Uncovering SIBO Understanding, Diagnosing, and Treating Small Intestinal Bacterial Overgrowth with Dr. Allison Siebecker

Episode Overview

Episode Topic

In this episode of Holistic Health Habits, host Surani Fernando is joined by Dr. Allison Siebecker, co-founder of Sibo Info, to explore the complex world of Small Intestinal Bacterial Overgrowth (SIBO). SIBO is a condition characterized by an overgrowth of bacteria in the small intestine, often leading to symptoms such as bloating, abdominal pain, and digestive disturbances. Dr. Siebecker shares her personal journey with SIBO, which sparked her passion for educating others about this often-overlooked condition. The conversation delves into the prevalence of SIBO, its connection to Irritable Bowel Syndrome (IBS), and the latest diagnostic and treatment methods.

Listeners will gain insights into the causes of SIBO, including common factors such as food poisoning and structural abnormalities in the digestive tract. Dr. Siebecker emphasizes the importance of accurate diagnosis through breath testing and explains how various treatments, including antibiotics, herbal remedies, and dietary modifications, can help manage and potentially resolve SIBO. Whether you’re a healthcare practitioner or someone dealing with digestive issues, this episode offers valuable information on understanding and managing SIBO effectively.

Lessons You’ll Learn

In this episode, you’ll learn about the critical role of accurate diagnosis in managing SIBO and the various methods used, including lactulose breath testing. Dr. Allison Siebecker provides a comprehensive overview of the three main types of SIBO—hydrogen, methane, and hydrogen sulfide—and how each type requires specific treatments. You’ll also discover the effectiveness of different treatment options, such as antibiotics, herbal remedies, and the elemental diet, which starves the overgrown bacteria while maintaining nutritional intake.

Additionally, Dr. Siebecker addresses common misconceptions about SIBO, such as the belief that diet alone can cause or cure the condition. Instead, she highlights the importance of identifying underlying causes, such as food poisoning or anatomical issues, and using a tailored approach to treatment. This episode is packed with practical advice for both practitioners and patients, including tips on preventing SIBO recurrence and maintaining gut health through lifestyle modifications and prokinetic therapies.

About Our Guest

Dr. Allison Siebecker is a naturopathic physician, educator, and co-founder of Sibo Info, a leading resource for information on Small Intestinal Bacterial Overgrowth (SIBO). With over 14 years of experience in the field, Dr. Siebecker has dedicated her career to raising awareness about SIBO and educating both healthcare professionals and patients. Her passion for SIBO research was ignited by her personal experience with the condition, which led her to discover effective treatments that dramatically improved her quality of life.

Dr. Siebecker has been instrumental in bridging the gap between dietary approaches and scientific research, creating comprehensive educational resources, including training courses and a popular SIBO conference. She continues to contribute to the evolving field of SIBO through her website, Sibo Info, where she offers training, masterclasses, and the latest updates on SIBO research and treatment strategies. Her expertise and commitment to patient education make her a highly respected figure in the world of digestive health.

Topics Covered

This episode covers a wide range of topics related to Small Intestinal Bacterial Overgrowth (SIBO), starting with an introduction to what SIBO is and how it affects the digestive system. Dr. Siebecker discusses the prevalence of SIBO in individuals with Irritable Bowel Syndrome (IBS) and explains the various symptoms associated with the condition, such as bloating, abdominal pain, and bowel movement irregularities. The conversation also touches on the different types of SIBO—hydrogen, methane, and hydrogen sulfide—and the unique treatment approaches required for each type.

Dr. Siebecker shares valuable insights into the diagnostic process, emphasizing the importance of breath testing and understanding test results to guide treatment. The episode explores various treatment options, including pharmaceutical antibiotics, herbal antibiotics, and the elemental diet, along with their effectiveness and potential side effects. Listeners will also learn about the importance of preventing SIBO recurrence through lifestyle changes, dietary modifications, and the use of prokinetics. This comprehensive discussion provides both patients and practitioners with the tools needed to understand, diagnose, and effectively manage SIBO

Our Guest: Dr. Allison Siebecker

Dr. Allison Siebecker is a renowned naturopathic physician and an authority on Small Intestinal Bacterial Overgrowth (SIBO), with over 14 years of dedicated experience in this specialized field. She co-founded SIBO Info, a comprehensive online resource that has become a leading authority on SIBO education for both healthcare professionals and patients. Dr. Siebecker’s passion for this area stems from her own personal struggles with digestive health, which began in childhood. Her experiences with chronic digestive issues led her to discover the benefits of natural therapies and ultimately guided her to a career in naturopathic medicine. After completing her education, she realized the critical need for more awareness and better diagnostic and treatment protocols for SIBO, sparking her journey into educating others and raising awareness about this often-misunderstood condition.

