# Richard Wragham. Catching Fire.



## Moises (May 20, 2000)

Wrangham's new book is chock-full of information that should be of great interest to followers of the SIBO theory of IBS. Wrangham, similarly to Pimentel, argues that a healthy diet is a diet that, besides providing the nutrients necessary to fuel our cells' metabolic processes, allows as much material as possible to be absorbed in the small intestine so that as little residue as possible will be sent on to the large intestine. Wrangham argues that substances sent to the large intestine will provide energy for the microbes that reside in it; they won't provide energy for us. Now Pimentel, I know, has no problem with microbes inhabiting our colon. But the basic principle is the same for both of them: we want a diet that maximizes absorption in the small intestine and minimizes residue.Wrangham then cites a series of fascinating studies of people with ileostomies. These are people who have had their colons surgically removed and replaced with bags. The bags fill with "effluent" which can be analyzed. From this analysis we can learn precisely how much residue makes it out of the small intestine. Note that if we were to analyze stool, we would only learn how much residue is left after both we absorb our share of the nutrients and our colonic microbes absorb their share of the nutrients. So, the result of stool analysis will not tell us which foods are most easily digested by us. It will only tell us which foods are most easily digested by us and by our microbes. What we want, is the nutrients to go to us. The nutrients that feed the microbes could actually cause us problems (gas, etc.)So, what does Wrangham find? Cooked starch is 95% digested. Kidney beans are 84% digested. What does that mean? That means if we eat 100 calories of white bread, our colonic microbes get 5 calories and we get 95. If we eat 100 calories of beans, the colon get 16 calories and we get 84. Compare the 5 calories to 16. With beans, the colonic microbes get more than 3 times as much energy than with white bread. So, Pimentel's dietary recommendations--that if you are going to have carbs, white bread is a good choice--make sense.A number of properties make food more digestible. Chopping food up into small bits, adding acid, cooking, and drying all permit more energy to be absorbed in the small intestine, leading to less residue moving into the large intestine.This jives with much of my own personal experience. I found that I am better off avoiding anything raw, including salads and fresh fruit. It also suggests that ground meat will be better for the person with IBS than whole meat. If you wanted fruit, applesauce would be better than a fresh apple, because the former is both cooked and more finely chopped up. I have not gone into his entire evolutionary theory of human diet, which is highly original and thought-provoking. I strongly recommend this book to IBSers who want both to deepen their understanding of their "syndrome" and create a more adequate set of dietary guidelines. The book never mentions IBS. But it has some wonderful commentary on the evolution and function of the processes of human digestion. No one with IBS can afford to be ignorant of these facts.


----------



## UrbanUrbane (Jul 31, 2006)

Moises, this is fascinating. Its probably really important that those of us with these persistent digestive issues are looking at sustainable dietary practices. I plan on picking up this book, thanks.


----------



## Moises (May 20, 2000)

UrbanUrbane,Thanks for the acknowledgment.Two weeks ago, based on ideas I got from Wrangham, I started an experiment that is still continuing. I am eating only meat. And I am only eating meat that I have put through a blender. I felt worse the first week. I have felt better for the second week. I am hoping to see continued progress.Basically, I have taken ideas from both Pimentel and Wrangham, and others, to come up with this dietary approach. No single one of them recommends it. The key contribution from Wrangham is his analysis of what makes foods more digestible: cooking, drying, salting, and chopping into finely divided bits. From Pimentel I get the idea that I _want_ to enhance the digestibility of what I eat, so that residue is minimized, or, in the best possible case, reduced to zero. (From Vilhjalmur Stefannson I get the idea of eating only meat. Google his Bellevue Hospital experiment.)I have done the Vivonex Plus regimen twice and it just made me feel lousy. This blended meat approach is much easier to tolerate, and, hopefully, can function in the same manner as an elemental diet.


