Is SIBO Causing Your Gut Issues? [Podcast with Phoebe Lapine] - PCOS Diva
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Is SIBO Causing Your Gut Issues? [Podcast with Phoebe Lapine]

PCOS Podcast 160: Is SIBO Causing Your Gut Issues? “Healthy hedonism is balancing the things that nourish your body with the things that feed your spirit, remembering those things and leaning into them.” – Phoebe Lapine

Phoebe Lapine is a best-selling author and award-winning food and health writer. She’s a SIBO expert, gluten-free chef, wellness expert, culinary instructor, and Hashimoto’s advocate and speaker. In her new book, SIBO Made Simple, she shares recipes for healthy comfort food and insights about balanced lifestyle choices beyond what’s on your plate. Through her own health journey, she was able to find the middle ground between health and hedonism. If you feel overwhelmed by kind of the rigidity and perfectionism of the holistic health world, Phoebe has advice you won’t want to miss. Listen in or read the transcript as we discuss SIBO and living well with a restricted diet.

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Complete Transcript:

Amy Medling:

Today’s guest is Phoebe Lapine. She is a best-selling author and an award-winning food and health writer. She’s a gluten-free chef, wellness expert, culinary instructor, and Hashimoto’s advocate and speaker. She shares recipes for healthy comfort food and insights about balanced lifestyle choices beyond what’s on your plate. Through her own journey with Hashimoto’s, she was able to find the middle ground between health and hedonism, which we’re going to be talking about, how she did that, later on in the podcast.

But she did that by making one lifestyle change one month at a time, which I love that approach. She’s also the host of the SIBO Made Simple Podcast, where she equips people with information on how they can overcome her own underlying gut issues. And she just released her second book, SIBO Made Simple, and I have a copy of it. I’ve been reading it over the last couple of days and it’s excellent. And I can’t wait to check out some of these recipes, so welcome to the podcast, Phoebe.

Phoebe Lapine:

Thank You. Thanks for having me.

Amy Medling:

So you’ve had quite a health journey. I’d love for you to share that with our listeners.

Phoebe Lapine:

Yes, absolutely. So I ironically, I was diagnosed with Hashimoto’s thyroiditis when I was 22, around the exact same time, I was leaving my corporate job to pursue a full-time career in food. And it took me a long time for those two storylines to dovetail, and for me to start actually using my skills in the kitchen to heal myself. But at the time I was young and immature and I just kind of pretended the conversation never happened and went on living my life. And in the years since, I kind of wound myself down to some sort of rock bottom. I was losing my hair, I had horrible skin. It’s rash, perioral dermatitis was something that I was just constantly struggling with. I had to stop exercising because my gut was such a mess. I was getting these horrible cramps every time I tried to run. I was waking up in the middle of the night with horrible night sweats.

And yeah, I was kind of cold all the time. I was just a mess. And eventually, I kind of got my act together and saw a more holistic doctor went on my first elimination diet, kind of discovered that gluten and I don’t really get along. And that is true for a lot of Hashimoto’s folks. And yeah, then I kind of was chapter two. I was just super overwhelmed by kind of the rigidity and perfectionism of the holistic health world. And the to-do list just seemed so, so long. And as still a young 20 something, living in an expensive city, trying to like jumpstart a career where, it helped to be an omnivore, it was very, very stressful. And I kind of found myself just at a crossroads. And I was just so overwhelmed by everything my doctor was telling me to do.

I just had to press the pause button and kind of figure out my own path forward. And that was kind of when the idea for the wellness project came to be, which is kind of my version of Gretchen Rubin’s, the Happiness Project, kind of taking her formula and applying it to health and kind of a really measured, step-by-step, one change at a time fashion, with really awareness being the number one intention, not necessarily doing it perfectly or having it all be cumulative. And it really helped me kind of tackle every single one of my problem areas because again, the to-do list can be very long. Sleep, hydration, stress management, exercise, alignment, cleaning up my personal care products, detoxing my liver, balancing my hormones, feeding my gut. All of those things when you stare at them, that would be really, really hard.

