What is the best treatment of SIBO? Part 1


The treatment for Small Intestinal Bacteria Overgrowth (SIBO) can be categorized by two groups: Reduce the overgrowth and Repair the damage done.  For this part of the series on SIBO treatment, I will focus on the strategies of reducing the overgrowth.  There are currently four approaches to treating the overgrowth.  To determine the best approach, we need to consider the patient’s symptoms and sensitivity, the level of gas detected on the test result, compliance of the patient, and the patient’s past response to treatments.  I will summarize some key features of each approach below.

Elemental Diet

This treatment aims to eliminate the overgrowth by starving the bacteria while feeding the individual. The patient will drink an elemental formula for a couple of weeks.  The person cannot eat any other foods.  It is about 80-85% effective based on clinical observation.  It can be a challenging and expensive diet, but it is the most ideal treatment for someone who has a high level of gas and is very symptomatic.  It can help reduce the duration of treatment needed.

You can find more information in my Elemental Diet article.


There has been a long history of using antibiotics to treat IBS and SIBO.  Although the record of the effectiveness hasn’t been impressive in the last few decades, we now have a few drugs that are quite promising based on recent research and clinical experience.  Patients who are sensitive to herbs do a lot better with this approach.  The antibiotics are about 70-73% effective, and the treatment duration from each round is generally half of the herbal approach.  One issue with this approach is insurance coverage.  It can be tricky to get some drugs covered by insurance. If not covered, they are quite expensive.  Another issue is that some antibiotics can increase yeast overgrowth after treatment.  

Herbal Antibiotics

Herbal antibiotics are as effective as antibiotics.  It just takes longer, about double the time, for an herbal antibiotic treatment.  It is also a lot more pills to take compared to antibiotics because a high dosage from multiple agents is needed.   

SIBO Diet 

There are many diets that can help with SIBO.  They are essential for reducing the frequency and severity of symptoms, but they are often not enough to eliminate SIBO if one’s wish is to prolong remission while expanding his/her diet.  

You can find more information regarding SIBO diet from my article: What foods should I eat if I have IBS?

When I work with my patients, I select an approach based on the patient’s interest.  I explain the pros and cons in detail for each approach and the potential rounds of treatment needed so that patients can make a decision based on cost and duration.  It is important for people to understand that what ultimately drives the treatment is how well you respond to the treatment.  It is not uncommon that one will need to do at least two or all three approaches to achieve the desired result. 


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