Vanquishing SIBO With Herbal Medicine

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22 years old. Five feet, zero inches. 77 pounds.

That’s the lowest my scale’s ever read. The first time I saw that number, I was on a Publix scale at the beginning of summer 2020. That night, I hardly finished a single, plain, baked chicken tender with a small, microwaved yam cut open on the side, one of the few meals my stomach could tolerate. I had become a creature of little to no appetite. As each day progressed, any attempts to find physical comfort were disrupted by excruciating stomach pain and bloating. Nausea had me dizzy all day. Each early morning would break and send me up out of bed to be sick all day again.

The weight loss and the symptoms had been gradual, with a strange pain starting at the top of my stomach around the beginning of 2017. I was at my standard petite size of 100 pounds at that time. The nurse at my primary care office waved it off as a minor case of gastritis and prescribed Zantac. After a month on the drug with no improvement, but instead, progression — a new symptom of lower stomach pain had begun — I decided it was time to visit my first gastroenterologist. This was in the middle of 2017.

I never did meet the doctor, except when it was time for my dueling endoscopy and colonoscopy. “Just to see if we can confirm anything,” they explained, after I dropped the bombshell that I did indeed have a father with ulcerative colitis. After the endoscopy and the colonoscopy came back clear, I discovered there was yet another hurdle to clear — a capsule endoscopy. A week later, I was back in that same room, swallowing a little robot pill that would spend the next eight hours photographing my insides. Two weeks later, they told me the only explanation was Crohn’s due to ulcerations they had detected.

“Isn’t there any more testing we should do first?” I questioned.

The nurse insisted there was no need; I did have a family history after all. Their recommendation was steroids, but I wasn’t feeling entirely convinced. So, I sought a second opinion.

When I arrived at the new doctor, the scale was now reading 90 pounds — 10 pounds gone in just under a couple months. “This might not be Crohn’s disease,” the second gastroenterologist said, as she stared down with a scowl at the pill camera’s photography. She complained of poor image quality. So, she ordered new tests — none I’d been given before — and all of which returned clean. My new GI concluded after two months of labs it was simply a case of IBS. “Try and up your calorie intake and take some peppermint capsules.”

With that, she sent me home. A month later the scale was at 84 pounds, with vomiting every morning. Upon reporting it to my GI, she recommended an iron level check. Three weeks passed, and I was back in her office. “Low iron anemia” was the term. “But you’re just borderline. We’ll do another pair of scopes to see if there’s an ulcer.” With that they scheduled me, and I did indeed have ulcers in a more visible spot, albeit small and scattered. “I’m still not convinced it’s Crohn’s based on that,” my GI explained as I shook off the sedation from the procedure. “I have to wonder if it’s SIBO,” she said, stunning me briefly. SIBO. The acronym was foreign to me, and the full name offered no further recognition. Small Intestinal Bacteria Overgrowth.

My SIBO Diagnosis

“Never heard of it,” I admitted.

“Many haven’t,” she nodded, and she was more than correct. Barbara Bolen, PhD, writing on VeryWell Health states that, “SIBO is thought to potentially cause most IBS cases in the United States.” Yet, many doctors aren’t educated enough to recognize SIBO as a condition. One of the most significant shortcomings of SIBO acknowledgment is the difficulty in diagnosing it. The primary method of doing so is to perform a hydrogen breath test (HBT) to measure the gas levels in one’s gut after drinking a sugary, lactose concoction, and collecting various breath samples into a plastic bag over 3-4 hours in a surgical setting. However, these tests only have a 65-70% accuracy.

Luckily, the test diagnosed me with ease. At my follow-up appointment to go over the results, I finally imagined this ordeal ending. According to my GI, SIBO only had one treatment — antibiotics — so I took the prescription. Unfortunately, even a 14-day run did not produce a single symptom change for me.

