# My Xifaxan Log



## Moises

In the spirit of Surfboar and others I have decided to keep on online log of my first attempt to treat my IBS with antibiotics.I will be taking 2 Xifaxan tablets, three times a day. That is, 400 mg. t.i.d. There was some research showing that symptom relief was dose dependent and higher doses yielded greater relief.I am 50 years old. I've had my IBS problems prior to being a teen-ager. I do remember getting serious food poisoning when I was 9 or 10. I am not sure whether that food poisoning was what Pimentel calls the "heralding event" of my IBS or not. The symptom that has bothered me most for more than 20 years is belching, AKA burping or eructation. I know that this is not a very common problem and few people on this board view it as their pimary complaint.More than 10 years ago I tried Elaine Gottschall's Specific Carbohydrate Diet. It represented a radical shift in my near-vegetarian dietary habits. It did not help me. But it forced me to increase my meat consumption. It then got me experimenting. I found that if I eliminated almost all my carbohydrates, my lifelong diarrhea was eliminated (pun intended) almost completely.This was good. But the problem was that I had never identified diarrhea as my primary sympton. However, it nice to no longer have 10 BMs a day and it was nice to no longer have mucus in my stool. Nevertheless, my belching continued. Also, when my symptoms were really bad I get abdominal distension as well.More than a month ago I read short news item in Prevention magazine about Rifaximin (Xifaxan) being helpful for a number of digestive ailments. This got me to do some research and eventually to read Pimentel's book and look at some of his research.Much of his theory is similar to Elaine Gottschall's, namely that undigested or partially digested carbohydrates in the small intestine serve to feed a bacterial overgrowth there. My initial reaction was scepticism because I had followed Gottschall's diet rigorously for more than a month with no benefit. However, I have seen patients' accounts on the internet saying that Pimentel told them that the Gottschall diet still requires too much food for the small intestine's bacteria.What convinced me to give Pimentel's protocol a try is that he, unlike the other gastroenterologists I have had contact with, does not diminish the significance of distension, eructation, and flatulence. If I could rid myself of these gaseous problems, I wouldn't care if I still had diarrhea, where the latter is defined as 4 or more BMs a day. Pimentel also taught me a few things that I did not get from Gottschall. First, Pimentel suggests that there may be motility disorders in the small intestine of an IBS sufferer and that this can be addressed with erythromycin or Zelnorm. Second, Pimentel suggests using antibiotics as the first means of removing bacteria from the small intestine. Third, Pimentel taught me that the elemental diet is available over the counter. From reading Gottschall, I had the impression that one could only be on the elemental diet by using a feeding tube.So I have embarked on my journey this morning by swallowing my first two Xifaxan tablets.I will have my first visit with a new gastroenterologist the first week of October. He has said he does the Quintron breath test. I don't know how familiar he is with Pimentel's research.My desired outcome is that in the next 10 days my burping and all digestive gas is reduced to normal levels. I would then see if the GI doc would still want to do the breath test. I would also ask him to put me on erythromycin or Zelnorm to maintain a health cleansing wave.If my course of Xifaxan does not alleviate my symptoms, I would very much like to get a breath test from the GI. If my breath test was positive for hydrogen-emitting bacteria in my small intestine, I would then seriously consider putting myself on the Vivonex Plus elimination diet.I am going to follow Pimentel's dietary guidelines while I am taking the Xifaxan. In one respect, I will deviate from the letter, but not the spirit of his recommendations. I bought a Yogourmet yogurt maker and I have made my own 24-hour cultured yogurt according to Gottschall's recommendations. She claims that the 24 hour culturing breaks down all the lactose in the milk. Pimentel recommends eating no yogurt but I take him to be referring to commercially available yogurt.Pimentel advises patients to eat food no more than three times per day. I will do this to enhance the effectiveness of my small intestine's cleansing wave.I hope that my experience with Xifaxan will be of some use to others considering adopting Pimentel's regimen.


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## Moises

I did not sleep well last night. I was woken at 2:00 am by a family member walking around the apartment. Then I went to urinate and had trouble sleeping because of pressure in my gut.I usually get up at 5 in the morning. But by 4:35 I couldn't sleep any more so I got up.I don't know if this is attributable to the Xifaxan or to my altered eating habits. For a couple of year I have been following advice I read in William Wolcott's Metabolic Typing book. I have found some minor relief in eating my high carb foods 30 minutes before my main meat meal. Now I am doing Pimentel's protocol so I only eat 3 times a day. So I had high-carb yogurt with my turkey lunch and I had a peeled apple and almond butter with my turkey dinner. It's possible my night-time gut discomfort was from bad food combining.I am aware that there is no scientific evidence for food combining. Nonetheless, I do think that it has been mildly beneficial for me.I suppose I should hope that Xifaxan is making me feel worse. Pimentel's book does state that the murdered bacteria give off toxins as their bacterial souls separate from their bacterial bodies. The thing is that I have read too many times that I have to feel worse before I can feel better. I've taken Nystatin and a thousand natural supplements in the past. I got lots and lots of Herxheimer reactions or die-off syndromes but the cure which was supposed to follow never materialized. I'm very susupicious when I hear that I must feel worse first as the bad guys are killed off.


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## Moises

Yesterday I went to bed late: partly because I hoped that if I was exhausted I would sleep through the night, partly because I was making more 24-hour Gottschall yogurt since that has become one of my major sources of carbs.I got up around 4:30 am. I lay in bed but my gut started bothering me with some burping and farting. I then got up around 4:50 am because it was just too uncomfortable lying in bed.There is a testimonial in Pimentel's book where the patient says that it five or six days before she had any relief. Then she said it was as if a switch was flipped and her problems were gone. Of course she was taking Neomycin in her anecdote and I am taking Xifaxan. I notice that Pimentel's dietary recommendations limit starchy carbs to 1/2 to 1 cup per meal. But he does not place a limit on Lactaid (lactase hydrolized milk). I am substituting 24-hour yogurt for Lactaid. My yogurt should be lactose-free. The yogurt I started making last night was 1 quart whole milk and 1 quart heavy cream. I can't wait to try it tomorrow. I used to make yogurt in my oven with the pilot light. But now I have an electric pilot light that does not stay on. I just bought a yogourmet yogurt maker. This is an excellent device for making Gottschall's yogurt. I makes 1/2 gallon and, unlike many other yogurt makers, it will stay on for 24 hours as Gottschall requires. I bought an extra container so that I can be eating out of one container while another batch is being cultured.


