Herbals vs. Antibiotics: A Guide to Treating Your SIBO

Hi friends!

I struggled with SIBO for about a year before I was finally able to clear it. I decided to go with the herbal route, as opposed to antibiotics, like Rifaxamin and/or Neomycin.
This was just my personal preference, and felt more comfortable and confident that herbals were safer and more effective, based on what I had read. They also saved me a lot of money, even though I am located in Canada, where the antibiotics for SIBO are generally more affordable than in the U.S

My naturopath also made her own formulas of herbals, combining all three herbals into ONE capsule, for ease of use. So, instead of taking about 12 herbal pills a day, I was able to just take just 3. They were also already appropriately dosed, so my fatigued and brain-fog riddled brain didn’t have to do any math, either.

I understand everyone’s needs and preferences can be so very different, and I also understand how overwhelming the information surrounding SIBO can be. That’s why I decided to put together this post, to help guide you through making a decision that works best for you!

Below, I will discuss the pros and cons between herbals or SIBO antibiotics, dosing, diet and probiotics with treatment, biofilm busters, different types of herbals and their main functions, effectiveness of herbals and antibiotics, and costs. As always, I try to include research-based citations wherever possible, and of course my personal experiences/takes on some of these sub-topics 🙂

As always, if you have any questions, please leave a comment below! I would love to hear from you and help you out!

What are Herbal Antimicrobials?

Most of us have had to use a prescribed antibiotic at some point in our lives, such as Amoxicillin, Ciprofloxacin or Metronidazole. When it comes to SIBO, there are even antibiotics that specifically are used for SIBO, and are localized (or restricted) to the small intestine, such as Neomycin, or Rifaxamin.

However, for treating SIBO, we also have the option to use herbal antibiotics, which are simply natural antibiotics that are extracted from herbs. Like traditional or SIBO antibiotics, they kill bacterial organisms and do not discriminate against “good” vs. “bad” bacteria.

Remember that, guys! Just like antibiotics can wipe out beneficial bacterial strains in your gut microbiome, so can herbals. They may be “natural”, but can do just as much damage if you aren’t careful. That is why taking round after round of herbals OR SIBO antibiotics without re-testing is reckless, in my opinion, and can do more harm than good. Symptoms alone are often not a good indicator as to whether SIBO has been eradicated (it definitely wasn’t for me).

Some common herbals are:
Oil of oregano
Neem
Allicin
Berberine

Which Do I Choose? Herbal Antimicrobials or Antibiotics for SIBO?

When first being diagnosed with SIBO, and looking at the treatment options, this process can be extremely overwhelming. There are so many differing opinions, methods and information that exist, which can make it difficult to decide on the basics, such as: Do I choose antibiotics (neomycin/rifaxamin), or herbal antimicrobials?

I personally chose to go the herbal route. But I won’t use this post as a way to convince you to choose one way or another. Rather, I will present you the information and evidence that exists for both, with the hopes that it will allow you to make an informed decision that’s best for you and your personal needs!

Choosing the Right Herbal for You

1 – Effectiveness

Maybe for you, choosing herbals or antibiotics comes down to the science – which one is actually more likely to clear SIBO?! According to a study, the response rate for normalizing breath hydrogen testing in patients with SIBO was 46% for herbal therapies vs. 34% for Rifaximin.

The study admits that more research needs to be done to validate these findings. Because SIBO is so individual, and root causes differ between patients, studies on SIBO are limited based on so many factors at play.

2 – Cost

Treating health issues is not cheap! Treating SIBO alone can end up costing you thousands of dollars, between the herbals/antibiotics, doctor/naturopath visits, supplements, diet change etc.

Therefore, another factor in your decision may come down to cost. Let’s take a look below to see which option is more affordable:

Let’s say we take the standard one-month herbal protocol for hydrogen-SIBO, containing two common herbs, berberine and neem. In the section below (Dosing), I listed a source where they claim you should take berberine, 400mg, 2-3 pills, 3x a day for 14 days.

That means 9 capsules a day, 126 capsules total for only 14 days. If we increase to a standard one-month treatment duration, that means 252 capsules total. One bottle of Berberine on Amazon typically contains 90 capsules, and costs about 20$, 400mg per capsule. That means you would need to buy three bottles to complete your one-month round. That would be a total of 60$.

