Dr. Allison Siebecker ND, LAc, SIBO specialist, was interviewed on the Anxiety Summit by host of the Anxiety Summit, Trudy Scott, Food Mood Expert and Nutritionist, author of The Antianxiety Food Solution.
Small Intestinal Bacterial Overgrowth and Anxiety
- An overview of SIBO/small intestinal bacterial overgrowth and recent research
- The SIBO connection to IBS and anxiety/depression
- Using a SIBO questionnaire and SIBO testing
- SIBO treatment: medications, a herbal approach and diet
- Gut motility and low serotonin
Here is the information on the 2015 SIBO Symposium, June 6–7, 2015.
Designed for the medical doctor, alternative medicine practitioner, and the public, the 2nd Annual SIBO Symposium features the nation’s leading experts on the topic to present an evidence-based educational program on managing small intestine bacterial overgrowth.
Small intestine bacterial overgrowth (SIBO) is a chronic bacterial colonization of the small intestine. These bacteria normally live in the gastrointestinal tract, however, in SIBO they have overgrown in a location not meant for so many bacteria. The bacteria interfere with our normal digestion and absorption of food and are associated with damage to the lining or membrane of the small intestine. These mechanisms in turn lead to myriad other disorders—gastrointestinal, systemic, and neurological.
Dr Siebecker has this quote on her site www.siboinfo.com (which has a wealth of information)
According to Bures et al,
It is mandatory to consider SIBO in all cases of complex non-specific dyspeptic complaints (bloating, abdominal discomfort, diarrhea, abdominal pain), in motility disorders, anatomical abnormalities of the small bowel and in all malassimilation syndromes (malabsorption, maldigestion).
I said there were no studies linking SIBO and anxiety but there are many studies connecting SIBO and IBS, and there are many studies connecting IBS and anxiety/depression
However I wrote this in my book the The Antianxiety Food Solution. (published in 2011)
Studies have found that people with digestive complaints such IBS, food allergies and sensitivities, small intestinal bacterial overgrowth and ulcerative colitis frequently suffer from anxiety and, to a lesser extent, depression (Addolorato, Mirijello, D’Angelo, Leggio, Ferrulli, Abenavoli, et al. 2008).
One study (Lydiard 2001) found that 50 to 90 percent of people with IBS who visited a doctor for treatment also suffered from various anxiety disorders (panic disorder, generalized anxiety disorder, social phobia, and post-traumatic stress disorder) and major depression.
Here is a list of the symptoms of SIBO
Here are some of the papers we mentioned:
Serotonin and Its Role in Colonic Function and in Gastrointestinal Disorders
Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth
You’ll find many more papers on Dr. Siebecker’s siboinfo.com research section
This is the book Dr Siebecker mentioned: A New IBS Solution: Bacteria-The Missing Link in Treating Irritable Bowel Syndrome, written by Dr Mark Pimentel
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I work as a nurse practitioner in the area of obesity/weight loss. I am dismayed to see nearly 50 percent of our patients have anxiety, depression, panic disorder, gut dysfunction, and a myriad of sx addressed in this summit. We do nothing to address improving contributing nutrition. Low variety, low CHO and appetite suppressants are the industry “mantra.”
Perhaps it’s time to create a realistic nutritional approach and set up my own practice which considers nutritional treatments presented here…
Susan
I love it and agree – do it! what an impact you will make!
Trudy
PLEASE do it!! You are so needed. Truly. I could tell you so many stories about dealings that I have had with medical personnel, who look and act like the unhealthiest people in the world, or act very condescending toward any mention of nutritional approaches. That’s what most of them are taught in medical school, not all, as I am am very blessed to have a pulmonologist who is very open to any approach that works. That’s why I drive a 470 mile round trip once a year to see him. No more steroids. I am able to control COPD by nutrition, prayer and meditation, volunteering, living a holistic life etc. I only occasionally use an albuterol inhaler. He said to me “Why would you want to take poison for the rest of your life?” Were that all healthcare providers as wise. I’ll get off my soap box now. 😉
And by the way I will be 70 in September, but you’d never know it. I have had problems with my lungs since I was a young child. I attribute it to both parents being heavy smokers, and I believe that since I was in the womb during WWII, my mother most likely did not get all the nutrition that she needed for a healthy pregnancy due to rationing. Just my 2 cents. I don’t know for sure, of course.
Trudy,
Is it possible for us to see comments from the previous days talks? I posted a comment for Dr. Osborne but did not see an answer before his talk expired.
Thanks.
