Traveling often changes the way you eat and throws your normal routines out of whack. While on an extended trip through East Asia and India, my carbohydrate consumption increased dramatically and I noticed bloating and gas on a daily basis, to the point that eating became a major stress. Seemingly after every meal, my stomach felt as if it were going to burst, uncomfortably bloated, even though my stomach would be relatively flat again when I woke up the next morning. I had noticed this pattern before, but I had always written it off as the side effects of a big meal. While spending a month in South Korea, I took advice from the locals and started smoking cigarettes after I would eat in order to get relief from the gas and bloating. Proof that folk remedies are often misguided.
As my suspicions about the origins of my nightly bloat grew, so did my curiosity, so I decided to do some research. During a late night google search, I stumbled across a disorder called SIBO (small intestinal bacterial overgrowth) and was immediately intrigued by the symptoms that it described - dizziness, fatigue, nausea, flatulence, and bloating. With bloating and gut discomfort starting to derail the enjoyment of my trip, I decided to take action. Being overseas, and thousands of miles from the closest healthcare provider covered by my insurance, I decided to self-diagnose based on my past experiences and see how my body responded to treatment. I would suggest that you consult a physician before undertaking any major dietary changes, and I stress that my experience is simply a single case study of success with this method.
Identifying SIBO - The Symptoms
Excessive Gas - Does your significant other complain about your flatulence? Do you sit in leather chairs so you can have something to blame your uncontrollable farts on? It might not be your fault...
Uncomfortable Bloating - After eating a large meal, do you often need to lie down because your stomach feels too full or bloated? Does it return to it's normal state after a few hours? This could be the result of overactive bacteria residing in your small intestine.
Fatigue - Find yourself napping on the job after a big lunch? Have trouble concentrating within an hour of eating? Your gut may be in a state of disorder due to bacterial overgrowth.
Stomach Pain - If you have chronic stomach pain after meals, often resulting in loose stools and diarrhea, you may have a "leaky gut", a result of excess gas in the small intestine, and another sign of SIBO.
Understanding SIBO (Small Intestinal Bacterial Overgrowth)
Small intestinal bacterial overgrowth is a disorder of the small intestine in which the bacteria that resides in the colon starts to migrate up the digestive tract and colonize the small intestines. In order to understand why this is a problem, we should first look at the composition of a healthy small intestine. Our small intestine is generally a sterile environment, in which our carbs and simple sugars are broken down using a mixture of enzymatic digestion and the contractions of the sphincters which transport partially digested food to the colon. The microscopic particles which are released through these processes are then passed through the epithelial (intestinal) lining, which has tiny holes made up of tightly woven protein membranes which allow the passage of enzymes, hormones, and fatty acids to our liver, which will eventually be distributed throughout the body via the bloodstream. Generally, fibers, plant matter, and complex sugars are unaffected by the milieu of digestive enzymes residing within this portion of our tract, and are passed onto the colon, where our gut bacteria can finish the digestive process using fermentation. In cases where the small intestine has been invaded by fermentative bacteria, the final stage of digestive process is initiated early, releasing gases and other chemicals that were previously foreign to this portion of our guts. The gases build up in the upper GI tract, which damage the walls of the small intestines, as well as creating uncomfortable pressure in and around your gut that can be seen clearly when large amounts of fermentable materials (starches, uncooked fruits and veggies, nuts) are ingested at once. The results of the excess gas is a dilation of the epithelial membranes that comprise our intestinal wall, creating dysfunction between that wall and the protein gatekeepers that generally dictate the transfer of our vitamins, fatty acids, and enzymes into our bloodstream. With these larger holes, the barrier between our nutritional inputs and the compounds that reach our bloodstream is put under excess strain, allowing toxins, non-nutrients, and all kinds of foreign substances to enter our bloodstream. This can cause a variety of problems including allergies, diarrhea, stomach pain, dizziness, fainting, fatigue, and of course, bloating and gas. Since these are maladies that many people all over the world experience everyday, they are often written off as simply the after effects of a big meal. The results of that notion were acceptance of a life filled with discomfort, and the need to cater my activities around two hours of forced sedation after eating a bowl of rice. I found freedom from that life using the methods described below.
Here’s what I’ve found to be most effective at restoring the digestive work assignments that are so pertinent to proper digestion.
I broke my SIBO treatment into 3 distinct stages -
- Lowering the defenses of small intestinal bacteria.
- Eliminating the bacterial overgrowth, without creating an environment of dysbiosis (digestive disfunction resulting from killing too many helpful bacteria).
- Repairing the intestinal lining.
