SIBO Treatment and FODMAPs

After taking the antibiotics to treat SIBO, small intestine bacterial overgrowth, I felt great.  For the first time in almost a year I felt that I could eat just about anything (I still stayed away from lactose).  I never felt bloated, my stomach never hurt, and I no longer had loose stool.  I felt normal!

I graduated from Physical Therapy School and my boyfriend graduated from Dental School in May and I was able to participate in all the celebrations without my stomach being angry at me.  I ate whatever I wanted and drank whatever I wanted.

To celebrate our graduations, my boyfriend and I went to Punta Cana in the Domincan Republic to an all inclusive resort.  We went to Secrets; absolutely amazing!  We had a great time eating, drinking and relaxing.  Not once did my stomach get upset!  I literally thought I was cured of all my stomach ailments.  

We returned from our trip June 8th and by June 15th I started feeling the same symptoms I've felt since last May.  The bloating, stomach ache, and loose stool returned.  Why oh why? I was feeling so good for almost 2 months!  What happened?  I can only guess that SIBO came back just like the gastro said it can. I didn't have another appointment scheduled with her until late July, so I decided to do some experimenting with my diet to see if there were any trigger foods.  

My boyfriend and I decided to do an elimination diet.  There are many forms of the diet out there for you to try, but we tried eliminating everything.  I mean EVERYTHING. We ate only chicken and rice for a week.  We seasoned our meals with salt, pepper, olive oil, and various spices.  No garlic or onions.  By the end of the week we both felt FANTASTIC! No bloating, no stomach ache, no tummy rumbling, no gas. I decided to start putting things back into my diet using the FODMAP diet as a guide. The nutritionist at the gastroenterology practice recommended me to try it after I finished the antibiotics for SIBO. 

• FODMAP basically eliminates many of the vegetable, fruits, and grains that could be upsetting your stomach
• FODMAP is a diet that is now commonly used to treat IBS. 

Here are a list of foods I added back into my diet that were OKAY and didn't upset my stomach: 

1. spinach
2. egg
3. tomato (in small quantities)
4. colored peppers (not green)
5. bread (in small quantities)
6. fish
7. pork
8. beef

Here are a list of foods I tried that I found did upset my stomach:

1. carrots (especially in large quantities)
2. garlic
3. onions
4. large amounts of cooked tomatoes (i.e. tomato paste, pasta sauce, and ketchup)
5. large amounts of wheat (i.e. full serving of pasta)
6. honey (this one was REALLY, REALLY BAD!!)
7. Blueberries  
8. Raspberries
9. Strawberries
10. Melons - watermelon, cantaloupe, honeydew
11. Avocados 

I am still trying to figure out all the foods I have issues with, but here is the start of the list.  Some websites, doctors, and other people say that they are able to eat some problem foods in small quantities without any issues.  I have yet to try and find out if this is the case with me.

The process is really long, but so far I feel great most days... as long as I eat at home.  Obviously if I go out to eat, it is really hard to stay away from some of the foods I know irritate my stomach, such as garlic.  I do my best to modify the dishes to my stomach's liking.  

A few things that I found work for my stomach and still allow me to enjoy what I love:

1. Garlic infused oil-- AMAZING, great garlic taste without the stomach ache
2. Vodka Soda with a SPLASH of juice.  I usually have grapefruit juice because it cuts the taste of the vodka a lot and is usually a juice that is lower in sugar.  Another good juice to use is cranberry.
3. Sorbet with NO high fructose corn syrup
4. You can view other things that work for me here

The adventure of determining a good diet with a happy stomach and a happy me continues...

Second Date with the Gastro

In April, three months after my initial visit to the gastroenterologist, I returned for my second appointment.  Prior to the appointment, I was very frustrated.  The fiber wasn't working and I tried being gluten free, but nothing was working.  I still felt bloated and uncomfortable with a 3 month old food baby.  

