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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/⁠⁠⁠⁠⁠⁠⁠

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/⁠⁠⁠⁠⁠⁠⁠

Most people think gallbladder disease is all about gallstones. But what if the real story is hormones? In Part 2 of our Gallbladder Series, we take a deep dive into the fascinating relationship between estrogen, progesterone, menopause, the microbiome, and gallbladder function. We explore why women are significantly more likely to develop gallbladder disease, why perimenopause may be a perfect storm for biliary dysfunction, and how both high and low estrogen states can increase gallbladder risk. Along the way, we unpack the surprising idea that the gallbladder behaves like a hormone-responsive organ, discuss how oral contraceptives and hormone replacement therapy may influence gallbladder health, and explain why the microbiome may be one of the most overlooked pieces of the puzzle. Whether you're navigating perimenopause, supporting patients with digestive issues, or simply curious about the intersection of hormones and gut health, this episode offers a fresh perspective on a commonly overlooked organ. Why women develop gallbladder disease more often than men The role of estrogen in bile production and gallbladder function How both estrogen excess and estrogen deficiency can increase gallbladder risk Why perimenopause creates a unique challenge for gallbladder health The relationship between oral contraceptives, hormone therapy, and gallstones How progesterone influences gallbladder motility The estrogen–microbiome connection Changes in the microbiome that occur during menopause The role of Lactobacillus, Bifidobacterium, Akkermansia, and other key organisms Why menopause may increase the risk of biliary dysfunction How hormone fluctuations impact bile flow and gallbladder emptying Why oral estrogen carries different risks than transdermal estrogen Clinical considerations for hormone replacement therapy in patients with gallbladder concerns The importance of antioxidant protection for the biliary system How this information has changed the way we evaluate and treat patients ✔ The gallbladder is highly responsive to hormonal signaling, particularly estrogen. ✔ Both high and low estrogen states can negatively impact bile acid production and gallbladder function. ✔ Perimenopause may be one of the highest-risk times for gallbladder dysfunction due to fluctuating hormone levels. ✔ The microbiome and estrogen metabolism are deeply interconnected and may influence gallbladder health. ✔ Menopause doesn't just affect reproductive hormones—it also changes the microbiome, bile metabolism, and digestive physiology. ✔ The route of hormone therapy matters, especially for patients with a history of gallbladder disease. Part 3 of our Gallbladder Series: Practical treatment strategies, supplements, and clinical tools for supporting gallbladder health before and after gallbladder removal. In This Episode We Discuss:Key TakeawaysListen Next 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/⁠⁠⁠⁠⁠⁠⁠

Most people think gallbladder problems start and end with gallstones. The reality is much more complicated. In this episode of The Turd Nerds, we discuss the hidden connections between the gallbladder, hormones, bile acids, estrogen metabolism, and the gut microbiome—and why these systems become especially important during perimenopause and menopause. We cover:✔ Why women develop more gallbladder disease than men✔ The estrogen–gallbladder connection✔ How the microbiome influences bile acid metabolism✔ What changes after gallbladder removal✔ Gallbladder dysfunction without stones✔ DIM and calcium-d-glucarate for estrogen metabolism✔ Taurine, glycine, bitters, phosphatidylcholine, magnesium, and bile support✔ Bile acid malabsorption and chronic diarrhea✔ How we approach gallbladder health in clinical practice If you've ever been told your only option is to remove your gallbladder, this episode explores the physiology behind gallbladder dysfunction and the tools we use to support patients 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/⁠⁠⁠⁠⁠⁠⁠

Could Lyme disease or co-infections be contributing to gut symptoms that aren’t improving? In this episode, Dr. Crane Holmes and the turd nerds break down Lyme disease and common co-infections - including Bartonella and Babesia - and how they can impact not just the gut, but the entire body. We explore how these infections can present as chronic digestive issues, brain fog, inflammation, and multi-system symptoms that don’t respond to typical treatments. In this episode, we discuss: What Lyme disease actually is (and why it’s often misunderstood)The role of co-infections like Bartonella and BabesiaHow these infections can affect the gut, nervous system, and immune systemWhy symptoms often go beyond digestion (brain fog, fatigue, joint pain)When to consider Lyme or co-infections in complex casesChallenges with testing and diagnosisTreatment approaches, including antimicrobials, herbs, and biofilm supportThis episode is for anyone dealing with chronic gut symptoms, unexplained inflammation, or complex health issues that haven’t improved with standard approaches. Music provided by Blue Dot. 👋 Connect with the Dr. Crane Holmes https://www.drcraneholmes.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/⁠⁠⁠⁠⁠⁠⁠

