@dt61 I too am coming around to the realization that SIBO might not completely ever go away but might be managed to the point when it's tolerable. Right now, that's where I seem to be, for the first time since becoming afflicted with it (SIBO with constipation) in summer 2024. Other symptoms: dyssynergic defecation, bad internal hemorrhoids. Here are some things that have helped me. Everyone will be different, but maybe some of this will give you some ideas to try. Keep in mind that it's taken me almost two years to get to this point! It's a process:

1) A little pelvic floor therapy to give insight on the best ways to poop. (Even just consulting online tutorials -- there are plenty.) And a poop bench.

2) Realization that you don't actually need to poop every single day. Try to aim for one BM in the morning, let's say, and don't interpret every bit of gas as a sign you need to go. Wait it out a bit, maybe it's just gas.

3) Nightly senna, magnesium. Docusate sodium (100 mg) at night after 2 days with no poop. Miralax every single day and trying to drink as much water as possible.

4) Diet: this is really important. I would urge everyone to go and get an endoscopy to determine whether your brush membrane has been damaged. I did and was diagnosed with ASID (Acquired Sucrase Isomaltase Deficiency). This means that your body can't digest certain kinds of sugar. It's why the FODMAP diet might help but is not enough.

5) So now I'm on a really restrictive diet. Pretty much no sugar, which is great for helping to starve the bad bacteria. And I lost 20 lbs just from not eating sugar, which, in my case, is a good thing. Everyone needs to tinker for themselves but here's pretty much what I eat right now: sourdough bread, aged cheddar or Swiss cheese, almost all animal proteins (e.g., fish, chicken, eggs), some spices, coffee, tea, berries, prunes, certain vegetables, tahini, avocados. If you are a meat-eater, a good standby in a restaurant is a hamburger. Japanese udon/ramen noodle soup is good, too, because it doesn't have a lot of additives (e.g., garlic, sugar). If there is a trace of some "bad thing" in something you eat it once or twice it probably won't have any effect (e.g., some sugar added to the challah dough).

6) Counter-intuitively: I discovered that whole grains and some high fiber vegetables are NOT good for me. Huge improvement once I figured this out. White-flour bread, even if there is a touch of sugar in it is tolerated. The best is sour dough bread, which is highly digestible.

7) No probiotics.

8) I did do a 3-week course of the Xifaxin and I didn't see any immediate change. I also didn't experience any side effects from it. However, about a month later (a few weeks ago) I had a terrible week that I think might have been a die-off of the bacteria (endless pooping, sometimes in middle of night, some diarrhea, rashes).

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Where am I at now: mostly regular BMs (sometimes loose, sometimes formed, a good brown color and not orange as they were for a long time), much less gas. Mostly just once a day, though sometimes still needing to return to the toilet once or twice more to finish.Some good stretches where my hemorrhoids don't bleed, don't prolapse, and don't hurt. I feel better, in general. When I first developed the SIBO I felt really sick, with strange numb sensations in my arms and legs, and had very low absorption of iron (leading to restless leg syndrome, insomnia). I'd like to experiment and see if my intestines have repaired themselves and I can tolerate a wider range of foods -- but not just yet. In short, it's possible for me right now to live a normal, functional life and not have to obsess every minute about this condition.

@dt61
I started a new round of medication Friday and the fatigue, fog and dizziness is worse this time around on the medication. I’m seriously regretting this new round of medication.