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So you’ve been diagnosed with SIBO….now what?

Your healthcare provider has probably left you with several different treatment options and has asked which one you would like to try. Do you go the traditional antibiotics route or try the SIBO herbal treatment? Are natural SIBO remedies just as effective as antibiotics? How long will each treatment plan take? How expensive will they be?…

These are only a few of the many questions you are likely asking yourself.

This article aims to answer these questions and more, so that you can make an educated decision about whether an herbal treatment for SIBO is right for you.  

What is SIBO?

Simply put, small intestine bacterial overgrowth, or SIBO, is an overgrowth and/or alteration of the bacteria in the small intestine. (1)

Under normal circumstances your small intestine has a small number of bacteria living in it compared to your large intestine. In addition, our bodies are designed to protect us from bacterial colonies from getting out of balance. However, SIBO can occur when one of these protective mechanisms fail.  

This overgrowth results in a variety of uncomfortable symptoms including gas, bloating, constipation, and diarrhea. It can also result in malabsorption (which is the imperfect absorption of food by the small intestine), unintended weight loss, and nutrient deficiencies. (1, 2)

Once SIBO has been diagnosed, the ideal approach to treating it is to fix the underlying mechanism that has failed, eliminate the overgrowth, and address any nutritional deficiencies that have occurred. (2)

Now that we’ve gone over what SIBO is and how it develops, it’s time to get into the nitty gritty of how to teat it.

SIBO Treatment Plan – Step 1: Eradicate

The first step to successfully treating SIBO is to eradicate, or get rid of, the overgrowth of bacteria that are causing problems. Currently there are three main ways of doing this: (3)

1. Prescription antibiotics
2. Herbal antibiotics
3. Elemental diet

Prescription Antibiotics vs. Herbal Antibiotics

What is the difference between prescription antibiotics and herbal antibiotics, or more accurately named, herbal antimicrobials?

• Prescribed antibiotics are made in a lab, treat only bacterial infections, and usually attack only one stage of the bacteria’s life cycle. For example, they can either: (3, 4)
  • attack the cell wall/coating of the bacteria
  • interfere with the reproductive process of the bacteria
  • OR block protein production

• In contrast, herbal antimicrobials come from whole plants, are made up of a variety of compounds and therefore have multiple uses. This means they can have anti-bacterial, anti-fungal, and anti-viral effects. (4)

The primary prescribed antibiotic used for treating SIBO is rifaximin (brand name Xifaxan) because it has the most amount of research available to support its use. However, recent research shows that herbal treatment for SIBO can be just as effective as rifaximin. (5)

That being said, there are several things you need to consider when deciding which treatment option is best for you. Things to consider include:

• Effectiveness (6, 4)
• Cost (7)
• Side effects (8)
• Length of time before improvement (5, 8, 9)
• Accessibility

The Elemental Diet

In addition to prescribed antibiotics and herbal antimicrobials, the elemental diet is sometimes used to treat SIBO naturally. This is often seen as the “when all else fails” treatment plan because of how difficult it is to follow and how expensive it is.

Moreover, there is a high recurrence rate with this treatment option. Meaning, the bacterial overgrowth can easily return if there is even one bacterium left in the small intestine after treatment.

SIBO Treatment Plan – Step 2: Repair

The second phase of treatment should be focused on getting to the root cause of your symptoms (because SIBO is a symptom, not the actual cause) and repairing your gut. Because aren’t we all looking for a way to enjoy the foods we love without fear of how our body will react? I know I am!

There are several possible physiological issues that may be increasing your risk of developing SIBO. The most common include a slowed migrating motor complex (MMC) and low stomach acid. (1, 10, 11)

Let’s start with the first one.

What is the MMC?

This is an involuntary action of your stomach and small intestine that occurs while you are fasting and stops as soon as you eat. The MMC is what moves your food through your gastrointestinal (GI) tract so that nutrients can be absorbed and waste can be removed. (11)

If this mechanism isn’t working correctly (referred to as dysmotility) and transit time has slowed, it can lead to bacterial overgrowth. (12, 13)

One way to address this is by taking prokinetics.

