Recap on the 2017 SIBO Symposium - Day One

Mark Pimentel, MD - SIBO Overview

• Clinicians worked on creating a standard for breath tests - 8-12hrs of fasting, prep diet, no promotility agents for a WEEK, 10g lactulose. "North American consensus on breath testing" on PubMed for free.
• at least 60% of IBS-D is SIBO
• stress doesn't cause SIBO but makes bowel issues worse and reduces the MMC (migratory motor complex).
• IBSChek - high vinculin antibodies means many treatments will be unsuccessful (incl Rif/Neo). High = 3.0
• IBSDetex - doesn't give raw data like IBSChek, it controls for 1, they use a ratio but theres a problem with a formula (not sure what this means other than "use my test" :)
• Methane is only detectable on breath test when it's at 1 million parts per mil. Methane causes constipation at 10,000 parts per mil.
• If you don't respond to Rifaximin the first round you shouldn't use it anymore, it won't suddenly start working. You need to try something else. Also if you rebound quickly after Rifaximin you need to focus on underlying cause (adhesions).
• SIBO is "Changes in flow in the gut causes the wrong bacteria to overgrow in the wrong place". IBS is a disease. SIBO is caused by another disease.
• They are doing the testing for Hydrogen Sulfide at Cedar-Sinai but still don't know what to do with the results so they are reluctant to give them out to providers/patients.
• Elemental diet is most effective.

Melanie Keller, ND - Risk Factors and Environmental Toxins

Risk Factors (essentially EVERYTHING!)

• Gestation/birth/infancy - traumatic birth, condition of mother, abx use as infant, length of hospital stay
• Procedures/surgery - tolerance of anesthesia, what type of procedures have they had done, sinuses, chronic infections, repair of altered anatomy, dental procedures, abdominal procedures
• Injuries - most notably head injuries, abdominal traumas
• Travel - food poisoning
• Infections - various parasites and bacteria
• Dental Hygiene - wisdom teeth extractions, dry socket, all four removed at once, root canals can never be sterilized so may never heal perhaps in greater than 99% of procedures, implants, veneers, amalgam filling removals, carbonated beverages (turns to carbonic acid in your mouth making it more acidic) - must you a straw then rinse after, apple cider vinegar
• Other - gastric acid, medications, eating disorders (why?), IBD with strictures, connective tissue issues, methylation issues (MTHFR and FUT2)
• Environment - US manufactures 5 trillion chemical compounds, fatal food allergies have increased over 50% in recent years, increase in diabetes and obesity related to environment, many toxins in our environment that have a negative lasting impact on digestion
• Q&A - MMC starts in stomach, go to PHCapsule.com to find where you can get a Heidelberg test - need a referral from provider,  

Mark Pimentel, MD -  Methane and Autoimmunity 

• Food poisoning is NOT related to Methane
• Methane comes from environment and family. If you live in impoverished areas where calories are either hard to come by or hard to extract from low quality foods then methane is protective.
• Methane is not an overgrowth, it's a bloom and may NOT be SIBO (WHAT??)
• The older you get the more likely you are to have methane.
• Methane slows transit time.
• Methane makes you hyperglycemic, impacting both blood sugar and insulin (there is data to support this).
• Methane predictive of obesity. Those who don't lose weight after weight loss surgery may have methane complicating picture.
• Combination therapy (Rif/Neo) does not work well for methane, it often comes back quickly and you can't keep people on therapy two weeks out of every month.
• Methane is not an overgrowth, it's a bloom, outgrowing other bacteria. We don't know how much is in colon and how much is in small bowel. Methane is not dependent on lactulose so it doesn't always go up on the test. It may be mostly in the colon.
• F420 enzyme allows M. Smithii to take hydrogen and make methane, lovastatin blocks this enzyme. Methane production drops in days. Hydrogen bugs the get sick and die from the excess of hydrogen.
• Syn-10 (the lovastatin drug in trial) stays in gut and is not absorbed so none of the same lovastatin side effects. Red Yeast Rice is absorbed so likely not effective the same way.
• C-Diff causes post infectious IBS.
• You can get SIBO via FMT
• Fasting helps, meal spacing necessary
• Methane + high fat diet may be recipe for weight gain as methane makes body more efficient with harvesting calories.
• If you have post infectious IBS, NEVER get food poisoning again. Always travel with Rifaximin and take 1/2 a pill with meals (IMO herbals are just as effective and so much less expensive!).
• Scleraderma the only other autoimmune condition that seems to be linked to high levels of vinculin antibodies.
• Allicin works temporarily for methane.
• Phase 3 research for Syn-10 starts in Sept
• Higher vinculin antibodies predict lack of response to treatment with Rif/Neo (Pimentel stated 3 on the vinculin antibodies is high).
• M. Smithii can use acid and ammonia to make methane so keep those lower in diet (ie lemon juice in water, ACV).
• In the process of investigating separate diet for SIBO and Methane.
• Norovirus can cause IBS even though it doesn't release Cdt-B, they are not sure why.
• Cipro does work for SIBO but generally only the first time and then the bacteria becomes resistant and you take a severe hit to the microbiome.

