The Healthy
Update on the Biphasic Diet for Small Intestinal Bacterial Overgrowth
Welcome to Healthy Gut, the place where you can learn how to achieve a healthy, happy gut with your host Rebecca Combs. On today's episode of Healthy Gut, I'm joined by the queen of SIBO, Dr. Allison. Look at Becca, a respected naturopath who bought SIBO into the limelight of alternative and
complementary medicine she was also the co-founder and former medical director of the SIBO Center for digestive health at MC nm clinic and she specialized in the treatment of sea boat since 2010 this is the first part of a two-part episode with dr. C Becca and we go deep into all things Zeebo what I find
fascinating is that dr. C Becca herself has SIBO she's had methane dominant SIBO so she knows firsthand exactly what it's like to suffer from this chronic illness and it is a chronic illness she discusses that with us around how two-thirds of all SIBO cases are chronic so it becomes about managing the
condition more than curing the condition we talk about what it is and interestingly that it is normal bacteria not pathogenic bacteria that is causing the problem and many people believe there are multiple causes for SIBO but actually dr. Siebert Becca talks to me about how there's only just a few small number of causes but there are multiple risk factors that can lead to the cause of sebum we discuss what they are you can also have a mild case of SIBO all the way through to a severe case of SIBO and we go
through the types of symptoms that you might experience things like bloating abdominal pain constipation diarrhea gas but interestingly as well she says that it almost always goes with food intolerances we also talk about the mental side and emotional side of dealing with SIBO because quite often we're focused on our physical symptoms but there's so much more that can happen with it we go through the tests what are accurate tests and what perhaps are not such accurate tests for testing for SIBO and then we discuss the treatment options so things like antibiotics herbal antibiotics the
elemental diet and why it can take multiple rounds of different types of treatments to actually get your SIBO under control or if your want the lucky 1/3 to actually get rid of your SIBO and I asked her that all-important question should we starve or feed our bacteria during during treatment we look at the diet options because that I know for so many of you is such an important part of your SIBO journey and which ones you should follow and why reducing carbohydrates can actually leave you feeling is
significantly better but conversely eating lots of carbohydrates in dr. Ellison see burgers opinion won't cause your sasebo now I will just put a precursor to you listening to thearticle that we had a few audio issues though unfortunately the audio quality isn't the best but there's amazing content in here so I do hope that you will listen through some of the glitches with the audio quality to an incredible interview with the queen of SIBO dr. Allison see Beca I hope you enjoy the show welcome to the show dr. Allison
see Beca it's so great to have you on the healthy gut articletalking all about SIBO today so I'd love to talk to you Allison about your story how you came to be such an expert on the topic of SIBO although I will say that I don't refer to myself as an expert because I find that term intimidating because you know then it makes people think that another person who is an expert knows everything and I don't and no neither does anybody but so I prefer the term specialist okay yes so my story is that I was born without
GI symptoms but when I was very young I got GI symptoms probably around the age of five and I suffered from them and mostly it was bloating abdominal bloating constipation and pain not all the time but a goodly amount of pain and I had these on ongoing my whole life and I I didn't even know that I had a diagnosable disorder until I was in medical college rush and then it got diagnosed as IBS and which isn't that helpful because before a lot of this information of Seva was was well known all that we knew about IBS is that you know you all it meant was that you have those symptoms that I just
described or maybe diarrhea and we don't know why and we don't know what to do for it to try and I did try them and they didn't help so so anyway there I was suffering from you know a chronic illness and it really at times it would be debilitating to me and then other times I was alright so then I'm in college and my gastroenterology professor had this recommended reading list and on it was breaking the vicious cycle by Elaine gotcha which describes the specific carbohydrate diet and I read it and I thought that what she was talking about might have been what I had wrong with me and she was talking
about small intestinal bacterial overgrowth but she didn't call it by that name she but she used those words you know bacteria overgrown the small intestine and what she was trying to do was she was trying to explain why the specific carbohydrate diet worked for her daughter who had inflammatory bowel disease and why it worked for all the people that it worked for which are mostly people with a flammable disease and celiac disease and so her theory one of her theories that she was putting forward in the book was that well maybe really what it was treating with SIBO and the diet and maybe that's
why it work now just a caveat to that is on the side here is that I don't think that's that's true there are lots of people with celiac disease and inflammatory bowel disease who don't have SIBO and the specific carbohydrate diet works for them too so there's more going on than that I just wanted to say sure but okay so anyway I read that I read it and I was like oh my gosh I think this is what I have I want to do this but I was in the middle of college medical school and you know it's extremely daunting hours
are extremely long and I I just I had no more effort to do much about it so once I graduated I was reminded of the book I was suffering very badly for my symptoms and I thought now I'm gonna do this and so I did the diet and within 24 hours my pain was gone yeah which was unbelievable so you know the diet just gave me my life back and the bloating was was reduced a very goodly amount like maybe 50% constipation it didn't do anything for but in a way I didn't really care because oh my god my pain
so this is just like let this fire under me to understand it I you know I said been through medical school I've had the disease I wanted to know what this is all about so then I had this chance encounter with my previous after college professor and he he mentioned SIBO now that that phrasing wasn't inner elaine conscious book so he mentioned that freezing to me and and sort of together we thought that maybe that's that's really what she was describing this sort of condition that was now being described as SIBO so I went and started doing research and so that's what I did I just threw myself into research I actually
stopped practicing I was doing primary care I stopped practicing for over a year and all I did was research all day long every day and then after that I began teaching so and so my previous gastroenterology professor is dr. Steven Sandberg Lewis who has been my partner in crime so speak ever since so anyway then we began teaching after I had studied for over a year year year and a half non-stop nothing else that I was doing day in day out then we began teaching and I was encouraged
