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Small Intestinal Bacterial Overgrowth (SIBO) is a common cause of unwanted bloating, abdominal pain, weight fluctuations, and GI distress. In this guide for achieving long-term healing, health advocate, chef, and SIBO sufferer Phoebe Lapine covers everything you need to know about SIBO and how to thrive in spite of it.
Lapine answers all your questions, from what SIBO is (and what it isn’t) to related conditions (Hashimoto’s thyroiditis, Celiac disease, and more) to practical strategies for on-going prevention.
With expert medical advice from dozens of top SIBO practitioners, SIBO Made Simple provides resources for all phases of treatment, offering a clear culinary road map that can be customized to fit a large variety of gut-healing diets, such as the Bi-Phasic Diet, GAPS, SCD, SIBO Specific Food Guide, and more.
With 90 delicious, easy, low FODMAP recipes that make a notoriously tough diet doable and delicious, SIBO Made Simple is a one-of-a-kind toolkit for learning about your condition and tailoring your diet toward healing. Every recipe adds anti-inflammatory ammunition to your diet, while offering suggestions for how to add problematic ingredients back in as you diversify your plate.
Getting healthy and feeling great doesn't have to be punitive. SIBO Made Simple offers a clear path forward, from someone who's been there.
by Dr. Will Cole
As a functional medicine practitioner who consults with people around the world, my heart and passion is immersing myself in complex health cases, uncovering their root facets. Being a part of someone’s wellness journey is a sacred responsibility, one that I don’t take lightly.
No matter who I am working with, I talk a lot about the gut and digestive system, because they are a core focus of health and the place where just about every chronic health problem has its roots. I’m often reminded that discussing bowel movements is not normal, when I ask my patients about them and get giggles, blushes, and embarrassment as a response. But in truth, the gut microbiome, the trillions of bacteria and yeast living in our digestive system, is one of the most fascinating health topics.
This bustling kingdom of bacteria living inside each one of us is vast and hugely critical to our overall well-being; this intelligent microbial ecosystem in your gut actually contains around 100 trillion bacteria, compared to your 10 trillion human cells. In other words, you are 10 times more bacteria than human—a sort of sophisticated (and beautiful) host for the microbiome. In addition, the genes of your microbiome bacteria outnumber your own by 100 to 1.
The bacterial diversity and balance of your microbiome is an important part of your health; the more balanced your microbiome, the better your health potential tends to be, and that balance comes from exposure to the down-and-dirty world, including not just the foods we eat but the dirt we work in outside, the animals that we play with, and the very air we breathe; even how and where we were born affects our microbiome. All these things determine the richness, diversity, and balance of our individual gut garden.
What sounds like science fiction is actually fact. These trillions of microbes and their colonies are the manufacturers and managers of how you look, how you feel, and how you think. Hippocrates, the father of modern medicine said, “all disease begins in the gut”; now research is catching up with antiquity. Scientists are quickly learning how much your microbiome regulates just about every system of your body.
For example, we now know that about 75 percent of your immune system is produced in your gut. It’s no wonder that many immune issues, including autoimmune diseases, can be linked to underlying gastrointestinal problems.
An amazing 95 percent of your happy neurotransmitter serotonin is made and stored in your gut, not your brain. Your gut and brain were actually formed from the same fetal tissue when you were growing in your mom’s womb and are inextricably linked for the rest of your life through what’s referred to as the gut-brain axis, the vagus nerve, and the enteric nervous system. It’s no wonder that the medical literature actually refers to the gut as the “second brain.” It is for this reason that imbalances of the microbiome are linked to brain problems like anxiety, depression, fatigue, ADD, ADHD, and autism.
Even more seemingly unrelated health problems, such as diabetes and heart disease, are now being linked to underlying gut problems. We have seen the implications of gut health problems reach far beyond digestion, but digestion itself is paramount for our total health. A sort of “check-engine light,” digestive problems are often a sign that something else in the body needs to be addressed, as well as needing to be dealt with directly. Small intestinal bacterial overgrowth—SIBO—is no exception to this principle.
