Despite the fact that this paper was published in 2014, it’s still very relevant and I’m just behind in sharing it via a blog post: Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth
Patients with small intestine bacterial overgrowth (SIBO) have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. Present treatment of SIBO is limited to oral antibiotics with variable success. A growing number of patients are interested in using complementary and alternative therapies for their gastrointestinal health. The objective was to determine the remission rate of SIBO using either the antibiotic rifaximin or herbals in a tertiary care referral gastroenterology practice.
I’ve also decided to post this study now because I’ve been dealing with chronic SIBO for some time and am in the middle of doing the Metagenics herbal protocol (more information on that below).
SIBO symptoms and conditions
Here is a summary of some of the chronic intestinal symptoms: Abdominal bloating (gas), belching, flatulence, abdominal pain, cramps, constipation and/or diarrhea, heartburn (reflux or GERD), nausea and food sensitivities.
Here is a summary of some of the extraintestinal (outside the intestinal system) symptoms and conditions that have been linked to SIBO and/or dysbiosis: disorders of mood and behavior (including anxiety), diabetes, obesity, cardiovascular disease, rosacea, restless legs syndrome, pain, anemia, interstitial cystitis, and other pelvic conditions such as vulvodynia and proctalgia fugax (rectal spasms), chronic prostatitis and polyneuropathy.
During season 3 of The Anxiety Summit, I interviewed Dr. Allison Siebecker on Small Intestinal Bacterial Overgrowth and Anxiety. We talked about the SIBO Questionnaire I use with my clients and she gave me permission to share my modified version. You can find this SIBO questionnaire here. Please check out Dr. Siebecker’s site siboinfo.com for a wealth of information about SIBO.
The herbal treatments in this study
In this study, one hundred and four patients who tested positive for newly diagnosed SIBO by lactulose breath testing were offered either 1200mg rifaximin a day or one of two herbal treatments for 4 weeks. Lactulose breath testing was done again at the end of the treatment.
These are the two herbal treatments that were offered:
Dysbiocide and FC Cidal (both by Biotics Research): take 2 capsules twice daily of each of these products
or
Candibactin-AR and Candibactin-BR (both by Metagenics): take 2 capsules twice daily of each of these products
The ingredients in each of the products
(from the paper: Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth)
Study conclusion
The study concluded that these herbal therapies are at least as effective as rifaximin for resolution of SIBO. It also states that the herbal products also appear to be as effective as triple antibiotic therapy in patients who don’t respond to rifaximin.
Adverse effects
With regards to adverse effects, they were reported as follows: in the rifaximin treated patients there was 1 case of anaphylaxis, 2 cases of hives, 2 cases of diarrhea and 1 case of Clostridium difficile; in the herbal group only one case of diarrhea was reported.
A comment about bioindividuality
You’ll notice that the only herb that is in both sets of herbal protocols is Red Thyme Oil or thymus vulgaris and yet both herbal protocols offer a solution. I’ve heard Dr. Siebecker share that of all the different approaches for SIBO (including the elemental diet), at least one approach works for everyone. So, if you’ve tried an approach and it hasn’t worked, don’t give up and move on to the next approach. This points to bioindividuality, and there being no one size fits all approach.
Dr. Siebecker lists the above combination herbal protocols together with the herbal protocol her and team use on her site, which, again, is different from the above: 1-3 of the following herbs x 4 weeks per course, at highest levels suggested on product labels.
- Allicin from Garlic (the highest potency formula is Allimed)
- Oregano
- Berberine- found in Goldenseal, Oregon Grape, Barberry, Coptis, Phellodendron
- Neem
- Cinnamon
My protocol and experience
As I mention above, I also decided to post this study because I’ve been dealing with chronic SIBO for some time and am in the middle of doing the Metagenics herbal protocol. I’m 14 days into a 28-day protocol.
I’m actually doing 1 capsule of Candibactin-AR, 3 times a day away from food and 2 capsules of Candibactin-BR, twice a day, and about 10 minutes before food. I landed on this protocol, so I would have enough of each for a 4-week protocol.
When I started on the products I immediately observed the typical SIBO bloating and almost quit but quickly figured out it was from the microcrystalline cellulose and hypromellose in the Candibactin-BR.
It turns out that these are soluble fibers (dispersible in water) and are more easily fermented than insoluble fibers. This fermentation in the small intestine can trigger IBS/SIBO symptoms. Adding 2 capsules of a product with cellulase (an enzyme that breaks down cellulose) has helped.
Pain, gas and GABA
I also remembered that Dr. Siebecker shared on the SIBO SOS I summit about how SIBO patients can have visceral hypersensitivity where their pain can be due to the pressure of the gas that is produced and the muscles in the digestive system actually contracting against this pressure. It got me thinking about how effective GABA is for relieving muscle tension. I use GABA with my clients all the time for relief of their physical anxiety and stiff and tense muscles. And GABA helps me and many others with proctalgia fugax (rectal spasms) which seems to be related to IBS/SIBO.
