Ep 74: What SIBO Really Is (And Why the Standard Approach Falls Short) [SIBO mini series part 1]

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Transcriptions:

SPEAKER: Dr. Heather Finley

Dr. Heather Finley: 0:03

Welcome to the Love Your Gut Podcast. I’m your host, Dr. Heather Finley, registered dietitian and gut health specialist. I understand the frustration of dealing with GI issues because I’ve been there and I spent over two decades searching for answers for my own gut issues of constipation, bloating, and stomach pain. I’ve dedicated my life to understanding and solving my own gut issues. And now I’m here to guide you. On this podcast, I’ll help you identify the true root causes of your discomfort. So you can finally ditch your symptoms for good. My goal is to empower you with the knowledge and tools you need so that you can love your gut and it will love you right back. So if you’re ready to learn a lot, gain a deeper understanding of your gut and find lasting relief. You are in the right place. Welcome to the love your gut podcast. If you’ve been told you have SIBO and handed another antibiotic or a low FODMAP diet or insert elimination diet here, but you are still bloated, constipated, and frustrated, this episode is for you. Welcome back to the Love Your Gut podcast. I’m your host, Dr. Heather Finley, and today we are kicking off a brand new mini series all about sibo, small intestinal bacterial overgrowth. This series is going to teach you what SIBO really is. Why it keeps coming back and why the standard kill it and restrict everything. Approach usually doesn’t get people long-term relief. We’ll be talking about SIBO testing, recovery stories, root causes that most people miss, and what to focus on instead. If you’re tired of being stuck in just this bloat restrict or symptom repeat cycle. But first I wanna just start off with a story because I wanna just lay the ground here so that you can relate and hopefully feel less alone. So we will talk about one of our clients. We’ll call her Lauren. Lauren came to us after, have done, have, having done four full rounds of SIBO treatment. She did antibiotics and she did herbals. She did antibiotics. Twice and herbals twice. So she had worked with her GI doctor and then she’d also worked with another alternative provider. I think it was a naturopath. So each time she felt a little bit better for a few weeks, but then the bloating and the constipation and the fatigue would come roaring back. And in fact, the last time, so the fourth time that she treated the sibo. She actually didn’t ever feel better. She was like that’s when I knew something had to change. She told me when we got on a call, I just feel like I’m buying tickets to this SIBO merry-go-round that I don’t want to be on anymore, how do I actually get off? So we started chatting and eventually she started working with our team. And when we finally zoomed out, we discovered that no one else had ever addressed really anything besides the sibo. She had serious motility issues from past food poisoning. Her nervous system was very dysregulated, partially just from all the stress of the symptoms. She had pretty severe mineral imbalances on her HTMA, which makes sense because you absorb nutrients in your small intestine. And then once we started focusing on restoring her gut function, not just killing bacteria, everything changed. She went from dreading every meal to actually enjoying food again without bloating that she had just kind of normalized for years. And I really want that for you too. If you’re curious about what could be driving your digestive symptoms, whether you have SIBO or not, don’t tune out if you. Don’t have SIBO or this is the first time you’re hearing about it if you have chronic GI issues. This message really applies to anybody, so we wanna look at the symptoms underneath the surface. It’s a great way to fully address your symptoms and fully find relief so. Let’s start off by just getting into what SIBO really is and why the standard approach keeps falling short. It’s not, I think there’s a huge misconception that SIBO just means that bacteria are in the wrong place, and that is true, but that’s just such a small piece. It’s a sign that your whole digestive environment is really out of sync. So let’s start with the basics. SIBO stands for Small intestinal Bacterial Overgrowth, and the key is it’s not an infection in the traditional sense, it’s more about a disruption in balance. I have a funny story to share about this actually. My kids have really been into anatomy recently and every night their bedtime stories, this is all them, not me. They have wanted me to tell them about their bodies. So we’ve learned about our stomach, we’ve learned about our gallbladder, which my Daughter so eloquently was like, okay, so your gallbladder is like a water gun and it shoots bile out when you digest fat. So from the, from the mouth of a 6-year-old. But your small intestine is. Really supposed to have relatively