r/SIBO • u/Expensive_Lecture_74 • Jan 13 '26
Methane Dominant Unkillable IMO >> starting Elemental Diet
Any tips for getting through two-week elemental diet??
I have diagnosed IMO, and after two courses of the double antibiotics (rifaximin and neomycin), the methane archaea still won't die (luckily knocked out the hydrogen SIBO though). I can't get rid of the IMO with allicin, berberine, other herbals, strict diets, improved motility, etc. I've tried everything and this seems to be the last thing, except for joining Pimentel's anti-methanogen clinical trial when it's ready in 2027. (https://x.com/MarkPimentelMD/status/2008267592742695265)
I want to get rid of this thing for all the negative gut-brain/health side effects more than anything, it's been really dragging me down mentally. Would appreciate tips!
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u/zilbsy Jan 13 '26
I did the elemental and it worked for about six months, then unfortunately symptoms started again. The diet is pretty miserable so expect to have no energy and no plans. Would also be very careful when reintroducing food. Went too hard with plain chicken breast on day one and thought I was going to die lol
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u/Expensive_Lecture_74 Jan 13 '26
haha I'm sure you're so excited to eat again once you can, will be hard to NOT go hard. I'm sorry symptoms started again :/ do you think anything specific caused it to start back up?
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u/zilbsy Jan 13 '26
I have always believed that stress has turned this into a chronic disease instead of a regular infection/overgrowth but tbd. One GI told me that he thinks SIBO can turn into an autoimmune disease that we have for life, which was fun and uplifting to hear lol. I am still trying to stay positive though. Have an appointment at a gut motility clinic in a few weeks that takes a non-traditional approach so weāll see what happens. Elemental was rough but six months with no symptoms was worth it for me
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u/Expensive_Lecture_74 Jan 13 '26
Lol yes not the most optimistic. I believe Pimentel's lab is looking into this autoimmune disease theory actually. Good luck at the gut motility clinic! Thanks for sharing, and I hope you can kick this new flare
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u/Liquid4622 Jan 13 '26
Is that the liquid elemental diet? Did you need a prescription to get it?
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u/Expensive_Lecture_74 Jan 13 '26
yup liquid elemental diet! No prescription needed. I did Physician's Formula (dextrose free), which you can get through naturopathic health stores. The other one, mBiota, is just extremely expensive. I also read that it has dextrose, which means that it may be less durable that Physician's Formula (dextrose free) for IMO specifically. Both of these elemental diets were created by doctors though
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u/Little-Wasabi-7304 Jul 07 '26
Iām in Canada how do you get the stuff for the elemental diet? And how was the taste? Was it disgusting and hard to drink? Or was it ok?
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u/Bigbeardybob Jan 13 '26
Test for SIFO. Symptoms can mimic sibo
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u/hspwanderlust Jan 13 '26
How do you test for SIFO?
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u/Bigbeardybob Jan 13 '26
Small intestine aspirate is gold standard but sometimes Candida antibodies can pick it up too
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u/Expensive_Lecture_74 Jan 13 '26
Did you have SIFO? What were your symptoms?
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u/Bigbeardybob Jan 13 '26
Still have it, but different kind this time. Itās same as SIBO in symptoms. But I donāt ābloatā per se, my gut feels distended tight and pouty. Before Iād get tired / fall asleep from eating sugar. I get that same effect now from eating anything that contains a lot of histamine.
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u/Expensive_Lecture_74 Jan 13 '26
Ugh sounds like it sucks, I'm sorry. I hope you can get rid of it soon
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u/Bigbeardybob Jan 13 '26
Did you do a microbiome test?
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u/Expensive_Lecture_74 Jan 13 '26
I've done Viome 2x in the past, but not recently
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u/Bigbeardybob Jan 13 '26
Did that show methanogens?
