In April-May 2018 I decided to go Vegan. I understood that the transition would cause some short term bloating - so I continued despite these experiences.
I began experiencing extreme endless hunger, and was losing weight. My go-to-protein sources were oats, grains, and lots of whole food plant protein sources like beans, chickpeas, lentils etc.
I experienced extreme bloating, internal stretching, to the point where I had an umbilical hernia, which I was operated on last year.
I was reluctant to give up on veganism and my hunger was so extreme that I was constantly eating, feeling stretched, and I lost around a stone of muscle weight.
Before I gave upon veganism - I had extreme slowness when it came to the initial phases of digestion, things just didn't seem to move very well in my stomach and small intestine, I was extremely bloated but also extremely hungry.
The first thing I did was try probiotics and that was when things went from bad to extremely bad.
Since then I have lived on a restrictive diet which includes meat, eggs, potatoes, some greens.
My ongoing symptoms occur when I have any food with fibre and/or sugary foods like fruit etc.
I have Asperger Syndrome and the whole situation combined with sleep loss due to regular pain and depression/anxiety has left much of my life in extreme turmoil and disarray.
Being from the UK - I have been frustrated with my simple diagnosis of 'IBS' and my referral to see dieticians which have been of little use so far.
After researching online I discovered a lot of talk about SIBO, including a channel called GojiMan - he promotes the idea that many cases of 'IBS' are actually SIBO.
My question is twofold -
1 - if I am unable to find a permanent resolution to my issues - what dietary approach would work best for me to cope in daily life to get optimal nutrition whilst avoiding the living hell of pain and bloating induced sleep loss?
2 - What can I ask doctors in the UK on the NHS to potentially get access to tests that can hone in on the root cause of my symptoms?
GojiMan offers referral to private testing in the form of - a lactulose breath test for SIBO, organic acids urine test, and a comprehensive stool test.
He claims that many (but not all) diagnoses of IBS are somewhat 'lazy' and that with further testing a more patient specific diagnosis of the root cause and potential permanent solution and fix is possible given the right treatment.
Would I be able to request these tests on the NHS and get ideas about a solution to my condition?
I am determined to discover whether I have small intestinal bacterial overgrowth, or some form of parasite, or some form of diverticulitis due to my disordered eating and extreme bloating.
Thankyou for any and all help I may receive!
Stevie
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Let me start by saying that there are many similarities between our two experiences with the one major difference being I have now been cured of both SIBO and IBS.
I was lucky to receive a correct diagnosis for SIBO by a mainstream doctor in 2017 after 5 years of suffering but unfortunately the same doctor how no idea about treatment/diet and in fact their advice made my condition ten times worse!
Around the same time I changed to a whole food plant based diet. If you suffer with SIBO this diet can actually make controlling your symptoms more challenging because a large number of the foods stuffs like some veg, fruit, grains and pulses are high in FODMAPs which ferment in the small intestine when suffering with SIBO.
I would encourage you to try the breath test. This is the 'gold standard' and employed throughout the profession for diagnosing SIBO. I too have had advice from "Gojiman" and would recommend the test he provides and which can be done from home. It is reasonably priced too.
I eventually had to go elsewhere because my results showed such a high methane 'score' that we decided that medication would be required to help eradicate my SIBO and Gojiman is not a clinical dietician/nutritionist so can not prescribe medication.
As you intimated there is a huge lack of knowledge on the subject of both SIBO and IBS in this country, and elsewhere it seems. I would suggest you take the test because on the face of you account you certainly might be a sufferer.
I would also encourage you to reconsider a plant based diet because of the many health advantages. Look in to a Low FODMAP diet. It is challenging as a vegan but do not think it is all about Fibre, it is not. Fibre is vitally important to our gut, and overall health. Even during the restriction phase of the low Fod' diet I was still getting over 50g of fibre per day. The minimum recommended in the UK is 30g...most people on a meat based diet fall woefully short of this target.
Look at Monash University who have a science based and evidential approach to FODMAP's and I think most who have experienced them on this site agree that they are the leaders in advice. monashfodmap.com
Tread carefully as I am very dubious about SIBO test results.
Besides some discrepancies reported in the literature, I also uncovered different opinions between a renowned test provider I used a few months ago and subsequent communication with a test organisation that follows North American Consensus Breath Testing Guidelines ncbi.nlm.nih.gov/pmc/articl....
In brief, I didnt accept the positive result my lactulose-based test apparently gave since my hydrogen increase up to 80 mins was nil which should be a NEGATIVE.
