SIBO Treatment Without Antibiotics

by | Dec 9, 2023 | Blog, SIBO

Within the medical industry, there are a vast number of topics to discuss, with even more differentiating opinions from practitioners and people alike. The topic of “Which is a better approach to treatment, synthetic treatments or natural treatments?” has been a long-standing conversation. As a naturopath, I tend to lean toward natural supports, as I believe they offer people more control over their health and have fewer side effects than pharmaceuticals. Plus, alternative medicines may work for people who do not respond to traditional treatments.

SIBO (small intestinal bacterial overgrowth) is one of the many conditions research indicates to respond well to natural medicines. SIBO treatment without antibiotics can sometimes be more effective.

What are some options for people wanting to improve their SIBO symptoms naturally? This post explains how to support SIBO without antibiotics, so keep reading to find out.

Step 1: Reduce SIBO Symptoms Using Diet

SIBO symptoms are extremely uncomfortable and can even impact someone’s quality of life when left untreated. The first step to improving SIBO, then, is to get symptoms like diarrhea or constipation under control.

Making dietary changes is the fastest way to manage SIBO symptoms in the short term. Certain diets can starve off gut bacteria, quelling the overgrowth. The best diet for SIBO depends on the type and other factors, but may include:

  • The low-FODMAP diet
  • The GAPS diet
  • The Carnivore diet
  • The Elemental Diet
  • Paleo diets
  • Bi-phasic diets
  • Low-carbohydrate diets

Notice that we said that diet manages SIBO symptoms in the short term. The diets listed above are not a long-term solution, as persistent dieting can potentially affect beneficial gut health bacteria, worsening or leading to new symptoms.

Step 2: Remove the Overgrowth

Once someone’s SIBO symptoms are under control, the next step is to address the bacterial overgrowth.

There is a common misconception that a single or group of microbes are the only cause of SIBO symptoms. Gut dysbiosis (or imbalanced good and bad bacteria) is also to blame.

When in balance, bacteria aren’t good or bad. Both types are essential for a well-functioning gut. Yet, when some microbe species multiply, throwing off that balance, they can become pathogenic.

Traditional advice for addressing microbial overgrowth and dysbiosis in the small intestine is to use an antibiotic and research-backed dietary solutions like the Elemental Diet.

Those who wish to use a natural approach can try herbal antimicrobials instead. Herbal antimicrobials contain active ingredients that either directly kill bacteria and other microbes or at least limit their growth.

Herbal Antibiotics for SIBO

Natural antibiotics for SIBO can be equally effective as the gold standard synthetic antibiotic treatment, rifaximin. The most commonly used herbal antimicrobials for SIBO are:

  1. Oregano oil
  2. Uva Ursi
  3. Hydrolyzed silver
  4. Soil-based probiotics
  5. Berberine
  6. Allicin
  7. Neem

Learn more about these natural remedies and the types of SIBO they are best for next.

Oregano Oil

Oregano oil is extracted from oregano plants. It offers antifungal, antiviral, and antibacterial benefits, meaning it kills off fungi, viruses, and bacteria.

This natural antimicrobial has been widely studied for multiple conditions, including intestinal microbe overgrowth. Studies show that it can destroy or at least significantly inhibit microbial growth in the intestines.

Carvacol and thymol are the active ingredients in oregano oil that may contribute to its medicinal effects. In studies on E. coli, these ingredients targeted the membranes of these bacteria, making them less active.

Thymol has also been known to stimulate enzymes in the digestive tract. Stimulating these enzymes promotes healthy digestion by improving motility, or how waste moves through the GI tract.

Uva Ursi

Uva Ursi comes from the leaves of the bearberry evergreen shrub. This herbal antibiotic may be best for a certain type of intestinal overgrowth, hydrogen-sulfur SIBO.

This herbal remedy is a Native American traditional medicine used for centuries as a urinary tract infection (UTI) therapy. Recent studies support this use. Uva Ursi can improve intestinal dysbiosis, a risk factor for UTIs.

The primary active ingredient in Uva Ursi is hydroquinone. Hydroquinone is commonly used for its skin-lightening effects but also has anti-inflammatory and antiseptic properties.

Hydrolyzed Silver

Hydrolyzed silver, or silver hydrosol, is a natural supplement containing positively charged silver ions suspended in purified water. It is similar to colloidal silver but has far more effective antimicrobial benefits.

Colloidal silver has been studied as an antibiotic for treatment-resistant bacterial infections. It can target gram-positive and gram-negative bacterial strains. This natural remedy produces reactive oxygen species (ROSs) that target and eventually destroy bacteria.


