# My Vivonex Plus Log



## Moises

My Vivonex Plus arrived today. I will be attending a family Thanksgiving gathering tomorrow. I plan to start the Vivonex Plus either tomorrow night or Friday morning. I have an office party I must attend on December 17. So I will use these two mandatory social eating settings as bookends for my Vivonex trial.Here is a summary of my situation.Age: 51Sex: MalePrimary symptom: BurpingSecondary symptom: DiarrheaTertiary symptom: FlatulenceI have had no breath tests. I will be looking for symptom relief, with burping being my main concern.I have had diarrhea since at least my early teens. In recent years I have been able to control the diarrhea most of the time by restricting my daily carbohydrate intake (not counting the carbs in fiber) to 72 mg or less. But my burping remains as a problem even as the diarrhea faded as a problem.To prepare for the Vivonex Plus I have been adding lots of carbs to my high daily meat intake. I gained 6 or 7 pounds in the last 16 days. I also have more distension, pain, diarrhea, and mucus in stool now that I am eating everything in sight. I recently tested a course of Xifaxan and created a thread titled "My Xifaxan Log." There were no changes in my symptoms after that course of Xifaxan.More recently I tried a home-made elemental diet consisting primarily of fat and glucose. I quit that after a few days of severe, watery, diarrhea.I have received 12 days of Vivonex Plus along with a very large supply of Raspberry flavoring supplements made from glucose and aspartame. I enter this trial with a great deal of trepidation, since so many find Vivonex intolerable and drop out of the regimen. My plan is to order another case of Vivonex Plus once I determine that I am going to be able to tolerate the diet. That would give me 18 days' supply. Pimentel has patients do Vivonex Plus for 14 days. For those patients who do not experience relief, he gives them another 7 days, for a total of 21 days. He reports relief in about 80% of patients after 14 days and 85% after 21 days. I have purchased glucose tablets, maltodextrin powder, amino acid powder, tryptophan capsules, and MCT oil. After 18 days, if I have the will to continue, I could mix my own Elemental Diet with the ingredients listed in the previous sentence or I could combine my home-made mix with small amounts of real food. I imagine that after 18 days of Vivonex Plus I'll be desperate to eat real food whether I am cured or not. Then again, if I were cured, I might be willing to endure gustatory deprivation as a small price to pay for a healthy digestion and eternal salvation.


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## Rick (never give up)

Hi Moises,Welcome to the Vivonex club







I wish you the best of luck. I notice that you've been following my own log, so you know the first days may be hard.One thing I can tell you is that you should not feel that hungry while on the Vivonex. I usually have small food cravings at night, but no big deal.I'll also recomend, if you may, not to add anything to the Vivonex. Take it alone cause that's how the protocol is designed to be followed.I'll be reading your log as well.


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## Moises

Rick,Thanks for the heartfelt support. I am glad that we will both be on it simultaneously, so that we can compare notes. I am absolutely taking nothing with the Vivonex except water and flavor packets. As far as I am concerned, this is the gold standard in the SIBO paradigm. This has the highest likelihood of success. I want to follow the published protocols to the letter, so that if it fails, I won't have to wonder if my modifications were the cause of the failure.This morning I mixed one day's worth of the Vivonex. I did this with a great deal of concern because an earlier posting here described the odor created during mixing as fetid to the point where he had to air out his apartment by opening all the windows in the middle of winter.My wife and son both have quite sensitive noses so I prepared myself for the complaints. They were both next door feeding the neighbor's cats when I started. My son came in while I was mixing and didn't say a thing. My wife came in after I finished and the Vivonex packets were in the garbage and she too has said nothing.I didn't find the smell offensive in the slightest.I did notice that one of my packets was punctured during shipping. Very little powder leaked out so I chose to use it and not go through the hassle of returning the damaged goods.I will end with an observation. I have only read two published authors in my entire life who discuss the elemental diet: Gottschall and Pimentel. To my astonishment, I have discovered that both were from Ontario. It defies all logic that this could be mere coincidence. I think we have the makings of an excellent conspiracy theory here.


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## Moises

I lay in bed for quite some time this day after Thanksgiving, knowing that once I arose I would have to drink the much-feared Vivonex. I sniffed it first before drinking. Didn't smell like much. The taste was tolerable. Certainly better than some stuff I've received from an herbalist in Chinatown.It did remind me of the glucose-flavored concoctions I made for myself a few weeks ago. I know that back then it didn't seem to bad on the first day and by the third day I was gagging just thinking about the stuff.In my imagination, I thought I would just gulp down the Vivonex the way I would a glass of water. This stuff is thick and it took quite some time for me to take the entire 600 ml.


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## Moises

I have taken the advice of a poster in a different thread on Vivonex. I hold my nose while drinking the stuff. The taste is tolerable but the smell, while tolerable, is not great. I would like to buy a clothespin or something to hold my nose shut during my "feedings."I am definitely losing weight on this diet, though I haven't actually been to the gym yet to weigh myself. I don't know if I will go to the gym at all since I already am feeling fatigued.I did sleep well last night even though I was burping a lot once I got up. This is going to be tough. I know that the worst is still ahead of me. But I wouldn't be doing this at all if I didn't think there was a reasonable probability of some good coming at the end.


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## Moises

The defining event of yesterday (day 2) was severe, urgent, explosvie, diarrhea around 3:00 pm. It was reminiscent of what I went through with my home-made elemental diet, which I abandoned because the unending diarrhea scared me so much I thought I might be doing myself serious harm.It's hard for me to imagine that I was suffering from die-off in the middle of my second day. I once consumed nothing but water for 5 days and that was not long enough to kill off what's inside of me. It seems doubtful that large numbers of bacteria were dying yesterday. It seems more likely to me that there is some other characteristic of the Vivonex that is not agreeing with me. When I was taking my own mix, I was in terra incognita so I abandoned it because of my ignorance. But I will keep on with the Vivonex because I know that it has helped so many.Meanwhile, after the extremely bad diarrhea I had severe burping and distension followed by lots of flatulence.Yesterday I again felt fatigued and kind of shaky.I get very little exercise, so my caloric needs are reduced from normal. The taste of Vivonex is tolerable. I don't mind drinking the stuff. As Rick and others have said, I miss eating real food. But I am glad I can eat something. I'd much rather be consuming Vivonex than be fasting. If this stuff works, it will be amazing. Two or three weeks of taking a liquid diet is a minor inconvenience. Having IBS is a major inconvenience. A minor inconvenience is a small price to pay for eliminating a major inconvenience. Even if I had to take Vivonex a couple of times a year, I would, if that's what was needed to stay IBS-free.


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## Moises

Yesterday was day 3. (I am using Rick's useful method of numbering the days. Thanks Rick!)Day 3 bore some discouraging resemblances to Day 2. Again, the defining event for Day 3 was an attack of extremely urgent diarrhea, this time at 1:30 pm. Again, I was fortunate that I was near a toilet and not driving in my car. Again, I rushed to the toilet and had pure liquid stools.The difference between day 3 and day 2 was that day 3's urgent BM was the only BM of the day. Day 2's BM followed 4 previous BMs that were formed.Day 3 resembled day 2 in that there was also extreme burping in the late afternoon.Last night my sleep was frequently disturbed by gut discomfort which was occasionally relieved by burping.Today is day 4. This is my first workday. Although I feel somewhat shaky still, I decided to go to the gym, where I did fine.I don't have a scale at home but I use the scale at the gym. Here is my bodyweight history.11/6/06 171.5 lbs: before I started eating lots of carbs on top of my normal almost all-meat diet.11/22/06 177.25 lbs: after eating lots of carbs on top of lots of meat and two days prior to commencement of the elemental diet.11/27/06 176.25 lbs: after 3 full days of the elemental diet.So I am not losing as much weight as I feared.


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## Moises

I had ordered 2 cases of Vivonex, each case has 36 packets. I needed to order a 3rd case but I wanted to see if I could tolerate the stuff. Today I went to walgreens.com and found that they are out of stock. I was starting to panic. I was imagining only doiong 12 days of Vivonex and then not being able to continue because none was available. So I called the San Vicente Pharmacy in LA. I should have gone there first. I found out about them from another thread here on Vivonex. They are quite nice on the phone, they have it in stock, they ship right away, and their price is better than walgreens.com.It's 4:47 and there were no BMs today. I feel slightly wobbly but there's no urgent diarrhea.


