Healing SIBO - An interview with Shivan Sarna on her new book

Medicine Health with Dr. Paul Anderson. This is a show about opening up the often mysterious world of how doctors think. The goal, to empower the listener to gain access to the best healthcare possible.

Good day and welcome to Medicine Health with Dr. Paul Anderson. That's me. I'm Dr. Paul. And today I've been waiting for this show. We have a guest on. If, if you're watching on the, on the video, you already see that. But we have a guest that I've worked with in the past and done some collaborations, and she's interviewed me a couple times, I think, at least. And she has a new book out, and it's about small intestinal bacterial overgrowth. And it's called Healing SIBO. And I don't know that there's a right way to say SIBO or SIBO. I think that's whatever you want. But I wanted to talk about this because it's— aside from the fact it's a great book and it's brand new and most people don't know it's out unless you happen to have it. But the whole topic of small intestinal bacterial overgrowth and how it affects a lot of people's health in ways that they don't even know it's affecting them and how it connects to a lot of other health problems that people have is something that many more people know about now than 5 years ago, but it's still a very, very unknown quantity. So I have today with us the author of Healing SIBO, and this is Shivani Sarna. How are you doing today?

I'm thrilled to see you. It's great to be here. Thanks. All, Dr. Anderson.

It's always great to talk to you. We always have fun. And I think it was the first time you interviewed me for some— I don't remember what it was. It was at a conference. And we talked about, I think, biofilms. And that went on, I think, longer than we had originally planned. So we don't ever lack for discussion anyway. But Siobhan has created and co-created a number of online summits, Digestion SOS documentary series, Gut and Microbiome Rescue Summit, Lymphatic Rescue Summit, and then Chronic Condition Research Foundation. And I will, rather than reading about you, I will just talk to you and ask you some questions, and we'll get— then we'll get into the book and all of that. But— So obviously you have a book, and usually when people get to the point of writing a book about a topic, they have a lot of background with it one way or the other. So for probably at least a large number of people listening who may have only heard of SIBO or know a little bit about it, can you give us the elevator pitch version of where do— the core of it? Obviously there's a lot of other places, but—

Yeah, absolutely. Uh, SIBO stands for small intestine bacterial overgrowth, and it can be caused from a variety of things, which we'll get into. But I just want to address, um, the symptoms, which I had so many of, and someone out there listening to this may also have and be like, oh, finally, now I know it has a name, possibly. So bloating, diarrhea, constipation, alternating diarrhea and constipation, Weird B12 levels, weird iron levels, malnutrition, unexplained weight loss, unexplained weight gain, brain fog, and on and on and on. This feeling of malaise, rosacea, restless leg syndrome. I've even spoken to some specialists who feel like it might be related to infertility as well. Interesting. So that is the result of when bacteria that should normally be in the large intestine ends up in the small intestine and overgrows. Thus the name FIBO. It can come from a variety of things, including adhesions, like if you get kicked by a horse in the belly or you softball, it's you, and then the body does this wonderful thing to try to put you back together and basically makes interior scar tissue. After abdominal surgery, cesarean sections, that can actually then move some of the other tissue in your body, including your small intestine, and inhibit a cleansing wave called the migrating motor complex, which is what— when that's malfunctioning, the bacteria will overgrow. But it also can be from serious scleroderma, alcoholism, opioid use, even a little, like, pain meds after dental surgery, deep anesthesia, Ehlers-Danlos, food poisoning, post-infectious IBS. Huge new— there's a fairly new test, IBS Smart Test. You can actually test if you have that. Food poisoning from when I was 5 impacted me still to this day. I am positive for the antibodies that have been confusing my migrating motor complex. So, it hasn't done the sweeping motion well. And I didn't even know what SIBO was, Dr. Anderson. Like, I just assumed I had IBS. I went to a doctor. It's all in the book. And he told me to run 3 miles and gave me a script for every day and gave me a script for an antidepressant. And I thought, okay. So, so bottom line is I fell down this rabbit hole and I was like, holy crap, literally, I need to tell the world about this because if I have a college education and I have a little bit of a disposable income and I have great insurance, I have a little bit of time on my hands and I'm having such a hard time and Most of the doctors I went to, and I went to a lot of doctors, had never even like heard of something beyond IBS. My Ayurveda didn't work. The acupuncture didn't work. The raw thing didn't work. Blah blah blah blah blah. Finally, I found out what SIBO was. I found Dr. Allison Siebecker. She's a world-renowned SIBO specialist. She helped me along with several other doctors, thank God, and I was able to now manage my SIBO because I do have those antibodies. I still could have SIBO if I didn't take a prokinetic to help stimulate the migrating motor complex. We'll get into it. There are 3 major treatments for treating SIBO, and then you want to be sure to follow up with a prokinetic so you can make sure that you don't have a relapse. There you go, in a nutshell.