Thank you for sharing this study. I have only scanned through it quickly but I think the gist of it trying to address the interpretation differences and the success, or not, of it in determining Carb malabsorption.
The test that the aforementioned 'Gojiman' offers is available via the Great Plains lab and to my knowledge conforms with all of the recommendations in this study as far as preparation is concerned and I also believe the results are produced against the criteria mentioned.
Of course it is also fair to say many tests are not as precise a process as the providers would like you to believe. IBS in general still does not have a reliable test to diagnose it and in this world of results based medicine leads many doctors to believe the condition doesn't exist in the first place. The same is true of SIBO with the NHS flatly refusing to even spell it let along treat it!
I freely admit to advocating both the understanding that SIBO is a real condition and that the breath test is a [mostly] failsafe test for diagnosis. I also support low FODMAP diets, and ultimately, laud the use of narrow spectrum antibiotics even though I believe one of the worst impacts on medicine and health has been the indiscriminate use of wide spectrum antibiotics...which may have lead to my problems in the first place.
All this said I am bound to be a supporter...these tests and practices cured me of my condition. The same condition (like many) that ruined my life and lead to the loss of my professional pilots position before my normal retirement age.
So I wear the T-shirt with pride...but then again I always listen to evidence, its how I found my redemption 😊
I have only followed and watched Gojiman's videos but have not consulted him directly.
Also my symptoms include neither constipation nor loose stools - it is just extreme bloating and discomfort not long after eating and terrible trapped gas.
I understand that a degree of gas is normal but the pain I get and resulting sleep loss is awful. I feel this is because it's in the small intestine and still has a long way before it is 'released' and therefore gives me hours of pain in the meantime.
I understand your recommendation to go back to veganism - I am determined to find my way back to it, but my own quality of life and sanity come first for now.
I am seeing a dietician about advice regarding fodmap dieting - but still struggle with some low fodmap foods - in particular oats and some fruit which set met off too despite being low fodmap.
During my own trial and error back and forth with my GP I have tried -
Rifaximin (antibiotic)
Allicin
Oregano oil
Atrantil
On top of elimination dieting.
I understand that without actual test results I have been aimlessly working in the dark.
May I ask what medications worked for you and what your staple foods were that didn't trigger your symptoms whilst giving you plant based nutrition and fibre?
Thanks again, I really appreciate the info and experience.
I am sure you are learning quickly that where IBS/SIBO are concerned, one size does not fit all. So what works for me will not necessarily help you.
Your bowel movement state may or may not be indicative but I would not exclude a route just because they are not affected. It is not clear if you have had proper testing or diagnosis.
From your description you could have IBS and/or SIBO. Without knowing what you have had tested so far I would recommend a breath test.
You will likely not get this on the NHS (not for SIBO) so follow Goji's links on his YouTube channel. You will not need to order a consultation, the results are self explanatory, so just buy a test kit.
Follow the instructions implicitly, including the prep.
As for diet...the honest truth is you need to do the 'leg' work. Monash and Kings both have smart apps for a few quid. Try them, they may make the whole FODMAP question easier to understand.
Many of the foods you mention are high on the FODMAP list which are foods containing simple, complex and long chain sugars. Follow the advice on the restriction phase. This cuts out the high FOD groups but also exclude processed or junk food, alcohol, coffee and added refined sugar.
Whether you have IBS or SIBO this diet will not do you any harm. Aim to stay on the restricted phase for 6-8 weeks.
Looking at your list of meds and supplements rifaximin is used in treatment plans but depending on your methane/hydrogen bias may need another antibiotic in parallel. Doses are often much higher than the PIL suggests as these are 'white label' application so you may well have not had a correct dose
If you have not had a diagnosis I would keep well clear of antibiotics. They kill all your gut flora and need a well designed protocol for 'rehabilitation'. The west has a very gung-ho attitude towards these drugs and most GPs never give advice about probiotic use after a course of any AB!! They likely caused my SIBO!
Have you been tested for Celiacs or IBD?
Good luck with the 'leg' work. Its a long and sometimes difficult journey alas!
Thankyou, I will attempt to get all that I can for free on the NHS, but will resort to GojiMan if they don't give me access to these tests.
The only tests I've had done are basic bloods , inflammatory markers, and celiac, all returned normal. Also an H Pylori test which was negative.
Thinking back - my eating was very disordered and my intestines felt constantly swollen to stretching point. I've even considered that I've done a little structural damage , but I don't know how possible this is. I would feel insanely hungry and eat to the point of almost exploding my stomach. I felt like I was absorbing very little protein, I lost a stone during this period. I was lean, so it was mostly muscle I lost.
