Many people with chronic gas, bloating, and abdominal pain actually have small intestinal bacterial overgrowth (SIBO). (Find a full discussion of SIBO symptoms here.)
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.
Treatment for SIBO
Fortunately, natural SIBO treatment is available that is just as effective (or more) than a conventional SIBO cure with antibiotics, according to the results of a new study. Physicians at John’s Hopkins and the University of Pittsburgh showed that natural treatment for SIBO using herbal antimicrobial supplements was as effective as rifaximin, one of the conventional SIBO antibiotics.
A group of 104 patients who tested positive for newly diagnosed SIBO took either a standard, high dose of rifaximin (1200 mg daily) or two capsules twice daily of each of the two supplements in one of the two following herbal protocols:
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.
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How to Treat SIBO Naturally
Of the patients who received herbal therapy, 46 percent showed no evidence of SIBO on follow up testing compared to 34 percent 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 percent of rifaximin non-responders that then took the herbal therapy, 57.1 percent 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.
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 Way to Cure SIBO
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. Combine the diet with a natural SIBO treatment of either the Metagenics or Biotics Research supplements for a wonderful natural option.
Share Your Experience on How to Cure SIBO
What SIBO treatments have worked for you? Have you tried a SIBO diet? To help your fellow readers with treating SIBO, please share your experience in the “Comments” section below.
Originally published in August 2014, this blog has been updated.