WEBVTT 1 00:00:08.080 --> 00:00:13.335 Hi. I'm Shivan Sarna. We're continuing our conversations about menopause and your health. 2 00:00:13.555 --> 00:00:15.895 And my very special guest today is 3 00:00:16.355 --> 00:00:22.535 the one, the only, Dr. Allison Siebecker. Hi, Dr. Siebecker. Hi. So glad to be here. 4 00:00:22.755 --> 00:00:29.890 Thank you. Dr. Siebecker is a personal friend, and she's also my main colleague in our SIBO SOS 5 00:00:30.270 --> 00:00:30.770 Adventures, 6 00:00:31.790 --> 00:00:37.650 small intestine bacterial overgrowth. She is the one who read my book, Healing SIBO Front to Back. 7 00:00:37.870 --> 00:00:41.594 She wrote the foreword for it. She and I have created courses together. 8 00:00:42.055 --> 00:00:45.995 She has a pro course for practitioners in case anybody's interested. 9 00:00:46.614 --> 00:00:50.315 She is an award winning naturopath and SIBO specialist. 10 00:00:50.774 --> 00:00:55.274 And if you don't know what SIBO is, let me just ask you this, are you ever bloated? 11 00:00:56.190 --> 00:01:02.610 And then I want you to really listen because if you've ever considered whether or not you have IBS, irritable bowel syndrome, 12 00:01:02.990 --> 00:01:09.170 SIBO is the number one underlying cause of it. Now doctor Siebecker and I have a mutual mission 13 00:01:09.615 --> 00:01:12.995 of educating the world about this particular health condition, 14 00:01:13.615 --> 00:01:14.755 and she is 15 00:01:15.135 --> 00:01:20.035 granular and global and everything in between. She has created SIBO conferences. 16 00:01:20.415 --> 00:01:22.354 She has helped me with every 17 00:01:22.920 --> 00:01:24.140 SIBO tangential 18 00:01:24.520 --> 00:01:26.140 idea we've ever had. 19 00:01:26.760 --> 00:01:27.740 You get the idea. 20 00:01:28.440 --> 00:01:33.340 And I wanted her to be in this new Science and Wisdom of Menopause Summit, because 21 00:01:34.520 --> 00:01:36.860 still people don't understand, 22 00:01:37.705 --> 00:01:41.725 unfortunately, and we're doing our best to change that, about IBS and SIBO. 23 00:01:42.104 --> 00:01:45.085 And we've both suffered from it since we were five. 24 00:01:45.465 --> 00:01:48.884 I'm gonna just start off with you, Dr. Siebecker, 25 00:01:49.225 --> 00:01:51.405 with what exactly is 26 00:01:51.945 --> 00:01:52.445 SIBO? 27 00:01:54.250 --> 00:01:59.229 Well, it is, as you said, the number one cause of irritable bowel syndrome. And just some stats, 28 00:01:59.689 --> 00:02:01.630 IBS for short is what it's called, 29 00:02:02.570 --> 00:02:04.829 is the most common GI condition worldwide. 30 00:02:05.685 --> 00:02:07.705 Some studies show it's up to 25% 31 00:02:08.005 --> 00:02:09.145 of the world's population. 32 00:02:09.445 --> 00:02:12.265 Some some studies show a lower percentage, like 10%. 33 00:02:13.205 --> 00:02:14.665 Either way, it's vast. 34 00:02:15.205 --> 00:02:15.705 And, 35 00:02:16.565 --> 00:02:18.100 and SIBO is the number one cause. 36 00:02:18.100 --> 00:02:22.360 And what it is is when there are some bacteria or other microorganisms 37 00:02:22.740 --> 00:02:23.400 that are, 38 00:02:24.020 --> 00:02:29.080 in too great of an amount in the small and actually or large intestine. The definition has expanded, 39 00:02:30.635 --> 00:02:31.855 that are causing 40 00:02:32.315 --> 00:02:33.455 they create gas, 41 00:02:33.995 --> 00:02:38.235 gases that they make, only they make, and then that leads to symptoms. 42 00:02:38.235 --> 00:02:40.075 And the symptoms are the same as IBS. 43 00:02:40.075 --> 00:02:43.435 And just briefly, those are abdominal bloating, which you mentioned right away. 44 00:02:43.435 --> 00:02:44.815 That's the hallmark symptom 45 00:02:45.160 --> 00:02:47.420 or distension when the abdomen swells out. 46 00:02:47.880 --> 00:02:48.200 The, 47 00:02:48.760 --> 00:02:51.420 the other one is pain or discomfort in the abdomen 48 00:02:52.520 --> 00:02:56.440 and bowel movement changes. So constipation, diarrhea, Sarna combination of the two. 49 00:02:56.440 --> 00:02:59.420 And there can be excessive burping or farting as well, 50 00:03:00.035 --> 00:03:05.095 or maybe there's none of that. So those are the symptoms of IBS and SIBO. SIBO also can cause, 51 00:03:05.555 --> 00:03:07.975 brain fog, which is also common in menopause, 52 00:03:08.675 --> 00:03:09.175 and, 53 00:03:10.435 --> 00:03:12.055 it can cause anxiety. 54 00:03:12.435 --> 00:03:15.080 Sometimes depression, but anxiety is quite common. 55 00:03:15.379 --> 00:03:20.680 And also acid reflux, it's a main cause of acid reflux. It cause could cause nausea 56 00:03:21.220 --> 00:03:25.160 and some other symptoms. So those are the main that's the main symptom picture. 57 00:03:25.540 --> 00:03:27.700 So it's just it's like it's what its name sound. 58 00:03:27.700 --> 00:03:34.095 It's an overgrowth or too many of a certain kind of bacteria in our small or large intestine that wreak havoc, 59 00:03:34.635 --> 00:03:35.135 basically. 60 00:03:35.835 --> 00:03:36.335 And 61 00:03:37.115 --> 00:03:38.715 how do people find out? 62 00:03:38.715 --> 00:03:44.095 So just, you know, belly fat is happening as we are in menopause and perimenopause 63 00:03:44.475 --> 00:03:45.375 because of, 64 00:03:46.090 --> 00:03:47.070 estrogen levels. 65 00:03:47.370 --> 00:03:52.990 And then if you put bloating on top of it, you really can start to feel like a loss of self confidence. 66 00:03:53.530 --> 00:03:55.070 You know, your clothes aren't fitting. 67 00:03:55.130 --> 00:03:59.290 You should have seen all the photos I've taken for for prior to knowing doctor Siebecker. 