SIBO - POSSIBLE SOLUTIONS
Updated: 4 days ago
I had such a hard time with SIBO. I started to dread eating. With the help of my doctors and the right tools, I was able to overcome it, and I no longer randomly look 6 months pregnant. What a joy it was to start enjoying food again! 😋
Short on time or energy? A quick-view graphic with the key points is at the bottom of this post.
Want to learn what SIBO is, the different types and how it's diagnosed? See my SIBO education post:
Links to the products I mention are under FIND THE PRODUCTS.
MY EXPERIENCE
- I've had SIBO twice. Both times it was a clinical diagnosis, once by my Lyme doctor and once by a gastroenterologist. I could never do the breath test because of the restrictions on what you can take before testing.
- My Lyme doctor puts me on Atrantil whenever I have SIBO or he suspects it, and he often goes back to it. It always works for me. It usually takes about three bottles for me, because one bottle won't cut it. Once my issues resolve, I stop it.
- In the past, Atrantil was also great for my nausea, especially with SIBO.
- My doctor has also used berberine/goldenseal and GSE (grapefruit seed extract) for SIBO.
- A low FODMAP diet helped me so much. When I slip up, I know right away.
- A histamine-friendly probiotic, ProBiota HistaminX, was super helpful for me. I used it for a really long time and rotated it with MegaSporeBiotic.
- Before meals, I take a DAO enzyme plus Similase Sensitive Stomach, which my doctor suggested.
- I use Sunfiber every single day.
- Not every swollen belly is SIBO. About a year ago, I developed extreme bloating, and specialists suspected my SIBO was back. It turned out to be something else. My Bloating post shares that story:
WHAT ILADS AND LYME LITERATE DOCTORS SAY
- ILADS doesn't have SIBO treatment guidelines. Its treatment guidelines do advise daily probiotics while on antibiotics, to lower the risk of C. diff and antibiotic-related diarrhea.
- A talk at the 2020 ILADS conference listed slow gut movement, an imbalance of gut bacteria and SIBO among the conditions that often show up with chronic Lyme.
- Dr. Todd Maderis treats SIBO with antibiotics or herbal regimens, and also uses probiotics, special diets and medicines that help the gut move.
- Dr. Tania Dempsey takes a multi-pronged approach: diet, stress reduction, herbal antimicrobials and/or antibiotics, probiotics, and calming mast cells.
- Dr. Jill Carnahan looks for the root cause too. Along with herbs, she works on stomach acid, bile flow, a mix of regular and spore-based probiotics, lowering toxin exposure, rest and good sleep, and whole, unprocessed foods, sometimes with a low FODMAP or SCD diet for a while. She feels antibiotics may help in the short term but don't fix the root cause and can upset the good bacteria.
- Dr. Marty Ross sees gas and bloating as a possible sign of SIBO. He often looks at yeast overgrowth first, because the two can look a lot alike.
- Dr. Bill Rawls (2020) believes recovery comes from getting the gut moving, digesting better and supporting the immune system, not only from killing bacteria.
- Global Lyme Alliance (2025) suggests starting fiber and probiotics slowly and drinking plenty of water.
- Every Lyme doctor has their own approach, and that's okay. Talk with your doctor about what's right for you.
WHAT HELPED ME AND IDEAS FROM MY ORIGINAL LIST
LOW FODMAP DIET
This helped me so much. FODMAPs are carbs that can ferment in the gut. It mainly eases symptoms like bloating.
ATRANTIL
One of my favorites. Quebracho, horse chestnut and peppermint leaf.
BERBERINE
Many doctors use it for SIBO, including Dr. Dempsey and my own doctor.
GSE (GRAPEFRUIT SEED EXTRACT)
My doctor has used it for SIBO. Choose a brand tested for added chemicals.
BITTERS
Dr. Rawls explains that bitter herbs get saliva, enzymes and bile flowing, which helps digestion and gut movement. I was told to get the Wise Woman Herbals brand.
