Podcasts about Rifaximin

What dosage of Nicotinamide Riboside is optimal in increasing mitochondrial biogenesis?I've been treated for SIBO in the past but haven't yet tried rifaximin. Do you recommend it?Is the choline in eggs causing thousands of people to suddenly form blood clots?Is the EBCT still the most accurate, least-radiation-exposure test for coronary calcification?How many milligrams of SAMe do you recommend for depression? 

Could a common antibiotic for liver disease be creating a superbug nightmare? New research has found that rifaximin is driving the rise of a super-resistant strain of vancomycin-resistant Enterococcus faecium (VRE), now untreatable with even the strongest antibiotics. This spells danger, especially for vulnerable hospital patients.With the UN sounding the alarm on antibiotic resistance, these findings are a major wake-up call! Are we fueling the next big health crisis?Watch to learn what this means for the future of antibiotic prescriptions!Supplements Featured In This Episode:• Acceleradine® Iodine https://www.acceleratedhealthproducts.com/products/acceleradine-iodine-supplement • Accelerated Liver Care™ https://www.acceleratedhealthproducts.com/products/accelerated-liver-care • Accelerated Leaky Gut Bundle https://www.acceleratedhealthproducts.com/products/accelerated-leaky-gut-bundle

Did you know that 75% of people will use complementary and alternative medicine at some point in their lives?  At our clinic, we're constantly researching the best new functional medicine approaches for our patients, because, like many, they  were not helped by conventional medicine and prefer non-drug, or natural treatments. In today's episode, I'll discuss how we've updated our approach to functional medicine to provide the most effective healing for gut issues, thyroid problems, and more. Learn about the latest in functional medicine practices. Watch now! 

Has your prescription for your IBS fixed the problem? Did you know it may have actually worsened the problem? On this episode of Vitality Radio Jared breaks down the prescription drug Xifaxin which is commonly prescribed for IBS symptoms. You'll learn how it functions in the body and why you may feel better in the short term and worse in the long run. Jared shares the natural supplements that address the root cause of your IBS symptoms and can actually heal the gut, for good. Pharmaceutical companies often develop drugs that target specific symptoms by interfering with the body's natural processes. These medications can be effective in providing temporary relief from symptoms, but they don't usually address the underlying causes of a condition. This is called suppressive medicine, and such treatments may offer short-term benefits at the cost of long-term health. In this series of episodes on suppressive medicine, Jared aims to help you understand the ways in which these drugs work and what natural alternatives there are that work WITH your body's natural systems to address the root cause and rebalance the body. Products:10 Day Results Back on TractL-GlutamineION Gut HealthPrecision Probiotic Vital SporesApple Cider VinegarVital 5 Assimil-8 Digestive EnzymesTUDCAOx BileAdditional Information:#449: Suppressive Medicine: How Big Pharma and FDA Get It Wrong With Statins#341: Your Digestive Health Supplement User's Guide. From IBS to Acid Reflux - Learn How to Balance Your Gut Health With Natural Products.#404: Uncover The Cause of Your Gas and Bloating and Get Rid of It for Good#427: How the Intelligence of Nature Can Help Restore your Gut Health with Kim Stevens#432: Your Parasite Cleansing User's GuideVisit the podcast website here: VitalityRadio.comYou can follow @vitalityradio and @vitalitynutritionbountiful on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Please also join us on the Dearly Discarded Podcast with Jared St. Clair.Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.

Yes, there are important differences between prebiotics and probiotics - and knowing them will help you heal your gut and overall health. In this episode, I cover the differences between the two, and great sources of prebiotics and probiotics in food and supplements. Watch now!  

Treating small intestinal bacterial overgrowth (SIBO) can be an unnecessarily complicated process. Today, I want to pinpoint the most common mistakes in SIBO treatments, and guide you towards the best solutions for healing your gut health. 

In this episode, I'm with Dr. William Davis and we're going to uncover the secret to a super gut with his amazing L reuterii yogurt recipe! By following this yogurt recipe, you'll be able to improve your gut health and restore your digestive balance. Dr. William Davis is a leading authority on L reuterii yogurt and its many health benefits, and his yogurt recipe is the perfect way to get started! Bio: Dr. William Davis is a cardiologist and New York Times #1 bestselling author of the Wheat Belly Undoctored and Supergut. Key Topics Discussed: Introduction of Dr. William Davis and his background - Dr. Davis' experience with his mother's sudden cardiac death after a successful two-vessel coronary angioplasty - Dr. Davis' realization of the flaws in the healthcare system and the limitations of managing diseases through procedures - Dr. Davis' search for a better way to identify potential heart disease - Dr. Davis' findings on the impact of modern wheat, grains, and sugar on our health - The effects of wheat and its gliding protein on the human brain and appetite - The impact of phytates in wheat on mineral deficiencies - The promiscuity of grains and their shared genetic characteristics - The negative health implications of consuming grains with prolamine proteins - The problems associated with rice, including high levels of arsenic - The impact of ancient humans turning to grasses as food and the associated increase in tooth decay, nutrient deficiencies, and autoimmune diseases. - Over time, dietary inclusion of grass seeds has resulted in a trade-off of calories for health - Fermentation can reduce some negative impacts of grain amino acids and phytates, but physiological effects remain - Sugar is a very destructive food and is a flagrant cause of coronary disease, heart attack, type 2 diabetes, and changes in bowel flora - Cholesterol is not heart disease, it's a crude indirect marker that has hardly any predictive value at all, and there are real causes that can be controlled - Doctors tend to focus on conventional ideas of cholesterol and statins, and how to drive revenue for their system, rather than real causes of cardiovascular risk - Vitamin D deficiency, insulin resistance, dysbiosis, and sibo are some of the real causes of heart disease that can be controlled easily, inexpensively, and effectively, without the use of drugs - Reduction of cholesterol can have deleterious effects on the body, including reduction of essential hormones like testosterone - Identifying the factors that allow disease to emerge in the first place is more important than treating health conditions - Reduction of saturated fat is not necessary, and the recommendation to do so is nonsense. - Dr. William's critique of dietary guidelines - Misconceptions about saturated fat and processed foods - Importance of consuming collagen, hyaluronic acid, and iodine - Dr. William's personal health journey and realization of the limitations of traditional medicine - The benefits of lactobacillus reuteri in restoring youthfulness and empathy - Discussion of the importance of certain microbial species for health, specifically boosting oxytocin and helping with autism symptoms - Making yogurt at home using specific microbial strains Importance of choosing the right strain of microbes for specific effects - Super Gut concept: replacing lost microbes and addressing overgrowth of unhealthy species - Using the AIR device to map out where microbes are in the GI tract - SIBO (Small Intestinal Bacterial Overgrowth) and its associated conditions -Issues with using antibiotics to treat SIBO - Herbal antibiotics and their efficacy in treating SIBO - Using specific microbial species, such as lactobacillus gasseri and reuterii, to treat SIBO by producing bactericins  - Informal success rates of using this yogurt to treat SIBO - Importance of Rifaximin in treating SIBO - Complicating factor of hydrogen gas produced by Rifaximin in the upper GI tract and need to stop yogurt consumption before retesting -  Success rate of 90% of people converting to negative SIBO - Recipes for lactobacillus yogurt, saccharomyces boulardii sparkling juice and other fermented foods in Super Gut book - Importance of fermented foods over commercial probiotics for a healthy microbiome - Tips for fostering a healthy gut microbiome, including filtering water, organic foods without herbicides/pesticides/GMOs, eliminating wheat and grains, and consuming prebiotic fibers and polyphenols Brought to you by: Nourishme Organics your online shop for all things Gut Health 10% off using code : happygut https://www.nourishmeorganics.com.au/ Parasite Quiz: https://www.nourishmeorganics.com.au/pages/a-night-of-bites-and-howls-a-full-moon-parasite-quiz Connect with Dr William Davis https://drdavisinfinitehealth.com/   Connect with Kriben Govender Facebook- https://www.facebook.com/guthealthgurus Instagram- https://www.instagram.com/guthealthgurus Youtube- https://www.youtube.com/c/guthealthgurus?sub_confirmation=1 Telegram: https://t.me/guthealthgurus  Gut Health Gurus Facebook Group: https://www.facebook.com/groups/nourishmeorganics/ Deuterium Depletion Support Group: https://www.facebook.com/groups/mitowellness/ Download links               If you enjoyed this episode and would like to show your support:   1) Please subscribe on Apple Podcasts, give us 5 stars and leave a positive review     Instructions:   - Click this link  https://itunes.apple.com/au/podcast/gut-health-gurus-podcast/id1433882512?mt=2   - Click "View in Itunes" button on the left-hand side - This will open the Itunes app - Click the "Subscribe" button - Click on "Ratings and Reviews" tab - Click on "Write a Review" button   Non-Itunes users can leave a Google Review here: https://goo.gl/9aNP0V     2) Subscribe, like and leave a positive comment on Youtube   https://www.youtube.com/channel/UCq5KxLvGIY4r6SqNaAphEUw?sub_confirmation=1   3) Share your favourite episode on Facebook, Instagram, and Stories 4) Let your friends and family know about this Podcast by email, text, messenger etc   Thank you so much for your support. 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15–20% of the population suffers from IBS symptoms like bloating, diarrhea, constipation, and abdominal pain. While drug therapies such as Rifaximin and Plecanatide may be prescribed to provide symptom relief, is there a place for probiotics? New research shows how probiotics and drugs each play a role in improving IBS. Hear the latest findings and how to use them to make the best decisions for your health. https://www.drruscio.com/medications-probiotics-for-ibs-treatment  My book Healthy Gut, Healthy You is available at https://drruscio.com/getgutbook If you're in need of clinical support, please visit https://ruscioinstitute.com Looking for more? Check out https://drruscio.com/resources

Dr. Mark Pimentel is an elite Gastroenterology researcher who has become a pioneer for IBS and SIBO/IMO. He's the executive director of the Medically Associated Science and Technology (MAST) Program and leads a team of Gastroenterology researchers. A few of Dr. Pimentel's most significant accomplishments include the discovery of Rifaximin as a treatment for IBS and developing the first blood test for IBS, The IBS Smart Test. Learn the root causes of IBS and how to treat each sub-type along with plenty of other information that provides hope for IBS patients. Buy his book The Microbiome Connection here: The Microbiome Connection: Your Guide to IBS, SIBO, and Low-Fermentation Eating - Kindle edition by Pimentel, Mark A. . Health, Fitness & Dieting Kindle eBooks @ Amazon.com. Learn about his research here: Pimentel Research Lab | Cedars-Sinai --- Support this podcast: https://podcasters.spotify.com/pod/show/gutfarmacist/support

Another podcast episode dedicated to gut health updates is here, providing a unique opportunity to hear about new findings and if they can help you better your health. While the featured studies shine the spotlight on how gut health conditions like SIBO, IBS, IBD, and travelers' diarrhea respond to various treatments, they also show what we've known for a while: your gut bacteria speaks volumes about your mood, fatigue, and other non-digestive symptoms. Tune in to hear if Rifaximin, sodium butyrate, 5-HTP, vitamin D, the low FODMAP diet, and fecal microbiota transplantation at reducing symptoms for a wide range of health conditions. https://www.drruscio.com/exciting-gut-health-updates-buytrate-rifxamin My book Healthy Gut, Healthy You is available at https://drruscio.com/getgutbook If you're in need of clinical support, please visit https://ruscioinstitute.com Looking for more? Check out https://drruscio.com/resources

For optimal healing, a patient needs their symptoms, not their lab test results, to be treated. In this episode, I offer dietary and lifestyle solutions for people looking to improve their gut microbiome and overcome digestive and non-digestive symptoms caused by small intestinal bacterial overgrowth (SIBO) and gut dysbiosis.  Listen in to hear the answers to these specific questions:  What test do you recommend for gut dysbiosis, even if you've already been tested for SIBO and it was negative? I have SIBO-related symptoms. Can I do treatments without getting tested for SIBO?  What are your thoughts on using the Food Marble for monitoring the efficacy of SIBO treatment and food intolerances?  I have had chronic SIBO for 10 years which was not diagnosed until approximately 4 years ago. I feel like I have to stay on antimicrobials indefinitely. I react to most foods when I add them in, therefore my diet is extremely limited. Why am I so reactive to food?  I understand that Dr. Ruscio likes to try the triple probiotic therapy first with SIBO before trying antibiotics or antimicrobials. However, from what I learned you want to avoid lactobacillus species since they are hydrogen-producing and like to live in the small intestine. For that reason, should I just try S. boulardii, bifidobacterium, and soil based?  How long should I take herbal antimicrobials when treating SIBO? I have tested positive for SIBO, methane predominant, and I tried Rifaximin and neomycin. These improved my SIBO breath test but had major gas and belching, brain fog, and fatigue after treatment. I then tried antimicrobial herbs, and SIBO test results were much worse. However, since I've stopped herbals, my brain fog and fatigue are much better, but I'm having indigestion/belching with really smelly stools. What is going on?  I'm currently experiencing symptoms of dysbiosis and leaky gut, and I'm not entirely sure if herbal antimicrobials would help my dysbiosis or make it worse. Do antimicrobial herbs kill good bacteria as well? My goal is to rebalance my microbiome in favor of the beneficial bacteria. https://www.drruscio.com/listener-questions-healing-sibo-dysbiosis-food-reactions My book Healthy Gut, Healthy You is available at https://drruscio.com/getgutbook If you're in need of clinical support, please visit https://ruscioinstitute.com Looking for more? Check out https://drruscio.com/resources

