Gut treatments, graded by evidence
Most gut-treatment writing online sits at one of two extremes: clinical caution that says nothing actionable, or confident protocols with no evidence behind them. These guides aim for the middle - specific and practical where the evidence allows, explicit about what is licensed, what is off-label, and what is still only a laboratory finding.
Before you read on: several treatments below are used off-label in the UK - meaning they are not licensed for that purpose. Off-label prescribing is legal and sometimes appropriate, but it shifts responsibility onto the prescriber and should always be supervised. Nothing here is a recommendation to self-treat.
Treatment guides
Rifaximin in the UK
The gut-selective antibiotic most associated with SIBO and IBS-D. Licensing, off-label use, NHS vs private access, realistic costs and safety.
Read the guide Treatment guideNystatin for gut candida
A non-absorbed antifungal that acts only in the gut lumen. UK dosing, off-label SIFO protocols, die-off vs allergy, and interactions.
Read the guide Research noteOligoG + nystatin biofilms
A 2023 lab study on potentiating nystatin against candida biofilms - what the “32-fold” headline really means, and why it is not yet a treatment.
Read the noteCovered within the condition pillars
Some treatments are best understood in the context of the condition they target, so they live inside the pillar guides rather than as standalone pages:
- Herbal antimicrobials (berberine, oregano, allicin, neem) - one study found them comparable to rifaximin for SIBO; see the SIBO guide.
- Elemental diet - a 2-3 week liquid approach that “starves” overgrowth; covered in the SIBO guide.
- Prokinetics (prucalopride, low-dose erythromycin, low-dose naltrexone) for relapse prevention - see protocols and the SIBO guide.
- Antifungal alternatives (fluconazole, herbal antifungals) - see the candida guide.
How to read the evidence tags: across these guides, claims are graded - strong (regulatory sources or randomised trials), moderate (smaller or observational studies), weak (single small studies or expert opinion) and mechanistic / in-vitro (laboratory plausibility only). The grade matters as much as the claim.
Considering an off-label treatment and want it done properly?
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