In August, Matthew started a three-month protocol designed to tackle biofilm-protected yeast colonies his gut.
Five months later we are feeling optimistic.
The Back Story
The symptom: debilitating nausea with no apparent cause.
The nausea first occurred in October 2013 after an autumn feast of chanterelle mushrooms I had picked.
It happened again when we ate chanterelles a second time that month.
And then just kept recurring. And getting worse. Until it gradually became Matthew’s most problematic symptom.
In fact, it was the severe nausea that finally prompted Matthew to take the leap and commit to the Autoimmune Protocol (AIP).
After a few test runs, we both committed to the AIP long-term in December of 2013. Almost immediately, Matthew moved to an even more restrictive low-FODMAP version of the protocol to reduce his nausea.
Improved all of Matthew’s other symptoms, including arthritis pain, psoriasis and severe brain fog;
Enabled him to get off Methotrexate, a toxic medication that he had been taking for 10 years that caused its own host of nasty side effects;
Helped him significantly reduce prescription and non-prescription pain medication; and
Caused me to feel younger and more vital than I had in my adult life.
But Matthew’s nausea kept getting worse. Read More
Like a one-love sauce, it’s universal. You can put it on everything and, in turn, it makes everything sing.
A gemolata is traditionally made from parsley, lemon zest & garlic. A pesto with basil, parmesan, pine nuts & olive oil.
This low-FODMAP fusion variation takes advantage of the low melting point of coconut oil to create a bright green sauce that is firm and crumbly when chilled & exultingly melty when it hits the hot components of your meal.
It omits the garlic, dairy and nuts. And uses a combination of fresh basil and spinach, making it slightly more of a food than a condiment.
Yet another way to get your greens on~.
Like both its Italian grandmothers, this combination gremolata~pesto is zesty & green.
And it makes more than you probably need for one meal, so you’ll have some leftover.
To brighten a mug of hot bone broth. Or add to salad dressing. Or crumble on top of tomorrow’s breakfast.
Gremolata~Pesto is also the secret to a quick supper.
Bake or pan fry some fish. Saute some zucchini spears in turmeric. Top with your new special sauce.
Quick. Fancy. Green.
Gremolata~Pesto (AIP & low-FODMAP)
2 cups (packed) fresh Basil
2 cups (packed) Spinach
2 tablespoons Lemon Juice
1 teaspoon Himalayan Salt (or similar)
1/3 cup Coconut Oil
1 tablespoon minced Lemon Zest (from an organic Lemon)
Put the Basil Spinach, Lemon Juice and Salt in a food processor.
Heat the coconut oil slightly, until just warm and liquified & pour it over the other ingredients.
Whirl, until a crumbly puree forms, scraping down the sides with a spatula once or twice, as required.
Transfer the mixture to a bowl or glass container, add the minced Lemon Zest and stir to combine.
Serve immediately or store in the refrigerator for good times to come~.
Note: the gremolata~pesto is low-FODMAP, but not all of the foods in these photos (like avocados) are.
Nausea: As I mentioned in my post Dietary Treatment for SIBO, after 9 days on this new Protocol, Matthew’s unexplained and debilitating nausea went from a 7-10 on a scale of 0-10 to a 4-6. And stayed there. Two months later, his nausea is still in the 4-6 range. This reduction has enabled him to participate in life, including cooking for himself (and me), engaging in moderate exercise, and doing things around the house. But the nausea has plateaued at the 4-6 level and that is barely tolerable much of the time.
Brain Fog: Over the past 2 months his brain fog lifted further. He’s winning at scrabble again. For the first time in years.
A New Hypothesis
Our Functional Medicine Doctor, Dr Cline, was as perplexed as everyone else about Matthew but (unlike everyone else) he didn’t give up.
Dr Kline talked to several colleagues and has a new hypothesis: yeast colonies protected by biofilms in the gut.
Biofilms are communities of microscopic organisms, such as bacteria and yeast, that produce their own protective matrix.
Organisms inside a biofilm are highly resistant to eradication attempts and, it seems, are also capable of complex, coordinated behaviour like quorum sensing.
The hypothesis that Matthew is colonized by biofilm-protected yeast colonies in his gut comes from a re-analysis of the results of a comprehensive stool analysis that Dr Kline ordered last year.
As Matthew had been on a low-FODMAP AIP for quite some time when that test was conducted, his results were better than any Dr Kline had ever seen.
Apparently, he should have been feeling great!