few bacteria, especially compared to the large intestine. And the reason that I was laughing when I started saying this is because my three-year-old calls the large intestine, the big intestine, so the small intestine and the big intestine, you’ve got two of’em. Your small intestine is actually bigger than your large intestine. Fun fact. But your large intestine houses the bulk of your gut bacteria. So we really don’t want a ton of bacteria in your small intestine. That’s not really its purpose. So when bacteria that would normally hang out in the colon or the big intestine start to overgrow in the small intestine. Or when certain types grow excessively, that’s when we start to see symptoms. Something that Dr. Ruscio talks about often is SIBO isn’t just about more bacteria. It’s about bacteria being in the wrong place or being imbalanced, and that imbalance throws off entire ecosystems. So we really can’t treat this like an acute infection that just needs to be killed off. We have to think about it as a sign that the gut environment isn’t functioning properly, and that’s what allowed that overgrowth to happen in the first place. So let’s talk about the types of sibo, because this can give some clues about what might be driving your symptoms. So the first type of SIBO is hydrogen dominant sibo. This is actually the most common type. It’s actually not the most common type that we see. But this is the most common type, supposedly. It’s associated typically with looser stools, diarrhea and urgency. Think of this as kind of stage one. Hydrogen is kind of the starter gas produced by fermenting bacteria. This is why this is not the most common type of SIBO that we see, because we typically see people when they’ve treated SIBO multiple times, and it’s now turned into. Methane as well. So methane dominant overgrowth, which is technically called intestinal anogen overgrowth, or IMO. This isn’t true SIBO because methanogens aren’t really bacteria. They’re archaea, but they feed on hydrogen. So if you’ve had hydrogen SIBO and it wasn’t resolved properly, it can turn into methane overgrowth. This type is typically linked with constipation, harder stools, more stubborn, bloating, and typically is when people have had symptoms for a long time. Hence why that’s the most common one that we see. And then the last piece, which is I guess the quote unquote newest form of sibo. This one is newer. It’s not routinely tested yet. It often shows up as really foul smelling gas, like sulfur or rotten eggs, plus fatigue, brain fog, sensitivity to su sulfur rich foods like eggs or garlic. It can also be associated. Joint pain and some really wonky symptoms. These clients often feel like toxic but they get a flat line result on a breath test, which can be super misleading. The only test that is really easy to get to test for all three of these is the Trio Smart Test. They have a process on their website where you can actually order it. But don’t go and order it. As you’re listening to this, I’m gonna talk about when you should and when you shouldn’t test for sibo. So while the type of overgrowth matters, the symptoms do often overlap, often persistent bloating. Excess gas fatigue, brain fog, skin issues is really common. Constipation, diarrhea. And then a big one is nutrient deficiencies, especially B12, iron fat soluble vitamins. SIBO can interfere with absorption, so your small intestine is primarily where you digest a lot of your nutrients. So if you’ve had SIBO for a long time and you also have low iron or poor B12 or whatever it might be. These things can all actually go together. So here’s the bottom line. SIBO is a downstream consequence, not a standalone condition. If you hear anything from the episode, let it be that it is your body’s way of waving a red flag that your whole digestive system is not working like it should. And before you get overwhelmed, I’m gonna simplify this for you. It’s helpful to understand the type of gas that’s involved, but the more helpful piece is fixing the environment that allowed the overgrowth in the first place. And that’s where real healing actually happens. So if you only focus on killing bacteria, you really will keep missing the reason that it’s growing in the first place. So let’s talk about the typical SIBO protocol that so many clients come to me after trying. Usually more than once. Here’s the typical sequence. You get a positive breath test, or you just have symptoms. We get a lot of clients that doctors were like, eh, we’re not gonna do the breath test. You probably have sibo. Just go ahead and take these antibiotics. Typically, you’re prescribed Rifaximin or Xifaxan Neomycin. Flagal is another one. Sometimes you’re prescribed a combination. You also are probably told to do a low FODMAP diet, something like the biphasic diet. You might feel a little relief and then all of a sudden your symptoms come back. Whether that is two weeks later, two months later, maybe six months later. There are also a lot of doctors that