Now for neem, the recommendation is 300mg, 1 capsule 3× per day for a total of 14 days (again, I listed this below in the Dosing section).

Neem Plus, a recommended brand, contains 90 capsules, and costs 33$ a bottle. To follow the one-month protocol, you would need to purchase just one bottle.

The total for berberine and neem therefore is about 93$.

Of course not everyone responds to just a one-month treatment duration. I personally did 12 weeks total. Your cost will be increased a bit depending on how long you do it for, which herbs and brands you choose.

If you choose the antibiotic route, your costs will be significantly more if you cannot get it approved by insurance/don’t have insurance. You may have trouble getting it approved by your insurance due to it not technically intended to treat SIBO (its original intended use was to treat traveler’s diarrhea).

It will also depend on which country you live in. This prescription is generally cheaper in my country, Canada, than it is in the U.S, for example.

A two-week dose of Rifaxamin costs around $1800 in the U.S. Unfortunately, most do not have success after just one two-week treatment round. So you’re looking at multiple thousands of dollars, and there is no guarantee it will work and clear your SIBO.

Not to mention, Rifaximin only treats hydrogen-SIBO. If you’re unlucky like I was, and have both types of SIBO, then you will need to also purchase Neomycin. Luckily it is much cheaper than Rifaxamin, typically, running at about 14$ for 28 tablets (each pill contains 500mg typically, and the standard dose is 1000mg a day for 14 days – see Dosing section for more details).

Of course there is still the option of obtaining your script through the pharmacy of another country, such as Canada, where drugs are typically cheaper.

3 – Ease of Access

When you’re already dealing with health issues/SIBO, the last thing you need is difficulty obtaining the very thing needed to clear the overgrowth! Let’s take a look at whether herbals or antibiotics are easier to receive.

With SIBO antibiotics, you will need a prescription from your doctor or naturopath. This will require not only convincing your doctor that you have SIBO (unfortunately this is far too common of an issue), but then actually getting him or her to prescribe you the proper antibiotic. I have seen far too many people being prescribed antibiotics not meant for SIBO, such as Cipro (which have crazy scary side-effects btw).

Let’s assume the stars align, your doctor gives you a breath test, diagnoses you accurately with having SIBO as well as the type (methane and/or hydrogen), prescribes you the proper antibiotic (neomycin and/or rifaxamin).

Now you have another obstacle, which is to get that (often very) expensive prescription approved by your insurance company. Unless of course you want to have to pay hundreds if not thousands of dollars for a SINGLE round (most people need more than one)!

Now, if this happens, you have the option of getting your prescription filled in another country, where this drug is cheaper. Canada (my lovely country) luckily can be an option for you if you are in the U.S.

If you choose to go the herbal route, you can skip all of this, and simply buy them online on most health food websites, such as iherb.com, well.ca, Vitacost.com, vitasave.ca, or even good ‘ol Amazon.

Tip: if your insurance company initially denies your claim to cover the antibiotics, I have seen people have success when their doctor re-writes the prescription for IBS rather than SIBO (as SIBO is unfortunately not yet always seen as a “real” diagnosis or disease).

You can also check out this website, where they have a form you and your doctor can fill out, in case an appeal to your denied claim is issued. It also contains a coupon or discount code for Xifaxan (Rifaxamin).

With herbals, because they are not a prescription drug, you run the risk of buying a brand/product that doesn’t use the best ingredients. I would verify that the company can provide a certificate of analysis that shows that the herbs do not contain dangerous levels of heavy metals. Unfortunately in today’s world, this is just something we have to get into the habit of doing and being wary of.

But let’s be honest; just because a drug is by prescription, has theoretically been tested and approved by the FDA, does not mean it is any safer to use!

Duration

If you are anything like me, you have little patience left for SIBO, and want to see it be gone as quickly as possible.

Here is the typical duration of improvement for herbals vs. antibiotics:

Antibiotics: May see improvement 1-2 weeks after beginning
Herbals: Usually takes 3-4 weeks to see improvement if not longer

Having said that, when treating SIBO, I have learned it is not a sprint, but rather can be a long drawn out process. Sorry ! It may take months to finally get rid of SIBO for good, and heal long term, so that it never comes back.

