Herbs can, in some instances, be as strong as drugs?
My general conception of herbs is has been that they’re what you grow in your garden. Yes, they can be helpful with illness, but mostly around the edges. Pharmaceutical companies, on the other hand, spend hundreds of millions of dollars to produce a drug. If you’re really sick – you’re going to need drugs.
This study threw a monkey wrench into that idea.
Small Intestinal Bacterial Overgrowth (SIBO) in ME/CFS and FM
SIBO is an often painful condition that can, depending on its severity, cause gas, cramping, diarrhea, heartburn, anemia, malabsorption, cognitive problems, rashes, joint pain, headache and more. We found out how far SIBO can go when Esther’s decades of brain fog, orthostatic intolerance, mood issues, and others mostly cleared up when she took care of her SIBO using antibiotics.
SIBO occurs when bacteria spill over from the gastrointestinal tract (where they belong) into the small bowel (where they don’t).
Key Indicators of SIBO by Dr. Siebacker
Little research has been done into SIBO prevalence in either ME/CFS or FM, and it’s not clear common it is. We know IBS symptoms are common in both, and we know SIBO is very common in IBS and that SIBO can trigger IBS. Increased gastrointestinal permeability – which is often associated with SIBO – appears to be fairly common in Fibromyalgia. Remarkably, in one study a higher percentage of fibromyalgia patients (100%) than IBS patients (84%) tested positive for excessive hydrogen gas in a lactulose breath test.
The Study
Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, Justino E, Tomakin E, Mullin GE. Glob Adv Health Med. 2014 May;3(3):16-24. doi: 10.7453/gahmj.2014.019.
Cramping, bloating, diarrhea, constipation… you name it – SIBO can cause just about any gut symptom – and more.
This retrospective study took a look back at four years of patients treated for SIBO at a single clinic. They were considered for SIBO if they were experiencing abdominal discomfort, cramping, bloating, flatulence, diarrhea, worsening of symptoms after eating, and low serum B12. SIBO was confirmed by a lactulose breath test.
They were given either an antibiotic (rifaxamin/Xifaxin – 2 200 mgs tabs/3x’s a day) or 2 capsules twice daily of an herbal preparation by one of two companies: Dysbiocide and FC Cidal (Biotics Research Laboratories) or Candibactin-AR and Candibactin-BR (Metagenics). The maximum cost of the herbal preparation was $130/month.
Patients that did not respond to Rifaxamin were either put on the herbal preparation or given triple antibiotics (clindamycin/metronidazole/neomycin) for four weeks and were tested again.
Results
Not only were the herbs as effective as Xifaxin (46% responders on herbs, 34% responders on Xifaxin), 57% of the patients who did not respond to Rifaxamin responded positively with the herbs (passed the breath test). Sixty percent of the Xifaxin non-responders also responded to triple antibiotic therapy. Nine percent of patients on Xifaxin had significant side effects (including one case of clostridium dificile-associated diarrhea) compared to one percent of the herbal treatment group.
As Effective, Cheaper, Fewer Side Effects … Hmm…
The authors noted that SIBO is a fairly common condition which is chronic, difficult to treat, and often recurrent (requires multiple treatments) and has no clear treatment guidelines.
Herbs were as effective as a drug in treating SIBO and were considerably cheaper and safer
Given some of the issues with Xifaxin, it’s easy to see why some patients and doctors are turning to herbs. As we saw with Esther’s story, Xafaxin can be very effective, but it’s no walk in the park. For one thing it’s very expensive ($1250/month), and because it’s not FDA approved for SIBO, some patients may have to pick up the costs. Patient costs even under Medicare are over $600+/month. Significant side effects may occur with antibiotics including, ironically, gut issues.
Most important, about 50% of people with SIBO do not respond to Xafaxin. Of those that do, the response may be temporary, setting them up for another round of an expensive drug or triple antibiotic therapy.
