It’s been almost a year since my last extended fast and my body has been begging for one. After reading the incredible case study of the woman who completely resolved her stage 4 cancer through fasting and keto alone, I was more eager than ever.
My current fasting routine includes a 44-80 hour water fast each week (Sunday night to Tuesday or Wednesday dinner, sometimes until Thursday morning.) This pattern is important for me to keep my glucose-ketone index in therapeutic range and enjoy the benefits of autophagy — among countless other benefits.
While my last 7-day fast was incredibly uneventful, this one was a bit more exciting because I’ve been grappling with a little something called SIBO.
Fasting and SIBO
SIBO, or small intestine bacterial overgrowth, is when the wonderful bacteria that cultivates your large intestine moves into your small intestine and causes all kinds of trouble. I won’t spend a lot of time talking about it here but suffice to say it can be pretty awful and extremely hard to get rid of. In my case I’d been experiencing terrible constipation and bloating for months. In Hong Kong I’d been able to manage it with regular colonics but, in lockdown London, all my home constipation remedy attempts had failed. After a couple of weeks, the swelling in my gut was painful and made it difficult to breathe at times.
There are two aspects to treating SIBO:
- Treat the symptom: Beat back the bacterial overgrowth for as long as possible. Success is called remission but, like cancer, SIBO will always come back unless the root cause has been addressed.
- Treat the root cause: In my case, the root cause of my SIBO is severely reduced gut motility either because of brain damage or, my hope, a carnitine deficiency.
In addition to my usual fasting goals, I hoped that an extended fast would allow me to starve the bacteria back and buy a period of SIBO remission. Many practitioners believe that a 14 day “elemental diet” or water fast is enough to kill a SIBO infection.
I knew from the beginning that this added twist would make things extra challenging as I’d be facing die-off symptoms.
SIBO Die-Off: The Herx Reaction
Die-off, known more medically as a Jarisch-Herxheimer reaction, or Herx reaction, refers to the body’s adverse inflammatory response to the toxins released by bacteria and fungus as they die. It can range from mild flu-like symptoms to, as I learned, something much more severe.
I warned Brad before beginning my fast that I might be bedridden for a couple of days. I also knew that, during this period of inflammation, my immune system would be depressed and so we made arrangements for me to avoid shops when that time came.
I also ordered a SIBO breath test which I expected to arrive on Day 2 of my fast to confirm my suspicions.
Fast Day 1: An Unusually High GKI
SIBO has made it harder to keep my GKI in the therapeutic zone on days when I eat and I rely on my weekly 48-hour fast to bring it back down.
My GKI was especially high at the beginning of this fast. I peaked at over 25 (!!!) at noon — my dawn phenomenon comes quite a bit after dawn — to just under 3.0 around 8pm.
Overall, since I fast at least one day a week already, there was nothing new about this day.
Inputs: Lots of water, physician-prescribed meds and supplements (lorlatinib, metformin, atorvastatin, doxycycline, mebendazole, beta glucans, melatonin, magnesium glycinate, CBD oil, Vitamin D3, carnitine), green tea.
Outputs: Nada. No bowel movement in over a week.
Fast Day 2: Business as Usual
Except during my dawn phenomenon, my GKI was in the therapeutic range (<3.0) throughout the day and finally dropped to the optimal range (<1.0) after 8pm.
It was a pretty easy day. I love not having to shop, cook, or do dishes!
Inputs: Lots of water, physician-prescribed meds and supplements, green tea, coffee.
Outputs: Still nothing. I have to wait until after the SIBO test to do a flush.
Fast Day 3: Back in Optimal GKI Range
Usually days 2 and 3 are the most difficult. Difficult for me means that my body likes to remind me that there’s food everywhere. Every time I open the cupboard or walk past a restaurant my body says, “Hey, we could eat that.”
This time it was easier -in large part because Brad was fasting with me for the first three days. Days two and three can be a lot less fun when you’re watching someone else eat. Huge thanks to Brad for seeing me through the tough part!
GKI-wise, I was happy to be under 1.0 almost all day.
Inputs: Lots of water, physician-prescribed meds and supplements, green tea.
Outputs: Nada. No bowel movement in almost two weeks. I started taking an herbal supplement called MotilPro to try to restore some motility. I email the SIBO test clinic and they say the test won’t arrive until Day 6 of my fast.
