Dr Nirala Jacobi:

Welcome to another episode of the SIBO doctor podcast. And I'm here with Dr. Allison Siebecker, who of course, needs no introduction to anyone who knows anything about SIBO. Dr. Siebecker has been educating us for about a decade now, all things SIBO, and she actually has formulated or put together a new sort of summit that she'll talk to us about in a moment, but I thought I'd welcome her back on the podcast. And also start off this podcast episode with just some of the SIBO updates 2020. 2020 has been a big year for in many respects. So welcome back to the podcast Allison.

Dr Allison Siebecker:

Thank you so much for having me, dear Dr. Jacobi. Happy to be here.

Dr Nirala Jacobi:

Good. And we're actually recording this on Zoom and I love your pumpkin T-shirt. I need myself a jack-o-lantern.

Dr Allison Siebecker:

So here we go. I've got a jack-o-lantern. Bring a little festiveness to our meeting.

Dr Nirala Jacobi:

Very, very nice. You know, this year is almost over and I had sort of traditionally, I usually do a SIBO update of every year. I skipped it last year. I probably won't do much this year. It's just been too much of a crazy year, but I thought I'd just check in with you. Like, what have you come across or what do you think is noteworthy in the field of SIBO for 2020?

Dr Allison Siebecker:

Oh, great. Well, I think probably the most noteworthy thing would be that the hydrogen sulfide test has been released commercially, only in the US, unfortunately, at this point. We know it will go to other countries eventually. So that's very exciting. It's called trio-smart right now. One lab is offering it. It's Gemelli Lab and Dr. Pimentel had invented this and also validated it with research. So we've been seeing, you know, you and I have, we've been talking about it and seeing the research he's been putting out the last few years as he's been working with this technology. And so the big news is that now it's available commercially, so practitioners can run it for their patients. And I'm really excited about it because I remember we were chatting with him at one of the SIBO symposiums at lunch, and we were asking him all about it.

Dr Allison Siebecker:

And he was telling us that before we would only know if somebody had hydrogen sulfide through testing if they had a flatline pattern, and he was telling us that something like 60 or 70%, or something like that, of people who actually have hydrogen sulfide don't have a flat line. And I know you and I were just like, oh my gosh. Well then, that means we've been missing the majority of people who have hydrogen sulfide. And also what his other study had shown is about 25% of cases of SIBO cases have hydrogen sulfide. So it's not the majority, but where I think this really plays in is going to be with the challenging situations, the ones that haven't made sense or people who have been missed, maybe they were told they didn't have SIBO or, or they had hydrogen or methane there, but they also had hydrogen sulfide. We didn't know it. We weren't sure what the best way to treat it was and we're having trouble. So I'm really, really happy that this is finally here.

Dr Nirala Jacobi:

Yeah. I'm really curious to see some of the test results. You know, some of the test results that start to come in with some of my patients that I'll start to run them through. Of course, my American patients. And it's called a trio test and it measures all three gases. So that'll be very interesting. And, you know, he also came out, or he was a co author, of this study about the small intestinal microbiome earlier this year that showed or confirmed really what he had said all along about proteobacteria being the main cause of SIBO. And, you know, it's going to be very interesting to see how this fits in also with hydrogen sulfide, because some of the newer ... There's just a lot of research coming out about just the milieu. You know, the environment of the intestines that allow hydrogen sulfide to overgrow, and it's very much also linked with proteobacteria.

Dr Nirala Jacobi:

So it'll be just really interesting to see how this whole thing plays out. And yeah, and also thinking about that, it's a more of a dysbiotic state, rather than just an overgrowth, that it's not just killing the bacteria, but really creating more of a sense of balance. That's what I, you know, in my naturopathic brain, that is what I start to think about when I saw that study. But I have an appointment with him to record him, he's rescheduled it a couple of times, to discuss that study about the microbiome. So.

Dr Allison Siebecker:

That was ... You and I were waiting for that for so long because they gave a lecture, his team gave a lecture, well, it was a year and a half ago, at least. And now when we're recording this, and I was able to view that, but there was no paper release and, you know, there was no like, abstract associated with it. It was just, you had to have listened to it, you know? And we were just waiting, and when it finally came out, you found it when it finally came out in July, we were like, Oh my God. So yeah, so just anyone who's interested, his team is working on a multi-year massive project called Re-imagine, the Re-imagine Project. And it's all about discovering the microbiome of the small intestine, because the work that had been done on the microbiome previously had only been done on the large intestine.

