I.      Symptoms of C Diff
II.     Cause of C Diff
III.    C Diff Diagnosis
IV.     Standard Medical Treatments of C Diff
V.      What is the Best Diet for C Diff?
VI.     New Treatments Currently Being Studied
VII.    Non-Conventional Treatments for D Diff
VIII.   Probably Bad for C diff
IX.      Either Good or Bad for C Diff
X.       Things That Probably Have No Effect
XI.      Ideas to Manage Anxiety
XII.    Things To be Cautious About
XIII.    Success Stories
XIV.    Frequently Asked Questions

I. WHAT ARE THE SYMPTOMS OF C-DIFF. (CLOSTRIDIODES DIFFICILE)?

The symptoms of  C. Diff can vary substantially. Typical symptoms are mild abdominal pain and diarrhea with or without mucous. However, some people also report experiencing nausea, vomiting and severe abdominal pain. In contrast, a minority of people report never experiencing diarrhea or mucus.

Symptoms typically begins 5 to 10 days after starting antibiotics— but may occur on the first day of antibiotics, or up to 2 months after finishing antibiotics. But, it should be pointed out, that some people get c diff without ever taking antibiotics.

In the worst case of c diff, patients may have abdominal pain, nausea, vomiting, and diarrhea, which results in the person not only having c diff, but also having dehydration. These symptom may require them to be admitted to a hospital for treatment. However, most people who have c diff can receive oral antibiotics and be treated at home.

II. WHAT IS THE CAUSE OF C. DIFF. (CLOSTRIDIODES DIFFICILE)?

C. Diff is caused by a baterium, which is now called Clostridioides D. (klos-TRID-e-OY-dees dif-uh-SEEL). Its name was changed in 2016 because its bilological analysis showed that it more correctly belonged to the clostridiodes genus-- rather than the clostridium genus. This bacterium can be a part a person’s normal intestinal flora or it can be transmitted from one person to another.

Approximately 40% of infants have clostridiodes at birth, and up 15% of adults clostridiodes dificile without having any symptoms.

A second way to get c diff is for a person to swallow some C. diff spores either in food or by touching objects contaminated with C. diff spores and then putting their fingers in their mouth. Often times, it difficult to determine how C. diff was transmitted to a person.

Sometime after the C diff spores are a person's intestines a favorable environment occurs, which allows the C. diff spores to grow (germinate) into a toxin producing bacterium. The toxins produced then cause damage to the host colon, which in turns causes symptoms such as nausea and diarrhea.

Typically, C. diff. infection occurs when a person is given strong intravenous antibiotics, which kill a lot of the colon's good bacteria. This in turn allows the C. diff spores to become C. diff bacteria. While this usually occurs as a result of very powerful intravenous antibiotics, it can also occur as a result of mild oral antiobitics, or to chemotherapy. It can also occur without any no cause.

III. HOW IS C. DIFF. DIAGNOSED?

C. Diff. can be diagnosed by a careful history and tests of the stool. There are 4 different tests for c diff. Unfortunately, none of these are 100% accurate. Also, unfortunately, different doctors will order different c diff test.

1. Cytotoxin Assay (~90% accurate)
2. PCR (or NAA Test) toxin A & B "gene" test (~99% accurate)
3. [EIA] ELISA C diff toxin test (~75% accurate)
4. [EIA] ELISA GDH Enzyme Antigen test (~90% accurate)

The Cytotoxin Assay is the most expensive and rarely done because of expense. It also has a chance of a false positive. Basically, a stool sample is placed on a thin layer of human foreskin and watched for a reaction.

The PCR (Polymerase Chain Reaction) test is a type of NAA Nucleic Acid Amplification test. This test looks for one or two genes that are present in a toxin produced by c diff. This is a very sensitive test for genes, but the presence of these genes does NOT determine if c diff bacteria are currently producing active toxins. Therefore, this test is usually a very good test for someone who has never had c diff, but if a person has had a c diff infection within the last 3 months, it can give a false positive.

The ELISA (Enzyme Linked Immmuosorbent Assay) c diff test basically takes a watery stool sample and adds a preprepared antibody to the solution. If there is a reaction between the bacteria in the stool and the preprepared antibody, the test is considered positive. This test rarely has false positives, but because the c diff bacteria can die very quickly when it is exposed to air, it can have a high number of false negatives (approximately 25%).

The ELISA GDH Antigen test is similar to the ELISA c diff test, but instead of looking for a reaction between the bacteria and the preprepared antibody, it looks for a reaction between the GDH Antigen Enzyme (which can be secreted by any bacteria in the colon--including c diff) and another preprepared antibody. This is a very sensitive test (approximately 90%), and is usually accurate for c diff, but CAN be positive due to another bacterium in the colon.

Basically, since none of these c diff tests are 100% accurate, oftentimes several tests are used to make the diagnosis of c diff.

Reference: Understanding C Diff Tests Reference

Reference: Sensitivity of C Diff Tests Reference

IV. WHAT ARE THE STANDARD MEDICAL TREATMENTS FOR C. DIFF.?

1. Oral Antibiotics:

A. Oral Vancomycin: usually 125 mg 4 x /day for 10 days. (Sometimes longer, Sometimes higher doses)

B. Fidaxomycin (Dificid) 200 mg tablet 2 x /day for 10 days
(Sometimes repeat treatments are required, and the repeat treatment can be a tapered dose.

C. Both vancomycin and fidaxomycin can be prescribed to prevent a relapse of c diff in people who are at a high risk for a relapse. The doses are usually one to two pills per day for the time a person is on another antibiotic plus 5 to 7 days more.

Reference: American College of Gastroenterology

2. Antidiarrheal agents:

A. Bismuth Subsalicylate (BSS) (Pepto Bismol) - has antibacterial properties against C. Diff. ; therefore, might be of some benefit in treating C. Diff.

Reference: Pepto Bismol

B. INITIALLY, Imodium and Lomotil are not recommended to treat C. Diff. because they have no anti C. Diff. qualities and may indirectly increase the toxins that affect the large intestine.   However, they can sometimes be used after c diff antibiotics are started. However, they must be used judiciously to avoid causing constipation or interfering with the desired actions of the c. diff antibiotics.

3. Fecal Microbial Transplant (FMT):

A.  FMT via a colonoscopy (~91% cure rate)
B.  FMT via a nasal gastric tube (~81% cure rate
C. FMT via pills (Vowst) FDA approved in 2024 (~96% cure rate)
D. FMT via enema (Rebyota) (~83% cure rate) 

V. What is the Best Diet for C Diff?

DON'TS

1. Don't Eat a High-Protein Diet
2. Don't Eat a High-Fat Diet
3. Don't Drink Protein Drinks or Shakes
4. Don't Eat a High-Calcium Diet
5. Don't Eat a High-Sugar Diet
6. Don't Eat a Lot of Salt
7. Don't Drink a lot of Alcohol

DOs

Some foods of food groups that you should probably eat or drink.

1. Do Consider a Low FODMAP Diet
2. Do Consider an Elimination Diet
3. Do Consider Eating Some Formented Foods
4. Do Consider Eating Some High-FODMAP Foods
3. Do Consider Eating Some Fruits
6. Do Drink SUFFICIENT Water



1. Don't Eat a Lot of Protein

There was a study of two groups of mice fed a relatively similar diets but the diets differed in the amount of protein and fat. Diet 5010 contained approximately 24% protein and 10% fat and, and Diet 5053 contained approximately 20% protein and 5% fat. Both groups of mice were infected with c diff, but the group that were fed Diet 5053 (20% protein and 5% fat diet) had less colon inflammation (colitis).

REFERENCE: Lower Protein and Fat Diet decreases C diff Severity

A second reason that protein consumption is probably not a good idea is that a second mice study found that reducing glycine among hamsters reduced their rate of dying. (Glycine is a type of protein that is found in most types of animals (meat, foul, and fish) and to a lesser extent in many types of beans.

This study is more complicated than simply not feeding hamsters glycine, instead the researchres created a type of c diff bacteria that was unable to digest glycine. The researchers just infected hamsters with their created bacteria versus a group of hamsters infected with the average c diff bacteria. The hamsters given the created c diff lived longer before dying than the other hamsters.

REFERENCE: Glycine Reducation Diet Reduces C Diff among Infected Hamsters

A third study also found a correlation between a high-animal protein diet (meat) and decreased levels of Eubacterium Rectale and Roseburia Intinalis Bacteria. Both of these bacteria produce butyrate, and butyrate reduces inflammation. Therefore, these bacteria are considered good gut bacteria.

REFERENCE: High-Animal-Protein Diet is Correlated with Inflammatory Bowed Disease Reference

In reality, it is nearly impossible to avoid all protein and it would not be healthy for a person to avoid all protein for a long period of time; however, it is possible to decrease the amount of protein eaten for a short period of time in the hopes that it might decrease the chance of c diff relapse.

REFERENCE: High Red Meat Consumption is Correlated with Cancer, Heart Disase, and Kidney Disease Referenc


2. Don't Drink Protein Supplements

A study tested 17 different sources of protein in protein drinks and found that NONE of them were beneficial to the colon. Although protein supplements might sound like a logical way to help the intestines heal and to get adequate protein while being sick or immediately after having c diff there is NO EVIDENCE to support this idea. In addition, many people find themselves being lactose intolerant after having c diff and many protein drinks contain lactose. (Lactose is a sugar contained in most dairy products: milk, yogurt, cheese, etc.)

