Healing SIBO
Healing SIBO - Essential Reading!
In talks such as this one on the RHR podcast, Chris Kresser and Gastroenterologist Dr. Kenneth Brown discuss the connections between IBS, depression, skin issues and SIBO(1), plus the ineffectiveness of synthetic antibiotic treatment for SIBO, methanogens/archaebacteria and the struggles for those with gut dysbiosis and dysfunction to get a diagnosis and successful treatment, among other topics. Reading this article and our Gut Dysbiosis/SIBO In Depth page is a good way to get a grasp on the slippery fish that is SIBO and understand why treating this chronic condition is no piece of cake. It’s crucial you get to grips with this vital info before you can begin your own healing journey, and being well informed and keeping well informed will help you avoid making mistakes. Believe us when we say that this so way too easy to do - we found this out the hard way. Elements of this page may not make sense without having read the SIBO In Depth page beforehand so if you haven’t already, now would be a good time :P
Our primary Healing SIBO sources include -
- Chris Kresser’s Revolution Health Radio (RHR) podcast + articles(2), (3), (4)
- PubMed study; Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth(5)
- Metsol Study; Selected Herbals Proposed as Beneficial in the Eradication of SIBO(6)
- Natural Medicine Integrative SIBO Conference(7)
- Dr Jocker’s Strategies to Beat SIBO Naturally(8)
Onward to health + happiness people!
Summary of the Healing Stages
Summary of our SIBO Healing SIBO Stages
Your recovery time and healing routine/groove will depend on the severity and longevity of your unique SIBO case and the condition of your gut. The full Healing Protocol Stages are below, but here is a bitesize summary of our steps for treating SIBO, healing the gut and restoring gut motility and function naturally -
The SIBO Diet + Botanical antibiotics (if they work for you) + Intermittent Fasting and regular short water fasts (+ extended fasts, if they are right for your case) + the Essential Supplements to Heal SIBO, the Gut and Autoimmunity = GOODBYE SIBO + HELLO HEALTH :)
The 5 necessary steps to overcoming SIBO are -
1 - Assess + Address your mental health + wellbeing
2 - Kill the bad, evil bugs (rebalance your gut microbiome)
3 - Heal the gut
4 - Repopulate the gut with beneficial 'good' bacteria
5 - Establish good habits to avoid relapse
1 - Assess + Address your Mental Health
As chronic anxiety and stress is a major cause of gut dysfunctional disorders such as SIBO, assessing our mental wellbeing is a vital first step to the healing process. We discuss this topic in depth on the Mental Wellbeing, On Happiness and Meditation + Neuroplasticity pages.
2 - The Kill Stage - Reduce Bacterial Burden + Break the Cycle
Combining the SIBO Diet and the Botanical Antibiotics listed on the SIBO-Killing Herbs page will starve and kill the SIBO and, in so doing, reduce hydrogen levels (produced by the bacteria), thus starving the archaea of their food source. As a result, methane (produced by Archaea) levels will reduce, halting any further gut lining damage.
Liquid, water fasting + IF will improve gut motility and reduce food sources and feeding opportunities for the bacteria, thus reducing bacterial burden and allowing the gut to heal, and in so doing, reducing chances of a relapse - very common among SIBO-sufferers. See stage 1 below.
3 - Fixing the Gut - Repair Gut Motility + Rebuild the GI Lining
As the bacterial load begins to decrease, fasting will become easier and easier as the toxins they dump into your system also decreases. You will begin to gain the upper hand as they diminish so fasting will become less of a battle mentally and physically and food intolerance reactions and other health issues attributed to and caused by the SIBO will improve.
Continue liquid, water and IF to allow the gut plenty of time to rest and repair. The amount of fasting required and recovery time will vary a lot from case to case. See stage 2 below.
4 - Hello Good Bacteria! - Repopulating Gut Flora
Rebuild beneficial flora population with high success rate probiotics such as the soil-based (see Healing the Gut + AI), which are also antimicrobial(4). This is the last part of the fixing the gut stage, and should begin when your SIBO symptoms and bacterial burden has been considerably reduced and your gut function and motility is back to normal.
5 - Recovery - Continue Good Habits to Prevent Relapse (on-going)
As chances of relapse for SIBO-sufferers is high, you should continue with your healing groove, including liquid fasts, water fasts and IF routines to maintain gut health, promote gut motility, ensuring that no SIBO has the opportunity to develop again.
A Tricky Business - Nutraceutical Treatment
Treating SIBO with Botanical Antibiotics
Antibiotic (noun) - a medicine (such as penicillin or its derivatives) that inhibits the growth of or destroys microorganisms.