----------



## UrbanUrbane (Jul 31, 2006)

Moises, best of luck to you in your experiment! As a longtime member of this forum, I'm familiar with your posts and not only do I remember reading about your experiences with the elemental diet but I think I remember you posting about zero carb/all meat diets in the past. That's really some dedication to put it all through the blender first. I would be really interested in the longer-term results of your experiment and in knowing where you are able to go from here. For example, do you think you could move on to the Optimal Diet or something similar? Or are eggs and cream out of the picture forever?I am curious about your weight; since your entire theory is based upon eating more easily digestible foods. Most people with SIBO and other absorptive issues have low body weight and trouble keeping weight on. I'm one of the people who has trouble with too much extra weight. A successful course of antibiotics can knock like 10 lbs off me in a week and I have trouble keeping my weight down otherwise. My digestive health depends on eating more digestible foods and less fiber, but this goes against what I'm supposed to do for weight loss. Eating high fat helps, but lately my body's been kind of out of control. I'm actually on a 7 day 1600 mg/day course of Xifaxan now so we'll see what happens. There's a link on my profile page to my SIBO yahoo group. We have around 40 members but about 10 of us are very active, and we're definitely an experimental group of folks; if you wanted a wider audience for your experimentation, you'd definitely have some people there who would be more than interested in what you're doing. Otherwise I will look out here for updates.


----------



## Moises (May 20, 2000)

UrbanUrbane said:


> There's a link on my profile page to my SIBO yahoo group. We have around 40 members but about 10 of us are very active, and we're definitely an experimental group of folks; if you wanted a wider audience for your experimentation, you'd definitely have some people there who would be more than interested in what you're doing. Otherwise I will look out here for updates.


Thanks for the invite. I will check it out.


----------



## hercules (Sep 12, 2009)

I’m wondering how much difference the “low residue” diet really makes in the Pimentel protocol?I read the book a couple months back and recall it mentioning that bacteria thrive on their favourite foods (ie. sugars, lactose, carbs, etc…) and go into a “prolifefation” type of mode, where they’re just feeding and reproducing flat out without a care in the world, and it’s during these times that these bacteria lower their guards and are easiest to kill off completely…ie. catch ‘em unawares and hit them with a heavy dose of Rifaximin (or whichever AB combo you personally need). Whereas it also states that if you starve them (ie. using the Pimentel low residue diet), large numbers of bacteria do indeed die off making it easier to wipe em out completely, however, also mentions briefly elsewhere that during hard times/starvation any remaining bacteria go into a defensive and more resilient “hibernation” type of mode instead, making them harder to kill!?So I’m left wondering what the best approach is during an antibiotic regime – starve them or fuel them??? My logic says to fuel them, drop they’re guards and hammer them hard with a strong dose! But I’m not sure. I plan to start the Pimentel/Rifaximin treatment in a few weeks time (if my 4th different probiotic trial fails…and it looks like it will, 3 weeks in) and would love some feedback on this.Also, because bacteria regenerate so quickly (every 20 mins apparently; a ten day AB course equates to ~700 generations…that’s about 20,000 years to us) I’m thinking one heavy dose from the outset ‘out of the blue’ would be better than incrementally increasing the dose with every unsuccessful treatment until success in order to minimise the chances of the bacteria evolving a resistant strain to the Rifaximin. But again, this differs from the Pimentel method. Any thoughts on this?


----------



## Moises (May 20, 2000)

Pimentel is clear. If you are taking the xifaxan, you should eat according to his dietary principles. This does not mean eat lots of residue. And it does not mean eat an elemental diet.


----------



## hercules (Sep 12, 2009)

Pimentel's "dietary guidelines" aim to: 1. eradicate bacteria overgrowth during the xifaxan treatment, and 2. prevent the return of SIBO after successful treatment. These are achieved by having foods that:1. don't contain bacteria favourites (sugars, carbs and lactose); 2. must be "low residue", meaning they are readily absorbed before reaching the "distal" regions of the small intestine leaving minimal fuel for sibo bacteria to thrive on and reproduce - sounds consistent with your description of the Wrangham theory.[Note: pimentel also says keep off high fibre foods because they will pass through to colon before being completely digested, hence, becoming a food source for normal bacteria in colon causing fermentation and thus gas formation&#8230;which is normal - this is managing symptoms rather than dealing with the cause. Helpful but no cure.][Note also: the other key factor is to increase motility or "cleansing waves" to help flush out sibo bacteria and their fuel sources&#8230;this makes sense and I've applied this since. It is a positive but again manages symptoms only.]To summarise, the purpose of the pimentel diet is to keep sibo bacteria populations as low as possible by minimising quality and quantity of their preferred foods. This applies whether trying to "cure" or "manage" your sibo. It's recommended mainly for maintenance after the xifaxan treatment to prolong its effectiveness. Then this. 76 - "Because of how effective Vivonex is at starving bacteria, the bacteria go into a hibernating, nonreplicating mode. The hibernating bacteria in general are not as susceptible to antibiotics."If hibernating bacteria are more resistant to xifaxan, why risk activating hibernation in even one single bacterium during antibiotic treatment by going on this diet?


