Need help with your gut? Visit my website gutsolution.ca to join a program:
Contact us:
September 8, 2025 • 54 mins
SIBO is becoming more well known as it's a major driver of gut problems like IBD, Crohn's and Colitis. But your doctor isn't likely to have the foggiest clue what to do about it (if they even bother to test for it).
SIBO is responsible for 70% or more of all IBD cases, and is a major player in 60% or more cases of Crohn's and colitis. Needless to say, if you're not talking about it, you're not going to heal your gut.
TOPICS DISCUSSED IN THIS EPISODE:
- How SIBO is the #1 cause of IBS
- How food poisoning is the elading cause of SIBO and what it mean for your health
- The 3 different types of SIBO
- What the migrating motor complex is and its role in recovery
- Types of bacteria that lead to SIBO
- Gow to treat it properly
- Everything else you need to know about healing from SIBO
More from Dr. Allison Siebecker
Website: SIBOinfo.com
Leave us a Review:
https://www.reversablepod.com/review
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Josh (00:07.972)Hi. A pleasure. I know we got connected through a few people. You've been so highly recommended to me. I'm like, we're gonna have her on the show. We gotta hear from Alison.
(00:01):
Allison (00:20.344)I don't know anything about you, but I'm happy to meet you. You're doing... do you want to tell me anything?
Josh (00:23.74)Well, thank you. Not really, no, I'm just a guy who loves gut health and is very passionate about it. I specialize in Crohn's and colitis. And so I've been, it's specifically the work I've actually been doing on the holistic functional side for Crohn's and colitis. It actually got me here with all these amazing doctors and sort of got me in touch with all these people. So it's been a ride, yeah.
Allison (00:30.006)Right on.
Allison (00:43.751)Are you a practitioner yourself?
Josh (00:45.616)I'm a nutritionist, a holistic nutritionist. And yeah, so I'm kind of getting into that world. I'm not a functional medicine practitioner on paper, but I love the functional medicine, the concepts and how it works. And I mean, we're reversing inflammatory bowel disease left, right and center like it's never been done before. And so it's just been an amazing, amazing ride. It's the most fulfilling work I've ever done, so.
Allison (00:47.658)Perfect! Yup, yes you are!
Allison (01:08.694)Wow, are you, like I came into the SIBO world from breaking the vicious psycho was probably the way I got in, to that world which is, you know, SED diet. So, you know, we know they had phenomenal results, particularly with pediatric. Is that sort of some of the stuff you get into?
Josh (01:25.464)Well, I look at food. I'm big on GI mapping. I know a lot of people in the functional space don't love it because it's not as conclusive. It's not comprehensive. We've got millions of different varieties. We can see like 50, but it's such a cornerstone in what we do. I use a lot of food in the way of, you know, bacterial profiling and stuff. So I recommend according to the profile and what they can tolerate and all of that. But a lot of it is supplementation. I do work with some doctors on an integrative medicine approach as well. So when I get Crohn's patients who are really severe, like truly autoimmune,
inflammatory bowel is autoimmune and I'm actually teaching on that here coming up soon. So I'll work integrative with like LDN and some other things peptide therapy and all that so it's a pretty cool ride.
Allison (02:05.374)I'm really glad to know about this. I have a couple of my colleagues who are really into IBD. And so I might want to connect you and them, you know? Naturopathics, it'd be Dr. Alana Gerovich and Dr. Steven Sandberg Lewis. I'll just mention their names now so I can think of it, you know?
Josh (02:09.514)Oh.
Josh (02:12.952)Yeah, I'd love to. For sure.
Josh (02:20.548)Yeah, perfect. And I already pressed the record button, so I'll have it on if I forget who they are. That's perfect.
Allison (02:23.626)We'll have it. So, Duncan Samperg Lewis is the, and I know we gotta start here, but he's the naturopathic gastroenterology professor who has taught all of the naturopaths. Like he's going to retire soon, you know, so he's been in practice for 50 some odd years and yeah. And so he'd be a fun person to talk to.
Josh (02:28.7)Oh, that's fine, I got time. I give a buffer.
Josh (02:35.184)Hmm. He's the guy.
Josh (02:43.396)No kidding, I appreciate that, thank you, yeah. I'm really looking forward to this. Well, how much time do you have? I always leave a buffer before and after for tech issues, for chit chat, for all kinds.
Allison (02:53.226)Yeah, I can go over a little bit past an hour if we need to.
Josh (02:56.6)Yeah, well, we'll see where it goes. If it goes over, I do have a 30 minute buffer. So if we need a chit chat, or if you need anything from me and there's anything I can do, tech issues, we're grand, but you sound great, which is nice. Yeah, so I think you've probably done one of the, two of these before I've looked you up. Ha ha ha.
Allison (03:06.37)Good.
Allison (03:09.918)Yeah, I sure have. I use a Yeti microphone and it's been giving me trouble. And I recently asked someone what to do and they're like, Yetis are horrible. And I'm like, I've done all my padcasts, all my courses with a Yeti and it's been just fine.
(00:22):
Josh (03:25.02)You sound fine. Are you familiar with the interface of the Yeti? Like, I mean, some people will turn up their game and not know what cranked up. Like, little things like that. Yeah. You sound great. We're not worried about it. So yeah, you're good. If you ever lose anything, future, fun little tidbit for you. I found a fella on Upwork.
Allison (03:32.535)Yeah, right.
Okay, good.
Josh (03:43.328)I pay him like 30 bucks. So some of my audio was some of my, I had Dr. Leo Galland on a couple, two, three months ago, but his microphone, it sounded like a bad Bluetooth speaker in a car, like when you're taking a phone call. And so it was really choppy, un-listenable. I found a sound clip on audio. I gave it to a guy for like 30 bucks. He threw it through an AI system, or re-replicated the entire conversation and his voice was perfect. It's unnerving.
Allison (04:06.572)No way. Okay, I wish I had that because as my microphone was going bad, I was recording a new course and I had corrupted audio and I had to re-record and re-record. I wish I'd had that. Ha ha ha.
Josh (04:15.99)Mm.
Josh (04:19.872)Upwork, any of these guys who do like AI voiceover work, they can replicate your stuff, they have the software. And it's staggering. There's actually been some stories of people who have done like fake ransom calls, who like took their daughter's voice off Instagram, replicated it, faked a ransom call to make money and scam the parents when this girl was at school perfectly fine. Yeah. It's scary.
Allison (04:44.086)Whoa, I'm gonna go tell my sound editing guy all about this because I don't think he knows. Ha ha ha.
Josh (04:47.864)Well, perfect. All right. So you got your look at this. We're on the right track already. We're both learning stuff. Well, Allison, I had just a quick intro that I pulled from your website, some little bits. We'll kind of just dive in. I always rerecord the intros after the conversation. So I redo my podcast intros. But it will sort of give us a kickoff just to kind of launch the conversation from and go from there. Any questions for me before we get started?
Allison (05:10.566)No, I don't remember. Well, yes. I don't remember what we said we were gonna talk about, but I assume it's just we're covering all the high points of SIBO.
Josh (05:13.097)Hehehehehehe
Josh (05:19.856)Basically, yeah, I mean, it's such a, we'll say a trendy topic that so few people truly understand. Well, I maybe have C, but I'm like, do you know? How have you tested? What have you done? What's, well, I'm bloated. I'm like, okay, perfect. Like that's...
Allison (05:32.398)Perfect.
Josh (05:33.016)you could, yeah, you're taking antacids, of course you're bloated. So anyway, there's lots to dive into, but I'd love to go through SIBO, how to define it, what it is, testing, how to know if we have it, what to do about it, kind of the basics that you've run through 100,000 times. And yeah, I know it's your specialty and so we'd love to hear about it.
Allison (05:46.73)I figure, yeah. I love it.
Josh (05:51.8)Cool, cool. I'll just I'll rip off this intro really quick and we'll just dive right in then. Perfect. So today's guest is a SIBO specialist and naturopathic doctor with a Masters in Oriental Medicine, who's been in the nutritional field since 1988. Allison, since before I've been alive, mind you. So we trust your opinion today. She is the co-founder and former medical director of the SIBO Center for Digestive Health at the NUNM clinic. And she's also won the 2021 Gastro A&P Lifetime Achievement Award.
pleasure to have you here. Did I pronounce that right, Seibacher? Seabacher. That's okay because we're gonna rerecord that anyway and snip it. I'll be like Allison Seabacher, you'll be like thank you for being here. I'll sound like I know things which will be great. So Allison you are the who's who in Sebo. A lifetime achievement award is no small thing. Now the introduction kind of just doesn't do a ton of justice. Can you tell us a bit more about who you are and what you do?
Allison (06:23.746)So happy to be here with you.
It's C. Becker, but I really don't care.
Allison (06:36.022)Hehehehe
Allison (06:51.182)Sure, yeah. I guess I should start by saying I'm a SIBO patient myself. So I'm a doctor, but I also have the condition. But I didn't know that till so much later. Like so many people, I had what was generally called IBS. Didn't even really realize that till much later. So when I finally found out about this, and when I found out all the ins and outs and things that could work, it just lit me on fire. So obviously I'm a doctor. I had a general practice, but I...
(00:43):
switched it to focus on this because I was so passionate about the topic. And I've mostly done education, really a strong focus on education. I had a clinical practice in SIBO for many years. I'm currently not seeing patients because I mostly just do so much education, really. So I started the first SIBO conference or SIBO symposium ever on SIBO, created the first SIBO clinic, you know, that only focused on that, et cetera, et cetera, really just trying to.
kind of do a campaign of raising awareness. And the reason why is because, you know, the big exciting, cut right to the chase here, the big exciting thing with SIBO is that it's been discovered in recent years, in the last, you know, 10 or so years that, which is not that long, that it is the number one underlying cause for IBS. There are other causes, of course, but the majority are thought to be SIBO. So it can help, you know, with one swath, it can help so many people knowing about this.
Josh (08:17.532)Hmm.
So SIBO is a term that we're seeing floating around the internet more and more. Right? And that's one of the beautiful things about gut health and SIBO and all these things, the importance of gut health, they're becoming more mainstream. So people are becoming aware. But the problem with mainstream in healthcare, really anything, is that it's like a game of telephone. Right? What started out as I want a banana sandwich turns into grandma fell off her brand new hammock. And everyone's like, what are we talking about? So can you tell us with the
Allison (08:49.058)Absolutely. Okay, so it has been actually redefined in recent years as a clinical syndrome, meaning that there's two things you need to have to say you have SIBO. You need to have proof of bacterial or microorganism overgrowth in the small intestine. So therefore you need some sort of diagnostic test to prove that. And then you need to have the corresponding symptoms.
So if you have one, like if you show positive on a test, but you have no gastrointestinal symptoms, that's not of concern. You need to actually clinically be experiencing trouble. But then on the flip side, if you have the symptoms, so what are the symptoms? They're the same symptoms as about 40 other conditions. So, right? So yeah, right. So what are these symptoms? It's the classic IBS, meaning irritable bowel syndromes. It's abdominal bloating or.
Josh (09:35.984)That's easy. That's easy to decipher. Sure.
Allison (09:42.858)so that's distension or swelling of the abdomen after food. And then it's constipation or diarrhea or combination of the two and then abdominal pain or discomfort. Those are the core symptoms. You can also have things like excessive gas leaving the body so excessive flatulence or burping. There could be nausea, there could be food sitting and not going down, there could be acid reflux. So a variety of symptoms as well as it can impact mood.
predominantly anxiety more so than depression. It can create anxiety. And the key thing is all of these symptoms, particularly the digestive ones, come after eating. So that is a keynote there. And bloating is probably. You know, for some people it's immediate, which can be confusing to understand, physiologically and medically. For most people it's anywhere from about an hour, hour and a half coming into the three plus hour range. So the classic scenario for SIBO,
Josh (10:22.816)How long after eating is that, Allison?
Allison (10:40.59)is you might feel better in the morning. Some people don't, nothing ever changes for them, they just have bad symptoms around the clock. But many people feel better in the morning and then as they eat their meals throughout the day, the symptoms get worse and worse. Just for example, the bloating gets worse and worse and worse and so maybe they started with a relatively flat stomach or belly area in the morning and then by the evening, they look like they're nine months pregnant, you know, no matter the...
biological gender there. So, so, um, so back to this definition, the, you know, you do need to have some of these symptoms as well as the test, but why the test is important is because those symptoms can occur with a myriad of other conditions. And so they're not, they're called non-specific symptoms. It doesn't, it's not specific to SIBO. So we have to have both to figure out if this is what's going on. Oh, and actually, I'm sorry, there's one other thing I should say on this definition.
Josh (11:33.334)So...
Allison (11:36.886)The definition's been expanded recently because there are these three different gas types and we just used to call them that exist in SIBO. We used to call it SIBO hydrogen, SIBO methane, SIBO hydrogen sulfide, and they link with bowel movement symptoms and we can discuss that later. But now the methane SIBO has been given a new name and it's not actually considered under the heading of SIBO anymore, although I still speak like it is because for so long it was it's hard to change my language.
Josh (12:04.609)Mm-hmm. Sure.
Allison (12:06.058)So that's called intestinal methanogen overgrowth or EMO.
Josh (12:10.721)So it's interesting. So your average user who might be coming and going, I've heard of SIBO, maybe I have it, maybe I don't. The only way to really know that would be to see someone like yourself or a SIBO specialized practitioner to go in, assess the symptoms, do either the breath testing or whatever other testing, stool testing, whatever you do, and then you get this diagnosis. Is that right?
