Disclaimer: As I have said in the past, I’m not a research blogger. I’m here to mix “data with soul” and give you useful info, but only in the context of my real, human experience. That is not to say that citation on my part and proper follow-up on your part are not important. Everything I wrote about in this blog was presented by Dr. Steven Sandberg Lewis, ND & Dr. Allison Siebecker, ND at the SIBO Symposium during January 2014 and you can pay to have access to those presentations through the National College of Natural Medicine’s website.
Here we go again, another SIBO blog this week. We’ll be chatting about herbal antibiotics and a few pieces of miscellaneous SIBO “stuff” that I thought should be shared. This topic is not getting old for me (and I hope not for you, either). The more I learn, the more I see how easily people, especially those of us dealing with autoimmune diseases, can find themselves in the grips of SIBO and how it can be missed by our doctors for years if a patient doesn’t have the details to advocate for his or her self.
At the Symposium, Dr. Steven Sandberg-Lewis, ND gave the talk on herbal “antibiotics.” These are herbs, extracts of herbs, or combinations of herbs that are powerful enough to slow the growth of or kill micororganisms. He started his talk by identifying the most commonly overgrown organisms in a SIBO infection, something I wanted to write about, because it is very useful if you prefer that your doctor treat SIBO with herbal antibiotics, since certain herbs are more effective against certain organisms than others.
Most to Least Common Anaerobic (do not require oxygen) Bacteria in SIBO
Most to Least Common Aerobic (needs oxygen) Bacteria in SIBO
- E. Coli
- Enterococcus spp
- Proteus mirabilis
There are some reasons you may want to choose herbal antibiotics. First, they are biodegradable and do not end up in our water supply, as regular antibiotics do. The possibility that bacteria will become resistant to them is much lower, since there are hundreds of compounds found in a single herb. They often have other effects, such as being anti-inflammatory, anti-fungal, and anti-viral. Extracts of herbs can also allow for significantly increased potency, which is usually not safe with regular antibiotics. A draw back to choosing this treatment path, is that while antibiotics can work within two weeks, the herbal course may take four to six weeks.
The first group of herbs Dr. Sandberg-Lewis spoke about are the Berberine herbs. They all have the plant alkaloid, Berberine in common, which is antibiotic, along with many other healing effects. Sandberg-Lewis focuses on using Goldenthread, Goldenseal, Huang Bo, Oregon Grape, and Barberry to treat his SIBO patients. Normally, he uses capsules containing two or three of these herbs, so that patients can take several at a time, since the dose may need to be as much as 5000 mg/day for a difficult overgrowth. Berberine is most effective against Hydrogen-Dominant SIBO or SIBO with diarrhea.
I found this interesting, since my experience using herbal antibiotics was with a treatment that used many of the above named Berberine herbs, along with several anti-parasitic herbs, but the recommended dose was not nearly high enough, which may be one reason the herbal course did not work for me. Another reason it did not work, was that I did not tolerate it well. We often have the mistaken idea that herbs will be more gentle for the body, but that is not necessarily the case. One possible reason for my intolerance . . . Berberine herbs can lower blood glucose levels. This is a potentially positive effect for a diabetic, but for me it was awful. Dr. Sandberg-Lewis noted that patients will start the herbal course and then complain about the effects of die-off, when in reality they are experiencing low blood sugar episodes. Now that I understand this, I am almost certain my intolerance to the herbal course had alot to do with low blood sugar. Berberine herbs can also have an effect on SSRI (anti-depressant) medications, so it could be important to keep that in mind if you are treating depression while dealing with SIBO.
The next herbal treatment Dr. Sandberg-Lewis spoke about was garlic or the more potent garlic extract, Allicin. Garlic is a high FODMAP, so some of you that know those with SIBO should be avoiding high FODMAP foods are probably wondering why it is used as an herbal antibiotic. The extract, Allicin, is fructan (the sugar named with the F in FODMAP) free, so not an issue for patients who need to use it. Garlic needs to be combined with the berberine herbs to treat Methane-Dominant SIBO or SIBO with constipation. Garlic is also anti-fungal, which can be useful for those who are prone to yeast overgrowth. One word of caution, is that Garlic can prolong bleeding time, so those on blood thinners should be aware of the interaction.
Finally, Dr. Sandberg-Lewis talked about his use of Neem and Oregano Oil in treating SIBO. He stated that he almost always uses Neem with the Berberine and/or Garlic, because he feels it enhances the potency of the other herbs. It is also highly anti-inflammatory, anti-viral, and can be anti-ulcer. He uses Oregano Oil less often, but does find it useful. His reason for using it less often is patient intolerance. This also confirms my experience using it to treat SIBO. Oregano Oil is very powerful and left me feeling quite rough.
Dr. Sandberg-Lewis also talked about natural factors that can help in the treatment of SIBO. He pointed out that any deficiencies in stomach acid, pancreatic enzymes, and bile should be addressed. Again, this confirms my experience, since identifying pancreatic enzyme deficiency and treating it, was a factor in helping me not only deal with SIBO, but other health concerns I had early in my Celiac diagnosis. Also, having intacted anatomy and motility of the GI system plays a role. The migrating motor complex must be working properly, the ileocecal valve must be working properly (this valve keeps the contents of the colon out of the small intestine), and the microvilli of the small intestine must be healthy. Since damage is to the microvilli in Celiacs, this may be one reason we are so susceptible to SIBO.
Dr. Sandberg-Lewis also touched on the idea that SIBO may be incurable in some cases. He found this with patients that have had continuous, long-term use of proton-pump inhibitors (PPIs, like Nexium), because it disrupts stomach acid production so much. He found this with patients who had continuous use of opiate painkillers, because it disrupts migrating motor complex. He also noticed it with patients that had altered anatomy or motility (so surgeries that changed the GI tract or anything that changed GI movement).
Dr. Sandberg-Lewis and Dr. Siebecker also did a presentation where they spoke about key indicators that SIBO could be at play. I found this really interesting and recognized myself in the list. If you find yourself in one of these positions, it is worth asking your doctor to take a deeper look, for possible SIBO.
- Low ferritin levels that are not explained by anything else, this may be malabsorption caused by SIBO
- Noticing alleviation of GI symptoms after antibiotic treatment for an unrelated issue
- GI symptoms getting worse after probiotic use (being one of those people who says, “All probiotics make me feel worse.”), as it may be the prebiotics in the probiotic feeding the SIBO
- If eating more fiber INCREASES constipation
- GI symptoms developing after a short-course of opiate use (decreases migrating motor complex & may let SIBO take hold)
- GI symptoms developing after proton-pump inhibitor use (stomach acid is not strong enough to kill bacteria & may let SIBO take hold)
- Diagnosed Celiac that is not improving, despite strict gluten free diet (I definitely had this issue & probably should have been treated for SIBO much earlier)
Okay, that’s a long entry in the SIBO saga today, but I think all good information! I will be writing about Diet for SIBO and also other health issues that are connected with SIBO in the coming weeks, so stay tuned. Sooo much to cover!
You can find Part 4 of the SIBO series here.