SIFO? and constantly making changes.

I've been doing great since March, as I mentioned in my last post. However, starting around November it was more of a challenge to maintain a state of wellness. It's difficult to stay on top of all the moving parts that keep me feeling my best, especially in times of financial or physical (working late, etc.) hardship. I found that my body was inflamed and was more difficult to "chill out" than usual. (For me, this means I'm low-level bloated after eating almost anything, my eyes are puffy and tired looking, I'm sluggish, brain foggy and prone to be moody AF.) I was taking the supplements that usually helped me to reduce inflammation, doing my diet (fairly well) and maintaining lifestyle interventions. In all transparency, towards the end of the year, the issue was that I'd indulge in something (maybe more alcohol than usual or starches I usually stay away from) and then before I could "chill out" my system (which usually takes a week, for me) I'd have something else and the cycle would continue. 

Because the diet that makes me feel great (right now) is so limited in variety, I also had a suspicion that maybe we hadn't completely solved the puzzle. I'd cleared SIBO in 2015 (we tested 3x and besides, the diet I consume would mitigate any remaining imbalance there). I haven't been able to reintroduce anything beyond greens, cucumber, limited amounts of tomatoes and avocado and small amounts of fermented foods into my diet. For the sake of my quality of life, I'd like to be able to tolerate some more foods, mainly vegetables. It would really make eating out more fun and tasty. Not to mention, while greens are packed with vitamins and minerals, I'd like to get a wider variety from other foods.

I had been listening to Dr. Ruscio's podcast and some others and hypothesized that perhaps my gut was still in a state of dysbiosis or perhaps there was a pathogen I was keeping at bay but hadn't eradicated. It's possible I'd cleared SIBO but not all of a fungal overgrowth (Candida or otherwise) that could have been there in the first place. I also know that while not diagnosed (for those concerned if i've "been diagnosed", it's a thing, LMGTFY!) with Crohn's Disease but suffering from the symptoms of it and benefiting from the treatment of an IBD like Crohn's, that it's possible that I am destined for a Low FODMAP diet forever. Research shows that people with IBD that go off of a low FODMAP protocol, often get worse. However, as the ever (now greedy) wellness consumer, I'm willing to try all my options.

I knew the first step was on me. I had to get back into a wellness routine that I knew worked for me. January first, I decided to do the elemental diet (I've done the semi-elemental diet in the past, which I do not tolerate well.) I did this for 3.5-4 days, a short, reset period. It's homemade, you can get the list of ingredients here. The purpose of this experiment was to see if I removed digestion from the equation by consuming this pre-digested liquid diet, could I get my body to de-bloat and "prune" (as Dr. Ruscio likes to say) back any initial overgrowth of either fungus or bacteria in my gut. I also committed to doing the first month of an herbal anti-microbial/anti-fungal protocol. It's the same one that I'd done with SIBO, just to prune back anything that had gotten out of control between November and January. 

It turns out, I tolerate the elemental diet very well. I was tired the first day and had a headache but that's pretty typical for me as a withdrawal symptom. I was symptomatic for the first two weeks of the antimicrobials/antifungals which indicates to me that I had some dysbiosis and/or fungus in my gut. I set a follow up meeting with Dr. Ruscio for the next month to discuss what I suspected and to talk about doing the second month of antimicrobials/antifungals which were more geared toward fungus, or if he had another suggestion.

In talking to Dr. Ruscio, I let him know the symptoms I was still experiencing: Low-level bloating, inability to add in more vegetables, some fatigue depending on lifestyle. He suggested that it's possible that I may have a microbiota that needs occasional "pruning" and is prone to overgrowth if not kept in check. The suggestions were the following:

• Consider doing periodic bouts of the elemental diet (the one I tolerate) to give my digestion a break and starve out any dysbiosis. 
• Do a round of the 2nd month of SIBO/SIFO treatment (the antimicrobials/antifungals)
• Consider doing a round of Fluconazole, a pharmaceutical intervention for SIFO that doesn't show adverse effects on the mirobiota. (TBD if i do this in addition to the protocol above) 
• Consider going on LDN or low-dose naltrexone, an immune booster now commonly used for those with autoimmune diseases. (It's his opinion based on research that my body's immune system attacks my microbiota, if this drug can help calm my system down from being on red alert all the time, perhaps I'll feel better.)
• Do a week of a low histamine diet. I had additional concerns that maybe I have histamine intolerance (which may or may not be affected by the possible fungal presence). I have sometimes have allergic symptoms when consuming wine, my heart races after eating some foods, I flush when I have too much or certain alcohols and I am sometimes intolerant to fermented foods. My hypothesis is that this will change after antifungals, but we'll see. I do better when I avoid these foods, currently.
   

