Few questions on increasing calorie intake with gastroparesis and SIBO

[Bergkamp]

Hi all,

29 year old male with ME/CFS and POTS (bedbound) for 2.5 years here. Haven't had any GI symptoms for 2 years but since about half a year I developed delayed gastric emptying. My main symptom is extreme gas buildup in my intestines, leading to basically 24/7 belching. Other than that I have bloating and constipation. If I eat too much, I wake up in the middle of the night with a belly that's so full of gas that I feel like exploding. It then can take me up to 12 hours to get it out so that I'm able to get food in again. The gas gets stuck very deeply within, so that it takes enormous effort to get it out - it comes out with extreme force. The belching takes such a high toll on my system that it puts me in sympathetic mode, worsening basically all my other symptoms. It's a vicious cycle.

My doc suggests SIBO causes the belching and I did quite some research and it looks like it. My current situation does not allow me to get tested at the hospital.

Anyways, I've lost a lot of weight over the past months and am trying to increase food intake. Right now I'm at 59kg and I'm 1.83m (6ft). It's starting to worry me.
I'm on a low FODMAP diet. My questions:
- what type of proteine shake would be recommendable? I'm looking for lactose free shakes but most are made from pea protein which is high FODMAP. Or is it not a big issue as it's in liquid form?
- Should I add olive oil for example, since it adds lots of calories, but is high in fat which is bad for gastroparesis? Does it make a difference that it's liquid fat?
- which other methods/products are there to increase calorie intake without it being either highly fermentable or bad for gastroparesis?

Thanks a lot!

 

[Pyrrhus]

I can share what helps with my episodes of gastroparesis, but it may not be a long-term solution, and I don't necessarily recommend it for others.

My episodes of gastroparesis typically last no more than 4-5 days, but those are particularly excruciating days. Basically, the lack of intestinal motility means that the food ferments in the intestines (SIBO), resulting in painful bloating. I am fortunate that my episodes are temporary.

When I get gastroparesis, I eat liquid-like nutritious food that is low in carbs and excess fat, such as chopped chicken breast with creamed spinach and whole milk. I give the food 24 hours to leak from the stomach into the intestines. Twenty-four hours later, I induce vomiting and repeat.

(I also stay away from all laxatives, as none of them work for me and some make things worse.)

Hope this helps.

 

[Plum]

With protein shakes I personally would try various protein powders in their simplest form i.e. just the protein in powder form, no additives. That way you know if you react to that protein.

Regarding calories - despite a lot of the advice given on GP I have found that I can eat more fat than is recommended. We get some very good coconut milk yoghurts in the UK which are high in fat. A few spoonfuls after a meal and that helps me. I also tolerate some veg and fruit especially if cooked. Pureed fruit designed as baby food can add an extra 50 calories to a meal for me.
I stick to protein I easily digest which for me is chicken and fish.
I struggle to get enough carbs so for me I have tea with homemade coconut milk (high in fat) and sugar 2 to 3 times a day after a meal.
I focus on everything being as nutrient dense as possible so even if I am not eating enough calories I am getting the most nutrition for the calories I do eat. The sugar I put in my tea is molasses so even that is a bit more nutritious than refined sugar.

 

[kangaSue]

There are no hard and fast rules around what you can or can't eat with having gastroparesis (delayed gastric emptying) and a lot of people with this can tolerate high fat content things. The only time fats "are bad for gastroparesis" is when they cause you significant GI symptoms personally.

 

[BeADocToGoTo1]

Hi all,

29 year old male with ME/CFS and POTS (bedbound) for 2.5 years here. Haven't had any GI symptoms for 2 years but since about half a year I developed delayed gastric emptying. My main symptom is extreme gas buildup in my intestines, leading to basically 24/7 belching. Other than that I have bloating and constipation. If I eat too much, I wake up in the middle of the night with a belly that's so full of gas that I feel like exploding. It then can take me up to 12 hours to get it out so that I'm able to get food in again. The gas gets stuck very deeply within, so that it takes enormous effort to get it out - it comes out with extreme force. The belching takes such a high toll on my system that it puts me in sympathetic mode, worsening basically all my other symptoms. It's a vicious cycle.

My doc suggests SIBO causes the belching and I did quite some research and it looks like it. My current situation does not allow me to get tested at the hospital.

Anyways, I've lost a lot of weight over the past months and am trying to increase food intake. Right now I'm at 59kg and I'm 1.83m (6ft). It's starting to worry me.
I'm on a low FODMAP diet. My questions:
- what type of proteine shake would be recommendable? I'm looking for lactose free shakes but most are made from pea protein which is high FODMAP. Or is it not a big issue as it's in liquid form?
- Should I add olive oil for example, since it adds lots of calories, but is high in fat which is bad for gastroparesis? Does it make a difference that it's liquid fat?
- which other methods/products are there to increase calorie intake without it being either highly fermentable or bad for gastroparesis?

