Episode 80: Should You Follow A Restrictive Diet When Treating SIBO?

Thanks for joining us for episode 80 of The Ancestral RD podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show.

Today we are answering the following question from a listener:

“I had recently been diagnosed with small intestinal bacterial overgrowth, also known as SIBO, and I’m diving into the murky research. Your podcast on why diet alone cannot treat SIBO made a lot of sense. But I’m wondering:

A. Why no discussion about the SCD diet, only FODMAPS?
B. Are you telling patients to follow a mostly low FODMAPS diet while taking the antibiotics or antimicrobials, or a total liberalized diet?
C. What protocol do you use after finishing a course of antibiotics or antimicrobials?

My naturopath recommends at least three months of strict SCD after finishing Xifaxin. Do you know of any research that supports this recommendation? Thank you.”

Many restrictive diets claim to be effective in the treatment of digestive conditions. But did you know that a diet protocol is not enough to treat SIBO?

If you are trying to address SIBO or think you may have SIBO, you’ll want to join us today! Tune in to hear whether restrictive diets have a role to play when treating SIBO as we discuss how treatment requires a very individualized approach.

Here’s what Laura and Kelsey will be discussing in this episode:

  • How diet is not enough to treat digestive conditions
  • Why doing a restrictive diet during SIBO treatment is not recommended
  • How treatment and post-treatment of SIBO with an individualized approach is more effective than a one size fits all protocol
  • The possible negative health effects of a restrictive diet after SIBO treatment
  • The importance of working with an experienced health practitioner to treat SIBO

Links Discussed:

TRANSCRIPT:

Laura: Hi everyone. Welcome to episode 80 of The Ancestral RDs podcast. I’m Laura Schoenfeld and with me as always is Kelsey Kinney.

Kelsey: Hey guys.

Laura: So Kelsey, how’s everything been going since our last call?

Kelsey: Pretty good. I’m trying to think. We were talking before we got on this call how we’ve both just been being consistent with our workout and diet regimens, and I guess regimen is a bad word because we were just talking about how easy it feels.

Laura: Habits?

Kelsey: Yes, our habits. Exactly, perfect. You were talking about your dress experience for picking out a dress for your wedding and how that was a much better experience than you were thinking. I’ve just been thinking about for me how for the last, I guess I’ve been regularly weightlifting for I think It’s been four months at my current place and then I was doing it on my own-ish for like a couple months before that.

Laura: Wow, it doesn’t seem like it’s been that long.

Kelsey: I know, right. I think the same thing. I think Its’ been about six months that I’ve been actually really consistent with it, which to me feels like a really big deal just because as many of our listeners know I had been dealing with kind of a bit of a health issue earlier this year. Working out was kind of inconsistent depending how I was feeling or what was going on. It feels really awesome to be putting in this effort on a regular basis without it feeling like a really difficult thing that I need to force myself to do. It’s been a really great experience in that regard because I’m actually really enjoying it and it doesn’t feel like something every day I’m dreading. I shouldn’t say every day, I’m not going every day. But it’s not something that I’m regularly dreading that I have to do and my body doesn’t feel like it’s worn out by the amount that I’m doing.

It’s just been a really awesome last six months and it feels like a big accomplishment for me. I’m always talking to my clients about great habits that they can put into their lives and it’s one of the hardest things think for people to do just to kind of start something, but then consistently continue doing it. It’s a really easy for a lot of people to start a great habit, but then when things get hard, it just falls to the wayside and they don’t keep it up. For me it’s been awesome to be able to continue this through getting married and going on trips and stuff. I’m not doing the exercise necessarily during that time, but I’m able to come back to it and feel refreshed and ready to do it again, and I keep doing it. I’m really proud of that and I hope I continue it for a lot longer.

Laura: Yeah. I still can’t believe it’s been that long. It seems like you just, I know this wasn’t the last time, but I feel like we were just talking about how you had joined a gym.

Kelsey: I know, right. I guess that was like four months ago that I joined this new gym. But even four months sounds like a long time.

Laura: Right. I’ve been training with my strength and conditioning coach for a year and a half at this point, which that sounds like a long time.

Kelsey: Yeah.

Laura: Especially because when I started I was just like I’ll just do this for a couple months to recover from my car accident and then I’ll go off on my own. Honestly, I don’t need him. As much as I enjoy working out with him, I don’t technically need him to do the lifts that I do. It was funny because today I was just training with him this afternoon and we were doing some heavier Romanian deadlifts and I was like I think I’ll use a strap just because my grip is usually what wears out first on those. We were doing 12 in a row and it gets a little tiring to hold on to the bar after the 12 reps. I was having trouble getting the straps on and he kind of just came over and tightened them for me. I’m like, see this is why I pay you the big bucks because I can’t do this for myself. It’s literally him putting the weights on for me and then making little adjustments like that.

Kelsey: Mm hmm.

Laura: But it’s just been really interesting because  I’ve been kind of inconsistent with my…and when I say inconsistent I’m just not, how do I say this? I’m missing weeks because of traveling. Now I try to work out when I’m traveling, but a lot of times when I’m visiting my fiancé in Ohio, I don’t end up working out because the closest gym is like a half hour away.

Kelsey: Mm hmm.

Laura: I’m just like I don’t feel like driving over there. I haven’t actually ever gone to the gym when I’ve been at his place. My workouts schedule has been pretty, I wouldn’t say inconsistent because I’ve been consistent when I’ve been home, but it hasn’t been as consistent as I would have liked.

The other weird thing for me having come from a collegiate sport background, I used to play volleyball in college for a couple years, I guess a year and a half when I was in college. I was used to 5-6 days a week, sometime 2 a day type of workouts and I think I kind of got it in my head in college that you have to work out 1-2 hours a day, 5-6 days a week to stay in shape. It’s been really interesting the last couple months because honestly I’ve been training maybe twice a week on average. Occasionally I’ll get in a third day if I’m feeling peppy or if I have some extra time, which lately has not been the case. I haven’t really had a lot of extra time.

It’s just crazy because I don’t know if I’ve mentioned it, I feel like I might have mentioned this, but since I started my training with my coach a year and a half ago, I’ve actually lost 20 pounds, which when I think about it, I’m like wow that’s kind of a lot.

Kelsey: Yeah.

Laura: It’s weird because I haven’t really put that much thought or effort into it. And honestly, a good 6 to 8 months of the training I was actually focusing on eating more to support the training, and then I got kind of sidetracked by getting engaged and all that stuff. But it’s been really kind of an interesting experience for me because I haven’t been paying attention to my diet that much other than just trying to make sure that I actually am eating before my training sessions which is important, and then getting a pretty balanced diet, certainly not all the time. And I’m not eating the best right now and I could probably improve it, but I’m just mainly focusing on basics at this point just to support my energy. Then with the training, like I said I’m only doing like 2 hard days a week and even the hard days are not so hard that I feel really sore afterwards or kind of run down at all.

It’s just been an interesting experience because I work with so many clients that are trying to lose weight or trying to lean out and they feel like they have to be training like 6 days a week, doing hardcore intense exercise all the time, eating 1200 calories a day, just doing everything they can to lose weight. I never got that extreme, like I don’t think I’ve ever eaten 1200 calories in a day. But I think this expectation that losing weight, and staying in shape, and being fit has to be hard, and has to be grueling, and that you have to be always restricting your diet, I just don’t think it’s accurate.

I’m not saying you don’t need to be in a calorie deficit because I do think I’ve been in a calorie deficit during the weight loss period. Not a huge one, but enough to see some weight loss. But I was really focusing on putting on muscle, and performance, and just gaining strength. And I feel like yeah, it took a year and a half so if you say I lost 20 pounds in a year and a half, it’s like okay that’s like half a pound a month or something, or a pound a month which doesn’t sound super impressive. But when you think about the fact that I work out 2-3 days a week and I don’t diet, actually I feel like it’s pretty good.

Kelsey: Yeah.

Laura: The reason this came up in our conversation before we got on the call is that I bought a wedding dress last week. And it was weird because I always had this thought that going wedding dress shopping especially with my family, or I guess my mom and my sister, and I was with my Aunt as well, I had this thought that it was going to be like this super stressful self-conscious just feeling bad about my body experience. I find that normally when I’m shopping, and often times it’s like jeans that I have this problem where I just don’t fit into things very well and it’s a little depressing. To be fair, I think with wedding dress shopping because the dresses are pretty loose unless you’re larger than a size 10 or 12 and they kind of crank you in there with the clamps and stuff so it kind of fits better. So anytime you get clothes that are tailored, they are going to fit better.

But it was just a really odd experience because I honestly went in thinking I was going to be super self-conscious or feel like we have to find a dress that flatters me or looks okay on me. I actually was surprised that I felt really good in the dresses and I felt like everything looks good and I can just choose what I want to get. It was just kind of a shock to me that that was the experience even though I had expected it to be like I’m going to have to find the thing that looks good on me.