So, I found that my system worked really well, and it truly did turn my health upside down. My blood work, my numbers were so much better by the end of it. And then after I ended up writing about it and it became a book and the book came out, I started to notice some mysterious symptoms creeping back into my life. And I mean, I had had my fair share of IBS, most people with an autoimmune disease are not unfamiliar with gut troubles, but this was a little bit different. I was burping all the time, during meals. I was just bloated in a way that never seemed to go away. And it just was getting very uncomfortable. So needless to say, I went back to the doctor, he immediately ordered a SIBO test and spoiler alert, I was diagnosed with SIBO and I hadn’t really come across very much about it in my research.

I thought I was basically a gut health expert by the end of my book writing process, but this was kind of this complete other acute issue that turned a lot of what I had learned on its head, because I had been trying during those months of misery, to apply all this knowledge, to pop the probiotics and eat the fermented foods and crush the beans and the cauliflower. And I was just making myself more and more miserable. So I kind of became a little bit of a SIBO evangelist, not necessarily trying to convince everyone that they have SIBO, but for those who are kind of dabbling in the wellness world and kind of feel they’re doing everything right, but are still experiencing all these symptoms, I’ve been there and I know that pain. And so I think it’s important to kind of spread the message about this other acute gut health issue that has a very different protocol for feeling better.

Amy Medling:

Yeah. It’s interesting, and I guess we should back up because SIBO, like you said, I would say sort of under underdiagnosed, kind of like PCOS was several years ago. And I think a lot of conventional medicine practitioners aren’t really familiar with it. So why don’t we back up and tell us… SIBO is an acronym. So what does that mean? And tell us a little bit about it. We heard a little bit about your symptoms, but common symptoms and you had mentioned a test. So, go ahead.

Phoebe Lapine:

Yeah. So it stands for small intestine bacterial overgrowth, and really it’s an issue of location, not type. So when people talk about your “good gut bacteria,” they are primarily referring to your large intestine. That’s kind of where the majority of it lives. It’s where it aids in the digestive process, helping to digest fibers that you yourself do not digest. And in the small intestine, that is where you digest your main nutrients.

So, there’s less of a role for bacteria, though there are some. Every area of your digestive tract kind of has its own unique ecosystem, but if the numbers kind of grow too large in the small intestine, you can start to experience really intense symptoms. And that’s because, then the bacteria are competing for your food resources. When they eat your food, they release gas and that gas is now much further away from an exit ramp.

And so can either get trapped, which kind of looks like really uncomfortable bloating distension, or can come out the other end, burping for me. But the symptoms, are kind of overlapping with IBS. And the research now says that over 60% of IBS cases are being caused by SIBO. But the SIBO symptoms because of kind of the damage that’s caused by having bacteria in this area that’s not designed for it, can span a whole gambit of things, including a lot of autoimmune spectrum symptoms, especially if leaky gut is an issue, which can often happen with the bacteria in that area. They can just damage the intestinal walls so that, your larger particles of food or even the bacteria themselves, once your immune system starts to break them into little pieces, can seep out into your bloodstream and kind of causes systemic inflammation.

And then, obviously so much of our mood is dictated by our gut, so anxiety, depression are big with SIBO, also weight loss or weight gain kind of depending on what types of critters are overgrowing. It can be really different for people. Nutrient deficiencies, since again, your other mouths at the table. Let’s see what else. I mean, again, more autoimmune spectrum symptoms like joint pain, food sensitivities, as a result of the leaky gut, which are kind of autoimmune sensitivity is not necessarily just like the gas you’re experiencing every time you eat. But yeah, I think the kind of most common ones are just that really uncomfortable bloating and distension, diarrhea, constipation, or a mixture of the two and kind of abdominal cramping, really uncomfortable stuff.

Amy Medling:

Okay. And so the other health issue that I think is gaining a lot of traction in terms of awareness is histamine intolerance and histamine intolerance and SIBO sort of tie in together. Maybe you could explain the type.

Phoebe Lapine:

Yeah. So, they’re really similar in some ways, because histamine is an essential part of our daily functions in the body. It’s just a matter of having the right amount in our system at any given time. And so we have these checks and balance systems. We have enzymes that can help to break down histamine. And then just kind of having a gut running on all cylinders, will also just naturally help to contain those levels.