Lower cost and safe alternatives are clearly needed, and at a maximun of about $120/month, these herbs fit the bill. They didn’t sucessfully treat a significantly higher percentage of patients than Xifaxin, did but their significantly lower cost and reduced side effects suggest they should probably be the first treatment option for SIBO. They were also effective in about half the people who didn’t respond to Xifaxin.
Unfortunately the study did not assess differences in treatment effectiveness in the two herbal products. Amazingly, the two herbal products only shared one ingredient in common — thymus vulgaris — suggesting that herbs provide multiple options for getting at gut issues.
The Biotics Research Laboratories products contained tinospora cordifolia, equistum arvense, Pau D’Arco, thymus vulgaris, artemesia dracunculus, sida cordifolia, olea europaea, dill seed, stemonia sessifolia, artemesia absinthium, pulsatilla cheninsus, brucea javinica, picrasma excelsa, acacia catechu, hedyotis diffusa, and yarrow leaf.
Demonstrating the richness of the herbal approach to SIBO, thyme was the only herb present in both herbal combinations
The other product contained thymus vulgaris, oreganum vulgare (oregano oil), salvia officinalis, (sage leaf), mellissa ofiinalis (lemon balm leaf), coptis chenensis (containing berberine), berberis artistata (Indian barbery root extract), beberine sulfate, scutellaria baicalensis (Chinese skullcap root), phellodendron chinense (bark), zingiber officinale (ginger), glycyrrhiza uralensis (Chinese licorice root), and rhemum officinale (Chinese rhubarb).
Dr. Alison Siebecker, an SIBO expert and the author of SIBOinfo.com reports similar experiences with herbs (or as she calls them ‘herbal antibiotics”) stating, “We find they have the same efficacy as pharmaceutical antibiotics.” She uses from 1-3 of the following herbs at the highest doses suggested for 4-6 weeks: allicin from garlic (highest potency formula – Allimed) / oregano /berberine (found in goldenseal, oregon grape, barberry, coptis, Phellodendron) / Neem / cinnamon. and she states a host of other options are available.
The idea persists that alternative health (nutrition, acupuncture, naturopathy, mind/body) protocols can help you around the edges, but if you’re really sick you’re going to need traditional medicine, i.e. drugs. There’s surely some truth to that, but Dr. Teitelbaum, in a talk with nutritionist and chiropractor, Dr. Courtney Craig, asserted that 80-85% of what works in Fibromyalgia and ME/CFS comes from the alternative health field, and here we have a study indicating that herbs can be as effective for drugs in SIBO.
- Check out Dr. Craig’s overview of this study here
- An Herbal Approach to Chronic Fatigue Syndrome – That Worked…
- For more on SIBO
Coming up soon – the story of one woman’s success resolving decades of gut symptom …from home.
Very interesting, thanks for this, Cort. I’m wondering can anyone purchase the herbs that were in the study, and if so how? Or do they have to come from a practitioner?
Might want to give this a try,
Sandra
I would surely be interested in trying these herbs. Are they available in ONE pill, I hope. If anyone can buy them, and you know a source, please share.
I put links to the herbs on the blog. I imagine you can get similar formulations at Prothealth (?) and if you click on the link to Dr. Courtney Craigs blog she has some formulations as well.
WillnerChemists.com carries Biotics and Metagenics.
I was sick with fibromyalgia and met someone named Radio on the other Phoenix Rising site that stole it from Cort. Those people are b*stards over there! They abused the heck out of Radio saying he never had CFS. Well guess what? No doc helped me RADIO DID! I suspect none of the lazy corrupt people over there wanted to get better because they didn’t want to lose their disability! I hope Trump kicks them off, i talked to some who sat on there chewing the fat all day while my family & I were out busting our cans to support ourselves AND forced to support them.
I recovered from fibromyalgia by treating sibo. I met a guy named Radio on the Phoenix Rising site that was stolen from Cort. Those people are b*stards over there! They abused Radio and he was the only one who helped me. I suspect the lazy rear ends didn’t want to lose their disability. They sit on their fat fannies all day and force me and my family to support them. I hope Trump kicks them off!
