# A New IBS Solution, Marc Pimental - does it work?



## idkwia (Feb 26, 2009)

I have read "A New IBS Solution" by Marc Pimental. For a layperson it seems a compelling argument. However I have also seen on other websites that certain people in the medical profession doubt Piemental's work. So I would like to ask if anyone on this site has tried Pimental's solution, or know of anyone who has tried it, and whether they have had any long lasting success with it?I am not interested in people's opinion or assumptions so please be kind enough not to post them here. I am only interested in hearing from people who know by first or perhaps second hand experience whether this solution works please.


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## Kathleen M. (Nov 16, 1999)

There has been a lot of discussion of this over the years..http://www.ibsgroup.org/forums/index.php?showforum=42 is one forum that focuses some of the discussion.Basically, it is hit and miss, like every other IBS treatment. Personally I had my IBS well controlled before this came out, so I didn't do it. I have read most of the threads of the people who have tried it here, so I'm basing the following on that accumulated reading.I would recommend getting breath tested rather than just hope maybe you have SIBO as if it doesn't work and you were not tested you really don't know if you never had SIBO or you might need another antibiotic. I haven't kept track of numbers, but it seems that it works for a higher percentage of those that are tested and know they have SIBO than those that just hope maybe their IBS is SIBO and got a doctor to give them antibiotics just to see if it helps or not.Many here find it is a temporary treatment and the bacteria just come back so they need repeated doses of antibiotics, but that is pretty much to be expected. I'm not sure they really know the best way to prevent relapse, or at least not based on what most doctors are doing with these patients.


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## Jeffrey Roberts (Apr 15, 1987)

I wrote this review when the book first came out. There was more discussion of the book itself in the Books forum.


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## laura29 (Apr 1, 2009)

I'm a patient of his for over 10 years ...was one of the earlier people to try Vivonex T.E.N. at his suggestion (book definitely wasn't out yet). Yes, the stuff tastes terrible even with the flavor packets added. Yes it requires some serious self control to stick with it. But I found my energy levels to be great on it and *properly balanced* you can maintain weight and daily activities just fine (I even went snowboarding some days on the stuff). For me, it was the only thing that worked. Now granted several years later I found myself needing to do it again. I would say that about once every 4-7 years depending it could be necessary to redo treatment. Having said that, it's the only thing I consider at this point. I don't need the stress of any more daily medicines or trials that just don't work. So I stick with what I've found does. I still have to be careful with certain foods but for the most part, it makes a world of a difference for many years. If you've never at least tried it I would suggest people consider discussing with your own doctors trying it properly. Best of luck to all.


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## idkwia (Feb 26, 2009)

Laura, thanks for your reply. May I ask if you tested postive for SIBO? Did you take rifaximin antibiotic? I have been tested for SIBO but it was negative. I was sort of hoping that I would be positive so that I could try Pimentel's protocol. I am wondering what he does with patients who do not have SIBO because his book doesn't mention it?


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## idkwia (Feb 26, 2009)

Jeffrey or any other moderator, can this thread be put into General Discussion please or somewhere where more people can see it. I would like to hear from other people who have seen Dr Pimentel and what he suggests when people test negative for SIBO as in my case.


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## mmar (Jun 8, 2009)

I'm new to posting here but thought it was a good time. I am 20 years old and have been seeing Dr. Pimentel since December '08 with IBS-C. I breath tested tested positive and did the protocol, a combination of Rifaximin and neomycin for 10 days. That was followed with a maintainance of of either a low dose Erythromycin or Zelnorm, both stimulating the wave in the intestines. I opted for the low dose Erythromycin since Zelnorm is much more difficult to get given it's been off the market in the US. I have to say, The last 6 months have been the happiest of my life, absolutely NO symptoms. Unfortunately it's back. Dr. pimentel did say that most patients have it return on average 6 months with the the erythromycin and I think 12 months with the zelnorm. I suspect on my next visit I will do another course of Antibiotics and then I will most likely try to get the zelnorm and see if I have longer success. I have the utmost confidence in Dr. Pimentel and will continue down his path in addition to diet modification and everything else that goes with IBS. My hope is that his research will turn something up that is longer lasting. I am curious what he does with people who don't test positive and perhaps I will ask on my next visit and post what I find out


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## Kathleen M. (Nov 16, 1999)

Thread moved as requested.


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## IanRamsay (Nov 23, 2008)

hi mateI have tried all sorts of things over the last 20 years, diets, treatment plans, excersice plans, drugs etc etc until i finally found my messiah. if this guys system works for you, thats great. try it, you have nothing to loose. i tried all of his regiems and treatment protocols and they diddnt work for me. im not a great fan because they only tackle the symptoms and a small part of the problem, instead of the root cause and prolonged recovery of an indefinate nature. the drugs will eventually not work because the bacteria will become resistant to them as we are seeing all over the world for all kinds of illness. BUTIf it floats your boat mate, jump in and row.CheersIan


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## idkwia (Feb 26, 2009)

*Mmar* - thanks for the response. Hope it works out for you. Ian is right, it seems that the SIBO always comes back. However maybe you know differently...........for example, has Pimentel told you if he has actaually eradicated SIBO completely of for very long periods? Or have you heard or spoke to others who have reported complete or long term eradication.Yes, as for me I do not have SIBO. Having said that I will at some stage get re-tested if my current regime doesn't work out as I know that breath tests are not 100% accurate. In the meantime I would be very grateful if you could ask Pimentel what he does when the SIBO test is negative because as I said earlier his book doesn't mention this. Thanks and the best of luck.


