Med for SIBO denied by insurance co.

[sddave]

I haven't been responding well after three months on gluten-free diet.   I'm almost always have loose stool in morning after eating breakfast.  I've tried different cereals and every milk except rice.    Also, I have a lot of digestive issues from cramping to reflux (dizziness, heart palpitations, etc).   My stomach almost never feels without pain.

So I went to see my primary and he prescribed 2wks taking XIFAXAN.   I go to the pharmacy and they said my insurance declined it.   $1,500 for the 2wks supply.   Called docs office back and there's no alternative to take.   His nurse said it might be cheaper all Walmart.

Anyone have any suggestions?

[GFinDC]

Hi sddave,

My suggestion is you stop eating cereal.  Try eating eggs, or ham or something else instead.  There are plenty of alternatives to cereal that can make a good breakfast.  After 6 months of eating low carb, non- processed foods is a good time to experiment with things like cereal.  If you are doing better by then that is.

[Ennis-TX]

32 minutes ago, sddave said:

I haven't been responding well after three months on gluten-free diet.   I'm almost always have loose stool in morning after eating breakfast.  I've tried different cereals and every milk except rice.    Also, I have a lot of digestive issues from cramping to reflux (dizziness, heart palpitations, etc).   My stomach almost never feels without pain.

So I went to see my primary and he prescribed 2wks taking XIFAXAN.   I go to the pharmacy and they said my insurance declined it.   $1,500 for the 2wks supply.   Called docs office back and there's no alternative to take.   His nurse said it might be cheaper all Walmart.

Anyone have any suggestions?

Cut the carbs, no cereal, no fruit, no sugar. SIBO is best treated with a low carb, high fat, high protein diet to starve off the bacteria. There is a few nice herbal products out there to help. Certain essential oils and foods are great at killing off the extra bacteria, MCT oil, Oregano, Sage, etc are great at helping manage it.

Your breakfast options should be eggs, bacon, ham, and if you want carb subs look at Julian Bakery stuff for keto approved diet like Pro Granola for a cereal replacement and the Coconut, Almond, and Seed bread from them for toast. You can also make a porridge out of coconut and almond flour that is super filling and low carb, and if you sweeten it use a non nutritive sweetener that the bacteria can not feed on like stevia, monk fruit, etc.

[Gemini]

18 minutes ago, sddave said:

I haven't been responding well after three months on gluten-free diet.   I'm almost always have loose stool in morning after eating breakfast.  I've tried different cereals and every milk except rice.    Also, I have a lot of digestive issues from cramping to reflux (dizziness, heart palpitations, etc).   My stomach almost never feels without pain.

So I went to see my primary and he prescribed 2wks taking XIFAXAN.   I go to the pharmacy and they said my insurance declined it.   $1,500 for the 2wks supply.   Called docs office back and there's no alternative to take.   His nurse said it might be cheaper all Walmart.

Anyone have any suggestions?

I don't know what insurance you have but most insurances will cover meds when there is no replacement (generic or otherwise) for the one prescribed. Your doctor may have to contact the insurance company or write a letter to approve it but that is the way it usually works.  This happened to me with Restasis eye drops.  They are insanely expensive and there is no other drug that can be used as a replacement so my eye doctor wrote the insurance company for approval.  I have Sjogren's so they now pay for the eye drops.  I pay a $50.00 co-pay for a 6 month supply so it's a deal!

Have you been tested for SIBO?  Without a proper diagnosis, they won't cover it.

I agree with GFinDC........ditch the cereal and milk for now. You would be better off with protein and veggies for breakfast instead of grains and dairy.

[Feeneyja]

My daughter's doctor had to provide documentation as to why it was needed for two weeks (it's typically prescribed for three days for travelers diarrhea).   Once the additional paperwork was put in, it was covered. Alternatively, you can use Flagyl. But some don't tolerate it as well. Or you can use herbal antibiotics (oregano oil, garlic extract, berberine worked for my daughter, alternating over 2 months or so).  Also the supplement Atrantil is designed to work for SIBO.  Plus adding a supplement to improve gut motility. Ultimately, you also need to cut the fermentable carbs so you are not feeding the bacteria.  It can take months to get SIBO under control and it often requires long term diet changes. 

See Open Original Shared Link for lots of good information. 

[cyclinglady]

2 hours ago, sddave said:

I haven't been responding well after three months on gluten-free diet.   I'm almost always have loose stool in morning after eating breakfast.  I've tried different cereals and every milk except rice.    Also, I have a lot of digestive issues from cramping to reflux (dizziness, heart palpitations, etc).   My stomach almost never feels without pain.