Natalie Gustafson, PharmD - LDN and LDE

Not much new here just explanations of risks and mechanisms of LDN and LDE

• LDN must be taken on an empty stomach
• LDN can be taken at night if it interrupts with sleep
• Always ask compounding pharmacy what kind of filler they use
• LDN upregulates Toll Like Receptor 4 so helps decrease inflammation
• LDE at 50mg does not appear to impact the microbiome
• LDE does have the very rare potential of QT elongation which increases cardiovascular risk
• LDE does block certain liver enzymes so make sure the check crossreactivity.  Will make berberine less effective.
• Enteric coating contains phalates so most pharmacies don't use this coating because they have to have special equipment and ventilation (I don't think she meant all enteric coatings are made from phalates)

Melanie Keller, ND - Managing Treatment Failures in SIBO, IBS & IBD

Many, many rabbit holes in this talk. Dr. Keller clearly deals with SIBO cases that require a much deeper dive into the body to resolve. My guess is is that most people with SIBO do not require such a deep investigation to heal.

• Step one - no more supplements.  She is seeing correlation that certain nutrients feed certain bacteria and if you are low there is a reason. If you simply supplement you could just be feeding the overgrowth of bacteria.
• Test for stomach acid levels - she sees people with both low and high stomach acid.  Both cause issues with digestion.  She believes that people with high stomach acid are actually more sensitive to foods than those with low. (link above to PHCapsule.com to find a Heidelberg test office near you).
• Her theory is that high baseline methane could be in the stomach. H.Pylori used to be erradicated with two medications, now it takes quadruple therapy. Is there some sort of correlation??
• There is a complex communication happening between bacteria, hormones, enzymes, etc. that we don't quite understand yet. Research currently being done.
• Hormones are an important component, need to make sure adequate growth hormone, not too much sex hormone binding globulin, etc.
• Amalgam filling removal - does not like to treat these patients as they don't do well, don't seem to recover.
• She utilizes www.scorecard.org to determine common pollutants in people's area.
• Using Strategene can help answer why some people do well with some things and not others.  She looks at methylation pathways of a person to determine which pharmaceuticals may work best.

I listened to this one twice and still just can even begin to grasp how she noodles all this stuff out.  Dr. Keller is also very interesting in environmental toxins and how they impact the body.  For example, research has shown Agent Orange acts as a xeno-estrogens and caused a rise in endometriosis for women and diabetes for men.  Ulcerative Colitis and Crohn's appear to have doubled from 1996 to 2006.

Next steps for dealing with methane while not actively killing....

While I wait for my antibodies to clear so my nerves can heal and restore function to my migratory motor complex in the small intestine I need to do something to keep the methane at bay.  I tried a 90 day protocol and that clearly didn't do much at all.  So what to do??  I don't want to dive into more killing so I may go back to the (possible) methane inhibitors.

Methane inhibitors
Red Yeast Rice - we know that Dr. Pimental is testing a lovastatin type drug to see if it inhibits methane production.  See here for information, scroll to bottom.  Red Yeast Rice does contain a natural form of lovastatin. I've used it in the past and was able to keep my methane numbers mostly in the single digits.  Once I got them to a certain level they wouldn't go lower but with Primary SIBO (aka the food poisoning induced autoimmune variety), getting the numbers down and maintaining them seems better than having them go up and down. And, it made goats fart less so why not us :) 

"At the genus level, the predominant archaea in the rumen of goats was Methanobrevibacter, 

which was significantly inhibited with the supplementation of red yeast rice. 

In conclusion, red yeast rice is a potential feed ingredient for mitigation of 

enteric methane emissions of goats." 
https://www.ncbi.nlm.nih.gov/pubmed/27467559

The link above is to a brand I used in the past. I might try a different brand this go 'round.

Ideal Bowel Support - this is a probiotic containing only 

Lactobacillus Plantarum which according to Chris Kresser can degrade methane.  I quite literally have a shelf of this stuff in my refrigerator.  Can't hurt!

Atrantil - This seemed so gimmicky when it first came out.  And there were so many "worked like a charm" and "didn't do squat" type comments on message boards that I really was skeptical. But I listened to Dr. Brown on a few recent podcasts and given my current situation (anti-vinculin antibodies negatively impacting motility) I thought I should at least try it.  It made me feel better, lighter.  I don't know how else to explain it.  I should say that I did use it after fasting so I was already feeling lighter and I do have most my digestive symptoms under control but wouldn't it be nice to be able to expand my diet without the usual repercussions. I think yes!  So I'm going to add it in while I focus on boosting motility and supporting healing.

Prokinetics
Cause if things aren't moving you are just generally screwed.  In hindsight I would have started taking these the second I learned I had SIBO.  Keeping things moving through the GI tract is the easiest way to prevent more overgrowth (in my opinion).  And note, not all of these are actual prokinetics, some have a more laxative effect, I realize that.  Slowing anywhere in the GI is just not good, makes you feel toxic, sluggish and ornery.
  
LDN - Low dose Naltrexone, although it really doesn't seem to actually have a prokinetic effect much if at all.  For those with Primary SIBO, LDE (low dose Erythromycin 50mg at bedtime) or Resolor (Prucalopride) seem to be the prescription of choice.  I don't tolerate Resolor because it has a teeny tiny amount of lactose.  Maybe you are luckier than I and tolerate dairy. Resolor is available through Canadian pharmacies.  I may ask for a script for LDE the next time I'm in office but I just hate the idea of more antibiotics even though it is a minidose. So for now I continue on LDN since it's beneficial for autoimmune issues.