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## mmar (Jun 8, 2009)

Hi,No Dr. Pimentel is very clear that the likely hood that bacteria will come back is high. The short version of why is because the bacteria releases a toxin that destroys the nerve endings in the intestines that signal the intestine to "wave" thus cleansing the intestines. If the intestines are not doing their natural "wave " then the bacteria accumulates again. He has found the the nerve endings almost never grow back although he has seen some cases. Therefore one would not be "cured" on his protocol but you can have long periods of relief if the intestine is "stimulated" as with Zelnorm or the erythomycin. The problem with IBS-c is that the intestine doesn't do it's natural cleansing wave, which I guess means a part of your natural body cleansing is not working properly and who knows what the long term implications are. The bottom line is that if there was a natural/safe source for stimulating the intestine on a regular basis that would be the solution. You would still need to get rid of the bacteria. If you don't have sibo then I don't know what the issue is but I will definitely ask and post on my next visit. By the way, I am only 19 so I would prefer NOT to be on a rotating course of antibiotics for the rest of my life.


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## DAD (Jun 12, 2009)

My wife, age 54, is on the anti-biotic procedure now after the preliminary Breath test reading came in at 88 whereas 40 is considered more normal and then the rest of the test showed positive too. She is now taking a 10-day regimen of Xifaxan 200 mg tabs & Neomycin 500 mg tabs together to try to eliminate future reoccurence. Her gastro doctor just attended a seminar for this very subject and he was told to prescribe the above anti-biotics together for better results so we'll see how it goes.For the first 4 days in the mornings she has gotten quite sick (nauseous) for an hour or two upon taking the medications, but is now improving each morning and each day since then. Her energy level has now returned today and her brain fog is gone the 5th day of the medications.She has had normal IBS conditions or food allergies for years, but started developing a more severe form of this last year after receiving a dose of food poisoning from eating at a buffet one day and it's been slowly downhill ever since. All the doctor prescribed tests previously were negative and even the heidascan showed 96% gall bladder function so we had to look for the intestional bacteria overflow. Her pains eminated in the right lower rib cage and then slowly spread to the left and all over and even into her back.We expect further improvement at this time and are glad to participate in this part of the forum and are elated it is here. Anyone having questions can reply to us on this site and we'll monitor it for awhile.DAD


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## starwoman (Jul 15, 2007)

Hi Ian,Care to tellus what did work for you?We would all love to know,Cheers,starwoman


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## IanRamsay (Nov 23, 2008)

strain specific probiotics from the bifidus family, to begin with in staggering doses.cheersIan


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## DAD (Jun 12, 2009)

Ian -We know people who know of a specific friend who was sick for years with this, couldn't find any answers, and did the breath test with positive results followed up with the anti-biotics procedure, and has been fine for years afterwards (as far as we have heard).Now whether this person did anything else afterwards, we don't know, but will be finding out soon.This procedure works for some and obviously fiddles out on others . . . all determined by your lifestyle, health, body system, stress levels, actual causes of your IBS, etc, BUT I sure wouldn't ignore it as a possible solution for many. Some are so bad with IBS problems, they up and lose hope and know not where to turn.DAD


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## DAD (Jun 12, 2009)

Our friend's friend referred to in the above reply did have to take 2 doses of the Xifaxan and Neomycin we have found out, but they did work for him and he has been greatly improved for several years. He has suspected that he may also have to take a periodic additional dose of the above anti-biotics every so many years to keep feeling his best . . . now whether this is still from his same original cause or whether from new sources or causes, we don't know that answer.It is stated that the above two anti-tiotics respectively are 99.6% and 95% NOT absorbed by the bloodstream and into the body. They therefore go directly into the small intestines where they stay and do most of their work so they are made to target this area. One can then maybe expect to be able to use them several times for this condition without body absorption to any noticeable extent. One might wonder, however, if the problem-causing intestional bacteria might mutate into a resistant strain to these drugs if exposed too many times to them? Also it is said that women should NOT have to deal with increased yeast infections when taking these 2 anti-biotics for a positive reading breath test. Read the book for all the information available.There is also yet another answer or method in the actual book as to riddance of this problem-causing bacteria overflow if the anti-biotics won't work for a particular person and this person still continues to show positive continual results on the breath test again.ALSO TO IAN . . . In referring to your above post . . . am wondering if you need to take staggering amounts of the probiotic you mention because most of it doesn't get thru your stomach alive. I am aware that certain probiotic delivery systems don't work as well as others and the probiotics have to make it thru the digestive part of the stomach acid (where many die) before they can get safely into the intestines or colon where they are needed most. Just a thought . . .DAD