PROBIOTICS AND SACCHAROMYCES BOULARDII
Dr. Dempsey often uses more than one kind for SIBO.
- Spore-based: MegaSporeBiotic or Klaire Biospora. Megaspore is also a good one when MCAS is at play.
- Saccharomyces boulardii (a beneficial yeast): Designs for Health FloraMyces.
- Histamine-friendly: ProBiota HistaminX.
DIGESTIVE ENZYMES
Help break down food. My doctor suggested Similase Sensitive Stomach before meals.
FODMATE is a FODMAP enzyme. I haven't used it yet, but it's the one I'd try.
DAO ENZYMES
For histamine issues. DAO breaks down histamine from food. I take Histamine Digest PureMAX by Omne Diem.
SUNFIBER
A gentle fiber (PHGG). It mixes easily and doesn't bloat me. My favorite.
BIOCIDIN
An herbal blend mentioned often for SIBO. Dr. Dempsey uses it, with care for people with Lyme or mold, since it can cause a Herx.
EAT COOKED FOOD
Dr. Rawls explains that cooked food gives digestion a head start, so your gut has more time to heal.
SHORTEN YOUR EATING WINDOW
Dr. Rawls says grazing all day gives an irritated gut no break and might aggravate SIBO. He suggests 12 to 16 hours without food, such as eating only between 7 am and 7 pm, but only if you tolerate it. If you're very ill, this may need to wait.
GET GOOD SLEEP
Dr. Rawls notes it takes 6 to 8 hours for food to travel from the stomach through the small intestine, so eating late can keep you up, and poor sleep makes it harder for your body to digest.
MORE TO LOOK INTO
- Wheat Rescue (for cross contamination). I haven't tried it, but it's worth mentioning.
- Priority One has products named for SIBO on Fullscript, like SIBO-MMC and SIBO-Rebuild. I haven't tried them. If you have, let me know! I didn't want to add them here without feedback.
OTHER OPTIONS LYME-LITERATE DOCTORS AND RESEARCH POINT TO
HERBAL ANTIMICROBIALS
Besides berberine, Dr. Dempsey uses black cumin seed oil, artemisia, oregano blends and neem for SIBO, chosen for each person. Dr. Carnahan uses an oregano oil extract with herbal blends, and for methane SIBO adds a garlic extract and/or black cumin seed oil.
PRESCRIPTION OPTIONS (ASK YOUR DOCTOR)
- Rifaximin: an antibiotic that mostly stays in the gut. Doctors often use it for SIBO.
- Other antibiotics, such as metronidazole or ciprofloxacin, are sometimes used instead.
- Dr. Dempsey finds antibiotics most helpful for hydrogen SIBO, and pairs them with probiotics to help protect against yeast.
- Methane overgrowth (IMO) is often harder to treat and may need more than one approach.
HELP FOR GUT MOVEMENT
Slow gut movement is a common root of SIBO.
- Gentle movement, like a short walk, if your body allows.
- Digestive bitters and aloe: milder herbal helpers, per Dr. Dempsey.
- Prescription prokinetics, such as prucalopride (Motegrity), for some people. Dr. Maderis compares these medicines to "physical therapy" for the large intestine.
BIOFILM SUPPORT
Germs can hide in biofilms. Ask your doctor whether a biofilm buster belongs in your SIBO plan. In his Bartonella treatment, Dr. Richard Horowitz uses cinnamon, clove and oregano oil and Biocidin to help open biofilms. Boluoke is the biofilm buster most recommended in our groups.
MAST CELL SUPPORT
SIBO can trigger mast cells, so Dr. Dempsey includes calming mast cells in her SIBO plan.
LOW-SULFUR DIET (ASK YOUR DOCTOR)
Dr. Dempsey notes a low-sulfur diet may be used in select cases of hydrogen sulfide SIBO.
