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Dr. Zachary Spiritos demystifies SIBO treatment for patients with complex conditions like endometriosis and mast cell activation syndrome. He cuts through the noise with a straightforward approach to this commonly misunderstood digestive condition, explaining why it’s often simpler to treat than many functional medicine practitioners suggest.
• SIBO treatment basics: antibiotics like rifaximin that shift your microbiome rather than traditional systemic antibiotics
• Preventing recurrence by identifying root causes: antibiotic use, PPI use, chronic narcotic use, or other factors slowing bowel motility
• Pro-motility agents can help the small intestine function properly to prevent bacteria from accumulating where they don’t belong
• Low FODMAP diets may help but are used sparingly due to their restrictive nature
• Elemental diets are a last resort for persistent cases
• SIBO is often overdiagnosed when the real issue is constipation or pelvic floor dysfunction
• Virtually all endometriosis patients have some degree of pelvic floor dysfunction
• Pelvic floor dysfunction prevents proper evacuation of both stool and gas, causing significant bloating
Have questions? Send them in using the link in the description, email contact@endobattery.com, or visit the endobattery.com contact page.
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SIBO diagnosis confusion explained
Speaker 1
0:00
Picture
this
you
walk
into
the
GI
doctor
and
you
tell
them
I
don't
know
what's
going
on
and
they
say
well
,
it
could
be
IBS
or
it
could
be
SIBO
small
intestinal
bacterial
overgrowth
.
Now
here's
the
thing
.
Many
of
us
have
gotten
this
diagnosis
and
really
feel
this
sense
of
either
despair
or
hope
,
depending
on
how
it's
presented
.
Well
,
if
you're
one
of
the
lucky
few
that
gets
presented
with
,
it
is
a
curable
thing
.
However
,
what
do
we
do
if
it
continually
comes
back
?
Dr
Zach
Spiritos
joins
us
on
this
Quick
Connect
and
breaks
that
down
just
a
little
bit
better
for
us
.
Stay
tuned
.
Speaker 1
0:39
Life
moves
fast
and
so
should
the
answers
to
your
biggest
questions
.
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to
EndoBattery's
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Dr. Spiritos on treating SIBO effectively
Speaker 1
1:12
you
the
answers
.
I'm
your
host
,
alana
,
and
it's
time
to
connect
.
Today
I'm
joined
by
my
guest
,
dr
Zachary
Spiritos
,
a
board-certified
neurogastroenterologist
with
a
passion
for
treating
irritable
bowel
syndrome
,
functional
abdominal
pain
and
mobility
disorders
.
He
brings
a
wealth
of
knowledge
and
compassion
to
the
table
.
Please
help
me
in
welcoming
Dr
Zach
Spiritos
to
the
table
.
What's
the
best
approach
for
treating
SIBO
in
complex
conditions
like
endometriosis
,
mast
cell
?
All
of
the
things
.
Speaker 2
1:52
Yeah
,
so
I
think
we
overthink
SIBO
sometimes
.
From
a
pathophysiologic
,
mechanistic
perspective
it
is
quite
complicated
,
but
fortunately
the
treatment
is
pretty
basic
and
it's
antibiotics
,
based
on
what
kind
of
SIBO
that
you
have
.
And
these
antibiotics
aren't
like
traditional
antibiotics
,
they're
more
like
eubiotics
,
which
really
just
shift
your
microbiome
to
something
that's
a
little
healthier
and
they're
not
absorbed
systemically
,
so
they
are
fairly
well
tolerated
.
That
said
,
if
someone
has
MCAS
and
responds
to
this
medication
,
rifaximin
,
which
is
traditionally
used
in
SIBO
unless
you
have
a
different
type
of
SIBO
that's
a
different
conversation
then
that's
different
and
you
just
can't
take
the
medication
because
you
have
a
reaction
to
it
.
But
that's
,
in
my
experience
,
few
and
far
between
.
Speaker 2
2:34
The
harder
element
to
this
is
how
do
you
get
it
from
coming
back
,
and
that's
all
identifying
why
it
was
there
to
begin
with
,
okay
.
And
was
it
antibiotic
use
?
Was
it
a
PPI
use
?
Was
it
chronic
narcotic
use
?
That
really
slows
the
bowel
down
so
that
bacteria
has
a
chance
to
proliferate
.
And
if
you
target
that
and
sometimes
we're
good
at
it
,
sometimes
it's
tough
to
identify
then
we
can
prevent
it
from
coming
back
,
Because
SIBO
can
come
back
over
and
over
again
.
You
can
continue
to
treat
with
antibiotics
called
rifaximin
,
and
again
there's
another
one
that
we
can
use
for
a
different
type
of
SIBO
that
can
be
.
