After documenting her year in The Wellness Project, Phoebe Lapine was still struggling with her health. He found she had small intestine bacterial overgrowth (SIBO). Her efforts to understand and address this illness brings us SIBO Made Simple.
Let's Say Hello
[00:00:48.220] – Allan Raz, how are you doing this week?
[00:00:49.780] – Rachel Good, Allan. How are you today?
[00:00:51.550] – Allan I'm doing pretty good. Outdoors, sitting on the patio at Lula's, my wife's bed and breakfast. And I've been kind of sweating because it's been some warm couple of days up here.
[00:01:03.370] – Rachel Nice.
[00:01:04.510] – Allan Yeah. Not so much in Michigan.
[00:01:06.790] – Rachel No, no. We've got frigid cold temperatures again and we just got another five or seven inches of snow last night. So we'll be digging ourselves out today, that's for sure.
[00:01:16.870] – Allan Yeah. And that this particular one obviously is taking a big dip south because I'm having grown up in the southeast. Most of my friends that I grew up with, they're dealing with snow and ice there and they're not equipped for it. What would be a normal Tuesday in Michigan is kind of devastating in Mississippi.
[00:01:37.780] – Rachel It is.
[00:01:38.530] – Allan Yeah. So there's there's some struggles there. And I just say, if the weather outside is that bad, if you can stay home, stay home, because it's you don't need to be on the roads and particularly if you're just not comfortable or you don't have the equipment necessary to be on those roads because the most of the tires that you're going to have in the southeast are not they're not built for snow. They're built for rain and they're built for warm weather. And so you get them on the snow and they're ice skates.
[00:02:07.780] – Rachel Yeah, it's a dangerous. It's a dangerous situation. Even up here in Michigan where we do have the equipment and the trucks and everybody's prepared, we all know usually how to drive in the winter. These frigid temperatures we're having makes such that the the salt does not work effectively. So even this morning, the trucks were able to clear all the snow off the highways, but they couldn't lay down the salt because it wouldn't have done anything. So we need to wait for the blue skies and the sun to come out, maybe get a little bit of melt before they can put the salt down. It's still a really tricky situation up here. So, yeah, the best advice is to stay home, if you can.
[00:02:45.640] – Allan The problem with the Southeast is that it it's not that cold. So you get you get right in that kind of that scary middle space where you've got snow and then you've got sleet and then you've got ice and then you've got snow and…
[00:03:00.370] – Rachel It's a disaster. It is just a disaster.
[00:03:04.060] – Allan And the general reminder, bridges do ice before roads do so…
[00:03:09.040] – Rachel Yes, that is true.
[00:03:10.840] All right. So, yeah, I've been in charge of Lula's this week. My wife is in David doing some shopping for the bathroom fixtures and sinks and stuff like that that she's going to need to redo the six bathrooms up here. And then we're going to do an owner suite and a bathroom downstairs. And so there's just there's a lot of construction that's going to be going on for the next several weeks. She's in David trying to get that stuff together. And she put me in charge. And I'm not doing all that well.
[00:03:40.210] – Allan I forgot to feed the workers today.
[00:03:42.700] – Rachel Oh, no!
[00:03:44.310] – Allan That's one of the things you're in keto and intermittent fasting. You don't even think about food. I woke up. I wasn't thinking about food. I'm doing my thing and and I'm like, okay, well, I got to go get the microphone because I left that at the gym and I wanted to be back here. And then I was walking back, I bought some groceries for dinner. And I said I probably forgot lunchtime. I don't even know what time it is. And then of course, here I am for a recording. I was a few minutes late because, I had no clue what time it was and I wasn't hungry. I'm not hungry. So, yeah, unfortunately I didn't feed the workers today. And when my wife hears this, she's not gonna be happy with me, but I am going to feed them tomorrow. I promise.
[00:04:22.180] – Rachel Oh good. Good thing.
[00:04:26.140] – Allan All right. So are you ready to go have a conversation with Phoebe?
[00:04:29.320] – Rachel Yes. Let's do this.
[00:04:55.570] – Allan Phoebe, welcome to 40+ Fitness.
[00:04:58.370] – Phoebe Hi, thanks for having me.
[00:05:00.460] – Allan I should say welcome back to 40+ Fitness because I had you on earlier back in 2017 when you had the book, The Wellness Project.
[00:05:11.290] – Phoebe Yes.
[00:05:11.650] – Allan And I have to admit, I stole a little bit from you. I like the word wellness. I liked it a lot. I liked your approach. And then so when I wrote my book that I actually published at the end of 2017, no 2018, I called it The Wellness Roadmap.
[00:05:32.440] – Phoebe Amazing
[00:05:32.980] – Allan It was kind of a lot. What you did was, okay, how did I get here, how did I do these things to make myself well. Now you did that in your book The Wellness Project, and I think you stole a project from Gretchen Rubin.
[00:05:48.200] – Phoebe Yeah. We're all stealing from each other.
[00:05:48.800] – Allan Yes, there we go. But we're all learning each other. And I think that's the other thing is I was able to bring some things that you had learned on your journey and I had learned on my journey and say, okay, let's let's put those together, because that's going to help people. And that's why you do the podcast. That's why I have you on again so we can talk about your book, SIBO Made Simple.
[00:06:09.380] – Allan Now, let me be honest with you. I started reading and maybe… I'm lucky. I'll just readily admit I'm really, really lucky in that I don't have bowel issues almost ever. Almost never, ever. I live in Panama. My wife has already gotten a parasite here and had to take medicine. Touch wood, knock wood, whatever you do, nothing like that's happened to me. So as I go into these topics, it's not something that I have personal experience with. So to me, SIBO and SIFO and Candida and all these things are a little bit like a Rubik's Cube.