I really feel like had I not been doing the heavy lifting and generally eating to support the lifting over the last year and a half that that not might not have been my experience. I don’t know, it’s hard to say, but it was just kind of a cool experience where I felt good in the dress I was wearing. It was an enjoyable experience, which I don’t think a lot of women have that experience when they’re shopping for a wedding dress even if they have a really ideal body shape or whatever. I think a lot of women tend to be very self-conscious. I feel like part of it is that the lifting and focusing on performance has improved my body confidence and it probably has nothing to do with my weight. But I think being able to go in and have a fun experience without having killed myself to get there was kind of a nice realization that I was like oh, I can work out two days a week, and not really care about my diet a whole lot, and still feel good about the way I look, and maintain my weight, and look good in a wedding dress.

I think ultimately the experience that I had just confirms my belief that people don’t have to be killing themselves at the gym all the time or being super restrictive with their diet to get to a healthy weight and to feel confident in the way that they look. I’m not a bikini model or something and I certainly am not as lean as I used to be when I was on the volleyball team. I’m probably, I don’t know, 15 pounds heavier than I was when I was on the volleyball team, so it’s not like I’m at my lowest weight or something that would suggest an excess level of body confidence. But I feel like it’s been a combination of finding a plan that does actually support good body composition for me without being obsessed with it, or worrying to much about it, or being like oh I still can see like this roll of fat, or I can see fat on the back of my arms. I don’t care anymore. I guess I’ve gotten to that point where I’m like eh, I look pretty good, I’m okay with it.

Kelsey: Right.

Laura: I enjoy the training. I’m kind of rambling at this point because it was very surprising to me because I’ve dealt with body confidence issues in the past and I honestly was like oh I hope this doesn’t suck.

Kelsey: Right.

Laura: I just was expecting it to be not fun and it turned into this dress up, just fun let’s try this dress on and let’s try that one. The consultant was like I know you don’t want this dress, but let’s try it on anyway because I think you’d look good in it. I’m like alright, let’s do it. It was just kind of like way different than what I had expected. Like I said, I think I can definitely attribute the extra confidence and just feeling good about how I look in the dress to the consistency of the workout, the effectiveness of the workout, and also just not caring as much, so it’s kind of like a combination.

Kelsey: Mm hmm.

Laura: I guess my point is that if people are looking to feel good about the way that they look, it’s a combination of working on the mindset piece and then also getting into a consistent routine of eating well and training, but not overdoing it and not killing yourself every day at the gym.

Kelsey: Yeah. I think what can kind of illustrate that point is that, like you said, you lost 20 pounds but over a year and a half. Most people when they’re talking about trying to kill themselves in the gym and really worrying about their diet, they’re trying to lose 20 pounds in like 3 months.

Laura: Right.

Kelsey: I think that’s the difference is that you need to realize that these kind of habits that go into getting to a particular weight and maintaining a particular weight are lifelong habits. They’re not something that you’re just going to do for 3 months, get to your weight, and then magically without continuing the habits you’re just to like maintain that weight. I think that’s a piece that a lot of people tend to overlook is that is that you’re way, way, way better off taking your time to do this so that it doesn’t have to feel like it’s torture and you then at that point created all these excellent habits that you’re really consistent with. So it’s not typically a problem to continue them to maintain the goal that you now achieved.

Laura: Right. For me training twice a week is not a burden at all. In fact I can probably do more. I just haven’t.

Kelsey: Yeah.

Laura: I think there’s this misunderstanding that weight loss, or weight maintenance, or feeling good about the way you look just requires so much sacrifice. Honestly I don’t think that’s true.

Kelsey: Mm hmm.

Laura: The more people understand that first of all getting into just a long term mindset is really important for weight loss and then also not focusing on the weight loss and really focusing on being healthy, and supporting your workouts, and exercising in a way that’s effective and not over doing it. It sound so unsexy, but it really is very effective.

Kelsey: Exactly. That the problem. It’s unsexy.

Laura: I know, it’s hard to sell that because it’s like, what? You’re saying I would lose a pound a month and it’s going to take me a year and a half? It’s like that doesn’t sound great.

Kelsey: Right.

Laura: Where these other programs are like lose 10 pounds in your first month. And it’s like I don’t really think that’s a great idea. I know it can be frustrating and I’ve had clients before that were like I only lost 2 pounds this month. I’m like that’s fine! There’s nothing wrong with that. It’s just kind of a weird experience to be at this place where I’m like if I lost a little bit of weight before my wedding, okay, I’m sure I would look a little bit better in my dress, but honestly I don’t really care. It’s just kind of a nice place to be in where you’re just like eh, whatever, it looks good enough.

Kelsey: Yeah. Honestly, at the end of the day, it’s one day too.

Laura: That’s what they say.

Kelsey: Yeah, that’s what they say. There’s this whole idea that it’s like the best day of your life, the most important day of your life. Just pick a dress that you feel comfortable with. And yeah, people are going to looking at you a lot, but if you feel good in it, you feel good in it and you don’t need to worry about what anybody else thinks.

Laura: Right.

Kelsey: That’s sort of my opinion on wedding dresses after being through it.

Laura: Yeah. Mine was a sample dress so it was 50% off. I’m like, alright it looks good on me and it’s super inexpensive.

Kelsey: Right. Sounds great, sign me up.

Laura: Yeah. I can totally see how people can take things so seriously. Yeah, I wanted to get a good dress and I didn’t want to rush into the decision, but I kind of got to the point where I was like this one is pretty good, and it looks good on me, and I’m Just going to go with it.

Kelsey: Yeah.

Laura: I do have to keep in mind that it is one day. That’s a little bit of stress over budgeting and guest lists and stuff.

Kelsey: Mm hmm.

Laura: I’m just like, okay, it’s not that big of a deal, just chill out. Alright, well I’m sure everyone’s like totally tired of hearing about wedding planning, which I apologize.

Kelsey: I know, sorry guys.

Laura: It just so happens that Kelsey and I were doing a lot of it at the same time. Now she’s done and hopefully I’ll shut up about it at some point. It’s hard when it’s like I spend 10 plus hours a week doing this stuff.

Kelsey: Oh yeah.

Laura: It feels like a second job right now.

Kelsey: Absolutely.

Laura: Alright. Well let’s jump into the question for today. But before we do, let’s hear a word from our sponsor.

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Laura: Alright. So today’s question is:

“I had recently been diagnosed with small intestinal bacterial overgrowth, also known as SIBO, and I’m diving into the murky research. Your podcast on why diet alone cannot treat SIBO made a lot of sense. But I’m wondering:

  1. Why no discussion about the SCD diet, only FODMAPS?
  2. Are you telling patients to follow a mostly low FODMAPS diet while taking the antibiotics or antimicrobials, or a total liberalized diet?
  3. What protocol do you use after finishing a course of antibiotics or antimicrobials?

My naturopath recommends at least three months of strict SCD after finishing Xifaxin. Do you know of any research that supports this recommendation? Thank you.”

Kelsey: Alrighty. I’m trying to think of how I want to go through this. Let’s go through it as a person would go through it.

Laura: As a person would as opposed to a non-person.

Kelsey: As a person would go through the process of determining that they have SIBO, treating SIBO, and then what comes after SIBO. Once you’ve determined that you do have SIBO, I tend to recommend pretty much as liberalized a diet as possible.

Now this person is asking why we didn’t talk about the SCD diet in particular as opposed to the FODMAP diet when somebody has SIBO. I think the reason we did that is because at least at the time of that recording and that article that I wrote most of the diet that people were talking about in regards to SIBO was the low FODMAP diet. But there’s definitely some recommendations about being on a SCD diet or an SCD combined with a low FODMAP diet now.

I still stand by the recommendation to eat a pretty liberalized diet or as liberalized as possible and I don’t really recommend the SCD diet or low FODMAP diet while you’re treating SIBO. And that’s because like we talked about in that other podcast, you do want to be feeding bacteria to more easily kill the bacteria with whatever protocol you’re using to get rid of your SIBO. Whether that’s herbal antimicrobials or antibiotics like Xifaxin that this person is mentioning, I really try to get people to eat as many different foods as they can including things that are typically restricted on the SCD diet or low FODMAP diet.

That can become a little bit complicated if you for example think you have SIBO, but you’re waiting for testing to come back. I have a lot of people that ask me should I be eating a low FODMAP diet now while I’m waiting to start on antimicrobials or antibiotics because I don’t have that evidence in hand that I need yet to start any of those protocols? Actually it’s kind of a tricky question because if somebody is strongly reacting to some of those foods, I will tell them that at least temporarily they can go on a slightly lower FODMAP or a more SCD type diet that helps to control their symptoms a bit. But unless somebody asks me that in particular, I typically don’t recommend that they change much about their diet at all unless they’re really, really suffering with the symptoms.

