Why Antibiotics Fail to Cure SIBO—and What Your Doctor Isn't Telling You

Hi everybody, I'm Dr. Sanda Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most in a natural way. Hi everyone, welcome to today's episode on The Holistic Dentistry Show. I'm your host, Dr. Sanda Moldovan, and with me today, I'm very excited to chat with Angela Pfeiffer, and we're talking all about SIBO. Now, a lot of you might not even know what SIBO is, so stay tuned if you have any symptoms that are, uh, bloating, gas, indigestion, bad breath, a discomfort in the intestinal area, because you might find some really interesting information and tools that could help you beat this. Angela is a functional medicine nutritionist with over 20 years of clinical experience, known as the SIBO guru. She is recognized as one of the nation's leading experts in gut health, specializing in digestive disorders, chronic gut conditions, detoxification, and of course SIBO. Angela holds a master's degree in nutrition from Bastyr University and psychology degree from University of Washington. Certified in functional medicine, serves as the scientific board for Physicians' Choice, makers of the number one probiotic in the US. Last but not least, she's the creator of and host of the Cracking the SIBO Code Summit, bringing together over 50 experts in functional and integrative medicine to explore the root cause of chronic gut dysfunction and inflammation. So Angela, I'm so glad that you are here. Welcome to the show.

Well, thank you. Thanks for having me.

So number one, SIBO, what exactly does SIBO stand for?

Yeah, small intestinal bowel overgrowth. So it's where we get an overgrowth of organisms, bacteria in the small intestine. And that area, we're not used to dealing with a lot of gas. A lot of pressure stretching. If there's too much gas production there, things move through there a little bit more rapidly where we have a lot of fermentation, like excess fermentation happening in the colon, and it can handle a little stretching and passing of the gas. If that gets trapped in the small intestine, it's very, uh, painful. And so too many organisms in that area consuming what we're sending down, they'll produce gases and that causes the symptoms for people. Mm-hmm.

So, so what happens is people, when they eat, they start developing this kind of bloating in this area and belching.

It's usually about a really classic symptom presentation would be about an hour to 3 hours after eating a meal. They would then feel that because it takes time to get that whole digestive process going and actually release food from the stomach itself to enter the intestinal tract, to then get it to move past that wherever that overgrowth is in the, that 20 feet of small intestine. It's gotta get there. Right. To then be consumed and those gases produced.

Okay. I'm curious, how did you become interested in SIBO? And actually, I haven't heard of it until I actually had to deal with it myself.

I know sometimes, right?

Exactly.

Sometimes it's all you see when it's like any, anywhere I go, all I see is SIBO, but I appreciate that. So yeah, I've been in practice 20 years. I said, you know, when I first came out for the first 4 years or so, I was focusing on IBS. And emotional eating. And I was very good at getting IBS symptoms settled down. I had so many people that were chasing bathrooms and knew where every bathroom was in the city, and I could get all of that calmed down so they weren't being driven and had to live by their symptoms. And it seems, you know, even when I speak to my colleagues that are, you know, some of the founders in the field as I am in terms of clinical treatment, it— there was this thing that reared its head that no longer listened to what we were doing. And it's just that the SIBO thing came out. It's very strange how it— and I speak to my colleagues about this, like, where did this come from? We all just noticed it about, you know, kind of coming out at the same time and seeing more and more cases with this present. And I, you know, I don't know that we have a clear answer on what caused this for people other than just, you know, to me, we can only take so much stress and so much technology pulling us in all these different directions and staring at our blue screens all the time and not think that something is going to give just in terms of processing and all of it. I mean, we know stress is not great for our system and we don't think about being on all the time, hearing the news all the time, which is very negative. And there, you know, something in our hand talking to us about this all the time. I'm not saying that's the cause, but that's the only thing I can come up with in terms of movement through the United States. You know, and where this came, but it's a, it's a worldwide phenomenon. And I'm not saying this is the first time that SIBO's ever reared its head. Of course, SIBO has— I'm sure there's been cases in the past, but it seems like as a collective, it came out on, you know, about 15 years ago where it was a lot more noticeable clinically to people.

Yeah. IBS, maybe more people have heard about it, right? What does IBS stand for?

Irritable bowel syndrome.

So I love that name, right? Irritable. Like what's irritating it?

Yes. Yes.

