Small Intestinal Bacterial Overgrowth (SIBO) is estimated to affect 60% of people with Irritable Bowel Syndrome (IBS) yet is largely unknown.
This is the second part of a two-part interview with the Queen of SIBO, Dr. Allison Siebecker. In this episode of The Healthy Gut Podcast, Rebecca Coomes talks to Dr. Siebecker about how to live with SIBO, especially when you react to everything.
If you haven’t listened to Episode 2: Understanding SIBO with Dr. Allison Siebecker, we recommend you listen to it prior to this episode. You can listen to it here.
In Episode 3 of The Healthy Gut Podcast, we discuss:
✓ How to find a SIBO practitioner
✓ The importance of building your own healthcare dream team
✓ The role probiotics play in SIBO treatment
✓ What to do when you react to everything
✓ Why people commonly experience weight gain and/or weight loss with SIBO and what to do about it
✓ The importance of the 5 key pillars to health: Awareness, Nutrition, Movement, Mindset and Lifestyle
Dr. Allison Siebecker’s website is jam packed full of useful information, resources and links to research. She also produces a quarterly newsletter which is a must-read for anyone interested in learning more about SIBO. She offers Skype consultations, which can be organised via her website.
Would you like to make a financial contribution to help support the continuation of The Healthy Gut Podcast? The podcast is funded entirely by Rebecca Coomes as she is passionate about sharing quality information about gut health to help others on their journey to health.
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Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.
REBECCA: Welcome back to the SIBO podcast and I am joined once again with the wonderful Dr. Allison Siebecker and we’re talking about SIBO or small intestinal bacterial overgrowth. If you haven’t yet joined us for part 1 of this podcast I do recommend that you go and listen to that first as that really is the foundational episode and we talk about what SIBO is, how it is caused, and treatment options.
Allison I would like to talk about how people can find a practitioner that can help some with treating SIBO.
[00:34] ALLISON: that can be tough. There’s a couple ways that I could suggest. There’s a, I think it is a Facebook group – SIBO discussion Facebook group that has a practitioner list that patients have been putting the names of their doctors on that have helped them. And we’ll probably be able to figure out exactly where it is and put the link underneath. I don’t have it off the top of my head.
[1:02] REBECCA: I will pop that on the show notes. I am part of that SIBO group. So that is in the show notes for people to click through and to join that group.
[1:12] ALLISON: Yeah. So that is one way. Another way to call some of the last that do SIBO testing and ask for names of doctors that order tests from them. So I have a lot of that information online of laboratory contact information. It’s underneath resources testing.
[1:32] REBECCA: Just give the website for the listeners so that they know where to go.
[1:36] ALLISON: Oh yes. It’s SIBOinfo.com It’s just a free educational website on SIBO with a lot material there for you. In fact a lot of people have given their support fully and they could be getting more help. So I recommend it and it’s there for your use.
So for instance, Quintron is the manufacturer of the breath test machine that then many labs use and many practitioners use. So you can contact them for names and then you can also contact local labs that might be in your area. And I have many of those labs on my website and that’s a great way to find practitioners. Of course, there’s also the SIBO discussion groups in general and word of mouth.
It can be hard to find a practitioner that is very well trained in it and SIBO is tricky. So I think what you are really looking for there if you are not finding someone who is as experienced or educated as you would like, it’s that at least they are open, they are open to sharing what you have to say. If you are gathering information. So you just thought the practitioner to be open to what you have to offer, what you have to say. I you want to bring them studies, if you want to bring them suggestions. That can be hard depending on somebody’s ego. But it’s important.
[2:53] REBECCA: I think about my journey and I went to counselors, GP, or doctors who… similar to your experience Allison, just diagnosed me with irritable bowel syndrome and said, “Well there’s not much we can do about it. And I really had to take my health into my own hands and hunt down naturopath in the end who understood SIBO. But it meant that I had to really take ownership and not settle. And I think that’s perhaps something important for people who are listening to the podcast that if you are not getting the answers that are satisfying you, perhaps you need to keep looking.
[3:38] ALLISON: that is such a good advice. The people that I see who do their best have educated themselves. That can be a hard thing to do when you are suffering and you have symptoms that are bothering you. But it could also be incredibly empowering and honestly one of the first steps toward regaining your health. And that’s why we are doing this podcast. That’s why we both do the work we do. It’s to help people feel empowered and get educated. I also do a lot of work educating physicians. I teach constantly. But you know there’s one some people we can reach at the time. It’s going to take a while for as many practitioners as we really need to be educated on this, to get educated. But we’re all going to help that happen.
[4:24] REBECCA: yeah. Definitely. And for the people listening to this podcast, just as an example. So I have an incredible naturopath here in Melbourne who treats me for SIBO. My GP or my doctor, my general practitioner, even to this day does not truly believe in SIBO. And as much as I try to educate her on the condition and I would love her to come along to an even we are holding here in Australia on SIBO in October, she is not open to it. So I have made the decision that whilst I will see her for sort of general things that I need to such as my once yearly checkup, I will not have battle with her over this. And I go to practitioners that I do know understand this condition and I can talk to them about it. That has kept me a little bit sane. Once I came to that realization.
[5:25] ALLISON: It’s kind of like… I don’t usually call it doctor shopping. A lot of times you need to doctor shop. It’s really no different with someone mysterious, chronic condition. Usually we are going to have to find a specialist and it might take a while and if you can’t find a specialist at this time there are also like myself so many practitioners that work through telemedicine. So you don’t have to necessarily find someone locally. I mean you will if you are going to have to get test order and prescription. Things like that, you will have to find someone open to taking the suggestions. But you can get help from people online as well who are practicing telemedicine.