Motilpro - Taken at bedtime, helps stimulate the cleansing waves of the small intestine at night.  In the beginning of my treatment it was recommended to take between breakfast and lunch as well but I don't really eat before lunch so I just wait until bedtime. Sometimes I take Ginger capsules in between breakfast and lunch.  The stuff is mega ginger burntastic so make sure to swallow it down with a LOT of water about a 1/2 hour before you actually go to bed.  

Vagal Tone - This shows some promise.  It was recommended by my ND but sadly I am reactive to the chamomile and it gives me a headache within seconds of application. Ugh! Similar to Iberogast in that you use it with meals and at bedtime, only it's external, apply a tiny dab on your occiput.

Magnesium - Most people recommend Magnesium citrate because it's not absorbed well into the system so does the trick. But it's acidic and can burn on the way out. Yikes!  Oxide is also not absorbed well and is not acidic, but I like a blend, that way your body can use some of the more absorbable forms and the rest can do it's job of pulling water into the colon and flushing the system.  I take it at dinner and bedtime so it can go to work in the evening and overnight.

Triphala - My new love.  LOL!  I used to swear this stuff did nothing but made me super constipated (and frustrated).  Turns out you just need to keep increasing to find your optimal dose.  I take 4 capsules at bedtime unless I've indulged and then I take a couple extra. Carbs and nuts do nothing but stop me up but oh how I love the taste of them!

I used Iberogast for a while but it started to not sit well.  It was the chamomile. Now the company has been sold to Bayer and is either being reformulated or completely taken off the market.  Either way pretty sad since I know it's used by many. I also try to use bitters before meals but got out of the habit and now forget a lot of the time.  These things can have a positive impact on motility as well.

Most of us have heard of the physical things we can do to stimulate the vagus nerve.  The vagus nerve stimulates the migratory motor complex so it's important that it's strong and active.  According to Dr. Kharrazian there is (vigorous) gargling, gagging and singing.  I also know from yoga that breathing stimulates the vagus nerve, most notably deep belly breaths followed by restricting and extending the exhale. It's your exhale that stimulate the parasympathic response. It's easiest to do this lying down.

Gut and Liver Support
Zinc Carnosine and L-Glutamine.  That's really all I have found that isn't mucilaginous and doesn't feeds the darned bugs.  I capsule up my own Glutamine because it's cheaper and I can avoid the fillers.  A lot of people drink it in water and it supposedly helps with sugar cravings, I just never liked doing it that way.  I recently added in a small dose of copper when I take extra zinc, apparently you are supposed to keep them balanced and not take zinc longterm on it's own.  Don't ask me where I read this, I cannot recall.

I always taking some sort of liver support because your liver takes the brunt of filtering whatever leaks through the intestinal wall.  If we are permeable and/or killing, your liver could use some assistance cleaning all that garbage out of the blood stream.  I've taken everything from plain Milk Thistle to ayurvedic formulas to herbal combinations.  I rotate formulas. 

Soil based probiotics remain my protocol (I would call it "my stack" but that seems really weird for some reason!).  I still take both PrescriptAssist and MegaSpore. I've done so much killing since my initial diagnosis that I feel it's necessary to support the microbiome in whatever way I can.  

Nerve Support
For those with Primary (autoimmune) SIBO, taking supplements that benefit nerve healing may be helpful.  It may not, who really knows.  I add Lion's Mane and Sunflower Lecithin to my hot chocolate and take Acetyl L-Carnitine in the morning. They talked about using Lion's Mane and Acetyl L-Carnitine at the SIBO Symposium a couple of years ago. 

The other thing I take that may or may not be of any help at all is Fibrenza.  My ND feels it may help remove antibodies in some way.  I have no idea how that would work but the idea of having something that scavenges the body seems good to me.



Please note - I do not make anything off these links I just included them for ease and examples.  All the links are products that I have used and companies I have purchased from.  Make your own decisions with your healthcare provider and buy from someone you trust.  Personally I don't like to buy supplements off Amazon unless I know it's coming straight from the company itself.  There are many rumors of counterfeit supplements out there.

Fasting vs. Elemental Diet

These are two very different things even though both involve no chewing.

Fasting is no calories, just water (and salt or trace minerals) for hours/days.  You can ease into fasting by drinking bone broth, which is what I tried but need to be somewhat careful as consuming too many calories can turn fasting into a low calorie diet of sorts.  Why does this matter?  When you fast, your body will burn through the energy stores in your liver in 2-3 days, with no other calorie options present it will turn to burning body fat for energy.  If/when you get into this magic zone, leptin, your hunger hormone decreases and your metabolism revs up because energy is required to convert body fat to energy.  That's the very, very simple way of explaining what I understand from listening to Jason Fung and reading The Complete Guide to Fasting.  If you are over 300 calories then your body will not switch into this magic zone, you will remain hungry and your metabolism will not rev up and go into body fat burning mode. It will just slow down because you are consuming both too many and not enough calories. This is the zone many dieters end up in after years of calorie counting, exercise and yo yo dieting.  According to the hosts of Fasting Talk this is also what happens to some people who only eat one meal a day.  Your body adapts to the low levels of calories and you do not lose weight.

