NCNM SIBO Symposium

Have you ever wondered where you can go to find the most up-to-date information regarding SIBO?  Well, I am here to tell you!  The 2nd Annual NCNM SIBO Symposium is coming up the first weekend in June and will be held here in Portland, Oregon.  If you have never been to Portland and would like to visit, here is a great excuse to come!

SIBO Symposium-2015
I am very excited to be attending this year’s event because it will include the world’s leading experts and they will be discussing what they have discovered in the past year.  This year’s event is going to skip over all of the basics that SIBO veterans are already well aware of and go right into the current research and cases.  The topics will be geared toward an advanced audience, but it is open to both physicians and patients.  Interested?  Click here to learn more.

SIBO-Friendly Beef Chili

@againstallgrain Slow Cooker Beef Chuck Chili (I adapted to make SIBO friendly) topped with cilantro and @ieatrealfood.recipes Zucchini Cheese #sibo #sibofriendly #ibs #ibsdiet #lowFODMAP #easy #dinner

Would you believe it if I told you that it only took me 10 minutes of active prep time to make last night’s delicious chili recipe?  I threw the ingredients in my crock pot before I left for work and came home to a delicious smelling house and warm food.  Note: if your crock pot does not have an automatic switch to turn from low to warm, you will need to make this on a day where you can manually change it after six hours.

Ingredients:

  • 1 T ghee or coconut oil
  • 2 lbs beef stew meat (preferably grass-fed)
  • 2 red bell peppers
  • 1 cup green onion (green part only for low FODMAP), finely sliced
  • 26.46 ounce container POMI chopped tomatoes
  • 2 Tablespoons chili powder (make sure to find one that does not contain garlic or onion)
  • 2 teaspoons sea salt
  • 2 teaspoons cumin
  • 1/2 teaspoon paprika
  • 1/2 teaspoon cinnamon
  • 1/4 teaspoon cayenne pepper
  • 1 cup water

Instructions:

1. Add ghee or coconut oil to slow cooker / crock pot.  Turn to low and allow slow cooker to preheat while you chop bell pepper and green onion.

2. Add beef stew meat, bell pepper, green onion, POMI chopped tomatoes, spices, and water.  Give chili mixture a good stir.  Heat on low for 6 hours.  Serve with any of the below optional toppings.

Optional toppings:

  • Fresh Cilantro, finely chopped (SIBO friendly if you do not have issues with sulfur/high thiol foods)
  • Avocado, diced (generally not SIBO friendly due to FODMAP content- use with caution)
  • Zucchini Cheese- (SIBO friendly)- make ahead of time using this recipe
  • Coconut Milk Yogurt (Dreamboat brand is sugar free)- not SIBO friendly due to probiotic content

Add-Ins to stretch recipe: do you have a large family?  Or perhaps it is not realistic (or healthy) for others in your family to be on as extreme of carbohydrate restriction as you?  No problem!  You can make this recipe stretch by cooking up some beans and rice to go along with it or serving with a side of starchy veggies.

  • Beans & Rice (not SIBO friendly)
  • Sweet Potato (not SIBO friendly)

SIBO “Cheese” Burgers

SIBO “Cheese” Burgers:

riley

Serves: 4

This is an excellent recipe for weeknight dinners.  Do you feel like the LAST thing you want to do when you get home from a long day at work is cook?  I know how you feel.  I am usually really hungry by dinner time because I do not snack in between meals and often it is 5-6 hours between my lunch and dinner.  Therefore, waiting for my dinner to cook is one of my least favorite activities.

Please note that this recipe includes raw vegetables and is therefore not intended for individuals in the intitial stage of their SIBO diet.

Prep recommendations: make the zucchini cheese over the weekend and save the rest of the (very minimal) meal prep for the week.