So while it might sound great that the antibiotics can allow you to see improvements within a couple of weeks, that is often not the case, or if it is, it’ll likely be short lived, or you will likely need more than one round. That is if you also get to the root cause of your SIBO, and heal your body in a multi-faceted way.

My advice: Don’t focus too much on how long it’ll take, or try to take shortcuts. Instead, focus your energy on figuring out what caused SIBO in the first place, and come up with a plan or protocol to heal your body and lifestyle. No single drug or supplement is going to fix everything, in my opinion. The herbals and antibiotics simply aim to clear the overgrowth. They are not going to address why you got SIBO (your root cause), nor is it going to be able to repair any damage that SIBO might have done (such as leaky gut, deficiencies, organs not functioning optimally etc).

 

Herbals and Their Different Functions

Figuring out which herbals you should choose depends first on which type of SIBO you have (hydrogen and/or methane), which will be concluded after doing a breath test. Make sure when asking for your breath test referral from your doctor that you get checked for both hydrogen and methane!

Once you know which type of SIBO you have, choosing the herbals comes down to what their best function is (treating either hydrogen and/or methane dominant SIBO), as well as your other symptoms.

For example, people with gastritis (inflammation of the lining of the stomach) will have a difficult time with oregano oil, due to it already being quite harsh on the stomach, even for people without inflammation or ulcers.

Therefore, they may opt for another alternative that still has a similar effectiveness, such as berberine or neem. Some people might even be sensitive or have allergies to the more common herbals, so having alternatives is great.

Here are the most commonly used herbals for SIBO, and their main function:

Oregano oil = hydrogen + methane + fungal
Allicin = methane
Berberine = hydrogen and methane
Neem = Hydrogen + methane + fungal

Some not-so-common herbs, but still worth knowing about or considering:

Pomegranate = hydrogen
Horopito = hydrogen + fungal
Clove = Hydrogen + fungal
Artemisia annua = hydrogen + fungal
Usnea = Hydrogen + fungal

There are some conflicting opinions on which herbals are used for the two types of SIBO. For example, on berberine, initially I found information that supported its use for hydrogen only. But later also found information supporting its efficacy for methane, too. So its importan to do our homework before choosing our herbals.

As you can also see from the above lists, some herbals can also help kill fungus (such as Candida)! If you aren’t sure you have a fungal overgrowth, or you do know you have a fungal overgrowth and want to kill two birds with one stone, some of those might be a perfect choice.

It will allow you to reduce the amount of supplements you have to take per day (who doesn’t want that?!). Of course it’s always best to run tests, such as the OAT or GI MAP, to see exactly what you have so you aren’t treating it unnecessarily.

Note on Allicin: Quite a few people wonder why they cannot have garlic on the FODMAP diet ( FODMAP is an acronym for “Fermentable Oligo-, Di-, Mono-saccharides And Polyols”. They are short chain carbohydrates that are poorly absorbed in the small intestine) yet allicin is okay.

Here’s why: Allicin is a compound produced when garlic is crushed or chopped. Allicin supplements are highly concentrated to contain this compound. This compound is not the “high FODMAP” portion of the garlic that is avoided when doing the FODMAP diet. So, it is perfectly safe to consume in that sense.

Personally, having had both types of SIBO (hydrogen and methane), I took a combination of herbals that included berberine, oregano oil and allicin.

Because I was also worried about the possibility of candida overgrowth, taking these herbals would have also covered that, since berberine and oregano can be effective against fungal overgrowths, such as candida.

On that subject, another herbal that can be effective against candida overgrowth is grape seed extract (GSE). If you have both SIBO and/or candida overgrowth, you may want to include GSE into your herbal combination.

Just like there is antibiotic resistance with traditional antibiotic usage, the same can apply for herbal antibiotics. The bacteria are quick to adjust to antibiotics and herbals, and figure out how to protect themselves from being “killed”.

This is why using at least 2 if not 3 herbals in combination is recommended and increases your chances of clearing SIBO. If you must do more than one round to kill the overgrowth, some people opt to change herbals for the second round, to account for antibiotic resistance from the bacteria.