[00:06:48.560] – Phoebe Hmm. Yes, definitely.
[00:06:50.660] – Allan Because it's not a one symptom, one cure. It's multiple symptoms and maybe multiple issues all happening at the same time. As you start adding the layers and I didn't realize until just recently they have a four sided Rubik's Cube. I just bought one. It arrived today.
[00:07:10.280] – Phoebe Four sided?
[00:07:15.770] – Allan They're all sided. But it's the one we had back in the day was a three by three. And then I found out they have the two by twos and have four by four. So I bought them just so I could play around with them. And as I got into your book, you basically wrote the algorithm to help us solve SIBO.
[00:07:36.620] – Phoebe It's a really good analogy. I'm going to have to steal that right back from you because, yeah, as you said, I tried to create a roadmap as much as possible. But it's not a linear journey. It's more like a really expansive map with lots of twists and turns and forks in the road. And I think it's important for you to be able to see the entire landscape because sometimes you have to go back to Go and start over again.
[00:08:05.000] – Allan You were in it. I mean, I think that was the thing of the book and the thing about your other book, The Wellness Project, is that you experienced this and you were down in the trenches. So this is not you just saying, hey, this is something that also affects people. You were in it. Can you tell us a little bit about your story?
[00:08:28.250] – Phoebe Yeah, I always seem to write the book that I wish existed when I was going through something. So, yeah, as you mentioned, like I started to experience symptoms right after I had supposedly learned everything there was to know about gut health by doing research for my last book. And it was so funny because I really was confused. I was doing all the things that the microbiome specialists had told me to do.
[00:08:51.980] – Phoebe And I interviewed some incredible people. And pretty much everyone's advice was the same. Eat a lot of fermented foods and insulin-rich vegetables and fiber, fiber and more fiber. So I was crushing legumes and drinking a lot of Bucca and kafia and whatnot. And I started to realize I was feeling miserable after every meal. So I went harder on all of those things and then felt more miserable.
[00:09:15.470] – Phoebe And eventually that got me back in the door of my doctor. And the diagnosis I received was SIBO, which is something I had heard of in passing but didn't truly understand. And honestly and this isn't just like making a silver lining out of a bad situation, but learning about SIBO was like such an aha moment, such an essential part two to my wellness project, my wellness story.
[00:09:41.510] – Phoebe And some of the other diets that I kind of heard of along the way, like the low FODMAP diet began to make sense. So I'll just tell those of you who don't know the actual definition of SIBO, it stands for small intestine bacterial overgrowth. And it's thought that at least 60 percent of all IBS cases are actually being caused by SIBO. But it's not necessarily like a disease in and of itself, kind of similar to IBS.
[00:10:06.920] – Phoebe It's a sign that something has gone wrong in the body, that the mechanics of our digestive system has gone off the rails. And I find that part really fascinating because also in my research and kind of just in the wellness world, I feel like, quote unquote, gut health, like the word gut just gets thrown around a lot and we kind of forget that it's the entire digestive system. So when people are talking about good gut bacteria, I didn't really realize that. It's not like, well, there's, of course, different types of bacteria in the entire digestive system, but the majority of it is supposed to be in the large intestine, not the gut as a whole. And the small intestine is really not supposed to have much bacteria at all because that's where you absorb your nutrients. So if they're bacteria present who have the same taste as you do, in large part, they're going to start competing for your nutrients. And when they eat your food, in particular, different types of carbohydrates, they release gas.
[00:11:05.540] – Phoebe And when that gas is super far up your digestive tract, it's not as close to an exit ramp. And so it's going to try and get out any way possible. Burping was a really strange symptom that I had that I kind of didn't even realize would have been associated with anything. But once I got diagnosed with SIBO and like read the list of symptoms, I was like, oh, my God, the burping. Because, again, that gas is just trying to get out. But for those who have IBS symptoms, the SIBOy IBS is really high up. Like you feel that bloating like underneath your ribs. It's not like for the ladies out there what you would feel like if you just were getting your period. And it's also something that happens very frequently.
[00:11:48.780] – Phoebe So pretty much so long as there are some sort of carb on your plate and that includes vegetables, fruit and vegetables as well, you're going to feel probably some sort of symptom because the symptoms are directly related to the food.
[00:12:03.650] – Phoebe So it's a tricky nut to crack because you're trying to eradicate bacteria from one area without doing too much damage to the large intestine. And that's kind of the tricky. The tricky walk you need to do with SIBO. And it's something that I know gives people a lot of confusion. But at the end of the day, I think it comes down to the fact that these bacteria are wreaking such havoc. They're causing so much inflammation because they're in the area of the gut that doesn't have a whole lot of protective… It doesn't have a whole lot of protection. You have a really thick mucus lining and the large intestine, which separates your immune system from the bacteria and in the small intestine since it's not designed for bacteria, you don't have that.
[00:12:47.540] – Phoebe So your immune system gets involved. Once that happens in the fog of war, you can damage the tight junctions of your intestines that leads to leaky gut and then that leads to food sensitivities. And there's a huge overlap with autoimmunity and SIBO for that reason. It's like kind of a chicken or the egg. And yeah, I think it's like one of the reasons well, the gut is kind of at the at the heart of so many different conditions, but in particular with SIBO, there's just a very long list of things that could be at play.