Dr Allison Siebecker:

And, you know, it was his postulation, his theory that, that wasn't sufficient, that can't represent what's in the small intestine. Why would we think it would? And so first, he validated a new technique for collecting the bacteria and the organisms in the small intestine to make sure that the study was going to be done well. And then he set about showing the differences, validating that it was true, that there really is a difference between what's in the small and large intestine, and then just has continued and continued with tons of information and studies. Every single one is just like, blowing my mind. And as you say, some of the stuff that he found is, he was able to find the bacteria that are overgrown in hydrogen SIBO. He already knew, we already knew what was the most overgrown in methane type SIBO, which another big thing this year is that it got a new name, intestinal methanogen overgrowth, or IMO for short.

Dr Allison Siebecker:

And with that, you know, it's sort of considered to now not be under the heading of SIBO, but for all intents and purposes, our treatments are the same and everything. It's just getting classified for nomenclature reasons differently. So, you know, I still say methane SIBO, you know, and then I'll go, now called IMO. But some people write to me and they go, well, I have IMO, and it takes me a minute. I'm like, wait, what's that? Because it's so new. What is that? But anyway, yeah. And then next , he said, he already now knows the major culprit in hydrogen sulfide SIBO, and it's already been submitted for publication. So of course, he can't tell us yet. And he keeps saying that there's like, a surprise with that. So see you can pull out of them when you [crosstalk 00:08:59].

Dr Nirala Jacobi:

I'll do my best.

Dr Allison Siebecker:

But so now, you know, coming about spring 2021, we will have a complete picture. I just think a lot of what's been mysterious and troubling to us as practitioners, we haven't had all the information, and he's been setting about trying to find that for us. And once he gets that, we'll be able to target better. And as you say, he's really been able to establish well proven that it really is a situation of opportunistic overgrowth of weeds overtaking in the garden. And, you know, you always have such a strong emphasis on, you know, making the garden be healthy, as you always do. So his work is absolutely showing us that. And I just think it's going to help us the more he goes with this project. So amazing. One last thing that was so cool about that study is he was actually able to correlate some of the symptoms with those bacteria, like bloating and urgency. I mean, I was like, to see you could correlate a particular bacteria overgrowth with bloating? Wow. I was like, oh my God.

Dr Nirala Jacobi:

Yeah. I'm going to have to get more information about that, how they actually determined that, you know?

Dr Allison Siebecker:

He'll talk to you about it. He's very excited about that because they actually measured the metabolic pathways and then they measured symptoms. So yeah. Find out everything you can, Nirala, when you talk to him.

Dr Nirala Jacobi:

Okay. I'm going over that study with a fine tooth comb and do my best. Because, you know, it's always, there's the bacteria, but then there's also, you know, during this last decade, we've really focused on the bacteria. And just in the last few years, I've also started to look a lot more at the milieu or the environment of the entire microbiome, because you know, there's a lot we don't know and a lot that's going to, I think be ... I think a lot of success of treatment will not just be killing the bacteria. I mean, in many cases it is, but in others, as we know, they get treatment-

Dr Allison Siebecker:

That's like, an assist. It's like an assist. It's like, yeah, if you've got ants running over your house, yeah, let's calm that down a little bit, but you can't just not look at other things, you know?

Dr Nirala Jacobi:

Yeah. Good analogy.

Dr Allison Siebecker:

And one other thing ... Well, that's because I've ants running over my house. We've had a really bad ant problem this year. But one other thing to keep in mind for everyone listening if they go look at that study, is that it's just the first. When they presented their findings in that oral presentation, if I watch that oral presentation and then I look at the paper, I'm like, but they didn't really talk about this and this and this and this, that was in that presentation. And this is the first publication of many to come. They have so much information. So, you know, they often do that. They'll do a study and they'll do like, four or five papers come out of it.

