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Struggling with SIBO symptoms like bloating, abdominal pain, constipation, gas, and diarrhea, can be very frustrating.
SIBO (short for small intestine bacterial overgrowth) is basically what it sounds like: Bacteria overgrow in the small intestine leading to many symptoms that impact the gut and other body systems.
The presence of SIBO can trigger IBS, SIBO malabsorption (where you don’t absorb the nutrients from food and end up with nutrient deficiencies), and even anxiety due to inflammation.
And SIBO symptoms can also include skin problems! For example, there’s an established SIBO-rosacea connection: Research has shown that SIBO is present in about 77% of people with rosacea!
Additionally, SIBO is found in about 20% of psoriasis cases.
In this episode, I’m joined by Dr. Allison Siebecker to answer all of your burning SIBO questions. We’ll discuss common (and uncommon!) SIBO symptoms, SIBO test options, as well as how to treat SIBO (the conventional vs alternative options).
Dr. Allison Siebecker, ND, LAc, MSOM has been specializing in small intestine bacterial overgrowth (aka SIBO) since 2011. She is the 2021 Lifetime Achievement Award recipient from the GastroANP, has been teaching Advanced Gastroenterology at NUNM since 2013, and is an award-winning author.
Dr. Siebecker was the co-founder and former Medical Director of the SIBO Center for Digestive Health at NUNM. Her integrative SIBO protocols have helped thousands worldwide.
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In This Episode:
- What is small intestine bacterial overgrowth (aka SIBO)?
- SIBO symptoms + surprising triggers
- SIBO-rosacea connection + (other skin rash connections)
- SIBO breath test vs other testing options
- How to treat SIBO (conventional vs alternative SIBO treatment options)
- Myth busting: Can you stop SIBO with a SIBO diet (low FODMAP)?
- Nervous system dysregulation + SIBO
Quotes
“Our small intestine is where we digest and then absorb our nutrients from our food. And when there's too many bacteria overgrown there or methanogens, they interfere with that process. It can cause malnutrition and then all sorts of other problems. Skin problems can be one of them.”
“What are those symptoms [of SIBO]? Abdominal bloating, that could come with discomfort, general pain or discomfort in the abdomen, constipation or diarrhea or a mixture of the two. So those are our core symptoms. There can also be nausea, a feeling that food is sitting in the stomach and won't move down. There could be gas exiting, so burping or excessive flatulence.”
Links
Find Dr. Siebecker online
Healthy Skin Show ep. 018: SIBO-Skin Rash Connection w/ Amy Hollenkamp
Healthy Skin Show ep. 019: SIBO-Rosacea Connection w/ Dr. Leonard Weinstock
For practitioners: The SIBO Pro Mini Course (SAVE $220)
For practitioners: Check Your Blindspots and Become A Better SIBO Practitioner book
Nerva App (for IBS symptoms)
332: SIBO Symptoms Trigger Rosacea, Psoriasis + Eczema w/ Dr. Allison Siebecker {FULL TRANSCRIPT}
Jennifer Fugo (00:06.82)
Welcome to the show, Dr. Siebecker. How are you doing today?
Dr. Allison Siebecker (00:10.122)
I'm doing great. Thank you for having me.
Jennifer Fugo (00:12.532)
I’m so excited to have you here and I honestly can't believe that it's taken this long to have you on the Healthy Skin Show because you are considered one of, I think you're one of the most brilliant minds when it comes to small intestine bacterial overgrowth. I had the pleasure of watching you lecture at a conference this past fall that I learned a ton in, so I'm excited that we're gonna talk about small intestine bacterial overgrowth, SIBO symptoms, SIBO test options + SIBO treatment protocols today!
Dr. Allison Siebecker (00:35.222)
Me too.
Jennifer Fugo (00:36.516)
So let's get into a little bit of an overview on small intestine bacterial overgrowth (aka. SIBO). What it is, the different types of SIBO, and maybe some SIBO symptoms, both common and uncommon, that could be a sign of this, I guess we'll call it, like a gut dysfunction, diagnosis, whatever you wanna describe it as.
Dr. Allison Siebecker (00:57.39)
Okay, well, it stands for small intestinal bacterial overgrowth, and what it is kind of what it sounds like. It's when a whole bunch of bacteria sort of make a home for themselves in the small intestine, it's an overgrowth. It isn't technically an infection because it doesn't meet all the criteria of an infection, but it sure behaves like a chronic infection and it is chronic for many people.
