Integrative approach to SIBO (Small Intestinal Bacterial Overgrowth)
SIBO underlies a significant portion of IBS diagnoses and drives symptoms including bloating, gas, abdominal pain, and malabsorption. Integrative protocols use herbal antimicrobials, motility support, and gut lining repair to address root causes rather than symptoms.
Evidence highlight
Herbal antimicrobial protocols (oregano, berberine, neem) show 46% SIBO eradication rates on breath testing — comparable to rifaximin in direct comparison studies (Grade B evidence), with lower resistance risk.
Commonly used supplements
- Oregano oil (enteric-coated)
- Berberine
- Allicin (garlic extract)
- Neem
- Partially hydrolyzed guar gum (PHGG)
- Prokinetics (ginger, 5-HTP)
- L-glutamine
- Zinc carnosine
- Digestive bitters
Key interaction flags
Berberine + CYP3A4 substrates and P-glycoprotein substrates
High-dose oregano oil + blood thinners
Rifaximin + herbal antimicrobials (additive disruption — sequence carefully)
5-HTP + serotonergic medications
Labs to consider
Clinical note
Prokinetics are the most underused component of SIBO protocols. Without motility support post-treatment, the migrating motor complex remains impaired and recurrence rates exceed 50%. Ginger (1g/day) and low-dose erythromycin are the best-studied prokinetic options.
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Evidence-graded supplements
Every supplement recommendation for SIBO (Small Intestinal Bacterial Overgrowth) carries an A-D evidence grade with a link to the source. You see exactly what the evidence shows before you prescribe.
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ClarityTX checks the full SIBO (Small Intestinal Bacterial Overgrowth) protocol against the patient's medication list. Severity rated: Contraindicated, Avoid, Monitor, or Caution.
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