Post Author: Victoria Tyler

SIBO Treatment uk

A Comprehensive Guide to SIBO Treatment in the UK and SIBO supplements treating SIBO naturally

Do you suspect you have Small Intestinal Bacterial Overgrowth (SIBO) and are looking for the best SIBO treatment to eradicate your overgrowth?

This article reviews various treatment toptions for SIBO—including both pharmaceutical and herbal antibiotics—supported by medical studies. We also examine the success rates of these treatments, the likelihood of relapse, and strategies to prevent recurrence.

What Is SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) is an increasing concern in gut health. It is one of the leading causes of chronic bloating, gas, and abdominal discomfort, affecting an estimated 6–15% of the general population. Prevalence is even higher among those with irritable bowel syndrome (IBS), with research indicating that up to 40–84% of IBS patients may have undiagnosed SIBO. Despite its high occurrence, many still struggle to understand and manage this condition.

SIBO occurs when there is an abnormal overgrowth of bacteria in the small intestine, disrupting normal digestion and absorption. Typically, the small intestine contains only a few bacteria, but in SIBO, excessive bacterial growth results in a broad range of  symptoms.

Symptoms of Hydrogen-Dominant SIBO

Hydrogen-dominant SIBO occurs when hydrogen-producing bacteria overgrow in the small intestine, leading to excessive fermentation of carbohydrates. This type of SIBO is commonly associated with rapid gut transit and can cause digestive discomfort shortly after eating.

Key Symptoms of Hydrogen SIBO:

• Chronic diarrhoea (hallmark symptom, often loose and urgent)
• Bloating and excessive gas (especially after consuming high-carb or fermentable foods)
• Abdominal cramping or pain (typically relieved after passing gas or stool)
• Unintentional weight loss (due to malabsorption)
• Nutrient deficiencies Difficulty absorbing key vitamins like B12, iron, and fat-soluble vitamins (A, D, E, K)
• Fatigue and brain fog (due to inflammation and poor nutrient absorption)
• Food intolerances (difficulty digesting fibre, dairy, and fermentable carbs)

Methane SIBO symptoms

Methane-dominant SIBO, also known as Intestinal Methanogen Overgrowth (IMO), occurs when methane-producing archaea (like Methanobrevibacter smithii) overgrow in the small intestine. This can lead to a unique set of symptoms, some different from hydrogen-dominant SIBO.

Common Symptoms of Methane SIBO (IMO)

• Chronic constipation (hallmark symptom, often severe and unresponsive to fibre)
• Bloating and gas (especially after eating, can be prolonged and uncomfortable)
• Abdominal pain or cramping (due to slowed gut motility)
• Hard, dry stools (often difficult to pass)
• Belching and reflux (due to altered digestion and gas production)
• Weight gain or difficulty losing weight (methane slows metabolism and increases calorie absorption)
• Fatigue and brain fog (due to gut-brain axis disruption)
• Food intolerances (especially high-fibre or fermentable carbs like beans, dairy, and starches)

Since methane slows intestinal transit, it leads to constipation rather than diarrhoea, which is more common in hydrogen SIBO. Managing methane SIBO typically requires targeted antimicrobials, motility support (prokinetics), and dietary adjustments to restore gut balance.

How did I  get  SIBO?

SIBO is often underdiagnosed because its symptoms mimic other gastrointestinal disorders like IBS, Crohn’s disease, or inflammatory bowel disease (IBD).  In fact, 70–80% of IBS patients may have SIBO  as an underlying condition.

Key risk factors include:

•Chronic use of proton pump inhibitors (PPIs) that slow gut movement and lower stomach acid
• Food poisoning
• Motility disorders such as gastroparesis
• Chronic constipation• Underactive thyroid and diabetes
• Autoimmune diseases (e.g., celiac disease, Crohn’s disease)
• Structural issues in the intestines, such as strictures or adhesions
• History of abdominal surgery

Testing: How do you test for SIBO?

Diagnosing SIBO is complex due to symptom overlap with other conditions. The most common diagnostic tool is called a Hydrogen and Methane breath test, which measures hydrogen and methane levels after consuming a sugar solution (lactulose or glucose). Elevated gas levels suggest bacterial overgrowth, but breath tests can produce false positives or negatives; therefore, test results should be interpreted along with clinical symptoms.

