Swedish Egg

Swedish Egg

Tuesday, May 16, 2017

SIBO Spaghetti Squash Shrimp Scampi

Before the spiralizer was invented, few food sensations could compare with the firm, toothy bite of well-cooked pasta. But there was always one exception: spaghetti squash.

Some of you may remember this unusual vegetable from your mother's Weight Watcher days. It's an oblong, yellow melon-shaped squash with golden flesh that separates into long, spaghetti-like strands after cooking. Unlike 'real' pasta, however, spaghetti squash is low in the kind of carbohydrates that feed SIBO bugs, making it a perfect food for you and me.

Spaghetti squash is more nutritious than pasta, too. A one cup serving provides vitamins and minerals including beta carotene, vitamin K, niacin, folate, calcium and iron. Plus a pinch of protein (1 gram) to boot.

But perhaps the best thing about this tasty vegetable is the cool factor. It's super easy to prepare, and it's fun to make.

Are you sold yet?

No, I don't own stock in a spaghetti squash operation. I just had one of these babies hanging around all week, so I decided to make SIBO Shrimp Scampi. Didn't follow a recipe or measure, so the amounts listed below are estimates.

Here are a few Recipe Notes.

Instead of butter, I used chicken fat-and-drippings (aka sauce) from a pot-roasted chicken. This is a uniquely flavorful ingredient I sometimes have on hand. Whenever I roast a chicken, I always pour off and save the sauce in a clean jar in the refrigerator, where it forms a thick layer of fat on top and keeps for a week or two. If you happen to have any of this precious elixir in your fridge, do use it in this recipe! Otherwise, butter will do.

I used frozen shrimp but there's no reason not to use fresh. The quantity of shrimp you'll need really depends on their size, as well as your appetite. Each spaghetti squash serves two people, so in terms of shrimp, use what you need.

If you're wondering how to make the "spaghetti", it's easy! Just drag the tines of a fork across the cooked innards of your squash, and watch the magic happen.

Finally, you'll notice an optional clove of garlic in the recipe below. Please opt out if you are new to SIBO eating or flaring. Garlic contains both fermentable carbs (FODMAPs) and sulfur compounds, a deadly combo when it comes to gas and bloating. I avoided garlic like the plague during my first two years of SIBO eating, and am only just now re-introducing it, once in a while and in tiny quantities for that hit of flavor. Garlic-infused oil is a decent substitute for fresh garlic if you want the taste without the FODMAPs.

And now....the recipe. Bon appetit!

SIBO Spaghetti Squash Shrimp Scampi

Serves 2


1 spaghetti squash
10-12 whole frozen pre-cooked shrimp, thawed
1 Tbs butter or chicken fat
1/2-1 cup chicken broth
3 Tbs chopped chives or green onion tops
1 small clove garlic, grated or pressed (optional, only for those in gut-stable mode)
pinch Himalayan salt & pepper to taste
2-4 Tbs parmesan cheese


Cut spaghetti squash in half lengthwise, use a spoon to scoop out and discard seeds. Place prepared halves, cut side down, in baking dish filled with about an inch of water. Bake at 350 degrees for 45 minutes or until fork tender. Remove from oven to cool. Each half spaghetti squash serves 1 person.

Melt butter in saucepan, add shrimp and sauté for about 3 minutes. Add chicken broth (more or less depending on how large the shrimp are—this will be the sauce), garlic (if using), chives, pinch of salt and a grind or two of black pepper. Simmer, covered for 5 minutes.

Fun part: While scampi simmers, place each half cooked squash on individual dinner plate (shallow bowls are ideal) and use a fork to scrape spaghetti strands from squash, right onto the dish. You should get about 2 cups spaghetti per each half squash.

When scampi is done simmering, divide shrimp in two portions and arrange over spaghetti squash mounds. Spoon sauce over top and sprinkle with grated parm.

Monday, May 8, 2017

SIBO Snack Pack

Because eggs are one of my safe foods, I have found gently hard-boiled eggs to be a satisfying and safe snack during all stages of treatment, including maintenance. Olives as well, just not too many.

