Today I'm going to share about the right way to use antibiotics for SIBO treatment, so you can be
a better advocate for yourself with your doctor. So, stay tuned. If this is your first time here,
welcome. My name is Amanda Malachesky, and I'm a certified functional nutrition gut health coach.
I'm also the host of the Calm Digestion Method online program, where I help people with IBS and
SIBO find their personalized IBS relief plan. For weekly videos on how to find your personalized IBS
and SIBO relief plan, please consider subscribing, and be sure to hit the bell to be notified when I
post a new video. So, today's video is coming from a little bit of a place of frustration for me. So,
as a gut health coach who is invested in helping IBS patients feel better,
I hang out in a lot of online IBS spaces like Reddit and other kinds of forums.
Here is a true but unpopular opinion that I've come to the conclusion of from my experience
in these places. Many doctors who are treating SIBO in their patients really don't know what
they're doing. Why do I say this? Well, here's just two simple examples that I saw just this
morning on Reddit, and pretty much every time I go on there, this happens. This woman said,
"I've done SIBO tests. I've tested positive, I've taken Metronidazole and Biocidin," and
this other person says, "I'm about to finish two weeks of daily Metronidazole. So far,
I'm not noticing any improvement. I wonder what my next step is." Both of these patients
have literally been given the wrong treatment by their doctors. The treatment they've been given
hasn't been supported by research. So, today I want to share what the research says about
how to use antibiotics to treat SIBO, so that you can be a better advocate when you go into
the doc doctor's office with a positive SIBO test. So, let's get started. We can debate about a lot
of aspects of the situation, but what I prefer to do is look at the research,
and use that as a guideline for what actually works. So, let's take a look at what the research
actually says about this question. There are a few studies looking at what is the right way to
treat SIBO with antibiotics. The downside here is that there really aren't that many actual clinical
trials. There's really just a few. So, the first thing I want to say is that there isn't a huge
body of definitive research, unfortunately. Instead, you have to work with the guidelines
that we have in the research, and then fill in some blanks with your practitioner. That said,
let's talk about what the research actually says about how to deal with your SIBO. A few separate
clinical studies recommend some slightly different treatment courses for Hydrogen SIBO, which is 10
to 14 days of Rifaximin with 550 milligrams either twice or three times per day. This is shown to be
the effective dosing in three separate studies. This study shows that patients who took rifaximin
for two weeks at 550 milligrams three times per day had better results than people who took a
placebo with their bloating, abdominal pain, and loose or watery stools. This one study helpfully
compared two different dosing regimens, either 1600 milligrams a day versus 1200 milligrams per
day, and the study showed that the patients who had the higher dosing, so 1600 milligrams per day,
which is 550 milligrams three times per day, had a higher success rate in treating their SIBO
than the people who were on 1200 milligrams per day. Although some studies like this one do show
success with 10 days of treatment, Dr. Pimentel, who is the main US-based SIBO researcher,
generally uses a 14-day course with his patients. So, even though the research shows
10 days should be effective, I think that Dr. Pimentel's research and his clinical experience,
because he's actively treating patients in his clinic, probably takes precedence.
So, what can we conclude here? So, given the combination of research studies and the clinical
experience of people actually treating patients with SIBO, it looks like 14 days of 550 milligrams
three times a day is the preferred treatment for Hydrogen SIBO. Now what about for Methane SIBO?
A study shows that Rifaximin paired with either Neomycin or Metronidazole is more effective than
just Rifaximin alone. Not only that, but the studies also show that Rifaximin paired with
Neomycin or Metronidazole is more effective than either one of those other antibiotics separately.
So, as you can see here in this particular study, the subjects receiving treatment of Rifaximin and
Neomycin, 85% had a clinical response, compared to 63% of subjects in the Neomycin-only group,
and 56% of subjects in the Rifaximin-only group. Additionally, the results in this study read that
87% of subjects taking Rifaximin and Neomycin combination eradicated methane on their breath
test. This is compared with 33% of subjects in the Neomycin-only group that eradicated methane,
and only 28% of subjects in the Rifaximin-only group. So, this study clearly shows that using
Rifaximin with the other antibiotic is much more effective than using either Rifaximin alone or
Neomycin alone, and I think these results probably carry over to the Metronidazole,
which is what these patients on the Reddit sub-thread were talking about, that their
doctors had given them just Metronidazole and they hadn't really seen any response.
Now, I suppose this may be due to insurance considerations or something like that,
but so often these people report, "Well, I took the 14 days of medicine and I didn't feel
any better." So, if you have Methane SIBO, the research suggests you should do a 14-day course of
Rifaximin combined with Neomycin or Metronidazole for your SIBO treatment protocol. Or if your
doctor wants to offer you only Metronidazole or only Neomycin or only Rifaximin for your Methane
SIBO, I'm going to link that study down below this video, so that you can take that study
into your doctor and say, "Actually, this is what the research says," because you really need both.
