Overcoming IBS (Irritable Bowel) & conquering Gut Health | Dr. William Chey, MD
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- เผยแพร่เมื่อ 28 มิ.ย. 2024
- A complete look at causes, diagnosis and treatment of IBS by one of the leading world experts. Gastroenterologist Dr. William Chey takes us through what causes Irritable Bowel (IBS), how to distinguish it from other similar diseases and how to treat it. The role of diet, medication, behavioral therapy, probiotics and acupuncture in IBS.
Follow Dr. Chey on Twitter: @umfoodoc
Connect with me:
Facebook: / drgilcarvalho
Twitter: / nutritionmades3
Animations: Even Topland @toplandmedia
References:
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Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.
#NutritionMadeSimple #GilCarvalho
0:00 Highlights
0:12 Intro
1:24 What is IBS?
10:59 What causes IBS?
24:50 Multipronged therapy
32:27 Diagnostic tests
41:00 Wheat intolerance & SIBO
48:03 Histamine intolerance
51:06 Low FODMAP & other diets
1:04:10 Fiber
1:08:07 Probiotics
1:13:35 Summary & Takeaways
I love this expert; he doesn’t try to blow smoke and use statistical gymnastics to convince an audience that he and his peers can work magic. I very much appreciate his transparency.
Yes, this was a great episode. I really enjoyed his measured approach too.
I agree this was amazing, and inspiring to keep going on the journey with my doctors. How do we get the algorithm to push this instead of content like dr.berg... would save so many people headaches.
Let's not forget the careful inclusion of reference notes for individual statements made by the expert. That is above and beyond what we normally see and a lot of work. Next level stuff, as far as TH-cam, where most people don't even cite references at all, let alone dozens of them for specific reasons (not reference stuffing, which is a problem, as well).
Low fodmap diet was awful. After doing that diet for two weeks I still had ibs but then couldn't digest the foods I could before and I lost so much weight that I couldn't afford to lose. I've never been able to gain that all that weight back and my digestion never healed to prefodmap diet status. Beware of this diet...don't do it very long.
Thanks Dr Carvalho, this is pure gold.
In a space mostly dominated by quacks, I hope everyone can appreciate how good this material is.
Fasting was the best treatment for my IBS.
I gave up finding a solution after three decades of allopathic and alternative medicines. I agree; fasting with water and bed rest after work plus TIME stabilized me. My family and even I just gradually grew disinterested in hearing about it. Needless to say, my digestive tract never misses an opportunity to give me a stern talking to when it has become offended.
“Bothersome” is stating it lightly. It has ruined my life. I’ve had IBS-D for 40 years.
I suffered with IBS-D for years, as a young woman, and still have flare-ups of IBS-M now and then at age 62. I can be constipated in the morning then have diarrhea two hours later.
Stress and eating out a lot are huge factors. Cutting back on grains and seed oils has helped me tremendously too.
You see, I can eat a piece of bread with multigrain seeds on the crust, have abdominal pain five hours later, run to the bathroom and pass only seeds and water. Then the pain goes away.
My gastroenterologist said that type of event is classic IBS. Oddly, cooked broccoli/cruciferous doesn't bother me, but if I eat it raw, I'll bloat up a pant size and run to the bathroom. Home made coleslaw does not bother me though.
I find that olives, sauerkraut and pickles feel good. Fast food, especially biscuits, tear my stomach to pieces. Yogurt is very soothing, and I have a friend with Crohn's disease who finds yogurt to be soothing also.
Thank you for your information. Do you recall any traumatic event(s) that may have occurred immediately b4 your original onset? I have always been healthy, stomach of iron. Then 2022 5 traumatic events occurred back to back. I ended up bedridden for almost 3 months. I battled trying to figure out WHAT the heck had happened. Going Google crazy trying to find a naturalist I got some crazy woman from CA that did a huge blood draw on me looking for anything. She orginally thought (sibo), but no, and never have me any advice other than (rest) and many hot salt baths. Here I am 2 years later and still haven't been able to figure this out. But I now found a dr (near me), have been doing research *(like this video) and really think I'm on the right track. I have 1st appointment Thursday. 😉
Had IBS for at least 15 years, stopped eating bread and took a probiotic on my GPs recommendation, and the blotting mostly stopped, but would get what I and my GP wife believe is diverticulitis flare ups. My symptoms evolved into many unexpected trips to the bathroom a day. Back in late summer my wife recommended Metamucil which worked really well, and I've since replaced it with psyllium powder which works even better. Should mention I had Covid around the same time I started this. Then in early Nov started a lower carb, no processed food, diet with intermittent fasting (dinner till five, breakfast at 10am sometimes skipped), no snacking, which as lowered my weight (180lbs to 176lbs) and improved blood pressure (from 138/85 to 123/80). Oh, and I now do eat some sourdough bread with no consequences occasionally. IBS is now mostly gone.
