Always BLOATED, Gassy, and Backed Up? It Might Actually Be SIBO (and How to Fix it) with Dr. Lindsey Walker

Here’s an overview of what you can expect in today’s episode: 03:14 - Introduction 04:20 - SIBO risk factors 05:46 - The role of the MMC (migratory motor complex) 07:51 - The role of eating disorders, dieting and restriction on SIBO risk 10:32 - How to test for SIBO 16:36 - How to cure SIBO 21:36 - Can carnivore diets cure SIBO? 23:40 - Probiotics for SIBO (what to choose and what to avoid) 30:00 - Fiber Dos and Don’ts in SIBO 31:37 - How to prevent SIBO recurrence 35:14 - How to Deal with Painful Bloating Check in with today’s amazing guest: Dr. Lindsey Walker, ND Website: Dr. Lindsey Walker, ND Appointment Booking Disclaimer: The content in this episode is for educational and entertainment purposes only and is never a substitute for medical advice. If you’re struggling with with your mental or physical health, please work one on one with a health care provider. If you have heard yourself in our discussion today, and are looking for support, contact the free NEDIC helpline at 1-866-NEDIC-20 or go to eatingdisorderhope.com. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✨ Reach Your Weight & Health Goals — Without Dieting! Pre-order The Hunger Crushing Combo Method, Abbey’s revolutionary additive approach to eating well. Learn how to boost satiety, stabilize blood sugars, reduce disease risk, and improve your relationship with food — all while getting the best nutrient bang for your caloric buck. With 400+ research citations, cheat sheets, evidence-based actionable tips, meal plans, and adaptable recipes, The Hunger Crushing Combo Method is the only nutrition bible you’ll ever need. 👉 Pre-order today! 🛒 Where to Purchase: Amazon Barnes & Noble Amazon Kindle Apple Books Google Play Kobo Apple Books (Audiobook) Audible abbeyskitchen.com/hunger-crushing-combo • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✉️ Subscribe to My Newsletters: Abbey’s Kitchen Newsletter 📘 Check out my FREE E-Books: Hunger Crushing Combo™ E-Book Protein 101 E-Book 👋 Follow me! Instagram: @abbeyskitchen TikTok: @abbeyskitchen YouTube: @AbbeysKitchen Blog: abbeyskitchen.com Book: The Mindful Glow Cookbook • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 🎧 Don’t forget to subscribe on Apple Podcasts, Spotify, or wherever you listen — and leave us a review! It really helps support the show ❤️ 💬 If you liked this podcast, please like, follow, and leave a review — and let me know who you’d love to hear about next! ⭐ ⭐ ⭐⭐ ⭐ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 0:31Speaker 01

  I would hear stories in my office about people who could not travel because they would not know where every bathroom was in a new location. People who would take public transit to work, who would know where all the bathrooms were on their route so that they could stop and move their bowels. It shrinks people's quality of life.

• 0:55Abbey Sharp?

  Welcome to another episode of Bite Back with Abby Sharp, where I dismantle diet culture rules, call out the charlatans spinning the pseudoscience, and help you achieve food freedom for good.

• 1:09Abbey Sharp?

  I am very excited about today's episode because it basically is like doubling for me as a free counseling session with one of my most respected colleagues. My longtime followers might recall that about three years ago, after my second son was born, I went through a very long, arduous battle with a functional gut disorder called SIBO, aka small intestinal bacterial overgrowth. This is a condition where excessive amounts of bacteria pool in the small intestine, leading to extreme bloating, gas, diarrhea, constipation, fatigue, and an inability to tolerate a lot of your favorite foods without a painful flare.

• 1:51Abbey Sharp?

