If you’ve discovered that the root cause of your endometriosis belly is, in fact, small intestine bacterial overgrowth (SIBO), today I will take you through your options for treating it with antimicrobial herbs. Herbs may be a great alternative for those who are not keen to increase their conventional medication intake, but make sure to consult with your SIBO doctor or other members of your healthcare team before making any treatment decisions.

What are the main antimicrobial herbs?

The main herbs Dr. Allison Siebecker uses in her practice and teaches in her SIBO course include neem, cinnamon, oregano, berberine, allicin, and atrantil.

Which antimicrobials are used for hydrogen SIBO?

The key herbs used to treat hydrogen-dominant SIBO are berberine, oregano, and neem. All three are readily available in the U.S., but I find it’s tricky to get a hold of neem in the U.K. You can listen to Dr. Siebecker explain dosage options here.

There are other alternatives, such as cinnamon, if these herbs don’t work for you.

Which antimicrobials are used for intestinal methanogen overgrowth?

Intestinal methanogen overgrowth (IMO), previously known as methane-dominant SIBO, is treated with either allicin or atrantil. However, because IMO is trickier to treat, this is combined with either oregano, neem, or berberine.

In some cases, IMO has been treated with a high dose of oregano and no allicin or atrantil. You can try this if the options above don’t suit you or if you’d prefer to try oregano.

You can listen to Dr. Siebecker explain dosage options here.

Which antimicrobials do I take for hydrogen sulfide SIBO?

Hydrogen sulfide SIBO is also difficult to tackle, but Dr. Siebecker has found high-dose oregano to be successful with patients. She includes this as an antimicrobial option for hydrogen sulfide in our SIBO training.

How long is a course of antimicrobials?

While shown to be just as effective as antibiotics, a round of antimicrobials is longer, lasting four to six weeks on average. Four weeks is the typical length of time for someone with an average level of SIBO, but for anyone with a higher gas level (55 parts per million and above), six to a maximum of eight weeks would be required.

Dr. Siebecker often sees resistance occur at six weeks, so if you did aim for eight weeks, you would need to work closely with your practitioner to look for signs of resistance.

Like antibiotics, antimicrobials reduce gas levels, on average, by 30 ppm per round. If your levels were 60 ppm, you would likely need at least two rounds for successful treatment.

What are the benefits of antimicrobials?

The most obvious benefit of antimicrobials is that they’re natural, which is a big plus for those of us looking for alternatives to antibiotics. Additionally, the success rate is just as high!

They’re also particularly useful if you have possible candida, small intestine fungal overgrowth, or parasites, as most antimicrobials will kill these off, too. However, there are some considerations and potential drawbacks, which I will explore in the next section. The other benefit is that in contrast to antibiotics, they won’t cause yeast overgrowth.

Additionally, many of the herbs come with unique benefits. For example, berberine helps repair leaky gut, which often occurs as a result of SIBO, and allicin is anti-inflammatory and doesn’t kill our good gut bugs, whereas antibiotics do.

There are so many herbs to choose from that it’s easy to rotate through different antimicrobials across treatment rounds to avoid resistance.

What are the risks and side effects?

The biggest side effect or risk of herbs is likely that die-off is often bad and can last between a few days and the entire round. This is the result of the herbs killing other things in the gut, such as candida, and can be especially tough in the first treatment round and with severe gas.

We can minimize die-off by using anti-inflammatory and detoxification supplements such as curcumin and chlorella as well as detox treatments such as Epsom salt baths and saunas.

We can also minimize die-off by doing phase one of the bi-phasic diet, which suppresses and kills off some of the SIBO so you have a less severe reaction when you begin.

Lastly, another method to reduce die-off is starting very slowly on the herbs and building up to the full dose over a week or longer.

Although we may suffer from die-off because the herbs are addressing yeast, parasites, and additional infections, antimicrobials are normally not enough to totally kill these off. Sometimes, additional herbs are needed. This is when testing for candida and parasites with a GI-MAP comes in handy.

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