SIBO SOS® Masterclass Library

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IBS Smart Test

Here’s something crazy:

Until recently, there was NO way to know for certain if a person had IBS (Irritable Bowel Syndrome).

And even if your doctor ruled out other diagnoses and landed on IBS, you had no way to know WHAT caused the IBS.

It felt like IBS was a medical mystery!

That’s why I have been so excited to share the new ibs-smart test with the SIBO SOS® Community. The ibs-smart test is a simple blood test that can definitively diagnose diarrhea-dominant and mixed IBS.

Here’s how it works:

ibs-smart tests for two antibodies (anti-CdtB and anti-vinculin) known to be elevated in patients with IBS-D and IBS-M. These antibodies are known to be triggered by gastroenteritis (AKA food poisoning), which is a key insight to help IBS, because further infections can significantly worsen your symptoms. (I’ve written about it before in this blog post.)

Find out for sure if you have IBS – and if food poisoning is to blame – with the ibs-smart test!

And even MORE good new – now you can order the test kit with an online prescription and get answers right away!

Use our Exclusive SIBO SOS® discount here —> (Price includes prescription and test, plus return shipping)

Outside the United States? Go here to get the test:

Questions? Learn more about the science behind ibs-smart in THIS blog post and by watching the interview below!

sibo course

Today I’m excited to share with you an all-new FREE webinar with my friend, colleague and founder of Microbiome Labs, microbiologist Kiran Krishnan!

Kiran is a fan-favorite here at SIBO SOS® and he is back by popular demand to talk about a “controversial topic” – stool tests!

If you’ve been confused or overwhelmed by stool tests, you don’t want to miss this Q&A. We’ll cover:

  • What stool tests can and can’t diagnose (SIBO, parasites, gut imbalances and more)
  • The problem with many stool tests
  • A new approach to stool testing (available directly to patients)

This is the very first time Kiran has spoken publicly about Microbiome Labs’ new stool test-  and for the first time, it’s available directly to the SIBO SOS® community!

Watch now:

You can view sample test results by clicking HERE.

Want to order your BiomeFX test?

Normally, you would need to order this test through a practitioner.

But Kiran has agreed to make the test available directly to the SIBO SOS® Community! That means you can order it yourself, and get the results delivered straight to you. (I do recommend working with a practitioner to help interpret the results.)

First, register as a patient with patient direct code “SIBOSOS” HERE: (This is the first step and it is essential to be able to order.)

Then, watch the below video to learn how to order and what to do once you place your order to successfully complete your test. (Having trouble? Please contact Microbiome Labs directly for help with ordering: or call 904-940-2208). (My customer service team cannot assist you with ordering!)

sibo course

Microbiologist Kiran Krishnan is a SIBO SOS™ fan favorite and the creator of truly gut-changing supplements like Megaspore and Mega IGG.

In this webinar, Kiran walks us through his 3 -step “Total Gut Restoration” process. You’ll learn about the differences between a healthy and unhealthy gut and how his 3-step process helps heal the gut.

P.S. If you want to try Kiran’s 3-step Total Gut Restoration Protocol, he gave us an exclusive 15% off code!

First, register as a patient with patient direct code “SIBOSOS” HERE: (this is the first step – you can’t order directly from Microbiome labs unless you do this) 

Next, add the Total Gut Restoration products you’ll need for the protocol (3 bottles of Megaspore, 2 bottles of Mega Prebiotic, and 1 bottle of Mega Mucosa) to your cart.

Finally, enter code “GUTRESTORE15” at checkout. 

Want to try a different product? Register with patient direct code “SIBOSOS” HERE:, then use code “DIGESTIONSOS” for 15% off your entire order! But this coupon is one-time-use only, so load up your cart!

Q&A With Kiran Krishnan

After the webinar (watch it by clicking on the video above), Kiran was gracious enough to answer questions submitted by viewers when the webinar was live. Here are those questions and answers:

Leigh-Anne C. Is this something we should do during treatment or after?

Kiran Krishnan (KK): This will be a critical part of your treatment, so you would start it during.

Elena V. Thanks for your products!! I have methane sibo and am starting another round of antimicrobials. I started using megaigg, megaspore and restoreflora. My gut likes them. What products should take while taking antimicrobials can I continue use of megaigg, megaspore and restoreflora or should I add something else

KK: Yes, you can continue to use those while on antimicrobials. I would recommend adding in the MegaGuard to address bile flow issues, gastric emptying and HCL production. 

Pam M. Does Mega prebiotic have dairy in it? Or Casein?

KK: No, it doesn’t. Although the oligosaccharide is from dairy, there are no dairy proteins or fat in it. The oligosaccharides are purified extracts.

Ingrid W. If we are someone who can not take supplements easily and have to try micro doses. How long can we take micro doses of Mega IGG? Is it something you can stay on long term?

KK: Absolutely, there is no risk, only benefit. 

Pam M. Why are immunoglobulins low with leaky gut?

KK: Because of systemic inflammation and compromised immunity. 

Laurie B. P. Can SIBO ever truly be cured or is it life management once you’ve been diagnosed?

KK: I absolutely believe it can be cured. There is a mechanism that causes it and its not genetic. If we address that mechanism, it can be reversed. Unfortunately, more often than not, the root causes are not being addressed. 

Glaucia S. L. What are the best digestive enzymes and probiotic strains for SIBO? KK: Digest Gold from Enzymedica would be fine and use HU58, RestorFlora and Megasporebiotic for probiotics. 

Jeanette F.  Jeanette in Stockholm, Sweden here. Is dr Krishnan in touch with any Swedish researchers/MDs?

KK: Hi, not in Sweden.

Mary Kay A. Question: How will MegaPreBiotic affect me, given that oligosaccharides are the fodmaps to which I seem to be particularly sensitive?

KK: These are longer chains and should have less negative impact. However, go slow, use as little as ¼ of a scoop per day to start. But remember to use it after 4 weeks of the probiotic. If you have been on low FODMAP, your large intestinal bacterial are starving for fermentable carbohydrates, which are critical for maintaining gut and immune health. 

Marilyn M. Can one take the IgG product continuously with no side effects? Should it be discontinued gradually?

KK: You can absolutely take it continuously. Should you want to stop, you do not have to discontinue gradually. 

Glaucia S. L. What test is recommended to found out this problem?

KK: The problem is complex and multifactorial, if you are referring to leaky gut and barrier dysfunction. There isn’t a single test for it. You can rest assured that if you have health issues, there is a high likelihood that the gut lining is compromised. 

Robin L. C.  I had been taking Megaspore and Megaprebiotic for several months. On a recent GI Map my “Bacillus spp” was flagged high. Do you think that’s a problem? Can you overdo it with the spores?

KK: The GI Map test is archaic, inaccurate and not validated in any study. Their arbitrary flagging of strains as “high” or “low” is nonsensical. Bacillus is normally in the gut at 1X10^6 cfu/g of stool, so their threshold for “high” is way off. These strains are also transient, so they don’t accumulate beyond a certain level.

Marilyn M. I see that there are citrus flavinoids and lemonade flavoring in the Megamucsa. Will this trigger histamine reactions in sensitive people?

KK: We have not seen that at all. 

