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Episode 71: Unexplained Symptoms? It Could Be SIBO

Episode 71: Unexplained Symptoms? It Could Be SIBO

Dealing with bloating, gas, belching, pain or nausea? These are common symptoms of small intestinal bacterial overgrowth, also called SIBO. And they’re symptoms that our guest knows all too well. 

Longtime listeners will remember Phoebe Lapine from episode 4, when she was just getting started on her SIBO sleuthing journey. Now, Phoebe has two years of research under her belt and she’s back to share her findings with all of us. 

Andrea and Phoebe set the stage on what SIBO is, Phoebe’s 10 “not so fun facts,” SIBO risk factors and so much more. If you’re dealing with any random, unexplained symptoms that you just can’t figure out, this episode could shed some light on the issue. 

To connect with Phoebe, follow her on Insta @phoebelapine or head to the SIBO Made Simple website

Questions? Ideas? Email us at themicrobiomereport@biohmhealth.com or reach out on Instagram @DreEats or @BIOHMHealth.

BIOHM gut quiz

Approximate Timestamps: 

  • Phoebe’s journey with SIBO (2:45)
  • “SIBO Made Simple” (7:25)
  • What is SIBO? (11:20)
  • SIBO and leaky gut? (14:12)
  • 10 “Not So Fun Facts” (15:16)
  • Can stress cause SIBO? (23:48)
  • Biggest take aways from Phoebe’s research (28:24)
  • Food is not the answer (or the problem) (32:14)
  • Diets that could be helpful for SIBO (34:34)
  • The benefits of figuring out your allergens and triggers (38:21)
  • Andrea’s favorite recipes from “SIBO Made Simple” (43:29)

Mentioned On This Show:

Transcript: 

Andrea Wien: Welcome to the Microbiome Report powered by BIOHM Health. I'm your host Andrea Wien and we are talking today with Phoebe Lapine. Phoebe is a food and health writer, gluten-free chef, wellness personality, award-winning blogger, on and on and on and also the author of a couple of our favorite books, The Wellness Project and her new book SIBO Made Simple.

So, Phoebe was a guest on the show very early on when she was just getting started with her SIBO sleuthing, as we call it on this show, and launching her podcast SIBO Made Simple so we've had her back on now to get into what she's really learned about SIBO through the last year or two of interviewing experts and practitioners who are really entrenched in the SIBO space.

Now, this episode is important, even if you don't have SIBO because we really talk about the ins and outs of IBS and just how the digestive system works optimally. So, it's important to understand some of these things and the concepts that we talk about in terms of a healing journey. And even if you think you don't have SIBO, but have some digestive issues, this episode might convince you otherwise that maybe it is the root cause of what you've been dealing with for however long you've had symptoms.

So, this is an episode that I think is very important for most people to listen to. Phoebe really makes things very easy to understand. I couldn't fangirl enough in this episode about her cookbook and what she's brought to the table with it. So, enjoy the show. As always, our show notes are at biohmhealth.com/pages/podcast, and you will get 15% off on BIOHM's website with the code pod15. Enjoy the show. Phoebe Welcome.

Phoebe Lapine: Hi, it's so nice to be back.

Andrea Wien: I think you were what? Number four, our number fourth guest on the show. But so much has changed since then. I think at that point, you were just starting your SIBO journey and starting the podcast, and beginning to talk to people. And now you have a whole book SIBO Made Simple book. And you've talked to so many experts across this space. And you're just really entrenched as a SIBO sleuth is what I'm calling you.

Phoebe Lapine: Yes, I really like that term. I wish I had come up with it myself. It's definitely what I feel like, a SIBO sleuth.

Andrea Wien: Well, for people who maybe did not listen to that past episode, I would encourage them to go back and do so. But can you give us just the beginnings of your health journey and how you got to where you are in this whole SIBO journey?

Phoebe Lapine: Sure. Yes. So my health story began when I was 22 when I was diagnosed with Hashimoto's thyroiditis and autoimmune disease that affects the thyroid gland. It took a really long time for it to dovetail with my food story, which is what I do as a profession. But that happened in my mid-20s when I started to finally take my diagnosis seriously, and to start modifying my diet and using food as medicine, and delving into the whole holistic side of healing.

What I discovered was really overwhelming, especially for a young person living in an expensive city. I felt like the to-do list was really long and hard to navigate and hard to afford. So I ended up designing my own wellness project, which is what it was called, and writing a book later that was called The Wellness Project, where I spent a year tackling each one of my wellness problem areas one month at a time.