And I felt very weak.
I am also considering if a stool test may be worthwhile just to rule out the possibnility of a form of parasite.
One other pain of note is that I often feel pain in my left-centre upper abdomen, the border between my abdomen and rib cage, I don't know if this is muscular stretching though or where a certain part of my internals are triggered.
I notice that I also get both gas and bloating in my upper abdomen and also 'break wind' very soon after eating. And it's hard to tell if this is an immediate reaction to the food I'm eating or a chain reaction and my body moving things along and the gas being released from food that has passed all the way through to the final stages of digestion in the large intestine.
Thanks again, I appreciate the help with all of this detective work, it really gives me hope.
I noticed in your first post and this latest reply you talk of hunger, protein and muscle loss. Are you getting enough calories in your diet and from a balanced point - cabs/fat/protein. UK guidelines for protein intake is 0.8g/kg body weight.
The food industry tries to convince men especially that they need lots of protein (and from meat normally). remember glucose is the basic building block the body uses for energy. Protein is helpful with repair and hormone production, and many other functions too but if you want energy turn to carbs. Fat is also important but don't be mistaken by Keto claims!
Discomfort soon after eating isn't necessarily SIBO. Stupid question but are you chewing your food enough?
Yes at the stage leading up to having an umbilical hernia I was eating as much food as I could. But still losing weight.
I am not protein obsessed, I was on a high carb whole foods plant based diet, all my protein was from legumes nuts seeds and grains. I just think perhaps my body was very ill equipped to break those foods down in such high amounts?
I have experimented with Keto in the past few months as a potential short term solution.
Keto facilitated easy fasting and fasting is heaven to a person with digestive discomfort when eating.
It worked great for me and I was full of energy.
However I stopped because my dietician advised me that I need carbs.
However when I went back to the foods that bloat me...they still bloat me, So it was a relief from the symptoms but not a longterm cure for the problem.
You are absolutely right about the chewing thing, I have developed a very stressful and fearful relationship to food and associate anxiety with it. I try to chew food thoroughly.
I notice that when I rush, it's worse, and when I am anxious generally it's worse.
All things considered - my problem not as simple as chewing, but you're right that I feel digestion is a symphony - it has to have all the working parts in place to go perfectly.
I normally go straight to the end of a research or study paper to view the competing interests listed by the contributors. I didn’t have time this morning when your messaged popped in to my inbox
Having just done so I see a list of pharmaceuticals longer than my arm...that always begs the question in my mind “conflict of interest??”
It of course doesn’t mean this study is biased but it does require greater scrutiny...just a thought
Thanks and sorry for the late reply. Not really sure that the reference I used is a conflict of interest, particularly as the organisation that sent it said that, by following its guidance, I would NOT be diagnosed with SIBO - hence no need for drugs. Indeed the Results Section states "A rise in hydrogen of ≥20 p.p.m. by 90 min during glucose or lactulose BT for SIBO was considered positive" - hence mine must be negative.
However, the test provider I used does supply supplements which does make me cautious, particularly with their guidance notes stating that "a follow up test is required soon after a positive result" (hence another £150+)!!
I did a quick check on Gojiman and note they also offer the same, laculose test I had but I cant really make comparisons with my provider unless Id had the test done via Gojiman and seen how the results are interpreted. For now, Im assuming no SIBO and dont plan any further tests in the immediate future.
To my knowledge the test will be on the same basis wherever you go, that is lactulose for SIBO. Maybe it was the company providing your test was at fault, or maybe you were just plain unlucky.
I have had 3 tests from different labs, one I physically attended near Harley Street (back in the private medical insurance days!) and the other two were test kits for home.
It is true that between Harley and home I went from Hydrogen to Methane but there was a gap of over a year and my symptoms had changed significantly. The home tests came out with similar results.
Now I cannot argue that three is a reliable sample but from my experience I would advocate the test.
As for conflict...I guess I am biased because I see so many poor studies involving the pharmaceutical industry that I may always 'self-inject' some cynicism when I read them!
Ultimately its about how we feel and can a test/medication/procedure help us to feel better... And if you feel better than more power to you! 👍🏻
Hello, it could be SIBO, either way, I would ask you to review my essay below and take from it what you can.
I am glad that you mentioned your protein sources, because this is probably what is messing you up most of all. Beans, chickpeas and lentils (and bread) are all the best sources of GOS (galacto-oligosaccharides) which is bacteria food. In small amounts, your good bacteria will preferentially eat this, and you need this, but by the sound of it you are eating so much that you do have overgrowth. Veganism is a good way forward, I don't do it, but I know others have been very successful with it. Essay, work in progress...:
Hello, this is my general response to help people repair and find a baseline of GI performance after addressing the factors that adversely interfere with it.
