Ep.31 Supplements for SIBO – IBS Podcast
27 Nov, 2023

Episode Intro

If you're someone who's got SIBO, you are probably well versed in all the different supplements and ways of treating SIBO. I find most people who have Small intestine bacterial overgrowth have done a lot of research and really understood this condition But it can be incredibly confusing to see all the different potential products What order should you take them in? Do you need a prokinetic? Do you need a probiotic? What about prebiotics? And what kind of antimicrobial treatment should you use to try and address the overgrowth of microbes in your small intestine?


Podcast transcript

Welcome to episode 31 of the Inside Knowledge. I am Anna Mapson.

Today, talking about supplements for SIBO (Small Intestine Bacterial Overgrowth).

(For background on SIBO listen to Episode 11 – What is SIBO  and Episode 12 – Treating SIBO)

Confusion about how to treat SIBO

I’ve picked this topic because I see a lot of confusion amongst people before they work with me, or in Facebook groups and online, people asking questions about how to treat your SIBO if you’re not working with a practitioner.

And actually, even if people are working with a practitioner, they don’t always have enough contact with them, or enough talk time to ask all the questions, like, how does this work? Why am I taking this supplement? And so they turn into Facebook groups to ask questions.

Of course you want to understand. But sometimes you’re getting not the most accurate information. So I thought I’ll just do a little summary of the things that I find helpful with my clients and why I do that. So you can understand how to try these out on your own.

Now, if you don’t yet have a positive SIBO breath test, I don’t suggest following any of this advice.

Start with a SIBO test

This is for people who know that they have got SIBO. They know whether it’s hydrogen or methane. They’ve tested for them both. So you’re clear on what your numbers are. These protocols are for people who already understand their results.

If you don’t yet have a breath test, this can be arranged either privately, or privately. You can do one at home or you may be able to get one through your doctor. I can arrange them for my clients and I will do that if I think it’s necessary. I don’t always do a SIBO breath test because I don’t think everyone I work with has got SIBO. It’s obviously an added cost, but it’s good to know before you start trying to treat it.

I’m going to talk through a couple of products for hydrogen SIBO, for methane SIBO, or intestinal methanogen overgrowth, as it’s sometimes called now. A little bit about hydrogen sulphide SIBO, although it’s much harder. We’ll talk about die off symptoms and a bit on probiotics, prebiotics, biofilm busters, and prokinetics.

Taking a natural approach to SIBO treatment

People always say they want antimicrobial treatments. rather than antibiotics because they want to take a more natural route. But the thing to be aware of is some of these antimicrobial substances do have an effect on your gut bacteria as well. They are effective at killing off microbes. Which means that they can affect the large intestine bacteria, some of the good bacteria as well. Which is why you shouldn’t take these for a very long time.

And always make sure you know the end date to taking any supplements when you take them from a practitioner. Or if you’ve just read about them online and you want to give them a go, make sure you understand when you will be stopping them.

The benefits of a herbal antimicrobial treatment for SIBO

The good thing about taking a herbal approach to antimicrobial treatment is that the herbs often have a multiple effect. So it might be antibacterial and antifungal and a little bit anti-inflammatory, for example, like Ginger or, Oregano. These can have different effects that are all positive if you’re someone who’s struggling with digestion.

And maybe it causes less damage to your microbiome as well rather than taking antibiotics.

The downside to supplements for SIBO

It’s not as strong and actually that is one of the drawbacks I think of doing it in a herbal way. It takes much longer, it can cost you more you’re more likely to have to take these things for four to six to sometimes to eight weeks. Whereas if you’re taking an antibiotic it’s just two weeks normally and then it’s done.

And you might have to do it again to be sure. But it can cost more and it can take longer doing it with supplements instead of medication. Some of the supplements might not be strong enough and you might not take them in strong enough doses, so it’s really important to take high doses of these for them to be effective. Otherwise, they don’t really work.

Supplements for hydrogen SIBO

So let’s start with some supplements for hydrogen SIBO. The antimicrobial herbs that are best tested and used for treatment of hydrogen SIBO.