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## Moises

Today is day 5. This morning I had a small formed BM at 5:30am. Around 8:00 am I had urgent, liquid, diarrhea. But the volume was less than it was during my diarrhea attacks of days 2 and 3.One thing to note. Rick has mentioned in his concurrent Vivonex log that the liquid stool burns. I have had a similar sensation. It was quite noticeable and uncomfortable on days 2 and 3. Today it was noticeable but less uncomfortable, perhaps because the stool volume was less.Yesterday I had moderate burping in the gym at around 6:15 am. Driving home around 12 hours later I had severe burping. The burping was followed by flatulence.Last night I had burping starting around 3 am. I still hold my nose when imbibing the Vivonex but it is not an unpleasant experience. I read about Crohn's patients who have to stay on Vivonex for 6 weeks at a time. I consider myself lucky to be doing this for "merely" three weeks. I consider myself lucky that I am not worried about having any part of my intestines removed.The raspberry flavored Vivonex tastes OK and the texture is fine.I went to the gym again this morning. My weight was 175 lbs. I do have enough energy to go to the gym but I do not feel normal. Yesterday afternoon I definitely felt wobbly. Overall I feel weaker and slightly out of it. I have the feeling that if I were to bump into something it would hurt more now than it would have before this Vivonex trial.


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## Moises

Today is day 6.Weight 174.25 lbs.Yesterday I had another urgent, liquid stools, BM at 2:50 pm. In the evening I tried to have a BM but nothing went into the toilet. I did wipe some mucus.I noticed that I am able to drive and type but it actually took some effort to fill out some forms by writing with a pen. I always am aware that I am not feeling quite right though I never feel downright sick. I reread Savateur's thread about Vivonex and she described it well.One good idea I got from rereading her thread was to try halving the dose of the flavoring packets. Today's feedings are already mixed. I mixed one feeding this morning tomorrow. I will taste it tonight when I get home from work and see if it is palatable.I had moderate burping throughout the day yesterday. And my sleep was disturbed by burping and discomfort last night starting at 2 or 3 am (I can't remember which).Today, so far, appears to be similar to yesterday. Around 5:40 am I had a formed BM with a small amount of string-like stool. At 8:30 am there was a BM that was pure liquid. It did sting slightly, as Rick has mentioned, but the discomfort was very mild. Maybe I am accommodating to the feeling or maybe the chemical makeup of the stool has changed.


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## Moises

Today is Day 7.Weight 171.75. I drank less before going to the gym yesterday. Maybe the scale at the gym is malfunctioning. In any case, I don't take daily weight fluctuations too seriously.Yesterday there was moderate burping. At 8:30pm I had liquid BM. Not much urgency. No burning sensation. There was a lot of burping after that.Today there have been no BMs thus far. There has been typical burping and mild cramps.


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## Moises

Today is Day 8.Weight 173.0 lbs.Yesterday I felt fatigued and wobbly.Only BM was around 8:15 pm. It was pure liquid. I had some flatulence before the bm. Unfortunately, I soiled my underwear before I realized it wasn't gas coming out.Today I had BMs at 5am, 5:30 am, and 9am. Mostly is was just mucus.Today is the beginning of my second week. I am still not clear exactly what Pimentel's explanation is for what is purportedly going on in my gut. I know that the bacteria in my small intestine are supposed to be starving to death and, perhaps, as they die they exude some of their toxins as a farewell gift to me. But, presumably, the same mechanism that is starving the small bowel bacteria is starving the large bowel bacteria. In fact, Vivonex should be more effective at starving large bowel bacteria than small bowel bacteria because Vivonex is present in the proximal small bowel but should be completely absent from the large bowel. Yesterday I was drinking my Vivonex with 1/2 dose of the flavor packs and it was fine. But I wouldn't recommend that anyone start a Vivonex diet with 1/2 dose of flavor packs. Another thread tells the tale of someone who tried the diet with no flavor packs. He was gagging on the stuff and later bought the flavor packs. My recommendation, for anyone who might be considering doing Vivonex themself, is to start with the flavor packs at full dose. Then slowly reduce them to see how little can be tolerated.


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## 17908

While on Xifaxin I experienced a lot of the things you're going through, Moises.D, huge poops, phantom poops with only mucus, etc. I have no explanation. I actually think part of the problem is that my bowels were very used to pooping several times a day, and any time there was the slightest aggravation, they would try to expunge it.Hopefully this works for you. I really felt like my gas problem was helped as much by Zelnorm as by the antibiotics, so don't give up if you're not 100% after all this.


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## Moises

npearce,Thanks for the words of encouragement. I need them.Today is day 9.Yesterday I had the general fatigue and shakiness. I remember years ago getting a glucose tolerance test. I drank a large glucose drink and then sat for 5 hours in a wating room with other people as our blood was tested. I had never realized before this how badly I react to high-carbohydrate meals. I was unable to concentrate on reading a book. I couldn't even read People magazine.But overall yesterday, I had more energy than in previous days.Unfortunately, there was a loud party that woke me up after I went to bed last night. Once I was awakened, at 12:30 am, I started burping a lot. And the party went on for hours. Around 2am or so I started having flatulence. It was not a good night.I got up at 5 am and there was more flatulence. At 5:45 there was some formed stool in a BM. At 8am there was a very urgent BM with purely liquid stool. I have a suspicion that these urgent liquid BMs are going to be with me until I stop the diet.


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## Moises

Today is day 10.Yesterday I had a BM around 12:45 pm. Small volume and formed.Last night I awoke at 2:30am with lots of burping but feel back to sleep quickly. Around 6am I lay in bed for a while with burping and flatulence.A BM around 7 am small volume and formed. I don't want to prejudge things but I would assess the probability of my burping being cured as 25 per cent. I once went months eating only meat. I know Pimentel claims that you need to have free-form amino acids to get full absorption high in the small intestine but even he suggests that carbohydrates are the main culprit.My major concern right now is that my Vivonex supply is running out. If I don't receive a shipment of another 6 days' supply tomorrow, I might be in big trouble. I could either fast for a day or mix my own maltodextrin, free-form aminos, and medium chain triglycerides. I will call the pharmacy tomorrow and have them track the package.


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## cynthia

Moises, Sounds like you've adapted well to the vivonex. As for the burping, remember that both feeding the bacteria AND starving it will result in gas build-up and release. The burping could be a form of die-off. So hang in there.Cynthia


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## Moises

Thanks, Cynthia, for the encouragement. You are, as usual, correct. It is too soon to say defnitively. Pimentel showed that some people who don't respond after 14 days to Vivonex do respond after 21 days. So I am not giving up.This afternoon and evening I had 3 more BMs. Mostly mucus.If anyone reading this thread is considering going on an elemental diet, I strong suggest they look at the full text of a 30-year old study called "A comparison of three defined formula diets in normal volunteers."It's filled with fascinating information about elemental diets (EDs) in general, though it does not examine Vivonex Plus, in particular.Ten subjects each tried 3 different ED formulations. Each formulation was tested for 10 days. The subjects had about one BM every 2 days, with stool weight about 50 gm/day. On a normal diet stool weight is about 120 gm/day with a BM once every 1.1 days. So, as others have reported here, BMs continue on EDs, though stool weight and frequency are halved.Longer term studies of 100 to 550 days showed that patients on EDs have one BM every 9 days. My experience has been that I have still had freqent BMs, even 10 days into my ED.Of particular interest to anyone interested in SIBO theory is the reported claim that studies from 1973-75 reported that "total microflora population size is relatively stable," while subjects are on EDs (!!!!!!!)And for those who are really curious, studies have shown that the average weight of the stool produced for any given BM does not change when one goes on an ED. Thus, one has fewer BMs, but the stool excreted during an ED BM weighs the same as the stool excreted during a normal diet BM. Researchers note that, "This supports the theory that a 'critical volume of bulk' must accumulate in the colon before defecation . . ."The researchers state that a weight loss of 2 to 3 pounds is typical upon commencing an ED, even if adequate calories are being absorbed. "This is atrributed to a diminished content of the gut and/or diuresis. . . A rapid return to at least pretest body weight by most of the subjects suggests that caloric deprivation was not severe."Perhaps of greatest interest to those of us who are about to embark on the ED journey are what the authors term "Subjective comments."They note that there is no correlation between subjective reports and objective data like "nitrogen balance, fat, and mineral absorption." The subjectively reported side effects were "taste, headaches, sweating, shaky-weakness, diarrhea, nausea, and constipation." I have experienced shaky-weakness and diarrhea daily.Regarding taste, "Initially, all subjects had difficulty with palatibility, however, by day 3 or 4, there were very few complaints." That tracks my own experience. My biggest fear from reading other reports on this and other boards was the taste and smell. That quickly became a non-issue for me. "Explosive diarrhea, gas, cramps, sweating, and feeling lightheaded were common complaints after subjects completed [the EDs]." I haven't yet completed my ED, so I have something to look forward to!


