09 Allison Siebecker Anxiety and Small Intestinal ... · Pediatric dosages et cetera, for the doctors to look up. Trudy Scott: Wonderful. It really is fantastic. And I love that you

Dr. Allison Siebecker – Small Intestinal Bacterial Overgrowth and Anxiety www.theAnxietySummit.com May 6-20, 2015

© 2015 Trudy Scott All Rights Reserved Page 1 of 34

Small Intestinal Bacterial Overgrowth and Anxiety

• An overview of SIBO/small intestinal overgrowth and recent research • The SIBO connection to IBS and anxiety/depression • Using a SIBO questionnaire and SIBO testing • SIBO treatment: medications, a herbal approach and diet • Gut motility and low serotonin

Trudy Scott: Welcome to The Anxiety Summit Season 3. I'm your host, Trudy

Scott. I'm a food expert, certified nutritionist, and author of The Antianxiety Food Solution. And today our topic is, "Small Intestinal Bacterial Overgrowth and Anxiety," with Dr. Allison Siebecker, a SIBO specialist. Welcome, Dr. Siebecker.

Allison Siebecker: Thank you, Trudy. Trudy Scott: A real pleasure to have you here. I’m really excited to talk about

this topic. I think it's something that we've seen so much more research on in the recent years, and I know you certainly share that on your website. And you have a great conference coming up, so it's really exciting to see this information getting out to more and more people.

Allison Siebecker: I agree. Thank you. Trudy Scott: Let me go ahead and read your bio, and then we will get started

with this wonderful topic. Allison Siebecker, ND, MSOM, LAc, has worked in the nutritional field since 1988 and is a 2005 graduate of The National College of Natural Medicine, where she earned her Doctorate in Naturopathic Medicine and her Masters in



Oriental Medicine. Dr. Siebecker is the Medical Director of the SIBO Center for Digestive Health at NCNM Clinic in Portland, Oregon, where she specializes in the treatment of SIBO. She is instructor of Advanced Gastroenterology at NCNM, teaches continuing education classes for physicians, is the author of the educational website, siboinfo.com, and is writing a book synthesizing the SIBO data into one source. In 2005 and 2013, she received the Best in Naturopathy award from the Townsend Letter for her articles “Traditional Bone Broth in Modern Health and Disease” and "Small Intestine Bacterial Overgrowth: Often Overlooked Cause of IBS".

Wonderful. I just want to say something about your site, siboinfo.com, it is an absolute wealth of information. I send my clients there all the time. I really appreciate the work that you've put into sharing this information and gathering all the research together. I think it's really important that we're sharing the research on this.

Allison Siebecker: I do, too. And thank you. I'm always amazed when I find out that

people don't know about the site who are interested in SIBO. So I'm glad you're mentioning it, because that’s what it's for, it's just a free educational resource for people, where they can find out all about SIBO, what to do, and look at the studies that they want to. It's good for doctors, as well. In fact, that was my original inspiration, to write it for my colleagues, so that they wouldn't keep e-mailing me all the time, one by one, with their questions. I just put it all online. And I even have dosages of medicines and things like that. Pediatric dosages et cetera, for the doctors to look up.

Trudy Scott: Wonderful. It really is fantastic. And I love that you put a whole

page on all the research, and you've gathered it by year. And I was actually looking at it before our presentation. I thought, "Oh, this is fantastic." What I didn't see was research connecting SIBO with anxiety, and I'm hoping we're going to see some of that. We know that we have a lot of anxiety that we see in people who have IBS. And we know that a lot of people with IBS possibly have SIBO, so I'm assuming that we will see these overlaps.



Allison Siebecker: Yeah, that's a really good point. You're right. There's not, to my knowledge, a study directly on SIBO and anxiety, where someone has done the test to make sure they have SIBO. And I really do hope that that will come out in the future. I think there's so much, so many avenues for research of SIBO that I'd like to see done in the future, as more people learn about it.

Trudy Scott: Now tell us one more thing before we get into the questions, and

that is, you are hosting the SIBO Symposium. I know it's the second one that you are hosting. Tell us a little about it, for folks who may be interested.

Allison Siebecker: Oh, yes. So it's the first weekend of June 2015, and it's being held

in Portland, Oregon, but it's also available by webinar. In case you don't want to travel, you can just watch from home. I love how conferences are being done like that now. It's so fabulous. Because then people all over the world can learn information, who may not have the budget or time to travel. So, just sign up. I think if you just type SIBO Symposium. And what we're doing is, we had one before, and that is available to listen to. It's been recorded. And we're trying to build on that one, so we won't repeat what was done in the first one. They'll stand alone. The first time, we covered a lot of history and the basics. And we presented three different treatment algorithms by three different experienced doctors, so people could know how to handle it. But now what we're doing is going a little bit more into detail with some of those treatments we didn't get to cover last year. We have all the same speakers as last year, plus new ones. New this year, we'll also be presenting a lot of cases from simple to complex. So people can, particularly doctors, learn best ways to handle that. And we have a whole section on testing interpretation. Even for folks who are practitioners, this is good. One doctor will interpret a test one way versus another. And so, if someone's really interested in this topic, to listen to this symposium would be good, because then they'll have the power, they'll have the information. So they can look at their own test, and say, "Wow, this is what this is showing me." And also, we'll have Dr. Mullin. Trudy and I, we spoke before on this subject, and we mentioned this. Dr. Mullin had done a big herbal antibiotic study, the first of its kind for treatment of SIBO. Wonderful that that has come out to validate that herbs can be used to treat SIBO. And he's making a special class for us on this. He's not able to



come in person. He had a schedule conflict, so he's kindly recording this ahead, and putting a lot of work into it. I've been talking to him about it. So I cannot wait to hear this. It's going to have lots of good stuff.

Trudy Scott: Wonderful. And then I'd like to talk a little bit more about Dr.

Mullin's study later on when we talk about some of the treatment. The other person that I know is speaking - who's very well known in this area - is one of the main researchers, Dr. Pimentel.

Allison Siebecker: Yes, he's the head of the whole field of SIBO. And we're so

fortunate; we had him last year come as our keynote speaker and he will come again. And this year, he's talking about all kinds of things. My favorite topic, the thing I really wanted him to cover is "Underlying Causes", which you and I can talk about now. But I cannot wait to hear his perspective on that. It's so important to understand underlying causes of whatever ails us, because then, our treatments can be better. We can target the situation better. Otherwise, we're about walking around in the dark. So he's going to lecture on underlying causes on various aspects of treatment and prevention, and give us cases. And I just can’t hardly wait.

Trudy Scott: Wonderful. That's really great. I'll make sure to share that

information on the speaker page that folks can look at it. And I do want to just clarify that this is available to obviously, practitioners, but then also the layperson who may want to learn more for themselves.

Allison Siebecker: Yes, and they're encouraged. I very much encourage everyone, of

any level of education, just as long as you're interested, we want you to listen to the information, because knowledge is power. And these diseases and disorders that we all suffer from, many people suffer from different ones, the best thing we could do is educate ourselves, and get empowered by that knowledge, so we can help ourselves better.

Trudy Scott: Love it. Absolutely love it. We do need to take our health into our

own hands. And when we know this information, we can be empowered. And I love that you talk about finding the underlying causes. That's so important, no matter what's going on. If you could find those underlying causes, it can make such a big difference.

Allison Siebecker: Yup.



Trudy Scott: Let's start with SIBO. For people who may not be familiar with it, you often see it spelled as S-I-B-O, and that's the abbreviation. And this is for small intestinal bacteria overgrowth. So can you just describe what that is for someone who may not be familiar with this?