Hello, I have been having so much trouble with UTI’s. They are bacteria and my Dr. keeps saying it’s from Intestinal Bacterial. And I’m about to believe it after reading this. My diarrhea and the UTI’s started at the same time almost 5 years ago. I have been on everything and neither with go away. Plus can’t take antibiotics anymore because of allergies from taking them so much now. I am now waiting for the next treatment from a UTI now. I have become so weak from all of this. I just need help from anyone. I’m about to give up!!!
Kathy
FYI, most UTIs are caused by e. coli, the most common intestinal bacteria. This in itself does not say why you are more susceptible to UTIs, or suggest SIBO. Frequent diarrhea is likely contributing, as it will be harder to keep the intestinal outflow from contacting your urethra (sorry about graphical details). Maybe, though, your diarrhea is a symptom of SIBO, and fixing that will fix the UTIs? I hope you find a solution; constant UTIs is a major bummer!
Here’s some info about bacteria involved in SIBO (from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890937/#!po=26.7857)
“In most patients, SIBO is not caused by a single bacterial strain. In general, there is an extension of colonic bacteria into the small bowel. Less frequently, the “normal” amount of small intestinal bacteria increases. Bouhnik et al[92] investigated samples of jejunal juice in 63 patients with diarrhoea and/or malabsorption. The diagnostic criteria of SIBO were fulfilled in 55 persons (87%). The authors identified 141 micro-aerophilic strains (Streptococcus 60%, Escherichia coli 36%, Staphylococcus 13%, Klebsiella 11% and others) and 117 anaerobes (Bacteroides 39%, Lactobacillus 25%, Clostridium 20% and others)[92].”
Try IBA Ursi capsules. Sometimes UTI-es are sign of Diabetes too.
Sandra, anyone can buy these herbs. Many of the herbs are probably already in your kitchen — thyme, sage, oregano, cinnamon — and are surprisingly powerful in treating a wide range of medical issues. But my very best advice is to contact a recognized practitioner of herbal medicine. In the U.S. the go-to organization (the American Herbalists Guild) can be reached at http://www.americanherbalistsguild.com/ Disclosure: I am not an AHG member, but I have studied with some of the members. These men and women are all real pros and after consulting with you are able to compound a herbal preparation that is appropriate for you. One size doesn’t necessarily fit all.
I was surprised not to see grape seed and grapefruit seed extract in the list!
Not to mention vitamin C one thousand mg every 2 hours up to bowl tolerance. Or, if your are an MD, you may administer vitamin C IV in much, much, larger doses very safely , as does Dr Martin Gallagher in Jeannette Pa. Also Silver Biotics IV!
Why so much C? As C enters the cells, it transforms to Hydrogen Peroxide, I believe. He uses it for cancer patients as well.
By the way, I don’t see it so difficult to kill these germs, it’s the “die off” effect that takes me completely out of the game. RP
I’m currently working with Dr. Siebecker to eradicate my SIBO using option #3 not mentioned here, a 14 day elemental diet to starve the little buggers. It’s intense, indeed, but according to Dr. S she’s seeing a higher efficacy rate than either Rx or herbal antibiotics. I’m on day 11 and the die off symptoms have been rough, but it feels like it’s working. I’ll know Tuesday next week when I retest. I’ve done several things to help heal my CFS and this feels like it could be the last big piece of the puzzle. I’ll keep you posted.
There is a great private Facebook group for SIBO sufferers. It’s provided great support and education for me during this intense therapy. Lots of talk about people’s experiences with both herbal and Rx antibiotics.
Thanks Jennifer. I look forward to hearing about the elemental diet 🙂
Good luck with the protocol
need more info on where to get these herbs/powders …thnx
I put links to the companies on the blog. I think you can probably find approximations of the herbal preparations at Prohealth as well. Dr. Courtney Craig has some supplements attached to her blog on the study.
I’ve been on the SIBO diet for years and I am still suffering so I guess for some of us we need more than the diet.
