The Delicate Carbohydrate Balance with SIBO

Carbohydrates are the most frustrating and confusing part of the SIBO healing process.  Bacteria in the small intestine LOVE carbohydrates and they express their love by leaving you bloated, gassy, experiencing abdominal pain, and with all the other lovely gastrointestinal symptoms.  Here is the confusing part: bacteria do not love all carbohydrates equally.  See Low FODMAP.  For example, I could eat 20 grams of carbs worth of carrots (about two large carrots) and feel just fine (as long as they were cooked).  If I exchanged those 20 grams of carbohydrates for some bread, or even some onion or fruit, we would have a very different picture on our hands.

If you analyze Dr. Siebecker’s SIBO Food Guide, you may notice that the high carbohydrate vegetables are the ones that tend to be prohibited.  Unfortunately, I was not able to touch many of the items in the SCD legal/Low FODMAP category without symptoms. The foods that I ended up being able to eat were all very low carbohydrate.  For about five months (May-September) I was using my digestive symptoms to determine whether I was eating too many carbohydrates.  The problem with this method was that I reacted to almost every carbohydrate, reducing my carbohydrate intake to only about 20 grams per day on average.  This was much lower than the recommendation I had received from my SIBO specialist of 60-100 grams daily, but I hadn’t realized it because I did not sit down and count out my carbs.  I really wanted to re-introduce more carbohydrates, but every time I did, my skin became itchy (which I had been told was a manifestation of leaky gut) or I would hear fluidy noises and feel tenderness in my intestines during my nightly abdominal self-massage.

My fatigue over my five month extreme low-carb expedition became worse and worse.  My T3 stopped converting to T4 effectively (resulting in free T3 levels as low as 1.8 L in July), but my TSH was also low (.58 in July).  I had signs of both hypothyroidism and hyperthyroidism at the same time.  My own research, consultations with my doctors, unsuccessful experimentation with T3 supplementation, and successful experimentation with carbohydrate reintroduction led me to realize that I was suffering from Euthyroid sick syndrome.  I was starving my body of carbohydrates, so it was reacting by making me so fatigued that I wouldn’t expend much energy.  It is pretty much the equivalent of turning your phone on “battery saving mode” (and keeping it there for 5 months) when you need to make it last a few extra hours.

One day, incredibly frustrated by my fatigue and tempted by the guest chef cooking delicious gluten free quinoa salad and almond torte in front of me, I caved.  I ate small portions of both of these items and have not turned back since (well, at least not in my quest for carbohydrate challenging).  After indulging, I was sure that I would pay the price the next day with symptom flare ups.  I waited and waited, but nothing dramatically out of the ordinary occurred.  My intestines were a little fluidy and tender, but for the first time, I had no itching from the grains.  I thought it was a fluke, so a couple days later I purchased a New Cascadia Gluten Free Baguette and ate a couple of slices each day.  Sure enough, my itching was gone.  My digestive system gave me a little bit of trouble, but it wasn’t unbearable.  My brain started functioning somewhat normally again- I could concentrate on my homework, comprehend things, and remember things better.  I had more energy (although not completely back to normal).

I am trying to think of what could have led to my miraculous tolerance of selected grains and more carbs (I am now averaging about 60 grams per day).  Did my immune system suddenly kick in because of a nutrient IV I received two days before?  I had done these four times before without this effect.  Or could it be the four days of sulfur-food avoidance and two days of chelated molybdenum that cleared some of my methylation pathways?  Read more about that here.  Perhaps it was the combination of the two?

Whatever the reason, I am thrilled by my renewed ability to function and I am hopeful that I am moving in a positive direction.

Another step forward occurred with an ileocecal valve manipulation from my SIBO specialist on Thursday (two days ago).  She said that my ileocecal value appeared to be stuck open.  She worked on some very tender points and moved some things around.  Last night, during my intestinal self-massage, I experienced NO tenderness and hardly any fluidy noises.  This is quite a miracle considering all the things I ate yesterday that I am “not supposed to”: 10 hazelnuts, 1/2 bunch baby turnip greens, 1/2 small sweet potato, 2 baby turnips, 1/2 very small bell pepper, 1 teaspoon cocoa powder, 1/2 teaspoon honey, 1/2 cup cooked white jasmine rice.

I am very thankful to be surrounded by such talented and caring doctors, to have parents that will do anything to help me heal, for a boyfriend who maintains a positive outlook when I feel hopeless in my health struggle, and for the supportive instagram community of individuals enduring similar health challenges.

6 thoughts on “The Delicate Carbohydrate Balance with SIBO

  1. Needed to read this I’ve been a low fodmap carb diet and I’m starting to lose weight and feel tired. I’m afraid how this will affect my thyroid. I tried quinoa last night and it was a bad idea. I think I’m just too early in my sibo journey for grains although perhaps gluten free bread might not be too bad…

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    • Hi Kat,

      A super low carb diet wrecked my thyroid. I got amenorrhea and euthyroid sick syndrome which I have now learned are clinical findings that appear in individuals with anorexia. I didn’t know it at the time, but I was literally starving myself of carbs.

      My favorite gluten free bread is Honey Gold or Seed Bread from New Cascadia. It is a Portland company. I am not sure where you are located.

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  2. I would like to hear more about your unsuccessful experiment w/ T3 meds. What med? How much did you take? What happened?

    I have hypothyroid symptoms. When I take Lyothyronine (T3) 2.5mcg, I end up getting wicked wicked diarrhea. I tried using even just a small nibble of a pill and still got the diarrhea.

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    • Hi IBS Sufferrer,

      The T3 supplement that I took was Liothyronine from a compounded pharmacy. I called the pharmacy and made sure that it did not have any weird fillers. It was made with microcrystalline cellulose and methacel which the pharmacist said were hypoallergenic.

      At first, the doctor started me on 10 mcg in the morning at least one hour before breakfast. It made me a little more tired, so she told me to double it. That made it even worse. She also had me try 10 mcg in the AM and 10 mcg in the PM. Still didn’t work.

      It appears that what was happening was that I was suffering from euthyroid sick syndrome from following a TOO low carbohydrate diet. I was eating less than 20g of carbs per day. I am now eating closer to 80-100g and feel so much better (in terms of fatigue & brain fog- not necessarily digestion). So we presume that my body was responding to me starving myself of carbohydrates by decreasing my thyroid function to conserve energy.

      I am still a little concerned about my thyroid because my grandmother is hypothyroid and I suspect my mom is as well. My grandmother told me that “everyone in our family is hypothyroid”. I have suffered from cold hands and feet as long as I can remember. My dad calls me a “fair weather skier” because I would literally have to go inside every half hour or so because I became so miserably cold.

      I am not sure why the medication would give you diarrhea. Could you be reacting to a filler in the medication? I would highly recommend checking out Andrea Nakayama at Replenish PDX. She is the thyroid nutrition expert. She put on a summit called “The Hashimoto’s Institute” that was all about thyroid health and it was incredibly helpful!

      Best of luck and let me know if you have anymore questions!

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      • Thanks for the reply Hope. It looks like your experience is different than mine. I did not experience any additional fatigue on T3. Just the diarrhea. I was also not low carb at the time. I am and was battling some kind of a gut infection. My doctor suspects that my hypo symptoms are my body’s response to trying to fight the infection. Taking the T3 was speeding up my body when it didn’t really want to be sped up. So I got diarrhea. I don’t believe that I was reacting to any fillers in the T3, since I have never experienced a bad reaction to any other meds.

        The T3 might end up working for me after I clear the infection. We’ll see.

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