Can we just have it check if there were any similar email addresses registered with an account in the last 5 minutes or something, and you can't create it
It's not possible to register more than one account with the same email address, the more problematic bots create tens/hundreds of email addresses which are different, but similar. Many of them follow the formula of oneword_another@example.com, so I've thought about whether we should make it impossible to register with an email address containing an underscore, but as with so many counter-measures I think that might cause trouble for genuine users, so I doubt that would be a good idea.