So, with SIBO, the bacteria actually contain their own histamine. And then sometimes the damage as a result of SIBO, can prevent you from making that necessary enzyme. So, that’s made in the villi of the intestines. And then oftentimes as a result of SIBO, you may change your diet to be more low FODMAP or just more heavy in certain vegetables, and there’s just natural histamine that’s in a lot of fruits and vegetables and aged meats, anything that’s kind of old or aged or fermented foods, which is another reason why fermented foods and SIBO, don’t always go hand in hand.

Those tend to contain a lot of histamine. So if you’re adding more histamine to the tank at all times, and you’ve lost the ability to regulate it, plus you have just a higher level of histamine and on-hand thanks to those bacteria, that’s when histamine intolerance can become an issue. And it is really interesting. It has so much to do with the immune system and your mast cells and all these other kinds of more obscure functions in our body. I mean, I’m personally very grateful for SIBO because it truly gave me a masterclass on my health. And again, I did tons of research for my last book, but these were not things that I learned about. I did not learn about histamine intolerance and a lot of these other things.

Amy Medling:

So if somebody is really resonating with what you’re saying, and I think, I hear from a lot of women with PCOS who have IBS and bloating, anxiety, certainly. And if doctors are not all that receptive to SIBO or may not know what it is, how would you recommend a woman talking to her doctor about it and what kind of tests should she request?

Phoebe Lapine:

Yes. So the test for SIBO is something called a breath test. There are a few different types. Recently, since the book came out, there is actually one that will test all three of the potential SIBO gases, it’s called Trio. And essentially it’s a three hour test that you do at home, or some people have their patients come into their office to do it, but you drink a sugar solution.

Well, first of all, you kind of prep for 24 hours to kind of rid your intestines of any fiber lingering things, so as not to disrupt it. Then the morning of you drink the sugar solution, and essentially the only thing that would be eating the sugar solution is bacteria, it’s a manufactured artificial solution. So you breathe into a tube every 15 to 20 minutes, kind of every lab has different criteria and methodology. And then they measure the amount of gas in each of those tubes. As in theory, the sugar is making its way down your intestinal track. So if there’s kind of a jump in those gases too early on, before that solution would have reached the large intestine where you expect to see a huge jump, because again, that’s where all of your bacteria are housed, that could indicate SIBO.

Amy Medling:

So is that a lab test that can be patient direct or do you need to go through-

Phoebe Lapine:

It depends.

Amy Medling:

Okay.

Phoebe Lapine:

Yeah. There’s some labs where you can get it directly, but if you want insurance to cover it, you have to get a prescription.

Amy Medling:

Okay. So do you think most gastroenterologists are familiar enough with that?

Phoebe Lapine:

I think gastroenterology is tough. They are kind of the most conservative in the health fields. Now they’re recommending the low FODMAP diet and some things that have ongoing research for IBS, but SIBOs still this kind of new diagnostic criteria. So I tend to find, and from what I’ve heard from my followers and readers is that the GIs are the least likely to recommend this test or know about SIBO, but more functional medicine doctors, holistic health practitioners, naturopaths, they’re the ones to go to.

Amy Medling:

Yeah. I mean, that’s kind of what we’re finding in terms of helping with PCOS, hormone testing, that type of thing, it’s the same thing.

Phoebe Lapine:

I’m not even being disparaging. My gastroenterologist, who’s a very well-respected guy in New York City, this was before I wrote my book, but he was like, “You know more about SIBO than I do.”

Amy Medling:

Yeah. And that’s been my experience too. Before we got on the call, I was telling you about my son and he has a gastroenterologist at Mass General, and I asked him about SIBO and he had no idea what it was. So it was really frustrating. But, now I’ll be able to go back and educate him with your book. I might even give him a copy. So, now you have a diagnosis and this is where your plan kind of comes into play. Maybe you could just sort of walk us through some of the steps that you took in order to heal yourself.

Phoebe Lapine:

Yeah, well, I was really lucky, my doctor gave me guidance. But, as anyone who’s seen a doctor knows, even the best functional medicine doctor or what have you, they’re going to give you a few pages to take home. And then it’s really just on you to kind of put it all into practice and to do some research on kind of what the ancillary things are. And so I dove really straight down the internet rabbit hole and tried to make sense of kind of all the various approaches. And there are so many, and it really depends on the individual and what your specific situation is, but essentially, most people go through one “kill phase.” So an actual process of eradicating the bacteria from your small intestine. There are conventional antibiotics for this, that work really well, but they tend to be expensive.

