Learn how I treated my SIBO with antibiotics, prokinetics, and partially hydrolyzed guar gum.

How I Treated My SIBO (and how I’m doing six months later)

As I explained in a previous post, I got diagnosed with SIBO in December 2017 after years of not knowing what was wrong with me. Now, I’m going to tell you exactly how I treated my SIBO, how things are going six months after treatment, and what I would do differently.

Medications I Used When I Treated My SIBO

Depending on who you ask (doctor, naturopath, or dietician) you may get some very different answers for how to treat SIBO. There are pharmaceutical antibiotics, natural antibiotics, or the elemental diet. Not to mention countless other supplements, diets, or protocols that people swear by.

My gastroenterologist trained under Dr. Mark Pimentel, one of the foremost SIBO experts, at Cedars-Sinai Hospital in Los Angeles. His approach basically mimics what Dr. Pimentel recommends. I had read up on this protocol beforehand, so I was pleased when my doctor recommended it without me having to educate him.

My doctor prescribed me a 14 day course of the antibiotics Rifaximin and Neomycin. My breath test showed both hydrogen and methane, and this combination is very effective when treating both. Using Metronidazole instead of Neomycin also been shown to be effective.

I took the Rifaximin three times a day in 550mg doses for a total of 1,650mg per day. The Neomycin I took twice a day (morning and evening), in doses of 500mg for a total of 1,000mg per day.

I set a timer on my phone to remind me to take them, because it’s a lot of medication to be taking all the time! I also found it pretty annoying to have to remember to take the bottles with me when I went to work.

Supplements I Used During Treatment

During the antibiotic phase, I only used one additional supplement, a prebiotic called Partially Hydrolyzed Guar Gum or PHGG.

Prebiotics are starches and fibers that act as food for the bacteria living in our intestines. PHGG, made from guar beans, mainly consists of a starch called glucomannan.

While “partially hydrolyzed” makes it sound a little scary, this process means that unlike normal guar gum, PHGG is much less gummy. This makes it easier to digest and won’t block you up like some other fibers.

I was very nervous about taking a prebiotic fiber because I haven’t had good experiences with fiber before. As I’m sure some of you know, they can make you very gassy and uncomfortable and either slow things down or speed them up too much!

However, I read a study of SIBO patients comparing those solely taking Rifaximin with those taking Rixfaximin and PHGG. The study found that patients who took 5g of PHGG had a higher rate of eradicating SIBO than those solely taking Rifaximin. The group taking Rifaximin and PHGG eradicated SIBO in 87.1% of cases, while only 62.1% of patients taking only Rifaximin eradicated their SIBO.

That’s a pretty big difference in success! I really, REALLY wanted my SIBO to go away, so I decided to take the PHGG. I figured I would just endure whatever unpleasant symptoms it might cause temporarily while I treated my SIBO.

As it turns out I tolerated it very well. PHGG mixes super easily into either hot or cold drinks with no grit or taste. I just mixed it into my tea and didn’t have any side effects. In fact I think it actually helped my digestion a little!

You can find PHGG very easily on Amazon. This is the one I took as it specifically said it’s ok for SIBO, but you can also find others on Amazon.

Learn how I treated my SIBO with Rifaximin, Neomycin, PHGG, and prokinetics

What I Ate During Antibiotic Treatment

Often people ask if they should be on a low FODMAP diet while taking antibiotics for SIBO. NO!

As Dr. Pimentel and other experts have explained, antibiotics work best when the bacteria are actively replicating. This is when the medicine enters the bacteria to destroy them.

So, you want to keep the bacteria happy and well fed while you’re on antibiotics. This means continuing to eat FODMAP containing foods like bread, fruits, etc. Don’t go crazy and eat donuts all week, but continue to eat a balanced, healthy, FODMAP-full diet.

My doctor told me that after I had completed the antibiotics, I needed to follow the low FODMAP diet for six weeks. So I was more than happy to enjoy FODMAPs while I still could.

How I Felt During Antibiotic Treatment

I had read a lot of scary stories about how terrible people felt on antibiotics while treating their SIBO. As it turns out, I had a relatively easy time on the antibiotics.