  There are a lot of proposed risk factors and mechanisms that put one at risk of SIBO. But for me, it was likely due to my existing IBSC, which affects gut motility, and the fact that I had to be treated with very strong antibiotics on five different occasions, basically back to back, for painful debilitating mastitis while nursing my sons. I was in so much pain and visibly so bloated that I looked pregnant, even though I was 18 months postpartum, which was exactly when I called my guest today, Dr. Lindsey Walker. Lindsay is a naturopathic doctor with an expertise in digestive disorders, women's health, dermatology, and pediatrics,

• 2:34Abbey Sharp?

  who is also a key scientific advisor for New Theory. But I'm super excited to have her on to chat about the causes and symptoms of SIBO, testing and treatment, the role of low FODMAP and carnivore diets, probiotics, and some tips for managing the bloat as you work through your treatment. A reminder that this episode is for entertainment and educational purposes only and is never a replacement for any one-on-one advice. So if you're experiencing some of the symptoms that we are going to be discussing today, definitely speak to your doctor, dietitian, or naturopath about SIBO testing. Also, if you are new here, I would really love if you'd give Bite Back a nice little comment and a five-star review because it really does help me out. All right, let's get into it.

• 3:26Abbey Sharp?

  All right, Lindsay, always such a pleasure. I love having, I love talking to you. My note-taking from all of our calls is just so intense all the time because I just learn so many cool things that I want to deep dive into after we get off. So thank you so much for coming on to share your expertise.

• 3:42Speaker 01

  Oh, that's really sweet. Thank you for having me.

• 3:44Abbey Sharp?

  So first of all, for folks who maybe are just hearing the term SIBO for the first time, how does SIBO differ from IBS?

• 3:55Speaker 01

  Well, that's a really good question. They're very closely linked conditions, like you're saying. And I would say that... There's a high propensity of IBS patients where SIBO is actually the root cause of their IBS dysfunction. So it's definitely something to keep in mind when somebody comes in with that pattern of IBS-D, IBS-M, or IBS-C. And it's worth ruling out because if you treat it, the patient can dramatically improve and not be left managing symptoms lifelong. Some of the telltale signs, I would say bloating and the degree of bloating, the pattern of bloating throughout the day, and certain foods that would make the bloating worse.

• 4:39Speaker 01

  And then accurate medical history, like case taking from that perspective to look for medical red flags that would put the patient at higher risk for having SIBO.

• 4:50Abbey Sharp?

  And can you talk a little bit more about what some of those, you know, risk factors would be?

• 4:54Speaker 01

  Sure. So when you're asking about medical history in the context of the SIBO lens, you definitely want to look at and ask about concussions. You want to ask about whether probiotics make them better, worse, or no change. You want to ask if they've had episodes of traveler's diarrhea or food poisoning or viral gastroenteritis that have rendered their digestion like permanently disabled.

• 5:20Abbey Sharp?

  Right.

• 5:20Speaker 01

  After those infections. And then that can be like shortly after, like you can recover from those incidents and be normal, and then months later, this pattern of SIBO can emerge. Screening for hypothyroidism, or asking if they've ever been hypothyroid on and off medication for that. Chronic proton pump inhibitor use, chronic antibiotic use. So that could be back to back antibiotic prescriptions for like stubborn strep throat, soft tissue infections. Or it can be prophylactic antibiotic use at low dose for cystitis prevention. So UTI prevention in females or acne treatment. Gallbladder removal.

• 6:02Speaker 01

  Because bile is really important at reducing bacterial load in the small intestine and keeping it free of too much. Those are really the main ones. And then you're always asking about high FODMAP foods, how they tolerate those.

• 6:17Abbey Sharp?

  And I'm hoping you can maybe kind of speak to the motility piece and the migratory motor complex, because we do hear often that one of the theories of SIBO is that there is some impaired MMC or migratory motor complex. Maybe you can speak to what that even is for people who've never heard that term.

• 6:34Speaker 01

  Sure. So that's really the predisposing factor that sets the gut up for this pooling and then overgrowth of bacteria in the wrong place inside the digestive system. So we are hardwired every night for our small intestine to make phase three contractions, which is the migrating motor complex, the MMC. And while we're sleeping, the small intestine makes high-intensity sweeping contractions to sweep debris and bacteria down to the colon. And it also keeps the pressure in the colon high so that bacteria can't flow backward into the small intestine and then start to populate.

