QC: SIBO or Just Need to Poop? Is The Low FODMAP Diet Beneficial?

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Dr. Zachary Spiritos demystifies SIBO treatment for patients with complex conditions like endometriosis and mast cell activation syndrome. He cuts through the noise with a straightforward approach to this commonly misunderstood digestive condition, explaining why it's often simpler to treat than many functional medicine practitioners suggest.

• SIBO treatment basics: antibiotics like rifaximin that shift your microbiome rather than traditional systemic antibiotics
• Preventing recurrence by identifying root causes: antibiotic use, PPI use, chronic narcotic use, or other factors slowing bowel motility
• Pro-motility agents can help the small intestine function properly to prevent bacteria from accumulating where they don't belong
• Low FODMAP diets may help but are used sparingly due to their restrictive nature
• Elemental diets are a last resort for persistent cases
• SIBO is often overdiagnosed when the real issue is constipation or pelvic floor dysfunction
• Virtually all endometriosis patients have some degree of pelvic floor dysfunction
• Pelvic floor dysfunction prevents proper evacuation of both stool and gas, causing significant bloating

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Episode Transcript

Speaker 1 (00:00):
Picture this you walk into the GI doctor and you tell
them I don't know what's goingon and they say well, it could
be IBS or it could be SIBO smallintestinal bacterial overgrowth
.
Now here's the thing.
Many of us have gotten thisdiagnosis and really feel this
sense of either despair or hope,depending on how it's presented

(00:20):
.
Well, if you're one of thelucky few that gets presented
with, it is a curable thing.
However, what do we do if itcontinually comes back?
Dr Zach Spiritos joins us onthis Quick Connect and breaks
that down just a little bitbetter for us.
Stay tuned.
Life moves fast and so shouldthe answers to your biggest

(00:41):
questions.
Welcome to EndoBattery's QuickConnect, your direct line to
expert insights.
Short, powerful and right tothe point.
You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember
expert opinions shared here arefor general information and not

(01:03):
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.
Today I'm joined by my guest,dr Zachary Spiritos, a

(01:32):
board-certifiedneurogastroenterologist with a
passion for treating irritablebowel syndrome, functional
abdominal pain and mobilitydisorders.
He brings a wealth of knowledgeand compassion to the table.
Please help me in welcoming DrZach Spiritos to the table.
What's the best approach fortreating SIBO in complex
conditions like endometriosis,mast cell?
All of the things.

Speaker 2 (01:52):
Yeah, so I think we overthink SIBO sometimes.
From a pathophysiologic,mechanistic perspective it is
quite complicated, butfortunately the treatment is
pretty basic and it'santibiotics, based on what kind
of SIBO that you have.
And these antibiotics aren'tlike traditional antibiotics,
they're more like eubiotics,which really just shift your
microbiome to something that's alittle healthier and they're

(02:14):
not absorbed systemically, sothey are fairly well tolerated.
That said, if someone has MCASand responds to this medication,
rifaximin, which istraditionally used in SIBO
unless you have a different typeof SIBO that's a different
conversation then that'sdifferent and you just can't
take the medication because youhave a reaction to it.
But that's, in my experience,few and far between.
The harder element to this ishow do you get it from coming

(02:37):
back, and that's all identifyingwhy it was there to begin with,
okay.
And was it antibiotic use?
Was it a PPI use?
Was it chronic narcotic use?
That really slows the boweldown so that bacteria has a
chance to proliferate.
And if you target that andsometimes we're good at it,
sometimes it's tough to identifythen we can prevent it from
coming back, Because SIBO cancome back over and over again.

(02:59):
You can continue to treat withantibiotics called rifaximin,
and again there's another onethat we can use for a different
type of SIBO that can be.
People don't want to be onantibiotics in perpetuity, so
it's really trying to understandwhy it's there and then treat
that.
And sometimes we usepro-motility agents to help the
small intestines squeeze, tohelp the kind of the small
intestines peristals adequatelyand get small bacteria or

(03:19):
bacteria to where it should bein the colon, or removing
offending agents like PPIs,narcotics that could lead to
conditions like small intestinalbacterial overgrowth.

Speaker 1 (03:27):
Do you combine that with a low FODMAP diet as well?

Speaker 2 (03:30):
I don't, I don't.
So the low FODMAP diet it canbe quite restrictive and does it
work?
In SIBO it does, but I think wejust treat the SIBO.
And so if someone has recurrentSIBO over and over again or
just it's not getting betterwith rifaximin which again is
really really rare but if wetest people and they're just not
getting better, then there arediets you can use.
You can use an elemental dietwhich effectively is starving
the bacteria and you're reallyjust giving food in its digested

(03:54):
forms.
You can imagine how tasty thatis.
It's pretty gross.
We don't use that unless it's alast resort.
But yeah, I have had patientswho just continue to get SIBO
over and over and over againbecause they have bariatric
surgery and these kind of blindloops of intestines that
continue to kind of justcultivate growth of this
bacteria that lead to ongoingfermentation.
Then we will use a low FODMAPdiet, but sparingly and on a

(04:16):
case-by-case basis.

Speaker 1 (04:18):
Side note on this endopatients are really big for
SIBO.

Speaker 2 (04:22):
It's really not that complex.
And so here's my issue withfunctional medicine doctors,
where they don't work in science, a lot, a lot of it's
pseudoscience, where they just alot of it's not based on
clinical data and they turn SIBOinto like high dose oregano or
high dose garlic and you're like, okay, well, sure, but we also
have an antibiotic that worksreally well, it's really safe,

(04:43):
and so in that world they reallyharp on SIBO.
And, yes, it happens.
It's not that common though.
In fact, when someone's reallybloated, they oftentimes just
need to poop more.
I was like am I bloated?
Do I have seaballs, like wehaven't pooped in 10 days?
So like, maybe let's work onthat?

Speaker 1 (04:56):
Probably, not Probably, just need to poop
Right A hundred percent.

Speaker 2 (05:00):
Another one is like pelvic floor dysfunction, which
is really underlooked, and ifyou can't evacuate stool, you
can't evacuate gas and it'stough to treat.
It really is.
You got to retrain the wholepelvic floor and people kind of
want an antibiotic or amedication to treat that.
But it's just, it's, it'sglossed over.

Speaker 1 (05:16):
I tell you, if I have a woman who's in her fifties
and sixties- who have a lot ofbloating pelvic floor is at the
dysenterges, like the top of mylist.
Yeah, that should be for, Ithink, pretty much everyone.

Speaker 2 (05:26):
Yeah.

Speaker 1 (05:26):
Like, pelvic floor is a huge, huge issue and actually
we don't know any endopatientsthat don't have pelvic floor
dysfunction.

Speaker 2 (05:34):
I bet.

Speaker 1 (05:37):
That's a wrap for this quick connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(06:01):
Until next time, keep feelingempowered through knowledge.