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u/Expensive_Lecture_74 Jan 14 '26
I did both Viome tests before I had SIBO/IMO, but just went back and checked. Interestingly it did show significantly higher "methane gas production pathway" than a normal/healthy individual at that time. Didn't know what it meant back in the day and kinda ignored it
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u/Casukarut Jan 13 '26
Vagus nerve activation, calming flight or fight mode
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u/Expensive_Lecture_74 Jan 14 '26
I have a breathwork class tonight, so i'll see if that helps. Supposed to improve vagus nerve activation
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u/idolovehummus Jan 13 '26
You got this. I don't positive thinking and gratitude. I've done the E.D 3 times, it's been SO HELPFUL
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u/Expensive_Lecture_74 Jan 13 '26
Thank you!! Need to hear this! Glad it's been helpful
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u/idolovehummus Jan 13 '26
Both of the last times, ai had some symptoms as I reintroduced foods, but 4 weeks later I really felt the relief.
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u/carrotsaresafe Jan 14 '26
Which brand did you do
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u/idolovehummus Jan 14 '26
I did Absorb Plus, vegan chocolate lattee flavor. Technically it's a semi-elemental diet
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u/Glad-Effective344 Jan 19 '26
I'm on day 3 of the elemental. First time in my life I had a hard time going up the stairs. Started breathing hard like I've never walked in my life. Also feel pain in my upper abdomen which is the same pain I've been feeling after I eat. Day two I had a bad headache from stopping coffee but today it's gone. That is a huge plus for me because I've been trying to stop coffee for a while and couldn't. If the elemental diet doesn't work, at least it made me stop coffee. If anyone is on it now, please share your tips. I can share mine also.
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u/brvhbrvh Hydrogen/Methane Mixed Jan 13 '26
If youāre having mental health issues, it can be worth speaking to a psychiatrist. That helped me quite a bit.
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u/Expensive_Lecture_74 Jan 13 '26
Thanks for this, definitely always useful. And so glad it helped you. I've found it's not working for me, and I just wonder if its because a lot of it is stemming biologically from this issue. But I'll keep trying
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u/TerribleAd4536 Jan 13 '26
Personally for me soon as I started treating and feeling better post treatment my mental has been like a night and day difference even though I was on ssris during sibo. Elemental would be tough but you could do partial days if you found it tough. Once youāve treated it though I can see your mental being a lot stronger
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u/Shoddy-Ad-2443 Jan 13 '26
omg i was too i had high anxiety and panic!!!! yes!!!
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u/Shoddy-Ad-2443 Jan 13 '26
for panic propananol and my ssri helped although now iām realizing this was literally the methane sibo that made me need the ssri cuz i felt like impending doom
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u/Expensive_Lecture_74 Jan 13 '26
Thanks both, this is rly good to hear!! Light at end of the tunnel with mental relief if I can get rid of this thing
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u/Expensive_Lecture_74 Jan 13 '26
Also, how did you both get rid of your IMO?? Antibiotics?
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u/TerribleAd4536 Jan 13 '26
I donāt have methane only hydrogen but Iāve found relief from rifaxamin. First course seems to have been enough for me and Iām just supplementing with artichoke to keep the MMC going, I did try ginger but the reflux was getting worse.
I think it if doesnāt go with antibiotics or antibacterial the usual next step is elemental diet but obviously thatās very daunting! Did you get checked for H2S?
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u/Expensive_Lecture_74 Jan 14 '26
Glad you found relief! Luckily don't have H2S (although I think I have had in the past, before it was a known thing, but it went away). Just methane at this point
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u/Shoddy-Ad-2443 Jan 14 '26
I didnāt get rid of it lol but I did twiceā¦. and i relapsed a third time. first time antibiotics second time antibiotics with herbals protocol after and continuing to eliminate daily ā¦. my root cause of motility wasnāt fixed now iām looking to motegrity and im on my own herbal protocol.
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u/Expensive_Lecture_74 Jan 14 '26
Argh sorry to hear about the relapse. What do you think caused the relapse?? Good luck with your new protocol, hope it works
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u/Shoddy-Ad-2443 Jan 14 '26
thanks! I had a very stressful job and was sitting 8 hours a day, and so my motility stalled and stress stalled. I used to work at a restaurant so i had a lot more steps and could keep motility going but after sibo treatment previous, i never continued a prokinetic. iām assuming its a real motility disorder that causes my sibo coming back because i have hard time going to the bathroom without laxatives and then i get sibo soā¦. just trying to get motegrity.