68 00:03:59.290 --> 00:04:05.144 Well, I would just take my big tote bag and put it in front of my tummy because I was like, oh, I'm gonna hide this. 69 00:04:05.845 --> 00:04:07.545 It's, you know, definitely 70 00:04:08.165 --> 00:04:08.665 a 71 00:04:09.125 --> 00:04:09.625 societal 72 00:04:11.284 --> 00:04:14.424 hot topic because I remember back in the day, 73 00:04:15.460 --> 00:04:17.220 it was like women's fitness magazines. 74 00:04:17.220 --> 00:04:22.580 If they had 6 pack abs, how to get, you know, a flat belly, and I think it still happens to this day. 75 00:04:22.580 --> 00:04:23.480 Like, those 76 00:04:23.940 --> 00:04:25.240 magazines would sell 77 00:04:25.620 --> 00:04:31.865 almost as well as if, Princess Diana was on the cover. I mean, it is like, it's a big, it's money 78 00:04:32.325 --> 00:04:34.645 because it bothers us. It's a huge pain point. 79 00:04:34.645 --> 00:04:39.945 But then you put on top of that, the estrogen belly, and then you put on top of that, that you have diarrhea or constipation. 80 00:04:40.245 --> 00:04:44.380 It's very uncomfortable. Bloating, the bloating. Bloating, hello. Right. 81 00:04:44.380 --> 00:04:49.180 So doctor Siebecker, what if this is starting to sound a little bit familiar or like, oh, yeah. 82 00:04:49.180 --> 00:04:49.920 I have IBS. 83 00:04:50.700 --> 00:04:55.120 What do we need to do in terms of testing to find out what we really have? 84 00:04:55.420 --> 00:04:56.860 Oh, yeah. See, that's the great thing. 85 00:04:56.860 --> 00:04:59.760 There's a test to figure out if you have it, and it's a breath test. 86 00:05:00.044 --> 00:05:02.785 And what I recommend is a 3 hour, 87 00:05:03.805 --> 00:05:05.965 lactulose breath test. So there's different, 88 00:05:06.365 --> 00:05:11.884 basically, you drink a solution of kind of a sugar when you do this test, and there's different types. 89 00:05:11.884 --> 00:05:16.340 And the one I recommend is the lactulose breath test. So this is called the SIBO test. 90 00:05:16.560 --> 00:05:17.940 Various labs have it, 91 00:05:18.800 --> 00:05:23.040 and it should be a 3 hour if at all possible. And that's what's gonna give you the best test. 92 00:05:23.040 --> 00:05:28.340 It's a 3 hour lactulose breath test. It's pretty easy to do. You do a special diet the day before. 93 00:05:28.474 --> 00:05:31.354 That's probably the hardest part where you can't eat many 94 00:05:31.754 --> 00:05:34.254 vegetable. You really don't eat vegetables or fruit 95 00:05:34.555 --> 00:05:35.535 for one day. 96 00:05:35.835 --> 00:05:42.050 And then the next morning, you do the you do the test in the morning for 3 hours of when when you're fasting, basically. 97 00:05:42.050 --> 00:05:44.449 And, and that's it. So I recommend everyone do that. 98 00:05:44.449 --> 00:05:51.530 That is the way we figure out whether anyone everyone who anyone who's thinking they may have this. 99 00:05:52.150 --> 00:05:55.000 That's how we figure out if if you have CBAR or not. You have to have the symptoms, 100 00:05:55.075 --> 00:05:58.055 and then you do the test. And if they're both positive, 101 00:05:58.675 --> 00:06:00.055 then you know you have it. 102 00:06:00.195 --> 00:06:05.255 And and, actually, Sivan, can I just jump in and talk about the relationship between 103 00:06:06.195 --> 00:06:09.575 menopause and IBS and or SIBO? Please do. 104 00:06:10.115 --> 00:06:10.615 Because, 105 00:06:10.960 --> 00:06:11.780 you know what 106 00:06:12.159 --> 00:06:15.300 the reason I think we wanted to speak about this here is that 107 00:06:15.840 --> 00:06:17.699 there are many people who have IBS 108 00:06:18.080 --> 00:06:22.319 and really it's SIBO because this is that's the number one cause of IBS. And they don't know that. 109 00:06:22.319 --> 00:06:27.775 That it's still new for a lot of people to know that there is an actual cause of IBS here. 110 00:06:27.775 --> 00:06:29.955 Most people are told there's it's a mystery, 111 00:06:30.575 --> 00:06:32.195 which it maybe it is. But, 112 00:06:32.655 --> 00:06:34.435 you know, studies show up to 70% 113 00:06:34.975 --> 00:06:37.235 of IBS patients, the cause is SIBO. 114 00:06:38.450 --> 00:06:40.470 But what what we know from studies 115 00:06:40.770 --> 00:06:41.510 is that 116 00:06:42.370 --> 00:06:43.350 before menopause, 117 00:06:44.210 --> 00:06:46.390 people's IBS, people who have IBS, 118 00:06:47.490 --> 00:06:52.070 the symptoms are not as severe as when we go into perimenopause, 119 00:06:52.875 --> 00:06:54.655 menopause, and postmenopause. So 120 00:06:55.275 --> 00:06:56.735 that hormonal situation 121 00:06:57.195 --> 00:06:59.375 makes the symptoms more severe. 122 00:06:59.675 --> 00:07:02.575 So that includes everything I mentioned, the pain, 123 00:07:02.955 --> 00:07:05.215 the bloating, the constipation, and the diarrhea. 124 00:07:05.835 --> 00:07:06.335 And 125 00:07:07.350 --> 00:07:12.090 studies sort of have a have some ideas of why is this, but it's basically that 126 00:07:12.550 --> 00:07:13.050 progesterone 127 00:07:13.350 --> 00:07:18.169 and estrogen are going down. They call it progesterone and estrogen withdrawal. 128 00:07:19.245 --> 00:07:22.225 And that seems to affect the symptoms. 129 00:07:22.285 --> 00:07:28.365 We know that ovarian hormones can affect GI motility, like the movement. 130 00:07:28.365 --> 00:07:31.265 You know, thinking of bowel movements and other things, 131 00:07:31.880 --> 00:07:32.860 as well as 132 00:07:33.240 --> 00:07:36.460 the perception of pain. They can absolutely modulate 133 00:07:36.920 --> 00:07:42.380 how we perceive pain. They can increase it or decrease it depending upon what's going on. 134 00:07:43.240 --> 00:07:46.700 They can also affect our response to stress. 135 00:07:47.925 --> 00:07:53.305 And stress, they can actually increase our response to stress. 