Veggie Soup with Rice (& Shrimp)

Once you know how to make your own chicken stock and bone broth, you can start making your own super delicious, gut-healing soup-based meals. You can even start living on these soups, like I do. What's not to like about wholesome, easy and reliable fare?

Here's my modus operandi:

Step 1. Start with the broth you've stored in fridge or freezer. Add SIBO-safe veggies like peeled zucchini or summer squash, mushrooms, bell peppers, baby spinach or Swiss chard, and green herbs like parsley. Simmer for 15-20 minutes or until the veggies are soft,  remembering to add in tender leafy greens only in the last few minutes of cooking. Voila! Veggie soup!

Step 2. Season to taste with herbs of choice, sea salt and black pepper. Or stir in some Thai red curry paste to make it fancy.

You can eat this soup as is, or add more substance and nutrition if you like. Try Jasmine rice & shrimp, like I did here, or get creative with your bad self. Any combination of Option A and Option B below is sure to please.

Option A. Add STARCH as 1/4 cup uncooked Jasmine Rice per serving and simmer for 20 minutes until done. This will soak up a lot of broth and create more of a stew feeling, as pictured here. (Note: I always cook just enough rice for one meal because after rice has cooled, it develops resistant starch, a leading cause of fermentation and gas symptoms. Fresh is best. Same goes for other starches like potatoes.)

Option B. Add PROTEIN as your choice of peeled frozen shrimp, organic eggs, sliced chicken or other meat. Feel free to use up any leftovers here, or start with uncooked animal protein and just simmer until done.

Option C. Add Jasmine rice and protein AT THE SAME TIME!!! (omg)

Step 3. When your soup is done, pour it into your bowl and top with finely chopped fresh cilantro, scallions or other green leafy herb to make it look and taste fresh and pretty. A squeeze of lemon or lime is nice, too.

That's it! Bon appetit!

White Chocolate Coconut Cups (Fat Bombs)

A year ago I would NEVER have made this recipe! I was eating a low fat, vegan, whole foods plant based diet—about as far away from a ketogenic, Paleo-inspired diet as you can get. The idea of eating a “fat bomb” would have made me laugh out loud, if not gag.

Then came SIBO.

Technically, these cute little treats are called “fat bombs”, not a pretty name. I prefer White Chocolate Coconut Cups. Doesn’t that sound nicer?

Backstory. I discovered fat bombs when scouting around online for a sweet treat that wouldn’t feed my archaea and aggravate my SIBO. The treat I was searching for needed to be grain-free, sugar-free and low in fermentable carbs.

Most of the fat bomb recipes I've come across are made with a base of coconut oil, which is fine, but I prefer to use cacao butter, which is the pure fat of the cacao bean.

Cacao butter is rock solid at room temperature but melts instantly upon contact with the human body.

It also tastes lovely, providing the aromatic essence of chocolate without any fiber or caffeine. Cacao butter is the key ingredient in so-called "white chocolate", hence the name of these adorable coconut cups.

In case you're wondering where to find Raw Cacao Butter, try The Raw Food World online, a super sweet family-run business. That's where I get mine.

As you can see, I use a fancy high tech kitchen scale (pictured at left) to weigh it out. Then, I melt it in the toaster oven on the lowest possible bake setting: 150 degrees Farenheit. You can also use a double boiler to melt cacao butter but please, don’t use a microwave. Microwaves alter the molecules in your food in unnatural, cancer-causing ways. (If you don't believe me, read this.)

By the way, if you don't have a kitchen scale, just chop up the cacao butter and measure it instead. 3 ounces equals about a half a cup chopped -->

According to my research, the purest fat bombs are made only with 2 main ingredients:

1) a fat (usually coconut oil)

2) a sugar-free, zero-carbohydrate sweetener such as stevia, erythritol or monkfruit.

Some recipes call for Sucralose/Splenda but I wouldn't touch that scariness with a 10-foot pole, let alone my lips. Not to be overdramatic, but really. Just, no.

For the sweetener in this recipe I used Golden Lakanto, a combination of monkfruit and erythritol. Lakanto, available in white or golden, is currently sold online only, as far as I can tell. The golden tastes quite nice—brown sugarish with no nasty aftertaste. It is kind of hard to get, though. If you can't find Lakanto, try organic erythritol, a pure sweet tasting, non-fermenting polyol (sugar alcohol) that's sold at Whole Foods under the somewhat unfortunate brand name "Zero." Zero erythritol is what I put in my tea these days. It's a white crystalline sweetener offering plain, slightly cool sweetness and is 100% SIBO-safe, as well as non-poisonous (e.g. sucralose, aspartame) and a little less pricey than Golden Lakanto. But I digress...

Anyhoo, here's a secret: I’ve been experimenting with making fat bombs for a while—adding whey protein isolate to make them chewy, spicing them up with cinnamon, ginger, vanilla extract and essential oils like lemon, orange and tangerine. But I haven’t shared any of those recipes because, to be honest, so far they haven’t been THAT great.

But...I got a little crazy yesterday and decided to make some über-fancy fat bombs with shredded coconut, pumpkin seeds and sunflower seeds added. BE ADVISED: nuts and seeds are not recommended when you are first starting out on a SIBO-safe diet.

I avoided all nuts and seeds like the plague over the entire summer, i.e. for two or three months while I was on my strict ketogenic healing program, and I’m NOT planning on eating them regularly now. But for a treat, IF you can limit yourself to one or two AND you’re out of the woods with the bloating (very important point), you might like to give these babies a try. They really are pretty darn good!

White Chocolate Coconut Cups (Fat Bombs)

3 ounces raw cacao butter (about ½ cup roughly chopped, 1/3 cup melted)

1 teaspoon coconut oil

3 teaspoons Lakanto or erythritol (Zero)

½ cup shredded coconut

¼ cup each raw pumpkin seeds & raw sunflower seeds

¼ teaspoon sea salt or Himalayan pink salt (my fave)

DIRECTIONS: Melt cacao butter in a low oven or double boiler. Stir in coconut oil and Lakanto. Add shredded coconut, pumpkin & sunflower seeds, and salt. Mix well. 

Divide mixture evenly into the 12 cups of a silicone mini muffin cup mold, or if you don’t have one of these (I just got mine at Bed Bath and Beyond—it’s awesome!), turn the mixture onto a sheet of wax paper, shape it into a log and roll it up. Refrigerate or freeze for 20 minutes to harden. If you did the log method, slice into 12 circles, or as desired. The mini muffin mold cups just pop right out!

Variation: Replace the coconut, pumpkin seeds and sunflower seeds with about ½ cup of whey protein isolate or Pure Paleo protein powder, vanilla or chocolate flavor.  This is a good option for people on Phase 1 of SIBO-safe diet. Note: The exact amount you need to add will vary depending on the consistency of your powder. Just start stirring it in one tablespoon at a time until the mixture starts to thicken up enough to divide into the mini muffin cups or roll into a log. Then, chill as above and enjoy. :)

Sexy Sibo White Chocolate Coconut Cups (aka Fat Bombs!)

Breakfast of Champignons

What I really wanted this rainy Saturday morning was a muffin. A whole grainy Morning Glory muffin packed with raisins, walnuts and grated carrots and zucchini. The kind I used to love before I learned that grains were not my friend.