So there are three types of SIBO basically. And this is based on both the bowel movement pattern and the gas. And what I mean by the gas is the gases that the bacteria make because they excrete gases. And so we have hydrogen, methane, and hydrogen sulfide. And the methane type of SIBO actually has gotten a new name in the last few years, and it's called intestinal methanogen overgrowth. Methanogens make methane. And it's a little different than the hydrogen-type SIBO because the methanogens can overgrow in the large intestine as well. And that's also the truth for the bacteria that make hydrogen sulfide, they can overgrow in the large intestine too. And so we've had to sort of with nomenclature, like the names of things, we've had to, there's sort of a new name for this methane one. But I still use the word SIBO to really mean all of it, just for simplicity.
So it causes a lot of problems for people. We're not supposed to have this situation. Our small intestine is where we digest and then absorb our nutrients from our food. And when there's too many bacteria overgrown there or methanogens, they interfere with that process. It can cause malnutrition (SIBO malabsorption) and then all sorts of other problems. Skin problems can be one of them, which we could talk about. But the core symptoms are the symptoms of irritable bowel syndrome or IBS for short. IBS is basically a collection of symptoms, and then you have to sort of figure out why you have it. And SIBO has been identified as a main underlying cause of IBS. So studies show about an average of 70%, 60 to 70% of people with IBS actually have SIBO. They could also have other things wrong too. So that's a very important connection. So the symptoms, now. What are those symptoms? Abdominal bloating, that could come with discomfort, general pain or discomfort in the abdomen, constipation or diarrhea or a mixture of the two.
Dr. Allison Siebecker (03:18.786)
So those are our core symptoms. There can also be nausea, a feeling that food is sitting in the stomach and won't move down. There could be gas exiting, so burping or excessive flatulence. I think I mentioned nausea. Oh, acid reflux. Acid reflux actually can be caused by SIBO, which is new to a lot of people's thinking. You treat the SIBO and the acid reflux goes away. So, very important to know.
Now, what are some of the less common? I'd say, actually, it's very common, but people don't think of it, is anxiety. SIBO causes anxiety, and this is through how the bacteria stimulate inflammation and their effects on the brain, basically, in mood. And also depression, but anxiety's more common. And then skin issues can occur, which I know we wanna focus on.
Jennifer Fugo (04:11.166)
Well, I did want to ask you quickly before we actually get into the skin conditions. The issue with food poisoning. I think a lot of people don't realize that food poisoning or a bout of food poisoning could have been a trigger for small intestine bacterial overgrowth. Is it just food poisoning specifically or getting like a stomach bug?
Dr. Allison Siebecker (04:29.258)
Yeah, so this is perfect, because now we could talk about what causes it, right? So the most common cause is food poisoning, as you mentioned, which is brand new thought to a lot of people. This has been very well studied over the last 10 to 15 years. A lot of work went into this, figuring this out. It's bacterial food poisoning. And one could say it's stomach flu as well, because nobody really knows, you know, travelers' diarrhea, stomach flu, food poisoning, you don't really know where you get it a lot of the time. Sometimes you do, you know, everyone ate a certain meal and all got sick. So I think of it in all of those words, but what we're really talking about medically is bacterial food poisoning. Turns out that all the bacteria that cause food poisoning share the same toxin, they all secrete the same toxin. It's called cytolethal distending toxin, or CDT, CdtB, for short. And this toxin looks like a protein that's a component of small intestine nerves. What happens is, in some people, they probably have a genetic predisposition because it doesn't happen in other people, their immune system confuses the toxin with that protein on the small intestine nerve and it starts attacking the small intestine nerve, and it actually creates nerve damage in an autoimmune process. And then what that does is make it so this natural movement we have, which is our number one protection, the body's number one protection against SIBO, which is called the migrating motor complex. It's basically like a housekeeper movement or wave where it sweeps bacteria down and out of the small intestine, and it actually has soap with it, like some bile and enzymes. It's like a scrubbing cleaning. Well, it can't function anymore because you need nerves and muscles to make that motion happen. And if there's damage to the nerves, it can't happen.
And so then this becomes a chronic condition because the autoimmunity continues for most people. And currently this condition, there's no known cure but this is being actively worked on. And I know and believe we will have a solution for it probably in the not-too-distant future. So the other thing to know about this is that it can be delayed. And so that's a hard thing to piece together for both somebody who has it and even a doctor, because it could happen six months after. So you have a bout of food poisoning. The other thing is you may not even remember because maybe it was just one night of diarrhea and it wasn't that bad. You don't even remember. And then six months later, four months later, three months later, you develop the IBS symptoms, and you're not linking it to that, you can't even remember. Of course then some people will remember if it was awful, if it was vomiting and diarrhea.
