A Comprehensive Guide to Effective SIBO Treatments

September 1, 2025

What Is SIBO?

Small Intestinal Bacterial Overgrowth, or SIBO, is a condition in which excessive bacteria accumulate in the small intestine, an area of the gut that normally hosts far fewer microbes than the large intestine. These bacteria can disrupt normal digestive processes, leading to a cascade of uncomfortable and often chronic symptoms. Unlike food poisoning or a short-term infection, SIBO tends to develop gradually and persist unless properly addressed.

Common Symptoms of SIBO

While symptoms can vary from person to person, some of the most commonly reported issues include:

Persistent bloating, often worse after meals
Excessive gas or flatulence
Abdominal pain or cramping
Diarrhoea or constipation (or alternating between both)
Malabsorption of nutrients, particularly fat-soluble vitamins and B12
Nutrient deficiencies (iron, B12, etc.) despite a balanced diet
Unexplained fatigue or low energy
Feelings of fullness shortly after eating
Unintentional weight loss or difficulty gaining weight

These symptoms not only cause physical discomfort but can also have a significant impact on day-to-day wellbeing.

Why It’s Important to Address SIBO

If left untreated, SIBO can lead to long-term complications. The ongoing presence of excessive bacteria can interfere with nutrient absorption, potentially resulting in deficiencies that affect multiple body systems from the immune system and energy levels to skin health and cognitive function. In some cases, untreated SIBO can contribute to more serious conditions, such as leaky gut syndrome or chronic inflammation, and may worsen existing digestive issues like IBS (Irritable Bowel Syndrome).

Addressing SIBO early and effectively is crucial not only for digestive health but also for protecting overall quality of life.

Important Disclaimer

This article is intended to provide general information on SIBO and its potential treatments. It is not a substitute for medical advice. If you suspect you may have SIBO or are experiencing any of the symptoms mentioned, please consult with a qualified healthcare professional. Diagnosis and treatment should always be tailored to your individual health needs and guided by a medical expert.

Conventional SIBO Treatments

When it comes to treating Small Intestinal Bacterial Overgrowth, conventional medicine often takes a structured and targeted approach. While SIBO can be a persistent and sometimes recurring condition, standard therapies aim to reduce bacterial overgrowth, restore balance in the digestive tract, and address contributing factors. Below is an overview of the primary conventional treatments for SIBO.

Antibiotic Therapy: The "Gold Standard"

Antibiotics are the frontline treatment for SIBO in most conventional settings. These medications work by reducing the number of bacteria in the small intestine, thereby relieving symptoms and supporting better digestion and nutrient absorption.

Commonly Prescribed Antibiotics:

Rifaximin (Xifaxan) – a non-systemic antibiotic that stays mostly within the gut, making it a popular and well-tolerated choice for hydrogen-dominant SIBO.
Neomycin – often used in combination with Rifaximin for methane-dominant SIBO, where symptoms include constipation and gas.
Metronidazole, Ciprofloxacin, or Amoxicillin-clavulanate – sometimes used in cases where Rifaximin is unavailable or if other bacterial strains are suspected.

Different types of SIBO may respond better to specific antibiotic combinations. For instance:

Hydrogen-dominant SIBO (more commonly associated with diarrhoea) typically responds well to Rifaximin alone.
Methane-dominant SIBO (often causing constipation) may require a combination of Rifaximin and Neomycin or another methane-targeted regimen.

Important Considerations:

While antibiotics can be effective, SIBO has a notoriously high recurrence rate, often requiring repeated courses or ongoing management. There's also the growing concern of antibiotic resistance, especially with repeated or incomplete treatment.

Additionally, antibiotics may lead to side effects such as:

Diarrhoea
Nausea
Disruption of the broader gut microbiome
Rarely, Clostridium difficile (C. diff) infection, particularly with broad-spectrum antibiotics

For these reasons, many practitioners pair antibiotic treatment with lifestyle modifications and adjunct therapies to reduce the risk of recurrence.