I know it's not completely nutrition related, but I would love an episode on cognitive behavioral therapy. I have found it very helpful for anxiety and insomnia and I know there is a lot of research behind it.
Yes, me too; I’ve endured decades of therapy with subsequent codependency on the therapists ( by their design I now think), and then I independently came upon CBT and it’s variations. Literally overnight my attitude of being alive turned a 180 and all the criticisms I have read about it simply are not accurate.
Great job getting Dr Chey on your podcast. As a gastroenterologist, I can affirm that you got one of the top notch, highly respected leaders in our field speaking on this topic. Your other listeners will not realize nor appreciate how fortunate they are to listen to an evidence-based expert like Dr Chey and not some social media celebrity who knows how to sell themselves with attention-grabbing sound bites, but really do not have a good grasp of science (ie. Paul Saladino). Thanks for this episode!
This level and quality of medical/health prof’l discussion and integrity of MD (not selling books or ideology) is needed on social media. Unbiased evidence based info to benefit all vs driven by competition and profit.
I have had IBS for close to 40 years and through trial and error have found things that help. My IBS was always worse during menstruation and improved greatly after menopause. I have found some food's and additives are worse than others, for example fake sugar is a recipe for disaster as is white bread and pasta, although I can eat sourdough and gluten free pasta. Alcohol and instant coffee is also off the menu. I started taking a particular brand of calcium supplement about 5 years ago after being diagnosed with osteoporosis, it did nothing for my bones but a completely unexpected side effect was it stopped my IBS within 10 days of taking it. As long as I remember to take it twice a day I rarely have a problem. I have absolutely no idea why it works. I have tried other brands with similar ingredients and they do nothing.
I found probiotic tablets were no help but having lactose free Kefir daily has eliminated bloating and indigestion.
Holy crap. $1600 for rifaximin? It's $29 here. $6 if you have a concession card. Factoring currency conversion that's 80-400 times more expensive.
Thanks Dr Carvalho. This is great information, I only wish the video had been available to me about 10 years ago when I was struggling with IBS. My experience was that because IBS is, as you say, heterogeneous very few clinicians have the time needed to diagnose an individual case, so IBS suffers are pretty much on their own to find a solution. And because IBS is largely invisible those stricken suffer on their own with very little community support. Ultimately I was able to cure myself by adopting a very restrictive diet, low FODMAP, low carb, vegetarian, no wheat, no alcohol, no dairy. Sounds like a lot to give up but the symptoms of IBS are so debilitating that for me it is well worth doing without those foods and fortunately I’m still able to get adequate nutrition eating primarily whole fresh foods. My IBS symptoms started after I started taking PPI drugs for GERD. I wonder if the resulting low gastric acid production allowed SIBO to occur which in turn led to bile acid malabsorption then causing IBS. I suspect this chain of events is what happened to me but the only evidence I had was extremely dark stool which I think is indicative of bile acid malabsorption. So my question is, is there an established link between PPI drugs and IBS? BTW in my case GERD was the result of a food sensitivity, had I know that in the beginning I could have avoided a long period of ill health. Thanks again and keep up the great work, information is power.
Some research is showing PPI use is correlated with SIBO (as well as other gastrointestinal infections like C-diff), so you might be correct in your deduction about why your IBS started.
I am actually a perfect case study for the post covid ibs. I am mildly autistic and I eat the same things every day. Same routine, same workout routine, same amount of stress, same enviroment everything the same.
As a doctor of acupuncture and Chinese medicine, I am VERY happy to hear this!!! Bravo, once again Gil! Thank you 🙏 ❤
Dr. Chey knows his field and is a good communicator of the information. I learned a great deal from this interview with him!