Allison (12:31.462)Yes, I will say we have hope for something, a different scenario, which is that, um, because just recently the I, the international diagnostic code agency, um, has given diagnostic codes for SIBA, which this is new. So ICD-10 codes. So we can see now it's getting, it's pretty hard for somebody to say, um, like a primary care practitioner to say, uh, it doesn't exist or it's not real when it actually has ICD-10 codes now. So because there has been
a lack of education for non-specialists. But one would hope that will change and there is a screening blood test that can be done. And so one would hope that primary care practitioners, when they hear you have these symptoms, they would run this screening blood test, let's hope insurance would cover it. And then if it's positive, if it's negative, it doesn't help you much. But if it's positive, it lets you know that SIBO is what you have. And it lets you know you have it from food poisoning, which is very interesting. So.
I think you're right currently that that's where the state we're in and I sure hope we can make continued progress on this.
Josh (13:36.792)Yeah, you know, it's interesting because so we've kind of established it can be identified. That's one big thing. Okay, so now we actually have this code, the ICD-10 code, which will legitimize it, like you said. So there are a lot of things that haven't had codes and insurance and said, nope, it doesn't exist. Therefore, we're not covering it's not been on paper. So now it's like it's a real thing. We're actually recognizing it. So.
(01:04):
If I was a mechanic, for example, right? I could go and fix a car because I understand how the car works. I understand what may have broken it down. I can go and figure out what steps to take. But before we can really understand how to fix anything, especially in the body, we have to know, one, why it got there, two, how it works. Can you walk us through how people end up with a SIBO condition?
Allison (14:18.422)Absolutely, and I absolutely love your analogy. That's the best. Because this is the way I like to talk about it. I like to separate causes into two levels, the physiologic underlying causes, meaning what's wrong in the body that allowed this situation to occur, and then all the risk factors, which is what most people will call the underlying causes, basically the diseases or injuries or things that could lead to that body problem. So what is wrong in the body is usually a lack of or a deficiency of
Josh (14:21.96)Thank you.
Allison (14:47.534)the migrating motor complex in the small intestine. And this is a sort of a form of peristalsis. Most people are familiar with that. It's the movement when we've eaten food and it churns and mixes and moves the food down along the GI tract. Well, this happens not with food. It happens when we, in between meals, when we're fasting. And it's called the housekeeper wave. And its function is to clean up after we've eaten.
And that includes sweeping any bacteria that's in the small intestine, sweeping it down and out into the large intestine. And that's really the body's number one protection against getting bacterial overgrowth in the small intestine because it's like a current of a river that's constantly flowing down. So it would be hard, if you imagine a flowing river, it's hard for there to be a bacterial accumulation there. But if you imagine a stagnant river, that becomes a swamp, right? So that's the best analogy.
Josh (15:39.28)Filthy.
Allison (15:42.606)So that can get impacted by so many things, so many diseases. Basically this migrating motor complex functions from both nerves and muscles. So anything that could damage the nerves that are needed to send these signals or the muscles can make a deficiency. And then there's one other main physiologic underlying cause which would be some sort of obstruction in the small intestine, like a partial obstruction. I say partial because a full obstruction is
a full-on emergency, but you can walk around living with a partial obstruction. You know this from your work with IBD, of course. Strictures would be a partial obstruction. So anything that narrows the intestine tube or blocks it like a tumor or what is most common is really adhesions. So these are like scar bands, which of course can happen with IBD, in the abdominal area that in some way are pressing or constricting against the loops of the small bowel and,
making a narrowed area. So what happens then if there's a narrow area of the small intestine when the migraine motor complex tries to sweep things out they back up behind that narrow area and that and that would be SIBO and adhesions are extremely common and people can get them. Surgery is probably a you know a universal way people can get them but um injuries and you know sports accidents a fall off a bike you know a car accident there's so many ways we can get them from.
It's a common and not well known about cause.
Josh (17:14.33)Hmm.
Yeah, I think most of us would assume, well, I, you know, maybe ingested something or my gut's highly inflamed or I have a mold infection or something that came in to mutate my bacteria or change it in a certain way. Maybe it was antibiotic usage that allowed these opportunistic bacteria to overgrow. Something must have happened. Now you mentioned a lot of these things like this migrating motor deficiency. You mentioned things that can cause strictures or injury. Is there something that your average person is really acquiring SIBO from that could be completely preventable?
Allison (17:46.89)What an interesting question, preventable completely.
Allison (17:53.89)I have to run through all of the things that cause SIBO.
Josh (17:56.948)So many, I know I see the Rolodex going in your head. I mean preventable in the same way. Well, it's like, you know, I will do this thing and I will get SIBO. If I ingest 50 pounds of probiotics a day and then punch myself in the gut, I'm probably gonna get SIBO, right? So.
Allison (18:12.166)I can't, I have to be honest, I can't, this is a negative answer. I can't think of anything that's completely preventable that causes SIBO, which actually helps to explain why it's so common. Because if we could 100% say, if I just don't do this, I won't get SIBO. So the most common cause of SIBO statistically from studies is food poisoning. And you know...
we all want to avoid food poisoning and we all want to prevent that, but that's not necessarily always in our, our ability to prevent. So just for example, you know, I love the things you mentioned earlier, you mentioned you imagine all these things coming in and really what they're doing is they're changing the bacteria. I think that's what most people think of would happen with SIBO. And that's it's really not the case. Something comes in that changes your nerves or your muscles or causes an obstruction.
Josh (18:37.729)Mm-hmm.
Allison (19:04.234)So it's not really about the bacteria because what we find is that the bacteria that are overgrown are already there. And then what happens is we actually know which bacteria finally, it's been incredible research that's been done. We know which bacteria are the main overgrown culprits in each of the types of SIBO or EMO. And they were mostly, they're really already there, but they do cause a terrible microbiome disturbance. So we do know that.
But let me just explain the food poisoning, for example. So food poisoning, and here I mean bacterial food poisoning because there's also viral food poisoning and that is not currently linked to SIBO, which is why only about 10% of food poisoning cases are thought to go into and turn into SIBO because so many of them are actually viral. But if it's bacterial food poisoning, all of the bacteria that cause that actually have the same toxin in common. They all secrete the same toxin. That toxin is called cytolethyldistending toxin.
that toxin looks very similar to a protein on the body's small intestine nerves. And so it's an autoimmune process. So basically through friendly fire, the immune system comes to attack this poison, this toxin, and from the bacteria, and it attacks the small intestine nerves at the same time. And then it damages our own nerves, and then past a certain threshold, the body's not able to make or create that migrating motor complex.
(01:25):
And so here what goes on is the initial food poisoning comes in, but that triggers an autoimmune response. So it's not the actual acute food poisoning. It's if the body gets triggered to do this autoimmune response. And so we often see after food poisoning, it could be up to three or even six months after the food poisoning that the person develops the SIBO. And now it's an ongoing autoimmune issue. It's not the same as, you know, Dr. Pimentel, our lead researcher in this, says,
It's not the same as lupus. Like he has seen many people, it reverse. It's not that intense, but it is an autoimmune situation. And so they are working desperately right now for a solution for that.
Josh (21:14.052)that's fascinating because you know it's such a unique branch of gut health research and you know there's a lot of a lot of things that are called autoimmune or not called autoimmune that are or some that I think I mentioned earlier
I don't know if we were recording at the time, but I don't believe all cases of IBD are autoimmune. Or if they are, it's at least a spectrum. Where in Western world, we just say, well, it's autoimmune, take the drugs, we'll cut out your colon one day, hope for the best you live with this. And it just doesn't have to be that way. That spectrum opens up a wide range of ability to start manage it. And so...
I had a question for you, it was really interesting, but as you went to the autoimmune side, I kind of answered my own question, but I'll leave it to the audience so they can hear this one anyways. Because oftentimes I talk about bacteria, particularly in the colon and other areas, as their neighborhoods, right? We had these microbiomes all over the place, your ears, nose, and mouth, in your intestines, in your organs, women have them vaginally, like they're everywhere. Now inside these microbiomes is always a competition for space. And there are some quote bad bacteria we often think of like Candida, which are normal parts
of our gut microbiome until they're overgrown, now they're problematic. But in a lot of these cases there are bacteria of course that police or can control and govern the growth of these other bacteria. And so sometimes we'll use specific probiotic strains like a really nice one that's been researched a bit that maybe you can speak on for SIBO, maybe it's condition dependent, would be like an L-Roydery or something else. Now I know Dr. William Davis talks about this a lot, they talk about the SIBO yogurt and bacteria combating each other. Can you
to that, whether or not it's been effective in your research, what probiotics may or may not be doing in a gut condition like SIBO.
Allison (22:54.446)Absolutely. This is a very frustrating area for most of us practitioners because what we see is that there is a plethora of excellent research showing that probiotics are fantastic for SIBO and the frustration is we are not able to achieve those same results. So I mean there are studies showing that all they do for SIBO is give probiotics and it
makes the test go negative, right? And I do not know a physician that's been able to achieve that, even with using the exact same formula that was in the study. So it's very frustrating. The other thing that's extremely frustrating is the intense individual spectrum of response to probiotics. So most SIBO practitioners that I know, there are a few outliers.
Josh (23:34.044)Hmm.
Allison (23:52.71)don't like to use probiotics in their SIBO patients because they get such terrible, terrible reactions. Now, basically what you have to do though, is I think, is you have to be brave and move, keep trying, move beyond the initial bad reaction from that probiotic and you have to keep trying different probiotics. A friend of mine, a colleague, likes to classify probiotics into three categories which I find helpful.
probiotic yeast, which is Saccharomyces pilaridae, your standard lactobacillus bifidus, so that's any lactobacillus bifidus strain, including streptococcal strains and such, and then your spore.
forming probiotics. So those are, you know, bacillus subtilis and all the others in products like Megaspore and prescriptocyst and such. So what he says is, you know, what most people do is just try a whole bunch of different lactobacillus herbifidus and never try the yeast or the spore. And maybe that's what they need and it can be, you know, the miracle. So you know, you mentioned the L-Ryuteri or Ruteri, you know, everybody says it different. I don't know which is the exact proper way.
Josh (24:57.254)tomato to Muda who knows
Allison (24:58.91)Yeah, exactly. That's an excellent one. Great studies at reducing hydrogen, reducing methane, helping constipation and diarrhea, right? So I think that'd be one of the first ones I would try for SIBO. I guess what I want to do is I just
I want to validate people's experience that try probiotics and really have a very bad response, including probiotics without prebiotics. Now we know prebiotics, these are short chain fibers that are beneficial in that they, for general use, because they feed probiotics, but they also feed, they're not supposed to feed bad bacteria when you look at the actual definition, but here in SIBO, we don't actually, it's not pathogenic bacteria.
overgrown, so they can ferment these prebiotics just as they ferment any other carbohydrate that comes in. And so that can aggravate symptoms. So that's the prebiotic story. However, some people with SIBO can tolerate prebiotics. And the issue with probiotics, most of them don't make gas themselves. They make acids, most of them. But those acids can then be turned into gases by other bacteria that are that are in the in the GI. So the story is nuanced and case
specific I believe, you know, so well what I've seen from my clinical practice. I very much like it when people will try probiotics. But if you've tried several different ones and several different from several different categories and it's not working, we just we just wait. We don't try to force the issue with anybody that's you know, because you know, there can be rigid beliefs here like the four Rs, you know, where you have to replace and replenish and do all these things. And I actually prefer trying probiotics.
Josh (26:38.481)Mm-hmm.
Allison (26:44.342)before even beginning to treat with antimicrobials. I wanna see how someone handles them because if they can handle them right then, I want them on board from the beginning.
Josh (26:53.564)It's interesting. Now, obviously I think we can conclusively say we don't recommend people go and just pop random grocery store probiotics hoping it will help. Interesting, hit me with it.
(01:46):
Allison (27:02.334)Well, I don't know. Um... Y-yeah, I mean...
Probiotics are, I mean, yes, we could say there's some that are better than others, absolutely, but I don't really see anything wrong with trying that. Because even if they're dead, even if you think they're poor quality and they're dead, there's the whole field of postbiotics, which is really a burgeoning field now, and I have some colleagues who are working in this field. Basically probiotics make many, many metabolites, and so even if they're heat killed and dead, you get the metabolites and they have many, many benefits.
Allison (27:37.116)to have many of the benefits. So I think it's fine for people to try whatever. I mean I can mention a few others that study well. Lactobacillus plantarum studies well. Bifidus infantis, the one that is sold as a line, studies very well for these types of conditions. So those are those are a few to think of.
Josh (27:55.436)That's really interesting. So you think of SIBO as like a small intestinal bacterial overgrowth. If I have this huge overgrowth of normal bacteria, right? Like again, like the bifidos and your different like lactose or acidophils, like the strains you find in the grocery store. If I have a surplus of these and that's causing my SIBO or my small intestinal bacterial overgrowth. Go ahead.
Allison (28:14.39)But here's the thing, that's not what's overgrown.
So what's overgrown we specifically know. So for hydrogen type SIBO we know it's E. coli. Now there's pathogenic E. coli and this is different. So because there's also probiotic strains of E. coli, many people don't know that. So it's E. coli, Klebsiella pneumonia and Klebsiella arimonis. These are what's overgrown for hydrogen SIBO. For methane SIBO which is now called Emo, what's overgrown is methanobrevi Bacter smithii or MSmithii. And then what's overgrown for hydrogen sulfide SIBO is
Fusobacterium varium and DeSulfo Vibrio. So this is what's overgrown. These are the culprits that are, these are now getting new names. You mentioned before how there's bacteria that can live in us and it's fine, but if it overgrows, it's bad. We generally put that in the category of opportunistic, you know, bacteria. So they're okay until they overgrow. So that's what these would be in the category of, but they're getting a new name now. It's been published, they're called disruptors because...
