SIBO and Leaky Gut: What the Science Says (webinar recording)

Ajouté : 2026-05-11

[00:00:11]Hello everyone and welcome. I'm Dr. Michael Greger coming to you live from my new treadmill. Just got it Wednesday.

[00:00:20]So quiet, so smooth, I don't think I'm ever gonna want to get off it. yesterday racked up 75,000 steps, hoping today to make six double digits. We will see. I'm currently sheltering in place uh until the world opens back up uh here in Washington State, which just recently opened up eligibility for the vaccine to everyone.

[00:00:47]And so finally in line um to uh get my shot wall I researched how not to age on the latest in longevity research. Tons of research but I should be able to get the book out December 2022 and hopefully then I will resume my speaking schedule and come to your hometown in 2023.

[00:01:13]Before hunkering down to write the new book though, I had to script out an entire year's worth of videos uh for nutritionfacts.org uh so I could truly immerse myself in the longevity research piece. And it is from this large batch of cued videos where I pull video um pull videos for the various webinars I've been doing every month or so. And uh so that's where this webinar came about on SIBO and leaky gut. Now I know in the last webinar I did the fun giveaway thing.

[00:01:49]Name that fruit. I was hoping it would become a regular thing but alas evidently Zoom could not handle it.

[00:01:56]There were so many thousands of people chatting in answers at the same time that Zoom crashed on the computer uh that was recording it. Thankfully, we had a backup. Um, but uh and it's possible it was totally random occurrence, but that has never happened before. And so, I've been asked to cool it with the fruit contests, but maybe when I'm back on the road, right, we can do it face to face and then maybe eat all the entries in the afterparty. So, looking forward to getting back out there. Anyways, are you ready to learn everything I think there is to know about SIBO?

[00:02:37]All the sneak peek videos I'm going to show are eventually going to be up on nutritionfacts.org over the next few months, but you're going to see them all right here, right now. But first, some housekeeping logistics. If at any time you run into technical difficulties, there are live chat room staff standing by. Let me paste that link in the chat.

[00:03:01]Um I don't with so many people chatting.

[00:03:03]I don't know if people will even be able to see it, but there it is. I just uh um pasted the link. Now, if they're unable to help, we also have nutritionfacts.org staff standing by, too. Though presumably if Zoom can't help, I don't know what we could do, but we of course want to avail ourselves to you. So, I'm going to um just put that in the chat as well. Um All right.

[00:03:26]Please reserve the Q&A button that you see in the Zoom window there to ask content questions. Uh the webinar uh is only going to go for an hour, super quick, way too fast hour. I have reserved some time for Q&A at the end, but feel free to add your questions any time throughout the webinar and the nutrition facts team will compile them all to be answered at the end. um particularly the most common questions that come through. Um and uh you may want to wait to see if your question is actually answered in the actual webinar or you can just um uh you can just um fire it away by clicking the Q&A button.

[00:04:08]You don't have to say worry about taking notes or everything anything because after the webinar is over, we are not only going to send you a full recording of it, but also a free link to download all the videos at high definition so you can see the uh videos in all their full resolution glory.

[00:04:26]All right, let's get started. Let me start with a video entitled, "Are small intestinal bacterial overgrowth SIBO tests valid?" Let's find out.

[00:04:53]Gastrointestinal symptoms like abdominal pain and bloating account for millions of doctor visits every year. One of the conditions that may be considered for such a non-specific presentation of symptoms is SIBO, small intestinal bacterial overgrowth. A concept that has gained popularity on the internet. In addition to certain clinical research circles, SIBO is broadly defined as the excessive growth of bacteria in the small intestine and is typically treated with antibiotics. But dispensing antibiotics to patients with such non-specific common symptoms is not without risks. You could be fostering antibiotic resistance. There could be side effects. And wiping out your good bacteria could set you up for an invasion of bad bugs like CIFF. all for a condition that may not even be real.

[00:05:46]Even alternative medicine journals admit that SIBO is being overdiagnosed, creating confusion and fear. SIBO testing is overused and overly relied upon. Diagnoses are often handed out quickly and without adequate substantiation. uh patients can be indoctrinated into thinking SIBO is a chronic condition that cannot be cleared and will require lifelong management.

[00:06:09]This is simply not true for most and is an example of the damage done by overzealousness.

[00:06:17]The monster that we now perceive SIBO to be may be no more than a phantom.

[00:06:24]The traditional method for a diagnosis was a small bowel aspiration, an invasive test where a long tube is snaked down your throat to take a sample and count the bugs down there. This method has been almost entirely replaced with breath testing. See, normally a sugar called glucose is almost entirely absorbed in the small intestine. So, it never makes it down to the colon. So if there is bacterial fermentation of that sugar that suggests you have bacteria up in your small intestine and can detect that fermentation because the bacteria produce specific gases that get absorbed in your bloodstream and then are breathed out from your lungs which can then be detected with a breathalyzer type machine. Previously a sugar called lactulose was used but laculose breath tests weren't found to reliably detect the overgrowth of bacteria. So researchers switched to glucose. But when glucose was finally put to the test, it didn't work either. The bacterial load in the small intestine was similar for those testing positive or negative. So that's not a useful test either. It turns out glucose can make it down to your colon after all. They labeled the glucose dose with a tracer and found that almost half of the positive results from glucose breast tests were false positives because they were just fermenting it down in their colon where your bacteria are supposed to be. So patients incorrectly labeled with SIBO may undergo multiple courses of antibiotics for a problem they don't even have.

