Dealing with persistent bloating, gas, abdominal pain, and unpredictable bowel habits can be incredibly frustrating, not to mention uncomfortable. If you’ve been battling these symptoms despite your best efforts, it’s possible that Small Intestinal Bacterial Overgrowth (SIBO) is the underlying cause.

At Birchwell, we empathize deeply with the challenges posed by SIBO. We understand the toll it takes on your physical, mental, and emotional well-being. That’s why we’re dedicated to providing holistic SIBO treatment tailored to your individual needs.

In this article, we’ll delve into the science behind SIBO, explore its symptoms, potential causes, and most importantly, discuss practical strategies for healing the root cause and managing your symptoms along the way. 

What is SIBO? 

Small Intestinal Bacterial Overgrowth, or SIBO, is a condition that occurs when there is an excessive amount of bacteria, good or bad, in the small intestine. While the small intestine normally contains a relatively small population of bacteria compared to the large intestine, SIBO disrupts this delicate balance, leading to a range of uncomfortable symptoms.  

SIBO is increasingly recognized as a contributing factor to various gastrointestinal disorders and can significantly impact your quality of life. 

Signs and Symptoms of SIBO 

The signs and symptoms of SIBO can vary widely among individuals but often include:

• Bloating – even without eating (i.e.waking up bloated) 
• Abdominal discomfort, pain, distension 
• Excessive gas 
• Diarrhea
• Constipation
• Fatigue
• Weakness
• Multiple nutrient deficiencies (vitamin B12, fat-soluble vitamins, iron, zinc)
• Development of multiple food sensitivities
• Histamine issues  
• Loss of muscle mass 
• Eating high FODMAP foods aggravates symptoms 

One of the key concerns with SIBO is its impact on nutrient absorption. When bacteria overgrow in the small intestine, they can interfere with the body’s ability to absorb essential nutrients, including vitamins like B12 and fat-soluble vitamins (A, D, E, and K), as well as minerals such as iron, zinc,  and magnesium. This can lead to nutrient deficiencies over time and result in symptoms like fatigue, weakness, and cognitive issues.

SIBO can also damage the lining of the intestinal tract, leading to increased intestinal permeability, commonly known as leaky gut syndrome. This heightened permeability allows undigested food particles, toxins, and bacteria to leak into the bloodstream, triggering an immune response and inflammation throughout the body. Chronic inflammation and the development of food sensitivities are common consequences of leaky gut, exacerbating the symptoms of SIBO and potentially triggering additional health concerns down the line.  

Addressing SIBO not only involves targeting bacterial overgrowth but also repairing and supporting the integrity of the intestinal lining to reduce inflammation and restore optimal nutrient absorption. 

How to test for SIBO? 

The primary method for diagnosing SIBO is breath testing. 

This non-invasive test involves the patient drinking a solution containing a specific type of sugar (usually lactulose or glucose) that bacteria in the small intestine can ferment. As the bacteria metabolize the sugar, they produce hydrogen and methane gasses, which are then measured in the breath at regular intervals over a period of several hours. Elevated levels of hydrogen and/or methane gasses in the breath can indicate the presence of SIBO. 

Due to its focus on the large intestine, stool testing is not diagnostic for SIBO. However, we often recommend the GI Map stool test in conjunction with breath testing to understand the full puzzle of what’s going on for you. Though not a definitive marker, it can reveal bacterial correlations with SIBO, along with co-infections or large intestinal dysfunctions that influence our treatment plan and help prevent relapse. Stool testing can identify the presence of pathogenic bacteria, yeast, parasites, and markers of inflammation that may contribute to gastrointestinal symptoms and SIBO. Additionally, stool testing can assess levels of digestive enzymes, assess the presence of inflammation, and evaluate the integrity of the intestinal barrier, offering valuable insights into how we can best support your body. 

A Note on Test Prep:

It’s important to note that test preparation really matters here! Four weeks before you take the test, you must stop taking antibiotics, antifungals, herbal or natural antimicrobial products. The week before the test, laxatives, motility agents, stool softeners, and antacids will need to be stopped as well. 24 hours before the test, you must stop taking probiotics, exclude any fermentable fibers, and limit your diet to simply prepared meat, poultry, fish, seafood, white rice, eggs, clear broth, olive oil, salt and pepper. The test prep really matters because small variations can affect the results.  