Berberine is an active ingredient found in many plant extracts. Barberry, goldenseal, goldthread, and philodendron are common sources of this antibacterial and anti-inflammatory natural drug.

Barberry root extract, in particular, has been studied for its antimicrobial and anti-inflammatory benefits. It also has anti-diarrheal properties, which can help with the primary symptoms of hydrogen-dominant and hydrogen-sulfide SIBO.


Allicin is the primary active ingredient in common household garlic. It offers antibacterial effects against many bacterial strains. Allicin also has antifungal activity against Candida, antiparasitic indications against intestinal parasites, and antiviral benefits.

Methane SIBO features constipation as the predominant symptom, and allicin is particularly helpful for treating constipation.


Neem is a plant-derived extract from the neem tree native to India. It has been used in traditional medicine for millennia, thanks to its antifungal properties. Neem also offers antipyretic, antacid, antiparasitic, anti-inflammatory, and antioxidant effects.

Along with berberine and oregano oil, neem is best for diarrhea-predominant SIBO. The types of SIBO featuring diarrhea as the primary symptom are hydrogen and hydrogen sulfide SIBO.

SIBO Treatment Without Antibiotics

People new to the world of natural medicine may wonder if plant-derived antibiotics can truly be effective. These products are effective and could improve SIBO symptoms even better than pharmaceuticals.

In a landmark study of 104 people diagnosed with SIBO, researchers investigated the effects of herbal therapy versus rifaximin. Recall that rifaximin is one of the most widely prescribed antibiotics for SIBO.

For many, rifaximin might be considered expensive, and insurance does not typically cover its cost. Worse, not all patients respond well to using rifaximin, especially in cases of antibiotic-resistant bacterial overgrowth.

In the study mentioned above, herbal therapy received a 46% symptom response rate. Compare that to rifaximin, which only led to a 34% response rate for SIBO symptoms.

The researchers used two different combinations of two herbal supplements in this study. Each supplement contained a blend of herbs, including oregano oil, barberry root extract, philodendron, and thymus extract.

Herbal preparations were not only more effective but also better tolerated. Side effects experienced by the rifaximin group included diarrhea, hives, and one case of anaphylaxis (an allergic reaction). The group taking herbal preparations had only one case of diarrhea.

Step 3: Optimize Digestion and Detoxification

Digestive symptoms may worsen before getting better when someone starts a new treatment regimen for SIBO, whether natural or not. The reason why this happens has to do with the cell death process.

When bacteria and other microbes die, they rupture into pieces of DNA, fats, proteins, and amino acids. Nearby microbes feast on those materials and produce gases like hydrogen and methane as byproducts.

These gases can cause symptoms that mimic the signs of SIBO. People may feel gassy, bloated, or tired. Flu-like symptoms such as fever and muscle aches are also possible during this phase, known as SIBO die-off.

Though these symptoms will dissipate with time, they can interfere with someone’s life. Optimizing digestion and the body’s natural detoxification pathways can help mitigate discomfort while the body continues to heal.


An unfortunate side effect of SIBO, especially hydrogen-dominant SIBO, is nutrient malabsorption. SIBO can damage the intestinal lining, where nutrients enter the bloodstream.

In severe cases, this damage can cause malnourishment, or when someone does not get the nutrients they need to survive. In milder situations, someone may develop a nutrient deficiency.

To combat these effects, individuals seeking to improve their SIBO should consider the following methods of supporting healthy digestion:.

Support Stomach Acid Production

The stomach produces chemicals like hydrochloric acid to help break down nutrients from food. Stomach acid also plays a role in the gut’s immune response to viruses and bacteria.

Low stomach acid is a risk factor for SIBO. When there is not enough stomach acid to break down food, it passes into the small intestine undigested. Undigested food in the small intestine is a direct cause of bacterial overgrowth.

Supporting healthy stomach acid levels is crucial for those who experience SIBO. This strategy can help address the underlying cause of SIBO in some people and avoid exacerbating SIBO die-off symptoms in others.

Taking hydrogen chloride (HCl) supplements is a natural way to approach low stomach acid levels. Pepsin enzymes and iron, calcium, or vitamin B12 supplements are also useful for stomach acid production support.

Chew Food Slowly or Until it is liquid.

Many people mistakenly believe that digestion begins in the stomach. The truth is that the first phases of breaking down food and absorbing nutrients happen in the mouth.

The saliva is filled with digestive enzymes that start the process of breaking down food. Chewing supports this process, creating a larger surface area for those enzymes to work more efficiently.

