A study reported in 2010 may be relevant to our Undoctored efforts to identify and reverse small intestinal bacterial overgrowth, SIBO.
In this study, people with SIBO (n = 77) were treated with either the antibiotic rifaximin or rifaximin + 5 grams of guar gum (partially hydrolyzed). The rifaximin alone participants had a 62% success rate (i.e., negative H2-breath testing), while rifaxamin + guar had an 87% success rate. While this is only one study with findings that have not been corroborated, the magnitude of difference and the otherwise “clean” prospective protocol make this a persuasive finding.
Ironically, the authors’ rationale for including guar gum in this study was that, as a prebiotic fiber, they believed that it might accelerate transit time that is often slower than normal in people with SIBO (hypomotility). But they overlooked the fact that, while guar is indeed metabolized by microorganisms as a prebiotic, it is also a weak emulsifier and can disperse or disrupt the mucous lining (“biofilm”) of the intestinal tract. This is potentially important, as much bowel flora reside in the mucous lining that may limit exposure of pathogenic (disease-causing) bacteria to antibiotics. Disrupting the mucous lining transiently may make mucous-sequestered bacterial susceptible to antibiotics. While we generally avoid products with emulsifying effects, use during antibiotics for SIBO would be an exception.
Unfortunately, we don’t know whether other compounds with emulsifying properties would yield similar results or whether any fiber, for that matter, might be useful, as the study authors surmised. We also do not know whether hydrolyzed guar is different in its effects from non-hydrolyzed guar; no details on the composition of the hydrolyzed product were provided (e.g., whether specific polysaccharide fragments were present, rather than larger non-hydrolyzed molecules).
Nonetheless, I believe it is worth considering adding guar gum at this small dose (5 grams or about 2 1/2 teaspoons) per day, divided into, say, 3 servings, by adding to various foods to enhance the possibility of successful eradication of SIBO. (I believe it is important to not exceed this dose, as greater quantities of guar have been associated with health complications, including intestinal obstruction.) It is truly a fabulous thickener, so it’s a shame that, at least until we obtain better insights, we avoid it outside of our antibiotic course.
I made a chocolate pudding (above) for a friend to get her 5 grams of guar gum into her regimen, but found that 3 teaspoons in 13.5 ounces of (canned) coconut milk yielded a solid end-result; 1 to 1 1/2 teaspoons yielded something closer to spoonable pudding. I’ve also stirred it into yogurts and kefirs, but add only a little at a time (e.g., 1 teaspoon) and stir it in immediately, else it solidifies into clumps. This is the brand I used, the NOW product:
Of course, should you choose to add guar, use it only during your antibiotic course.