Surviving SIBO Part 2: The Treatment Phase

Surviving SIBO Part 2:

The Treatment Phase

 Now you know the background (Surviving SIOB Part 1). Just a quick reminder of how it came to be that I got SIBO: poor diet, over-prescribed antibiotics, leaky gut, stress, anxiety... While the  how  it happened was important to know, what treating SIBO led to is the most important part of my path to healing. Uncovering SIBO led me to greater self-awareness, significantly improved health, more sympathy, and more humility (~I actually don’t know it all~ and a plant based only diet  is not for everyone ~) So, once I knew I indeed had SIBO, I started researching how to treat it. That is where I got really-really-really  confused .  There is a lot of contradictory information out there when it comes to treating SIBO. There are varied dietary protocol approaches, herbal antimicrobials versus traditional antibiotics, and not to mention the timing of when to add, use, or implement it all. Since it seemed that being on antibiotics for the majority of my adolescence was a main factor of how I got SIBO, it did not seem reasonable to me that antibiotics would be the solution for me.  After a ton of research that included reading articles, books, blogs, websites, listening to podcasts, getting some random advice, as well as some very well-informed advice, I decided to go with a specific dietary approach combined with herbal antimicrobials. There are differing options in the SIBO treatment community: some say to not change your diet while taking the herbal treatment so the bacteria stay active and alive long enough to get destroyed by the antimicrobials. Other experts say to starve the bacteria by doing the dietary protocols along with antimicrobials. Starving them seemed like the quicker route to getting the job done, so I choose this combination in an effort to get this over with as soon as possible!  After several weeks of planning and prepping, I began a regime of the herbal antimicrobials Berberine and Neem Plus. I also implemented a low-FODMAP’s nutritional protocol. FODMAP’s are:  Fermentable  Oligosaccharides, Disaccharides, Monosaccharides and Polyols. The concept of low-FODMAP is that you don’t eat anything that is fermentable in the digestive tract. This will starve the bacteria that have migrated to the small intestine (they are not supposed to be there.) If the bacteria don’t have the delicious fermentable compounds in the high-FODMAP’s foods to feed on, they can’t survive in your gut any longer! You can google it for more specific information, but basically on a low-FODMAP approach you can’t eat much-- Of anything--At all. I mean you can eat all the low-FODMAP’s foods you want, but overall it is limiting (and a little bit sad).  I downloaded the SIBO Food Guide app that is based on Dr. Allison Siebecker’s work. She has helped many people heal SIBO, and it seemed like a reliable and useful tool. The app has a handy list of all foods in every category: veggies, fruits, grains, proteins, fats… with a Red dot for: ILLEGAL-OFF-LIMITS-DO-NOT-EAT foods. A Yellow dot for: eat only LIMITED amounts, for example- asparagus: 1 spear is legal- (I mean seriously, I’m going to have  just one  spear of asparagus?) An Orange dot for: you are PUSHING IT, example- asparagus: 4 spears are legal, (again,  seriously ?) A Green dot for: EAT ALL YOU WANT!: meats, oils, some leafy greens, some veggies and some fruits, but basically, not m(any) carbs allowed.  I had to make a ton of changes. I used to have apples every single day. Well guess what, they are ILLEGAL-OFF-LIMITS. I had avocados every day, they are mostly illegal. I ate sweet potatoes a good bit: ILLEGAL-OFF-LIMITS. I ate a good bit of quinoa and rice: ILLEGAL-OFF-LIMITS. Onions and garlic: ILLEGAL-OFF-LIMITS, this made it super difficult to eat out or cook anything that had the robust flavors I enjoy. (You  can  use garlic infused oil, which was a life saver!) I consulted some cookbooks and websites and seemed to manage, but a lot of the joy of eating was zapped (no carbs allowed.)  This is one of the hardest elements of surviving the healing path: finding pleasure in eating. Not just because I couldn’t have carbs, avocados and apples, but also because I felt miserable. In Sylvie McCracken’s ebook about SIBO, she recommends a different specific gut healing approach: The Elemental Diet. When I first read about it, it seemed insane. After a week on the Berberine and Neem Plus I was seriously considering the Elemental Diet! (Hint:  you don’t actually eat on an Elemental Diet .) No Food. You just get the nutrients you need through an expensive or difficult to make concoction- which is the most important part of doing that particular healing protocol. But no food. Sounded miserable and a little crazy. Didn’t happen for me.  The Berberine made me feel horrible, way worse than the day to day SIBO symptoms I had been experiencing. You feel worse before you feel better. The bacteria die-off side effects are dreadful. (At times, the Elemental Diet really seemed like a really enticing option.) Pretty much everything I ate made me feel sick, and yet at the same time I was having the  craziest   cravings ! I would drive past a fast food place and think, cheesy fries, THOSE WOULD BE AMAZING!!! I NEED TO EAT THEM RIGHT NOW!!! The bacteria were desperate. They wanted carbs. They wanted sugar. They wanted pizza. They wanted cookies. They wanted everything and anything I could not eat in order to heal. They really did not want to go away. Now remember, I had been working on healing my leaky gut for a year and half before the SIBO diagnosis, I had not eaten pizza, cookies, cheesy fries, bread, or much added sugar in over a year! Those bacteria just wanted carbs, dairy, and sugar and they were trying super hard to convince me that I should eat pizza, eat cookies, eat fries!  The cravings were seriously off the charts and my stomach and digestion were  mis-er-able . I started taking Activated Charcoal to help with the die-off symptoms and detox the nasty little bugs and their toxic die-off waste (called Herxheimer reaction.) The Activated Charcoal seemed to help, but I still felt pretty bad. When treating SIBO t is considered to be counterintuitive to take probiotics, as adding in any bacteria, even the good stuff, is supposedly not useful. I had been taking and eating probiotics as a part of my lifestyle for some time. Not having them seemed to be impacting me, so it was recommended that I take a “SIBO-safe” probiotic called Sibiotica as well as S. boulardii. Integrating these did seem to provide some relief for my sad, mad stomach and digestion. I took digestive enzymes with every meal and did apple cider vinegar shots at night.  