Combining breath testing and stool testing allows us to obtain a more comprehensive picture of your gastrointestinal health and tailor treatment strategies accordingly. 

How to tell which SIBO you have? 

SIBO is typically categorized into three main types based on the bacteria present in the small intestine: hydrogen-dominant SIBO (H-SIBO), methane-dominant SIBO (M-SIBO), and hydrogen sulfide SIBO (HS-SIBO).

1. Hydrogen-Dominant SIBO (H-SIBO):

This type of SIBO is characterized by an overgrowth of bacteria that produce hydrogen gas as a byproduct of fermentation. The excessive production of hydrogen gas can lead to symptoms such as bloating, gas, abdominal pain, diarrhea, and malabsorption of nutrients. Individuals with H-SIBO may experience increased flatulence and discomfort after consuming fermentable carbohydrates, such as apples, avocados, and other specific fruits, vegetables, and grains. H-SIBO is associated with weight loss for some individuals. 

2. Methane-Dominant SIBO (M-SIBO): 

In M-SIBO, there is an overgrowth of bacteria that produce methane gas. Methane gas slows down gut motility, leading to symptoms like constipation, bloating, and abdominal discomfort. Unlike H-SIBO, constipation is the hallmark symptom of M-SIBO. People struggling with M-SIBO may experience infrequent bowel movements, difficulty passing stools, a feeling of incomplete evacuation, and abdominal distension. Weight gain is more common with this type due to the impact on the metabolism and how the body absorbs nutrients from food. 

3. Hydrogen-Sulfide SIBO (HS-SIBO):

HS-SIBO is characterized by an overgrowth of bacteria that produce hydrogen sulfide gas. This type of SIBO is less commonly recognized but can still cause significant symptoms. Hydrogen sulfide SIBO can lead to bloating, abdominal pain, diarrhea, and foul-smelling gas. People with HS-SIBO may experience symptoms similar to both H-SIBO and M-SIBO, as hydrogen sulfide gas can affect gut motility and contribute to malabsorption issues. These symptoms can seem random in nature, and bladder pain, tension headaches, and joint aches may be more common in people with this type. 

Note- Most SIBO breath tests only test for hydrogen and methane dominant SIBO, but there is one test (Trio Smart) that looks at all three. 

Each type of SIBO presents with its own set of symptoms and challenges, and identifying the type is essential for developing an effective treatment plan.  

Exploring Root Causes of SIBO 

The body has natural protective mechanisms for maintaining bacterial balance in the gut. Peristalsis, the waves of intestinal muscle contractions help move intestinal contents forward, while appropriate sphincter functions are responsible for moving food and bacteria out of the small intestine and into the large intestine. Digestive enzymes, stomach acid, and bile also help protect against bacterial overgrowth, but if any of these things are disrupted, the risk of a bacterial overgrowth in the small intestine increases.  

There are many potential root causes of SIBO and oftentimes a combination of several makes an individual susceptible to overgrowth. The most common causes we see in practice include: 

1. Chronic Stress

Chronic stress can profoundly impact gut health and lead to SIBO. Stress triggers physiological responses that can disrupt normal digestive processes, including gut motility and stomach acid production. Additionally, stress weakens the immune system, compromising its ability to control bacterial overgrowths. 

2. Impaired Gut Motility

Impaired gut motility, including dysfunction of the migrating motor complex (MMC), plays a pivotal role in the development of SIBO. The MMC is a cyclical pattern of coordinated contractions that sweep through the small intestine during periods of fasting, helping to clear out residual food particles and bacteria. Conditions that disrupt the MMC, such as adhesions, scar tissue, or neurological disorders like diabetic neuropathy or Parkinson’s disease, can significantly slow down the movement of food through the digestive tract.

When the MMC is compromised, the normal clearance of bacteria from the small intestine is impaired, allowing them to accumulate and multiply. This bacterial overgrowth can lead to SIBO, as the stagnant environment provides an ideal breeding ground for bacteria. Food poisoning and hypothyroidism are two of the more common causes of slowed or damaged MMC function that we see in our clients, but GI surgeries, C-sections, Celiac disease, traumatic brain injuries, and certain medications can also damage the MMC.

