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I healed my gut. Then I relapsed. Then I did it again. And again.

Five times. Five rounds of SIBO.

By the time I reached what turned out to be my final round, I had tried more protocols than I can count. And it was right there, near the end, that I finally found Digest Plus.

I did not find out about it until late. But once I did, I took it religiously.

Around that same time, I started hearing the stories. People clearing SIBO with Digest Plus and Clear Plus together, INSTEAD OF reaching for rifaximin. Not as a desperate last resort. As the actual plan.

So I made myself a deal. IF I relapsed a sixth time, I was not starting with the antibiotic. I would go the Elemental Diet plus Digest Plus plus Clear Plus route.

I never had to. But I have watched enough people walk that exact road since then to know it deserves a real, honest guide.

This is that guide.

Herbal Antibiotics for SIBO vs. Rifaximin: Full Guide [Clear Plus and Digest Plus]

Click HERE to save this information for later.

What is in each formula, why every herb is there, what the research actually says about using them for SIBO, and how that compares to rifaximin. I am going to give you the honest version, cautions included, because that is the only version worth reading.

Circle what makes sense for you. Then take it to your practitioner. Work with your doctor on these before you start, especially if you take medication or have a liver, kidney, or autoimmune condition.

But first, what is SIBO?

SIBO stands for small intestinal bacterial overgrowth.

Your small intestine is supposed to be relatively low in bacteria. Most of your microbial population lives further down, in the large intestine. SIBO is what happens when bacteria set up camp in the wrong neighborhood and grow to numbers your small intestine was never built to handle.

The result is a SIBO symptom list you probably know by heart: bloating (often worse as the day goes on), gas, abdominal pain, changes in stool, and that “I look pregnant by dinner” feeling. And no, it’s not a “cute” look. It’s painful and extremely frustrating.

SIBO rarely happens on its own. There is almost always a reason for it: slow motility, low stomach acid, a structural issue, a past infection, or a medication effect. This matters, and I will come back to it, because clearing the overgrowth without addressing the cause is how you end up in the relapse cycle.

Trust me. I lived that loop five times.

SIBO is also common in people with IBS. A systematic review and meta-analysis found SIBO in roughly 38% of people with IBS, much higher than in people without it.¹ That overlap is a big part of why “treat the gut, not just the label” has become such a central idea in this space.

The two formulas, in plain terms

Digest Plus is a broad blend of Eastern and Western herbs chosen for their traditional use in gut and antimicrobial support. This is the one I took religiously in my final round.

Clear Plus is a blend of 7 botanicals. Total botanical content is 500 mg per capsule. At the typical intake of 2 capsules daily, that is 1,000 mg of the combined blend per day. Note: that is 1,000 mg of the whole blend, not 1,000 mg of each herb.

They are built to work as a pair, and that pairing is exactly what was studied in the research I will walk through below.

A quick, important note on how to read the rest of this guide. Both formulas use proprietary blends, which means the exact milligram amount of each individual herb is not disclosed on the label. I am going to be straight about that limitation throughout, because it changes how you should think about dosing and safety. It does not make the formulas useless. It does make practitioner guidance more important, not less.

What is actually in Clear Plus

The botanical blend totals 500 mg per capsule and includes:

• French tarragon (Artemisia dracunculus), leaf
• Indian tinospora (Tinospora cordifolia), stem and root
• Horsetail (Equisetum arvense), whole herb
• Thyme (Thymus vulgaris), leaf
• Pau d’arco (Tabebuia impetiginosa), inner bark
• Stinging nettle extract (Urtica dioica), root
• Olive (Olea europaea), leaf

Other ingredients are gelatin, water, cellulose, and vegetable-source magnesium stearate. The formula is gluten-, dairy-, and GMO-free. It is not recommended during pregnancy or lactation.

Here is the honest breakdown of each herb: why it is in there, what the research supports, and what to watch.

1] French tarragon leaf (Artemisia dracunculus)

Rating: proceed with normal caution

Tarragon is a culinary herb in the Artemisia family. It carries aromatic compounds and polyphenols (estragole, eugenol, limonene, linalool, flavonoids, and more) whose exact profile shifts with the plant, the growing conditions, and how it is extracted.