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## Pete

Moises,We have the same symptoms. I have found this antibiotic to be the only med that helps. I took 2 200mg tabs 3X a day for 2 weeks. Now I take one 200mg pill daily probably forever. I can't stop the excessive burping but it did stop the constant farting. My lower gas vanished as did abdominal distension and bloating. I do still have to stay away from sugar. Please let me know how you do.Did you find any benefit from nystatin? That was my next thing to try. You can email me if you want to chat at pmorris799###aol.comIt does get worse before it gets better with rifaximin


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## 18651

hiya pete,how long ago did you take the 2 200mg 3x a day?or, how long have you only been on the one pill a day? and how does your doc feel about an antibiotic daily? thanks...


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## Pete

I took the high dose for 2 weeks then was told to take zelnorm at night. I could not tolerate zelnorm as it gave me the runs. My doc called Pimental and he told her that his patients who have trouble with zelnorm, he puts on low dose rifaximin long term. I have taken one pill for about 8 months. I believe it is safe as it is not absorbed. I also take the probiotic vsl#3. Pimental says he honestly doens't know if probiotics help or hurt. I feel they help.


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## Moises

Pete,Thanks for responding to this. I will be in touch with you. I've never heard of anyone with my symptoms; it's a relief to know there is someone else out there that knows what it's like.Regarding your troubles with Zelnorm: in his book Pimentel says you can choose between Zelnorm and erythromycin 50 mg at bedtime. If the Zelnorm isn't satisfactory, have you tried the erythromycin? 50 mg is a very low dose. Pimentel claims that this serves the same function as Zelnorm: maintain a healthy "cleansing wave" to clear out the small intestine and prevent reinfection.I tried the vsl#3 a few years ago and didn't feel it helped me. Ten days ago I started Align, a probiotic I heard about on this board. It can only be ordered online, from the same manufacturer that makes Metamucil. It's too soon to say whether it's helping or not. Nystatin never did a thing for me. (It's named after the state we both have in common: NY.) Nor did any of the multitude of other candida-killers I've taken over the years.I am glad to hear that you feel the rifaximin has helped you. I hope that you can find some effective way to treat the burping.moises.For my daily log I have little to report. I went to bed later than I would have preferred last night due to a very busy day and suboptimal planning. I had gut discomfort in bed after 4:30 am. But when the alarm went off at 5 am I was sleeping and exhausted. I will make every effort to get to bed early tonight since I know from past experience that skimping on sleep is the best way for me to induce a cold.I had some burping this morning but nothing that was bothering me very much or interfering with my normal activities. If this keeps up, I will abandon my pre-Xifaxan habit of trying to eat my high-carb foods 30 minutes before my main meat dish. Since doing the Xifaxan protocol I have been mixing all my foods without feeling any worse for it.


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## cynthia

Moises,My son's overwhelmingly worst symptom is his upper body gas. His burping is loud and long and constant. But he says that is preferable to those times when the gas is trapped and he feels like he needs to burp but can't. When that happens he becomes nauseous and will stay that way until the gas is broken up and he can burp again.


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## Moises

> quote:Originally posted by cynthia:Moises,My son's overwhelmingly worst symptom is his upper body gas. His burping is loud and long and constant. But he says that is preferable to those times when the gas is trapped and he feels like he needs to burp but can't. When that happens he becomes nauseous and will stay that way until the gas is broken up and he can burp again.


Cynthia,OK. I can sympathize. When I have it bad I can burp for hours (see my post titled: "What are your gassy statistics.") I'm sorry that the Vivonex didn't help him. I do find it worrying that Pete, who was helped significantly by Xifaxan, did not have his burping problem improve.I have always felt that there was a common cause to my eructation and flatulence. In Pete's case, it appears, there was not, since his flatulence normalized but his eructation did not. Perhaps upper gas is generated by a different mechanism.


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## cynthia

Is it possible that the bacteria that is causing the upper body gas (probably in the upper portion of the small intestine) is more difficult to get rid of? I would think it's getting fed more readily than bacteria further down in the SI even if your not on SCD.


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## Moises

Cynthia,It seems as if there are a few issues. First, it's not clear how many people with IBS actually have a bacterial overgrowth in their small intestine as the cause of their problem. Second, it's not clear how accurate the breath test is at diagnosing a bacterial overgrowth.Third, it's not clear how effective rifaxamin, neomycin, augmentin, Vivonex, and other interventions are at eliminating bacterial overgrowth. Fourth, it's not clear exactly what role motility plays in IBS symptoms and bacterial overgrowth.Fifth, it's not clear how, if there are motility disorders, they can be ameliorated.This line of investigation still appears to be in its infancy. Pimentel seems to be doing what he can to push it into the forefront and get more people researching it. By publishing his book he has gotten the attention of lay people like myself, who are now demanding his protocol from their own physicians. But right now your son, the people on this board, and I are guinea pigs in an experiment, the conclusions of which are not foregone. In the long run, I have a high degree of confidence that medical science will know a lot more about our problem. But I can't wait for the long run, so I roll the dice today and take my chances.From other postings it appears as if the results are mixed. There clearly are other factor(s) that are not yet understood. That's not a very satisfying answer but the truth is often not very satisfying. People don't want to buy books and lay out big bucks to see someone who tells them there's a lot we don't understand and a lot of uncertainty in this field.My log for today:It is unusual for me to get out of bed early this often during the week. I am getting very tired. This morning I had cramps and burping and farting and got up, rather fatigued, around 4:35 am. I can feel the pressure in my sinuses building. After breakfast I went to the gym where my burping continued. Not a good morning.This is the beginning of day 5. I am ripe and ready for the switch to be flipped tomorrow morning, the sun to shine through my window, the veil to be lifted, and me to wake up born again, the first day of my new life with a gas-free stomach and a bacteria-free duodenum, jejunum, and ileum.In the meantime I can fantasize that this morning's burping was the last gasp surrendered by the most resistant platoon of jejunal bacterial holdouts in their final death throes. I expect to flush them down the toilet in the next day or so. As I watch their lifeless carcasses spiral rapidly down towards their burial among the sewage, I will think to myself, "If only they had chosen to work for good, in the large intestine, instead of for evil, in the small intestine. Goodbye and good riddance."


