The Microbiome Connection: Your Guide to IBS, SIBO, and Low-Fermentation Eating

by Mark Pimentel, Ali Rezaie

An essential resource to understanding gut health, the microbiome, and their connection to maintain digestive balance through diet--featuring meal planning guides and sample menus--by two leading experts in the field.

Over the last fifteen years, research into the vast inner workings of the "microbiome" (the trillions of bacteria harbored in the gut) has led to groundbreaking advances in human health and well-being. Now, two of the leading experts in the field, Dr. Mark Pimentel and Dr. Ali Rezaie at Cedars-Sinai, have teamed up to create The Microbiome Connection, a must-have guide that arms readers with all of the knowledge and resources necessary to understand their microbiome, any symptoms they may be experiencing, and how to navigate symptom relief.

An estimated 70 million people in the United States are affected by SIBO, IBS, or one of the more than a dozen other diseases linked to digestive health, and 74% of Americans say they live with symptoms of digestive discomfort. Irritable Bowel Syndrome (IBS)--the most common gastrointestinal condition in the United States--affects millions of people of all ages. Not only do those who suffer from IBS and its similar, sister diagnosis--small intestinal bacterial overgrowth (SIBO)--experience symptoms such as abdominal pain, bloating, and altered bowel habits, they may also avoid participating in activities, social events, or travel for fear of having to constantly disappear to the bathroom or the embarrassment of explaining their discomfort.

In The Microbiome Connection, doctors Pimentel and Rezaie provide explanations of what happens to IBS/SIBO patients from the first diagnosis to the end of treatment; reveal what changes can occur in the body in terms of the underlying physical processes to symptoms that may develop; and share evidence-based management and treatment of those symptoms through dietary changes and drug treatment. Also included are meal plans and sample menus for breakfast, lunch, and dinner, all of which are accompanied by explanations of which foods to eat in moderation and which foods to avoid because they will feed bacteria in the gut and could cause additional symptoms.

A must-have resource for anyone who suffers from IBS or SIBO, or who wants to better understand their microbiome, this book will provide readers with the knowledge and resources to live a gut-happy and gut-healthy life.

Genres: Health, Nonfiction, Self Help, Science, Nutrition

192 pages, Kindle Edition

Published April 12, 2022

Reviews

[Vlad Cherchezan · Rating 5 out of 5]

This book is a must read for any gastroenterologist. I feel like buying the paper copy of this book and smaking on the head with it pretty much all the doctors I've went to so far and then having them read it by force.

Very easy to read and understand, it pretty much explains what is known about IBS and SIBO and tells about ways to treat it, even though he doesn't give the exact treatment (I'm guessing it would be considered medical advice) there is enough there that if you connect the dots you can make a lot of progress.

It was a good read, I wish it would had given a much more step by step treatment plan and what to do when you are finished, but still, I felt like I learned from it and found another piece of the puzzle so its definitely worth the money.

I suggest following Dr Pimentel on FB and instagram to get some of his interviews as well and also find podcasts where he'd been interviewed to get some extra info, even though pretty much all of it is covered in the book.

P.S. I don't understand why the book was 10.99$ when I looked on amazon and as soon as I logged into amazon the price went to 12.59$ - not really a huge difference but Amazon sure makes you feel like you got ripped off a little bit - not the author's fault of course

[Maren bosley · Rating 4 out of 5]

After about 15 years of trying to figure out all my digestive/stomach issues, I visited a GI doctors that suggested I might have something called SIBO. (Which I had never heard of). I did the breath test and the results were positive! I was so excited to finally have an explanation for my problems! Unfortunately, the solutions aren’t so simple and my SIBO isn’t quite so straightforward. So I am thankful that dr pimental (one of the leading experts in SIBO) wrote this book. Jam packed with info and explanations for what SIBO is, what may have caused it, and suggestions for treatment have been so valuable for me! I feel ready to see my GI doctor again, armed with information, so that I can hopefully take the best treatment approach and avoid having it come back. This book is thorough and clear and a great resource for doctors and patients.