Effective Supplements for  for SIBO

There are several ways available for treating SIBO in patients with IBS, including the use of antibiotics, herbal supplements, dietary measures,  probiotics, and prokinetic agents.

SIBO Treatment NHS- Antibiotics for SIBO

Other broad-spectrum systemic antibiotics like amoxicillin-clavulanic acid, metronidazole, and ciprofloxacin have been used to treat Small Intestinal Bacterial Overgrowth (SIBO).

However, these antibiotics often come with unpleasant side effects, including diarrhoea, constipation, dizziness, weakness, skin rashes, and digestive discomfort.

While they can be effective at clearing bacterial overgrowth, many patients are looking for safer alternatives with fewer side effects.

SIBO Herbal Treatment SIBO Natural Treatment

For those who are looking for ways to treat SIBO naturally, supplements like oregano oil and berberine and neem can be as effective as pharmaceutical options. This is what we use at our clinic.

Studies suggest that oregano oil can reduce bacterial overgrowth by 50-80%, making it an excellent choice for patients who suffer from  both hydrogen and methane-dominant SIBO.

The choice of herbal antibiotic often depends on the specific types of gas that are produced or suspected- Hydrogen, Methane or Hydrogen Sulfide.

Dr. Allison Siebecker, a leading authority on Small Intestinal Bacterial Overgrowth (SIBO), has developed specific herbal antibiotic protocols tailored to the different types of SIBO: hydrogen-dominant, methane-dominant, and hydrogen sulfide-dominant. Below is an overview of her recommended approaches for each subtype. Please note it is very common for herbs to cause side-effects so it is imperative to work under professional guidance.

Hydrogen SIBO – how to treat naturally

There are several supplements that may be used for Hydrogen SIBO, these include Oregano, Berberine and Neem.

These herbs can be used as single doses or mixed doses.

• Berberine
• Neem
• Oregano Oil

Methane SIBO natural herbal Treatment

For methane-dominant Small Intestinal Bacterial Overgrowth (SIBO), also known as Intestinal Methanogen Overgrowth (IMO), Dr. Allison Siebecker recommend the  following:

1. Allicin

• Note: Use purified allicin rather than whole garlic, as whole garlic is highly fermentable and may aggravate SIBO symptoms.

2. Atrantil:

• Composition: Contains a blend of natural compounds, including Quebracho extract, which targets methane-producing archaea.

3. Berberine:

• Note: Berberine is effective against hydrogen-producing bacteria and is often combined with allicin to address both hydrogen and methane overgrowths.

4. Oregano Oil:

• Note: Oregano oil possesses broad-spectrum antimicrobial properties and is commonly included in SIBO treatment protocols.

Combination Therapy:

For methane-dominant SIBO, combining these herbs can enhance treatment efficacy. A typical regimen might include:

• Allicin  combined with Berberine
• Alternatively, Atrantil combined with Oregano Oil

Supplement Duration:

Herbal antimicrobial protocols are generally administered for 4 weeks, which is approximately double the typical duration of antibiotic treatments.

Our Perspective on Oregano Oil for SIBO

Through clinical experience, we have found oregano oil to be one of the most effective herbal treatments for SIBO due to its broad-spectrum antimicrobial properties. It helps reduce bacterial overgrowth and serves as a natural alternative to pharmaceutical antibiotics.

A study published in European PMC compared herbal therapies—including oregano oil—to rifaximin. The results showed that 46% of patients tested negative for SIBO after herbal treatment, compared to 34% for rifaximin.

For methane-dominant SIBO, a 2020 study in the Journal of Alternative and Complementary Medicine confirmed that oregano oil effectively targets methane-producing bacteria, making it a promising option instead of rifaximin or neomycin.

Key Benefits of Oregano Oil for SIBO:

Contains carvacrol and thymol, which fight SIBO-related bacteria
Studies suggest its effectiveness is comparable to rifaximin
Offers a natural alternative with fewer side effects

If you’re considering herbal treatment for SIBO, oregano oil may be a powerful option to discuss with a healthcare professional. Please note that there are some possible side-effects of Oregano. These include:

 Gastrointestinal upset (nausea, vomiting, diarrhoea) at high doses.
• Mucosal irritation if not diluted properly.
• Allergic reactions (rash or itching).
• Mild blood-thinning effects; caution for those on anticoagulants.