Okay. Something obviously is, it's not just irritating itself, but so a lot more people have heard of that, but very few people have heard of SIBO.

Mm-hmm.

So how do you distinguish between the two?

Yeah, not everyone with IBS has SIBO by any means. I think from studies on average, maybe 30% of people who, you know, 14 to 30%, I'd say, of people who have IBS could have SIBO. SIBO is just different where I'd say IBS has a lot of different factors that could drive it, there's this nervous system response that's happening with that. So the irritability, I mean, if you go in and have a colonoscopy and they're going through, you're sedated, and yet as the gastro is moving the scope through, the entire intestine will just shake like it is irritable. It's a, it's a nervous system response to the being touched and being things moving through. So it really is quite different when we look at. SIBO, that's going to be, we measure it through a breath test. There's some symptoms that are very similar and in the presentation. So if we suspect SIBO, we do, we do a breath test for SIBO and they're going to do glucose or lactulose as a substrate. They drink that because those are fermented in the intestinal tract and then they basically blow through these tubes at increments and it'll tell us if your gases are too high at one point and we're measuring for hydrogen and methane.

Very interesting. I've actually taken one of these breath tests. It just takes time, right? I think every half an hour or so you have to keep testing. Yeah.

Yep.

And for me, uh, what triggered SIBO is actually food poisoning. Mm-hmm. Is that a common thing that you see and what other factors are out there that can cause SIBO?

Yeah, definitely. It's definitely common. It really, really is. So I kind of feel like, you know, well, first of all, all SIBO is secondary. There's no primary cause of SIBO. So if someone has had maybe diabetic neuropathy where the nerves are being affected because they have diabetes that's not in control and they're getting a breakdown of communication in the small intestine, you could see how maybe things could slow down a little bit and allow that overgrowth to happen. Some people have short bowel syndrome where they have resectioned intestines and, you know, if they don't have change anatomically in terms of just length of intestines, there's going to affect things. But if that has removed their ileocecal valve, kind of offering some, just a tube where the ileocecal valve closes off your small intestine into your large intestine. So if that's not there, just like your esophagus is at the bottom of your throat, you'd get acid coming back up. So you can get backwashing coming back up from the colon as well. Post-infectious IBS is what you're talking about. So basically you had a foodborne illness and what's common about that, whether it's Campylobacter, Salmonella, E. coli, or, and so on, Cryptosporidium, they all produce something called the CDTB toxin, cytolethal distending toxin. You are going to mount an antibody response to that. Your immune system will, that's what makes us sick. That's what makes things go up. And out. Body just wants to get this toxin out. In about 10% of people, they will have almost like an autoimmune response from that. Well, they'll kick over— something is really similar in that CDTB toxin to vinculin, which is normally in us. It's a communicator connector in the intestinal tract. So when you eat, things move down your throat with peristalsis, right? When you have food moving through your intestines, they're moving down your intestines through peristalsis, these earthworm-like movements that go down that help to propel things forward.

Mm-hmm.

So vinculin helps with that communication. So if your immune system is going after it and breaking it down, that signaling can't occur. That gets inhibited a bit, and then you can have a buildup of bacteria causing SIBO, and usually we'll have a food poisoning event, people will get better because it's a slow attack of vinculin. And then eventually, maybe 2, 3 months later, we'll get this, oh my gosh, what's going on? I've got all these symptoms. What happened? Sometimes people don't even equate it to the food poisoning event cuz that, you know, I got all better after that. So it's, it's a way, and there's testing that we can do. We can actually test for antibodies against the CDTB toxin and also vinculin. So we'll know that that's more of a root cause. And then for that person, we're usually doing nerve regeneration. And they're gonna need to be on a prokinetic a lot longer. Prokinetic being pro or for kinesis or that migrating motor complex support that moves down. So there's, there's ways we would address that more, you know, specifically more than moving into one of the more functional presentations. And the more functional presentations is none of that happens, but could this be because the person is massively stressed out and they've got a big toxin load? Massively stressed out and they have an underperforming thyroid, which can slow everything. And they have a toxin load or a pathogen load or a parasite, or they have mold. I see mold as a big driver that is just the body dysregulator. And again, if we think about, you know, our vagus nerve, our vagus nerve helps to kick us down into parasympathetic. And if we're in a stress state, that gets inhibited. Cuz why would we get down into rest and digest if we're stressed out? We need to run or we need to fight.

