The Best Herbs for SIBO

What Is SIBO? 
An Introduction to Small Intestinal Bacterial Overgrowth

SIBO is an acronym for Small Intestinal Bacterial Overgrowth. This essentially means there is a dysbiosis, or imbalance of good and bad bacteria, in the small intestine. The gut, along with the entire body, has an invisible ecosystem of microbes, such as bacteria, yeasts, worms, and more, called the microbiome. A healthy microbiome is not only needed for proper digestion, but has also been linked to immune function, lowered inflammation, weight management, clearer skin, and even better mental health. 

In a healthy, normal digestive tract, there is a robust and diverse population of these beneficial microbes, nourished by a healthy mucous membrane, which help to digest and absorb food in the small intestine. 

However, in the case of SIBO, there is not enough of these "good" microbes in the gut and unwanted bacteria take over. This can be caused by multiple factors, such as a nutrient-poor, industrialized diet, chronic use of antibiotics or other medications, history of certain types of infections, poor gut motility, low stomach acid, hypothyroidism, and even chronic stress.

When the gut doesn't function properly, food doesn't get adequately digested and move through the GI tract as it should, allowing undigested food to remain longer in the small intestines This is where opportunistic, pathogenic bacteria can thrive and take over.

Certainly, everyone has some of these "bad" microbes in the gut at various times. However, when their population grows and there aren't enough commensal, or beneficial, microbes to keep them at bay, they encroach into parts of the gut where they don't belong. The beneficial microbes are then able to do their jobs, and problems in the gut will arise.

Symptoms of SIBO

SIBO can have a variety of symptoms, many of which are digestive issues. Some of these include gas, bloating, abdominal pain, diarrhea, constipation, chronic pain, weight changes, eczema, brain fog, fatigue, and nutrient deficiencies from malabsorption. 

SIBO is becoming more prevalent due to poor diets and all of the industrial chemicals in our world, as well as our increased stress and disconnection from nature (a great source of beneficial microbes!). There is growing evidence that SIBO is connected, if not the underlying cause of, other digestive issues, including irritable bowel syndrome (IBS), with one study showing between 30-85% of patients with IBS also having a SIBO diagnosis.

The overlap of IBS patients and SIBO diagnoses demonstrates the strong connection between dysbiosis and inflammation in the gut. When bacterial overgrowth occurs, it can lead to inflammation and damage in the gut lining, with a lack of healthy mucosa (mucous membrane) for protection, which can then cause  dysfunction and increased permeability in the gut, such as in the case of IBS or leaky gut syndrome. ​

Many of the SIBO symptoms can also be symptoms of other digestive issues and diseases, so getting tested to ensure you pursue the right course of treatment for your body's needs is important. 
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Diagnosing and Treating SIBO

SIBO is commonly diagnosed through a breath test, using the glucose and/or lactulose breath tests. It cannot be diagnosed through stool tests like some other GI conditions, nor can it be diagnosed by symptoms alone. These tests, which are less expensive and less invasive than other tests for SIBO (such jejunal aspirates, the "gold standard" for SIBO testing), are measuring for hydrogen and methane in the breath, which are metabolites of bacteria.

These gasses would normally only be produced by large intestinal bacteria in a healthy gut, which would not show up in a breath test. If there is overgrowth of bacteria in the small intestines, they will produce these gasses and these will be then measurable in a breath test. The best testing protocols look for both hydrogen and methane, as different bacteria will have different metabolites and only testing for one of these may not give an accurate diagnosis.

​Other testing, such as stool tests, are great to have in conjunction with the breath tests, to see if other pathogens are contributing to symptoms, such as SIFO (fungal overgrowth) or H. pylori, as well as seeing if there is a low population of beneficial microbes, which is all helpful information for making a treatment plan with a provider. 

Conventional treatment for SIBO typically uses antibiotics, sometimes accompanied by diet changes and/or probiotic recommendations. The antibiotic Rifaximin has been shown to be the most effective antibiotic treatment for SIBO, with some other antibiotics being used with less consistent results. However, this prescription medication can be expensive, is not always covered by insurance, and can come with side effects  as well.

​Plus, overuse of antibiotics can be counterproductive to creating a healthy microbiome and often plays a role in how many arrive at SIBO in the first place. 