The elemental diet on the other hand, if done correctly, keeps your calorie consumption up to your normal levels.  If you do the homemade version and keep the fats high and carbs low you will go into ketosis and much of the initial weight that comes off will be water.  It shouldn't slow your metabolism.  The problem comes in that many people with SIBO end up not digesting fat well so they rely more on carbs, which with the elemental means sugars. This is also the problem with many packaged elemental diet formulas, heavy on sugars and nutrients, not much fat.  Thankfully so far I am not one of these people, protein and carbs give me difficulty, fat not so much.  I sucked a tiny bit of honey out of my son's honey stick at the farmer's market today and have had a headache ever since.  I didn't used to be this sensitive but cutting sugars out has reduced my tolerance. It probably doesn't help that I seem to have some lingering insulin resistance issues as well.  Turns out my BS monitor is wildly inaccurate and needs to be replaced so I don't know this for sure.

Given that my body is not digesting well and I have a lot of lingering methane I am considering the homemade elemental.  First I need to finish eating the perishable food in the house that only I will eat, then I'll decide.

In a holding/healing pattern

Instead of being impulsive and diving right into the next killing spree since my small intestine is still overrun with methane, I'm trying a little patience.  Not my strong suit and if you've read any of my earlier posts you know I was more likely to go stronger, longer which has not been to my benefit.  I tried fasting, lasted two days, which makes sense since SIBO can have such a damaging effect on your ability to digest and assimilate.  So I was talking this through with my coach on Wednesday.  She's more of a business/lifestyle coach, not a health coach but she's so darned good at reading me and getting me to really think things through on my own that I broached the subject with her.  You tell me what to do and I'm likely to push back but lead me there and let me think it's my idea and I'm all in :) . Such is the way of my crazy brain!  

So, a year and a half ago after my last major "I'm going to rotate through ever last antimicrobial in the cupboard in a last ditch effort to get rid of every last archaea" episode, I gained 10 lbs, like BOOM!  This has annoyed the hell out of me for a multitude of reasons, one being I can't get my wedding band on, the other being I feel like a stuffed sausage in my clothes.  So while I say that I want to fast to let my digestion rest what I really want to do is lose these stubborn 10 lbs.  So this was the conversation with my coach, am I really fasting for the right reasons??  Maybe I just need to read The Complete Guide to Fasting again, I said.  She responded, stop reading, you are just giving yourself analysis paralysis, what does your body tell you?  I started to respond again from the head.  No, she said, take some time, lay on the floor, hand on heart and belly and really listen.  I don't have to.  My body is soooo hungry for nutrition, which means fasting will continue to be torture and I should really contemplate elemental if I do in fact want to give my digestion a rest.

I have a bag of the Integrative Therapeutics Physicians Elemental Diet but it's so sugary (dextrose and tapioca maltodextrin are the first two ingredients) that I am too chicken to try it.  I'm afraid it's just going to make me itch like crazy since I react so easily to sugars.  Not to mention that I would have to take antifungals as it can feed yeast overgrowth bigtime.  I'm sensitive to both potato and tapioca so there's that too.  I believe the dextrose is from potato since the formula is corn and wheat free. Those are the major sources of dextrose (potato, corn, wheat).  So back to contemplating the homemade elemental....  so nasty.  Still not sure that I want to go that route but really feel like my body could use the love.  In the meantime I'm stuffing my face with mexican food and contemplating beer :P.

Knock, knock?

Is anyone still out there??  

So, yes, it's been forever.  I felt pretty good for about a year, working on motility, gut healing and rebuilding my gut microbiome.  Then the election happened and I won't get political but I just tanked from all the stress.  First, my thyroid took a nose dive and I started pushing into Reverse T3.  Worked to get that sorted out, eventually just throwing in the towel and switching from NDT (natural dessicated thyroid) back to Cytomel.  The muscle cramping didn't go away and the itching came back, which are my body's major SIBO signs.  I'm on so many prokinetics that I have the digestion stuff down so it's the only way my body can cry wolf. On New Year's Day I broke down and did a breath test.  Hello Methane!  

Baseline was so much higher than it's ever been.  Super discouraging and I knew I had to know for sure.  Was my IBS due to the two bouts of food poisoning I had in 2010??  I printed out the lab requisition for the IBSChek and presented it to my ND.  Results came back positive on both measures meaning yes, I have had food poisoning and yes, this SIBO is autoimmune in nature.  Even though the events were nearly 7 years ago I still have antibodies well over the cutoff.  Drat!

We know that when SIBO is autoimmune there's not a heck of a lot you can do until the antibodies clear but I added Lion's Mane and Acetyl L-Carnitine back in to support nerve regeneration.

I opted to do Chris Kresser's SIBO protocol because I've tried many of the others.  90 days of GI-Synergy, biofilm disruptors (lauricidin and Interfase plus), probiotics (Megaspore, PrescriptAssist and Ideal Bowel Support) and hydrolyzed guar gum.

Retest last week...

A big ole...  let down.  Are things better?  Yes!  Have my symptoms reduced?  Yes!  Did I expect more from 90 days of protocol?  Hell YES!

So for now I'm trying Atrantil as I hear for some it can really help with methane.  I'm also playing around with fasting.  Not elemental diet, plain old broth only fasting a couple of days here and there.  I feel pretty darn good.  I have a bag of the ITI ED (Integrative Therapeutics Elemental Diet) sitting in my cupboard but I've heard so many stories of "now I have SIFO" or "now I have a horrible yeast problem and it's worse than SIBO", that I'm seriously scared of the stuff.  I do not tolerate carbs or sugars very well at all so there's that too.  Not sure I could stomach going the homemade elemental diet again and that seems to be the only way you can control the amount of carbs.

