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SIBO Explained: Why IBS, Bloating & Constipation Won’t Go Away | Dr. Allison Siebecker, Part 1 · The Shivan Show with Shivan Sarna

• 0:00
  SIBO has been proven to be the main underlying cause of IBS. It's very common for tests to come back saying a test is negative when it's really not. Someone was told they had SIBO and then it turned out it was ovarian cancer.
• 0:15
  All we could do before, just give some things for symptoms. Now we can target the bacteria. Hi, I'm Siobhan Sarna, and this is The Siobhan Show. I have a very special guest today, my dear, dear friend, like truly a soulmate, Dr. Allison Seebecker.
• 0:32
  Hi, Dr. Seebecker. Hi, Allison. Hi, hello. Let's get everybody set with this SIBO situation. It's small intestinal bacterial overgrowth. We're going to talk about what it is, what it isn't, symptoms, as well as what you can do about it. And because there's so much misinformation or partial information about this condition out on the internet and in the world, we take this very,
• 0:59
  Seriously, but also in a relaxed fashion. So, Dr. Siebecker, what is SIBO? It is an overgrowth, like its name sounds, an overgrowth of actually particular bacteria or similar organisms to bacteria called archaea in the small intestine. And now the definition has expanded, or the large intestine.
• 1:18
  that basically interfere with digestion and absorption and cause a whole bunch of symptoms. These are the symptoms of IBS. And really, just right up front, any discussion of SIBO, we probably should mention IBS, irritable bowel syndrome, because many people know about IBS or they've heard of it, but they may not have heard about SIBO. SIBO has been identified and proven to be the main underlying cause of IBS.
• 1:47
  So IBS is really just a group of symptoms, really. And of course, IBS and SIBO have the same symptoms. And the symptoms are abdominal bloating, which could also be called distension, but it's when the abdomen swells out or feels like it's swelling out. But for many people, it really swells out like a balloon. It could be abdominal pain or just discomfort.
• 2:08
  And then constipation or diarrhea or a mixture of constipation and diarrhea. That's called IBS mixed or SIBO mixed. And then there can be other symptoms. Those are the main symptoms. But other symptoms would be like flatulence or belching, nausea or feeling like food sits in the stomach and won't go down. There can be anxiety, sometimes depression. Fatigue is really common. There could be brain fog. There's a lot that can go on. Acid reflux is actually common for a lot of people.
• 2:36
  Now we know that IBS is predominantly caused by SIBO. There could still be IBS. It's about 60% to 70% of IBS is caused by SIBO. So, you know, 30% to 40% is something else.
• 2:51
  But it's very important to know now that SIBO is a main underlying cause of IBS because we can treat it. All we could do before for it is just give some things for symptoms. But now that we know that there's a bacterial overgrowth, we can target the bacteria. And if we get rid of those or decrease them, we can affect all the symptoms. And we don't have to just give something for each symptom.
• 3:17
  So, of course, whenever you know what's underlying something and you can target that, you have much greater success. This is like a wedding cake because they're underlying causes and then they're the underlying bacteria and they're caused by other things. And then these overgrowths cause other things. In the middle, let's call it the frosting or the filling of the cake, is the beloved migrating motor complex.
• 3:43
  Would you explain what that is, please? It's so not discussed. This is a form of movement or peristalsis in the intestines. Most people know what peristalsis is. It's like that slow churning mixing movement that occurs after we eat to just move the food down and present it to the walls of the intestine so it can be absorbed. Well, this is a form of movement that is not when we're eating or after we've eaten. It's when we're fasting. So like in between meals or overnight. Yeah.
• 4:11
  And its purpose is to really clean up after we've eaten. And so it has the nickname as the housekeeper wave. And so we could just imagine it coming in and kind of like washing the dishes after eating. And because there's actual bile and enzymes and they kind of act like soap and water.
• 4:28
  And then sweeping up, like sweeping the floor where all the crumbs fell. And the migrating motor complex is this movement. It comes along with the, you know, with bile and enzymes. But then it's this movement that sweeps everything down and out. So the reason that we're talking about it at all is because it's the body's number one and main protection object.