soon after I first talked I was encouraged to make the website and the encouragement for that was because the first class that I taught was at the annual naturopathic convention in the United States national convention and there you know so a lot of doctors there and I was getting on slotted with emails from them and phone calls to answer their questions everybody took to the topic like a wildfire you know they were just totally into it and they had tons of questions and I could not live a life like that where I was just answering all day long for free everybody's questions I at one point I tried to do that
for two weeks and I worked 80 hours a week straight for free answering the public and doctors questions so I realized like I can't do that so I made a website to try and answer the questions so I spent many months just writing all the information down so people would have a reference also I was I was rather outraged that the condition didn't have anything like that I mean when I first when I first got into CBI which was six I guess seven years I can't remember now years ago I tried to find how to test for it and I typed in all sorts of search terms and you know Quintron who's the manufacturer of the breath testing machine they came up like on page three it was like it was insane you could not find anything
online nothing there was no you know there was one Medscape article so where I had to go to learn it was into PubMed and at the time naturopathic training didn't stress reading like MD research articles on PubMed now the schooling has changed and that is very much stressed in my school but back then it wasn't we went to other sources and so that was something I had to learn all about and I guess if I was just sort of to summarize some of those things basically when I read breaking the vicious cycle I just
had so many more questions so many more deep questions I wanted to answer for myself and that's really what spurred me on and honestly that's still what's first me on there are so many things I don't understand well enough even though after six or seven years of constant study I understand a lot but I'm still spurred on by that there's things that I don't understand and I just read and read and I and it has also led me to befriend most or many of the authors of these articles reaching out to them in the in in a kind
way so that I'm not a pain but you know to to talk with them about what they're learning and what they know and so that's another way that I've I've come to come to learn and so I do that all the time like all these amazing you know gastroenterologist now because I know so many of them and we Skype or we talk we're whatever so that I can ask some questions about what they've written mm-hmm and and what what I still don't understand you know I was just going to ask and so at what point in this journey did
you were you able to find treatment options that work that worked for you and what did you do was your treatment yeah so I started with diet with a specific carbohydrate diet and that helped us a 60% overall which was amazing and then and what did you say it it actually addressed in that what was reduced in that sixty percent that was my pain in 24 hours right away Wow my floating got maybe 50% better and then of my overall well-being so we improved and but my constipation wasn't helped that was not help but just not having pain every time I would eat or most funds it unbelievable I mean you know oh I can imagine yeah yeah so diet first then I tried antibiotics after long hard study on those
antibiotics to make sure I felt okay taking them and that took away my constipation which was incredible because because it meant that my constipation was created by bacteria if an antibiotic could remove my constipation Shh much like what happens to most people I relapsed within about two weeks for some people it's longer but for me it was two weeks because I wasn't on a prokinetic at the time I I didn't know about pro kinetics but I was experimenting on myself in all sorts of ways before I would treat patients I always did yeah so so then later I have repeated antibiotics I have tried lots of different herbs and I found one herb which we know that actually dr. Jacoby figured out is helpful for methane
which is the Allison products that actually reduced my bloating but once again for those listeners that haven't heard of dr. Jacoby she's actually one of Australia's leading specialists on SIBO and we're very fortunate to have her in Australia yeah dr. Jacoby came to that first lecture that I was telling you about that I gave to the national of convention of naturopath and then yes I contacted me soon after and said I want to be the SIBO person for Australia and I was like fantastic and then she did a little in office study and very soon after that and she was able to find that Allison which is an extract from garlic works on
methanogens and this is quite extraordinary because there are very few things that work on the managing and which so she found this out long time ago and they're not - by the community and everyone else has benefited ever since from from figuring that out so I benefited too but once again Ellison were you a methane dominant SIBO person and what because you were constipation and I know we can talk about that a little bit later but yeah but so since then I have tried many you know
different balances of herbs different out of antibiotics I myself have not done elemental diet although I have many patients who do it which is our sort of our third main our third main killing option and I I still have Zeebo I still have symptoms but I I'm one of the more complicated chronic cases sometimes I think that the universe is it's keeping me with Zeebo so that I'll keep studying and I'll figure out for the hardest hardest cases what I you know what needs to know I try and tell the universe really you can't
take my thing is that I meet with with a diet and with various treatments periodically I'm able to stay at a level that is accessible to me I have lived my happy life so and I'm very productive so yeah that my dream yeah that's correct and I think it's it's it's good for people who are listening to thisarticle to know that getting a cure or or ridding yourself of true of SIBO may not be what happens for you but it it doesn't mean that life isn't worth living still that you can get it into a position where life can still be pretty good and it's just about managing a chronic illness rather than looking for a you know that finite
point in the future which is where you're given the all clear um I'd like to backtrack a little bit sorry yeah so many people when they're suffering when they haven't had treatment yeah and symptoms are at their worst and they discover you know okay this has a name the idea of not being cured people you know people have a way of thinking that of that as that I will never feel any better than I feel right now but sure doesn't mean you know so people something chronic illness is the fastest life for a majority of human beings actually various chronic illnesses but it doesn't mean that they feel bad all the time I
