Hannah Aylward (00:05.88)
Welcome to the Nutrient Dense Podcast. I’m your host, Hannah Aylward, holistic health coach, functional gut health practitioner, and the founder of HAN. So many people are continuously failed by conventional and alternative healthcare. We are here to do it differently. Alongside my team of functional registered dietitians, I’ve helped hundreds of women around the world overcome their chronic digestive issues when nothing else worked.

I’ve learned a thing or two about what it really takes to transform your health from the inside out, and I’m here to share it all with you. Please keep in mind that this podcast is for educational purposes only and should never be used as medical advice. Now, let’s dive in. Your transformation is waiting.

Hello, my dears, and welcome to another episode of the Nutrient Dense Podcast. I’m excited to dive in today because we’re going to be discussing SIBO, or small intestinal bacterial overgrowth. Now, this is pretty prevalent today. It’s a big underlying root cause of many different digestive conditions and kind of symptoms like bloating and constipation and diarrhea and IBS-like symptoms.

There are actually some studies that suggest that up to 60 % of individuals with IBS or Irritable Bowel Syndrome may actually have SIBO, which is an underlying cause of their symptoms. I will say what we see with our clients is it’s not, that number isn’t quite that high because we can see a lot of different imbalances in other things in the GI tract, whether it’s bacteria in the large intestine or fungi or maldigestion.

that are also causing a lot of those symptoms that are similar to IBS, where it’s like, you know, varying bowel movements, maybe diarrhea or constipation, maybe it’s both, it’s chronic bloating, it’s lots of food reactions. There can be a lot of underlying root causes, but some of the research does suggest that SIBO essentially is pretty prominent, right? So let’s just dig into all things SIBO today. My team, we have like a lot of pretty extensive training.

Hannah Aylward (02:10.433)
in this topic because yeah, it’s pretty prevalent in this space that we’re in helping women really overcome their chronic digestive issues. So we’re gonna break down like what it is, different causes, different root causes, how our approach to it is a bit different and then what that looks like and what you can do about it. So I get a lot of questions about this. I get a lot of questions on my Instagram about SIBO and I think I’ve done, I know I’ve done a couple other trainings on it, but this is gonna be the most in-depth one I would say.

So really what is SIBO? SIBO is when there is an overgrowth of bacteria in the small intestine. So the majority of our bacteria and our gut microbiome is really going to be in our large intestine or the colon. So when you’re taking something like probiotics, for example, you really want those bacteria to be going and making their way into the large intestine or the colon. That’s really where the like trillions of bacteria that make up your gut microbiome reside.

We do have some bacteria in the small intestine and we do have some in the stomach as well, kind of like higher up the chain in the GI tract, but the large majority is going to be in the large intestine. Now we want a big variety of many different microorganisms and bacteria, especially those supportive gut bacteria. We want a lot of those in our gut microbiome. We have trillions, which is kind of like wild to actually conceptualize.

However, when we do get that overgrowth in the small intestine, we can get like lots and lots of painful symptoms. And if you haven’t told you have SIBO by your medical doctor, then you know what I’m talking about, or even if you suspect that you have it. So we’re gonna go through some pretty common like signs that you might have it and the discomfort it typically causes. But just so you can really understand what it is, we have an overgrowth of bacteria in the small intestine. Now, it’s not necessarily like…

dysbiotic unsupportive bacteria that’s overgrown. So sometimes we can have overgrown dysbiotic, more opportunistic bacteria. We can have that both in the large intestine and the small intestine. But when we’re looking at SIBO, sometimes you just have too many of your bacteria overall. It’s not necessarily the harmful unsupportive ones. We can also see SIBO caused by an overgrowth of those good gut bacteria. And that’s why you can also really

Hannah Aylward (04:32.301)
begin to question things because you’re like, thought these bacteria were good. We want a lot of these, which we do. But this also really reflects that SIBO is not an issue of the bacteria really. It’s more so an issue of the location of the bacteria. So let me say that a bit more clearly. It’s really not about the type of bacteria that are in the small intestine because like overgrown strains of good gut bacteria and supportive gut bacteria can cause SIBO.

At the core, SIBO is not a bacterial issue, it is a motility issue because we have gotten this overgrowth in the small intestine when these bacteria should have moved along into the large intestine. Now, this is also my belief and my team’s belief as to why it has such a high relapse rate. And we’ll get into that a bit later in the episode. But a lot of the times, you know, medical doctors are using antibiotics, things like rifaximin or neomycin.

to treat the SIBO or the overgrowth in the small intestine, but it comes right back. And the reason for that is because we’re not actually addressing why it happened in the first place. So we’re gonna cover all of those root causes and ways to look at this condition a bit differently in this episode. But so you know, when we get an overabundance of bacteria in the small intestine, that’s when we get like super symptomatic, very bloated, reactive to lots of foods. Typically you’ll have more bloating like in the upper abdomen.

a lot of like belly distension. So it’s pretty classic that those with SIBO have that like six months pregnant belly bloat. We can see overgrowth in the large intestine contribute to that as well. This is why testing is really important and working with someone that knows what they’re doing is very important. So you’re not just guessing at this, but yeah, essentially you have that overgrowth in the small intestine that’s causing all of this. And the small intestine, you know, it’s very important in the digestive process and in digestion really overall.

The majority of nutrient absorption occurs in the small intestine, especially in the duodenum and the jejunum. And the small intestine also uses these rhythmic contractions called peristalsis to move the partially digested food through the GI tract. So the small intestine plays like, it’s playing many different roles in our digestive process. Overall, it’s really responsible for breaking down food into its more simple forms through enzymatic actions.

