SIBO Update #7: One minor set back and my healing plan outlined for easy reference.

Sometimes, set backs happen.

When they do, especially with a SIBO recovery, I’ve found that the problem often isn’t the set-back itself, but the story that my mind creates around the discomfort. This is what happened to me last week.

I’ve been dealing with a high level of stress, due to running a business and planning a DIY wedding (in which I’m making the decor, cooking the food, organizing everything – oh, and getting married). I’ve been doing a good job at managing the stress through consistent exercise, regular massage and other body work, time with friends, and meditation. Last Thursday, I was handed a great business opportunity and took it, which had two effects: first, it made me feel warm, fuzzy and excited to be chosen to help solve a problem for a business I care about while getting paid for it; and second, the responsibility made me feel insanely nervous.

So nervous that I spent most of Thursday with monkeys in my stomach (I think butterflies is the usual term here, but these sensations were not light and fluttery. They jumped around and punched things inside of me). I experienced anxiety, spent extra time in the bathroom, performed my job adequately, then anxiety dreamed about it all night.

The next day, my nerves had settled, but my back hurt. A lot. And my gut felt bloated. I was still following my diet, but a few higher fodmap foods slipped in. I felt worse on Saturday – the pain in my sacrum (low back) had increased and I couldn’t sit or stand for too long. I had a drink a party I went to that I later found out was made with mango juice (mango is high-fodmap). By the end of the night, I was super bloated and in pain. I was constipated, too. I had no appetite. The story in my head was screaming, “This is really, really bad – you’re probably back to square one with both the back injury AND sibo. What have you done? Should you just give up now? You are going to feel like a bloated cripple for your wedding, and it’s probably all your fault!”

I awoke on Sunday and had a very bland breakfast – three scrambled eggs. I tried to ignore the voice in my head and the negative feelings I was having and just focus on allowing for what was, without making up stories about it. I went to the park and worked out, incorporating lots of mobility, strengthening and stretching for my back and hips. I felt better, then. My hunger returned for lunch and I made a simple smoothie with banana and almond milk. My back continued to calm down. I managed my way through dinner. Monday morning, I woke up with a tight abdomen. I scheduled an appointment with my ND and my physical therapist. By the end of Monday, I felt a lot better, but still off. And the voice in my head was still very scared.

I walked into Dr. Kimball’s office almost in tears and told her the story that I had created around my symptoms. She listened intently, then said, gently, “Anna, you’re not doing anything wrong – you’re busy, you’re stressed, you’re just trying to live your life, so don’t take this as criticism. The problem is the diet. From what you explained to me, this isn’t the bacteria returning or taking a gigantic step back. This was a perfect storm of stress and dietary inflammation, which builds on itself. The inflammation causes bloating and irritation. When this happens, you have to look at your diet first and dial it back in. You didn’t have any big cheats, but lots of little things that added up.”

She continued by explaining that when we have even just a few inflammatory triggers, like a few high-fodmaps and some additional stress, they build on each other to create an environment of swelling. Left alone for more than several days, this is what leads to relapse. Addressed within a few days by dialing the diet back in and reducing stress, and things should resolve themselves.

Her words brought relief. And . . . and the voice in my head really wanted to punish me for it. It was very, very difficult to turn off the story in my head that said, “It’s your fault! It’s your fault!” but I knew that self-punishment would only make things worse. I laid on the table in her office as she gently stuck me with acupuncture needles. Each point was more tender than the one before it, indicating how much my body needed the work. Some points in my abdomen cramped and released, cramped and released the full 20 minutes. However, the main sensation that went along with the session was relief. I felt like a host of pent up emotions and energy was running like rivers out of my feet. I felt my abdomen relax the tension that had been building for the last several days. My head became clearer as tears escaped my eyes, running sideways down my face and pooling in my ears, which tickled. Two ancient arts were working in harmony to help me heal – the first of acupuncture and it’s magical healing abilities. The second was compassion from a trained healer.

It’s been three days since then, and things in my body have calmed down immensely. My diet is back to the strict and I’m continuously working to release those stories of fear that my mind creates.