[6:32] REBECCA: Given that this condition can be chronic and long term and difficult to treat for people what are your overall implications for your overall gut health or health of your micro biome when you are in a life of long term SIBO treatment?
[6:22] ALLISON: well what I see in terms of my patients is if I see people getting their digestive health getting better and better over time as we treat their SIBO. So I am not so worried about the fact that we are using…. I think they might be concerned over because we are using antimicrobial over and over again in various types of forms. Isn’t that hurting us? It may be but I see health coming up in people. I see improvement. I don’t see worsening. And I think that is because a big load of bacteria is working where it is not supposed to be is very unhealthy. So getting rid of that improves things.
For people who are concerned repeated on going to antimicrobials damaging their food micro biome, of course we can use fermented foods or probiotics. The unfortunate thing though is that those sometimes bother people with SIBO. Very often they can often people with SIBO. Sometimes you can find one formulation or one product is better tolerated than another. And that’s worth the effort. But also, many people over time as they heal, they then can handle fermented food and probiotics. And for some people can handle right from the get go and it’s a wonderful thing for them because there’s a spectrum of how people handle probiotics. It’s the tactic for some, it’s sort of so so that does nothing for a larger people and then it’s bad for another group of people.
So there are certainly things we could do if we’re worried. But in general I am not that worried.
[8:06] REBECCA: Something that I see a lot, I think probiotics have got quite a lot press and media coverage in recent times and there’s a lot of discussion about which probiotic or how should I go on probiotics, when should I take probiotics. Do you have any advice for the listeners on around just probiotic use?
[8:27] ALLISON: you know I think probiotics are one of the types of things that are probably very often tried even before a person gets their diagnosis. It’s one of those things you can easily try for yourself. Know that it can be helpful for gut health. So I think that is a great place to try, a great time to time. It’s before you even know it you have or you just had an IBS diagnosis.
Now if you have SIBO, I still think its fine to try it. Just with the knowledge that everybody is different and it might not feel good for you. And I think you need to trust, everybody needs to trust their body’s reactions over whatever anybody is saying. So even with all these diet we were talking about in part one, no matter what rule or whatever anyone is saying in those diets, if it doesn’t work for you, you pay attention to that. So same thing with probiotics. There’s stuff to be the savior of all digestive health. But if you try it and it doesn’t feel good, don’t do it.
Now one thing to know is that sometimes probiotics can bother a person for a day or two and then that goes away. So if their reaction isn’t horrible give it a couple of days. We’ll see. If it gets better. Also, another thing, if you are worried about trying the, worried about symptoms, you can try a lower dose product or whatever product you have, you can open the cap and take a little bit of it out so that if you do get a symptom it won’t be as severe.
So that is a good way to try them. But in terms of SIBO, you can honestly try a probiotic at any time. And doing that is probably a helpful experiment to find out if it helps or doesn’t help. And honestly there’s just no way that we have to know without trying it. There’s no test to tell. There just isn’t. You just have to try it and see.
And lastly, like I said different probiotic formulations do work for one person or another. Think about fermented food. Some people may be good worth fermented food and not probiotic supplements. Some people are good with certain fermented foods and not for others. Some people do good with one probiotic and terrible with a different probiotic. And once again there’s no telling ahead of time.
We have studies. We have certain streams that are studied for certain symptoms of certain conditions. And I have gathered all that information and used it on my patients and see it not predict anything. So you just have to try. And that’s it, that’s my advice.
[11:11] REBECCA: Yeah, and it really comes back to again and again as we have been talking over the first and second podcast on SIBOs, it is so individual and it really is up to you as an individual with SIBO working with your practitioner to test and trial things to see what works for you. And that it’s not a one size fits all diet or program or treatment protocol.
[11:34] ALLISON: In fact if I can add something there because you summed that up so well, we were talking just before about how to find a practitioner. I think another key component you might be looking for a practitioner is someone who understands and knows that there is a lot of experimentation because individualization and customization – the only way to do that is experimentation. And a practitioner that understands that and wants to do it with you and keeps your trust during that process.
[12:07] REBECCA: that is so important
[12:08] ALLISON: really really important that you are don’t lose trust over time and that you tried these experiments. Very important. Because I don’t think, for most people with SIBO there isn’t a way through this without some experimentation. And that you got to have trust with your practitioner as you do that.
[12:25] REBECCA: definitely, I was just telling my story with my naturopath Natalie Cruttenden, as we commenced the treatment I was using Dr. Jacobi’s biphasic diet. We obviously tested out the foods on her diet and I was quite lucky I was able to tolerate pretty much everything on the first phase. But I didn’t cope very well with some of the supplements. And so Natalie and I had to, with some supplements, start a really tiny doses and slowly like inch-by-inch increase the dose until I could tolerate it and my system could tolerate it. And we changed the… I used herbs only. We changed the herbs every three to four weeks so that we were constantly rotating them and I used to say to her, “I am like a walking science experiment. This is so much fun because we are just testing things. We are seeing what works for me.” And I was fascinated by it and I trusted Natalie my naturopath so implicitly because she is well educated on SIBO but she also listened to me. So I went to her and said, “Oh gosh Natalie, that just did not work for me. I felt awful.” She said, “Ok, great! Thanks for sharing that with me. Now let’s do something different.”
