Small Intestine Bacterial Overgrowth
For years now, perhaps even more than a decade, I’ve had problems with my stomach. Bubbles, cramps, swelling, pain, unpleasant bathroom issues ranging far beyond mere urgency. At best it was distracting. At worst, actually debilitating. It cast a shadow on everyday life, and ruined what should have been good times. Eating out made it worse. Eating not-great food made it terrible. Thus some of my worst bouts occurred while traveling, ultimately making vacations unpleasant. Traveling across Europe should be fun, not uncomfortable and stressful.
Along the way I had a myriad of diagnosis. IBS. Nervous stomach. I had a variety of procedures to no avail, from ultrasounds to, eventually – when I finally became frightened enough to start wondering if I had cancer or Crohn’s – a colonoscopy (which cost an arm and a leg since my insurance is terrible and I had it done prior to the recommended age of 50). Nothing. “You must have some sort of food allergy,” said the gastroenterologist.
Sure. But it must be an allergy to food in general then, because it doesn’t matter what I eat.
Pre-colonoscopy my troubles were at their most severe. I’d gone from being a long-term vegetarian to veganism, both because I was finding my personal ethics shifting that way and because I thought it might help my problems. Instead it seemed to kick things into a higher gear. Finally, a naturopath brought up SIBO – Small Intestine Bacterial Overgrowth, and recommended I take the breath test used to diagnose it. The test came back proof positive. I definitely had SIBO.
That was a couple of months ago. Since then my diet shifted into elimination mode. Eggs came back in. Nearly everything else went out. Most SIBO sufferers rely on meat to get by in the beginning, as meat doesn’t sit and ferment in your gut. I couldn’t do this. I hadn’t eaten any meat of any kind in probably 20 years. I tried fish – twice – and both times it made me sick. But I couldn’t eat most protein alternatives either. No beans. No tofu. No tempeh. Also, no fresh vegetables. No dairy. No wheat. No onion. No garlic. No processed food. No sugars. Nothing with any thickeners. No soy. No beer. No fruit. Coffee black only, with coconut oil in it to help cut down on the acid, and not too much of it.
I started keeping a food journal. I began to take two different antibiotics, the insanely expensive Xirfaxan for SIBO and another for Candida (which I was also diagnosed with), with each meal, 3 times a day, for two weeks. I ate eggs, a tiny bit of spinach and tomatoes, and protein shakes. 3 meals a day, at least 4 hours between each meal, no snacking (which becomes easy when there aren’t any snacks you can eat). I discovered I could handle sourdough bread in small amounts so long as it had a minimal amount of ingredients. Luckily, local baker Big Ed’s makes a sourdough english muffin that’s both delicious and simple, and it became a staple.
I also started taking fistfuls of supplements as prescribed by a local nutritionist in town versed in SIBO treatment. Some are to try to put back in vitamins and minerals and whatnot that my diet lacked. Others are natural antibiotics, proven to fight the microorganisms that make up SIBO (proven in many cases to be more effective than the prescription antibiotics).
It has been nearly 2 months now. I’m down to about 136 pounds (for perspective, I’m a 5’10” 45 year old man). I’ve made precious few missteps in my diet, because it has been working. My stomach has, for the most part, calmed down. Bathroom issues have minimized. In some ways I have my life back. In others, not quite yet. I’m low energy. Tired a lot. I tend to turn in for the night at 9 PM or even earlier (more perspective: I’m up, or I’m supposed to be anyway, at 5:30 AM for work). I used to exercise vigorously roughly 5 times a week, running 5 miles or mountain/fat biking decent distances. I can’t run. Not yet. I’ve been on a few tame mountain bike rides (12 miles) and once hiked Misery Ridge at Smith Rock. Afterwards I slept 12 hours and felt beaten for the following 24. Post antibiotics my toes have broken out in swollen, prickly rashes. I’m no longer hungry all the time, but oftentimes I abruptly fall off an edge if I don’t eat in time.
Being depressed about my stomach feeling terrible shifted to being depressed about being crippled by the treatment. And the food – it’s amazing how you can go for months without eating something and have no problem with it, but as soon as you’re told it’s forbidden it becomes all you want to eat. I burned through massive sugar cravings, carb cravings, you name it. Pizza, cookies, pastries, pasta, salads, Mexican food, Indian food, burritos, I want it all. Now. Immediately. I would contemplate murder for something as simple as coffee cake.
But I progress. I’ve slowly begun introducing things back to my diet. Individually. It has to be that way. If I eat too many new things at once, and I suffer for it, I don’t know which of those things is the culprit. So one at a time – which is harder than it sounds. Most beans still mess me up, but I’ve begun eating some sprouted lentils with success. I’ve made lentil curry, lentil fritters, lentil taco filling – all pretty bland since I can’t use onion or garlic or their powders. Unspiced organic tortilla chips have thus far been well received, as have sprouted corn tortillas. I’ve begun adding the smallest amount of homemade cashew milk to my morning coffee. I’ve experimented with a mid-afternoon snack between lunch and dinner with varying results.
Some things I’ve tried still don’t work. No tofu. No tempeh. No dairy with lactose. For the most part, however, progress is slow but steady. I even managed to survive visits with my family to Food Fight! and SweetPea in Portland, though I’d be lying if I didn’t admit that it was very hard, and made me very grumpy. I talk about how I can’t wait to eat a burrito, or pizza, or simply a muffin, but the truth is I’m really not sure if I ever will be able to do so again. I’ve developed a healthy fear of food… which is crazy considering I’m a huge food lover.
Most of this – it’s psychological. It’s wonderful to feel better. I’m reminded of it every time I slip up, and slips have been few and far between since the are instant reminders of how I used to feel nearly all the time. I just have to shift my thinking on food. Food is, for now anyway, no longer pleasure, or fun, or entertainment. It’s fuel. Sustenance. Nothing more. I’ve considered just doing protein shakes for the foreseeable future. Fuel. Sustenance.
During this process I found a SIBO Facebook group, and now I consider myself lucky. Many people have had it far, far worse than I have. I feel for them. At the same time, life is relative. I’m finding this very, very frustrating. Some days I don’t want to get out of bed. Other days I’m ready to go back to bed by lunchtime.
I’m not going to turn this on-again-off-again blog of mine into a SIBO journal, but there will undoubtedly be future posts about it. It’s become a huge factor in my life.
