What is SIBO and How Can Diet and Probiotics Help? With Dr. Joe Mather

Today, in the Scheer Madness Podcast, Dr. Joe Mather joins Rachel to talk about gut health. They discuss what Irritable Bowel Syndrome (IBS) is, the leading causes of SIBO (Small Intestinal Bacterial Overgrowth), what we can do to help control bacterial growth, and how functional medicine can help address gut issues long-term. 

At the Ruscio Institute for Functional Medicine, Dr. Joe Mather uses an integrated approach of both natural and conventional medicine to help you heal, while also taking the time needed to get to the root cause of your health issues.   

For more information about working with our team at Rachel Scheer Nutrition, book a free 30-minute call at www.rachelscheer.com/application 


  • 00:00 Intro
  • 03:26 Why did you take interest in gut health?
  • 05:43 Why is gut health important?
  • 09:37 Shifting more to deemphasize laboratories
  • 14:02 Most common root causes of IBS (Irritable Bowel Syndrome)
  • 17:31 What is SIBO (?
  • 19:58 How does SIBO develop?
  • 22:10 Poor sleep lead to low stomach acid
  • 25:44 The decrease in production of stomach acid
  • 29:48 Probiotics is a cost effective treatment
  • 35:33 Supplements aren’t necessary all the time
  • 40:25 Diets to help cure SIBO
  • 44:09 The elemental diet
  • 50:18 The three biggest gut killers 

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Podcast Transcript

Dr. Joe Mather: Gut is such a powerful tool that it often makes a lot of other second and third level interventions unneeded. If you get the gut healthy, like you said, we see improvements in the skin or in our patients with arthritis or autoimmune arthritis, we see joint pain going away. Right? So we see anxiety, depression, thyroid, uh, cholesterol.

I mean, the list goes on and on for things that we. Get better on a daily basis. When we really focus on the gut, 

Rachel Scheer: insanity is doing the same thing over and over again and expecting different results. But if you are ready to level up your life and get results that truly matter in your health business, mindset and relationship.

Then this is the podcast for you. Welcome to shared madness, where we have unscripted real conversations with the world’s top athletes, entrepreneurs, and coaches discover real world and tactical advice from the best in the business. Let’s go everyone. And welcome back to another episode of sheer madness today.

I got Dr. Joe Mather on the show here today. He is a medical. At the Rio Institute for functional medicine, where they specifically focus a lot on the gut microbiome and overall gut health, which as you guys know, I am incredibly passionate about when it comes to reaching our optimal level of health. Dr.

Joe uses an integrated approach of both natural and conventional medicine to help you heal while also taking the time needed to get to the root cause of your health issues. Dr. Joe, welcome to the show today. 

Dr. Joe Mather: Thank you so much, Rachel, I love talking about the gut. And so I’m eager to jump right in with you.

Rachel Scheer: Yes. We’re gonna nerd out on all things, gut health here today. I’ve had a few experts come on my show that I’ve gotten to really go into different rabbit holes with, um, but I think you are the second functional medicine physician that I’ve had on the show. The first being Dr. Kenneth Brown. Not sure if you’ve heard of him before in his 

Dr. Joe Mather: work.

I think he, he, is he the, the GI doctor who formulated Aran Aran, correct? 

Rachel Scheer: Yeah. Awesome. Yeah, he actually figured out a lot of my gut issues that when I was experiencing everything and before I even got into functional medicine, so he does a lot of awesome work with SIBO being more on the gastroenterology side.

Yeah. Absolut. But I’m always super passionate about learning what your story is with getting you into gut health and the gut microbiome, and even functional medicine to say that, um, for me, I actually came from the body building world. I was a fitness model for quite some time and I ended. Dealing with a ton, a ton of gut issues that no Western medicine doctor could really get to the root cause.

Yeah. To the root cause for, and I pretty much got to the point where even one physician wanted to even do a full colectomy on me with how severe my gut issues became and the mortality in my gut, completely coming to a halt and needless to say it all really winded. Coming down to a gut microbiome issue.

So once I was able to finally address the bacteria issue in my gut leaky gut, and really take more of root cause based approach, you know, everything in my life massively massively improved, but is there any particular story, uh, that got you more into gut health and functional medicine? 

Dr. Joe Mather: It was really just curiosity.

I, at the end of my medical training, I, I remember being a, a third year resident in family practice and looking at my, my day of clinic and realizing that my patients weren’t better. So here I was having spent all this time and effort to get through medical school and do family practice and learn for some awesome doctors.

And just feel like I, I didn’t have the tools to really help my patients get well. And so that’s kickstarted the journey into functional medicine and I basically was just casting around for, for what is gonna actually move the needle to help my patients. And as you know, the gut is one of the largest levers we can pull to help our patients get better.

So, uh, after some, some time, uh, drifting in the wilderness, I found, uh, my friend, Michael Russo, online. And, uh, I realized that he had a lot to say and a lot of good information and, uh, I attached on and followed him and, uh, harassed him until he taught me what he. Knows. And now I’m his medical director, so yeah.

It’s been a, a really fun ride. 

Rachel Scheer: Yeah. That’s awesome. And it is so interesting coming from like the Western medicine world. Right. And just really realizing like, okay, we need, we need more, we really do need to figure out what the root cause is instead of just giving a bunch of bandaids out, which I’m never against medication by any means.

Yeah. Um, but I am definitely for figuring out the root cause with what is going on there. And I think, especially when it. Down to a lot of these chronic health issues, IBS, autoimmune conditions, even things like anxiety, depression. This is when we typically rule out anything major. And then just slap someone with a label like IBS, um, anxiety, depression based.

Based basically off of just symptoms and of itself. And then it’s very disempowering because people really stop looking for answers and they just spend the most of their life managing their symptoms. So I’m, I love the work that you guys are doing. And I also love that you take more of a gut centric approach first and for.

Because I know that’s where a lot of, um, disease really does begin. Um, it all begins and ends in the gut. So let’s talk a little bit about here. Just your philosophy on gut health and why gut health is even even important at all. For us, 

Dr. Joe Mather: we’re looking for how we can help patients get better. The quickest.

With the least amount of expense with the least amount of fus, we just want our patients to come in and, and do well. And gut is such a powerful tool that it often makes a lot of other second and third level interventions. Unneeded. If you get the gut healthy, like you said, we see improvements in the skin.