Other considerations to take into account are possible die-off reactions. It’s advisable to start with lower doses and adjust based on tolerance and effectiveness. It is essential to consult with a healthcare provider experienced in SIBO treatment as this is crucial to select the appropriate  dose and monitor for potential side effects. It is essential to ensure that herbal supplements are sourced from reputable manufacturers to guarantee purity and potency.

What is the best diet for SIBO?

The best diet for managing and preventing relapse of Small Intestinal Bacterial Overgrowth (SIBO) is one that helps reduce the fermentation of undigested carbohydrates in the small intestine, controls bacterial growth, and supports gut healing. Several dietary approaches have been shown to be effective for SIBO, and the choice depends on individual tolerance, the severity of symptoms, and the type of SIBO (hydrogen-dominant, methane-dominant, or hydrogen sulfide-dominant). Here are the most commonly recommended diets for managing SIBO:

Low-FODMAP Diet and foods to avoid for Hydrogen and Methane SIBO

The Low-FODMAP diet is one of the most researched and effective diets for managing SIBO, particularly for those with IBS-related symptoms.

FODMAPs are a group of short-chain carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) that are poorly absorbed in the small intestine. These include foods like certain fruits (e.g., apples), vegetables (e.g., garlic, onions), legumes, dairy, wheat, and certain sweeteners.

FODMAPs ferment in the gut, feeding the overgrown bacteria, which can cause bloating, gas, and discomfort. By limiting high-FODMAP foods, you reduce the fuel supply to the bacteria in the small intestine, helping to alleviate symptoms.

The Low-FODMAP diet is typically followed in three phases:

• 1. Elimination: Avoid high-FODMAP foods for 4-6 weeks.
  2. Reintroduction: Gradually reintroduce high-FODMAP foods one at a time to identify individual triggers.
  3. Personalization: After identifying food sensitivities, continue with a modified diet that minimizes symptoms.
  4. Long-term use may negatively impact beneficial gut bacteria, so reintroduction of high-FODMAP foods is necessary.

SIBO Probiotics

Whether you should take probiotics for SIBO depends on your type of SIBO, your symptoms, and how your body responds to different strains.

Research on probiotics for SIBO is both lacking and mixed—some studies show they can help, while others suggest they may worsen symptoms.

Probiotic efficacy in SIBO hinges on subtype, strain selection, and timing. During active overgrowth, probiotics risk aggravating symptoms post-treatment, whereas targeted strains may aid recovery.

The best probiotics for SIBO depend on the type—hydrogen-dominant, methane-dominant (IMO), or hydrogen sulfide SIBO—as different strains can either help or worsen symptoms.

Best Probiotics for Hydrogen-Dominant SIBO

Hydrogen SIBO is typically associated with bloating and diarrhoea. The best probiotics for this type include:

• Soil-Based Probiotics (SBOs) – Bacillus subtilis, Bacillus coagulans (e.g., MegaSporeBiotic, Just Thrive). These are resilient and do not contribute to bacterial overgrowth.
• Saccharomyces boulardii – A beneficial yeast that supports gut balance (e.g., Florastor, Seeking Health S. Boulardii).
• Lactobacillus plantarum – Helps reduce hydrogen gas and improve gut barrier function (e.g., Jarrow Ideal Bowel Support).

Best Probiotics for Methane-Dominant SIBO (IMO)

Methane-dominant SIBO, often linked to constipation, is caused by methanogen overgrowth (not bacteria), requiring different probiotics:

• Bifidobacterium infantis, Bifidobacterium lactis – Helps regulate motility and reduce methane gas (e.g., Align, ProBiota Bifido).
• Lactobacillus reuteri, Lactobacillus casei – Supports gut motility and methane reduction (e.g., BioGaia Gastrus).
• Akkermansia muciniphila & Clostridium butyricum – Found in postbiotic formulas, improves gut lining and methane balance (e.g., Pendulum Akkermansia, CoreBiotic).