On that note, I will mention again the importance of re-testing (via a breath test), after your herbal protocol. The guideline is 14 days after it has completed, but don’t wait too long (no longer than 16 days)! You want to retest before regrowth of bacteria (recurrence) has time to occur.

Re-testing 14 days after treatment will tell you whether or not the herbals made an impact on your bacteria levels, and whether or not you should do another round. Maybe at this point you’ll also want to consider implementing a biofilm buster (more on that topic below).

As mentioned above, herbals and SIBO antibiotics will kill both good and bad bacteria. We definitely do not want to take either of those things longer than necessary. The point is to kill the overgrowth, and repopulate the good bacteria. This will only be harder if we kill off too much good bacteria!

Taking Your Herbals

1 – Dosing

I would recommend consulting with your health care professional when deciding on dosing. It will depend on your level of bacteria/numbers from your breath test, tolerance, herbals or antibiotic choices, etc.

If you do not have access to a health care practitioner, there is data available from experts online that can help you to create a dosing protocol.

At siboinfo.com, Dr. Siebecker (a leading expert on SIBO) gives these as some examples of SIBO dosage options. Keep in mind that there aren’t any established protocols for SIBO antibiotic dosages, so your doctor may prescribe something different:
•• Rifaximin 1600mg daily × 10 days
•• Rifaximin 1200mg daily × 14 days
•• Rifaximin 1600mg daily + Neomycin 1000mg daily × 10 days
•• Rifaximin 1600mg daily + Metronidazole 750mg daily × 10 days

Here is another source of dosing information you may want to consider:

Allimed/Allimax (Allicin) : 450mg
1–2 capsule 3× per day for a total of 14 days; start
with 1 cap 3× per day and on day 3 increase to 2 caps
3× per day
Berberine: 400mg
2–3 capsules 3× per day for a total of 14 days; start
with 2 caps 3× per day and on day 3 increase to
3 caps 3× per day
Neem Plus: 300mg
1 capsule 3× per day for a total of 14 days

Personally, this was my herbal protocol:

Berberine: 1800mg a day  (or 600mg, 3 times a day)
Oregano oil: 430mg (or 140mg 3 times a day)
Allicin: 720mg (or 240mg 3 times a day)

These were split throughout the day. I took it with breakfast, lunch, and dinner.

I took these herbals for 12 weeks total, with food, because my stomach was too sensitive to take them 30 minutes before food as initially instructed by my Naturopath.

Keep in mind, I had hydrogen and methane SIBO, both in high numbers. I assume the herbals really helped (along with the other health and lifestyle changes I made), because I was SIBO-free not long after this! I am still SIBO-free one year later, too!

2 – How Long to Take Herbals/Antibiotics for

This one is tricky because you will likely not be able to accurately rely on your symptoms as a determination as to whether the herbal or antibiotic treatments were effective or not, or whether you should extend your herbal round or not.

Like me, I was SIBO free according to my second breath test, however I still had some symptoms and did not really feel all that much better. If I had not re-tested, I would have incorrectly assumed that I still had SIBO, and thus would have continued taking herbals for even longer, completely unnecessarily. This could cause more good bacteria to die in the process (yes, herbals kill both good and bad bacteria, just like traditional antibiotics!).

So, you might be wondering how the heck to know how long to do your herbal protocol for.

The general guideline seems to be based on how high your initial numbers were from your first breath test. If your numbers are very high, you will likely need a longer round of herbals than someone with lower numbers.

If we compare the general duration of antibiotics for SIBO, such as Rifaxamin or Neomycin, those are typically administered for 10-14 days. Herbals on the other hand, are usually taken for 4-12 weeks.

I personally took my herbals (oregano oil, berberine and allicin) for 8 weeks, and extended it to 12 weeks as directed by my naturopath. We decided together that because my symptoms were still quite bad, and my initial numbers were very high.

In retrospect, I would have re-tested after 8 weeks rather than continue on with the herbals.  Because again, re-testing after 14 days post-treatment is the best thing to do, so you are not taking more herbals or antibiotics unnecessarily, further harming your microbiome.

