Treating SIBO

ebethc

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I've been tested 2x for sibo and both times the tests were inconclusive. I definitely have some kind of gut dysfunction, and have read a lot about sibo.

Herbs are just as effective if not more (per this study, not per me :)) and much less expensive. you definitely have to do some kind of anti-sibo diet in combination w the antibiotic/herbal therapies, and multiple rounds of antibiotics or herbs may be necessary.

there are other threads in this forum re sibo, so check around.. good luck
https://www.ncbi.nlm.nih.gov/pmc/ar...at least,therapy for rifaximin non-responders.
 

ljimbo423

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So, I tested positive on a SIBO test from Genova Diagnostics. My doctor is prescribing me an antibiotic. Does anyone have experience treating and managing SIBO? What were your experiences? Did the antibiotic help?

Thanks,
Matt
Hi Matt-

Treating sibo is often very difficult in healthy people. I think it's much more difficult for most of us with ME/CFS. Here are the stats for healthy people being treated with Rifaximin-

Recurrence of symptoms after the treatment course
What is the likelihood of SIBO recurrence after completing a course of rifaximin treatment? To help address this question, Lauritano and colleagues treated 80 consecutive patients with IBS and SIBO with rifaximin 400 mg three times daily for 10 days.

The presence of SIBO was followed up at 3, 6 and 9 months after the end of treatment. Recurrence of SIBO was documented in 12.6% of patients at 3 months, in 27.5% of patients at 6 months and in 43.7% of patients at 9 months. These results suggest that there is the need for further treatment courses in many patients [Lauritano et al. 2008].
https://www.ncbi.nlm.nih.gov/pmc/ar...f SIBO was documented,of patients at 9 months.

There are things that you can do to improve your odds though. As "ebethc" said above, diet is very important. If you can do a low starch diet, that will help A LOT. Because starch feeds bacteria in the small intestine.

Another thing you can do is wait at least 4 hours between meals. This allows your migrating motor complex to kick in and help move excessive bacteria out of your small intestine, into your large intestine.

I've been able to completely reverse the chronic loose stools I had for years and greatly improve my ME/CFS by treating gut dysbiosis. Although it's been a slow process because everything I need to do to speed it up I can't tolerate, because my system is so sensitive to diet changes and supplements.

2 examples are, I can't tolerate a very low carb diet or keto, which would help tremendously. Second, I can't tolerate higher doses of antibiotic herbs to kill off the bacterial overgrowth, without getting more flu-like flares consistently.

So at present, it looks like I need to settle for slow but fairly consistent progress. Which is far better than none and I am light years away from being mostly bedridden like I was for several years!:):thumbsup:
 

Sushi

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Treating sibo is often very difficult in healthy people. I think it's much more difficult for most of us with ME/CFS. Here are the stats for healthy people being treated with Rifaximin-
Rifaxamin helped me a lot...but in line with the research, it was necessary to repeat a short course after some months.
 

ebethc

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... I can't tolerate a very low carb diet or keto, which would help tremendously. Second, I can't tolerate higher doses of antibiotic herbs to kill off the bacterial overgrowth, without getting more flu-like flares consistently.
@Matthew_2

"low carb" is a confusing term because it means different things to different ppl...

>30g carbs per day is hardcore... I do this if I want to lose weight, and I still can't tolerate it all the time, so I do 1-2 days w more carbs, like 75-100g carbs per day... (this is called "carb cycling" although I discovered it by trial and error :)

You generally have to go >50g per day to be in ketosis (a metabolic state where you use ketones instead of glucose for primary energy source... ppl like it b/c their energy is more stable & consistent, and some ppl lose brain fog. of course, it has a positive benefit to digestive probs too b/c you're starving the bad bacteria).. NOTE about ketosis: As your body adjusts to ketosis, you'll feel lousy, which is called the keto flu... It lasts from a few days to a week usually... increase in fatigue and brain fog and, generally, a feeling of malaise...

75-100g carbs per day is still considered "low carb" but on the high end of low carb...