I am so blessed to have stumbled across her on Google. There are good things that could come out on Google searches. Not all Google searches lead to cancer. I would like to talk about what your advice is to people who are reacting to everything that they… I hear people say to me, “even if I drink water, I blow up or I am in pain.” What can people do to help and try and calm the craziness that is going on inside them either physically or also the emotional/psychological component of what is happening when that occurs?
[14:30] ALLISON: Ok, well this is something I teach so commonly. And you know there are a handful of doctors that don’t ever see patients like this and then they think that the patients who are like this and the doctors that see them are crazy. Because they don’t see it. This is the bulk of what I see actually.
So I’ve got a bunch of different strategies and I will just lay them out for you. So first of, maybe the least helpful but always important to just keep in mind with the… I have a handout on my website called SIBO symptomatic relief suggestions and it is underneath the resources tab underneath handouts. And it’s got a whole bunch of options that can help. Sometimes, that can help. So even in this situation – OH my gosh I am even reacting to water.
So for instance something like iberogast which is and overall general digestive product. Adaptogenic, it can help with diarrhea or constipation. Pain or acid reflux. Anything. You can try some of these suggestions. It may calm your situation down and there are all sorts of suggestions there. We just talked about sometimes you just need to try different ones to see what is going to help your situation. And I myself have done that when I have had a really bad situation. I try one thing and Oh that didn’t work. And I try the next thing, wait half an hour. Try the next thing.
Now, another situation is that sometimes it is best not to do any intervention at all. So like an example. If I just need to rest. Granting you still have to drink water, so you are kind of out of luck with that one. But try to calm down. This is sort of the opposite strategy of what I just mentioned. Calm down all the interventions you are doing. Take supplements away. Take everything away and just let there be some rest. So an example would be, I don’t know if you have ever gotten a really really bad sun burn but I certainly have
[16:38] REBECCA: yeah sadly I have too.
[16:39] ALLISON: I am thinking of a time where I was actually at a wonderful trip with snorkeling and I didn’t realize that the sun was hitting me all day and I couldn’t lie on my back side. You know after that. So in situations like that when things are so wild up, even putting something as soothing and helpful as aloe vera on the skin can irritate the skin. The skin doesn’t even want it. Basically, it just wants to be left alone. So that’s another strategy. And by the way there are sort of two ways to think about the person that reacts to everything. One is a general heightened tendency and another is a flare and a lot of people with SIBO have flare. They can be triggered by all kinds of things. It’s maddening and often mysterious. But things are going great and they are just not.
So there is a sort of curious cycle. Two weeks or maybe shorter and it gets bad. So back to the strategies, as much as you can rest. I mean you still need to eat but you got to be careful with your diet as you can. Often what is the most careful diet for people with SIBO is basically the prep diet for the SIBO test which is only meat and fat and if you tolerate it – white rice.
Some people would tolerate lactose free dairy so possibly cheese if they can tolerate dairy well because cheese is just basically protein and fat. Each cheese is about half carbohydrates in it. Basically removing as much carbohydrate as you can. The idea with white rice is many people can digest it and absorb it very quickly before the bacteria has a chance to eat it. So just that and rest.
Ok, now here is another strategy. Two more. Go ahead and push through it but following it with treatment essentially. It’s really the opposite like just go for it with antibiotics, herbal antibiotics. You just go ahead with your treatment. Go ahead and treat SIBO and push through it. And even if they are reacting to the treatments you are giving. This can only be done if the reactions are bearable and tolerable and often this depends on personality type. All of these strategies depend on personality type which is why we need some of these different strategies because of different personalities. There are people who are… the pushier type of people and even if I tell them… like I love the strategy of like what you did were you started with extremely small doses in titrate up. That’s probably one of my favorite strategies in general for people with SIBO.
There are people’s personalities that will not tolerate or accept that. They are going to start at the highest full dose right away and then nothing I can say can stop them from doing it. So got to deal with it. So there’s the strategy. Just treat it hard. They know it is going to suck and the would rather have that. They would rather have it suck hard for like a week and be very hard to do it and then be done through the difficulty.
Ok now, the last suggestion I have is bodywork. So oftentimes I see when people are reacting to everything, they can’t do anything. They can’t take supplements. They are reacting too soon. So we have to find a treatment that isn’t through the digestive tract. So body work I have found something very helpful for them. My favorite form of body work would be probably visceral manipulation. I have seen that work maybe the best. However, I don’t really care. Whatever you like whatever your practitioner likes. So that could be craniocecal, cranioosteopathy. It could be acupuncture, it could be a massage. It could be any type of therapeutic body work. And there are all these forms and types you know.
On and on it goes but some sort of therapeutic physical therapy. Usually best when it can deal with the abdomen. That’s probably why I like the manipulation. But any of those messages can be helpful. It’s like the… you are using a different a different approach to get in there and help change things. So that’s it. Those are my strategies.
[21:23] REBECCA: and another side effect I see on SIBO, I hear from people around SIBO is weight gain or weight loss. And it seems to be at the extreme and of either of those spectrums. It’s people gaining weight rapidly or they are losing weight and they feeling incredibly underweight and very thin. Can you talk about why that happens and what people can do to help manage either weight gain or weight loss?
[21:53] ALLISON: yeah so let’s talk about weight loss first and then remind me to come back to weight gain. So I see weight loss much more commonly. Although this could just depend on the practitioner and their patient population. So the weight loss tends to be for several reasons. What we think of most is the diet. Low carbohydrate diets are famous for being weight loss diets. When you reduce the carbs, you could really lose a lot of weight. That’s one thing and all the SIBO diets are reduced carbohydrate diets.
