Xifaxan is the brand name for the antibiotic drug Rifaximin. Like all antibiotics, it works by killing off bacteria. What makes Rifaximin different is that it is non-systemic, meaning that it doesn’t get absorbed into the bloodstream and instead stays in the intestines. Thus, Rifaximin is often prescribed for intestinal infections such as Small Intestinal Bacterial Overgrowth (SIBO). Rifaximin was also recently approved for treating Irritable Bowel Syndrome (IBS).
Why Rifaximin is Prescribed for SIBO and IBS
Irritable Bowel Syndrome is a condition which affects upwards of 15% of the population. Yet, until recently, doctors were mostly clueless as to what causes IBS. The disorder was largely dismissed as stress and patients were told to “take it easy” and “watch what they eat.”
Now, we are finally starting to realize that IBS is a condition caused by dysbiosis of gut flora. In layman’s terms, this means that the levels of bacteria in our guts has become unbalanced.
SIBO is a condition in which there is too much and/or the wrong kind of bacteria in the small intestine. Research shows that as many as 84% cases of IBS are really misdiagnosed cases of SIBO! So, if you have been diagnosed with IBS, there is a good chance that you really have SIBO.
Since Rifaximin is an antibiotic which kills bacteria in the gut, it should be no surprise that multiple studies have shown it effective in getting rid of IBS and SIBO symptoms. In 2015, the FDA approved Rifaximin for treating IBS with diarrhea (IBS-D). Rifaximin is often prescribed for treating SIBO.
*Note that is why diets help for IBS and SIBO. Those diets all work by removing foods which bacteria feed off of.
My Own Personal Experience with IBS and SIBO
I should also note here that IBS and SIBO are something personal to me. I had long dealt with GI symptoms which were diagnosed as IBS. Only after nagging my doctor did he finally order a breath test which confirmed that I really had SIBO (read about how to diagnose SIBO here).
My doctor prescribed Rifaximin and, like so many others, I hoped that popping these antibiotic pills would cure me. And, like so many others, I soon found that curing SIBO isn’t as easy as taking an antibiotic.
Rifaximin Is Ineffective for IBS and SIBO in the Long Run!
For the millions of people who suffer from IBS or SIBO, it should be great news that Rifaximin is an approved treatment.
But there is one little problem: Symptoms come back!
The recurrence rates of IBS and SIBO after treatment with Rifaximin are appalling.
IBS Recurrence Rate with Rifaximin
An initial study into Rifaximin for IBS found that symptom relief lasted 10 weeks after stopping the medication.2
Later clinical trials followed patients for longer. One study found that 64% of IBS patients relapsed after 6 weeks of taking Rifaximin. However, approximately 1/3 of patients did go 22 weeks without relapsing. Considering that there is no other IBS treatment other than diet protocols for managing symptoms, this makes Rifaximin a very attractive option for patients and doctors alike.3, 4, 5
SIBO Recurrence Rate with Rifaximin
There is a lot of variance in the findings of Rifaximin-SIBO findings. The antibiotic isn’t always effective for SIBO (depending on the study, Rifaximin is 40% to 91% effective in treating SIBO). When Rifaximin is effective for treating SIBO, the results don’t last long.6, 7 Studies show that SIBO recurs in almost half of patients within 1 year of treatment with antibiotics!8
Why Rifaximin Doesn’t Work in the Long Run
It’s an understatement to say that gut flora is complex. Researchers are only now starting to understand the multitude of roles that gut flora has in our daily wellbeing. Unbalanced gut flora could be at the root of diseases like depression, anxiety, obesity, autism, diabetes, and heart conditions.
Consider that we have 100 trillion bacteria in our intestines alone. This is 10x the number of cells we have in our bodies! The research is still in its infancy, but it is really fascinating stuff. To learn more, read this article on Gut Flora Dysbiosis.
Antibiotics like Rifaximin indiscriminately kill off ALL bacteria. They do NOT balance out the bacteria in our guts.
Rifaximin will likely relieve IBS and SIBO symptoms for a short time (because the antibiotic has reduced the amount of bacteria in your gut). But, once those bacteria start to breed again (and they will), the symptoms will only return.
Can’t I Just Take Rifaximin Again When Symptoms Return?
When I was diagnosed with SIBO, my doctor prescribed me Rifaximin and Neomycin (another antibiotic for SIBO) for 14 days. The 14-day course of antibiotics didn’t even come close to getting rid of my SIBO.
My doctor was ready to prescribe me more antibiotics for my SIBO. I later learned that it would have probably taken four courses of antibiotics to get rid of my severe case. And, considering the high recurrence rate, I probably would have had many more courses of antibiotics in the future!