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## IanRamsay (Nov 23, 2008)

HiThe only way to tackle a problem like SIBO and IBS is to throw everything at it untill you find something that works for you. pimentels work does have good results for alot of the people that settle on it. but if it dosent work, try something else. cheersIan


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## Kathleen M. (Nov 16, 1999)

All probiotics tend to have billions of bacteria.Even if you kill 99% that still is quite a bit getting to the end and it isn't that they just live there an never divide. Once they get into a food source whatever lives will start growing and reproducing at a good clip.I've never had to take hundreds or thousands of billions to get a result. One a day of the normal dose (like a billion or two) of these things seems to be more than enough.Remember they are evolved to live in colons at least part of the time so even if the acid kills off some of them they have always (even at doses people used to only get from food or from other people and the environment) made it through the GI tract and found a home. It isn't like they are bacteria that never lived in those conditions naturally that we are forcing to do something they never did.Any of the brands with clinical data usually has a paper somewhere that has the data that they tested the stools of people taking them and found that they could find live ones in the stool to demonstrate enough did get through the stomach to seed the colon.Now you do seem to need to reseed once you get a good population going in there every so often as the effective population will fade over time, but I've never gone back to the large amount of farting I used to do once I found brands that will live in me.I take them for a few days whenever my fart frequency goes up but I really don't have to take a whole bottles worth every day to get any effect at all.


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## IanRamsay (Nov 23, 2008)

Hi"Reseeding" (thats a great way of saying it! i never thought of that) is a good point. sooner or later (and every single person will have a different threashold of time barriers) more will have to be added as teh GI tract is a very hostile place, even for bacteria to live. most bacteria will have a hit rate (as in getting through the stomach) of about 55 - 85% generally, if they are taken at the right time not too soon before or after food. if they are taken with food, they have to hang around in teh stomach for longer and the hit rate is greatly reduced but a good amount will still make it to the target area. Stomach acid dosent have the same effect on probiotic bacteria that it has with other types of bacteria. teh exact reasons for this are as yet not entirely clear (What im trying to say is we havent got a clue). I need to clafiy something here, alot of the time when i took absolutely daft amounts of bacteria, i was doing it to see what happened, and in a way i was using myself as a guinea pig, which I WOULD ABSOLUTELY NOT RECCOMEND TO ANYONE. you cant OD on probiotics and it is extremely hard to hurt your self with them (at worst you will have a very uncomfortable few days) but a normal dose of 2 - 10 billion will do the job if probiotics is what you need. you DONT HAVE TO TAKE STAGGERING AMOUNTS. in fact its quite teh opposite, start off small and work your way up slowly. how the probiotics are taken, and how they are packaged can have an effect on how effective they are but thats a whole different story...............cheersIan


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## Kathleen M. (Nov 16, 1999)

Partly because they can dry them easily and put them in a pill, and they have to get through a pretty hostile environment to get from colon to colon I always assumed they had some sort of spore/dormant form.Remember a lot of them were initially isolated from humans that were not taking some insane amount of bacteria. Usually they look in people who are healthy to get species and strains to develop.A lot of bacteria have a resting state where they are metabolically shut down and may have changes to the cell wall so they can hang out waiting for good growth conditions.I've had a bacterial contaminate that has spores that could survive being autoclaved dunked in ethyl alcohol and the alcohol being flamed off the spreader. It was a persistent bugger.Given that all humans (and every other animal) starts out with no bacteria inside and pretty quickly has a fully colonized colon I would say lots of species of bacteria have figured out how to have a protected state where at least some get through the stomach. Some of them can't really survive out in the world with all the oxygen and have to wrap up in a way to survive at least a couple of different hostile conditions.Anyone who has tried a few brands that have helped others and isn't seeing benefit from whatever the dose on the package says may have to move on to other treatments. There isn't one single modality that will help all of us. And like most things if any is good it is usually some. More isn't always better and there really isn't any point downing a week or month's worth at a time if the daily dose isn't working for you.What works for one person doesn't work for another. You don't have to force a treatment that doesn't work for you to work by taking some insane amount of it, or assume that if something isn't working for you it cannot ever work for anyone and anyone that claims it worked for them is lying or crazy or something else bad. It is just different things work for different people and most everything ever claimed to be a treatment for IBS does work for some people. There are a few things that are just totally insane but there is some clinical data that says for some people some strains of bacteria do actually work. But there is no way to guarantee it will work for any given individual.