First, go to the doctors and get yourself checked for intestinal infections, and whatever other tests they want to do. Most people find they are all clear, and that IBS is a condition brought on by our modern diet, freely accessible food, sedentary lifestyles and is usually initially set off by a GI infection or other trauma to the GI tract, and is then maintained by several factors. Particularly for IBS-D (diarrhoea predominant), the gut becomes hypersensitive to certain triggers, and the official description is that a physical brain-gut dysfunction develops which causes the gut to over-react to mild stimuli. This leads to insufficient residence time of food in the small intestine, resulting in nutrient rich food arriving at the colon and causing inflammation, bacterial imbalance, gas, pain and worsening gut performance that tends to spiral out of control. Be aware that in this state you can still get new GI infections, or have other underlying issues that are not connected to IBS, so you need to be vigilant for this, and if concerned then visit your doctor again.
The good news is that this situation is reversible, and you need to be positive that with the correct understanding and behaviours you can get your life back in control.
After 27 years of suffering with IBS I have found that the long-term solution that actually works for addressing IBS is about FOUR key topics: your vitamins, daily fasting periods, peristalsis control and toxic food additives.
You are effectively the manager of a “food nutrient extraction factory”, I know that sounds obvious, but I have found that IBS is not about medicines, but about changing the way you run the factory, and learning how to get the best performance out of it. Imagine a chaotic factory where the raw materials keep getting added half-way through a running reactor process, where someone is randomly messing with the speed dials of the processes, where the place is never cleaned, where you don’t have the right tools (vitamins and enzymes) to do the job properly, and the occasional spanner gets thrown in too. It’s not going to work well.
So after your doctor’s tests, if IBS is the diagnosis, then the first thing is to get familiar with the FODMAP diet, and be cutting out wheat and milk products at least, and replacing them with oats, gluten-free options and lactose free milk options, and understanding which fruit and vegetables you can eat. You can gradually work off this diet as your symptoms improve.
The next thing to sort out is your vitamins. An incident of food poisoning or GI infection can start you on a cycle that you need to make a really concerted effort to break out of. IBS causes vitamin deficiencies which are practically impossible to overcome in most people’s diets, especially if you’ve already adopted the FODMAP diet. But fundamentally, your vitamin levels affect the health of your intestines, and the health of your intestines affects your vitamin absorption and your production and effectiveness of your pancreatic digestive enzymes; it is a vicious circle that you have to break out of.
So, get some really good, multi-vitamins and take them without fail every day with your breakfast. Don’t use ones with high levels of Vitamin E on a daily basis, as in my case I found I was getting weakened skin on my hands resulting in ruptured finger blood vessels practically every day - so I keep this now well below 100% RDA (or NRV) and I’ve not had one for weeks so far. Get a blood test for Vitamin D and get you doctor to judge your supplement level required in IU’s to get you well healthy for Vitamin D. Do not get vitamins with high calcium and magnesium content initially as certainly in large doses these minerals can mess you up as they consume your stomach acid, and doses of magnesium will give you diarrhoea. You should get enough of these minerals from your diet. If you are on the low FODMAP diet, go for all lactose free dairy products can maintain your calcium, as unfortunately the diet tends to cut out almost all good sources of calcium.
Secondly, you should understand that your “food nutrition extraction factory” works on a batch-wise basis, and definitely not on a continuous process. So, you need to sort out your fasting periods immediately to give a clear break between batches, and the complete processing of each batch. This is normally overlooked by GP’s, but is an absolutely essential element for resolving IBS. Your small intestine should be practically sterile, and your stomach acid along with bowel cleaning contractions during fasting (called MMC) will usually do the cleaning. But, you need to fast for this to be effective, and by that I mean, ABSOLUTELY NO eating in between meals, ideally drinking only water. Imagine if you never washed your dinner plates and just kept putting food on them all the time!, they would be filthy and full of bacteria and this is what happens in your small intestine. This results in SIBO (Small Intestine Bacterial Overgrowth), which is apparently responsible for 85% of IBS cases, but is really only one of factors that you need to address. You need to give your small intestine plenty of time free of food for cleaning and maintaining the factory. The modern scenario of have cupboards full of rich foods permanently available day and night is a modern luxury outside of human evolution, and this is bad for you. Your stomach will sort itself out when you have got control of your small intestine (although if you've got gastritis you'll need to finish a course of omeprazole first), and then your large intestine will improve later as nutrients are more efficiently absorbed from your small intestine. Furthermore, you should be able to avoid future bouts of gastritis as during the fasting periods, your stomach becomes more neutral at nearly pH 4.
