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Strategies include: Prokinetics: Support the migrating motor complex and prevent relapse Examples: Ginger, MotilPro, low-dose erythromycin, prucalopride Probiotics (cautiously): Spore-forming strains like MegaSporebiotic may help without worsening symptoms Use only after clearance and once tolerated Dietary reintroduction: Begin with a low-FODMAP or Specific Carbohydrate Diet (SCD) Gradually reintroduce fermentable fibers as tolerated Lifestyle optimization: Stress reduction (mindfulness, breathwork, vagal stimulation) Meal spacing (4-5 hours between meals to allow MMC activity) Quality sleep and circadian rhythm alignment How to Prevent SIBO from Coming Back Recurrence of SIBO is common without addressing the underlying causes

Freeze rules: do not freeze a reconstituted (already-mixed) vial freeze-thaw degrades peptides

doi:10.1021/bi500650h