#325 The Bloat Stops Here: Cracking the SIBO Code with Alexa Ress

The information provided in this podcast is educational and not intended to diagnose or treat medical conditions.

Dr. Doni Wilson struggled for decades to solve her numerous health issues and heal her body, but with focused determination, she healed herself. And in doing so, she discovered the Dr. Doni Stress Recovery Protocol. On this show, you're gonna hear from doctors, nutritionists, and experts along with Dr. Doni, who will give practical advice and wisdom to help heal your body. This is How Humans Heal.

Hi, and welcome to How Humans Heal. I'm Dr. Doni Wilson, and in this episode, I'm really looking forward to introducing you to Alexa Ress. She is a holistic nutrition and functional medicine certified health coach, and she specializes in SIBO, IBS, and gut health in general, which is such an important topic, and she has so much good information to share. So thank you again so much for joining us today, Alexa.

Thank you, Dr. Doni Wilson, for the invitation, and I'm happy to be here. Yay!

You're welcome. It's— and I see what you're sharing with this information, and we'll talk more about that today. It's such an important topic because so many people are dealing with gut health issues, whether that's bloating, gas, heartburn, maybe constipation, diarrhea. They're getting confused, right, how to solve this. And there's a lot of different information out there on the internet and social media and so on. And so sometimes people get really into a stuck spot trying to find solutions. I know too, because I help a lot of people in my practice with gut health issues. And so that's why I'm so glad to get to talk it all through with you today. Um, maybe let's start off with just explaining some of these— this terminology like SIBO, IBS. What is it and why is it so difficult to resolve?

Okay. Yeah. So I agree that I think everybody knows someone who suffers from these digestive issues that you mentioned. So it's getting more and more common, unfortunately. And I think many people start their journey with a diagnosis of IBS. IBS, so irritable bowel syndrome. But for me personally, it doesn't really tell much about what's happening with the person. It seems like that we ruled out a bunch of, uh, um, serious conditions, and then the doctors usually don't know how to proceed, and they just give the person the IBS diagnosis. Now the research is evolving, of course, around SIBO more and more. So SIBO stands for small intestinal bacterial overgrowth. And it's estimated that around 45% of IBS patients, some studies even say around 80% of the patients, could suffer from SIBO instead of just IBS. So when we talk about SIBO, it's more about like the accumulation of bacteria that's in the wrong place, so in the small intestine. Where their number should be relatively low compared to the colon, so the large intestine, where we basically have trillions of microbes together that we call the gut microbiome. So this process, the fermentation process that the bacteria does, is happening earlier than it should. Now, this can lead to a bunch of uncomfortable symptoms. So people usually experience bloating, the chronic bloating that get worse by the end of the day, or some people describe it like feeling 6 months pregnant. So it's really like a tight, uncomfortable feeling. Some people can feel how the gas is moving throughout the intestines. It could create abdominal cramps and pain. And we can also see the changes in bowel habits. So some people may become constipated, while others may have urgency and diarrhea and loose stool. And then besides the digestive symptoms, they can feel low energy, low mood, brain fog, concentration problems. Also, skin could also be affected, so more breakouts, acne, rosacea, eczema, and some people may also experience joint and muscle pain. So it can really affect not just the digestive system but also other parts of the, the body. And to talk about terminology, because SIBO is a bit complex, so I would say right now we differentiate 3 types under the umbrella term of SIBO. So SIBO has hydrogen-dominant type of overgrowth, so when bacteria produce hydrogen gas. And then we have another type which is methane gas. These are produced by archaea, so they are technically not bacteria. So that's why they change the term to intestinal methanogen overgrowth, or shortly IMO, or emo, and they create methane gas. And the third type is hydrogen sulfide gas, and the new name is intestinal sulfide overproduction. And these are producing hydrogen sulfide gas. So I would say these are the three main types that we can differentiate.

