Sources of Mercury Exposure

Need another reason to avoid soda?  It may contain mercury!  I know, I know, for those of you who are seasoned SIBO warriors or health enthusiasts, avoiding soda is probably a “no brainer”.  It probably doesn’t even sound good to you!  But I couldn’t help but share a 2009 research article that analyzed a few brands of high fructose corn syrup for the presence of mercury.  Sure enough- it was in there.

My interest in researching sources of mercury exposure came from my suspicion that it could be an underlying cause for some people’s SIBO.  When I dug in deeper, I was surprised by how many different sources of mercury were out there.  We can’t completely avoid it, but we can certainly improve our detoxification pathways to help reduce the body burden that could accumulate.  Read on to learn more!

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Low FODMAP Butternut Squash Chicken Tikka Masala

Winter squash has got to be one of my favorite vegetables- which means I love this time of year!  I love seeing new squash recipes arrive in my inbox and on my Facebook news feed.  I usually print them out and add them to a binder labeled “recipes to try”.  One of my favorite sources of recipe inspiration is an online Facebook group called “Low FODMAP Paleo Community” which is run by the lovely Kelly of TastyFace Organics.  She posts really awesome recipe ideas that can be adapted for a low FODMAP and/or paleo diet.

When I saw that Kelly posted the idea for this recipe adaptation, I knew I had to make it!  And boy am I glad I did- it is super flavorful and pretty simple to make!

chicken tikka masala (2)

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Words of Wisdom for SIBO Newbies

Have you recently been diagnosed with SIBO or know someone who has?  I have compiled a list of my top 8 pieces of advice that  I wish someone had told me when I was first diagnosed.  Please enjoy and share with others who are just beginning their road to recovery.