Hi Lynne
Yes this has links to all the blogs….https://www.everywomanover29.com/blog/anxiety-summit-season-3-articles
You can also always use the search in the top right of the blog
Trudy
What is the recommended maximum daily protein intake? I have been following a low oxalate, salicylate, amine, fructose, sulphur, etc. GAPS diet and am eating appx 200 grams a day with 100g of carb (includes 40g of fiber), and 50g of fat and I don’t seem to tolerate additional fat or goat yogurt processed for 24hrs. My foods are farm fresh turkey & chicken that are not fed soy, grass fed beef, lettuce juice, sprouted lentils, sprouted peas, choko/chayote and winter squash, rutabaga, and goat butter.
The recommended maximum daily protein intake will depend on many things: age, gender, activity levels, current body weight/composition but MOST OF ALL: how well is your body absorbing protein? I went to see a dietitian two years ago, she said I was eating too much protein, but my blood tests show I am eating too little protein (or rather, I am not ABSORBING enough protein). Your body could be malnourished even if you eat the healthiest diet in the world but have low stomach acid (perhaps some parasite, H. Pylori is known for promoting low stomach acid, which often persists once eradicated) or your pancreas and liver are challenged and your enzymes are insufficient or untimely.. .then you will not absorb all the protein you eat. PS: hypothyroid is linked to difficulty absorbing protein.
My suggestion: exclude parasite presence, add herbs to your meals for better digestion, take additional Betaine HCI (in small amounts until you figure out how much you need), digestive enzymes, and possibly systemic ones. Ensure they are non-GMO, gluten-free, soy-free etc.
Sprouts: watch out for sprouted stuff, as some research shows that grains at least have higher quantities of some substances that seem to promote cancer. If you are sprouting lentils and peas, are you then cooking them? Cooked stuff is easier to digest (according to Ayurvedic and Traditional Chinese Medicine).
Good luck.
What blood test did you do to indicate your protein absorption status? I cook the sprouts and process in a Nutribullet. FYI – Magdalena has an hour-long utube and a 40-page document on sprouting in http://www.cookingforbalance.com. I originally read about sprouting in Sally Fallon’s Nourishing Traditions cookbook. Thank-you!
I am wondering if you could address the controversy over the testing for SIBO in some depth. I’ve had two doctors – One practicing functional medicine and one conventional GI doc. say that the test is not accurate and not worth doing. Both treat SIBO by the symptoms. I understand the test has both too many false positives but mostly too many false negatives.
Thank you
Monica
Based on the research and Dr. Siebecker this is a valuable test but I’ll have Dr. Siebecker come and comment on this aspect for you.
Trudy
Wonderful, wonderful talk! Thanks so much. I believe I have had SIBO for years and have controlled it with a very low carb diet. My problem I that I sleep better and my energy level is better when I get some starchy carbs. It is a tough balancing act. It is good to know that I am not alone. Thanks again.
I do have one question. I wonder if probiotics could be a cause for the small intestines getting an overgrowth of bacteria. Dr. Seibecker did say the overgrowth was good bacteria.
Cheyanne
I have not heard that this could be a cause but it’s a great question that I did not ask Dr Siebecker. I’ve since done some additional reading and found that the use of probiotics in SIBO patients is controversial. Probiotics may worsen symptoms at first, but many people can benefit by rebalancing the gut flora. I would go slow and avoid probiotics with inulin, fructooligosaccharides or other prebiotics
Thanks for sharing Cheyenne – you are not alone and it is a balancing act! Good for you for controlling it with diet. If you don’t yet, you may want to look at Dr Siebecker’s site or work with her on other areas like improving gut motility etc
I was tested for SIBO, but it was negative. I found out afterward, due to some faulty information from the nurse and my confusion, that I wasn’t supposed to add any spices to my food on the day before, but I had used salt and some herbs on my food. I followed the diet other than that. Should I redo the test, or is my negative result most likely still correct?
Carrie
If your nurse and the test instructions said not to add spices then I’d check with them about redoing the test
Trudy
I could not hear Dr. Siebecker at all. I could hear you just fine but Dr. Siebecker had no audibility at all. All of the other speakers have come in loud and clear so far.
Hi Linda
Sorry about this – we’re fixing the issue and will do a replay. Most could hear fine but a few had issues. Stay tuned…
Trudy, thank you very much for organizing and holding this outstanding summit. I’ve missed a few speakers who I was hoping to catch, but I’ll vote for them for the encore. You’ve done a masterful job as an interviewer.
I’m especially grateful for your outstanding interview with the wonderful Dr Siebecker. I always enjoy her talks; she is such an effective and compassionate communicator on an otherwise confusing and technical topic: SIBO. I tested positive for methane last year and just retested last month with almost identical results. Concurrent with SIBO and IBS, I’ve developed some other chronic symptoms. I feel like my life and health have turned upside down in the past 2+ years, and with those conditions, my anxiety has reached high levels. Of course, I question and blame myself continually for my condition, so I was comforted to hear you and Dr Siebecker talking about the anxiety and self-blame, etc, as practitioners, and this probably has a lot to do with your own personal experiences in grappling with SIBO symptoms.
