7 Tips to Treat SIBO Naturally  

Introduction 

SIBO is a gut health condition that is conventionally treated with antibiotics. In many of the SIBO cases I see at the clinic, patients have already tried antibiotics but have not seen an improvement in their symptoms.  

This may be where a more natural approach can be needed that takes more than just the antibiotic approach into consideration. 

Additionally many are opting for a more natural approach with approaches with both supplements and dietary interventions, of which there are many options. 

What is SIBO? 

SIBO (small intestinal bacteria overgrowth) is characterised by an elevated level of bacteria in the small intestine. Since the small intestine is meant to have a relatively low level of bacteria, this overgrowth in this part of the gut can then lead to symptoms. 

This can be due to changes in how certain foods are being absorbed or how they’re being fermented.  

Rather than SIBO being seen as an infection involving invading ‘bad’ bacteria, there needs to be an understanding of the underlying reason for this change in the gut microbiome. This is what we can refer to as the underlying issue.  

Even though SIBO may be considered an underlying issue for IBS, consideration does need to be taken into consideration what has led to SIBO developing. 

The underlying causes of SIBO include: 

• Food poisoning 

• Low-grade inflammation 

• Abdominal surgery 

• Hypothyroidism 

• Endometriosis 

• Motility disorders 

• Pancreatitis [1] 

What are the symptoms of SIBO? 

The symptoms of SIBO can fall into 2 main categories, these are digestive symptoms and non-digestive symptoms. 

The digestive symptoms of SIBO are typically what is seen in IBS and include: 

• Bloating 

• Distention 

• Abdominal discomfort 

• Changes in bowel movements (constipation and diarrhoea) 

In some cases, further symptoms can be present which include: 

• Malabsorption 

• Heartburn 

• Reflux 

SIBO symptoms can also appear outside of the digestive tract. These can be due to the by-products of the bacteria in the small intestine or the irritation along the gut lining, which may trigger an immune response. 

These include: 

• Brain fog 

• Fatigue 

• Acne rosacea 

• B12 deficiency 

• Iron deficiency [2] 

How to treat SIBO naturally 

Treating SIBO with natural methods often takes into account 4 areas of the gut. These can involve: 

• The gut microbiome 

• Low-grade inflammation in the gut lining 

• Gut lining irritation/intestinal permeability 

• Activation of the immune response 

In most cases of hard-to-treat SIBO, attention needs to be paid to these areas at the same time. If may be due to the (over)activation immune response or the low-grade inflammation actually being responsible for the bacteria overgrowth.  

If this is the case, antibiotics may lead to a short-term improvement, but it’s common for SIBO to return if this underlying aspect is not addressed. 

7 tips to treat SIBO naturally  

SIBO can be treated without the use of antibiotics with natural and evidence-based approaches including the following 7 tips. 

Probiotics 

A common misconception of probiotics is that they should not be used in SIBO. This is not correct, as probiotics do not ‘add more bacteria’ to the issue. In fact, the probiotics taken in capsules or food are classed as transient organisms, which means they travel through the gut but do not live there.  

However, as they pass through, they interact with the gut lining, leading to a beneficial response from the body. This can involve the gut lining producing its own antimicrobials to lower bacteria. 

This has been reported in studies that use specific strains of bacteria (such as Bacillus clausii), which have found that probiotics can be as effective as antibiotics for SIBO. [3] 

Prebiotics 

Prebiotics may need to be used with caution in those with SIBO. However, there is good research on a certain prebiotic called PHGG, helping with a range of digestive symptoms found in SIBO. In particular, it can be used to help normalise bowel movements. 

Specifically for methane SIBO, PHGG has been found to reduce levels of methane, the type of gas that is more commonly associated with constipation. 

Additionally, even in patients who take antibiotics for SIBO, if PHGG is taken with the antibiotics it increases the eradication rate from 62% to 87%. This is essentially due to the fact that ‘well-fed’ bacteria (from the prebiotic) are easier to kill. [4] 

Anti-microbial herbs 

A range of herbs with antimicrobial properties can be used to address bacteria overgrowth. In some cases individual herbs may be used or in others, a combination formula with several herbs can be considered. 

A benefit of herbs is that many of them have antibiotic and antifungal properties. This takes into consideration the possible presence of SIFO (small intestinal fungal overgrowth) alongside SIBO.  

These herbs include: 

• Garlic (allicin) 

• Oregano oil 

• Berberine 

• Neem 

A strategy that is often used is combining the results of a microbiome analysis with SIBO test results. This may provide specificity around which bacteria may be overgrown. However, from experience, this may not always provide better patient outcomes. 

Importantly, herbal therapies have been studied and found to be as effective as antibiotics. [5] 

Sodium butyrate 

Sodium butyrate is described as a post-biotic. This refers to the fact that it is produced as a by-product of the fermentation process that takes place in the gut but our gut bacteria. 

Its roles include supporting the repair of the gut lining and reducing inflammation. It also possesses its own antimicrobial properties as well as triggering the production of our natural antimicrobial defences. 

Sodium butyrate can also be taken in a capsule that can deliver a higher amount into the gut, which can be used for SIBO. [6] 

Bio-film disruptors 

Microbes can live in what are described as bio-films. There can be seen as a protective layer around the bacteria, which prevents antimicrobials from reaching them and being effective. 

Disrupting biofilms can be a consideration if limited improvements have been seen with herbal antimicrobials alone. However, many of the herbs used to treat SIBO also have biofilm-disrupting properties. 

Alongside these herbs, NAC (N-acetyl cysteine) can be used to make the bacteria more susceptible to antimicrobial therapy. [7] 

Try the Elemental Diet 

The elemental diet is a short-term liquid diet that is a very different approach to other diets, such as the SIBO diet or a low FODMAP diet.  

Where the elemental diet is different, is that it doesn’t simply reduce fibre intake to manage symptoms (as the other 2 diets mentioned do), but it works in a different way. 

This is to not only reduce fibre intake but also remove all other food compounds that may aggravate an immune response or increase inflammation. [8] 

Introduce Colostrum 

Colostrum is the first milk that mammals produce to feed their newborns and it contains a wide range of nutrition and support for the gut lining.  

While colostrum hasn’t been studied directly in those with SIBO, it has been found to be helpful in treating IBS. Due to the understanding that up to 80% of those with IBS actually have SIBO, we can connect the dots and consider colostrum to be addressing the SIBO.  

This is something I have found to be helpful in a wide range of digestive issues in the clinic. [9] 

Summary 

Rather than antibiotics being the only considered approach for treating SIBO, a wide range of natural therapeutic options are available. As these take into consideration the underlying cause of the overgrowth, it’s possible to see longer-lasting changes with these approaches.  

This is reflected in the improvements seen in many SIBO patients who may not have responded to antibiotics but see improvement with some of the options mentioned here. 

Contact the clinic today to understand how we can help you take back control of your gut health.