I knew where to get one, too. In fact, I was THIS close to getting in my car, 2nd Street Bakery bound, when...

I got saved. What saved me were two things. 1) The honest knowledge, based on experience, of how crappy I'd feel for the rest of the day (if not longer) if I introduced wheat into my body for breakfast. And 2) the knowledge that I could make myself a delicious, savory breakfast WAY more satisfying and digestible than some dumb old muffin with its sweet secret promises of pain and noisy farts to come. 

I had everything in the fridge for a veggie and cheese omelet. I made it, I ate it, I enjoyed it and my belly feels like a million bucks. Full, but functional. Going out for the whole day now and I won't be hungry till dinner. Feel like a champ. Mind over matter rocks. 

Mushrooms rock, too. Surprisingly nutritious and immune enhancing. Perfect for fall. Beats a flu shot any day.

What's in my bowl:

Portobello Mushroom & Cheddar Omelet

(made with 2 local pastured Eggs, Raw Goat Cheddar, Portobello Mushroom, Orange Bell Peppers, Roasted Garlic & Chard)

Organic Wild Mushroom Chicken Sausage

Avocado garnish. Yum. 

Romaine-inspired Tuna Boats

Often, the hardest thing to wrap your mind around when starting a SIBO-safe diet is the “no bread” conundrum. Gluten or not, bread shows up often (if not in every, single meal) for much of the population. What in the world could possibly take its place?

Enter Romaine, one of my top bread replacements. True, all large-leafed green leafy vegetables can be used to wrap, layer or stuff toppings into and on. Swiss chard and collard greens are two others that come to mind. But as far as I’m concerned, Romaine rules.

Romaine lettuce is crisp and juicy, with just the right hint of saltiness and a trace of sweet. It enhances the experience of any sandwich made with bread, and as a stand-alone, is a perfect foil for fillings of all ilk. Romaine is also incredibly easy to digest, especially when compared to leafy greens in the Brassica family such as kale (watch out!) or even collards.

Think Romaine in place of sushi wrapper, taco shell or tortilla and proceed as usual. Or, if you’re eating nut butters, try this: spread a tablespoon of almond butter, peanut butter or tahini down the soft centerline of a fresh romaine leaf. Drizzle with honey, fold the sides over to make a packet and then munch. You’re in for a sweet surprise!

The photos on this page showcase Romaine lettuce in action today, playing the role of Boat in a quintessential summer luncheon favorite: Tuna Boats. (The term “tuna” is used loosely here: these green boats are actually stuffed with salmon salad, made with natural mayonnaise, lemon juice, parsley, scallions and dill.) Just use your favorite tuna (or salmon) salad recipe and you’re in business.

Note: Even though it’s not bad enough for the Dirty Dozen, always buy organic Romaine. Lettuce is one of the most heavily sprayed vegetables in the supermarket. Bon appetit!

Tuna Boats with Timi Hendrix, world's sweetest lunch buddy.

Eating out with SIBO: Road Food

Clouds over Mass Pike, enroute to Lenox in 2013, my early SIBO days.

There are two ways to go on a road trip with SIBO. 1) Be prepared. 2) Wing it. 

If I'd gone with Option One, I'd have packed myself a nice cooler filled with assorted hard cheeses, 2 or 3 freshly hard boiled eggs and some low-FODMAP veggies like blanched green beans, sliced zucchini and raw carrot sticks to snack on. 

Instead, I left for Montreal with no food in the car and did the best I could with Option Two. 

Four hours into the 5-hour drive, I filled up with gas in Swanton: last stop before the border. It was after 1 PM and I hadn't eaten anything yet all day, so I ordered what I call a "deconstructed sandwich" at the service station sub shop. For protein, the choice was between egg or tuna salad. I went with egg.

A "deconstructed sandwich" means you ask to hold the bread, and then keep it simple—lettuce, tomato and black olives, in this case. Not the highest quality vegetables here, as you can see, but the impromptu salad plate pictured above did the trick.

Coming home, I fared a little better after accidentally getting diverted off the main highway into Stowe, Vermont. Right off the ramp I lucked out with Maxi's, an all-day breakfast joint.

Maybe the waitress was quizzical when I ordered, but the kitchen did a nice job with this customized Spinach and Mushroom Scrambled Eggs (hold the onions, no home fries, no toast, please). They had several good-looking omelets on the menu, too, but only the scramble came with spinach.

If I'd wanted more on my plate, Maxi's also serves bacon and sausage. But again, "keep it simple" is my rule, as well as "minimize the meat" when possible. Besides, standard issue bacon likely contains sugar and no doubt is chemically cured. As for what comes in a roadside pork sausage, your guess is as good as mine. But (organic aside) it's hard to go wrong with cheddar, eggs and fresh veggies.

Happy trails...

xo Diana

The Main Idea: Ketogenic Healing and a No-Bloat Food List for Meaningful SIBO Reduction

Remember those reading comprehension tests in grade school where you had to identify the Main Idea of a story? That question always bothered me. The best stories have lots of main ideas! Narrowing it down to just one didn’t make sense.

Because I was an advanced reader, I only attended Second Grade for a couple weeks before the adults decided to skip me up to Third. Unfortunately, matronly Mrs. Williams, my new 3^rd grade teacher, was a mean old beast and I was bullied on the playground by all the bigger-than-me girls. I had to go last at everything. “Respect your elders!” was the rule.

I pretty much cried my way through 3^rd grade, so my parents took me out of the crowded New Rochelle public school system and off I went to Riverdale. (This is the Riverdale that Carly Simon attended, not the one with Betty and Veronica.) At the time, Riverdale was co-ed only through the 4^th grade. After that, school tradition dictated that boys and girls be separated, all the way through to 12^th grade graduation.

Interestingly, when I started Riverdale it was 1968, meaning cultural values were changing and sex segregation was on the outs. By the time I hit eighth grade, the entire school became fully coeducational for the first time.

But in 5^th grade, my class was all girls and at some point in Spring, we had a special event. A heavy, lumbering film projector and squeaky expandable screen were wheeled into our small classroom and, with window shades pulled down and door closed tight, we got to see a movie!

The movie was called It’s Wonderful Being a Girl.

It’s Wonderful Being a Girl featured two new teenagers, Libby and Jane, and their experience around getting their periods. Mostly, the flick was about using menstrual napkins and how great they were. (I guess tampons weren’t invented yet, or maybe the sponsors of the film only made pads.) My favorite take-away from the entire short film was that a hot shower really helps when you feel crampy. This is true!

It’s also true that I was only 9 years old in 5^th grade. Menarche was in the far distant future for me. So when the lights came up and our pretty, dark-haired teacher invited those of us with any personal questions about our bodies to come up to her desk for a private discussion, my question didn’t have anything to do with puberty. I did have something kind of embarrassing about my body that I thought maybe Mrs. Begelman could help me with, though.

“Sometimes I get a little gas bubble in my butt,” I confided, “and I don’t know what to do when that happens. It makes a funny noise when it comes out, and sometimes it even smells bad.”

To her credit, Mrs. Begelman succeeded in suppressing a nascent smile before responding. Her advice, basically, was that I just let the “gas bubble” come out. “Better out than in,” she said.

What’s remarkable about this story to me is two things. First Remarkable Thing: I didn’t know the word “fart” in fifth grade! What the hell?