The first few days I was very gassy and my stomach felt pretty rumbly. It kind of felt like I had indigestion for a few days, basically. I also noticed that overall I felt a little tired and out of it.

After the first few days though, I started feeling better and better. Before the treatment, I had gotten so used to my stomach being bloated for years that I had apparently forgotten what I looked like when not bloated!

My digestion also became lot more regular. I thought, is this what having a normal digestive system is like?! It had been ten years since I had developed SIBO, so I’d forgotten what that felt like before I treated my SIBO.

I was almost sad to finish the course of antibiotics because I felt so great.

I also knew that the next phase of treatment involved eating a low FODMAP diet for six weeks. I’d done the diet before and knew how restrictive it was, so I was sad to stop cramming my face full of carbs and yummy FODMAP foods. But once I treated my SIBO, I wanted it to stay away…far, far away.

My Post-Antibiotic Diet

After the antibiotics, I did (and still continue to do) several things to try and keep the SIBO from returning.

First, like I just said, I followed a low FODMAP diet for six weeks. I followed it fairly strictly although I did drink moderate amounts of wine and beer. I really dislike the diet because it makes socializing so difficult, but I endured.

Fortunately the diet only lasted six weeks.

Long term, I continue to follow a number of maintenance tactics to hopefully keep me from relapsing.

Long Term: Prokinetics

Right after finishing the antibiotics I started taking a prokinetic. Prokinetics drugs stimulate the migrating motor complex to do its job properly and clean the bacteria out of the small intestine.

I take a low dose of Erythromycin. Erythromycin, you say? Isn’t that an antibiotic?

Yes, but it doesn’t have antibiotic properties at such a low dose (I take 62mg, which means I cut up the 250mg tablets into four!). Other prokinetics include Low Dose Naltrexone and Resolor. Resolor supposedly works very well, but isn’t available in the U.S.

In addition to Erythromycin, I also take an herbal prokinetic, Iberogast, that my doctor ok’d. Iberogast is a mixture of 9 herbal extracts that acts as prokinetic. I’ve found it seems to help with nausea and indigestion as well. I take 20 drops of it in the morning and at night.

Iberogast tastes slightly medicinal, and I don’t like to put it in water for that reason. I prefer to mix it into my ginger tea. For some reason the ginger masks the flavor of the Iberogast really well. As a bonus, ginger also works as a natural prokinetic and digestive aid.

I order my Iberogast from Amazon as it’s the cheapest place I’ve seen it for sale.

So, how am I doing six months after I treated my SIBO?

So far, I’ve been really pleased at my improvement so far. While it’s not like my digestive system returned to “normal,” it is significantly better.

I don’t expect I will ever feel 100% “cured” but I have only had a couple bad days since taking the antibiotics. I’ve only taken Imodium twice and haven’t felt like I needed it at all otherwise.

The thing that feels least improved is that I sometimes still get cramping stomach pains. In particular, this tends to happen after I haven’t had a good night of sleep. I recently wrote about how I’ve improved my sleep, and you can read about it here.

As for diet, I mostly eat whatever I want now. However, I avoid beans and legumes out of an abundance of caution. I avoid artificial sweeteners when possible as I’ve heard they impair the migrating motor complex. I tend to avoid gluten when practical, but I definitely eat it sometimes.

I have not redone a breath test since treatment, as my doctor prefers to go by symptomatic improvement instead. If I had to guess, I think I probably still have some inappropriately located bacteria, because my initial levels were super high. But given my improvement, there’s not enough reason to warrant more treatment right now.

My plan is to continue taking a prokinetic, probably forever, as there doesn’t seem to be any downside. I am interested in switching to Low Dose Naltrexone as it has immune system benefits, but I haven’t done that yet. Has anyone had experience with LDN? If so I’d love to hear about it in the comments.

Last Words

Given that I’d had digestive problems for a decade with no answers or improvement, I consider myself extremely fortune that I accidentally found a doctor who knew the favored protocol for treating SIBO.

I’m also very fortunate I tolerated the antibiotics so well and that they seem to have largely worked.

Of course, I’m aware that often SIBO comes back and generally is a chronic condition. While I still manage mine on a daily basis, right now it feels like largely preventative measures. Hopefully it stays that way!