I have reservations about pharmaceutical interventions.
Taking antibiotics throughout my life, I believe, helped me to arrive in this condition.
I'm starting with the herbal antimicrobials/antifungals and then we'll consider the rest of the options in a month or so. 
I'll update the site then!

A Couple of Side Notes

COST
I have a Covered California health care plan, the cheapest one that covers the least. Dr. Ruscio doesn't accept insurance so he's out of network no matter who I'm covered by (though his office does encourage you to super bill your insurance for their fees.) After 2015, I knew that my health care costs would be fewer in frequency and less in cost. I chose to downgrade the coverage I had to save money monthly (but not bankrupt myself if I have an accident). I do still have an HSA so if I make any money via w9, all of that money can go to paying me back (income tax free!) for any healthcare costs I incur during the year. This is one way that I help pay for my wellness on a budget.
Additionally, as Dr. Ruscio is an FMD, I needed a prescription written for the Fluconazole and the LDN (whether or not I fill them and take them we'll decide at a later date). Rather than paying another doctor for an appointment to get that written, I used my FREE (thanks #ACA) physical appointment to consult with my General Practitioner (who admittedly said he literally knows nothing about what I'm doing but if it works, then he's for it) and have him write me those prescriptions. That saved me an additional $150 on a doctor visit. 
 

In other exciting news, our new album is available for Pre-Order!

RESEARCH
Here's the info that I heard that made me consider SIFO or fungus a lingering issue:

• SIFO with Dr. Satish Rao
   
• LDN, Autoimmunity, and How SIBO Causes Symptoms Outside of the Gut with Dr. Leonard Weinstock
   
• SIBO Updates with Dr. Allison Siebecker

• Reacting to fermented foods? Could be a histamine intolerance

The Road to Recovery (or "Something is working!")

Hieeeeee. I've been waiting to post an update. I wanted to live with some dietary changes and lifestyle habits before writing.

Shocking revelation: I've come to find, that unfortunately, there may not be one diet that suits me.

When i started the more recent part of this journey, the last 2-3 years or so, my goal was to have a very specific list of foods i could and could not eat. Dream scenario: I would just stick to that and my skin would clear up, my energy would return and i wouldn't look pregnant after eating. Well folks, I'm sorry to say that may not be in the cards for me. 

It's become obvious to me through all of these dietary changes, treatments and experiments that one diet for the rest of my life isn't realistic. Not only am I in a different phase of healing than i was 2 years ago but so many factors affect my digestion, energy and general sense of well-being.

Um, so what's the good news? Why should I even listen to you?

The good news is that I AM feeling better.

When i'm tired on the road (Dustbowl travels 200 days a year now(!)) i feel like a normal tired person. I don't feel exhausted or like "how could i possibly get up there and perform this show right now/get out of bed" (which is what a lot of the past 2 years felt like.)
I don’t feel tired all the time. it’s not a perfect result. If i have some FODMAPS, or too much alcohol or something else that inflames my system, i feel like going to sleep. (I often will sleep if I can and that’s what my body is asking for.) But overall I’m feeling more "tired like the average person on a tour that doesn’t get regular sleep".
I also don't feel cripplingly depressed anymore which is a huge relief.

My skin has improved dramatically. The only treatment that seemed to budge that symptom was doing chelation. While it was expensive (and I'm still paying for that year of medical bills, thanks insurance!), I believe it was very necessary for me to rid my body of those toxins. My skin is proof of that.

Digestion wise, my diet is still very limited. But, if i stick to food in my life being practically perfect (in terms of what makes me feel best and not "what I'd like to be eating") then I can get away with this crazy tour lifestyle of never sleeping at the same bedtime and experiencing light to moderate stress on a consistent basis. I have energy and I am more patient, pleasant and physically comfortable.