Jennifer Fugo (07:15.832)
I feel like the vomiting piece, nobody forgets that. But if you just had diarrhea, you'd be like, oh, maybe I ate something, maybe, you know, and you move on.
Dr. Allison Siebecker (07:26.07)
Who knows? It's nothing you would regard, right? So this is a very interesting thing. There is actually a test now that can test for this exact situation. The test is called the IBS Smart Test. It's a blood test, and it checks for the autoantibodies against the vinculin protein, that's the protein, the name of the protein, and the toxin, CDT, CdtB. And so if that is positive, then you know you have SIBO. You also can say you have IBS. And it's actually called, there's a subtype of IBS and this is post-infectious IBS. And post-infectious IBS is none other than SIBO. But the distinction here is SIBO can be caused by about 40, 50 different things, more. This is one of those things. So this is one type of SIBO caused by one thing.
Jennifer Fugo (08:12.604)
Well, I did want to just touch on a couple of connections, especially with the skin for the listeners who are tuning in. Most research I've looked at, especially with rosacea, it's like 77% of rosacea cases have SIBO, or they at least found SIBO in about 77%. Is there any thoughts on the rosacea piece or connection here?
Dr. Allison Siebecker (08:38.382)
I mean, what we know is there's all these articles showing the SIBO-rosacea connection. And we know that when it's treated, when the SIBO is treated, if somebody has SIBO, not everyone with rosacea is positive for SIBO, but then the rosacea goes away. And the results are absolutely incredible, like up to about 90% resolution. In fact, some studies show pretty much 100% resolution, and also that that resolution holds. In one study, they went out for three years, so the rosacea was gone for three years. Another study looked at nine months, gone. So therefore what these articles theorize is that SIBO was a cause. So, you know, no one has stated that anywhere, they just, but it's like, well, if you get rid of the SIBO and then the rosacea is gone for good, it sort of just makes sense, right?
Jennifer Fugo (09:30.956)
It makes sense, I know. And it's the same with ocular rosacea can also be triggered by this as well. So it could be something that maybe your ophthalmologist or optometrist picks up on, and then you're like, oh, yeah, I do have these GI symptoms. And you start to hopefully put some pieces together. But I feel like a lot of times those connections get missed, still, in conventional medicine at times.
Dr. Allison Siebecker (10:01.402)
The rosacea connection to SIBO, you know, I'm an educator myself, and this is one of the things that I pull out in particular for people, doctors to listen to, and of course, obviously patients. If somebody has rosacea, you should be thinking about SIBO because the connection is so strong and the solution and the result is so impactful, you know. So it's like that is one of the things to listen for. If somebody says that in ocular rosacea, I've seen many patients with ocular rosacea. And it's actually just as you say, they'll often come with a main complaint of ocular rosacea saying, I have no GI problems. And then when you really question, there actually are, but they don't matter to the person. They're not even caring. They don't think about it because they just care about the rosacea.
Jennifer Fugo (10:47.328)
With other skin conditions, do you tend to see anything else as a possible skin-SIBO connection?
Dr. Allison Siebecker (10:58.53)
Really, the other main one is psoriasis. It's not as prevalent, the SIBO connection, at least there's very few studies where there's a lot on rosacea, about 20, 21% prevalence in what has been looked at so far, but also really good results from treating. Not like a full remission, but very much decrease in plaque size and intensity for psoriasis when SIBO is treated. So it doesn't seem to be the whole primary situation but treating it really, really helps. So those are the main connections. One could speculate, of course, about general eczema and dermatitis, but we just don't have any literature on it. And I myself haven't seen a lot of patients with it, so I cannot comment from my own practice, but I think it's a worthy thing to test, does someone have SIBO who has eczema or dermatitis?
Jennifer Fugo (11:57.392)
Yeah. And so you've mentioned a lot about SIBO test options. We mentioned this IBS Smart protein, correct? Blood test, sorry. So aside from that, are there any other SIBO test options available, like the SIBO breath test?