SIBO is something that I see clinically on an almost hourly basis. Manifesting differently in different people, SIBO exists on a larger inflammation spectrum, from mild to extreme symptoms. My patients with SIBO report everything from mild digestive discomfort to painful bloating that they describe as making them look “eight months pregnant”; they also report everything from looser or sluggish bowel movements to the throes of an irritable bowel syndrome (IBS) flare, indigestion to extreme acid reflux, or GERD. SIBO can not only do a number on your digestion, but when your GI tract is weakened or damaged, it can trigger a number of potential autoimmune problems throughout the body. This is the SIBO spectrum.
Over the years, I have seen firsthand how living with SIBO can be an isolating existence. To everyone else, you look “normal,” but others don’t see the silent suffering behind closed doors or the struggle it takes just to get through the day. SIBO can mess with your emotions as much as your stomach.
Additionally, there can be great overwhelm with the endless vortex of conflicting information online. Dr. Google is one fickle, confused physician. Low-FODMAP, low-histamine, low-oxalate, SCD, GAPS, carnivore, plant-based, paleo, low-carb, high-carb, keto, pharmaceutical antibiotics, herbal antibiotics, no antibiotics… it’s difficult to be both your own health advocate and the one suffering at the same time.
Phoebe Lapine is an angel in the time of health distress; she is a source of calm direction in a storm of disillusionment and frustration. In this book, she offers clear explanations for SIBO, as well as offering information on related conditions, how you can get an accurate diagnosis, how you can develop a plan to ease your symptoms, and how you can nourish your distressed gut with health-supportive, delicious food. She’s been on the front lines with SIBO, and I believe her words certainly will be a light in a dark time in your wellness journey.
My friends, the book you are now holding is a priceless, practical road map for all your SIBO questions. Finally, SIBO Made Simple.
Your Digestive System Cast of Characters (in Order of Appearance)
The GI tract is a series of organs joined in a long, winding path from the port of entry (your mouth) to the exit ramp (your anus). There are hollow organs that transport and process food—such as the stomach, small intestine, and large intestine, and solid organs—such as the liver, pancreas, and gallbladder—that don’t deal with food directly, but aid in breaking it down. Here’s a brief description of the main players and how they come together in this ensemble cast to keep your body fueled and healthy.
“Sorry, I Don’t Speak SIBO”: A List of Essential Terms
Reading about SIBO can sometimes make you feel as if you need to learn a new language. This section contains bare-bones definitions of some of the most referenced conditions, bodily functions, and processes in this book. If you ever find yourself confused or want to work on your SIBO literacy, flip back here.
GI, Interrupted: Getting to the Bottom of Your IBS Symptoms
Irritable bowel syndrome has long been thought of as a mystery, symptom-based disorder—what many physicians refer to as a “wastebasket diagnosis” that should only be reached after all other possibilities are ruled out and thrown in the trash.
Over forty conditions could cause the keystone symptoms of IBS: abdominal bloating, abdominal pain, constipation, diarrhea, or a combination. But more often than not, someone will walk into a doctor’s office with two or more of these issues, and with no further investigation they are diagnosed with IBS and sent on their not-so-merry, gassy way.
If this scenario sounds familiar, you are not alone.
IBS is the most pervasive gastrointestinal condition in the world, affecting anywhere from 10 to 20 percent of the global population, whereas GI diseases, such as celiac, make up only around 1 percent. IBS sufferers are twice as likely to be female, and therefore, that much more likely to be told that the distress is all in their head and the best medicine is a chill pill.
For this camp, learning about SIBO can be a welcome light at the end of the IBS tunnel. Before the twenty-first century, this type of overgrowth was only discussed in medical literature in isolated instances—usually when a section of the small intestine was removed. It wasn’t until the last decade that we’ve come to understand that SIBO is far more pervasive, and now estimated to be responsible for more than half of IBS cases.
Still, as awareness for SIBO grows, it risks becoming a similarly catch-all diagnosis, when in reality, it is really a symptom of a larger problem in your digestive tract, not a disease in and of itself. If you have SIBO, there’s always a reason the bacteria are overgrowing, and often several. It could be that endometriosis or a tumor is pressing down on your intestines. It could be inflammatory bowel disease—Crohn’s or colitis—which makes someone nine times more likely to develop SIBO. Similar to IBS, with SIBO, it’s not the what we should be after, but the why. Because a more serious problem can go ignored if we feel SIBO is the one answer we’ve been looking for after many years of suffering.