But for most people with SIBO, they are having some bloating, they may be having some bowel changes that aren’t particularly great, but they’re not really interfering with their life in the sense that they couldn’t handle those symptoms for a couple weeks. I typically don’t really change much about their diet while we’re waiting to start antimicrobials or antibiotics because I want them to be eating those foods anyway and for a lot of people once they start on some of these lower FODMAP diets or an SCD diet and they realize that they’re bloating goes down, it’s really, really tempting to just continue on that with the idea that that’s going to heal you. Even if you are doing antibiotics or antimicrobials as well, I can tell somebody all day long that eating higher FODMAP foods or eating things that are usually prohibited on an SCD diet will help them to recover. But when they’re symptoms go away because they’ve taken those foods out, it’s really hard to convenience them to add them back.

I don’t know if you do anything similar, Laura, but I typically don’t have people take out those foods while they’re kind of waiting to start their treatment protocol.

Laura: Yeah, I mean I’d say if you feel like the treatment is imminent, then I don’t normally do that either. I’d say occasionally, well I shouldn’t say occasionally, a lot of times I’ll start with a low FODMAP diet and see how that affects their symptoms and see if that gives them relief. And then if it does, then maybe going for the testing. I tend to be a little less, what’s the word? I don’t order SIBO testing for my patients.

Kelsey: Oh, okay.

Laura: So that kind of makes me a little more, not hesitant, but I feel like the low FODMAP diet you can get fast results from that for a lot of people.

Kelsey: Oh yeah.

Laura: It doesn’t always work, but if you want people to start feeling better in the short term, a lot of times the low FODMAP diet can be really helpful. And then once the antimicrobials… either you order the antimicrobials or if you get the SIBO tests and then they’re going to start the antibiotics, then I’ll get them off that diet. Because I think for me, my goal is always to minimize symptoms.

Kelsey: Mm hmm.

Laura: So if they feel better in the short term on the low FODMAPS diet, I don’t really see that being a problem especially if it’s not difficult for them adhere to that diet. Then once their doing the antibiotics or antimicrobials, like you said, liberalizing the diet as much as possible with the understanding that if somebody feels really bloated or really ill eating certain foods, then I’m not going to have them reintroduce those.

Kelsey: Right.

Laura: Which I think you’re on the same page there.

Kelsey: Yep.

Laura: I feel like maybe because I don’t do the testing for SIBO, since that’s what you do, it’s almost like well why not just go straight into that. So for me it’s sort of like, okay, let’s just try the low FODMAPs for now and see if that makes you feel better. If it does make you feel better, then that’s even more evidence for getting a SIBO test.

Kelsey: Mm hmm.

Laura: Then they end up getting a test done through a GI doctor, or a local naturopath, or something like that. And then like I said, as soon as we get them on some kind of antimicrobial protocol, we can add foods back in.

Kelsey: Yeah. That’s makes sense and it’s just a different approach to dealing with it. You’re right. I do SIBO testing in my practice and it’s probably one of my most ordered tests I would say.

Laura: Mm hmm.

Kelsey: Just because literally so many people come to me with symptoms of SIBO. And I think we’ve mentioned before that both of us literally, I don’t think I’ve ordered a SIBO test that has come back negative at this point.

Laura: Mm hmm.

Kelsey: Which is kind of incredible to me. But it just goes to show you how many people are out there dealing with this fairly easily treatable disease that really should be treated. For me it makes the most sense to just kind of deal with the root cause as soon as possible and not have people go through a lot of different diet changes that they maybe don’t need to do. But if someone wants to do it and because they are having really bad symptoms for example that they just need to get under control, it’s certainly something I do use on occasion in my practice because I don’t want anybody to be suffering with really terrible symptoms if they don’t have to. If there’s times before we’re going to start antimicrobials we might go on a low FODMAP diet just to kind of take control of those symptoms a little bit and then when they get started on the antimicrobials, I’ll just have them add into whatever point makes sense some of the low FODMAP foods or some of the SCD foods that they would have taken out on that kind of diet.

Basically it’s a matter of taking out foods that are really problematic so that somebody can maybe handle some of the discomfort of some FODMAP foods or some SCD foods that would normally cause some problems, but by taking out the main offenders they can kind of handle the medium offenders I’ll call them. That way they’re at least getting some FODMAPs or some SCD foods in their diet and they’re eating bacteria so that it’s more easily killed.

Then if somebody really is having a problem with FODMAPs and they can’t kind of eat those foods at all while they’re on the antimicrobials, I will try them on prebiotics. Prebiotics are FODMAPs but when someone is one a really low FODMAP diet, it can sometimes work for them to actually be on a prebiotic because the rest of their diet is so devoid of FODMAPs that the little bit that they’re getting from a prebiotic supplement is enough to feed the bacteria, but not cause a bunch of symptoms for them. That’s something I will do if somebody has major, major problems with FODMAPs or perhaps they’ve been on a low FODMAP diet before they came to me and they’re not willing to get back onto FODMAPs until they start to see some symptom improvement first. That’s sort of the area I would use prebiotics with though I do use prebiotics in somebody can handle some FODMAPs in their diet as well.

It’s just kind of a very personalized approach and I base it on the individual symptoms. It’s kind of hard to answer general questions like this because it does really vary from person to person. But my general take away for diet during antimicrobial treatment is that it should be as liberalized as possible without causing really intense symptoms for someone.

Laura: Mm hmm. Now they do ask why we don’t discuss the SCD diet which is the Specific Carbohydrate Diet.

Kelsey: Yes.

Laura: What’s your feeling on that?

Kelsey: For me, I just think the FODMAP diet is a little bit more important to talk about only because those are carbohydrates that are specifically feeding bacteria. I found the SCD diet, I guess to me the SCD diet seems a little bit more generalized. It’s not specifically related to what is feeding particular gut bacteria. Even though it’s got a lot of carbohydrates in there obviously that you’re restricting, so those carbohydrates will feed bacteria. But with FODMAPs, I feel like there’s been a lot more research on the low FODMAP diet and SIBO so that’s typically what people are coming to me asking about. Whereas the SCD diet, honestly I actually don’t get a whole lot of questions about it in regard to SIBO.

Laura: Mm hmm.

Kelsey: And I don’t get a lot of people coming to me that are on an SCD diet or really have much interest in starting it. So I guess it’s just more because I don’t typically deal with clients who are really interested in that. And from I’ve seen, I don’t believe that it would be all that helpful to put someone on an SCD diet. Of course it’s not something that I’m bringing up to my clients either.

Laura: I know that there’s been a lot of people who have gotten lots of great health benefits from the SCD diet, so I’m not anti SCD diet. But with SIBO, I often find that it’s just way more restrictive that it really needs to be.

Kelsey: Yeah.

Laura: Like we’ve talked about, the different diet is not what’s going to cure SIBO, so why bother going so hardcore with the diet if it’s not really going to be curing the SIBO in the first place? As far as doing 3 months of strict SCD after finishing Xifaxin, it really just depends on the person. Some people can do strict SCD and it’s fine and they don’t develop health issues or other gut issues that come from the SCD diet, but I do get a little worried about totally avoiding anything that would feed gut bacteria at all.

Kelsey: Mm hmm.

Laura: Just because with recovering from SIBO, yeah it’s helpful to not feed remaining gut bacteria if the SIBO hasn’t fully been kicked, but you also have to think about what’s happening to the bacteria in the large intestine in that situation. So I would be a little concerned that 3 months of strict SCD could potentially cause other gut issues that have nothing to do with SIBO just because you’re not feeding the beneficial flora in the large intestine.

Kelsey: Yeah.

Laura: If bacteria still exist in the small intestine after Xifaxin, honestly I’d rather see someone do some low dose antimicrobials for a couple months after doing Xifaxin just to keep things at bay in the small intestine.  And ether like we were saying keep a mildly liberalized diet or fully liberalized diet, or potentially take those supplemental prebiotics if they don’t feel uncomfortable doing a liberal diet and not try to starve the bacteria using food.

Kelsey: Yeah.

Laura: I’ve just seen a lot of issues with people that are post SCD or post GAPS diet where they develop new gut problems that weren’t there before. My feeling is that if the goal is to kill off the bacteria in the small intestine, then continuing some kind of antimicrobial treatment in either mild amounts after Xifaxin or repeating the Xifaxin if somebody’s working with a doctor, which is usually my preference. If I have to choose, I’d rather someone get a prescription from a doctor as opposed to doing the over the counter antimicrobials. I don’t know why that’s the case. I just feel like I’ve seen better results with people doing the Xifaxin and maybe then Neomycin on top of that. I’m not anti-antimicrobial herbs, it’s more I like to use those as a follow up to just continue some of the antimicrobial action after they’ve gone through the antibiotics.

But honestly I feel like because of what we’re talking about, there’s probably a handful of ways to deal with this that some are going to work better than others, some will work differently for certain people than other people, and no two patients are going to have the exact same experience. But my general experience has been that, I don’t know, it’s just funny because you and I guess have a little bit of a different approach, but I’m sure we both get good results.