Second, if intestinal gas was already a concern of mine by age nine, it can be assumed that IBS-C goes way back in my history.

I’m not sure which of these remarkable facts is the main idea—they kind of go hand in hand.

Anyway, when I started the Sexy Sibo blog, my main purpose was to chronicle my personal experience in dealing with—and hopefully solving—the digestive disorder which has plagued me for, evidently, decades. My primary goal wasn’t to “share my expertise,” let alone “hold forth” to my audience. But it is also true that I have some expertise to share, both as a person with lifelong digestive issues and as a trained clinician with a Master of Science degree in human nutrition who indulges a voracious appetite for research.

I’m not yet an expert in SIBO, though. No one really is, as each person with SIBO is so unique. Trial and error is the only way. But maybe my trial can save you some error down the road. That’s what I’m hoping for. We’re all in this together!

What I’ve been learning about SIBO is turning my world, and my diet, upside down. I started out in January (five months ago) giving up my vegetarian diet and embracing an approach that I believed would work, which I wrote about here.

This dietary approach was a great place to start, but ultimately it didn’t do enough. I’m talking about the classic SIBO-safe diet (per Dr. Allison Siebecker, et al.) consisting of:

• animal protein (eggs, fish, seafood, poultry, beef)

• lactose-free dairy (aged cheese, 24-hour yogurt, heavy cream)

• healthy fats (coconut oil, EVOO, butter)

• low-FODMAP vegetables

• low-FODMAP fruits (including bananas, berries, oranges, pineapple)

• honey

• nuts and seeds (small servings)

• treats: dark chocolate, peanut butter, potato chips, blended frozen banana “ice cream”

• rarely: low-FODMAP starches (potatoes, rice, gluten-free bread/crackers)

It turned out that this diet was successful in significantly reducing the belching and farting that had previously accompanied me through life 24/7, which was great. But my motility didn’t improve, and my uncomfortable belly distension, i.e. bloating, continued. Not surprisingly, the more I strayed into the fruits, “treats” and “rarely” segments of the above list, the worse my suffering.

So last week, I decided to try something new: a 3-4 day “ketogenic” diet, followed by a stricter version of the above. A friend of mine on Facebook suggested this to me, and guess what? It worked! For the first time in over a year: no bloat. It’s a miracle.

Actually, though, it’s not a miracle. It’s just common sense. Bloating comes from gas. Gas comes from microbial fermentation of sugars and starches. If you don’t eat sugars and starches, the microbes don’t have anything to ferment. If the microbes don’t have anything to ferment, they can’t make gas as a byproduct, hence no bloating. Keep the sugars and starches out for long enough and eventually, the microbes will die off.

It’s that simple. In fact, I’d say it’s even the main idea in understanding SIBO:

If you don’t feed your SIBO, your microbes don’t eat and you don’t bloat. As long as you have bloating, you are not making a dent in your SIBO reduction.

So what the hell is a ketogenic diet, you might ask. A ketogenic diet (keto for short) means you stop using glucose as the primary energy source for your body by taking all sugars and carbohydrates out of the diet. In this way, you force the body to get its energy from fats which produces “ketone bodies”, a breakdown product of fatty acids burned as an alternate energy source when glucose is not available.

The process is called ketosis and, despite all the hype on the internet about keto diets, it’s not really a great idea to do long term. Metabolic acidosis and a weird fruity kind of bad breath, known as “acetone” breath, are two reasons. (Acetone is a type of ketone.)

Short term, however, a ketogenic approach can be very healing for people with digestive disorders because it removes all fermentable foods (sugars and starches) from the diet, cutting off gas and bloating at the source.

Practically speaking, a keto diet for SIBO means you only eat animal protein, fat and cooked low-FODMAP green vegetables. (Always avoid salads and raw veggies when your gut is inflamed—they won’t help.)

My SIBO Keto Diet List looks like this:

• animal protein (eggs, fish, seafood, poultry, beef)

• lactose-free dairy* (aged cheese, heavy cream)

• pure fats (coconut oil, EVOO, butter)

• low-FODMAP GREEN vegetables (spinach, chard, bok choy, zucchini, green beans)

*If you want to try this diet, include dairy only if tolerated. I am lucky in that hard, aged cheeses digest beautifully for me, especially raw milk cheese from goat or sheep milk. I only use heavy cream in small quantities, for coffee or tea. Plain lactose-free yogurt with no additives (24-hour yogurt or Greek style) also could be on the list but I don’t do as well with yogurt, so I’m keeping it out for now. The cheese is a lifesaver, though!

My plan was to do this for 3-4 days but when I woke up the morning of Day 4 with a flat stomach for the first time in maybe a year, I didn’t want to stop! So today, I am essentially on Day 10 of this very low carb approach. I’ve had a small salad twice and have tested two low-FODMAP orange veggies—roasted butternut squash and raw grated carrots—once each. I did okay with both but am not in a rush to repeat. Even though the squash tasted SO SWEET my tongue thought it was in heaven, I think it’s good to keep coming home to baseline. It feels safe at baseline and I have to say, I really like not having symptoms!

Jasmine rice might be the next thing I test. But (referring back to the original list) I’m going to stay away from most everything below the low-FODMAP vegetables line, including most fruit with a few exceptions (lemons and limes for sure, and possibly avocado and coconut which I will test when I am solidly symptom free.)

So for those of you who are still reading, here’s my new food list for the next three months. By the way, this list functions in tandem with Dr. Norm Robillard’s Fast Tract Digestion: IBS system, a quantitative approach which utilizes the fermentation potential (FP) values of different foods to reduce IBS symptoms. Dr. Robillard is the one who figured out the FP of Jasmine rice is zero, making it safe for many SIBO peeps.

No-Bloat Food List for Meaningful SIBO Reduction

• animal protein (eggs, fish, seafood, poultry, beef)

• lactose-free dairy (aged cheese, heavy cream, 24-hour or pure Greek yogurt)

• healthy fats (coconut oil, EVOO, butter)

• low-FODMAP vegetables: primarily cooked, mostly green plus some orange

• Jasmine rice (limit to ½ cup serving per meal)

• lemons and limes

• allowed sweeteners: liquid stevia drops, pure stevia, erythritol

With this plan, I hope to make some REAL progress in getting my symptoms and my SIBO under control. It sounds tough, but actually, it’s not so bad. To paraphrase Kate Moss, “Nothing tastes as good as symptom-free feels.”

I guess that’s the point for me, the bloody Main Idea, if you will: I want to feel better ALL THE TIME. Feeling better calls for figuring out through trial and error what works, and being mature enough to actually do it.

This is where I’ve gotten stuck, repeatedly through the years. The maturity thing. I’m a rebel at heart. I don’t like to follow rules, even rules I make for myself.

But I’m not a kid anymore. I’m not like Libby and Jane, navigating a turbulent adolescence. Au contraire, I’m the mother of two young men in their 20s! A full-grown woman who hasn’t had a monthly cycle since October! I’m navigating menopause now, and the sea is calming. I love myself and I want to heal. I think I’m finally ready. Wish me clear skies, fair winds and a steady rudder, will you? Wish me bon voyage, and feel welcome on board.

xo Diana

Slow Cooker Braised Beef

I’m in love with my new old Crock Pot. I bought it at a neighbor’s Memorial Day yard sale for $3 (recipe book included!) and we are having so much fun getting acquainted.