[Sabrina]

Says that 60% of IBS cases are due to SIBO, and a lot of SIBO is caused by food poisoning. 11% of people who get food poisoning develop SIBO. SIBO can be detected with a breath test and is often treated with the antibiotic rifaxamin. It also helps to eat a low fermentation diet and not snack. Leave 4-5 hours between meals with not even a bite so your small intestine can finish the digesting phase and move on to the cleaning phase. If your small intestine isn’t fully cleaned out, bacteria that belongs to the large intestine will grow there and that isn’t good. Mouths have millions of bacteria, esophagi have little, stomach has up to 100 per mL, small intestine has between 100-1,000, and large intestine has 1 trillion bacteria of 1,000 different types.

[Jules · Rating 4 out of 5]

Interesting and informative. Confirmed and validated the misgivings I had about FODMAP diet. I’ll be doing the low fermentation diet they recommend, though the information on it is sparse. Seems like they’re developing it as they go as the research in this area is ongoing.

[Brinlee Priddis · Rating 5 out of 5]

This was incredibly well researched and very helpful. I really liked that they broke down the pros/cons of each treatment and just gave the facts without fear mongering. Would absolutely recommend to anyone dealing with gut issues.

[Harry Harman]

Small Intestinal Bacterial Overgrowth (SIBO), a debilitating condition that occurs when bacteria that normally grow in other parts of the gut begin to grow in the small intestine

Many people who suffer from chronic IBS choose not to travel on planes, trains, and buses, and avoid dates or outings with family or friends for fear of having to explain their bathroom trips and their pain and discomfort.

Today there are eight drugs for IBS on the market: five drugs to treat IBS with constipation and three drugs to treat IBS with diarrhea.

antibiotic rifaximin, can eliminate or lessen bacteria in the gut.

Globally, about 11 percent of the world has IBS.

the Rome Criteria useful only after the clinician eliminates other diseases (Figure 1.3). This concept is called a “diagnosis of exclusion,”

Types of IBS
First, there is IBS-C, meaning IBS with constipation. This type is found in 35 percent of patients. Second, there is IBS-D, which is IBS with diarrhea, found in 40 percent of patients. Third is IBS-M (mixed type), which is IBS with alternating bouts of diarrhea and constipation, found in 23 percent of patients.

psychosomatic (all in your head)

Anxiety Doesn’t Give You IBS—IBS Gives You Anxiety

If your gallbladder is removed or is not functioning properly, bile will flow straight from the liver into the small intestine and eventually to the colon, often resulting in diarrhea. It’s important to note that when bacteria encounter bile, they convert it to toxic bile acids (such as deoxycholic acid and lithocholic acid), which are believed to cause diarrhea. This is known as bile acid diarrhea (BAD) and is different from SIBO, but it’s worse when SIBO is present. One of the main causes of bile acid diarrhea is SIBO.

In a clinical study published in 2002, we found that IBS and SIBO patients had 60 percent fewer housekeeping waves compared to healthy controls, meaning that the small bowel motility of these IBS patients was insufficient to completely clean out their small intestine. On a regular basis, bacteria in the colon creep back up to the small intestine in search of more food. However, the small intestine pushes them back to the colon with housekeeper waves. If these waves are impaired, bacteria can build up in the small intestine. This is also known as small intestinal bacterial overgrowth (SIBO). SIBO can lead to fermentation and the production of gases, including hydrogen sulfide, methane, and hydrogen, as well as other by-products, leading to multiple symptoms that include brain fog, diarrhea or constipation, and fatigue.

Up to 30 percent of SIBO/IBS patients have smearing or fecal incontinence; that is, they are unable to control their bowel movements, causing stool (fecal matter) to leak unexpectedly from the rectum. This happens in both men and women, but it’s more common in women. Even more notable, patients with IBS and SIBO have altered stool form. The stool is more like peanut butter, and it you’ve had peanut butter on your hands, you know how hard it is to remove. So, if stool like that passes through the anus, it’s hard to clean and sometimes it cannot be completely cleaned by just wiping after bowel movements.

Gut problems may occur when there are bacteria your immune system has never seen before. If you eat a meal in a developing country, you might experience gastrointestinal upset. Similarly, someone from an underdeveloped country who comes to the United States may become sick from eating a fast-food hamburger.