When flaring or just starting out with the diet, it's best to stick with cooked SIBO-safe foods, as they are easiest to digest. After advancing to eating raw vegetables (generally 2-3 months in for most folks), you can enjoy a yummy DIY snack pack like this!

Clockwise from top left: organic baby rainbow carrots, hard boiled egg (free-range, local), organic cherry tomatoes, Greek olive medley, guacamole.

Wednesday, April 5, 2017

Hot Salad Bar

Unless you prepare it yourself, in your own kitchen, you can never be sure if a dish or a meal is going to be totally SIBO-safe. And then there's life in the real world, where restaurants exist. Newbies are wise to dine at home for a while as they get symptoms under control and adjust to a new way of cooking and eating. Fortunately, that phase doesn't last forever!  I've been on this journey long enough to feel comfortable taking a few risks with eating out. In general, I find salad bars and hot bars a pretty good bet. Today's lunch-on-the-go features sauteed vegetables, chicken salad and a ripe avocado-tomato medley. Besides needing to pick out the sautéed onions, the selection was near perfect. Thank you Maple Farms in Hadley, MA. It was delicious!

Monday, April 3, 2017

Fiber & Constipation: The Dirty Truth?

Since 19th century health nut Sylvester Graham (the “prophet of bran bread”) began espousing the nutritional and moral superiority of whole vs refined grains, Fiber has assumed a central role in medical lore as essential for healthy digestion and elimination.

Today, whenever issues of constipation come up, one of the first questions you get asked is "Are you eating enough fiber?" Ironically, often, the answer is "Yes!" Many people suffering from irregularity eat extremely high fiber diets. (As a former raw foodist, I myself was an excellent example of this unfortunate phenomenon.) In such cases, adding more fiber is rarely a solution. On the contrary, experience leads many people with bloating symptoms to develop a near mortal fear of fiber (think of the incredible expanding psyllium seed, and other "bulking" agents that threaten to blow your intestines up to monstrous proportions).

At any rate, in response to anecdotal evidence challenging the value of fiber for bowel health, investigators have begun asking: What if fiber isn't the constipation cure-all it's promoted to be? Research designed to answer this question, ended up with remarkable results, as evidenced by the following title:

Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms.
[Ho K-S, et al. World J Gastroenterol. 2012 Sep 7; 18(33): 4593–4596]

Here's the scoop on what went down.

Sixty-three constipated adults between the ages of 20 and 80 (median age 47) were enrolled in the study referenced above. All subjects went on a 2-week fiber-free diet. Afterwards, if they had found the fiberless plan to be beneficial in terms of constipation relief (which all of them did), they were asked to remain on as low a fiber diet as possible.

Six months later, a follow-up was performed. 41 of the patients had remained on a no fiber diet, 16 on a reduced fiber diet, and 6 had resumed their high fiber diet for religious or personal reasons. And guess what? Those in the first two groups reported significant improvement in their symptoms, while the few who went back to a high fiber diet remained as constipated as ever.
A classic "zero-fiber" meal: Roast Chicken

Patients on the zero fiber diet got the best results, improving from an average of 3.75 days between bowel movements (sound familiar?) to just 1 day (the dream!) Results for the 16 low-fiber dieters were mixed, but most people in that group also started having daily poops.

To read the entire study, click here. Below are some of my favorite quotes from the paper:

"This study has confirmed that the previous strongly-held belief that the application of dietary fiber to help constipation is but a myth."

"Constipation is often mistaken by the layman as the state of not passing stool, with the subsequent false notion that making more feces will allow easier defecation. In truth, constipation refers to the difficulty in evacuating a rectum packed with feces, and easier defecation cannot possibly be affected by increasing dietary fiber which increases bulky feces."