Berberine for hydrogen SIBO

I’m going to start with berberine. Berberine is a compound in other herbs. It’s in things like Oregon grape or golden seal. And you can find it in a product on its own, but often it’s in a sort of antimicrobial combination product.

There are quite a few studies showing that berberine can potentially lower your weight, it can lower Blood glucose levels. Anybody who is diabetic should take care taking any kind of product like this or has any blood sugar imbalances. And that’s partly because you have to take it in a really high dose to have an effect in the gut.

The kind of suggested levels are around 3 to 5 grams per day, spread out into 3 different treatment times. So taking it 3 times a day, adding up to between 3 and 5 grams a day. That’s quite a lot, and that will involve taking a lot of capsules. You need to be careful if it’s going to have other systemic effects, like lowering your blood glucose, potentially lowering blood pressure, or cholesterol, lowering body weight. So do be careful when taking any sort of supplement really, but specifically this, because we do know it has other effects other than just in the gut.

The other thing about berberine, just lastly, is it potentially can lower a neurotransmitter in your brain called GABA, which may increase anxiety when that goes down.

So you want to be careful if you’re someone who experiences low mood or high anxiety. And just be aware of potential changes. If you start taking an antimicrobial treatment like this.

Neem for hydrogen SIBO

So alongside berberine, another herb which I really like using because it’s relatively cheap compared to the others and it’s a bit more gentle, I find, people don’t tend to react to it, is neem.

This is another herb which is useful for people who have hydrogen producing microbes. But to be honest there isn’t that much research about neem. So I often do it as a secondary herb or alongside berberine rather than as the only thing. I wouldn’t rely on neem in order to reduce microbes, but I like it alongside berberine. They tend to work quite well together.

Oregano oil for hydrogen and methane SIBO

Now another type of antimicrobial treatment that can be used for hydrogen and methane gases is oregano oil. Some people find that this can be quite rough on your gut and can cause some problems, particularly in the upper digestive tract. So kind of burning in your stomach.

Some people find it makes them feel a little bit nauseous. You can get side effects of taking high doses of oregano oil. Again, you’re aiming for quite high doses of oregano oil, around 200 milligrams spread out through the day, so in two doses. And this is taking an emulsified form, so you can get a product where it’s emulsified.

There’s one called ADP. And this oregano is I think better. It depends. Sometimes, if you get a cheap oregano oil from a health food shop, you may find that it is more likely to cause upper abdominal pain and irritation than one that is emulsified. So that’s the one I tend to use with my clients because it just is a little bit more gentle on the gut.

Trying different combinations of products

But anyone can have a problem with any of these supplements. Everybody’s got an individual digestion, so it might not always work for you. But oregano can be used for both hydrogen and methane type gases. And sometimes we’ll use one and then another treatment round you’ll use another type of herb. So it’s good to know what all the different herbs are.

Allicin for methane SIBO

Something else that’s really good for treating methane producing microbes, so if you’ve got methane overgrowth is allicin, and that is an extract from garlic. Sometimes it’s called Alimed, Alimax, there’s a variety of different products.

But it’s essentially the active compound out of garlic. Now if you’re someone who reacts to FODMAPs, and particularly garlic, you might be really worried about taking this allicin, because it is a garlic extract. However, It doesn’t have any of the starches, the FODMAP element, so it’s not likely to cause you any problems.

The one thing I will say is sometimes people feel like they get garlicky burps after taking it, and that can be really off putting. A lot of people don’t have a problem with it at all, but some people do, and they’re keen to finish the treatment round.

Again, similar to the others, you need really high doses, so this is normally three times a day, somewhere in the range of like one and a half grams to two and a half grams a day.

A SIBO trained practitioner can help

This is where working with a practitioner is really helpful to sort of tailor it to you. I normally say with any of these, start low and slow, start small doses, start one once a day and then ramp up.

You’re not going to see much improvement at that dose. However you don’t want to just launch into taking, you know, three capsules three times a day, because If it’s not a great reaction, then you’ve got to scale back quite quickly. So, do start with a small dose and build up.