If you're a woman in your 40s, 50s, or beyond, you know that hormone health is key. But did you know that gut health is essential for hormone balance?   In this episode of The Hormone Prescription Podcast, Lindsey Parsons, a Certified Health Coach specializing in helping clients locally and nationally heal gut health issues and reverse autoimmune disease naturally as well as lose weight without cutting calories and hosts the podcast "The Perfect Stool: Understanding and Healing the Gut Microbiome", joins us to discuss the gut-hormone connection.     Lindsey shares with us:     How the gut and hormones are interconnected     How to heal your gut for better hormone health     The link between gut health and autoimmune disease     Type of tests to diagnose gut issues     How to create a healthy gut environment     Why some people suffer from SIBO as a chronic long term illness     The latest treatments for GI problems like  fecal microbiota transplant, breathwork, and colostrum   And more!   If you're interested in learning more about the gut-hormone connection and how to heal your gut for better hormone health, tune in now!   [00:00:00] "I'd rather pay for healthy food now than healthcare later." Would you? So the big question is how do women over 40, like us keep weight off, have great energy balance. Our hormones in our moods feel sexy and confident and master midlife. If you're like most of us, you are not getting the answers you need and remain confused and pretty hopeless to ever feel like yourself again.   [00:00:23] As an OB GYN, I had. Discover for myself, the truth about what creates a rock, solid metabolism, lasting weight loss, and supercharged energy. After 40 in order to lose a hundred pounds and fix my fatigue. Now I'm on a mission. This podcast is designed to share the natural tools you need for impactful results.   [00:00:41] And to give you clarity on the answers to your midlife metabolism challenge. Join me for tangible natural strategies to crush the hormone imbalances you are facing and help you get unstuck from the sidelines of life. My name is Dr. Kyrin Dunston. Welcome to The Hormone Prescription Podcast. Hey everybody.   [00:01:00] And welcome back to another episode of The Hormone Prescription Podcast with Dr. Kyrin. Thank you so much for joining me. My guest today is Lindsey Parsons. She has an amazing podcast called The Perfect Stool, Understanding And Healing, The Gut Microbiome. When I discovered her recently, I saw her podcast and I saw all the amazing guests she had and just really the depth and breadth of her knowledge in gut health and healing.   [00:01:26] And I know how central this is to hormone health and overall health. I had to have her on the podcast. And I reached out and she kind of said, well, I don't really do that kind of thing. I said, no, please, you gotta come talk to my ladies. So I bring her here to you today and I hope you enjoy her as much as I do.   [00:01:45] In addition to hosting the podcast, the perfect stool. She's a certified health coach and she works in Tucson. She specializes in helping clients nationally heal gut health issues and reverse autoimmune disease, as well as lose weight without cutting calories who doesn't want that. She also has this wonderful quote about a calorie not being a calorie.   [00:02:06] And she tells a little bit of a story about that, but you don't want to miss. She talks about fecal transplants, which if you don't know about that, you're gonna wanna hear about that. She talks about colostrum use for healing gut issues. We talk about SIBO testing. What tests to do.    [00:02:28] We talk about everything.   [00:02:29] So you'll see this episode is a little all over the place because I was super excited to talk to her. I knew I only had her for max an hour, so I was trying to jump around and hit all the things that I really wanted to chat with her about. You like it, and I hope you take it as an invitation to listen to her podcast and go more in depth into a lot of these issues that are of interest to you.   [00:02:54] There are way more than we could even cover. And I think we talked for 35, 40 minutes, so she has even way more available. So without further ado, please welcome Lindsey Parsons.   [00:03:06] Thank you.   [00:03:08] So glad to have you here. I don't remember where I found your podcast, but I was super excited when I did the perfect stool, understanding and healing, the gut microbiome, and then all the amazing guests and topics that you've had and how in depth you go.   [00:03:27] I was like, I have to talk to you.    [00:03:31] and I have to have you on the podcast. So thank you so much. Yeah, well, I appreciate you for inviting me. So I think that a lot of people in the general public who are looking for answers to their health, tend to only look for physicians. I'm glad to see that that's changing because I think there are some amazing health coaches, for instance, like you out there who really go so much deeper into a lot of these issues and really are better experts than a lot of physicians on things like you are for gut health.   [00:04:06] So talk to us about how you became so passion. About gut health and really what led you down that.    [00:04:15] So it was really my own health struggles that led me into this path. So years ago, unbeknownst to me, my, an episode of food poisoning led to something called Post infectious IBS, which I only actually found out within the last year or so is an autoimmune diagnosis that I have because I didn't have a typical presentation of IBS, which you might think of as, you know, may having diarrhea six times a day or severe constipation.   [00:04:47] I didn't have either of those, but. I did have gut symptoms that, you know, including bloating and reflux and things like that, that went on for years. And when I did see traditional doctors didn't really get a lot of help other than suggesting I take proton pump inhibitors, which I did for something like 10 or 15 years.   [00:05:08] And now they super strict about not taking more than two weeks at a time. So, you know, the long term damage from that, you can only imagine. . And when I did eventually find my way to a functional medicine provider and was put on a course of herbal treatment for something called SIBO or small intestine, bacterial overgrowth, which is what happens when you have this post infectious IBS.   [00:05:29] What happens is you have an autoimmune situation where the Migrating motor complex or the process by which food is cleared through your intestines after eating is impacted negatively and is attacked by your own body. Therefore, you don't have that clearing of the intestines and clearing of the bacteria and the intestines.   [00:05:50] So you get these overgrowths and stagnation, and then you end up with bloating every time you eat, because it's coming, the food's coming in, and immediately the bacteria are going crazy and producing gases. So I had that going on for years and you know, you meet a lot of people that have a lot of bloating after they eat and they just sort of rack it up to, I ate too much or, you know, a whole number of things.   [00:06:12] So. I did finally see somebody and they cleared the placebo for me. Eventually it took herbals and then followed by Rifaximin, which is a prescription, very expensive prescription drug that, that takes care of it. And then over time started changing my diet, getting rid of gluten, getting rid of dairy.   [00:06:29] Really, you know, reducing sugar significantly. And all of those things contributed to me getting much better. And then I also had several autoimmune diagnoses that, you know, cuz when you have these kind of gut issues, you can have followed on autoimmune issues. And so I had Hashimoto thyroiditis, which really, you know, when I found out about that, that really kicked me into gear about trying to turn things around because the doctor had said to me, oh, you can just wait until your thyroid's gone.   [00:06:55] Then we'll put you on. You know, thyroid hormones. And I thought, oh, I'm just gonna sit around and wait until my entire thyroid's destroyed by this. No, that's not what I'm gonna do.    [00:07:05] right. But that's such a typical mainstream medical approach. Um, nothing to do. You have raging thyroid peroxidase antibodies, you have Hashimotos and they do nothing.   [00:07:16] And then they literally say, we're not gonna do anything, you know, until you're you burn out your thyroid, which is just kind of insane. So then what happened at that point? I think I, all of this is a bit perhaps out of order, but I did eventually get off gluten, get off dairy and for a while off of Soy.   [00:07:34] Yeah, mm-hmm and, and, and I just kept retesting my hormones as I, my, I mean, my antibodies, rather my thyroid antibodies as I retested those foods. So it took a couple years. I, you know, I stayed off gluten for a year before I think I even retested, but then I, you know, you try it again and you see what happens and, and each of those foods.   [00:07:52] So anyway, I ultimately decided gluten and dairy are the two things that I'm most sensitive to. And then of course, everyone should stay off added sugar. So I try and avoid that in any case. And. Ultimately, I never had to take any thyroid hormones. My antibodies are now at zero. They're all completely normal and I never, now they can still see the damage from Hashimotos when they all use an ultrasound on my thyroid, but I still have normal TSH levels.   [00:08:17] I mean, not even just normal, optimal TSH levels. That's awesome.    [00:08:21] I want everyone listening to hear that clearly. She just told you that she healed herself from Hashimoto has no antibodies and has optimized thyroid function. This is what's possible with a root cause approach. And I think that when I talk about this on the podcast or on social media, people don't believe me because it's such an anomaly in mainstream medicine.   [00:08:44] And of course, regular doctors will look at you. Like you're crazy and say, that's not true, but it happens every day. We see it's an everyday miracle. So I love that you came down this path and you became so passionate about gut health. And I think to me, it makes sense why you focus on having the autoimmune disease or diseases focused on gut health, but I don't know  that's gonna make sense to everyone.   [00:09:11] Can you help them make that link betweeut health and autoimmune disease.   [00:09:15] Absolutely. So. There are three things that are necessary for an autoimmune condition to happen. And one is a genetic predisposition for that particular autoimmune disease. So some people's bodies will attack one, some one organ, some people's bodies will attack a different organ.   [00:09:32] Then you need to have a leaky gut or intestinal permeability, which means that the tight junctions in your intestines are not holding together or there are holes through actual cells in the intestines that are letting. Both toxins, undigested, food, bacteria, body parts, all sorts of things that your immune system is going to then start attacking.   [00:09:54] And then you activate the immune system like this. And that's what inflammation is in essence. And when you have undigested gluten proteins in particular or gliadin, it's called is the protein in gluten. It resembles the cells in your thyroid gland and your body will attack this protein and then also create antibodies that attack your thyroid.   [00:10:19] So in essence, it's a, what they call molecular mimicry or some sort of confusion in your body where it starts attacking itself. So that's always at the root of all autoimmune diseases. Yes.    [00:10:30] So if you have an autoimmune immune disease, I always tell people by definition you have a gut problem and people will say to me, well, My gut works just fine.   [00:10:39] I eat, I poop. I don't have loose stool. I'm not constipated. I don't get indigestion gas, bloating. And they say, I don't have a gut problem. I say, yes, you do. If you have a autoimmune disease, you've got a gut problem. So where is the disconnect? Why do people seemingly have no gut symptoms? But they have a gut problem, help us understand that.   [00:10:58] Well, sometimes I think what happens is there's a balance of bacteria in the gut, such that your stool looks okay, right? Like maybe, you have some constipating bacteria and you have some loosening bacteria and together they've canceled each other out. But that doesn't mean that you don't have a leaky gut.   [00:11:16] Typically there is some sort of gut infection causing leaky gut, but it doesn't necessarily. I mean, you could have toxins that are also in play or mold or things like that, but in general, something is causing your gut to be leaky. So, you know, it's interesting because sometimes I will see people's gut tests for potential stool donors for fecal transplants.   [00:11:39] And. And I'll say, oh no, you can't take this person's stool. They may have good stool, and they may seem healthy and have good digestion, but it's just full of problems. Like, I mean, they have, you know, major pathogens that you'd never wanna take on. So just because you don't have any obvious gut problems doesn't mean something's not gonna show up on a test, right?   [00:11:58] Yeah. I mean, you may not overtly have symptoms, but that doesn't mean that on a microscope or on the micro level, you're not having problems you are. If you have an autoimmune. Yeah. So you mentioned testing, let's start with that. Cause a lot of people, you know, they're used to going to their regular doctor and what happens at their regular doctor.   [00:12:19] Oh doc, I have indigestion after I eat. No tests are done and they're given a proton pump inhibitor or Hey doc, I can't poop. No tests are done. And then they're given some pro motility agent for their gut. Hey doc, I alternate diarrhea, constipation. oh, diagnosis of exclusion. You have irritable bowel syndrome.   [00:12:39] Mm-hmm and they're put on anti-spam. So they're not used to doing gut stool tests. And I remember when I first started doing this work and I started with my gynecologic patients and I told them they needed to do a stool test and they would look at me like I was crazy. What are you talking about? Well, you need to poop in this pie plate and send it off to scoop it into these little tubes and send it to the lab.   [00:13:01] And they're like, what? I'm not doing that cuz no doctor ever asked them to do that. mm-hmm so talk about, you know, the testing, maybe what are some of your favorite tests to do and what it shows you and how people can get comfortable with this idea of pooping in the pie plate?    [00:13:21] Well, I have to say the people who come to me have no problem giving up their stool for a test because they are coming typically with gut issues.   [00:13:28] However, yeah, my favorite is the GI map. I like that one because it includes H pylori and I have found it now over the course  of. Three or four years now of helping people with gut issues that people who are severely constipated often have an overgrowth of H pylori or just a high level of it that's given their symptomatic is also problematic.   [00:13:51] So that's a bacteria that causes ulcers or stomach cancer, but not always only when it has certain virulence factors. Nevertheless, people will typically present with stomach pain with reflux, but sometimes just constipation. Sometimes they don't have those upper GI symptoms with H pylori. So I like that it includes also the GI map.   [00:14:14] You know, a number of different levels of bacteria in the gut. So you can see if certain classes or certain Gena or certain species are elevated or too low, both of the commences, the normal good ones, and then the potentially pathogenic and then the actual toxic pathogenic ones. It also includes all the parasites.   [00:14:33] So you can catch up somebody as a para and then it includes markers of gut health and just digestion. So, like, do you have enough pancreatic enzymes? Do you have elevated levels of beta lyase, which ties into hormones? Do you have sufficient secretory, IGA, or is that super elevated? Indicating your gut immune system is on high alert and trying to fight something.   [00:14:55] So I just like that it's a good overall test of various markers. And then of course it has marker for Calprotectin, which is a marker of inflammatory bowel disease and the inflammation in the colon.    [00:15:07] Yes. That's actually my favorite too. So great minds think alike. I think it really gives you the most comprehensive view.   [00:15:14] And sometimes people will come to me and say, well, I had a volume test. Can't you use that? and I go, yeah, that's not useful at all. Can you share with your people your thoughts on the bio, that one or any other one of these direct to consumer tests are not as far as I'm concerned, clinically useful. They might be good for the consumer, but they typically, you know, they will make all sorts of commentary about what diet changes are necessary, for example, based on your microbiome and no harm in trying those things.   [00:15:49] But when you're dealing with parasites or digestive dysfunction, Dysbiosis, et cetera. I think you need a clinical level test for that kind of stuff. There's just not a lot of actionable for a practitioner. There's not a lot of actionable information on a volume test. I agree.    [00:16:11] I, I think the same is true for a lot of the DNA direct to consumer test.   [00:16:15] Like, is it 23? And me, it's just not all the actionable information that you would want. Like the Alzheimer's gene mm-hmm , that's something I think everyone should have. And, uh, they don't include. Oh, really? I feel like they've included in well, so, oh, maybe they have, well, you can take, you can pull the raw data.   [00:16:34] I'll sometimes ask my clients for their raw data and I put it in genetic genie and I run that. And then I see, cause I, because I know that I'm, I'm APO four, three Aprile four. Homozygous. So I have my high Alzheimer's risk, which I, the only reason I know that is from the 23 and me. So I know it came through may, either on genetic gen genie or directly on 23 and me.   [00:16:55] Great.    [00:16:56] And so how has that empowered you? Do you feel like it's empowered you or disempowered you to have that information?   [00:17:03] I don't know that I would be doing anything different because I'm already somebody who seeks to optimize my health and have been my entire life. So I don't know, but I think as I get older, I'm definitely going to be more attentive to any kind of lapses in memory.   [00:17:21] And then at some point I'm probably going to get hooked up with that. Program the Dale BNS program related to Alzheimer's just to make sure that I'm doing absolutely everything preventative and everything testing wise, to make sure I don't lose my memory any sooner than necessary. Yes, absolutely. The Recode protocol.   [00:17:38] And I think there are 28 parameters, 28 things you need to be doing that are totally worthwhile. My mom. It has advanced Alzheimer's. So it's something I'm very keenly aware of and, you know, it's too late for her. Like I shared in a recent TEDx talk that I did talk about her only risk factor was that she had been menopausal for three decades without hormone therapy.   [00:18:01] And that is, of course, one of the main tens of the Recode protocol is using. Hormones therapy, natural hormone therapy. Speaking of which the podcast is called the hormone prescription. So I tie everything into hormones because to me, everything in the body is related to hormones. So how does let's go back to autoimmune disease with gut dysfunction, leaky gut.   [00:18:25] Intestine intestinal hyperpermeability as a key factor.    [00:18:30] How does this interact with the hormonal meal, you and the body?   [00:18:32] In my particular case, I'm not sure if there's a huge interaction, but in general, I mentioned on the GI map, there's a hormone, uh, I mean an enzyme called beta Gluar days and that. Is an enzyme that breaks the tight bond between glucuronic acid and toxins, including circulating estrogens in the intestines.   [00:18:55] And so when that gets elevated in certain bacteria in the gut, produce it so certain bacteria from the, the, uh, class ties also certain clostridia E coli. And there's a lot of healthy E coli, not just the ones that are known to be pathogenic and stalac rheumatic. So there's a number of different bacteria that produce it.   [00:19:18] And when those tend to get overgrown, then you can have access. Beta glucoronide and then this is breaking apart, this bond and recirculating estrogens in the body, which can lead to estrogen-related breast cancer, potentially colon cancer. So there's some correlations between those and. When that happens, what you can do to reverse it is to move to a lower fat, lower meat diet, to more of a plant-based diet because higher fiber will help undo that process.   [00:19:50] Yes, it's so    [00:19:51] true. The beta glucuronidase. So anyone who is suffering, which is very common sometimes in thirties and forties year old women, before they go through menopause with excess estrogen. And symptoms of that. It could be fibroid, endometriosis, heavy, painful periods, which is often associated with weight gain bloating.   [00:20:13] These are estrogen dominant conditions. You gotta look at your beta Glu UASE in your stool because it could be elevated. So that could be one of the key causes of one of your hormonal imbalances And then the other thing I always like to say for anyone with an autoimmune disease is you've got a foot on the accelerator of inflammation and that's this leaky gut, but you have no break on your car.   [00:20:39] And that would be cortisol, which is your body's natural steroid. So what do they do when you have a flare up of any type of inflammation or autoimmune disease? Steroids is the treatment and that's your body. Cortisol inside naturally. So you have a brake failure and you have a foot on the accelerator.   [00:20:57] So it's kind of a two-prong problem. So you've got to address both, but by healing your gut, you can work on your cortisol as well.   [00:21:03] So let me interrupt you for a second, because when you said all those things, as I think of this stuff now more in terms of my client than myself, but I did actually have estrogen dominance.   [00:21:15] No, no doubt. I had always low progesterone and I went through years of infertility. So I, I assumed that all of my gut stuff was at the root of that as well as the autoimmune stuff and probably, uh, you know, some thyroid issues.    [00:21:28] Yeah. You know, I think it's, isn't it Louis pastor who said death begins in the colon and I think  it's absolutely true.   [00:21:37] The gut is the center of your body physically. And it's the center of your health. Literally. It has branches to everything. And, you know, I always like to say. I ask people, what's your biggest interface with the external environment? And they say, oh my skin. And I say, no, think again. And it takes them a minute and most people don't get it.   [00:21:58] It's your gastrointestinal tract, cuz you're taking the external environment and you're putting it inside of you into this tube. That seems like it's in you, but it really just passes through and interacts. So it's like an inner skin and it's as big as two doubles tennis courts, the surface area. And so.   [00:22:17] Really that's your biggest ability for the environment to program you? You mentioned genetics, right? That's part of probably five, 10, maybe 20% of our health, but then what turns on those genes? In terms of our epigenetic code and, and food is the biggest programmer of that, that we're putting into our body and think of all the food you eat in the day.   [00:22:41] So I, I wanted to, to touch on something else. You said, well, we were talking about testing and I think you mentioned earlier about that you had SIBO small intestine bacteria overgrowth.    [00:22:53] Yes. What are your favorite tests to diagnose that? And it's such a Gnarly topic for the people who have it. How do you get rid of it?   [00:23:02] You mentioned the migrating motor complex, which a lot of people really don't have that working. So there's no motility going. So can you talk about SIBO?   [00:23:14] I don't tend to use breath tests. I'll start by saying mm-hmm . I tend to use the GI map and organic acids in general. When I see somebody with some type of presentation of bloating and what look like SIBO symptoms.   [00:23:31] Mm-hmm that being said, if. After looking at those and after taking herbal supplements to get rid of bacterial overgrowth, there still seems to be no resolution. I may recommend either the trio smart, especially if I suspect there could be hydrogen sulfide overgrowth, or I might recommend the IBS smart test to see if they have post.   [00:23:57] Infectious IBS to see if they have that autoimmune component and are always gonna be dealing with SIBO. So some people just get this overgrowth, they clean it up once, and they're all good. And then other people like me are going to constantly have to be fighting it. So I have to take something each night.   [00:24:12] A prokinetic. In order to keep things moving in my migrating motor complex and just be conscientious of not eating tons. No, not snacking all day long, letting my intestines empty out completely and periodically have to kind of Rell the bacteria. I have to take antimicrobials, you know, every year, roughly.   [00:24:31] In some quantity when I start to see things getting bloated again. Okay.    [00:24:35] So now the average person listening and probably a lot of the clients that you see and that I see they've been to their regular doctor and they've got this bloating problem. That seems pretty consistent. They're probably not gonna get any of these tests.   [00:24:50] Are they, there are some doctors at this point who will order SIBO, breath tests. That's not unheard of now at this point for GI doctors and some will have heard of, and may be using some, the trio smarter, the IBS smart, because they are, they were developed by an MD who is the expert at, Mark Pimentel.   [00:25:10] Who's the expert in SIBO and who does try and reach that traditional audience or conventional, I should say audience, but typically you'll have to ask for and seek out these more. Specialized tests with somebody who's either practicing functional medicine, a natural path, a health coach, somebody who is mm-hmm, more of a non-conventional expert in gut health.   [00:25:34] Yes.    [00:25:35] And so it sounds like you're describing, which has kind of been my experience too, with people who have SIBO. Some people do recover, and they don't have a problem any longer, but there is a subset of people who this is a very chronic problem. Can you talk a little bit about why someone might suffer with that as a chronic long term condition?   [00:25:57] Sure. So I did talk about. The primary, I guess I think about it as the primary, but I'm not actually sure. In terms of percentages, but I did mention the primary, which is the post infectious IBS, there, incidents of food poisoning, where you have an autoimmune problem, you can also have of course thyroid issues that can contribute to it.   [00:26:17] Hypothyroid, you can have traumatic brain injuries that are causing issues with the vagus nerve and with. Movement in the intestines from that of course infections, diabetes can be a root cause. Mold toxicity. You can have problems with your production of stomach acid, so you can have low stomach acid or hypochlorhydria.   [00:26:41] And that can cause. Overgrowth of bacteria or poor bio flow, uh, lack of pancreatic enzymes or brush border enzymes. There can be deficiencies in your secretory, IGA. If you've been under periods of extreme stress that can reduce secretory IGA, which is your gut immune defense, which is what is killing off these bacteria that are coming in.   [00:27:00] Mm-hmm , you can have medications that you're taking that could be causing problems and slowing your motility, obviously proton pump inhibitors, but also antidepressants. Anti SMOs opiates, narcotics. Then you can also have issues that are physical in nature. So you've had a past abdominal surgery and you could have adhesions for example, that are keeping your intestines from flowing properly endometriosis, which I also had, can be a root cause.   [00:27:28] Alors Danlos syndrome can also cause problems with motility. And then you can have dysfunction of your I valve.    [00:27:35] Yeah. There's such a long list of problems that you can have that can contribute to this. And I think, you know, people listening, I kind of want, because you have such breadth and depth of knowledge.   [00:27:48] For them to really get a good idea of what you, what you know, and what you offer. You have so much information on your podcast. We're definitely gonna give everyone, um, we'll put the link in the show notes to the podcast. And I was just looking at all the episodes you have. I was like, oh my gosh, I wanna talk to her about this.   [00:28:11] I wanna talk to her about that. I want her to share this. I want her to share. And so I think even if you're listening and you're like, oh my gosh, you guys are going way too fast and covering way too much ground. That is information for you to spur your interest, to go watch. Or listen to Lindsey's podcast, cuz she has so much valuable information.   [00:28:32] And then you can select the topics that interest you and you can listen to those. She talks about the FMT, the fecal microbiota transplant as a treatment. And I'm wondering if you could share a little bit about what that is and what it's used for? Cause I don't think a lot of people know that. An up and coming treatment for our GI problems.   [00:28:54] Okay. So FMT in the US is legal only in non-experimental contexts for recurrent C difficile infections, which is very potent bacteria that causes, you know, explosive diarrhea that can kill you and kills. I don't know something like 40,000 people a year. So if you have recurrent C diff, that's not treatable by antibiotics a couple times, then you could, in theory, if you can access it, get a fecal transplant done in a hospital.   [00:29:23] And it's basically taking the stool from a healthy donor and either putting it in capsule format or in ENMA format. And then you get a retention en ENMA of it. And for C diff it's usually just one treatment for other. So in other countries it's legal for other conditions like. IBS or inflammatory bowel disease with different levels of success, given the condition, even for autoimmune conditions, for any number of things, even, even conditions you might think aren't connected to.   [00:29:58] The gut is like ALS or multiple sclerosis. Well, that's autoimmune. So you may think that, but in any case, there are definitely some testimonies on a number of different conditions. So in, in particular, I think I know of clinics that do this in Australia, in the UK, in The Bahamas in Canada. Now I think there's one in Mexico focusing on, on children with autism in particular.   [00:30:23] Oh, and I think there used to be one in Argentina. I'm not sure if that's still there. So around the world, you can do treatments. And typically those will last for two five-day courses, essentially over the course of two weeks during the work week. And, you know, there are just some amazing testimonials of, of, oh, and of course mental health.   [00:30:41] I hadn't even discussed that cuz I have a lot of stories of people with serious mental health issues from bipolar to depression, to anxiety and pan and pan pans and pan, does that have been resolved after fecal transplants? And then of course it's also being used and in a particular, very purified form, that's an experimental form being used for autism.   [00:31:03] So it has the potential to be quite life changing, which is not to say it is for everyone. Uh, there's a Facebook group full of people who have tried it and it didn't help them. So I think the donor quality and just sort of the good match between the donor and the recipient are also important. So it's not always a foolproof thing.   [00:31:22] I. but, but there are for those, for whom it makes a difference, boy, it sure can make a big difference. Yeah. And I think probably some people listening are thinking, wow, that's really radical. Cuz I know when I talk about coffee, ENMA some people just really freak out. they're like what? I'm not doing.   [00:31:39] Putting what in my butt. No. And so when we talk about a fecal transplant via enema, I know some people get freaked out, but you know, if anybody listening has heard any of the recent data or information or knowledge that we have about the microbiome and how key it is for our overall health, you really, for some people could call it almost like getting a brain transplant, cuz your gut is your second brain.   [00:32:04] And. See the podcast episode that you had with the woman who I think she healed herself from bipolar using fecal transplant. Can you talk a little bit about her story?   [00:32:15] So she was in Australia and had bipolar for many years. I think she had probably, I think if I recall correctly, I think there had been suicide attempts.   [00:32:27] She had been in the hospitalized maybe five times with, you know, major depressive episodes. So. It was a serious and ongoing problem for her, from which she would emerge, you know, for periods of time when she could function normally, but mostly couldn't hold down a job. She did get married though, to a wonderful man who also had a wonderful stool.   [00:32:49] And at some point heard about yeah.    [00:32:52] New criteria for finding a partner.    [00:32:55] Absolutely.    [00:32:56] So did I get a stool sample before we seriously? Well, she didn't test it or anything. She just tried it and sure enough. It really worked for her. I think she, I think she did it more intensely at first and then more periodically afterwards, but it absolutely pulled her out of her depressions.   [00:33:15] And, you know, in large part resolved her bipolar. I wouldn't say she said it wa I think she emphasized it. Wasn't like a hundred percent cure, but from what I could hear, it really turned her life around. So she just DIYed it. She DIYed it. Yeah. So there's a lot of people doing that in the US, by the way, they're just finding donors.   [00:33:35] They may or may not be testing 'em I always recommend, of course, if you're gonna consider a donor that you do the full protocol of testing, which involves both blood tests for infectious diseases and sexually transmitted transmitted infections, as well as a stool test to, to make sure they don't have any of the major stool pathogens that you could potentially get.   [00:33:52] Because especially if you're doing it. Reasons related to gut issues. And you're, if you're in fragile health, like, especially if you have any kind of inflammatory bowel disease, you can really mess yourself up. If you bring in a pathogen and your gut is not prepared to fight it.    [00:34:07] Yes. Yeah. I would say, you know, it'd be similar to having sex.   [00:34:11] It's pretty intimate. You might wanna even more so.   [00:34:15] Right. Even more so. Yeah. Wow. So much. And then I was wondering, I saw you had another, a few episodes. I. On colostrum. Yeah. The one with ni not Nike, is that how you say his name and how and breathwork and colostrum that he used to restore his gut. And I was wondering if you could talk about some of that.   [00:34:39] So colostrum is the first milk that comes out of the breast and, or the cow in this case, because if you buy it, you're buying cow colostrum and. It is full of antibodies and transfer factors and immunoglobulin. And in particular, now they're also selling these serum bovine immunoglobulin, which are extracted from colostrums. [00:35:05] So I often recommend those to clients who have serious gut issues, because it just kind of enhances your. Immune system in the gut, without specifically, it's not like an antibiotic, which kind of indiscriminately kills. It's more like bringing in an extra immune system. Mm-hmm . So I often do recommend those powders to people who have something that you don't quite want to hit with an antimicrobial right off the bat.   [00:35:29] So anyway, so in his case though, he used a colostrum to heal his gut. And so it's just, I think it's just a way of bringing in a new immune system to the gut slowly but surely and helping it turn itself around. Yeah, I love them as like, you it's like a supportive, I don't know that it fixes necessarily.   [00:35:47] It's a bandaid and it gives support in the short term and can help promote healing. So I love them. And then I was just interested. For you to also talk about breathwork, which is something that I use in my programs all the time with people. Um, I teach them about the nature of HR V heart rate variability and parasympathetic sympathetic, autonomic nervous system balance.   [00:36:09] And how that really programs your gut, your guts motility. Is that something that you recommend for people?   [00:36:16] I have recommended it to certain people since that podcast in particular. And then since I read the word, the book breath by while I'm in the middle of it by James Nester Yes. So I definitely have gotten more interested in the breath and how it relates to good health in particular.   [00:36:32] Now, if I have a client who snores, I'll suggest mouth taping, mm-hmm . If I have a client for whom. Everything has been tried in terms of diet changes in terms of supplements and antimicrobials. And there's still kind of the root cause of their stress or of their dysfunction has not been identified. I'll really think about breath work and or some other type of practice like meditation or yoga, etcetera, to start reducing stress and just bringing some focus.   [00:37:05] But  I probably have not exploited it to the extent that it could be, because there's always so many different things you can bring in with a client and you don't want to overload them.    [00:37:15] That is so true. And along those lines, I'm wondering if, because we've jumped all over the place, cuz I'm just so excited to talk to you.   [00:37:23] And there's so many things I wanna ask you about and chat with you about, but for everybody listening, can you kind of bring it full circle, maybe using a who comes to mind that maybe had really been suffering for a long time. And who came to you and kind of, what is the process you usually take people through. And what does, what does a gut journey look like?   [00:37:46] for people? So I have such a variety of clients, from people who think they've been suffering a long time because they've had something for a year versus people who've had something for 15 years. And, but I would say, uh, a typical journey might be somebody who comes in with a little more complexity.   [00:38:02] Maybe they have both gut issues and autoimmune issues. Typically, we would just have a first appointment to talk over a complete medical history in the way that no doctor has ever sat and listened to you where I'm gonna totally try and understand all the potential root causes of what has come to pass and how they've ended up where they are.   [00:38:20] And then together we'll decide on what tests fit in based on. What their symptoms are and then what their budget is because obviously not everybody can afford a thousand dollars worth of testing right off the bat. It would be lovely if everybody could, but not everyone can. So we have to be thoughtful about that.   [00:38:37] And then typically we'll get the results back, and then we'll go over those results and all the potential things that could help given what, what was found on the test. And I'll educate them about the protocols that practitioners use to deal with those that's come up, be it some type of dysbiosis or SIBO or overgrowth of candida.   [00:38:57] Or something like the ion profile, we may be looking at deficiencies in amino acids or in fatty acids or vitamins and minerals that can come up on organic acids or on the ion profile. So we'll look at that. And then typically I'm recommending things to them over a period of time because you can't again, throw.   [00:39:15] A hundred supplements at a person at the same time, people can only take so much. I mean, there are, people are just like, give it all to me. I want it all right now but other people are gonna be like, yeah, that's too much both financially and too much in terms of taking pills. So, you know, I'll, I'll explain to them what, what the different supplements the benefits are and what I think in a good order would probably be for doing it.   [00:39:37] And then diet changes, of course, will be recommended based on. What they've already tried, but I find that by the time people get to me, they're usually already eating some version of a paleo diet, or I do occasionally get people who are plant based and I often have to push them towards getting more protein.   [00:39:54] Somehow mm-hmm, potentially moving towards eating some animal protein or some seafood, just because I can see frequent deficiencies, amino acids when that happens. And, it's also very common to see mental health issues in my clients. So if that's the case, then I'm often. You know, educating them about the amino acids that can bring up serotonin and dopamine.   [00:40:16] And you can see the deficiencies of that  on an organic acid test, or you can see actual levels of the amino acids on the ion profile. And then with autoimmune stuff, then we're also looking at supplements that can help reduce inflammation if we've already addressed gut stuff. So typically we'd go through addressing any kind of gut.   [00:40:36] But then after that, if they're still flaring, then we might look at anti-inflammatory supplements, like, you know, fish oil or SPMS, or I get the name of right off the bat. Oh, alpha glyco, ISO Quatrine Soin BAIC or Cuban. Yeah. Curcumin. Right. Those kind of anti-inflammatory things. So over time, you know, I'll educate them about each kind of supplement and how it might play a role in helping them heal. [00:41:04] and yeah, so I'll ultimately see people over the course of five appointments that might take most of a year and slowly but surely help them restore their health and get them at least to a point of stability. There's no magic cure in terms of autoimmune disease. Not everybody's gonna have the results I did because I caught it early enough and there was not so much damage to my thyroid.   [00:41:25] So. You know, you have a certain amount of damage, and it's not gonna be, you're not gonna reverse it, but you may reduce your medication dosages and you may at least get to a point of stability or potentially if, if the client is interested, get off any kind of, you know, steroid medications or. Other autoimmune prescription medications.   [00:41:46] Yeah. Immunosuppressive drugs. Right. I'm curious to know.    [00:41:49] I mean, we're, we're getting short on time. I'm gonna have to let you go, but I wanna know your thoughts on alcohol, cuz my thoughts are not necessarily popular. So I just want to see where you stand on that with gut health. Well, it is toxic. There's no question about that.   [00:42:05] And it does. Kind of go in and cause some damage to gut bacteria. And if you're having guest right and upper GI issues, for sure. It's definitely not helpful. That being said, I can't say I'm a non-drinker, so I'm not, but generally my clients who are really sick are just not drinking in the first place.   [00:42:26] So I'm not having to tell most of them to stay away from alcohol there, but they've already done it themselves. So obviously you want to stay at the lowest levels. You want to be considered a low level drinker, not a moderate level, which unfortunately for a woman is no more than a drink a day. And for men no more than two, up until 65 than one after 65, if I recall correctly.   [00:42:47] And then the other things is that people wanna say, do we all have to stop eating gluten and cow smoke dairy Lindsey?    [00:42:55] We'll typically recommend cutting out gluten and dairy to everybody for some period of time. Now, if I have a very simple case of SIBO that resolves quickly and easily, and the person says, I don't seem to have any problem with gluten, I cut it out, and I put it back in, and I had no difference.   [00:43:12] Then I won't necessarily say you have to cut out gluten. If you have an autoimmune issue, I'm gonna say gluten's gone for life.   [00:43:20] Yeah. I, I generally would agree with that for sure Lindsey, so much great information that you shared today. I know everybody listening has been like, it's a whirlwind Kyrin, you took her all over the place.   [00:43:31] I know, I know guys, but I wanted you to get a sampling of everything that she has to offer. There's so much more, even on her podcast, the perfect stool, which is an amazing name. And great content. You've had some of the same. Yes. I've had Steve Wright and Dr. Gray SL and they're probably more if I continue to look at it, I did wanna ask you about this before we wrap up, you shared, uh, some quotes that you like before we started with me and I just wanna share this one.   [00:44:01] A calorie is not a calorie. And can you tell everyone what that means to you?   [00:44:04] Absolutely. So, number one, I, before I did this, I was. A, an advocate for healthier school food. And one of the things that we fought the most in that particular battle in Montgomery County, Maryland, was to try and reduce the sugar in school food.   [00:44:22] And I remember sitting at a hearing with the state Senate, trying to get a bill passed, to reduce sugar in school food, and having. Former home EC teacher who was a state Senator said, well, a calorie's just a calorie. And I said, no, it is not. In fact, that is a soda marketing campaign to try and convince you.   [00:44:41] You can just go calories and calories out, just exercise more, and you can drink your Coke every day, which I definitely do not believe. So part of the issue with calories is that they're not metabolized the same. So for example, when you eat protein, 25 to 30% of it is. Of the calories of protein is used up just in digesting the protein.   [00:45:01] Whereas it's, it's a much lower number for carbohydrates and fat. So, you know, something like six to 8% of the carbs are used to digest carbs and two to 3% of the fat. So therefore you're getting a lot more calories from your fat and your carbs. And then. You also have different foods and have that have different impact on the body.   [00:45:20] So for example, fructose versus glucose, glucose can be used by almost all your cells. Fructose is going to your liver and ultimately, mostly being stored as fat. So, you know, that's why the whole thing against high fructose corn syrup, not to say glucose is good, but just to say that, that they impact your body differently.   [00:45:37] And then of course you have fiber. So, you know, if you eat a hundred calories of almonds versus a hundred calories of soda, That impacts your body in a completely different way because the almonds have healthy fats, and they have fiber, and that is gonna slow down the absorption of the calories of any sugars, et cetera, that are in the food when you're eating fiber.   [00:45:59] So it just makes a complete difference in which kinds of foods you're eating. A calorie is not a calorie. It's so true.    [00:46:04] And I, I really love to help people understand that a lot of people believe the food that they eat is only about calories. And it's speaking to your system on so many levels. Right.   [00:46:17] Mm-hmm, in so many languages at one time. It's like they're having this international language conference. It's speaking because of its bio force. It's life force, it's PR it's Chi, whatever you want to call it, it's speaking nutrition, right? Certain vitamins, which are not present in soda and in the almonds are of course speaking the fiber language, right.   [00:46:39] Or it's not speaking fiber language. And so about so much more than macronutrients, which are calories. It's about micronutrients, energetic nutrients. And I think that goes to the other quote that you shared with me that I love. I'd rather pay for healthy food now than healthcare later. So one of people's biggest objections to doing this type of work is eating, trying to eat healthy and particularly organic.   [00:47:07] And so talk a little bit about that and then we'll go ahead and wrap up.   [00:47:09] Oh, I just have, I've been of the philosophy since I have tried to turn around my health, that that indeed it is worth it to pay for more expensive organic foods and in particular, and this is a lot of people, they, they think, well, I, I mostly buy organic vegetables and I say, do you eat Pasteur raised meats?   [00:47:29] How about your dairy products? Are they pasture raised? So I don't, I, the only dairy I. Is butter and GE. And so I make sure that those products and, and I know it cost $4 more, a pound for pasture raise butter, but I get it because that's where all the toxins from the body settle into your fat.    [00:47:54] So if you want to maximize your, you know, or minimize your consumption of toxins, then you definitely wanna look for high quality meat and wild cut seafood and that kind of thing not. And then of course, low mercury seafood at that. When you're looking for your animal products, cuz the animals, you know, you think about everything else. It's the build up the entire environment and the plants that builds into the  animal and the protein and the fat.   [00:48:10] So true.    [00:48:14] Thank you so much, Lindsey for joining us today, Lindsey Parsons, we are gonna have links in the show notes. You've got a free E booklet available on your website, finding your root cause through stool and organic acids testing. So I'll have a link over to that.   [00:48:29] We'll have a link to the 30 minute breakthrough session that people can do by phone or video chat. We'll have a link to the podcast also that you definitely wanna check out if you're interested in your health and healing from a root cause. Gut is a huge part of that. So you want to go there and check out the perfect stool so you can have the perfect stool and thanks so much for joining me today.   [00:48:53] Any last words you'd like to leave everybody?    [00:48:54] No, I just wanna thank you so much for bringing me on and for checking out my podcast and recommending it. I really appreciate it.    [00:49:02] It is absolutely my pleasure to have you here, and thank you all for listening today. Thanks for spending a little bit of your day with us.   [00:49:10] Hopefully you have learned something today that you can put into action. This is all about taking action to move your. To the brilliance that it can be. I thank you for joining me, and I'll see you next week until then peace, love and hormones. Y'all thank you so much for listening. I know that incredible vitality occurs for women over 40.   [00:49:32] When we learn to speak hormone and balance these vital regulators to create the health and life that we. If you're enjoying this podcast, I'd love it. If you give me a review and subscribe, it really does help this podcast out so much. You can visit the hormone prescription.com, where we have some free gifts for you, and you can sign up to have a hormone evaluation with me on the podcast to gain clarity into your personal situation until next time.   [00:50:02] Remember, small steps each day to balance your hormones and watch the wonderful changes in your health that begin to unfold for you. Talk to you soon.   Get Lindsey Parsons's free e-booklet: “Finding Your Root Cause Through Stool and Organic Acids Testing.” https://highdeserthealthcoaching.com/newsletter/   30 Minute Breakthrough Session with Lindsey Parsons - by phone or video chat https://calendly.com/highdeserthealth/30-minute-breakthrough-session-by-phone-or-vi-clone   Feeling tired? Can't seem to lose weight, no matter how hard you try? It might be time to check your hormones.   Most people don't even know that their hormones could be the culprit behind their problems. But at Her Hormone Club, we specialize in hormone testing and treatment. We can help you figure out what's going on with your hormones and get you back on track.   We offer advanced hormone testing and treatment from Board Certified Practitioners, so you can feel confident that you're getting the best possible care. Plus, our convenient online consultation process makes it easy to get started.   Try Her Hormone Club for 30 days and see how it can help you feel better than before. CLICK HERE to sign up: https://www.herhormoneclub.com/  

