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My log of the Cedars-Sinai Protocol (Dr. Pimentel's protocol)

19K views 39 replies 9 participants last post by  nathanapearce@gmail.com 
#1 ·
I thought I'd post a thread of my expereinces, rather than random bits in different threads. I'll keep this short, so you don't have to sift through too much BS.
I was never tested for bacterial overgrowth. I live in an extremely rural area, and I was able to get my local doctor to read Dr. Pimentel's book and proceed with the regimen (minus the breath test). I was diagnosed and treated for colitis (caused by a bacterial infection) prior to my troubles with IBS. I feel fairly confident in thinking that the bacteria in my lower colon that caused the colitis probably traveled into my small intestine.I was prescribed Xifaxan for 10 days (1200mg per day). After the 10 days, I felt my symptoms improved 50% to 70%. It's hard to say exactly. Diarhea was always my my main symtom, and for the first time in many years I have only gone to the bathroom once a day. However, I still have about 50% of the gas and bloating that I usually do in the mornings.Because the Xifaxan alone didn't improve my symptoms to 90% or better, I have now started neomycin (1500mg per day) and Xifaxan (1200mg per day). If the combination works wonders, I'll proceed to Zelnorm once a day.I'll keep everybody posted.
 
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#2 ·
UPDATE: Day 5The first 2 days of neomycin and Xifaxan were a little rough. The drugs were causing some pretty intense gas, and I went to the bathroom several times to try to relieve my bowels, only to sputter little bits of poop mixed with lots of gas.On the third day, things started to calm down. Now on day 5, I have only gone to the bathroom once each of the last 2 days, and each time it was only a little bit. The poop was still a little loose, though. I'm hoping for some nice solid turds, for the first time in YEARS.The amazing thing is that the last 2 mornings, I've had very little gas pain. This is usually the most painful time of day for me. Xifaxan alone didn't do away with near this much of the gas, but it did help control the loose stools a lot. I'm thinking the neomycin has really helped the morning gas pains.More days of analysis are needed, but so far I'm progressing nicely, I'd say.I'll keep you updated.
 
#3 ·
UPDATE: Day 8Day 8 of the neomycin/Xifaxan combo. I still feel better than I ever did without the antibiotics, but I still have occasional gas/bloating. I normally have constant loose stools and D, but now I can barely go once a day. I hope this means the bactieria is gone, and I just need to restore gut function.I'm interested in trying the Zelnorm. I believe I'm feeling good enough to proceed with the Zelnorm as soon as I'm done with the antibiotics.
 
#4 ·
Thanks i'm really interested to follow the effect of Neomycin.
 
#5 ·
The only difference, that I can tell, from taking just Xifaxan compared to neomycin/Xifaxan, is that the combo gives me less gas and bloating, especially in the mornings. This could be from the neomycin, or it could simply be from the prolonged use of Xifaxan . . . or I guess it could be a combo of those to things.
 
#6 ·
UPDATE: Day 10I finished my Xifaxan/neomycin combo last night, and I also took 3mg of Zelnorm before bed last night.For the first time in YEARS, I woke up with NO gas pain, and I also felt like my stomach was cleared out. Normally I feel like my dinner from the previous night is still being digested.I don't know if this was because of the Zelnorm of the antibiotics, but if the Zelnorm helps me get rid of that "full" feeling, I'm all for it.I don't feel like the antibiotics were a "cure", because the "fullness" and "bloating" thing are caused by slow motility in the small intestine. I'm just going to assume that 20 days of antibiotics killed off most/all of the bacteria, and I will proceed with the Zelnorm to see how that works for me.So far I'm very happy with the way I'm feeling. I have almost no discomfort during the day, and my mornings are becoming much better.By the way, I am also following Pimental's diet pretty closely.I'll keep everybody updated.
 
#7 ·
npearce,Good for you! I'm glad to hear you are getting some relief.By the way, have you ever had a gastric emptying study? You mentioned that you now feel as if your stomach was clearing out properly. This test would have indicated if your stomach were emptying slowly.
 
#8 ·
All the studies I had done were when I had colitis. So I had a barium swallow study, which indicated that I had "sluggish" digestion. The study is mostly only designed to show if I had an obstruction or stricture. They weren't too concerned with something as simple as "sluggish" at the time. After the GI's found out I didn't have colitis any more, I was literally brushed off because my symptoms indicated ONLY IBS. That's why I went back to my family doctor, who is very smart, by the way.
 
#9 ·
UPDATE: DAY 3 without antibioticsZelnorm is still doing a great job of clearing my stomach at night. I can feel that a litte gas is coming back every now and then, but I'm assuming this would be normal, since bacteria of different varities will be growing back now that I'm off the antibiotics.So far, I'm very happy with my progress. No solid poop yet, though. My morning poop, which is my only poop, is nice and gooey. But who cares, since all my gas, bloating, and pain are gone.
 
