SIBO Made Simple Podcast | EP 05 | Intermittent Fasting & Other Strategies for Making the MMC Move Smoothly with Dr. Amy Shah

Intermittent fasting has become a quickly accelerating wellness trend. As with any fad, this has led to a lot of misinformation and unhealthy applications of the original concept in daily life. In this week’s episode, we get to the bottom of how fasting and meal spacing can help your digestive system recover and repair. And a lot of it comes down to how these strategies allow the migrating motor complex to better do its job.

To help us understand the strategies for making our MMC—the intestinal street sweeper—work smoothly, is double board-certified doctor and nutrition expert Dr. Amy Shah. Dr. Shah utilizes her specialized skill-set in Eastern and Western medicines to focus on hormones, allergies and gut health. In today’s conversation, we’ll talk about how we eat (not just what we eat) and how these tactics can help the body heal from the inside out.

A quick taste of what we’ll cover:

• The concept of intermittent fasting versus meal spacing
• How our cells’ circadian clocks work
• Understanding autophagy (cellular clean-out) and how it limits inflammation
• Disrupted sleep cycles and what effect that can have on SIBO recovery
• Common mistakes with intermittent fasting and who it’s right for
• The right timeline for spacing your meals
• Natural supplements and dietary approaches that can help your body get back into rhythm

Resources, Mentions and Notes:

• Dr. Amy Shah’s website
• Study of nightshift workers’ lifespan
• Amy’s post on apple cider vinegar and hormone balancing
• Phoebe’s post on the best natural sleep aids
• The Wellness Project Pillow Time chapter for sleep tips
• Join the SIBO Made Simple Facebook Community Page

This episode is brought to you by Fody Foods, my favorite resource for condiments, sauces and spice blends that are low FODMAP and use real ingredients to promote digestive health. Everything is Gluten-Free, Dairy-Free, non-GMO, and most importantly, delicious. The garlic-infused oil and tomato-basil sauce are my personal favorites. Use code SIBOMADESIMPLE at checkout for 15 percent off your order!

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INTERMITTENT FASTING TO CURE SIBO

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Phoebe Lapine:  Thank you, Dr. Amy Shah, for coming on the show.  So thrilled to have you.

Dr. Amy Shah:  Thanks so much for having me.

Phoebe: So, in this discussion, we’re going to focus on all things motility.  So, how to get our Migrating Motor Complex working properly and specifically, how meal-spacing can play a role in SIBO management.  So, I’d love to dive right in and talk a little bit about the concept of intermittent fasting.  It’s become a very trendy term in the wellness world lately and not just for SIBO.  But, you know, you see it cropping up everywhere and I know that you’ve talked a lot about it. So, can you tell us just, you know, top line what is intermittent fasting and how does it work?

Dr. Shah: Intermittent fasting is taking breaks between your meals.  So, that, for example, you might be not having breakfast or having an early dinner.  It might be as little as 12 hours or 13 hours so say you eat dinner at 7:00 PM you might not eat breakfast again till 7:00 AM.  And intermittent fasting is literally just that. It’s not, you know, something extreme.  It’s really just like the age-old ancient wisdom that everybody’s probably heard of not eating after dinner and going to bed.  You know, without eating something and then waking up in the morning and eating again with kind of the sunrise, which is the old, ancient ways.  You think about ancient times before there was lights and electricity, pretty much stopped eating, you know, well before sundown, actually.  And then, they would not eat again until sunup. And so, that’s the concept of it and it really makes sense because our genes, our cells actually have circadian clocks in them. And then, and there is some evidence that, you know, in the evening hours when the sun is down our digestion is not at optimal speeds because the genes are turned off. And then in the morning, sun up, those genes are turned up.  And they think part of the reason people get acid reflex or issues with SIBO and IBS, like, later in the evenings is because of this internal circadian clock.

Phoebe: That’s so interesting because I feel like, you know, the old grandma tales just that you shouldn’t be lying down immediately after eating.  Which, you know, also makes sense. But that’s a really interesting perspective on the genetics of all of it.  So, what exactly is turned off and how does that work against us?