Prokinetics: Supporting Gut Motility

Prokinetics are medications or supplements that help stimulate muscular contractions in the gastrointestinal tract. In the context of SIBO, their primary role is to improve the migrating motor complex (MMC), a cleansing wave that helps sweep residual food and bacteria out of the small intestine between meals.

When the MMC is impaired, bacteria are more likely to accumulate and persist in the small bowel. By supporting this natural mechanism, prokinetics can reduce the likelihood of relapse after antibiotic therapy.

Commonly used prokinetic agents include:

Low-dose erythromycin
Prucalopride
Natural options like ginger extract or 5-HTP (in some integrative protocols)

Prokinetics are generally taken at bedtime or between meals and may be used long-term in chronic or recurring cases of SIBO.

Addressing Underlying Causes

A key reason for SIBO’s recurrence is that it’s often a secondary condition, meaning there is usually an underlying issue contributing to bacterial overgrowth. Without identifying and treating the root cause, symptoms are likely to return.

Some of the most common underlying causes include:

Structural abnormalities (such as adhesions or scar tissue from surgery)
Impaired gut motility, often seen in individuals with IBS or post-infectious gastrointestinal issues
Low stomach acid (hypochlorhydria), which reduces the stomach’s natural defence against bacteria
Chronic use of certain medications, including proton pump inhibitors (PPIs) and opioids
Ileocecal valve dysfunction, allowing backflow from the colon into the small intestine

Dietary Approaches for SIBO Management

Diet plays a significant role in managing Small Intestinal Bacterial Overgrowth. While food alone cannot eradicate SIBO, the right dietary strategies can help minimise symptoms, reduce fermentation in the gut, and support the success of medical or natural treatments. Several nutritional approaches have emerged as helpful tools in managing this condition.

The Low-FODMAP Diet

One of the most commonly recommended dietary strategies for SIBO is the low-FODMAP diet, originally developed for IBS. FODMAPs are Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols types of carbohydrates that are poorly absorbed in the small intestine and easily fermented by bacteria. This fermentation can produce gas and worsen symptoms such as bloating, cramping, and diarrhoea.

How It Works:

The diet typically unfolds in three phases:

Elimination Phase: All high-FODMAP foods are removed for a short period (usually 4–6 weeks) to calm symptoms.
Reintroduction Phase: FODMAP groups are gradually reintroduced one at a time to assess tolerance.
Personalisation Phase: A long-term eating plan is created based on individual triggers and tolerances.

It’s important to note that the low-FODMAP diet is not intended to be followed indefinitely. Prolonged restriction can lead to nutritional deficiencies and negatively impact the gut microbiome. Working with a registered dietitian or nutritionist ensures the diet is properly managed and tailored to individual needs.

The Elemental Diet

The elemental diet is a highly restrictive, short-term nutritional protocol that involves consuming a nutrient-rich liquid formula containing predigested macronutrients (amino acids, simple carbohydrates, and fats). The aim is to "starve" the bacteria in the small intestine while still providing the patient with essential nutrition.

Key Points:

Typically followed for 2–3 weeks under medical supervision
Shown to be effective in reducing bacterial overgrowth, especially in cases resistant to antibiotics
Often used when other treatments have failed or when antibiotics are not well tolerated

However, this diet is extremely challenging to follow due to its taste, cost, and restrictive nature. It should never be attempted without professional guidance, as improper use can result in significant nutrient imbalances and weight loss.

The Specific Carbohydrate Diet (SCD)

The Specific Carbohydrate Diet is based on the idea that certain carbohydrates are more easily digested and less likely to feed harmful bacteria in the gut. It eliminates complex carbohydrates and focuses on simple, single-sugar molecules that are easier for the body to absorb.

Principles Include:

Removing grains, starches, and most processed foods
Emphasising well-cooked vegetables, fruits, nuts, meats, and fermented dairy
Supporting gut healing and reducing fermentation

While some people report symptom relief on the SCD, it can be restrictive and difficult to maintain. As with other diets, it’s best used short-term and ideally guided by a practitioner.

