by Dr. Alex Heyne Contributor

The Best Herbs for SIBO Treatment

Small Intestine Bacterial Overgrowth, also known as SIBO, is defined by excessive growth of unhealthy gut bacteria in the small intestine. These bacteria produce gas, including methane and hydrogen, which can cause bloating, abdominal pain, and diarrhea.

Bacteria overgrowth is not the only concern. SIBO also causes gut damage. While traditional prescriptions can help, Traditional Chinese Medicine (TCM) herbs offer a more holistic approach to treating SIBO.

In this blog, we will discuss the following:

Herbs vs Prescription Drugs
Side Effects
Cons of Prescription Drugs
Methane SIBO herbal treatments
The Future of SIBO

What is SIBO?

SIBO happens when too many bacteria grow in the small intestine, causing bloating, gas, and digestive issues. TCM views SIBO as an imbalance in the digestive system.

Diagnosis – SIBO Breath Test

Health professionals can diagnose SIBO with a breath test, a quick and non-invasive method. You drink a sugar solution, then breathe into a device at set times. If hydrogen or methane levels rise, it suggests bacteria are fermenting the sugar in your small intestine.

The breath test is safe and simple, making it the most common way to check for SIBO. While not perfect, it’s an effective tool that helps doctors confirm the condition and plan treatment.

Traditional Chinese Herbs vs Prescription Drugs

A 2014 John’s Hopkins study found that herbal treatments for SIBO worked just as well as the drug Rifaximin. It was the first of many studies to show that herbal therapy can be an effective option for natural treatment of 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 treatment used a mix of 4-10 herbs for SIBO, such as sage leaf, Chinese licorice root, Chinese skullcap root, berberina, oregano oil, and lemon balm

The researchers found that herbs for methane dominant 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 drug therapy or an “herbal rescue therapy.” Additionally, this herbal option was found to be as effective as the prescription drug 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.

Prescription drugs tend to be more damaging to the gut microbiome in general. The researchers thought that since herbs 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 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.

3 Natural Herbs for SIBO

1. Berberine

Berberine (huang lian su) is often used 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 spread 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 Support: Berberine reduces gut inflammation, helping relieve 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.
Gut Motility Support: Berberine helps food and bacteria move properly through the digestive tract, which may 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 Support: Berberine helps regulate blood sugar, which supports 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

2. Oregano Oil

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

Oil of oregano for SIBO helps 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 especially helpful for reducing bacterial overgrowth in the small intestine, which is the main sign of SIBO.
Broad Support: Oregano oil fights many types of 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 helps preserve the beneficial gut flora, which is important for maintaining healthy digestive enzymes and overall immunity.
Reduction of Inflammation: SIBO often triggers inflammation in the intestinal lining. Oregano oil has anti-inflammatory effects that can easy gut inflammation and relieve SIBO symptoms.
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.

Oregano oil can help with SIBO, but it should be used under professional guidance. It’s a strong herb, so proper dosing and limited used is important to avoid side effects.

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, decocting the oil made the bacteria resistant.

3. Allicin

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

Strong Antimicrobial Support: Allicin fights bacteria, fungi and viruses, helping reduce harmful bacteria overgrowth 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: Allicin targets harmful bacteria while having less effect on beneficial ones 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. Those treating SIBO usually take Allicin as a capsule so it reaches the small intestine more easily.

While allicin has antimicrobial activity on its own, it has also been found to increase the productivity of other therapies, including antimicrobial drugs. Taking allicin with an antibiotic may boost its effect and protect gut health.

Other Natural Treatment Options: Low FODMAP Diet

A low FODMAP diet limits certain carbs that are hard to digest and can feed bacteria in the small intestine. These include some fruits, vegetables, dairy, and grains. By reducing these foods, you can lower gas, bloating, and discomfort caused by SIBO.

In TCM, this approach supports digestive balance and helps the gut function more smoothly. Combining a low FODMAP diet with TCM methods like herbal remedies or acupuncture may improve digestion and overall gut health.

Herbal Remedies for SIBO: Potential for the Future

SIBO was only recently named in 2004. Therefore, the research behind herbal supplements 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.

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.

A variety of herbs can help treat SIBO as mentioned above. 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