Surviving SIBO Part 2: The Treatment Phase

Now that you know the background of my experience with SIBO from my post Surviving SIBO Part 1- I wanted to follow-up with how it’s going. If you didn’t read part 1, no need to go back to it, I’ll just give you a quick reminder of how it came to be that I got SIBO: rough diet, over-prescribed antibiotics, leaky gut, stress, anxiety... While how it happened was important to for me to know and understand, but what treating my SIBO led to is the most important part of my path to healing. Uncovering SIBO led me to greater self-awareness, significantly improved health, more sympathy, and more humility (~I actually don’t know it all~ and a plant-based diet is not for everyone~). So, once I knew I indeed had SIBO, I started researching how to treat it. That is where I got really-really-really confused.

If you haven’t already noticed, there is a lot of contradictory information out there when it comes to treating SIBO. There are varied dietary protocol approaches, herbal antimicrobials versus traditional antibiotics, and not to mention the timing of when to add, use, or implement it all. Since it seemed that being on antibiotics for the majority of my adolescence was a main factor of how I got SIBO, it did not seem reasonable to me that antibiotics would be the best solution for me.

After a ton of research that included reading articles, books, blogs, websites, listening to podcasts, getting some random advice, as well as some very well-informed advice, I decided to go with a specific dietary approach combined with herbal antimicrobials. There are differing options in the SIBO treatment community: some say to not change your diet while taking the herbal treatment so the bacteria stay active and alive long enough to get destroyed by the antimicrobials. Other experts say to starve the bacteria by following the dietary protocols along with antimicrobials. Starving them seemed like the quicker route to getting the job done, so I chose this combination in an effort to get this over with as soon as possible!

After several weeks of planning, prepping, and maybe over-obsessing, I began a regime of the herbal antimicrobials Berberine and Neem Plus. I immediately implemented a low-FODMAP’s nutritional protocol. FODMAP’s are: Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. The concept of low-FODMAP is that you don’t eat anything that is fermentable in the digestive tract. This will starve the bacteria that have migrated to the small intestine- hence the name SIBO- (hint: they are not supposed to be there)! If the bacteria don’t have the delicious fermentable compounds in the high-FODMAP’s foods to feed on, they can’t survive in your gut any longer! You can google it for more specific information, but basically on a low-FODMAP approach you can’t eat much—of anything—at all. I mean you can eat all the low-FODMAP’s foods you want, but overall it is limiting (and honestly, a little bit sad).

I downloaded the SIBO Food Guide app that is based on Dr. Allison Siebecker’s work. She has helped many people heal SIBO, and it seemed like a reliable and useful tool. The app has a handy list of all foods in every category: veggies, fruits, grains, proteins, fats… with a Red dot for: ILLEGAL-OFF-LIMITS-DO-NOT-EAT foods. A Yellow dot for: eat only LIMITED amounts, for example- asparagus: 1 spear is legal- (I mean seriously, I’m going to have just one spear of asparagus?) An Orange dot for: you are PUSHING IT, example- asparagus: 4 spears are legal, (again, seriously?) A Green dot for: EAT ALL YOU WANT!: meats, oils, some leafy greens, some veggies, and some fruits, but basically, not m(any) carbs allowed.

I had to make a ton of changes. I used to have apples every single day. Well guess what, they are ILLEGAL-OFF-LIMITS. I had avocados every day, they are mostly illegal. I ate sweet potatoes a good bit: ILLEGAL-OFF-LIMITS. I ate a good bit of quinoa and rice: ILLEGAL-OFF-LIMITS. Onions and garlic: ILLEGAL-OFF-LIMITS, this made it super difficult to eat out or cook anything that had the robust flavors I enjoy. (You can use garlic infused oil, which was a life saver for me!) I consulted some cookbooks and websites and seemed to manage, but a lot of the joy of eating was zapped (no carbs allowed).

