My doctor prescribed xifaxan and neomycin to tackle my hydrogen and methane SIBO, but I am hoping to avoid the neomycin because I fear the possible ototoxic effects it can have. I'm planning to try an elemental diet first on my own, and am thinking about how best to proceed. A couple of years ago I tried an elemental diet with Vivonex Plus at the recommendation of a naturopath. While taking the Vivonex Plus, my aches in joints and gut got continually worse. My neck got increasingly stiff, my ears started ringing worse, and other symptoms deteriorated. Most distressingly, my heart would beat harder at times shortly after consuming the Vivonex. I would note that this heart beating hard feeling is the same one I had when I first got SIBO after taking acid reducing drugs, and is also a feeling I got at times from taking certain probiotics. After eleven days of worsening symptoms, I stopped the elemental diet (perhaps not the correct move) out of fear that it was making me worse. More recently I tried another dose of the Vivonex and shortly after could again feel my heart beating in my chest. At the time I assumed that I was feeding the bacteria. Now, with more experience, I wonder if it might have actually been a sensitivity to an ingredient in the Vivonex. Most of my symptoms are now ones that I associate with leaky gut and fibromyalgia. The maltodextrin in the packets comes from corn, and there's cornstarch as a major ingredient, so I wondered if this might be the culprit. However, a year ago I took some Cyrex Laboratories tests that were supposed to look at food sensitivities by measuring IgG and/or IgA, and they showed negative for corn, popped corn, and corn oleosin. At the same time, there's this warning in the results: "Due to +Spinach and Tomato AQUAPORIN it is advised to also exclude Corn and Soy even though you do not specifically test positive to those AQUAPORINS as they are cross reactive." I've seen that a number of people have tried doing antibiotics at the same time as an elemental diet, or just before the diet, or just after. (I've seen claims that bacteria are more vulnerable while eating, so before or after the diet might make more sense rather than during.) I have a xifaxan prescription, which I've found to be safe when I've used it previously. I also have herbal antibiotics such as Allimed which is reputed to tackle methanogens, though I've used it multiple times and it may have since caused the microbes to become resistant. I could also get other herbal antibiotics to take around the same time as the elemental diet. It seems that a prokinetic is a valuable addition, and might even be useful while on the elemental diet or antibiotics rather than just after. I have resolor and low dose erythromycin, and could also get herbal options such as Iberogast. The Cyrex array 10 test showed that I was positive for ginger, so ginger may not be an appropriate prokinetic. Now for some questions: Do you believe that there is validity in food sensitivity testing such as Cyrex Laboratories provides? Do you believe that the maltodextrin source (corn) might have been part of my problem? If so, I need a new carb source for my home made formula such as tapioca maltodextrin or dextrose/glucose from something such as wheat. I see a few possibilities on Amazon. Opinions? What do you think the cause of my heart beating hard was while previously taking the elemental diet, and at other times such as when I first contracted SIBO? There was no pain, but it was disturbing and could also make sleep very difficult. How do I prevent this? What do you think of the idea of taking antibiotics and/or a prokinetic during, just before, or just after the elemental diet? My best days are now a lot worse than my worst days were the last time I tried the elemental diet, so I'm looking for something that will be effective but also very safe. If I can come up with a plan then I'll try it this month and report back with the results.