Updates on SIBO

SIBO Q & A with Dr. Allison Siebecker.

Key Takeaways

  • Siebecker’s biggest piece of advice for SIBO patients is, “Within balance, believe your own body over any outside authority.”
  • Choose a doctor whose practice model matches your care expectations.
  • The main reason to continue with a SIBO diet is to control symptoms.

I recently spoke with small intestinal bacterial overgrowth (SIBO) expert Dr. Allison Siebecker, who shared:

  • Key tips for SIBO treatment;
  • Recent research about SIBO from the Digestive Diseases Week Conference; and,
  • Answers to listener questions about SIBO. 

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In This Episode

Dr. Siebecker’s New SIBO Course … 00:06:27
Study: SIBO & Diabetes … 00:11:51
Study: Food-Poisoning Bacteria & SIBO … 00:13:57
Study: Hydrogen Sulfide & Reflux … 00:17:31
Study: UV-A Light SIBO Treatment … 00:19:07
Study: Histamine & SIBO Connections … 00:21:38
Study: Lactobacillus Colonizes the Small Intestine … 00:23:39
Study: Lack of Sleep & IBS … 00:23:58
Key Tip for SIBO Patients … 00:26:36
Balancing Information Overload with Choices … 00:30:30
Can I Eat Animal Meat with SIBO? … 00:37:37
Is Full SIBO Recovery Possible? … 00:39:52
Does a SIBO Diet Require 100% Adherence? … 00:41:00
How Does SIBO Relate to MCAS? … 00:49:54
Clear SIBO Before Conceiving? … 00:51:59
Best Probiotics for SIBO/MCAS? … 00:53:31

Key Tip for SIBO Patients

Dr. Siebecker’s biggest piece of advice for SIBO patients—especially related to diet—is, “Within balance, believe your own body over any outside authority.”

She noted that people will often believe in a diet because it’s printed, or like it’s a “spiritual religious work of great importance over believing what’s going on in their own body.” She went on, “I guess one of the main things is just paying attention to your own body’s symptoms…. If a SIBO diet is telling you that X food is fine to have but you are reacting poorly to it, then avoid it.”

What to Look for in a SIBO Practitioner

Dr. Siebecker suggested two main criteria for patients looking for a SIBO practitioner:

  1. Choose a doctor with a practice model that suits you. She suggested most doctors either practice in an “alpha” model, or a teamwork model. “What I would say is…find a doctor that has a style [you like].”
  2. Choose a doctor who has been trained to interpret SIBO testing independently: “It was actually shocking for me to learn that [many] …practitioners don’t have training in how to interpret SIBO breath tests.”

SIBO Studies from Digestive Disease Week 2020

Digestive Disease Week is the largest gastroenterology conference in the world. The 2020 conference just happened in May. Here is a selection of studies Dr. Siebecker found interesting.

SIBO & Diabetes

“Dr. Mark Pimentel’s team found that diabetes could be a bacterially based disease… They found that the bacteria genus Scardovia was colonizing the small bowel in diabetic patients and Actinobacillus shows a marked increase when blood sugar goes up.”

Food-Poisoning & Post-Infectious IBS SIBO

“Dr. Pimental’s group developed an antibody test for anti-CDTB and anti-vinculin antibodies in post-infectious IBS (irritable bowel syndrome)…They found that some of the initial bad bacteria that cause food poisoning, like Campylobacter and Salmonella are… the initial trigger.”

It was previously thought that these bacteria leave the body, but that their after effects lead to nerve damage and small intestine stagnation. “This study found there were low levels of Campylobacter and Salmonella bacteria in the small intestine of previous acute gastroenteritis patients—meaning they have SIBO from acute gastroenteritis—but they no longer have the acute vomiting and diarrhea. This might be one of the reasons why people with this type of SIBO are chronic and can’t get over it.”

The study also noted that certain inflammatory markers are decreased in post-infectious IBS, which may be why the infections can take hold.

Hydrogen Sulfide SIBO & Reflux

Dr. Pimentel’s group developed a first-of-its-kind breath testing machine for hydrogen sulfide SIBO. “They were previously able to correlate hydrogen sulfide SIBO…with diarrhea and pain. Now they found…[SIBO is] also associated with acid reflux or heartburn…because hydrogen sulfide gas is known to produce smooth muscle relaxation. They’re thinking that it’s relaxing the lower esophageal sphincter…So now we have a new symptom to correlate with hydrogen sulfide [SIBO].”

UV-A Light Treatment for SIBO

Dr. Pimentel’s team also last year “developed a UV-A light to use for IBS, IBD, and various enteric infections. …It’s antibacterial, antifungal, and it’s also anti-inflammatory, which is really interesting. And they now have continued those studies and done this in people…and have proven…It’s antibacterial, antifungal, anti-inflammatory.

“But believe it or not, they actually did start doing research with this for coronavirus because they know it pretty much kills most everything.”