The idea was for it to really distill the common sense stuff to not get so lost in the minutiae and to really figure out what was worth my time, money, and energy. So, the research and experiments span the gamut from liver detox, to sleep, to exercise, to hormone balancing, to gut health, of course, to stress management, and a lot of things in between. It taught me so much, it really did help me get my Hashimoto's under control and just gave me a really good foundation of life skills and self-care practices to carry with me.

And then the book came out, which was a whole other thing. It was a very stressful time. About seven months after it came out as I was cooling off from the book tour circuit back when that was a real thing you did in person, I started to notice some weird IBS symptoms creeping back into my life. And obviously, most autoimmune diseases have some precedence in the gut whether or not they originate there, who's to say?

But I was no stranger, of course, to IBS, but these symptoms seemed a little different and strange. It was like bloating that never went away. I was burping a lot in the middle of meals, which was definitely not in my spectrum of symptoms prior. I just did what I thought I was supposed to do what all the microbiome specialists who I interviewed for The Wellness Project said to do, which is I just doubled down in all my fermented foods and prebiotics. I was just eating lots of beans and drinking kombucha and eating sauerkraut and all that. And needless to say, I was just fueling my issues without knowing it.

So, I eventually ended up back in my functional MD's office. And he immediately tested me for SIBO, which is something that hadn't really come up much in my research. I'd heard of it, but I didn't really know what it was. And spoiler alert, I got the diagnosis and that kicked off this whole sleuthing 2.0, was like my wellness project 2.0. So I started to do lots of research online, and it was just so confusing. I felt like everything I came across was contradictory, or just really complicated.

And so I ended up just doing my due diligence, as I always do, and writing about it on my website, as I wanted to do. And the response was just crazy. I joke about it in the book. But the response is so amazing that my mom was like, "Wow, Phoebe is so amazing that you're already attracting this audience around SIBO." And I was like, "No, mum, my audience already has SIBO. They know it." So, it was a sign to me that I needed to create some more resources for people. So I started the podcast to really talk to practitioners who were on the ground dealing with this condition since it's fairly new, and there's still a lot that has yet to be validated in research.

So I really did feel like practitioners were the ones with the immediate answers. And yeah, what I learned was really fascinating. I always intended to put it into a book, just because again, I didn't feel like there was one out there that really covered all the bases, both the food side of things and the healing and treatment side, healing and treatment, two very different things. So yeah, that's what I did. And now I'm your SIBO amigo, your SIBO sleuth.

Andrea Wien: I love it. Not that you got SIBO or that anyone else has it but you really did succeed at putting all of this information into a book that's so easy to understand for such a complex topic. And it goes so far beyond just SIBO. I've been recommending it to people just in terms of how your digestion works, and the whole section that you have on different antimicrobials and probiotics and different supplements that help with different stages of kill stages or healing stages. It's so comprehensive that we could do five hours on this show and probably not get to everything that we want to talk about.

But I really encourage people to pick it up even if you don't have SIBO, if you have any other type of digestive ailment that is going on, or if you know someone that has something going on, give it to them because it's just been really useful in explaining to people and helping to explain to clients what's going on in there. And then secondarily, we didn't even touch on this, but the recipes are really good. My husband and I have been cooking from them pretty regularly. I would say we make one or two things a week. And they've all been excellent and work well. And they're really easy.

My husband actually joked the other day. He's like, "I feel like there's less dishes after you cook." And I was like, "Yeah, Phoebe's recipes are actually very easy to do, and don't take a million ingredients. And they all come together in a way that you don't have to use so many bowls." So, that's just my personal little side note on it. But I love it. I love the book.

Phoebe Lapine: Oh, thank you. That's such great feedback. And also, I will say that it's amazing the things you don't learn. When I was researching my last book, I truly didn't really understand how the digestive system worked. SIBO was honestly a gift in that it really allowed me to drill down and learn about some essential pieces of the anatomy. I don't know, I didn't even really know what the biggest nerve was. I didn't know what the migrating motor complex was. All of these key players for making sure that our digestive system works the way it's meant to work. I don't know, I think SIBO can be a gift for those of us who are unfortunately plagued with it and just helping us understand how our body is really supposed to function.

Andrea Wien: Absolutely. Yeah, we started doing these mini-episodes where I get on and riff on a topic and the very first one that I did was how digestion works and why you should care because it is so important. And I think once you understand some of these concepts that not many people know about, it just puts you in a different frame of mind when you're eating, but also when you're having a healing journey, just any type of place along that path, it can be really helpful.

Phoebe Lapine: Yeah, totally.

Andrea Wien: So you have some 10 not-so-fun facts that I would love to dig into. Your book is also really great in the fact that it keeps things light. You call people your SIBO amigos. Things are just very accessible. And so your 10 not-so-fun facts. The first two are really striking to me. So the first one is there are 25 to 45 million Americans living with IBS, 75% of which are women. Something to be said there, maybe the whole stress factor that we'll get into later has something to do with this. And the 60% of all IBS cases are said to be caused by SIBO.