They used the stool as a surrogate for the entire 25 feet of the gut, not realizing that stool is only the gut’s exit material. We now know that the microbiome in the 20-foot-long small intestine is radically different from the microbiome in the stool.

We’ve developed a technique that inserts an instrument called an endoscope into the mouth and snakes it down into the small intestine. Then, using a newly designed sterile aspiration catheter, we remove samples from different parts of the small intestine.

we don’t know what a perfect microbiome should be. There’s no known magic mix of bacteria, which makes treatment of the microbiome complicated.

emulsifiers are added to food to make it creamy, or sodium benzoate is added to reduce fungal growth and preserve shelf life.

Before REIMAGINE, studies of the microbiome were not fully standardized. If a researcher sent a stool sample to two different laboratories, it might yield two different results.

The first hypothesis is that methane produced by this microbe slows down gut transit. The slower the chyme transits, the more time the gut has to absorb nutrients. And the longer food stays in the gut, the more calories are absorbed each time you eat.

Only a small fraction of Parkinson’s disease cases is inherited. In the remainder of patients, an entity appears to kill selected nerve cells (neurons) in the brain. The prime suspect is abnormally misfolded and clumped proteins, but other possible causes include head trauma or exposure to heavy metals, pesticides, or air pollution.

One theory holds that Parkinson’s disease is caused by an inflammatory reaction that alters the gut microbiome. The inflammation causes proteins, called alpha-synuclein, to misfold and travel along the vagus nerve from the lining of the gut to the brain, causing nerve cell death. A hallmark of Parkinson’s disease is the presence in the brain of Lewy bodies that contain clumps of alphasynuclein. Researchers have found signs that Lewy bodies begin to form in the colon before they manifest in the brain.

it happens that patients with Parkinson’s disease have often had digestive issues, such as constipation, long before the neurological disease appears. This can occur 2 to 10 years prior to the appearance of Parkinsonian symptoms.

we often diagnose Parkinson’s disease for the first time in our clinic.

Use of the fecal transplantation technique has been found to be a highly effective treatment for C. difficile infections. For recurrent infections, antibiotics are 30 percent effective, while fecal transplantation is about 90 percent effective.

In some patients with severe refractory disease, the stool was diverted to an ostomy bag (a pouch worn to collect stool) so that no stool entered the colon. Patients’ inflammation disappeared and their IBD went into remission, only to relapse when the bowel was reconnected and stool and bacteria were introduced into the colon. This phenomenon demonstrates that the mucous membranes lining the gastrointestinal tract don’t become ulcerated unless they’re exposed to the flow of stool and its bacteria. When stool flow was diverted back through the gut, the ulcerations and IBD symptoms returned.

No single microbe has been identified as a disease-causing agent in IBD.

In 2017, Mayo Clinic researchers conducted a meta-analysis of 45 published food poisoning outbreaks, and found that 11 out of every 100 people who have food poisoning will develop IBS

If you do get food poisoning with significant symptoms, it may be better to treat it right away with antibiotics like rifaximin for E. coli or other antibiotics for invasive pathogens.

To minimize your risk of food poisoning, follow these tips:
• Avoid eating raw foods, such as salads
• Don’t eat foods that are left at room temperature for a prolonged amount of time.
• If there is no bottled water available, add iodine tablets to the local water before drinking it. Avoid the use of ice cubes, which are likely made from local water.
• When you bathe or shower, avoid getting water in your mouth.
• Eat at restaurants that have a reputation for cleanliness and avoid those with code violations
• Peel the skins off fruit before eating.
• In hotel rooms, use disposable cups instead of reusable glass or porcelain cups. In some hotels reusable cups are only rinsed rather than properly washed.
• If you plan to travel to an area that is high-risk for food poisoning, you may want to consider taking half of a rifaximin pill with every meal during your trip, although this is not an FDA-approved treatment.
• Wash all sponges in the dishwasher. Sponges are known to carry tons of bacteria.

An autoimmune disease is best described as a condition in which the immune system mistakenly attacks healthy cells in the body.