Josh (28:51.569)Mm.
Josh (29:13.22)I was hoping it would say gentrifiers, but keep going.
Allison (29:18.024)They disrupt the entire microbiome. The ratio gets thrown off and it's not good news. So this is considered a microbiome disorder. But I wanted to say one other thing that I didn't clarify.
And why the name got changed to Emo for methanogens, actually the methane type SIBO and the hydrogen sulfide type, the problem, it also overgrows in the large intestine. So the initial nomenclature, we've started to have to expand it. So for the hydrogen SIBO, that really is localized to the small intestine, the E. coli, clepsiella pneumonia, clepsiella arimonis. But the hydrogen sulfide and methanogen overgrow in the large intestine as well.
with the same exact result and disease, we'll just say.
Josh (30:05.052)Hmm.
really interesting. I know for some of our listeners a lot of this shop talk can be a little bit much to absorb the specific bacterial cultures and names so I'll put that aside just for them. I've learned so much already it's so interesting because SIBO all your intestines obviously they're connected it literally goes stomach to small to large and out like we all built the same but my experience in one area of intestinal disease is so vastly different than yours and there's such an incredible crossover I mean I see a lot
Allison (30:11.636)Yeah.
Josh (30:35.638)that you mentioned in inflammatory bowel disease. And oftentimes we'll do a stool test, we'll do a GI map and we can measure and we do some protocol and then they're taken care of and they've kind of rebalanced themselves. And it's so interesting to see how they affect different parts of the body differently. But we're dealing with these conditions. So we've sort of gone over how we get it, right? Where it comes about. It's clearly not preventable, which is kind of daunting and scary. It might just happen, who knows? Trying to get food poisoning. So what I've gotten here is don't
which will probably be fine. And so that's one way, Mexican street food, stuff like that. But so we've got that down. And so what are the next steps? If somebody comes in and they come to see, say you're back 10 years ago, you're still practicing. And they say, hey, I've tested positive for SIBO. I've got all these issues, I've got these symptoms. We know I've got the methane, I've got the hydrogen sulfides, I've got the things. What can I do next? What steps should I be taking besides probiotics as earlier discussed?
Allison (31:08.43)I'm gonna go get some water.
Josh (31:35.418)start correcting my gut bacteria if possible. Like what does that look like?
Allison (31:40.386)Right, so what we do is we use antimicrobials or antibacterials. That's the key thing. As our sort of, let me just give you the overview. You know, we've got three layers we can focus at. We can focus on symptoms. We can focus on the bacteria that are overgrown. And we can focus on the underlying cause. Generally, we often have to do a little bit of all of it. Like, you know, if somebody is really suffering, we might have to get right in there with some symptomatic relief while we're getting the tests and everything, you know? But once we know they have the overgrowth,
use antibacterials to bring those bacterial levels down. We haven't really found anything else that handles that perfectly, although those studies show that probiotics can. We just can't seem to replicate it very well.
(02:07):
But so within that category, there's three main tools we use. There's pharmaceutical antibiotics, there's herbal antibiotics, and then there's elemental diet. And that's basically liquid nutrients that are in pre-digested form. And the idea there is you drink this in place of all meals for two weeks, kinda like you would do antibiotics for two weeks. And it absorbs so quickly in the body that the bacteria don't have a chance to ferment it. The fermentation of carbohydrates
in SIBO. And so if they can't get their food then they starve and so then they would die by starvation with an elemental diet versus the pharmaceutical and herbal antibiotics. It's the more standard like targeting their cell wall or various ways that they kill them. So we use antibacterials and this is to you know to bring that bacterial overgrowth down into the more normal level.
And then what we do is, so like one thing is this step, because this is an overgrowth and not like a technically like an acute infection, it's a little different.
Allison (33:27.498)We have to keep treating until we get those bacterial levels down. And it often takes more than one round of treatment. So more than one two week course of something for herbal antibiotics, we typically do about four weeks. So it just can take more time. We have found it often around anywhere between two to four or maybe even five rounds. And just quickly, let me say, why isn't, we wouldn't just continue that, that antibacterial treatment we're doing longer. We, you can, and sometimes that works, but we've tried that in over and over.
Treatments just peter out after a little bit of time and they stop their effectiveness stops And then we have to just stop reevaluate and do another round of something So anyway after we do that after we do those rounds we get someone on a prokinetic and what a prokinetic is This can be either pharmaceutical or natural or herbal
they stimulate the migrating motor complex in the small intestine. And so we do that while we're assessing between the rounds to make sure, you know, how much is the gas lowered? How are the symptoms? Do we need to treat more? To hold the gains. And then once we have feel that we've gotten to our goal, and what is the goal? You know, for me, it's 90% symptomatic relief. That's that's what I think.
is true success. Often we can't get to 100% because there's an underlying cause there that has symptoms of its own. We have to evaluate that. Sometimes we do get to 100%, but I would I like to see 90%. Do I need a negative test? No. My goal is the symptomatic relief, but you know, we could also use a negative test. Once we have achieved that, then we also stay on the prokinetic and we do this because
it's very common for people to relapse, at least at first, at around two and a half, three months. And so we keep them on this to get them through that sort of vulnerable period. And let's find out what's gonna happen. You know, are you going to relapse or not? And let's see if we can extend that. Prokinetics have been studied and shown to extend a remission period in SIBO, like up to four times as long. So they're very effective at that.
Allison (35:34.034)And then if somebody does relapse, because we don't know, is somebody going to be chronic or not? And the rates on this are about, from studies, about one-third of cases are not chronic. So whatever it was that was wrong got corrected, is handled, we just needed to get that overgrowth down and they're fine. And they're never going to deal with it ever again unless they get, you know, another cause comes in. So a third of cases are, that's it, we get the bacteria down, they're good.
But two thirds of cases are chronic. And this lines up with the stats we see on IBS. And why would that be? The reason why is because there is a cause there. And so if somebody winds up relapsing, then we know we have to figure out what the underlying cause is if we don't already know. And I didn't mention a lot of different causes, but there are a lot of different causes that are currently incurable, that nobody actually knows how to actually fully get rid of.
talk about, like that we say incurable, that just means you don't have to ever think about it again, you don't, it's gone. But most of these situations can be very, very well managed, as you know from IBD. So even if somebody has something like that, we can manage it very, very well. But basically we have to figure out what the underlying cause is. There are also a lot of causes that can be gotten rid of, but they may not be easy to be to be gotten rid of, like mold illness. You know, obviously you can get rid of that in your house, but it can
You have to treat it in your body. Another one would be Lyme disease can cause SIBO. Not the easiest thing to treat, but it can be done, you know. Adhesions, they can be treated. There are manual techniques for treating adhesions, dissolving them even without, you know, going in and doing surgery, which can create more adhesions. So that's the situation. We want to get the bacteria down. We want to use a prokinetic. There's all sorts of adjunctive treatments we can use to support along the way. We talked about probiotics, prebiotics. There's all sorts of things we can do. Other things
Josh (37:17.116)course.
Allison (37:31.408)can do to boost up the body's defenses against SIBO. But in the end, that's the simple way of doing it. Do the prokinetic, and then if somebody relapses, see if we can not figure out what their cause is, and can that be dealt with? Because otherwise it's just gonna keep coming back.
Josh (37:46.392)So I'm going to ask a question that'll sound silly, so I'll preface. The question is, is SIBO a modern?
problem. The reason it's silly I know I've talked about on a previous podcast about Dr. Summowise right back in 1856 when we kind of discovered bacteria and hand-washing and all of that. For those listeners who don't know he worked in he basically observed two pediatric or like delivery wards with pregnant mothers delivering babies. One had doctors and one had midwives. It turns out the one with doctors was having five times the death rate of the other one and he discovered well they were also doing autopsies with those tools with those
hands without washing then touching you know moms and new babies and that's why they were dying and so that was 1856 so it's been a hundred and seventy some years we've just really known about this and so I guess my question would be is SIBO a modern problem in the sense where there's medical evidence leading back maybe hundreds of years we can say okay look like there's maybe a possibility that these people dealing with this could have been SIBO or is it like no
Josh (38:51.006)modern stress, all these things that are causing the problem.
Allison (38:54.378)I don't think it's modern at all. I think it's been around as long as humans have been around because we understand why it occurs. And these symptoms that we're talking about, like IBS, it's the most common GI disorder in the world, because really, because it's a conglomeration of symptoms, but we know SIBO is the primary underlying cause.
No, I mean, we know food poisoning causes it. That's been around forever, right? I mean, that used to, in fact, it used to kill the majority of people who had it. So maybe we're seeing more SIBO because more people are living after having food poisoning. It's still a terrible problem, terrible problem, especially for children in third world countries, food poisoning. But all of the other things that we know that can cause it have been around forever. I mean, for instance, diabetes, tumors, cancers,
Allison (39:44.608)you know, Parkinson's, these things have been around. Anything that can affect the nerves, muscles, et cetera, anything that could cause an obstruction. So infections, things like this, these things have been around forever. But keeping all that in mind, and by the way, we also have evidence in the medical literature going back. It just has new names and things like that. But also it affects animals, and in cows it's called bloat. It's just called bloat, right? So animals get SIBO too.
(02:28):
Josh (40:03.548)Mm.
Josh (40:10.524)Thanks for watching!
Allison (40:13.622)But I do think that the rates and incidences could have very well been.
gone up and one of the reasons could be because people travel so much now by plane as opposed to previous times where it was longer travel and we can quickly get to some place where we might get food poisoning and then we come back. And also another thing is so many people eat out, there's restaurants everywhere. It used to be you would just mostly eat from home. There weren't restaurants like five on every block. So this increases the incidence as well as other things that increase the incidence of food poisoning.
we have all the modern insults that I think make many chronic diseases more prevalent today, at least maybe in societies like the U.S. where we have increased stress.
I think it makes people more susceptible to all forms of this poor eating. You know, I think our gut health in general is very poor. You know, we have, you know, often we're not breastfed. Everybody's on a lot of antibiotics. There's PPIs. There's so many things that can affect the general terrain that makes it weaker and more susceptible, I think. And then also something, if we just look at something like mold illness,
can have increased simply by building practices of homes. What are the materials we're using, and how are we creating? Do we all have more homes now that are more susceptible to mold? And I think I've heard lectures that is so. So there's so many other conditions that can, I'm just briefly. So it's been around forever, but I do think we might make a case for it being more prevalent.
Josh (41:58.46)It's really interesting. I mean, I mean, there's a lot of debate. You mentioned things that have been around forever, like diabetes. There'd be a lot of, I mean, myself included up to this immediate conversation, which I'd love to, I mean, kind of dive into maybe another time, but to say, well, diabetes is a modern problem with all the modern sugars, all the modern grains, the weights, the white breads, the this and that. So, I mean, do we know for certain?
Allison (42:17.41)Well, maybe type 2, but not type 1, per se. Yeah.
Josh (42:19.864)Oh, yeah, if we're talking like autoimmune condition and stuff. Yeah, see, it's really interesting to kind of dive into and explore. And I wish so much, Allison. I wish I had a time machine. Now I would just go figure it out. I would get my wife and I talk about this all the time. Like, I go back to the Library of Alexandria. I would go back to these monumental moments in history. I just I want to know stuff. And I hope that when I die, God's like, yeah, here's a snap of a finger. Now, you know all this shit's in your brain. And that is how I will die.
Allison (42:30.992)So we can check it out.
Allison (42:35.278)I'm gonna go.
Josh (42:49.338)is from my head exploding from knowledge would be ideal. That's kind of like my way to go. So you mentioned this pro-kinetic stimulation a migrating motor complex so really it's a motility disorder combined with some autoimmune because your body's sort of attacking itself identifying if you have the food poisoning so it identifies
Allison (43:06.122)only if you have the food poisoning. Yeah, and also it's not a motility disorder if your cause is obstruction. So...
Josh (43:13.016)Right. So it's so call it a stagnation of some situation. Would that be fair? Okay. And so, so let's bring it back then. So we had the food poisoning, your body identified what you're producing similar to the bacteria it's attacking itself. Now you say that can sort of get under control. Now, is this something like a conventional autoimmune disorder where
Allison (43:17.278)Yes, for sure. Yes, that's fair.
Josh (43:34.86)if you get really stressed or you get really sick or something else happens that your immune system might go back out of whack and it can be trigger this, re trigger this disease process or this disorder.
Allison (43:44.726)That's interesting, like a flare.
Allison (43:49.638)I guess in a way one could sort of see a pattern of that in that there are periods of remission and period of relapse. However, I don't really think of it so much as being based on the autoimmunity. It's more in my mind.
there's already a lack of movement there. If we're talking about the food poisoning type where the migraine motor complex is inhibited, the prokinetic is doing its best to try to stimulate it as it's deficient, to try to bring it back to a proper level. You know, maybe it's not able to do that in everyone. And so there's just, over time, there's going to be, it's probably not, even with the prokinetic, functioning perfectly, so therefore, there will be a relapse at some point. And that is what we see for people who are chronic.
So is it really about the intensity of autoimmunity? I can't say that we know that. All I can say we know is that our lead researcher in this, Dr. Pimentel, has observed that people who... There's one prokinetic we use that actually has been shown to be able to regenerate nerves. And he's seen people, a couple of cases where they've been on that for say 10 years and they never got food poisoning again, because if you get it again, you're just sort of reinforcing the problem.
