# SIBO Vivonex Fast without the Vivonex



## Moises (May 20, 2000)

Mark Pimentel, the primary advocate of the SIBO-IBS connection, acknowledged in his book that some people might have bacterial overgrowth very high up in the intestines. That is, there might be an infection immediately after, or distal to, the stomach's pyloric valve.

Let us do a little thought experiment. A patient presents with IBS and takes Xifaxan, the antibiotic that Pimentel uses as his first mode of treatment. But Xifaxan doesn't always work. And, in fact, it does not work with this patient.

So, then he uses Vivonex, the elemental diet.

But if someone had bacterial overgrowth high up in the proximal duodenum, or upper reaches of the intestine, then the Vivonex would provide nutrition for the bacteria. And the patient would not be helped by the Vivonex because the bacteria would not be starved out.

So, if a 14-day Vivonex diet is Pimentel's big gun against SIBO

http://www.ncbi.nlm.nih.gov/pubmed/14992438

why wouldn't a 14-day WATER FAST be the silver bullet?

If bacteria die in 14 days, they die in 14 days. Just consume nothing but water for 14 days.

Yes, it's uncomfortable. But that Vivonex was pretty nasty tasting. And it was very expensive. And it's not always easy to get for some people.

Fasting for 14 days is no walk in the park. And I am sure that some people with some serious health problems can't do it. But it's probably easier for most people to drink only water for 14 days than to drink Vivonex.

What do you think of this scheme? It seems so obvious. No one can make any money off of it. Is that why no one is proposing it?


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## Brownish72 (Aug 26, 2012)

Hey there, seems like we cross paths often,

here's a great talk about water fasting from an NPR network in Utah called Radio West. Its a great program, and this is an informative talk about how to water fast, is it safe, etc.. This guy did a total of 31 days if im not mistaken, and he wrote a book about it as well.

http://radiowest.kuer.org/post/starving-your-way-vigor-0


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## Moises (May 20, 2000)

Brownish,

Thanks for the link. He definitely stresses the financial conspiracy aspect.

Before I wrote my post I did a bit of googling. I could only find one person who mentions water fasting as a substitute for Vivonex:

http://gopaleo.com/blog/2011/12/19/60-million-suffer-with-ibs-sibo-in-the-us.html

And it appears that she did not do it for the required 14 days. Furthermore, she does not give any detail about its effectiveness.

In the audio link you gave, the guy mentions going vegan in preparation for a water fast. Obviously, that is not something that I would consider doing.

He also talks about doing a lot of shorter fasts in preparation. That also seems to be contrary to what I would like to accomplish. I am not interested in fasting for fasting's sake.

I only want to fast to see if it could get rid of my small intestinal bacteria.

The audio link was fascinating to listen to because it gave some interesting history on fasting. I was amazed last night when I looked around amazon.com how little good information is available on fasting. Most of what exists is a mix of pseudo-science and mysticism.


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## Brownish72 (Aug 26, 2012)

Glad you enjoyed the audio I sent you. Obviously he was fasting for other reasons than you and I would. Also, there are so many arguments for and against vegetarian, vegan diets. I was vegetarian for awhile, I really enjoyed it, but after SIBO, its impossible. And now I've changed my opinion on eating meat, especially with how I treat my food literally as my medicine in keeping me healthy and feeling good. So why he says follow a vegan diet before fasting, I don't know, i think thats his personal opinion. I on the other hand would think thats a bad idea... Nonetheless, I really enjoyed the talk.

I have met someone who has water fasted for a week. The problem I find with it is the extreme strain on the body, and if you are already underweight, it could be quite scary. But I understand 100% why you would be willing to do it, to get rid of SIBO. I'll let you know if I come across any more talks about water fasting


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## Moises (May 20, 2000)

I actually water fasted for a week many years ago. At the time I did it to see if my gut wouild improve. That was the only reason. And to my great disappointment, it made no difference. But back then I knew nothing about Pimentel and SIBO. In the original post to this thread I gave the Pimentel PubMed link. He seems to have evidence to suggest that maybe 1 week was insufficient time to exterminate the bacteria.