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## Nanobug

> quote:Of particular interest to anyone interested in SIBO theory is the reported claim that studies from 1973-75 reported that "total microflora population size is relatively stable," while subjects are on EDs (!!!!!!!)


This is an interesting claim, indeed. Copuld it be that this is true in the colon but not in the small bowel? Even if this is the case, not sure I understand the difference, though...


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## Moises

> quote:Originally posted by Nanobug:
> 
> 
> 
> quote:Of particular interest to anyone interested in SIBO theory is the reported claim that studies from 1973-75 reported that "total microflora population size is relatively stable," while subjects are on EDs (!!!!!!!)
> 
> 
> 
> This is an interesting claim, indeed. Copuld it be that this is true in the colon but not in the small bowel? Even if this is the case, not sure I understand the difference, though...
Click to expand...

This is precisely the question I've been considering for the past few days. This is why I have asked (in vain) for those who have had breath tests to report whether their two peaks (of hydrogen or methane) resolve to one peak or to no peaks after their SIBO has been eradicated. Pimentel's theory would suggest to me that killing bacteria is killing bacteria. So to remove the SIBO one would take steps that would have as a byproduct the removal of bacteria from the colon. Of course, my reasoning is a gross oversimplification and it is possible that removal of SIBO occurs long before the colon is sterilized because (perhaps) the volume of bacteria in the small intestine is vastly less than the volume of bacteria in the colon.Day 11Weight: 171.75 lbsI've had 6 BM since 5 am. I also had one BM last night at 9 pm. Mostly it's a small amount of relatively clear liquid that I've been calling mucus.Yesterday morning I surmised that my odds of success on this diet were about 25%. That calculation was the product of brainfog. My thinking was as follows: Pimentel reports that after 14 days on Vivonex the success rate is 80% and after 21 days it's 85%. So there is a 5% chance that if you didn't improve after 14 days, you will improve after 21 days. I haven't improved after 9 days, so I'll estimate that my odds are 25% of success and they will decline to 5% if I am not cured after 14 days.The error was in thinking that "there is a 5% chance that if you didn't improve after 14 days, you will improve after 21 days." What is correct is that 5% of the people who _start_ Vivonex don't succeed after 14 days but do succeed after 21. But 80% succeed after 14 days. Only 20% don't. Of that 20% who don't suceed, 1/4, or 25% of them, will succeed after 21 days. If you start with 100 people, 20 will remain after 14 days. Five of those 20 will get better after 21 days. So, my chances will be 25% if I am not better after 14 days. Thus far, I've only completed 10 days on the diet. So my best guess is that there is still a 40-50% chance of Vivonex helping me in 21 days and a 15-25% chance that it will help me in 14 days.


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## Moises

Day 12Weight unchanged at 171.75.Yesterday afternoon two BMs that were mostly mucus.Burping after I went to bed.Woke up at 2:30am with burping.Today, 5 BMs from 5:00AM to noon. At first mucus. Then sometimes liquid, sometimes solid.There was noticeable burping this morning at the gym from 6:30am to 7:15 am.I had some good news yesterday: my 6-day supply of more Vivonex arrived. So, I'll be on it for 18 days. If I want to go for 21 days, I will cobble together my own mix of glucose, maltodextrin, safflower oil, MCT oil, and free-form amino acids. It will include glutamine in the aminos but it might not have as much as Vivonex. And it won't have all the vitamins and minerals. But it would only be three days at the most.In his article,  A 14-Day Elemental Diet Is Highly Effective in Normalizing the Lactulose Breath Test, Pimentel states that he doesn't record patients' self-assessments until one month after the completion of the Vivonex diet. I would urge Rick and Savateur and others who have completed their Vivonex diets to share their followup results with the forum. It might be that you feel cruddy on day 15 but feel much better on day 45.


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## 21718

Hi Moises,Sorry I've been away from the message boards for so long... It sounds like you're handling the Vivonex as well as could be expected.Few comments: 
 I imagine everyone has diarrhea while on Vivonex? My doctor explained that since you're not consuming solid food, you're not going to have solid stools.
 Over the course of 15 days on Vivonex, I lost 8 pounds. I put 4 of them back on within two days of ending the diet.
 Be sure to eat real light for the first day or two after you stop the Vivonex-- give your tummy time to readjust to food.
That's it... stay positive!!


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## Moises

Hi Savateur,Thanks for the advice. Good to hear from you. I am sorry to read in another thread that you still have not seen your symptoms improve after the Vivonex. I have had someone contact me with the following report. Someone did Vivonex for 14 days and did not get symptom relief. A month later he took VSL#3 and had major improvements.I have taken VSL#3 in the past and it did not help me. There's always the chance that it works better after Vivonex. (As an FYI: it's very expensive.)Day 13Weight 170.25Yesterday I had 5 more BMs spread through the afternoon and evening giving me a total of 10 for the day.Woke up at 1:15 am last night with large amounts of burping. BM at 2:30 am. Probably fell asleep around 3am. Awake again at 4:20 am with burping and flatulence. Arose for good at 5am. Had 4 more BMs so far today. It's getting very draining going to the bathroom so often. But I've gone this far and the end is in view. I will use up my 18-day Vivonex supply and then decide my next move.


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## 17908

I'm starting to believe that the reason Pimental doesn't have a higher success rate with antibiotics and/or Vivonex is because lots of people that try it don't have the exact same SIBO/whatever that others do.IBS is still a VERY confusing problem. My case of amazing improvement with antibiotics is completely different than everybody elses. I don't think there is a "one size fits all" formula for helping IBS and/or SIBO.Moises, have you ever had your burping checked out by anybody? Could it possibly be that you have some problem that makes you swallow way more air than a normal person? It could be something that you don't even know you're doing. Just a thought . . .


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## Moises

npearce,I have been to gastroenterologists over the years. About 20 years ago one told me of aerophagia. So, following his advice, I didn't swallow for a week: I spit into a cup. It didn't help.I've been scoped and tested. I haven't had a stomach emptying study; that's next on my to-do list.


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## Nanobug

> quote:I haven't had a stomach emptying study


Before you do that, you could try taking a couple of grams of ginger root a day. It is reportedly helpful in this situation.Oh, another thing that may help is to add some hydrochloric acid at the end of meals.


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## Moises

> quote:Originally posted by Nanobug:
> 
> 
> 
> quote:I haven't had a stomach emptying study
> 
> 
> 
> Before you do that, you could try taking a couple of grams of ginger root a day. It is reportedly helpful in this situation.Oh, another thing that may help is to add some hydrochloric acid at the end of meals.
Click to expand...

I've taken ginger capsules for many years. I just stopped it to do the vivonex. I have tried the hydrochloric many times as well. But I never stayed with it because it never helped me. Pimentel mentions pancreatic enzymes. I've done every kind of enzyme and they do nothing for me. I appreciate the suggestions nonetheless. Keep them coming. What npearce said 3 posts up about IBS being confusing is true. What was so revolutionary and exciting about Pimentel's hypothesis is that he took a multitude of symptoms, some of which are contradictory--transit too fast; transit not fast enough--and found a single cause to explain them all: bacterial overgrowth in the small intestine. It was really quite elegant.I felt the same rush when I first read Pimentel that I had when I first read Gottschall. It all made such good sense. The problem with my experiences with Gottschall's diet was that I did not improve. Nonetheless, I am quite glad that I went on Gottschall's diet. Before that I ate meat at one or two meals a month. Her diet forced me to try eating meat daily. I still had symptoms but I felt that the carbohydrates were causing them. That led me to a low-carbohydrate diet, which did allow me to control my diarrhea.If Vivonex doesn' work, I still might learn something useful from this experiment.


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## 17908

Moises: Did you try prescription pancreatic enzymes or just the over the counter stuff. I tried the prescription enzymes with no luck. The over the counter stuff is widely disputed as pure quakery. Some people will claim they help, but most scientific stuff is going to tell a different story.


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## Nanobug

> quote:The over the counter stuff is widely disputed as pure quakery


Really? That's news to me. Do you have any references?


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## Moises

> quote:Originally posted by npearce:Moises: Did you try prescription pancreatic enzymes or just the over the counter stuff. I tried the prescription enzymes with no luck. The over the counter stuff is widely disputed as pure quakery. Some people will claim they help, but most scientific stuff is going to tell a different story.


I was not aware of the fact that there were prescription pancreatic enzymes. Thanks for the heads-up. I'll look into them.