Other Dietary Considerations

Beyond formal protocols, a few additional dietary strategies can be beneficial during active SIBO:

Avoid highly processed foods that may disrupt gut balance
Limit refined sugars which can feed both beneficial and harmful bacteria
Reduce excessive fibre intake temporarily, as fibre can be overly fermentable during active SIBO
Chew food thoroughly to aid digestion and reduce the workload on the small intestine
Stay well hydrated, as proper hydration supports healthy motility and nutrient absorption

Everyone’s response to food is different, so personalisation is key. Food should support recovery, not become a source of stress or malnutrition.

Natural and Complementary Approaches

In addition to conventional therapies, many people managing SIBO explore natural and complementary approaches to support their recovery. These alternatives may be used either as stand-alone treatments or alongside standard medical protocols. While promising, natural remedies should always be used under the guidance of a qualified practitioner, as they can be just as potent as pharmaceuticals and require careful monitoring.

Herbal Antimicrobials

Nature provides a variety of herbs with broad-spectrum antimicrobial properties. These herbs may help reduce bacterial overgrowth in the small intestine and are frequently used as alternatives to or in conjunction with antibiotics.

AlliTech: Harnessing the Power of Allicin

One of the most potent natural antimicrobials is allicin, the key active compound found in garlic. AlliTech, offered by Dulwich Health, delivers a stabilised and bioavailable form of allicin, making it a powerful option in natural SIBO protocols.

Mechanism of Action: Allicin has been widely recognised for its broad antimicrobial activity, capable of targeting bacteria, fungi, and viruses. This makes it particularly relevant for methane-dominant SIBO, which is notoriously difficult to treat. Research suggests that allicin may help inhibit methane-producing archaea microorganisms linked with constipation-predominant SIBO.
Additional Benefits: In addition to its antimicrobial action, allicin may support immune function and reduce inflammation. As a natural compound, it’s also less likely to contribute to antibiotic resistance and can serve as an adjunct or alternative to pharmaceutical treatments.
Why AlliTech? Dulwich Health’s formulation ensures that the allicin is both stabilised and absorbable, offering consistency and efficacy not always found in raw garlic or basic garlic extracts.

Other Herbal Antimicrobials

Several other herbs have shown potential in managing SIBO:

Oil of Oregano: Contains carvacrol and thymol, compounds known to disrupt bacterial cell membranes.
Berberine: Found in herbs like Goldenseal, Oregon Grape, and Phellodendron, berberine is effective against a wide range of bacteria and supports intestinal health.
Neem: A bitter herb used in Ayurvedic medicine, known for its antibacterial, antifungal, and anti-inflammatory effects.

While these herbs are natural, they are not without risks. Improper use can lead to bacterial resistance, gut irritation, or imbalance in the microbiome, so professional guidance is strongly advised.

Gut Motility Support

Restoring healthy gut motility is crucial for long-term SIBO management. When the small intestine fails to clear itself between meals, bacteria can accumulate and cause recurring overgrowth.

OxyTech: Oxygen-Based Colon Cleanse

OxyTech, another standout product from Dulwich Health, is designed to gently cleanse the colon using a magnesium-oxygen compound. This process releases oxygen in the gastrointestinal tract, which:

Supports a cleaner gut environment
Promotes regular bowel movements
Reduces stagnation in the colon, which can alleviate pressure and microbial backflow into the small intestine

While primarily a colon cleanse, OxyTech indirectly supports small intestinal health by improving overall motility and reducing putrefaction, which can otherwise worsen SIBO symptoms. Unlike harsh laxatives, OxyTech provides a gentle yet effective solution for maintaining gut hygiene.

Other Natural Motility Aids

Ginger: Shown to enhance gastric emptying and stimulate the migrating motor complex.
5-HTP: A precursor to serotonin, which plays a key role in gut motility.

Again, these supplements should be introduced carefully, particularly in those with sensitive digestive systems or neurological conditions.

