{"id":1423,"date":"2018-04-28T19:01:31","date_gmt":"2018-04-28T19:01:31","guid":{"rendered":"https:\/\/drvanta.com\/?p=1423"},"modified":"2019-02-20T10:06:23","modified_gmt":"2019-02-20T10:06:23","slug":"sibo-c-treatments-prescriptions-drugs-and-natural-therapies","status":"publish","type":"post","link":"https:\/\/drvanta.com\/sibo-c-treatments-prescriptions-drugs-and-natural-therapies\/","title":{"rendered":"SIBO-C. Methane Dominant SIBO (SIBO-C) Treatment. Prescription Drugs and Natural Solutions"},"content":{"rendered":"

1.Methane Dominant SIBO (SIBO-C) Treatment <\/strong><\/h3>\n

2.Methane Dominant SIBO- Prescription Drugs. Why Prescription Antibiotics Aren\u2019t Working That Well ? Pros and Cons Of the Antibiotics<\/strong><\/h3>\n

3.Why Natural Antimicrobials Offer a Better Solution for Archaea Overgrowth. Methane Dominant Neem for SIBO, Other SIBO Herbal Treatments. SIBO Herbal Treatment Side Effects<\/strong><\/h3>\n

4. My Approach to Methane Dominant SIBO (SIBO-C) Treatment<\/strong><\/h3>\n

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You may want to read first <\/strong><\/h3>\n

Part I: Chronic Constipation, IBS-C, SIBO-C? What Is The REAL Cause For All Of Them?<\/a><\/strong><\/h3>\n

Part II: That Hidden Depression No One Talks About (Hint: It\u2019s In The Gut. As seen in chronic constipation, SIBO-C and IBS-C)<\/a><\/strong><\/h3>\n

 <\/h3>\n

1. Methane Dominant SIBO (SIBO-C) Treatment <\/strong><\/h3>\n

SIBO (small intestinal bacterial overgrowth) can be methane producing, hydrogen producing or both. Bacteria produce hydrogen where archaea produce methane. Excess hydrogen is usually associated with diarrhea (SIBO-D) where methane dominant SIBO is typically linked with constipation (SIBO-C).<\/strong><\/h3>\n

There are a few breath tests for SIBO that your doctor can order, and also some home kit tests available in some countries. These tests measure the levels of methane and hydrogen. However, they are not always accurate, yelding false negative results. For this reason, it makes a lot of sense to interpret the results of the methane dominant SIBO test in combination with symptoms.<\/strong><\/h3>\n

I mentioned in my other articles about the fact that chronic constipation, IBS-C and SIBO -C being as one disease<\/a>, not three different conditions: an archaea overgrowth. More and more studies support the significant overlap between SIBO and IBS. Many individuals report a history of chronic constipation before developing SIBO and IBS. This means that I find useful for chronic constipation and IBS-C some supplements described here for managing methane dominant SIBO (SIBO-C). <\/strong><\/h3>\n

Back to the topic of this article. Let\u2019s look at how SIBO-C treatment.<\/strong><\/h3>\n

I do emphasize the need for treating this condition. It is more common that was previously thought. Research suggest that up to 15% of people with no symptoms may have SIBO and over 80% of those with IBS have associated SIBO.  <\/strong><\/h3>\n

SIBO is a sign of dysbiosis (altered gut flora), which can complicate with other-and more serious conditions -including autoimmunity. SIBO is also more commonly diagnosed in MS [1<\/a>]. <\/strong><\/h3>\n

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The small intestine and its flora plays an important role in overall health. The beneficial flora helps protect against bad (pathogenic) microbes, help absorb essential nutrients and produce vitamins like vitamin K and folate, as well as short fatty chain acids. The overgrowth of methanogens or other microbes will impair the metabolism of proteins and fats, nutrients such as vitamin B 12, A, D, E, iron, calcium and the overall digestion.  The small intestinal microbiome also supports normal intestinal motility and transit, which is slowed down by excess methane.<\/strong><\/h3>\n

To no surprise, someone with SIBO will experience abdominal discomfort, signs and symptoms of nutrient deficiency (ie anemia) poor absorption of the food and food intolerances, bloating, heartburn and constipation (SIBO-C), weight changes (weight gain with SIBO-C is common), malnutrition, rashes (ie eczema, rosacea), joint pain. Other symptoms include brain fog, poor concentration and fatigue (because of the brain-gut connection), anxiety and depression. <\/strong><\/h3>\n