I told the gastro everything.  Her rebuttal, "your symptoms sound like you might have SIBO."  SIBO, what is SIBO?  SIBO stands for small intestine bacterial overgrowth.  You always have bacteria in your intestines because that is how we break down our food.  However, if there happens to be more bacteria than there should be in your intestine, especially your small intestine, the excess of bacteria produces and excess of gas.  Your small intestine is not made for gas.  It is small in diameter, there is lots of it, and it is all folded up inside you.  So, if gas is produced in your small intestine, you usually get a very bloated feeling.  Your large intestine is made for gas; it is wide and not folded and you wouldn't feel too uncomfortable if there was an excess of gas... you would just fart. 

Here are the symptoms I had that lead my gastro to believe I might have SIBO:

• Gas
• Bloating
• Diarrhea

Some literature says that SIBO is turning out to be more common than doctors really thought.  Originally, doctors only thought that people with gastric surgeries got SIBO.  Now, there is speculations that SIBO might be linked to IBS.  Just speculations though.

What is the treatment? Taking very expensive antibiotics (I paid $140 for 10 days).  These antibiotics are specifically for the small intestine.  They are meant to kill off the excess of bacteria.  If you have SIBO and the antibiotics do their job, you should feel great within a few days. 

Well, that is what happened to me.  By day 3 on the antibiotics I felt 70% better.  After I finished the course of antibiotics I felt better than I had for a year.  I still felt a little bloated, but I felt immensely better.  I was no longer worried about what I was eating.  I felt like I could eat just about anything.  I was on top of the world.  Probably the best $140 I've ever spent.  

Disclosure: The gastro did warn me that the antibiotics are not a "fix it forever" drug.  She said that there is a good possibility that the SIBO will eventually come back and you may need another round of antibiotics somewhere down the road. 

Turning Over A New Leaf

Even though I wasn't happy or satisfied with my first visit to the gastroenterologist, I thought I would at least give her suggestions the benefit of the doubt and also try a few of my own things.  

So I started taking the fiber; a spoonful at night to start out.  After a week or so I add another spoonful in the morning.  Although this did harden my stool, the fiber didn't make me feel any better.  I still felt very bloated, especially by 2-4pm. By bloated I don't mean gassy, I mean like I looked and felt like I could be 3-5 months pregnant.  Wearing pants with any sort of waist band was out of the question because I couldn't fit into them come 2pm.  Thank goodness I was working as a physical therapist in a hospital and could wear scrubs otherwise I would be 10x more uncomfortable.  I also still had stomach cramps throughout the day and even more intensely at night.  

So why was I still bloated and miserable even though ALL my lab results came back negative?  I was not ready to just be pooled into the IBS category and ignored.  Deep down I knew this was not  just IBS.  So, just like anyone else I started do my own research and try different diets and suggestions that I found on the web.  And here it goes folks, all my trials and errors documented. 

Through my own research on the web, I discovered that people could still be sensitive to gluten without testing positive for celiacs. So, I decided to eliminate gluten from my diet completely.  This was easier said than done being that grains was  my main food group for many, many years.  At the time, I was also vegetarian and had been for about 5 years.  Grains are a major food group for some vegetarians especially ones that exercise at a high intensities (like me).  I quickly found myself in a tough situation.  I wasn't getting enough nutrients.  So, I decided to do something that I never thought I would ever do again.  I added some meat back into my diet.  I added more fish, chicken, turkey and even some pork to my diet. 

At the time,  I belonged to a Crossfit gym.  If you know Crossfit, you can't step into a box without hearing someone talk about the Paleo Diet.   Crossfit and Paleo pretty much go hand in hand.  So, I basically started the Paleo Diet; eating more meat, not eating legumes, not eating grains. After a week of the Paleo Diet, my stomach felt maaaaybe 20% better.  I didn't have the stomach cramping anymore, but I still felt bloated and horrible most of the time. 

All I could conclude is that maybe gluten had something to do with how horrible I felt, but it wasn't 100% the cause. I found my self excited to go back to the gastroenterologist.  I couldn't wait to tell her my findings and I hoped she had something else for me to try. 