Dr. Allison Siebecker (12:13.394)
Yeah, that test really just lets you know if you have your SIBO from food poisoning. And in general, that test is used, should be used, in primary care setting as a screening test for IBS, just to find out if somebody has IBS. And if they do, it's SIBO, right? And then what you then need to do is go on and do the real test for SIBO, which is the SIBO breath test. And it's a breath test that checks for the gases. So typically hydrogen and methane, there's also a newer test now that also checks for hydrogen sulfide. And that's actually called the TRIO Smart Test. And the others are just called the hydrogen-methane SIBO breath test. And there are discrepancies in the way the SIBO breath test is offered. And that is based on length and which gases are being tested for and what substrate is used.
So the way this SIBO test works, it's a simple test to do. You do it at home with a kit usually. And so what you do is you do a one-day prep diet where you have a reduced carbohydrate diet. And that's because bacteria make the gas out of carbohydrates. That's what they use as their fuel, as what they eat basically. So you wanna remove carbohydrates so that you can get a clear reaction to the test substrate, which is a carbohydrate. And so we typically use lactulose, but you can use fructose as well.
And unfortunately in the US, lactulose is prescription, which can make it a little hard for some people to get ahold of this test, because not every doctor is fully educated on this and wants to run the SIBO breath test. But I can also say there are places that, like, do you have a Rupa Labs account?
Jennifer Fugo (13:42.504)
I do. I think most alternative or integrative practitioners do.
Dr. Allison Siebecker (13:57.33)
Yeah, so you can get it through Rupa and they have a physician services where, you know, someone can get a SIBO breath test without a prescription and like Direct Labs, True Health Labs. There are places people can order lactulose SIBO breath test. But the key is you want to do it for three hours, and that is, not every test offers it for three hours. And the reason why is the first two hours indicate the small intestine time, generally on average, and the final hour, the large intestine. We need to see that final third hour because methane or methanogens and the hydrogen sulfide can overgrow there. So we need to see that. And there's other reasons we need to see it as well.
So anyway, once you have do a SIBO breath test, you base your SIBO treatment on the gas types. So we need to know which gases are present and in what amount. And the hydrogen sulfide type is much rarer. So even though we do have one option now for testing that, it is okay for a lot of people to just do the hydrogen and methane one because it's much less common to have that other gas positive.
Jennifer Fugo (14:48.744)
I don't generally run a SIBO breath test on clients because typically small intestine bacterial overgrowth is not the primary focus of things that I look for, but there can be times where with symptoms and different things and we do stool testing, I'm like, well, there's a good chance that this might be a factor here. Is it possible also from looking at stool testing where if you started to see the methanogens high on like a stool test in the large intestine, could that possibly also be a clue that there is a problem in the small intestine as well?
Dr. Allison Siebecker (15:21.758)
Yeah, hopefully I'm not mistaking this, but I believe Dr. Pimentel's teammate is Dr. Rezaie. Dr. Pimentel is our lead researcher and Dr. Rezaie is his teammate, a phenomenal physician. If I'm not mistaken, he said he does interpret high methanogens on stool tests as accurate. And so, what that would mean is that there's an overgrowth of methanogens in the large intestine. Stool tests just let you know about the large intestine, but that is part of the condition, right? And it would be the same if you saw high Desulfovibrio spp. or Fusobacterium varium (these are the organisms), it's M. smithii that causes the methane overgrowth and those other two that cause hydrogen sulfide. And by the way, the organisms that are causing the hydrogen small intestine overgrowth are E. coli and Klebsiella pneumoniae and Klebsiella aerogenes. So if you see the methane on stool tests, yes, then you know they have an overgrowth in the large intestine.
You could treat it, but it would be best if you could do the breath test because that will let you know how high the gases go. When you know how high the gases go, that informs your SIBO treatment because, we can just get into that, but just briefly, there are three antibacterial treatments that we can choose from, pharmaceutical antibiotics, herbal antibiotics, and elemental diet. The pharmaceutical and herbal antibiotics, on average, lower gas about 30 parts per million per treatment round or course, whereas the elemental diet lowers it on average about 70 parts per million per treatment course. But it's a more challenging treatment for people to do. And so if you know the severity of the gas, you can choose your treatment based on that and even calculate and project how many rounds of SIBO treatment you think you might need. Because overgrowths, we treat until we get effects. Basically it's not like an acute infection where 10 days and you're done. We typically need multiple rounds of SIBO treatment depending on how high the gas is. So if it's at all in someone's possibility to get the breath test, it's the best idea because then you're being the most methodical. You know what you're starting with, you can project your rounds of treatment, choose your treatment exactly, and really do the best job possible. Sometimes budgetary concerns exclude doing a SIBO breath test though.
