Almost there

Back to my diet, back to my walks, back to yoga, back to probiotics.  I'm almost back to normal. I keep forgetting to drink my probiotic tonic shots with breakfast and lunch but I put my pill form probiotics in with my meal supplements so I know I am getting those in.  I am taking Ortho Biotic with breakfast and PrescriptAssist with lunch.  I'll definitely be packing them on our trip next week (more camping, more mountain biking, a water park and a dude ranch).  When I get back I'll rotate them out and add Primal Defense back in.  I think it's good to switch things up.  I need to place another order for MegaSpore Biotic since that one seems to take the longest to get.  I'm also slowing tapering off my current kill protocol as I run out of supplements.  I'll keep just keep on with the biofilm and cell wall disrupters.

Oh, and I'm tapering off my thyroid medication and then I'll test my thyroid to see how it's holding up.  Hopefully my conversion from T4 to T3 has improved with the addition of Thyrosol (a Metagenics product specifically designed for supporting conversion).

Vacation recovery time

The bugs in me still love the carbs.  I have been trying to get my digestion back on track the last couple of days since returning from vacation and it's just a struggle.  I'm bloated, constipated and annoyed.  I have a love/hate relationship with vacations.  I find them fun but incredibly stressful (to be honest this was probably the most stress filled vacation I have ever been on).  

We were in Whistler and stayed in a condo with a full refrigerator and kitchen.  I packed a ton of food - ground meat, offal muffins, chicken thighs, veggie soup, stir fry veggies, coconut milk, etc.  I ate my usual breakfast of an offal muffin, veggie soup and hot chocolate.  I was doing several hours of yoga workshops/classes for 5 days (Wanderlust) so I would eat nut butter and drink tea at lunchtime, do more yoga and then come home for a dinner of curried veggies and chicken.  My digestion was holding it's own.  Same rigid diet on the same schedule I had been eating at home.

Wanderlust went away and I went back to eating 3 meals a day.  We were doing a lot of biking, hanging out at the lake, having more relaxing days.  I started nibbling on potato chips here and there with meals and ate french fries one day when we went out to dinner with friends.  I drank a glass of wine one night too close to bedtime and ended up a bloated, nauseuos, painful mess in the middle of the night. We packed up and moved into a yurt and everything just trickled to a halt. Bristol scale - 1. I'm not complaining, I thank my lucky stars that things are moving.  I have to admit I am a little envious of the people who easily clear this or move on with life, asymptomatic even though they still have some infection.  For some of us, it's just not that easy, we blink and things just fall apart.  

Came home Monday night and I treated myself to a hot chocolate after nearly 8 hours on the road home.  Again, too close to bedtime and I ended up awake half the night, bloated and nauseous.  Arg!  Oh, and I'm still actively treating (red yeast rice with garlic, oreganol, Biocidin, Olivirex, etc, etc) so what the heck!  Shouldn't all these antimicrobials be taking care of business!  

I started in with this.  Aromatic spice formula, ha!  It feels like squirting fire up your nose.  I have always had sinus issues so I wonder about an overgrowth of commensal bacteria.  I'm too lazy to schedule an appt to get my sinuses cultured (I have an appt in late September) so I thought I'd see if the SinuOrega would make a difference with my symptoms. 

Things I would have changed:

• Taken my probiotics with me and LOADED up.  I took my probiotic tonic but that was not enough.
• Stayed away from the carbs! Knowing that my system was already taxed from stress I should have stayed away from the carbs!  I tolerate them okay when life is easy and good but clearly not otherwise.
• Been a little better prepared before leaving and not overpacked on everything.  This creates more stress because things start thawing and produce starts spoiling.
• Communicate better with my family so we all are on the same page before splitting up or making plans.  To be honest, much of the time it felt like we were on someone else's vacation.  We didn't do enough of the things that we love doing.
• Sometimes you just have to embrace "the hippy shit" as my husband's friend Amy calls it.  My family was doing yoga together and it turned into a big circle lovefest and we ran.  We should have just gone with it, but in all honesty I kinda wanted to go meditate.

I have a week to get my shit together before we pack up and head to Idaho.  Will definitely be better prepared and do things differently.

I think I'm almost there....