• 4:48
  against getting overgrowth in the small intestine because it happens throughout the day in between meals and overnight. So it happens a lot, sweeps the bacteria, any bacteria that might be there in the small intestine that might be wanting to overgrow, sweeps it down and out of the small intestine.
• 5:05
  Now, just like how many people know that the large intestine has like a bacterial population called the microbiome that's there and that's positive and should be there, the small intestine has that too. So the migrating motor complex doesn't sweep that away. Like they live in harmony together. It sweeps away like something that shouldn't be there, like an overgrowth.
• 5:27
  So if that becomes deficient or fails, which is common, actually, we get overgrowth. It's just like imagine a stream or a river that isn't flowing well now and stops flowing. It's going to turn into a swamp with bacteria overgrowing.
• 5:45
  So when the migrating motor complex is impaired, it leads to the possibility, probability of SIBO, small intestinal bacterial overgrowth. When we're talking about those underlying causes, what's the number one underlying cause of impairment for the migrating motor complex?
• 6:04
  It's actually food poisoning, which is a surprise when you first hear about it. That's a disease, but it's an acute disease, meaning it's short-lived, as opposed to a chronic long-term disease. Other names for it would be medically acute gastroenteritis, and in this case, acute bacterial gastroenteritis. And then common other terms we could use would be traveler's diarrhea or stomach flu.
• 6:29
  So there are different causes of these. There can be viral, bacterial, parasitic. And the main one we've identified with SIBO is bacterial. So not everybody who gets food poisoning will go on to develop SIBO. Maybe they had a viral organism instead of a bacterial. And even everybody who gets bacterial food poisoning may not go on. You know, it's not like it's 100% rape.
• 6:50
  But food poisoning is so common, so common. I mean, if you just think of stomach flu and food poisoning, pretty much everybody's had it. And many people have had it really more times than they can count. So statistics show about maybe 10 or 11 percent on average of cases of food poisoning will go on to develop SIBO. But you can still understand how many people that might be. I mean, we know how many people have IBS. It's up to 20, 25 percent of the world's population.
• 7:20
  And, you know, up to 70% of those have SIBO. So we can then understand this. But the way that food poisoning is related to the migrating motor complex and SIBO, causing SIBO, is that it actually instigates an autoimmune process where...
• 7:38
  where the bacteria that cause food poisoning secretes a toxin, and it looks really similar to one of our nerve cells, to a protein on one of our nerve cells that exist in the small intestine. And so through a process of autoimmunity, other terms are cross-reactivity or molecular mimicry, or you could think friendly fire.
• 7:59
  the immune system starts attacking its own nerve cell in the small intestine while it's trying to attack the toxin. Then, by attacking this nerve cell and this protein on this nerve cell, this nerve cell is very, called the interstitial cells of Cajal, they're vitally important to perform the migrating motor complex. If the cell goes down, studies have shown the migrating motor complex becomes deficient.
• 8:25
  after a certain threshold. And then slowly, then maybe a little bit over time, once that becomes deficient, someone will develop SIBO. So after food poisoning, sometimes the symptoms change a little bit from the really acute presentation, and then they'll sort of move into the IBS symptoms, and they just sort of move right into SIBO. But for many people, there's a delay, and it could be anywhere from one to six months from having food poisoning to when they develop the SIBO.
• 8:53
  And that really is confusing. It throws everybody for a loop because you're not thinking back. You may not even, if it wasn't a really severe or bad case of food poisoning, you may not even remember it. Okay, we're going to continue to get personal. Have you ever been bloated, like really bloated? Have you ever had diarrhea or constipation or maybe have a combination of all of it? Maybe you have SIBO, small intestinal bacterial overgrowth.
• 9:16
  I have answers for you, the ones that I couldn't find for so many years. The website, my website, SIBOSOS.com, has a ton of free information, some premium courses you can take, small group coaching, and discounts on supplements and other health products.