As a basic program, eat a good breakfast at say 7am (porridge with 50% almond milk or lactose free milk) or what suits you and then a good lunch at 12 o'clock – and absolutely no food in between. After lunch, no food at all for at least 5 hours, and eat well again for your evening meal because it has got to get you through the night. Ideally, no food after 7 pm, no supper or snacks, no food or milk at all until breakfast the next day. You will feel hunger in the fasting periods, but you will not starve, and this is doing you good!, You must NOT respond to the hunger - only with water or fruit tea. This is CRITICAL. Unless you are in a very healthy GI state, a mid-morning or afternoon snack interrupts your set meal digestion, causing acidity, SIBO, and driving premature advancement of food into your colon resulting in putrid fart gases mentioned later. Importantly, when you are feeling better, do not resort to your old ways, you are still recovering as you intestinal villi repair and become more efficient, and you need to make a life-style change to have this level of discipline in your eating and continue with it. It takes a few weeks at least, and you need to persevere with this. Failing on this will undermine all of your other good works. In a couple of weeks, you should be able to be getting off the low FODMAP diet, and begin working back the higher FODMAPs slowly into your diet. Some people recommend longer fasting periods, but for me the regular program above is sufficient without going extreme.
If your farts really stink like something died in your guts, then this is because partially undigested proteins are making it through to your large intestine and the amino acids lysine and arginine are being metabolized by bacteria into cadaverine and putrescine which are the compounds that give the smell to rotting flesh! – do not worry that you yourself are rotting, this is just temporary, but it shows that you really need to sort your digestion out. One reason for this can simply be that you have eaten more proteins than you can handle, if your gut peristalsis is too fast.
So, the third aspect of IBS is peristalsis control, also called gut motility. This is the speed at which your intestinal contractions drive food through your intestines. IBS-D can be characterized as having excessively fast gut motility or excessive peristalsis, while IBS-C is where the motility and peristalsis is too slow. If it’s too fast, then your digestive enzymes don’t have enough time to work on the food and for you to absorb the nutrients, and the food is driven prematurely into your colon which gives IBS-D. “Digestive enzyme” supplements are usually plant-based enzymes which work in a wider pH range than your own enzymes, and so can get to work on the food while it’s still in your stomach and also during transit through your small intestine, and so boosting the work of your own pancreatic enzymes, that are released by your pancreas into your small intestine. In this case, not only are you ensuring you have sufficient enzymes working on your food, but you are also gaining extra time for effective enzyme and food mixing and action. I would suggest trying some multi-component digestive enzyme supplements, and take these with at least two meals a day, particularly your heaviest meals. You want them to contain at least amylases, proteases, and lipases (for starches, proteins and fats respectively), but they can also contain other enzymes such as cellulase (for tough vegetables) and betaine HCl which helps with stomach acid production. Pancreatic enzyme production can decrease as you get older, and is also affected by stress/anxiety, vitamins, and the general health of your guts. You want to be sure that undigested food does not get to your large intestine where the bad bacteria will go to town on it, causing bloating, inflammation and pain. Using enzymes for IBS-D can improve your nutrition and help you to break out of the IBS cycle, but for IBS-D you still need to slow down that gut peristalsis.
This is affected by several things:
Caffeine massively stimulates peristalsis of the intestines and so this is negative for IBS-D, but positive for IBS-C. Between meal snacking, spicy foods, black pepper, chilli peppers, sucralose, sorbitol, black tea, coffee (and de-caffeinated coffee!), peanuts, cashew nuts, almonds, black beans also stimulate peristalsis. The general advice given for IBS is to cut down on tea/coffee stimulants, no more than 3 cups a day is the NICE guidance, but this entirely depends on whether you have IBS-D, IBS-C or a mixture of both. If you have IBS-D, you must cut out tea and coffee altogether, and for IBS-C you could try drinking more! You can “tune” your gut peristalsis by how much tea or coffee you can tolerate in a day. A mug of coffee contains about 120 mg of caffeine, there is about 50 mg in black tea, and 30 mg in the same volume of coke. A Pro-Plus caffeine tablet only contains 50 mg of caffeine (equivalent to one cup of tea!), and if you were having 10 of these a day you would rightly be concerned! Caffeine is a drug with no nutritional value. The half-life for excretion of caffeine from your body is between 5 and 15 hours depending on your health. So, it can take about three days to remove it all from your body to know how you would really perform without it. For IBS-D, you must do this, and then try re-introducing it by one cup per day (starting with tea), and then do not exceed what you determine is the optimum for you. You may only tolerate one cup of tea per day, or none at all, as in my case. Acknowledging this powerful effect is very important, because even if your natural enzyme levels are good, and you also take enzyme supplements, if your gut peristalsis (motility) is too fast you will still drive undigested food to your colon causing all of the usual symptoms simply because these enzyme reactions take TIME. Be aware that, caffeine also “drives” anxiety, agitation and nervousness. If you are also suffering from stress, then tea and coffee is definitely not helping you. Caffeine is a drug substance, it’s just that as a society we’ve mistakenly chosen to ignore that important fact, and have adopted living with a certain caffeine fuelled life as being normal. Even de-caff coffee, contains other substances that trigger gut peristalsis, so with coffee you just cannot win.