will say that you kind of proactively need to treat SIBO just to prevent it, which is totally wrong if you fix the reason that it came. Then you don’t have to keep taking the antibiotics for it. So the Lofo hop diet, if you’re not familiar, removes fermentable fibers. So things like garlic, onions, legumes, certain fruits, grains. This can help reduce gas and bloating, the biphasic diet. I’ve actually had the founder of this diet. On the podcast is a more structured version of this, often done in two phases strict elimination, then reintroduction alongside antimicrobials. Now here’s the thing. This podcast is not about whether you should do lo fodmap or biphasic or not, because these symptoms or these approaches can reduce symptoms and the short term, but they’re not actually gonna fix the problem or prevent recurrence, and that’s the problem. You cannot starve your way out of sibo. You cannot kill your way into balance. So it’s like spraying weed killer on your garden without fixing the poor soil conditions that allowed for those weeds to take over in the first place. So, sure, the weeds might die for now, but they’ll be back unless you enrich the soil. You plant new things, you pull them out by the root. And you tend to the ecosystem itself. So let’s talk about the three big reasons that this kill and restrict approach fails. Number one, if it isn’t already obvious, is it doesn’t address why SIBO developed. So SIBO is a secondary issue. You have to ask why did bacteria overgrow in the first place? Why didn’t the body clear it out naturally? This is where my. North to south digestion framework becomes really important. Whether you are a client in our programs or you are a practitioner in my practitioner programs, I teach this to you. If you’ve heard me talk about this before, you know, I always say you can’t fix what’s happening in the small intestines so south if you don’t support what’s happening upstream, north. So we start at the top. How’s your meal hygiene? Are you chewing? Well, can you salivate? Can you swallow? Are you eating in a calm state? Do you have enough stomach acid to break down your food? Is your bile flowing properly to digest fats? Is your pancreas releasing enzymes? How’s your liver? There’s so many steps of digestion that have to go correct in order for food to even end up in your small intestine. So because if any of this is going wrong, you’re sending undigested food into the small intestine where it sits, it ferments, it feeds bacteria, creating the perfect storm for sibo, which is not what we want. Problem number two is it starves good bacteria too. So the longer you stay on restrictive diets like low FODMAP or whatever it might be. The lower your microbial diversity eventually will be especially important strains or keystone strains of bacteria like bifidobacteria. These are keystone for long-term gut health. These diets were never meant to be long-term, and I think that a lot of people that use these diets in their practice, they would agree with me Like, yes, the low FODMAP diet is gonna help you possibly be less bloated, but it’s not actually gonna fix the sibo. It’s not gonna kill sibo. But what happens is a lot of people go to practitioners that are uneducated about what low FODMAP is, and then they end up on these diets for way, way, way too long. So low fodmap. Was a four to six weeks max elimination, but we’ve had clients come to us who’ve been on it for like two plus years. By then, their gut is so depleted. Not of even just the bad stuff, but the very microbes that keep things in balance to support your immune function, your hormone health, even your mood. And they just didn’t know. No one told them, do this for four to six weeks and then you have to reintroduce. They were never guided correctly. Alright, the last problem is it ignores the whole body. Contributors like the nervous system, gut motility, even minerals. Even the best diet or protocol will fail if your bowels aren’t moving daily. If your nervous system is stuck in fight or flight, if you’re depleted in minerals that drive gut motility. Minerals help your body to make energy. They also help your muscles to contract. So if you’re really constipated and your gut muscles can’t contract, then that’s a problem. Your minerals also help you to make stomach acid and enzymes. So if your gut isn’t moving or your digestion isn’t working properly upstream, you can do all the killing and restricting in the world and it’s not gonna stick. And the real trap is clients often think that they failed the protocol. When in reality the protocol failed them because it was actually missing a huge, huge piece. So in short, SIBO isn’t just about bacteria. It’s about function. It’s about flow. It’s about balance. You can’t heal the system by attacking one piece of it over and over again. Let’s talk chat about testing and why. Testing actually isn’t everything. I love testing. Sometimes when it’s for the right reasons. So I know so many of you’re wondering