This is one of the hardest elements of surviving the healing path: finding pleasure in eating. Not just because I couldn’t have carbs, avocados, and apples, but also because I felt miserable. In Sylvie McCracken’s ebook about SIBO, she recommends a different specific gut healing approach: The Elemental Diet. When I first read about it, it seemed insane. After a week on the Berberine and Neem Plus I was seriously considering the Elemental Diet! (Hint: you don’t actually eat on an Elemental Diet.) No Food. You just get the nutrients you need through an expensive or difficult to make concoction- which is the most important part of doing that particular healing protocol. But no food. Sounded miserable and a little crazy. Didn’t happen for me, it was enticing because I felt so terrible, but it really seems overall dangerous and unhealthy. But, I digress…

The Berberine made me feel horrible, way worse than the day to day SIBO symptoms I had been experiencing. You feel worse before you feel better. The bacteria die-off side effects are dreadful. (At times, the Elemental Diet really seemed like a really enticing option? Wait, no, it’s terrible). Pretty much everything I ate made me feel sick, and yet at the same time I was having the craziest cravings! I would drive past a fast food place and think, cheesy fries, THOSE WOULD BE AMAZING!!! I NEED TO EAT THEM RIGHT NOW!!! The bacteria were desperate. They wanted carbs. They wanted sugar. They wanted pizza. They wanted cookies. They wanted everything and anything I could not eat in order to heal. They really did not want to go away. Now remember, I had been working on healing my leaky gut for a year and half before the SIBO diagnosis, I had not eaten pizza, cookies, cheesy fries, bread, or much added sugar in over a year! Those bacteria just wanted carbs, dairy, and sugar and they were trying super hard to convince me that I should eat pizza, eat cookies, eat fries! It really was the bacteria talking, I didn’t feel well enough to be genuinely craving these foods.

The cravings were seriously off the charts and my stomach and digestion were mis-er-able. I started taking Activated Charcoal to help with the die-off symptoms, and detox the nasty little bugs and their toxic die-off waste (called Herxheimer reaction.) The Activated Charcoal seemed to help, but I still felt pretty bad. When treating SIBO it’s considered to be counterintuitive to take probiotics, as adding in any bacteria, even the good stuff, is supposedly not useful. I had been taking and eating probiotics as a part of my lifestyle for some time. Not having them seemed to be impacting me, so it was recommended that I take a “SIBO-safe” probiotic called Sibiotica as well as S. boulardii. Integrating these did seem to provide some relief for my sad, mad stomach, and digestion. I took digestive enzymes with every meal, and took apple cider vinegar shots at night.

After about 15-days on the herbal antimicrobials I started taking Interfase Plus, a biofilm disruptor. The gross bacteria create little biofilms in your gut where they can “hunker down.” They seriously DO NOT want to be destroyed, and they are resourceful little buggers (gross). The Interfase Plus helped clear out the biofilm, and while I think it was effective, it was also unpleasant. After the herbal antimicrobials were finally over, I began taking MotilPro, which is basically super ginger, with some other helpful elements to aid with gut motility. One of the main causes/effects of SIBO is poor motility of food through the digestive tract. The longer it takes to digest, the more likely bacteria will start to feed on it. Yuck.

Another oh-so-delightful symptom of SIBO is that your small intestine (which is super important for assimilating the nutrients in your food) becomes terribly inflamed, and you don’t properly absorb nutrients. This left me deficient in some vitamins and minerals. Over time, if not treated, this will cause other health problems that often get misdiagnosed. The inflammation was definitely where my skin troubles, including the rosacea, were coming from, and most likely my hormone imbalances, low energy, and anxiety as well. I started supplementing the vitamins, and I also took L-Glutamine in powder form to help repair my gut. The money I once spent on wine, tasty chocolate, and going out to eat I now spent on freaking supplements!

During this phase I still felt rough, and my skin was looking rough. Although I was still feeling pretty bad, (the die-off symptoms last a long time) the cravings did begin to decrease. While I was no longer jonesing for pizza and cookies, I was craving tasty real food.

Oh- did I mention I was a total grump throughout this whole treatment phase? I was. It was miserable, I felt miserable, I basically whined and chose to stay miserable. When I finally got tired of whining and feeling miserable, I remembered that wait—I am a yogini and a health coach! I had some really cool tools that I had been too busy being whiny and miserable to access. I love helping others, I can think of so many ways to give people useful tools and strategies to heal, but I forgot to help myself! What is wrong with me? I started including Ayurvedic approaches to healing the gut, which supported my process of getting rid of SIBO.

