How My Doctor “Cured” My SIBO (For Now, At Least)

Last week I wrote a blog post about my recent diagnosis of SIBO (Small Intestinal Bacterial Overgrowth), which is a gnarly stomach disorder that may be the root cause for up to 80% of IBS sufferers. I’m happy to report that, after a couple months of treatment, I’m now able to eat EVERYTHING except wheat and dairy. This may not sound like much of a victory to any Digestively Normal readers (actually, I’m not sure I have any Digestively Normal readers; and if I do, man, this must be a really boring blog for you). But considering that for the past few years I haven’t been able to tolerate beans, garlic, onions, coconut milk, cruciferous vegetables, or any other high-FODMAP foods (complete list of high- and low-FODMAP foods here), I am ELATED with my broadened diet.

How did I get “cured”? Well, SIBO is notoriously difficult to cure – it often comes back. I’ll talk more about that later. But here’s how I’ve arrived at my much-improved condition.

Immediately following the diagnosis, my functional medicine doctor prescribed a potent cocktail of herbal antimicrobials. Rather than list them all here, I’ll just show you what I was taking:

I took those antimicrobials for a month, during which I experienced pretty extreme and consistent bloating and pain, as well as reduced motility. It was not a fun month. Maybe I should’ve stopped taking them after the first few days, but I’m pretty desperate for a “cure,” so I soldiered miserably through the month.

After the month, my doc told me that the pain I was experiencing could be due simply to inflammatory reactions to the meds. He said that we wouldn’t know if they’d worked until I got the inflammation under control. So he took me off the antimicrobials and put me on some herbal anti-inflammatory meds, and lo and behold, after about a week, I found that I was able to tolerate a MUCH greater variety of foods. I was eating onions and garlic for the first time in years, and only experiencing very minor bloating and pain. I even traveled to Vietnam and ate baguettes (like, made from WHEAT), and I was like, hallelujah, god bless me, bread and I are back together.

But then I got home from Vietnam and ate seven Ritz crackers and was knocked on my ass for two days with symptoms ranging from crushing lethargy (i.e. I couldn’t get off the couch) to intense brain fog to behind-bathroom-doors symptoms that nobody here wants to read about. Sooo, I trotted back to the doc, who explained to me that the wheat that’s grown overseas is much different from the wheat that’s grown in the U.S. (all of which is hybridized). Apparently, overseas wheat is much easier to digest, which I don't yet entirely understand (and I will try to get more info about this STAT). But I can now verify this phenomenon as a true fact based on my personal experience.

After the Ritz Cracker Incident, my doc put me on a two-week course of SIBO-eating antibiotics (Rifaximin and Neomycin), and during those two weeks I felt like a million bucks. I ate anything I wanted other than bread and dairy, and experienced zero bloating or pain. Zilch. This is, for me, revolutionary. I've gained about 5 pounds in the last couple weeks eating coconut milk ice cream and rice pasta with REAL marinara sauce (i.e. loaded with onions and garlic) and hummus and other stuff that I haven’t eaten for years. I even ate Chinese food made with soy sauce, which has traces of wheat in it, and didn’t feel too bad afterward. 

I've now been off the antibiotics for 2 weeks and I'm still eating a helluva lot more foods than I used to.

So, am I “cured”? Well, there’s a pretty decent chance that the SIBO may come raging back. So I’m now on a pretty extensive protocol of maintenance meds (mainly herbal) for the next couple of months to try to make sure that I avoid relapse. Also, I still can’t eat wheat and dairy, but I’m actually allergic to dairy, so that’ll never change. And I have high hopes that my relationship with wheat may continue to improve with time.