There’s herbal antimicrobials, which are a little bit more broad spectrum, but of course, “natural” and over the counter. And then there’s this thing called the elemental diet, which is not really a diet, it’s a medical shake and you could drink it for all of your meals for two weeks. And that is very effective with SIBO, but fewer people will want to take that on. And then there’s the whole question of diet. Obviously when you’re healing the gut or treating the gut, what you’re eating has tremendous importance, but not everyone will layer that on to the treatment process. I kind of always have to remind people that treatment and healing are two very different things. And oftentimes, that aggressive kill phase will require even more healing on the other end of it. And so oftentimes, some people will, and this was the case for me as well, get a negative SIBO test and still be feeling symptomatic.

And sometimes that could because there’s something else going on, but oftentimes I think it’s just because you just need a lot of healing, off the other end of it, that bacteria did cause a lot of damage. So, that’s kind of where the diet piece comes into play. I mentioned the low FODMAP diet, that’s kind of the most popular recommendation. You’re essentially kind of taking away your bacteria’s favorite foods, which kind of the misconception is that that starves them. It doesn’t really, but it can encourage them to kind of go to the right place. And more importantly, it can help just curb any remaining symptoms that you have, to make you less miserable, to help your gut heal since that gas can be really disruptive and harmful just on its own.

And then, I always think, especially since leaky gut is a factor for SIBO, that removing some of the big allergens as well is important, maybe even more important than the FODMAPs. So, dairy, gluten, soy, corn, being some of the biggies and then really just adding in as much ammunition for healing as possible. Unfortunately the low FODMAP diet includes a lot of really healthful vegetables, which can make people kind of fearful of ordinary, healthy foods. So especially in my book and when I was healing, I tried to keep as many vegetables as possible and really add in things like fresh ginger and turmeric and bone broth, anything that has a lot of healing power to it.

Amy Medling:

I think you made a really good point in your bio about how it’s difficult to be on these restrictive diets and that you have kind of a philosophy and approach of how to do that without feeling deprived. And I know, I really want to hear more about that. I talk about how the PCOS Diva Lifestyle is really not about diet, deprivation, and denial, you have to shift that mindset and I’d love to hear how you’ve done that.

Phoebe Lapine:

Yeah, well, I think it’s really tough for SIBO people. There’s a lot of food fear, again, because your symptoms are very much correlated to eating. I mean, it is not in your head, you are symptomatic because you’re eating. But it doesn’t necessarily mean, those symptoms don’t necessarily mean whether the SIBO is getting worse or better or whatnot, because diet didn’t cause SIBO, and it’s not going to be diet alone that helps you cure it. It can, of course make you less miserable, but you should just always remember that the goal is not perfection on the diet front, and the goal in life is not necessarily symptom perfection either. You can live a perfectly wonderful life at 80% better, which is kind of my big learning from the Wellness Project.

So yeah, my philosophy of healthy hedonism, I kind of define as, balancing the things that nourish your body with the things that actually feed your spirit and remembering those things and leaning into them I think is so important and that can be a French fry or it can be something like a walk in the middle of the day, or just spending times with friends and oftentimes restricted diets can get in the way of your social life, it can get in the way of your financial wellness. And all of those things are not true healing in the macro sense.

Amy Medling:

I think that a lot of women that are on these kind of diets, when you’re diagnosed with PCOS, and you get all of that information, like you were talking about with your Hashimoto’s, the supplements to take, the food to eat, you can become very obsessive and there’s even a term, when it comes to eating, I think it’s called orthorexia, and you just get so obsessed with what you can eat and what you can’t eat. And it becomes really unhealthy. How do you help your clients and readers kind of create a healthy balance?

Phoebe Lapine:

Yeah, I mean, it’s so hard. I think, a lot of us have felt so out of control with our health for so long that of course like, the food you’re putting in your mouth three times a day is among the things that you can control. It doesn’t necessarily mean that you’re making yourself better. For the gut healing standpoint, I always remind people that, the ultimate goal, the ultimate rules of good gut health, are still to eat as diverse, a diet as possible, and as many plants on your plate as possible.

