Xifaxan Diet: Foods To Eat And Avoid

If you have irritable bowel syndrome, traveler’s diarrhea, or are at risk of developing hepatic encephalopathy, Xifaxan might become a part of your life if your healthcare provider prescribes it.

Xifaxan is a type of antibiotic. Antibiotics can be helpful in treating bacterial infections, but they also come with side effects and potential risks. 

In this article, we’ll cover foods to eat and avoid while taking Xifaxan, as well as discuss safety concerns, side effects, and more.

What is Xifaxan (rifaximin)?

Xifaxan (drug name Rifaximin) is an antibiotic used to reduce the risk of a condition called overt hepatic encephalopathy. This condition results in changes in memory, mood, and behavior related to liver problems. 

Xifaxan is also used to treat patients with irritable bowel syndrome with diarrhea (IBS-D), as well as traveler’s diarrhea.

Xifaxan comes in 200 and 550-milligram tablets. According to the Food and Drug Administration, the recommended dosages for Xifaxan are:

• For traveler’s diarrhea: one 200 mg tablet taken orally three times a day for three days
• Hepatic encephalopathy: one 550 mg tablet taken orally two times a day
• Irritable bowel syndrome with diarrhea: one 550 mg tablet taken orally three times a day for 14 days

How does Xifaxan work?

Xifaxan is a rifamycin antibiotic, which means it stops bacteria from producing specific proteins necessary for their survival.

According to the manufacturer, Xifaxan works by slowing the growth of certain types of bacteria in your gut. 

These types of bacteria are thought to be the culprit behind causing hepatic encephalopathy, as well as diarrhea from IBS or traveler’s diarrhea.

If you haven’t heard of the conditions Xifaxan are used to treat, here’s a bit more information about them.

Traveler’s diarrhea

Traveler’s diarrhea is a digestive condition that causes abdominal pain and loose, watery stools. It’s usually caused by eating or drinking contaminated food or water, especially in new places where sanitary practices might be different from what you’re used to.

Traveler’s diarrhea usually isn’t serious, nor does it usually cause long-term problems. It typically resolves within a few days (or up to a week at the most) and causes symptoms like:

• Sudden onset of looser and watery stools 
• An urgent need to defecate (have a bowel movement)
• Abdominal cramps
• Nausea
• Vomiting
• Fever

Irritable bowel syndrome with diarrhea

IBS is a condition that impacts your digestive tract (stomach and intestines). IBS is quite common and can cause symptoms like abdominal pain, constipation, and diarrhea.

People with IBS are usually sensitive to certain foods, which may worsen their symptoms. Some people with IBS follow specific IBS diets and may sometimes require antibiotics like Xifaxan.

Acute hepatic encephalopathy

Hepatic encephalopathy primarily occurs in people with severe liver disease. When your liver loses its ability to filter toxins from your body, the toxins can build up in your blood, impacting your brain and causing encephalopathy.

It’s estimated that up to 50% of people with liver cirrhosis (scarring on your liver from damage) experience hepatic encephalopathy at some point.

Symptoms of hepatic encephalopathy usually include:

• Anxiety or irritability
• Confused thinking or judgment
• Coordination or balance problems
• Difficulty concentrating or having a short attention span
• Flapping hand motion (asterixis)
• Mood or personality changes
• Muscle twitches (myoclonus)
• Reduced alertness
• Sleeping problems
• Slurred speech

Foods to avoid when taking Xifaxan 

The foods to avoid while taking Xifaxan will vary and depend on the reason you’re taking it. 

For instance, if you have IBS, you probably have specific foods and drinks that you avoid because they worsen your symptoms. These foods will be different for people who are only experiencing short-term diarrhea.

Grapefruit juice and grapefruit

Grapefruit causes certain medications to remain in your system longer than they should. Xifaxan is one of several medications that interact with grapefruit, and you should avoid it while you take Xifaxan.

Raw or undercooked meat or eggs

Eating raw or undercooked meat (including fish) can increase your risk of getting a bacterial infection. 

This is especially true if you’re suffering from traveler’s diarrhea, which is typically caused by eating or drinking something that has been contaminated with bacteria.

