How can you permanently eliminate an abnormal colonization of the small intestine without medication – and strengthen the microbiome in the long term?

Norman Reffke
Jul 22
4 min read

Introduction

Imagine eating a healthy meal – and still experiencing bloating, a feeling of fullness, or even nausea. Not because you ate too much. But because bacteria are living in your small intestine that don't belong there. This condition, known as small intestinal bacterial overgrowth (SIBO), affects millions of people – often undiagnosed. The good news? It can be managed without medication – with natural remedies, a healthy diet, and a targeted daily routine.

In this article you will learn:

which symptoms indicate SIBO,
why medication is not always necessary,
and how you can strengthen and stabilize your microbiome through simple routines.

What is SIBO? (Definition and Causes)
Biochemical mechanisms: MMC, gastric acid, mucosa
Symptoms: Subclinical and typical symptoms
Natural treatment without medication
Prevention through nutrition, rhythms and coaching integration
Supplements for SIBO: Effects and Dosage
Study situation and current research
Conclusion
Sources

What is SIBO?

SIBO stands for "Small Intestinal Bacterial Overgrowth" – an overgrowth of bacteria in the small intestine that shouldn't be present there, or only in small numbers. Instead of doing their work in the large intestine, they mistakenly migrate upwards and ferment carbohydrates – which can lead to gas, bloating, and nutrient deficiencies.

Main causes:

Lack of stomach acid (often caused by stress or PPI medication)
Slowed small intestinal motility (impaired migrating motor complex)
Operations, diabetes or chronic intestinal diseases

Biochemical mechanisms behind SIBO

Stomach acid as a natural barrier

Too little stomach acid means that germs from food are not killed off and enter the small intestine alive. This promotes bacterial overgrowth.

The Migrating Motor Complex (MMC)

This cleansing program of the small intestine only works when fasting – approximately every 90–120 minutes. It transports indigestible residues and microorganisms toward the large intestine. If this rhythm is interrupted, for example, by constant snacking, stress, or lack of sleep, it becomes stagnant – and bacteria can multiply.

Biofilm and mucosal barrier

Many bacteria organize themselves into so-called biofilms – protective mucous structures that shield them from the immune system and active substances. A weakened intestinal mucosa also promotes inflammation and permeability (leaky gut).

Symptoms: This is how SIBO manifests itself (also subclinical)

SIBO isn't always obvious. Many people live with symptoms without knowing the true cause.

Typical signs:

Bloated stomach after eating (especially after carbohydrates)
Irritable bowel symptoms (diarrhea, constipation, or both alternating)
Feeling of fullness, heartburn, loss of appetite
Fatigue, brain fog, mood swings
Skin problems (acne, rosacea, eczema)
Nutrient deficiencies (especially B12, iron, zinc)

Diagnosis:

Breath test (hydrogen & methane measurement after lactulose or glucose administration)
Indirectly through symptoms and exclusion of other causes

Natural treatment without medication

1. Meal breaks & daily rhythm

No snacks between main meals → at least 4–5 hours apart
Fasting window of 12–14 hours overnight
No late meals → relief of the MMC

2. Natural antimicrobial plant substances

Oregano oil (Carvacrol) : inhibits pathogenic germs, destroys biofilms
Berberine : antibacterial, anti-inflammatory, modulates intestinal flora
Allicin (garlic extract) : particularly effective in methane SIBO
Neem, cinnamon, thyme oil : also highly antimicrobial

Dosage only with accompanying instructions – e.g. in a coaching context.

3. Biofilm management

N-acetylcysteine (NAC) for the dissolution of biofilm structures
Serrapeptase, InterFase Plus (enzymes)

4. Structure & mucosal regeneration

L-glutamine, butyrate, omega-3 fatty acids
Fermented foods (sauerkraut, kimchi, yogurt – if tolerated)

Prevention through nutrition, rhythms and coaching integration

Important pillars:

Bitter substances before eating to activate stomach acid
Low-sugar, plant-rich diet with prebiotics (e.g. psyllium, green banana)
Stress reduction & exercise to activate the MMC
Cycle-appropriate adaptation in women : Hormonal fluctuations influence intestinal motility

Coaching integration in the VMC program

Reset phase: fasting window, bitter substances, antimicrobial cuisine (oregano, cinnamon, turmeric) Cell building: mucous membrane care with L-glutamine, butyrate, omega-3 Stabilization: probiotic-rich diet + targeted plant diversity

Supplements for SIBO: Effects and Dosage

Active ingredient	Effect	Dosage recommendation
Berberine	antibacterial, anti-inflammatory	500 mg 3 times a day
Oregano oil (carvacrol)	antimicrobial, biofilm-dissolving	150 mg 2–3 times a day
Allicin	Methane-inhibiting, antioxidant	450–500 mg/day
N-acetylcysteine (NAC)	Biofilm-dissolving, antioxidant	600 mg 1–2 times a day
L-Glutamine	Mucosal regeneration	5–10 g/day
Butyrate (tributyrin)	anti-inflammatory, epigenetic effect	500–1,000 mg/day
Saccharomyces boulardii	Immunomodulator, protection against relapse	5–10 billion CFU/day

Study situation and current research

Pimentel et al. (2020): Rifaximin effective in H2-SIBO, allicin in methane-SIBO
Ghoshal et al. (2019): Importance of MMC for the prevention of colonization
Scarpellini et al. (2016): Phytotherapeutics as effective as antibiotics in SIBO
Rezaie et al. (2021): Biofilm management as a key strategy
EFSA database: Studies on L-glutamine, omega-3 and butyrate in mucosal care

Conclusion

An imbalance in the small intestine isn't just a problem with irritable bowel syndrome—it can also affect the entire body. The good news: With conscious eating habits, bitter substances, herbal antimicrobial therapy, and targeted coaching, SIBO can be permanently improved even without medication . Prevention is key—and a strengthened microbiome is your best friend.

Sources

Pimentel, M. et al. (2020). Rifaximin Therapy for SIBO. Gastroenterology Today . https://pubmed.ncbi.nlm.nih.gov/31623399/
Ghoshal, U. et al. (2019). Role of MMC in gut health. Indian J Gastroenterol . https://pubmed.ncbi.nlm.nih.gov/30868218/
Scarpellini, E. et al. (2016). Herbal vs. antibiotic therapy in SIBO. World J Gastroenterol. https://www.wjgnet.com/1007-9327/full/v22/i6/1061.htm
Rezaie, A. et al. (2021). Biofilm Disruption Strategies. Good microbes . https://www.tandfonline.com/doi/full/10.1080/19490976.2020.1857430
EFSA Journal. (2021). L-Glutamine and gut health. https://www.efsa.europa.eu/
ClinicalTrials.gov . NCT04075636. Evaluation of Berberine in Functional GI Disorders
NIH Office of Dietary Supplements. Butyrate Overview. https://ods.od.nih.gov/
Mayo Clinic. Small Intestinal Bacterial Overgrowth (SIBO). https://www.mayoclinic.org/
Center for Health. Natural substances against intestinal dysbiosis. https://www.zentrum-der-gesundheit.de/