Probiotics: A Nuanced Approach

The use of probiotics in SIBO is controversial. While probiotics are typically associated with gut health, in SIBO they can sometimes exacerbate symptoms, especially if they contribute to further fermentation in the small intestine.

However, certain strains may offer benefit, particularly during the post-treatment phase:

Lactobacillus plantarum: May help restore balance without excessive gas production.
Saccharomyces boulardii: A beneficial yeast that can crowd out pathogens and support immune modulation.
Bacillus species (e.g., Bacillus coagulans): Spore-forming probiotics that tend to colonise the large intestine rather than the small.

As with other treatments, probiotic use should be personalised and ideally selected based on symptoms, SIBO type, and test results.

Digestive Support

When digestion is compromised, undigested food can feed bacterial overgrowth and worsen symptoms. Supporting digestive function is therefore a key element of SIBO treatment.

Digestive Enzymes

Taking enzymes with meals can help break down carbohydrates, fats, and proteins, reducing the burden on the small intestine and limiting the amount of fermentable material left for bacteria.

Betaine HCl (Stomach Acid Support)

Low stomach acid (hypochlorhydria) is a common contributor to SIBO, especially in older adults or those using antacids. Betaine HCl can help restore normal acidity levels, improving digestion and acting as a first-line defence against bacterial overgrowth. This should be introduced cautiously and only under supervision.

Nutrient Repletion

Due to malabsorption, people with SIBO often develop deficiencies in key nutrients, including:

Vitamin B12
Iron
Magnesium
Fat-soluble vitamins (A, D, E, and K)

Blood testing can help identify deficiencies, and targeted supplementation may be necessary to restore optimal health.

Lifestyle and Holistic Considerations

While dietary changes and targeted treatments are essential in managing SIBO, lifestyle factors play a powerful, often underestimated role in both symptom relief and long-term recovery. A holistic approach that nurtures the body, mind, and gut together can make a significant difference in outcomes.

Stress Management

Chronic stress is closely linked to digestive dysfunction, particularly in conditions like SIBO. Stress can impair gut motility, weaken the immune system, and disrupt the delicate balance of the microbiome. It activates the sympathetic nervous system (the 'fight or flight' response), which slows digestion and creates a more favourable environment for bacterial overgrowth.

Techniques for Managing Stress:

Mindfulness meditation: Encourages relaxation and awareness, helping reduce anxiety and digestive symptoms.
Yoga: Combines movement, breathwork, and meditation to promote nervous system balance and physical wellbeing.
Breathwork and deep breathing exercises: Can stimulate the vagus nerve and improve digestive function.
Spending time in nature or engaging in creative hobbies: Proven to reduce cortisol levels and promote calm.

Incorporating daily stress-reducing practices, even for just 10–15 minutes, can support better motility and gut health over time.

Sleep: Restoring the Gut Overnight

Quality sleep is essential for gut repair and regulation. During sleep, the body activates the parasympathetic nervous system, the 'rest and digest' mode allowing the digestive system to repair, detoxify, and maintain balance.

Inadequate or disrupted sleep has been linked to changes in gut flora, increased inflammation, and heightened sensitivity to digestive symptoms.

Tips for Better Sleep:

Maintain a consistent sleep schedule
Avoid screens and heavy meals close to bedtime
Create a calming nighttime routine to signal the body to wind down

Aiming for 7–9 hours of restorative sleep each night supports the body’s natural healing processes, including the cleansing waves of the migrating motor complex.

Exercise: Movement for Motility

Physical activity helps stimulate digestion and encourage healthy gut motility. Gentle to moderate movement can assist with the movement of food and bacteria through the intestines, potentially reducing the risk of stagnation and overgrowth.

Beneficial Activities:

Walking, especially after meals
Swimming or cycling for low-impact cardiovascular support
Stretching or light yoga to relieve bloating and abdominal tension

While intense, high-impact training might be too much during flare-ups, regular light movement is an excellent addition to any SIBO recovery plan.

The Mind-Gut Connection

The gut and brain are in constant communication via the gut-brain axis, a complex, bidirectional system that influences everything from digestion to mood. This means that mental health can directly impact gut health, and vice versa.