Susan G.I recently started a regime by my nutritionist for healing my gut. Started taking Aloe Vera Gel beginning of September; 2-3 Tbsp a day. I just got back my full Metabolic lab tests today, and my liver tests (AST/ALT) are extremely elevated (I am not at risk for hepatitis, I don’t drink any alcohol, and don’t take Tylenol). I searched online and it says that Aloe Vera Gel can cause adverse liver toxicity?!

KK: That may be true, but I haven’t researched aloe and liver health. Leaky gut is also a big driver of liver toxicity. It is important to use a clinically studied solution for gut healing, you should consider the Total Gut Restoration.

Robin L. C. Do you think that the GI Map is a reliable indicator for Zonulin? My symptoms say my gut is leaky, but zonulin marker is well within range. Also, I was on Megapore and Megaprebiotic for several months. My Akkermansia was still below detectable levels. Shouldn’t it be detectable by now?

KK: The test is virtually useless in detecting strains with any accuracy and zonulin is only partially correlated with leaky gut. Use a more accurate whole-genome sequencing test to more accurately detect to the species level. Tests are not the be all end all in functional medicine, follow your symptoms and how you feel as well. 

Marilyn M. Will your protocols help with longstanding autoimmune

KK: Leaky gut is a major driver of autoimmune conditions, the protocol is designed to fix leaky gut, so it should be an important part of supporting your immune system. 

May S. F.  I am currently taking megaspore and IGG for Sibo. Will I kill my good bacteria by consuming antibacterial foods like onions garlic and coconut oil, even if well tolerated? 

KK: Coconut oil will likely kill good bacteria, I would use is sparingly, the rest of the foods are ok.

Glaucia S. L. Having SIBO does it mean there is Leaky Gut?

KK: Almost certainly. 

May S. F.  And, is it true that sugar substitutes like Splenda can affect gut bacteria adversely, even affecting eyes?

KK: Not sure about eyes, but certainly gut diversity.

Glaucia S. L. Can we measure LPS in a blood test?

KK: In a lab, yes. Not in a doctors office. 

Marilyn M. Will the Mega Mycobalance assist in eliminating a systemic fungal infection?

KK: It is designed to do so. We have had success with it in people with localized and systemic issues. 

Sonja P.  Why does megaspore increase the keystone strains?

KK: Absolutely, then the addition of MegaPreBiotic increases them further. 

Ingrid W. If we can’t take Megaspore at a micro dose or Just Thrive – can we try the prebiotic instead to try to work on the gut? Can this be a back door way to recondition and build good bacteria when we have tried over months to get on the probiotics but it was too stimulating.

KK: Sure. There is no issue there. 

Karen P. N.  I am on a probiotic that was supposedly made for me based on the study of my stool sample. Can I add megasporebiotic and also your additional protocol while also on this custom probiotic? Can you use anything like Biocidin during this time for SIBO or will your protocol alone help SIBO?

KK: You can certainly use the total gut restoration as well, it will only help. Use that first and give it a single round (90 days), if the symptoms of SIBO are still present then, you can look at using biocidin.

Jordan P. what if you have Sibo? can this get rid of id?

KK: SIBO is multifactorial, this targets key underlying causes, there may be a need for other interventions, but try the system first and see how you do. 

Katie J-E. Is it ok to start with intestinal mega mucosa when starting spore probiotic or does it hinder your outcome

KK: It is perfectly ok.

Sonja P. Do you distribute your products in Europe too, i.e. Germany? I could only find products in the US.

KK: Yes, either from Romania or the UK. Look at

Eliza it ok to just take the megasporebiotic and megaiGG2000 or do i need the rebuild and reinforce too

KK: Ideally you would do all 3 steps, but if you do just the probiotic and MegaIGG, you will see significant benefit as well. 

Sonja P.  Do the spores settle in the colon or they are just transient – so they get excreted with a bowel movement?

They stay for about 21 days and then leave. 

Sonja P. I can barely tolerate any carbs. Do you recommend taking more than two capsules of megaspore in such cases?

KK: Go slow and build up to 2 caps. Once you are there, you can go beyond 2 to 3 or 4 to see if the extra dosing will help.

Michele V. Pimentel said not to take probiotics if we have SIBO, don’t add more bacteria to the situation. Don’t do this if we have SIBO?!

KK: He isn’t referring to spores and he doesn’t study probiotics. Spores can actually bring down the growth of bacteria in the small intestines. 

Katie J-E. What do you do if you have low lactobacillus buts have SIBO os ok to just do megaspore and not lactobacillus

KK: Megaspore increases your natural lactobacillus, so it will take care of that issue. 

Kristie R. Why are spore based probiotics listed as opportunistic in a GI Map?

KK: Because its an archaic test and is poorly designed. They clearly haven’t read studies on microbiome commensals and composition. Numerous studies clearly define bacillus as a commensal and a keystone genus. 

Jeanette F. Chronic constipation? Take full program?

KK: Yup. You should see improvement even in the first month. 

Katie J-E. How do you increase lactobacillus bacteria (especially for women) if they are low in lactobacillus but have SIBO and are taking megaspore

KK: Megaspore has been shown in a published study to increase lactobacillus. 

Sonja P. Is it possible that the spores could settle in the small intestine – when the conditions are favourable for the spores – like in case of SIBO?

KK: They do function in the small intestine, but once there they modulate the immune response and they bring down the growth of over-grown bacteria.

Glaucia S. L. How to revert it and have a healthy connexion with brain and gut?

KK: You have to fix leaky gut. 

Andrea Beth T. can they break through biofilm?

KK: Yes

Sonja P. Sometimes the spores can turn pathogenic, what helps the most from your experience to get the situation under control in such a case?

KK: They cannot turn pathogenic; this is a complete misnomer and simply false info that has been perpetuated by competitive probiotic companies. We would never develop and sell and product that could turn pathogenic. They have been completely gene sequenced, tested for virulence factors, etc. 

Sonja P. Is restore flora containing sacharomyces also good for constipation??

KK: It can be, yes. 

Sonja P. Do megaspore probiotics produce lactic acid?

KK: They produce L+ lactic acid which is then converted to butyrate and other short-chain fatty acids.

Sonja P. Do you have an idea why some people having SIBO can’t tolerate any probiotics and some do? Apart from lactobacillus strains that assists building up secondary bile salts. What are the main reasons?

KK: It likely depends on the nature of their overgrowth, what kinds of microbes are overgrown and how the immune system is responding to the presence of those microbes. 

Sonja P. Do you know why Epstein Barr virus causes slowing down of the motor migrating complex and initiating SIBO?

KK: I have not seen good evidence that EPV slows down the MMC. 

Vlog: Learning More About SIBO & IBS with Dr. Ken Brown, MD

IBS & SIBO SOS™ Summit Vlog

Today I want to share something I’m really excited about with you: our very first IBS and SIBO SOS® video blog (AKA a vlog!)

This is an excerpt from Dr. Ken Brown, MD’s presentation for the next IBS & SIBO SOS® Summit in 2020! Dr. Brown is the creator of Atrantil, the supplement that has helped so many people deal with constipation and bloating. 

Watch the vlog and let us know what you think. 

