I was excited today to find the Gastroparesis & Dysmotilities Associations pamhplet on Small Bowel Bacterial Overgrowth & Digestive Motility Diseases. It looks to have been published in 2006 but its the first I’ve seen of it. I linked it to the yahoo group because I think its a very thorough document in an easy-to-understand format. The pamphlet really touches on some of the major points that are usually left to the more scientific literature, as well as on some of the less mentioned ones. I even learned something new; I had no idea that patients on TPN (total perenteral nutrition) have an increased risk of SIBO.

I’m especially pleased to see the dietary advice given in the pamphlet. Although vague, its clear and concise. On treating SIBO (or SBBO as GDPA refers to it) they have this to say:

“Initial treatment, for less severe cases of SBBO, can be attempted by altering the diet. This approach will not be for everyone since it requires restricting dietary carbohydrates and increasing fats. To have success the diet should be rigidly adhered to every day.”

They’re not kidding about rigid adherance. I’m the loudest, proudest member of the one-meal-isn’t-a-dealbreaker club, but all the same, sometimes it only takes one meal, or a few days of meals to derail good progress, or just leave you feeling lousy.

My job is often full of inappropriate people, but then a lot of jobs are. A lot of times it can actually feel like I’m babysitting a bunch of rude children, only I’m not really paying all that much attention to what they spend all day doing. I’ve been chided more than once for taking lots of supplements (so much so that I’ve bought little pill keepers and carted things back and forth instead of keeping my bottles on my desk) and I’ve been asked why I spend so much money on food when people spot me carrying bags in from the local organic market. I’ve been asked point blank why I don’t ever partake in birthday cakes. Because we have about a million birthdays every week here. And apparently some people are offended when everyone on the floor doesn’t participate. Even though I pay into the cake fund each month when asked!

Today I got in the elevator with a gentleman who works here on my floor. He turns to another gentleman in the elevator, a friend of his, and asks, “If you don’t mind me asking, why are you putting on so much weight?”

I was mortified for them both. The poor guy was really embarrassed. He wasn’t really overweight, by the way. The offending man turned towards me and tried to explain himself, but I told him that there wasn’t any explanation in the world that he could offer to get himself out of that one.

Xifaxan has been done for some time now. I’m feeling like my old self again. Still low carb, although my doctor has urged me to test the carby waters, so I do every now and then. I have a wrap, I have a bowl of puffed rice. I always react, only not as badly as before. the discomfort is always there but the bloating just isn’t as bad as it used to be. We are waiting it out and I may undergo a second breath test in July, and respectively a second course of antibiotics. I’m really into the idea of regaining my carb tolerance, but not in order to eat them regularly, because I’d like to get back into deep ketosis. I’ve been playing around with my macronutrient breakdown a little bit this month, going back and forth from high protein to high fat. Again, I have no idea what I’m doing, but high fat does seem to rev up my metabolism a little. I realized today that if I look at weekly or even monthly totals, I’m still losing at a very slow rate, but if I look at the long view, or two months to the day since I started weighing everyday, using a heart rate monitor, and burning more calories but less frequently, I have lost 7 lbs. That’s 3.5 lbs per month – that’s quite fast for me.

I’m still at The Daily Plate and can’t get used to Fitday or any of the other calorie/nutrient counters, but I will say that the environment there is a little stifling. I guess my bad for being annoyed by the very thing that attracted me to the site in the first place – the “calorie in, calorie out” anyone can do it mentality. I wanted it to be true so badly, many times 1200 calories badly. Now that I’m low-carbing it, I’m reading more posts in the forum on the topic and I really can’t believe how close minded people are. No that’s not it – I my mind was super closed on the topic at one time. What I can’t believe is how vocal people are about their close mindedness, and how they can be that way in the face of others who are screaming loudly “this works/worked for me!” they continue to make blanket statements about low-carb, statements that include the words “believe,” and “water weight” and “stupid.” There are also so many low carb apologists. They don’t do it long term, its not very healthy, but they feel just great, and hey it works! but they eat whole grains, don’t get them wrong.

