SIBO: Symptoms, Causes & Treatment | 2

Today we are talking about small intestinal bacterial overgrowth, known as SIBO. SIBO occurs when excessive bacteria colonize the small intestine and can cause serious gastrointestinal discomfort. This is the second of our two-part program with Dr Michael Traub. In this program we will be detailing treatment protocols for this common and challenging condition.

SIBO may affect up to 80% of patients with irritable bowel syndrome, which makes it very common - but also complicated to diagnose and treat.  In part one of this series, we highlighted the risk factors, symptoms and diagnosis of SIBO. 

Today, in part two, we are taking a deep dive into treatment approaches for SIBO. Dr Michael Traub is our guest. He is medical director of Lokahi Health Center in Hawaii. He is past president and current board member of the American Association of Naturopathic Physicians (AANP) and has been honored by them as Physician of the Year. He is a renowned expert on SIBO.

Key Take-Aways


Treatment options for SIBO
Antimicrobial therapy - A combined pharmacological and botanical approach can be effective in treatment of SIBO. 

Typically, this antimicrobial therapy includes a) Rifaximin 550 mg TID x 14 d, b) Botanical antimicrobials: allicin, berberine, oregano, Neem BID x 4-8 wk, and c) elemental diet x 14-21 d.


Therapeutic diet
A low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet with careful attention to nutritional adequacy is effective as a SIBO treatment.


Prokinetic agents
Prokinetic agents include medications that help control acid reflux. Typically, a Prokinetic medication includes a) Prucalopride 0.5-1 mg at bedtime (qhs), b) Low-dose erythromycin 50-62.5 mg qhs, c) Low-dose naltrexone 1.5-5 mg qhs, d) Ginger root 1000 mg qhs, and e) Iberogast 20 drops TID.


Psychological therapy
Psychological therapies, including cognitive behavioral therapy, hypnotherapy, and mindfulness-based therapy, should be considered in SIBO patients with functional symptoms.


The use of probiotics can potentially increase the risk for methane predominant variant of SIBO which has been associated with constipation-predominant symptoms. 

Probiotics containing lactobacillus or Bifidobacterium strains are not recommended for SIBO until you eliminate your bacterial overgrowth and repair your gut microbiome.


Structural therapy
Structural therapies should be offered to SIBO patients including visceral therapy and pelvic floor therapy.


Physical exercise
Exercise is always a good idea, but when it comes to SIBO there is a definite yoga connection. A systematic review of the effects of yoga in inflammatory bowel syndrome (IBS) analyzed six randomized controlled trials and showed evidence for a beneficial action of a yogic intervention over conventional treatment in IBS, with significantly decreased bowel symptoms, IBS severity, and anxiety.




The opinions expressed in this Nutramedica program are those of the guests and contributors. They do not necessarily reflect the opinions of Nutritional Fundamentals For Health Inc.

This video is intended for licensed or registered health professionals and students of health professions only. These statements have not been evaluated by the Food and Drug Administration. Information contained in these programs are not intended to diagnose, treat, cure or prevent any disease.