Kelsey: Yeah.

Laura: So it’s probably not super important what you do. I mean it’s important, but it’s not like there’s one specific protocol that’s going to work and everything doesn’t work. But basically, my experience is that getting some kind of antibiotic treatment at least once or twice and then continuing antimicrobials for a period of time after the Xifaxin or whatever antibiotic the person is on, maybe Rifaximin or Neomycin or something like that, or a combination, it just makes me feel less worried about future gut problems than going on a super restrictive diet.

Then even beyond the gut problem, I also worry about other problems that can be caused by a super restrictive diet like strict SCD or GAPS because we’ve seen a lot of people develop things like HPA axis dysregulatlion, or disordered eating, or that kind of experience where I don’t want to send someone down that route just to reduce their SIBO symptoms. I’d rather it take them longer to kick SIBO and not develop this like I said HPAD or disordered eating, or lose too much weight, or there’s a lot of different things that can happen on a super restrictive diet and just my preference is to avoid that as much as possible.

Kelsey: Yeah. I agree and I think that the tough thing, because everybody wants this answer like what do I do after I have killed off this infection to keep it from coming back because unfortunately SIBO reoccurs fairly often in people. Honestly I wish I had a great answer, but we don’t really know. And that’s the hard part with this kind of stuff is that yeah we’ve discovered that this is a really big problem for people, especially for people with IBS. We want to have all the answers right now, but we just don’t. As a practitioner that can be a really difficult conversation to have because people are coming to you for answers. But the research, at least that I’ve seen, there’s no research that has shown us what kind of diet somebody should be on after they kill off a SIBO infection. My typically approach is to personalize it to the person.

Laura: Mm hmm.

Kelsey: Sometimes after treating for SIBO, a person will still deal with some degree of FODMAP intolerance. For example, they might still be sensitive to garlic and onions, those tend to be kind of the two that are really big.

Laura: Common.

Kelsey: Yeah, and they don’t sometimes go away even after you deal with SIBO. If a person is still sensitive to those things after they’ve treated their SIBO, I’m not going to just have them include those things just because I feel like they should, they don’t have to be on a low FODMAP diet or they shouldn’t have to be on a low FODMAP. Obviously that person is responding to that food in a negative way.

I think that taking things out that a person is having a clear reaction to makes sense, but I don’t think a general recommendation of doing an SCD diet or doing a strict low FODMAP diet makes a whole lot sense just because for a lot of people that restriction is problematic just from a mental perspective. If somebody gets way too caught up in that restriction, it can cause issues with the HPA axis, it can cause other gut issues like Laura was mentioning.

My whole goal while working with someone no matter what they come to me with is to get them to a place where they can know what bothers their body in particular and avoid those foods. But otherwise, they’re eating healthy foods. They’re not just avoiding foods for the sake of avoiding them because they’re in this particular diet, like the SCD diet.

Laura: Mm hmm.

Kelsey: Because we don’t really have a whole lot of information on what is best to do after you kick the SIBO infection, I really just personalize it to the individual. And then I will say that this does not really have any scientific backing, but I do it because it makes sense from just a logical perspective is sometimes I will have people do a five day course of antimicrobials once a month just to kind of keep bacterial loads down if they’re a person that has SIBO multiple times, they have trouble getting rid of SIBO in the first place. For someone like that, it’s really much more important for them to not develop SIBO again in the first place. That can be something that I’ve seen to be very helpful for people, but there’s no research showing that that’s what you should do or anything like that. It’s just something that from my own opinion and my own experience has worked really well for some of my clients that are very prone to SIBO infections.

That’s kind of just what happens when you don’t have all of the answers. You need to just do the best you can and use kind of common sense from a clinical perspective and just see what happens. Someone might of course develop SIBO again, but that just gives you some more clinical data to go off of. So I think it’s important to remember that we don’t have the answer to this question even as much as we wish we did.

Laura: Right.

Kelsey: And that you certainly can do a strict SCD diet for 3 months after your treatment. I guess there’s not a super big amount of harm that could necessarily come from that because it’s only 3 months. I think the problem becomes that maybe in 3 months if you’re still not feeling much different, then the naturopath might tell you let’s just continue it for another 3 months, and another 3 months, and then next thing you know you’ve been on the SCD diet for like a year and you’re starting to get other health problems. Hopefully this person has a good naturopath who wouldn’t do something like that and would get your more treatment if you weren’t feeling all that much better.

But any sort of diet that is meant as a general diet that is meant to treat a kind of digestive condition is not going to treat it. It’s just going to reduce some of the symptoms if they’re still there. My purpose at the end of the day is to get rid of the root cause of what is causing those symptoms rather than cover the symptoms up.

Laura: Yeah, I mean this is kind of where it comes to the art of being a practitioner.

Kelsey: Yeah.

Laura: And it’s not always a science. A lot of times it’s based on experience, based on what works for other clients, based on intuition. There’s a level uncertainty that can come from working with someone on a problem if there’s not a lot of evidence or standard of practice for. I’m sure this is obvious to a lot of people, but SIBO is one of those conditions that you definitely need to be working with someone on. It’s not like DIY SIBO treatment. You need to be having some kind of professional guidance on that to try to do like a DIY SIBO treatment. I guess there may be people who get good results on their own without having someone give them more clinical recommendations or professional recommendations, but it’s not something I would recommend to trying on your own 100%.

Kelsey: Right.

Laura: Which I think there’s a lot of health issues that you can see improvements without working with someone directly, but SIBO is one that can be a little trickier. I feel like a lot of the online recommendations tend to be too one size fits all and don’t really take into account people’s diversity of needs or experiences, or how that kind of diet might affect other issues in their lives. Maybe that’s a plug for working with one of us, but it’s like I just honestly feel like with a condition like SIBO, you don’t want to be screwing around on your own trying to figure things out and potentially making things worse or potentially causing other problems.

Kelsey: Yeah. I totally agree. That’s one reason why there’s a part of me that loves the fact that you can look up all this stuff online and you can learn about all this interesting stuff that maybe your doctor doesn’t talk to you about. But on the other hand, I think there’s’ a lot of people that do try to DIY this kind of treatment and to be honest it really never works out well. I am pretty much always seeing people that have been through some degree of their own treatment.

To be honest, sometimes they’re working with other people who have tried to treat them in the past and it didn’t work out well either. I guess you need to make sure that the person that you’re working with is very experienced in this kind of stuff because it is a bit of an art and some clinicians just kind of follow whatever guru online whatever they’re saying about SIBO and stick to that even when it doesn’t work for someone. I think there’s something to be said for flexibility when you are working with a client and if something isn’t’ working, you need to try something else. It’s not just like okay let’s just try harder and it will work.

Laura: Yeah. I think as we explained before, it’s not like there’s one perfect way to fix a problem. And as you already heard, Kelsey and I have somewhat different approaches to the same problem or similar problem. But just because you can kind of approach it from different directions doesn’t mean that either way is better or worse.

Kelsey: Right.

Laura: And I think honestly the most important thing is working with someone like you said who’s going to know when to change course when something’s not working.

Kelsey: Mm hmm.

Laura: I do think the desire to minimize how restrictive the diet is important, and I think that’s something that often gets missed. We always talk about that, but I think it’s just because it’s so important and people often end up going so much more restrictive than they need to be and then that causes more problems.

Kelsey: Yeah, exactly.

Laura: Anything else to add before we wrap this up?

Kelsey: I don’t think so. I mean SIBO is just an interesting topic because we don’t know as much as we wish we know at this point. But I think we are learning more everyday so it’s important to just keep reading this stuff that comes up on the internet, but also work with somebody who is experienced with this stuff if you do have SIBO because it is a complicated thing to deal with. No one responds exactly the same way as somebody else responds to treatment, or diets, or whatever. Your practitioner really does need to listen to you and you’re experience and change course when that needs to happen. That’s not to say that you shouldn’t give things a fair shot. You do need to kind of try things for significant periods of time, but a practitioner should be able to tell you okay if we’re going to try this, if it doesn’t do anything by 8 weeks in, that’s kind of my cut off where maybe we should try something else. You should be able to get at least some degree of a timeline from the practitioner you’re working with that if whatever you’re trying now doesn’t work, what might be the next step, and when might that happen.

Laura: Sure, yeah. Well hopefully this was helpful. I know it was a little bit, what’s the word? It’s always that it depends answer.

Kelsey: Yeah.

Laura: Like well, this can help, but not always, and here’s some things to think about. But we do hope that the answer was helpful and gives you some stuff to chew on before you see your practitioner.

Alright, well thanks so much for joining us again this week, guys. If you have any questions you want to submit to the show, feel free to go to TheAncestralRDs.com and click the Contact tab and you can submit a question there. And we will look forward to seeing you’re here next week.

Kelsey: Alright, take care.

Laura: You too, Kelsey.