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks…   Richard: Hello Dr. Cabral, I would really appreciate it if you would provide your thoughts on dry fasting. I tried to search for previous shows where you spoke of this but couldn't find one where you spoke of dry fasting in detail, it's pros, cons and if there is ever a time where it should be used. Some say its dangerous and should never be done and others think it has its uses. I have a lot of cysts/lipomas (not sure which one) all over my body and a podcast I was listening to said drying fasting might work to get rid of them because when the body is dehydrated it will look for dysfunctional cells, tissues etc. to dissolve and extract water from. What do you think about all this? Thank you for answering my question, hope you are having a great day!   Gail: Hi Dr. C! Thank you so much for all that you offer to us humans seeking to learn and find health and balance in our lives. I am currently going through the program to become certified as an IHP level 1 and then level 2 health coach to add to my work as an acupuncturist and I'm so excited to have finally found the knowledge I have been looking for. I am curious to hear your thoughts about Rifaximin to treat SIBO. My friend was diagnosed by her ND with SIBO and Rifaximin is part of her protocol to treat it. Thank you for your wisdom on this and so many other health-related topics!   Michael: Hi Dr Cabral, what could cause burning/pin sensations in the hands and fit ? Tested negative on h pylori and candida. Tested positive for mold toxicity and possible sibo.   Michael: Hi Dr Cabral, what would cause someone to wake up about every 2 hours at night to frequently urinate?   Anonymous: Hi there! Thank you for all the great work that you do! It has made a huge impact on my life. I have been working on improving my gut health for almost 4 months now and I have noticed some improvements. I realized that i am extremely sensitive to lectins. I have always been but i never knew they had a name. So what i'm wondering is, can i still use oils from lectin-heavy nuts or seeds on my skin? Things like sunflower or chia seed oil? I am also trying to resolve a histamine issue that I have which came as a result of my leaky gut. So while i have eliminated high histaminr foods for a while, i am noy sure if i can still use them topically e.g with avocado hair masks. I look forward to your insights!   Jade: Hello, I have recently come out of having 4 months of antibiotics in hospital, plus have also come off my contraception; the hormone coil. Obviously this has sent me hrmones and metabolism into chaos, I feel so puffy and bloated and lethargic. I am such a healthy person, eat well and exercise and I can barely get out of bed! I am about to start a liver cleanse, but would you recommned this and can you suggest anything else to help? Thanks so much   Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right!   - - - Show Notes and Resources: StephenCabral.com/2361 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!

