Simple Lifestyle Changes That Can Help Cure SIBO

The PHD diet is more than just a diet. There are a number of recommendations in the book to improve health, nutrition status and sleep — and they will also help eradicate SIBO:

Circadian Rhythm Entrainment

Curing sleep problems is key to curing SIBO. The migrating motor complex (MMC) that cleans our gut while we sleep tends to be disrupted in those with interrupted sleep. It can actually be THE cause of SIBO-C in some, because when the small intestine is not getting cleaned out at night, it creates a perfect environment for bacterial overgrowth.

To get myself back on the path to good sleep, I walk outside every morning to get early sun, I exercise daily, wear blue-light blocking glasses after 8pm while reading on my ipad, watching TV or using the computer, and take 5 mg of melatonin 20 minutes before bedtime.

Daily Exercise
Daily exercise not only helps with circadian rhythm entrainment, it helps with motility. So I'm walking for one hour every day, followed by 30 minutes of stretching and muscle work.

Intermittent fasting

Most people stop eating around 8pm and don't eat again until breakfast. That is, they "break the fast" around 7am the next day. That's an overnight fast of about 10 hours. Intermittent fasting expands the fast to 16 hours by delaying the first meal until around noon.

By having the first meal at noon and last meal at 8pm, you create an eight-hour feeding window. Why is this important? Jaminet goes into this at length in his book The Perfect Health Diet.

Prolonging the overnight fast improves gut motility. The migrating motor complex (MMC) that cleans our gut while we sleep is disrupted in people like me who wake periodically through the night. Interrupted sleep and MMC dysfunction can actually be a cause of SIBO. When the small intestine is not getting cleaned out at night and constipation is keeping toxins from being eliminated, it creates a perfect environment for bacterial overgrowth.

By waiting until noon to have my first meal, I'm allowing additional opportunity for the MMC to kick in and do it's thing. And I don't find it difficult. After a few months following the PHP diet, I no longer experience food cravings. And like many SIBO-C sufferers, I actually feel best (less fatigue, brain fog and bloating) when I'm not eating.

I generally have two meals a day — the first at noon and the last before 8pm. As an added bonus, 8/16 fasting, as it's called, boosts the immune system by encouraging autophagy — a body cleansing mechanism that cleans out toxins and recycles damaged cell components. This is important when your small intestine is teeming with bacteria that are eating all your nutrients before you can get to them and spewing methane gas and other detritus that erode the gut barrier and lead to leaky gut that in turn causes autoimmune flares.

Eating only twice a day also simplifies the challenge many of us face of when to take various supplements, as some require meals and others require an empty stomach, per instructions on the label.

Even more importantly, it helps with circadian rhythm entrainment.

Alcohol

Though the PHD diet allows moderate alcohol intake, I'm limiting it for now, while my liver is being taxed with cleaning up endotoxins that the SIBO is spewing into my body. 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. 

Other Lifestyle Changes

I was skeptical about Squatty Potty, which you may have seen on Shark Tank, but it's so inexpensive that gave it a try and I'm glad I did. All the promo info about the right position to encourage bowel movements and letting gravity take it's course must be true because it works. In fact, it may be the most effective $20 I've spent since being diagnosed with SIBO. 

In addition to all of this, I'm taking actions to stimulate the vagus nerve — but that's a pretty complex topic that deserves it's own post so stay tuned.

References:

The Perfect Health Diet: Circadian Rhythm
The Perfect Health Diet: Intermittent Fasting
Self-Hacked: 33 Hidden Scientific Causes of IBS That Your Doctor Doesn’t Know About

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.)

Testing for IBS-C: Colonoscopy, Endoscopy and SIBO Breath Test

I chose to see the same gastroenterologist who had performed my "screening colonoscopy" just six months previous. I reasoned that any new doc would want to have their own look-see and it really wasn't an experience that I was eager to repeat. I also knew that six months ago everything had looked normal and I was hoping she'd give me a full pass so I could move my primary doc onto some other line of inquiry. But that's not what happened.

While the gastro didn't make me repeat the colonoscopy, she did order an endoscopy and a SIBO breath test. The endoscopy, like the former colonoscopy, did require anesthesia but it didn't require the icky prep — no drinking a vast amount of solution designed to clean me out before the procedure. I had to follow a light diet 12 hours beforehand. If I recall, I was allowed broth and some chicken breast the day before and nothing after 8pm. The endoscopy scope is inserted down your throat while you're "out." I had a slight sore throat afterward, but otherwise didn't feel a thing.

The SIBO breath test was absolutely painless. I just had to drink a lactulose solution, wait about 20 minutes for it to digest, then breath into a tube every 10 minutes over the course of a few hours while they measured levels of gasses my stomach was producing.