3 – Timing (With or Without Food)

If you are going  along with the theory of feeding the bacteria while in the kill phase, then it makes sense to take your herbals/antibiotics slightly before or with food.

My naturopath instructed me to take my herbal antibiotics 30 minutes before food. I tried this a few times but it resulted in severe nausea. She then recommended I take them with food and this helped reduce the nausea to a tolerable level.

Taking with food will also help lessen the side-effects of taking it on an empty stomach. Most herbs (especially oregano oil) are quite potent and harsh on the gut lining, so taking with food could definitely help reduce the possibility of discomfort.

Bad Reactions

Let’s talk about bad reactions when treating SIBO for a moment. Die-off, or more scientifically, a herxheimer reaction (AKA herx), is the onset of symptoms caused shortly after or during an antibiotic or antimicrobial/herbal treatment.

Most people who take SIBO antibiotics or herbals will experience symptoms associated with die-off, such as:
Fatigue,
Fever,
Chills,
Headaches,
Worsening bowel symptoms like diarrhea or constipation.

Something I want to mention, because I think people forget, is that die-off, while it’s a good sign the treatment is working or at least doing something, is not necessarily a good thing to be experiencing. Here’s why I say that:

Die-off, technically is caused by toxins being released by the dying bacteria, overloading the body, or more specifically your liver and kidneys.

Usually these toxins are handled efficiently by the liver and kidneys, and you don’t really notice it happening, or at least not majorly.

If you are noticing the die-off with really bad symptoms, it may mean your organs are not functioning optimally, or you need to support your detox pathways, as to reduce these side-effects. Essentially, you are killing off bacteria too quickly for your system to effectively handle, resulting in negative severe symptoms

Now, you might say “well, I can handle the die-off symptoms, it’s fine”. Not so fast! What can happen when your detox organs are unable to keep up with the toxin overload, is that it can then be reabsorbed/recycled back into your system/body. This can affect your kidneys  and other bodily functions.

For example, when killing off yeast, they give off two toxic substances, called acetaldehyde, and gliotoxin. Acetaldehyde is a neurotoxin. It can be irritating to your brain and it can even cause neurologic symptoms, which is why some people literally feel as if they are drunk while experiencing die-off. Gliotoxin can suppress your immune system and damage your liver cells.

There are some simple things we can do to support our detox pathways, and prevent a build-up of toxins.

You can try:

Epsom salt baths
Dry Brushing
Oil Pulling
Dandelion root tea (be careful if you have mercury toxicity, this can be hard on an already-burdened liver)
Milk Thistle
Certain Vitamins and minerals: B-vitamins and methyl donors such as vitamin B12 and methionine are a key part of both phases of liver detoxification. N-Acetyl-L-Cysteine (NAC): an amino acid that acts as an antioxidant and is a precursor to glutathione.
Increase sulforaphane (found in cruciferous veggies). Broccoli sprouts are an awesome source of this compound.

I recently found out that I have heavy metal/mercury toxicity, so my liver is already struggling to function well. Now that I know this, looking back, it makes sense why I was having such a severe reaction to the herbals and elemental diet.

Another thing that may be recommended is to take a break for a day or two, or reduce the amount of your herbals. My naturopath suggested this to me when I was going through a severe die-off reaction, which helped my body “catch-up”.

You may also want to try using what is known as a binder. Binders essentially “bind” to toxins, and help carry them out of the body. A popular one you probably have heard of is activated charcoal. Others include:
– Zeolite
– Chlorella (If you have heavy metal toxicity, specifically mercury, it is important for me to note that the Andy Cutler protocol says not to use this, as it doesn’t actually bind and carry out mercury. Using this can make you feel a lot worse!)
– Pectin
– G.I Detox (which contains a few active ingrediets:  Zeolite clay, Activated Charcoal, Aloe Vera (inner leaf), Silica (as Monomethylsilanetriol), Apple Pectin, Humic Acid, Fulvic Acid)

Bad Reactions vs. Die-Off: How Do We Differentiate?

On the topic of die-off, I need to mention to you how often I see people use this word or ask if what they are experiencing is in fact die-off. Sometimes it is assumed that the symptoms you are experiencing are caused by die-off, but this is not always the case.