And it's, it's just, just from what you just described, it's a changing— like, the more we learn, the more some of these terms are coming about and the differentiation is coming about that we weren't even really paying attention to that, to that degree 10 years ago. So anyone listening who's maybe been dealing with this or had a prior diagnosis, but you're still dealing with symptoms, just to help you understand that it, it can be— SIBO is not the same for every person. It could be slightly different for each person, and it actually might be renamed as something else depending on what, which type of microbes are overgrowing and which types of gases they're producing. And I think that's one of the key things that I really help people to understand is that it's— is that we have these microbes in our gut and we want microbes in our gut. But if certain microbes start overgrowing and producing too much of the wrong gases in the wrong locations, we're going to feel it. And it's usually going to be burping or bloating or gas or something, right? It's these extra gases. So if there's— if you're like, why am I having burping or bloating? It's like probably that there are some microbes that are overgrowing and there's ways for us to figure this out. What, what's the latest, Alexa, on in terms of testing? Right. Like, how do we identify? Because there is testing that's available even through a standard doctor's office, although not all gastroenterologists do these tests.

Yes, for sure. So currently the most commonly used form of test is the breath test. And yeah, so it's not widely available everywhere. And unfortunately, not all types of gas can be identified. So the breath test is a non-invasive test that basically means that in every 15 to 20 minutes you breathe into this tube and then they can analyze it. Which type of gas or which type of overgrowth that you have. And you also have to drink a sugar solution that's mostly lactulose or glucose. And if you have an overgrowth, then the bacteria can start fermenting this sugar solution. Now, in terms of the types of gases, so the most commonly measured tests or gases are the hydrogen and methane. So that's the one that's widely available, I would say, everywhere globally. And in the US only, you have the Trio or TrioSmart test. That's the only company that can test all three types of gases. So hydrogen, methane, and hydrogen sulfide. The cutoff values look, of course, different for each gas. So usually when we talk about hydrogen, we want to see a rise of 20 parts per million from the baseline within the first 90 minutes. While for methane, there is a different cutoff value, so it's 10 parts per million within the whole 180 minutes. So throughout the whole test, anytime there is a rise of 10 parts per million. Now for hydrogen sulfide gas, there is no official cutoff value as far as I know. I know that Trios Smart Test has defined their own standard, and I think they measure around 3 or 5 parts per million of rise throughout the test for hydrogen sulfide. So of course the test is really valuable, but it's not perfect. So there are mistakes along the way that could happen either from the patient side or from the practitioner side. So we need to, uh, calculate with these errors and consider together with the patient's symptoms and health history, uh, together. Just wanted to say an additional information because I feel like it's important. So because we talk about the gas types, of course, so when somebody has hydrogen, uh, overgrowth or hydrogen dominant overgrowth or gas production, we usually associate with the, with associated with diarrhea or more loose stools and bloating. And while having methane overgrowth or methane gas production is associated more with slowed bowel movements, constipation, indigestion, nausea, and sometimes methane or methanogen can extract more calories from the food that you are eating, and sometimes it can lead to weight gain. And with hydrogen sulfide gas, we see more diarrhea symptoms, but we also see more pain. So more bladder pain or more muscle or joint pain. And some people say that this rotten egg smell of gas can also happen, although I think that's not always the case. So I would say if you want to differentiate with the symptoms throughout this, or yeah, between these gas types that we could see this presentation.

And sometimes people may have a combination of these scenarios, right? It's not just a clear-cut single type of gas.

Yes, that's true. So it's not always that a single gas is producing all the problems, so multiple gases could be present at the same time. So we can see hydrogen and methane together or hydrogen and hydrogen sulfide together commonly. I would say these are the two combos that are happening most often.

So it's— if you've been dealing with these symptoms, then the question becomes, you know, whether to do the test. And, and I'm curious about your opinion. I find that as a practitioner, especially if a person has never had this kind of a test before, I do find that it's helpful so that, if at all possible, we can identify which gases because it could change the treatment. Actually, the treatment could be different depending on what gases we see on the test, right? And there may be some scenarios where, say, the person has been having repeat, you know, they've been dealing with this for a long time and they've been tested before and now it's recurring, which is quite common, then we might decide, okay, let's, let's try treating it and then maybe do a test once we've treated it to make sure it's been resolved. But what, what is your take on that? What do you— how do you talk people through, you know, kind of this decision to, to get access to— because I can help people get access to these tests through my office, but a lot of times patients will say to me, do I really need to do this test?