Ingredients:

  • 1 head butter lettuce, leaves carefully removed
  • 1 large tomato, sliced
  • 1 lb grass-fed ground beef, formed into 1/4 lb patties
  • 1 slice zucchini cheese – optional – (*Note: I like to use ghee instead of coconut oil, add another teaspoon of lemon juice, and reduce nutritional yeast to 2 teaspoons.  Make sure to read the ingredients on your nutritional yeast.  I do not like the taste of zucchini cheese on its own, but it tastes amazing on a “cheeseburger” or atop beanless chili.  Place directly on the warm burger patty to melt slightly.)
  • 1/4 small avocado- optional– (only if you can handle it- I do not recommend using it several days in a row)
  • Dijon mustard- optional – check ingredients (watch out for ‘spices’, preservatives, sugar, etc.)

Instructions:

1. Make zucchini cheese (At least 3 hours before, but I recommend doing this on your weekend.  It will last 2 weeks in the fridge).

2. Cook burger patties on grill or stovetop until medium or well-done (approximately 4-5 minutes per side over medium heat).  When you have SIBO, you are more susceptible to food poisoning, therefore, I like to err on the side of caution and make sure there is not much pink left in my burger.

3. Serve with a butter lettuce “bun”, sliced tomato, optional zucchini cheese, avocado, & mustard.

Let me know what you think in the comment section below!

SIBO-Friendly Pumpkin Pie

pumpkin pie

(Gluten-free, grain-free, dairy-free, soy-free, paleo, egg-free, low FODMAP, SCD, low sulfur)

The recipe is finally here!  Last year I was the one who had to sit there staring at my family while they ate dessert.  This year, I vowed to be able to enjoy it with them.  I had to experiment a couple of times to get the pie just the way I wanted it, but I have officially created a SIBO-friendly pumpkin pie recipe that your guests won’t even realize is “special.”

Kitchen Equipment:

  • Food processor
  • Measuring spoons/cups
  • Glass pie dish
  • Medium saucepan
  • Egg beaters for optional whipping cream

Ingredients:

Crust:

  • 1 cup pecan pieces
  • 1 cup blanched almond flour
  • 1/2 teaspoon finely crushed sea salt
  • 1 teaspoon cinnamon
  • 2 tablespoons coconut oil + a little more for greasing the pan (about 2 teaspoons)
  • 1 tablespoon clover honey (or other SIBO-friendly honey- see siboinfo.com)
  • 1/2 teaspoon pure vanilla extract

Filling:

  • 2 teaspoons gelatin (this is the one I used)
  • 2 teaspoons cinnamon
  • 1/2 teaspoon nutmeg
  • 2 tablespoons water
  • 1/2 cup full fat coconut milk + 1/2 cup water (must use gum-free coconut milk such as this one in order to be SIBO-friendly)- you could try substituting lite coconut milk, but the flavor will not be quite as creamy
  • 3/4 cup pureed pumpkin (can be canned or make your own using a pie pumpkin- personally, I used half of each)
  • 3 tablespoons clover honey (or other SIBO-friendly honey)

Optional Additions:

Instructions:

  1. Preheat oven to 350 degrees Fahrenheit.  Generously grease bottom & sides of glass pie pan with approximately 2 teaspoons of coconut oil.
  2. In a food processor, pulse pecans until very finely chopped (about 15-20 seconds).  They will begin to stick to the bottom edges of the food processor just a bit.
  3. In a medium bowl, combine almond flour, finely chopped pecans, sea salt, and cinnamon.
  4. In a small bowl, melt 2 tablespoons coconut oil & 1 tablespoon honey.  Add vanilla extract.  Stir melted mixture into dry ingredients.
  5. Add crust “batter” to greased pie pan.  Use your fingers to press down firmly, beginning at the center and working your way to the edges.  This step is very important, so take your time.  If you do not make sure the pie is firmly pressed, it will be very crumbly.  See photo below of what the crust should look like before going into the oven.
  6. Bake crust 10-13 minutes.  Watch carefully to make sure it doesn’t burn.  It is done cooking when golden brown.
  7. In a medium saucepan, combine gelatin, cinnamon, nutmeg, and 2 tablespoons water.  Stir to form a paste.
  8. Add coconut milk and water, pumpkin puree, and honey.  Heat on low for about 10 minutes, until warm throughout.  Use the side of your spoon to break up any chunks of gelatin.  The mixture should be smooth and warm when done.
  9. Pour filling into crust and allow to set in refrigerator for 3 hours or overnight.
  10. Use a sharp knife to carefully cut pie into 8 pieces.  Be extra careful when removing the first piece.  Serve with any of the recommended additions.

pie crust

***In order to keep this SIBO-friendly, make sure that you limit yourself to one piece per day.  Additionally, depending on how able you are to handle carbs, you may need to limit your carbs from other sources.