Dr. Shah: So, we have in every single cell of our body, there is a clock. And the clock basically decides we can’t have all the genes turned on all the time; we can’t be working on repair and restorative stuff when we need our cells to be working on digestion, for example. So, during the day there’s different times of the day where different activities peak and different genes are turned on.  And when we looked at that it is obvious that there are certain times of the evening, especially in nighttime, where the genes for restoring, repairing the G.I. tract and other places are turned on in the evening.  And when you are constantly eating and needing that digestion juice turned on, you are really impairing the repair and restorative mode.

Phoebe:  Okay. So, I assume a lot of the benefits are in regard to digestion, what are some of them specifically? And then, how does that apply to people suffering from SIBO?

Dr. Shah:  The main things that intermittent fasting does is, one, autophagy. Autophagy is a cellular clean out.  So, in our digestion and all over our body as our [Innaudible] cells work hard every day there is byproducts, kind of like the garbage.  You know, old cellular organelles, there is debris, there is pieces of the cell and it accumulates. Kind of like in our house, right? And just like we do a spring cleaning once in a blue moon, there is a process called autophagy, which is a full-on cellular clean up.  The interesting thing is that autophagy is activated with intermittent fasting and if you think about it in your digestion, cells especially are working super hard also, your brains are.  That’s why we see the most benefits I think, with intermittent fasting.   With your energy, mood, and sharpness. Like, mind-based benefit, and also digestion based benefits. Because those are kind of the cells that are probably working the hardest and also have a lot of turnover and have a lot of garbage, so to speak, that autophagy can clean up.  And so, when autophagy is activated, you get a cellular cleanup of the cells.  Something like spring cleaning, you know?  Everything is kind of sent out there and the cell becomes clean again. And it is so interesting because when they look at cellular aging, like, when they look at peoples’ cells and they try to figure out how old they are.  They use of this cellular debris as one of the markers for the age of the cell. So, effectively by activating autophagy, more often, you are making yourself younger.

Phoebe:  Which is always a good thing

Dr. Shah:  Can’t argue with that, no.

Phoebe:  Yeah. So, how about for those of us suffering from SIBO or attempting to continue the long road of prevention?

Dr. Shah:  Yeah. So, this is where we talk about fasting being beneficial in other ways beyond just that autophagy and the cleanup benefit. There’s also some — lots of people who believe that fasting during the day really does starve down some of that bacteria that’s over-growing in the gut.  You know, beyond the enhancing of the healing process and the restoration of the gut you really do starve down some of that bacteria which, you know, may be feeding on constant sugar or carbohydrates or whatever.  You know, eating all the time and having a protocol where you, 1.  Follow your circadian rhythms. And what I mean by that is, the way I like to do fasting especially for SIBO and certain other conditions is to eat during the sun hours and really try to have an early dinner.      Something like 6:00 PM or 5:00 PM and then not eat again until the next morning. And what that does is not only does it optimize your circadian rhythm so the genetics in the cell — cellular based stuff that we talked about — but it also gives it a prolonged amount of time where there’s no sugar intake where the theory is that those pathogenic bacteria can die off during that time.

Phoebe: And during the summer months when it’s lighter later, does that mean that eating time can be extended slightly later or does some of it also have to do with, you know, the proximity to bedtime?

Dr. Shah:  Yeah. Some of it does have to do with the proximity to bedtime, and I just use the sundown and sunup as kind of, like, rough markers. But if you think about it, most people have — they said that 95% of people have very, like, the same circadian rhythms. Which is basically, like, your sleep is optimized if you sleep between, like, 10:00 or 11:00 PM and wake up between 5:30 to 7:30 AM or whatever. So, even though we are all really different and say “Oh, I’m a night owl and I’m a day person and I’m a morning person…” The circadian rhythm is pretty stable in almost everyone and so just use that as a rough guide. Then it makes sense that ending your food around 6:00 PM gives you a good four hours before that natural wind-down of the circadian clock.

Phoebe:  And, you know, being on our blue-light devices at night doesn’t have maybe, a silver lining of allowing us to eat later now?