REFERENCE: Protein Supplements to do NOT Help heal the intestines


3. Don't Eat a High-Fat Diet

A study compared a high-fat (low-fiber) diet to a low-fat (low-fiber) diet on mice who had been infected with c diff.
1. High-fat (low-fiber) was called the Western Diet
2. Low-fat (low-fiber) = LF/LF Diet
The mice fed the Western Diet had a significantly higher death rate than the LF/LF Diet.

CAUTION: The study only examined a high fat-diet accompanied with a low-fiber diet; therefore, it is not known for certain if it was the high fat part of the diet alone that caused the increase in mortality. It could have been from the combination of high fat and low fiber, NOT just because of the fat in the diet.

A second study examined how a high-fat/high-protein diet (like the Atkins Diet) increased the chance of c diff mortality by decreasing protective bacteria (Lachnospiraceae and Ruminococcaceae). This study compared three different diets:
1. high-fat/high-protein diet
2. high-fat/low-protein diet
3. carbohydrate/low-fiber diet.
Both of the high-fat diets increased the chance of c diff mortality. The high-fat/high-protein diet did it consitently; where as, the high-fat/low-protein diet had mixed results.
The carbohydrate/low-fiber diet had the least amount of illness.

REFERENCE: A High-Fat/High-Protein Diet Increase C diff

A general population study empphasized the potential harm of excessive fat intake. However, this study was NOT specific to c diff. It found that there was approximately a 5% increase in deaths due to the consumption of excess dietary fat. This was a meta analysis of 19 different studies. This meta analysis contained over a million people in it and was conducted over many years. It demonstrated an association of a high-fat diet with several illness, primarily cardiovascular disease and cancers.

Caution: The total suggested dietary-fat for a day should be about 20-35% of a person's total calorie count. A minumum suggested amount of fat each day is 20% of total daily calories. Too little dietary fat, just like too much dietary fat can also be detrimental.

High-Fat/Low-Fiber Increase Morality REFERENCE


4. Don't Eat A High-Calcium Diet

There is a study that found that feeding mice a calcium-deprived diet reduced the c diff relapse in mice by 90%. The study found that calcium is a necessary mineral needed for c diff to germinate (in mice).

CAUTION: It is important to remember the humans need a certain amount of calcium in there diet, primarily to have strong bones; however, they rarely need calcium supplements, and they are able to go without calcium foods for a period of time without reprocussions. This study infers that if a person is at a high risk for a c diff infection, that person MIGHT try decreasing their calcium intake for a short period of time to prevent relapsing. However, it should always be remembered that this study was on mice, and mice are vastly different from humans. Not all results from mice studies hold true to people.

REFERENCE: Calcium-Deprived Diet

5. Don't Eat a High-Sugar Diet

A mice study found that mice fed a VERY high-sucrose diet significantly increased their mortality rate. The mice were fed a diet that contained 94% sucrose (table sugar), and the rest was from cornstarch and maltodextrin.

Caution: The above study fed mice a diet that was 94% sucrose (table sugar). The typical American diet has approximately 10-13% simple sugar. The world Health Association states that up 10% of a person's daily calorie intake can be in the form of simple sugars, such as table sugar. However, there is NO MINIMUM requirement for the intake of simple sugars. A person can easily live without the intake of simple sugar.

REFERENCE: A High-Sugar Diet is Bad


6. Don't Eat Excessive Salt

One study that found that high-salt diets will decrease Lactobacillus Bacteria (which is considered a good bacterium). Salt has also been reported to cause c diff to adhere to the colon wall better. Therefore, there is circumstantial evidence that a high-salt diet MIGHT be detrimental to a person trying to prevent c diff.

REFERENCE 1: Salt Decreases Good Gut Bacteria
REFERENCE 2: C diff Is Able to Adapt to High-Salt Environment


7. Don't Drink Excessive Alcohol

One study on alchol abuse and c diff found that if people abuse alcohol there is about a 2 fold risk of c diff infection. However, the study subjects were ALL known to be alcoholics, not just occasional alcohol drinkers. Thus, there is some evidence that drinking alcohol excessively will increase the risk of c diff infection and relapse, but there is no evidence that the same is true for light-alcohol users.

However, there is also evidence that alcohol abuse is associated with higher rates of inflammatory Bowel Disease (IBD). But, once again, the studies indicate that there is a higher rate of IBD among alcohol abuses, but don't define how much risk is generated by drinking small amounts of alcohol.

REFERENCE: Alcohol Increases Risk of C Diff
REFERENCE: Alcohol Increases Risk of IBD


DOs

1. DO Consider a Low FODMAP Diet

During an infection with c diff, or immediately after a c diff infection, many people will develop post-infection irritable bowel syndrome (PI-IBS). During this period of time a person MIGHT need to follow a "Low" FODMAP diet for a period of time. This period of time is NOT clearly defined. It seems to vary between a few weeks to many years. Ideally a low FODMAP diet should NOT be followed for more than a couple of months because eating a low FODMAP diet can cause a decrease in a person's good gut bacteria, which can inturn increase their chance of c diff relapse.

FODMAP is an ancronym for for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. These are short-chain carbohydrates that are poorly absorbed in the small intestine and can cause digestive issues like gas, bloating, and diarrhea. HOWEVER, these SAME short-chain carbohydrates can increase the number of good bacteria in the gut, and thereby decrease the chance of c diff infection or relapse. Therefore, while a LOW FODMAP diet MIGHT be necessary for some period time after a person has c diff, it should not be continued longer than it is necessary.

Low FODMAP foods are foods such as:
eggplant, green beans, bok choy, carrot, cucumber, potato, oats, gluten free pasta, white rice, rice cakes, sourdough bread, white bread, dark chocolate, maple syrup, table sugar, eggs, firm tofu, plain cooked meats, poultry and seafood.

REFERENCE: Low-FODMAP Diet for IBS

Caution: It is important to remember that some of the food mentioned in a low-FODMAP diet are HIGH in protein and some studies have indicated that a low protein/low fat diet can reduce the chance of c diff relapse.


2. DO Consider an Elimination Diet

If a person has Post Infection-Irritable Bowel Syndrome and cannot tolerate the foods on the Low-FODMAP diet they may want to consider an an "Elimination Diet." An elimination diet is similar to the aforementioned Low- FODMAP Diet, BUT is even more limited in the foods that can be eaten. It also should not be continued any longer than is absolutely necessary, because by eliminating numerous foods a person can reduce the number of good gut bacteria, which can be helpful to reduce the chance of c diff infection.

There are two basic methods by which an elimination diet can be done. The first method is for a person to remove ALL the foods from their diet that they think are bothering them. After they are better for a period time, they can test one additional new food at a time to determine if they are able to tolerate the new food. By increasing the diversity of their diet, they should be able to increase the diveristy of the good bacteria in their colon.

A second method of doing an elimination diet is where ALL foods except either rice and water or bread and water are removed. After a period of time when their gut feels reasonably well they start testing one food at a time, watching each food for a reaction. If a food can NOT be tolerated, then it should be temporarily eliminated. Once a person feels better again, they can try a new food. Each new food is usually tested for a couple of days before testing another food. Foods that seem to cause a problem can be retried when a person is feeling better to determine if they are still intolerable.

REFERENCE: Elimination Diet for C Diff


3. DO Consider Eating Some Fermented Foods

The word "condsider" is used because some people cannot tolerate fermented foods. In addition, some fermented foods such as Yogurt and Kefir contain high amount of calcium, which a person MIGHT be trying to avoid after having c diff.

There was one small study, using 36 HEALTHY people, that studied how fermented foods, "OR" a high-fiber diet influenced the gut microbiome.

In this study, 36 subjects at Stanford were grouped into one of two groups, one group ate a high-fiber diet, and one group that ate a diet high in fermented foods. All subjects were followed for 10 weeks. The study found that eating fermented foods three times a day increased gut bacteria diversity, which in turn reduced gut inflammatory markers. In contrast, the study also found that eating a high-fiber diet for 10 weeks did not change the gut bacteria.

REFERENCE: Fermented Food Reduces Gut Inflammation

Examples of Fermented Foods:
Kombucha (No Sugar Added)
Fermented Vegetables
Tempeh (Gluten-Free)
Miso (Refrigerated)
Pickles (In salt, Not vinegar)
Sauerkraut (Refrigerated)
Kimchi
Kefir
Plain Yogurt (Those marked Live Culture are probably better.)
Cottage Cheese (Those marked Live Culture are probably better.)
Certain aged cheeses (Check label for live and active cultures)

CAUTION: People with C diff were NOT used for this study; therefore, the studies results MIGHT NOT be APPLICABLE to people who have their intestines inflamed or depleted of good intestinal bacteria due to a recent c diff infection.

In addition, an increased diveristy of gut microbiomes does NOT guarantee a person will have less c diff.

Lastly, one study found that eating yogurt increased streptococcus bacteria-- but, at the same time decreased odoribacter bacteria. The odoribacter bacteria is also considered to be a good gut bacteria. Thus, the overall benefit of eating yogurt might not be as good as hoped.