“Well, you seem less bloated. I’d say it worked,” she insisted in response. “Just try and not think so much about it. Please also be aware this gastroenterology office is closing, so we won’t be having a follow up. You’ll get your records in the mail.” I felt floored by her rapid, apathetic tone, though her morbid disregard for my condition and her insistence to close the case now made sense. She was unwilling to admit that my condition was not ending alongside her employment.

This was towards the middle of 2019, and I was down to 81 pounds. As I began searching for a third GI, Crohn’s was put back on the table, so I had a third coloscopy. I was barely out of sedation once again before being told there was no doubt it was Crohn’s, although the biopsy came back acute, not chronic. All we had were those tiny ulcers and the symptoms as evidence, no pathological presence.

“It’s not a perfect science,” he said when I questioned it, and explained that IBDs can present differently for everyone. He insisted I give up my denial. I had Crohn’s, albeit mild Crohn’s.

After six unsuccessful months on a sour, powdered, prescription medical food drink, and repeated recommendations to “just give it more time,” the scale was reading 79 pounds.

“Let’s start Humira,” my doctor suggested, a biologic for the treatment of Crohn’s. It was at this moment the prospect of SIBO floated back into my mind. The doctor scoffed at the very mention of the acronym.

“If it is SIBO, it’s from the Crohn’s and you were already treated for SIBO.”

“But maybe I still have it…”

“If you still have it,” he cut me off, “it’s from the Crohn’s. If you treat the Crohn’s, you treat the SIBO.”

I refused the Humira, and realizing I was losing this GI’s support, began to research things on my own. I typed “SIBO” into my search bar three days after I watched the Publix scale read 77 pounds. I canceled my follow-ups and read as much as I could about the condition that I was growing more and more confident had plagued me these past several years.

According to the Mayo Clinic, “SIBO occurs when there is an abnormal increase in the overall bacterial population of the small intestine.” It can have a variety of causes, from heavy aspirin and antibiotic use to structural abnormalities and poor motility in cells. Sometimes, it occurs without clear reason at all. The symptoms include bloating, weight loss, nausea, and vomiting. The National University of Natural Medicine adds that SIBO also leads to iron deficiencies.

The Crohn’s and Colitis Foundation claims that infectious and bacterial conditions of the small intestine can mimic Crohn’s flares in individuals with inactive Crohn’s disease, as well as mimic the symptoms of Crohn’s in those who do not have Crohn’s at all. When it comes to treatment, antibiotic therapy is considered the gold standard, lasting from two to six weeks. However, it is also acknowledged that most SIBO patients should expect a relapse within nine months, which means another two to six weeks of antibiotic therapy.

Armed with this information, I returned to my GI and politely demanded another round of antibiotic treatment. I was on the medication for six weeks total, and they were the most miserable weeks of my life. Most SIBO patients are not aware of a challenging symptom called a die-off period, as your body kills off both harmful and good bacteria from your gut. By the time my six hellish weeks were up, my vomiting had stopped, and my bloating had gone down to nearly nothing. I was finally cured! For three weeks.

My SIBO soon returned with ruthless vengeance. I was gaining no weight. I struggled to focus on school or even on tasks I enjoyed. Some days began to feel as if they’d be better off not being lived at all if this was all there was. My GI still pushed treatment with Humira, though we still had no definitive diagnosis of Crohn’s. I continued to refuse and went back to my research, where I discovered online blogs and Reddit threads of people claiming to be in the same hell. Massacred by the side effects of repeated antibiotic therapy, some finally had given up and said they were simply resigned to live with their SIBO.

SIBO Rescue Herbal Therapy

But then, I found it. It was a National Center for Biotechnology Information study in partnership with the U.S. National Library of Medicine National Institutes of Health. “Herbal Therapy is Equivalent to Rifaximin (Xifaxan) for the Treatment of Small Intestinal Bacteria Overgrowth.” I watched the title for the longest time as if I expected it to change. My eyes felt like they would pop clean out as I read the results of the tiny study of 104 patients that showed that “herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for Rifaximin non-responders.”