Dr. Shah: Yeah, exactly. I mean it really does I think that’s what’s happened because of smartphones and devices and, you know, electricity. A lot of people have shifted their circadian clocks. But, if you look at it we still see a ton of studies looking at night-shift workers. This is just an example:  If you’re a night-shift worker; like a nurse or a firefighter, whatever they do. They have much lower lifespans, much higher rates of disease than someone who is equal to them, same profession but working daytime hours. So, we know that inflammation and, you know, part of SIBO is obviously the inflammation, that happens when you try to flip your clock or you try to, like, really mess with that inner circadian rhythm. That’s another evidence that, you know, that inflammation happens when you try to do things on the opposite schedule than our bodies are kind of made to do.

Phoebe:  So, how do you use intermittent fasting in your practice? Who kind of should and shouldn’t try it and what are some of the common mistakes you see?

Dr. Shah:  People who are really thin very, very low body fat. You know, less than 18% body fat should really be careful and be guided in their intermittent fasting because part of intermittent fasting is weight loss or fat loss. And, you know, if you’re really struggling with that already then you have to make sure you work with someone who’s making sure you have adequate nutrition during that time. And, likewise; pregnant women, nursing women, they should not be intermittent fasting for those same reasons. You know, fat loss, and so, milk supply loss. And I never will do it with a pregnant person although, it’s just, you know, presumably possible If you really work closely with a nutritionist or practitioner.
And then, I do not recommend it in anyone who’s had an eating disorder. Something that is not controlled because, you know, things like intermittent fasting,  things that really do seem to activate people who are OCD or have active eating disorder issues. Because it kind of, you know, can make you obsessive about food and food intake and timing and all stuff especially when you’re first getting started. So, those are the rough guidelines. And, of course, anyone who has diabetes, for example, should be careful. Because, you know, your insulin levels might decrease – people who have heart disease. So, basically, you know, if you have a lot of medical problems you should probably talk to your provider as well. Anything you know, any time you’re starting a new diet but, that being said, most people do really well. Women have historically done poorly with intermittent fasting because our hormones are quite sensitive to any kind of fasting as you probably know, Phoebe.  And probably every woman knows, you know, if you’ve tried to diet and you try to starve yourself, your hormones go haywire pretty quickly, and the next couple of days your hunger hormones are off.  You’re tired, you’re cranky, and you’re super hungry. And so, I always think be really careful, go really slow, and easy when you start intermittent fasting.
So, something like ending your food at 6:00 PM to finishing your dinner early and then not eating again until 6:00 AM would be super great way to start and do that for two weeks before you ever start anything more. And I even say start with three times a week and then up it to maybe, four times a week but, you don’t need to be doing it every day to get the benefits. And then once you’ve gotten to the two-week point where you’ve done it a few times, you’ve done it well, you feel good, your energy levels are stable, you’re not having any major problems then, two to three times a week I up that. So, two to three times a week I say. Instead of eating breakfast at 6:00 AM, push it to 10:00 AM so your fasting from 6:00 PM in the evening all the way until 8:00 or 10:00 or whatever feels comfortable for you. But that 10:00 would be the maximum and then you could do, like, 8:00 AM or 10:00 AM and feel how your body feels on that. Do that for two times a week and that would be pretty much the ideal situation where you’re doing a daily, time-restricted eating which is another way to say fasting just for 12 hours. So, doing it daily, something like 6:00 to 6:00 AM and then two to three times a week pushing it a little bit to 10:00 AM or 9:00 AM.

Phoebe:  And do you operate ever off of just simply the time span? So, 12 hours versus 14 hours, versus 16 hours or is it really more about the time of day that you’re ending and then beginning again?

Dr. Shah:  So, yeah. There is still a benefit if you say, you know what I ate this — it was Friday night, you know, we all have, you know, social dinners, whatever, you finished dinner late. Yes, you can definitely count 12 hours from that point. I’m just telling you the ideal situation on weekdays. For example:  When you have a little more control but, even if you could do a 16 hour fast.  The traditional way of doing intermittent fasting, I think, that you’ll see all over the Internet is eating a later dinner and then skipping breakfast. And having – kind of going straight to lunch. And the reason I say that for a SIBO, for example, the other way would be better is because of that digestion gene autophagy. All those reasons are reasons to do it kind of the reverse way which is the way I like to do it. Meaning early dinner and regular breakfast, rather than the traditional way of doing intermittent fasting which is a late dinner and skipping breakfast.