REFERENCE: Eating Yogurt Decreases Odoribacter Bacteria

4. DO Consider Eating High-FODMAP Foods

The word "consider" is used because after a person has had c diff, there intestines are oftentimes more sensitive to all different types of foods, especially FODMAP foods. However, FODMAPS foods are high in soluble fiber and a diet high in soluble fiber has been found to be protective against c diff. If a person does not have PI-IBS and wants to try to diversify their gut bacteria, they can try to eat to some of the following FODMAP foods.

Oatmeal Cereal, peas, beans, apples, bananas, avocados, citrus fruits, carrots, barley and psyllium.

Fiber Chart

A mice study found that mice that were fed a high- soluble-fiber diet produced MORE ACETATE in their intestine. This increase in acetate helped regulate the immune response in the protective layer of the colon. This in turn was found to help protect against c diff.

REFERENCE: A High-Soluble-Fiber Diet Improves the Immune System in Mice

CAUTION: A small study on humans found that humans who ate a high-fiber diet for 10 weeks were unable to change their intestinal bacteria.


5. DO Consider Eating Some Fruit (Apples, Oranges, Lemons, Berries)

Apples, oranges, lemons, and berries contain pectin and this pectin has been found to be beneficial. A study on mice found that the pectin helped to improve intestinal integrity and increase Lachnospiraceae bacteria in the intestine. Higher levels of Lachnospiraceae bacteria are associated with better health.

MACs Reduce C diff in Mice Reference
Reference: Pectin Might Decrease C diff in Mice

CAUTION: Fruits are FODMAP foods; therefore, if a person has IBS or PI-IBS these foods may be hard to tolerate.


6. Do Drink Sufficient Water

Some people may decrease their fluid intake to try minimize their diarrhea. However, when a person is having loose bowel movements or diarrhea they have an increased chance to become dehydrated. When a person is dehydrated they will often not feel well; however, beyond not feeling well being dehydrated can in some cases lead to kidney damage and in extreme cases dehydration can cause death.

The average amount of fluids a person should drink in a day is 1500 ml. 1500 ml is equal to 50 ounces of fluid, or approximately three 500 ml bottles or water, or six 8 ounce glasses of water. However, if a person has diarrhea, there if often a need for even more fluid.

In the worst case of dehydration, a person may need to get fluids intravenously.

Caution: While being correctly hydrated is very important to good health, excess fluids can be a problem as well. Although, overhydration does not occur that often it can cause excessive urination and a lowered sodium in the blood. The lowered sodium is called hyponatremia, and it will also cause a person feel poorly.

In addition, a person MUST be cautious when hydrating themselves. Some electrolyte solutions such as Gatorade and Powerade can actually cause diarrhea. It is best to try to hydrate with a solution that contains a little salt and sugar. A person can make their own or by Pedialyte.


SPECIFIC FOODS

1. Kefir

There is one study that reported that Kefir will favorably change the gut microbiome. Kefir was found to primarily increase Acetinobacteria. Acetinobacteria is thought to be a bacterium that is beneficial to the gut. It is hoped that an increase in acetinobateria will inhibit the growth of c diff spores.

CAUTION: The study that was done only proved that kefir increase acetinobacteria, it did not prove this increase in acetinobacteria would decrease the rate of c diff infection or relapse.

Reference: Kefir

2. Yogurt

Yogurt probably has some short-term benefits on the gut microbiomes. A study has reported that a short-term increase in Streptococcus Thermophilus and Bifidobacterium Animalis bacteria among people eating yogurt. These two bacteria are considered to be good gut bacteria.

However, another study found that was while they found an increase in Streptococcus bacteria among regular yogurt eaters, it also found a decrease in odoribacter bacteria. This odoribacter bacteria is also considered a beneficial gut bacterium. Thus, there is a chance that too much yogurt MIGHT be detrimental.

REFERENCE 1: Yogurt Support
REFERENCE 2: Yogurt Support
REFERENCE 3: Yogurt Decreases Odoribacter Bacterium

CAUTION: Not all yogurts are made the same; therefore, some yogurt brands MIGHT be more beneficial than others. Most yogurt studies do NOT include the brand of the yogurt used, and they don't compare one yogurt brand to another. They also don't identify the starter bacteria (Lactobacillus Bulgaricus, Streptococcus Thermophilus, Bifidobacterium Lactis or Lactobacillus Acidophilus) that were used to start the yogurt; therefore, the specific probiotics that are produced by the yogurt is not known.

Starter bacteria are the bacteria that are used to cause fermentation of the yogurt, and they can vary. Starter bacteria include the following: Lactobacillus Bulgaricus, Streptococcus Thermophilus, Bifidobacterium Lactis or Lactobacillus Acidophilus. The starter bacteria determine the probiotics that are produced at the end of the fermentation process.

Generally, yogurts labeled "Live Active Culture" are considered to have more probiotics. A couple of the brands that meet this criteria are the following: Chobani, Activia, Stonyfield, FAGE, and Siggi's. But, there are no studies that prove one yogurt brand is better than the other.

3. Plantains

There was a study on one specific food, called plantains and c diff. In the study, plantains were found to both inhibit c diff and decrease the ability of c diff bacteria to stick to the wall of the intestines.

CAUTION: This study was ONLY DONE in the laboratory; thus, the effect on eating plantains by humans is unknown.

Reference: Plantain Are Beneficial

Reference: Plantain Supplement



DIET SUMMARY

A diet for C diff is COMPLICATED. It needs to be INDIVIDUALIZED and adjusted over time. In addition, there are no tests available to determine if a person is eating the right foods to attain the ideal gut microbiome.

There are NO foods or diets that are definitely helpful because there are no studies that have determined what the ideal gut microbiomes are, and there are no tests that an individual can do to determine if they are moving toward the perfect gut microbiome. (There is a GI Panel Test available, which tests about 40 gut bacteria, but there are over 500 gut bacteria, and the GI Panel test only test for about 40.)

Because of these difference, there are a variety of diet suggestions. EACH PERSON MUST CONSIDER THEIR OWN CIRCUMSTANCES BEFORE MAKING ADJUSTMENT TO THEIR DIET.

Lastly, it must be mentioned that a person might NOT NEED to alter their diet at all.

1. A person could choose to simply take the antibiotics for c diff and eat a regular diet. This works for some people.

2. A person could choose to take medications that are used for Irritable Bowel Syndrome and eat a regular diet. Medications for IBS are medications such as Bentyl, Imodium, Elavil, and Nortriptyline. These work for some people--but they OFTEN have side effects.

3. A person could try a variety of supplements and continue to eat their regular diet. These supplements include, but are not limited to Florastor, Bentonite Clay, and Black Seed Oil. These treatments also sometimes work. They are explained in another section of this website.

CAUTION ON ALL DIET INFORMATION

Before anyone adjusts their diets, they should be aware that there are four problems with the studies that have been done.

The first problem is that rodents and humans have vastly different intestines. Not only is the shape of rodents’ intestines different, but rodents have different normal gut bacteria.

The second problem is that the only study that was done on people was done on HEALTHY people NOT people who are infected with c diff. A person who is infected with c diff and has an inflamed or irritated colon MIGHT NOT respond the same way as a healthy person does.

The third problem is that laboratory studies (in vitro) have no test on living organism; therefore, their applicability to people infected with c diff is even more distant than the relationship between mice and humans.

The fourth problem is that there are conflicting reports between different studies.

These problems within these studies does NOT mean they should be totally disregarded, but it does mean that they can NOT be TOTALLY RELIED UPON.

VI. What ARE NEW TREATMENTS BEING STUDIED?

*If you want to see if there are any new treatment studies that are going on in the United States you can check the following website, https://clinicaltrials.gov. Click Here

1. VE303 (RESTORATiVE303)
VE303 is one of the more promising new treatments for c diff. It is a new type of FMT that is being tested and thus far has been found to be about as effective as Vowst. However, this type of FMT is different from Vowst because VE303 it is NOT made from human excrement. Vowst is. Instead, VE303 is made from 8 specific bacteria, which are grown in a laboratory. The advantage of VE303 over Vowst is that there is less risk of adverse effects. This treatment is currently in Phase 3 and is looking for participants.

Phase 3 Study Looking for Particpants

2. DAV132
DAV132 is an enteric-coated activated charcoal. Enteric coated means it has a hard outer shell designed to prevent the pill from being broken down in the small intestines, but rather being broken down in the large intestines. Once it is broken down in the large intestines the activated charcoal will absorb unwanted antibiotics while preserving the good intestinal bacteria. Two research studies have demonstrated that it is partially effective, but further research still needs to be done. It is currently in phase 2 trials; But, the trials are being conducted in France, Bulgaria, Serbia and France. There are none in the United States.

3. Ebselen

Ebselen is a medication is currently being studied for the treatment for Meniere's disease; however, some researchers have also looked at it for the use in treating c diff. One study on mice showed that ebselen decreased intestinal inflammation and damage due to c diff toxins. The problem with this information, is the study was done on mice and there are no studies currently being done on ebselen for the purpose of treating c diff. There are studies researching the effectiveness on Meniere's disease, cochlear implants, and depression--but none regarding c diff. Thus, the effectiveness on people who have c diff has yet to be proven. Perhaps more information will be gained on the effectiveness of ebselen for c diff through the other investigational studies.