What if your gut symptoms aren’t SIBO—and aren’t improving despite treatment? In this episode, we explore a common clinical scenario: patients with bloating, gas, and digestive issues that look like SIBO but don’t respond to standard therapies. We take a deeper look at mold exposure, mast cell activation, and histamine as overlooked drivers of chronic gut symptoms. Dr. Crane Holmes joins us to break down how mold can impact the gastrointestinal system, why symptoms often extend beyond the gut, and how to recognize when something more complex is going on. In this episode, we discuss: When to suspect something beyond SIBOHow mold exposure can drive gut inflammation and symptomsThe connection between mold, mast cells, and histamineWhy patients may have multi-system symptoms (brain fog, fatigue, sinus issues)The role of environmental testing (ERMI) vs lab testingPractical approaches to treatment, including binders, detox support, and reducing exposure 👋 Connect with the Dr. Crane Holmes ⁠https://www.drcraneholmes.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/⁠⁠⁠⁠⁠⁠⁠

What does the vagus nerve actually do—and why does it matter for gut health, IBS, and anxiety? In this episode, we break down the vagus nerve in a clear, practical way, focusing on how it connects the gut and brain and why low vagal tone is linked to conditions like IBS, IBD, anxiety, depression, and chronic inflammation. We also explore why common advice like humming, gargling, or cold exposure which often isn’t enough on its own, and what actually makes a meaningful difference clinically. You’ll learn how the vagus nerve regulates digestion, stress response, inflammation, and gut motility, and how disruptions in this system can create a cycle of persistent symptoms. In this episode, we discuss: - What the vagus nerve is and how it connects the gut and brain - Why low vagal tone is linked to IBS, anxiety, and inflammation - How stress and the microbiome impact vagus nerve function - Why gut symptoms and mental health symptoms often overlap - Evidence-based ways to support vagal tone (breathing, cold exposure, exercise, social connection, and more) - When vagus nerve stimulators and clinical tools may be helpful This episode is for anyone dealing with IBS, chronic gut symptoms, anxiety, or feeling “stuck” despite trying multiple approaches to gut health. 👋 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 chronic diarrhea continue even when testing is normal? In this episode, we walk through a case of microscopic colitis and how to approach persistent gut symptoms that don’t respond to standard treatment. We break down what microscopic colitis is, why it’s often missed on routine colonoscopy, and how it can present as long-standing, non-bloody diarrhea. We also explore how medications like PPIs, NSAIDs, and SSRIs may contribute, and how overlapping factors like dysbiosis, inflammation, and even constipation can complicate the clinical picture.In this episode, we discuss:- Chronic diarrhea and when to look beyond IBS- What microscopic colitis is and how it’s diagnosed- Why colonoscopies can miss key findings- The role of medications in gut inflammation- Treatment approaches, including budesonide, bismuth, and bile acid binders- Functional medicine perspectives on persistent gut symptomsMusic provided by Blue Dot.👋 Connect with the Turds!Rebecca Sand ND, LAc, MSOM⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ilana Gurevich ND, FABNG, LAc, MSOM⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠⁠Ami Kapadia, MD, ABFM, ABIHM⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

In this episode, we revisit bloating through a Chinese medicine lens with Ellen Goldsmith, focusing on digestion as a process of movement, not just intake. We explore how patterns like stagnation, dysregulation, and impaired “downward flow” contribute to symptoms like distension, brain fog, and discomfort. The conversation highlights common contributors such as stress, irregular eating, cold foods, and dietary excesses. We also discuss practical strategies like meal timing, warming foods, and simple dietary adjustments to support more efficient digestion. It’s a systems-based approach to understanding why bloating happens and how to address it in a more individualized way. Music provided by Blue Dot. 👋 Connect with the Ellen Goldsmith ⁠https://pearlnaturalhealth.com/⁠ ⁠Nutritional Healing with Chinese Medicine by Ellen Goldsmith⁠ 👋 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.gurevich⁠⁠⁠⁠⁠⁠Ami Kapadia, MD, ABFM, ABIHM ⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠

In this episode, we’re joined by Chinese dietetics expert Ellen Goldsmith to explore how traditional food systems approach digestion, health, and prevention. We discuss the framework of the five flavors, seasonal eating, and how these principles influence digestive function, satiety, and overall physiology. The conversation also highlights how modern dietary patterns can disrupt these regulatory signals, leading to persistent symptoms and cravings. Rather than focusing on restriction, this approach emphasizes restoring balance through everyday food choices. It’s a practical, systems-based perspective on how to think about food as part of long-term digestive health. Music provided by Blue Dot. 👋 Connect with the Ellen Goldsmith https://pearlnaturalhealth.com/ Nutritional Healing with Chinese Medicine by Ellen Goldsmith 👋 Connect with the Turds! Rebecca Sand ND, LAc, MSOM ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drrebeccasand.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@drrebeccasand⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ilana Gurevich ND, FABNG, LAc, MSOM ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.openwellnesspdx.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@openwellness_pdx⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@ilana.gurevich⁠⁠⁠⁠⁠Ami Kapadia, MD, ABFM, ABIHM ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠⁠⁠⁠⁠