 

 

 

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Laura: Hi everyone. Welcome to episode 80 of The Ancestral RDs podcast. I’m Laura Schoenfeld and with me as always is Kelsey Kinney.

Kelsey: Hey guys.

Laura: So Kelsey, how’s everything been going since our last call?

Kelsey: Pretty good. I’m trying to think. We were talking before we got on this call how we’ve both just been being consistent with our workout and diet regimens, and I guess regimen is a bad word because we were just talking about how easy it feels.

Laura: Habits?

Kelsey: Yes, our habits. Exactly, perfect. You were talking about your dress experience for picking out a dress for your wedding and how that was a much better experience than you were thinking. I’ve just been thinking about for me how for the last, I guess I’ve been regularly weightlifting for I think It’s been four months at my current place and then I was doing it on my own-ish for like a couple months before that.

Laura: Wow, it doesn’t seem like it’s been that long.

Kelsey: I know, right. I think the same thing. I think Its’ been about six months that I’ve been actually really consistent with it, which to me feels like a really big deal just because as many of our listeners know I had been dealing with kind of a bit of a health issue earlier this year. Working out was kind of inconsistent depending how I was feeling or what was going on. It feels really awesome to be putting in this effort on a regular basis without it feeling like a really difficult thing that I need to force myself to do. It’s been a really great experience in that regard because I’m actually really enjoying it and it doesn’t feel like something every day I’m dreading. I shouldn’t say every day, I’m not going every day. But it’s not something that I’m regularly dreading that I have to do and my body doesn’t feel like it’s worn out by the amount that I’m doing.

It’s just been a really awesome last six months and it feels like a big accomplishment for me. I’m always talking to my clients about great habits that they can put into their lives and it’s one of the hardest things think for people to do just to kind of start something, but then consistently continue doing it. It’s a really easy for a lot of people to start a great habit, but then when things get hard, it just falls to the wayside and they don’t keep it up. For me it’s been awesome to be able to continue this through getting married and going on trips and stuff. I’m not doing the exercise necessarily during that time, but I’m able to come back to it and feel refreshed and ready to do it again, and I keep doing it. I’m really proud of that and I hope I continue it for a lot longer.

Laura: Yeah. I still can’t believe it’s been that long. It seems like you just, I know this wasn’t the last time, but I feel like we were just talking about how you had joined a gym.

Kelsey: I know, right. I guess that was like four months ago that I joined this new gym. But even four months sounds like a long time.

Laura: Right. I’ve been training with my strength and conditioning coach for a year and a half at this point, which that sounds like a long time.

Kelsey: Yeah.

Laura: Especially because when I started I was just like I’ll just do this for a couple months to recover from my car accident and then I’ll go off on my own. Honestly, I don’t need him. As much as I enjoy working out with him, I don’t technically need him to do the lifts that I do. It was funny because today I was just training with him this afternoon and we were doing some heavier Romanian deadlifts and I was like I think I’ll use a strap just because my grip is usually what wears out first on those. We were doing 12 in a row and it gets a little tiring to hold on to the bar after the 12 reps. I was having trouble getting the straps on and he kind of just came over and tightened them for me. I’m like, see this is why I pay you the big bucks because I can’t do this for myself. It’s literally him putting the weights on for me and then making little adjustments like that.

Kelsey: Mm hmm.

Laura: But it’s just been really interesting because  I’ve been kind of inconsistent with my…and when I say inconsistent I’m just not, how do I say this? I’m missing weeks because of traveling. Now I try to work out when I’m traveling, but a lot of times when I’m visiting my fiancé in Ohio, I don’t end up working out because the closest gym is like a half hour away.

Kelsey: Mm hmm.

Laura: I’m just like I don’t feel like driving over there. I haven’t actually ever gone to the gym when I’ve been at his place. My workouts schedule has been pretty, I wouldn’t say inconsistent because I’ve been consistent when I’ve been home, but it hasn’t been as consistent as I would have liked.

The other weird thing for me having come from a collegiate sport background, I used to play volleyball in college for a couple years, I guess a year and a half when I was in college. I was used to 5-6 days a week, sometime 2 a day type of workouts and I think I kind of got it in my head in college that you have to work out 1-2 hours a day, 5-6 days a week to stay in shape. It’s been really interesting the last couple months because honestly I’ve been training maybe twice a week on average. Occasionally I’ll get in a third day if I’m feeling peppy or if I have some extra time, which lately has not been the case. I haven’t really had a lot of extra time.

It’s just crazy because I don’t know if I’ve mentioned it, I feel like I might have mentioned this, but since I started my training with my coach a year and a half ago, I’ve actually lost 20 pounds, which when I think about it, I’m like wow that’s kind of a lot.

Kelsey: Yeah.

Laura: It’s weird because I haven’t really put that much thought or effort into it. And honestly, a good 6 to 8 months of the training I was actually focusing on eating more to support the training, and then I got kind of sidetracked by getting engaged and all that stuff. But it’s been really kind of an interesting experience for me because I haven’t been paying attention to my diet that much other than just trying to make sure that I actually am eating before my training sessions which is important, and then getting a pretty balanced diet, certainly not all the time. And I’m not eating the best right now and I could probably improve it, but I’m just mainly focusing on basics at this point just to support my energy. Then with the training, like I said I’m only doing like 2 hard days a week and even the hard days are not so hard that I feel really sore afterwards or kind of run down at all.

It’s just been an interesting experience because I work with so many clients that are trying to lose weight or trying to lean out and they feel like they have to be training like 6 days a week, doing hardcore intense exercise all the time, eating 1200 calories a day, just doing everything they can to lose weight. I never got that extreme, like I don’t think I’ve ever eaten 1200 calories in a day. But I think this expectation that losing weight, and staying in shape, and being fit has to be hard, and has to be grueling, and that you have to be always restricting your diet, I just don’t think it’s accurate.

I’m not saying you don’t need to be in a calorie deficit because I do think I’ve been in a calorie deficit during the weight loss period. Not a huge one, but enough to see some weight loss. But I was really focusing on putting on muscle, and performance, and just gaining strength. And I feel like yeah, it took a year and a half so if you say I lost 20 pounds in a year and a half, it’s like okay that’s like half a pound a month or something, or a pound a month which doesn’t sound super impressive. But when you think about the fact that I work out 2-3 days a week and I don’t diet, actually I feel like it’s pretty good.

Kelsey: Yeah.

Laura: The reason this came up in our conversation before we got on the call is that I bought a wedding dress last week. And it was weird because I always had this thought that going wedding dress shopping especially with my family, or I guess my mom and my sister, and I was with my Aunt as well, I had this thought that it was going to be like this super stressful self-conscious just feeling bad about my body experience. I find that normally when I’m shopping, and often times it’s like jeans that I have this problem where I just don’t fit into things very well and it’s a little depressing. To be fair, I think with wedding dress shopping because the dresses are pretty loose unless you’re larger than a size 10 or 12 and they kind of crank you in there with the clamps and stuff so it kind of fits better. So anytime you get clothes that are tailored, they are going to fit better.

But it was just a really odd experience because I honestly went in thinking I was going to be super self-conscious or feel like we have to find a dress that flatters me or looks okay on me. I actually was surprised that I felt really good in the dresses and I felt like everything looks good and I can just choose what I want to get. It was just kind of a shock to me that that was the experience even though I had expected it to be like I’m going to have to find the thing that looks good on me.

I really feel like had I not been doing the heavy lifting and generally eating to support the lifting over the last year and a half that that not might not have been my experience. I don’t know, it’s hard to say, but it was just kind of a cool experience where I felt good in the dress I was wearing. It was an enjoyable experience, which I don’t think a lot of women have that experience when they’re shopping for a wedding dress even if they have a really ideal body shape or whatever. I think a lot of women tend to be very self-conscious. I feel like part of it is that the lifting and focusing on performance has improved my body confidence and it probably has nothing to do with my weight. But I think being able to go in and have a fun experience without having killed myself to get there was kind of a nice realization that I was like oh, I can work out two days a week, and not really care about my diet a whole lot, and still feel good about the way I look, and maintain my weight, and look good in a wedding dress.

I think ultimately the experience that I had just confirms my belief that people don’t have to be killing themselves at the gym all the time or being super restrictive with their diet to get to a healthy weight and to feel confident in the way that they look. I’m not a bikini model or something and I certainly am not as lean as I used to be when I was on the volleyball team. I’m probably, I don’t know, 15 pounds heavier than I was when I was on the volleyball team, so it’s not like I’m at my lowest weight or something that would suggest an excess level of body confidence. But I feel like it’s been a combination of finding a plan that does actually support good body composition for me without being obsessed with it, or worrying to much about it, or being like oh I still can see like this roll of fat, or I can see fat on the back of my arms. I don’t care anymore. I guess I’ve gotten to that point where I’m like eh, I look pretty good, I’m okay with it.

Kelsey: Right.

Laura: I enjoy the training. I’m kind of rambling at this point because it was very surprising to me because I’ve dealt with body confidence issues in the past and I honestly was like oh I hope this doesn’t suck.