• 9:33
  What changed everything for me was working with Dr. Allison Seebecker, and she is involved in so many of these projects. She is a true and legitimate SIBO expert. So if you'd like to work with us, you'd like to find out more, even just want to just take a little look and see if maybe that might be you, then check it out. You'll see the links in the description, and I hope you don't have SIBO, but if you do, I'm glad we found each other.
• 9:57
  How many times in SIBO small group coaching have we talked to people and we're like, so it could be food poisoning. And they say, well, I've never had food poisoning. And then we're like, you know what? At some point, go get the IBS SMART test through Jameli Labs. Let us know what the antibody test shows, which is referring to what you were just saying.
• 10:17
  talking about. And lo and behold, they have the antibodies being positive, which means that they have post-infectious IBS, which is what we're talking about here. But there are a lot of other ways you can get SIBO2, but this is the most overlooked
• 10:32
  The most sort of people get incredulous about like, oh, how could that be? That was when I was five. This is one of the things that Dr. Mark Pimentel and Dr. Ali Rezai, who are at the mass program at Cedars-Sinai, who are doing just this amazing research and work to really cure SIBO. And their work has been so instrumental in this.
• 10:56
  helping the whole world understand this condition. Dr. Pimentel spent years working on this and finally proved it all. So we just have such a huge gratitude to Dr. Pimentel and his teammates for figuring this out. And currently, and for many years, he's been, as you said, working on a cure, and basically he's developing a drug that can decrease the antibodies that
• 11:23
  You know, if the antibodies keep going, we keep damaging the nerve cells, and he's made great progress. It's still going to be, at this time we're recording, you know, some years out because drugs take time to be tested and come to the market. But there will be basically a cure for SIBO caused from food poisoning.
• 11:42
  Very, very exciting since that's how my food poisoning started and then led to SIBO. From milking a cow with like on a field trip, you know, when you're little, whoever was watching over us as kids on this like farm in upstate New York looked away. And then we were like, oh, you know what, let's taste the milk. Like, what was I thinking?
• 12:02
  Very sick. Very sick. And then a trip to India that didn't go well for me food-wise. And that's a really good point to make for those of you who are like, huh, food poisoning. Once you have it and you have this sort of context set up or this perfect storm set up,
• 12:20
  you are more likely to get the next bout of food poisoning. And so that explains why everyone can have lunch at the same picnic and eat the warm potato salad. You get sick and no one else does. And they're like, oh, it must not be food poisoning because Mary ate the same thing you did. Well, Mary hasn't had three other bouts of food poisoning. All those buffets and the Thanksgivings and the Christmases, just make sure the cold food is really cold the way it's supposed to be and the hot food is really hot the way it's supposed to be.
• 12:47
  Yeah. And actually, you mentioned the IVS smart test. So, you know, just to just to, you know, put an exclamation point on that or whatever. That is the test that we use to find out if somebody has had food poisoning caused their SIBO. We can actually figure that out. That's what that test lets you know. It's a blood test. So it's very simple. I think it's like a finger prick or something like that. So it's a very simple, easy test.
• 13:11
  And honestly, it's the most common test that I order when we really don't know why somebody has SIBO. And we've really talked a lot about their history and looked at many things. It's the first thing I order because so many people don't remember the incident. And then it comes positive and then we know.
• 13:30
  Knowing what your underlying causes are one of them really changes your, I'll speak for myself, my compliance with taking a prokinetic, which is something that helps to harmonize the migrating motor complex, which helps to prevent relapse.
• 13:46
  And it's not a laxative. I just want to put that out there because I think a lot of people, that's another distinction. I ask people in small group coaching and in our courses and Q&As so frequently, are you on a prokinetic? That Dr. Seebecker for my birthday had a t-shirt made for me. I should be wearing that now. The t-shirt says, are you on a prokinetic? Because I ask it so many times and so many times the answer is no. And it is such a critical and overlooked part of the protocol.