Dr. Siebecker has been instrumental in bridging the gap between the scientific community and holistic health practitioners by merging dietary approaches with evidence-based research. She has developed educational curricula and comprehensive training courses on SIBO, which she teaches at medical institutions, including the National University of Natural Medicine (NUNM) in Portland, Oregon. Her efforts have been pivotal in advancing the understanding of SIBO, emphasizing a holistic approach to treatment that includes dietary modifications, herbal remedies, and probiotics. Additionally, Dr. Siebecker is known for organizing the annual SIBO Symposium, which brings together experts from around the world to share the latest research, treatment strategies, and clinical experiences.

Dr. Siebecker’s work extends beyond clinical practice; she is a prolific educator and speaker, frequently presenting at conferences and seminars to share her expertise on SIBO and digestive health. Her contributions to the field have been recognized widely, making her a sought-after expert for both professional audiences and patients seeking guidance on managing SIBO. She regularly updates her website, SIBO Info, with the latest research, treatment protocols, and resources to support both practitioners and patients. Through her unwavering commitment to education and patient care, Dr. Siebecker has significantly impacted the understanding and management of SIBO, helping countless individuals achieve better digestive health and overall well-being

TRANSCRIPT 

Surani Fernando: Welcome to another episode of Holistic Health Habits, the podcast where we explore the latest trends and innovations in holistic health and wellness with a focus on nutrition. I’m your host, Surani Fernando, and today I’m delighted to welcome Doctor Allison Siebecker, the co-founder of Sibo info. Sibo info is a leading resource for information and treatment of small intestinal bacterial overgrowth Sibo. Allison brings a wealth of knowledge and experience to our discussion today, so this should be a super insightful episode. Welcome to the show. Allison, it’s great to have you on.

Allison Siebecker: Thank you for having me. Happy to be here.

Surani Fernando: Great. So just to start us off and before we get into the ins and outs of Sibo, can you tell us a little bit about your background? And what led you to focus on this specific area of Sibo?

Allison Siebecker: Well, I always figure that my story is similar to many others in that I had digestive problems my whole life, ever since I was five, and couldn’t figure it out. Basically, it fits what is considered to be IBS irritable bowel syndrome, which is just a group of symptoms with nothing else, right? Not much else to help you. Not much else to diagnose. And eventually I figured out that it was Sibo that was really the issue and got amazing benefits. Honestly, just within 24 hours from applying some of the treatments, I started first with diet and, you know, amazing help. So that lit a fire under me to,, to share it with others. I could see it was not well known at the time. This was about 14 years ago, and I just began a campaign of awareness raising, and I had already been to naturopathic medical school. I’m a naturopathic physician and no one there really knew anything about it, honestly. I mean, no one anywhere really knew. So then. But there were people and I found them and they’re there. So I will say one thing this is fascinating to me is that there was sort of a dietary world that knew something about it, and then there were hardcore researchers. And the main thing I did in the beginning was to merge those two together, those two sort of disparate areas of knowledge. And I started a conference, a Sibo conference, where I would meld all that together. It’s like, let’s just bring all the knowledge together. And so that’s basically my background. I’ve been focusing on Sibo for about 14 years now, and when I was in practice, I’m no longer just an educator. But when I was in practice, that’s all I saw every day. Every patient had Sibo. So that’s just what I devoted myself to.

Surani Fernando: Okay. And then how did you actually find out it was Sibo? Did that take a lot of steps to get to that ultimate a diagnosis.

Allison Siebecker: Well, I was doing research and I came upon the term and yes, in the beginning it was like, well, how do you diagnose it? I did a Google search back then. It was crazy to think about this, but the test for Sibo, which is a breath test and the main primary one we use is a lactulose breath test. We can talk more about that, but it was on like page 5 or 6 on your computer of a Google search. Like who usually even goes past page one. Right. So you can see how obscure it was. Right. And I finally, you know, I contacted them, you know, got to know them, figured it all out, got the diagnosis, spoke with the researchers, you know, merged all my information together. And I can tell you also the first treatment I did, the main treatments we do diet is very helpful for symptoms. Excellent support. But the main treatments we do since this is a bacterial overgrowth is we use antibacterials. So I did that and you know, basically all my symptoms went away immediately., but the problem is it didn’t last. And that’s a big issue for treating Sibo and knowing about Sibo is that about two thirds of cases are chronic. And just very briefly, the reason for that is because there are many chronic conditions that cause it. And so then it starts to be a little bit more complicated. You know, some people about a third of cases will just that. They’re better. But the rest you need a little more help. Okay.

Surani Fernando: Okay. And just to dial us back, I guess, you know, there might be some people here listening that are not exactly sure what Sibo is, where it comes from. Are you able to share a little bit about, you know, the basics of Sibo and how prevalent it is and what are the most common symptoms?