Yes, it's a valid concern, and I'm usually for the test or repeating the gas if it's possible, because it can really change the direction of the treatment or the protocol, um, based on the type of gas. So each type requires different type of protocol or treatment. So just to give you like an example, if you have a methane gas overproduction as well besides hydrogen, so let's say you have a mixed gas type, hydrogen and methane, then the most common antibiotic that GI doctors prescribe is rifaximin, but it's only good if you only have hydrogen. If you have also methane, it's not going to do too much. So you would need like a second type of antibiotic combined together. Or if you would use like a natural approach, so herbal antimicrobials, then you would need different herbs to tackle the problem. So I would say that's why it could provide key information about the treatment approach. And it could also give you like information about the level of overgrowth or how much overgrowth that you have, because each treatment cycle could reduce around 30 to 40 parts per million of gas. So if you have like a lot of overgrowth, sorry, on the test, you see 60, 70, 80 parts per million, then it may happen that you may need several rounds to tackle that overgrowth so that you, you can have clear expectations about the process. And of course, for some people, it could be beneficial to do a retest if they are willing to do that so that you could see whether or not the body responded to the treatment. Or not. So I think this kind of decisions could be influenced by doing the test.

Yeah, I agree. And the— and this recurrence rate, let's talk about that, you know, because I think sometimes people go into it thinking, oh, I'm just gonna take this one treatment, one antibiotic, or whichever treatment once, and I'll be done with this. But I think people could be quite surprised and frustrated when they learn, oh my gosh, it may require multiple treatments to just even resolve this.

Yeah, so there is a high recurrence rate for, uh, SIBO. So the current— or one study found that almost 45% of the people who have taken one round of rifaximin relapsed at 9 months after finishing this treatment. So that means that almost 50% of the people relapsed within one year. So I think that's a high number.

And so too, we could do much better, right? I really think like, let's, if we can look at it as a more comprehensive issue and address it more comprehensively, we can, I find we can cut that down much more.

Yes. Yes, for sure. So obviously this test only looked at it from the traditional conventional medicine, uh, perspective. And, uh, what I like to do with clients is more of a holistic approach that we try to support the body from multiple angles. And I think the biggest question is why SIBO keeps coming back. So what's the underlying driver behind SIBO? Because I think one of the mistakes is that people go ahead with the SIBO treatment like it would be a sort of infection. Mm-hmm. Why it's not. So the body has its own defense mechanisms built in against the overgrowth. So if you talk about these defense mechanisms, we could say that you have the upper GI region where you have a good stomach acid level that could also keep bacteria in check, or the pancreatic enzymes so that you can digest the food and they don't get fermented, or the bile flow, which also has antimicrobial properties. Or the structural part, like an intact ileocecal valve function that opens and closes at the right time so the bacteria doesn't flow back into the small intestine. And then we can also mention the gut microbiome, the immune system as well, or the nervous system as well, which is crucial for supporting this good gut-brain communication. So the body has its own defense mechanisms, but the question is where you have weak points that we need to support.

It's— I love the way you're explaining that, right? It'd be like, this isn't an infection. This is because something in your digestion or your body isn't supporting your digestion well enough. And so the overgrowth is subsequent to that. And if we just go in and try to kill the microbes, we're not solving the underlying issue. Of like what's really going on here. And it could be different for each person and it could be multiple things. So yeah, let's, let's talk that through some more. And I, especially as someone who specializes in stress and, and helping people recover from stress, I love that you talk about this too, right? That it's like, wait a minute, we have to stand back and be like, what is it that's allowing this to happen? And And, um, and right, is, would you say like stress is a big part of it?

Yes, could be. I'm not saying it's a direct factor or a causing factor, but indirectly it can definitely be a part of it. So I usually say this to my clients that if you are stuck in a chronic stress state, then your digestion is shut down basically because survival is the most important thing in this case, not that you digest the food that you eat. So, and the other thing is that many people don't realize that they live in chronic stress or they get disconnected from their bodies so much that they can't really differentiate between hunger cues or gas moving or these little things sometimes. So we need to train basically their bodies to get to the toilet, to have a rhythm, to know when to expect the food, so to say. So really having a good meal hygiene, meal rhythm, and even mindful eating habits. So we— where I basically have to teach them how to eat. I know it sounds a little bit silly, but it makes sense to me. Something—

the basics, we don't learn it. We don't really don't learn it, or if we did learn it, we forgot. You know, we're like you said, we're so distracted with our busy lives. And we're just eating fast and our digestion isn't even getting the signal. So maybe talk through a little bit about how do you teach people how to eat and allow their digestion to work for them?