Yeah.

Right.

Oh, yes.

And so, yeah. So all the resources, if you can't get into a, a calm state, a rest and digest state, all the resources are diverted away from digestion and moved out to the peripheral so you can run or fight. Yeah.

Right.

And so you'll have slower motility, less blood flow. Every chemical that helps you digest from saliva to enzymes, to stomach acid, to pepsin enzymes, to pancreatic enzymes. Enzymes, to bioflow, to blood flow, to motility support. All of that is going to slow down because you can't get into rest and digest. Mm.

Yeah.

Stress.

It's usually stress.

Stress is a problem.

Yeah. Yeah. So I hear stress, I hear mold issues, you know, and, and you also mentioned, you know, digestion, how important that is. And I know when I'm on the run, even when I was a resident, you know, I would be like, chew my food like twice and then run back to my studies and, uh, stress. You know, digestion starts in the mouth. Yeah. That's the important thing.

Digestion starts in the brain.

In the brain.

I love that. It starts in the brain because when you look at food and smell food, that's when your body's like, kick, you know, like if I tell everybody visually, you know, figuratively to, to, you know, hold a lemon in your hand and bite it, everyone's mouth is going to start watering. And mine just did even saying that.

Yes.

And so that the brain needs to get involved and we don't, you know, we make the food. We eat the food. I know you do that. I know I do it. We try to slow down, but I'll look down and like, oh, the meal's gone.

Exactly.

Right. I hope I chewed it enough.

Yeah.

You know, we get busy, but yes.

Yeah.

Yeah. So second step, so important. It's actually chewing food until it's liquid before you swallow.

Yeah. So not chewing enough, can that increase the risk for SIBO?

Not chewing enough can do a few things. I mean, I would say some people just have really good robust stomach acid and great digestive enzyme production, and you would never know they ever had a symptom ever. They're great. They're just getting on in life. I mean, how good— how can people eat fast food all day and not take care of themselves and not have SIBO, right? So food doesn't cause SIBO. You can get a food poisoning event, but it was the exposure to the pathogen from that. It's not the food. So you can't eat a bunch of potatoes and get SIBO. You can't eat, you know, oh, I had a bit, you know, oh, I ate gluten and got SIBO. Food cause it. The pattern of food that they ate prior did not cause it. You could graze all day long. You could fast, you could eat 3 squares, doesn't matter. That did not cause SIBO at all.

And you mentioned stomach acids and when someone is stressed, does that lower their stomach acids? Yeah.

So stress, when you're in a stress state, all, like all the resources top down in this tube, mm-hmm, get pulled to the periphery. So you won't produce enough saliva enzymes, stomach acid. And the problem is, I think, you know, that's one thing I think for people to understand. The other thing is one signal step begets the next. If you're not hitting the right pH with your stomach acid, you're not gonna gastric empty properly. You need to get down below 2.5 on the pH scale to actually signal the proper release of stomach content. So sometimes if people aren't getting to that point. Food will sit in the stomach too long.

Mm-hmm.

Kind of back up a little in the throat. Most acid reflux is actually too little stomach acid. Mm-hmm. But at the same time, when you're releasing the contents of the stomach that haven't hit the right pH, that more acidic pH, when they go down into the duodenum, which is that upper first part of the small intestine, the pH is supposed to signal bicarbonate to come in to neutralize the acid. It's supposed to. Kick that pH up to a much more basic state. So when the enzymes come in that are also being released, then they can be active and work. Otherwise, if it's too acidic and it doesn't hit that right stage, then the enzymes aren't gonna work as well. So stress throws a wrench into all of it. And now it's why, why you might keep hearing me say stress and stress is present. What else is present? It's those two together.

Yeah.

Whether toxins, mold, parasites, pathogens, like, and stress is like just such a huge, huge setup for dysregulation. Wears and tears everything down. You don't sleep as well. You can't heal as well. You can't detox. I mean, detoxification is a parasympathetic state. Why would we detox if we have to run or fight?

So true. You know, stress is a killer for the mouth too. Like I look at people, you know, they're grinding their teeth and Dry mouth is actually setting in, increase of pathogens. I love it. See, I got my water here too.

I know you're like dry mouth. I'm drinking away. Yeah.