  1. It’s a marathon, not a sprint.  I am a planner. I can’t help it.  As I was healing from SIBO, I kept wanting to know when I would be “fully recovered” so that I could get on with my life and stop feeling handicapped.  I wanted to know how much longer I had to continue spending ridiculous amounts of money on healthcare expenses.  But no doctor seemed to be able to tell me that.  The truth is that only time will tell how long it will take to get you back to feeling healthy again (or maybe for the first time).  If you are a planner like me, it may be helpful to think of your healing journey as a marathon, not a sprint.  Try to enjoy life (for me it’s about time with family and friends, yoga classes, walks, and date nights) and appreciate the positive aspects of SIBO (perhaps as a wake up call or a lesson in patience).
  2. Get ready for change (and withdrawals). Sometimes I wish my diagnosis had been different because making changes is difficult.  Especially when it involves food.  One of my daily routines before beginning to treat SIBO was rewarding myself with a sweet treat every afternoon.  There was a little coffee shop a block from my apartment that carried my favorite brand of gluten-free, vegan treats.  I thought that it couldn’t be too bad for me- heck, it was free of gluten, dairy, and eggs (some of my main triggers).  But what I didn’t realize was that I was eating a lot of sugar with each of those treats.  When I gave up sugar (in all forms- refined, unrefined, & fruit) cold turkey, I was a MESS for about three weeks.  I mean a REAL MESS- I was a miserable person to be around.  It is important to stay committed, because it gets easier the longer you stay away from it.  And when I began to allow myself to have a treat here and there again, it was easier for me to recognize when I was starting to spiral into my “too many treats” mode again.  Another tip for staying committed is to prepare- remove all sweets from the house and ask family members and friends to help support you by avoiding bringing temptations around you.
  3. Only restrict your diet as much as absolutely necessary.  Dietary restrictions pose the risk of creating nutrient deficiencies, especially if they are extreme or long-term.  I would consider many of the diets recommended for SIBO to be highly restrictive and pose a risk for creating these issues.  Additionally, they can be highly problematic for individuals with a history of eating disorders or disordered eating.  My recommendation- consult with a SIBO-knowledgeable physician, nutritionist, or health coach before implementing any dietary restrictions.  And if your diet ever gets to the point where you stop enjoying food or you feel like you need to quit your job to be able to cook for yourself, you may want to rethink whether you REALLY need to be that restrictive.  Don’t get me wrong- dietary changes can be very helpful and often necessary with SIBO, but you also need to be able to live your life.
  4. It will cost lots of money.  Healthy food is expensive.  My food budget nearly doubled when I began eating for SIBO and I had already been eating pretty healthfully before.  But I was unable to enjoy as many meals provided by other people (such as at events).  Plus, I couldn’t buy cost savers such as beans and rice or subsidized foods such as milk and corn.  And when you have to choose buying low FODMAP vegetables over buying those that are inexpensive and/or in season, the costs add up.  And then there are the health care costs…my health expenditures have amounted to over $9,000 since I began treating SIBO in early 2014 (and that’s with REALLY good insurance that covers alternative health care such as naturopathic and chiropractic visits).  I recommend considering expensive testing very carefully- ask your doctor what information it will provide and in what ways (if any) the testing will change the treatment plan.  Then, speak with others and see about their success (or lack thereof) with such testing.
  5. Find your root cause.  When I was first diagnosed with SIBO, some of the articles I read made curing it seem easy.  Simply take some antibiotics, then a prokinetic, then follow a diet.  However, when this didn’t work for me, I thought I was a hard case and became frustrated.  But I am seeing over and over again that other people are in a similar scenario.  I think that there is a disconnect between how the treatment process is portrayed and reality.  I also think that there just isn’t enough knowledge out there right now for how to deal with SIBO in the long-term.  However, finding your root cause is a surefire way to truly heal.  You may be thinking “well, where do I start?”  Start with something, try it, see if it works, and look for patterns. You will slowly start peeling back the layers and getting closer to your root cause. I think it is really helpful to continually ask “why?”.  When I realized that I didn’t tolerate kale, I asked why.  I then realized that it was because high sulfur foods or supplements caused issues for me.  I started searching for why that could possibly be the case since these foods are supposed to be so healthy.  I came up with two possible answers: 1) genes and 2) heavy metal toxicity and started treating the one that seemed most plausible/fixable.  Only time will tell if I have gotten to the ultimate root cause.
  6. Don’t believe everything you read.  Including this blog post!  Find what resonates with you and your body, not just what someone on the internet (or even an expert) says.  There are plenty of sources out there that say fiber and water will cure your IBS.  For some people, this is true.  But for the majority of those with SIBO-induced IBS, fiber will make you feel worse.  Just because it is written, does not mean it is true.  I am also a bit skeptical of current breath test interpretation for some individuals.  Many of the labs interpret a positive lactulose breath test as a certain elevation above baseline within the first 120 minutes, but some physicians disagree with that time frame and believe that the lactulose solution reaches the large intestine sooner.  If the later is correct, then there are false positives going around out there.  Ask your doctor how they interpret the breath test.  If they take your symptoms into consideration in the interpretation, that is probably a good sign (For example, if you have a faster transit, perhaps the solution reaches your large intestine at say 90 minutes.  Or if you have slower transit, perhaps it has not even reached your large intestine at 120 minutes).
  7. (If possible) work with someone who has experienced SIBO firsthand.  I found that it can be really difficult for practitioners who have not experienced SIBO firsthand to relate to patients or clients going through the struggle.  It is a condition that goes against so many of the things that medical doctors, naturopathic doctors, and even nutritionists learn in school.  I could imagine how someone with SIBO would seem like a crazy person to a doctor who has not actually been in the scenario and experienced how frustrating and difficult it can be.  They may think- how on earth could a person react to fruits and vegetables!!  These foods are supposed to be healthy!  But if you cannot find a practitioner who has experienced SIBO firsthand, do not worry.  There are individuals out there who are very compassionate and intelligent and may be able to help guide you along.  You may just have to do some of the grunt work yourself.
  8. There is hope!  After reading all of these tips, I realize that they may sound sort of depressing.  But there are so many things to look forward to.  If you got this far in my blog post, please give yourself a BIG HUG because it signifies that you are committed to taking control over your own health.  When you tune into your body and make positive changes in your life, you are bound to experience the benefits.  With a little bit of patience and perseverance, you will be able to enjoy a healthy and fulfilling life!  I wish you the best of luck and I have an open door- comment box 😉 – for any questions or concerns.

VSL#3: A Remedy for Constipation

Probiotics and their efficacy for individuals with SIBO is a controversial topic for which I have been on both sides.  At times, probiotics have worsened my SIBO symptoms and at other times they have been very beneficial.  But no probiotic formula has been as effective for me as VSL#3.  In this post I will discuss research that has been conducted on VSL#3 in regard to improving symptoms of constipation.  VSL#3 has also been studied for a variety of other conditions- I encourage you to search on PubMed for more information.

