Are metronidazole and rifaximin the two best antibiotics to try to treat this? Are there any other antibiotics that could help? What are the best herbals? Berberine or Oregano Oil?
Hi, Jwarrior,
sorry I have not been on the site for a while, but Metronidazole was the best Antibiotic for me. I have tried Oregano, but cant be sure of its efficacy, because I still fell ill although it may have helped it was not as decisive as using Metronidazole which stopped often dangerous symptoms quickly until I eventually failed to respond due to resistance. I am now using Vancomycin. Antibiotics are not the best method of controlling Bacterial Overgrowth, because they can further affect the balance within the Microbiome (even reduce necessary symbiotic species causing other problems), but it will tell you a great deal if you respond to Metronidazole and depending upon how unwell you are may give back some quality of life; but ideally should be done through a Gastroenterologist after Bacterial Overgrowth has been diagnosed; but I have talked to others with ME/CFS who cannot get this investigated through the NHS, due to the lack of training and understanding of most Doctors, many of whom have been trained to believe that ME/CFS is a psychological disorder which will limit further patient investigations (Psychologists use claims of Gut problems lasting as long as 2 years as perceptual issues; and can diagnose Somatization disorder from symptoms such as abdominal Pain, which happened to me).
Some Antibiotics can select for, and cause Bacterial Overgrowth as well as eradicate (eg C.Diff can be caused by some antibiotics and eradicated by others). There are no absolutes because so little is known about the Microbiome and interrelationships between different Bacteria, Immune Policing and Host and for me Antibiotic use is like using a sledgehammer to crack a walnut, but (perhaps one day we will be able to target specific Bacteria through Phages). C.Diff is just another form of Bacterial Overgrowth and I believe that there may be a number of other possible combinations causing the abnormal production of Orgainic Acids that ammount to fluctuating levels of poisoning from Neurotoxins for at least a subset of ME/CFS.
There are a number of ways to stop the symptoms, but finding the cause is the most important (eg. Motility issues due to another underlying problem and a number of Medications can cause or contribute to Bacterial Overgrowth); but I have used Anbtibiotics, Probiotics (with Prebiotic Inulin Fructo Oligosacharides 'FOS'), Diet and Motility aids including Naltrexone and Resolor and I am trying for FMT.
I use Probiotics between Antibiotic courses, but they only work as long as they are taken because the majority do not remain in the Gut. Symbioflor 2 may remain longer (Ecoli variants used for IBS was also used in the past for other 'functional gastrointesinal disorders';
https://www.hindawi.com/journals/ijb/2016/3535621/ ).
Reports are often contentious because understanding is still in its infancy, but a number of artilcles state that Probiotics can cause D-Lactic acidosis and that non D-Lactic producing Probiotics can stop D-Lactic symptoms;
https://www.google.com/search?q=Pro...2i29i30l3.29261j0j15&sourceid=chrome&ie=UTF-8
Case Reports;
Apr-Jun 2013;98(2):110-3. doi: 10.9738/CC169.
A stand-alone synbiotic treatment for the prevention of D-lactic acidosis in short bowel syndrome
Kazuhiro Takahashi 1,
Hideo Terashima,
Keisuke Kohno,
Nobuhiro Ohkohchi
Affiliations expand
Abstract
Synbiotics are combinations of probiotics and prebiotics that have recently been used in the context of various gastrointestinal diseases, including infectious enteritis, inflammatory bowel disease, and bowel obstruction. We encountered a patient with recurrent D-lactic acidosis who was treated successfully for long periods using synbiotics. The patient was diagnosed as having short bowel syndrome and had recurrent episodes of neurologic dysfunction due to D-lactic acidosis. In addition to fasting, the patient had been treated with antibiotics to eliminate D-lactate-producing bacteria. After the failure of antibiotic treatment, a stand-alone synbiotic treatment was started, specifically Bifidobacterium breve Yakult and Lactobacillus casei Shirota as probiotics, and galacto-oligosaccharide as a prebiotic. Serum D-lactate levels declined, and the patient has been recurrence-free for 3 years without dietary restriction. Synbiotics allowed the reduction in colonic absorption of D-lactate by both prevention of D-lactate-producing bacterial overgrowth and stimulation of intestinal motility, leading to remission of D-lactate acidosis.
