SIFO? and constantly making changes.

I've been doing great since March, as I mentioned in my last post. However, starting around November it was more of a challenge to maintain a state of wellness. It's difficult to stay on top of all the moving parts that keep me feeling my best, especially in times of financial or physical (working late, etc.) hardship. I found that my body was inflamed and was more difficult to "chill out" than usual. (For me, this means I'm low-level bloated after eating almost anything, my eyes are puffy and tired looking, I'm sluggish, brain foggy and prone to be moody AF.) I was taking the supplements that usually helped me to reduce inflammation, doing my diet (fairly well) and maintaining lifestyle interventions. In all transparency, towards the end of the year, the issue was that I'd indulge in something (maybe more alcohol than usual or starches I usually stay away from) and then before I could "chill out" my system (which usually takes a week, for me) I'd have something else and the cycle would continue. 

Because the diet that makes me feel great (right now) is so limited in variety, I also had a suspicion that maybe we hadn't completely solved the puzzle. I'd cleared SIBO in 2015 (we tested 3x and besides, the diet I consume would mitigate any remaining imbalance there). I haven't been able to reintroduce anything beyond greens, cucumber, limited amounts of tomatoes and avocado and small amounts of fermented foods into my diet. For the sake of my quality of life, I'd like to be able to tolerate some more foods, mainly vegetables. It would really make eating out more fun and tasty. Not to mention, while greens are packed with vitamins and minerals, I'd like to get a wider variety from other foods.

I had been listening to Dr. Ruscio's podcast and some others and hypothesized that perhaps my gut was still in a state of dysbiosis or perhaps there was a pathogen I was keeping at bay but hadn't eradicated. It's possible I'd cleared SIBO but not all of a fungal overgrowth (Candida or otherwise) that could have been there in the first place. I also know that while not diagnosed (for those concerned if i've "been diagnosed", it's a thing, LMGTFY!) with Crohn's Disease but suffering from the symptoms of it and benefiting from the treatment of an IBD like Crohn's, that it's possible that I am destined for a Low FODMAP diet forever. Research shows that people with IBD that go off of a low FODMAP protocol, often get worse. However, as the ever (now greedy) wellness consumer, I'm willing to try all my options.

I knew the first step was on me. I had to get back into a wellness routine that I knew worked for me. January first, I decided to do the elemental diet (I've done the semi-elemental diet in the past, which I do not tolerate well.) I did this for 3.5-4 days, a short, reset period. It's homemade, you can get the list of ingredients here. The purpose of this experiment was to see if I removed digestion from the equation by consuming this pre-digested liquid diet, could I get my body to de-bloat and "prune" (as Dr. Ruscio likes to say) back any initial overgrowth of either fungus or bacteria in my gut. I also committed to doing the first month of an herbal anti-microbial/anti-fungal protocol. It's the same one that I'd done with SIBO, just to prune back anything that had gotten out of control between November and January. 

It turns out, I tolerate the elemental diet very well. I was tired the first day and had a headache but that's pretty typical for me as a withdrawal symptom. I was symptomatic for the first two weeks of the antimicrobials/antifungals which indicates to me that I had some dysbiosis and/or fungus in my gut. I set a follow up meeting with Dr. Ruscio for the next month to discuss what I suspected and to talk about doing the second month of antimicrobials/antifungals which were more geared toward fungus, or if he had another suggestion.

In talking to Dr. Ruscio, I let him know the symptoms I was still experiencing: Low-level bloating, inability to add in more vegetables, some fatigue depending on lifestyle. He suggested that it's possible that I may have a microbiota that needs occasional "pruning" and is prone to overgrowth if not kept in check. The suggestions were the following:

  • Consider doing periodic bouts of the elemental diet (the one I tolerate) to give my digestion a break and starve out any dysbiosis. 
  • Do a round of the 2nd month of SIBO/SIFO treatment (the antimicrobials/antifungals)
  • Consider doing a round of Fluconazole, a pharmaceutical intervention for SIFO that doesn't show adverse effects on the mirobiota. (TBD if i do this in addition to the protocol above) 
  • Consider going on LDN or low-dose naltrexone, an immune booster now commonly used for those with autoimmune diseases. (It's his opinion based on research that my body's immune system attacks my microbiota, if this drug can help calm my system down from being on red alert all the time, perhaps I'll feel better.)
  • Do a week of a low histamine diet. I had additional concerns that maybe I have histamine intolerance (which may or may not be affected by the possible fungal presence). I have sometimes have allergic symptoms when consuming wine, my heart races after eating some foods, I flush when I have too much or certain alcohols and I am sometimes intolerant to fermented foods. My hypothesis is that this will change after antifungals, but we'll see. I do better when I avoid these foods, currently.
     