(02:49):
sort of basically the problem went away. So that's what I meant about that spectrum that you were talking about with autoimmunity where it might over time be able to go away. So that person would not then relapse again.
Josh (45:22.108)Interesting.
It's such a complex, deeply woven issue. I mean, obviously the intestines are arguably one of the more complex organs in the body next to the brain and the liver. The heart seems pretty straightforward. It's got some pumps, it's got this, it's got that. It changed electrolytes, you're done. But the intestines, they are so connected to everything. I often hear the idiom like we are what we eat, but we really are what we break down, digest, and absorb. And if we do that improperly or have a motility disorder or have some kind of autoimmune condition
some sort of disruption in this extraordinarily delicate ecosystem that really we know almost nothing about. It's one of these like the more we learn the less we know isn't it?
Allison (46:03.79)I think so. I find it incredibly complex. Sometimes the more I delve into it, the more I feel like this, this can be the problem. I hardly know what to do for someone except, you know, that's where, you know, we make charts and algorithms and things. Just look, don't get overwhelmed. Just follow these steps and you'll get some progress.
Josh (46:19.612)Sure. Ha ha ha.
I wish it was so step by step. I mean, yeah, there's definitely going to be these, like you said, some algorithms. Well, here's what we'll, you know, for 80% of the population, get them 50% better if they just follow steps one through six. And that's a great way of at least getting a start. You get your quality of life back. But I guess the question would then become what do we do if we get stuck? I mean, in colitis, for example, right, Crohn's a bit of a different story. It's kind of a mouth to anus inflammatory process that comes and goes.
Josh (46:52.166)I mean you really can't just cut out all your intestines you will die very quickly and so if someone feels stuck They've tried these different interventions or trying probiotics Like what are the steps that they can take or maybe what are some complicated? Situations you've seen in your practice where someone felt like they were stuck and was maybe a surprising Intervention that might have made some progress for them
Allison (47:12.826)is so fascinating because you know getting stuck there's so many different ways we could say how is someone getting stuck there's so many different things I could say here one thing there's so many so I guess the first thing I would say is there we you know so in our SIBO clinic what we did is we did before and after breath tests that's the main way we diagnosed SIBO
Josh (47:22.728)Let your brain just do what it does.
Allison (47:38.098)with every treatment we gave and by doing this over many years we found what works both herbally and pharmaceutically and so we have lists of these things and charts and such and I teach these in courses and all that and I give free classes too. By the way, if anyone wants these they can sign up for my newsletter It's SIBO. Go to SIBOinfo.com and if I have free classes, you'll know about them. So Yeah, so
Josh (48:02.101)We'll put that in the show notes for sure.
Allison (48:05.862)The first thing I think I would say is, have you actually tried all your options? Because this is probably the number one stumbling block I see. People who, their doctors may not know all these treatment options. They may not even know about elemental diet. They may, what if they're conventional and they only know about the pharmaceuticals, they haven't tried the herbals or the elemental? And so what we always say is have you tried all three treatment options, pharmaceutical antibiotics, herbal antibiotics, and elemental diet, and have you tried multiple options from the pharmaceutical and herbal options?
actually know your gas types. And this is a very important question because hydrogen sulfide is not easy to diagnose and we only have one test on the market that can test for it directly. And sometimes even that has issues. So these are things we, you know, there's always things you have to do first to make sure are you actually stuck? Like, because for somebody like myself, being stuck is something different than maybe who somebody's listening and they're just going to their primary care.
Now that being said, some things you can do would be to try anti-biofilm agents. Sometimes that really helps. With SIBO, we've tried them all. And there was really only one that we find that really makes a clinical difference, and that is ones containing bismuth.
And so there's a pharmaceutical combination formula from Dr. Paul Anderson. If anyone's interested, you can Google Dr. Anderson Bismuth Antibiofilm or Bismuthyle, you'll find that. And then he has an over-the-counter one. It's called, I always get these words backwards, like biofilm advanced phase two, or advanced biofilm phase two, something like that. So,
So you can try that. Some other things you could do is try working on the nervous system. Because sometimes what we find is that there's been sympathetic dominance physiologically in the body. So that's, you know, we think of sympathetic as fight or flight or freeze. But there's all sorts of things that can create that and even disease-wise. It's not just like, oh you're stressed or something.
Allison (50:04.546)And we need to get the nervous system sort of toned, exercised and working again, sort of turned back on. And so these could be things like brain retraining, like DNRS or the Gupta protocol. These could be vagal exercises. It could be gut centered hypnotherapy. So there's things like the Nerva app where you can find a gut centered hypnotherapist. Things like this, there's so many other heart math, I mean, you know, there's so many other things you could do to just try and make sure
has the ability to work as well as it can, because that is where the migraine motor complex is going to come from, and most of all, our digestive function. So there's that. Then there's things like...
Allison (50:50.862)There are alternative treatments. You know, like I mentioned, find out do you have adhesions? Because there's not just manual therapies, there's frequency-specific microcurrent, and there's neural therapy that can help dissolve adhesions, things like that. And then, you know, the other thing I would say, where myself and some of my colleagues who see some really advanced, difficult cases, often these are...
altered anatomy situations. So these are in which I know you see a lot of too. People who've had a lot of organs, intestinal organs removed and or tied together in strange ways because for whatever reason they needed to. But when you have, you know, large parts of the intestines missing, you know, then you might have short bowel syndrome or, you know, you have the colon resection, you have all these things like this.
(03:10):
That gets very hard to manage. It doesn't mean we can't manage it, but very often what has to happen there is these people need to be on rotating or continuous antibacterials. And so that's a place we go to when we're stuck. This is a small amount of cases, but you asked, right? So these are some of the hardest ones where, you know...
Josh (52:04.929)I did.
Allison (52:08.534)where there's resections and things like this and short bowel syndrome. So these are not gonna be taken care of by something that someone, they could, there are people who like, one of the herbal antibacterials we take, we use for SIBO is allicin, which is an extract from garlic.
There are some people with SIBO, they can honestly take a bunch of garlic cloves. Garlic as a food is one of the most common triggers for SIBO symptoms because it contains a lot of FOS and that feeds the bacteria. Not every... oh yeah, fructo-ologosaccharide. So it's a short chain fiber and it's
Josh (52:38.264)And so for our listeners, could you define FOS?
Josh (52:43.884)Just like a fermentable that can be eaten by the bacteria.
Allison (52:45.834)It's a carbohydrate. Yeah. And the bacteria will eat it. And then they, when they eat carbohydrates, they make gas. So, but then on, so there are people I talk to these, I have colleagues that, you know, they have a kind of a primary care practice. They they're not seeing these really advanced cases. They the person doesn't maybe have a lot of money at their disposal and they just eat a bunch of garlic and they're good to go. And it's like, they're handled and they actually really did have SIBO, you know, they were tested and then that's it. And uh,
So you've got somebody out and then they take some probiotics. It doesn't bother them. They eat the SED yogurt, which now Dr. Davis has his updated version of SED 24 hour yogurt. And they're healed. And then you have people who they've had surgeries and they're not made. They don't have the same anatomy as somebody else. And we have a totally different circumstance. Some garlic and some...
probiotics is not going to handle it. It doesn't mean we don't want to use those things, but what happens is we often.
things progress. Another thing would be like somebody with scleroderma. I've seen many cases like that. This is a progressive autoimmune disease that there's no cure for that is known now. Many people are working on this and I believe we will have it. But in essence, the intestine begins to sclerose or scar and then it cannot perform the contractions anymore. So you see, I'm trying to describe something. It's probably not what the average listener has, but in the beginning of this disease, it's much easier to manage. And some of those, some of the honestly
Some of those patients I've seen have less symptoms than other people. But it progresses. As it gets to that level, what can we do? Those people are on ongoing antibacterials.
Josh (54:29.488)interesting because I mean we look at ongoing antibiotics and or antibacterials of any kind really. Bacteria can develop resistances or if we're on them for a long period of time we can completely or further disrupt our microbiome which can further disrupt every aspect so how can we put somebody on antibacterial safely for an extended period of time?
Allison (54:38.848)Absolutely.
Allison (54:51.514)This is the question that just wrestles with the heart and soul of the physician. It's like, what else are we left with? Usually, some of my colleagues who see a lot of these cases, they really have tried so much else. Sometimes you have to do what you have to do.
Josh (55:13.42)I guess that really is... Sure.
Allison (55:14.634)You can give protection. You can, there's, when you understand what's going on, you can give as much protection as you can think to give in all sorts of ways. But no, it's not ideal, but then again, neither is the person's anatomy. You know, when it's been surgically altered. Because it had to be, yeah.
Josh (55:27.853)Bye.
kind of working with what you've got. Yeah, I guess that really is kind of just the punctuation on today's entire conversation, isn't it? It's like, well.
Sometimes we can and sometimes we can't. It's just not as ideal. I know we like to find something that's conclusive but the reality is with gut health as a whole like it is so ongoing and we are just scratching the surface of the complexities of it and the microbiomes and how they work and why they work and you know We know some bacteria produce certain things. We know some produce others, but we don't have a clue about a lot of different bacteria I mean we look at what one to two thousand species seven to nine thousand strains You can multiply it up to say there's about 18
million different varieties of these bacteria making up pounds and pounds inside your gut like it's just this fascinating thing that I think one day it the complexities are gonna be so vast it's almost too much for one brain like one human physician right like one practitioner how could you look at a GI map 50 years from now we've got 50,000 different check boxes to go through and say yep we have these 18 million bacteria here's exactly the genus and
Allison (56:22.65)Oh, I'm so with you. I am so with you.
(03:31):
Josh (56:38.974)here's a treatment. No, like it's gonna have to be run by AI who does poop tests one day. Like it's crazy. Some of it's scary, but yeah, I hear ya.
Allison (56:43.93)I'm kind of excited about AI coming in for some of this. Yeah. You know, and one thing is that as you keep mentioning bacteria and really microbiome issues, it's never going to be bad. It's always going to be good to work on the microbiome in general, you know, when somebody has SIBO. It's just sometimes we can't do all the things we want to do at first because the person's too reactive.
You know, and some other things, I guess I just want to say one other thing about that getting stuck question. What really gets a lot of people stuck is if they have, if they're very, very sensitive, meaning they can't actually take the treatments for SIBO, the antibacterials or really anything. And so I don't, you've probably seen a lot of these people, they just about anything you give them, they react.
Yeah, and it could be a histamine reaction. So the key things there to think about are, you know, and that's where we really run into trouble with probiotics, by the way, is because of the people who are either MCAS or have histamine intolerance, and then they can't take any probiotics.
So the thing there is to look at MCAS and to look at mold. And if you can deal with that, that usually gets the sensitivity down so that you can get in there with some treatment. And then maybe we can start focusing on our microbiome treatments, because there are some people you just really can't give them anything orally.
Josh (58:03.864)It's really interesting. I know this is such a conversation that I mean, you do lectures on, you do entire symposiums and weekend courses and all kinds of stuff just on SIBO. So I know it's really damn near impossible to kind of wrap up and summarize in a one hour conversation. So I want to open the door for you, Allison, just as we're kind of coming to the end of our time here, is there anything you'd like to say to our listeners that maybe we haven't said yet? Um, and then of course, after that, where they can find you.
Allison (58:31.366)Yes, because we've talked about some very advanced and complex topics, but it doesn't need to be that advanced or complex for most people. We find that the quality of life of people with SIBO can be pretty easily quickly impacted for the positive by simply, so long as you know you have SIBO and you know what type you have, doing the treatment for your type of gas, meaning the antibacterial, an antibacterial for the type, just do that and lo and behold, and then get
on a prokinetic, which we haven't talked about what they are yet, but, and I know we're at the end, but that takes care of so many people's suffering, you know? And yeah, so naturally that would be ginger root. And then we have many, many brands and supplement companies that now make ginger containing prokinetic formula. So for instance, Motility Pro or Motility Activator are some examples.
Josh (59:12.316)Can you give us some examples of prokinetics?
Allison (59:28.83)And then ibirogast, which is harder and harder to get now, but is available on Amazon. It's been around forever and it's like a nine herb combination. It's been studied head to head against pharmaceutical prokinetics and shown to have a prokinetic effect. So ibirogast and then the, the really, some really good prescription ones to consider would be procalipride. In the U S that sold as Motegrity. It's safe. Many prokinetics are not safe. This is a safe prokinetic, very effective. And also LDN, which you use all the time in IBD.
It's not a prokinetic, but it has a prokinetic effect in many people. So those are some options. And you know, for the antibacterials, you know, these are things like I mentioned allicin, oregano, berberine. We need the allicin for methane. We need high dose oregano or bismuth for hydrogen sulfide. You have to know which one you're treating. And pharmaceuticals are different for gas. But basically, I don't want to make it sound so complicated. You get in there with the right antibacterial for your gas type.
hold. Like your food tolerance is just expand because now the bacteria level is down. They're not fermenting everything you eat into gas and the gas creates all the symptoms. So and then you get on a prokinetic and let's hope you don't relapse. So there you go!
Josh (01:00:42.468)That's a summary. I love that. So if someone wants to learn more about SIBO, it's so clearly very specialized and so nuanced. I know you mentioned you have some courses. Of course you got a website where can people learn more about you and find your information.
Allison (01:00:56.802)Yeah, just cboinfo.com.
