1600 mg/day for 7 days. Each script for this stuff is a plane ticket to an exotic location I’m afraid I’ll never see.  Back on the ketogenic diet too.

Definitely at a low point. Feeling sick – bloating, body aches, brain fog. Spending a lot of time alone as I don’t feel well enough to go out as much as normal and my husband is working on a campaign. The weight is out of control. My body is still doing bizarre things and I get scared that I will never have a streak of good weeks/months again.

I’ve internet stalked some folks who I thought might have some good insight for the blog and the yahoo group and I’ve been ignored. I can’t blame them because its odd to be contacted privately and out of the blue but I would never turn someone down who asked for information like that. I wrote to Dr. Pimental with some questions on recurrance and I haven’t heard back; no surprise there. I’ve contacted some RDs in the area and what I’m hearing back about their knowledge of SIBO isn’t good news. Internet research turns up a lot of the same old forum posts/journal articles and even more dishearteningly, my own writings.

Then again, some things are going well. We have a new member in the Yahoo group and some enlightening discussions have been sparked. We’re possibly on the prowl for a doctor type that would hang out online and serve in an advisory capacity. I also managed to turn up a new-ish piece of research…for the second time. Its funny how bad brain fog can be. I posted the latest work of Dr. Pimentel (from June of this year) to the group back in August. Which means I obviously read it myself. However, it was all new to me when I reread it and found that he’s now recommending 50 mg of Erythromycin in a pediatric suspension as maintenance after antibiotic treatment for SIBO. Due to its pro-kinetic properties, E-mycin extended the time between symptom recurrence from 50 to 146 days. So I faxed the report to my doctor and I’ll be taking E-mycin after the Xifaxan.

And due to some of these enlightening discussions I just mentioned…I’m going to continue this yogurt/kefir fast. Its scary but after a gazillion recurrances with mere weeks in between, it cannot hurt.

I’ve taken about an 8-day homemade kefir break and gone back to a more simplistic meat-and-eggs (and cheddar cheese) Atkins-style diet. I no longer feel like a zombie walking around but I’m still very tired. I’m going to start a new batch of kefir tonight (my grains have been sitting in milk for a week) as I just can’t buy into it being a black and white thing – as in kefir is really good or really bad for me….I think I just need to drink a much smaller amount each day.

I’m still having the body aches and pains. I haven’t gotten around to getting back on the VSL. I’ve been taking the peppermint oil and oregano oil again (natural anti-microbials) although this recent thread from some folks in the Rosacea community doesn’t give me much hope that these efforts will assist in bringing any lasting relief.  The bloating was pretty awful yesterday even though I ate above the line all day. I am about to start my cycle so I’m not freaking out about it. I’m even having small amounts of sugar today since the bloating is coming of its own free will. Myperiod = cravings for chocolate. I’m only human.

Still working through some complex thoughts on the constant return of digestive symptoms for those of us who experience great luck with Xifaxan. It really seems to be the norm, not the exception. I found a few old articles that I won’t even bother linking where Pimentel notes that patients can experience symptom relief for around 10 weeks. This is a fair enough number if 1) Xifaxan didn’t cost so much for off-label use and 2) it actually happened for most folks.

So I didn’t find any new research on reoccurance, but I did find a new Italian study on SIBO in children. Enjoy the abstract here.

So I wanted at some point to update this blog to document my foray into both the traditional diet via Nourishing Traditions and Weston Price, as well as my kitchen adventures with culturing my own dairy, in the way of making yogurt and kefir. I guess I have been so busy making yogurt and kefir and eating a traditional diet that I haven’t gotten around to it.

I think in my head the entry began something like “Radical diet changes often cure superficial problems. Low carb diets cure a lot of less superficial issues. SIBO specifically can be very successfully managed with a diet low in carbs; but isn’t there more out there than managing symptoms?” I need to get ahead of myself already, though, and answer that after months of slaving away in the kitchen I still do not know the answer, and I also have to ask if any of it is worth my time?

Sometime last winter I started making yogurt in a Euro-Cuisine that we picked up at Williams-Sonoma and making 24-hour yogurt (like the SCD yogurt) with my VSL#3DS. It is not very difficult to do, mostly bringing the milk to boil, letting it cool down again and washing out the pot are the hardest parts, and with the yogurt maker (which isn’t necessary equipment but seems to make things simple for someone not so detail-oriented like myself) I don’t have to worry much about timing or temperature at all. Over the months, its really difficult to say anything but the following blanket statement: I felt a small change. Honestly, I can’t say much more than that. I still reacted poorly to eating the wrong foods, sugars, starches, etc. but I felt that there was a small negative correlation between the amount of yogurt that I ate and the length of time I would suffer bad reactions such as bloating and distention, meaning that if I ate more yogurt then I suffered less.This is a small, but very good thing. I did find, however, that I would have to eat around 21 oz a day of the yogurt to get these results on a consistent basis. So I bought another 8 jars so that I could have 2 batches lagging each other.