Now that is the main set of antimicrobial treatments that I use. There are others that people would maybe use, but these are the most effective that I find with my SIBO clients.

Treating hydrogen sulphide SIBO

Now the third type of SIBO that I haven’t yet mentioned is hydrogen sulphide. This… is particularly challenging in the UK because we don’t have a test that can show whether you’re positive for hydrogen sulphide microbes or not.

Bismuth for H2S SIBO

If you are working with someone who thinks that you might have this, there are products you can try, but it’s also challenging to get the right kind of products and they’re really expensive. There’s something called bismuth, which is an ingredient in pepto bismol, that pink reflux medication.

That is the most accessible form of bismuth but there are also other products that you can find that have got bismuth in them. A couple of products that I’ve found that have got it in apart from Pepto Bismol is there’s Thorn Peptigard that has got some bismuth in it and there’s also something by Biotic Research called BioHPF which also has it in but they’re not always available in the UK. So these are really tricky to find for hydrogen sulphide.

You can also use oregano and some of the other herbs that I’ve already mentioned. The other thing that you potentially could take is soy isoflavones. So soy, like soy products from food, there is extracts of that that are potentially of use, but again, not a great lot of research using these for gut disorders, so I don’t actually use these very often, unless there’s a particularly challenging, case, and symptoms might suggest it’s worth it.

Those are the things that we use to kill off the microbes.

Managing the ‘die off’ reactions

I thought I’ll just quickly touch on what might happen, or how you might feel when you start taking antimicrobial treatments. Because sometimes you will get something called a die off reaction, or it’s referred to as a Herxheimer reaction. That is when the bacteria are breaking up, small fragments of them are going into your bloodstream. They’re getting absorbed and your immune system is raising a response to these pathogenic microbes or elements of them.

What it does is it makes you feel like you’re getting flu. So often people feel very very tired suddenly, they might feel achy, a bit headachy, just feel like you’re coming down with something.

It should only last for a couple of days, and it should be normally when you get up to a large dose, so it wouldn’t necessarily be on the time you take the first tablet. But it could be once you’re taking them three times a day. And you’re into a bit of a roll with them, then things start breaking down in your gut. That is where you might start getting this reaction, the die off reaction.

Supporting your body 

If you feel that this is you, that that’s happened to you, what I suggest is a little bit like when you actually have a cold or a flu or a virus or something. You can try upping vitamin C to give yourself and your immune system a little boost to try and help yourself recover. You can rest and look after yourself.

So have a little easy day if you can. Things where you are sweating are really good. So I really like recommending particularly during the winter time, a nice hot bath before bedtime. Sweating is one of the ways we get rid of, it’s a detox process basically.

So a nice hot bath before bed, particularly if you put in some Epsom salts. For some people, this can be really helpful. Epsom salts can help you with this reaction. Or, a binder that goes into your gut and helps to… Absorb things and take them out. So for example, activated charcoal tablets, you can take these for a couple of days without any problem. I don’t recommend taking charcoal long term because it does interfere with the absorption of key minerals like iron and zinc and so on. So it’s not great to take long term. But in a an acute case, where you want to just get over a problem like this die off reaction or taking it for bloating after a large meal can also be quite helpful. You can take one or two of those capsules like two hours apart for a day or two.

But I wouldn’t do more than that. Oh, the other thing is that they can make your stools go black when you take charcoal. If you do get This die off reaction. Try to keep going with your treatment plan for a few days. Obviously if it’s terrible, and it’s really making you feel awful, you must stop.

Don’t give up on your treatment straight away

But what you don’t want to do is to switch treatment plans too quickly and go to another route without really giving this a chance because then you’re never going to get to the crux of the treatment If you can’t take any of these antimicrobial things. it is really hard I would say especially if you’re navigating all of this on your own.

How to take supplements for SIBO

So now, you know, which type of antimicrobial treatments I most commonly use with my clients. I want to talk about how to use them. Like how long you should take them for and what you should do before and after. And then also I’ll just talk briefly about biofilms. 

