The Plan

I had a great talk with my doctor this week, where he explained more about what's happening inside my intestines and answered a lot of questions that I'd been wondering about.

In fact, here's a quick plug for One Medical Group for people in SF, NY, or DC. It's a single clinic with a bunch of different offices, with primary care physicians and various specialists, including alternative medicine and nutrition. They charge $150 annual membership fee in addition to the normal office visit fees, and in exchange they try to really meet the needs of their patients, e.g. online appointment scheduling and email contact with doctors. I've seen 5 different practitioners so far and they have all been very knowledgeable, caring, and easy to work with.

Okay, back to my update.

It turns out I had some misconceptions about SIBO based on our earlier conversations. As he explained to me this week, SIBO is not just about having a bunch of bacteria in the wrong place, eating sugar, and releasing hydrogen/methane. Those bacteria really represent an infection in the small intestine, causing irritation/swelling/damage that will take time to repair. This was in answer to my question about "why do I need to be on the low carb diet for 2-3 months before experimenting with carbs again?" The answer is that my body needs time to heal in order to provide a stable platform for doing the food tests. If I started doing those experiments now, it would be hard to get conclusive results. Also, sending lots of sugars through my digestive tract might encourage the wrong bacteria to return and make the infection worse, since they love carbs. Eating low carb for a while will allow my body to heal while reducing the chance of a relapse. This makes a lot of sense to me logically, and in order to stay motivated about this restrictive diet over an extended period of time, it makes a huge difference to understand what's happening behind the scenes.

On the dietary front, I found out that I really shouldn't be eating beans or root vegetables at all (including carrots...see previous post). But there are a few bright spots when it comes to food. I can eat a few blueberries! I can also have alternative sweeteners like stevia and aspertame, so when I get a crazy craving for sugar I can drink Diet Dr. Pepper. Yay! I've never been a fan of diet soda before, but I found some stevia-based root beer at Whole Foods and compared to vegetables and chicken it's not bad at all.

For the majority of people, Rifaximin is very effective at eliminating their bloated/painful abdomen. It seems like it helped a little bit for me, but not definitively. So I will probably end up trying a different (somewhat more risky) antibiotic if I don't feel a consistent improvement in the next week.

In the longer term, after finishing the next round of antibiotics (or deciding not to do it) I'll start taking probiotics and maintaining the low-carb diet for a few months. After that my intestines should be healthy again so I can start introducing specific foods one at a time and seeing how my body reacts. When I get to the food experiments stage, he expected that I would be able to detect a food intolerance with symptoms that are a bit different from my current ones, most likely diarrhea and pain (swelling) in my abdomen after eating. I'm excited about that part -- debugging is one of my better skills!

But for now I will continue drinking lots of tea and trying to eat enough to stay alive and happy. I think I've lost about 10 lbs so far and I really wasn't trying to. It's just hard to overeat when your diet primarily consists of eggs, chicken and lettuce. A person can only eat so much leafy green stuff in a day.

I should have another update next week after we decide what to do about the antibiotics. In the meantime I'll be experimenting with new recipes and indulging in bacon and sausage.