The next day I started searching for an herbalist I could talk to. I was rapidly growing discouraged until a small one-doctor practice appeared on my Google page, located 15 minutes away. I called nervously. A week later, I was sitting in a small, quiet room that smelled of lavender and a hint of rose, painted with green pastel walls. Across from me on the other side of the desk the doctor sat, blonde hair in a tight tail, the shape of her eyes indicating a soft smile beneath her mask.

“So, tell me about what’s been going on,” she invited, and did I ever. I poured the last few years of symptoms, doctors, antibiotics, and even the nagging Crohn’s label over her desktop in a wave. I told her I wasn’t sure how much longer I could go on this way. “I’m spent,” I said.

“Understandably,” she replied. “But I believe I can help you.” So, with hesitant hope, I watched as she began to lay out the plan. Herbal therapy uses a tea of ground thyme, oregano, allicin, and berberine made consumed multiple times a day for several months. There was only one catch: the program was going to cost $1200, and was not insurance reimbursable.

Herbal therapy uses a tea of ground thyme, oregano, allicin, and berberine made consumed multiple times a day for several months. According to the NIH, “herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for Rifaximin non-responders.”

This number initially overwhelmed me as I questioned how I could manage such a cost. But then I began to measure the difference in cost between the Western diagnostic medicine I had already undergone and this herbal treatment. According to MDsave, the average cost of a colonoscopy without insurance is $2,611, and I’d already had three, not to mention all other tests, office visits and prescriptions. My insurance premiums run $270 monthly, not including out-of-pocket co-pays, which for some people can run into the thousands. The cost of herbalism is worlds beneath what Western healthcare demands. I committed to coming up with the fee.

For the first six weeks, I wondered if I’d just flushed my savings away for what amounted to some excellent quality tea. Finally, I noticed results starting to occur! With each passing week, my symptoms diminished bit by bit. My calorie intake rose to between 1800-2000 a day by the end of month four. At this point, I decreased my herb consumption from three times a day to just once to prevent that all too familiar element of SIBO — the high risk of relapse.

23 years old. Five feet, zero inches. 87 pounds.

That’s what the scale read at my annual wellness exam with my primary care provider at the end of 2021. Ten pounds gained since my worst moment. I found a fourth gastroenterologist, one who acknowledges that I don’t have Crohn’s. In fact, even with my family history, I only have an 8% additional chance of developing inflammatory bowel disease (IBD), a number not that significant, and yet a label that was used against me to gain proper and compassionate treatment. I wondered why there was such determination to label me with a disease I did not have, and to prescribe pharmaceuticals without enough evidence to confidently make a Crohn’s diagnosis.

As I began to search for answers to this question, what I found was shocking. In 2018, The Chicago Tribune reported on a California lawsuit filed against the makers of Humira, claiming the company had paid for doctors’ meals, drinks, and travel just to prescribe their drug — the same one my 3^rd gastroenterologist had pushed so aggressively. Further, nurses claimed they were encouraged to do door-to-door visits peddling this pharmaceutical, and downplaying the chances of deadly infections and cancers that can come from its long-term use, sometimes not disclosing these risks at all. Bottom line, these doctors made money when they prescribed the drug to their patients.

I’m grateful for the second chance that herbalism gave me. It is a true injustice that more sufferers from SIBO are not educated on this option, and are simply given repeated antibiotic treatment with no long-term improvement. It is an even greater injustice that in our society of Western medicine, treatments such as herbalism aren’t even considered an option by mainstream healthcare. If they were, more people could be aware of these treatments as safe and effective.

SIBO is a monster that ravages the body and refuses to let go without intervention. More disturbing, it is a prevalent condition, and yet a thoroughly neglected one in the medical community. But now I know there are options and solutions. I’m thankful I took charge of finding help for myself. Now, all there is left to do is continue to heal.

Rosalind E. Rohrbaugh is an undergraduate student at the University of Central Florida currently pursuing a B.A in English Creative Writing and a minor in Writing and Rhetoric. She adores reading scary stories, taking her chihuahua on stroller rides, and watching horror movies.