Yeah. But, but, but it does happen is with dry mouth, actually there's an increase of pathogens in the mouth. And it's interesting because stress affects the GI tract from the beginning, right? From the brain, from the top of the head all the way down. For sure. Yep. Absolutely. Very interesting. And, um, You know, I have some of my patients with SIBO, actually they said, oh, I'm taking an antibiotic. Uh, I think Xifaxan is one of the things that, yeah. So what's your take on that? Treating SIBO?

I think they're old school. I think they're old school. I think they have no place here. And the reason I say that is because, you know, again, 15 years ago, whether antibiotics or whether herbal antibiotics, we were all putting people on kill phases. We were all putting people on, go on this diet to starve 'em out. Totally the wrong approach. 2 years in, 3 years in, I'm looking back going, where does— I mean, people are dropping their endurance. They're getting in this recurrent state. Like this isn't working and they're putting so much effort into this diet. And then you just like start to really, really think about it deeper when you're not seeing the results. And I'm like, this isn't even making sense. We should be recovering the gut. We should be. And we are always looking for root cause. Don't get me wrong, but if we can get someone stabilized, if If it was a one and done with an antibiotic, we would not be here. If it was a two and done with an antibiotic, we would not be here. Originally in the algorithm, it was Rifaximin or Xifaxan, and that's for hydrogen dominant SIBO. If there was a methane issue present, they would use that antibiotic and pair it up with Neomycin or Metronidazole, which is a much broader antibiotic. Okay. So, mm-hmm. Now, 6 years ago, 7 years ago, the new treatment algorithm includes Ciprofloxacin. And it includes Bactrim out of the gate for something that is not an infection.

Wow.

It's an overgrowth in the wrong place. Yeah. Doesn't feel good. Don't get me wrong. I'm not saying, ah, it's not an infection. Don't worry about it. But this is an overgrowth in the wrong place. And there are so many things that we need to do to correct the terrain top down and get to root cause before we even think treat SIBO. Mm-hmm. Because SIBO is a downstream collection of symptoms, right?

Yeah.

And we have to look upstream to say, why is this here? In your case, it was post-infectious IBS. So the support, I don't know exactly what you did for treatment, but I would've looked at that like nerve regeneration support, prokinetic support, figure out what you are doing that's stressing your system out, work on stress mitigation, work on resetting all those digestive steps and figuring out where do we need to go from there. It's not always treatment. It's much more to me acidifying the gut. Recovering motility, getting the vagus nerve working again, which is a lot to work on. And really looking at how do we recover the gut, not put people in this blind loop of antibiotic. By the way, it came back. Here's another antibiotic. By the way, you're gonna have to go on a stronger antibiotic. Well, that didn't work. Let's do another antibiotic. And it doesn't seem the right way to approach this. I'm also massively concerned about antibiotic resistance. And why our field feels like it's just okay to dump this level of antibiotics into the body or into the system. I think my concern is, yeah, Xifaximin, Rifaximin, same product, different names. It's always touted as, well, it doesn't absorb, so it's good. It's a safe antibiotic. Like, okay, it doesn't absorb, which means again, it's gonna stay in the intestinal tract, but what the heck's it doing in the small intestine? Like, right? Where are the studies showing us how much gets knocked down? What comes back? Because what I see is the treatment algorithms with that kind of antibiotic use over and over are just setting up recurrence. They're knocking down the healthy flora is, is single cell bacteria. They're gonna be much more susceptible to antibiotics, especially something like Cipro, which is just malpractice to me to use.

I agree. Cipro's so toxic.

So toxic.

You know, with that fluoride molecule. Yeah. Yeah.

Yeah. So toxic. I don't recommend that at all. But basically you're knocking down all the good guys and we're thinking we're gonna come in and just cherry pick the one bad guy, right? I'm gonna take take this antibiotic, I'm gonna just go in and it's gonna get the exact thing that's causing this in me. But mainly they're gram-negative bacteria, which have a double cell wall. They're proteobacteria that reside in the mouth that we're swallowing down and it's not getting killed off by stomach acid. That's what's colonizing with SIBO. And they're gonna be less susceptible to the antibiotics. They need stronger antibiotics. So you're gonna knock them down along with all the good stuff.

Yeah.

Along with just the balance point. And then what's gonna come back? The resistant stuff. And then you keep doing it over and over. You're just breeding bigger biofilm and you're stronger biofilm and you're gonna bring more resistance back. And that's a huge concern I have for treatment. I know the answer is a little bit more involved here, but I wish SIBO was thought of as something really complex versus something that is so simple. You can stick it in an algorithm, which is only supposed to treat primary conditions.