I started doing more research on probiotics and I decided that it wasn’t such a bad idea to try experimenting with some other strains. If I had two batches going then I could have one VSL batch and another of a different kind, and I could eat one kind in the morning and one in the evening. I was already paying a staggering amount for the VSL so I didn’t want my experiment to turn into a money sinkhole. I used what was in my house already; Digestive Advantage IBS. I took it by mouth first and I felt that it was beneficial. For starters, I had more bowel regularity. That is not usually a big problem for me; if anything I have the occasional diarrhea. But I do get backed up for a day or two from time to time and in my experience these are dangerous times that can be the tipping point for getting my SIBO symptoms back. So Digestive Advantage was a big win. Then I bought some Culturelle, due to the studies I read on it. I even got a nice little book on probiotics for free from the labs that create the Lactobacillus GG strain. My first yogurt experiments were interesting; I made one batch with VSL only. I made a 2nd with Digestive Advantage and VSL. When the first one was done I made a 3rd batch with VSL and Culturelle. This 3rd batch was a little constipating. Then I realized that with all this probiotic mixing I might have competing strains and could be losing some of them even. So I stopped mixing VSL with the others. The result = kind of crappy tasting yogurt that didn’t seem to do much for me.

Back in time for a moment, I should also bring the reader up to speed on my antibiotic treatments. During this time, I had to go through two more rounds of Xifaxan; one in December of 2008 (this one gave me around four months of  relief) and one in June of 2009 (didn’t work at all.) Both of these were the standard 1200 mg per day for ten days. I took a third round in August – 1600 mg per day for 7 days. This round knocked my socks off. I lost 9 lbs and felt better than I’d felt since I’d first gotten sick. As always is my best intention, I kept a super strict low carb diet during and after the meds. I did not take probiotics during the antiboitic course and I was cautious to add them back in after. I flew to Chicago for a business trip not two weeks out from finishing the course and got bloated on the plane. The first night in the city I was so tired I went to sleep at 9:30 PM. I got up very early the next morning and I have to say that is the last time I remember feeling thoroughly refreshed from a night’s sleep. I went to the gym and then went off to training where I started feeling like I had a cold or allergies. I ate yogurt (from Starbucks or Fage from the grocer) the first two days rather than eat the food that was available to me at work, which was not safe. But by the end of the trip I had had a few food mishaps (in the form of pizza and candy.) By the time I came back to New York I was bloated and tired and I almost immediately started having skeleto-muscular pains. I went back to my regular regime of making yogurt. I also started taking natural anti-microbials like garlic oil, peppermint oil, and wild oregano oil.  And I started looking into the Weston Price Foundation and, as I mentioned in my last entry, bought the Nourishing Tradtions book.

I could go into great detail about adjusting to NT, but as I was already eating low carb, and as I was obviously not able to do everything that the book suggested (read: grains,) it wasn’t a difficult transition. We learned how to make bone broths and we started using a lot more coconut oil. I soaked my nuts before I ate them or made nut butter or flour out of them and I have to say that this had a big effect; I no longer felt like nuts were a “in moderation” food, but they seemed to be pretty safe as long as they were soaked.  (If nothing else comes out of this effort, I have delicious almond crackers that I make with my own soaked almonds, from this recipe.) I tried soaking my oatmeal in kefir but it still cramped me up and made me run to the bathroom. I didn’t start lacto-fermenting my own veggies, because I trialed the super expensive stuff at Whole Foods and it seemed to bloat me. Kefir, on the other hand, seemed like a great idea. I was already buying it in the store (I had recently found out that not all brands were made with FOS/inulin, and it seemed fine, and I felt myself a little addicted to it…dreaming about creamy, yummy kefir all the time.) I got my  kefir “grains” from someone on etsy.com and I started making my own.

Ok first of all, homemade kefir does not taste like storebought kefir. Its yeasty….it smells yeasty, it tastes yeasty and it fizzes a little. I can drink gallons of the storebought stuff in the plain flavor; goat kefir, cow kefir, I love it. This is probably because its made from some type of powdered starter culture, much like yogurt can be, but my suff is made with “grains,” or clumps of beneficial yeasts and bacterias. But my homemade kefir needs a lot of salt and sweet n’low/stevia, coconut milk, cocoa powder, whatever I can find to make it palatable to me. I just don’t really like yeasty drinks; I never have been a big beer-drinker.

So I’m drinking my kefir and I’m making my yogurt, and we’re eating bone broths and we’re making pot roasts in our own broth that we’re making from home. Let me just say here that calorie counting has flown out the window. I have always eaten way more whole unprocessed foods than packaged ones, so calorie counting has always been sort of a bitch but I have made myself do it. But at this point I don’t even feel like its an option anymore. The weight issues that I’m dealing with could be their own entry at this point; so I won’t go into them, but I have put on around 14 lbs. Not just from NT eating and drinking kefir – the weight gain has been going on even longer than that, but NT and all this homemade stuff just isn’t making things any easier.