But he wasn’t.
The trace amounts of yeast in each of the three tests didn’t seem consequential at the time. But the specialist Dr Kline consulted with, Dr Tom O’Bryan, thought they were. Quite.
Vratislav Šťovíček, Libuše Váchová and Zdena Palková explain: “Pathogenic yeasts can colonise various surfaces within the human body, including host tissues… and form biofilms that resist otherwise effective drug therapy. Biofilms are thus very difficult to eliminate and serve as a source of serious systemic infections.”
Apparently yeast can grow roots, called hypha, which can puncture the intestinal wall and thereby create intestinal permeability (leaky gut). So even though Matthew has been on increasingly restrictive gut healing protocol for a year & a half, if the yeast is armored inside biofilms and putting down roots, his gut is still leaky.
It makes sense~.
A New Protocol
Dr O’Bryan has recommended a 3-month protocol designed to attack the biofilms and eradicate yeast colonization, with supplemental colostrum for gut-healing.
He has also recommended an ‘Intestinal Antigenic Permeability Screen’ from Cyrex Laboratories to measure Matthew’s gut permeability before and after the protocol. That will enable us to get a baseline and then measure any improvement.
I created these muffins a year ago as a way to overcome my squeamishness about eating organ meat. Since then, Victorious Muffins have become an absolute staple at our house, because:
They freeze beautifully & reheat quickly (even from frozen) in the oven, making them a perfect AIP ‘fast food’;
They provide a regular dosage of organ meat without ever having to decide ‘today is the day I am going to prepare & eat a weeks worth of liver’ (because that day might never come);
They make me feel GREAT~! I specifically plan to have one for breakfast on days when I have to facilitate a challenging meeting or make an important presentation at work.
Over the past year we’ve tried all kinds:
Ground elk, venison, water buffalo & lamb;
Liver from ducks, lambs, cows, chickens & bison;
Wild boar bacon, pork belly & wild boar belly;
Various vegetable & herb combinations.
At the moment, Matthew is on an extreme gut-healing protocol that omits cured meats (no bacon~!) and allows very limited carbohydrates. Therefore, this version of the Victorious Offal Muffin recipe is the ‘Uncured Remix’. Unlike the original recipe, this remix is low-FODMAP & is also compliant with Matthew’s current protocol (as outlined by Aglaée Jacob in her book Digestive Health with Real Food).
Victorious Offal Muffins: the uncured remix (AIP & low-FODMAP)
But the nausea has not been responding. It’s been worsening. Slowly. For a year.
Until this April when he was hardly eating & was almost completely incapacitated.
We determined the nausea is NOT autoimmune & will require a different treatment. So we set out to hack that.
All the specialists, including his functional medicine doctor, have poked, prodded, tested and hypothesized & come up with nothing. Then shrugged & left us alone with a deteriorating, undiagnosed, unresponsive health issue that has caused Matthew to be unable to work since December 2013.
We’ve suspected Small Intestinal Bacterial Overgrowth (SIBO) for a long time.
Despite the fact that Matthew’s Gastroenterologist says SIBO doesn’t exist.
Small Intestinal Bacterial Overgrowth (SIBO)
SIBO is a condition in which beneficial bacteria become displaced in the digestive tract.
They migrate from the colon, where they are supposed to be, into the small intestine. This results in fermentation of carbohydrates in a part of the gut where fermentation is not supposed to occur, causing gas, abdominal pain, constipation or diarrhea, heartburn &/or nausea. Symptoms range from mild to debilitating.
SIBO causes primary symptoms, but it also contributes to intestinal permeability (‘leaky gut’) which is implicated in autoimmune & other chronic health conditions.
Treatment options include specific pharmaceutical antibiotics (such as Rifaximin), herbal antibiotics or a dietary protocol that makes a low-FODMAP AIP look like a cakewalk (at least at first).
Experts seem to disagree about whether it is possible to treat SIBO through diet alone.
As SIBO experts Allison Siebecker & Steven Sandberg-Lewis explain, “diet alone has proven successful for infants and children, but for adults one or more of the other three treatment options are often needed to reduce bacteria quickly, particularly in cases in which diet needs to be very restricted to obtain symptomatic relief.”
After combing thorough the research it remains unclear to me whether it is truly impossible to cure SIBO through diet, or if maintaining the required protocol for a sufficient length of time is considered too difficult, or too risky from a nutritional standpoint.