Gut peristalsis is very sensitive to adrenalin. A friend of mine says that “adrenalin not used by your muscles goes to your guts” and there may be some truth to this. If you have a busy life, you are probably not coasting along on a bed of feathers, and you probably not aware of your almost constantly high adrenalin levels – that is until you start actively lowering them. Crucially, what does work, is hard exercise to burn up your adrenalin and stop it interfering with the nervous system of your guts. My advice is to do something every day, whatever you can manage in your busy life, it will all help. It will improve your gut motility, general health, bone strength, relieve tiredness, help you sleep better, improve your mental agility and help get your anxiety under control. To many people, exercise may seem like a waste of time, but it is equivalent to spending a bit of time sharpening an axe – of course it is not wasted time, but time very well spent in servicing your whole body and mind.
Closely related to this (and possibly more importantly is serotonin), which is a controlling hormone for your bowel, and is the target of low-dose anti-depressants used for IBS treatment that are used to raise your levels of it by inhibiting its destruction. TCA’s (tricyclic antidepressants) are used for IBS-D, and SSRI’s are used for IBS-C. It is important for your doctor to get this the right way round if you choose to try the medicine route. Exercise increases your serotonin levels, but there are also two other surprising ways to do this: 1.) increase your agreeableness (and avoid hostility), 2.) bright light, i.e. get outside in the daylight as much as possible and avoid dim lighting indoors.
The fourth aspect of IBS is that some food additives are quite simply toxic for you and cause direct irritation and inflammation of the colon, allergic reaction of the colon, or they are laxatives that give you diarrhoea that you didn’t realise you were eating.
1.) Try to seek out and eliminate “trans-fats”. These cause direct inflammation of the colon, and you will be more sensitive than most people and this confuses what is causing you trouble. Chips, hash browns, butter, doughnuts, popcorn and things cooked in cheap or old frying oil as you find in many restaurants and commercial products can give you colon pain directly through inflammation. It can take up to three or four days to recover from this inflammation, but trans-fats are bad for you in a miriad of ways (cardio-vascular and diabetes etc), not only by inflammation of the colon. A big problem here, is eating out at commercial outlets that do not change their cooking oil often enough. There is evidence that as cooking oil is re-used that the trans-fats (and other compounds) increase. So, if you want fried food as a treat, do it at home with new oil at a low temperature, and only use it once. Ideally, starches should only be boiled, rather than fried.
2.) E407, or “Carrageenan” – is a food additive derived from a red seaweed, which is only present in small quantities as a thickener, but even at low levels it has been shown to be “highly inflammatory to the digestive tract” and associated with IBS, colitis and other GI diseases. There is loads of literature and objections to this substance on the internet. It is present in commercial Crème Caramels, soft cheeses, and many other dairy and meat products. After weeks of good health, just one of these products can knock you out for 24 hours with colon bloating and pain. I have found this by trial and error several times. Food tests show that even the food grade carrageenan contains between 2 and 25% of the non-approved “degraded” carrageenan, which is colon damaging and carcinogenic. Some food agencies now prohibit this additive altogether, and it may be responsible for a lot of IBS cases. It might be found in chocolate milk, cottage cheese, cream, crème caramel, ice cream, almond milk, diary alternatives, such as vegan cheeses or non-dairy desserts, coconut milk, creamers, hemp milk, rice milk, soy milk, and particularly processed meat. It is used extensively in cheap meats and is even injected into beef joints – so always get organic or local butcher fresh good quality meat!). It may be labelled as E407 or Carrageenan, but if you’ve got IBS, you must consider it as highly toxic for you.