Was it the Red Rice Yeast or the addition of a crapton of probiotics??? I'm not sure but my guess is it's a combination of both.  I have been taking Red Rice Yeast with the herbal biotics (Biocidin, Oliverix, garlic in some form and for 10 days oreganol) before every meal. I drink the juice from sauerkraut with breakfast, just a shot.  Between breakfast and lunch I am taking 1/3 tsp of Garden of Life Primal Defense in water (blech!).  I am taking a soil based probiotic (PrescriptAssist) or MegaSpore Biotic with lunch.  Then I lay off because in my experience if I do any probiotics after dinner I generally wake up in the middle of the night bloated.

I'm also being really good about not eating anything that I could be sensitive too which is really hard since we traveled over the weekend.  Does this mean my inflammation is down too?? Hopefully yes and it definitely seems so.

My gut has been happy.  My kid and I stopped at the Alberta cart Cultured Caveman in Portland, OR last weekend and there were 3 other food carts there that were either vegan or paleo, which means no dairy.  I'm pretty sure all the trucks were gluten free as well.  We ate like piggies - chicken strips, ice cream, donuts (2 orders), and a fudge bar. Not the healthiest but oh well.  The ice cream was strawberry-banana and the fruit chunks were a little big for his liking so I ate it. Bananas!  I ate banana with no reaction.  Everything did hit my stomach like a brick but I ate a ton of heavy, fatty food so that's reasonable :)  I have been eating cashew cheese too.  I was missing my cheezy kale chips.  No more.  And french fries!  Too many french fries over the weekend :)

My hormones have not been so good.  I had a lot of stress last week, PMS through the roof and my body temperatures have plummeted.  I know it will resolve as my gut heals but it's hard to ride the wave sometimes while waiting. I went online to schedule a follow up with Dr. Keller but she has increased her prices to $250 for 30 minutes of skype so that's just not going to happen.  AND, the new policy is you can't get breath test results without a consult with her.  In the past I was able to order tests and get results whenever I want.  Ah well, I have a local ND and I can get the tests through him, it's just more annoying because he travels and teaches a lot.  Anyway, I searched online and found both thyroid and adrenal support that is similar to what I was taking.

This webinar does really good at explaining how your gut can mess up your thyroid, adrenals, etc. etc.  I know nothing about the program and am not recommending you buy it but I did think the information was worth watching.  The link will expire on Monday, July 20th.

Next up.... adding in Lion's Mane (which seems to be on sale everywhere right now, which I took as a sign :) to help support rebuilding the nerves in the gut.

Then maybe in a few months I can start adding in resistant starch.  YIKES!

Mixing It Up - Adding to the Current Protocol

I'm really kicking it up a notch with the probiotics.

After breakfast I added in 1/3 tsp of Primal Defense HSO Probiotic Formula, it's supposed to be taken on an empty stomach.  It is hard to get down, like drinking gritty, dirty water.  With lunch I am still taking the somewhat controversial MegaSpore Biotic and added in Lactoprime Plus. I've had the Lactoprime a while and I really don't think it's live anymore. I tried to make yogurt out of it and it did nothing so I figured might as well use it up.  I'm trying to drink my Probiotic Tonic from the Classic Kraut with breakfast and lunch, but I don't enjoy it nearly as much as the tonic from the Firefly Kimchi (yum!).  Alas, the Firefly Kimchi drink has spicy peppers in it and they came up positive on the Array 10 so I'm trying to be good and refrain (although the rice, beans and carne asada from the taco truck today was quite spicy ;).  Just drawing the bugs out so I can kill them.  I do this on occasion.  If I had it to do all over again I'm not sure I would have restricted my diet until the bugs were gone.  I can't be sure, but I wonder if the whole SIBO diet just slowed the killing.

It's fascinating because the M. Smithii archaea are a mechanism for retaining energy (calories).  Research has shown that the archaea is very common in starving populations like anorexics and in Sub-saharn Africa.  Makes me wonder if starving the buggers with diet and even the elemental diet does a bit of good.  They seem to be quite unstarvable!  Which leads to how to get through their biofilm and get them.

After listening to Dr. Ruscio's wrap up of the SIBO Symposium I decided to add in Red Rice 
Yeast. He said that statins appear to inhibit their cell wall formation. I picked up a blend from Solaray Garlicare with Red Rice Yeast.  This yeast is a natural statin. I'm going to try this blend while I do more research since it's inexpensive.  Hoping I don't react to the garlic but if anything it will draw the archaea and bacteria out while I pummel it with Biocidin, Olivirex, and the newly added Oreganol (which should arrive tomorrow).  My stomach has stopped bloating in the middle of the night so I figured it's time to stir things up. Ha!