In late August I read Dr. Alan Logan’s thoughts on VSL#3 and its connection to possible D-Lactate build-up in CFS patients. I can’t say I knew who this Dr. was or was familiar with his work but the he impressed me somewhat with his theoretical framework for D-Lactate buildup and his knowledge on the connection between the gut and chronic fatigue. I thought it was worthwhile to try doing without the VSL.

So that’s kind of where I am now. I’m left with only my unpalatable yogurt so I don’t make it as much anymore . I recently got access to raw milk and even though I followed the instructions on the WPF’s website, I couldn’t get the yogurt to set so I don’t even have any yogurt right now. I do have my unpalatable kefir and I don’t eat a lot of real foods anymore because there are so many calories in the kefir (since I try and drink about 2 to 3 cups for breakfast.) I will admit the kefir tastes a little better now with raw milk.

So that’s where I am – how am I feeling? I am a bit lethargic; its hard to get to sleep at night and even harder to wake up. Therefore I am barely exercising. I have always been a stickler about exercise but between the lethargy and the time spent in the kitchen I just don’t do it lately. I am weepy and sad and angry a lot. I fight with my husband a ton. I don’t drink often but when I do I don’t feel drunk at all and I drink far too much and I wake up very sick, unable to do anything the entire day. When I do cheat or eat off-diet, I have immediate postprandial hypotension in addition to the regular bloating and gas and distention. I’m beginning to get the muscle pains again. I feel most of the time like only part of my brain is working, like I can only do or be good at one thing at a time. If I have a good idea at work or I catch and fix a mistake in our unit’s analysis before a big presentation, then I cannot think of anything funny to say to a friend on his birthday. If I am leaving my friends witty facebook comentary or actually completing a blog entry or yahoo group post, then I cannot figure out where I left my keys.

Last night I went dancing and I expected to not make it for very long considering how lazy I’ve let myself become. But I managed around 2 hours of solid dancing, if not a little more. I came home at the normal time for a late night out Thursday; I am always very tired on Friday morning but honestly once I get through lunch I feel pretty refreshed and I always think of a book I read years ago on natural depression treatments. Sleep deprivation can be a great tonic for depression, but apparently only when the patient is woken early from their slumber, as opposed to taking to bed very late. Today I feel like there must be a gas leak in the house. I woke up to my alarm but not until it had been going off for 35 minutes. I got up and went into the bathroom, where I promptly fell back asleep. At this point I realized I wasn’t going anywhere; so I went back to bed. At 2 I could no longer sleep but I felt far from refreshed. I have been in the kitchen much of the day because our dishwasher recently broke and the place looks like a war zone; there are so many dishes from the kefir alone – the strainer, the smaller strainer, the kefiring jar, the other jar that it goes in when its done, the pitcher, the blender to make the kefir into something I can manage to choke down, and the glass I drink it out of. I have been crying off and on all day; I feel hopeless and depressed. I am very bloated. I feel very guilty for not going to work. Sometime I wish cats weren’t such lethargic animals. Because they have also been sleeping fairly deeply for the better part of the day, I am wondering if something really is wrong with the apartment, but then I remember that they are cats.

And ultimately I know there are about ten different reasons why I could be feeling the way that I am feeling. And I do not know if have the energy to trial them all. I’m frankly quite sick of this. I want to be functional and normal again. I want all of my efforts to pay off. I suppose the immediate courses of action will be to reinstate VSL and natural anti-microbials, and after that I will have to reevaluate the kefir, and after that I will have to reevaluate the NT way of eating, given that thanks to Plant Poisons and Rotten Stuff, I’m aware that its very high in food chemicals (although I have never suspected FCIS for myself, I suppose eventually you have to try everything.) After that, there’s always another round of Xifaxan but I’m frankly longing for the days when it would give months of relief and sick of the current week-long stay of execution.

At present I’m taking a course of Neomycin. This is my first time on an antibiotic that isn’t Xifaxan, and I’m not liking what’s going on with my body. Lots of bloating, popping out of my clothes, abdominal pain and no appetite whatsoever.

The nicest thing anyone could ever say to me when I tell them how bloated and distended I am is “Wow, I see. I’m sorry.” Barring actually agreeing with me, just a simple “That sucks, I’m sorry you’re going through this” would suffice.

Things that aren’t so cool to hear:

No one can tell.

You feel it, but no one can see.

It probably feels worse than it is.