People
don't
want
to
be
on
antibiotics
in
perpetuity
,
so
it's
really
trying
to
understand
why
it's
there
and
then
treat
that
.
And
sometimes
we
use
pro-motility
agents
to
help
the
small
intestines
squeeze
,
to
help
the
kind
of
the
small
intestines
peristals
adequately
and
get
small
bacteria
or
bacteria
to
where
it
should
be
in
the
colon
,
or
removing
offending
agents
like
PPIs
,
narcotics
that
could
lead
to
conditions
like
small
intestinal
bacterial
overgrowth
.
Speaker 1
3:27
Do
you
combine
that
with
a
low
FODMAP
diet
as
well
?
Speaker 2
3:30
I
don't
,
I
don't
.
So
the
low
FODMAP
diet
it
can
be
quite
restrictive
and
does
it
work
?
In
SIBO
it
does
,
but
I
think
we
just
treat
the
SIBO
.
And
so
if
someone
has
recurrent
SIBO
over
and
over
again
or
just
it's
not
getting
better
with
rifaximin
which
again
is
really
really
rare
but
if
we
test
people
and
they're
just
not
getting
better
,
then
there
are
diets
you
can
use
.
You
can
use
an
elemental
diet
which
effectively
is
starving
the
bacteria
and
you're
really
just
giving
food
in
its
digested
forms
.
You
can
imagine
how
tasty
that
is
.
It's
pretty
gross
.
We
don't
use
that
unless
it's
a
last
resort
.
But
yeah
,
I
have
had
patients
who
just
continue
to
get
SIBO
over
and
over
and
over
again
because
they
have
bariatric
surgery
and
these
kind
of
blind
loops
of
intestines
that
continue
to
kind
of
just
cultivate
growth
of
this
bacteria
that
lead
to
ongoing
fermentation
.
Then
we
will
use
a
low
FODMAP
diet
,
but
sparingly
and
on
a
case-by-case
basis
.
Why low FODMAP isn't always necessary
Speaker 1
4:18
Side
note
on
this
endopatients
are
really
big
for
SIBO
.
Speaker 2
4:22
It's
really
not
that
complex
.
And
so
here's
my
issue
with
functional
medicine
doctors
,
where
they
don't
work
in
science
,
a
lot
,
a
lot
of
it's
pseudoscience
,
where
they
just
a
lot
of
it's
not
based
on
clinical
data
and
they
turn
SIBO
into
like
high
dose
oregano
or
high
dose
garlic
and
you're
like
,
okay
,
well
,
sure
,
but
we
also
have
an
antibiotic
that
works
really
well
,
it's
really
safe
,
and
so
in
that
world
they
really
harp
on
SIBO
.
And
,
yes
,
it
happens
.
It's
not
that
common
though
.
In
fact
,
when
someone's
really
bloated
,
they
oftentimes
just
need
to
poop
more
.
I
was
like
am
I
bloated
?
Do
I
have
seaballs
,
like
we
haven't
pooped
in
10
days
?
So
like
,
maybe
let's
work
on
that
?
Speaker 1
4:56
Probably
,
not
Probably
,
just
need
Bloating myths and pelvic floor truth
Speaker 1
4:58
to
poop
Right
A
hundred
percent
.
Speaker 2
5:00
Another
one
is
like
pelvic
floor
dysfunction
,
which
is
really
underlooked
,
and
if
you
can't
evacuate
stool
,
you
can't
evacuate
gas
and
it's
tough
to
treat
.
It
really
is
.
You
got
to
retrain
the
whole
pelvic
floor
and
people
kind
of
want
an
antibiotic
or
a
medication
to
treat
that
.
But
it's
just
,
it's
,
it's
glossed
over
.
Speaker 1
5:16
I
tell
you
,
if
I
have
a
woman
who's
in
her
fifties
and
sixties-
who
have
a
lot
of
bloating
pelvic
floor
is
at
the
dysenterges
,
like
the
top
of
my
list
.
Yeah
,
that
should
be
for
,
I
think
,
pretty
much
everyone
.
Speaker 2
5:26
Yeah
.
Speaker 1
5:26
Like
,
pelvic
floor
is
a
huge
,
huge
issue
and
actually
we
don't
know
any
endopatients
that
don't
have
pelvic
floor
dysfunction
.
Speaker 2
5:34
I
bet
.
Episode wrap-up and contact info
Speaker 1
5:37
That's
a
wrap
for
this
quick
connect
.
I
hope
today's
insights
helped
you
move
forward
with
more
clarity
and
confidence
.
Do
you
have
more
questions
?
Keep
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,
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