Best Probiotics for Hydrogen Sulfide SIBO

• Hydrogen sulfide SIBO is associated with sulfur intolerance, gas with a “rotten egg” smell, and gut inflammation. The best options include:

• Bacillus subtilis, Bacillus coagulans (SBOs) – Reduce inflammation and balance gut bacteria (e.g., MegaSporeBiotic).
• Clostridium butyricum – Supports gut lining and reduces hydrogen sulfide production (e.g., MIYAIRI 588, CoreBiotic).
• Lactobacillus plantarum & Saccharomyces boulardii – Help regulate gut balance without worsening sulfur metabolism issues (e.g., Seeking Health S. Boulardii, Jarrow IBS Support).

Probiotics to avoid for SIBO

Some traditional probiotics can worsen SIBO symptoms, especially those with Lactobacillus acidophilus or fermentable prebiotics like inulin, FOS, and GOS, as they can feed bacterial overgrowth.

Prokinetics for SIBO

Prokinetics help stimulate the muscles of the digestive tract, improving peristalsis and preventing food and waste from lingering in the small intestine. By enhancing motility, they reduce the risk of bacterial overgrowth, making them a valuable tool in SIBO management. Slow gut movement can allow bacteria to proliferate in areas where they shouldn’t, so maintaining proper motility is key to preventing relapse.

Research supports the use of prokinetics alongside antibiotics or herbal antimicrobials to both clear bacterial overgrowth and address underlying motility issues. A 2012 study in the Journal of Clinical Gastroenterology found that prokinetics like prucalopride improved gut movement and reduced SIBO symptoms such as bloating and constipation. Some patients also benefit from continuing prokinetic therapy after treatment to help prevent recurrence.

Common prokinetics for SIBO include prucalopride (2 mg daily), domperidone (10–20 mg three times daily), and low-dose erythromycin (50 mg 2–3 times per day). Natural options like ginger (500 mg daily) and Iberogast (20 drops three times daily) may also support gut motility. Since some prokinetics have potential side effects, consulting a healthcare provider is essential to determine the safest and most effective option.

How can you avoid reoccurrence of SIBO?

To prevent the recurrence of SIBO, focusing on improving gut motility is key. Prokinetics, help stimulate motility and ensure food moves efficiently through the digestive system, reducing the risk of bacterial overgrowth.

A diet tailored to support gut health, like a low FODMAP, can limit fermentable carbohydrates that feed bacteria may need to be re-instated if symptoms come back. Additionally, digestive enzymes and hydrochloric acid (HCL) supplements can aid digestion and reduce the chance of undigested food sitting in the small intestine, which can promote bacterial growth.

Stress management plays a vital role in gut health, as chronic stress can impair digestion and motility. Practicing relaxation techniques such as meditation or yoga can help manage stress levels and support digestive function. Avoiding processed foods, which can fuel dysbiosis and inflammation, is also crucial for maintaining a healthy gut. Finally, low-dose antimicrobials like oregano oil can be used to target harmful bacteria, helping to keep bacterial balance in check without causing disruption to the beneficial microbiota.

References:

1. Staudacher, H. M., et al. (2016). “Mechanisms and efficacy of dietary FODMAP restriction in IBS.” World Journal of Gastroenterology.
2. McIntosh, K., et al. (2018). “FODMAP diet and its effects on gut microbiota in IBS and SIBO patients.” Clinical and Translational Gastroenterology.
3. Gibson, P. R., et al. (2017). “The role of diet in the pathophysiology and management of small intestinal bacterial overgrowth (SIBO).” Gastroenterology.
4. Pimentel, M., et al. (2020). “Probiotics in Small Intestinal Bacterial Overgrowth: Clinical Evidence and Treatment Outcomes.” Journal of Clinical Gastroenterology.
5. European PMC Study (2020). “Herbal therapies versus rifaximin in the treatment of SIBO.” European Journal of Gastroenterology & Hepatology.
6. Journal of Alternative and Complementary Medicine (2020). “The effect of oregano oil on methane-producing bacteria in SIBO treatment.”
7. Journal of Clinical Gastroenterology (2012). “Efficacy of prokinetics in improving small intestinal motility and reducing SIBO relapse.”