These are all well-meant as the person is trying to assist me in moving past the discomfort and getting on with my life. That’s great. But it just hurts my feelings. IF I’m complaining to you about my bloating and distention, we’re not just acquaintances – we know each other pretty well! so feel free to acknowledge that you sort of know what I look like! I mean, walking around with my gut hanging over my waistline is not really my normal thing; I tend to buy clothes that fit me. This thing takes over my body and blows me a little bit out of proportion. I don’t think I’m gaining the 6 inches each day that I used to before the diagnosis, but it still gets hard to breathe, hard to wear my clothes, and therefore hard to feel comfortable in my own skin. There’s nothing worse than walking around distended and thinking that even your friends think you always look this way. What’s the point of anything? I think I’ll just wear a potato sack to work! Although first I’ll need someone else to clear all these potatoes out of the way…

On Monday morning I found out that my hydrogen breath test was positive for small intestinal bacterial overgrowth. Today is my second day on 1200 mg of Xifaxan. I am also taking VSL #3. I am trying to keep my regular low-carb diet with minimal lactose. It’s going well. I don’t feel so great. Kind of like a good day pre-low-carb. A bit of gas, especially at the gym. Some pain. Lots of rumbling, but some of it from places that I’ve never really heard rumbling before. I will start my period soon, so the little bit of bloating could be that.

 I’ve done some math and I actually have been eating more than I thought during my Daily Plate days. As I restricted to 1200 only part of the time, I knew that an average, if taken, would be higher, although I would have guessed closer to 1450. The number is more like 1550 – 1650. Although this means I still should have seen more weight loss than I have, the disparity between what “should be” and “what is” is actually less than I thought. Enter the calorie-restricted, low-carb diet. I’ve never been daft enough to think that metabolic advantage would get me weight loss at any number. I guess I just thought that with an RMR of 1980, I could get away with 1600 – 1700 calories. Now I’m keeping it in the neighborhood of 1200 net, which in the past I had thought was too low. I used to be very hungry on 1200. Now that the majority of my calories come from fat, 1200 is not really so hard. I’m netting 1200 too, not grossing 1200, so on very active days I will be liable to eat closer to 17 – 1800 calories.

Distention is still at bay but I feel a little puffy now and then. I eat things that I know I shouldn’t and I react but not as badly as I used to. I know that means that I am healing, and I know I should not keep eating these things, if I want to continue to heal. It seems that inulin is still a bad idea, although not nearly as bad as it was only a little over a month ago. Wheat is really not a good idea, nor is soy.

I have upped my carbs from induction numbers and I feel water retention. I’m thinking ketosis is a good place for me right now, yet I’m having trouble reconciling my desire for ketosis with my need to work out a lot. I’m doing Pilates most every morning and trying to make it to yoga twice a week, a sculpting class once a week, and cardio most other days. I need to find ketosis above induction numbers but most probably below 40 g. Perhaps a Fage after workouts would help.

This is what happens when one does not keep up with one’s blog. When one’s notes are strewn all over the place, in journals and notepads and one’s daily plate. I will attempt to recreate the best I can the events of the past few weeks.

I passed on the nutritionist’s request for hydrogen breath tests to my gastro. The tests we requested were for a small intestinal bacterial overgrowth (SIBO,) fructose intolerance, lactose intolerance, and sucrose intolerance, in that order, to be administered until a diagnosis is available. My doctor said he approved the tests, but I’d have to pass the request on to the union to find someone who would administer them because he just didn’t do it in his office.  This meant I had to put the ball in the court of my GP, the doctor who told me in December that I needed a really good shrink, because the problem was in my head. This led to a lot of trepidation and anxiety on my part, as I often relived the conversation that we had while holding for him on the phone. My mood had really lifted since the elimination diet – I’m convinced due to the sharp decrease in sugar intake, and it was difficult dealing with the anger of talking to this man again. In the meantime I did a lot of reading, on SIBO and on fructose intolerance. I got more and more interested in the carbohydrate connection involved in an overgrowth. Interestingly, I once had a gastro who tried Xifaxin on me. She gave me 200mg x 3 daily – I still haven’t bothered to pick up the Pimentel book (I really need to) but I don’t think this is even close to the dosage originally suggested. Besides, these days, doctors are experimenting with various courses of the drug – low doseage for a month, higher dosage for a few weeks. She also didn’t ask me to change my diet. When one has a SIBO, carbohydrates basically fuel the fire and encourage continued overgrowth, causing symptoms of abdominal distention and bloating, pain, diarrhea or constipation, as well as sugar cravings. The antibiotics did nothing except produce stool with lots of gas inside, and cause a little pain.

The doctor baited me several times – began to tell me how the test was academic, compared it once to a magic herbal drink that could possibly cure me. I kept my cool with multiple “thank you”s and abrupt “goodbye”s each time. At the end of it all, he claims he spoke with both the head doctor and the Brooklyn gastro in the attempt to identify a testing location and failed to find one, leaving me on my own. He would however, be happy to biopsy my small intestine. I know of course that while a biopsy will find all sorts of malabsorption issues, it will not find a SIBO. I told him I’d leave it up to my gastro and get back to him.