I’ve had a few people ask about my current treatment plan with resources. Although my plan is written in story form throughout the posts, and really examined in some detail here, I thought I’d list out my plan in bullet form for easy reference:

  • Working closely with Dr. Sabrina Kimball, who lives in Seattle
  • Used the anti-biotic Xifaxin for two weeks, three times a day (this was in early March 2015)
  • Started a low-fodmap diet following a dietary list given to me by Dr. Kimball. There are a lot of resources out there about low-fodmap, and many of the information is contradictory. My approach has been to follow this one list given to me, and then to listen to my body. If I have adverse reactions after a meal, I dig through the ingredients and remove what I believe to be a trigger. For example, small amounts of hard cheeses are allowed on my list, but I had significant adverse reactions to it, so I cut it out. This is where knowing my body and choosing to pay attention comes in very handy. This diet will be followed for TWO YEARS.

    My Food Plan

  • Immediately following the antibiotic treatment, I started taking 50mg of erythromycin at night before bed, along with two Tri-Magnesium capules, both to help with motility.
  • I take two caps of Bio-Gest digestive enzymes before each meal.
  • I eat three meals a day at least four hours apart from each other and I do not snack. This took time to transition to, as I was used to eating more carbs than protein and fat. After about two weeks, my body adjusted. If I become hungry between meals, I drink extra water or limeade (water, a squeeze of lime, a teaspoon of maple syrup and a dash of salt). One thing I learned in Ayurveda school is that because we in developed countries have such easy access to food and drinks, we often mistake our body’s signals for hunger and thirst. So, I drink extra water between meals, then wait 30 minutes. If I’m still hungry, know that my last meal was smaller than usual, and at least four hours have gone by, I might have a small snack. This is rare and I try to avoid it to give my gut the time it needs to clear out before my next meal.
  • I DO NOT use probiotics. Until motility is restored in full and the gut has healed, the theory is that they will only hinder the healing process. Bacteria will populate the gut through regular foods anyway. More important now is restoring enzyme production and motility.
  • I get regular exercise. Two to three times a week I do kickboxing. Once or twice a week I do my own circuit training workouts in the park next to my house. The other days, I take 30-60 minute walks. I also practice yoga. No matter what I’m doing, I focus on being mindful of my movements and really “being in my body.”
  • I meditate. This is mandatory for me since it is part of my work, but it really helps me get present to what is and learn to let go of the story that my mind is trying to make up about what is. 
  • I journal and spend time in nature, which are both stress relievers for me.
  • I spend time with friends, which helps reduce stress and fulfills connection needs.
  • I practice constructive rest pose and include stretches and strengthening exercises in my workouts to support my hips/psoas.
  • I receive visceral manipulation at least once a month to help with motility and other connective tissue issues related to inflammation
  • I receive massages twice a month to reduce stress
  • I receive acupuncture as needed to restore harmony in my digestive tract and reduce stress

22 Comments on “SIBO Update #7: One minor set back and my healing plan outlined for easy reference.”

  1. Hi Anna,
    I’m sorry you had a minor setback, but it sounds like you’re well on your way now. Similar thing happened to me last week. I’ve been on the diet for 9 weeks now, taking herbal antibiotics for the first four. I then switched to a supplement to help rebuild the GI tract, along with ginger. Everything was going great until I started taking soil-based probiotics last week. Those combined with a job interview seemed to create the perfect storm of digestive woes. I too was panicking that I was back at square one. Your post has quelled my fears and made me feel more hopeful about continuing on this journey. Maybe I should talk to my ND about the probiotics. Hope you’re feeling even better now and good luck with the wedding planning. Congrats!

  2. Just wanted to say thank you for continuing to post your journey with SIBO. I have been following you and am working through my own journey which has been very up and down and confusing. I have been working with a ND for a number of months now and will be doing the breath test in September. When I first found your post, I thought I was reading somehing from my journal. Nice to know i’m not alone.
    I have just signed up for some beginner meditation classes and have massage therapy lined up.
    You are very inspirational and motivating and I wish you continued health!

  3. Hi! I have been dealing with a stubborn case of sibo for about a year and really appreciate you for sharing your story! I wondered what brand of tri mag you suggest. I am also taking erythromycin at night and thought adding the magnesium may boost its effects. Thanks!