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## Moises

On second thought, with dinner last night I had mashed, boiled, new, organic potatoes with butter. They had the skins on them. It was just about a cup, I think, when mashed. Maybe that was the problem. Maybe the skins had too much residue. And maybe even if there were no skins, that was just too much starch for one meal.


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## 18651

thanks for the info pete...i am only on one 200mg 3 x a day. my dr was closed today so on monday i will call and ask if he can place me on the 400 mg 3x a day. i'm on day 5 and i see no difference, maybe even worse bloating and belching. and now i'm more constipated. i've though if this didn't work i would try a food elimination diet for two weeks. any input?


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## Moises

Another not so good night. Woke up at 3:30 am with burping. Had burping throughout the day.I am starting to think that Xifaxan is not going to help me. I will continue to finish the course, however.


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## cynthia

Moises, Is your burping at all different from the way it was before you started taking the Xifaxan?


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## Pete

I was worse for probably a week after starting


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## Moises

Hi Cynthia and Pete,What's so tough about this stuff is that my IBS symptoms go through periods of flare-up and periods of, not remissions, but milder symptoms.I am still having my sleep disturbed in the early morning hours and I am still having burping throughout the day. I was tracking my symptom severity for a week prior to initiating the Xifaxan and my symptoms have not changed. But I am not in a period of severe burping, flatulence and distension. I think that the three days in my "What are your gassy statistics" link given above must have been a period when my symptoms were quite high on the severity scale.It's very difficult to count burps throughout the day. It took a lot of discipline to do that. Otherwise, I would track my burping for much more than 3 days.


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## cynthia

One of the things I find so frustrating about monitoring symptoms with my son is that we never know if a sudden abundance of gas means that his bacteria has just been fed or if it means that whatever treatment we happen to be using at that time is killing off bacteria. Is this a problem for others?


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## 18651

calling the doctor tomorrow to see if he'll double my dose. i have noticed a tremendous increase in burping and farting. but i am also constipated despite all the laxative type stuff i take.pete, when you say stay away from sugar, do you mean added sugar like sweets, or natural sugar like fruit?


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## Moises

I think I am moving into a flare-up mode. Burping severity increased noticeably Sunday afternoon. My entire night was disturbed and uncomfortable, not merely the early morning hours as it has been the last week.And I woke up bloated and there is bloat and burping constantly after waking.


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## 18651

well, tomorrow starts my 14 days of 400 mg 3x a day. my doc gave me samples, 84 freakin pills in two huge bags, thank God for that. but he says, now annie, this might not work. i know this but i'm almost to the point where if someone said snorting ritalin would help, i would be thinking about trying it. sad huh? moises, any switch flipped yet? i am still burping CONSTANTLY and as if i've just guzzled a millers or something.


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## cynthia

Annie,Have you been taking Xifaxan for the last week or so? And now you're going to be taking the same for the next 2 weeks but at a higher dose - Is that right? I was looking back at posts and trying to get it straight - For the last week or so I see you said you've been real gassy. But have you been gassier than you were before you started the meds? Sorry for all the questions. And I'm really hoping you'll see your gas just disappear with this next round. Please let us know how you're doing.Cynthia


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## 19462

Annie,I was on Xifaxan for about 1 1/2 months. It was just so bad in so much pain so much trapped gas. Told dr. gas pains were so bad felt like I had swallowed a small dagger. The pain was so intense. I was missing more and more time from work.After being on the Xifaxian things are 90% improved. Life is actually good again.I told my dr. that I was just in such intense pain and misery if he told me to eat mud and it would clear up my problems. I would have asked hot/cold how much and how many times per day.I can so relate to your message.Hope you find relief soon.Deborah


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## Moises

Deborah,I am heartened to hear of your 90% improvement with Xifaxan. It's my wish that others can get some hope from your experience.Were you taking 400 mg three times a day?How long before you saw improvement?Did you take any breath tests or other tests?Back to my log:I was gassy last night before bed. I was gassy during my sleep time. And I woke up with some distension burping and farting.I had loose stools for 2 of 3 BMs in the morning.I went to the doctor's office for an echocardiogram. The technician never showed up so I went across the street to have it done at the hospital.It's a sonogram. So I have to lie on a bed in a dark room while for more than 30 minutes the technician has her arm on my chest and her torso leaning against my back. She's pointing the transducer at my heart but she could feel every burp as it migrated up and out of me. And the whole time there was the good old borborygmus--perhaps my favorite word--or rumbling of gut. I was very uncomfortable lying there feeling the pressure growing in my gut.Today is day 9. Pimentel recommends a 10-day course. If I were a betting man, which I am not, I would bet that I will not show any improvement at the end of 10 days. I have enough Xifaxan for about 16 days. So I will continue using up the Xifaxan that I have. But my assessment so far is that Xifaxan has not improved my IBS symptoms. My results so far are consistent with the results that Pimentel got: the majority of subjects in his experiments did not show improvement.


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## Pete

I think you will find your gut feels much better after you are off xifaxin. For example, I know someone who did the Vivonex Diet for 21 days. He felt like hell for probably 30 days then went into a 9 month remission. Right now there is a war going on inside you GI tract. My only advice is after day 16 when you are all done, it would be a good idea to get a breath test(if possible) to see if you are still positive. If still positive, then you should combine rifaximin and neomycin for another 2 weeks. If you can't take breath test, then I would limit carbs, cut out sugar, and take VSL#3 probiotic and see what happens. I think at the end of the day you will find that xifaxin helped you more then anything else. Are you able to fly to LA to see Pimental?


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## cynthia

I agree with Pete that improvement shows up after treatment is over. That's why I've been asking about people actually being gassier when they're on an antibiotic. I think the gas can be a symptom of both feeding the bacteria and killing it. So when it's being killed during treatment, whether it be vivonex or antibiotic, gasses are being released as the bacteria is dying off, thus resulting in extreme gassiness. But it's confusing because it feels the same as when the bacteria is worsening. Moises - I think your current discomfort is actually a good sign. Hang in there and I agree that you should continue to take the rifaximin.


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## 18651

all the questions are fine! i took xifaxan 200 mg 3 x day for 8 days. yes i was much gassier, with really "good" burps. usually my burps are pretty feeble, i don't drink soda or beer. today i began 400 mg 3 x day for 14 days. i am back to my feeble burps today and wishing i would let one rip. i got a little relief from those belches.i eat stonyfield yogurt daily and i'm thinking this could interfere with the treatment. have yet to receive pimental's book but i know he says to limit or eliminate lots of stuff. i currently take zelnorm 2 day anyway so i don't know what effect that will have. i also find myself ravenously hungry!!!any luck yet moises??