Similar articles
Tinidazole from the same family as Metronidazole also works well, but I have sadly gained resistance to both. Rifaximin should be an ideal antibiotic, but did not work as well as Metronidazole for me. I have used a number of Broad Spectrum Antibiotics, whereas those limited to the Gut are more ideal if they work for you because they should limit resistance and damage to other areas where Natural Bacteria Proliferate, not just in the Gut. But there are other alternatives to antibiotics. D-Lactic overgrowth means that due to Bacterial Overgrowth that you can no longer metabolize certain Carbohydrates and Sugars, so you can use other methods to stop fermentation;
You could also try a FODMAP diet that includes Complex Carbohydrates that will not ferment in the Small Intestine or even try a Carbohydrate Exclusion Diet (No Carbs or Sugars to see if your symptoms stop or reduce after 4 days). I still get low level symptoms using the FODMAP diet, and you are still vulnerable to certain Carbohydrates (Bread, Pasta, Pizza, Simple Sugars etc....) if you cannot find the correct foods, but it has helped although I have found the diet is extremely difficult to adhere to especially when family members invite you round to meals that consist of Carbs and Sugars and hunger often overides good sense when there is nothing else available.
I have found that a number of Broad Spectrum Antibiotics also work for me including Oxytetracycline and Co-Amoxiclav, but all Antibiotics may also cause further damage to the Gut, which could theoretically reduce other species and allow for further Overgrowth. But for many years, Metronidazole worked well for me, but it only had a temporary effect of roughly 5 to 12 weeks before my symptoms returned. This may be because it was not taken for long enough to completely eradicate the Overgrowth to begin with because I was only prescribed for 5 to 7 days.
Antibiotics would ideally be used prior to FMT, and there are a number of protocols for doing this with multiple antibiotics to clear the Gut of unwanted Bacteria that you can find on Curt Johnson's site Healthrising, based on other reports and experiments. FMT is probably the best Probiotic of all, because the Bacteria and other components may remain in the Gut long term, resetting the Gut to within balance if the underlying issues have been addressed.
Rifaximin may well work for you and is an better Antibiotic because it remains only in the Gut. I have also had success with some Probiotics, which have given me a temporary reprieve. I have to say that you need to keep a diary and log all symptoms and log against what Antibiotics or Probiotics that you use (but remember there can be a 3 or 4 day delay in Gut changes). Nothing is simple and I have to say at this point that I had tried Symprove once again just to be sure; and I have gone into remission (I started by doubling the dosage, meaning that the Bacteria concerned may be sensitive to higher dosages and there is no guarantee of quality for many Probiotics that may not meet the quantity or quality necessary).
We are literally pioneering our way through this and finding a good treatment may be different for each of us with possibly different forms of Bacterial Overgrowth affecting us. There are dangers with Antibiotics and Probiotics and I should be giving you advice to contact your Doctor before trying any, but most Doctors remain untrained and are ignorant of these issues! But you should find one that you feel comfortable enough to discuss these issues with if that is possible. Perhaps this will change in time. A number of medications are also known to cause or contribute to Overgrowths eg. proton pump inhibitors such as (and many people take these due to Helico-Bacter which affects approx. 50% of the population).
It all comes down to experimental choices, trial and error and there will always be some risk taking, even with Probiotics or other medications; but I had been close to suicide due to the level of illness at times before diagnosis in 2017. I had serious symptoms similar to Merryn Crofts (who died in Hospital while being given food that would have contained Carbohydrates and Sugars directly into her stomach). Choices also depend upon the severity of illness, so I have no regrets taking Metonidazole over a prolonged period because I was put in a position that there was no other choice. I had only used Antibiotics when my symptoms were severe and often had months of fluctuating life changing symptoms that would slowly increase to severe again.
Remember that you still need to find the underlying cause of your Bacterial Overgrowth, which can be caused from multiple underlying problems including Diabetes. Merryn Crofts was believed to have developed Ehlers-Danlos syndrome, which can be related to GI symptoms. Gut motility changes alone can cause Overgrowth. Ehlers-Danlos syndromes are Collagen related genetic disorders;
''Evidence suggests a link between connective tissue disorders such as the Ehlers-Danlos syndromes (EDS) and digestive system (gastrointestinal, GI) symptoms. Patients with EDS can come to the doctor with hernias, out of place organs, and prolapse, as well as functional problems such as changes in the speed of the digestive system (gut motility). Patients with hypermobile EDS (hEDS) show GI symptoms related to the gut and often meet the criteria for disorders such as indigestion and irritable bowel syndrome.''
Hope this helps and is not too daunting.
I hope that you all have a good Christmas.
Paul.
