Cbd oil for globus sensation

GABA is the answer after 40 years of a lump-in-the-throat sensation, nervousness and muscle tension at work

Earlier this year, I published a blog post on the sensation of having a lump in the throat when you feel anxious. It’s called globus pharyngeus which is defined as “the painless sensation of a lump in the throat and may be described as a foreign body sensation, a tightening or choking feeling.”

Globus means globe/sphere and it can actually feel like you have a golf-ball sized object in your throat. It’s very uncomfortable and quite terrifying outside of the anxiety that is often the trigger. I share my lump-in-the-throat story and my success with GABA in this blog: Anxiety and globus pharyngeus (lump in the throat): GABA to the rescue?

Pam recently shared her wonderful success with GABA on the above blog, after having dealt with what she calls “her throat thing” for 40 years!

I have dealt with this throat thing since I was a teenager. I’m now 57. It was only when I saw what you wrote about how yours came back after a scary airplane incident that I made the connection that GABA could help me. I saw that in the summer of 2019, so I spent about 40 years dealing with this until I found the GABA answer!

Mine comes up when speaking in front of others, such as work meetings, or even just one-on-one work discussions, and it was getting consistently worse. I would be swallowing constantly and trying to talk. Absolutely awful. Of course everyone could see it happening.

GABA solved this for me, and I can’t even describe how grateful I am!

How wonderful are these results! I am so happy for her and thanked her for coming back and sharing in the comments. I also asked some follow-up questions so I can continue to learn and so I can share so you get to learn too:

  • How much GABA helps and how do you take it (when you know you’ll be in this situation or a few times a day to get your levels up)?
  • Did you ever use a prescribed medication or were recommended something?
  • Have you seen any other benefits from using GABA – improved sleep, reduced anxiety in other situations, reduced cravings?
  • Have you made other changes too – like dietary changes such as gluten/sugar/caffeine/alcohol removal?

She shared this about timing and how GABA helps with anxiety-related physical/muscle tension and nervousness:

I take GABA Calm … one upon waking, 1 mid-morning, and 1 mid- afternoon. I take an extra one right at the time of a meeting.

That is the only change I made. I’ve never been on any prescription medication.

Other than the specific throat issue, I notice I’m generally less physically tense, with muscles not getting so knotted up in my face, scalp, neck, shoulders, and back, which is wonderful.

I work at a computer job, which causes lots of muscle tension, but I feel that anxiety-related muscle tension has reduced.

I notice that my muscles have less of that “immediate tightness” upon seeing someone whom I’m nervous to interact with.

This timing and dosage of GABA Calm is typically what I use with clients and what works so it was great to hear that it’s working for her. I was also so pleased to hear the anxiety-related muscle tension and nervousness has reduced too. This is also to be expected.

I did remind her to keep in mind that the amino acids are intended for short-term use. This could be a few weeks up to 6-12 months depending on each person. While using the GABA, I have my clients start to address all the dietary changes, gut health, nutritional deficiencies (zinc and B6 are needed to make neurotransmitters and key with pyroluria), toxin exposure (like BPA, phthalates, pesticides, fluoride etc), infections (like Lyme and co-infections, parasites, PANDAS/PANS) etc. and everything else that may be causing low GABA levels (as we covered in The Anxiety Summit 6).

Vagus nerve support is also key. I cover what I did for my vagus nerve in this blog that Pam referred to: Vagus nerve rehab with GABA, breathing, humming, gargling and key nutrients

Globus pharyngeus or this sensation of the-lump-in-the throat is way more common than most people realize and mainstream medicine seldom has a solution. Medications that are commonly prescribed for globus pharyngeus are benzodiazepines, antidepressants/SSRIs and sometimes PPIs/proton pump inhibitors. Cognitive behavior therapy has some success in some instances but it’s always best to get to the root cause of low GABA and address that with the amino acid GABA. And then figure out why GABA is low and address that too.

If you’re new to the amino acids here is a quick summary about GABA: low levels of GABA, a calming neurotransmitter can lead to anxiety, fears and panic attacks. With low GABA, the anxiety is a physical kind of anxiety with muscle tension or muscle spasms. I propose that low GABA may be one possible root cause of globus pharyngeus.

