Ep.75: What you need to know about SIBO before you spend more money on antibiotics [SIBO mini series part 2]

Episode Transcript

Dr. Heather Finley (00:03):
Welcome to the Love Your Gut Podcast.
I'm your host, Dr.
Heather Finley, registereddietitian and gut health
specialist.
I understand the frustration ofdealing with GI issues because
I've been there and I spent overtwo decades searching for
answers for my own gut issues ofconstipation, bloating, and
stomach pain.
I've dedicated my life tounderstanding and solving my own

(00:24):
gut issues.
And now I'm here to guide you.
On this podcast, I'll help youidentify the true root causes of
your discomfort.
So you can finally ditch yoursymptoms for good.
My goal is to empower you withthe knowledge and tools you need
so that you can love your gutand it will love you right back.
So if you're ready to learn alot, gain a deeper understanding

(00:46):
of your gut and find lastingrelief.
You are in the right place.
Welcome to the love your gutpodcast.
Hello, and welcome back to thenext episode of the Love Your
Gut podcast.
If you have ever wondered ifyour SIBO test was wrong or you
still felt awful despite testingnegative, then this episode is

(01:10):
for you.
So in the first episode of thislittle SIBO series, we talked
about what SIBO really is andwhat it's not.
So if you miss that one, Ihighly recommend going back and
listening because.
The biggest takeaway from thatepisode is SIBO is not a root
cause.
It's only a symptom or a redflag that something deeper in

(01:33):
your digestion isn't working theway that it should.
So if you didn't catch thatepisode, definitely pause this,
go back, and then come backafter you have finished that
episode.
For many of our clients, thejourney that leads them straight
into the confusing world oftesting is symptoms that.
Are unresolved or SIBO teststhat are negative or positive

(01:58):
and look kind of wonky.
Or maybe they've done SIBOtreatment and just have never
gotten relief.
So that's what we are gonna digin today.
Maybe you've done breath tests,you've done stool tests, you've
had no normal blood work,sometimes dozens of labs, and
yet you still feel miserable.
So let's unpack what testing isactually helpful.

(02:20):
When it might not be worth yourtime or money, and what kinds of
sneaky root causes like maybeadhesions or gallbladder
dysfunction that you won't catchon a SIBO breath test.
There's just so much more to thepicture.
So I always think about, I mean,so many clients that we've had,
but this one particular clientcomes to mind.

(02:42):
We'll call her Emily.
She came us, came to us, justconvinced that she had sibo.
She'd done a breath test twice,and both times she had
completely just flatlineresults, but she had all the
classic symptoms.
She was bloated after everymeal, progressively more bloated
throughout the day, painful gasfatigue, constipation.

(03:04):
She was even starting to haveskin issues the longer her GI
issues went on and.
Felt like, okay, if my Sibosnegative, then I don't know what
else is wrong with me.
And what I told her was, what Ishared in the previous episode
is that SIBO ISS just one tinypiece of the picture.
You could, it could look likesibo, but it actually could just

(03:26):
be something completelydifferent.
So when we found.
When we did some testing on herand we ran a GI Map,
comprehensive stool test, wefound that she had an active,
like extremely high h Pyloriinfection.
She had sluggish bile flow.
Her gallbladder had actuallybeen removed years prior, and no

(03:48):
one had really ever connectedthe dots for her on her gut
symptoms.
So, no, she actually didn't havesibo, even though she was
convinced because she wasreading all of these things
online, saying, if you'reprogressively more bloated
throughout the day, you havesibo.
If you are constipated, youprobably have methane, sibo, et
cetera.
But she had major upper GIdysfunction that looked exactly

(04:12):
like sibo.
So this is why where othertesting can be really helpful.
Of course, not necessarilydiagnostic.
But when we zoom out and use theright tests, we really stop
chasing symptoms and finallystart addressing actual causes.
So that's what we're gonna coverin this episode.

(04:32):
When SIBO testing is helpful,when it might be doing more harm
than good, what to look for onother labs like the GI Map or
even mineral testing, sometimesblood work that can reveal
deeper imbalances.
And then often overlooked causesof sibo.
We're gonna talk aboutadhesions, pelvic floor issues,
bile flow problems, stuff thatyou're just not gonna get on

(04:53):
standard testing.
So let's get into it and startwith breath testing.
So we briefly covered this inepisode one, but I just wanna
circle back because one of themost common questions that we
get is, do I need a SIBO test orshould I just start treatment?
And here's the truth.
Breath testing can be helpful.
But really only in the rightcontext.