Dr Nirala Jacobi:

Very interesting. Okay. So that study, I'll put that in the show notes, but just rest assured as listeners, that I will be kind of talking to Dr. Pimentel, who's one of the lead investigators I think, in this study. So that's coming up. Now, I want to talk about your summit that you've put together. Very, very interesting topics. And why don't you tell us a bit more about it? Because it is happening very soon. I think we're going to be releasing this podcast as soon as we can so that people can sign up. It's a free online summit and it's really sounds very exciting. So please tell us more about that

Dr Allison Siebecker:

I'm so thrilled about it. I've been working on it in my mind for several years and it's ... You know, think of it like a SIBO conference. We've generally had SIBO conferences every year, sometimes two a year. This year, we didn't, right? So we do. We have one this year and it's like a combination between a conference and summit because we're going to have a summit format means you can watch it for free, which, you know, I very much like, because I want to get this information to people. I'm a SIBO patient myself. You know, I suffered for years. I want to be sure people can have access to this really incredible information, but it is like a conference because it's not just interviews, it's actual like, PowerPoint lectures like you would see at a conference.

Dr Allison Siebecker:

So they called it Masterclass because of the PowerPoints and Summit. So, you know, that's why it has that name,

Dr Nirala Jacobi:

Master summit.

Dr Allison Siebecker:

Yeah. Masterclass Summit. Right. And the name of it is called Next Steps for Treating Tough SIBO. And what this is all about is, three or four years ago, you know, quite some time ago, I know that this was occurring to you at the same time, as it was to me, to many of us who specialize in treating SIBO, I was seeing more and more difficult cases in people who have very complex situations where my standard approaches were not enough. I knew they weren't enough and I needed more options and I needed better understanding of what was going on. And so I began attending all kinds of different conferences, talking to colleagues, doing research, et cetera.

Dr Allison Siebecker:

And over the course of a couple of years, was able to discover various treatment tools, basically, that a lot of us don't know about that are incredibly effective, that some of our colleagues were using for SIBO successfully, you know, privately in their offices. You know, they're not on a lecture circuit telling people. And so I'm like, we got to get this information to people, and others are treatments that maybe weren't being used for SIBO, but I could clearly see the application, and maybe the practitioners in their field, they didn't really know about SIBO very much. And so it's things like this, and I'm just thrilled with it. I've watched through all the classes, and honestly, I can say it's mind blowing and I'm actually going to watch them all again. So let me tell you some of the topics that are just amazing. One of the ones that was my favorite, which I know you're already a huge fan of, is hypnotherapy and guts centered hypnotherapy.

Dr Allison Siebecker:

And so Dr. Peter Warwick, he's a researcher, a clinician, gastroenterologist that I've been reading his research for years because he's one of a few doctors that do bloating research. And I harp on bloating because it's one of our most difficult symptoms. It's not as easy to affect that symptom, and it can be very bothersome to people. So anyway, I was familiar with his work, and so I had read a paper he had done that I thought was so fascinating on bloating. And I wrote to him and I said, "Would you please talk about this on a podcast?" I referred him to Dr. Ruscio's podcast. I remember when I told you that, you're like, "Why didn't you send him to my podcast?" Then I felt bad. I just had happened to read his article and talk to Michael, and then I'm like, you have to interview this.

Dr Allison Siebecker:

So he goes on Dr. Ruscio's podcast. This was, you know, I don't know, year and a half ago or something, or two years ago. And then lo and behold, he talks all about hypnotherapy. Turns out he's done all this incredible research on hypnotherapy. His last study had over a thousand patients and they've studied out five, six years out using this, people stay well, something like up to 80% stay well for five years. It is mind blowing. You know, he can affect, not he, I mean, the treatment affects all the symptoms, you know, they have. Just, it's evidence proven. So, I mean, I'll stop there before I go on to other topics, because I know you have something to say probably about hypnotherapy.

Dr Nirala Jacobi:

Yeah. Because I was also reading these studies and there were a couple done here at Monash University about IBS and not specific for bloating, but IBS symptoms and-

Dr Allison Siebecker:

And like, IBD, I think they did too. Didn't they?