After about 15-days on the herbal antimicrobials I started taking Interfase Plus, a biofilm disruptor. The gross bacteria create little biofilms in your gut where they can “hunker down.” They seriously DO NOT want to be destroyed, and they are resourceful little buggers. The Interfase Plus helped clear out the biofilm, and while I think it was effective, it was also unpleasant. After the herbal antimicrobials were  finally  over, I began taking MotilPro, which is basically super ginger with some other helpful elements to aid with gut motility. One of the main causes/effects of SIBO is poor motility of food through the digestive tract. The longer it takes to digest, the more likely bacteria will start to feed on it. Yuck.  Another oh-so-delightful symptom of SIBO is that your small intestine (which is super important for assimilating the nutrients in your food) becomes terribly inflamed and you don’t properly absorb nutrients. This left me deficient in some vitamins and minerals. Over time, if not treated, this will cause other health problems that often get misdiagnosed. The inflammation was definitely where my skin troubles, including the rosacea, were coming from, and most likely my hormone imbalances, low energy and anxiety as well. I started supplementing the vitamins and I also took L-Glutamine in powder form to help repair my gut. The money I once spent on wine and going out to eat I now spent on freaking supplements!  During this phase I still felt rough, and my skin was looking rough. Although I was still feeling pretty bad, (the die-off symptoms last a long time) the cravings did begin to decrease. While I was no longer  jonesing  for pizza and cookies, I was craving tasty  real  food.  Oh- did I mention I was a total grump throughout this whole treatment phase? I was. It was miserable, I felt miserable, I basically whined and chose to stay miserable. When I finally got tired of whining and feeling miserable, I remembered that wait-- I am a yogini  and  a health coach! I had some really cool tools that I had been too busy being whiny and miserable to access. I love helping others by giving them useful tools and strategies to heal, but I forgot to help myself!  What is wrong with me?  I started including Ayurvedic approaches to healing the gut and getting rid of SIBO.  I started doing self-abdominal massage of the ileocecal valve (the IC valve is located between the small and large intestines and should stay shut after digested food moves from the small to large intestine). Because of the inflammation and low motility associated with SIBO, the IC valve may be stuck open- allowing bacteria to migrate from the large to the small intestine-  gross . I had fresh ginger infused in my tea every morning to help aid digestion and soothe inflammation. I started doing Kapalabhati breathing, Agni Sara exercises and oil pulling with coconut oil every  single morning. I added in additional yoga postures that aid in detoxing and toning the digestive system. These changes allowed the detoxing processes of my body to improve, which significantly began to aid in me feeling better.  After a good bit of research, I also started incorporating Intermittent Fasting (IF). With the slow motility associated with SIBO, my body did not have ample time or energy to digest after each meal. Eating the same amount of food in a shorter eating window helped to heal the gut and improve my overall health. Although it was initially tough to figure out the right timing, and assure that I got enough caloric and nutrient density during the eating window, it helped. Staying on top of Intermittent Fast is super important, you must nourish your body with ample nutrition and give it enough calories or it won’t heal!  This integrated approach helped me turn the corner. I started feeling better, but still was not normal digestively. I was freaked out that the SIBO was not completely healing. I never want to go through the misery of treatment again, so not feeling 100% was not an option. I found an acupuncturist who had experience with healing SIBO, and her treatments and magic herbs seemed to be the final trick. After just a few acupuncture sessions I returned to having “normal” digestion. For those of you who also suffer with abnormal digestion, you know how exciting it is to have “normal” poop! She put me on a regimen of Chinese herbs, recommended I stay away from food that are difficult to digest such as foods, and to begin adding the FODMAP’s back in one at a time.  I had been on the low FODMAP’s for just over 12 weeks, so I was super excited to start incorporating them again. It is important to  start slowly . I added in one, then increased a little every day for 5 days. I took good notes on all symptoms: digestion, energy, skin, mood, and so on. I started with onions and garlic and had no problem. After 5 days, I added in avocado, no trouble again! I continued with this pattern and was able to add all the FODMAP’s back in with no problems, but some ideas about what would be best to reduce. This process took about 2 weeks, and I’ll admit, it was super tempting to just go all the way back in after adding in the first couple with no troubles. Taking it slow really helped to notice what foods cause what symptoms, positive or negative, to assure that my system remained happy.  This brings me to the most important phase of treatment: maintenance. I’ll be back to share how I am maintaining so far. I’ve made it over 8 months since beginning treatment, and so far, I am hopeful. Once I started feeling better I wanted to go back to how things used to be. To eat whatever, whenever. At times I have let some things slide, but I know I can’t make that the norm. It takes  a long time  to heal the gut and if you remember from Surviving SIBO Part 1: I probably started damaging my gut at a very young age. I am 42 years old. That is  a long time  to have a crazy gut, the damage runs super deep. Keeping my gut happy and healthy keeps me happy and healthy. While the nutritional healing protocols, supplements and lifestyle help keep my gut in check, maintaining stress management and self-care practices are also extremely vital to remaining healthy. Everything is intimately interconnected.  I will be back to let you know how I continue to maintain a healthy, happy gut--  SIBO free !!  Are you struggling with an unhappy gut, a SIBO diagnosis or treatment? If so, reach out! Community is super important and sharing your story can be healing!