I’m a total newbie to slow cooking since: a) even though I grew up in the 1970’s, my family didn’t own a Crock Pot, and b) my former vegetarian, frequently raw food diet didn’t have much use for such a tool! But dealing with a mid-life case of SIBO now, all I can say is WOW: what a perfect kitchen appliance for folks who must base their diets around meat and vegetables! Especially those of us who work outside the home, since the slow cooker makes it possible to leave the house for hours and come home to dinner. Genius.

According to the official Rival companion recipe book that came with my bargain find, there are multitudes of dishes—even desserts—that can be made in a slow cooker. But so far, I like it best for stews and braises.

Braising is the process of simmering vegetables or meat in a small amount of stock or seasoned broth. It’s one of my favorite cooking methods, even in a regular pan. Using a Crock Pot makes the whole thing totally fuss-free.

This very simple recipe contains only the safest of SIBO-specific foods: low-FODMAP green vegetables and naturally-raised beef. These ingredients provide, essentially, zero fermentation potential, meaning NO BLOAT. Yay!

Suitable for those on ketogenic diets, Slow Cooker Braised Beef is also GAPS-friendly, SCD-legal and Paleo in spirit. (Cavemen did not cook in Crock Pots, so I can't say it's Paleo in practice, lol.) 

Best of all—besides being fuss-free and bloat-free—it makes a delightfully satisfying meal.

Slow Cooker Braised Beef

with Parsley & Green Vegetables

Cooking Time: 4 hours

Number of Servings: 2

Ingredients

2 cups chopped green vegetables 

        (I used: 1 sm. zucchini, 2 heads baby bok choy and a fistful of fresh parsley. Other options: green beans and/or swiss chard.)

3/4 to 1 LB grassfed stew beef, cut in cubes

1.5 cups vegetable stock

1 bay leaf

salt, pepper, dried oregano & thyme

additional parsley for garnish

Directions

Chop green veggies and add to the bottom of your slow cooker, like this:

Place cubed beef over the vegetables and pour stock on top. Sprinkle the beef with salt and fresh ground black pepper. Crush dried oregano and thyme between your fingers to release their aromatic oils as you sprinkle these on top of the beef, too. Nestle bay leaf in the center. 

Cover crock pot and set to 4 Hours (High). When done, stir well to moisten meat and marry flavors. If desired, shred the beef before transferring to serving bowl. Garnish with fresh chopped parsley and an additional pinch of dried thyme. Bon appetit!

NOTES: I chose to cut my vegetables small so they would virtually melt into the stock, creating a flavorful, savory, mineral-rich sauce to serve over the cooked beef. If you prefer to have bigger chunks of vegetables in your bowl, simply chop zucchini, etc. in larger pieces.

Using only low-FODMAP green vegetables makes this dish 100% SIBO-safe at any stage of healing, and an ideal recipe for flare recovery. If you are further along in your progress and can tolerate higher carbohydrate vegetables, consider adding half a cup of thinly sliced yellow or orange veggies such as delicata squash, butternut squash or carrots for added texture and color.

Eating out with SIBO: Breakfast (Veggie Scramble with Hollandaise)

 

One of the hardest times to have a digestive disorder is when you go out to eat. Until you figure out how to navigate a menu (hint: side dishes are your new BFF) and get comfortable asking the waitron to Hold Everything (well, not quite everything!) restaurant dining can be daunting. So I thought I'd share some Sexy Sibo tips and start a new feature here on the blog: Eating Out with SIBO.

Today's topic is Breakfast. The first meal of the day is super easy to enjoy outside the home if you tolerate eggs and lactose-free dairy because eggs, low-starch vegetables and aged cheese are all legal on the SIBO-specific diet. You just have to remember NO BREAD, and in the early stages, NO POTATOES. This means you can enjoy omelets and veggie scrambles (with lots of veggies, or a side of greens, please) to your heart's content. Add uncured bacon or sausage if available, and you are so inclined.

Eggs Benedict can be ordered without the English muffin. I know it sounds funny, but just ask for a nice, thick slice of tomato on the bottom. Or do what I did here: Put on your nicest smile and order the Veggie Scramble, no toast, no homefries, hold the red onion, substitute tomato and add a side of Hollandaise. (Don't worry about Hollandaise sauce: it's just an emulsion of egg yolk and liquid butter, plus SIBO-safe seasonings: lemon juice, salt, pepper.)

The wonderful folks at Bread & Butter, a wonderful new breakfast joint in Amherst, MA, didn't bat an eye when I ordered this up the other day, and it came out just how I wanted, perfectly scrumptious.Yay!

As for your hot beverage, go with black coffee, black tea or herb tea. (Some restaurants do have heavy cream in the kitchen and will share upon request. Heavy cream contains only 3% lactose and is tolerated by lots of SIBO peeps, so ask for it if you like! Otherwise, stick with black.)

Bon appetit!

Fasting therapy - a solution for IBS?

People with SIBO put a lot of focus on food. Figuring out the Right Diet that will allay symptoms for good, once and for all, is basically our Holy Grail. I've talked about this a bunch, like in this earlier post about creating your own list of safe foods to eat. But what if not eating anything at all for a while was the answer?

In an article entitled "Effects of fasting on irritable bowel syndrome" (Kanazawa M, Fukudo S. Int J Behav Med. 2006;13(3):214-20), a study is described where fifty-eight patients with IBS were divided into two groups. One group was given prescription meds and psychotherapy to reduce their symptoms. The other group fasted for 10 days, drinking only water. To break the fast, food was reintroduced in a controlled manner over a 5 day period.

 

Results? The 10-day fasting group did better. Fasting was found to significantly improve 7 out of the 10 symptoms assessed: abdominal pain-discomfort, abdominal distension, diarrhea, anorexia, nausea, anxiety and "interference with life in general" (love that symptom). Drugs and psychotherapy improved only 3 symptoms (abdominal pain-discomfort, abdominal distension and interference with life.)

 

The researchers concluded that fasting may have beneficial effects on intractable IBS. "Intractable" would include those of us for whom IBS has advanced to SIBO, I fathom.

In my former life, I juice fasted on a regular basis (consuming only green juices and/or veggie juices with lemon and green apple added for flavor and sweetness, see photo above.) A 3-day fast was sufficient to give great results in the bloating department, although I remember feeling gassy was still a problem.

 

Maybe juice fasting low-FODMAPs style would be a success. 

 

I hesitate to water fast, despite the great results reported above. Fasting on water alone is often not recommended for anyone. There are different reasons for this, such as potential to damage the intestinal lining due to lack of substrate for fiber-fermenting bacteria. (Hmmm...isn't that who we want to starve? I'm in a quandary.)

 

One popular SIBO therapy is to follow a 10-day+ Elemental Diet, which is essentially a modified fast with fortified liquid protein drinks taken daily. Supposedly they taste pretty nasty, though.

 

I'm having good luck doing a very simple, unflavored isolated whey protein shake in the AM, which I spike with powdered supplements including L-glutamine, quercetin and a powdered multivitamin/mineral. Now I'm thinking about doing some kind of fast, maybe drinking more of these shakes per day in place of meals, or adding in small quantities of low-FODMAP vegetable juices. Not sure, just contemplating. Would love to hear your thoughts.

