My general conception of herbs is has been that they’re what you grow in your garden. Yes, they can be helpful with illness, but mostly around the edges. Pharmaceutical companies, on the other hand, spend hundreds of millions of dollars to produce a drug. If you’re really sick – you’re going to need drugs.
This study threw a monkey wrench into that idea.
Small Intestinal Bacterial Overgrowth (SIBO) in ME/CFS and FM
SIBO is an often painful condition that can, depending on its severity, cause gas, cramping, diarrhea, heartburn, anemia, malabsorption, cognitive problems, rashes, joint pain, headache and more. We found out how far SIBO can go when Esther’s decades of brain fog, orthostatic intolerance, mood issues, and others mostly cleared up when she took care of her SIBO using antibiotics.
SIBO occurs when bacteria spill over from the gastrointestinal tract (where they belong) into the small bowel (where they don’t).
Key Indicators of SIBO by Dr. Siebacker
Little research has been done into SIBO prevalence in either ME/CFS or FM, and it’s not clear common it is. We know IBS symptoms are common in both, and we know SIBO is very common in IBS and that SIBO can trigger IBS. Increased gastrointestinal permeability – which is often associated with SIBO – appears to be fairly common in Fibromyalgia. Remarkably, in one study a higher percentage of fibromyalgia patients (100%) than IBS patients (84%) tested positive for excessive hydrogen gas in a lactulose breath test.
Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, Justino E, Tomakin E, Mullin GE. Glob Adv Health Med. 2014 May;3(3):16-24. doi: 10.7453/gahmj.2014.019.
This retrospective study took a look back at four years of patients treated for SIBO at a single clinic. They were considered for SIBO if they were experiencing abdominal discomfort, cramping, bloating, flatulence, diarrhea, worsening of symptoms after eating, and low serum B12. SIBO was confirmed by a lactulose breath test.
They were given either an antibiotic (rifaxamin/Xifaxin – 2 200 mgs tabs/3x’s a day) or 2 capsules twice daily of an herbal preparation by one of two companies: Dysbiocide and FC Cidal (Biotics Research Laboratories) or Candibactin-AR and Candibactin-BR (Metagenics). The maximum cost of the herbal preparation was $130/month.
Patients that did not respond to Rifaxamin were either put on the herbal preparation or given triple antibiotics (clindamycin/metronidazole/neomycin) for four weeks and were tested again.
Not only were the herbs as effective as Xifaxin (46% responders on herbs, 34% responders on Xifaxin), 57% of the patients who did not respond to Rifaxamin responded positively with the herbs (passed the breath test). Sixty percent of the Xifaxin non-responders also responded to triple antibiotic therapy. Nine percent of patients on Xifaxin had significant side effects (including one case of clostridium dificile-associated diarrhea) compared to one percent of the herbal treatment group.
As Effective, Cheaper, Fewer Side Effects … Hmm…
The authors noted that SIBO is a fairly common condition which is chronic, difficult to treat, and often recurrent (requires multiple treatments) and has no clear treatment guidelines.
Given some of the issues with Xifaxin, it’s easy to see why some patients and doctors are turning to herbs. As we saw with Esther’s story, Xafaxin can be very effective, but it’s no walk in the park. For one thing it’s very expensive ($1250/month), and because it’s not FDA approved for SIBO, some patients may have to pick up the costs. Patient costs even under Medicare are over $600+/month. Significant side effects may occur with antibiotics including, ironically, gut issues.
Most important, about 50% of people with SIBO do not respond to Xafaxin. Of those that do, the response may be temporary, setting them up for another round of an expensive drug or triple antibiotic therapy.
Lower cost and safe alternatives are clearly needed, and at a maximun of about $120/month, these herbs fit the bill. They didn’t sucessfully treat a significantly higher percentage of patients than Xifaxin, did but their significantly lower cost and reduced side effects suggest they should probably be the first treatment option for SIBO. They were also effective in about half the people who didn’t respond to Xifaxin.
Unfortunately the study did not assess differences in treatment effectiveness in the two herbal products. Amazingly, the two herbal products only shared one ingredient in common — thymus vulgaris — suggesting that herbs provide multiple options for getting at gut issues.
The Biotics Research Laboratories products contained tinospora cordifolia, equistum arvense, Pau D’Arco, thymus vulgaris, artemesia dracunculus, sida cordifolia, olea europaea, dill seed, stemonia sessifolia, artemesia absinthium, pulsatilla cheninsus, brucea javinica, picrasma excelsa, acacia catechu, hedyotis diffusa, and yarrow leaf.
The other product contained thymus vulgaris, oreganum vulgare (oregano oil), salvia officinalis, (sage leaf), mellissa ofiinalis (lemon balm leaf), coptis chenensis (containing berberine), berberis artistata (Indian barbery root extract), beberine sulfate, scutellaria baicalensis (Chinese skullcap root), phellodendron chinense (bark), zingiber officinale (ginger), glycyrrhiza uralensis (Chinese licorice root), and rhemum officinale (Chinese rhubarb).
Dr. Alison Siebecker, an SIBO expert and the author of SIBOinfo.com reports similar experiences with herbs (or as she calls them ‘herbal antibiotics”) stating, “We find they have the same efficacy as pharmaceutical antibiotics.” She uses from 1-3 of the following herbs at the highest doses suggested for 4-6 weeks: allicin from garlic (highest potency formula – Allimed) / oregano /berberine (found in goldenseal, oregon grape, barberry, coptis, Phellodendron) / Neem / cinnamon. and she states a host of other options are available.
The idea persists that alternative health (nutrition, acupuncture, naturopathy, mind/body) protocols can help you around the edges, but if you’re really sick you’re going to need traditional medicine, i.e. drugs. There’s surely some truth to that, but Dr. Teitelbaum, in a talk with nutritionist and chiropractor, Dr. Courtney Craig, asserted that 80-85% of what works in Fibromyalgia and ME/CFS comes from the alternative health field, and here we have a study indicating that herbs can be as effective for drugs in SIBO.
- Check out Dr. Craig’s overview of this study here
- An Herbal Approach to Chronic Fatigue Syndrome – That Worked…
- For more on SIBO
Coming up soon – the story of one woman’s success resolving decades of gut symptom …from home.