mean in just a funny funny example of that you know live chicken pox that virus stays within us for our entire life we're never cured of it but we're not suffering from the outward symptoms so that's it's important that we remember you know what is sure really mean I think people in their mind are thinking they just want to know am I going to feel better and that is possible for most everybody yeah definitely and I think it I know myself when I was at the worst and feeling pretty miserable with with the state of health that I was in all you want is for it to go away you just don't want to feel like that
anymore so if not feeling like that at that at the height of the illness is is something that can change then anything from there feels good I'd like to backtrack now and just talk about SIBO itself you know what is Seebohm okay in very layman terms it's just an accumulation of the normal bacteria that normally live in our digestive tract it's an accumulation of them in the small intestine and so for people who don't know the anatomy of the small intestine we start with the mouth and the esophagus the stomach after the stomach coffee comes the small intestine and it's very long and you know coiled around in our abdomen then after that comes the large intestine which is also called the colon and while
it's wider it's much shorter and it just has three segments and then and then that's the end of the track where the stool comes out on so normally the large intestines have bacteria most people are familiar with that we have good bacteria and just normal bacteria that don't cause us any disease lots of them living in our large intestine they do good things for us so sometimes what can happen is those bacteria that are down below can come up into the small intestine and also bacteria are constantly entering into our digestive tract through our mouth and are no it's just as we breathe and as we swallow and as we eat and drink because bacteria are coding everything everywhere don't you just live in a room bacteria so
they come in and they normally will just pass down and through the small intestine but there can be reasons why they then wouldn't pass through so they can accumulate from above as well so it's when bacteria are accumulated in the small intestine we call it an overgrowth sometimes we call it a colonization and that's improper they should they shouldn't be there in large numbers and and the body actually have many many protections and mechanisms to make it so that the bacteria pass through the small intestine and their reason it's trying to do that is because the small intestines where we break apart
and absorb our food breaking apartment's digestion breaking persecutes digestion and then absorbing us taking it into into the rest of our body and so to do those functions we don't want bacteria around because they they do those same things for themselves and basically they would compete and try and digest and absorb our food and that's what they do when we have SIBO so the body doesn't want that to happen it doesn't want that bacterial competition for our food so they shouldn't be there so so just in summary it's too many bacteria in the wrong location sure and what causes that to occur there are there
are a lot of causes or I have to call them risk factors but it might be easier to think of it first as what the underlying causes are the things that go wrong in the body understand a few of those it's basically when those protections against it fail and so some of the most common would be the deficiency of motility and it's a separate kind of motility called the migrating motor complex that happens in the small intestine itself most people are familiar with you know having a bowel movement that's a form of motility that happens from the large intestine and also we're familiar with the concept of peristalsis
which is where food is pushed down through the digestive tract as it's getting absorbed this is something a little different it's a strongly propulsive movement that just happens right in the small intestine sometimes we can feel it as those hunger pains like we hear sort of a girl kind of move we feel it yeah and you don't it can be happening and you don't hear those hunger sounds but that is a sign of it so what that function is it's meant to actually it happens sorry should backtrack and here it happens when we don't eat so it happens between our meals and then overnight well are sleeping and its function is to clear the small intestine of bacteria and any sort of and adjustable food residue it's basically like
washing the dishes after eating it's just it's called a health keeper wave it's tidying up making sure everything is nice and so this is really the number one way people want it is this migrating motor complex doesn't work very well becomes deficient where it works improperly so that's that's funny the number one way to second most common way or cost of getting people would probably some sort of structural problem like for instance a partial obstruction so some other piece of anatomy might be pushing in on a small intestine blocking the clear passage of the bacteria or or maybe there's an
adhesion which is like a scar band either within the small intestine or wrapped around it kind of squeezing it and then once again the passage through gets locked there are other structural things that could happen but those are probably the two most common underlying causes of SIBO another one that well two more that are better better sort of have a lot of process is in review who know about it would be a deficiency of stomach acid the hydrochloric acid in the stomach kills bacteria and that can kill the bacteria that comes in and if we take proton pump inhibitors or if we just happen to have low stomach acid then the bacteria aren't killed and then they can spill over into the small intestine possibly
accumulate now this one is a debatable underlying cause and here's another debatable underlying cause it would be the ileocecal valve this is the valve that separates the small and the large intestine it's it's like a fainter and it's closed at most times and then it opens to allow the passage of contents through but if it's open all the time then the bacteria from the large intestine would able to move upward into the small intestine more easily this was also a little bit debated because the idea is that if you have your migrating motor complex working well then both of those avenues of having bacteria accumulate
technically they really should be overcome because if you have to spill over from above or migration of bacteria up from below wouldn't the downward current of the migrating motor complex just push it out and there are studies to show that that's that that's true so we're still all trying to figure out how does how do these all work together which one's the most important important you know and that sort of thing it's not clear but we do we do know that these are the underlying causes now just let me skip over to the causes or risk factors for a minute I mentioned proton pump inhibitors so if we think of what
actually causes the underlying causes those the deficiency of the migrating motor complex or structural abnormality we can clasp those into some categories like diseases drugs lifestyle factors surgery maybe genetics things like that so proton pump inhibitors would be in the class of drugs they can lower the stomach acid opioid narcotic painkillers that people might get prescribed after surgery those slow motility throughout the whole GI tract so they can decrease the migrating motor complex that's actually a very common way people can get SIBO because because the motility slows down and bacteria accumulate and then when they stop means their motility might come back but they have a situation now that it might be a little hard to clear sometimes people sometimes it will clear on itself over time