If you aren’t having a daily bowel movement that’s easy to pass, it’s a good idea to consider your motility. Foods like sesame seeds, corn, or beets can be used to assess motility by timing how much time passes between eating these foods and seeing them in your stool. If you experience bloating between meals or it feels like meals sit heavy in your stomach hours after eating, slow motility may be an underlying cause of your SIBO.  

3. Low Stomach Acid 

Inadequate production of stomach acid, often due to factors like chronic stress, aging, or the use of proton pump inhibitors (PPIs) or other acid-suppressing medications, can impair the body’s ability to effectively kill bacteria in the stomach before they reach the small intestine. This creates an environment conducive to bacterial overgrowth and SIBO development.

4. Structural Abnormalities 

Structural abnormalities in the gastrointestinal tract, such as strictures, diverticula, or anatomical variations from surgeries or conditions like PCOS and endometriosis, can create pockets or obstructions that allow bacteria to overgrow in the small intestine.

5. Dysfunction of the Ileocecal Valve

The ileocecal valve is a muscular valve located between the small and large intestines that helps prevent the backflow of fecal matter and bacteria from the large intestine into the small intestine. Dysfunction of this valve can allow bacteria to migrate back to the small intestine and contribute to SIBO. 

6. Immune System Dysfunction 

Impaired immune function or immune system disorders like Celiac disease, Crohn’s disease, and immunodeficiency disorders, can compromise the body’s ability to control bacterial overgrowth in the small intestine, leading to SIBO.  

7. Impaired Pancreatic Enzyme Production 

Insufficient production of pancreatic enzymes can result in undigested food reaching the small intestine, providing a substrate for bacterial fermentation and overgrowth. 

8. Previous Intestinal Infections 

Past episodes of gastrointestinal infections, particularly those caused by bacteria or parasites, can disrupt the balance of gut bacteria and create an environment conducive to SIBO development. Food poisoning in particular can damage the MMC and slow motility in the gut, creating an environment conducive to SIBO. 

9. Underlying Diseases 

Associated underlying diseases such as hypothyroidism and diabetes are recognized as potential root causes of SIBO due to their impact on gastrointestinal function. Hypothyroidism is characterized by an underactive thyroid gland and can lead to slow gut motility, impairing the transit of food through the digestive tract and creating an environment conducive to bacterial overgrowth. 

Similarly, diabetes, especially when poorly controlled, can affect nerve function in the gastrointestinal tract, contributing to dysmotility and impaired intestinal clearance. Conditions like inflammatory bowel disease (IBD), celiac disease, and autoimmune disorders may disrupt the balance of gut bacteria and compromise the intestinal barrier, increasing susceptibility to SIBO.

10.  Undereating 

Under consuming adequate nutrition can serve as a root cause of SIBO by altering the balance of gut microbiota and compromising digestive function. The reduced availability of nutrients can weaken the integrity of the intestinal lining and impair the function of immune cells within the gut. Undereating can also slow motility and allow the stagnation of food particles to promote bacterial overgrowth in the small intestine. Insufficient intake can also disrupt the production of digestive enzymes and stomach acid, impacting the body’s ability to properly digest and absorb nutrients, creating an environment conducive to SIBO. 

11. Mold Toxicity and Heavy Metals 

Mold toxicity and heavy metal exposure can be root causes of SIBO by suppressing the immune system, compromising gut motility, inhibiting enzyme production, and disrupting bile acid secretion. Consequently, these disruptions create an environment in which bacteria can proliferate unchecked in the small intestine, leading to SIBO. 

12.  Medications 

Several medications can contribute to the development of SIBO by altering the normal function of the digestive system. For example, Proton Pump Inhibitors (PPIs) reduce stomach acid production and antibiotics disrupt the balance of bacteria in the gut by killing harmful and helpful bacteria, both of which create an environment conducive to bacterial overgrowth. Opioids and common weight loss medications like GLP-1s slow gut motility, allowing bacteria to stagnate and overgrow in the small intestine. Antidepressants, oral birth control medications, and immune suppressing medications are also associated with an increased risk of developing SIBO due to their effects on the gut and immune system. 

It’s important to note that while these medications can potentially contribute to the development of SIBO, they are not the sole cause, and individual factors such as underlying health conditions and diet also play a significant role. If you have other risk factors or root causes, certain medications can exacerbate the problem. 

