SIBO-C Can Make You Gain Weight

One of the first symptoms of SIBO that sent me to my doctor two summers ago was weight gain, despite being on a restricted diet. I could tell he didn't believe me. I felt like Ingrid Bergman in the film noir classic Gaslight. (Hah, gas = methane = SIBO — hiyo!). Having SIBO-C and watching your weight can be similarly maddening.

In the film, Ingrid's husband Gregory is trying to make her seem crazy, so he can institutionalize her and claim her inheritance. One of Gregory's evil tactics is to flicker all the lights in the house which, thanks to eerie mood music, comes off a lot creepier in the movie than it sounds. Ingrid keeps telling her psychiatrist that her nerves are shattered living in that house because the lights flicker on and off all the time. But there's Gregory standing in the background, shaking his head no. And who does the psychiatrist believe? Yeah, it's like that.

Because my weight gain was occurring along with symptoms like muscle cramps, joint pain, hair loss, dry skin, and feeling cold all the time, I suspected hypothyroid. My doctor at the time ran the standard blood and urine screens and my TSH level was within what's considered normal range. I had read at Stop the Thyroid Madness that the TSH test is not a good indicator, and I asked him if he could test my free T3, free T4 and reverse T3 levels and also look for thyroid antibodies. He handed me a lab sheet and said check off the tests you want and mail it back, but I'm telling you right now, I'm not prescribing thyroid medication to a patient whose TSH is in range.

Whoa! — who said anything about thyroid meds? I'd just asked to learn what my hormone levels are.

As a parting shot as he was walking me out, he said try a low-carb diet. But I was already on a low-carb diet. I'd eating low carb for most of the eight years I'd been his patient.  In fact, as I would soon come to find out, a low-carb diet for so many years may have been a causal factor in my gut dysbiosis.

Recovering from a shoulder injury that grounded me from my usual summer activities like biking and kayaking, I was concerned about weight gain, so I had been eating even fewer carbs than usual. I'd been watching my diet extra carefully and keeping an online food diary. What I was seeing was very strange. For most of my life when I was active I could eat 1800 calories a day and maintain my weight. When I needed to lose weight, reducing consumption to 1600 calories a day would result in about a two pound weight loss per week. But now here I was down to 1200 calories a day and steadily gaining weight.

I could tell he didn't believe me, so I exported my food diary into a PDF and sent it to him, but was met with stony silence. He wasn't the only one not listening. Even some of my closest friends were saying unhelpful things, like "a calorie is a calorie" and "there were no fat people in Auschwitz." And I couldn't blame them, as I'd spent a lifetime subscribing to the same "eat less, move more" philosophy.

If you have SIBO-C and think you're gaining weight even on a restricted diet, it's not all in your head. This paper by SIBO pioneer Dr. Mark Pimentel explains how methane gas production in SIBO-C leads to constipation, irritable bowel syndrome (IBS), and obesity.

In this Chris Kresser podcast, Dr. Pimentel further explains:

"... Methanogens, it turns out, based on the microbiome work that’s being done on that particular organism, are super important to help liberate calories from nondigestibles. So let’s say you have a high-fiber diet. Humans generally can’t eat fiber. Cows and ruminating animals have a lot of methanogens because the methanogens help facilitate digestion of fiber. So what does that mean? That means that you can get more calories from a meal if you’re a methane producer because you’re liberating calories from things that people who don’t have methane can’t get.

So where am I going with this? What I’m saying is if you take a population from Africa and immigrate them into the United States, and those folks, for genetic reasons or environmental reasons, have methanogens flourishing in their gut, which is an evolutionary advantage for getting and harvesting nutrients, it’s not an advantage when food is abundant and food is so processed and easily digested that you get more calories."

Hearing this from the world expert on SIBO didn't help cure my condition, but it did explain what was happening in my body. The bacteria colonizing my small intestine are extracting MORE calories from fiber foods that I eat.

I'm all for efficiency, but just once in my life I'd like to have the ailment that makes a person LOSE weight!

Optimizing Nutrients: Vitamins I'm Taking to Help Cure SIBO

I'd been a lifelong sceptic about supplements, until I was diagnosed with SIBO. When you have SIBO, bacteria that are normally located in the large intestine have migrated up to the small intestine, where they encounter your nutrients earlier in the digestive process and get to them before you do. SIBO patients are deficient in many vitamins, especially fat-soluble ones, and these vitamin deficiencies can actually mimic other very serious health issues. For example, a B12 deficiency can look amazingly alot like MS, ALS, Parkinson's or other incurable disease.

The PHD diet advises getting our nutrients from food wherever possible, but those of us with SIBO have malabsorption issues and are very likely deficient in Vitamin B12 and D3, among others. To heal the gut it's essential to optimize your nutrients as quickly as possible. This means asking your doctor for an extensive vitamin and mineral panel and researching the type of vitamin you need to take for best absorption. (Example: Methylcobalamin B12 is more bioavailable than the less expensive cyanocobalamin.)