Allison Siebecker: Yes, it's when bacteria that normally would live in our large

intestine, as they're supposed to do, where they do good things for us, so this is just normal bacteria that's not disease causing, it's when they then come up into the small intestine, and colonize it, make a home for themselves. And for people who aren't familiar with the way the intestinal tract is set up, we all know, it starts with the mouth, and then we go into the throat, and then the stomach. And after the stomach is the small intestine, and then comes the large intestine. And so, the small intestine is in the middle of the whole tract. And it's not supposed to have a lot of bacteria in it, and that's because that's where we digest and absorb our food. And if the bacteria were there, they would then interfere, because they like our food, too. And they want to eat our food. So they would interfere with the process of digestion and absorption. That's what they do in SIBO, actually. So our body has a lot of protections set up to make sure we don't normally have a lot of bacteria in our small intestine. And SIBO is a circumstance when something's gone awry, and now we have too much bacteria in our small intestine. And just to clarify, I know I said they're just a normal, non-disease producing bacteria, but just to clarify that. Pathogenic bacteria are ones that we could think of that would cause food poisoning, like Salmonella, or forms of E. coli, Campylobacter jejuni. And this SIBO is not a condition of those bacteria. That's a separate thing. This is just normal bacteria of the intestinal tract, really in the wrong location. They're just in the wrong location.

Trudy Scott: Okay. So you could say that it's good bacteria in the wrong

location. Allison Siebecker: Yeah, absolutely. Trudy Scott: Okay, great. So when you've got these good bacteria in the small

intestine, it's in the wrong place, what kind of symptoms are we going to expect to see?



Allison Siebecker: Well, the symptoms are the same as IBS, irritable bowel syndrome. And those are abdominal bloating, which some people think of as distention, it's when the belly swells out often after a meal, and usually getting worse throughout the day, so bloating. Next would be abdominal pain. Sometimes it's not outright pain, it's just discomfort. But that happens as well. And then it's bowel movement irregularities, so either constipation or diarrhea, or some kind of mixture of the two, either, person might alternate between constipation or diarrhea, or, they might be mixed and jumbled up in an odd way like, a person has a hard time going to the bathroom, and goes infrequently. But then when they do go, it comes out watery, so some sort of mixture. So those four symptoms are, again, bloating, well, three symptoms, bloating, pain, and bowel movement trouble, constipation or diarrhea, or the two. Those are the main symptoms of IBS. Those are main symptoms of SIBO. But additionally, there are other symptoms that can go with it, like, excessive farting or burping, one or the other, or both. Also, acid reflux could occur with SIBO. Nausea could occur. And then fatigue, it can be quite wearing to experience these symptoms, so fatigue or lethargy. And then SIBO can cause leaky gut in some people. And so then there can be symptoms of leaky gut, which would be a reaction to food that is not so much occurring in the digestive tract, but more so throughout the rest of the body, like a rash, or nasal mucus, or headache. Sometimes it can trigger asthma or brain fog, things like this. Then, of course, lastly, we have to say, many people with SIBO have anxiety, and often, brain fog, some cognition impairment, and sometimes, depression, but often, anxiety.

Trudy Scott: Okay. Let's just go back to the comment about it that it can cause

leaky gut. Is that causing leaky gut? Tell me a little bit more about that.

Allison Siebecker: Yeah. So there's so many ways a person could have leaky gut.

And leaky gut is just when the spaces between the cells that line the intestinal wall are opened a little bit more than they should be. And that allows larger particles of food to go between the cells, and then enter into our blood stream. And then when that happens, because these food particles are larger than they should be, the body can identify those as foreign invaders.



Almost like a virus, or something. Something that the immune system identifies and doesn't like, and then you can have some kind of immune reaction, which are all those things that I mentioned. You know, rashes, headache – all these things. Joint pain, actually – things like that. SIBO has been studied. There are two studies to see how often does it cause or occur with leaky gut. And it's about 50 percent of people. So not everybody, but in about half of the people, SIBO will cause leaky gut. So known causes of leaky gut are intestinal infections like bacterial infections, yeast infections, parasitic infections, or viral. And then there are other causes, too. Alcohol, alcohol abuse, like in alcoholics, that's a known cause of leaky gut. And there are others as well, different medicines. So that can pose its own problem for those people with a whole lot of other symptoms. And often, that can be related to anxiety.

Trudy Scott: Wow. Suddenly, you've got these food sensitivities to everything

under the sun, which makes it even more complex, because you've got to think about some of the foods that may be causing problems just by the fact that you've got this bacteria, this good bacteria, in the wrong place.

Allison Siebecker: Yeah, absolutely. And you know, when we think about that list of

symptoms I just gave, it's awful. It's just awful. It's not fatal, but it is a severe impairment to daily living. And for those that have chronic IBS or chronic SIBO, it's a serious disease that really affects daily living. And my heart just goes out to everyone who has these symptoms. It's a burdensome thing.

Trudy Scott: Yeah, I'm glad you say that, because some people may think,

"Well, this is not life-threatening," but it is very, very, very – it's a strange thing when you have these symptoms. And I wanted to share how I have become connected with you, and it was because I suspected that I had SIBO. I had a lot of these digestive symptoms – that actually had them for a very long time, and I went online and searched for SIBO and came across your website. That's how I first found you. I don't know if you know that.

Allison Siebecker: That's great. Trudy Scott: I read your site from beginning to end. I listened to your

wonderful interview that you did with Dr. Lauren Noel on Dr. Lo



Radio, which I thought was fantastic. And I thought this really sounds like me. And then I set up to do a consult with you, and then did some testing, and discovered that I do actually have SIBO. And I did the breath test, and discovered that I've got the high methane. And we're going to talk about testing a little bit later. It was dreadful. It really affected my sleep a lot, and I had really, really bad pain issues, until I made the dietary changes. I know we're going to talk about some of the herbal protocols. I've tried various herbal protocols with no luck, but I've totally controlled mine with diet. And I think that's something I want to share and inspire people who are going through this and maybe trying things just to realize that it can be controlled with diet.

Allison Siebecker: Yeah, and you know, my story's the same. Well, not the same but

very similar to yours. I had a lot of those same issues. I got into all this because I have SIBO, although I didn't know what the diagnosis was for most of my life. And you know, I just sort of felt I was on a mission of empowerment, also, to learn for myself and to share what I was learning, so I could help others who might have been suffering the way I was. But like you, I’ve had it for a very long time. For me, it was most of my life. And I think I got SIBO when I was around 5 years old, and I'm 45 now, so that's a long time. And it also affected my sleep and I had terrible pain. And like you, I used diet to mostly control my symptoms. I've done other treatments, which have helped. But mostly for me, diet is very effective. So it's very similar.

Trudy Scott: Great. It's great to share. So this is why you've gone into SIBO, so

you could obviously learn for yourself and then share with other people.

Allison Siebecker: Exactly. And when I first started learning about SIBO, it's

astonishing. There are so many research articles about SIBO. The real explosion started around 2000. That's when Dr. Pimentel came out with his theory. People always knew about SIBO. Medical doctors knew about SIBO. There's plenty in the literature about it, but no one had thought it was as common as they now think it is. It was Dr. Pimentel putting forth the theory that SIBO could be a main underlying cause of IBS that brought it into everyone's awareness more so. And that happened in 2000. But even still, it



was quite hard to find information out about it. And when I did learn about it, I looked online, and I could find almost nothing. The information on the breath test came up on like page five of the Google search. And I just thought, "This has to change." And that's one of the other reasons I made my website, so that if someone was searching, they could find information for themselves, and know what to do, and how to converse with their doctor.