ELEMENTAL DIET (ASK YOUR DOCTOR)
A special liquid formula that replaces all food for a short time (2 weeks in one study). Studied in a small group of people with SIBO so far.
WHAT RESEARCH SHOWS
- Berberine: a 2025 review that compared 30 SIBO treatment trials (1,552 people) ranked berberine highest for clearing uncomplicated SIBO. The authors said this needs to be confirmed in head-to-head studies. A trial comparing berberine with rifaximin was planned in 2023; I couldn't find its results yet.
- Herbal blends: in an older 2014 Johns Hopkins study of 104 people, 46% of those who took herbal blends (one product included berberine itself) had a negative breath test after 4 weeks, compared with 34% on rifaximin. People chose their own treatment, and the researchers concluded the herbs worked at least as well (older source, still worth reading).
- Herbs and probiotics added to treatment: in a 2024 trial of 179 people, adding herbal antimicrobials, probiotics and prebiotics to antibiotics and a low FODMAP diet didn't change breath gas levels much, but more people felt better, especially with methane SIBO.
- Rifaximin: a 2021 review of 26 studies (874 people) found it cleared SIBO in about 59% overall, and higher doses tended to work better. MedlinePlus lists its main uses as traveler's diarrhea, IBS with diarrhea and a liver-related brain condition, and notes it may be prescribed for other uses, so ask your doctor about SIBO.
- Low FODMAP: a 2026 review of SIBO diet guidelines from around the world found it's the diet discussed most, mainly to ease bloating, belly pain and bowel changes, but it isn't proven to clear SIBO. In a 2026 survey of 98 people with IBS, SIBO or methane overgrowth, bloating improved the most. Fewer than half found the diet easy, and those who finished both phases (cutting foods out, then adding them back) had about 3.5 times the odds of improving. Dr. Dempsey notes it can lower hydrogen but doesn't seem to lower methane, so it may not suit everyone.
- Elemental diet: in a small 2025 study, 30 adults with SIBO or methane overgrowth used only a better-tasting elemental formula for 2 weeks. 73% had a normal breath test afterward and 83% reported good relief. There was no comparison group. Research so far is small and short-term.
- Gut movement: a 2025 review found that for people who also have IBS-type gut disorders, rifaximin plus a prokinetic ranked highest.
- Probiotics: a 2024 review found low-quality evidence that probiotics help clear SIBO. In a small 2023 study of people with diarrhea-type IBS and SIBO, S. boulardii plus diet advice for 15 days lowered hydrogen a little more than diet advice alone (41% vs. 29%), and fewer people had diarrhea (about 26% vs. 48%). In a 2025 study of 108 long-term acid blocker users, SIBO was still there 4 weeks after treatment in about 22% of those given rifaximin plus S. boulardii, compared with about 42% given rifaximin alone.
- Biocidin: a small 2024 study (16 people enrolled, no comparison group, funded by the maker) found some had negative breath tests after 10 weeks of Biocidin liquid plus G.I. Detox+.
- Biofilms: in a very small 2025 chart review (13 people), adding a biofilm disruptor to herbal antimicrobials lowered hydrogen and methane more, but the clearing rates weren't significantly different, and neither group cleared methane overgrowth. The lead researcher owns the company that supplied the supplements.
- Atrantil: in a small 2016 study of 24 people with constipation-type IBS (no placebo group), 21 had less belly pain, bloating and constipation after 2 weeks (older source, still worth reading). The researchers were connected to the company that makes Atrantil. A Northwestern University trial for methane overgrowth finished in 2022, but no results have been posted yet.
- Fiber: a 2022 review notes that soluble fiber can ease symptoms in IBS and SIBO.
- FODMAP enzymes: in a 2026 study of people with IBS (no placebo group), 78% reported less bloating and gas after 4 weeks on a FODMAP enzyme blend. It was funded by the company that makes the enzyme blend studied (not FODMATE).