Reference 1: Ebselen for C diff
Reference 2: Ebselen for C diff
Reference 3: Ebselen for C diff

4. SYN-004 (Ribaximase)
SYN004 (ribaximase) is a medication designed to break down beta-lactam antibiotics after they have entered the large intestines. Beta-lactam antibiotics are antibiotics such as penicillin, amoxicillin, Keflex and Rocephin. One study reported that ribaximase did reduce the percentage of people who got c diff while taking it; however, the same study showed that those people who received rebaximase had substantially more adverse effects. The authors reported that they thought the adverse effects where coincidental. There is currently a study being conducted that may determine the effectiveness and chance of adverse effects; but the trial is in Missouri, and it is only on people who are receiving treatment for a severe blood disease.

Reference: SYN004

VII. NON-CONVENTIONAL TREATMENTS :

1. SACCHAROMYCES BOULARDII

Saccharomyces Boulardii benefits are highly debated. Florastor is a common brand of Saccharomyces Boulardii. In theory, Saccharomyces boulardii (SB) should help reduce c diff because SB has been found to produce a protease which inactivates the receptor site for C. difficile toxin A.

Reference: Probiotics Debated

This theory is supported by a hospital study conducted in 2021 with over 8000 hospitalized patients. This study, which gave patients 500 mg SB 2x/day, found that giving saccharomyces boulardii reduced the chance of c diff occurring from 0.82% to 0.56%.

Reference:Saccharmyces Boulardii Support

Another small study found that giving patients Saccharomyces Boulardii, who were taking high doses of vancomycin (presumably 500 mg 4x/day), reduced their chance of c diff relapse. However, this was NOT found to be true among patients taking a lower dose of vancomycin (presumably 125 mg 4x/day).

Reference: Reduced Evidence that Saccharomyces Boulardii Helps

In addition to the one study that did not find a benefit among patients receiving low-dose vancomycin, some medical doctors discourage the use of saccharomyces boulardii. Among these doctors are Dr. Cynthia Sears, an infectious disease doctor, and Dr Curtis Donsky, also an infectious disease doctor. Dr Curtis tells his patients that if they decide to take Sarchomyces Boularii, they should probably only take it for 28 days. These doctors do not specifically explain why they don't suggest the use of Sarchomyces Boularii; however, it is known that the use of Sarchomyces Boularii has a RARE risk of fungal septicemia (fungemia).

Reference: Fungal Septicemia is Possible

Reference: MD States Limit Saccharomyces Boulardii to 28 Days


2. Bentonite Clay

Bentonite Clay has many positive articles written about it regarding the absorption of toxins; however, few specifically associate bentonite clay with the treatment of c diff. However, there is one article that describes the combination of Bentonite Clay with Black Seed oil and lactobacillus probiotics that reports that a 2-year-old was cured of c diff with this combination.

Reference: Bentonite Clay


3. Black Seed Oil

There is some evidence that Black Seed Oil (2%) with myrrh water can inhibit the growth of c diff.

Reference: Black Seed Oil

In addition, there has been at least one documented case of successfully treating a 2-year-old child with a combination of bentonite clay, black seed oil and lactobacillus probiotics.

Reference: Lactobacillus, Bentonite Clay, Black Seed Oil


4. BILE ACIDS REDUCTION WITH QUESTRAN (Cholestyramine: Questran)

It seems that at the time of c diff infection, for unknown reasons, there is often a change in both primary and secondary bile acids. When primary bile acid enters the large intestine, the primary bile acid is converted into over 50 different secondary bile acids. If the ratio is unbalanced, a person will often have less of the good gut bacteria. This imbalance can also contribute to inflammation and diarrhea. A small study (less than 50 people) found that people given cholestyramine (Questran), a bile acid sequestran (binder), along with Rocephin IV (a strong antibiotic) had a lower rate of getting c diff infection than those who did not. Thus, cholestyramine (Questran) MIGHT have some role in preventing or treating c diff.

Reference: Bile Sequestrant Support


5. Butyrate

Butyrate is a short-chain fatty acid (SCFA) produced by beneficial bacteria in the gut. It is found primarily in beans, peas, soybeans, fruits, and nuts. It may have a role in preventing and treating c diff because it helps to regulate the balance between primary bile acid and secondary bile acids, which tend to become unbalanced when a person has c diff. It also has an anti-inflammatory effect. A study on mice found that giving mice a supplement of butyrate helped to regulate bile acid metabolism and reduce inflammation.

Reference: Butyrate Benefits


6. CBD (CANNABIDIOL)

CBD (cannabidiol), has also been shown to have some effect in reducing the chance of getting c diff. This was demonstrated in a retrospective study that examined CBD users and non-CBD users who were hospitalized.

Reference: CBD Risk of C Diff

In addition, another study, which was done in the laboratory–not with real people– found that CBD helped a particular type of colon cells heal.

Reference: CBD Colon Cell


7. IVIG: Intravenous Immunoglobulin (IVIG)

Intravenous Immunoglobulin (IVIG) MIGHT be of some help for people who have a reduced immune system, such as those who have recently had cancer. One 72-year-old patient, who had recently received cancer treatment and who also had recurring c diff, was given one IVIG infusion and was able to stop his recurring c diff. He was given one dose of 400 mg IVIG. However, it should be remembered that IVIG is not a standard treatment for c diff, and it is very expensive, about $10,000 for one treatment; therefore, it is rarely ordered for average people who have c diff.

Reference: IVIG

Oral Immunoglobulin IgG is a possible substitute for IV immunoglobulin G, and it is much less expensive. It costs about $600 for 30 doses, a week’s worth. The oral form of IgG is called Enteragam. Although there are no specific studies reporting that Enteragam reduces c diff infection, there have been 2 case reports of Enteragam helping patients resolve IBS after they have had c diff.

Reference: Enteragam Reduces PI-IBS


8. LACTOBACILLUS REUTERI

One probiotic that has some evidence that it is helpful is Lactobacillus Reuteri. According a laboratory study lactobacillus reuteri a type of food called "Glycerol" and forms "reuterin." (Glycerol is an oil or fat found in food.) The reuterin enters a c diff bacterium cell and activates a "reactive oxygen system" ROS. This process kills a c diff bacterium cell.

Caution: This hypothesis was only tested in a laboratory. It was NOT tested on either rodent or humans; therefore, while it MIGHT be true for a person, it can NOT be relied upon.

Reference: L. Reuteri Might Reduce C diff Infection

Video How To Make L. Reuteri Yogurt


9. LACTOBACILLUS PLANTARUM 299v

One probiotic that has some evidence that it is helpful is Lactobacillus Plantarum. It was tried on 44 adult ICU patients in 2008. This small study found that none of the 22 ICU patients who were given fermented oatmeal gruel containing Lactobacillus Plantarum 299v got c diff. However, 4 of the 22 ICU patients who did not get Lactobacillus 299v got c diff.

Lactobacillus Plantarum 299V Reference


10. Melatonin

There is a study that found that Veterans who took Melatonin reduced their chance of having c diff. The theory of why this happened is that Melatonin can decrease inflammation, and a reduction in inflammation can decrease relapse rates. This study was conducted on patients at the VA Hospital. The study did NOT disclose the dose of Melatonin used, however. But, it is known that the usual dosage recommended to treat inflammation is 10mg/day of melatonin. This is a relatively high dose of melatonin, and it may cause many people to be very sedated in the morning after taking it.

Reference: Melatonin


11. METAMUCIL

One 72-year-old man with recurrent c diff was told to take Metamucil while waiting for his newest c diff results. Remarkably, by the time his test results came back positive, he reported he no longer had symptoms. He was followed over the next few months, and his c diff did NOT recur.

It is hypothesized that it was the fiber in the Metamucil that helped him. However, other than this one 72-year-old man, there are no studies correlating Metamucil with the treatment of c diff. But, there is some evidence that a high-fiber diet MIGHT increase the good bacteria in the colon; therefore, it is possible that Metamucil MIGHT have caused an increase in good bacteria, and thereby cured him. However, to reiterate, it is uncertain whether Metamucil is helpful for c diff patients or not.

Reference: 72-Year-Old-Man Cured with Metamucil


12. Manuka Honey (Enema)

A manuka Honey enema MIGHT have some benefit in the treatment of C diff; however, the evidence is very weak. There was one 71-year-old male patient who had recurrent c diff who was treated with a Manuka Honey “ENEMA” and was reported cured of his c diff. In addition, there are other studies that show Manuka Honey has antimicrobial effects. However, most of these studies have been done in vitro. In vitro means that it was done in a test tube, or a culture plate, and no animals or humans were used. There are no animal or human studies that have been done to show that Manuka Honey has an inhibitory effect on patients with active c diff.

In fact, the authors of one in vitro study on Manuka Honey were quoted as saying, “...we did not find manuka honey to be universally bactericidal or inhibitory against C. difficile growth...”