Okay. So normally I have, of course, an intake or about how the person lives his life or what eating habits they have. And, um, I also have like a little cheat sheet, uh, to print out for the person that could remind, uh, about what was the color of the food? How was the taste? Can you remember, like, can you describe the food that you have just eaten? Because as you said as well, that, uh, we are so distracted or sometimes we tend to scroll on our phone, uh, during the meeting. Biggest mistake. And we don't even realize what we are eating, how much we are eating. So this is, this is also the first step to leave the phone in the other room and just concentrate on the food, just you and the food, nothing else. And they really have to go through this list of questions and to see what they can remember as well. And then it helps to build more mindfulness around eating in a way. Of course, breathing exercises before getting or sitting down to the table to eat. So even just 3 rounds of deep belly breaths, just release any thoughts that you arrive at the table and you're going to eat. So kind of like a conscious process and preparing the mind that food is coming in. And usually that's the first step to release digestive juices later on or to digest that food or bite of food. So I would say these are some of the things that we are working on to really get in tune again with the whole process and with the body.

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Yeah, it's so amazing, right, to realize that, like, we can actually communicate to our nervous system, to our digestion, that we're about to swallow food and we need it to help us digest the food by doing these things, right? By actually, like, consciously being like, oh, what am I eating? What does it look like? What does it feel like? What does it taste like? And the breaths activate the vagus nerve, right? So it's like directly nervous system communicating to not just the, the stomach and the intestines, but also the pancreas and the gallbladder and saying, hey, we need to— we need some stomach acid, we need some pancreatic enzymes, we need some bile because the food is coming. And give your body some time, right? Eating more slowly so that we can It gives your body some time to catch up and actually digest your food better. Because if— because the point is, is if your food is not digesting well, you're not going to get the nutrients, first of all. And instead, it's going to overfeed the microbes in your gut. And when microbes are overfed, they make extra gases, right? Like, I think, right, sometimes for you and I, that's so obvious. But for some people, you're not— we're not thinking, oh, whatever you're swallowing and eating it could feed these bacteria. And while yes, we want to— we always hear about how we need to feed our bacteria, but there's such a thing as overfeeding them. Maybe you can talk about that. What are some of the common ways you find that, say, even someone is more mindfully eating and they're being careful, but do you also see that they might be overfeeding their bacteria thinking that they're doing a good thing, right? They're like, oh, I heard I need to eat a bunch of fermented foods and fiber. Do they— do you see that too, that sometimes we just overdo it and overfeed them?

Um, to be honest, I see the opposite by the time that they come to me. So usually people restrict their diet too much.

They've been dealing with the symptoms and so they restricted their diet.

Yeah. So normally people go through several diets before they come to me. So, and they are under eating and they are not eating enough nutrients and they really fear of food, and, uh, that's usually about the most fermentable ones and fibers for sure. But yeah, of course, if somebody is like just following general guidelines and we hear about probiotics or fermented foods as the first sign of support for any gut issues, then of course it can backfire very easily if you have SIBO because these are the the things that could add like fuel to the fire, so to say. So yeah, they can create more problems if you start eating a large can of sauerkraut or if you start drinking kombucha. So these are the things that may not be the best at that stage and you may need to follow like a different approach at the time.

Yeah.

Such a, so it's so good to see like where are, so people listening could say, where are you on that kind of like spectrum? Spectrum. It could be over on this side where you're like, why am I so gas and bloated? And, and yet you might be consuming something that could be aggravating it at that point, like extra fermented foods or extra fiber that may— and how we have to first address the overgrowing microbes and then slowly come back to the, the pro— the probiotics and fiber and things later. But like you're saying, there's also the extreme where someone's been trying to treat this for a long time and they end up overly restricting their diet and then they're— maybe they're having weight loss and, and, and extreme restriction in their diet. And how do you— what do you help them with at that point? How do you guide them through that process? Because that can be pretty stressful too, right? It's like it's too— I see that also where people are so restrictive they don't even know what to eat anymore.

