“Do herbal antibiotics actually work for SIBO?”
I’ve been asked this hundreds of times.
My first SIBO treatment was an herbal protocol. It didn’t work for me. Years later, herbs became a big part of how I stayed relapse-free.
Same herbs. Different results. The difference was knowing which ones, why, and how they fit with everything else.
Here are 13 herbal antibiotics for SIBO, with what the research actually shows for each one.
What are herbal antibiotics for SIBO?
SIBO is too much bacteria in the small intestine, which can cause bloating, gas, diarrhea, constipation, and more. (source)
Herbal antibiotics (also called herbal antimicrobials) are plant compounds used to lower that bacterial load. They’re the most common alternative to prescription antibiotics like rifaximin.
Most SIBO herbal protocols combine 2 or more herbs instead of using one alone.
Do herbal antibiotics work for SIBO?
The best study we have is from Johns Hopkins in 2014.
Researchers looked back at 104 people with SIBO. After treatment, 46% of people on herbal protocols had a normal breath test, compared with 34% on rifaximin. (source)
Make note: the study looked back at records instead of randomly assigning treatment, and the difference wasn’t statistically significant. It’s encouraging, not proof.
The same study found that 8 of 14 people (57%) who didn’t respond to rifaximin had a normal breath test after herbs.
Want the full side-by-side? Read Herbal SIBO Support vs. Rifaximin.
The 13 herbal antibiotics for SIBO at a glance
| Herb | Where you’ll find it | Tested for SIBO in people? |
|---|---|---|
| Clear Plus | 7-herb formula | Same herbs as a studied pair |
| Digest Plus | Eastern + Western herb blend | Same herbs as a studied pair |
| Candibactin-AR + BR | Metagenics pair | Yes, as a pair (2014 study) |
| Berberine | Barberry, goldenseal, Candibactin-BR | Trial designed, results not yet published |
| Allicin | Garlic extract | No (animal studies on methane) |
| Oregano | Candibactin-AR, oregano oil | Only as part of a pair |
| Wormwood | Digest Plus | Only as part of a pair |
| Atrantil | Quebracho, conker tree, peppermint | No (small IBS-C study) |
| Neem, cinnamon, lemon balm, barberry | Various protocols | No |
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1. Clear Plus
Clear Plus is my 7-herb formula: French tarragon, Indian tinospora, horsetail, thyme, pau d’arco, stinging nettle root, and olive leaf.
It uses the same herbal ingredients as FC-Cidal, half of one herbal pair in the Johns Hopkins study. The study didn’t test Clear Plus itself. (source)
Clear Plus is designed to pair with Digest Plus.
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2. Digest Plus
Digest Plus is my blend of Eastern and Western herbs, including dill seed, stemona, wormwood, java brucea, Chinese pulsatilla, Jamaica quassia, cutch tree, and hedyotis.
It uses the same herbal ingredients as Dysbiocide, the other half of that study pair.
For me personally, Digest Plus is the herb I’d never want to be without. Read why in Dissecting Digest Plus.
Make note: Digest Plus contains wormwood. Read the safety section below before you take it.
Get Digest Plus HERE, or save with the Herbal Stack (Clear Plus + Digest Plus). Use code AGUTSYGIRL to save 15%.
3. Candibactin-AR
Candibactin-AR is a Metagenics formula with oregano and thyme oils plus lemon balm.
It was half of the other herbal pair in the Johns Hopkins study. (source)
4. Candibactin-BR
Candibactin-BR is the partner formula to AR, with berberine and other herbs. In the study, people took AR and BR together.
5. Berberine
Berberine is a compound found in plants like barberry, goldenseal, and Oregon grape.
It’s one of the most talked-about herbs for SIBO. A randomized trial comparing berberine with rifaximin for SIBO was planned and published as a study design in 2023. (source) I couldn’t find published results yet.
Berberine can lower blood sugar and interacts with several medications, so check with your doctor first.
6. Barberry root
Barberry is one of the main plant sources of berberine. It’s often used in SIBO formulas for that reason.
No studies have tested barberry on its own for SIBO.
7. Allicin
Allicin is the active compound in garlic. In animal studies, garlic compounds lowered methane production. (source) That’s why allicin comes up so often for methane-type SIBO (IMO).
Wondering about garlic itself? Read Garlic and SIBO.