and then sometimes people will need treatment for that surgery is another one where it's very common to get adhesions little scar scar bands after abdominal surgery and if the adhesions form in such a way that they compress the small intestine that can be a way to get see though so I'm just giving examples now here's probably the most common way would be food poisoning which is also known as stomach flu or travelers diarrhea this is the most common ray it's thought for people to get see though is that they get food poisoning and then what happens is there's a tough lesson poisoning is caused by pathogenic
bacteria not the normal bacteria that accumulate you'll see though these are different these are pathogenic bacteria that come in and cause acute illness and then leave so when they come in basically to toxin that can trigger our immune system to actually damage some of our small intestine nerve cells because the toxin looks like our small intestine nerve cells so kind of like your friendly fire or a mistaken identity our immune system can damage these nerve cells and the nerve cells that it damages are the ones responsible for the migrating motor complex now this this thing I just mentioned here is
actually phenomenal information that has only been really recently fully discovered and published it's so we have new learning here on chow how come a lot of people get SIBO and this seems to be the number one cause so so those are some of the other bugs some of the risk factors I actually didn't mention a lot of the diseases so let me just briefly mention that there are to be sure slow motility like diabetes can and scleroderma and cystic fibrosis and even hypothyroid hyperthyroid is pretty famous for causing constipation it can also slow motility in the small intestine so and type of thyroid very
common of course you can treat the hyper thyroid and then the mochila T gets better kind of like coming off the opioid drug like so there are all kinds of ways people can get C though from from drugs they're taking temporarily from drugs they're taking long term from diseases that might be incurable like Square derma or diseases that might Journal and from lifestyle factors and things like that and surgery so all sorts of ways can cause see but really there's so many ways if it gets to be a huge list if there are so many ways that we can disrupt those underlying protections but then it's good to remember that what is really underlying it's just a few things like deficiency of the migrating motor complex or
some sort of partial obstruction what are some of the risk factors when it comes to lifestyle that can contribute to C by really the main taking if there's besides the big drugs that people take that's kind of a lifestyle factor its dress and the way stress can affect SIBO is because it can decrease stomach acid production and also it can decrease the migrating motor complex so it can decrease that positive motility in a small intestine now 10 stress in and of itself cause sebum could it be enough I have heard of some situations where there are people who have acute stress that it did seem to cost about and I've also heard of a couple situations where people had very severe chronic stress and we think that's what collagen now what one other thing like I can say on that is that in most of those situations except for maybe one or two people did have other risk factors and so that's a game where we wonder how much needs does it need to be a combination but one thing we can say that's never going to be bad for
someone to reduce their stress mm-hmm yeah so it's not like a primary college but it's an important factor yeah definitely and when I think about my own journey I had so many elements of that that I believe could have contributed to Sasebo like food poisoning and I had parasite infections I've got endometriosis I've had abdominal surgery I've had a lot of stress in my life is it is it a case of that these things can just layer on top of each other and until then you have SIBO or is there one defining moment that is the cause of SIBO in your in your opinion I have seen it both ways I have absolutely seen both ways there are a lots of people who they just like you they tell me each one of those almost every single one of those things you mentioned is a big enough risk factor in and of itself to cause people SIBO but yet it's not any one of them caused it like you know you might have had one than another so I see that a lot it's like all these risk factors stack on top of each other and then there's just the straw that or paddles back and you're not even really sure you know I guess that was just the last trigger and it particularly with food poisoning that can happen because studies have shown that damage to those nerves is
cumulative most people have had multiple bouts of food poisoning you know at least three for most people and the damage can can keep accumulating so the nerves function might go down and they go down a little bit more and then the last time it's low enough it slows the migrating motor complex enough that now you can get FIBO so one way but then I've also seen it the other way I've seen it where somebody had perfect gastrointestinal health never a problem in their life they went traveling in a third-world country they got travelers diarrhea food pudding and bam that was it never well since they got there see Bo so eat so it happens in all kinds of ways mmm and I look at my journey and my digestive health I can now look back on and and see was pretty compromised from almost from the start but it just got progressively worse with every occurrence of you know risk factor occurring until it then got unbearable and I couldn't ignore --is-- any longer so I suspect for myself I had SIBO for a very long
time but I was a to tolerate get to an extent for many years before I then decided this I can't live like this anymore because there's a spectrum of severity of SIBO and I think it's true that a lot of people have a milder form of SIBO and they're not even really knowing that they have something wrong like they they sort of know but it's just an annoyance and that's that could be see though just in a milder form you know versus then it gets worse and worse and then finally it's just the unbearable point so I do see I do see people with stories like that where I think if they probably had a mild form for a long time and it progressively got worse and you know it's unfortunate because if we can treat it in the mild form it's a lot easier to you know yeah so I'd like to talk a little bit about the symptoms that you see
commonly with SIBO and what people perhaps some if someone's listening to this article who hasn't received a diagnosis of SIBO but is interested to know whether maybe some of the symptoms they're experiencing might be associated with the condition okay so the the main symptoms are abdominal bloating abdominal pain or discomfort it doesn't have to be pure pain and either constipation or diarrhea or a mixture of the two those are the course and the belonging sometimes that's called distension what what we're talking about here are really discuss sort of two things one is when physically the abdomen swells out like a balloon or looking like pregnant and the other part is a feeling that the abdomen is
