SIBO Herbal Antibiotic Treatment

Like pharmaceutical antibiotics, herbal antibiotics seek to attack bacterial overgrowth head on and fairly quickly. Herbal antibiotics have been shown to be equally successful to pharmaceutical antibiotics in a multi-center study, including Johns Hopkins University. [1] It is the first choice for most Naturopathic physicians and functional medicine practitioners. Like all antibacterial SIBO treatments, it must be followed with preventative measures, since relapse is so common.

Which Herbal Antibiotics Are Used for SIBO?

Herbal Antibiotics are based on SIBO Type. Different herbs are needed to target the different bacteria and archaea (methanogens) that produce each type of gas. See specific protocols and doses by signing up here.
Primary:
  • Berberine, Neem and Oregano - used for hydrogen, as well as methane and hydrogen sulfide in combination with another herbal antibiotic
  • Allicin and "Atrantil" - used for methane in combination with Berberine, Neem or Oregano
  • Bismuth and Oregano - used for hydrogen sulfide, alone or in combination
Also used:
  • Pomegranate husk/peel - used for hydrogen
  • Uva Ursi - used for hydrogen sulfide in combination with another herbal antibiotic
  • Combination antimicrobial formulas that include various herbs (see below)

See "Where to Get Herbs" below for specific products.
Numerous herbs demonstrate antibacterial activity, but as with any condition that antibiotics are used for, finding the right match and dose is crucial. Myself and other SIBO specialists who have been using herbs to treat SIBO since 2011, have found them to be as effective as pharmaceutical antibiotics, when the right herbs are used for each type of SIBO (in the right dose). However, the duration needed is longer to reach this same effectiveness - 4 weeks for herbs vs 2 weeks for antibiotics per treatment round.

Herbal antibiotics have many benefits including being anti-inflammatory and having anti-fungal, anti-viral and anti-parasitic effects, depending upon the herb. Side effect risk tends to be lower than pharmaceutical antibiotics, for example they are not known to cause urinary tract or yeast infections.

Bismuth, while not an herb, is a key antibacterial used for hydrogen sulfide [2], and in Thiol form, is also anti-biofilm, according to Dr. Paul Anderson who pioneered bismuth-thiol formulas.

SIBO Herbal Antibiotic Duration

A standard treatment round of herbal antibiotics is 4 weeks. If hydrogen or methane gas is high (≥ 70 ppm), a 6 week course is sometimes used. 

Most cases need 2-5 treatment rounds of herbal antibiotics or antibiotics to clear SIBO (elemental diet typically requires less rounds). Retesting is used to determine if/when more rounds are needed, based on gas ppm levels. Unfortunately, extending herbal antibiotic treatment for a longer duration to avoid the need for multiple rounds, often proves ineffective, as effect tends to peters out after 6 weeks in many cases. 

See Treatment Overview for more info. 

Herbal Antibiotic Protocols and Dosage

Specifics are not displayed publicly on this website for legal purposes, but are available for free by signing up here.
​(If you have already signed up: log in here)

Combination Herbal Formulas for SIBO

Combination herbal formulas containing multiple herbs are often used as a first approach to address bacterial (SIBO), yeast and parasitic issues at the same time. However, they may not contain the right doses or forms of herbs known to be effective for each type of SIBO, and due to the multiple ingredients, may cause reactions in sensitive people. If combination formulas are not effective, consider using the specific SIBO protocols listed here.
The following combination formula protocols have been studied for SIBO [1] and are best suited to Hydrogen SIBO, with some dose modifications (see doses here)  - For Methane, consider the addition of the following to the above formulas: Allimed/Allimax Pro (Hollywood Homestead 56% off trusted source) (Amazon) or Atrantil (Amazon or exclusive pricing at Fullscript), (see doses here)
- For Hydrogen Sulfide, consider the addition of Bismuth (Amazon) / Bismuth-Thiol (Amazon or exclusive pricing at Fullscript) or high dose Oregano (Amazon or exclusive pricing at Fullscript), to the above formulas. (see doses here)

Where to Get Herbs  

Most herbs are widely available commercially. The following brands have been shown effective in Dr. Siebecker's practice with before-and-after SIBO breath testing. 

Berberine is a component of many herbs such as goldenseal, Oregon grape, barberry, phellodendren, coptis and yerba mansa. Neem Oregano is often better tolerated in dry tablet form (vs oil in capsules). Allicin is a component of garlic, and is more effective and better tolerated by those with SIBO than whole garlic, garlic oil or aged garlic. Read labels to make sure a product labeled 'allicin' is not whole garlic and contains 450mg of allicin.  Atrantil is a 3 herb combination with mild killing activity that primarily works to stop methane production. If effective as a treatment, it is then continued ongoing at a lower dose (see doses here). Uva Ursi Bismuth while not an herb, is a primary antibacterial used for hydrogen sulfide. Bismuth-Thiol is an alternate form of bismuth, that additionally works as a biofilm buster.
- Bismuth Rx (prescription)
  • bismuth subnitrate or subcitrate is available from some compounding pharmacies in 650-750 mg/pill.
- Bismuth OTC (over-the-counter) - Bismuth-Thiol Rx (prescription)
  • available from some compounding pharmacies as: 200 mg Bismuth Subnitrate / 100 mg Alpha Lipoic acid / 25 mg DMPS or 100 mg DMSA, per cap* 
- Bismuth-Thiol OTC (over-the-counter) *formulated by Dr. Paul Anderson, see his Bismuth-Thiol Handout 

Combining Antibiotics + Herbal Antibiotics

Antibiotics and Herbal Antibiotics can be combined. For example, Allicin can be used with Rifaximin, in place of Neomycin or Metronidazole for Methane SIBO/IMO. See specific SIBO protocols and doses here.

For more details about herbal antibiotics and SIBO treatment, see Courses, join a Q&A and sign up for Dr. Siebecker's newsletter.
More Resources: SIBO Herbal Antibiotic playlist on my YouTube  

   Learn more
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