[00:07:54]Why do experts keep recommending breath testing then? Oh, you mean the experts at the conference supported by a breath testing company, most of whom had personally received funds from SIBO testing or antibiotic companies. And even if we could properly diagnose it, does it even matter? In those with digestive symptoms, there is a range of positivity for SIBO from approximately 4% to 84% all over the map. And there may be no difference in symptom scores between those testing positive versus those testing negative. So testing positive could mean anything. Who cares if some people have bacteria growing in their small intestines if that doesn't necessarily correlate with symptoms? Now antibiotics can make people with irritable bowel type symptoms diagnosed with SIBO feel better. So doesn't that prove SIBO was the cause? No, because it can make just as many people feel better who are negative for SIBO. Currently, Refaxamin is most often used for SIBO, but it's not FDA approved for SIBO. So, the cost can be prohibitive for SIBO. So, even if you have good insurance, you may be shelling out of pocket as much as 50 bucks a day and you typically take it for two weeks. And while antibiotics may help in the short term, they may make things worse in the long term. Those who are given a course of antibiotics are more than three times as likely to report more bowel symptoms four months later than controls. So what can we do for these kind of symptoms?

[00:09:31]That's exactly what I'm going to turn to next.

[00:09:40]All right. You know, I just realized completely independent of the topic.

[00:09:45]This is actually people's first sneak peek. Everyone who just watched that is the first sneak peek at our new video format.

[00:09:55]You know, uh um before the pandemic, you know, it was me against a green screen talking about the studies as they flash by. Then uh I couldn't get into a recording studio and so we had to have some kind of like you know we had to go back to just showing the papers and we're always trying to figure out what's the best way to show it. Um I think before there was so much movement of pages on the screen it got a little disorienting hard to watch. So this is our new attempt. Um where so there's a little less movement the the quotes come out a little clearer. Um so yeah I'd actually be interested to know what people think. So, but this is the future, at least the near future um of nutritionfacts.org uh in terms of what the videos are going to look like. I hope people hope people liked it. I didn't even realize that this webinar would be people's first sneak peek, but very cool. All right. Anyway, um getting back to the subject at hand, I just want to reiterate that even if we could accurately diagnose SIBO if there's no difference in the symptoms between those testing positive and those testing negative, what's the point of even there being a clinical entity called SIBO, right? It turns out it may not be the number of bacteria growing in your small intestine but rather the type of bacteria which can be connected with diet. I give you next video fiber versus low FODMAP for SIBO symptoms.

[00:11:48]Gastrointestinal symptoms like abdominal pain and bloating account for millions of doctor visits every year. One of the conditions that may be considered for such a non-specific presentation of symptoms is SIBO, small intestinal bacterial overgrowth, a concept that has gained popularity on the internet in addition to certain clinical research circles. SIBO is broadly defined as the excessive growth of bacteria in the small intestine and is typically treated with antibiotics. But dispensing antibiotics to patients with such non-specific common symptoms is not without risks. You could be fostering antibiotic resistance. There could be side effects. And wiping out your good bacteria could set you up for an invasion of bad bugs like CIFF. All for a condition that may not even be real.

[00:12:41]Even alternative medicine journals admit that SIBO is being overdiagnosed, creating confusion and fear. SIBO testing is overused and overly relied upon. Diagnoses are often handed out quickly and without adequate substantiation. Uh patients can be indoctrinated into thinking SIBO is a chronic condition that cannot be cleared and will require lifelong management.

[00:13:05]This is simply not true for most and is an example of the damage done by overzealousness.

[00:13:12]The monster that we now perceive SIBO to be may be no more than a phantom.

[00:13:19]The traditional method for a diagnosis was a small bowel aspiration, an invasive test where a long tube is snaked down your throat to take a sample and count the bugs down there. This method has been almost entirely replaced with >> Sorry about that. I was playing the wrong video. Okay, sorry. Now on to video two.

[00:13:41]If you test more than a thousand patients suffering from irritable bowel type symptoms such as excess gas, bloating, diarrhea, and abdominal pain for longer than 6 months who don't appear to have anything more serious going on, such as inflammatory bowel disease, a significant percentage were found to be suffering from lactose intolerance. intolerance to the milk sugar lactose. In infancy, we have an enzyme in our small intestines that digests milk sugar, but most of us understandably lose it after weaning.

[00:14:12]Although a genetic mutation has led to the persistence of the enzyme in a minority of adults, about 75% of the world's population malabsorb lactose and have lactose intolerance after age 30. A third though were diagnosed with SIBO, small intestinal bacterial overgrowth.