Sandra, most of the Sibo docs and researchers don’t believe you can eradicate the bacteria through diet alone, though you can alleviate symptoms tremendously. I’ve been able to keep my gastro symptoms way down with the GAPS diet, but my bacterial counts were still very high. The elemental diet is one of the protocols to eradicate the critters by starving them. For 14 days, possibly 21, you take a mixture of pre-digested amino acids (sounds yummy, eh?), glucose and MCT oils. 2,000 calories over 3 quite unpalatable “meals” each day. It absorbs high up in the GI tract before it gets to the bugs. It’s been an adventure indeed and I about quit 3 times. Not for the faint of heart!
For many, the answer may be fecal transplant. Remember? RP
I am currently a patient of a Dr. Melanie Keller, ND at the SIBO Center for Digestive Health in Portland Oregon. (Dr. Siebecker who founded the center is not taking new patients now as she is taking time off to right a book on SIBO but her colleagues are up to speed on the most effective treatments). Initially I went to Portland for an in person appointment but followups are done by Skype so this works for out of town patients. I am having an excellent response to treatment which includes taking Allimed, following a specific diet low in sugars that feed the bacteria, and taking ginger as a prokenetic agent. I also am benefiting from taking apple cider vinegar before meals to increase stomach acid thus preventing an overdose of bacteria to begin with and Homozon a magnesium powder that keeps my bowels moving. The fibromyalgia muscle pain which I experienced after exercise for many years has almost entirely resolved after 2 months of treatment. This is a big breakthrough in my recovery but I know that completely eliminating SIBO is a process and will take time to completely heal.
There is excellent information on Dr. Siebecker’s website http://www.siboinfo.com as well as the website of the SIBO Center site http://sibocenter.com. The doctors at the center are at the forefront in the research and treatment of SIBO and hosted a symposium on the subject last January where physicians including the leading gastroenterologist in this field Dr. Mark Pimentel (author of “A New IBS Solution Bacteria-The Missing Link in Treating Irritable Bowel Syndrome”) attended. You can download lectures from the symposium on the siboinfo site.
Although some people are having success treating SIBO with herbs Allimed is the alternative therapy of choice recommended by the doctors at the SIBO Center. Allimed is an extract of allicin stabilized and concentrated in a patented process. One capsule is many many times the strength of a bulb of garlic. This product is a really potent anti-bacterial, anti-fungal and anti-viral drug. However it is not cheap. $135 for a bottle of 60 capsules. Typical treatment is 3-6 capsules a day for at least a month. You can order Allimed without a prescription at http://www.allimed.us.
An important point that is missing from this article is that treatment of SIBO with Rifaximin alone has not proven to be effective over time especially if one has high levels of methane gas as measured in a breath test. According to SIBO physicians patients who take Rifaximin alone may feel better for a time but symptoms will return. In the case of methane producers Rifaximin must be combined with Neuromycin. The doctors at the SIBO Center have seen equally good results taking Allimed. Also paramount to recovery is taking some kind of prokenetic agent following treatment with antibiotics. These include low dose erythromycin and low dose naltrexone. (Yes LDN because it causes the production of endorphins that stimulate gut motility – no wonder it is effective for FMS). The underlying cause of SIBO according to Dr. Pimentel is an autoimmune response in the gut that damages motility allowing bacteria to migrate into the small intestine. So killing the bacteria alone is not a cure. However many patients completely by taking a course of antibiotics and taking a prokinetic agent and staying on diet for a year.
Thanks for the great summary Darden! Much appreciated 🙂
I must have missed this, but what is the “breath test?”
Its a lactulose breath test I believe that measures the amount of hydrogen in your breath.
SIBO is diagnosed with a breath test that measures the hydrogen and methane gas produced by bacteria in the small intestine. Patients drink a sugar solution of glucose or lactulose after a 1 or 2 day preparatory diet. Measurements are taken at a baseline (before consuming the solution) and then every 20 minutes for 3 hours. The lactulose breath test diagnoses overgrowth in the distal end of the small intestine where SIBO is thought to be more common. The glucose test can only measure gas in the upper end. Initially when neither my physician or I did not know that much about SIBO I did a one hour glucose test which was negative. Then on further research I learned that the 3 hour latulose breath test is most accurate – the gold standard of SIBO doctors. I did two of these tests concurrently from two different labs to see if there would be a difference. The results were the same – small levels of hydrogen and high levels of methane. Typically patients with high levels of hydrogen suffer from the diarrhea form of IBS and patients with high levels of methane suffer from the constipation form. Most of the people I know with FMS tell me they suffer from both diarrhea and constipation so one would expect to find high levels of both gases, which was true for me constipation being dominant.
