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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55 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.

    1. I took one after. I don’t think there’s any harm in taking one during your antibiotic treatment though. I would check with your doctor to be sure.
      Good luck!

  9. Hi thank you 🙏🏻 so much for wonderful information. I have sibo/ dirreha for last seven years, I am on erythromycin they are many things I can’t eat I get relapses in between the treatments, I was wondering the prebiotic PHGG you mentioned is good for my condition?my concern is don’t want to have more dirreha.
    Thank you so much.

  10. Good, basic, simple information. Thank you! There is so much on FB and on line. Gets VERY confusing. I’ve done similar things and I am better and as you say, not perfect, but have been able to add so much back into my diet.

  11. First, I want to thank you for sharing your story and yes for letting us know we are not alone, but more importantly giving us hope that there can be a light at the end of the tunnel. SO THANK YOU! Last year, I was diagnosed with SIBO methane dominant. From everything I have read either you experience diarrhea or constipation. Mysteriously, I have experience neither. Regular bowel movements ever sense the diagnosis from another practitioner that it was methane dominant SIBO. While I am thankful to experience neither, I am confused as to why neither symptom is experienced. However, I do experience bloating, gas, bad breath, and occasional slight burning below middle of ribcage. My first indication of SIBO was after eating a breakfast sandwich from local diner. Since then, I have had the symptoms. I’ve read SIBO can be brought by food poisoning. Subsequently, I had two unsuccessful treatments with Xifaxin. I later found out that Xifaxin does to work on SIBO methane dominant, neither did my old practitioner. New practitioner gave me a choice herbal or prescription antibiotics. I have been on herbal antibiotics for 16 days with another 14 days left. Sometimes I feel better other times it feels the same. I keep hearing herbal take longer. If this does not work I will take the combination of Xifaxin and Neomycin followed up by LOWFOD MAP Diet for a minimum of 2 weeks. My new practitioner has not said anything about Prokinetics, but I am definitely going to mention them, and ask when I can take them. My main concern is that SIBO is the secondary issue and if I do not get to the root cause of the condition, I will be constantly trying to stop reoccurrences. I have read that if a slower motility is the causes that it can be improved with prokinetics.

    1. Hi Theo, I also never experienced a change in bowl movements – just gas and bloating, but my breath test results sure did show methane dominant SIBO!

      1. Hi Mallory,
        Thanks for the response. The herbal antibiotics are wearing me out. I have 10 more days of taking 14 pills a day. Not feeling much better. Most likely I will have to take Xifaxin and Neomycin. it sounds like you took both for 14 days. My doctor prescribed14 days Xifaxin and 10-14 days for Neomycin. Prior to successful treatment, did you have any discomfort, like slight radiating below the middle of your ribcage? CAT SCANS with and without contrast and Ultrasounds were negative. Blood test for celiac and thyroid issues were negative. It is that same feeling I felt when after eating the infamous sandwich that lead to the onset of what turned out to be SIBO. But its always in the same location. right underneath ribcage (middle). I am wondering if there is a correlation between this feeling and the onset of SIBO,,,, Also, while my doctor has not mentioned prokinetics, I agree there are benefits particularly for improving motility. So, I am going let my doctor know that I plan to take them while on low fodmap diet and then she can let me know if she prefers that I not take them and explain why. Again, thank you for sharing your story. I pray that I, too, can get to the other side like you.

        I

        1. I’ve had a similar problem in the middle area. There or further to the right. I suspect it’s bacterial, as when I started antibiotics, it went away, plus I’ve also had suspicions (as my doctors looked stupid) that somehow I had some sort of “infection” in my bile ducts, something else that’s stopped! One word of advice. Don’t let your doctor decide too much. Get educated in every way you can. You know your body. Follow your instincts or, duh, “go with your gut.” I’ve had a lot of practitioners, if they aren’t fully educated on something, who simply say “Don’t do that.”