An antibiotic is anything that kills bacteria or other microorganisms. It can be made synthetically in a lab or extracted directly from a plant. Herbal antibiotics are simply natural antibiotics that are extracted from herbs and plants grown around the world or in your own garden. Humans have been relying on natural substances taken from bark, roots, fungi, flowers, rhizomes (underground stems) and plants in the form of herbal antibiotics for thousands of years.
“Healing with medicinal plants is as old as mankind itself. The connection between man and his search for drugs in nature dates from the far past.”(9)
Botanical/Natural/Herbal Antibiotics as Medicine
Plants, just like humans, have evolved defense mechanisms which we term as “antibiotic substances” in order to protect themselves from bacteria, viruses, fungi and other parasites. Humans have developed a complex immune system as have all other living organisms and plants are no different. They have developed an amazing array of substances and chemicals that they use to protect themselves against infection. When therapeutic amounts of these plants are taken into the human body, these substances help us fight off infections also. They also provide us with a myriad of other profound health benefits.
“Contemporary science has acknowledged their active action, and it has included in modern pharmacotherapy a range of drugs of plant origin, known by ancient civilizations and used throughout the millennia.”(9)
When to Take the Botanical Antibiotics
“...this is an old microbiological concept — happy bacteria, happy and well-fed bacteria, are more sensitive to antibiotics and are easier to kill. What that means is that most antibiotics work on the replicating cell wall of bacteria. When bacteria are in hibernation, starving, distressed, they wall off, don’t replicate, and they just sit there, waiting for conditions to improve. That’s a survival mode. So when the bacteria are in survival mode, antibiotics won’t penetrate and won’t work as well.”- Mark Pimentel MD(10)
When the bacteria feed, they emerge from their protective biofilm barrier, so taking the antibiotics with a meal can be far more effective than taking them on an empty stomach. Many are also highly potent so it’s best to avoid taking them without lining your stomach first - just in case. Don’t worry too much about biofilms - most of the SIBO-killing herbs are biofilm disrupting agents.
The Difference Between Herbal + Prescribed Antibiotics
The main difference between herbal antibiotics and prescribed antibiotics is the source and the purification methods used. 25–50% of current pharmaceuticals are plant derived but highly processed into specific compounds(11).
- Anti-bacterial and anti-microbial antibiotics derived from plant sources tend to spare the healthy (and vital) gut bacteria that live within all of us, decreasing the risk of diarrhea and other complications of antibiotic therapy.
- Plant sources of antibiotics tend to be less specific than prescribed, synthetic antibiotics and so the overall risk of adverse effects also decreases with use of herbal antibiotics
Botanical Antibiotics > Fighting Antibiotic Resistance
Since the introduction of synthetic antibiotics, bacteria have been able to adapt quickly to these purified compounds. And this is far from surprising. The “life purpose” of bacteria is to reproduce, grow and colonise and bacteria can double in number very quickly, so they rapidly adapt new ways to escape the selective pressure put on them by synthetic antibiotics. So, in order to survive, bacteria evolve ways to out-compete the effects of antibiotics—they become antibiotic resistant.
Herbal antibiotics, however, give the bacteria far fewer opportunities—plants have been making antibiotics for a lot longer than we have and are more robust, complex and harder to out-smart. Plant extracts have the ability to bind to protein domains, leading to modification or inhibition of molecular mechanisms of action (MOAs).Thus they may not only kill microorganisms, but by affect key events in the pathogenic process and thereby, halt the defence mechanisms and adaptations of the fungi, bacteria or virus, reducing their ability to develop resistance to the botanicals(11). They also spare the healthy bacteria which can quickly grow to “reclaim” the territory that the infectious pathogenic bacteria were colonising. The healthy or ”good” bacteria grow better and stronger than the infectious bacteria and effectively crowd them out.
“...botanical treatments make a lot of sense.” “A study showed that botanical treatments were as effective, or more effective than antibiotics for SIBO, and had far fewer side effects. One of the reasons for this is that botanicals, herbs, plant substances, have a really broad spectrum of activity. And it’s far less likely that organisms will be able to develop resistance against a botanical, because within each single herb, there are many different active compounds, instead of just one active compound that’s in an antibiotic. So it’s much harder for the organism to adapt to that.”(4)
Stage 2 - Start Killin' Them There Bugs!
Stage 1 - The Kill Stage
The SIBO Diet + Eliminating Damaging Foods
The SIBO Diet is a combination of 2 or more diets, all of which consist of easily fermentable/digestible foods, aimed to pass quickly through the small intestine and thus reduce the food source to “starve” the bacterial overgrowth. It is essential to combine this diet with Intermittent Fasting and prokinetics as the underlying cause of SIBO is typically Impaired gastric peristalsis/gut motility(12).