The next thing is people not eating enough because they are afraid of food. We mentioned that in part 1. Also, it’s not just because they are afraid. It’s a way they manage their symptoms. Eating brings all symptoms which usually does, and the more foods you eat, the more symptoms. That’s the answer for a lot of people who eat a very small amount and/or infrequently. So it’s really just actual food restriction – under eating.
Now a third reason is the condition itself, the bacteria are competing for our food and they cause malabsorption. They cause malabsorption on most carbohydrates that is actually the symptoms that we see form SIBO most of them are technically derived from carbohydrate malabsorption. And they call it lactose malabsorption or just malabsorption from all the rest. So in that process they are stealing our food. We are not getting it. They are getting it and they can also cause mineral and vitamin deficiencies. Anemia is a common supply of SIBO.
So the actual condition itself can cause weight loss. And then lastly, if a person dies have diarrhea and the diarrhea is bad, diarrhea can cause weight loss especially through fluid loss. It’s very difficult to keep weight on when you have diarrhea. So those are all the reasons for weight loss.
Now let’s talk about weight gain. So with weight gain, there are two things I can link. One would be if you have methane gas. Methanogens have been linked with actually obesity and weight gain. I see many many people who have methane who do not have weight gain but it just can be a connection for some individuals.
That is very interesting and the second thing that I could say would be related to SIBO is then changing the diet. When we reduce carbs very often we increase fat to compensate for the calorie loss of the carbs. And if somebody overcompensates with diet they can have weight gain. Now those are things I can think of related to SIBO but in all honesty, the people who I have seen being with weight gain sometimes I don’t feel it’s directed related to SIBO. I feel that some people already have some sort of hormonal disruption. Hormones are famous for being able to make us gain weight. There is some sort of imbalance or disruption might be going on there. At the same time it might have even started beforehand. It might not have.
Now could that be triggered by SIBO? Yes. I can think so. So maybe that is a way a hormone imbalance could be triggered from SIBO and be related to that. We just often keep our minds open there might be two things going on at once that might not be directly related. In the end result of all of these, assuming that most what I described is directly related, the answer is to treat the bacteria. They are overgrown, try to kill them and remove them. Get them out of the small intestines. So most of these situations can be balanced.
Which is why in the part 1, stressed the three methods that are important for the killing strategies. Pharmaceutical antibiotics, herbal antibiotics or elemental diet. As opposed to just diet. This is where we need to actually get in there and get rid of them.
[26:31] REBECCA: definitely. I am all for myself when I commenced my SIBO treatment program and went on the bi-phasic diet by Dr. Jacobi. I was really excited. I thought, “I am going to lose so much weight. This is going to be brilliant! I am finally going to be slim again!” And whilst I lost a lot of centimeters around my abdomen which I am sure was a few whack of that as just from the bloating disappearing. I virtually didn’t shift the numbers on the scale which really really surprised both myself and my naturopath. But what that did for us then was we hypothesized that there is something else she suspects that’s hormone related. We are now investigating and exploring that avenue. And like you say, we have eliminated the SIBO. We can now cross that off and say that is not directly related to SIBO because I don’t have it and we have been actively healing my leaky gut.
We are trying to patch up all the holes to allow my immune system to do a better job. And now we are looking at what’s happening to keep weight on my frame and when I eat and when I eat an incredibly healthy diet, I am not eating burgers and fries and a lot of processed foods. It’s very natural. Let’s keep exploring. And I don’t let myself get down about the fact that I am not a very slim person. I am not obese but I am not slim. And because I now recognize that my resistant weight loss is just the body’s way of saying, “things are still not right with me. Keep looking, keep going.
[28:28] ALLISON: I am so glad you mentioned your story because it connect with what I said. Because I really see that as the most common thing that goes on with people who are gaining weight when they have SIBO. It does seem to be usually hormone related and then I don’t specialize in that so I have done them to someone who does that and then they usually get some good results.
[28:40] REBECCA: and given that I also have endometriosis, I can imagine that my hormones and my reproductive system are already compromised because I have another disease and condition. So for me I just treat myself as a walking science experiment. I am fascinated by what I learned these days and I don’t beat myself up anymore. I spent years beating myself up that the scales didn’t hit a number when I thought that they should hit.
It does lead on to my next point which is around… in my journey to regaining health; I realized that I had to cover 5 key areas. The first being awareness. The 2nd being my nutrition. The 3rd being around movement. The 4th around mindset and then the 5th being my lifestyle. So I would like to look just a little around those 5 key steps and your perspectives on them Allison.
So awareness to me was really around I had to start to reconnect and listen to my body and become aware of what was happening and to stop hiding behind over the counter pharmaceuticals, alcohol, excessive work to keep me busy to stop being aware of what was really going on in my life. What is your take on the importance of awareness as a first step for people?
[30:15] ALLISON: You know all of the experimentation you were talking about. We can’t really do that if the person doesn’t know where? How are we going to get the feedback from the person? Or how are you going to get from yourself if you didn’t pay attention to how things affected you? So if you are not already sensitive to the message from your body, it is very important to start paying attention so you can learn.
I would say that actually SIBO and digestive illnesses seems to be a pretty good teacher of awareness for a lot of people. A lot of people don’t have a problem being aware they are highly sensitive to their body and what bothers them. At least they progress naturally
[31:00] REBECCA: They are. Although I think that there is a tipping point and I know with myself that ignored my digestive discomfort for I would say nearly 30 years, nearly most of my life because I just didn’t want to know about it and I also didn’t want anybody to tell me that I had to make changes.