Yeah.

Right. But it's not, it's a secondary condition, but it's even, even in function, in the functional world, antibiotics are just handed out so much for this and it just doesn't compute.

Yeah, it doesn't. So, um, if antibiotics worked, then you wouldn't have a summit, but I'm excited about your summit.

Really? Honestly, that is what I, I say that often. 15 years later, it's not because we didn't have Cipro and Bactrim on the SIBO algorithm. Is why we still have SIBO, but yet that's what they put out. It's mind-blowing.

Yeah. I'm, I'm very excited about your, uh, summit and also because you decided to incorporate oral health, which, yes, it makes sense because it's, it's, you know, the opening of the GI tract. So we, we need to look at the mouth as well. But what kind of inspired you to create the summit?

Yeah, I honestly, I think it's everything that we're talking about because So many people are just doing the, you know, change the diet and here are the antibiotics or even the herbal antibiotics thinking that they're doing something more natural and healthy, you know, won't be as broad of a stroke as an antibiotic, but it still is going to knock things down. And my take on this has always been, where's the momentum? If you're going to come in and treat even with an herbal antibiotic supplement, What sets SIBO up? We know we have to have vagus nerve inhibition. We know we have to have a motility issue, probably low stomach acid if we're looking at that functional group. So why would taking an antibiotic or an herbal protocol correct all of that?

Mm-hmm.

So I'm always, even if someone comes to me with 7 positive SIBO tests, that's interesting. I'm going to take it with a grain of salt with everything else that they have going on because SIBO's always the first thing people jump on, right? Oh, SIBO, here's the antibiotic. Come back, we'll work on the rest. Let's take this as a symptom collection. It is, and reset the terrain top down. So that's why I did the summit. I'm, I'm presenting over the 7 days, brain to bowel. The brain is all the first day. Sinuses, oral, throat is the next day. We go into energy and detox the next day, and we're just going step by step by step. So it's a way that people can come in and actually, you know, pick out what speaks most to them. Course, but go through and just like really hone in and work on, am I sleeping? Where's my stress out? Is my vagus nerve even activated? How's— am I getting daylight versus living under these light bulbs that put us into a stress state that dysregulate everything? And so it's really a way for people to kind of have a roadmap stepping them through how to correct things versus the summit on, you know, treat with this protocol, treat with that protocol. The protocols are out there, but I don't think that they're working because we haven't done all the other work. For example, if someone has mold, I don't care how many times you use a protocol in their gut for SIBO, it is not going to work. Mold has to come first. MCAS has to come first. Parasites have to come first. So there's reasons that, you know, reasons why we would look in another direction to treat that and correct that. And I've never not had SIBO completely just reconcile on its own after treating mold. And I treat a lot of mold.

Amazing.

Yeah.

Yeah. I didn't even know there was a correlation and a lot of people listening, you know, everybody's zooming in on the gut, but mold could be really all over. Like what's, what's the place that mold likes to hide typically?

Well, it dysregulates. So basically if I have mold growing in the corner of my office, I've been treating mold the last decade and I went through a mold illness myself 6 years ago. Don't wish it on anyone. So sorry if you're dealing with it, but if I have mold growing in the corner of my office here, I'm in a closed area. It's really the mycotoxins that that mold produces that float in the air and they're supposed to— the purpose is to attach to other molds to kill them. It's their defense mechanism. But 10,000 mycotoxins fit on the head of a pin. They're so tiny. They absorb through our skin and we breathe them in and they're toxins. Some of them have been weaponized by the government for use. Like they are toxins. And when you get that load of toxin coming into your system, everything dysregulates. Right?

Yeah.

Chronic stress state, neural inflammation, poor detoxification, leaky gut situation, dysregulation, immune dysregulation. Immune system doesn't know which way's up. It's getting these constant toxin load and it can't clear anything or do anything. And it really, there's no perfect way that it presents, which I think has been hard in the mold field. You know, you'll have these 4 symptoms, you know, but it's more about, gosh, I've been through everything. I can't get better. I'm getting worse. And I'm getting worse and I'm getting worse, I'd start to think about, is there something in the environment that's causing this?

And actually checking the house and the workplace to see if there's mold there.