It is recommended that those with gut dysfunctional disorders eliminate all foods that they are reacting to. For those with advanced leaky gut syndrome and autoimmune conditions, avoid grains, nuts and seeds (this includes spices) and other foods which cannot be easily digested or are potential gut irritants to up to 12 weeks(13) to lower inflammation and allow gut healing. Once your gut is in a better state, you can then reintroduce these foods slowly, carefully noting if and how you react to each in a food journal. All people suffering from gut disorders should consider eliminating all forms of sugar including fructose (fruit, except low FODMAP berries which contain the lowest amount), lactose (all dairy) and glucose (found in wheat glucose).
Breaking the Cycle - Activated Charcoal, Methane + Gut Motility
While healing SIBO, it is important to take Activated Charcoal, 1ml+weekly or more often if needed. This agent absorbs toxins and chemicals including those from SIBO die-off as well as hydrogen gas produced by the overgrowth, thus starving the archaea of their food source. It also absorbs the damaging methane which the archaea produce, which slows intestinal transit time(14). So the less hydrogen, methane and biotoxins that are absorbed by our intestines, the better! Be sure to drink a tonne of water before, after and during as the charcoal is super absorbent and can leave you dehydrated. Like all other essential supplements we recommend, carry out your own research so you know how to use these magical substances safely.
Prokinetics - Keeping Things Moving
As is often the case, things will get worse before they get better. Your symptoms may worsen temporarily as both the Die-Off/Herxheimer reaction and the herbs will affect your digestion. It’s important to support gut health and healing and promote gut motility in every way you can, keeping food moving through to hinder any further bacterial overgrowth. Thus, taking a natural prokinetic agent during this time is essential. We list many on the Essential Supplements page.
“There are studies showing that treatment with laxatives and bowel cleansing, like a colonic, can reduce or eliminate methane production in some patients. So that would suggest that constipation, at least to some extent, may increase—methanogens may favor a slow transit type of environment, and when you’re constipated, you might get an increase in methane-producing species.”(4)
As stated above, gut motility is also key to the healing process as slower colonic transit time is favoured by both the bacterial and archaea populations of a SIBO-C infection. Therefore, regular liquid/water fasting/IF, plus prokinetics and regular enemas will all help to reduce the digestive burden on your gut and improve intestinal transit times. Allowing your gut to rest will also allow it to heal, thus fixing your underlying gut motility disorder and leaky gut condition at the same time. Fasting is magic.
Before You Start Your Treatment
Before You Take Any Botanical Antibiotics...
Remember - You Are Unique
Bear in mind that each person and their gut microbiome are unique, as is each case of SIBO. Which antibiotics are most effective for you will depend on your particular bacterial populations. Different herbs are more effective against either methane-dominant (SIBO-C) or hydrogen-dominant (SIBO-D) bacteria but some are effective against both. However, which herbs your particular bacterial populations are sensitive can be uncovered by undertaking a stool test. Alternatively, (to save money) you can experiment with the herbs listed below, which have been shown to be effective for most SIBO cases.
Nothing In Isolation - Self-Care is Essential to Healing + Wellbeing
As stated above, none of the treatments work in isolation - just taking the herbs without the SIBO diet, an intermittent fasting routine, water fasting, self-care routine and supplementing for gut and immune health, will not be effective.
“Alternative therapies commonly used by IBS patients that have some level of scientific basis in the literature include acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotics, hypnotherapy, psychotherapy, cognitive therapy, and behavioral therapies.”(5)
***If at any time your die-off symptoms are too intense, reduce your herb dosages rge intestine.
The Healing Groove
The Healing (SIBO) Groove
We followed this healing groove which worked wonders for us! Feel free to use this as a guide and adapt it to create your own healing routine, incorporating in tonnes of self-care habits as you go -
- Intermittent fasting routine - only one meal daily (OMAD) or x2 meals daily if you are refeeding between long (7+ day) water fasts. X2 meals allowed on a Saturday/Sunday - the “cheat day”. We all need to cheat now and again. Being good is so hard!
- 40-72 hour water fasts weekly with enemas (at least once weekly) for a system cleanse. How long you will need to fast for, and how often, will depend on the condition of your gut and severity of your SIBO case. Water fasting may be too tough at first if the bacterial die-off symptoms are overwhelming. It’s important to undertake short water fasts regularly once and when you can, for gut healing and gut maintenance, detoxification and to speed up SIBO die-off. ***Bear in mind that as your bacterial load starts to shift, fasting will become easier and easier as the toxins they dump into your system decrease
- X3/4 different herbs with your daily meal. Rotate every two weeks. Keep a diary/calendar and make a note of those which are most effective for you and stop after one month if you haven’t noticed any significant improvements or if symptoms worsen
- Stick very strictly to the SIBO diet - SIBO-safe foods only! This will speed up die-off (by starving the SIBO), promote peristalsis and unburden your GI system as all the foods on this diet are super easy to digest
- Take multiple digestive aids + prokinetics daily. Digestive enzymes, fresh ginger, ACV, lemon/lime juice with meals will help lessen the digestive burden on your compromised GI and 5HTP + magnesium away from meals will promote GI motility.