Fast Day 4: Holding Steady
My GKI was steady under 1.0 all day.
To keep my energy high I started supplementing electrolytes – for me that’s:
- 3 grams sodium (7 grams Himalayan pink salt)
- 800mg magnesium citrate (in addition to the magnesium glycinate I take each night)
Most people will also need to supplement potassium which can be found in salt substitutes like Morton’s Lite Salt but it’s best to consult your doctor first. I just happen to have naturally too-high blood potassium levels and am under strict medical instructions to avoid extra potassium.
Many people will need to start supplementing electrolytes earlier in their fast. Generally, if you feel weak, shaky, fatigued or headachy after starting a fast, you need more electrolytes. If electrolytes don’t help, it’s wise to break the fast and consult your doctor.
Brad returned to normal eating today but I was past the point of hunger and no longer had any problem sitting with him while he ate. Once I hit day 4, I always feel like I could go forever.
Inputs: Lots of water, physician-prescribed meds and supplements, electrolytes, green tea, black coffee.
Outputs: One tiny rabbit pellet. I’m hoping the magnesium citrate will help as it has known laxative properties.
Fast Day 5: Herx Reaction Begins
GKI remains slow and steady the rest of the fast just wobbling between 0.6 and 0.8 based mostly on exercise and my mood – that little spike in the afternoon was immediately following a small conflict with Brad.
Today is most notable because its the day Die Off Symptoms Begin!
It began with me starting my period. I almost never get my period – this was the third time in a year. Normally I’d think, “oh yay, thanks to fasting my body is healing and my hormones are finding balance.” I knew that wasn’t the case this time, though, because I’d just finished my second period of the year a week ago. I was about 8 months early by realistic accounting, two week early by best case accounting.
I realize now that the bacteria in my gut were dying and creating/ becoming toxins that my body was desperate to eliminate through any means available.
In the evening I started experiencing excruciating pain in my hips. While I normally sleep very well while fasting, I spent the night writhing.
Inputs: Lots of water, physician-prescribed meds and supplements, electrolytes, green tea, bone broth.
Fast Day 6: Powerful Herx Reaction
My GKI remained stable and less than 1.0.
Today, my whole focus was on my Herx reaction. The pain in my hips, buttocks, thighs and back was almost unbearable and I spent much of the day in a hot bath, which helped, or pacing the hall since movement also seemed to help. I wasn’t able to complete my daily yoga practice.
I had a sudden, crazy breakout across my back and chest with a couple pustules on my face.
It’s like all the poison in my gut was being squeezed out my muscles, joints and skin. I needed to help my body detox and my bowels weren’t helping in the effort. I focused on drinking lots of water, deep breathing exercises, and took some activated charcoal.
The SIBO breath test finally arrived but I wouldn’t be able to take it until morning.
I drank some bone broth in the evening in the hopes of feeling a little better. I spent a restless night writhing on the sofa and pacing the hall in pain.
Inputs: Lots of water, physician-prescribed meds and supplements, electrolytes, activated charcoal, green tea, bone broth.
Outputs: No movement. I plan to flush tomorrow immediately after the SIBO test.
Fast Day 7: SIBO Test and Flush
The SIBO breath test takes 3 hours. I started a Vitamin C flush immediately after.
Under normal circumstances I reach for the salt water when I need to flush but I was concerned about my electrolyte balance while fasting.
It was my first time using Vitamin C and it will be my go-to from now on. I ended up needing over 80 grams dissolved in water over several hours to achieve the flush. I’m surprised my body was able to absorb that much – a clear indication that my immune system didn’t have all that it needed. While the flush didn’t help with the pain as much as I’d hoped, the bowel and bloating relief was substantial.
Inputs: Lots of water, physician-prescribed meds and supplements, electrolytes, activated charcoal, green tea, bone broth.
Outputs: A satisfying clear-out riding the flush.
Fast Day 8: Refeed
Despite yesterday’s flush, my pain continues and is excruciating.
I start having serious concerns that my immune and detox systems are overwhelmed and the implications for my cancer. Are my immune cells too focused on dealing with the toxins in my gut and leaving my cancer to grow?
If I break fast now, the bacterial that is still alive will repopulate my small intestine within a week. Worse, it will repopulate my small intestine with strains of bacteria that can survive 8 days without food.