SIBO is common in CFS and FMS because people with these conditions have low stomach acid which kills bacteria initially in the gastrointestinal tract and they have low levels of endorphins which control gut motility. Even if one is recovered from CFS which is the case for me, one can still have SIBO if not treated. Its a complication of these syndromes that causes a condition of toxemia and overwhelms the liver’s capacity to detox. It turns out that it is not the specific bacteria that we harbor but the location. That is why detox programs, probiotics and fecal transplantation do not work long term. It took me a long time to figure this out. I had recovered from CFS but I still had poor digestion and fibromyalgia muscle pain after exercise. I had a positive ANA and suspected that this was coming from my gastrointestinal tract but otherwise I remained clueless until I stumbled upon SIBO. Now all the pieces of the puzzle have been found!! That said I know that full recovery from SIBO is a long process.
Darden, have you eradicated your Sibo or are you still in process? Also is your CFS recovery story on this site somewhere? I’d love to read it. I’m always looking for inspiration!
Thank you,
Jennifer
Hi Jennifer,
I’m in the process of eradicating SIBO. My recovery story is on my blog: http://www.fibrofriends.typepad.com. I haven’t written a blog post specifically on SIBO as yet but its mentioned in a number of posts including my opening post which is a summary of effective treatments for CFS & FMS. Read my post “Hope” for inspiration!
Darden,
Thanks so much for your summary of your SIBO protocol. It is SO helpful to read. Is Allimed the only herb that you take? I am wondering since the above article states the use of different herbs in the study of SIBO patients. Is Allimed alone enough to start with if you have a positive breath test? Also if you are hydrogen or methane dominant would Allimed work for both?
Thanks,
Sandra
Hi Sandra,
Yes I am only taking Allimed as an antibacterial agent. According to the docs at the SIBO Center it works well for both hydrogen and methane producers but you need to take it longer than pharmaceutical antibiotics. The program I have arrived at is: apple cider vinegar before meals, 2 Allimed and ginger root capsules with meals and Homozon (magnesium powder) before bed. Hopefully these more “natural” agents will do the trick. So far my health has been steadily improving. Fibromyalgia muscle pain almost entirely gone and no more gas or bloating.
Yes you can buy the herbs in question in the United States. The names in brackets after the names of the herbs are the names of the companies that produce them and they are all American companies. So you can purchase on the internet or through a herbalist or nutritionist.
The companies are Biotics Research; Metagenics and AR stands for Californian company Allergy Research.
I have used these companies for some years as British nutritionist and have found them ethical and highly reputable. Hope this is useful.
Phillida
PS.
The protocol for SIBO used here in the UK uses the FODMAPs diet in the elimination period if the protocol.It avoids a lot of die off problems. The diet is out of the clinic at the University of Newcastle New South Wales Australia, and while a rather odd diet it is only for the short period of cleaning out the gut and it makes the patient MUCH more comfortable because it eliminates the foods which cause so much distension and discomfort.
In the UK the breath testis available through Regenerous Labs. which is reputable lab, but not available on the NHS.
FODMAPS – I live it. I’ve been meaning to do a blog on it. I think it is the best diet for me.
And some of these herbs are the same ones which successfully treat chronic EBV!
Your viral load should also go down along with the bacterial overgrowth. You have to treat the chronic viruses for longer , sometimes much longer but one advantage of the herbs is that they ( as the paper says and experience confirms) have FAR fewer side effects and people weakened with CFS don’t need side effects.
I wonder if the possible connection with SIBO and chronic virus infections will prove to be a link? Meanwhile you have little to loose by giving this treatment a go.