There are a numerous reasons why you wouldn’t want to take antibiotics each time your SIBO or IBS recurs:
1. The Cost of Rifaximin Isn’t Cheap
According to Drugs.com, the cost for a supply of 30 Rifaximin tablets is $547. That doesn’t even include the costs of going to the doctor to get your prescription. Even with health insurance, the copay costs can quickly add up.
2. Rifaximin Can Have Some Nasty Side Effects
Drugs.com also lists some of the common side effects of Rifaximin, including:
- Bloating
- Difficulty with moving
- Fever
- Frequent urge to defecate
- Headache
- Passing gas
- Stomach pain
- Swelling of the hands, ankles, feet, or lower legs
And those are only some of the common Rifaximin side effects – not to mention the many less-common side effects!
It is rather ironic that you’d take an antibiotic which causes many of the very same IBS and SIBO symptoms you are trying to cure, and then adds even more symptoms on top of that.
3. Antibiotics Don’t Address the Underlying Problem which Caused SIBO or IBS in the First Place
If your gut flora is unbalanced, there is a reason it got that way. Bad diet is probably the main reason for this (read how bad diet causes IBS). Other causes of gut dysbiosis could include stress, oral contraceptives, alcohol, or antibiotics.9
Which brings us to….
4. Antibiotics May Cause SIBO and IBS
We now know that taking antibiotics disrupts our gut flora. The disrupted gut flora can lead to SIBO. It can also cause IBS by damaging the nerves in the gut.10
Luckily, most of the time our gut flora seems to recover from antibiotics quickly. However, this isn’t the case with everyone. As microbiology expert Jeroen Raes says in his Brussels TEDx talk on the subject,
“If you get a normal dose of broad-spectrum antibiotics, some of you will recover, in terms of gut flora, after a few weeks. For some of you, it will take months. For some of you it can take over a year for your gut flora to become ‘normal’ or to return to what it was again. And for some people, they never recover. They have permanently altered their gut flora.”
Considering that antibiotics may be the underlying cause of SIBO and IBS, it is ironic that Rifaximin is prescribed for treatment! If you want to learn more, read how antibiotics can cause IBS.
What’s a Better Alternative to Rifaximin for SIBO or IBS?
Sorry to break it to you, but there is no one easy solution for curing IBS or SIBO for the long run. Because our gut flora is so complex, it often takes a multifaceted approach.
For me personally to cure my SIBO, I took herbal antibiotics along with a prokinetic while simultaneously doing an elemental diet. I then followed a careful diet afterwards to ensure my gut bacteria developed in a balanced way.
You might not need to do all of this to cure your SIBO or IBS. But, if you haven’t had success with Rifaximin or simply don’t want to take antibiotics, one or more of these alternatives are worth considering.
Herbal Antibiotics
As with pharmaceutical antibiotics, herbal antibiotics also work by killing off bacteria in your body. However, herbal antibiotics are less likely to cause side effects, they don’t cause antibiotic resistance, and they may even be more effective.
The reason why herbal antibiotics are preferable over Rifaximin is because herbal antibiotics work on many levels. Whereas antibiotics like Rifaximin are just one isolated chemical, herbal antibiotics contain multiple chemicals which work together to attack bacteria on multiple levels.
In one study which compared herbal antibiotics to Rifaximin for SIBO, it was found that herbal antibiotics were effective with 46% of users compared to just 34% of the Rifaximin users. You can read more about herbal antibiotics for SIBO here.
There are numerous herbal antibiotics which can be used as an alternative to Rifaximin. These are the ones I used:
- Allimed (Allicin) 450mg: Allicin is a component of garlic. Take 1-2 caps 3x per day for a total of 14 days (start with 1 cap 3x per day and on day 3 increase to 2 caps 3x per day). It is important that you take 450mg! You can buy Allimed here. You will need 1 bottle for a 14 day course.
- Berberine Complex: Berberine is a compound found in Oregon grape, barberry, goldenseal, and other herbs. Take 2-3 caps 3x per day for a total of 14 days (start with 2 caps 3x per day and on day 3 increase to 3 caps 3x per day; can cause headaches). You can buy Berberine here. You will need to buy 2 bottles for a 14 day course.
- Neem Plus: Neem is a tropical evergreen tree. Take 1 cap 3x per day for a total of 14 days. You can buy Neem here. You will need 1 bottle for a 14 day course.
I took all three of these herbal antibiotics for a 14 day course. Because 84% cases of IBS are really SIBO, it makes sense that these same herbal antibiotics would work for IBS patients as well.
Probiotics
In forums around the web, there is all sorts of anecdotal evidence of probiotics helping for SIBO and IBS. The reason for this is because probiotics are “good” bacteria which live in our guts. These good bacteria have important roles in digestion and some of them even kill off “bad” bacteria.
The problem with probiotics is that they are just one to a few different strains of bacteria. Consider that we’ve got at least 5,600 separate strains of bacteria in our colon alone.11 It is unlikely that adding two or three strains of bacteria as a probiotic to the mix is going to cure the unbalance!