[00:14:31]The evidence for SIBO and IBS symptoms is shrouded in controversy predominantly because of the fact that the breath tests used in clinical practice to diagnose SIBO are not valid. As I explored in the last video, it's not even clear what the implications are of having more versus less bacteria growing in your small intestine since the number don't seem to correlate with symptoms.

[00:14:55]It turns out it's not the number, but the type. It's the kind of bugs you have growing in your small intestine. So, it's small intestinal microbial disbiosis, not overgrowth in general, but the wrong kind of growth that appears to underly symptoms associated with functional gastrointestinal disorders like irritable bowel syndrome.

[00:15:17]How can you prevent this from happening?

[00:15:20]Well, the symptoms appeared to be correlated to a significant drop in the number of prevatella species. Remember them, prevatella are healthy fiber feeders suggestive of a higher fiber intake in healthy individuals. While the bugs found more in symptomatic patients ate sugar, which may reflect a higher dietary intake of sugars.

[00:15:41]Yes, but correlation doesn't mean causation. To prove cause and effect, you have to put it to the test, which is exactly what they did.

[00:15:51]Switching a group of healthy individuals who habitually ate a higher fiber diet to a more typical standard American low-fiber diet with lots of sugar produced striking results within just 7 days. The first 80% developed new gastrointestinal symptoms out of the blue such as bloating and abdominal pain that resolved on resumption of their more healthful habitual higher fiber diet. And the diet related changes in the small intestinal microbiome were predictive of symptoms and linked to an alteration in intestinal permeability.

[00:16:25]In other words, they developed a leaky gut within 7 days. And while some went from SIBO positive to SIBO negative or SIBO negative to SIBO positive, it didn't matter since the number of bacteria growing didn't correlate with symptoms. It was the type of bacteria growing. And no wonder their guts got leaky. Short-chain fatty acid levels plummeted. Those are the magical byproducts that are good gut bugs make from fiber, which play an important role in intestinal barrier integrity, meaning keeping our gut from getting leaky. So, while we don't have sound data that something like a low FODMAP diet has any benefit for SIBO symptom patients, there have been more than a dozen randomized control trials putting fiber to the test. And overall, there was a significant improvement in symptoms among those randomized to increase their fiber intake. That may actually help explain why high-fiber plant-based diets may prevent so many common diseases. the effect such diets have on the composition and metabolic activity of our microbiome. Our good gut bugs take the plant residues like fiber and produce healthpromoting and cancer suppressing metabolites like those short- chain fatty acids which have profound anti-inflammatory properties.

[00:17:42]All the evidence points to a physiological need for about 50 grams of fiber a day, which is the amount contained in the traditional African diet and associated with the prevention of westernized diseases.

[00:17:55]That's approximately twice what's typically recommended and three times more than what most people are getting dayto-day.

[00:18:02]Perhaps it should be no surprise we need so much. Even though we split from chimpanzees millions of years ago, there's still broad congruency in the composition of our respective microbiomes to this day. While they're still eating their 98 to 99% plant-based dice to feed their friendly flora with fiber, we've largely removed fiber richch foods from our food supply.

[00:18:31]Okay, sorry about that. because uh I uh had started that first video again. Uh but uh caught it uh after a little while. Um I just uh I'm always doing a million things uh while these these videos are playing. But all right. Okay, we're good. Okay. Um so uh again, it's not about treating SIBO since it doesn't matter if we have bugs growing in our small intestines or not.

[00:19:01]But the way to treat SIBO symptoms, symptoms that have been ascribed to this syndrome that is meaningless is to feed the good bugs. And you do that with fiber and resistance starch, so called prebiotics, which are found concentrated in whole grains, especially gros, whole intact grains like ryberries or barley gros. my whole brawl bowl thing. You know, I did a a recipe recently using some bol um which stands for barley, rye, oats, lentils, or you can I actually did some kind of the what did I do? I added sorghum and a type of millet. And anyway, lots of ways you can do it. Lots of different growths out there. Um um so intact whole grains and legumes, beans, split peas, chickpeas, and lentils. um actually has the most um per serving. And so I mean that's really the only way you're going to nail at least easily nail the 50 grams of fiber a day that we need.

[00:20:11]Though of course all whole foods have fiber, right? Processed foods have little or none and animal foods have zero. Um, and the common fiber supplement psyllium sold as Metamucil is useless in this regard since it's nonfermentable by our friendly flora, right? It can help with constipation, but our good gut bacteria can't actually eat it. You actually have to eat real foods. And it's particularly those drier foods like whole food, like whole grains and legumes have the most fiber just because um most fruits and vegetables are mostly water between 80 and 90% water. And so yes, it has fiber, but you eat a whole bunch and there's actually just a little fiber in there as opposed to uh gats and beans.

[00:20:59]All right, so eat your hummus is the uh is the answer here. But all right, let us move on. Um, so we are going to move on now to a focus on leaky gut with a video if I get the video right this time. Foods to avoid to prevent a leaky gut. Let's find out.