Finally, thank you both for discussing the upcoming symposium and welcoming laypeople to attend either in person online. I’m definitely considering it now. I live in your area, so I may also contact you for a consult.
Hi Susan
Thanks for sharing and yes, no self-blame here! So glad you enjoyed Dr Siebecker! It’s a challenging condition. Hope to see you at the conference and maybe locally too
Trudy
Love your interviews Trudy – learned stax of new stuff.I am suffering from digestive complaints maybe even SIBO which this summit made me aware of.I also suffer from Adrenal/Thyroid problems which made me aware of the “GUT” being the underlying problem of ALL of it. I have started a program of Kefir, homemade Sauerkraut, Probiotics (VSL#3), L-Glutamine, Acetyl-L-Carnetine, Acetyl-L-Cystine, Taurine, homemade bone broth and green juice once a day. I am feeling much better than I did in January this year when I did a stool test and found out I had H.Pylory. Been on Mastic Gum and Pine Nut Oil and since then and am just about to test it again. Your summit (Dr.Siebeker) specifically made me aware to maybe test for SIBO. I am with a Functional Med. Practitioner here in South Africa and feel I am in good hands. I really appreciate you putting this summit on as I am feeling the depression and anxiety as my cortisol levels are all over the placee and not letting me sleep well are all related to my GUT not being up to scratch and functioning properly.This summit is right up my alley, thank you for letting all of us have this very important information it is very much appreciated.
Hi Maria in South Africa! glad to have you here. I’d love you to share your Functional Med. Practitioner as a resource for others
Trudy
Hi Maria I also suffer with sibo and live in south Africa. Could you share your functional specialist details please? Have you been cured?
Great interview! I am curious about the berberine dosage that was mentioned in the interview. Dr. Siebecker said that she uses 5,000 mg per day of berberine or berberine-containing herbs. However, there is a big difference between using 5,000 mg of, say, goldenseal (whole herb) vs 5,000 mg of standardized berberine HCl. Any clarification here would be helpful. Thanks!
Hi David
I’ll check to see if Dr Siebecker can hop on and clarify. She did mention that all her protocols are on her site http://www.siboinfo.com so I’d check there too.
Trudy
Okay, thanks for checking into that. Dr. Siebecker has specific doses listed in her Townsend Letter SIBO article, but again, the wording for berberine is a bit ambiguous and could refer to either the whole herb or the isolated berberine alkaloid: “goldenseal/berberine: 5g q.d. in split dosage”. I can’t imagine that straight berberine (e.g. berberine HCl or berberine sulfate) would ever be used in such high doses (typical doses are often somewhere around 500 mg TID), but I would just like to know specifically what she’s referring to in order to be sure.
Hi David,
I’d like to know the specifics on the herbal protocol too. So far I have not found a Dr. in my tea who has had any success in clearing SIBO.
David – I’ll check to see if Dr Siebecker can hop on and clarify
David
This is from our actual interview: “we use Berberine-containing herbs, either something like Berberine Complex or Berberine-500 or just choose a Berberine-containing herb like Goldenseal. And we use that at quite a high dose. We use it at 5,000 milligrams a day, which usually winds up being somewhere between 9 and 11 pills a day. So that’s five grams.”
Hello Trudy,
Thanks for this powerful summit! I’d like to know more about the physical therapy/bodywork protocols for helping restore MMC functioning that Dr Siebecker mentioned.
Thank you!
I’ll check to see if Dr Siebecker can hop on and clarify. –
Wonderful talk with Dr. Siebecker! Thank you!
I’ve been working with quite a few clients with SIBO and it was so good to hear confirmation of the treatments and approaches I’ve been using to help clients.
Wanted to echo that the Monash University app is fantastic! Not all foods have been tested, but it is a growing list and very helpful to use (especially since a low FODMAP eating plan is not exactly “intuitive”). I also like how it breaks down into categories the different carbohydrate groups, which can be very helpful when a person is ready to reintroduce foods by category.
Really liked what Dr. Siebecker had to say about using Rifaximin versus herbal antibiotics. I have had positive results with both options. Like she said, it really depends on the person and the situation.
Lastly, I REALLY want to encourage anyone who is taking on a new eating plan like low FODMAPs or SCD, please seek out a nutrition professional for support. It makes such a big difference to have someone there to guide you, support you, and help you come up with a plan that works for your personally. It can feel overwhelming, especially when you are not feeling well, so having a professional on your side can make a big difference.