Have a friend who might enjoy this recipe?  Share this link on Facebook or have them follow me on Instagram: @sibowithhope

Let me know what you think in the comments below!

Thai Lettuce Wraps

20141121_131650

Caution: raw vegetables can be problematic for individuals with poor digestion.  This recipe is intended for individuals who have reintroduced raw veggies or are using this recipe as a way to see if they are ready.  Dr. Siebecker recommends remaining on the SIBO diet for 1-3 months before introducing raw veggies (see SIBO Food Guide).

I have always been a big fan of Thai food, especially salad rolls with a delicious peanut sauce.  Unfortunately, there are all sorts of ingredients in those that I can no longer eat (rice, garlic, peanuts, sugar, soy, who knows what else!).  Here is my take on SIBO-friendly salad rolls, also known as Thai Lettuce Wraps.

This recipe is perfect for the end of the week for several reasons: butter lettuce lasts a while if you leave it attached to the stem, the sauce is super quick and easy to make, and the filling ingredients are flexible which allows you to use up any veggies left in the fridge.

Enjoy!

Ingredients:

Butter lettuce leaves (approximately 3 large leaves)- the loose bunches are easier to pull apart without breaking the leaves

1/5 or 1/4 lb chicken or turkey breast (cooked to your liking)- I like to bake mine at 350 degrees for about 20-30 minutes

Sauce (all you have to do is add the ingredients to a bowl and stir):

1/4 c finely chopped fresh Italian parsley (approximately 1/2 c loosely packed before cutting)

1/2 teaspoon finely grated ginger

2 T salted almond butter (or unsalted and add some sea salt)

1.5 teaspoons coconut vinegar (substituting apple cider vinegar should be fine)

1.5 teaspoons walnut oil

1.5 teaspoons coconut aminos (this is a soy sauce alternative that can be found at natural grocery stores)

Optional Filling Ingredients: thinly sliced cucumber, beets (boiled then thinly sliced), shredded carrots (these might be too hard to digest), sliced tomato (nightshade- might cause inflammation).

Tangy Spiced Delicata Squash

tangy spiced delicata

I find myself fascinated by foods that I have never tried before.  Delicata squash fell into that category a couple of months ago and I have made it my mission to figure out how to make a delicious, SIBO-friendly recipe with it.  It is a delightful winter squash and the only one I know of for which the skin can be eaten (and actually tastes good!).  My creation is SIBO-friendly (as long as you do not surpass your carbohydrate tolerance), paleo, SCD, low FODMAP, gluten-free, grain-free, dairy-free, soy-free, egg-free, and has a low free thiol content (for those who are intolerant to sulfur foods).

Tonight I enjoyed it with Coconut Lime Pan-Seared Rockfish and Baked Thai Eggplant Rounds.  Leave your requests below for which one of these two recipes you would like to see posted on my blog!

Ingredients:

  • 1 medium delicata squash
  • 2 tablespoons extra-virgin olive oil
  • 1 tablespoon lime juice
  • 1/8 teaspoon cayenne pepper
  • sea salt & crushed black pepper, to taste

Kitchen Supplies:

  • Baking sheet
  • Metal spatula
  • Parchment paper- optional

Instructions:

  1. Preheat over to 375 degrees Fahrenheit.
  2. Wash squash skin (because the skin is edible) and cut off stem.  Slice squash in half lengthwise.  Scoop out the seeds.  Cut into 1/2 inch thick C-shaped slices.
  3. In a medium bowl, combine olive oil, lime juice, cayenne, salt and pepper.  Add squash and toss evenly to coat.
  4. Line baking sheet with parchment paper (paper is optional- I do this to avoid my food having direct contact with the metal baking sheet).  Transfer squash to baking sheet.  Pour any remaining sauce over the squash.  Bake 25-30 minutes, flipping half way through.

