The Turd Nerds

What if we could target problematic gut bacteria without wiping out the rest of the microbiome?
In this episode of The Turd Nerds, we're diving into the fascinating world of bacteriophages (phages) — viruses that infect bacteria and are being explored as a more targeted approach to treating bacterial infections and gut dysbiosis.
Dr. Ilana Gurevich takes Rebecca and Ami through the history of phage therapy, why antibiotics largely replaced it, and why researchers and clinicians are taking another look at these tiny bacteria-targeting viruses.
We explore what makes phages so interesting: their ability to target particular bacteria while potentially leaving much of the surrounding microbiome undisturbed.
Ilana also shares her clinical experience using bacteriophages in patients with persistent gut dysbiosis, including difficult-to-address organisms such as Pseudomonas and Klebsiella. We discuss how she approaches stool testing, biofilms, treatment sequencing, and assessing patient response.
And, because we're the Turd Nerds, the conversation doesn't stop there. We get into microbiome restoration, fermented foods, prebiotics, histamine, hormones, gut motility, nutrient absorption, and even a tangent about iron supplementation.
In This Episode:
What bacteriophages are and how they work

Why phages are different from conventional antibiotics

The history of phage therapy and why it's making a comeback

How phages target specific bacteria

Why matching the right phage to the right bacterium matters

Using phages for persistent gut dysbiosis

Pseudomonas, Klebsiella, and other difficult-to-treat bacteria

The relationship between phages and bacterial biofilms

Ilana's clinical experiences and patient cases

Potential side effects and limitations of phage therapy

How prebiotics, fermented foods, and fiber fit into microbiome restoration

Why addressing gut dysbiosis may sometimes help with persistent digestive symptoms

The big takeaway?
Phage therapy offers an intriguing possibility: instead of broadly suppressing bacteria, could we target specific problematic organisms and allow the rest of the microbiome to recover?
There's still a lot to learn, especially about how best to use phages in gastrointestinal disorders, but the science and clinical possibilities make this an area worth watching.
If you're a clinician working with stubborn gut dysbiosis — or someone who's curious about the future of microbiome medicine — this episode is for you.
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/

Why does SIBO keep coming back?
Treating bacterial overgrowth is one thing. Figuring out why it developed in the first place is an entirely different challenge.
In this episode of The Turd Nerds, we’re joined again by SIBO expert Dr. Allison Siebecker to dig into the underlying causes of SIBO and, more importantly, how to think through them clinically.
Allison walks us through a simple framework for understanding SIBO: What allowed bacteria to accumulate where they shouldn’t? We look at the body’s natural defenses against bacterial overgrowth, including stomach acid, bile, digestive enzymes, immune function, normal anatomy, and, perhaps most importantly, the migrating motor complex.
From there, we get into the many things that can disrupt those protective mechanisms, including food poisoning, adhesions and abdominal surgery, Crohn’s disease, endometriosis, Ehlers-Danlos syndrome, diabetes, hypothyroidism, Parkinson’s disease, chronic stress, medications, immune dysfunction, and mold illness.
We also tackle some of the messier questions: Do PPIs actually cause SIBO? What about antibiotics? What are GLP-1 medications doing to motility? And why can two patients with the same SIBO diagnosis need completely different approaches?
In This Episode:
✔ Why the migrating motor complex is so important in preventing SIBO
✔ The “river vs. swamp” analogy for understanding bacterial overgrowth
✔ How food poisoning can damage the migrating motor complex
✔ Structural causes of SIBO, including adhesions, strictures, surgery, and altered anatomy
✔ Crohn’s disease, the ileocecal valve, and SIBO risk
✔ Endometriosis and Ehlers-Danlos syndrome
✔ Diabetes, hypothyroidism, Parkinson’s disease, and impaired motility
✔ Chronic stress and the migrating motor complex
✔ PPIs, antibiotics, opioids, and GLP-1 medications
✔ The conflicting research on antibiotics and SIBO risk
✔ Mold illness and difficult-to-treat SIBO
✔ Immune dysfunction and bacterial overgrowth
✔ Why food poisoning may be worth investigating even when a patient doesn’t remember getting sick
✔ Why recurrent SIBO often requires looking beyond another round of treatment
The big takeaway? SIBO isn’t necessarily a one-size-fits-all disease. Understanding why someone developed it can help explain why it keeps returning and may change how we approach treatment and prevention.
If you’ve ever treated SIBO only to have it come roaring back, this episode is for you.

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/⁠⁠⁠⁠⁠⁠⁠

SIBO testing used to feel pretty straightforward. Take a breath test, look at hydrogen and methane, and make a treatment decision. But the world of SIBO testing is changing fast.
In this episode of The Turd Nerds, we’re joined once again by SIBO expert Dr. Allison Siebecker to break down some of the newest research in SIBO and breath testing, including updates presented at Digestive Disease Week (DDW).
We dig into FoodMarble and how this handheld breath-testing device is being used in research, how it compares with traditional breath testing, and where we still have questions. We also take a deeper look at Trio-Smart, evolving hydrogen sulfide cutoffs, methane interpretation, and the mysterious “flat-line” breath test.
And because we’re the Turd Nerds, we obviously take a few detours, including some fascinating new research suggesting methane production may change during the menstrual cycle. Yes, there may actually be a reason for all that PMS bloating and constipation.
In This Episode:
✔ What’s new in SIBO breath testing
✔ FoodMarble vs. traditional SIBO breath tests
✔ What recent research tells us about FoodMarble
✔ Why timing and test duration matter
✔ Hydrogen, methane, and hydrogen sulfide are interpreted differently
✔ New thinking around hydrogen sulfide levels between 1.5 and 2 ppm
✔ When a “borderline” result may or may not warrant treatment
✔ How to interpret a flat-line breath test
✔ Why methane may increase during the second half of the menstrual cycle
✔ SIBO, constipation, PMS, and endometriosis
✔ Why restrictive SIBO diets don’t have to be perfect to improve symptoms
✔ New evidence addressing whether breath tests actually reflect gases in the small intestine
SIBO testing is evolving, and this episode is a reminder that the number on the test is only one piece of the clinical picture. We’re talking about what the latest research tells us, where the evidence is getting stronger, and where there are still plenty of questions.
If you diagnose or treat SIBO, or you’ve ever stared at a breath test wondering, “What the hell am I supposed to do with this?” — this episode is for you.

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.c⁠

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/⁠⁠⁠⁠⁠⁠⁠