I’ll write about the post-SIBO-treatment protocol next time. For now, this blog is already long, and if you’re still with me, it means that you’re suffering in the same ways that I have for the last 7 years, and my heart goes out to you! Get tested for SIBO!

xo

Finally, After Seven Years, A Diagnosis For My Gut Problems: SIBO

If you have IBS, and you don't know what's causing it, you might wanted to get tested for SIBO (Small Intestine Bacterial Overgrowth). What's SIBO? I'll tell you in a minute. But first, I'll summarize my circuitous and frustrating journey toward getting a diagnosis:

I’ve suffered with stomach issues for years. I've had chronic painful bloating and various other symptoms that range daily from curl-up-in-fetal-position-debilitating to mildly annoying. More than one gastrointestinal doctor has tested me for various things, only to tell me that I have “IBS,” which is a meaningless and unhelpful non-diagnosis. And since it’s meaningless, there’s no way to treat it. One doctor told me to “eat some fiber every day, but not too much fiber, because that’ll just cause more pain, good luck!” Another told me to take an antidepressant that would numb my pain sensations. Seriously.

I got so desperate at one point that I actually took the antidepressant for two days, and… (drum roll, please)… it made me depressed. And it increased my pain. And it made me nauseated. So I kicked that pill to the curb.

The only thing that’s helped me has been a low-FODMAP diet, which eliminates the most difficult-to-digest carbohydrates (FermentableOligosaccharides, Disaccharides, Monosaccharides and Polyols). But if you can’t tolerate FODMAPs, you can’t eat onions, garlic, beans, or a zillion otherthings, which means it’s virtually impossible to eat food prepared by anyone but yourself. Eating out becomes the opposite of fun. 

My incredible nutritionist Sarah Kennedy surmised that I had SIBO (Small Intestine Bacterial Overgrowth). SIBO is a chronic bacterial infection of the small intestine that causes bloating, cramping, diarrhea and/or constipation.  The excess bacteria in the gut interfere with the absorption of food, increasing gas production, decreasing fat absorption, and leading to a further proliferation of bacteria. SIBO can be caused by many things, including celiac or Crohn’s disease, chronic constipation, or any episode that disrupts gut flora and damages the gut, such as traveler’s diarrhea. Some doctors estimate that SIBO may be the root cause for up to 80% of IBS sufferers.

I told my GI doctor that my nutritionist suspected that I had SIBO, and the doc scheduled an appointment to test for it. The day of the test, however, I discovered that although my insurance technically “covered” the test, my co-pay was going to be $300. My doctor advised that I could buy the test from Commonwealth Laboratories and do it myself at home for only $200. It’s an easy breath test (for 3 hours you breathe into a tube every 15 minutes) so I did it myself, and the test came back negative. Sarah and I were both mystified, since my profile fit SIBO pretty perfectly.

Fast forward two years, and my digestive woes were so debilitating that I decide to pay out-of-pocket to see a Functional Medicine doctor who specializes in IBS (why my insurance won’t cover this kind of doctor is another rant for another day). Unlike previous doctors, this one spent an hour asking questions about my digestive history before making any recommendations. When I told him that I could pinpoint the year in which my symptoms appeared (2008), he felt certain that there was a “foreign actor upon my system” (i.e. I picked up some bad bacteria or a virus somewhere). He asked if I’d had a notable stomach illness within the year prior to the onset of symptoms, and I said, yep, I had a gnarly water-borne stomach bug in Guatemala in 2007. Bingo, he said – your system was infiltrated by something in Guatemala, and it’s still wreaking havoc today. He did a battery of (very expensive) tests, including a re-test for SIBO. He told me that Commonwealth Labs delivers notoriously inaccurate results, and I should use a better testing center.

Lo and behold, the SIBO test delivered a STRONG positive. It is wildly empowering to have a diagnosis, and to finally understand what has turned my gut upside-down. A bit of a bummer that I could’ve/should’ve received this diagnosis TWO YEARS ago, had Commonwealth Labs gotten it right. But no matter.

