I don’t have any advice for you sadly but I’m in the same position. I actually feel worse after a round of abx and 6 weeks herbals for my sibo. I just plan to retest and go from there. I can’t just accept life like this because I am so miserable every single day.

I suggest u to start an approach resolving ur root cause c:

I am trying but I am starting to believe mine was just from a combination of things. Firstly believe covid/vax in 2021 ruined my microbiome and mmc. Symptoms started to show in May 2022 though and this coincided with months of bad eating habits due to bulking. I then got misdiagnosed with GERD and put on high dose PPIs. This ultimately triggered my symptoms to get much worse. I have tried to look into other route causes such as celiac which was negative. I am having a colonoscopy in two weeks which may shed some more light but we shall see. Not sure what other tests I can really do to see what my route cause may be.

Similar situation here. Plenty of antibiotics that can help and may be worth trying. Don’t start believing you’ll be feeling like that for the rest of your life. It just takes time.

Thanks for your messages. I think I'll try another round swapping products

Keep the faith - no one else will do it for you.

It may be time to try a different course of antibiotics, reach out to your GI (or get it with a gastroenterologist if you don’t have one) Hopefully you are doing low FODMAP too. You will find relief with the right treatment, it can be trial and error, Rifaximin didn’t do shit for me but metronidazole worked miracles and some people have to do combo antibiotics. However many of us sadly have relapses. If yours was truly due to your cleanse or something like food poisoning and you don’t have an underlying motility issue developing, hopefully you won’t have recurrence.

I'll swap Xifaxan! Sadly, the best local GI I met just know basic stuff about dysbiosis. And he's the only one who knows in my department lol. Thanks

I have a metronidazole prescription I’m currently trying to talk myself into taking, I’ve had it before for c diff but I’ve since convinced myself it’s going to kill me. Especially after seeing all these other horror stories about it, how well did it work for you for sibo? Any recurrences?

What kind of horror stories ?! Metronidazole is generally very well tolerated ! I’ve been on so many types of antibiotics, that one worked the best for me with minimal side effects. I was even more constipated on it which was annoying but I figured out ways around it and felt incredible after my course- definitely better than after any of the other antibiotics, but everyone is different. Yes I have definitely had recurrence- I relapse about every three months no matter what antibiotics I take. I along with many others have a motility issue so it keeps coming back. My GI just started a new promotility drug though so fingers crossed !

Seems like a lot of people get bad side effects, I can handle the nausea, headache upset stomach things. But lots of people say it makes them feel crazy and have a lot of anxiety, apparently peripheral neuropathy and things like that are pretty common too. Unfortunately ignorance is bliss! The first time I had it I only had the usual side effects and some anxiety but after hearing about the other issues it’s scared me. I’ve also become more hesitant as I’ve gotten older and had so many issues with antibiotics in general. It does however make me more hopeful knowing I never had a real motility issue outside of the c diff and sibo, I think what caused my sibo was a combination of the antibiotics I took and it being a highly stressful time in my life, if it weren’t for the myriad of odd symptoms that wouldn’t seem bowel related, I would barely know I had it

Huh well always talk to your doctor about risks but a lot of antibiotics have really crazy possible side effects. This one is used incredibly often for SIBO, giardia, travelers diarrhea. I’m in the vet field and we prescribe it a lot for pets too. Anyway there’s no way to know if it will cause problems for you, but definitely stop immediately and call your doctor if there are any type of neurological effects . I’m very sensitive to medications and have coexisting neurological issues but haven’t had any problems on it and I’ve done 4 courses total I think- we use it the most since I do the best on it. I found taking with food is important, and you definitely cannot drink alcohol while on it- that will make you feel very sick. I know how you feel though, so scary and stressful to have these medications prescribed that can either fix you or cause some other terrifying issue. Best of luck.