[00:21:33]Intestinal permeability. The leakiness of our gut may be a new target for disease prevention and therapy. With all of its little folds, our intestinal barrier covers a surface of more than 4,000 square feet. That's bigger than a tennis court and requires approximately 40% of our body's total energy expenditure to maintain. Mounting evidence implicates the disruption of intestinal barrier integrity in the development of numerous ailments such as inflammatory bowel disease. Here, researchers measured intestinal permeability using blue food coloring.

[00:22:07]It stays in your gut if you're healthy, but can be detected in the blood of extremely sick individuals as their gut barrier breaks down. You don't have to end up in the ICU to develop a leaky gut, though. Simply taking some aspirin or or ibuprofen can do the trick.

[00:22:23]Indeed, taking two regular aspirin or two extra strength aspirin just once can increase the leakiness of your gut.

[00:22:30]These results suggest even healthy individuals should be cautious with aspirin use as may result in gastrointestinal barrier dysfunction.

[00:22:39]What about buffered aspirin? It doesn't make any difference. Both regular aspirin and buffer produced multiple erosions in the inner lining of the stomach and intestines. Put a scope down people's throats and you can see extensive erosions and redness inside 90% of people taking aspirin or bufferin in their recommended doses. How many hours does it take for the damage to occur? None. It happens within five minutes.

[00:23:09]Acetaminophen sold as Tylenol in the US would be a better choice unless you have problems with your liver. And rather than making things better, vitamin C supplements appeared to make the aspirin induced increase in gut leakiness even worse. Interestingly, this may be why NSAID drugs like aspirin, ibuprofen, and neproxin are involved in up to 25% of food induced anaphilaxis. In other words, increasing the odds of life-threatening food allergy attacks by more than 10fold. Presumably, because these drugs increase the leakiness of the intestinal barrier, causing tiny food particles to slip into the bloodstream. Okay, but why can exercise increase risk too? Strenuous exercise like an hour at 70% of maximum capacity can divert so much blood to the muscles away from your internal organs that can cause transient injury to your intestines causing mild gut leakiness.

[00:24:05]But this can be aggravated if athletes take ibuprofen or any of the other NSAID drugs which is unfortunately all too common. Alcohol can also be a risk factor for food allergy attacks for the same reason increasing gut leakiness.

[00:24:20]But cut out the alcohol and your gut can heal up. What other dietary components can make a difference? Elevated consumption of saturated fat, which is found in meat, dairy, and junk, can cause the growth of bad bacteria, which make the rotten egg gas hydrogen sulfide, which can degrade the protective mucous layer. It is said to be clear that high-fat diets in general negatively impact intestinal health by disrupting the intestinal barrier system through a variety of mechanisms. But most of the vast array of studies cited on the negative effects of highfat diet and gut leakiness were done on lab animals or or in a petri dish. You don't know for sure until you put it to the test.

[00:25:04]Rates of obesity and other cardiumabolic disorders have increased rapidly in parallel with a transition from traditional lowerfat diets to higher fat diets. We know a disturbance in our good gut flora has been shown to be associated with a high risk of many of these same diseases. And studies using rodents suggest that a highfat diet unbalances the microbiome and impairs the gut barrier resulting in disease. To connect all the dots though, we need a human interventional trial. And here we go. A six-month randomized control feeding trial on the effects of dietary fat on gut microbiota. And indeed, higher fat consumption appear to be associated with unfavorable changes in the gut microbiome and pro-inflammatory factors in the blood. And note, this wasn't meat and dairy. The researchers just swapped in refined carbs in place of refined fats like white rice and white flour for oil. These findings suggest countries westernizing their diet should advise against increasing intakes of dietary fat, while countries that have already adopted westernized diets should consider cutting down. So far, we've discussed things to prevent a leaky gut. What about foods to heal a leaky gut? That's what we'll cover next.

[00:26:24]Okay. Uh, so damage to your stomach and intestinal lining within five minutes of taking an ibuprofen, right? Think about that the next time you have a headache and you say, "Wait a second. I need ibuprofen because I have painful periods or something." Check out nutritionfacts.org about all the things that work as good as or better than ibuprofen, like ginger powder, ground ginger. You can get any store. Um, and don't cause damage. Actually, protect your, um, gastrointestinal lining. Um, anyway, um, as I said, just to reiterate, also avoid alcohol, cut down on saturated fat and fat intake in general. Um, I know, see, normally when you are able to watch videos on YouTube and nutritionfacts.org, you can rewind.

[00:27:17]I know there's so much information. Uh, you can watch it again, you can watch it slower, you can pause. Um, and so that's why just uh just to reiterate those were that those I think are the takeaways from that video. But I ended that video with kind of a setup for the last one we're going to watch today before taking questions. And that is how to heal a leaky gut with food.

[00:27:54]Our intestinal tract is the largest barrier between us and the environment.

[00:27:59]more than what we touch or breathe. What we eat is our largest exposure to the outside world. Normally, our entire gastrointestinal tract is impervious to what is inside of it, allowing our body to pick and choose what comes in or out.