Or in our patients with arthritis or autoimmune arthritis, we see joint pain going away, right? So we see anxiety, depression, thyroid, uh, cholesterol, the list goes on and on for things that we see get better on a daily basis when we really focus on the gut. So for, for us at the show Institute, and I say us, it it’s Michael Roha myself, and now we’ve grown to two additional practitioners.

We’re all using this gut based lifestyle model to try to get our patients. Better as quickly as they can be because the, we see, we see integrative and functional medicine while being brilliant and, and amazing at innovating. And having people understand that you can’t just put on, run around putting bandaids on symptoms.

You have to go deeper to get them better. That model unfortunately has shifted to this place where people are going in to see an integrative and functional medicine doctor, and they’re leaving with $8,000 worth of lab. They’re leaving with 16 supplements. And that’s just gotta stop. It’s just inefficient.

Yeah. In elegant care, that’s harming patients. Right. And so what we’re trying to do is, is just kind of take a step back and say, how do we just get our patients better with the least amount of fuss and worry so they can get back to their life. And again, and again, if, if you’d missed the gut, you’re, you’re missing one of the major opportunities to really heal and optimize.

That that’s kind of the backstory for why we focus so much time and love on the gut. 

Rachel Scheer: I love that because I think there’s, there’s all these different systems right? In the human body. There’s our hormones, our thyroids, our adrenals, our, our brain health, there’s our metabolic function. And when we get our guts in a really, really good place, very often all of these other different systems, not all the time, but tend to fall into place really ultimately.


Dr. Joe Mather: well, as you’re lost, right? You’re like, where do I start? Am I. adaptogens and my stress hormone. Is it my B vitamins here? Is it my exercise? Is it my sleep? Is it my insulin? It there’s, there’s so much things that you can do, right? Mm-hmm you need a couple guiding principles for where 

Rachel Scheer: to start. Yeah. And I like that you guys start with the gut first.

Um, that’s really what a lot of my philosophy is with my functional medicine, nutrition practice. We don’t use any medicine in particular. We just do all of the testing, looking at what’s happening in the. Um, looking at the other different systems in the body too, but really using food as medicine and some different types of herbal therapies as well.

Okay. But I find it interesting that you do even mention other practitioners in the functional medicine world who do a ton of testing people spending upwards to, you said $8,000 in all of these different types of tasks, which some of it can be useful. Some of. You know, it’s kinda like nice to know information in my opinion.

Yeah. Um, but then also too, just leaving with a laundry list of supplements to take and, you know, still going to this functional physician, which is not the same as going to Western medicine where maybe they’re just doing some basic type lab work, um, colonoscopy, endoscopy given a medication, but they’re still not really getting the holistic approach in my opinion, with.

A bunch of labs and being handed over a bunch of supplements. Um, so I think it’s really, really empowering that you do mention that your guys’ philosophy is, is different in terms of. Testing and really addressing some of these root causes. What kind of testing do you guys find the most useful with your 

Dr. Joe Mather: clinic?

Uh, I’m gonna answer it a little different way because we’ve actually gone to a model where upfront we do very little testing okay. With exceptions. And we find that because we, we find that generally speaking, the more testing that’s done, the more distraction there is from working on the big issues that are gonna get someone.

And so often we’ll do no testing on the very first visit. There, there are low hanging fruit, obvious solutions that just need to be implemented. And if I say, okay, go do a breath test and a stool test and have your blood work done. And maybe we should think about heavy metals or maybe there’s a mold toxin test that we want.

If I do that, all of a sudden the patient’s so overwhelmed that yeah, we’re not getting into the meat of their recommendation when we’re trying to improve their. Having them work through a therapeutic trial of a diet or getting some of the most evidence based effective treatments on board, comprehensive probiotic therapy.

So we’re shifting more and more to, to deemphasize the laboratories, particularly the ones that aren’t, aren’t validated. There, there are a lot of interesting tests out there, but it doesn’t necessarily tell a good clinician. How to treat. And I think that this is one of the things we need to get better at in terms of the field of, of functional medicine.

There’s a time and a place for these tests. Yeah. But they’re usually after you’ve done some initial work, if you’re still having troubles, you may wanna look back. Am I missing an a Miba that’s really out of place. Am I missing Canda over overgrowth? That wasn’t obvious at the first am I missing a parasites?

Those are, those things are not as common. Right. And so you don’t wanna lead with that. You wanna do the fundamental treatments. Then pivot over to the lab and look, it, it saves the patient money. It, it makes the whole process easier and simpler. And so that that’s generally our, our philosophy. Yeah. If, if you want to ask specific questions about labs, I’d be happy to, to go into detail, but that’s generally what we do these days.


Rachel Scheer: that makes sense. And actually with all of our clients that we work with, we start with nutrition first, before we get even some of the lab testing back. And what’s so interesting. We’ll even still get clients who, after their entire first month of doing all lifestyle, different therapies, um, working a little bit on their nutrition.

They’re like, oh, I haven’t started anything yet because I was waiting for my labs to come back and we’re like, well, we’re gonna go back now to month one. I know. And we’re gonna get started with all of that. So. 

Dr. Joe Mather: You know, there, there, it just, it just became just so obvious when, when I think you have the right tools in place, a patient gets better quickly.

It’s usually not this big rigamarole. Yeah. The bloating, the heartburn, the nausea, the just Pepsi, that constipation, all that goes away. Right. So there’s nothing more rewarding than having, you know, just taking a patient and saying, okay, low FAP diet. We’re gonna give you our comprehensive probiotic protocol.

Come back in five weeks. And so many times they’re better. Yeah. And if you had spent, you know, the time spending $2,000 on some functional tests and they were better already. You know, you just missed the boat and it, um, so yeah, again, it comes back to I’m so glad to hear you say that you’re focusing on, on the lifestyle first and foremost.

Rachel Scheer: Yeah. A lot of people do love all of the testing and we even get a lot of people who’ve worked with all the different gastroenterologists, the dieticians before, and they, they really need the testing. And we find out things like you’ve mentioned candy to overgrowth, or they have, you know, just a massive amount of dysbiosis, heavy metals and even different things like that.