So that's huge because so many practitioners to date have said, "Yeah, you have IBS, there's not really anything we can do about it. Go along on your way." And so now to say 60% of those cases could be caused by something that we could begin to treat is massive. Before we move on, I do want to just stop and say, let's give a quick overview of what SIBO is and what it stands for so people are all on the same page before we move on.

Phoebe Lapine: Sure. So, IBS is I feel like a BS diagnosis is literally a descriptor of your symptoms. 60% of all IBS cases being SIBO is a really conservative number. There are a lot of people who say it's 80%, but we'll go 60%. You're not always error on the side of being conservative. So small intestine bacterial overgrowth, what it stands for, really well, I guess this is my not-so-fun fact number three, but it's an issue of location, that type. So, it doesn't really matter if it's "good or bad bacteria" it's just that it's in the wrong place.

So, a lot of jargon that gets thrown around in the wellness space right now is just talking about gut health as this amorphous thing and gut bacteria. The reality is, the majority of those critters are in your large intestine, that's where they have a function, they help to break down excess debris that your body can't really deal with. And then have a whole host of other roles as metabolizers of various things, and as helpers to your immune system and whatnot.

But in the small intestine, that's where you absorb your nutrients. And whether it's bacteria, they're sharing the food on your table, it can create a host of issues, primarily that when they eat something that they like, they release gas. And since that gas is so far from an exit ramp now, it can get stuck there, cause really uncomfortable bloating, and find other means to get out of your body like burping, which is, I think, a pretty good illustration of why I had that symptom.

But then, the gas itself can be very inflammatory and damaging. The bacteria themselves can also be damaging to your intestinal wall, there's a very direct correlation between SIBO and leaky gut or intestinal permeability. And then that can cause this whole downwind lists of symptoms that are more on the autoimmune spectrum that are associated with SIBO. So, anything from brain fog, joint pain, skin issues, food sensitivities, a huge one, and that's tied to the leaky gut piece.

Then, of course, weight loss or weight gain, depending on what types of critters are overgrowing anxiety and depression since so much of your mood is directly related to the health of your gut.

Andrea Wien: Yeah, like so many of these things, there's so many different symptoms that can be attributed to SIBO and leaky gut that it's sometimes hard to start to pinpoint these things.

Phoebe Lapine: Yeah.

Andrea Wien: So, I think it's good to have in your mind, if you are dealing with any type of random symptom, even one that we haven't mentioned here, this could be someplace to look, especially if you have digestive symptoms that go along with it. So I think that that's an important piece to just touch on.

Phoebe Lapine: Yeah. And there's a huge list of overlapping lifestyle risk factors, and then also overlapping diseases and conditions. And I will say, a lot of people hear about SIBO, they've had these chronic IBS symptoms their whole life and they get very excited. It's not necessarily the answer for everyone. I think I put the number in the book, I can't remember, there's like 40 different conditions that could cause or issues that could cause the hallmark symptoms of IBS. So, I'd say probably a lot of those for sure are also, unfortunately, in some way linked to SIBO. There's just a lot of different ways that the gut/your digestive tract can fall down on the job or break down or have some issue.

Andrea Wien: Yeah, and that's actually a couple of these not-so-fun facts. I'm looking at six, seven, and eight. So SIBO is a sign that something in your digestive system has gotten wrong. It's not a disease in and of itself. I think that's a very important distinction to make. So you might get rid of the SIBO, but unless you're fixing that root cause, it's going to come back.

Phoebe Lapine: Exactly. Yeah. So a lot of the buck, there's a huge section goes over the root causes. We can talk about the main buckets if you'd like to right now, but it is people who complain about SIBO that never goes away, it's a chronic condition. Not that it's fear-mongering for people who just first find out they've been diagnosed but there's a reason why it becomes chronic, it's not a condition that's just you're stuck with it for life. Usually, the chronic element is something else that again, has gone wrong, and sometimes it can't be remedied, unfortunately. That's where chronic SIBO comes from. But so long as you do tackle some of those issues, it shouldn't be chronic, your digestive system should be working the way it's meant to work.

Andrea Wien: Let's jump into those buckets now. I think that would be a good thing to get into.

Phoebe Lapine: Awesome. Yeah. So, the first big bucket is motility. So this has to do with something called the migrating motor complex, which I mentioned earlier, something that I never knew about until doing this research. But it's essentially this street sweeper mechanism that clears the deck after a meal. It only kicks in during a fasting state of 90 minutes or more. And it's different than peristalsis, which is like the muscular motion that moves food through.