IBS appears to be more common in women than men, because women are more prone to autoimmune diseases; almost all autoimmune diseases are more common in women than men. For example, more than 90 percent of patients with lupus or primary biliary cirrhosis are women.

we infected rats with Campylobacter jejuni, which is the most common cause of food poisoning in the US and Canada. This was the first study to show how rats infected with Campylobacter developed IBS and SIBO from one infection.

In addition, we found that the nerves in the gut used to initiate cleaning waves were damaged or reduced in rats with bacterial overgrowth from Campylobacter.

We Developed the IBS Blood Test. The test has limitations. It’s not useful in identifying patients who have IBS with constipation. In addition, a negative test doesn’t mean that you don’t have IBS, as IBS may still be caused by other mechanisms. If the test is positive, you may be 98 percent certain you have IBS and you can quickly begin IBS treatment.

my SIBO was treated with an anti biotic, rifaximin, and I went on a low-fermentation diet; now I’m doing very well.

(double- balloon enteroscopy) that’s capable of reaching deep into the small intestine all the way to the ileum (the last part of the small intestine, almost 20 feet down).

lactate, pyruvate, sex hormones, histamine, neurotransmitters, and mediators that can directly affect us. For example, they can produce a form of lactate (D-lactate) that at very low levels leads to brain fog. We’re in the process of identifying these neurotransmitters

While the true epidemiology of SIBO is not yet known, the lack of cleaning waves appears to be very common.

The primary—and easiest—method of diagnosing SIBO is through a breath test. produce hydrogen and methane

The body is designed to absorb glucose in the first few feet of the small intestine, but it’s absorbed so fast that any bacteria below four feet in the small intestine won’t receive any glucose. If you have bacterial overgrowth below those four feet of small intestine (which, remember, is 20 feet long), we won’t be able to assess three-quarters of the small intestine using glucose in the breath test. Hence, we believe lactulose is a better substrate for breath testing.

Diabetes alters gut motility, and when your blood sugar level is high, your brain thinks you have too much food in the stomach or that you’re absorbing too much food. The brain doesn’t know you have diabetes, so the brain slows the intestine down.

the carbohydrates in beans are not digestible by humans and other animals. As a result, the bacteria receive these calories and flourish in the small intestine. overuse of sucralose, excessive lentil ingestion, hummus ingestion

Pg 101 (1-5 categories).

Our IBS/ SIBO patients who’ve had antibiotic treatments such as rifaximin fall into five categories:

5. No response. If there’s no improvement in symptoms, caution flags should go up, indicating further evaluation. The symptoms you have may have nothing to do with SIBO. There’s a long list of potential causes for this, but some (while uncommon) can be sinister, like fluid in the abdomen or even cancer.

rifaximin alone doesn’t work well for IBS with constipation. (rifaximin and neomycin) appeared more effective.

hydrogen, methane, carbon dioxide, and now hydrogen sulfide. The addition of hydrogen sulfide completes the breath test because these are all the main gases produced by gut bacteria during fermentation.

The more hydrogen sulfide seen on the breath test, the more diarrhea, pain, and urgency a patient is experiencing.

How do you treat hydrogen sulfide? rifaximin (which reduces hydrogen, the fuel for hydrogen sulfide production) and bismuth (which reduces hydrogen sulfide production). Future studies will refine this approach

Pg 108 chart

prokinetic drugs, “pro” for promoting and “kinetic” for movement. That’s exactly what they do—promote movement of the gastrointestinal tract.

Prokinetics are most often prescribed for constipation because they promote bowel movements. However, with SIBO what you really want are more cleaning waves. In our experience, using a prokinetic with food in the morning promotes bowel movements. But if you have SIBO you want more activity when you’re not eating (when the cleaning waves happen). This indicates that it’s better to take the prokinetic at night. Taking it at night ensures that it can clean the small intestine without promoting diarrhea. The main prokinetic drugs used for SIBO are low-dose erythromycin, tegaserod, and prucalopride.

