Natural Health Advisory

Many people with chronic gas, bloating, and abdominal pain actually have small intestinal bacterial overgrowth (SIBO). (Find a full discussion of SIBO symptoms in part 1.) An increasingly recognized problem, SIBO occurs when bacteria that normally occupy the colon migrate to the small intestine, feast on carbohydrates, and multiply. This causes inflammation in the gut as well as a diverse range of symptoms all over the body, most commonly in the digestive tract.

Promising study results

Fortunately, natural SIBO treatment is available that is just as effective (or more) than conventional treatment with antibiotics, according to the results of a new study.[1] Physicians at John’s Hopkins and the University of Pittsburgh showed that SIBO treatment using herbal antimicrobial supplements was as effective as rifaximin, the conventional antibiotic most commonly used to treat SIBO.[1] 

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One hundred and four patients who tested positive for newly diagnosed SIBO took either a standard, high dose of rifaximin (1200 mg daily) or 2 capsules twice daily of each of the two supplements in one of the two following herbal protocols:

• Dysbiocide and FC Cidal (by Biotics Research) or
• Candibactin-AR and Candibactin-BR (by Metagenics)

The products were specifically chosen because they contained antimicrobial herbs, such as oil of oregano, thyme, berberine extracts, and wormwood, shown to provide broad-spectrum coverage against the types of bacteria most commonly involved in SIBO.

SIBO treatment with herbs more effective than antibiotics

Of the patients who received herbal therapy, 46% showed no evidence of SIBO on follow up testing compared to 34% of rifaximin users. Those taking the herbal therapy were significantly more likely to test negative for SIBO at follow up than those taking rifaximin.

The participants who did not improve on the rifaximin were then prescribed either one of the herbal protocols or triple antibiotics (clindamycin, metronidazole, neomycin) for four additional weeks. Of the 31.8% of rifaximin non-responders that then took the herbal therapy, 57.1% tested negative for SIBO compared to 60% of those taking the triple antibiotic therapy.

Adverse effects reported among those taking rifaximin included anaphylaxis, hives, diarrhea, and Clostridium difficile, while only one case of diarrhea and no other side effects were reported in the herbal therapy group.

“Herbal therapies are at least as effective as rifaximin for resolution of SIBO …” concluded the study authors.

Combining the SIBO diet with herbal antimicrobials

Naturopathic doctors and integrative physicians often advise that patients follow a SIBO diet along with antimicrobial therapy for best results. A SIBO diet is primarily a low-carbohydrate diet, since bacteria use carbohydrates as their energy source and ferment them to gas. The SIBO diet can directly reduce symptoms by decreasing the amount of gas produced and possibly by reducing the overall bacterial load as the food supply shrinks.[2]

The SIBO diet is a combination of either the specific carbohydrate diet (SCD) or the gut and psychology syndrome diet (GAPS) with parts of the low FODMAP diet (the FODMAP fruit and vegetable recommendations). With both the SCD and GAPS diets, all grains, starchy vegetables, lactose, sweeteners other than honey, and beans are eliminated. Eliminating these normally well-absorbed carbohydrates is essential in SIBO because these polysaccharide and disaccharide sources feed the inappropriate bacteria in the small intestine, creating symptoms and worsening the problem. The exact protocols for the SCD and GAPS diets can be found in the links above.

By further eliminating the highly fermentable fruits and vegetables recommended in the low FODMAP diet, even more of the bacteria’s food source is reduced. The low FODMAP diet is an irritable bowel syndrome treatment diet and was not specifically designed for SIBO; therefore, it does not eliminate all polysaccharide and disaccharide sources such as grains, starch, starchy vegetables, and sucrose unless combined with either the SCD or the GAPS diet.  Use the FODMAP link above to find the list of fruits and vegetables to avoid.

The best SIBO treatment

For the best results, follow the SIBO diet for three to four months. Most of the bacterial overgrowth is eliminated by week four, but practitioners have found that following the diet for another three months is usually necessary for more permanent eradication.[2] Combine the SIBO diet with one month of either the Metagenics or Biotics Research supplements for a wonderful natural option for effective SIBO treatment.

Share Your Experience

What SIBO treatments have worked for you? Have you tried a SIBO diet? Please share your experience below.

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[1] Glob Adv Health Med. 2014 May;3(3):16-24.

[2] Townsend Ltr. 2013 Feb/Mar;355(56):85-91.

Originally published in August 2014, this blog has been updated.

The post SIBO Treatment with Herbs Is as Effective as Antibiotics; Combine with a SIBO Diet for Even Better Results appeared first on Natural Health Advisory.

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