#11 ·
npearce - You mention that you are following Pimental's diet protocol. What exactly are you eating? The restrictions present me with an enormous problem of what to feed my son. I keep giving him the few foods that don't make him overly gassy, but it's so boring for him. And he's been eating like this for 2 years now. What are you eating in a given day and still sticking to Pimental's diet? Thanks, Cynthia
 
#12 ·
cynthia,I live in the boonies, so it is hard for me to find much of anything pre-packaged to eat. Some oranic/health-food stores would probably have a good selection of that kind of thing.So what I eat, is basically no dairy and very minimal fructose. I also get fiber only from about 2 or 3 servings of well cooked vegetables. For vegetables I only eat well cooked green beans, brocolli, carrots, cauliflower (occasionally), and maybe a few others. Nothing raw, and nothing slightly cooked. Only weel cooked. I mostly like just brocolli and carrots, but I'm finding I can tolerate a little more than before the antibiotics.I eat most meats, but I make sure they are prepared at home and low in fat. No fried chicken or anything like that. My wife has many cook books that have helped her find recipes. Look for cook books that are healthy and low residue.For carbs, I eat mostly white rice and white bread my wife makes at home. She has a bread machine and claims it is easy.Basically I'm lucky to have my wife to help with all this.Here's a list of some basic meals I have:1) Cream of wheat with some brown sugar, scrambled eggs with chopped mushrooms.2)Tuna wrap with white flower tortilla, olives, oil, and vinegar.3) Barbeque chicken sandwich on home made white bread bun (the barbeque sauce is also home made without fructose), cooked carrots.4)Hamburger with mustard and dill pickle relish.I could go on, but basically my diet is a little boring. But we keep getting better at it. I'm going to start adding flax oil to just about everything because I have a hard time no losing weight.
 
#14 ·
npearce,I don't have a copy of Pimentel's book with me. But I think he recommends staying away from legumes, which would nix the green beans.On the other hand, I think he says that if his protocol works, you can eat whatever you please. I just wanted to make sure that others get a fair sense of his dietary recommendations.
 
#15 ·
quote:Originally posted by Moises:npearce,I don't have a copy of Pimentel's book with me. But I think he recommends staying away from legumes, which would nix the green beans.On the other hand, I think he says that if his protocol works, you can eat whatever you please. I just wanted to make sure that others get a fair sense of his dietary recommendations.
Yes. You're right. Green beans just seem to work OK with me. I only occasionally have them.
 
#16 ·
UPDATEEverything has been going great. The Zelnorm really seems to be helping.BUTI had TERRIBLE gas pain (at least I think that's what it was) from about 2pm yesterday all through the day and night. I couldn't sleep at all last night. Does anybody know what could be causing this? It seems to feel a little better this morning after going to the bathroom. But this is the the WORST gas pain I've ever had. I'm a little worried it could be related to the 20 days of antibiotics or maybe the Zelnorm. Can anybody help me here? I sure hope it goes away and never comes back, because I've been doing so good.I did eat some home made cinnamon rolls and peanut butter cookies (my wife was trying to be nice, and I couldn't reisist). Would peanut butter cause all this?
 
#17 ·
Do you normally eat that much starch all kinda at the same time.I can't think there would be enough in the few peanuts in a peanut butter cookie to cause that much of an issue (did the pain go away after you fart, sometimes it feels like gas pains, but it is pain for any number of reasons). Peanuts might have some of the sugars in legumes that make you more gassy than usual, but there isn't that much peanut in a peanut butter cookie, I mean there is some, but not like eating a bowl of beans.With the size of some cinamon rolls you do get a lot of wheat starch, and then more in the cookies, and some people do get gas when they consume a lot of wheat flour in a fairly short period of time.K.
 
#19 ·
I'm currently waiting for my doc to call me back. I don't have any gas coming out as farts or burps, and I have a terrible side ache type of pain. I'm wondering if this has nothing to do with SIBO or IBS. I hope I figure something out soon, because I'm in pain.
 
#20 ·
Npearce: I would guess that the home made cinnamin rolls you had were a much more likely source of overgrowth gas than peanut butter - but then I subscribe to the "simple carbs like white flour and sucrose are the worst thing" theory. I cringe at the thought of eating cinnamin rolls - would be in trouble for days afterwards if I ate them. Peanut butter on the other hand, no problems for me whatsoever.
 