Hannah Aylward (06:52.373)
and it’s going to turn things like carbohydrates into sugars, proteins into amino acids, and fats into fatty acids. It also absorbs nutrients, like I mentioned, including things like water, electrolytes, vitamins, macronutrients, all of these things really into the bloodstream or into the lymphatic system. And this process ensures that the body gets the nutrients that it needs for energy growth and repair. Now that you really understand that, you can also see how someone with SIBO

It wouldn’t just be digestive issues. We’re also going to run into a lot of malabsorption issues. And this is why people can typically be very tired. They can develop other different issues that are kind of more widespread throughout the body. So things like hair loss, things like poor skin repair, anything that’s going to require a lot of nutrients from the body, because if we’re not absorbing the nutrients that we need from our food efficiently,

we’re going to run into issues more widespread. So even though it is a condition of the GI tract and specifically the small intestine, it’s going to contribute to many different symptoms that are more widespread. Like I said, low energy, we can see hair loss, we can see a lot of skin condition. So it’s something that should be taken seriously. If you can’t absorb the nutrients from your food efficiently, we’re going to run into way bigger issues. It’s going to start to hit the thyroid, the energy production, et cetera. So

Some of the most kind of common symptoms of SIBO or signs that someone might have SIBO are gonna be bloating, abdominal pain and discomfort. Like I mentioned, really classically that six months pregnant belly bloating typically will also see that you’re bloated within like two hours of eating because that’s kind of how the digestive process works. So if you’re really bloated like within 30 minutes of eating, that’s usually poor digestion. You’re not breaking down your food very well.

If we see it around that like two hour mark, then that’s kind of signaling that there’s something wrong in the small intestine. And if we see it after that, then it’s typically signaling that there is an issue in the large intestine. I will say with what we see in clients, it’s not as clear cut as that, just to be completely honest, but sometimes the timing of your bloating can help us better understand why you’re bloated in the first place and what is that underlying root cause? Like where’s the breakdown in the digestive chain that is contributing to some of these symptoms.

Hannah Aylward (09:10.339)
Typically we get a lot of like distension as well because when we have an overgrowth of these bacteria, these bacteria eat up the food that you’re eating and then they produce gases. So we’ll see as the abdomen really like fills with gas, we get a lot of that belly distension where we can look pregnant with bloating. It’s super uncomfortable. A lot of the clients that we see will say, you know, I have to like unbutton my pants by the end of the day. Not always SIBO can also be large intestinal bacterial overgrowth. However, you know, pretty prominent in SIBO.

We can also see diarrhea, constipation, or alternating between the two of them. Typically when someone’s alternating between the two, they have constipation and then we get this overflow diarrhea. So we get like the stool is so backed up that then we start to get overflow diarrhea where then we can’t stop going. And that’s after days of not being able to go at all. It feels just totally, absolutely awful. So I really feel for anyone that’s dealing with that, but please know there’s like truly so much that we can do.

to get you feeling a million times better. Other signs and symptoms would be fatigue or brain fog. Once again, we’re not absorbing our nutrients. That’s gonna hit us pretty hard. Malabsorption and nutrient deficiencies. So we can also see like levels of nutrient stores go down. We can see nausea, especially, you know, when there’s a lot of bloating and a lot of like trapped gas, we can get very, very nauseous. I remember when I was struggling with some dysbiosis.

I would get constipated here and there, you know, and which was interesting too, because it’s not like I was constipated all the time, but when I did get constipated, oh my gosh, it would make me so nauseous because I was just like, things were just stuck, you know? It’s a horrible, horrible feeling, oh my gosh. We can also see food intolerances, so lots of different food reactions, your inability to tolerate certain foods. We’ll also see skin rashes or other skin conditions like acne.

And I can do a podcast dive for you guys on this topic if you want. Let me know if you’re listening to this on Spotify, just drop it in the comments. If you want me to do a deep dive into the gut skin connection, I can go ahead and do that for you guys. But essentially, the skin is really reflecting what’s going on inside us. And when we have this dysbiosis or this imbalance in our gut bacteria, that’s going to cause damage to the small intestinal lining. And then that is going to trigger inflammation more widespread, including the skin.

Hannah Aylward (11:29.209)
So our gut lining or that gut barrier is a big barrier that we have in the body. And then our skin is a huge barrier, right? These are both like barriers that we have to the outside world. So they have a lot in common. So a lot of dysbiosis triggering a lot of inflammation, triggering that immune system response. And then we see it showing up on the skin. So the gut and the skin are hugely, hugely connected. And we have an entire clear skin program where we walk clients through and we help them.

really transform their skin through their, really like through a lot of the gut work that we work on together. So yeah, anyone that’s interested in that, just don’t hesitate to reach out. Another big thing that we see with SIBO is bad breath. So a lot of the times if someone has like chronic bad breath, even when you’re brushing your teeth or you’re using mouthwash or whatever, that can be a big sign that there’s something going on in the gut because the oral microbiome and the gut microbiome are also very connected.

So when we have this overgrowth of bacteria or putrification of food, which I know sounds honestly terrible, but it is terrible. It feels terrible. Food is sitting in the GI tract longer than we want it to. It’s being maldigested. It’s fermenting. We can really feel that into our oral microbiome, and it can lead to things like bad breath. So once again, studies really suggest that up to 60 % of those with IBS actually have SIBO that’s causing their symptoms.

But we look at things a bit differently because we ask, well, why do you have SIBO in the first place? And that is a question that a lot of other practitioners do not ask. And this is why I think we get our clients like pretty amazing results after they’ve done all of the things to eradicate their SIBO. And it just keeps coming back and or if it never gets better. So there are a lot of like flaws, honestly, like there’s a lot of flaws in all of it. I see some doctors prescribing antibiotics without even testing.

Yes, the test, the SIBO breath test has pluses and minuses, and we’ll talk about that. I also see doctors prescribing antibiotics and just blindly prescribing rifaximin, which won’t really hit methane dominant SIBO as well as hydrogen dominant SIBO. It also takes a hydrogen molecule to make a methane. So sometimes when people show that they have very high methane levels, they can then do go through treatment with a doctor, retest, and then their hydrogen looks very high. But

Hannah Aylward (13:47.791)
That doesn’t necessarily mean that you’ve made no progress. The other thing that I see is I’m trying to think of like all of the things that the clients that our clients really bring up to us. And I’m just like, no, this is not going to do it. Mostly, you know, doctors are just throwing antibiotics at it. And then they’re saying, take this for 10 to 14 days. And then it’s fine. And a lot of people might feel a little better while they’re doing it. They might feel better for a couple of weeks after. And then like, it comes right back. So

What I really, really want to emphasize to you all listening, because I know how dreadful SIBO is. I’ve had a bit of SIBO in the past, and I actually saw a functional medicine doctor for it. And she really, like, she’s very well known in this space too. And she didn’t really give me anything for it. I was very confused. She was kind of just like, yeah, you have some. And I was like, okay, well, what do I do? And then that was it. So that was fun. But maybe I knew too much going into it. I’m not sure.