• 7:17Speaker 01

  So dysmotility is the term that's used to describe those contractions being discoordinated, weak, or not happening at all. And that rhythm is critical, because if you don't have that rhythm nightly, this condition has a very high rate of occurrence in a person where that's happening. And dysmotility can be a short-term occurrence, and it can self-resolve, and the patient could be fine. Or it can be a long-term occurrence and become chronic, and then the patient is set up for long-term SIBO symptoms. And really, when you're treating this condition effectively, when you're rounding third base

• 7:59Speaker 01

  and going to slide into home, and the treatment's going to be well-rounded, that's the last step, is correcting the dysmotility so that the condition does not reoccur. Because if you don't do that step, it will reoccur. Yeah, so it's the root cause of the condition and needs to be addressed as part of the plan for long-term remission maintenance.

• 8:21Abbey Sharp?

  And you know, I'm thinking about my audience here and that so many of my listeners are coming from a place of, you know, diet culture, history, eating disorder history, under eating, you know, chronic dieting, things like that. How does under eating or, you know, history or active eating disorders potentially affect the MMC, the motility? And how is that a potential risk factor for SIBO down the road?

• 8:52Speaker 01

  So cases where that is part of the history, they do have a higher rate of SIBO and other dysbiosis. When you are actively participating in bulimic patterns, it gives, the gut does not know whether it's coming or going. It's because it's having a lot of reverse peristalsis from the vomiting action, the coordinated muscular contractions, they're not coordinated because of the pattern. So those cases, yes, they have a higher rate. When you're under eating or restricting, your gut doesn't have the energy to move well.

• 9:29Abbey Sharp?

  Yeah.

• 9:29Speaker 01

  Because you need all the cells to be pulling together. You need proper cellular metabolism and cellular respiration to be happening. So people who restrict tend, their guts tend to move slower because they don't have the capacity, they have to use the calories they have to run their brain and their cardiovascular system. So the gut ends up being kind of second or third fiddle.

• 9:55Abbey Sharp?

  Yeah.

• 9:55Speaker 01

  If you are, yeah, participating in active restriction and anorexic patterns.

• 10:00Abbey Sharp?

  Yeah, and you know, it's so hard for people because unfortunately, the symptom of SIBO, the bloating, for example, and the pain that you then experience from eating a wide range of foods, tends to then kind of further encourage people to eat less. So it becomes this like, this cycle, this self perpetuating, you know, the self fulfilling prophecy, which just perpetuates the poor motility. So yeah, very important to be working with a dietitian or a naturopath like yourself to help you kind of navigate those SIBO symptoms. If you're concurrently stuck in disordered eating behaviors, because again, that can severely interfere with your treatment and your success in your treatment.

• 10:41Abbey Sharp?

  But speaking of treatment, we have a test that's quite easy to do, you know, even though the prep for it sucks, I will just say, I hate it. Because you're really only allowed to eat like rice and chicken, basically, like no, no fiber whatsoever for one to two days. Not as bad as a colonoscopy prep, I will say that. But can you kind of briefly explain how the SIBO test works? Like what's involved? What do people need to know?

• 11:09Speaker 01

  Sure. So I think the first starting point is to understand this is not a new test. This test has been around since 2006. It's not a new kid on the block. It's a very effective tool for diagnostics and it's a very effective tool for reassessment to see how your treatment's going, if you've achieved full eradication from SIBO treatment. And so it's a provocation test. So like you highlighted, it involves eating a preparatory diet for one to two days that has no fiber. So you just eat white, white, white rice, white bread and protein because there's no fiber in those foods. And then effectively, when you do that for the preparation, it gets all the fiber out

• 11:54Speaker 01

  of the digestive tract. So if you do have an overgrowth of bacteria in the small intestine, it will not have been fed from the preparatory diet. So then after doing the preparatory diet, you do a 12-hour overnight fast and then you wake up and you're ready to test. And this test is done at home and you have a little device that you blow through and you collect your breath specimens with test tubes. So the first specimen that you take is in that fasted state after doing the preparatory diet for one to two days. So that's your baseline sample. And then you drink a testing substrate, which is, in this case, the, the top testing substrate is lactulose, not lactose, lactulose.

• 12:39Speaker 01

  I always like make that distinction. Lactulose is an indigestible, non-absorbable sugar, which means it will not be altered by the digestive system as it passes through the small intestine. It will stay just in the intestine and it will interact with any bacteria that will be there. They will feed on it and it will generate measurable gases of hydrogen and methane gases in your breath. So the small intestine, it's 22 feet long. So this test is three hours. And after you collect your baseline sample, you and you drink the testing solution.