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## cynthia

Like Moises, my son's main and most troubling symptom is burping or, in my son's case, often having a stomach that first fills up with gas that he then has to wait to burp off. I don't know about everyone else but my son will have a gaseous reaction to foods that feed his bacteria rather soon after having ingested them. Tonight for instance he had rice (not something he often has) and started feeling stomach gassy (first trapped and then burping away) within just a few minutes. I agree with npearce that SIBO can manifest itself differently in different people. As has been mentioned before, I'm wondering if the placement of the bacteria within the small intestine accounts for many of the differences with regard to symptoms, specific foods that feed it, and treatments (including vivonex, antibiotics, antimicrobials, enzymes, etc.)


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## 17908

> quote:Originally posted by Moises:
> 
> 
> 
> quote:Originally posted by npearce:Moises: Did you try prescription pancreatic enzymes or just the over the counter stuff. I tried the prescription enzymes with no luck. The over the counter stuff is widely disputed as pure quakery. Some people will claim they help, but most scientific stuff is going to tell a different story.
> 
> 
> 
> I was not aware of the fact that there were prescription pancreatic enzymes. Thanks for the heads-up. I'll look into them.
Click to expand...

Pimental is ONLY talking about the prescription pancreatic enzymes. As far as references regarding the over the counter stuff: I can't find anything truly scientific that says they are more than a scam. They don't even merit the research of scientists, I guess. I'm not the best internet researcher, though. Lactase is probably an exception among all the over the counter stuff.My doctor, two GI's, and the GI I visited at Mayo clinic all said that the over the counter enzymes were a complete scam. That is the only evidence I'm going off of. They all said the enzymes are all digested before they even have a chance to work on any of the foods in your gut. Lactase in milk is different, because it goes to work before the milk is even in your body.I don't have time to go into much more detail, but I'll do some more research when I can.


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## eric

FYIEnzyme Supplements http://www.berkeleywellness.com/html/ds/dsEnzymeSupps.phpI have seen references to why papaya helps break dow proteins.Be Choosy About Carbshttp://www.berkeleywellness.com/html/fw/fwNut03Carbs.html


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## Kathleen M.

The pancreatic enzymes probably work via signalling for bloating.I did find an over the counter version with pancreatin (So not the stuff made from papaya and all that other assorted sort of stuff) did help for post meal bloating when I was taking some medication.Most supplements don't get a lot of research because they can sell them just fine without it. Occasionally a supplement will get enough research that you can say something about it, but a lot of time all you have is guesswork and anecdotal evidence to go on.K.


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## Nanobug

> quote:As far as references regarding the over the counter stuff: I can't find anything truly scientific that says they are more than a scam. [...] My doctor, two GI's, and the GI I visited at Mayo clinic all said that the over the counter enzymes were a complete scam.


How can the doctors say that if there are no studies either way? I actually have no clue whether there are any studies or not. You are the first person to ever suggest digestive enzymes are a scam so it took me by surprise. Given that I spend quite a bit of money on enzymes, it would be nice to know for sure. If you could find additional info on this, that would be great.


> quote:They all said the enzymes are all digested before they even have a chance to work on any of the foods in your gut.


Digested where, in the stomach?


> quote:Lactase in milk is different, because it goes to work before the milk is even in your body.


What do you mean? You lost me here...Thanks!


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## Kathleen M.

A lot of time people put the lactase drops in the milk, you can buy milk products pretreated with the lactase.Enzymes are protiens and most proteins tend to start digestion in the stomach unless they are specifically resistant. I think a lot of the enzymes we use to digest food are released by the pancreas into the small intestine after the acid bath of the stomach is neutralized, but I'll double check on that.I don't know if the prescription creon enzymes are set up so they get past the stomach before dissolving or if those ones are resistant to protein digestion in the stomach.see http://digestive.niddk.nih.gov/ddiseases/pubs/yrdd/ for what happens where.


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## Nanobug

I am looking at the Physicians Desk Reference right now and don't see even a whiff of a suggestion that they don't work at all or are a scam. I understand that stomach acid denatures many enzymes but it is also true that denaturing is, in many cases, a reversible process. I'm not sure whether this is the case with your typical digestive enzymes but I will try to find out. In any case, this wouldn't affect pepsin, for example.By the way, is acid released into the stomach right away or after some time after a meal? I'm doing some reading that suggest acid may take around one hour or so to be released to give time for plant-based enzymes to do a great deal of work. Is this correct?More at 5...


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## 13968

Hi Moises,I'm avidly reading your posts on Vivonex, as Iâ€™ve considered this option, despite my GI advised to not do so. Iâ€™m in my second round of Xifaxan for SIBO, and I still have foul smelling gas, maybe not as frequent as before Xifaxan, but its intensity is still very noticeable by my neighborsâ€¦Iâ€™m also reading Pimentelâ€™s Book, so what can you say of the effects of Vivonex on your health problem? Did it help, was it worth? Thanks, Tony


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## Nanobug

I'm reading the following from the "Enzymes FAQ":"6. Arenâ€™t enzymes taken orally destroyed by stomach acid or the bodyâ€™s own enzymes?Some enzymes taken orally, including those made from animal pancreas extracts, become inactive in the low pH of stomach acid. *Microbial-derived enzymes are acid-resistant, and can maintain activity at pH as low as 2.0 and as high as 10.0*. Microorganisms use their enzymes to break down and digest the plant material that they grow upon. Since the site of fungal growth in nature can vary, fungi have evolved enzyme systems that allow the plant to grow under a variety of conditions, including differences in pH and temperature. Pancreatic enzymes work under a much narrower range of pH in the animal, since their environment is more controlled. Manufacturers often enterically coat pancreatic enzymes to provide resistance to acidity. Some of these coatings contain ingredients considered unhealthful."Is the sentence in bold plausible or bull****? What do y'all think?PS. Just noted that the forum software replaces some words with asterisks...


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## Nanobug

Finally! A paper entitled "Unique Features and Application of Non-Animal Derived Enzymes" from which one can read:"One of the most functionally valuable attributes related to microbial enzymes is that they appear to possess unusually high stability and activity throughout a wide range of pH conditions (from a pH of 2-10). This enables them to be more consistently active and functional for a longer distance as they are transported through the digestive tract."I'm starting to think that digestive enzymes might not a scam after all...


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## Rick (never give up)

> quote:Originally posted by Nanobug:
> 
> 
> 
> quote: Of particular interest to anyone interested in SIBO theory is the reported claim that studies from 1973-75 reported that "total microflora population size is relatively stable," while subjects are on EDs (!!!!!!!)
> 
> 
> 
> This is an interesting claim, indeed. Copuld it be that this is true in the colon but not in the small bowel? Even if this is the case, not sure I understand the difference, though...
Click to expand...

I'm wondering, if this is true, then if I still experience symptoms after the Vivonex, could it be that the problem is indeed a "bad bacteria" that is causing trouble in my colon?. The Vivonex would have normalized the SIBO, but the colon strains may still be the same. In this case, I will think that only an antibiotic protocol could get rid of it.


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## Moises

> quote:Originally posted by Tony13:Hi Moises,I'm avidly reading your posts on Vivonex, as Iâ€™ve considered this option, despite my GI advised to not do so. Iâ€™m in my second round of Xifaxan for SIBO, and I still have foul smelling gas, maybe not as frequent as before Xifaxan, but its intensity is still very noticeable by my neighborsâ€¦Iâ€™m also reading Pimentelâ€™s Book, so what can you say of the effects of Vivonex on your health problem? Did it help, was it worth? Thanks, Tony


Hi Tony,Thus far, my assessment is that Vivonex has not helped me. I suppose one might therefore conclude that it was not worth it. My take is somewhat different. The Pimentel published research that I linked to in an earlier post states that 85% have their breath test normalized and among that 85% there is a 66% improvement in symptoms. If I am not helped in the next few days, I still think it was worth trying a protocol that has a high likelihood of helping. If I hadn't tried it I would always wonder if I could have been helped by it. For example, if I couldn't afford it, I would have been very upset that this substance with the potential to help me so much was beyond my reach. That said, we do have the results of a prospective study on this forum. I know of two people beside myself--Rick (never give up) and Savateur--who have done the Vivonex and were not helped. Savateur normalized her breath test but had no symptom relief. I am on my 14th day and have not benefited yet. If I don't see any benefit, then that's 3 Vivonex dieters and 0 improvements.


> quote:Originally posted by Rick (never give up):I'm wondering, if this is true, then if I still experience symptoms after the Vivonex, could it be that the problem is indeed a "bad bacteria" that is causing trouble in my colon?. The Vivonex would have normalized the SIBO, but the colon strains may still be the same. In this case, I will think that only an antibiotic protocol could get rid of it.