However, we just see a lot of flaws. I see a lot of flaws across the board, but what I really want to make sure you understand is that SIBO at its core is not really a bacterial issue. So using an antibiotic to target that bacteria is very likely not going to get rid of it and keep it away for most people. I would say in some cases, using antibiotic interventions can help decrease the levels of bacteria. And if you’re

root cause is not anything more serious. So if you like took an antibiotic to clear another infection and then you ended up with SIBO after that, cause that can be a deeper root cause antibiotics can. And that, there’s no other issues. There’s no maldigestion issues. There’s no structural issues, adhesions, anything else really contributing to it. Then, you know, using that other antibiotic to clear the SIBO could be helpful for some, but a lot of people also get stuck in this like spinning of their wheels where they’re

just trying more antibiotics and it keeps coming back and keeps coming back. And then you increase your risk for fungal overgrowth or candidases as well, which is no, no bueno. So what I want, once again, what I want you to understand is it’s really not a bacterial issue at its core. We have to ask, why are we getting this overgrowth of the bacteria in the small intestine when these bacteria should be moving right along into the large intestine? So there’s a breakdown in the chain. There’s a breakdown in your gut motility, and that’s what we need to address. And there are many reasons why that can happen as well.

Hannah Aylward (16:02.275)
The other kind of area where the antibiotics really miss the mark is there’s no brute cause assessment. There’s no understanding of why you got it, how you got it, know, when did it happen, how long it’s been there. Typically that’s not being covered in an appointment with your doctor. And then we’re really not given any strategy to like prevent relapse. We’re not really given any strategy other than the antibiotics. So we also know that a lot of overgrown bacteria in the small intestine is going to damage the gut barrier or the gut lining.

That alone can cause a lot of digestive symptoms, additional nutrient absorption issues, yeah, lots of bloating, you know, and there’s no support given for that after there’s no digestive support given. There’s no re-inoculation support given. So there is, you know, when I hear someone who’s like, I have tried to get rid of the SIBO and it’s come back and I’m at my wits end and you know, nothing ever works for me. I’m like, girl, like you just didn’t get the right help. And you know, I’m glad that you’re here. That’s okay.

So there’s really so much more that can be done. So let’s get into the causes and risk factors for SIBO, because this is going to help you guys better understand maybe why you have it and also what really needs to be addressed here. So some potential root causes of SIBO, motility issues, right? And I mentioned this. So we can have slow transit, slow stall transit. Things aren’t moving through the GI tract at the rate at which we want them to, or we have weakened peristalsis.

This can be due to many different reasons. This can be due to low stomach acid. This can be poor pancreatic enzyme secretion or pancreatic insufficiency. When these things are happening, you’re not digesting your food efficiently and things aren’t moving through the GI tract efficiently. A very simple kind of way to think of it is like your gut is this big long tube. It’s like a long hose and it’s got twists and turns and it’s like many, many, many feet long, but that’s how you can kind of conceptualize it.

Now any kink in the hose or any slowdown in the hose, like things aren’t going to move through at the rate at which we want them to and things can get stuck or they can hang out there longer than we want them to. So if you are not breaking down and digesting your food efficiently, that’s going to overfeed bacteria. And then that’s going to contribute to the abundance of bacteria where it shouldn’t be. So in the case of low stomach acid or hypochloridria, know, stomach acid is essential for killing off ingested bacteria.

Hannah Aylward (18:23.697)
And low stomach acid can reduce the body’s ability to control bacterial overgrowth in the gut contributing to something like SIBO. Now in the work that we do, we want to optimize stomach acid production if necessary, but we also have to ask why do you have low stomach acid? So as you can see, there’s a lot of deeper digging to be done in this conversation. If you really want to take a root cause approach. Now, I think a lot of people want to take a root cause approach or they think they do and then they don’t. They still just want a bunch of supplements and to move on with their lives. And we can definitely give you lots of supplements. However,

We have to dig deeper if we really want you to get better and stay better. Why do you have low stomach acid in the first place? Is it nutrient depletion? Certain minerals are required for low stomach acid. Is it chronic stress? Is it a different gut infection? That’s a huge, huge cause of low stomach acid. And it’s a big cause of low stomach acid and then therefore contributes to SIBO. And it’s so, so largely missed when it comes to this condition. So people can really, like I said, like spin their wheels.

We’ll see a lot of clients who have been told that they have SIBO by previous doctors. And then when we run our functional stool testing, we see that they have a gut infection that’s negatively impacting their ability to produce stomach acid. And no one else has caught this. No one else has addressed this with them. So we’ll see people that have been to some of the top medical institutions with big, big names in this space. And then when we run their labs, we see that there are a lot of other gut imbalances that are basically contributing to the fact.

or the reason why the SIBO is not going away. So hugely largely missed. And it honestly does not make any sense to me why people are missing this, but we’re here to help. So low stomach acid, a huge underlying root cause of SIBO, especially SIBO that won’t go away. Pancreatic insufficiency. So when your pancreas doesn’t produce adequate digestive enzymes, that can lead to poor digestion. And then that really just creates the environment conducive to bacterial overgrowth. Once again, not breaking down your food very well.

these chunks of maldigested food sitting in the GI tract, GI tract is loaded up with bacteria, bacteria are eating up these maldigested food particles, producing gases, you are bloated and your belly is distended. That’s basically what’s happening in that case. So any maldigestion pattern, whether it’s bile, acid, pancreatic enzymes, any maldigestion pattern, including any of those things is going to basically

Hannah Aylward (20:47.164)
create or lead to that dysbiotic picture that sometimes can be SIBO. So bile is the other one that I mentioned there. Bile is produced by the liver and pushed out by the gallbladder. It helps us break down our fats and absorb our fat soluble nutrients. And it also is antimicrobial in nature and it pushes into that small intestine. So it helps to kind of like clean up the small intestine a little bit. It’s not entirely sterile, but when we either don’t have our gallbladder,

that’s been removed, which means we had liver issues for a while previously because you don’t just need to have your gallbladder removed out of nowhere, which is also why the removal typically doesn’t fix people’s issues. It can fix them temporarily and then they come back and sometimes they come back worse. So once again, more digging to be done there. But when we don’t have adequate bile, we’re going to have that fat maldigestion and then we’re missing out on that antimicrobial nature of the bile.

