It has been two months since I started seeing Dr. Bowen at Bothell Natural Health and got serious about the Specific Carbohydrate Diet, SCD. I was on pretty much a ground meat and baby food diet for over a month but finally in the last few weeks have graduated to somewhere between Phase 2 and 3 of SCD and am eating quite a bit more food and actual real meals. Is it all SCD or is it also acupuncture?
Category Archives: SIBO
Small Intestine Bacterial Ovegrworth, or SIBO, is a chronic bacterial infection of the small intestine that I have been dealing with since the fall of 2013. These are not necessarily bad bacteria and are typically beneficial bacteria but they have moved up from the colon into the small intestine where they interfere with digestion and damage the lining of the intestine causing leaky gut syndrome and possibly auto-immune disorders. In my case I quickly developed a severe gluten and casein intolerance, peripheral neuropathy in my feet and malnutrition/vitamin deficiencies that contributed to a sharp drop in weight.
Symptoms of SIBO include abdominal bloating and pain, constipation or diarrhea, and a feeling that one is basically allergic to food, especially carbohydrates. Many other symptoms are also possible depending on the severity. With leaky gut one can have fatigue, food sensitivities, headaches, and “brain fog”, I had all of these at the beginning. With malabsorption syndrome one can have weight loss, I lost close to 35 pounds in a matter of a few months. If left unchecked SIBO can lead to many auto-immune disorders or fibromyalgia.
SIBO is found with a lactulose breath test which measures the levels of hydrogen and methane in your breath. These gases are not created by our human cells and can only be present if bacteria are producing them. The test, spaced at 20-minute intervals over a 3 hour period can pinpoint where the bacteria are located in the small intestine.
SIBO is typically treated with one or more rounds of antibiotics, usually Rifaxamin and, if you have methane producing bacteria, Neomycin or Flagyl. These antibiotics were too strong for me and I was in the unlucky 10% that experience severe side effects and I had to stop taking them before the full course was done. Instead I had to use multiple rounds of herbal antibiotics – AlliMed and Neem Plus – to start to drop the bacterial levels. I have also been using Metagenics CandiBactin-AR and -BR as well as FC-Cidal, Dysbiocide, ADP and Berberine HCL from Biotics Research. Diet is also important in controlling SIBO and one must stick to a low FODMAP version of the Paleo or Specific Carbohydrate Diet. The diet that worked best for me was developed by Dr. Allison Siebecker at the SIBO Center in Portland and it is SIBO Specific based on a low FODMAP version of SCD.
Some resources for those dealing with SIBO that I have found helpful include:
- SIBOInfo.com – site maintained by Dr. Allison Siebecker
- Natural Functional Medicine – site of Dr. Melanie Keller, also of the SIBO Center, who I see via Skype.
- SIBO: Often-Ignored cause of IBS – good overview article by Drs. Siebecker and Sandberg-Lewis of the SIBO Center.
- Sibo Support Group – We Cured It and So Can You on Facebook
- SIBO Discussion/Support Group on Facebook
- Western Washington SIBO Support Group – Facebook group for a local SIBO support group I am trying to put together. We are trying to meet once a month locally. If you want to join, send an invite from the page and I’ll add you assuming you live in the Puget Sound region.
SIBO App – I developed this iOS app in conjunction with Dr. Allison Siebecker of the SIBO Center. It includes an interactive version of her SIBO Specific Food Guide which can be searched, sorted and filtered. Free on the AppStore.
The following blog posts cover my ongoing journey with SIBO from the beginning.
How running long distance has helped me cope with illness
Hard to believe that only a few years ago I was running trail marathons in sandals and even ran a 50k ultra marathon. Last year I was out of running much of the year due to a hamstring tear and just when that began healing and I was able to start ramping up mileage again I came down with SIBO and hit a downward spiral of health issues stemming from my gut problems. Now I’m totally sidelined from running, or much activity at all, since I’ve lost over 20 lbs and am still dealing with malabsorption issues.
The Zen of carrot prep
In the last five or six weeks pureed carrots have become my comfort food. They are one of a handful of “safe” foods that I have at this point. They are the only vegetable included in the SCD Intro Diet and are something I eat daily and go back to when my gut starts flaring up. Recently I’ve realized that preparing my carrots is also a good practice for me, it is very meditative.
I now start my carrot practice at the nook table overlooking the back yard and the river. I place my cutting board on the table, a big bowl to hold the peels, my peeler, knife and about five pounds of carrots. Step one is peeling al the carrots mindfully to remove all the peel and be able to use as much carrot as possible. Step two is cutting the smallest amount of ends off the carrots. Step three is chopping the carrots into 1″ pieces and placing them in a pressure cooker. Once all five pounds of carrots are in the cooker, I go to the stove, add water and pressure cook for one hour. After the pressure has dropped I open the cooker and proceed to puree the carrots in two batches in the food processor and transfer the puree to containers for the frig. Five pounds of carrots lasts me about 2-3 days so I quickly get to repeat the practice.