          1. Hi,
            Thank you for the response. I agree with you. I suspect that it is the bacteria from gut as well. My physician said that that area is where the stomach meets the small intestine. That makes sense given SIBO is in the small intestine. You are right, we have to go with our GUT. Some doctors really do not know and will subject patients to whatever treatment and procedure that comes in their head, with nothing to support it. I am on herbal antibiotics and now have whats called black tongue. I have gone to my general practitioner and he said its nothing serious and could be related to the herbals. Immediately contacted my GI said she never had anyone have that side effect. I go on line, and it says that some herbal antibiotics can cause black tongue. I have an appt with Ears, Nose and Throat doc next week. What’s crazy is that it brushes off the tongue with a toothbrush.

            Theo

        2. Hi Theo,

          Sorry to hear your herbal protocol is not helping, but it definitely sounds like you have other good treatment options to try. I do not experience pain below my rib cage or elsewhere in my stomach really.

          I have not yet been treated successfully for SIBO. Like you, my doctor didn’t know that Xifaxin + Neomycin is the best way to treat methane SIBO. I underwent Xifaxin-only with lackluster results. I’ve since found a doctor who at least knows that there are different ways to treat SIBO based on whether you are a methane-producer. Hoping he will prescribe me Xifaxin and Neomycin next week!

          1. Hi Mallory
            Interesting that you have no pain, or discomfort below your rib cage in the middle. Mine is not all the time. A couple other folks that post on the site, stated they experienced the same discomfort in that area, but once prescribed the right meds, the discomfort, cramping, bloating went away. I guess symptoms can be different depending on the individual. I hope you are prescribed what will heal you. Thank you for the response.

            Theo

          2. Hi Mallory, I hope your new doctor has prescribed you the right antibiotics that will help you! Keep a positive attitude and let us know how it goes. Best of luck and I hope you feel better.

  12. Thank you so! You cannot imagine how valuable your words are in aligning my universe! I’m, literally, DECADES (broken medicine) into undiagnosed bacterial overgrowth–a duh, considering most of my childhood NON-STOP on antibiotics–and your experience is so valuable. How do I find a Pimental-trained doctor in my area? New Mexico,

    1. I do not personally know of Pimental-trained doctors in New Mexico, but I haven’t looked either. I have seen a list someone put together of SIBO doctors, I will have to see if I can find it again.

  13. You will probably have to fly to Beverly Hills to see him or you can fly to Oregon to see Siebecker who treats the same way. Other than those 2 it will be hard to find some one competent.

    1. Hi Ray,
      Thanks for the response. After reading your response, I called Dr. Primental Office and got a recording stating that he is not taking any new patients. I heard this same response from another leading SIBO GI doctors on the east coast. Its tough finding a GI that even bring up the possibility of SIBO being the cause of discomfort let alone knows how to best treat it. You are right, it is extremely hard to find someone competent. I hope you and everyone on this blog get well and STAYS WELL!!!

      Theo

      1. I’ve been good for about 4 months now but won’t be in the clear until the 12 month mark as SIBO has a high relapse rate the first 1yr. I ended up treating myself as the two main doctors were not accepting new patients. I gathered enough information from these two doctors from online sources and created a treatment plan for myself. I flew down to San Diego, went over into TJ and got 2 rounds of meds (4 weeks total). Before my 1st round my numbers were at 28 hydrogen and 13 methane. After the 1st round I took a breath test that I purchased online for $300.00 (it was home kit) and a week later I got my results. Hydrogen was now down to 12 and methane at 8 but still had some mild diarrhea but no high fodmap symptoms. I waited 4.5 weeks (during which I was on a low fodmap diet) and did the second round. After the second round my numbers were 7 hydrogen and 2 methane which is considered a negative test result for SIBO. I don’t recommend this route to anyone but I was desperate and there was no way I was going to live like that. Plus during my research I learned that the longer you have SIBO the more damage it does to the lining of your small intestine to the point that you may never recover. There was no way I was going to let that happen and I already had SIBO for 9 months….too much to risk. I received no help from my gastro doc as he didn’t know much about SIBO. I was skeptical about the quality of the Mexican drugs but the box stated the Rifaximin was made in Italy and the Neomycin was made in Mexico but the Mexican drug company had been around since 1965. I felt confident about the quality so bought them for about $350 for the two rounds. And luckily it worked out. I’m taking a prokinetic now (ginger capsules) and 3 more months on this and I will be done. I can totally empathize with everybody here and I feel your pain. I wish you all luck on your healing efforts.