[31:23] ALLISON: certainly. And you know another thing that is interesting here is it’s easy for me to forget as a doctor who specializes in the condition that is all about bowel movements and stuff is that they are ashamed. They can be ashamed to think about these properties of our body, certainly to talk about it. So that is another place where awareness comes in. it is just self-acceptance. If a person wants to feel better, they need to think about it a little bit and be willing to talk about it.
[31:54] REBECCA: Exactly! I know for myself I was chronically constipated with small bouts of diarrhea but my standard state was constipation. I honestly believed that to go to the toilet once or twice a week was completely normal because that is how I had been since I could remember. And I remember going to a GP, I was trialing a new GP, I had heard that she was great for women’s reproductive health and I was having a lot of abdominal pain which I at that time thought was due to my endometriosis. And she did, I think she might have even done a vaginal exam. And she said to me, “Gosh you are so constipated. You must go to the toilet.” And I said, “Ah, I am not constipated, I go.” And she said, “No, you are not going. You are completely backed up.”
And instead of then saying to me, talked to me about how frequently you go to the toilet and do you have difficulty going to the toilet every day, it was so much shame put on me. And she kind of barked at me that I was constipated and it was my fault. And then I felt really embarrassed about it and I thought, “I am not telling anybody about that. Look at what happened to me?”
So it is important to find the right practitioner and to keep going and to not let these situations which can be so embarrassing and humiliating at that time to prevent us from seeking out further assistance.
[33:25] ALLISON: that story… how inappropriate. This is something that a lot of people feel with a lot of aspects of their health and certainly their digestive health. It’s performance anxiety. It’s like I don’t go to the bathroom enough like I am anal or a bad person or something or I go to many times. But how are we supposed to stop that when it is beyond our control. These are physiologic situations beyond our control and also when you have a disease causing them. And other things like bloating, performance anxiety, you know now I look fuller or pregnant or whatever it is I look. I need to not look like that to be healthy and to look attractive. People can really put a lot of performance anxiety on itself and it’s certainly no good when the doctor does that. Of course that doctor would have done a much better job if she had suggested how to help.
[34:24] REBECCA: exactly. I think as well when I comes to awareness, there’s the awareness pre- SIBO diagnosis or even when you are going through your treatment but I think it is also important to remain very aware and connected with your body when you have received that all clear diagnosis and I know from myself that life post SIBO has been wonderful and glorious. But I really listened to my body now to stay in tune with it, to listen to when things might be getting a little bit out of control. And my tactic remaining SIBO-free, especially given that I have endometriosis which puts me at much greater risk of redeveloping SIBO is that I listen to my symptoms. And if my motility slows down and perhaps I am not going to the toilet as easily, so if my morning bowel movements start to happen at lunch time rather than first thing in the morning as it normally does, it hen think, “Ok things are starting to… I got to be really mindful of what I am doing here and I might do another round of herbs just in case there are some bacteria that is starting to increase and I don’t want it to go into full blown SIBO.” So I think awareness is really important post treatment as well.
[35:47] ALLISON: that is such a good point. And there is something I am thinking about as well that might be related to mindset as well. But there is sort of a flip side of the coin where we can also become hyper aware. I’ll just use this as an example, the diet diary for example, in the beginning it can be so helpful to help you gain awareness to track the foods you eat and the symptoms it produces. It is just like it might not be easy to connect the two unless you are jotting it down. So it is a very good tool. But then people can become quite obsessive over such things like excessive over those symptoms and how they are going to rate their symptoms each and every day and which food caused it. And that is sort of can create the extra issues around food. You already are going to have some of those because they are causing symptoms but then this is sort of piles on another layer of topic. Maybe it doesn’t need to be there.
So then there is a point where we need to pull back from that. So we could still be aware in a wonderful way that you just described but not hyper aware. And there is a time to stop diet diaries and to stop thinking about the symptoms that you have every day and at what severity are they. In fact stop thinking about them altogether. So that you can live a happy life. So just the flip side.
[37:16] REBECCA: Yeah. Definitely and I must say I don’t think about my gut or my digestive system much every day. Maybe I might think about it during the week maybe, maybe not it is so liberating. I don’t have to think about what I am eating necessarily and then what symptoms my body is giving me. That is so nice. So the second point for my five key pillars of my health was around my nutrition. Obviously when you go on to the SIBO diet whichever one you choose, you will have some form of restriction on your diet. But can you talk to us Allison just around you believe to be the importance with good nutrition for general health and also when treating SIBO.
[38:04] ALLISON: You know I think in a way that’s one of the blessing in disguise. Once there are many with illness and chronic illness. But it can be one of the blessings in disguise with SIBO because dietary modification is a very important part of treatment. Really incredible for helping symptoms. And all of the diets recommend steering away from processed food really focused on pure good healthy food. And less eating out and more home cooking which can be very difficult as lifestyle change. But it is so incredible when one does that. I mean just the difference of preparing your own food and having less processed food. And second, buying hopefully higher quality ingredients for your food. People feel so much better on SIBO diet. I had so many people tell me that they will actually never go back to the way that they used to eat even when their SIBO I gone. And actually I have followed up with people like that. You know 5 year follow ups. They have never returned to the way they used to eat before. Even if the way they used to eat before wasn’t hardly bad.