The endoscopy came back clear, which was a relief, however, the SIBO breath test came back positive for methane, which was a total surprise. Methane gas indicates an over colonization by an organism called archaea that naturally occur in the body but usually in the large intestine. This type of organism cause the constipation variety of SIBO. If hydrogen gas had been present, that would indicate an overgrowth of a type of bacteria that causes the diarrhea version of SIBO.

So, I had SIBO. It felt good to have a diagnosis, but what did it really mean? How could SIBO be causing my kind of symptoms?

Well, like most people who have SIBO, I have leaky gut. The erosion of the mucus lining that's the barrier that normally keeps food we eat from getting into our bloodstream has become permeable, allowing food particles into my blood. When my immune system detects these, it treats them like an invader and a cascade of events is triggered. One of these is histamine production. The same histamine involved in allergy attacks, for which many people take over the counter antihistamine tablets. Things like skin rashes and other autoimmune reactions like joint pain may very well be attributed to this.

Other symptoms like numbness and tingling and leg cramps are likely due to vitamin deficiencies caused by SIBO. Because bacteria have colonized the small intestine, where they don't belong, they are able to get to our nutrients earlier in the digestive process, depleting us of vitamins. And some vitamin deficiencies can mimic the symptoms of very serious health ailments.

So, what now? A combo of antibiotics xifaxin and erythromycin had been the forward thinking treatment for the past few years, formulated by SIBO pioneers Dr. Mark Pimentel and Dr. Allison Siebecker. But I was dismayed to read about the dismal failure rate of antibiotic treatment for my type of SIBO, SIBO-C (40-50% recurrence rate, according to many studies). Even those who are initially "cured" by the antibiotic duo are likely to relapse and require rounds and rounds of more antibiotics, which can eventually lead to antibiotic resistance and even bigger problems such as C-dif. Studies showed herbal antimicrobials are sometimes more effective than antibiotics. I was further encouraged by the accounts of bloggers at Hollywood Homestead and Animal Pharm/The Gut Institute, who eradicated SIBO using botanical medicines. I did my research on the various botanicals and was just about to purchase a slew of herbal antibiotics, prebiotics and probiotics when I came across this Chris Kresser podcast and learned about a new herbal drug called Atrantil that targeted the archaea that cause SIBO-C. 

I changed track and started formulating a treatment protocol, and prepared to discuss it intelligently with my gastro.

My Symptoms Didn't Seem SIBO-Related

Getting the diagnosis that I had Small Intestinal Bacterial Overgrowth (SIBO) — an imbalance of certain bacteria in my intestines — didn't happen overnight. In fact, everything I learned about my condition has been like peeling the proverbial onion, one layer after another. The troubling symptoms that first sent me to the doctor didn't seem like a gut issue:

• Nightly leg cramps
• Tingling in my hands
• Numbness in my feet
• Hair loss
• Always feeling cold
• Weight gain (despite being on a restricted diet)
• Constipation
• Various skin rashes
• Vitamin deficiencies (despite taking supplements)

All of these were symptoms that my previous doctor of eight years had dismissed. He implied they were just part and parcel of menopause. But I hadn't actually begun menopause yet.

My new doctor did not dismiss the symptoms, especially the vitamin deficiencies. She jumped in right away with a slew of tests to systematically rule out one condition after another — from hypothyroid to diabetes to anemia to pernicious anemia — then, honing in on the constipation symptom, she referred me to a gastro specialist to see if perhaps IBS was causing malabsorption.

To my doc's credit, I would never have gone down the IBS path had she not suggested it. Before I became the voracious reader of digestive health info that I've now become, I had a general sense of IBS as being about stomach pain, gas, nausea, GERD, acid stomach and diarrhea, none of which I was experiencing. I'd never heard of IBS-C, the constipation version of IBS, and my constipation was more an occasional annoyance than a real problem, I thought. I recall reading many articles in women's magazines through the years advising that constipation is different for every person and some people go every day or even twice a day and others go every three days and all of these are normal.

Knowing what I now know of course, I take a completely different view. I now know that everyone should be having a bowel movement every day. If we're not being swept clean daily, there's opportunity for overgrowth of the bacterias that commonly reside in the gut and we're not ridding our body of the endotoxins created by those bacteria.

But I'm getting ahead of myself. My next step was testing.

My SIBO-C (Methane) Treatment Protocol

When I was finally diagnosed with the methane type of Small Intestinal Bacterial Overgrowth (SIBO) after a breath test, my primary care doc suggested that I be treated with Rifaximin and neomycin. This had been the most forward thinking treatment in recent years, formulated by SIBO pioneers Dr. Mark Pimentel and Dr. Allison Siebecker, and my doc advised me to make a case for it to my Gastroenterologist.