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## Moises

annilady,I would not eat Stonyfield yogurt while taking the Xifaxan. My understanding is that commercial yogurts all contain lactose. Pimentel strongly states that all lactose should be avoided on his program.I have decided to follow Elaine Gottschall's method of making my own yogurt. She claims that if you culture the milk for at least 24 hours all the lactose is digested by the yogurt cultures. An added benefit is that I am making my yogurt with 50% heavy cream. It's quite tasty.Pete and Cynthia,I must admit that I find it difficult to accept the claim that my gassiness could remain a problem as long as I am on antibiotics. I know there is much no one understands. But the pretty narrative that Pimentel has created states that there are bacteria in the small intestine that are responsible for the symptoms. If the antibiotics rid the small intestine of the bacteria then the symptoms end. So, one could still be on the antibiotics and, as long as the bacteria have been eliminated, the symptoms should be gone.I once went months eating absolutely nothing but meat. I still had upper and lower gas. The upper gas was the biggest problem. And when I went back to having some carbohydrates with my meat, I still had the gas. There have been other threads here about Pimentel's claim that it's not a good idea to take the antibiotics with the Vivonex because the Vivonex puts the bacteria into hibernation and the antibiotics work best when the bacteria are replicating. Others have pointed out that this explanation is less than clear. If the bacteria are hibernating, why does Vivonex work so effectively? Why don't the bacteria come out of hibernation and begin replicating again once the Vivonex diet is ended?Anyway, I counted my pills. I have enough to last me through the middle of day 15. I will keep taking the Xifaxan till the pills run out.I have an appointment with a new GI on 10/30. I'll discuss my options with her. My current plan would be to start on Vivonex Plus for at least 2 weeks after seeing the GI.My log:Yesterday there was a marked increase in flatulence. There was diarrhea. And there was uncomfortable burping.Last night I awoke at 3:30am filled with gas. Getting out of bed helps because it enlists gravity on my side. When I stand up much of the gas is forced up and I can burp it out. I went back to bed but had occasional burping and minor cramps.I am burping now as I write this.


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## cynthia

Moises, Yes, when the antibiotics eliminate the bacteria the symptoms are gone. However, what if that process takes longer than just a few weeks? If the symptoms for the bacteria being fed and dying off are the same, then when either you've just eaten alot of food that feeds your bacteria or when you're taking antibiotics that are killing off alot of the bacteria, you're going to feel gassier than ever. If the bacteria is totally eradicated then yes all gas should be gone. But since, I believe, that process is a very long one, one would feel better after a round of antibiotics is over then when on it because the bacteria left afterwards has been reduced.


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## 18651

i will stop the yogurt for the remainder of my "trial." though it will kill me...i just love the stuff! i don't really grasp how you make yogurt...what does culture mean? anyway, day two for me moises, i am able to burp a little better...but this morning i awoke incredibly nauseous and i can feel the gas bubble rising in my chest and the back of my throat bubbles like a glass of soda; you can actually HEAR it at times when i open my mouth. pretty gross actually. how do you feel today moises?


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## cynthia

To everyone who describes their symptoms honestly and in depth and without concern for how gross it may sound:I sincerely thank you. My son has been going through this for the last 2 years and we've finally found people having the identical symptoms. I would never have known this if not for your bluntness in describing it all. I just read a number of your words in this thread to him and he's relieved just to hear that others are going through the same thing. Thanks again folks!


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## 19462

Moises,Sorry I am just getting back in touch with you.Yes my dr. had me taking 400 mg. three times a day.I saw improvement after 2 weeks,but then the third week things got bad again.I think my system starting fighting the pills or maybe the bacteria was fighting against the xifaxan. Then maybe two are so weeks before I finished all the pills I did start feeling major improvement.No breath tests were done, but I had already been in a couple times. The physician assistant had me to try Zelnorm before I was put on the Xifaxian. Zelnorm made me extremely sick. Dr. suspected it might. So after the Zelnorm problems I was prescribed the Xifaxian.The said their practice was doing a clinical trial on Xifaxin. However, I didn't qualify to be part of the clinical trial. I also think that the acidpolphus and the hyoscyamine helped out a lot also.Deborah


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## 14438

Moises, just started yesterday Xifaxin 1200 mg/day for 10 days; my hydrogen level from the breath test was not exceedingly high, but my dr. decided to try the antibiotics; she didn't recommend any dietary changes; is it just carbs I'm to avoid? was on the probiotic Align for 2 wks prior to taking X & she told me to stop for the 10 days then immediately start again to replace the good bacteria


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## Moises

> quote:Originally posted by joanne g.:Moises, just started yesterday Xifaxin 1200 mg/day for 10 days; my hydrogen level from the breath test was not exceedingly high, but my dr. decided to try the antibiotics; she didn't recommend any dietary changes; is it just carbs I'm to avoid? was on the probiotic Align for 2 wks prior to taking X & she told me to stop for the 10 days then immediately start again to replace the good bacteria


Joanne,Pimentel's dietary recommendations are somewhat unusual.I interpret them as follows:1. Unlimited fats.2. Unlimited meat, fish, fowl, and eggs.3. No dairy except butter, Lactaid (and, I make yogurt at home for 24 hours, which removes all lactose.)4. 1/2 - 1 cup of starches allowed (but not required per meal. I actually avoid almost all starch except for occasional boiled potatoes. He says that white flour is better than whole grain.5. I think he says 2 servings of fruit per day are allowed, but I never have more than 1 piece of fruit per day.6. He doesn't say anything about nuts, so I eat some of them daily.7. Nonstarchy vegetables allowed in unlimited amounts.8. I avoid all artificial sweeteners; he says Aspartame is OK.9. I just drink water, he says one cup of coffee or tea is OK.10. Eat no more than 3 times per day. More frequently eating prevents the small intestine from cleaning itself out, increasing the opportunities for infection.11. He says small amounts of sucrose (white sugar) are permissible but I stay far away from the stuff, since I am constitutionally incapable of having small amounts of sweets. Once I start I can't stop. So I don't let myself start.


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## Moises

> quote:Originally posted by cynthia:To everyone who describes their symptoms honestly and in depth and without concern for how gross it may sound:I sincerely thank you. My son has been going through this for the last 2 years and we've finally found people having the identical symptoms. I would never have known this if not for your bluntness in describing it all. I just read a number of your words in this thread to him and he's relieved just to hear that others are going through the same thing. Thanks again folks!