In the meantime, I’ve found Breaking the Vicious Cycle, and have finally begun to read it. I’ve been given “Let’s Get Well,” which I put down almost immediately after I read “Reducing is not for everyone.” Most importantly, I have found Emma Davies, and this post about her experience with the ketogenic, or Atkins diet.

I also picked up “5 Days To a Flatter Stomach,” and read through it. Things began to make sense. Carbohydrates seemed to be the key that ran through all of it.

5 Days
You eat oatmeal in the mornings and yogurt all day. You are grain, fructose and dairy-free until the evening, when you eat large meals of carbohydrates, pasta, potatoes, and fruits for desert. These things are consumed in the evening for their laxative effect – essentially you’re cleaned out by morning, ready to begin your next grain, fructose, and dairy-free day, that is until six o’clock, when you gorge on D-causing foods again. All the while you are exercising, both cardio and toning your belly with resistance bands and sit ups. The author of this book kind of denies that there is such a thing as celiac disease; otherwise it all makes great sense.

Atkins
You eat under 20 grams of carbohydrates each day for two weeks, kicking yourself into a ketogenic state, burning fat instead of your stored glycogen. You drop weight fast, rid yourself of carb cravings, and switch over your metabolism from one that runs on carbs to one that runs on fat. This diet depends on tons of meat and leafy green veggies, with moderate amounts of dairy. This diet includes very few problem foods for me (tomato, garlic)

Specific Carbohydrate Diet (SCD)
I will admit I didn’t read this one all the way through. I know the premise is Atkins-esque, but it is dairy and soy-free, and you are allowed certain carbs, I belive the more complex ones, all the ones I cannot eat.  This book provides a great explanation about why an overgrowth of unfriendly bacteria can cause an individual to lose the ability to process carbs, from simple to complex. This diet depends heavily on meat as you cannot even eat tofu like you can on the Atkins diet.

One thing was clear from the start. My ten years of vegetarianism were over. I didn’t know how I would do this considering that turkey breasts and pictures of happy seafood made me cry in public a few weeks ago, but there didn’t seem to be any way around it. It was a Friday night and I met my husband at our favorite vegan restaurant; we discussed a grocery list. I had a three-part plan. First I was going to do “5 days;” I didn’t think all the fruits and oats would sit well with me, but it would be a good way to bring out a true food intolerance. I realize now this was a funny way of thinking about a program that is so not vetted and based on any actual science, but I have to admit the plan seemed like a good one all around; folks on the internet gave it rave reviews. On Day 6 I would go into Atkins, and if that didn’t work I’d have little recourse except the SCD.

I was a little afraid of five whole days of bloating and discomfort from fruit bowls and oatmeal. Sometime before the whole grain bread and sweet potato spread even came out (we were not about to order from the gluten-free menu on this my last night of blithesome vegetarianism) something like “Fuck it, let’s just do Atkins” came out of my mouth and we built a grocery list of sausage, eggs and cheese for two. I ate an ice cream bar at home after my awesome but bloating vegetarian dinner of mushroom wraps and pinenuts and veggies in soy sauce with lettuce wraps. The total package for the evening blew me up to the tune of the normal extra five inches and I went to bed unhappy about eating animals but hopeful that I would never have to feel this way again. I weighed in Saturday morning at 169.4 pounds. It is not very scientific of me that I did not journal my foods and reactions over the weekend, but I mostly spent the time adjusting to the texture of meat and the absence of a bloated stomach. By Monday morning I had lost three pounds.

Mon. 2/11
166.6 lbs

Breakfast: one thin slice of cheddar, 2 hard boiled eggs, 1 oz crema, decaff coffee with half & half, bite of proscuitto
Lunch: chicken breast, creme fraiche, aioli, duck rillettes, tea with heavy cream
Snack: creme fraiche
Dinner: turkey patty, romaine lettuce, asparagus in olive oil
Late Snack: Devon cream

Tues, 2/12
166.4 lbs

Breakfast: 1 hardboiled egg, italian sausage, one thin slice of cheddar, 1/2 decaff coffee with heavy cream
Tea: stash decaf pumpkin, red vanilla tea with heavy cream
No lunch
Afternoon snack: 2 slices thin cheddar, 1 hard boiled egg, creme fraiche
Dinner: cod filet, broccoli with aioli, maple cheddar

Very itchy nose after dinner! Could this be from the broccoli? All that I can find that diferentiates broccoli from other veggies I’ve eaten lately are glutamates.