Jennifer Fugo (17:44.648)
Can I just ask you quickly, because we've talked before, even, we started this interview about there's this fear that if you go the antibiotic route, so the medication route, you're somehow going to always deeply damage your microbiome. But my experience has been, granted, I'm not a naturopathic doctor, I'm a nutritionist, but my experience has been that there is a time and a place for medications. And if there is really, really severe overgrowth, oftentimes, like you kind of, I think alluded to here, that one round might not be sufficient to even really, you know, you really have to do multiple rounds to finally feel a significant impact and treat small interestine bacterial overgrowth. So can you just speak a little bit to that antibiotic fear that some people have
Dr. Allison Siebecker (18:40.19)
Yes, of course it's understandable, especially because many people do think, they feel, that antibiotics actually triggered or caused their SIBO symptoms. And we actually do have a study that's a pilot study that showed that some antibiotics, they're not commonly used ones, at least not for this condition, can slow the motility in the stomach into the small intestine, which could mean they could cause it.
But the antibiotics that we use to treat SIBO are different, they're targeted. And in particular, this main one we use is called rifaximin, in the US that’s sold as Xifaxan. And Dr. Pimentel, so he's involved right now, years of studying and mapping the small intestine microbiome, that has not been done before. All the microbiome mapping has been done on the large intestine. And he actually had to develop equipment and validate equipment to be able to do this. It's a very hard place to reach and test the small intestine.
So he's undergoing this massive re-imagined study, it's called, to map the small intestine microbiome. What he has found, this has not been published yet, but he has taught it in lectures, is when you look at the signature of the microbiome, it's all disturbed in SIBO, it's terribly disturbed in SIBO. When you treat with rifaximin and then you re-look at the microbiome, it has restored to normal. So in this case, the antibiotic restored the microbiome to normal. It's the exact opposite of what everyone is afraid of. So it's a really important thing to think about. If you have a completely disturbed microbiome, antibiotics can actually fix it, restore it to normal, at least rifaximin in particular, that's what they were looking at. So rifaximin is what we use for the hydrogen SIBO. When you have methane or hydrogen sulfide, you additionally have to add a second antibiotic to be able to target those organisms that are involved.
Jennifer Fugo (20:07.112)
Okay, is that the neomycin I've read about for SIBO symptoms?
Dr. Allison Siebecker (20:37.406)
Yeah, so we add neomycin or metronidazole for methane. And for hydrogen sulfide, we add bismuth, which you can get over the counter, but you need a good amount of it. You need about 2000 milligrams a day. I recommend the forms that you can get it in that don't have the sugar alcohols, because some people are really bothered by sugar alcohols. They can be fermented by bacteria. Some people can tolerate them okay though. So that's for the pharmaceutical side.
Jennifer Fugo (21:02.476)
Can I also ask quickly, in regards to the low FODMAP diet (also called the SIBO diet), which sometimes people do need to avoid certain types of fermentable starches and fibers and food, but I've also read online, oh, just go low FODMAP, it'll starve your SIBO. Do you agree with that statement?
Dr. Allison Siebecker (21:25.61)
I wish that was true. I mean, wouldn't that be so incredible? I have never, ever seen that to work. So I'll tell you what I have seen work. Low FODMAP is one of about five core diets that we use for SIBO. It wasn't developed for SIBO, and honestly, it's not the best match. And what do we really use diet for? We use it for symptom relief. We use it for symptom relief, and also to generally assist in the, once someone's got their SIBO cleared, the prevention of relapse phase, because being on a lower carb diet can help during that phase. There's a lot of nuances here, but anyway, I've just never seen, like if somebody tests positive for SIBO and they do it, they do the diet, then they get a negative test. But what I have seen is when the diet matches perfectly for that person, whichever SIBO diet we're using, and let's say we've done testing, what I mean is experiments to figure out with a person what foods are really triggering and not, you can get to 100% symptom relief. So there are people who can get 100% symptom relief with diet. What I find though, is that is not satisfactory to the person. And the reason why is that they've altered their diet and they don't want to live like that for the rest of their life. They would rather get that condition treated so they could then expand their diet.
And this is a personal choice for people. But I've had people without 100% symptom relief and they're like, this is all I want doc. And maybe there are people who don't, but these people show back up in my office saying, I'm frustrated. Let's go ahead and treat it now. Let's treat this overgrowth. So that's what I see.