I was OK with fasting back then. Like the audio and many websites say, the hunger goes away after a few days. That's why to me it seems strange to do a lot of 1-3 day fasts. With those you get mostly pain and not much gain. After 3 days the hunger is gone. What always amazes me is how much time I spend on food. There is shopping, cooking, eating, cleaning up. Even with Vivonex that became real obvious to me. I had a lot more time on my hands.

One other way to look at this, and I have not researched it at all, would be to do a water-fat fast. It sounds disgusting and I don't know if I could handle it. But I don't think that fatty acids provide fuel to bacteria (not sure, though). But there certainly are fatty acids that are essential to human metabolism. So, if we don't want to give the bacteria protein or carb, why not at least give ourselves some fat with our water?

I think I might puke it up, though, if I were eating nothing but fat. But if I could hold it down, it is conceivable that it might provide me with more energy and allow me to endure the fast with greater ease.

Then the question becomes, what fat? I know some people are big fans of MCT oil. I am dubious. I once went 2 days having only water and coconut oil. Coconut oil just gives me terrible diarrhea.

So, it seems like the best way to go is just water, and maybe some vitamins or minerals, like they say in the audio link you gave. As the author of the gopaleo link points out, Vivonex is really bad for you if you have blood sugar issues. It will send your blood sugar sky high. Plain water is really the way to go.


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## lowimpact (Jul 3, 2010)

Well, i have SIBO and am a vegetarian for over two decades. Most of that time i had no issues. Since having SIBO my diet has changed but meat is still not a part of it.

As to the Vivonex, i have done it twice now as the meds Pimentel's colleague gave me didn't work after multiple tries and combining other drugs. My only other options in their arsenal were drugs i coudl try from Canada that had been banned here.

The first time i took the Vivonex it worked, but the SIBO came back in five months and i had maintained a very low carb almost low FODMAP diet. The second time it did nothing and i took it for 14 days. What it did do, was give me candida from the crystal light you have to take to make the Vivonex palatable. So i would also add that on top of blood sugar issues it's filling your body with large doses of aspartame. I essentially didn't eat food for a month that year and was still suffering.

The other interesting thing is i have i think Liptin Resistance and though i didn't eat for all that time i only lost two pounds. Some of us with SIBO have losing weight being a problem. For me, the SIBO results in a large weight gain from my normal weight for years and no matter what i eat or don't eat that won't change until the bacteria are under control. I have had the weight since i got the SIBO and only in the brief months of respite after my first course of Vivonex did most of it drop off, only to come back...

I wish we had our own forum and also that there was some other doctors finding new ways to treat this besides just Pimentel's protocol which i know hasn't worked for myself or two of my friends.


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## Moises (May 20, 2000)

lowimpact,

Sorry to hear of your struggles. I was vegetarian for years and that's when my problems began.


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## lowimpact (Jul 3, 2010)

I'm sorry Moses that going vegetarian caused you to have these issues. We are all so different, i never advocate for anyone to do one way or the other because you really don't know what would be better for someone. I know people who are better on Paleo and people with prostate cancer who have knocked their PSA's way down going vegan. I wish i could go to eating meat and see if that would help me, but it''s just a no go for me after this long! So i need to find a way to eat without bloating up!


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## faze action (Aug 6, 2009)

Moises said:


> lowimpact,
> 
> Sorry to hear of your struggles. I was vegetarian for years and that's when my problems began.


Odd. That is exactly what happened to me... was a vegetarian for about a decade overall, and about 7-8 years into that timeframe is when my problems started. I always thought there was not a direct connection, but now I think part of the problem was that I was substituting carbs (and gluten specifically) for meat and my body just couldn't handle it.