So about 1/2 hour before meals I am now doing:

• Biocidin 20 drops
• Oliverix - 2 capsules
• Serrapeptase - 2 capsules (I won't be buying this again).
• Alli-C - 2 capsules (almost out)
• Garlicare - 1-2 capsules*
• Oreganol - 1-2 capsules*
• Iberogast - approx 40 drops
• Bitters - 1/2 -1 tsp (depending on how heavy my protein is going to be)

* I'll likely start with one capsule and work up to two.

If you haven't checked this cookbook out yet, do it!  I picked it up from the library today and it looks AMAZING.  It seems like a lot of the recipe's can easily be modified to be low FODMAP.

Oh, and my son's ND gave him some RepairVite-SE and I have been taking a bit of it but I think the luo han guo fruit extract may have made me bloaty yesterday.  I can't think of anything else it could have been.  RepairVite-SE is pretty much the same as Endozin except way more potent and with some digestive enzymes.

I've slept more this past week than I have in ages and I'm finally feeling rested (another reason to turn the heat up!).  I'm also doing better with hydration since I started squeezing in a lime and an orange into my quart of water.  That is probably helping with the feeling of exhaustion as well. 

Enough for now!  I'll let you know in a couple of days how things are going.  Could get exciting :)  Have a fun and safe 4th of July!  I don't know about where you live but it's dry as can be around here in Washington.  No real rain in months!

Another great perspective from the SIBO Symposium

From my friend, Tim.

http://www.dharmaworks.net/Tim/sibo-symposium-recap/

My notes from SIBO Symposium

I should preface this by saying that on Thursday I received my son's results for the Cyrex Array 3 & 4.  Turns out he was off the charts sensitive to both wheat (interestingly enough the lectins way more than the gluten) and dairy (casein but not whey).  My family loves their bread products and dairy products and they are a staple in our home (I don't eat them of course due to SIBO and dairy sensitivity).  We talked on Thursday evening and Friday morning after they guys left I cleaned all the dairy and wheat out of the house, jumped in the shower and left for the symposium.  Needless to say all this was heavy on my mind during the weekend since I didn't know what the results actually meant in terms of autoimmunity. Our ND can't see us until July.  Thankfully I ran into the Cyrex Rep at the Symposium and she talked me through the results.  Not specific to him or diagnostic but what each value measures, translates to (eg - wheat germ agglutanin is a lectin), and how symptoms may manifest in the body for people.  After talking with her I was able to breathe because I think that Celiacs and IBD are likely off the table. Phew!

Dr. Pimental spoke first about the Underlying Causes of SIBO.  He has teamed up with the military to study IBS because the majority of soldiers get food poisoning on deployment, as if they don't have enough stress!!!  In these studies they have found that 10% of soldiers returning have IBS from one deployment. You can imagine the rates for soldiers going through multiple deployments! They ruled out stress as a cause by asking question such as - did you fire a weapon, did you shoot another human, were you injured, etc. Through these studies he has determined that IBS is not caused by stress (and therefore is NOT all in your head).  His belief is that the majority of SIBO is caused by food poisoning.  Based on a study, 60%+ cases of IBS are caused by SIBO.  They determined this using both duodenal sample and the breath test.  This number is likely low because if the breath test was positive and the sample negative they said negative for SIBO.  Dr. Pimental mentioned that the duodenum is just a small sample of the upper small intestine and often the bacteria is lower down so this percentage is likely low.

Dr. Pimental has done A LOT of work looking at how food poisoning causes SIBO.  He found that when you get food poisoning often from Campylobacter Jejuni, E. Coli, Salmonella or Shigella they can all cause SIBO.  The bacteria produce CDT (Cytolethal Distending Toxin).  The toxin attaches to the wall of the small intestine and the our immune system creates antibodies (Anti-CdtB and Anti-Vinculin), these antibodies go to attack the CDT and in the process destroy the vinculin which in turn damages the Interstitial Cells of Cajal (ICC).  These ICC cells are responsible for motility.  Dr. Pimental found that if you remove CDT from bacteria before injecting it into the mice they still got gastroenteritis but did not get lasting intestinal damage or SIBO.  This is where Dr. Pimental's new test comes in that measures these antibodies. It's his first step in finding a way to cure SIBO. These antibodies - cause SIBO, the greater the antibody the greater the SIBO so can predict treatment length and if we measure antibodies perhaps we can learn how to decrease them and heal the ICC/motility.  Dr. Pimental stated that if you remove the antibodies the body will heal in 3 weeks.  He also said it is imperative for people with SIBO to NEVER get food poisoning again.  He advises some type of antibacterial while traveling with every meal (of course he said Rifaximin but that's only because it's his weapon of choice and he's rumored to get kickbacks, personally I will stick to Biocidin).