And that’s to kind of naturally regulate things. Like your body has all of these natural processes to keep things in check. And whenever we interfere with that, we start to see different issues pop up and different symptoms and things like bloating. So bile, low stomach acid, pancreatic insufficiency, all of those things can be underlying root causes to SIBO. Then we’ll see structural abnormalities. So things like intestinal adhesions or diverticulosis.

Adhesion, so sometimes we’ll see people have had their gallbladder removed and that’s left in adhesion. Sometimes people will have had a C-section that’s left in adhesion. These are things that me and my team can help with a bit less because these are more like physical structural abnormalities that are contributing to the bacterial abnormality, which we can come in and really help with. But this is also where myofascial release really can be truly so helpful because we can start to break up some of that scar tissue.

and essentially help lessen that kink in the hose where things are just getting stuck in there. So we refer people to myofascial release experts often. It’s a great therapy to do in conjunction with the work that we do with clients. So if you’re someone that’s gone in for a surgery and then after that, everything started to pop up, that could be a sign that there is a structural abnormality.

Hannah Aylward (23:01.692)
or that scar tissue, adhesion, that’s essentially like acting as that kink in the hose so things can’t flow through as freely as we want them to. And in that state, we’re going to get that bacterial overgrowth. Then we have things like the use of medications, specifically antibiotics, proton pump inhibitors, and opioids. So antibiotics are fantastic to treat like really dangerous infections. I just, I’m always mindful of knocking antibiotics. I do think they’re very widely overprescribed. I think kind of everyone knows that at this point.

But you know, I’m not anti-antibiotics and I have taken antibiotics in my lifetime. I have taken way less, like way fewer in my adulthood after I learned all of this than I did in my childhood, that’s for sure. I used to take, my gosh, probably like four a year as a kid. My parents really had no idea. However, when you have a very serious infection, the antibiotics are warranted sometimes. So I’m not knocking them at all. I do think we’re seeing this like big uprise in just like…

All pharma is bad and all medical everything is bad. And listen, I am here teaching y’all all of these natural ways, all of this functional root cause approach. I get it. And there is a time and place for more extreme medical intervention. So that’s my little soap box that I will, I will get off of now. I just think like social media is pushing way too much stuff out. And I’m like, this is going to become dangerous. And listen, y’all know where I stand. I mean, I am, we help people with all of these natural modalities. So anyway, I’ll end it there.

However, antibiotics, right? They can be very effective for treating different infections, especially when very serious, but they will disrupt the natural balance of your gut microbiome. So they essentially come in, they wipe out all bacteria, all gut bacteria, and that means they’re wiping out the good ones and the bad ones. So very effective at wiping out the bad ones, unless you’ve built up antibiotic resistance, which I do think is we’re going to have that issue pretty soon, but I don’t have the exact timeline on that, with people just taking too many and then building up resistance.

but they’re always also wiping out the good. So that also really creates the environment for more pathogenic bacteria to overgrow and for fungi or yeast to overgrow. So I always kind of explain it’s like a parking lot and you’ve got all these cars like in the parking lot. Now, if the antibiotic comes in, these cars are taking up all the spots in the parking lot. The antibiotic comes in, it gets rid of all of the bacteria cars that are taking up the spots. But where do all those, what happens to all those candida or fungi cars?

Hannah Aylward (25:28.432)
They’re going to come on in, they’re going to take those spots. They are, they are looking to park their cars. They’re looking to take up those parking spots and they’re opportunistic in nature. So they really need the right environment to thrive. And when we get rid of all of our good gut bacteria, these other things can begin to thrive. That is one of the big reasons why our good gut bacteria are so important. They’re helping to really balance out this ecosystem of like in the gut microbiome. So antibiotics come in, they just wipe everything away.

which can, like chronic antibiotic use, can contribute to SIBO or small intestinal bacterial overgrowth. Then we also have PPIs or proton pump inhibitors. I would also say acid blocking like drugs in here. And these really reduce the stomach acid production and that can increase the risk of SIBO by reducing the stomach’s ability to kill bacteria. It’s going to negatively impact motility. It’s going to not kill off additional gut bacteria that can contribute to that SIBO picture.

Then we also see opioids. So medications like opioids slow down gut motility, and that can also contribute to bacterial stagnation in the small intestine. So there’s kind of this like medication component to it. There’s this maldigestion component to it. And then we’ve got a few other things here too. So underlying health conditions, things like diabetes, Crohn’s disease, and celiac disease, these can also increase your risk of SIBO. Celiac disease and SIBO go hand in hand. So a lot of the times people

that didn’t know they had celiac disease, and then they finally find out they get the right testing for it, which could take years. And then they take out gluten, and that doesn’t really get rid of all their symptoms. And sometimes they feel no difference, very likely a bacterial issue still present in the small intestine that’s then contributing to that gut barrier issue, contributing to systemic inflammation. So I guess when we see people, they’ve tried a lot of this, right? So the people that we’re seeing pulling the gluten alone wasn’t really enough.

to help them feel a lot better, but definitely necessary in the case of celiac disease. My point is really that when we have all this inflammation in the small intestine, other things can start to pop up, including SIBO. And celiac and SIBO really do go hand in hand. So if you have been told you have celiac and this is resonating, definitely time to dig a bit deeper because we can get you feeling a lot better.

Hannah Aylward (27:53.254)
We are big fans of eating enough protein over here on Team Han. Protein is essential for muscle repair, a strong gut lining, balanced blood sugar levels, and so much more. For most of our clients, we like recommending around 100 grams of protein per day to start, and adding in a good quality protein powder can be super helpful for hitting those numbers. It’s an easy add-in. You can throw it into a smoothie or even add it to oatmeal. Choosing the right protein powder can feel so overwhelming.