Now you know the background (Surviving SIOB Part 1). Just a quick reminder of how it came to be that I got SIBO: poor diet, over-prescribed antibiotics, leaky gut, stress, anxiety... While the how it happened was important to know, what treating SIBO led to is the most important part of my path to healing. Uncovering SIBO led me to greater self-awareness, significantly improved health, more sympathy, and more humility (~I actually don’t know it all~ and a plant based only diet is not for everyone~) So, once I knew I indeed had SIBO, I started researching how to treat it. That is where I got really-really-really confused.

There is a lot of contradictory information out there when it comes to treating SIBO. There are varied dietary protocol approaches, herbal antimicrobials versus traditional antibiotics, and not to mention the timing of when to add, use, or implement it all. Since it seemed that being on antibiotics for the majority of my adolescence was a main factor of how I got SIBO, it did not seem reasonable to me that antibiotics would be the solution for me.

After a ton of research that included reading articles, books, blogs, websites, listening to podcasts, getting some random advice, as well as some very well-informed advice, I decided to go with a specific dietary approach combined with herbal antimicrobials. There are differing options in the SIBO treatment community: some say to not change your diet while taking the herbal treatment so the bacteria stay active and alive long enough to get destroyed by the antimicrobials. Other experts say to starve the bacteria by doing the dietary protocols along with antimicrobials. Starving them seemed like the quicker route to getting the job done, so I choose this combination in an effort to get this over with as soon as possible!

After several weeks of planning and prepping, I began a regime of the herbal antimicrobials Berberine and Neem Plus. I also implemented a low-FODMAP’s nutritional protocol. FODMAP’s are: Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. The concept of low-FODMAP is that you don’t eat anything that is fermentable in the digestive tract. This will starve the bacteria that have migrated to the small intestine (they are not supposed to be there.) If the bacteria don’t have the delicious fermentable compounds in the high-FODMAP’s foods to feed on, they can’t survive in your gut any longer! You can google it for more specific information, but basically on a low-FODMAP approach you can’t eat much-- Of anything--At all. I mean you can eat all the low-FODMAP’s foods you want, but overall it is limiting (and a little bit sad).