Late night snack: mineral water and devon cream

Wed, 2/13
166.8 lbs
1732 calories

Breakfast: 1/2 caf with heavy cream, 2 scrambled eggs with cheddar and proscuitto
Lunch: 5 oz herbed chicken breast, pumpkin tea with heavy cream

At 3:15 my supervisor came by to remind me that I had asked him if I could come by later in the afternoon to go over something. All of a sudden it totally seemed like I had been at the office for a million years. Spaciness? I thought I had been pretty on target today, getting work done pretty quickly.

Dinner: baked chicken thigh, pepperoni, cheddar cheese, spinach, celery stalk with cream cheese

Snack: Devon cream, mineral water

Thurs, 2/14
166.8 lbs
1375 calories

Breakfast: ham omlette with no cheese but I tracked a ham and cheese omlette on the Daily Plate, coffee with heavy cream
Lunch: asparagus, baked salmon, curry chicken salad (a bite) hard boiled egg, crema, 4 olives
Snack: asparagus

My husband and I celebrated Valentine’s Day at the gym! I spent 25 in the weight room and only 20 on the elliptical machine. I thought this would be all that I could do, but I really could have gone my normal 30

Dinner: filet mignon, spinach with salt and pepper, salad with viniagrette (diner in Greenpoint)
Snack: 2 celery stalks with duck rillettes, cheddar cheese

Unfortunately, this evening took an unfortunate turn. I wasn’t bloated after the gym, like usual, but after we ate at the restaurant there was some bloating. We decided eating out wasn’t really in the cards for us at the moment, and I spend the next few days wondering if I’m bloated because of unknown ingredients in my meals or because of my period which starts on Saturday and period-related problems

Fri, Feb 15
166lbs
1566 calories

Breakfast: Spinach and cheese omlette (tracked as ham and cheese,) coffee with heavy cream
Lunch: 3.5 oz chicken breast, crema, vanilla nut spice tea
Dinner: rotisserie chicken from Whole Foods, called “Simple Chicken,” spinach, aioli, celery stalk with cream cheese and cheddar

I tried out a Pilates tape I’d recently purchased and unlike my triumph at the gym, my two months of non-exercise caught up with me here. Also I laid my yoga mat out on the floor and it was way too thin given the painful knot that had popped up in my lower back to herald the coming of my period.

Saturday I stayed at 166 even. I bloat, in fact, I’m about as bloated as normal but I googled the ingredients in my Midol and two of them are suspect. Pre-gelatinized starch is not gluten free, and well, starchy. And microcrystalline cellulose is an intestinal irritant in large quantities. Okay, so two pills didn’t contain large quantities, but I am a person who blows up like a balloon and gets super cranky after half a donut or a few pieces of crystallized ginger so maybe I am sensitive. I start to take the prescription-strength Ibuprofin we have here at the house left over from when one of us pulled a muscle for the pain instead. The bloating goes down in a few hours, which is uncharacteristic. I’ve always had heavy periods, bad cramps that keep me home for at least the first day; I even used to vomit from the pain in high school. Frankly, I’m a little bummed to have cramps this bad this time around. I’ve been off processed foods and aspartame for two months. I haven’t smoked in six months. I have been nearly sugar-free the past month and a half, save for inbetween days here and there. As far as the implications of caffeine on my cramps, I didn’t drink coffee from 1998 – 2002, and besides, I really couldn’t tire more of hearing how bad one of the main ingredients in Midol is for cramps! Friday night we should have seen some friends, but I didn’t picture the my first time out as an omnivore I would be bloated and sitting with a heating pad on my tummy, so I stayed home. And out of frustration I had the husband pick up some Equal and I had a low-carb dessert. Then I had three gin and tonics. All in all, on Saturday I had 2190 calories. And on Sunday I still weigh 166.

Saturday I also cried for the animals I had eaten.

So the final verdict on the ketogenic diet and its effects on my meteorism (abdominal bloating and distention?)

There isn’t one. Diet is an iterative process. I’m terrified that “it’s not working anymore,” now that I’m bloating again. But if I want to be scientific at all, I have to admit several things about the bloating.

1. Its probably my period
2. Its probably my period
3. The duration is much shorter than normal
4. Its probably my period

So I’m just going to have to wait and see. My body should normalize by Tuesday or so, and we’ll take it from there. Meanwhile I’m going to keep up with the diet. I got five bloat-free days from this diet, which is five more than I have achieved through any other measure. And today I’m doing okay to boot, so far.

And how about the effects of a ketogenic diet on my weight loss efforts? Well, I didn’t expect the Monday through Sunday stall that I’ve had, but I have to admit that 3.5 pounds in nine days is pretty good for me. That’s about half the amount that I lost in four months of calorie counting on TDP and regular exercise. So again, I’ll keep it up for now.

Tonight I saw my nutritionist for a review of my detection diet journal. I was anxious to hear her take on it all. I had known since our last conversation that she didn’t doubt my suspicions of fructose/sugar intolerance, so I wanted to see what she thought about whatever else might have been bothering me.