Prokinetics are drugs or supplements that can be used to help correct this issue by increasing transit time. (14) These can either be prescribed or not, so work with your healthcare provider to determine which option is best for you. Examples of commonly used prokinetics for SIBO include:

Prescription Prokinetics:

• Low Dose Naltrexone and
• Low-dose Erythromycin 
• Low-dose Prucalopride

Non-prescription motility supplements: (15, 16, 17, 18, 19)

• MotilPro
• Triphala
• Iberogast
• Ginger
• Artichoke extract

I myself have used Naltrexone and MotilPro to assist with my dysmotility and have seen good results over time.

Low Stomach Acid

Long-term use of drugs meant to treat heartburn and stomach ulcers often leads to changes in the make up your gut, AKA your gut microbiome. (20) These drugs are called proton pump inhibitors, or PPIs, and have been shown to alter your gut’s microbiome even more than antibiotics. (21)

This change to your microbiome can leave you more susceptible to gut infections and bacterial overgrowth. (1, 21, 22) Gastric bypass surgery can also have a similar impact on stomach acid and the microbiome. (23)

Knowing this, what are your next steps?

PPIs should be used in moderation, with the input of your healthcare provider, and only as a last resort. There are lifestyle changes can help alleviate symptoms of heartburn and these include:

1. Avoid trigger foods
   • This is different for everyone, but common ones include high-acidic foods (like tomatoes and citrus), high-fat (including fried) foods, caffeine, alcohol, and soda.
2. Eat smaller portions
3. Wait before lying down after a meal
4. Eat enough fiber (i.e. whole grains, fruits and vegetables)
5. Quit smoking

Chronic PPI use not your issue? Here are 4 other ways to help increase your stomach acid naturally.

1. Gargle with water for 2-3 minutes twice per day
2. Sing or hum
3. Turn the shower to cold for the last 30 seconds
4. Integrating stress management strategies into your daily routine (i.e. 5 min meditation, journaling, taking a bath, etc.)

What about probiotics?

Probiotics are often touted as a great way to replace the “bad” bacteria with the “good”. However, there are different schools of thought surrounding their impact on SIBO. Although additional research does need to be completed in this area, it appears probiotics are most effective at reducing symptoms rather than preventing reoccurrence or relapse. (24, 25, 26)

They also may not be beneficial for everyone. Work with your healthcare provider to determine what strains and dosages will be most beneficial to your unique circumstance.

SIBO Treatment Plan – Step 3: Sustain

Last but not least, is the sustaining phase. This is the phase I know you’ve all be waiting for, what the heck am I going to do after I get rid of my “bad” bacteria?!?

Unfortunately, SIBO has a high reoccurrence rate, so it’s incredibly important to have a plan for how you’re going to adjust your lifestyle post treatment. This will likely include dietary changes, supplementation, and overall stress reduction strategies.

I do NOT believe in following a highly restrictive diet and strict supplementation regimen for the rest of your life (in fact that can lead to even more problems down the line), but some lifestyle changes will need to be made immediately after the eradicate and repair steps in order to prevent those suckers from returning.

Check out my post on SIBO diets for more info on how to choose a diet plan that’s right for you.

Final Thoughts

In conclusion, an herbal treatment for SIBO can be just as effective as prescribed antibiotics as long as you follow the same 3-step SIBO treatment plan – eradicate, repair, sustain.

As always, you want to work with your healthcare provider to determine which method of treatment is best for you. This includes considering each plan’s effectiveness, cost, side effects, length of time until improvement and accessibility.

And finally, the only way to truly live SIBO free is to get to the bottom of the root cause. Why is your gut susceptible to bacterial overgrowth? Do you have slow GI motility or low stomach acid? Or is your situation completely different?

Whatever it is, identifying the underlying issue is the only way to free yourself from SIBO’s grasp.

For an even more in-depth information on herbal treatments for SIBO, visit The Best SIBO Natural Treatment Options at Functional Nutrition Answers.