Half of them are full of fillers and crap ingredients and the other half honestly just tastes bad. Equip Protein is one of my go-to recommendations for our clients and one of my personal favorites. We love it because it only has a small handful of ingredients. It’s 100 % carefully sourced, real foods, no additives, allergens, chemicals, fillers or other junk. It’s gluten-free and it contains 21 grams of protein per serving. Equip’s Prime Protein also offers

a complete amino acid profile. It’s also independently tested to make sure that the protein powder is free of harmful amounts of heavy metals and toxins like glyphosate, which is honestly super hard to find. EquipPrime protein is a grass-fed beef protein. So it is animal-based, but it’s dairy-free, unlike whey or casein protein powders. Grass-fed beef protein is packed with collagen, gelatin, and micronutrients that your body needs.

We also see that it’s typically much better tolerated in our clients with chronic gut and digestive issues over something like a plant-based protein powder. In addition, some of their flavors do contain natural flavors, but they’re distilled vapors from natural and organic compounds or fruits like vanilla, coconut, and strawberry, and are processed without any chemicals, fillers, binders, or artificial ingredients, which once again is incredibly hard to find. Personally, I buy both the chocolate and the vanilla.

flavors of the Equip Prime Protein, but honestly, they have like so many other incredible flavors out now. If you’re interested in trying out Equip Prime Protein, you can use the code HANNAHILWARDHHC at checkout for 15 % off, and we’ll pop that code in the show notes of this episode for you as well. So once again, you can go to equipfoods.com, choose the flavor of protein powder that you want, and then use code HANNAHILWARDHHC for 15 % off.

Hannah Aylward (30:10.16)
The other thing that I see that’s pretty, pretty prominent is people that have a history of an eating disorder or disordered eating patterns. I want to say that the stat is that 97 % of those with a history of disordered eating develop a functional gastrointestinal disorder. And a lot of the time what we see is those that have had so much restriction in their past develop that overgrowth in the small intestine or that SIBO picture.

And when you think of it, there’s been so much stress put on the body. We end up nutrient deficient. If there was any purging as well, any binging, any like bulimia present, we’re getting all of that food back up the GI tract and out of the mouth. I mean, that’s going to contribute to bacterial overgrowth in the small intestine as well. And then just like further restriction, that’s going to negatively impact gut motility. It’s really setting the stage for that SIBO to take place and that bacteria to overgrow in the small intestine.

It’ll also decrease stomach acid production because you’re basically just like without adequate nutrients, guys, straight up just like eating enough, without eating enough and putting your body in periods of heavy restriction, especially the menstruating female body. It’s like, Nope, we’re not safe. Start to conserve, start to slow everything down. So it’s going to naturally slow down your gut motility and also cortisol is going to rise and then cortisol and that stress response will decrease stomach acid production.

These things are all very connected. So it’s really not a coincidence at all why those with a history of disordered eating end up with a lot of gut issues. As I say, I feel like I say it all the time, stress does not stay stress. So whenever we’re putting many different, like differing stressors on the body, like we’re going to have issues, going to have hormonal issues, digestive issues. Yeah. So, so, so much. It’s not, it doesn’t just stay mental stress. And the other thing that I would just mention here too is when we have a big disruption in the circadian rhythm,

because the gut has its own circadian rhythm as well. So we actually see a lot of nurses, like women that work overnights or long 12 hour shifts where they are not eating. Like a lot of nurses can’t eat like their entire shift or they have a hard time taking breaks. They’re also in a very stressful state. They’re like walking into emergencies. Sometimes it’s very high stress, sometimes it’s a bit more chill. But I would just say we see a lot of nurses that have a lot of bacterial overgrowth, specifically in the small intestine.

Hannah Aylward (32:34.638)
And my understanding or really my theory on that is the disruption in the circadian rhythm, the eating at many different times, like whenever you can, basically, a lot of nurses are just eating whenever they can. And that alone can disrupt the GI function and the rhythm in the gut itself. So it’s very helpful to eat at the same times each day, to rest your GI tract overnight, and to not let yourself get too, too hungry. So the sweet spot for most people

is around that four hour mark where they want to eat again, and then you want to eat your whole meal and you want to rest your GI tract. So your migrating motor complex can really do its thing. And I’m going to talk about that here soon. So those are some of the main underlying causes. I couldn’t go through this whole root cause section without mentioning stress, which I’ve kind of alluded to already. But chronic stress will impact gut motility. It’s going to contribute to an imbalance in your gut bacteria.

It’s going to make it easier for these bacteria to overgrow in the small intestine and that, you know, your gut brain access plays such a significant role in regulating digestion and prolonged stress can really negatively impact this balance for some of the reasons or in some of the ways that I’ve already noted, right? Increasing cortisol, wearing away at the gut liner, the gut barrier, decreasing stomach acid production. That’s then going to decrease pancreatic enzyme production, slowing down gut motility. So chronic stress over time is also a

big, big underlying root cause of SIBO. And the other honorable mention that I would throw out here is going to be mold. Mold illness, mold exposure can cause SIBO, especially recurring SIBO. So if you’re someone who maybe you’ve even worked with a functional practitioner and you’re like, I have done so much stuff. Like I’ve supported digestion. I’ve looked at my minerals. I’ve tested my thyroid.

I have done the GI map, functional stool tests, I’ve done the breath tests, like I have done everything and this stuff is not going away. That’s when I would ask you about mold. I would also ask you a lot more questions to see if mold could be contributing, but that may be something to look into. Mold will essentially contribute to that bacterial overgrowth in the GI tract, including the small intestine and can also cause a fungal overgrowth in the gut. So it’ll cause a lot of issues and really, yeah, it just causes so many symptoms for people.

Hannah Aylward (34:51.384)
It’s not fun. those are some of the main causes of SIBO. Okay. The one other thing that I want to note that wasn’t on my notes here, but I’m remembering now cause I just kind of said it thyroid issues. So hypothyroidism Hashimoto’s right. If you’re on lebo thyroxine, lebo thyroxine increases your risk for SIBO because it impacts your gut motility. Hypothyroidism, your gut motility will be impacted. whenever, honestly, we’re looking at any thyroid issues, whether it’s hypothyroidism or Hashimoto’s, we always have to look at the gut.

because gut issues influence the thyroid and the thyroid influences the gut. essentially when you have sluggish thyroid function, your gut motility is going to slow down and that can contribute to the overgrowth in the small intestine and in the large intestine. So that’s also going to really like increase your risk, including if you’re on a medication for your thyroid that can also impact your gut motility and can increase your risk for SIBO. So very connected there. We see a lot of

Yeah, poor thyroid function and gut issues, they go hand in hand. And once again, there’s a lot that we can do there. What’s really cool is we’ve seen clients in the past, many clients honestly, have these thyroid issues, sluggish thyroid function. And then we come in and we repair the gut and we do a lot of like nutrient repletion, adrenal work, blood sugar work, liver detox work. We support many different systems and then we’ll see that they can decrease their thyroid medication.