Here’s the good news: there’s a treatment for SIBO. It doesn’t work for 100% of patients, but it does work for a substantial portion of them. I’m in the midst of the treatment now and I already feel vastly better, for the first time in 7 years. Of course, it remains to be seen what I feel like when I'm finished with the meds. I’ll blog about the treatment options and outcomes later, but in the meantime: if you suffer from IBS and your doctors have been unable to determine the cause of your suffering, consider getting tested for SIBO. And don’t use Commonwealth Labs; use Sibocenter. G’luck!

Low-FODMAP Veggie Spring Rolls with Fresh Peanut Sauce

These are so good they make you forget you’re eating raw vegetables:

Ingredients:

Peanut Sauce:
- 1 cup creamy peanut butter
- ¼ cup rice vinegar
- ⅓ cup water
- ¼ cup coconut aminos
- 1½ tablespoons maple syrup
- ½ teaspoon ground ginger
- ¼ teaspoon red pepper flakes

Spring rolls:
Spring roll rice wrappers – one package (about 8 sheets of rice paper)
2 or 3 carrots (depending on size)
1 cucumber
1 beet
handful of green beans
1 red pepper

Directions for Peanut Sauce:
Combine all the ingredients in a food processor or blender. Add more water if it needs to be thinned out a bit. You can also add more red pepper flakes if you want it super spicy.

Directions for spring rolls:
Chop veggies into thin strips. This is about the right portion for a single spring roll:

Soak a rice wrapper for about 20 seconds in some water, until it becomes soft and pliable:

Gently lay out the rice wrapper on a clean plate. Place a handful of mixed veggies onto it. Pull the rice paper taut around the veggies, like you’re wrapping a package:

As the rice paper dries it’ll set. Now you can make another one. Once you've wrapped them all, you may eat your masterpiece. 

Low-FODMAP, Stupidly Yummy Broccoli Tots

Here’s a good way to enjoy eating more vegetables: fry the hell out of them. These broccoli tots are so good that your friends will be like, HOW DID YOU DO THAT.

Ingredients:
2 heads of broccoli, stems cut off
½ cup cooked white rice
3 tbsp. rice flour
½ lemon, squeezed
½ tsp. sea salt
½ tsp. pepper
1/8 teaspoon cayenne pepper
2 tbsp. olive oil
2 tbsp. walnut oil (or you can just use 2 more tbsp. olive oil)
1 egg

Directions:
1. Boil the broccoli for about 3-4 minutes, until it starts to get soft (but isn’t entirely cooked). Drain the broccoli in a colander, and then finely-dice on a cutting board.

2. While the broccoli is boiling, whisk together the egg and lemon, and then add the salt, pepper, cayenne pepper and rice flour. Once that’s nicely mixed, add the white rice and then the finely-diced broccoli.

3. WAIT AT LEAST 15 MINUTES BEFORE PROCEEDING. This step is important, because it allows the tot “batter” to bind together a little bit. If the batter doesn’t bind, the tots may fall apart in the skillet.

4. Heat 3 tbsp. of oil in a large skillet on high (cast iron works really well for this recipe). Once the oil is hot, turn the temperature back to medium.

5. While the oil is heating, work the batter into tot-shaped pieces using your fist and fingers, as shown below.

Be sure to squeeze out all excess liquid before you place each tot on the skillet. If you don’t do this, the tot will fall apart.

6. Place tots on skillet. 

Once the bottom of the tot has browned (about 3-4 minutes, depending on how hot your skillet is), carefully give it 1/3 turn so it’s now resting on a side that’s not yet browned. Then once that side is browned, give it another 1/3 turn. If the oil “dries up” at any point during this process, add the last tablespoon of oil to the skillet.

Serve with dipping sauce. I love these with honey mustard or Sriracha. The recipe makes about 25 tots.

Easy Low-FODMAP Cucumber Sesame Salad

I’m still obsessed with my spiralizer (for details, see previous recipe for zucchini pasta).

This cucumber salad is super easy and pretty adorable, if vegetables can be adorable.