Organic Urine Acid Test Confirms Sulfur Suspicions

I do not remember ever being as excited to go to a doctor’s appointment as I was today.  Why?  Because today I got to see the results of my Organix Comprehensive Urine Profile from Genova Diagnostics.

One of the markers that I found to be interesting from these test results was that I am positive for MTHFR.  While my gene testing also showed this, gene mutations are not necessarily expressed and it is only when they are expressed that they lead to issues. The Organix urine test informed me that not only do I have MTHFR, but it is activated and could be creating an imbalance in my enzyme function.  Based on my genetic testing, I know that I am heterozygous for the A1298C gene mutation (that means it came from only one of my parents).  I actually found this piece of information out in September, but the doctor who ordered the blood test told me that having only one copy of this gene mutation does not generally cause problems.  However, my own research (see links below) and confirmation from my SIBO doctor today has led me to believe otherwise.  I still may do 23andme testing to gain an even better understanding of my genes and figure out if there is anything else going on that would leave me susceptible to bacterial infections.

Here is what was indicated on my summary of abnormal findings:

Fatty Acid Metabolism: This may explain why all of the women along my matriarchal lineage have developed gallstones.

Adipate: Very High

Suberate: High

Carbohydrate Metabolism:

Pyruvate: High

Energy Production Markers:

Cis-Aconitate: Very Low

Methylation Cofactor Markers: confirms MTHFR gene mutation

Formiminoglutamate: High

Oxidative Damage and Antioxidant Markers:

8-Hydroxy-2-deoxyguanosine: High

Detoxification Indicators: confirms my difficulty with detoxification (elevated liver and kidney levels) and the fact that sulfur is an issue for me

Glucarate: High

Pyroglutamate: High

Sulfate: Very High

Summary:

I have not had a chance to really sit down and sort out all of the pieces, but I wanted to get my results out there for those who have similar issues and want to start looking into getting this test done for themselves.  It is clear that avoiding sulfur foods and promoting healthy detoxification will be important for my healing process.  I plan to detoxify slowly so that I do not overwhelm my already fragile system.  I would like to get into a regular hot hatha yoga practice and support my immune system by receiving nutrient IVs that are tailored to my specific needs (as determined by my organic urine acid test).  Further reducing my bacterial overgrowth will also be a piece of the puzzle.  To start, my SIBO doctor has me using Berberine Complex from Integrative Therapeutics.  I will be checking back in with her in two weeks to discuss the results of this treatment protocol.

Links for some of my research:

Hydrogen Sulfide Gas Health Impacts: my SIBO doctor actually asked if she could keep the copy of this patent that I brought to her.  We both agreed that hydrogen sulfide was likely an issue for me.  However, I recently took the Protea Biopharma gut dysbiosis test and had a negative result.  I am uncertain whether the test is inaccurate or whether I actually do not have hydrogen-sulfide producers in my small intestine.

MTHFR from Stop the Thyroid Madness

Methylation/MTHFR by Dr. Amy Yasko

SIBO-Friendly Convenience Foods

One of the most challenging aspects of following a strict SIBO-friendly diet is finding foods that you do not have to make for yourself.  Convenience foods are necessary when you do not make enough food or things just do not go as planned.  The first several months (and even beyond), it can be really challenging to predict exactly how much food you need to make for the week.  Also, the prep time for making your food for the entire week can really eat into your weekend (assuming you batch-cook on weekends).  Luckily, if you search hard enough, there are convenience foods out there for us SIBO sufferrers!  In this post, I am going to share with you some of the ones that I have found.  Please feel free to leave comments about your go-to SIBO-friendly convenience foods.