(05:14):
It's not always necessary andit's definitely not the end all
be all for figuring out what'sgoing on.
So I would say that SIBO breathtesting can be helpful if you're
experiencing symptoms for thefirst time and you wanna
understand what's going on.
You have sulfur like gas, brainfog, fatigue, et cetera, and you
suspect hydrogen sulfide sibobecause that's a whole different

(05:35):
beast.
If you've already had a workupon digestion and motility and
you still feel stuck.
Sometimes this just gives youclarity and almost just peace of
mind of okay, there is somethinggoing on, but I would never stop
there.
In those cases, breath testingis gonna give you insight into
whether you have hydrogenmethane or hydrogen sulfide gas,

(05:57):
and that can help guide thestrategy a little bit.
If you're going to test, I wouldrecommend the trio Smart.
This is not sponsored in anystretch of the imagination by
them.
But it's really the only testthat's gonna look for all three
gases.
So if you're gonna go throughthe headache of following the
prep diet and doing it, thenjust go for it and do the trio

(06:19):
Smart.
In my opinion, when testing isprobably not worth it, is if
you're just retesting just tosee even if you've already
tested negative a couple times,there's other testing that is
gonna be way more worth yourwhile than going through all of
that.
Poop law again, if you haven'taddressed the foundational

(06:40):
issues like motility, mineralstatus, nervous system
regulation, blood sugar balance,et cetera, then maybe weight and
see if some lower lift thingscan help you resolve your
symptoms.
And then I really don't thinkit's worth it to keep testing
SIBO if you've already donemultiple rounds of treatment and

(07:01):
you're still stuck.
Okay, probably you still have itif you still feel the same way.
And another test isn't gonnachange the outcome unless your
strategy actually changes.
And I know that that soundsreally harsh, but just trying to
save you some headache anddollars by like, let's just not
keep doing the same thing overand over again.
And breath tests, definitelythere's quite a bit of prep

(07:24):
involved and they're notfoolproof.
There's lots of false positives,flatline results.
Or even just completely normalresults that can make you feel a
little bit crazy even thoughyou're not.
So here's a reminder.
You don't need testing over andover and over again to start
healing, because again, SIBO isa symptom, not a root cause.

(07:46):
So most of our clients do notstart with the breath test.
We focus on the why and why thegut became that vulnerable and
support it from the top down.
So sometimes your se, yoursymptoms aren't sibo.
They're just something thatlooks like it, just like the
client that I described earlier.
So let's move a little bitbeyond breath test and talk
about two labs that I think giveus kind of the Terrain report,

(08:11):
the GI Map and HTMA.
The think of these like highresolution satellite images of
your gut ecosystem.
They don't just tell us likethere's a weed here.
They tell us why the weeds keepcoming back, and that's really
important.
So there's so much that we coulddig into.
I could probably do an entireepisode on like multiple,

(08:32):
probably another series ofepisodes on all of these tests,
which maybe I should, if youwant me to send me a message.
But I whittled it down to fourthings that stand out on a GI
map that scream fix the terrain.
Number one is h pylori.
Like I mentioned earlier, you'veprobably heard me use my North
to South digestion analogy.

(08:54):
If the traffic light at the topof the highway is red, every car
behind it backs up and lowstomach acid caused from h
pylori.
Suppressing digestion is thatred light, so h pylori is
flipping that switch bysuppressing stomach acid.
So food is not sterilized orbroken down.

(09:15):
Motility, crawls, fermentation,explodes.
Hence the gas and bloating.
And suddenly you look six monthspregnant by dinner.
So here's the kicker.
Conventional biopsies often misslow grade h pylori, but the GI
map will catch it.
We see this all the time and ourclients whose breath test said,
Nope, you don't have SIBO yet.

(09:36):
The root cause was quietly justcamped a little bit up higher in
their stomach.
The next thing or number two islow pancreatic elastase.
So if stomach acid is step oneof digestion, pancreatic enzymes
are step two.
Low elastase tells us that yourpancreas is not clocking in for
work.
The causes of this can bechronic stress.