There is the possibility that your symptoms are caused by a bad reaction to whatever you are doing or consuming (whether that be supplements of foods).

So, how do we differentiate then? Here are some general guidelines that may help:

1 – Die-off is typically not caused by supplements or one single new food in your regime. For example, if you’ve recently added bone broth to your diet, and are experiencing negative symptoms, I wouldn’t assume this is die-off. Why? Because die-off requires a significant or drastic change in your gut microbiota. A food or supplement is unlikely to cause this.

2 – Die-off symptoms that last weeks or months. Die-off typically lasts for a few days as your body adjusts to the treatment and shift in microbiota. Instead, I would be looking at changing herbals for one your body can tolerate better.

Even with this in mind, it can still be challenging and unnerving to not know whether what you are experiencing will subside, or is a bad reaction you need to pay attention to. If you don’t feel relief after 3-7 days, despite trying to support detox pathways, I would consider trying a new herbal. Some people do not tolerate oregano oil but do fine with neem, for example.

Biofilm Busters

Yet another controversial subject in the world of SIBO – Biofilm busters! Biofilms are the protective layer that bacteria encase themselves in. This can make it more difficult for the antibiotics or herbals to reach and kill the bacteria.

Because most bacteria are encased in a biofilm, and not floating around in a planktonic form, most treatments for SIBO may be unsuccessful for not taking this into consideration and including a biofilm buster into their protocol.

The currently known biofilm busters for SIBO are:
NAC ( n-acetyl cysteine)
EDTA  (not advised to use if mercury toxic – can mobilize mercury (move it around, not actually chelating and removing from body, making you feel much much worse)
Interphase Plus
Biocidin

What the experts are saying:

In an interview with Dr. Alison Siebecker and Dr. Mark Ruscio, two of the leading experts in SIBO have quite opposing experiences with using biofilm disruptors:

Dr. Alison Siebecker has not been able to perceive a benefit of using biofilm busters with her patients. She also goes on to say that she did not see “someone who gets anti-biofilm, that their treatment course is shorter, they do better overall, they have fewer relapses. I have never noticed anything like that”

Dr. Ruscio did a small study, where he gave herbal antibiotics to two sets of patients, where one group only received the herbals, while the other group also received a biofilm disruptor (Interphase Plus and NAC). The group that was given the biofilm disruptor saw a larger decrease in their hydrogen levels compared to the group that was only given the herbals.

Listen to this interview for more info.

Personally, I did not use a biofilm buster and I was still able to clear SIBO (and prevent a relapse). If my first treatment failed, I may have then considered implementing a biofilm buster into my protocol.

Diet: To restrict or not restrict, that is the question!

There are SO many diets out there, such as the SCD (specific carbohydrate diet), Paleo AIP (autoimmune protocol), Carnivore, FODMAP, Fast Track, Keto. The question that concerns us SIBO folk is: Should we “feed” or “starve” the bacteria while using herbals or antibiotics?

The theory
Essentially the theory behind this debate is whether or not the bacteria should be “fed” during herbals, with the intention of luring them out of hiding, so to speak, so that the herbals or antibiotics can do their job and kill them.

The concern is if we do not feed them high FODMAP or carbohydrate foods during the “kill” phase, that the bacteria will starve, and go into hiding (or more accurately, into a biofilm, making it more difficult to kill them).

So, is there any truth to this concern? What are the experts saying? In sum, both of the leading experts in the SIBO field, Dr. Allison Siebecker and Dr. Mark Pimentel both appear to have different views on the subject.

Pimentel says to not use any specific diet while using your antibiotics or herbals, which essentially means, feed them to your heart’s desire with whatever type of food you feel like eating.

Siebecker on the other hand says that “tweaking the biphasic treatment to accommodate a little of both” is best.

The concern from Siebecker’s point of view is that eating a bunch of carbs and fermentable foods only exacerbates symptoms in patients.

Personally, I followed her advice. I stuck to a mostly low FODMAP diet, but still had some tolerable high FODMAP food items in my diet. The point is to feed our good bacteria, without adding any additional strain on your body and digestive system, and also limiting how much the bacteria have to feed on.

You do not want to give them TOO much to eat, where it enables them to proliferate like crazy, making the job of the herbals/antibiotics that much harder.