This is like the equivalent of cleaning the dishes after the meal. And it's really important because the small intestine improperly named is really long and windy and the surface area of a football field. So, there's a lot of nooks and crannies and opportunities for an opportunist like bacteria or fungi or yeast to pull off at the exit ramp and set up a little shanty town and stay for a while.

So that migrating motor complex is really important for making sure that doesn't happen. Unfortunately, there are a lot of different conditions. And again, lifestyle factors, that can prevent the migrating motor complex from doing its job. One of the big ones is actually food poisoning. So that's been a really interesting area of SIBO research that has been verified. There are multiple names for these things. It's called post-infectious IBS as well. But post-infectious IBS is the same thing as SIBO. It's just caused by food poisoning. SIBO, that's caused by food poisoning.

So what happens is, when you eat something or have some stomach flu or have any pathogen that comes in, that sparks your immune system to go on the offensive, sometimes through an acute case of autoimmunity, an acute case of mistaken identity, your immune system accidentally attacks the nerve cells that power the migrating motor complex.

So, a lot of people really have a hard time linking this as the acute event because you've had food poisoning, you're miserable for 24 hours, maybe two days, but then you feel fine. But with SIBO, that stagnation that's caused by the migrating motor complex just being temporarily put out of commission, it just means that thing is slowly accumulate over the course of days, weeks, months, until, for some people, you have an actual issue months later, and that issue is SIBO.

So, some other things that overlap in the motility bucket are Hashimoto's. Oh, who knew? It's actually a really big risk factor for SIBO because, well, I'll get into that later, if you want to. We'll get through the buckets first. But there are certain other medications that are issues like opioids, even antibiotics can damage, your motility. And then a lot of different autoimmune diseases are also on the list.

Then the second bucket is a structural issue. So, that could be anything from missing an essential piece of your anatomy like the ileocecal valve, which is what separates the small and the large intestines, the back door to make sure that the bacteria in the large intestine don't migrate upwards. That normally does not happen unless you have something wrong with your ileocecal valve. Some people have had to have their valves completely removed and file that under an issue that would cause chronic SIBO because you cannot replace that.

But then, there could be something as simple as like a kink or a blockage or something more subtle like a lot of laparoscopic surgeries have been associated with SIBO just because of the internal scar tissue that can form. You may not have much of a scar on the outside, but sometimes after these interventions, the fascia will reform internally and grip and bind to organs and just cause them to not move as freely as once before.

It could be a mass that's bearing down on your intestines. Endometriosis is one that falls into all the buckets mainly because laparoscopic surgery is one of the main interventions. But then also, if you have masses growing in your abdomen outside the uterus, that can again, bear down in your intestines. Tumors that people don't know about, even if they're benign, bearing down on the intestines, again, it's any pressure in that area, since it's such a long winding path can turn a four-lane highway into a two-lane highway. And that can just cause a little bit of a bottleneck that over time, potentially with some other risk factors attached to it can eventually lead to a bigger issue.

And then the third bucket, which some people don't call it a root cause, some people call it just a risk factor. But it's that the bacteria just aren't killed. Because if you think about it, again, our digestive system is very well designed and constructed. We have all of these antimicrobial substances that are designed to neutralize bacteria that naturally comes in through the nose and mouth. Even in the first place, food poisoning, you have to maybe have one of these risk factors in order for it to make it to the intestines past the labyrinth of your stomach acid.

And yeah, I'd say like deficiencies in some of these antimicrobial substances, stomach acid being one, bile acids, pancreatic enzymes. I know a lot of people with SIBO who have had their gallbladder removed. That's a double whammy again, that like laparoscopic surgery, but then also you're missing one big antimicrobial substance.

And then another thing that falls into that bucket is just any immunosuppression or immunocompromised. Because again, like in the case of food poisoning, your immune system is designed to attack things that are not you and are not in the right place. And there is a very thin mucus wall that separates the immune system and bacteria in the small intestine, whereas there's a larger one in the large intestine because that's where it's meant to be. So in theory, your immune system should not be allowing bacteria to have a party in your small intestines.

Andrea Wien: That's so much information. And it's so good to hear it spelled out like that. We did a whole episode on visceral manipulation with Dr. Bob Bob Griesse, where we were talking about that ileocecal valve and how we can really even manipulate it from an external point of view. So when I go to the chiropractor, for example, as someone with celiac, I have them do essentially, abdominal massage, but it's a little bit more uncomfortable than that, where they are making sure that that ileocecal valve is free to move and working with some of my other organs, my liver, and other things, just to make sure that that stuff is all opened up and free of kings, as you said, to make sure that all of those complex is migrating motor complex, and just the movement of food through the intestines is able to move freely.

