In part two of our SIBO series, we’re joined again by Dr. Allison Siebecker to focus on what often determines whether patients stabilize or relapse: nutritional management and supportive care during and after SIBO treatment. We explore how to use prokinetics to support migrating motor complex function, when digestive aids like bile acids and enzymes may be appropriate, and how to apply SIBO dietary frameworks as personalized, flexible tools—not rigid rules. We also cover practical approaches to suspected yeast/dysbiosis overlap, how to support gut barrier integrity without worsening fermentation, and the key myths that can derail outcomes. This episode helps clinicians move from “eradication mode” to sustainable, integrative SIBO care.
Summary
In part two of our SIBO series, we’re joined again by Dr. Allison Siebecker to focus on 2 key pillars that can influence whether patients stabilize or relapse: nutritional management and supportive care during and after SIBO treatment.
We explore how to use prokinetics to support migrating motor complex function, when digestive aids like bile acids and enzymes may be appropriate, and how to apply SIBO dietary frameworks as personalized, flexible tools—not rigid rules.
We also cover practical approaches to suspected yeast/dysbiosis overlap, how to support gut barrier integrity without worsening fermentation, and the key myths that can derail outcomes. This episode helps clinicians move from “eradication mode” to sustainable, integrative SIBO care.
Clinical Takeaways from This Episode
- How do prokinetics help to prevent SIBO relapse and support the migrating motor complex?
- Dr. Siebecker frames prokinetics as a core strategy to support upper GI motility and migrating motor complex activity, particularly between treatment rounds and for maintenance after major symptom improvement, individualized to relapse risk and underlying drivers. Prokinetics help to accomplish roles that the migrating motor complex and motilin typically perform in the GI tract, including the routine out-movement of foodstuffs, resulting in less time for bacteria to ferment specific carbohydrates (Deloose, 2015).
- Can you use prokinetics in diarrhea-predominant patients, or are they basically laxatives?
- They’re not laxatives by definition. Prokinetics are intended to support coordinated GI motility (often esophagus, stomach, small intestine) and may still be considered in diarrhea-predominant cases when small intestine motility impairment is part of the picture; dose and individual tolerance matter (Camilleri, 2021).
- Should clinicians use restrictive SIBO diets during treatment, and can diet “cure” SIBO?
- Food based diets are best positioned as symptom support, not a standalone cure. Low-fermentable carbohydrate approaches may reduce gas-related symptoms and improve adherence during treatment, and clinical experience shared here suggests improvement can still occur even when diets are quite restricted. Food is distinct from the elemental diet, where patients only intake a supplement for 2 weeks, discussed part of the series (Knez, 2024).
- How should clinicians approach SIBO diet personalization and food reintroduction after treatment?
- Dr. Siebecker recommends using established dietary frameworks (low FODMAP, SCD, hybrid approaches like the SIBO-specific guide/biphasic structure) as starting points, then customizing based on symptom response. Food reintroduction can be gradual, sometimes using “micro-dosing” exposures, with repeat trials to reduce confounding factors. Not everyone with the same subtype of SIBO will be able to tolerate the same foods.
- What supportive care is commonly missed in complex or relapsing SIBO cases?
- Commonly missed supports discussed by Dr. Siebecker include: physical medicine for for structural contributors, thoughtful use of digestive support (enzymes, bile acids when clinically indicated), and careful selection of gut barrier supports—noting that some mucopolysaccharide-rich “leaky gut” agents may aggravate symptoms in active SIBO for some patients.
Guest Introduction
Dr. Alison Siebecker is a clinician and educator recognized for her work in SIBO subtyping, breath test interpretation, treatment sequencing, and relapse prevention strategies. She provides practitioner education, patient resources, and community learning through
siboinfo.com
Labs, Nutrition, and Lifestyle Support Mentioned
Motility support: prokinetics (pharma and botanical options discussed)
- When used: between rounds and for remission maintenance (often at least ~3 months, individualized).
- Options discussed: prucalopride, low-dose erythromycin, LDN (adjunct), ginger and ginger-based blends, Iberis amara–containing multi-herbal combinations.
Digestive support: bile acids and enzymes (individualized)
- Bile support may be considered when clinical suspicion of low bile flow exists; enzymes may support digestion during symptom management and re-expansion.
Yeast/dysbiosis overlap: testing options
- Stool testing (colonic yeast), urine organic acids (yeast metabolites), Candida immune markers (reactivity patterns), and symptom questionnaires as pragmatic adjuncts.
Gut barrier support during active SIBO: choose lower-fermentation options first
- Trial cautiously: marshmallow, aloe, comfrey (may aggravate symptoms for some).
- Often better tolerated options discussed: IgG/colostrum, zinc carnosine, non-fermentable anti-inflammatory supports.
Integrative lifestyle medicine and structural support
- Physical medicine, acupuncture, chiropractic when appropriate.
Key Moments
03:30 – Why some physical medicine modalities may improve outcomes in complex SIBO
04:45 – Prokinetics explained: migrating motor complex support vs laxative misconceptions
06:45 – Timing between treatment rounds and how practice scheduling impacts success
14:31 – Foods for symptom relief: why diet alone may not resolve relapse drivers
23:00 – Leaky gut support during active SIBO: what may aggravate symptoms vs better-tolerated options
27:06 – Biphasic/SIBO-specific dietary frameworks and personalization principles
30:26 – Common SIBO myths that derail care and patient confidence
31:40 – Clinical hope message: troubleshooting why patients aren’t improving
Want to elevate your practice?
This episode is sponsored by
Fullscript, a comprehensive care delivery platform designed to support whole-person, integrative healthcare.
Fullscript allows clinicians to streamline supplement dispensing, lab ordering, and patient education in one free, centralized system—helping reduce administrative burden while supporting clinical decision-making. For practitioners,
Fullscript offers access to professional-grade supplements, evidence-informed protocols, and lab integrations that can support more efficient treatment planning and follow-up. For patients, it provides a clear, organized way to receive recommendations, manage refills, and stay engaged in their care. The goal is not to replace clinical judgment, but to make it easier for clinicians to focus on what matters most: thoughtful, individualized patient care.
Disclaimer
The views expressed on this podcast are those of the hosts and guests and don’t necessarily reflect those of Fullscript or any affiliated organizations. This podcast is for informational and educational purposes only and is not intended to be medical advice. For your safety, always check with your doctor or healthcare provider before making changes to your health routine.
Citations
- Camilleri M, Atieh J. New Developments in Prokinetic Therapy for Gastric Motility Disorders. Front Pharmacol. 2021;12:711500. Published 2021 Aug 24. doi:10.3389/fphar.2021.711500
- Deloose E, Janssen P, Depoortere I, Tack J. Redefining the functional roles of the gastrointestinal migrating motor complex and motilin in small bacterial overgrowth and hunger signaling. Am J Physiol Gastrointest Liver Physiol. 2015;309(9):G649-G661.
- Knez E, Kadac-Czapska K, Grembecka M. The importance of food quality, gut motility, and microbiome in SIBO development and treatment. Nutrition. 2024 Aug;124:112464. doi: 10.1016/j.nut.2024.112464. Epub 2024 Apr 5. PMID: 38657418.