Yes. So right now I also have a client who has a very restricted, or I would say simpler, simple diet. And nowadays I rarely use any SIBO-specific diet with anyone, to be honest. So we may take out the biggest offenders like onion, garlic, or some of the brassica family veggies, um, um, sweeteners, artificial sweeteners, or sometimes wheat, lactose. But for the most part, I think We don't even have to do that because they only have 5, 10 safe foods that they are eating, and we need to heavily work on increasing and expanding the diet. Then sometimes this can happen in tiny steps. So just to give you an example, I have now a client and, um, they have a garden. So now it's summer, they have peaches in the garden, and he really likes baking peach pie for his kids. And he told me that he was, uh, feeling so sad because he didn't dare to take a bite of that peach because he thought that it's going to blow up his stomach if he tries that. And we need to work with this mindset. Like, do you really think it's realistic that's going to happen? Or what happens if you just try one slice? And we really have to take this, uh, like in a in a tiny step and just try it and see what happens. Will you feel worse or maybe better or nothing going to happen at all? And when they start experiencing, oh, okay, I actually tried that, nothing bad happened and I feel fine. And then we can move on to the next item that they really miss from their diet. And then we can add back that too. So it's this trust with the food that rebuild up again within themselves. Or I don't know how to express this, right?

But, uh, yeah, yeah, to realize that it's— sometimes we think of things as kind of like black and white, you know, like I can eat this, exactly, but actually healing the gut, a lot of times we need to go with these, like, the gray zone, you know, like going little by little and So as you're helping people to digest their food better and, and get rid of the overgrowing microbes, then they can start to bring back things that they may have in the past might have really caused the problem, but now they can start to bring it back little by little. And it helps to heal their connection with their food. You know, it's so— it's such an important part of this because it's— the goal isn't to have a forever restricted diet. The goal is to get back to a healthy digestion and, and a nutrient-filled diet, right?

Yes, of course. So I like that you mentioned this black and white thinking. I think this is really dominant in this space, and a lot of people also have perfectionism, that they feel like they need to follow a plan 100%, otherwise it won't work, or they fail, or I don't know, so some kind of scenarios that they think will happen. And I have to remind them that life is happening. So you're always going to have responsibilities. You have children, you have work to do. So you can't really force a habit or you can't really force a 60-minute morning routine into your morning if it doesn't fit. So we need to find something that fits your lifestyle and it decreases the stress that you have, not adding more. Because if you're going to get stressed about, again, about a certain habit or a diet or anything, that's going to backfire.

It is. It's just creating more stress on your system.

I don't know if you get what I'm going to.

I exactly agree. We have to— it's like if stress is already part of the reason why this problem exists, we want to help you heal without creating more stress because The more stress, the more it just winds tighter and tighter and tighter, and your number of foods goes smaller and smaller and smaller. And it's just not a— it's not the solution we want. We want the solution where— and I, by the way, I had SIBO and also fructose intolerance and severe leaky gut. This was earlier in my life, and, and I learned this through that process of like, oh my gosh, how do I heal my gut to the point where Now I, I, I can eat fruit, you know, like I can, I can eat these things that I, that were definitely causing a problem for me many years ago. But it's, I could be an example of what it's like when you, you're talking to us, getting me, reminding me how much more freedom I have with my diet now than I ever had before. But it, it's about getting that commitment to the healing process, right? Like get the right mindset, because I think the mindset really matters when it comes to healing any part of your body, but especially the gut.

Yes, of course. I mean, mindset is a huge part that we— or I support the clients with. And of course, you have to also believe that healing is possible for your case. And with the right support, of course, we don't want to blame everything on the mindset or the stress or everything. Around that because obviously it's a two-way pathway. And we also want to support the body from the biological side, but we also need to work with the mind, mental or mindset part as well, because they have influence each other.

Yeah, it's about how to find that, that balance, right?

Balance, yes.

Maybe you can, maybe this relates a little bit to, and you can we can talk about the migrating motor complex because this is something that I think when people are learning about SIBO and they often hear about this and there's a lot of confusion about it and how to support it in the healing process.