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## DAD (Jun 12, 2009)

FOLLOW--UP FROM PREVIOUS POSTS REGARDING iNTESTIONAL BACTERIA OVERFLOW POSITIVE TEST RESULTS:After a positive reading on the bacteria overflow "breath test" and 10 days on the anti-biotic remedy, it has now been about 2 weeks AFTER the anti-biotic regimen . . . and I'm happy to report that my wife, Jeri (age 54 and 5' 3") has been doing much much better and is almost like a new woman at this time from what she was . . . has about her normal energy back, no more brain-fog and isback to doing normal activities again.She has now lost about an inch around her abdoman too and the size 6 slacks that were too tight for her before are now bagging around the abdoman-waist area so that area has decreased and stayed that way on most days now.Adding to her allergy-restricted diet, she is now taking Source Naturals Women's Life Force Multiple Vitamin (No Iron) 2 to 3 tabs per day AND also has added Heather's Organic Acacia Fiber to some meals . . . all with good results so far so this has helped her recovery too, she feels. Also introducing probiotics back into her system, she decided to do it with the Xocai Xobiotic healthy chocolate product a day or two after she was off the anti-biotics. You can read about this healthy chocolate probiotic product earlier in these posts on this thread.Until something changes or tells us otherwise, we've been very happy with the recommended procedure for Intestional Bacteria Overflow and the above for her previous serious IBS conditions along with possible food poisoning that had taken all her energy away and plagued her with rib-cage and horrible abdominal pain.In2day


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## IanRamsay (Nov 23, 2008)

just keep an eye on it as SIBO tends to come back after several months (4-9) in eneral.cheersIan


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## DAD (Jun 12, 2009)

The above post FOLLOW-UP signed In2day is same as DAD . . .Also to IAN . . . thanks again for your reminder that SIBO tends to repeat itself in 4 to 9 month cycles . . . we are aware of that and have briefly discussed this in previous posts. Will be watching for that tendency, but are also using other nutritional products to try to help that trend NOT happen if she is in that line-up for repeats . . . never know that yet at this time or if it's repeated by lack of proper intestional wave action.?One of the reasons for using the 2 antibiotics together was to help prevent repetitiveness of SIBO, but we'll see how it goes. It's much better to have my wife back to "her normal self" again than constantly sick so we'll say this procedure has worked splendidly for now.I have been reading posts from you, Ian that appear you are not doing so well again?? Did not the huge doses of probiotic "bifidus family" as your messiah help your IBS symptoms as you mentioned in an earlier post or did you relapse since then?I wonder if many IBS sufferers are able to figure out how to completely get rid of their symptoms and the root cause . . . probably depends on the original cause if one can pinpoint that.In2day or DAD


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## idkwia (Feb 26, 2009)

DAD - many thanks for keeping us updated. Pleased to hear that your wife is doing so well, let's hope that she continues to be well. Please keep us posted.


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## IanRamsay (Nov 23, 2008)

DadWhat are you talking about? im fine?Ian


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## DAD (Jun 12, 2009)

Sorry IanRamsay . . . read so many threads/posts that I was remembering another Ian (Strange 4) from another thread who did seem to be having problems from the posts. Interesting that you're both listed from UK.Cheers that you are doing fine at this time . . .DAD


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## DAD (Jun 12, 2009)

TO ALL INTERESTED READERS . . . UPDATING SIBO BREATH TEST SOLUTION:Updating my wife, Jeri's bout with IBS from previous posts under this thread . . . since testing positive on the breath test for SIBO in May-June period, she took a prescribed 2 antibiotic regimen for 10 days . . . was greatly improved with energy back, abdominal pain and IBS symptoms mostly disappeared for about 2 weeks . . . then all the symptoms came back again . . . she was presribed a 2nd set of the same antibiotics for another 10 days during first part to mid-July and has been mostly symptom free since. Once in awhile yet she'll eat something that brings back a symptom of slight nausea or slight pain, but that is all at this time and it is now the last of August.This SIBO reduction process thru antibiotics that specialize working almost entirely in the intestines with only a few percentage only absorbing into the rest of the body has worked well for her thus far. She now has most of her normal energy back, no more brain fog, no more rib cage abdominal pain, etc.She is very happy with the results, but realizes she has only been off the regimen for 6 weeks.If the SIBO type symptoms seriously return anytime in the future, another round of the anti-biotics or a side trip to the Seattle IBS Center could follow . . . but considering she is probably recovering from 2 separate bouts of buffet food poisoning that had been building bad bacteria up in her small intestines for the past 10 to 20 years, she feels fortunate to even recover this well now.DAD


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## idkwia (Feb 26, 2009)

DAD - Thanks for the update, pleased that she is doing so well. Please let us know in the future how things go. I am certain that many people who have been diagnosed with IBS do indeed have SIBO instead. Of course the difficulty is managing the SIBO but at least one knows what is wrong and has a chance to make things better rather than the "we don't know what is wrong with you tag" of IBS.