What is the difference between SIBO vs IBS?I brought the perfect person on to the A Gutsy Girl podcast show to break it down, namely SIBO.The prevalence of SIBO is increasing, and Dr. Jacobi believes it is due in large part to the fact that our gut dysfunction is increasing and practitioners are becoming more privy to SIBO and what it means.SIBO vs IBS {and a SIBO Q&A with Dr. Nirala Jacobi}Resources MentionedYouTube SIBO series (see below for a list of all videos currently available in the series)What Caused My SIBO?Common symptoms of SIBOAll About Probiotic Strains and SpeciesIBS diagnostic criteriaReasonable SIBOTheSIBODoctor.com (her website)The SIBO Success Plan (her course, includes Bi-Phasic Diet Plan)clinic, The Biome ClinicDr. Jacobi on Instagram HERESIBO Diet Recipes – A Gutsy Girl WayDon't Miss These ThoughtsWho is Dr. Nirala Jacobi?What is the difference between SIBO (small intestinal bacterial overgrowth) vs IBS (irritable bowel syndrome)?What is the lactulose breath test?“Some people think that SIBO is the biggest cause of IBS, but not everyone who has IBS has SIBO.” – Dr. Jacobi“Gut symptoms are on the rise, and SIBO diagnosis are getting better.” – Dr. JacobiHow can I figure out my underlying cause? What is the best way to diagnose?Does Dr. Jacobi think dietary changes are necessary? And for how long?What do you think about the Elemental Diet? How about the low FODMAP diet? Other diets for SIBO?Dr. Nirala's thoughts on things like: hydrolyzed guar gum, sprouted gluten free oats“Methane gases are very curious.” – Dr. JacobiWhat is the bi-phasic diet? And how long is the protocol?“You've painted yourself into a corner only eating 10 foods.” – Dr. JacobiWhat are treatment options for addressing stubborn SIBO?Antibiotic alternatives?Can you have SIBO and not know it? i.e. no SIBO symptoms“SIBO actually causes leaky gut. You can't get rid of leaky gut unless you get rid of SIBO.” – Dr. JacobiIs it possible to improve leaky gut (intestinal permeability) while having SIBO? Or should SIBO be treated first?What do you believe is the gold standard when it comes to a probiotic supplement and SIBO?The type of bacteria matters when it comes to the probiotic you need.“It's an art to produce a good, lasting probiotic that is the strain you need.” – Dr. JacobiWhy don't regular doctors think SIBO is real?What is one thing Dr. Nirala Jacobi thinks people get wrong when it comes to SIBO?“It should not be this difficult to treat bacteria.” – Dr. JacobiDr. Jacobi's 3 convictions around gut health and gut healing.IBSThe main difference between IBS and SIBO is that IBS is a category of functional gut disorders. It's an umbrella of sorts; SIBO is a cause of IBS.IBS patients typically get thrown into a bucket of “who the heck knows what's wrong.” A diagnosis of IBS is then slapped on.This is the real and raw truth, and after talking at length with Dr. Jacobi it's clear that part of the reason is because if healthcare providers are not well versed on IBS vs SIBO (or the conditions in general), then we do not heal.And by the way, remember that it's not their fault. It is up to us, as patients, to seek the right help. Any old practitioner just will not do; different specialists and practitioners for different conditions.I have an IBS symptoms list that you can find HERE. {In that post, you'll also learn more about the differences between IBS and IBD – inflammatory bowel disease.}SIBOSIBO is an overgrowth of bacterial in the small vs. large intestine. This distinction between small and large is actually important because while we do not want an overgrowth of gut bacteria in the small intestine, we do, in fact, welcome too much bacteria in the large intestine.A healthy gut consists of a strong gut microbiome which is created through having an abundance of good bacteria in the large intestine.In addition to everything else I've written about SIBO on this website, here are more things Dr. Jacobi mentions on the show:Rifaximin is a great antibiotic therapy for SIBO because it stays in the small intestine.Hydrogen-dominant SIBO = Berberine, Neem, oreganoMethane-dominant SIBO = garlic extract or oregano oilSIBO treatment in the order Dr. Jacobi typically follows: herbs, antibiotic treatment, Elemental diet (for more severe cases)Bio-film buster (for multiple antibiotic courses); PHGG (partially hydrolyzed guar gum), Ox BileClassic SIBO symptom = bloating immediately after eating; not classic (but still can indicate SIBO); histamine intolerance, food sensitivities, end-of-day bloatConditions that can commonly co-exist with SIBO: Restless Leg Syndrome, Acne Rosacea, and Interstitial cystitisPHGG: great for high methane levelsMotility disorders are a root cause for SIBOGut motility can be affected by things like mold and hypothyroidismAdhesions/obstructions can also increase your risk of SIBOUnlike the IBS diagnosis, a diagnosis of SIBO is more test-based.Breath testing is the most common way for an accurate diagnosis.Dr. Jacobi mentions her own breath test she gives, and I have discussed these breath tests at length over the years both on this website and via the YouTube channel.YOU CAN ALSO TEST **BOTH** HYDROGEN AND METHANE LEVELS UPON EATING VARIOUS FOODS WITH THE FOODMARBLE AIRE 2 DEVICESmall Intestine Bacterial Overgrowth YouTube VideosGood news! Here is a list of all the videos I've tackled thus far around SIBO on the A Gutsy Girl YouTube channel:SIBO Series Small Intestinal Bacterial OvergrowthPart 1 DietSIBO Part 2 Root Cause AnalysisPart 3 Hydrogen DominantFoodMarble AIRE Review 2 DeviceSIBO Part 4 Methane Dominant SIBOPart 5 Hydrogen Sulfide SIBOSIBO Part 6 The DiagnosisPart 7 Questions to Ask Your Doctor {After Getting Diagnosed}SIBO Part 8 How to Do the Breath TestPart 9 How to Heal SIBO Long TermSIBO Part 10 Fiber + SIBOCLICK HERE TO GO TO THE ‘SIBO' PLAYLIST ON YOUTUBEMore from A Gutsy GirlWant to learn even more about the gut and ways to heal it? Learn all the secrets via my signature book, A Gutsy Girl's Bible: a 21-day approach to healing the gut. Grab your copy on Amazon HERE.Or, have this book at your fingertips instantly by downloading the PDF now. Welcome to A Gutsy Girl PodcastHang out on InstagramBFF's on YouTubeFree resource: The Master Gutsy SpreadsheetRated-G Email ClubWrap UpTime to wrap this up. As always, a huge goal for this show is to connect with even more people. Feel free to send an email to our team at podcast@agutsygirl.com. We want to hear questions, comments, show ideas, etc.Did you enjoy this episode? Please drop a comment below or leave a review on Apple Podcasts.If you're looking to finally get started on your gut healing journey, Gut Healing for Beginners is now open! Dr. Nirala Jacobi BioDr. Nirala Jacobi is a naturopathic doctor (ND) and internationally recognized expert on small intestinal bacterial overgrowth (SIBO). She is the creator of the SIBO Biphasic Diet, a resource that has helped tens of thousands of SIBO sufferers around the world.Dr. Jacobi is the host of The SIBO Doctor Podcast and the founder of The SIBO Doctor, an online educational platform that includes a practitioner certification program. She is also the medical director of SIBOtest, providing innovative testing options for SIBO and IBS.Dr. Jacobi is known for her systematic and effective approach to diagnosing and treating SIBO and other functional digestive disorders. Having received her naturopathic doctorate in 1998 from the esteemed Bastyr University in Seattle, Washington, she brings more than two decades of clinical experience and expertise to the Biome Clinic.If you liked this episode, you might also enjoy:Your Digestive SystemLow-FODMAP DietVitamin B12 and SIBOXox,SKH Connect with A Gutsy GirlThrough the websiteOn InstagramVia LinkedIn

What is the difference between SIBO vs IBS?I brought the perfect person on to the A Gutsy Girl podcast show to break it down, namely SIBO.The prevalence of SIBO is increasing, and Dr. Jacobi believes it is due in large part to the fact that our gut dysfunction is increasing and practitioners are becoming more privy to SIBO and what it means.SIBO vs IBS {and a SIBO Q&A with Dr. Nirala Jacobi}Resources MentionedYouTube SIBO series (see below for a list of all videos currently available in the series)What Caused My SIBO?Common symptoms of SIBOAll About Probiotic Strains and SpeciesIBS diagnostic criteriaReasonable SIBOTheSIBODoctor.com (her website)The SIBO Success Plan (her course, includes Bi-Phasic Diet Plan)clinic, The Biome ClinicDr. Jacobi on Instagram HERESIBO Diet Recipes – A Gutsy Girl WayDon't Miss These ThoughtsWho is Dr. Nirala Jacobi?What is the difference between SIBO (small intestinal bacterial overgrowth) vs IBS (irritable bowel syndrome)?What is the lactulose breath test?“Some people think that SIBO is the biggest cause of IBS, but not everyone who has IBS has SIBO.” – Dr. Jacobi“Gut symptoms are on the rise, and SIBO diagnosis are getting better.” – Dr. JacobiHow can I figure out my underlying cause? What is the best way to diagnose?Does Dr. Jacobi think dietary changes are necessary? And for how long?What do you think about the Elemental Diet? How about the low FODMAP diet? Other diets for SIBO?Dr. Nirala's thoughts on things like: hydrolyzed guar gum, sprouted gluten free oats“Methane gases are very curious.” – Dr. JacobiWhat is the bi-phasic diet? And how long is the protocol?“You've painted yourself into a corner only eating 10 foods.” – Dr. JacobiWhat are treatment options for addressing stubborn SIBO?Antibiotic alternatives?Can you have SIBO and not know it? i.e. no SIBO symptoms“SIBO actually causes leaky gut. You can't get rid of leaky gut unless you get rid of SIBO.” – Dr. JacobiIs it possible to improve leaky gut (intestinal permeability) while having SIBO? Or should SIBO be treated first?What do you believe is the gold standard when it comes to a probiotic supplement and SIBO?The type of bacteria matters when it comes to the probiotic you need.“It's an art to produce a good, lasting probiotic that is the strain you need.” – Dr. JacobiWhy don't regular doctors think SIBO is real?What is one thing Dr. Nirala Jacobi thinks people get wrong when it comes to SIBO?“It should not be this difficult to treat bacteria.” – Dr. JacobiDr. Jacobi's 3 convictions around gut health and gut healing.IBSThe main difference between IBS and SIBO is that IBS is a category of functional gut disorders. It's an umbrella of sorts; SIBO is a cause of IBS.IBS patients typically get thrown into a bucket of “who the heck knows what's wrong.” A diagnosis of IBS is then slapped on.This is the real and raw truth, and after talking at length with Dr. Jacobi it's clear that part of the reason is because if healthcare providers are not well versed on IBS vs SIBO (or the conditions in general), then we do not heal.And by the way, remember that it's not their fault. It is up to us, as patients, to seek the right help. Any old practitioner just will not do; different specialists and practitioners for different conditions.I have an IBS symptoms list that you can find HERE. {In that post, you'll also learn more about the differences between IBS and IBD – inflammatory bowel disease.}SIBOSIBO is an overgrowth of bacterial in the small vs. large intestine. This distinction between small and large is actually important because while we do not want an overgrowth of gut bacteria in the small intestine, we do, in fact, welcome too much bacteria in the large intestine.A healthy gut consists of a strong gut microbiome which is created through having an abundance of good bacteria in the large intestine.In addition to everything else I've written about SIBO on this website, here are more things Dr. Jacobi mentions on the show:Rifaximin is a great antibiotic therapy for SIBO because it stays in the small intestine.Hydrogen-dominant SIBO = Berberine, Neem, oreganoMethane-dominant SIBO = garlic extract or oregano oilSIBO treatment in the order Dr. Jacobi typically follows: herbs, antibiotic treatment, Elemental diet (for more severe cases)Bio-film buster (for multiple antibiotic courses); PHGG (partially hydrolyzed guar gum), Ox BileClassic SIBO symptom = bloating immediately after eating; not classic (but still can indicate SIBO); histamine intolerance, food sensitivities, end-of-day bloatConditions that can commonly co-exist with SIBO: Restless Leg Syndrome, Acne Rosacea, and Interstitial cystitisPHGG: great for high methane levelsMotility disorders are a root cause for SIBOGut motility can be affected by things like mold and hypothyroidismAdhesions/obstructions can also increase your risk of SIBOUnlike the IBS diagnosis, a diagnosis of SIBO is more test-based.Breath testing is the most common way for an accurate diagnosis.Dr. Jacobi mentions her own breath test she gives, and I have discussed these breath tests at length over the years both on this website and via the YouTube channel.YOU CAN ALSO TEST **BOTH** HYDROGEN AND METHANE LEVELS UPON EATING VARIOUS FOODS WITH THE FOODMARBLE AIRE 2 DEVICESmall Intestine Bacterial Overgrowth YouTube VideosGood news! Here is a list of all the videos I've tackled thus far around SIBO on the A Gutsy Girl YouTube channel:SIBO Series Small Intestinal Bacterial OvergrowthPart 1 DietSIBO Part 2 Root Cause AnalysisPart 3 Hydrogen DominantFoodMarble AIRE Review 2 DeviceSIBO Part 4 Methane Dominant SIBOPart 5 Hydrogen Sulfide SIBOSIBO Part 6 The DiagnosisPart 7 Questions to Ask Your Doctor {After Getting Diagnosed}SIBO Part 8 How to Do the Breath TestPart 9 How to Heal SIBO Long TermSIBO Part 10 Fiber + SIBOCLICK HERE TO GO TO THE ‘SIBO' PLAYLIST ON YOUTUBEMore from A Gutsy GirlWant to learn even more about the gut and ways to heal it? Learn all the secrets via my signature book, A Gutsy Girl's Bible: a 21-day approach to healing the gut. Grab your copy on Amazon HERE.Or, have this book at your fingertips instantly by downloading the PDF now.  Welcome to A Gutsy Girl PodcastHang out on InstagramBFF's on YouTubeFree resource: The Master Gutsy SpreadsheetRated-G Email ClubWrap UpTime to wrap this up. As always, a huge goal for this show is to connect with even more people. Feel free to send an email to our team at podcast@agutsygirl.com. We want to hear questions, comments, show ideas, etc.Did you enjoy this episode? Please drop a comment below or leave a review on Apple Podcasts.If you're looking to finally get started on your gut healing journey, Gut Healing for Beginners is now open!  Dr. Nirala Jacobi BioDr. Nirala Jacobi is a naturopathic doctor (ND) and internationally recognized expert on small intestinal bacterial overgrowth (SIBO). She is the creator of the SIBO Biphasic Diet, a resource that has helped tens of thousands of SIBO sufferers around the world.Dr. Jacobi is the host of The SIBO Doctor Podcast and the founder of The SIBO Doctor, an online educational platform that includes a practitioner certification program. She is also the medical director of SIBOtest, providing innovative testing options for SIBO and IBS.Dr. Jacobi is known for her systematic and effective approach to diagnosing and treating SIBO and other functional digestive disorders. Having received her naturopathic doctorate in 1998 from the esteemed Bastyr University in Seattle, Washington, she brings more than two decades of clinical experience and expertise to the Biome Clinic.If you liked this episode, you might also enjoy:Your Digestive SystemLow-FODMAP DietVitamin B12 and SIBOXox,SKH