This doesn’t mean that probiotics aren’t helpful. Here are some probiotics which are proven to work for IBS or/and SIBO. Unfortunately, I can’t recommend brands for all of them because, even if they are available, many manufacturers add off-limit ingredients. I’ve included links to the probiotic brands I can recommend.
- Saccharomyces boulardii: This is actually a type of yeast which fights off pathogenic bacteria and reduces inflammation. You can buy it here.
- Lactococcus lactis Rosell-1058: This probiotic produces enzymes which help digest starches and lactose. It is proven to help reduce bloating.
- Bifidobacterium bifidum MIMBb75: This probiotic was found to relieve pain, discomfort, bloating, urgency, and digestive disorder significantly in IBS patients.
- Bifidobacterium infantis 35624: Research suggests that this probiotic has immune-modulating roles which make it helpful for reducing pain, bloating, and bowel movement difficulty. Klaire Labs makes a gut-friendly probiotic with Bifidobacterium infantis called Ther-Biotic Complete. You can buy it here.
- Bacillus Indicus (HU36TM): Better known by its brand name MegaSporeBiotic, this is a soil-based probiotic which many SIBO and IBS sufferers have reported success with.
- Bifidus lactis: This probiotic is shown to enhance the immune system, reduce occurrence of antibiotic-associated diarrhea, and support proper bowel movements. Kirkman makes a good probiotic with this strain. You can buy it here.
- Lactobacillus plantarum: This probiotic is shown to reduce bloating, normalizes stool frequency, relieve abdominal pain, and improve IBS symptoms, prevent overproduction of yeast, and reduce bacterial translocation. This is also found in Ther-Biotic Complete by Klaire Labs. You can buy it here. 11, 12, 13, 14, 15
Note: Only Take Probiotics without Prebiotics
Bacteria is a living thing and it needs to eat something. This is true for probiotics as well. To help the probiotics thrive in the body, probiotic manufacturers often add something called a prebiotic, which is basically food for the probiotic.
The problem is that prebiotics can feed the “bad” bacteria living in your gut. Many of the prebiotics are also not allowed on the FODMAPs diet which is commonly used for treating IBS and SIBO symptoms. Without the prebiotics, the probiotics might not be able to repopulate your gut so you will have to take probiotics every day until your gut bacteria is reset.
Long-Term Diet Changes
As mentioned before, Rifaximin doesn’t address the underlying cause of your IBS or SIBO. To get rid of IBS or SIBO for good, you need to get rid of what caused it in the first place. In many cases, this is probably bad diet.
If you don’t fix your diet, the IBS or SIBO will probably come back eventually. Now is the time to stop eating all of those starchy foods, sugars, processed junk, and chemical additives.
Yes, You CAN Beat This!
IBS and SIBO can be frustrating and ruin your life. And treatment isn’t always easy either. But I want to emphasize that you can beat this disorder and get your life back.
There is only so much information I can give in a blog post. If you want detailed information on how to beat SIBO for good along with step-by-step instructions for treatment methods and diet protocols, download my eBook The SIBO Solution. You can buy it here.
Have you taken Rifaximin for IBS or SIBO? I’d love to hear your experiences!
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I have SIBO; dx’d by a breath test. I was prescribed Rifaximin and I do not have a gallbladder. What can I take along with the Rx 2wk treatment to help absorption? Can I continue to take my digestive enzymes? My probiotic is on hold while I treat.
Rafaximin doesn’t kill everything. It’s a modulator. Raises some bacteria, lowers others. wouldn’t take it because yes it doesn’t seem to work but it still doesn’t kill everything.
I love this information. It is so helpful. I ordered the herbal supplements, however do I purchase all of the probiotics? Or just one of them? Thank you
after years of probiotics and top of the line brands I kept getting worse and worse…any antibiotic kills good gut bacteria and it is for life never to be recovered even if you take probiotics…probiotics don’t restore…Xifaxan is only thing that has helped me plus eliminating processed sugar, as natural sugars are tolerated. Xifaxan is not absorbed systemically so only stays in small intestine…very expensive but with coupon and my insurance it is free
I agree, Sharon. I was taking probiotics prescribed by an ND and got SIBO. Did the natural antibiotics, they helped, did inulin according to Dr Nemechek’s Protocol, that helped, then did Rifaximin. Had to give in. Not worth suffering. Eating only natural probiotics like homemade sauerkraut.
Hi Sharon, I am about to jump into xifaxan and would like to understand how it worked for you and how you feel after nearly 8 months. I am fed up with SIBO symptoms and with two little kids I desperately need to feel better. The only thing that has worked so far is fasting for very long periods which isn’t sustainable. My dr prescribed xifaxan but also said to try magnesium citrate to see if that does the trick but I am at that point of needing something to work and feel better… any info would be helpful!