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## DAD (Jun 12, 2009)

Idkwia -I believe as you do . . . that SIBO is a greater part of IBS'ers problems than most would believe . . . all it takes is a breath test just to see.Jeri went thru MD's, Gastro's, Alternative Cares, tests upon expensive tests with negative results until the rather inexpensive Breath Test. We had to finally find this process ourselves and actually ask a Gastro to refer this test . . . and then he referred it to a test area that only duration tested for 1.5 hours which was incorrect timing and we knew that . . . so we outsourced to a special test center in another city that tested for the correct 3 hour duration. Jeri had a very high initial reading before even starting the test so she knew right there what to expect. It's no wonder people get incorrect disgnosis's sometimes if these tests are done incorrectly or some procedure isn't followed to the Tee.What is amazing and hard to understand is that all these doctors we utilized refused to specifically do anything about Jeri's mention of 2 different food poisoning episodes in her past as the start of her problems . . . AND after reading all these forum situations, it is obvious that IBS seems to be a broad general term used for a general lack of understanding of how to really solve most IBS issues.And I'm convinced by just observing what I have, contrary to what some physicians have told us . . . that IBS and SIBO can kill or take one's life prematurely through not being able to eat and energy loss, nutrition decline allowing more disease to enter the picture, constant intestional irritation leading to cancer, etc. . . just think of the ways.IBS needs to be studied so much more by all involved since it inflicts and inhibits the lives of so many and sufferers do need to try some of these more simple tests first just to see if there is a connection and to think back to every rememberable detail of what started your IBS symptoms and what you can do to help solve your own symptoms if it's possible. DAD


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## IanRamsay (Nov 23, 2008)

But anti biotics only attack the symptoms and part of teh cause where sibo is concerned, which is why it comes back over and over again. without regulating teh bacterial balance in the GI and repairing the gut at source after initial anti biotic treatment its just putting a plaster on it. sooner or later antibiotic will no longer do the trick as the bacteria will become resistant to them. more than 12 years ago i realised bacteria was the root cause of all PI IBS, either in long term alteration of the bacterial balance of teh gut or long term damage to the gut caused by an acute imbalance of bacteria. the only long term resolution of SIBO and PI IBS is replacement of normal bacteria that have been eliminated and re settlement of bacteria that have settled in teh wrong part of the small intestine. and in some cases repair of the IC Valve that allows SIBO to occur in the first place. all these things pimantel dosent seem to grasp and is still bent on antibiotics being the key to recovery. untill all these things are taken in to account, a real cure for sibo will never be afforded.Ian


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## idkwia (Feb 26, 2009)

Ian, you strongly suggest that you know how to resolve SIBO, but can you be more specific and detailed on exactly how to do it?


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## IanRamsay (Nov 23, 2008)

1. repairing teh faulty IC valve (if it is faulty as it isnt in some cases)2. anti biotic treatment, followed by:3 specific diet for several months and Targeted probiotic therapy (this bit is the difficult bit)4 Treatment with L Glutanamine or similar gut healing suppliment5 suppliment s of anti oxidants and flavenoids6 Maintenance of specific probiotic or broad spectrum probiotic at a dose of between 10Bil and 250Bil dependant on required levels.well, that is how i fixed mine anyway, but i didnt bother doing the antibiotics again, i did it without step 2. i havent had a reocurance since and it was years ago.Following that i also beat my IBS A, GERD, and GASTRITIS with similar targeted probiotic therapy. i had a headstart because bacteria is what i do.Ian


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## idkwia (Feb 26, 2009)

I am still fascinated by the treatment that Dr Pimentel carries out so I am here again to ask DAD, Laura29, MMAR and anyone else who is with Dr Pimentel how things are going?It seems to me that many people who think they have IBS do in fact have SIBO and so if there is a doctor who says he can cure this then this is surely worth a try. I would have thought that everyone on this site would be queuing up to try this protocol. It may well be that there is a high chance of the SIBO coming back but if it can give medium or longer terms of no symptoms whatsoever as is reported then it surely is worth looking at.As for me, I have been tested for SIBO but it was negative so I am still hoping to hear from Pimentel as to what he proposes when this happens (MMAR promised to find out so I hope he/she will provide an update).


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## Kathleen M. (Nov 16, 1999)

I think the reason we aren't all lined up at his door is a lot of people have over the years since this was proposed (and the almost all IBSers have SIBO numbers are disputed) have tried this approach and the results are like everything else.(and a lot of people have found other things that worked, it isn't like it is SIBO or their is no treatment at all)Helps some, doesn't help others, and some find the week or so of relief (as the results aren't always long or even medium term) isn't worth it.It would be nice if it really were something that always gave 6 months to a year of relief for 85% of IBSers but it seems it helps a few, and some people find after a few rounds of antibiotics in a year or two amount of time their bacteria are too antibiotic resistance and they don't get additional benefit.Unfortunately a lot of people don't even have access to SIBO testing so randomly throwing antibiotics at any random IBSer gives even poorer results than you see in those that do have access to testing. Especially since for some IBSers antibiotics make them much worse instead of all better.