That's, that is, that's a great summary. Yeah, I think, of course, if someone's listening and they have it or have been diagnosed, they know the difficulty usually of getting to a diagnosis because it's I mean, it's not like it's a brand new thing doctors are thinking of, but in most doctors' minds, they either don't know about it or it's sort of a, I've heard of that, but there must be some other doctor that deals with that. One thing I would say that's— the door is cracking open a little bit in the world of gastroenterology, the specialty where, you know, the GI tract is involved. It's slowly opening there to at least be known and at least be maybe tested for, et cetera. Another thing I find interesting, which we can talk about the connections later, but a pop in your description earlier of this just wide variety of symptoms and signs that people can have when they don't know that SIBO is the problem.

Yeah.

A not insignificant number of our patients who were diagnosed with things like fibromyalgia and chronic fatigue and, you know, some of those things, also this was one of the huge contributing factors because as you were saying, you know, it throws off a lot of things that the person might look healthy and they feel horrible and then their labs are just oddly skewed, you know, and, uh, and they can suffer from, even though they may be eating quote unquote normally, a level of malnutrition. And so then their cells aren't getting the nutrients, et cetera. So I think that's another really important thing to bring up, that a lot of people have these sort of broad diagnoses like fibro or chronic fatigue, et cetera, and there can be many causes underneath. And this is one, um, where when we were starting to become aware of it and testing for it, et cetera, you know, there were a number of our fibromyalgia patients especially that this was a big, huge contributor. And I'm sure that might be in your background. I mean, just, and it's obviously it's in the book too, but you had a very florid trip, I'll say, from your childhood and not feeling well to finally figuring out kind of what the hub of the wheel Yeah, it was a journey.

And I have a few, like, funny stories, dramatic stories, a lot of tips about how to get through the day when you have SIBO and the diet, which doesn't cure it but does treat the symptoms. And you can feel better very, very quickly with that. You know, Paul, I did have fibro and I did have, you know, cortisone shots And, you know, again, thousands of dollars in bodywork because it was like the only thing holding me together. Um, just massive inflammation. And LDN, low-dose naltrexone, really helped my fibro. Uh, you know, I love to tell people about that too, just because it's such a magic drug. Go to LDNresearchtrust.org if you have inflammation and check that out. LDN. But I think what I think I do still hear doctors, people tell me in the Facebook group, SIBO SOS Community, that their doctors don't believe in SIBO, which makes me sad and laugh at the same time. If you have all these symptoms, the other thing that I want to always mention is if you do get a SIBO breath test from maybe Aerodiagnostics Labs or Gemelli Labs, which now has a test for all 3 gases that are produced by those bacteria in the small intestine overgrowing, Hydrogen, methane, or hydrogen sulfide. If you get a negative test and you prep for it properly and you, you know, it's right, like you really know it's right and the lab knows it's right, then test for parasites, uh, and Candida, which is hard to test for. I know the questionnaire is great. So because the symptoms of SIBO mimic those 2 things, and by the way, A lot of times, like you were saying, people with SIBO also have parasites and also have Candida. So it's a real joy.

Yeah, that's what it is. Yes. Yeah, it— and I think, you know, with any chronic problem, obviously the earlier you figure out that it's a problem for you, the better, because you don't have years of, you know, improper treatment and things to, you You know, stack up. But often the people that, you know, we wind up encountering and seeing, and probably the people you interact with the most, it's not been diagnosed early. It's, it's been, you know, diagnosed later, and then you build all these other layers of problems on top of it. So you can have like 3 or 4 things at the same time, all who have similar symptoms. And I think that— You know, as we've talked about on some of the summits and then some of the SIBO conferences, we go into this, teasing that out and unwinding it becomes the, you know, that's why you wanna work with a doctor who's done this before and kind of has that, has a macro view down. Because what I would call, quote unquote, a simpler case is usually someone diagnosed earlier, They haven't, you know, they may not have mechanical problems like adhesions and things. They haven't had time to build up a bunch of other infectious problems and biofilms and stuff. But a lot of the people, the SIBO can be really well addressed. And if those other things aren't looked for, it's just this loop, you know, it's this sort of evil cycle. So in, obviously your own story led to the book. And again, we both have one, but there it is, Healing SIBO. And I'm assuming that people can get this anywhere online.

Yeah, anywhere books are sold.

Anywhere books are sold. So whatever your favorite, probably Barnes Noble online, Powell's Books online.

Places. I'm so sorry, I love local bookstores, but I don't know if they all have it. So, but definitely Amazon.