To find out more on what foods are low or high FODMAP, check out the Monash FODMAP app !

You might be wondering why you should listen to this advice, and are worried about eating some high FODMAP foods and making your SIBO worse. So, let’s look at a study that backs this claim up!

One study aimed to determine if Rifaxamin administration alongside partially hydrolysed guar gum (PHGG) supplementation is better than Rifaxamin on its own.

Researchers used a glucose breath test (GBT) and symptom reduction questionnaire as means of scoring.

PHGG is a soluble fibre (which can feed SIBO bacteria) derived from guar gum.

In this study, a 50g glucose breath test was given to 500 consecutive patients with IBS-type symptoms. Patients with a positive glucose breath test and predisposing conditions to SIBO entered into the study, and were randomised to receive rifaximin 1200mg/day or rifaximin 1200mg/day and PHGG at 5g/day for 10 days. Patients completed a symptom questionnaire and GBT both in the basal condition and 1 month after withdrawal of therapy.

Eradication rate of SIBO was 62.1% (23/77) in the rifaximin group and 85% (34/40) in the rifaximin plus PHGG group. Clinical improvement was observed in 86.9% and 91.1% of eradicated cases in rifaximin and rifaximin plus PHGG groups, respectively

It appears based on this study, that the theory of feeding bacteria (in this case, with PHGG) while on antibiotics, boosts your chances of eradicating SIBO.

Based on these results, it would be worth considering using a prebiotic such as PHGG alongside your herbal or antibiotic treatment.

Personally, I did not use PHGG, however as mentioned previously, I did eat some tolerated high-FODMAP foods during treatment, which may or may not have had a similar effect as PHGG does on treatment outcomes!

Restricted diets long term

Another thing that is often overlooked but extremely important to take into consideration: Diets that restrict fermentable carbohydrates and/or fiber and plant diversity, should not be done long term!

The FODMAP diet for example is not meant to be a long-term diet.

You will without question do damage to your microbiome when limiting fermentable carbs, fiber and plant diversity. Your microbiome is already likely lacking a diversity of microbes, and by sticking to these diets for longer than a couple of months, it may limit it even further, leaving you more susceptible to gut health issues.

This is because without a balance of microbes, “bad” bacteria like e.coli and strep have more of a chance to take over. Our “good” bacteria are responsible for many things, including immune function, breaking down our foods, producing our vitamins and protecting our gut lining. They are also responsible for keeping a perfect balance within our microbiome, keeping the “bad” guys in check.

As you can imagine, if you stop feeding these good guys, they will start dying off, allowing the “bad” ones or even healthy good guys, to grow out of control. This is what can cause SIBO, leaky gut, bloating, gas, diarrhea, constipation etc.

Now you might be wondering what you’re supposed to do: You have SIBO, you’re told you should reduce FODMAPS, and/or whenever you eat certain FODMAP foods, you have a terrible reaction. I understand the frustration and confusion, I’ve been there, too.

My suggestion is to eat high FODMAP foods that you can tolerate, without severe symptoms. This way, you’re still feeding the good guys, getting diversity in your diet, and making it less difficult for you to repopulate the gut once you do clear SIBO.

See, this is where gut sensitivities usually stem from: you eat a food, it causes a bad reaction such as bloating gas or pain, so you think “oh I am sensitive to this food”, and you stop eating it for a long time.

What’s happened here is that those gut bacteria responsible for breaking down that food die off, because you’ve stopped feeding it that food item, and so when you try to eat it again at a later time, it becomes even more difficult!

Instead of realizing this conundrum, many just continue to assume that they were correct in removing it from their diet in the first place, rather than be aware of what it likely really means. The sensitivity is very likely coming from a lack of fiber and diversity, so while it appears that removing that food item is the best thing to do, it might not be that simple, and could be making things worse in the long run.

All in all, treating SIBO and gut issues is no easy task. There are so many layers and things to consider. I believe it’s best to be fully informed on all of these possibilities, so you can make the best decision for yourself!

Probiotics: To take or not to take, that is the question!

The topic of probiotics and SIBO has a lot of controversy surrounding it. That is because some argue that taking probiotics with your treatment will help rebuild the gut, as you are killing off the bad and good bacteria with herbals/antibiotics.