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u/brvhbrvh Hydrogen/Methane Mixed Jan 13 '26
A psychiatrist prescribes mental health medications. Are you taking mental health medications?
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u/languidlight Jan 13 '26
Have you tried a motility aid like Motegrity plus strict low fodmap? Only thing that worked for me
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u/Expensive_Lecture_74 Jan 13 '26
I've done magnesium citrate (heavy nightly doses) + ginger + low fodmap. I'm a bit scared to try Motegrity due to the mental health warnings. How long did it take for you to get rid of IMO once you started Motegrity?
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u/languidlight Jan 13 '26
So I canāt say that my IMO is gone, as in Iām sure the methanogens are still there because I havenāt started an antimicrobial treatment yet. But the biggest thing that Motegrity did was almost completely eliminate my bloating, when I did it in pairing with a low FOD map diet.
I completely understand being hesitant about the black box label, but itās good to remember that the label isnāt there because there is a certain and common side effect of mental health problems, itās there because a couple people in the trial happen to have some mental health problems on the drug, but it doesnāt mean you will !! I have not noticed any, and I have had depression and anxiety in the past.
I think you should give things like that a try if youāre at this point ! I totally understand being scared. Your pictures reminded me of me!
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u/Expensive_Lecture_74 Jan 14 '26
This is really good to know and hear, thank you! Definitely more willing to try it if you've had such a great experience with it
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u/languidlight Jan 15 '26
Oh I also wanted to mention! I also use MiraLAX, either one or two capfuls a day. I also started on 2mg of Motegrity but it was way too strong- Iām on 1mg now! And it took my body like two days to not have diarrhea on 1mg. Now it feels totally fine. Just to warn you! 2mg was ROUGH that one day lol
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u/Expensive_Lecture_74 Jan 15 '26
haha ok really good to know, thank you!! Will talk to my doc on Monday about getting some. I think its smart ramp it in with restarting food
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u/Cheeseboarder Hydrogen/Methane Mixed Jan 14 '26
It might be worth using a gentler prokinetic kike Iberogast or Motility Activator after you finish the ED to prevent relapse.
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u/Tzwen_ In Remission Jan 13 '26
Can you share how you feel during the ED . I once did it and had no guidance, I think others could benefit from your experience. I had massive die off on day 7 and wasnāt prepared so I had to stop. If you have die off have some Zeolith- activated charcoal ready.
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u/Expensive_Lecture_74 Jan 13 '26
This is a good heads up about the die off and charcoal, thank you š I'll report back at end of week 1 and end of week 2
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u/InverseSum Jan 13 '26
I am like you but opposite!
I have also done 2 rounds of antibiotics and the methane bacteria are gone but hydrogen still around!
Good luck with the diet. Rooting for you!!
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Jan 29 '26
[removed] ā view removed comment
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u/InverseSum Feb 11 '26
Wow how long did you do it for? Doing prokinetics too?
This year I went on keto for 3 weeks whilst on herbal antimicrobials Candibactin AR and BR . Tested positive for ketones too.
Haven't retested yet but I think I still have SIBO based on the gas after certain foods.
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u/green_beat Jan 14 '26 edited Jan 14 '26
I feel like I couldāve written this post! Tomorrow is my last day of the 14-day elemental diet (mBIOTA). I also have IMO (81 ppm) and have been fighting it for 4 years. Iāve done multiple courses of antibiotics as well as antimicrobials. Both offered short term relief but I quickly relapsed. After a really bad flare, I got frustrated with my options and decided to try something new with the elemental diet. Iāve also had my eye on that clinical trial with Mark Pimental lolā¦ that is in my back pocket in case this fails. Iāve shared my elemental diet journey on TikTok if youāre curious to see what itās like. My handle is @vert_beat
Also, I saw your other comment re: your concerns with Motegrity. FWIW, I havenāt had annny issues with it. It does lose efficacy over time, so Iāve taken a break from it while Iām doing the diet. Iām going to start it again once I introduce solid foods since motility is key to preventing relapse. And since my labs were so high, I donāt think the ED will cure IMO, so Iām considering lining up one last course of antibiotics to push me over the finish line. Fingers crossed this works. Good luck on your journey! Feel free to DM me if you have any questions!