I’m like mindful of saying that. I don’t like putting out blanket statements where I’m like, just, we can just get you off all your meds. We’re not medical doctors. We don’t work with meds. We don’t work with medication. Do you always want to talk to your provider about that? However, we’ve just seen a lot of clients like after doing this, we’ll see thyroid antibodies normalize. We’ll see thyroid numbers normalize. And sometimes we’ll even see clients be able to get off in conjunction with their doctor’s supervision, thyroid beds or decrease the amount that they need, which is also like a huge, a huge feat. So it’s very cool.

Okay, so how is SIBO diagnosed? There’s different ways. Typically, you are using like the breath test. So you can get a lactulose or glucose breath test. Yes, there are false positives and false negatives with this breath test. There’s many reasons why as well. So we have to make sure that you’re doing proper prep. There is a prep diet to follow before you do this breath test. You have to make sure you’re doing that. And if you have constipation, you may need to do it for a little longer. So a lot of people don’t get this instruction. I do not know why.

Hannah Aylward (37:15.97)
I honestly, a lot baffles me in this area, especially with like traditional Western medicine. However, proper prep is needed. We can also see some different patternings on the breath test sometimes. So I did a lot of training in this, my gosh, at the beginning of my career. But essentially, if we see gas levels be very high at the beginning, that can sometimes be due to constipation. That could also be due to large intestinal bacterial overgrowth.

If we see your test is completely flatlined, that can suggest something else. If we see that you’re on the edge. So if you’re not really familiar with the SIBO breath test, this may not be making sense to you. So let me kind of break down. You essentially do this breath test. You’re blowing your breath into this tube after you drink this solution, lactulose or glucose. And basically the test is checking when the gas levels rise. Now, because that’s, you know, based on your transit level should rise later on in the test.

I’m forgetting the exact time, honestly, off the top of my head. I want to say it’s about 120 minutes. We really don’t use these tests anymore, so I’m a little rusty. But essentially, if they rise at that time, that’s when they should be rising. That’s when you should have more gas being produced by more bacteria in your large intestine. Now, if it’s rising before that, that can be suggestive or indicative that you have SIBO. We don’t run this test. We do not diagnose SIBO. We’re not medical doctors. Only your medical doctor can diagnose SIBO.

Now, if the gas levels don’t really rise that much, then you may not have SIBO. So you really want someone to look at this test who like knows how to look at this test because it can show us, it can give us kind of some more information. But the breath test is really the gold standard for diagnosing SIBO. Now, we don’t use this breath test very often. Sometimes we will refer you out to your doctor to get a breath test. That can be helpful for some. However,

If I’m looking at only getting someone one test, we’re always going functional stool testing over the breath test. And that’s because the functional stool test is going to give us a heck of a lot more data. I’m going to do a whole podcast episode for you guys on functional stool testing that might be next week or the week after. So stay tuned for that. I’m going to be breaking it all down, but the stool test gives us a lot more information to work with. And the other thing is that it’s going to catch things that the breath test does not catch. So the breath test is

Hannah Aylward (39:35.369)
basically just checking for bacterial levels and it’s kind of going to tell you if you’re positive or negative. If someone’s really good at looking at the test, they can maybe tell you a little bit more. The functional stool test is going to give us so much information like gut immune function, gluten sensitivity, digestive output capacity, other infections. It’s not just checking for bacteria, checking for fungi and yeast, parasitic infections, other bacterial infections. The breath test is not checked for this. Now the breath test is assessing the small intestine.

stool test is assessing the large intestine. in an ideal world, like we could have both tests, possibly. I don’t see that it’s always necessary. The stool test can be suggestive that there could be an overgrowth higher up the chain. But essentially when we work with clients, we are crafting protocols in the way that they would address both overgrowth in the small intestine and the large intestine. So it’s typically not necessary with our clients. Every once in while it is, and then we’ll refer out.

They can discuss that with their doctor and then they can also, we can check in on them about that too. If those levels aren’t in the right, you know, if the levels are outside the normal range, then we can address things there. If those gas levels are very high. But long story short and for clarity here, functional stool testing, non-negotiable in my book. All the years that I’ve done this, absolutely non-negotiable. SIBO breath test, sometimes it’s helpful, sometimes it’s not basically. However, it’s still the gold standard for diagnosing SIBO. And yes, there are issues with it.

true transparency, there’s issues with every test. Every test, there’s issues with, I mean, we’ll see medical doctors miss H. pylori with an endoscopy. Like there are pluses and minuses to every test, which is once again why you need to work with someone who’s willing to keep digging. And that’s what we really commit to with our clients. So that’s how it’s diagnosed. You’d want to go to your GP. They’d probably refer you to your gastroenterologist or to a gastroenterologist. And then they’d order you a SIBO test and you would do that. You have to prep properly. Make sure you get information about that.

And you have to also like take the test properly and it’s about three hours. So it’s kind of a pain in the ass, honestly, but you want to make sure you’re doing everything properly. So you get the most efficient results and then make sure that your doctor’s like super comfy with it. Cause sometimes they’re still not. And yeah, I don’t know y’all. It doesn’t make much sense to me. Okay. So what do we do if you’re like, okay, that’s cool. Sounds like me. Like what, what do I do here? So the first thing is to note, right? Is that.

Hannah Aylward (41:58.623)
SIBO has a very high relapse rate and I’ve mentioned that already in this episode. And that’s really because in my opinion, we’re just throwing antibiotics at it. All these other things that I just shared with you guys, all of these other root causes, Maldigestion, pancreatic enzyme insufficiency, low stomach acid production, poor bile flow, sluggish gut motility, thyroid issues, mold exposure. I mean, no one’s addressing this stuff.