I appreciate Pam for sharing her story and I’m sharing it here in order to give you practical solutions and hope. If she can find a solution to her 40-year the-lump-in-the throat and physical tension issues then anything is possible.

Please also share your lump-in-the-throat story and what has helped you. Or if you’re a practitioner, do share how you have helped your clients/patients who experienced this sensation.

Feel free to post your questions here too.

[The above statements have not been evaluated by the Food and Drug Administration. Products listed in this blog post are not intended to diagnose, treat, cure or prevent any disease.]

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About Trudy Scott

Food Mood Expert Trudy Scott is a certified nutritionist on a mission to educate and empower anxious individuals worldwide about natural solutions for anxiety, stress and emotional eating.

Trudy is passionate about sharing the powerful food mood connection because she experienced the results first-hand, finding complete resolution of her anxiety and panic attacks.

Reader Interactions

Comments

I have been taking Gaba calm 125 mg twice a day for a few years.
It immediately lessons the stress and anxiety without taking any
other medications. I am a teacher and the stress level is at an all
time high with COVID-19. Are there long term side effects? Is there
anything else you recommend?

Trudy Scott says

Fina
Thanks for sharing and so glad to hear it helps. I’m sorry to hear about this stress you’re experiencing!

I am not aware of any issues with long term use of GABA but ideally we want to figure out what it’s low and address this – stress (clearly challenging for you right now), low zinc, low B6, poor gut health, parasites, low intake of animal protein and/or low stomach acid, poor adrenal function, sex hormone imbalances etc. For stress during COVID and other types of disasters, a good B complex is invaluable https://www.everywomanover29.com/blog/b-complex-gaba-zinc-tryptophan-vitamin-b6-powerful-nutrients-disaster-recovery/

My 30 year old son is tapering off antidepressants. He tried tryptophan and it made him hyper and not able to sleep. Have you ever heard of this?

Trudy Scott says

Susan
Too much tryptophan can do this but it’s more typical to see this with 5-HTP. When using tryptophan or 5-HTP during tapering be sure to have the prescribing doctor monitoring for serotonin syndrome. Best is to read this blog and work with and discuss with your prescribing doctor https://www.everywomanover29.com/blog/taper-from-antidepressant-tryptophan-amino-acids/

Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.

Hi Trudy
Thank you so such for this information. I have had the sensation you describe for at least 20 years so I am very keen to try GABA. I have heard that supplements in this country are synthetic and are manufactured in China. Can you shed some light on this. I would like to select a good supplement to use. I live in South Africa so I am not sure which one to purchase locally. Thank you

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Trudy Scott says

Theresa
Best would be to check with supplement companies there

Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.

Interesting!! I notice that I have a crying response that’s different, but I wonder if it’s a similar origin. I just kind of choke up and feel like I’m going to cry from any little thing that pulls at my emotions, whether it’s heart-warming or sad. I am convinced that this is a physiological response, because it did not happen for most of my life, but for the last few years, it happens at the drop of a hat, even if I don’t feel like I’m sad. Also, I can tell that when I’m physically feeling better it doesn’t happen the same way. I’ve had pretty severe chronic illness for 30+ years and I know that my neurotransmitters, hormones, vagus nerve and mitochondria are completely shot. I’ve done a lot of work in the functional med realm for the last several years and am building back up, and I have taken GABA for periods of time, usually in powder form at bedtime. I’m really curious, though, if this is a vagus nerve or GABA deficiency kind of issues. Have you ever seen this as a symptom of vagus nerve dysfunction or neurotransmitter deficiency? Thanks so much for your work and sharing your information.

Trudy Scott says

The best way to know is to do trial of respective amino acids. Based on your description I’d explore low endorphins and DPA, in addition to vagus nerve support. More on that here – DPA to end comfort-eating, end weepiness and boost endorphins https://www.everywomanover29.com/blog/dpa-comfort-eatin-weepiness-endorphins/ Feel free to search for blog for more info on this topic.