It’s just that when a lot of people have a digestive complaint and they altered their diet for it, they do better. They do better with their nutrition and their diet and they feel so much better for it in every way. They feel better for both gastrointestinal symptoms and for every other symptoms. That’s why this diet is so amazing at. Allergies get better. Inflammations get better. So many other symptoms get better that the classic combination of sleep and energy gets better. The whole quality of life improves. So it’s an incredible thing to increase one’s nutrition.
There is no disease and there is no healthy person that doesn’t feel better by having higher quality and better nutrition and diet. That’s just across the board.
[40:15] REBECCA: definitely. I am one of those people not wanting to return to the diet I used to have. I used to be a carb addict. I loved bread and pasta and rice and potatoes and when I eliminated those foods strictly during my SIBO diet. I felt incredibly healthy and energetic. And these days whilst I can have a little bit of those foods, I actually choose not to for most of the time. The only time I will eat gluten for instance is fi I am eating out and there aren’t any options for me to eat just protein and vegetable. Or if I have gone to a friend’s place and they have cooked… most of my friends I must say are very good now they know that I eat very healthily so they make very healthy food for me but occasionally. Or if I am traveling on a long haul flight like when came over to America recently and you are kind of stuck with airplane food. But when am cooking jus for myself, I am cooking day to day food, I buy the best quality protein that can afford and I buy the best quality vegetables that I can afford and good quality fats and that’s pretty much it. I don’t drink much alcohol anymore. I used to drink very heavily when I was younger. And I really don’t have any sugars. Minimum, I have a little bit of honey here and there and I feel amazing for it because there is just no processing in my food. It is all really natural.
[41:48] ALLISON: I experienced the exact same thing when I went on a specific carbohydrate diet. Right in the beginning my SIBO treatment was just incredible and I was already a healthy eater. I was a naturopath and totally into healthy food and nutrition. But just pumped up and made a difference. So it can only help people and if somebody falls off that path and brings back in foods that are more processed or maybe whatever food it is that not doing right by then.
Going back to that awareness piece and you gave that example. Try to just stay away of that and you will let yourself back on to the right path because you won’t like how it feels. I mean everybody is going to have times were maybe they fall off the path that…we can spring ourselves back on with good nutrition. It can be hard for some people to stay with good nutrition depending on their social group or what is going on or stress management techniques but we always feel better for it.
[42:49] REBECCA: definitely. The 3rd piece of the puzzle, I suppose we could call it, is around movement or exercise. It’s really one and the same. How important do you believe it to be to move or exercise when you have a condition like SIBO?
[43:07] ALLISON: well this is kind of a tricky one because sometimes exercises and movement can really exacerbate the symptoms. So I think it is probably kind of like a moving target. Movement is a moving target because it depends on how bad when symptoms are. Like somebody has very very bad bloating and distention. Exercise will pull down that protrusion and really increase pain on someone. Even walking is a terrible aggravator when somebody is extremely distended and same thing on a lot of other GI symptoms. So we have to get the very severe symptoms under control before i think exercise will be helpful.
In general, for anybody’s health, exercise and movement – we all know that that is important. It’s just like nutrition we were talking about. But you know if someone is very sick we have to get them over that and then as they begin to heal I feel that movement is a wonderful supporter. I don’t think it plays as important as a part as diet and nutrition but I would put it in around the realm of like how probiotics are for the majority. The majority of people I would say probiotics help 20 to 25% and I would say exercise and movement is that it is supportive, it’s helpful. It’s adjunctive and good.
If we are talking about someone, not just SIBO…but if we are talking about people and their life and health, I would rate it higher. But if we are just talking about SIBO it’s not a major player but it is helpful and adjunctive. You know where i think it comes in is of course circulation, endorphins and positive attitude. Especially if you were feeling bed bound or house bound with symptoms once you then can get out void and you feel like you are living again. If you get movement and exercise. But also, just then we were talking about body work and physical therapy treatments, in general and even in the abdomen. So the movement can help with that. It’s your own way to sort of do some body work depending on the exercise that you are doing. So it’s definitely important.
[45:39] REBECCA: and I know for myself that I had been a bit of a gym junkie at times and I am one of those people either lying flat on the couch or training for a triathlon. I am 0 -100 and then my SIBO kind of held me back a little bit. So I started just going for really gentle walks. Just around the block to start with just to get some fresh air and to…I actually found personally for me that when I was particularly bloated, a gentle walk could often help alleviate some of my bloating and that helped me personally. That was my personal solution. And I have pulled back on the really crazy exercise that I have done in the past and I now focus on more gentle movement and flow when I do things like yoga or I go walking or just gentle things to just keep my body a little bit calm. But I find personally moving has been really beneficial for me as I have got better.
[46:46] ALLISON: You see, there is a prime example of the individuality that we are talking about with SIBO that walking helps your bloating whereas for other people walking hurts their bloating. And this is where people just have to try things. They have to experiment and see what works for them. So it’s actually really good that you had a different experience than what I said.
How does everyone know how individual it is?
[47:08] REBECCA: The 4th step is mindset and I know I have had to draw a lot of work around my mindset and it is ongoing for me. Can you talk to me about how you feel what you believe the importance to be around how you think the mindset you have when you are treating SIBO?
[47:28] ALLISON: well I think what is so helpful to someone is to not take it too personally. Any disease acute or chronic is so hard not to… but that’s why I think you know the experiments can help because it gets you a little bit objective. It gets you a little bit out of your own personal self to an observer. And where education helps. It does the same thing. You think about the condition instead of just of how the symptoms are hurting you. So anyway that you can get a little it removed from how personally it is horribly affecting you, it is very helpful. Perspective, it gives you perspective so that you move on and live your life because with any chronic condition or acute you could just hold yourself up in your house and feel so terrible for what is going on.