Kelsey: Right.

Laura: I just was expecting it to be not fun and it turned into this dress up, just fun let’s try this dress on and let’s try that one. The consultant was like I know you don’t want this dress, but let’s try it on anyway because I think you’d look good in it. I’m like alright, let’s do it. It was just kind of like way different than what I had expected. Like I said, I think I can definitely attribute the extra confidence and just feeling good about how I look in the dress to the consistency of the workout, the effectiveness of the workout, and also just not caring as much, so it’s kind of like a combination.

Kelsey: Mm hmm.

Laura: I guess my point is that if people are looking to feel good about the way that they look, it’s a combination of working on the mindset piece and then also getting into a consistent routine of eating well and training, but not overdoing it and not killing yourself every day at the gym.

Kelsey: Yeah. I think what can kind of illustrate that point is that, like you said, you lost 20 pounds but over a year and a half. Most people when they’re talking about trying to kill themselves in the gym and really worrying about their diet, they’re trying to lose 20 pounds in like 3 months.

Laura: Right.

Kelsey: I think that’s the difference is that you need to realize that these kind of habits that go into getting to a particular weight and maintaining a particular weight are lifelong habits. They’re not something that you’re just going to do for 3 months, get to your weight, and then magically without continuing the habits you’re just to like maintain that weight. I think that’s a piece that a lot of people tend to overlook is that is that you’re way, way, way better off taking your time to do this so that it doesn’t have to feel like it’s torture and you then at that point created all these excellent habits that you’re really consistent with. So it’s not typically a problem to continue them to maintain the goal that you now achieved.

Laura: Right. For me training twice a week is not a burden at all. In fact I can probably do more. I just haven’t.

Kelsey: Yeah.

Laura: I think there’s this misunderstanding that weight loss, or weight maintenance, or feeling good about the way you look just requires so much sacrifice. Honestly I don’t think that’s true.

Kelsey: Mm hmm.

Laura: The more people understand that first of all getting into just a long term mindset is really important for weight loss and then also not focusing on the weight loss and really focusing on being healthy, and supporting your workouts, and exercising in a way that’s effective and not over doing it. It sound so unsexy, but it really is very effective.

Kelsey: Exactly. That the problem. It’s unsexy.

Laura: I know, it’s hard to sell that because it’s like, what? You’re saying I would lose a pound a month and it’s going to take me a year and a half? It’s like that doesn’t sound great.

Kelsey: Right.

Laura: Where these other programs are like lose 10 pounds in your first month. And it’s like I don’t really think that’s a great idea. I know it can be frustrating and I’ve had clients before that were like I only lost 2 pounds this month. I’m like that’s fine! There’s nothing wrong with that. It’s just kind of a weird experience to be at this place where I’m like if I lost a little bit of weight before my wedding, okay, I’m sure I would look a little bit better in my dress, but honestly I don’t really care. It’s just kind of a nice place to be in where you’re just like eh, whatever, it looks good enough.

Kelsey: Yeah. Honestly, at the end of the day, it’s one day too.

Laura: That’s what they say.

Kelsey: Yeah, that’s what they say. There’s this whole idea that it’s like the best day of your life, the most important day of your life. Just pick a dress that you feel comfortable with. And yeah, people are going to looking at you a lot, but if you feel good in it, you feel good in it and you don’t need to worry about what anybody else thinks.

Laura: Right.

Kelsey: That’s sort of my opinion on wedding dresses after being through it.

Laura: Yeah. Mine was a sample dress so it was 50% off. I’m like, alright it looks good on me and it’s super inexpensive.

Kelsey: Right. Sounds great, sign me up.

Laura: Yeah. I can totally see how people can take things so seriously. Yeah, I wanted to get a good dress and I didn’t want to rush into the decision, but I kind of got to the point where I was like this one is pretty good, and it looks good on me, and I’m Just going to go with it.

Kelsey: Yeah.

Laura: I do have to keep in mind that it is one day. That’s a little bit of stress over budgeting and guest lists and stuff.

Kelsey: Mm hmm.

Laura: I’m just like, okay, it’s not that big of a deal, just chill out. Alright, well I’m sure everyone’s like totally tired of hearing about wedding planning, which I apologize.

Kelsey: I know, sorry guys.

Laura: It just so happens that Kelsey and I were doing a lot of it at the same time. Now she’s done and hopefully I’ll shut up about it at some point. It’s hard when it’s like I spend 10 plus hours a week doing this stuff.

Kelsey: Oh yeah.

Laura: It feels like a second job right now.

Kelsey: Absolutely.

Laura: Alright. Well let’s jump into the question for today. But before we do, let’s hear a word from our sponsor.

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Laura: Alright. So today’s question is:

“I had recently been diagnosed with small intestinal bacterial overgrowth, also known as SIBO, and I’m diving into the murky research. Your podcast on why diet alone cannot treat SIBO made a lot of sense. But I’m wondering:

  1. Why no discussion about the SCD diet, only FODMAPS?
  2. Are you telling patients to follow a mostly low FODMAPS diet while taking the antibiotics or antimicrobials, or a total liberalized diet?
  3. What protocol do you use after finishing a course of antibiotics or antimicrobials?

My naturopath recommends at least three months of strict SCD after finishing Xifaxin. Do you know of any research that supports this recommendation? Thank you.”

Kelsey: Alrighty. I’m trying to think of how I want to go through this. Let’s go through it as a person would go through it.

Laura: As a person would as opposed to a non-person.

Kelsey: As a person would go through the process of determining that they have SIBO, treating SIBO, and then what comes after SIBO. Once you’ve determined that you do have SIBO, I tend to recommend pretty much as liberalized a diet as possible.

Now this person is asking why we didn’t talk about the SCD diet in particular as opposed to the FODMAP diet when somebody has SIBO. I think the reason we did that is because at least at the time of that recording and that article that I wrote most of the diet that people were talking about in regards to SIBO was the low FODMAP diet. But there’s definitely some recommendations about being on a SCD diet or an SCD combined with a low FODMAP diet now.

I still stand by the recommendation to eat a pretty liberalized diet or as liberalized as possible and I don’t really recommend the SCD diet or low FODMAP diet while you’re treating SIBO. And that’s because like we talked about in that other podcast, you do want to be feeding bacteria to more easily kill the bacteria with whatever protocol you’re using to get rid of your SIBO. Whether that’s herbal antimicrobials or antibiotics like Xifaxin that this person is mentioning, I really try to get people to eat as many different foods as they can including things that are typically restricted on the SCD diet or low FODMAP diet.

That can become a little bit complicated if you for example think you have SIBO, but you’re waiting for testing to come back. I have a lot of people that ask me should I be eating a low FODMAP diet now while I’m waiting to start on antimicrobials or antibiotics because I don’t have that evidence in hand that I need yet to start any of those protocols? Actually it’s kind of a tricky question because if somebody is strongly reacting to some of those foods, I will tell them that at least temporarily they can go on a slightly lower FODMAP or a more SCD type diet that helps to control their symptoms a bit. But unless somebody asks me that in particular, I typically don’t recommend that they change much about their diet at all unless they’re really, really suffering with the symptoms.

But for most people with SIBO, they are having some bloating, they may be having some bowel changes that aren’t particularly great, but they’re not really interfering with their life in the sense that they couldn’t handle those symptoms for a couple weeks. I typically don’t really change much about their diet while we’re waiting to start antimicrobials or antibiotics because I want them to be eating those foods anyway and for a lot of people once they start on some of these lower FODMAP diets or an SCD diet and they realize that they’re bloating goes down, it’s really, really tempting to just continue on that with the idea that that’s going to heal you. Even if you are doing antibiotics or antimicrobials as well, I can tell somebody all day long that eating higher FODMAP foods or eating things that are usually prohibited on an SCD diet will help them to recover. But when they’re symptoms go away because they’ve taken those foods out, it’s really hard to convenience them to add them back.

I don’t know if you do anything similar, Laura, but I typically don’t have people take out those foods while they’re kind of waiting to start their treatment protocol.

Laura: Yeah, I mean I’d say if you feel like the treatment is imminent, then I don’t normally do that either. I’d say occasionally, well I shouldn’t say occasionally, a lot of times I’ll start with a low FODMAP diet and see how that affects their symptoms and see if that gives them relief. And then if it does, then maybe going for the testing. I tend to be a little less, what’s the word? I don’t order SIBO testing for my patients.

Kelsey: Oh, okay.

Laura: So that kind of makes me a little more, not hesitant, but I feel like the low FODMAP diet you can get fast results from that for a lot of people.

Kelsey: Oh yeah.

Laura: It doesn’t always work, but if you want people to start feeling better in the short term, a lot of times the low FODMAP diet can be really helpful. And then once the antimicrobials… either you order the antimicrobials or if you get the SIBO tests and then they’re going to start the antibiotics, then I’ll get them off that diet. Because I think for me, my goal is always to minimize symptoms.