I think we can all thank Jeffrey Roberts for making this possible. A lot of doctors in general, and GIs in particular, appear to be in the dark when it comes to our symptoms. I still find it embarassing to write about my own burping, farting, and diarrhea. But why be embarassed? We'll never help ourselves if we hold back in describing the functions of our bowels. I am happy to hear that your son gets some consolation from this. It is reassuring to know that your feelings are shared by others.


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## Moises

Log,Last night I was very tired and wanted to go to bed early but I needed to stay up till 9:45 PM so that I could give my yogurt its full 24 hours of culturing before I put it in the refrigerator. So I ended up staying up till 10:15 PM and then going to bed and forgetting to put the yogurt in the refrigerator.At 3:30 AM I have burping and farting. At 4:30 AM I can't sleep because of the gas and get up remembering I forgot to put the yogurt away. I stayed up after that.Yesterday there was a lot of burping and farting throughout the day.Today there was a lot of burping early in the day, less later in the day and less farting than yesterday.Cynthia has suggested that the bacteria are partially eradicated by the Xifaxan and then there is a stage of the bacteria being constantly regenerated by food and the Xifaxan constantly killing some of them. That could be the stage I am in.Right now I don't have a doctor who has any experience with this stuff. I could probably get another prescription for Xifaxan but I don't want to take this stuff for too long without supervision from someone who knows how to use it. So I will just finish this course. I think the last pill will be Monday morning.


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## Moises

This morning I felt bloated at 3:20 am.Lots of burping after arising. I got out of bed at 5 am with my alarm but I was ready to jump out anyway because the bloating feeling was so uncomfortable.I go to the gym every weekday morning. Lots of burping there and when I went to take a shower there was visible abdominal distension.As is usual in this kind of situation I kept on burping and a couple of hours later the distension gradually subsided as it was burped and farted out.Accompanying the distension were moderately painful cramps. Despit the discomfort of the cramps and the nonstop burping, I was able to complete all my exercises in a satisfactory manner at the gym.I was thinking about Cynthia's comments about her son. It is great that this board allows us to discover that others share our fate. But there is also a tendency to obsess over one's symptoms and use them as a crutch to avoid facing life. These are general thoughts; they are not directed at Cynthia or her son. It's just that my response to her last night prompted me to think some more about this.I have kept this log online not to garner sympathy but to provide real-time data to others so that they can see the results of a particular antibiotic intervention. I know that some people have been disabled by their IBS. I also know from my personal experience that I am much happier if I do everything I can to work around my symptoms and attempt to live my life as normally as possible. I really wish I could have had some more restful sleep this morning. I really wish I could have done my exercises at the gym without the burping and painful distension. Sometimes it just is impossible to exercise and I have to listen to my body. But if I can possibly exercise, I will. And I am always happier afterwards for having done it. I will do what I can to eliminate my IBS symptoms. But I do not want fighting IBS to be the central focus of my life. If the Xifaxan doesn't help I will try other regimens. But I don't want fighting IBS to be the center of my life. I am fortunate that I can still work, enjoy my family, and relax, despite having IBS. IBS definitely has a significant negative impact on my quality of life. But if I have to live with IBS for the rest of my life, I will do my best to make the most of it.I am half-thinking that I might try the 50 mg at bedtime of erythromycin after I finish the Xifaxan even if I do not get full or any symptom relief from the Xifaxan. Maybe the motility effects alone of the erythromycin could be beneficial.I was also thinking about the despised Vivonex. Does anyone know anything about what a feeding tube is and how they work and how they can be obtained? I have no doubt that the Vivonex tastes truly vile. If it is possible for a conscious nonhospitalized person to take food by a feeding tube, I would consider doing that. Then I might be able to bypass the taste-sensing receptors on my tongue. I might even avoid much of the foul smell. Any help out there? How does a conscious nonhospitalized person self-administer Vivonex by a feeding tube?


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## 14438

Moises, thx so much for the food breakdown; I have not yet experienced your symptoms but it's only day 3; I'm so done w/this condition (I can't work/on SS disability), that if X doesn't work & the allergist doesn't find any food allergies, I'm going to try to find a doc that will agree to remove part of my intestines; the way I see it--less intestines, less problems; then I can very little, feel full & cut my bathrm runs--who knows--from 10/day to every other day!!!


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## Moises

> quote:Originally posted by joanne g.:Moises, thx so much for the food breakdown; I have not yet experienced your symptoms but it's only day 3; I'm so done w/this condition (I can't work/on SS disability), that if X doesn't work & the allergist doesn't find any food allergies, I'm going to try to find a doc that will agree to remove part of my intestines; the way I see it--less intestines, less problems; then I can very little, feel full & cut my bathrm runs--who knows--from 10/day to every other day!!!


Joanne,I had years of 10/day, so I can sympathize. But I'd be very reluctant to have them cut out my intestines.My diarrhea came under control by eating almost nothing but meat. That's quite drastic I know. But I don't think it's nearly as drastic as having some of my intestines sliced out. You might want to give it a try before surgery.Also, this morning before I reviewed Pimentel's book and realized that I left out one of his dietary recommendations when I gave you that list, above. So please add:12. Avoid legumes: peas, beans, peanuts, etc.Pimentel calls his a "low-residue" diet. When other people use the words "low-residue" I believe they mean low-fiber. Pimentel seems to call foods low-residue if they are absorbed within the first couple of feet of the small intestine. So milk seems to be high-residue on his definition because it takes the entire length of the small intestine to break down the lactose.


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## 18651

sorry it's been a couple days. i've been fighting the bug that's going around my place of employment. today is day 4 of xifaxan. the bloating is no better, but i am able to get off a few good burps throughout the day. trying to follow the dietary guidelines. strange how the gi docs tell ibsers to eat small frequent meals, then if you have sibo, only eat 3 x day. they both make sense in their own perspectives.it's really difficult to try to get a handle on the distension and constipation. one food contradicts the other symptom and i feel like yoyo. plus the weight loss is very frustrating. i've always been thin but people are really starting to notice the 16 pound loss and i get so frustrated at the comments. lately i've been telling folks it's a medical condition and that seems to shut them up for awhile. i don't need to be reminded of how thin i am daily. i know that but i can't do anything about it. it's difficult when you look like a child from a 3rd world counrty with abdominal distension and pencil thin arms and legs. the belching i am able to release gives relief in my chest and stomach, but does nothing for the distension. the only thing that works is fasting but i can't do that. once i begin to eat again, no matter what, the distension returns. i'm with moises, not quite sure i'd be willing to get some intestines removed.?!