Holistic Treatment Options for SIBO

Addressing SIBO holistically requires a multifaceted approach aimed at reducing bacterial overgrowth, restoring gut health, and alleviating symptoms. While there is no one-size-fits-all approach to treating SIBO, several interventions have shown promise in clinical practice. These interventions include antibiotics, herbal supplements, and the elemental diet, each offer unique benefits and considerations.  

Although dietary patterns can complement a SIBO treatment plan, diet alone does not cure SIBO. It can however help you manage your symptoms while you address the root causes. We can’t emphasize enough the importance of working with a professional while addressing SIBO. SIBO increases the risk of nutrient deficiencies while certain dietary interventions can make treatment less effective. Fortunately, a qualified healthcare provider can help you navigate those nuances. 

1. Antibiotics:

Antibiotics are commonly prescribed as a first-line treatment for SIBO. Rifaximin, a non-absorbable antibiotic, is often used due to its targeted action on the small intestine. That means it targets the problem area, without affecting bacterial balance in other areas of the GI tract. Rifaximin is most effective for hydrogen-SIBO and works by inhibiting bacterial RNA synthesis, effectively reducing the population of bacteria in the small intestine. Treatment typically involves a 2-week course of rifaximin, sometimes combined with another antibiotic or followed by a round of herbal antimicrobials.

Neomycin is another antibiotic that’s more commonly used for methane-dominant SIBO. It does have a systemic rather than local effect, meaning it can influence microbial balance throughout the entire GI Tract, not just the small intestine. It becomes even more important to support the whole system while on this antibiotic to prevent future dysbiosis. Supplements such as S. Boulardii and colostrum can be used during antibiotic treatment to protect the gut microbiome, and a post-antibiotic gut repair protocol will be used to achieve homeostasis after treatment. 

2. Herbal Supplements:

Herbal supplements offer a natural alternative to antibiotics for treating SIBO and have been shown to be as effective as antibiotics. Plus, they tend to come with fewer side effects and less risk of antibiotic resistance or disturbing the microbiome balance even more. 

Herbal protocols typically involve rotating or combining multiple antimicrobial agents to target different bacterial strains and minimize the risk of resistance. We often use herbal supplements in combination with other supportive therapies such as prokinetics, digestive enzymes, and dietary modifications to enhance treatment efficacy. The herbals differ depending on the condition we’re treating, so we’ll work together to build a plan to target your specific needs. Some herbal antimicrobials that we may consider include: 

Berberine: 

Berberine is a potent antimicrobial agent with broad-spectrum activity against various bacteria, including those associated with SIBO. It helps inhibit bacterial overgrowth in the small intestine while also reducing inflammation and promoting gut health. Recommended dose: 500-1000 mg three times daily, away from food, with meals for six weeks. 

Oregano Oil: 

Oregano oil contains compounds such as carvacrol and thymol, which exhibit strong antimicrobial properties against SIBO-causing bacteria. It can help eradicate bacterial overgrowth and restore microbial balance in the gut. Recommended dose: 200-500 mg twice daily after meals for six weeks.

Allicin (Garlic Extract): 

Allicin, the active compound in garlic, possesses potent antimicrobial and anti-inflammatory properties. It can effectively target SIBO bacteria while also supporting immune function and reducing intestinal inflammation. Recommended dosage: 600-1200 mg daily in divided doses for six weeks. 

Neem: 

Neem is a traditional Ayurvedic herb known for its antimicrobial and anti-parasitic properties. It can help eliminate pathogenic bacteria in the small intestine and support overall gut health. Neem oil does have some safety concerns, but neem leaf is safe for most people. Recommended dose: 500-1000 mg twice daily with meals for six weeks. 

Combination products, containing a variety of herbs in one product, can be an alternative to supplementing with individual herbs. Biotics Research Dysbiocide and FC Cidal are two products that combine a variety of herbs such as yarrow, stemona, and wormwood that work together to eradicate bacterial overgrowths and support healthy GI function. Studies show that four weeks of these products are as effective at eliminating SIBO as antibiotics. The recommended dosage is 2 capsules of each formula, twice a day for six weeks. 

Another pair of products, Metagenics Candibactin-AR and Candibactin-BR, have also been found as effective as antibiotics for eradicating SIBO. We recommend 2 capsules of each product, twice a day for 6 weeks. 

