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.