Methane Dominant SIBO- Standard Treatment (Prescription Drugs)<\/strong><\/h3>\n

Standard treatment includes dietary changes and antibiotics. You may receive a low FODMAP diet handout like this  <\/a>along with the prescription for antibiotics. Laxatives are also recommended for sibo constipation relief. . <\/strong><\/h3>\n

Rifaximin is the preferred antibiotic for SIBO- although the success rate is about 40% for SIBO-D and even less of SIBO-C. For this reason, SIBO-C treatment involves a combination of two antibiotics- for example rifaximin and metronidazole (or neomycin). Guar Gum appears to increase the efficacy of rifaximin. Unlike all other antibiotics, rifaximin is absorbed locally, does not appear to significantly alter the gut microbiome and there are low chances for microbes to develop resistance to it. However, rifaximin is never given alone, but with another antibiotic, therefore there will have a significant impact on the gut flora. <\/strong><\/h3>\n

Laxatives are given often, perhaps too often and for too long- for example osmotic laxatives like polyethylene glycol (brand Miralax).  <\/strong><\/h3>\n

 Why Prescription Antibiotics Aren\u2019t Working That Well ? Pros and Cons Of the Antibiotics<\/strong><\/h3>\n

Since we are dealing with Archaea overgrowth, it makes a lot of sense to use antimicrobial agents, right? Currently, the antibiotics are used for treating SIBO, but they have limited success rate and relapse rate are common. If you wonder why, here is my explanation:<\/strong><\/h3>\n

Archaea microbes are not bacteria ! Archaea are biochemically and genetically different from bacteria. No wonder  studies show consistently that Archaea are resistant to most antibiotics- that\u2019s because Archaea are not bacteria, but a different form of microbes, which are actually closer to fungi\/parasites than to bacteria in the way they behave. An example: the antibiotic metronidazole is working against methanogens not because is antibacterial- but because of its strong anti-fungal\/ anti-parasitic effects. <\/strong><\/h3>\n

Technical: Archaea form a distinct kingdom of life, in addition to eukaryotes (fungi\/parasites), bacteria, and large viruses. Archaea possess genes and several metabolic pathways that are more closely-related to those of eukaryotes, notably the enzymes involved in transcription and translation (although they are prokaryotes) [<\/span>2<\/a>]. <\/span>Archaea display a broad-spectrum resistance to antimicrobial agents. Their cell wall lacks peptidoglycan, making them resistant to antimicrobial agents. Archaea is however susceptible to fusidic acid, imidazole derivatives, and squalamine [3<\/a>]. <\/span>Fusidic acid is derived from the fungus Fusidium coccineum and has antibacterial, antifungal, and antimalarial activities. Squalamine has a broad spectrum coverage- antifungal, antibacterial, antiparasitic and even antiviral actions. Imidazole derivatives have mostly antifungal\/antiparasitic effects  [<\/span>4<\/a>],[<\/span>5<\/a>],[<\/span>6<\/a>]. <\/span><\/strong><\/h3>\n

The Side Effects of Antibiotics: While prescription antimicrobials can help treat some cases of SIBO-C, the recurrence rate is frequent (up to 44% of people treated with antibiotics will experience recurrence after 9 months; increased relapses correlate with older age, appendix removed and used of acid blockers PPIs) [7<\/a>]. Here is a review of  some side effects<\/a> of the antibiotics. <\/strong><\/h3>\n

Antimicrobial drugs have a negative impact on gut flora. They kill both bad and good bugs. Microbes compete one with another, so they have their \u201cspots\u201d within the  GI tract. What happens when you kill some of them ? They will be replaced by the overgrowth of other species. The typical example is Candida overgrowth after taking antibiotics. Also consider how important is the gut flora for the overall health. More details here<\/a>. Just one round of antibiotics can negatively impact your gut microbiome for several years. It may be hard to treat SIBO, but even harder to  reverse the side effects of antibiotics.<\/strong><\/h3>\n

I do see a lot of value in antibiotics for treating acute, life threatening infections. However, I prefer natural treatments for treating chronic infections like SIBO, IBS, H pylori or Candida.<\/strong><\/h3>\n

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3. Why Natural Antimicrobials Offer a Better Solution for Archaea Overgrowth. Natural Treatments for SIBO-C.<\/strong><\/h3>\n