I started doing self-abdominal massage of the ileocecal valve (the IC valve is located between the small and large intestines, and it should stay shut after digested food moves from the small to large intestine). Because of the inflammation and low motility associated with SIBO, the IC valve may be stuck open, which allows bacteria to migrate from the large to the small intestine, again, gross. I had fresh ginger infused in my tea every morning to help aid digestion and soothe inflammation. I started doing Kapalabhati breathing, Agni Sara exercises, and oil pulling with coconut oil every single morning. I added in additional yoga postures that aid in detoxing and toning the digestive system. These changes allowed the detoxing processes of my body to improve, which significantly began to aid in me feeling better.

After a good bit of research, I also started incorporating Intermittent Fasting (IF). With the slow motility associated with SIBO, my body did not have ample time or energy to digest after each meal. Eating the same amount of food in a shorter eating window helped to heal my gut, and improve my overall health. Although it was initially tough to figure out the right timing, and assure that I got enough caloric and nutrient density during the eating window, it helped. Staying on top of Intermittent Fast is super important, you must nourish your body with ample nutrition and give it enough calories or it won’t heal! You are not intended to skip a meal, but eat more just within your eating window. (It’s also important to note that this is not meant for a long-term dietary approach, 6-12 weeks and then back to a more normal eating window).

This integrated approach helped me turn the corner. I started feeling better, but still was not normal digestively. I was freaked out that the SIBO was not completely healing. I never want to go through the misery of treatment again, so not feeling 100% was not an option. I found an acupuncturist who had experience with healing SIBO, and her treatments and magic herbs seemed to be the final trick. After just a few acupuncture sessions I returned to having “normal” digestion. For those of you who also suffer with abnormal digestion, or IBS, you know how exciting it is to have “normal” poop! She put me on a regimen of Chinese herbs, recommended I stay away from food that are difficult to digest, and to begin adding the FODMAP’s back in one at a time.

I had been on the low FODMAP’s for just over 12 weeks, so I was super excited to start incorporating them again- but also terrified of regressing. It is important to start slowly. I added in one, then increased a little every day for 5 days. I took good notes on all of my symptoms: digestion, energy, skin, mood, and so on. I started with onions and garlic and had no problem (YAY!!). After 5 days, I added in avocado, no trouble again (SWEET!!). I continued with this pattern, and was able to add all the FODMAP’s back in with no major problems, but I had some ideas about what would be best to reduce. This process took about 2 weeks, and I’ll admit, it was super tempting to just go all the way back in after adding in the first couple with no troubles. Taking it slow really helped me to notice what foods cause what symptoms, positive or negative, to assure that my system remained happy.

This brings me to the most important phase of treatment: maintenance. I’ll be back to share how I am maintaining so far. I’ve made it over 8 months since beginning treatment, and so far, I am hopeful. Once I started feeling better I wanted to go back to how things used to be. To eat whatever, whenever. At times, I have let some things slide, but I know I can’t make that the norm. It takes a long time to heal the gut, and if you remember from Surviving SIBO Part 1: I probably started damaging my gut at a very young age. I am 42 years old. That is a long time to have a crazy gut, the damage runs super deep. Keeping my gut happy and healthy, keeps me happy and healthy. While the nutritional healing protocols, supplements, and lifestyle help keep my gut in check, maintaining stress management, and self-care practices, are also extremely vital to remaining healthy. Everything is intimately interconnected.

I will be back to let you know how I continue to maintain a healthy, happy gut-- SIBO free!!

Are you struggling with an unhappy gut, a SIBO diagnosis or treatment? If so, reach out! Community is super important and sharing your story can be healing!

Surviving SIBO Part 1: Background to Diagnosis

SIBO stands for Small Intestine Bacterial Overgrowth, woof. Sounds gross because it is. If you’ve ever had SIBO, you know just how uncomfortable it is, how incredibly difficult it is to treat, and how hard it is to keep it away once treated.  Digestive symptoms can include bloating, digestive distress (diarrhea and/or constipation), gas, belching, dyspepsia (food sits in your stomach/slow motility). Other symptoms are often a result of prolonged SIBO and can include brain fog, anxiety, depression, low energy, skin disorders, and hormonal disruptions.  If you are curious about whether or not you may have SIBO, other symptoms and the science-y stuff such as testing and treatment, I recommend, of course, Google. I also recommend the e-book The SIBO Solution by Sylvie McCracken. I found this book super helpful, concise, and made several treatment decisions based on her recommendations. I also listened to countless podcasts, and read other books once I was officially diagnosed. I’ll get to all that, but for now, the background of my experience with SIBO…