"It is well known that increasing dietary fiber increases fecal bulk and volume. Therefore in patients where there is already difficulty in expelling large fecal boluses through the anal sphincter, it is illogical to actually expect that bigger or more feces will ameliorate this problem. More and bulkier fecal matter can only aggravate the difficulty by making the stools even bigger and bulkier. Several reviews and a meta-analysis had already shown that dietary fiber does not improve constipation in patients with irritable bowel diseases."

"The role of dietary fiber in constipation is analogous to cars in traffic congestion. The only way to alleviate slow traffic would be to decrease the number of cars and to evacuate the remaining cars quickly. Should we add more cars, the congestion would only be worsened. Similarly, in patients with idiopathic constipation and a colon packed with feces, reduction in dietary fiber would reduce fecal bulk and volume and make evacuation of the smaller and thinner feces easier. Adding dietary fiber would only add to the bulk and volume and thus make evacuation even more difficult."
All this is GREAT news for those of us C types following a SIBO-safe diet! (Since fiber is the Great Fermenter, there is very little of it in a good SIBO protocol.) However, everyone has a different body, and a different response to food. I get terrible bloating from whole grains, but do find that a little "bulk" can sometimes push a stool through. However, I always try to keep it in the realm of the less-fermentable starchy vegetables (carrots, winter squash), sometimes Jasmine rice, and occasionally, Lundberg rice cakes.

What's your experience been with fiber and constipation. I'd love to hear about it in the comments below!

NOTE: Thanks to Dr. Norm Robillard for pointing me in the direction of this groundbreaking study. To learn about Dr. Robillard's work, visit his digestivehealthinstitute.com.


Saturday, January 14, 2017

Ginger Tea

A nice cup of freshly brewed ginger tea.

If you suffer from digestive problems like SIBO or IBS, you really must learn how to make ginger tea, one of the kindest drinks ever invented to help calm, warm and comfort your tummy.

Ginger is a first class anti-inflammatory, so it helps to soothe irritated tissues in the intestines and throughout the body. Ginger also has warming and stimulating properties. Ginger tea is well known to aid a sluggish digestive system, and also is effective for reducing nausea due to pregnancy, motion sickness and other causes.

Nothing could be easier than making ginger tea from freshly grated ginger root. Simply use one teaspoon of ginger root (grated or minced) per cup of water, and follow either of the two methods outlined below. A thumb-sized chunk makes 2-3 cups.

A thumb-sized chunk makes about 3 cups of tea.
It's probably a good idea to peel off the ginger skin before grating. If you don't have time, at least scrub the piece you are using to remove traces of outer contaminants. Peeling is essential if you are using conventionally grown ginger, but even organic ginger root should be scrubbed clean. Always discard moldy bits first.

Use a box grater for speed, and don't mind those fibers.
*Remember to use approximately one teaspoon grated ginger per cup of water.* That's basically all you need to memorize, and you've got this recipe dialed in.

Quick Method: Place grated ginger in a mug, mason jar or teapot. Pour boiling water on top. Steep 5-10 minutes, strain and drink. The longer it steeps, the stronger the tea.  

Slow Method: Place grated, minced or thinly sliced ginger in a pan, add water, bring to a boil, reduce heat and simmer, covered, for 20 minutes.

Depending upon how long it steeps or simmers, you often can get a second batch of tea out of previously used, once-steeped ginger root. I've also been known to add this soggy ginger to soups, smoothies and marinades, for a little extra zing. And because waste not, want not.

Enjoy ginger tea plain, or with a squeeze of lemon. If desired, you can also sweeten it with a SIBO-safe sweetener, such as stevia, Lakanto or a touch of raw honey (a touch means 1/2 teaspoon). Just be careful on the honey--not the best choice during a flare, or during early stages of the SexySibo diet, due to high content of fermentable fructose. That being said, honey-lemon-ginger is an outrageously satisfying drink and perfect for colds and sore throats, too.

Note: It might seem more convenient to brew ginger tea using pre-made tea bags, but besides this beverage neither tasting as spicy nor having equal medicinal value as fresh ginger root tea, consider this.