Why it is here: tarragon extracts have shown antimicrobial and antioxidant activity in lab studies, including against organisms like E. coli, Pseudomonas, Staph aureus, and Enterococcus. That gives it a reasonable role in a microbial-balance formula.

What to know: most of this evidence is from cell, animal, or food-preservation research, not human gut trials. Tarragon also contains estragole, a compound that has raised safety questions at high isolated doses in animal studies. Ordinary culinary-level exposure is considered far lower risk, and the amount in a blend is small, but the label does not specify the estragole content. People with ragweed or Asteraceae-family allergies should be aware.

My read: biologically plausible, clinically underdeveloped. A sensible team player in a broad blend, not a proven standalone SIBO treatment.

2] Indian tinospora (Tinospora cordifolia), stem and root

Rating: the one to discuss with your doctor first

Tinospora (also called guduchi or giloy) has a long history in Ayurvedic medicine and shows immune-modulating, anti-inflammatory, and antimicrobial activity in preclinical studies.

Why it is here: lab work suggests it can influence immune-cell activity and microbial growth.

What to know, and I mean it: tinospora has been linked in published medical case reports to acute liver injury, sometimes with autoimmune features. A 2022 multicenter study from India documented 43 cases of giloy-associated liver injury and concluded it can unmask autoimmune hepatitis in susceptible people.² The NIH LiverTox database likewise notes that while older short-term studies reported minimal issues, more recent reports describe clinically apparent liver injury tied to Tinospora cordifolia.³ This is a real safety signal, not a generic disclaimer.

Because the blend is proprietary, the exact tinospora dose is not disclosed, so the product-specific risk cannot be precisely quantified.

Who should be especially careful and get clinician sign-off first: anyone with autoimmune disease, autoimmune hepatitis, prior herb-induced liver injury, elevated liver enzymes, chronic liver disease, or anyone on multiple medications that affect the liver.

If you ever develop jaundice, dark urine, pale stool, unusual itching, severe fatigue, or right-upper-abdominal pain while taking any botanical, stop and get evaluated.

My read: this is the formula’s clearest caution ingredient. It has useful biology and a genuine liver-safety consideration. That is exactly why this is a guided, time-limited product, not a daily-forever supplement.

3] Horsetail (Equisetum arvense), whole herb

Rating: proceed with normal caution

Horsetail is an ancient plant known for its silica content, plus flavonoids and phenolic acids.

Why it is here: antioxidant and antimicrobial activity in preclinical work.

What to know: horsetail’s best-established human effect is actually mild diuresis (increased urine output). A randomized, double-blind trial found a standardized horsetail extract (900 mg per day) produced a diuretic effect comparable to the prescription diuretic hydrochlorothiazide, without the same electrolyte loss.⁴ Some horsetail preparations can also contain thiaminase, an enzyme that breaks down vitamin B1, though processing often reduces it. Because of the diuretic potential, use caution if you take prescription diuretics or lithium, or if you have kidney issues or electrolyte concerns.

My read: an unusual pick for a gut formula. Real phytochemistry, weaker direct link to intestinal balance. Its role here is likely supportive.

4] Thyme leaf (Thymus vulgaris)

Rating: one of the stronger ingredients

Thyme has one of the clearest antimicrobial rationales in the whole formula. Its oil is rich in thymol and carvacrol, compounds that disrupt microbial cell membranes.

Why it is here: thyme extracts and oils show activity against a wide range of bacteria and fungi in lab studies. For a formula meant to influence microbial balance, thyme earns its spot.

What to know: the strongest studies use concentrated thyme essential oil or isolated thymol and carvacrol. Clear Plus uses thyme leaf, not the essential oil, so do not assume one capsule delivers the same exposure as those oil studies. And antimicrobial in a dish does not automatically mean it selectively removes only the bad bugs. Human research has not mapped exactly what this blend does to microbial diversity.

My read: mechanistically one of the best-justified herbs here. Form and dose still matter.

