Metronidazole (flagyl) helped me with regular bowel movements more than anything else

General Discussion
#1

I’m not sure what pfs is but I’ve been insanely constipated since it started and that seems pretty universal.
I read a thread or two on here and another on the pssd subreddit and decided to try flagyl. I took 500mg 3 times a day for 7 days. By day 2 I’d say my bowel movements became much more regular, like they were before. I started getting the urge to go after eating, just like I did pre fin. I’d also have a bowel movement in the morning. Not to be too explicit but the movements themselves weren’t perfect, but much improved.

I also felt a few very weak mild spikes of libido return. Additionally, my joints stopped cracking almost entirely and my skin symptoms also largely got better. I’m not sure what causes pfs, but I think, at least as a downstream effect, alleviating gut issues is pretty huge in improving quality of life. The downside here was that my sleep issues continued to be very rough.

I might revisit this and add some more antibiotics in (someone said they got cured from pssd by getting treated for h pylori- although they were actually diagnosed). I’m not saying we all have that (that seems wildly unlikely) but perhaps many of us have slowed bowels which resulted in dysbiosis.

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#2

This experience sounds logical. Metronidazole kills off pathogens in the gut, like those responsible for SIBO/IMO. I think most, if not all, PFS sufferers have some degree of gut dysbiosis as a high-on-the-causal-chain problem. And with constipation as your main symptom (as opposed to Diarrhea), combined with the positive response to Metro, I’d venture to say your dysbiosis/sibo is Methane-dominant (IMO).

However, it usually takes a bit more than a single antibiotic for a few days to permanently resolve gut dysbiosis, especially methane sibo. If it works for you, great…but most people need a diagnosis to pin down the type of dysbiosis, and then have to use a combination of meds/supplements and diet modifications to properly treat it.

If your issues return, at least this was a very close swing at the problem. Don’t give up on this angle. Worst case, you improve your general health 10x. Many of us here (including myself) have gone down ridiculous avenues to try to shock our body chemistry back to normal. Some have worked for me, but it was still very much a cart-before-horse approach.

#3

I’m just unsure how to bolster my response if I were to try flagyl again. Just take the antibiotic for longer? Even further increase the dose? I was already taking 500mg thrice daily.

#4

I wouldn’t just try flagyl again without a diagnosis (ideally) and a treatment plan. I’m pretty sure you were already at the maximum dose, but duration is just as important. I would solicit a referral for a Gastroenterologist who can evaluate you and order a breath test to confirm your SIBO type (95% sure yours is Methane-based given your symptoms and response to Flagyl). If that test confirms you have Methane SIBO (IMO), they will typically prescribe Rifaximin + Neomycin or Metronidazole. There are also several dietary and supplement interventions that will help the abx work better, which I can share if interested.

This is where conventional medicine can be helpful, unless of course you live in a shitty area where there aren’t any decent specialists. And even then, you still need to do your own research on SIBO so you can arm yourself with enough information to fire back at any dismissive responses. They’re going to want to ask if you if you’ve tried X, Y, and Z otc meds…just say that you have and that none were helpful. Fortunately the breath test isn’t terribly expensive, so you shouldn’t have to jump through too many insurance-dictated hoops here. But if the shitty area thing applies and they look at you like you have 4 heads when you mention SIBO, you might consider just ordering your own at-home breath test.

#5

Thanks for the response.

Would love to hear about the supplements and dietary changes that help that you mentioned. I assume you’re talking about berberine and stuff like that?

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#6

Yes, berberine is just one of them. I put together a protocol based on naturopathic recommendations and user experiences.

SIBO Elimination Protocol

Prep Phase: start biofilm disruptor 1-2 weeks prior to starting antibiotics/herbs - this starts to weaken the protective shell that bacteria have, making them more vulnerable to the killing agents below. Continue through kill phase.

Kill Phase: 2-4 weeks.
(a) Antibiotics (Rifaximin+Neomycin*),
and/or
(b) Antimicrobial herbs (Allicin, Neem,
Berberine, Oregano)-exact combo
depends on type of SIBO.
i. Methane:
- Allicin 500mg 3x/day
- Neem 900mg 3x/day
ii. Hydrogen:
-Berberine 500mg 3x/day
-Oregano (max on bottle)
-Can also add Neem
© Adjunctive supplements:
i. Digestive enzymes (optional)
ii. PHGG (a very specific fiber)
iii. Probiotics - only S. Boulardii +
Bacillus Subtilis (aka HU58).
(d) High Fodmap diet during this
phase (brings nasties out to feed
and get slaughtered by abx).

Finish/Replenish Phase: 2-4 more
weeks after finishing antibiotics.
(a) Switch to Low Fodmap diet;
(b) Add glutamine supplement;
© Continue all other supplements;
(d) Promote digestive function/motility
with prokinetics like ginger,
artichoke, etc. or meds like
Prucalopride, LDN, etc. to keep
things moving and prevent SIBO
from reoccurring.
(e) When current supply of probiotics
is finished, can add a basic SBO
probiotic (containing no more than
4 bac strains) for another month or
so to help replenish healthy
foundation of bacteria.

*Neomycin/metronidazole - usually prescribed in combination with Rifaximin for Methane SIBO (IMO), but is harsh on the body and best avoided. Rifaximin and/or herbal microbials is much safer.

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#7

This is really detailed and helpful, thanks man.

Are you cured by following this?

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#8

You’re welcome. Apologies for the formatting, I couldn’t get the outline to paste properly. I’ve just started it myself (also suspected methane), so I’m following everything for IMO except the antibiotics.

I just did a breath test on Thursday which was negative, but found out they used the more inaccurate type (glucose, instead of lactulose), so now I have a change of opinion on relying on (most) typical medical facilities for diagnosis.

If I could do it all over, I would simply have ordered an at-home breath test from somewhere like Trio-Smart, etc, which are more accurate and would have been cheaper than the hospital visit.

#9

I know someone who did a SIBO protocol, did a 10 day water fast. After treatment he improved quite a bit.

As for H.pylori. Testing seems a little iffy for that, you may have a false -ve/+ve. A way to test - what I did lmao - was doing a juice fast completely on cabbage juice and adding some mastic gum. I caught my first cold since PFS which was cool after that. Funny that the guy who did the SIBO protocol also caught his first cold since PFS lol. Die off can be a little intense so adding some binders may be beneficial, or you can spam saunas and epsom salt baths.

Good luck!

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