We have learned that Matthew’s diet definitely needs to be very restricted to obtain symptomatic relief, but nevertheless he is taking a dietary approach.
Partly because he tried to get a prescription for antibiotics to treat SIBO but was turned down by two different doctors, who cited their own ignorance about SIBO & the fact that he was in such rough shape. Neither was wiling to risk making him worse.
According to Angie Alt, it can be extremely challenging to get a prescription for antibiotics to treat SIBO here in Canada.
So, as of a month ago, Matthew is following the elimination diet outlined by Aglaée Jacob, in Digestive Health with Real Food. Lots of bone broth (no surprise there!), no caffeine & the only carbohydrates he is eating currently are carrots & spinach.
This is meant to be a short-term elimination diet, until symptoms have been ‘mostly absent’ for at least five consecutive days. According to Aglaée, this may take 3-4 weeks, but up to 8 weeks for particularly intransigent cases.
We were pretty confident that Matthew’s gut was the intransigent type, so from the beginning we figured he’d give it an 8 week trial.
He is now 5 weeks in.
At the beginning he was almost completely disabled. Unable to care for himself.
Not only was he suffering excessively, I was drowning in stress. We were back where we’d been at the worst of his autoimmune crisis: I was caring for him; keeping the household running, including all the food prep & cooking that is required on the AIP; keeping up with a demanding career (currently our only option for income); parenting; and worrying constantly about our future.
That was our baseline.
Within 9 days on this new protocol his nausea had reduced from a 7-10 (on a scale of 0-10, in which ‘0’ is no nausea and ’10’ is completely incapacitated) to a 4-6.
One month in, he is still in the 4-6 range. And as he says, the difference between a 4 and a 6 is “at 6, I’m just tending to my immediate needs whereas when I’m a 4, I can be more thoughtful and proactive about life. Over 6 and I can’t really take care of much”.
As Matthew’s spouse, I can vouch for that.
This post is part 1 of a 2-part series. Find part 2 here.
Thanks to the Autoimmune Protocol, I revere ordinary vegetables.
Even carrots, which previously seemed as though they didn’t require my positive regard.
I’ve found if I focus in on one vegetable, really contemplate it, including the ways I can incorporate it as food, I naturally develop a profound respect ~reverence~ for it that I didn’t have before.
That reverence changes my attitude toward the food I eat.
Why not worship food? Bless it. Devote ourselves to it.
Even a humble carrot.
I got into that kind of reverence with turnips recently.
A Bisque, traditionally, was made with seafood broth, and one could certainly use a seafood stock in this recipe. The original version also incorporated the ground mollusc shells as a thickener. And to add minerals.
I want to try that.
But this is not a bisque in that sense of the word.
This is a pureed soup. A delicious vehicle for Bone Broth.
Made with love. From carrots. And optionally garnished with spinach~lime coulis.
1/2 cup green onions, chopped (green part only for low-FODMAP)
2 large or 3 medium bunches chard
1 1/2 cups no-additive coconut milk
4 portions Halibut
2 tablespoons Coconut Aminos
2 more teaspoons Himalayan Salt (or similar)
1/2 cup chopped Cilantro
Place chopped Turnips, Water and 1 teaspoon Salt in a large frying pan with a lid. Turn heat to medium-high and simmer, with the lid offset slightly, until the turnips are softened and the water has evaporated.
Meanwhile, prep the green onions and chard. Use scissors to cut the thick sections of chard stem from the leaves. Chop the chard stems finely. Add the coconut oil to a second frying pan on medium heat and sizzle the chard stalks gently with the chopped green onions.
Cut the chard leaves into manageable pieces. Once the chard stalks have softened, add the leaves to the pan with the Coconut Aminos and 2 teaspoons of salt. Stir to wilt.
Once the water has evaporated form the turnips, turn the heat down to medium, and add the coconut milk to the pan. Nestle the fish portions in the turnips and place the lid on tightly. Cook for 10 minutes, slightly longer if the portions are very thick.
Plate the greens first, then the Coconut-Poached Halibut & Turnips. Garnish with chopped Cilantro.
Low-FODMAP: Coconut is low-FODMAP in small quantities. Moderate consumption of the poaching liquid.
How do you navigate a family reunion full of potato chips, beer, pasta (& family) when you’re on the Autoimmune Protocol? Here a couple of ideas & a recipe. ‘Cause we just successfully survived one~.
A Weird Diet called the AIP~?!