But still at the end of the day, the test is only information we have to make. All of those dietary changes. We have to make some of the lifestyle changes, work on sleep, because those are really, like you said, the lowest hanging fruit when it comes to getting our gut in a really good place, ultimately.

Let’s talk a little bit about IBS. Um, and I’ll tell you my opinion on IBS, but I consider it to be a trash can diagnosis. Um, and, and that’s just because right. IBS is not really a diagnosis, it’s just an accumulation of symptoms. And there are a lot of different potential root causes as to why someone can develop IBS.

Right. Um, it can be bacteria overgrow. It can definitely be sometimes like a parasite. It can be so many other different things that cause someone to develop IBS. It can be stress, right. Our we’re just stressed out all the time and that’s negatively affecting our digestion. Um, but what would you say are some of the most common root causes of IBS that you see in your clinic?

Dr. Joe Mather: Such an interesting question, because I remember when I. Uh, was done with my medical training. I, I really didn’t have any good options to treat this. And so I didn’t see good, good results. Um, the, the very first one that people, I think under underappreciate is SIBO, small intestinal bacterial overgrowth.

And this is approximately 40 to 50% of IBS cases tend out to have CBO. There are some estimates that are up to 80. I don’t think those are. I’d say somewhere around half. And the, the deeper question is to me, SIBO is also, I won’t say trashcan diagnosis. It seems, it seems a little bit too harsh. Um, but I think the, the better question is when someone has SIBO, then why do they have SIBO?

Because that’s what. Truly gets you closer to fixing that as quickly as possible, but irritable bowel syndrome is a huge percent of the population these days. And it’s, it’s sad because there are very easy treatments here that they make a big, big difference. Yeah. And while IBS, you know, doesn’t make you live less, it doesn’t necessarily give you a higher rate of cancer or make you die sooner.

It just destroys the quality of your life. For sure. Abdominal pain, the bloating, constipation, diarrhea, these are absolutely miserable things. And so we’re happy. We love treating it, cuz it, it, it’s kind of our, our bread and butter and, and we see great results. 

Rachel Scheer: Yeah. And just so you know, I don’t think CIBO is a trashcan diagnosis at all.

Um, I totally agree with you with most cases of IBS, um, coming from things like CIBO or other type of bacteria imbalances in the guts, and that’s why the FODMAP died is so effect. Right. Is it removes a lot of those food sources? I be a hundred percent. Yep. Yeah, definitely. But IBS, right. Saying like I have an irritable bowel syndrome then being swap with the label.

And I know for myself, when I went to, you know, just a lot of Western medicine, gastroenterologist, it was, you can have an antidepressant or 

Dr. Joe Mather: you can have fiber. 

Rachel Scheer: Oh, I got, I got all of it. I got the antidepressant I got here. It takes some more fiber. I got a prescription based laxative and then it was like, here, come back to me in, you know, six months and see if you’re better.

Well, I continue to get worse and worse and worse. Um, and no one really at the time was talking about SIBO. They talked about maybe probiotics. And I know I got sent the, the general aligned probiotic that you get at the pharmacy is like, Hey, take this. This is gonna fix all of your gut issues, take these laxatives.

Um, but SIBO really, really does impact your quality of life. Or I. If you have any kind of gut issues. And I know that from my personal experience, um, all I could focus on was my gut and I was depressed. I had anxiety. Um, I couldn’t focus in my work. My relationships began to suffer. So a lot of the clients who do come to us, like, it’s not just about, Hey, I’m a little bit bloated or I can’t go to the bathroom.

Like it literally. Every single area of your entire life, your quality of life is massively, massively, you know, impacted. And I think unless you’ve dealt with gut issues yourself, it’s really even sometimes hard to understand that, um, overall, but. Kind of going back to SIBO because some of my listeners actually, probably most of my listeners know what SIBO is, but let’s just break it apart a little bit.

What is SIBO and how does SIBO really begin to develop? Because I think it’s important for people to understand, especially if you’re someone who is dealing with gut issues, it’s very likely, you know, as he said, 50% of cases with IB. Tend to come back to having bacteria overgrowth in your gut or CIBO, CIBO 

Dr. Joe Mather: stands for small intestinal bacterial overgrowth, and really simply put its bacteria in the small intestinal where it’s not supposed to be.

So if you think of a simple model of a GI tract from mouth to anus, What happens is, is starting at the mouth. You should have extremely small amounts of bacteria moving down the stomach with a stomach acid, and then you move in the small intestine. You have bile, and then the stomach acid moving down, you have increasing amounts of bacteria as you go farther down the GI tract, right?

Mm-hmm so you should have very little bacteria in the upper part of the small intestine. And then as you get closer to the large intestine, you have more and more bacteria. Right. This is what a normal GI tract is set up. That’s how the normal microbiome is. It’s not that it’s sterile, but the upper part is very, very few bacteria.

Mm. Sebo occurs when the intestinal health of that early part of the small intestines becomes damaged and allows the promotion of bacteria. That really shouldn’t be there. Those bacteria then are like along for a free ride. So they’re able to eat the foods you. Ferment the, the sugars that you eat and create all of that intestinal inflammation, bloating, and stool irregularities that we see.

So from a very, very conceptual place, SIBO is just bacteria in the early part of the small intestine where it’s not supposed to be. 

Rachel Scheer: Yeah. And that’s what causes a lot of the bloating, the distension, because these bacteria are eating basically all the foods that you’re eating, specifically, different types of carbohydrates, they’re producing gas.

And then that gas is causing for some people constipation, especially if it’s methane producing. Um, if it’s hydrogen producing, some people can get diarrhea, but altogether we end up looking like we’re six months pregnant. The end of every single day. Yeah. Which is not fun, nor is the brain fog and all of the other symptoms that tend to go with it as well.

So when we get SIBO, we have bacteria in the wrong area of the gut. Um, how does this. Begin to happen for people. What are some of the root causes for developing SIBO in the first place? 95% of your body’s serotonin is produced by the bacteria that resides in your gut. And this explains why when my gut was erect or when clients come to work with me at Rachel sheer nutrition, they don’t just suffer from things like bloating, constipation, diarrhea.