HSP/Empath

The last 3 years or so have definitely been more about food for me. A lot of self-searching, a lot of self-love practice (still a lot of work to do there) and self-acceptance practice has been instrumental for my physical progress. The more I do this internal work, the less likely I am to self sabotage by going "off diet" as a way to distract my heart and mind from what it's feeling.

A friend of mine suggested in the past month that I should read "The Highly Sensitive Person" a (self help) book about people who are easily overwhelmed by the world around them (stimuli) and their internal, emotional lives. I've been told my whole life "you're so sensitive" which, i often took as a criticism. That I should not be hurt or affected so deeply by everything. I always have been. I cried and almost threw up and had to run out of the movie theatre during the end of Edward Scissorhands (spoiler alert) when the town is chasing him. Similarly, I leapt out of bed to go bawl in the bathroom just this year when Brahm and i rented Chappie and (spoiler alert) the kids were throwing rocks, teasing and kicking him. And it obviously doesn't end with movies...

I've seen HSP lately all over the place, others confirming I'm not alone in essentially being shamed for operating from a place of feeling and intuition. It's real, I pick up on nuances that are definitely there and that not everyone picks up on in relationships, in conversation, in the temperature of a group. It's also called being an Empath which i think is seen as a little more woo woo. I'm beginning to let go of the self judgement that's been impressed upon me; it's gonna take some time.

I used to think this was a weakness. I realize now:

THIS IS MY (not so secret) SUPERPOWER.

Though annoying/eye rolling/tease-inducing to some, I think reading this book was one way for me to accept that yes, I am sensitive, but it's not something i need to hide or tuck away or PROVE myself out of. Being sensitive means that I have an explanation for the chronic empathy (or lastima as Katya would say) that i experience on a daily basis. I can revel in the emotions i feel while singing and then give that gift to our audience (or to myself if i so choose). It makes me a more intuitive friend and wife. 

I am still struggling with the New England work ethic i have, where i wrap up all my self worth in the job i'm doing and then harshly criticize myself for not being better. This whole life I've spent working to prove that i deserve a place on this planet. I wonder what it's like to feel like you're meant to be alive and not that you have to earn your keep.

It extends to physicality as well. If I weren't so sensitive (HSPs are statistically more likely to have digestive/autoimmune issues) who knows if I would have made all these changes to my life and ended up in a healthier, happier place? I've been eating "so clean" for so long that I can really feel the difference if I introduce a food that doesn't agree with me now, or if i over do it with booze (which takes much less, than It used to). It helps keep me on track because I don't want to feel like crap, i'm better at avoiding foods because it's usually not worth it for the "cheat" experience. 

Things I'm doing now to continue healing

You can follow what those meals look like on tour with my instagram hashtag #howdoyoueatontheroad and food I eat in general with my instagram hashtag #feelsgoodblog

 

DIET

I was focusing on SCD + Low FODMAP for a couple months and still experienced bloating. I started looking into the Fast Tract Diet (which does a Weight Watchers style points attribution to foods based on their "fermentation potential") to see if that would help. I believe it did to a point. However, for cases like mine that are a little more difficult to pinpoint and mitigate, Dr. Norm Robillard (author of The Fast Tract Diet) suggests limiting carbohydrates to 20g> day. His app doesn't account for that so I switched back to using My Fitness Pal where you can control macros you're tracking very specifically. I knew if I was going to limit carbs by that much, I'd need to up my fat intake. Essentially putting me in the ketogenic diet basic framework. Once I became vigilant at carb counting. I noticed that if could stay on track i was sated, my bloating reduced substantially and that overall, the diet generally agreed with my system (for now).

This means i'm aiming for percentages of 5% (specifically 20g> of carbs a day), 80% Fat and 15% Protein. I am not currently testing to make sure I stay "in ketosis" but I am concerned with the carbohydrate number as carbohydrate malabsorption and gut fermentation seems to be the more prominent reasons I keep bloating and feeling zapped of energy.