Thank you for your info. I have two questions:
1. Anyone heard of Atrantil? I am going to try it along with the SCD/Low FODMAPS diet. The studies on it are interesting and promising.
2. I just started Rifaximin two days ago and my stomach pain increased significantly. Then I started learning get side effects (of course, AFTER starting it). Anyone have thoughts on whether or not it is ok to just STOP taking it? It’s only been two days. Is there harm in starting and stopping this antibiotic like that? I want to just switch to the Atrantil and diet…maybe add in Allimed.
Thanks!!
I would like to know too. After two days, I’m so constipated, and nothing is making me go. This has to be creating more bacteria!
I just started Xifaxin as well and was in so much abdominal pain I had to get in a warm bath to stop the pain. I thought I was going to burst literally. I’d rather do the Elemental diet. I’m going to look up Antratil. I have had great success with bile and enzymes!
I have SIBO and H Pylori and 20+ years ago was diagnosed with low stomach acid. I was never super consistent at that time to take HCL. I was taking 8-10 HCL with meals (with no burn) and it was too much, so I took a lower dose randomly. Then developed H Pylori in 2013 but could have had it for years. This year it came back and also SIBO after adding in resistant starches for a weight loss issue. I then took Pepti-Guard by Thorne for about 6 weeks and Biocidin for 6 weeks following and now taking Berberine for the SIBO but feel I need more. I am very clean with my diet. I follow the Plant Paradox but also eat low FODMAP. Still struggling so thinking of trying GastroMend and Integrative Therapeutics Berberine Complex. Any thoughts? Still having discomfort. I do take HCL with meals and digestive enzymes. Thanks a bunch. Hoping this thread is still active. LOVE YOUR BOOK!
I have severe SIBO and am about to begin Rifaximin. My SIBO has been caused from taking probiotics. They are bacteria that is intended for the large intestine. But they are released in the small intestine. I am suffering now from severe symptoms of osteoporosis, fat soluble vitamin deficiency, and severe weight loss (38 pounds so far) in spite of high fat diet. I have neurological damage (probably from b12 malabsorption) severe arthritis and muscle pain and tinnitus.
Probiotics have been devastating for me. I should point out that I have also been on proton pump inhibitors which may have made me vulnerable to SIBO to begin with.
Gill, I’m not sure your cause is probiotics. I’d suspect proton-pump inhibitors, diet, past antibiotic use that finally reared it’s ugly head and MOST IMPORTANTLY (since, if nothing else, gut issues can cause it) a B-12 deficiency, which as you allude to is huge. When B-12 is low, it blocks mineral absorption (I take them in liqurd form now.) and can result in hormone imbalances (not necessarily reproductive hormones) that can affect the gut’s motility–yet another area the average doctor is clueless about! If you’re having trouble with probiotics, it’s likely because (like me) you can’t tolerate dairy–ANY dairy–and “lacto” this and that are in probiotics, which are cultivated from things like dairy. Are you doing the low-FOBMAP diet? Sort of essential and an explanation as to why, from the time I was a child, I’d “crash” if I ingested sugar or other refined carbs. I now realize that as I got sicker the way I “wanted” to eat was actually the way my bad gut bacteria “wanted” me to eat!
Gill, my story is soooo very similar to yours. Probiotics actually started it all. I have ms, doctors recommended the prescription strength probiotics and let me tell ms is nothing compared to sibo. I’ve lost 40 pounds and it just keeps going. Doctors are all clueless as to how to get under control. I really hate reading all of these people pushing probiotics. They can actually be quite dangerous, as in cases like ours.
Have you ever heard of a positive methane breath test due to a rapid transit time in the small intestine?
I am going to start Dr. Rostenburg’s protocol. He talks about something no one else I have looked at has and that is Haital Hernia. Most of his patients with SIBO have this. He has a combination of SIBO diet, herbal antimicrobials, digestive enzymes and doing a massage for Haital Hernia before and after ever meal. If our gut is not functioning correctly the other stuff is really not going to work. I think my SIBO is a combination of things, the Haital Hernia which might be from my lyme and mold exposure and the antibiotic treatment for my lyme. He has the most comprehensive clear plan that I have seen so far. He has it all on this website beyondMTHFR.
A hiatal hernia happens when part of your stomach bulges up through the diaphragm and into your chest. The diaphragm is a sheet of muscle that separates your belly (abdomen) from your chest, this condition cause GERD but not SIBO or IBS.
I can’t necessarily agree. When I treated my SIBO, my hiatal hernia stopped bothering me and feeling swollen. Face it, this crap can infect wherever it wants to. I even suspect the bad bacteria had spread up into my bile ducts.