Looking forward to your book Dr. Siebecker!
Hi Michelle
Thanks for sharing more about that Monash University app and yes I totally agree with your comment about finding a nutrition professional to work with! It can be very overwhelming trying to do it alone.
I also liked hearing about the Rifaxamin from Dr. Siebecker
Trudy
Thank you Trudy for so many interesting speakers. I have been working on my IBS/weight issues for over 3 years now. I have been stuck with the FODMAPs elimination diet for that period, since I am sensitive to even the lowFODMAPs foods. Negative for H Pylori, got rid of D Fragilis parasitie, taking gut healing and mineral deficiencies supplements. Taken herbal treatments for SIBO, including biofilm disruptors. Intergrative medicine and naturopath have been helpful but still no answers to the cause. I think the only thing I haven’t tried is the prokinetics that Dr Siebecker mentioned in her talk. Any suggestions helpful! The food restrictions alone are enough to give me anxiety – let alone the MTHFR, Pyrouria and no thyroid!
Sandra
Dr Siebecker mentioned a few diets – SCD and elemental are two others. She also talked about Rifaxamin and a variety of herbal treatments.
She does do long-distance consulting so that may be worth considering
Trudy
Hi Dr. Siebecker and trudy. i have tried following the SIBO treatment protocol for methane caused sibo and every time, even with iberogast, i get really constipated for weeks. my gastro gave me constella or linaclotide capsules. is this ok to try for SIBO (i’m in canada) or should i push for resotran? anything else that could help? green plantains help but i really want to get off them for 30 days while i treat. thanks!
Kelly
I’ll have Dr Siebecker come and comment
Trudy
I would be very curious to know as well because my doctor has also prescribed this to me
Hi, I would like to ask dr Siebecker if any part of the herbal and antibiotic sibo treatments are not ok to do when breastfeeding?
Thank you
This would be a question for Dr Siebecker. I would guess no due to die-off
Hi, would Dr. Siebecker be able to answer this question: Have you done work with eliminating the bacteria Prevotella Copri? The stool analysis that I just had showed an overgrowth and it looks like it is not antibiotic sensitive. Anxious because of it’s association with RA. Is there any treatments for this? Thank you!!
I’m hoping to have Dr Siebecker come and comment
If someone has SIBO from chronic PPI but also significant weight loss, should they avoid the more restrictive SIBO diet? or would it potentially help them regain absorbtion that would allow them to gain weight?
I’m hoping to have Dr Siebecker come and comment
Loved this interview, thanks!
There was no mention of false negatives with the breath test. Is there a possibility that someone may test negative on the breath test and still have SIBO? When you you want to re-test? How can I find out if the lab my doctor used is a good one?
Yes, this is possible if it is the variety of SIBO that results in hydrogen sulfide gas (as opposed to just regular hydrogen or methane). Hydrogen sulfide will not show up on the hydrogen/methane breath test, but is often suspected if there are SIBO symptoms with flatline gases on the breath test.
It’s also possible to get a false negative if the transit time is very slow. One can have distal SIBO (SIBO in the far end of the small intestine) that can be missed if the testing period is too short (2 hrs vs 3 hrs, for example). This most often occurs in cases of severe constipation.
Thanks David – good to know
Have filled prescription for antibiotic mentioned but have not started it. Can herbal treatments also result in C. Dificile in some cases?
I’m hoping to have Dr Siebecker come and comment
At the end of your interview with Dr. Siebecker she mentioned why people get reinfected. She said we don’t know why it happens in the first place. All we can do is treat with antibiotics (herbal or pharmaceutical) then treat with diet…then she mentioned something everyone should be on to help keep it from coming back. It was NOT the meds to get rid of it. I missed it and couldn’t get back to it. It is a newer thing I’ve just begun to hear about …..what was it?
Prokinetics – they enhance gastrointestinal motility
Hi there,
This was really interesting and especially about the ileo cecal valve and if open it can cause backflow.
Alison mentioned that it just needs a physical adjustment which she did. Is she able to explain how?
Also, she said there is a low FODMAP app but see that it is for Iphones only. Are you aware of one for Samsungs??
Thanks!
Susan
Susan
I’d google it or check with your chiropractor.
I don’t know of an app for Samsungs
Dear Trudy,
Please answer this question for me. I had appendectomy surgery a couple of weeks ago. Ever since I have high anxiety. I am taking rifaximin at the moment because of dhiarrea as I suspected sibo from the operation which I did not have before. Please tell me dear trudy if the appendix surgery is the cause of my anxiety or is it a side effect of the medication. What can I do? Please help I had none of those issues before the operation.
Thank you