The man behind HC records (Hypnotica Colectiva) David Verdeguer delivers the next podcast for our TRM mix series. Since 1990 David has been DJing and pushing the electronic scene in Valencia (Spain), becoming one of the main DJs and promoters in the city. He has also worked as resident DJ at clubs considered as temples in the local Valencian scene such as Barraca, Rockola, Terminal and Miniclub among others. Currently David runs La Discoteca K&H Vinyl Store in Valencia aside his own label HC records. Constant music researcher and meticulous selector, David drops a 2h journey of atemporal gems. Hope you enjoy! tracklist__ 01 Somatic Responses - "Interluding" (WELSH MODULAR ALLIANCE, Ammanford, Walles, UK 2021) 02 Roel Funcken – Danzar Arturion (Anthony Baldino Remix) (Analogical Force, Madrid 2020) 03 Somatic Responses - "Slo_ph1" (WELSH MODULAR ALLIANCE, Ammanford, WAlles, UK 2021) 04 Belief Defect ‎– "Unnatural Instinct" (Raster Chemnitz, Germany 2017) 05 Mike Devious – "Saber" (Underground Music Xperience, Netherlands 2018) 06 Pye Corner Audio - "Octal Run" Half-Light - Prowler Remixed (More Than Human, Canada 2017) 07 Somatic Responses - "Kammerl Acid Test" (WELSH MODULAR ALLIANCE, Ammanford, Walles UK 2021) 08 Absis – "Search And Find" Found Ritual EP (Hivern Discs, Catalunya 2021) 09 Donato Dozzy – "Aquatica" Palinoia LTD 001 (Palinoia, Germany 2020) 10 Black Cadmium – "Muted Chaos" Muted Chaos EP (Vault Wax, Netherlands 2020) 11 Sigma Algebra – "Ni" Delta Ring EP (Tensor Norm, Spain) 12 ADJ - "Any Planet" Eye Of The Jaguar EP (ANOTHER PERSPECTIVE, Spain 2021) 13 Antechamber – "Susurrus" Archaic Idol EP (Polymorphism Records, UK/Spain 2020) 14 RNXRX – "Mutant 4" (Fill-Lex Records, Spain 2021) 15 Artificiero - "Carbomedic N25" (Discos Atónicos, Germany 2019) 16 Mariska Neerman - "Rise Up" Finding Our Way Back Home EP (HC Records – HCR007 Valencia, Spain 2021) 17 V9813 - "Lost To The Void" (V-MAX Records, Michigan U.S.A.) 18 De Sluwe Vos – "Switching Lanes" (Patron Records, Netherlands 2018) 19 Albert Chiovenda - "Some Wizadry Going On Here" (Legend 1997, Spain 2021) 20 Somatic Responses - "Aria" (HC Records, Spain 2020) 21 Estrato Aurora & Siarem- "400 ppm" (HC Records, Spain 2022) 22 Vofa (Sawf & ANFS) - "Agosame" (Pi Electronics, Greece 2020) 23 Oscar Mulero - "Taste The Rope" (Rave Or Die, France) 24 Umwelt - "Ravenous Horde" (Midnight Shift Records, Singapore 2021) 25 Kwartz - "Reinforced Control" (Monrella Remix) (Trauma Collective, Spain 2021) 26 Sansibar - "Sissi" (Avoidance, Finland 2020) 27 Vladimir Dubyshkin – "Grasshopper's Opinion" (трип, Russia 2019) 28 Maelstrom - "No Escape" (Acid Avengers, France 2017) 29 Silicon Scally – "Dust Biter" (Rator Mute, Spain 2020) 30 Somatic Responses - "Unreal Memory" (SR records Ammanford, UK 2021) 31 Daed – "H2fsbf6" (Dwaallicht Remix)(Analogical Force, Madrid 2020) 32 RX-101 – "Serenity" (Suction Records, Canada 1999/2019) 33 Spawn (Daniel Bell, Fred Giannelli, Richie Hawtin) – "Tension" (Sysex Remix)(Probe Records, Canada 1993) 34 Traxman - "Road Runner" (Tekworkz Rmx)(New Boy Shit Trax, U.S.A. 2018) 35 Galaxian - "Negative Realm Agenda" (Breakin' Records, UK 2019) 36 Daniel Kyo a.k.a. CØRE - "Rifaximin" (HC records, Spain 2021) @davidverdeguer @hypnoticacolectivarecords

The man behind HC records (Hypnotica Colectiva) David Verdeguer delivers the next podcast for our TRM mix series. Since 1990 David has been DJing and pushing the electronic scene in Valencia (Spain), becoming one of the main DJs and promoters in the city. He has also worked as resident DJ at clubs considered as temples in the local Valencian scene such as Barraca, Rockola, Terminal and Miniclub among others. Currently David runs La Discoteca K&H Vinyl Store in Valencia aside his own label HC records. Constant music researcher and meticulous selector, David drops a 2h journey of atemporal gems. Hope you enjoy! tracklist__ 01 Somatic Responses - "Interluding" (WELSH MODULAR ALLIANCE, Ammanford, Walles, UK 2021) 02 Roel Funcken – Danzar Arturion (Anthony Baldino Remix) (Analogical Force, Madrid 2020) 03 Somatic Responses - "Slo_ph1" (WELSH MODULAR ALLIANCE, Ammanford, WAlles, UK 2021) 04 Belief Defect ‎– "Unnatural Instinct" (Raster Chemnitz, Germany 2017) 05 Mike Devious – "Saber" (Underground Music Xperience, Netherlands 2018) 06 Pye Corner Audio - "Octal Run" Half-Light - Prowler Remixed (More Than Human, Canada 2017) 07 Somatic Responses - "Kammerl Acid Test" (WELSH MODULAR ALLIANCE, Ammanford, Walles UK 2021) 08 Absis – "Search And Find" Found Ritual EP (Hivern Discs, Catalunya 2021) 09 Donato Dozzy – "Aquatica" Palinoia LTD 001 (Palinoia, Germany 2020) 10 Black Cadmium – "Muted Chaos" Muted Chaos EP (Vault Wax, Netherlands 2020) 11 Sigma Algebra – "Ni" Delta Ring EP (Tensor Norm, Spain) 12 ADJ - "Any Planet" Eye Of The Jaguar EP (ANOTHER PERSPECTIVE, Spain 2021) 13 Antechamber – "Susurrus" Archaic Idol EP (Polymorphism Records, UK/Spain 2020) 14 RNXRX – "Mutant 4" (Fill-Lex Records, Spain 2021) 15 Artificiero - "Carbomedic N25" (Discos Atónicos, Germany 2019) 16 Mariska Neerman - "Rise Up" Finding Our Way Back Home EP (HC Records – HCR007 Valencia, Spain 2021) 17 V9813 - "Lost To The Void" (V-MAX Records, Michigan U.S.A.) 18 De Sluwe Vos – "Switching Lanes" (Patron Records, Netherlands 2018) 19 Albert Chiovenda - "Some Wizadry Going On Here" (Legend 1997, Spain 2021) 20 Somatic Responses - "Aria" (HC Records, Spain 2020) 21 Estrato Aurora & Siarem- "400 ppm" (HC Records, Spain 2022) 22 Vofa (Sawf & ANFS) - "Agosame" (Pi Electronics, Greece 2020) 23 Oscar Mulero - "Taste The Rope" (Rave Or Die, France) 24 Umwelt - "Ravenous Horde" (Midnight Shift Records, Singapore 2021) 25 Kwartz - "Reinforced Control" (Monrella Remix) (Trauma Collective, Spain 2021) 26 Sansibar - "Sissi" (Avoidance, Finland 2020) 27 Vladimir Dubyshkin – "Grasshopper's Opinion" (трип, Russia 2019) 28 Maelstrom - "No Escape" (Acid Avengers, France 2017) 29 Silicon Scally – "Dust Biter" (Rator Mute, Spain 2020) 30 Somatic Responses - "Unreal Memory" (SR records Ammanford, UK 2021) 31 Daed – "H2fsbf6" (Dwaallicht Remix)(Analogical Force, Madrid 2020) 32 RX-101 – "Serenity" (Suction Records, Canada 1999/2019) 33 Spawn (Daniel Bell, Fred Giannelli, Richie Hawtin) – "Tension" (Sysex Remix)(Probe Records, Canada 1993) 34 Traxman - "Road Runner" (Tekworkz Rmx)(New Boy Shit Trax, U.S.A. 2018) 35 Galaxian - "Negative Realm Agenda" (Breakin' Records, UK 2019) 36 Daniel Kyo a.k.a. CØRE - "Rifaximin" (HC records, Spain 2021) @davidverdeguer @hypnoticacolectivarecords

In this episode Sal, Adam & Justin speak to Dr. Stephen Cabral about gut health, SIBO and how to correct the underlying cause of many common health problems. How misinformation is harming the health industry. (1:33) Why everything doesn't need to be black and white. (5:50) Why gut health is the epicenter of 80% of any health conditions anyone can suffer from. (8:34) What are the symptoms of having poor gut health? (11:13) How does he communicate that you may have an intolerance to “healthy” foods? (14:56) The four main issues with the gut that you have to look for. (18:25) How you may be giving yourself SIBO. (21:54) Does he see common themes with autoimmune diseases? (23:46) Why he believes irritable bowel syndrome (IBS) is NOT a disease. (25:47) His take on artificial sweeteners and gut health. (27:39) Conventional medicine NEVER provides a cure. (29:50) Are there natural antifungals one could take? (34:22) Biofilm 101. (37:46) Giveaways that you may have an autoimmune disease. (41:27) Why he would NEVER recommend any antibiotics for SIBO. (45:28) What are his thoughts on red-light therapy? (49:09) Does he believe creatine is the next big health supplement? (50:23) Can you chase aesthetics and longevity at the same time? (57:17) Why you shouldn't drink cold water. (1:06:12) Featured Guest Dr. Stephen Cabral (@stephencabral) Instagram Website Podcast Related Links/Products Mentioned June Promotion: MAPS Prime, Prime Pro, and the Prime Bundle 50% off!  **Promo code “JUNEPRIME” at checkout** Visit Joovv for an exclusive offer for Mind Pump listeners! The Rain Barrel Effect: How a 6,000 Year Old Answer Holds the Secret to Finally Getting Well, Losing Weight & Feeling Alive Again! – Book by Stephen Cabral Mind Pump #875: Dr. Stephen Cabral H. Pylori Infection: How Do You Get, Causes, Symptoms 7 Symptoms of Candida Overgrowth (Plus How to Get Rid of It) SIBO- Small Intestine Bacterial Overgrowth Parasites: Types, in humans, worms, and ectoparasites CBO FAQ - Stephen Cabral EquiLife Products Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth Mind Pump Podcast – YouTube Mind Pump Free Resources  

Resources MentionedAll About Just Thrive ProbioticProbiotic Strains and SpeciesHuman Microbiome ProjectWhat to Expect When Starting ProbioticsMigrating Motor ComplexWhat is Leaky Gut Syndrome?How to Achieve Optimal Microbiome DiversityThe Secret to a Healthy Gut Microbiome Note: There are affiliate links in this post, as I work with Just Thrive Probiotic. However, I only work with Just Thrive Probiotic because it's the probiotic my entire family uses. Because of it, when you click HERE and purchase anything from Just Thrive, you can save 15%. Simply enter code AGUTSYGIRL at checkout and you'll be in on the savings.Don't Miss These ThoughtsWhy Tina left the pharmaceutical industry to start Just Thrive HealthKiran's top 3 things you can do for your microbiome today.Food diversityIntermittent fasting + meal spacingTake the right type of probioticWhat is a spore probiotic and are they for everyone?"Most of our genetic material comes from microbes." - KiranWhat are the barriers to entry for the ecosystem?How compromised stomach acid can lead to SIBONature already created a probiotic, but how?Tina's top 3 Just Thrive Health products.Can children take probiotics? How about women who want to get pregnant, are currently pregnant, or are nursing?Babies and children sample their world around them via the mouth."A booger is essentially a vaccine." - KiranWhat exactly is the difference between Megaspore and Just Thrive Probiotics?Is it okay to take the Just Thrive Probiotic when you have SIBO?Kiran says neither Rifaximin nor herbal antibiotics work. Why?How are Leaky Gut Syndrome and SIBO connected?Liver health is directly tied to SIBO.Simple steps that can have a profound effect on your gut health and healing trajectory."We only bring things to the market that are needed and missing." - TinaTina + Kiran's top 3 convictions around gut health and gut healing."True health comes from building resilience, and resilience comes from building a healthy, diverse microbiome." - Kiran More from A Gutsy Girl1. Welcome to A Gutsy Girl Podcast2. Hang out on Instagram3. BFF's on YouTube4. Free resource: The Master Gutsy Spreadsheet5. Rated-G Email ClubBtw – don't forget to grab a copy of your 90-day healing journey journal (there is also a PDF e-version you can download today HERE).Gut DefinitionAccording to Kiran, The gut and the digestive system, from a proximity standpoint, are the same; the effects and the scope are different. Digestive system: hone in on the process; breaking down and assimilating nutrientsGut: structural ecosystem of the largest part of the microbiome and largest structural component of the immune system; acts as a central command center for the rest of your bodyJust Thrive ProbioticThe Just Thrive Probiotic, as you'll hear in the episode, is a proven, potent and effective spore probiotic.The spores in Just Thrive® have been successfully used to enhance digestive health in the pharmaceutical market for more than 50 years.What are SporesSpores and spore-based probiotics are mentioned throughout the show.At the end of the show, Kiran mentions that wherever he can put up a little post it note with these two words, he does:Eat SporesIn case you're wondering why he might do this, (because you're not fully certain as to what spores exactly are) here you go:A very basic definition of a spore is that it is a dormant survival cell.By nature, spores are durable and can survive in less than ideal conditions.All fungi produce spores; however, not all bacteria produce spores!Furthermore, fungal spores and bacterial spores are different in how they function and how they are produced.They are reproductive cells in plants; algae and other protists; and fungi. Sources: HERE and HERE.When Just Thrive refers to their spore-based probiotic, here is why the spore part is important:Their spore shell protects them from stomach acidity.The only strains used in Just Thrive Probiotic are “gut commensal,” meaning their natural home is the gut. Once in the intestines, these licensed strains of bacillus immediately move from their inactive, spore-protected state and come alive by opening their shell, eating, reproducing and cleaning up the microbial population. Wrap UpTime to wrap this up. As always, a huge goal for this show is to connect with even more people. Feel free to send an email to our team at podcast@agutsygirl.com. We want to hear questions, comments, show ideas, etc.Did you enjoy this episode? Please drop a comment below or leave a review on Apple Podcasts. Connect with A Gutsy GirlThrough the websiteOn InstagramVia LinkedIn

Resources MentionedAll About Just Thrive ProbioticProbiotic Strains and SpeciesHuman Microbiome ProjectWhat to Expect When Starting ProbioticsMigrating Motor ComplexWhat is Leaky Gut Syndrome?How to Achieve Optimal Microbiome DiversityThe Secret to a Healthy Gut Microbiome Note: There are affiliate links in this post, as I work with Just Thrive Probiotic. However, I only work with Just Thrive Probiotic because it’s the probiotic my entire family uses. Because of it, when you click HERE and purchase anything from Just Thrive, you can save 15%. Simply enter code AGUTSYGIRL at checkout and you’ll be in on the savings.Don’t Miss These ThoughtsWhy Tina left the pharmaceutical industry to start Just Thrive HealthKiran's top 3 things you can do for your microbiome today.Food diversityIntermittent fasting + meal spacingTake the right type of probioticWhat is a spore probiotic and are they for everyone?"Most of our genetic material comes from microbes." - KiranWhat are the barriers to entry for the ecosystem?How compromised stomach acid can lead to SIBONature already created a probiotic, but how?Tina's top 3 Just Thrive Health products.Can children take probiotics? How about women who want to get pregnant, are currently pregnant, or are nursing?Babies and children sample their world around them via the mouth."A booger is essentially a vaccine." - KiranWhat exactly is the difference between Megaspore and Just Thrive Probiotics?Is it okay to take the Just Thrive Probiotic when you have SIBO?Kiran says neither Rifaximin nor herbal antibiotics work. Why?How are Leaky Gut Syndrome and SIBO connected?Liver health is directly tied to SIBO.Simple steps that can have a profound effect on your gut health and healing trajectory."We only bring things to the market that are needed and missing." - TinaTina + Kiran's top 3 convictions around gut health and gut healing."True health comes from building resilience, and resilience comes from building a healthy, diverse microbiome." - Kiran More from A Gutsy Girl1. Welcome to A Gutsy Girl Podcast2. Hang out on Instagram3. BFF’s on YouTube4. Free resource: The Master Gutsy Spreadsheet5. Rated-G Email ClubBtw – don’t forget to grab a copy of your 90-day healing journey journal (there is also a PDF e-version you can download today HERE).Gut DefinitionAccording to Kiran,The gut and the digestive system, from a proximity standpoint, are the same; the effects and the scope are different.Digestive system: hone in on the process; breaking down and assimilating nutrientsGut: structural ecosystem of the largest part of the microbiome and largest structural component of the immune system; acts as a central command center for the rest of your bodyJust Thrive ProbioticThe Just Thrive Probiotic, as you'll hear in the episode, is a proven, potent and effective spore probiotic.The spores in Just Thrive® have been successfully used to enhance digestive health in the pharmaceutical market for more than 50 years.What are SporesSpores and spore-based probiotics are mentioned throughout the show.At the end of the show, Kiran mentions that wherever he can put up a little post it note with these two words, he does:Eat SporesIn case you're wondering why he might do this, (because you're not fully certain as to what spores exactly are) here you go:A very basic definition of a spore is that it is a dormant survival cell.By nature, spores are durable and can survive in less than ideal conditions.All fungi produce spores; however, not all bacteria produce spores!Furthermore, fungal spores and bacterial spores are different in how they function and how they are produced.They are reproductive cells in plants; algae and other protists; and fungi. Sources: HERE and HERE.When Just Thrive refers to their spore-based probiotic, here is why the spore part is important:Their spore shell protects them from stomach acidity.The only strains used in Just Thrive Probiotic are “gut commensal,” meaning their natural home is the gut. Once in the intestines, these licensed strains of bacillus immediately move from their inactive, spore-protected state and come alive by opening their shell, eating, reproducing and cleaning up the microbial population. Wrap UpTime to wrap this up. As always, a huge goal for this show is to connect with even more people. Feel free to send an email to our team at podcast@agutsygirl.com. We want to hear questions, comments, show ideas, etc.Did you enjoy this episode? Please drop a comment below or leave a review on Apple Podcasts.