I loved this interview, so helpful and informative. Would that we all had access to integrative medicine for our gut health issues! Until then, please could you have a registered dietician and behaviorial psychologist provide more details on these aapects of treatment? Thank you for your consistently excellent content.
Been impatiently awaiting this for months! Thanks Gil!
I AM SO EXCITED TO LEARN FROM THIS
Good to see you again, Doc. 😊
I thank you wholeheartedly for this video🙏🏽
Thanks. Dr. Chey is a great guest (and researcher!)
Would love more details on the restriction and re-introduction phases!
Dr Carvalho.. If you were to go through the dietary strategies for IBS I would really recommend Kate Scarlata. She has worked with Dr Chey and is incredibly knowledgeable in the area! Thanks so much for promoting an evidence based approach!
Oh ive been waiting for an ins episode,thanx
I was diagnosed in the late 60s with IBS. I was in HS at the time. The fact that this was viewed as a psychological problem was exactly how it was presented to me. This follows that predominately women were affected and so there was not a physical cause presumed. Maybe in the 1970s and later men were having this condition and that bringing a closer look into what was really going on. TY for this video.
Very good point. Many times, women seeking medical help are told "it's all in your mind, you're stressing too much, etc." If men were the ones who had this first (in the 1960s when it started to become prevalent) they would NEVER have been told what women, to this day, hear ("it's all in your head, you stress/worry too much"). Clearly, there is a physiological component here. I don't know why women's health continues to be put on the back burner.
Fantastic information. Very helpful.
Superb discussion!
Thank you so much -- this was such helpful information and was very interesting too. Anyone whose IBS symptoms are not yet under control could really benefit from this video.
Very useful information! I would love to hear the perspective of a registered dietitian as well related to diet therapy in IBS
Thank you so much for this !!
Thank you so much for this video ❤
Excellent information . Thank you
Great information, thanks
Thank you, much appreciated.
Love this content! If i could
make a suggestion, a video on dermatological conditions (psoriasis,alopecia, vitiligo) related to diet/nutrition if possible.
I love evidence based references. 🌻
Excellent interview and information from Dr. Carvalho!
One thing I didn't catch in the interview, which i wish was included -- has there been any studies and finding in the correlation between IBS and trauma, CPTSD or PTSD.
No, you're right. BUT considering I am 53 AND it bit me 2 years ago immediately after 5 traumatic events at once, I would say so. .. Did you know that this was called (nervous stomach) back in the 70-80's?.... Very interesting 🤔😔
Great video
I’ve had IBS/Spastic Colon for over 20 years. Amitriptyline is the only medication that has made a difference as it does decrease the intensity of the spasms. But amitriptyline has huge downsides, it impacts memory and speech and it’s impossible to get off of.
I got off of Amitriptyline 2 years ago, still have spastic colon and headaches. Best thing about taking it was my sleep was great, but now I'm lucky to get 5 hours a night (and that's with taking CBD every night).
@@christhompson7558 I’ve tried multiple times but like you I couldn’t sleep and anxiety was through the roof.
Your videos are awesome Dr. Carvalho, is always so educational to watch them!
Could you do a video about energy drinks and their impact on heart and on health in general? Most often people are worried about the amount of sugar, which doesn't matter if you only drink sugar-free versions of this energy drinks. But what about the other bunch of vitamins and artificial stuff found inside? Also they appear to be illegal in some countries?
Only *50* scientific references and links? Again, a very thorough and well presented video, thank you.
Thank you for this video. My IBS journey started about 35 years ago, though after many tests and an elimination diet (Prince Alfred hospital elimination diet), I am getting closer to working out what triggers my symptoms. Great to know I am not alone 😅
You are not alone. I’ve had this for about 40 years and still don’t have any answers.
Your professionalism and honesty make me trust your words completely. Please, could inform about the role of MCT oil in helping against dementia, I have seen some videos about it but you know better than anybody how some videos are ....Sorry about the poor english. Thank you very much!
This has been so helpful. I had no idea. I've recently been diagnosed with IBS following a stomach virus which lead to colitis. I was not giving any information about ways to help the symptoms. I was also told I have a tortuous colon and told to take Miralax. This is a big NO for me. I tried it and was doubled over in pain from the bloating. I currently take Magnesium to help move the gut. I'm hoping to try some of the food restrictions that will help with the pain and diarrhea I get. Thank you ❤
"Bran has been largely poo-pooed" He really said that.