(09:58):
Long-term vegan diets don't hatethe messenger.
Persistent low stomach acid, sono enzymes or low enzymes means
proteins and carbs just driftdownstream, half digested, which
is a prime buffet forovergrowth.
You cannot starve sibo.

(10:18):
If you keep feeding it freelunch, and you really can't fix
SIBO with diet alone anyways,but you certainly don't want to
address your SIBO while yourbody can't even digest your
food, which is a really, reallycommon thing that we see with
our clients that have treatedsibo 2, 3, 4, 5 times.
The next one, or number three isheist, derate, or fat in your

(10:42):
stool.
So.
I mentioned this on the previousepisode.
My kids this summer have beenlike very into anatomy, and this
is all them, not me.
I guess they're fellow nerds,but we've been having anatomy
lessons where we break downdifferent organs and learn what
they do.
And it's been really fun.
And so my 6-year-old calls thegallbladder a squirt gun.

(11:04):
And honestly, it's the perfectanalogy.
When you eat fat, that squirtgun should be shooting bile to
emulsify it.
If SCR is elevated, that squirtgun is jammed, which totally
ruins your summer pool time.
Fun.
So maybe your gallbladder's beenremoved, maybe your bile is
thick and sluggish.
Research shows that peoplewithout a gallbladder up to 10

(11:27):
times, literally that's so much,10 times more likely to develop
sibo.
So this is not a death sentence,it just means that we need to
intentionally support bile flow.
Using maybe bitters trine,sometimes ox bile, rather than
just like throwing anotherantibiotic at it.
That's probably gonna make thesituation worse.

(11:49):
So whether you have agallbladder or not, you can have
bile flow issues.
I posted a reel probably acouple months ago now that went
completely viral.
It has like 1.5 million views orsomething.
And it was about having stickypeanut butter stool.
So in case you didn't see thatreel.
Maybe you feel less alone, that1.5 million people struggle with

(12:12):
that just from my real alone.
So this is a really, reallycommon thing is we have our
livers and our gallbladders needa lot of extra love from our
lifestyle, from differentmedications, from our diet, and
our bile flow is struggling.
Your bile is like the, it's theantimicrobial that coats your

(12:32):
small intestine.
And so this.
Really sets up the stage forbacterial overgrowth if you
don't have adequate bile flow.
But that's a story for adifferent day.
The last one that I want tomention here is high beta
glucuronidase and possiblydysbiosis as well.
So you wanna picture your liveras like the neighborhood trash

(12:53):
man.
That's the other analogy that mykids have come up with.
If the trash man doesn't comeone week, what happens?
Your trash pile's up.
The alley stinks.
The rats move in, right?
So high beta glucuronidase meansthat the liver microbiome trash
service is backed up.
So estrogen and toxinsrecirculate in the gut.

(13:14):
Inflammation rises, motilitywill slow down, and a backed up
liver is a terrain issue, andSIBO really loves a messy
terrain.
So these are four things that weoften see on a GI map.
There's so much more that Icould dig into.
And you probably realize herethat I didn't even mention
bacteria.
Um, of course there are bacteriain the large intestine that can

(13:39):
impact this, but all of thesethings take priority because
they're top of the chain.
They're north to south, and wehave to fix how digestion is
working first if we actuallywanna see improvement.
Okay?
Another thing that we often seeon mineral testing.
Which might seem kind of weird,like why?

(13:59):
How would minerals affect sibo?
But I can tell you from nowlooking at probably, I don't
know, hundreds, thousands ofmineral tests, so many people
are so depleted in the mineralsthat are needed for digestion,
for motility, and for overallstress resilience.

(14:20):
So let's talk about sodium,potassium, and magnesium.
These are the spark plugs foryour nervous system and for your
gut muscles.
So when sodium, potassium,magnesium are low, or maybe
you're having a really highmagnesium loss, your peristalsis
will slow down or thecontraction of your gut muscles

(14:41):
and like movement of things,your blood sugar will be wobbly,
your anxiety's gonna be higher,and most motility supplements
often won't work for you becausethe electrical wiring is shot.
You have to have minerals.
They're like the spark plugs ofenergy for your body.
They turn the electricity backon, and so you can take all the

(15:04):
ginger, all the moeity, all themotility, either medications or
supplements, but if theelectricity is off, things
aren't working.
So we have to support mineralsand the gut will then have
energy to actually move.
Another thing that we see ontesting is low copper or cobalt.
Okay, copper is helpful forstomach acid production.