136 00:07:53.525 --> 00:07:55.465 And when we have that going on, 137 00:07:55.765 --> 00:07:58.105 that could lead to things like leaky gut. 138 00:07:58.645 --> 00:08:02.730 Some of you may be familiar with that, And a decrease in our immune system, 139 00:08:03.670 --> 00:08:05.290 meaning, like, we could be more, 140 00:08:05.990 --> 00:08:09.850 susceptible to GI infections, which are actually a major cause of SIBO. 141 00:08:10.550 --> 00:08:12.330 So it's not thought that 142 00:08:12.824 --> 00:08:18.604 these change in hormones are a cause of IBS or SIBO, but they they can affect the symptoms. 143 00:08:19.225 --> 00:08:19.965 And so, 144 00:08:20.425 --> 00:08:23.805 basically, if you have had these symptoms we're describing 145 00:08:24.264 --> 00:08:26.525 and you're now noticing them to get worse, 146 00:08:27.330 --> 00:08:29.910 that makes sense as you come into menopause. 147 00:08:30.290 --> 00:08:32.870 And no better time to get tested. 148 00:08:33.490 --> 00:08:35.110 And if it's there, treat it. 149 00:08:36.130 --> 00:08:40.929 Great. Great advice. What else could so if you have bloating, it could be other things too. 150 00:08:40.929 --> 00:08:44.965 Right, Dr. Siebecker? I mean, it is. That's why it's so important to get tested because 151 00:08:45.345 --> 00:08:46.325 if you have, 152 00:08:47.425 --> 00:08:47.925 parasites, 153 00:08:48.305 --> 00:08:49.285 if you have, 154 00:08:50.625 --> 00:08:53.045 Candida Yeast overgrowth. Yeah. Candida. 155 00:08:53.505 --> 00:08:59.519 I mean, we call it the differential diagnosis list, meaning what else could it be that what things cause these same symptoms? 156 00:08:59.740 --> 00:09:01.040 These symptoms are nonspecific, 157 00:09:01.660 --> 00:09:08.639 meaning many, many things cause them. And so that list is, you know, 45 conditions long at least. 158 00:09:09.259 --> 00:09:11.660 So that's that's why you wanna get a test. 159 00:09:11.660 --> 00:09:15.685 But I think the first place to start is with a SIBO test because 160 00:09:16.065 --> 00:09:18.885 up to 70% of IBS is caused by SIBO. 161 00:09:18.945 --> 00:09:26.565 So that's like the best use of your money and time is check for that first since it's the most common cause underlying 162 00:09:26.945 --> 00:09:27.685 of IBS. 163 00:09:28.500 --> 00:09:29.860 So that's where I go. 164 00:09:29.860 --> 00:09:35.000 And and one other thing I just wanted to say is about what we know from studies is 165 00:09:35.620 --> 00:09:37.560 if the drop in hormones 166 00:09:37.860 --> 00:09:39.480 makes the symptoms worse, 167 00:09:40.315 --> 00:09:44.975 Does that mean that, of course, we would all wonder that taking hormone replacement therapy 168 00:09:45.675 --> 00:09:50.235 would help the symptoms? And we don't actually have studies on that to my knowledge. 169 00:09:50.235 --> 00:09:55.250 There aren't a whole lot of studies on hormone replacement therapy and and the gut, basically. 170 00:09:55.250 --> 00:09:59.510 They're starting to be. But we do have one from one of our lead researchers 171 00:09:59.970 --> 00:10:04.390 in SIBO, and that's Dr. Pimentel. He and his wife were involved in this study 172 00:10:04.895 --> 00:10:06.932 that, she's also a physician 173 00:10:07.295 --> 00:10:09.075 that looked at the microbiome, 174 00:10:09.455 --> 00:10:10.915 the small intestine microbiome 175 00:10:11.455 --> 00:10:11.955 of, 176 00:10:12.495 --> 00:10:12.995 postmenopausal 177 00:10:13.375 --> 00:10:18.195 compared to premenopausal women. And what they found was hormone replacement therapy preserved 178 00:10:18.970 --> 00:10:21.310 the youthful and healthy microbiome. 179 00:10:22.410 --> 00:10:27.450 And that matters because the microbiome is associated with various risks. 180 00:10:27.450 --> 00:10:31.630 Like, for instance, if it becomes dysbiotic, which it seemed to be in 181 00:10:31.975 --> 00:10:34.155 menopausal women without hormone replacement, 182 00:10:36.055 --> 00:10:39.435 the fasting blood sugar level was higher. 183 00:10:39.575 --> 00:10:42.635 And, you know, that's a risk for diabetes and many other problems. 184 00:10:42.775 --> 00:10:45.275 And when they were on the hormone replacement therapy, 185 00:10:45.959 --> 00:10:49.740 they had a microbiome that had a much lower risk for cardiovascular 186 00:10:50.279 --> 00:10:50.779 disease. 187 00:10:51.319 --> 00:10:53.240 So we do know this. 188 00:10:53.240 --> 00:10:59.100 We don't know its exact effect on SIBO or IBS, but we do know, hormone replacement therapy 189 00:10:59.480 --> 00:11:01.834 looks like it really helps helps the microbiome. 190 00:11:03.255 --> 00:11:04.375 Phenomenal. Phenomenal. 191 00:11:04.375 --> 00:11:12.074 We have, Shivan Krishnan also part of this event, and he also talks about that and how hormones affect the microbiome, 192 00:11:12.695 --> 00:11:13.195 including, 193 00:11:14.670 --> 00:11:15.170 BHRT 194 00:11:15.630 --> 00:11:16.130 bioidentical 195 00:11:16.830 --> 00:11:20.690 hormone therapy. So definitely keep keep listening and all that. 196 00:11:21.870 --> 00:11:24.130 Let's just briefly talk about food poisoning, 197 00:11:24.830 --> 00:11:25.330 because 198 00:11:26.555 --> 00:11:31.454 it's so important to understand. And, also, even if you feel like you've never had food poisoning, 199 00:11:31.915 --> 00:11:33.214 have you ever had, like, 200 00:11:34.555 --> 00:11:36.415 a short term bout of diarrhea 201 00:11:37.035 --> 00:11:39.935 or, like, oh, I must have eaten something or 202 00:11:40.680 --> 00:11:43.180 some other things that may not be called food poisoning. 203 00:11:43.800 --> 00:11:45.740 It may have been a foodborne 204 00:11:47.160 --> 00:11:50.200 pathogen that actually officially would be food poisoning. 205 00:11:50.200 --> 00:11:52.300 So would you address that for us, please, doctor? 206 00:11:52.845 --> 00:11:59.084 It is the number one most common underlying cause of SIBO and IBS, actually. 