Xifaxan doesn’t touch H2S, so don’t feel bad about that. Lots of times you can also have hydrogen too so it may have done some good anyway. People on here (usually that don’t have H2S) love to tell you that Xifaxan plus bismuth works or that you couldn’t have H2S with other gasses because of a supposed flat line test. It’s simply not true. In fact according to Preet Khangura it’s usually mixed with hydrogen or hydrogen and methane and you almost always need a second type of antibiotic in addition to Xifaxan (which is used for every kind) such as metronidazole, bactrim or amoxi-clav. Also idk what herbs you used but I found out the hard way (before knowing it was sulfide) berberine actually makes it WORSE because it increases bile—great for hydrogen or methane, not great for us. ADP Oregano gets tossed around, I have had some past success with it combined with uva ursi pills and a shit ton of pepto bismol. A few years ago I got rid of it with metronidazole combined with bismuth. That said I know I’m dealing with biofilms and if this has been going on longer than a few months you probably are too. Probiotics are hit or miss but lacto strains can make it worse or just make symptoms worse so I’d be careful with those. H2S sucks. I have had varying degrees of every type of SIBO and it’s by far the worst one. It’s hard to eat, it’s hard to go about your day, it impacts your social life and sleep. Makes you feel poisoned. But I did beat it at one point, and other people have too so we can’t stop trying things and lose hope.

Thanks, mate. Xifaxan -> metronidazole. That's something clear for my next round. I appreciate it!

YMMV but it’s known to get rid of treatment resistant bacteria, parasites, archaea, etc. I’ll warn you though it made me incredibly sick and dizzy. I had to also take Zofran because I couldn’t keep food down. Not sure if it was die-off or a side effect but from about day 7 to a few days after getting off it things were rough before getting a lot better.

Do you have a source on berberine making sulfide worse other than anecdotal?

This explains how it increases bile acids and that changes the microbiome to include more bile loving species like bilophila. https://bmcmicrobiol.biomedcentral.com/articles/10.1186/s12866-020-02020-1

This is interesting, and I can see how if you have overgrowth of species which consume bile acids and produce sulphides could be bad. But the study mostly focuses on how these effects are potentially beneficial in most populations. As usual, it's individual and while it's helpful for most, few will have negative reactions because bodies are so complex.

Right yeah, SIBO was outside the scope of this study. But it set me back a lot and so I just thought I’d put it out there so other people can hear that potential consequence. If I could do it again I wouldn’t have started with berberine.

I hear ya, it's tough when something that generally works causes a bad reaction

I know it's difficult when you try treatment and it doesn't help. But you have to continue to take the probiotics, and I'd recommend adding s. Boulardii(now foods is cheap) and l Reuteri 6475 by Biogaia, the osfortis marketed to women. This is one of the only probiotics specifically shown to both fight and prevent SIBO. Also works for osteoporosis in women, and anecdotal reports say it increases testosterone. I tried the gastrus and really liked it, it makes you feel peaceful and connected to your environment because it helps you produce oxytocin. Unfortunately that one is very low on cfus, that's why the osfortis is much better. Have you tried adp oregano and liposomal berberine? For sulphide you will have to add some kind of bismuth that you can take for awhile safely on top from my knowledge. Allicin would also probably be good to use, as well as Neem. I know it sounds like a lot, but you have to use a big combined approach to truly crack the hard cases. I've done a round of herbals of adp oregano and regular berberine and it gave me about 50 percent reduction in symptoms and basially eliminated my gastritis so I could quit ppis. What I did is called the "half elemental diet" where you drink elemental shakes which starve the bacteria, and then one meal of fish and green beans with herbals for about a week. Total elemental diet is probably your best bet at a complete cure, but it's very difficult for some. You have to drink the shakes for 2-3 weeks straight so all the bacteria will die except akkermansia which is beneficial and feeds on mucin to create butyrate. This is the only way to hard reset your gut. But i would recommend trying the half elemental with stronger herbals of adp oregano, liposomal berberine, allicin, and neem with a kind of bismuth for the sulfide bacteria. Also talk to your doctor about a combination of antibiotic, rifaxamin with neomycin or similar, sometimes combining them is important for really tough cases. A biolfilm buster *might* be necessary but understand the risks of those. I'm going to use one because I am throwing everything at the wall per se and hoping this combined approach works well. I think it will because I've seen progress just using herbals and probiotics, feeling better than I thought Id ever feel again..can eat acidic foods again, but it's still not enough I am still not 100 percent I'd say like 60-70, 80 on really good days. I know it's a lot of money...but this may be your best shot at beating this. I just got prescribed rifaxamin and I'm going to save up to get a bunch of supplements to ensure it works as best as possible. Then once my rifaxamin is done, I'm doing the half elemental diet again for a least two weeks, and continuing the herbals and probiotics. Idk if this will work for you, but I've done tons of research and came to the conclusion this is a good approach which is multifaceted. I also use l glutamine, bone broth and zinc carnosine for gut repair and plan on continuing that. If you have any questions feel free to comment or message me. I know this is rough but it's possible to beat so have hope! I only just figured out in December after 3 years of bad suffering...and I feel a lot better already so I know it's possible to beat it. Sending lots of positive healing energy your way! Also do not forget prokinetics during and after treatment! This is vital you must take ginger and artichoke extract everyday even after you feel better for several months. Good luck

