Sibo treatment Rifaxamin and Neomycin

Following Breath testing, I was DX with Methane levels double the normal. Started Rifaxamin 8 days ago with a strict dietary plan. It is working somewhat but not as well as my doctor expected. Yesterday together with caution we added Neomycin 500mg twice a day. You must radically alter your diet to get success and be vigilant about the change. It's tough to do because of flimsy US food labeling. So you must do as much home cooking of fresh food as possible!! I can't say that enough. I'm having much better results only this way. I'll be happy to share my diet success with anyone out there. It is complicated but it works and it takes individual allergies, sensitivities into consideration because everyone's chemistry is different. It's helpful to monitor what you are eating at every meal so I use the free online app My Fitness Pal, recommended by my dietician. The app is easy to use, allows you to set personal goals for weight, water intake, exercise, and each element of food intake (calories, carbs, protein, fat, sugar, fiber, sodium). It's become my guide for this strict diet change for SIBO treatment. I'm not there yet, so it's a work in progress, but I am more hopeful than I was before. I've been dealing with this chronic life-changing disease since 2019, lost 20+ pounds that year, can't get my weight up to 100lbs yet, but the research is starting to improve and there is new info to help us each year. In the past 3 months, I've endured 5 different GI tests that have finally determined my underlying problem- SIBO! For years I was told I had IBS-C and IBS-D mix. That was false due to a lack of medical knowledge. Now the medical community is indicating that SIBO is underdiagnosed. Hang in there. Happy to share my successes and challenges if you ask.

Was the Fodmap diet recommended?

@seabright2001
Hi.. thank you for asking. The Fodmap diet is not completely appropriate for SIBO but it is a guide. Basically the guidelines for me are gluten-free, dairy-free, low fat, low fiber, low sugar, and very limited for sugars both natural and artificial, of many kinds. I cannot tolerate glucose syrup, high fructose corn syrup, fructose, complex sugars. So that eliminates apples, pears, ripe bananas, mango, melons, peaches, avocado, dates, raisins, sweet potatoes, figs, beets or any other fruits or vegetables that produce methane (like chickpeas) when digested in the small intestine. I can eat small portions of berries (blueberries, raspberries, strawberries, pineapple, all citrus, kiwi, only cooked carrots, zucchini, green beans, parsnips, spinach, kale, chard, bok choy, rice, quinoa, oats, GF oatmeal, eggs, fish, 93% lean beef, pork tenderloin, chicken or turkey breast, non-dairy, low sugar yogurt, Whole Foods sourdough bread, nuts, nut butters that are sugar free. It's complicated but experimenting for each person is key to finding what works for you. Snacks are challenging!! I bake my own muffins with yogurt, banana, berries, and walnuts. Snack bars brands that are decent to buy are Aloha, GoMacro, and Lara. I like Skinny Pop for a snack. It's recommended to cook with olive oil mainly because of its purity and heart health benefits.

@eileen57 - I wanted to let you know I moved your post here to this existing discussion where the original poster, @azj, also was talking about the same medications for SIBO:

- Sibo treatment Rifaxamin and Neomycin https://connect.mayoclinic.org/discussion/sibo-treatment-rifaxamin-and-neomycin/

You also mentioned something about flimsy US food labeling. I think perhaps you are talking about something like what is described in this National Science Foundation 2025 article https://www.nsf.org/news/americans-demand-greater-clarity-standardization-food-labeling. However, will you talk more about any concerns you have with food labeling and how that affects you as a patient with SIBO?