Let's unravel the complexities of supplementing for Small Intestine Bacterial Overgrowth (SIBO). If you've found yourself lost in the maze of SIBO treatments and supplements, this episode is your compass.

• Understanding SIBO Supplement Confusion - navigating the multitude of available products.
• Knowing Your SIBO Type -Before diving into supplement protocols, ensure you know your SIBO type—hydrogen, methane, or hydrogen sulphide.
• Antimicrobial Treatments for Hydrogen SIBO - Berberine, neem and oregano oil are explored as complementary options.
• Addressing Methane SIBO with Allicin- For those dealing with methane overgrowth, allicin, an extract from garlic.
• Tackling Hydrogen Sulphide SIBO - bismuth and soy isoflavones. Challenges in testing are acknowledged.
• Managing Die-Off Reactions - A crucial aspect of supplementing for SIBO is managing die-off reactions. How to recognise die-off symptoms, including fatigue and flu-like feelings.
• Exploring Biofilm Busters - e.g. N-acetylcysteine, glutathione, alpha-lipoic acid, and enzymes like serrapeptase are discussed.
• Crafting Your Supplement Plan - How to graduate your treatment.
• Probiotics, Prebiotics, and Prokinetics

For more personalized guidance on managing SIBO and digestive health, consider joining the Gut Reset group. If you have questions or topics you'd like covered in future episodes, reach out. Stay tuned for more insights into digestive wellness. Until next week, goodbye!

Links

• How to use prokinetics in SIBO - https://www.goodnessme-nutrition.com/sibo/using-a-prokinetic-in-sibo/
• Risk factors for SIBO - https://www.goodnessme-nutrition.com/sibo/four-risk-factors-for-sibo/

Relevant episodes

• Ep 11 - SIBO
• Ep 12 - SIBO treatments
• Ep 22 - Supplements for IBS

Work with me

• Group Gut Reset - https://www.goodnessme-nutrition.com/group-course-ibsc/
• 1:1 Gut Reset - https://www.goodnessme-nutrition.com/consultations/

If you're someone who's got SIBO, you are

probably well versed in all the different

2

supplements and ways of treating SIBO.

3

I find most people who have Small

intestine bacterial overgrowth have

4

done a lot of research and really

understood this condition But it

5

can be incredibly confusing to see

all the different potential products

6

What order should you take them in?

7

Do you need a prokinetic?

8

Do you need a probiotic?

9

What about prebiotics?

10

And what kind of antimicrobial

treatment should you use to try

11

and address the overgrowth of

microbes in your small intestine?

12

That's what I'm going to be

covering in this episode of

13

the Inside Knowledge podcast.

14

Welcome to episode 31

of the Inside Knowledge.

15

I am Anna Mapson.

16

Today, talking about supplements for SIBO.

17

And I've picked this topic because I

see a lot of confusion amongst people

18

before they work with me, or in Facebook

groups and online, people asking

19

questions about how to treat your SIBO if

you're not working with a practitioner.

20

And actually, even if people are

working with a practitioner, they don't

21

always have enough contact with them,

or enough talk time to ask all the

22

questions, like, how does this work?

23

Why am I taking this supplement?

24

And so they turn into Facebook

groups to ask questions.

25

Of course you want to understand,

but sometimes you're getting...

26

not the most accurate information.

27

So I thought I'll just do a little

summary of the things that I find helpful

28

with my clients and why I do that.

29

So you can understand how to

try these out on your own.

30

Now, if you don't yet have a positive

SIBO breath test, I don't suggest

31

following any of this advice.

32

This is for people who know that they

have got SIBO and they know whether

33

it's hydrogen or methane, and they've

tested for them both, and so you're

34

clear on what your numbers are.

35

These protocols are for people who

already understand their results.

36

If you don't yet have a breath

test, this can be arranged

37

either privately, or privately.

38

You can do one at home or you may be

able to get one through your doctor.

39

I can arrange them for my clients and I

will do that if I think it's necessary.