Yes, and I think this is something I missed from the list when I mentioned the protective mechanisms, which is one of the most important ones, the gut motility. And in case of SIBO, we namely talk about the migrating motor complex, or shortly MMC. And this is a certain type of, uh, gut movement that helps, uh, clear out remaining, uh, food particles and bacteria from the small intestine toward the colon. And this only happens in fasting periods. So when we are not eating or drinking any caloric beverages. So usually it kicks in around 90 or 120 minutes depending on the person. And it really involves like nervous system or nerve function, muscle contractions and hormones as well. So it's a complex interplay. And one of the ways how we can really support this gut motility is through meal spacing. So we really want to give the digestive system a break, ideally 3 to 5 hours between meals. So it really has the job to do this housekeeping task to clear out every, any remaining derbies. And, um, and also mindful eating habits and all of this that we talked about, the vagus nerve, the nervous system support, because how it can really, um, manage the nerve function. And of course, we can also mention the usage of prokinetics. So these are— there are prokinetic agents that can help trigger this gut motility. And then we also have pharmaceutical options and natural options. And yeah, there are a list of supplements that we can choose from. And, uh, me— me— so besides the meal spacing, eating habits also play a role, and the circadian rhythm as well. So we want to have a good wake-up and sleep cycle because that can influence how things are working.

Absolutely. And it's— I love that you're— we're talking about how supplements can help because A lot of times if someone's just going to, let's say, a practitioner who's recommending, let's say, the antibiotic type of protocol, they might not talk about supplements that you can use that, that help with this process. So just for people to, again, like emphasize that this is— it's not just about taking one pill and you're done.

It's—

we need to really understand what's going on underlying and that we can, alongside any anti-inflammatory microbial treatment be using these different approaches to help with the migrating motor complex and using prokinetics? And maybe if you can explain a little bit about biofilm disruptors, because that's another one that people will come across, this concept of biofilm, and do we need to address that?

I think, yeah. So maybe not everybody, but I think most cases, especially if somebody relapsed I would recommend using a sort of biofilm disruptor. So because sometimes the bacteria and other microbes can shield themselves or live in this community and kind of like, so to say, shield. So antimicrobials will have a hard time to penetrate through this shield and to reach them and really kill them. So using a biofilm disruptor before the protocol or even the treatment can make the treatment more effective. There are also gentle ones like NAC, but also there are more potent ones, and even in the natural forms, so to say, like the Interface Plus, or I think Priority One also has one, the um, Biofilm Advanced, I'm not sure, something like that, by Phase 2. So they also have some, uh, products, uh, that could work. So I think starting, uh, the protocol with this biofilm destruction could really make treatment more effective.

And, and that's a cool thing too I find about the antimicrobial herbs is a lot of them are also biofilm disruptors. So they can— sometimes these natural approaches, you can get multiple effects in, in a single product. Um, maybe since we didn't talk about this before, I'm curious about what you find in terms of, you know, using a conventional antimicrobial versus a plant-based or herbal antimicrobial, and what do you find in your work?

Um, good question. So it depends on the person. So sometimes they come to me after they tried a conventional approach, antibiotics, and they didn't really work, or yeah, they relapsed. And of course, the pharmaceutical ones have also side effects. So especially if you, if you need like a second or additional one for methane, they are not without side effects. And many people don't want to take that chance., to develop such severe side effects. So they rather want to try the natural approach. There was one study that showed that natural antimicrobials could be as effective as antibiotics, but of course this is a very limited study, so take it with a hint of salt. And, uh, from the natural side, so they could also be really beneficial. Then we talk about berberine or neem, Oregano oil or elderberry for methane, thyme oil, or even combo formulas like CondiBactin, BR-AR, Dysbioside. And there are many others on the market. Now, one thing I think it's important to mention that even though they are natural, it doesn't mean that they are also safe. So it's also recommended to use it under a guidance of a practitioner or a doctor who can help you, uh, especially if somebody is on medications. Because for example, with berberine, uh, it can interact with many type of— many types of medications. So it's something that not to take just, uh, on the side or—

yeah.

And I think that's a really good point because it's like you can— it's tempting to just kind of like search and find like, oh, I'm just going to try this or try this on my own. I like— you probably see this too, many people who eventually then contact me and say, oh, I tried this on my own and then I felt worse or it didn't work. And that's why it can be so much more efficient to contact someone like Alexa or, you know, have me help you because it— then you can actually get help with all of this. It's complex. And you can't— I don't think we should expect that someone can just figure this out on their own unless it's a very simple, minor thing that's the first time that it's happened to you. But it's more often it— by the time you realize what's going on, it's more severe or been going on a long time. And, and having someone guide you with the dosing really makes a difference, right?