Reference: Manuka Honey Enema
Reference: Manuka Honey Variable Effects
Reference: No Universal Inhibitor Effects


13. Vitamin D

A deficiency in vitamin D is associated with a 4.75 times higher risk of dying from c diff. A small study with 65 patients was conducted. Those who were deficient in Vitamin D had poorer outcomes. Vitamin D deficiency was defined as having a blood vitamin D level less than 21 ng/dl. If a person wants to increase their Vitamin D they have three choices. One choice is to take a daily supplement of Vitamin (~2,000 IU). A second way would be to sit in the sun for 10 minutes to 2 hours. The less body parts that are exposed, the darker the skin, and the older a person is, the MORE time they will need to be exposed to sunlight each day. A third way is to get an injection of vitamin each week. This injection usually contains 50,000.

Reference: Low Vitamin D Caused Poor Outcomes

One other study found that administering a high dose of vitamin D increased the good gut bacteria.

Reference: High Dose Vitamin D Increases Good Gut Bacteria

VII. THINGS THAT ARE PROBABLY BAD FOR C DIFF

1. Certain antacids: Several studies have found that antacids increase the chance of c diff infection, and at least one that was found the opposite. Two studies found that stronger antacids (PPIs) such as:
Prilosec (omeprazole),
Neximum (esomeprozole)
Protonix (Pataprazole)
Are PROBABLY the highest risk for increasing the chance of c diff.
Histamine Blockers (H2 Blockers) such as:
Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid)
Are also associated with c diff infection--but to a lesser degree (OR[odds ratio] of 1.96 compared to 1.40 respectively.

The theory of why c diff is associated with antacids is that the stomach's acidity helps to kill unwanted bacteria. If the stomach is less acidic, more harmful bacteria can occur. The good news is that the lower the dose and the shorter the duration these medications are used, the less likely they are to cause a c diff infection. One study found that if antacids were taken for less than 2 weeks, there was a very low chance of the antacid leading to c diff.

Reference 1: Antacid Increase Risk of C. Diff.
Reference 2: Antacid Increase Risk of C. Diff.
Reference 3: Antacid Don't Increase Risk of c diff


3. Most Oral and Intravenous Antibiotics

Most antibiotics, whether or not they are taken orally or given intravenously, can cause c diff. Most people get c diff after taking antibiotics. One study found that only about 7% of c diff infections occur without people taking antibiotics.

Each antibiotic has its own risk of causing an infection. Rocephine, given intravenously, is probably the highest risk IV antibiotic. Clindamycin, Augmentin, and Amoxicillin are probably the highest risk oral antibiotics. Among the lowest risk antibiotics are Doxycycline, Macrobid and Gentamycin (given intramuscularly or intravenously).

Reference 1: Antibiotics
Reference 2: Antibiotics
Reference 3: Antibiotics
Reference 4: Antibiotics

4. Trehalose
There was a study that indicated that trehalose MIGHT increase c diff virulence. Trehalose is a naturally occurring sugar found in shellfish, oysters, yeast, honey (primarily honey produce by stingless bees), and in many edible mushrooms, (including shiitake, oyster, king oyster, and golden needle mushrooms, yeast, , and shellfish.)

Reference: Trehalose


5. High-Sugar Diet

A high-sugar diet is not directly associated with c diff, but it has been shown to increase proteobacteria in the gut, while simultaneously decreasing the abundance of Bacteroidetes, which can mitigate the effects of endotoxin, as well as reinforce gut barrier function. The result is more proinflammatory bacteria. However, it should be mentioned, that there are no studies on low-to-moderate-sugar diets that associate them with a negative microbiome change.

Reference: High-Sugar Diet Is Detrimental


8. Indomethecin (High-Strength NSAIDS)

Indomethecin, which is a high-strength prescription NSAID (non-steroidal anti-inflammatory drug) has been found to be associated with a higher rate of deterioration among mice infected with c diff. This study found that mice given indometacin had more severe symptoms than those that didn't. A follow-up study found that indomethacin injured the upper layer of the intestinal wall, which the researchers suggested caused an increased susceptibility to c diff infection.

Reference 1: Indomethacin
Reference 2: Indomethacin


9. Oral Iron Supplements

There are several causes of anemia. If anemia is due to a low level of iron, and it is severe, it will probably require treatment with either Oral iron (pills) or intravenous (IV) iron.

There has been at least one study that has found that taking oral iron MIGHT increase a person's chance of c diff relapse.

Reference: Iron Increases Chance of C. Diff.

However, there are no studies that have found an association between IV iron and c diff.

VIII. THINGS THAT COULD BE EITHER GOOD OR BAD FOR C DIFF

1. Certain Antidepressants

There have been several studies done on antidepressant and their association with c diff. Unfortunately, the studies have not reached the same results. One study found that only two antidepressants (Prozac [fluoxetine] and Remeron [mirtazapine]) increased the chance of c diff infection.

Another study found that the following antidepressant could increase the chance of c diff relapse.
Paxil (paroxetine)
Prozac (fluoxetine)
Remeron (mirtazapine)
Desyrel (trazodone)

A third study found that a few antidepressants were associated with either no risk or a lower risk of c diff.
The antidepressants that were found to actually reduce the risk of c diff were the following:
Zoloft (sertraline)
Lexapro (escitalopram)
Celexa (citalopram).

Reference: High-Risk Antidepressant
Reference: Medium-Risk Antidepressant


2. Steroids (Cortisone Injection, Prednisone, Budesonide, etc.)

Steroids are debated in their risk and benefits. There is a study that found that taking steroids reduced the risk of c diff. There is another study that found that taking steroids increased the risk of c diff. These conflicting results make it difficult to know if steroids help or hinder c diff. Whether steroids can decrease or increase c diff infection MIGHT be due to the dose that is administered and the reason that it is administered. No general statement can be made regarding the use of steroids.

Reference: Steroid Support
Reference 1: Steroid Avoidance
Reference 2: Steroid Avoidance


3. OXYGEN THERAPY

Oxygen therapy via a hyperbaric chamber MIGHT be of some benefit. There are two studies regarding c diff and an oxygen increased environment via a hyperbaric chamber. The study on human found hyperbaric oxygen treatment was beneficial, while the study on mice found no benefit of hyperbaric oxygen on mice.

Reference 1: Oxygen
Reference 2: Oxygen

IX. THINGS THAT PROBABLY HAVE NO OR LITTLE EFFECT ON C DIFF INFECTION

1. Antibiotic Eye Drops: Only a small amount of antibioitic is absorbed

2. Topical Antibiotics: Only a small amount of antibioitic is absorbed

3. Ear Drops: Only a small amount of antibioitic is absorbed

4. Acetaminophen (Tylenol)

5. Chlorine and Florine in Drinking Water

Neither Chlorine or Florine in the water have been well studied, but one study found NO significant changes in the gut microbiomes due to chlorine or florine. There were some changes, but the changes were not considered significant. There are no known studies on an association between c diff and chlorinated or florinated water.

Reference: Chlorine and Florine

6. C Diff Spores in Food

There are also numerous studies that have found c diff spores in the food we eat: mainly meats, poultry, and fish, but also in some vegetables such as potatoes. But, these studies do not include any studies that found that either animals or people have became infected from eating food. Thus, even though there PROBABLY are some c diff spores in the foods we eat, it is NOT known if there is a sufficient quantity of c diff spores in food to cause a new C diff infection. The Canadian Goverment C Diff Fact Sheet states that if food is cooked at 250 degrees F for 15-30 minutes it will kill c diff bacteria AND SPORES.

Reference: No Food Transmission of C. diff.
Reference: What Kills C, diff.
Reference: Baking Food Probably Kills D diff Spores


3. Low-dose Over-The-Counter NSAIDS (Non-Steroidal Anti-Inflammatory Drugs)

There is a study, which used mice to examine an association between c diff and indomethacin (which is a prescription strength NSAID)--BUT, other researches have stated this Indomethecin study is flawed because it failed to take into account treatment assignment bias. In addition, this study only looked at the effect of Indomethacin, it did not look at over-the-counter (OTC) NSAIDS, such an ibuprofen, naprasyn, and aspirin.

A retrospective study, looking at data from hospitalized patients, who were taking OTC NSAIDS, like ibuprofen, failed to find any association between OTC NSAIDS and c diff. Thus, eventhough there is suggestive evidence from the Indometheacin Mouse study, there is no evidence confirming that OTC NSAIDs will have the same effect on humans. The retrospective study on humans found NO association between c diff and OTC NSAIDS.

Reference: OTC NSAIDS

IF YOU HAVE ANY QUESTIONS OR COMMENTS, PLEASE SEND THEM TO

DWIGHTTHOMASPARTNER@GMAIL.COM

XI. Ideas To Manage Anxiety

1. Consider WRITING your feelings down in a journal
2. Consider Therapy by a trained therapist
3. Consider Automatic Intelligence Therapy (AI Therapy)
   A. Supposably Free: Ash AI Therapy, Earkick, and Wysa
   B. Youper, Sanvello, Earkick, Serena, and more
4. Consider DISTRACTING yourself from WORRYING by any means possible:
   A. Talk with friends: Not always about your health
   B. Walk
   C. Watch TV, Movies, Netflix, etc.
   D. Play games
   E. Read a good book silently or OUTLOUD
   F. Work

5. Consider Medications
   A. Ativan, Xanax, Valium
   B. Atarax
   C. Antidepressants (Zoloft, Celexa, Lexapro )
   D. CBD

XII. Things to be Cautious About

1. It is important to manage c diff carefully because approximately 15-30,000 people die in the USA each year due c diff. In about 20 to 25% of people with a C. Diff. infection, C. Diff. returns. These people will oftentimes require a repeat dose of either Dificid or Vancomycin— or they may need a prolonged course of Vancomycin or tapered Dificid, or even an FMT.