 

Bottom line: Diet alone isn't cutting it.

And: Sometimes, no food is the best medicine.

New Starbucks non-dairy Coconut Milk vs Organic Soy Milk. Safe or not safe? You decide.

In case you didn't hear, coconut milk is now available at Starbucks. I snapped a pic of the ingredients panel when I went in there today, just to show you. 

It's great to see non-dairy alternatives offered in mainstream coffee shops. Unfortunately, this one contains a bunch of questionable additives, namely carrageenan (high FODMAP), two processed sugars (plain cane and corn dextrin), and three different kinds of gels, aka highly fermentable (gas-producing) soluble fiber sources.

For comparison, Starbucks organic soy milk only contains carrageenan, one sugar (organic evaporated cane juice), and no gums. But it's made from whole soybeans vs soy protein isolate, making it high FODMAP. 

Sigh. Looks like a classic case of "Six of one..." 

...But wait: Starbucks new coconut milk also fails the eco-sustainability test: not fair trade, not organic, sourced from Sumatran coconuts and flown halfway around the globe before making it into your venti.

Hmmm. Maybe organic soy milk comes out ahead in this round after all, with black coffee still in firm command of first and safest place. 

Great idea, though, Starbucks! Real coconut milk would be a welcome addition to your menu, so please keep trying!

Dinspiration: Swiss Chard 3-Way

If you’ve ever perused the vegetable section of the awesome Monash University FODMAP app and wondered what the hell “Silver Beet” is, here’s your answer:

Swiss Chard.

I don’t know why they call it Silver Beet down under and Swiss Chard up top but beets and chard are in the same family and the stem of the classic Swiss Chard is white, which is kind of silvery compared to red, the stem color of beet greens. 

However, modern Swiss Chard appears not only in classic white stem, but also in a panoply of Rainbow Chard colors—orange, pink, yellow and even a deep, beety red. So “Silver” Beet is somewhat of a misnomer, imho.

Anyhoo, Swiss Chard (plain old “chard” for short) is extremely low in FODMAPs, fully green-lighted in the Monash app and one of THE safest vegetables you can eat when you have SIBO (provided you don't also have kidney stones*, which hopefully you don't because ouch, and SIBO is bad enough.) Peak season runs all summer long so it’s definitely worth getting to know this veggie now in case you don’t already.

Chard is not only delicious but also super high in vitamins and minerals. According to WHfoods.com, it ranks second only to spinach, another cousin, in overall nutrient bang for your buck. (Chard, beets and spinach are all related to quinoa, too—what a healthy family!)

Chard is packed wth phytonutrients including detox-supportive betalains, cardio-protective kaempferol and blood-sugar regulating syringic acid, along with at least 10 other identified antioxidant polyphenols that double as anti-inflammatory compounds. Anti-inflammatory means gut-healing. SIBO + chard = a match made in heaven.

Chard leaves only take about 3 minutes to cook and are a bit less tender and fragile than spinach leaves, meaning chard exhibits much less shrinkage than spinach in response to heat. The stems are even sturdier, resembling a thin, flat celery stalk. Being more fibrous than the leaves, chard stems take longer to cook. To account for this fact, I usually dice up the stems and cook ‘em first for a minute or two before adding leaves to pot or pan.

Chard is coming into season this month so I’ve been eating it pretty much daily, in different guises. Here are three methods I like for preparing and enjoying the incredible Silver Beet, aka Swiss Chard.

1. Braised Chard (served here with "Classic Brined" Rotisserie Chicken)

In this first recipe, I simply simmered some chard in about an inch of homemade chicken broth. (Braising's just another word for cooking things in broth.) To try this at home, dice chard stems and cook for 2-3 minutes in simmering broth, then add chopped leaves, cover pot and simmer on low until wilted, another minute or two. Easy! 

After a long day at work, this quick and easy side dish added some fresh love to my pick-up meal, provided courtesy of Whole Foods Market where both the Plain and Classic Brined rotisserie chickens are made with SIBO-safe seasonings.

2. Sautéeed Chard (accompanied here by Pan-Fried Salmon with Dill)

In this flash-of-genius one-pan recipe, I saved myself some clean-up time by cooking salmon first in a medium sized cast-iron pan. When fish was done, I set it aside and cooked the chard right in the same pan over medium heat!

As always, cook diced stems first until they begin to soften, then add the leaves. I also tossed in a handful of fresh chopped dill and let that cook in for the last minute. 

To make salmon taste great, I start it off skin side down and pour some wheat-free tamari on the top, which causes a sizzle. Cook fish for first 5 minutes skin side down, then flip and brown the other side until done, another 5-8 minutes. Flip back to skin side down if more cooking time is required.

3. Scrambled Chard with Cheesy Eggs and fresh Chives

This was fun—kind of an easy “faux soufflé” or chard pancake. I admit it doesn't look too beautiful, but looks can be deceiving.

To make this dish, just fry up some chard in a little butter, diced stems first (you knew I was going to say that!) for a couple minutes, followed by chopped leaves. When leaves have turned bright green, add 2 beaten eggs per person to the pan. (I beat mine with a dash of wheat-free tamari or Bragg’s Liquid Aminos—very tasty.) 

Let eggs set for a minute, then flip, fold or scramble. When eggs look nearly done but are still slightly wet, add a tablespoon or two of grated hard cheese and some fresh chives if you have ‘em. (If not, use dried herbs of choice. Tarragon is GREAT with eggs, as is dill.) Wait until the cheese melts (you might do a final fold here), then plate and serve!

*Note: The only potential downside to chard is that it contains fairly high levels of oxalic acid, a compound that can bind to calcium, blocking its absorption. Calcium-oxalate stones may form in the kidneys of people who are sensitive to oxalic acid but it is not clear if dietary oxalate is a major cause of oxalate stones, and many foods contain it—not just chard, but also spinach, beets and quinoa (surprise!), rhubarb, berries and a bunch of others. While consuming oxalic acid-rich foods is not generally recommended for people with kidney or gallstone problems, research suggests that the amount of protein, calcium, and water you consume may influence calcium oxalate stone formation as much as, if not more than, dietary oxalate intake. This is good news for SIBO peeps who rely on animal protein as their #1 safe food, and hopefully are hydrating regularly. Cooking reduces the amount of oxalic acid in foods.

Sexy Sibo Word of the Day: Borborygmi (and some good news about erythritol)

Now here's a ten dollar word for you: Borborygmi

I'm not sure how to pronounce it, but the definition is "a rumbling or gurgling sound caused by the movement of gas in the intestines."

Sound familiar? 

I learned this fancy new borborygmi word from a study I was reading, comparing the digestive tolerance of sucrose (table sugar) with that of two polyols, xylitol and erythritol.

Xylitol (like most other polyols—sorbitol, mannitol, etc.) causes lots of gas, loose stools, borborygmi and other GI distress, as you may have found out the hard way. But erythritol, it turns out, not so much! Check it out:

"When consumed in water, 35 and 50 g xylitol was associated with significant intestinal symptom scores and watery faeces, compared to the sucrose control, whereas at all levels studied erythritol scored significantly less symptoms. Consumption of 20 and 35 g erythritol by healthy volunteers, in a liquid, is tolerated well, without any symptoms. At the highest level of erythritol intake (50 g), only a significant increase in borborygmi and nausea was observed, whereas xylitol intake at this level induced a significant increase in watery faeces."