207 00:11:59.084 --> 00:12:04.385 Like, what actually would give somebody that those conditions? It would be the same in this case. 208 00:12:04.685 --> 00:12:07.425 For years, it was called, oh, can I even remember 209 00:12:08.670 --> 00:12:09.890 post infectious IBS 210 00:12:10.750 --> 00:12:13.870 which is the it's the same thing as SIBO And it's IBS. 211 00:12:13.870 --> 00:12:16.850 It's all the same in this particular case from this cause. 212 00:12:16.910 --> 00:12:21.950 So, yeah, we now know that if you get bacteria food poisoning, there's also viral food poisoning. 213 00:12:21.950 --> 00:12:22.930 That's more common. 214 00:12:23.305 --> 00:12:31.085 So it's a lower percent of people that get that will get food poisoning that's bacterial, but then that is likely to go on and become 215 00:12:31.625 --> 00:12:34.445 SIBO. And how it works is there's an autoimmune 216 00:12:34.825 --> 00:12:36.125 situation going on 217 00:12:36.560 --> 00:12:39.040 where the bacteria secrete a toxin. 218 00:12:39.040 --> 00:12:43.380 They all the bacteria that cause food poisoning secrete the same toxin actually. 219 00:12:43.839 --> 00:12:47.220 And that toxin looks very similar to a nerve 220 00:12:48.000 --> 00:12:48.500 221 00:12:48.925 --> 00:12:51.825 a protein on our nerve cells in our small intestine. 222 00:12:52.365 --> 00:12:57.425 And through, like, mistaken identity or friendly fire, basically, the immune system attacks 223 00:12:57.725 --> 00:12:59.505 the nerve cells in the small intestine. 224 00:13:00.045 --> 00:13:04.225 That then decreases a particular movement that is a a sort of a peristaltic 225 00:13:04.899 --> 00:13:08.360 healthy form of movement in the small intestine called the migrating motor complex, 226 00:13:08.980 --> 00:13:10.120 MMC for short. 227 00:13:11.060 --> 00:13:20.795 That is our number one way to keep SIBO away because it just sweeps away naturally sweeps away any accumulated extra accumulated bacteria 228 00:13:21.095 --> 00:13:22.215 on a daily basis. 229 00:13:22.215 --> 00:13:27.435 And so if that becomes deficient and the sweeping isn't there, bacteria can accumulate. 230 00:13:27.815 --> 00:13:30.715 And that is what happens in this particular situation. 231 00:13:31.415 --> 00:13:34.555 So the key thing to know here is that it can be delayed. 232 00:13:34.890 --> 00:13:39.710 So it is possible you have food poisoning and you move right into having IBS or SIBO. 233 00:13:40.010 --> 00:13:43.630 But for many people, the food poisoning symptoms themselves clear up. 234 00:13:43.850 --> 00:13:47.950 And then it's a month, 2, 3, 4 months later, 235 00:13:48.384 --> 00:13:51.285 they develop the symptoms of IBS or SIBO. 236 00:13:51.745 --> 00:13:56.485 And it just can take time actually for that damage to accumulate and that MMC 237 00:13:56.865 --> 00:13:57.605 to slow. 238 00:13:58.065 --> 00:14:03.125 And that's why there's a delay. Very important to realize there can be a delay between the event 239 00:14:03.740 --> 00:14:06.000 and getting the IBS or the SIBO. 240 00:14:06.779 --> 00:14:11.660 And then also traveler's diarrhea counts as food poisoning. And stomach flu. 241 00:14:11.820 --> 00:14:15.555 Because we because we unless you go and get a test, you don't know what it is. 242 00:14:16.435 --> 00:14:18.995 So food poisoning, traveler's diarrhea, stomach flu. 243 00:14:19.235 --> 00:14:23.235 If you think you've been exposed well, everyone's been exposed basically to those things. 244 00:14:23.235 --> 00:14:27.495 But if you think your symptoms could be related, there's actually a different test for this. 245 00:14:28.435 --> 00:14:29.555 And it's called the, 246 00:14:30.115 --> 00:14:31.335 IBS Mark test. 247 00:14:31.810 --> 00:14:36.449 And you can just look that up online, and it's been validated. And it's a blood test. 248 00:14:36.449 --> 00:14:38.209 And it tests for the, 249 00:14:39.089 --> 00:14:40.870 in the blood immune markers 250 00:14:41.250 --> 00:14:42.949 actually for this situation. 251 00:14:43.735 --> 00:14:48.395 And the reason why I like that test in addition to the SIBO breath test is because 252 00:14:48.935 --> 00:14:51.675 it really helps you to hone in on the underlying cause. 253 00:14:51.815 --> 00:14:59.430 And, and there are a lot of underlying causes, but you can still treat SIBO and IBS, even if you don't know what caused it, which is very exciting. 254 00:14:59.890 --> 00:15:04.630 So let's talk about that. Let's talk about like, let's say you get a positive SIBO breath test. 255 00:15:05.490 --> 00:15:06.790 What are the treatments? 256 00:15:07.810 --> 00:15:13.125 So, what we do is we focus our treatments on reducing the bacteria or the microbes. 257 00:15:13.265 --> 00:15:16.165 So we're looking at using killing agents, basically. 258 00:15:16.385 --> 00:15:20.165 And there's 3 categories we choose from, pharmaceutical antibiotics, 259 00:15:20.945 --> 00:15:21.845 herbal antibiotics, 260 00:15:22.385 --> 00:15:24.964 and elemental diet, which is sort of like a, 261 00:15:25.825 --> 00:15:26.565 a medical 262 00:15:27.470 --> 00:15:29.649 medical food beverage sort of. 263 00:15:30.029 --> 00:15:33.949 It works a little different. I'll just address that first. We all know how antibiotics work. 264 00:15:33.949 --> 00:15:34.610 They kill. 265 00:15:34.829 --> 00:15:41.329 Well, what this does is, it basically has all the nutrients we need in the most predigested form. 266 00:15:41.605 --> 00:15:51.685 And so when we drink it, we absorb it very quickly and it feeds us, but it goes so quick into our body that it doesn't allow the bacteria to feed off of it. 267 00:15:51.685 --> 00:15:57.279 The bacteria are feeding off our food, and that's how they're creating the gas and the symptoms. 