Conditions such as anxiety and depression can alter gut motility and microbiota composition
Gut imbalances can, in turn, affect neurotransmitter production and emotional wellbeing

Recognising and respecting this connection is vital. Supporting mental and emotional health can often improve digestive symptoms, and healing the gut can enhance clarity, mood, and resilience.

The Importance of Professional Guidance

Small Intestinal Bacterial Overgrowth is a complex condition that often requires more than a one-size-fits-all solution. While dietary changes, supplements, and lifestyle shifts can play valuable roles in symptom relief, SIBO is rarely resolved through guesswork alone. Its recurrent nature, multiple underlying causes, and overlapping symptoms with other gut disorders make professional input essential.

Why You Should Work With a Healthcare Professional

Whether you choose to follow a conventional, natural, or integrative treatment path, it is strongly advised to work with a qualified healthcare provider. This might include:

A GP or gastroenterologist for diagnostic testing and prescription options
A functional medicine practitioner who can explore root causes and support long-term gut health
A registered dietitian or nutritionist to guide therapeutic diets and avoid nutritional deficiencies

Accurate diagnosis through breath testing (measuring hydrogen and methane gases) is a critical first step. Only with proper testing can your practitioner determine the type of SIBO you have and tailor treatment appropriately.

The Risks of Self-Treating

Attempting to treat SIBO on your own, especially with strong antimicrobials or restrictive diets can lead to:

Misdiagnosis, potentially overlooking other digestive or systemic issues
Nutrient deficiencies from poorly planned diets
Worsening symptoms from inappropriate supplements or antibiotic use
Increased risk of resistance or recurrence from incomplete or ineffective treatment protocols

SIBO can be stubborn, but with the right support and strategy, it can be managed effectively. A well-informed, structured approach not only increases the likelihood of success but also helps preserve your long-term digestive and overall health.

Frequently Asked Questions (FAQs) About SIBO and Its Treatments

Q1: What are the most common symptoms of SIBO?

SIBO symptoms often overlap with other digestive issues, making diagnosis tricky. The most common include persistent bloating, excessive gas (belching and flatulence), abdominal pain or cramping, diarrhea, constipation (especially in methane-dominant SIBO), and sometimes nausea, fatigue, and nutrient deficiencies due to malabsorption.

Q2: How is SIBO typically diagnosed?

The most common diagnostic method for SIBO is a breath test. After consuming a sugar solution (lactulose or glucose), the test measures the hydrogen and methane gases produced by bacteria in your small intestine. A significant rise in these gases within a specific timeframe indicates bacterial overgrowth. Stool tests are generally not considered reliable for diagnosing SIBO directly, as they primarily reflect large intestinal bacteria.

Q3: Are antibiotics always necessary for SIBO treatment?

Antibiotics like Rifaximin are considered a first-line conventional treatment for SIBO and are often effective. However, they are not always the only solution, and SIBO can recur. Many individuals explore natural and complementary approaches, sometimes in conjunction with antibiotics or as alternatives, especially for recurrent SIBO or if they prefer a more natural path. The decision should always be made in consultation with a healthcare professional.

Q4: What is the role of diet in managing SIBO?

Diet plays a crucial supportive role in SIBO management. Approaches like the low-FODMAP diet aim to reduce fermentable carbohydrates that feed the overgrown bacteria, helping to alleviate symptoms. The Elemental Diet can also be used in severe cases to "starve" the bacteria. It's important to remember that dietary changes are often temporary and should be guided by a practitioner to ensure nutritional adequacy and to prevent the gut from becoming too restrictive long-term.

Q5: How can natural antimicrobials, like AlliTech, help with SIBO?

Natural antimicrobials, such as those found in herbs like garlic (allicin), oregano, and berberine, possess properties that can help reduce bacterial overgrowth in the small intestine. AlliTech, which harnesses the power of stabilized allicin from garlic, is noted for its potent broad-spectrum antimicrobial action. Allicin is particularly researched for its potential effectiveness against methane-producing bacteria, which are often associated with SIBO-C (constipation-dominant SIBO). These natural options can be used as alternatives or in conjunction with conventional treatments, but always under professional guidance.