Having regular bowel movements is extremely important for detoxification because it is a process by which waste is removed from the body.  Alarmingly, it is estimated that as much as 27.1 percent of the US population suffers from functional constipation [1]. Fortunately, low-risk remedies such as probiotics exist to aid in this important detoxification process.  Studies have indicated that administration of VSL#3 can positively impact symptoms of constipation.  It is unclear whether the benefits of VSL #3 probiotic supplementation are temporary or whether they can provide lasting improvement.

VSL#3 contains eight probiotic strains including Streptococcus thermophilus, Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacilus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, and Lactobacilus delbrueckii subsp. bulgaricus.

A 2015 study [2] regarding the efficacy of the probiotic formulation VSL#3 showed positive benefits in individuals with functional constipation selected based on Rome III criteria.  Before administration of the probiotic, lower amounts of bifidobacterium and bacteriodes species were found in the stool of these individuals than in controls.  Seventy percent of individuals with functional constipation noted symptom improvement from administration of the probiotic.  Additionally, participants noted increased frequency of bowel movements from an average of 2.5 +/- 1.3 per week to 6.3 +/- 3.1 per week.  Stool consistency (based on the Bristol Stool Chart) improved from an average of 2.6 +/- 0.7 before treatment to 4.1 +/- 0.9 after the two week probiotic therapy.  Unfortunately, the results were not lasting.  Of the participants who experienced symptom improvement during probiotic administration, 61 percent reported return of hard stools or less frequent bowel movements within one month of the study’s completion.

It appears that VSL#3 may be only a remedy, not a cure.  At a cost of approximately $9-10 per day, administering VSL #3 at the dose utilized in this study may be prohibitive for many individuals.  However, VSL#3 may be an effective and welcomed means of symptom relief for individuals with chronic constipation.  No adverse reactions were noted in the study I analyzed, indicating that these protocols may be safe treatments for promoting elimination and therefore, detoxification.  Of course, it is always recommended that you consult your physician to ensure safety.

References:

[1] Schmier JK, Miller PE, Levine JA, et al. Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model. BMC Public Health. 2014;14:374.

[2] Kim SE, Choi SC, Park KS, et al. Change of Fecal Flora and Effectiveness of the Short-term VSL#3 Probiotic Treatment in Patients With Functional Constipation. J Neurogastroenterol Motil. 2015;21(1):111-20.

Health Update: Goodbye Antimicrobials

It has been a while since I have shared an update on my healing journey.  I am pleased to announce that it has been 5 months since I have taken antimicrobials and over a year since I have taken antibiotics.  Previously, I had been reliant on antimicrobials, prokinetics, and a strict low FODMAP, limited fruit, low sulfur (low thiol, specifically) diet for managing my SIBO.  I could sometimes go two weeks without antimicrobials, but my symptoms would slowly return bringing about a sense of hopelessness.

My decision to abandon antimicrobials was inspired by the results of my Genova Comprehensive Stool Analysis.  The test showed non-existent lactobacillus and bifido bacteria as well as very low microbial diversity.   I attributed this to a variety of factors: heredity, a low FODMAP diet and antimicrobials for an extended period of time, and antibiotic use throughout my lifetime (especially IV Vancomycin to treat Toxic Shock Syndrome at age 17).

Since discontinuing antimicrobials, I have had ups and downs in regard to my symptoms, but the overall trajectory has been positive- I have greatly expanded my diet and have continued to have healthy daily bowel movements (some days are better than others).  I figured it might be helpful to share my current routine with you all to give you a launching pad for ideas to discuss with your physician.

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Tomatillo Salsa

Flavor
Definition: an often forgotten (yet important) element of eating with SIBO

I am currently half way through the first term of my Master’s in Nutrition program. Wow has time flown!

My apologies to my loyal followers for the lack of content over the past month- posts may be far and few between over the next year.  I have been busy learning all I can about the different body systems and the impact of different foods on either supporting or damaging them.

I have also gained a greater appreciation for the importance of making food taste good.  That may sound silly to some, but it is easy to become so focused on avoiding flavorful “problematic” SIBO foods such as onion and garlic and forget about how making food taste good influences the digestive process.

Have you ever noticed that you salivate more when a food smells good or you are excited about a meal?  Well this is actually an important first step in the digestive process- saliva contains a digestive enzyme called amylase which helps to break down carbohydrates.  So keep on (or start) salivating my friends!

When I came home from school today, my boyfriend had created this yummy low FODMAP, paleo, gluten-free, dairy-free, grain-free, SCD-friendly tomatillo salsa with tomatillos we purchased from the farmer’s market this weekend.  It was delicious and I decided I must share the recipe with all of you!  So I asked him how he made it and whipped up the instructions.  Let’s give a big shout out to Amani for his courage to create a salsa recipe without using onion or garlic!

