One of the most popular chapters of my book, SIBO Made Simple, is the medicine cabinet section where I give a whole chart on types of SIBO supplements, from natural remedies for symptoms, to how to make your treatment work better, to essentials for prevention, especially while traveling.
And since questions on SIBO supplements also tend to be a major topic of my Q&A sessions, I thought it was worth doing a deep dive here so everyone can have access to the information and easy ways to buy this medicine cabinet toolkit.
One of the things that makes SIBO treatment so tricky is that sometimes medicating makes you feel worse. You might be fixing the SIBO, but causing some other damage or discomfort in the process.
Luckily, there is a whole arsenal of over-the-counter remedies that can relieve your symptoms before, during or after treatment.
Some of these SIBO supplements can improve your outcomes with antibiotics or antimicrobials. Others are important for giving the digestive process a leg up and preventing relapse. And many are often necessary to ease a flare up.
This list may seem overwhelming, so remember that it is not an “all of the above” suggestion, but tools to pick and choose from as needed. I’ve organized them below by necessity, but if you prefer to look at charts, the entire Medicine Cabinet Cheat Sheet can be found in SIBO Made Simple.
Once you learn more about why you need certain SIBO products, feel free to skip to the bottom for a quick list of my favorite SIBO supplement brands and where to buy them.
Do you have any favorite supplements you’ve used in the wake of SIBO? I’d love to hear about your experiences in the comments section!
With health and hedonism,
Phoebe
The Best SIBO Supplements to Prevent Die-Off During Treatment
“I just started my SIBO treatment and I’m feeling so much worse.” This is an email or comment I’ve received hundreds of times.
While some symptoms at the beginning of treatment are the norm in many cases, it’s important to tease out whether you’re reacting to the treatment itself, the process of bacteria dying, or simply trigger foods in your diet that you have yet to uncover.
Herxheimer reaction, what is more colloquially referred to as “die-off,” is what happens when either bacteria or fungi die and spill their endotoxins. The bacteria that tend to be present in SIBO, like Klebsiella and E. Coli, have lipopolysaccharide (LPS) in their cell wall.
This molecule is one of the most potent triggers of inflammation, depression, and anxiety. In many ways, this toxin released in death is more harmful to your body than the bacteria was when it was alive.
Some have described the experience as feeling like you’re coming down with the flu—extreme fatigue, brain fog, aches, pains and irritability. Constipation and bloating are also common. For supplements for digestive symptoms, skip down a few sections. Here’s how we can manage die-off:
Activated Charcoal or Bentonite Clay: Adding a binder like charcoal or bentonite clay, can assist in ushering the toxins out of your system more efficiently, as can taking something to alleviate constipation. An important note is that charcoal binds to everything, so make sure to take it 2 hours apart from any medication, supplement, or meal if you still want to benefit from their efficacy or nutrients.
Reducing your herbal or antibiotic dose and going slowly can also ease the transition. If none of these tactics move the needle, the second possibility is you’re reacting to something in the treatment itself. Nausea can be common with berberine containing herbs. If symptoms continue past a couple of days, this is likely the case.
The Best SIBO Supplements to Increase Efficacy of Treatment
Biofilm disruptors: Opportunistic bacteria and fungi can be tricky creatures to tackle directly with antibiotics. This is in part due to an adaptive tactic whereupon which a whole community of organisms will join together into a colony that shares nutrients and is enveloped by a physical barrier called a biofilm.
Areas of the intestinal wall that no longer have mucus to protect it are the most vulnerable to biofilms forming. According to the National Institute of Health, the vast majority of human bacterial infections involve biofilm.
To make antimicrobials more effective during SIBO treatment, many integrative practitioners will add an agent that helps dismantle the biofilm itself.
There are several enzymes and minerals that have good data for tackling biofilms, as well as a compound product that many practitioners use. The full list is below.
Lastly, certain ingredients can be added to your diet to help with biofilms: apple cider vinegar, turmeric and coconut oil. Garlic is also a powerful biofilm buster, but those with SIBO may benefit from taking an Allicin supplement since eating whole cloves can cause symptoms.
Bile acids: Another aid that has been studied alongside rifamixin and shown to increase efficacy is bile acids. While the habitat of the large intestine is primarily water, the small intestine on the other hand, is filled with bile.