[00:28:13]But there are things that may make our gut leaky, and chief among them is our diet. What happens is the standard American diet can cause gut dispiosis, meaning a disruption in our gut microbiome, which can lead to intestinal inflammation and a leaky intestinal barrier. Then tiny bits of undigested food, microbes, and toxins can slip uninvited through our gut lining into our bloodstream and trigger chronic systemic inflammation.

[00:28:41]To avoid this dispiosis and intestinal inflammation, plants should be preferred. Vegetarian diet gut bacteria are associated with intestinal microbiome balance high bacterial biodiversity and integrity of the intestinal barrier. They tend to suffer from marketkedly fewer uremic toxins like indole and pressol. And because fiber is the primary food for our gut microbiome, the gut bacteria of those eating plant-based diets produce more of the good stuff, the short- chain fatty acids that fulfill a protective and nourishing role for the cells lining our gut, ensuring the preservation of the intestinal barrier. Plant fiber is of prime importance to the preservation of intestinal barrier integrity, but you can't know for sure until you put it to the test. People were given whole grains, beans and lentils, fruits, vegetables and nuts and seeds and got a significant reduction in zonulin levels.

[00:29:39]Zulin is a protein responsible for the disassembling of the tight junctions between gut lining cells and so it's a biomarker that reflects an impairment of the intestinal barrier. In other words, zonulin is considered to be a useful marker of a leaky gut. But since adding all those plants seem to lower levels, that may imply that appropriate fiber intake helps to maintain the proper structure and function of the intestinal barrier. But whole healthy plant foods have a lot more than fiber. How do we know it's the fiber? And the study didn't even have a control group. That's why they say gut permeability might be improved by dietary fiber to prove cause and effect. It'd be nice to have a randomized double blind crossover study where you compare the effect of the same food with or without fiber. And here we go. People were randomized to pasta with or without added fiber. And there was a significant drop in zonulan levels in the added fiber group. So fiber does appear to improve gut leakiness. Any plant foods in particular that may help?

[00:30:44]Curcumin, the the yellow pigment in the spiced turmeric, can help prevent the intestinal damage done by ibuprofen type drugs, but that's in rats. Similar protection was noted for the broccoli compound sulurophane, but that was in mice. No human studies on broccoli yet, but there was a study on 3 days of the equivalent of about 2 to three teaspoons a day of turmeric, which did reduce the gastrointestinal barrier damage caused by exercise. Less may work too, but no smaller doses have been put to the test.

[00:31:16]If you ask alternative medicine practitioners what treatments they use for a leaky gut, number one on the list after reducing alcohol consumption is zinc. Zinc doesn't just protect against aspirin-like drug induced damage in rats. When put to the test in a randomized trial of humans, the same thing was found. The insaid drug indomethasin caused a three-fold rise in gut permeability as one would expect from that class of drugs. But when they were also taking zinc, this prevented the rise in permeability, strongly suggesting a small intestinal protective effect.

[00:31:52]The dose they used was massive though, 75 milligrams a day. That's nearly twice the tolerable upper daily limit for zinc. What about getting zinc just at regular food doses? There was a significant improvement in gut leakiness even with a dose of just 3 milligs of zinc, suggesting that even relatively low zinc supplementation may work. You can get three extra milligs of zinc in your daily diet eating a cup of cooked lentils.

[00:32:24]Any video that ends with lentil soup is a good video as far as I'm concerned. All right. Once again, the the takeaway from that video, as far as I'm concerned, is fiber, fiber, fiber. All right, we evolved eating probably in excess of 100 grams of fiber a day. Um, if you remember, you can watch that video, Paleo Poo. If you type in paleo poo into nutritionfacts.org talks about copper lights, human copper lights, fossilized species, we have a sense of what we were eating long long time ago and uh estimating over 100 grand tripledigit fiber intakes. That's massive amounts of plant matter. That's what our body is used to. Um and our body just does not seem to work well without it. And where's fiber most concentrated? In beans, which is also where zinc is concentrated. So you can get the best of both worlds. Why do you think in the daily dozen I say I suggest people should be eating legumes, beans, split peas, chickpeas, and lentils three times a day or three servings at least. um which is also what the American Institute for Cancer Research, the kind of most prestigious um body looking at cancer and diet also recommends. Um whole grains, leg gums three times a day. Anyway, all right, it is time for your questions. Let me pull up the questions. Um uh oh, actually I've um I I forgot we did this last time, the last webinar. um there we get so many gazillions of questions that it takes the staff a while to comb through and see which ones are the most common ones etc. So I'm we're actually going to take a fivem minute break allow the staff to to pull them all together um and then we'll come back and answer questions for the rest of the time. So let me uh do that right now.

[00:34:31]Oh hold on hold on where's my little uh zoom thing?

[00:34:40]Zoom. There we go. Okay.

[00:34:46]Okay.

[00:36:22]Nah.

[00:37:24]Heat. Hey, Heat.

[00:37:42]Heat. Heat.

[00:39:58]All right, we are back and uh let's get our list of questions. Oh, if I could just add the ask the staff to add something um to the to the Slack channel where the questions are. Um so it'll pop right back up and I will then star it and be able to hold on to it.