In case you want to translate the above into practical terms, a teaspoon of erythritol (the one I've tried comes from Wholesome Sweeteners, under the brand name Zero) weighs about 6 grams. Meaning it is probably safe to use a teaspoon or two of erythritol in your tea or lemonade, for example, without it setting off your IBS/SIBO symptoms.

Sweet!

Have you tried erythritol? I'd love to hear how it worked for you. To me, it's got an interesting kind of sweetness—kind of cooling in the mouth. I think it works really well in drinks or foods containing cooling herbs like mint or cilantro, such as peppermint iced tea and cilantro vinaigrette. Still I feel a little nervous about it. I tend to stick with raw honey or a pinch of green stevia for sweetness, but I'm all for branching out. So it's nice to see some evidence suggesting that erythritol may be tolerable for SIBO.

:-)

REFERENCE

Storey D, et al. Gastrointestinal tolerance of erythritol and xylitol ingested in a liquid. 
Eur J Clin Nutr. 2007 Mar;61(3):349-54.  To read the study abstract, click here.

Saying grace.

Food gratitude (back in my raw food days)

Last week I did the math and realized I've been on a Sibo-Safe Diet for 3 months and counting. My main food during this time has been Chicken Soup. You might as well start calling me the Queen of Chicken Soup, because that's the way I feel. Like the Queen.

"Off with their heads!"

It's not just chickens, either. I'm also eating other kinds and parts of animals. Fish bodies, cow muscles...even (once or twice, ahem) parts of pigs, as in BACON. 

The weird thing is, I used to be a vegetarian. Not only that, but a high raw vegan. It's kind of freaking me out. WTH happened to me?

The answer is, of course: SIBO happened. It happens to a lot of people, including a lot of people who 'used to be' vegetarian.

I don't BLAME my vegetarian diet for SIBO. But I can see how over the years, in the absence of sufficient bowel motility to keep things moving along at a respectable clip, all those plant-based foods—rich in fiber, natural sugars and starches—contributed to the bacterial overgrowth situation.

It still feels weird to be consuming animal flesh. It's important for me to acknowledge that. Along with the guilt and shame I can't help but feel around it sometimes. At my core, I still believe in the ethical and evolutionary superiority of a flesh-free diet.

It was a tough coming to terms, allowing my paradigm to shift. But here's the thing: I got sick. And I want to feel better. I want to regain my vitality and zest, which was the promise of raw foods in the first place. Big raw salads, dried fruits & nuts, 16-ounce green juices, multi-ingredient superfood smoothies—they simply aren't right for me at this time. Just thinking about them makes me bloat.

Going forward, I want to figure out a way to include more living, fresh plant foods in my diet. I really do. But right now is a healing time. Cooked food is easier to digest. Fiber-free animal protein and pure fats don't feed microbes. That's just the way it is.

The best I can do is to feel gratitude for all the animals that gave, and will be giving, their bodies and bones for my healing.

It doesn't seem fair that any creature must die for another to live. Especially not a "higher" level, developed sentient being. But perhaps it is not a question of fair. It is just part of the Planet Earth paradigm. Eat or be eaten. Adapt or perish. Evolve or die.

For me, right now, eating to evolve involves bringing animal's bodies into my body. I will do my best to honor the sacrifice of these creatures by remaining conscious of the truth that they were once aware and breathing, just like me. I will do my best to choose only flesh foods from wholesome origins (even though organic/pastured/grass-fed meat and eggs are more expensive) as a sign of respect for the value of animal lives. And I will do my best to pause and say grace, to remember its life and bless the being whose body I am consuming... before, during and after my meals.

Blessed are all creatures of the earth. I humble myself and give thanks for each gift of sacrifice, taken so that I may be healthy. May all beings be happy.

Ridiculously Easy DIY Coconut Milk

Did you know how ridiculously easy it is to make your own fresh, delicious coconut milk? I mean the regular thin kind of coconut milk that stands in for cow or plant milk (i.e. almond milk, hemp milk, etc.)—not the thick, creamy canned stuff.

Well, let me tell you! All you need is two things: shredded coconut and water. Just blend them together in a 1:4 ratio (1 part shredded coconut to 4 parts water). Seriously, that's it!

I'm totally glad that store-bought coconut milk exists but it is far from a perfect food. Besides the fact of being a) produced in a faceless factory far away without love, b) heated to high temperatures that damage the healthy fats and other nutrients it contains, and c) packaged in a sterile box, commercial liquid coconut milk contains "other ingredients" that may not be ideal for SIBO sufferers. I'm talking here, primarily, about gums: a type of soluble fiber that feeds gut bacteria.

Shredded coconut itself in smallish amounts (1/4 cup per sitting) is generally safe for most SIBO peeps. But as for xanthan gum, guar gum, etc—not to mention the flavors, sweeteners and synthetic vitamins that often go into boxed coconut milk—maybe not so much.

Anyway, fresh-made is always better, naturally! So I am thrilled to report what a cinch this is to make! Plus it really tastes yummy and super coco-nutty. You must try.

The recipe below makes a small, 2 cup batch that can be enjoyed fresh and warm. If you want to make more, just increase the amounts, keeping the 1:4 ratio, and store in the fridge. Fresh DIY Coconut Milk should keep well for a few days, but expect it to separate after it sits a while—nothing a little stir 'n' shake won't cure.

Ridiculously Easy DIY Coconut Milk

Ingredients
2 cups water
1/2 cup organic shredded coconut

Directions
Heat water in a pan until it starts to feel warm to your finger. Put shredded coconut in your Vitamix* and pour the warm water on top. Blend on low speed for about 1 minute and high speed for 2-3 minutes. Pour through a stainless steel mesh strainer into a clean bowl and use the back of a wooden spoon to press excess liquid out of the pulp. (You can also use a nut milk bag if you like, that's just never been my style.)

Feel free to save the leftover pulp for another use (could be a nice sub for coconut flour in a SIBO safe muffin or pancake recipe) and enjoy your fresh coconut milk!

*If you don't have a Vitamix or other high speed blender, a regular blender will do—just expect the process to take a few minutes longer.

Article Review: SIBO Treatment Strategies by Aglaée Jacob

Aglaée Jacob, MS, RD is a French Canadian holistic dietitian specializing in the Paleo approach to digestive health. I've been following her work since 2013 when I first found out about SIBO, and have always appreciated her professionalism and attention to detail.

Today I'd like to share some highlights from an informative article by Aglaée on the Treatment and Management of SIBO, published in Today's Dietitian in December, 2012. I've underlined the parts that stand out to me for emphasis:

"SIBO and IBS symptoms are the same: abdominal distension, flatulence, cramping, diarrhea, and constipation. These digestive symptoms result from both the high osmotic activity and fermentation potential of incompletely digested and unabsorbed carbohydrates present in the small intestines."

In other words, bloating and distention are caused by accumulations of gas (the byproduct of bacterial fermentation) and water (drawn into the gut via osmotic activity) that build up in the small intestine. The presence of gas and water make your belly expand like a balloon. The reason this fermentation and osmotic activity happens is related to the presence of undigested carbohydrates in your gut.