Phoebe:  It’s funny, I didn’t even think we’d be really touching on sleep in this conversation. But now I’m curious, you know, does intermittent fasting actually lead to better sleep? how does sleep play into SIBO recovery? Obviously, it’s super important for any type of recovery but, I’m curious if there’s something specific.

Dr. Shah:  Yes.  You know, whenever you’re trying to fix your sleep, circadian rhythms really does have to play into it. So, that’s why I’m talking so much about that because with digestion related disorders I find that when you start to really stick to that circadian clock a lot of things improve. Which is your energy, your sleep, and your digestion. And they’re all, like, really intra-connected. So something, like, I would recommend to people who are both struggling with SIBO and sleep, I would say get some sunlight, direct sunlight during the morning hours before 10:00 AM. It doesn’t have to be more than five minutes. It could be just five minutes of stretching outdoors or take the long way to walk, you know, to work or whatever. It is five minutes of direct sunlight and that should be good to reset your circadian clock, your melatonin. You have a hormone access the hypothalamic-pituitary-adrenal axis which is very closely related to your circadian rhythm as well.  So, you can basically get that in shape and your sleep will improve, your digestion will improve, and then add that to eating early in the evening and you really optimize it. And, of course, we haven’t talked about diet. I’m sure you go into diet all the time but, you know, this is assuming as well that your diet has a low-sugar content and your diet is having a high vegetable content, for example. And those two things just go hand-in-hand with all the stuff that we’re talking about.

Phoebe:  Yes. Totally agree.  So, if someone is intimidated by this concept of intermittent fasting, let’s talk about, kind of, the gateway into that which is maybe meal spacing. Can you talk a little bit about the kind of the rules of thumb for meal spacing and SIBO? Things to keep in mind about snacking or just in general, how you recommend structuring your meals throughout the day?

Dr. Shah:  I think the idea of kind of having your meals in a window of time and having your meals all within eight hours, for example, is a great way to prevent snacking. And to say “Okay. you should try to eat between the hours of 8:00 AM and 5:00 PM.” Say, for example, or 9:00 PM and 9:00 AM to 6:00 PM and having an eight or nine-hour window is actually kind of, like, another form of fasting but, it is thinking about it in a different way.
You know it’s, like, called time-restricted feeding or time-restricted eating and really having long periods of time. The goal is to have a good, long period of time where you’re not snacking and that you’re not spiking that blood sugar and you’re not feeding that bacteria — that —  especially that bacteria that you want to get rid of in the small intestine. You know, we have so many more bacteria in the colon than we have in the small bowel and so, it’s really important to remember that what you have abnormal or the wrong amounts of bacteria or the wrong kinds of bacteria in your small intestine, it’s because we don’t have a ton of bacteria like we do in the colon. And there’s less and so, when you get the pathogenic bacteria in your small bowel, what you’re trying to do is starve out kind of — and that’s how I think of it. As kind of starve out the bad kind and grow and endorse the good kind.  Is that kind of how you think of that or what’s your thoughts?

Phoebe:  Yeah, Absolutely. We’ve talked a little bit about the Migrating Motor Complex on previous episodes. And, you know, a kind of a big “aha” moment for me when I was dealing with my own diagnosis was remembering that it takes 90 minutes in a fasting state for the MMC to kick in, and that to me was just kind of a no-brainer. Why snacking especially people, even if it’s something super healthy like eating one or two almonds every five minutes, you know why that might be problematic.
And, actually, you know on that subject I would love to talk a little bit about some of your other strategies for managing motility. Maybe we can break them up into medication, natural supplements, and then if there any other lifestyle recommendations in addition to the meal spacing and intermittent fasting I’d love to hear them.

Dr. Shah:  I love using certain fermented foods. But, like, for example, apple cider vinegar. This is what I do: I literally go to my pantry with a glass of water and I take a shot of my apple cider vinegar and I wash it down with water and that’s how I consume it. I don’t consume it necessarily in foods or drinks and all of that and I just think of it as kind of like a medicinal property. And because I’d like to do it before meals, for example, at least once or twice a day. I think that it’s easier for me at least and a lot of people I work with just to say “you know, mix it into a glass of water. One to two tablespoons per eight ounces” and just kind of have it before your meal.