I am unlikely to be able to get the breath test that diagnoses SIBO in my area. However, a few years ago I had a Comprehensive Stool Analysis (“Fedexed” to the U.S. through a naturopathic office). My report indicated zero to extremely low levels of expected/beneficial flora, and extremely high levels of one commensal/imbalanced flora (Hemolytic Escherichia coli) and one dysbiotic flora (Enterobacter cloacae). Among other abnormalities, I had an abnormally low concentration of Secretory IgA(sIgA) which is central to the normal function of the GI tract as an immune barrier, and a stool pH that was too alkaline. The report indicated that many GI pathogens, including bacteria and yeast, thrive in an alkaline pH.
I have many SIBO symptoms, and have already determined I do better eating the foods recommended for SIBO patients. Would it be safe to assume that the imbalanced flora detected “further down” in my system may also occur in my small intestine? In the absence of a definitive breath test, would there be any harm in taking the herbs recommended for SIBO, and more strictly following one of the SIBO diets?
Karen,
You can have the test kit mailed to you from the SIBO center in Oregon if you have a doc who will request it and do the test at home. Also direct labs (directlabs.com) you can order the breath test on your own without a doctor’s prescription. You do have to pay for it and I believe it is $239 but then you get the results online in a few days after you mail it back and can have someone help you with the right treatment protocol for you.
I used direct labs for a test recently and it went very well. They use Lab Corp to do the actual testing but for almost any test you can order it yourself.
Hope this helps,
Sandra
Thanks, Sandra, for the information regarding Direct Labs. Ordering online is an option I hadn’t considered for this type of test. However, I do have one concern. The website indicates the test must be shipped within 48 hours of collection, and only on Monday through Thursday — presumably so the vials don’t sit over the weekend. Another U.S. lab that does the same test stated they are not responsible for delays regarding test kits that get held up at the border. These statements lead me to question if the tests are “time sensitive”. If there is a longer-than-anticipated time between sample collection and interpretation by the lab, I wonder if the results would be accurate.
How did you test for small intestinal bacteria?? Ihave had the addition of a baby bump with no baby. I have IBS-C and an enlarged fatty liver with no known cause found for over two years. It came with a 70 lb. Weight gain in 5 months. Still looking for help.
Hi Karen,
I believe you have 2 weeks from the time you take the breath test and send it in until it would expire as far as interpreting the test goes. I am trying to verify this for you so I will write back in the comments if this information is not correct.
Sandra
Hi Karen,
Just to confirm I checked with the SIBO center in Oregon and they said the samples must be tested no longer than 2 weeks after you breath into the tubes. I hope this helps.
Sandra
Hi Sandra,
Yes, your information certainly helps. Thanks so much for taking the time to obtain this answer for me.
Karen
Just wondering — I was diagnosed with SIBO over 20 years ago. Did the whole antibiotic thing (in the 90s, before Xifaxan, though) in my 30s (which did help, and did save my life — I was dropping weight dangerously). Had done the whole candida thing for ten years in my teens and 20s, and just got worse. I also did the alternative thing — individual herbal antibiotics, gut permeability supplements, etc., in my 30s and 40s, but only got better by eliminating pretty much all foods (and acupuncture helped, too). Now, at 50, I have only been able to eat 2 foods for 7 years (and times like now, even those are not okay). I have been holding off on trying other treatments because I am so sensitive (guts and all) that I cannot tolerate even a sip of ginger tea (doubles me over), or some of the other things that are supposed to be used for SIBO or IBS. I would love to try some of these things, but they seem so out of reach because of my sensitivities. And I’ve tried so many of them before. But my guts seem to be getting worse, rather than better. Has anyone else been in this situation and found help?
Has anybody ever combined antibiotics with herbal antibiotics?
Has there been a study done using the correct dose of Rifaximin? This study seems a bit biased considering they are not taking a high enough dose? (Supposed to be taking 1650 a day but they are only taking 1200mg for some reason)
I’m deciding whether to go down the herbal path or the antibiotic path – but hoping for a more accurate study case.