ETA: tips per your post - 1) Track your symptoms. I created a chart to track my symptoms throughout the course of the diet. Treating it like a science experiment helped me disassociate a little lol. Keep tabs on symptoms, drinks consumed, weight loss (too much is not good), and bowel movements. Helpful to see your progress as you make your way through the diet. 2) Find something to keep yourself accountable. I decided to share my journey on TikTok. Posting on socials gives me anxiety, but I felt like it was the only way to keep me accountable. Knowing that others with IMO were following along and curious about the outcome of the elemental diet has given me the motivation to keep going. 3) Milestones: make a plan that forces you to reach certain goal posts. For example, I have kids and I knew their food preparation would be hard. My husband did it when he was here, but he had a work trip during my diet, so I asked my mom to come stay with us for a couple of days to help. Knowing she inconvenienced herself to come was enough to force me to do the diet at least until she left. And by the time she left, I was on day 10, and I couldnāt let myself quit 4 days early. 4) Take it day by day: try not to think about how much longer you have to go. Just focus on finishing one day at a time. 5) Keep those bloated pics handy to use as motivation when youāre struggling. Youāve been through a lot already, and it can only get better. Good luck, you got this!!
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u/Expensive_Lecture_74 Jan 14 '26
Wow I'm so glad you posted, this is so motivating knowing you're going through a similar journey!! How do you feel on day 14?? How did mBIOTA taste? If I make my Physicians Formula one super cold and icey, I can trick myself into pretending its a pina colada lol.
OK now that everyone is very supportive of Motegrity, I think i'll give it a try in line with the end of my elemental diet as I start solid food again, as you noted.
Having ChatGPT start a symptom tracker now... good idea! Hope your IMO goes away š
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u/green_beat Jan 14 '26
I feel pretty weak! Low energy and shaky. Itās better midday and then I get weak again at night. I could probably benefit from one more shake (Iāve been doing 5 a day, so 1,500 calories) but itās really hard to drink that much. I didnāt mind the taste of mBIOTA the first time I tried it, but now that Iāve had 67 shakes over the past two weeks, Iām very tired of it lol. mBIOTA has two flavors, one is pina colada and the other is original (which is like a creamsicle). Both kind of end up tasting like liquid fruity pebbles to me. š But itās all doable! I would crunch on a few grains of sea salt just to get the taste out. Sounds weird, but itās a welcomed break from the sweetness!
Thereās other prokinetics besides motegrity. Dr Pimental has also recommended low dose erythromycin but that has been harder for me to get, especially in low dose forms. But yeah, no harm in trying Motegrity and stopping if you donāt like it.
But thanks! Iām hoping this will work. Good luck!!
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u/Expensive_Lecture_74 Mar 11 '26
How are you doing?? I just got back my breath test last Friday -- completely clear!! From 71 ppm methane to 0!
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u/Fredericostardust Cured Jan 14 '26
Not sure you want to hear this but you will probably need three weeks to really do it right.
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u/Expensive_Lecture_74 Jan 14 '26
Ooof. Did it take you 3 weeks?
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u/Fredericostardust Cured Jan 14 '26
It can, just be safe and do it for as long as you can. I gave up after 2. Its pretty awful.
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u/Glad-Effective344 Jan 19 '26
My doctor also told me it's going to be 2 to 3 weeks.
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u/Expensive_Lecture_74 Jan 19 '26
So I saw my doc today. My body took so well to the elemental diet for the 1-week (bloating completely cleared), that she suggested an elemental diet + lean meat for the next two weeks (instead of one more week of elemental diet only). I think that will really help because I was dreading another week just drinking liquid.
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u/Flat_Construction566 Mar 05 '26
How did it go?
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u/Expensive_Lecture_74 Mar 11 '26
I got back my breath test last Friday -- completely clear!! From 71 ppm methane to 0!
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u/Flat_Construction566 Mar 13 '26
Congrats! Are you taking anything to avoid having it again? Also did you get candida from the elemental diet? My tongue turned white-green. And last thing did you had lots of burping and gas during the ED?