If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/store/aafsbook.html

Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.

Christine Butterfield says

Hi, I have this throat issue but I didn’t know there was a name for it, and didn’t know it was related to anxiety even though I suspect it might be. I just bought GABA calm, and I’m always cautious when I start a new supplement. Is there a way to start out slowly with it?

Trudy Scott says

Christine
I have sensitive folks always start low. Starting dose of GABA is 125mg and some folks start with 1/4 and go up from there. Keep us posted how it goes.

If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/store/aafsbook.html

Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.

Hmm – get that too – I will try some GABA

Trudy Scott says

Brett
A reminder to do a trial to find out your unique needs – and to start low. I typically have clients do a trial with 125mg GABA Calm or open a GABA-only product (sublingual is always best).

Can a person stay on GABA long term?
I read something about it blocking dopamine receptors.
In mouse research, upon activation of GABA neurons in the VTA, a strong inhibitory effect was reported on the rate of firing in DA neurons. In contrast, following GABA neuron inhibition, a disinhibition or increase of dopamine was witnessed. These findings indicate that firstly, GABA activation could be associated with dopamine suppression, and secondly, that GABA neurons in the VTA may have a direct connection with the synapses of local DA neurons.

Trudy Scott says

Susan
I have not seen issues with long term use but ideally root causes are addressed so long-term use is not needed. I cover all this in my book “The Antianxiety Food Solution.” More here https://www.everywomanover29.com/store/aafsbook.html

Interesting article (https://www.news-medical.net/health/GABA-Activation-and-Dopamine-Suppression.aspx) which I take to mean GABA has a positive impact on the dopamine reward pathway helping with addiction. I’d have to dig deeper to be able to comment further so I’ve added it to my long list.

Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.

I have suffered with Globus pharyngeus since 2006. After seeing many doctors, I found a otolaryngologist in NYC where I was diagnosed with vagus nerve damage (not sure of the medical name). I was initially given PPIs, diet change, and then gabapentin. That was in 2014. At this point, I am just taking 200 mg of gabapentin along with CBD (prescribed medical marijuana – high CBD/almost negligible THC). It seems to be doing the trick unless I talk for a long time or sing! My question is this – I’d like to get off gabapentin and try Gaba Calm (which I have already bought but I’m not sure if I can take both Gaba Calm and gabapentin together until I wean off the gabapentin. Suggestions? Thank you

Trudy Scott says

It’s best to work with the prescribing doctor on gabapentin withdrawal. Be aware of discontinuation syndrome during withdrawal.

Apologies for the delay in your comment approval and my response. We had a computer glitch where a large number of comments were hidden from view in a spam folder. It mostly affected new folks who were commenting for the first time but it’s hopefully resolved now.

Hi Trudy,
Been dealing with Globus for a few months (never before) during a very stressful time of my life. Anxiety and stress very high (caused severe acid reflux) as I experienced some health issues. I’m going to try this but I do take BP medication and a PPI at this time. Any conflict there? I’m sure the GI issues are tied to the stress and anxiety. 54 year old male, do I start with 125 mg a day and for how long? So excited I may have a solution other than antidepressant medication (which may or may not help).

Trudy Scott says

Tom
I always start low with 125mg and go up from there over the course of a few weeks. With globus it’s also important to address other underlying root causes and the severe acid reflux is a big one. I’d start with looking at food sensitivities especially gluten.

Dealing with GERD, intense anxiety and Globus sensation episodes that can last for hours, constipation, lots of belching/gasses and heart palpitations. All started happening after I put on a ton of weight plus being on Accutane. GI Dr. doesn’t think I have SIBO but does anyone think it might be?

Pretty long so I apologize but there’s just so many factors and my life has been horrible since.

