Hundreds of thousands, maybe even millions of people, suffer from SIBO. Understanding which approaches, supplements, drugs, and SIBO treatment protocols work the best can be really hard.
There is no substitute for working with a true medical expert when treating SIBO; however, research suggests that most medical professionals are ill-equipped to diagnose and treat actual cases of SIBO.
Below, we will highlight popular forms of SIBO treatment and the benefits, considerations, and drawbacks of these different approaches.
Lastly, we’ll look at why different approaches might be a good fit if you suffer from SIBO.
What is SIBO?
SIBO stands for small intestine bacterial overgrowth. It is a growingly common diagnosis that includes a bevy of different symptoms from bloating to exhaustion and even full body inflammation.
As medical researchers begin to understand more and more about the gut, the more they learn about the connection between the bacteria that live in the small bowel and their effect on overall personal health.
Microbiota, a term used to describe gut bacteria, plays a role in just about everything from the creation of neurotransmitters to the digestion of food. Imbalances of this bacteria can cause serious disturbances in overall health.
SIBO is a condition in which an overgrowth of certain types of bacteria disrupt the normal and proper function of the gut.
How is SIBO diagnosed?
The most common way you will see SIBO diagnosed is by a hydrogen breath test. This is a lengthy process in which patients are subjected to a breath test to look for the over-production of gases that are often present in situations in which SIBO could be present.
These tests are a good part of piecing together a puzzle of someone potentially suffering from SIBO; however, they are not conclusive on their own. Additionally, a patient could have normal results on a breath test and still be suffering from an overgrowth of “bad” bacteria in their gut.
The best gastroenterologists, specializing in SIBO, typically look at a wide group of factors; focusing largely on symptoms, health history, and physical exams to ultimately confirm a SIBO diagnosis.
Since most SIBO treatments are fairly safe to practice with most patients, if SIBO is suspected, doctors will often begin treatment without confirmation of a hydrogen breath test.
What types of SIBO symptoms do top doctors look at?
One of the primary issues alongside SIBO are related to malabsorption. Malabsorption causes nutritional deficiency and a host of other problems that can cascade from that core problem. Sometimes this is associated with weight loss.
However… SIBO is more than just a malabsorption disorder. SIBO can cause excessive bloating and inflammation in the body as well. This can actually lead to weight gain, water retention, and exhaustion. SIBO weight gain is often overlooked but can be a very real part of the disorder.
Other common symptoms of small intestine bacterial overgrowth include:
- bloating / abdominal distension
- joint stiffness and soreness
What is the best treatment for SIBO?
Answering this question is really the point of this article.
SIBO can be a real puzzle to treat. What works great for one person may not work for another. Not all people are the same and not all gut bacteria that causes SIBO is the same. This means that we have two factors with a lot of variabilities to account for when treating SIBO.
This can lead suffers to become frustrated with doctors and treatment protocols; as it is often a journey in treating each person’s unique condition.
The SIBO treatments below highlight popular treatments that may be a good fit for individuals diagnosed with SIBO.
The SIBO Diet and Low FODMAPs Diet
I have included both of these together; as both have similar core principles. These diets specialize in grossly limiting the amount of FODMAPs in the patient’s diet.
FODMAPs are Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.
These are special types of sugars that are believed to be readily used by the types of bacteria that are most responsible for SIBO. This means that these compounds actually feed the bad bacteria.
The underlying principle here is that limiting the consumption of these sugars will ultimately starve the bad bacteria; allowing the patient’s gut biome to return to normal.
Does the SIBO Diet and Low FODMAPs Diet work?
The diets do fundamentally do what they say they will do. Eating a low-FODMAP diet will result in less of the problematic sugars in the gut.
Popular foods high in FODMAPs include, but are not limited to:
- Baked beans
- Beetroot, fresh
- Black beans
- Celery – greater than 5cm of stalk
- Soy beans / soya beans
- Processed Meats
- Wheat containing products such as (be sure to check labels):
- Almond meal
- Cashews and other nuts
That is far from a complete list; which is what makes the diet extremely difficult to follow. Even if the diet alone could provide a “cure” it would be a real legitimate challenge for many SIBO patients. Not only are most ill-equipped to manage a nutritional plan devoid of FODMAPs, but there is some real research that suggests that eliminating FODMAPs alone is likely not enough to combat a real chronic SIBO issue.
This means that the diet, while a great supplement inside most SIBO treatment protocols, could be considered a subpar standalone treatment plan.
There are likely some holistic professionals that would disagree with this, but most integrated medicine practitioners would agree that the diet could supplement other treatments well, but probably needs other forms of treatment to fully support a successful SIBO recovery program.
Treatment with SIBO probiotics
We recently wrote a bit about Mutaflor as a very powerful and underrated bacteria that can be used for treating SIBO. While Mutaflor does have a ton of online positive reviews from those suffering from SIBO, there isn’t a ton of research on this probiotic/bacteria by itself yet (largely due to its limited availability).
The benefit of Mutaflor vs. other probiotics on paper is that Mutaflor actually competes in the gut. It kills off a lot of “bad” bacteria — which is the cause of some of its hyper-motility-like qualities.
This is preferred by some patients; as probiotics, in some cases, have been known to make SIBO symptoms worse. This is likely due to an overabundance of bacteria or an artificially created imbalance of gut microbiota.
Again, everyone is different in this case.
Some patients have had really good results by using single-strain probiotic supplements for SIBO.
Disclosure: We may earn money or products from the companies mentioned in this post via affiliate links to products or services associated with content in this article.