Josh (01:00:59.524)That's as easy as it gets. I'll never forget that. It's eight letters. That's great. Well, Alison, it's been an absolute delight. Thank you so much for being here and coming on and sharing all of the things that you have to share. It's just really fascinating. SIBO as a condition by itself and something I'm still will continually be learning about as I'm sure we all are as the time goes on. So, for myself, on behalf of our listeners, thank you so much for your time today. It's been an absolute pleasure. So I just press that recording.
Allison (01:01:00.938)There it is.
Allison (01:01:21.91)Thank you so much for having me.
Josh (00:07.972)Hi. A pleasure. I know we got connected through a few people. You've been so highly recommended to me. I'm like, we're gonna have her on the show. We gotta hear from Alison.
(00:01):
Allison (00:20.344)I don't know anything about you, but I'm happy to meet you. You're doing... do you want to tell me anything?
Josh (00:23.74)Well, thank you. Not really, no, I'm just a guy who loves gut health and is very passionate about it. I specialize in Crohn's and colitis. And so I've been, it's specifically the work I've actually been doing on the holistic functional side for Crohn's and colitis. It actually got me here with all these amazing doctors and sort of got me in touch with all these people. So it's been a ride, yeah.
Allison (00:30.006)Right on.
Allison (00:43.751)Are you a practitioner yourself?
Josh (00:45.616)I'm a nutritionist, a holistic nutritionist. And yeah, so I'm kind of getting into that world. I'm not a functional medicine practitioner on paper, but I love the functional medicine, the concepts and how it works. And I mean, we're reversing inflammatory bowel disease left, right and center like it's never been done before. And so it's just been an amazing, amazing ride. It's the most fulfilling work I've ever done, so.
Allison (00:47.658)Perfect! Yup, yes you are!
Allison (01:08.694)Wow, are you, like I came into the SIBO world from breaking the vicious psycho was probably the way I got in, to that world which is, you know, SED diet. So, you know, we know they had phenomenal results, particularly with pediatric. Is that sort of some of the stuff you get into?
Josh (01:25.464)Well, I look at food. I'm big on GI mapping. I know a lot of people in the functional space don't love it because it's not as conclusive. It's not comprehensive. We've got millions of different varieties. We can see like 50, but it's such a cornerstone in what we do. I use a lot of food in the way of, you know, bacterial profiling and stuff. So I recommend according to the profile and what they can tolerate and all of that. But a lot of it is supplementation. I do work with some doctors on an integrative medicine approach as well. So when I get Crohn's patients who are really severe, like truly autoimmune,
inflammatory bowel is autoimmune and I'm actually teaching on that here coming up soon. So I'll work integrative with like LDN and some other things peptide therapy and all that so it's a pretty cool ride.
Allison (02:05.374)I'm really glad to know about this. I have a couple of my colleagues who are really into IBD. And so I might want to connect you and them, you know? Naturopathics, it'd be Dr. Alana Gerovich and Dr. Steven Sandberg Lewis. I'll just mention their names now so I can think of it, you know?
Josh (02:09.514)Oh.
Josh (02:12.952)Yeah, I'd love to. For sure.
Josh (02:20.548)Yeah, perfect. And I already pressed the record button, so I'll have it on if I forget who they are. That's perfect.
Allison (02:23.626)We'll have it. So, Duncan Samperg Lewis is the, and I know we gotta start here, but he's the naturopathic gastroenterology professor who has taught all of the naturopaths. Like he's going to retire soon, you know, so he's been in practice for 50 some odd years and yeah. And so he'd be a fun person to talk to.
Josh (02:28.7)Oh, that's fine, I got time. I give a buffer.
Josh (02:35.184)Hmm. He's the guy.
Josh (02:43.396)No kidding, I appreciate that, thank you, yeah. I'm really looking forward to this. Well, how much time do you have? I always leave a buffer before and after for tech issues, for chit chat, for all kinds.
Allison (02:53.226)Yeah, I can go over a little bit past an hour if we need to.
Josh (02:56.6)Yeah, well, we'll see where it goes. If it goes over, I do have a 30 minute buffer. So if we need a chit chat, or if you need anything from me and there's anything I can do, tech issues, we're grand, but you sound great, which is nice. Yeah, so I think you've probably done one of the, two of these before I've looked you up. Ha ha ha.
Allison (03:06.37)Good.
Allison (03:09.918)Yeah, I sure have. I use a Yeti microphone and it's been giving me trouble. And I recently asked someone what to do and they're like, Yetis are horrible. And I'm like, I've done all my padcasts, all my courses with a Yeti and it's been just fine.
(00:22):
Josh (03:25.02)You sound fine. Are you familiar with the interface of the Yeti? Like, I mean, some people will turn up their game and not know what cranked up. Like, little things like that. Yeah. You sound great. We're not worried about it. So yeah, you're good. If you ever lose anything, future, fun little tidbit for you. I found a fella on Upwork.
Allison (03:32.535)Yeah, right.
Okay, good.
Josh (03:43.328)I pay him like 30 bucks. So some of my audio was some of my, I had Dr. Leo Galland on a couple, two, three months ago, but his microphone, it sounded like a bad Bluetooth speaker in a car, like when you're taking a phone call. And so it was really choppy, un-listenable. I found a sound clip on audio. I gave it to a guy for like 30 bucks. He threw it through an AI system, or re-replicated the entire conversation and his voice was perfect. It's unnerving.
Allison (04:06.572)No way. Okay, I wish I had that because as my microphone was going bad, I was recording a new course and I had corrupted audio and I had to re-record and re-record. I wish I'd had that. Ha ha ha.
Josh (04:15.99)Mm.
Josh (04:19.872)Upwork, any of these guys who do like AI voiceover work, they can replicate your stuff, they have the software. And it's staggering. There's actually been some stories of people who have done like fake ransom calls, who like took their daughter's voice off Instagram, replicated it, faked a ransom call to make money and scam the parents when this girl was at school perfectly fine. Yeah. It's scary.
Allison (04:44.086)Whoa, I'm gonna go tell my sound editing guy all about this because I don't think he knows. Ha ha ha.
Josh (04:47.864)Well, perfect. All right. So you got your look at this. We're on the right track already. We're both learning stuff. Well, Allison, I had just a quick intro that I pulled from your website, some little bits. We'll kind of just dive in. I always rerecord the intros after the conversation. So I redo my podcast intros. But it will sort of give us a kickoff just to kind of launch the conversation from and go from there. Any questions for me before we get started?
Allison (05:10.566)No, I don't remember. Well, yes. I don't remember what we said we were gonna talk about, but I assume it's just we're covering all the high points of SIBO.
Josh (05:13.097)Hehehehehehe
Josh (05:19.856)Basically, yeah, I mean, it's such a, we'll say a trendy topic that so few people truly understand. Well, I maybe have C, but I'm like, do you know? How have you tested? What have you done? What's, well, I'm bloated. I'm like, okay, perfect. Like that's...
Allison (05:32.398)Perfect.
Josh (05:33.016)you could, yeah, you're taking antacids, of course you're bloated. So anyway, there's lots to dive into, but I'd love to go through SIBO, how to define it, what it is, testing, how to know if we have it, what to do about it, kind of the basics that you've run through 100,000 times. And yeah, I know it's your specialty and so we'd love to hear about it.
Allison (05:46.73)I figure, yeah. I love it.
Josh (05:51.8)Cool, cool. I'll just I'll rip off this intro really quick and we'll just dive right in then. Perfect. So today's guest is a SIBO specialist and naturopathic doctor with a Masters in Oriental Medicine, who's been in the nutritional field since 1988. Allison, since before I've been alive, mind you. So we trust your opinion today. She is the co-founder and former medical director of the SIBO Center for Digestive Health at the NUNM clinic. And she's also won the 2021 Gastro A&P Lifetime Achievement Award.
pleasure to have you here. Did I pronounce that right, Seibacher? Seabacher. That's okay because we're gonna rerecord that anyway and snip it. I'll be like Allison Seabacher, you'll be like thank you for being here. I'll sound like I know things which will be great. So Allison you are the who's who in Sebo. A lifetime achievement award is no small thing. Now the introduction kind of just doesn't do a ton of justice. Can you tell us a bit more about who you are and what you do?
Allison (06:23.746)So happy to be here with you.
It's C. Becker, but I really don't care.
Allison (06:36.022)Hehehehe
Allison (06:51.182)Sure, yeah. I guess I should start by saying I'm a SIBO patient myself. So I'm a doctor, but I also have the condition. But I didn't know that till so much later. Like so many people, I had what was generally called IBS. Didn't even really realize that till much later. So when I finally found out about this, and when I found out all the ins and outs and things that could work, it just lit me on fire. So obviously I'm a doctor. I had a general practice, but I...
(00:43):
switched it to focus on this because I was so passionate about the topic. And I've mostly done education, really a strong focus on education. I had a clinical practice in SIBO for many years. I'm currently not seeing patients because I mostly just do so much education, really. So I started the first SIBO conference or SIBO symposium ever on SIBO, created the first SIBO clinic, you know, that only focused on that, et cetera, et cetera, really just trying to.
kind of do a campaign of raising awareness. And the reason why is because, you know, the big exciting, cut right to the chase here, the big exciting thing with SIBO is that it's been discovered in recent years, in the last, you know, 10 or so years that, which is not that long, that it is the number one underlying cause for IBS. There are other causes, of course, but the majority are thought to be SIBO. So it can help, you know, with one swath, it can help so many people knowing about this.
Josh (08:17.532)Hmm.
So SIBO is a term that we're seeing floating around the internet more and more. Right? And that's one of the beautiful things about gut health and SIBO and all these things, the importance of gut health, they're becoming more mainstream. So people are becoming aware. But the problem with mainstream in healthcare, really anything, is that it's like a game of telephone. Right? What started out as I want a banana sandwich turns into grandma fell off her brand new hammock. And everyone's like, what are we talking about? So can you tell us with the
Allison (08:49.058)Absolutely. Okay, so it has been actually redefined in recent years as a clinical syndrome, meaning that there's two things you need to have to say you have SIBO. You need to have proof of bacterial or microorganism overgrowth in the small intestine. So therefore you need some sort of diagnostic test to prove that. And then you need to have the corresponding symptoms.
So if you have one, like if you show positive on a test, but you have no gastrointestinal symptoms, that's not of concern. You need to actually clinically be experiencing trouble. But then on the flip side, if you have the symptoms, so what are the symptoms? They're the same symptoms as about 40 other conditions. So, right? So yeah, right. So what are these symptoms? It's the classic IBS, meaning irritable bowel syndromes. It's abdominal bloating or.
Josh (09:35.984)That's easy. That's easy to decipher. Sure.
Allison (09:42.858)so that's distension or swelling of the abdomen after food. And then it's constipation or diarrhea or combination of the two and then abdominal pain or discomfort. Those are the core symptoms. You can also have things like excessive gas leaving the body so excessive flatulence or burping. There could be nausea, there could be food sitting and not going down, there could be acid reflux. So a variety of symptoms as well as it can impact mood.
predominantly anxiety more so than depression. It can create anxiety. And the key thing is all of these symptoms, particularly the digestive ones, come after eating. So that is a keynote there. And bloating is probably. You know, for some people it's immediate, which can be confusing to understand, physiologically and medically. For most people it's anywhere from about an hour, hour and a half coming into the three plus hour range. So the classic scenario for SIBO,
Josh (10:22.816)How long after eating is that, Allison?
Allison (10:40.59)is you might feel better in the morning. Some people don't, nothing ever changes for them, they just have bad symptoms around the clock. But many people feel better in the morning and then as they eat their meals throughout the day, the symptoms get worse and worse. Just for example, the bloating gets worse and worse and worse and so maybe they started with a relatively flat stomach or belly area in the morning and then by the evening, they look like they're nine months pregnant, you know, no matter the...
biological gender there. So, so, um, so back to this definition, the, you know, you do need to have some of these symptoms as well as the test, but why the test is important is because those symptoms can occur with a myriad of other conditions. And so they're not, they're called non-specific symptoms. It doesn't, it's not specific to SIBO. So we have to have both to figure out if this is what's going on. Oh, and actually, I'm sorry, there's one other thing I should say on this definition.
Josh (11:33.334)So...
Allison (11:36.886)The definition's been expanded recently because there are these three different gas types and we just used to call them that exist in SIBO. We used to call it SIBO hydrogen, SIBO methane, SIBO hydrogen sulfide, and they link with bowel movement symptoms and we can discuss that later. But now the methane SIBO has been given a new name and it's not actually considered under the heading of SIBO anymore, although I still speak like it is because for so long it was it's hard to change my language.
Josh (12:04.609)Mm-hmm. Sure.
Allison (12:06.058)So that's called intestinal methanogen overgrowth or EMO.
Josh (12:10.721)So it's interesting. So your average user who might be coming and going, I've heard of SIBO, maybe I have it, maybe I don't. The only way to really know that would be to see someone like yourself or a SIBO specialized practitioner to go in, assess the symptoms, do either the breath testing or whatever other testing, stool testing, whatever you do, and then you get this diagnosis. Is that right?
Allison (12:31.462)Yes, I will say we have hope for something, a different scenario, which is that, um, because just recently the I, the international diagnostic code agency, um, has given diagnostic codes for SIBA, which this is new. So ICD-10 codes. So we can see now it's getting, it's pretty hard for somebody to say, um, like a primary care practitioner to say, uh, it doesn't exist or it's not real when it actually has ICD-10 codes now. So because there has been
a lack of education for non-specialists. But one would hope that will change and there is a screening blood test that can be done. And so one would hope that primary care practitioners, when they hear you have these symptoms, they would run this screening blood test, let's hope insurance would cover it. And then if it's positive, if it's negative, it doesn't help you much. But if it's positive, it lets you know that SIBO is what you have. And it lets you know you have it from food poisoning, which is very interesting. So.