Other takeaways from his talk:

• 10 times more people with IBS have an abnormal breath test than normal people.
• Methane slows transit time in the small intestine 69%.
• You are 5 times more likely to get IBS if you have had food poisoning.
• Also, the breath test is not good at measuring methane under 3 so if your hydrogen is elevated and you still have constipation assume it's positive for methane and keep treating.
• If the breath test shows methane in the colon it's still a positive because you shouldn't have methane produced anywhere!
• Stomach acid (and Betaine HCL) slows motility but kills bacteria so take it if you need it!!
• PPIs increase motility but they are NOT recommended because the decrease acid (which kills bacteria)

Dr. Pimental and Dr. Siebecker then presented Elemental Diet Treatment for SIBO.  Dr. Pimental noted that he only has a 50% success rate with methane producers using Vivonex.  Sometimes people don't feel better until 10 days after they stop the elemental diet.  It's important to reintroduce foods SLOWLY, starting out with soups.  Antibiotics don't work during the elemental diet because the bacteria can hibernate.  The elemental diet is effective in 80% of people in 2 weeks, 85% of people in 3 weeks, there is no benefit in going longer.  Thrush can be a side effect of Vivonex due to "all the nutrition being swished in the mouth".  There have been no studies yet on Peptamen but it appears to have the same effectiveness.  Dr. Siebecker has done no formal studies on the homemade formula but she has found virtually the same effectiveness as Vivonex and says she has found it is effective with Methane.  You can find the recipe here.  Can I just say she is so tiny and absolutely adorable?!?!

I skipped Dr. Pimental's presentation on Rifaximin.  Been there, done that, wouldn't do it again, wouldn't recommend it.  I've found herbals much more effective.

Prokinetic Prevention of SIBO presented by Drs. Pimental, Weinstock, Siebecker, Keller.  I didn't take any notes on the prokinetic discussion because I've used most of them :)  The only one I haven't tried is Resolor because it's expensive and you have to get it from Canada.  Dr. Siebecker does a good job outlining prescription options here.  Dr. Pimental likes Resolor the best.  Dr. Weinstock talked about LDN. Dr. Siebecker seems partial to Iberogast (even for kids).  Dr. Keller presented on Motilpro.

Herbals include:

• Iberogast 20 drops with meals and/or at bedtime
• Motilpro - no instructions provided
• Ginger - 1000-1500mg daily

They all seemed to feel that there may not be a benefit to starting prokinetics early.  Often the methane overrides the benefit of the prokinetic and you are just wasting your money.

Steven Sandberg Lewis and Dr. Shaver presented on Beyond the Breath Test: Other tests for SIBO patients.  My takeaway from this was that a provider should never assume it's just IBD, or Celiacs that if the patient doesn't get better they should always check for SIBO (and in some cases vise versa).  Dr. Shaver indicated she likes to r/o celiacs, non-celiac gluten sensitivity, do food sensitivity testing and a stool test.  Celiacs and SIBO often seem to go hand in hand.  Food sensitivity testing helps you identify and remove foods causing symptoms and/or inflammation, stool testing can help identify parasites/pathogenic bacteria/fungus, bacterial imbalance, inflammation, and sIgA ("a key marker of humoral immune status").

Larry Wurn presented on Physical Treatment for SI Obstruction and all I have to say about this is if you feel like surgical scarring/adhesions are an issue for you, you need to check them out.  I have a friend that has been to their clinic and had treatment and it changed her life.  There technique has been well studied and it's no bull!