Rick,You raise some pertinent questions. What I believe we need to know first is whether the mechanisms that eradicate small intestinal bacteria have the same effect on large intestinal bacteria. Does the Xifaxan or Vivonex eradicate all bacteria or does it work predominantly on the bacteria of the small intestine? I don't know. But people who have had breath tests after successful treatment would know. If they went from 2 peaks before treatment to 1 peak after treatment we would have strong indirect evidence that the SIBO protocols eradicate small intestinal bacteria but leave sufficient numbers of large intestinal bacteria viable to produce a peak in hydrogen or methane breath tests.The studies from the 1970s referred to in the article I cited were almost certainly discussing colonic bacteria since it is not normal to have small intestinal bacteria. In your situation, Rick, it might be that there are "bad" bacteria in your colon causing your problems. But such an explanation runs against everything Pimentel claims. You might want to see other physicians regarding antibiotic regimens.Day 14Weight 169.75Yesterday started out looking pretty bad. I thought I was going to be running to the toilet all day. But after 9am I was OK (in terms of diarrhea). I still had moderate burping, unchanged from prior to initiating Vivonex.Last night I woke up a few times with burping but fell right back asleep. So I got some good, well-needed rest.Today there has been moderate burping and 5 BMs from 5am to 9am. Mostly liquid, some urgent.


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## Nanobug

> quote:I'm wondering, if this is true, then if I still experience symptoms after the Vivonex, could it be that the problem is indeed a "bad bacteria" that is causing trouble in my colon?


In my case, I don't know whether I had SIBO or not. What I knew, and my doctor knew, is that a previous course of antibiotics to eradicate Helicobacter pylori also "cured" my IBS-D. This was the reason that I took Xifaxan. And it helped a lot!Moises is right in that Xifaxan may very well be killing bad bugs in the colon, and not just bugs "out of place" in the small bowel. Pimentel would indeed be wrong if this is the case although given that he follows an antibiotics first, Vivonex second, his protocol may end up working nonetheless.


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## cynthia

Moises, You can add my son to the list of those unhelped by the vivonex. A few weeks after the vivonex treatment we (he and I) thought he was burping less. But now, in retrospect, I don't believe he was helped at all.Cynthia


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## Rick (never give up)

Hi eric,You are right again.I think that the Pimentel Protocol should be started by antibiotics and then if required the Vivonex.The antibiotics will address the who, and perhaps the where.Ultimately, the Vivonex will address the where.But for me one thing is sure now. I will not recommend starting with only the Vivonex.However, not everything is bad news. 1 week after the Vivonex, I got one improvement, my bloating seems to be over. Yep, although I'll keep watching that specific symptom, since I finished the Vivonex and slowly started with normal food (well, my same old light diet), I noticed I don't feel bloated at all!!







And that was my second major symptom, steady everyday for 2 years.I'll start a post to follow up.


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## Moises

Rick (never give up),As I posted on this thread, in his Vivonex study Pimentel tests the breath immediately after the Vivonex is finished but he does not assess symptom relief until 30 days after the Vivonex is finished. So, do not make any conclusive assessment regarding the effectiveness of Vivonex until one month after your last swallow of Vivonex.Day 15Weight 170.25Yesterday there were 8 BMs, mostly liquid or mucus. In the review article of different elemental diets, the average BM frequency was one every 48 hours. My frequency is about 15 times higher than normal.I had a period in the early evening yesterday of severe burping for about an hour. This morning at 3:45am I had burping and never slept after that. About an hour later the flatulence began. I got up at 5am and the burping and flatulence continued.I have completed 2 weeks on Vivonex. Day 18 will be my last day. After that I will mix my own maltodextrin, free-form amino acids, glucose, safflower oil, and MCT oil. Given that others have said that the transition to real food is not easy, I will try to continue taking maltodextrin even after I consume solid food.


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## 17908

> quote:I have completed 2 weeks on Vivonex. Day 18 will be my last day. After that I will mix my own maltodextrin, free-form amino acids, glucose, safflower oil, and MCT oil. Given that others have said that the transition to real food is not easy, I will try to continue taking maltodextrin even after I consume solid food.


A suggestion if you decide to mix your own maltodextrin concoction:I've been mixing pure whey isolate, maltodextrin, and flax oil. I have added peanut butter at times, but that's beside the point. Anyway . . . I've found the taste is easier to tolerate if I mix it in a blender with ice. HOWEVER, if you decide to mix in flavor packets, it gets REALLY foamy. So foamy I wouldn't want to drink it because of all the air bubbles. Your drink with the aminos will probably taste even worse than mine, but if you can chase it with something tasty, you'll be fine.


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## Moises

npearce,Thanks for the advice. It was from you that I got the idea to buy maltodextrin. I've stocked up on the stuff but I haven't tried it yet.Day 16Yesterday was a big improvement in the diarrhea department. Only two BMs and only one was mucus. It was a real pleasure spending my day outside the bathroom.Burping yesterday was moderate.Last might at 2am there was some burping and I fell back asleep.


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## Moises

Day 17Yesterday there were about 5 BMs. Most of them were a small amount of mucus. Yesterday had moderate burping as did last night.A couple of items that I didn't mention on previous days. About 3 days ago I noticed that the skin on the small webs between the fingers of miy right hand were very dry and flakey. The next day the skin there was red and irritated. This occurred with the onset of very cold weather (in the 20s F.) here in New York. But I have never had that occur in the past during the cold weather. It might be related to the extremely low fat content of the Vivonex diet.The other item is rather humorous. I had been waiting for it to occur because it has occurred when I have started other restrictive diets in the past. Two or three nights ago I dreamt that I was with my family at a restaurant and my son asked for french fried potatoes. I went behind the counter to scoop some in a bowl for him. On the way back to our table I unconsciously popped a few in my mouth. As soon as I swallowed, I thought, "Oh my god!!! I still have 3 days left to go on my Vivonex diet! I am not allowed to eat food yet; what have I done? All those days of misery and all that money was for nought because of this single lapse. Woe is me!" Then I quickly rationalized my action. "Oh well, at least I completed the 14 days that Pimentel recommends, so it's not so bad. It wasn't a complete waste." Then I woke up.


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## Moises

Day 18Weight 167.75Yesterday I got out of bed around 7am and fell asleep around 7:20pm.In between I had moderate burping. I had a morning BM that was only mucus. In the afternoon I had an extremely urgent explosive BM that was totally liquid. I had another liquid BM in the evening that was liquid but less volume and not urgent.The diarrhea really wiped me out.This morning between 5 and 5:45 am I had 4 BMs all mucus.My provisional thoughts on the results of my Vivonex regimen so far are as follows:It could be that my problems have nothing to do with SIBO. But I will assume, for the moment, that SIBO is the explanation of my symptoms.My primary symptom is burping. This is not a common symptom among sufferers of IBS and among those who do complain of burping, few of them identify it as their primary symptom. I am not trained in medicine so whatever I say here is speculative. Unfortunately, the entire field of IBS studies is rather chaotic, so even what the experts say is speculative.Since I am assuming SIBO explains my symptoms, I assume that my burping is not from swallowing air. SIBO theory would state that I burp because small intestinal bacteria are generating gases. Some of these gases pass out of the lumen and are absorbed into the body. But the volume of gas produced exceeds the absorptive capacity of the lumen so some of this gas must exit the body by other means.Some of the gas travels downward and is released as flatulence. Some of the gas travels upward, into the stomach, and is released during eructation. Why is eructation an uncommon symptom while flatulence is not? My speculative answer is that, according to SIBO theory, ileal and jejunal bacterial overgrowth is common while duodenal bacterial overgrowth is uncommon. Since peristalsis proceeds from higher to lower, it is unusual for gas to be released orally as eructation. This would happen, however, when the infection occurs higher up in the small intestine.The above explanation would also explain why, thus far, Vivonex has not proved effective for me. Pimentel reported in his book that clinically he finds Vivonex to be effective in almost 90% of his IBS patients. He also reported the results of other researchers who found that only 11% or 12% of IBS patients have bacterial overgrowth in their duodenum. Put another way, almost 90% of IBS patients have their SIBO limited to their ileum and jejunum.According to SIBO theory, one would expect Vivonex to work for all IBS patients with SIBO in their ileum and jejunum because Vivonex is predigested and absorption occurs in the duodenum, above the jejunum and ileum. One would expect that IBS patients with duodenal overgrowth would not be benefited by Vivonex because Vivonex is absorbed in the duodenum. So Vivonex would feed duodenal bacteria. One might also expect that burping is a symptom more commonly associated with duodenal infection higher up in the intestinal tract.My results thus far with Vivonex have been that I have had a lot of mucus BMs. This is not a problem I have when I eat my regular low-carbohydrate diet. At first, I hoped the mucus was a "die-off" reaction as the bacteria were starved to death by the Vivonex. But I now speculate that the mucus is an inflammatory reaction caused by the carbohydrates in the Vivonex which feed the duodenal bacteria causing my duodenal cells to secrete lots of mucus to protect themselves from the bacterial infection.In conclusion, my symptoms might have nothing to do with SIBO. But if they are explained by SIBO, then perhaps I have a duodenal infection. If I have a duodenal infection, then orally consumed Vivonex would not be an effective treatment for me. The only hope for eradicating a duodenal infection would be antibiotics or perhaps total parenteral nutrition, where nutrients are supplied intravenously, bypassing the intestinal tract completely and starving bacteria in the intestinal tract.