Do you have any questions about how I treated my SIBO? What have you tried to treat your SIBO? Let me know in the comments!

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26 comments

  1. Could you write what you ate for a typical day’s meals for breakfast, lunch, dinner, etc? What were good things to eat?

    1. Hi Sue, you can read more about the low FODMAP diet online (just google low FODMAP to get ideas for shopping lists, foods, etc.). Generally, I would eat eggs, bacon, and hash browns for breakfast, or a low FODMAP cereal (like Mesa Sunrise or Gorilla Munch) with low FODMAP fruit like tangerines or strawberries. For lunch and dinner I would usually have some kind of protein like chicken or fish, sometimes rice, salad, or greens like kale or swiss chard. Here is a good resource for learning more about what foods are low FODMAP: https://www.monashfodmap.com/i-have-ibs/starting-the-low-fodmap-diet/

      Hope that helps! Good luck!

    1. I had tried Glutamine before I learned I had SIBO (when I thought I had IBS and didn’t know what the problem really was). It didn’t seem to do anything for me then. I haven’t tried it since.

  2. Hi, Thank you so much for posting this!!! So you took the Iberogast at night and morning. Did you take the Erythromycin at a specific time?

    1. Hi Inna, I just took it before bed, not at any specific time. Same with the iberogast, I just put it in my evening up of ginger tea. Thanks! Hope it helps.

  3. Hi, Thank you for posting this!!! So you took 50mg of the Iberogast at morning and night. Was there a specific time you took the Iberogast?

  4. I’m confused. I have hydrogen dominant SIBO, with occasional urgent diarrhea. I haven’t quite figured out about prokinetics. I’ve been enjoying my morning ginger/peppermint tea, but if ginger is a prokinetic, a motility encourager, perhaps I shouldn’t be drinking it in the morning when my symptoms are worse. Prokinetics for SIBO with constipation?

    1. So, prokinetics do not cause diarrhea any more than they cause constipation really. They are not the same as laxatives. Prokinetics help restore the normal smooth muscle contractions than SIBO messes up, which causes both constipation and diarrhea. My understanding is that the difference between constipation and diarrhea is caused more by the type of bacteria that is overgrowing. So, prokinetics should not make it worse. I drink ginger tea with Iberogast pretty much every morning!

  5. I appreciate you taking the time to tell us your story. So many of us are suffering and I’m sure this has helped many. Thanks.

  6. Thanks So much. I am starting Xifaxan for 14 days on Monday. When and how much PHGG did you take? I have read to take 5grams daily for 10 days, but they never say what time of day or whether to take it with an xifaxan dose or not. Also what times of day did take the Xifazan? Thanks again I’m trying so hard to get this right and get my life back.

    1. I took 5 grams of PHGG, divided up into 2 doses, one in the morning and one at night. No particular reason I took them in the AM or PM though, I’m sure you could take it all at once probably. I don’t recall what time of day I took the Xifaxan, I want to say it was divided up into a morning, afternoon, and evening dosage. Best of luck!

  7. Thanks for your blog. The two foremost SIBO experts are Siebecker and Pimentel. Siebecker has a great site with lots of information and guidance and can be found at siboinfo.com. You got lucky that your doctor studied under Pimentel. I end up with some putz so I ended up treating myself. What low fodmap diet did you follow? Was it Pimentel’s Cedars-Sinai SIBO Diet?

    Thanks again.
    Ray

    1. Yeah, unfortunately most doctors just aren’t up on the latest SIBO information, if they have even heard of it it at all. I followed the normal FODMAP diet, not Dr. Pimentel’s. I’m not sure which is better or if there is any advantage of one or the other though. I think as long as you stay away from high-fermentation foods for a while that’s the main goal, and there are likely many ways to achieve this.

    1. I am still doing pretty well, although some recent medication changes have been affecting my stomach lately. I will be doing a more thorough post on how I’m doing soon so look for that! To prevent relapse I take prokinetics (Iberogast and erythromycin) and try to avoid things that trigger my digestion, which isn’t a lot (coffee / caffeine, ice cream, fried stuff).

  8. Is it good to take a prokinetic while taking xifaxan or after I am done with it? I’ve been reading conflicting things about this.

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