What do you feed a drunken biome?
January 3, 2019 7:49 AM   Subscribe

So my doctor has put me on a course of Rifaximin for IBS-D. I've had gastro issues all my life, but this looks like something that might actually really set me pretty straight. How can I feed this right?

I'm a CIS lady who has had gut issues most of her life (I'm in my mid 40s). As a child I was a vegetarian due to gastro issues and on some meds that were compounded back in the day (no idea what it was).

I'm overweight, also on Metformin (the Met is not causing this, been on it for years). I was on Rifaximin last summer, but sadly short cut its success by taking a different antibiotic (same PCP) for a pretty serious skin infection that was starting to go necrotic. Just getting over a couple of psorasis breakouts and some now-resolved sleep deprivation issues.

In the past as I got to be an adult, my guts started acting up again. I'd have to avoid some foods for years at a time, and sometimes out of desperation would go on extremely bland BRAT style diets or soup only diets just to starve whatever the heck was killing me with the not quite constipation/burning flaky diahrehaa loop.

SO. I'm on the med again. I'm a few days in, and sadly seeing no progress. I'll stick it out, but I have no problem with eating the same one or two things for a few weeks to help it along.

What am I killing with these meds, and what are the best things to eat to support everything rallying to take over the bad with the good?
posted by anonymous to Health & Fitness (8 answers total) 3 users marked this as a favorite
If you're taking antibiotics, feed yourself probiotics.

I'm extremely sensitive to antibiotics and have learned that I need to at least attempt to counteract the killing-off of the good bacteria.

I take this: Schiff Digestive Advantage Intensive Bowel Support and supplement with other probiotic products, like fermented foods (yogurt - but check the label for active strains like Acidophilus, sauerkraut, etc).

There are also drink packets like this that I occasionally use.

It looks like rifaximin has a lower chance of causing gut issues (per your article link) but I would still think probiotics are a good start, if you're not already doing so.
posted by rachaelfaith at 7:59 AM on January 3

If you ingest probiotics, take them at a different time than the antibiotics. If you have everything in your stomach all at once, the probiotics will just get killed off.
posted by Juliet Banana at 8:10 AM on January 3

Fermented foods are probiotic; fresh sauerkraut, homemade pickles, fresh yogurt, esp. if you avoid the sugar. You can usually find kimchi at Asian markets. Fresh vegetables grown in the ground have beneficial bacteria, so sweet potatoes, potatoes, radishes, carrots, squash, lettuce, spinach, kale, etc. Extra cover is good for gut health, start slow because you have issues, but your but benefits from soluble and insoluble fiber. Applesauce and instant are a good way to start.
posted by theora55 at 8:53 AM on January 3

You should ask your doctor this question!

That said, I took this drug a few years ago and didn't do anything special in terms of probiotics or whatever. It worked miracles for me, although I don't remember how long it took to show an effect.
posted by radioamy at 8:56 AM on January 3 [3 favorites]

I know you say the metformin is not thought to be the cause of this but metformin is notorious for causing GI side effects, especially IBS like diarrhea. I would speak with your PCO about trialing a few days off metformin (if you haven’t done so) to ensure it isn’t contributing to the issue, if it is safe for you to do so. If it is a factor it is likely to be apparent fairly quickly. For my mom getting off Metformin (which had been tolerated okay for a few years) was literally life changing for her gut. For many of metformins applications there are other drug options too.
posted by Northbysomewhatcrazy at 10:08 AM on January 3

You might also want to consider prebiotics ("resistant starch", which they're calling the third type of fiber, beyond soluble and insoluble). Prebiotics (more here, although I'm not endorsing any brands/products) preferentially feed the good bacteria in your gut. (Well, that's the idea, anyway; we're really just shooting in the dark here as no one really knows what the hell we're doing with the microbiome, as knowledge is currently in its infancy. This is a good academic article on the current state of our knowledge, with links to other articles at the right)

My understanding is that while probiotics can be helpful for GI issues, it's unclear whether they actually permanently colonize the gut (here, and elsewhere), so prebiotics might be more beneficial than probiotics for you. I personally take acacia fiber, which has helped with my chronic diarrhea and reviews suggest has helped others with chronic constipation and other GI issues. I also take hydrolyzed guar gum (this brand) for the same reason. I additionally regularly eat Quest protein bars, which have a lot of soluble corn fiber, which is another prebiotic (see more here). You can get prebiotic fiber naturally in your diet, but it's quite difficult with a modern diet to get it in the amounts that are probably needed - although if you eat that many Jerusalem artichokes, green bananas, and chicory root on a daily basis, you're living your best life more than I am! :-)

The nuclear option would be trying to get a fecal transplant. I think it may only be being done currently for those with C. diff., but I've heard of some incredible results.
posted by ClaireBear at 10:30 AM on January 3 [4 favorites]

Some people have had success with the FODMAP diet:

posted by SereneStorm at 5:16 PM on January 3

Have you been tested for celiac? It can cause some nasty skin issues- google Dermatitis herpetiformis.
posted by fshgrl at 12:59 AM on January 4

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