From antibiotics to antidepressants, my journey with SIBO and APD
So this will be a very very lengthy vent/experience post of more than a year of dealing with this and I’ll be descriptive. A TLDR would be rough without context but basically gas, bloating, and distention from an evil combination of SIBO and APD has stayed with me through anitmicrobials, antibiotics, an elemental diet, physical therapy, and I’m now on antidepressants.
First, my symptoms and current diagnosis. I’m a 22YO male, completely normal 2 years ago. From late 2024, I began to notice bloating and gas. These days, lots of excess gas, lots of bathroom trips to relieve gas. Bloating is an understatement, I get distended beyond belief. It feels like everything inside wants to be outside. The low fodmap diet resolves the excess gas and some distention, but a majority of the distention remains. This is how SIBO and APD react. I tested positive for hydrogen SIBO, and was diagnosed with Abdominal Phrenic Dysnnergia based on symptoms. APD has gained some traction here but basically it’s a paradoxical muscular response to food and gas that creates crazy distention. The SIBO creates excess gas, bloating, and distention based on diet. The APD creates comical distention from any sort of ingestion, even just a glass of water immediately after consumption. Sucking in and laying down is my only relief. If I couldn’t suck in I’m not sure how I would survive, it’s already impacted my life enough. Obviously this is physically straining. Even when I’m fasted I still feel some pressure so I have to suck in a little. SIBO AND APD effectively create an evil symbiotic relationship to make sure I’m uncomfortable at all times. Funnily enough though, my stool is normal almost all the time.
Okay so taking it back I’m sure the doctor process is familiar for a lot of people, first appointment early 2025. My GP does the usual basic parasitic, blood work, ultrasound tests and finds nothing. Have you tried gasx? I get referred to a GI.
First appointment sucks. I explain the distention, bloating, and gas. When asked about diet changes I explained that I began eating a higher protein diet more than a year earlier, months before any symptoms started. She explains that bloating is her number one complaint, that farting is normal, and my high protein diet is to blame. Have you tried gasx? I get referred back to my GP. I press for another appointment after explaining that the beano, antantril, and gasx did nothing. She orders a SIBO breathe test. 4 months later I get blessed by our great healthcare system and can finally blow air into a tube. A month after I get the results, positive for hydrogen overgrowth, 30 ppm at 90 minutes, which I think is mild to my understanding. During this 4 month wait I tried oil of oregano and berberine based on my own assumption that I was positive and my desire to not do nothing for 4 months. They didn’t help and by the end of the course they were actually causing me immense abdominal pain. Anyway after the positive test my GI prescribed me xifaxan. I did the 2 week course and did not notice any improvement. At some point I call the office out of desperation, have you tried gasx? At a follow up at the start of this year she explains fear of trying again as she doesn’t want to nuke my gut with more antibiotics. This is also when she diagnoses me with APD based on my description of the extremity of the distention. She explains that her primary hope is physical therapy for the APD as well as a dietician. (I also try fodzyme which does nothing).
So physical therapy has just been silly. My first PT leaves the country after the second visit and she recommends me another one who she describes as “the only other one who can help you here”. The day of the appointment with her I get a call that she does not work with men. They offer me another PT who I guess is similar in experience. I decide to call back immediately after making the new appointment and ask to make sure this one does work with men, and no. So fourth times the charm and I finally get a PT that will help me. He explains he and nobody else at the facility has ever heard of APD, which explains the incontinence surveys I got each visit. He has been as good as he can be though. He gave me some general exercises but now we’re working on some that I found online for APD (shoutout the pinned APD post) and he approved of (namely pendulum breathing). I do feel it has helped a bit with my distention.
Dietician wise, low fodmap diet. Also have you tried gasx? She puts me on the diet and about a week and a half in my gas normalizes. My distention improves but only partly, as APD doesn’t care about that. About a 2 and half weeks in I get frustrated. Why am I doing this diet when I should be getting rid of the SIBO that’s making me do this? I message my GI asking about this. I’ve seen several people online mention they believe they developed APD from sucking in SIBO bloat. SIBO might be the cause in this way. They definitely correlate from what I’ve seen. I basically asked her if I could ever fully fix a paradoxical response to food and gas if I never fix the thing that might have caused it? She messages me back saying I do not have SIBO, only APD. I get frustrated and crash out on the low fodmap diet. I question the positive test and the last 3 appointments, and her response is basically oops you’re right my bad.
At this point I brought up the elemental diet, GI approves under the supervision of a dietitian. My first dietitian does not like the idea and refers me to another. I finished the 14 days last week and wow it was beyond horrendous sticking with it. Somehow no improvement, although besides periodic gas and diarrhea it was nice having relief while on it. If anything my symptoms are worse now, I guess(hope) my gut could still be recalibrating, but any improvement I’ve gathered from physical therapy has seemed to be reversed. Been taking motility supplement to cope for now.
So that’s how we’ve gotten to the antidepressants. I saw my GI yesterday and explains that we’ve basically tried everything. She prescribes me an SNRI, venlafaxine. Apparently it has helped people with IBS pain, and it might help for APD. She seemed confident though. Basically she explains that my gut brain interaction is on hyperdrive or corrupted, hypersensitive, or something like that, and that the anxiety from all of this isn’t helping either. She wants to try it out to see if it will help. I think I’ve seen this mentioned once or twice in APD spaces. So yeah today is day 2. I think after 2 weeks I’m supposed to update how I’m feeling. The potential side effects are pretty horrifying. Obviously this does not address gas production from SIBO, and we didn’t really even talk about trying to fix that anymore, after all the kill attempts I guess she’s focused on APD. I kinda want to ask for another SIBO test after all these attempts, I wonder if it’s gone and I just have a general gut dysbiosis or something.
Yeah that’s it. Good luck to everyone dealing with their own mysteries and healthcare bureaucracy. For APD I’ll keep doing physical therapy and I guess we’ll see how the SNRI experiment goes. For SIBO I’ll hopefully take a new test although hope for fixing that at this point is slim, probiotics next maybe? Hmm…