swelling out and sometimes people can have that feeling without the physical swelling and that is still a part of it and then often they go together and would that be a feeling of fullness even if you have an Asian for a while is that what you're referring to it could be interpreted that way if it's actually it's more of a sensation as if the belly was outstretched even if you look in the mirror and it's not there that's a feeling like that that's feeling it's actually called bloating technically medically that's what bloating is
and the physical swelling medically is called distension but nobody uses those terms really biologists say bloating to mean the actual swelling and then the feeling is sort of a secondary not you know I think anyone that suffers from bloating especially visible bloating they know exactly what that is because it's embarrassing and it's uncomfortable and as a woman and Allison I know that you've said this and I very much experienced this it can often render you looking pregnant when you're not which I don't know that there's many people that want to walk around looking pregnant when they're not actually pregnant for yourself a steam it can be terrible for your libido and your sex drive and just on and on it goes and
also men you know have the same thing and they say I look seven months pregnant I mean maybe it's even worse for a man what are some of the less known symptoms with SIBO so you know a whole constellation of symptoms goes with it it wasn't a core symptoms but almost always what goes with it is food intolerance food sensitivity DISA symptoms are most often caused by eating so people react to all kinds of foods and have a terrible time they get their symptoms from soup so another symptom that can come with that honestly they don't speak a lot about is fear of food and this is like a condition to response you know sometimes when we're trying to expand people's diet you know the practitioner might want to say to the person don't be afraid it's time to to expand and try things but that's a little insensitive because it's a conditioned response it's like you if I think it causes you pain or horrible diarrhea you're not going to want to eat it though so it takes to get over that fear as a person heals and
gets better and another sort of mental thing or emotional that can come with it is anxiety now sometimes depression comes with but more often I see anxiety and I don't I don't think that this is I mean there's an obvious level of emotional upset that comes with with these symptoms of having symptoms - being ill or Aglio but actually I'm talking more about an anxiety that seems to be produced I think for material bacterial metabolites I think the local polysaccharides or that's another word for that endotoxin I think one of their effects is to cause anxiety on through the gut brain access so that's a
problem and then we have a whole constellation of other of other GI symptoms for instance excessive burping or farting there can be food feeling like it sits in the stomach and won't go down or at done there can be no Co sometimes vomiting although that's not that common and there could be acid reflux that's very common yeah then of course the teat it's a very fatiguing illness for various reasons bloating in and of itself is quite fatiguing diarrhea is very fatiguing due to electrolyte added schools lost and many of the other other symptoms are too so and and one other thing is that a female can cause leaky gut so one of the main symptoms of leaky gut is reacting to foods again but this time with systemic
symptoms like headache or nasal mucus or skin rash joint pain things like this so so that could be a part of fever as well mmm definitely and like I look at my own experience and I used to break out in hives very itchy hot hives after certain foods I would have headaches I was often quiet flare me and mucousy and I had really strong back pain for a long time for many years and when I had treated my SIBO that all disappeared of course sometimes men disorder constellation symptoms but and you were probably gonna ask me about this anyways but there's a whole host of diseases that are associated with SIBO that aren't necessarily gastrointestinal on me any gastrointestinal disease can have SIBO along with and one may cause the other or the other may cause the other one but there are conditions that it might be
helpful for people listening to know are associated with you but like for instance acne and acne rosacea so rosacea and restless leg syndrome and prostatitis interstitial cystitis these are some extra classic conditions that seem to go with SIBO and we don't know the exact reason why even rheumatoid arthritis so if so many listening has any of those symptoms the idea here is that if you've tried treatment for those conditions standard treatment for those conditions and it's have failed you may want to look into SIBO because studies show that when SIBO is treated in these diseases that are associated the original disease just greatly improved like for instance rest of legs syndrome the study showed an 80% improvement when the fever was treated Wow and I wish I had known that so many years ago I
remember as a child I used to want to rip my legs and feet off because they were so irritating to me and then when I was 11 and I hit puberty I developed the most extreme acne which took I spent years and I now know how damaging it was for my gut health but I spent years and years on antibiotics with the doctors using antibiotics as a treatment option for my acne and it wasn't until I was 16 and I went on a very strong drug called rocket and that cleared my acne up but I look at what you know it was almost like a Holocaust from my digestive health at that time with all those years of antibiotics in an attempt to clear up a condition which possibly you know I could have been treating my SIBO then and and would have seen a huge improvement in my condition for both West restless leg and acne that I didn't even
mention my actual website call number but it's SIBO Infocom and on there there's a section for associated diseases and you can see the full list and I have the study's link so if you want to look at them or have your doctor look at them you can see everything yeah great and that link is also in the show notes so Ellison talk to me about how you can test for SIBO so if someone suspects that they've got stibo they're matching up with some of the symptoms that you've talked about what next well most people do is the SIBO breath test there is another test that it can be used to diagnose fever and that's a small intestine culture but that's invasive you do it with an endoscopy it's like an in-office procedure which usually with some anesthesia not always but this is much simpler and it's the main test that's used to diagnose fever so it's a hydrogen and methane breath test and the best will be three hours long and
