Antiobiotic found to relieve IBS, and what might work better

I see that a study has been published today in the New England Journal of Medicine [1] that concerns the condition irritable bowel syndrome (IBS). You can read a summary of the study here. This study tested the effect of an antibiotic (rifaximin) on individuals with IBS. Compared to placebo, two weeks of this antibiotic helped to reduce IBS symptoms, and this benefit was sustained for some weeks after the antibiotic was taken.

How might this work? Well, the antibiotic’s benefits here almost certainly had something to do with the fact that imbalance in the organisms within the gut is a potential underlying factor in IBS. I have seen in my time in practice many individuals with IBS symptoms and normal stool test results (from conventional testing) who turn out to have significant imbalance in the gut when more sophisticated stool analysis is performed. Not uncommonly we find one or more of the following:

1.     a lack of healthy bacteria

2.     the presence of potentially pathogenic (disease-causing) bacteria

3.     the presence of potentially pathogenic (disease-causing) yeast organisms

4.     the presence of potentially pathogenic (disease-causing) parasitic organisms

On occasion, I have used conventional drugs in an effort to kill off one or more offending organisms, and believe such an approach has at least some merit. However, I don’t believe that this approach should be the mainstay of treatment.

To begin with, such treatment may further erode the population of healthy gut bacteria. This, as I pointed out above, can already be quite depleted.

So, I think it makes sense to use probiotics (healthy gut bacteria supplements) in cases of IBS. And my experience with them has been generally very positive. And I would certainly advise using them after a course of antibiotics, even if the antibiotics have been taken to treat a condition that is outside the gut.

Another major, but often-overlooked, factor in IBS is food sensitivity. Here, foods have the seeming capacity to irritate the lining of the gut and provoke digestive symptoms. In theory, any food can do this, however I have to say that my experience in practice tells me the number one offender here is wheat. Other gluten containing foods including rye and barley should be viewed with some suspicion here too.

Not everyone has a problem with such foods. Even not everyone with IBS has a problem with such foods. However, I can say, hand on heart, that I have found the removal of these foods from the diet (and perhaps other grains too) is a generally hugely beneficial strategy in individuals with IBS.

Some find it hard to accept that supposedly healthy and wholesome foods such as wheat and other grains can be problematic to gut health. However, let us not forget that grains are a relatively recent addition to the diet and, from a theoretical standpoint at least, are foods we’re not likely to be best adapted to. Specifically, grains are rich in certain proteins (rich in the amino acid proline) that are thought to be hard to digest, and this can lead to gut irritation. Grains are also quite rich in substances called lectins which may not be digested in the gut, and end up triggering inflammation in and beyond the digestive tract.

Those of you with IBS may be interested in listening to an audio-book I recorded on this subject last year. You can learn more about its contents and how to purchase it here.


1. Pimentel M, et al. Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation. N Engl J Med 2011; 364:22-32

6 Responses to Antiobiotic found to relieve IBS, and what might work better

  1. david murray smith 7 January 2011 at 1:27 pm #

    I very much enjoy your articles, and found your book “waist disposal” the best diet book I have ever read and managed to lose nearly 2 stone and maintain the loss with very little variance.
    I suffered from IBS for very many years, probiotics did help a bit but about six years ago I went on a daily ration of stabalised Aloe Vera Gel and it is has made a huge difference. You need to be on it for about 2 months for it to really show benefit. I never miss a day and no longer suffer from IBS.

  2. Diana 7 January 2011 at 1:37 pm #

    As a kinesiologist who does food intolerance testing, I see a lot of people with IBS. As John says, wheat is often the problem. Sometimes it’s just wheat, or it can be all gluten containing foods. If the condition is severe or has been going on for a long time, the lining of the intestines becomes over-sensitive and temporarily intolerant to a wider range of foods. Improvement is almost instant once the diet is changed, though it can take time for things to settle down completely. The other major cause of IBS is dairy intolerance, especially where there’s diarrhoea. Lots of foods can potentially be involved in IBS, including orange juice (or other acidic fruits), coffee, eggs and soda drinks.

    IBS can usually be dealt with this way, plus taking probiotics. It’s very frustrating that most doctors don’t even suggest food intolerance, and when all the tests reveal nothing, say it must be stress.

  3. Richard 7 January 2011 at 5:01 pm #

    I suffered with IBS for years and years, but since eliminating grains and legumes 2 years ago that has become a thing of the past, I also avoid eating large amounts of cruciferous veg as that can lead to excessive wind!

    I did have a recent bout of IBS, but my GP and myself put this down to stress due to being made redundant.

  4. Soul 7 January 2011 at 6:00 pm #

    After learning that vitamin D3 is good at preventing and fighting infections, I’ve often thought that this is why D3 has helped my IBS as much as it has.

    The only drug that helped a little with my condition was called dicyclomine I believe. It’s an old, expensive, antibiotic I think, that brought some relief.

  5. frances 8 January 2011 at 1:24 am #

    After suffering with IBS for 10 years and ending up with an unhealthy relationship with food, cutting out more and more foodstuffs, I finally found an answer after attending the Weston Price seminar just over a year ago. Now nearly all foodstuffs are back in my diet, except that dairy is unpasterised, bread is sourdough and I have started eating (pasture fed/free range) meat after 24 years.Most importantly I soak porridge/rice etc the day before eating which makes them so much more digestible. The IBS is about 85% better, and would be higher if I completely gave up my one morning coffee and the odd glass of wine and chocolate/fruit that I can’t always resist. However, it is now something that I don’t have to think about all the time, and even better, I am really enjoying my food again.

  6. Reijo Laatikainen 8 January 2011 at 8:50 pm #

    Many of IBS patients report getting relief from so called FODMAP diet (elimination of poorly absorbed carbohydrates including wheat). See for example: or

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