In 2019, I finally discovered why I had digestion problems that caused bloating, gas, rosacea, and constipation. I was tested and treated for SIBO. This was not a quick recovery as I had many years of being very rigid with my diet, but I finally have the confidence to say I am SIBO free.
If you have not read about my SIBO journey, follow this link to go back four years to understand what I was feeling.
As a quick recap, I was deemed SIBO + in 2019 after countless efforts of trying to figure out what was going on with my GI system. Every night, I'd experience bloating, gas, constipation, water retention and skin irritation. I hated the way I felt and the way I looked. It got so bad that it eventually affected my relationship with myself (confidence), my husband (lack of wanting physical touch), and any social situation (anxiety of gas). I decided to seek out a gastro doctor in Michigan, who was deemed one of the better ones. As I described my symptoms and proceeded to show him photos of my stomach, he generalized that I should "stop eating broccoli" and "workout more". I was appalled. I brought up the words SIBO and IBS as he completely dismissed them. He decided to do a endoscopy, which he merely found acid reflux and h.pylori. All of which are very treatable. As he sent me on my way, I knew I wasn't finished here.
The symptoms continued to progress getting worse and worse every night. I would fast all day in fear of feeling pregnant at work, to only eat a healthy plate of protein and vegetables and still blow up like a balloon. During a visit to my endocrinologist, she recommened I talk to Dr. Badari with OSU. She has sent diabetics who suffer with gastroparesis to him and they had found great luck working with him.
Thank God she did this, as Dr. B ended up testing me for SIBO through a breath test. I came across "HIGH" in both methane and hydrogen levels.. both of which indicate small intestinal bacteria overgrowth. My blog post from 4 years ago describes why this happened and how I treated it.
Left: SIBO stomach every night (2019) | Right: waist summer of 2023 with no SIBO
Now, four years later and I am symptom-free. I did not feel like this overnight as it required almost perfectionism on my diet, stress management and supplementation. I want to list out the best pieces of my treatment success so that you can also feel as good as I do:
#1 Follow the low-fodmap diet for a long fucking time
All those blog posts you read are true; the low-fodmap diet helps. Quite literally, I followed this diet for almost two years. It's extremely limiting and annoying to be consistent with, but if you want true success, you need to. I began my healing journey following the low-fodmap diet while on antibiotics and supplements. I continued the low-fodmap diet for about two months before re-introducing any fodmaps. I worked with a GI dietician on reintroducing food groups and testing what works and what does not. If you are interested in working with this incredible dietician, click here to be re-directed to Paula's website.
During my reintroduction phase, I found out gluten, dairy, fruits, and sugar alcohols were O.K for me to consume. I had no SIBO reactions after testing small amounts to larger amounts. What's ironic is, dairy and gluten are the first things I cut out to try to feel better! They were never the culprit in the first place. During my reintroduction period, I also found out I did not tolerate sweet potato, Brussel sprouts, cauliflower, onion, garlic or broccoli. These bad boys all belong to two different FODMAP groups. Therefore, I avoided all foods that fell under these groupings (food like asparagus, pears, apples... extremely healthy foods I loved). From here, I followed this strict diet for two years. I stuck with the vegetables my body tolerated and completely cut out the ones it did not. This is very limiting, especially becasue most sauces, dressings, and cooking styles use onion and garlic. But when I would eat these items, I'd have severe SIBO responses that lasted for days.
So when did I start to reintroduce these foods back in to my routine? After about two years of being incredibly strict (three years if you want to include the time following the low-fodmap diet loosely before getting help) along with the other key points to my success, I started to reincorporate tiny bite-sized vegetables into my routine. I began to not ask for modifications when eating out (besides asking simply for no raw onion or extra garlic). When Mike would make a trigger food, I would try it. Extremely slowly, I began eating the foods I loved and missed. But again, this was after many years of cutting these foods out of my diet cold turkey. Now, I have zero side affects and when/if I begin to bloat while eating, I have the tools to get back to normal and cleanse my system.
If you are following the low-fodmap diet, download the Monash university FODMAP diet app. Monash has the most up to date studies around SIBO and developed an app that categorizes foods into specific FODMAPS. For instance, after understanding what fodmaps I reacted to (mannitol and GOS) I filtered those as foods to avoid while grocery shopping.