Trudy Scott: Wonderful. And I think that helps a lot, because you're right, I

remember when I first studied to become a nutritionist, I don't ever remember learning about it. I remember learning about IBS. And then I went to these conferences, I heard this term, "Small intestinal bacteria overgrowth". And there wasn't much literature on it, and it's just this absolute slew of research that's been done recently. So it's really exciting to see that it's been recognized, and that we are looking for answers. And we are going to talk about some of those in a bit. And I'd like to go a little bit more into the research in a second, but I wanted to go back to this whole dietary approach, because when we talked before, I shared how my sister feels sorry for me that I have to restrict my diet. I cannot consume these starches and grains and she feels sorry for me, and I say, "No, I don't feel that you have to feel sorry for me. I don’t feel like this is a problem that I have to live with. To me, I feel like it's empowering that I can actually control my symptoms by changing my diet." And I really want to get that message across, because a lot of people, "Yeah, oh, my gosh, I have to give this up," or, "I have to stop this. How am I going to manage?" And look at it the other way around. Think of it as this is you having control of your life.

Allison Siebecker: I agree, completely. Especially anyone with digestive symptoms

of a long term will identify with this. We're always trying to find what foods bother us and what foods don't. And it's not innate. And when we finally can put it in this cohesive picture and have a little bit of guidance, finally, it comes together. And you do get the control that you've been looking for all along.

Trudy Scott: Yes. And it's wonderful when you do. It really is. Because it's not

great to feel uncomfortable, to have pain, for it to affect your sleep, to affect your anxiety levels, or whatever ever else it's affecting. And the challenging thing, I think, for a lot of people, is that there are so many symptoms that overlap with so many different



conditions. So that's where it gets challenging to try and figure out what the underlying cause is. And that's where some of the testing comes in, too. So we'll talk about that. So if you have some of the symptoms that Dr. Siebecker has talked about here and you suspect it, then the next thing would be to do some testing, so you can actually figure out if you do have it.

Allison Siebecker: Yes, do you want me to describe the testing now? Trudy Scott: Yes, let's do that. Allison Siebecker: Okay, well, the test for SIBO, there's two tests you can do to

diagnose it. One is invasive and expensive and not done as often. And that's a small intestine culture that's done during an endoscopic procedure. But the one that everybody really uses, that's easily available, is a breath test. It's called the Hydrogen/ Methane Breath Test, or the SIBO Breath Test. And this can be done at home with a kit the doctor can order, and it comes to your house. That's how most people do it. And the way it's done is you do a one-day preparatory diet – sometimes a two-day preparatory diet – depending on your symptoms. You fast overnight, so just say like, from eight PM on, and then on the morning of the test, you only have water. And then in the morning you do the test, and it takes two or three hours. The research always uses the three-hour test. I prefer a three-hour test. And the way you do it in the morning is that you drink a sugar solution that's meant to feed the bacteria. And have them produce gas. And that would be your hydrogen or methane. And then you sample your breath in the equipment that's given. It's quite simple. For the next 3 hours, every 20 minutes. And then it's mailed off to the lab. And the levels of the gases are analyzed and given back to you and to the doctor. And it's based on those levels, whether you have SIBO or not. And the way it works is that we look at both the height that the gas got to, the overall level. As well as how quickly it was made. Because the sooner the gas was made, that indicates the small intestine, versus in the third hour – that indicates the large intestine. And so that gives us a comparison when we have a three-hour test between the timing of the small and large intestine.



And we can compare and see do we really think that the bacteria are there in the small intestine or not. And that's how it's done.

Prices vary, but usually it's covered by insurance. And there are some labs that have a test for under $200.00 in case that insurance doesn't cover it. So it's a really accessible, simple, non-invasive test.

Trudy Scott: Excellent. Now, a few follow-on questions that I just want to

clarify for folks. So this is a test that you could get done through someone like yourself, a naturopath or functional medicine doctor. But it's also something that your regular GI doctor would be able to order.

Allison Siebecker: Absolutely. And an important point is that there are two sugar

solutions that are generally used for the SIBO test. One is glucose. And the other is lactulose. Lactulose is a synthetic sugar that is not a normal dietary sugar. It isn't lactose. It's lactulose. And that's what we generally use in the United States for our SIBO tests, because it's best at accessing SIBO throughout the whole length of the small intestine. Comparing that to glucose, the glucose breath test can only diagnose SIBO in the top portion of the small intestine. But what's important here is that anybody could order themselves the glucose breath test. So you could go online to the lab companies that have this. And you can see I listed those on my website under "resources testing". You could order yourself a glucose breath test. If it's positive, then there's your answer. But if it's negative, it's important to know you then need to go on and do the lactulose breath test to check the whole rest of the small intestine, because the small intestine could be up to 20 feet long. So with the glucose breath test, you're only accessing the first two to three feet. And that's because that sugar is just absorbed so quickly in our small intestine so fast. So that's just an important point for people to know.

Trudy Scott: That really is important. So when you are ordering these tests

from these labs, they will actually tell you whether they use glucose or lactulose?

Allison Siebecker: Yeah. A lot of the labs in the United States – the SIBO Breath

Test is a Lactulose Breath Test. So if you wanted a glucose test, you will have to probably ask for that specially. But there's no problem in doing that. It's easily available.



Trudy Scott: Okay. And then which countries do the glucose test, because

we've got listeners here from the U.K. and from Australia. Allison Siebecker: Yes. So in Italy, that's the country that they really prefer glucose.

The doctors there don't prefer using lactulose. They have their own reasons for that. In U.K. and Australia, they use both. And I think it's pretty easy to get a lactulose.

Trudy Scott: Okay. So just being aware and then asking a question if you're not

sure. Now, going back to this – so say you did the glucose test by mistake or maybe you decided to do that. And it comes back positive. Is that going to give you enough information to know – does it measure methane and hydrogen?

Allison Siebecker: That's a really good question. It does measure both hydrogen and

methane. But you're probably better off – if you're concerned about methane. Methane is associated with the symptom of constipation. And it's actually been shown in studies – methane gas has been shown to actually cause a slowing of the GI tract and cause constipation. So if that's your symptom, you might be better off getting the lactulose, because the transit usually in those people is a bit slower. You need a little bit more time to get a sense of the methane. So I do think for constipation folks, a lactulose test might be better.

Trudy Scott: Okay. And it sounds like a better test anyway, so it's good to know

there's a difference. When I ordered mine, I had no idea that there was a glucose one, so I'm glad I didn't end up with that one. And I ended up with high methane and constipation had always been my issue. So I did see that correlation.

I've got another follow-up question. A bit of clarification here when you talked about getting the home kits and then you collect your breath. Actually, I just wanted to describe it for folks who may not be aware of what to do. And you blow into a mouth piece, and it collects your expired air. It's pretty interesting that they can actually gather that, and measure it. I just find it fascinating.

Allison Siebecker: Me too. We use this kind of test for other things, too, mostly

carbohydrate malabsorption. So if somebody wanted to be tested for lactose intolerance, it would be the same test. It's just now you would drink lactose as your solution. And other carbohydrates can be tested out with too – fructose malabsorption. And this actually brings up an interesting point, which is that a lot of the reasons



why the symptoms are generated in SIBO are because of carbohydrate malabsorption. So various sugars and carbohydrates are being eaten by the bacteria instead of us – you don't get to absorb them. And then they're making gas out of it. Bacteria make gas. Many bacteria make gas as their end product, and that's what we can measure. If I didn't mention that before it's only bacteria that make hydrogen and methane. Humans don't make hydrogen and methane gas. So that's how we can be sure that there are bacteria present. So the principle is the same, whether we're checking for SIBO or a specific carbohydrate intolerance.

Trudy Scott: Okay, excellent. And then following on about the testing, because

I know a lot of people are going to be interested in this. My first question is, you've got SIBO and you take this lactulose formula and preparation for doing this test. Could this cause some symptoms for some people?