Raw sushi and runny egg yolks are some examples of undercooked foods that should be avoided to reduce your risk of getting a gastrointestinal infection.

Here are some general guidelines on the correct internal temperatures for meat and egg dishes:

• Poultry: 165 degrees Fahrenheit
• Ground meat and egg dishes: 160 degrees Fahrenheit
• Fish, steaks, and roasts: 145 degrees Fahrenheit (plus a three-minute rest time for beef, veal, pork, and lamb

High-fat foods

Fatty foods can worsen diarrhea, whether it’s from IBS or traveler’s diarrhea. Some high-fat foods to avoid while on Xifaxan include: 

• Non-lean cuts of beef or pork
• Lamb
• Poultry with the skin on
• Processed meat like bacon, salami, etc.
• Lard and cream, including cream-based soups and sauces
• Butter
• Cheese
• Ice cream
• Coconut (including coconut oil)
• Palm oil and palm kernel oil
• Some baked and fried foods
• Processed foods with any added fats from the sources above
• Any fried or greasy food, such as French fries, pizza, etc.

Foods high in insoluble fiber

Fruits and vegetables with skin and seeds contain a lot of fiber, especially insoluble fiber. Whole grains are also high in this type of fiber, which can worsen diarrhea because it shortens digestion time. 

Soluble fiber, like the kind in oats, absorbs water and forms a gel, so it isn’t as likely to cause diarrhea.

It’s good to eat plenty of fiber when you don’t have diarrhea, but during a bout of diarrhea, you should avoid foods that are especially high in insoluble fiber, like:

• Almonds
• Apples with the skin on
• Beans, lentils, and legumes (can also increase gas)
• Berries 
• Coconut 
• Dried apricots, prunes, raisins, dates, and figs
• Flaxseeds
• Green peas
• Oat bran
• Okra
• Pears with the skin
• Popcorn
• Potatoes with the skins on
• Radishes
• Rutabaga
• Spinach
• Sunflower seeds
• Turnips
• Walnuts
• Wheat bran and wheat germ
• Whole grains

Dairy products (for some)

Dairy can worsen diarrhea in some people, especially if you’re sensitive to lactose, the sugar in cow’s milk. 

If you’re experiencing diarrhea and are sensitive to dairy, you should avoid things like cow’s milk, yogurt, cheese, ice cream, and other foods or drinks with cow’s milk as a main ingredient.

There are plenty of dairy alternatives you can eat instead.

Sugary foods

Eating a lot of concentrated sugar (like the kind in sugary drinks, sweets, and desserts) can cause water to move into your digestive tract to offset the sugar load. 

Adding more water to your digestive system can worsen diarrhea. Therefore, if you’re taking Xifaxan for diarrhea, you should avoid the following foods:

• Sugar-sweetened beverages
• Concentrated sweets (candy, ice cream, and other desserts)
• Processed foods with added sugar, like sweetened granola bars, flavored yogurt, sweetened cereal, etc.

Alcohol

You should be avoiding alcohol if you’re taking Xifaxan for hepatic encephalopathy and have severe liver disease. 

Alcohol use can worsen liver cirrhosis (scarring of the liver) and exacerbate symptoms of hepatic encephalopathy like confusion, slurred speech, etc.

High-sodium foods

If you’re taking Xifaxan for hepatic encephalopathy, your healthcare provider might suggest that you follow a low-sodium diet. 

Sodium (found in salt) can cause fluid retention, which can worsen outcomes in liver disease. 

Processed foods are especially high in sodium, so be sure to check the nutrition facts label and try to avoid things with more than 20% of the daily value for sodium.

Other high-sodium foods to potentially avoid on Xifaxan include:

• Bread and rolls, including quick bread mixes
• Pizza
• Sandwiches
• Cold cuts and cured meats
• Soups
• Burritos and tacos
• Savory snacks (pretzels, jerky, chips, etc.)
• Cheese
• Fast food and restaurant food
• Canned soups
• Certain condiments (soy sauce, salad dressings, etc.)