And a lot of One thing I found with our books too is that most of sales are online now, but if you want to support a local bookstore, a lot of them now have online portals where they at least get something for the sale. So check that out. But one of the first, at least the way that SIBO kind of came to me, and, you know, I'm in a different— I have a different point of view because I'm a clinician. And so I watched it sort of emerge as a diagnosis. as opposed to, you know, it's one of the health conditions I don't have, so that's great. So I got to watch it from the outside, but I had a lot of really sick patients. I was very intrigued by the early work that was done. And one of the— I think this is a subtitle— Fix the Real Cause of IBS, Bloating, and Weight Issues. So IBS, irritable bowel or inflammatory bowel syndrome, is one of those things, if you've been diagnosed with IBS, you already know that. And normally it's a lot like, say, being told you have fibromyalgia. It's a cluster of symptoms and your doctor says, well, you know, thankfully you don't have Crohn's or colitis. You don't have cancer. You know, we don't want any of those.

Right.

But we don't know what it is. It's something a lot of people have and we call it, you know, irritable bowel or inflammatory bowel syndrome. And so then it's like, well, what do I do about it? And then depending on the doctor, the advice may be shorter or longer. And the people I started to hear about this crazy idea of small intestinal bacterial overgrowth about were researchers who were working also with patients. And they were talking about, you know, there's a—

Yeah.

an underlying cause to a lot of IBS cases, which is great because we've never been able to figure it out. And these were people who weren't, you know, any people who don't realize anything new in medicine is not embraced really quickly. So these were researchers where they really had to kind of keep at it and they had to keep telling people and showing their data and all of this. And it really kind of grew out of that. And so, you know, we, we owe a debt to those folks. But as soon as I heard some, some of the early people talking about it and writing about it, I started to see a lot of my chronically ill patients and see that this, this has to be a piece of the puzzle. But the other thing was, I always felt like IBS had some infectious component or another.

Yeah.

that we just didn't know about yet. And it turns out that's one of the problems. Now, one of the things that you said earlier that I just wanna go back to, 'cause I think it's really important for people to get the picture in their mind, and that's this idea of the cleansing wave and the migrating motor complex and all of that. So what people may or may not know is, so after your stomach is the small intestine and it's in 3 parts, it's a very long tube. And it has this motion called peristalsis that moves through. But it is, it's distinct anatomically, but it's also distinct from a point of view of its normal bacterial flora and other flora from the large intestine, which comes after it. And so it's supposed to have certain things in it that are alive and helping you digest, et cetera. And it's not supposed to have certain things in it. When you mix the two and you put the wrong bugs in the wrong place, Usually you don't feel well. That's the quickest way to say it.

Yeah.

And so it literally is your small— the biggest part of your intestines, the small intestine, has bacteria that overgrow that are not really infectious in SIBO. They're just in the wrong location. And that's why this motility part and the cleansing wave and all this business becomes so important. So, and I know in the book you talk about that and you get into describing it, letting people know, you know, all about it. But when you look at the core treatments that are involved, you had mentioned that some people like yourself still need to be on a prokinetic. Explain what that is to folks.

The 3 main treatments for SIBO are, and these are not in order of importance, is herbal protocol, which has been studied to be maybe even slightly more effective than pharmaceuticals, but you have to take them for longer. So like, let's say a month instead of 2 weeks of the pharmaceuticals. With the herbals, it can be like oil of oregano, candy backed in AR, candy backed in BR, allicin in like Alimed, Alimax, some good killing machines basically.

Right.

So that's one approach. The other approach is with a drug that is actually given to people who have traveler's diarrhea. And that is Xifaxan. That's the brand name. Rifaximin is the name of this drug. And it's a fascinating drug because it is an antibiotic. It stays in the small intestine. You can actually take multiple rounds without becoming resistant to it. And it will, when paired with neomycin and a couple of other possible combinations, can help with methane producers because there are 3 sort of producers, like these Overgrowth organisms can either produce hydrogen gas, hydrogen sulfide gas, or methane gas. And then the treatment can— in those pharmaceuticals can be slightly tailored, as it can also be done with the herbals to impact each one. Then there's the elemental diet, and the elemental diet is a liquid diet that is nasty and tastes like vomit. And it's also the most effective. But the good news is formulations have come out that taste a lot better than when I started this whole thing 5 years ago. And Integrative Therapeutics makes one called Physician's Elemental Diet. Dr. Michael Ruscio has one. You know, they taste like very sweet sort of protein drinks. And you do that exclusively, like it is a liquid diet for 14 to 17 days, and then you retest at the end. To see if you still have a bacterial overgrowth and maybe you go a little bit longer. Always good to work with a really qualified SIBO nutritionist or a doctor. You're doing a liquid diet, you need to make sure you're drinking enough of it to get enough calories. Some people even gain weight with the Elemental Diet because they're finally getting nutrition. Fascinating.