While I appreciate her forward thinking — it's a sad fact that many doctors across the country are not aware of the pioneering SIBO work — I decided not to follow her advice, no offense intended. I'm grateful to her for putting me on the path of a gut disorder as the cause of vitamin deficiencies that were giving me scary neuropathy and autoimmune joint flares — after eliminating conditions like diabetes, hypothyroid, and celiac — but she's running a busy family medical practice and doesn't have time to stay up to the minute on the very latest developments in this one not-so-common disorder. New information is arriving every day that wasn't known even six months before. That's why when you get diagnosed with SIBO, you have to become your own medical sleuth.

One of the unfortunate SIBO symptoms affecting me right now is insomnia. I say unfortunate, because research shows that disrupted sleep interrupts the cleansing mechanism of the gut, called the Migrating Motor Complex (MCM), and can in and of itself be the cause of SIBO.

I'd been a lifelong "good sleeper" and not getting good rest is almost the worst of my symptoms — coming in rough second only to the ugly autoimmune attacks on my finger joints. The one benefit of insomnia, if there can be said to be one, is that it gives me lots of additional time for quiet reading. As a result, I spend about three hours a night reading up on SIBO and other related gut issues, and this information has helped me tremendously as I direct the path to what will hopefully be my recovery.

It was only through reading and research that I learned the dismal failure rate of antibiotic treatment for SIBO-C (40-50% recurrence rate, according to many studies) and shared these studies with my primary care doc. Once I saw the failure rate for the Rifaximin and neomycin protocol to treat SIBO-C, I knew that wasn't the course for me. Even patients who are initially "cured" by the antibiotic duo usually relapse and most require rounds and rounds of more antibiotics, which for some can eventually lead to antibiotic resistance and even bigger problems such as C-dif. No thanks.

Almost immediately I was on a path to find a botanical antibiotic protocol instead. In many studies herbal antimicrobials are more effective than antibiotics.

In fact, I was just about to hit the "buy" button on Amazon Prime for a slew of herbal antibiotics, prebiotics and probiotics that bloggers at Animal Pharm/The Gut Institute and Hollywood Homestead had used to cure their SIBO when I learned that the bacterias that cause SIBO-D (diarrhea) and SIBO-C (constipation) are quite different and that there was a brand new botanical treatment available to treat SIBO-C called Atrantil that actually targeted the archaea bacteria that cause SIBO-C. I corrected my course accordingly.

MY PROTOCOL

Your SIBO treatment will likely not be exactly the same as mine. Every body is different and responds differently to treatment, based on existing conditions or infections, genetic expression, metabolic makeup and diet. But I'm writing this blog in the hopes that what I'm experiencing might help others like me.

Medicines

My herbal protocol is simple:

• Atrantil, to create an unfriendly environment for the archaebacteria that's colonizing my small intestine, weaken their cell walls to eliminate them, and sop up the methane production that causes severe bloating
• Iberogast, a prokinetic proven to increase gut motility
• Natural Calm, a powder form of magnesium citrate, to bring water into my small intestine and encourage bowel movements (tastes better than the liquid magnesium citrate you can buy at any pharmacy for a few dollars, but works exactly the same way)
• Apple cider vinegar-spiked water drunk with every meal, to increase stomach acid and bile

Diet

If you've looked into diets for SIBO, you've likely come across the GAPs Diet, Specific Carbohydrate Diet, Paleo AIP Diet and FODMAPs diet. These diets have calmed symptoms for millions with gut problems, but when it comes to SIBO-C, they don't cure the source of the problem and may even over time make things worse. Practitioners like Chris Kresser have made the case that diet alone is not enough and that starving the gut of carbs and FODMAPs could have a deleterious effect on the large intestine biome. Additionally persuaded by evidence that very low carb diets can actually cause gastrointestinal disease by depleting the gut of Mucin-2, I decided to follow The Perfect Health Diet, and in fact I had already started the diet three months before I even got the actual SIBO-C diagnosis.

You can read more about my diet and nutritional supplements here. In addition, I'm implementing other lifestyle changes that might help, like yoga and other forms of vagus nerve stimulation.

Resources

Sites I owe a debt of gratitude to:

• The Perfect Health Diet: For setting me on the path to good nutrition and improved gut health and arming me with a vast amount of well-documented research to show my doctors.
• Chris Kresser: For breaking down very complex digestive issues into laymen's terms and for introducing readers to experts in the field, like SIBO pioneers Pimentel and Seibecker in addition to Dr. Kenneth Brown, the gastro who developed the botanical treatment Atrantil that I'm taking.
• Fix Your Gut: For clearly illustrating the difference between SIBO-C and SIBO-D.
• The Gut Institute: For sharing an herbal antibiotic protocol that has cured many SIBO patients — it is the protocol I would have tried if I hadn't come across the newly released Atrantil.
• Hollywood Homestead: For the lead on motility dysfunction and vagus nerve damage as possible causes of SIBO.
• Digestive Health Blog: For the lead on botanical medicine Atrantil to treat the archaea bacteria that cause the constipation version of SIBO that I have.