So glad to have found you guys, I have been on the same painful journey as most of you, and will post a lengthier message later on, but first wanted to comment on the bile acid sequestrants (welchol, colestipol, cholestyramine):

First, they need to be taken with food (right before, during, or after a meal), if you take them on an empty stomach you will get unbelievably painful issues. Also, if you find that you are getting issues regardless, it may be that you are not eating enough fat with a meal.

Second, you probably should not take them if you are prone to constipation. As a doctor once told me, these drugs will stuff up a goose. These treat bile-acid malabsorption diarrhea, which is related to SIBO (I will elaborate later).

Third, you should really consider asking your doctor for welchol or colestipol and not cholestyramine. Unless they changed it, welchol and colestipol both come in a convenient pill, but cholestyramine comes in this disgusting powder which does not mix well at all. If it comes in a pill, fine go for it, but I, and countless others, found the powder to be so inconvenient that it was effectively useless. Maybe the one benefit of the powder is that it is easier to dose, for example, do 1/2 or 1/4 of the pouch at a meal, but most of us need 2-4 pills (1.5 to 4g) of the acid sequestrants anyways.

What is the connection between SIBO and bile acid malabsorption? A GI told me that bacteria will digest and ferment extra bile acids, leading to even more symptoms and issues. So getting them out of your system via the sequestrants help to minimize the symptoms, even though the underlying SIBO is still not being addressed. Still, a game changer. Good luck all, again I have a longer post forthcoming with questions and ideas for all of you.

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