Yeah, so one thing that— because I get asked this a lot, When, when you talk about an elemental diet, and, and I, I would underscore what you said, most people, if you've ever been put on one, especially by a doctor who's not aware of the, the newer varieties, it's really rough. It's—

Yeah.

It's very rough. And, and what elemental literally means is it's, it's all the nutrients in their simplest elemental form, with nothing that, or as little as possible that would feed these, the bacteria that shouldn't be there. So you're literally trying to starve them out while feeding you, okay?

Right.

So it's a great theory, didn't taste very good. And thankfully, and it's really fairly recent where some of the ones that are not, you know, that horrible are. So when you look at, And, and you had mentioned there's, there's sort of a drug, a pharmaceutical approach, there's an herbal approach, and both actually have a fair amount of research. Both work, as you said, which is the normal experience. If you do the herbal approach, it's usually a little bit longer than the drugs. One of the things I think that's cool with the herbal approach, and sometimes people need it mixed, it depends how your doctor does this, but the herbs also Most of them that you mentioned that are used there also have some other properties. They lower fungal elements and they're kind of hard on some of the parasites. So sometimes the herbal approach, even if you've either partly failed a drug approach or whatever, is a good one to add on anyway for other reasons too.

Well, and because it is— so it has a reputation for relapse, And that's because if you don't do a prokinetic, you will relapse. And a lot of people don't understand that they need to do a prokinetic. So, I've heard across a lot of different platforms, people say that, oh, no treatment works. People always relapse. But that's a why. I want people to understand the reason they relapse is because if they're not doing a prokinetic.

Yeah.

And if they are doing one that's effective, maybe do a couple of them depending, because there's ginger, there's Motegrity, there's Modalpro, which is a brand of, you know, one brand's name of a combination. So there are a lot of different ones you can do, and you just need to find the combination that works for you. And yeah, and if you don't do that and you've done all this other work, it's a drag because you could relapse. So please, ProConnect.

It just goes— yeah, you go back. And I think to go back to the just a mechanical part of it, if you don't keep the the motion going in the direction it's supposed to go, the bacteria that overgrow will just keep working their way back up in. And that's, I think, as you mentioned earlier, but I really want to underscore, if you've ever had an abdominal surgery of any kind, those adhesions develop. If you've ever had, as you said, you know, just blunt trauma to the abdomen, taking a fastball to the abdomen or getting kicked, or if you did—

Yeah.

You know, martial arts people get this or other sport, you know, people, all sorts of things. And what I always— it's just how our brain works. We don't like to remember, you know, really bad things. So many of the patients that I found, it would be like the 3rd time I would ask if there'd ever been any trauma before they would remember, oh gee, yeah, I, when I was 15. And you think, How'd you forget that the first 2 times? It's like, well, it was a bad memory, you know, and it didn't— or people forget they had a surgery or whatever. So the prokinetics kind of universally are necessary for a while, but in people where you have mechanical reasons why things aren't moving, very like, you'll just keep going in the cycle and having problems. So I do think that's really important. You do a great job in the book with that. Now, in the book, the way that it's laid out, and I— you know a lot of doctors, you talk to a lot of doctors, and you involve them in all of this.

I drag them into it.

I know that you're very aware of how we all think. So one of the things I was looking at was from the point of view of a provider. Let's say I'm not informed very well about SIBO, but I think, gee, there's something to this, and my patient brings the book in. Is it the kind of thing that is a good provider interface? So they could look at it and kind of get the big picture and You know, because there are a lot of people who are interested who are providers.

Yeah.

What page are we on there, by the way?

Go to page 111. And is it 111? It's— hold on. What? Yeah, 110. And this is the algorithm that Dr. Mark Pimentel created, and then Dr. Allison Seabecker and I— not an I— and Dr. Stephen Sandberg-Lewis added to. And actually, I have another version where I did add to it, and I see that it's not in here, so that's really bumming me out. I have a massive major typo. There you go. Um, but because underneath it should be a whole line that says find your underlying cause. But basically, Yeah. it starts out, so you think you have SIBO, symptom relief through diet and, you know, you know, charcoal and other therapies there, and Dr. Siebecker's specific food guide. You can really feel better quite quickly with the symptoms. Do a lactulose 3-hour breath test. Uh, there's some other versions of it. Um, consider other diagnoses, choose a treatment, elemental diet, herbals, antibiotics, test after those treatments to see how much progress you've made and if it worked. And then you can either manage it or treat again. So this little guy is a really good template. We call it the SIBO Recovery Roadmap. It's a mouthful.

Yes.