Hey Gil, great video. Do you have any video or could you make on the effects of tea and/or coffee? I think it would be interesting since there's little people on the world that do not consume any of them
This was excellent. Thank you so much. I would love to learn more about the different fiber options and which is best for IBS-C specifically. Also what about fibers like SunFiber (PHGG) and Acacia Senegal which are often touted as great for IBS-C. Are they? Is there any data behind them? As for psyllium husk, do we need to worry about lead content? (per Consumer Lab, some tested exceeded lead limits)Thanks again! ❤
Thanks
Can you do a video about The China Study please? I am interested in reducing the chance of cancer through a plant based whole food diet.
I would like more content on the diagnosis and treatment on this topic if you haven't done it already
Look, I'm aware of the fact that most people don't have any problems with having a colonoscopy, but having a colonoscopy completely destroyed my digestive system and my life. And it is not unheard of for people to suffer terrible consequences from the procedures such as perforation, hemorrhaging, infection, and death. I will never have another colonoscopy again. Not only was I assaulted by the doctor and the nurse during the procedure, but it also literally destroyed my physical health.
I am so sorry to hear about your traumatic experience. I have heard of others having similar. I have mixed feelings on this. I had my first colonoscopy at 24 last week, because I am at increased risk. Turns out I had early stage cancer, no symptoms. Had they not screened, apparently it would be full colorectal cancer in less than 3 years. I haven't experienced any ongoing negative symptoms. These procedures are so important for early detection, and have greatly reduced the death rate of colorectal cancer. However, I believe that we need more research into how to better perform them, and stricter supervision and accountability for the doctors doing them. I sincerely hope that you are able to find healing and relief soon.
Really enjoy your videos and balanced viewpoints. Can you address in a video if more saturated fats may possibly be eaten if a hypocaloric state is always maintained? Any research on the resulting effect of such a diet on lipids? Personally, I'm always trying to balance high blood sugars (pre-T2D) with a low carb diet with the need to keep my lipids in check (i have hyperlipidemia as well). Seems there must be many people in my situation with a lot of conflicting advice (keep you BG low with low carb but don't eat too much saturated fats, etc.). A cup of beans or oatmeal sends BG through the roof, and I can only eat so much fish and nuts...😊
Again, great program. A very balanced person. I like it Dr. Gil, keep inviting ppl who are not prejudiced. I am just so tired of the epiphanies and othere shi** lke this. Thx£
An excellent and informative video! I wasn't sure if I would commit to the full 1:17, but each section was explained so well by both you and Dr. Chey. Who knew IBS info could be so captivating! 62 F here. Experienced severe IBS symptoms at onset of puberty that has continued for most of my life. Definitely a stress component but I always wondered if there was a hormonal cause to my suffering?
It would be a little silly to go from 14 to 62 without trying an elimination diet once.
@@DrummerDucky Gee, thanks. I had a question for Dr Carvalho, but didn't realize that i needed to quantify my post. As a teen, my GP gave me dimenhydrinate injections, and PO once I wasn't vomiting. I've tried Probiotics, and elimination diet twice with some success discovering some wheat and dairy sensitivities. The worst of my pain was always associated with my menstrual periods, hence the query about hormones. I am now in menopause (which didn't occur until I was 56!), and things are better.
@@barbarahultberg9453 I am not Dr Carvalho, but I am a woman with IBS and I have read as much as I can on the topic. You are right that our hormones affect our IBS symptoms, particularly estrogen. I also notice my symptoms fluctuate with my hormones, which makes sense considering they affect digestion even in women without IBS!
@@what.the.bleep.do.i.eat. Thank you for the supportive comment! I may need to watch it again, but didn't think the topic of hormones was mentioned. I hope you are finding ways to ease your IBS symptoms. My very best to you.
@@barbarahultberg9453 Oh no, it wasn't mentioned in this video. I just know hormones affect symptoms from my own research. I am doing reasonably well these days thank you!