Carboxy methyl cellulose (CMC) which is more widely used in the food industry, and has similar toxicology in animal studies, giving inflammation of the colon. However, the jury is still out on CMC to its impact on humans, and personally I can tolerate this.
I’ll also mention here mono-sodium glutamate (MSG). Clinical trials and several scientific articles connect MSG with IBS, so given the option to avoid it you should avoid it.
Also, NICE advises against the use of Aloe Vera for IBS - although I would say for the hydration of skin burns the pure plant gel itself is miraculous, so I would recommend you get a tube of this for your medicine cabinet for minor burns.
3.) E338, E339, E340, E341, E450, E451 and E452, are phosphates, diphosphates or polyphosphates as different salts. Natural phosphates are essential for life, and your body is full of organically bound phosphates, however, free ionic phosphates have several problems. Firstly, they are laxatives and will give you diarrhoea (sodium phosphate was once used to prepare patients for colonoscopies!). Secondly, they are associated with cardiovascular disease and accelerated aging. Since the 1990’s we are now exposed to twice the amount of added phosphate in foods; this is bad. There are calls to have added phosphate labelled on products as a health warning. Particular culprits are mass produced sausages and processed ham and chicken slices (and other meats), some cheeses, and cola (both diet and normal). So, always buy ham “on the bone”, which usually has no phosphate added. Personally, all phosphate additives in commercially processed meats make me ill. Unfortunately, this along with the excess of fats, and added pepper means that sausages and sausage rolls are bad for you for multiple reasons, and I have resigned myself to having to quit them altogether.
4.) Aspartame and other sweeteners definitely have a negative role to play in IBS for many people. As with the other toxins above, your ability to cope with them varies on a spectrum. If you look at some of the work of K.J. Mielke, many of these additives can be allergens or “pseudoallergens” and with time you can develop a colonic reaction to them. The best sweetener for IBS is normal table sugar (sucrose), otherwise, it’s “Stevia” which is quite a new plant based sweetener and seems to be safe for IBS.
Other points...
There is a lot of support for L-glutamine to help with repair of your small-intestinal lining; this means buying 500g of the bodybuilder powder type and having a couple of tea-spoons of this a day - one before breakfast and one just before you go to bed, and you can have this in a light cordial drink. I don’t think this is a permanent requirement, but I think it may help you recover more quickly from long term issues.
Excessive burping which starts a couple of hours after eating can be due to excessive acid being neutralized by the sodium bicarbonate that is released by your pancreas, releasing more CO2 than you can cope with re-adsorbing. The simple remedy for this is to take a couple of ant-acid tablets, or Ranitidine.
I am not a fan of pro-biotics, I have never found that they actually do anything for me compared to getting control of fasting and peristalsis. However, I have had more success with pre-biotics, which are basically food for your large intestine good bacteria. This helps to strengthen the lining of your colon, and further improve your resilience to potential trigger foods and inflammation. Again, I would only use these periodically for a few weeks to help you back to a good state which you can then manage with the other good behaviours. It’s not that they do you any harm, but they are expensive and are just another thing to shop for. They can give a noticeable improvement in your GI comfort and performance, but don’t depend on them alone - it won’t last. You cannot get away with having poorly digested food getting to your large intestine.
I should add that although I eat bread and milk now in moderation, I am still cautious about high FODMAP fruits and tend to avoid them. The FODMAP fruit list is complicated, but an easy way to remember it is like this: the "fleshy", juicy fruits are bad, i.e. (nectarines, peaches, apricots, pears, apples, plums, dates etc), but segmented fruits (oranges, mandarins etc.) and all berries are generally OK as you are not likely to eat lots of them. Best of all is bananas which you can eat loads of. Microwave three of them until they are mushy and put a couple of fried eggs and cheese on them is my favourite weekend breakfast! For efficient fructose adsorption, you need glucose to be present with it in a ratio of 1:1. No enzyme will help you with fructose adsorption from fruits with excess fructose compared its glucose, but what can help is trying to balance the fructose with an excessive glucose fruit like banana. Bananas, figs, kiwis and pineapples have an excess of glucose over fructose, and so you can balance fruits with excess fructose. If you try using pure glucose powder, this will not travel slowly in your guts and you’ll still be left with excess fructose later on, so it is better to use bananas for the slow release of glucose to accompany the fructose. So you can experiment with this by making yourself a fruit salad mainly composed of bananas, and small amounts of other fruits. However, beware, that the problem with “fleshy” fruits (e.g. nectarines) is not only in fructose ratio, but also the polyols that they contain, which can still make you ill!