Thanks a lot!

Hi @Bergkamp

Cut out the pea, that will definitely cause bloating, gas and belching! That is a hard one to digest and is an easy one to be sensitive to. Legumes in general can be quite tough, especially when you have issues digesting. I avoided all legumes for years and only slowly introduced in very small amounts when I got stronger. Also many protein powders and shakes are full of additives, sugars and chemicals. If you are down to only eating liquids your doctor will be able to set you up with medical food. I used Metagenics GI Sustain for many months, but in Holland there will be different brands. It includes key vitamins, amino acids, minerals, and fatty acids as well as calories to keep the lights on.

You are eating way to few calories based on your other post, and that will also cause damage and set you into a viscious cycle. Your body will cannibalize muscle for amino acids, bone for minerals in order to keep the body 'working'. Add an amino acid supplement (no need for the body to break down) to the mix.

Are you able to handle bone broth? Clear, chicken or vegetable soups? Home made in a slow cooker is optimal so you know all the ingredients that go in it. Home made soup was all I could tolerate for many months. Any and all restaurant and cafe food should be avoided of course.

If you are not sensitive to whey or casein, the protein powders that are purely whey might be helfpul for amino acids and calories (make sure they are super clean, organic, no sugar or fillers)? I use Vital Proteins organic whey protein that has just 1 ingredient.

Olive oil is great. So is a can of sardines, a piece of clean, hard cheese, or a handful of nuts if you can handle them. However, this is where the pancreatic enzymes come into play. If you are having trouble digesting and breaking these down it will cause all kinds of issues further down in your intestines. Undigested particles cause all kinds of havoc, pain, bloating, auto-immune reactions, bacterial overgrowths.

If it takes a while for the doctor to get you a prescription, there are over the counter ones like Dipan-9 (Thorne) or Enhanced Super Digestive Enzymes (Life Extension - Europe HQ is in Holland) that you can experiment with. They need to be taken with every single meal or calorie drink.

What do you use for oil for cooking and in products you eat? It is often overlooked and can also cause irritation. Many 'vegetable' oils are not vegetable at all, but GMO, highly processed seed, corn or soy oils and to be avoided when not well. Do any products you eat have butter in them or are cooked in butter? I have to take a lactase pill even if there was a drop of butter used in the pan otherwise I get bloating, gas and pain.

What do you drink beside the pea protein shake?

 

[BeADocToGoTo1]

SIBO and Candida

I would test it first to make sure that is even an issue, as resolving it requires anti-biotics (2 types) for SIBO and anti-fungals for Candida. This took 2-3 months. Have you done a breath test for SIBO or a urine metabolite test for SIBO and Candida? How about a Candida blood test to see whether it is systemic?

It might be best to find a functional/integrative medicine doctor who has experience with SIBO and Candida treatments. In my experience Rifaximin alone is not effective for methane related SIBO, which is what many prescribe. You will also need supplements to attack the biofilm (important!), pre- and pro-biotics. I took a 10 day course of both Neomycin and Rifaximin together along with all the other steps. For Candida yeast overgrowth some of the steps are similar, but the anti-fungal I used was Nystatin (From a compounding pharmacy, 1 million units per day for a month is what I did) along with things like botanical agents, enzymes, molybdenum, probiotic yeast, biofilm attacking supplements. But you have to also tackle food and beverage intake and be quite strict for a few months to not overfeed the critters whilst trying to rebalance the microbiome. I dedicated a chapter to the SIBO, Candida and acid reflux (not sure if this is an issue) steps I had to take to rebalance as it requires a multi-pronged approach. Temporarily stricter on yeast containing products (if you have Candida overgrowth), no milk, very limited fruit, no juices, no sodas, no alcohol, no deli meat (sugar), no gluten, etc. Have a look at what Mark Sisson or Chris Kresser mention about food, SIBO, Candida. There are herbal anti-microbial drops like Biocidin, oregano oil, molybdenum, Serralase (enzymes), Interfase Plus (biofilm disruptor), coconut oil (MCT), cinnamon, garlic, mustard, thyme, that are all non-prescription things that helped me.

Here is a study that might be of interest which covers a few of those natural treatments:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/

Stomach acid

Is your pH low enough to start digesting food? If it is too high this will exacerbate any SIBO, candida overgrowths, and malabsorption. Are you taking antacids or PPI? Do you suffer from acid reflux or silent reflux (without the classic heartburn pain). Have you tried the simple selftest.