• 13:19Speaker 01

  You then collect samples every 20 minutes until 180 minutes. And that gives us an excellent snapshot of the microbial distribution of the small intestine.

• 13:33Abbey Sharp?

  Right. And so you get your results and you're going to see different subtypes of bacteria. And we have hydrogen, methane, and then sometimes they'll report hydrogen sulfide. Can you kind of explain how these different bacterial overgrowths present themselves differently?

• 13:48Speaker 01

  Sure. So with the three subtypes, you have your classic presentation, which we'll review. And then you have your a classic. So sometimes I'll run a test and I will assume what the results might be based on the patient's symptoms, and they won't match. That's why testing is important because clinicians do not have a crystal ball to predict what results will be. So with the hydrogen subtype, it's the most common. And that's that means that the organisms that are detected on the test are generating hydrogen gas. So when they consume hyphoid map substrates from the patient's diet, they generate that type of gas. And generally, the symptoms would be bloating,

• 14:33Speaker 01

  diarrhea, urgency, and intestinal cramping because hydrogen gas, as it flows through the system and goes into the colon, it makes the colon contract. So that's when you're case taking and you hear that somebody has frequent urgent spasmodic diarrhea, that that is a regular occurrence, weekly. Your mind goes that, okay, this might be a hydrogen overgrowth. So IBSD would be kind of the diagnostic there. And then the methane subtype is the opposite. The organisms there generate methane and the colon hates methane gas. It slows it right down. Like basically, the contractions go to like

• 15:15Speaker 01

  very low intensity and very low frequency. So the colon kind of arrests when methane is in the system. And that picture will be infrequent bowel motions, straining, bloating, trapped gas because the system is not moving well. And then the third subtype, the rarer subtype, hydrogen sulfide, SIBO, they are hyper fermenters. They are uber bloated. They can have diarrhea. They have other hallmarks. So they will tell you that they have like bad breath all the time, or they have a metallic taste in their mouth.

• 15:58Speaker 01

  And the type of gas that's generated in that instance, the traditional SIBO breath test does not directly report it. But you can tell by looking at the hydrogen numbers and the methane numbers, if it's possible that that's the subtype the patient has.

• 16:14Abbey Sharp?

  Yeah, I always get sacked with the more difficult methane, which is again, the IBFC, which is again, what I've struggled with most of my adult life, but is trickier to treat, is it not?

• 16:25Speaker 01

  Yeah. So out of the three, hydrogen overgrowth are the easiest to treat. The second subtype, the methane, are harder to treat. And the toughest ones are the hydrogen sulfide.

• 16:37Abbey Sharp?

  Yeah.

• 16:38Speaker 01

  Yeah. Because the treatments so far, we have the treatments we have. And I believe that science will evolve over time, just like it has to bring us to where we are now in this arena. And we will have better treatments for hydrogen sulfide as, as things evolve.

• 16:52Abbey Sharp?

  Great.

• 17:06Abbey Sharp?

  Let's kind of talk about treatment first. And obviously, everybody's SIBO eradication protocol is going to be very different. But generally speaking, it's positive. What are the next steps for, for most people generally?

• 17:20Speaker 01

  Yeah. So there are three ways to kind of approach this from an eradication standpoint. So generally, you want to, A, set yourself up for success and do some prep in the gut before moving on to eradication. And that involves generally taking a formula to address bacterial biofilms.

• 17:41Speaker 01

  Biofilms, like the straight up way to think about them is they are the apartment building that bacteria live in. So inside our gut, they live in this kind of network. It looks like a coral reef and they, the bacteria that are there actually steal small amounts of minerals from the diet to make this structure.

• 18:01Abbey Sharp?

  Wow.

• 18:01Speaker 01

  And it protects them from treatment and it protects them from the immune system. So they're smart. They're not just, this has not been their first rodeo, these bacteria. They want to survive, just like any other organism.

• 18:13Abbey Sharp?

  Yep.