Chewing also signals the stomach to contract and release additional digestive enzymes. The better someone chews their food, the less work the stomach and intestines have to do to break it down.

Eat Sit Down and Relax

The parasympathetic and sympathetic nervous systems have opposing effects on the body. The sympathetic nervous system is often referred to as the fight-or-flight system. It keeps people alert to environmental threats.

On the other hand, the parasympathetic nervous system is also known as the rest and digest system. When this system is activated, we feel relaxed. Parasympathetic activation is also when our bodies burn the most calories and digest the most food.

Relaxing during meal and snack times can signal activation of the parasympathetic nervous system. As a result, the body will prepare for digestion, preventing food from sitting in the digestive tract and causing bacterial overgrowth.


Another side effect of SIBO die-off is the buildup of toxins in the digestive tract. The body’s natural detoxification system—the liver, kidneys, and GI tract—eliminates these toxins.

These organs and systems experience much stress while trying to neutralize so much waste. Luckily, there are things someone can do to reduce stress on the liver, kidneys, and GI tract.


Though the liver, kidneys, and GI tract take care of most of the toxins in the body, the skin also plays a role in detoxification. Specifically, the skin removes toxins via sweat. Saunas and exercise are excellent ways to help the body sweat out toxins created by SIBO die-off.

A particular kind of sauna, known as an infrared sauna, has added benefits for the gut. Infrared saunas can help heal a damaged intestinal lining and create a gut environment for beneficial bacteria to flourish.

Coffee Enemas

Enemas are tried-and-true methods designed to empty the bowels. They involve administering fluid into the rectum—in this case, coffee. Enemas are a go-to treatment for chronic or severe constipation.

Coffee enemas provide additional benefits. They are known to reduce die-off symptoms, improve blood flow to the liver, and combat gut inflammation.

However, consult a doctor before trying any type of enema for the first time.


Colonics are similar to enemas; they involve administering fluid into the rectum. The difference is that colonics require multiple fluid infusions rather than one and target the colon instead of the entire bowel.

Certified hydrotherapists administer these treatments. Colonics have similar benefits as enemas. They help with constipation, encourage the removal of toxins from the intestines, and combat bacterial overgrowth.

Red Light Therapy

Red light therapy is similar to an infrared sauna. It uses light at the infrared end of the light spectrum. These light rays are powerful enough to penetrate the skin, offering various benefits for the brain and body.

One of these benefits is detoxification. Red light therapy is known to improve blood circulation, which helps to pump out toxins faster.

Using red light therapy can also help with other aspects of health. For example, it can improve sleep, aid digestion, and reduce inflammation in the gut.

Castor Oil Packs

Castor oil originates from the castor plant in eastern countries like Egypt. It has been used for thousands of years as a laxative. The FDA has also approved castor oil for this use.

Secondarily, castor oil targets the lymphatic system. It can help fight off infections and SIBO-causing toxins and bacteria. Additionally, it plays a role in glutathione synthesis to support the body’s detox pathways.

Step 4: Replenishing the Microbiome

By now, the microbes causing someone’s SIBO symptoms should have died off and been eliminated from the system. The final phase of a holistic SIBO regimen is restoring beneficial gut bacteria.

A secondary goal during this phase is to heal damage to the intestinal lining. Without targeting the gut’s lining, toxins and harmful bacteria may continue seeping into the intestines, causing someone’s symptoms to re-emerge.

The best way to promote good bacteria, restore gut balance, and heal the gut lining is with certain probiotics and supplements.


Probiotics are live cultures of bacteria, yeasts, and other microbes that can benefit gut health. Individuals can buy probiotics in supplement form or obtain them through their diet with yogurt and other fermented foods.

The best probiotics for SIBO are soil-based. They contain strains of microbes naturally found in healthy soil. The theory behind soil-based probiotics’ benefits is that human ancestors evolved by consuming bits of soil from the plants they ate.

In today’s over sanitized world, humans can no longer access these beneficial microbes. Incorporating a soil-based probiotic can re-introduce these beneficial strains and promote a healthy gut.

Another reason why gut health experts recommend soil-based probiotics is that they are incredibly hardy. Traditional probiotics may not survive long enough to reach the intestines.

Soil-based probiotics are different. They can survive stomach acid and enter the bowels, strengthening the gut lining and encouraging good bacteria to flourish.

Gut Lining

SIBO can be extremely harmful to the intestinal lining and may lead to complications like leaky gut syndrome. Repairing the damage requires a multi-step process to combat inflammation and promote healing.