- Drink fresh ginger, peppermint and nettle leaf tea during the day - ginger is an anti-inflammatory, antimicrobial and a powerful prokinetic agent, peppermint relaxes the muscles in the gut, improving digestion(14) and nettle is an antihistamine, nutrient-rich and an anti-inflammatory agent
- Nutrient-rich, energy boosting morning drink - Shilajit, Magnesium, L-Glutamine + Vitamin C in filtered water
- For gut + immune health - take zinc daily (optional - plus x1 adaptogen) and multivitamins every other day or weekly - it’s best to avoid the body relying on them or getting used to them so they become less effective. Rotate adaptogenic herbs every 2 weeks. See Essential Supplements.
- Toxin Binder, such as Activated Charcoal. This will help with bloating and the toxic dump from the bacterial die-off. Take a dose weekly or more frequently if needed, but be sensible and don’t take too much - the consequences are not fun! By absorbing the harmful gases and chemicals produced by die-off, the AC will also eliminate the food source of the archaea, thus halting 2 major causes of gut damage in the process
- Mental Hygiene + Sleep Hygiene - develop routines you enjoy and which promote health in mind + body. More details on this on the Health-Hacks and Mental Wellbeing pages - there’s a lot to this. We both try to get early nights most nights (between 10.30-11PM) and meditate daily
- Have FUN! Though your unwell, that shouldn’t stop you having fun. I draw a lot which is like my art therapy and we both try to go dancing and walking in nature regularly which we love! Do things you love and do them often.
Stage 3 - Gut Healing with Gut Feeling
Stage 2 - Fixing the Gut - Repair Gut Motility + Rebuild the GI Lining
After 1-2 rounds (or more) of stage 1. The Kill Stage, you can move into stage 2. Fixing the Gut, which focuses on repairing the MMC wave/peristalsis and rebuilding the gut barrier which is essential to health in the body. We discuss the gut barrier and exactly how SIBO damages the gut on the Gut Dysbiosis/SIBO In Depth page.
Healing the Gut + Autoimmunity are inextricably linked and we discuss the gut-autoimmune connection and how to heal the gut in depth on that page.
As the integrity of your gut lining improves, your capacity for nutrient absorption will increase. You can now focus on flooding your system with vitamins and minerals to boost your strength and fighting power. Supplements such as Lauricidin or lauric acid, taken as a multivitamin(4) and which is also antimicrobial, is a good place to start.
Stage 4 - Hello Good Bugs
Stage 4 - Hello Good Bacteria! - Repopulating the Gut
Continue the good habits of healing stages 1+2 until your SIBO symptoms have diminished and your gut is functioning normally again. Well bloody done to have come this far - it’s no mean feat!
When you have recovered sufficiently, begin introducing high FODMAP foods into your diet again, one by one. Depending on the extent of the reactions, you will know the condition of your gut and whether you will need to return to stage 1 or 2 again for a time - don’t worry if you do, you are not going back to the beginning. Fighting SIBO is no straight road and you haven’t failed - far from it! You will have learned a lot on your healing SIBO journey and things will be much easier for you the second time around :)
As chances of relapse for SIBO-sufferers is high, you should continue with your healing routine, including liquid fasts, water fasts and IF schedules to maintain gut health, promote the MMC, ensuring that no bacteria has the opportunity to recolonise the SI.
Repopulating the beneficial gut flora population for SIBO sufferers is a tricky business and knowing the right probiotics to buy is crucial. Because this is easy to get wrong and such an important topic, we’ve dedicated a whole section to this on the SIBO + Autoimmunity page.
Stage 5 - Recovery
Stage 5 - Recovery - Continue Good Habits to Prevent Relapse (on-going)
If at anytime you notice symptoms recurring, you can simply return to the routine you created in The Kill Stage to get rid of those pesky bugs!
Avoiding sugar in all its myriad of forms, including alcohol, fructose, glucose, immunosuppressants and following the habits we recommend and discuss on this site which promote optimal health. We include all the info you could need to keep your immune system and gut health optimal and in check.
This isn’t a linear journey and patience is key. Trust your gut instinct.
Recovery Time + Advice
Recovery time varies hugely from one SIBO sufferer to another as each case and body is so different. But typically, SIBO recovery is a 6- to 12-month process. Be patient, keep a journal to record which herbs you are taking, duration, symptoms they caused or decrease and the dosages plus your intermittent fasting, liquid and/or water fasting routines. It’s vital to keep a detailed journal so you can keep track of what works for you and avoid making mistakes.