I think you're right currently that that's where the state we're in and I sure hope we can make continued progress on this.
Josh (13:36.792)Yeah, you know, it's interesting because so we've kind of established it can be identified. That's one big thing. Okay, so now we actually have this code, the ICD-10 code, which will legitimize it, like you said. So there are a lot of things that haven't had codes and insurance and said, nope, it doesn't exist. Therefore, we're not covering it's not been on paper. So now it's like it's a real thing. We're actually recognizing it. So.
(01:04):
If I was a mechanic, for example, right? I could go and fix a car because I understand how the car works. I understand what may have broken it down. I can go and figure out what steps to take. But before we can really understand how to fix anything, especially in the body, we have to know, one, why it got there, two, how it works. Can you walk us through how people end up with a SIBO condition?
Allison (14:18.422)Absolutely, and I absolutely love your analogy. That's the best. Because this is the way I like to talk about it. I like to separate causes into two levels, the physiologic underlying causes, meaning what's wrong in the body that allowed this situation to occur, and then all the risk factors, which is what most people will call the underlying causes, basically the diseases or injuries or things that could lead to that body problem. So what is wrong in the body is usually a lack of or a deficiency of
Josh (14:21.96)Thank you.
Allison (14:47.534)the migrating motor complex in the small intestine. And this is a sort of a form of peristalsis. Most people are familiar with that. It's the movement when we've eaten food and it churns and mixes and moves the food down along the GI tract. Well, this happens not with food. It happens when we, in between meals, when we're fasting. And it's called the housekeeper wave. And its function is to clean up after we've eaten.
And that includes sweeping any bacteria that's in the small intestine, sweeping it down and out into the large intestine. And that's really the body's number one protection against getting bacterial overgrowth in the small intestine because it's like a current of a river that's constantly flowing down. So it would be hard, if you imagine a flowing river, it's hard for there to be a bacterial accumulation there. But if you imagine a stagnant river, that becomes a swamp, right? So that's the best analogy.
Josh (15:39.28)Filthy.
Allison (15:42.606)So that can get impacted by so many things, so many diseases. Basically this migrating motor complex functions from both nerves and muscles. So anything that could damage the nerves that are needed to send these signals or the muscles can make a deficiency. And then there's one other main physiologic underlying cause which would be some sort of obstruction in the small intestine, like a partial obstruction. I say partial because a full obstruction is
a full-on emergency, but you can walk around living with a partial obstruction. You know this from your work with IBD, of course. Strictures would be a partial obstruction. So anything that narrows the intestine tube or blocks it like a tumor or what is most common is really adhesions. So these are like scar bands, which of course can happen with IBD, in the abdominal area that in some way are pressing or constricting against the loops of the small bowel and,
making a narrowed area. So what happens then if there's a narrow area of the small intestine when the migraine motor complex tries to sweep things out they back up behind that narrow area and that and that would be SIBO and adhesions are extremely common and people can get them. Surgery is probably a you know a universal way people can get them but um injuries and you know sports accidents a fall off a bike you know a car accident there's so many ways we can get them from.
It's a common and not well known about cause.
Josh (17:14.33)Hmm.
Yeah, I think most of us would assume, well, I, you know, maybe ingested something or my gut's highly inflamed or I have a mold infection or something that came in to mutate my bacteria or change it in a certain way. Maybe it was antibiotic usage that allowed these opportunistic bacteria to overgrow. Something must have happened. Now you mentioned a lot of these things like this migrating motor deficiency. You mentioned things that can cause strictures or injury. Is there something that your average person is really acquiring SIBO from that could be completely preventable?
Allison (17:46.89)What an interesting question, preventable completely.
Allison (17:53.89)I have to run through all of the things that cause SIBO.
Josh (17:56.948)So many, I know I see the Rolodex going in your head. I mean preventable in the same way. Well, it's like, you know, I will do this thing and I will get SIBO. If I ingest 50 pounds of probiotics a day and then punch myself in the gut, I'm probably gonna get SIBO, right? So.
Allison (18:12.166)I can't, I have to be honest, I can't, this is a negative answer. I can't think of anything that's completely preventable that causes SIBO, which actually helps to explain why it's so common. Because if we could 100% say, if I just don't do this, I won't get SIBO. So the most common cause of SIBO statistically from studies is food poisoning. And you know...
we all want to avoid food poisoning and we all want to prevent that, but that's not necessarily always in our, our ability to prevent. So just for example, you know, I love the things you mentioned earlier, you mentioned you imagine all these things coming in and really what they're doing is they're changing the bacteria. I think that's what most people think of would happen with SIBO. And that's it's really not the case. Something comes in that changes your nerves or your muscles or causes an obstruction.
Josh (18:37.729)Mm-hmm.
Allison (19:04.234)So it's not really about the bacteria because what we find is that the bacteria that are overgrown are already there. And then what happens is we actually know which bacteria finally, it's been incredible research that's been done. We know which bacteria are the main overgrown culprits in each of the types of SIBO or EMO. And they were mostly, they're really already there, but they do cause a terrible microbiome disturbance. So we do know that.
But let me just explain the food poisoning, for example. So food poisoning, and here I mean bacterial food poisoning because there's also viral food poisoning and that is not currently linked to SIBO, which is why only about 10% of food poisoning cases are thought to go into and turn into SIBO because so many of them are actually viral. But if it's bacterial food poisoning, all of the bacteria that cause that actually have the same toxin in common. They all secrete the same toxin. That toxin is called cytolethyldistending toxin.
that toxin looks very similar to a protein on the body's small intestine nerves. And so it's an autoimmune process. So basically through friendly fire, the immune system comes to attack this poison, this toxin, and from the bacteria, and it attacks the small intestine nerves at the same time. And then it damages our own nerves, and then past a certain threshold, the body's not able to make or create that migrating motor complex.
(01:25):
And so here what goes on is the initial food poisoning comes in, but that triggers an autoimmune response. So it's not the actual acute food poisoning. It's if the body gets triggered to do this autoimmune response. And so we often see after food poisoning, it could be up to three or even six months after the food poisoning that the person develops the SIBO. And now it's an ongoing autoimmune issue. It's not the same as, you know, Dr. Pimentel, our lead researcher in this, says,
It's not the same as lupus. Like he has seen many people, it reverse. It's not that intense, but it is an autoimmune situation. And so they are working desperately right now for a solution for that.
Josh (21:14.052)that's fascinating because you know it's such a unique branch of gut health research and you know there's a lot of a lot of things that are called autoimmune or not called autoimmune that are or some that I think I mentioned earlier
I don't know if we were recording at the time, but I don't believe all cases of IBD are autoimmune. Or if they are, it's at least a spectrum. Where in Western world, we just say, well, it's autoimmune, take the drugs, we'll cut out your colon one day, hope for the best you live with this. And it just doesn't have to be that way. That spectrum opens up a wide range of ability to start manage it. And so...
I had a question for you, it was really interesting, but as you went to the autoimmune side, I kind of answered my own question, but I'll leave it to the audience so they can hear this one anyways. Because oftentimes I talk about bacteria, particularly in the colon and other areas, as their neighborhoods, right? We had these microbiomes all over the place, your ears, nose, and mouth, in your intestines, in your organs, women have them vaginally, like they're everywhere. Now inside these microbiomes is always a competition for space. And there are some quote bad bacteria we often think of like Candida, which are normal parts
of our gut microbiome until they're overgrown, now they're problematic. But in a lot of these cases there are bacteria of course that police or can control and govern the growth of these other bacteria. And so sometimes we'll use specific probiotic strains like a really nice one that's been researched a bit that maybe you can speak on for SIBO, maybe it's condition dependent, would be like an L-Roydery or something else. Now I know Dr. William Davis talks about this a lot, they talk about the SIBO yogurt and bacteria combating each other. Can you
to that, whether or not it's been effective in your research, what probiotics may or may not be doing in a gut condition like SIBO.
Allison (22:54.446)Absolutely. This is a very frustrating area for most of us practitioners because what we see is that there is a plethora of excellent research showing that probiotics are fantastic for SIBO and the frustration is we are not able to achieve those same results. So I mean there are studies showing that all they do for SIBO is give probiotics and it
makes the test go negative, right? And I do not know a physician that's been able to achieve that, even with using the exact same formula that was in the study. So it's very frustrating. The other thing that's extremely frustrating is the intense individual spectrum of response to probiotics. So most SIBO practitioners that I know, there are a few outliers.
Josh (23:34.044)Hmm.
Allison (23:52.71)don't like to use probiotics in their SIBO patients because they get such terrible, terrible reactions. Now, basically what you have to do though, is I think, is you have to be brave and move, keep trying, move beyond the initial bad reaction from that probiotic and you have to keep trying different probiotics. A friend of mine, a colleague, likes to classify probiotics into three categories which I find helpful.
probiotic yeast, which is Saccharomyces pilaridae, your standard lactobacillus bifidus, so that's any lactobacillus bifidus strain, including streptococcal strains and such, and then your spore.
forming probiotics. So those are, you know, bacillus subtilis and all the others in products like Megaspore and prescriptocyst and such. So what he says is, you know, what most people do is just try a whole bunch of different lactobacillus herbifidus and never try the yeast or the spore. And maybe that's what they need and it can be, you know, the miracle. So you know, you mentioned the L-Ryuteri or Ruteri, you know, everybody says it different. I don't know which is the exact proper way.
Josh (24:57.254)tomato to Muda who knows
Allison (24:58.91)Yeah, exactly. That's an excellent one. Great studies at reducing hydrogen, reducing methane, helping constipation and diarrhea, right? So I think that'd be one of the first ones I would try for SIBO. I guess what I want to do is I just
I want to validate people's experience that try probiotics and really have a very bad response, including probiotics without prebiotics. Now we know prebiotics, these are short chain fibers that are beneficial in that they, for general use, because they feed probiotics, but they also feed, they're not supposed to feed bad bacteria when you look at the actual definition, but here in SIBO, we don't actually, it's not pathogenic bacteria.
overgrown, so they can ferment these prebiotics just as they ferment any other carbohydrate that comes in. And so that can aggravate symptoms. So that's the prebiotic story. However, some people with SIBO can tolerate prebiotics. And the issue with probiotics, most of them don't make gas themselves. They make acids, most of them. But those acids can then be turned into gases by other bacteria that are that are in the in the GI. So the story is nuanced and case
specific I believe, you know, so well what I've seen from my clinical practice. I very much like it when people will try probiotics. But if you've tried several different ones and several different from several different categories and it's not working, we just we just wait. We don't try to force the issue with anybody that's you know, because you know, there can be rigid beliefs here like the four Rs, you know, where you have to replace and replenish and do all these things. And I actually prefer trying probiotics.
Josh (26:38.481)Mm-hmm.
Allison (26:44.342)before even beginning to treat with antimicrobials. I wanna see how someone handles them because if they can handle them right then, I want them on board from the beginning.
Josh (26:53.564)It's interesting. Now, obviously I think we can conclusively say we don't recommend people go and just pop random grocery store probiotics hoping it will help. Interesting, hit me with it.
(01:46):
Allison (27:02.334)Well, I don't know. Um... Y-yeah, I mean...
Probiotics are, I mean, yes, we could say there's some that are better than others, absolutely, but I don't really see anything wrong with trying that. Because even if they're dead, even if you think they're poor quality and they're dead, there's the whole field of postbiotics, which is really a burgeoning field now, and I have some colleagues who are working in this field. Basically probiotics make many, many metabolites, and so even if they're heat killed and dead, you get the metabolites and they have many, many benefits.
Allison (27:37.116)to have many of the benefits. So I think it's fine for people to try whatever. I mean I can mention a few others that study well. Lactobacillus plantarum studies well. Bifidus infantis, the one that is sold as a line, studies very well for these types of conditions. So those are those are a few to think of.
Josh (27:55.436)That's really interesting. So you think of SIBO as like a small intestinal bacterial overgrowth. If I have this huge overgrowth of normal bacteria, right? Like again, like the bifidos and your different like lactose or acidophils, like the strains you find in the grocery store. If I have a surplus of these and that's causing my SIBO or my small intestinal bacterial overgrowth. Go ahead.
Allison (28:14.39)But here's the thing, that's not what's overgrown.
So what's overgrown we specifically know. So for hydrogen type SIBO we know it's E. coli. Now there's pathogenic E. coli and this is different. So because there's also probiotic strains of E. coli, many people don't know that. So it's E. coli, Klebsiella pneumonia and Klebsiella arimonis. These are what's overgrown for hydrogen SIBO. For methane SIBO which is now called Emo, what's overgrown is methanobrevi Bacter smithii or MSmithii. And then what's overgrown for hydrogen sulfide SIBO is
Fusobacterium varium and DeSulfo Vibrio. So this is what's overgrown. These are the culprits that are, these are now getting new names. You mentioned before how there's bacteria that can live in us and it's fine, but if it overgrows, it's bad. We generally put that in the category of opportunistic, you know, bacteria. So they're okay until they overgrow. So that's what these would be in the category of, but they're getting a new name now. It's been published, they're called disruptors because...
Josh (28:51.569)Mm.
Josh (29:13.22)I was hoping it would say gentrifiers, but keep going.
Allison (29:18.024)They disrupt the entire microbiome. The ratio gets thrown off and it's not good news. So this is considered a microbiome disorder. But I wanted to say one other thing that I didn't clarify.