We've done a whole course based on this. So I think if I want— I wish I had this 5 years ago walking into my practitioner, and they would have been like, okay, got it. And then all the, you know, the studies and stuff. At some point, I did start doing that. I just started walking in with studies and I had some great folks. It's like, okay, so where's your pharmacy?

Yeah, it's, it is getting Yeah, I think in North America, it's getting much more common that at least the provider would have heard of it and won't just dismiss it out of hand. But I think like you were saying, the feedback that we hear from patients is not all providers are there. Like, and there's many other things in medicine that that happens with, but new things, even though this is not a brand new idea, doctors will use the terminology, I don't believe that that's a problem, or I don't believe in that, like it's the Easter Bunny or something like that.

Oh, right.

And it's one of the reasons that— there are many reasons that happens. Sometimes it just means their curiosity hasn't been piqued enough or not enough patients have come in and said, this is a thing, check into it. But the other side of it is doctors get really, you know, they know what works for them. They know what they've done in the past. And not all doctors are incredibly curious and wanting to add new, you know, like saying, gee, maybe I could have this big chunk of my IBS patients who I just treat symptomatically get better. Wouldn't that be, you know, crazy good? Not everyone thinks that way. And so that's one of the things I was going to say because you've— I mean, we've both been on the different sides of that equation.

Yeah.

From the patient point of view, you got somebody out there who this is probably a piece of the pie of what's going on. What's the best way to interact with their healthcare provider if they're not getting very far? I mean, obviously the final solution is getting a different healthcare provider, but let's say there's a crack that the door opens a little. What's the way to get through there?

I would say, you know, just to, be calm, be educated yourself, be respectful, um, and be like, you know, I really think I have this, or I'm curious. And I invite them to be on the journey with you. I did— I mean, literally, I, I lucked out and found a gastroenterologist who was curious and very supportive, but I did have to bring the studies and, and the dosage.

Mm-hmm.

And, uh, that kind of thing. And now he's like, you know, always gets SIBO patients and sort of thanks me for that, sort of. Um, he's not totally sure because he gets really complicated cases. But I just, you know, I came in and I just said, listen, here's some of your peers, you know, Dr. Pimentel, Dr. Satish Rao, dropping names and all that, and handed them copies of the, the studies with highlights just to make the appointment go faster and better. And I'd been like Can I have a script for this? What do you think? You know, engage them, invite them. Don't just be like, you know, steamroller over them. Be respectful of yourself and them. And I think that's a good start. And if you have a doctor or somebody who says, don't ever bring me a study, then that's a good, really good reason to like leave.

So yeah, yeah, yeah. I think that those are extremely excellent points. You do, you know, obviously you don't want to start out confrontational. Right. Because, you know, that said, I mean, in any human interaction, that sets people, you know, not on the path to oneness. But I think that, you know, I have had the experience many times of patients coming in and maybe having just like a one-page of a front of a study or just a name of something and saying, have you ever heard of this? And, and, or maybe brought in a book and said— and I would say, well, I've heard of it, but I don't know anything, you know, about it really as far as treating people. And then realizing that, you know, they thought, well, that's a piece of what's going on in my case, maybe would you look into it? And then I think people who especially are trying to help larger sections of their chronically ill patients if you make it a pretty easy entry point, you know.

Yeah.

And you have a lot of, you have a lot of good studies listed and a lot of things of that nature, but a lot of times when they see, oh gee, this is like a real, you know, gastroenterologist from a real university who's doing studies and I just didn't realize that was going on, it's like, oh, maybe I should catch up on this, you know. And yeah, there's always, and we see this with all forms of medicine, there's always times where it's just not going to work because they don't want to go there.

Yeah.

You know, it's just, you know, it's just that, and then you just have to move on. Something nice, I think, for people to know is it's great if you have a gastroenterologist who wants to work with you on this. A lot of people in more rural areas, the nearest gastro may not be near them. And this is something that any, any type of healthcare provider who is interested in learning how to do it can help you with. You don't have to go to a gastroenterologist.

Right.

You might have to for certain, you know, testing to rule stuff out, but you can have this treated with— there are many nurse practitioners who do it, family practice type folks, internal medicine folks, just Whomever. Uh, it's not limited. Yeah.