Dr Nirala Jacobi:

I can't remember now, but basically, it was just on gut-centered hypnotherapy. And they actually have clinics here that offer this type of hypnotherapy. And in a response to that, you know, our holistic counselor, Serita Ford, studied up on this and is offering gut-centered hypnotherapy and is getting some pretty amazing symptom relief, right? So we were talking about the sensations and symptoms of SIBO being greatly reduced without using ... I mean, we do a lot of other things here at the Biome Clinic, but you know, I think she does other things besides the gut-centered hypnotherapy. There's a lot of other sort of holistic counseling that goes on with it. And people just are in love with her because she's so good at it. And I haven't done any kind of formal assessment of all of these charts of people that are seeing her, but because it's a relative, like, I think it's been about, well, this whole year just flew by, didn't it? [crosstalk 00:17:58] Six to eight months or 12 months that we've offered this now and she's just been booked out.

Dr Allison Siebecker:

That's fantastic.

Dr Nirala Jacobi:

So Mm-hmm (affirmative). It's been really good.

Dr Allison Siebecker:

Yes. And so what's amazing is these topics in this Masterclass Summit, many of them, about half of them, are treatments where you don't need to swallow anything, you know, and what could be better for our sensitive patients? And by sensitive, of course, if you are, you know what I mean. But I mean that people who react to food, supplements, prescriptions, you know, just about anything. Sometimes even things as lovely and benign as essential oils, you know? So these are very good options for sensitive patients. So some other topics are things like neural therapy, which is just superficial, and sometimes deeper, injections of Procaine. It's a treatment that is used for all kinds of things, but where it's really effective in SIBO is for adhesions. And speaking of adhesions, yeah. It's just amazing. And it can reset the nerve, the nerve tone, the parasympathetic. It can reset the nervous system.

Dr Allison Siebecker:

It's an astonishing treatment. We actually have four people speaking about it. Two main lectures. Really amazing. And another one is frequency specific microcurrent. I remember I was telling you about that a year ago. You know, just so anybody knows, as I've been learning about these, I've been sharing them. It's not like I've been holding them to my chest, but now they're all put together in one whole conference. It is really mind blowing. Frequency specific microcurrent is amazing. Dr. McMakin actually taught it at the naturopathic college that I attended some years ago and stopped. But again, it can be used for adhesions. She has proven published studies on that. Also, incredible treatment for resetting the nervous system and the vagus. And she's particularly interested in it for helping actually heal the migrating motor complex.

Dr Allison Siebecker:

Now, she uses this treatment in combination with standard SIBO treatment. She says it does not replace her herbal antibiotics or antibiotics or elemental diet. So she uses it in tandem with, but we haven't had things to treat these types of underlying causes very well. What we have had all along, for those of us, you know, who have been doing this well and attending all the symposiums, is the Wurn Technique, which is by Larry and Belinda Wurn, to get rid of adhesions. And they actually have just changed the name of it to call it the Clear Passage Approach. So it's the name of sort of their institution instead of just having their own name in there. And so we had to have him speak again, of course, because not everybody knows about it. You know, for those of us who are familiar with SIBO, we know about it, but what if you've just learned about SIBO in the last year? You might not have heard.

Dr Allison Siebecker:

So he gives an incredible lecture. And then there's a whole bunch of other things, but there's things that are ingested that are newer and different, like low dose immunotherapy, which is kind of like an allergy desensitization type of protocol. If you think about allergy shots, it's like that, but done orally and different, but it gives you the concept. Actually for SIBO. This is a postulation again. What if the underlying cause has something to do with a person being allergic to their own, you know, bacteria or their own yeast? In fact, what you'll hear if you listen to the lectures, what seems to work the best in these difficult SIBO patients that get low dose immunotherapy is yeast in very, very low doses.

Dr Nirala Jacobi:

That does not surprise me.

Dr Allison Siebecker:

Exactly. It seems to be potentially a causative factor, potentially, in many actual SIBO cases. So I mean, these things, I'm going to have to be sitting with these lectures and thinking deep for quite some time. Then we've got things like the fabulous Annie Hopper with Dynamic Neural Retraining System, D-N-R-S. I know you're very familiar with this as well. I've just heard from so many colleagues who've used it in their SIBO patients. Remarkable success with decreasing food sensitivities in particular. Other things too. Some people, Annie shares cases of people who really get all the way better with their SIBO from just using DNRS. This is something you do at home. And I can't describe the whole thing of it, but it's, again, nothing ingested. She has various exercises you do, mental, emotional, and other, that retrain the brain. And the concept here is that we could have, if our brain is dysfunctioning in that it's identifying that we're in a stressful circumstance or identifying foods as, you know, foreign invaders when they shouldn't be, like a carrot is really not going to harm you.