like, okay, this sounds like me. Do I need to be tested for SIBO before I start working on this? The truth is sibo breath testing can be helpful, but it’s very far from perfect as many tests are. So here’s how it works. You drink a sugar solution, usually lactulose or glucose, the sugar is gonna move through your digestive tract. If bacteria in your small intestine are fermenting, they’ll produce a gas. So hydrogen methane, sometimes hydrogen sulfide, you breathe into a tube every 15 to 20 minutes over a few hours to measure the gas levels. So it sounds really straightforward, right? But there’s a lot of things that can skew the results, and there’s a lot of limitations. Number one is that there’s a lot of false positives that are common, especially if you are constipated. If you’re constipated, you have sluggish motility. The sugar solution can sit longer in the small intestine. This gives bacteria more time to ferment. It can read to it, it can, create a positive in gas readings that suggest sibo, even if it’s not actually that significant. And then even small things like toothpaste can affect the outcome. If you. Accidentally swallow toothpaste the day of the collection or eat something off planned during the prep period. You have to follow a strict diet. It can throw things off, so can exercise. Alcohol, not spacing it. I mean, so many things can affect this. And then flatline results can be misleading as well. Sometimes you’ll get the test results back and it’s just all high. So that is, it can either be all high or it can be all low. It’s what we call a flat line. That might mean the test wasn’t performed correctly. It could point to hydrogen sulfide sibo, which most tests don’t measure besides the trios Smart, like I mentioned. And then actually many people with classic SIBO symptoms have negative tests. We’ve seen clients with bloating after. all the meals, especially if they’re like super bloated by the end of the day, constipation, fatigue and their breath tests were normal, but they responded beautifully. Once we address their gut environment, motility upstream, and it might, it still might not have even been sibo, it might just be Libo, which is large intestinal bacterial overgrowth and, yeah. So I mean, if you wanna do a test, great. It can be really helpful, especially if hydrogen sulfide is present. If you have sulfur smelling gas, that can be helpful to know. So while testing can offer clues, it’s not the whole story. You don’t have to do a test. I think that it’s better to spend your money on other tests, which we’ll get into. So you don’t wanna get overly focused on. If you have it or if you don’t. Just because there’s so many variables. So together, like looking at a GI map, which is gonna look at your large intestine, your overall microbial balance, how you’re digesting inflammation, it’s just you’re gonna get a lot more bang for your buck if you’re trying to decide where to put your finances. Versus doing another SIBO test or even an HTMA is gonna look at mineral imbalances that often drive slow motility poor detox. We see a lot of our clients with chronic SIBO respond super well to minerals because their bodies are just so starved and depleted. So together, I think those can paint a better picture of what’s going on, especially if you haven’t responded to typical SIBO treatment. So if you’ve been holding off, you know, taking action until you get that diagnosis, you can start healing without a test because we really need to figure out why you have the SIBO or potential SIBO in the first place. So let’s talk about why the gut would be vulnerable to sibo. Like I mentioned, it’s the result often of something not working. It’s the red flag, not the root. Sibos, the, not the root cause. It’s the result of something in the gut environment that has become vulnerable. Normal functions like digestion, motility, microbial balance are no longer being properly supported. So instead of asking, how do I kill the sibo, the better question is what allowed it to get here in the first place? So let’s talk about the first one, which we commonly see, which is. Slow gut motility. This is one of the most overlooked root causes, especially if you have methane dominant or constipation. When your digestive system slows down, food sits too long in the small intestine and bacteria that are supposed to be swept downstream, start fermenting start fermenting leftover leftovers, for lack of a better analogy. And then you get gas, you get bloating, you get overgrowth. So the question is why the slow motility, chronic stress can shut down the vagus nerve, which is key in keeping things moving. Low thyroid function slows everything, including digestion. We commonly see that mineral imbalances, like I mentioned, so especially like low potassium, low sodium, often cobalt. These often show up on testing. We often see this as a huge reason why so many of our clients can’t move the needle even after trying everything. So a helpful analogy I like to use is if