I have reservations about pharmaceutical interventions.
Taking antibiotics throughout my life, I believe, helped me to arrive in this condition.
I'm starting with the herbal antimicrobials/antifungals and then we'll consider the rest of the options in a month or so. 
I'll update the site then!

 

A Couple of Side Notes

COST
I have a Covered California health care plan, the cheapest one that covers the least. Dr. Ruscio doesn't accept insurance so he's out of network no matter who I'm covered by (though his office does encourage you to super bill your insurance for their fees.) After 2015, I knew that my health care costs would be fewer in frequency and less in cost. I chose to downgrade the coverage I had to save money monthly (but not bankrupt myself if I have an accident). I do still have an HSA so if I make any money via w9, all of that money can go to paying me back (income tax free!) for any healthcare costs I incur during the year. This is one way that I help pay for my wellness on a budget.
Additionally, as Dr. Ruscio is an FMD, I needed a prescription written for the Fluconazole and the LDN (whether or not I fill them and take them we'll decide at a later date). Rather than paying another doctor for an appointment to get that written, I used my FREE (thanks #ACA) physical appointment to consult with my General Practitioner (who admittedly said he literally knows nothing about what I'm doing but if it works, then he's for it) and have him write me those prescriptions. That saved me an additional $150 on a doctor visit. 
 

In other exciting news, our new album is available for Pre-Order!

In other exciting news, our new album is available for Pre-Order!

Why I'd recommend an Elimination Diet to anyone.

I get a lot of eye rolls when i talk about food. Most of the time because my symptoms could be explained by almost anything. If these were occasional or one off reactions i'd totally get that. I also get that most people probably don't keep stock of how they feel throughout the day (meticulously or at all). Reasons why I'd recommend someone try an elimination diet: headaches, allergies, asthma, undiagnosed or unexplained anything from your Doctor. Acne if you're not 14, acne if you are 14, weight gain, weight loss, fatigue, moodiness, poor memory, if you've never done one before, if you have done one before, insomnia, anxiety, depression, joint pain, gut pain, heartburn, teeth grinding/clenching, gas, bloating, burping, diarrhea, constipation, gallbladder issues. You get the point, if you have an "issue" it's worth examining how your diet may be a contributing factor. There is no gold standard test for food allergies or intolerances. Because our bodies are so unique to us, the most effective course of action currently, is doing an elimination diet. 

Of course I do believe that I'm a product of my own life. My experiences, environments, diet, lifestyle, friends, community, activity level and general life decisions have all shaped who I am. Of course I've been to therapy. Of course I've seen General Practitioners for a bunch of the symptoms I've experienced (as you may have read). The point is, if it's not getting better and you want it to, my FIRST suggestion to you is going to be: try an elimination diet. 

Eliminate food as the possible source of your ailment.

That is my suggestion. It is far too easy to have eaten wheat and dairy and sugar (to name some of the main offenders) and become accustomed to how it feels in your system. You can be symptomatic and not know it or have NO symptoms currently and still have a possible issue. Admittedly, I'm one who had symptoms of intolerances to these foods and never really felt the effects until i went off them and then reintroduced them. These diets are not just for allergies/intolerances. The food you eat influences your micro biome and diversity of that bacteria is instrumental to your health. Eating certain foods can kill off the variety of bacteria in your gut which can lead to health problems as simple as being more susceptible to colds or as complicated as allergic reactions to food. This could be step one of merely living a healthier lifestyle catered to your specific needs.