    1. My ND has me taking the Integrative Therapeutics brand of Tri-Mag. I buy it off of Amazon. Hope that helps!

  4. Hi Anna,
    Wow, I love the detailed healing process you are delivering regarding SIBO. Great work!
    I have been following my fodmap diet for 11 months now. I have lost 18 pounds of inflammation!
    I feel better than I have in a long long time.
    My list varies a little bit from the one you posted, and I also noticed lots of discrepancies with online research. One thing I have found to be very effective in NOT producing symptoms though, and I thought it valuable to mention, is avoiding any thickeners and gums (especially in alt-milks). This category includes starches as arrowroot, cornstarch, katakuri starch, potato starch, sago, tapioca and their starch derivatives. Vegetable gums used as food thickeners include alginin, guar gum, locust bean gum, and xanthan gum. Anything that makes liquidy things all smooth and creamy. I find them in so very many ingredient lists. It feels like it sticks to the small intestine and slows everything down.
    Good luck and keep healing! Liz

    1. Hi Liz, Yep – those are worth mentioning! I don’t eat them either, although I realize I didn’t mention it here 🙂 Hugs! ~Anna

  5. Hey

    Glad to know you’re getting back on track. How much has the low FODMAP diet helped you? Also, did your doctor ask you not to take probiotics? I have such bad loss of appetite and bloating from IBS that even water makes me bloat. I’m scheduled for a CT scan tomorrow.

    1. Yes, the low fodmap diet has been paramount to my healing. It was the only diet that really helped. And yes, no probiotics because you don’t want to repopulate bacteria until motility is working properly – otherwise, you get the same problem. It helps me to remember that it’s not a case of “bad” and “good” bacteria, it’s a case of too many bacteria in the wrong place because the gut isn’t moving properly. Good luck!

    1. It’s helped a LOT! I use it less as a regular and more as a harmonizing treatment to get me back on track after minor set backs or periods of inflammation. It always gets me back on track.

  6. Hi Anna,
    Thanks for sharing your journey! I know it helps the rest of us struggling with the same issue enormously. I’ve just finished me second round of antibiotics for SIBO and my symptoms are worse than before I started (noooo!). Just wanted to see how you’ve been doing since the last update? Thanks, and best wishes!

    1. Hi Alexandra,
      I, too, felt way worse after antibiotics – because you kill all the stuff that allows you to digest easily and have to reset your digestion. I’m still hanging out around 85-90% better. I’ll be writing about it soon, but I’m in a phase where I’m starting to reintroduce foods back into my diet. During this phase, new foods and quantities make digestion hit or miss, so I’m still struggling with some inflammation. Overall, I’m much better – but similar to the last post I wrote. Good luck with your healing! ~Anna

    1. Hi Kristen, For me, green beans were depended on amount and frequency. I had to have them in small quantities and not two days in a row.

      1. also, when you were taking the antibiotic, were you on a lower carb diet? i know you followed the low fodmap diet, however, were you told to limit your carbs? my GI recommends eating lower carb.

        1. Hi Kristen, my ND just had me on the low-fodmap, straight up. she didn’t say anything about limiting carbs. I’ve heard other ND’s (and my ND now confirms this, too) recommend eating high-fodmap during the antibiotic phase, to coax out the bacteria and be able to kill them. I just ate low-fodmap, no real moderations. ~Anna

          1. do you now follow a low fodmap diet? or just eat what you want? sorry, I have so many questions!

          2. If you keep reading the updates, you’ll see that I’ve been able to add foods back into my diet. Plus, I’m now pregnant – the progesterone in pregnancy adds an additional level of anti-inflammatory properties, so I’ve most probably been able to get away with more than normal. However, I do notice that if I stray too far away from low-fodmap (eating too many high fodmap foods either in one sitting or over the period of a few meals or days), then I tend to flare up. So I consider low-fodmap to be my home base to keep everything regular. But currently, I’m generally able to eat some hummus and some cheese in a day (and some yogurt) and be fine. Note that you can always put your questions in an email through my contact form and I”ll be happy to answer them privately 🙂

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