrong data-start=\"2647\" data-end=\"2666\"\u003emixed-type SIBO\u003c\/strong\u003e, consistent with her alternating bowel habits and mixed IBS presentation.\u003c\/p\u003e\n\u003cp data-start=\"2612\" data-end=\"2740\"\u003e\u003cimg src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0574\/4571\/2039\/files\/JBefore.png?v=1770499808\" alt=\"\"\u003e\u003c\/p\u003e\n\u003cp\u003e \u003c\/p\u003e\n\u003cp\u003e\u003cspan style=\"color: rgb(43, 0, 255);\"\u003e\u003cstrong\u003eTreatment: Implementing Dr. Rajsree’s Herbal Protocol for SIBO  \u003c\/strong\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003eShe was placed on \u003cstrong\u003eDr. Rajsree’s Herbal SIBO Protocol\u003c\/strong\u003e, with emphasis on restoring motility, and improving digestion.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase 1-2: Promote Motility and Reduce Gas Levels\u003c\/strong\u003e\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eDigestive Enzyme Pro \u003c\/strong\u003e(2 capsules after meals)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eBetaine \u0026amp; Pepsin\u003c\/strong\u003e (1-2 capsules after meals)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eEssential Magnesium\u003c\/strong\u003e (up to 4 capsules at bedtime)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eMotility Activator \u003c\/strong\u003e(1 capsule at bedtime)\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003e\u003cspan style=\"color: rgb(43, 0, 255);\"\u003e\u003cstrong\u003eDietary Strategy:  \u003c\/strong\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003eShe began a \u003cstrong\u003elow FODMAP \/ low lectin SIBO diet,\u003c\/strong\u003e with specific instructions to practice meal spacing: \u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003eAvoid snacking between meals\u003c\/li\u003e\n\u003cli\u003eMaintain 4–5 hours between meals\u003c\/li\u003e\n\u003cli\u003eMaintain a 12-hour overnight fast between dinner and breakfast\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch4 data-start=\"3829\" data-end=\"3874\"\u003e\u003cstrong data-start=\"3834\" data-end=\"3874\"\u003eNutritional Support During Treatment\u003c\/strong\u003e\u003c\/h4\u003e\n\u003cp data-start=\"3876\" data-end=\"4169\"\u003eDue to progressive weight loss and risk of becoming underweight, the \u003cstrong data-start=\"3945\" data-end=\"3963\"\u003eElemental Diet\u003c\/strong\u003e was incorporated strategically during treatment to support nutrition and prevent further weight loss. This provided calories while minimizing digestive burden and fermentation during antimicrobial therapy.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase 3-4: Reduce Inflammation and Herbal Antimicrobial Therapy  \u003c\/strong\u003e\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAddition of:  \u003c\/em\u003e\u003c\/strong\u003e\u003c\/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eSpore Probiotic IgG\u003c\/strong\u003e in AM on empty stomach\u003c\/li\u003e\n\u003cli\u003e\u003cstrong\u003eHerbal antimicrobials:\u003c\/strong\u003e\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eBerberine Pro, Oregano Oil\u003c\/strong\u003e, and \u003cstrong\u003eAllicidin \u003c\/strong\u003e(1 capsule each after every meal) for 6 weeks\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003e\u003cspan style=\"color: rgb(43, 0, 255);\"\u003e\u003cstrong\u003eFollow-Up and Outcomes  \u003c\/strong\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003eAfter 6 weeks of herbal antimicrobials:  \u003c\/p\u003e\n\u003cul\u003e\n\u003cli data-start=\"4335\" data-end=\"4381\"\u003eHydrogen (H₂): decreased from 24 ppm → 1 ppm\u003c\/li\u003e\n\u003cli data-start=\"4384\" data-end=\"4430\"\u003eMethane (CH₄): decreased from 36 ppm → 8 ppm\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003e\u003cimg src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0574\/4571\/2039\/files\/Jafter.png?v=1770499809\" alt=\"\"\u003e\u003c\/p\u003e\n\u003cp data-start=\"4432\" data-end=\"4460\"\u003eClinically, she experienced:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli data-start=\"4464\" data-end=\"4492\"\u003eResolution of IBS symptoms\u003c\/li\u003e\n\u003cli data-start=\"4495\" data-end=\"4555\"\u003eSignificant reduction in bloating and abdominal distension\u003c\/li\u003e\n\u003cli data-start=\"4558\" data-end=\"4617\"\u003eNormalization of bowel habits (1–2 bowel movements daily)\u003c\/li\u003e\n\u003cli data-start=\"4620\" data-end=\"4649\"\u003eImproved tolerance of meals\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp data-start=\"4651\" data-end=\"4857\"\u003eAlthough she lost approximately 10 pounds during treatment, the use of elemental nutrition helped stabilize her intake, and she was able to regain weight after completing therapy.