What not to do. What you need to understand going into this is that, for a little while at least, we must starve our gut bacteria so that we can give our digestive systems a fresh start. First, eliminate all starchy carbohydrates (rice, potatoes, green bananas, and anything else listed in the section entitled “Resistant Starches”) and significantly reduce your sugar intake (one apple per day, or the equivalent, is acceptable, preferably in a smoothie) while doing the Hard Reset, since they act as nourishment to both the good and bad bacteria in our small intestines. Another tenant of the diet is lowering your caloric consumption per meal, accomplished by eating small, protein and fat-rich meals every 2-3 hours, or whenever you feel hungry, but this will continue on throughout the GUT diet, so you should just start to adjust to it now. The last limitation during the Hard Reset is temporarily eliminating live cultures of any kind from your diet. This includes probiotic supplements, fermented and acidified foods like yogurt, kombucha, kefir, sauerkraut, and anything else that utilizes bacteria in it’s production. Don’t worry, it’s only temporary, I love my kefir and kimchi.
Okay, now that I’ve covered the no-no’s, here’s how to actually fix SIBO.
Lowering their Defenses
The bacteria in your small intestines sometimes form what is called a “biofilm matrix” which is a membrane that a collective of bacteria live in, where they can share resources and even DNA in order to maximize their chance at survival. In order to effectively eliminate these bacteria we have to disrupt that biofilm using disrupting agents that break down this protective shell.
Lactoferrin and N-Acetyl-Cystein - Both of these nutrients are effective at destroying the protective layer covering bacterial deposits in our gut. There is a good supplement offered by Klaire Labs, called Interfase Plus, which is available at Amazon.com for a pretty reasonable price (~30 bucks for 120 caps). Open up the caps and take it with water or food to ensure it is absorbed by the bacteria in your small intestines. I like to just shotgun it in water before breakfast.
Clearing the Small Intestine (Natural and Synthetic Methods)
Synthetic Anti-Microbial Agents-
Monolaurin capsules - Available at the vitamin shoppe for about $20 bucks for all that you will need. This is an antimicrobial agent that will help destroy the bacteria living in your upper GI. Again, when you take the supplement, you want to open up the capsule and just swallow the powder with food or some water. This ensures that the monolaurin is activated before it reaches the colon, where it’s affects would be misdirected on your normal gut colonies. Repeat this process once per day for a month.
Rifaximin - This is a selective antibiotic that will target the bacterial overgrowth in your upper GI tract. You will need a prescription for this and it can sometimes be costly, so consider your options carefully and pursue testing before jumping into an antibiotic regimen. That being said, this is the most effective treatment for SIBO, and should be utilized if you have a serious case of bacterial overgrowth that severely effects your life on a daily basis. You will want at least a ten-day supply of the drug, with 21 days being optimal.
Natural - Anti-Microbial Agents
Freshly Grated Garlic and Ginger - Both have been known for a long time to help with digestive problems and have been widely used as folk remedies for weight loss and any number of other maladies. The downside? They are hard for some people to palette and a little bit burdensome to freshly grate each morning. Be aware that garlic will make your breath, skin, hair, poop, everything, smell like garlic, so if you’re not a garlic enthusiast like I am, take your time deciding which method to pursue. Eat a tablespoon of whichever you choose with every meal for about 30 days.
Oregano Extract Oil- This one is a little bit unpredictable. According to health personality Chris Kresser, oregano extracts are used commercially as an antimicrobial agent. That should give you some indication on how strong it is. There are plenty of synthetic antimicrobial agents out there, but many food processing companies still use oregano oil as their substance of choice for sterilization. It is effective, undoubtedly, but the danger you run is destroying too much of your bacteria, making recolonization of the colon more difficult after, and creating the risk of developing diseases such as IBS and Crohn’s disease. If you are going to use oregano extract oil, consult your doctor and continue to work with them to monitor your health throughout the process.
Repairing the Epithelium
This one is pretty simple, the cells that repair our intestinal lining require glutamine to operate properly. In order to help the repair of our gut walls, we want to increase our glutamine intake. Glutamine is abundant in beef, fish, and other protein rich foods. So go eat a steak. You can also take glutamine powder, but that’s not as fun as eating steak. Try to ingest 50-60% of your daily caloric value from protein, 20% from healthy fats, 20% from vegetables, and the remaining 10% from fruits and anything else the fat kid living in your stomach can’t resist. Also, try not to blacken the meat too much or else you run the risk of depleting the nutritive value contained within it.
Remember, this diet is temporary, and serves a very specific purpose, and will be confined to a month long timeframe, not the rest of your life. The goal is to reset your gut, so that, when we begin to recharge our metabolism, our efforts are directed to the colon, where they belong, instead of the small intestine, where bacteria can lead to a whole slough of disorders.