Over the last week I’ve tried sublingual GABA a few times to ease the pain and pressure and it’s been amazing. I’ve used it as soon as I notice the bloating starting AND even the next morning when I wake with the bloated ache in my belly. I’ve been using the NFH GABA-T SAP opened on to my tongue. This product contains 300mg GABA and 150mg of theanine.
I’m going to keep this in mind in case of a future flare up of my IBS/SIBO if I’m accidentally exposed to a food I can’t tolerate – assuming this protocol doesn’t clear it up for me. I suspect, as Dr. Siebecker reports, and based on the fact that I have chronic SIBO, that I’ll need a few more rounds anyway.
There is research supporting why this works: there are GABA receptors all over the gut and GABA is important for motility. (Stay tuned for a detailed blog post on this topic).
As well as the initial bloating and pain, I’ve also experienced some die-off symptoms like brain-fog and feeling blah, together with some sleep issues a few nights. The GABA helps with this and so does the tryptophan that I’ve also added.
If you’ve used GABA for this purpose or medications like Gabapentin or others to achieve similar results, I’d love to hear from you.
I’ll share more as I progress through the protocol. I’m also going to be speaking on SIBO SOS summit (the 3rd one) hosted by Dr. Allison Siebecker and Shivan Sarno. I will share more about my SIBO journey then, as well as all my results with this herbal protocol and any other challenges I face along the way.
Please also share if you’ve had success with any of the above herbal protocols or other approaches for your SIBO.
And feel free to post any questions below.
Hi Trudy,
Thank you for the informative reads I can hardly wait for you publications to come. Excellent info!
Hi Trudy,
Dr. Gerard Mullin was the lead author of the research paper you are referencing.
He and I worked on the listed protocol. The Dysbiocide and FcCidal are correct, however, ADP the time released emulsified oil of oregano from Biotics was part of the protocol and not mentioned here. In addition, some patients require 3 tabs bid of each.
If a patient cannot tolerate the ADP due to concurrent stomach inflammation then Berberine HCL is the best alternative.
While other companies and doctors have adapted their version to treat SIBO, the listed protocol is the only published referenced study.
Hope this is helpful.
Dr. Marks
Dr. Marks
How exciting that you worked with Dr. Mullin on these protocols and thank you for contributing to the field in this way! Thanks for the correction about Biotics A.D.P. oregano product being part of the protocol. I’m very curious why this was not mentioned in the paper? It’s good to know about the berberine alternative – would this be 500mg x 3 per day?
It’s also good to know about 3 tablets twice a day for some (I assume this is for the Biotics products?)
I’d love to hear your feedback on the Metagenics protocol and if you see similar results as what Dr. Siebecker reports i.e. different people respond to different protocols?
Also, have you found sublingual GABA to help your patients who experience visceral pain as a result of their bloating and gas?
Hi Trudy,
My apologies, you are correct that the research paper only listed Dysbiocide and FcCidal and also the 2 Metagenics products. It has been 3 years since that research was published (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/) and I had forgotten these important details. However, Dr. Mullin and I use these additional botanicals in the treatment of SIBO in clinical practice.
I have treated numerous patients with the aid of the additional ADP or Berberine and of note, often replace one with the other after a few weeks of treating. There is often a loss of bactericidal activity over time that can occur as the organisms adapt to certain botanicals. ( I determine this with IAT, an advanced muscle testing procedure when and if this occurs). Whether one uses Biotics or the Metagenics formulations, I would suggest these additional adjuncts in either recalcitrant cases or for those patients with more significant presentations as well as adjusting dosages higher if warranted.
When I use the Berberine HCL, my starting dose is 2 caps bid.
I have not tried sublingual GABA, however, I have found that enteric-coated peppermint oil works extremely well for those symptoms.
Low ilio-cecal valve pressures have been correlated with SIBO as well. Consider having a kinesiologist evaluate and treat if necessary.
Lastly, the MMC (Migrating Motor Complex) is a major contributor to the gut dysmotility in the small intestine associated with the condition. Prokinetics can be very helpful here.
Hope all this helps,
L
I was thrilled to find this info and am now trying to find the products mentioned. I hadn’t heard of SIBO before. It certainly sounds like what I’m dealing with! I live in Israel and have relatives and friends in Canada who visit, so, knowing a source in Canada for your protocol is helpful.
Many Thanks,
Sheli
Hi Sheli,
You need to find a doctor to diagnose you properly. Look up Hydrogen breath testing through a functional medicine doctor or call a gastroenterologist to see if they perform these tests.
There actually is a distributor for Biotics Research in Israel. Call the US ofc to get the number.800-231-5777.
Dr. Marks
Trudy I’ve been following you for years. Thank you for sharing on your SIBO experience. I have almost every symptom and have not been very encouraged by other people’s approaches to eradicating SIBO. I am struggeling with how to find someone in my area to work with that gets this or can I order these products on my own? For the longest time I just thought I had to live like this. Even the proctal fugax you have been addressing I have had off and on for years. Now I realize why my thyroid never gets better. It won’t until I address my SIBO. I live in St Petersburg FL and if you have any contacts from all the seminars you attend I would greatly appreciate it.