(15:26):
Cobalt is tied to B12 and nerveconduction, so low levels can
equal weak motility, poor acid,brain fog, constipation, that
looks exactly like, especiallymethane, sibo.
And then the last thing thatI'll mention that we see a lot
is high calcium.
So some, I've heard peopledescribe this as like body in a

(15:49):
cast.
So if you ever feel tight,stiff, constipated, high tissue
calcium is a classic stresspattern that literally casts
quote unquote smooth muscle.
So your transit time will beslower.
You actually will physicallylike or mentally feel more
frustrated.
And when we can lower tissuecalcium, this can be the single

(16:12):
biggest breakthrough for ourchronically constipated clients.
These are the clients that arelike taking, I mean so much
magnesium and literallynothing's moving because their
calcium is way too high.
So here's the bottom line.
Minerals build stomach acid.
They keep bile flowing.
They fire the vagus nerve, theydrive detox, and without them

(16:35):
you're kind of gardening inconcrete.
If we're sticking with like thisterrain analogy.
So why does this matter?
This matters because we needprecision, not guessing, breath
tests, shout, Hey, there's aproblem.
Whereas other testing, whetheryou're doing a GI map, GI X,
there's so many comprehensivestool tests.

(16:56):
We just prefer the GI map.
GI Map, HTMA.
They whisper why it happened,and that's why we can get such
good results with our clients.
It also stops themerry-go-round.
You can clear SIBO a dozentimes, but if you leave
everything that I mentioned notworking, guess what?
It returns and then it justguides smarter protocols.

(17:18):
Maybe you need to eradicate hpylori.
Maybe you need to use bilesupportive ingredients.
Maybe you need visceral therapy,mineral repletion.
You probably don't at thispoint, need more antimicrobials.
There's a time and a place forthat, but if you've already done
it a bunch of times.
It's time to approach it alittle bit different.

(17:39):
So if your breath test isnegative or positive, again, I
want you to pause and just askwhat is the terrain telling me?
Because a perfect SIBO result isreally useless if your squirt
gun is not working.
If you have low stomach acid, ifyour mineral flat battery just
keeps setting the stage forovergrowth these are the cases

(18:02):
where you keep clearing thesibo, you feel great for two
weeks, and then your symptomsstart coming back.
You don't want that.
You wanna actually clear it forgood.
So let's zoom in on some ofthese sneaky mechanical root
causes, like adhesions andpelvic floor dysfunction that
labs can't capture, but yourbody will feel every single day.
Interrupting this episode reallyquick to tell you about our

(18:25):
Christmas in July sale.
I'm so excited.
We have never done this before,but we have not opened the doors
to our HTMA package since BlackFriday and decided to do this
fun Christmas and July promo togive you access to HTMA testing
because I know so many of youwant it and so many of you need

(18:47):
it.
So what is gonna happen is onJuly 25th, so this coming
Friday, if you're listening tothis episode on the day that it
comes out, we will be opening aselect few spots for our
Christmas and July HTMA bundle.
The sooner you enroll, the moreyou'll save.
So the first 10 people will get$50 off the HTMA bundle.

(19:08):
We typically only do that$50 offat Black Friday.
And then the next 20 people willget$25 off, and then the doors
will close again until BlackFriday.
So if you have been ready to getyour minerals tested, get custom
insights into why you feel theway that you do, possibly a
missing piece of your SIBOpuzzle.

(19:30):
Then set your alarms.
If you have downloaded themineral guide, then you're on
the wait list.
You will get an email at nineo'clock central time on Friday
morning about the HTMA bundleopening for Christmas in July
sale, and I'm so, so excited.
I.
So stay with me a little bit.
Let's dig into first abdominaladhesions and scar tissue.