L-glutamine is an amino acid. Amino acids are the building blocks of proteins. Amino acids and proteins are among the main components of cells, including the squamous epithelial cells that make up the intestinal lining.

Supplementing with L-glutamine capsules or bone broth improves the integrity of the gut’s lining. This amino acid may also combat gut inflammation to promote healing.


Infrared light from red light therapy or infrared saunas is not just beneficial for detoxing the body during SIBO die-off. It can also aid in healing the gut lining.

Light delivers energy to human cells. Infrared rays can deliver even more energy than visible light. This energy travels to the mitochondria, the powerhouse of the cell.

When stimulated, the mitochondria encourage the growth of new cells. That includes the growth of new cells to repair the intestinal lining.

Aloe Vera

Aloe vera is a common natural remedy for skin injuries. It also has indications for digestive problems with its wound-healing, anti-inflammatory, and antimicrobial properties.

This plant may be particularly helpful for people dealing with SIBO who also have irritable bowel syndrome (IBS). A 2018 review and meta-analysis found that aloe vera significantly improved symptoms in people with IBS.

Marshmallow Root

Marshmallow root is a plant-derived substance commonly used to treat skin issues. It may also relieve digestive complaints like diarrhea and constipation.

This natural remedy creates a thin coating over mucosal membranes that line the mouth, nose, lungs, stomach, and, importantly, the intestines.

The marshmallow root coating can soothe inflammation and protect healing epithelial cells from infection-causing bacteria.

woman standing next to bike, movement for SIBO maintenance

Everyday Maintenance

Relapse after SIBO treatment is unfortunately common, with some estimates of a nearly 50% relapse rate.

Luckily, there are some things people can do to lower their risk of relapse.

Environmental Factors

We can’t escape the toxins in the environment. They are in the air we breathe, the foods we eat, and the water we drink. Here are a few tips for boosting the immune system response against these toxins to protect a healing gut.


Light (and infrared light, in particular) helps detox the body. It also combats swelling and inflammation to encourage the gut to heal faster.

Stress Reduction

Stress compromises the immune system and slows the healing response. Practicing mindfulness, eating healthily, and connecting with others can help combat stress to support the SIBO healing journey.


Another way to combat stress is by staying active. Moving the body also promotes digestion to help with constipation and other motility issues.

Can I Address SIBO on My Own?

Yes, you can address SIBO on your own with some of the tips in this guide. However, we recommend working with a gut health expert to avoid making common mistakes that can hinder SIBO recovery progress.

Using the Wrong Supplements for Your Type of SIBO

There are three types of SIBO, each caused by one or more specific species of microbes. Using the wrong herbal antimicrobial may potentially exacerbate symptoms.

Not Taking a High Enough Dose

Taking the right dose of an herbal antibiotic is crucial. If someone does not take enough, their symptoms may not respond.

Taking Too High a Dose

Taking too much is just as harmful as not taking enough of a supplement. Too high a dose could result in too many beneficial gut bacteria dying off, allowing pathogenic microbes to continue growing and worsening SIBO symptoms.

Not Taking the Supplement for Long Enough

Not taking an herbal antimicrobial for long enough may have the same effect as taking too low a dose. The course may not be sufficient to manage the overgrowth.

Taking the Supplement for Too Long

Taking an herbal antibiotic for too long could worsen gut dysbiosis. In worst-case scenarios, gut bacteria could even become resistant to the supplement, making it harder to have natural improvements.

Not Ensuring You Have a Bowel Movement Every Day

Daily bowel movements are essential in addressing SIBO symptoms, especially when detoxing. Bowel movements remove waste from the body, preventing it from sitting in the intestines and causing more overgrowth.

An Overly Restrictive Diet

Restricting some foods is beneficial for SIBO. However, an overly restrictive diet may affect beneficial gut bacteria, worsening dysbiosis and having a downstream effect on SIBO symptoms.

Can You Heal SIBO Without Antibiotics?

Yes, you can improve SIBO symptoms without antibiotics. Special diets, herbal antimicrobials, probiotics, and other natural remedies can help improve symptoms, destroy pathogenic gut bacteria, and replenish the microbiome.

Though achieving these goals without a professional’s help is possible, we always recommend consulting a healthcare provider. Trying to relieve yourself of SIBO on your own may be ineffective at best or exacerbate symptoms at worst.

Do you need expert advice about improving SIBO symptoms without antibiotics? Revolution Gut Health exclusively specializes in supporting digestive conditions like SIBO.

Schedule a consultation with our gut health doctors to start your safe and effective SIBO recovery journey.

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