So I think it's important for people to realize that there are ways maybe if you do have a bout of food poisoning to be more conscious of that. And potentially, there are some external therapies that might be able to prevent some of this stuff from happening, which maybe we can talk about a little bit more when we get into what you've learned from some of these experts.

I do want to talk about number nine on the not-so-fun facts, which is that stress can cause SIBO. And so we talk on this show a lot about sleep and exercise and stress. And I think sometimes people think about it, and they're like, "Yeah, yeah, I'm all good." Right?

Phoebe Lapine: Mm-hmm (affirmative).

Andrea Wien: But this is such an interesting piece to me that we have all of these physical components that could potentially interact with what is going on in there and really be huge risk factors. But stress is such a big one. It just makes me think that 75% of women are experiencing IBS symptoms, that maybe there's a tie here with how stressed out modern-day women are with what's going on inside of their body. So I'd love to just dig into that piece a little bit.

Phoebe Lapine: Yeah. No, it's absolutely, I think the SIBO piece that people don't give enough airtime to or consideration of and it's rare that that will be the only thing. But it can certainly be the catalyst if you have other risk factors in place. I said that my SIBO cracked up after book tour, I can't really think of anything else that happened in those months besides being really stressed and strung out.

But I have underlying causes like Hashimoto's makes me have lower stomach acid. And if my B12 is not high enough, then it's also going to affect the migrating motor complex, and not having enough thyroid hormone usually means low B12. A lot of Hashi people know, definitely, B12 is among the higher deficiencies. So it's like, I haven't had SIBO for the entire decade that I've had Hashimoto's. But with stress in the mix or some other things, it can absolutely create the ideal environment for an overgrowth.

So yeah, stress is definitely in research been shown to limit motility, to limit stomach acid, again, two of those really big important buckets. And for women, especially, there's so many hormonal implications entwined in that. Our stress response is a hormonal response. I think that the Hashimoto's example really shows how some of these things can be a vicious cycle, just alone, not having enough T3 hormone means, again, not being able to make enough stomach acid, not having enough B12 to fuel that migrating motor complex.

But then, the conversion of your thyroid hormones from the inactive to the active form T4 to T3 happens in the gut. So if your gut's not healthy, then you're going to struggle with that conversion. So, it does become a self-perpetuating cycle. And it's similar to a lot of other hormone imbalances. Estrogen dominance, I think, is another really big issue for women. And also just having a sluggish liver, which will make any hormonal balance hard to navigate if your liver is falling down on all of its chores associated with that.

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So you've interviewed some of the top names in wellness and in the SIBO world. And I'm just curious as you think back, you really put a lot of it into the book. But what are some of the biggest takeaways that you've learned from them?

Phoebe Lapine: Oh, man. So much about the nitty-gritty of treatment and just about how the body works. But I will say, of the modalities that have been most fascinating to me and the practitioners I've interviewed about those, there's still manipulations definitely up there. I really do think bodywork is an underutilized and appreciated form of prevention and SIBO treatment. For those who don't know, for most people, there is some sort of "kill protocol" associated with SIBO. So, there are antibiotics for this. There are also herbal antimicrobials if you want to go the more "natural route" and something called the elemental diet, which is not actually a diet, it's like a medical shake.

But there are all these other modalities that maybe have a little bit more research associated for IBS. But again, if you drill down on those statistics, you have to assume that they're going to help some people with SIBO as well, maybe not the people with really big overgrows high gas numbers, but certainly some of the people with maybe more borderline cases, or just less severe cases. And yeah, that would be a huge one. And I also say I would definitely read that section in my book because there are a lot of people who I think would fall into the structural issue camp who might not even realize it.

One of the examples that I love and there is actually a really interesting interview that I did on my podcast about traumatic brain injuries and SIBO, that was an expert named Kayle Sandberg-Lewis. She's so fascinating and smart. But just in talking about with brain and spinal injuries, the downward effects for your vagus nerve and for your ability for your brain to send messages to your gut to switch into rest and digest mode.

So I'd say one example of something that probably has happened to a lot of people and maybe minor, but any just small accident, maybe even childhood, like falling off the monkey bars or falling up a horse or being in a little fender bender, these kinds of accidents cause the disease process that is a brain injury, it's not just this isolated thing, and it has real consequences for the digestive system. And then, you can take into consideration the way that the body reheals maybe in some dysfunctional way, alignment-wise, and the medications you may be put on for some of these things, including opioids, or antibiotics, or NSAIDs. All of those medications have unfortunate halo effects for motility.

So, it's just one example of something that happened that could have a foot in every single SIBO bucket. And then, I think hypnotherapy for the mental side of things for both stress in your life, but then also in healing certain types of just anxiety issues or stress and anxiety issues associated with your IBS or a condition. Because a lot of us especially with SIBO become really fearful of food because that's what directly sparks our symptoms, or just in fearing the onset of symptoms, which may not actually be tied to anything real.