Ingredients:1 cucumber
½ teaspoon sea salt
2 teaspoons sesame seeds
2 teaspoons rice vinegar
½ teaspoon sesame oil
¼ teaspoon maple syrup (or sugar)
dash red pepper flakes (less than 1/8 teaspoon)

Directions:
-Spiralize the cucumber (do not remove the peel or it will fall apart). Toss with salt, then put cucumber in a colander and let it breathe for half an hour.
-Meanwhile, toast the sesame seeds in a pan.
-Mix together rice vinegar, sesame oil, maple syrup, and red pepper flakes.
-RINSE cucucumber thoroughly and pat dry with paper towels (I skipped this step once and the salad was intolerably salty).
-Toss with dressing

You can double or triple this recipe, depending on how many people you’re serving.

Easy Low-FODMAP Zucchini Spaghetti with Lemon Shrimp

My new obsession is my Oxo Spiralizer, which turns boring veggies into noodles:

For this dish, I noodle-ized zucchini. To make the noodles, just cut the tip off the zucch, press the un-peeled flat edge to the center of the Spiralizer, and twist. I’m 99% certain that zucchini tastes better in noodle form. Especially when it’s smothered in olive oil and herbs:

Ingredients:
2 zucchinis
10-12 shrimp
2 tablespoons olive oil
½ lemon, squeezed
¼ teaspoon fresh thyme (if you use dried herbs, use less)
½ teaspoon fresh oregano
½ teaspoon fresh basil
½ teaspoon salt
¼ teaspoon pepper
Parsley for garnish (or you can skip the garnish)

Directions:
Drop the zucchini in boiling water until it starts to get soft, about 3-4 minutes. Meanwhile, sauté the shrimp on medium heat in the olive oil and lemon for 2 minutes per side. Add the herbs and let the shrimp continue to sauté while you briefly drain the zucchini in a colander. Add zucchini to the pan with the shrimp and herbs. Toss and sauté everything together for another 2-3 minutes, until zucchini is at desired level of softness. Total cooking time will probably be around 8 minutes – make sure the shrimp are cooked all the way through.

Garnish with parsley and additional lemon if desired.

Makes 2 servings.

Low-FODMAP Almond Flour Pancakes

Your non-digestively-challenged friends will love these pancakes just as much as their beloved traditional pancakes. Actually, a lot of my friends love them more.

Ingredients:

4 eggs
2 tbsp maple syrup

1 tsp vanilla
¼ tsp salt

1 ½ cups almond flour
¼ teaspoon cinnamon (I sometimes add more)
¼ cup blueberries
Coconut oil for cooking

Directions:
Whisk together eggs, maple syrup, and vanilla. Add the salt, cinnamon, and 1 ¼ cup almond flour. If you want the batter to be thicker, add the rest of the almond flour. Once batter is the right consistency, add the blueberries.

Heat a tablespoon of coconut oil in a large skillet (I use cast-iron) over medium heat. Pour 1/4-cupfuls of batter onto the skillet and cook the pancakes until golden brown and cooked all the way through (about a minute or two per side).

Y'welcome. :) 

Low-FODMAP Samon Croquettes

I could eat these salmon croquettes twice a day for my whole life and never get tired of them. They are as gentle on the stomach as they are yummz. I try to use all organic ingredients, because I figure my sensitive stomach might not appreciate a dose of poison.

Ingredients:

1 8-oz can of salmon (you can use slightly more or less salmon if you prefer)

1 medium sweet potato, boiled, peeled and mashed

1.5 cup rice, cooked

1 egg

½ teaspoon salt

1 teaspoon dry dill

½ teaspoon dry rosemary

Juice from 1 lemon

1 tablespoon brown rice flour

1 tablespoon olive oil

1 tablespoon walnut oil (you can use 2 tbsp olive oil if you don’t have walnut)

Directions:

Mix the first 9 ingredients together (everything except the oil) to create a sort of “batter.” Heat the oil in a big pan (cast iron works great for this recipe). Form mixture into patties the size of a small burger and drop them into the oil. You should be able to make about 20 patties. Cook the croquettes on medium-high for 5 minutes per side, or until browned and cooked through. Serve over greens.