40

I don't always do a SIBO breath

test because I don't think

41

everyone I work with has got SIBO.

42

It's obviously an added cost, but it's

good to know before you start trying.

43

to treat it.

44

I'm going to talk through a couple

of products for hydrogen SIBO, for

45

methane SIBO, or intestinal methanogen

overgrowth, as it's sometimes called now.

46

A little bit about hydrogen sulfide

SIBO, although it's much harder.

47

We'll talk about die off symptoms

and a bit on probiotics, prebiotics,

48

biofilm busters, and prokinetics.

49

People always say they want

antimicrobial treatments.

50

rather than antibiotics because they

want to take a more natural route.

51

But the thing to be aware of is some of

these antimicrobial substances do have

52

an effect on your gut bacteria as well.

53

They are effective at killing off

microbes, which means that they can affect

54

the large intestine bacteria, some of

the good bacteria as well, which is why

55

You shouldn't take these for a very long

time and always make sure you know the

56

end date to taking any supplements when

you take them from a practitioner or if

57

you've just read about them online and

you want to give them a go, make sure you

58

understand when you will be stopping them.

59

The good thing about taking a

herbal approach to antimicrobial

60

treatment is that the herbs

often have a multiple effect.

61

So it might be antibacterial

and antifungal and a little bit

62

anti inflammatory, for example,

like Ginger or, Oregano.

63

These can have like different effects

that are all positive if you're someone

64

who's struggling with digestion.

65

And maybe it causes less damage

to your microbiome as well

66

rather than taking antibiotics.

67

It's not as strong and actually

that is one of the drawbacks I

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think of doing it in a herbal way.

69

It takes much longer, it can cost you more

you're more likely to have to take these

70

things for four to six to sometimes to

eight weeks, whereas if you're taking an

71

antibiotic it's just two weeks normally

and then it's done and you might have to

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do it again to be sure but it can cost

more and it can take longer doing it

73

with supplements instead of medication.

74

Some of the supplements might not be

strong enough and you might not take

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them in strong enough doses, so it's

really important to take high doses

76

of these for them to be effective.

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Otherwise, They don't really work.

78

So let's start with some

supplements for hydrogen SIBO.

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So the antimicrobial herbs that

are best tested and used for

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treatment of hydrogen SIBO.

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I'm going to start with berberine.

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Berberine is a compound in other herbs.

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So it's in things like Oregon grape or

golden seal And you can find it in a

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product on its own, but often it's in a

sort of antimicrobial combination product.

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There are quite a few studies showing

that berberine can potentially lower

86

your weight, it can lower Blood glucose

levels, so anybody who is diabetic should

87

take care taking any kind of product like

this or has any blood sugar imbalances.

88

And that's partly because you

have to take it in a really

89

high dose to have an effect.

90

In the gut.

91

The kind of suggested levels are

around 3 to 5 grams per day, spread

92

out into 3 different treatment times.

93

So taking it 3 times a day, adding

up to between 3 and 5 grams a day.

94

That's quite a lot, and that will

involve taking a lot of capsules.

95

So you need to be careful if it's

going to have other systemic effects,

96

like lowering your blood glucose,

potentially lowering blood pressure, or...

97

cholesterol, lowering body weight, so

do be careful when taking any sort of

98

supplement really, but specifically

this, because we do know it has other

99

effects other than just in the gut.

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The other thing about berberine,

just lastly, is it potentially

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can lower a neurotransmitter in

your brain called GABA, which may

102

increase anxiety when that goes down.

103

So you want to be careful if

you're someone who experiences

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low mood or high anxiety.

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And just be aware of potential changes.

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If you start taking an

antimicrobial treatment like this.

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So alongside berberine, another herb

which I really like using because it's

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relatively cheap compared to the others

and it's a bit more gentle, I find,

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people don't tend to react to it, is neem.

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This is another herb which is

useful for people who have hydrogen.