Though the mechanics aren’t yet known, one study showed that adding more bile acids during treatment helped rifaxamin absorb better. They may also help weaken the bacterial cell membrane. Ox bile in particular is a great addition to your medicine cabinet as it can also help those with fat malabsorption better process their meals.
Partially Hydrolyzed Guar Gum (PHGG): This prebiotic fiber has been shown in study after study to improve outcomes for a variety of IBS symptoms. Most notable for your treatment plan is one study that found that adding PHGG to rifaximin improved SIBO eradication from 65 percent to 85 percent.
The Best SIBO Supplements for Gas, Bloating, Constipation, Diarrhea and Nausea
Peppermint Oil: Much of the abdominal pain caused by SIBO is due to your muscles contracting against trapped gas. Peppermint oil has been studied extensively, particularly for relieving abdominal pain in IBS patients.
It acts as a smooth muscle relaxant, and has the added benefit of being antibacterial (a plus for Hydrogen-dominant SIBO). Peppermint can be brewed as a strong tea, taken as a tincture, or rubbed directly on the abdomen if using an essential oil. The most common vehicle is enteric coated peppermint oil pills, which are best for reaching pain in the mid-abdomen. I also like these compound pills that have peppermint leaf in them. Peppermint is not ideal for those with acid reflux issues.
Activated Charcoal: Charcoal is an extremely effective binding agent, working well for any unwanted junk, be it a toxin, bad bacteria, or virus. It’s particularly useful for those with SIBO since it absorbs gas, thereby reducing abdominal pain and improving both diarrhea and constipation.
Disclaimer again: charcoal binds to everything, so make sure to take it 2 hours apart from any medication, supplement, or meal.
Iberogast: These herbal drops are extremely popular as an adjunct to SIBO treatment. They were designed to treat gastritis, stomach pain, abdominal bloating, gas, nausea and heartburn. It’s fast acting for relaxing abdominal muscles and moving gas out if taken with meals. It’s also thought of as a prokinetic, helping to move food through your system if taken at bedtime, which can be helpful for those with constipation. Important note: this herbal remedy is NOT appropriate for women who are pregnant or are trying to conceive.
Magnesium Oxide or Citrate: In addition to being an essential mineral, magnesium can be helpful for constipation as it pulls water into the gut and functions as a mild laxative. Best practices are to take it before bed on an empty stomach. Since it’s also a muscle relaxant and generally calming for the body, it’s been known to promote a better night sleep as well.
Ginger: One of the best fighters of nausea is good old fashioned ginger. You can make yourself a fresh tea or seek it out in capsule, tincture, or chew form. Ginger is also a natural prokinetic (more on that below) so can help stimulate your motility.
Atrantil: For those with methane SIBO, this herbal blend has been helpful for many in battling difficult symptoms of constipation and bloating. It was formulated based on research that was aiming to limit methane emissions in cows. While it does not have hard evidence as a treatment for SIBO, anecdotally, it has helped some people with persistent methane issues. You can find out more about methane natural SIBO treatments in this post.
Full-Spectrum Hemp Oil: CBD oil, along with new research on how the endocannabinoid system works, has been on the rise over the past few years. We’re still learning how the mechanisms work in the body, but it’s clear that high quality hemp products can be a huge asset in your medicine cabinet for managing IBS issues, activating the immune system, and reducing inflammation in the gut.
Choose oils that contain the whole plant rather than a CBD isolate. Hemp is very mineral-rich and research indicates that the whole (which includes small non-psychoactive doses of THC) is greater than the parts.
Full spectrum hemp also includes CBG which is one of the cannabinoids that’s been shown in research to be most effective for IBS, repairing tight junctions and improving leaky gut. Some of these positive effects on the gut are thanks to how these cannabinoids effect the brain, regulating vagal tone and improving anxiety in many users.
For best use, place the oil under the tongue and hold there for 30 seconds before swallowing. Full spectrum hemp oil isn’t a fast-acting medicine for a flare up like many of these other supplements, but rather, something you can take every day to regulate your symptoms and reducing your likelihood of having one.
The Best SIBO Supplements for Digestion
Digestive Enzymes: High potency enzymes can digest foods three times faster than if your system was left to its own devices, especially if those devices (like your pancreas) have fallen down on the job.
Adding these supplements won’t give your gut a break in the same way as the pre-digested ingredients in the elemental diet. But they can be a very helpful leg up if you don’t have the proper nutrient stores to ensure that stomach acid, liver bile, and pancreatic enzymes are being produced in high enough supply (like, say, if you’re missing your gallbladder). As a reminder, when food isn’t broken down properly prior (or upon arrival) to the small intestines, it gives unwanted bacteria a robust food source.