Additional Supplements to Support SIBO Healing 

1. Digestive Enzymes: Supplementing with digestive enzymes can aid in the breakdown of food particles and improve digestion, reducing the substrate available for bacterial overgrowth. Look for a comprehensive enzyme blend containing proteases, lipases, and amylases. 
2. Probiotics: Once antimicrobial treatment is completed, it’s essential to restore beneficial gut bacteria with probiotics. We recommend Ortho Spore IG by Ortho Molecular for our patients with SIBO since this is a spore-based probiotic that doesn’t colonize the small intestine and feed the overgrowth.  
3. GI Detox: As bacteria die, they release toxins and can make you feel temporarily worse. Leveraging the power of binders can help ease these side effects since they help bind and excrete excess toxins. We love Biocidin Botanicals GI Detox. Recommended dosage: 1 capsule with a full glass of water at least 1 hour away from food, medications, or other supplements. 

You can sign up and purchase supplements directly from our online pharmacy called Fullscript, here. 

3. Elemental Diet:

The elemental diet is a specialized liquid nutrition therapy designed to starve bacteria in the small intestine while providing essential nutrients to support overall health. Elemental formulas contain predigested nutrients in their simplest forms, allowing for easy absorption without requiring significant digestion. By bypassing the need for digestion in the small intestine, the elemental diet deprives bacteria of their primary food source, ultimately decreasing bacterial overgrowth. 

Treatment typically involves consuming only the elemental formula for 2-3 weeks under the guidance of a healthcare provider. While the elemental diet can be highly effective in rapidly reducing SIBO symptoms, it may be challenging to adhere to and is not suitable for long-term use due to its restrictive nature. However, it can serve as a valuable tool for resetting the gut microbiome and breaking the cycle of bacterial overgrowth in the small intestine.

Incorporating these treatment options into a comprehensive SIBO management plan can help individuals effectively address bacterial overgrowth, alleviate symptoms, and support long-term gut health. It’s essential to work closely with a knowledgeable healthcare provider to determine the most appropriate treatment approach based on individual factors such as SIBO subtype, underlying health conditions, and treatment goals.

Common SIBO Questions

How long does it take to heal SIBO? 

​​The duration of SIBO treatment and the timeline for achieving remission can vary depending on the person and several factors, including the severity of bacterial overgrowth, the underlying causes, the chosen treatment approach, and individual response to treatment. 

In general, treatment ranges from several weeks to several months, and in some cases, ongoing management may be necessary to prevent recurrence.

Treatment with antibiotics typically involves a course of 1 to 2 weeks, although longer durations may be necessary in certain cases or if symptoms persist after initial treatment. Herbal protocols often take longer since we use sequential herbal antimicrobials over a period of several months. We may use the elemental diet for up to 2-3 weeks, but for some people, this may not be enough to fully eradicate SIBO. 

While completing treatment, we’ll work on addressing the underlying factors that led to your SIBO and support your gut health with a variety of tools. The time it takes to fully heal from SIBO depends greatly on your root cause.  

How can I prevent a SIBO relapse?  

Preventing a SIBO relapse involves addressing the underlying factors contributing to your bacterial overgrowth and adopting strategies to optimize gut health. Here are some key steps to help prevent SIBO relapse:

1. Identify and Address Underlying Causes

Work with a provider to identify and address underlying factors contributing to SIBO, such as impaired gut motility, low stomach acid, structural abnormalities, immune system dysfunction, and dietary factors. Addressing these root causes is essential for preventing recurrence.

2. Promote Healthy MMC Function

Support healthy Migrating Motor Complex function by spacing meals about 4 hours apart and fasting for at least 12 hours overnight. Reducing stress, chewing your food well, and limiting snacking between meals are additional tools for optimizing MMC function. 

3. Stimulate the Vagus Nerve

Stimulating the vagus nerve supports the MMC by enhancing motility and clearing food particles and bacteria from the small intestine. You can stimulate the vagus nerve with deep breathing, gargling water, laughing, singing, and cold exposure. 

4. Follow a Gut Healthy Diet

Adopting a gut healthy diet can help reduce the risk of bacterial overgrowth and support gut health. Incorporate a variety of fiber-rich foods, especially those rich in soluble fibers, easy to digest proteins, and prebiotics to maintain a healthy balance of gut bacteria. 