5] Pau d’arco inner bark (Tabebuia impetiginosa)

Rating: proceed with caution, especially around bleeding

Pau d’arco (lapacho) comes from the inner bark of South American trees. Its known compounds include lapachol and beta-lapachone.

Why it is here: antimicrobial, antifungal, and anti-inflammatory activity in lab and animal research.

What to know: human efficacy evidence is limited. One 8-week safety study in healthy women (ages 18 to 45) found about 1,050 mg per day generally well tolerated, but that study was about safety and menstrual pain, not gut microbes.⁵ Pau d’arco’s lapachol has shown vitamin-K-related anticoagulant activity at some exposures, so it is commonly flagged for caution with blood thinners (warfarin, apixaban, rivaroxaban, clopidogrel, high-dose aspirin), bleeding disorders, or upcoming surgery.

My read: promising lab chemistry, incomplete clinical proof. Respect the bleeding caution.

6] Stinging nettle root extract (Urtica dioica)

Rating: one of the lower-risk herbs here

Nettle is different depending on which part you use. Clear Plus uses the root, which in research is most studied for urinary and prostate mechanisms rather than gut health.

Why it is here: anti-inflammatory, antioxidant, and some antimicrobial activity, with lab hints at effects on bacterial adhesion.

What to know: NIH LiverTox reports nettle extracts are generally well tolerated and have not been convincingly tied to liver injury.⁶ It may have mild effects on blood pressure, blood sugar, or fluid balance, so keep it on your list to mention if you take medication in those categories.

My read: probably one of the gentler botanicals in the blend. Supportive rather than a headliner.

7] Olive leaf (Olea europaea)

Rating: one of the lower-risk herbs here

Olive leaf is rich in polyphenols, especially oleuropein and hydroxytyrosol.

Why it is here: oleuropein and olive-leaf extracts show antibacterial, antifungal, and anti-inflammatory activity in lab models, including against foodborne organisms like E. coli, Listeria, and Salmonella.

What to know: most human olive-leaf trials look at blood pressure, blood sugar, and lipids, not SIBO. Olive leaf may lower blood pressure or blood sugar in some people, so use care if you take medication for either.

My read: a rational, generally favorable ingredient. Standardization would make it easier to evaluate.

The other ingredients in Clear Plus

Gelatin forms the capsule shell (worth knowing: it is animal-derived, so not vegan or vegetarian). Water is used in capsule production. Cellulose is a small-quantity filler and flow aid. Magnesium stearate is a manufacturing lubricant used in tiny amounts; despite a lot of internet fear, there is not persuasive human evidence that these small amounts harm the gut lining. None of these four meaningfully affect your microbiome.

What is actually in Digest Plus

Digest Plus is a proprietary blend that pairs Eastern and Western botanicals. The combination is designed for a broad anti-dysbiotic effect even at modest dosing. Its herbs include:

• Dill (Anethum graveolens), seed
• Stemona (Stemona sessilifolia), root
• Wormwood (Artemisia absinthium), shoot and leaf extract
• Java brucea (Brucea javanica), fruit
• Chinese pulsatilla (Pulsatilla chinensis), rhizome
• Jamaica quassia (Picrasma excelsa), bark extract
• Cutch tree (Acacia catechu), heartwood and bark
• Hedyotis (Hedyotis diffusa), aerial part

I have already written the full breakdown of these ingredients contained in Digest Plus HERE.

Why the two are used together

Digest Plus and Clear Plus are designed as a pair, and that is not a marketing accident. It is how they were studied.

The idea is coverage. One formula leans on wormwood, dill, yarrow, quassia, and a set of Eastern botanicals. The other leans on thyme, olive leaf, pau d’arco, and tarragon. Together they bring a wider range of polyphenols, bitters, terpenes, and quinones to the table than either would alone. In a condition as variable as SIBO, that broader botanical spread is the whole point.

A common approach is 2 capsules of each, twice daily, for about 4 weeks, taken under practitioner guidance. Your practitioner may adjust based on your history, your SIBO type, and how you tolerate it.

