SIBO Maintain
The step that decides whether your SIBO Repair-4 result lasts. A daily probiotic and ongoing antimicrobial pack designed to be taken for a minimum of 6 months after the 42-day eradication protocol — because up to 44% of SIBO patients relapse within 9 months without a structured maintenance strategy. Built to be reordered every 2 months, no thought required.
Eradication is half the job. Maintenance is the other half.
SIBO Repair-4 clears the overgrowth and rebuilds the terrain. It cannot, in 42 days, fully restore the Migrating Motor Complex — the cleansing wave whose impairment is the single most important predisposing factor for SIBO recurrence. That restoration happens over months, not weeks, and it happens under cover of a daily probiotic and ongoing antimicrobial protection.
The numbers are the case for this product. Up to 44% of patients who complete a SIBO eradication protocol relapse within 9 months without a structured maintenance strategy. That isn't a failure of the eradication — it's a reflection of the underlying motility, anatomical, and medication factors that allowed SIBO to develop in the first place. They don't disappear at day 43.
SIBO Maintain is built to be the easy answer: three components, one daily routine, reordered every two months for at least six months. Nothing to think about, nothing to deviate from.
Three components. One daily routine.
Upper-GI Re-colonisation
Lactobacillus reuteri (60 capsules — 1 per day for 2 months)
L. reuteri specifically colonises the small intestine — the SIBO terrain — and produces reuterin, a natural antimicrobial that helps keep the small bowel hostile to overgrowth. Daily dosing through the maintenance window holds the rebuilt flora in place after Phase 2.
Daily — keep the right bugs where the wrong ones used to live.
Resilient Colonic Seeding
Spore-based Bacillus species (60 capsules — 1 per day for 2 months)
Spore-based probiotics survive gastric acid intact and germinate in the colon, seeding the lower bowel with antimicrobial-resistant beneficial flora. Resilient by design — they tolerate the ongoing low-dose antimicrobial coverage that runs alongside them.
Daily — reinforce the downstream microbiome.
Ongoing Antimicrobial Coverage
Enteric-coated essential oil blend — taken at least 2 hours apart from probiotics
A low-dose continuation of the antimicrobial coverage used in Phase 2, holding the small-intestinal environment hostile to any residual overgrowth while the MMC and barrier finish healing. Timing matters: separate from the probiotic doses by at least two hours.
Daily — keep the small bowel inhospitable to relapse.
Why six months is the minimum.
From Repair-4 to durable remission.
Transition straight into Maintain.
Order at the start of Week 5 of SIBO Repair-4 so the first 2-month pack arrives before Phase 2 ends. The handover should be seamless — no gap, no waiting for symptoms to nudge you back.
Daily dosing + meal-timing discipline.
One probiotic of each type per day. Continue the antimicrobial coverage as directed, taken at least 2 hours apart from the probiotics. Maintain 4–5 hours between meals and a 12–14 hour overnight fast to keep the MMC sweep working. Guided FODMAP reintroduction begins under your Microbiome Doctor's oversight.
Re-test SIBO breath test.
Repeat your hydrogen and methane breath test at the 6-month mark to objectively confirm sustained eradication and decide — with your Microbiome Doctor — whether to step down, continue, or extend Maintain further.
Questions, answered.
Do I have to finish SIBO Repair-4 before starting Maintain?
Yes. SIBO Maintain is designed as the step that follows the full 42-day Repair-4 program — Phase 1 eradication + Phase 2 rebuild. Starting Maintain without first clearing the overgrowth means dosing daily probiotics into a small intestine that's still colonised with the wrong bacteria. Complete Repair-4 first, then transition directly into Maintain at day 43 with no gap.
Why six months minimum? Can I stop earlier if I feel fine?
Feeling fine is not the marker — sustained low breath-test values are. Up to 44% of SIBO patients relapse within 9 months without a structured maintenance strategy, and the relapse window stretches well past the point at which symptoms have settled. The 6-month minimum exists because that's the timeframe over which the Migrating Motor Complex, gut barrier, and microbial terrain consolidate. Stopping earlier is the most common cause of recurrence we see in clinic.
How do I take the three components each day?
One upper-GI probiotic capsule and one spore-based probiotic capsule per day, with food. The enteric-coated essential oil blend is taken at least two hours apart from the probiotics — typically morning or evening, on the opposite side of the day to the probiotics. Your digital Maintenance Guide includes a worked daily schedule and meal-spacing prompts.
When should I order my next 2-month pack?
Order your next pack 1–2 weeks before your current supply runs out so there's no gap. The product is set up to be reordered every 2 months across the 6-month minimum maintenance window — three packs back-to-back. Most patients set a calendar reminder at week 6 of each pack.
Can I take this if I'm pregnant or breastfeeding?
No. The enteric-coated essential oil blend included in this maintenance pack carries an explicit pregnancy warning — it is not to be taken if you are pregnant, breastfeeding, or planning to become pregnant. If this applies to you, please consult your Microbiome Doctor for an alternative maintenance approach — do not start this pack.
What about diet and meal timing during Maintain?
Continue the Low-Fermentation Restoration Protocol principles from Repair-4 until your Microbiome Doctor clears specific reintroductions. Maintain 4–5 hours between meals to allow the MMC cleansing wave to activate, and aim for a 12–14 hour overnight fast. Reintroduction of fermentable foods happens gradually, under clinical oversight — usually beginning after the 6-month re-test.
Should I re-test at 6 months?
Yes. A repeat SIBO breath test at the 6-month mark objectively confirms sustained eradication, flags any quiet returning overgrowth, and decides whether to step down, continue Maintain, or extend further. Symptoms alone are an unreliable guide — testing is the only way to know.
Important — general advice only. Information presented on this page is general health information and is not personal medical advice. Always consult your treating practitioner before starting any new supplement.
Pregnancy: The enteric-coated essential oil blend included in this maintenance pack carries an explicit pregnancy warning and is not to be taken if you are pregnant, breastfeeding, or planning to become pregnant. Consult your Microbiome Doctor for an alternative if this applies.
These products are listed complementary medicines and are not intended to diagnose, treat, cure, or prevent any disease. The Microbiome Clinic has no commercial affiliation with any specific supplement brand included in this protocol — supplements are selected on the basis of clinical evidence alone, in line with the Microbiome Clinic Independence Guarantee.