If I continue fasting my overwhelmed immune system could fail. My cancer could grow. Also, until I fix the root cause, my gut motility, the SIBO will come back anyway.
And the pain. I’m really good with pain but this is on a whole other level.
I ended up breaking fast that evening. Because my body was in such a precarious place, I was extra cautious about my refeed and took a multivitamin with calcium, phosphorus and B vitamins before eating a simple bowl of leafy greens in broth.
Day 9 & Beyond: Herx Recovery
I resumed normal eating on Day 9. I shouldn’t have been surprised that my symptoms didn’t magically disappear after eating the soup.
- My false period did stop almost right after refeeding on Day 8
- The pain reduced over the course of Days 9-10
- The breakout across my back and chest resolved a week or two after refeeding.
I’ve continued my regular weekly fasts without any problem or hints of die-off.
The constipation and bloating continue after 2 weeks although I’ve made progress against them. The abdominal distention returned within a few days, disappointingly.
A New Strategy for SIBO
I’m now focused on treating the SIBO more slowly with herbal antibiotics and biofilm disruptors that have been shown to be effective against methane-dominant SIBO like mine:
- Oregano Oil (120mg taken 2x daily)
- Neem Leaf (500mg taken 3x daily)
- AllicinMax (180mg taken 3x daily)
- Cistus Tea (1-2x daily)
- Kirkman Labs, Biofilm Defense (1x daily)
So far I haven’t experienced any die-off symptoms or, if I have, they’ve been too subtle to notice.
At the same time, I’m working to fix the root cause, my lack of gut motility, with the following:
- Observing discrete mealtimes and not snacking in between. For me this means only eating from 1-2pm and 6-7pm. I’m an inveterate snacker so this has been challenging.
- Supplemental digestive enzymes and Betaine Hydrochloride with Pepsin at mealtimes to help with digestion.
- Chewing my food thoroughly and not drinking much water at meals to avoid diluting my stomach acid. I have no idea what that means for soup.
- Digestive bitters after eating.
- MotilPro (13mg Vitamin B6, 2g ginger, 1g Acetyl-L-carnitine, 100mg 5-HTP)
- Acetyl-L-carnitine supplementation (an additional 2-3g daily as I have a documented carnitine deficiency that could be causing a weakening of smooth muscles like the small intestine)
- 800mg Magnesium Citrate
- Ginger tea
- Meditation and yoga poses focused on the solar plexus and vagus nerve. From an emotional/ energy healing perspective this seems to be tied to anger issues and related to some stuck energy in my neck and shoulders.
- Vagus nerve stimulation exercises like gargling and chanting.
Finally, the following are helping to manage the symptoms while I work on root cause:
- My whole food, plant based ketogenic diet is already fairly low FODMAP but the GI consequences are a great motivation not to cheat with artificial sweeteners.
- I temporarily stopped my daily probiotic, daily homemade saurkraut and other fermented foods, and reduced the pre-biotics in my diet. I can’t bring myself to give up garlic, though.
- Senna tea 4x per week and a weekly Vitamin C flush has helped to keep a few things moving through.
- Abdominal massage.
- An incredibly patient husband whose world is currently a swirling cloud of my moans and farts.
I’ll do a whole post on it once it’s resolved.
As awful as it is, I’m incredibly grateful to be able to experience SIBO and die-off first hand. I’ve had people report symptoms like rashes and body pain after a day or two of fasting. I’m now much more understanding that these are likely symptoms of a Herx reaction and know first hand how painful they can be.
I originally felt a little shame that, after 18 months of such immaculate eating and attention to my gut health, I could suffer from something like SIBO. I’ve since heard from some of the cleanest eaters and purist healers I know that they’ve experienced the same.
I understand now, too, that I was experiencing overgrowth last year while I battled diarrhea and bowel incontinence. Those are classic symptoms of hydrogen-dominant SIBO that I wrongly attributed to my meds. The hydrogen-releasing bacteria feed the methane-releasing bacteria and archaea. This explains my transition from uncontrollable diarrhea to constipation to my current point of complete bowel immobility.
Above all, I’m excited for the place where my body will be once I clear this infection. The gut-brain-immune system connection has been well established and I need healing in all three elements. Hopefully I have that and a post with my learnings in just a few months.
In the meantime, I’ll keep up my regular 2-3 day fasts and look forward to another long fast in the future.