Some other things that are important with mindset is to pay attention to the good things. This is classic sort of stress management technique for all life is to pay attention to what is going well and be thankful for that instead of paying attention to everything that sucks. That is really the way I think to take step by step forward through difficult situations. And I will just share a little tip that my sisters often use that I like. Because everybody has their stresses in life no matter what illness they have or don’t have and so they each make list of ten things that they would like to do in a day that is taking care of themselves. And they don’t have to do them all. But if they could get even a few of them done then they will feel good. And they put things on their like brushing their teeth.
So it’s like if you are having a bad day, whether from your SIBO or not, you can go to bed saying, “Hey I brushed my teeth today.” If I have things like that if all else go to crap or something like, “You know what, you brushed your teeth. It’s a good day.” These are classic techniques to get through . But they are important to when things are really bad.
Now one other thing I will say is that mindset is of course going to be helpful for your emotional state which can be very impacted illness. However, even if you have a bad attitude, if you keep treatment for SIBO, those treatments are still going to work. You are not going to inhibit the effect of an antibiotic if you feel miserable, if you attitude isn’t positive. So mindset does not make or break a treatment. But boy you sure feel better if you can fix your mindset to be more positive and forward thinking.
[50:44] REBECCA: Something that I have started doing which helped me stop focusing on myself and start focusing on the small wins that I have every day is that I have set up a happiness jar were I put on a little piece of paper, something has made me happy for the day and sometimes it’s just that that the sun has been shining and I sat in the sun for 5 minutes or it might be that I heard my favorite song on the radio or it could be I got to cuddle a cat. Really simple things that have given me momentary pleasure and I look through my notes. Sometimes they are really big things, they are really exciting things like coming to America and coming to the SIBO symposium. That was really a great thing for me. So it can be little or big and I look through my notes and then that gives me happiness to think, “Oh Gosh there has been some really nice things that have happened and it takes away from focusing on any negative things that might be happening in my day.
[51:46] ALLISON: That is so important. One of the best ways to increase the parasympathetic nervous system which is sort of the opposite of what we think of the stress, I think stress is the sympathetic nervous system, is gratitude. And so that’s one of the things you are describing there. It is so good. Just at any time of the day or maybe before you go to bed or certainly before a meal. Of course, saying grace is about. If you think of something that you are thankful for that you feel gratitude for in true honesty. Not something you think you should feel grateful for. Something that you actually feel grateful for connecting with that…. And add in a one conscious breath, then boy, you are really doing great.
You know these are the classic strategies. I think this is what is taught. I hear a lot from war veterans especially who become handicapped or disabled in some way. But this is what they do. Focus on what you can do. Focus on what you feel good about and it is such a great way forward.
[52:52] REBECCA: Yeah definitely. And then the 5th piece or the 5th step that I needed to really work on in my return to health was lifestyle. Can you talk to me a little bit around your sorts of suggestions on how people can work on their lifestyle?
[53:11] ALLISON: there are so many aspects to what you can mean by lifestyle but one of the first things I think about is sleep. The timing of our sleeping and the timing of our eating. So making sure that you get enough sleep. Now this can be very hard. Sleep can be disturbed by symptoms. Watching people struggle with insomnia and various types. So I am saying this with that knowledge. Some people might be saying how. But what we can do is if we can stay up late working or watching TV or something, we can work on not doing that and going to bed at a decent hour and at a better time to get better sleep.
One of my professors used to say, every hour before midnight is worth two after or something like that. You know not staying up to one or something. Trying to get if I can. You know whatever I can do. And keeping that schedule similar day to day, that is something the body really likes… really likes consistency and sleeping patterns and eating patterns. So another thing is eating your meals at the same time day to day. I mean about an hour. Sometimes you might be a little late or something is going on. That is a little thing that calms and strengthens the body and the nervous system. So that is very helpful. Keeping these sort of schedules and consistencies is good.
Some other lifestyle things are what we talked a lot already like good nutrition, exercise and things like that. But other things are support systems. Making sure if you don’t have them, try to encourage some new support systems and this can be all sorts of things. It’s friends and family encouraging you during your SIBO treatments. It’s fun with friends and family so that you are not just thinking about your illness. And you know it could be church groups, it could be religious, it could be SIBO support groups. Sometimes SIBO support groups give you more stress. So finding what works for you. But support is still important in lifestyle because no one can just deal with life all alone really. We all have to have help.
So lifestyle can mean is taking a critical look at relationships that maybe are abusive and maybe making some decisions there for change.
[55:52] REBECCA: Yeah. Definitely. I know that with my journey I had been as I have said a heavy drinker. I wasn’t an alcoholic. I just really enjoy socializing and partying. And so my weekends were spent drinking a lot with my friends. And when I completely cut alcohol out of my diet and out of my life when I commenced SIBO treatment. And now I don’t drink very much at all. The people that I had considered good friends and had been there with me for so many years didn’t particularly like the new Rebecca, the non drinking Rebecca. And I have made it to make some lifestyle decisions around who is in my social groups. Who did I want to spend time with? And who had values more aligned with my new values which was around health and happiness and longevity and those types of things.
So I needed to go out and make some new friends. And that can be quite difficult but it’s been really beneficial for me to have some people in my circle now have a real focus on their health and wealth being.