A simple unscientific test to approximate acid level is by drinking a quarter teaspoon of baking soda (sodium bicarbonate) mixed in a glass of water on an empty stomach in the morning. This creates bubbles within two to three minutes when mixed with the hydrochloric acid in your stomach. If after five minutes nothing happens, there is a very good chance the pH of your stomach acid is too high (i.e., low stomach acid).

 

[Mary]

@Bergkamp - I used to have low stomach acid but before I knew what was going on , all I knew was that food would just sit in my stomach for hours, it felt like it wasn't being moving or being digested. Low stomach acid is very common with ME/CFS and can also lead to SIBO. Try the baking soda test @BeADocToGoTo1 suggests above.

I've been taking betaine HCL with pepsin (the pepsin is important for digesting protein) for many years and my digestion is now good. My doctor told me to start with one capsule or tablet with a meal and work up to a dose where I felt "acidy" and then to cut back by one. The dose depends on the strength of the betaine HCL with pepsin, I generally take 2 or 3 with meals.

It's made a world of difference in my digestion. Low stomach acid caused gallbladder and liver issues which are resolved. (plus I had to do a liver detox, unrelated, due to chemical solvents I'd been exposed at a job I had a long time ago)

 

[Rufous McKinney]

That is a hard one to digest and is an easy one to be sensitive to. Legumes in general can be quite tough, especially when you have issues digesting.

We were actually removing the outer skin of the cooked garbonzos before we made hummus and it helps.

Took a little time.

 

[BeADocToGoTo1]

We were actually removing the outer skin of the cooked garbonzos before we made hummus and it helps.

Took a little time.

Preparation of legumes is crucial to lower the amount of anti-nutrients like phytic acid (called phytate when bound to a mineral) and lectins (damage intestinal lining and can cause an autoimmune reaction). A healthy microbiome also helps as Lactobacillus and Bifidobacterium bacteria help break down phytates, which otherwise chelate important minerals from the body. But if your microbiome is out of whack it makes it even more difficult to digest. A side note is that some legumes can have a high glycemic index as well.

@Bergkamp - Are things like a boiled egg, a bit of fish, or chicken breast too hard to digest as well? One other protein powder that may be worth a try is Hemp as I find that easier to digest than pea.

One more side (perhaps too obvious) thought is that chewing food longer helps with digestion. You do produce some enzymes (amylase) through saliva to breakdown carbs, and chewing longer mixes it better. The smaller the bits are that your stomach acid and pancreatic enzymes need to break down, the more nutrients you will be able to get from them.

 

[Rufous McKinney]

One more side (perhaps too obvious) thought is that chewing food longer helps with digestion. You do produce some enzymes (amylase) through saliva to breakdown carbs, and chewing longer mixes it better.

I am now wondering if my recent bouts of delayed emptying....may also be associated with my efforts to reduce chewing.

I had a root canal issue that took three weeks to solve, during which time I avoided chewing and biting down on things...

Focusing now on a bit more chewing. to see if that stimulates the stomach

 

[Hopeful1976]

@Bergkamp - I used to have low stomach acid but before I knew what was going on , all I knew was that food would just sit in my stomach for hours, it felt like it wasn't being moving or being digested. Low stomach acid is very common with ME/CFS and can also lead to SIBO. Try the baking soda test @BeADocToGoTo1 suggests above.

I've been taking betaine HCL with pepsin (the pepsin is important for digesting protein) for many years and my digestion is now good. My doctor told me to start with one capsule or tablet with a meal and work up to a dose where I felt "acidy" and then to cut back by one. The dose depends on the strength of the betaine HCL with pepsin, I generally take 2 or 3 with meals.

It's made a world of difference in my digestion. Low stomach acid caused gallbladder and liver issues which are resolved. (plus I had to do a liver detox, unrelated, due to chemical solvents I'd been exposed at a job I had a long time ago)

Mary, do you take any probiotics and prebiotics?

 

[Mary]

Mary, do you take any probiotics and prebiotics?

I drink kefir a few times a week. About 4 years ago I had a period of over 6 months where I basically had diarrhea almost every day. A test for SIBO was negative. I tried several different probiotics, spent a lot of money, to no avail Then for the heck of it I tried kefir from Trader Joe's and within a week it all cleared up. And I periodically drink kefir (I used to drink it more regularly) and I'm fine. But for it's not a substitute for me for betaine HCl with pepsin.

 

[Rufous McKinney]

And I periodically drink kefir (I used to drink it more regularly) and I'm fine.

Wondering about how yogurt and kefir differ....apparently Kefir may deliver more BANG.