Oh and can I just say Biohealth rocks for breath testing - Quintron machine, 3 hr lactulose, I did my test on Monday and had the results by Thursday morning.  I NEVER have to go through NCNM/NUNM again.  Woot! Woot!

Holy Histamines

That's getting a little carried away, but I've never noticed a problems with histamines until recently.  I guess my spinach bread with turkey breast lunch meat and cashew cheeze is a bit heavy on the histamines and I itch after I eat it.  It's so good though.  Guess I'm going to have to do a little research and figure out how to keep my histamines low for a while as I imagine constantly triggering a histamine response doesn't help with gut healing.  Boo!  I've been making Pesto spinach wraps in the dehydrator and it was so fun to be able to eat a sandwich type thing again.  Back to the drawing board!

Stress is such a bugger!

We all like to pretend that stress doesn't matter.  We like to think we are handling it or that we are not stressed.  My husband purchased me the Inner Balance gadget for Christmas with a lovely meditation pillow. Inner Balance is a cord (with an app, of course!) that you plug it into your "i" device, in my case my iPad, and clip it onto your ear.  The sensor on your ear measures your heart rate variability as a way to determine your level of stress and help you learn how to train your mind to bring your heart rate variability to a less stressful pace. There is a lot of science around it, books, etc. none of which I was interested in enough to read.

The first few uses over Christmas break I was easily able to keep it in the green (meaning good heart rate variability, low stress and their term "coherence").  Fast forward a couple of months and I have increase to level 2 and am trying to do around 10 minutes of my HeartMath every day.  Some days, more often than not, it's HARD to get into and stay in coherence.  Dang!  I thought with all my yoga and everything that I was so chill. Apparently not :(  It's amazing how I can be sitting there doing great, in the green, and my mind just wanders to something I have to do or don't want to do and boom! I immediately go into the red.  Then you have to focus again on breath, gratitude, heart thoughts, working your way through blue back to green only to wander and go back to red.  Wow!  It's so much more relaxing to be unplugged and not know :)

I've found when I eat in a rush or under any stress my food just sits in a giant lump in my stomach and doesn't want to go anyway.  I get a little reflux even sometimes.  If it happens to be dinner when this goes down then the next morning can be rough.  So, even though Dr. Pimental has done research that shows that stress alone does not cause SIBO, it can definitely contribute to your symptoms and inhibit your ability to digest.  And remember that the stress hormone cortisol is catabolic, meaning it breaks things down, definitely not helpful for healing!

Dr. Ruscio and Dr. Siebecker podcast

Discussing SIBO treatment - diet, prebiotics, probiotics, etc.

Contemplating Digestive Enzymes

And came across this article. Seems like a good basic description. For me I'm most interested in breaking down protein since I know I have difficulty there and with vegetable fibers since I have a hard time chewing them completely. Still on the hunt for what, I can't honestly say I've noticed a difference with any of them, except ox bile.  I'm currently using OrthoMolecular Products DigestzymeV. It's fairly comprehensive but expensive, especially if the whole family is taking it.

I heard Mike Mutzel say recently that you should avoid DPP-IV in your routine digestive enzyme because it doesn't something bad in your gut.  Of course I can't remember what he said exactly or whether it was on his podcast or in one of the online summits he's been involved in.  The only enzyme I've seen it in are those targeted to gluten/dairy specific digestion.

I've also recently heard that you shouldn't take a digestive enzyme with Cellulase in it because this is not an enzyme that humans actually have (ruminant animals like cows do). I have yet to come across a comprehensive enzyme that doesn't have it.

Two new podcasts I'm listening to:
Gut Guardians
Nourish Balance Thrive

Such a viscous cycle...

I've been exhausted and pretty miserable.  My thyroid tests came back and while my TPO antibodies have dropped to the low 100's, my hormones still remain on the low side of the lab's range of normal.  It's frustrating because I look at them from a Functional Medicine ideal standpoint and my ARNP looks at the lab norms.  I think if it were just my thyroid I wouldn't be in such rough shape but since it's the whole thyroid-adrenal-gut thing it's been tough.  Freezing (low body temp), hair falling out, exhausted, not feeling rested, water retention, weight gain, loads of freaking fun, just ask my husband.  Thankfully my motility seems to be staying out of the game although I am still doing Iberogast before each meal, ginger between breakfast and lunch and again at bedtime and Vit C and Magnesium with every meal.  Vit C is supportive to the adrenals and my body just doesn't seem to ever get enough magnesium.  I'm trying to do ConcenTrace Minerals in water when I can remember but they are gross :)  I am great at remembering pills because I can organize those in individual containers.  The tinctures not so much, even though they are right next to where I hang out the most.

Update:
My ARNP finally called in a prescription for T3 2.5mcg in the morning and at bedtime.  I wanted to try a T3/T4 combo since my T4 is borderline low but there just don't seem to be many good options out there and she wouldn't prescribe.  So I did what I always do and went rouge.  I went back through all my notes and found that you can get one product that may be beneficial without a doctor and that is Thyro-Gold.  The ND of my nutrition program had recommended it but didn't clue me in that it was not prescription.  I went ahead and ordered a bottle since I had instructions on how to take it and I wasn't sure 2.5mcg BID was going to cut it (I was on 15 mcg BID before I stopped meds and crashed).  I have to say I have felt a bit better this week (after starting meds on Monday), but not stellar and I am still really tired.  The Thyro-Gold just arrived so I think I may start it tonight in place of the nightly T3 and see how it goes.  I react poorly to Adrenal glandulars (they make me beyond exhausted) so I may have to contact the ARNP to increase the dose if I react to thyroid glandular as well.  It's a bit tricky given that sometimes the antibodies can get riled up when you add in more thyroid gland.  We'll see.