there are different sugars basically that you drink and the idea of that is you you drink these sugars that are meant to feed the bacteria in the small intestine because then they will transform those into gas it will eat them and make gas and then that gas some of it will diffuse across into our lungs and will expire it out we can collect the breath and then see how much gas was there so excuse me so the sugars there are two main sugars that are used one is glucose and one is lactulose and that's lactulose not lactose and they have they both have pros and cons most physicians I know tend to use left of us because it is non-absorbable meaning it's going to traverse the whole small intestine and be able to feed and reach and feed the bacteria that might be lower down throughout the whole small intestine whereas glucose is absorbed within the first two to three feet of the small intestine so it can only diagnose SIBO that's in the top two or three feet of a smaller company them it does a very very good job and
identifying SIBO because it basically it won't have any false positives because it because bacteria loves mitosis if they eat it you will see it you will know that you have fever but the unfortunate thing is then you're missing the bottom like 18 feet so probably the best option of all would be to do a good because end of lactulose but that takes a little more time and a little more money so what a lot of people do what most people do is they just choose lactulose because we'll cover the whole small intestine and the other thing that's quite important is to be sure that both hydrogen and methane caps are being tested for with the labs that you're using because there are some machines that are older that don't test my thing or there are some physicians that are so you have to feed on the most recent research and don't know you you really need to represent the methane so their machine might test it but they don't even record it so that's the key and three hours is the last piece that's quite important because that really helps us with distinguishing another gas that we cannot actually test for which is called hydrogen sulfide there's no currently no commercial test for that but we can get a good sense of it by seeing what happens in the third hour of the test so that's the best rush and why is it important that that you are seeing both
hydrogen and methane results in the test it's important because it changes your treatment and it also changes the prognosis or how easy we think it's going to be to treat how long this might go on it really informs us about the whole situation and particularly the treatment and I'm stories one in your probably ought to answer this is one more difficult to treat than the other is harder nothing is harder to treat and harder to get rid of and it's tricky and very often when I when I inform people that they have methane and it's trickier to treat a little harder they'll go yeah I could have told you that already a lot of them are already familiar with intimately familiar with their condition and they know when they've got a tricky case you know so it really helps it really helps the physician manage the treatment when we have the test and then if I might just say why testing in general is a good idea is because the symptoms the core symptoms that I mentioned bloating pain constipation or diarrhea these are nonspecific symptoms
they're very common symptoms that can happen from a multitude of and conditions so there are about 35 or 40 other common conditions that can cause those exact same symptoms so who is to say if we just try and treat based on symptoms who's to say you don't trust one of those other 35 or 40 conditions we need to diagnose it especially if our treatments are going to be antimicrobial in nature whether we're using what we what we believe is to be kinder gentler treatments like herbs or not I think if we're going to be altering someone's microbiome with antimicrobials we should be sure that that is called for a common example I like to give of the difference of what my person might have with the lactose malabsorption or lactose intolerance but many people do have genetic primary lactose intolerance and don't know it they really have not linked their symptoms with the consumption of lactose containing Garry there are actually studies on this to show the prevalence of how much people link it or don't like it and a lot of people don't and so if that was the problem that the underlying cause there is there's deficiency a genetic deficiency of an enzyme not a bacterial overgrowth so the lactose intolerant have the exact same symptoms so let's just say you found someone with antibiotics or the kinda ler with what we think the kinder gentler herbal antibiotics but you're not treating the right thing because there's not a bacterial overgrowth there's just deficiency of an enzyme so it's not the proper treatment so we really need we need the test dive into the condition and inform of our treatment yeah and and that moves us nicely on to what are the treatment options for SIBO okay so there's four main treatment options there's
diet there's antibiotics pharmaceutical antibiotics there's herbal antibiotics and then there's elemental diet so those are the four main treatments and what I would say there is that diet is a bit of a sort of a supplementary treatment to the other three which are kind of like killing strategies more really going after killing and the bacteria where the diet the diet is useful to support all of those and very much to help symptoms but it doesn't seem to be the best it is truly eliminating the bacteria the way that the others are so with regards to antibiotics and herbal supplements is there a time when you would use one over the other or together would you use one for say hydrogen or one for methane I'm really interested to know when you choose what type of herbal or antibiotic treatment to choose for a patient okay so I find that all three of those killing strategies are equally effective and so really it just comes down to the pros and cons of each one and sort of customizing it to the person you have in front of you to the to the
individual so ways that we might choose are things like philosophy first and foremost there are people who don't ever want to take another pharmaceutical antibiotic and won't do it and they want earth okay so then we choose that there are people who have tried herbs and react terribly to them and so then we choose pharmaceutical antibiotics it's really just an individual case-by-case saying once you know that they are equally effective then it's just all the pros and cons another thing is time antibiotic of course is usually two weeks herbal course is usually four weeks there are some people that might make the decision based on that like for instance they have an important event coming up I've had patients and
have a wedding or a certain thing coming up a neighbor you want to get some treatment under their belt before the event things like that now typically the patients that I see need multiple rounds of one of the three you know antibiotics herbal antibiotics or elemental diet to to successfully treat their SIBO and and that's because it's not like a like what we need to say a urinary tract infection where you take a course of antibiotics and then it completely goes away and you're all better unless you happen to have the chronic type of relaxing here Neriah tract infections but that is a less common well with fimo it seems to be more common to not get it handled with one round of treatment just because there's just probably so many bacteria in there there's only so much the treatment can do what I find is that I use all three methods with most of my patients you know we might start with herbs and then we go to an antibiotics and then eventually elemental fact or we do you know two rounds of antibiotics and then we do two amounts of herbal so for me I I just use everything you'll have to question to lightly combine them sometimes we do sometimes we combine an antibiotic with an herbal antibiotic but most often I