Well I disagre a bit on the idea of trying fermeted food and stoping if it does not work. Maybe in USA fermented food is considered a costly and exotic way of eating but really should be included in daily diet. Of course if it has negatif impact you should stop or drop to minimal amount but otherwise continue fermented food till you die 🙂
When I was in my 20's I found Food For Life Bran Bread and 1 or 2 slices per day totally stopped my symptoms. Food for Life stopped making it. But I can make my own bread. So for me bran worked.
YESSSS LES GOO
"its an important concept for some, but not all"
maybe there are other factors at play, that have not been accounted for. maybe it can be an effective stratigy when its application becomes more refined and specific.
Does it apply to IBD as well? Frend of mine has it and I would love to help him. I know that low sulfur diet is the key.
Thanks a lot for this video, very interesting. I seldom have pain in my stomach, so I don't fit perfectly into the IBS category, as you said it should include "abdominal pain". However, I often have digestive issues, bloating, diarrhea or constipation, often causing discomfort, difficulty in eating enough or having a drink at a bar, and problems sleeping because of gas stuck in the gut.
It seems to be triggered by carbonated drinks, sugar, lack of sleep, stress and tight pants or belts. I try to avoid these triggers, but I still feel that I'm abnormally sensitive to them. Would it still make sense to treat my symptoms with IBS strategies, even though I don't fit the official definition of IBS?
Would love to see more videos on digestive issues and bloating!
You should see a gastroenterologist and have a colonoscopy done.
What about yoga and other energy healing modalities?
Going through a flare up right now. Going on day 4
Did you change your diet 4 days ago or add any foods you normally don't eat? I'll do an elimination and I usually find the culprit.
It's got to be something in the food i moved to Mexico for the pandemic my ibs went away after 6 months it returned 3 months after I got back to the USA. I was in Mexico for about 2 years and a half
Might have something to do with food additives and perhaps the percentage of wheat vs corn in the diet? I can tolerate Mexican cuisine far, far better than North American cuisine even though I live in Canada purely because the starches are mostly corn and rice.
I'm trying to interpret European research on microbiotics and low calorie sweeteners.
Can sweeteners like cyclamates in the EU+Canada and Allulose in the US+Mexico contribute to antibiotic resistance for the gut microorganisms that cause pneumonia meningitis and urinary tract infections?
I'd be curious to know whether all of this applies to IBD
what happens to people with gastroparisis? how are they able to improve their gut health with the gut emptying issues?
An overall interesting talk, acupuncture aside - but no mention of localised allergy/mast cell issues via the work of Prof Boeckxstaens et al? One of the biggest breakthroughs in IBS research for a very long time. Its not the same as histamine intolerance.....
I certainly have issues with garlic and onion, when they’re raw. When I cook them, I have no issues. I’d think the fructans are still there tho…I kinda decided to run against the danger and bump up my fermented foods, I wanna bring in as many good bacteria as I can to bump out the bad ones. I am burping more, but having fewer farts, so I consider that a win.
I was diagnosed with IBS as a teen. The specialist told me to take some Metamucil and that way I can just eat whatever I want. How is that suppose to actually heal the gut?!
I would say anxiety, high sugar and low fibre upbringing caused it. But I am finding more and more although there may be no pain there's still diarrah or constipation. I don't believe you have to have stomach pain. Trying to go predominantly plant based.
Did. the outer change?
🙏
Has anyone found symptom relief using a grounding matt? Not sure if this would be a relevant topic for Gil because it is not nutrition based.
0:00: 🔍 Dr. William Chey discusses IBS, its causes, identification, and therapeutic approaches.
6:21: 📈 The prevalence of irritable bowel syndrome (IBS) may be increasing, particularly since the COVID-19 pandemic.
13:40: 🧠 The complex and heterogeneous nature of IBS involves interactions between the microbiome, bile acids, immune system, enteric neurons, and gut-brain interactions.
19:04: 🧠 The gut micro-environment can have effects beyond the GI tract, and treating gastrointestinal conditions can have psychological and mood effects.
25:07: 😊 Clinicians at the University of Michigan have observed that tailoring and combining evidence-based strategies can help over 80% of patients with IBS.
31:29: 📚 Integrated care is the standard for treating patients, particularly those with severe IBS, in 2023.
37:57: 🔍 Colonoscopy is helpful in diagnosing IBD but unremarkable in IBS; age-appropriate colorectal cancer screening is important.