So I went to see my primary and he prescribed 2wks taking XIFAXAN.   I go to the pharmacy and they said my insurance declined it.   $1,500 for the 2wks supply.   Called docs office back and there's no alternative to take.   His nurse said it might be cheaper all Walmart.

Anyone have any suggestions?

Why?  Why would you take a drug for SIBO prescribed by a GP/PCP?   You should be evaluated by a GI!  Get tested!  

You were diagnosed three months ago.   At the beginning (mid June) you were in denial.  You talked about gradually going gluten free.  You ate out at Fuddruckers and most likely at other places where you might have been exposed to gluten.  Intestinal healing can take months to years to improve.  Why?  Because most people make dietary mistakes.  The learning curve is steep.  Learning to correctly read labels and avoiding cross contamination is hard!  Not impossible, but it takes time.  Food intolerances can develop, so gluten is not always the culprit.  

I urge you to get a second opinion from a GI.  Every drug has a risk.  Make sure you are treating the right thing.  Have you had follow-up testing to confirm if your celiac antibodies are going down?  Do that before blaming SIBO.  Consider trying the gluten-free Fasano diet for a few weeks.  Changes to your diet for the short term is safe.  Taking drugs are not.  There is no easy fix for celiac disease.  It took time for you to get sick and it will take time for you to heal.  

I thought you were considering a dietitian consult out of the San Diego celiac center?   I would seriously consider seeking a celiac-savvy dietitian.  

You could have SIBO, but I would bet (note I am not a doctor) that celiac disease is the cause of your current issues.  At least rule that out first!  

 

 

 

[Jherm21]

Sorry your not responding well I've been gluten free dairy free and soy free since january. I didnt notice ANY improvements until that lucky 6 montb Mark you hear about quite often. There is definitely truth to that time period. With that being said I too had alot of dizziness heart Palps panic attacks and the list goes on especially lose stools. I stopped having lose stools about 5 months in. Depending on what I eat or hormonal changes in the month I will get random lose stools always in the morning like an urgency problem! I would get tested for sibo, talk to a specialist. I recently did a sibo test and was negative for hydrogen levels but had elevated methane levels. She technically said i didn't have SIBO but then I read you could have SIBO with high methane just different treatment and different problems in the intestines. Anyway she prescribed me neomycin and rifaximin same stuff that your pcp prescribed but my insurance also didn't cover I because she didn't give them a proper clinical diagnoses. It comes to the point where you have to outweigh your other options. I would try to be as strict as possible on the diet try low fodmap. That's what I believe my new alternative is since I am doubtfully going to be the antibiotics even if she gets prior authorization. 

[Jmg]

This:

11 hours ago, GFinDC said:

My suggestion is you stop eating cereal.  Try eating eggs, or ham or something else instead.  There are plenty of alternatives to cereal that can make a good breakfast.  After 6 months of eating low carb, non- processed foods is a good time to experiment with things like cereal.  If you are doing better by then that is.

One mistake a lot make is just switching their previous grain choices to the gluten-free versions. The problem is that they're still difficult for digestion and you can find yourself reacting to them even though they're gluten-free. I eat far less gluten-free cereal or bread now than I did when I ate gluten and if I do overdo it my body lets me know. 

A 2 or even 3 egg omelette in the morning will fill you up, give you protein, amino acids and can be filled with kale, spinach etc. to give you vitamins as well.  Its very easy to cook and will allow you to remove those muffins or cereals etc which are harder on the stomach.

Treat these first 6 months as a healing period, your body will thank you for it.  

[Gluten-free-01]

15 hours ago, sddave said:

Anyone have any suggestions?

What do you drink in the morning? Could e.g. coffee be the reason you don't feel well after breakfast?

Do you take any vitamin/mineral supplements (especially in the morning)? Could this be a side effect? E.g. not everyone tolerates magnesium citrate.   

[sddave]

2 hours ago, Gluten_free_01 said:

What do you drink in the morning? Could e.g. coffee be the reason you don't feel well after breakfast?

Do you take any vitamin/mineral supplements (especially in the morning)? Could this be a side effect? E.g. not everyone tolerates magnesium citrate.   

I've been tested for vitamin deficiencies and everything is normal so I stopped taking vitamin.   Stopped taking probiotics since they didn't seem to help either.   I'm currently not taking anything except an occasional Pepto Bismol or Tums.   I mostly now just learned to live with it.   I cut out most of my coffee except maybe a half cup in the morning a couple days a week M-F.

