by Dr. Alex Heyne Contributor

3 Natural Herbs for treating SIBO

Small Intestine Bacterial Overgrowth, also known as SIBO, is defined by excessive growth of unhealthy gut bacteria. These bacteria produce a disruptive amount of gas, including methane and hydrogen, leading to symptoms including bloating, abdominal pain, and diarrhea.

Bacteria overgrowth is not the only concern. SIBO also causes gut damage. While prescription antibiotics are standard to kill off these bacteria, Traditional Chinese Medicine (TCM) herbs pose an alternative, and more holistic option.

In this blog, we will discuss the following:

Herbs vs Antibiotics
Side Effects
Cons of Antibiotics
Berberine
Oregano Oil
Allicin
The Future of SIBO

Read More: What is “Dampness” in the Gut?

Traditional Chinese Herbs vs Antibiotics

A clinical trial in 2014 by Johns Hopkins University found holistic herbs for SIBO treatment to be as effective as pharmaceutical antibiotics. The antibiotic involved was Rifaximin, and this study is the first of many to show the efficacy of herbal therapy for SIBO.

During this study:

104 patients who recently tested positive for SIBO were offered either herbal therapy or rifaximin for four weeks.
The herbal therapies included four different commercial preparations.
Each preparation included four to ten different herbs for SIBO, including sage leaf, Chinese licorice root, Chinese skullcap root, berberine, oregano oil, and lemon balm.

The researchers found that herbs for SIBO treatment were as effective as Rifaximin. Notably, some of the patients who received Rifaximin did not see any improvements with their SIBO.

Those unsuccessful with Rifaximin then selected a triple antibiotic therapy or an “herbal rescue therapy.” This herbal rescue option was additionally found to be as effective as the antibiotic route.

Watch: How Your Gut Bacteria Controls Your Mood

A Difference in Side Effects

The study found a notable difference in side effects between the two groups. In the Rifaximin group, 9% experienced diarrhea. In the herbal therapy group, only 1% experienced diarrhea.

Antibiotics tend to be more damaging to the gut microbiome in general. The researchers hypothesized that since the herbal therapies are less disruptive to the gut microbiome, they are more likely to protect the healthy gut bacteria. Healthy gut bacteria are essential for preventing harmful bacterial growth.

On the contrary, taking antibiotics can lead to an increase in opportunistic infections such as C. difficule because antibiotics increase bacterial resistance. Increased bacterial resistance can cause an unbalanced gut with more unhealthy than healthy bacteria.

Why Not Antibiotics?

Antibiotics are controversial because they kill both harmful and beneficial bacteria in the gut. Just seven days of a common antibiotic, clindamycin, has been shown to reduce supportive gut bacteria and diversity for over a period of two years. Herbal antimicrobials are more protective against supportive bacteria; therefore, they do not negatively impact the gut long term.

Berberine: A Natural Antimicrobial

Berberine (huang lian su) is a compound found in Oregon grape, barberry, and goldenseal, and is often found in TCM formulas utilized to treat bacterial diarrhea. Berberine helps combating small intestinal bacterial overgrowth (SIBO) due to several key properties:

Antimicrobial Activity: Berberine possesses strong antimicrobial properties, which make it effective against a wide range of bacteria, fungi, and other pathogens. By inhibiting the growth and proliferation of harmful bacteria, berberine reduces bacterial overgrowth in the small intestine.
Modulation of Gut Microbiota: Berberine selectively targets pathogenic bacteria while having a lesser impact on beneficial bacteria such as Lactobacillus and Bifidobacterium. This helps to restore and maintain a healthy balance of gut microbiota.
Anti-inflammatory Effects: Berberine has anti-inflammatory properties, which can help reduce inflammation in the gut lining, thereby alleviating symptoms like bloating, pain, and discomfort.
Improvement of Intestinal Barrier Function: Berberine may help strengthen the intestinal barrier, preventing the translocation of harmful bacteria and toxins into the bloodstream. This helps reduce systemic inflammation and prevents conditions associated with “leaky gut,” which can sometimes accompany SIBO.
Antimotility Effects: Berberine supports healthy gut motility, aiding in the proper movement of food and bacteria through the digestive tract, which can help prevent bacterial overgrowth.
Antioxidant Properties: Berberine also has antioxidant effects, which help protect the body’s cells from damage caused by bacteria. This is particularly beneficial in reducing oxidative stress.
Blood Sugar Regulation: Berberine’s ability to regulate blood sugar levels can be an added benefit, as stable blood sugar levels are important for overall metabolic health.

In a 2011 review, researchers explained that berberine most significantly impacts growth of the following bacteria species:

Staphylococcus
Streptococcus
Salmonella
Klebsiella
Clostridium
Pseudomonas
Proteus
Shigella
Vibrio
Cryptococcus

Streptococcus, Proteus mirabilis, Staphylococcus, Clostridium, and Klebsiella pneumoniae are a handful of bacteria responsible for hydrogen-based SIBO.