\u003c\/p\u003e\n\u003ch3 data-start=\"4859\" data-end=\"4895\"\u003e\u003cspan style=\"color: rgb(43, 0, 255);\"\u003e\u003cstrong data-start=\"4863\" data-end=\"4895\"\u003eFood Reintroduction Strategy\u003c\/strong\u003e\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp data-start=\"4897\" data-end=\"4990\"\u003eAfter completing \u003cstrong data-start=\"4914\" data-end=\"4940\"\u003e4–6 weeks of treatment\u003c\/strong\u003e, she began a structured food reintroduction plan:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli data-start=\"4994\" data-end=\"5035\"\u003eFoods were added back one at a time\u003c\/li\u003e\n\u003cli data-start=\"5038\" data-end=\"5104\"\u003eEach food was trialed for 2-3 days before introducing the next\u003c\/li\u003e\n\u003cli data-start=\"5107\" data-end=\"5187\"\u003eThis approach allowed identification of triggers while minimizing relapse risk\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp data-start=\"5189\" data-end=\"5281\"\u003eShe remained somewhat sensitive to certain foods but continued to expand her diet gradually.\u003c\/p\u003e\n\u003ch3 data-start=\"5283\" data-end=\"5327\"\u003e\u003cstrong data-start=\"5287\" data-end=\"5327\"\u003eAdditional Insight: Low Stomach Acid\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-start=\"5329\" data-end=\"5558\"\u003ePersistent throat phlegm raised concern for hypochlorhydria. The addition of \u003cstrong data-start=\"5406\" data-end=\"5429\"\u003eBetaine with Pepsin\u003c\/strong\u003e led to significant improvement, supporting low stomach acid as a contributing factor to her digestive dysfunction and SIBO risk.\u003c\/p\u003e\n\u003ch3 data-start=\"5560\" data-end=\"5584\"\u003e\u003cspan style=\"color: rgb(43, 0, 255);\"\u003e\u003cstrong data-start=\"5564\" data-end=\"5584\"\u003eMaintenance Plan\u003c\/strong\u003e\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp data-start=\"5586\" data-end=\"5712\"\u003eFollowing successful eradication of SIBO, she transitioned into the \u003cstrong data-start=\"5654\" data-end=\"5679\"\u003ePrevention of Relapse\u003c\/strong\u003e phase of Dr. Rajsree’s protocol:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli data-start=\"5716\" data-end=\"5759\"\u003eContinued \u003cstrong\u003eDigestive Enzyme Pro\u003c\/strong\u003e and \u003cstrong\u003eBetaine \u0026amp; Pepsin\u003c\/strong\u003e with meals\u003c\/li\u003e\n\u003cli data-start=\"5762\" data-end=\"5827\"\u003eContinued \u003cstrong\u003eEssential Magnesium\u003c\/strong\u003e and \u003cstrong\u003eMotility Activator\u003c\/strong\u003e at bedtime\u003c\/li\u003e\n\u003cli data-start=\"5830\" data-end=\"5936\"\u003eTransitioned from Spore Probiotic IgG to \u003cstrong data-start=\"5871\" data-end=\"5896\"\u003eProbiotic 100 Billion\u003c\/strong\u003e for broad-spectrum microbiome support\u003c\/li\u003e\n\u003cli data-start=\"5939\" data-end=\"5974\"\u003eOngoing gradual dietary expansion\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch3 data-start=\"5976\" data-end=\"5996\"\u003e\u003cspan style=\"color: rgb(43, 0, 255);\"\u003e\u003cstrong data-start=\"5980\" data-end=\"5996\"\u003eKey Insights\u003c\/strong\u003e\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp data-start=\"5998\" data-end=\"6171\"\u003eThis case illustrates how \u003cstrong data-start=\"6024\" data-end=\"6050\"\u003emixed-type IBS (IBS-M)\u003c\/strong\u003e often reflects \u003cstrong data-start=\"6066\" data-end=\"6085\"\u003emixed-type SIBO\u003c\/strong\u003e, underscoring the importance of breath testing rather than symptom-based assumptions.\u003c\/p\u003e\n\u003cp data-start=\"6173\" data-end=\"6214\"\u003eContributing root causes likely included:\u003c\/p\u003e\n\u003cul\u003e\n\u003cli data-start=\"6218\" data-end=\"6304\"\u003eImpaired intestinal motility related to chronic stress and reduced physical activity\u003cbr\u003e\n\u003c\/li\u003e\n\u003cli data-start=\"6403\" data-end=\"6488\"\u003ePossible low stomach acid contributing to bacterial overgrowth and food intolerance\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp data-start=\"6490\" data-end=\"6810\"\u003eDespite significant symptom severity and weight loss, this patient responded extremely well to Dr. Rajsree’s 4-Phase SIBO Herbal Protocol. Treatment led to normalization of her SIBO breath test, resolution of IBS symptoms, improved food tolerance, and restoration of weight—without the use of pharmaceutical antibiotics.\u003c\/p\u003e\n\u003cp data-start=\"6812\" data-end=\"7081\"\u003eThis case further highlights the importance of sequencing treatment properly: supporting motility and digestion first, using targeted herbal antimicrobials, protecting nutrition during therapy, and implementing a slow, structured food reintroduction to prevent relapse.\u003c\/p\u003e","brand":"Supplements by Dr. Rajsree","offers":[{"title":"Default Title","offer_id":47857873387687,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0574\/4571\/2039\/files\/JBefore.png?v=1770499808","url":"https:\/\/dr-rajsrees-public-supplement-store.myshopify.com\/products\/patient-11-a-43-year-old-woman-with-mixed-ibs-ibs-m-hormonal-flares-and-mixed-type-sibo","provider":"Supplements by Dr. Rajsree","version":"1.0","type":"link"}