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Discussion Starter · #1 ·
In the spirit of Surfboar and others I have decided to keep on online log of my first attempt to treat my IBS with antibiotics.I will be taking 2 Xifaxan tablets, three times a day. That is, 400 mg. t.i.d. There was some research showing that symptom relief was dose dependent and higher doses yielded greater relief.I am 50 years old. I've had my IBS problems prior to being a teen-ager. I do remember getting serious food poisoning when I was 9 or 10. I am not sure whether that food poisoning was what Pimentel calls the "heralding event" of my IBS or not. The symptom that has bothered me most for more than 20 years is belching, AKA burping or eructation. I know that this is not a very common problem and few people on this board view it as their pimary complaint.More than 10 years ago I tried Elaine Gottschall's Specific Carbohydrate Diet. It represented a radical shift in my near-vegetarian dietary habits. It did not help me. But it forced me to increase my meat consumption. It then got me experimenting. I found that if I eliminated almost all my carbohydrates, my lifelong diarrhea was eliminated (pun intended) almost completely.This was good. But the problem was that I had never identified diarrhea as my primary sympton. However, it nice to no longer have 10 BMs a day and it was nice to no longer have mucus in my stool. Nevertheless, my belching continued. Also, when my symptoms were really bad I get abdominal distension as well.More than a month ago I read short news item in Prevention magazine about Rifaximin (Xifaxan) being helpful for a number of digestive ailments. This got me to do some research and eventually to read Pimentel's book and look at some of his research.Much of his theory is similar to Elaine Gottschall's, namely that undigested or partially digested carbohydrates in the small intestine serve to feed a bacterial overgrowth there. My initial reaction was scepticism because I had followed Gottschall's diet rigorously for more than a month with no benefit. However, I have seen patients' accounts on the internet saying that Pimentel told them that the Gottschall diet still requires too much food for the small intestine's bacteria.What convinced me to give Pimentel's protocol a try is that he, unlike the other gastroenterologists I have had contact with, does not diminish the significance of distension, eructation, and flatulence. If I could rid myself of these gaseous problems, I wouldn't care if I still had diarrhea, where the latter is defined as 4 or more BMs a day. Pimentel also taught me a few things that I did not get from Gottschall. First, Pimentel suggests that there may be motility disorders in the small intestine of an IBS sufferer and that this can be addressed with erythromycin or Zelnorm. Second, Pimentel suggests using antibiotics as the first means of removing bacteria from the small intestine. Third, Pimentel taught me that the elemental diet is available over the counter. From reading Gottschall, I had the impression that one could only be on the elemental diet by using a feeding tube.So I have embarked on my journey this morning by swallowing my first two Xifaxan tablets.I will have my first visit with a new gastroenterologist the first week of October. He has said he does the Quintron breath test. I don't know how familiar he is with Pimentel's research.My desired outcome is that in the next 10 days my burping and all digestive gas is reduced to normal levels. I would then see if the GI doc would still want to do the breath test. I would also ask him to put me on erythromycin or Zelnorm to maintain a health cleansing wave.If my course of Xifaxan does not alleviate my symptoms, I would very much like to get a breath test from the GI. If my breath test was positive for hydrogen-emitting bacteria in my small intestine, I would then seriously consider putting myself on the Vivonex Plus elimination diet.I am going to follow Pimentel's dietary guidelines while I am taking the Xifaxan. In one respect, I will deviate from the letter, but not the spirit of his recommendations. I bought a Yogourmet yogurt maker and I have made my own 24-hour cultured yogurt according to Gottschall's recommendations. She claims that the 24 hour culturing breaks down all the lactose in the milk. Pimentel recommends eating no yogurt but I take him to be referring to commercially available yogurt.Pimentel advises patients to eat food no more than three times per day. I will do this to enhance the effectiveness of my small intestine's cleansing wave.I hope that my experience with Xifaxan will be of some use to others considering adopting Pimentel's regimen.
 

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Discussion Starter · #2 ·
I did not sleep well last night. I was woken at 2:00 am by a family member walking around the apartment. Then I went to urinate and had trouble sleeping because of pressure in my gut.I usually get up at 5 in the morning. But by 4:35 I couldn't sleep any more so I got up.I don't know if this is attributable to the Xifaxan or to my altered eating habits. For a couple of year I have been following advice I read in William Wolcott's Metabolic Typing book. I have found some minor relief in eating my high carb foods 30 minutes before my main meat meal. Now I am doing Pimentel's protocol so I only eat 3 times a day. So I had high-carb yogurt with my turkey lunch and I had a peeled apple and almond butter with my turkey dinner. It's possible my night-time gut discomfort was from bad food combining.I am aware that there is no scientific evidence for food combining. Nonetheless, I do think that it has been mildly beneficial for me.I suppose I should hope that Xifaxan is making me feel worse. Pimentel's book does state that the murdered bacteria give off toxins as their bacterial souls separate from their bacterial bodies. The thing is that I have read too many times that I have to feel worse before I can feel better. I've taken Nystatin and a thousand natural supplements in the past. I got lots and lots of Herxheimer reactions or die-off syndromes but the cure which was supposed to follow never materialized. I'm very susupicious when I hear that I must feel worse first as the bad guys are killed off.
 