Own the Masterclass recording which includes the video, audio, and full transcript for your highlighting and note taking! click here.

P.S. Please leave a comment and let us know – do you like the vlogs? Do you prefer more written content or more videos?

P.P.S. Don’t forget – the Workshop with Dr. Brown gives YOU the opportunity to ask your specific questions! Add the Masterclass recording which includes the video, audio, and full transcript for your highlighting and note taking to your SIBO SOS® Library, click here.

SIBO and Hormonal Imbalance

Lately, hormones have been on my mind.

I just finished recording a brand new Workshop training with Dr. Steven Sandberg-Lewis, ND about hormones, the gut, SIBO, and how it’s all connected.

Dr. Sandberg-Lewis really explained to me HOW exactly the gut can impact our hormones (and it was information I’d never heard before). If you want to get access to the Workshop, go here.

Hormones are much more than estrogen and testosterone – there are about 50 different hormones in the body, and each has a really important function. They control everything from mood to weight – and they can cause SIBO and other gut issues to get worse (or develop). But having SIBO or other gut issues can also lead to hormone imbalances. It’s a “chicken and the egg” scenario.

Hormone imbalance and gut issues – which came first? It’s a chicken and the egg scenario!

Here’s what’s clear: whether you’re a man or a woman, and no matter your age, you NEED to be thinking about your hormone health. And especially if you have SIBO, IBS, or ANY gut issues.

(And especially if you’ve had your gallbladder removed or have had gallbladder issues in the past.)

Ahead of the Workshop with Dr. Sandberg-Lewis, I wanted to share a few interview snippets from past discussions I’ve had with experts about hormones.

My goal is to get you thinking and open your idea to new perspectives about hormones and SIBO.

If you want to go further, please join us for the live Workshop on May 4th.

SIBO & Fertility – Dr. Stefani Hayes, ND

Shivan Sarna: “You do treat a lot of people with SIBO, and also, with fertility issues. Tell us how you have observed a relationship between those two if you would.”

Dr. Stefani Hayes: “I think the relationship came about over several years of practice, especially with a lot of my patients who had unexplained infertility, or fertility struggles from PCOS or endometriosis. A lot of them didn’t have GI issues, but some of them did.

Because a lot of my colleagues are experts in SIBO, we started trying SIBO tests on a lot of my patients, and surprisingly, many of them came up highly positive usually with a methane-type SIBO overgrowth, which was really surprising for us.

And a lot of them didn’t have the constipation pattern that a lot of methane-type SIBO does. But they often had had constipation as young adults or young kids, but had learned over the years how to manage it. And sometimes literally never really struggled with much GI stuff beside some occasional bloating.

But when we addressed the SIBO, it seemed to make a significant effect on pelvic bowl health and their women’s health.

The connection between SIBO & Fertility.

Some got pregnant on their own, naturally, and were able to hold their pregnancies and have sweet, little kiddos.

Others tolerated IVF a lot better, and were able to start ovulating on their own with PCOS, if they hadn’t before, or were able to, with endometriosis, there’s often times—endometriosis is really tricky, and so patients who had had multiple surgeries, and then it re-grew, I definitely saw sometimes after we balanced out the SIBO that the endometriosis would re-grow slower, or not at all.

We would just get a little bit longer window between those surgeries, so that those patients could have more options for trying to get pregnant.”

Shivan Sarna: “Why do you think that is?”

Dr. Stefani Hayes: “Because the small intestine does really overlay, not just the uterus, but over the top of the ovaries, and when I think about methane-type bacteria, it’s a pretty noxious gas.

And if I think about what that might be like, I imagine it would seep into the surrounding region. And for me, I like to have visuals of things that seems to me like a fog or a smog, if you will, that’s in that whole pelvic bowl.

And so again, it’s coming back to that smog—if the neighborhood is not very happy, the some other neighboring structures can really get affected too, in my perspective.”

Cortisol & SIBO – Dr. Mona Morstein, ND

Dr. Mona Morstein: “Cortisol is kind of like Goldie Locks with the bears. Cortisol needs the middle chair and the middle bowl of oatmeal.

If there’s not enough cortisol there is development of gut inflammation. And that’s a problem because from gut inflammation we can lose our protective mucus lining, we can start changing our microbiome, we can start breaking away the IGG immunity there and start reacting to what would necessarily shouldn’t react to and so forth.

But if you have too much cortisol for over time it’s also inflammatory to the lining of the intestine as well.

There are so many ways to work with people along that level of cortisol. Whether it’s getting counseling, addressing their sleep, their stress and relaxation – do they do journaling or gratitude, do they exercise, are they creative? Do they take time, you know to relax, do they get into nature?

Broad-based look at ways that people are feeling bad. We can also of course use homeopathy. I do that quite a lot with people.

Of course supplements such as nutrients that support adrenal hormone functioning, there are botanicals that support and help balance what we call adapter genes. If the cortisol is low it can raise it up, if it’s high it can lower it down.

And of course diet, right? What you eat and drink can be very supportive to adrenal healing or very problematic to adrenal healing.

We can also get into methyltetrahydrofolic law because the adrenal gland needs a lot of mentholated enzyme reactions to have it function well, so it’s a broad-based look at both, since we do know that there is inflammation with SIBO.

Whatever else may be happening in their life, if we’re trying to heal that intestinal lining, heal the lining, heal the leaky gut, heal the nerves having a proinflammatory state is going to work against us in that regard through the cortisol.”

SIBO, Your Hormones, & Weight  – Dr. Steven Sandberg-Lewis, ND

Dr. Steven Sandberg-Lewis: “Another really important thing is the “thyro-adrenal,” which is something I made up. Both the thyroid gland and the adrenal glands are so important in normalizing blood sugar, maintaining bone mass, helping with mood and energy and blood sugar, very, very important, and blood pressure as well.

Those glands are so important for the maintenance of normal function. And so often, in standard medicine, the only time you really look at the adrenals is when there’s 90% of their function gone. That’s called Addison’s disease. It’s very rare. It’s an autoimmune disease.

Or when a person has Cushing’s disease, which is when their stress hormone, cortisol levels are so high that everything goes haywire, and we can actually die from it. Very serious condition, which is a little more common than Addison’s.

But in naturopathic medicine and other forms of natural medicine, we like to look at the adrenals before they’re 90% gone because many people have a lot of dysfunction there, and you can’t really—in my book, you can’t really separate thyroid from adrenal. They work so closely together.

So that’s my suggestion is balance your adrenal and thyroid function, so that your blood sugar can normalize, so that you can lose the weight around your waist because that’s one of the better ways that we have of measuring abdominal fat or that apple fat.

The waist circumference for women, over 35-inches is too much. For men, over 40-inches is too much.

And so it’s easy enough to say, “Oh, lose that waist circumference. Bring it down. Just get to it.”

Well, that can be almost impossible. If your insulin levels are very high, and your DHEA levels are very low, and your cortisol is very high, that’s the worst group of hormonal levels that can lead to a waistline that just gets bigger and bigger.

You could lose weight all over your body. Your face might look amazing, but you can’t lose the weight around your waist. And that’s the weight that’s controlling the whole blood sugar issue, which causes GERD and causes SIBO and other digestive problems.