Yeah.

Yeah. Yeah. So super important. And, and it's interesting because SIBO is just more of a, your body showing you, hey, something's wrong, but it might not be the, the root cause.

It's never the root cause. Yes.

Super interesting. And I know part of your summit, you have so many experts. Kudos to you for gathering all these experts into 7 days. That's super hard work.

It has been, and they're all an hour to an hour and a half talks. I wanted to do more long form so we could really get into the topic.

Out of all the experts, which one do you think people will find the most surprising?

Most surprising? Oh, that's an interesting one. You're a speaker, so of course I'll list you first. You were amazing. Um, there, it hasn't gone live yet. I actually just I finally got her to do the interview this Monday. So it'll go live soon. Ruth Criss, she is a nurse practitioner who works on bladder and interstitial cystitis and has figured out, I mean, it's her presentation's amazing from ammonia loading up, causing interstitial cystitis, looking at genetic SNPs, looking at the biofilms that are created causing chronic UTIs. and then that group gets placed on antibiotic after antibiotic. The parallels when we were talking were just mind-blowing. And so amazing. We're gonna start doing a lot of work because I see so many commonalities around the gut. She sees Klebsiella in the intestinal tract, or excuse me, in the bladder as well. Um, she uses Microgen DX for genetic testing, um, among some other things. And it's brilliant if you can type out the exact bacteria that's causing the issue. Our fungal issue in the bladder. Mm-hmm. And you know what pH they like to hang out at. If they're an ammonia producer, could we break up biofilm and then actually take something exactly that would go after the exact thing that was found? Can we get this person out of a chronic UTI cycle so they don't have to do antibiotic after antibiotic after antibiotic? And that's what I think of in terms of gut. So that one had so many parallels. And she's on day 6 of the summit. That, that one's gonna be really, really great. Yeah.

Yes. I can't wait to listen to that one because it's fascinating that we're pretty much dealing with biofilms everywhere.

Yeah.

Now, are people going to be able to walk away with some practical tools that they could implement at home?

Yeah, that's the goal with all of it. As we're talking through, these are, you know, we'll, we'll talk about things that we recommend to directly to our patients, some, you know, this little pearl you can take home today. And again, just figuring out what speaks to you. I have, I have a person that contacted me, just said, oh my gosh, I just listened to the first talk that was on the list with Dr. Lindsay Renschagen. And, and it was on sleep. And she was like, I didn't realize my sleep was caused by inconsistent blood sugar at night. And she's like, I'm gonna get a CGM and test this out. And she's like, I think this is my issue. I wake up with adrenaline hits 2, 3 times a night. So it's just the, as you listen through, people will find what really speaks to them. And, and I think it's gonna be a lot of great information, very practical for them to take home.

Yeah, I'm very excited about it.

Thanks.

I've listened to, and I've been a guest on many summits, but this is the first and only SIBO summit that I know of. So I, I encourage everybody, we're gonna post a link below in the show notes so you can go ahead and maybe even listen to the recordings on the website. There's an opportunity to purchase those and definitely if you know anybody anybody that's suffering from GI discomfort, chronic fatigue, they feel like they want some practical tools, highly recommend you join the summit, Cracking the SIBO Code.

Would love to have you.

Yeah, it's super exciting. Now you mentioned the vagus nerve and there's a lot of people that are in the fight or flight and the vagus nerve, for those of you that are, don't know, it's the nerve that actually is responsible for putting us in a relaxed state and it goes and it gets dysregulated. What is one exercise that you can share with us that we can all like start to work on this vagus nerve? Mm-hmm. Or one thing that we can do, a habit to help every day.