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producing microbes, but to be honest

there isn't that much research

112

about neem so I often do it as a

secondary herb or alongside berberine

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rather than as the only thing.

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I wouldn't rely on neem in

order to reduce microbes, but

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I like it alongside berberine.

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They tend to work quite well together.

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Now another type of antimicrobial

treatment that can be used for hydrogen

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and methane gases is oregano oil.

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Some people find that this can be

quite rough on your gut and can

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cause some problems, particularly

in the upper digestive . So

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kind of burning in your stomach.

122

Some people find it makes them

feel a little bit nauseous.

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You can get side effects of

taking high doses of oregano oil.

124

Again, you're aiming for quite

high doses of oregano oil,

125

around 200 milligrams spread out

through the day, so in two doses.

126

And this is taking an emulsified

form, so you can get a

127

product where it's emulsified.

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There's one called ADP.

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And this oregano is...

130

I think better.

131

It depends.

132

Sometimes, if you get a cheap oregano

oil from a health food shop, you

133

may find that it is more likely

to cause upper abdominal pain and

134

irritation than one that is emulsified.

135

So that's the one I tend to use

with my clients because it just is

136

a little bit more gentle on the gut.

137

But anyone can have a problem

with any of these supplements.

138

Everybody's got an individual digestion,

so it might not always work for you.

139

But oregano can be used for both

hydrogen and methane type gases.

140

And sometimes we'll use one and

then another treatment round

141

you'll use another type of herb.

142

So it's good to know what

all the different herbs are.

143

Something else that's really good for

treating methane producing microbes, so if

144

you've got methane Overgrowth is allicin,

and that is an extract from garlic.

145

Sometimes it's called Alimed, Alimax,

there's like a variety of different

146

products, but it's essentially

the active compound out of garlic.

147

Now if you're someone who reacts to

FODMAPs, and particularly garlic, you

148

might be really worried about taking this

allicin, because it is a garlic extract.

149

However, It doesn't have any of the

starches, the FODMAP element, so it's

150

not likely to cause you any problems.

151

The one thing I will say is

sometimes people feel like they

152

get garlicky burps after taking it,

and that can be really off putting.

153

A lot of people don't have a problem with

it at all, but some people do, and they're

154

keen to finish the treatment round.

155

Again, similar to the others, you

need really high doses, so this is

156

normally three times a day, somewhere

in the range of like one and a half

157

grams to two and a half grams a day.

158

This is where working with a

practitioner is really helpful

159

to sort of tailor it to you.

160

I normally say with any of these,

start low and slow, start small doses,

161

start one once a day and then ramp up.

162

You're not going to see much

improvement at that dose.

163

However you don't want to just launch

into taking, you know, three capsules

164

three times a day, because If it's

not a great reaction, then you've

165

got to scale back quite quickly.

166

So, do start with a

small dose and build up.

167

Now that is the main set of

antimicrobial treatments that I use.

168

There are others that people would maybe

use, but these are the most effective

169

that I find with my SIBO clients.

170

Now the third type of SIBO that I haven't

yet mentioned is hydrogen sulfide.

171

This...

172

is particularly challenging in the

UK because we don't have a test that

173

can show whether you're positive for

hydrogen sulfide microbes or not.

174

If you are working with someone who

thinks that you might have this, there

175

are products you can try, but it's also

challenging to get the right kind of

176

products and they're really expensive.

177

There's something called bismuth,

which is an ingredient in pepto

178

bismol, that pink reflux medication.

179

That is the most accessible form

of bismuth but there are also

180

other products that you can find

that have got bismuth in them.

181

A couple of products that I've found

that have got it in apart from Pepto

182

Bismol is there's Thorn Peptigard that

has got some bismuth in it and there's

183

also something by Biotic Research called

BioHPF which also has it in but they're

184

not always available So these are really

tricky to find for hydrogen sulfide.

185

You can also use oregano and some of the

other herbs that I've already mentioned.

186

The other thing that you potentially

could take is soy isoflavones.