But they also have symptoms of anxiety, depression, and brain fog because our gut and our brain are highly interconnected. And as hypocrites says, all disease begins and ends in the gut. And this is the exact reason why I am so passionate about taking a functional root cause based approach for any chronic health condition, gut issues, mental health illness.

Autoimmune conditions, stubborn, weight loss, you name it. Me and my team do a comprehensive analysis, looking at all these different systems so we can test instead of just guess, and then develop a customized nutrition plan in protocol to address these root causes and balances in the body and restore function.

If you wanna book a free 30 minute call with anyone from my team. Click the link in the show notes or visit Rachel shear.com. So 

Dr. Joe Mather: there are a lot, and we’ll just kind of run through a quick, uh, quick summary. Uh, so for many patients it’s an inappropriate diet, so it’s a diet excessively high and processed carbohydrates, which is kind of like the, the junk food.

Uh, and the bacteria love it. They just eat it, uh, and it promotes their growth. And so that’s, that’s one, uh, for many patients it’s, uh, poor circadian rhythms, bad. Which has the secondary effect of lowering stomach acid and lowering the efficiency of your bile. That in turn the stomach acid and the bio, like I mentioned, should be cleaning out the small intestine.

Right? And then when you lower that ability, you lower one of the natural defenses against the bacteria and you allow that bacteria to grow. 

Rachel Scheer: How does, so I’m gonna stop you there. How does poor sleep lead to low stomach acid in low bio 

Dr. Joe Mather: flow? So it has to do with the balance between the sympathetic and the parasympathetic nervous system.

One of the, the biggest up regulators of the fight and flight sympathetic is a lack of sleep. So the body is extremely exquisitely sensitive to am I getting enough rest to repair and heal my body when it’s not. You see that sympathetic nervous system activity Jack up and it lowers the parasympathetic nervous system as, as part of that activation.

So to, to talk about that activation, when I used to work in urgent care, I would see patients come in and they’d have a blood pressure of 200 over 100, about 80% of the time. I’d be like, well, did you sleep last night? And they’re like, oh, well, no, my mom was in the. Or I was up all night writing a paper.

And so that was just enough to really just Jack up their nervous, their sympathetic nervous system, and slow down the parasympathetic, which is that the arm of the nervous system that helps promote the motility through the gut, activating the secretions, activating the digestive repair. Right. So that’s the main way that it happens.

Yeah. And so that, that sleep is one of those under missed pieces when someone’s coming in with, with advanced GI disease. Um, particularly those people who already come on probiotics, I’ve already tried, you know, HCL, I’ve already done a low FAP diet. I did that. Buring stuff from the integrative doctor and I’m still just struggling.

Sleep is one of the first places I I’ll I’ll really think is this person sleeping adequately to help their gut heal. Mm, they’re the causes of sea will go on and on though. Yeah. So, uh, do you want to keep going, or do you want to dive more into sleep 

Rachel Scheer: or? Yeah, just some of like the big, big root causes, ultimately, like you’ve mentioned diet you’ve mentioned sleep.

Um, I definitely. Understand how, when we get into more of that fight or fight state, how our digestive system shuts down motility can come to a little bit of a halt or at least slow down in the body. Um, but I, I love that you mentioned even too like our, our bio flow and our stomach acid are also very negatively affected because a lot of us will just focus on, you know, I’m gonna take a bunch of.

Probiotics and supplements. And we don’t really think about sleep very often 

Dr. Joe Mather: is mu I, I probiotics are among my favorite things in the world, but, um, there is a case where a probiotic itself may be a bandaid if you’re missing a sleep issue, right? Mm you’re. Meeting a chronic stress or an emotional health problem.

Then this, the probiotics will absolutely help. And I’d love to talk about those in more. Uh, in a bit, but yeah, we just wanna make sure we’re getting to the deepest level cause possible. Yeah. 

Rachel Scheer: So we got diet sleep, 

Dr. Joe Mather: we got diet, crappy diet. We got crappy sleep. Yeah. Um, we can see medications. So things like proton pump inhibitors, we know increase the risk to a smallish degree of CIBO, but we absolutely hear see this, that, that interesting thing about the PBIS that if, if you open up the package, insert these things are FDA approved for very short term, use eight weeks.

Wow in gastritis or in peple ulcer disease sometimes a little bit longer, but, but eight to 12 weeks. Right. And how long are people put on PBIS year? 

Rachel Scheer: I mean, years I’ve had plenty of clients. Who’ve been on it for most of their life. 

Dr. Joe Mather: Yeah. Most of their life. And so that’s, that’s a really, really negative risk factor that we see, um, become a problem for, for patients with CI.

Rachel Scheer: Okay. So medications, diet, lifestyle, specifically lock and sleep. Those are some of the biggest ones. And, 

Dr. Joe Mather: and I, I will put, I will put diminishing stomach acid, um, as, as a cause as we age our body’s ability to make stomach acid. Decreases naturally. It’s just one of the things that happened. You know, when you’re 18 years old, you could probably eat pizza and French fries upside down, you know, four days a week and have no heartburn, right?

We’re just like unbeatable. You ask a 60 year old to do that. They’re gonna get heartburn most likely, right? Our bodies are different. As we age, as we age our acid production naturally declines. And there are a few risk factors, particularly autoimmune thyroid disease. That makes the chance of you having, um, poor stomach acid a bit higher, right?

So that’s one of the things that we’ll often screen for. If someone is having reoccurring GI issues, that just doesn’t seem right then we’ll, we’ll look into, does this patient benefit from a trial of, of stomach acid, which can be done very easily and safely. 

Rachel Scheer: And if you notice you guys, he mentioned acid reflux, but specifically pertaining to low stomach acid, um, instead of producing too much stomach acid.

And I think that’s very often missed as well as people experience a lot of this reflux like symptoms and immediately, this is when they, they get put on something like a proton pump inhibitor, or maybe. End up loading up in a bunch of Toms or antiacid, but very often it is a low stomach acid issue instead of a high stomach acid issue.

Be low. 

Dr. Joe Mather: It can be high, right? It’s a, Goldilock not too little, not too much. You gotta find the right amount for the right patient for some patient. It’s absolutely low stomach acid. There are hyper secrets. There are patients out there for whom PPIs are extremely appropriate because their body. Makes too much HCL, which damages the, the mucosa of the intestines can cause, uh, damage to the esophagus.