[00:13:18.630] – Allan Yeah, I think, one of the kind of aha moments of this is actually understanding that the digestive track, each segment of it. I guess the best way I can say it, your mouth, your stomach, your small intestine, large intestine, each one of those has a particular purpose. And the large intestine is is there to break down fiber and do its thing. But if you end up with the bacteria too far up, meaning it's into the small intestine, the small intestine isn't designed for that.
[00:13:47.640] – Allan And as a result, it kind of made sense because it was like, leaky gut, you end up with these these gaps. I'm kind of thinking how how would that actually work? How it's kind of actually, you think of it as a mesh, but that's fine. You think of there's a mucus layer and that's fine. But then when you actually said, okay, you're getting gas and the gas is expanding, something that wasn't designed to expand, it was just existing, designed to pass this stuff through, pull out the nutrients that can because it's churning.
[00:14:18.960] – Allan So it's pulling out the nutrients as it goes over. It was 17 feet. So it goes across this distance. And during that time, it's pulling out all the nutrients and there's a very specialized process. But if it's swelling up because there's excess gas in there, then I can now I can kind of understand how it would force things out, and of course, the gas is trying to escape, but at the same time…
[00:14:47.100] – Phoebe Yeah, often it just gets trapped.
[00:14:49.680] – Allan All the stuff in there is also getting forced to go somewhere to some extent because it's in that same space. It's trying to occupy that same space, which is getting more and more compressed. And you you feel like you're eating well. You feel like you're doing everything you're supposed to do, but you're getting sicker and sicker.
[00:15:07.180] – Phoebe Yeah. and I think that's another really difficult thing and why I think learning about SIBO and having some sort of awareness is so important because, we're all like grabbing for straws and there are definitely going to be certain experts or influencer or whatever you want to call that people follow and they will reach towards whatever the piece of advice is. But we're all so different and anything that can help can also hurt. And SIBO is a prime example of that.
[00:15:33.040] – Phoebe So the low FODMAP diet, which is something I had heard about kind of while I was doing research for my first book, is basically the opposite of what the gut sensis were telling me to do. And at the time I didn't understand. I'm like, why would this help people with IBS and the low FODMAP diet is very data-backed for reducing IBS symptoms. And I kind of knew deep down that I had to be because their guts were so damaged in the first place that they couldn't even handle some of those, quote unquote, good gut foods. Or perhaps they're missing bacterial species that helped to break them down. Could be all of the above and or SIBO.
[00:16:09.570] – Phoebe But SIBO really appealed to my common sense because it makes perfect sense that bacteria, good or bad, if they're eating their favorite foods but they're in the wrong place, are going to cause you a lot of symptoms.
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[00:18:03.100] – Allan Now, one of the things, like I said, where you kind of added an extra row to my Rubik's Cube was that a lot of people will go through. And IBS (irritable bowel syndrome) and it's somewhat of a nebulous thing. That just means you you have diarrhea or you have constipation or you have gas or just any kind of digestive problem.
[00:18:27.730] – Allan Then you throw in some other things that often accompany this same issue and diagnosing it and then beyond diagnosing it, actually knowing how to treat it. Because, like you said, we we want to be able to remove what we need to remove without doing complete damage to the entire rest of our system. So you talked about topics like SIFO, which is more of a fungal thing like candida. You talked about estrogen dominance and kind of some things about the thyroid that often come hand in hand, almost like you said, amigos. But I would say Co-villians.
[00:19:11.280] – Phoebe Yeah.
[00:19:15.550] – Allan They're basically the criminal mastermind group that gets together to go against the Superfriends. Can you kind of talk about a few of those that, for lack of a better word, are related issues that you'll find with SIBO?
[00:19:28.330] – Phoebe Yeah. So SIFO, that one is easy. So that's just the same acronym. But instead of bacteria you've got fungus overgrowing, which Candida falls into that category. And it's because the mechanics again, when the mechanics go off the rails, you have a chance for anything to overgrow. So I can give you a little bit of an overview of of what the main reasons why someone who gets SIBO might have as contributing factors.
[00:19:55.120] – Phoebe So kind of the first category is any sort of structural impediments. A lot of people have had any sort of abdominal surgery, even if it's laparoscopic, you kind of have this internal scar tissue that you may not know about that kind of restricts or changes the movement.
[00:20:13.060] – Allan And that even includes a hysterectomy, right?
[00:20:14.770] – Phoebe Yeah, yeah. And like not to scare you, but if you have some sort of tumor like that, it's going to change the structure of the abdomen and endometriosis is a big one for women. It causes the endometrial lining to occur outside of the uterus, and that can mean a lot of growth that are bearing down on the intestines. It also can mean a lot of laparoscopic surgeries. So, check check both boxes there.
[00:20:38.890] – Phoebe The second big category has to do with something called the migrating motor complex. Again, something that I never heard of when I just did my basic gut research prior. But this is the street sweeper wave that moves food through your small intestine. So it's not like the same as peristalsis. It's kind of described as cleaning up the dishes after a meal. So it just helps literally to kind of like conveyor belt food through. And so when that breaks down and it can for so many different reasons, then that's, of course, going to equate to an overgrowth very easily.
[00:21:16.330] – Phoebe The third category, I would say, is just various ways that bacteria aren't killed. So someone with an immune deficiency, someone with low stomach acid, someone with out a gallbladder, anyone who's not producing enough enzymes or bile, that's of course, all those ingredients were designed by your body to neutralize unwanted bacteria because bacteria is coming into our body through our nose and mouth every single day. It's just part of the way of life. So, again, like included in those ingredients could be yeast or fungus. And our body is naturally going to have a certain level of bacteria and fungus, but not in the small intestines per say, because we're meant to have a lot of bile and acid in there and we're meant to have this street sweeper wave moving things through
[00:22:11.320] – Phoebe The second category, I think of the overlapping conditions that you mentioned would kind of fall under hormones. Hypothyroidism and Hashimoto's, which is what I wrote about in my last book, The Wellness Project, I didn't even realize, really goes hand in hand with SIBO. And it's because you need a healthy gut in order to have your inactive thyroid hormone T4 converted into T3, which is the active thyroid hormone. But on the flipside, you need the T3 hormone in order to have a healthy gut so it can become this real vicious cycle, as many things with SIBO can.
