The course of treatment is usually 1 to 6 months. A typical dose of enteric-coated peppermint oil is one to two capsules three times a day, taken in between meals with a glass of water. Side effects can include heartburn, rectal burning, and minty burping.
Other herbal antimicrobials used to treat bacterial overgrowth are:
- Grapefruit seed extract - for people who don’t like taking capsules,
grapefruit seed extract can be found in liquid form. Add a few drops to a
glass of water and drink in between meals.
- Oregano oil capsules
- Garlic
- Berberine - goldenseal, oregon grape
- Olive leaf extract
- Pau d'arco
Diet
A popular diet for bacterial overgrowth is the specific carbohydrate diet by Elaine Gottschall. This diet limits grains, starchy vegetables, and some legumes, and was created to address digestive disorders such as bacterial overgrowth, Crohn's disease, and ulcerative colitis.
Medium Chain Triglycerides - Unlike regular oils, which a person with bacterial overgrowth may not be able to assimilate, medium chain triglycerides are absorbed directly without the need for digestive enzymes. Medium chain triglycerides are often recommended for people with bacterial overgrowth or any type of malabsorption. Coconut oil is a medium chain triglyceride.
Digestive enzymes - Digestive enzyme supplements can support the body's digestive enzymes until function is restored. They should be taken before meals. A typical dose is one capsule before each meal.
Vitamins and minerals that may be deficient in people with bacterial overgrowth include vitamin B12, magnesium, calcium, iron, zinc, copper, vitamin A, D, E, K.
Probiotics - needed to replace healthy bacteria in the intestines. Lactobacillus plantarum and lactobactillus GG are some types that have been used for bacterial overgrowth.
Getting a Diagnosis
The "gold standard" test is to take bacterial cultures of small intestine fluid.Lactulose hydrogen breath test - The most common test is the lactulose hydrogen breath test because it is less invasive. Lactulose is a non-absorbable sugar that's fermented if there is intestinal bacteria, resulting in hydrogen production. If there is bacterial overgrowth, fasting hydrogen levels will be high. In addition, after ingesting glucose, there will be a significant rise in hydrogen.
more about the breath test
Other tests are the schilling test (for b12 deficiency). A small bowel follow through may be done to look for structural problems.
One of the underlying causes of bacterial overgrowth is insufficient stomach acid, called hypochlorhydria. Stomach acid naturally declines with age. Take the hypochlorhydria screening test.
What Conditions Can Bacterial Overgrowth Lead to?
References
Kerlin P, Wong L. Breath hydrogen testing in bacterial overgrowth of the small intestine. Gastroenterology. 1988 Oct;95(4):982-8.Pimentel, Mark, Chow, Evelyn J. & Lin, Henry C. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. American Journal of Gastroenterology 2000, 95 (12), 3503-3506.
Lichtman SN, Keku J, Schwab JH, Sartor RB. Hepatic injury associated with small bowel bacterial overgrowth in rats is prevented by metronidazole and tetracycline. Gastroenterology. 1991 Feb;100(2):513-9.
Shindo K, Machida M, Miyakawa K, Fukumura M. A syndrome of cirrhosis, achlorhydria, small intestinal bacterial overgrowth, and fat malabsorption. Am J Gastroenterol. 1993 Dec;88(12):2084-91.
Teo, Marcus, Chung, Stephen, Chitti, Lauri, Tran, Cuong, Kritas, Stamatiki, Butler, Ross, Cummins, Adrian. Small bowel bacterial overgrowth is a common cause of chronic diarrhea. Journal of Gastroenterology and Hepatology 2004; 19 (8), 904-909.
de Boissieu D, Chaussain M, Badoual J, Raymond J, Dupont C. Small-bowel bacterial overgrowth in children with chronic diarrhea, abdominal pain, or both. J Pediatr. 1996 Feb;128(2):203-7.
Jeffery S. Meyers, MD, Eli D. Ehrenpreis, MD, and Robert M. Craig, MD Small Intestinal Bacterial Overgrowth Syndrome. Current Treatment Options in Gastroenterology 2001, 4:7-14