Others say that you are adding fuel to the fire – potentially feeding/introducing the very bacteria you are trying to kill, or adding strains of bacteria that you don’t want in the small intestine.

At the end of the day, you will need to decide what is best for you, and simply try probiotics or fermented foods and see what your personal reaction is.

Everyone’s microbiome is so individual, that there simply is not a one size fits all approach to anything surrounding SIBO or gut health!

If you want to try a probiotic however, there are a lot of experts who say that soil-based probiotics are best for people with gut issues or SIBO. The reason being is because soil based probiotics do not act in the same way as regular probiotics do. Here are some “facts” about soil based probiotics:

– They crowd out bad bacteria
– Do not need to be kept in the fridge because they are very stable
– You don’t need to worry about them surviving through the gastric system (many probiotics won’t even make it past that which is why when you buy probiotics you need a very large minimum amount per capsule to make up for this)
– They actually can colonize, unlike most regular probiotics
– They recondition the gut
– They can help autoimmunity

Megasporebiotic – one of the biggest brands for spore-based probiotics – have several studies listed on their website on the 5 soil based strains (Bacillus strains). However, none of their studies appear to be low quality studies at this time, so we must keep this in mind.

Another great tip is to actually target your specific gut issue with a specific evidence-based probiotic. Meaning, there are studies that currently exist that show how certain strains of probiotics can help specific issues such as bloating, gas, constipation, diarrhea.

A great place to look for these studies is over at “https://theplantfedgut.com/”. Simply go under the “Research” tab and fill out your info, and you will soon be sent over the research to your email, that will contain studies on probiotics and their main functions.

More tips to consider when choosing a probiotic:

1 – Quantity of bacteria: 25-50 billion minimum. Most of the bacteria likely won’t make it passed your acidic gut. So, the more bacteria per capsule, the better
2 – Number of individual strains: Diversity is everything when it comes to our microbiome, so choosing a probiotic that has the most diverse amount of strains is best. The specific strains you choose will depend on your health symptoms you are attempting to correct, as well as the research that backs up the claim.
3 – Allergen free: Your probiotic should be free of common allergens which include: eggs, dairy, nuts, seafood, soy, wheat and gluten. If you have a negative reaction to your probiotic, you want to be more sure that it’s coming from the bacterial strains and not from an allergenic food ingredient
4 – Delayed-release capsule: Most bacteria live in our colon, and that’s where we want the probiotic bacteria to end up! As mentioned above, most of the bacteria will be destroyed by our acidic stomachs, so having a delayed-release capsule helps ensure most of them end up where they should.
5 – Need for refrigeration/Packaging: Most probiotics say that refrigeration is best to keep the bacterial strains alive. However, not needing refrigeration generally could mean that the survivability of the probiotic is improved. Megaspore does not require refrigeration for example, due to them being in “spore” form. I assume this means that they only become active once they have reached their destination (your colon), and therefore are stable until then.
Another consideration is buying a probiotic that comes in individual blister packs. This means that each capsule is in individual protection to ensure freshness and protects the bacteria from heat changes that could alter their stability.

What to Keep in Mind When Treating SIBO

No matter what route you decide to take to treating your SIBO (antibiotics or herbals) you must also focus on root cause (https://hindsighthealth.com/the-first-steps-to-battling-sibo-finding-your-root-cause/)!

Remember that SIBO is a symptom of a larger issue or malfunction within the body. SIBO is not your main underlying cause to your health issues, it is merely a consequence of something else that broke down along the way.

I think it is also important to support the body in more than one way – taking herbals or antibiotics alone will very likely not be enough to heal you. You need to address the underlying cause(s) and support the body through healing, such as by taking other supplements where needed, changing your diet and lifestyle. This will help prevent a relapse or recurrence of SIBO (getting it once is more than enough, amiright?)

Testing to see what kind of deficiencies you may have or other underlying causes (impaired motility, leaky gut, major deficiencies, heavy metal toxicity etc.) is a good option, so you know what to focus on (link posts to root cause and recommended tests).

If you’ve liked this post or have any questions, please leave me a comment! I love hearing from you guys 🙂 Thanks for reading!