The research: herbal therapy versus rifaximin for SIBO

Here is the study everyone in the SIBO world references, and for good reason. It is also the study I heard about right around my final round, the one that made me draw my line in the sand.

In 2014, researchers at Johns Hopkins published a study in Global Advances in Health and Medicine titled, plainly, “Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth.”⁷

Here is what they did. They reviewed patients who tested positive for SIBO by lactulose breath test and were treated either with rifaximin (1,200 mg daily) or with an herbal protocol, for 4 weeks, then retested.

Here is what they found.

Of the patients on herbal therapy, 46% (17 of 37) had a negative follow-up breath test.

Of the patients on rifaximin, 34% (23 of 67) had a negative follow-up breath test.

The herbal arm used a two-formula protocol: the same botanical combination that Digest Plus and Clear Plus are built on (one of two commercial herbal pairs tested in the study). In other words: the exact kind of combination this guide is about was one of the herbal protocols that outperformed the antibiotic on breath-test normalization.

It gets more interesting for the people antibiotics fail. Among rifaximin non-responders who were then offered herbal rescue therapy, 57% (8 of 14) had a negative breath test afterward, which was comparable to the 60% (6 of 10) who responded to a heavy triple-antibiotic regimen (clindamycin, metronidazole, and neomycin).

And on side effects, the contrast was notable. The rifaximin arm logged one case of anaphylaxis, two cases of hives, two of diarrhea, and one case of C. difficile infection. The herbal arm logged one case of diarrhea.⁷

Now the honest part

I want you to trust this guide, so here is exactly what the study can and cannot tell you.

This was a retrospective chart review, not a randomized, placebo-controlled trial. Patients were not randomly assigned. Two different commercial herbal pairs were grouped together in the herbal arm. And the difference between herbal and rifaximin, while it favored the herbs numerically, was not statistically significant.

So the accurate way to say it is this: a real study found that an herbal protocol like this one produced breath-test normalization at least as good as rifaximin, with far fewer serious adverse events. The honest way to say it is that this is promising, practitioner-supported evidence, not proof that Clear Plus alone cures SIBO. Anyone who tells you a botanical blend is clinically proven to cure SIBO is getting ahead of the science.

That distinction is the whole reason I would rather you use these with a practitioner than chase a promise.

How this compares to rifaximin, honestly

Rifaximin (brand name Xifaxan) is the most-studied antibiotic for SIBO, and it has real strengths. It is minimally absorbed, so it stays mostly in the gut, and it has a low risk of driving broad antibiotic resistance. A 2017 systematic review and meta-analysis of 32 studies put its overall SIBO eradication rate around 71%, though results ranged widely from study to study depending on dose and criteria.⁸

Where it gets complicated is what happens after.

Recurrence.

A landmark 2008 study by Lauritano found SIBO came back in 44% of patients within 9 months of successful rifaximin treatment, with recurrence climbing from about 13% at 3 months, to 28% at 6 months, to 44% at 9 months.⁹ This is the relapse cycle so many SIBO patients know firsthand. I know it firsthand. And it points back to the same truth: if you do not address why the overgrowth happened, clearing it is only temporary.

Cost and access.

Rifaximin is expensive and there is no generic in the US yet. A typical course runs well over $2,000 out of pocket without insurance coverage, and insurance often will not cover it for SIBO because that is an off-label use.¹⁰ That is a real barrier for a lot of people. By the way, I wrote ‘Why is Rifaximin So Expensive?‘ back in 2019. You should read that, too.

Side effects.

Rifaximin is generally well tolerated, but as the Hopkins study showed, antibiotic therapy carries risks the herbal route largely did not in that data set, including the possibility of C. difficile.

None of this makes rifaximin the wrong choice. For some people it is exactly right, and for some situations an antibiotic is the appropriate tool. After all, this is the route I went — 5 times. And maybe the fact that it took that long is the precise reason to consider the alternative.

This is a conversation to have with your doctor, not a verdict I am handing down. What the evidence supports is that a well-formulated herbal protocol is a legitimate, research-backed option¹¹ worth putting on the table, whether as a first approach, an alternative when antibiotics are not accessible or tolerated, or a rescue when rifaximin did not get you there.