Allison Siebecker: Absolutely. So it’s thought from studies that about 70%, 60 to 70% of IBS is actually Sibo,, caused by Sibo. You treat Sibo, the Sibo goes away, the IBS goes away. We know in terms of prevalence that up to 20% of the population worldwide have IBS, which is huge. It’s a vast, vast number. Everybody knows somebody with IBS pretty much. Right. Especially if you’re a practitioner. So, you know, I mean, real statistics might be smaller than that. But it’s a. So you imagine 20% of the population and 70% of them, that’s the kind of prevalence of Sibo. So you know, just briefly what it is is it’s, it’s when there’s too many of a particular type. Actually, now we know of bacteria overgrown in the small intestine. That shouldn’t be like that. Of course there are bacteria in the small intestine, but it should be a small amount because otherwise they interfere with digestion and absorption of food. That’s the primary thing that’s occurring in the small intestine. In the large intestine in comparison, we know we have a lot of bacteria. We have the healthy microbiome. Now another fundamental thing with Sibo is we now have been able to sort it out into three and really almost four types. It’s a very fundamental thing to know.

Allison Siebecker: So I’ll just briefly mention that the type is based on the gas that the bacteria or microorganism make. So there’s hydrogen methane and hydrogen sulfide. It’s a similar classification with IBS because these affect bowel movement patterns. And IBS is classified by bowel movement pattern. So the hydrogen type that’s in the small intestine and it’s associated with diarrhea, the methane type we know that causes constipation. So that’s associated with constipation. That overgrowth can be in the small or large intestine. And because of that the name of that type of Sibo has changed because Sibo, the C for small intestine, didn’t technically fit. So now this is called intestinal methanogen overgrowth or IMO this is just a technicality. It’s a nomenclature thing. I still say methane Sibo because I’m so used to that from so many years. Right? The third type is hydrogen sulfide gas. This is associated with diarrhea and studies clinically we often see constipation. This is kind of a curveball. And that can also overgrow in the small or large intestine. And then the fourth type is just when you have more than one gas. So a mixed. So that would be Sibo mixed. So that’s a very fundamental thing to know. And the and the core reason why is because our treatments are actually based on gas type.

Allison Siebecker: Because there’s different bacteria or archaea or methanogens or what are causing the methane type that are overgrown in each type. And many people will be familiar with pharmaceutical antibiotics. They use different ones for, for different conditions. So it’s basically based on the bug you’re trying to target. So that’s just a core piece of knowledge that you want to know, because you want to be able to tailor your treatments to the type of Sibo. So that’s basically the prevalence what it. I didn’t mention the symptoms though. Let me mention that. Yeah, it’s the symptoms of IBS. So that’s abdominal bloating or distension which is just a terrible symptom that bothers people. Pain is terrible. It could just be discomfort. But abdominal pain can be mild or it can be so bad it keeps people awake at night. And then there’s the bowel movement troubles. So constipation diarrhea or a mixture of the two. And then there can be other symptoms like acid reflux nausea, a feeling of fullness in the stomach where it won’t go down. There’s also mental and emotional symptoms. Anxiety is very common in Sibo depression. Also anxiety is more common and brain fog. And then, as you can imagine, fatigue is very common.

Surani Fernando: Okay. And in terms of the common causes of Sibo, is it mainly diet or are we still trying to figure out what’s actually causing this overgrowth?

Allison Siebecker: No. We know each other very well and it’s not diet. I’d say that’s probably one of the biggest misconceptions that I can’t imagine a way a person could give themself Sibo from their diet. It’s caused by diseases. Sometimes medications. And I guess we could say external factors like surgeries or injuries, things like that. So the most common cause of Sibo that’s been very well studied and shown and proven is actually food poisoning. So this is a disease or a condition, but it’s an acute one. It comes and goes pretty quick. So this is also traveler’s diarrhea or stomach flu. And the exact pathophysiology of how this causes Sibo has been fully figured out. And I would say that’s probably not only the most common generally, but in my practice what I saw was was the most common. And it’s very surprising to a lot of people to think about that. You know, something like, you know, a day or two of diarrhea or vomiting and diarrhea could very unfortunately lead to, you know, lifelong IBS afterward, which is actually Sibo, but it helps explain how common it is because food poisoning, traveler’s diarrhea, stomach flu is extremely common, and many people have had it more than once. One thing to know here, though, is that it’s bacterial food poisoning we’re talking about. Viral food poisoning is the most common. It’s actually only about 11% of cases of food poisoning that become IBS and Sibo. So that’s the most common, I’d say coming right behind that are actual anatomical or structural problems in the small intestine. Probably the most common would be adhesions. These are scar bands that form in the abdomen from surgery.