Erythromycin between 50 to 100 mg at bedtime—triggers cleaning waves that can help prevent SIBO. higher doses can interfere with the metabolic pathways of certain drugs, such as statins.

prucalopride (tegaserod). The serotonin agonist kept bacteria away for over 200days, while erythromycin kept bacteria away for only a few months.

tachyphylaxis. This term is used when a drug loses its effectiveness over time (usually months)

the consumption of fructose from high-fructose corn syrup increased more than 1000 percent from 1970 to 1990.

Non-digestible sugars will always cause bloating. you should avoid sugar-free gum, which often contains artificial sweeteners.

if you have IBS or SIBO, you’ll need to limit or eliminate high-fiber foods. When we advise less fiber in your diet, it doesn’t matter whether it’s soluble or insoluble. Less fiber means less gas production in the small intestine.

absolute “no-no’s” black beans, pinto beans, kidney beans, and lupini beans. Chickpeas, lentils

the housekeeping waves don’t occur until you are fasting.

we recommend waiting four to five hours between each meal as part of low-fermentation eating.

Snacking is new to human culture. It began in the 20th century with the invention of refrigeration, and is now very much part of our culture.

Our constipated patient drank water faster than her kidneys could process it, but not faster than her small intestine could absorb it. The end result was blood dilution that could have been life threatening. And by the way, her constipation didn’t relent, despite all the water she drank.

Your small intestine doesn’t have that luxury. If you have a lot of gas in your small intestine, when the plane goes up, the gas expands and you may become severely bloated. You can’t belch or pass gas. The key is to board the plane with the least amount of gas in your small intestine. Often, IBS patients avoid eating two to four hours before flying, if possible.

Lubiprostone. This medication is used in the management of chronic constipation. but it does have a box warning for suicidal ideation.

It’s almost an urban myth that if you eat more fiber, your bowel habits will be perfect. The largest fiber study ever done, with more than 10,000 patients, found no association between a low intake of fiber and constipation.

metaanalysis. This occurs when all the studies of particular type are pooled.

Bile acids produced by the liver travel through the small intestine and help with the absorption of fat until they are reabsorbed at the end of the small intestine. If bile gets into the colon, it can cause diarrhea, which happens often in Crohn’s disease because the end of the small intestine is inflamed or has been surgically resected. SIBO is another common cause of bile acid malabsorption.

Very few of the thousands of strains of bacteria in the gastrointestinal tract are in fact “good” or “bad.” The concept of “good” bacteria has been largely promoted by the companies that manufacture probiotics. We now know that probiotic supplementation has shown little long-term benefit for IBS patients.

The deficiency of Lactobacillus acidophilus in IBS patients may have been an artifact of a self-imposed dairy-free diet.

(the placebo worked better than the transplant).

The absence of cleaning waves is known to cause bacterial overgrowth. Another factor that can influence bacterial overgrowth is a lack of stomach acid.

physicians: my IBS gets worse when I’m stressed. A more important question to ask yourself is, “Do I still have symptoms even when I’m not stressed?”

Exercise makes IBS better. This is true. Exercise increases blood flow to all organs, improves motility of the gut,

Nearly one-third of the general population carry the genes for celiac disease, but only one percent of them have celiac disease.

Antroduodenal manometry An advanced test that measures the contractions of the stomach and small bowel

Bile acid diarrhea (BAD) When excessive amounts of bile reach the colon, causing diarrhea. SIBO is one of the most common causes of BAD. Also known as bile acid malabsorption (BAM)

IBS-M A type of IBS in which the predominant stool form alternates between watery and hard at an irregular interval

Peristaltic waves Snake-like movement of the gut that moves food through the digestive tract

Small intestinal fungal overgrowth (SIFO) Excessive growth of fungi/yeast in the small bowel causing various symptoms, including bloating and change in bowel habits

Tachyphylaxis A sudden drop in drug effects due to rapid development of drug tolerance

[Mia · Rating 3 out of 5]

This book is sometimes information for medical professionals, sometimes guidance for IBS/SIBO patients, and sometimes an advertisement for the products developed by these doctors. As someone who is not a medical professional, parts of this book were difficult to follow and caused flashbacks to AP biology. However, this book did validate some things I've learned through trial and error to manage IBS symptoms over the years (low fermentation eating, peppermint tea). Most importantly, it gave me an update on new tests available (IBS blood test & a broader breath test) that I have asked my doctor for. It wasn't a fun read, but it was a quick and useful read.