On the following cheat sheet, you’ll see the many disparate symptoms that might be a result of SIBO. As we get into the nuances of the different organisms that can colonize the small intestine (here), you may better understand why certain seemingly opposite symptoms (e.g., constipation or diarrhea, chronic weight loss, or stubborn weight gain) are present in some people and not others.
Women with SIBO will often report that they wake up feeling normal, but after breakfast, their abdomen balloons to the point of looking visibly pregnant. The timing, frequency, and location of your symptoms is one of the biggest indicators of whether you have an issue in your small intestine or another type of gut imbalance. Distension, that feeling of wearing an internal inner tube below your ribs, is one of the hallmark symptoms of SIBO. It’s a different sensation than what a woman might experience during her period. With SIBO, that bloating happens much higher, the pressure is harder, and it’s chronic.
Most SIBO sufferers will feel the impact of their meal within the first hour of eating, whereas GI symptoms six hours after your bean burrito are likely due to gas in the colon. If you find you’re experiencing pain or discomfort after every meal, that is more indicative of SIBO than are intermittent bouts of IBS, which may be due to an intolerance or exposure to a specific ingredient. The sample Symptom and Activity Tracker (here) should help you better identify where and when symptoms occur and whether food triggers could be at play.
In other words, just because you experience gas, bloating, diarrhea, or brain fog, it doesn’t mean you have SIBO—or, that it’s only SIBO.
The most important element of unpacking your symptoms is ruling out additional causes. SIBO is associated with many other disorders, and we are still in the process of understanding the chicken-or-the-egg relationship between them. Chapter 1 is all about helping you parse through your symptoms, test properly for SIBO, consider or rule out coinfections, uncover the malfunctions within your digestive system, and overall, discover a more complete picture so you can formulate the appropriate treatment plan in Chapter 2.
We’ll discuss the role that something as common as food poisoning can play in your intestines’ ongoing functionality (here) and why women may be more susceptible to foreign invaders than men are (here). Lastly, we’ll talk about the beast that is yeast and how Candida overgrowth can be an equally formidable foe for your small intestine (here).
SIBO SYMPTOM CHEAT SHEET
Playing Gut Detective: Uncovering Your Root Causes and Risk Factors
To be able to wrap your head around how bacteria can overgrow in the small intestine, you first need to understand your digestive system’s fundamental anatomy and functions.
We are constantly ingesting bacteria through our nose and mouth via the food we eat and our most basic interactions with the world around us. The labyrinth of our alimentary canal is designed to ward off the bad guys before they have a chance to join the bacterial ecosystem of our large intestine and potentially throw its delicate balance into disarray. To accomplish this, our digestive organs work together to produce a cocktail of naturally antibacterial substances. These include the industrious HCl in our stomach, bile from our gallbladder, and digestive enzymes from our pancreas. The latter two are secreted into the small intestine and act as safety nets, killing and arresting growth of whatever critters manage to get past the stomach.
The most robust safety measure, of course, is our own immune system. What doesn’t get killed by acid, bile, or enzymes must then face our immune cells, 70 percent of which live in our intestinal lining. When a foreign invader seems to be gaining ground, this battalion unleashes its own patented brand of antimicrobial toxins to fight it.
If all else fails and bacteria manage to survive these measures, your body can rely on its own anatomy to at least get rid of them in a timely manner. The migrating motor complex (MMC) is our small intestine’s local dishwasher, responsible for clearing the decks and street sweeping undigested food and unwanted critters through the canal after each meal. Because of this role, the MMC only kicks in during a fasting state of ninety minutes or more. If you have a noisy or gurgling gut in between meals, that’s a good sign that your MMC is not falling down on the job.
- "[T]he book you are now holding is a priceless, practical road map for all your SIBO questions. Finally, SIBO Made Simple."—Dr. Will Cole, bestselling author of The Inflammation Spectrum
- "Phoebe Lapine has fully delivered. Chock full of science forward and understandable information, Phoebe has provided everything you need to know about SIBO, feeding your gut properly, and optimizing your health. Not only is it needed, but it's crucial in how we move the needle forward in effective and sustainable healthcare."—Dr. Michael Ruscio, clinical researcher, bestselling author of Healthy Gut, Healthy You
- "Finally! A comprehensive and easy to read manifesto for anyone struggling to understand SIBO and trying to figure out what to do about it.
- On Sale
- Jan 12, 2021
- Page Count
- 336 pages
- Hachette Go