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There has been a lot of recent discussion about bacterial overgrowth and various diet changes on the forums - low carb, paleo, etc. I wanted to share my recent experiences in hopes that it may help some of you.

Though I no longer have a jpouch, I was diagnosed by Dr. Shen several months ago with small intestine bacterial overgrowth (sibo). I have a very extreme case of it - not just gas, severe abdominal pain, beer drinking level of belching, etc.. but I am losing significant weight and clinically underweight now. I reduced my carbs, cut out sugar wich really didn't help me much. I was then put on xifaxan which initially worked, though I couldn't get off of it. And with a history of cdiff and allergies to many many antibiotics.. that became concerning. But more recently the xifaxan has lost its effectiveness.

Dr. Shen's PA, Geeta, suggested I try a low FODMAP diet. There is significant medical research about this in other countries for IBS and it is recently becoming known in the US. I won't get into the full details of the science behind the diet as you can read it in the links below, but in general, it restricts certain types of carbohydrates.

The diet starts with a time period of eliminating all the FODMAPS and then you go through very systematically and add in one group at a time to see your tolerance. It is tough to follow, requires more money to spend on food at Whole Foods as there are so many restrictions, ridiculous amounts of time reading labels for strange ingredients, and also a lot of thought into cooking, etc. But you can still eat certain carbs. - so rice pasta but not anything with wheat in it. And this is not because of the gluten in wheat, but rather there is a specific type of carbohydrate in wheat. (I think this in itself is a testament to the diet because many of us have tested negative for celiac disease, but when we remove wheat we feel better). But you can't eat anything with onions or garlic or even garlic powder. Also no inulin which seems to be in almost everything. And many many other details. The diet is explained by the individual groups of FODMAPS.

According to Dr. Shen and my CC dieticien there is no medical evidence/studies that this diet works for SIBO but they believe the concepts make sense and it should. So I am yet again a lab rat for Dr. Shen. Lucky me! BUT... amazingly enough, the diet seems to be working. I am still in the elimination phase of it but am feeling much better and I think the weight loss has halted.

The diet was developed at MOnash university in australia and the first link is for that. The second link refers to a US dieticien who is focused on low FODMAP and has the best book on it for the US according to my CC dieticien. She also has shopping lists, product names, etc.. which make it easier to follow the diet with.

http://shepherdworks.com.au/di...tion/low-fodmap-diet

http://www.ibsfree.net/

Just wanted to throw this out there as it seems many are suffering from bacterial overgrowth and there seems to be a lot of medical research about this diet, so it may be worth a shot for some of you.

If you have questions about it, I'm pretty literate on it now. It is difficult, but for me it has been worth it thus far.

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L liz11Member
Yes jan, my favs are italian and mexican too. That was my major complaint initially. But Im making do somehow thus far. Im allowed the green only ends of scallions and garlic infused oil right now.Hoping the fructan group - onion, garlic, leek, etc - will be ok once I start the adding back in phase. But wheat and inulin are in the fructan group so I'm a bit doubtful.
L
Last edited by liz11
CTBarristerCTBarristerMember
In changing onto low carb/Paleo diets I have substituted complex carbs from legumes as my chief source of carbs. Chick peas and soy beans (edamame) are kind of high in carbs but I eat modest portions.

Fodmap is a another diet that restricts foods that fuel bacterial overgrowth and may be more user friendly than the Paleo which looks for you to kick most processed carbs out of the kitchen. Fodmap is kind of a Paleo Junior type diet. It is a less aggressive less restrictve approach.
CTBarrister
Last edited by CTBarrister
L liz11Member
Ct dont think thats necessRily true. Paleo doesnt address fructose and poloyls. That fructose category is huge. The elimination phase of fodmap is pretty restrictive as its not just the carbs we normally think of that are eliminated. I definitely wouldnt consider it paleo junior at all. Good thing about it is there is science behind it and it works to try to get as many groups back incorporated as an individual can tolerTe. Also there are many fruits and veg allowed even on the elimination phase so one can end up with a well balanced diet.
L
Last edited by liz11
Jan DollarJan DollarModerator, RN, retired
I read the links with interest, Liz.

What I find most interesting about a low FODMAP diet is that the "rules" are basically for your elimination phase, to get you to your baseline, so to speak. But, after that, it is about adding as much variety as you can according to your personal tolerances. So, in that sense I think it is a better diet, because it winds up being tailored to you, rather than you having to conform to it.

It makes a lot of sense, when you are looking to improve IBS symptoms. They have known for a long, long time that undigested foods, particularly carbs, wind up being digested by bacteria, causing bloat and gas. In the old days, we called it an elimination diet, but it was not as focused as this. So, it is nice to see some advances there, particularly compared to keeping a food diary, which can be quite laborious. One point that was mentioned is the fact that we tend to blame the last meal we had when we are having symptoms, but it can be many hours before or even the day before, depending on the transit time. Not having a colon probably helps narrow that time frame, but still, it is good to remember that your breakfast can cause symptoms in the afternoon.

Let us know how this works in the long run!

Jan Smiler
Jan Dollar
L liz11Member
Exactly Jan. They get you to baseline of zero basically. And then you very systematically attempt to add in a category at a time. So for galactans challenge you would add in chick peas, lentils, soy milk, etc. Fructans challenge you would add back in kale, inulin, garlic, white or whole wheat breads and pasta. You may find out that the lactose is problematic but you may be ok with galactans or fructose. So then you just have to keep those categories of food out of your diet.