"Both the gas produced by intestinal fermentation and the water drawn through osmosis can contribute to bloating in SIBO patients. The type of gas produced by the bacteria also seems to impact the motility of the intestines. Hydrogen-producing patients are more likely to suffer from diarrhea, while methane producers are more prone to constipation."

I'm super fascinated by the impact of bacterial gas type on motility. A C-type myself, I have long been a proud producer of odorless methane farts. Methane-producing bacteria get overgrown when slow transit time causes an overgrowth of hydrogen producing bacteria. But isn't it ironic (if not ingenious, from the microbe's point of view) that methane itself is a CAUSE of constipation. Why might this be?

"Research conducted by Mark Pimentel, MD, director of the gastrointestinal motility program at Cedars-Sinai Medical Center and author of A New IBS Solution, indicates that increased intestinal transit time associated with methane isn’t due to decreased motility but rather to hyperactive reverse peristalsis.[1]"

What the hell: hyperactive reverse peristalsis? Doesn't that sound a lot like "poop going in the wrong direction—with a quickness"? I need to learn more about this. According to the dictionary, "reverse peristalsis" also means "vomiting." Con-fu-sing! Note to self: further investigation warranted.

Anyway, the article continues with some basic dietary recommendations for IBS, specifically the strict avoidance of fermentable carbohydrates. This means a) following a low-FODMAP diet and b) further avoidance of all polysaccharides (grains and starchy veggies), even those which are considered lower in FODMAPs, until symptoms resolve:

"Digestive symptoms tend to significantly improve after SIBO treatment, but it’s important for patients, especially in the beginning, to avoid foods that can contribute to intestinal fermentation. Damage to the lining of the small intestines can impair secretion of brush border enzymes, such as lactase, sucrase, and maltase, according to SIBO expert Allison Siebecker, ND.[2] Undigested lactose, sucrose, and maltose (starch fragments) aren’t absorbed and can become substrates for intestinal fermentation. Restricting lactose, sugars, and starches can attenuate bloating and normalize bowel movements until the brush border is sufficiently healed to normally produce digestive enzymes again.[2]

"Foods containing FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) also can ferment in the small intestines and therefore should be limited if they induce symptoms in SIBO patients.[2] FODMAPs include fructose (eg, high-fructose corn syrup, agave syrup, honey, apples, pears); lactose (eg, milk and yogurt); fructans (eg, wheat, barley, rye, onions, garlic); galactans (eg, legumes); and polyols (eg, sugar alcohols, mushrooms, cauliflower, avocados, stone fruits)."

Beyond eating the right foods (for as long as necessary until healing has occurred) another recommendation for treating SIBO is to NOT eat between meals, also known as meal spacing. Meal spacing allows for proper functioning of the MMC (Migrating Motor Complex), a mechanical wave-like process that cleans out the small intestine between meals:

"One of the most common underlying causes of SIBO is the impairment of the migrating motor complex (MMC). The MMC corresponds to cleansing waves activated approximately every 90 minutes in the small intestines when fasting to prevent the accumulation of debris and excessive amounts of bacteria. Pimentel found that the MMC is decreased by 70% in SIBO patients.[1] Apart from snacking, stress also negatively impacts the MMC. Encourage patients to space their meals every three to five hours and better manage their stress to promote regular MMC activation and prevent SIBO from returning."

Eating too often throughout the day (the popular Graze Method) and high stress levels both impair the MMC. Meal spacing boils down to waiting at least 3 and preferably 4-5 hours after a meal before you consume any kind of caloric food or drink. This means only water (or another non-caloric beverage, such as unsweetened herbal tea) would be allowed. Such mini-fasts permit the cleansing wave of the MMC to push excess bacteria out of the small intestine.

Meal spacing is a strategy I try to apply consistently. Bonus: Meal spacing rests the digestive organs, increases energy and helps stimulate healthy appetite, adding to the pleasure and enjoyment of eating. As for stress management, consider deep breathing, meditation, yoga and exercise. A strong, metabolically active body and a calm, quiet mind are well worth cultivating, don't you agree?

Click here to read the Today's Dietitian (Vol. 14, No. 12, p.16) article, excerpted above, in its entirety.

Click here to visit the website of Aglaée Jacob, The Paleo Dietitian. (You really should. She's got sound advice, tasty recipes and great diet handouts available for free download, too!)

REFERENCES
1. Pimentel M. A New IBS Solution. Sherman Oaks, California: Health Point Press; 2005.
2. Siebecker A. Small intestine bacterial overgrowth: clinical strategies (webinar). September 17, 2011. http://ce.ncnm.edu/course/search.php?search=SIBO. Accessed September 25, 2012.

C difficile

A beautiful place to go.

I’m feeling frustrated this morning. Despite my dedicated AM hydration practice, my nightly magnesium supplements, my SIBO-specific diet and everything else, I am still C.

Backed up. Constipated.

For years I have been playing around with different strategies, different supplements and different herbs to help get me going. It’s not the funnest game in the world, but I seem to be stuck with it. Haha—no pun intended.

Back in my 20’s, I drank 8 ounces of lemon water every morning but that didn’t do jack. I tried it hot, cold and room temperature. No go. Coffee and a cigarette were more likely to induce a poop during that bygone era, but I don’t smoke anymore so that option’s out.  (As for coffee alone, in case you’re wondering: nada mucho.)

Another thing I’d do back in the day but only when things got serious (I once went BM-less for TEN DAYS, and I don’t mean half naked) was to make senna tea with real senna leaves that I crumbled into a teapot and covered with boiling water to steep for 20 minutes. That potent brew was highly effective in emptying my colon within 6-12 hours of drinking but the griping sensation (feeling of your entire insides coming out while doubled over with intense cramps) generally knocked me out for an entire day. Yuck.

Another in-a-pinch solution through the years (one upon which I still rely) has been to do an enema—the real kind, featuring a red rubber bag connected to a tube with a clamp and a plastic nozzle at the end. When done properly, a real enema offers tremendous relief. But it’s often followed, for me anyway, by knife-sharp stomach pains later that day and/or the next. The prospect of stabbing pain is a deterrent. Just saying.

And then, there is the encapsulated laxative category. Ah yes, laxative pills: The holy grail or the devil incarnate, depending on your perspective.

Personally, I've somewhat guiltily indulged in natural, stimulant laxative supplements from time to time but only in strict moderation, largely because I’ve been terrified of—God forbid— “becoming dependent on laxatives”. Laxative dependency is often framed as one of the worst things that can happen to you, ever, in your whole entire life. Because why? Because if you become dependent on laxatives, you won’t be able to go to the bathroom on your own anymore.

Um…HEL-LO. Go on my own? Anymore? What magic universe are we talking about here?

I mean, it would be REAL nice if I could go on my own on a daily basis. Find the true solution, the final answer, and become honestly, dependably regular. Sure. But this C business started when I was fifteen. We’re talking FORTY FUCKING YEARS.

At this point, I really have to wonder what would be so horrible about being “dependent” on laxatives? If Armageddon happens and I can’t buy my Colon Clean* at the coop anymore, I’ll deal with it then. Short of that, I really don’t care anymore! I can’t stand being backed up. I hate feeling bloated. IBS sucks. And SIBO is no barrel of laughs, either.