Herbal Remedies Shown to Help with SIBO

Luckily, herbal medicine has much to offer for the treatment of this bacterial overgrowth. Many herbs are known for their anti-microbial properties and have been used in traditional medicine practices such as Ayurveda and Traditional Chinese Medicine for centuries.

To accompany this traditional wisdom, several anti-microbial herbs have actually proven in studies to be as effective as Rifaximin in the treatment of SIBO. Science is finally able to prove what herbalists and traditional healers have known for a very long time. These alternatives are not only more cost-effective, but are often safer to use with fewer side effects and are remedies given to us by nature. Below is a list of some of my favorites. 

Herbal remedies used to help treat SIBO: 

• peppermint oil 
• oregano oil 
• other aromatic essential oils: tarragon, rosemary and thyme oils
• berberine-containing herbs: barberry, Oregon grape root, coptis, and goldenseal
• olive leaf extract 
• garlic (especially helpful for methane-dominant SIBO; available as allicin extract for low FODMAP individuals)
• ginger 
• horsetail 
• horse chestnut
• neem
• cinnamon
• wormwood 
• licorice root 
• chamomile 
• lemon balm 

Many of these herbs not only act as anti-microbials for SIBO, but have other digestion-promoting properties as well, making them helpful in a gut healing regimen. For example, oregano oil and garlic also act as anti-fungals; wormwood also acts as an anti-parasite and it, along with ginger and chamomile, have bitter compounds to stimulate digestion; chamomile and lemon balm help soothe the nervous system; licorice supports adrenal health and is a demulcent to support healthy mucosa, along with chamomile. Ginger is not only anti-microbial, but it also is anti-inflammatory, anti-nausea, and promotes gut motility by acting as an herbal prokinetic...this is just an all around dynamite herb for digestion!

This is not necessarily an exhaustive list, but is a good start if you are looking to add herbs to your SIBO protocol. Plus, all of these have been shown in studies to be effective at treating SIBO; many more exist with clinical and/or anecdotal support behind them. 

These herbs can be taken as tinctures or capsules, and some in tea form as well. I like to use enteric-coated capsules to ensure they reach the small intestine when using encapsulated herbs, especially in those formulas with essential oils, as they can be irritating to the stomach in sensitive individuals. Some work well in tincture form, such as the more bitter herbs, whereas a tea may be quite unpleasant to drink, but tasting the herbs does provide some benefit in stimulating digestion, as this process starts in the mouth. 

Typically, I like to do a combination of these herbs as part of a SIBO protocol,  in order to offer the best defense and account for individual differences amongst clients. Combining enteric-coated essential oils with other anti-microbial herbs can be very beneficial. There are some brands and products on the market aimed at SIBO and related issues, that include a combination of many of the above herbs, so you and a provider can decide what is right for your body and price point.

Here are a few of my favorite products out there with SIBO-fighting herbs (I have no affiliation with these brands, I just like their combination of herbs for SIBO) : Atranil, Dysbiocide and FC-Cidal from Biotics Reserach, Candibactin AR and Candibactin BR from Metagenics, Microdefense wth Oregano from Pure Encapsulations, Oregano Oil Complex and Peppermint Oil GI from Protocol for Life Balance, Thorne, Peppermint-Oregano Oil Complex from Natural Factors, Peppermint Soothe from Nature's Way, and Iberogast (which itself has evidence as a SIBO treatment). 

Some practitioners will also recommend taking herbs or supplements that disrupt the biofilm, or protective layer, emitted by these pathogens, to improve the efficacy of the anti-microbial herbs on these bacteria. Beneficial microbes use biofilm to protect themselves as well, so this is an important mechanism that plays a role in a healthy microbiome; however, it can inhibit the efficacy of antimicrobial herbs in a treatment regimen.

Examples of natural biofilm disruptors include: nattokinase, curcumin (from turmeric), linoleic acid (an omega 6 fatty acid), and berberine. Use of these additional remedies may be considered if an antimicrobial treatment does not seem effective or infections recur. ​
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​Other herbs may be used as well that can relieve symptoms of SIBO until it is resolved, including carminatives for gas and bloating, anti-spasmodics and astringents for diarrhea, laxative herbs for constipation, bitter herbs for stimulation and motility (and many other symptoms), as well as nervines and adaptogens to support the stress response and the nervous system, as we know the strong connection between stress and gut health. 
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​These, of course, are not health care recommendations, but are examples of products with proven anti-SIBO herbs in them. Always consult your own health care provider before using supplements and I highly encourage you to work with a practitioner to get the right treatment rather than taking shots in the dark in hopes of treating yourself.