• 18:13Speaker 01

  So the first phase is that preparatory phase to like, what I effectively say, let's prepare the garden for weeding. So like, if you were going to make a garden and you just hedge your backyard, the first thing you would do, you would rotor till the soil. You would till it up and, and really bust it up so that you could actually access the fertile soil beneath. And a biofilm disruptor is exactly like that. It is busting up the biofilm so that the bacteria will be exposed to whatever eradication therapy you're going to select. And that phase, uh, the preparatory phase continues throughout the eradication phase. So then the eradication phase involves you selecting either pharmaceuticals,

• 18:56Speaker 01

  natural antimicrobials, or something called the elemental diet to eradicate the overgrowth. And those, whatever you select, uh, depending on the case, the chronicity, the severity, the test results, you would deploy those treatments anywhere from two weeks, four weeks, six weeks. And you're always monitoring clinically and then reassessing with the placebo breath test to see how things have been going. So that's the eradication phase. And then the third and final phase is that phase we talked about before, where you are recovering the motility of the small intestine with generally a medication or a natural agent to correct dysmotility. And that phase is 90 days minimum.

• 19:40Speaker 01

  Yeah, that phase can go on longer to protect the patient's investment and protect their clinical remission in having completed the other two phases. That's kind of a overview.

• 19:51Abbey Sharp?

  And you know, as you probably know, there's, there's a lot of talk online about, you know, how do you, how do you cure SIBO naturally through diet? And you mentioned the elemental diet, maybe just like very briefly, like what do you have to eat on the elemental diet? It's a hard no for me. I'll take the antibiotics any day, but what is the elemental diet that is an option?

• 20:12Speaker 01

  So the elemental diet is a 14 to 21 day period where you consume a Health Canada approved meal replacement, where the shake that you're drinking, which is your sole source of nutrition, is all of the macronutrients broken down into their elemental form. So literally it's sachets that are flavored in vanilla and chocolate, and you consume a certain amount to meet your caloric needs. But there's no fiber, there's nothing, there's only the, the macronutrients and microminerals you would need. And that formula is rapidly absorbed in the first three feet of the small intestine to nourish the patient. But there's nothing for the bacteria to eat, so they die by starvation.

• 20:57Speaker 01

  And it is an effective eradication tool, especially if antibiotics have not been well tolerated or they've failed. And so if you have a treatment failure, the elemental diet is a really good selection. It is psychologically quite difficult to do. You have to clear your calendar. Like you can't be going to social events where there's food.

• 21:17Abbey Sharp?

  No.

• 21:17Speaker 01

  Because you're really on a liquid diet and there always is some weight reduction. It's always water weight. People gain it back once they start eating again. And when you do the elemental diet, it's always medically supervised. You have to be overseen by a clinician so that you are, you're drinking enough of the shake to, to function and be able to move through the process. And during the elemental diet, you're monitoring the digestive symptoms. Everything goes pretty quiet, pretty fast when you're not eating, because there is an element of bowel rest and like digestive rest. And the elemental diet is not just used for SIBO, it's used for other like IBD, it's used for ascinophilic esophagitis.

• 21:58Speaker 01

  It's used for other conditions where we need the digestive system to rest from its process and provide, you know, adequate nutrition through, through those means.

• 22:07Abbey Sharp?

  So then, building on an evidence-based, you know, treatment protocol like the elemental diet, we see a lot of animal-based or ancestral or carnivore advocates online claiming that you can cure SIBO and other forms of dysbiosis by eating carnivore. What's the take on that?

• 22:25Speaker 01

  So with the carnivore diet, you would have to engage in that diet probably long term. So let's say you committed to eating that diet for two years. Technically, scientifically, over time, because there's nothing for the bacteria to eat, they would reduce. Maybe they would be fully gone. But generally, what we see when people take that approach is when they return to a diet that has fiber, fermentable fiber, sugar, polyols, their symptoms come back. Now, they might be to a lesser degree because the overall bacterial load has reduced by eating that diet, but I've never found that particular approach to be curative. I do believe you need some form of eradication to really get the job done.

• 23:10Speaker 01

  I would say those diets, they subdue the overgrowth, they subdue the symptoms, they reduce the symptoms. They're a management tool. And maybe folks who have certain philosophies about not wanting to use the eradication therapies we have available, well, then they have those dietary tools to manage.

• 23:27Abbey Sharp?