Allison Siebecker: Yes. Thank you for mentioning that. We call it a challenge test,

it's meant to provoke, essentially, the problem. Feed the bacteria. And they make gas. And gas is the main reason why the symptoms are generated in SIBO. And let me just explain that for a moment, because I think it's pretty interesting. But first of all, bloating is distension. And that's a physical swelling of the intestines with a gas that is not leaving. It's backing up. It's not being pushed out. And so they add to the swells. When it is pushed out, one end or the other, that's the burping and the farting that can happen. It can be excessive. Pain can come, because the intestines are actually sensitive to pressure. And gas creates a pressure, so that can hurt. And also, the muscles can contract around that gas, causing a cramping circumstance. Cramping, muscular pain, can be very awful pain. And also, some people with – if you're specifically diagnosed with IBS – a feature of that is visceral hypersensitivity, where the organs that you shouldn't really be feeling, you can feel now. It's an increased sensitivity. And it's usually uncomfortable. So that’s where the pain can come from. And then, the constipation or the diarrhea – well, constipation can be caused by methane gas. Diarrhea tends to be



more associated with hydrogen gas, but we don't exactly know the mechanism there. But honestly, both can happen with both gases. These symptoms are associated with the gas creation. And then also, acid reflux and nausea – that very often comes with methane gas, because methane gas slows the transit. And gas can back up. There can be gas back pressure that brings the acid back up. And also creates a sense of nausea. So yes, back to your question. It is possible that symptoms can occur. What I will say is that in the majority of the patients that I test, it's not troublesome. They're not terribly worse off – some small amounts are. And they aren’t very upset by it. We do warn ahead. And what I do is I give my handout that is available also on my website under "resources" – "handouts". And it's called "SIBO Symptomatic Relief Suggestions". And I give that to anyone that's going to take the test first time, so that if their symptoms are provoked, they have some power to do something about it. I don't know ahead if someone's going to have symptoms or which symptoms. So this way they can take a look at that handout. And mix and match what they need.

Trudy Scott: Right. That's really helpful to know. Allison Siebecker: My overall summary is that I will prefer that people don't be afraid

to test, because the majority of people don't get aggravated. Trudy Scott: Yeah. That's a good point to make. It didn't seem to bother me,

but I would say each person's different. But it is good to know. I know a lot of people obviously who are listening to this, may have anxiety and fears and worries. So the thought of doing something like this, which they might think would make these symptoms worse, may make them a little bit afraid. So I'm glad you made that clarification. Thank you, Dr. Siebecker.

And I wanted to just make a point that this is something that you offer at the NCNM Clinic. You offer testing and consulting.

Allison Siebecker: It's true. Yeah. That's the SIBO Center that I helped create with my partner. And we have several breath test machines. And so we do have a lab where people can have the test done. Or their doctor can order a kit from. There are other labs, also, around the country. And at the SIBO Center, I had been working there.



My two colleagues work there. Right now, I'm on a break from seeing patients in person while I'm really working hard on my book. So I'm on light duty right now. But we have physicians there that people can absolutely see who really want to see a specialist in this.

Trudy Scott: Wonderful. That's really great to know. Allison Siebecker: Oh, and I should mention, just in case, for people listening – I still

do consult with folks. And I just do it online. I do it via Skype. And that's what we did. I think. Did we not?

Trudy Scott: We did do that. Yes. Allison Siebecker: Yeah. That's also available to anyone who's listening, if they

would like to talk with me about it. I really love doing that. I love consulting with people about it. And that is available, also, on my website.

Trudy Scott: Wonderful Allison Siebecker: And Trudy, of course, can help you as well. Trudy Scott: Well, we'll share your website. And you're the expert. And I often

will have people come to me because they've got anxiety. And not even realize that maybe SIBO is part of the picture. And then I'll have them do various different questionnaires. And I actually created a questionnaire from the symptoms on your website that I will give my clients initially to say yes there is a possibility that SIBO may be part of the picture here. And then we'll decide the next step. You may need to talk to a GI doctor. You need to see a specialist. You need to get the testing done. And then decide what the steps are. So it's good to have that initial discussion, whoever you're working with, to figure out if maybe it is a factor and then seeking help. So we've kind of skipped some of the research, because we got into the testing. I'd like to just go back and have you talk a little bit about some of the recent research that we've seen. And then I'd like to talk about what we do in terms of diets and meds and supplements.

Allison Siebecker: Okay. Now, the research, it's so big. Any particular area you

wanted to cover?



Trudy Scott: Maybe any recent research or some of the initial research connecting SIBO and IBS?

Allison Siebecker: Well, yes. That's the work that Dr. Pimentel did. And what he

found was that in his study, up to 84 percent of those who have IBS tested positive for SIBO. And he had very good success in treating. He found that, I think, like, 75 percent responded. So when he cleared the SIBO, their symptoms were gone. And they were no longer categorized as having IBS, so pretty amazing. This research has just continued and continued. When I say continued and continued, what I mean is, other doctors and other centers around the world have repeated that research. No other center has found as high of a percent as the initial research, in terms of how many people with IBS have SIBO. And I think that's probably due to the different test interpretations. But it still winds up being the majority, like, average of about 50 percent. But the research that's very exciting in recent years is the ones on underlying cause, which of course Dr. Pimentel will really address at the symposium. But should I mention it now, Trudy, one of the main underlying causes?

Trudy Scott: Yes. Allison Siebecker: So what's really fascinating to me is a lot of research Dr. Pimentel's

been working on for years – showing that a subcategory of IBS that's called post-infectious IBS – that is actually SIBO. They're one and the same thing. And this research has been fascinating. And what it is – is it's basically when someone gets food poisoning, which is also called traveler's diarrhea, or stomach flu. And the medical term is acute gastroenteritis. When this happens, a certain portion of these people would go on to develop IBS. And that's called post-infectious IBS. And that is SIBO. And what Dr. Pimentel's been able to figure out is that what’s happening is that it's from an original bacterial infection from pathogenic factors. That would be like campylobacter jejuni or shigella or salmonella. And they also create the same toxin, which is called CDT. And a portion of this toxin triggers an autoimmune response in people who have the problem, because it looks similar to a protein on our small intestine nerves. And the small intestine nerves are responsible for creating the most important protection against SIBO, which is the migrating motor complex.



It's a form of motility that whose sole job, really, is to sweep bacteria, any bacteria that are accumulated, out of the small intestine down into the large intestine. And it happens when someone's healthy, it happens every day throughout the day in between meals. So it happens in between the meals. And then overnight when we're sleeping. And so what happens is the nerves that are responsible for generating this motion, this cleaning motion, get damaged by our own immune system, because they've been triggered to have this response by the initial food poisoning. And this is just phenomenal information to me. And so when enough nerve damage has been done, the migrating motor complex becomes deficient. And then the bacteria can accumulate. So what's fascinating about this is really trying to identify the underlying cause. That's very exciting. But what is depressing about it, I suppose, or not so great, is that no one yet knows how to help repair those nerves. It's not known how to do that. That's something Dr. Pimentel has also been working on for years. And I'm sure as soon as he comes up with something, he'll let us all know. But that's very interesting to me. And these nerve cells have the ability to repair themselves. So it's a bit of a surprise why they don't in more people. But the stats are actually not so bad. It's about 50 percent of people who get some of this nerve damage will go on to spontaneously repair. And then about 50 percent don't. And those are the people who have chronic IBS, post-infectious IBS, or SIBO.

Trudy Scott: Very interesting. So a few follow-on questions here. You said that

this triggered an autoimmune response. So are we saying that SIBO is actually an autoimmune condition across the board? Or just in some instances?