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## gravitas (Jul 30, 2009)

Ian:"1. repairing teh faulty IC valve (if it is faulty as it isnt in some cases)"Can you explain how this valve is repaired? Is it done through surgery? I've never heard of this.(Also, why do you always use "teh" instead of "the"? Just wondering.)Thanks,Gravitas


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## IanRamsay (Nov 23, 2008)

kinesiology can repair tthe IC valve, but it can be done through surgery although it is a drastic way of doing it. sometimes simply time will fix it. i have also heard of posture correction repairing it as well. there are quite a few ways of doing it.I type at 200 words a minute so typos are quite normal.Ian


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## idkwia (Feb 26, 2009)

Kathleen M. said:


> I think the reason we aren't all lined up at his door is a lot of people have over the years since this was proposed (and the almost all IBSers have SIBO numbers are disputed) have tried this approach and the results are like everything else.(and a lot of people have found other things that worked, it isn't like it is SIBO or their is no treatment at all)Helps some, doesn't help others, and some find the week or so of relief (as the results aren't always long or even medium term) isn't worth it.It would be nice if it really were something that always gave 6 months to a year of relief for 85% of IBSers but it seems it helps a few, and some people find after a few rounds of antibiotics in a year or two amount of time their bacteria are too antibiotic resistance and they don't get additional benefit.Unfortunately a lot of people don't even have access to SIBO testing so randomly throwing antibiotics at any random IBSer gives even poorer results than you see in those that do have access to testing. Especially since for some IBSers antibiotics make them much worse instead of all better.


Thanks for that Kathleen. Although my view of things is that if you have SIBO then you don't have IBS. It is also clear that if you have SIBO and you can get rid of it then you will get better - although I fully appreciate that getting rid of it and keeping it away is tricky; but a number of people have achieved it, Ian Ramsay for example explains on this page how he did it. To my mind if there is a hope of dealing with our illness then we should try every means possible. If someone is tested but doesn't have SIBO then they can move their search for a solution to something else.


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## IanRamsay (Nov 23, 2008)

a cure is a very strong word. i got rid of mine, and it has so far (touch wood) stayed away but it took a long time to find the right method for me personally that diddnt involve antibiotics of any kind. i honestly believe that a similar method can work for anyone but teh hard part is finding teh right diet, suppliments and bacteria that will work for teh next person. this is something i am working on but i have been working on it for a while and i recon its going to be a while yet before i have something will stand up to a medical trial. (possibly several years). there is just so much variation without a dedicated bacterial map of an individuals gut flora (Big problem 1) and a comparison database (Huge problem 2), it is like a needle in a hay stack. but it is a hay stack that i am plodding my way through. im not saying that antibiotics are bad, because relief, even if it is brief, can give you teh break that you need to regroup and re charge. i just think that there is a better way that will offer a much longer respite as long as maintenance is kept up. my biggest issue is with bacterial resistance to antibiotics. they are smart little buggers and they are getting smarter all teh time the more antibiotics that we throow at them. there was a time when a dose of penicillin would knock off every bug on teh block, stone dead. sadly that is no longer the case. some when in the future, possibly not that distant, sibo will not respond at all to antibiotic therapy because teh bacteria will be too strong and too evolved to be affected by it. this is what worries me because it isnt just sibo that is fighting back, its all kinds of things that could once be taken care of with antibiotics or penicillin. sadly it is like everything else in teh strange world of IBS.... its just hit and miss, back to the drawing board and try again.Keep the faithIan


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## idkwia (Feb 26, 2009)