This week I've been reading:
The Prime - which I love and find really fascinating.  It's written by a neurologist who is also trained in Ayurveda so she uses lots of herbs for healing and health.
Why Do I Still Have Thyroid Symptoms and Root Cause - just gathering information on how to best support my body and what my options are.  It's good to be educated!
Thank goodness I have so many great libraries in such close proximity to my house.  I can't imagine the cost of buying all the books I want to flip through and then where the heck would I store them?!?!?

testing, testing

H. Pylori retest came back negative today.  So happy for that.  I dreaded another round of treatment so it's nice to hear it's gone and I can move on.

I saw my primary care provider today to review thyroid labs from late November.  Since going off my T3 supplement I have been slowly crashing.  My antibodies were in the mid 200's (likely due to the H. Pylori) so she wants to do a retest to see where my hormone levels and antibodies are now. It would be nice if everything came back stellar but I know I need a little supplementation in the form of hormones to boost me back up and support motility and healing.  Results should be back in a couple of days.

SIBOwise things have been pretty calm.  I'm sure there are some little bugs in there but they seem to be held at bay for the moment.  

My ARNP kind of scolded me for not keeping up on the bone broth.  I made excuses but I know better so I came home and put some stew meat and marrow bones in the hot pot and started a batch of soup.  It's much easier on digestion and I need to keep that in mind.  I'd much rather sit with a jar of nuts, kale chips and chocolate :)

If you haven't been watching/listening to the Fat Summit you may want to check it out.  It's been pretty good so far.

Self Sabotage

I was thinking about self sabotage this morning as it's been a topic bounced around a bit. As I drove I started thinking about what I would say.  When I got home and popped open my email I discovered a blog post by Petra8Paleo on the subject and Sean Croxton's new podcast The Sessions which cover it, both far more eloquently than I ever could.  

Off to do my HeartMath.

A post to read

One of the best thing to come out of my struggle with SIBO is my friendship with this guy.  Here he outlines his treatments and the protocols used by all the major players. Thank you!

Stuck in a rut

I am in a big time rut.  Not sure which way I want to go.  My bloating is pretty minimal although I felt really bloated after drinking hot water yesterday morning, go figure.  My food is in a rut, my routine is in a rut, all in kind of a negative way.  I'm feeling the need to branch out but that takes decisions and I'm really sick and tired of making decisions :)  Remember the good ole days when you bought what was available, did what the doctor (or neighbor) told you and just spent a lot of time hanging out.  That's how my family was anyway. Everything is so pressured these days, so much information, options, responsibilites, worries.  Maybe it's just because I'm a grown up, but I remember my mom doing lots of crafts, having coffee and game nights with friends, doing things for pleasure.

So I've been working on rebuilding and reseeding my gut, taking tons of probiotics (ColonCare, OrthoBiotic, Primal Defense, MegaSpore and PrescriptAssist), sometimes all in one day at different times but generally I rotate.  The links are not necessarily the best prices or best places to buy just links from either stores I use or places that I have seen that carry hard to find products. I am not affiliated with any or them nor has anyone advised me to use these products.  In other words proceed at your own risk.  

I put my uBiome results through a program to create a uBiome tree and then consulted with Dr. Grace Liu.  She seems to be the one on the cutting edge of the microbiome, talking a lot on her podcast about different bacterial families and their impact on gut health, but it seems that she bases a lot of her information from animal studies since not many human ones have been done yet.  That said, she is wicked smart and all over the paleo community these days.  (Dr. Ruscio encourages caution here and doesn't believe the microbiome is clinically useful at this point.)  I was hoping that she was going to say I was ready for adding in some fibers and feeding my little critters but she said, "you are not ready".  Now if the one person out there who is pushing people to feed their microbiome tells you no, you have to listen. She feels I need to get my adrenals and thyroid better supported, build my good flora and then I can move forward.  After our call she emailed me two pages of information and recommendations.  Well worth the money spent, in my opinion.

She also brought up an interesting point that I think we may start hearing more of, hidden viruses and pathogenic bacteria.  She claimed that strep can hide out in the gut and "induce autoantibodies".  She said that a couple of the probiotics above contain streptococcus but I couldn't find it on the label and have emailed the companies to clarify.  I could find information online that they used to but nothing to indicate they still do (in my quick search).

So I've been looking into a couple of different diets protocols as well in an attempt to shake things up.  I hate counting anything which is why I hang out where I am but really need to expand my horizons a bit.  I'm also still hanging onto an extra 8 pounds that I have put on since August.  While I am not overweight, I just don't feel myself and I haven't been keeping up my usual activity level so I am feeling really out of shape.  I've started ZGym (the bunny slope workouts).  She eats like a rabbit which is why she is so thin :)  I looked at her food log.  Anyway so I purchased the AltShift book and the Fast Tract App (already have the book).  The former seems real meat heavy and the latter just too much counting.  I've been playing around with adding carbs but I really turn into a carb monster and then overdo it.  I wonder what my blood sugar is doing???

So, been doing a lot of questioning, a little bit of experimenting, some grumbling and wallowing :)  

Merry... err... Happy Holidays

Sorry I haven't been posting much.  Lots of experimentation, questioning and thinking.