----------



## hercules (Sep 12, 2009)

"To summarise, the purpose of the pimentel diet is to keep sibo bacteria populations as low as possible by minimising quality and quantity of their preferred foods."...ie. starving them, as per the elemental diet, only not as extreme.


----------



## Moises (May 20, 2000)

Hercules,All this is theoretical.Thanks for provoking a thoughtful discussion.First, if Pimentel's diet (PD) truly starved the bacteria, we could cure SIBO by his diet alone. There would be no need for antibiotics or for an elemental diet (ED). Essentially PD would equal ED. So, let us assume, for the sake of argument, that PD does not cure SIBO and that ED does cure SIBO.By your criteria, we might infer that the reasons that PD does not cure include:1. it includes bacterial favorites that2. provide energy that passes to the ileum and cecum, encouraging migration of bacteria from the proximal colon to the distal small intestine.I understand you to be claiming that PD, even though it does not kill all bacteria, will attenuate them, making them more resistant to antibiotics.This does not seem to be a question that we can resolve _a priori_. It can only be answered empirically.But we can have fun, nonetheless, speculating. a. Everything seems to be a matter of degree. Does PD increase bacterial resistance? If so, to what degree? (This restates your previous post that ED is PD to a greater degree.)b. Does PD lessen the overall numbers of bacteria, while, at the same time leaving the bacteria that do survive health, active, and fully susceptible to antibiotics?c. Do antibiotics selectively kill small intestinal bacteria or do they universally kill both small and large intestinal bacteria? (Same question for ED.)d. Suppose antibiotics selectively kill small intestinal bacteria (which is suggested by Pimentel's claim that the problem is not having bacteria in our digestive tracts, rather, the problem is that the bacteria are located in the wrong place in our digestive tracts), would a high-carb high-residue diet combined with antibiotics create a sterile small intestine while, at the same time, providing much more energy to colonic bacteria?e. Continuing with e, above, could this excess of fuel going to the colon increase the likelihood that, with the cessation of antibiotics, bacteria will migrate, again, from the colon to the small intestine?I know of no way to answer these and other questions except to test them in real, live people.


----------



## Moises (May 20, 2000)

Here's a related question. Pimentel's dietary recommendation limits the refined carbohydrate intake to 1/2-1 cup per meal. Why doesn't he describe the portions for meat in a similar fashion? For meat he advocates "portions that are appropriate for your body size" (or words to that effect, I don't have his text in front of me). My decades long experience has been that it takes a lot of effort to restrict my refined carbs to 1/2 - 1 cup per meal. I can do it, but it takes discipline. And I have found that if I exceed the quantities that Pimentel recommends, I will surely increase the probability that I will suffer from an increase in burping, flatulence, and diarrhea. Why would this be? The most obvious answer would be that our absorptive capabilities for refined carbs are limited. Maybe we can only produce a limited quantity of enzymes, or maybe the absorptive surfaces of the duodenum provide the limit. But, whatever it is, there is something about the digestion that cannot absorb more than 1/2 to 1 cup of refined carbs per meal.And this really seems to be unique to the refined carbs. There are other foods he says we can limit the intake of, but it would probably be better to eliminate them altogether, like beans or beverages other than water. I wonder about this because my own dietary experiences have yielded some fascinating results.I did the PD (with Align) for about 2 years. I was not cured, but I had better results with it than with any other regimen. My version of PD and Align included some refined carbs each day.Then, in November 2008, I decided to eliminate the refined carbs. I soon experienced worse digestive outcomes. I ate only Align, meat, nuts, and low-carb vegetables. This change made my digestion worse. I stayed on it for about 7 months. Then, in June 2009, I eliminated all carbs, except for the small amount of glycogen in meat. I have been eating this way since June 6, 2009. I want to give it at least a 6-month trial. But, again, so far, I feel worse than I did when had refined carbs with my meat and low-carb vegetables.So, my interim conclusion is that there is some "sweet spot" for the consumption of refined carbohydrates (at least for me). If the refined carb intake is too low, my digestion backfires and I do not feel well. If the refined carb intake is too high, my digestion again does not work well. But if I have may 36-72 grams/day of refined carb, (with Align) I seem to do better, digestively. So, my interim conclusion is that refined carbs can be used almost as some kind of medicine. With the proper dosing, they can bring about significant improvements. Significant under- or overdosing will cause more harm than good.