So the thyro-adrenal, if you would, gland is really important there. It’s just my way of letting my student doctors and my patients know that—it’s my way of thinking. It’s a little superficial to be treating somebody’s thyroid and ignoring their adrenal or vice versa. You have to look at both.”

SIBO & Hormone Balance

This blog isn’t meant to be comprehensive – there are plenty more ways SIBO and IBS interact with the hormones that I didn’t get a chance to cover in this post.

If you want to go deeper and really understand how gut health issues like SIBO and IBS can interact with your hormone levels, I hope you’ll attend the Workshop with Dr. Steven Sandberg-Lewis on May 4th.

The Workshop includes a 1-hour class on the link between the gut (and specifically the gallbladder) and your hormones. Then there will be 2 hours of live Q&A with Dr. Steven Sandberg-Lewis. We’re also adding new community discussion before and after the class to help you take your learning even deeper. (You don’t have to attend live, either – we always offer the full recording and transcript. You can even pre-submit your question.)

→ Get Your Ticket For The Workshop Here

You can also access this Workshop with the SIBO SOS™ Speaker Series. When you join the Speaker Series, you get access to 10 brand new Workshops and 7 exclusive bonuses for one low price. It’s like buying SIBO knowledge in bulk to save money! You can access the Speaker Series here. 

P.S. In the past, we’ve done expert Masterclasses – but starting now, Masterclasses are going to be Workshops. Why workshops? We want to highlight how interactive and action-oriented these events are. It’s not just listening or reading – it’s like being in a classroom with other people! We’ve added some new features to the Workshops, too – learn more here.

P.P.S. Our Workshops are taking what you already love and making them EVEN better, more hands-on, and more useful. I can’t wait. If the Workshop sounds like what you need, please join in here.

Hope For Healing SIBO and IBS
Don’t give up! Here are the wise words that gave me hope in my own journey to heal SIBO.

Have you ever felt 100% hopeless about your gut health?

Especially when you’ve seen multiple doctors and specialists…

Tried this diet and that…

Tested positive, then negative, then positive again…

I get it! At one point I felt a real sense of hopelessness around my own SIBO and IBS.

What changed?

First, I took responsibility for my own health. I stopped looking for a doctor to fix me and started trying to figure out how i could heal myself.

Second – I immersed myself in as much information as I could! Everything I learned was like a little nugget of hope. Some things I applied right away (and had BIG results). Other things I filed away for later on.

I don’t feel hopeless anymore – I feel empowered.

I want that for you too. So today, I’m sharing some of my favorite nuggets of hope with you!

I hope these inspire you to keep learning and never, ever give up!

Dr. Mona Morstein, ND: People Get Better

Dr. Mona Morstein: “There’s been a lotta people very poorly treated with SIBO. It’s not necessarily that SIBO is this totally impossible disease to treat. It just means it’s one of, by far, the more complicated ones, which is why, you need to do it in a very step-by-step fashion, addressing all of the components that need to heal in the gut; but when it’s done that way. I know, people get better! For sure! Absolutely! The majority get better.”

Riley Wimminger, MScN: It’s A Marathon

Riley Wimminger: “I think my biggest thing that I always tell people is that it’s a marathon, it’s not a sprint. And to have this concept in your mind that you’re just going to take an antibiotic, and then you’re going to take a prokinetic, and everything is going to be healed, maybe – maybe, you’ll have great results happen. But that’s just not what I’ve seen in most people.

So, don’t feel discouraged when that stuff doesn’t work for you. Just take it at the pace you can and start uncovering what else is going on and be patient with your body. And there will be ups and downs. But ultimately, I really see that, a lot of people, they have this upward trend. It maybe looks like this, but it goes up eventually as long as you stick with it and be patient with yourself.”

Dr. Stefani Hayes, ND: Look At The Bigger Picture

Dr. Stefani Hayes: “We think about SIBO as a chronic illness, like diabetes or something like that, that it has to be managed for potentially a lifetime. There’s every once in a while sometimes the miracle cure, one treatment and they’re better forever. But most individuals, it’s a lifetime’s worth of management, whatever that means, if it’s a modified diet or every few years, getting a re-treatment or just being conscious of the decisions and choices they make, know about some area of weakness for them, and could potentially be an area of weakness for their children.

And so just watching that and working on long-term management, I think, is where we often go.

And I think then it’s a little more empowering rather than disempowering because if the self-expectations and the negative self-talk that can come in when—cheats on the diet, it’s about finding that sweet spot where you live your life, and you enjoy your life, and you don’t struggle with the symptoms whether they be the typical IBS-type symptoms or if they show up differently like my patients have with pelvic pain or menstrual irregularities or fertility struggles.”

Dr. Michael Ruscio, DC: Reframe How You Think About Chronic Conditions

Dr. Michael Ruscio: “And we were talking specifically about how IBS is a chronic condition that has a propensity towards relapse – which is true. But what the public will go to with that understanding is “Oh, my God! This is a chronic condition. I’m never going to be able to get rid of them my entire life.” That’s not really the case.

What more so is the reality is that you can go from having IBS and from having SIBO and feeling awful—being bloated, having constipation or diarrhea and some of these associated symptoms that go along with that like insomnia or fatigue or brain fog – and then you can start feeling way better. You may have occasional times when you flare a little bit. But the example I used with Dr. Siebecker when we were talking on the phone the other day was if you had a bad knee injury in college, every once in a while, your knee may start to ache, you’ve got to do some stretches, you’ve got to do some exercises. It’s not a huge deal.

The same thing with your gut. You may have a flare every once in a while. Not a huge deal! We’re all human. There’s therapies we can use to quell that flare. It doesn’t mean anything is wrong or broken or you’re in a dire situation.”

Trudy Scott, CN: Be An Archaeologist

Trudy Scott: “There’s no magic solution. There’s no “You’ve got SIBO. This is the protocol that you need to do.” You need to try this. And if it works, great. If it doesn’t, you try this. Or you try various different permutations.

I mentioned my diet is not exactly the same as someone else’s diet who has SIBO. You may need to try LDN. It may not work for you. You may try tryptophan, and it may work for you. People will often have this fear of starting something or having to be almost a human guinea pig.

I remember you talking about being like an archaeologist, digging and trying to find solutions.”

Don’t Give Up!

Dr. Allison Siebecker, ND told me that it usually takes about four years for her patients to really figure out how to manage SIBO and IBS, so that they’re not having their lives run by their SIBO.

Learning that was a relief in some ways and a real bummer in other ways. Of course, SIBO and IBS are really obnoxious conditions. We want to get better right away! But once I developed a “long-term” perspective, it gave me peace.

It is so helpful to say, “Yes, this is a chronic condition. This is something that I need to manage.” Once I tried that on as a concept, it made me less anxious because I realized that it was just a new way of being. It wasn’t my preferred way of being, but it was a new way of being that if I at least embraced it, and took the pressure off.

That’s why my company is actually called Chronic Condition Rescue because we are dealing with these chronic conditions (and you really do need to be rescued, or you need to rescue yourself).

The Way Forward For SIBO & IBS

I’ve been where you are right now – and I made it to the other side. Sure – SIBO and IBS are conditions I’ll live with forever, but I’m not hopeless. I’m empowered.