Those patients feel better on a PPI. And so there are some cases where we even have where as natural medicine is, you’ll get in our practice. Right. We have a few patients on PPIs because medically that’s what their body needs and, and the key is. Having a practice where, where you’re able to really listen and focus in to individualize this for the patient, rather than saying it’s all low stomach acid or it’s all, we just gotta slam it with PPIs.

There’s a, a middle ground that, that I I’d like to see the field be better at 

Rachel Scheer: achieving. Yeah. Okay, so low stomach acid or high stomach acid. Would you say some of those kind of manifest in very similar symptoms though, with people getting some of that or what feels to be kind of like that reflux like symptoms, but where, where they could very often be actually low on stomach acid.

Dr. Joe Mather: Yeah. And, and some of this it’s it’s because I’m not doing, uh, pH assessments in my patients. So it’s, it’s a little bit of guesswork and it’s a, it’s a lot of observation, but I would say generally the answer is. Okay. Okay. 

Rachel Scheer: And so let’s say someone does get the diagnosis of SIBO. Um, what are some of the treatments that you guys utilize at the DRIO clinic for treating SIBO?

Um, I would imagine it starts with addressing some of those root causes first and foremost, but because we can throw. Ton of different things, not CIBO, but if you’re still not getting good sleep, if your diet’s still crappy, you know, mm-hmm and if we’re still on medications, sometimes that are maybe also playing a big role in our overall gut microbiome.

If we’re stressed out all the time, we can do a lot of different things to treat Sebo. Right. But yeah. The rate of relapse is incredibly high from what I understand with SIBO. And I think a big part of it, at least from a lot of the research out there that talks about that comes down to, um, people not really addressing the root cause, but just getting on a bunch of antibiotics.

So is the Foxen I’m with you? Yep. Yeah. Is Fox in neomycin so they take a lot of these antibiotics and that’s really. Sole therapy for treating the CIBO. Um, I think where you guys are different, you do address the root causes. So I would imagine your guys’ rate of relapse is much slower than like what a lot of the standard is out there.

It is. But once you’ve been able to address some of those root causes, what kind of treatment therapies do you guys utilize for treating CBO? 

Dr. Joe Mather: So, this is, this is where I have to probiotics. Um, we love probiotics and this is such a reasonably cost effective treatment that I’m still amazed that there are so many, uh, conventional GI doctors, uh, functional medicine doctors who are not quite on board with how effective they are.

So probiotics we know from a really well done, randomized controlled trial was more effective than an antibiotic. We just head to head. We know that they work in the setting of CIBO. We see better, um, head to have with the antibiotic. We see better response rate in terms of symptoms. We see lower breath tests.

Right. And so for a very simple, easy, healthy treatment, I think that that’s where we start. We also know that it is not just one cherry picked study. We, we can take groups of studies together and talk about meta-analysis right. So we know that 18 of those trials. For probiotics and SIBO showed significant rates of reduction of symptoms, lowered breath tests.

Right. And so these are extremely effective treatments for SIBO. And so we use a lot of probiotics in our practice. Oh, 

Rachel Scheer: interesting. And how do you know what to look for when picking a probiotic? Because I feel. Some probiotics out there are not super helpful. I felt like for me, when I was dealing with CIBO getting on, you know, the aligned probiotic that you get at the pharmacy, it’s just not enough, right.

Yeah. Can really do me a whole lot of good. So what do you guys really recommend and look for when picking a probiotic? 

Dr. Joe Mather: So, so a little bit of background here, not all probiotics are created the same, but generally what, what you’re looking for are a large diversity of species. So there are some schools of thought out there that we can micromanage by pick and choose to strain and to get a clinical effect that doesn’t work.

What we recommend is using broadest amount of probiotics possible at the highest dose tolerated. And so for us, that usually looks like using three of the main classes of probiotics. We found that just clinically, when we started to use one strain of probiotics or one grouping of probiotics, we got pretty good results.

When we used two, we had even better results. And then we used three even better still. So we like to think of it as a lactobacillus blend as being the first main class. And that’s about 90% of the supplements you’ll get. If you spin the bottle around at whole foods or wherever you’re buying your supplements, the second group would be a yeast, a healthy yeast called sacro.

And the third is, are the soil based species. So we use all three at once and we get great results. And so that’s our preference. We, um, in terms of what to get, um, if you would go to, uh, our, our store, right? We have a Dr. Russo store. Uh, you can see each of those products up, so you could see the type of, of species that we like to use in the clinic.

And, uh, so three in one, uh, triple probiotic therapy. It’s what we use a lot. We’re, we’re excited to be publishing some research on the effectiveness of triple probiotic therapy, uh, in Sebo itself. So we have some really good, uh, preliminary data that we’re working on and, uh, hope to publish in the next six months.

So we see it work clinically. Yeah. We think that there’s a huge base of medical evidence for it. It’s inexpensive, it’s safe and probs work for a number of reasons. So we, we love it and we start 

Rachel Scheer: there. Yeah, I, I think that’s really fascinating that you mention probiotics, cuz I know there’s so many different opinions out there about probiotics.

Um, I know I’ve spoke with another functional medicine physician who said, you know, sometimes if you’re dealing with Sebo, adding in probiotics can be adding more fuel to the fire for some people. How 

Dr. Joe Mather: strongly push back against that thinking there’s kind of this easy, this. Train of logic that if the problem is too much bacteria in the small intestines, you can’t give probiotics to the small intestine.

I think that’s based on a misunderstanding of how probiotics work, whereas probiotics are working to my understanding, not just a colonize, the gut that maybe a smaller part, most probiotics lack the adhesion molecules to actually stick and remain on the gut for more than a short period of time. But they do act as antimicrobial.

They do act in a way that changes the function of the immune system. And that might be the most important way that a probiotic achieves an effect. And so we, we think that, you know, when there’s an opinion out there, like we shouldn’t use probiotics, there’s usually a reason if someone has a poor response to a probiotic and you just have to solve that rather than blame the probiotic.

And when you have 18, you know, 18 studies in a meta analysis, showing that they improve symptoms in placebo. I think that should be the first thing we pay a to the first step. Right. Um, and, uh, does any of that interest you in terms of a deeper dive or, uh, we leave it there. 