• 14:11
  There's a lot of questions about how do I find out, Dr. Seebecker, if I have SIBO? I'm bloated. I have weird bowel patterns. I sometimes have pain in my belly. I feel like I can't eat Italian food anymore. How could I tell? What's the testing like?
• 14:27
  Yeah, it's pretty simple. It's a breath test. And these tests can actually be ordered yourself, you know, on my website and probably on yours, too. And we'll put the links here, too. Or you can have a doctor order it for you. But the breath test, there's basically what you do is you do a one-day prep diet.
• 14:44
  where you reduce carbohydrates, which includes plant foods. So, you know, vegetables and fruits and grains and things like that. And then you fast overnight. And then the next morning you drink a sugar solution, and that's called a substrate. And there are different ones, but the one that I like the best is lactulose for this test. And that is now well supported by studies. There used to be controversy on that. And so the lactulose, here's where we have a slight problem, is that
• 15:13
  As a holdover from an older time, it's prescription in the U.S. It shouldn't be. There's nothing. It's safe. There's nothing dangerous about it. But it just would cost a lot of money to get it off the formulary. So that's where sometimes people can have a hard time obtaining these tests. But there are labs that will directly deal with patients and get them lactulose breath tests.
• 15:34
  You sample your breath, then you drink the sugar solution, and then you sample your breath every 15 or 20 minutes for three hours, and then you mail it off, and a lab will analyze it. And what we're measuring are the gases that the overgrown bacteria or archaea produce, and that's hydrogen, methane, and hydrogen sulfide. And this gives us our different types of SIBO, basically. And the interpretation guidelines, it's very important to,
• 16:01
  I would say just look at my website for the interpretation guidelines. It's really important that you not just look at the lab reports analysis, because there are different ways to interpret. As a whole, we've tried, the industry has tried to standardize, but not everybody has the same opinions.
• 16:20
  So you can look at the interpretation criteria on my website, SIBO info under testing, because it's very common for tests to come back saying a test is negative when it's really not. Right. So this happened to Siobhan. Want to tell your story? It's a long story about how I went and got the breath test. It's in my book, Healing SIBO. When we finally did look at the paper versus just them reporting to another doctor, you know, negative or positive,
• 16:45
  It had positive written down, crossed out, and then the letters N-E-G for negative. So they didn't know how to interpret the test is the bottom line. And I lost 18 months of additional confusion, stress, money, rabbit hole after rabbit hole. I was so frustrated. And the only thing we came up with is you have a motility disorder. Okay, okay.
• 17:09
  Which causes SIBO. Which causes SIBO. Getting the interpretation right is so important. And we do have a masterclass, the SIBO testing masterclass, that if you want to really know how to do it right, get the most out of the test, increase your chances of having an accurate test, find out what you can do at home.
• 17:27
  find out what you can do as an alternative to the typical lab test and what the labs are all about, check out our SIBO testing masterclass. Dr. Sebecker created this beautiful, beautiful masterclass that you will know more than most practitioners out there in the world about SIBO testing. It's only an hour long too.
• 17:45
  But this brings up a really important point, which is that you actually can't diagnose SIBO without the test. And it's actually written into the definition that it's a clinical syndrome. And as part of the definition, you need to be both exhibiting symptoms.
• 18:00
  And have proof, basically with a test, of the overgrowth of the bacteria. So you need both, right? If you have a positive test and you have no symptoms, you don't have SIBO. And if you have symptoms and a negative test, you don't have SIBO, right? So long as the interpretation is correct on that negative. Right.
• 18:20
  But the issue here is that the symptoms I described of IBS and SIBO are very common symptoms that many other diseases can cause. Probably about 40-ish other diseases can cause the same symptoms. So we can't tell by the symptoms. You have to have a test. So it's very important.
• 18:38
  Like candida, parasites, even ovarian cancer. They're like, it's a full spectrum of things that cause the same symptoms. And so it's really important to get tested. So nobody's guessing. And I've heard about that very sad case where someone was told they had SIBO. And then it turned out it was ovarian cancer. This is not common, but it happened. And so it's something, it's a cautionary tale.