I want to guide you to the other side too – it is my calling in life to help other people with SIBO & IBS get relief.

Here’s how I can help you right now: The 2019 SIBO SOS™ Speaker Series. 

To be honest – I wish I had named this the “SIBO Solutions Series” – because that’s what the 10 SIBO experts teaching are doing: sharing solutions for relief from SIBO. 

We have someone to cover every topic I have found to be vital to healing from SIBO – parasites, hormones, root causes, probiotics, candida, the brain-gut connection, and more. It’s not just “theory” – it’s real information you can put to use right now. 

Every month we have a new expert speaker who teaches the Masterclass and then answers YOUR questions at a live Q&A. 

Because SIBO and IBS are chronic conditions, you need continuos information.

It took me 4+ years to learn all of this – but you’re getting it all in just 10 months. (That’s the benefit of having someone who has been through it all as your guide.)

We’ve already had 3 of the speakers present (if you join the series now, you can immediately access those so you can watch whenever you want) and 7 more to come. Not to mention TONS of bonus classes, Q&As and other resources.

(Plus we are adding more bonuses all the time – it’s our way of telling you we appreciate you!)

This is your last chance to join the Speaker Series at this price and with the easy payment plan.

I’ve been where you are right now – and I want to help you get the answers you need to get relief, and GET YOUR LIFE BACK FROM SIBO!!

Won’t you join us? This is LAST CHANCE to join with the payment plan.

>> Join the Speaker Series Here <<

sibo course

In today’s post I’m getting REALLY real (and vulnerable) – talking about a subject that’s hard for many people to broach: depression and anxiety.

Listen – I didn’t want to accept I had Small Intestine Bacterial Overgrowth (so not sexy), or Lyme Disease (from a bug!) so you can imagine my reaction to even considering depression & anxiety as factors in my health.

Didn’t wanna go there…

But that’s why this topic is SO important (and why I’m sharing my own story). Depression, anxiety, and gut health are all linked (in big and little ways).

Today, I’m going to share my OWN story and experiences, and then I’ll share excerpts from discussions I’ve had with various gut health experts about depression and anxiety.

The link between SIBO depression & anxiety
What’s the real connection between gut health and mental health?

My Story of Depression & Anxiety

First, I should say I never thought I had problems with anxiety or depression. I’m generally a happy and positive person.

But I didn’t realize until I got my neurotransmitters balanced how whack-a-doodle-do they were. They were off!

I had genetic testing that showed I had some imbalances in serotonin and dopamine. My practitioner prescribed low dose naltrexone (LDN) (not an antidepressant – but it can help balance dopamine levels).

It changed my life!

Like I said – I’ve always been a happy person. But my entire life I’ve struggled with a feeling of anxiousness, which I thought was normal. It would come and go. I would walk to that edge. And it was uncomfortable.

But I thought it was normal.

With the right neurotransmitter treatment, my whole entire being has transformed. I don’t feel despair anymore. Of course, if something horrible happened, I would.

But I don’t live on that edge anymore. And I feel like, “Oh, my gosh! Is this how people that don’t have neurotransmitter imbalance live all the time?”

I share this so that you know: it can happen to ANYONE. And the signs aren’t always the ones we think of first (like unable to get out of bed, crying all the time…).

What helped me might not help you – but I hope something in these next excerpts WILL help you.

Dr. Lisa Shaver, ND, MSOM, LAc on Neurotransmitters

Dr. Lisa Shaver: So, absolutely, I would say there could be a link between addictions to anything—addictions to food, addictions to watching TV, addictions to social media, gaming online, to sex, to working out…

Shivan Sarna: Shopping…

Dr. Lisa Shaver: …shopping, absolutely, because of malabsorption of amino acids which feed our neurotransmitters. And neurotransmitters is what we need to feel balanced inside and balanced in the world out there. It helps us interact with us and interact with the outer world.

Shivan Sarna: And who sits around and thinks about “Hey, well, my quadriceps are doing great. My biceps are doing great. How are my neurotransmitters today?” No one talks that way.

Dr. Lisa Shaver: Even the word “neurotransmitter,” people are like, “I think I’ve heard of that before. What does that mean? How do you go about it?”

But I’ve done what I’d call targeted amino acid therapy or neurotransmitter balancing, gosh, for 18 years. And it’s so easy. You just use basically the breakdown of nutrition. You’ll be able to feel whether your balance that day and if you’re taking the right dose that day.

And so every person, again, individualized medicine. You could have a big, burly guy with severe depression and severe anxiety take a very low dose, or you could have a petite person with mild symptoms really need to go high on their dose because it all has to do with the internal biochemistry and our receptor years being able to take that signal and tell the brain and tell the body, “This is what you need.”

So, it’s individualized. You can’t have a standard dose for every person.

Dr. Stefani Hayes, ND, LAc on The SIBO-Depression Link

Shivan Sarna: You were talking about how you help people with SIBO, who have—it manifests also some depression and some anxiety, it’s part of the cascade. What do you think is causing that and what do you do for them? How can we help somebody today who maybe feels anxious or has bouts of depression that could be linked to their SIBO? What’s your take on all of that?

Dr. Stefani Hayes: As a naturopath, we’re trained in understanding the physiology of the body, and thinking about pathology along those lines. And what we know is that a large percentage, over three-quarters of our immune system lives around our gut. And so when there’s some dysfunction with the membrane of our intestine, then some big molecules can come through that can be inflammatory to the immune system, and also across that blood/brain barrier, or irritate the blood/brain barrier in a way that’s maladaptive.

And also, if the body can’t fully break down, let’s say, the amino acids, into the components where they can be turned into neurotransmitters, that can be really hard for depression and anxiety.

For me, it’s about finding that middle ground between helping with the inflammation component, so if it’s a neurotoxic effect, like often times, we talk about gluten for some individuals, and depending on their genetics, gliadin, if it’s not broken down well can be neurotoxic, so then an inflammatory component.

And sometimes just treating the SIBO, tightening up those gap junctions in the small intestine, really decreasing that inflammation in that whole region can help their brain because their body is not under this onslaught of inflammation can help their immune system for autoimmune conditions, where their body is confused.

Again, that smog, a lot goes on when the bulk of your immune system is living in that smog, and then it can mistake, it can attack the small intestine itself because one of the main theories about SIBO is that it’s an autoimmune condition.

It can attack the thyroid, it can attack the joints. And also, thinking about how can we minimize some of these chronic conditions, other chronic conditions, autoimmune conditions, that are really debilitating.

But then the other piece of how do you optimize because the main way to really help people with their products that build amino acids is to hopefully help them break down their foods well for that, or give them supplements, or even if they’re taking pharmaceutical medications, you want to make sure that they’re able to absorb them and assimilate them and get them to the brain in a way that’s efficient. And you can’t do that unless the small intestine is nice and healing.

Trudy Scott, CN on The IBS-SIBO-Anxiety Trio

Shivan Sarna: I know Dr. Siebecker and I have spoken about that, about how people—I mean, it’s pretty well-known if you’ve been studying your SIBO or depending on where you are in it, or IBS, that it is associated with anxiety. And like which came first, the anxiety or the SIBO/IBS, or the IBS/SIBO came first and then the anxiety…?