[Kristel · Rating 4 out of 5]

3.5 stars. This is another helpful book. If you're dealing with issues with your gut and trying to figure out methods and strategies to support healing. I did find some of it to be counterintuitive and they talked a lot about how eating a low fermentable diet would be super useful but then didn't spend hardly anytime talking about it. And they pretty much write it off for plant-based eating, which is frustrating. That being said, though, there is a lot of good information about what's going on in the gut when you're having issues.

[Elizabeth Bien · Rating 4 out of 5]

3.5 stars
I wish they could have gone more scientifically into the data and theory, but it was so fulfilling to see the description of debunking IBS myths (looking at you probiotics and fecal transplants).
I don’t have as-of-yet- diagnosed SIBO, but I’m going to ask my nutritionist if I can do the breath test because my low fodmap diet results were confusing.

[Stacy · Rating 4 out of 5]

Before starting The Microbiome connection, I listened to Dr. Mark Pimentel from Cedars-Sinai in several health oriented podcasts. He does not support research that PPI’s can cause SIBO and he claims the low fermentation diet is better and less restrictive than a low FODMAP diet. Having both the Monash University app and a list of what is on the low fermentation diet, I have concluded they are pretty much the same. Seemingly the diet a patient takes before the Trio-Smart or any other SIBO test is the low FODMAP diet they may be referring to . . . White rice, lean protein, no veggies.

The book is worth a read, and I filled mine with Post-It notes.

During one of his recent interviews, he mentioned a drug that is entering clinical trials that can possibly help IMO/SIBO. The book is approaching 4 years since its first publication, so I guess a new book or extra chapters are just a few years away.

[Sabrina Drammis · Rating 5 out of 5]

Must read if you are suffering from SIBO/IMO.

[Darlene Oberg` · Rating 5 out of 5]

Best Book I ever read on IBS. Grateful to Dr. Pimentel for his dedication to researching this condition . IBS is one of those issues that many write about as if they have the answers if you buy their products or services. Its so frustrating that you want to give up. I trust that he is passionate about understanding and finding a cure for IBS and SIBO. The mere fact that he is not selling anything, but is sincere in his mission adds to my trust. I'm going to follow him, because I had pretty much given up on getting help, but I think even my Drs. are benefiting from his research. He gives us hope.

Don't know about the Low-Fermentation diet, as there are many areas where it conflicts with the low Fod Map diet I have been following....and yes, contrary to his advice, I am permanently low Fod Map.

[Georgia Rankin · Rating 4 out of 5]

This was a really interesting read that gave me a much better understanding of how to live and heal SIBO through daily habits and diet. I found it fascinating and comforting how many people are affected by gut health issues globally. The explanations of the microbiome and gut-brain link were also interesting.
The only downside for me was that some of the diet recommendations were different with other SIBO sources which left me a bit confused on what approach to follow.
Overall, very informative book for anyone dealing with SIBO or wanting to learn more about gut health.

[Debbie Rosa · Rating 4 out of 5]

All About SIBO

This book was loaded with information about gut microbiome, SIBO and IBS. I learned a ton about SIBO, which I was diagnosed with, and found helpful The book reads more like a textbook so its not for everyone.

[Mr H · Rating 4 out of 5]

very informative

Great but glossed over how a low fibre diet might be harmful but overall very useful and will follow advice

[Betsy Cornwell · Rating 5 out of 5]

We hear a lot about gut microbes. There are plenty of probiotics, prebiotics and other supplements to support our digestive health. This book was written by two doctors who are involved in current research on the topic. What better source of information could there be?

I've been struggling with gut issues for almost twenty years. I've had so many bad experiences with gastroenterologists that I refuse to ever see one again. These two doctors are different. They have an obvious concern for the welfare and comfort of their patients. They clearly understand the problems that patients with irritable bowel syndrome (IBS) and similar disorders face. They give a thorough, understandable description of the digestive system. They also provide a wealth of tips and information on how to achieve and maintain gut health.