[00:40:17]Just write anything in there and it should give me a new message.

[00:40:26]Let me see. There we go. Okay, we are starring that puppy. Okay, here I have a long list of questions here. I'm going to see how many I can get through.

[00:40:36]Okay, first one on the list is uh is it possible that a plant-based diet like beans and legume specifically beans and legumes causes SIBO symptoms of gastrointestinal pain? What can help with excessive gas and bloating, especially from legumes? That's a fantastic question. Uh kudos to the staff for popping that up first. Um uh so uh people who have uh spent their lives slathering their guts with cheeseburgers and milkshakes uh may not have the microbial machinery in their gut to um handle uh normal levels of fiber. Um, and so you just have to go slow. Um, and, uh, so, uh, so I have a bunch of videos talking about like beans and flatulence or higher fiber foods and flatulence, um, in and bloating, those kind of symptoms in general. And it's all about going slow. It turns out most people actually don't have a problem at all. You can actually randomize people.

[00:41:34]I think that randomized people to chickpeas or carrots. Carrots were like the placebo. They wanted to give people something, but we wouldn't expect carrots to cause anything. Um, and I think if I remember correctly, most people actually did not suffer any gastrointestinal effects of all of a sudden eating I forget how many how many uh it was like half a cup or a cup of chickpeas a day. But for this the minority that did actually experience um excessive flatulence, for example, it disappeared within a few weeks, like two or three weeks, I forget. Again, check out the video. Type in flatulence into nutrition facts and it'll pop right back up. Um and so you just have to give your gut bacteria time. So uh the healthy bacteria in your gut are the fiber feeders like prevata. They eat fiber um and they what do they do with fiber?

[00:42:24]They create these short- chain fatty acids which heal up the leaky gut have actually absorbed from our colon into our bloodstream go up into our brain have anti-inflammatory effects. Um that's how you know high fiber foods help with things like asthma has psychiatric effects. has boosting our immune system. All sorts of wonderful things from these short- chain fatty acids. Um, and how do we get them in our body? By having fiber feeding bacteria in our gut. How do we get fiber feeding bacteria in our gut? By eating fiber.

[00:42:54]Um, and we can foster the growth of the good ones. The bad ones die off. Um, and then we have the best of all worlds. But if you're experiencing if you start eating higher fiber foods and experience gastrointestinal stress, what does that mean? What do you have to do? go slow.

[00:43:10]Even like starting a a spoonful of beans a day, whatever it takes. You just got to get uh those good bacteria rolling.

[00:43:19]Um, so they can uh they can handle uh the fi the prebiotics coming down and then you can build it up to kind of normal human physiology where we're eating where our our colon is just packed with fiber feeding and we just have this massive production of short- chain fatty acids all the time because we're eating fiber three times a day.

[00:43:41]Um, and then we have all these uh benefits from it, but it may take um a while to ramp up, particularly if you had a terrible diet before.

[00:43:53]All right. Um, oh, I just had a there's something in the webinar chat. Just make sure everything's okay. Okay, let's go back.

[00:44:02]Next question. Um, okay. Already answered that. Um, do food in Oh. Do food intolerances like oxalate, sulfur, and histamine go away when SIBO is cleared? SIBO doesn't have anything to do with food intolerances?

[00:44:18]Um, but there is a link between leaky gut um and uh and you know, food allergies. Um, as I talked about with the anifilaxis, um, how can you distinguish SIBO or leaky gut symptoms from ordinary excess bowel activity caused by a plant-based diet? uh plant-based diet should not the only thing in terms of excess bowel activity is more frequent bowel movements but they should be effortless without uh you know pain, bloating, all those symptoms that one would associate with something like irritable bowel um or SIBO um and so uh uh so yeah you can distinguish it because they don't they shouldn't exist.

[00:45:06]Uh if you have to take ibuprofen, how can you offset the gut related side effects by eating more fiber or anything else? Also, is baby aspirin okay for gut health? Um so, uh there was a suggestion maybe that that the turmeric um might help um uh and then um fiber is the way we seal up the gut period. Um, so you can eat a really healthy diet. Um, and you can uh find natural alternatives um to ibuprofen. Um, and I have lots of videos as I said on painkillers. So for example, ginger works for migraines too.

[00:45:45]um if that's why you're taking ibuprofen. Um and so uh so in general if there is a dietary approach that works as well or better then um uh drugs with only good side effects we should go for that in my opinion. Okay. Are there any connection between SIBO and leaky gut and autoimmune diseases? How do you know if you have intestinal impermeability or permeability? Is it related to autoimmune disease or food allergies?

[00:46:15]So, yes, leaky gut is associated with food allergies. Um, if your gut is leaky, little uh the bits of food particles can get through and if you're allergic to it and cause a serious increase your risk of a serious uh reaction. Um, also associated with autoimmune disease like celiac disease.

[00:46:34]with leaky gut um can increase your risk of celiac disease too which is an autoimmune disease to gluten.

[00:46:43]I like next question. I like the brawl bowl recipe. Um curious if I put it cooked in the food processor to make it smoother does that take away nutritional benefits? Ah okay.