Allison Siebecker: Not across the board, only in some instances – because SIBO can

occur from many different reasons. Diseases, some chronic, drugs, surgery, injury, or some kind of infection. There's a lot of different ways a person can get SIBO. This is just one way. It does happen to be probably the most common.

Trudy Scott: Do we know what the percentage is? Allison Siebecker: We don't. But I could say that from my practice, it's like, probably

85 percent.



Trudy Scott: And you know this because you've asked people if they've had some kind of traveler's diarrhea or gastroenteritis in the past? And that's when their symptoms started?

Allison Siebecker: Exactly. Many people will not remember the event, the

gastroenteritis event. And they can't link it to it. But so many people can. They have fine digestion. And then they went traveling, got gastroenteritis. And they've never been the same since or soon after came the problems. And they can tell the link. So it's very common. Not everyone can, because sometimes you don't remember. Maybe you had a night of diarrhea. And you just didn't think anything of it. And you forgot about it, so yeah.

Trudy Scott: Okay. Good to know. That’s a good question to be asking, then.

And then you had said earlier that you think yours started when you were five years old? Did you have an incident that you remember?

Allison Siebecker: I do. I had such terrible gastroenteritis that I remembered it. I had

it. I don't remember much from when I was five, but I remembered that. It was so severe. I do remember that I was afraid to eat for a very long time. And at every meal, every time I was offered food, I would say, "Will it make me throw up?" So I can definitely remember that. And I was not born with these symptoms and these problems. My whole family knows that. They remember that. And then I developed them. Dr. Pimentel has a wonderful book on this subject. And it's called A New IBS Solution. I recommend it. And he discusses this. And he discusses with a harrowing event. And when I read his book, I was like, "Oh, my God." I'm pretty sure this is what happened to me.

Trudy Scott: Really good. And this is important to be aware of, because it's not

something that you hear a lot of people talk about. And the fact that it's damaging the nerves, that's a little concerning. The fact we can repair things like diabetic neuropathy and some nerve damage that was caused by diabetes, do you think we're going to see some kind of research looking at some of those mechanisms to help with the nerve damage?

Allison Siebecker: I don't know what the mechanisms will be, but I have such hope,

because if these nerve cells have such a good ability to repair,



which they do, it can't be that hard to find a way to tap into that. So I really have good hope for this.

And one other thing I wanted to say is that whatever the cause might be in identifying the underlying cause, one of the things that are so helpful about knowing a cause or identifying it is that it does remove some anxiety, I think, for many people. Because what happens for so many with a mysterious disease, like IBS, which has no known explanation, is that a person tends to blame themself. Sometimes we blame others. We just get really angry and blame out and blame others. But so often it's internalized. And this does create so much anxiety. And when you have some kind of an answer or some knowledge that can take the blame off you, it's so relieving.

Trudy Scott: It is. And empowering, which is what you said earlier, really

important. So you've talked about this underlying infection, post-infectious IBS as being one of the causes. And let me just talk about the ileocecal valve issue, because that was one that I was familiar with. And I thought that was a factor in mine. Can you just talk about how this dysfunction could cause a problem?

Allison Siebecker: Yeah, the ileocecal valve separates the small and large intestine

from each other. And it's like a sphincter that closes them off. And it's one of the big protections against backflow of the bacteria from the large intestine to the small intestine. The other very important prevention against backflow is the migrating motor complex, because that creates a downward current, like a stream, that the bacteria would have to push against to move upward in the small intestine. But if that valve is weakened in some way, and is open all the time, well, then that could allow some backflow. This is the controversial issue, a lot of these underlying causes we don’t have enough studies to fully be sure about, or clear on yet. Because there are studies done where people have had their ileocecal valve surgically removed. And they don’t get SIBO. And what I think is going on in those people, is they have an intact migrating motor complex. And that's enough to prevent it. It may be that more than one factor needs to be involved if the ileocecal valve is missing or weak. I don’t know yet. I don’t know if anybody knows that yet. But it's definitely an issue. And actually Dr. Mullin did address that in his herbal antibiotic paper. He did mention that. And it



came out with another paper saying that he really does agree that a weakened valve is associated with SIBO.

Trudy Scott: Okay. Good to know. And you can actually have an adjustment to

get it closed or you can do it yourself. I went online and looked for how to do it. And I did it myself.

Allison Siebecker: Thank you so much for mentioning that. That's something that can

be tested for by a lot of physical medicine practitioners, naturopaths, chiropractors and many others. And as you say, there's a physical adjustment. So thank you for mentioning that.

Trudy Scott: Good. All these weird things that happen to us means we learn.

We learn by what happens to us. And then we want to share it with everyone. I actually wrote about it in my book, because it was such an unusual thing. And it took me quite a long time to figure out that it was actually contributing to my issue. And when I looked it up, they talked about this fluttering feeling in the low abdomen area. And it actually felt like I was sitting on a bee. That's the feeling that I had. And then I Googled that. And found these online forums and then discovered that it was an ileocecal valve issue and then discovered the connection between ileocecal valve and SIBO. I feel that was one of the contributing factors in my area for me. I also had some traveler's diarrhea, so I think that was definitely a factor in mine, as well. So putting all these puzzle pieces together and seeing what some of the causes are. But it's exciting that you say that they are identifying some of the causes. And they're looking for solutions which is great.

Allison Siebecker: Yeah. Trudy Scott: Before we go into the treatment, I just wanted to touch on the

migrating motor complex. You talked about how this helps to flush bacteria from the small intestine down into the large intestine. And we know that the serotonin plays a role in that motility. Could we just talk to that a little bit?

Allison Siebecker: Yeah. It is true. Serotonin may be one of the things that stimulates

the migrating motor complex. And many of the prokinetics – prokinetics means, "for movement," – and these are herbs or pharmaceuticals that are meant to stimulate the movement in the intestines that we use to prevent SIBO relapse. Many of these prokinetics work on the mechanism of stimulating certain serotonin receptors.



It gets a little complicated in the intestines because there are many different serotonin receptors. They have their own numbers, the names, and they do different things. Some of them inhibit motility, and some of them increase motility. So sometimes people can try to take a 5-HTP supplement and it may help them. But then it may not, because of the complications of the different receptors. But it is something that might be of help.

Trudy Scott: Okay. And we know now with all the research that we've seen, so

much is going on in the gut in terms of neurotransmitters being produced by some of the good bacteria. And I'm sure that plays a role in it as well. And I see so many people with low levels of serotonin. I really think this is possibly a factor that we need to be thinking about. And as we know, a lot of people with low serotonin have anxiety and depression. And we see anxiety and depression in people with IBS and now SIBO. So I'm hoping we're going to see some connections there. And more research. I shared a number of studies looking at serotonin and the connection to the gut motility factors. I'm hoping that we'll see more.

Allison Siebecker: I like what you're saying. But I want to add that, of course, the

link between low serotonin and IBS has been there in studies all along.

Trudy Scott: Okay. Good. Allison Siebecker: You're absolutely spot-on. Trudy Scott: Okay. Good. Yeah. So I think everyone's going to be different.

If 5-HTP or tryptophan – I happen to like tryptophan a lot as well – if that's helping with your anxiety and depression symptoms, and happens to help with your digestion as well, that's great. But there's obviously a lot more to it. And we're going to talk about some of those treatments that you can share now.

Allison Siebecker: Okay, so, yeah – treatments. I think there are four main treatments

that I think of for SIBO. There's diet, which has helped you and I very much. There are antibiotics, pharmaceutical antibiotics. There are herbal antibiotics. And then there's elemental diet, or you might want to call it elemental formula, because sometimes the word "diet" throws people off. I find herbal antibiotics and antibiotics work about the same, which is very good. Elemental diet tends to work often even better, at reducing gas levels, anyway, than herbal antibiotics and



antibiotics. But it's a harder treatment. And diet, the key thing I want to say about that, is that many people, unlike us, they find diet is not enough for them. It's not able to control their symptoms to a level that is satisfying. And so they do need to move on to other treatments. So that's really how you want to judge. If a person tries diet, maybe they want to try that first. And if they're satisfied, excellent. But if they're not, there are other options.

