Diagnosis: SIBO

Diagnosis: SIBO

Because of my inability to tolerate sugars (even FODMAP-approved sugars), the IU dietitian suggested I might have small intestine bacterial overgrowth (SIBO). He put me on a diet of 5-6 small meals a day and asked me to never eat carbs/sugars alone – to always pair them with protein to help with digestion. In an effort to reduce inflammation, which he said SIBO likes, he suggested I replace running and weight lifting with more gentle exercise (hello, swimming and yoga). He also put me on 600mg Magnesium Citrate /day, which has proven to be a far superior alternative to Miralax.

His tweaks made a huge difference. My RUQ pain disappeared and my energy levels returned. I followed his plan while I worked with my doctor in Chicago to get a hydrogen breath test order called into Bloomington Hospital. HBT prep is ZERO fun. No probiotics or magnesium for one week prior; the day before I could eat only salt, white chicken, and white rice. Nothing orally (including water) for the 12 hours immediately before the test. I was not a happy camper.

I was overjoyed, however, when the results came back positive for SIBO. Mainly, I was relieved to have a definitive answer. Although false negatives are common, false positives are rare. I scanned the report and emailed it to my doctor for her interpretation. (FWIW, I had the lactulose test from Metsol. My score was 37. Normal is 20.) She put me on 14 days of 550mg Rifaximin 2x/day, which I started the evening of Thursday, March 10. She said she did not expect any side effects.

By Friday afternoon, after 2 doses, I was miserable. I hadn’t changed my diet from what the IU dietitian recommended, but I was experiencing all my usual symptoms. Fatigue, leaden limbs, wooziness, difficulty concentrating, and bloating. The bloating! I spent the weekend in bed and restricted my diet to Popchips, plain yogurt, and ginger tea steeped in unflavored LaCroix. By Monday I was better and by Tuesday I was back to normal. I re-introduced my hemp protein powder and tolerated it well. I ran on Tuesday over lunch (woohoo!) and ran strong. Then Wednesday I went swimming. I should have eaten more before heading to the pool; in an effort to prevent a crash I had a serving of raspberry Hammer Gel after ~15 laps. Bad, bad idea. I have been reactive to gel while swimming (when taken alone) the past few weeks – more than normal. But I had hoped that after almost a week on antibiotics I would notice a difference. Nope.

Normally, a gel crash means I cut my swim short – ~25 laps instead of 36 – and am fine the rest of the afternoon. This crash, though, lasted days. Exacerbated, no doubt, by 3 squares of dark chocolate I had that evening. I was really, really craving sugar. I was still dragging on Thursday, but did not feel great. 1 more square of dark chocolate Thursday evening… and I was down for the count. The dizziness, the fatigue, the apathy, the anxiety, the nightmares, the nausea, the constipation, the bloating. Such bloating! And the sugar cravings. I was unhappy.

No additional sugar on Friday. None Saturday, either, even though we went grocery shopping and it would have been so very easy to pick up some lemon cookies. Or some pecan cookies. Or who knows what else! I remained strong.

This morning, two and a half days since the last sugar, I am back to normal. I slept a reasonable amount last night (10-11 hours, instead of 14) and my abdomen is no longer distended. There’s a stomach bug going around; it could be that, coincidentally, I came down with the flu at the same time I started the course of antibiotics. It could also just be side effects of Rifamixin. But after two cycles of sugar-illness-no sugar-health, I’m ready to blame the sugar. My top suspicion that that, for whatever reason, the antibiotics make me more reactive to sugar in general.

We have an appointment scheduled with the Chicago doc on Friday, April 1, followed by an appointment with her dietitian. (Hopefully the dietitian doesn’t cancel, as she has on the previous FOUR occasions.) Naturally, I have lots of questions about SIBO, SIBO treatment, and my prognosis. Until then, I’m focusing on taking the Rifamixin, avoiding sugar, and exercising as I feel able.