Firstly, I’m much better than I have been. I’m by no means out of the woods but there is very strong light at the end of the kennel. (Thank you Nick Harper!) I’m to be treated as if I have small intestinal bacterial overgrowth (SIBO), along with irritable bowel syndrome (IBS). (I wish I’d recorded the conversation with the GI specialist – then I might recall the link between these two conditions.)
Medication and treatment
There will be medication for the SIBO. On Monday the GI specialist suggested three options: no change to the current medication; antibiotics for a few weeks (these would be antibiotics that don’t cross the gut wall – one of them isn’t on the regular NHS list of prescribable drugs and so might be difficult to obtain); or a longer course of a SIBO-specific drug. This is the one I opted for. I can’t remember the name of this drug but I should be reminded on Monday when I see my GP. The specialist was going to email her to ask her to prescribe this drug. Previously when he has written to her I’ve been copied in. I’ve seen nothing yet so here’s hoping.
For IBS, I am to avoid FODMAPs: Fermentable Oligo-saccharides (fructans & galactans), Di-saccharides (lactose), Monosaccharides (fructose) And Polyols (sugar alcohols). These tend to hang around in the gut and ferment, giving rise to constipation, diarrhoea, and other unpleasant symptoms. Apparently everyone is poor at digesting these but people with IBS are exceptionally poor at doing so, so they really notice the symptoms.
I don’t see how SIBO and IBS can cause the random pains in my legs and feet, but they might explain the fatigue. That’s the biggest nasty just now, followed by the leg pains which delay me getting to sleep. The gut pains are mostly an inconvenience just now. I can wear my normal cycling shorts for a while, I’m back to spinning at least once a week and I was pleased to cycle to Shawfair Park Hospital to see the GI specialist. There’s a long steep hill (ooh – at least 5%!) which almost had me out of the big ring (a major infraction of the Velominati rules but they only apply to road-racers so I’m not that bothered), crawling along so slowly that Lev’s dynamo stopped charging my phone. But I made it, and I can feel that eventually I will be as cyclopathic as I was before this all started. best of all, the specialist has said that it’s safe for me to travel. We’re both looking forward to a couple of weeks out of the UK, tootling about on hired touring bikes and imitating Don Quixote!
More on FODMAPs
During the initial illness I may have been my own worst enemy. For several weeks I was so bloated and uncomfortable that I could only take small amounts of comfort foods such as microwaved frozen peas with a dash of vegan salad cream. Well guess what: peas are high in FODMAPs, so I was probably just aggravating the condition. Other no-nos include: onions and garlic (it’ll be hard to avoid these); all forms of wheat, rye and most other grains; apples, pears, peaches (duh – fructose!) and quite a few of my favourite foods. Fortunately rice, tofu and most vegetables are OK. Sprouts are on the approved lists, although they make me noxiously flatulent.
The basic plan is to avoid all FODMAPs for 6 to 8 weeks, then slowly reintroduce small amounts of potential nasties to see whether they set me off. Apparently everyone has different reactivities to different FODMAPs, so what’s bad for me might be tolerable to another IBSer and vice versa. This will restrict eating out, but I can always carry rice-cakes and peanut butter. I’m not yet sure how long it takes for a ‘bad’ food to start causing symptoms, so I’m not yet able to start experimenting. Still, I have over a month to find out.
My sources for FODMAP information are
- the app created by Monash University – that’s australian so it must be right
- this web-page
- a source for vegan no-FODMAPers
- another source for vegan no-FODMAPers, including a handy chart of ‘good’ and ‘bad’ foods
Inevitably there are some contradictions – one source says chickpeas are OK-ish, another says to avoid them completely – but I shall live, learn and try not to be noxious!
Would laying off the veganism help in terms of nutrition?
I don’t know but I suspect not: leaving ‘irritants’ out of my diet is one thing, but introducing things that my digestive apparatus hasn’t had to deal with in years may be a retrograde step. As I understand it, pro-digestive bacteria may have lost the ability to deal with things. I will ask (FYI only) if I get to see a dietician.