187

So soy Like soy products from food,

there is extracts of that that are

188

potentially of use, but again, not a

great lot of research using these for

189

gut disorders, so I don't actually

use these very often, unless there's

190

a particularly challenging, case, and

Symptoms might suggest it's worth it.

191

Those are the things that we

use to kill off the microbes.

192

I thought I'll just quickly touch on what

might happen, or how you might feel when

193

you start taking antimicrobial treatments.

194

Because sometimes you will get something

called a die off reaction, or it's

195

referred to as a Herxheimer reaction, and

that is when the bacteria are breaking

196

up, small fragments of them are going...

197

into your bloodstream, they're getting

absorbed and your immune system is raising

198

a response to these pathogenic microbes

or elements of them and what it does is

199

it makes you feel like you're getting flu.

200

So often people feel very very

tired suddenly, they might feel

201

achy, a bit headachy, just feel like

you're coming down with something.

202

It should only last for a couple

of days, and it should be normally

203

when you get up to a large dose,

so it wouldn't necessarily be on

204

the time you take the first tablet.

205

But it could be once you're taking

them three times a day, and like,

206

you know, you're into a bit of a

roll with them, then things start

207

breaking down in your gut, and that

is where you might start getting

208

this reaction, the die off reaction.

209

If you feel that this is you, that that's

happened to you, what I suggest is a

210

little bit like when you actually have

a cold or a flu or a virus or something.

211

You can try upping vitamin C to give

yourself and your immune system a little

212

boost to try and help yourself recover.

213

You can rest and Look after yourself.

214

So have a little easy day if

you can Things where you are

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sweating are really good.

216

So I really like recommending

particularly during the winter time,

217

a nice hot bath before bedtime.

218

Sweating is one of the ways we get rid

of, it's a detox process basically.

219

So a nice hot bath before

bed, particularly if you

220

put in some Epsom salts.

221

For some people, this

can be really helpful.

222

Epsom salts can help

you with this reaction.

223

Or, a binder that goes into

your gut and helps to...

224

Absorb things and take them out.

225

So for example, activated charcoal

tablets, you can take these for a

226

couple of days without any problem.

227

I don't recommend taking charcoal

long term because it does interfere

228

with the absorption of key minerals

like iron and zinc and so on.

229

So it's not great to take long term.

230

But in a an acute case, where you want to

just get over a problem like this die off

231

reaction or taking it for bloating after

a large meal can also be quite helpful.

232

You can take one or two of those capsules

like two hours apart for a day or two.

233

But I wouldn't do more than that.

234

Oh, the other thing is that

they can make your stools go

235

black when you take charcoal.

236

If you do get This die off reaction.

237

Try to keep going with your

treatment plan for a few days.

238

Obviously if it's terrible,

and it's really making you

239

feel awful, you must stop.

240

But what you don't want to do is to

switch treatment plans too quickly

241

and go to another Route without really

giving this a chance because then

242

you're never going to get to the crux

of the treatment If you can't take

243

any of these antimicrobial things.

244

it is really hard I would say

especially if you're navigating

245

all of this on your own.

246

So now, you know, which type of

antimicrobial treatments I most

247

commonly use with my clients.

248

I want to talk about how to use them Like

how long you should take them for and

249

what you should do before and after And

then also I'll just talk briefly about

250

biofilms, biofilms are a bit like where

the bacteria get together and they create

251

a little coating around themselves that

makes them more resistant to treatment

252

by antibiotics or antimicrobial herbs.

253

What we can do is take some additional

things to try and break down these

254

biofilms to try and make them

more accessible to your treatment.

255

The ones that I like are N acetylcysteine,

glutathione or alpha lipoic acid.

256

These are really good at supporting the

liver, supporting your immune system.

257

I just feel like it gives your

whole body like a nice little

258

boost as well as helping.

259

With the bacteria biofilm breakdown.

260

There are also products that contain

enzymes such as serrapeptase.