And I think the best application of the low FODMAP diet since it is kind of quantity specific, is that it can teach you to do that. Because its massive amounts of cauliflower or certain medium FODMAP ingredients, can make you not feel great, but having little bits of this and that can, and again, when applied properly, that means that instead of kind of a blue plate special, you maybe have five different vegetables mixed together, just smaller quantities of each.

So, I completely sympathize that, it’s really hard to get from point A to point B with SIBO, because they’re opposites. But you just have to face your fears and work on those food fears in order to get there. And just remember that, that diversity is the ultimate goal. But any restrictive diet is pretty much going to stand in opposition to that goal of diversity. And you may require a level of restrictiveness now and that’s okay. But remember that the aspiration is to get back to the diversity, that’s the ultimate goal always.

Amy Medling:

Hmm. That’s a great point. One of the real, what I want to say, the aspects of your book that I enjoyed was your symptom and activity tracker worksheet. I talk about how PCOS is just kind of like a big science experiment, living with it, trying to figure out what works for you, what doesn’t work. And I loved your tracker sheets. Maybe you could talk a little bit about what you track during this time.

Phoebe Lapine:

Yeah. So that actually, that tracker sheet is the 2.0 of one I created off the back of the Wellness Project for my online course, Four Weeks to Wellness, which is kind of the lightning fast version of my year of health and how I primarily work with people. And it’s the low tech version. I wish there was an app that perfectly had all these different lifestyle elements in one place. Maybe there is one and I just need to learn about it.

But for women especially, seeing where you are in your cycle, coupled with what you’re putting on your skin every day, coupled with what you’re drinking every day, what you’re eating every day, when your symptoms occur. I think that’s really important for SIBO. Is it in the morning, the afternoon, the evening? Let’s see what else, exercise, of course your sleep, how well you slept, not just how many hours you were in bed for. And then I think I have some lifestyle things on there too. Did you meditate that day? Did you do yoga? Some of these things do actually counteract some of the other imperfections and it all adds up at the end of the day. So it’s important for people to kind of stare at the sheet, pull back, and kind of look at that.

Amy Medling:

Well, you have some really beautiful food photography. I know you make healthy food look really delicious and I’m sure it tastes great too. Is there any way to heal without getting into the kitchen and cooking real food?

Phoebe Lapine:

I think it’s really hard, to be honest, I think kind of the stealth benefit of some of these restrictive diets, like Whole 30, AIP, all these other ones, is not the big things that you’re eliminating, it’s that you’re cooking in the first place, because your diet is so restrictive, you can’t eat out. And I think, people don’t quite realize that that is really what’s moving the needle.

I also think that kind of the big guns, alcohol, caffeine, and sugar, if you start with those, half of your problems will probably be cleared up. That’s what we do in my program. We don’t just launch into an elimination diet, we just do those three, week one. For some people it’s really tough, for others, it’s like, “Oh.” But, most people do see extreme improvement. And I think that’s so important then. It’s kind of the concept of my project, not doing too many things all at once ,because you won’t really be able to tell what’s moving the needle.

Amy Medling:

I think a lot of women with adrenal issues, it’s so comforting to start your day with coffee and end it with wine. And it is, it’s hard, but it’s really disruptive to your gut.

Phoebe Lapine:

Totally. Everything. Your hormones.

Amy Medling:

I know everything. So you’ve talked a little bit about your programs, where can we learn more about your work?

Phoebe Lapine:

Yeah, so I have a lot of free recipes that suit a whole number of diets on feedmephoebe.com. And then if you want to learn more about the book that’s, SIBOMadesimple.com and if you want to learn more about the other book and the program, that’s at the wellnessproject.com

Amy Medling:

And you have a podcast?

Phoebe Lapine:

Yes. SIBO Made Simple, the Podcast, you can find that on my main site, feedmephoebe.

Amy Medling:

Well, it’s been awesome having you here. And you’re really, as I said before we get on the podcast, you’re my first SIBO expert and just really happy that you were here and sharing about this important topic. I think a lot of women with PCOS, it may be one of those missing pieces of the puzzle.

Phoebe Lapine:

Awesome. Well, thank you so much for having me.

Amy Medling:

And thank you everyone for listening. I look forward to being with you again very soon. Bye-bye.

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