On this episode, I discuss rifaximin pharmacology. Rifaximin is most commonly used in hepatic encephalopathy and C. difficile infection. Rifaximin systemic absorption is minimal so that is why it is primarily only used for GI conditions. Drug interactions with rifaximin are fairly minimal compared to its cousin rifampin which has tons of drug interactions.

Today we have a special guest, Dr. Jared Bunch, an international expert in atrial fibrillation and ablation, to talk about the state of atrial fibrillation and which patients benefit from early catheter ablation based on two new trials published last week in the NEJM. We also talk about whether you should stop ACEi or ARBs in patients admitted with COVID-19, whether oral antibiotics are adequate for uncomplicated appendicitis, and whether you should target a high (90 mmHg) or low (60 mmHg) paO2 in patients with respiratory failure. STOP-AF First trialEARLY-AF trialACEi and ARBs in COVID-19IV vs Oral Antibiotics for AppendicitisRifaximin after TIPS to Prevent HEReimagining Endocarditis Care in an Opioid EpidemicLower vs Higher Oxygen TargetsMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

This week we cover a new treatment submission to the FDA for the prevention of diabetes; The launch of a bupivacaine implant to treat post op pain; The DEA schedules a newly approved opioid; The FDA classifies over 200 drugs as essential and wants manufacturers to ramp up production; And more news on drugs that are in the pipeline.

Your questions answered: FMT for C. diff, coughing after eating, Rifaximin dose, red-light therapy for fatigue, spore-based probiotics and their effects on SIBO. http://drruscio.com/listener-questions-on-fmt-for-c-diff-coughing-after-eating My book Healthy Gut, Healthy You is available at https://drruscio.com/getgutbook/ Looking for more? Check out https://drruscio.com/resources  

Overuse of herbal antimicrobials in a quest to get SIBO breath test results to normalize can cause bad effects for patients. I share a case study illustrating how this practice led the patient to develop C. difficile infection. I also share the results of two studies comparing probiotics to the antibiotic Rifaximin for IBS and SIBO that suggest probiotics are similarly effective. https://drruscio.com/overuse-of-herbal-antimicrobials-probiotics My book Healthy Gut, Healthy You is available at https://drruscio.com/getgutbook/ Looking for more? Check out https://drruscio.com/resources  