#2: "Fasting" the SIBO way
I call this the "sibo-fast" as it's not your traditional fasting protocol. I never went half a day or even longer than 8 hours without eating. However, when you understand how SIBO occurs (bacteria grows in your small intestine) you understand it feeds on food. So. by "cleansing the system" the bacteria has no way to survive. This fast needs to be at minimum 5 hours to work; this is called the MMC (migrating motor complex). The MMC works to sweep out your small intestine and push things through into the colon. This is very helpful for those with SIBO to ensure bacteria doesn't overgrow. After every meal, I would "fast" for 5 hours. This will look different to everyone but here are two examples of how my day looked depending on my work schedule:
Day 1:
Eat breakfast at 8 am (mostly carbs)
Workout/ fasting period of 6 hours
Eat a light lunch at 2 pm (mostly fiber/protein)
Work/ fasting period of 5.5 hours
Eat dinner at 7:30 pm (mix of protein, fast, and fiber-rich carbs)
Day 2:
Workout first thing in the morning with water + coffee
Work
Eat "brunch" at 11 am (carbs, fat and protein)
Fast all day while working, nothing but water / fasting period of 8 hours
Eat dinner at 5-6
Relax/Work/ fast for 4-5 hours
Have a light snack at 10pm
These are two examples of how my day played out with fasting in terms of my workouts, work and ability to cook. The macros don't matter in this situation, but I like to give context for what works for me. During these short fasts, I would only drink water or coffee. La Croix and most seltzers are fine to have as they are just water and natural flavors, unaffected by calories and added ingredients.
Fasting helps when you have a flare. This is the first tool I'd turn to; if I didn't react to a meal well, I would fast for 8-12 hours depending on the severity. It would mostly happen at dinner if at all, which allowed me to fast while sleeping and push breakfast off til my workout was complete.
Remember, gum and diet soda break a fast. It doesn't matter if they appear to have "zero calories", you are still consuming ingredients that your body has to digest. Stick to water, black coffee or black tea while fasting.
#3: Reduce stress and prioritize sleep
Initially, I thought I had this under control. I am a health expert in nutrition and fitness yet I was blinded on how inflamed my body was. This is a huge culprit to you GI-distress that goes hush hush many times, but I truly believe the change in my schedule allowed my body to finally rest, digest, and work accordingly. Specific things I did:
Prioritize sleep. It's hard when you work a job that requires you to wake up early and work late, but you must protect your health. I am not ashamed to lay down at 8pm on the mornings I wake at 4. On days I am able to sleep in, I do and I hit my workout later. Sleep deprivation is something that will inflame your body everywhere and if this is something you think is keeping you from success, you need to change it now. If I can, you can.
Stop trying to "work out the bloat". If you experience chronic bloating like I did, you know that sweating and working out makes it feel better. That is until now you're hungrier, and eat more, and bloat again! It's a vicious cycle. One thing that I did was workout less during the day to allow my body recovery and a chance to de-stress. Walks helped when I felt like I needed to move to aid in digestion.
Stop binge eating. This has never been a real problem for me as I love food and believe in the power of using it for fuel to power my workouts, my workday, and energize my social life. However, I can easily fall into this trap when you immediately feel better fasting but then end up getting really hungry. The best thing to do is create full, well-rounded meals that have protein, fat, fiber and micronutrients. By ensuring you have macros that are satiating and keep you full, you'll be less likely to hit the "ravenous hunger" later on in the day and ruin the whole goal of you fasting (eating in your window or eating foods that cause distress).
#4: Get your blood sugar in check (T1D specific, but maybe you too)
I can't help but categorize a lot of successful health outcomes and my T1D control. During the time of SIBO, I would absolutely describe my life as uncontrollable. My sleep amount and quality were both hindered. My schedule (eating, working out, resting, working..) all depended on other people and not just one big boss, but 20 clients who all had different schedules too. Eating was few and far between becasue of my work schedule and fear of how I'd feel. Therefore, my numbers were just rolling hills. Specifically, my blood sugar would soar at night when I was asleep and it would take awhile to work on bringing it down in the AM (DOM effect). I can't help but think my body was more focused on my diabetes, numbers, turning carbs into energy, than it was how well I was digesting food. It makes sense; if my body is unable to convert food into energy, then it probably is also having a hard time digesting it.
My management took a turn after I realized I cannot keep living life this way. It was a lot of work throughout the day to prepare for HAVOC every night and it was affecting my health in other areas. You can have perfect numbers 9am - 5pm, but your time in range and A1C will reflect the other 16 hours of the day. When I started tackling my SIBO, I also began making changes to my insulin dosages, wearing a CGM (I was manually checking-- for 18 years!), and eventually a pump. I believe the increase in insulin over the last 2 years has absolutely helped the way my body responds to food, even if the science isn't totally there to connect insulin and SIBO. This is just my experience.
If you don't have T1D, maybe try looking at your bloodsugar post meal AND fasting. I know many people like to wear CGM's now too. Being aware of your risk for higher blood sugar or understanding what foods make you spike might reflect foods that also cause a SIBO response. If you don't want to wear a CGM, you can easily get a meter and test strips from the pharmacy to check your blood sugar at home. It's a good tool to have and use during times like these.
It has been a long road to recovery and it is not easy. I have had so many people reach out over the years from my blog post being helpful. I want to tell you this is not the end, this is not your life. You will find a solution but it means you must be diligent in finding the right practitioners, accept the hard, be 100% perfect, and never stop striving for better. You will become SIBO free with your time, energy, and strong will.