I wrote a whole deep dive on digestive enzymes for IBS where you can read more about it.
Betane HCL: If you suspect low stomach acid might be one of your underlying causes, fixing it can be a huge part of on-going prevention. Not having enough stomach acid makes you that much more susceptible to food poisoning, and food poisoning is one of the primary causes of SIBO.
Ironically, low stomach acid is one of the reasons why some (not all) people have symptoms of reflux. When your stomach senses low levels of acid, it leads to relaxation of the lower esophageal sphincter, allowing that back splash to take place.
You can experiment with the right dose by doing an HCL test: take 1 pill right before a meal, increasing with subsequent meals until you feel any reflux symptoms. That should give you an indicator of how many it will take to reach a normal level without going overboard.
Apple Cider Vinegar (ACV): Another method to stimulate stomach acid prior to a meal is to drink 1 tablespoon of ACV or fresh lemon juice in 8 ounces of water before eating.
This has also been shown in studies to improve insulin sensitivity in carb-heavy meals, so potentially helpful for those with blood sugar issues.
If you’re worried about your tooth enamel, sip it through a straw. This is also not the best ingredient for those who suspect a yeast overgrowth or histamine intolerance.
The Best SIBO Supplements to Heal Leaky Gut
We are deeply reliant on the intestinal wall’s ability to discriminate properly between what should and shouldn’t pass through. The keepers of this barrier are tight junction proteins, and they are responsible for making sure migrants have the right passport for entry. When the lining of the small intestine becomes damaged, the result is an increased permeability. Meaning, the fine mesh sieve formerly in place now allows larger particles through. I wrote more about leaky gut here.
Unwanted bacteria in the small intestines is one of the many things that can increase this permeability, also known as leaky gut.
Once in the bloodstream, foreign organisms (like bacteria) or food particles can fire up the immune system, creating systemic inflammation. Reducing inflammation in the gut relies in part on quieting the immune system. And an essential way to do this is to improve the integrity of your intestinal wall.
While removing unwanted bacteria via SIBO treatment is half the battle, there are other supplements that support repair of the tight junctions.
L-Glutamine: The amino acid L-glutamine is one of the most well-recognized supplements for healing leaky gut. You can buy it in pill or powder form, but if your gut is in bad shape, start with the latter.
It’s also abundant in many foods, particularly in cabbage. Adding a daily shot of cabbage or kraut juice to your recovery plan is another tactic, so long as Hydrogen Sulfide SIBO isn’t suspected.
Collagen: The reason why bone broth is such a salve to the intestinal wall is due in part to its wealth of collagen, a web of potent amino acids. These are the big workhorses for rebuilding tissue and fortifying your hair, nails and teeth.
You can add powdered collagen to your morning tea, soups, smoothies and baked goods. Or simply make one of the homemade broth recipes in SIBO Made Simple and sip a cup as part of your morning or evening routine. Avoid collagen powders or long-cooked broths if you have a histamine intolerance.
Colostrum: This compound in breastmilk prepares the baby’s gut for receiving good bacteria and helps it transition from highly permeable to a functioning closed ecosystem. Studies have shown that colostrum improves outcomes for certain IBS symptoms like bloating, and it’s used by many as added ammo for healing leaky gut.
Zinc carnosine: The primary benefit of zinc carnosine is as a powerhouse for cell repair. It travels directly to damaged tissue and lowers local inflammation in the process. Studies in particular have found it to have a beneficial impact on gut mucus, improving symptoms of IBD and IBS.
Vitamin D3: Many studies have demonstrated the effect of vitamin D on intestinal barrier function. It’s important to use a supplement that also contains Vitamin K because it works in tandem with D. Another thing to keep in mind is that vitamin D is fat-soluble.
If you have a history of autoimmune issues or have noticed fatty deposits in your stool, you would benefit from taking Ox Bile or another bile salt in order to make sure you’re reaping the benefits of your Vitamin D.
Saccharomyces boulardii: This beneficial yeast is a commonly used probiotic for travelers’ diarrhea, and has also racked up compelling evidence for its capability to preserve and restore intestinal barrier function.
Even practitioners who are wary to advise probiotic use during SIBO treatment sometimes recommend taking S. boulardii since it can maintain gut balance but doesn’t run the risk of overgrowing in the small bowel.