[00:22:51.520] – Phoebe So that's one. And then estrogen dominance you mentioned again comes down to hormones. So our liver is such an important player in the digestive process if your liver is not functioning up to snuff, you're going to not be carrying out your estrogen in the way you should, and then that could create estrogen dominance. And you also could have estrogen dominance because of all the hormones in dairy products and the animals we eat and the personal care products we put on our body. There are just so many ways that that can happen.
[00:23:23.390] – Phoebe And then guess what? Estrogen dominance can also prevent you from converting your thyroid hormones properly. So all of these things, again, do feed into one another. And another funny one with the Hashimoto's and estrogen dominance connection is that if you're not pooping and stuff which can happen is a very common symptom of Hashimoto's, because if you're not if you don't have enough T3 in circulation, the migrating motor complex doesn't work as well. So again, you're going to have a motility issue. You tend to not be able to absorb your B12 as much, which also leads to brain fog. So, yeah, again, you're not pooping enough, then you're going to have estrogen dominant because you're not getting rid of your excess hormones.
[00:24:16.910] – Phoebe Oh, gosh, that's a lot to keep track of.
[00:24:19.880] – Allan It is. And that's why I think this book is valuable, because if you're going through this, you have this is a reference. Now, one of the things you got into in the book that I thought was really important because, prior to this, again, I knew there was IBS. We've talked about the low FODMAP diet on the podcast before. But if you can segment this and start to understand exactly what's going on in your body, then you're going to have the right treatment protocol to get things done well, rather than just have to do a full on. Let's just cut everything out, do this huge elimination diet and all of that. You can basically refine how you're approaching things and deal with them the right way, is the testing. And so if you go through and say, okay, I'm going to do the testing, you can get some information about what might be going on. But even that is a little bit of a complexity.
[00:25:13.340] – Phoebe Yeah.
[00:25:13.850] – Allan Can you talk a little bit about the testing?
[00:25:16.190] – Phoebe Sure. So, I get people who write me and are saying I got a stool test and it says I have SIBO. And I just have to politely say, there is no stool test that can tell you if you have SIBO that's really just covering the large intestine. So the main testing for determining SIBO is a breath test and it makes you feel a little bit like a mad scientist when you do it. Essentially the trick is you have to kind of prep your system similar to an endoscopies, a colonoscopy, not as intense, not as crazy, but by modifying your diet for 24 hours before only doing white rice and lean meats, you're trying to make sure that there's nothing left in the canal that could cross react, then fasting for 24 hours, then the morning of you drink a sugar solution. And there are a few different types that they use in these tests.
[00:26:08.720] – Phoebe But essentially you drink this sugar solution and then you breathe into a tube every 15 to 20 minutes, different tests of different intervals, and they measure the levels of gases in your breath. And if they find hydrogen or methane and they're essentially tracking it in those intervals to see how far the sugar solution has made it down your intestinal track. Because once you reach the third hour and it in theory has reached the large intestine, you should see a spike in those gases.
[00:26:37.880] – Phoebe The only reason why you would be seeing these gases in your breath is because of bacteria eating your food. There's no other reason. So if you see within the first hour or two some sort of spike with hydrogen or methane, that could mean an overgrowth. And it is a little bit of the Wild West, different labs and different countries, all and different doctors all have different criteria for what levels constitute a SIBO diagnosis. But at the very least, like a lot of studies have compiled, all the data can see that a positive breath test does correlate to having someone experience some relief after treatment.
[00:27:16.670] – Phoebe So whether you want to call it SIBO or not, there's something wrong that in your digestive system. The treatments for SIBO seem to work. And one of the reasons why that is, is there are different treatments for different types of bugs that are overgrowing. So it's important to kind of see if you're hydrogen dominant or methane dominant or a third type, which now they just introduced a test to test all three at once, which is hydrogen sulfide, dominant.
[00:27:42.410] – Phoebe So it's it's a very complicated and imprecise science, but that's the best we got right now.
[00:27:50.030] – Allan Well, and that is what we have. And you've put a lot of that in the book. So, again, as a reference, I think anyone that's suffering from IBS or SIBO would want to kind of go through this. Now, we don't really have time on a podcast. Like this to go through all the treatment, things that you should consider and all that, but you you hit like really quickly in the book The 10 Treatment Rules of Thumb. Could you kind of just walk us through those real quick? Because I think this is this will give someone an idea of what's involved in actually going through a treatment protocol.
[00:28:21.790] – Phoebe Yeah, I wish I could remember them. I should, like, open the book and have my cheat sheet in front of me. But essentially, there are three buckets. There are different types of antimicrobials. One is a conventional antibiotic and there are a few different types. And the kind of main one for hydrogen SIBO is not as harmful to the large intestines as some conventional ones. It's really designed specifically for SIBO and does a great job and just eradicating the Zebo and not affecting the balance in large intestines. Then there is some herbal options. So just natural combinations, compound formulas of herbal antimicrobials and some antifungals in there as well.