That’s once again why when clients come to us, like we get them a lot of answers that they may have not gotten in the past because we’re just taking a much more thorough approach here. So very high relapse rate. The eradication rate of SIBO is specifically with rifaximin. So typically your doctor, your medical doctor will just write you a script for an antibiotic. It’s going to be rifaximin or neomycin. I have heard that they’re recommending this less now, which kind of sucks.

And sometimes they recommend both. They’ll write you the script for both of those. Now the eradication rate of SIBO with rifaximin is typically around 40 to 60%. Just know that going in y’all, because you go in, you hear you have SIBO, your doctor tells you that you have SIBO, you are like, okay, great, I’ll take this antibiotic. Now this thing only has 40 to 60 % success rate. So just know that going in. This is also where herbals can be so helpful, you know, and a lot of people think that they need antibiotics for this. They don’t necessarily need antibiotics for this. However,

Listen to your medical doctor. I’m not a medical doctor. But there are other ways and there are other very efficient like methodologies to bringing down these bacteria levels. So the drug, rifaximin, can lead to symptom improvement. Yes. And some people, every once in while, it kicks it and people are great and then they move on with their lives. I wish that for everyone. However, if it was that simple, I probably wouldn’t be in business. So it can lead to some symptom improvement, but it’s not going to always completely eradicate.

that bacterial overgrowth. So just kind of know that and know that there are other things. Now, if your doctor didn’t even test you for SIBO, I would be even more like hesitant in that case, or maybe hesitant is the wrong word. Just like aware in that case, because we don’t really even know what we’re looking at. If your doctor’s like, you just have the symptoms, here’s Rifaximin, go take it. And then you feel no different. Like do not put yourself in the category of I’m a lost cause and I’m broken. Totally inaccurate.

Hannah Aylward (44:17.467)
there was a lot that was like overlooked and missed here and there’s a lot more that can be done. So that’s really the antibiotic route. That’s the classic route for addressing SIBO or small intestinal bacterial overgrowth. Now, when we’re looking for imbalances in the gut as a whole, we are going to always look to address underlying root causes. Once again, previously mentioned, maldigestion, sluggish motility, hypothyroidism, all this stuff. None of this is being addressed with the antibiotic intervention.

So we’re going to dig deeper. We’re also going to see, there other imbalances present that are contributing to this picture as well? So for example, if someone has a parasitic infection, that can be the reason why SIBO keeps coming back. If someone has a helicobacter pylori infection, that can be the reason why SIBO keeps coming back. If someone has like really poor liver function, maybe bile is sludgy, with something pushed out into the small intestine efficiently, that can be the reason why it keeps coming back. If you have hypothyroidism, that can be the reason.

or just really sluggish thyroid function. We’re looking to dig a lot deeper and address from the ground up here to help our clients get better and stay better longer. That’s really the goal. So we have to address your digestive capacity. We have to address your gut motility and we have to look at your stress. Once again, chronic stress is a big cause of this. We’re looking for other imbalances that could be present in the gut microbiome. We’re also going to work on your gut barrier.

we’re going to work on replicating your good gut bacteria. So there’s a lot more to this conversation than simply using an antibiotic to come on in and take these levels down. The other thing to just note about the antibiotic is like, if you’re not retesting after, then you really don’t know. You don’t know if it worked. You don’t know if levels went down. So if it’s covered by your health insurance and you’re working with your doctor, like test, get the antibiotic, retest.

see what levels look like. If you’re just like sick of that approach and you want to explore different options, you know, reach out to us and we can chat about helping to rebalance your gut microbiome. The other thing that the doctors will kind of like chuck out pretty typically is a low FODMAP diet. You probably have heard of it. You’ve probably already tried it. A low FODMAP diet is simply just reducing your amount of fermentable carbohydrates. So FODMAPs are just fermentable carbohydrates. They’re nothing to be like afraid of or vilified.

Hannah Aylward (46:41.117)
A lot of people, like it pains me so much you guys, when I see someone, gosh, we had a client who had been on Lufadmat for like 13 years and I was like, no. I mean, if you’ve tried it, it’s very difficult to adhere to. Your quality of life significantly goes down. And in most cases with what I hear from people, real people that we’re working with, they don’t really see that big of a difference with it. So if you don’t see a huge change in your bloating and your gas and your constipation,

after going low FODMAP, it’s of no use. It’s not really helping anything. It’s not addressing the root cause once again. So you’ll hear me say it a million times and I’ve already said it so many times out this episode, so I’ll try not to just get up on my high horse too much or my soap box or whatever, but we got to dig deeper. We have to dig deeper. A low FODMAP diet is just decreasing the amount of fermentable carbohydrates that are then going, it’s then going to like kind of slow the feeding of these bacteria because these bacteria

eat up these fermentable carbohydrates and that produces gas and that’s causing bloating. So reducing these can help symptomatically, temporarily, but it’s not actually addressing why we have the bacterial overgrowth in the first place. That’s what I really want you to fully understand after this episode. We have to address the reason why the bacterial overgrowth is present in the first place. low FODMAP diet does not do that. Now there are many different trains of thought when it comes to low FODMAP.

in conjunction with like SIBO eradication. Some people say reduce them. Some people say keep them so the antibiotics can be more efficient in the eradication phase. Honestly, I don’t see it matter like too too much. I don’t want you pulling foods out of your diet unless it’s 100 % necessary. Ultra-processed like highly inflammatory foods that aren’t super healthy like a lot of processed like ultra-processed cookies and cakes and crackers and stuff. Yeah, for sure. Like let’s get those out of the diet. We already know that.

But I don’t want you guys being afraid to eat broccoli if you don’t have to be, right? And well, you shouldn’t be afraid either way, because we can help you with that. But I don’t want you not eating an apple or a watermelon or broccoli or whatever it might be, because it’s not Lufthand map enough. These are whole healthy foods. We want to keep as many of these foods in your diet as possible. And you will be able to tolerate these foods better on the other side of.