So I started bulking after working out again around June 2019. Put on about 40-50 pounds total in 11 months by eating tons of carbs and calories and everything was going good. I also hopped on Accutane around the beginning of 2020. 3 months on Accutane and i started experiencing Globus sensation during my workouts then eventually pain in my heart area, stomach pains and belching. Saw my Dr, quit Accutane and went on PPIs, helped for a bit then my Globus sensation episodes got intense and started happening daily. It basically feels like my throat is closing and I’m choking to death. It’s very difficult to swallow my own saliva, and my throat becomes very dry. My anxiety sky rockets as well. The whole thing can last from 20 minutes to 3 hours and it is hell. I also noticed that I was very constipated and had pebble stools. Another thing is that sometimes swallowing pills can trigger my Globus sensation for no reason.

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Had to stop working out since the tension always caused my throat to feel like closing. I lost around 30 pounds in just two months after I stopped working out because of how the Globus lasted so long and I couldn’t eat. I eventually got a endoscopy and it showed everything was fine.

Had a biospy for esophagitis and it was negative but didn’t get a biospy for my stomach or small intestine as my Dr. says it wouldn’t help. Went on a higher dose of PPIs, and they helped again until recently. My anxiety has skyrocketed, the Globus episodes came back and I started getting more heart palpitations and sometimes even body spasms. I saw a cardiologist recently and now have a heart monitor on.

My GI. Dr. doesn’t believe I have SIBO because I don’t have the risk factors like diabetes and thinks it could be anxiety and won’t test me. But at the same time how does that explain the constant belches and gasses I get and the stomach pains. I’ve never had anxiety like this until all this happen. This has consumed all my life these past 5 months and made me miserable and depressed. Does anyone think I should get a 2nd opinion from a different GI Doctor?

Edit: thank you for all that have read and commented, reading your comments have helped ease my mind and make me not feel alone on this.

I don’t want to speculate on whether or not you have SIBO or anxiety but as an anxiety sufferer I have learned that it is VERY closely associated with the gut, and there is a lot of scientific evidence emerging that the gut biome plays a large role in anxiety. The gut has as many nerve endings as a cat brain, so it is your second brain, in effect. The gut plays a role in constipation, of course.

Anxiety is a very phisical disease that can manifest anywhere in the body because of its effect on muscle tension. It’s not “all in your head”, that is a primitive way that other people use to understand anxiety.

Thank you for this, it does help ease my mind reading this. I do have a history of anxiety but just no where close to this extent as I never experienced a panic attack until this. I do agree that my anxiety has made whatever stomach issue I might have way worse. A lot of my Globus sensation moments seem to ease down when I distract myself from my symptoms, but other times the symptoms become so scary for me that I can’t stop focusing on them thus making those Globus sensation episodes worse.

It just confuses and frustrates me that I was at my happiest point of my life when I was working out and now I’m at my lowest in the same year because of what I’ve been going through. I’m still talking with my doctors about my issues but one of Drs. did set me up with a stress class that will determine if I need to go see a therapist. So I’m kind of looking forward for that.

Seconding the ‘not a doctor’, as this sounds serious and scary, I’m sorry you’re going through that! I’m not sure this is SIBO either, but perhaps an elimination diet for a month like whole 30 or AIP with slow food reintroductions and keeping a food diary would help figure out if it’s specific foods triggering you. My anxiety goes through the roof when I eat nightshade vegetables, and my throat gets tight when I eat gluten, for example. Liquid Benadryl really helps me when the reactions are at their worst.

Perhaps a functional medicine doctor might have some other solutions that a typical MD might not.

Look into information on increasing stomach acid to get rid of GERD as opposed to alkalinizing it. Increasing my stomach acid helped me greatly with it, but it goes against the traditional idea that it’s high stomach acid that causes GERD. But from what I’ve read of people’s stories, the ones who go on antacids seem to be reliant on them for symptom relief for life most of the time. I did this by taking Betaine HCL with any meal containing a lot of protein. The unexplainable white tongue I had went away after trying everything else.

Yes! This helped me when I first had GERD. Quit all PPI’s and bought supplements to help increase stomach acidity, the Betaine was one of them. There was a rebound effect for a few days, but then I got much better. Also lots of probiotics, small and frequent meals and my GERD disappeared. And drink lots of water. I hope you get better soon, it’s a difficult condition.

100% worth getting a second opinion! Get that test done! The worst that happens if you get tested is that it’s negative, which just means it’s something else – but at least you’ll know either way!