- SIBO often comes back. A 2025 position paper from Brazil's gastroenterology federation advises long-term follow-up for this reason.
GOOD TO KNOW
- Read the warning on each bottle, and talk with your doctor before starting anything.
- Berberine may interact with medicines and can cause stomach upset, bloating, constipation or diarrhea. It's likely unsafe for infants and may be unsafe during pregnancy or breastfeeding. The Integrative Therapeutics berberine label also says not to use it if pregnant or nursing, and to check with your doctor if you have diabetes.
- The Atrantil label says it contains tree nuts and is not for use if pregnant or nursing.
- GSE: some products sold as GSE have been found to contain synthetic disinfectants, so choose a tested brand. Ask your doctor first if you take a blood thinner.
- Rifaximin: tell your doctor about your other medicines and supplements, liver disease, pregnancy or breastfeeding. Call your doctor right away for watery or bloody diarrhea with cramps and fever (during treatment or up to 2 months after) or signs of an allergic reaction.
- Saccharomyces boulardii has rarely caused a bloodstream infection, mostly in very sick people (in intensive care, fed by IV or tube, or with diarrhea). Ask your doctor first if you're seriously ill or in the hospital.
- Histamine Digest PureMAX is made from pork kidney, so check with your doctor if you have alpha-gal.
- The Wise Woman Herbals Bitter Tonic contains alcohol.
- The FODMATE label says to limit use to 3 months at a time.
- If you feel worse when starting antimicrobials, my Herx post has ideas that may help.
FIND THE PRODUCTS
Buy products on Fullscript for a 25% discount
Atrantil
Integrative Therapeutics Berberine 500 mg
Klaire Labs Berberine
Allergy Research Group ParaMicrocidin 125 mg (GSE)
Allergy Research Group ParaMicrocidin 250 mg (GSE)
Wise Woman Herbals Bitter Tonic
Microbiome Labs MegaSporeBiotic
Klaire Labs Ther-Biotic Biospora
Designs for Health FloraMyces (Saccharomyces boulardii)
Seeking Health ProBiota HistaminX
Integrative Therapeutics Similase Sensitive Stomach
Microbiome Labs FODMATE
Omne Diem Histamine Digest PureMAX (DAO)
Tomorrow's Nutrition Sunfiber
SOURCES
Dr. Marty Ross. Small Intestine Bacterial Overgrowth (SIBO) in Lyme Disease. Updated October 15, 2026.
Dr. Todd Maderis. Gastrointestinal Symptoms of Lyme Disease. Updated October 24, 2023.
Dr. Jill Carnahan. Small Intestinal Bacterial Overgrowth: Is There a Natural Cure for SIBO? May 2023, updated September 2023.
Dr. Tania Dempsey. How SIBO Connects to Lyme Disease, Mold Toxicity, Mast Cell Activation, and More. November 2022, updated November 2023.
Global Perspectives on Dietary Management of Small Intestinal Bacterial Overgrowth (SIBO): A Systematic Review of Clinical Guidelines, Consensus Statements and Expert Recommendations. Frontiers in Medicine, September 2026.
FODMAP-Targeting Digestive Enzyme Blend for Management of Gastrointestinal Symptoms: A "Real-World" Pre-Post Intervention Cohort Study. Gastro Hep Advances, 2026.
Effectiveness of the Low FODMAP Diet in Patients with Irritable Bowel Syndrome and Small Intestine Bacterial Overgrowth Syndrome. Frontiers in Nutrition, January 2026.
Rifaximin. MedlinePlus, National Library of Medicine. Last revised July 15, 2026.
Healing from the Inside Out: Why Fiber and Probiotics Matter for Lyme Disease Patients. Global Lyme Alliance, August 21, 2025.
Comparative Efficacy of Diverse Therapeutic Regimens for Small Intestinal Bacterial Overgrowth: A Systematic Network Meta-Analysis. Therapeutic Advances in Gastroenterology, December 2025.
