How does one shout from the rooftops?

April 16, 2008

On Monday morning I found out that my hydrogen breath test was positive for small intestinal bacterial overgrowth. Today is my second day on 1200 mg of Xifaxan. I am also taking VSL #3. I am trying to keep my regular low-carb diet with minimal lactose. It’s going well. I don’t feel so great. Kind of like a good day pre-low-carb. A bit of gas, especially at the gym. Some pain. Lots of rumbling, but some of it from places that I’ve never really heard rumbling before. I will start my period soon, so the little bit of bloating could be that.



  1. I found your blog doing a search for SIBO and it seems really helpful thus far. I go in on Friday for my breath test and was just curious what to expect. I’ve had these digestive problems for 10 years and so the dr is pretty sure the tests will come back positive. I heard the antibiotic/diet regime is difficult and may not even produce results. Do you have any advice for me as far as what to expect? Do the antibiotics cause pain or discomfort? Why do people say it’s so difficult to follow? I am a HUGE candy fiend, as well as bread, pasta and cheese so I know this is going to be extremely difficult for me! Any other suggestions or words of advice to make the process easier? Thanks!!

    • Nicole, I’m glad you found my blog helpful. When I go back and read through I wish I had left out the weightloss stuff as I feel it muddies up the details of the SIBO discovery and treatment, but as long as you were able to separate the two, then that’s great. I can’t believe you’ve lived with this for a decade and I’m so glad that you’re going to have a breath test.

      What to expect? Well, the breath test itself is no big deal. Its more boring than anything. Find someone to help you pass the time if you can. 🙂 I thought the lactulose was going to make me sick, but I only had a mild stomach ache afterwards, and no bloating, nothing to write home about. Its true that the antibiotic course does not work for everyone, for many reasons. The antibiotic approach isn’t a conventional one and despite hard evidence of its efficacy, its still very controversial. The scientific literature doesn’t come to consensus on antibiotic type, dosage and course length, but it does point to a few important trends: antibiotics help some people with IBS, and even more people with SIBO. Xifaxan is the drug of choice, mostly due to its nonsystemic properties, but it is costly as it is hardly ever covered by insurance because its use as treatment for SIBO is still off-label. 10 days of 1200 mg/day or 7 days of 1600 mg/day have been the courses that show the best results. In my own experience, I think I even mentioned in this blog, one course of 600 mg/day sans dietary changes was NOT enough. However, 1200 mg/day and a very low carb diet and I was fine for 5 months.

      Segueway into diet – yes it can be difficult. Again, there isn’t an official guide to what should and shouldn’t be eaten. Carbs are hard on the system as we’re fighting the bacteria to see who can get the nutrients first. Elaine Gottschall goes into the specifics regarding how the bacteria render our digestive systems virtually worthless; see her book on the Specific Carbohydrate Diet for more details. White carbs are best for most people (“bad” carbs like table sugar and white flour) while fiber and fructose are universally difficult for most folks with SIBO. Starches can be in the middle, hard for some and easy for others. I personally went from a carb-heavy vegan diet to a Atkins-induction style low carb diet literally overnight and I felt amazing. I have never heard of diet “curing” anyone like this, nor can I alleviate my symptoms as effectively with diet alone now that my system is fairly used to it. If I were you I’d go in the general low carb direction and take it from there. If white carbs work for you then go ahead and eat them. If dairy is okay, eat that too, but if you want to be extra safe, eliminate it during the antibiotic course. Since it costs so much, I generally try to be as strict with my diet as possible while taking Rifaxan. I would definitely give up candy for the 10-day course, but if you must satisfy a sweet attack, go for candy over fruit. Think backwards of what a healthy person would do. 🙂

      As far as the antibiotic course itself, I didn’t find it too terrible, but everyone is different. Some people feel better a few days into the course; I never do. I just sort of hold my breath and wait. If I were you I would be super careful with my diet, and give it time. Please update me on your breath test results, either here or via my Yahoo group.

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