And why the name got changed to Emo for methanogens, actually the methane type SIBO and the hydrogen sulfide type, the problem, it also overgrows in the large intestine. So the initial nomenclature, we've started to have to expand it. So for the hydrogen SIBO, that really is localized to the small intestine, the E. coli, clepsiella pneumonia, clepsiella arimonis. But the hydrogen sulfide and methanogen overgrow in the large intestine as well.
with the same exact result and disease, we'll just say.
Josh (30:05.052)Hmm.
really interesting. I know for some of our listeners a lot of this shop talk can be a little bit much to absorb the specific bacterial cultures and names so I'll put that aside just for them. I've learned so much already it's so interesting because SIBO all your intestines obviously they're connected it literally goes stomach to small to large and out like we all built the same but my experience in one area of intestinal disease is so vastly different than yours and there's such an incredible crossover I mean I see a lot
Allison (30:11.636)Yeah.
Josh (30:35.638)that you mentioned in inflammatory bowel disease. And oftentimes we'll do a stool test, we'll do a GI map and we can measure and we do some protocol and then they're taken care of and they've kind of rebalanced themselves. And it's so interesting to see how they affect different parts of the body differently. But we're dealing with these conditions. So we've sort of gone over how we get it, right? Where it comes about. It's clearly not preventable, which is kind of daunting and scary. It might just happen, who knows? Trying to get food poisoning. So what I've gotten here is don't
which will probably be fine. And so that's one way, Mexican street food, stuff like that. But so we've got that down. And so what are the next steps? If somebody comes in and they come to see, say you're back 10 years ago, you're still practicing. And they say, hey, I've tested positive for SIBO. I've got all these issues, I've got these symptoms. We know I've got the methane, I've got the hydrogen sulfides, I've got the things. What can I do next? What steps should I be taking besides probiotics as earlier discussed?
Allison (31:08.43)I'm gonna go get some water.
Josh (31:35.418)start correcting my gut bacteria if possible. Like what does that look like?
Allison (31:40.386)Right, so what we do is we use antimicrobials or antibacterials. That's the key thing. As our sort of, let me just give you the overview. You know, we've got three layers we can focus at. We can focus on symptoms. We can focus on the bacteria that are overgrown. And we can focus on the underlying cause. Generally, we often have to do a little bit of all of it. Like, you know, if somebody is really suffering, we might have to get right in there with some symptomatic relief while we're getting the tests and everything, you know? But once we know they have the overgrowth,
use antibacterials to bring those bacterial levels down. We haven't really found anything else that handles that perfectly, although those studies show that probiotics can. We just can't seem to replicate it very well.
(02:07):
But so within that category, there's three main tools we use. There's pharmaceutical antibiotics, there's herbal antibiotics, and then there's elemental diet. And that's basically liquid nutrients that are in pre-digested form. And the idea there is you drink this in place of all meals for two weeks, kinda like you would do antibiotics for two weeks. And it absorbs so quickly in the body that the bacteria don't have a chance to ferment it. The fermentation of carbohydrates
in SIBO. And so if they can't get their food then they starve and so then they would die by starvation with an elemental diet versus the pharmaceutical and herbal antibiotics. It's the more standard like targeting their cell wall or various ways that they kill them. So we use antibacterials and this is to you know to bring that bacterial overgrowth down into the more normal level.
And then what we do is, so like one thing is this step, because this is an overgrowth and not like a technically like an acute infection, it's a little different.
Allison (33:27.498)We have to keep treating until we get those bacterial levels down. And it often takes more than one round of treatment. So more than one two week course of something for herbal antibiotics, we typically do about four weeks. So it just can take more time. We have found it often around anywhere between two to four or maybe even five rounds. And just quickly, let me say, why isn't, we wouldn't just continue that, that antibacterial treatment we're doing longer. We, you can, and sometimes that works, but we've tried that in over and over.
Treatments just peter out after a little bit of time and they stop their effectiveness stops And then we have to just stop reevaluate and do another round of something So anyway after we do that after we do those rounds we get someone on a prokinetic and what a prokinetic is This can be either pharmaceutical or natural or herbal
they stimulate the migrating motor complex in the small intestine. And so we do that while we're assessing between the rounds to make sure, you know, how much is the gas lowered? How are the symptoms? Do we need to treat more? To hold the gains. And then once we have feel that we've gotten to our goal, and what is the goal? You know, for me, it's 90% symptomatic relief. That's that's what I think.
is true success. Often we can't get to 100% because there's an underlying cause there that has symptoms of its own. We have to evaluate that. Sometimes we do get to 100%, but I would I like to see 90%. Do I need a negative test? No. My goal is the symptomatic relief, but you know, we could also use a negative test. Once we have achieved that, then we also stay on the prokinetic and we do this because
it's very common for people to relapse, at least at first, at around two and a half, three months. And so we keep them on this to get them through that sort of vulnerable period. And let's find out what's gonna happen. You know, are you going to relapse or not? And let's see if we can extend that. Prokinetics have been studied and shown to extend a remission period in SIBO, like up to four times as long. So they're very effective at that.
Allison (35:34.034)And then if somebody does relapse, because we don't know, is somebody going to be chronic or not? And the rates on this are about, from studies, about one-third of cases are not chronic. So whatever it was that was wrong got corrected, is handled, we just needed to get that overgrowth down and they're fine. And they're never going to deal with it ever again unless they get, you know, another cause comes in. So a third of cases are, that's it, we get the bacteria down, they're good.
But two thirds of cases are chronic. And this lines up with the stats we see on IBS. And why would that be? The reason why is because there is a cause there. And so if somebody winds up relapsing, then we know we have to figure out what the underlying cause is if we don't already know. And I didn't mention a lot of different causes, but there are a lot of different causes that are currently incurable, that nobody actually knows how to actually fully get rid of.
talk about, like that we say incurable, that just means you don't have to ever think about it again, you don't, it's gone. But most of these situations can be very, very well managed, as you know from IBD. So even if somebody has something like that, we can manage it very, very well. But basically we have to figure out what the underlying cause is. There are also a lot of causes that can be gotten rid of, but they may not be easy to be to be gotten rid of, like mold illness. You know, obviously you can get rid of that in your house, but it can
You have to treat it in your body. Another one would be Lyme disease can cause SIBO. Not the easiest thing to treat, but it can be done, you know. Adhesions, they can be treated. There are manual techniques for treating adhesions, dissolving them even without, you know, going in and doing surgery, which can create more adhesions. So that's the situation. We want to get the bacteria down. We want to use a prokinetic. There's all sorts of adjunctive treatments we can use to support along the way. We talked about probiotics, prebiotics. There's all sorts of things we can do. Other things
Josh (37:17.116)course.
Allison (37:31.408)can do to boost up the body's defenses against SIBO. But in the end, that's the simple way of doing it. Do the prokinetic, and then if somebody relapses, see if we can not figure out what their cause is, and can that be dealt with? Because otherwise it's just gonna keep coming back.
Josh (37:46.392)So I'm going to ask a question that'll sound silly, so I'll preface. The question is, is SIBO a modern?
problem. The reason it's silly I know I've talked about on a previous podcast about Dr. Summowise right back in 1856 when we kind of discovered bacteria and hand-washing and all of that. For those listeners who don't know he worked in he basically observed two pediatric or like delivery wards with pregnant mothers delivering babies. One had doctors and one had midwives. It turns out the one with doctors was having five times the death rate of the other one and he discovered well they were also doing autopsies with those tools with those
hands without washing then touching you know moms and new babies and that's why they were dying and so that was 1856 so it's been a hundred and seventy some years we've just really known about this and so I guess my question would be is SIBO a modern problem in the sense where there's medical evidence leading back maybe hundreds of years we can say okay look like there's maybe a possibility that these people dealing with this could have been SIBO or is it like no
Josh (38:51.006)modern stress, all these things that are causing the problem.
Allison (38:54.378)I don't think it's modern at all. I think it's been around as long as humans have been around because we understand why it occurs. And these symptoms that we're talking about, like IBS, it's the most common GI disorder in the world, because really, because it's a conglomeration of symptoms, but we know SIBO is the primary underlying cause.
No, I mean, we know food poisoning causes it. That's been around forever, right? I mean, that used to, in fact, it used to kill the majority of people who had it. So maybe we're seeing more SIBO because more people are living after having food poisoning. It's still a terrible problem, terrible problem, especially for children in third world countries, food poisoning. But all of the other things that we know that can cause it have been around forever. I mean, for instance, diabetes, tumors, cancers,
Allison (39:44.608)you know, Parkinson's, these things have been around. Anything that can affect the nerves, muscles, et cetera, anything that could cause an obstruction. So infections, things like this, these things have been around forever. But keeping all that in mind, and by the way, we also have evidence in the medical literature going back. It just has new names and things like that. But also it affects animals, and in cows it's called bloat. It's just called bloat, right? So animals get SIBO too.
(02:28):
Josh (40:03.548)Mm.
Josh (40:10.524)Thanks for watching!
Allison (40:13.622)But I do think that the rates and incidences could have very well been.
gone up and one of the reasons could be because people travel so much now by plane as opposed to previous times where it was longer travel and we can quickly get to some place where we might get food poisoning and then we come back. And also another thing is so many people eat out, there's restaurants everywhere. It used to be you would just mostly eat from home. There weren't restaurants like five on every block. So this increases the incidence as well as other things that increase the incidence of food poisoning.
we have all the modern insults that I think make many chronic diseases more prevalent today, at least maybe in societies like the U.S. where we have increased stress.
I think it makes people more susceptible to all forms of this poor eating. You know, I think our gut health in general is very poor. You know, we have, you know, often we're not breastfed. Everybody's on a lot of antibiotics. There's PPIs. There's so many things that can affect the general terrain that makes it weaker and more susceptible, I think. And then also something, if we just look at something like mold illness,
can have increased simply by building practices of homes. What are the materials we're using, and how are we creating? Do we all have more homes now that are more susceptible to mold? And I think I've heard lectures that is so. So there's so many other conditions that can, I'm just briefly. So it's been around forever, but I do think we might make a case for it being more prevalent.
Josh (41:58.46)It's really interesting. I mean, I mean, there's a lot of debate. You mentioned things that have been around forever, like diabetes. There'd be a lot of, I mean, myself included up to this immediate conversation, which I'd love to, I mean, kind of dive into maybe another time, but to say, well, diabetes is a modern problem with all the modern sugars, all the modern grains, the weights, the white breads, the this and that. So, I mean, do we know for certain?
Allison (42:17.41)Well, maybe type 2, but not type 1, per se. Yeah.
Josh (42:19.864)Oh, yeah, if we're talking like autoimmune condition and stuff. Yeah, see, it's really interesting to kind of dive into and explore. And I wish so much, Allison. I wish I had a time machine. Now I would just go figure it out. I would get my wife and I talk about this all the time. Like, I go back to the Library of Alexandria. I would go back to these monumental moments in history. I just I want to know stuff. And I hope that when I die, God's like, yeah, here's a snap of a finger. Now, you know all this shit's in your brain. And that is how I will die.
Allison (42:30.992)So we can check it out.
Allison (42:35.278)I'm gonna go.
Josh (42:49.338)is from my head exploding from knowledge would be ideal. That's kind of like my way to go. So you mentioned this pro-kinetic stimulation a migrating motor complex so really it's a motility disorder combined with some autoimmune because your body's sort of attacking itself identifying if you have the food poisoning so it identifies
Allison (43:06.122)only if you have the food poisoning. Yeah, and also it's not a motility disorder if your cause is obstruction. So...
Josh (43:13.016)Right. So it's so call it a stagnation of some situation. Would that be fair? Okay. And so, so let's bring it back then. So we had the food poisoning, your body identified what you're producing similar to the bacteria it's attacking itself. Now you say that can sort of get under control. Now, is this something like a conventional autoimmune disorder where
Allison (43:17.278)Yes, for sure. Yes, that's fair.
Josh (43:34.86)if you get really stressed or you get really sick or something else happens that your immune system might go back out of whack and it can be trigger this, re trigger this disease process or this disorder.
Allison (43:44.726)That's interesting, like a flare.
Allison (43:49.638)I guess in a way one could sort of see a pattern of that in that there are periods of remission and period of relapse. However, I don't really think of it so much as being based on the autoimmunity. It's more in my mind.
there's already a lack of movement there. If we're talking about the food poisoning type where the migraine motor complex is inhibited, the prokinetic is doing its best to try to stimulate it as it's deficient, to try to bring it back to a proper level. You know, maybe it's not able to do that in everyone. And so there's just, over time, there's going to be, it's probably not, even with the prokinetic, functioning perfectly, so therefore, there will be a relapse at some point. And that is what we see for people who are chronic.
So is it really about the intensity of autoimmunity? I can't say that we know that. All I can say we know is that our lead researcher in this, Dr. Pimentel, has observed that people who... There's one prokinetic we use that actually has been shown to be able to regenerate nerves. And he's seen people, a couple of cases where they've been on that for say 10 years and they never got food poisoning again, because if you get it again, you're just sort of reinforcing the problem.
(02:49):
sort of basically the problem went away. So that's what I meant about that spectrum that you were talking about with autoimmunity where it might over time be able to go away. So that person would not then relapse again.
Josh (45:22.108)Interesting.