Yeah. So, and it also depends on the person. So there are also sensitive people, and jumping straight into antimicrobial protocol I don't think it's a wise approach and I never does that, never do it. So we always want to make sure that we work on the foundational stuff. So that includes like nutrition, meal rhythm, motility support, upper GI support, inflammation, and so on. Especially if somebody has also like mast cell activation syndrome or histamine intolerance because their system is much more sensitive. Before considering adding any antimicrobial herbs, because they can also trigger die-off symptoms even though they are natural. So when the microbes start dying, they can release toxins. And if they cannot really get out or the detoxification pathways get overwhelmed, then they can create more symptoms during this phase that you may need to tackle. And it's better if you have someone who can advise you on how to do this or how to get through the protocol or how to modify it as well. So not everybody can tolerate the same dosage, even though some people may recommend to take 1,200mg LSD, it may not be the right dose for you, maybe. So I think it's, uh, very individualized at the end.

Yeah, I completely agree. And getting these, these foundational parts in place first, like the bowel regularity. Now, like you mentioned before when you were describing the different types of SIBO, some types are more likely to have constipation associated, whereas some don't. And so when, say, someone is experiencing constipation, Let's talk that through a little bit. Like, what is— what does that mean? And, and what are some things they might try to begin with to help with constipation? And then definitely working with a practitioner to help with that, because sometimes that in itself requires help to resolve. Because if the— right, if the constipation is still happening, probably the SIBO or bacterial overgrowth or microbial overgrowth is going to continue happening. So we got to solve the constipation thing first.

Yes, I agree. So you don't— definitely don't want to start any antimicrobial phase until you are severely constipated. So I would say usually the goal is at least 1 bowel movement a day, preferably more, but that one should be like a good bowel movement, not like feeling incomplete. Um, so yes, um, with methane it's a bit more trickier. Yes. Because anyway it slows down and sometimes, uh, it's a bit harder to achieve, uh, perfect bowel movements, um, in the beginning. But, um, like magnesium is something that we are trying to use as well to support peristalsis and also, uh, bowel movements, either the citrate form or sometimes oxide if it's really needed. But we can also use, uh, kiwi fruits, for example. Uh, I also like coconut water because it has additional potassium that's also needed. Like, minerals are needed for bowel movements and the vagus nerve support as well. Eating habits, chewing, it's really important that they can start digesting the food that way with the mechanical— supporting the mechanical part. Vitamin C is also a great option, and certain actually prebiotics could also be handy. So one of my favorite is partially hydrolyzed guar gum, or shortly PHGG. And this is really great not just for constipation but also for diarrhea. It could be really beneficial, but the key is that we really start slow and low. So really just 1/4 of a teaspoon so the gut microbiome has time to adjust. And it can also help with improving bowel habits. And the other favorite one is ginger tea, or even ginger capsules for some people. So this can also be a really great way to boost gut motility. And, um, and even Prokinetics can come handy right at the start, actually, to boost the gut movement process. So, and then of course exercise.

Of course. Yeah. So good, right? Like we do need to be able to move our bodies in order to move our bowels. And, and I like, I always like to emphasize that distinction. Like when we talk about bowel motility, like in terms of the stool moving with constipation and correcting the constipation, it's about the large movements in the smooth muscle of the intestines, whereas the migrating motor complex that the prokinetics help with is these, this little fine-tuning motion in the gut. And so, you know, that we're trying to get the big motion, but we're also trying to get the small motion to keep things moving through. We don't want things sitting still because if it's sitting still, it's the opportunity for these microbes to overgrow again.

Yes, exactly. So, and sometimes structural issues can also be a problem or a contributing factor. So I have worked with women with history of endometriosis or any abdominal surgery, and I always recommend in those cases to see a manual therapist, especially one who is specialized in visceral manipulation technique, because they can really discover the belly area manually and they can release any obstacle that may feel, or yeah, they can release so everything can flow again way, way better. And they can also teach the clients certain techniques that they can practice at home. So I have seen massive results just from this addition with many clients.

That's, yeah, that's amazing. And it's so good. It's such a good reminder to that sometimes, yeah, it's using physical therapy or even pelvic floor physical therapy, or, you know, there's different specialists who can help with restoring healthy function in your digestion and, and, and in the pelvic area for sure. And, and it reminds me that, like, to just— I think you mentioned this early on in terms of the symptoms, but that there's so many connections with the gut. So like what you'll be going through, sometimes this process may feel like, oh my gosh, okay, this is quite a project to get your gut back. But getting your gut health back on track can have such good ripple effects throughout your whole body.

