A case of Small Intestinal Bacterial Overgrowth, or SIBO, has completely changed how I look at food. I'm trying not to let it change my whole life.
Credit: RyanKing999

It's my dear friend's birthday and I've been dreading it for days. I'm eager to celebrate him, and we'll be in comfortable company. We're even going to a restaurant I'd been dying to try. The problem is that he's signed us up for the chef's tasting menu: 11 courses of food I won't get to choose for myself, and I'm barely managing to choke down toast these days for fear it's going to come back up.

That's not exactly accurate; I can't eat toast.

After an uncomfortable, invasive, and expensive battery of tests, I now know that I have what my gastroenterologist calls a "severe" case of Small Intestinal Bacterial Overgrowth, or SIBO. Also: I have a gastroenterologist now.

Don't worry if you've never heard of SIBO. I hadn't before my nutritionist (got one of them now, too) suggested that my nearly constant nausea, bloating, feeling of sloshy fullness after just a bite or two of food, inexplicable weight gain, joint pain, terrifying stomach rashes, and general gastric awfulness might be because some mighty gnarly bacteria had set up housekeeping in my intestines and decided to invite all their friends to eat my food.

There's really no one generally accepted reason why SIBO shows up, and even among experts, it's rather poorly understood. I was diagnosed with both endometriosis and SIBO around the same time, and while that co-morbidity is frequent, men suffer from SIBO pretty often, as well.

And I do mean suffer. The condition manifests in a foul bounty of ways that also include similarly inexplicable weight loss, diarrhea, malnutrition, and bloating severe enough that it can mimic a late-term pregnancy—yes, even in men.

Treatment is a crapshoot, and there's no consensus about what will actually work. I've gone with an absurdly expensive antibiotic that I had to body slam my insurance company to cover, and an herbal protocol of 20-plus pills and powders a day. Other people may opt for different sets of antibiotics, herbs, potions, incantations, and prayers.

SIBO hasn't been an official diagnosis for all that long, so plenty of medical professionals may not even know or think to administer a test for it, let alone treat it. In my experience thus far, and talking to fellow SIBO sufferers, the standard treatment (if you're lucky enough to find a doctor who understands the condition) tends to be a prescription for a 14-day course of an antibiotic usually prescribed for diarrhea and irritable bowel syndrome—and often not covered by insurance—in combination with a Paleo or low FODMAP diet so as to deprive the bad bacteria of the fiber that they so greedily gobble along with the nutrients the food carries.

If you're me and have an especially forward-thinking nutritionist, there's a 30+ day course of natural (and hella pricey) supplements designed to draw out the bad bacteria, and slay it with herbal combinations that mimic the effects of the antibiotics.

The use of probiotics to combat SIBO while it's still active is somewhat of a hot-button topic. I personally take them and also eat kimchi and swig kombucha like it's my job. But once the bad bacteria has been felled, they're understood to help the good guys rebuild their ranks. And some days they make me feel like swollen, sloshy crap.

But good luck getting there. In any case, it rarely gets cured for good the first time. Almost every SIBO patient I've encountered (we are legion in Facebook groups) has had to make some significant dietary changes—almost certainly ridding or minimizing their diet of fresh dairy, grains, and legumes, and quite often fresh fruit.

Everyone's trigger foods are different. For me, that's been every bit as painful as having my insides wrench, bubble, and stab simply for having the audacity to put food into my mouth and swallow.

I love food. That is in no way unique or noteworthy. Eating is one of the extremely few things that we all as humans must physically do to remain alive, so beyond the whole subsistence part, it's how many of us get our personal kicks, define ourselves culturally, and commune as the two-legged beasts that we are—often quite joyously.

But due to this illness, I've been feeling so very separate from that. It's compounded by the fact that, in addition to living to eat, I eat to earn a living. I'm a food writer, editor, and public speaker. I travel frequently to do this. Oh yes, poor me: Not able to jet about and indulge myself with the food of the world's greatest chefs, boo-hoo. But it's not that—not really.

It's this: sitting in a hotel room far from home and gnawing on one of the dozen RxBars I brought along because I'm afraid that restaurants nearby might not have any food free of grains, dairy, legumes, and the other hidden things that I've learned make my gut sear.

It's having panic attacks in a neighborhood cafe when I can't figure out if there's anything I can have. It's telling my husband I'm just not that hungry, so he can order something for himself.

It's keeping a smile stapled to my face as everyone around the table on Christmas Day gets up for seconds of the gloriously cheesy and crumb-topped casseroles while I nibble at my plain turkey and unadorned sweet potato.

And it's missing dinners and get-togethers and celebrations with loved ones because the thing they're centered around keeps making me sick to my stomach. Even if I'm there—and I do try to be as best I can—I'm not fully present because I am hungry and hurting.

I've been paralyzed for a while, by shame (did I do something to bring this on myself?), my deep-rooted impulse not to cause fuss or worry to anyone, and my increasing terror that it will always be this way—that the thing that has brought me so much life, joy, community, and a steady paycheck is now the thing that harms me.

I show up at the restaurant, terrified, but I can tell my friend is happy I'm there. That would be sustenance enough (plus I have a secret RxBar in my purse to eat in the bathroom if I have to), but he's thought to call ahead and explain my restrictions to the chef, who comes out and explains each course and any alterations he's made so I can partake along with everyone else.

I know that every meal can't possibly be like this, but tonight is enough. I am full and happy in a way I have not been in recent memory, and it gives me hope. This will not eat me alive.