I had bad anxiety most of my life. My anxiety disappears when my SIBO medicine is working. I know it’s wearing off because my anxiety comes back. I’m not a “nervous” person; anxiety is simply an internally-based external input, which for me, is driven by a messed-up gut. HUGE links between the gut & anxiety!

Definitely will do after I talk with my primary Dr. about getting a CT scan to check if there’s anything else causing my palpitations.

What I realized is ever since my GERD, whenever I’m anxious or tense my stomach feels upset and vice versa so that’s definitely true. What is the SIBO medicine is and how long do you take it for? Thanks

I sound like a broken record on this subreddit, but look into histamine intolerance as well, which can be caused by SIBO.

I have both histamine intolerance and SIBO. I had severe acidity/reflux type issues, heart palpitations, chest tightness and then switched to a low histamine diet which magically made my worst symptoms almost vanish. My SIBO symptoms are uncomfortable (bloating, pressure in abdomen from bloating), but my histamine symptoms were WAY worse, and those I have managed to pretty much tame just through diet, whereas treating SIBO is longer and more complicated.

In short, you can try a low histamine diet and very quickly you’ll know if that’s an issue for you – and potentially get some relief. And if it does seem you’re histamine intolerant, that would be another finger pointing in the direction of SIBO.

Check the histamine intolerance subreddit or hit me up for more info. https://www.reddit.com/r/HistamineIntolerance/

The fact that you were eating lots of carbs before these symptoms started seems to be a potential indicator that you may have exacerbated a pre-existing SIBO condition. I say this because I’m pretty sure the same thing happened to me.

Anxiety is a big symptom of SIBO for many people – and then, why wouldn’t you be anxious having heart palpitations all the time? It’s terrifying.

Also, strenuous exercise causes histamine release in the body, so that might explain why you were reacting while working out.

Definitely get a 2nd opinion, but you also might want to find a more holistically minded medical professional if you don’t find a GI doctor who takes SIBO seriously.

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Also, I understand that anxiety issues are worse for those with methane type SIBO – which is the kind that causes constipation.

Thank you so much for this, you explained a lot of my questions and more. I never heard of histamine intolerance but will check that out. I even told my GI Doctor about Methane SIBO and my constipation and he still brushed it off and told me to ask my primary about an anti-depressant people use that have GERD. It just made me really frustrated that he didn’t even bother testing me for it. I’m for sure going to ask for a 2nd opinion.

I’m in my early 20s and was super hopeful about my future after beating depression due to some things in life. Working out made me the happiest I’ve been and now it’s like I’m back in a bigger hole in just a year because of these issues. So just those thoughts definitely don’t help the anxiety that my potential SIBO already causes.

What’s a meal you eat that’s low histamine for example? And I heard about the Breath test for SIBO, do you know if that the best test to take for it? Also, we’re you ever on any PPIs?

Thank you again!

Did you have a breath test ? Get one done and figure out if you have SIBO and what kind you have! Any questions feel free to ask. Sibo sufferer for about 10 years. Have lots of general knowledge on subject

No I haven’t and it seems like my current GI Dr. doesn’t even want to rule that possibility out so I’m definitely going to get a 2nd opinion.

Is SIBO something that can’t be cured? And how do you deal with yours? Thank you!

Possibly a hiatal hernia. That’s what I have with those same symptoms plus more. I have put it into remission before and would not try surgery for it because it is small. People have had vagus nerve damage from hernia surgeries.

Wouldn’t the endoscopy have ruled that out?

Hey, first I want to say—don’t be scared. You’re going to do what you need to do to find out more information. You’ll do your research, you’ll talk to experts and doctors, and you’ll get multiple opinions. (I can’t stress the multiple opinions thing enough—I saw about 15 doctors who told me I was crazy before I found 1 that listened to me.)