Kelsey: Mm hmm.

Laura: So if they feel better in the short term on the low FODMAPS diet, I don’t really see that being a problem especially if it’s not difficult for them adhere to that diet. Then once their doing the antibiotics or antimicrobials, like you said, liberalizing the diet as much as possible with the understanding that if somebody feels really bloated or really ill eating certain foods, then I’m not going to have them reintroduce those.

Kelsey: Right.

Laura: Which I think you’re on the same page there.

Kelsey: Yep.

Laura: I feel like maybe because I don’t do the testing for SIBO, since that’s what you do, it’s almost like well why not just go straight into that. So for me it’s sort of like, okay, let’s just try the low FODMAPs for now and see if that makes you feel better. If it does make you feel better, then that’s even more evidence for getting a SIBO test.

Kelsey: Mm hmm.

Laura: Then they end up getting a test done through a GI doctor, or a local naturopath, or something like that. And then like I said, as soon as we get them on some kind of antimicrobial protocol, we can add foods back in.

Kelsey: Yeah. That’s makes sense and it’s just a different approach to dealing with it. You’re right. I do SIBO testing in my practice and it’s probably one of my most ordered tests I would say.

Laura: Mm hmm.

Kelsey: Just because literally so many people come to me with symptoms of SIBO. And I think we’ve mentioned before that both of us literally, I don’t think I’ve ordered a SIBO test that has come back negative at this point.

Laura: Mm hmm.

Kelsey: Which is kind of incredible to me. But it just goes to show you how many people are out there dealing with this fairly easily treatable disease that really should be treated. For me it makes the most sense to just kind of deal with the root cause as soon as possible and not have people go through a lot of different diet changes that they maybe don’t need to do. But if someone wants to do it and because they are having really bad symptoms for example that they just need to get under control, it’s certainly something I do use on occasion in my practice because I don’t want anybody to be suffering with really terrible symptoms if they don’t have to. If there’s times before we’re going to start antimicrobials we might go on a low FODMAP diet just to kind of take control of those symptoms a little bit and then when they get started on the antimicrobials, I’ll just have them add into whatever point makes sense some of the low FODMAP foods or some of the SCD foods that they would have taken out on that kind of diet.

Basically it’s a matter of taking out foods that are really problematic so that somebody can maybe handle some of the discomfort of some FODMAP foods or some SCD foods that would normally cause some problems, but by taking out the main offenders they can kind of handle the medium offenders I’ll call them. That way they’re at least getting some FODMAPs or some SCD foods in their diet and they’re eating bacteria so that it’s more easily killed.

Then if somebody really is having a problem with FODMAPs and they can’t kind of eat those foods at all while they’re on the antimicrobials, I will try them on prebiotics. Prebiotics are FODMAPs but when someone is one a really low FODMAP diet, it can sometimes work for them to actually be on a prebiotic because the rest of their diet is so devoid of FODMAPs that the little bit that they’re getting from a prebiotic supplement is enough to feed the bacteria, but not cause a bunch of symptoms for them. That’s something I will do if somebody has major, major problems with FODMAPs or perhaps they’ve been on a low FODMAP diet before they came to me and they’re not willing to get back onto FODMAPs until they start to see some symptom improvement first. That’s sort of the area I would use prebiotics with though I do use prebiotics in somebody can handle some FODMAPs in their diet as well.

It’s just kind of a very personalized approach and I base it on the individual symptoms. It’s kind of hard to answer general questions like this because it does really vary from person to person. But my general take away for diet during antimicrobial treatment is that it should be as liberalized as possible without causing really intense symptoms for someone.

Laura: Mm hmm. Now they do ask why we don’t discuss the SCD diet which is the Specific Carbohydrate Diet.

Kelsey: Yes.

Laura: What’s your feeling on that?

Kelsey: For me, I just think the FODMAP diet is a little bit more important to talk about only because those are carbohydrates that are specifically feeding bacteria. I found the SCD diet, I guess to me the SCD diet seems a little bit more generalized. It’s not specifically related to what is feeding particular gut bacteria. Even though it’s got a lot of carbohydrates in there obviously that you’re restricting, so those carbohydrates will feed bacteria. But with FODMAPs, I feel like there’s been a lot more research on the low FODMAP diet and SIBO so that’s typically what people are coming to me asking about. Whereas the SCD diet, honestly I actually don’t get a whole lot of questions about it in regard to SIBO.

Laura: Mm hmm.

Kelsey: And I don’t get a lot of people coming to me that are on an SCD diet or really have much interest in starting it. So I guess it’s just more because I don’t typically deal with clients who are really interested in that. And from I’ve seen, I don’t believe that it would be all that helpful to put someone on an SCD diet. Of course it’s not something that I’m bringing up to my clients either.

Laura: I know that there’s been a lot of people who have gotten lots of great health benefits from the SCD diet, so I’m not anti SCD diet. But with SIBO, I often find that it’s just way more restrictive that it really needs to be.

Kelsey: Yeah.

Laura: Like we’ve talked about, the different diet is not what’s going to cure SIBO, so why bother going so hardcore with the diet if it’s not really going to be curing the SIBO in the first place? As far as doing 3 months of strict SCD after finishing Xifaxin, it really just depends on the person. Some people can do strict SCD and it’s fine and they don’t develop health issues or other gut issues that come from the SCD diet, but I do get a little worried about totally avoiding anything that would feed gut bacteria at all.

Kelsey: Mm hmm.

Laura: Just because with recovering from SIBO, yeah it’s helpful to not feed remaining gut bacteria if the SIBO hasn’t fully been kicked, but you also have to think about what’s happening to the bacteria in the large intestine in that situation. So I would be a little concerned that 3 months of strict SCD could potentially cause other gut issues that have nothing to do with SIBO just because you’re not feeding the beneficial flora in the large intestine.

Kelsey: Yeah.

Laura: If bacteria still exist in the small intestine after Xifaxin, honestly I’d rather see someone do some low dose antimicrobials for a couple months after doing Xifaxin just to keep things at bay in the small intestine.  And ether like we were saying keep a mildly liberalized diet or fully liberalized diet, or potentially take those supplemental prebiotics if they don’t feel uncomfortable doing a liberal diet and not try to starve the bacteria using food.

Kelsey: Yeah.

Laura: I’ve just seen a lot of issues with people that are post SCD or post GAPS diet where they develop new gut problems that weren’t there before. My feeling is that if the goal is to kill off the bacteria in the small intestine, then continuing some kind of antimicrobial treatment in either mild amounts after Xifaxin or repeating the Xifaxin if somebody’s working with a doctor, which is usually my preference. If I have to choose, I’d rather someone get a prescription from a doctor as opposed to doing the over the counter antimicrobials. I don’t know why that’s the case. I just feel like I’ve seen better results with people doing the Xifaxin and maybe then Neomycin on top of that. I’m not anti-antimicrobial herbs, it’s more I like to use those as a follow up to just continue some of the antimicrobial action after they’ve gone through the antibiotics.

But honestly I feel like because of what we’re talking about, there’s probably a handful of ways to deal with this that some are going to work better than others, some will work differently for certain people than other people, and no two patients are going to have the exact same experience. But my general experience has been that, I don’t know, it’s just funny because you and I guess have a little bit of a different approach, but I’m sure we both get good results.

Kelsey: Yeah.

Laura: So it’s probably not super important what you do. I mean it’s important, but it’s not like there’s one specific protocol that’s going to work and everything doesn’t work. But basically, my experience is that getting some kind of antibiotic treatment at least once or twice and then continuing antimicrobials for a period of time after the Xifaxin or whatever antibiotic the person is on, maybe Rifaximin or Neomycin or something like that, or a combination, it just makes me feel less worried about future gut problems than going on a super restrictive diet.

Then even beyond the gut problem, I also worry about other problems that can be caused by a super restrictive diet like strict SCD or GAPS because we’ve seen a lot of people develop things like HPA axis dysregulatlion, or disordered eating, or that kind of experience where I don’t want to send someone down that route just to reduce their SIBO symptoms. I’d rather it take them longer to kick SIBO and not develop this like I said HPAD or disordered eating, or lose too much weight, or there’s a lot of different things that can happen on a super restrictive diet and just my preference is to avoid that as much as possible.

Kelsey: Yeah. I agree and I think that the tough thing, because everybody wants this answer like what do I do after I have killed off this infection to keep it from coming back because unfortunately SIBO reoccurs fairly often in people. Honestly I wish I had a great answer, but we don’t really know. And that’s the hard part with this kind of stuff is that yeah we’ve discovered that this is a really big problem for people, especially for people with IBS. We want to have all the answers right now, but we just don’t. As a practitioner that can be a really difficult conversation to have because people are coming to you for answers. But the research, at least that I’ve seen, there’s no research that has shown us what kind of diet somebody should be on after they kill off a SIBO infection. My typically approach is to personalize it to the person.

