SIBO Treatment Overview
Treatment for SIBO is important to learn about for the most effective treatment outcome. Unfortunately, there is no perfect treatment option at this time, but there are a few different effective strategies. All treatment options work to reduce the bacteria in your small intestine and improve motility since those are the two main causes of SIBO.
It’s also important to remember that you should review your medical history with a doctor before starting SIBO treatment. This will allow you to choose the specific protocol that best suits your individual needs. In this article, we will walk you through everything you need to know: the basics, SIBO antibiotics, elemental diet, diet, prevention, and prokinetics.
Table of Contents
SIBO Treatment Basics
Treatment for SIBO is fairly simple to understand. There are 3 keys to treatment:
- Reducing the overgrowth of bacteria in your small intestine
- Fixing underlying issues which are contributing to decreased motility
- Supplementing with any products that help symptom relief
Unfortunately, researchers still don’t have perfect treatment options so there are some SIBO patients who have to make longer-term diet changes and re-treat the bacterial overgrowth occasionally. The trickiest part about recurrent SIBO is that the underlying cause (thought to be a damaged migrating motor complex) is not easy to fix.
Cultivating a healthy lifestyle is also important in order to recover and thrive again. Habits like adopting a SIBO friendly diet, managing stress effectively, understanding how the digestive system works, and a shift in mindset are necessary to improve your quality of life. It is a challenge, but you can get there.
The SIBO treatment strategies that doctors use to reduce bacteria are:
- Herbal Antibiotics
- Elemental Diet
The algorithm below shows the treatment process designed by a few of the top doctors:
NOTE: Before starting any treatment protocol it’s important to get a breath test done and work with a doctor to make sure you choose the best course of action for your own body. If you need to get a breath test done to find out if you might be dealing with SIBO I have included a link below.
SIBO Antibiotics (Pharmaceutical)
Antibiotics are a top choice for most gastroenterologists. They act quickly and are easy to implement. Treatment duration with antibiotics is usually 10-14 days. Patients usually do breath testing before and after to make sure the gas levels are normal after treatment.
I have found that antibiotics are very effective when first using them but can lose their potency with continued use possibly from some resistance or a changing microbiome over time. For some people, antibiotic treatment can be all they need, but for others, a long-term strategy is needed.
Which Antibiotics are Used to Treat SIBO?
The main antibiotics used to treat SIBO are Rifaximin (Xifaxan) and Neomycin. They were chosen because they act specifically in the intestines and do not have systemic side effects like many other broad-spectrum antibiotics.
- Rifaximin is usually used in all protocols
- Rifaximin + Neomycin is usually used in constipation cases
If you want to learn more about antibiotics and how they can be used for treatment check out the SIBO antibiotics page.
SIBO Herbal Antibiotics (Natural)
Herbal antibiotics treat SIBO in the same way that pharmaceutical antibiotics do by killing bacteria. They are widely used by natural practitioners and an excellent natural treatment option for SIBO. They are not quite as strong as pharmaceutical antibiotics so they have to be used for longer treatment duration.
One of the benefits of herbal antibiotics is that a prescription is not required and you can buy them online. A study done comparing herbal antibiotics to Rifaximin (SIBO pharmaceutical antibiotic) concluded that herbal antibiotics were equivalent to Rifaximin for the treatment of small intestine bacterial overgrowth. That is a very positive finding for patients who would rather try a natural protocol.
What Herbs are Used for Treating SIBO?
There have been a couple different combination protocols studied and used with effectiveness.
- 1-3 herbs from below for 4 weeks at highest dosing suggested on the label:
- 2 herbal combination formulas together, at dosing of 2 caps twice a day, for each formula:
If you want to learn more about herbal antibiotics and how they can be used for treatment check out the herbal antibiotics for SIBO page.
Elemental Diet (Natural)
One of the most effective treatment options is doing a 14-day elemental diet.
The elemental diet works by starving the bacteria and feeding the person. The elemental diet is powdered nutrients in a pre-digested form so that you absorb nutrients high up in the intestines before they can feed the bacteria.
Studies done using the elemental diet show success rates in the 80%+ range.