I'm feeling pretty darn good.  The only SIBOesque symptom I have on a regular basis is bloating, although that could be related to the permeability that's still lingering or the H. Pylori (if that's still there) or my inability to digest protein well coupled with my lack of digestive support due to H. Pylori protocol.  I've had constipation a few times in the last month but not horrible.

Feeling much better after working on the adrenals.  I have been using the adrenal glandulars, DHEA and licorice root.  I've worked up to one drop (1.2mg) of DHEA with breakfast and one drop with lunch.  That was ROUGH.  For the first 3-4 days I was sooooo irritable, angry and just climbing out of my skin.  I don't know how bodybuilders ever survive actual hardcore steriods.  Phew!  If you recall my ND recommended I work up to 3 drops, 3 times a day and honestly I don't know that that kind of dose is warranted.  Less is more!  I've been using a couple of drops of licorice with lunch to help extend my cortisol since afternoons are my biggest drop in energy.  I have not added in the Pregnenolone yet.

I ordered some mushrooms from Four Sigma Foods after listening to this podcast from Ben Greenfield.  He can be a little out there but I believe he is smart and does his research on things that he himself uses.  Like me he is also interested in a lot of self experimentation.  So while mushrooms themselves are a big NO NO for SIBO I decided I'd give them a whirl since they can be so supportive of the other issues I am dealing with (thyroid, adrenal).  And my husband LOVES mushrooms so if I don't like them I'm sure he will.  I ordered the Lion's Mane, Reishi, Cordyceps and Chaga bundle since they were on sale plus there was a coupon for an additional 15%.  It's still listed on their site but I'm not sure it's still active.  I wanted to try the hot chocolate blends but they have nightshades and I'm avoiding those for now.

After finishing the digestion portion of my nutrition certification class and learning a lot about the structure of the intestinal lining I decided to try coconut elimination for a while.  I cannot put coconut on my skin or lips without them getting super chapped.  It takes about 3 days and then the skin feels like it's going to be peel from my body.  It's weird.  The intestinal lining is made of epithelial cells, obviously different from the skin, but seemingly a lot more delicate.  As I've restricted my diet more and more I've added in more coconut oil and more coconut milk.  Given the response of my skin I thought it would be good to take a break and see what happens.  Oh and I was negative on the Array 10 which is part of why I kept ignoring my external reaction.

After listening to Dr. Keller on the Phoenix Helix podcast and her extreme caution about probiotics I cut back on them for a while.  I don't know why.  I was a patient of hers and didn't find her methods super effective.  It only took a few days for me to realize I feel so much better when I take a ton of various probiotics.  I resisted listening to the podcast for a long time and now I know why.  Of course Dr. Ruscio came out with his own video and said if you tolerate things there is no reason to get rid of them.  That speaks to me a lot more than possible unnecessary restriction.

I got my UBiome results back.  I haven't had a time to really dive into them but I can tell you the reporting is so much faster and more detailed and easier to understand than The American Gut Project that I did before.  And UBiome often runs smoking deals where you can get 3 kits and run time lapse self experiments on your gut biome to see how much of an impact your treatment or diet or exercise or whatever impacts your bacteria.  Fascinating!

I hope everyone enjoys their holiday season whatever they celebrate!  Remember to take time to take care of yourself.  You deserve it!

Current Protocol

Adrenals:

• Adrenal Glandular - 100mg breakfast and lunch
• Licorice Root - a few drops with lunch (helps extend life of cortisol)
• Cordycepts - one tablet with breakfast
• DHEA sublingual - up to 4 drops with meals (haven't added this yet)
•  Pregnenolone sublingual - up to 4 drops with meals (haven't added this yet)

Thyroid

• Zinc - breakfast and dinner
• Wobenzyme-N - 5-10 caps, 3 times a day on an empty stomach.  WOW!  Just looked through my notes and found that.  Wonder if she meant 5-10 separated into 3 doses or up to 30 a day!  That's a ton of pills!

SIBO/Gut Support

• Digestive enzymes with meals
• Lion's Mane at bedtime*
• Acetyl L-Carnitine at bedtime*
• L-Glutamine between meals and at bedtime
• Zinc L-Carnosine between meals and at bedtime
• Iberogast before meals
• Megaspore - 2 caps with lunch
• Orthobiotic/PrescriptAssist/Primal Defense (rotating) - between meals

H. Pylori

• Mastic Gum - 2 caps with meals
• NAC - 1 cap with meals
• Biocidin - before meals (both kills and provides biofilm disruption, contemplating switching to Interfase Plus and Allimax)

*Lion's mane and Acetyl L-Carnitine are thought to help with nerve regeneration in the small intestine.  Even though I've had lifelong motility issues I don't recall having the bloating or other issues until after the two food poisoning incidents 6 years ago.  I'm running off the assumption that they were the tipping point.  Although to be honest I don't remember a heck off a lot about my health from the first couple of years of my son's life.  My adrenals just tanked after my pregnancy and it's all a blur.

Has it really been that long...

I would blame it on the holidays but I really don't get all up in arms about it.  We don't make many obligations and we don't buy gifts.  What did happen is I got a whopper of a cold from my son just after Thanksgiving.  I even ended up taking Mucinex D several days.  For him it landed in his chest for me it socked into my sinuses.  I really didn't feel that bad but ended up draining out a lot of bloody mucus and my massage therapist said my sinuses felt really puffy.  The draining was almost worse than when it was stuck.