  Right, yeah. I mean, my followers know I'm anti-carnivore for many reasons. I think plants are important, you know, if, for long-term health specifically. You know, again, because once the SIBO is healed, we know that, you know, good gut bacteria need probiotics and fiber to flourish and thrive. And, you know, even when we look at the literature, there was a review of the literature that found that folks whose diet was low in fiber and high in animal protein, like what we would expect on an all-meat diet like that, had guts with, you know, a bacterial species ratio that is linked to conditions like obesity and other metabolic conditions. So maybe short-term relief, but perhaps long-term, you know, disadvantage.

• 24:10Abbey Sharp?

  But I want to talk about probiotics, because obviously, we hear probiotics and we automatically think, yay, good for gut. And if we are struggling with- Our gut, because we have SIBO, people may automatically think more is better. Anything goes, all probiotics are appropriate. But in some cases, it may actually make it worse. Can you kind of explain the do's and don'ts of probiotics and SIBO?

• 24:32Speaker 01

  Sure. So I find probiotics are like a litmus test for whether SIBO is likely. So let's say a client comes in and they have a pattern suggestive of IBSD and they've never taken probiotics. They're hesitant to run the test, they're unsure. I'll say, let's do a trial of probiotics and this will be a bit of a canary in the coal mine, if you will. So we'll prescribe a multi-strain probiotic for two weeks. And if they flare, SIBO likelihood is very high. Because when you think about the condition itself, it's a pooling of bacteria in the wrong place that are now overgrowing.

• 25:14Speaker 01

  The bacteria present, they're not pathological or pathogenic. They're our natural flora, but just in the wrong place because of the dysmotility in the small intestine, short term or long term. So when you take probiotics, they are a test. And if it's a multi-strain probiotic that contains both lactobacillus species and bifidobacterium, you will probably see either a flare, no change, or improvement. If they improve, chances are that SIBO is like moving down the diagnostics list because they have tolerated the product and they have actually improved by 50% in bloating, bowel movement frequency, abdominal pain, burping and flatus.

• 25:58Speaker 01

  But if they do get worse, that's definitely a red flag and they should likely move forward with being assessed with the breast test. There is in the probiotic community a big differentiation between the two main species that we see in products, so lactobacillus and bifidobacteria. The bifidobacteria, they actually are quite SIBO friendly and they're friendly to patients who've recovered from the condition and received the proper care. Because they are like very small organisms. They self-propel. They can get to the colon on their own. Whereas lactobacillus organisms, they do not self-propel. They are much larger.

• 26:39Speaker 01

  They require being shuttled to the colon by the small intestinal contractions. And in a SIBO patient, those contractions are messed up. So they can pool and add to the overgrowth. And that's why they make patients who have existing overgrowth flare, make their symptoms worse.

• 26:58Abbey Sharp?

  And what about the bacillus strains and the esbulardi?

• 27:01Speaker 01

  The esbulardi is in a different category because it's actually a yeast.

• 27:05Abbey Sharp?

  Yep.

• 27:06Speaker 01

  So it can be very friendly, especially during eradication phase where we're using pharmaceuticals to eradicate the overgrowth. Because yeast is part of our flora. And when you are going after the bacterial overgrowth and reducing it with your treatments, we don't want there to be a flourish of the yeast organisms flourishing. So we give the esbulardi and it helps really increase treatment tolerability and reduce the possibility of yeast overgrowth from the eradication itself. And then the spore formers, they're really interesting. I think we're just kind of in the infancy of really understanding them. They kind of recondition, like they have a reconditioning effect that the lactobacillus and the bifido don't have.

• 27:51Speaker 01

  And they seem to have like more immune interaction with like the local enteric immune system. So the GI immune system, the digestive system has its own immune system, which communicates with the systemic immune system, but it has its own comings and goings. And spore formers, sometimes they're used short term just to kind of like hit reset, recondition, and then add the other organisms. And sometimes they're used chronically. So I'd say like with probiotics, it is about figuring it out. And it is about like using the data we have in the scientific community to say, look, I believe based on everything to date, this probiotic. Would be well suited for your case based on your diagnosis and what we've done so far.

• 28:35Speaker 01

  The other question I get sometimes is, do I need to change my probiotic? No. If it's working well for you, that means it's meeting your needs on a microbial level. You don't need to switch it up. And if your diet is a healthy diet full of plant fiber, you're going to get other diversity and populace from your nutrition.