#21 ·
I agree that it was the cinnamon rolls. I've had PB before, and no problems. I think I just had too many over the course of about 2 days. I was so excited about my stomach feeling so good, I think I just thought I could eat without consequences.Anyway . . . I talked to the doc, and he said to keep taking the Zelnorm. He thought the pain was most likely a very stubborn air pocket. He thought it should get better soon. Well, I slept a little better last night, and sure enough I'm feeling quite a bit better today. I still think there is some gas built up in there, but I'm feeling much better.The lesson here is that antibiotics can kill most/all of the bacteria in your gut, but as soon as you start putting things back in there (including germs, etc.) the bacteria start coming back. The Zelnorm is supposed to keep the stomach moving like it did before the "bad" bacteria slowed it down, and thus I am hoping that the "bad" bacteria won't come back.As long as the gas episode passes completely (pun possibly intended), I am still happy with my progress. Zelnorm actually helped the gas get better, in my opinion.
 
#22 ·
Hi npearceI found your diary very useful since I'm about to start the Vivonex diet myself next weekend.I just have one thought for you. I think Pimentel says that the problem is not actually about "good" or "bad" bacteria, but rather their overgrowth in some sections of the GI track where they are not supposed to reside in such numbers.So far I agree on the motility theory as the basis for complete remission. Personally, I've found that enteric coated peppermint oil capsules helped me because they slow down my hipermotility and at the same time the mint kills some of the bacteria. I confirmed that several times by eating specific amounts of fructose (which gives me problems). If I take peppermint oil capsules shortly after the fructose, I hardly get the symtoms I get if I don't. However that's just me, but I think the point is still valid.In your case I guess is not necessary to take anything else besides the Zelnorm to keep your motility in control. Lucky you
Anyway, thanks again for all your valuable info.
 
#23 ·
"I think Pimentel says that the problem is not actually about "good" or "bad" bacteria, but rather their overgrowth in some sections of the GI track where they are not supposed to reside in such numbers."Exactly, its not really about good or bad bacteria, but normal bacteria that are swept up into the small intestines.Small Intestinal Bacterial Overgrowth(SIBO) Medical Author: Dennis Lee, MDMedical Editor: Jay W. Marks, MDWhat is small intestinal bacterial overgrowth (SIBO)? What causes small intestinal bacterial overgrowth? What are small intestinal bacterial overgrowth symptoms? What is the normal relationship between bacteria and the small intestine? What conditions cause increased production of gas? How does small intestinal bacterial overgrowth cause symptoms? How is small intestinal bacterial overgrowth diagnosed? Is there a relationship between small intestinal bacterial overgrowth and irritable bowel syndrome? How is small intestinal bacterial overgrowth treated? What’s new in small intestinal bacterial overgrowth? Small Intestinal Bacterial Overgrowth (SIBO) At A Glance http://www.medicinenet.com/small_intestina...wth/article.htmIrritable Bowel Syndrome (IBS)http://www.medicinenet.com/irritable_bowel...ome/article.htmI also highly recommend watching this on IBS.Integrated Approach to Irritable Bowel SyndromeThis is an online CME course featuring Dr. Drossman http://www.ja-online.com/dukeibs/#
 
#24 ·
PS Peppermint could help IBS regarless if you have sibo.It is not a good thing to take if you have upper gi conditions like gerd or functional dyspepsia, as it can make it worse.fyi Altern Med Rev. 2002 Oct;7(5):410-7. Links Comment in: Altern Med Rev. 2003 Feb;8(1):3; author reply 4-5. The treatment of small intestinal bacterial overgrowth with enteric-coated peppermint oil: a case report.Logan AC, Beaulne TM. Integrative Care Centre, 3600 Ellesmere Road, Unit 4, Toronto, ON M1C 4Y8, Canada.Recent investigations have shown that bacterial overgrowth of the small intestine is associated with a number of functional somatic disorders, including irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue syndrome. A number of controlled studies have shown that enteric-coated peppermint oil (ECPO) is of benefit in the treatment of IBS. However, despite evidence of strong antimicrobial activity, ECPO has not been specifically investigated for an effect on small intestinal bacterial overgrowth (SIBO). A case report of a patient with SIBO who showed marked subjective improvement in IBS-like symptoms and significant reductions in hydrogen production after treatment with ECPO is presented. While further investigation is necessary, the results in this case suggest one of the mechanisms by which ECPO improves IBS symptoms is antimicrobial activity in the small intestine.PMID: 12410625
 
#25 ·
UPDATE5 days after the extremem gas attack, I seem to have recovered about 99%. The gas was way higher up than I was used to, and way more painful. Not just annoying. It's gone now, and I've learned my lesson. DO NOT EAT TONS OF CARBS! No matter how good you feel.The Zelnorm is still doing great for me. I'm one of those with terrible D, but after the antibiotic, I'm doing fine. The Zelnorm makes me poop once in the morning. I occasionally poop again in the evening.I'm still trying to stick to Pimental's diet recommendations, and I've started taking peppermint pills again. They never did it for me in the past, but I figured at the least I'd burp up Christmas flavoring.
 
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