I was listening to Dr. Ruscio's podcast yesterday. Mickey Trescott (the author of the cook book I have and used before I went low FODMAP) was the guest. She made a great point about AIP (and this applies to elimination diets in general): It's a tool.

"No diet is going to fit one person for the rest of their life".

Maybe what you ate 5 years ago doesn't agree with you now. Your body is constantly in flux. Stress, sleep, illness, all of that can play a part in what you can or can't handle digestively. And, to make it more annoying and confusing (because believe me it is both) you can't even go by what everyone says the symptoms are. You have to figure out how that food makes YOU feel and listen to YOUR body's reaction.

I, for one, do not present "normally" when it comes to a lot of the issues Ive been faced with. Acupuncturists, chiropractic and "regular" (or M.D.) doctors have all had a difficult time diagnosing what's up with me because of this. Knowing what makes you feel your best and if you're not quite there yet, is what I've found to be the key in prioritizing my health. The first step in really knowing what affects you is eliminating possible offenders and then reintroducing them methodically, so you can rule them out as a culprit. Regardless of the outcome, you will gain some control in your own day to day energy, digestion and mood.

I can practically promise you that. 

the good news?

If I can do this, LITERALLY ANYONE CAN.

I am a junk food addict. I love McDonalds, I love Dominos. I've eaten my fair share of each of them and many more foods like them. I think sometimes it just comes to a point where you're either really ready to feel better, or at the time, perhaps it's not worth it to you. I had to wait until I was ready, my will power wasn't enough otherwise. Now if I eat Domino's, I not only get bloated but i have almost immediate neurological effects. Depression, anxiety, physical heart palpitations, insomnia, nightmares, my body is very clear about not wanting this food. However, those reactions weren't clear until i cut out all those ingredients and then reintroduced them. My picture still isn't complete of what's healthful for me and what isn't, but for now I do have a good idea what to stay away from. Once I'm finished with chelation, i'm going back to AIP low FODMAP (strictly) and seeing if I can heal my leaky gut enough to reintroduce more FODMAPs. (I'm so symptomatic in treatment, I eat what I know makes me feel good 80% of the time but I've also allowed myself some leniency. It's a balance.)

There are a bunch of diets one can try. If a certain diet doesn't cure your symptoms, unfortunately that doesn't mean that food is not a factor. It could mean that. However, it could also mean you just hadn't removed that food item or group yet. That was the case for me with Kale and FODMAPS. This may mean trying more than one diet. It may mean committing a little longer than you originally anticipated.

Elimination Diets I can suggest:

SCD - great one to try for suspected leaky gut, and IBDs (Celiac, Ulcerative Colitis, Crohn's)

GAPS - developed from the SCD, this diet is tailored towards gut flora health and healing leaky gut. (In my opinion, if you go either of these routes, you may as well look at the lists between the two and decide where you might want to start.

The Paleo Cure - this book by Chris Kresser is extremely informative about how your body absorbs nutrients and is not preachy. This is a good diet for anyone who wants to feel better overall but doesn't necessarily think they have any "issues". It removes the main offenders but isn't too intense in my opinion. You can also check out Robb Wolf's website here.

AIP - if the diets above aren't producing the results you desire. Or if you feel like going balls to the wall and "getting it over with" this diet is the one for you. It removes more food groups comprehensively than the Paleo diet, such as nightshades, seeds, nuts and the spices that fall under those categories.

Low FODMAP - (stands for Fermentable Oligo-Di-Monosaccharides and Polyols) a good reference to start if you have IBS, Crohn's or other IBDs. FODMAPs are short chain carbohydrates that can ferment if undigested in your gut. The cool yet tricky thing about FODMAPs is that it's not a black and white situation. It is dependent on the amount of the food taht you eat. Perhaps 1c of broccoli is OK for you but any more than that causes a host of symptoms. I tacked this on to AIP because they were clearly an issue for me, I was super uncomfortable and swollen from the vegetables and fruits on this list. I hope once my gut heals I can add them in, I MISS MOST VEGETABLES!

Here are some AIP friendly meals courtesy of Mickey Trescott's Instagram, not too shabby.

Being "Good" (my story part 2)

New to My Story? Read Part 1.

