I have permanent SIBO as the result of removal of my ileocecal valve. Before my diagnosis - and before taking rifaximin - I had malabsorption issues and started a gluten and lactose free diet. After my SIBO diagnosis, I was prescribed rifaximin, taking it every other month for just over two years. I take a calcium supplement every day, as well as iron and vitamin D, and get a B-12 shot once a month. I no longer take rifaximin because it doesn’t seem to reduce my SIBO symptoms any longer. I stick to my diet - high protein, no beans or legumes or cruciferous vegetables, very little fruit or leafy greens - and take my supplements and do my best to treat the symptoms when I have a SIBO flare. The only “cure” for my SIBO is reconstruction of my ileocecal valve which I’m looking into.

I have SIBO and am now on an anti-biotic. I couldn't tolerate the xifaxan. I never knew one could have permanent SIBO. You seem to be doing everything right regarding your diet. Good for you. also am gluten and lactose free. When you say you have a flare up, do you mean nausea or stomach pain? Best wishes if you go forward with the reconstruction.