Rachel Scheer: Yeah, no, I, I think that is awesome.

And especially people looking for a probiotic, N one, I think everybody should be on a probiotic. There’s really four big supplements. I talk about. Everybody should be on probiotic, a omega-3 fish, soil, vitamin D, and then, you know, a good quality multivitamin and a lot of the rest can definitely be tailored to each person individually.

So I know it’s great for my listeners to hear about what to really look for specifically. Um, would you say that type of a probiotics? So let’s say one that is. In lots of strains of lactobacillus, and maybe we have some SA Ilardi in there then might maybe a soil based type, uh, probiotic intertwined.

That’s the one that you’re talking about. Would that be something that would be beneficial for, you know, just overall general health or would that be mainly used just for the treatment of CIBO in particular used 


Dr. Joe Mather: be in that camp and I’ve softened a bit. I think it depends on the person. So if you have someone who has a 30 year history of IB, Yes, right.

So the, the idea here is we treat them to their symptoms are better. And then we work to find the minimum dose of supplementation that keeps their, their, their symptoms at bay. So it may look like for the first four months, while we’re getting the symptoms controlled, they’re on a decent amount of supplementation.

Cause we have three days of probiotics. Maybe we’re using gut healing, nutrients like glutamine or Allo where it ES. Maybe we’re doing herbal antimicrobials, right? There’s a lot of tools here that we, we have at our disposal. But the idea here is that as the symptoms go down, you should be diminishing your supplements.

You should not be on a path to take. I have to take more X number of supplements for the rest of my life, because that makes people sick. If they are having the feeling that I always have to be on something. That makes them sick. And we, this is a growing problem that we see in our clinic. Um, yeah, just, just chronic over supplementation, uh, needs to, to be kind of pushed back against a little bit for someone with GI issues.

A daily probiotic is, is a very excellent, uh, recommendation, um, for people, for maintenance, absolutely. For someone who has no GI health problems, they’re sleeping well, they’re exercising, they’re eating well. They have no GI issue. I don’t think it’s needed. Okay. Um, so it, it, it just, just depends on what your outcome is, right?

Yeah. If we know that probiotics improve anxiety and brain fog and blood sugar and cholesterol, But it, it, so for example, we know it’s just a couple points on, on the, the LDL from a probiotic. It may be that that’s not the best use of your time. And energy is, is to, to shave off a couple points on the LDL with a probiotic.

Maybe you wanna look back at optimizing your exercise schedule or your sleep routine or your diet. Okay. So if you got those nailed in, then it’s, then it’s an option. But I think the field needs to get away a little bit from just the, you need supplements to be. Okay. 

Rachel Scheer: So maybe not needing a probiotic with every specific scenario, but, um, we can get a lot of probiotics through food as well, too.

Definitely. Mm-hmm and I think that should be our, our first choice. And anytime we get on any kind of a supplement, we wanna par it. Food pair it with a kind of supplement, um, because we can’t expect the supplement to really do all of the work. It’s kind of like taking they’re called 

Dr. Joe Mather: supple supplemental, right.

For a reason. 

Rachel Scheer: Yeah. Supplementing the diet there. But I, I find that very helpful with what you mentioned. About about probiotics in general, just because I think there’s a lot of different mix information out there about when it comes to who needs a probiotic. And should I be on one? Is it necessary? And I think a lot of my listeners tend to have gut issues.

So it’s probably good for you to get on some 

Dr. Joe Mather: kind of a good idea. To be on a broad 

Rachel Scheer: spectrum blend. Yeah. Yeah. To get on a good broad spectrum probiotic. But I also think it’s good to really differentiate, um, between gut healing and overall gut health as well too. And I think a lot of the people who need like more of these supplements, like you’ve mentioned, whether it’s gonna be antimicrobial protocols or they’re getting on a, you know, a few different probiotics, um, There’s someone who’s more in a gut healing type phase mm-hmm

And sometimes we tend to mesh gut health with overall gut healing. Um, and gut healing can sometimes be a lot more restrictive. There can be a lot more supplements because what we’re trying to do is we’re trying to get the body back to a place of more maintenance and overall health versus gut health.

In my opinion. More like a maintenance lifestyle. It’s like the person who’s just in a good regimen. They’re sleeping good. Like you said, they’re eating healthy most of the time, they have a good amount of fiber in their diet. Um, a little bit of a, a good range there with the type of foods that they’re picking from, and that.

Person may really fall into the category of, Hey, I just wanna work on my gut health a little bit there. Um, but I don’t really need to do like this massive gut healing protocol ultimately. So I think it’s really good for anyone who’s listening is kind of thinking of which one you may really fall into.

Um, gut healing is gonna be a lot more in depth and with the diet and the supplements versus gut. We definitely wanna minimize a lot of those different things and not have to be on a laundry list of supplements all the time. Ultimately, there let’s talk a little bit about diet if you don’t mind, because I heard you mentioned two diets so far, um, the elemental diet and the low FOD map diet.

And we’ve talked a little bit about how probiotics are really, really essential addressing the root cause with lifestyle. Um, but. Types of diets. Do you find most effective for treating people with IBS or even CIBO? 

Dr. Joe Mather: So I’d love to talk about the elemental diet and the Loma diet a little more, but I’d love to be able to just take one step back first in just the same principle that I talked about with the supplements that you use, or maybe more supplements at the beginning, and then Peter out that same principle really needs to happen with diet.

so I, I don’t want people to have the idea that they, that, because I talk about the low FODMAP diet that they should be on a low FODMAP diet forever. Mm-hmm , it’s a restrictive diet. And it’s not healthy to restrict your diet. All things considered. Some people need to some people’s GIS, their motility structural issues that they have mean that they just can’t tolerate fiber.

They can’t tolerate higher fiber diet. So they are gonna need to restrict to reduce symptoms at a baseline. But for the average person who, who may be struggling with CIBO or IBS, we like to use these diets in the short term, say four to six months. Then as we’re healing, the gut, their food tolerance should increase.

Naturally. We see it all the time, right? So although they may need a diet like a low FODMAP diet, initially the goal is to get them to a more relaxed version, a more expanded diet later, because the problem we’re seeing is we, we tend to see patients who, who have struggled even after seeing other practitioners.