• 19:05
  Yeah, and also our treatments, which we're going to get into, I'm sure, soon, are antibacterial in nature, antimicrobial in nature. I think we all know we don't want to be using antibacterials if they're not needed and called for and appropriate for the circumstance. We all, I think, have now heard of the importance of the microbiome, things like that, and we don't want to do these things unless it's the correct thing to do.
• 19:28
  It's a microbiome condition. It's a motility condition. It's a malnutrition condition. In some cases, a biomechanical underlying cause. You could have adhesions. You could have endometriosis. Strictures. It can be just anatomical.
• 19:46
  And with adhesions being a very common cause of SIBO also. And what an adhesion is is an internal scar. So if you've ever had a cesarean, if you've ever had any abdominal surgery, then you may have adhesions. But it could also be from the softball that hit you in the belly when you were a kid. It could be from a fall.
• 20:08
  internal scars that are holding you together, and thank goodness they are, right, in many cases, but it can lead to a pulling of the tissue that then impacts the migrating motor complex, basically. You may have a strong migrating motor complex, but some of that tissue may be like an endometriosis, right? You could be pulling your intestines in a way. It's a plumbing issue, right? It doesn't flow the way it goes. Yeah, it's accurate.
• 20:31
  Actually more like a log jam. Like it's a we call it an obstruction. Really, it's a partial obstruction. It's like a physical obstruction to allowing the bacteria move through the intestine and get out. So even if the migrating motor complex is doing its job, there's a block.
• 20:46
  Let's talk about treatments. So there are three main ones. Which one do you want to start with? I'll say what they are. So the antimicrobial treatments that we have are pharmaceutical antibiotics or prescription antibiotics, herbal or natural antibiotics, and elemental diet, which maybe we should call elemental formula just because so many people get it confused with diet of what you're eating. This is an antimicrobial treatment, elemental diet.
• 21:12
  AKA liquid diet for a certain period of time. Well, why don't we start with that one? Let's do that. This is the Siobhan Show, Health, Wealth, and Wisdom. Please subscribe, forward, save, share, do all the things so that you can get this delivered into your feed every week here on Apple. Sadie and I say thank you very much.
• 21:31
  Okay, so it's a medical food beverage, as you were just sort of describing, where basically it's like powdered nutrients, or sometimes they come already as a liquid. And it's going to be a drink, and then the nutrients are just all of our nutrients in most broken down form. The idea with it is that it absorbs quickly into our body before it gets a chance for the bacteria to eat it or ferment it. I mean, their kind of eating is fermentations, and so it starves them.
• 21:57
  Now, there are some thoughts about new ways elemental diet is working. The established way we have always thought is that it's basically starving the overgrown bacteria, and it takes some time. Dr. Pimentel has always said it takes at least 10 days, and we typically do this for 14 days. He's the one who came up with the protocol for this, for SIBO, and studied it and published and proved. And then they have continued work on this, and they now have studies...
• 22:23
  showing 100% eradication rate. It's the highest eradication rate, you know, of any of our treatments to date. So just incredible. It's always been a very successful treatment. Although I will just say that out of these three treatments, it certainly happens that sometimes one or more may not work for a person where another one will. That just is part of the individuality of people.
• 22:47
  So that happens. So don't get discouraged if you try a treatment and it doesn't seem to work. I want to talk about how we know whether a treatment works or not. But let me just first finish elemental diet. You can also do it for three weeks. The way Dr. Pimentel did this is you test after two weeks to see if it's gone. And if it's not gone, you could continue for a third week if you feel you can do that. And then you would stop after three weeks. Okay.
• 23:12
  So elemental diet, you're not eating solid food at the same time in the way this protocol was originally developed. You can have water. Maybe you could have some herbal tea or black coffee. But for the most part, you're not supposed to. So it can be hard because you're just drinking this, you know, basically the shake for two weeks. That can be a little challenging.