(19:54):
So we see this a lot in clientswith C-sections, laparoscopic
appendectomies, endometriosisendometriosis, surgeries, even
repeated like pelvic infections.
They can leave behind type tinyfibrous bands that like tether
the intestines and they canmimic SIBO because they can kink

(20:15):
or pinch sections of the bowel.
They can slow motility.
Create just cul-de-sacs wherefood can ferment.
So some red flag symptoms, maybeyou have one-sided bloating.
After any meal you have crampingor like stitching, pain.
What can be helpful if this isthe case for you is in addition

(20:36):
to addressing other root causesis possibly visceral
manipulation pelvic floor orabdominal myofascial pt.
Castor packs to soften thetissue over time.
All these things can be reallyhelpful.
No antimicrobial is gonna killscar tissue, so you're gonna
need a dual approach here.

(20:57):
The next one that I mentionedearlier, but we see just so
much, so I wanted to make surethat we talked about was
gallbladder dysfunction.
So back to kind of the squirtgun analogy if the squirt gun
never fires, then we're notgetting that antimicrobial.
Coating that we want missing agallbladder or just a sluggish

(21:17):
one means that bile dribblesinstead of sprays.
And this matters because bileemulsifies fats and it acts like
an antimicrobial detergent inthe upper gut.
And then also in the smallintestine.
So if you have poor bile flow,you have poor fat mal
absorption, that could be partof the reason that you have
chronically low vitamin D.
We might see high scr on a GImap.

(21:40):
And then we might see lots ofbloating and gas and burping and
possible sibo, SIBO overgrowth.
So some telltale signs would bebloating, burping, nausea, 20 to
30 minutes, especially afterhigh fat meal floating, sticky,
greasy stools.
Right shoulder pain can also bea sign of gallbladder
dysfunction as well.

(22:01):
And so we really wanna focus onbitter herbs, touring
phosphatidylcholine possiblyoxil.
And not necessarily fearingfats, but making sure that your
body has the tool to actuallysupport them.
So like I mentioned, postgallbladder patients are
dramatically more prone to sibo.
It's not a death sentence.

(22:22):
It doesn't mean that justbecause you had your gallbladder
removed, you're gonna get sibo.
It's just a sign that you mustintentionally support your bile,
even though your doctor probablytold you you're good.
There's no need to change yourdiet.
You don't have to do anythingdifferent since you got your
gallbladder out.
Okay, next one is pelvic floordysfunction.
It's really hard to clearbacteria if your pelvic floor is

(22:46):
too tight or not functioningcorrectly.
We see this a lot in runners orlike high impact sport athletes.
If you have high stress likebracing, like kind of the suck
your tummy in culture chronicstraining from being
constipated.
So if you have overly tight orpoorly coordinated pelvic

(23:07):
muscles, it's gonna stallevacuation.
So your pelvic floor PT is gonnabe your best friend to help you
actually coordinate thosemuscles.
Make sure that you can passstool.
You can do biofeedbackrelaxation drills, diaphragmatic
breathing, humming, gargling toengage the vagus nerve.
You can also use mineralsupport, but possibly seeing a

(23:29):
pelvic four pt.
To get assessed if, especiallyif you have chronic constipation
and it's very hard for you torelax.
It's often the one of the mostmissing referrals after you've
had a lot of workups.
Okay, and then last one is justliver sluggishness and kind of
this whole like detox overwhelm.

(23:53):
Like I mentioned, we don't wantour trash man skipping a week
because things start to stink.
No matter how many candlesyou're burning, et cetera.
So why this is connected to SIBOis your liver packages up excess
hormones and toxins into yourbile.
If phase one and two detox isstalled, the bile thickens up,

(24:16):
it backs up.
This can lead to bloating,fatigue, histamine flares.
Sometimes on HTMA testing, we'llsee that high calcium, like I
mentioned, we'll see low zinc.
Lo molybdenum or sulfur showingthat detox pathways are under
supplied.
Sometimes you'll even see themreally high.
If you're waking up between oneand 3:00 AM you have nausea with

(24:36):
supplements.
If you have headaches after highfat meals, this can be signs
that your liver's justoverloaded, rashes, et cetera.
So we really wanna make surewe're supporting our liver.
Bitters beets, dandelion tea,castor oil packs, adequate
minerals, especially zinc andsulfur donors.
Getting lots of cruciferousvegetables if you can tolerate

(24:58):
those.
Broccoli sprouts are probably myfavorite thing for liver
support, and they're really easyto grow and you can get them at
the store as well.
Okay, and then just a couplehonorable mentions that I won't
get into too much, but ileocecalvalve dysfunction.
If you have a stuck valveconnecting the small and the
large intestine, this can leadto bacteria backflow.