I think hypnotherapy is an underappreciated art for a lot of different medical conditions. And considering that SIBO can have so many different types of root causes, I think that it is a broad-spectrum approach in some ways that can allow you to heal various parts of the body just by the power of your mental imaging. It's amazing.

Andrea Wien: I think that you make such a good distinction too. And I pulled out some of these points from the book. So diet did not cause your SIBO and any cheats or reintroductions will not cause it to return. So I think sometimes when we're dealing with things that are digestive-related, and we're really noticing it when we're eating food, we think that food is the answer and the problem.

Phoebe Lapine: Yeah.

Andrea Wien: So, I think that that is such an important piece to remember that you can't fix this only with food, you're going to have to go a little bit deeper, and explore some other aspects and some other root causes that maybe feel a little bit uncomfortable or out of the norm or out of the box from what we typically talk about.

Phoebe Lapine: Yes, exactly. People get really bogged down in the diet piece. And there are plenty of ways to heal SIBO without making a single change to your diet.

Andrea Wien: That said, I do want to talk a little bit about the diet because it's interesting when we talk about this "ideal diet" for gut health, we're often talking about things like kombucha and high fiber foods, and sauerkraut. That diet is horrible for SIBO in many ways. So, it's actually quite the opposite of many of the healing diets that you talk about in the book.

Phoebe Lapine: Yeah.

Andrea Wien: I think this is important and interesting because I always say to clients, the diet that heals you is not the diet that sustains you. And I think that that's so perfectly illustrated in SIBO cases. So, it's almost like we have to get out of our own way of what's healthy and tune into what our body is trying to tell us and what is going to work for that. And that piece is a process that's ongoing for life.

So, again, coming back to SIBO almost being this gift in a way, being able to really tune into what's working for you and leaving all of the "healthy advice" that people might be giving you in very well-meaning ways is only for people who already have a baseline of health to start from. So, I think that that is really critical just to touch on. So, maybe you can just talk about a little bit of the characteristics of the diets that could be helpful for SIBO and some of their core components.

Phoebe Lapine: Yeah. So, the main one is called the low FODMAP diet. That's actually, I think it's the number one in terms of symptom reduction efficacy treatment for IBS at this point. So, it's actually pretty widely known in a lot of conventional GI circles, which is amazing to have these doctors consider any diet as a solution. But it's often misused as a long-term solution when in fact, it should be used as just a short-term therapeutic diet. And it's also something that I was like, "Why does this diet work? It's literally the opposite of whatever microbiome scientist tells you to eat for your gut."

When you understand SIBO, it's like a no-brainer. You're like, "Oh, yeah, of course, if you have bacteria in the wrong place, and you feed them their favorite foods, you're going to be miserable." It doesn't mean those foods are bad, or the bacteria is bad, they're just in the wrong place. So, the low FODMAP acronym is basically just different types of carbohydrates. And bacteria eat other things too, they'll eat anything. But it tends to be that these are the ingredients that produce the most gas.

So, again, will therefore making most uncomfortable. There's a misconception in the SIBO world that doing this diet will be a starvation technique for bacteria and cause them to just die off on their own. That doesn't really happen. But there is something to be said for reducing that gas load so that your gut can heal. Because again, as we talked about at the beginning, it can be really inflammatory to just have all of that gas. And ultimately, the more we can calm things down, cause our immune system to recede, the more healing we're going to be able to do in the gut.

So, there are different approaches in terms of layering on diet and treatment. Some people will say, "Do no diet during your kill phase because we want the bacteria to be as active as possible so that the medication you're taking can kill them." For some people, that just leaves them really uncomfortable. So, usually, some practitioners will have some hybrid approach, and you're not taking out some of the big guns, maybe still eating a few things here and there that are high FODMAP to keep your bacteria on your toes.

But it's like, you want to find the happy medium between not being too restrictive, and not being too miserable from a symptom standpoint. But I think the diets that aren't talked about enough is the autoimmune component. So the food sensitivity component associated with the leaky gut that's happened or just for a lot of people who maybe had autoimmune diseases that predated SIBO and our, again, vicious cycles that are fueling one another.

So I actually for my recipes in the book, even though it sounds like taking out even more, but I layered on some more traditional big gun allergens onto the low FODMAP diet. So I didn't use gluten, dairy, soy, or corn for the most part in the book. I think that's something to explore to if low FODMAP... low FODMAP is a very complicated diet, and it takes out a lot of different vegetables that are totally good for you.