A 2010 study reported that powdered ginger may be "naturally contaminated' with several mycotoxins, aflatoxins and something called ochratoxin A. (I never heard of that one before, either.)

Researchers steeped tea bags containing powdered ginger in hot or boiling water, and analyzed the resulting tea for contaminants. They found that up to 40% of the toxins present in the powdered ginger migrated into the tea, especially the aflatoxins and ochratoxin A. The most toxins ended up in the tea made with boiling vs lukewarm water, contradicting my intuitive feeling that because boiling water kills germs, tea made with boiling water must be safer.

I'm not suggesting that all powdered ginger and ginger tea bags are contaminated with toxins, but after reading that study, I'm sticking with fresh. Fresh ginger is by no means immune to contamination, but when you start with an actual root, you can see what you're working with. I prefer organically grown ginger that is firm to the touch, with a taut skin. Store it loose or in a paper bag in the refrigerator. Ginger that appears soft or moldy, with brown or blue spots, should be discarded.


Iha MH and Trucksess MW.
Aflatoxins and ochratoxin A in tea prepared from naturally contaminated powdered ginger.
Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2010 Aug;27(8):1142-7.

Wednesday, December 7, 2016

Hydrochloric Acid: SIBO Wants You.

Here's a trick question for you. We all know the acronym SIBO refers to an overgrowth of bacteria, in a place it does not belong (the small intestine). But how and why did that bacteria overgrow there in the first place? The answer is: it depends.

Many cases of SIBO are caused by infection. Some nice person traveling in South America catches a stomach bug, and the next thing you know, they’ve got post-infectious IBS and SIBO. For others (*blush*) it’s long-standing IBS with chronic constipation that gets the ball rolling. And then there’s that little-discussed culprit: eating disorders. The research may be scant, but in my personal experience, as a clinical nutritionist and through my involvement with various IBS discussion groups and boards, it appears that many SIBO sufferers have experienced anorexia, bulimia or binge eating. (You can count me in there, too. Full disclosure.)

Eating too much too fast isn’t good for anyone, but it’s especially problematic when what goes in doesn’t come out. Folks with eating disorders seem to develop IBS or other digestive problems across the board. Those who develop acid reflux are often prescribed drugs like Proton Pump Inhibitors (PPIs) to inhibit hydrochloric acid production (makes sense, right?). But, surprise! People taking PPIs are at high risk of developing SIBO.

The thing is, not only do we NEED hydrochloric acid to properly digest our food, we need it to digest (i.e. kill) germs. Stomach acids help to maintain proper gut pH levels in the gut and subsequently prevent the overgrowth of pathogens and bad bacteria. The less gastric acid we produce, the more alkaline our GI tracts become, and the more likely that Small Intestine Bacterial Overgrowth will follow.

Reduced acidity in the stomach may be caused by PPIs and antacid drugs like Tums, but that's not all. Low stomach acid also results naturally from the normal decrease in gastric HCl production that occurs with age. And low stomach acid essentially cripples the antimicrobial effects of healthy gastric phase digestion. Bacteria, parasites and yeasts that survive gastric phase digestion due to low levels of hydrochloric acid go forth, thrive and multiply in the warm, dark moist environment of the small intestine. 

Meanwhile, poorly broken down food particles (notably carbohydrates) that linger in the small intestine without sufficient acids and enzymes to digest thembut plenty of bacteria to frolic withundergoes fermentation. Fermentation inside the closed tube of the intestine creates trapped gas, and from there you get symptoms such as pressure, stabbing pain, increased feelings of fullness, embarrassing flatulence and belching.

Hello, SIBO.

Now for the good news. You can boost your hydrochloric acid levels by taking a Betaine HCL SUPPLEMENT. Betaine HCL comes in tablets or capsules, and it’s not expensive. Look for a product like this one that delivers 750 mg or so per pill, and ALWAYS TAKE WITH FOOD. Betaine HCL will help boost protein digestion, increase vitamin and mineral absorption, lower gastric pH and kill off bad pathogens in your stomach and upper GI tract.