There are several common probiotic strains associated with clinically positive results from SIBO. This includes:
- Lactobacillus plantarum (Jarrows brand) …
- Align (Bifidobacterium Infantis) …
- Lactobacillus reuteri Protectis (Helpful for constipation SIBO) …
- LactoPrime Plus (Blend) …
There are a few more but these are the most popular.
As we mentioned, there are anecdotal reports of patients claiming to have core SIBO symptoms subside with the addition of probiotic supplements.
How quickly do I know if all natural SIBO probiotics are working?
Most patients should know within 1-2 weeks whether or not probiotic supplements are healing or harming them.
With any form of microbiota, there is usually some form of an adjustment period, but this is usually complete within about a week. SIBO sufferers should see improvements in some symptoms relatively quickly after using probiotic supplements. If they don’t it’s possible they fall into the camp of people that generally feel worse when introducing any additional types of bacteria into the gut when dealing with SIBO.
Do probiotics work with SIBO?
This will vary from patient to patient. In some cases, probiotics have been proven to improve SIBO symptoms. In others, it has been shown to make them worse. Most patients will know within a week or two which camp they fall in to.
However, in almost all cases, probiotics do play some role in repopulating a healthy gut with good bacteria. For the most severe or chronic cases of SIBO, the underlying overgrowth of bacteria must be controlled first before probiotics are brought into the mix.
Treatment with SIBO antibiotics
Since SIBO is essentially an overgrowth of bacteria in the gut, it makes sense that researchers and doctors would explore the effect of antibiotics on patients diagnosed with SIBO.
While many researchers and clinicians point to prior antibiotic use as a potential culprit behind the underlying cause of chronic SIBO, there are some promising results for certain types of patients with the antibiotic Xifaxan.
Xifaxan for SIBO?
Xifaxan (also known as Rifaximin) is known for being readily available in the gut and not very disruptive or easily absorbed by the rest of the body. This makes it a good antibiotic for SIBO.
It also has the methane killing properties that researchers were looking for in antibiotics that could potentially attack SIBO; as the methane is characteristic of the type of bacteria associated with SIBO.
Xifaxan has proven to have some promising clinical results with patients formally diagnosed with SIBO. Patients saw reductions in their core symptoms of gas, bloating, and distention.
Unfortunately, this was not the experience of 100% of patients; which is why it is often a common form of treatment but not a true standard of care.
Integrated medicine professionals see the problem as more complex than just killing off the methane-producing bacteria in the gut.
In fact, many patients claimed that use of Xifaxin (rifaximin) made their SIBO symptoms much worse. I’m not talking about SIBO die-off; which is actually sort of a good thing (SIBO die-off is when patients have short-lived negative effects from the elimination of harmful gut bacteria)
Xifaxan can cause constipation and slow down gut motility. Making dysbiosis symptoms and conditions of SIBO much worse in patients with this chief complaint.
To summarize, like many of the other treatments so far, it works better for some than others. it also works better in combination with other treatments better than as a standalone.
Do other antibiotics for SIBO work?
While Xifaxan is the most researched and most common antibiotic you will typically see prescribed for SIBO, there are some others that have shown limited promise in clinical and anecdotal settings.
Many have the same properties as Xifaxan, but some are a bit more unique. It has been noted that some patients that struggle with Xifaxan actually do well with Bactrim.
Bactrim is a combination of antibiotics and is known for causing hyper-motility — the opposite of Xifaxan. These contrasts may provide some insights as to why some patients do well with one vs. the other; as it is fairly obvious that not all patients are experiencing SIBO in the same fashion.
What all-natural SIBO treatments have been proven to work?
Now, we’ll quickly run down some of the other possible SIBO supplements and treatments to discuss which ones may or may not have some merit.
Oregano Oil for SIBO
Oregano oil would fall under the category of a natural antibiotic. Its mechanism would be that safely eliminates gut bacteria, but it is like antibiotics in that it does not self-select which bacterias it would harm.
Oregano oil in combination with other natural antibiotics may prove to be a good way for SIBO patients to see how they do with an “antibiotic” approach to treatment before using a drug like Rifaximin.
SIBO herbal treatments
This can include everything from teas to supplements like mallow root. Most of these have very little research behind them but often show some limited anecdotal support.
The early evidence tells us that these forms of treatment may provide some improvement but are highly unlikely to cure SIBO. If tea or other natural supplement is able to make all of a patient’s symptoms subside, it is likely they were not experiencing a very severe case of SIBO or misdiagnosed.
This does not mean that these forms of treatment don’t belong in a part of a larger treatment plan.
Many integrated medicine professionals use a mixture of tinctures, teas, herbal supplements, and other forms of therapy to holistically treat SIBO.
In fact, some of the best results recorded from actual SIBO patients that went through full treatment protocols leveraged these kinds of tools to assist them with their recovery from SIBO.
What’s the best way to treat SIBO?
As evidenced by all the detail above, SIBO is not something that has a universal form of treatment yet. It’s fairly obvious that not all patients are experiencing the same thing; nor do they likely have the same underlying causes.
This means treatment is a practice with SIBO. Those suffering from small intestine bacterial overgrowth must be diligent in their pursuit of a method of treatment that yields result for them.
This condition is something more and more medical professionals are becoming educated about. We recommend finding an integrated medicine professional with experience treating SIBO patients.
They can help you with your diagnosis and the process of exploring different combinations of treatments. One thing is fairly obvious, combinations of treatment seem to work much better than singular methods applied on their own.
Questions, discussions you’d like to start? Leave them below.
Tyler is an award-winning entrepreneur, former athlete, and founder of several successful online publications about sports, health, and well-being. Tyler has both a storied career in business and as an author/writer — contributing to publications like Forbes, The Harvard Business Review, The New York Post, and many more. A former competitive athlete, Tyler is now the founder of InjuryHealthBlog.com.