The foods I'm eating are very similar to what you've seen me list before, i'm just tracking how much I'm having now. Eggs, Pasture raised animal fat (no, i'm not worried about cholesterol ), Greens (wilted at home, usually a salad on the road), Pasture raised/organic meats (the fatty-est ones if available) and limited dairy (hard cheeses, experimenting with heavy cream in coffee etc.) I am allowing alcohol (red wine and tequila/soda mostly). I am very aware of the irritating and inflammatory effects and try my best to be picky of quality and not overdo it.

It's working for now; so I'll do it until I don't, just like everything else.

SUPPLEMENTS

Under the supervision of Dr. Ruscio, my functional medicine doctor in SF,  I'm on supplement rather than pharmaceutical treatment for Crohn's Disease: Curcumin from Turmeric for anti-inflammation, Vitamin A, Digestive Enzymes, Betaine HCL, three types of probiotics as well as self-prescribed/leftover from past doctors: Concen-Trace Minerals, and chlorella (to continue chelating until my skin is blemish free).

This is working out well for me. We talked about FMT as a last resort if the heavy probiotic therapy doesn't rebuild my gut microbials enough but we're not there yet.

SCOBY facial! also note how clear my cheeks are yahoo!

SKINCARE

I use FATCO religiously at home and on the road. Their oil cleansing method of feeding my skin from the outside while I'm working on changing the inside with diet has made my (non broken out) skin look so healthy! I am so hooked on using organic, conscientious skincare as I think that part of my problem in the first place was just chemically treating symptoms my whole young adult life. Their face cream is so damn soothing, I recommend all of their products (at least to try) to everyone.
I've also been doing SCOBY facials at home as well as organic peels, exfoliation and hydrating masks to keep the skin looking and feeling healthy and to prevent any breakouts from traveling/stress/not sleeping/dehydration. They look weird but the acid from the SCOBY really does a number on eating away dead skin cells and keeping my complexion bright. I do one RIGHT when i get home from tour and right before i leave again. As soon as I take it off I use these tools if i need any blackhead extraction while everything is moisturized and right at the surface, then i tone with FATCO toner + rose water. 

SLEEP/MEDITATION

It's very difficult for me to get proper "what is recommended for a normal adult" sleep on the road. We never go to bed at the same time and rarely get 8 hours consistently (listen to this podcast to learn more, see also page 17 of the transcript for shocking info on bed time/sleep amount if you're not going to listen to the podcast.)

What i do to "do my best" is go to bed ASAP after a gig, I wear amber glasses to cut blue light as soon as i'm in the hotel room (and i use night shift on my phone). I wear a sleep mask and earplugs while sleeping and I do a guided meditation every night. I sleep as long as long as my body allows and when we are off the road i try to go to bed around 10p as frequently as possible to recoup any sleep deficit. 

EXERCISE

Let's be honest, i'm not really exercising. I try to walk as much as possible at home and on the road. I have grand plans to do yoga but usually spend off tour times trying to get rested and chill for a minute before we go back out. Yoga though, not cross fit or spinning like the old days, is what I think would benefit my nervous system right now. I just need to motivate...

 

Revelations

I think I had to acknowledge I was ill to realize that I'm happier knowing I'm not perfect and don't need to be and stick to a lifestyle that makes me feel well.

Accepting that my body has trouble digesting and that I'm sensitive is part of my solution. There is no one diet for me, there is just what I'm tolerating right now. Of course, It's hard for a type A person like me not to have a "fix". To not be able to get to "normal". (What does that even mean? Be able to eat crap food and feel fine? To have a flat stomach 100% of the time? To have perfect skin?) Maybe I was presented with physical circumstances as a method of accepting myself, as a way of learning to let go of shit that doesn't matter and be a more patient, loving and positive person. I certainly think it's a good lesson to learn before I bring any children into this world. It helps me strive to be a better partner, friend, co-worker, self.

2015 was the year of "give no fucks", during which I gave entirely too many fucks about so much bullshit. I think 2016 is the year of letting go (dare i say, actually giving no fucks?). I've made a lot of progress in setting boundaries for myself (both work wise and also personally). I'm listening to myself and adjusting the plan of action as needed. I'm trying to be present in every moment and take everything i can from those experiences (whether pleasant or not). I'm sure I'll have to switch up what I'm doing again soon. It seems that going with the flow is the point.