Trudy Scott: Yes. I’ve got two. And these are quite old ones which is interesting. When I wrote my book in 2011, I didn’t really know much about SIBO. But I did know that it was an issue for me. I didn’t actually have a name for it. I knew it was these digestive issues.

Well, the book came out in 2011. But it had to be delivered in 2009. So this was as of 2009—not ’09, 2010. But I did find two studies then. And these still apply. One was a paper. It was a published in 2008. It’s called State & Trait Anxiety and Depression in Patients Affected by Gastrointestinal Diseases.

And what they found is that “people with digestive complaints such as IBS, food allergies and sensitivities”—and they actually used the term “small intestinal bacterial overgrowth,” but the word SIBO wasn’t really well-known in those days. I didn’t learn about it in school—“the small intestinal bacterial overgrowth and ulcerative colitis frequently suffer from anxiety and depression.

And then, this other one which was published in 2001, Irritable Bowel Syndrome, Anxiety and Depression: What are the Links?

So, this is before there were the studies connecting IBS with SIBO. Now we know that a large proportion of people who have IBS, it is actually SIBO. But what they find in this particular study was that 50% to 90% of people with IBS who visited a doctor, all their digestive issues also had panic disorder, general anxiety disorder, social phobia and even post-traumatic stress disorder, and major depression.

So, there’s the research there. And now, we’ve got newer research that I know you and Dr. Siebecker has talked about. But it’s pretty interesting that this research has been around a long time.

Shivan Sarna: I’m just so glad we have concrete numbers on it to help people who are not believers. It really does help. The rest of us sometimes don’t need the double blind study. We get it. It’s there, it’s there.

Niki Gratrix on ACEs, Trauma, and SIBO

Shivan Sarna: So what if I’m just getting through my life, I’m getting through my day. I’m struggling. I’m hanging in there. I have some joy. I’ve got some days off where I actually relaxed. My gut is not in great shape. I don’t feel traumatized. I mean I’m stressed, but isn’t everybody stressed?

What should we be thinking about in a new way to help ourselves because I think most people are operating like that—actually if they’re lucky. They’re lucky to be operating like that, right? That is a champagne problem right there. How can we dive deeper?


Niki Gratrix: So, “stress” is a widely used word. And we’re going to define more closely what we mean by the word “stress” and dive into that. But what most people don’t realize is, when you’re stressed, most people just think of that as maybe they’re stressed in their mind, and actually you are truly a stressed organism when you have stress. The whole body responds to stress.

And the issue is that most people don’t realize, when you look at the stress literature about adult stress, you use that word, most people kind of think about having too much to do, too many emails, the school runs, that is somewhat stressful. But what people don’t realize is that most of your stress response is actually set up in childhood.

In the stress research, when you have an external stressor, something big like maybe losing a job, or a job stress, the big things that can happen when you’re an adult, it’s not the event itself, it’s the perception and how we respond to it. The problem is that one person actually deals with that fine, and another person, they’ll tell you that “I had this stressful event, and that’s when all my gut problems started” or “That’s when I got this chronic illness. I had this stressful event.”

The point is that you have a bit of stressor at the time. But most likely, it was caused by early life experiences because someone else has had the same stress as you and didn’t catch a physical illness.

And bear in mind that you’re not just stressed in your mind, you are a stressed organism. Your whole body is responding to stress. And we’ll talk about that a little bit more.

If early life stress is what is setting us up for our resilience to stress in adulthood, how sort of prevalent is early life stress?

I’m going to talk about the Adverse Childhood Event Studies which were studies of early life stress in children where they were looking over 17,500 adults. It was done by the CDC and Kaiser Permanente, sort of mainstream researchers. It was a massive study of that many people. And they basically looked at the correlation between the amount of early life stress and the onset of chronic complex illness in adulthood.

The researchers said that, from the time the trauma is happening in the child, they are marinating in inflammatory cytokines from the date the trauma happens.

So, when you get a physical expression of gut dysbiosis, you develop SIBO, you develop whatever digestive issues, it probably started 20 years before. It was cumulative over time. And then, you probably had a trigger event, and then you had a more of a physical manifestation of symptoms.

Dr. Steven Sandberg-Lewis, ND, DHANP Explains Depression & SIBO “Cross Talk”

Shivan Sarna: I know this is a rabbit hole, but I’m okay with this because I really think a lot of people are dealing with this. Are they called SSRI? Is that what they’re called?

Dr. Sandberg-Lewis: That’s the original group, and now, we have the SSNRIs also that affect not just serotonin but norepinephrine as well.

Shivan Sarna: So is the SSNRI, is that Wellbutrin?

Dr. Sandberg-Lewis: I believe so, yes. So those things modulate serotonin receptors as well. At least they affect the reuptake of serotonin from the interneuronic space, and make a stronger serotonin effect.

Shivan Sarna: Could this possibly be one of the connections between the brain and gut? Is this where they’re saying that people—this is such a reach, but people with the altered microbiome could be more prone to depression and mood disorders? Is that the same deal?

Dr. Sandberg-Lewis: It’s a real thing. It is true that even—yes. Digestive problems can definitely cause or add to depression and anxiety through many mechanisms—which I love to get into if you want to, but maybe you don’t want them. There are some mechanisms, but we’ll try to make it more practical.

Shivan Sarna: Would it also be the reverse? So you are depressed, and that leads to more digestive problems. You have digestive problems, that can lead to you to being more depressed. That’s depressing. That whole thing that I just said is depressing.

Dr. Sandberg-Lewis: We call it crosstalk. It goes both directions—from the central nervous system, to the gut, and the enteric nervous system, and the enteric nervous system is interacting very intimately with the microbiota that make up the yeast, the bacteria, the viruses that make up the GI microbiome.

No Shame  – Just Information

Since my own journey with these issues, I’ve realized that the stigma around these conditions causes many people to suffer for YEARS in silence.

That’s got to stop. No more shame!

So where do you start if you want to learn more?

First things first – you should always talk to your doctor or practitioner. Every situation is unique and you need someone who can make specialized recommendations for you.

But I also have a quick resource to share: 21st Century Solutions to Depression eBook.

This is a free eBook produced by GreenMedInfo that I found helpful personally. It has lots of new information on depression and anxiety that I hadn’t heard before.

I’d also love to know what our experience with SIBO, gut health, and depression anxiety has been. I think open dialogue on this topic is the MOST important thing we can to get rid of the stigma and get more people the help they deserve. Please leave a comment and share your thoughts!

Mark Pimentel Blog Post Cov

Who are you???”

I had just walked into Dr. Mark Pimentel’s office for my first appointment when his nurse looked up and said that.

At first I thought she mistook me for a celebrity (we were in Los Angeles at Cedars-Sinai hospital after all!).

But actually, she was just surprised because Dr. Pimentel hardly ever takes on new patients anymore.

Between researching, teaching, running his own laboratory and directing the Medically Associated Science and Technology (MAST) Program, and treating his existing patients (who have some of the most complex GI conditions in the world) he’s a pretty busy guy.

I was very, very lucky to be able to get an appointment (and to have the resources to fly clear across the country to see him, too!)