Dosing Betaine HCL is a bit of an art. To find out the actual dosage that’s right for you, start by taking one pill per meal. Then, increase your dose gradually, day by day (2 pills per meal, then 3 pills per meal, etc.) until the point where you start to feel a slight burning sensation in your gut. That is the sign you’ve reached your tolerance level. Once you’ve determined your tolerance level, drop back to the next level down and take that many going forward. (Or you can just do what I do: use your intuition and, depending on the size of your meal, take 1, 2 or 3.)

Geeky Note: Isn’t it weird to think that hydrochloric acid, one of only six strong acids on earth, is made INSIDE of our bodies? And that it can be contained in a pill, which you can safely put in your MOUTH?! Click here to see what HCL does to an apple...

Tuesday, September 13, 2016

Leaky Gut and SIBO: Are they BFFs or not?

A lot of people (like me) who end up with SIBO just started out with plain old IBS. Studies have found that anywhere from a meager 10% of IBS patients all the way up to a whopping 84% (hel-lo!) will test positive for intestinal bacterial overgrowth. Not all people with IBS get SIBO, therefore, but if you have SIBO, you pretty much are guaranteed to have IBS. SIBO and IBS go together like outlaws in love.

Lots of people with IBS also test positive for increased intestinal permeability—sometimes referred to as gut barrier dysfunction, and commonly known as "leaky gut syndrome."

A leaky gut situation results from chronic irritation, inflammation and immune activation in the GI tract. Alcohol abuse, aspirin and other drugs, toxins, trauma, synthetic food additives, food allergies and food intolerances (think gluten, casein, even potatoes) are some possible causes of leaky gut syndrome.

Anyway, the other day I was wondering if I have leaky gut. My thinking was that if both leaky gut and SIBO are common in people with IBS, leaky gut might be common in people with SIBO, too. Makes sense, right? But evidently, the association is not that straightforward.

A 2009 study titled The Relationship between Small-Intestinal Bacterial Overgrowth and Intestinal Permeability in Patients with Irritable Bowel Syndrome (Park JH, et al. Gut Liver. 2009 Sep;3(3):174-9) looked into this very question.

Researchers compared the digestive tracts of 38 people with IBS and 12 healthy controls without IBS. All subjects were tested for both SIBO and leaky gut, and the results were surprising.

Yes, incidence of leaky gut was higher in subjects with IBS, as expected. However, in those people with IBS, the presence of leaky gut was NOT correlated with the occurrence of SIBO.

The researchers stated, "no significant difference in intestinal permeability was observed among the patients with IBS-D, IBS-C and IBS-A". [Note: A=Alternating Diarrhea and Constipation, but sometimes called M for Mixed.] In other words, leaky gut was equally common in IBS of all types.

Not so with SIBO. The researchers had expected SIBO and leaky gut to go together like cheese and crackers, but contrary to expectations, no significant difference in leaky gut occurrence was observed between those IBS patients with SIBO, and those without.

Take home message: If you have SIBO, 
you may or may not have leaky gut syndrome, too.


If you want to find out if you actually have leaky gut, you can take a test such as the famous Lactulose/Mannitol urine test—in use since the mid-1970s and available from places such as Genova Diagnostics. The test is pretty basic. You drink a pre-measured amount of two sugars, lactulose and mannitol, in solution, and then pee in a cup at 30-minute intervals over a 6 hour period. Typically, only mannitol, the molecularly smaller of the two sugars, is rapidly absorbed by villi in a healthy, intact small intestine, after which it is excreted in urine. The chunky disaccharide lactulose molecule is too large for normal villous absorption, and therefore should not show up in the urine, unless it managed to "leak" through the intestinal lining due to swelling, inflammation and weak gut barrier function. So depending on how much lactulose appears in the urine, leaky gut is there or not.

A nice cup of bone broth, with herbs.
If you DO have a leaky intestine, your next step is deciding how to address it.