[00:29:04.510] – Phoebe And some doctors prefer to just use like singular herbs when targeting. Unfortunately, those have a little bit more of a wide, broad range, broad spectrum reach. So people who think, oh, I want to go the natural route, it's not necessarily better or worse. I personally want the natural route because I'm one of those people. I'm like, I want to do the natural thing. But they're not innocuous. A really powerful plant medicine. So something to keep in mind.
[00:29:30.280] – Phoebe And then there is this one category called the Elemental Diet, which is not a diet at all. It is, in fact, a medical solution. That is, all of your nutrients boil down to their most elemental form so that they absorb immediately upon reaching the small intestine so they don't make it through far enough for your bacteria to ever feast on them and the treatment plan is to do it for two weeks, which is a long time to just be drinking your food. But it appeals to some people.
[00:30:01.720] – Phoebe With the the varied options in your toolkit, you can really look at what are your lifestyle priorities? Do you want to do you want to get this thing done quickly? Do you want something that's the least expensive? Because budget is your main concern. Do you not want do you want to have a social life and not have to drink your nutrients every single day and actually go out to dinner with your friends? These are all things to keep to keep in mind.
[00:30:24.820] – Phoebe But I think the most important part of treatment, and I'm sure this was in my commandments, which I wrote a long time ago, so I can't remember off the cuff. It really comes down to you can get rid of the bacteria, you can do all these kill protocols. But that's only the first leg of the labyrinth because, again, it's SIBO is just a sign that there's something that's not right. So if it's your migrating motor complex, if it's that you have low stomach acid, if it's that you have some sort of structural issue, you kind of need to uncover those root causes if you don't want SIBO to recur, because that's why it's a chronic condition, is when people don't take the time to uncover those root causes and some of them you cannot fix. But if you know about them, if you're able to keep them in mind, there are lifestyle ways to try and protect yourself as much as possible.
[00:31:17.530] – Allan Sometimes minimizing the damage is the best way to do. Now, you mentioned something, and I think it's really important because most of us actually do want to have a life, and when things get back to normal, we're going to want to go on dates with our spouse, meet a friend for lunch or something like that. We're going to get back to doing that one of these days. If I've got this stomach issue, now I've got a fear, a deep seated fear that I really can't be out in public eating like that or I really don't know how to approach it because I don't know what to eat at a restaurant. You talked about in the book. Can you talk a little bit about how do I plan for and actually go out and eat.
[00:32:05.480] – Phoebe Yeah. So first of all, I'll put the the whole concept of diet in the context of treatment and where it fits in. And it is kind of one of the questions I get asked the most because people are quite confused about it because again, low FODMAP map really, really data back for reducing IBS symptoms does necessarily cure SIBO or help kill the bacteria. Most doctors say on its own, no.
[00:32:27.710] – Phoebe So there are plenty of people who will go through a SIBO treatment and won't make a single change to their diet and they end up fine. That's not most people because again, there's usually a big overlap of other issues, especially autoimmune issues that happen with SIBO.
[00:32:43.310] – Phoebe So the low FODMAP diet is kind of twofold. A, you're trying to get rid of some of the things that are making your body most reactive, making the bacteria most reactive so that you can quiet your immune system and start to heal your gut. Then there's kind of the second camp of thinking, OK, well, I'm starving the bacteria by taking away their favorite foods. I think that's probably less true. And again, why it's not like a treatment in and of itself.
[00:33:12.020] – Phoebe So a lot of people will recommend you do the kill protocol, the quote unquote kill protocol first and then layer on a low FODMAP diet to just help with symptoms. Some people say you can just do it and have it be imperfect. So making sure you're kind of like feeding the bacteria every now and then so that the antibiotics and antimicrobials actually work properly. There's different thinking on it, period. But I will say a lot of people do end up layering in the diet because it makes them feel better. And it's the one thing that you have to control to feel better immediately, because that doesn't always happen with the medication. They're hard core medications, even the herbs. And you may sometimes feel worse when you first go on that because there's a lot of killing involved and that comes with its own toxins and side effects.
[00:34:00.830] – Phoebe So a lot of people end up on these SIBO diets and they end up not having much of a social life because they can't eat out, because one of the biggest categories of ingredients to remove on a low fat diet or a SIBO diet is garlic and onion, which is in 99% everything.
[00:34:17.390] – Allan The delicious things.
[00:34:20.222] – Phoebe Yeah. It's actually really easy, as you'll see in the book, to create gorgeous, delicious food at home without those things. But restaurants have not gotten that memo. There's usually some of it in everything.
[00:34:32.450] – Phoebe But, yeah, I think it comes down to just mindset. And I know a lot of people with Sebo who just have such food fear because, food is associated with symptoms. My biggest piece of advice is if you stray from this diet, if you have symptoms, it's not going to necessarily make SIBO come back. It's not going to set you back beyond the cycle of your digestive system. So you may feel crappy for a day or two, but after that, you're going to be fine. It's not causing any permanent damage. So there is some leeway there for you to go out and have fun. And, if there's a little bit of garlic in your food, it might make you feel bloated and miserable, but you have to just kind of let that go and accept that as a consequence and as a proper tradeoff for having time with your friends and family.
[00:35:21.710] – Phoebe It's harder for vegetarians, I would say, to eat out. But there is usually a scenario at most restaurants, especially like French and Italian, which do have a lot of garlic and onion. But you can usually call ahead. And there's usually a way to have like a piece of protein that's grilled or or seared plain and a side of salad or wilted spinach. I think having done this for a while, if you explain your medical predicament in the off hours before you arrive, then there's usually something that can be done for you that doesn't have to be a spectacle at the table.