Other Considerations for the Treatment of SIBO:
​Stress, Diet and Lifestyle Practices and Associated Health Conditions

Treating the microbial overgrowth associated with SIBO is an initial, important step in getting your digestive system back on track and symptoms under control. But, it is important to remember that SIBO itself is a symptom. There is a reason that these pathogenic microbes were allowed to run rampant, and it is essential to address these when considering how to resolve the dysbiosis and dysfunction in the gut--taking anti-microbials to control SIBO is not a stand-alone protocol.

Anti-microbial herbs are not to be taken indefinitely, as they can be counter-productive  for the beneficial microbes as well if taken for too long. Getting their population low enough to decrease inflammation and symptoms, while allowing beneficial microbes to thrive and help repair the gut is the goal. A practitioner can help not only select the right herb combination, but also with appropriate duration of the treatment, as well as other important approaches like the addressing the diet.
 
Dietary changes, both a short-term healing protocol as well as lifelong improvement in the diet, cannot be overlooked in improving gut health. You may consider a dietary approach such as the low FODMAP or GAPS/SCD diets after herbal treatment to provide further healing and relief, working with a practitioner to find the right course of action for you and to ensure elimination diets are followed properly to prevent nutrient deficiencies and unhealthy relationships with food.

Other areas to address for SIBO, IBS and related conditions include: 

• Oral health and oral microbiome, presence of mercury fillings
• Inadequate stomach acid or other upper GI issues like GERD and H.pylori infections
• Digestive enzymes and pancreatic/liver/gall bladder function
• Impaired gut motility (this is huge with SIBO!)
• Low thyroid function
• Stress and mental health, mindfulness and counseling (this absolutely must be addressed with SIBO or other GI conditions!)
• Ileocecal valve function
• Inflammation and allergies
• Exercise and movement
• Body work, acupuncture, and abdominal massage
• How we eat (not just what we eat)--chewing, meal timing, fasting, etc.
• Environmental toxin exposure, such as pesticides and antibiotics in food, plastic use, etc.
• Time spent in nature--we get some of our microbiome from earth, natural water, air, plants, and animals!
• Nutrient deficiencies--including B vitamins, copper, zinc, iron, vitamins A and D
• Methylation and MTHFR mutations
• Support and repair of the intestinal lining and mucosa with bone broth (collagen, L-glutamine), demulcent herbs, anti-inflammatory herbs, and prebiotics when tolerated

What about probiotics?

There is a need to repopulate with the gut with beneficial microbes after antimicrobial treatment and elimination diets. Of course, dysbiosis is not just presence of unwanted microbes, but even more so, lack of beneficial microbes. However, this is not typically the first line of treatment, as many with SIBO and IBS do not actually tolerate probiotic supplements and foods at first, because of the inflammation, dysbiosis, histamines and other reasons. 

Once you are ready to add probiotics in, however, it is important to select species/strains proven to support SIBO/IBS, including supplements that include: b.clausii s. bouldarii, b. infantis, s. thermophilus l. reuteri, l. rhamanous, l. acidophilous, l. platarum,  b. coagulans, b.subtillus, b. breve, b.longum, b.lactis; many of these have been shown to help with IBS symptoms and may be beneficial to include to improve the gut biome.

​I like to use supplements that provide a combination of lactobacillus, bifidus, and bacillus (SBO, or spore-forming) species,  ​as well as fermented foods when tolerated (these also provide postbiotics and prebiotics--the total package!)

Remember that SIBO is rarely one-and-done with herbal treatment, where one round of herbal antimicrobials makes all signs of SIBO disappear. Consider if these additional, whole-person approaches can offer long-term healing once antimicrobial treatment is finished. The gut is so complex and is affected by so many parts of our life--the goal is not just to kill of anything potentially harmful, but to heal and rebuild with a healthy, robust microbiome.

Want some guidance on your gut healing journey?

If you are looking to approach SIBO, IBS and gut-healing in a new way, you may want some help and support in your healing journey. This can be overwhelming and confusing...but there is hope and a way forward! 

Reach out to me by clicking the "Work with Me" tab at the top of the page or click here, where you can purchase a health coaching package or schedule a FREE 15 minute discovery call to see if working together is right for you!