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## Inndie (May 19, 2012)

I am new to this site so haven't read all the threads...however, I noticed your conversation and thought I would butt in! Hope that's OK?

I definitely started to have problems with IBS soon after I turned vegetarian, and couldn't figure out why. Eventually due to anaemia I had to go back to meat, and the symptoms did improve a little. My view is that I started to eat a huge amount of dairy and wheat to replace the meat and make the food more interesting, and I think like you say the high amount of carbs was too much for me. I am waiting for an appointment with a gastroenterologist and am hoping they will agree to a lactulose breath test. I am in the UK, so it could take a long time before I get to see them let alone get the results of any test!

Also, I cannot find a supplier of Vivonex in the UK - I wouldn't try this until I have the results of a test, but I thought I would prepare just in case everything else fails...bit pessimistic about all of this now as have tried so many things :-(


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## Moises (May 20, 2000)

Inndie,

I wouldn't put too much faith in the lactulose breath test. Pimentel's experiments with it have not been replicated consistently by other researchers.

I am not saying that it is completely invalid. I am merely saying that its results are far from definitive.

Why not read Robillard's book, Fast Tract Digestion, and give his diet a try for two weeks? If you get better, you have simultaneously diagnosed and cured yourself.


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## Inndie (May 19, 2012)

Thanks Moises, I will try and get hold of Robillard's book. Has that diet worked for you? I am following the FODMAPs diet and having great results. However it is not a cure and once I stray off it when eating out, my symptoms return. I was hoping to find something a little more permanent, but maybe that's asking too much!


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## salvationishere (Mar 2, 2013)

It's interesting what you all are saying above because we share similar issues and past. I went to Cedars-Sinai last year to see the GI mobility department and had the lactulose test. This test was unnecessary though because from my experience I already knew I had a problem with every sweet substance: sugar, aspartamen, honey, etc. And also a lactose intolerance.

I am very fortunate that the Vivonex Plus has been very effective in alleviating all of my symptoms while on it. But its effects do not seem to last me after I discontinue using it, event when I was on it for 2 contiguous weeks. Of course, I live in Memphis so I did not repeat the lactulose test after the 2 weeks was over. So I am not sure what to try next. I am considering instead of staying on this Vivonex only for 2 weeks, that this time I will try to make the Vivonex stretch out over 5-6 months by just consuming 2 packets per day.

It is not safe for me to water fast since my problem is that I am way underweight and I also have anemia. But it is interesting what you all said above about the blood sugar hiking from Vivo because for the first time I was told that my blood sugar was below the normal range and that I might be hypoglycemic. Has this happened to any of you from Vivonex? Your blood sugar plummeting. I know diabetes runs in my family, so this might not have been caused by Vivonex after all.

And do any of you know of any patient assistance programs for Vivo? My insurance doesn't cover this. How is Vivonex Plus designed to be used? For 100% of one's diet for a SET amount of time or ALL of the time?


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## Moises (May 20, 2000)

salvation,

If you are new to diabetes, it can seem complicated. But, what often happens to people is that their blood glucose (BG, or blood sugar) soars after consuming lots of simple sugars (like the maltodextrin in Vivonex). This is because their ability to tolerate glucose is impaired. But then they do start to produce insulin and that drives the glucose out of the blood and into the body's cells. So then they get lood BG or hypoglycemia. It could be that you went high, then you plummeted.

I suspect that was happening to me on my two Vivonex regimens. But back when I did them I understood little about BG and I did not have a meter. I now realize how easy it is to check my BG throughout the day.

I am glad the Vivonex worked for you and empathize with how frustrating it must be to have it not last. Have you given the Robillard diet(s) a try?