----------



## Flowby Jonas (Aug 14, 2006)

This all goes along with what my doctor, Dr Wang says. That is that, food, all food for people with SIBO should be cooked. Its lots of work for the body to process raw food. The stomach in way cooks raw food before we digest it. Makes lots of sense. I don't know if the non-residue food makes all that much difference but I eat lots of good grains and veggies. I eat fish and meat too. Sweets I love but in very limited quantities. I find not drinking coffee on a daily basis the worst. I have begun to drink a bit of coffee again and no ill effects but I know if I try to drink it like I used to I will suffer. I also feel that over time and even though I havent suffered any attacks in about 4 months I need to be careful still and probably the rest of my life.


----------



## hercules (Sep 12, 2009)

Gday Moises, Apologies for the delay in responding...here goes.Firstly, no, I'm not saying PD starves sibo bugs completely but instead reduces fuel source for sibo bugs resulting in reductions in sibo populations compared to equilibrium state achieved during no diet at all (ie. settled sibo population might reduce from 20 million bacteria in small intestine on 'normal person' diet to 5 million on pd&#8230;for example). So I'm not saying pd should cure sibo alone. But yes, this is yet another theory to be proven right or wrong; hopefully someone already has&#8230;I'd love to know either way. The cecum is part of the large intestine. Thankfully, my ileocecal valve is actually fine and doesn't leak colonic bacteria into my ileum. Furthermore, my motility is perfectly functional too&#8230;I have no reason to suspect it isn't. The only absolute fact in my case is that whatever's in me was introduced during one eating session which resulted in a very severe food poisoning incident. Since then I've had sibo. [It's improved a fair bit since the early days but nowhere near fixed (cramping, urgency, pain, flatus and stool formation have improved but not normal still; burp rate has remained unchanged)] I believe that nasty bug, whatever it was that day, is now established in my small intestines, and what makes them so resilient is they're embedded within my epithelial walls and lamina propria (Lymphocyte counts from duodenum biopsies analysis indicate this).So what I'd like to discuss is what we can do to purge out these bugs from these protective hiding spots in order to kill them off successfully. Once purged out, high stomach/duodenal acid strengths alone should be just about enough to kill them, let alone ab's like rifaximin and ciproflaxin. Also, once they're out, inflamed walls can be repaired (glutamine&#8230;or even just naturally) and walls will once again be protected like the good old days. If they're left in there, then the sibo will always return, no matter what you throw at it. In fact, this may even explain why the ED doesn't deliver the blow neither&#8230;sibo bugs could be feeding off nutrients passing through the (their) walls during assimilation keeping them alive. So my question is, "What can we do to kill the 'sub-epithelial' sibo bugs???".Other stuff:• I don't believe Rifaximin targets small intestinal sibo bugs only, and nor does Pimentel imply this. I reckon he simply refrained from pointing out that they'll kill indiscriminantly throughout the entire alimentary canal potentially causing other problems&#8230;the only difference with rifaximin is it doesn't pass through the intestinal walls (large or small intestines) [similarly, he does his best to keep as quiet as possible that this "New IBS Solution", as stated in the title of his book, is in fact not an IBS solution at all&#8230;yeah yeah minor detail I know].• my understanding of the duodenum is that it's major role is to transfer chyme from the stomach through to the jejunum. I thought the duodenum was only about 1-2 foot long and didn't really do much absorption at all??? Also, biles, gastric juices, enzymes etc are injected in this section from the gallbladder and pancreas? Speaking of enzymes, our bodies are designed/evolved to process foods choc full of enzymes. We used to be hunter gatherers and those diets meant eating living things, not the kind of foods you find in supermarkets today. Enzymes in animal tissues and even homeostatic soil organisms in plants (plus heaps more I suspect) - 75% of digestion in the stomach is done via enzymes ingested (making digestive enzymes from the local pharmacist/health store a good idea) and the rest by acids and mechanical muscular grinding. Low enzyme diets mean that the pancreas needs to inject larger amounts of enzymes into the duodenum to finish the job off properly - way more than it's designed to cope with. That's why most westerners have enlarged pancreases as early as their 30's and 40's&#8230;almost all elderly have humungous pancreases (it's not pancrei is it?...digressed again).Anyhow, Moises, I have to say I really admire your discipline and determination regarding your diets and trials. I don't think I could do those for so long! Were you ever able to eat larger amounts of carbs or have you always had these negative reactions to them? Take it ease! Hercus


----------



## hercules (Sep 12, 2009)

Correction - homeostatic soil organisms are probiotics, not enzymes...sorry


----------