• 28:55Abbey Sharp?

  Super helpful.

• 29:10Abbey Sharp?

  And if there is suspected or confirmed SIBO, should we also be ideally limiting kind of natural sources of probiotics, like fermented foods, kombucha, yogurt, sourdough, all that jazz?

• 29:22Speaker 01

  I would say it depends on load and frequency. So generally, those will, if the patient has active SIBO, those foods will make them worse.

• 29:32Abbey Sharp?

  Yep.

• 29:32Speaker 01

  If they eat them below a certain threshold, they probably will tolerate them okay. But if they go over that threshold, they will be symptomatic. And in cases where we've reached the final phase and they are in remission clinically from their previous symptoms that plague them every day, I will say, like, stay away from fermented foods.

• 29:54Abbey Sharp?

  Yep.

• 29:54Speaker 01

  They're not your friend right now. They might never be your friend. And we can talk about weaving them in down the road. But right now, we're so close to like having you 100% cured that I don't want to muddy the water with you ingesting them. Fermented foods are a great source of diversity for a healthy digestive system.

• 30:15Abbey Sharp?

  Yep.

• 30:16Speaker 01

  SIBO patients do not have healthy digestive systems. They have an ongoing chronic process.

• 30:22Abbey Sharp?

  Right. So work through the eradication. And then, once things are looking good, then you can work in some of those nutritious fermented foods. And what about fiber? Because again, we know a healthy gut depends on fiber. What should we be thinking about when we're actively dealing with SIBO symptoms when it comes to our fiber choices?

• 30:42Speaker 01

  During, so during treatment, if you're on a pharmaceutical protocol or a natural version of that, natural antimicrobials.

• 30:52Speaker 01

  You do want to eat a high-fiber diet while on eradication because it makes the overgrowth more active and it will improve the effectiveness of the eradication medicines. When the patient is in that phase, they often ask, oh, do I need to eat like a low FODMAP diet or do I need to eat like I did when I was preparing for the tests? I'm like, no, we want the bacteria to come out and play so that the agent that we're using, they will interact with it and it will kill them.

• 31:25Abbey Sharp?

  Right.

• 31:26Speaker 01

  So you want to eat a high-fiber, high FODMAP diet when on eradication.

• 31:30Abbey Sharp?

  Yep.

• 31:30Speaker 01

  In fact, some of the trials on rifaximin, which is the main pharmaceutical use for hydrogen overgrowth, they give it with like five grams of partially hydrolyzed guacam and the effectiveness of it goes up because of the fiber being present and the overgrowth being more active and that whole kind of thought. And then on the back end, once eradication's complete and you've completed correction for the dysmotility, you can go back to enjoying fiber, both soluble and insoluble because they have different roles and are important in healthy gut process.

• 32:05Abbey Sharp?

  Yeah, super, super helpful. And finally, we know SIBO recurrence is incredibly common, unfortunately. Here I am and I felt, you know, I felt like I did everything that was within my control to prevent it. Yeah, you know, I take my fiber solvents, I take my resitran, I've got a high-fiber diet, but I'll never deny antibiotics when needed. So what can we do to give ourselves that best shot of preventing the SIBO from reoccurring? If we're thinking like long-term, yes, we've done the, the stage three as required or recommended, now what?

• 32:37Speaker 01

  Ah, not to sound fatalistic, but some people, this will be a coming and going condition for them, simply because we can't get the motility perfect.

• 32:47Abbey Sharp?

  Yeah.

• 32:47Speaker 01

  And most people who have only had SIBO a short time, like less than two years from the starting point of the bacteria started to pool and overgrow, generally they'll be treated, it will never reoccur. People who have had chronic SIBO or IBS for five, 10, 15, 20, 30 years, they probably are going to need more routine oversight and eradication here and there when their symptoms and testing dictate it. And I would say the bulk of the cases I have seen are the one and done. They're treated once, the treatment's good, I never see them again, once they're in remission.

• 33:29Abbey Sharp?

  Great.

• 33:29Speaker 01

  And then the more chronic folks, they're a lower number for sure. But they probably go through a period of dysmotility for one of the risk factors that's either chronic or new to their case.