268 00:15:57.660 --> 00:16:03.680 So, basically, we starve them with the elemental diet where we're it's a 2 week course like it would be with pharmaceutical 269 00:16:04.060 --> 00:16:04.560 antibiotics. 270 00:16:05.420 --> 00:16:08.380 But the the way it works is different. We're trying to starve them. 271 00:16:08.380 --> 00:16:11.275 So these are all killing agents in their own way, 272 00:16:11.654 --> 00:16:13.755 and they all work equally well, 273 00:16:14.535 --> 00:16:15.435 which is great. 274 00:16:16.214 --> 00:16:22.395 And so we just pick and choose from these based on various things, you know, someone's history of use with them, 275 00:16:23.519 --> 00:16:24.019 cost, 276 00:16:24.639 --> 00:16:25.139 philosophy, 277 00:16:25.519 --> 00:16:29.300 etcetera. But it's good to know we have all of these options that work 278 00:16:29.839 --> 00:16:30.660 all effectively. 279 00:16:31.600 --> 00:16:36.755 And one thing I just wanna mention is while the elemental diet and the pharmaceutical antibiotics, 280 00:16:37.695 --> 00:16:41.795 one round of treatment is typically 2 weeks, sometimes 3. 281 00:16:41.935 --> 00:16:45.714 For herbal antibiotics, they work just as well, but it just takes a little longer. 282 00:16:46.015 --> 00:16:47.475 So it's 4 weeks, 283 00:16:47.880 --> 00:16:49.100 sometimes 6 weeks. 284 00:16:49.640 --> 00:16:53.820 And one other thing to know, so important to know, is that 285 00:16:54.520 --> 00:16:58.460 for most people with SIBO, one round of treatment 286 00:16:58.840 --> 00:16:59.900 is not enough. 287 00:17:00.440 --> 00:17:07.765 It's different than your typical acute infection you might be used to using pharmaceutical antibiotics for 288 00:17:08.305 --> 00:17:10.325 where you take one course and you're done. 289 00:17:11.025 --> 00:17:16.085 Usually, we need multiple rounds. I don't know. On average, I'd say 2 to 4 rounds, maybe more. 290 00:17:16.650 --> 00:17:18.970 And so it's very important to know that, 291 00:17:19.530 --> 00:17:22.410 there are people where one round of treatment will take care of it. 292 00:17:22.410 --> 00:17:25.790 We call them 1 and done, and it's wonderful when that happens. 293 00:17:25.849 --> 00:17:28.830 But for for most of us, it's time and fine. 294 00:17:29.050 --> 00:17:33.184 So, when you're done with 1 round, you're not done for a lot of people. 295 00:17:33.325 --> 00:17:39.505 And we typically will retest if there are still symptoms to see because we use the test to choose our treatments. 296 00:17:40.044 --> 00:17:45.345 The pharmaceutical and herbal antibiotics, the exact medicines and herbs that we choose 297 00:17:45.678 --> 00:17:47.345 are based on the gases. 298 00:17:48.070 --> 00:17:53.930 We didn't go into that too much, but there's 3 types. And so it they're made by different microbes. 299 00:17:53.990 --> 00:17:55.530 And we know we need different 300 00:17:55.910 --> 00:17:57.770 killing agents for different microbes. 301 00:17:58.230 --> 00:17:58.730 So, 302 00:17:59.110 --> 00:18:02.490 we need the test to know exactly what to choose for our treatments. 303 00:18:03.015 --> 00:18:03.995 So we retest, 304 00:18:04.295 --> 00:18:11.675 if symptoms are still there, and we just keep going with rounds and retesting to make sure it's still there, and we're still treating the right thing, 305 00:18:12.535 --> 00:18:15.195 until we get the good effect. 306 00:18:15.760 --> 00:18:21.940 And the good effect is very common. We typically see, and my goal is, 90% 307 00:18:22.480 --> 00:18:23.620 symptom removal. 308 00:18:24.080 --> 00:18:29.540 Now, I didn't say a 100 because there's usually an underlying cause there for many people. 309 00:18:29.755 --> 00:18:30.715 There are many 310 00:18:31.275 --> 00:18:32.575 ongoing underlying causes 311 00:18:33.195 --> 00:18:36.095 for SIBO that have symptoms of their own. 312 00:18:36.315 --> 00:18:41.534 But, I think most people will be very happy with 90%, and some people get a 100%. 313 00:18:42.075 --> 00:18:44.095 So, that's how we go through the treatment. 314 00:18:44.920 --> 00:18:46.860 So, that's the 9 step protocol 315 00:18:47.240 --> 00:18:48.300 that the, 316 00:18:49.140 --> 00:18:52.060 Dr. Pimentel first created and then Dr. 317 00:18:52.780 --> 00:18:56.780 Siebecker and Dr. Steven Sandberg Lewis, another one of our dear friends and colleagues, 318 00:18:58.280 --> 00:19:02.955 that have developed, you know, based on Dr. Pimentel's work, a 9 step protocol. 319 00:19:03.495 --> 00:19:09.995 And what I see in our Siebecker SOS community Facebook group with about 30,000 people in there on a daily basis, 320 00:19:10.375 --> 00:19:11.434 that practitioners 321 00:19:12.840 --> 00:19:13.900 who are not trained 322 00:19:14.600 --> 00:19:21.179 properly by you, and and it's not enough in medical school, like in traditional medical school and GI school, like it's 323 00:19:21.480 --> 00:19:25.080 mentioned. I don't think this is even talked about. Yeah. It's not even really talked about. 324 00:19:25.080 --> 00:19:30.585 I know because I've gone to gastros that are wonderful for scoping and certain things, but, 325 00:19:30.965 --> 00:19:33.705 I handed Dr. Schulman, my GI doctor, 326 00:19:34.005 --> 00:19:34.825 the studies 327 00:19:35.284 --> 00:19:39.544 and the protocol, and he was like, oh, thanks. I didn't learn this in school. So God bless him. 328 00:19:39.684 --> 00:19:40.585 Right? So 329 00:19:41.200 --> 00:19:42.660 the thing is is that 330 00:19:43.920 --> 00:19:45.060 people are confused, 331 00:19:45.600 --> 00:19:52.580 first of all, what it is, and that there is a treatment, and that it has a way to be prevented in terms of relapse, 332 00:19:53.040 --> 00:19:54.020 and that, 333 00:19:55.195 --> 00:19:59.294 what I was saying is that there's a lot of confusion about it out in the world. 