Dr Allison Siebecker:

So if it's things like that, we really need to get our brain to stop doing that. And there are about seven different classes in this conference with treatments of how to do that. Hypnotherapy is another one. There's the Gupta protocol, which he's speaking. And there's Emotional Freedom Technique as well is in this. So there's just the most interesting things. Then there's things like peptides. People are very interested in how peptides can affect SIBO. Immunoglobulins, and more. We have you speaking with something I've never heard about before, which is how you have analyzed and categorized prebiotics into these different categories. And you've identified which category is going to be the best suited for SIBO. Because that's so tricky finding prebiotics that can be tolerated in SIBO. So maybe if you're a frequent listener of Dr. Jacobi's, you already know, but I'm not sure everybody does. I think they're going to have to come and listen to what you have to say on which category might be suitable of prebiotics for SIBO.

Dr Nirala Jacobi:

Yeah. It was a really fun interview with it. But getting back to these other topics, because you know, one of the things I really love about this conference besides the fact that it's free to listen to, so listeners, you know, look in the show notes, you'll have a link to the sign up page for this really exciting conference, is the fact that it's not focusing on just the bacteria. It's not about killing the bacteria. It's about maximizing or improving other peripheral systems, whether that's your nervous system or the immune system or your mind, how you approach things. And so that is what really resonates with me.

Dr Allison Siebecker:

Me too.

Dr Nirala Jacobi:

Because I feel like that's where I get a lot of improvements in my patients when they've kind of hit a dead end with killing, killing, killing, killing, and they're not improving. We need to rethink what we do for these patients rather than, well, I don't know what else to do because I've given you everything I know. There are so many other treatments that potentially can really improve these patients. So that's what's really exciting for me because you and I see the toughest of the tough, don't we? And we need everything in our tool belt that we can.

Dr Allison Siebecker:

Well, you have just described my exact journey and the entire point of the conference. So thank you. There is not a single antibacterial talked about. No antibacterials in this conference. The antibacterial approach is well established. And for anyone who isn't familiar with it, there are some of my old or previous recorded Masterclasses on the basic established treatments of SIBO that one can watch to get up to speed, but that is not the point of this conference. It is nothing antibacterial, great for sensitive patients, great for complex and tough cases. Next steps, just like you said, and that is exactly what happened to me. It's like, we need other tools and, oh my God, this is such an interesting conglomeration of tools.

Dr Nirala Jacobi:

I can't wait for it. It's really good. And this kind of brings me back to another kind of SIBO update that we forgot to mention, which is the methane study, right? What is it? The CIN 010. The delayed release levo ... What is it? Not levothyroxine.

Dr Allison Siebecker:

It's like lovastatin.

Dr Nirala Jacobi:

Lovastatin. Yeah.

Dr Allison Siebecker:

Yeah.

Dr Nirala Jacobi:

So that's also underway, which is a treatment for IMO, and-

Dr Allison Siebecker:

Well, there's news there. You'll be able to talk with Dr. Pimentel about it, but his results were not, now they have come back in and not what they were hoping for.

Dr Nirala Jacobi:

Oh okay.

Dr Allison Siebecker:

And so back to the drawing board with that one. You know, they know that that drug helped stop methane production and they thought if they did it in this way .. When they did it, like in test tubes and things like that, it worked great. So they tried to make it work better in people and back to the drawing board. So he'll talk to you about it.

Dr Nirala Jacobi:

All right. Okay. So yeah. All right. Well, I am totally stoked. And I think that there are all sorts of new discoveries that offer hope for people that are really at their, you know, they're at their wits end as to how to manage this. And I think also with this anxiety that we've experienced, not just because of the pandemic, but also this real unrest that we're experiencing in the world in general, and particularly the US, I think there has just been an increase in people's anxiety in general, which always translates into a worsening of digestive symptoms. So the people that I'm seeing right now have had a real tough time with managing their anxiety and their gut symptoms. So I think this will come as a real welcome, you know, another offer of therapies. Will you also be giving, or will these speakers give, us like, a place where we can find some of these therapies?