It goes without saying that numero uno is maintaining your diet upgrade and continuing to avoid all the fermentable sugars and starches that feed SIBO bugs.

In addition, I suggest you consume bone broth made with marrow bones or meaty bones (not cartilaginous joint bones) and either drink a cup daily, or use the broth regularly in your cooking.

Leaky gut or not, bone broth is deeply nourishing for the intestinal lining.

Next, consider supplements. Interestingly, some of the so-called "top supplements" for treating leaky gut syndrome are verboten, or at least highly questionable on a SIBO-friendly diet. FIBER supplements? No, thanks! PROBIOTICS? A big question mark for SIBO peeps. (We already have too many bacteria in our guts—much of which may be the right bacteria, but in the wrong place—so adding in more doesn't necessarily make a whole lot of sense.)

But there are a few SIBO-friendly supplements that I really do like for treating leaky gut syndrome. Two favorites are L-Glutamine powder and Hydrolyzed Collagen powder—supplements that can be stirred into water and taken daily to help heal your inflamed intestinal lining. I also recommend taking digestive support with meals, both to help promote proper food digestion and breakdown, and to help minimize the chances of large undigested food particles traveling too far down the digestive tract where they can interact with and irritate your gut lining.

L-Glutamine is an amino acid that directly enhances gut barrier function and protects the endothelial cells lining your small and large intestines. Glutamine has been shown to help support the rapid turnover, healthy reproduction and maintenance of these cells. Glutamine also has an anti-inflammatory effect on the gut lining, to help further promote healing.

Collagen is a short chain protein, or peptide, that occurs naturally throughout the body as a building block of connective tissue. Collagen peptides are present in hair, skin, nails, bones, joints, cartilage and the endothelial cells lining both vascular and intestinal tissues. Collagen contains high levels of the amino acids proline and glycine which, along with L-glutamine, are critical players in repairing a damaged intestinal lining.

Digestive Enzymes supplement the function of your pancreas, an organ designed to secrete digestive enzymes every time we eat. Pancreatic enzymes are required to help us break down fats, proteins and carbohydrates. However, pancreatic function decreases with stress and age, and many of us just don't produce a sufficient quantity to do the job. Taking supplemental pancreatic enzymes or plant-based digestive enzymes can make a HUGE difference in how well you digest your meals.

Betaine HCl is a form of hydrochloric acid (HCl). Hydrochloric acid is naturally produced in the stomach to initiate protein digestion and to kill pathogenic microbes every time you eat, but again, production decreases as we age, or may be impaired by medications such as proton pump inhibitors prescribed for reflux. Many people with IBS and SIBO have hypochlorhydria, a fancy term for low stomach acid production. Taking extra helps.

I have not been tested for leaky gut syndrome and don't know if I have it, but I am currently taking a few supplements to help support digestion and promote intestinal comfort. Since readers often ask what I personally am eating or taking to treat my SIBO, I'm sharing this short list with you in friendliness, not as a prescription. (For a prescription, please email me to set up an appointment!)

Pancreatin Select is a broad-spectrum digestive enzyme that contains pancreatic digestive enzymes along with extra lipase, ox bile, digestive bitters and betaine HCl. It's fantastic. I take one or two per meal. And I'll take an additional capsule or two of straight up Betaine HCl if I'm eating a large protein meal. These two supplements are fantastic for increasing digestive power and vitality.

I also just started taking a Hydrolyzed Collagen supplement which, surprisingly, tastes awesome—kind of like whey protein. I'm hoping it will help fortify my gut lining, but other researched benefits include stronger bones, stronger joints and improved skin tone and texture, so we'll see how that goes!

Finally, I've been enjoying a drink of GI Select at least a few times a week. This product combines L-glutamine with other gut healing ingredients, comes in a powder you mix with water and tastes like lemonade. I find it to have a very soothing effect on my gut while being refreshing and hydrating. (Drinking enough water is always an issue for me, so anything that makes water taste better gets two thumbs up from Sexy Sibo.)