-------------INTERMISSION-------------

Okay. Done venting. Feel better now. Just needed to get that out, lol. Thanks for listening.

xo Diana

P.S. Don’t worry, I’m not giving up. There are still a few things I haven’t tried. Iberogast for one. I bought it a while ago, but I didn’t really give it a fair trial. 20 drops at bedtime. Maybe I’ll start tonight…

*Colon Clean is a great product by the way. They only sell it at River Valley Market and it really works. One or two caps at bedtime and (usually) voila!

Here’s what’s in it, per capsule:

Cascara sagrada bark     225 mg

Yellow Dock root               75 mg

Triphala                             50 mg

Oregon Grape root            25 mg

Licorice root                       25 mg

Gentian root                       25 mg

Ginger root                         25 mg

Treating SIBO with an herbal antibiotic protocol

Fresh oregano, a potent antimicrobial.

Because I am the kind of person who always prefers to use natural medicine whenever possible and because research indicates that herbal antibiotics may be as effective as prescription antibiotics in the treatment of small bacterial overgrowth, I decided to treat my SIBO with herbs.

After reading a ton of articles on SIBO treatment strategies and microbiome structure/function, I developed a protocol for myself. This was largely based on the recommendations of Allison Siebecker, ND (from her siboinfo.com website) and on a 2014 paper entitled Herbal Therapy is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth by Victor Chedid, MD, et al.

My program incorporated a biofilm disruptor and a variety of herbal antimicrobials. I also used a 2-part rotation protocol to keep the minions guessing. SIBO bacteria are smart little buggers. As sessile creatures (meaning stay-put surface colonizers vs free-living planktonites) they live within a self-generated biofilm: a flexible, slippery matrix composed of proteins and polysaccharides. Intestinal biofilm adheres to the gut lining and resists dislodgement (so that you don't 'evacuate the premises' every time you poop). Unless you break it down, you can’t get through to the bugs.

Biofilms aren’t all bad, mind you. They are what allow friendly flora, for instance, to reside happily in the colon and do their good work there—breaking down fiber, making butyrate, contributing to intestinal barrier function, etc. It's just that when you have SIBO, you’ve got biofilm-embedded flora in the wrong place.

To kill the overgrowth, you first need to disrupt the defensive biofilm shield, and for that, there are some excellent products. My favorite is InterFase™ by Klaire Labs, a potent enzyme formulation clinically researched to help degrade biofilm matrix and to degrade bacterial and yeast cell wall structures. InterFase basically breaks down the biofilm wall so that antibiotics can access their intended target, the SIBO bugs. You just gotta have it.

To kill the bugs themselves, I used two different herbal strategies. Bacteria are so damned good at mutating to develop tolerance to antibiotics. A rotation protocol cycling multiple products can help to inhibit their adaptive abilities.

Consider oregano, one of our best botanical antimicrobials. Even in its most concentrated form, Oil of Oregano, this powerful bactericide has been reported to “only work” for the first month of treatment—indicating to me that if you want to avoid developing a tolerance, a solid month of oregano may be too long. For enhanced efficacy, my thinking is to do a bait and switch, known clinically as a rotation protocol. Example: use Oil of Oregano for two weeks, then replace it with a different herb or comprehensive formula and cycle it back in at a later date if needed.

This is what I did. For a total of 30 days of treatment, I used InterFase™ all the way through, plus two different herbal antibiotic strategies for two weeks each. (The prescription antibiotic Rifaximin only requires two weeks of use, but studies suggest herbal ABx treatment requires double the length of its prescription counterpart to be effective, hence my 30-day program.)

I also took digestive enzymes plus Betaine HCl with every meal and followed a strict Level One SIBO diet. (No grains. No starchy vegetables. No high-FODMAP foods. Limited seeds and nuts. Chicken soup up the wazoo.) And I did everything I could to keep my bowels moving, using magnesium citrate, herbal motility support and an enema here and there, as necessary. C people: your bowels MUST move if there is ever to be healing.

That being said, here’s an outline of my herbal ABx program.

Sexy Sibo Herbal Antibiotic Protocol

Note: Take products together on an empty stomach, 20 minutes before food.

Week Zero: Preloading Titration Phase

Days 1-3                               1 cap, once per day: InterFase

Days 4 & 5                            1 cap each of the following, once per day:

                                                InterFase, Berberine, Oil of Oregano

Days 6 &7                             1 cap each of the following, twice per day (AM and PM):

                                                InterFase, Berberine, Oil of Oregano

Week One - Take the following, TWICE daily (AM and PM):

2 caps InterFase

2 caps Berberine

1 cap Oil of Oregano

Week Two - Take the following, TWICE daily (AM and PM):

2 caps InterFase

3 caps Berberine

1 cap Oil of Oregano
1 cap Allicillin (garlic macerate) or AlliMax

Week Three - Take the following, TWICE daily (AM and PM):

2 caps InterFase

2 caps CandiBactin-AR

2 caps CandiBactin-BR

Week Four + 2 extra days (for 30-day treatment total) -

Continue taking the following, TWICE daily (AM and PM):

2 caps InterFase

2 caps CandiBactin-AR

2 caps CandiBactin-BR

For at-a-glance products checklist, scroll to bottom of page.*

Please Note: For most of the time I was on the herbs, I felt like crap. Antibiotics are not known for causing gut ecstasy in general, but still, it was discouraging, especially since I continued to feel bloated, even on my ‘perfect’ diet. 

I will say, however, that for once in my life, I wasn’t farting up a storm. Basically I was having no burps and farts whatsoever. Even at night. Miraculous.

Finally on day 27, I started feeling better. (Day 27 out of 30, mind you!!) But at long last, feel better I did. This was a breakthrough.

It worked!

After 37 days (30 plus the preloading titration week) I was so happy to get off the pills. I stayed off them for two whole weeks. But I know from the way my gut feels now that I am not altogether cured. So a few days ago, I started again.

I’m still mixing it up. Keeping on top of the situation, which I believe is firmly entrenched, but not forever. I expect to need a few cycles of herbal treatment. And I expect to keep working with my diet, hydration and motility support for as long as it takes. Probably for life.

The GI doc I saw last winter told me that “refractory SIBO is VERY common” in her patients taking Rifaximin and other prescription drug treatments. Refractory means “it comes back.”

This makes sense. Unless you address the slow motility and reduce the starches, FODMAPs and anything else that caused the problem in the first place, your SIBO will come back. Guaranteed.

You just gotta keep fighting, is all. Be a calm belly warrior. Stay in it for the duration, for victory. To arms!

*Sexy Sibo Herbal ABx Products Checklist

o InterFase (Klaire Labs)

o CandiBactin AR & BR (Metagenics)

o Berberine Select (Moss Nutrition) or Berberine Synergy (DFH) - 400 mg capsules

o Oil of Oregano - 150 mg softgels (Moss Nutrition)

o Allicillin (DFH) or AlliMax or other high allicin garlic cap - 200+ mg capsules

Note: These products are all professional brand supplements, meaning they are intended for use only by practitioners and their patients. I like them because they are formulated by clinicians, based on research, manufactured in tightly controlled, GMP-compliant facilities and rigorously tested for purity and potency. (Safety first!) For details on how to access to these products, to schedule a FREE 15-minute Supplement Consult or to become my client, email me at eat2evolve@gmail.com.