Helminthic therapy and small intestinal bacterial overgrowth (SIBO)

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    SIBO can be challenging to treat, and it may be best to do whatever one can to get the SIBO under control before starting helminthic therapy.

    One individual began by taking the herbal, Atrantil, in combination with appropriate dietary changes and efforts to boost gut motility using vagus nerve stimulation, before adding hookworms for longer term management of SIBO. His post also contains a number of useful practical tips. [1]

    Here is how another helminth self-treater approached this.

    I had SIBO before using NA (Necator americanus). I used large doses of vitamin c and pancreatic enzymes to combat it before I tried HT. Once I started with NA I kept using the vitamin c and now it’s all gone. [2]

    Some doctors have apparently told their patients that helminths don’t work in someone who has SIBO. However, there is no evidence for this claim, and one doctor has been reported to have found that SIBO is easier to manage using conventional therapies when HDC are being taken at the same time. (Link expired.)

    The fact that helminthic therapy can help SIBO can be seen from the entries for this condition on the following page.

    While helminthic therapy can improve SIBO in the longer term, the gastrointestinal side effects that are possible following the first introduction of hookworms may exacerbate SIBO before eventually improving it, and there has been one case where each new dose of NA taken by a patient with SIBO caused the condition to flare temporarily.

    If someone were to develop SIBO while hosting helminths, the condition can be treated medically before inoculating with more worms.

    I took metronidazole, according to the medical protocol (750mg of metronidazole daily [250mg every 8 hours] for 7 days), and immediately afterwards (re)inoculated myself with NAs. This put an end to SIBO and allowed HT to work in the best possible way. [3] [4]

    Also worth noting

    • Hookworms will not affect the hydrogen breath test for SIBO. [5]
    • Peppermint oil, which provides antimicrobial activity in the small intestine and is sometimes used in the treatment of SIBO, [6] (PDF) may also adversely affect the human helminths, TTO and NA, especially the latter. [7]

    See also

    Herbal therapies are at least as effective as rifaximin for resolution of SIBO by lactulose breath testing (LBT). Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders.
    • Therapeutic "Yogurt" (high CFUs from a 36 hour culture) made with the probiotics, L. Reuteri and L. Gasseri, can be effective against SIBO. [8]