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Vanilla Honey Granola

As I prepare for the fast-approaching start of my master’s degree program on July 6th, I am eager to find ways to maintain my clean eating regimen while having less free time.  I have created a tasty granola recipe that is multi-purpose and super easy to prepare.  It also creates very few dishes, which is always one of my goals!  I do not mind cooking- I actually enjoy it when I can be creative and am not hard-pressed for time, but dishes, those are not my cup of tea!

I hope you enjoy this recipe as much as I do 🙂

Vanilla Honey Granola

  • Servings: 3
  • Difficulty: easy
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Paleo, Gluten-Free, Grain-Free, Low FODMAP, Low Thiol, Egg-Free, No Refined Sugar, Dairy-Free, Soy-Free, SCD, GAPS, SIBO-Specific Food Guide

vanilla honey granola

Ingredients:

  • 2-3 Tablespoons coconut oil, melted
  • 1 Tablespoon honey
  • 2/3 cup unsweetened shredded coconut
  • 1/2 cup finely chopped pecans
  • 1/2 cup finely chopped walnuts
  • 1/2 tsp pure vanilla extract
  • 1/4 tsp sea salt (I like Redmond Real Salt)

Instructions:

  1. Preheat oven to 300 degrees Fahrenheit.
  2. In a medium bowl, add melted coconut oil and while still hot, stir in honey.  Add remaining ingredients and mix.
  3. Spread mixture on a baking sheet lined with parchment paper.
  4. Bake for 8-10 minute, stirring granola once or twice.  Watch carefully to avoid burning.
  5. Allow to cool.  Transfer to a sealed container and store in cabinet or fridge.

Serving Suggestions:

  • Sprinkle atop acai bowls
  • Add to a trail mix
  • Serve with nut milk & berries

Chocolate Banana Smoothie

Sometimes you just need something easy for breakfast…

Chocolate Banana Smoothie 2
Living with a chronic illness can be exhausting.  Individuals with chronic illnesses often have less hours in the day to get everything done.  They typically need at least 9-10 hours of sleep per night in order to function somewhat normally.  Additionally, there is cooking the majority of meals from home, taking time for yourself, remaining active, practicing mindfulness, attending doctors appointments, and more!

Although I typically rely on whole-foods based meals with plenty of veggies (even for breakfast), there are some times when I need something that is quick and easy that does not flare my symptoms.  Here is a recipe that I created to do just that.

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Key Takeaways- NCNM SIBO Symposium 2015

What a wonderful, informative, thought-provoking weekend!  I spent this past weekend at the 2nd Annual NCNM SIBO Symposium learning a myriad of information about digestive conditions- specifically IBS & SIBO.  While listening to the presentations, I kept a keen ear out for information that relates to individuals with chronic relapse, to those with sulfur/thiol intolerance, and additional testing to help reveal underlying causes for SIBO patients.

I have scoured through my notes to present to you some of my key takeaways from the presentations:

1) Stress is NOT the trigger/cause of SIBO, but it often plays a role in the manifestation of the condition.
Dr. Pimentel shared that a study has been conducted on soldiers sent overseas to regions such as Afghanistan & Iraq. The study showed that stressful circumstances such as shooting a gun or experiencing a major injury did not correlate with the subsequent development of IBS.  However, patients often indicate that stress exacerbates their IBS/SIBO symptoms and practitioners find that patients who are able to integrate strategies such as yoga, meditation, massage, etc. into their healing journey experience greater improvement than those who do not.  Therefore, it seems that stress does not trigger IBS/SIBO in the first place, but it may worsen symptoms.

2) Finding the right prokinetic often requires experimentation, but here are some tips to lead you in the right direction:

Pharmaceuticals: often required due to greater efficacy than natural options

  • Resolor (prucalopride)– highly effective for individuals with constipation, but contraindicated for those with diarrhea due to invoking slight motility of the large intestine rather than just the migrating motor complex (MMC)
  • Low Dose Erythromycin– frequently used for both IBS-C and IBS-D due to affordability and availability.  Currently, there are no studies on potential impacts on the large intestine commensal flora.
  • Low Dose Naltrexone– potentially beneficial for those with autoimmune conditions, however, many of the physicians did not find it to be a strong enough prokinetic unless combined with other options