2. All medication and supplements, including probiotics, antibiotics that treat C. Diff and FMTs, have a risk of side effects. Sometimes, adverse reactions are mild, such as nausea or rash, but sometimes they can cause a more severe reaction such as extreme diarrhea or an anaphylactic reaction, where a person is unable to breathe. Probiotics and FMT's are also capable of causing various types of adverse reactions. Therefore, everyone should be careful when trying a new medication or supplement. If it is possible, it is best to start at a very low dose.

3. When a person has c diff, it is important to distinguish between diarrhea and mucus. Low doses of Imodium or Lomotil and other anti-diarrheal medications can be used once a person has been started on antibiotics; however, MUCUS will not respond to antidiarrheal medications. And if a person takes anti-diarrheal medications for mucus, they might cause constipation. Diarrhea usually consists of a high amount of watery discharge, whereas mucus is generally a small amount of slippery discharge. Mucus in the colon is usually caused by inflammation of the colon--but it is not diarrhea.

4. Drugs such as Imodium and Lomotil that decrease diarrhea might be detrimental in the treatment of diarrhea caused by C. Diff. This is because C. Diff. bacteria make a toxin, and if diarrhea is slowed down, this may leave the C. Diff Toxin in contact with a patient's colon for a longer period of time. However, this has not been proven.

5. Medications such as creams, lotions, and gels should be tested in small dosages in areas of the body that are not easily seen the first time they are used.

6.Consult “Epocrates.com ” for each Specific Medication’s possible “Adverse Reactions.” Side effects are also referred to as “ Adverse Reactions.” Epocrates.com will tell you both “common reactions” and “serious reactions.” You will have to create an account, but it is simple, fast, and free.

XIII. Success Stories

If anyone would like to tell their success story on how they successfully treated c diff and have it published here or in a book, please send it to me at dwightthomaspartner@gmail.com
Please follow the following format.

Name: (Fictitious or real)
Age:
Gender:
Where you grew up:
Where are you currently living:
Number in family:
Your profession:
Any other details you think would make an interesting story:
At what age did you get c diff:
What do you think was the cause of your first c diff illness:
How many times have you had c diff:
The different treatments you tried:
Any mistakes you made:
What treatment finally worked:
What is your advice for others who have c diff:

My Own Success Story (while waiting for others)

Name: My name is Tom Partner and I’m 70 years old. I grew up in Pittsburgh, PA. , but, I currently live in Los Angeles, CA. I am single and don’t have any children. I am a nurse practitioner, and I have been for the last 17 years. Before that, I was a RN and a Health Teacher.

About age 31, I had a small hemorrhoid surgery. I got a small infection from the surgery and was advised to take 7 days of Recephin IV, which I did. A week or two later, I had my first case of c diff. I was treated with 2 rounds of metronidazole and 1 round of vancomycin and finally got better.

For the next 30 years, I was good. However, I developed appendicitis at age 62 and had to have an appendectomy. I, of course, had to take antibiotics for the surgery, and again I got c diff. Since that time, I have had c diff 3 more times, usually following antibiotics, but one time there were no antibiotics. I probably had c diff 4 times between the ages of 62 and 68.

At age 68, following 3 courses of vancomycin, I got an FMT via colonoscopy. After 21 days and a change in diet to mostly rice, I had a normal bowel movement and have been relatively well since then.

Over the course of about 5 years, I tried over 10 different treatments for c diff. These included: metronidazole, vancomycin, Dificid, FMT, psychotherapy, a tiny amount of bentonite clay, nortriptyline (Pamelor), amitriptoline (Elavil), mirtazapine (Remeron), Pepto-Bismol, Imodium, cholestyramine (Questran), Welchol, sunbathing, Lotrimin cream, Vaseline, fasting, eating once a day, eating only bread and water, eating only rice and water.

The big mistake I made was listening to my primary care physician, who suggested I use Rocephin to treat a small infection that occurred as a result of hemorrhoid surgery. The infection was not that bad. I think I could have taken a less powerful antibiotic. I also tried amitriptyline (Elavil) and mirtazapine (Remeron). These are two antidepressants that can increase the chance of relapse, but I did not know that at the time. I also think I exercised too much, which I did not know at the time, that excess exercise can decrease a person’s immune system. Lastly, I thought maybe I could starve the c diff bacteria, so I tried fasting, but that did NOT help. It probably made it worse.

The treatment that finally worked was 3 courses of Vancomycin plus an FMT via colonoscopy. I had avoided an FMT for 4 years. But after 4 years, I decided to try it because I felt I no longer had much to lose. It seemed like my life was an endless loop of illness and moderate recovery, always watching what I was eating, and always worried that c diff would recur if I ate the wrong food, took an antibiotic, or exercised too much. Fortunately, the FMT treatment and trying to eat the right foods have worked for the last 2 years.

My advice for others is:
1. Read my website and some of the references listed
2. Learn from my and other people’s mistakes
3. Consider all possible treatments, BUT be cautious
4. Slowly and Carefully make adjustments to diet, medication, and exercise

XIV. Frequently Asked Questions.

1. How do I get Dificid if my insurance company refuses to pay for it?

If you earn less than $62,000/year, or you and your spouse make less than $84,000/year, or your family of 4 earns less than $128,000/year, you MIGHT be eligible to obtain Dificid for free, or for $50.

Contact the Merck Pharmaceutical Company, the manufactures of Dificid (fidaxomycin).
Merck Contact Information

2. What do if I do if I have a positive C diff Toxin Test but I don't have symptoms?

The general recommendations if you don't have symptoms of c diff is NOT to take antibiotics. Taking any antiobiotics, even Dificid and Vancomycin have some risk. You can continue to monitor yourself for symptoms and if symptoms occur, you can either retest for c diff to make sure that is what you have or you can begin treatment for c diff.

3. What can be done for gas (flatulence)?

There seems to be disagreement from different medical sources. According to a UCLA (University of California Los Angeles) Website, the combination of Simethicone and Activated Charcoal it the best solution for gas and bloating. However, another prestigious medical website called UpToDate does NOT suggest the use of simethecone and activated charcoal. A third medical site called American Family Physician, suggests either the use of Rifaximin (which is a very expensive antibiotic usually used for SIBO), or or Probiotic supplements.
Rifaximin +++ (The highest value of effect is ++++)
Probiotics
  1. Prescript-Assist3 Volume +++
  2. Bifidobacterium and Lactobacillus species mixtures +++ The use Alpha-galactosidase (Contained in Beano) can be of help if someone has flatus that is directly related to eating beans.

Reference: UCLA Website
Reference: American Association of Family Physicians

4. What is the Best treatment for Constipation?

The ideal treatment for constipation is to make an alteration in one's diet. For example, to reduce rice and bread and increase fiber with vegetables and fruits. However, if a diet change is insufficient then a person CAN look to medications. But, if there is a chance of intestinal obstruction, a person should consult their doctor first before taking oral medications for constipation. An intestinal obstruction CAN BE even worse than having c diff.

If you fairly sure that your constipation is not due to an obstruction, you can consider any of the following:
1. Psyllium hust (Metamuciil)
2. Lactulose
3. Milk of Magnesia
4. Magnesium Citrate liquid

None of these medications have a known association with c diff. Psyllium Husk (Metamucil) and Lactulose MIGHT be of some benefit. There is a very small amount of evidence that Psyllium Husk and Lactulose will NOT ONLY help relieve constipation but will also reduce the rate of c diff relapse. Magnesium is a well known laxative and is active ingredient in both Milk of Magnesia and Magnesium Citrate. There are no known studies associating Magnesium and the chance of c diff relapse.

Reference: Metamucil
Reference: Lactulose

5. Should a person get the Flu Vaccination when they have C diff?

There are no known assocatiation with the Flu Vacciantion and c diff.

In the northern hemispher the usual peak flu season is after Christmas, January and February. Therefore, often times, there is no rush to get the flu vaccination.

Also, it is important to remember that the flu vaccination is only effective about 40% of the time.

Other members of an infected person's family MIGHT want to be vaccinated to protect the infected person.

Even though there is no known association between the flu vaccination and c diff, this might be because it has never been studied.

*If a person is in a position where there is a high risk of getting the Flu, the risk and benefit of getting the Flu vaccinated must be recalculated.

6. What it the best way to prevent a urinary tract infection (UTI)?

Urinary tract infection after having c diff is very concerning. There is no easy way to prevent URI but there a couple of options.

Non-Antibiotic Medications:
1. Methenamine: This medication works by making the urine acidic, which inhibits bacterial growth.
2. D-Mannose supplement. It attaches to bacteria in the urine and prevents them from attaching to the walls of the bladder.
3. Probiotics: specific strains of lactobacilli. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 (previously called L. fermentum RC-14) seemed to be the most effective among the studied lactobacilli for the prevention of UTIs. L. casei shirota and L. crispatus CTV-05 have also shown efficacy in some studies.