I don’t think I mentioned it here, but I have done some more research on fructose, and found out that there are plenty of things I was eating during the elimination diet that could have been causing reactions, such as brown rice and even celery. Additionally, thanks to some google sessions over the weekend and during the first part of the week, I’ve come to feel comfortable with a more general diagnosis of carbohydrate intolerance, specifically intolerance to sugar. I also have a new plan to begin at the end of this week, which I will get to in a moment.

My nutritionist had a few recommendations for me. Unfortunately, one of them was to drink more water. I thought I made the disclaimer somewhere that I drank way too much water (80 – 100 oz per day) to write it down. I had a hard enough time journaling at all; I can’t imagine logging each bottle. I guess I didn’t though, because a whole page of my 12 page brief was on the importance of drinking water. I can’t blame her; I really should have written it down. Otherwise, she noted my need for digestive support, since on the few days that I drank some sort of cleansing tea, I had an elated mood. I told her that I would drink it more often but it was often too harsh for me and she said she would get back to me on suggestions for gentler cleansing teas. She recommended a hydrogen breath test which was great because I recently asked my gastro for one; he said it was an obscure test and he’d get it for me eventually but that it might take some time and investigation. He also wanted a note from the nutritionist specifying which test, because I’m an idiot, so now things are in the works for him to get one. I really don’t quite get why anyone would consider the test obscure, especially not a hip young gastrointerologist on the Upper East Side, but I guess nothing is relative. No different than the naturopath in Harlem who thought I should eat an apple everyday even if it hurt my stomach. Now that I’m taking this into my own hands, I just can’t justify the $50 spent at Whole Foods every third day, the tears, the separate dinners, the cravings fought off, etc. etc. on top of the two years of suffering, if I can’t get an equal effort back from the medical community.

Other suggestions were chlorella and keeping off the coffee. She also gave me a DVD on the Emotional Freedom Technique. I haven’t gotten a chance to explore it, but her demonstration in the office was fairly interesting. She asked me to focus on something that really made my blood boil. The thing is unfortunately this is super easy for me; I just have to picture my last visit to my new general practitioner at the union health center. This guy gently kept me in his office for nearly an hour and a quarter, all the while trying to convince me that my stomach problems were psychological in nature. He said there was nothing wrong with me functionally and since I wasn’t losing weight I obviously was not sick, but rather I just needed “a really good psychiatrist to help me get at the root of whatever deep-seated problem” was causing all of my symptoms. I can’t lie. Sadly this was when I still had the energy for working out, and I was netting 1500 – 1600 calories a day with weekly cardio, strength training and yoga and not losing a pound. It really boggles my mind that I sit in my cubicle all week with my master’s degree so brain-fogged and bloated and sore that I can hardly do my work while this guy makes God knows what to not even keep up with the latest research in his field.

So anyway, I pictured this Doctor. She asked me to say “Even though I’m really angry with this doctor, I’m fully accepting of myself.” About twelve times. Each time she had me tap on a different part of my face. Then I just repeated the phrase “angry at this doctor” over and over again whist tapping myself on the arm and hand. After a few minutes she asked me to relate on a scale from one to ten, how angry the doctor made me. After tapping myself silly I had to admit I wasn’t really angry at the doctor anymore. My husband asked me later in the train if the technique had really made me less angry. I told him that it had been so tactile and silly that I just wasn’t able to concentrate on being angry anymore, so yes, it actually had.

Last night we ordered Self-Help Way to Treat Colitis and Other IBS Disorders on Amazon. I read about the book on a celiac forum, and on a few other places – all anecdotal evidence; several people mentioned it helped them. The premise is that carbohydrate intolerance, specifically intolerance of fructose and lactose, are genuinely responsible for many cases of bowel disorder, and the author promotes a diet that excludes all sugar except minuscule amounts of table sugar, all dairy except yogurt, and fiber. I didn’t know about their instant “read online” upgrade for only a dollar fifty, so after my husband paid twice the price of the book to have it shipped in two days, I upgraded and started reading. Before he left me and the laptop for bed, we laughed about how it would be nice if for once we paid good money to read something completely new and fresh. Well, besides the premise, which despite being relatively fresh, is nowhere near being completely novel, the diet is incredibly different from anything of which I’ve yet heard. I’ll be making just a few tweaks (leaving things out, not adding them in – I’ve learned the hard way) and beginning it on Friday. Strangely this diet allows white bread and potatoes. I am not sure those things will work for me but I am excited about trying a diet that allows them to see if it suits me. Maybe it will just be a sugar-free, dairy-free week between elimination diets or maybe it will be sustainable. I’m just not sure at this point. I’ll be writing lots about the diet in the days to come.