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Discussion Starter · #3 ·
Yesterday I went to bed late: partly because I hoped that if I was exhausted I would sleep through the night, partly because I was making more 24-hour Gottschall yogurt since that has become one of my major sources of carbs.I got up around 4:30 am. I lay in bed but my gut started bothering me with some burping and farting. I then got up around 4:50 am because it was just too uncomfortable lying in bed.There is a testimonial in Pimentel's book where the patient says that it five or six days before she had any relief. Then she said it was as if a switch was flipped and her problems were gone. Of course she was taking Neomycin in her anecdote and I am taking Xifaxan. I notice that Pimentel's dietary recommendations limit starchy carbs to 1/2 to 1 cup per meal. But he does not place a limit on Lactaid (lactase hydrolized milk). I am substituting 24-hour yogurt for Lactaid. My yogurt should be lactose-free. The yogurt I started making last night was 1 quart whole milk and 1 quart heavy cream. I can't wait to try it tomorrow. I used to make yogurt in my oven with the pilot light. But now I have an electric pilot light that does not stay on. I just bought a yogourmet yogurt maker. This is an excellent device for making Gottschall's yogurt. I makes 1/2 gallon and, unlike many other yogurt makers, it will stay on for 24 hours as Gottschall requires. I bought an extra container so that I can be eating out of one container while another batch is being cultured.
 

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Moises,We have the same symptoms. I have found this antibiotic to be the only med that helps. I took 2 200mg tabs 3X a day for 2 weeks. Now I take one 200mg pill daily probably forever. I can't stop the excessive burping but it did stop the constant farting. My lower gas vanished as did abdominal distension and bloating. I do still have to stay away from sugar. Please let me know how you do.Did you find any benefit from nystatin? That was my next thing to try. You can email me if you want to chat at pmorris799###aol.comIt does get worse before it gets better with rifaximin
 

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I took the high dose for 2 weeks then was told to take zelnorm at night. I could not tolerate zelnorm as it gave me the runs. My doc called Pimental and he told her that his patients who have trouble with zelnorm, he puts on low dose rifaximin long term. I have taken one pill for about 8 months. I believe it is safe as it is not absorbed. I also take the probiotic vsl#3. Pimental says he honestly doens't know if probiotics help or hurt. I feel they help.
 

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Discussion Starter · #7 ·
Pete,Thanks for responding to this. I will be in touch with you. I've never heard of anyone with my symptoms; it's a relief to know there is someone else out there that knows what it's like.Regarding your troubles with Zelnorm: in his book Pimentel says you can choose between Zelnorm and erythromycin 50 mg at bedtime. If the Zelnorm isn't satisfactory, have you tried the erythromycin? 50 mg is a very low dose. Pimentel claims that this serves the same function as Zelnorm: maintain a healthy "cleansing wave" to clear out the small intestine and prevent reinfection.I tried the vsl#3 a few years ago and didn't feel it helped me. Ten days ago I started Align, a probiotic I heard about on this board. It can only be ordered online, from the same manufacturer that makes Metamucil. It's too soon to say whether it's helping or not. Nystatin never did a thing for me. (It's named after the state we both have in common: NY.) Nor did any of the multitude of other candida-killers I've taken over the years.I am glad to hear that you feel the rifaximin has helped you. I hope that you can find some effective way to treat the burping.moises.For my daily log I have little to report. I went to bed later than I would have preferred last night due to a very busy day and suboptimal planning. I had gut discomfort in bed after 4:30 am. But when the alarm went off at 5 am I was sleeping and exhausted. I will make every effort to get to bed early tonight since I know from past experience that skimping on sleep is the best way for me to induce a cold.I had some burping this morning but nothing that was bothering me very much or interfering with my normal activities. If this keeps up, I will abandon my pre-Xifaxan habit of trying to eat my high-carb foods 30 minutes before my main meat dish. Since doing the Xifaxan protocol I have been mixing all my foods without feeling any worse for it.
 

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Moises,My son's overwhelmingly worst symptom is his upper body gas. His burping is loud and long and constant. But he says that is preferable to those times when the gas is trapped and he feels like he needs to burp but can't. When that happens he becomes nauseous and will stay that way until the gas is broken up and he can burp again.
 

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Discussion Starter · #9 ·
quote:Originally posted by cynthia:Moises,My son's overwhelmingly worst symptom is his upper body gas. His burping is loud and long and constant. But he says that is preferable to those times when the gas is trapped and he feels like he needs to burp but can't. When that happens he becomes nauseous and will stay that way until the gas is broken up and he can burp again.
Cynthia,OK. I can sympathize. When I have it bad I can burp for hours (see my post titled: "What are your gassy statistics.") I'm sorry that the Vivonex didn't help him. I do find it worrying that Pete, who was helped significantly by Xifaxan, did not have his burping problem improve.I have always felt that there was a common cause to my eructation and flatulence. In Pete's case, it appears, there was not, since his flatulence normalized but his eructation did not. Perhaps upper gas is generated by a different mechanism.
 