Yeah, that's a great point. It's not so— it's not like a colonoscopy or an endoscopy where you really need a specialist, right? Right. You know, if you have a complicated case, uh, definitely try to find a SIBO specialist. And, you know, I have a list of speakers at sibosos.com. Dr. Allison Siebecker's siboinfo.com is an incredible resource. Um, but You can literally go to Gemelli Labs and, you know, get a requisition form. I think you can go to AeroDiagn— I think I've done this— go to Aero Diagnostic Labs and, you know, walk in with a requisition form. And you might even now help other patients because now that doctor is going to start working with that lab and being able to have the test kits. You can do those tests at home. I mean, it has, it has become much more user-friendly. And Medicare often pays for the breath tests. So, and out of pocket, I think the most you're going to spend at Aero Diagnostic Labs— I don't work for them, so please don't hold them to it— but it was like around $175 out of pocket for cash. And if you, you want to retest at the end of your treatment, so logistics at the end of that treatment, 2 weeks, a month, whatever you're doing. Make sure you have a test at home so that you can do the prep diet and then the 12-hour fast and then do the test because otherwise you got to make a doctor's appointment and, you know, it's a whole thing. So logistically it's a really important point, make sure you get a second test at home.

Yeah, you want to have your kit for before and after and then also, I mean, unless something goes off the rails in the middle of your treatment, it's easier on the on the healthcare provider too, because you've got your before and after, you know how it went, you can tell them, they can look and decide what to do next. And you've got all that laid out in the book.

I do.

Really, really well, which is great. The less vagueness in the world, the more likely your doctor is to do things. So how long ago— I don't remember how long ago I met you, but how long ago did you encounter Allison Uh, Seabecker. Dr. Seabecker.

2016, 2016-ish. Um, she wasn't practicing at the time, and I would just go to her website and like stare at her schedule, doctor schedule, where, you know, she would take online appointments. And a lot of this was my intuition. Like, I was doing a lot of listening to God in all forms. I was like, just scared of heard like, hey, go check Alice's, you know, website today. And sure enough, she, um, was seeing patients again. And so I booked like 6 appointments, like the initial one and then one 2 weeks later and then one a month later. And then like as far out as she could go, I was like planting myself in her schedule, um, because I'd already spent so much money on trying to figure it out that— and wasted a lot of money. I knew that I was gonna actually spend money to go to a specialist, but ultimately was going to save me money and time because it wasn't, you know, how's that working for you? The other way wasn't working.

Definitely. Yeah, yeah, yeah. Dr. Seebecker has a lot of amazing resources, and you've mentioned her and her resources in there. And that flowchart that you showed us comes from some of her work. She's— I've worked with her for a long time. I don't know how long I've known her, but probably since she was in school, actually. And I think that, you know, it's people like Dr. Pimentel and Allison and all of the others who have just really kept pushing this forward as far as not just doing research but helping to refine the clinical practice because The research is great. And I remember like when Pimentel first started to publish and we saw it and thought, those of us who are a little more open to trying new things, and we thought, let's give this a go. And it was like, there was no guidance at all. Like we were just, well, theoretically this should do this. And the patients, some of them got better, some didn't, like you see. And that's how kind of we all learned about stuff. So— I think for somebody, even though you probably, if you're a SIBO patient and you don't know it, you've had a frustrating health journey one way or the other. Now is a really wonderful time to try and encounter the healthcare system as opposed to, you know, years ago. The other thing I would mention, because I, you know, one benefit of age is before SIBO was a known quantity or anyone wrote anything or anyone even had idea that to study it, while we had thoughts that there were these, you know, we called it, you know, like dysbiotic activity of, you know, wrong bug, wrong place, right? But that's something that's just sort of, we know it happens, but no one had figured out, put two and two together. I do remember, and I'm mostly saying this for people out who might be listening and saying, well, I wonder if that's in the ballpark. So we talked about like people diagnosed with fibro and IBS and chronic fatigue and all those things. The other thing that I noticed in retrospect now that the pre-SIBO— so my practice goes pre-SIBO and post— The people who reacted very oddly or atypically to either herbal or drug things that should have done one thing when they took them orally, and they wound up getting extremely bad, you know, pain or diarrhea for days that didn't stop or other things that don't match that treatment. Most of those people that had the most, you know, what I would call just the most wild atypical reactions to things that we didn't see coming, they all wound up being SIBO patients.

Wow.

That was— and that's only knowing people and looking at their cases long enough to see Oh gee, you know, well, you know, 20 years ago this bad thing happened when we gave you this treatment and it was because you already had SIBO and, you know, it just interacted the wrong way. So if you have atypical reactions to taking things orally, sometimes that's another thing I've seen. I don't know if you've noticed that, but it seems to be true.

Yeah, I mean, people— so the SIBO Facebook group, SIBO SOS Facebook group, Facebook group has 18,000 people in it, so they are all talking about the weird stuff that is happening to them. Some people are like, oh, I did Rifaximin for 2 weeks and I feel so great, you guys. And other people are like, I took it and this happened or that happened. Or, you know, does anyone have like, you know, ingrown toenails from SIBO? I mean, it's just everybody's got something going on.

Yeah.