A word on die-off and detox

If your symptoms flare when you start any antimicrobial, herbal or pharmaceutical, it is tempting to call it die-off and push through.

Please do not automatically do that.

New or worsening symptoms (headache, nausea, diarrhea, abdominal pain, reflux, rash, fatigue, dark urine) can reflect a lot of things: intolerance, direct irritation, an allergy, a medication interaction, too high a dose, dehydration, or in rare cases something that needs medical attention like a liver reaction. Calling every reaction a Herxheimer or detox can delay a real conversation you should be having with your practitioner.

Slow down, do not tough it out, and check in.

Who should get professional guidance first

Talk to your doctor or practitioner before starting Clear Plus or Digest Plus if you:

• Are pregnant or breastfeeding (both formulas advise against use)
• Have liver disease or elevated liver enzymes (especially relevant given the tinospora in Clear Plus)
• Have autoimmune disease or kidney disease
• Take blood thinners or antiplatelet medication
• Take lithium or prescription diuretics
• Take insulin, other glucose-lowering drugs, or blood-pressure medication
• Take multiple medications that affect the liver
• Are preparing for surgery
• Have alarm symptoms like unexplained weight loss, anemia, GI bleeding, persistent vomiting, fever, or nighttime diarrhea
• Are treating presumed SIBO without an actual breath test to confirm it

These formulas are meant for a focused, time-limited plan under guidance. They are not daily-forever supplements.

The bottom line

Clear Plus and Digest Plus are not a random handful of herbs. Several ingredients have credible antimicrobial biology, thyme and olive leaf especially. And a real study at Johns Hopkins found that the botanical combination these formulas are built on normalized SIBO breath tests at least as well as rifaximin, with far fewer serious side effects.

That is a strong, honest starting point.

It is also not a cure-all, and I will not pretend otherwise. The research is one retrospective study plus a lot of preclinical herb data. The proprietary blends mean you cannot see every dose. And a couple of ingredients, tinospora most of all, carry real cautions that make practitioner guidance genuinely important.

Here is how I would hold all of that at once.

Botanicals are pharmacologically active. The more active a formula is, the more its dose, timing, and purpose matter, and the more it deserves to be used with intention instead of hope.

Clear the overgrowth. Address the reason it happened. Support the terrain so it does not come back. That is the whole game, and it is the reason I built these two to work together.

I made myself a promise near the end of my healing: if I relapsed again, this was the road I would take. I never had to walk it. But it is the road I would trust, and it is the one I would want in your hands before you need it.

You have been through enough guessing. This part, at least, you can do with a map.

If you liked this article, you might also enjoy:

1. Master List of SIBO Healing Tools
2. Best Supplements for SIBO
3. How I Healed SIBO Long Term

Xox,
SKH

This guide is for education and is not medical advice. Statements about these products have not been evaluated by the FDA, and these products are not intended to diagnose, treat, cure, or prevent any disease. Always work with a qualified healthcare provider before starting any supplement, especially if you are pregnant, nursing, taking medication, or managing a health condition.

1. https://pubmed.ncbi.nlm.nih.gov/29761234/ ↩︎
2. https://pubmed.ncbi.nlm.nih.gov/35037744/ ↩︎
3. https://www.ncbi.nlm.nih.gov/books/NBK608429/ ↩︎
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC3960516/ ↩︎
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC10032363/ ↩︎
6. https://www.ncbi.nlm.nih.gov/books/NBK547852/ ↩︎
7. https://journals.sagepub.com/doi/10.7453/gahmj.2014.019 ↩︎
8. https://onlinelibrary.wiley.com/doi/10.1111/apt.13928 ↩︎
9. https://pubmed.ncbi.nlm.nih.gov/18802998/ ↩︎
10. https://www.singlecare.com/blog/xifaxan-without-insurance/ ↩︎
11. https://journals.sagepub.com/doi/full/10.1089/acm.2020.0275 ↩︎