From the Guidelines
Treating dysbiosis involves restoring balance to the gut microbiome through several approaches, with the most recent and highest quality study suggesting the use of fecal microbiota-based therapies for select gastrointestinal diseases, as recommended by the AGA clinical practice guideline 1.
Treatment Approaches
- Start with dietary changes by increasing fiber intake from fruits, vegetables, and whole grains while reducing processed foods, sugar, and artificial sweeteners.
- Probiotic supplements containing Lactobacillus and Bifidobacterium strains at doses of 10-50 billion CFU daily can help repopulate beneficial bacteria; specific formulations like VSL#3 or Align may be beneficial for certain conditions, as supported by studies on intestinal microbiota in functional bowel disorders 2, 3.
- Prebiotic foods such as garlic, onions, bananas, and asparagus feed good bacteria.
- In more severe cases, antimicrobial treatments may be necessary, including herbal options like oregano oil (200mg twice daily), berberine (500mg three times daily), or prescription antibiotics like rifaximin (550mg three times daily for 14 days) for small intestinal bacterial overgrowth.
- For severe dysbiosis, fecal microbiota transplantation may be considered under medical supervision, with a clinical response rate of 87% reported in a recent review of 536 patients 4.
Lifestyle Modifications
- Lifestyle modifications including stress management, adequate sleep, and regular exercise also support microbiome health.
- The goal of treatment is to reduce harmful microorganisms while promoting beneficial ones, as a balanced microbiome supports proper digestion, immune function, and even mental health through the gut-brain connection.
Fecal Microbiota Transplantation
- Fecal microbiota transplantation should be given upon completion of a course of standard of care antibiotics for recurrent CDI, with careful consideration before proceeding with fecal microbiota-based therapies in patients who require frequent antibiotics or long-term antibiotic prophylaxis 1.
- Conventional FMT should be performed with appropriately screened donor stool, and special testing may be necessary for immunocompromised patients.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Dysbiosis
- Intestinal microbiota transplantation (IMT) is one optional treatment for inflammatory bowel diseases (IBD), in particular to patients with recurrent Clostridium difficile-induced pseudo-membrane colitis 5
- Modulating a gut microbiota dysbiosis with nutritional concepts may contribute to improving health status, reducing diseases or disease symptoms or supporting already established treatments 6
- Fermented foods can affect the gut microbiome in both the short and long term, and should be considered an important element of the human diet 7
- Probiotics, particularly with Bifidobacterium and Lactobacillus strains, have shown improvement in IBS symptoms 8
- Fecal microbiota transplantation (FMT) is also effective for managing IBS, with no serious adverse events reported 8
Dietary Interventions
- A high-fiber diet can increase microbiome-encoded glycan-degrading carbohydrate active enzymes (CAZymes) despite stable microbial community diversity 9
- A high-fermented-food diet can steadily increase microbiota diversity and decrease inflammatory markers 9
- Plant-based fiber and fermented foods can influence the human microbiome and immune system in healthy adults 9