The elemental formula contains protein as amino acids, carbs as glucose or maltodextrin, fat as oils, and vitamins/minerals.
Pros: Anyone can purchase online, no antibiotic side effects, highly effective
Cons: Can be a challenge to drink liquid for 2 weeks, unpleasant taste, expensive
Although the elemental diet has its share of cons, if you are willing to go through with the treatment it has some of the highest success rates.
If you want to see specific instructions and the best formulas available see the elemental diet for SIBO post.
SIBO Diet (Natural)
Diet is one of the foundations for improving your health with a gastrointestinal disease like IBS-SIBO.
It can be a good choice to try a natural treatment first by altering your diet or by using an elemental diet before resorting to antibiotic therapy.
This is because even though the antibiotics specifically picked for SIBO do not have the same systemic side effects that others have, they are still antibiotics and can cause side effects.
Studies using the Low FODMAP diet in IBS have shown that patients can dramatically decrease their symptoms just by altering their diet.
To learn more about diet fundamentals for SIBO and IBS see the SIBO diet page.
SIBO is a condition that often relapses because eradication does not always fix the underlying cause.
In a lot of cases, this is a deficiency of the migrating motor complex.
The MMC (also known as small intestine cleaning waves) sweep bacteria down into the large intestine during fasting at night and between meals.
Unfortunately, bacteria can recolonize the small intestine within a month of treatment, if someone has deficient cleaning waves. This is why it’s important to use prevention strategies.
This is by far the most frustrating part of the SIBO treatment process because it can be a challenge to keep it away and to fix underlying issues in your body.
The following are the current prevention methods doctors use:
- Prokinetic drugs to help stimulate the small intestine MMC
- Following a lower carbohydrate SIBO diet
- Removal of proton pump inhibitor drugs
- Correct Ileocecal Valve Syndrome
- Treating any other diseases or imbalances that are contributing to decreased motility
Prokinetics for SIBO
Prokinetics are drugs that stimulate the cleaning waves of the small bowel.
They are often used as a prevention strategy for recurrent SIBO.
Patients will take these drugs before going to bed since that is the longest period of fasting. Doctors usually prescribe them for a 3 month period following treatment, then re-evaluate symptoms before discontinuing.
You will need to work with your doctor to find the right prescription. Some of the prokinetics studied for SIBO are:
- Prucalopride (Resolor)
- Low-dose erythromycin
- Low-dose naltrexone
Steps for SIBO Treatment
Treating SIBO can be different for each person. Sometimes patients will need a combination of conventional and natural medicines while other times a totally natural strategy may be the most beneficial over the long term. Below are some example steps you can follow to heal your gut.
The following is a treatment process that starts with natural remedies:
1. First, start with a SIBO natural treatment option like the Low FODMAP diet. Sometimes this can be enough to reduce symptoms by 50%. Including non-caffeinated herbal teas like peppermint or fennel in your diet routine as well as the best probiotics for SIBO can also be helpful. In conjunction, try to find time to do low-stress activities like walking, surfing, swimming, or light gym workouts. Diet and lifestyle modification are the building blocks of health. It’s smart to start slowly and naturally.
2. If diet modification isn’t enough consider using the elemental diet. Even though it can be challenging it’s worth giving a shot before opting for antibiotics. The elemental diet has an 85% success rate after 2 weeks of treatment.
3. If diet and elemental diet don’t help enough consider SIBO antibiotics. Start with herbal antibiotics for SIBO first. Herbs like allimed, neem, berberine, oregano, and cinnamon can kill bacteria effectively.
4. Lastly, if you need the big guns SIBO antibiotics like Rifaximin and Neomycin are highly effective. Work with your doctor to develop the appropriate protocol.
5. Remember that SIBO occurs because of an underlying cause. The condition is about more than bacteria. A lot of people will need a prokinetic to help stimulate their cleaning waves or they will need to fix other coexisting issues which can lead to SIBO.
It takes time, investigation, and a long-term commitment to healthy living.
If you’re finally ready to learn the ins and outs of SIBO and how to use a comprehensive treatment strategy to heal your gut, check out the SIBO Toolkit with the link below.