Unlike prescription antibiotics, natural herbs and supplements contain multiple active ingredients (antimicrobial chemicals). This means they typically have broader coverage -for bacteria, fungi, parasites and even viruses. Since they are so versatile, it is less likely for those microbes to develop resistance to herbal supplements vs antibiotics (resistance to antibiotics is a very big problem nowadays). Many herbs with antibacterial qualities also have antifungal effects, thus there is a lower risk to develop Candida, while increasing the success rate of killing Archaea species. <\/strong><\/h3>\n

SIBO Herbal Treatment Side Effects: Natural antimicrobials are more gentle for the gut microbiome and won\u2019t kill as many friendly bacteria compared with prescription drugs (if they are used right). However, natural treatments should also be used properly to avoid problems. For example, oregano oil is very effective but also very strong it can cause damage to gut flora if overused. Yes, herbal antimicrobials can kill some probiotics too, but overall are safer than prescription drugs. For this reason, I always keep the herbal treatment as short as possible (no more than 10 days for oregano oil, up to 3 weeks in total) and recommend them along with probiotics. Herbs can cause allergic reaction in susceptible individuals and can also interfere with prescription drugs and other herbs (drug-herb and herb-herb interactions). I think herbs should be chosen wisely based on other health concerns (ie some can lower blood pressure or low sugar levels- thus should be used cautiously in those who already those issues). Not a side effect, but rather disadvantage \u2014 we don\u2019t have enough research studies to see which herb inhibits methanogens thus herbs with broad antimicrobial coverage are the best choice. This is a problem for standard treatment (drugs) as well. <\/strong><\/h3>\n

Herbs are wise. They had to learn to protect themselves to survive in a harsh environment with plenty of archaea, bacteria, fungi, parasites and viruses around. Certain herbal compounds had been found specifically to inhibit methane production -for example saponins, tannins, essential oils, organosulfur compounds, flavonoids and many other metabolites [8<\/a>]. <\/strong><\/h3>\n

Neem for SIBO or Other Herbal Combinations \u2014 How Do They Work ? <\/strong><\/h3>\n

The best study in humans evaluated a combination of supplements Candibactin-AR with Candibactin-BR (Metagenics brand) which was found as effective (actually a bit more effective) than rifaximin for treating SIBO [9<\/a>]. There are many herbs included in these two supplements- the key ones being Red Thyme Oil, Oregano Oil and Berberine.<\/strong><\/h3>\n

Other natural protocols include combination herbs \u2014 for example Oregano Oil with Garlic, Berberine, Neem<\/a> and Cinnamon for 4 weeks or longer. <\/strong><\/h3>\n

A quick note about neem for SIBO-C : seems to be popular supplement for treating SIBO-C naturallly. There is very little research about its benefits specifically on methanogens [10<\/a>]. However, this herb has a broad antimicrobial activity (including antifungal\/antiparasitic action) and great for gut detox, and there are over 100 research papers about this herb. Thus, I do consider neem for SIBO-C as a good option [11<\/a>]. You can read here more details about the health benefits of neem<\/a>.<\/strong><\/h3>\n

Atrantil is a smart combination of peppermint, quebracho and conker tree and these ingredients work synergistically. Peppermint decreases local inflammation, quebracho targets gas and reduce hydrogen (thus starving the methanogens). Conker tree (a saponin) is the one that inhibits methanogens. <\/strong> <\/h3>\n

Diet. There are a few diets recommended along these natural supplements, for example low FODMAP, SCD (Specific Carbohydrate Diet) or GAPS (Gut and Psychology Syndrome Diet), low fermentation diet and a few more. There is a lot of information available online for all these diets. Basically they all reduce the foods that feed the bacteria that overgrow (mostly carbohydrates). The goals of these diets are to  relieve symptoms of IBS, SIBO, constipation, diarrhea and bloating, lower the gut inflammation, while increasing nutrient absorption and promote gut health.<\/strong><\/h3>\n

4. My Approach to Methane Dominant SIBO Treatment<\/strong><\/h3>\n

Diet and supplements are very important, of course. Based on my experience, diet and supplements or drugs can work short term. There are another lifestyle changes you need to make if you want to be symptom free long term. <\/strong><\/h3>\n

I looked at the following question: What methanogens love (and will make them overgrow)? <\/strong><\/h3>\n

Dietary Factors:<\/strong><\/h3>\n