Recurrent SIBO

[Tina Vu]

Hello docs,
I have a patient with hx of hashimotos and SIBO. On Armour thyroid and have been successful in lowering antibodies with dietary changes, supplements, etc.

Tested + for SIBO (bloating, loose stools are primary complaints; no constipation). First test + for methane and hydrogen. Treated with berberine complex (by integrative therapeutics) and allimed. Used motilpro after with lactoprime plus. 2nd test still + for methane and hydrogen, GI doc prescribed Xifaxan for 10 days, no retest was done, but symptoms persisted so did another round of xifaxan for 14 days. Follow up test showed decrease in hydrogen but significant increase in methane. Thoughts as to how to proceed? Another round of xifaxan + neomycin?

She has also done SCD, lowfodmap, biphasic diets during that time, with digestive enzymes, ox bile, gut health protocols (glutamine, etc.)

[DrWoeller]

Tina,
I would suggest adding in Atrantil – https://atrantil.com/. This should take care of the Methane, perhaps by itself or in association with Rifaxamin and Neomycin. From an antibiotic standpoint the additional of Neomycin is important to also get rid of The Methane.

Sincerely,
Dr. Woeller

[Tina Vu]

Thank you. Patient’s gastro refuses to add in neomycin because of black box warning. I was wondering if doing Xifaxan + atrantil + allimax pro should be considered? If so, would they be taken all at once?

[DrWoeller]

Tina,
These would be a great combination. However, in our experience it is not a requirement that all of them be taken at the same time together but at least taken daily even if spread out. However, they can be taken together if tolerated by the patient.

Sincerely,
Dr. Woeller

[Tina Vu]

Would she continue with atrantil and allimax even after xifaxan treatment is complete? If so, for how long? And then when it comes time to retest, how long to wait after this type of treatment (when herbals are combined with antibiotics)?
Many thanks!

[DrWoeller]

Yes. I would be advisable to continue with the Atrantil and Allimax after the Xifaxan is completed for at least 4 weeks. Retesting is done 4 weeks after completing antimicrobial botanicals and/or antibiotics. I am assuming this person has high Methane which is prompting the use of Atrantil and Allimax?

Dr. Woeller

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