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!