The Turd Nerds

SIBO treatment continues to evolve—and Dr. Allison Siebecker is back on The Turd Nerds to break down even more of the latest research on how we treat SIBO and intestinal methanogen overgrowth (IMO).
In Part 2 of our SIBO research update, we move beyond conventional antibiotics and dig into new data on herbal antimicrobials, probiotics, prokinetics, gut motility, and post-infectious IBS.
We start with new human research on an herbal antimicrobial combination containing allicin, neem, and pomegranate peel, including its effects on hydrogen and methane production and SIBO symptoms.
Then we tackle one of the more controversial questions in SIBO care: probiotics. Can probiotics actually improve SIBO treatment outcomes? Allison walks us through new research on Saccharomyces boulardii, Bacillus coagulans, E. coli Nissle 1917, synbiotics, and probiotics used alongside rifaximin.
We also take a deeper look at two of our favorite prokinetics. New research on Iberogast suggests its benefits may extend beyond motility and symptom relief to include prebiotic, anti-inflammatory, and intestinal barrier effects. And prucalopride may be doing much more than helping patients poop—with emerging research exploring cognition, enteric nerve regeneration, visceral sensitivity, and the gut-brain connection.
Finally, Allison gives us an update on research into post-infectious IBS and SIBO, including work targeting the anti-vinculin pathway that could eventually change how we approach SIBO that develops after food poisoning.
IN THIS EPISODE:
• New research on herbal antimicrobials for SIBO
• Allicin, neem, and pomegranate peel for hydrogen and methane
• Can probiotics improve SIBO treatment success?
• Saccharomyces boulardii, Bacillus coagulans, and E. coli Nissle
• Probiotics alongside rifaximin
• Iberogast as a prokinetic, prebiotic, and gut-barrier support
• Prucalopride and intestinal nerve regeneration
• Prucalopride, cognition, and the gut-brain connection
• Motility and visceral hypersensitivity
• Anti-vinculin antibodies and post-infectious IBS
• What future SIBO treatment may look like
Whether you treat SIBO every day or you're trying to understand why it keeps coming back, this episode offers a look at how rapidly the SIBO treatment landscape is changing.

Music provided by Blue Dot.

👋 Connect with Dr. Allison Siebecker
⁠https://www.siboinfo.com/⁠

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

In this episode of The Turd Nerds, Dr. Ilana Gurevich and Dr. Rebecca Sand sit down with Dr. Allison Siebecker, one of the leading voices in small intestinal bacterial overgrowth (SIBO), to break down some of the most exciting new SIBO research presented at Digestive Disease Week (DDW).
From emerging treatments for intestinal methanogen overgrowth (IMO) to new ways of making rifaximin more effective, Allison walks us through what may be coming next in SIBO treatment—and what clinicians can potentially use now. The conversation explores a new methane-targeting molecule designed to reduce methane production without killing methanogens, as well as research combining sustained-release N-acetylcysteine (NAC) with rifaximin to improve antibiotic delivery in the small intestine.
We also dive into surprising new research examining the relationship between methane and body weight, including evidence suggesting a U-shaped relationship between methane levels and BMI, with higher methane levels seen in both underweight and obese populations.
Finally, we take a closer look at new research on the elemental diet. Allison discusses impressive eradication rates for hydrogen SIBO, its effectiveness in methane-positive patients, and emerging evidence that elemental diets may reduce Candida while preserving beneficial small-intestinal commensal organisms.
In this episode, we explore:
• What’s coming next for methane/IMO treatment
• A new molecule that may suppress methane production without antibiotics
• Why sustained-release NAC may make rifaximin more effective
• Whether rifaximin doses could eventually be reduced
• The surprising connection between methane and BMI
• Why clinical observations sometimes precede published research
• New data on elemental diets for SIBO and IBS
• Elemental diets, Candida, and the small-intestinal microbiome
• When an elemental diet may be worth considering clinically
Whether you’re a clinician treating SIBO every day or someone struggling with recurrent SIBO or IMO, this episode offers a fascinating look at where SIBO research—and treatment—may be headed next.

Music provided by Blue Dot.

👋 Connect with Dr. Allison Siebecker
https://www.siboinfo.com/

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

Can acne start in the gut?
In this episode of The Turd Nerds, we're joined once again by Dr. Megan Larravey for a fascinating case-based discussion exploring the connection between chronic acne, gut health, H. pylori, dysbiosis, and inflammation.
We walk through the case of a woman in her 30s who developed persistent cystic acne despite eating a clean diet, using clean skincare products, exercising regularly, sleeping well, and trying many conventional and natural treatment approaches. With no obvious hormonal pattern and no significant digestive symptoms, her case challenged many of our assumptions about what drives chronic acne.
What we found highlights the powerful relationship between the gut microbiome and skin health—and why some skin conditions may be rooted in underlying gastrointestinal dysfunction, even when the gut appears perfectly healthy.
✔ Why acne isn't always a hormone problem
✔ The surprising connection between H. pylori and chronic skin conditions
✔ How dysbiosis can contribute to persistent acne
✔ The role of biofilms in chronic inflammatory conditions
✔ Why some patients with gut dysfunction have no GI symptoms
✔ Pseudomonas, endotoxins, and systemic inflammation
✔ Leaky gut and its impact on skin health
✔ How we approach stubborn acne from a functional medicine perspective
✔ Stool testing, organic acid testing, and evaluating the gut-skin axis
✔ The role of probiotics, spore-based probiotics, and immunoglobulins
✔ Biofilm disruptors and antimicrobial herbs
✔ Why healing the gut often takes longer than people expect
✔ The importance of fiber, fermented foods, and rebuilding microbiome resilience
Acne is often viewed as a skin condition, but for some patients it may be a manifestation of deeper immune, inflammatory, and microbiome imbalances. This episode explores why chronic acne can persist despite doing "all the right things" and how addressing gut dysfunction may be an important piece of the puzzle.
Whether you're struggling with acne yourself or you're a clinician looking to better understand the gut-skin connection, this conversation offers a practical and thought-provoking look at how the microbiome influences skin health.