261

These can also be used Although I like

the ones that are more the antioxidant

262

type, the thiols that actually help you

with the antioxidant Action as well.

263

However, some people do get on

all right with the ones that

264

contain So that is biofilm busters.

265

And then I just wanted to talk

about how to actually take

266

these antimicrobial treatments.

267

I would say taking them one

at a time to begin with.

268

So starting with one product,

ramping that up to its full dose.

269

Then start to add another product

at a low level and ramping that up.

270

That gives you the best chance to

see if you're having any reactions.

271

Then after a week or so you're

at a full dose for all the

272

treatments and you can just...

273

Go on right ahead.

274

Doing it in that way just allows you to

see if you get any of those reactions.

275

You don't want to take these antimicrobial

substances for a very long time.

276

We're aiming for around six weeks.

277

Sometimes it's a bit less,

sometimes a bit more.

278

You know, if you end up getting

the end of the bottle and it's

279

five weeks, that might be enough.

280

It's also really dependent

on your symptoms.

281

So how are you actually feeling?

282

Do you feel like things have changed?

283

But as I mentioned at the beginning,

sometimes you won't see an improvement,

284

in your symptoms, but you may see a drop

in the numbers, which is where retesting

285

your SIBO figures again can be so helpful.

286

And can help you to feel like things

are moving along, even if your symptoms

287

haven't got better straight away.

288

Other SIBO supplements that can be very

helpful include prebiotics and probiotics.

289

Now in my IBS supplements podcast,

episode 19, I covered PHGG, that

290

is partially hydrolyzed guar gum.

291

I love this for SIBO because it

helps to feed the good bacteria

292

in your large intestine, it's low

FODMAP, doesn't cause bloating in...

293

majority of people, some people it

does, but that is a good addition

294

and you can take that alongside

the antimicrobial treatment.

295

So that is fine to take at the same time.

296

Now I don't suggest normally taking

probiotics alongside an antimicrobial

297

treatment, but you can do.

298

Some people get on really well like

this and I have actually seen some

299

research showing that substances

like The rifaximin, that's the

300

antibiotic for SIBO and treatments

like oregano actually work really well

301

alongside probiotics at the same time.

302

However, it can feel like you're taking

too many supplements and I try to keep

303

things as simple as possible for people.

304

So normally I would wait for probiotics

until such time that you feel like you've

305

made progress with your symptoms or that

you finish the treatment, have a little

306

break and then take the probiotics.

307

Now, the other thing I really want

to stress is the Prokinetic, and

308

that is something that helps to keep

your migrating motor complex working.

309

It includes things like

Ginger, or Artichoke, or 5 HTP.

310

This is really important to maximize

any gains that you've got through the

311

treatment, and to keep things moving.

312

Often when you get prescribed Rifaximin or

treatment from your doctor, you will not

313

be given a Prokinetic at the same time.

314

And so.

315

Something that you can do and talk

to your doctor about if you have got

316

antibiotics, but certainly after taking

a Antimicrobial treatment I suggest

317

you move on to a prokinetic And I will

put a link in the show notes to a blog

318

post that I have got about this on my

website Right that has easily filled

319

up enough in this episode talking

about just the antimicrobial elements.

320

I realize it's a lot of detail If

you have got questions, then a great

321

place to get these answered is my

group gut reset, where you work with

322

me for three months, in a group,

but you get an individual plan.

323

So for people who've got SIBO, I

give you some clarity on how to

324

tackle it, as well as what to eat

during all this treatment rounds and

325

how to best manage your symptoms.

326

So if you're looking for advice and

support with managing SIBO, the group

327

gut reset is a great way to do that.

328

And if you're listening in real time

329

It is on offer, but it's only

300 pounds the rest of the time.

330

For people to get support with dealing

with this digestive condition because SIBO

331

is pretty complex, as I'm sure you know.

332

Okay, thank you very much for listening.

333

I will see you next week.

334

Goodbye.