Finally, if you have Hydrogen Sulfide SIBO, this is a little bit trickier of a situation,
because there isn't really any good clinical research yet about what exactly you should
do in this situation. The current best thinking according to Dr. Pimentel is to combine Rifaximin
with Bismuth. In other words, Pepto Bismol, and that's for now, the best treatment that they have.
They're actively working on figuring out what might be better, but for now, that's the option.
So, we're just going to have to stay tuned to learn more about what to do about Hydrogen
Sulfide. Now what about herbal antibiotics? Currently, there's only one clinical study
showing the effectiveness of herbal antibiotics for treating SIBO. As shown here on the screen,
it tells us that herbal antibiotics are generally as effective as Rifaximin therapies, and that
they may be more effective for people who didn't respond well to the antibiotic Rifaximin. Now,
the herbals used in this study were either the Candibactin AR and BR products, or the FC-Cidal
and Dysbiocide products. There are multiple active ingredients in each of these formulas, and they're
not really apples to apples. So, it's a little bit difficult to make conclusions about what exactly
this tells us. But some of the more common active ingredients across the products include berberine,
red thyme oil, oregano oil, and olive leaf, all of which are potent herbal antibiotics.
Now, there is also a systematic review, which is a study that combines multiple studies to look at
bigger trends in the data. The systematic review concludes, "Our findings suggest preliminary
evidence for a role of alternative therapies in the treatment of SIBO, however robust clinical
trials are lacking." So, what does this mean for you? Essentially, it's reasonable to try herbal
antibiotics to treat your SIBO, but you need to know that there's less specific and clear evidence
about exactly which herbals actually work. This highlights the general challenge of proving that
herbs work, because herbs are plant-based medicines, and they're not standardized
necessarily, so their preparations and their combinations can affect their effectiveness,
and they aren't always an apples to apples comparison. So, if you rely exclusively on the
data from the study that we have, those specific products are the only ones proven to work.
However, Dr. Alison Siebecker, who's a SIBO expert in Portland, Oregon, uses combinations of Allicin,
which is a garlic extract, oregano oil, berberine, neem oil and cinnamon as their preferred herbal
SIBO treatment options, and it seems to work generally well for their patient population. So,
if you're going to choose the herbal route, just know that there is evidence that it works, but
you may need to work directly with a practitioner to help you do the process right, and figure out
which specific agents would be best for you to use. This brings me to the most important factor
that you need in order to use antibiotics for SIBO correctly, whether you choose pharmaceuticals or
herbal antibiotics. More important than the specifics in the research or the theories
about what should work is how this aligns with what's true for you and your body. I've seen both
herbal antibiotics and pharmaceutical antibiotics work for my clients who are dealing with SIBO.
My client Barbara, used herbal protocols to get rid of her SIBO, while my client Daryl
used the antibiotics, and they both had really great success, but these protocols need to be
used with a little bit of savvy and strategy to be successful as well. As I often say,
"It's not enough to know about the specific tools that you're using to get rid of your
gut problems. It's also essential that you have a strategy guiding your use of those tools to
get the most out of them." What this means is you have to be thinking critically about what
you're seeing in terms of your body's response, and your response on test results. You need to
adapt your actions going forward, based on what you see with those test results and your symptom
response. Most importantly, you also need to know that you should be following up your treatment
with some kind of prokinetic therapy afterwards. If you need more information about exactly what
that looks like, you can check out my earlier video called All About Prokinetics for SIBO. So,
I hope this video has helped you understand what the research says about how to use antibiotics for
SIBO, and how to better advocate for yourself while you're in the doctor's office getting
appropriate treatment. I've linked the studies that I've mentioned down below this video,
so that you can check them out for yourself or take them into your doctor if they're giving
you pushback or blow-back about the appropriate treatment. I also want to let you know that if
you haven't had the knowledgeable help and support you need with your SIBO diagnosis,
this is one of the things that I help my clients with in my online program called The
Calm Digestion Method. I help my clients find their personalized IBS and SIBO relief plan,
and I'd love to have the opportunity to help you find your personalized relief plan as well.
So, if you'd like to get started with that, I want to invite you to download my free Roadmap
to Gut Recovery. It's a short guide that shares the exact strategy that I teach my clients inside
my program, to find their personalized IBS and SIBO relief plan. You can grab your free copy of
that by going to confluencenutrition.com/roadmap. Let me know if this video is helpful by clicking
like or leaving me a comment, or certainly leave me a question if you have one. Don't forget to
check out this video called All About Prokinetics for SIBO, and I will see you in the next video.