Allison Siebecker: So any kind of abdominal abdominal surgery could be a sporting accident, a fall off a horse or a bike, a blow to the abdomen like a car accident from a steering wheel or just, you know, something like that. Endometriosis. Very, very common to cause Sibo that causes adhesions. Lesions. Inflammatory bowel disease causes the same. So then then we come to the category of diseases. So diseases that can lead to Sibo would be things like IBD inflammatory bowel disease diabetes extremely common. Hypothyroid extremely common Ehlers-Danlos syndrome which not many people know about but is actually pretty common, especially in the IBS population. It’s a disease where the connective tissue becomes lax and adhesions can form. And there are more, you know, so when you start to think of all these things, you can see how come it’s so common that 70% of IBS. And then I didn’t mention the drugs, just very briefly., opioids, uh, of course, we know there’s been an epidemic of that opioid painkillers can lead to Sibo. And a risk factor for Sibo is proton pump inhibitors, an extremely common drug that is prescribed. They’re not a primary cause, but they can stack up and predispose someone to be more likely to get it. So there’s more. I honestly, you know, that’s a good smattering. But honestly, when I, I’ve compiled all the causes that I can find, it’s two full slides and it’s, it’s about, you know, 80, 80 causes right now more than I’m up to. So and they’re all very, very well studied.

Surani Fernando: Right. Yeah. There’s definitely seems very multi-layered and like secondary to a lot of things. So like finding the root. Yeah. Root cause that’s quite difficult. And is there any particular patient profile that shows up with this. You know, are there any particular people or specific ages, genders that might be predisposed to getting this if they have? You know, one of those things that you mentioned?

Allison Siebecker: Generally, you know, in studies when we look at like IBS, you know, which obviously the majority of Sibo females are more at risk. They’re more common. And that there are a lot of reasons suspected for that, but that could be because of hormones. We know that progesterone in particular can slow small intestine motility. A little bit. That’s actually the main way physiologically in the body that all of these diseases and drugs and everything can cause. Sibo is they slow the migrating motor complex, which is a form of motility in the small intestine., or we can have the structural things where you get like an obstruction. But so females and ages, you know, middle age to older studies have shown older people are more at risk. But I can tell you that in my clinic, I saw, you know, from three year olds to 75 year olds,, and men and women, you know, of course, we have to remember that there’s a higher likelihood of females to go to the doctor for help than males. So we do tend to see more females. It doesn’t mean males aren’t suffering as well.

Surani Fernando: Right. And you mentioned that, you know, a lot of people who have Sibo would just have IBS and would be living with IBS. So how do you go from that IBS, you know, awareness to then go and get checked to see if you have Sibo and get diagnosed with Sibo.

Allison Siebecker: Yeah, one would hope that your practitioner, you know, and of course all these wonderful people listening will be now, these people will be educated on Sibo and know what the test is. So the test is, as I mentioned, a breath test. We have three substrates basically that you can use for this test: glucose, lactulose and fructose. The two key ones are glucose and fructose. I’m sorry I said that wrong. Glucose and lactulose and lactulose is what I highly recommend that we use. And the reason why is because glucose absorbs very quickly in the small intestine high up within about two feet. And then it’s not available for the through the rest of the small intestine to test it. So what we’re doing here is we’re giving a carbohydrate substrate down into the small intestine. And then the bacteria or methanogen in the case of the methane sebum will consume it. And then they turn it into gas. And it’s those gases we’re trying to measure excreted out of the breath, to let us know indirectly whether those bacteria are there. Because bacteria make hydrogen and methane, humans don’t or methanogens make methane. And then humans do make hydrogen sulfide. Bacteria do as well. And in that case we’re just looking for the excess amount. So this is how the test works. It’s sort of an indirect measure of how many bacteria are there creating all these gases. So the problem with glucose is that using that as a substrate is we can really miss a lot of cases.

Allison Siebecker: And clinically we really don’t want to do that. We want to be sure we’re helping the people, diagnosing them if it’s really there. So I strongly recommend Lactulose. Now this can be a problem because in the US at least, lactulose is a prescription substance. It shouldn’t be. It’s a mistake and honestly it’s used as a laxative. But that can limit access. You have to have prescribing rights to get it. Luckily there are some lab companies that you can get a lactulose breath test no matter who you are. Direct to the consumer or whatever your degree is, whether you’re a patient or practitioner. Those would be like direct labs, true health labs. Genova is the main test that is going through those. Rupa labs also offers it. Another option just you know, just this is practical information is you can always have your patient get a glucose test, but then don’t use the glucose. And you know, for anyone who isn’t a prescriber, ask the patient to go to one of their prescribing doctors like their primary care physician, and just ask for some lactulose. It’s pretty easy to get that from most primary care doctors because it’s nothing harmful. It shouldn’t even be a prescription. It’s used for pets. You could even ask for it for your pet, for, you know, constipation. It’s used as a laxative, so that’s a good way to handle it.