This is great! I too had great initial success with Rifaximin but for a very short period of time and then symptoms came back with a vengeance and worse! The second time I tried it, it did nothing. I then had a severe and terrible reaction to Berberine (twice), what do you recommend I use as a natural herbal antibiotic?
Hi Emily, Check out this post for my take on herbal antibiotics for SIBO: https://hollywoodhomestead.com/herbal-antibiotics-sibo/
Hmm I think you’re being really harsh about SIBO and benefits of rifaximin. You also don’t mention that SIBO is the movement of normal gut bacteria from your large intestine to the small intestine. The idea of taking rifaxmin is that removes incorrectly growing bacteria from the small intestine, a fresh start. To then allow the regrowth of your bacteria back in the right place. You also don’t mention that SIBO and IBS can be caused by trauma to the gut, drugs, anti inflammatories, stress, gastritis infection or a traumatic life experience. So if you do take rifaximin then there is a chance you could be cured. Think you’ve shat on a lot of good research. You also haven’t mentioned dosage research, which has recently showed 1200mg/day for 7 days is better than 600/800g for 7 days, Majewski et al 2007 etc. I don’t know this article kinda brought me down, not brought me up. I tested positive for h2 breath test before even doing the test at 44ppm so I have been given rifaximin and advised against taking probiotics otherwise you are just ingesting more hydrogen producing bacteria which are going to make your symptoms worse! and also antibiotics are changing your gut flora and produce symptoms, but they are temporary whilst your on the drug – there not nice but it’s just part of the process you have to deal with if you want to try and improve lifestyle in long run. Also no mention of hypnotherapy or anxiety induced IBS etc or CBT.
So i am doing xifixan treatment now. Should i be taking prebiotics, beriberine etc with it or no?
Did you take the three herbal antibiotic capsules in succession or all together?
Hello and thanks for very helpful article! Is it safe to combine Rifaximin with other herbal antibiotics like Oregano Oil od GSE?
I wouldn’t but you can certainly check with your doc! 🙂
Never heard of diet causing SIBO. My research and talking to experts is that is caused by: antibiotics, stress, surgery leaving scars in the gut and tummy viruses/infections often picked up abroad. Once you have SIBO then the dietary changes need to be put in place to stop feeding the bad gut bacteria.
My GI doctor is a gut motility specialist written up in Philadelphia magazine. He did a gastric emptying test on me and said my gut motility is perfect until it reaches the colon. He will not prescribe Low Dose Erythromycin and says that gut motility drugs will not work when the issue is only in the colon. I think you disagree with him and I was wondering if there is research I can bring him about the gut motility options you recommend that shows it improves motility in the colon.
This is the first time I have read any of the things you have written and I am very excited about the what I have learned through you. I plan on buying your book and I think it will be a valuable resource. Thank you!
You’re so welcome, Sherry! Wishing you all the best!
Hi. Yes, I think I’m on my 4th round of it and having no success this time. Gastro wants to treat monthly after I complete this round as I ‘seem like one of his patients who can’t recover’. After reading info from you and others, my answer will be a firm H*ll no!
Ugh. I’ve lived like this for years. Right now I’m so weak and dizzy from the Xifaxin
I was diagnosed with sibo last year. I took the antibiotics and had some relief. It has now reared it’s ugly head again worse than before so need try different alternative not only did the xifaxan make me sick, it cost me $150 out of pocket copay. Thanks for all the info because I need try something different. This is a frustrating diagnosis. I really suffer with this.
Hi
I came across your site searching for info on SIBO and Xifaxan. I was interested to read your imput until I got to the very first line. There’s a lot of confusion about this so I wanted to share correct info. You have the drug info backwards. Rifamaxin is NOT the brand name for Xifaxan. Rifamaxin is the active ingredient in Xifaxan. Unless you are doing compounding the RX should be for Xifaxan. Xifaxan IS the BRAND name. There is NO generic for it. People use it interchangeable but it’s not really the same as one is the finished drug (Xifaxan) and one is an ingredient (Rifaximin) IN Xifaxan.
I would also suggest telling patients to get their thyroid thoroughly tested and look at thyroid issues. They cause and affect digestive issues. For some people fixing the thyroid greatly helps with SIBO.
Hi,
I got diagnosed with 3 brain tumours last March. Out of which, they removed two of them through brain surgery. For the remaining one,I went through 33 radiotherapy session. When Radiotherapy session got completed, out of nowhere I started to face IBS problem. Going to washroom for more than 10 times a day. After a couple of months, I went to second gastro doctor who finally helped me out. He told that I am facing ibs because I have already taken a lot of antibiotics post surgery and suggested to take rifaximin for a week (2 tablets a day ) and then after to start probiotic for a month(2 tablets a day). Suddenly after taking few doses of rifaximin, I felt lot better and after completion of 14 tablets/one week, I started taking probiotic medicine( Lactobacillus Acidophilus and Bifidobacterium capsule -> Providac capsule). I am still taking 5 temozolomide tablet in every month after completion of radiotherapy session. I believe, these probiotics tablets really helped me out but whenever I eat something little bit oily or odd stuff, really I face same situation again and go to washroom a number of times again. Is it possible to know, how much time will it take for me to recover completely with such probotic tablets or it requires change? Also I diagonsed with vitamin d defficient .For which I have already taken tablets and exposed to sunlight.