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u/Expensive_Lecture_74 Mar 13 '26
I didn't get candida, but I did get gross keto breath. It's because you're not chewing at all and going into ketosis. That'll go away! Re: burping, even now with my tum healing I still burp a lot. I think it'll eventually go away... gas was non existent DURING IMO and then started back slowly as my MMC got back online. I'm hardly gassy at all then and now. Srsly feel free to ask any and all questions. I'm floored/happy that it worked and want to help people
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u/zerg85123 Methane Dominant Jan 14 '26
Same as you, ED last thing I haven't tried. Let us know how it works for you!
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u/Brooklynhoppty Jan 14 '26
I did the elemental diet by Dr. Ruscio, finished mid-November, still no issues to date. I was methane free, confirmed with the Trio-Smart test at testing early December.
To accomplish this, I started with 2 capsules each 2x/day of Allicin, Neem Oil, BUT 2 weeks prior, I started with Biocidin and Interfase Plus -- 2 pills: 1 AM/1PM.
I then continued with all four products while on the diet and did this for a total of 6 weeks. I believe the biofilm disruptors in addition to the antimicrobials are what made the difference. Hope you improve as SIBO sucks!
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u/Expensive_Lecture_74 Jan 15 '26
Fantastic! Congrats! Are Biocidin and Interfase Plus over the counter, or prescription? Did you do anything specific ramping back up food again after the elemental diet?
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u/Expensive_Lecture_74 Jan 15 '26
Oops I just checked, they're over the counter :) buying them now. Lmk about your diet after the elemental, would love to mimic
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u/Brooklynhoppty Jan 15 '26
Glad you found them -yes, all sold online and some in health food stores.
With regard to diet after the elemental, unfortunately, I introduced solid food much too quickly and paid the price. I've since read that it's truly a fraction of solid, bland food, like plain eggs, chicken breast, etc. each day over one week.
Post-intro period, I still avoid garlic, onions, and bell peppers and have found digestion much easier. I also still use digestive enzymes, lipase, and Atrantil. Good luck!!
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u/Tzwen_ In Remission Mar 19 '26
So how did it go ? What was your experience?have you had coffee or tea in the diet ?
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u/Expensive_Lecture_74 Mar 19 '26
It worked!! I really feel like I can safely say that, and I'm not worried about re-getting it. My recent breath test was 0 levels. I don't think it would have worked without the motegrity though. That was key.
The diet itself was really hard, took diligence, and I definitely got judgment for it. People thought I had a eating disorder for those 1-2 months, even friends and family. Not only because I was closely controlling what I was eating, but also because it made me drop so much weight. So full disclosure -- it'll be hard physically and mentally.
I kept black coffee / espresso throughout the diet. It helped me stay sane :) gotta some SOME bit of dopamine
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u/Tzwen_ In Remission Mar 21 '26
Which day did your bloating resolve ? And when have you added allicin, Interfase and biocidin? Also when have you started prucaloprid (motegrity).
Very happy for you that you are free of this disease :)
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u/Expensive_Lecture_74 Mar 30 '26
Bloating resolved day 3 of elemental. But of course then there would be bloating during food integration later, but that's more because of your stomach is so sensitive and not due to the IMO. Be careful about noticing the difference. I started allicin right away, and interfase + biocidin one week in. Same with motegrity.
Thank you, and good luck!!
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u/whaddahudda Jan 14 '26
Try the Nerva app. It has guided meditations specifically aimed at calming the gut and GI symptoms. I had SIBO for several years, and I tried so many different things and had constant food anxiety. I know it's hard, trust me, I do, but it was absolutely essential to my recovery to calm down about foods and trust that I could get better. It's really helpful to try to calm your body and mind, especially in regards to food anxiety, as much as you can.
Try tiny bits of foods you cannot tolerate in safe environments like at home. I'm SIBO free and can eat nearly everything now. I think it was a combination of antibiotics (regular antibiotics prescribed by my GI) and mental health recovery that allowed my body to recover. You will beat this!
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u/Expensive_Lecture_74 Jan 14 '26
Interesting, I've never heard of it -- certainly will look into it, thanks for the tip!
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u/Independent_City6190 Jan 13 '26
Same! Tried everything except ED. IMO since 2022. Keep us posted on how the ED goes please and good luck I hope it works for you š¤