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## salvationishere (Mar 2, 2013)

Thanks, Moises. Here is the thing. I separately bought 100% maltodextrin a couple months ago. From what I recall, when I took about 3 Tablespoons of this at once, I developed a sore throat and it brought down my immune system. So I stopped taking it. The #2 ingredient in Vivonex Plus is corn maltodextrin (after #1 water). But I've never had sore throat, sleep, or other problems I am aware of with Vivonex. I don't understand well how diabetes works but I do know that I have had my blood sugar levels tested many times over the past 10 years and I have *never* had one high BG reading. This year was the first time I ever had a low BG reading, however.

My dad has diabetes now and his mom had diabetes. My brother has hypoglycemia. Beyond this, nobody else in my immediate family has blood sugar problems. I am super sensitive to sugar. If I consume as little as 2g of sugar in one sitting from almost pure chocolate (85% chocolate bar), this keeps me from sleeping often. How can I test my BG level and what should I tell my endocrinologist regarding this Vivonex?

I don't have heartburn but I do have carbohydrate malabsorption. I already only eat meats, fish, and chicken. Other than these, I eat butternut and acorn squash, almonds, and olive oil. And leafy green vegetables. And now this Vivonex--does this book contain additional foods on the diet? How long have you been on this diet? I have been trying to gain weight for a long time.


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## Moises (May 20, 2000)

Salvation,

You and I have tried a lot of similar things. I also have anemia on and off. I too once bought maltodextrin in bulk in an attempt to make my own elemental diet.

Believe it or not, diabetes is UNDERdiagnosed. I know that that sounds incredible, because so many in the US have it. But, in the US, by the time you get the diagnosis, you've already had it for years and you have already suffered a lot of damage (typically to your eyes and feet).

The typical test in a doctor's office is fasting blood sugar. They will not tell you there is a problem if your reading is below 100 mg/dl (only the US uses the mg/dl measurement).

But what you need to do is measure your blood sugar a couple of hours after a meal. Go to a drug store and buy a blood glucose monitor (meter) along with some test strips. The problem is that most of them are terribly inaccurate. The best ones are not terribly inaccurate; they are just inaccurate. The least bad ones are Aviva Accu Chek, Freestyle Freedom Lite and Freestyle Lite. There is a confusing mishmash of names. Make sure you get the correct one.

Take your BG reading (blood glucose). Eat your meal. About 2 hours after the meal, see if your BG went up and, if so, by how much. Do this for breakfast, lunch, and dinner. The dynamics of BG change throughout the day. They are affected by illness, exercise, and, of course, diet.

You said you have an endo. Are you seeing her for hypoglycemia? With your family history, obviously you are at high risk for disorders of BG regulation.

One thing I have learned is that my doctors work for me. I had to ask my doctor to test my A1c. He wasn't going to do it. And when it came back high (this is an indirect measure of BG) he wasn't interested in treating it. He only wanted to give m a statin (Crestor) for lowering cholesterol. You have to be the same way with your endo. Get as much information as you can so that you can make an informed choice.

It is worth the bucks to test your own BG after meals (postprandial). That is the most important thing you need to know right now.

You need to find out if your only problem is low BG or if you also are going too high. You can do this on your own.


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## salvationishere (Mar 2, 2013)

I got a Contour Next EZ a couple weeks ago and I tracked my blood sugar 30 minutes prior to every meal for one week. What about this meter? I recorded the entries and since I normally ate once every 3-4 hours, my BG levels were almost always in the lower end of normal range. However, on one night I waited 6 hours between meals and my BG went all the way down to 37 mg/dl! I felt like I was going to pass out and was confused and naucious.

During that week I never did register above a 120 mg/dl. Yes, I will discuss these items above with my endocrin. Thank you! Nok , I'm not seeing him for hypoglycemia. I have a pituitary tumor and am hypothyroid. I think you are correct about getting my money's worth, but because I have so many ill-health conditions, it gets complicated trying to decide which specialist to see for each problem.


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## Moises (May 20, 2000)

salvation,

If your meter is accurate and you went down to 37 mg/dl, you need to tell your endo right away. That is a serious, life-threatening situation.