I downloaded the SIBO Food Guide app that is based on Dr. Allison Siebecker’s work. She has helped many people heal SIBO, and it seemed like a reliable and useful tool. The app has a handy list of all foods in every category: veggies, fruits, grains, proteins, fats… with a Red dot for: ILLEGAL-OFF-LIMITS-DO-NOT-EAT foods. A Yellow dot for: eat only LIMITED amounts, for example- asparagus: 1 spear is legal- (I mean seriously, I’m going to have just one spear of asparagus?) An Orange dot for: you are PUSHING IT, example- asparagus: 4 spears are legal, (again, seriously?) A Green dot for: EAT ALL YOU WANT!: meats, oils, some leafy greens, some veggies and some fruits, but basically, not m(any) carbs allowed.

I had to make a ton of changes. I used to have apples every single day. Well guess what, they are ILLEGAL-OFF-LIMITS. I had avocados every day, they are mostly illegal. I ate sweet potatoes a good bit: ILLEGAL-OFF-LIMITS. I ate a good bit of quinoa and rice: ILLEGAL-OFF-LIMITS. Onions and garlic: ILLEGAL-OFF-LIMITS, this made it super difficult to eat out or cook anything that had the robust flavors I enjoy. (You can use garlic infused oil, which was a life saver!) I consulted some cookbooks and websites and seemed to manage, but a lot of the joy of eating was zapped (no carbs allowed.)

This is one of the hardest elements of surviving the healing path: finding pleasure in eating. Not just because I couldn’t have carbs, avocados and apples, but also because I felt miserable. In Sylvie McCracken’s ebook about SIBO, she recommends a different specific gut healing approach: The Elemental Diet. When I first read about it, it seemed insane. After a week on the Berberine and Neem Plus I was seriously considering the Elemental Diet! (Hint: you don’t actually eat on an Elemental Diet.) No Food. You just get the nutrients you need through an expensive or difficult to make concoction- which is the most important part of doing that particular healing protocol. But no food. Sounded miserable and a little crazy. Didn’t happen for me.

The Berberine made me feel horrible, way worse than the day to day SIBO symptoms I had been experiencing. You feel worse before you feel better. The bacteria die-off side effects are dreadful. (At times, the Elemental Diet really seemed like a really enticing option.) Pretty much everything I ate made me feel sick, and yet at the same time I was having the craziest cravings! I would drive past a fast food place and think, cheesy fries, THOSE WOULD BE AMAZING!!! I NEED TO EAT THEM RIGHT NOW!!! The bacteria were desperate. They wanted carbs. They wanted sugar. They wanted pizza. They wanted cookies. They wanted everything and anything I could not eat in order to heal. They really did not want to go away. Now remember, I had been working on healing my leaky gut for a year and half before the SIBO diagnosis, I had not eaten pizza, cookies, cheesy fries, bread, or much added sugar in over a year! Those bacteria just wanted carbs, dairy, and sugar and they were trying super hard to convince me that I should eat pizza, eat cookies, eat fries!

The cravings were seriously off the charts and my stomach and digestion were mis-er-able. I started taking Activated Charcoal to help with the die-off symptoms and detox the nasty little bugs and their toxic die-off waste (called Herxheimer reaction.) The Activated Charcoal seemed to help, but I still felt pretty bad. When treating SIBO t is considered to be counterintuitive to take probiotics, as adding in any bacteria, even the good stuff, is supposedly not useful. I had been taking and eating probiotics as a part of my lifestyle for some time. Not having them seemed to be impacting me, so it was recommended that I take a “SIBO-safe” probiotic called Sibiotica as well as S. boulardii. Integrating these did seem to provide some relief for my sad, mad stomach and digestion. I took digestive enzymes with every meal and did apple cider vinegar shots at night.

After about 15-days on the herbal antimicrobials I started taking Interfase Plus, a biofilm disruptor. The gross bacteria create little biofilms in your gut where they can “hunker down.” They seriously DO NOT want to be destroyed, and they are resourceful little buggers. The Interfase Plus helped clear out the biofilm, and while I think it was effective, it was also unpleasant. After the herbal antimicrobials were finally over, I began taking MotilPro, which is basically super ginger with some other helpful elements to aid with gut motility. One of the main causes/effects of SIBO is poor motility of food through the digestive tract. The longer it takes to digest, the more likely bacteria will start to feed on it. Yuck.