Finally, some variety in my diet
Real food for once
It has been a little over a month now on my baby food diet. It started out pretty basic but in the last few weeks has expanded somewhat and that has been great. First though, we moved in the middle of all this GI mess which is something I would not recommend. Between the general stress of moving and the amount of activity needed for the move I managed to drop three more precious pounds during the week of the move. Once we got through the big push I’ve been trying to take it easy, rest more, and shove in more calories than I’m expending each day. The rest and a bit of added fats have helped and I managed to put back on 1.5 pounds in the last three days.
New faith in SCD
It has only been 18 days since I was lying in the ER at Evergreen Redmond thinking that I just was unable to eat anything at all without my gut turning against me and causing me nothing but grief. Two days later after finding out the doctors at Puget Sound Gastro had given up on me I sat sobbing at the Bothell Natural Health clinic waiting to see Dr. Christine Bowen who had become sort of my last hope. Dr. Bowen got me back on the Intro phase of the diet, minus dairy, I’d started back in January, the Specific Carbohydrate Diet, SCD. SCD was popularized but Elaine Gottschall’s book Breaking the Vicious Cycle which is appropriately named since I was indeed in a vicious cycle that needed breaking. This time she wanted me to do it right with only eating ground meats, baby food vegetables, fruit sauces and lots of gelatin. I was skeptical but Dr. Bowen wasn’t. She said she’d seen SCD turn people back from the grave and that the diet definitely worked if followed precisely, something I didn’t do the last time I started it. She said we could change the microbiom of the gut in a day and get me back into balance. Her faith rubbed off a bit and I gave it a shot.
Do I still have SIBO or not???
Today I got the results back from my most recent breath test from March 9th. The way I felt the day I took the test and the way I’ve felt off and on since I was expecting things to look much worse than they did back in January when I was showing between 33-44ppm CH4 from my breath, that is a fair bit of methane to be exhaling. Well, today the results showed that I’m actually doing much better. In fact, good enough that according to most doctors I would not be classified as having SIBO any longer. Dr. Pimental, however, uses a different standard and says than any CH4 over 3ppm anywhere in the chart is a sign of SIBO since we just should not be producing methane on our own. That means my friend, Methanobrevibacter smithii, is probably still roaming around in my SI though in about 1/4 to 1/5 the quantity than before.
My Un-FitBit
As part of this whole SIBO mess I found myself using multiple tools to track symptoms, food consumption, and bodily functions. I started out using the My Wonderful Days app which was pretty nice since it worked on iOS and OSX but that meant manually figuring out all my calories for all the foods each day. It also had no graphing capability so I had a big Numbers spreadsheet stored in iCloud too that I would move weight, calories, sleep hours, etc… from the journalling app into so that I could see a chart. Lots of work.
Back to baby food…
Yum, pureed carrots
What a week I’ve been through and it is only Thursday. My gut has been a wreck for almost the last month since I tried the antibiotic treatment but it hit a new level of crisis over last weekend. I was prepping for a new SIBO test on Sunday morning and had to eat a protein and fat only diet for two days as part of the prep then fast for 12 hours plus the 4 hours for the test. On day 2 of the meat and fat diet I actually felt good, I figured that with no carbs to ferment my gut had settled down. I ate dinner, chicken drumsticks (my mistake) and some halibut, and a few hours later the bloating, churning, waterfalls, and pain were in full force. Sleep was nearly impossible due to all the intestinal distress I was in.
SIBO Update – confusion reigns
Meet Methanobrevibacter smithii, the little bastards that have been causing me a ton of grief for the last several months. This guy eats up hydrogen from other bacteria and then emits methane gas. I finally got my actual breath test results back the other day and I’m emitting 0ppm H and 33ppm CH4 at baseline with a peak of 44ppm after about an hour which means that these guys, as well as some other bacteria, are living somewhere in my small intestine where they don’t belong. This is a mild to moderate case of SIBO, I’d hate to see what a severe case of SIBO is like because mild totally sucks.
The SIBO Saga Continues…
After my meeting in Portland with Dr. Siebecker on Feb 6th I was pretty confident that I was going to be able to kick this thing in short order. We had arrived in Portland on the 5th and I found out that my breath test came back positive for SIBO and that it was all methane producing bacteria that were present but a low level of them. The treatment protocol that Dr. Siebecker, Puget Sound Gastro and Dr. Pimental from Cedar-Sinai all agreed upon was 10-14 days of a mix of 1650mg Xifaxan and 1000mg of Neomycin. The dual combo was needed to fight the methane producing bugs.