your gut is the freeway and the bacteria are cars, slow motility is like. Traffic at a standstill. So bacteria that are supposed to pass through, just pile up, and it’s not just hydrogen sibo, methane gas in particular slows motility even more, creating just a really vicious cycle, which is why constipation is so stubborn. When you have intestinal meth antigen overgrowth,’cause the gas itself is making things worse. The next root cause that we often see is low stomach acid. Your stomach is supposed to act like an acid bath, breaking down food, neutralizing pathogens, triggering bile and enzyme release. But if you’re low, food isn’t broken down, it’s easier for pathogens to grow like h pylori. And then that undigested food becomes a fermentable fuel for bacteria farther down the line. So again, stomach acid is a north to south trigger. If that’s not working, everything downstream suffers. And again, minerals matter. You need zinc, you need chloride, you need sodium to even make stomach acid in the first place. Another reason is poor bile flow or pancreatic output. Like I mentioned my daughter called the gallbladder a water gun. It kind of really is like that. Um, even if you don’t have a gallbladder, you really, even more than that, need to focus on B flow. When bile and enzymes aren’t released, fats and proteins go undigested. This can really affect bloating and things after meals. Poor bile flow is often a result of low stomach acid, again, the north to south connection, sluggish liver function, dehydration, of course, mineral depletion. This is why we don’t just give enzymes. We need to look at what’s causing it. The next one that I wanna talk about is post-infectious IBS or food poisoning. If you’ve ever had food poisoning even years ago, you may have developed what’s called post-infectious IBS, and what’s wild is according to Dr. Ruscio. About one in nine people who get food poisoning go on to develop IBS and SIBO is one of the most common outcomes. So that’s because the immune response to food poisoning can damage a key part of your migrating motor complex. So that’s kind of like that cleanup crew that moves bacteria and waste through your small intestine. And when that wave gets disrupted, overgrowth can take over. Another one that can be tricky is adhesions or scar tissue. This one gets missed all the time. If you’ve had C-sections, if you have endometriosis, an appendectomy, or even chronic inflammation in the gut. You might have scar tissue or adhesions that physically block movement in the intestine. And in these cases, visceral therapy or manual work can work. Obviously if you have endometriosis, then there’s lots of other things involved with that. Pelvic floor PT can be incredibly helpful and so you often need an alternative provider on your team in that case. And then the last one that I wanna bring up today is, are actually two more and they kind of go together. One is mineral depletion. This is a big one, especially for women who are burnt out. Exhausted, been doing this forever. You cannot heal a gut that doesn’t have the raw materials to function Often. On htma, we see low sodium and potassium, which causes sluggish motility, poor hydration. We see low cobalt, which can go hand in hand with B12 deficiency and nerve dysfunction, and. Stomach acid issues, we often see high calcium. This can be a stress pattern. It can also impact how much your bowels move, and then low magnesium. This can cause tension. It can cause constipation. Poor enzyme activation. So again, back to the garden analogy, you can’t grow anything. Even good bacteria, if the soil is dried out and depleted, you need minerals to rebuild the terrain. To fuel motility to regulate your nervous system, which is the next thing. And the last thing I’m gonna talk about and then drive detoxification. The last one, and probably the most not popular one, is a dysregulate, a dysregulated nervous system. You really cannot heal your gut in a state of chronic fight or flight. And hear me when I say I totally get it. I’ve been there. I still catch myself. It’s very hard to live in a, uh, just. A regulated way, your vagus nerve controls digestion. So when your body is constantly in stress mode, whether you have a high stress job, whether you have kids, whether you just never have downtime, whether you’re just an easily overwhelmed person, digestion literally shuts down. Stomach acid drops, motility slows, inflammation goes up. So this is why we spend so much time helping our clients. Focus on stress, resilience, anchor in safety before meals regulate their nervous systems. We’ve even brought in a nervous system coach now in our program who’s doing monthly sessions to help our clients identify where they’re getting stuck, how their self-talk is affecting them, and kind of how they can support their nervous system. So the bottom line is SIBO isn’t the problem. It’s your gut and your body raising its hand saying, Hey, something else isn’t working here, and this has happened as