1) Mario Snack Olives- Kalamata with a Hint of Thyme:  These are lightweight and easy to keep in your purse for emergencies.  Although they are only 100 calories and therefore not that filling, they can get you past those I NEED FOOD NOW!!! moments.

Mario Camacho Foods Pitted Snack Olives, Kalamata with a Hint of Thyme, 1.05 Ounce (Pack of 12)

2) Diestel Brand No-Salt Turkey:  Although labeled just as “no-salt” it is also sugar free and actually, the only ingredient is turkey.  If you eat it plain, it is pretty boring.  I like to dip slices of this turkey in olive oil and sea salt (kind of ironic considering it is no-salt added turkey).    The only place in Portland that I know carries this is Food Front Co-Op.  Last time I checked (yesterday) they charge $11.99/lb.

Diestel_SK_077

3) Unsulphured Shredded Coconut– Coconut can be a touchy subject in the SIBO world.  Personally, I have not found it to negatively effect me.  In fact, I find it to be an excellent source of calories with minimal carbohydrates.  One cup contains approximately 500 calories and 20 grams of carbohydrates.  The reason that I buy unsulphured is that I believe I am sensitive to sulfur.  You can read about that here and here.

Shredded Coconut

4) The Smokery Smoked Salmon (Simply Salmon variety only, unless you can tolerate honey)– This one can be purchased at the Portland State University Portland Farmer’s Market on Saturdays.  It is pretty expensive, but truly delicious.  It lasts in the fridge unopened for several weeks, so it is good to have around in case of emergencies.

smoked salmon

5) Sardines Packed in Olive Oil– Okay, I will admit, I saved this one for last because it is not my favorite.  However, the health benefits and convenience have me going back to it in times of desperation.  The first can of sardines I ever purchased sat in my cupboard for probably two months before I ever tried it.  When I finally toughened up and tried them, I was pleasantly surprised that they were not nearly as bad as I imagined they would be.  Some people even say they enjoy them.  Sardines are packed with omega-3’s and are therefore a really great anti-inflammatory food.  Just give them a chance, you might be pleasantly surprised as well!

sardines

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.

Symptom Timeline

I have compiled a timeline of events and symptoms that I believe are related to my SIBO.  My hope is that by sharing my experiences, people will be able to find similarities to their stories and add to the wealth of knowledge about a condition that is really just beginning to be understood.  Also, I hope that people who think they may have a more mild case of SIBO are able to find help earlier in their journey than I did so that they do not have to go through the many food intolerances and health challenges that I am now facing.

2009: Emergency Room Visit for Toxic Shock Syndrome.  I was given Vancomycin (an antibiotic) to which I had an adverse reaction, causing my entire body to become extremely itchy and red.  Medical students were coming in to look at me and I was told I had “Red Man’s Syndrome” (a histamine reaction to the antibiotic).  I developed seasonal allergies (a histamine reaction) in 2009 after this incident.

2011 (September): Began taking contraceptive pills

2012 (March): First visit to a gastroenterologist due to digestive issues- primarily gas and constipation.  Eliminated dairy with some relief.  Celiac test came back negative.

2012 (December): Horrible acute abdominal pain that kept me up all night and lasted about 24 hours.  I went to the pediatrician’s office and she sent me to the emergency room for suspected appendicitis.  Pain went away on its own.  CT scan revealed no problem with appendix and doctors ultimately had no answer for me.  They instructed me to follow a low-residue diet for a couple of weeks.

2013 (March): Second visit to the gastroenterologist for gas and alternating diarrhea and constipation.  She tried to prescribe me a colon relaxer.  I never took the drug and instead turned to the naturopathic route.

*Saw some relief based on naturopathic recommendations, including acne clearing up somewhat.  Treatment protocol included acupuncture, fish oil supplement, probiotic, digestive enzyme, no gluten, no dairy, no soy, and no legumes.*

2013 (August): Stopped taking contraceptive pills due to suspicion that they were contributing to my digestive issues.  Also, I did IGG/IGA allergy testing which indicated that I had several food allergies including eggs yolks and whites (which I was eating a fair amount of at the time).