That first appointment was life-changing – and every time I’ve encountered Dr. Pimentel since then has equally enlightening.

If you’ve ever heard him speak, you know that Dr. Pimentel has a way of speaking that is direct, concise, and simple to understand – even when he’s talking about crazy-complex concepts.

Today, I’m going to share some of what Dr. Pimentel taught me about fiber, the low-FODMAP diet, and what to eat during Small Intestine Bacterial Overgrowth (SIBO) treatment at one of our last sit-downs.

And if what you learn in this blog post is helpful, make sure you sign up for Dr. Pimentel’s upcoming Masterclass and Q&A part of the 2019 SIBO SOS™ Speaker Series on March 4, 2019.

Fiber and SIBO

Shivan Sarna: People are wondering about SIBO and fiber. How do we get enough?

Dr. Mark Pimentel: The bigger question is, what is enough fiber and do we really need fiber?

The question other than that is, after eating cardboard for 20 years, have we made an impact on colon cancer at all?

A lot of people have been eating fiber because they think it’s healthy and then, now, everybody’s going Paleo and going to even keto diets, and all these diets seem to be even healthier than high-carb diets.

I don’t know that you need a lot of fiber in your diet. I think fiber can be helpful in terms of if you’re a normal person and you want a nice, smooth bowel movement and maybe fiber to help the beneficial bacteria of the colon, have more food.

For SIBO, fiber is no good either.

SS: No bueno.

MP: No bueno. It’s just a lot of fermentation, a lot of gas, and a lot of trouble.

The Low-FODMAP Diet Long Term

SS: Let’s talk about the low FODMAP diet and how we don’t want to allegedly be on it for a really long term because it reduces the variation of the microbiome. Do you agree with that? Should we be thinking about that?

MP: Fiber, yes, leads to more diversity in the colon. But as I’ve said before, if you put fiber in the gastrointestinal tract like beans, it’s going to take a lot longer for cleaning waves to recover. It’s going to take a lot of time for the fiber to evacuate from the small intestine leaving more fermentables there for gas, bloating, and distention.

But, the low-FODMAP diet is not healthy long term, and even those who discover and continue to discuss low-FODMAP diet have suggested that. Bill Chey from Hanover, Michigan presented at the ACG Meeting the first study looking at how bad is it to be on low-FODMAP [long term].

After three months, you start to see micronutrient deficiencies. It is not a long-term solution to IBS, which is what it’s touted for. SIBO was kind of the extension of it.

Now, it can be helpful. So, I kind of tell people, “If you don’t eat any food at all, your SIBO will disappear,” because the bacteria can get no food – but that’s not a solution.

The more you restrict calories, the more better your SIBO will feel. But then you’re going to cause harm to yourself, so you’ve got to find that best practice for you, which is why we sort of developed the low-fermentation diet.

We developed that in 2001 or something, and it’s meant to be 100% recommended daily allowance of all mineral and vitamins, so that you don’t get the deficiencies, and yet calorie-restrictive enough to help SIBO.

What To Eat During SIBO Treatment

SS: When you’re taking Rifaximin or treatment [for SIBO], you say, “Eat whatever you want because we want the bacteria having a party,” so that they’re out and about, so the medicine can do its job of killing it. Is that right?

MP: Yes. [But] I don’t tell people to go and eat like a gallon of Haagen-Dazs ice cream every day to make their SIBO go away!

You want to be a little more open with your diet during SIBO treatment, that’s what I suggest. [But if you go too far] What ends up happening is you’ll feel worse on the treatment thinking that the antibiotic is making it worse, when it’s actually the diet.

I just tell people, just go about your normal business, eat what you normally eat while you’re taking the treatment. You don’t need to hyper activate the bacteria.

SS: Nor would you suggest like really being super strict on a low-fermentation diet?

MP: I would suggest not to be on a low-FODMAP diet while you’re taking the antibiotics because you are restricting calories to a great extent and bacteria will tend to be more resistive to antibiotics in hibernation.

The Complex Becomes Digestible

Anytime I have a conversation with Dr. Pimentel, things that I thought were so complex – like what to eat during treatment – become crystal clear.

He has a true gift for teaching from a patient’s perspective!

That’s why I’m overjoyed to welcome Dr. Pimentel back for another Masterclass and Question and Answer session on March 4, 2019.

If you’d like to participate, we have 2 options available:

  1. Buy a single ticket for his Masterclass and Question and Answer Session on March 4th, 2019 at 9 AM Pacific | 12 PM Eastern – $59
  2. Buy the 2019 Speaker Series for access to all 10 Masterclass and Q&As (including Dr. Pimentel’s) PLUS access to an exclusive bonus Q&A Session with Dr. Pimentel on June 7th, 2019 from 12 -1 PM Eastern – $198.

The SIBO SOS™ Mission

My mission at SIBO SOS™ is to connect as many IBS and SIBO patients as possible with the very best doctors in the world.

I have spent more money than I want to think about trying to find out what was “wrong with me.” SIBO is an expensive condition and takes so much time and energy.

Let’s acknowledge that right here and now!

But I also want you to know, I’m in it with you.

So while we can’t all see Dr. Pimentel in person, there is still a way we can all learn from him directly: it’s our Masterclasses!

Myself and the entire team at SIBO SOS™ work diligently to make these programs as accessible and affordable as possible.

Information and Inspiration.. Both are needed to get well.



P.S. Lately I have heard from some people that there is “too much information.” I have felt that way myself at times. My goal is never to overwhelm you, but it is also my calling to share as much as I can! Please, take what you need and leave the rest!

P.P.S. Do you have any suggestions for overcoming the “overwhelm” that comes with a condition like SIBO? Please share with us in the comments.

Gary Weiner SIBO SOS™ Summit Interview

Shivan Sarna interviews guest expert, Dr. Gary Weiner on the topic of IBS, IBD, and SIBO

If you’re having digestive problems, you have enough to deal with without having to keep a bunch of acronyms straight.

But if you go visit your doctor – or do some research on your own – you’ll find a LOT of acronyms – and three of them more than any others: IBS, IBD, and SIBO.

IBS stands for Irritable Bowel Syndrome, IBD for Inflammatory Bowel Disease, and SIBO for Small Intestine Bacterial Overgrowth.

Today, I want to teach you not just what each of these important acronyms means, but what the difference between each is – and, most importantly, how they are all related.

Understanding the link between Irritable Bowel Syndrome, Inflammatory Bowel Disease, and Small Intestine Bacterial Overgrowth can help you get the right treatment the first time.

If your doctor has told you or someone you love that you have any of these conditions (or even if you just suspect it), keep reading. 

What Is IBS?

IBS stands for Irritable Bowel Syndrome.

In Western medicine, “syndrome” is a way of classifying a group of symptoms. Think Chronic Fatigue Syndrome or Restless Leg Syndrome.

In almost any syndrome, doctors use what is called a diagnosis of exclusion. A diagnosis of exclusion just means that there is no other physical explanation for a person’s symptoms.

Imagine you go visit your doctor with stomach pain and diarrhea. They might refer you to a gastroenterologist who performs tests to check for pathological issues, something like Celiac Disease or an ulcer. But if all those tests come back negative  – yet you still have symptoms – you might be told you IBS.

