SIBO treatment substancesSIBO Treatment: Natural & Pharmaceutical

Treatment for SIBO is important to learn about since there are a few different options you can use. Unfortunately, there is no perfect treatment option at this time but there are a few super 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 is important to also remember that you should test and review your medical history with a doctor before starting SIBO treatment. This will allow you to choose the specific protocol that best suits your body and microbiome. In this article I’ll walk you through everything you need to know: the basics, SIBO antibiotics, elemental diet, diet, prevention, prokinetics, and a recommendation.


SIBO Treatment Basics

Treatment for SIBO is fairly simple to understand but can be tricky if you have other underlying factors which are causing the condition. There are 4 keys to treatment:

  1. Reducing the overgrowth of bacteria in your small intestine
  2. Fixing any other underlying issues with your body that are causing decreased cleansing waves
  3. Preventing relapse by correcting or improving any underlying causes
  4. Supplementing with any products that help symptom relief

Unfortunately, researchers still don’t have perfect treatment options so many SIBO patients often 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.

I have found it takes a change in lifestyle design to survive and thrive with the disease. Habits like adopting a SIBO friendly diet, becoming educated, figuring out how to handle the ups and downs, discussing with friends, managing stress effectively, and a shift in mindset are necessary to improving your quality of life. It is a challenge, but you can grow so much as a person through the trials!

The SIBO treatment strategies that doctors use to reduce bacteria are:

  1. Antibiotics
  2. Herbal Antibiotics
  3. Elemental Diet
  4. Diet

SIBO treatment algorithm


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 harsh systemic side effects like many other broad spectrum antibiotics.


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 a 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 do a natural protocol.

What Herbs are Used for Treating SIBO?

There have been a couple different combination protocols studied and used with effectiveness.

  1. 1-3 herbs from below for 4 weeks at highest dosing suggested on label:
  2. 2 herbal combination formulas together, at a dosing of 2 caps twice a day, for each formula:

mixing an elemental diet shake for siboElemental 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. The studies done on elemental diet show great 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. There are a couple different brands but most people use Vivonex Plus or make their own elemental formula.

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 best success rates. Personally, I have done the elemental diet before and didn’t find sticking to the regimen too horrible. After about a day drinking the liquid my gut started to feel awesome and my symptoms vanished. I would strongly recommend SIBO patients to try an elemental diet first because from my experience starting with natural remedies before moving to pharmaceuticals is the smartest decision you can make.

If you want specific instructions, a comparison of pricing options, and my personal experience check out the SIBO elemental diet post.


Sibo DietSIBO Diet (Natural)

Diet is one of the foundations for improving your health with a gastrointestinal disease like IBS-SIBO. I think it is the smartest to try natural treatment first by altering your diet or trying an elemental diet before resorting to antibiotic therapy. The reason being that even though the antibiotics specifically picked for SIBO do not have the same broad spectrum systemic effects that others have, they are still antibiotics and can cause some resistance over time. Sometimes people can dramatically decrease their symptoms just by changing their diet.

One of the key steps in SIBO treatment wether you use it as your main treatment or in combination with another is changing your diet. A diet lower in specific fermentable foods can help reduce symptoms dramatically. I have laid out all the information on my SIBO diet page and made an awesome recipe book that combines the two most commonly used diets: SCD and Low-FODMAP. I have found recipe books to be a huge help in my healing journey. They make eating much simpler.


SIBO Prevention

SIBO is an infection 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 the small intestine cleansing wave) sweeps bacteria down into the large intestine when fasting at night and between meals. Unfortunately, bacteria can recolonize the small intestine within a month of treatment, without using prevention.

This is by far the most frustrating part of living with SIBO because it is a challenge to keep it away, and to find/fix underlying issues in your body. Personally, this is the area of future research I am most excited about because we need better treatment options that target the root causes.

The following are the current prevention treatments that doctors use:

  • Prokinetic drugs to help stimulate the small intestine MMC
  • Following a lower carbohydrate SIBO diet
  • Removal of any Proton Pump Inhibitor drugs (reduce HCL in stomach)
  • Correct Ileocecal Valve Syndrome
  • Treating any other diseases or imbalances that are contributing to SIBO

 Prokinetics for SIBO

Prokinetics are drugs that stimulate the cleansing waves of the small bowel. They are often times used as a prevention strategy for recurrent SIBO. Patients will take these drugs before going to bed most of the time since that is the longest period of fasting. Doctors usually prescribe them for a 3 month period following treatment then re-evaluate symptoms after coming off. 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

What’s my Recommendation for SIBO Treatment?

Personally, I have been through the different treatment options above and fall in the category of SIBO patients who are difficult to treat. I often have to re-treat the condition and stick to maintenance strategies. This can be frustrating. The good news is that I have learned to manage my symptoms effectively and have seen other patients have remarkable results. It really just depends on the individual. From everything I have learned the following is what I would recommend:

  1. First, start with a SIBO natural treatment option like changing your diet to a low-fermentation plan for a while. Sometimes this can be enough to improve symptoms to the point where you can heal through diet modification and lifestyle. Get rid of dairy, excess sugar, and indigestible foods. I also drink non-caffeinated herbal teas and try to find time to do low-stress activities like walking, surfing, swimming, or a light workout. I have found that diet and lifestyle modifications are the building blocks of health and sometimes people with SIBO can heal just through them. With a more severe case this often times is not enough. I believe you should always start with natural treatment options then move to pharmaceuticals.
  2. Next, I would recommend the elemental diet which is also a SIBO natural treatment. Even though this can be challenging and expensive I strongly encourage people to give it a go before opting for antibiotics. I’ve taken SIBO antibiotics and would recommend trying the elemental diet first. The elemental diet has a high success rate and can do the job. I use this for occasional re-treatment and maintenance.
  3. Some people need SIBO antibiotics. I would start with the herbal antibiotics for SIBO first. Doing a combination therapy like I outlined above can be super effective. Herbs like allicin, neem, berberine, oregano, and cinnamon can kill bacteria effectively.
  4. Lastly, if you need are more potent protocol the SIBO antibiotics like Rifaximin and Neomycin are highly effective. Work with your doctor to develop the appropriate protocol.

In summary, I would always recommend starting with a SIBO natural treatment like modifying your diet. If you need some help starting a SIBO diet check out my recipe book and guide.

Starting with diet, then moving to the elemental diet, then to antibiotics is probably the smartest path you can take. Yes, antibiotics and prokinetic drugs are often necessary. I have taken them and have found them effective. The one thing I have noticed is that over time you develop some resistance to the antibiotics and they are not as potent as before. This is why it is the best to develop a long term strategy which starts with diet and lifestyle design mixed with any necessary medicine along the way.