We know that gut health is trending, it's pretty hot right now, right?! Well, tune in to today's episode as Mase explores SIBO with a bonafide SIBO doctor. Small intestinal bacterial overgrowth, it's a deep dive today, exploring what the heck is this actually?! Mason and Dr Nirala cover the nuanced approach required to treating SIBO, exploring why it may be overdiagnosed and other gut symptoms (constipation, food sensitivities and more).   If you've ever traveled to a third world country, got some sort of bug, 'fixed it' and then realised you never truly recovered, then today's episode is for you! (Also, if gut health and immunity are important to you, you are going to love today's episode.) Dive in, here are some of the stuff discussed in today's episode: The nuanced nature of SIBO when compared to irritable bowel syndrome To heal from SIBO, a strategic approach is required, not just a one-size-fits-all What role chronic stress plays in suffering from SIBO How hypothyroidism, mould exposure and other autoimmune diseases are connected to SIBO The misunderstanding around 'reseeding' the gut How the 'breath' test works in diagnosing SIBO Which foods to avoid during SIBO Dr Nirala's dietary treatment plan Dr Nirala covers the three possible treatment plans (herbs, antibiotics, diet) A brief touch on the Blood Type diets   Who is Nirala Jacobi? Dr. Nirala Jacobi, BHSc, ND (USA) graduated from Bastyr University in 1998 with a doctorate in naturopathic medicine. Dr Nirala practiced as a primary care physician in Montana for 7 years before arriving in Australia and is considered one of Australia’s leading experts in the treatment of small intestine bacterial overgrowth (SIBO), a common cause of IBS. Dr Nirala is the medical director for SIBOtest, an online testing service for practitioners. Dr Nirala is so passionate about educating practitioners that she founded “The SIBO Doctor”, an online professional education platform. Dr Nirala lectures nationally and internationally about the assessment and treatment of SIBO and is the host of the popular podcast The SIBO Doctor podcast for practitioners. Dr Nirala is the medical director and senior naturopathic physician at The Biome Clinic, center for functional digestive disorders in Mullumbimby, New South Wales. Dr Nirala is the co-founder of the Australian Naturopathic Summit. When she is not actively researching, seeing patients or lecturing, Dr Nirala can be found enjoying the beauty of nature   Resources: Dr Nirala's Instagram The Human Microbiome Project Dr Nirala's  FREE SIBO Questionnaire The SIBO Success Plan 8 Hour Course SIBO Mastery Program (for practitioners) Visceral Manipulation Barral Institute Feeding Your Microbiome (Dr Nirala Podcast with Dr B) The Blue Zones book Healthy to 100 book Blood Type Diet   Q: How Can I Support The SuperFeast Podcast?   A: Tell all your friends and family and share online! We’d also love it if you could subscribe and review this podcast on iTunes. Or  check us out on Stitcher, CastBox, iHeart RADIO:)! Plus  we're on Spotify!   Check Out The Transcript Here:   Mason: (00:00) Hi, Nirala.   Nirala Jacobi: (00:02) Hi, Mason.   Mason: (00:03) Did I pronounce your name correctly?   Nirala Jacobi: (00:04) You did.   Mason: (00:06) Okay. Nirala Jacobi?   Nirala Jacobi: (00:07) Very good.   Mason: (00:08) Yeah, yay.   Nirala Jacobi: (00:12) Yes.   Mason: (00:13) Okay. Guys, got to do it in person today, which is-   Nirala Jacobi: (00:17) What were the chances of that?   Mason: (00:19) Considering you live in Wilson's Creek, I think they're pretty good. But in terms of the chances of doing it, two people, that's a party but I think that's a legal party at these times, isn't it?   Nirala Jacobi: (00:29) These days, it is.   Mason: (00:31) Oh, pretty legal. Goji is sitting in the room if you hear Goj wrestling around, but dogs don't count. Guys, we're talking about SIBO. We got the SIBO Doctor here. I'm following you on Instagram for, I think, like three years.   Nirala Jacobi: (00:51) Wow. Okay.   Mason: (00:51) Yeah. I've been aware of your work. SIBO has been one of those things I used to say, facetiously, that it got trendy about three years ago in terms of I don't know where you see the mass awareness come about in the naturopathic and medical circles or whether it's even really accepted in the medical circles but, obviously, you would have watched the trend occur and then the mass misdiagnosis and then realisation that we're actually able to test and find out that it is this SIBO, which we'll find out from you what it is. Why did it, all of a sudden, hit mass consciousness? What I see a few years ago anyway.   Nirala Jacobi: (01:42) I'm going to go back nine years. I've been a naturopathic doctor for about 22 years now. I have practised in Montana and saw everything from heart disease to urinary tract infections to actual IBS or irritable bowel syndrome. We had really good result rates, but there was always a subset of patients that just did not improve. Then fast forward nine years ago, I sat in a lecture at one of our conferences and heard about SIBO. It was like a light bulb went on because it explained those cases that just didn't improve with conventional naturopathic approaches even to irritable bowel syndrome.   Nirala Jacobi: (02:27) Then, I started to become an expert in SIBO. I moved here about 15 years ago, Australia, but I became an expert and started lecturing for other supplement companies and to practitioners and started a breath testing company because there was just nothing here at all about SIBO. I think one of the reasons why it has really exponentially grown the interest is if you think that about 11% of the world's industrialised nation has IBS. IBS, according to conventional medical texts and the conventional medical approach, has no real cure.   Nirala Jacobi: (03:18) To find something that actually is the cause of IBS that is so profoundly responsive to treatment, I think, really gave hope to a lot of people. Now, of course, with that comes the fact that SIBO is often, as you mentioned, I do think there is an element of overdiagnosis. Everybody just basically treats according to the symptoms, which is not what I recommend at all. Because in that case, you can use antimicrobials and things like that for far too long.   Nirala Jacobi: (03:53) I think it has to do with the fact that there really wasn't other options for people. They really improved when they began to treat SIBO, or I saw a dramatic improvement in my patients when we finally treated the cause rather than just giving probiotics and giving fibre and giving all of the stuff that we know how to do, and people were actually getting worse, not better with those approaches. That was really my journey into this.   Mason: (04:22) That was probably about a time when I think naturopathic medicine got a little bit more integrated even. There were all these different pockets. All of a sudden, naturopaths, even though they were specialising in particular areas, became aware of just all these different specialisations, became I did say trendy for that reason, because it was about the end of that era where people were really trusting health coaches who would read up about the symptoms of SIBO and, therefore, put their clients onto an antimicrobial or whatever it was and just flying blind. You've got the breath test of your business where I see it's like if you're in Chinese medicine, you are doing pulse and tongue and the questions diagnosis. If you're in naturopathic medicine, you need that testing most of the time, I'd imagine.   Nirala Jacobi: (05:25) Yeah. I'm a gastrointestinal specialist. I don't just do SIBO. I specialise in functional gastrointestinal disorders, so I do a number of tests. This, I think, is a big shortcoming of practitioners where they consider the finances of ordering a test for a patient. I always tell practitioners that I teach, "You're not their accountant. You don't know if they want to test or not want to test, but it's your job to give them the best options and the diagnosis," because if you're just reading, you're not going to get better because SIBO is a really distinct condition that requires a really strategic approach. There's different kinds of SIBO.   Mason: (06:10) That's always what happens. Yeah. It's the same with PCOS or whatever it is. There's different arms. Obviously, there's different sources. There's mainly four major causes, is that right?   Nirala Jacobi: (06:25) There's four major groups of causes.   Mason: (06:27) Okay, okay.   Nirala Jacobi: (06:29) But maybe what we should do is backtrack and really define what SIBO is, right?   Mason: (06:33) Yeah, good idea. Well leading, you can tell you have a podcast.   Nirala Jacobi: (06:35) Yeah. All right. Let's talk about ... so that people can really understand that it's not just bacterial overgrowth, and as soon as you kill the bacteria, boom, that's it, you're cured. In some instances, that's the case, but it's actually the exception rather than the norm. But SIBO stands for small intestinal bacterial overgrowth. It's a condition where bacteria that are typically usually found in the large intestine are, for some reason, found in the small intestine.   Nirala Jacobi: (07:03) Now, the surface area of your small intestine is about the surface area of a double tennis court. Imagine having a massive bacterial overgrowth right where you absorb your nutrients, where you release your enzymes, where you do all of these different important digestive functions and, all of a sudden, that surface area is just chock-a-block with bacteria. These bacteria ferment the food that you're eating into hydrogen gas. There's a group of bacteria or a phylum called proteobacteria. The main gram-negative bacteria in that group are Klebsiella, Proteus, E. coli, those types of bacteria that are the biggest culprit for causing SIBO.   Nirala Jacobi: (07:47) Why is this happening? This is how we get into the underlying causes. I think one of the main driving cause of SIBO is, imagine you've gone to Bali, you had a case of food poisoning, or if your listener is in America, you've gone somewhere else and you had food poisoning. You came home, it resolved, but then you still have ongoing digestive symptoms. Actually, over time, they become worse, you go to the doctor, they diagnose you with IBS. That is the classic scenario.   Nirala Jacobi: (08:19) What happens there is the bacteria that caused the food poisoning are not the bacteria that are causing SIBO, but they're the bacteria that are damaging to the enteric nervous system, which is really the motility, the brain of your gut. You are meant to have this innate ability to clear bacteria from the upper gut, because the body doesn't want them there. You're supposed to sweep them all towards the small intestine. When you've had a case of food poisoning that results in this damage, you actually cannot effectively clear these bacteria from your upper gut.   Mason: (08:55) What is it that's affected in the small intestine and it stops you from having the motility to move it out?   Nirala Jacobi: (09:03) This part of the nervous system is called the migrating motor complex. It's a part of the enteric nervous system. Enteric just means digestive or your gut. It's basically the brain in the gut. This particular section of the small intestine is meant to clear these bacteria out every 90 minutes on an empty stomach. Imagine that you've had this food poisoning and it damaged that section or that particular part of what clears the gut out in the upper gut.   Nirala Jacobi: (09:32) That actually can be tested with a blood test. We're trying to get it to Australia. Because of COVID, we've had some issues. But we do want to offer this test for people to test for these antibodies, because if you know that's the cause, the proper treatment for SIBO for you would be to have antimicrobials, whether that's the conventional antibiotics that are indicated for this or herbs. Then you must follow it up with something called a prokinetic, which is a medicine that aims to reset this migrating motor complex. That's probably the biggest group of people that have this as an underlying cause.   Nirala Jacobi: (10:10) But then you also have people that just were totally stressed out for a long time. Chronic stress, as you probably have discussed this before, causes you to be in this chronic fight or flight. If you're in chronic fight or flight, you're not in rest and digest, it turns off your digestion. These natural antibiotic fluids, like hydrochloric acid, bile, digestive enzymes that are meant to kill bacteria are very poorly produced and, therefore, you suffer not just from maldigestion, but then also bacterial overgrowth. That's a different kind of cause of SIBO that then wouldn't necessarily require the prokinetics.   Mason: (10:50) Like a stealthy, slow-grown...   Nirala Jacobi: (10:54) Yeah, yeah.   Mason: (10:54) I like that you're just actually bringing up those antibacterial fluids. I was going to ask you, and you did it straight away.   Nirala Jacobi: (11:04) Yeah. Then the other one, there's more, the fourth group ... The first one would be a matter of a problem with motility. That is not just this, what we call, post-infectious IBS. It can also be hypothyroidism, other autoimmune diseases, mould exposure. All kinds of things can cause this problem with motility. Then you have these digestive factors, and not a big one because a lot of people don't think about this, but previous abdominal surgery that causes scar tissue known as adhesions that actually attach to the small intestine in the abdominal cavity and cause like a kink in the garden hose. That prevents bacteria from leaving the small intestine. Also for that, you would need prokinetics. You can see how it's so much more intricate than just, "Here are some antibiotics," or "Here's berberine and here's Allimax."   Nirala Jacobi: (11:59) One last thing I'll say about SIBO before the next question is that there are two groups. I've mentioned the proteobacteria that produce hydrogen. There's another group of ancient organisms. They probably live on Mars, too. Honestly, they're like extremophiles. They live on the bottom of the ocean. There are these ancient archaea. They're not even bacteria. They produce methane. Methane, we know, causes constipation. If you're somebody that's been diagnosed with SIBO methane or SIBO-C or SIBO constipation, it's likely that your methane is high. That's a different kind of treatment. That's starting to be thought of as actually a separate condition. That's advanced SIBO discussion.   Mason: (12:46) I like that. We always got this travelling of these bacteria up through the ... Is it the ileocecal valve?   Nirala Jacobi: (12:55) Ileocecal valve.   Mason: (12:57) Ileocecal valve. Is that a constant occurrence of reality?   Nirala Jacobi: (13:00) No.   Mason: (13:00) No?   Nirala Jacobi: (13:01) No, that is not how it happens. These bacteria, they are normal in very, very small amounts. Nothing in your body is really sterile. Nothing really, even though we think it is, but it's not really.   Mason: (13:17) But we've been told it is.   Nirala Jacobi: (13:17) Yes, exactly.   Mason: (13:17) Programmed.   Nirala Jacobi: (13:18) Yeah. It's like modern medicine at the time thought that's what it was, but it turns out that one of the most famous bacteria that survives the stomach is H. pylori. We know it can survive very well there. But you have maybe 1,000 bacteria or colony-forming unit per mil in the upper gut, just below the stomach, the duodenum. Then as you progress towards the large intestine, actually, the diversity and the sheer number of bacteria increases. That's normal.   Nirala Jacobi: (14:00) These bacteria, even though gram-negatives that cause SIBO, are actually not pathogens. They're called pathobionts. Pathobionts are organisms that you normally find in low amounts. But when they get overgrown, they become pathogenic. I often tell people, my patients, I say, "Your gut is like a white supremacists neighbourhood. It's just one kind of bacteria, and you need diversity and you need low numbers of those organisms." That's what we're aiming for.   Mason: (14:36) There's, I guess, an as above, so below, we've sterilised everything in our environment, in our house, and we have low bacterial biodiversity there, we're going to see low bacterial biodiversity internally. Is there a particular macro or even micronutrient cycles that that gram-negative bacteria ... What did you say? What was the group?   Nirala Jacobi: (15:02) The group is called proteobacteria.   Mason: (15:03) Proteobacteria. Is there anything that would feed them excessively?   Nirala Jacobi: (15:08) No, it's basically food. Those bacteria are usually found in higher amounts in the large intestine. They're normal there. A pathobiont becomes problematic when it outgrows its environment or the other bacteria in that location. They've actually just did a microbiome assessment study on the small intestine. I think the other reason, just to briefly sidetrack to get back to your first question, why is this such a big deal now, is because we know so much more.   Nirala Jacobi: (15:44) The Human Microbiome Project that's undergoing, it's like discovering the universe, because what happened before we were able to actually understand what was happening in the small intestine, we couldn't culture out these organisms because they would die. They were anaerobes. They couldn't be cultured out. Now that we have this different technology that uses RNA and DNA, we can understand far more. Now we actually understand the normal microbiome of the small intestine a lot more. It's totally fascinating to be in this field of microbiome research.   Mason: (16:26) Of the large intestine bacterial testing and analysis of the biome, testing has got a little bit more efficacy with that, is that right?   Nirala Jacobi: (16:33) Oh, way more.   Mason: (16:34) Way more?   Nirala Jacobi: (16:36) Way more, because it used to be culture-based, it turns out it's like fairy dust of what actually is in the large intestine as a representation of the ... We know about Lactobacillus and Bifidobacterium. That is literally just 2% to 5% of your entire microbiome. There are so many more species that do fascinating things.   Mason: (16:59) We've had the chat on the podcast a couple of times of why just throwing a probiotic in the gut is ... Quite often, you can get a little bit more sophisticated.   Nirala Jacobi: (17:09) I think we're at that place now where ... I'm somebody who used to just do a probiotic. "Yeah, just a couple of Bifido, couple of Lacto, you're good." But now, I'm way more strain-specific. I would use Bifidobacterium lactis HN019 if you're constipated. I'm not going to necessarily give a whole combination of products, or I give you Lactobacillus rhamnosus if you have leaky gut and eczema, for example. It's a lot more fun now than it used to be.   Mason: (17:46) Yeah, I can imagine. It's like rather than just having your shotgun, you got the Men in Black chamber. You walk and there's all different types of guns and grenades all over the wall, but in a more life-giving kind of ... Like a seed gun.   Nirala Jacobi: (18:01) I like that. Actually, this brings up a really important point, is that even when I went to naturopathic medical school, it was taught to us that we could reseed the gut. Remember that?   Mason: (18:15) Mm-hmm (affirmative).   Nirala Jacobi: (18:15) We cannot do that. These Lactobacillus and Bifidobacterium, they are response modifiers. They actually do something that is not involving reseeding. If you've lost a lot of your native species because you were on chronic antibiotics for acne, or Lyme disease, or whatever that may be, if you've lost a lot of your species or have really reduced them, probiotics will not reseed what you've lost. You can't do that. It's a really important point because some practitioners still preach this method, but I had to really switch my thinking. I tell my patients, "I'm going to give you this probiotic for this symptom. I'm not going to give it to you because you're reseeding." You can't do that. Not if it's 5% or 2% of the gut.   Mason: (19:01) In terms of it being for the symptoms specifically, is that because the probiotic is able to do it like having a short-term effect within the gut and then it's on its way?   Nirala Jacobi: (19:11) Yes, exactly. Exactly. That's what probiotic research is really good at, is seeing what symptoms a particular strain can alleviate.   Mason: (19:24) Obviously, we've touched that medication and antibiotics can be another reason why we could lead to SIBO and IBS.   Nirala Jacobi: (19:33) Medications like proton pump inhibitors that stop stomach acid, there's some debate whether or not, but I have seen people definitely have a problem with SIBO after using chronically proton pump inhibitors, and others that are more slowing the gut down. Medications like opiates and things like that, morphine will really slow it down. But then that's pretty temporary, you're not going to see chronic SIBO with that.   Mason: (20:05) Yeah. The stress factor, you're looking at a combination, mould exposure, stress, and antibiotic here and there, it's kind of a cocktail of reasons, I imagine.   Nirala Jacobi: (20:18) This is always the overwhelming part for people. It's like, "Oh, my God, where do I even begin?" But this is where a really skilled practitioner can ... I actually have a questionnaire that you can get on thesibodoctor.com. That is a questionnaire about finding the cause for SIBO. You can download it, it's free, as is the diet that I've devised for SIBO. You can take that to your practitioner and it can whittle it down to what the possible causes are. It goes through these four groups of causes.   Mason: (20:52) That's cool. Something that I really like about your approach is I'm hearing just on your website right here, you've got the patient course, practitioner course. Obviously, you're a practitioner and you've got a focus on the patient being able to understand it and get to the source themselves, getting, for lack of a better word, empowered around it, getting informed, and then bridging the way that they can then take that questionnaire and they can create a dialogue between them and their practitioner.   Mason: (21:25) It's something we always ... You go there automatically. It's why I like your work. It's something we always try to do and talk about on the podcast when we're chatting with practitioners as well, because it diffuses it. You've even got great resources there of like once you've treated yourself, how are you going to stay out of that practitioner office, which it's overlooked quite heavily. I don't know what your thoughts are on that.   Nirala Jacobi: (21:49) The SIBO Success Plan, which is the patient course, it's an eight-hour course that goes through everything from leaky gut to all these different things, it really was born out of a necessity. In a perfect world, everybody would have a practitioner that is SIBO savvy that can nail this thing for you. But I got calls from people or emails from people in Finland and from all over the world that just said, "There's no one here. No one can help me." This is the course that really had to be made for people like that. They don't have a practitioner.   Mason: (22:26) You go straight to sibodoctor.com/sibo-success-plan/. So good. Eight hours?   Nirala Jacobi: (22:35) It's eight hours because it's eight modules. One of the reasons I shouldn't say I love SIBO, because SIBO is a medical condition, but if a practitioner is listening to this, if you can master SIBO, you got the gut down. You understand practically most of the things that can go wrong with the gut, bearing in mind that there are other issues that are more anatomical problems and stuff.   Nirala Jacobi: (23:06) But everything from, like I mentioned, leaky gut, the effects of stress on the gut, what to do when you're constipated, how to help yourself with different home treatments, I have an online dispensary guide that guides you through all the major products that are out there that are for SIBO, and pros and cons and stuff like that, and food sensitivities, histamine intolerance, salicylates, oxalates, SIFO. SIFO is small intestine fungal overgrowth, which often accompanies SIBO. There's a lot there that I had to cover to really make it comprehensive for people.   Mason: (23:46) Do you do a leaky gut analysis on a patient as well? Is there always going to be a presence of SIBO and therefore-   Nirala Jacobi: (23:55) Not always. No.   Mason: (23:57) No?   Nirala Jacobi: (23:57) The thing is SIBO can cause leaky gut.   Mason: (24:00) Can cause... Right.   Nirala Jacobi: (24:00) But just because you have leaky gut doesn't mean you have SIBO. But it is a major cause of it. They've even done research on, all right, well, one month after clearing SIBO, the intestinal permeability was also resolved. If you have the wherewithal and the fortitude to get rid of SIBO, then you can also get rid of leaky gut.   Mason: (24:24) I think it's important that you said you do love SIBO because it's, as I mentioned before in the podcast, we're at that point where my mum, she's nine years post-aneurysm, 24-hour care, in a wheelchair all the time. We've done well to keep her off medications and keep her going well, but it's just this bloating that's been there and it finally got to the point where we're like, "Right, we got to test for SIBO," and so we've got there. We're doing the breath test thing. Is it five days?   Nirala Jacobi: (24:52) No, it depends on if you're constipated.   Mason: (24:55) All right.   Nirala Jacobi: (24:55) If you're constipated, it's a 48-hour prep for this test because what we want to do is have bacterial fermentation really down, really reduced before you then start the test, which is a three-hour test where, first, you get up in the morning, you drink this very sugary drink. That's a prebiotic substance that promotes the growth of those bacteria that you've starved over the past two days, one or two days. Then you're measuring your breath every 20 minutes. If we see a rise of hydrogen or methane before 90 minutes, that's the window of SIBO.   Mason: (25:36) Yeah. If you get the methane, then we're going into that real nerdy, new sector of SIBO. Is that right?   Nirala Jacobi: (25:46) Yeah. [Laughing].   Mason: (25:47) For that instance, my stepdad, he's managing that and he's just looking at like, "All right, test, okay, we can handle it," and trying to get a bunch of carers to all unite and align on that and then looking at having the management of the diet. I think the SIBO diet is the thing. That's why I say I appreciate you saying that you love SIBO because ... But I am curious when you're approaching, how do you keep the excitement up with your patients when you're-   Nirala Jacobi: (26:21) That's a really good question. I think that even just this morning, I spoke with somebody who has been ill for so long, and I'm not saying that just curing her SIBO is going to be the be-all, end-all. People are complicated. There's no one approach to it. You can have somebody who has childhood trauma. We know from studies that even childhood trauma can cause what they call adverse childhood events. It can cause a major shift in the microbiome, for example.   Nirala Jacobi: (26:53) You can have somebody like that that you work with in finding a good practitioner around trauma and regulating their own nervous system. Then you have somebody who just discovered that their house was full of mould, or you have somebody who has an autoimmune disorder or chronic viral infection. It always is different presentations. It forced me to really become really good at all these different conditions, and that's why I think if you can really not just look at SIBO, but the underlying causes for me is where it's really at where I continue to learn also.   Mason: (27:32) Yeah. I guess that's the exciting part, is knowing that you're not just going to have another random go at figuring out what's wrong with you, but you're actually ticking things off to be like, "Look, if it's not this, great. We know it's not this. We know it's not this. We know it's not moulds. That means you're getting closer." I think just the trouble is finding a good practitioner.   Nirala Jacobi: (27:56) We have an answer for that. On thesibodoctor.com, we have also the SIBO Mastery Program for practitioners. After they've completed all three levels, they're eligible to be listed free as a SIBO doctor approved practitioner, so all the people that are listed in there. We had to purge a whole bunch. We had to start fresh from scratch this January. As we go along, this list will get bigger and bigger, but they all have taken these very extensive training courses that covers all of these topics. I think you're pretty safe. A lot of them do Zoom calls. I will say that. Nowadays, we're forced to do more and more virtually.   Mason: (28:37) Which is amazing.   Nirala Jacobi: (28:39) It's amazing. It has its drawbacks. I do, as a practitioner, a hands-on practitioner that does physical assessment and certain manoeuvres, I miss that part but-   Mason: (28:50) Can you explain what the physical assessment and manoeuvres are?   Nirala Jacobi: (28:54) In America, we're trained like physicians. We're actually like naturopathic GPs, if you will. We're trained in physical exams. I always enjoyed that part of my practise, too. Some people have things like the ileocecal valve problem, which is the valve between the small and the large intestine and it can be stuck open, and then you have this backflow problem with bacteria. You can easily manipulate that with using different manoeuvres, or the hiatal hernia manoeuvre, which is part of the stomach moving into the thorax. It's those kinds of things, as well as physical exam and stuff like that. You get a lot of information from looking at somebody's body, for sure.   Mason: (29:39) Yeah, 100%. I can get the drawback, if we can get back to getting in-person as much as possible, great. Otherwise, if you're in Finland and you don't have a practitioner, "Oh, well, that's wonderful."   Nirala Jacobi: (29:49) Honestly, well, 90% of my practise is virtual, and then sometimes I'm like, "Okay, stand up, lift your shirt, press there." That will have the work.   Mason: (29:58) Yeah, you do what you have to do.   Nirala Jacobi: (29:59) Yeah.   Mason: (29:59) Do you ever recommend for people to be physically manipulating their own gut with massage as treatment?   Nirala Jacobi: (30:07) That's a great question because let's hypothetically say ... Well, let me rephrase it. Yes, if it's for just the ileocecal valve. I do have a little video on my Facebook page, The SIBO Doctor, where I go through how to do it, how to actually release the ileocecal valve yourself. It's not going to be as great as when a trained practitioner does it, but it's good. The massaging of the gut, let's hypothetically say that you're a patient that's listening to this and you're like, "Oh yeah, I may have SIBO."   Nirala Jacobi: (30:45) You may have had abdominal surgery for things like you may have had caesarian or you may have had your appendix out or you may have your gallbladder out or the myriad of other things that would be considered routine surgeries, and you have adhesions. That is not a good thing to massage your own belly because it can trigger more scar tissue formation, but light touch, we're just talking light touch. For that scenario, I usually refer to a visceral manipulation practitioner.   Mason: (31:17) What's that?   Nirala Jacobi: (31:19) Visceral manipulation, so the viscera are the organ up in the abdomen. It's extremely light touch but they are trained to actually feel the rhythms of these organs. Don't ask me what that is.   Mason: (31:31) Actually, Tahnee, my fiancée, she's a Chi Nei Tsang practitioner. Do you know that? It's Daoist abdominal massage.   Nirala Jacobi: (31:37) Oh, okay. Yeah.   Mason: (31:38) We've talked a little bit about it. I was wondering whether that's what you were talking about.   Nirala Jacobi: (31:41) Right. No. Visceral manipulation, as far as I know, there's a group from The Barral Institute and they have a very specific technique to very gently break down scar tissue or break up scar tissue.   Mason: (31:58) Okay. That's good to get that resource because there's people listening to the podcast, like Tahnee's not practising and she gets asked a lot about doing abdominal massage, so to be able to tune in with another group of practitioners that are doing this I think will help a lot of people. All right. Well, that's going to be in the show notes, gang. When we do get to treatment and, obviously, the dietary charts, there's different phases of healing of SIBO?   Nirala Jacobi: (32:27) No, so what happened is, okay, so in a nutshell, the food that promotes or that feeds the bacteria are foods that are high in fibre. That makes sense. Those are healthy foods that feed our own microbiome. That's why we want to eat them. In a case of SIBO, the bacteria are like miles further up so they're fermenting in the wrong place, and so you want to minimise those foods. Those foods are known as from FODMAPs, so Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. Did I miss it all? Did we miss one? Anyways, so these are fermentable fibres.   Mason: (33:06) Forgot the A?   Nirala Jacobi: (33:09) And.   Mason: (33:09) Oh, okay.   Nirala Jacobi: (33:13) I know, right? Those are the foods that typically are to be avoided when you suffer from SIBO. What I did is I took that diet from Monash. Fantastic work that they did over there to really pinpoint this. Before then, we didn't really know. I took that and put my own spin on it because I found even with that, people were reacting. I made it more restrictive, also added in SCD stuff and that type of thing, because I'm a very structured person and I don't like wishy-washy, vague treatment plans, and so I needed to structure it for myself.   Nirala Jacobi: (33:49) What I found is that I got very good results by having a diet that was in two phases. Then I called it the bi-phasic diet. Phase one was the most restrictive part where you have almost no grains and no fruit and really the high-fermenting foods, and you are basically getting tested for SIBO and you're waiting for your test result. I was already seeing dramatic improvement by the time they came back and yes, indeed, the test says it's SIBO, so then we initiated antimicrobials. That then prevented a massive die-off reaction of just throwing in antimicrobials in a system that was still really activated.   Mason: (34:33) Okay. You've got them going for, what, a couple of weeks now?   Nirala Jacobi: (34:35) A couple weeks, yeah. Yeah. I really did it for practitioners so that they could also tailor it. It still has different food ... Some people are very sensitive to histamines when they have SIBO, and that means no fermented foods, so no sauerkraut, those kinds of-   Mason: (34:55) That was very confusing for people, I think, about 10 years ago when capers and sauerkraut and body ecology diet and all that were going off real big time, and then some people will just get these intense levels of bloating every time they'd eat sauerkraut and kimchis and they wouldn't get it. They're like, "What's going on? This is a healthy food."   Nirala Jacobi: (35:14) "Persist. Persist. Keep it up. It's just your body detoxing." No, it's your body reacting.   Mason: (35:18) Yeah. Herxing became the ultimate. Just, "Oh, it's just a Herx."   Nirala Jacobi: (35:20) Yeah, yeah. Exactly.   Mason: (35:24) Is that normally enough to reduce the die-off from being too hard for someone just recently getting on the diet for a couple of weeks?   Nirala Jacobi: (35:32) It depends. The other thing is if somebody's really constipated, I don't start antimicrobials until at least even with the aid of magnesium oxide or something, I get their bowels moving, because if you add in antimicrobials in a really constipated system, you really are begging for a Herxheimer reaction because the river is not flowing, there's algae growing, it's muddy, it's not moving, it cannot clear out these toxins. I get the system ready before I add in antimicrobials.   Mason: (36:06) That's the most important part, is getting the river flowing.   Nirala Jacobi: (36:11) If you're constipated.   Mason: (36:11) If you're constipated.   Nirala Jacobi: (36:12) Yeah, I would say that that's often when people feel really horrible, when they start something like that and it's just not working. It's ironic because with these archaea or these methanogens as we call them, these organisms that produce methane, once it's actually reduced by the help of antimicrobials, you can expect that the bowel returns to normal, but you can't expect it if you're using some form of garlic extract to combat your methanogens. It will take you a couple of months, or if not longer, to really reduce that level to such an extent that you can have spontaneous bowel movements.   Mason: (36:53) What antimicrobials are you normally using?   Nirala Jacobi: (36:57) When we talk about treatment, there's three kinds. You have your herbs. You have your conventional antibiotics, and these are very specific antibiotics that are not for ear infections or sinusitis. Then you have a third treatment called the elemental diet. Herbs are usually berberine-containing plants, some essential oils like oregano, clove, those kinds of things. There's a bunch of herbs that I use and an extract or a low-fructans kind of garlic. Garlic typically is a FODMAP food, but if we use it with a high-allicine content, we can use quite a lot of it without a problem for these archaea, and we know that they're really effective for that. Then when you look at antibiotics, you're looking at rifaximin, which is a type of antibiotic that stays in the small intestine, doesn't get absorbed, and it's bile-soluble so it works in that perfect environment.   Mason: (37:57) Like the way doxycycline works, I think.   Nirala Jacobi: (38:00) No, doxy is way more broader and you will absorb some of that. Rifaximin is not absorbed. It stays in the upper gut. Then you have neomycin for the methanogens. Some people use metronidazole or Flagyl, and I shy away from that because I think as practitioners, we're the custodians of our patient's microbiome and we have to really respect that. Some people, I have seen some shocking microbiomes, let me tell you, by just looking at stool tests and things like that. Stool tests will not give you any information about the small intestine but, very often, it's not like it's only in the small intestine. Problems continue on with the large intestine.   Mason: (38:44) You're going to have an overgrowth most likely in the large intestine?   Nirala Jacobi: (38:45) Yeah. I've seen microbiomes that are completely denuded, like a clear-cut rainforest, and you're trying to regrow it and no wonder they're so reactive. You had actually mentioned my last podcast guest on my show was the guy who wrote Fibre Fueled, Dr. B., Dr. Will B.   Mason: (39:10) Dr. Will B. Yeah, that's what I call him instead of [mumbling].   Nirala Jacobi: (39:11) Bulsiewicz. I think it's Bulsiewicz.   Mason: (39:15) Yeah, I can never... We were in Arizona.   Nirala Jacobi: (39:19) Oh, right.   Mason: (39:20) I met him at the mindbodygreen weekend. We had a we called it dads gone wild night...   Nirala Jacobi: (39:28) Oh, do tell. Do tell.   Mason: (39:29) Yeah, it wasn't that exciting. It was just me, the DJ, and Dr. B just having chats about the gut and veganism and getting on the gluten-free beers.   Nirala Jacobi: (39:44) All right. That sounds like a hell of a party.   Mason: (39:49) Yeah, it actually was. I think tequila made its way at some point, which is wonderful.   Nirala Jacobi: (39:54) You were in Arizona after all.   Mason: (39:55) Exactly.   Nirala Jacobi: (39:56) Anyway, I really appreciated having him on the show because here he was, a gastroenterologist, epidemiologist, highly, highly trained specialist, and he had a sort of "Come to Jesus" moment when he really started to study the microbiome and started to work on it for himself. Now, he's like a complete convert about protecting the microbiome and regrowing it. I just think he's done a really good job with that book.   Mason: (40:25) Is that where his book is coming from? From that angle or-   Nirala Jacobi: (40:28) Fibre Fueled, yeah. I'm not his publicist, but I have the book and I read it and it's pretty good. Half the book is recipes, so vegan recipes, and how to regrow it. One word of caution, don't start with SIBO with that. We had this conversation. You can listen in on The SIBO Doctor podcast if you want to listen to the Feeding Your Microbiome. That shift is slowly happening. There's a lot more respect for the microbiome. I know of a lot of physicians who look back on medicine, on what it's done with antibiotics with real regret of like this was the wrong thing to do to just prescribe amoxicillin for every child's ear infection, or to prescribe for sinusitis, for these types of things. Still, to this day, it's happening day in, day out not just here but across the world where it's just way over prescribed, and it will catch up with you.   Mason: (41:33) It's an important part of any practitioner's arsenal to be able to reflect on what they're doing and not be too concrete and make sure you don't have too much morality and judgement of yourself if you did just follow the doctrine at the time, but make sure you've got the capacity to... motility to actually move on to what's important, because I know I wasn't really up on the conversation on testing the microbiome and I think we were chatting about that.   Mason: (42:01) Since then, I've got a naturopathic friend who he's basically moved a huge amount of his practise over to testing the microbiome and talking about how it takes out a lot of the guesswork, not only is it the antibiotics and seeing exactly the effect that they're having, which is great as well because you know what you've wiped out, but just dietarily as well, if it's vegan, high-carb, if it's carnivore or just high ... Whatever it is.   Nirala Jacobi: (42:32) Yeah, carnivore, I would never promote. Never because it is so hard on the microbiome. It just is. That's basically just meat, and unless you live in countries where, for centuries, that's what you did and I just ... Anyways, that's digressing but they are, and we agreed on that. We totally agreed that most diets, really if it already has a diet, then it's a fad mostly. What we know is where people live the longest and, to me, that's evidence and that's the Blue Zones.   Nirala Jacobi: (43:14) That's Dan Buettner's work. He wrote a book called the Blue Zones where people lived to be the oldest in the world, fully functional, still doing their daily work, very cognitively attentive, and very happy. There were seven hotspots in the world. They all had different things, but what they all had in common was 80% plant-based diet. For me, I'd go by that. I'd go by that. If people do well on veganism, then do that because the more plants you can eat, the more diverse your bacterial blueprint will be.   Mason: (43:56) That's always with the Blue Zones. Yeah, I first heard about it ... The book I got was Healthy Till 100, I believe it was. That book included a couple of other places. I'll put it in the show notes, guys, the scientifically proven secrets of, I think, the world's longest living people. Vilcabamba was in there in Ecuador, which I think isn't in there with Dan's work but, otherwise, it's like Okinawa, Sardinia.   Nirala Jacobi: (44:26) Yeah, and Loma Linda which is like eating processed vegetarian food.   Mason: (44:33) I think that their faith gets involved.   Nirala Jacobi: (44:33) Yeah, I don't know, but they got there in there, Sardinia.   Mason: (44:37) Maybe they're just right.   Nirala Jacobi: (44:38) Maybe. Well, who knows?   Mason: (44:40) Maybe their prayers are just better than health.   Nirala Jacobi: (44:41) Yeah, respect Loma Linda, California.   Mason: (44:44) Oh, that's right, John Robbins was the author of that book I was talking about. I like him. He balances out, because I think the thing with Dan's work which always I'm like, "So good," then he's like ... because I'm only talking about his behalf and it's like because it's 80% to 90% plant food and then 100% is the obvious conclusion, which I don't find to be the obvious conclusion.   Nirala Jacobi: (45:09) No, because I think and I will say if you look at the standard bi-phasic diet just to keep it in the SIBO spectrum, the standard bi-phasic diet is very animal protein heavy. Then I created a vegetarian bi-phasic diet, which is very amenable to vegans, and it's not just about taking the meat. That was a lot of work that I co-authored that with our clinical nutritionist, Anne Criner, here at our clinic. Then we have a third one which is the histamine bi-phasic. But there is something.   Nirala Jacobi: (45:41) A lot of people have tried veganism and it's just like, constitutionally, they just couldn't do it. I don't know what the answer is for those people because there are some people that just they get weak. Dr. B would probably argue that he thinks that everybody can live like ... I think, I shouldn't speak for him, but I don't know. I find that everybody is a bit different.   Mason: (46:09) Yeah, I'm with you as well. I find if you take one part of the body and solely focus on it, same if you're only focusing on the large intestine and the microbiome and not cellular, in particular cellular markers, then I can see how it would be really easy to justify a vegan diet. I was vegan and raw foodist for quite a while and then moved away from that direction and just was really questioning my need to eat a certain amount of domesticated vegetable and fruit matter.   Mason: (46:46) Then once I got back into the microbiome, I've really come to peace and to terms with the fact that, "No, you know what, that's ..." I was really rocking. I was rocking with that majority of my well-being, and even moving back into lentils and legumes and beans, which had a huge chip on my shoulder about. But then just staying open to ensuring there's potentially ... Like in the Blue Zones, meats are normally a side dish, and I like that.   Nirala Jacobi: (47:15) Yeah. I do, too. I know myself, I haven't eaten red meat in 40 years probably but I eat chicken occasionally. That's my one and only animal that I eat because also the carbon footprint. It's whole 'nother conversation, Mason. Nothing to do with SIBO. But in a nutshell, the diet is a therapeutic diet. It's not a stay-on-it forever diet.   Mason: (47:40) Greaaaaat distinction. I'm going to have to get excited about the diet. I'm going to have to get my mum, because I'll let you all know how. Maybe if I can have a chat again, get you back on here after, I'm going to use all your resources, all the listeners are going to ... I'll keep you in the loop of where mum's at, especially.   Nirala Jacobi: (48:02) Sure.   Mason: (48:03) Yeah, I'll let you know on an intro at some point where she comes back with in the test. If it's positive, then we'll go on that journey together. With meat and impact. Have you tried a wild, invasive deer or anything from around here. It's like-   Nirala Jacobi: (48:21) No, but I'm not opposed to it. I trust my body and I just have no affinity towards those things. Red meat, just no.   Mason: (48:35) Yeah, that's fair enough.   Nirala Jacobi: (48:38) We're really covering a lot of ground, but there's something about the whole blood type thing that I can tell you as a practitioner, that's been nearly a quarter of a century in practise that there's something about that. Blood type As tend to have a little bit harder time with digesting animal protein.   Mason: (48:58) Is that just going back to the classic book, The Blood Type Diet?   Nirala Jacobi: (49:02) Dr. D'Adamo.   Mason: (49:03) Yeah, D'Adamo. That's right.   Nirala Jacobi: (49:06) Yeah. Look, it's still got work to do, but I think there's elements that I certainly have seen be proved in practise. For me, I don't just need theories, I actually need evidence. For me, evidentially, I have seen that in practise, that people that are blood type O, they fade sometimes on a vegan diet because I don't know. I never got so fully into it that I can rattle off the science right now, but it has to do with rhesus factor and different ... Well, the theory was really that when we originated ... See, an evolution story.   Nirala Jacobi: (49:47) When we originated in Africa, everybody was blood type O because you needed to be able to eat dead animals and stuff. You had a very forgiving type of blood type that was not very reactive. Then as we moved north and into Europe, it wasn't really economical to eat your animals, and so you became more farmers and started to grow things, and that was blood type A. Then as you move further north, you had natural refrigeration, and that was the AB type or the B type, which can handle dairy really well. That's the theory anyways. I can tell you that much.   Mason: (50:22) It's a good theory.   Nirala Jacobi: (50:23) It's a good theory.   Mason: (50:23) That was always the thing with The Blood Type Diet.   Nirala Jacobi: (50:26) It checks out.   Mason: (50:27) It checks out. I remember The Blood Type Diet was a funny one because every practitioner I've talked to has said there is something to this-   Nirala Jacobi: (50:35) Yeah, there's something to it.   Mason: (50:36) But the science was never rock solid so it was open for criticism, yet anecdotally, it was on point. I love it. It's good to know. It's good to go into that world because as soon as you get into, as you said, you made that decision, it's why it's hard sometimes to listen to a practitioner talk about diet long-term because you know that the mindset is based on healing. Then as you said, this is a healing-   Nirala Jacobi: (51:03) Therapeutic.   Mason: (51:03) Therapeutic diet. Huge distinction because, otherwise, you stay in a "I'm sick" mentality long-term.   Nirala Jacobi: (51:11) Right. Look, I always tell my patients when you travel ... Well, it's a different world now, but if you were going to see Paris, I don't want you on this diet. I want you to eat baguette and dip it in the cafe au lait. I want you to eat things that you enjoy. Most of the time, when people travelling and they suffer from food sensitivity, it actually miraculously goes away. Of course, celiac disease is a different story, but there is this element of you just having just more endorphins and your secretory IgA goes up and all of that, and people can tolerate a lot of foods that they would not normally tolerate in a happy setting and a happy live-your-life, I want you to drink wine if you're in Italy. Why restrict ourselves to this myopic thinking, it has to look this way?   Mason: (52:03) It's refreshing. I like the way that you're bridging over there. It's something that I've always liked about your accessible approach because it's like bridge into what's actually going on and then I'm going to see your bridge out over there to live your life because, obviously, people do get addicted to being sick and something being wrong and then the fear of if I do something outside of the therapeutic-   Nirala Jacobi: (52:23) There's a lot of fear. There's a lot of food fear and there's this whole new term of orthorexia.   Mason: (52:29) Yeah, exactly.   Nirala Jacobi: (52:30) That's a real thing. A lot of people are so concerned about having made some small error on the bi-phasic diet. I'm like, "You've made no error. It's fine." Not just the bi-phasic diet but also anything, really. They get very, very hooked on that they did something wrong, and there's a lot of food fear and that. Imagine, you're sitting down to eat your meal and you're already worried about the food. Sometimes, I tell people sit for two minutes and just appreciate the food, just take a moment and get into a rest and digest before you eat.   Mason: (53:13) That's where the prayer comes in, the grace.   Nirala Jacobi: (53:16) It used to be prayer, it used to be grace, all of that. That's all. It's a thing.   Mason: (53:21) I feel like we go down this rabbit hole, that's probably another podcast talking about the orthorexia. I know it very well. I've had to go. I was so down the rabbit hole of raw foodism. I had to go and start eating things that I swore I would never eat again to start cracking myself out of just like that scrubbing myself clean with my diet. It's hardcore, and it isn't orthorexia, and it isn't eating disorder in varying degrees. But thanks for bringing it up, because especially when you're promoting a therapeutic diet, I always think the duty of care comes with making sure that people and patients are aware not to get stuck in it. Thank you for that.   Nirala Jacobi: (54:00) My pleasure.   Mason: (54:02) I had really a lot of fun chatting with you.   Nirala Jacobi: (54:03) I did, too. We've covered a lot of ground.   Mason: (54:06) We've covered a lot of ground. We run really fast on this podcast. Look, let's just repeat it again. The SIBO Doctor podcast, and it was episode 64 and 65 that we just talked about with Dr Will B. Worth probably checking out.   Nirala Jacobi: (54:26) It's on iTunes. It's on everywhere. You can go to The SIBO Doctor and just look around. There's resources. All the guides are free downloads, the handout on bringing that to your practitioner in terms of what caused you SIBO. It's a free download. There's a lot of videos, lots of stuff. I'm on Instagram, Dr. Nirala Jacobi, the SIBO Doctor.   Mason: (54:46) Perfecto. Thank you so much.   Nirala Jacobi: (54:48) Boom.   Mason: (54:49) Boom.   Nirala Jacobi: (54:50) Mic drop.   Mason: (54:52) All right. All right. That didn't work. That was a terrible mic drop.   Nirala Jacobi: (54:55) No, that's a very sensitive, very fancy road microphone.