I had emergency surgery for a bowel obstruction last year and 18″ of my ascending colon had to be taken out which include the cecum, appendix and the all important iliocecal valve which works to keep bacteria out if the small intestine. I’ve had IBS my whole life and I’m 61 years old. The bowel problems before surgery were fairly well controlled with diet, magnesium and vitamin c. Those things no longer control the symptoms and I now have chronic SIBO due to the loss of the ileocecal valve. I am on xifaxan about every 5-6 weeks. It’s a miracle for me. I wish my problems could be controlled with diet but there is no replacing the valve. I worry about the bacteria becoming resistant to the xifaxan but not sure what else I can do. I’m under the care of a good specialist. Wishing good health for all.
I purchased this book yesterday and still haven’t received it yet. How long does it usually take?
Hi Diane, It should be instant. Please check your spam folder and if not there please email support@hollywoodhomestead.com so we can manually resend 🙂
Hi Sylvie,
Thank you for this information. I was recently diagnosed with SIBO even thought my tests came back negative. I’ve had years of IBS issues and they got worse in May (stomach ached from everything I ate, acne roseaca, food allergies, my thyroid is now off and so are my hormones plus I have a lot of lost weight!). I did the 3 hour hydrogen breath test and while my tests were negative, they said my gas pressure was so high before drinking the Lactulose that they are convinced I have it. I am seeing a doctor and being treated with the herbs Candibactrin AR and Candibactrin BR and hoping they work (I would consider the antibiotic but want to try the herbs first as I hear they are just as effective). I hear so many different thoughts about taking probiotics while killing the bad bacteria but aren’t we supposed to starve them? Thank you again for your knowledge and wisdom! I need to get your SIBO book!
I wouldn’t take probiotics while treating, nope… Is that what your doc recommended? Yes, you need the book 🙂 TheSIBOebook.com
I did a 14 day Elemental Diet fast. I felt great. Started back on food with the SIBO restricted diet and the intestinal pain, bathroom visits, now the upper GI with gas and burning after BM is coming back. I’m on Berberine and Neem 2 x day, NAC and 2 and 2 AM & PM of Interfase plus enzyme with GastroMend.
I can’t take the Allimed (Allicin) 450mg: as suggested and I can’t have garlic I double over in pain.
Hi Paula, Did you test before and after the elemental diet? Are you working with a doctor?
Hi there – you said you used all three of those herbal antibiotics you mentioned. Does that mean you took them all at the same time? Or tried one drug for 2 weeks, then the other? Thanks
Hi Sylvie – Great site and valuable information. I have IBS-D for almost 5 years now. Started with Giardiasis which took almost 2 years to diagnose and then the treatment. Though the flatulence and stomach rumblings havent subsided at all. Anytime I eat I have to pass gas after like an hour or 2. My SIBO breath test came positive however I do think I may have Candida and SIBO both as I have developed sugar intolerance. I recently finished 14 day course of rifaximin ( hoping to get quick relief !! ) but it didnt do nothing. I am still the same with flatulence and stomach rumblings after I eat. I am now wanting to undertake the herbal protocol that you suggested. Though I will wait for 15 days ( more suffering ! ), take a breath test to confirm. A question I wanted to ask – do you suggest taking Alimed post rifaximin or only during the protocol ? Thanks.
Great article and one of the best detailed explanations online, I would like to share my advice based on a personal experience which may not apply to all:
1- Get strong: SIBO consumes your energy and you need to get strong before curing it by using antibiotics or Prebiotics ( whatever works ) which only stops the symptoms and allow your body to relax and absorb food, also use multivitamins like centrum to refill what was missing from your body, antibiotics are only advised when the case is severe, then you can continue using Prebiotics to keep a balanced bacterial population, I used “super multi dophilus”.
2- Be Happy: it’s hard with SIBO but after getting strong, avoid any human contact that may cause emotional tension, this includes “drama queen” friends and family members on Facebook or any social groups, block people if you have to, SIBO triggers a cycle of light depression that feeds itself from TV, people and their stories ( happy or sad ).
