The herbal pharmacopeia lists many substances with natural anti- biotic activity and the potential for herbal treatment of gut dysbiosis is virtually unlimited. A tannin-rich mixture of herbal concentrates including extracts of gentiana, sanguinaria and hydrastis has been marketed under various names. In vitro studies at Great Smokies Di- agnostic Laboratory have found this mixture to exert more potent ac- tivity against enterobacteriaceae and Staphylococcus than any of the common antibiotic drugs tested; its major side effect is nausea pro- duced by the high tannin content.

Summary and Conclusions
Altered microbial ecology in the gut may produce disease and dys- function because of the intense metabolic activity and antigenicity of the bacterial flora. Bacterial enzymes can degrade pancreatic en- zymes, damage the intestinal brush border, deconjugate and reduce bile acids and alter the intestinal milieu in numerous ways, some of which can be easily measured in a properly collected sample of stool. Bacterial antigens may elicit dysfunctional immune responses which contribute to autoimmune diseases of the bowel and of connective tissue. Effective treatment of dysbiosis with diet, antimicrobial sub- stances and biotherapies must distinguish among patterns of dys- biosis. The failure of common approaches utilizing fiber and Lacto- bacilli is a strong indication of small bowel bacterial overgrowth, a challenging disorder which demands a radically different approach.

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