You know, we're all different. We all, uh, you know, have, have stuff. And, you know, Paul, when I first started this, uh, my own personal journey, and, and went out to Portland, Oregon, where like this cache of SIBO specialists exists, right?

Yeah.

Um, I, I would have told you that I definitely didn't have Lyme and that I had no mold exposure and I never had mono, so I don't have Epstein-Barr virus. And what ended up happening is— oh, and Ehlers-Danlos, thank you. I'm not even talking about like a second-year medical student who has it all, right? Who's like, oh, I got that, I got that, I got that. But it turns out like you really do have all those things, which explains a lot. So remember, SIBO is caused by something else. It causes other things. Um, you can feel better. I do. Managing a chronic condition can make you feel 100% better. than an unmanaged chronic condition. And that's a big learning for me and a big message I have for everyone. Because if you, you know, of course everyone wants to be cured of— yeah, I'd love it. Of course, that's totally normal.

Yeah.

But yeah, if you can at least manage a condition, you can feel 100% better. And that's, I think, some of the wisdom I have learned from this process. And I want to I want to encourage people because the, the cynicism that can come from long-term unresolved health issues and the financial burden and the depression and the isolation and the loneliness and all of those horrible things, you're not alone. There are solutions. Hang in there and work a plan, and maybe one day you do absolutely nothing, and then other days you're super enthusiastic. That's all fine. That's all fine.

Yeah, yeah, that's— thank you for bringing that up. That's, um, obviously, yes, everybody would like just something to cure the problem and have it be an old memory, you know, like breaking your arm or something. Um, and, and one thing I would say, just as a plug, maybe to, you know, maybe not people who are in their middle or later ages who might be diagnosed, but Now that people are aware, or as parents become aware, if you start seeing these symptoms in your children, they have a much higher chance of healing, etc., completely, the earlier you find out this is the problem. You know, like you were saying, your, you know, your food poisoning from when you were 5 years old, you know, haunts you to this day. I mean, that's, that's a problem. That's a thing.

Yeah.

So the The earlier you can help younger people, but let's say it's, you know, okay, good for the young people. The psychology behind having something chronic is a whole other part of being more or less well, like, and you did a really good job of explaining it. And I do think that you brought up some other things like people with chronic infections, say whether it's the Lyme family or Epstein-Barr or whatever. If you've been dealing with those things and you're still kind of hitting a wall in certain places and no one's looked at this end of the problem, you know, that goes both ways really. And so that was another thing that we did with folks once we started to become aware of this, um, was we would send a lot of our chronic infectious people that were just in this loop of, you know, they get a little better and then they'd crash and they get a little better and they crash.

Yeah.

you keep having to look under rocks. Well, SIBO became one of the big rocks to kind of pick up and make sure wasn't going on, because everything that weakens you makes everything else worse. And there is, you know, it's not great fun to have something that's chronic that's probably not going to go away. But you do need to live your life, and you can either push it in a direction where you're more healthy more of the time and you feel better more of the time, or not. And it's really hard when you've been kicked around by the system, or you went down, you know, roads that didn't, you know, dead-end roads or whatever. And it's just being encouraged about that, that there are more answers is sometimes that's enough to get people to kind of, you know, pick it up and do more.

Keep going. I mean, I spent so much time and energy and money, and I love Ayurveda, and I love acupuncture, been Rolf and you name it.

Yes.

But, but, but the thing that— to your point, it's, it's, it's easy to normalize not feeling well, right? So that's another thing you have to be careful of. Like, it's like if you look at old photos, I've done this before where I look at— we used to gather for birthday parties, obviously, but we had a very strong pattern of gathering for birthday parties for this, like, 8 of us. And I can look back at these group pictures and tell you, yeah, I didn't feel good that day.

Yep.

I didn't feel good that night either. Yep. I remember I had to unbutton my pants underneath the dining room table that night too. Oh, look, I'm really— I mean, like, I can— like, everyone's having a good time, but I can track how I wasn't feeling well year after year after year after year. It's not normal to not feel well, and you deserve to feel well.

Yeah.

And it's your birthright. And sometimes you have to put out a lot of effort for it and it sucks, but there you go. And then tell your friends about it and talk about it and educate other people about it because maybe they're in that same situation or they know someone. Word of mouth is huge for these situations because it's not happening in your typical medical environment. So please spread the word.

Yes. Now, so in just a couple of minutes, because we're gonna— we're on the tail end of before we get the electronic hook, but so here's the book, Healing SIBO, right there, and you can get it anywhere where you get books. Now, we got a couple of minutes before I'm going to transition to your resources and where to get a hold of you and all of that business. But before we hit that, is there any other one or two things about the book in particular that— now there's not a lot of books for the public about SIBO anyway, but some real shining lights. I think the page 111 flowchart is a big shining light because that simplifies about 10,000 pages of problems.