        1. I commend you for taking matters into your own hands. It appears we have to be our biggest advocates and some cases only advocate. I just finished 30 days on herbal antibiotics (14 pills a day). This is a brutal regime. I do not have to be a doctor to know it’s harsh on a lining that was already compromised before ingesting the herbal antibiotics. What’s crazy is that for first three weeks still felt bloated, full, and gassy after only eating dinner. Did not experience symptoms after breakfast and lunch after the first week on herbal antibiotics, just after dinner. Then last three days on treatment, I stopped feeling bloated and full after dinner, almost forgot what it felt like to feel good. But I qualify this statement by saying my stomach still feels sensitive/raw from, what I believe is taking over 400 herbal capsules. Next step now is low fodmap diet for at least 2 weeks then retest breath. If I still have it I will opt for pharma meds you took for 14 days. My doc said NOTHING about Prokinetics even after I asked via email. But like you, all the research leads me to believe they are a must after treatment. Particularly given that the majority of SIBO suffers underlying causes is attributable to slowed or impaired motility, which can be improved/repaired. Reading your story has encouraged me tremendously and thank you for sharing alternative sources for getting the meds. Hang in there, and everyday you wake up feeling better is a day closer to the 12 month mark, which you will achieve!!!

          Theo

          1. I tried the herbal route 1st for 3 months. I took something like 40 pills a day to no avail. They were really hard on my intestines and it was really hard to finish the program. Wasted 500 dollars and 3 months time. I could have been healed that much sooner if I had went straight to GI doc first. Most of the doctors out there pushing the herbal method of treatment are usually chiropractors and thus they are not able to prescribe medication so they tell you they can heal you on antimicrobials. I haven’t heard about 1 person being successfully healed by using antimicrobials and I’ve done over 150 hours of research and read 6 books on stomach/intestinal problems. That doesn’t mean they are not out there, I just haven’t seen it. I hope it works for you but I had no luck with it. Good luck with everything and try to heal yourself as fast as possible because the longer you have SIBO the probability of never fully getting rid of it increases.

            Ray

          2. Hi Ray, sorry to hear that herbals didn’t work for you, I hope you managed to find a SIBO literate GI who was able to successfully help you with antibiotics or otherwise. There are several peer reviewed clinical studies showing that herbals can be as effective as pharmaceutical antibiotics, however like you said, not everything works for everyone! Another aspect is that a lot of the time, repeat courses are needed (of either herbals or pharmaceuticals) to eradicate SIBO. I hope you are healing well and thanks for reading!

          3. Hi Theo, thank you for reading and I hope your regime was successful. I definitely believe (just my opinion – I’m not a doctor however) that evidence and research shows that prokinetics are crucial for maintaining motility after the bacterial overgrowth is eradicated. The nice thing about prokinetics is that if your doctor refuses to prescribe one there are non-pharmaceutical options. I myself rotate between low dose erythromycin, which is prescribed, and iberogast, which is not prescription but does have research backing it as a motility agent. I rotate because erythromycin I have been told loses its efficacy after a while, so you have to take “vacations” from taking it so that it is effective again. So during those “vacations” I take Iberogast, or just when I’m feeling bloated / gassy as Iberogast tends to help with that. I hope you feel better!

      2. Theo, you may want to ask to speak with those doctors (or their staff) who are not taking patients and see if they can recommend another GI doctor for SIBO. They will often know of who else in the area is SIBO-literate.

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