Allison Siebecker: So that’s the test. It’s very important to know how to interpret the test. And one of the key things is it’s very important, I think, to do a three hour test because the first two hours represent the small intestine and the third hour represents the large intestine. And remember with methane and hydrogen sulfide, we have to see that third hour. And so one final thing I have to say is the standard test that we all have been using for years doesn’t test hydrogen sulfide. That’s a new advancement. It had to be created to figure out how to test that gas. And that came out about two and a half, three years ago. And there’s only one test that I know of that tests that. And that’s called Trio Smart by Gemelli Labs. And same situation there with glucose and Lactulose. You know. So if you want to actually test the hydrogen sulfide you need that test. If you’re using the traditional test there’s a sort of a way we get a sense if somebody had hydrogen sulfide, and that’s with a three hour test, if there’s no rise of hydrogen in the third hour, no rise of methane, almost no gas in the third hour. We suspect hydrogen sulfide. Obviously, this is just a brief little primer. This is why I say it’s important to understand how to interpret the test correctly.

Surani Fernando: Yeah, definitely. And, you know, are you finding that the education and awareness around Sibo and, you know, diagnosing it has evolved rapidly over time. And is it still, you know, is it still a little bit blurry in mainstream, you know, health practices. Well, what I could.

Allison Siebecker: Say is that our diagnostic methods are the same as they have been. The interpretations are the same. It’s really, you know, the whole time I’ve been in it, it’s except for the advancement of now testing hydrogen sulfide. It’s really just a matter of trying to get that information to practitioners, because this hasn’t been very known about it’s not embedded curriculum in most medical schools, no matter what medical school you’re in. I did create a curriculum and have been teaching it in medical school that I teach at. But that’s one school, you know, for 13 years. And so that means it has to be post-graduate that people are going to have to learn about it. So that’s really the problem. It hasn’t changed. It’s just trying to get the information to people. And, you know, we have to take the burden upon ourselves now that we’re out in practice to learn about this, which is unfortunate. Yeah.

Surani Fernando: And let’s talk about treatments, because you mentioned that, you know, the misconception is that diet is causing this, but you also mentioned that one of the first steps to heal your Sibo is diet. Can you talk a little bit about, you know, different, different sort of treatment steps that you can use from the natural sort of practices in daily life to medication?

Allison Siebecker: Absolutely. Diet is honestly one of the best tools that patients can have at home to help themselves feel better. So the key thing is that it helps symptoms. It’s it’s a symptomatic, relieving treatment, and it becomes very important for those with chronic Sibo who have a chronic underlying cause that there’s no known way to get rid of, you know, at this time, because then they can use diet ongoing to manage their symptoms, along with other things we do to really live kind of a symptom free life. That’s the really good news here with Sibo, despite the bad news being that for many people it’s chronic, it doesn’t mean you have the bad symptoms continuing. We typically see people get to 90% symptom relief. That’s like standard actually, which is incredible. I’m often 100%, and diet is a key part of that. You can bring diet in along the whole treatment journey wherever it suits you in the patient. So let me just briefly describe sort of a treatment algorithm for you. And this is based off. So Doctor Pimentel is our lead researcher in Sibo. He works out of Cedars-Sinai in Los Angeles. And he published a treatment algorithm back in 2006. Believe it or not. And who knows about this? Not many people. Right. So then my team, you know, we created a Sibo center. And as I mentioned, we saw only Sibo patients. We made some adaptations to that algorithm. So basically the first thing is test find out if it’s Sibo. If it is then you can bring diet in anywhere along the way. But I would recommend waiting till after you test just so you can get the most accurate picture with the test.

Allison Siebecker: Then you want to use Antibacterial to bring that overgrowth down. Now the question always comes up could you just diet? Yes. If the person if the patient is getting satisfactory symptom relief and you as the practitioner are satisfied with the quality of their diet, the you know, the making sure they’re not too limited, because sometimes to get that really good symptom relief, people are down to five foods and that is where we want to come in with Antibacterial to get the overgrowth down, because the diet doesn’t actually get the overgrowth down. So we can then expand the diet. Right. So, you know, we work with what we need to in front of us. So for Antibacterial we have three main options: pharmaceutical antibiotics, herbal antibiotics and elemental diet which is like a medical food beverage. So for pharmaceutical antibiotics I’ll just briefly, you know, describe everything here. The main one is Rifaximin sold as Rifaximin in the US. And this treats hydrogen, but we use it for all three types of Sibo. When someone has methane we add to it metronidazole, which is sold as flaggy or neomycin because we have to target the methanogens. They’re not actually bacteria with a different item. So it’s a double antibiotic therapy there. And then when there’s hydrogen sulfide we add either bismuth high dose oregano to the rifaximin or na2so4 arsenide, which is sold as ail Nia. Now the herbal antibiotics just wanted everyone to know what those are. Yeah. Herbal antibiotics. My group has done a lot of experimenting with dose finding and with before and after testing to really figure out what herbs help each type of Sibo.