Second, I want to say your symptoms sound a lot like my own were when my SIBO was at its worst. I am not a doctor, and I cannot diagnose you. But of my SIBO symptoms (and there have been many), the worst were probably the choking sensation you describe; the extreme panic attacks and debilitating brain fog; the sudden muscle spasms or weakness; the tender and throbbing migraines; the heart palpitations and chest tightness; and the full-body numbness. These things literally kept me from sleeping for almost 2 months at one point. I was averaging 3 hours of sleep in about 20 minute intervals, because my nervous system was so fried and I was so afraid of my symptoms.

Like you, my throat would suddenly get so tight, sometimes I would be afraid I was going to pass out; it literally felt like someone was choking me. I had X-rays of my whole body, multiple CT scans of my brain and chest, an MRI of my head; I saw a neurologist; I saw a cardiologist who put me on a heart monitor; I saw a rheumatologist to check me for autoimmune diseases; I saw an ophthalmologist to look into my dry eye and migraines. I saw every doctor I could find. They all kept telling me I was perfectly healthy, that I didn’t fit the bill for any serious diseases, and that it was all in my head.

I started doing research about the Vagus nerve and the Sympathetic/Parasympathetic nervous systems, and I had heard about SIBO while doing research about brain fog. One day, my face went numb, and my throat got so tight, that I couldn’t sit still. I had the hunch to see a chiropractor, thinking maybe I had a pinched nerve. Luckily, the chiropractor I chose at random happened to be a Network Spinal Analysis practitioner (a Chiro who specializes in nervous system repair, rather than cracking your back) as well as a licensed nutritionist. He ordered more X-rays of my entire spine along with a SIBO test. Sure enough, some issues with my spinal alignment were irritating my Vagus nerve, and combined with my high-stress lifestyle and high-carb diet, both my nervous system and my digestive system were a complete wreck. I tested positive for both Hydrogen and Methane SIBO, and I immediately began a strict low-FODMAP diet, and started a Network Chiropractic and herbal antibiotic regimen with my Chiropractor/Nutritionist. That was in May 2020. After a week or two of low FODMAP, I felt like a new human being. Completely. The brain fog started to clear, the choking stopped coming back, the muscle spasms stopped. By September, I felt almost like my old self. And now, in January, my doctor can’t believe how far I’ve come. I went from a suicidal basket case to a person with more energy and clarity than I did before!

That’s not to say I’m done with the process. I still am quite constipated and my motility is still sluggish. (If I accidentally eat lactose or gluten, for example, I will have minor symptoms for a day or so.) My doctor and I still have to rebuild my gut with good bacteria so that I’ll be able to introduce more FODMAPs and have a more diverse diet. I am seeing an acupuncturist to help with my motility, on top of all the supplements I take. Going the natural route is slow work, but all things considered, my SIBO is under control and has improved IMMENSELY. It’s like day and night.

What I recommend for you is to try cutting FODMAPS completely for a week or two, and see if your symptoms start to clear up. That’s a great place to start, because if you see a change, you’re likely on the right path. That will give you some peace of mind, and more information to discuss with your doctor. I personally did no-FODMAP for about two weeks to give my body a chance to flush everything out. In those early days, if I slipped up and ate bread or onion or milk, I would quickly regret it. The symptoms would come back, and it would take 1-5 days for my body to reset again. But I was comforted when I could physically see the evidence that my issue was related to what I was eating. So be strict with it, at least until you can gauge whether or not this seems to be a food-related issue. I downloaded the Monash University FODMAP database app to help make grocery shopping easier, and I committed to preparing all my meals myself, so I knew what was going into them.

Keep a food diary, and if changing your diet seems to make a difference, bring your food diary to a doctor who has SIBO experience. Most medical doctors in the US don’t know much (if anything) about SIBO, sadly. But don’t let that discourage you. Don’t be afraid to try a nutritionist or naturopath; as SIBO is a holistic issue, it really takes a holistic approach to heal it. And realistically, even if it is SIBO that you have, there will be an underlying cause of that SIBO (for me it seemed to have been my nervous system and my slow motility). Just don’t give up, and don’t be afraid of your body like I was. If this process taught me one thing, it’s that our bodies are always—ALWAYS—trying to find balance and heal themselves. We just have to help them do it sometimes.