So how did I, or how does anyone get SIBO? So. Many. Reasons. Here’s most likely why I ended up with SIBO, but I think there there is no way to know for certain. Throughout most of my teenage years I had terrible acne. I tried all kinds of topical creams and treatments, special face wash products, you name it, I tried it. None of it seemed to help. Like many others, I was placed on oral antibiotics for years to help manage my skin troubles. The skin problems lead to emotional distress as well, or maybe it was the other way around, either way my skin was horrible and I felt pretty anxious, embarrassed, and sad much of the time. I also had a pretty awful diet: cereal for breakfast with skim milk, peanut butter sandwiches and some sort of sugary snack for lunch, with a red delicious apple. Maybe there were some carrot sticks in there too that I most likely did not eat. Pop Tarts were my after-school snack of choice. Coke was my favorite drink, until of course I switched to Diet Pepsi to watch my calories (so sad). So, that’s the nutshell: Antibiotics, emotional stress and a terrible highly processed, sugary diet. There’s more to the story, but that would be enough, damaging my poor gut with highly processed sugary food (not sure the ingredients in much of what I ate would qualify as actual food!) and destroying my poor microbiome for years with antibiotics. Emotional distress, anxiety, and overall stress were major contributing factors as well in damaging my gut.

Fast forward from my awkward teenage years into my 20s and 30s. In my 20's I became very interested in healthy eating, nutrition, wellness, and yoga. I began eating more fruits and vegetables, and drinking more water, and although I had no idea about how to implement mindfulness, the concept intrigued me. However, I was still consuming a ton of cheese, pasta, and refined foods. I still ate a ton of sugar. I became a vegetarian, but really, I could have been called a cheese-atarian! My skin trouble now included acne and rosacea, an equally unattractive, and uncomfortable condition. I also landed on birth control, while that did seem to help my skin, it was definitely a contributing factor in damaging my gut and disrupting my hormones. By my mid-thirties I struggled with hormone imbalances, primarily low progesterone, and infertility. My energy levels declined and yet sleep did not come easily.

I thought I was so healthy. I had changed my diet, I became a passionate vegetarian, and even went through bouts of being vegan. I could not understand why I had these health struggles. In my mid-20’s I began practicing yoga regularly, in my late 20's I became a yoga teacher, and managed my stress and anxiety way more effectively. I didn’t get why I had these annoying health problems. Intermingled with skin, hormone, and energy problems, I began having uncomfortable digestive distress as well. Nothing crazy, nothing I would label as IBS, but still, not great—or pleasant.

After becoming a health coach in my 30’s, I became far healthier in terms of nutrition, lifestyle, and overall wellness. I consumed WAY less sugar and WAY more veggies and fruits. I honestly never understood how much sugar I was actually consuming, knowledge gave me a lot of empowerment. After eliminating the cheese-cheese-cheese that I ate every day, much of my acne did clear up (especially the painful acne on my back!), but the rosacea, hormone imbalances, low energy, and digestive distress were all still there, still annoying me daily.

In my late-ish 30’s I sought outside help for these health concerns. It was recommended that I do food allergy and intolerance testing as well as hormone testing to see if I could address the root cause of my hormone imbalances and skin/digestive concerns.

Turned out that I had a leaky gut. No shocker there! Looking back, I most likely had a leaky gut for a long time. However—at the time I learned I had a leaky gut, I was shocked! I was living in total denial. (If you are unfamiliar with leaky gut, I again, recommend Google!). The testing that revealed my leaky gut also revealed that I have a mild allergy to peanuts and almonds, both of which I ate nearly every single day. I discovered that I had grown intolerant to ALL of my vegetarian protein sources: beans, most nuts, peas, soy, and nearly all dairy. All of these intolerances, allergies, and system disruptors were causing a ton of inflammation in my body. The inflammation was majorly throwing all of my systems out of balance.

How was this possible? How could my way of eating—that I believed to be so healthy—how could it be hurting me? The doctor who did the testing broke the news to me; I needed to eat animal protein. I needed to eat meat. She said other testing revealed that I also had low blood sugar and vitamin deficiencies, which can be just as dangerous as high blood sugar. One of the best ways to stabilize blood sugar: Eat Protein. Yikes!