[00:46:59]So the whole point of roll um the whole point of gross let's is um is intact grains. So when we think of whole grains we think oh whole wheat bread, whole wheat bagels, whole wheat spaghetti, those are not intact grains. Um they're whole meaning they haven't had the fiber stripped from them. And so, wait a second. If whole wheat flour has all the fiber of of uh of of of whole wheat um berries, you know, the wheat berries, then why does it matter if we flour it or not? Why does it matter if we take oat gros and chop them up into into pieces and make steel cutouts? Why does it matter if we take oat gros and flatten them out into rolled oats? Um, it's the same. It's literally the same thing. In fact, why not go instant oats, which is basically like powdered pre-cooked tiny little flakes of oats?

[00:47:55]It's all has the exact same nutritional profile. So, what's the problem? The problem is missing the structure. Why does that matter? Because your good gut bacteria eat starch.

[00:48:08]Um but um we absorb starch in our small intestine when we uh you know if you eat whole wheat flour um all the starch is out there exposed which is not how it's supposed to be in nature. It's all exposed and it gets absorbed. Um and so yeah the fiber makes it down to a good gut floor but all that starch is lost um for our microbiome. Whereas when we eat food the way nature intended um there are bits. So when you eat nuts as opposed to nut butter for example, when you eat nuts um no matter how well you chew, you get these little few millimeter particles um that are not broken down um and you have all this um nutrition wrapped up. So that's why so for example, it's why nuts are less fattening than nut butters, the exact same amount because you actually poop out some of the fat because it's all trapped in these little particles. Well, when we uh eat oat gros or steel cut oats, which are smaller but still better than something like uh like uh oatmeal, um yeah, you chew all you want. Uh you chew your brawl all you want. you're still going to get little bits of particles um that go down and aren't digested and pack in all this starch and then makes it down to to our uh uh colon and then the colon can then the bacteria eat the fiber release that starch and then they have this bounty um and so there's this great video I love on nutritionfacts.org um where they have people eat the same exact foods um but in two different forms. Um so they had people eat uh like chickpeas or hummus. Um they had people I forget exactly what they used but one was kind of in porridge form, one was a whole intact form. And what happened is they like doubled their stool output. Exact same amount of food. Wait a second. Why do they get twice as much stool when you eat the whole intact foods? It's because most of stool literally more than 50% is pure bacteria. It's not undigested food.

[00:50:11]Pure bacteria. And so you just doubled the amount of bacteria you make. had this like the bacteria factory so many trillions that you actually you actually have this doubled the weight of your stool because all of a sudden when you chew chickpeas as opposed to hummus um they got all those little bits down there, all that extra starch in the colon, all that super happy bacteria, all that um short- chain fatty acids, all that health that comes with it. And so you should not put your gatros in a in a in a food processor. Um that's the whole point of eating gros is that undigested bits end up in your colon to then be digested by our good bacteria?

[00:50:56]Hopefully that made some sense. All right.

[00:51:01]Um do probiotics help cure SIBO? If so, which type is best? Also, is there a way to ensure the probiotics survive stomach acid acidity? Okay. So, um your good gut bacteria will grow all on their own as long as you feed them, as long as you don't starve them. So, better than probiotics would be prebiotics. So, if you because if you take probiotics and eat the same miserable diet, then they're just gonna starve away and die.

[00:51:29]Um, right? Because I mean, the reason you don't have a lot of good fiber feeders in your gut is you're not eating enough fiber. So yeah, you could take capsules of of fiber feeding bacteria like bifidobacteria, right? And then it'll get into your gut and then it'll just die off because you're not eating fiber. better is to actually eat fiber like we should every day, fiber richch foods and then foster the growth of the few little fiber foods we have in there and um then we have this like we have a little fermentation vat going down there um and they make their own new probiot they they they create their own probiotics by just dividing and going crazy um that's the best way to do it.

[00:52:11]Next question is there a connection between SIBO and high blood platelets?

[00:52:14]Not that I know of. What top two or three practical suggestions should RDS, registered dietitians make when working with patients with suspect with suspect SIBO? Okay. So, the first thing you tell them um is that for all intents and purposes, there's no such thing as SIBO, right? It doesn't matter whether you have uh more or less bacteria growing in your small intestine. However, what does matter is symptoms. If you have symptoms, whether you label them SIBO, irritable bowel, whatever you label them, and how best to deal with those se with those symptoms is a high fiber diet. Um, and so what are the top two or three suggestions? Fiber, fiber, fiber.

[00:52:52]That's what I would suggest. Um, but you'd also well, yeah, and all the other things, lowering saturated fat and and reducing alcohol, etc. Okay. Having a gut imbalance, SIBO, leaky gut food insensibility. That's the question. What is a good non-animal source to supply the protein intake when beans and nuts are not tolerated?