Multivitamins aren't a good option. They'll never have the right proportion of each vitamin that you need. Why? Because some vitamins like C and magnesium are so big that to put all that into a single multivitamin would not be swallowable. In addition, you don't need to take all vitamins daily — just those you're deficient in or ones critical to correcting a health condition. To bring my nutrition up to speed I take this panel recommended by the Perfect Health Diet:

Daily
* D3 — to go weekly, after serum 25OHD of 40 ng/ml is achieved
* B12 500 mcg — to go weekly after deficiency is addressed
* B-5 500 mg
* C 1 g
* K2 100 mcg
* Magnesium 200 mg (when not taking Natural Calm)
* Iodine 225 mcg

Weekly
* B vitamins:
    * 50 to 100 mg each of B1, B2, and B6
    * 5 mg biotin
* Boron 3 mg
* Zinc 50 to 100 mg

And when not eating 1/4 lb of liver per week:
* Copper 50 mg
* Vitamin A from cod liver oil, 50,000 IU/week

And when not eating brazil nuts::
* Selenium 200 mcg

Additionally
I start my morning with a tsp of virgin cod liver oil — that's right, our grandmas knew a thing or two that we've forgotten. The omega-3s in cod liver oil balance out the omega-6s I get in olive oil. The only other oils I cook with are grassfed butter and coconut oil.

Next, I mix a 1/2 tsp of glycine powder in a glass and drink it down with 1 NAC capsule. Both are healing to the gut lining, and NAC helps get neurotransmitters back on track, which can help with the sleep disruption that throws the migrating motor complex off, slowing up digestion.

I fast until noon, when I eat my first meal — usually eggs in some type of veggie frittata. While I'm eating I gulp down two Atrantil capsules. Atrantil is a botanical antimicrobial that tamp down my "bad" gut bacteria population. About a half hour later, I pop a soil-based probiotic (usually Prescript Assist).

I mix a 1/4 tsp of vitamin c powder in a 1-liter travel bottle and take it with me to work. When I've finished it, I fill it up again. I try to drink two of these during the day before it's time to commute home.

After dinner I take all of the above supplements, and I'm done for the day, unless constipation symptoms have raised their ugly head. When that happens, I take mix two teaspoons of Natural Calm magnesium drink into a mug of warm water and drink it down before bed.

My SIBO Diet (Hint: It's Not About the FODMAPs)

If you google "diet for SIBO," you're sure to come across the GAPs Diet, Specific Carbohydrate Diet, Paleo AIP Diet and Low-FODMAPs diet. These diets have calmed symptoms for millions of IBS sufferers and they deserve all the praise they get, but they don't cure the source of the problem, especially when it comes to SIBO methane — the constipation variety of SIBO that I have. Practitioners like Chris Kresser make the case that diet alone is not enough and, further, that a diet that starves the gut of carbs could have a deleterious effect on the large intestine biome. I certainly don't want to fix SIBO in the small intestine only to create a different problem in my large intestine. Additionally, persuaded by Paul Jaminet's argument that very low carb diets can actually cause gastrointestinal disease by depleting the gut of Mucin-2, I chose to follow the diet prescribed by his book The Perfect Health Diet — and in fact I had already started three months before I got the actual SIBO-C diagnosis, when I was merely hoping to improve my symptoms.

Diet

PHD is a whole-foods, moderate-carb diet that, similar to other ancestral diets like Paleo recommends eating a plethora of wholesome vegetables and fruits, as well as grass-fed, pastured and wild protein sources, while eliminating refined sugar, grains, legumes, and chemical additives. Jaminet is a scientist, and his site is extremely well-researched with exhaustive footnotes. The philosophy of the Perfect Health Diet (the title is aspirational) goes like this: Poor health is the result of nutrient deficiencies, food toxins, and infection. So the primary goal of any diet should be to provide optimal intake of all necessary nutrients (optimal meaning "enough to derive the biological benefits, but not enough to become toxic"); to avoid food toxins; and to address any underlying infection in the body.

To quote Jaminet: "Given two equally nourishing alternatives, say wheat or white rice, if there is evidence that one is significantly more toxic than the other (in this case, wheat more toxic than rice), we should avoid that one and get the nutrition from the safer source."

On the diet I eat grass-fed, pastured and wild protein, dairy and eggs; the rainbow of fruits and vegetables; all starchy root vegetables; white rice; and homemade gelatin-rich bone broth.

I don't eat sugar, seed oils, soy, peanuts, legumes, chemical additives, or any grains at all except white rice.

I'm not finding the diet difficult. It probably helps that I'd given up sugar many years ago. I'd also eliminated gluten six years ago, when I started getting an itchy rash on my elbows, knees and tailbone that a friend told me looked like a food reaction. Though I tested negative for celiac and for gluten antibodies, the rash does return any time I've been inadvertently "glutened." It was slightly harder to give up other grains like corn and GF oats, which so many gluten-free folks depend upon, but I've been able to adjust, experimenting with coconut flour and cassava flour. In a future post I'll share some of my favorite recipes, including a cassava pizza crust.

The toughest thing for me to give up on PHP has been legumes, including peanut butter (peanuts are actually a bean — boo!). I used to love having steamed lentils for lunch or making a big vat of chili, and I have yet to find a decent substitute for hummus, which I practically lived on in my previous life.

I'm also avoiding alcohol for now, while my liver is being taxed with cleaning up endotoxins that the SIBO is spewing into my body. I used to love visiting wineries of the Northfork in the summer. Once I've healed the leaky gut and stopped the joint flares and neuropathy, I do look forward to having a glass of wine again, which the PHP diet supports.

In addition to diet, there are a number of lifestyle changes that the PHD book encourages, such as intermittent fasting and circadian rhythm entrainment and I'm doing those as well. (See: Health Hacks.) I'm also optimizing nutrients by getting my vitamin levels up. (See: Optimizing Nutrients with Vitamins.)