don't most often I just do pharmaceutical air box and then verbal antibiotics and elemental diet is something you do I should just maybe have to just describe what it is if it's a medical food and so what it is is it either comes in a powder form or a premix will perform and it's it's the nutrients that we would need that we would get from food but in their most broken down or mostly broken down form so it's protein comes as amino acids and then fat it's not actually too broken down it comes with oil and then the carbohydrate comes usually as a monosaccharide so the most broken down simple form of carbohydrates like glucose for example sometimes it's a little longer chain something called multi-texture and then we have all the vitamins and minerals in there as well and plus of salts for electrolytes so it's basically everything you you nutritionally should be getting from your food but broken down in the form of medical food and so you either mix the powder with water or you take the pre the premix strength and the idea behind it is that it feeds the person but it starves the bacteria because it absorbs quickly up high in the small intestine before getting a chance to feed the bacteria and so the bacteria die
from starvation so in this method and by the way it's done for usually two weeks like how farms to the Mona biotics are and within that timeframe it it seems to be very effective one thing quite special about elemental diet is that it's able to reduce a high level of gas or bacteria that makes that gas in one two week course whereas the pharmaceutical antibiotics and the herbal antibiotics they they can't reduce gas as much in their courses so we often will choose elemental diet for somebody that has high gas another reason why it's good to have the test if it informs which of the choices you're going to make we'll use that for them and then in two weeks we might be able to get you know gas as high as 150 down to negative and once you of course so so back where was I where was I going with this with it oh yes I
know I remembered elemental diet is not done with antibiotics or herbal antibiotics because the bacteria sort of go into a hibernation mode and the they need to be replicating for the mechanism of action that antibiotics and herbal antibiotics have so it's sort of just a useless to do them with so we don't combine that with anything else mmm okay and that leads me to my next question which is around should you be having a restricted diet whilst using herbs or antibiotics or should you be eating to feed the bacteria to allow them to produce and multiply so that then the herbs and antibiotics can attack them while they're in full force well there's different opinions on this so dr. Pimentel the lead researcher on see though he likes the idea of feeding them and so that's the way he does it i i'm not so keen on that idea and then it's just because of patient feedback that I've had I think that that might be a good way to do it for someone who has not yet gone on a restrictive carbohydrate diet which is which is what the diets that treat people are all about they restrict carbohydrates so if you're just new to treatment I would say don't alter your diet while you're doing your antibiotic treatment but then as you start to finish the treatment begin to get get yourself on a diet and you take advantage of dr. Pimentel idea but what I wound up seeing is people who had been on restriction carbohydrate diet then added hot
carbohydrates to their treatment to see if that would help when they heard him discuss this and I got very negative feedback on that people saying that it seemed to be less effective and when they did the low carb diet and since then I've talked to a lot of my fellow practitioners about it and I've seen that sure and I think that's such an important point to make that this isn't a one-size-fits-all treatment or or even condition that's it's completely unique to us as individuals because our microbiome is unique to us yeah yeah one thing because I mean unless you're on your telly mental diet which is a liquid diet the rest of us are eating food every day and I know that there's some confusion around which diet to choose from you know there's the specific carbohydrate diet there's a low fodmap diet there's the gaps diet there's the fast-track diet there's the biphasic diet what's your advice or approach when it comes to people choosing a particular diet protocol to follow well my main advice is to just choose one it should just pick one and not worry too much about it pick whatever one you're drawn to you I don't even really care just pick
one and then start customizing it to you because all of those diets they all are targeting and reducing carbohydrates which is the general point but the problem is that what which carbohydrates are going to be aggravating are going to be different most aggravating are going to be different from one person to the next and so there is no diet that that can be written on a page that can predict that so that's why in a way it almost doesn't even matter just pick one and then begin customizing it now the problem there is if you're following a diet and they have rules and saying you you know you must eat this and you are not allowed to eat that you have to be actually willing to break the girls should be able to modify the diet to use successfully so I would say pick any diet and then brief break the rules to find out what really works for you and doesn't work for you I have other other advice I can give but that's my main advice don't sweat it basically yeah and I think it can be so it's so easy to fall into the trap of really swishing it because especially if you've been stick for a long time and you've been reacting to foods for a while you can become and I know I was a little bit obsessive over what you're consuming so I really like your advisor don't sweat it now I can say some hundred vice for people who are really suffering is you know a lot of people will just come come to this on their own is the more you can reduce
carbohydrates the less carbohydrates you can eat the better you will feel the better the symptom control and that is because carbohydrates are the primary food for bacteria and then they take that and they make gas out of it and the gas produces the symptoms all of the symptoms we talked about actually can come from gas so there are there are other factors involved there's the underlying cause generating symptoms and some other things but predominantly the symptoms come from bacteria eating carbohydrates so so anytime what are the carbohydrates that people could you can Institute list off for people that they could go oh yes I am amazing that oh I didn't realize that was a carbohydrate Sarah yeah start with carbohydrates so sure the hugest category of foods so protein is me any kind of meat