Berberine has many other functions, including supporting the growth of healthy bacteria in our guts. While studying berberine’s antimicrobial effect against E. coli, researchers in 2008 found berberine to have no negative effect on lactobacilli and bifidobacteria, two beneficial gut bacteria.

Watch: The Mind-Blowing Benefits of Berberine

Oregano Oil: An Antibacterial Ingredient

Oregano oil is another herbal antimicrobial. It is a well-documented ingredient that directly inhibits the growth of intestinal microbes.

Oregano oil helps with combating SIBO for the following reasons:

Antibacterial Properties: Oregano oil contains powerful compounds like carvacrol and thymol, which possess strong antibacterial effects. These compounds disrupt the cell membranes of harmful bacteria, causing the bacteria to die off. This is particularly beneficial in reducing the overgrowth of bacteria in the small intestine, which is the main indicator of SIBO.
Broad-Spectrum Activity: Oregano oil is effective against a wide range of bacteria, including both gram-positive and gram-negative bacteria. This broad-spectrum activity addresses the diverse bacterial species that may be present in cases of SIBO.
Selective Targeting: While oregano oil is potent against pathogenic bacteria, it has a lesser impact on beneficial bacteria like Lactobacillus and Bifidobacterium. This selective action helps preserve the beneficial gut flora, which is crucial for maintaining a healthy digestive system and overall immunity.
Reduction of Inflammation: SIBO is often associated with inflammation of the intestinal lining. Oregano oil possesses anti-inflammatory properties that can help reduce inflammation in the gut, thereby alleviating some of the discomfort and symptoms associated with SIBO.
Antifungal and Antiviral Properties: Besides its antibacterial effects, oregano oil also has antifungal and antiviral properties. This makes it useful in treating coexisting infections or dysbiosis that might accompany SIBO.

While oregano oil can be beneficial for SIBO, it is essential to use it under the guidance of a healthcare professional. The potency of oregano oil means that it should be used in appropriate doses and for a limited duration to avoid potential side effects or interactions with other treatments.

In 2009, scientists tested oregano oil (Origanum vulgare Linn.) against 111 gram-positive bacteria from 23 different species. The oil successfully exhibited antibacterial activity. However, when the oil was decocted, the bacteria became resistant.

Allicin: Garlic’s Healing Potential

Allicin, a compound derived from fresh garlic, combats SIBO due to several notable properties:

Strong Antimicrobial Properties: Allicin inhibits the growth of various bacteria, fungi, and viruses, which aids in reducing the overgrowth of harmful bacteria in the small intestine.
Disruption of Bacterial Cell Function: Allicin interferes with bacterial cell processes, such as enzyme activity and cell membrane integrity. This leads to the death of harmful bacteria, helping alleviate bacterial overgrowth.
Selective Action on Pathogens: While allicin is effective against a wide range of harmful bacteria, it tends to have a lesser impact on beneficial bacteria like Lactobacillus and Bifidobacterium. This selective action helps maintain a healthy balance of gut microbiota.
Anti-inflammatory Effects: Allicin possesses anti-inflammatory properties, which can help reduce inflammation in the gut lining often associated with SIBO. This can alleviate symptoms such as bloating, abdominal pain, and discomfort.
Immune System Support: Allicin’s antimicrobial and anti-inflammatory properties help the body combat infections and maintain a balanced gut environment.
Antioxidant Activity: Allicin has antioxidant properties that protect cells from oxidative damage caused by bacteria.

It’s important to note that allicin is unstable and can degrade quickly. Therefore, it is often taken in the form of enteric-coated capsules or other stabilized formulations to ensure it reaches the small intestine effectively.

While allicin has demonstrated antimicrobial activity on its own, it has also been found to increase the efficacy of other therapies, including antimicrobial drugs. If an individual were to take an antibiotic, an addition of allicin might help support the drug’s action while protecting gut health.

Herbs for SIBO: Potential for the Future

SIBO was only recently named in 2004. Therefore, the research behind herbs for SIBO treatment is just starting to gain momentum.

Scientists in 2020 published a protocol for systematic review and meta-analysis on Chinese herbal medicine for SIBO. The herbs include garlic, black cumin, cloves, cinnamon, thyme, all-spice, bay leaves, mustard and rosemary. All of these herbs have demonstrated antimicrobial properties.

Research on the efficacy of herbs for SIBO is currently limited, therefore more placebo-controlled studies need to be performed in the future. As of now, this article will hopefully help provide high-quality evidence for health practitioners and their patients.

TCM Help with SIBO

SIBO is a tricky disease that involves several steps to restore a healthy gut microbiome. Some of these steps may involve herbs, antibiotics, and diet alterations. There are a variety of herbs that can help treat SIBO, a few of which are mentioned above that are backed by scientific research. Moreover, TCM holds valuable tools to help resolve SIBO in a holistic way. I recommend you meet with a TCM practitioner to discuss treatment options and personalized guidance to combat SIBO.

Watch: 5 Tips for SIBO, Anxiety and Spleen Qi Deficiency