Of course currently I haven’t exactly gone to Taco Bell or anything, but I have been eating all kinds of organic foods that I shouldn’t, like cheese and chocolate and a banana. Today I even had crystallized ginger in grain-sweetened chocolate. I am so paying for it now. Once the sugar bug was triggered, I couldn’t help myself. At my husband’s office after the nutritionist I stealthily managed five pieces of chocolate into my mouth before I realized what I was even doing. Now that I have empirical proof that what I eat does affect me the next day (and sometimes the next) I really have to work on abandoning the I already feel horrible so screw it mindset I’ve grown used to over the past two years. I’ve begun the habit of measuring my waist and hips each morning upon rising and each night before bed. I used to measure a lot, and take pictures, because I actually needed proof that I was dealing with abdominal distention when I went to see doctors. Until I started doing this, I got a less than pathetic response from physicians who probably just thought I didn’t know that I was overweight. Now I could care less what doctors think about my girth; I figure this type of information will serve me well the next time I’m eliminating. This morning I woke up three inches smaller in the waist and two and a half inches smaller in the hips than when I went to bed last night. Of course, this was not due to weight loss but rather the distention subsiding overnight. Now that its bedtime, the 5.5 inches are back!

I really need wheat, gluten, sugar and dairy-free breakfast ideas. Other than hardboiled eggs. After failing so hard on this diet, I wanted so badly to keep abstaining from soy, gluten and wheat; the main foods that I really never minded giving up. However, thinking about giving dairy up again I realized I would really need a substitute for cereals in the morning and for tea. I found Edensoy unsweetened soymilk tonight – the only ingredients are organic soybeans and water, and it tastes amazing.

“It is certainly delicate,” said my friend with an amused smile, “but I have not been struck up to now with its complexity. It has been a case for intellectual deduction, but when this original intellectual deduction is confirmed point by point by quite a number of independent incidents, then the subjective becomes objective and we can say confidently that we have reached our goal.” – Sherlock Holmes, The Adventure of the Sussex Vampire

Twelve days of longing interspersed by craving and occasional manic episodes where I don’t care if I ever eat anything that tastes good ever again are over. Two remain. And I don’t think I would have the benefit that I do tonight without the rampant cheating that I perpetrated tonight. Okay, so given that my nutritionist gave me dairy back on day five, its not really cheating, but today at Bell Bates I picked up an organic spaghetti squash, three more boxes of Celestial Seasonings Madagascar Vanilla Rooibos, sheep’s milk yogurt, an avocado and a bottle of organic kefir, of which I managed to drink nearly three-fourths over the course of two hours. After the onset of a burning up high in my belly, right below my breast, I noticed that my daily bloating was of pre-elimination diet proportions. This warranted a second look at the kefir label. I think I could have died when I read INULIN…I could not believe I had been so stupid. Inulin is notoriously hard to digest; since I wasn’t taking my probiotic anymore while on the diet, I figured it couldn’t hurt. Just to be sure I looked it up and found that inulins are a “group of naturally occurring polysaccharides (several simple sugars linked together) produced by many types of plants” and “belonging to a class of fibers known as fructans.” (wikipedia) blah blah blah. Inulin is a fructose, one that is “problematic for people with fructose malabsorption.”

I think it would have been a lot better had I stumbled upon a spoonful of crystalline fructose, considering the low digestibility of inulin for many, however, I feel this is a clear lead. Unlike Sherlock, I can’t wrap things up just yet. Not nearly. Something I’ve been eating all week long has not affected me nearly as badly as the kefir, but has been causing symptoms all the same, namely bloating, diarrhea, and constipation. Or else, I’ve been doing right by my stomach and the bloating and friends are just residual. I can’t really be sure, but I have to make a decision about the next phase based on an educated guess of sorts. I can either continue with limited, clean dairy and move on with adding things in, or I can take out the dairy completely as I will have eggs to make up for the protein. Clearly re-eliminating dairy will be the smart choice, although I’m exhausted with such limited food choices by now.

Additionally I have not given up coffee completely. This I am chagrined to admit, as one of my pet peeves is the treatment of those of us with gastrointestinal distress as stupid children who don’t know how to stop putting harmful things in our mouths. More on this later, but I will be abstaining tomorrow and indefinitely. I wonder who will get my place in the Starbucks line.

I’m sick to death of this diet. I thought keeping this blog would help me hold onto an “on a quest” feeling, but its not really working. Today I made flatbread from amaranth flour and arrowroot powder and olive oil. It was amazing. The recipe, from The Complete Candida Guidebook, makes 8 little flatbreads. Of course I ate them all today. I had four for breakfast and was fine. Quinoa flakes for lunch today made me bloat up. I really don’t know if I am supposed to just deal with the bloating, as something like that probably would never go away in two weeks even if I was doing everything exactly right, or if I’m supposed to take the cue since I bloat every time I eat rice or quinoa. I don’t normally eat these things – except out at a restaurant or something. My nutritionist seems open minded enough but she really wasn’t open to me not eating rice, even though I told her this tended to happen.