334 00:19:59.434 --> 00:20:02.875 So people will do part of the protocol, not the whole protocol. 335 00:20:02.875 --> 00:20:07.054 They'll do it out of order, which will also mess things up. And then it leads to this 336 00:20:07.355 --> 00:20:09.294 malaise within the patient population 337 00:20:10.140 --> 00:20:12.800 who are like, see, it's never going away. 338 00:20:13.580 --> 00:20:15.440 My anxiety was confirmed. 339 00:20:15.900 --> 00:20:20.160 I still feel bad. I spent all this money on supplements. I have a supplement graveyard. 340 00:20:20.300 --> 00:20:22.480 I tried the crazy rifaximin antibiotic, 341 00:20:23.100 --> 00:20:24.640 and it still didn't work. 342 00:20:24.995 --> 00:20:28.215 And this is makes doctor Siebecker and I cuckoo 343 00:20:28.675 --> 00:20:32.855 because there is this protocol. There are results to be had. 344 00:20:32.995 --> 00:20:36.295 She and Dr. Steven Sandberg Lewis have run 1,000 345 00:20:36.595 --> 00:20:39.015 of before and after validated 346 00:20:39.640 --> 00:20:41.179 SIBO breath tests to 347 00:20:41.480 --> 00:20:46.620 yield negative breath test results and to yield these positive results for people. 348 00:20:47.400 --> 00:20:51.660 I know, soapbox. But this is what makes us so cuckoo because, 349 00:20:52.785 --> 00:20:58.605 we have suffered, and now we're doing so much better because we've done these protocols, and we feel so much better. 350 00:20:58.625 --> 00:21:03.445 Even if you have an underlying cause, it cannot be resolved, which leads me to one of my favorite things to say. 351 00:21:03.665 --> 00:21:10.700 It's not the thing you put on a t-shirt for me, Dr. Siebecker, which is that a managed chronic condition can help you feel 100% 352 00:21:11.400 --> 00:21:16.460 better than an unmanaged condition, which kind of ties back into the bioidentical 353 00:21:16.919 --> 00:21:18.779 hormone idea for menopause. 354 00:21:19.924 --> 00:21:23.705 I have many friends, and this is one of the reasons why I'm doing this event, 355 00:21:24.325 --> 00:21:26.424 who are not on bioidentical 356 00:21:26.804 --> 00:21:32.245 hormones or were on them and got off of them because their provider said, oh, you don't need them anymore. 357 00:21:32.245 --> 00:21:33.945 You're too old for it. Or, 358 00:21:34.870 --> 00:21:41.669 they got on it and didn't notice the result very quickly and got off with all the reasons, whatever the reasons are. 359 00:21:41.669 --> 00:21:46.309 Or they literally were never even offered them to begin with. 360 00:21:46.309 --> 00:21:54.165 And not that menopause is a chronic condition or an illness because it's not, but it can be a condition that is managed. 361 00:21:54.385 --> 00:21:57.925 And so this is just part of me encouraging you to manage these conditions. 362 00:21:58.545 --> 00:21:59.045 Okay. 363 00:22:00.120 --> 00:22:03.000 How do we prevent relapse, Dr. Siebecker? 364 00:22:03.240 --> 00:22:06.280 You knew where I was going with this. I knew. I knew where you're gonna go. 365 00:22:06.680 --> 00:22:09.880 So we use prokinetics. It's our one of our main things we use. 366 00:22:09.880 --> 00:22:13.260 And these are either natural, such as herbal or supplemental, 367 00:22:14.135 --> 00:22:15.755 or pharmaceutical agents 368 00:22:16.135 --> 00:22:16.955 that stimulate 369 00:22:17.735 --> 00:22:18.315 that MMC, 370 00:22:18.615 --> 00:22:25.514 that movement in the small intestine that is our number one protection against getting an accumulation of bacteria there. 371 00:22:26.000 --> 00:22:26.320 And, 372 00:22:26.800 --> 00:22:31.380 the idea is that most people have a little bit of a deficiency in this or a lot of a deficiency. 373 00:22:32.000 --> 00:22:33.380 And these medicines 374 00:22:34.160 --> 00:22:36.260 stimulate it. So, you know, it 375 00:22:36.560 --> 00:22:42.395 just you know, it's not like our body can't do it. They it needs a little help. And so we use these. 376 00:22:42.934 --> 00:22:52.230 And what we do is we use them between our treatment rounds to prevent backsliding while we're retesting and assessing whether we need more treatment or not. 377 00:22:52.870 --> 00:22:58.010 And then we for sure use them when we're done with our whole treatment protocol 378 00:22:58.470 --> 00:22:59.929 of reducing the bacteria. 379 00:23:00.390 --> 00:23:02.090 That's what we use as our main 380 00:23:02.870 --> 00:23:04.650 relapse prevention. Because, 381 00:23:05.190 --> 00:23:10.005 SIBO is chronic for many people, for the majority, not for everybody, but for the majority. 382 00:23:10.305 --> 00:23:16.005 And that primarily is because there are many ongoing conditions that continue to cause SIBO. 383 00:23:16.865 --> 00:23:23.290 But as Shivan said, it doesn't mean you can't be very well managed with almost no symptoms even if you're in that situation. 384 00:23:23.510 --> 00:23:24.810 So we use these prokinetics. 385 00:23:25.190 --> 00:23:27.770 You take them every day, usually at night before bed, 386 00:23:28.470 --> 00:23:28.970 ongoing. 387 00:23:29.590 --> 00:23:35.210 And and that's the main thing. We also use diet. We can use diet anywhere in this 388 00:23:35.775 --> 00:23:36.275 program, 389 00:23:37.215 --> 00:23:40.275 before we start treating, during treat treatment and after. 390 00:23:40.655 --> 00:23:43.715 And the main diet alteration is to reduce carbohydrates 391 00:23:44.415 --> 00:23:49.770 because that's the food that the back overgrown bacteria eat and what they make the gas out of. 392 00:23:50.170 --> 00:23:53.150 And it's the gas that creates the symptoms and all the troubles. 