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## cynthia

Moises,EXACTLY. I believe that the symptom of burping, and the fact that the bacteria is not eradicated by Vivovnex, is because the SIBO is in the duodenum while most other cases of SIBO are lower down in the small intestine.With regard to killing duodenumal bacteria, do you know anything about intravenous feeding? How does the body get its nutrition? Is the small intestine totally out of the picture with intravenous feeding?


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## Moises

Cynthia,Intravenous feeding (total parenteral nutrition, or TPN) takes the entire gut out of the picture. Nutrients are put directly into the bloodstream. Under normal eating, the digestive system is a means to deliver nutrition to the bloodstream.My statement about TPN being a way to eradicate a duodenal infection was the result of my speculative musings. It stands to reason that if an Elemental Diet starves bacteria below the duodenum, TPN would starve all bacteria. But, to my knowledge, no physician would put me on TPN to cure my burping. Furthermore, I haven't done the research (yet) to figure out how much time you need on an IV to get your daily nutritional needs met. I can't imagine an insurance company paying for a 3-week stay in a hospital solely to get IV nutrition.If there is a way to get TPN at home and still live an active life, it sounds like a possibility.


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## Nanobug

> quote:If there is a way to get TPN at home and still live an active life, it sounds like a possibility.


Wouldn't a strong course of non-absorbable antibiotics be a better start?


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## Moises

> quote:Originally posted by Nanobug:
> 
> 
> 
> quote:If there is a way to get TPN at home and still live an active life, it sounds like a possibility.
> 
> 
> 
> Wouldn't a strong course of non-absorbable antibiotics be a better start?
Click to expand...

Of course. The question arises, what if someone tests postive on the breath test after taking the course of antibiotics. In my case, I took 400 mg rifaximin 3 times/day. I don't know what the status of Cynthia's son is with respect to rifaximin.


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## cynthia

Nanobug,The problem with doing antibiotics alone is that while the antibiotic is killing the bacteria, the next meal is feeding it. So the net result is that one's bacteria remains constant. With bacteria that's lower in the small intestine, Pimental's (or Gottshall's) diet can be incorporated so that nothing is feeding the bacteria while the antibiotic is doing its work.


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## Nanobug

> quote:In my case, I took 400 mg rifaximin 3 times/day.


That's the standard. I said *strong!*







Or maybe a combo of antibiotics, similar to what one does with H. pylori eradication?


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## Nanobug

> quote:The problem with doing antibiotics alone is that while the antibiotic is killing the bacteria, the next meal is feeding it


That is the reason Pimentel suggests the use of a prokinetic agent like Zelnorm, no?In any case, there's always the possibility of the problem being aerophagia.


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## Moises

Day 19Weight 169.0Yesterday there were 7 BMs. Moderate burping. Sleep disturbed by burping.This morning was the end of my Vivonex Plus regimen Phase I. I have exhausted my Vivonex supply.Today I began what I hope will be three days of home-made Vivonex. The stuff was awful. I don't know what tastes so bad: the maltodextrin, the free-form amino acids, or maybe something else. I threw in 1/2 teaspoon of free-form arginine per meal. I know that stuff is nasty tasting. To be honest, I just hope I can swallow this stuff for three days. I wasn't planning on using them, but I have lots of extra Vivonex flavor packs left over and I am just pouring them into my disgusting concoction. I thought it would be fun to play mad scientist. But drinking this stuff is tough.Conclusions with respect to VivonexSince last night was my last Vivonex "feeding," I feel it is appropriate to sum up my experience.Fortunately, some of my biggest fears never came to pass. I was concerned that the taste would be so bad that I wouldn't be able to consume the Vivonex. That is a problem I am facing with my current concoction but the Vivonex was palatable enough. As others have pointed out, it has a smooth consistency and goes down OK. After a week or so, I decided to reduce the flavor packets to half the suggested amount. And the stuff was still palatable.Another fear I had was that I would get a cold, flu, fever, or headaches. Fortunately, that did not happen. Now for the downside. First, it is important to understand that I went into the Vivonex diet with years of eating 72 mg or fewer of carbohydrate per day (excluding fiber). About 10 days prior to commencing Vivonex I really upped my carb intake. But I was still eating a large portion of meat at every meal up until Vivonex day 1. I believe that Vivonex was spiking my blood sugar and then sending it way low. I am not accustomed to eating that many carbs without a heavy dose of fat and protein to buffer it.Throughout the regimen I felt tired, shaky, and less able to focus on complex tasks. Digestively, I had burping, diarrhea, flatulence, and mucus throughout the course of Vivonex.One additional comment: Vivonex comes in foil packets. You must purchase packets to flavor the Vivonex separately. About 5 of the flavor packets had to be discarded because the contents were not a smooth-flowing powder but a solid block. Novartis must be having some quality control problems in their production process. Since I had lots of extra packets, this was not a show-stopper.


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## Moises

Day 20Weight 166.75Yesterday had 5 BMs. Moderate burping. This new mix certainly satisfies my hunger. With Vivonex, an hour before mealtime I was usually feeling hungry. Not with my current regimen.Last night was a particularly bad night. I was awake a lot with feelings of pressure that would be relieved temporarily with burping and then return.I now have the flavoring down for my homemade Vivonex. I use two Vivonex flavor packets per meal. I am back to holding my nose as I drink my meals. But it's much easier to take. I imagine in a few days, if I were to continue that long, I would stop holding my nose.My homemade mix is not thick like Vivonex. It's watery, like punch. I think the amino acids are what smell so nasty. When I was mixing today's meals last night I only noticed a problematic odor when I was adding the aminos.I think that MCT oil solidifies at colder temperatures. My wife keeps the safflower oil in the refrigerator and it stays in liquid form. MCT oil is derived from coconut oil and I know that coconut oil solidifies right around room temperature. So MCT oil wasn't such a great idea for a drink that I keep refrigerated. But I am still using it.Today I have a lot more flatulence than usual, occasionally it is foul-smelling. I have noticed that my 3 BMs so far today were mucus-free. On the brand-name Vivonex I always had mucus.


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## Moises

Day 21Weight 166.0Yesterday 6 BMs. Some mucus. Moderate burping. Some sleep disturbance.Today I didn't want to drink my breakfast but I forced myself to get it down. For lunch and dinner, I am not going to force myself to drink the full amount, if I don't want it. Today's the last day, so I am not concerned if I go to be hungry.


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## Moises

ConclusionYesterday was day 21. This morning I ate my first meal of real food in three weeks. Then I went to the gym, worked out, and weighed myself. I was 163.5 pounds.My provisional conclusion is that Vivonex did not help. I did not get a breath test before or after. But my burping problem remains.I am not planning on taking Zelnorm.My conclusion is provisional because Pimentel measures subjective improvement 1 month after the cessation of Vivonex. So I will report my final conclusion in one month.I have no further plans regarding Pimentel's protocol. It's possible someday in the future I would get a lactulose breath test. But I will, for the moment, go back to my GI who does not view SIBO theory as legitimate.


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## cynthia

Moises,Even though you're thinking the ultimate results may not be promising, I still want to congratulate you for getting through this. The vivonex protocol and then your own follow up were incredibly difficult to handle. But you did it and even if it proves not to be the answer for your problems, you'll always know that you tried. And of course, who knows - maybe in another month you'll feel much better.


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## Moises

> quote:Originally posted by cynthia:Moises,Even though you're thinking the ultimate results may not be promising, I still want to congratulate you for getting through this. The vivonex protocol and then your own follow up were incredibly difficult to handle. But you did it and even if it proves not to be the answer for your problems, you'll always know that you tried. And of course, who knows - maybe in another month you'll feel much better.


