From the Guidelines
When treating Small Intestinal Bacterial Overgrowth (SIBO) with Xifaxan (Rifaximin), it is not necessary to follow a low FODMAP diet simultaneously during the antibiotic treatment. The standard approach is to take Xifaxan at a dose of 550 mg three times daily for 14 days while maintaining your normal diet. In fact, some gastroenterologists recommend eating a regular diet that includes FODMAPs during treatment because these fermentable carbohydrates can help "feed" the bacteria, making them more metabolically active and thus more susceptible to the antibiotic 1.
Key Considerations
- The use of a low FODMAP diet is recommended as a second-line diet for IBS, with benefits seen in reducing the risk of remaining symptomatic, compared with all control interventions (RR 0.71; 95% CI 0.61 to 0.83) 1.
- However, the quality of evidence from these trials was very low, due to small sample sizes, difficulties in blinding and heterogeneity between studies 1.
- After completing the Xifaxan course, you might consider implementing a low FODMAP diet for 4-6 weeks as a maintenance strategy to help prevent SIBO recurrence, followed by a structured reintroduction phase.
Important Points to Note
- Treatment plans should always be personalized, so follow your healthcare provider's specific recommendations for your situation.
- The effect of FODMAP reintroduction to tolerance on IBS symptoms is unclear, although there have been open-label studies reporting the long-term efficacy of an adapted low FODMAP diet ranges somewhere between 50% and 60% 1.
- Issues with following a low FODMAP diet include the need for a specialist dietitian to implement it, followed by close monitoring to avoid nutritional deficiencies or the development of overly restrictive eating habits 1.
From the Research
Treatment of SIBO with Xifaxan and Low FODMAPs Diet
- The use of a low FODMAPs diet in conjunction with Xifaxan (Rifaximin) for the treatment of Small Intestine Bacterial Overgrowth (SIBO) has been explored in several studies 2, 3.
- A case study published in 2017 found that a multifaceted approach, including a low-FODMAP diet, antimicrobial botanical therapy, and homeopathic medicine, was effective in resolving abdominal pain and bloating in a patient with SIBO 2.
- Another study published in 2019 compared the effects of three treatment regimens in patients with irritable bowel syndrome (IBS), including short-term rifaximin treatment followed by a low-FODMAP diet, and found that patients treated with MegaSporeBiotic had similar severity scores and rectal volume sensation test results, but improved quality of life measurements 3.
- Rifaximin has been shown to be effective and safe for the treatment of SIBO, with an overall eradication rate of 70.8% and a low rate of adverse events 4, 5.
- A study published in 2019 found that patients with hydrogen-positive SIBO responded well to rifaximin therapy, with a response rate of 47.4% for hydrogen positivity alone and 80% for both hydrogen and methane positivity 6.
Efficacy of Rifaximin in SIBO Treatment
- Rifaximin has been found to be effective in eradicating SIBO, with an overall eradication rate of 70.8% according to intention-to-treat analysis and 72.9% according to per protocol analysis 5.
- The drug has also been shown to improve or resolve symptoms in patients with eradicated SIBO, with a rate of 67.7% 5.
- Rifaximin has a favorable adverse event profile, with a low rate of adverse events, including diarrhea, nausea, and abdominal pain 4, 5.
Use of Low FODMAPs Diet in SIBO Treatment
- A low FODMAPs diet has been found to enhance antibiotic therapy in the treatment of SIBO, and may be beneficial in reducing symptoms of abdominal pain and bloating 2, 3.
- The diet involves limiting the intake of fermentable oligo-, di-, and monosaccharides, and polyols, which can be difficult for some people to digest and may contribute to the development of SIBO.