Laura: Mm hmm.

Kelsey: Sometimes after treating for SIBO, a person will still deal with some degree of FODMAP intolerance. For example, they might still be sensitive to garlic and onions, those tend to be kind of the two that are really big.

Laura: Common.

Kelsey: Yeah, and they don’t sometimes go away even after you deal with SIBO. If a person is still sensitive to those things after they’ve treated their SIBO, I’m not going to just have them include those things just because I feel like they should, they don’t have to be on a low FODMAP diet or they shouldn’t have to be on a low FODMAP. Obviously that person is responding to that food in a negative way.

I think that taking things out that a person is having a clear reaction to makes sense, but I don’t think a general recommendation of doing an SCD diet or doing a strict low FODMAP diet makes a whole lot sense just because for a lot of people that restriction is problematic just from a mental perspective. If somebody gets way too caught up in that restriction, it can cause issues with the HPA axis, it can cause other gut issues like Laura was mentioning.

My whole goal while working with someone no matter what they come to me with is to get them to a place where they can know what bothers their body in particular and avoid those foods. But otherwise, they’re eating healthy foods. They’re not just avoiding foods for the sake of avoiding them because they’re in this particular diet, like the SCD diet.

Laura: Mm hmm.

Kelsey: Because we don’t really have a whole lot of information on what is best to do after you kick the SIBO infection, I really just personalize it to the individual. And then I will say that this does not really have any scientific backing, but I do it because it makes sense from just a logical perspective is sometimes I will have people do a five day course of antimicrobials once a month just to kind of keep bacterial loads down if they’re a person that has SIBO multiple times, they have trouble getting rid of SIBO in the first place. For someone like that, it’s really much more important for them to not develop SIBO again in the first place. That can be something that I’ve seen to be very helpful for people, but there’s no research showing that that’s what you should do or anything like that. It’s just something that from my own opinion and my own experience has worked really well for some of my clients that are very prone to SIBO infections.

That’s kind of just what happens when you don’t have all of the answers. You need to just do the best you can and use kind of common sense from a clinical perspective and just see what happens. Someone might of course develop SIBO again, but that just gives you some more clinical data to go off of. So I think it’s important to remember that we don’t have the answer to this question even as much as we wish we did.

Laura: Right.

Kelsey: And that you certainly can do a strict SCD diet for 3 months after your treatment. I guess there’s not a super big amount of harm that could necessarily come from that because it’s only 3 months. I think the problem becomes that maybe in 3 months if you’re still not feeling much different, then the naturopath might tell you let’s just continue it for another 3 months, and another 3 months, and then next thing you know you’ve been on the SCD diet for like a year and you’re starting to get other health problems. Hopefully this person has a good naturopath who wouldn’t do something like that and would get your more treatment if you weren’t feeling all that much better.

But any sort of diet that is meant as a general diet that is meant to treat a kind of digestive condition is not going to treat it. It’s just going to reduce some of the symptoms if they’re still there. My purpose at the end of the day is to get rid of the root cause of what is causing those symptoms rather than cover the symptoms up.

Laura: Yeah, I mean this is kind of where it comes to the art of being a practitioner.

Kelsey: Yeah.

Laura: And it’s not always a science. A lot of times it’s based on experience, based on what works for other clients, based on intuition. There’s a level uncertainty that can come from working with someone on a problem if there’s not a lot of evidence or standard of practice for. I’m sure this is obvious to a lot of people, but SIBO is one of those conditions that you definitely need to be working with someone on. It’s not like DIY SIBO treatment. You need to be having some kind of professional guidance on that to try to do like a DIY SIBO treatment. I guess there may be people who get good results on their own without having someone give them more clinical recommendations or professional recommendations, but it’s not something I would recommend to trying on your own 100%.

Kelsey: Right.

Laura: Which I think there’s a lot of health issues that you can see improvements without working with someone directly, but SIBO is one that can be a little trickier. I feel like a lot of the online recommendations tend to be too one size fits all and don’t really take into account people’s diversity of needs or experiences, or how that kind of diet might affect other issues in their lives. Maybe that’s a plug for working with one of us, but it’s like I just honestly feel like with a condition like SIBO, you don’t want to be screwing around on your own trying to figure things out and potentially making things worse or potentially causing other problems.

Kelsey: Yeah. I totally agree. That’s one reason why there’s a part of me that loves the fact that you can look up all this stuff online and you can learn about all this interesting stuff that maybe your doctor doesn’t talk to you about. But on the other hand, I think there’s’ a lot of people that do try to DIY this kind of treatment and to be honest it really never works out well. I am pretty much always seeing people that have been through some degree of their own treatment.

To be honest, sometimes they’re working with other people who have tried to treat them in the past and it didn’t work out well either. I guess you need to make sure that the person that you’re working with is very experienced in this kind of stuff because it is a bit of an art and some clinicians just kind of follow whatever guru online whatever they’re saying about SIBO and stick to that even when it doesn’t work for someone. I think there’s something to be said for flexibility when you are working with a client and if something isn’t’ working, you need to try something else. It’s not just like okay let’s just try harder and it will work.

Laura: Yeah. I think as we explained before, it’s not like there’s one perfect way to fix a problem. And as you already heard, Kelsey and I have somewhat different approaches to the same problem or similar problem. But just because you can kind of approach it from different directions doesn’t mean that either way is better or worse.

Kelsey: Right.

Laura: And I think honestly the most important thing is working with someone like you said who’s going to know when to change course when something’s not working.

Kelsey: Mm hmm.

Laura: I do think the desire to minimize how restrictive the diet is important, and I think that’s something that often gets missed. We always talk about that, but I think it’s just because it’s so important and people often end up going so much more restrictive than they need to be and then that causes more problems.

Kelsey: Yeah, exactly.

Laura: Anything else to add before we wrap this up?

Kelsey: I don’t think so. I mean SIBO is just an interesting topic because we don’t know as much as we wish we know at this point. But I think we are learning more everyday so it’s important to just keep reading this stuff that comes up on the internet, but also work with somebody who is experienced with this stuff if you do have SIBO because it is a complicated thing to deal with. No one responds exactly the same way as somebody else responds to treatment, or diets, or whatever. Your practitioner really does need to listen to you and you’re experience and change course when that needs to happen. That’s not to say that you shouldn’t give things a fair shot. You do need to kind of try things for significant periods of time, but a practitioner should be able to tell you okay if we’re going to try this, if it doesn’t do anything by 8 weeks in, that’s kind of my cut off where maybe we should try something else. You should be able to get at least some degree of a timeline from the practitioner you’re working with that if whatever you’re trying now doesn’t work, what might be the next step, and when might that happen.

Laura: Sure, yeah. Well hopefully this was helpful. I know it was a little bit, what’s the word? It’s always that it depends answer.

Kelsey: Yeah.

Laura: Like well, this can help, but not always, and here’s some things to think about. But we do hope that the answer was helpful and gives you some stuff to chew on before you see your practitioner.

Alright, well thanks so much for joining us again this week, guys. If you have any questions you want to submit to the show, feel free to go to TheAncestralRDs.com and click the Contact tab and you can submit a question there. And we will look forward to seeing you’re here next week.

Kelsey: Alright, take care.

Laura: You too, Kelsey.

Disclaimer

This podcast is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this site and linkages to other sites, Laura Schoenfeld and Kelsey Marksteiner provide general information for educational purposes only. The information provided in this podcast, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. Laura and Kelsey are not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site.

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Laura Schoenfeld and Kelsey Marksteiner, your favorite Ancestral Registered Dietitians, will teach you everything you need to know about ancestral nutrition and lifestyle to optimize your health - without stress or unnecessary restrictions!

Comments

  1. says

    This was my question, thank you so much for answering it on the podcast!!!

    Your responses helped a lot with figuring out what to do while on the antibiotics and/or antimicrobials.

    You spoke a lot about the importance of working with a trained healthcare provider. I totally agree with that, but it’s just not that simple! I see a naturopath regularly, who had recommended the 3 months on the SCD diet, have consulted 2 gastroenterologists, read everything on siboinfo.com, listened to Chris Kresser’s podcasts, etc. There just does not seem to be any clear answer on what to do after the antibiotics/antimicrobials. Even Dr. Siebecker discusses the GAPS, SCD and low-FODMAPs diets, but does not give a specific recommendation.

    What I understood you to be saying overall is that diet is not a treatment for SIBO. If someone has an intolerance to FODMAPs, then it make sense to restrict the food in question to relieve symptoms, but not for the purposes of ameliorating the SIBO…?

    I’m working on getting pregnant, so continuing to take antibiotics is not an option. I also don’t think it makes sense to just cut out FODMAPs for the purpose of symptom relief as my symptoms are relatively benign (although my lactulose breath tests have shown high levels of methane and hydrogen).

    I know that the research is just not there to answer all my questions. I appreciate your insights and welcome any additional thoughts or suggestions.

    Thank you!

    Anna

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