It's—

right.

Do you hear this from your clients that they feel so not just their gut feels better, but their whole body feels better after going through this?

Yes, of course. I mean, after working together with many clients, so after a few months, they can report usually much better bowel movement. Regular bowel movements, nicer skin. So these breakouts and acne, they slowly going away. More energy that they thought that they never gonna get back, or feeling like this big doom is going away. So they don't feel so sad and, um, yeah, gloomy, uh, all the time as they used to before. Better concentration, better performance. They can return to exercise. That they felt like that they needed to give up before, and less bloating. So it really affects the whole body once the changes start happening.

And I see so much— being a women's health expert, I see so much interconnection between vaginal health issues, and even you mentioned bladder before, but bladder health issues related to gut health issues. So the more we heal the gut, the more we also benefit the vaginal health and bladder as well. Do you see that too?

Um, I mean, I'm not specialized in the vagina area, so I don't know, but sexual performance and libido may return as well. So this is something I hear sometimes from the clients, that they feel like wanting their partner again, which I think is an amazing, uh, sign. And yeah, sometimes we could see bacterial vaginosis or Candida happening with SIBO, so it's not really uncommon. And this can— these things can also start clearing up as the balance or the microbiome start shifting again. So not just in the gut, but also in the vagina, for sure.

And, um, you offer— I'm thinking we're going to share your— you have a free guide that we're going to share, the Ultimate SIBO Guide. So, um, if you're listening in, to look down in the notes to, to find that guide from Alexa. But also, um, you offer, uh, online consultations, or how is it that you help your clients usually?

Yeah, so I only offer one-on-one consultations. So I really believe in the personalized approach for anyone who is looking for support. So currently there is like a 1-month foundational program where we really look through the whole health history, symptoms, and we are searching for patterns, possible root causes, and really starting with the whole process. And then we can take it from there. So a 1-on-1 support is available for everyone. Yes. Okay, there is also more information.

It's seekingguthealth.com, is your, your website. I think that's where you are on Instagram as well.

Yeah, the handle is the same, Seeking Gut Health, all together.

Yes, I love that, I love that, because that's the thing, we at this point, people really are seeking gut health. They're like, what do I do to solve this? I'm tired of being bloated all the time and and more than that. And it's in it. If you feel like you've been going in circles, I'm hoping this is helping you to start to sort out some of the confusion and see what a plan looks like. And, and I'm so grateful, Alexa, for sharing, you know, like, that it's, it's better to sit down with someone and make a plan and be comprehensive and to take it slow. That's one of the main things I'm hearing from you, and I agree with that.

I, yes.

Really find, like, I call it the paradox of the gut, which is that it's the— even sometimes the more severe your symptoms are, it means the slower we have to address it.

Because I like that.

Yes, right. It's like it— I've just seen it time and time again that when we make small changes and introduce even single ingredients very slowly, then we actually make more progress. It actually is faster than if you try to throw everything at it at once and then you feel worse and then it backfires and you have to start over again. So it's so worth it to honor this gut paradox and be like, okay, let me take it slow, kill the bad microbes slowly. Even it's a better strategy to kill them slowly than to try to kill them quickly and allow your body time to heal so that you can actually change the whole environment and, and win your body back and win your gut back and, and have your microbes actually working for you instead of against you.

Yeah, I absolutely agree, and I love that you mentioned this. And unfortunately, I know that when you're in a lot of pain and you are overwhelmed and you want to fix this like yesterday, then you don't want to hear that it takes time, or you go— you don't want to hear that it's a slow approach. But as you said, it's exactly the right way if you want to achieve long-term results. And I have seen this time and time again. So this really works like that.

Amazing, right? Well, I'm so glad that people have you as a resource and an expert in this area. Thank you for everything you do and all the information you've shared here and that you share all the time in your, on your Instagram, that then in other places. I'm so glad you're able to join us here at How Humans Heal.

Thank you. Thank you so much for inviting me, and thank you for hosting this amazing podcast series and sharing your knowledge as well, and that I could be also part of the series and share my insights with your audience. Thank you.

You're welcome. You're welcome. And thanks everyone for listening in. You feel free to reach out to Alexa if you have other questions for her. And if you are new here to How Humans Heal, then I welcome you to subscribe so you don't miss the next episode. Take care, everyone. Talk to you soon.

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