Below is a copy of an interview with Dr Marc Pimentel. The original can be see at http://www.irritable-bowel-syndrome.ws/mark-pimentel.htm*How do people develop SIBO?*We believe that movement problems of the small intestine result in bacterial overgrowth in IBS. The concept that disordered small bowel motor function causes SIBO is not new. What is new is that it could be the culprit in IBS also.In essence, often IBS patients describe that they had perfectly normal bowel habits until, for example, "the case of food poisoning they had 10 years ago.'' This would be known as the "heralding event'' for their IBS. The book describes how the association between IBS and the patient's "heralding event'' was discovered and how it could lead to bacterial overgrowth, which causes chronic IBS symptoms.*Are there any specific symptoms for SIBO?*SIBO symptoms are bloating, abdominal cramping and alternating bowel habits. Essentially the symptoms are identical to IBS. *What percentage of IBS sufferers do you think could actually be suffering from SIBO, and do you think of IBS and SIBO as two separate conditions?* Based on all the research, it is likely that somewhere between 40 and 84% of IBS patients may actually have this problem.*There has been some criticism of the SIBO theory, and some studies have had difficulty in replicating your results. How do you respond to this criticism, and do you think that the SIBO theory is now generally accepted or is it still controversial?*Only one study has had difficulty replicating our results. The rest is just commentary. There are more than 10 papers that have replicated the results. It has been quite interesting this past year. Over the last 12 months there has been a growing use of Rifaximin for IBS. Rifaximin has changed everything because in contrast to our previous antibiotic, Neomycin, Rifaximin is very effective. Now gastroenterologists are seeing dramatic improvements in IBS based on this drug.I would estimate that compared to a handful of physicians using this concept to treat IBS two years ago, more than half of all gastroenterologists in the US are now considering bacterial overgrowth in the framework of IBS and treating it this way. Just remember that bacterial overgrowth can recur and the book outlines ways that may help prevent this from happening so as to avoid excessive antibiotic use. *Is there a list of hospitals or clinics in the US which administer the breath test for SIBO, and do you always need a doctor's referral?*Last I heard, nearly 60-70% of gastroenterologists in the US are trying or considering antibiotic-based approaches for IBS. *Is the breath test available in the UK or Australia?*Yes - both.*Would you ever advise a patient to try the SIBO treatment (antibiotics etc) without having a breath test first, if they did not have access to the test?*Many doctors do this but our operation is geared toward doing breath testing first.*I know you have used Zelnorm as part of the SIBO treatment. What was your view of circumstances surrounding the Zelnorm recall, and do you think it may return in the future? *I think that the FDA suspension of Zelnorm may be temporary. It seems unlikely that the small number of patients with pre-existing cardiovascular disease who get another event while on Zelnorm means anything. Zelnorm may have made patients feel well so they became more active and this is why they had more events.*What kind of diet advice would you give to IBS patients?*While I do not believe diet issues to be the cause of irritable bowel syndrome, diet has an important role. If bacterial overgrowth is a major causative factor in IBS, these bacteria cause trouble because they ferment, thus producing gas that will cause distention and bloating symptoms.The best way to help bacteria is to give them carbohydrates. But not all carbohydrates are equal. The worst carbohydrates are those that humans cannot digest. What you cannot digest will go to the gut bacteria. The top carbohydrates I suggest avoiding on this basis are fiber, high fructose corn syrup, sorbitol and sucralose. By reducing these sugars, there will be less bloating. *Would you recommend probiotics as a general treatment for IBS, and if so is there any particular strain or product to look for?*Probiotics such as lactobacillus and bifidobacteria provide relief to the severity of IBS symptoms by stimulating the cleansing wave mechanism of the intestines. In a double-blind study involving 50 patients with IBS, test subjects received either the probiotics or a placebo powder for a period of 28 days. At the end of the study, 49% of the probiotic group showed improvements in the level of their abdominal pain, compared with 29% of the placebo group. While probiotics have not been found to eliminate IBS, the reduction of IBS symptoms is certainly a good outcome.*What are some of the reasons you recommend peppermint capsules?*Peppermint has been shown to be a calcium channel blocker of the muscle because of its ability to block calcium fluctuations in the muscle cells, thereby causing muscles to relax. When taking peppermint, the muscles of the stomach, small intestine, and colon are less likely to contract against gases, reducing the sensations of high pressure (or cramping) in the abdomen. To achieve the above benefits, the peppermint needs to be enteric-coated to protect it from being broken down and digested prior to reaching the important areas of the gastrointestinal tract.*In your book, you discuss some of the advantages of taking digestive enzymes. What are some of those benefits?*The basis for using digestive enzymes in treating IBS is that I believe taking the enzymes will increase the speed of digestion. The faster the food is digested, the quicker it is absorbed. This leaves fewer available calories (or nutrients) for the bacteria of the gut. With this reduced number of calories, the bacteria will likely decrease in number. Typically, patients who take pancreatic enzymes report a 30% to 40% improvement in their symptoms.*Do you believe that stress plays a major role in contributing to IBS symptoms?*I do not believe that IBS symptoms are caused by stress. However, I do believe that stress can exacerbate the situation, making symptoms worse. There is data to suggest that stress may even increase bacterial levels in the gut. IBS patients often tell me that they feel worse when stressed, but are still symptomatic when not stressed.


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## idkwia (Feb 26, 2009)

Bump


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## DAD (Jun 12, 2009)