44:15: 📺 The video discusses the controversy surrounding the overlap between SIBO and IBS, including the definition of dysbiosis and the best way to diagnose SIBO.
49:55: 📚 There is little scientific evidence to support the use of low histamine diets for IBS.
56:12: 🍽 A diverse and balanced diet is important for overall health, even for those with food sensitivities.
1:02:07: 🍽 The low FODMAP diet is valuable for treating patients with IBS, but it is not the only option.
1:08:42: 🔬 Probiotics have shown some evidence of benefit for IBS symptoms, but more research is needed.
1:15:33: ✅ Combining approaches leads to a success rate of 80% and above in treating intolerances and dietary restrictions.
Recap by Tammy AI
He’s skeptical of histamine being an issue for people but not acupuncture ? Hmm 🤔
🙌🙏
Hello doctor, I have a question that I can't find a answer for.
What do you think of the belief that unsaturated fats (and especially polyunsaturated fats) are only healthy when they are consumed when they are not oxidized (i do not believe that saturated fat is good because it is more stable).
I am not saying that baking ground flaxseeds (which mostly have polyunsaturated fats) is making them toxic/bad, they still have the fiber, the phytonutrients and so on.
I am asking this because I've read and heard that a lot of times, the body won't even change the fat that it absorbs from foods, so if you ingest some super oxidized polyunsaturated fat from an oil that was exposed to oxygen, sunlight, very high heat etc. the body will potentially use that damaged/deformed fat as a component of the cell wall!
Is this true or not?
Could this mean that consuming poly and monounsaturated fats (while keeping saturated fat low) should be best done when they are least likely to be oxidized (consuming whole raw nuts and seeds, and things like raw avocado) and avoiding heating even extra virgin dry pressed oils, especially the PUFA ones?
And maybe this is in the realm of "going into the details" but I really can't wrap my head around this.
I really hope you will answer.
Thanks!
If “IBS” exist then why is it so hard to diagnose? How was it identified in the first place?
I've heard endometriosis is one of the causes of IBS it travels to the colon from the uterus but I no longer have a uterus so I'm not sure that's my reason for having it I think mine is stress related
I’m so glad I don’t have IBS.
Can pesticides and herbicides cause ibs ?
👏
Get vitaminPHD
I have a question that is not mentioned in the video. How is alcohol affecting IBS?
Alcohol has a high content of Histamine which is an inflammatory Mast Cell Mediator.
Possible cause, alcohol can worsen IBS symptoms for those who have Mast Cell Activation Syndrome (MCAS) or Histamine intolerance.
Articles
Mast Cells in Gastrointestinal Disease - PMC - NCBI
Low Histamine Alcohol Guide
Thank you Dr. William Chey.
Is the bran in "whole-wheat flour" fine or course bran?
1:07:09 Course bran has an irritant effect in the colon and will stimulate people to go to the bathroom more often. Fine bran actually can be constipating.
Fructans, instead of gluten, are the culprit. Yay, I can eat more seitan now.
Gil,
a number of the citations in the description are not hyperlinked and cannot be clicked on.
Please fix!
fixed! :) thanks!!
Rectocele? Bloating and constipation…metformin making it worse.
I had to stop Metformin. Not only was it painful, but it really messed with my gut.
@@SuperAngelic5 changing to a half dose worked for me.
As soon as acupuncture, the king of all theatrical placebos, came up and was given the imprimatur of medical legitimacy, that's when I tuned out. Vitalism has been soundly debunked for decades. Comparing placebo to placebo will always give positive results. RCTs of high quality consistently show no benefit.
As a rando on the internet, I'd suggest you continue watching this video. The fact that they talked about the placebo effect, and the fact that placebo plus the stress release of acupuncture/massages has shown to help with IBS, shows that they are very much aware that acupuncture isn't some kind of magical thing. Also, it's very very low risk. And treatment isn't only about how well it works, it's also about what potential risks it bears. And so, if something is very low risk, even if it doesn't help alot of people or the results are mixed, it doesn't hurt to try it. I think that's pretty intuitive and simple to understand.
butyrate.
Rifaximin worked for me for 3 weeks. Then a slow slide back to pain and severe flatulence within a couple of months when I eat any type of plants besides rice. About to try Rifaximin again with Metronidazole but at $460 a pop it is going to get prohibitively expensive to do this once a month.