Re low starch / low carb guidelines, I like the SCD ("specific carbohydrate diet")... It was developed to treat serious intestinal problems, and is like a forerunner of FODMAPS (low fermentation diet, which leads to less bacteria)... FODMAPS excludes onions & garlic, but SCD allows these... These small differences make it easier for me to follow SCD..
http://www.breakingtheviciouscycle.info/legal/listing/

Also, if you're hungry, try adding more healthy fats, like olive oil... Avocado oil is good, too, but it's high in histamines, which a lot of CFSers have a problem with.. I can't tolerate too much..
 

Wolfcub

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I also have some gut dysfunction going on since coronavirus in April. Not sure if it's SIBO or not at this stage, but so far it's apparently negative on fecal immunology and inflammation testing.

I tolerate antibiotics very badly, and can get some seriously scary reactions from them and have done for many years even when I didn't have ME/CFS. The last lot I had was in 2006 and I just about managed to complete the course owing to side effects including the same level of utter drained exhaustion I now get with ME/CFS (fortunately back then, it was only for 5 days then I recovered immediately on stopping them!!)

If I do find out I have SIBO I would definitely try the herbal treatments. But I would struggle seriously with low carbs as I am not a meat eater (dislike the taste of meat and it doesn't suit my digestion), though can eat fish. So it would be hard for me to find anything I could eat apart from eggs, fish, few veggies, nuts and seeds! Not sure I could manage that to be honest.
:(
 

Sushi

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Did you retest for sibo or go by symptoms to find out if you had completely gotten rid of it?
I’ve taken about three courses of rifaximin and was tested a few times in those years and while the SIBO improved, it always comes back and I don’t know if I will ever get rid of it. The main symptom change that I had was a clear head and no headaches after a course of rifaximin.
 

Wolfcub

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Are there side effects with Rifaximin? I have heard it's different to most antibiotics, in what it does to the system. More targeted. Am I right?
 

Sushi

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Are there side effects with Rifaximin? I have heard it's different to most antibiotics, in what it does to the system. More targeted. Am I right?
Rifaximin is supposedly almost entirely active in the gut and not systemically. I had no side effects, I just felt better and better. The people I have talked to who got side effects were prescribed what my doctor considered too high a dose. I am trying to remember and I think I took an eight day course of 550 mg per day, or using the generic, 600 mg per day as it comes in 200 mg tablets. I’d take it again it I could get my hands on it—insurance did not pay for the 550 mg brand name and there was no generic available in the States last time I took it, but this may have changed. My doc had to fax the prescription to Canada.
 

ljimbo423

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Are there side effects with Rifaximin? I have heard it's different to most antibiotics, in what it does to the system. More targeted. Am I right?

I took 2 courses and had some minor loose stool one day and that was it for side effects. It's not absorbed by the body, only works in the Small intestine and becomes deactivated when it reaches the colon.

So it's about the safest, if not "the" safest antibiotic available. A lot of people get horrendous die-off symptoms from bacteria being killed off in the gut that have LPS in their cellular makeup. The LPS then get absorbed into the blood, causing an immune system reaction and die-off symptoms (flu-like symptoms).

Rifaximin works by preventing bacteria from multiplying, not actually killing them off directly. So it doesn't raise blood levels of LPS and cause die-off symptoms.

I experienced NO die-off symptoms at all.
 
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Hip

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Yes, I fasted for 12 hrs, drank a lactulose solution, and then did 3 hrs of breathing periodically into tubes.
This Treatments Strategy for SIBO page might be of interest. It says that herbal approaches can be as effective as antibiotics in the case of SIBO.

Relapse after treatment is common, and this page offers some advice on preventing relapse.

SIBO can cause a lot of fatigue, so although it's not the cause of ME/CFS, it can add an additional fatigue burden onto the the existing fatigue of ME/CFS.
 
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@Hip Thanks for the info. My GI issues have been horrible and have been among my first symptoms. With the nausea, I was near anorexic. Thankfully, that has passed, but the gas and bloating are unbelievable 24/7. I used to be a runner and ate a very clean diet. I now eat anything to get calories. I am hoping I can make dietary changes to help me manage the SIBO without dropping weight again.
 

Hip

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I am hoping I can make dietary changes to help me manage the SIBO without dropping weight again.
Maybe taking some antibacterial herbs long term might be an option. That may help prevent the return of the SIBO, if you go for the antibiotics and they temporarily fix the SIBO.

@ljimbo423 had some success in treating his own SIBO with antibacterial herbs, which I think included things like oil of oregano.