Trudy Scott: So tell us what those dietary changes are that someone might need

to make. And I know it's going to be different for different people. But just ballpark, what are we looking at?

Allison Siebecker: Yeah. So what all of the diets are doing, is they're trying to restrict

and lower carbohydrates. So they don’t concern themselves with protein and fat. So those are all okay. It's all about carbohydrates, which is a huge category of foods. It's all plant foods. Fruit and vegetables and nuts and seeds and beans and what else am I forgetting, anything? – Probably sweeteners. I think that's mostly it.

Trudy Scott: And all the grains, of course. Allison Siebecker: Oh, of course. I forgot grains. I knew I was forgetting something,

great. So that's what the diets are targeting. And there are five main diets that I think of to be used for SIBO. And that would be the Specific Carbohydrate Diet; the GAPS Diet, which is a variation of the Specific Carbohydrate Diet; the Low FODMAP Diet; a combination that I made and my team of Specific Carbohydrate Diet, which is called SCD for short, that plus Low FODMAP, and we call that the SIBO Specific Diet. And then lastly is Dr. Pimentel's prevention diet, which is called the Cedars-Sinai Diet. So those are the five I think are – what's confusing is that they are all targeting different carbohydrates from one to other. They have a few things in common. They all remove lactose. They all remove sugar alcohols. And they all remove sucralose sweetener. And that's because sugar alcohols and sucralose are known to malabsorb in people anyway. So those are removed. And lactose is the most common carbohydrate malabsorption that we see in SIBO. So they all remove that. But after that, they do different things. So for instance, the SCD and the GAPS Diet are grain-free and starchy tuber-free. But the Low FODMAP Diet is



the opposite. It allows gluten-free grains and starchy tubers, so that can be very confusing to people. What's the right thing to do? Which diet? What I always say is don’t worry too much about it. Just pick one that appeals to you or maybe one that you think you could have a better chance of success with. And then begin customizing. Because whichever diet you start, there's always customization. It's a rare person that can follow a diet just as it's written, because everybody's different from one another. So then you start trying to find what works for you and what doesn't work for you. We'll say that the SIBO Specific Food Guide, the one I put together between Low FODMAP and SCD, across the board myself and my colleagues have absolutely seen that be the best at reducing symptoms without a doubt. But the trade-off and the con is that it's the most restricted. The reason it's the most successful is because it removes the most carbohydrates. And that can make it certainly harder to follow. And also it can reduce weight too much. Reduced carbohydrate diets are weight loss diets, in general. Like Atkins and South Beach and all that. So I see that as a problem in a lot of my patients. They get too underweight. So what I think is a prudent way to go is maybe choose one of the broader diets like SCD or Low FODMAP first. And see what kind of success that gives you. And only move towards the more restricted one if those others aren't working for you. Because I have certainly seen people where every one of those diets worked beautifully for them. Even with only minimal customizes. So start with something and then begin customizing to find what's right for you.

Trudy Scott: Great. And as you say, everyone's different. You may find that

you can do the SCD Diet, which is the Specific Carbohydrate Diet. I just want to mention this for people who may not know that's the one that was created by Elaine Gottschall. And then the GAPS Diet, as you said, was built on that. And that was the one that Natasha Campbell-Mcbride created. And that one, that's called the Gut and Psychology Syndrome. And she's found very good results with people who have anxiety and depression and schizophrenia and a lot of mood problems. So there we've got that tie-in back to mental health.



Allison Siebecker: Actually, thank you so much for mentioning that, because for the people listening to The Anxiety Summit, that might be their best choice. She customized and crafted the SCD. She modified that diet for her patients with autism and mood and brain disorders. And so I think her diet is the perfect diet for someone who has both gastrointestinal problems, like digestive symptoms, along with mood or brain issues – really fantastic.

Trudy Scott: Great. And I'm really excited to look at your SIBO Specific Diet,

because I think there are obviously going to be some people who do need to take it to the next level. And we just want to encourage people to feel empowered when they're on these diets. And not just feel, "Oh, my gosh, I'm so deprived." And that's where I find using targeted individual amino acids helps. Because if you really craving some of these carbs, and you are feeling deprived, using some of the amino acids can help you reduce that emotional eating component that you may have for some of the carbs. Because giving up grains and giving up starchy vegetables can be very difficult for a lot of people.

Allison Siebecker: It's so true. And going on a new diet, changing things, it takes a

while to learn how to feed yourself properly, what combinations of foods you're going to need in what amounts so you don't feel deprived. And so you're not starving and all that sort of thing. Got to give yourself some time to learn how to do it.

Trudy Scott: Yes, absolutely. And then I just want to also follow up on the Low

FODMAP Diet. We're seeing a lot of research on that now. And there are a lot of researchers in Australia that are doing work in this area.

Allison Siebecker: Absolutely. It was invented by Dr. Shepherd and Gibson in

Australia. And this is a really fabulous thing, I think. Because there, Dr. Gibson is a gastroenterologist and they put this diet out. And they've done research on it. And I think that's one of the reasons why so many gastroenterologists have not recommended diet to their patients is because there were no studies on it to show that it did anything. And now there are, on the Low FODMAP Diet. And the studies have just been taking off at a huge rate. So now I can't even keep up with them all. I think last year there was something like 15 FODMAP studies and this year, more. So this is fabulous. Because now the gastroenterologists and even in primary care they will now recommend the Low FODMAP Diet.



And it's a good diet. It may not be the perfect match for someone. They may need to go farther and remove the grains. But it's a great diet. So it's excellent. And by the way, there is an app for this diet. I have all of these resources you'd need linked on my site. But I just want to mention there is the Monash University Low FODMAP app you can get for your phone.

Trudy Scott: Can you just spell Monash for us, please? Allison Siebecker: Yeah, M-O-N... I think it's O-S-H. I hope I got that right. It might

be A-S-H. Trudy Scott: I'll check. And I'll make sure I put it on the site. And now I'm

going to direct people to your site so that they can read up on all the wealth of information there. But there are specific things that you mentioned I'll have on your speaker blog, so people who are listening to this can go back and actually get some of the links. So I'll make sure I get the links that we need.

Allison Siebecker: I just checked. It is M-O-N-A-S-H. That's the app. It's very

helpful. Trudy Scott: Okay, great – excellent. And then one follow on thing was the

comment about losing a lot of weight . Would you then recommend people add in a lot more fat? Good, healthy fats?

Allison Siebecker: Yes, there's a whole list of things I recommend when someone is

not able to maintain their weight. And there are more reasons for being underweight or weight loss than just the diet in SIBO. There can actually be damage to the intestine that creates malabsorption in and of itself. But yes, increasing fat, lactose-free dairy. If someone can tolerate lactose-free dairy, I recommend that. That is a great stabilizer to weight. And you can get a lot of good fat in that, like you can make your 24 hour homemade yogurt. That's a feature of GAPS and SCD. You can make that with half and half. So you've got your fat increased. Also, people just need to eat more and more often. This is very hard for people with digestive symptoms. And increase whatever carbs they can within the diet that they tolerate, like winter or summer squashes, honey, fruit, fruit juice. And then lastly, often I have to tell people the weight becomes a more serious issue than the gastrointestinal symptoms.



And so I'll have to tell people for those who are on more like a SCD Diet, I'll have to tell them to try white rice and white potato. And I find many people tolerate those just fine. Those are allowed on Low FODMAP Diet and Cedars-Sinai Diet. And I find many people tolerate them. And that very much helps with weight stabilization.