• 23:42
  more gas in that same time period. In that way, it's a little bit more effective. It can lower 100 or even 150 part per million of gas. What's positive is 20 for hydrogen, 10 for methane, although there's some differences there. And now one and a half for hydrogen sulfide. That's brand new information from Dr. Pimentel.
• 24:06
  So, you know, we can have people go into the hundreds for their positivity. And that's where elemental diet is amazing, because in two weeks, you could potentially, if it worked on you, get rid of all of it, you know, in just two weeks. It's a heavier lift. Some people are like, oh, my gosh, I never want to come off this lift.
• 24:26
  liquid shake as my nutrition because, but you must, because I feel so good. Other people are like, oh, I couldn't wait to get over it. What I found really interesting is talking to Debbie Steinbach, who is a specialist in the elemental diet, a nutritionist. And she said that the taste changes over the time of the course of your treatment, your relationship to it kind of changes. You go through this transformation of,
• 24:53
  with this beverage over the time that you're doing it, which I found to be interesting because sometimes those first couple of days are really tough, but then like people can sometimes crave it while they're doing the treatment. So if it sounds intimidating or even you've done it for like a day or two and thought, yeah.
• 25:10
  Not for me. If you can hang in there, the results that we've seen, I know you've seen so many patients get resolved. And then just recently in our small group coaching, we've had a lot of people be like, I didn't believe it was going to work. And it did. We have some discount codes we can include for people. A hundred percent. And also there's all different brands of these with different flavors. But you wouldn't even have to just do one. You could, you know...
• 25:38
  buy some of each different kind so you have different flavors. One of the biggest things people get concerned about with elemental diet would be the concern of potential weight loss. And what we have found is, especially if somebody's coming into it already underweight, what we have found is that so long as you consume the recommended amount of calories, which is 1,800, or you could even increase it to 2,000, there isn't real weight loss. What most people will experience is a little bit of water weight loss.
• 26:06
  usually in the first two or three days of, you know, usually no more than four-ish pounds. And of course, water weight will just return when you begin eating. That is acceptable for most people, and it's not substantial weight loss. So that's just something I wanted to mention because people get really concerned about it.
• 26:24
  It's not your average protein powder. So this is not the shake that you're used to. It's not your fitness shake. It's not what you probably have in your cabinet right now that you picked up at the health food store or on Amazon or something. This is a very specific medical food. And on your Fullscript dispensary, there is a variety of the elemental ingredients.
• 26:45
  formulations. And you can find that under the protocols in your Fullscript dispenser. And there'll be a link below for you all to be able to have access to that with her exclusive pricing. I have no problem about interspersing these types of money-saving ideas throughout the presentation because, you know, I like to pinch a nickel so hard I make it cry. So I like to help you save time, energy, and money. Okay, so let's move on to another one of the treatments.
• 27:14
  Let's talk about pharmaceutical antibiotics. Most people are familiar with those. Well, in this first part, we covered so many important things with Dr. Allison Seebecker, SIBO specialist, like the migrating motor complex, like bloating, distension, diarrhea, constipation, alternating diarrhea, and constipation. And the MMC cannot be overstated. And it's one of the things that is missed most recently.
• 27:38
  When people talk to us about SIBO, it's like there's a blind spot about the migrating motor complex. Not everybody, but so many people. So I'm so glad we covered it. That concludes the first half of our session with Dr. Seebecker. Be sure to come back and watch the second half where we cover those treatments, including the antibiotics and so much more. So we'll see you then. So that's a wrap on today's episode. Thank you so much for being here. It genuinely means everything to me.
• 28:05
  If something in this conversation sparks something for you, share it with a woman or a guy in your life who needs to hear it. That's how this show grows. That's how we heal the planet together. And that's how we really connect. For more resources, free tools, and everything we talked about today, head over to SiobhanSarna.com. That's S-H-I-V-A-N-S-A-R-N-A dot com. It's all there waiting for you. And until next time, keep asking the questions, keep finding the answers. You deserve the full picture and the very best. Namaste.
• 28:35
  you