5. Use Prokinetics

Prokinetic supplements help improve gut motility and prevent stagnation of food and bacteria in the small intestine. Natural prokinetics include ginger, iberogast, licorice root, peppermint leaf, and artichoke leaf.

6. Support Digestive Function

Support proper digestion and nutrient absorption by taking digestive enzymes with meals, particularly if pancreatic enzyme production is impaired. Betaine HCl supplements may also be beneficial for individuals with low stomach acid.

7. Maintain a Healthy Lifestyle

Adopting a healthy lifestyle that includes regular exercise, stress management, and adequate sleep can help support overall gut health and reduce the risk of SIBO recurrence. Chronic stress and poor sleep can disrupt gut motility and immune function, making individuals more susceptible to bacterial overgrowth.

8. Monitor Symptoms and Follow-Up Testing

Stay vigilant for signs of SIBO recurrence, such as bloating, gas, abdominal pain, or changes in bowel habits. Completing a follow-up hydrogen breath test after treatment helps ensure complete eradication of the overgrowth, while periodic testing can help monitor for relapse and guide treatment adjustments as needed.

By addressing underlying factors contributing to SIBO and adopting proactive strategies to support gut health, you can reduce the risk of relapse and maintain long-term digestive wellness. 

Diet Recommendations for SIBO 

The most common dietary recommendation for SIBO is the low-FODMAP diet. This style of eating involves restricting certain types of carbohydrates that are fermentable by gut bacteria, including fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. 

Common high-FODMAP foods to avoid or limit include certain fruits (apples, pears), vegetables (onions, garlic), legumes, wheat-based products, dairy products containing lactose, and sweeteners like sorbitol and mannitol. Although following a low-FODMAP diet may ease symptoms such as bloating, gas, and abdominal pain, it doesn’t treat the root cause and if implemented in the long term, can actually make your gut worse. 

A low-FODMAP diet can lead to nutritional deficiencies and further disrupt the microbiome by restricting so many healthy, fiber-rich foods. Plus, it can foster disordered eating in a population of people who are already highly susceptible.  

So what do we recommend? 

• Focus on well-tolerated, easy to digest foods. 
• Build your meals around simple proteins like ground beef, poultry, fish, and eggs. 
• Add well-cooked vegetables to your body’s tolerance. Root vegetables such as carrots, potatoes, and radishes are often easier to digest, in addition to zucchini, summer squash, green beans, and spinach. Make sure to steam, roast, or saute your vegetables to make them easier to break down. 
• Include healthy fats like olive oil and  grass-fed butter to support nutrient absorption and eat high-fiber fruits like berries and citrus. 
• Adequate hydration is important for supporting overall digestive health and preventing constipation, which can exacerbate symptoms of SIBO. Drink at least half your body weight in ounces of water throughout the day and consider incorporating hydrating foods like soups, bone broth, and herbal teas into your diet. 
• Adding electrolytes to your water can support regular bowel movements and your overall health. We love LMNT single serving packets for balanced, sugar-free electrolytes. 

How you eat is also important while combating SIBO. We want to support digestion from all angles, and helping your body feel calm is a great way to shift your nervous system to rest-and-digest. 

Get in the habit of sitting down to eat, taking a few deep belly breaths, and really chewing your food. Remove distractions like your phone and TV to help you eat mindfully and slowly. Each of these steps allows your body to focus its energy on properly digesting and absorbing your food. 

Final Thoughts 

Addressing SIBO is tricky due to its intricate nature and the diverse array of underlying factors. SIBO is not a one-size-fits-all condition; it manifests differently in each person, making treatment approaches complex and multifaceted. 

One of the primary reasons SIBO can be challenging to treat is its tendency to recur, even after successful interventions. Without addressing the underlying factors that predispose someone to SIBO, such as impaired motility, anatomical abnormalities, or dysregulated immune function, relapse becomes more likely.

Fortunately, we understand SIBO and can tailor a plan to address the root causes, manage your current symptoms, and restore nutrients gaps – all at the same time. 

Our emphasis on personalized care ensures you receive the guidance and resources needed to navigate your entire SIBO journey successfully. While treating SIBO may require dedication and persistence, with a thoughtful approach and ongoing support, it is possible to overcome this challenging condition and reclaim your health and vitality.  

Let us help!