Dr Allison Siebecker:

Yes. We've asked them all to say, like, how could we find them? And, you know, are there directories? And they didn't all share that, but we did ask, but they've done their best. And for those who didn't, who didn't necessarily share it, I've written to them and said, people are going to ask, what can you tell me? So I'll try and include it down in the notes underneath, but we did ask for practical information. And, you know, you bring up a really good point, just sort of in closing is that, like I was mentioning, most of these therapies, they're not SIBO therapies, right? They were not developed for SIBO. They're maybe standalone treatments that can be applied to a myriad of diseases. And really what they're all about is complex and chronic, maybe mysterious illness, which so many people have. And we see so often in SIBO because it comes along for the ride. It just comes along for the ride with complex other illness. And so just keep that in mind that these therapies can be used really for any dis ease in the body.

Dr Nirala Jacobi:

That's a really good point because sometimes, actually very often, I find that SIBO is just comorbid. You know, it's maybe not the [crosstalk 00:29:24].

Dr Allison Siebecker:

It's like the tertiary.

Dr Nirala Jacobi:

Yeah. Yeah. It's just, okay, we found it, but treating it made no difference, so we have to look elsewhere also. So there is this situation, is it really just chronic SIBO and we haven't figured out why this is the case, or is this a case of mold, for example, where you have relapsing SIBO, but improving that or getting rid of it doesn't improve the patient's symptoms? So it's always good to get a really sort of a broader view of what's going on, and I think the nervous system really is so key in so many of these chronic illnesses and I mean, other systems too, but in terms of motility, in terms of gut-brain axis, in terms of-

Dr Allison Siebecker:

The immune system. It affects the immune system. I mean, of course we are talking about our brain, it affects everything. And you and I, we keep talking about mold. I'm not sure if maybe there was a couple of speakers that didn't mention mold. I mean, everybody is finding how common it is in their patients. And I do just want to mention that, Margaret Christensen, Dr. Christensen, who had done a wonderful mold summit, she actually recorded a whole class just as sort of a bonus on the side about it and about mold and how to treat it. So.

Dr Nirala Jacobi:

Okay, great. And you know, just in closing, when are the dates for this?

Dr Allison Siebecker:

Oh, of course. It is November. November 17th and 18th is when this Masterclass Summit is happening.

Dr Nirala Jacobi:

That's the free times, and you will probably be able to offer it for those listeners who are tuning in after this date at some point. And we can put that on in the show notes for those.

Dr Allison Siebecker:

Yeah. I mean, it's free on those two days, and then of course, if you want the recordings, then you purchase it. But you know, it's wonderful that, you know, you can at least listen for those two days free. I mean, of course I recommend purchasing it because then you can listen again and again.

Dr Nirala Jacobi:

Like you will do.

Dr Allison Siebecker:

Which I'm going to be doing. I'm going to be doing.

Dr Nirala Jacobi:

That's so great. I'm so happy you put this together because you've been talking, you've been gathering all these little, you know, gems of people, first starting with anecdotal telling you that they were getting great results with this and that. And so you have been collecting them, and now you're putting this little collection on offer and that's so wonderful.

Dr Allison Siebecker:

Yes, exactly.

Dr Nirala Jacobi:

Thank you so much for your time, Allison.

Dr Allison Siebecker:

Thank you.

Dr Nirala Jacobi:

Is there anything else in closing you'd like to say about the summit or SIBO or anything else?

Dr Allison Siebecker:

I guess the main thing would be for either practitioners who are struggling with difficult patients, or if you're a SIBO patient and you're struggling with your own SIBO, that there is more hope. There's a lot of hope, actually. And like, just keep that in mind and don't give up and don't despair. Really, there's more that can help us. And, you know, I would recommend listening to this for free at least to see some of those options.

Dr Nirala Jacobi:

Thank you so much and all the best with the summit. And I know I'll be promoting it through the different channels and hopefully you get a really great turnout and we will talk again very soon, I'm sure.

Dr Allison Siebecker:

Thank you so much for having me.