Cynthia,Thanks for your kind words. I am reminded of the justifiably-maligned G. Gordon Liddy's quotation of Nietzsche: "That which does not destroy me makes me stronger."I have an experimentalist view of life. I am going to test lots of things. Those that work, I preserve. Those that don't, I discard.Ruling something in or out _a priori_, i.e., before testing it experimentally, is not, in my opinion, a useful strategy for living.Of course, testing has its costs--both in dollars and discomfort. We each must decide for ourselves how much we will risk for how much potential reward.


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## Nanobug

> quote:Ruling something in or out a priori, i.e., before testing it experimentally, is not, in my opinion, a useful strategy for living.


This is exactly my philosophy too. In my opinion, life is too short for us to be waiting for the Whole Truth(tm) before doing anything. If our ancestors had decided to wait instead of taking chances, I'm pretty sure no one would be here today.To explore is our heritage and our destiny, whether we do it with our own selves or whe reaching to the starts.


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## flux

> quote: I assume that my burping is not from swallowing air.


In general, this assumption is off the wall wrong. Burping does not appear to be related to swallowed air either. It's just a contraction of the longitudinal muscle of the esophagus and it forces open the upper esophageal sphincter. There happens to be dead space air (air as in atmospheric air) in the area and that does get pushed out.


> quote: SIBO theory would state that I burp because small intestinal bacteria are generating gases. Some of these gases pass out of the lumen and are absorbed into the body. But the volume of gas produced exceeds the absorptive capacity of the lumen so some of this gas must exit the body by other means.


The bacteria in the colon outnumber the bacteria in SIBO, probably 1000 to 1. And the bacteria in the colon don't produce that much gas. Of course, there'd more substrate available to small intestinal bacteria, but by and large, people who have proven SIBO do not have gas a major symptom and certainly not burping.


> quote:Some of the gas travels upward, into the stomach, and is released during eructation.


There's no evidence gas can travel upward to the stomach. In general, things move downward.


> quote:Why is eructation an uncommon symptom while flatulence is not? My speculative answer is that, according to SIBO theory, ileal and jejunal bacterial overgrowth is common while duodenal bacterial overgrowth is uncommon.


There's a simpler explanation and that is the premise is false. Flatulence in excess is as uncommon as belching and probably even more so. Over the last decade, I think I've seen about two dozen or so posters who had could be documented as excess flatulence. That makes for a super rare condition.


> quote:But, to my knowledge, no physician would put me on TPN to cure my burping.


Hopefully, not. Putting you on TPN to cure a problem that is not even related to gut bacteria is nuts.









> quote:If there is a way to get TPN at home and still live an active life, it sounds like a possibility.


TPN will put you in the hospital on at least some semi-regular basis and you can even die. This is due to infections that occur related to the method by which the nutrients are delivered. *You'd be sicker on TPN than you would be off it.*


> quote:go back to my GI who does not view SIBO theory as legitimate.


He's right.


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## Kathleen M.

They usually do TPN when the alternative is death, not discomfort or life quality.A friend of mine had to have that when pregnant because she literally could not eat anything at all. Every single thing that went down came back up and she was losing so much weight from not being able to eat (how they knew for a fact she couldn't eat) while pregnant that both she and the baby might not survive to full term.Even with it she had to try to eat something every single day. The moment she could eat and keep things down they took it out because they didn't like the risks of infection and other complications for one day longer than necessary. I'm almost totally sure they won't do it for something that is a quality of life issue like burping.K.


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## Pete

Moises,I would listen to flux as he does seem to know more then any GI. Flux,My question for you is this. I know you consider excess flatus rare, but at the same time you know I had it and have cured it through antibiotics and probiotics. The burping is the symptom I have yet been able to totally overcome. In your post to Moises you explain your opinion to the cause of burping. I have kept in contact with other people who have the burping problem. Some were cured by nexium, others by antibiotics, one by baclofen, and another by zoloft. Do these cures make sense to you? Even more interesting is a case of constant burping that tried everything. Finally he had a botox injection to his pyloris that cured him for 5 months. After that the burping came back. 2nd injection cured him for 3 months. The last injection didn't work. My question is why do you think scientifically that botox cured him temporarily. Second, why did it lose its effect over time? Do our bodies develop antibodies against the toxin?Thanks Flux. I for one value your knowledge.Pete


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## Kathleen M.

I think I've heard for other medical issues that sometimes the botox becomes less effective over time. It might have to do with the immune system.K.


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## 17908

I have an uncle that has had to live strictly on TPN for the last 15 years or so. He is in the hospital once or twice a year for checkups and/or infections from the TPN site. He recently had to retire early because his health just isn't what it should be.So it is possible to live at home with TPN, but after seeing what my uncle goes through, I would not recommend it. Many doctors have been amazed he has lived this long.On the subject of gas from SIBO/IBS: My gas always seems to build up and make me feel bloated and pretty terrible, then it eventually just disipates in my body (or something like that), because I don't seem to burp or fart all that much. Of course the antibiotics have improved these symptoms DRAMATICALLY.


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## Moises

At a holiday party yesterday afternoon I spoke to a nurse who often works in the geriatrics word. She confirmed that my speculation regarding TPN was not a viable option.Flux's argument about the relative bacterial populations of the small and large intestines is compelling. One could alRegarding Flux's comments about flatulence: In June 2006 I documented by symptoms over a Friday, Monday and Tuesday. The averages were 81 farts/day and 1063 burps/day. This was a difficult period for me and I believe that these represent higher than normal numbers for me.But something is generating that gas since I do not believe it is aerophagia. I also have measurable abdominal distension at times. If it's not generated in the small intestine, then it's gastrically generated.


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## 17908

I burp less now than I did before the antibiotics. My wife would agree.


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## 13840

> quote:Originally posted by npearce: Of course the antibiotics have improved these symptoms DRAMATICALLY.


Which antibiotic did you take?


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## 17908

Days 1-20 (1200mg Xifaxan)Days 11-20 (1500mg neomycin . . . I think that's the right dosage . . . 3 pills a day)


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## flux

> quote:Some were cured by nexium, others by antibiotics, one by baclofen, and another by zoloft. Do these cures make sense to you?


We don't know for sure that they have been cured by these interventions? It may have just been coincidence. For the case of pure supragastric belches (not involving the stomach), I can't imagine any reason for the Nexium or antibiotics. For the gas of gastric belches, then perhaps the Nexium reduced episodes of reflux and reflux does appear to be associated in some people who have gastric belches (and who are also swallowing excess air).


> quote:My question is why do you think scientifically that botox cured him temporarily. Second, why did it lose its effect over time? Do our bodies develop antibodies against the toxin?


If the botox doesn't cause permanent structural changes (which it appears not to do), it will eventually be metabolized by the body and the body will regain its normal (in this abnormal) functioning. And as K said, the immune system can get involved--developing antibodies to it.


> quote:One could al


...so argue?


> quote:Regarding Flux's comments about flatulence: In June 2006


What were you trying to tell us that it's gone down signficantly since?


> quote:But something is generating that gas since I do not believe it is aerophagia. I also have measurable abdominal distension at times. If it's not generated in the small intestine, then it's gastrically generated.


 I think it's pretty obvious that air from the atmosphere is the culprit in your case. The whole SIBO/Vivonex experiment was just a straw man. There was once was a guy who actually gas bacterially generated in this fashion. The intestine was so full of bacteria, it actually obstructed the intestinal lumen: http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum


> quote:I burp less now than I did before the antibiotics. My wife would agree.


But were the antibiotics responsible?


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## 13840

> quote:Originally posted by npearceays 1-20 (1200mg Xifaxan)Days 11-20 (1500mg neomycin . . . I think that's the right dosage . . . 3 pills a day)


Did both work or just one? Sorry I'm asking so many questions but I'm trying to find out if my problem is related to SIBO but I'm c and most people seem to be d. Kinda frustrating.


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## SpAsMaN*

Flux said:


> quote:There was once was a guy who actually gas bacterially generated in this fashion. The intestine was so full of bacteria, it actually obstructed the intestinal lumen: http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum


Do you think it's the only explanation for loud fart?I mean i have to ask about loud fart.Perhaps it's just IBS.


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## flux

> quoteo you think it's the only explanation for loud fart?I


Nothing to do with bacteria. Remember, gas can be air. Sound is from vibration, so it is probably vibrating the walls of the anal canal, possibly because they are only partially, not completely relaxed and that creates turbulence as the gas moves past. Also dependent factors are the amount and force of gas motion and the shape of the anal canal are involved.