TO ALL IBS SUFFERERS - Listen Up This Could Be Very Important To YouUPDATING JERI'S CONDITION From Posts on 6-13-09 thru 8-30-09 Remember the discussed IBS and food poisonings of my wife, Jeri from past postings under this thread (go back & read them if you haven't yet) . . .6 weeks after her Mid-July - second round of anti-biotic prescription for Xifanan and Neomycin, her symptoms of continuous nausea, IBS, and lower right-side rib cage pain returned slowly at first and then with a vengeance by Oct-Nov. By that time Jeri could barely exercise or stand very long. Eating anything became a big problem as she again became continually weak, and exhausted so . . .. . . In December we scheduled her into the IBS Treatment Center in Seattle where she was decidedly tested for the Standard Food Allergy Panel for both IgG and IgE antibodies AND the New, Improved Stool Testing using DNA Microbial Profiles for bacteria, yeast, and parasites. The results 30 days later showed plenty of food sensitivities (allergies) AND the only bacteria that showed an abnormally high reading was H. Pylori and that was all. That made sense to us since she had previously dealt with two bouts of food poisoning.Jeri dealt with trying to rid the unhealthy H. Pylori bacteria first and was prescribed two different anti-biotics to deal with this special type of bacteria overgrowth . . . 250mg Flagyl, 500mg Amoxicillin, and Pepto Bismol as a stomach soother if needed (which she didn't need). plus L-glutamine as a digestive tract healer, and fish oil. These drugs were taken twice a day for 2 weeks and very easy on her other than a sore throat side-effect. It is very important when taking Flagyl not to use any type alcohol with it nor use alcohol-based skin lotions, oils, etc. or you could have a very tough time.Now since the medications are over and only eating foods that don't bother her, she once again is like a new person . . . nausea completely gone, lower right rib cage pain mostly vanished, and she is again exercising, walking inclines and buttes, etc. Jeri is also taking medium doses of healthy pro-biotics from the IBS Center each day now too.Will this mostly symptom-free woman now remain that way without re-treatment? By eating mostly foods her body can deal with and hoping the H.Pylori have mostly vanished, we certainly hope so and will post it here if she doesn't.IT IS IMPORTANT to note here that long-term food poisoning from eating out or at home can elevate all IBS symptoms to more and more severe with time. An advanced method of testing using DNA Microbial Profiles could discover your problem where all other tests you have taken through normal medical procedures won't show a thing wrong . . . and the newer series of advanced blood work for food allergies will show what foods react in your body. These tests taken together just might take the mystery out of your IBS and help you heal. Be aware that most medical practices probably don't use these advanced testing methods so be sure to thoroughly ask or check into the IBS Center in Seattle and use this special place to your advantage.DAD


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## idkwia (Feb 26, 2009)

DAD - I am really pleased to hear that your wife is so much better and I hope the improvement continues and remains.However, I have got to say that I find it amazing that your wife has been so ill for so long and nobody tested her for H. Pylori as this is surely one of the first tests that any GI doctor should carry out with her symptoms. And she wouldn't have needed a DNA stool test to detect it either. Anyway, at least it was found in the end.I assume she had the stool test by Metametrix is that correct?One point: there is great debate about the validity of testing blood for food intolerances and most doctors believe they are very unreliable. The gold standard for food intolerance is doing a food elimination diet. However, if your wife stays off the foods suggested by the test and gets even better then this will be good proof for her.Does your wife still have her gallbladder and if so has she had a gallbladder test? I am asking because the classic symptoms of gallbladder disease is pain under the right side of the rib cage which is often accompanied by nausea.Thanks so much for sharing your story and please keep us posted on progress.Good luck.


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## DAD (Jun 12, 2009)

Reply to idkwiaIt's very amazing after 2 MD's, 2 GI Internalists, and an advanced alternative practitioner that none ordered a stool sample or any specific bacteria test, but with the above she did manage an endo, a colonoscopy, a multi-organ ultrasound, a nuclear gall-bladder scan (showed 96% functioning), several different blood tests showing nothing. Dr Wangen did specifically mention she should have the DNA stool test (by Metametrix) as a normal stool test can easily miss items that we might need to know about so that was fine.In the last 25 years, Jeri has been thru allergy scratch tests, blood tests, NAET testing/treatment. Her food & body symptoms have all changed thru time as this has carried on. She still has her gallbladder and probably always will with a high function rate. When anti-biotics brings her right back to good health, that pretty well eliminates direct gall-bladder ills unless bacteria or infections interfere with that organ.The secret no doubt lies in the fact that she developed a weakened digestive tract after surgery for a total hysterectomy for endomitreosis at age 29 . . . and that is what the doctors knew to do at that time in the past . . . even scar tissue can be playing a part in this still too . . . then years later along comes a couple separate doses of restaurant food poisoning with shaking, chills, deep abdominal pains, total nausea, etc. those nights . . . and then the longer term effects still lingering.Thanks for showing interest and hope it helps others.DAD


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## idkwia (Feb 26, 2009)

DAD - thanks for the reply.I thought that when they do an endoscopy they take a biposy to test for H.Pylor.Anyway, hopefully she will now make a complete recovery.


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## DAD (Jun 12, 2009)

Idkwia -Doing a biopsy at that time would have been fine, but the doctor didn't find any irritated enough area to feel he needed to do it. That was his decision and not ours and maybe if he had gone ahead with a biopsy, H.Pylori may not have even shown up in those areas anyway.This is the impracticality of all medical and test decisions that affect the outcome. . . was it done with enough skill or was it thorough enough. We're not saying H. Pylori causes IBS although we are aware that is can cause ulcers (but not in Jeri's case) . . . that is just what was found in this test AND it could be a different bacteria bothering someone else, but the option is open to at least be tested to see.And I add also this is part of the reason IBS seems such a mystery to so many sufferers out there. You just have to keep searching until you find what you can discover and what helps.Some doctors believe food allergies alone cause iBS and others in the medical community don't believe that.That's why we continue to periodically post here so others can see all the different treatments and tests available that we have used to improve Jeri's health.DAD


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