• 33:42Abbey Sharp?

  Yep.

• 33:42Speaker 01

  And they see a slowdown, the slowdown is like longer and it allows the condition to reoccur and then they need to be treated again.

• 33:52Abbey Sharp?

  Yeah.

• 33:53Speaker 01

  And then where I'm always hopeful, like when we treat them again, that the remission will be longer and generally the new results from the recurrence are not what they were when they first had the condition.

• 34:07Abbey Sharp?

  Right.

• 34:07Speaker 01

  The overgrowths are more mild, they're easier to take care of. It's like a little blip.

• 34:12Abbey Sharp?

  Yep.

• 34:12Speaker 01

  And you're like, okay, we got to treat the blip. This seems like it's back. It's not back to the same degree as five years ago when we first detected it and had you go through treatment at that time.

• 34:22Abbey Sharp?

  Yeah.

• 34:23Speaker 01

  So I think there's just that population where we can't get the motility perfect.

• 34:27Abbey Sharp?

  Yeah, I mean, that's definitely me. Again, I'm kind of grateful that my second rodeo seems a lot less aggressive than my first. So we're just kind of staying grateful for that and that this is an easier eradication phase.

• 34:39Speaker 01

  My mission to assist with this condition because I would hear stories in my office about people who could not travel because they would not know where every bathroom was in a new location, people who would take public transit to work. Who would know where all the bathrooms were on their route so that they could stop and move their bowels. It's definitely a quality of life shrinker. It shrinks people's quality of life.

• 35:06Abbey Sharp?

  Yeah.

• 35:06Speaker 01

  And you know, when you have a day and your digestion is good, it's like such a great day for those people.

• 35:14Abbey Sharp?

  Oh, my God. Yes, I think everyone, anyone with IBS can identify with that, like a good poop day or like, you know, you're not feeling bloated that day or, you know, you just feel comfortable for once and it's just like, whoa, this is what it's supposed to feel like. So, thank you so much, Lindsay. This was so insightful as always. And of course, I'm going to be leaving links below to where people can find you. So, thank you again.

• 35:40Speaker 01

  You're welcome. My pleasure.

• 35:45Abbey Sharp?

  Oh, I could honestly talk to Lindsay all day. She's just such a wealth of knowledge. So, I'm just so grateful to have her to call on for advice on our formulas at New Theory. And as Lindsay and I alluded to, resolving SIBO can be a long game, which can feel like an absolute eternity when you're feeling physically uncomfortable after every meal and emotionally uncomfortable in your body and clothes. But as someone who's now been through this twice, I want to share some perspective on what has been really helpful for me.

• 36:23Abbey Sharp?

  So, for one, when I'm having a particularly bloated day, going for daily walks after my meals can really help to address the psychological stress piece of IBS, but also help to support digestion. Number two is making meals and snack times a priority. So, that means sitting down, chewing thoroughly, and not rushing through.

• 36:48Abbey Sharp?

  Tip number three, so for days that I get a flare from like very high FODMAP foods like cauliflower, legumes, onions, asparagus, or dairy, I am definitely leaning on my brand new New Theory Digestive Bloat Supplement because it's got high potency digestive enzymes, plus herbs for motility and gut irritation and inflammation. So, I'm going to leave a link to where you can find that below for folks who struggle with regular or sporadic bloating.

• 37:18Abbey Sharp?

  And finally, practicing self-compassion. You know, wellness culture may try to make you believe that your bloating or SIBO diagnosis is some kind of like visual cue that you aren't prioritizing your gut or your health. But as Lindsay and I mentioned, there are so many risk factors for SIBO that we have little to no control over. So reminding myself that I am not defined by my disorder or symptoms, that dysbiosis is not permanent or a static state, and that with the right supports, I will overcome this challenge. And that brings me to the end of our episode. So thank you so much to Dr. Lindsey Walker for the incredible insights that she brought to today's show.

• 38:03Abbey Sharp?

  Again, I will be leaving a link in the show notes for where you can find her. And if you are not already, I would love if you would subscribe wherever you get your podcasts and leave me a little love note review and a five-star rating because it really does help my show out. Signing off with Science and SaaS, I'm Abby Sharp. Thanks for listening.

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