Histamine & Abdominal SIBO Pain

“A different group showed that Klebsiella and E. coli strains of bacteria release histamine at rates two-to-three-fold higher than our probiotic bacteria like Lactobacillus. Klebsiella and E. coli are now being shown to be the main [SIBO bacteria]. And what they… showed in their study was that histamine may be a cause of visceral hypersensitivity or abdominal pain in SIBO.”

Lactobacillus Colonizes the Small Intestine

“Dr. Pimentel and his group found that Lactobacillus colonizes the small intestine with probiotic use. It’s never been actually shown before that when you’re taking it supplementally it can colonize, and they showed that it did.”

Lack of Sleep & IBS

I’ve talked about the bi-directional relationship between sleep, melatonin and the gut in Healthy Gut, Healthy You. Dr. Siebecker shared one last study that affirms this. “The last one I wanted to mention is that circadian disruption and shift work is associated with IBS.


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SIBO Q & A with Dr. Siebecker

Can I Eat Animal Meat with SIBO?

The answer is generally, yes. Meat and other proteins are very well tolerated in SIBO, so long as you don’t have an allergic reaction to the particular item you’re eating. Fats are pretty well tolerated, and carbohydrates are very poorly tolerated. However, sometimes people with hydrogen sulfide SIBO don’t deal with the animal meat that well because there’s sulfur in it. They might need to eat less.

Is Full SIBO Recovery Possible?

Yes, full recovery is possible. Some studies that show about a third of SIBO cases have a full recovery with no relapse. And then in the other two thirds of cases, the majority do not resolve completely, meaning that they may resolve, but then there’s a relapse at some point that requires some kind of ongoing or periodic maintenance.

Does a SIBO Diet Require 100% Adherence?

The main reason to continue with a SIBO diet is to control symptoms. But patients should be patient with themselves. You don’t have to be perfect.

Diet is best at symptomatic relief, helping you control SIBO symptoms, so it’s up to you how much benefit you want for how much pain, so to speak.

I think there could be a conception here that often comes from Specific Carbohydrate Diet that you have to adhere to the diet very strictly or you won’t get better. That’s not what we see in SIBO.

Diet doesn’t have the ability to cure SIBO, but especially for people who have chronic SIBO from an underlying cause…diet is going to be really important to learn what to have and what to not have to make your life better.

How Does SIBO Relate to MCAS?

SIBO is bi-directional with mast cell activation syndrome (MCAS). They seem to influence each other.

Mast cell activation syndrome has been shown to increase your risk of SIBO. And it goes back the other way—SIBO could potentially lead to MCAS.

And there’s also the aspect of histamine intolerance. There is a kind of spectrum: on the one end, you have histamine intolerance, and on the other end you have MCAS.

Additionally, the DAO enzyme, which breaks down the histamine in our food, sits on the tips of the microvilli, which are often damaged by the overgrown SIBO bacteria. So we tend to have less DAO enzymes if we have SIBO.

Clear SIBO Before Conceiving?

Broadly speaking, it would be a very good idea to get one’s microbiome in order before conceiving. In fact, clearing up SIBO can actually help your ability to conceive. There are numerous cases where clearing SIBO has allowed people with fertility problems to conceive.

Best Probiotics for SIBO/MCAS?

The easiest way to answer this question is that probiotic supplements have been shown to have a net anti-histamine effect. And it doesn’t matter if they’re special low-histamine or non-histamine-producing probiotics.

Likely that’s because there are a multitude of ways those gut imbalances directly or indirectly increase histamine levels.

Even with MCAS patients, about 70 percent benefit from one of the three categories of probiotics. If we can just personalize the probiotic protocol and listen to your body, we have a decent probability of a net antihistamine and symptom-reducing effect.

I see the least histamine reactions with Saccharomyces boulardii. What I’ve also noticed is that the soil-based probiotics might be the most reactive in that subgroup.

Dr. Siebecker’s SIBO Course

If you’d like to learn more about SIBO, Dr. Siebecker has a SIBO course for both patients and for practitioners. She does an excellent job of clearly staying abreast of the research and also makes sure that she translates the published science into what is clinically useful, doable, and affordable. Enroll in either course within a month of this podcast going live and use the coupon code “RUSCIO” to receive $700 off the practitioner course or $150 off the patient course.

  • SIBO Pro Course (practitioner course):
    • 22 hours of training
    • Continuing medical education credits (CME)
    • A full, postgraduate professional practitioner training in SIBO: How to treat it and how to help your patients
  • SIBO Recovery Roadmap (patient course):
    • A 6-hour training in short, bite-sized pieces for patients
    • How to work with your doctor or practitioner
    • What do you need to know as a patient
    • How to get better.

If you’re a practitioner listening, you can also go to the SIBO Pro Course page and get a free lesson Dr. Siebecker taught on how to interpret breath tests.

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Discussion

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