You can read (much) more about probiotics for SIBO in this post.
Curcumin: Color is a great indication of a food’s anti-inflammatory power. Because of this, turmeric is a long-hailed spice for healing. Curcumin is the main compound in turmeric and it’s specifically helpful for leaky gut because it encourages glands on the surface of your intestines to regenerate. The pills are commercially available in concentrated therapeutic quantities. Adding turmeric to food also works!
The Best SIBO Supplements for Preventing Food Poisoning While Traveling
If you know you’re susceptible to food poisoning or are traveling to a place where risk of parasites runs high (Mexico, India, and other developing nations), it’s important to fortify your digestive system every way possible.
The first option is to take small doses of an antimicrobial like oil of oregano while you’re away. If you can afford it, Dr. Pimentel recommends carrying rifaximin and taking a low dose (half a pill) with meals. I also like monolaurin for this purpose.
It’s also increasingly important to take HCL and digestive enzymes to ensure that your stomach acid and bile are in full flow and ready to take down any foreign invader.
If it agrees with you, a probiotic will also be useful for keeping your immune system in fighting shape. Spore-based probiotics are best for travel since they don’t require refrigeration. You can read more all about the best SIBO Probiotics here.
Finally, make sure you pack an arsenal for if symptoms arise: charcoal can help mitigate the damage of ongoing food poisoning, Iberogast or ginger chews can calm your stomach and act as a prokinetic, curcumin can fight the inflammation. I also usually carry with me this bloat relief formula.
The Best SIBO Supplements for Managing Motility
One of the biggest underlying problems that contributes to SIBO is a screwy, slowed Migrating Motor Complex (MMC).
Luckily, there are several easy changes you can make to your diet to help your digestive system catch up and keep your MMC running smoothly (I talk about these more in my SIBO book). While lifestyle changes can make a big difference, there is always the possibility that you might need pharmaceutical intervention or the assistance of extra supplementation.
Prescription prokinetics: Particularly those of us who are hypothyroid or have other conditions that limit motility, may benefit from a prescription prokinetic like Low Dose Naltrexone, Prucalopride, or Erythromycin. These medications are often implemented after the first round of SIBO treatment for on-going support and prevention. You will have to discuss your options with your medical professional.
Natural prokinetics: Natural prokinetic options include herbal formulas with high concentrations of ginger (1,000mg).
Ghee and coconut oil—healthy fats that grease the wheels of your digestive tract are also thought of as natural prokinetics, though they don’t stimulate contractions of the MMC in the same way as the prescription meds above.
If you’re suffering from constipation during treatment, you’re better off turning towards options with laxative properties like magnesium citrate or oxide.
BUYER’S CHEAT SHEET! The Best SIBO Supplements For Your Medicine Cabinet
For more on each of these supplements and why they are good for SIBO symptoms or treatment, scroll back to the first half of this post.
Remember, this is not an all of the above – you will want to drill down by efficacy and what you need help with. Hopefully many of these things are already in your medicine cabinet!
- Activated charcoal (make sure you note the disclaimer above)
- Bentonite clay
- N-acetylcysteine (NAC)
- N-acetyl-glucosamine (NAG)
- Monolaurin
- Biofilm Defense by Kirkman Labs
- Ox Bile from Allergy Research Group
- Partially Hydrolized Guar Gum (PHGG) from Perfect Pass or Sunfiber
- Enteric-Coated Peppermint oil from Solaray
- Gas and Bloat Relief from Hilma
- Iberogast
- Gin Gin Ginger chews
- Magnesium Citrate Powder from Natural Calm
- Full Spectrum Hemp Oil from Radical Roots (I like the Rest and Relax or Reset)
- Atrantil
- Digestive Enzymes from The Healthy Gut
- Betane HCL from The Healthy Gut
- Apple Cider Vinegar (ACV) from Bragg’s
- L-Glutamine from Pure Encapsulations
- Green Lakes Collagen Powder
- Colostrum
- Zinc carnosine
- Vitamin D3 + K by Thorne
- Saccharomyces boulardii by Klaire Labs
- TheraCurcumin by Integrative Theraputics
- Spore-based probiotics by Megaspore
- MotilPro for Motility by Pure Encapsulations
Do you have any favorite supplements you’ve used in the wake of SIBO? I’d love to hear about your experiences in the comments section!