Another oh-so-delightful symptom of SIBO is that your small intestine (which is super important for assimilating the nutrients in your food) becomes terribly inflamed and you don’t properly absorb nutrients. This left me deficient in some vitamins and minerals. Over time, if not treated, this will cause other health problems that often get misdiagnosed. The inflammation was definitely where my skin troubles, including the rosacea, were coming from, and most likely my hormone imbalances, low energy and anxiety as well. I started supplementing the vitamins and I also took L-Glutamine in powder form to help repair my gut. The money I once spent on wine and going out to eat I now spent on freaking supplements!

During this phase I still felt rough, and my skin was looking rough. Although I was still feeling pretty bad, (the die-off symptoms last a long time) the cravings did begin to decrease. While I was no longer jonesing for pizza and cookies, I was craving tasty real food.

Oh- did I mention I was a total grump throughout this whole treatment phase? I was. It was miserable, I felt miserable, I basically whined and chose to stay miserable. When I finally got tired of whining and feeling miserable, I remembered that wait-- I am a yogini and a health coach! I had some really cool tools that I had been too busy being whiny and miserable to access. I love helping others by giving them useful tools and strategies to heal, but I forgot to help myself! What is wrong with me? I started including Ayurvedic approaches to healing the gut and getting rid of SIBO.

I started doing self-abdominal massage of the ileocecal valve (the IC valve is located between the small and large intestines and should stay shut after digested food moves from the small to large intestine). Because of the inflammation and low motility associated with SIBO, the IC valve may be stuck open- allowing bacteria to migrate from the large to the small intestine- gross. I had fresh ginger infused in my tea every morning to help aid digestion and soothe inflammation. I started doing Kapalabhati breathing, Agni Sara exercises and oil pulling with coconut oil every  single morning. I added in additional yoga postures that aid in detoxing and toning the digestive system. These changes allowed the detoxing processes of my body to improve, which significantly began to aid in me feeling better.

After a good bit of research, I also started incorporating Intermittent Fasting (IF). With the slow motility associated with SIBO, my body did not have ample time or energy to digest after each meal. Eating the same amount of food in a shorter eating window helped to heal the gut and improve my overall health. Although it was initially tough to figure out the right timing, and assure that I got enough caloric and nutrient density during the eating window, it helped. Staying on top of Intermittent Fast is super important, you must nourish your body with ample nutrition and give it enough calories or it won’t heal!

This integrated approach helped me turn the corner. I started feeling better, but still was not normal digestively. I was freaked out that the SIBO was not completely healing. I never want to go through the misery of treatment again, so not feeling 100% was not an option. I found an acupuncturist who had experience with healing SIBO, and her treatments and magic herbs seemed to be the final trick. After just a few acupuncture sessions I returned to having “normal” digestion. For those of you who also suffer with abnormal digestion, you know how exciting it is to have “normal” poop! She put me on a regimen of Chinese herbs, recommended I stay away from food that are difficult to digest such as foods, and to begin adding the FODMAP’s back in one at a time.

I had been on the low FODMAP’s for just over 12 weeks, so I was super excited to start incorporating them again. It is important to start slowly. I added in one, then increased a little every day for 5 days. I took good notes on all symptoms: digestion, energy, skin, mood, and so on. I started with onions and garlic and had no problem. After 5 days, I added in avocado, no trouble again! I continued with this pattern and was able to add all the FODMAP’s back in with no problems, but some ideas about what would be best to reduce. This process took about 2 weeks, and I’ll admit, it was super tempting to just go all the way back in after adding in the first couple with no troubles. Taking it slow really helped to notice what foods cause what symptoms, positive or negative, to assure that my system remained happy.

This brings me to the most important phase of treatment: maintenance. I’ll be back to share how I am maintaining so far. I’ve made it over 8 months since beginning treatment, and so far, I am hopeful. Once I started feeling better I wanted to go back to how things used to be. To eat whatever, whenever. At times I have let some things slide, but I know I can’t make that the norm. It takes a long time to heal the gut and if you remember from Surviving SIBO Part 1: I probably started damaging my gut at a very young age. I am 42 years old. That is a long time to have a crazy gut, the damage runs super deep. Keeping my gut happy and healthy keeps me happy and healthy. While the nutritional healing protocols, supplements and lifestyle help keep my gut in check, maintaining stress management and self-care practices are also extremely vital to remaining healthy. Everything is intimately interconnected.

I will be back to let you know how I continue to maintain a healthy, happy gut-- SIBO free!!

Are you struggling with an unhappy gut, a SIBO diagnosis or treatment? If so, reach out! Community is super important and sharing your story can be healing!

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