Allison Siebecker: And so just the basics here is that oregano, berberine and neem are used for hydrogen. They’re good for hydrogen. When we have the methane we add either we add allicin. And the one that we like to use is alli med or alli max pro sold as both or otranto that targets the methanogen. So again it’s double antibiotic therapy. Herbal antibiotic therapy. Can you choose one of those hydrogens and one for the methane. And then for hydrogen sulfide you could use bismuth high dose oregano alone or together or. Yeah. No, that’s it. Because otherwise we get into pharmaceuticals. Yeah. Then for the elemental Diet, there’s now a whole lot of wonderful commercial brands that are more naturally oriented, you know, available through, you know, fullscript and, you know, you know, not prescription. And we and we use that. And the premise of that is people are not eating anything else. They’re just drinking that. And they wind up starving the bacteria because that substance easily absorbs into the body, feeding the person, but does not feed the bacteria. And so it’s a different mode of killing. So we would consider that natural because it’s a very natural approach really. And the herbal antibiotics to be natural, those don’t need prescriptions. And they’re very effective. One key thing to know is that pharmaceutical and antibiotics and elemental diet are done for two weeks as one treatment round, whereas herbal antibiotics, it’s four weeks for one treatment round, meaning it just takes longer to get the same effect when you’re using the herbs. But they are all equally effective. Equally effective. Right.

Surani Fernando: And just talking about the pharmaceutical side of it because, you know, just generally when we talk about antibiotics, we talk about, you know, that also impacting the gut microbiome. So how does that like how does that work with, you know, using that to to solve the problem like a microbiome problem. I’m so.

Allison Siebecker: Glad you brought it.

Surani Fernando: Up.

Allison Siebecker: Because rifaximin is extremely special and it’s considered a biotic by many. Some don’t even want to consider it an antibiotic, although it is because it has incredibly beneficial properties. It’s the most unique antibiotic you’ll ever find. Not only does it not harm the microbiome, it actually helps it. And we have study after study of this. It increases Lactobacillus, bibirus Faecalis bacterium and several others. I can’t remember them all. So it’s actually phenomenal. Doctor Pimentel has done studies with Rifaximin. So he’s done deep sequencing of the small intestine Huston with culturing. He’s actually there. That’s the most advanced. You know how the microbiome has been mapped? That was just the large intestine. He is mapping the small intestine microbiome. Anyway, point being, he’s done before and after testing with, you know, normally and Sibo patients and just with rifaximin only that brings the microbiome completely back to normal. So no harm in only help. Now when you start adding in metronidazole, neomycin or lineal then you will have some harmful effects on the microbiome. And if you’re using pharmaceuticals and you have methane you must bring those in. So then yes, you can add in probiotics to help, you know, to help mitigate that damage. Okay.

Surani Fernando: And you did mention that I believe the elemental route of treatment is a form of starving the bacteria. Is is fasting, a tool that can be used in, in conjunction with, all of, you know, the treatment methods.

Allison Siebecker: Absolutely. You know, and it’s so great you thought about that because honestly, I think it’s one of the first things a lot of us think, well, hey, why can’t we just water fast? Meaning all you’re taking is water. Mhm. One problem is that what studies have shown is you need about ten days of starving the bacteria for there to be an effective treatment. So we’re talking a ten day water fast at minimum if not even 14 days. That’s arduous. Yeah., you know, that takes fortitude. People do it, but that’s not the common thing we’re going to be asking our patients to do. Whereas this they’re getting proper calories, proper nutrition. In fact, many patients with Sibo are underweight because this is a malabsorption condition. The bacteria are consuming the host’s food. So people who are underweight actually very often, so long as they consume the full calories that are recommended on an elemental diet, will actually gain weight because they’re actually absorbing the nutrition. So very beneficial in that way. Okay.

Surani Fernando: And just going back to the food poisoning because, you know, you mentioned, you know, different causes that lead to Sibo. And I think as a, you know, thinking about myself in particular, like as a generally healthy person, I’m not on any medications. I don’t have any, you know, diseases, but I travel and I could be, you know, a, you know, a victim of food poisoning. Are there any particular bacteria, you know, that are coming into the food that people should be a little bit conscious, more conscious about with it leading to something like Sibo?

Allison Siebecker: Yes. The exact bacteria are known as Campylobacter salmonella and E coli. Okay, but how do we know that that’s in our food, right? Right, right. So and and, you know, while traveling seems to be more likely to get it, honestly, people get food poisoning going out to restaurants in the US or wherever. So if you’re concerned about it, what’s recommended is to take either an herbal antibiotic or a pharmaceutical antibiotic, like one one pill with meals. Many people will use Ali Med or Al Ali Max Pro for that. You know, just take one with meals. Another thing you can do is use serum bovine immunoglobulin. That’s been shown in studies to prevent food poisoning., and I know several cases of that working. So that’s kind of expensive. Then again so is Ali Ahmed Ali Max Pro. You know, you could use oregano. You could use something else, but something that would be preventative. Certainly a good idea when traveling.