If that feels like too much, maybe just try going on an allergen elimination diet and seeing if that calls off your immune system. The low FODMAP diet is very different than an allergen elimination diet. Low FODMAPs are the building blocks of all plants, so you're not allergic to them, you just may have some symptoms or not be able to digest certain groups as well as others.

Andrea Wien: Yeah. And I think you make a good point that figuring out your allergens and food triggers is more important than starving these bacteria. And I have to imagine that's because that is a huge root cause. So if you can address that, then your inflammation and symptomatology drops, and then you can address the other issues that are still present. But at least you're starting from a baseline that's a little bit less inflammatory.

Phoebe Lapine: Yeah, exactly. And that's the goal and healing, no matter what, is just to call off the immune system, allow for there to be more calm so there can be more healing, and then giving your body the nutrients and the [inaudible 00:38:56] it needs to actually heal that gut lining.

Andrea Wien: One of the other things that I thought was really important that you talked about is that you have to give yourself a year to heal with SIBO. And I think people hear that and they're like, "Oh, my goodness, that seems so long." But this is often a condition that didn't pop up over the course of a week or two or even a couple of months.

And so, I think that just getting the expectation down that you're in it for the long term, embracing the trial and error as you say, and being okay with taking one step forward and then taking two steps back that this is really going to be a give and take process where you're figuring it out because it's not going to be the same protocol for everyone. And there's so many different avenues that people could go down that might or might not work for them that really just getting in your head that this is going to take a year is super important.

Phoebe Lapine: Yeah. You should always set up your expectations well so that you can achieve that. But I think The Wellness Project seemed like a crazy thing to a lot of people, taking a whole year to make all these changes. And now I realized, "Oh, how could I have expected my body to heal in any less time?" And an organ like the gut, luckily, things can change there fairly quickly. But as you said, if the damage has been... being done for a long period of time, it's, of course, going to take a similar period of time in order to have the healing take hold.

Andrea Wien: Yeah, I think it's so important. And I love... I'm looking at one of the pages of your 10 diet rules of thumb and there's so many good pieces on here because again, I think people get so into their head of diet as the enemy. So if you don't react to an ingredient, eat it, don't let your diet be the enemy of your inner and outer worlds, and on and on in that vein. So it's so important to not make the food the issue.

I just want to keep reiterating that because I think it can become so easy to do that. And then suddenly, we're eating like boiled chicken, super well cooked [inaudible 00:41:12], whatever it is, and suddenly our whole world gets shrunk down and that can contribute to the stress. Not many people are going out to eat right now. But just from a community aspect, it's like not being able to go out to eat with your friends, or enjoy meals with your family, or whatever that might look like for you.

I just want to make sure we're keeping the whole holistic view in mind, even though SIBO can be so frustrating to deal with like any digestive condition, or autoimmune disease, or insert any type of chronic condition that you're dealing with. Let's keep it all in perspective.

Phoebe Lapine: Yeah. Well, I wanted the recipes to be as diverse as possible with the great amount of restrictions. But I read Amazon reviews online of other bugs and I do get nervous with people who try a recipe, and then they react to something and they get very down and out about the whole thing, when in reality, we're all individuals, we all have our own set of sensitivities.

But I'd say, I've been really pleasantly surprised by more people who were on the other side of the spectrum had whittled themselves down to so few foods. And the book has been a huge liberator for that. They're like, "I'm eating so many things that I have never tried or haven't thought were possible for me, and I'm having no reaction. And it's amazing." Yeah, I just think that should always be the driving force is just remember that diversity is the most important thing for your overall gut health. Maybe you're not there right now but it should always be the aspiration, even during periods of therapeutic diets that are more restrictive. There's still ways to have diversity on the plate, even on those diets.

Andrea Wien: Definitely. And I think in your book, it's nice, at the bottom of each of the recipes, you have a little key of if you're following certain diets omit this or add this or even an onward section when you start to be able to tolerate more foods, try this. And again, keeping in mind the whole that food didn't get you here. So having one flare up or one issue with something that you eat is not going to totally rock at you back to square one. I think that's also important to think about.

You have a whole section two in the back, gut healing bootcamp menu, low FODMAP healing menu. And so it's nice to just see them laid out week by week. So if someone is totally starting from scratch and doesn't know where to begin that they can follow these recipe guidelines and this schedule and it's just an easy thoughtful but also easy for them thoughtless way to incorporate some of this stuff.

Phoebe Lapine: Totally. So glad you like this.

Andrea Wien: I really do. It's not only because you're on my show, I really like the book. And I really like your food. So, it's a completely genuine experience of the book that I'm giving as a total.

Phoebe Lapine: Yay. Well, you'll have to tell me offline what your favorite recipes are.

Andrea Wien: I'll tell you online. Here, let's just look at them right here. Because I want everyone else to know too, let's see. So I love the congee.