Yeah. So the vagus nerve, uh, about 80% of its function is listening to signals coming up from the GI tract and the organs that are in your thoracic cavity, your heart, your lungs, your breathing. It's like, it's, it's listening to all of that. All those messages are going up the vagus nerve into the brain freeway into there. And if anything, you know, you're inflamed here or you're stressed from something environmental, job, work, you know, family and such, you can get inhibition of the vagus nerve to kick you back down into parasympathetic or getting you into relaxed state. So a lot of times online you might hear about gargling or singing. Clinically, most of us have not seen that ever work for people. So think about diaphragmatic breathing exercises, breathing. Is a fantastic way to calm down the vagus nerve. And you want to exhale longer than you breathe in. Because if you think about it, if you're running from a lion, you're not going to exhale more than you're going to breathe in. You're going to breathe in, breathe in, breathe in, breathe in. You know, it's this completely different message. So you're flipping that on its head. So I would say that meditation, those two things are absolutely free. You can go onto YouTube and find so much, so many free videos walking you through that. Walking, one of the best ways to reduce cortisol. And I don't mean walking, I gotta go, I gotta go, I gotta go. I'm staring at the pavement the whole time. I'm gonna put my weighted vest on and go. I'm saying go out for a walk and look at nature. Breathe. Like be present. Right? So just think about, we gotta slow down. We are going from task to task to task. And if, and I do this too, I always have to catch myself doing this, task to task to task, everything's quiet. I don't have a call, podcast immediately. I can't have quiet time. I gotta learn something. Entertain me. He's like, do something over here. So we all were just ramping up the signaling and the input over time. So that's a really big one, but I would also back up and say, we've gotta make sure that we're protecting our sleep. We need to get good restorative sleep. There's a lot of great trackers that you can wear, body trackers and devices you can wear from Garmin to an Oura Ring. You know, if I work on some other things, if those are not affordable, I appreciate that very much, but I like those because they tell me how much time am I spending in my REM am I REM sleep? How much time am I spending in deep sleep? And I really pay attention to those. I'm getting enough sleep, but I'm paying attention to those because if you're not sleeping well, you're in a stress state. If you're not, if you're low oxygen at night or getting woken up a bunch, you're in a stress state and you can't heal downstream when you're stressed out up here.

Those are the people with sleep apnea, not enough oxygen at night. Yeah.

Yeah. That can occur. People dealing with trauma over time, people, I think a lot, lot of the time they'll wake up in the middle of the night with this adrenaline hit thinking I'm having a panic attack or I just can't calm my mind down. That's usually blood sugar dipping too low. And the brain signals the release of adrenaline to wake you up to go eat.

Interesting.

But people think they're getting a really active mind at 3:00 AM and I'm just worried about stuff. You might be worried about stuff during the day, but you, you get adrenaline, your mind just starts going. It's like, it just does. So, but it's that correlation. People feel like I'm, you know, anxious, panic when it's really probably a blood sugar issue. Yes. Might be related to being anxious and panicked, but when you're getting, uh, that woken up in the middle of the night, that's more likely what's happening.

Super interesting, Angela.

Yeah.

So I'm excited for your summit. I think it's gonna be amazing. This is just a snippet of all your knowledge and everything that you put together. Where can people find you?

Yeah, for me, um, you can find me at siboguru.com and then I'm on Instagram @sibo.guru.

Perfect. Yeah. And what's the website for the summit?

We'll put that in the show notes.

We'll put that in the show notes. Perfect.

Okay.

Any last minute or any last words before we close the show?

Yeah. Uh, the summit isn't just for people dealing with SIBO. If you're dealing with chronic symptoms with your gut for any reason, feeling fatigued, feeling rundown, you know, just feel like you're having a hard time day to day. You're going to get a lot out of this because again, we're walking through how to reset things top down. Everyone needs to not be so stressed out to make sure they're sleeping better, to make sure that they've got good oral microbiome. They've got good stomach acid. Their vagus nerve is working. Digestion is supported. Everyone. Needs that. I mean, those are, it's, it's the foundations to a lot of the work that's being done in medical clinics that if we did the foundations, we might not even need, you know, I'm not gonna say medicine, medicine saves lives, but again, there's this functional presentation. If you don't have a good lifestyle and your body's responding to that, and then, well, we've got this medication to fix it. Maybe changing lifestyle could make some improvements that you and your provider could work on.

Yeah, yeah, absolutely. You're right. It's the foundation for a healthy lifestyle and a lot of prevention probably, uh, of SIBO by just following these tools. Yeah. Amazing, Angela. Well, thank you so much for joining me today and explaining SIBO to everybody that might not have even heard about it.

Love it. Thank you very much. I had a great time.

And with that, everyone, thank you so much for joining us on today's episode. Go ahead and leave me a message on Instagram @DrSandaMoldovan or on our YouTube channel where we will be posting, uh, this episode. Episode. Until next time, keep smiling. Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram @drsandamoldovan. This is Dr. Sanda Moldovan, and remember, your mouth is the gateway way to your health, so take care of it in the most natural and best way possible.