[00:53:14]Um well, so um uh um the uh so I hope this may have kind of come through earlier when I didn't get to the whole fiber thing. We want to um you say, "Wait a second. I eat beans. I don't feel good. So what can I eat instead of beans?" Is basically the question. And the answer is you should eat beans, right? Slowly ramp up so you can handle it. Um, that's the best way to do it. Um, uh, and in my videos when I talk about flat zones, I talk about how some, um, there are some, uh, legumes that are less kind of gassy or bloated than others. I talk about beino.

[00:53:54]There's all sorts of ways you can, um, ease that transition to improve your intake. Um, uh, and so, I mean, those really are the plant protein superstars.

[00:54:04]Um but uh um there's obviously you know protein and whole grains um and nuts and seeds um as well. Can SIBO be healed by fecal transplants? So fecal transplants are uh are are ways of kind of u of swapping out the gut in your the the bacteria in your colon, not in your small intestine. Um, and SIBO is not something to be healed because SIBO doesn't matter. It doesn't matter if we have bacteria growing a small intestine because whether we do or not based on tests that actually can tell which is this putting a tube down your throat.

[00:54:48]Some people have uh bacteria uh growing at high and more or less in their small intestine and it doesn't matter terms of correlation with symptoms. Um, so nothing to be healed, but what could be healed is the dispiosis, having not enough good bacteria throughout your um gastrointestinal tract, and that's healed by eating healthy fiber containing foods.

[00:55:14]Um, can PCOS, um, polycystic ovaries cause leaky gut?

[00:55:20]Not that I'm aware. Should we avoid gluten or saturated fats like coconut oil to help with SIBO leaky gut? Um so avoiding saturated fats uh reducing fat intake in general should um improve leaky gut. Um and uh um in gluten there are basically three groups of individuals that should um be concerned about gluten containing foods. Um one about one in a thousand people have actually a formal wheat allergy. Um so it's actually has nothing to do with gluten but they're actually just allergic to other things in wheat. Um, and so they would avoid what's typically not thought of as gluten containing foods. Um, and then there's people with celiac disease. 140 or so Americans um have this autoimmune disease where your body attacks um um basically kind of attacks yourself. um uh uh when it when when you eat gluten and and the only cure or the only treatment of celiac disease is lifelong strict extremely strict um um uh gluten exclusion. So you're cutting out all um wheat, barley, rye products from your diet. Um and then um and I have uh lots of videos on these of course um there's non-seliac gluten insensitivity where people even though they do not have um celiac disease which is diagnosed with an intestinal biopsy they experience symptoms when they eat gluten. And you can actually prove that's the case by randomizing on people to for example you know rice flour capsules versus wheat flour capsules.

[00:57:02]And it turns out most people who think they're gluten insensitive actually aren't and can't actually tell. But there is a small percentage probably uh uh um on the order of 1% of people that are um have this non-seliac gluten in insensitivity. And for those people I'm reducing gluten should reduce those symptoms. So that could be as many as 2% about 1% celiac 1% non-seliac. So about one in 50 people may feel better cutting gluten out. Um but for the other 49 out of 50 people I would continue to urge them to eat healthy gluten containing foods like you know you know ryberries um etc. All right. Okay. Does the quantity of food per meal affect SIBOS symptoms? Um is it better to have three normal meals or more smaller meals spread spread throughout the day? Um I don't think it should matter.

[00:58:02]Um uh but it's interesting I do talk about u meal frequency in a chapter in how not to diet though the emphasis is on weight loss rather than um than uh have anything to do with uh with like irritable bowel symptoms. Um, and basically I think I remember uh that it's better not to snack uh particularly if you're eating uh junky foods. Like I think they gave people like orange juice between meals or with meals and actually get significant increased body fat having orange juice between meals even though they the exact same amount of orange juice but just having it between meals.

[00:58:42]Um um so basically increasing the frequency of chloric intake they had significantly increased body fat. if I remember correctly. Okay. How do we encourage healthy, resilient, diverse microbiomes? Oh, in all areas of our bodies, including mouth, eyes, vaginal canals, and vulvas, ears, sinuses, and feet. What about our foot microbiome?

[00:59:07]That's a great question. I do have videos coming up. Uh, so yeah, microbiome. When I talk about the microbiome, I'm usually talking about the gut microbiome, but we actually have different microbiomes. We have a skin microbiome, etc., etc. Anyway, I do have videos coming up talking about the oral microbiome and how critically important it is to have specific bacteria on your tongue and what you can do to improve the microbiome in your mouth like tongue scraping. Um, actually turns out tongue scraping uh may actually be a good idea.

[00:59:36]Um, I got a whole series of videos coming out that that's a little sneak peek. Um, maybe I should do a whole webinar on it. I don't know. We'll see.

[00:59:45]Anyway, um, unfortunately we are out of time. I just want to thank everyone so much for joining. Hope you learned a ton. I know I certainly did. When I went into this, I knew very little about um SIBO. Um just because we weren't taught about it in medical school, but it was nice to actually see because I got that question a lot. Um and uh so uh so thank you for giving me the excuse to dive into a topic that I I wasn't aware of um so I could share with you. And uh thanks everyone. Um, stay safe, uh, be kind, get vaccinated, and eat your veggies.