Right? Yeah. Exactly.

Yeah.

The diet part will tell you you can start feeling better right away by switching up your diet because the diet, the food is what's feeding the bacteria and it doesn't cure it, remember, but it can make you feel better really quickly. And I have over 40 recipes that are actually really delish.

Yes.

And I have Dr. Siebecker's SIBO-specific food chart in the back. She was very gracious to let me use that. So you'll be able to really tell what to consume. And then I did make a 21-day plan, mainly because the publisher wanted me to. So I was like, for sure. And it's basically suggestions like, okay, if you're just figuring this out now, this is what I would do first. And then I would do this, and then I would do this. And if you did it in 21 days, you'd be well on your way to feeling so much better. So I give you a, you know, a week-by-week guide. But what's cool about like that algorithm is you can come in anywhere on the algorithm and, and work your plan. So that's one of my favorite parts. Yeah, that, that combination of the recipes and the algorithm.

Yeah, I think if you didn't mention it, I was going to. One of the— I know for everybody, one of the most frustrating things when you have diet-manipulated disease of any type is, well, what in the world do I eat? Because it's not that people don't want to change things, it's just there's a billion ways you can eat or not eat, and you don't have time to reinvent the wheel.

Right.

The recipes are amazing. They're the kind of thing that every patient I've ever talked to about this would have loved to have had, because at least you got a place to start. And then, you know, like, and you've got Dr. Seebecker's you know, chart that shows you, okay, more or less fermentable foods, then you can kind of branch out and you, you know, okay, this is what I'm going for with my diet, but you can literally start to feel better just by shifting your diet, you know, and then there's many other things to do. So yeah, I think that's a real gold mine among many other things. The other thing too is, you know, it's not a difficult read, you know, it's because some books even written for the public, and I'm speaking from my own experience with editors, I've been told by editors, this chapter is great, but you're not writing for doctors, you need to rewrite this for anybody who wants to read it. So then I rewrite it.

Right.

This reads really easily. It describes things the way they need to be described. Anybody can manage, you know, being informed. And the other thing is, if you do give it to your doctor, they like simple things too, usually. Like, your doctor, if they're interested, can pick up the ideas really quick out of the book. So, um, now, of course, if the person has the book, on the back there's a lot of contact information for you, etc. But So there's S-I-B-O-S-O-S, so SIBOSOS.com. And is that your main landing site?

That's my main website, yeah, and we have all kinds of resources there and exclusive discounts on SIBO supplements because I strong-armed people into making them give them to me so that the community could get them. Yeah, I mean, really good discounts. So that's a great place. The SIBO SOS community on Facebook is a great place. It's really a hotbed.

And if on Facebook, if they just search SIBO SOS, it'll come to the community?

It will come to our page, and the page is like, okay, but you really want to get into that SIBO SOS Facebook group. So go to the page, check it out, like it, thank you, but then find the search groups in Facebook, SIBO SOS community. You'll find us there.

Okay, so SIBO SOS, search through groups. Very good. SIBOSOS.com will get to you and I bet you probably have links there to everything as well.

Absolutely.

Very good. And of course, the book Healing SIBO and I think if you just search that, that will get you there because I don't think there's any other book with that title out there.

I hope not because I'd be— it's on Amazon, guys. And by the way, the actress that read the Audible book did an excellent job. You can get on Kindle and all that jazz.

Right. So it's, it's all the usual electronic ways of getting books, including Kindle, etc. Well, that's great that you've got an audiobook too. That's, that's awesome. Well, we're, we're winding right down. And so first, I just want to thank you for coming on. It's always, it's a lot of fun to talk. You and I have never had a bad conversation. They've They've often run longer than we wanted. And I think we may do this again in a few months. You never know. We might talk about some other things related to it. Usually I get feedback and I would love to have you back if you're amenable.

Thank you. Of course, because we didn't talk about biofilms.

No, no, that— gee, that'd be hours if we—

Yeah, that would be hours. You're the only interview I ever did where I cried. Oh, but it was just because— no, no, it wasn't sad. It was, it was tears of joy that you've made so much progress in the world of science. It was just, I was sad that my mom who died of cancer didn't know you and have those resources. But what a beautiful thing you do for the world to help us all heal and get educated and think differently. So remain curious, everyone. Thank you.

Yes, remaining curious, very important. Thank you so much. I didn't know that was coming, but, uh, so SIBOSOS.com, you can find everything else from there, or Healing SIBO anywhere you get books of any form. All right, well, this is the end of the program for today. It's Dr. Paul Anderson, and I will see you all on the radio next week, and you can check out the podcast anytime you want. See ya.