Phoebe:  And explain what that does, what the benefit is to having it before your meal. Because I was recommended this as well but, I chose to do it with fresh lemon juice instead because I find it more palatable.

Dr. Shah: Yeah.  And you can do that too. When they looked at a study, the most scientific reason — because there’s so many.  I mean, if you look up apple cider vinegar there’s, like, all old wives tales and there’s ancient – you know things which is all awesome but the real evidence — and I looked into this a while ago –is the insulin, the hormone balancing benefits.
Okay. So, what happens is if you take apple cider vinegar about two hours, one to two hours after you ingest the apple cider vinegar, your body is just more insulin sensitive and it’s just able to process food in a way that will spike your insulin a little bit less. What that means is insulin spikes and other hormonal spikes has really been correlated with inflammation, with diabetes, with all kinds of negative things in disease states. And so, having that insulin spike not as sharp or not as strong when you eat your meal is a real benefit for anyone who is struggling with SIBO, struggling with inflammation in general, struggling with — especially with fat gain around the stomach area because that’s where insulin, high spikes of insulin tends to deposit.  They will notice a benefit before meals, meaning a benefit when you take it before meals. So, it’s kind of like a hormone balancing effect and that’s the thing that’s actually been shown in studies.
The other things, you know, about it when you take apple cider vinegar is it is a fermented food, and as we know that it can be nice for that reason. Also, there’s some evidence that it improves the production of digestive juices like hydrochloric acid, bile, and pancreatic enzymes. And so, it seems to be a good thing to have before meals.

Phoebe:  Yes. That was the efficacy I was told about —

Dr. Shah: Yes.

Phoebe: — to make sure that my stomach acid got in the game right before the food entered

Dr. Shah:  I guess that’s, like, a really a thing — a hard thing to measure. Whereas — you know, though hormonal balancing facts actually has been shown during and after a meal. And so, that’s kind of like all the different reasons I think that you know, the apple cider vinegar part of it — so the studies on hormone balancing effects are just vinegar and don’t need to be apple cider vinegar. Apple cider vinegar fermented benefits go to the other things about digestion.  And, I think that apple cider vinegar just gets a halo effect. I think that any kind of vinegar is going to help with the production of digestive juices, you know?  And so, it’s not necessarily apple cider, per se, that you need to use.
And then, of course, whenever we’re talking about fixing the gut I always talk about broths and doing some liquid-based foods because I think that — I don’t know if you’re in agreement with this, but people digest liquid soups just better, broths and soups. And it really gives the body a chance to recover and repair without having to do a ton of work.  So, herbal teas, broths — I mean, I do coffee but, you know, depending on how you tolerate coffee try to be on a, you know, low FODMAPS diet.
You know, FODMAPS is a great short-term solution, going on a low FODMAPS diet. But I think that this is a slow reintroduction of certain higher FODMAP food groups is a better long-term strategy.  So meaning, like, having a modified FODMAP diet when you’re on a long-term protocol is probably where I go more often than not.

Phoebe:  Yes.  And we have talked about this in more depth in other episodes but, I’m so glad you brought it up because I was actually going to say that one of my recommendations for people who are reintroducing FODMAPS and they’re nervous about it, is to make sure that they have it in kind of a cooked, easy, potentially soup-like preparation. Because it, you know, sometimes it’s not that you’re reacting, per se, to the food because, you know, you have a long-term intolerance. But, you know, when you take anything out of your diet, it can be hard to reintroduce anything, like, your body is not used to digesting it so, I always recommend that you do it in soup form or anything that’s kind of well cooked and easy to break down.

Dr. Shah:  Yes. I love — huge fan of soups and juices. And, you know,  giving the body a little bit of breath from digestion.
Also, drinking a ton of water. Making sure that you are really well hydrated.  Trying to flush out some of the bacteria. And I think that the morning like you said, some of the benefits of having that morning water is also backed.
Phoebe:  Okay.  So, back in kind of segue from the idea of broths and cooked foods, talk a little bit about how chewing factors into all of this.