It's such a complex, deeply woven issue. I mean, obviously the intestines are arguably one of the more complex organs in the body next to the brain and the liver. The heart seems pretty straightforward. It's got some pumps, it's got this, it's got that. It changed electrolytes, you're done. But the intestines, they are so connected to everything. I often hear the idiom like we are what we eat, but we really are what we break down, digest, and absorb. And if we do that improperly or have a motility disorder or have some kind of autoimmune condition
some sort of disruption in this extraordinarily delicate ecosystem that really we know almost nothing about. It's one of these like the more we learn the less we know isn't it?
Allison (46:03.79)I think so. I find it incredibly complex. Sometimes the more I delve into it, the more I feel like this, this can be the problem. I hardly know what to do for someone except, you know, that's where, you know, we make charts and algorithms and things. Just look, don't get overwhelmed. Just follow these steps and you'll get some progress.
Josh (46:19.612)Sure. Ha ha ha.
I wish it was so step by step. I mean, yeah, there's definitely going to be these, like you said, some algorithms. Well, here's what we'll, you know, for 80% of the population, get them 50% better if they just follow steps one through six. And that's a great way of at least getting a start. You get your quality of life back. But I guess the question would then become what do we do if we get stuck? I mean, in colitis, for example, right, Crohn's a bit of a different story. It's kind of a mouth to anus inflammatory process that comes and goes.
Josh (46:52.166)I mean you really can't just cut out all your intestines you will die very quickly and so if someone feels stuck They've tried these different interventions or trying probiotics Like what are the steps that they can take or maybe what are some complicated? Situations you've seen in your practice where someone felt like they were stuck and was maybe a surprising Intervention that might have made some progress for them
Allison (47:12.826)is so fascinating because you know getting stuck there's so many different ways we could say how is someone getting stuck there's so many different things I could say here one thing there's so many so I guess the first thing I would say is there we you know so in our SIBO clinic what we did is we did before and after breath tests that's the main way we diagnosed SIBO
Josh (47:22.728)Let your brain just do what it does.
Allison (47:38.098)with every treatment we gave and by doing this over many years we found what works both herbally and pharmaceutically and so we have lists of these things and charts and such and I teach these in courses and all that and I give free classes too. By the way, if anyone wants these they can sign up for my newsletter It's SIBO. Go to SIBOinfo.com and if I have free classes, you'll know about them. So Yeah, so
Josh (48:02.101)We'll put that in the show notes for sure.
Allison (48:05.862)The first thing I think I would say is, have you actually tried all your options? Because this is probably the number one stumbling block I see. People who, their doctors may not know all these treatment options. They may not even know about elemental diet. They may, what if they're conventional and they only know about the pharmaceuticals, they haven't tried the herbals or the elemental? And so what we always say is have you tried all three treatment options, pharmaceutical antibiotics, herbal antibiotics, and elemental diet, and have you tried multiple options from the pharmaceutical and herbal options?
actually know your gas types. And this is a very important question because hydrogen sulfide is not easy to diagnose and we only have one test on the market that can test for it directly. And sometimes even that has issues. So these are things we, you know, there's always things you have to do first to make sure are you actually stuck? Like, because for somebody like myself, being stuck is something different than maybe who somebody's listening and they're just going to their primary care.
Now that being said, some things you can do would be to try anti-biofilm agents. Sometimes that really helps. With SIBO, we've tried them all. And there was really only one that we find that really makes a clinical difference, and that is ones containing bismuth.
And so there's a pharmaceutical combination formula from Dr. Paul Anderson. If anyone's interested, you can Google Dr. Anderson Bismuth Antibiofilm or Bismuthyle, you'll find that. And then he has an over-the-counter one. It's called, I always get these words backwards, like biofilm advanced phase two, or advanced biofilm phase two, something like that. So,
So you can try that. Some other things you could do is try working on the nervous system. Because sometimes what we find is that there's been sympathetic dominance physiologically in the body. So that's, you know, we think of sympathetic as fight or flight or freeze. But there's all sorts of things that can create that and even disease-wise. It's not just like, oh you're stressed or something.
Allison (50:04.546)And we need to get the nervous system sort of toned, exercised and working again, sort of turned back on. And so these could be things like brain retraining, like DNRS or the Gupta protocol. These could be vagal exercises. It could be gut centered hypnotherapy. So there's things like the Nerva app where you can find a gut centered hypnotherapist. Things like this, there's so many other heart math, I mean, you know, there's so many other things you could do to just try and make sure
has the ability to work as well as it can, because that is where the migraine motor complex is going to come from, and most of all, our digestive function. So there's that. Then there's things like...
Allison (50:50.862)There are alternative treatments. You know, like I mentioned, find out do you have adhesions? Because there's not just manual therapies, there's frequency-specific microcurrent, and there's neural therapy that can help dissolve adhesions, things like that. And then, you know, the other thing I would say, where myself and some of my colleagues who see some really advanced, difficult cases, often these are...
altered anatomy situations. So these are in which I know you see a lot of too. People who've had a lot of organs, intestinal organs removed and or tied together in strange ways because for whatever reason they needed to. But when you have, you know, large parts of the intestines missing, you know, then you might have short bowel syndrome or, you know, you have the colon resection, you have all these things like this.
(03:10):
That gets very hard to manage. It doesn't mean we can't manage it, but very often what has to happen there is these people need to be on rotating or continuous antibacterials. And so that's a place we go to when we're stuck. This is a small amount of cases, but you asked, right? So these are some of the hardest ones where, you know...
Josh (52:04.929)I did.
Allison (52:08.534)where there's resections and things like this and short bowel syndrome. So these are not gonna be taken care of by something that someone, they could, there are people who like, one of the herbal antibacterials we take, we use for SIBO is allicin, which is an extract from garlic.
There are some people with SIBO, they can honestly take a bunch of garlic cloves. Garlic as a food is one of the most common triggers for SIBO symptoms because it contains a lot of FOS and that feeds the bacteria. Not every... oh yeah, fructo-ologosaccharide. So it's a short chain fiber and it's
Josh (52:38.264)And so for our listeners, could you define FOS?
Josh (52:43.884)Just like a fermentable that can be eaten by the bacteria.
Allison (52:45.834)It's a carbohydrate. Yeah. And the bacteria will eat it. And then they, when they eat carbohydrates, they make gas. So, but then on, so there are people I talk to these, I have colleagues that, you know, they have a kind of a primary care practice. They they're not seeing these really advanced cases. They the person doesn't maybe have a lot of money at their disposal and they just eat a bunch of garlic and they're good to go. And it's like, they're handled and they actually really did have SIBO, you know, they were tested and then that's it. And uh,
So you've got somebody out and then they take some probiotics. It doesn't bother them. They eat the SED yogurt, which now Dr. Davis has his updated version of SED 24 hour yogurt. And they're healed. And then you have people who they've had surgeries and they're not made. They don't have the same anatomy as somebody else. And we have a totally different circumstance. Some garlic and some...
probiotics is not going to handle it. It doesn't mean we don't want to use those things, but what happens is we often.
things progress. Another thing would be like somebody with scleroderma. I've seen many cases like that. This is a progressive autoimmune disease that there's no cure for that is known now. Many people are working on this and I believe we will have it. But in essence, the intestine begins to sclerose or scar and then it cannot perform the contractions anymore. So you see, I'm trying to describe something. It's probably not what the average listener has, but in the beginning of this disease, it's much easier to manage. And some of those, some of the honestly
Some of those patients I've seen have less symptoms than other people. But it progresses. As it gets to that level, what can we do? Those people are on ongoing antibacterials.
Josh (54:29.488)interesting because I mean we look at ongoing antibiotics and or antibacterials of any kind really. Bacteria can develop resistances or if we're on them for a long period of time we can completely or further disrupt our microbiome which can further disrupt every aspect so how can we put somebody on antibacterial safely for an extended period of time?
Allison (54:38.848)Absolutely.
Allison (54:51.514)This is the question that just wrestles with the heart and soul of the physician. It's like, what else are we left with? Usually, some of my colleagues who see a lot of these cases, they really have tried so much else. Sometimes you have to do what you have to do.
Josh (55:13.42)I guess that really is... Sure.
Allison (55:14.634)You can give protection. You can, there's, when you understand what's going on, you can give as much protection as you can think to give in all sorts of ways. But no, it's not ideal, but then again, neither is the person's anatomy. You know, when it's been surgically altered. Because it had to be, yeah.
Josh (55:27.853)Bye.
kind of working with what you've got. Yeah, I guess that really is kind of just the punctuation on today's entire conversation, isn't it? It's like, well.
Sometimes we can and sometimes we can't. It's just not as ideal. I know we like to find something that's conclusive but the reality is with gut health as a whole like it is so ongoing and we are just scratching the surface of the complexities of it and the microbiomes and how they work and why they work and you know We know some bacteria produce certain things. We know some produce others, but we don't have a clue about a lot of different bacteria I mean we look at what one to two thousand species seven to nine thousand strains You can multiply it up to say there's about 18
million different varieties of these bacteria making up pounds and pounds inside your gut like it's just this fascinating thing that I think one day it the complexities are gonna be so vast it's almost too much for one brain like one human physician right like one practitioner how could you look at a GI map 50 years from now we've got 50,000 different check boxes to go through and say yep we have these 18 million bacteria here's exactly the genus and
Allison (56:22.65)Oh, I'm so with you. I am so with you.
(03:31):
Josh (56:38.974)here's a treatment. No, like it's gonna have to be run by AI who does poop tests one day. Like it's crazy. Some of it's scary, but yeah, I hear ya.
Allison (56:43.93)I'm kind of excited about AI coming in for some of this. Yeah. You know, and one thing is that as you keep mentioning bacteria and really microbiome issues, it's never going to be bad. It's always going to be good to work on the microbiome in general, you know, when somebody has SIBO. It's just sometimes we can't do all the things we want to do at first because the person's too reactive.
You know, and some other things, I guess I just want to say one other thing about that getting stuck question. What really gets a lot of people stuck is if they have, if they're very, very sensitive, meaning they can't actually take the treatments for SIBO, the antibacterials or really anything. And so I don't, you've probably seen a lot of these people, they just about anything you give them, they react.
Yeah, and it could be a histamine reaction. So the key things there to think about are, you know, and that's where we really run into trouble with probiotics, by the way, is because of the people who are either MCAS or have histamine intolerance, and then they can't take any probiotics.
So the thing there is to look at MCAS and to look at mold. And if you can deal with that, that usually gets the sensitivity down so that you can get in there with some treatment. And then maybe we can start focusing on our microbiome treatments, because there are some people you just really can't give them anything orally.
Josh (58:03.864)It's really interesting. I know this is such a conversation that I mean, you do lectures on, you do entire symposiums and weekend courses and all kinds of stuff just on SIBO. So I know it's really damn near impossible to kind of wrap up and summarize in a one hour conversation. So I want to open the door for you, Allison, just as we're kind of coming to the end of our time here, is there anything you'd like to say to our listeners that maybe we haven't said yet? Um, and then of course, after that, where they can find you.
Allison (58:31.366)Yes, because we've talked about some very advanced and complex topics, but it doesn't need to be that advanced or complex for most people. We find that the quality of life of people with SIBO can be pretty easily quickly impacted for the positive by simply, so long as you know you have SIBO and you know what type you have, doing the treatment for your type of gas, meaning the antibacterial, an antibacterial for the type, just do that and lo and behold, and then get
on a prokinetic, which we haven't talked about what they are yet, but, and I know we're at the end, but that takes care of so many people's suffering, you know? And yeah, so naturally that would be ginger root. And then we have many, many brands and supplement companies that now make ginger containing prokinetic formula. So for instance, Motility Pro or Motility Activator are some examples.
Josh (59:12.316)Can you give us some examples of prokinetics?
Allison (59:28.83)And then ibirogast, which is harder and harder to get now, but is available on Amazon. It's been around forever and it's like a nine herb combination. It's been studied head to head against pharmaceutical prokinetics and shown to have a prokinetic effect. So ibirogast and then the, the really, some really good prescription ones to consider would be procalipride. In the U S that sold as Motegrity. It's safe. Many prokinetics are not safe. This is a safe prokinetic, very effective. And also LDN, which you use all the time in IBD.
It's not a prokinetic, but it has a prokinetic effect in many people. So those are some options. And you know, for the antibacterials, you know, these are things like I mentioned allicin, oregano, berberine. We need the allicin for methane. We need high dose oregano or bismuth for hydrogen sulfide. You have to know which one you're treating. And pharmaceuticals are different for gas. But basically, I don't want to make it sound so complicated. You get in there with the right antibacterial for your gas type.
hold. Like your food tolerance is just expand because now the bacteria level is down. They're not fermenting everything you eat into gas and the gas creates all the symptoms. So and then you get on a prokinetic and let's hope you don't relapse. So there you go!
Josh (01:00:42.468)That's a summary. I love that. So if someone wants to learn more about SIBO, it's so clearly very specialized and so nuanced. I know you mentioned you have some courses. Of course you got a website where can people learn more about you and find your information.
Allison (01:00:56.802)Yeah, just cboinfo.com.
Josh (01:00:59.524)That's as easy as it gets. I'll never forget that. It's eight letters. That's great. Well, Alison, it's been an absolute delight. Thank you so much for being here and coming on and sharing all of the things that you have to share. It's just really fascinating. SIBO as a condition by itself and something I'm still will continually be learning about as I'm sure we all are as the time goes on. So, for myself, on behalf of our listeners, thank you so much for your time today. It's been an absolute pleasure. So I just press that recording.
Allison (01:01:00.938)There it is.
Allison (01:01:21.91)Thank you so much for having me.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
The Herd with Colin Cowherd
The Herd with Colin Cowherd is a thought-provoking, opinionated, and topic-driven journey through the top sports stories of the day.