And so we’re seeing increasing numbers of patients coming in on six foods. Right. Extremely limited. They’re fearful of food. They’re worried about food. They’re worried about oxalates and solicitate, they’re worried about the, the grams of FODMAPs and they, they are sick because of that worry, at least in part they’re sick from a GI perspective structurally, but then that limitation causes its own set of problems.

So we need to get better as a field of right diet for the right time and continually work to. Does that make sense? And does that resonate with what 

Rachel Scheer: you said? Oh, no. 100%. Um, I’ve had so many clients who come to work with us and they’ve been on a low FODMAP diet for years and I’m, I’m a big fan of low FODMAP diet.

I put a lot of people on a low FODMAP diet when we’re in that gut healing phase side of everything, um, where we need to restrict for a short period of time in order to restore balance and do some healing where a body may not tolerate a good amount of those carbohydrates because we have bacteria over.

And those are gonna be food sources for the bacteria. Exactly. Right. But I always say it’s a disservice to put someone on a low FOD, not diet and then just leave them there and be like, oh, oh my gosh, I fixed all of your gut issues. You’re good to go. and then sooner they, we can do better. Yeah. Then they learn over time, like, oh my gosh, I can eat less and less and less and less.

Um, so really it should be something that is short term. I want a hundred percent degree with you. And then we need to address the root causes and maybe get on some kind of a therapies for some people who are dealing with things like CIBO, um, Especially, depending on how severe it is, but ultimately it shouldn’t be something that we stay on forever at all.


Dr. Joe Mather: a general rule, the more restricted the diet gets, the more likely there is another problem that’s being missed. And there are lots of other things that can be missed. But, um, I, I hope listeners take that as, as you need to do more digging with someone who knows what they’re doing, uh, if you’re finding yourself more and more restric, Yeah, because that’s a sign that something’s being missed.

Um, and it’s not always in the gut. There are lots of things that can make people sick. Um, mm-hmm but maybe we can spend a little bit of time talking about the elemental diet because I get the sense that your, your listeners, uh, are probably FOD mapped out. Uh, and they probably, uh, know plenty about it.

The elemental diet is, is a really underused tool in GI health. And there was a classic study, uh, that showed that two weeks of elemental diet, basically eradicated. Breath tests or eradicated Sebo reduce symptoms. And so an elemental diet is just, I think like a PO protein shake, right? It’s all the, the carbs proteins, fat vitamins, nutrients you need.

Uh, in a powder form. So you mix it, blend out vice and you sip on it throughout the day. So you replace solid food with liquid diet. Elemental diets used to be awful they used it taste so bad that no one would use them. And so there’s a whole generation of, of gastroenterologists who just don’t use it because they tried it once in residency.

And it was just the most disgusting foal tasting formula they ever had. Mm-hmm um, but one of the things is now is that we found that, that the newer semi elemental diets work just as. And they’re really effective, right? So for stubborn cases, we use this in a clinic a lot. And the beauty here is that you don’t, we, I was talking with Michael Russo the other day and we can’t remember the last time we, we needed a 14 day course of elemental diet.

We, we instead do little bursts, right? A two day semi elemental diet, just where you’re having a liquid diet for two days is usually enough to just really reduce symptoms and allow some gut healing to happen. Really. Okay. And so we use that as a tool. We lean on that quite a bit, uh, in our patients. It’s not a panacea.

It’s not, it’s not perfect for everybody. Um, mm-hmm but there are, uh, enough cases where that really. Helps put people over the edge in terms of symptom reduction. So that the other things like the probiotic and the rest of their diet, maybe the herbal antimicrobials can do their job. So we love elemental diets and find it really helpful clinically.

Rachel Scheer: Yeah. Um, we’ve used elemental diets. Couple times we don’t use it quite a bit. I think there’s a lot of fear for people revolving around those, especially because most of the therapies, like you’ve mentioned have been, you know, two week periods of I’m getting on, you know, full liquid diet. And I don’t that’s, that’s hard to do.

That’s really hard. Yeah, it can, it can feel very 

Dr. Joe Mather: sick and motivated if you wanna slot do two weeks at elemental. 

Rachel Scheer: Yeah, but what you’re saying is you actually see a lot of symptomatic relief with just two days of going on an elemental diet. 

Dr. Joe Mather: Absolutely. Okay. All right. All the time. In many ways it mimics it fast.

So those same patients where they could just stop eating for two days would get a similar reduction, usually in bloating or stool or regularity, abdominal pain, the elemental diet lets nutrition come into the system while mimicking that fast because there’s no solid food. Right? Yeah. And so it it’s, it’s quite effecti.

Rachel Scheer: And I talk a lot about fasting too, and how that can be beneficial for the gut. But I think it does depends still on the person too. Like definitely not, 

Dr. Joe Mather: not can they crash at 20 hours. And so you would like to push ’em more for their gut health, but they’re, they’re gonna. , you know, be cranky and irritable and like head and fall, and it’s not, it’s not worth pushing it.

And so yeah, elemental diet is a nice way to get the gut healing benefits of a fast while still getting nutrition in to prevent that hypoglycemia. Yeah, it it’s a, I mean, fasting is phenomenal. It’s yeah. It’s one of the more powerful ways we can change immune immune activity in the body. And, uh, really you can decontaminate the gut pretty quickly.

It’s uh, the, the gut sometimes is just like anything else, right? If you sprain an. The the therapy wouldn’t be okay. You’re gonna, you’re gonna be doing wind sprints three times a day. Really working that ankle. Mm-hmm the gut is the same way. If you have dysbiosis, if you have SIBO, if you have some functional GI issues, you gotta let it.

Right. Yeah. And so maybe the, the frequent meals that people like to do all throughout the day, right? Yeah. Um, that’s not gonna be particularly helpful. And the elemental diet really gives us away to, to widen how much time that person can go without eating, without crashing it, feeling terrible. 

Rachel Scheer: Yeah. Yeah.

I’m not a big fan of the small frequent meals throughout the day. And I get so much pushback from the, the fitness and the body building world, because I’ll always get a bodybuilder who jumps in there and is like, I ha how am I supposed to get in 4,000 calories, my calories one day? 

Dr. Joe Mather: And I’m like, well, I, this is why so many body builders get sea period.

