Even though I made promises to update the blog, I’ve failed at many attempts. I’m having a couple of issues.

I prefer discussion over a monologue. Obviously this is why I do tend to give a little more attention to my yahoo group, because we can bounce ideas off one another, and address specific and targeted issues that people are having. Here too, however, I can be slow/late/negligent when it comes to writing and responding to group discussions because Outside of work I spend very little time sitting down. I had a knitting blog once. I used to like movies. But as a cursory glance at this blog will tell you, I am not one of those SIBO’ers who has trouble keeping weight on; quite the opposite, I have trouble losing, and I haven’t lost nearly 40 lbs in the last 2 years or so by blogging or knitting or watching movies. I run, I use the elliptical and crosstrainer, I lift weights, I play wii sports and wii active and I go dancing whenever I can. So blogging is just once thing that’s slipped out of my grasp a little in an effort to hit my weight loss goal (about 10 – 15 more  lbs to go btw. Lastly, I’m learning something about myself lately and it’s that I’m uncomfortable with the amount of knowledge I have about this condition. I have yet to meet/cross paths with anyone who knows more about SIBO than I. Bloggers, forum posters, doctors, you name it. I value expertise very highly and I do not think it comes easily. All this time I have been avoiding telling people how they should deal with their own overgrowth, what they should eat, what they should take, etc. But a few things are becoming clear in my group. There are only a handful but I want to discuss them a post at a time. So for starters, lets talk about diet.

1) A Low carb, high fat diet helps most everyone with SIBO to manage their symptoms and feel a little more normal. The people who aren’t helped by low carb generally fall into two categories: A) People who either think they have issues with fat digestion or people who really have issues with fat digestion and B) People who won’t even bother trying. A group discussion recently brought me enormous frustration when it went something like this:

“I am very sick.” “what’s your diet like?” “I eat pretty much nothing but fruits and oats.” “Try low carb.” “Oh that doesn’t work for me. I need lots of fiber to keep me regular. I put psyllium husks in my fruit smoothie.” “Okay, well maybe you should stop that and try to drop the carbs and up the fat.” “Oh no, I’ve tried a high protein diet before and I have issues with C.”"Okay well protein isn’t going to help you go to the bathroom but fat is.” “Oh I can’t eat a high protein diet.”

I haven’t done a ton of research on high protein diets. I eat what some might consider high protein, at between 110 – 150 grams per day. I also run 3 miles a day most days, or go dancing for 3 hours at a time with no breaks. I need the protein I consume. I remember the hair loss that used to occur all the time in my vegan years; I don’t have to deal with that anymore. When you look at my macronutrient breakdown, however, my diet is really high fat. Always my fat intake is at least 60% of my total intake. That leaves less room for protein and even less room for carbs. There are a few reasons for that. First of all, when you have SIBO, fiber becomes fairly indigestible. If you can easily digest fiber, I’ve got news for you – you probably don’t have SIBO. Secondly, most sugars aren’t digestible either, so if you have no sugar, and you have no fiber, all you’re left with is starch. And guess what? While Dr. Pimentel says you can eat all the potatoes, pasta, rice, and bread that you want, (and I hope for your sake he’s right) you may be like me, and those foods may bother you about as much as low GI carbs do. Generally, we with SIBO have two modes of operating – Playing It Safe, and Life Experimentation. Playing it Safe occurs when we feel worst, when we’re trying to figure out what is wrong, when we have an important event coming up and we don’t want to pop out of our party dress or spend the evening in the restroom missing out. Life Experimentation is what we’re doing when we’re not Playing it Safe. Playing it Safe means neither of us are eating rice or oatmeal or buckwheat, if we’re smart. Unless we know for a fact that those foods aren’t feeding the SIBO, and I doubt I can find one person who doesn’t know that. But if you are them, by all means, eat those oats! During Life Experimentation, very few rules apply, except that there is no reason to think you can go overboard on fruit and fiber with no consequence. The important thing, however, is that Life Experimentation gives you something you didn’t have before – knowledge. Of how a food gets on with your digestive tract. During a certain time of the day. During a certain length of time out from your treatment. During your period. All the time. Whatever you can grasp.

High fat and high protein are not the same thing. Okay, now that we are clear there, I will need a person to tell me that they ate a lamb chop cooked in coconut oil (or something less chemically offensive if they are FCI) or a broiled steak or a piece of baked cod and then tell me that they experienced bloating and gas and cramping or some other symptom due to their meal before I will change my tune from the simple gospel that if you have SIBO, meat will not make you sick. I get so tired of reading blog after blog and discussion post after discussion post about people eating ramen noodles while their family dines on turkey or ham. If you have SIBO, there is no mechanism by which the bacteria living in your small bowel can digest or even attempt to digest meat. Meat is probably the safest food you can eat, followed by eggs if you are not allergic (most people aren’t) and dairy if you are not intolerant to that. You can add green veggies to your diet as long as tolerated – the fiber can get you though so be careful with that one.

I have heard a lot of excuses for not going low carb. Especially distubing is the SIBO sufferer who is having trouble keeping weight on; he or she is afraid to eat a low carb diet because then won’t they just lose tons more weight? Maybe I just love food too much, but my answer would be “not if you eat enough of it,” which might be easier to do once you begin to eat food that your body is capable of digesting.

What’s your experience with low carb, high fat? Did it help your SIBO? If not, please share your thoughts and help me understand why I’m being a douche.

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 wish I really knew what I was talking about when it came to nutrition, but I don’t. I only know that I constantly stride the balance between a biologically driven disaster waiting to happen and someone who learns from experience. I think that’s what most of us are. How much we learn varies. How willing to act on what we learn varies even greater. And how lucky we are when it comes to the efficacy of our application is an entirely different story.

Tonight I will take my 27th dose of Xifaxan, bringing my next to last day of the ten day course to a close. Each day has been different. I’ve felt pretty bad almost the whole time – physically and emotionally. Although I ran my first non-stop mile last weekend, my workouts otherwise have been kind of crappy. I’ve lost interest in work. I am generally weepy and tired a lot. I don’t attribute this to Xifaxan on the whole. I’m curious about a whole host of things. I have my period. I’ve been drinking Diet sodas again. Emma says that the effects of aspartame are worse after exercise and I live at the gym these days. I’ve been getting whole caff coffees rather than half caffs. I’ve been eating a ton of protein. And my carbs have been high – in the high 30s to low 40s.

The weight loss is going well. Its slow but not as slow as it had been. I think I’m losing at a pace that I can accept now. It’s for shame that I would be at or around my ideal weight if it had only come off like this from the start. I’ve lingered for a few days at my lowest adult weight ever. I’m looking forward to getting lower. I hope that a weekend in CT won’t ruin things. I don’t plan on eating off diet or anything, its just hard to know what you’re really getting when you are dependent on restaurants and the B&B kitchen.

I’m incredibly thankful that I had a chance to have a breath test and I’m incredibly thankful that I had a chance to take Xifaxan. And I’m pretty terrified that it won’t work. That’s where I am with 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.