Trudy Scott: Oh, good to know. That's good to get that feedback. So are the

white rice and the white potato part of your SIBO Specific Diet? Allison Siebecker: It's not, because it's the most restricted. There are a lot of people

who can't handle those foods, particularly when they have active SIBO. Once they go through some other kind of treatment, herbal antibiotics or antibiotics, often their tolerances will expand. But there are just plenty of people that can tolerate those right off the bat.

Trudy Scott: Okay, good to know. I've got a quick question for you about the

treatment. When would you pick a medication approach versus the herbal approach? As a nutritionist, I would pick the herbal approach first. And I think a lot of people who are listening to this would obviously pick the herbal approach, too. Would there be a reason why you might go for the medication approach?

Allison Siebecker: Yes, there are many reasons. And really this is just based case by

case, person by person. People have different philosophies. Some people prefer antibiotics. Some people prefer herbal antibiotics. Some people have terrible reactions to either allergies or terrible die off to the herbal antibiotics. They may have tried them. And they cannot tolerate them. I've seen this time and time again. And then they must go to the antibiotics. Sometimes people choose it based on the timing in their life. They desperately want these symptoms taken care of as quick as possible. I've seen people where they're getting married soon. And they need a treatment to go quickly. The antibiotics are a two-week course, versus the herbal antibiotics are a four-week course. There are so many factors. Age can be a factor based – like if someone's very young, how we can give the medicine, what form it comes in. There's just this slew of pros and cons for each choice. Now if there's a practitioner there that they are opposed to pharmaceutical antibiotics, well, then, their choices are already made. They are not going to be doing that with their patients. And that's



everyone's prerogative to follow their beliefs. Same with patients – I've had patients go both ways. They will not touch the pharmaceuticals; they will not touch an herbal. So each person can make that decision with their doctor or the doctor with the patient – case by case.

Trudy Scott: With the medication, just tell us a little bit about the specific

antibiotic that is used, because it's a little different from other antibiotics?

Allison Siebecker: It is, yes. The antibiotics are called Rifaximin. And the brand

name, at least in the U.S., is called Xifaxan. And it is different, because it stays only in the small intestine. It doesn't absorb into the blood. So it's less likely to cause standard antibiotic side effects or problems like urinary tract infections and yeast infections. It's been studied and shown that it doesn't cause yeast infections after it. That's actually been studied. It's anti-inflammatory, which is a very unique property for an antibiotic / pharmaceutical to have. In fact, it's even been used to be injected into joints that are swollen, to reduce inflammation. And it stays only in the small intestine. It doesn't travel down and affect the bacteria in the large intestine. That's because it's biosoluble. So it's an extraordinary antibiotic that's quite different. And upon hearing these sorts of things, sometimes people who might have been totally opposed to antibiotics, now would be okay with using this one. It's quite special. The problem is if a person has methane, the Rifaximin alone is not usually enough to handle that. And then they need to combine it with either Neomycin or Metronidazole, which is also called Flagyl. In Neomycin's case in the intestines it will affect the large intestine, but it stays in the intestines at least. That's good. Metronidazole does not. That can travel into the blood and cause side effects. But I will say this: in all the years of using these with patients, certainly I see negative reactions to them, but honestly, not any more than I see negative reactions to the herbs. I find that these antibiotics are better tolerated than I would have ever expected. And I think it's because they are so targeted at the specific situation. And we're using them with people who particularly would need it. Maybe it's not that reason. I just have been surprised.



And just jumping over to the herbs, just because something's natural doesn't mean a person won't have an allergic reaction. I've had horrible things happen to my patients on herbal antibiotics just as they could with pharmaceuticals. Vomiting that puts someone in the hospital, bleeding out of the rectum. It's good to hear these things because sometimes people think they're harmless. And they really are herbal antibiotics. They have incredible positive properties. They are all anti-inflammatory. They're almost all antifungal. They do amazing things for us. They're more natural, certainly. But that doesn't mean someone can't have a serious reaction to them. And it's just good to mention, so that we take things in proper stride here.

Trudy Scott: And that's really good. And that's lovely to hear both of these

comments coming from a naturopathic doctor - certainly saying that you are seeing that the negative reactions to the medications are not any more than the herbal. That's good to know – and then the fact that you could have a bad reaction to some of the herbals, which is important to clarify as well.

Allison Siebecker: And particularly what's important there is for someone who is all

natural minded and says, "I'm never going to use any antibiotics. I'm just going to use the herbs." And then they go to use the herbs and they hurt them or bother them. Then they might feel ashamed or bad, like, "But these are natural." I'm just trying to mention it, so once again we wouldn't blame ourselves or feel we've gone against our beliefs or something. That maybe now you might need to choose a different route. I like to keep everything open for people so whatever they need is available.

Trudy Scott: And that's very good. And I must say when I first came across

your site and started reading everything, and I saw the mention of the medications and the antibiotics, I thought, "Oh, this is weird. How can a naturopath be talking about drugs?" So it's really good that we're having this discussion. I think it's important.

Allison Siebecker: Well, and actually, one more point on that, is that that's because

that's what's been studied and proven to be effective. And that's another thing that can happen to naturopaths or natural-minded people, is they just throw the baby out with the bathwater – right?



It's like they've got their mind made up about something. But do we not want to know what actually has been proven to work. And that's why I certainly don’t have any philosophical bias one way or the other. I'm not going to not report success, because it doesn't fit with the natural philosophy.

Trudy Scott: Yes. But now we have the study by Dr. Gerard Mullin, which has

tackled herbal therapy – is it equivalent to Rifaximin for the treatment of small intestinal bacteria overgrowth? And this is a very new study. And it's pretty exciting to see that this has now been studied as well.

Allison Siebecker: I'm thrilled. My colleagues and I, we've been using herbal

antibiotics for about five years with SIBO. And we have definitely found it to be as successful as pharmaceuticals. But we never published anything. It's very hard to do a study. It takes a lot of time and money, actually. We were so happy when he came out with this, because now there's proof. There was actually one other published study, but it was one case report. So now there's a nice big study to show it really does work.

Trudy Scott: That's great. So can you just mention a few of the herbal

antibiotics that we're talking about here? Allison Siebecker: Yes. So what Dr. Mullins' team presented in their paper is two

different options that they use. My team doesn't tend to use what they use, so now a person who listens to this will have plenty of options. What they use is by Biotics – the brand Biotics. They use Dysbiocide and FC-Cidal. And I believe they use two. Two times a day of each. I have it on my website if I'm getting this wrong. You can check. Every day for a month, that's one option. The other option was Metagenics brand, Candibactin-AR and Candibactin-BR. And I believe it might be the same dosing. Two pills, two times a day of each, for a month. And they actually found it worked even a tiny little bit better than pharmaceutical antibiotics. The formulas Dr. Mullins' team use are big kitchen sink formulas with lots of different herbs in there. What my colleagues and I prefer to do is use single herbs. And use two or three of those. It's just a different way to do it. And so we use Berberine-containing herbs, either something like Berberine Complex or Berberine-500 or just choose a Berberine-containing herb like Goldenseal. And we use that at quite a high dose. We use it at 5,000 milligrams a day, which usually winds up being somewhere between 9 and 11 pills a day. So that's five grams.



We also use oregano. The one we tend to use is by Biotics; A.D.P. is the name of it. It's emulsified. Oregano oil can be quite harsh and irritating to people's intestines. Emulsifying it, I think, helps. That means it's in a tablet. It's not oil in a capsule. And that is two pills twice a day. We often use Allimed; the substance is Allicin, but the product we tend to use is Allimed, and I think the brand is Allimax. Because it's the highest form in a supplement we found of Allicin. Allicin is the antibacterial ingredient in garlic. And so this is very high-strength; we use it anywhere from three to six pills a day. And then we often neem; the brand we tend to use is Ayush Neem Plus. And we use it anywhere from three to six a day.