I was surprised by some of the advice, especially what they said about probiotics and the FODMAPS diet. I didn't know there was a blood test for IBS. I didn't know about the connections among food poisoning, IBS and SIBO.

I've read a few books about gut health. This is the most complete, current, and useful one.

[Mariya Krutkova · Rating 4 out of 5]

Most of the information found in this book I already knew from reading countless online articles on SIBO and IBS. But it was nice to have it all organized in a book format and there were two important things I learned. First, though I knew that food poisoning is considered the most common cause of SIBO, it was interesting to learn the mechanisms behind it. And second, this was the first time I heard about the low-fermentation diet. Huge relief to know that there is a well balanced diet one can eat on a long-term basis to prevent relapse.

[Lili Kim · Rating 4 out of 5]

Some key SIBO takeaways I got:

-food poisoning is the most common path to SIBO (I got that twice!)

-bacteria got dislocated from your large intestine to your small intestine

-one group of bacteria that produces hydrogen leads to bloating

-any factor that slows the speed of flow through the small intestine can lead to overgrowth, think of it like an impairment of cleaning waves in the gut (this happens every 90-120 minutes when fasting). Undigested food just sits in your gut and breeds bacteria

[Abigail Sobanski · Rating 5 out of 5]

This is hands down one of the best medical/scientific books I’ve ever read. It’s straightforward and helps you make informed choices for treatment. There’s a sort of hopeless stigma that treating gastrointestinal diseases is mostly guesswork and trial and error, but I now understand the exact what and why of my pain. Understanding low-fermentation eating and how to support the migrating motor complex with timed eating has greatly reduced the discomfort of SIBO in my day to day.

[Heidi Moretti · Rating 4 out of 5]

I found this book enlightening regarding the causes of SIBO and IBS. Some of the advanced testing is unknown by many GI docs today. As a functional medicine nutritionist, however, there is a lot missing regarding clinical research about ways to heal the gut and help with gut motility, which is at the root of much of IBS and SIBO issues.

[Kyle · Rating 5 out of 5]

Very informational if you have IBS / SIBO. Great source of truth for a lot of information instead of trying to google it and figure it all out. Will be using the information from the book to discuss with my gastroenterologist and try to figure how to reduce the recurrence of my SIBO.

[Matt Winfield · Rating 3 out of 5]

After 50+ days with a stomach ache, I finally found a cause with a SIBO diagnosis. I ordered this book the same day to learn about it. Very readable for me as a lay person for a book written by a doctor.

[Arielle · Rating 3 out of 5]

This book reads like a textbook but is filled with informative information on what exactly is in your microbiome and how to combat problems if you have an abnormal gut. This book answers many why’s (ex. why is this happening to me), which can be helpful or overwhelming to some.

[Eileen · Rating 5 out of 5]

This amazing guide has answered many questions I've been asking for years!
These doctors are at the forefront of new treatments long overdue for millions of folks suffering worldwide.
This is my go to guide for healing.

[Laura · Rating 5 out of 5]

A must read for anyone wanting to understand SIBO and IBS better - incredible resource filled with the latest science backed research. I learned so much! Can’t stop raving about this book!

[Rikki Uhrich · Rating 5 out of 5]

Not my normal genre but this was super informative with data that was easy to digest and lots of helpful tips. Highly recommend if you struggle with tummy issues

[Amanda Kim · Rating 5 out of 5]

must read for those struggling with IBS and SIBO

[E S R · Rating 4 out of 5]

4.5

[Devlin Welch · Rating 5 out of 5]

The Microbiome Connection is one of the most informative and eye opening books I’ve read in a long time. I learned so many facts I never knew existed about gut health and how deeply it affects the rest of the body. It’s one of the few books I’ve found myself highlighting page after page because there’s just so much valuable information. The author explains complex concepts in a clear and practical way, which makes it easier to understand how to apply them to your own health. I truly believe this book will help me in treating and managing my condition. Highly recommend for anyone struggling with gut issues or simply wanting to understand how the microbiome impacts overall wellness.