Rachel Scheer: The end. Truth truth. Right. Um, and that actually was probably part of the reason as to why I developed CIBO when I was into competing and body building, combine that with, um, not so gut healthy foods, um, that I was eating. I I’ll call them. It’s hard. Those, those guys are pretty intense. Yeah. I mean, a lot of, even the, the fitness industry foods, they’re not gut friendly.

Um, they may be macro friendly, but they’re terrible, terrible for your gut gums and fillers. And I even know there’s a. Studies specifically with CIBO where they utilize things like gums, the Anthem gum, GU gum, um, intentionally right. To try to get a lot of the bacteria to be live and flourishing. And this is found in so many different products, which can be major, major gut triggers for a lot of people.

Um, but I love that you mentioned, um, fasting and even doing maybe an elemental diet, because I know for. When I got all of my gut issues, fasting probably wouldn’t have been the best thing for me because I was really, really lean and I didn’t have a whole lot of fat reserves. And my nervous system was already quite dysregulated along with my blood sugar.

So for me, probably doing a 24 up to even a 36 or 48 hour fast, wouldn’t be very feasible. Um, where sometimes. Some of my clients who maybe are more insulin resistant, they do very well with getting ’em a bit more fat adopted and then moving ’em into doing a little bit more of a, an extended fast, and they get kind of double benefits with lowering their blood sugar, but also too, they get the benefit of giving their gut rest and increasing a lot of that migrating motor complex in their gut to really help clean it out.

Ultimately nailed. Yeah, but I like that you mentioned the elemental diet specifically for people who maybe can’t do a more extended fast, whether that’s for metabolic reasons, just like their overall health. I, I definitely wanna be cognizant of your time here today. This has been super helpful. And I know a lot of my listeners who are super into gut health will get so much from this.

But one last question that I have here is what would you say in your opinion is the three biggest gut killers. That we see. And then what is the best thing that someone can do to start healing 

Dr. Joe Mather: their gut? I would say processed food is probably number one by a big chunk. I, I think that that’s just so detrimental for so many ways that I, I think that that has to be just the, the number one, absolute destroyer, I would say number two, um, or.

And number three, excess stress. So again, lifestyle in our, in our world is paramount and so important not to miss it. It’s just so heartbreaking to see someone come into our clinic and they’ve spent tens of thousands of dollars on lab testing that spent thousands of dollars on lab fees. Uh, I’m sorry. On physician fees.

They’ve spent years of their life trying to get better with a doctor or a, a nutritionist or some kind of therapist, and it’s not better. Right. And so many times we see them and they’re better quickly because we’re focusing on the deepest root cause that that’s how we see that those things are just so critical not to miss and.

If you have problems there and, and you’re, you’re doing the right things with probiotics and herbs, you may be wasting your time, right? So you get the foundation built steady first. Then you start applying that the evidence based scientifically proven safe remedies, like probiotics, elemental diet, we didn’t touch on herbal antimicrobials, but they absolutely have a place.

Yep. Right. Fasting and, and you can get the vast majority of your patients better without too much fuss at all. So I, I would start the list with, with the lifestyle and kind of ended up lifestyle and, uh, go from there. 

Rachel Scheer: All right. So lifestyle. So if you’re someone who’s been working on your gut health, you’ve been doing all the things with your diet.

Maybe you’ve done a low FODMAP diet, or you’ve gotten rid of a lot of the processed foods from your diet. You’re paying attention to all of the ingredients and everything that you’re you’re buying. Yeah. But you’re still dealing with a lot of these gut issues. This is. Hey, maybe we’re missing something like, are you getting enough sleep every single night?

Um, what does your stress look like? Ultimately, because all of those things can also really negatively impact the gut. And those are some of the, I think, easiest things to see, but sometimes the hardest things to really, really make a change with, because it can sometimes be easier to just say, I’m gonna take a bunch of supplements.

Them do all this testing and it’s super black and white, but it is harder to actually have to sit back and be like, all right, I’m going to have to really make a lot of lifestyle changes because my, my work, my toxic relationships, all of these things are really, really playing a massive role in my overall health.

And even sometimes manifesting in overall gut issues. So lifestyle, lifestyle, I will 

Dr. Joe Mather: say, I will say one note is. Is that sometimes little, little tweaks around the board, add up to something bigger than those individual tweaks. And so it’s not that we have to be perfect on diet. Perfect on slate. Perfect on stress, cuz that will never happen ever.

right. Not for me, not for you, not for our clients. Right. But, um, focusing their first gives those other therapies a better chance to work. And so it’s really about meeting the patient where they are and uh, doing the best job we can as healers to get them better as quickly and as cost effectively as possible.

Right. Yeah, I 

Rachel Scheer: agree. I agree. Well, thank you so much for coming on the show here today, Dr. Joe, welcome. This has been awesome. And I know so many people will get a lot from today. Where can people learn more about what you guys are doing in functional medicine and overall gut health? 

Dr. Joe Mather: Absolutely the best place is to come on over to our clinic website.

So I’m the medical director of their gr show Institute for functional medicine. And the website is gr show, institute.com and they can find all sorts of good stuff there. And, uh, if you search Dr. Russo online, you’ll get a multitude of social media and blogs. And the podcast is fantastic. We have a clinician training program.

Uh, there’s just more gut geek stuff than you could ever hope to. Uh mm-hmm find, 

Rachel Scheer: yeah, they have a ton of awesome content out there. Their blog is amazing. So definitely go check out their website. You guys, their Instagram is at Dr. Rio. If you guys want to check out some of their social media content, um, we’re pretty big on Instagram.

Um, but you guys can definitely follow along with some of the. Studies and things that they’re implementing with their practice. So thank you again, Dr. Joe, it’s been a pleasure having all myself. Pleasure. Thank 

Dr. Joe Mather: you, Rachel. All 

Rachel Scheer: right. And you guys know the drill. If you enjoyed today’s episode, uh, please do me a favor and share it in your stories on your social media.

Tag at Rachel shear and at Dr. Russo, we will definitely share it with our followers and share this with a friend, especially if you know, someone who’s maybe struggling with gut issues and they need to take more of a functional medicine approach. That would be incredibly helpful. And this is Ben share madness.

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