And lastly, we sometimes use cinnamon. And we just follow label dose; there's no particular brand that we prefer. And so we usually use two of these and sometimes three. But the key thing here is that Allicin or Allimed is what we need to use for methane. We've never been able to find, as of yet, within our team, anyways, an herbal antibiotic that effectively targets the methane, other than Allicin. And so similar to how with pharmaceuticals you need Neomycin or Metronadizole with the Rifraximin when you have methane, you need to use Allimed. And you could use it, say, with Berberine or maybe with neem. So that's what we tend to do. And we find it very effective. One thing I will mention, though, is that die-off is very common, particularly with the herbal antibiotics. I often find die-off occurs more with the herbal antibiotics than with the pharmaceuticals, although it happens for both. And I think that's because the herbal antibiotics have antifungals as well. And they can kill many other substances. So I think more things are dying. And there's this stronger die-off reaction. And die-off is just when the immune system is triggered. When bacteria die, they break into pieces. And the little bits of their cell wall are recognized by the immune system. And then they react to it. They create inflammation. And then we get symptoms. And so the common symptoms are flu-like feeling, or feeling like you're coming down with something; fatigue, which is part of that; an aggravation of the symptoms you already have, which is just terrible when that happens. But it's part of die-off. And sometimes new gastrointestinal symptoms can happen.



Trudy Scott: Wow, thank you for sharing all of that. That's really useful. And I know it's on your site, and we'll direct people back to that. I've got one final question. So why is it that some people can do the Rifaximin approach, some people will the herbal approach. They'll get some symptom resolution, but then their symptoms come back.

Allison Siebecker: That's because we're not treating the underlying cause. By clearing the bacteria out, we have not addressed anatomically and physiologically what allowed the bacteria to accumulate in the first place.

So relapse is expected, actually. And that's the sorry state we're all in right now with where the SIBO research is, because in many cases we don't know to fix the underlying cause. And sometimes it can't be fixed, for example, in scleroderma. For those with scleroderma, that disease causes SIBO in a large proportion of its patients. Because that will progressively damage nerves and muscles in the intestinal tract. And then they cannot perform the migrating motor complex. And there is no cure for scleroderma that I am aware of. And it's a progressive disease. And there are many other diseases like this that can cause SIBO. So like diabetes is another one that has nerve damage involved with it. These are not simple diseases to just snap your finger and fix. Same thing with the post-infectious IBS, we don't know yet how to fix those nerves. Another cause could be obstruction – an obstruction type of cause. Very commonly, it could be adhesions, which are like scar bands that could constrict the small intestine. Creating like a partial obstruction, where the bacteria can back up behind. Often surgery is done to remove these, but these scar bands come from surgery. That's a difficult circumstance. The very thing to fix it could cause it again. So there are physical therapy methods that are available. Actually, we're going to featuring one of those at the symposium. This is such an important underlying cause. So that's where you need just really an excellent gastroenterologist, and a team of doctors who can help investigate and find out why – what is the underlying cause – and is there any way to fix it? So that's my answer for that.

Trudy Scott: That's a good answer. So the approach would be you've got the

symptoms, do the diet – maybe do the herbal and the Rifraximin so you can reduce the amount that you have. But be aware that it's likely to come back, and you've just got to manage it.



Allison Siebecker: Yeah. And we do have something for prevention, it's very

essential to do something for prevention. And that would be what we always recommend: is diet combined with a prokinetic. And very often, people will have the treatment that reduces bacteria, but they're not put on either one or the other or both of the preventions. And so then they relapse much more quickly. And that is a very unfortunate mistake that I see extremely commonly, is that they're just left out there with no prevention. And prevention is needed particularly when we haven't fixed the underlying cause. So please be sure to take a look at the algorithms that I have in my articles. And whoever is treating you, make sure you get that prokinetic along with the diet.

Trudy Scott: And a prokinetic is a... Allison Siebecker: That's a promotility agent; it makes for movement, and it can either

be natural or pharmaceutical. Although we really don't know how well the naturals work, but we just are trying to include natural things there.

Trudy Scott: Well, this has been absolutely fantastic, Dr. Siebecker. Thank you

so much, you are an absolute wealth of information. This has been so great. Every time I talk to you, I learn more. So it's been great. And I know it's been wonderful for folks listening – any final words of wisdom for us?

Allison Siebecker: Just don't stand for these symptoms. Do something about it. You

don't have to live like that. Trudy Scott: Thank you. Thanks so much. It's been great and I look forward to

seeing you at the SIBO Symposium. And I'll make sure to share that information and all the wonderful resources that you've shared today. Thanks again. And thank you everyone for joining us for another fabulous interview on The Anxiety Summit Season 3.

Speaker blog: http://www.everywomanover29.com/blog/anxiety-summit-intestinal-bacterial-overgrowth-anxiety



Allison Siebecker, ND, LAc, SIBO specialist

Allison Siebecker, ND, MSOM, LAc, has worked in the nutritional field since 1988 and is a 2005 graduate of The National College of Natural Medicine (NCNM) where she earned her Doctorate in Naturopathic Medicine and her Masters in Oriental Medicine. Dr Siebecker is the Medical Director of the SIBO Center for Digestive Health at NCNM Clinic in Portland, OR, where she specializes in the treatment of SIBO. She is instructor of Advanced Gastroenterology at NCNM, teaches continuing education classes for physicians, is the author of the educational website siboinfo.com and is writing a book synthesizing the SIBO data into one source. In 2005 and 2013, she received the Best in Naturopathy award from the Townsend Letter for her articles “Traditional Bone Broth in Modern Health and Disease” (2005) and "Small Intestine Bacterial Overgrowth: Often Overlooked Cause of IBS" (2013).

Trudy Scott, CN, host of The Anxiety Summit, Food Mood expert and author of The Antianxiety Food Solution

Food Mood Expert Trudy Scott is a certified nutritionist on a mission to educate and empower anxious individuals worldwide about natural solutions for anxiety, stress and emotional eating. Trudy serves as a catalyst in bringing about life enhancing transformations that start with the healing powers of eating real whole food, using individually targeted supplementation and making simple lifestyle changes. She works primarily with women but the information she offers works equally well for men and children.



Trudy also presents nationally to nutrition and mental health professionals on food and mood, sharing all the recent research and how-to steps so they too can educate and empower their clients and patients.

Trudy is past president of the National Association of Nutrition Professionals. She was recipient of the 2012 Impact Award and currently serves as a Special Advisor to the Board of Directors. Trudy is a member of Alliance for Addiction Solutions and Anxiety and Depression Association of America. She was a nominee for the 2015 Scattergood Innovation Award and is a faculty advisor at Hawthorn University.

Trudy is the author of The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings (New Harbinger 2011). She is also the host of the wildly popular Anxiety Summit, a virtual event where she interviews experts on nutritional solutions for anxiety.

Trudy is passionate about sharing the powerful food mood connection because she experienced the results first-hand, finding complete resolution of her anxiety and panic attacks.

The information provided in The Anxiety Summit via the interviews, the blog posts, the website, the audio files and transcripts, the comments and all other means is for informational and educational purposes only and is not intended as a substitute for advice from your physician or other health care professional. You should consult with a healthcare professional before starting any diet, exercise, or supplementation program, before taking or stopping any medication, or if you have or suspect you may have a health problem.

Documents

09 Allison Siebecker Anxiety and Small Intestinal ... · Pediatric dosages et cetera, for the doctors to look up. Trudy Scott: Wonderful. It really is fantastic. And I love that you