Oh and I had another screw put in my jaw just as I was getting sick. That helped a lot!  And another screw came out yesterday (meaning I took it out).  They wanted to cut my gums and screw into my cheekbone but I said no. (Um, no way in hell!).  It makes sense to pull on the jaw if you are trying to intrude the teeth but to pull on the cheekbone to push up into the jaw just seems like you are asking for trouble.  

I finally finished up my Matula tea treatment for the H. Pylori.  I have another month of the biofilm buster (biocidin), Mastic gum and licorice root and then I retest.  I can't wait to be able to take Betaine and/or Ox Bile again.  I just feel like I am not breaking things down and my digestion feels more sluggish.  I do not like it.

I've been taking adrenal glandular support and licorice root when I remember to help prolong the life of the cortisol circulating.  I need to add in DHEA and Pregnenolone although I am toying with adding Cordycepts first.  My mentor is against this, she feels that formulas provide a better synergistic effect.  

I went over my thyroid tests with the ND on Monday and my thyroid hormones were borderline so no need to supplement, Yay!  But my TPO antibodies were in the high 200's. She thinks it's due to the H. Pylori treatment.  I'm hoping so!  She recommended Wobenzyme-N to help bring the antibodies down by reducing inflammation.  I've heard great things about proteolytic enzymes.  Livestrong calls bullshit on them but they help the body break down protein so if I don't feel like they are having a benefit outside of meals I can take them with meals since I can't break down protein completely by myself.

Oh and no more itching!  Ha!  Stupid ass lactase!  In light of the Hashimoto's confirmation it's back to LDN.

Damn Dairy

I cut out the Resolor (lactose) a couple of nights ago and the itching has all but gone away. The little bit of residual itchiness is just due to dry winter skin something I've always dealt with.  As much as I really want to incorporate dairy in my life it's just not going to work.  I think I can probably handle ghee on occasion without consequence but clearly daily consumption is just out.  My Cyrex testing all came back completely negative for dairy but I hadn't eaten it for 4 years prior to testing.  However, there were some foods that came back positive on the Cyrex testing that I have never, ever eaten.  Quite interesting.

Energywise I am hanging in there.  I ran out of thyroid hormone a few days ago.  I will get the results of my thyroid testing back in the week and meet with Dr. Pomeroy to go over results.  My new adrenal supplements will be here tomorrow so I will add glandular support this week. 

I'll post my updated supplements in the coming week for anyone who is interested.

Let the negotiations begin..

The last couple of days I have been reading through Aglaee Jacob's book.  I had dismissed it for one reason or the other the last several times I checked it out from the library.  I guess desperation has finally set it.  I was interested enough in the copy I checked out that I purchased it on Amazon, it was only $5.99 on Kindle (they always sucker me in!).  Her elimination phase diet consists of protein, fat and vegetables, specifically zucchini (peeled and seeded), carrots, green beans and spinach.  Wednesday night I was all in.  Today having not even started the diet, I'm already negotiating.  "I didn't react positive to kale (or broccoli or bell peppers) on my Array 10, surely I can eat those", my brain argues.  It's been a good day with minimal itching so that doesn't help strengthen my resolve :)  I didn't really start itching until I took my Resolor.  Could be just a mind thing since I know it has lactose. I'm going to see if I have any refills on my LDN script, switch to that, see if I calm down a bit.

Dr. Ruscio released another SIBO podcast this week.  


Hope everyone had a wonderful Thanksgiving.

I eat dead food...

according to Ayurveda, the sister science to yoga.  Ayruveda says food should be prepared fresh and eaten right away. Leftovers, items that have been frozen or canned are apparently dead and do not feed the body.  I can only seem to chew veggies if I cook the bejeezus out of them so I'm sure there is not much nutrition left to them at all.  Is it worth eating them at all??  A friend posted this on her fb group a while back but I promptly ignored it.  There's   I'm eating too much, not taking my time and chewing enough (hard with all the orthodontia) and just feeling overly full most of the day.  I am off all ox bile and HCL while I treat the H. Pylori and that's not helping at all.  I read today that the itch can come from H. Pylori (my friend always suggests histamines, which I DO NOT want to hear!).  I'm banking on the pylori (and lactase) for now since it's primarily after meals and all freaking night after my Resolor. Need to do something about that.

And I was reminded of this today which has a lot of similarities but with actual science behind it.

As I mentioned before if I eat the same thing every day my digestion stays spot on but I am really feeling the need to shake up my diet.  I feel swollen and kind of gross.  I'm eating waaaaaay too much chocolate.  I keep threatening elemental (which would not be good for my adrenals or thyroid) or just scrapping the whole lot which wouldn't been good for my SIBO.  I need to come up with a reasonable middle ground.  I just can't imagine not reaching for my frozen jars of (dead) soup.  I did drag out the dehydrator today and dehydrated some kale.  I pulled out a raw bread recipe book in hopes of making some raw wraps out of greens and herbs.  We'll see how well I tolerate them.  I really don't want to pull out my juicer, it's just a beast and I hate cleaning it.

I do know I need to make the time to do my daily yoga practice, meditate 12 minutes a day (that's the minimum necessary for positive brain benefits) and take time to read.

Alright, enough bitching and moaning for now :)  Everyone have a Happy Thanksgiving!