Foods to eat while taking Xifaxan

Lean protein

High-quality protein is generally well-tolerated by people with IBS and diarrhea. Be sure to choose lean protein if you’re experiencing diarrhea (as mentioned earlier – fat can worsen diarrhea!)

Choose high-quality protein sources like:

• Lean beef
• Skinless poultry
• Lean cuts of pork like tenderloin
• Eggs
• White meat fish like tuna, tilapia, and cod
• Beans and lentils
• Low-fat dairy
• Higher-protein grains/seeds like quinoa

Probiotic foods

Taking antibiotics can kill off some of the healthy bacteria in your digestive tract. These bacteria are important for promoting healthy bacteria, supporting a healthy immune system, and more.

Foods that contain probiotics contain healthy bacteria to help replenish your gut flora (population of healthy bacteria). Probiotics can improve your digestive health and might even reduce symptoms like diarrhea.

Fermented foods are the best sources of probiotics and include foods and drinks like:

• Yogurt
• Kefir
• Sauerkraut
• Tempeh
• Kimchi
• Kombucha

Bland, low-fiber foods

If you’re taking Xifaxan for diarrhea, stick to bland, low-fiber foods until your symptoms start to resolve. 

A low-fiber diet can help reduce the frequency of passing loose or watery stools. Some bland foods for diarrhea include:

• Crackers or toast made from non-whole wheat bread
• Canned or well-cooked/skinless fruits and vegetables (applesauce, bananas, etc.)
• White rice
• Broth-based soups

Other things to avoid while taking Xifaxan

• It’s unclear if taking Xifaxan is safe while breastfeeding or pregnant. In some animal studies, Xifaxan caused malformations in fetuses of animals taking Xifaxan, but there aren’t any studies on the use of Xifaxan in human pregnancies to determine its safety.
• You might need to avoid other antibiotics while taking Xifaxan since taking multiple antibiotics can negatively impact your gut and might worsen your diarrhea.
• Xifican can be used up to two more times after your initial treatment. After three different times of being treated with Xifican, your healthcare provider might recommend a different medication.
• Cyclosporine and warfarin might interfere with Xifaxan, so you should ask your healthcare provider what you should do if you’re taking these and are prescribed Xifaxan.

Should Xifaxan be taken with food?

Xifaxan can be taken with or without food. If you’re experiencing nausea, you should take Xifaxan with food or a glass of milk to help reduce stomach upset.

What is the best time to take Xifaxan?

You should take doses of Xifaxan around the same time each day, allowing 12 hours between twice-daily doses or around eight hours between three-times-daily doses. 

It doesn’t matter what time you take Xifaxan, just aim to keep it consistent during the duration of your treatment. 

Avoid taking two doses of Xifaxan close together, which can interfere with how effective it is, and may worsen side effects.

How to reduce the side effects of Xifaxan

The most commonly reported side effects of Xifaxan are nausea and an increase in liver enzymes. 

While an increase in liver enzymes can’t necessarily be prevented, you can help reduce the side effect of nausea by eating small meals throughout the day, eating a bland diet, and taking Xifaxan as prescribed. Avoid taking doses of Xifaxan too close together, which can worsen nausea.

Any other safety concerns? 

• Taking antibiotics like Xifaxan can increase your risk of getting an infection called C. difficile. C-diff can cause intestinal inflammation and severe diarrhea. If you experience worsening of your diarrhea while taking Xifaxan, contact your healthcare provider to rule out C. diff.
• Taking Xifaxan with severe hepatic (liver) impairment can increase the side effects of Xifaxan.

Conclusion

Xifaxan is an antibiotic used to treat traveler’s diarrhea and irritable bowel syndrome with diarrhea and to reduce the risk of hepatic encephalopathy (a complication of liver disease).

The foods to avoid while on Xifaxan will vary depending on the reason you’re taking it but generally can include: fatty foods, high-sugar foods and drinks, alcohol, high-sodium foods, undercooked meats, and grapefruit.

Foods to eat while on Xifaxan include lean protein and probiotic-rich foods, bland foods, along with any other foods tolerated, given your health condition.

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