In regards to transit time. Very true what you said Jan. I have learned that when the bad bacteria are really hip hopping around that it dramatically slows down intestinal motility. My challenge has been to find try to find things that will help get things cruising through without adding to the bad bacteria frenzy.

What I find intriguing is that they have very scientifically identified and categorized these specific carbohydrates like fructose that are known to cause intolerances in many people. There is such a thing as "fructose malabsorption." They have also tested significant types of food to identify the type and levels of FODMAPS in them.

Lastly it is called a low FODMAP diet. Not a no FODMAP diet. It is not just about which particular FODMAPS trigger bad things but also about the "volume" of each of these FODMAPS in your diet. Each person is individual. Some people may find that the bad bacteria in the small intestine are not interested in having a party with just a half an apple (fructose) eaten each day, but if you add in barbeque sauce, agave syrup on a snack, honey in your tea, ketchup on your cheesburger, and asparagus with dinner.. it might get that fructose bacteria party going in your gut.

And to circle back to the paleo thing. There is a lot of stuff on the internet about adding FODMAP intolerances to a Paleo diet. It makes PALeo more restrictive. I am not here to promote one or the other. I simply wanted to share what the jpouch guru of the world advised me to try for my severe sibo. And also my "success" with it thus far, hoping it may be of benefit to others on this forum.
L
Last edited by liz11
Scott FScott FMember
I'm intrigued. This really does seem to add sophistication to an elimination diet. I confess that like Jan I don't know that I'm ready to tackle it. Part of the problem is that I'm feeling fine, even though I'm stuck on Cipro. I guess if I hated Cipro more I'd be motivated to take this on. Maybe the bigger issue is that this can only work, I think, when there are symptoms to monitor. It seems like I'd have to go off Cipro, get sick (again), and then eliminate all the potentially troublesome foods...and hope things get better on the most restrictive diet. The irony is that a restricted diet is almost certainly better than continuous antibiotic usage, but the path to get there seems like avoidable unpleasantness.

I'd do this in a heartbeat if I didn't already have things under good control. And yes, I'd miss the garlic.
Scott F
kathy smithkathy smithMember
Liz!!! I hope this is the answer for you. You've been struggling for way too long and it's damn time you were struggle-free.

I also like that the links you provided said it's a guide and not rigid. How long to stay on the elimination phase? "Don't stay on it any longer than you have to." It's a 'learning' diet. It also doesn't claim to cure anything but it may help manage symptoms. And if one isn't seeing results in a number of weeks then the diet isn't going to help and to try something else. I like that it's not so dogmatic.

I have everything crossed that this works - forever - for you.

kathy Big Grin
kathy smith
Laurie49Laurie49Member
Vanessa -- Kathy clearly quoted that the diet doesn't claim to 'cure' anything. However, if one doesn't see 'results' in a few weeks, then don't waste time with it and move on. I think this low FODMAP diet is all about common sense. It's important to have an elimination phase with any lifestyle change in terms of diet. Introducing one food group at a once you have reached your baseline is the only way to figure out what works and what doesn't.

I've had my pouch for almost 18 years and, although I have it pretty much figured out, I still need to change it up every now and then.

I certainly hope you find the answers you need at Mayo. Good luck.
Laurie49
CTBarristerCTBarristerMember
It seems to me that there are two distinct issues coursing through this discussion, malabsorption or intolerance of foods and bacterial overgrowth causing inflammation. Perhaps the issues are intertwined to some extent. In any event the more restrictive low carb/low sugar diets are being implemented by people with small bowel inflammation, whether pouchitis, Crohn's or otherwise, on the theory by Dr. Bo Shen that reducing the bacterial overgrowth will reduce the inflammation. It seems to me that systemic malabsorption is a wholly separate issue although I am not certain to what extent malabsorption is caused by bacterial overgrowth. I thought it was caused by your body not being able to secrete enzymes necessary to digest the foods.

For this reason the objective of the diet needs to be made clear before discussing the merits. If your goal is to isolate "problem foods" then the FODMAP may be a wonderful thing. If your goal is to believe Dr. Shen's theory that reducing bacterial overgrowth will reduce inflammation you may be opting for a more restrictive approach because as vanessavy said, it may take time to reduce bacterial levels and you may shorten the time period by increasing the restrictions on the bacterial overgrowth-inducing foods. It seems to me these issues are being mixed up and confused in this thread. The absolute 1st thing that needs to be discussed is what is the objective of the diet before one can proceed to discuss its merits.
CTBarrister
Last edited by CTBarrister
Jan DollarJan DollarModerator, RN, retired
I think the point is pretty much the same whether it is SIBO or food intolerance. I may be misunderstanding the concept, but my understanding is that the bacterial overgrowth can be dependent on specific food for the bacteria. Not all bacteria thrive on the same food, so the only way to know which food to eliminate that is specific to your specific gut flora, is an elimination diet. All bacterial overgrowth is not the same. The same could be true for food intolerance (which may actually be bacterial overgrowth for many people). Malabsorption can be due to inflammation, or from intolerances, which are likely genetic.

To have the least amount of restriction, you need to find out what the bad actors are.

Whether this takes a month, or more, or a year, I have no idea.

Jan Smiler
Jan Dollar

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