393 00:23:53.850 --> 00:23:54.350 So, 394 00:23:55.370 --> 00:23:59.150 low carbohydrate diets can be used. Typically, after treatment, 395 00:24:00.010 --> 00:24:01.630 we don't have to be so strict 396 00:24:02.345 --> 00:24:06.745 because now there's not an overgrowth of bacteria, so we can expand the diet. 397 00:24:06.745 --> 00:24:09.805 But having some amount of reduction in carbohydrates 398 00:24:10.345 --> 00:24:11.945 also can help prevent relapse. 399 00:24:11.945 --> 00:24:15.485 And then there's other things we can do, but those are our main things. 400 00:24:16.320 --> 00:24:18.340 So diet does not cure SIBO. 401 00:24:18.799 --> 00:24:22.320 It manages also doesn't cause SIBO. Yeah. Right on. Right. 402 00:24:22.320 --> 00:24:25.220 So it's not like you cheated and now you have SIBO. 403 00:24:26.240 --> 00:24:27.059 It manages 404 00:24:27.360 --> 00:24:29.044 the symptoms. Symptoms. 405 00:24:29.184 --> 00:24:33.764 It manages the symptoms, and you can feel better within depending on each person, 406 00:24:34.144 --> 00:24:39.125 within, like, 3 days if you, even one day. And some people get 100%, 407 00:24:39.985 --> 00:24:42.085 100% symptom relief with diet. 408 00:24:42.705 --> 00:24:43.205 Wonderful. 409 00:24:44.150 --> 00:24:49.909 Then it's a decision they have to decide, do they want to stay on that diet to control those symptoms? 410 00:24:49.909 --> 00:24:50.685 Or do they want to 411 00:24:51.429 --> 00:24:54.010 expand their diet so they wanna do some of those treatments? 412 00:24:54.549 --> 00:24:58.570 And expanding your diet is always a good idea because your microbiome thrives on diversity. 413 00:24:58.789 --> 00:25:01.975 And sometimes you won't eat a piece of birthday cake. So 414 00:25:03.075 --> 00:25:03.555 so, 415 00:25:03.955 --> 00:25:05.395 that's just something to keep in mind. 416 00:25:05.395 --> 00:25:10.278 That's a big myth I see where people are like, oh, I've been doing the diet and I don't feel better, 417 00:25:10.595 --> 00:25:12.135 or I'm doing the diet and, 418 00:25:12.870 --> 00:25:15.110 and I still had a SIBO positive breath test. 419 00:25:15.110 --> 00:25:19.270 So to Dr. Siebecker point, you can still have it and, yeah, you can feel better. 420 00:25:19.270 --> 00:25:22.330 Can we talk about fructose for a second? Because, 421 00:25:23.830 --> 00:25:25.050 fructose malabsorption 422 00:25:25.510 --> 00:25:28.905 is not a hot topic. People do not talk about this. 423 00:25:28.905 --> 00:25:32.685 And yet if you have SIBO, chances are you have fructose, 424 00:25:33.225 --> 00:25:35.165 as in fruit sugars malabsorption. 425 00:25:35.865 --> 00:25:37.085 What does that all mean? 426 00:25:37.465 --> 00:25:39.405 That and lactose malabsorption 427 00:25:39.945 --> 00:25:43.870 are both caused by SIBO. Now people can have these genetically. 428 00:25:44.410 --> 00:25:50.830 They're both genetic conditions, and then they can they can also have them induced by a condition such as SIBO. 429 00:25:51.210 --> 00:25:57.365 So that causes a lot of food sensitivities. That's another main symptom I didn't mention of SIBO 430 00:25:58.065 --> 00:25:59.445 is having gastrointestinal 431 00:25:59.985 --> 00:26:00.485 reactions 432 00:26:00.785 --> 00:26:02.965 to foods, food sensitivities, basically. 433 00:26:04.465 --> 00:26:11.045 And so SIBO can cause this because, the back overgrown bacteria can damage the enzymes we need to digest 434 00:26:11.389 --> 00:26:11.889 those, 435 00:26:12.350 --> 00:26:13.649 those sugars, their sugars 436 00:26:14.029 --> 00:26:18.370 in our small intestine. And when we reduce that overgrowth of bacteria, those enzymes 437 00:26:18.830 --> 00:26:21.090 can healthily just come back again. 438 00:26:22.110 --> 00:26:26.210 Usually takes 1 or 2 weeks for them to come back. And then people 439 00:26:26.545 --> 00:26:30.405 find they can start eating fructose and lactose again if they weren't genetically, 440 00:26:31.425 --> 00:26:35.365 unable to have them. So that's another key thing. Why treating it? 441 00:26:35.585 --> 00:26:41.730 If honestly, it's one of the main reasons people want to treat SIBO so they can expand their diet now, 442 00:26:42.210 --> 00:26:42.870 and also 443 00:26:43.250 --> 00:26:44.710 reduce those awful symptoms. 444 00:26:45.250 --> 00:26:49.250 Exactly. Not even just the bloating, but like being in the bathroom for a really long time. 445 00:26:49.250 --> 00:26:54.075 One, because you're going, then it's diarrhea or Two, you're going and you can't go. You're trying to go. 446 00:26:54.235 --> 00:26:59.294 I mean, in the first chapter of my book, Healing SIBO, I tell a story about how I went out to lunch with my boss 447 00:26:59.595 --> 00:27:00.394 at the time. 448 00:27:00.394 --> 00:27:05.434 And I was like, you know, I didn't go out with my boss to lunch all the time, but I was really excited. 449 00:27:05.434 --> 00:27:07.855 I was gonna be asking for a raise during this conversation. 450 00:27:08.560 --> 00:27:14.420 And I ended up spending half the lunch in the ladies room. It was very embarrassing because 451 00:27:15.120 --> 00:27:20.020 the restaurant ended up, like, we went at 1, and by the time, like, I got out of the bathroom, 452 00:27:20.695 --> 00:27:26.615 everyone in the restaurant was gone except my boss and the waiter, and they both looked at me, and he was like, are you okay? 453 00:27:26.615 --> 00:27:28.395 And I just said, oh, body functions. 454 00:27:29.495 --> 00:27:33.330 And it was terrible. Oh my gosh. It was so terrible. He was a very nice man, 455 00:27:33.830 --> 00:27:37.450 fortunately, but it was extremely awkward. We all have those nightmare stories. 456 00:27:37.750 --> 00:27:41.610 Dr. Siebecker and I and our small group coaching for people with SIBO, 457 00:27:42.310 --> 00:27:46.250 hear about people who can't leave the house, hear about people who won't go on an airplane. 458 00:27:46.765 --> 00:27:48.684 And, you know, that breaks our hearts. 