Biofilm Disruption Enhances Antimicrobial Therapy for Small Intestinal Bacterial Overgrowth and Intestinal Methanogen Overgrowth. Cureus, December 2025.
Effect, Tolerability, and Safety of Exclusive Palatable Elemental Diet in Patients With Intestinal Microbial Overgrowth. Clinical Gastroenterology and Hepatology, November 2025.
Study on the Efficacy of Combination Therapy with Rifaximin and Saccharomyces boulardii CNCM I-745 in Patients with Small Intestinal Bacterial Overgrowth Associated with Long-Term Use of Proton Pump Inhibitors. Terapevticheskii Arkhiv, August 2025.
Diagnosis and Treatment of Small Intestinal Bacterial Overgrowth: An Official Position Paper from the Brazilian Federation of Gastroenterology. Arquivos de Gastroenterologia, February 2025.
MEDICAL DETECTIVE: Effective treatments for Bartonella infections (Dr. Richard Horowitz). LymeDisease.org, February 2025.
An Oral Botanical Supplement Improves Small Intestinal Bacterial Overgrowth (SIBO) and Facial Redness: Results of an Open-Label Clinical Study. Nutrients, September 2024.
Efficacy of Probiotic in the Treatment of Small Intestinal Bacterial Overgrowth: Systematic Review and Meta-Analysis. Revista de Gastroenterología del Perú, July-September 2024.
Do Herbal Supplements and Probiotics Complement Antibiotics and Diet in the Management of SIBO? A Randomized Clinical Trial. Nutrients, April 2024.
Berberine and Weight Loss: What You Need To Know. National Center for Complementary and Integrative Health (NCCIH), NIH. Last updated November 2023.
Epidemiology of Saccharomyces Fungemia: A Systematic Review. Medical Mycology, February 2023.
Botanical Ingredient Forensics: Detection of Attempts to Deceive Commonly Used Analytical Methods for Authenticating Herbal Dietary and Food Ingredients and Supplements. Journal of Natural Products, 2023.
Berberine and Rifaximin Effects on Small Intestinal Bacterial Overgrowth: Study Protocol for an Investigator-Initiated, Double-Arm, Open-Label, Randomized Clinical Trial (BRIEF-SIBO Study). Frontiers in Pharmacology, February 2023.
Impact of Saccharomyces boulardii CNCM I-745 on Bacterial Overgrowth and Composition of Intestinal Microbiota in Diarrhea-Predominant Irritable Bowel Syndrome Patients: Results of a Randomized Pilot Study. Digestive Diseases, 2023.
Efficacy of an Irritable Bowel Syndrome Diet in the Treatment of Small Intestinal Bacterial Overgrowth: A Narrative Review. Nutrients, August 2022.
Efficacy of Rifaximin in Treating with Small Intestine Bacterial Overgrowth: A Systematic Review and Meta-Analysis. Expert Review of Gastroenterology and Hepatology, December 2021.
Atrantil for Intestinal Bacterial Overgrowth (NCT04755673). Northwestern University, ClinicalTrials.gov, completed 2022.
Product labels on Fullscript (checked October 2026)
Older sources, still worth reading:
ILADS Treatment Guidelines: Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Review of Anti-infective Therapy, September 2014 (2014, older source, still the current ILADS guideline).
Dr. Bill Rawls. Natural SIBO Solutions for Lyme Patients: How to Overcome This Painful Gut Problem. August 2020.
ILADS 2020 Annual Conference, Abstracts ("It Ain't Just One Thing"). ILADS, 2020.
Response of irritable bowel syndrome with constipation patients administered a combined quebracho/conker tree/M. balsamea Willd extract. World Journal of Gastrointestinal Pharmacology and Therapeutics, August 2016.
Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth. Global Advances in Health and Medicine, May 2014.
Adverse effects by artificial grapefruit seed extract products in patients on warfarin therapy. European Journal of Clinical Pharmacology, June 2007.
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Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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