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## Moises

annilady,I am glad you're getting some relief.Joanne:Also Pimentel's dietary recommendations include limiting the consumption of raw foods. No more than one small salad per day.My log:Yesterday was the worst day (as opposed to night) of this course of Xifaxan. I noted that there was extreme burping and distension in the morning. The early evening also had severe burping and distension. I was stuck driving in a major traffic jam and I got concerned. When I got major bloating it is usually followed by major flatulence. And when I have major flatulence I can never be sure whether what comes out is going to be solid, liquid or gas. But, fortunately the only thing that came out was gas.


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## Moises

Today's my last full day on Xifaxan. Yesterday I had moderate symptoms. Last night they were mild to moderate.My plan was to try erythromycin 50 mg at bedtime starting Monday night. My doctor is a retired pediatrician and looked it up in the PDR (physician's desk reference). He was quie familiar with erythromycin but never heard of this dose.He gave me a script for Ery Ped drops. But none of the pharmacies had it. So I won't be taking anything after Monday morning.


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## Pete

The dose is 50 mg is liquid form. It is a pediatric dose


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## 18651

well that sucks, moises. after googling neomycin last night, i remembered my daughter had taken it when she was little for ear infections. what else can you do? try the xifaxan 200 mg daily? or neomycin at low dose?today is day 5 for me so i've got 9 more to go. i want to say i feel better, but i slept all weekend and barely ate anything due to the flu bug. so of course i'm not as bloated as usual. my belching is increasing. today was the first day of october so i began my normal pilates/yoga workout that i do every winter. i remembered that i had posted i was going to try an elimination diet if the xifaxan did not work, but i am on sort of an elimination diet anyway. boy do i miss yogurt!!! moises, have you considered homeopathic remedies?


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## Moises

Pete,I have the prescription. My problem is that I can't find a pharmacy that carries the liquid form.anniladay,I hope you are successful with your antibiotics.I once was prescribed homeopathic remedies by a naturopathic associate of Dr. D'Adamo of Eat Right For Your Type fame, who suggests eating according to your blood type. Neither the blood type diet nor the homeopathic dose helped me.Today is my last day on Xifaxan. Technically, I should avoid drawing any conclusions until I am done but I don't anticipate any dramatic changes between now and tomorrow morning so I will begin to draw my preliminary conclusions.First, my log. Yesterday I missed my first dose. I took a morning and evening dose of 400 mg but forgot my midday dose.Yesterday's symptoms were normal. I was bothered by burping and farting but not to any extreme.Yesterday, for the first time in my life, I tried glucose tablets. They were sold at my corner drugstore (the same one which did not have the liquid erythromycin) behind the counter where the prescriptions are issued. Each tablet is 4 mg. Mine were grape flavored. When placed in the mouth they do not have much flavor. But when they are chewed and dissolved they are quite sweet. I tried these because Pimentel and Gottschall claim that glucose is absorbed with the first couple of feet of the small intestine and does not provide sustenance for the bacterial overgrowth in the small intestine. Today I have been burping and farting since I got up. The burping has been especially annoying but has not been so severe that distension has accompanied it.Now to my preliminary conclusions.First, I have not formally followed the Pimentel protocol because I did not undergo a breath test prior to my course of antibiotics. I cut some corners, so the conclusions that I reach will be less useful than they might have been otherwise.The symptom that I find most bothersome is burping. I decided to try the Xifaxan because it has been most effective with diarrhea-predominant IBS and that describes my variety of IBS. I also believed that Pimentel's approach made sense of my symptoms. Pimentel's book goes into some depth treating the definition of the criteria that researchers use to classify people as having IBS. Bloating, distension, farting and burping have tended to be derogated recently and Pimentel argues that these gaseous symptoms should, rather, be elevated as important symptoms in determining whether someone has IBS. My experience has been that burping has interfered most with my quality of life, and distension occurs when my burping is extemely severe. So I was attracted to anyone who gives attention to upper and lower digestive gas.My tentative conclusion is that SIBO may still be a legitimate explanation for the IBS that many of us endure. I may have had SIBO and I may still have SIBO. A lactulose would provide important information in that regard. It is possible that I have SIBO and the Xifaxan was not successful in eradicating that bacterial infection. It is possible that I might be able to heal my IBS if I can find a different means for eradicating the purported bacterial overgrowth.My current plan is to try a new GI, with whom I have a 10/30/06 appointment. I imagine she will offer me a choice of SSRIs or other prescriptions. I am willing to consider trying whatever she offers.In the meantime, my medium range plan is to start Vivonex plus in about three months. In the next three months I will prepare for the Vivonex by slowly transitioning to a meat-predominant diet to one that is predominantly carbohydrate. I will also gradually reduce taking red yeast rice which contains the statin that is in the heart drug Mevacor and gradually reduce an anticoagulation supplement that I take called Nattokinase or Nattozyme.I haven't found out much about feeding tubes but it does not seem like a good idea for me to take Vivonex via a tube up my nose, so I will drink the stuff. My plan would be use the glucose tablets as the flavoring agent rather than the aspartame.I am disappointed that the Xifaxan didn't help me. But I knew going into this that the odds of Xifaxan were not very promising. According to Pimentel the odds for Vivonex are much higher.


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## Moises

Yesterday was my final day of Xifaxan. Yesterday I had burping and farting throughout the day.Last night my gut bothered me in the early AM hours while I tried to sleep.This morning I had some loose stool after my third bowel movement in an hour. I also had a fair amount of burping.Conclusion: Xifaxan did not help alleviate my IBS symptoms.Next actions:1. continue to take Align.2. see new GI end of October and discuss options with her. Ask her for lactulose hydrogen breath test.3. seriously consider 2-3 weeks of Vivonex.


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## cynthia

Hi Moises,Couple of questions for you - Why are you transitioning from a predominantly meat diet to a carbohydrate diet in preparation for Vivonex?Also, what was the homeopathic remedy that you were given by the naturopathic associate of D'Adamo's?I'm so sorry the Xifaxan wasn't of more help to you. I know some people say that the benefits are felt a bit after treatment ends. Hopefully that might still happen with you.