[56:59] ALLISON: that is just such a good story. And you know you brought up the point with alcohol as well and that is such a key thing in lifestyle. You know I often talk about hard living. Trying to get away form hard living. You can see hard living on someone’s face. You could hear it in their voice and you certainly see that in illness. What is hard living? It’s alcohol. It’s smoking and other drugs. It’s staying up late like we talked about before. And eating poorly, poor nutrition. That is actually what hard living is. You know everyone is susceptible to hard living.
[57:42] REBECCA: I am a classic night owl who loved to party and I was never asleep and I still to this day you know I think, “Gosh if I could be one of those people that never needs sleep then that would be great. Imagine what I could do.” But I have seen it’s a constant process for me. I definitely wouldn’t say that i am there but I am really conscious now about the importance of good quality sleep. So I set alarms to start reminding me to stop packing up and getting ready for bed. I switch off my electronic devices. I take myself away from my compute at least an hour before bed. I really love listening to podcasts. So I’ll go into my bedroom. Turn all the lights down really low. I might listen to a really kind of soothing and relaxing meditation podcast that helps just wind me down and get me ready for sleep.
And I find that that is really helping to bring me back into a more normal sleeping pattern where I am not getting to bed at 1 or 2 am. Now I try to get to bed before midnight as my general rule. So, it is possible for those people that think, “Gosh I am just never asleep.” “I’ll never get to bed before midnight.” Or, “I’ll never give up drinking.” It’s just small steps forward in the right directions that help get you there in the end.
[59:07] ALLISON: you know circadian rhythm can be something that people might listen to. “Yeah I am just a night owl and if I lie there I cannot fall asleep.” You hear something like that. There are some things you can do for that if you wish to. A lot of this has to do with lights. The therapy lights that are used for soothing affective disorder. You can use those lights to reset ones circadian rhythm. Some people might be familiar that those lights are often used for jet lag and helping adjust to different time zones. And in a similar way they can help reset or alter someone’s circadian rhythm so that if they wish to they can come to a pattern that is more aligned with the society that we are living in.
[59:51] REBECCA: What resources would you recommend people use when they are looking for support with their treatment or at even just education and knowledge around SIBO.
[1:00:01] ALLISON: well certainly my website because that’s what it’s all about. It’s all about free education. SIBOinfo.com and I have a whole resource section with many available things there. So for basic education I have many…. If people want to learn more I have many articles and many trainings like the SIBO symposium that we have. People can buy and watch that. There are so many people blogging. I don’t have those all linked but you can certainly go to those and find it. The only thing is that sometimes you have to be a little bit discerning how much does the person writing know? Because there are some people who write that might not be fully educated.
But another resource that I think is very helpful, more specific one are cookbooks. When you are changing your diet and if you feel deprived, cookbooks are about the best things you can look at because when you see gorgeous pictures of all these wonderful meals and foods, you don’t feel deprived. So that is just a basic resource. And I have a lot of cookbooks linked on my website and of course you are about to have two cookbooks which are gorgeous.
[1:01:14] ALLISON: I do. Thank you
[1:01:16] REBECCA: And I am not mentioning this simply because you have cookbooks. It’s truly something I tell a lot people when you are just new with SIBO and you are thinking all foods bother me and I have to go on this diet. Cookbooks, there is just no way you can feel bad about what you are going to eat when you look at those beautiful pictures. So those are the basic ones. We talked a little bit about how to find a doctor. So those are the main things I can think of.
One other thing, podcasts like this. This is great. This is a 2 part series. I have done many interviews offering just tons of very specific treatment information you don’t even need to pay for and I have those interviews linked on my website as well, a god place to find them all along with a lot of articles is underneath the contact tab on my website. If you go to my bio, I have all my free interviews there that you can listen to.
[1:02:11] REBECCA: Right. And your website is such a great resource Allison and I send so many people there and I just wish that everyone went there in the first instance when they first to run their SIBO research because there’s just an absolute wealth of information and knowledge on that website. So thank you for putting that together because I know how much time it has taken you to do that.
To finish off the podcast what do you see the future of SIBO is being? It’s a pretty broad question.
[1:02:43] ALLISON: I think we are going to get a lot more research answers particularly with methane. I think we are going to find… the researchers are focusing on better and more treatments for methane. Also sort of the pathophysiology of methane. It has been shown that it is quite different now from the other forms of SIBO. There was a recent article Dr. Pimentel and group published on the different disease. I think we are going to see a lot more development there. I think we are going to see… I think Dr. Pimentel has been working on a cure. He has been working hard on research and study on a cure for the food poisoning type of SIBO that I mentioned. It is also called post infectious IBS.
Basically a cure for the autoimmune mediated migrating motor complex efficiency with cell damage, I think we are going to see that cure in not too long. I don’t know how many years but I think we are going to see that. I think there might be a better test coming out for the migrating motor complex that might in office I am hoping. I have heard rumors about that. We might see that.
So I think we are just going to progress farther and farther with the information. The other thing where I see SIBO going just sort of a more general, not too much or research and information is I think more and more doctors will come to accept it and learn about it as awareness spreads on it. I think we will see a good movement there.
[1:04:16] REBECCA: Wonderful. I think it is going to be exciting times ahead when it comes to SIBO research understanding and general awareness.
Dr. Allison Siebecker, I would like to thank you so much for being involved in this 2 part series on SIBO on the healthy gut podcast. We have really appreciated your time and I am sure I speak on behalf of myself and my listeners to say thank you so much for sharing your fountain of knowledge when it comes to SIBO treatment.
ALLISON: You are so welcome and thank you.