Reference: Probiotics for UTIs

Post-Menopausal Women might consider Vaginal estrogen. It changes the bacteria in the vagina to reduce bad bacteria.

Small Doses of Antibiotic can be tried--If Other Measures are Ineffective

1. Macorbid (Nitrofurantoin)
2. Bactrim (Trimethoprim-sulfamethoxazole)
3. Fosfomycin

7. What is the best treatment for a urinary tract infection (UTI)?

The standard treatment for a UTIs caused by E. Coli are the following:
Macrobid, Bactrim, Fosfomycin, and Keflex.
Of these, Macrobid is the least likely to cause a c diff relapse.

Non-conventional antibiotics that can be tried for UTIs due to E. Coli are:
Doxycycline, and Gentamycin IM.
These antibiotics are less likely to cause a c diff relapse.

Reference: Doxycycline
Reference: Gentamycin IM

8. What it the best treatment for a "Strep" sore throat?

The starndard treatment for Strep Thoat is one of the followoing:
Penicillin V or Amoxicillin.
For people who are allergic to penicillin: Azithromycin, Chlarythromycin, and Clindamycin can be used.

A non-conventional treatment for strep throat is Doxycycline.
Doxycycline is less likely to cause a c diff relapse. However, although Doxycycline does kill some strains of Group A beta hemolytic streptococcal bacteria, some strains are resistive.
Reference: Doxycycline

9. What is the Best Treatment for an OUTER Ear Infection?

When a person has ear pain, it must be determined if the pain is coming from the middle ear or the outer ear. Usually, if it is an outer ear infection, the person will have pain when they touch or move the outer ear. The outer ear infection, will usually only require antibiotic ear drops. There is only a small amount of antibiotics in the ear drops and a small percentage of that will be absorbed into the body. For these reasons, there is a low chance of causing c diff.

Commomn treatments for an outer ear infection (otitis externa) include the following: Ciprofloxacin/dexamethasone, ofloxacin, and ciprofloxacin ear drops.

For severe ear infections oral antibiotics can be used. Ciprofloxacin, Amoxicillin, and Augmentin are common medications recommended for severe otitis externa, but each of these has a high risk of causing a c diff infection. (Epocrates.com) Among these Ciprofloxacin probably has the lowest risk of causing c diff.

10. What is the Best Treatment for a MIDDLE ear infection?

The standard medical treatments for MIDDLE ear infection (otitis media) are
Augmentin, Amoxicillin, Omnicef (Cefdinir)
Azithromycin (if a person was allergic to penicillin).
Doxycycline, Clarithromycin, and Levofloxacin can also be used.
Of these, Doxycycline is considered the lowest risk of causing c diff; however, it is probably NOT the most effective.

Reference: Doxycycline Otitis Media: UpToDate

Myringotomy and Tympanostomy:
A Non-coventional treatment, which is usually reserved for a child with repeated otitis media, is a myringotomy and tympanostomy. A myringotomy is a small surgical hole made in the tympanic membrane. A tympanostomy is a tube placed in the hole. The tube stays in place and if a person needs to have a treatment for an ear infection, he can be given antibiotic ear drops. These ear drops have a low risk of causing c diff. However, an ENT Doctor MIGHT NOT want to do this procedure because there are NO guidelines that suggest this procdeure should be used to prevent c diff infection.
Tympanostomy Video
Reference: Tympanostomy

11. What it the best treatment for a MILD bacterial sinus infection?

Viral sinus infections are commonly mistaken for a bacterial sinus infection. The best method of determining if a person has a bacterial or viral sinus infection is to puncture the sinus and culture the specimen--but this is a painful procedure and requires special training.

The second best method to determine if a person has a bacterial sinus infection if to culture a mucus specimen that is at the opening to the infected sinus. But, most doctors do NOT have an endoscope; therefore, the best person to make a diagnois of a bacterial sinus infection is an ENT doctor. But, even a culture does not guarantee the correct diagnosis.

The third way (and most common) to determine if a person has a bacterial sinus infection is to examine the patients symptoms. The following are signs and symptoms that can be examined.
1. Blood test: C-reactive protein: which becomes elevated when there is inflammation
2. White Blood Cell (WBC) Presence (this can be done with urine dipstick)
3. Thick mucus secretions
4. Pain in one sinus area
5. Temperature greater than 102 for three days
6. Symptoms greater than 10 days
7. One sided upper teeth pain
*. An on-line Calculator can also be used:

Bacterial Sinus Infection Risk Calculator

When it is possible an ENT doctor should examine a patient's sinus to determine if that person has bacterial or a viral sinus infection or some other type of problem such as a polyp or tumor.

The traditional antibiotics used for bacterial sinusitis are the following: Augmentin, Clindamycin, Levofloxacin, and Doxycycline. Augmentin works the best is the most likely to cause a c diff relapse. Clindamycin is also has a very high risk of causing c diff. Severe bacterial sinusitis may require intravenous antibiotics.

Second Line Antibiotic: Doxycycline is the least likely to cause a c diff infection--but probably does work as well as the other antibiotics.

12. What is the best treatment for a MILD skin infection?

Skin infections are usually caused by either streptococcal bacteria or stapholaccal bacteria. However, some may be caused by bacteria that are resistant to common antibiotics. These are called methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Skin infection that are thought to be caused by MRSA require slightly different antibiotics.

Common treatments for both streptococcal and staphyloccal bacteria Oral antibiotics including penicillin, clindamycin, erythromycin, cephadroxil (Duracef), Bactrim, and cephalexin (keflex). All of these have a risk of causing a c diff infection. Clindamycin is the most likely to cause a c diff infection.

Less Common Antibiotic for a Skin Infection:
Although doxycycline is used less commonly for skin infections, doxycycline has anti-bacterial qualities for all types of infections. It has anti-bacterial properties to not only staphylococcusl aureus and stretococcal pyrogenes, but also against MRSA. Therefore, although it is not considered a first-line treatment for a skin infection, it MIGHT be a good option for a person who is at a high risk for getting a c diff infection. Doxycycline is one of the lowest risk antibiotics for causing c diff.

Topical antibiotics such as mupiricin (Bactroban) is also effective in treating both streptococcal and staphylococcal skin infection. In addition, because very little is absorbed into the blood stream there is no known association with c diff.

If a person is thought to have a severe infection, they might need an intravenous medication such as vancomycin or linezolid.

13. What is the Best Treatment for a MILD Lung Infection?

This information is for the treatment of a MILD lung infection only. If someone is having difficulty breathing. That person needs to go to the Emergency Room for evaluation and treatment. This website will not discuss the treatment for this type of lung infection. However, mild to moderate lung infections can be discussed.

For the purpose of this discussion, let's talk about someone who either been diagnosed with either bronchitis or a mild pnemonia.

Acute Bronchitis

(a recently occurring bronchitis) rarely starts out as a bacterial infection, but it can develop into one, especially if patients are over 80 years old or over 65 with another serious illness. If there is no indication of a bacterial infection, an inhaler such as Albuterol inhaler can relieve some symptoms of bronchitis and there is no known association between Albuterol and c diff. The antibiotics that are commonly ordered (if bacteria is suspected) is Azithromycin and clarithromcyin. These are both a medium risk of causing a c diff infection.

Less Common Treatment for Bacterial Bronchitis.

Doxycycline has been used for bacterial bronchitis and found to be relatively effective. It is also one of the antibiotics with a low risk of causing a c diff infection.

Reference: Doxycycline For Bronchitis

Mild Pneumonia

can also be treated with oral antibiotics most of the time. There are nine different bacteria that cause pnemonia. The most common are streptococcal, hemophilus influenza, and mycoplasm bacteria. When are started it is usually impossible to know which type of baceria is causing the infection. Therefore, the usual treatments for ADULTS with pnemonia are usually Amoxicillin, Augemtin (amoxicillin and clavulanate) Azithromycin, or Clarithromycin. Augmentin and Amoxicillin both have a high risk of causing c diff. Azithromycin and Clarithromycin have a medium risk of causing a c diff infection.

Less Commonly Used: Doxycycline

Although Doxycycline is not USUALLY used as often as other antibiotics for pnemonia it can be used and it has a much less chance of causing a c diff infection.

Reference: Doxycycline for Pnemonia

14. What Can Be Done for Anal Pain or Anal Itching?

The exact reason for anal itching, burning and pain can vary. However, regardless of the cause the treatment is similar.

1. A few seconds before having a bowel movement, apply a barrier to anal area (Vaseline, A&D ointment, etc.)
2. Wash the anal area with mild water and soap. Some people find a bidet wash to be helpful. If time permits, a shower is probably the best way to keep the anal area clean.
3. Pat dry the anal area. A hair dryer on low heat can be used. Do NOT rub the area roughly.
4. Consider applying OTC Hydrocortisone or Lotrimin cream to the anal area
5. Lidocaine gel 4% (OTC) can also be applied for severe pain.
6. If hemorrhoids are present and extend outward, they should be gently pushed back in.