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## Pete

I think you will start to see a benefit in a week or two. In the meantime I would consider taking 2 vsl#3 packets per day.Hope you feel betterPete


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## Moises

Cynthia,The naturopath gave me a single dose of Carbo Veg. Since he worked in D'Adamo's office, he asked me first if I was willing to try homeopathy. I said, "Sure." I am sure the dose he gave me was significantly more powerful than the Carbo Veg that can be purchased by anyone at a health food store. If you are interested, I can comb through my records and see if I have the dose he gave me.


> quote:Why are you transitioning from a predominantly meat diet to a carbohydrate diet in preparation for Vivonex?


 The answer to this is rather convoluted. In the excellent book title Life Without Bread, the authors state that radical shifts in one's diet can induce blood clots. Blood clots can kill. In 1998 I had a blood clot. I suffered no ill effects from it and it was dissolved. I was given no medication to take but I don't want to do anything that has a remote possibility of inducing another blood clot.Since I eat mostly meat right now, and this does a decent job of keeping my diarrhea in check. (As an aside, I spent most of my life being underweight. Once I started eating less carbs, I gained a lot of muscle, looked beter and felt better.)I don't have the exact figures at my fingertips but I believe Vivonex is about 80% carbs. I don't want to abruptly go from low carb to high carb back to low carb and risk another blood clot.Pete,I've taken vsl#3 in the past with no benefit. Maybe I will try again. The Align seemed to have been helping me but I only took it for 1 week prior to the Xifaxan so it wasn't enough time to make a conclusive determination.


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## 18651

i am really sorry to hear that moises. like pete, i hope you will see improvement since the treatment is finished. today is day 8 of xifaxan. i believe i am not AS BLOATED AND DISTENDED as usual, but still somewhat. if i don't get yogurt soon, i will go crazy!!! still burping a lot and this am i had extreme trapped burps in chest. the belching offers minimal relief to how i feel, but nothing to the distension.i was told nat phos 6x after each meal for about a week for belching. and lycopodium for bloating. i tried the lyco and it worked after 3 days, but i kept taking it and the bloating came back. i was then told you take it until the symptoms disappear, then stop. perhaps you would want to try?


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## cynthia

I notice Moises mentioned that he was underweight most of his life and I think that's a problem for many people with SIBO especially those with an extreme upper gas problem. So, for those of you who have this issue of keeping your weight up while avoiding foods that add to your already overwhelming gas, what do you eat? This is a BIG problem for my son and I've love to get some ideas. Thanks, Cynthia


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## 14438

[Moises wrote] My diarrhea came under control by eating almost nothing but meat. That's quite drastic I know. But I don't think it's nearly as drastic as having some of my intestines sliced out. You might want to give it a try before surgery.[Moises wrote] No more than one small salad per day.Moises, funny you should mention meat; meat & haagen daz are my main sources of nutrition; funny you should mention about avoiding raw veggies--I had a HUGE salad for lunch Tues. & was in the bathrm w/a bad attack for a few hrs that eve; called the restaurant & told the mgr that I had gotten food poisoning! Oh, well...I have (3) days left on X & nothing has really changed; never got gassy or burpy; still missing out on social events as per usual (had to be ### a 40th b'day party Sun. 12:30/25 mins fr my home & couldn't make it); can really only be sure to make it ANYWHERE if I take a laxative & then fast a day or 2 in advance, but didn't want to mess up anything while on X; tonight I went ahead & took them because I have to get to my son's baseball game (he thinks I have no interest since I've already missed 3 of them); the dilemma will be our planned apple picking trip on Mon--I get no enjoyment out of taking small rode trips to places that only have port-a-potties, so I'll probably do more laxatives on Sat., miss any activites or obligations that fall on Sun., take a couple of immodium & a couple of Xanax in the car on Mon & hope to God that I fall asleep, wake up under an apple tree & not have to go....Sorry X hasn't worked for you, but as others have said, anitbiotics keep working days after the dose is finished. Thx so much for keeping this log for the rest of us. __joanne


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## 18651

sorry guys, LOST was on last night.today is day 10 xifaxan. still the same. slightly less bloated and burping all day. one can only hope that this still works after treatment.i hadn't noticed moises post about being underweight but yeah, i have trouble with gaining weight. as i've mentioned, the weight loss of 16 pounds has baffled the doc and he really doesn't addres it. it's hard when everything makes you bloat or sick or whatever. i love raw and cooked veggies but have to limit them and limit fruit as well. and i worry i'm not getting enough vitamins. the doc seriously thought i had celiac, then he seriously thought i had malabsorption, but now i think he'll do and give whatever i ask for just to shut me up. i eat a lot of odd combinations that make other people think i'm odd. but a meal does not necessarily have to have meat and veg and potato. sometimes i'll eat cooked green bean and cottage cheese for lunch.


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## 18651

well, guys, finished the 1200 mg a day of xifaxan yesterday. i have about 7 left, so i will take one a day for a week. today i have less belching than while i was on the xifaxan, and overall, no real improvement. still bloated as big as a house. another false hope. another dream shot to pieces. boo hoo wah wah wah.


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## cynthia

Annie,Hang in there. You may find that you actually have improvement after you stop the antibiotic. - Gaining weight is a real problem for my son. And I'm a lousy cook, so that doesn't help!


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## 18651

thanks for the word cynthia. still waiting..


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## 13968

Hi there, Iâ€™m amazed I found this thread by Luck. I suffer from Leaky Gas, bloating, cramps, however Iâ€™ve been told itâ€™s not IBS. I had the Lactulose breath test, and it was positive. Well, Iâ€™m not convinced, as I had 3 readings: Before the lactulose; 90 min and 120 min. I had 36ppm at 90 and 120 min. I then was told by one user here (Flux) that the test was incorrect. I also found references to last 3 hours, in 15 minute intervals. Iâ€™ll ask my Dr. when I was told I had SIBO, I did some Google research, then found Pimentel Book and bought it. My gastro ordered Xifaxan 400mg thrice/day for 10 days. Today is day 3 and in my case I noticed my gassiness decreased, also the gas and stool odor changed, less smelly. I usually had bad breath, and sour taste in my mouth, despite flossing, scrapping, brushing my tongue and gargling Mouthwash. After I took Xifaxan, I donâ€™t have that sour taste nor strong odor. My Bowel movements increased, but now more consistent. I suffered from Diarrhea since my gallbladder was removed 6 months ago. Iâ€™m somehow following Pimentel diet, as I get used when I saw a Naturopath, who just was guessing around and stole me 1000 bucksâ€¦ Iâ€™ve seen some of you have some improvement with Xifaxan. Do you have suggestions for a course of action if Xifaxan doesnâ€™t work for me? Iâ€™m also taking Celexa and Risperdal, but these are unlrelated to my GI problem, but to the depression and paranoid state I got stuck because the isolation and rejection caused by my smell. Thanks, take care, Tony


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## Moises

> quote:Originally posted by Tony13o you have suggestions for a course of action if Xifaxan doesnâ€™t work for me?