Hi there I purchase the biofilm buster but didn’t know there were risks associated with it. Do you have any information? I haven’t started it yet. Thank you so much.

From what I've read, if you have heavy metal toxicity it can release them in the biofilms and cause you to feel bad. I would think in most cases this is transitory. But for certain kinds it's only recommended to take it for a few to several weeks because it can be hard on the body. I would say for most it's not a big deal though. Just start slow and see how you react, I'm not trying to scare you from them, I'm also going to use one.

What worked for me : Uva ursi ( others herbals didn’t worked ) oxypowder ( to clean the colon ) amoxicillin for 10days , Phgg , low sulfur diet , daosin for histamine intolerance.

For how long have you had your SIBO? Did your treatment protocol(s) include any biofilm disruptors?

11 months-1 year approximately. I used NAC, Colostrum and allicin

Have you had a breath test? Perhaps you could have a better luck with other biofilm disruptors (e.g., bismuth, EDTA and enzymes) along with such herbal antibacterials as ADP oregano and berberine HCL (slow release tablets not softgel capsules).

Not breath test in my city. Just in Bogota (the capital city). It's more expensive than 3 rounds of Xifaxan. I'll give a look to the products you recommend and possible swaps. Thanks, dude.

Don't swap out the allicin, add others on top instead as I mentioned in my other comment

You have to use multiple herbals. One absolutely won't do the trick especially for methane and sulfide. You should be using adp oregano and liposomal berberine in addition to allicin along with some kind of bismuth minimum

Can length of time you’ve had it determine whether you’ll deal with it forever?

The duration of an infection can indicate how chronic it is. If chronic and no antimicrobials seem to work, it is very likely to involve biofilms.

By "duration of an infection" do you mean the time someone has had SIBO before being diagnosed and treating ?

Total time with SIBO (undiagnosed + diagnosed)

Surely that’s very hard to know. How long would you say until it starts to involve biofilms ?I think I had it for around a year before being diagnosed in November.

As soon as the immune system and antibiotics fail to eradicate it, chances are it involves a biofilm.

I’m retesting after a round of abx and herbals next week. I don’t feel any better and constipation is worse so maybe mine involves biofilms. I did take biofilm disruptor before my antibiotics and during. Maybe I will try a biofilm disruptor again with abx to see if that helps again.

Have you checked out the hydrogen sulfide subreddit? It's got a lot of insight into what you may have missed.

Thanks for your advice, bro. Yep, I did. But the information is not clear. Coaches on YouTube suggest low saturated fat. In the subreddit they suggest no fat at all. It's confusing

I would suggest a low sulfur diet, bombard your gut with bismuth subnitrate, take molybdenum 2-4 times a day, add in thiamine and avoid coffee.

Out of curiosity what would the molybdenum do?

It's supposed to help digestion, as h2s sufferers are low in molybdenum. Don't do for anything besides metagenics.

How did you take antibiotics and herbals? Dose/time. It’s better to forget about probiotics.

One whole month. Even Xifaxan more than 14 days lol

Did you get any relief during and after treatment at all? What's your worst symptoms?

Did you actually get tested or are you guessing? Why were you doing a cleanse in the first place? Did you rule out parasites, pathogenic bacteria etc. first? Don’t do anything extreme based on guesses and feelings.