[sddave]

6 hours ago, Jmg said:

This:

One mistake a lot make is just switching their previous grain choices to the gluten-free versions. The problem is that they're still difficult for digestion and you can find yourself reacting to them even though they're gluten-free. I eat far less gluten-free cereal or bread now than I did when I ate gluten and if I do overdo it my body lets me know. 

A 2 or even 3 egg omelette in the morning will fill you up, give you protein, amino acids and can be filled with kale, spinach etc. to give you vitamins as well.  Its very easy to cook and will allow you to remove those muffins or cereals etc which are harder on the stomach.

Treat these first 6 months as a healing period, your body will thank you for it.  

I have very high metabolism so I would eat cereal, brown rice, gluten-free pasta, and occasional baked potatoes to keep from getting hungry all them time.   Plus to get back the 7 lbs I lost.  I've given those up now.

[Ennis-TX]

12 minutes ago, sddave said:

I have very high metabolism so I would eat cereal, brown rice, gluten-free pasta, and occasional baked potatoes to keep from getting hungry all them time.   Plus to get back the 7 lbs I lost.  I've given those up now.

Sounds like me 12 eggs every morning with a bunch of spinach or kale seasoned differently each day, 2-3 slices Nut based breads or toast, with almond butter and a few handfuls of seeds or nuts while cooking......this is after my post working protein shake in the mornings.

[Jmg]

1 hour ago, sddave said:

I have very high metabolism so I would eat cereal, brown rice, gluten-free pasta, and occasional baked potatoes to keep from getting hungry all them time.   Plus to get back the 7 lbs I lost.  I've given those up now.

With any luck your metabolism will stabilise as you progress on the diet. In any case, the pasta and baked potatoes may not be the best fuel you could take on board. The potatoes in particular have a really high GI index Open Original Shared Link and would help to spike your blood sugar and leave you feeling hungrier quicker. If you can switch more of your diet to foods lower on the GI index you should see some benefits 

 

[Feeneyja]

Well, high GI foods are TERRIBLE for someone with SIBO.  I know first hand. My daughter had a confirmed SIBO diagnosis. Anything with fermentable carbs (low GI foods, fiber, complex starches) made her blow up like a balloon.  From a dietary standpoint, she needed to cut all starches and high fiber foods. Red potatoes and Jasmine rice were actually OK because they are high glycemic index.  They hit the bloodstream before they reached the bacteria in the small intestines.  

The dietary approach to SIBO treatment is a low carb diet. No starches, no fiber. No grains at all. Limit nuts (they are high in fiber).  It's no fun, but it works.   So, if the problem you are having is SIBO related, you need to make some changes. 

Here's the diet for SIBO:  

Open Original Shared Link

You really should follow up with testing. Check your celiac antibodies. Have a SIBO breath test done.   It could be SIBO. It may not be SIBO. Following the SIBO diet won't hurt you (and is an easy to digest diet so good for celiac healing anyway).  Taking antibiotics if not necessary is no good. 

[Jmg]

2 hours ago, sddave said:

I've been tested for vitamin deficiencies and everything is normal so I stopped taking vitamin.

You may want to rethink this. Over time you will not be getting the vitamins from 'fortified' gluten grains. You may also find that even though your levels are ok that you do better with some supplementation. I take a B multi vitamin and it makes a difference. I've also been taking magnesium, calcium and zinc and again its proving beneficial. Anyway, food for thought hopefully

[Posterboy]

sddave,

jmg has given you good advice.  B-vitamins can help with any stress you have been under.

also have thought about taking some BetaineHCL.

When our stomach acid is low it is not uncommon to have GI problems.

doctor's forget timeline.

If you have GI problems (heartburn etc.) when eating food then you stomach acid is already too low to digest the food/carbs you are eating.

going low carb/ketogenic  can help the heartburn because it eliminates ALL carbs not just gluten carbs.

And carbs ferment causing bloating.  The excess pressure pushes on our trap door and when the stomach acid (little though it is) leaks out burning the uncoated esophagus.

When you understand digestion is a north/south process it begins to make more sense.

see this bodywisdom article about the role stomach acid plays in digestion.

Open Original Shared Link

I think you will find it informative.

IF your stomach acid was HIGH as you often hear (everywhere) you hear take a Proton Pump Inhibitor aka acid reducer’s for heartburn/GERD (medical name for heartburn) then eating food (carbs, greasy things) wouldn’t bother you.

The acid would cut it up but if it is already low/weak then even a little acid can burn your esophagus which is not coated like the stomach to protect you from high acid.

BUT if it is low to start with then food will WEAKEN our/your acid so that you lose the food fight your in and things (carbs/fats) become to ferment, rancidify and cause heart burn.