3- Wait: keep strong and happy for at least two weeks
5- Stop taking Prebiotics and move directly to point 4
4- Investigate: review everything that you consume on daily bases; drink, food, (medicine), test stopping, replacing or changing the time of one item for two days and monitor the effect, take a rest and go back to Prebiotics for few days if you get tired, ###stopping/ replacing your medicine should be consulted with your doctor####, some medicines cause digestion problems when combined with other medicines or food/drinks, check with your doctor and insist on changing the timing or distribution of your drugs, check with other doctors if your doctor is rejecting to cooperate, some will resist getting involved in your SIBO suffering. Trust me, not everything is tested in labs and doctors don’t know everything!
5- Optional: use turkish toilet, no need to explain, just try it and you will discover what was missing from your life!
My Issue: my SIBO suffering was caused by the distribution of blood pressure drugs, one part of my investigation included asking my doctor to change the timing of pills by separating them into Morning/afternoon/evening, my next option was to find replacements but this seems to be working so far, Rifaximin is another antibiotic with less side effects, it is very cheap in some countries like India, 50 pills 200mg cost is around 3 dollars, I know this crazy , best of luck for all.
Hi Sylvie, I read in your book that you had histamine issues while going through SIBO. I too am experiencing hives. Did you have to go on a low histamine diet as well as a SIBO diet concurrently? I just completed two weeks of the elemental diet and started to add back food (fresh white fish) which gave me hives once again along with bloating and discomfort. What was your experience when adding back food?
If Jeroen says that some people will never recover from altered gut flora, how is it at all possible to cure sibo? I’ve been suffering from SIBO for the last 3 years but I didn’t just discover it until now because I had a false negative on my test. I tried the herbal antibiotics but I didn’t feel any better so now my naturopath and my family doctor are prescribing Rifaximan to me, followed by Prucalopride. I have methane dominant SIBO. Do I have any other options besides taking the antibiotic if the herbal antibiotics didn’t work?
Natasha, did you retest after the herbal antibiotics? Did you use the herbal antibiotic combination I wrote about here:
https://hollywoodhomestead.com/herbal-antibiotics-sibo/
Or did you use something else and if so, what?
Hi Sylvie, I just got diagnosed with SIBO after taking the breath test. I’ve had chronic bloating and gas for a decade or so…I’m 33 now. I only went because my insurance was running out after years of being insured and I wanted to check everything out so I went to a bunch of doctors. So I believe that I’ve struggled with this for years and just thought that is the way I am. I also have bade sebboreic dermatitis on my face and scalp which I believe is related to my gut issues. I also cannot keep on weight. I’m 6’0, 150 lbs male. You mentioned changing diet but didn’t say to what. Do you recommend that I do the low FODMAP for a while? So much conflicting advice on the web! Thanks in advance!
Hi Gary, Sorry to hear you’re dealing with this but glad you’re on top of it. I wrote about the best diet for SIBO in this post: https://hollywoodhomestead.com/sibo-diet/ and in my ebook The SIBO Solution: thesiboebook.com Hope you feel better soon!
My doctor treated my SIBO (methane from breath test) with a regimen of Xifaxin and the low fermentation diet, so I found and follow “The SIBO Solution”. The diet change made the biggest difference, but I wasn’t quite free of symptoms. My doctor said that I may want to try Atrantil which targets bad bacteria in the small intestine. It took about 2 weeks to work, but it really helped reduce the bloating and gas. For me, the combination of low fodmap diet + Atrantil keeps my SIBO symptoms in check.
Thanks for sharing Mark! Glad you’re feeling better.
Thank you so much for this post!!! I found it after taking rifaximin and all the sibo coming back with such an incredible vengeance. I was just wondering- do you suggest taking the Neem with meals or on an empty stomach?
Thank you!
PS: thank you so much for writing your book too, it’s the best sibo resource I’ve ever come across. ????????
Which prokinetic agent do you recommend? I’m on Linzess and I’d rather not be. It’s expensive and it is powerful stuff!
I’m still so confused with probiotics. Can or cannot take probiotics. I’ve been dealing with SIBO for a while, not finding any positive results so far. Visiting a new naturopathic in a week, but still can’t get the probiotic intake issue. Can I take probiotics during herbal treatment?
I would not advise probiotics during herbal treatment. Would love to hear how it goes with your doc.
thank you for this article! i recently got retested after doing your elemental/herbal protocol and the SIBO test came back negative! i cannot thank you enough, truly. now just trucking forward with preventative measures. also, i just wanted to point out that the Saccharomyces boulardii brand you linked to does contain inulin– that’s a no-no, right? xx
If you JUST tested negative Adina, IMO ALL probiotics are a no-no for you right now.
I have SIB0 and have been following the SIBO diet for two weeks with herbal antibiotics. I find it hard to stick to diet but am trying. I had C-diff two years ago and too two different antibiotics before taking the expensive one which didn’t seem to help either except when I starting taking probiotics. I was ok for about a year then the SIBO started. My doctor tested me for everything else and finally I asked about small intestine so I did the SIBO test. It came out positive. Don’t have results of tests but I ‘m sure I can get them.