Pimentel has higher success with the elemental diet Vivonex Plus than with antibiotics.


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## Pete

Moises,Do you feel xifaxan helped not that you have been off for a while?


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## 17908

Hi,I'm new here, but I'm glad I came across this thread. I'll get into my history with GI problems in another thread. I'll address my experience with Pimmentel and Xifaxan in this thread.I just found out about all this Xifaxan stuff a few weeks ago. I read Pimmental's book and had my Dr. prescribe 10 days of 1200mg Xifaxan and then Zelnorm if my symptoms were gone.I'm on day 7 of the Xifaxan. My symptoms have improved about 50%. I'm hoping for dramatic results in the next 3 days. If not, I will not start the Zelnorm. Instead I will go to my Dr. and get 10 days of Xifaxan AND neomycin, since this is what Pimmental suggests. If I still don't get 90% improvement (or better), I'll do 2 weeks of Vivonex Plus. THEN I will go on the Zelnorm.I've tried everything, and I'm really hoping I can see something come from all this.


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## Moises

npearce,I am glad to hear that the Xifaxan has provided you some relief. Keep us updated on your progress.moises


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## 17908

Day 9 and I'm just certain my symptoms are about 60% better. I ate a big lunch, which usually give me terrible gas/cramps/etc., and I had absolutely NO trouble.If I wake up tomorrow or the next day with no gas or bloating, I'll consider going on the Zelnorm. Otherwise, I'm going to do 10 days of Xifaxan and neomycin before the Zelnorm. I am starting to feel like the antibiotics are helping enough that I might not do the Vivonex. I'd like to see what the Zelnorm will do for me, but at the same time I'd like to make sure I kill as many bacteria as possible.I'll keep you guys updated.


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## 21781

Does anyone have probl with yellow stool..I have alot of it I took predizone got ridde of it now off of it and it is back they just put me on xifaxan three times a day 200 mg very sick gasy all the time everything i eat i have bad cramps and run to bathroom although i have noticed i dont have to go to bathroom to morning when it is so bad


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## Nanobug

> quoteoes anyone have probl with yellow stool..


Bile stals are responsible for the yelowish color of the stools. Usually, the bile salts that aren't absorbed by the ileum are oxidated and turn brownish. However, if you have very fast transit or if the ileum is inflamed and isn't properly absorving bile salts, you'll have fast transit and yellow stools. DO you happen to have low cholesterol? Bile salts are precursors to cholesterol. When they aren't absorved, the body doesn't produce as much cholesterol.


> quote:I took predizone got ridde of it


Ok, so you had some kind of inflamation going, no? DO you supplement with fish oil and/or turmeric/curcumin? I take both daily as both help reduce inflamation.Nano


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## 21781

i dont mean to sound so gross but dang it I am tired of this...lol my stool isnt really yellow it is just when i whip (sorry)i hate talking about this but no doc can help it is on toilet paper and it is neon yellow and today it was even a little green slime but more yellow slime then yellow...they first thought i had uc but test was neg i had upper scope to found polpys in stomach,neg for cancer...no gallbladder probs either .They cant find out what it is.So he gave me that x drug...still yellow on toliet paper HELP


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## 21781

also he said i had alot of inflamation but he cant find why he is doing celiac test on me and zoller ellison test and if it is zoll des, there is no cure and u die of it .So i am really freaked out


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## 21781

nanobug,What causes the inflamation the doc cant give me a straight answer he put me on an antibotic starts with xifan i think....my stool isnt really yellow when it settles in toliet the water is yellow and the paper in yellow i mean neon with some mucus i have had every test upper scope lower scope hydra scan lab work the only thing that cleared it up was predizone....when i got off of it it came back,any ideals


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## Nanobug

> quote:What causes the inflamation


Inflammation could the response of your body to an infection. If your doctor prescribed you Xifaxan, then he thinks you might have small intestine bacterial overgrowth. These bacteria may be causing the inflammation of the ileum. In turn, the ileum doesn't absorb the bile salts and your stools end up more yellow than normal.


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## ibs_drama

I'm definitely the new guy here but I had SIBO (and IBS) and needed to use Xifaxan. Total came to $533 so I ended up buying it from Mexico under the generic name Rifaximin. I was initially concerned that the website I found wasn't legit because they didn't require a prescription but it showed up 4 days later and was only $120 and I used a credit card with no problem. 600 mg twice a day for 10 days normalized my hydrogen breath test and took care of my symptoms but I still am going to follow the SCD and maybe add something like sweet potatoes and see how that goes. Since SIBO recurs in most folks who don't stick to the Specific Carb Diet, I'm planning on taking a full dose every few months or doing an herbal anti-biotic/fungal cleanse every few months. There doesn't seem to be a way to get away from recurrence other than following the SCD fairly strictly which is really just no fun. Xifaxan is the only med I've seen work but it clearly doesn't work for everybody.For those of you who get recurring SIBO, it may be the orientation of your small intestine that creates this problem and without correcting the orientation, SIBO will continue to recur. It could also be something like extreme Candida causing the SIBO, in which case you need a fungal cleanse for 2 months plus SCD until the symptoms disappear. In which case I would still stay on the SCD for 3 years at least based on all the research I've done. It seems xifaxan + SCD + three meals a day evenly spaced + plenty of sleep and rest + exercise + various herbal supplements and B12 shots + probiotics = a much better life with IBS and/or SIBO. In a slightly sad summary, I haven't seen many posts from folks who have had SIBO and have gotten purely cured with no recurrence even if it occurs 2+ years later. There seems to be a fundamental physical problem (related to various sphincters or MMC dysfunction?) that is not fixed by mere anti-biotics....we NEED more research and studies done!Cheers,IBS_Drama


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