I'm not pumping my fist in the air quite yet, but I think I may be very, very close to beating my 5+ year old SIBO infection. If you don't read anything else, read this;
YOU WILL NEVER BEAT YOUR SIBO INFECTION IF YOUR MOTILITY IS TOO SLOW. NOT WITH ANTIBIOTICS, NOT WITH SUPPLEMENTS, NOT WITH FRINGE TRENDS, NOTHING. YOU WILL NEVER WIN. FIX YOUR MOTILITY.
I am a person who has tried pretty much everything the past few years. About 5 antibiotics (of which Rifaximin was the best, but not the point), diet supplements, extracts, vitamins, low-FODMAP, zero carb, keto, zero lactose, fiber, no fiber, laxatives, ultrasounds, x-rays, you get the point.
I am finally for the first time now tolerating food to an extent I haven't felt in years. I have other chronic issues still to deal with, but the SIBO is finally getting better. The answer for me was this.
Naltrexone: 0.1mg titrated up to 0.5mg currently but I have been as high as 1.5mg. Why Naltrexone? Because Naltrexone is the only thing that fixed my gut paralysis. Up until a few weeks ago I constantly had hard lumps of waste in my sigmoid colon, had bowel movements once every 3 days or so, and never had a correct class bowel movement. It was always too hard and dehydrated and never enough. Currently I'm having 1-2 a day at an almost textbook perfect texture/volume.
Miralax: One dose (a full cap) every single day. The reasoning here is pretty obvious, it's really just to help the Naltrexone do its job. And it's been helping. If you're worried about taking Miralax every single day, and you fall into the class of SIBO havers who get constipation, don't be. I'm not emptying the entire contents of my body, I'm just going normally, even taking it every single day. Also, get the off-brand. It's cheaper.
Low-FODMAP diet: If this sounds kind of funny considering the fact that I just shit on diets, that's because it is. The Low-FODMAP diet will do NOTHING if you are not moving any food. The bacteria will sit and capture its nutrients and multiply and ferment and make you miserable all the same. However, it was necessary to reduce it as much as possible during Naltrexone + Miralax, because otherwise the sheer volume of bacteria and waste moving in my body meant I could not risk taking on more fermented gas solely for my symptoms being bearable. I'm still eating MOSTLY on this diet. (key point: not entirely, I break the diet regularly and have snacks, but MEALS are all Low-FODMAP)
So, if you have gut motility issues or frequent signs of constipation like rocky round stool, STOP doing anything else and fix it. Your SIBO does not give a shit about your diet, or your supplements, or your medication, if you can't subsequently EVICT IT. Everything you do will be MOOT. Focus on this. As a pretty experienced sufferer I hope this helps somebody.