I had diarrhea all summer and then about in Sept. I started getting constitipated. I could deal with that because there are foods that help. I was constitipated for about 6 weeks and then I started diarrhea again. The last two weeks I was only having diarrhea in the morning and not the rest of the day. That was a lot better. Does that mean I”m getting better?
I am getting really discouraged and can’t lose much more weight. I am taking care of my husband with dementia and that is stressful so I don’t know what to do. After a one day relapse in diet I’m going to continue with herbal antibiotics.
As you and others have mentioned in the past, Rifaximin is not very effective for SIBO-C. I took one course of herbal antibiotics recently (Candibactin AR and BR, Neem and Interfase). This brought my methane numbers down to around 50 (from 127!) but the hydrogen went up 5 points. So I’m doing another round of herbals, this time including Allimed (vile smelling and tasting, but worth it if it helps). By the way, I looked into a 14 day course of Rifaximin and it was in the thousands of dollars–insurance would only cover for IBS-D. On the Canadian meds website, the cost of Rifaximin is $92! I came to the conclusion, however, that taking Rifaximin wouldn’t help me much without the Neomycin and I’ve heard of some potentially very risky side effects from that antibiotic. As far as diet goes, Low Fodmaps seems to help and is doable for me. I’m unwilling to go Paleo (too much meat).
All in all, I do feel better and the GERD I used to experience has improved dramatically.
I took Rifaximin for SIBO starting last April. I was diagnosed with a pretty severe case, numbers off the charts. My naturopath said that my results were the most severe she had ever seen and that I had probably had SIBO for several years, my previous MDs just said I had IBS but never properly tested me. About 2 years ago, my mental health started to decline including severe anxiety, PMDD and depression and I started seeing my current Naturopath. After learning how gut health can be connected to mental health, we started tackling both. In addition to the above, I had high red blood cells, high cholesterol, low vit D & B, so we had a lot to tackle. At this point, I was having constant diarrhea, terrible bloating, nausea every morning, etc. I also have celiac, so I just figured I kept getting exposed to gluten some how. My doc and I developed a game plan. We started me on Rifaximin and a strict Low FODMAP/SCD diet. My insurance covered 100% of the Rifaximin! I also took Neomycin after a while too, I can’t remember the timing to be honest. I took about 3 rounds of Rifaximin, and the nausea and diarrhea slowly went away. I then continued on the Neomycin for a little while longer, then continued on the SIBI diet alone. About 5 months later we had a death in the family so I went a little ‘off the deep end’ on my diet. I then started experiencing awful constipation — which has NEVER been the issue for me. Now I am on my second month of a low dose antibiotic Erythromycin 50mg and a new probiotic called Lactoprime Plus which his SCD compliant. I am almost back to ‘normal’. I am still about 75% compliant with my SIBO diet, and have found that there are certain foods that I will always struggle with…garlic, onion, processed sugars. I am going to take a follow up SIBO test soon but I am really pleased with where I am at. I think the hardest part was the SIBO diet. I was already celiac, and trying to do paleo, but the SIBO diet can be pretty difficult, especially if you weren’t grain/gluten free + paleo before hand. It’s been a long journey, but the fact I don’t have to plan my meals/trips around finding a bathroom, can fit into my clothes after eating, and I am no longer severely dehydrated… those are all HUGE wins in my book! 🙂
Wow. That’s a heck of a journey, Sarah! Thanks for sharing- would love an update here after your retest. Agreed on your huge wins! -Sylvie
I tried Rifaximin for SIBO and the result was horrifying. First, it didn’t get rid of the SIBO. Second, around Day 7 of taking it, I began to feel nauseous and couldn’t eat. This extreme nausea lasted for two days. I kept asking my doctor if she thought the Rifaximin was causing it, and she kept saying no. Nausea is not a common symptom while on the drug. So I stayed on it, but I was losing too much weight. Finally, on Day 11 I stopped. I had to take anti-nausea medication to be able to eat again while I waited for the Rifaximin to leave my system. It was awful.
The reason I decided to try Rifaximin was because I was so skinny from SIBO that the elemental diet wasn’t an option for me. I was already on the SIBO diet you outline in this book. I have been slowly gaining weight as I add things back into my life with the help of a nutritionist, but I still experience extreme bloating no matter what I eat or drink. So… the SIBO is probably still there.
So frustrating. Thanks for sharing Jessica.
Hi. Just wanted to mention that the current discount price for brand name Rifaximin is approaching $2000 per month. The list price is close to $3000, I believe. So, herbs are the feasible treatment for most of us.
This is AWESOME — completely explains IBS and SIBO AND gives many resource information to help! I bought your book “The SIBO Solution” and use the recipes every day — thank you 🙂
Thanks Sherrie! So glad you’re liking it!