When I started college, I had the not so vague idea that grains didn't serve my body well. I still loved (and ate) pizza but tried not to consume them quite as much. I went off of the depression and anxiety meds I was on from high school. I was still on the pill and my skin was normal (occasional breakouts but mostly under control.)

New Symptoms

Now that my skin seemed to be doing better and I wasn't panicking all the time, i became more aware of my physical symptoms from food.  I had the most FOUL smelling gas. Totally awful, anxiety inducing and difficult to manage.

I also noticed i would get SEVERELY bloated. Within 20 minutes to an hour i could look 3 months pregnant. Of course, bagels and pizza would set it off but sometimes i'd be bloated from other foods too. The nickname we had for it was "buddha belly". I wish I had the opportunity to learn about digestion in school, we barely talked about it in biology.

It in college that i also discovered "alcohol flush reaction". One night we were at my boyfriend's apartment, playing some drinking game. I went to the restroom and noticed my face had totally "rashed out" under the skin, it was all flush on one side of my face and down onto my décolletage. Any previously healed blemish looked bright red (though not raised). I was like WHAT IS HAPPENING?! it looked like an allergic reaction. It faded after about 10-20 minutes. From then on I had my eye out for what would set that off. 

The summer between my Freshman and Sophomore year of college i did my second elimination diet. I was a lot more committed this time around, i lost weight from not eating all the crap and enjoyed not being super bloated most of the time. I had more energy, the circles under my eyes reduced, i was less "Swollen and inflamed" looking. When i got back to school, i tried really hard to stick to it. I was off grains and dairy (except for caesar salad dressing, no one's perfect). I was eating a lot of salads in my dorm and trying to just avoid the pasta bar in the dining hall. 

It didn't last. 

I spent all of college bouncing back and forth between being "good" for a while and i avoid foods that I know (or think) aren't making me feel healthy and being "bad" and eating whatever i want. It's a challenge to eat what's healthy for you when you're not sure what it is (exactly) and when everyone around you eats "normal food"! I was trying to be better about listening to my body and paying attention to symptoms, hoping to figure out a cause. I wasn't consistent enough with my diet (or my paying attention) to make significant progress. 

Freshman Year

Freshman Year

Sopohmore Year

Sopohmore Year

Mental Stuff

I was still having anxiety, I had xanax as needed. I was scared of new situations (still) but pursued them anyway. I knew that anything i was fearful of, I had the most to gain from. My guts were in knots (basically) constantly. If i didn't have anything to worry about, my brain would come up with something. I hadn't made the connection between food and gut and brain at this time and was not helping myself at all by avoiding the offenders i was aware of.

I also was a CRAZY PERSON in my college relationship. Hindsight is 20/20, let me tell you. I would fly off the handle over stuff that was really not a big deal. I would also fly off the handle (but not break it off) over stuff that was important to me. We did not communicate effectively. Looking back, it's clear to see that it wasn't a good place for either of us. I didn't really trust him but I was so set on "making it work" that I stayed way longer that I should have (fear of failure? not wanting to let go of my first "big" relationship? any and all of the above?). (Spoiler Alert: Mood swings were a symptom.)

Put aside how anxious i just was on a base level as a person, when we would argue i would turn into a monster. Just like yelling and crying and shouting and even wanting to break stuff. I can remember what it felt to be like in that situation. It was terrifying, knowing that it was outrageous behavior and not being able to control myself. It felt insane, like a temper tantrum with adult awareness. Have you ever seen a 2 year old just work themselves up over something simple and not be able to chill out? It's like that but also with defensiveness and shame and embarrassment. I think the word rage is appropriate here. Our poor communication aside, I was also having TERRIBLE nightmares. In Hindsight, it's so clear to me my body was like STOP IT, whether that had to do with the food, the relationship, the stress (probably a combination of everything) my system was operating in overload and everything I was doing was exacerbating it. I take full responsibility for my behavior. I just wish I knew then what I know now about how my lifestyle was affecting me physically and mentally.

We broke up after my Jr year. The nightmares stopped (almost immediately) and I spent the final year of college trying (or not trying as the case may be)  to take care of myself. I had big plans, I was moving to LA.

To Be Continued...