459 00:27:48.684 --> 00:27:54.065 And so we're, you know, just continuing to feel the fire of shouting from the mountaintop this information. 460 00:27:55.405 --> 00:27:55.905 So, 461 00:27:57.005 --> 00:28:00.545 the other thing that I just wanted to mention is that 462 00:28:01.260 --> 00:28:02.480 having a digestive 463 00:28:02.780 --> 00:28:05.520 disorder, much like having a hormonal imbalance, 464 00:28:07.180 --> 00:28:11.360 is quite intimate. Right? You're not usually talking about this to everybody. 465 00:28:11.500 --> 00:28:15.905 Dr. Siebecker, I'm a very low threshold for talking to people about these types of personal 466 00:28:16.445 --> 00:28:17.505 situations, like, 467 00:28:18.045 --> 00:28:18.785 no problem. 468 00:28:19.405 --> 00:28:24.285 But prior to my experience with all of this, it was like I sat with my nail tech, Dr. 469 00:28:24.285 --> 00:28:30.530 Siebecker, for 2 years, twice a week, and we never talked about our digestive problems, only to find 470 00:28:30.830 --> 00:28:36.430 out she absolutely could have been helped by the information I had, and I could have been helped by the information she had. 471 00:28:36.430 --> 00:28:39.950 So we do like to encourage people to talk about it, but it is intimate. 472 00:28:39.950 --> 00:28:41.730 And I wanted to address that because 473 00:28:42.355 --> 00:28:47.894 there are answers for your hot flashes, your vaginal dryness, for your diarrhea, for your constipation, 474 00:28:48.595 --> 00:28:52.107 and at the very least, they can be better. 475 00:28:52.355 --> 00:28:54.054 And to not give up hope, 476 00:28:54.480 --> 00:28:54.980 because 477 00:28:55.280 --> 00:28:58.740 there are people out there who know the answers. 478 00:28:58.800 --> 00:29:01.860 And it's just that's one of my jobs is to connect you 479 00:29:02.480 --> 00:29:04.100 with your symptoms and scenarios 480 00:29:04.400 --> 00:29:06.980 with the people who know. I'm quite the optimist. 481 00:29:07.355 --> 00:29:12.155 When I had SIBO in the beginning and I finally found out the name for it, thank goodness for doctor. 482 00:29:12.163 --> 00:29:13.062 Dr. Siebecker. 483 00:29:13.275 --> 00:29:14.255 And I, 484 00:29:16.075 --> 00:29:21.140 you know, started to feel better. I was like, I have a lot of privilege. I have some money. 485 00:29:21.140 --> 00:29:24.760 I have insurance. And if I'm having a hard time figuring it out, 486 00:29:25.300 --> 00:29:28.040 I can only imagine what other people are going through. 487 00:29:28.100 --> 00:29:31.720 So this was part of my solemn vow was to spread the word. 488 00:29:32.294 --> 00:29:35.514 And I have done that for the lymphatic system, fascia, 489 00:29:35.894 --> 00:29:39.434 for biological dentistry, certainly for SIBO and the microbiome, 490 00:29:40.375 --> 00:29:40.875 and, 491 00:29:41.894 --> 00:29:42.955 and now menopause, 492 00:29:43.495 --> 00:29:43.995 because 493 00:29:44.560 --> 00:29:49.380 all of these conditions can be made better when you are working with a specialist. 494 00:29:49.440 --> 00:29:50.660 1 hour with a specialist, 495 00:29:51.360 --> 00:29:56.260 as I always say, is worth years with someone who does not know 496 00:29:56.985 --> 00:29:59.325 how to lock and key and unlock 497 00:29:59.625 --> 00:30:00.285 the condition. 498 00:30:00.985 --> 00:30:06.285 But that's why telemedicine is so amazing. You can sit and talk to someone for literally 499 00:30:06.745 --> 00:30:13.720 less than an hour, one appointment, and be well on your way to the proper course versus this frustration that I know we've all felt 500 00:30:14.100 --> 00:30:16.680 of not having like, feeling like 501 00:30:19.300 --> 00:30:21.160 there's missing information here 502 00:30:21.460 --> 00:30:26.975 and going down the wrong rabbit hole, going down paths that lead to a lot of expense, a lot of time wasted. 503 00:30:27.355 --> 00:30:28.495 And so please, 504 00:30:29.035 --> 00:30:33.775 I'm encouraging you. The call to action is just to get tested if this is resonating with you, 505 00:30:34.075 --> 00:30:37.935 for both your hormones and your digestion with a SIBO breath test, 506 00:30:38.280 --> 00:30:38.680 And, 507 00:30:39.080 --> 00:30:42.780 you can feel better. Dr. Siebecker, parting thoughts. 508 00:30:43.880 --> 00:30:47.820 Well, I just wanna say that you and I both have resources for people. 509 00:30:48.280 --> 00:30:49.420 Go to our websites. 510 00:30:49.720 --> 00:30:50.940 Shivan's is Sibosos.com. 511 00:30:51.960 --> 00:30:53.020 Mine is Siboinfo 512 00:30:53.785 --> 00:30:54.525 .com. 513 00:30:54.825 --> 00:31:00.525 And we have resources for you all about this, how to get tested, what the treatments are, etcetera. 514 00:31:01.065 --> 00:31:01.565 So 515 00:31:02.105 --> 00:31:08.525 use those resources if needed. And my general parting thoughts is for anyone who has 516 00:31:09.230 --> 00:31:11.810 GI symptoms that we've that we discussed 517 00:31:12.510 --> 00:31:13.410 before menopause 518 00:31:14.030 --> 00:31:17.570 starting now, you know, peri or postmenopause, 519 00:31:18.590 --> 00:31:23.010 look into seeing whether it's SIBO. It's one of the most common 520 00:31:23.550 --> 00:31:26.505 reasons that people have GI symptoms. 521 00:31:27.125 --> 00:31:30.245 Find out if it's that or not. And if it is, treat it. 522 00:31:30.245 --> 00:31:33.865 If it's not, then there's, you know, you have to then meet with other people who will 523 00:31:34.165 --> 00:31:35.625 start looking for other things. 524 00:31:36.085 --> 00:31:39.305 But it is so common and so overlooked. 525 00:31:40.380 --> 00:31:46.080 And so treatable when you're doing it right. There's so much help and hope for treating it. 526 00:31:46.220 --> 00:31:47.743 Thank you, Dr. Siebecker. 527 00:31:47.900 --> 00:31:49.120 Thanks for having me.