Herbals: sometimes used in conjunction with pharmaceuticals

  • Ginger– a remedy traditionally recommended for nausea, ginger is effective at stimulating gastric motility i.e stomach emptying (Ming-Luen, Hu et al 2011) so it may be helpful for individuals with gastroparesis.
  • Iberogast– a combination of herbs that appears to be highly effective for nausea.  This formula has been used for decades in Europe as a remedy for a myriad of digestive complaints ranging from nausea to acid reflux, bloating, constipation, diarrhea, and more.  It was indicated as a safe option during pregnancy.
  • D-limonene– one of the presenters shared this as a prokinetic option, but it did not seem to be widely used among practitioners.  It has been used clinically to dissolve gallstones, provide relief from GERD, and induce phase 1 and 2 liver enzymes which could help protect against cancer (Sun, J. 2007).

3) Biofilm disruptor may be unnecessary in SIBO treatment
Many SIBO experts have not seen an increased benefit when adding a biofilm disrupting agent to their SIBO treatment protocols.  It was expressed, however, that biofilm disruptors may be more beneficial in the treatment of SIFO (small intestine fungal overgrowth) such as with candida albicans.  It was discussed that stool testing may not be reliable for ruling out candida.  One suggestion was that if a stool test is negative for candida, but an antibody test is positive, it could indicate the presence of SIFO specifically in the small intestine.

4) Hormone imbalances and birth control pills may be at play in some SIBO cases
I find it very fascinating that the number of women afflicted with IBS/SIBO far outnumbers the number of men with this condition.  I have suspected that oral contraceptive pills may have played a role in the development/worsening of my GI symptoms.  My friend, Emily, who shares similar skepticism about the connection was brave enough to submit a question to the panel of SIBO experts regarding this issue.  The experts shared that they clinically see hormonal issues and SIBO go hand and hand and that it is certainly possible that oral contraceptive pills could be a factor in SIBO.  I was curious about this issue and stumbled upon a couple of fascinating studies on this issue.  An article titled “Sex Hormones in the Modulation of Irritable Bowel Syndrome” indicates:

“Sex hormones may influence peripheral and central regulatory mechanisms of the brain-gut axis involved in the pathophysiology of IBS contributing to the alterations in visceral sensitivity, motility, intestinal barrier function, and immune activation of intestinal mucosa” (Agata, Mulak et al 2014)


5) Heavy metals as a potential underlying cause of SIBO

I have suspected for a while now that heavy metals (specifically, mercury- due to my high thiol sensitivity & high levels of mercury on my hair test) could be one of my underlying causes, but I never had a scientific explanation until now.  Heavy metal toxicity causes oxidative stress (which my Organix test showed that I have) which can lead to delayed gastrointestinal motility- i.e. constipation (Rana S.V. et al 2014).  One of the biggest controversies with heavy metal testing is how to test the body burden accurately.  At the SIBO symposium, I was able to speak with a Cyrex representative about the Array 11.  It appears that it tests for immune reactions to mercury toxicity (among other toxins) rather than just the presence of the toxin.

6) The infamous hydrogen sulfide- more to come later this year!
Dr. Pimentel shared a very exciting notice regarding the third type of gas produced in SIBO- hydrogen sulfide.  He promised that there would be more information on sulfate-reducing bacteria sometime this year- perhaps it could be testing?!?  As some of my followers may be aware, the connection between sulfur intolerance and SIBO is one of the areas that I focus much of the content of my blog.  Plan to hear more in the future!

Don’t forget to subscribe to my blog for future updates!

Thanks for reading! =)

Article titles & links to the sources listed above:
Effect of ginger on gastric motility and symptoms of functional dyspepsia
D-Limonene: safety and clinical applications
Relationship of cytokines, oxidative stress, and GI motility with bacterial overgrowth in ulcerative colitis patients
Sex differences in irritable bowel syndrome: do gonadal hormones play a role?

Chili Vinaigrette Salad with Creamy Walnut Sauce

The inspiration for this recipe comes from one of my favorite places to eat here in Portland- Prasad.  It is a gluten-free, vegan, organic cafe located in the Pearl district.  Although many of their recipes contain beans, quinoa, lentils, or other high thiol or high FODMAP foods, their El Dorado Salad can be made mostly low FODMAP, low thiol by removing the cilantro, green onion, and avocado.  But that’s no fun!  I can usually (now that my symptoms are minor) handle the salad without having to make any changes.  My love for this salad inspired me to make a flavor-packed SIBO-friendly version.  Enjoy!

Salad

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