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Is it possible that the bacteria that is causing the upper body gas (probably in the upper portion of the small intestine) is more difficult to get rid of? I would think it's getting fed more readily than bacteria further down in the SI even if your not on SCD.
 

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Discussion Starter · #11 ·
Cynthia,It seems as if there are a few issues. First, it's not clear how many people with IBS actually have a bacterial overgrowth in their small intestine as the cause of their problem. Second, it's not clear how accurate the breath test is at diagnosing a bacterial overgrowth.Third, it's not clear how effective rifaxamin, neomycin, augmentin, Vivonex, and other interventions are at eliminating bacterial overgrowth. Fourth, it's not clear exactly what role motility plays in IBS symptoms and bacterial overgrowth.Fifth, it's not clear how, if there are motility disorders, they can be ameliorated.This line of investigation still appears to be in its infancy. Pimentel seems to be doing what he can to push it into the forefront and get more people researching it. By publishing his book he has gotten the attention of lay people like myself, who are now demanding his protocol from their own physicians. But right now your son, the people on this board, and I are guinea pigs in an experiment, the conclusions of which are not foregone. In the long run, I have a high degree of confidence that medical science will know a lot more about our problem. But I can't wait for the long run, so I roll the dice today and take my chances.From other postings it appears as if the results are mixed. There clearly are other factor(s) that are not yet understood. That's not a very satisfying answer but the truth is often not very satisfying. People don't want to buy books and lay out big bucks to see someone who tells them there's a lot we don't understand and a lot of uncertainty in this field.My log for today:It is unusual for me to get out of bed early this often during the week. I am getting very tired. This morning I had cramps and burping and farting and got up, rather fatigued, around 4:35 am. I can feel the pressure in my sinuses building. After breakfast I went to the gym where my burping continued. Not a good morning.This is the beginning of day 5. I am ripe and ready for the switch to be flipped tomorrow morning, the sun to shine through my window, the veil to be lifted, and me to wake up born again, the first day of my new life with a gas-free stomach and a bacteria-free duodenum, jejunum, and ileum.In the meantime I can fantasize that this morning's burping was the last gasp surrendered by the most resistant platoon of jejunal bacterial holdouts in their final death throes. I expect to flush them down the toilet in the next day or so. As I watch their lifeless carcasses spiral rapidly down towards their burial among the sewage, I will think to myself, "If only they had chosen to work for good, in the large intestine, instead of for evil, in the small intestine. Goodbye and good riddance."
 

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Discussion Starter · #12 ·
On second thought, with dinner last night I had mashed, boiled, new, organic potatoes with butter. They had the skins on them. It was just about a cup, I think, when mashed. Maybe that was the problem. Maybe the skins had too much residue. And maybe even if there were no skins, that was just too much starch for one meal.
 

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thanks for the info pete...i am only on one 200mg 3 x a day. my dr was closed today so on monday i will call and ask if he can place me on the 400 mg 3x a day. i'm on day 5 and i see no difference, maybe even worse bloating and belching. and now i'm more constipated. i've though if this didn't work i would try a food elimination diet for two weeks. any input?
 

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Discussion Starter · #14 ·
Another not so good night. Woke up at 3:30 am with burping. Had burping throughout the day.I am starting to think that Xifaxan is not going to help me. I will continue to finish the course, however.
 

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Discussion Starter · #17 ·
Hi Cynthia and Pete,What's so tough about this stuff is that my IBS symptoms go through periods of flare-up and periods of, not remissions, but milder symptoms.I am still having my sleep disturbed in the early morning hours and I am still having burping throughout the day. I was tracking my symptom severity for a week prior to initiating the Xifaxan and my symptoms have not changed. But I am not in a period of severe burping, flatulence and distension. I think that the three days in my "What are your gassy statistics" link given above must have been a period when my symptoms were quite high on the severity scale.It's very difficult to count burps throughout the day. It took a lot of discipline to do that. Otherwise, I would track my burping for much more than 3 days.
 

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One of the things I find so frustrating about monitoring symptoms with my son is that we never know if a sudden abundance of gas means that his bacteria has just been fed or if it means that whatever treatment we happen to be using at that time is killing off bacteria. Is this a problem for others?
 

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calling the doctor tomorrow to see if he'll double my dose. i have noticed a tremendous increase in burping and farting. but i am also constipated despite all the laxative type stuff i take.pete, when you say stay away from sugar, do you mean added sugar like sweets, or natural sugar like fruit?
 

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Discussion Starter · #20 ·
I think I am moving into a flare-up mode. Burping severity increased noticeably Sunday afternoon. My entire night was disturbed and uncomfortable, not merely the early morning hours as it has been the last week.And I woke up bloated and there is bloat and burping constantly after waking.
 
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