Surani Fernando: And I think about myself, you know, when we’re having this discussion, I’m sort of the person that does the sniff test with food when you know it’s in the fridge, it’s been there for a few days. You smell it. Is it okay? Uh, maybe someone else might be like, no, I’m not taking any chances, but sometimes I’ll go there. And so now I’m thinking, you know, like, this could not just be, you know, sometimes I’m like, oh, okay, well, if I have a little bit of something the next day, that’s fine. I don’t have to go anywhere important. But now this is putting a different light on it like a chronic condition. Well, I’ll.

Allison Siebecker: Tell you what is so interesting. Very often people who’ve had food poisoning are the very ones that are less strict about it. And I almost think it’s, you know, how people sometimes think of you if you have yeast overgrowth. Well, I think many of us think this. It makes you crave sugar. You know, you know, so it’s like those of us who have had food poisoning, we’ll do the sniff test and be like, yeah, it’s fine. We’ll take much more risk than other people. They’re like, I’m not. I’m not going to risk getting food poisoning.

Allison Siebecker: So definitely if you’re at all concerned, don’t do it. Don’t. It’s not worth it. Good Lord. It’s not worth it.

Surani Fernando: So tell me a little bit about Sibo info. So you mentioned that you’re not practicing anymore. You’re more like the information provider. What does Sibo info do.

Surani Fernando: Sibo.

Allison Siebecker: Info is just a free educational website that I created way back when to try and get the information to people. Honestly, when I first started, like I said, you had to go to page five and page five of a Google search and there was nothing. So I just was like, oh my gosh, all of us need something. So it’s just a free educational website with lots of information. I’ve got labs, testing labs listed internationally. It’s a resource for you and your patients. I also have training courses on test interpretation. You know, I’ve got a mini training course. If somebody wants to get in, get out quick. And then I’ve got full comprehensive with CME. That’s like 22 hours to teach you everything. I also do a lot of,, I give free Q and A’s. I do masterclasses that you can all access through there. Good idea to just sign up for my newsletter. Also, if you want to stay up to date on research every year in the spring, there’s a ton of new research in Sibo that comes out because, as you mentioned, it’s still an evolving field. And I do a big update, you know, in my quarterly newsletter in the spring, or I guess you could say in the summer, because that’s when that’s when I’ll leave. So that’s what I’d recommend if you want to stay up to date on all this.

Surani Fernando: And you know, I’m sure you have so many case studies that you, you know, you’ve, you’ve gone through throughout your career. But just for our listeners, listeners to get a little bit of tangibility is there something you can share like maybe a patient, you know, and their journey from, from having the symptoms, getting diagnosed and then being on the road to a cure or recovery.

Allison Siebecker: You were going to ask me this at the beginning. And what I was thinking is it’s actually hard to think of single people because we just have so many cases like this. The good news is, you know, knowing how to treat Sibo well and treating it, it makes a huge impact. It’s the rare person that does not improve dramatically, you know. So I mean, I guess we could use ourselves as an example. I had symptoms that would keep me up at night with terrible pain and awful food intolerances. I was suffering so bad. And I did the diet, I did pharmaceuticals, I’ve done herbals, I have chronic Sibo. I’m still looking for my underlying cause, although I have some suspicions. And you know, I work full time. I’m happy I don’t suffer from symptoms. I’m free of symptoms. You know, for the most part, everything’s really managed. I’ve got a friend who’s a doctor, an MD. Her underlying cause was Lyme, and she was suffering maybe even worse than I had been. Terrible, terrible food intolerances. She was emotionally, terribly impacted. She could hardly eat anything. This is so common. We treated her Sibo and that managed things. Then we found the underlying cause was Lyme.

Allison Siebecker: Lime. She went and got treatment for that. That can be long and complicated, but she did it. She’s free of Lyme and she’s free of Sibo. She doesn’t have to think about anything she eats. It’s incredible. You know, she’s all better. So this. You know, anyone who treats Sibo, you see this? You just get in there, get that bacteria down. And one other thing I didn’t mention that just must be mentioned is because so many people are chronic, you must have a plan in place for managing relapses if they occur. And the main thing we do is we put people on a prokinetic as soon as they finish their antibacterial treatment. This is something that helps stimulate the migrating motor complex, and there are a lot of natural herbal options. I call them the ginger containing prokinetic formulas, things like Modal Pro, motility Activator, there’s a smattering of them, and Libero gist and similar products to Iberogast. There are pharmaceuticals as well, but I. I couldn’t end this without making sure because this is a huge missing component in people’s treatment. You don’t just work on the bacterial level, you must do something to help hold what you’ve done.