Hannah Aylward (48:58.313)
this work, like as we eradicate that bacterial overgrowth and we help your digestive function, you’ll be able to digest and tolerate these foods a lot better. So, you know, to sum it all up, because I go on my little tangents here, thanks for bearing with me. The low FODMAP diet is not a real solution. It’s not. Some dieticians practice and they’re like, okay, you have IBS, let’s do low FODMAP. And then they just keep you on the FODMAP and then you try to reintroduce these foods. And like, you don’t really get anywhere a lot of the time. So,

We have to address why you need the low FODMAP diet in the first place. And nine times out of 10, it’s because we’ve got a bacterial overgrowth. So we have to address the bacterial overgrowth to then get you to the point, like the other side of the low FODMAP diet where you can tolerate many more foods. So I hope that that is clear for you guys. Any super restrictive diet where you are pulling out loads and loads of foods, whether it is nightshades or oxalates or FODMAPs or high histamine foods or high fat foods.

This is almost never the solution. The solution is addressing why you have to take all these foods out in the first place. All these things that I mentioned all have different root causes, all stemming from the gut and gut function. But I just hope that that, I hope that you know that. And this is where I think we really offer a very different perspective in this space. It’s not just about eliminating a ton of foods. It’s not going to get you the results that you want nine times out of 10. We have to address the gut environment.

essentially why you’re reacting to these foods in the first place. So I hope that that’s very, very clear. Biggest things that I want guys to understand are SIBO is not just a bacteria issue and food restriction and very restricted diets are not a solution. Okay. So going back to like, what do we do and how do we handle SIBO and really like take care of it or really how we handle like any imbalance in the gut microbiome. We dig deeper and address root causes.

We optimize digestion, we support the nervous system, we reduce chronic stress. If there’s any thyroid, sluggish thyroid function, we have to address that as well. We have to balance our blood sugar. Yes, we can bring in interventions to take down these bacterial levels. That’s very important. Stress management techniques, working on the gut brain connection, tonifying the vagus nerve, optimizing your migrating motor complex. All of these things are very important. Optimizing the diet, yes, but not like tons of heavy restriction, right? More so,

Hannah Aylward (51:19.081)
just making sure you’re eating like good, healthy, whole foods, getting in enough protein, getting in enough fiber, all of those things, and addressing any of these underlying root causes. So in the case of like mold toxicity, like we’d have to address removing the mycotoxins from your body. That would also help optimizing detoxification. We also have to look at the gut barrier, repairing the gut barrier and re-inoculating the gut with good gut bacteria. So we’re looking at all of these things are really like

essential to move someone through a bacterial imbalance and have them stay better. Now, when we’re looking also at the long-term effects of having SIBO and not getting rid of it, it’s not something you guys want to have for a very long time. I mean, you never want to have it. It’s super painful and awful. From my personal experience, I’m like, this is just horrible. And women on my team, so many of us have had it. That’s how we got into all this work and the traditional methods didn’t work, et cetera.

However, over time, what we see very commonly in those that have SIBO is a lot of nutrient malabsorption. So we’ll see low B12 specifically. We’ll see low iron. We’ll see low levels of fat soluble vitamins, so things like low vitamin D. These are things that probably a lot of you guys listening have been told that you have. Once again, it’s not just about adding in a supplement to increase those vitamin B12 levels. We have to ask why are we low in the first place?

If we have a bacterial imbalance and that’s basically making it more difficult to absorb the nutrients from our food, that must be addressed in order to replete those levels, whether it’s low iron or low B12 or low vitamin D. So I always say like, we take a root cause approach to a root cause approach. Like we’re not going to see, you have low vitamin D here, just take vitamin D. We’re going to ask why. Why do you have low vitamin D in the first place? And we talk more about this in the podcast episode on functional lab testing. If you’re interested and you want to dig deeper.

learn more, you can go listen to that episode as well. It was posted recently, so you should be able to find it. So nutrient malabsorption, a big issue. Then we have increased intestinal permeability and inflammation that can also contribute to skin issues, acne, eczema, rosacea. We also have a possible impact on immune function and overall health. a large majority of your immune system resides in your gut. If we have a big source of inflammation in the gut, we have a lot of bacterial overgrowth, that’s going to

Hannah Aylward (53:43.475)
trigger that immune system activation and that can contribute to systemic inflammation, which can show up in many different ways. Joint pain, headaches, skin issues. It’s basically increasing inflammation and we know that’s kind of a no-no. So we really want to take care of this. We don’t want you suffering with this for a very long time. Okay. So I just want to leave you guys with a couple of tips for like preventing this bacterial overgrowth. Managing your stress. That’s going to be number one.

Eating enough, avoiding heavily restrictive diets. Those can increase your risk for the spectral overgrowth. Staying hydrated, that’s very important here too. That’s going to support your gut motility. Letting your migraine motor complex do its job. So spacing out your meals, a good four hours in between meals. In order to do that, you have to eat enough. So keep that in mind. I don’t want anyone starving themselves. In order to actually go from one meal to the next meal, easily, we have to make sure that we’re balancing your blood sugar and you have to make sure that you’re eating enough.

Those that are under eating will struggle with that more. So that’s really important because you’re migrating motor complex that helps sweep this debris through the small intestine into the large intestine can actually do its job. So we have to make sure that we’re supporting our gut motility with that. And then also really avoiding the overuse of antibiotics and these other medications that can disrupt your gut flora. All of these things can help kind of prevent it, prevent it from coming back and then preventing people from getting it in the first place.

So that’s really my deep dive on SIBO or small intestinal bacterial overgrowth. I know it’s so prominent, so many people struggle with it. So I hope this was very helpful. I hope it offered you kind of like a different way of viewing all of this. And as always, if you guys are looking for help when it comes to balancing your gut microbiome, if you are looking for one-on-one support in supporting overall digestion, decreasing bloating, constipation, all of that good stuff.

Don’t hesitate to reach out. You can always send me message on Instagram, but there’s always the link to book a strategy call with me in the show notes of every single episode. And that allows you to book time. can talk about your goals, your history, and best next steps to getting you feeling better. So I hope that this was super helpful for everyone listening and I will see you in next week’s episode.

Hannah Aylward (56:00.031)
Thanks for joining me for this episode of the Nutrient Dense Podcast. If you found this episode valuable, don’t forget to subscribe, leave a review, share with a friend, and come back next week for a new episode. See you then!