[00:35:55.010] – Allan Yeah, having worked in the restaurant business, I can tell you, if you're calling it six o'clock for seven o'clock dinner, they're busy. And so the little girl's going to answer the phone on the at the front of the house and she's going to go back there and say, you really want me to tell the chef this? And it's not going to make it to the chef.
[00:36:12.800] – Phoebe No.
[00:36:13.310] – Allan Whereas if you call at two o'clock in the afternoon when she's basically cutting lemons and wrapping silverware. She'll be able to go back there and the chef is at that point starting the prep and everything, and maybe you talk to the sous chef, maybe talk to the chef. But, yeah, just saying, I've got I've got an issue with garlic and onions. Could I have prepared without them or what would you recommend off your menu? In many cases, they might even have something on their menu that they can just recommend straight away.
[00:36:41.390] – Allan Or you can ask them to modify a few things, get your protein, get the vegetables and that are appropriate for you and charge on. And this is with any way of eating.
[00:36:51.150] – Phoebe Yeah.
[00:36:52.100] – Allan You're the customer that you're the patron coming into that restaurant. So take ownership, make the phone call, get the menu out and have the conversation with them and you should be able to figure it out.
[00:37:08.010] – Phoebe Yeah, I have a friend who has lupus and really can't have any salt. Otherwise, she'll potentially have kidney failure. And that's, again, very hard to do at a restaurant because a lot of the meats are preseasoned and marinated, a lot of even vegetables that are blanched in a pot of salted water in advance, like it can be a real minefield. And she has a very cute laminated card with a note from her mother. That's like it's just like, please don't kill me. And she just asked the waitstaff to take it back into the kitchen. She has places by her house where she knows the staff and the chef and they know what to do with her. She can call in advance. But in last minute scenarios, she has to go back with the card. And people always find something for her. It's maybe sad. It's not ideal, but like they always find a way. So, yes, if you can appeal to someone's conscience or sense of wanting to feed you, that's great.
[00:38:09.060] – Allan Well, that's why they get into that business. That's what they want. So, yeah, you're just asking them to do it in a more responsible way for you. And that's good.
[00:38:19.070] – Allan Phoebe, I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and stay well?
[00:38:27.800] – Phoebe Oh man. So many. So forgive me if I said some of these the last time around because I'm so grateful that I did my wellness project before the CIBO experience, because it really did teach me a lot. And I already had a pretty robust toolkit in terms of the lifestyle stuff that helped me on my way with SIBO. But I would say, number one, set yourself up for success at home so you can find more freedom out in the world, assuming we'll all be more out in the world at some point.
[00:38:58.790] – Phoebe But maybe this past year has been a blessing in disguise for a lot of people setting themselves up in that way at home. So I think kind of one time swaps for me, just like switching everything over to natural's in terms of cleaners, personal care products, et cetera, was huge. And I never have to think about it again.
[00:39:15.680] – Phoebe And the three meals a day that I eat where I have to think about putting a filter on my tap, never have to think about getting chemicals out of my water again. I just know that those things are lowering my toxic burden every single day without me having to lend any sort of mindspace to it.
[00:39:36.800] – Phoebe Then I would say number two is more specific to SIBO is that how you eat is much more important than what you eat. I know the information circulating out there is always around what you're eating, but again, thinking about kind of the mechanics of your digestive system, how you eat it truly is much more important.
[00:39:57.800] – Phoebe So that migrating motor complex, it only kicks into gear during a fasting state of 90 minutes or more. So that means it doesn't matter what you're eating, but if you're snacking all the time, if you're grabbing for a couple almonds and even if it's not prepackaged, like but certainly prepacked is the so that it doesn't matter, like your you're stopping that function from kicking into gear and that's going to prevent food from moving through your system in the way it was meant to.
[00:40:25.250] – Phoebe And then number three, I would just say, like, do not forget about the the mind gut connection and the power of mindset in general. I do think if we stress too much about what we're eating, it doesn't matter how much kale or what have you is on your plate. You're not going to be healthy and you could be creating symptoms without even knowing it. I know that happens to a lot of SIBO people on the other side of treatment.
[00:40:50.540] – Phoebe And when they're starting to reintroduce, there's just so much fear around it that it becomes a self-fulfilling prophecy. So for that reason, I'd say like if you have IBS, if you have a lot of gut issues, don't just look into all these protocols, but maybe also look into a modality that's not talked about as much like hypnotherapy for IBS, just as effective as the low FODMAP diet for reducing symptoms. And I would say probably has more of a holistic impact on your overall condition.
[00:41:20.640] – Allan Thank you, Phoebe. If someone wanted to learn more about you or about the book, SIBO Made Simple, where would you like for me to send them?
[00:41:28.530] – Phoebe You can send them to SIBOmadesimple.com for everything about the book and to get some of the bonuses, which will still be available after launch. And for recipes, you can go to feedmephoebe.com and really just to keep up with my my usual happenings, the best place to go is Instagram, which is just my name at Phoebe Lapine.
[00:41:51.540] – Allan Cool. So you can go to 40plusfitnesspodcast.com/475 and I'll be sure to have the links there. Phoebe, thank you for being a part of 40+ Fitness.
[00:42:01.980] – Phoebe Thank you.
[00:42:08.070] – Allan Welcome back, Raz.
[00:42:09.690] – Rachel Hey, Allan. Wow! I don't know that SIBO is very simple. It sounds like a very complicated situation.
[00:42:16.410] – Allan It is. I compared it to a Rubik's Cube. And that's kind of one of those puzzles that I've never really ever wrap my mind completely around. There is an algorithm to it that they tell you, get this side worked and then you can just start doing these things. And over time, you're going to end up with with a solved puzzle. I'm not going to say that this is that simple, but Phoebe did do a pretty good job of putting together an algorithm for you, for lack of a better word, approach, a program to kind of help you deal with this, because it isn't simple.