What are biofilms? 

Biofilms are a bit like where the bacteria get together and they create a little coating around themselves that makes them more resistant to treatment by antibiotics or antimicrobial herbs.

What we can do is take some additional things to try and break down these biofilms to try and make them more accessible to your treatment. The ones that I like are N acetylcysteine, glutathione or alpha lipoic acid. These are really good at supporting the liver, supporting your immune system. I just feel like it gives your whole body like a nice little boost as well as helping with the bacteria biofilm breakdown. There are also products that contain enzymes such as serrapeptase. These can also be used although I like the ones that are more the antioxidant type, the thiols that actually help you with the antioxidant action as well.

However, some people do get on all right with the ones that contain enzymes. So that is biofilm busters.

Starting out with your SIBO antimicrobial treatment

And then I just wanted to talk about how to actually take these antimicrobial treatments. I would say taking them one at a time to begin with. So starting with one product, ramping that up to its full dose. Then start to add another product at a low level and ramping that up.

That gives you the best chance to see if you’re having any reactions.

Then after a week or so you’re at a full dose for all the treatments and you can just… Go on right ahead. Doing it in that way just allows you to see if you get any of those reactions. You don’t want to take these antimicrobial substances for a very long time.

We’re aiming for around six weeks. Sometimes it’s a bit less, sometimes a bit more. You know, if you end up getting the end of the bottle and it’s five weeks, that might be enough.

Monitoring your symptoms

It’s also really dependent on your symptoms. So how are you actually feeling? Do you feel like things have changed? But as I mentioned at the beginning, sometimes you won’t see an improvement, in your symptoms, but you may see a drop in the numbers, which is where retesting your SIBO figures again can be so helpful.

And can help you to feel like things are moving along, even if your symptoms haven’t got better straight away. Other SIBO supplements that can be very helpful include prebiotics and probiotics. Now in my IBS supplements podcast, episode 22, I covered PHGG. That is partially hydrolyzed guar gum.

I love this for SIBO because it helps to feed the good bacteria in your large intestine, it’s low FODMAP, doesn’t cause bloating in majority of people.

Some people it does, but that is a good addition and you can take that alongside the antimicrobial treatment. So that is fine to take at the same time.

Now I don’t suggest normally taking probiotics alongside an antimicrobial treatment, but you can do. Some people get on really well like this and I have actually seen some research showing that substances like the rifaximin, that’s the antibiotic for SIBO and treatments like oregano actually work really well alongside probiotics at the same time.

However, it can feel like you’re taking too many supplements and I try to keep things as simple as possible for people. So normally I would wait for probiotics until such time that you feel like you’ve made progress with your symptoms or that you finish the treatment, have a little break and then take the probiotics.

Don’t forget the prokinetic

Now, the other thing I really want to stress is the Prokinetic. That is something that helps to keep your migrating motor complex working. It includes things like Ginger, or Artichoke, or 5 HTP. This is really important to maximize any gains that you’ve got through the treatment, and to keep things moving.

Often when you get prescribed Rifaximin or treatment from your doctor, you will not be given a Prokinetic at the same time. And so something that you can do and talk to your doctor about if you have got antibiotics. But certainly after taking a Antimicrobial treatment I suggest you move on to a prokinetic.  

Right that has easily filled up enough in this episode talking about just the antimicrobial elements.

I realize it’s a lot of detail If you have got questions, then a great place to get these answered is my group gut reset, where you work with me for three months, in a group, but you get an individual plan. So for people who’ve got SIBO, I give you some clarity on how to tackle it, as well as what to eat during all this treatment rounds and how to best manage your symptoms. So if you’re looking for advice and support with managing SIBO, the group gut reset is a great way to do that. And if you’re listening in real time now, before the of November, 2023. It is on offer, but it’s only 300 pounds the rest of the time.

For people to get support with dealing with this digestive condition because SIBO is pretty complex, as I’m sure you know.

Okay, thank you very much for listening. I will see you next week. Goodbye.




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