The most common symptom patterns in IBS are abdominal pain, bowel motility disruption like spasms or gastroparesis, diarrhea, constipation (or alternating between both) and pain, bloating and discomfort.

Doctors use something called the Rome Criteria to define what type of IBS a person has:

  • Predominantly diarrhea
  • Predominantly constipation
  • Mixed constipation and diarrhea
  • Post-infectious

(Just FYI – there is some controversy about the Rome Criteria. Not all doctors think it is useful.)

Depending on what type of IBS you have, your doctor might suggest medications or other treatments that can make the symptoms go away or be less severe.

What Is IBD?

Unlike IBS,  IBD (Inflammatory Bowel Disease) is a pathological disease.

That means that there is a pathology  – AKA a cause – for the symptoms that doctors can find.

It gets confusing because IBS and IBD can cause the same symptoms: abdominal pain, constipation and diarrhea, and bloating (to name a few!). But IBS and IBD are different.

Imagine you’re back at your doctor with symptoms. They refer you to a gastroenterologist who performs more tests. But this time, not all the tests come back negative: instead, tests show you have an Inflammatory Bowel Disease.

There are two inflammatory bowel diseases: ulcerative colitis and Crohn’s Disease.

Ulcerative colitis (UC) causes inflammation on the mucosa of the colon. This can cause severe diarrhea, blood in the stool, and lots of pain.

Crohn’s Disease causes inflammation throughout the entire digestive system – anywhere from your mouth to your anus – but the inflammation goes deeper than it does in ulcerative colitis. This is called intramural inflammation.

Treatments for IBD include both medications to manage symptoms (sometimes the same ones used for IBS) and to treat the inflammation in the digestive system.

Why IBS & IBD Aren’t Totally Same OR Different

You might be thinking that it sounds like IBS and IBD are totally different. You either have IBS or you have IBD.

But that actually isn’t all true.

In fact, according to naturopathic physician Dr. Gary Weiner, IBS and IBD are more likely two different ends of the same continuum.

Both IBS and IBD have overlapping features. And even more importantly: the same person can have both IBS and IBD.

This can be confusing for both people with IBS and IBD and for their doctors. They might wonder why treatments don’t seem to be working or why some symptoms went away and others didn’t.

While IBS and IBD can cause similar symptoms, the treatment needed for each can be totally different in some cases  – that’s why figuring out which symptoms are part of IBD and which are caused by IBS is a crucial step in the healing process.

Does That Mean IBS Causes IBD?

Right now, doctors can’t say for certain that IBS and IBD exist on a continuum or that one could cause the other.

But there is evidence to support the idea.

IBS and IBD can have overlapping features like causing:

  • Production of inflammatory cytokines
  • Alterations in the microbiome
  • Inflammation at levels not detectable by colonoscopies or or other standard tests

This evidence has led some experts – like Dr. Weiner – to question if IBS is a precursor to IBD.

After all, many people who are diagnosed with IBD have struggled for years with IBS symptoms – or even have a formal IBS diagnosis. Their tummy troubles seem to have “escalated” into either UC or Crohn’s.

And, just because someone has IBD doesn’t mean they can’t also have IBS. Sometimes people with IBD have an increase of symptoms like diarrhea, pain, gas and bloating. But when they are tested for elevated levels of fecal calprotectin or fecal lactoferrin (two signs of inflammation), results come back normal. This means their IBD isn’t active or “flaring” – they are just having IBS symptoms.

Of course, not everyone who has IBS develops IBD – and not everyone with IBD had IBS symptoms first. But there’s another thing IBS and IBD have in common, too.

What Does SIBO Have To Do With IBS and IBD?

You just learned that IBS and IBD can overlap. Now, imagine 2 circles drawn so they overlap – a Venn diagram. One is labeled IBS, and the other is labeled IBD. Right in the middle where the overlap occurs, that’s SIBO.

SIBO stands for Small Intestine Bacterial Overgrowth, and it can be both a cause and an outcome of IBS and IBD.

SIBO researcher Dr. Mark Pimentel has demonstrated that SIBO is often a root cause of IBS.

And SIBO is also often present in people who have an IBD.

So what’s the difference?

While SIBO is a known cause of Irritable Bowel Syndrome, with Inflammatory Bowel Disease, it’s the other way around: Inflammatory Bowel Disease can cause SIBO.

Let me repeat that because it can be confusing:

SIBO can cause Irritable Bowel Syndrome.

Inflammatory Bowel Disease can cause SIBO.

Is SIBO the Chicken Or the Egg?

Just like the question of the chicken and the egg can be very confusing if you think about it too much, so can the relationship between IBS, IBD, and SIBO.

SIBO is often the cause of Irritable Bowel Syndrome. While there are many other potential causes for IBS, and not everyone with IBS has SIBO, it is estimated that as much as 84% of people who have IBS have SIBO, too.

But there actually isn’t any evidence that SIBO causes Inflammatory Bowel Disease. In fact, it seems to be the other way around: having an IBD can cause SIBO to develop.

The inflammation caused by IBD can create an opportunity for SIBO to develop when normal motility is disrupted.

In basic terms, this just means that when inflammation brought on by UC or Crohn’s causes the digestive system to either slow down (constipation) or speed up (diarrhea), bacteria has a chance to overgrow in the small intestine.

IBD can also interfere with the function of the migrating motor complex (MMC). The MMC is responsible for moving food through the digestive system – some people think of it like a broom sweeping food down the digestive system. When the MMC is interrupted, SIBO can occur.

Why The IBS-IBD-SIBO Link Is So Important

I know that everything we’ve covered so far has been complex and sometimes confusing – but it is really important to understand how Irritable Bowel Syndrome, Inflammatory Bowel Disease, and Small Intestine Bacterial Overgrowth are all related if you want to get healthy again.

If you have SIBO, you (or your doctor) might be confusing it with Inflammatory Bowel Disease. If you IBS, your doctor may not realize it is being caused by SIBO. And if you have Inflammatory Bowel Disease, you might also develop SIBO.

Knowing this is so important for getting effective treatment.

Treating the SIBO within Inflammatory Bowel Disease can help you get better faster and go into remission from IBD. For some people, treating SIBO can cause all IBS symptoms to disappear. And if IBS does often to lead to BID later on, getting IBS under control is even more important.

If you have symptoms of IBS, IBD, or SIBO it’s very important to find out which condition is causing what symptoms. If you treat the SIBO as IBS or the IBD as IBS, you wind up very frustrated and not healing.

Take Ownership & Find The Right Treatment For You

Whether you have Irritable Bowel Syndrome, Inflammatory Bowel Disease, SIBO, or a combination of all three, there is hope for healing and remission.

But, healing starts with become educated and empowered about what is happening to your body! Just like I did, you need to take ownership of your health. That means asking questions, researching, and staying informed.

After all, if you won’t advocate for yourself, who will?

That doesn’t mean you have to become the expert on SIBO, IBS, or IBD. Fortunately, there are many other people who already ARE experts on these complex topics – and they’re willing to share their knowledge with us so we can finally get better.

Who is your favorite SIBO expert?