Sunday was a bit more of a blur.  The conference started at 8am and the presentation was done via video (for an hour and 15 minutes).  It was hard to follow along.  My friend Tim will do a much better job of summing up Dr. Mullin's presentation and I will link it when he does.  Dr. Mullin spoke on a wide variety of topics, one was using D-Limonene 1000g daily as a prokinetic. I don't recall timing but prokinetics are usually at bedtime.  He also talked about use of the Smart Pill to measure PH in various parts of the digestive tract, in addition to measuring motility, pressure and the ICV.  Sound intriguing!  I also wrote down S. Boulardii increases SigA (which is a good thing!).  I think I tossed mine out long ago however so can't add it in now and again.  He spoke about adding in fermented food but I glazed over :(. His uses the garden metaphor, first kill all the weeds (SIBO), support the soil (gut) so good plants can grow, then reseed (pre- and probiotics).  I'm on the probiotics, the prebiotics still scare me a bit!!  Oligosacchararides promote bifido and lacto, discourage growth of clostridia, prevent constipation, etc.  Sounds kind of important.  Oligo's are found in artichoke, asparagus, broccoli, brussel sprouts, fennel, garlic, leek, onion and cabbage. It was interesting, Dr. Mullin seems to be willing to try anything and if I am remembering right he talked about patients ending up in the hospital (one due to use of biofilm buster EDTA) and said "we discontinued use of that treatment" a handful of times. Which is both awesome and frightening.  We need strong SIBO fighters but I'd hate to end up in the hospital!  He has a new book tomorrow!

Dr. Weinstock spoke again about leaky gut and SIBO.  The feeling is that pretty much everyone with SIBO has leaky gut and if your intestinal permeability test comes back negative it's only because the SIBO has eaten all the lactulose/mannitol before it leaked through to the blood and could be measured.  I believe he said they use 10g of lactulose for the breath test and only 5g of lactulose/mannitol for the intestinal permeability test.  Other ways you can look at intestinal permeability is butyrate, lower levels imply impaired barrier, the other ways, measuring LPS (lipopolysaccharide) is difficult, Anti-LPS only shows in acute phases and the endotoxin test requires measurement in the portal vein.  Bottom line, assume intestinal permeability and support repair using the following supplements:

• Serum Bovine Immunoglobin (SBI) - binds and removes microbial components
• Zinc (I use Endozin) - supports tight junctions between cells
• Glutamine - nutrition to support mucosal integrity
• Curcumin - reduces inflammation
• Probiotics - increases zonulin

The Lactulose Breath Test Interpretation was fascinating and we all pulled out our breath tests to follow along.  It went really fast though.  The only takeaway I had was that you want to see a double peak, the dip between peaks indicates that you have moved from the small intestine to the large intestine.  

That pretty much sums it up.  Phew!  Let me know if you have any questions!

More ferments

Love having a Whole Foods 10 minutes away.  I can pop in and browse and find great deals, especially since they just opened.

Yesterday I popped and found all their Kevita fermented coconut waters on sale for 50% off! 50% off!!!  My 9yo son thinks they are the best thing on earth.  Yay!  I would much rather give him fermented foods or beverages than a pill.  The only problem I have is making sure he doesn't drink too much.  For those watching FODMAPs you'll need to read the label because ingredients vary.  I saw one bottle that even had sugar!!! What the heck??  It must have tasted pretty bad for them to add sugar just to that flavor :P  So far his favorite is the pineapple/coconut.

I'm doing fine with ferments, thankfully.  I tried a little resistant starch (potato salad) over the weekend and I just don't think I'm ready yet.

A few of my favorite things

Whole Foods opened up nearby a little over a week ago.  I knew I wanted to add back in some fermented foods and I just have trouble making them myself.  They grow weird stuff and I panic about food poisoning myself.  I love Firefly Kitchens, a local company.  I had not tried their Firefly Kimchi.  You open it up and it smells like spicy garlic.  I heard somewhere, probably not a reliable source even, that fermenting helps break down the FODMAPs in garlic.  Not sure I believe it but since I haven't been reacting to much of anything I thought I'd give it a go.  So far so good.

Then someone posted the Probionic Tonic on facebook and tagged Whole Foods.  I was completely unaware of this product!  It was so crowded on the day I was there that it was hard to see much of anything.  Back I went and disappointed I was not!  I love the tonic.  Although the spiciness give me a touch of burn.  I drop about half of a shot glass with one meal a day, eat the kim chi with another and take my MegaSpore with a 3rd.  Hopefully I'm not just refilling my small intestine with bugs!!!  We'll see.