While this news was devastating at the time, I had to figure this out. I wanted to feel better, to actually be healthy. As a wholistic food therapist, I encourage people to listen to their bodies, and to find what works best for them. I tell people all the time that there is no one right way to eat for everyone. Now it was my turn to take my own advice. This was not an easy part of this process! So, with some organization and planning, I started working on healing my super leaky gut.

I started with eliminating all the foods I was intolerant to, as well as alcohol, and any added sugar. The way the test works is that it shows you what you are super intolerant to: probably should not eat much of that ever again (or at least for a long, long time), what you are pretty intolerant to: eliminate for 3 months and slowly add back in and see if you tolerate it, and what you have a low intolerance to: eliminate for 4-6 weeks and slowly add back in and notice how you feel. Unfortunately, how leaky gut works, you often build up an intolerance to the very foods that you eat most often because when your gut is leaky, your digestive tract becomes permeable, and food particles get back into your blood stream (they are not supposed to be there!), and your immune system attacks them (because they are not supposed to be there!). Most of the foods I enjoyed and ate regularly, I now had to live without. 

I followed the plan, eliminated the low offenders for 6 weeks (we’re talking things like black pepper, chocolate, mushrooms…) The medium offenders I eliminated for 3 months, the highest ones for 6 months. Still to this day, some of the medium and highest offenders I just don’t eat much of anymore. Feeling bad is just not worth it. I added in the recommended supplements: L-Glutamine, a high quality fish oil, Vitamin D, digestive enzymes, methylated B vitamins, and… meat. Yes, meat. I started with seafood and worked my way to land animals. Turns out my body prefers to eat meat. It is ridiculous, a dedicated vegetarian and yogini, and yet my body thrives on meat. Boo.

I worked really hard to make peace with this, that my body seems to need meat, at least for now, and somedays I still struggle, but it truly has made a difference.

So, this is it, right? End of the story, I took out the offenders, added in what would help heal me, and I’m healed! Uh, NOPE. Unfortunately, that is not where my Surviving SIBO story ends. While I did absolutely feel way better, there were still problems. While my typical acne completely cleared up, and my skin looked better than ever, I still had the annoying and uncomfortable skin condition rosacea. Itchy, red blotches and little gross bumps on my cheeks, and sometimes forehead, chin, and nose. Super yuck. I also still had some stomach upset and IBS symptoms, pretty much daily. Not all day, just nearly every day. While not to the degree it was, it was still there, manageable, but definitely unpleasant and concerning.

Over the course of the next year or so, I adapted to a mostly Paleo-style way of eating, and that seemed to work for me overall. I would say I was at about 70% better after about a year. At this point I had heard about SIBO, probably considered that I had SIBO, but after the hard work of healing leaky gut, I was in denial that I had it. It’s such a pain (but SO worth it) to heal the gut. Over time, the discomfort of my symptoms became more uncomfortable than the fear of the hard work to truly heal myself. So, I got tested for SIBO. I was positive for hydrogen-dominant SIBO at a pretty high level. Again, no shocker there. It felt like I had to go back to the drawing board. I had figure out all these new protocols, supplements, and dietary theories.

There is SO much information out there in the way of healing SIBO, but there are no two people with SIBO conditions exactly alike. Some people respond better to certain treatments than others. Not to mention that there are a ton of differing opinions amongst the “SIBO guru’s”  out there and it seems what one professional recommends, another recommends a seemingly opposite approach. 

Through discovering and studying other peoples experiences of how they healed their SIBO, it became extremely apparent that this was NOT going to be easy. Or any fun…

Does this story sound familiar? Have you also struggled with digestive disorders or leaky gut? If so, keep in touch! Community is a great way to reduce stress and find support and hope! I know one thing for sure, without the support of my husband, sister, and friends and family, I would not have survived this. It’s so helpful to share your experience and get support to heal yourself.

I can say (now that I have the treatment phase behind me) that it was all worth it. Along with support, the other thing that got me through was the hope that every day was an opportunity to feel better, and to improve my health for the long term.

So that’s it, the story of the background up to my diagnosis. Come on back to hear about how I treated my bout of SIBO, and how I am maintaining my gut health!