Thursday, August 18, 2016

Cracking the Code: The SIBO Diet

Breakfast: Kale "pancake" with bitter greens and heirloom tomatoes

Lunch/dinner: Zucchini noodles & kale basil pesto with clams

Real talk. I've been living with a variety of stomach/digestive issues since I was in high school, discovered by my not-so-crack pediatrician after a bout of reflux nearly sent me to the ER after having a late night, very-fancy-for-a-16 year old cappuccino at a local cafe with a friend of mine. This was the same crack pediatrician who used to give me antibiotics like they were candy to treat strep throat and - what I've since come to learn is totally made up - a "carrier case" of strep. By the time the coffee drink nearly killed me, I was well on my way to killing off all the good bacteria in my body and setting myself up for what would turn out to be MANY years of pain, doctor's visits, nasty tests.

Am I entirely blaming poor Dr. Kaufman who also thought the best way to treat a cyst on my hand (when I was 8) was by slamming it with a hard copy of Grey's Anatomy? Well, maybe a little. But the antibiotic overload continued with many other doctors for lots of other conditions over many more years. And then there was the matter of my seemingly innate tendency to worry about everything.

In the past few years, the digestive challenges became exponentially worse (as I've documented here as well). I had stomach bleeding, muscle wasting, pain, difficulty swallowing, terrible reflux/heartburn. Many endoscopies and colonoscopies and biopsies and medications later, I also had few answers as to why things were so bad, but because of my other underlying medical conditions I continued to be monitored and tested (see: "watchful waiting") meanwhile struggling to enjoy foods that I don't just love but adore.

Finally, my doctor here in Portland decided to test me for something called SIBO - small intestine bacterial overgrowth. A relatively newly discovered issue that involves bacteria from the large intestine migrating to the - supposed to be sterile - small intestine causing issues such as pain, heartburn, gas, severe bloating, constipation, diarrhea, etc. Everything that has historically been labelled "Irritable Bowel Syndrome" may in fact be SIBO.

The test is really, really, truly, really no fun. For four days, you discontinue medications that you may have been depending on to get through the day (i.e. antacids and/or non-stimulant, osmotic laxatives such as Miralax) and on the fourth day eat only completely plain protein for 24 hours. In my case that meant scrambled eggs and broiled salmon. By the end of the day, your body thinks you're trying to kill yourself and you're nauseous and headache-y. And then the next morning you drink a cup of lactulose (a sugar alcohol that can act as a laxative) and for the next three hours, you take breath samples every 20 minutes to determine if you are essentially off-gassing hydrogen and methane. Two gases that shouldn't be, um, coming up. The only people for whom this will show positive results have SIBO. By the end of taking my samples, I considered blowing my head off out of pure physical discomfort. Headache, nausea, bloating, dizziness. Oh and then I had to go to work. Good times.

Ok. So if you're still with me, surprise surprise I found out that I have SIBO and here's where things got even more challenging. My doctor explained that SIBO is exceedingly hard to treat. Many people go on a specialized liquid diet for a month and take powerful antibiotics that I learned (when my insurance refused to cover the cost) total up to almost $2000. The other alternative is a VERY restricted diet and herbal antibiotics that, studies have shown, are equally effective as the pharmaceutical but take longer to work. I had no other choice and this would be my route for at least two months, longer if the protocol didn't work, and even longer if I cheated.

Here's what I learned I could not eat: Sugar of any kind, artificial sweetener, nuts and seeds, grains of any kind, alcohol, soy, dairy (except aged cheese and homemade yogurt if I didn't already have a dairy allergy go there). I could eat plain protein: eggs, chicken, turkey, beef, game, fish, shellfish. I could eat a few vegetables (zucchini, leafy greens, tomatoes, carrots, radishes, peppers, ginger) and berries (approximately 1/2 cup per day). Spices are also ok. Meals needed to be spaced out by 4 hours and antibiotic needed to be taken in between. Because I am a chocolate fiend who depends on it for mood boosting and magnesium, I was able to include 3 tablespoons of plain cocoa/cacao a day OR 1 oz of unsweetened 100% baker's chocolate. This would have to carry me through!

I am currently on Day 40 and here's what I've learned so far:
1. I love food even more than I thought I did. I want to marry food. Especially the food I can't eat.
2. Olive oil can be and should be poured on everything in copious amounts.
3. Food restriction is not my bag
4. Beer = summer. When there is no beer (or ice cream!!), does summer really exist?
5. Having visions brought on by a little hint of starvation should be expected
6. When and if you cheat (as I did with a piece of my own cake and some lactose free ice cream) YOU HAVE TO START ALL OVER AGAIN

Insert sobbing here.

So...This is the situation. I'm trying to make the best of it. I am less fun at dinner gatherings because, for the most part, I'm bringing my own food with me everywhere I go. BUT on an up note, I think I have figured out a way to make eating the most extraordinarily pleasurable, healthy, nourishing experience I never thought possible. I feel more connected to what I'm eating and am mindful of appreciating every bite. Living in the Pacific Northwest has also given me access to incredibly fresh and affordable seafood, meats, and vegetables. Canned shellfish is a really affordable and easily transportable way to get great protein (and iron) when you're not going to be at home.

I've included recipes for two of my faves above and I'll keep on documenting and posting this journey which I anticipate will be lengthy in the hopes of feeling better and spreading the SIBO diet food lurve.
For more info on SIBO:
For more info on SIBO testing:

Kale "pancake" & heirloom tomato salad
1/2 cup of cooked organic kale (I use frozen kale cooked in the microwave for ease and cheapness)
1 egg
1/2 cup - 1 cup baby tomatoes
Lots of olive oil!

Oil up your frying pan and place it on the heat while you prep everything else.

Beat an egg in a mixing bowl with a fork. Stir in cooked kale. Allow the kale to absorb the egg a bit. Pour on to the griddle in a pancake shape. Cook for 2 minutes on each side until cooked through. Serve with chopped tomatoes, extra greens, and lots of olive oil and sea salt poured on top.

Zucchini noodles & kale basil pesto with clams
*If you don't have a spiralizer, use a veggie peeler to make the noodles.

Spiralize or peel 1-2 zucchinis (skin removed)
2 bunches organic basil leaves, cleaned and dried
2-3 cups of packed organic baby kale
Olive oil / sea salt
1-2 cans of good quality chopped clams (I used Natural Sea wild seafood or Bar Harbour), drained and rinsed

In a food processor, blend kale, basil. Pour olive oil in and blend until creamy. Add sea salt and pepper to taste.
Spiralize or peel the zucchinis into noodles. Heat olive oil in a sauce pan and saute clams for approximately 2 minutes. Add spiraled noodles. Add pesto. Serve with chopped heirloom tomatoes.

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