Hydrochloric Acid: SIBO Wants You.

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

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

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

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

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

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

Hello, SIBO.

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

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

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

Leaky Gut and SIBO: Are they BFFs or not?

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

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

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

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

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

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

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

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

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

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

Ha!

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

A nice cup of bone broth, with herbs.

If you DO have a leaky intestine, your next step is deciding how to address it.

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

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

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

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

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

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

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

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

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

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

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

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

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

xo

SIBO Green Juice ~ The Cat's Meow

Back in the day, I was a big juicer. Detox and juicing were, in fact, a major part of my whole nutrition program, which you can read all about on my old blog, Eat to Evolve!

Then came SIBO. Since my diagnosis a year and a half ago, I pretty much left raw foods and juicing behind. But not all juice is verboten on Sexy SIBO. Today, I'm plunging back into Juice Land with a scrumptious, 100% green, SIBO-safe juice that is knocking my proverbial socks off. You may like it, too. (Apparently Clyde does, and he's a super cool cat.)

Before

After

SIBO Green Juice

3 Lg peeled cucumbers

1 Lg head romaine lettuce

1 bunch cilantro

1 or 2 juicy limes

Run all ingredients through a juicer such as the Breville juice fountain. Makes one quart incredibly delicious, detoxifying green juice!

Drink your greens - I mean business!

Baby Spinach & Salmon Patties

This very simple dinner-for-one is quick to prepare and super delish! I'm having it tonight for the second time in a row, that's how good it is.

The recipe below makes one good sized patty. Double or triple amounts depending on number of mouths to feed. One tall can (14.75 oz) of canned wild pink salmon should make 3 good sized patties. If you're dining solo like me, keep unused portion of salmon in the fridge—ideally in a covered glass container to preserve flavor—and consume within 3-4 days.

Tonight, I served my Baby Spinach & Salmon Patty atop a simple shredded carrot salad, nestled alongside a sweet pile of fresh sliced heirloom tomatoes. The carrot salad was made with a peeled carrot, which I peeled further into shreds and then tossed in fresh lime juice with a dash of chipotle chili pepper plus a sprinkle of Herbamare seasoned salt for pizazz. Herbamare is one of my favorite salty condiments when it comes to dishes made with fish, eggs or avocado. (NOTE: SIBO peeps should always peel their carrots and other veggies, in order to reduce overall fiber content and avoid associated fermentation.)


Baby Spinach & Salmon Patties

1/2 cup drained, canned salmon
1/4 avocado, more or less (about 1 heaping Tablespoon, after mashing)
small handful of baby spinach, chopped
1 teaspoon lime juice
generous pinch each: black pepper, dill weed, cumin powder

Combine all ingredients in a bowl. Use a fork to mash gently until well combined. You don't want to oversquish the salmon, but rather strive to retain an essence of fluffiness.

Once well combined, form salmon mixture into a patty using your own two CLEAN hands. and fry in healthy fat of choice (a little bacon grease, butter, ghee or coconut oil) on medium heat, preferably in a cast iron pan if you have one, but stainless steel will do.

Flip patty after 5 minutes or so and repeat, to heat through and brown both sides nicely. Voila! Dinner is served :)

SexySibo Safe Foods List - Updated

It's been 16 months since I posted my original "Safe Foods List" in one of my first posts on this blog. Well, today I have a new Safe Foods List to share with you. Because Things Change.

This is something you, too, will discover, as you modify your diet and advance, stall or heal on this journey. Don't consider it a setback if a food you used to be able to eat without any problem suddenly starts bothering you. Be prepared to adapt. Dealing with SIBO is an ongoing and transformational challenge. Your diet will always be a work in progress. Just keep paying attention! When you stay in sync with the body's changing needs, you can keep symptoms at bay, feel a million times better and beat the bloat, one day at a time, every day. Oh, Yeah.

2016 *NEW* SexySibo 
Safe Foods List

animal protein
-eggs
-seafood (salmon, tuna, shrimp, cod, etc.)
-meat (beef, lamb, Paleo bacon, etc.)
-fowl (chicken, turkey, duck)
-bone broth & meat stock

cooked vegetables
-spinach
-chard
-zucchini
-carrots
-green beans
-winter squash (butternut, kabocha, acorn, etc.)

lactose-free dairy
-aged hard cheeses (best are those made with raw milk, and goat/sheep milk)
-full fat Greek yogurt (no added gums/pectins) or 24-hour yogurt (GAPS style) -1/2 cup serving
-heavy cream (no added gums/pectins)

safe treats & sweets
-dry wine
-distilled spirits (gin, vodka, whiskey)
-chubby checkers (see recipe on this blog!)
-non-fermenting sweeteners: monkfruit (Lakanto); erythritol (Zero); stevia
-lemon & lime juice

----------------------------------------------------

Second Tier Safe Foods - I avoid these if symptomatic, otherwise I do okay with them.

raw veggies (stick with cooked veg when symptoms are present!)
-lettuces of all types
-spinach
-carrots & baby carrots
-green herbs (chives, dill, cilantro, etc.)
-ripe tomato
-red bell peppers
-olives

fruits (not for every day, but nice every now & then)
-avocado (up to 1/4 medium avo. per meal)
-blueberries, other berries - 1/4 cup

Takra--an Ancient Ayurvedic Digestive Remedy

 
While discussing SIBO with a colleague who specializes in Ayurvedic medicine, I learned about an ancient digestive remedy known as "Takra" - loosely translated as "buttermilk". You make it by blending yogurt with with water until a foam forms on top, then remove the foam in stages until only liquid remains; then add spices specific to your dosha (Ayurvedic type) and health concerns. For IBS, a basic blend of black pepper, cumin, turmeric and Himalayan pink salt might be appropriate. Other recipes suggest coriander and ginger.