It’s true, all carbs are just fine and everyone should eat them all the time. Or at least just eat the “right” ones, no matter who you are. People who restrict a single nutrient (unless that nutrient is fat) are just crazy and obsessive. It’s not healthy to cut carbs. And its not at all telling that there are currently three active forum topics on the Daily Plate about breakfast cereal (there is only one about chocolate and one about kale.) And one of them is called “Cereal = Crack” and there are over two pages of posts by women talking about how they can’t stop after one bowl and they’re obsessed with Cheerios and they could eat all their calories in cereal and have done so on certain days.

“I confess that I have been as blind as a mole, but it is better to learn wisdom late than never to learn it at all.” – Sherlock Holmes, ‘The Adventure of the Man with the Twisted Lip’

I worked in grocery for around five years before I discovered the accommodating and relatively high-paying (until I moved to New York) world of clerical work-study. Three of those five years were in natural and organic grocery, and two of those were spent stocking, ordering, cleaning, and selling produce. I never heard of gluten sensitivity or candida or even food allergies before the organic market. I listened to countless stories, almost always told by women, about their symptoms: weakness and fatigue, the aches and pains and the often drunken not-of-this world brain fog that shrouded their lives. These things led them on arduous journeys to root out a wheat allergy or a yeast overgrowth. Often it took them months or years and often no one helped them along the way; maybe one or two of them had a naturopath’s assistance. I wonder now how helpful in truth that assistance was. So many people abruptly swinging from one end of the spectrum to the other; omnivores suddenly eating raw diets, vegetarians adding red meat to their menus. I always listened intently to these women while they told their stories. I often asked questions. “Well, what do you eat while you’re trying to find out your allergies?” “How did you know that was ultimately what was making you sick?” These women were always thin and almost always middle-aged. They were sometimes hippies, and other times they could have passed for suburban soccer moms, and they probably were just that, willing to drive east or over the river to the urban fringe to pick up their organic food. Some of them practiced healing arts, as I suppose their experiences empowered them to be more than just well for themselves. Sometimes they espoused all kinds of New Age crap that I couldn’t care less for. Sometimes they didn’t.   I confess now that I didn’t always believe them. It is difficult to explain. I respected their stories, especially the parts where they were symptomatic. Who wants to feel that way? I had lived my whole life feeling like something wasn’t quite right – depression and lethargy despite a natural optimism. I had aches and pains too, and it was always difficult for me to lose weight – my body always seemed like it wanted to hold on to things, especially hurtful things. During the parts of their story where they figured out what was making them sick, I even cheered them on inside, but I don’t know if I ever fully believed them. How could something as innocuous as food make you that sick? Surely the relationship was not causal. Something else was going on. Hormones? Stress? A latent medical condition? I took these stories with a grain of salt, the way I took the stories of women who went on olive oil diets and lost tons of weight.

For the past two years I have felt sick and no doctor has been able to find a cause. In order to cure, a cause must be found. The one causal factor identified, my gallbladder, was removed one year ago, and the procedure only minimally lessened my symptoms. And gradually, all the symptoms returned. I have been back and forth in these two years with food. I have at times felt empowered when investigating my food, happy that I could actually be the one controlling not only the disease but the cure. I have at other times felt helpless and burdened. Food = my fault, again. I can’t just take a pill, get some rest, eat smaller meals. All this time, however, I have secretly and silently taken my strength from the women in the organic grocery store. I am only 32. Probably the age of many of the women I spoke to when they first began to hunt down their intolerances and allergies. Now I realize that the women who lost weight on olive oil probably did so because they put down the sugar and the bread. Now I realize that food can make us all incredibly ill; the same food can make us all ill for different reasons. I feel that I have a lifetime of diet detection ahead of me. But I feel that one day it may be old hat, it may be comfortable, and I may see lasting benefits that will allow me to tell stories that begin with “I went through a couple of very rough years until I figured out that I….”

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.

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.