Music provided by Blue Dot.
👋 Connect with Dr. Meghan Larivee
⁠https://www.integrativedermatologysolutions.com/about⁠

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM

Why Acne Isn't Just a Skin Problem: The Gut-Skin Connection
What if your acne, eczema, rosacea, or chronic skin condition isn't actually starting in your skin?

In this episode of The Turd Nerds, we're joined by naturopathic physician and acupuncturist Megan Larivee for a deep dive into the fascinating world of the gut-skin axis.

We explore why the skin is much more than a protective barrier—it's actually the body's largest immune organ. From the skin microbiome and immune signaling to leaky gut, leaky skin, acne, eczema, rosacea, and psoriasis, we unpack the growing evidence connecting gastrointestinal health to chronic skin conditions.
We discuss how gut dysbiosis, inflammation, barrier dysfunction, hormones, diet, and environmental exposures may all contribute to skin symptoms—and why simply treating the skin often isn't enough.
✔ Why the skin is considered an immune organ
✔ The relationship between the skin microbiome and the gut microbiome
✔ Leaky gut and leaky skin: what they are and why they matter
✔ Acne, eczema, rosacea, psoriasis, and other chronic skin conditions
✔ How H. pylori and gut dysbiosis can influence skin health
✔ Why skin conditions often persist despite topical treatments
✔ The role of fiber and the microbiome in acne management
✔ Dairy, insulin signaling, and androgen-driven acne
✔ Candida, fungal overgrowth, and skin symptoms
✔ The impact of personal care products, soaps, and environmental chemicals on skin health
✔ Why skin barrier function is critical for long-term healing
✔ Clinical pearls for evaluating chronic skin conditions through a gut-health lens
The skin and gut are constantly communicating through immune, inflammatory, hormonal, and microbial pathways. When that communication breaks down, chronic skin conditions may develop—or become difficult to resolve.
If you've struggled with acne, eczema, rosacea, psoriasis, or unexplained skin symptoms, this episode offers a new perspective on where to look and what questions to ask.
Because sometimes the best way to heal the skin is to start with the gut.

Music provided by Blue Dot.
👋 Connect with Dr. Meghan Larivee
https://www.integrativedermatologysolutions.com/about

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

What can you actually do to support gallbladder health—before or after gallbladder removal?
In Part 3 of our Gallbladder Series, we move from theory into practice. After exploring the relationship between the gallbladder, microbiome, hormones, and bile acids in Parts 1 and 2, we discuss the clinical tools, supplements, dietary strategies, and testing considerations we use to support patients with gallbladder dysfunction, bile acid disorders, and post-cholecystectomy symptoms.
We explore why some patients continue to struggle with digestive symptoms long after gallbladder removal, how hormone fluctuations impact bile flow, and why supporting the microbiome may be one of the most overlooked pieces of gallbladder care.
Whether you're dealing with gallstones, bile acid diarrhea, digestive symptoms after surgery, or simply want to better understand how to support healthy bile flow, this episode is packed with practical takeaways.
✔ Conventional approaches to gallbladder disease and gallbladder removal
✔ Why removing the gallbladder doesn't always solve the entire problem
✔ The long-term microbiome consequences of cholecystectomy
✔ The connection between gallbladder function, metabolism, and insulin resistance
✔ Taurine and glycine for bile acid conjugation and bile production
✔ Bitter herbs and how they support bile flow and gallbladder function
✔ Dandelion, gentian, chicory, and other classic digestive bitters
✔ Phosphatidylcholine, lecithin, and cholesterol balance within bile
✔ Choline supplementation and gallbladder support
✔ Magnesium and gallbladder motility
✔ Ox bile, TUDCA, UDCA, and digestive enzyme support
✔ Psyllium fiber and bile acid regulation
✔ Butyrate and microbiome support after gallbladder removal
✔ The estrogen–microbiome–gallbladder connection
✔ DIM and calcium-d-glucarate for estrogen metabolism
✔ NAC, milk thistle, and liver support
✔ Hormone replacement therapy considerations in patients with gallbladder disease
✔ Functional testing options for patients with gallbladder concerns
✔ How these concepts have changed our clinical approach to patient care
✔ Gallbladder removal may be necessary, but it should also prompt a deeper look at why gallbladder dysfunction developed in the first place.
✔ Taurine, glycine, bitters, magnesium, and phosphatidylcholine can all play important roles in supporting bile production and flow.
✔ The microbiome is central to bile acid metabolism and should be considered in patients with ongoing digestive symptoms.
✔ DIM and calcium-d-glucarate may help support healthy estrogen metabolism and reduce gallbladder stress in susceptible individuals.
✔ Post-cholecystectomy patients may benefit from additional support for digestion, microbiome balance, fat-soluble vitamins, and bile acid regulation.
✔ Hormones, bile acids, the liver, and the microbiome are deeply interconnected systems that influence one another in meaningful ways.
Part 1: Gallbladder Physiology, Bile Acids & The Microbiome
Part 2: The Estrogen–Gallbladder Connection: Hormones, Menopause & Bile Acids
Part 3: Practical Strategies for Supporting Gallbladder Health Before and After Surgery

Music provided by Blue Dot.

👋 Connect with the Turds!
Rebecca Sand ND, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Ilana Gurevich ND, FABNG, LAc, MSOM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠
⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠

Ami Kapadia, MD, ABFM, ABIHM
⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