One of our strategies was a nightly salad bar with supper. All the ingredients prepped and presented for everyone to make a build-your-own salad with a choice of store-bought & homemade AIP dressings.
Picky children could pick what they liked and it was easy for Matthew to make a low-FODMAP salad without having to explain why he doesn’t eat broccoli or kale, but can eat arugula and cucumber.
Another tactic was putting delicious and festive low-FODMAP AIP entrees on the menu, like this one, that had everyone raving (for days) without even knowing a thing about FODMAPs and having only the sketchiest notion that Matthew and I are on a weird diet called the AIP.
Of course, the family infilled their meals with grain and potato-based starches, but we interjected turnips and yams into that rotation occasionally, and added sauerkraut to the offerings at meals, which was mostly politely ignored.
All the more for us~!
Mahi-Mahi is a common fish in Hawai’i, so it only makes sense to pair it with papaya (currently in season) and pineapple in a fresh AIP-friendly salsa for a tropically-themed (low-FODMAP) extended family party meal.
Mahi Mahi with Pineapple~Papaya Salsa (AIP & low-FODMAP)
½ cup green onion greens, chopped (use the white ends too, if FODMAPs are not an issue)
Juice of 2 lemons
2 teaspoons Himalayan salt (or similar)
1 thumb fresh ginger, peeled & minced finely
Turn the grill on medium or preheat the oven to 350.
If baking, lay the Mahi Mahi portions on a parchment-lined baking sheet and bake for 10 minutes an inch until the fish is opaque, moist & just flakes with a fork.If grilling, lay the portions gently on the grill and cook quickly (6-10 minutes, depending on thickness), until it becomes opaque & just begins to flake. Don’t overcook this lean fish~.
Meanwhile, or (perhaps) earlier in the day, remove the rind of the pineapple with a sharp knife and cut the fresh fruit into a dice. If the pineapple is large, you may need to cut the tough centre section of the fruit even smaller, or omit it entirely. Repeat the peeling & dicing with the Papaya, removing the seeds.
Mix the diced fruit with all the remaining ingredients. The salsa can be made ahead or served right away. Serve each portion of the Mahi Mahi with a generous helping of Salsa.
Mahi Mahi is the Hawai’ian name for a fish that is also known as Dorado in Latin America, Shiira in Japan or Dolphinfish in the United States, reflecting it’s international presence. Mahi Mahi can be found in warm oceans around the world; in the Atlantic from the Caribbean to Africa, and throughout the Pacific from the Americas to Asia.
Paleolithic Mahi Mahi
This fresco tells us that humans have probably always eaten the distinctive-looking Mahi Mahi, and that they definitely harvested them during the Minoan Bronze Age in Akrotiri on the island of Santorini (then Thera) in ancient Greece. One of the largest volcanic eruptions in recorded history on Thera in 1627 BCE preserved this and many other artifacts under hundreds of meters of ash.
Human activity in the fishing village of Akrotiri has been traced back to the 5th millennium BCE, when people likely still ate Mahi Mahi. Evidence indicates that humans, and their early hominid ancestors, have lived and fished on the Greek islands since the Middle Paleolithic around 128,000 BCE. As there were no signs of agriculture in the islands until recently (7000 years ago), I’m guessing they ate a lot of fish for those intervening millennia.
The Environmental Defense Fund has classified line or pole-caught Mahi Mahi from US waters as ‘Eco-Best’, its top ecological rating. The Natural Resources Defense Council has given it the second lowest of four categories of mercury toxicity, calling it a ‘moderate mercury’ fish.
He goes to butcher & gets an enormous bag of pig fat (this makes our butcher happy). Enough for a couple of slow cookers full. For about $12.
He chops up the fat & slow cooks it. Freezes the fat he doesn’t use in the first round. Then we use the lard for cooking & Matthew also uses it in his other new hobby: Autoimmune Protocol (AIP) baking.
For our first 12 months on the AIP we did no baking. But suddenly, on the advent of year 2, Matthew tried a couple of recipes & now makes AIP shortbread somewhat regularly (substituting his home-rendered lard for the palm-oil shortening).
Being ketogenic, I don’t eat his shortbread much, but he says it increases his quality of life and is helping him get through the winter.
Why lard? Lauren Geersten at Empowered Sustenance offers 10 reasons.
The 11th reason is that you get cracklings as a delicious by-product of the rendering process.
And making one’s butcher happy could easily be reason #12 (never underestimate the potential benefits of a happy butcher as an element of biohacking success~).