(25:20):
Mold and mycotoxins, that can bea whole episode in itself.
But this is really gonnaoverload your detox pathways.
It's gonna disrupt themicrobiome.
So testing your environment ifyou suspect this.
And then foundational minerals.
We covered this, but really thisis often a missing piece for a
lot of our clients.
So here's the big picture.

(25:40):
A breath test is not going tosee your adhesions if you have
those.
Antibiotics are not gonna thinyour bile.
Low FODMAP is not going to relaxa clenched pelvic floor and all
that to say real healing isgoing to happen when you fix the
real root of your problem, whichis going to require a lot more

(26:02):
than just testing your SIBOafter everything we've covered,
hopefully it's kind of comingtogether for you that when a
SIBO test.
Might be worth your money.
Maybe it might be worth lookingat other avenues maybe
exploring, possibly theunderlying root causes,

(26:22):
especially if you have treatedit before.
So I always like to tell ourclients before you go and do
another SIBO test, ask, willthis change my plan?
If the answer is no, maybe justwait.
Go back to the foundations.
Let your body's feedback just bethe guide and try to understand

(26:46):
the whole picture before youjust go constantly taking
antibiotics, waiting for yoursymptoms to come back.
So the main takeaway that I wantyou to take from this episode is
it's the terrain, not theprotocol that determines whether
SIBO sticks around.
Your gut is like a garden.
If the soil is compacted, it'sbone dry, full of trash.

(27:10):
You can spray weed killer everyweek, but the weeds are gonna
keep coming back.
The major terrain disruptors aregonna be stress, slow motility,
low stomach acid, mineraldepletion, hidden scar tissue,
pelvic floor issues, gallbladderdysfunction, that they turn that
soil into a perfect.

(27:32):
Breeding ground for overgrowthlong before any breath test
turns positive.
So this is why we have tosupport the whole body.
We have to support minerals.
We have to hydrate, we have toget the quote unquote irrigation
system flowing, motility bileenzymes, and then we have to
reseed the gut with diversity.
Colorful plants, prebioticfibers, eventually targeted

(27:55):
probiotics, so antibiotics andantimicrobials.
And kill protocols definitelyhave their place, but a
resilient, balanced terrain isgoing to keep the SIBO or the
weeds from returning.
So I hope you found this episodehelpful.
Stay tuned for part three.
Next episode and part three,we're gonna dive deeper into the

(28:18):
terrain approach.
So, how to rebuild diversitywithout flaring your symptoms,
practical ways to support bileand motility in your liver on a
day to day.
I'm gonna share some casestudies.
On clients who have had repeatedSIBO and been able to find
relief.
So make sure you are subscribedto the show so you don't miss an

(28:39):
episode.
If today's episode hit home,share it with a friend, share it
with your GI doctor, whoeverwho's still stuck on the SIBO
merry-go-round, and I wouldabsolutely love it if you would
leave a quick rating and reviewon either Apple Podcasts or
Spotify.
If you screenshot it and emailit to Happy
[e-mail], you willbe entered to win a free HTMA

(29:04):
test in consult with our team.
I would love for you toexperience the magic that is
this test, so please leave areview.
It helps other people find thepodcast who maybe don't know
about it yet, who are strugglingwith the same symptoms that you
are.
So.
As a token in my appreciation,you'll be entered to win that

(29:24):
HTMA package.
And then of course, if you needpersonalized help, if you're
listening to this and just readyfor a different approach, a more
comprehensive approach, I wouldinvite you to apply for a gut
together.
Just a reminder, the investmentis going to increase on August
1st, so now is the time toapply.

(29:44):
As long as you apply beforeAugust 1st, you'll lock in the
current pricing, even if youapply and set your discovery
call for after August 1st.
So now is the time we would behonored to work with you, and I
will catch you on part three ofthe series.