First Date with the Gastro

As noted in the previous post, my first date with the gastroenterologist didn't go as I had planned.  I, like most people these days, did my homework. I figured out I probably had Irritable Bowel Syndrome, but wanted to rule out any allergies or diseases first.  So, I went to an allergist and got tested for food allergies and had a blood work up done for celiacs and other GI diseases.  When the tests came back negative, I knew I probably had IBS.  I didn't need a $400 dollar doctor visit to confirm that's what I had.  

Well that's how the appointment went.  She [the gastro] wanted another blood work up to make sure I didn't have any other GI illnesses (including celiacs, which I had already ruled out).  This blood test also came back... surprise, surprise... negative! 

She suggested I started taking an oral fiber to help with my watery stool, such as Benefiber, which is a corn dextrose based fiber.  CVS sells a generic brand call Easy Fiber.  She also suggested I started tracking the foods I ate with a food diary. The food diary became the hardest part of my homework for me to be compliant with because as a girl that LOVES food and LOVES to eat, keeping track of every piece of food I put it my mouth was rather hard.  I didn't really get good at keeping a food diary until months down the road.  

So, summary of my 1st appointment:

1. take Benefiber
2. track my foods

My next appointment with the gastroenterologist would be 3 months later, in early April 2013.  

The Beginning

I used to be a normal, healthy, go lucky, young female.  I could eat and drink anything I wanted with full enjoyment.  Late in college I became lactose intolerant.  Big deal.  The majority of people are lactose intolerant to some extent.  So, I just didn't eat cheese, yogurt, or ice cream in large quantities, but I was still able to eat these foods without too many issues.  This did not last. 

I've always been an athlete and in May 2012 I ran my first (and quite possibly my last) marathon.  Training went well, but as my runs go longer my stomach start getting... well... angry.  I attributed this to the long miles and those nasty gels/gummies I had to eat while running in order keep all my electrolytes in balance and give me fuel.  

After I finished my marathon (I did extremely well) my stomach problems still persisted.  In fact the problems intensified around July/August 2012.  A few days a week around 2-4pm I would become extremely bloated and uncomfortable.  Eventually these symptoms would iron themselves out before I went to bed and would be completely gone when I woke up in the morning.  

The bloating, cramping, uncomfortable feeling continued to get worse.  By October/November 2012, these symptoms occurred every day and usually pain or cramping accompanied them.  I started to find it hard to treat patients.  Being a physical therapist, a job that requires me to move around on the time, is a hard job to do when you are bloated, uncomfortable, and always trying to hold in a fart.  I found it very uncomfortable to wear any sort of pants with an actual waist.  Most days I resorted to wearing scrubs, tights, or exercise clothes.  I was so uncomfortable that I didn't want to go out with friends or make plans on the weekend.  Everyday was uncomfortable and painful not just physically, but mentally as well.

In December 2012, I decided to go see an allergist.  Maybe I was allergic to a type of food that I didn't know about.  Maybe I had celiacs (even though it doesn't run in my family).  I got a whole work up for food and a blood work up for celiacs.  All my tests came back negative.  I am not allergic to wheat. I am not allergic to any foods.  Back to square one. 

So, in January 2013, I decided to go to a gastroenterologist.  I lived right across from a hospital, so why not go.  My first appointment was very disheartening.  I had so much hope for this appointment.  I hoped that this doctor would have some magic cure for my ailments and make me "normal" again.  Well, let's face it,  there isn't a magical cure for gastric diseases especially when you are labeled in the Irritable Bowel Syndrome (IBS) category.  Many treatments are not proven and work for some while not working for others.  The realm of IBS is trial and error.  And well... IBS just plain old sucks.  

I hope through this blog that I can help someone with their own dietary issues, help them realize that they are not alone, and maybe save someone some frustration.  This blog is a journey through my trials and errors.  Hopefully if I find out what works for me, some recipes and ideas that will work for you. 

Cheers!