2014 (February): Tested positive for SIBO via a lactulose breath test from Commonwealth Labs that revealed hydrogen gas of 72 ppm & no methane (however, SIBO specialist suspected methane due to my symptoms and believes the test was not sensitive enough to pick it up).  Somewhere around this time, my acupuncturist noted that my ileocecal valve was malfunctioning (discovered during abdominal massage based on the sound that my ileocecal valve was making when pressed on).

2014 (Late March/Early April): First round of Rifaxamin (two week course).  No prokinetic taken afterward.  Began SCD diet immediately after finishing antibiotics.  Also, took probiotics twice daily.  SIBO symptoms returned within two weeks.

2014 (May): Comprehensive stool testing from Parasitology Center Inc. revealed no existence of yeast or parasites (or any other abnormalities other than bacteria).

2014 (May 12th): Began elimination diet (low FODMAP, SCD, AIP) which was very low-carbohydrate.  By week three of following this protocol (combined with recommendations from SIBO specialist in early June), I was having daily bowel movements that were like type 3 on the bristol stool chart rather than type 1 or nonexistent (when my symptoms were really bad, I was only have one bowel movement every 4 days).  I also began to experience amenorrhea around this time.

2014 (May 19th): Onset of brain fog/fatigue symptoms (word-finding difficulty, trouble concentrating & reading, clumsy & unbalanced walking, slow brain function, feeling “out of it”, running into and dropping things, losing track in the middle of doing or saying things, tired, lethargic).  Very severe for a few days until I received a nutrient IV.  However, symptoms returned within a week and subsequent IVs did not provide the same relief.  Fatigue & brain fog have continued to worsen ever since this onset of symptoms.

2014 (May 23rd): Blood work (comprehensive metabolic panel, T3, T4, & CBC) revealed the following were out of range: BUN (too high), BUN/Creatinine ratio (too high), albumin (too high), and free T3 (too low).

2014 (Early June): Appointment at the NCNM SIBO Center for Digestive Health.  SIBO specialist had me start taking cod liver oil, STOP TAKING PROBIOTICS (shocker, I know!), and increased my dose of neem herbal antibiotic to 6 capsules daily.  Also recommended that I remove pork and coconut products from my diet (I have since reintroduced coconut oil without symptoms).  After this appointment, my bowel movements became better and my itching mostly disappeared.

2014 (July 25th): Follow-up blood work showed that all levels returned to within the normal range, except for my free T3 which dropped even lower (in correlation with my fatigue) to 1.8L.  My glucose level also dropped from 76  to 71 mg/dL (still within normal range, but on the lower end).

2014 (July 17th-August 2nd): Second round of Rifaxamin.  Although I had more itching while taking the Rifaxamin, there were some days where I had two bowel movements (that is a good thing).  After completing this round of antibiotic, I began taking neem herbal antibiotic (4-6 per day) again.  I trialed spaghetti squash, blueberries, and homemade almond milk (all of which produced a histamine reaction).  However, I continued to have daily bowel movements and hardly any itching.

2014 (August 11th): Began taking Resolor prokinetic (not covered by insurance because it had to be shipped from the UK- cost is about $3 per day on my current dose).  While taking neem & resolor, my bowel movements actually felt like they had complete emptying (first time this has happened in years).

2014 (August 23rd): Ran out of neem herbal antibiotic.  Still having daily bowel movements and minimal itching, but bowel movements no longer feel like complete evacuations.

Next steps: My insurance company denied my request for another round of Rifaxamin (this time was going to be with Neomycin to address suspected existence of methane-producing bacteria).  Instead, I will be taking herbal antibiotics (allimed & neem) for 2-4 weeks while continuing the prokinetic (Resolor).  One new symptom that I am curious about is that my intestines have been making more growling/gurgling noises than ever before.  I am curious whether this is a good or bad thing (or neutral).  Let’s hope that I can figure out what is at the root of my fatigue and also clear up my SIBO enough that I can reintroduce foods without having a histamine or digestive reaction.