Methane SIBO that kept coming back — what finally held
Current status
Mostly resolved- Still struggling
- Somewhat resolved
- Mostly resolved
- Fully resolved
The story
It started after a bad bout of food poisoning on a trip. The acute part passed in a week, but the bloating never really left. Within a couple of months I was severely constipated, distended by mid-afternoon regardless of what I ate, and dealing with reflux and a level of brain fog that made work genuinely hard.
A lactulose breath test came back methane-positive — high, and rising across the timepoints. That gave it a name (IMO / methane SIBO), which helped emotionally, but the label alone didn't tell me what to do about the recurrences.
The pattern over the next three years was frustratingly consistent: a treatment would knock symptoms down, I'd feel almost normal for a stretch, and then it would creep back — usually within three to five months. I logged every round, every supplement, and every relapse, which is the only reason I can lay it out cleanly now.
What eventually changed things wasn't a stronger antibiotic. It was taking motility seriously between rounds — a prokinetic at night, deliberate meal spacing, and not grazing. The relapses got further apart, then mostly stopped. I'm not calling it cured, but it's the most stable it's been since before the food poisoning.
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Symptoms
Tests & diagnoses
Treatments
Each treatment this contributor tried, in the order that mattered, with their own reported result. The ones marked with a trophy are the treatments they credit as decisive.
4–5 hours between meals, nothing after dinner. Cheap, unglamorous, and clearly part of what held.
Low dose at night to support the migrating motor complex. This is the piece that stretched the gaps between relapses from months to — so far — not coming back.
Cut the peak bloating and made day-to-day more predictable, but it was symptom management — the moment I widened the diet, it drifted back.
Paired with rifaximin specifically for the methane component. Same story: real short-term relief, not durable on its own.
Two-week course with neomycin for the methane. Clear knockdown each time — bloating and constipation eased within days — but symptoms returned within 3–5 months every round.
Tried enteric-coated for the cramping. Didn't notice a difference either way.
A broad multi-strain made the bloating and pressure noticeably worse within a week. Stopped it.
Treatments in similar stories
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- Mar 2026Mostly resolved
Six months on the prokinetic-plus-meal-spacing routine and no relapse. Bloating is occasional and mild instead of daily. Reflux and brain fog are basically gone.
- Sep 2025Improving
First long stretch without a full relapse. Added deliberate meal spacing to the nightly prokinetic. Cautiously optimistic but not ready to call it.
- Feb 2025Relapsed
Symptoms back ~4 months after the last antibiotic round. This is the point I stopped chasing repeat courses and started treating motility as the actual problem.
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Stories with a similar shape
Hydrogen SIBO after antibiotics — carnivore + acupuncture over 18 months
High hydrogen on breath tests after food poisoning; antibiotics and probiotics didn't help, but diet and motility support did.
Somewhat betterTwo years methane-positive — prokinetics + fasting got 90% there in a month
Limited help from antibiotics; adding prokinetics, intermittent fasting, and meal spacing led to a fast, large improvement.
Mostly betterRecurring bloating with normal tests — nervous-system work moved the needle
Test-negative but symptomatic; breathing, vagus work, and walking after meals changed the daily baseline.
Somewhat betterThis is one person's reported experience aggregated by GutPattern, not clinical advice, a treatment protocol, or a diagnosis. What helped one contributor can do nothing — or harm — for someone with a different underlying cause. Sudden, severe, bloody, feverish, or worsening symptoms belong with medical care. Always discuss care decisions with a qualified clinician.
26 comments
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Sign in to replyThe meal-spacing piece is so underrated. Everyone chases the next antibiotic round and skips the boring stuff that actually holds. Did you notice a minimum gap that worked, or was 4–5 hours the sweet spot?
4 hours was the floor for me — under that and I'd feel the pressure build again. Nothing after dinner mattered just as much as the daytime spacing.
Same probiotic reaction here — every broad-strain one made me worse within days. Curious if a soil-based or single-strain was different for you, or if you dropped them entirely.
Really clear write-up. The relapse timeline is exactly what I see clinically — the antibiotic knocks it down but without motility support the gap is almost always 3–5 months. Thanks for logging it this precisely.