I should also mention hormone changes in women can be connected with IBS, affecting serotonin and the brain-gut nervous system, but being male I have no personal experience in this! Similarly, hypnosis is actually recommended by NICE as the best alternative therapy, again trying to get a grip on the nervous dysfunction. I have tried this, but for me it was just about being very relaxed with your eyes shut for half an hour, and not spoiling the fun for everybody by pretending you actually are “hypnotized”! Unfortunately, I was £75 worse off for the privilege. However, like other psychotherapies it concentrates on repeatedly putting lots of positive thoughts in your mind, boosting your self-confidence and giving strategies for dealing with negativity, so I’d say it is a good complement for your psychology and anxiety, although it will not address fundamental organic issues like SIBO. But, as an example of your sub-conscious on your guts, try taking yourself off camping for a few days in a “proper” tent. The change of living environment will slow down your gut motility into emergency mode as your mind tells your body to get everything it can from the food you eat in case you don’t have any in the future. Camping also removes you from your usual daily anxieties, gives you more serotonin, and gets you more active.
Dealing with Flare-ups
First thing is, fix your SIBO as described above. If you still have SIBO symptoms, oregano oil capsules are very good, it is bactericidal, anti-inflammatory and can help with acute SIBO problems. It is not “gassy” as you may find with peppermint oil. Take some digestive enzymes, to ensure your digestion is complete. Fixing your SIBO has got to be your priority.
If you are on top of your SIBO, then a bowel toxin might hit you 5 to 8 hours after a meal as the food gets to your large intestine. The first line of attack in this case is ibuprofen which is far more effective than paracetamol for bowel pain, and I find that 200 mg alone is enough. Second, a couple of 10 mg Buscopan will stop the cramps. If you have IBS, always have available advance some linseed (the seeds) and natural aniseed (Star Anise), and when you are bad make the following tea: in a saucepan, add 1/2 teaspoon of linseed, ½ to 1 anise star, 1 teaspoon of sugar, a squirt of lemon juice (bottled is fine), and one full mug of water. Boil to simmer, with stirring, for 3 to 5 minutes, then sieve off the hot liquid back into the mug. This is a very effective remedy that I have used countless times, and it really does help. The reason that it helps (anecdotally) is that the “gooey” linseed extract coats the intestinal lining. There may be some truth to this, as some propose that the mechanism of intestinal inflammation is a chemical attack on the mucus lining of the intestine which then allows food particles be exposed to the more delicate tissues underneath, causing inflammation. The linseed goo would provide a temporary replacement to the mucus lining, preventing further inflammation. In fact, NICE recommends oats and linseeds for daily consumption for IBS patients.
A few of my most appreciated references…
“Treatment and Management of SIBO — Taking a Dietary Approach Can Control Intestinal Fermentation and Inflammation, by Aglaée Jacob, MS, RD; Today’s Dietitian; December 2012, Vol. 14 No. 12 P. 16”.
Thankyou very much, I will read and reread this thoroughly. My experience with Peristalsis is very much on the 'slow' side and foods seem to linger and fester and create bloating from not long after the very moment I eat any foods that may trigger symptoms.
I of course avoid these for the most part, but occasionally 'try my luck' and attempt small quantities hoping I have progressed to curing my issues.
I drink large amounts of coffee in the morning and I find great relief from it.
However I also find that I am on high alert and in stress mode often as I try to cram all my work into mornings when I have more energy, and when I take time to relax and lay down my digestive system feels much better and 'flows' in a more smooth and relaxed way.
I think I need to balance my stress levels and distribute my energy more evenly through my day instead of having a tense period and a looser lay down period in the afternoons.
I see that the reference material that you site (Aglaee Jacob) is from a nutrition magazine and they are a freelance writer. The article does reference Pimentel and Siebecker who have done some research on the subject of SIBO.
The budget.org's research seems to have been surveys in recent years I could not find any references to large scale studies on their website, perhaps you could guide me.
I would also be interested to see studies supporting many of your other claims most of which I have not seen before.
I am keen to learn more so I look forward to your reply. Thank you.
Hi David, you'll have to ask me on a specific point or theme and I'll tell you what I can. There is a lot of info and a lot of references, mixed with my own experiences.
Hi stevie - my symptoms are similar to yours with much bloating and crazy gas but no bowel changes. I have tested postitive for both hydrogen and methane. I am not cured yet but best thing i have done is take a prokinetic after treatment. This gets the small intestine working and should not affect large intestine. See siebeckers sibo info website for details. Good luck!
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