I also reccomend chris kresser's three part series on the subject

Open Original Shared Link

you can also learn more about my experience with restoring my stomach acid to a healthy level by reading my posterboy blog post on celiac.com about how taking betainehcl helped me.

https://www.celiac.com/gluten-free/blogs/entry/2106-is-ncgs-andor-celiac-disease-really-low-stomach-acid-misdiagnosed/

This does not help everyone but it can help if you are still struggling with carbs in your diet by helping you digest carbs before they reach the small intestine triggering  the SIBO that Feeneyja mentioned.

I hope this is helpful.

****** this is not medical advice only my experience with taking betaineHCL to unlock the power of digestion.

food must be digested before it can be absorbed/metabolized or else proteins set off our auto-immune reactions in the lower GI and if your stomach acid is not strong enough -- proteins (food allergens) get through to set off our immune system.

I think of stomach acid like the moat around a castle.

A dry moat and the castle falls to invaders.  The same  with Stomach acid.  Too Low stomach acid and you have a weak defense against food.

The castles' that stood the test of time have water in their moats.  The weak castles (with dry moats) became ruins in time.

Mount a strong defense with strong stomach acid and proteins can be cut up/digested into harmless peptides the body can now digest/absorb in the small intestine. (My opinion only ****this is not medical advice) but seems logical too me after much time studying this issue.

It (stomach acid) also helps absorb B-Vitamins and Magnesium too.  Or else you have to take high amounts to absorb enough vitamins to keep you healthy.

Note on the ads for stomach reducers (PPI's) they say after 6 months you will/can become low in Magnesium.

Their is a reason/connection for/to this.  You stomach acid is no longer strong enough to extract enough Magnesium from the food you are eating at a level high enough to keep you healthy.  Thus you need to supplement with it.

good luck on your continued journey.

BetaineHCL is a fairly easy supplement to find and it couldn't hurt to try.

I found that when I begin burping (yes SIBO can cause that too) but not burping and bloating but burping without bloat in your stomach then your stomach acid is strong enough to cut up/digest your food the way nature intended.

And not in the first 20 minutes only after eating but two hours later (burping will occur) after  you have completed eating and your food/stomach is turning over in the stomach - a sign stomach acid is still completing  digestion of your food even 2 hours later.

Again I hope this is helpful.

2 Timothy 2:7 “Consider what I say; and the Lord give thee understanding in all things” this included.

Posterboy by the grace of God,

 

[sddave]

On 8/24/2017 at 10:44 AM, Ennis_TX said:

Sounds like me 12 eggs every morning with a bunch of spinach or kale seasoned differently each day, 2-3 slices Nut based breads or toast, with almond butter and a few handfuls of seeds or nuts while cooking......this is after my post working protein shake in the mornings.

12 eggs every morning!   84 eggs a week....wow.   You must live on a farm.  Lol

[Ennis-TX]

3 minutes ago, sddave said:

12 eggs every morning!   84 eggs a week....wow.   You must live on a farm.  Lol

I wish, I spend so much on food it is literally crazy. my food consumption cost me between $400-600 a month.  The fact a large part of it is protein powders, eggs, and expensive nuts and seeds does not help. I found I can knock it down cheaper by changing my veggies to canned spinach instead of fresh organic like I was using, and I started making my own breads more often instead of buying the $10 loafs I was to save time. I miss the college days of living on cabbage soup, rice and potatoes....used to be able to live a month on less then $100. My dang body can not do carbs anymore so cheap roads gone now.

If I ever get a buyer to buy my house/business, my next place with be out in the country and I WILL have my own cage free chickens and raise them like I used to with my grandpa. Free eggs again lol.

[sddave]

1 hour ago, Ennis_TX said:

I wish, I spend so much on food it is literally crazy. my food consumption cost me between $400-600 a month.  The fact a large part of it is protein powders, eggs, and expensive nuts and seeds does not help. I found I can knock it down cheaper by changing my veggies to canned spinach instead of fresh organic like I was using, and I started making my own breads more often instead of buying the $10 loafs I was to save time. I miss the college days of living on cabbage soup, rice and potatoes....used to be able to live a month on less then $100. My dang body can not do carbs anymore so cheap roads gone now.

If I ever get a buyer to buy my house/business, my next place with be out in the country and I WILL have my own cage free chickens and raise them like I used to with my grandpa. Free eggs again lol.

Know what you mean.   Between doctors visits and expensive gluten-free food it's hard for me to save money for retirement nowdays.

I feel gluten-free food prices are too high for the quantity.  Feel we are being taken advantage of from our disease by the producers.   Hopefully the Amazon acquisition of Whole Foods will force down prices of all gluten-free foods.   Not just at Whole Foods.