Q6: What is OxyTech and how does it relate to SIBO?

OxyTech is an oxygen-based colon cleanse supplement. While primarily focused on supporting a healthy colon environment and promoting regular bowel movements, its mechanism of action (releasing oxygen in the gut to support beneficial bacteria and aid in gentle cleansing) can indirectly benefit SIBO management. Improved overall gut motility and reduced waste accumulation in the large intestine can alleviate pressure on the small intestine and create a less hospitable environment for bacterial stagnation. It is viewed as a supportive tool for overall gut health and regularity, which is vital for SIBO recovery.

Q7: Can I take OxyTech and AlliTech together?

Many individuals choose to incorporate both OxyTech and AlliTech into their SIBO management protocols, often alongside other dietary and lifestyle changes. AlliTech targets the bacterial overgrowth with its antimicrobial properties, while OxyTech supports gut regularity and detoxification. However, it's crucial to consult with a healthcare professional before combining any supplements, especially when dealing with a complex condition like SIBO, to ensure they are appropriate for your specific needs and won't interact with any other medications or conditions.

Q8: What are the potential side effects of natural SIBO treatments?

Even natural treatments can have side effects. For example, some individuals may experience a "die-off" reaction (Herxheimer reaction) from antimicrobials (like AlliTech) as bacteria are eliminated, leading to temporary worsening of symptoms, fatigue, or headaches. OxyTech, being a colon cleanse, can lead to loose stools initially as the system is cleansed. It's important to start with lower doses and listen to your body. Always discuss any concerns or adverse reactions with your healthcare practitioner.

Q9: How long does SIBO treatment usually take, and can it be cured permanently?

The duration of SIBO treatment varies greatly depending on the individual, the severity of the overgrowth, and the underlying causes. Treatment can range from a few weeks to several months. While SIBO can be resolved, recurrence is common, especially if the root causes (e.g., impaired gut motility, structural issues, low stomach acid) are not adequately addressed. A long-term strategy involving diet, lifestyle, and supportive supplements is often necessary for sustained remission.

Q10: Why is professional guidance so important for SIBO?

SIBO is a complex condition with diverse underlying causes and varying bacterial profiles. Self-diagnosing and self-treating can lead to ineffective results, nutrient deficiencies, or even exacerbate symptoms. A qualified healthcare professional (e.g., gastroenterologist, functional medicine practitioner, registered dietitian specializing in gut health) can accurately diagnose SIBO, identify root causes, and create a personalized treatment plan that integrates conventional, dietary, and natural approaches safely and effectively.

Regaining Balance: Your Next Steps in SIBO Recovery

SIBO is a treatable condition, and with the right approach, many people are able to find relief, restore digestive balance, and reclaim their quality of life. Whether you’re just beginning to explore your symptoms or are navigating a long-term struggle, it’s important to remember that you are not alone and improvement is possible.

Key Takeaways:

SIBO occurs when excess bacteria build up in the small intestine, leading to a range of digestive symptoms
Effective treatment often involves a combination of conventional therapies (like antibiotics and prokinetics), dietary strategies (such as the low-FODMAP or elemental diet), and natural remedies (including AlliTech and OxyTech)
Lifestyle factors like stress, sleep, and exercise also play a vital role in long-term recovery
Personalised care is essential, self-treatment can be risky, and working with a qualified practitioner ensures that your treatment plan is safe, effective, and suited to your unique needs

SIBO can be frustrating and persistent, but it is not permanent. With the right support and a comprehensive, holistic plan, it is entirely possible to regain digestive health, restore energy levels, and feel like yourself again.

Ready to take the next step? Reach out to a knowledgeable healthcare professional, and explore natural support options like AlliTech and OxyTech from trusted providers such as Dulwich Health, helping people achieve better health naturally since 1986.

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