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## SpAsMaN*

> quote:Sound is from vibration, so it is probably vibrating the walls of the anal canal,


"Normal people" get that too so it isn't a cause of IBS.I would rather point finger ### big volume of gas released spontaneously from an entrapped bowel.


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## Pete

Flux,You're a smart guy but air from the atmosphere? Why would one just start swallowing air one day? Sounds like a load of #### to me.


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## flux

> quote:Why would one just start swallowing air one day?


The same way any other disease starts. Something, somewhere changed. I don't know what it is, but there's no reason why this should be different.By the way, I didn't exactly say it was from swallowing per se. I don't know how it would happen though it doesn't appear to be related to the ordinary clinical notion of "aerophagia", but that the gas is room air is pretty obvious from what's been posted. And it would easy to prove by measuring the flatus gas and having it analyzed.*It would have made a lot more sense to have testing on the nature of the gas done first rather than embark on a complex diet that assumes the less likely hypothesis.*


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## 17908

> quote:Originally posted by dancechick:
> 
> 
> 
> quote:Originally posted by npearceays 1-20 (1200mg Xifaxan)Days 11-20 (1500mg neomycin . . . I think that's the right dosage . . . 3 pills a day)
> 
> 
> 
> Did both work or just one? Sorry I'm asking so many questions but I'm trying to find out if my problem is related to SIBO but I'm c and most people seem to be d. Kinda frustrating.
Click to expand...

I felt about 75% releif from symptoms after 10 days of just Xifaxan. I then took 10 more days of Xifaxan and neomycin, which resulted in about 90% relief from symptoms. I've been using 6 mg of Zelnorm ever since. I feel the Zelnorm really helps with the "sluggish digestion" I felt before the antibiotics. Overall, I truly have noticed relief, but I still have occasional symptoms. Luckily my morning problems are all but gone. They were the worst symptoms for me (bloating, sluggish feeling digestion, etc.).


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## Nanobug

> quote:but I still have occasional symptoms


Remember those abnormal liver enzymes? Have you had the chance to retest?


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## eric

npearce Were you diagnosed with sibo and what tests did they use?Were you also diagnosed with IBS?Was it the same doctor?What symptoms did you have? What symptoms have improved?


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## 17908

> quote:Originally posted by Nanobug:
> 
> 
> 
> quote:but I still have occasional symptoms
> 
> 
> 
> Remember those abnormal liver enzymes? Have you had the chance to retest?
Click to expand...

No. I haven't retested yet. It might be a little while. That would be pretty cool if they were down, because they've been up for a while.


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## 17908

> quote:Originally posted by eric:npearce Were you diagnosed with sibo and what tests did they use?Were you also diagnosed with IBS?Was it the same doctor?What symptoms did you have? What symptoms have improved?


I was never diagnosed with SIBO. I live in the boonies, and I'd have to travel at least 4 hours to get a breath test. After reading Pimental's book, I talked to my regular doc (not my GI) and he agreed the antibiotic approach was worth a try.I was also never diagnosed with IBS. I was originally diagnosed with colitis. They thought it was either Crohn's or Ulcerative Colitis, but they couldn't tell from the original colonoscopy. I spent a year on several drugs related to those diseases. After no real improvement, I went to the Mayo Clinic in Minnesota. They told me the colitis was all gone, and it was likely a bad bacteria infection in my colon that caused the colitis (based on some things found in both the original colonoscopy and their follow-up). The Mayo Clinic also told me my symptoms that I continued to have (which were slightly different than when I had colitis) were likely a result of the bacteria (or some other toxin) aggravating my small intestine. Because I was extremely healthy otherwise, they said they'd treat me like I had IBS. That basically meant they sent me home with information on eating to avoid gas and stuff.My symptoms from colitis were: terrible D, some blood in stool, "sluggish" digestion, bloating, and weight loss (probably from being so picky with what I ate, because everything gave me D it seemed like).My symptoms after the colitis seemed to have gone away: constant loose stools with occasional D, gas and bloating, stomach pain and pressure, and a terribly "sluggish" feeling with regards to my digestion. Every morning I woke up feeling like I had a HUGE meal still sitting in my stomach, and I had terrible bloating.All symptoms have improved. The sluggish digestion is gone entirely. The bloating is 90% gone, and the loose stools are much improved. I don't go to the bathroom near as often anymore (maybe 2 or 3 times a day, compared to 6 to 20 before).I hope things continue like this. I should also note that I'm following Pimental's diet regimen, which I feel helps quite a bit.


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## 20415

> quote:Originally posted by Moises:ConclusionYesterday was day 21. This morning I ate my first meal of real food in three weeks. Then I went to the gym, worked out, and weighed myself. I was 163.5 pounds.My provisional conclusion is that Vivonex did not help. I did not get a breath test before or after. But my burping problem remains.I am not planning on taking Zelnorm.My conclusion is provisional because Pimentel measures subjective improvement 1 month after the cessation of Vivonex. So I will report my final conclusion in one month.I have no further plans regarding Pimentel's protocol. It's possible someday in the future I would get a lactulose breath test. But I will, for the moment, go back to my GI who does not view SIBO theory as legitimate.


If your GI does not view SIBO theory as legitimate, I'd recommend suggesting to your GI to go back to medical school for a 2nd time, not drink alcohol heavily while in medical school, and subscribe to things called medical journalsmaybe then he or she will be a remotely effective doctor


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## Moises

> quote:Originally posted by bookie12348:
> 
> 
> 
> quote:Originally posted by Moises:ConclusionYesterday was day 21. This morning I ate my first meal of real food in three weeks. Then I went to the gym, worked out, and weighed myself. I was 163.5 pounds.My provisional conclusion is that Vivonex did not help. I did not get a breath test before or after. But my burping problem remains.I am not planning on taking Zelnorm.My conclusion is provisional because Pimentel measures subjective improvement 1 month after the cessation of Vivonex. So I will report my final conclusion in one month.I have no further plans regarding Pimentel's protocol. It's possible someday in the future I would get a lactulose breath test. But I will, for the moment, go back to my GI who does not view SIBO theory as legitimate.
> 
> 
> 
> If your GI does not view SIBO theory as legitimate, I'd recommend suggesting to your GI to go back to medical school for a 2nd time, not drink alcohol heavily while in medical school, and subscribe to things called medical journalsmaybe then he or she will be a remotely effective doctor
Click to expand...

My GI publishes to things called medical journals. I think rather harsh to accuse an opponent of SIBO theory of being an alcohol addict solely on the basis of her opposition to SIBO theory. I think that reasonable people can disagree about SIBO. The evidence published in those journals is not univocal. Personally, I have no a priori commitment to any viewpoint since neither my reputation nor my personal finances depend on the verification or falsification of SIBO. My only interest is in ameliorating the IBS experienced by so many.You appear to have some very strong feelings about SIBO. Have you been helped by Pimentel's protocol or do you know people who have been helped?


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## Rick (never give up)

Hi Moises, hope you had happy holidays.I was wondering how are you doing after the Vivonex. I still feel the same as before, but without the heavy bloating I used to have. I'm going to my GI next Monday, so I'm collecting stories to tell him.Bye.


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## 14389

Hi all,Can anyone recommend a good doctor in Phoenix, AZ where I can get the Sibo test done? Thanks in advance!


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## eric

Moises well said. Deathwish You might try calling the Mayo Clinic in Scottsdale perhaps.http://www.mayoclinic.org/scottsdale/


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## Moises

> quote:Originally posted by Moises:ConclusionYesterday was day 21. This morning I ate my first meal of real food in three weeks. Then I went to the gym, worked out, and weighed myself. I was 163.5 pounds.My provisional conclusion is that Vivonex did not help. I did not get a breath test before or after. But my burping problem remains.I am not planning on taking Zelnorm.My conclusion is provisional because Pimentel measures subjective improvement 1 month after the cessation of Vivonex. So I will report my final conclusion in one month.I have no further plans regarding Pimentel's protocol. It's possible someday in the future I would get a lactulose breath test. But I will, for the moment, go back to my GI who does not view SIBO theory as legitimate.


My provisional conclusion has held. I have just as many symptoms now as before the Vivonex.My GI's office is in total disarray and I have been unable to book an appointment. Be that as it may, I can state with confidence one month after completing my Vivonex diet that Vivonex did not help.


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## flux

> quote:I have just as many symptoms now as before the Vivonex.





> quote:I can state with confidence one month after completing my Vivonex diet that Vivonex did not help.


The expected result if the gas is from atmosphere.


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