Currently, SIBO can be treated through three options: antibiotics, herbal antibiotics, and the Elemental Diet.
Antibiotics are often a preferred treatment option by gastroenterologists and patients alike, as they seek to attack the bacterial overgrowth quickly. Rifaximin and Neomycin are the most commonly prescribed antibiotics for SIBO, as they are almost completely non-absorbable and stay within the small intestine. This means they have a localised action and don’t cause systemic or widespread side effects.
Herbal antibiotics also seek to attack the excess bacteria directly by reducing the number of bacteria living in the small intestine. Herbs are often the first choice for alternative practitioners, naturopaths, and integrative physicians. They do take longer to take effect, so for every week on an antibiotic, two weeks are required on an herbal antibiotic. Studies have shown that herbal therapies are as effective as Rifaximin and have a similar response rate and safety profile. Some of the most commonly used herbs include allicin, oregano, berberine and neem, among others. Like all treatments, the correct herbal protocol needs to be determined for each individual patient and their specific type of SIBO.
The Elemental Diet replaces meals with a pre-digested liquid diet, which seeks to starve the bacteria while providing the individual with amino acids, carbohydrates, fats, vitamins, and minerals, which are absorbed in the upper digestive tract. The Elemental Diet can be made at home or purchased in over-the-counter formulations. Some formulations taste better than others, and this diet can be challenging, as it requires a complete liquid diet for at least two weeks. Some patients also complain of dramatic weight loss, which can be problematic for those already underweight.
The Elemental Diet is believed to have a high success rate in the treatment of SIBO, but it has many challenges, including cost, taste, food deprivation, and weight loss. It is often a last resort for patients. Some patients only need to do one of the three treatment options to recover from SIBO. However, for two thirds of people, SIBO is a chronic, recurring condition and multiple rounds are required of one or all three of the available treatments.
In addition to the treatment protocol, a patient’s nutrition is important in supporting the recovery from SIBO. It is currently believed that diet alone cannot cure SIBO, and instead is used to support treatment and provide relief from digestive symptoms. A restricted diet is designed to be used only for a short time. It is important to reintroduce a wide range of foods and fermentable fibers, as they feed the broader gut microbiome. In addition, it needs to be understood why the body developed SIBO in the first place. Just as bloating can be a symptom of SIBO, SIBO is a symptom of an underlying condition that has allowed the bacteria to migrate and multiply in the small intestine. Understanding and addressing the underlying cause should occur to achieve a permanent recovery from SIBO.