According to the website trueayurveda, "Takra or buttermilk, not to be confused with the buttermilk we buy already prepared by other methods in the store, is a liquid preparation prepared by continuously churning yogurt in water. This preparation is used in many diseases and is overall quite healthy for the human being. It is a great treatment for IBD and Crohn’s disease as well as poor digestion, hemorrhoids, tumors, oedema, diarrhea, anemia, urinary diseases and many more."

I haven't tried Takra yet, but I'm intrigued. The first question is what yogurt would I use? "Fresh yogurt is best" means making my own, ideally. I did once make 24-hour yogurt with raw milk from the farm, but it was a lot of work. I think store-bought 24-hour yogurt, which is extremely low in lactose, could do, at least for starters. (I like the Bulgarian yogurt sold in glass jars from White Mountain Foods. According to their website, it contains just 5 g of lactose per cup.)

The big recommendation for this remedy is to make it fresh EVERY DAY, using a ratio of 1 cup of yogurt to 4 cups of water. The takra made with that is divided into thirds, to be consumed over the course of one day in three divided doses, each taken 20-30 minutes before a meal.

If you're interested in trying Takra, please let me know how it goes! I'll report back on my experience, too, but I didn't want to wait for that to share. Recipe instructions and further details may be found by following the link below:

Atmayaan Arogya Sangha: Takra: Butter milk -The healthy drink Butter milk is known as “Takra” in ayurveda. Its properties and medicinal qualities are described in as fo...

Jasmine Rice Muffins ~ Pumpkin Spice & Coconut

It's taken me a while to figure out how to make a SIBO-safe muffin. I really thought about it a lot! What flour could I use? Um, none. In terms of grain-based flours, wheat of course is out, spelt is out, brown rice flour is out, any "gluten-free flour" blend is still packed with starch, so it's out, too. Then you have your nut flours, the foundation of most Paleo baking. But nuts are still really high in fiber, not to mention dense. A little bit might be okay, but not a whole muffin full. Think lead belly. Not appealing.

That's when inspiration struck. Why not make my own flour from Jasmine rice, the ONE safe, non-fermenting grain in the world, which I know about from the work of Norm Robillard and his brilliant Fast Tract Diet. For some reason, Jasmine rice is so starchless and fiberless (and probably nutrient-less, lol) that it doesn't feed gut microbes at all, at least not when you eat it in the proper quantity which is one half of a cup of cooked Jasmine rice. This translates to 1/4 cup of raw Jasmine rice...and from there, these muffins were born.

Once my idea hatched, I spent several weeks dreaming up a Jasmine rice muffin recipe. There was sweetness, flavor and texture to consider. I went with raw Jasmine rice that I grind myself, rather than pre-cooked, another option. For sweetener, Golden Lakanto (a blend of monkfruit and erythritol—zero calorie, zero glycemic, zero fermentation potential) works perfectly. There's a little (but just a little) bit of coconut flour and shredded coconut in the blend, while mashed, cooked Kabocha squash adds depth and consistency. (You could also use butternut squash, or even pumpkin itself.) It's a miracle I hit it perfectly on the first try. But I did. Here they are!

Jasmine Rice Muffins with Pumpkin Spice & Coconut 

Makes 9 muffins

Ingredients

¾ cups raw, uncooked Jasmine rice

¼ cup coconut flour

4 Tbs shredded coconut (+ a little more for sprinkling on top)

2 tsp pumpkin pie spice

2 pinches Himalayan pink salt

½ tsp baking soda

¼ cup Golden Lakanto sweetener

3 large pastured eggs

¾ cups mashed Kabocha squash

½ tsp natural vanilla extract

¼ cup melted butter, coconut oil or combination of the two

Directions

Preheat oven to 350 degrees. Grease 9 muffin tins with butter or coconut oil. Use a nut/seed grinder (or coffee grinder) to grind the raw Jasmine rice into coarse flour—it will feel like cornmeal between your fingers. Combine the Jasmine rice flour with remaining dry ingredients in a large mixing bowl and set aside.

Place butter or oil in the warm oven to melt. Use a whisk to beat the eggs well in a separate bowl. Add mashed squash and beat again until there are no lumps. Add vanilla extract and beat to combine. Finally, beat in the melted butter/coconut oil, adding it slowly so the temperature doesn’t shock the eggs.

Make a well in the middle of the flour mixture and begin adding the wet ingredients mix as you stir. Do your best not to overwork the batter. It will be very thick! When fully combined, divide batter between 9 muffin tins, filling each cup a little more than ¾ full. Press sides of batter down with your fingers to smooth and round the top. Sprinkle a bit of shredded coconut and add a tiny dot of butter on top of each.

Fill empty muffin cups half way with hot water. Put muffins in the oven and bake for 20 minutes or a little longer, up to 30 minutes depending. When tops start to brown and a sharp knife inserted in the center of a muffin comes out clean, they are done!