8. Oregano
Oregano oil is one of the most common herbal antimicrobials and is in Candibactin-AR.
Make note: oregano essential oil is strong. Never take it straight or in amounts beyond what a product label says.
9. Neem
Neem comes from a tree native to India and is used in several SIBO protocols.
No studies have tested neem for SIBO in people.
10. Wormwood
Wormwood (Artemisia absinthium) is in Digest Plus and many other SIBO formulas.
It’s also the herb on this list that needs the most care. See the safety section below.
11. Lemon balm
Lemon balm is in Candibactin-AR. In lab testing, lemon balm oil was one of the more potent essential oils against bacteria. (source)
12. Cinnamon
Cinnamon shows up in clinical SIBO protocols, including combinations used by SIBO practitioners.
No studies have tested cinnamon alone for SIBO.
13. Atrantil
Atrantil combines quebracho, conker tree, and peppermint. It’s marketed for methane and bloating.
In one small study of 24 people with IBS-C, 21 (88%) reported less pain, bloating, and constipation. (source) The study had no placebo group and didn’t measure SIBO or breath tests.
My experience with it was mixed. Read Does Atrantil Work?
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How to use herbal antibiotics for SIBO
- Confirm SIBO first. Get a breath test so you know what you’re treating. Start with my Buyer’s Guide to SIBO Tests.
- Work with a practitioner. They’ll choose the herbs, amounts, and length based on your test results and health history.
- Expect a protocol, not a single herb. In the Johns Hopkins study, each herbal pair was taken for 30 days.
- Retest after. A breath test tells you whether it worked.
- Find the underlying cause. Herbs lower the bacteria. They don’t fix why it grew. Read When SIBO Keeps Relapsing. And this might be the most important part of this article.
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Who should NOT take herbal antibiotics without a doctor
Herbal antibiotics for SIBO FAQ
What is the strongest natural antibiotic for SIBO?
There’s no single strongest herb. The best research supports combination protocols. In a 2014 Johns Hopkins study, 46% of people on herbal pairs had a normal breath test afterward.
Are herbal antibiotics better than rifaximin?
In that study, herbs did slightly better than rifaximin (46% vs. 34%), but the difference wasn’t statistically significant. Both are options to discuss with your doctor.
How long do you take herbal antibiotics for SIBO?
In the Johns Hopkins study, people took herbal pairs for 30 days. Your practitioner may choose a different length.
Is berberine good for SIBO?
Berberine is widely used for SIBO, and a trial comparing it with rifaximin has been designed. Published results aren’t available yet.
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These statements have not been evaluated by the Food and Drug Administration. Clear Plus and Digest Plus are not intended to diagnose, treat, cure, or prevent any disease.
This content is for education only and isn’t medical advice. Please work with your doctor before starting or changing any treatment.
Xox,
SKH
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Thank you for this great article. So well organized and articulated. I do have a question regarding antibiotics. I recently was told I had a sinus infection and needed to take an antibiotic. Prior to that I’ve been treating my SIBO and H Pylori with a product called Gastromend which is DGL and Mastic Gum and having lots of relief.l This week i was diagnosed with a sinus infection and am on day 3 of an antibiotic. What would be a good support to take in between doses of the antibiotic. I know you are not a doctor but I appreciate your thoughts. Thank you, cindy
Hi Cindy – Thanks for reaching out and stopping by. I just think anything to help boost your immune system and support any healthy bacteria. Just give it time, and know that your gut bacteria can change in as little as three days so you’ll be fine with consistency.
Hi.
You mentioned underlying causes to be treated to prevent sibo from returning. But what can underlying causes of Sibo be? I thought it WAS the underlying cause. Thanks in advance!
Thanks for sharing such great information I liked natural things @!!
Hi Cindy. I have taken the Rifaximin and Neomycin. It left me not able to eat at night. Better. But my doctor doesn’t seem to want to figure out what is the cause of my methane SIBO. Where should I go in Montana, and what should I ask them to do?
Thank you for all this info! I think my situation is different from most. I was diagnosed with methane dominant SIBO last year. But I don’t have bloat, I have the opposite problem. I have chronic D, for 6 years now. Low FODMAP and atrantil helped in the beginning. But, FC Cidal & Dysbiocide made everything go completely off the tracks. Now everything I eat is poison. What are your thoughts?
Apparently my underlying cause to SIBO was low stomach acid.
Very typical.