a result. So the only way truly out of this cycle is to zoom out and actually listen. So the goal is to balance your gut. It’s not just about bacteria. So we don’t wanna ask the question, how do I kill the sibo? It’s, why did it show up here? And how do I change this environment? So one of the most important mindset shifts I wanna leave you with, that so many of our clients come to us with, especially after multiple rounds of antibiotics or even antimicrobials. Is they often say I, I felt better for a little while, but it always came back. And the reason is because they’re focusing only on killing bacteria and never really on restoring the gut environment. You can’t just empty your house, you have to rebuild it. We have to rebuild digestive function from top. Down, starting with your brain, your nervous system, how your body responds to stress and healing is not about controlling every food or even running test after test. It’s about creating internal conditions where your gut can actually function again. So we wanna focus on supporting motility that looks like daily bowel movements, nervous system regulation, minerals, gentle movement. We wanna replenish minerals. We want to. Add in mineral rich foods, we wanna use mineral mocktails, or even custom mineral blends for a lot of our clients because they fuel every part of digestion. We want to repopulate microbes. We’re gonna introduce prebiotic foods gradually. We’re gonna add targeted probiotics when it’s appropriate. We’re gonna build diversity and resilience in your gut. We wanna add in stress and nervous system regulation. So that can be vagus nerve activation, that can be breath work, grounding nervous system tools, eating in a relaxed state, sleep and safety, and then improve the gut terrain. So this is the foundation. Think of it like your soil health. Hydration, sleep, bile flow, joy, connection, purpose, even pleasure can support digestion. And that could be silly things like watching a movie that you like, finding downtime. And yes, this takes time. It’s really easy to think oh, I have gut issues. I just need to fix them, and then I’ll never have to deal with gut issues again. But the reality is, your gut journey is exactly that. It’s a journey. It’s not a destination. And so we want to develop habits and foundations that you can do for the rest of your life. Uh, we don’t wanna just focus on what you need to take and get it over with. It’s about how you live, how you nourish yourself, how you support the systems that help you to feel your best and keep you well. So hopefully you’re getting from this that you might not need another round of SIBO treatment. Right now you need to understand your why. Then you can fix the sibo. We do SIBO protocols all the time, but not until we’ve identified all the missing pieces and all the root causes. We don’t wanna follow the standard approach because we’re gonna end up in the same place. And. The definition of insanity is doing the same thing over and over again with not any better of results. So you need a whole body root cause strategy that rebuilds from the top down. And when you do that, you really stop managing symptoms and you finally start to heal. So in the next episode where we’re talking about sibo, we are going to dig into a little bit more about SIBO treatments, et cetera. But here’s your next step. If you’re listening and thinking, this is me, I’ve done all the protocols and nothing sticks, you have two things that I’m gonna leave you with. Number one is our free quiz. We have a free quiz that is simple and short and will help you uncover. What is not working digestion wise and what could be driving your symptoms behind the scenes? It takes about two minutes. You’ll get a action plan after with some resources that is completely free, so you can do that. Or if you’re ready to just get personalized support, you can apply for one-on-one support through the program. We’ll use advanced testing like the GI Map and the HTMA to tailor your plan from day one. And just a quick note on that, the investment for Gut together is increasing on August 1st. Unfortunately, lab costs have just continued to go up, so if you’ve been thinking about applying, now is the time. Apply before August 1st, and you’ll lock in our current price, even if you choose a start date a couple days after that. So get on my calendar if you’d like to chat through your case and we can make sure it’s a good mutual fit and see about working together. So. Thank you so much for tuning in today. If you found this helpful, I’d love a rating and review. That’s the best way to share this show, especially because we are a small show. We have less than a hundred episodes, and the way that people find it is through ratings and reviews. So share it with someone. Leave a rating and review. If you send me a screenshot, I’ll send you something. You just have to email your review to our support. Which I’ll put in the show notes. So thanks for tuning in and see you on the next episode.