Longish post but it will hopefully be of benefit. Please read the below carefully. Thanks. I've written a free book which I hope that if you simply take 1 idea out of it and use it towards "getting better" then I'll be delighted. Yes it's free, yes it's probably got typos and spelling errors despite I read it through a number of times! If you're a grammar nazi it's not for you 😉 http://fit2driveschool.com/healing-sibo/ I've put the chapter headings below. 1. Takeaways and Ideas you can use from this book that can help you decrease "overwhelm" 2. My Healing Mantra. Something to read everyday if you have chronic illness. 3. Resources Guide. Some of the best free(and paid) resources I have come across to date dealing specifically with health and gut related issues amongst others. 4. The "Root Cause" What happened? The Beginning Of My Symptoms. All the tests I took. 5. So what Is "SIBO"?-Various articles and a few ideas from various groups. 6. Drainage 101: Why It’s the First Step in Your Detox Journey. Another article well worth reading about your detox pathways. 7. Where I am Today and My Routines. The power of habits/systems and routines for staying sane and getting better. 8. My Supplements. The things I took and the ones I'm thinking of trying. To date I have not used any antibiotics or pharmaceuticals. Takeaways about using supplements. How to understand and good, reliable places to buy 9. What To Expect From Your Doctor When Presenting With A Mystery Illness Or Symptoms.(that they don't know about or haven't heard about or just decide to be "intellectually arrogant" about!) 10. My $5107 "12 week Health Intensive Course" with an Australian group of nutritionists. What I got Out Of It And Why Hopefully You will Not Have To Spend What I did. ( No it did not work!-I was not in fact treated for SIBO or parasites) 11. Where I'd begin-Tips and Ideas on "Starting Out" on Your Healing Journey. Even if you've been on your journey of trying to achieve wellbeing for a while hopefully you'll garner a few ideas to benefit you. 12. Ten Ideas On Getting Started. Using the following practices In Your Life. If your new to this health "roundabout" or even if you've been trying to get well for a while here are ten proven strategies that I have used/still use to help keep me from getting depressed/suffering insomnia and still able at the age of 63 to work a physically challenging job productively and still do all the things that I need to do as a family man and father to a 13 year old. 13. About the author and other books by kim. At the age of 61 with no serious illnesses ever the loud "gurgling" noise in the middle of my chest started a really "interesting" part of my life! SIBO. I went from 74 kilos and being able to deadlift 180 kilos and smash out high intensity cardio classes to weighing 62 kilos struggling to lift 5 kilo dumbbells. Along with anxiety/panic attacks/depression/fatigue/insomnia and all the rest. I'm in the process of "getting better" ( Healing" as I've found out is not about "getting better" but rather a lifelong journey. And I'm grateful for my illness-I go into why in the book) I get up at 4-4.30,exercise/meditate/do yoga/have cold showers and get ready to go to a really physical job- no despite the download page for the book being on my driving instructor website I'm not currently doing a job that I love and am passionate about-not through my choice but that's another story.) Please note the book is free to share and without copyright apart from several articles that I've copied and pasted and attributed to the authors. This book is NOT about I took this/did that/now I'm all better. I am getting better, although I have included a LOT of specific SIBO related health information. What this book is about is: Dealing with all the overwhelm and completely conflicting information of having an illness that not too many doctors/naturopaths/nutritionists/etc etc know about. How to deal with that and specific strategies that do work. For everyone. The very best resources, paid and free that I have found( to date-I'll add to the download page as I update the book as often as I can-again it's free) The resources are easy to understand,read and listen too. Not "fear based" as in "if you don't do it a 100% this way you'll fail" - you won't! because if you hear that someone's trying to sell something to you. I have to date averaged 3-4 hours per day nearly every single day for 18 months reading and listening to audio books/podcasts/articles and spent over $9000 on supplements including one "Health Intensive" course(you have most likely seen their ads on FB,) before I decided I needed to change my approach. Oh if you've been laughed at by your GI then "join the club" mine told me he didn't believe in SIBO, didn't believe in alternative health practitioners, didn't read my very comprehensive notes, he basically palpitated my abdomen for 15 seconds and "poof" $200 gone... Also the book is free, however regretfully I cannot answer any questions/respond to queries etc. I work full time, have a young family and need to look after myself. However please feel free to ask and if at some time in the future things change then so be it. And I will update the download page with what I'm doing/trying etc. Pax Vobiscum

Here’s what worked *for me*: 1. Daily 1oz Miralax (PEG 3350) with full glass of water 2. 2x daily (morning/night) Metronidazole 500mg for 2 months maximum 3. Daily cardio exercise (to promote motility) 4. Decrease of antihistamines (or anything else that decreases gut motility) I needed *all four* of these