[00:42:51.700] – Allan It's just not a simple thing. And it's never necessarily even one thing. Sometimes you've got two or three things all coming in together. And that complexity means that most of the time you go to your doctor and you're going to hear, oh, you have IBS.
[00:43:07.050] – Rachel Mm hmm.
[00:43:07.710] – Allan Are they going to know what's causing the IBS. Not necessarily. So you have this syndrome that they really haven't defined what's wrong with you. And they can try they'll try different things. But in many cases, it's just going to make things worse. So Phoebe did do a really good job of making it as simple as it can be. So if you're dealing with this, I mean, just something I've never really had to deal with. I've got a steel tank for a stomach that can pretty much I'm going to be fine.
[00:43:36.630] – Rachel Lucky you!
[00:43:38.300] – Allan The only thing I've ever eaten that I that I probably had to stress with was was durian fruit in Malaysia. And the problem I had was. One, it smells horrible, too. It doesn't taste that good. They like it and the Japanese like it. But and then three, it made me extremely gassy. And I had it the day before I got on an airplane for the States. So yeah, 15 hours on an airplane after eating durian fruit. I was not a very popular person.
[00:44:08.910] – Rachel That's so aweful.
[00:44:11.700] – Allan Otherwise I can pretty much eat anything. And I do well. I don't have a lot of stomach distress, but I recognize the impact it has on people's lives. If you're having to wait for a movement in the morning before you feel comfortable and confident to leave the house, that's that's not a good scene. That's not how you want to live. And so making sure that you're doing the right lifestyle things to to manage your health and manage your gut microbiome, because there are no real short, simple answers.
[00:44:45.930] – Rachel Yeah. It's a good thing she wrote this book because SIBO is such an unusual situation. And the thing with IBS is that it has a broad range of of symptoms and it's hard to sometimes put your finger on. And like you mentioned, it's hard to get diagnosed properly. So to have this kind of handbook to highlight some of the key points, to watch for or to or even the treatments to try seems like a really beneficial thing for such a unique disease or problem.
[00:45:15.750] – Allan And to your to your point there, I mean, yeah, when constipation and diarrhea are both symptoms of the same thing.
[00:45:22.110] – Rachel Oh my gosh. It happens all the time and it could be just something you ate or it could be the signs of a bigger looming problem. It's hard to figure out.
[00:45:33.390] – Allan Yeah, but if it's something you're dealing with on a day to day basis, you've got to actually put the time in and get that fixed because that's that's pulling away from the quality of your life. And, I say this at the end of every show, you know what? What are the things that you would do to be healthy and fit and happy? Those are all in my wellness formula. You have to have all three. And if you're dealing with stomach distress and other symptoms of SIBO, it's worth taking the time to work through some of these protocols and try to get that under control.
[00:46:05.730] – Allan And one of the cool things about the human body and particularly our digestive track is it heals itself. So if you take the time to do those things, you might not ever have to deal with this again. Once you've solved the problem, unlike a lot of other chronic illnesses, you have to keep treating it. You have to keep dealing with it. But SIBO is one of those things that once you kind of get that bacteria out of your small intestine, once you get the maybe even the fungi, because, again, the SIFO, once you get that stuff done and out of your system, if you're eating right and you're doing the right lifestyle things, it's probably not going to come back. And that's that's a very positive message to kind of take out of this is, if irritable bowel syndrome syndrome is something that you deal with on a regular basis, there is a solution. And Phoebe has done a really good job of mapping that out, taking care of herself. This is something she personally went through. And then she's done the research a lot of really good research with that to put forward solutions for you.
[00:47:10.950] – Rachel That's really wonderful. It's nice to have that ray of sunshine knowing that it's treatable and you may not ever have to deal with it once you know how to treat it and maybe watch the foods to avoid are the the way of eating that you should avoid.
[00:47:27.820] – Allan I finished up the pre launch of my 12 week program and man, I cannot tell you how proud I am of the 12 people that went through this program.
[00:47:38.640] Yay, they worked… they're working so hard because they're still in it. It's 12 week program. Some of them started all the way back in early December, the last days of December, even before New Year's Eve. So they they didn't wait for New Year's resolutions. They jumped on it. And then I've got others that have just come in recently. So they're just kind of getting started. But it's like having a family now.
[00:48:00.260] I mean, we're really, really cool to have people that are all going through a common mission, try to get healthy and fit to try to lose some weight. And they're doing it and they're doing it. And it's not always a straight line and then gathers struggles just like any other thing that's worth having. But they're putting the work in and it's just so rewarding to watch people succeed at something that they've struggled with. One of the clients in there, she said before we got on there, she says, is it can you even lose weight when you're over 50?
[00:48:30.740] – Rachel Oh, wow.
[00:48:31.640] – Allan She had this limiting belief that you couldn't lose weight after the age of 50, particularly if you're a woman, that she was just destined to stay overweight.
[00:48:42.260] – Rachel Wow.
[00:48:43.610] – Allan She's learning so much about her body and learning so much about how she can get healthy and as a really cool side effect of being healthy, losing weight. It's just it's just really exciting to see that change in people. So I'm loving what I'm doing right now.
[00:48:58.760] – Rachel That is so exciting. What are some of the commonalities you're seeing? Are you seeing people moving more or making some really neat swaps with their diet? What are you seeing with your change with your group?