Phoebe Lapine: Oh, yes.

Andrea Wien: The chicken that cooks in that congee is just perfect. We've done the green detox soup, which has been really yummy. Let me see, what's another one that we've... Oh, the mild and creamy butterless butter chicken is really delish.

Phoebe Lapine: My favorite.

Andrea Wien: [inaudible 00:44:47] sweet potato chili. I mean really, we've made a bunch of different things. And every single one my husband is like, "You can make this again. This is good. You can make this one again." And an even bigger I think pat on your back is that my toddler will eat it.

Phoebe Lapine: Oh, I love hearing that. That always makes me really happy.

Andrea Wien: Yeah. Oh, and the seared scallops with the succotash was a very nice surprise.

Phoebe Lapine: [inaudible 00:45:09]. I don't know anyone else who's made that.

Andrea Wien: Yeah, we've made it twice now in the couple of weeks that we've had the book and we've really enjoyed it. So, those are some of our faves.

Phoebe Lapine: Usually, the recipes that don't have pictures are the ones that don't get made as much. So you've listed a lot of ones that don't have pictures so I'm very proud of you because it's great.

Andrea Wien: Oh, thank you.

Phoebe Lapine: They're not recipes that are any less delicious, just [inaudible 00:45:33]. It's a bowl of mush.

Andrea Wien: Yeah, but it's so good. I think you used chicken breasts maybe in your recipe and I think we threw some chicken thighs in there and it was just delicious.

Phoebe Lapine: Yeah, definitely not breast. I hate white meat. It's probably my drumsticks.

Andrea Wien: Yeah. Oh, you're right. It is the drumsticks. Yes.

Phoebe Lapine: [crosstalk 00:45:55] But yeah, chicken thighs are amazing, they're my fav.

Andrea Wien: So good. So, I guess just to wrap it up one last question, have you been surprised by anything? When you think about this journey over the last year or two, what is something that really sticks out that after you heard it, you just couldn't stop telling all your friends and family?

Phoebe Lapine: Actually, about meal spacing. I think it's the simplest thing but in understanding how the migrating motor complex works in 90-minute fasting interval, it's like it only kicks in after 90 minutes of fasting. There's all these arguments about some people are metabolized differently, some people need lots of small meals, some people need three balanced meals. I'm going to call bullshit on the people who are talking about you should be snacking all the time. It is just not the way your body is designed to process food. And it was certainly not the way like we had food resources back in the bush which our bodies are still intimately linked to on a biological level.

So just knowing that and fasting is a very trendy thing right now and I think meal spacing is the sensible cousin of fasting. It's literally just like have three large balanced meals. If you're getting hungry in between, add more fiber and healthy fat, eat more at your meals, eat as much as you want in your meals, just keep them four or five hours apart and see how you do. And if that's really hard for you maybe that means taking a better look at your blood sugar and what's going on and again what you're actually eating in those meals. But I know it's been a real game-changer for a lot of people who follow me and who have read the book and who have been through some of my programs and I know it's been a huge game-changer for me.

Andrea Wien: That's awesome. Phoebe, thank you so much as always for coming on and sharing all your knowledge with us. We will certainly link to the book in the show notes at biohmhealth.com/pages/podcast. And again BIOHM is B-I-O-H-M and you'll find links to everything else that we mentioned here and maybe Phoebe will even let us share one of her lovely recipes from the book, one of the nonpicture ones.

Phoebe Lapine: Yeah. Totally. You can have a picture one too.

Andrea Wien: And we can put that up there. So, thank you so much as always. If people want to find you online, can they find you on Instagram? Where are you at?

Phoebe Lapine: Yeah, so I'm @phoebelapine, just my name on Instagram, and my website is feedmephoebe.com and you can find lots of free recipes there and resources on SIBO. And also links to my podcast also called SIBO Made Simple and then sibomadesimple.com is where you can find links to buy the book at any of your favorite retailers. And you can also download my free gut heal bootcamp just like a fun free five-day email sequence and the gut heal bootcamp menu that you mentioned in PDF form.

Andrea Wien: Perfect. We will link to all of those links as well on the BIOHM website. So, Phoebe, thank you so much for joining us. We'll talk to you soon.

Phoebe Lapine: Thank you.

Andrea Wien: Thanks so much for listening. As always, I am Andrea Wien. Show notes are at biohmhealth.com/pages/podcast. Again, BIOHM is B-I-O-H-M. You'll also find BIOHM's new products there, it's called Super Reds and it's really yummy, tastes almost like a fruit punch but is packed with goodness of probiotics, prebiotics, and the antioxidants of different red fruits. So, definitely go check it out, save 15% with the code POD15 and we will catch you next time.

 

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