Surani Fernando: Really good tips there. And, you know, just for some of the health practitioners out there that might be, you know, struggling to navigate these patients and getting them onto the road to recovery, you know, what would be the major challenges that you would say to focus on? And, you know, over overcome the challenges that you see as the major challenges?

Allison Siebecker: Well, for many people, the main challenge is testing, just making sure you’re able to have your patients do a lactulose breath test. And I didn’t mention this, but the majority of patients will need more than one treatment round. This isn’t an acute infection. It’s an overgrowth we treat to get effects. So that’s a key thing to understand. You’re not doing anything wrong and you haven’t failed if it wasn’t cleared in one treatment round. Most people need 3 or 4 treatment rounds, so we also advise testing between treatment rounds if a patient can afford it in their budget, because this really guides your next treatment and makes sure it really is still there, because sometimes it’s gone, but they still have symptoms from something else. People have more than one thing wrong with them. So I would say making sure you’re testing. The biggest point of failure and making a case tough to treat is guessing, right. So you want to know what you’re doing. So test with a three hour lactulose breath test.

Allison Siebecker: Now putting that aside that you’re going to test, you’re going to do multiple treatment rounds. And we often switch up what we’re doing round to round. If you’re doing all that you know, all these treatments I’ve said you’re doing all that and they are not improving. The number one thing we think about is mold illness. Mold illness is, you know, probably an epidemic. And it makes it that you cannot progress forward in what you’re doing to treat Sibo. And we find it must be treated first. And it’s a whole specialty unto itself. You don’t need to have that as your specialty. You can refer to, you know, there’s excellent other people doing it or do it yourself, but that is probably practically something very important to look at. And also MCAS or histamine intolerance if you’re really having trouble treating Sibo, because that makes it so that people can’t tolerate the treatments that we give. As you know, people with histamine intolerance and MCAS can hardly handle anything, any supplement, right? They just react to everything. So you’ve got to get that under control so you can then give the treatments.

Surani Fernando: That mold thing is something that I’m hearing about more and more. And it’s just kind of, you know, that sabotages lots of, you know, routes to finding a treatment to whatever other disease that you might think you might have. So yeah, I think I become a little bit more conscious of if there’s damp around or if it’s been raining or, you know, mold around the place. Just because I’m hearing a lot more about them. But that’s definitely a good tip for our listeners. And just finally, just for, you know, the general people listening out there that are just, you know, curious about this area, what practical tips can you offer, you know, for people looking to improve their gut health and potentially prevent conditions like Sibo generally?

Allison Siebecker: Improving gut health is, of course, you know, not eating processed foods. It’s going to be all your basics and making sure you’re eating fermented foods and or taking probiotics, you know, healthy lifestyles, getting enough sleep, drinking enough water. You know, we call them the basics, but they’re so not basic. They’re so powerful, right?

Allison Siebecker: All of these wonderful healthy habits.

Allison Siebecker: Preventing Sibo. This is a hard one because there are so many causes. So it’s like, well, how do you prevent diabetes, you know? Well, you don’t eat a ton of sugar. You know, you have a healthy lifestyle. How do you prevent food poisoning? Well, we talked a little bit about that. Maybe take an herbal antibiotic. If you’re traveling with your meals, you know, how do you prevent hypothyroid? I don’t know. You know how you know how do you prevent Ehlers-Danlos. That’s genetic. Mhm. Okay. So it depends on the disease. If you when we get to medicines, if you need to take an opioid for, you know you’re having a surgery or something and you’re going to need it or a proton pump inhibitor, take a prokinetic with it, particularly opioids. You can get those in a form compounded or in a form that does not cause constipation. Ask the doctor for that. And if you have to take a PPI, take it with a prokinetic or better yet, take an H2 blocker, a less strong PPI so you know anything you can do to protect the normal, normal digestive mechanisms. We want hydrochloric acid secretion. We need that movement in the small intestine. Don’t slow it down. Things like that.
Surani Fernando: Well, these have been amazing tips. Thank you so much, Alison, for joining the podcast and sharing all of your insight. This has been, you know, quite a new area for me. So I definitely have learned a lot and have a lot of food for thought to take forward. And I’m sure our listeners have gained a lot from this discussion as well., so for those who want to learn more about our Alison and Sibo info, which she mentioned that she’s got some courses, be sure to visit the website at Sibo Info.com. And do you have anything else to mention? Alison, in terms of what you’re offering in terms of the main thing is good enough? Yeah. And, yeah. For everyone listening, don’t forget to subscribe to Holistic Health Habits for more episodes featuring top experts in the field. Until next time, I’m Suhani Fernando. Take care and stay healthy.