Enjoy. xo

Video Explaining What FODMAPs Are and How They Affect The Gut

For lots of people (including myself), a low-FODMAP (Fermentable Oligo-Di-Monosaccharides and Polyols) diet is a reliable way to eliminate painful IBS symptoms. The diet was developed by researchers from the Australia’s University of Monash, who discovered that IBS sufferers have trouble digesting certain kinds of food sugars. Those sugars are found in foods in varying degrees: for example, watermelon is high-FODMAP and cantaloupe is low-FODMAP. A complete list of high- and low-FODMAP foods can be found here.

The University of Monash has created a video to explain what FODMAPs are and how they affect the gut. The first 20 seconds of this video feature some laughably bad acting (you can skip the first 20 seconds), but the animation in the next 2 minutes is really useful.

Here's the article associated with the above video, which gives some additional info. You can also download a smartphone app where you can look up any food to find out whether it’s “safe.”

Happy eating, my friends. 

2015 Movies that Deserve More Recognition

Like everyone else, I loved Star Wars and Spotlight and The Big Short. But a lot of the best movies from the past year aren’t getting the recognition they deserve. Here are some of my favorites, in no particular order:

Amy – Grotesquely compelling and important documentary about the degenerative power of fame. http://www.rottentomatoes.com/m/amy_2015/?search=amy

Far from the Madding Crowd – How is this film not getting more recognition? If you love epic, perfectly-acted, beautifully shot British romances, you’ll thank me for recommending this one. http://www.rottentomatoes.com/m/far_from_the_madding_crowd_2014/?search=far%20from%20the%20madding

Love & Mercy – One of the best films I saw this year. I don’t understand why it’s not nominated for more awards. Paul Dano and John Cusack were masterful, and the story is fantastically compelling. http://www.rottentomatoes.com/m/love_and_mercy/?search=love%20and%20mercy

The Wolfpack – If this story about 5 kids who grew up almost exclusively inside a NYC apartment (they only went outside briefly once each year) weren’t a documentary, I wouldn’t believe the story was possible. http://www.rottentomatoes.com/m/the_wolfpack/?search=the%20wolfpack

Going Clear – I thought about this Scientology documentary for days after I saw it - http://www.rottentomatoes.com/m/going_clear_scientology_and_the_prison_of_belief_2015/?search=going%20clear

Ex Machina – This unique sci-fi film should be nominated for all the awards. Go see it. http://www.rottentomatoes.com/m/ex_machina/?search=ex%20machina

Slow West – This indie western is unique and beautiful. One of the best films I saw this year. http://www.rottentomatoes.com/m/slow_west_2015/?search=slow%20west

McFarland USA – there’s nothing Oscar-worthy about this inspiring film about a track team from a rough part of LA, but I loved every second of it. http://www.rottentomatoes.com/m/mcfarland_usa/?search=mcfarland%20usa

Going Clear – I thought about this Scientology documentary for days after I saw it. http://www.rottentomatoes.com/m/going_clear_scientology_and_the_prison_of_belief_2015/?search=going%20clear

Trainwreck – Not a perfect movie, but it made me laugh. And laugh. And that’s worth a lot. http://www.rottentomatoes.com/m/trainwreck/?search=trainwreck

Obvious Child – This movie, which admittedly came out in late 2014 (though I didn’t see it ‘til 2015 so it’s going on my list) is a comedy about an abortion, which at face value sounds like a really bad idea. But in actuality, it’s incredibly compelling and touching and funny. http://www.rottentomatoes.com/m/obvious_child/

Happy viewing! And please send me YOUR recommendations!