[00:49:09.880] – Allan It's a little bit of all of it, because as as as we look at making changes like this that are not just a diet, so you go in and say, Okay, here, I'm going to go on, I'm going to go on a diet and then I'm going to do that. So I lose the five pounds or the 15 pounds that we're trying to lose here. And then you say, okay, I'll just I'll go back to eating what I ate before because I lost the weight. And guess what happens? The weight comes back and it comes back with a vengeance. And people like I don't understand, I diet and then again, all back. Well, you didn't stay eating a way that was sustainable for your body. So what we're trying to do here is we're trying to look at. Moving more, you've got a trainer that's giving you workouts and holding you accountable, then you have the guidance and support and accountability that you need just to remain active. So that's there.
[00:49:57.350] – Allan And then with the food and everything else is sort of like, Okay, what's sustainable for me. What's the right thing for me? And so I have have 12 people. All of them are eating their own way. They're all unique in what they're doing, the exercises they're doing because they're building a sustainable lifestyle that works for them.
[00:50:19.970] So there are some commonalities. Yes. If you were used to eating a certain food and you're like, I really want pizza, just an aside, so pizza. Pizza's one of those dangerous foods in general because it's high carb and high fat, okay, and that's that's just like you're just telling your body that you don't like it. I just don't get me wrong. I love this too. But it's high fat and it's high carb. And so it's way too many calories for the nutritional value that you're getting from a pizza to be worth it. And so some people, it's just like, okay, they ordered pizza and I scraped the topping off and didn't eat the bread. Is that a good thing? I said yes, better. And then I shared a recipe for what they call the fat head pizza crust, which is just basically cheese and almond flour. And basically you make a crust with that and then you put your toppings on. So is it the healthiest thing or the best nutrition thing in the world? And the answer's no, but it's not high fat, high carb anymore. It's high fat. And what you'll find with the with the fat head type pizza is you just can't eat six slices of this stuff.
[00:51:37.704] – Rachel Gosh no!
[00:51:40.740] – Allan You're going to eat one or two slices and say, oh, my goodness, I am I am full. And you're six hours later, you're still going to be full. Ao that's one of the advantages of of things like that when you're when you're you're looking at the not just the calories in, calories out because it is a thing. But we're going to I'm going to talk about that in an upcoming podcast. But there's also the what you're eating and are you getting the nutrition you need. And there's the hormone piece. And so all of those are layers on something that's a very complex thing that everybody want a simple rule.
[00:52:15.200] – Allan Tell me what to eat. Tell me what's naughty. And it's it's never really that simple, because if I told someone they could never have pizza again every single day of their lives, they're going to be craving pizza because I said they couldn't have it. So not saying you can't have it just under. And what it is, I have a plan and then manage to that.
[00:52:38.310] – Allan If you slip up, it's like, okay, you went out with friends and you had a piece of pizza. You're not going to die.
[00:52:46.360] – Rachel No.
[00:52:47.590] – Allan But now you put the carbs in your system, you put the high fat in your system, and you feel a little bloated, you feel a little bad the next day because you did it. And if you did it for the right reasons, then that's great. But if you didn't, then lesson learned. Let's move on.
[00:53:05.030] – Allan There's not one common lesson. And I think that's why at times I've used cookie cutter stuff and it generally works for most people. But some of those things are just not sustainable because they're cookie cutter.
[00:53:19.000] – Rachel Right.
[00:53:19.630] – Allan They're not designed for you. And so everything I'm doing with this program is completely custom. And so I'm talking to each and every person, what do you like to eat? What do you do? I've got a vegetarian in there. Other people that were like, you mean I get to eat meat and I'm like, you get to eat meat, you should be eating meat if you like meat, it's got tons of great nutrition in it. You don't have to ignore or throw out an entire food group. And no, I don't consider carbs a food group. I consider vegetables a food group. I consider meat a food group. And so I'm not saying you can't have carbs, you can have some carbs, but you want to get it from sources that are actually food.
[00:54:02.180] – Rachel Yes.
[00:54:02.800] – Allan And pizza dough is not actually food.
[00:54:07.290] – Rachel No nutrients in that that's for sure.
[00:54:09.910] – Allan Well, they might they might enrich the the flour with with some B vitamin, niacin. But at best that's that said it's enriched flour but it's flour and it's going to be blood sugar and it's going to be insulin and then it's going to be fat.
[00:54:25.900] – Rachel Yeah.
[00:54:26.800] – Allan Because you're eating the high fat on top of that, the calories are higher and boom, it's like, OK, we've got all this stuff, let's just start storing it because I got nothing. I got nothing to do with this. And so it just stores it as fat. And so, that's the unfortunate reality of things, is you don't have to say no, but you might have to substitute or if you're going to do it, at least understanding what it's going to mean in your overall approach to health and wellness.
[00:54:55.990] – Rachel That sounds awesome. Well, I'm really excited for all your people who get these customized training programs and and tips and and all this support from you. I'm really excited to see that success. That's wonderful.
[00:55:08.120] – Allan Yeah, they're having… I'm having a ball. They don't know exactly. But at the same time, I'm saying, well, what do you what are you missing? What's not there that you want there? And for the most part, they're not really missing much.
[00:55:25.600] – Rachel No, but it's a big habit change, though when you're used to eating something or moving in a certain way, sometimes it's really hard to make those big changes. But once they try it, it leads to other things. When you are starting to eat well, you can move better. And when you're starting to move better, you want to eat better. So it's like a snowball. Once it gets rolling, it gets better. So that's exciting.
[00:55:53.110] – Allan Anything else you want to go over, Rachel, before we call it a day?
[00:55:56.140] – Rachel No, today was a good one, but thank you.
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