Dr. Shah:  You know, chewing is really interesting our brain is — if you think about Pavlov’s Dog kind of thing where chewing is the signal to our brain, right? That we basically are going to ingest food. And once we start to chew, we have digestive juices that slow. That’s why people will say when you’re having a lot of digestive issues you may not want to chew gum or chew things because our brain is very, very, very sensitive to — once you start chewing they’re starting to send signals to your gut, like “Okay. Food is coming. Start to, you know, be prepared. Start to, you know, release the digestive juices and also the digestive enzymes” and all of those things that also gives your body a signal to start to sense fullness. And, you know, a lot of people will eat so fast, not chew, and they’ll swallow real fast  and it doesn’t give the body enough time to kind of send signals all over to be like “okay. you’re full, stop eating now.” And it’s, like, by the time you get that signal it’s quite too late.

Phoebe:  And is there anything specific that you know kind of correlates to SIBO? Does it not stimulate the stomach acid to be produced? Like, are there any other downwind issues for SIBO with not chewing your food? Obviously, probably more particles ending up in your — undigested particles ending up in your small intestine.

Dr. Shah:  Yeah. And, basically and not having proper digestion is obviously some of the problems in SIBO, and many other gut disorders. It’s, like, your body is probably having digestion issues. For example:  Say you’re super, super hungry and you’re not chewing very well and are just kind of eating very, very quickly and your brain doesn’t have time to signal to your gut that this food is coming, your body is not able — your stomach and your intestines, you know? Because it goes from the stomach to the small intestine. It’s not able to digest and extract the vitamins and minerals that it needs from this food and then goes into the colon. So, it’s basically traveling through your gut, like, and in a non-optimal way. And not only non-optimal but, also may be creating a lot of these problems.
It’s a really good — you’re bringing up a really good point because I think that a lot of people don’t even think about how fast you eat your food as one of the ways that they can help their digestion.

Phoebe:   Yeah. It’s something I’ve had to learn the hard for sure in my own life. And, you know, trying to chew your food when you haven’t been doing it properly for a long time can really not feel so pleasant. You know I’m, like, “Oh, I don’t like this mush forming in my mouth.”

Dr. Shah:  Yeah.  Yeah, that’s really, really interesting because, you know, there’s lots of data that the gastric stretch and the chemoreceptors will change when they know that there’s food coming in and so there’s a lot of changes that happen brain and G.I. wise. Because of basically that gut/brain connection that you want to keep intact. The gut/brain connection, you know, is such an important part of our digestion. And that’s why I think that strategies like chewing slowly also or like sitting in a quiet place without too much chaos can really optimize that gut/brain connection. You’re really trying to connect your brain to your body and chewing slowly is just one part of that but, is an important part of that.
So, one of the things I find with people that have SIBO and other gut disorders is that they seem to be out of touch with their body in terms of their G.I. Tract. And getting them back in touch with their body, back in touch with their digestion by rekindling that gut/brain connection can be difficult. Like you said because you’re not used to taking your time when you’re eating. You’re not used to kind of concentrating on that digestion or not being distracted all the time.  You’re not used to sitting down in a quiet place without a ton of distractions. So, those are always — and in general like lowering inflammation, having that body/mind connection is so important.
That’s why yoga has been such an amazing healing technique for so many people. It’s because it’s kind of reestablishing that connection to our body that we’ve lost.

Phoebe:   Yes. Totally. Well, thank you so much for coming on the show and giving us your time today. Before we let you go, is there anything else? Any other manageable tip which, you’ve given us so many of, that you’d like to suggest on the subject of managing motility and meal spacing etc.?

Dr. Shah:  Yeah. I think that someone who is — if I have to give you kind of a take-away – someone was just trying this,  I would say try for one week to give your body a break from eating. So, digestive break for 12 hours. So, like, you know, end your meals, like I said, at 7:00 or 8:00 PM or, you know, 6:00, 7:00, 8:00  PM, and then don’t eat for 12 hours. And that will be a simple introduction to the benefits, I think within a week. Although, you know, when we talk about digestion, things can take more than two to three weeks. But within a week, I noticed that most people will notice some kind of digestive benefit and that’s a great way to test it out for yourself.

Phoebe:  I love that.  Thank you so much, Dr. Amy Shah, for coming on and have a wonderful day.

Dr. Shah:  Thank you so much for having me.

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Disclaimer: The information shared in this podcast is not meant to provide medical advice, professional diagnosis, or treatment. The information discussed is for educational purposes only and is not a substitute for medical or professional care.