15. What Is the Best Treatment for Hemorrhoids?

Sometimes, when people have excessive bowel movements they will develop hemorrhoids. A hemorrhoids is basically a vein in the anal area that has ballooned out.

1. The First and Most important treatment for hemorrhoids is to avoid straining. When a person has c diff, they may experience a feeling that their is something in their rectum, this is called tenesmus. This feeling may increase their desire to push, or bear down. This MUST be avoided, in order to avoid getting hemorrhoids or to treat hemorrhoids.
2. A few seconds before having a BM, a person should apply a barrier skin to their anal area. (Vaseline, A&D ointment, etc.)
3. After having a bowel movement, wash the anal area with mild water and soap. Some people find a bidet wash to be helpful. If time permits, a shower is probably the best way to keep the anal area clean.
4. Pat dry the anal area. Do NOT rub the area roughly. A hair dryer on low heat can be used.

5. Apply OTC Hydrocortisone or Lotrimin cream to the anal area

6. Lidocaine gel 4% (OTC) can also be applied for severe pain

7. If hemorrhoid are external, they should be gently pushed back in.



8. Sometimes hydrocortisone suppositories can help. This is usually placed in the rectum before a person goes to sleep. The hydrocortisone can reduce inflammation inside the rectum.


9. If someone has very severe hemorrhoids, a more invasive treatment MIGHT be needed. (Usually, hemorrhoids will shrink to normal if they are not stressed for a period of time.) However, if hemorrhoids are unsuccessfully treated with the above mentioned treatments, there are other treatments. These treatments include rubber band ligation, sclerotherapy, coagulation therapy and surgery.

16. What is the best treatment for Post-Infection Irritable Bowel Syndrome?

Generally, Post-Infection Irritable Bowel Syndrome (PI-IBS) has the same treatment as IBS. However, traditional IBS can be either dominated by constipation or diarrhea, or can be a combination of both of these. IBS due to due to c diff usually causes loose stools or diarrhea (IBS-D).

The most conservative treatment for PI-IBS is a change in diet. If someone has IBS-C (constipation), high-fiber foods are recommended. If someone has IBS-D (diarrhea), low-fiber foods are recommended. This is essentially the same as a low-FODMAP diet. FODMAP stands for fermentable oligosacharides, disacharides, monosaccharides, and polyols. These are foods that are harder to digest. Examples are the following:
Vegetables: Garlic, onions, leeks, broccoli, cauliflower, and mushrooms.
Fruits: Apples, pears, mangoes, cherries, and dried fruits.
Dairy: Cow's milk, soft cheeses, ice cream, and yogurts.
Grains and cereals: Wheat, rye, and barley products, and many breakfast cereals.
Legumes and nuts: black beans, kidney beans,lentils, cashews and pistachios.

If people continue to have loose stools and diarrhea despite eating a low-fiber diet they can try an elimination diet. There is several ways an elimination diet can be done.

One way to try an elimination diet is to avoid foods or drinks that a person suspects is causing them diarrhea. The second way is to start with very basic foods such as white rice and water and then slowly test one ADDITIONAL NEW food at a time for a day or two to see if they can tolerate that food. If a food is tolerated it remains in the diet, if a food is not tolerated it is eliminated--but, can be retried in a month or two. If changing the diet does not work, then a person can try medications.

The most common medication for IBS (diarrhea) are the following: cholestyramine (Questran), loperamide (Imodium), dicyclomine (Bentyl), nortriptoline (Pamelor), amitriptoline, paroxetine (Paxil), (Elavil), hyoscyomine (Levsin),
Reference: Epocrates.com

A couple of these have less potential side effects than the others. Dicyclomine, cholestyramine, and loperamide have less possible side effects. Antidepressants such as nortriptoline, amitriptoline, and paroxetine have more side effects and MIGHT increase the chance of c diff relapse. According to one study, paroxetine and amitriptoline have a about a two-fold risk or increasing relapse-- but nortriptoline MIGHT increase the risk of c diff infection as much as four times. (However, some studies found NO Increased Risk with these antidepressants.)

Reference: SOME Antidepressant MIGHT Increase the Risk of C. diff.

If a person has IBS-c (constipation). there are several medications that can be tried Metamucil, Lactulose, Miralax, Milk of Magnesia, Magnesium Citrate, and Senokot. Metamucil, Lactulose, and Miralax are probably the safest.

17. What is the best treatment for MILD Nausea?

Provided that the cause of a person's nausea is known (for example c diff) a person can usually be treated with common medications for nausea. The most commonly used medication for nausea are odansetran (Zofran), promethazine (Phenergan), metoclopramide (Reglan), and prochlorperazine (Compazine). Of these, odansetran is the most commonly used. Odansetran works by blocking the NAUSEA nerve receptor.

Reference: Common Medications for Nausea

There is one other medication that can be considered for nausea that does not respond to odansetran, and that is gabapentin (Neurontin). Neurontin works by slowing nerve transmissions down, and c diff can sometimes overstimulate nerves.

Reference: Gabapentin Anti-Nausea

18. What is the best treatment for Intestinal Cramps?

The treatment for intestinal cramps or spasm is more complicated than it may seem. There are at least 8 different products that can be used for intestinal cramps. However, their effectiveness in studies was found to be inconsistent. Among the many medications that can be used for intestinal cramps are alverine, dicyclomine (Bentyl), hyoscine, hyoscyamine (Levsin), mebeverine, otilonium, pinaverium, and trimebutine. Some of these (mainly the calcium channel blockers) are not available in the United States.

Reference: Antispasmodic Medications Mayo Clinic>
Reference: AJG Review of Antispasmodics

The two most commonly used in the United States are dicyclomine (Bentyl) and hyoscyamine (Levsin). There is no known association with the use of these medications and increased risk of c diff; however, they do tend to slow down gastric motility and excessive use MIGHT theoretically increase the chance of a c diff relapse.

19. When Can I Return to Work or School?

The Center Disease Control (CDC) states that a person can return to work 2 days after their symptoms stop.
Per CDC: "You should only resume everyday life (return to work or school) after symptoms stop." However, this information is ambiguous because the term "symptoms" is ambiguous. Which symptoms are the CDC talking about, loose stools, fatigue, fever, abdominal pain. Some people will require months before all of their symptoms stop. Therefore, the CDC's guideline is Not very useful.

Reference: CDC's Guidelines for Returning to Work

There are NO EXACT criteria as to when to return to work. The logical answer is that a person can return to work when they feel almost normal. But, c diff has about a 25% chance of relapse and many people have PI-IBS for months to years after having c diff. Therefore, these additional facts make it almost impossible to say when a person can or should return to work. It is basically up to the individual and their doctor to decide when they should return to work.

20. Can I Exercise?

There are no known studies on c diff and its association with exercise. There is only general information known about exercise. Generally, exercise in the correct amount is beneficial to the immune system. However, in contrast, excessively high exercise is bad for the immune system. This is evidenced by the fact that approximatly 1 out every 7 runners who completes a marathon will get a cold or flu. However, in contrast, total bedrest causes a quick decline of muscle mass, 1-3% per day, approximtely 20% in a week. Each person will have to make their own decision regarding when to resume exercise.

Reference: Exercise Can be both Good or Bad
1 of 7 Marathon Runners Get Sick Reference



21. How Should I Clean My Home to Protect My Family?

Generally speaking, your family will be protected from getting c diff by their own good intestinal bacteria. Many people who are well have c diff spores in their intestines and these spores never germinate (grow into active infections) because good gut bacteria inhibit them from growing.

To further reduce the risk of transmission of c diff to other family members it is important to try to limit the number of c diff spores. C diff spores can never be totally elminated because they are everywhere, with the fast majority being on the ground.

Of course a person who has an active infection will not only have some spores but will also have some active bacteria. The active c diff bacteria will die by themselves when exposed to air for a couple of hours. The c diff SPORES require either a solution containing sodium hypochlorite or hydrogen peroxide. Sodium hypochlorite is found in bleach. It can also be found in cleaning wipes. A person can make their own cleaning solution with one part bleach and 9 parts water. If hydrogen peroxide is used, it should be a 7% solution or higher. The over-the-counter hydrogen peroxide perparations only contains 3-6%; therefore, they are not recommended for cleaning.

It is important to note that once a hard surface is wiped with a sodium hypochlorite solution, it should be left on the surface for 5-10 minutes to be effective. Also, sodium hypochlorite will bleach the color out of fabric so therefore it can only be used on hard surfaces. There is no practical way to clean carpets and fabric furniture.

Wearing disposable latex gloves and good handwashing can further reduce the chance of c diff transmission.

Reference: Cleaning Supplies for C. diff.

22. Is there generic Dificid?

Yes. There is generic Dificid (Fidaxomycin). This pill is manufactured by the Teva Pharmaceutical Company. However, this generic form of Dificid MIGHT NOT be any cheaper than Dificid if a person's prescription formulary does not have Fidaxomycin in it. But, if the person's prescription formulary does have Fidaxomycin in it, they MIGHT be able to get Fidaxomycin for about $50. A person needs to contact the pharmaceutical company to determine their eligibility. There might be other criteria they must meet.

Reference: How to Get Generic Fidaxomycin

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