fish fowl ate and and dairy like cheese that's sort of concentrated protein now there are other foods that have protein in it but those are those are protein foods not fats are going to be oils and then there's fat in other like protein foods like there's not an eggs and there's fat meat and then the carbohydrates is a huge category so this vegetables fruits all grains so grains would that means any baked goods or bread or you know any anything like that cereal granola etc nuts seeds beans or legumes and then there's and then it's any sweetener any sugar or sweetener and the natural sugars that exist in certain foods like the lactose sugar that's in milk so dairies a lot of dairy products that have lactose that's the carbohydrate and even the natural saccharides that exist in there's some in animal parts and particularly that gets concentrated when we make broth like bone broth it's it's mostly concentrated in the cartilage so if you eat like say if you have ribs and you make it in a crock pot that might bother someone symptoms because there's a lot of Zecharia which or bone broth something like that so it's just the largest category of foods it's the
foods that people tend to most crave and enjoy and yeah use as their reward in life it's so it just sucks so it's like thank you very much for giving this you know condition that takes away these lovely foods our caller uses these you know have these foods conception so so it's just a general tip is if someone's really suffering reducing as many of those foods as possible health symptoms I you know back to your question of what to do during treatment i generally favor following a diet that helps your symptoms during the other reasons and that can take time to figure out and then you know other so that it's going on that advice I would say that the diet that I sort of compiled of two diets low fodmap diet and specific carbohydrate diet I call it an Evo specific food guide I think that tends to be the most restricted on carbs and therefore it can give the best symptom relief but you may not want to start with that if you're not in terrible suffering and by the way dr. Jacoby biphasic diet is inter version it's a particular clinical version
of the CBO specific mm but if you're not suffering terribly you know you might want to start with just fvb specific carbohydrate diet or even the FACA you know there's a lot of ways to choose but the end result is just be willing to modify it to you and over time you're gonna figure it out yeah definitely and just moving on to sort of the final question for the part one of the SIBO interview with you Allison what do you see as some of the biggest misconceptions around Seebohm one is that people tend to think eating a lot of carbohydrates eating like a junk food diet or a poor you know heavily laden carbohydrate diet causes SIBO and that's just I can't see a way that that can't happen that's not true to my knowledge you'd need one of those underlying protections to fail first and I I cannot imagine any way in which eating of carbohydrate rich diet could cause those to fail and there are no studies on that nobody had
ever felt that that's true but yet I mean experts who right but yet people tend to think that they do I gave it to myself because I eat a lot of potato chips it's like no not going to do it and I think that's important to know first of all because so you don't blame yourself and second of all to get accurate information about what really is wrong in your body so that you can better target it because just stopping to eat the potato chips isn't gonna make it you don't go away completely your symptoms will probably be reduced because now you're not feeding the bacteria they're not making gas but it's just not accurate yeah and people can honestly a lot of sort of crazy ideas about how they think they got their SIBO because they haven't had education on the subject and this includes a lot of practitioners and a lot of doctors if they haven't taken any courses you know good educational courses you're just going to come up with
wackadoodle ideas you know so it's kind of good to get grounded the other the other misconception I can think of is that that the urine organic acid test can be used to diagnose vivo and it can't it can give a reflection the urine organic acid test will show bacterial and also yeast metabolites in the intestines but the problem with the test is that it can't distinguish small from large intestine so it cannot diagnose SIBO it what you might be seeing could be in large intestine now it might be that your treatment is going to be the same depending upon many policy issues but it goes back to that question of what does like this the person have lactose intolerance you know I think it's really important to properly diagnose the condition mmm definitely so we're going to wrap up part 1 of the SIBO discussion with dr. Ellison see Becca but we will be back in part two talking more about how to find a practitioner what happens if you're quite a sensitive patient and it's it's your finding treatment very difficult and also some of the lifestyle pieces around life with SIBO so Allison I'd like to thank you so much drawing us are part one of the SIBO article and we look forward to speaking to you in part two thank you I hope you enjoyed episode 2 of the healthy gut article with dr. Allison see Becca if you would like a copy of the show notes and any of the links that we discussed in today's show head to the healthy gut dr. koh /c bo you will also be able to download a handy guide on that SIBO causes risk factors and associated conditions and diseases so head to the healthy gut dr. koh /c bo to download that for free now i would love to hear your feedback on this show so please do leave me a review in itunes and if you know anybody that
might benefit from listening to this show perhaps someone a friend or family member that might be experiencing some of those typical SIBO symptoms and that it might help them to listen to this article and hear all about Zeebo please feel free to share it with them you can follow us on Facebook Instagram Twitter Pinterest where everywhere on social media platforms so just look us up where the healthy gut and as I said at the beginning of this article this is a the first part of a two-part episode with dr. Ellison see Becca so do tuned in to episode 3 where we talk about how to find a practitioner how to build your own healthcare dream team the role of probiotics in your treatment and what to do when you react to everything because that's the type of patient that dr. Allison see Becca sees quite frequently we also
talked about the weight gain and weight loss that so many of us experience with SIBO and then we finish on the five key pillars of health awareness nutrition movement mindset and lifestyle I look forward to seeing you on episode three with dr. Allison see Becca you've been listening to the healthy gut articlewith Rebecca Coombs to learn more about the healthy gut or thearticle head to the healthy gut dot Co forward slash articleif you would like to help support the continuation of thisarticle you can make a contribution at the healthy gut Co forward slash articlewith thanks to Julian Pryor from Jay articlefor the production and editing of this article to learn more head to Jay article.com we would also like to thank Belinda Coombs for the original score to hear more of Belinda's head to soundcloud.com forward slash Belinda Coombs the healthy gutarticle is a production of the healthy gut
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