Hi Trudy
Wondering how you got on after you finished this protocol.
Also is there any where in Australia the products you mention could be purchased. Seems many suppliers do not ship to Australia.
Thanks for your advice,
Theresa
Theresa
I didn’t notice anything right away (in terms of being able to eat problematic foods) but in the month following my last dose I have noticed that my bowel movements have changed. I need 1/3 of the magnesium I used to use on a daily basis. My previous SIBO test indicated high methane which is associated with constipation I am much less constipated so assume my methane has gone down and plan to redo my SIBO breath test.
The Metagenics product line is available in Australia.
Hi Trudy.
i am so happy to find your post. My aire device from food marble is only testing for h2. since i get chronic constipation and after 24 hour fasting flatulence become more, i suspect i have methane gas but need to get to ND to test it.
short story, i prescribed metagenic candibactin ar/ br for myself. the first 10 days, mild fever and lethargy, then abdominal pain. i skipped 1 morning C.ar/br after 10 days of fever, felt better, but then my friends from sibo protocole encouraged me to continue. that night of that morning, i took it and next day, i had sever diarrhea and 3 high fever. next day i stopped it, fever stopped. a lab blood test shows lipase of 149 shows while maximum range of lab should be < 75 U/ L AND MY eGFR is 67 while should be less than 60, also my CRP has jumped 1.1 point up since july 2020.
my question to you is this:
is Candibactin AR/ BR from metagenics has high oxalates content and if yes which product because in the past i had kidney stone and efgr is high again. or am i the only person that can not tolerate this product?
i love your feedback and at this point i have stopped taking candibactin, bcause i am stuck.
Thank you for helping me.
Forough
Not everyone tolerates this product and it’s wise to stop when having issues. I suggest working with a functional medicine practitioner in order to try and navigate this. Susan Owens and the TLO (Trying Low Oxalates) FB group may also have some insights
I had a bad fall may 2018 which exacerbated my periformis sciatica and triggered some classic sibo symptoms which i didnt recognise as such till years later. Jan 2019 i started taking naproxin 200 plus 100 gabapentin before bed. This allowed me to sleep on my back (easier on sciatica) for 8 hrs of dreamless sleep. Id taken Naproxin many times before, so i knew that it was the gabapentin that caused me terrible brain fog. I had to stop it eventually. In may 2019 the sibo erupted with a vengence, kept me up at night, and i was diagnosed. I have since taken 100 gr pharmagaba at bedtime as a burn buffer for my prokine (300 ginger). Lately i have substituted 220 l tryptophan for the gaba, its a bit stronger, as a nightcap. But if i awaken during the night, gravol is my goto for more zzzs. Half tab usually buys me couple more hrs. Occ full tab good for 4 hrs. I have pharmagaba loz, but try to stay away from those as the sugars interrupt motility.
Toni
Keep in mind there are many forms of GABA that don’t contain sugars or sugar alcohols. You can find the products I recommend here https://www.everywomanover29.com/blog/amino-acids-pyroluria-supplements/
Also GABA works to raise GABA levels and tryptophan raises serotonin and helps make melatonin.
Hi Trudy!
Sibo Sufferer here since 2019, 3 rounds of tough antibiotics tipped the scales for me. My NP did a Sibo test that is inconclusive so has started Candidex 3 tablets a day until the bottle is gone 1 month. I’m back to not sleeping again unless I eat carbs in the middle of the night. I’ve never treated for Sibo in the past even though 2 other Aerodiagnostics Sibo test showed positive. 1st one hydrogen 2nd methane mix. Now inconclusive. I have Rifaximan. My Dr says not to treat. I’m terribly confused because I have so many symptoms. Fatigue as my main one. Can I purchase the GABA sublingual you sell to help with that muscle pain you’re taking about, or is it futile until I treat the Sibo? What dose to sleep all night?
Thanks
Melinda
If there are SIBO symptoms (I use this questionnaire with clients https://www.everywomanover29.com/blog/sibo-small-intestinal-bacterial-overgrowth-questionnaire/) and with 2 prior positive tests I’d consider a herbal protocol to try and address symptoms.
If there are low GABA symptoms I have clients start GABA right away – it helps with sleep and pain when bloated (which can keep you awake). The dose depends on each person’s unique needs. We start low and increase from there. Tryptophan for serotonin support may be needed too. We use the amino acid questionnaire to start https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/
My book “The Antianxiety Food Solution” is a great place for the foundations (you don’t mention what dietary changes have been made) and has a chapter on the amino acids with dosing/timing information. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
My online GABA Quickstart group program is helpful when you have questions related to GABA and need guidance (and moral support/encouragement). More here about the program and purchase info https://www.anxietynutritioninstitute.com/gabaquickstart/