This seemed informative....

https://www.kefir.net/kefir-vs-yogurt/

"Yogurt contains transient beneficial bacteria that keep the digestive system clean and provide food for the friendly bacteria that reside there. But kefir can actually colonize the intestinal tract, a feat that yogurt cannot match."

 

[Rufous McKinney]

I drink kefir a few times a week.

My doctor recommended I not consume yogurt due to the lactose, and efforts to control blood sugar.

This small preliminary study- suggests kefir may be helpful...for diabetics....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401881/

Conclusion
Consumption of probiotic-fermented milk (kefir) in diabetic patients in comparison with conventional fermented milk decreased the fasting blood glucose and HbA1C levels. Compared with two groups, serum level of total cholesterol declined but this reduction was not statistically significant. These findings suggest that probiotic fermented milk can be useful in medical nutrition management of diabetic patients.

 

[Mary]

But kefir can actually colonize the intestinal tract, a feat that yogurt cannot match

This small preliminary study- suggests kefir may be helpful...for diabetics....

@Rufous McKinney - thanks for the info, very interesting! Maybe this is why kefir works so well for me, definitely better than yogurt and better than any probiotic I've taken. And it doesn't take a lot to work for me. Initially I drank it every day when my digestion was so screwed up, but once I got stabilized, drinking it 3 times a week was enough, and now I drink even less! Though I should go back to at least 2 x a week.

 

[kangaSue]

But kefir can actually colonize the intestinal tract, a feat that yogurt cannot match.

I've seen kefir suggested to come out on top as the most beneficial of the probiotics in a couple of different studies where sampling of the microbiome was used before and after to see which probiotic had the most effect on improving the gut bacterial balance.

Filmjolk is a Scandinavian strain of kefir that some people find has a much more palateable taste than the European kefirs.
https://forums.phoenixrising.me/threads/how-filmjoelk-has-saved-my-gut.78484/

I've tried many different probiotics (including filmjolk) but I'm yet to find something that doesn't make me vomit in having gastroparesis.

 

[Belbyr]

Are you in the U.S. ?

If so, set up an appointment with Dr Abell's group at the Jewish Hospital in Louisville, KY. I just had my first visit with them. I will have to return at a later date to do testing, but they seem to be really on top of their game. They have shrunk the 'idiopathic gastroparesis' group to a very small number after they do their tests. Many patients find their cause and I am hoping they find mine.

 

[Rufous McKinney]

Many patients find their cause and I am hoping they find mine.

My gastroparesis seems to be clearing...I got one acupuncture treatment from an expert and am taking chinese herbs specifically for that. Those herbs were added to the herbs i normally take for IBS-d. Between both those things...my system feels very "different" at the moment....like its somebody elses body.

And I stopped some vagal nerves stimulating activity I was doing- which was an additional variable. Maybe my vagal nerve massaging- was telling my stomach to go to sleep.

 

[BeADocToGoTo1]

My doctor recommended I not consume yogurt due to the lactose, and efforts to control blood sugar...

Thanks for the link. It is something to check with your glucose meter. But, that is why it is better to stick with plain and full fat versions. Organic raw Kefir versions also taste great, and some tout more beneficial. I wonder if buttermilk will have similar potency as Kefir.

 

[Bergkamp]

Hey @BeADocToGoTo1 , thanks for all the tips, apols for the late reply.

Cut out the pea, that will definitely cause bloating, gas and belching! That is a hard one to digest and is an easy one to be sensitive to.

I'm not eating any pea (protein) lol, I think you misunderstood my post. I avoid it like the plague!

Are you able to handle bone broth? Clear, chicken or vegetable soups? Home made in a slow cooker is optimal so you know all the ingredients that go in it. Home made soup was all I could tolerate for many months. Any and all restaurant and cafe food should be avoided of course.

Yep, I'm eating chicken bone & vegetable broth made by my mom. I haven't eaten a meal outside my bedroom for 2 years so restaurants and cafés are easy to avoid

What do you use for oil for cooking and in products you eat? It is often overlooked and can also cause irritation. Many 'vegetable' oils are not vegetable at all, but GMO, highly processed seed, corn or soy oils and to be avoided when not well. Do any products you eat have butter in them or are cooked in butter? I have to take a lactase pill even if there was a drop of butter used in the pan otherwise I get bloating, gas and pain.

What do you drink beside the pea protein shake?

My mom cooks with coconut oil.

I bought egg protein shake which I drink with almond milk. It's pretty ok to drink and easy on the stomach. Also, I've gotten quite some benefit from ileocecal valve massage, which is accelerating my gastric emptying and helps a bit with the belching. For the last week, I was able to eat decent amounts because of this.