Treating Biofilm in the Small Intestine for Long-Term Relief of Small Intestinal Bacterial Overgrowth (SIBO)

by Dr. Susan Tanner, MD

The term “biofilm” has been mentioned in recent times in several different contexts. Understanding what it is and why it may be present has larger implications when we discuss small intestinal bacterial overgrowth (SIBO) and its treatment.

What is Biofilm?

Biofilm has been described, in most basic terms, as the formation of a microscopic layer, or film, that coats and protects bacteria as they nestle in the linings of mucous membranes. These membranes may be in the nose and sinuses, in the mouth and gums, and in the lining of the intestines. It is thought to arise by the specific activity of the bacteria with the protein lining of these surfaces. The bacteria then secrete a slime layer, made of polysaccharides, which acts as a suit of armor to protect the bacteria, thus making them much harder to get to and to eradicate. Further, since many antimicrobial agents act by destroying the cell wall or membrane of the offending organism, the biofilm covering protects from this activity.


A long- known biofilm and one that most people can understand for the purpose of illustration is dental plaque. The hardened areas around the gum line are the direct result of the interaction of mouth bacteria with the mucous membrane or gum lining. I hardened film forms, and as we know, it can take more than simple brushing to remove it. As a matter of fact, most of us know quite well that unpleasant experience of sitting in the dentist’s chair while the hygienist scrapes the plaque from our gum line as a dental cleaning begins. The better job we do of flossing and cleaning our teeth between visits, the less plaque build-up there is to scrape.

The same concept or formation of biofilm can happen in the sinuses, especially with fungal and secondary bacterial infections. The difference being that when biofilm develops in the sinuses, it causes formation of fungal balls and deep infection in the tissues. Many times, fungal balls need to be surgically removed for a patient to fully eradicate the infection and recover.

Biofilms in the Gastrointestinal Tract

For the sake of this discussion, however, we will focus on biofilms of the GI tract, and especially as they influence the efficacy of the treatment of SIBO. The bacteria and yeast that can cause SIBO are all capable of forming biofilm and are in a prime environment to do so. The lower the immune function of the gut lining, the more opportunistic these organisms become, and the more they can proliferate. Thus, for SIBO treatment to be effective long term, it must include continued efforts toward restoration of the immune gut lining as well as pathogen eradication. To get to the pathogens to eradicate them, however, often means that using substances to break down biofilms may well be necessary.

Treating Biofilms in the Stomach

Well-known in the traditional medicine world, is the need to address biofilm formation when it comes to the treatment of the bacteria, helicobacter pylori, which can cause significant problems with gastritis and ulcers. Helicobacter pylori bacteria bore down into the stomach lining, produce biofilm, and require long-term therapy to remove. The use of proton pump inhibitors is thought to help break down the biofilm in these cases, as is the use of bismuth most commonly known to be contained in Pepto Bismol. These agents do help somewhat, but we have found that the natural substance, Mastic Gum, actually works better and can be used for the much longer durations required for complete eradication without side effects.

Treating Biofilms in the Small Intestine

In the small intestine, however, its pH is more alkaline, and its way of absorbing of nutrients is a bit different; therefore, the same modalities do not work so well as the upper GI treatments. A multi-focused approach works best to treat SIBO and biofilm.

Steps to Breaking Through Biofilm to Eradicate SIBO:

  1. As always, “clean air, clean water, and clean food” should come first. This is the baseline approach to healing any GI issues—actually any health issues at all. Think of it this way: If microbes are continually being put into the system, then it is impossible to get ahead of their reproduction. Whether these are being breathed in, consumed in foods or water, or simply being fed by a poor diet, “cleaning” the body just by way of stopping the influx of microbes can help tremendously. Many previous articles specifically deal with each of these, but, in brief, no chlorinated water, no processed or overly-refined sugary foods, and no dirty, moldy air.
  2. Remove the offending organisms with medications and/or supplements. These are specifically recommended based on testing, and may entail antibiotics, antifungals and anti-parasitics.
  3. Break down biofilms. Depending on the organism, the “biofilm buster” may be a specific enzyme that targets the polysaccharide itself. One of my favorites is “InterFase” made by Klaire Labs. (This can be ordered on the Wellevate site.) It is safe and easily tolerated, even among the most sensitive patients. It is usually taken 2 to 3 times daily. Another that I like to use is Biocidin which comes as both a liquid in drops and as a capsule. Biocidin acts to break down biofilm and helps to eradicate the organism. The drop formula is easily titrated up and down to tolerance and age of patient.
  4. Bind the die-off organisms. As biofilm and organisms are broken down, it is beneficial to bind them up and carry them out of the body through the stool. These binders are also helpful in removing toxic byproducts from the liver as they are eliminated.   My particular favorite of these is GI Detox. Two capsules taken once or twice a day, well away from other supplements does an amazing job without causing severe constipation as some other binders can do.
  5. Reestablish the immune lining and microbiome. This helps to bring the immune function of the gut back up, so as not to be as good a host to these pathogens. The prescription product, EnteraGam (formerly a supplement, now prescription is very good, but now costly. Use of Colostrum by Allergy Research Group or Douglas Laboratories is excellent and not as expensive.
  6. Flood the gut with Probiotic/beneficial bacteria. There are so many of these on the market, but I try to find those which are excellent products at great prices. TherBiotic Plus by Klaire Labs is one of these, 2-3 per day to start, then reducing to one daily as things improve. A prescription product, VSL #3 is also quite good, but again, tends to be rather expensive for long term use.

To summarize, treating SIBO doesn’t have to be a lifelong battle that never seems to end. Biofilms should be addressed and eradicated, just as dental plaque can be removed from teeth and gums. As long as the biofilm remains, the bacteria creating the intestinal havoc can hide and remain, only to start causing problems again as soon as antimicrobial treatment has ended. If you work diligently on all of the above steps, you can have long-term success, and an end to GI discomfort and sickness.

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