Jennifer Fugo (23:10.608)
It's not necessarily the most sustainable option. Would you say that if someone was to go on a low FODMAP diet, because they're having these GI symptoms that you've discussed, and they do see a substantial improvement, could that be a sign or an impetus that maybe they should get checked for SIBO?
Dr. Allison Siebecker (23:30.486)
It's a great one. One thing I would say is you wouldn't want to say, that means I have SIBO, because what we call the differential diagnosis, meaning what are all the list of conditions or diseases that can cause the same symptoms, is huge. And there are other conditions that a low FODMAP diet will alleviate the symptoms that are not SIBO. And one example would be lactose intolerance. So like, let's say a genetic lactose intolerance, meaning you don't have the enzyme to break down lactose. A low FODMAP diet is lactose-free, although you're actually supposed to figure out whether you have lactose intolerance or not when you're doing that diet. And the treatment for that is completely different than SIBO. So you wouldn't want to assume and not do testing. I think testing, but it's a really good point, yes, do the testing for SIBO.
Jennifer Fugo (24:18.592)
Awesome. Well, I have I feel like I have a million other questions for you. So I'm going to leave it with this last question because it was something that I found so thoughtful and fascinating from your presentation at GastroANP, was you talked about nervous system regulation training that could potentially be helpful. And I think a lot of times everybody just thinks about the SIBO diet or about killing things, but there is another part or component of healing that may not necessarily have anything to do with that. It's how our nervous system interacts with things. Can you speak just briefly about how that could be helpful for somebody who's going through this?
Dr. Allison Siebecker (25:03.018)
Absolutely. Yeah, so that presentation was about tough cases of SIBO. So this wouldn't necessarily be something you need to do immediately. You'd wanna see if you have trouble with the regular treatments. Although, on the other hand, some of these treatments I'll mention in just a second help people tremendously, so maybe you do wanna try them right at the beginning. So what these are is treatments like gut-centered hypnotherapy, brain retraining like DNRS or the Gupta protocol, and I know there's others. And there's other things too that work on the nervous system, you know, HeartMath, all sorts of things. The idea behind this is that in some people with SIBO, their parasympathetic nervous system, which is really what handles the digestive components and function, is almost like it's dampened or turned off. It's not truly turned off, but it's not working well. And these treatments help it to turn it back on, help it to work better. And we need that, we need that aspect of the body working well to get a good response to the SIBO treatment and really keep it gone.
And so just as an example, a colleague of mine has had patients who've had constipation for most of their life who went and did the Nerva app. So the Nerva app is a gut-centered hypnotherapy app you could do at home. I want to just mention they force you to agree to some statements in the beginning that are factually incorrect, so please just ignore that about IBS, it is not factually correct. But they do this at home and got an 80% improvement in symptoms with the Nerva app alone. Now look, there are other people who have tried it and gotten no benefit, right? So maybe don't pin all your hopes on it, but it is remarkable for many people. And the brain retraining and any of these, what my colleagues, because I interviewed a bunch of colleagues to ask them about treatments they're using for tough SIBO, what they said to me, what they all said was, no one ever says that it was a waste. So it seems to really be helpful for so many people.
Jennifer Fugo (27:20.196)
Well, Dr. Siebecker, how can everyone find you? And by the way, I'm going to have to, we're going to have to meet again. We have to do this again. I have more questions, but for today, how can everybody connect with you? And I'll make sure to put all the links and everything in the notes because I know you, number one, have your own, I think, clinical practice, but you also train professionals as well. And we have a lot of professionals that listen to the show too.
Dr. Allison Siebecker (27:47.422)
I don't see patients in office anymore. I just focus on education and have for years, I teach at university, et cetera. How you find me is siboinfo.com. That is my website and if you go there, free educational website, if you go there, if you join my email list, my newsletter list, that's how you get notified of everything. I do research updates with all the researchers, I do free trainings, I do all sorts of things. That's how you can find out about everything.
Jennifer Fugo (28:14.94)
Thank you so much for this. I really appreciate the time and I'm excited to have you back the next time. So we can dive deeper into SIBO and complex cases and recurrent issues. Because I do think that this is a topic where we can provide so much benefit to, not only somebody who's dealing with this, but also those who are listening, who do support patients or clients who are struggling with this. And I always find knowledge is power, even if it's not something that's within your wheelhouse, sometimes knowing can help you get to the right person.
Dr. Allison Siebecker (28:47.518)
Agree completely. Thank you so much, Jen.