In the meantime, you should be carrying glucose tablets with you. Anything below 75 or so and you should be taking glucose.

Please. Get professional medical treatment.


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## salvationishere2 (Jul 1, 2009)

Moises,

I just returned from my endocrinologist and discussed this with him. But in regards to the 37 mg/dl reading, he believes the real problem was not my BG level but that I had entered ketosis. What do you think about that? Also, he wants to see me add more variety in my diet and especially caloric intake by gradually adding new foods into my diet. Have you successfully been able to reintroduce foods that you used to be intolerant of? I only eat about 10 different foods currently.

In regards to the Vivonex Plus, how should I take that next time? Take it 100% of the time for 2-3 weeks straight and nothing else? Or to use it as a supplement on a permanent basis?


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## Moises (May 20, 2000)

Salvation,

Your problems are quite complex. You need to work closely with a knowledgeable physician.

In answer to one of your questions, yes, in theory Vivonex should be able to sustain human life indefinitely. But realistically, it is much too expensive for most of us.

You say you are hypothyroid. How was that diagnosed? What are you taking for it? Has anyone given you T3 (liothyronine, brand-name "Cytomel")?


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## Moises (May 20, 2000)

http://chriskresser.com/thyroid-blood-sugar-metabolic-syndrome

Above is a link that discusses some of the relationships between hypoglycemia and hypothyroidism.


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## salvationishere2 (Jul 1, 2009)

I don't remember how I was diagnosed, but I have been diagnosed as hypothyroid by several endocrinologists now from multiple tests. I am taking Cytomel and Levothyroxin for it.


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## salvationishere (Mar 2, 2013)

That was an excellent article! Thanks!


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## Moises (May 20, 2000)

Today is the 14th day of my 14-day fast. I consumed only water and thyroid tablets. The thyroid tablets did contain a very small amount of water and sugar.

There was zero improvement to my belching.

I entered this fast believing that the gas emitted during belching can originate from only two sources: microbes in the digestive tract or swallowed air.

I have since learned from this wonderful article, http://www.giresearch.org/site/gi-research/iffgd-research-awards/2005/understanding-intestinal-gas , that there are two other sources:



> Back-passage of gas from the blood stream into the intestines.
> The production of gas through chemical reactions within the intestines.


My conclusion is that it is highly unlikely that I have SIBO. Or, I might have SIBO, but SIBO causes my diarrhea and not my belching.


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## Brownish72 (Aug 26, 2012)

dangit. I was hoping to hear better news. Sorry to hear about this. Unbelievable you held out 14 days. Good on you for the will power you show.

Best of luck in finding a solution. As always, hope you find relief soon


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## Moises (May 20, 2000)

Thanks!


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## LRHG (May 7, 2013)

Moises said:


> Today is the 14th day of my 14-day fast. I consumed only water and thyroid tablets. The thyroid tablets did contain a very small amount of water and sugar.
> 
> There was zero improvement to my belching.
> 
> ...


I have the same belching problem as you Moises. Ginger is helping quite a bit right now with the belching but the bloating persists so it seems the ginger is just moving things down.

Thanks for the article - that is good. I read it and thought about my own case for a bit and wondered if that could be giong on with me (build up of normal gas in small intestine and not excess gas from an overgrowth). And I don't think so because:

a. diet at one timne did clear up all symptoms

b. inulin made symptoms infinitely worse

c. so does kefir

Anyway, I've decided to go and get a aspirate done as it is apparently the gold standard to see if there is an overgrowth. This will be done in November.

I jsut wonder if there couldn't be some way to still have belching while on a fast ... could the overgrowth have colonized the mucosa and be feeding off the blood supply ? Or the cellular supply ? Or the biofilm as it does contain polysaccarides.

Anyway I have wanted to touch base with you for a while since we do share the burping symptom.


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