Is there a connection among Hashimoto’s disease, hypothyroidism, and small intestinal bacterial overgrowth also known as SIBO? Does Hashimoto’s disease cause SIBO or does SIBO cause Hashimoto’s? I’ll answer these questions in my latest research review below. There isn’t a lot of research, only two papers actually, on the specific connection between Hashimoto’s disease and SIBO which I’ll cover in this article. There are more papers on the connection between hypothyroidism and SIBO without mention of Hashimoto’s and the basic conclusion of those papers is that hypothyroidism is connected to SIBO because gastric motility is decreased in hypothyroidism. Decreased gastric motility basically means the food you eat is moving through the bowels to slowly so bacteria can build-up in the small intestine. The first paper is entitled, “Association between Hypothyroidism and Small Intestinal Bacterial Overgrowth” published in the Journal of Clinical Endocrinology and Metabolism. The authors begin by giving an overview of SIBO which is basically an overgrowth of bacteria in the small intestine which damages the gut wall leading to malabsorption of nutrients. The main signs and symptoms of SIBO are bloating, abdominal pain, cramping, gas, weight loss, and diarrhea or constipation or actually a mix of the two. The main causes of SIBO are hypothyroidism, proton pump inhibitors and antacids, Helicobacter pylori, autoimmune disease, malnutrition, and immune dysfunction. Anything that can decrease gut motility may lead to SIBO such as gut surgeries, inflammation, metabolic issues, endocrine diseases, and muscle and nerve illnesses. We know that thyroid hormones, especially T3, are involved with proper movement of food through the intestines known as peristalsis. Those with hyperthyroidism tend to have diarrhea and those with hypothyroidism tend to be constipated due to too much or too little thyroid hormone. The authors wanted to answer three questions: 1. Is hypothyroidism associated with the development of SIBO? 2. How does treatment of SIBO affect those with hypothyroidism? 3. Does SIBO affect thyroid hormone levels? How was this study on Hashimoto's Disease and SIBO done? 50 patients with hypothyroidism due to Hashimoto’s disease were enrolled. TSH, Free T4, Free T3, thyroid peroxidase (TPO), and antithyroglobulin antibody were tested. Hypothyroidism was considered a TSH above 2.8 and low Free T4 and Free T3 which was quite promising because most studies use a higher cut-off point for TSH. Thyroid antibody levels were elevated and thyroid ultrasounds were done showing tissue changes in the thyroid gland which is a normal sign in Hashimoto’s disease. These patients were supplemented with synthetic T4 which normalized their thyroid function in 2-6 months before beginning the study. The good news is that we did have a control group of 40 healthy volunteers which strengthens the validity of the study. A glucose breath test was done on everyone to measure hydrogen levels which is a gas produced by bacteria in the gut. Every patient who tested positive for SIBO was then treated with the antibiotic Rifaximin for 7 days. A glucose breath test was then repeated one month after the antibiotic treatment to see if the SIBO was eradicated. Thyroid hormone levels were tested prior to beginning the study and one month after antibiotic treatment and then one month after the initial evaluation in those who didn’t have SIBO. Patients were asked to fill out a symptom questionnaire before and after treatment including abdominal pain, bloating, gas, constipation, or diarrhea. What were the study results? 27 patients or 54% of the study group tested positive for SIBO compared to only two in the control group which was statistically significant. No significant association was found between the presence of SIBO and age of hypothyroidism diagnosis, time from diagnosis, or average T4 daily dose.

Do you suspect Candida or SIBO is at the root of your digestive concerns? Want to know how to distinguish symptoms of candida overgrowth from small intestinal bacterial overgrowth? Curious about where to start with testing and treatment options? Tune in to hear Ali and Becki take a deep dive into bacteria and yeast overgrowth, assessment for overgrowth, compounds used clinically for treatment, biofilms, lifestyle elements of cleanse support and beyond!   In this episode, Ali and Becki go deep into the topic of candida and SIBO and discuss both the overlapping and distinguishing symptoms of both. Learn about assessment options from blood to stool to breath testing and how you can test at home with a probiotic challenge. Plus get insight into best treatment if dealing with candida or SIBO, how to support bowel motility, bust biofilms and more!   Also in this Episode: Virtual Food As Medicine Ketosis Class - Starts April 10th! Food As Medicine at the Farm - April 25 Past Podcasts on Gut HealthEpisode 87: The Gut Brain Axis Episode 60: Dysbiosis Episode 22: Candida Albicans and Yeast Symptoms of Candida and SIBOTake the Candida Quiz Why Does Overgrowth Occur? Testing For Candida and SIBOMRT Food Sensitivity Test Stool Test How to do a Probiotic Challenge Treatment RecommendationsBeat the Bloat: Candida Ebook & Supplement Bundle GI Reset Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study Supplement Recommendations for Bowel MotilityDigestaid B Complex Relax and Regulate Biofilms and Treating Resistant Yeast and BacteriaCellular Antiox Inflammazyme Biofilms: the Barriers of Bacteria Blog Lifestyle Support for CleanseDetox Supporting Turmeric Lemonade How Keto Carnivore Can Be SupportiveEpisode 127: In Defense of Vegetables How Low FODMAPS Can Help Rebuilding Bacteria After a CleanseBacteria Rebuild Bundle   This episode is sponsored by Further Food, a female owned and operated company that provides the highest quality food as medicine supplements including their Collagen Peptides, Pasture-Raised Gelatin Daily Turmeric Tonic and Mindful Matcha.  

Cirrhosis TIPS for the decompensated cirrhotic & acute on chronic liver failure from expert hepatologist and keto-practitioner Scott Matherly MD, @liverprof and chief hepatologist at @KashlakHospital. We walk through acute management of variceal bleeds, when to suspect SBP in decompensated cirrhosis (all the time, it turns out), how much fluid to remove in paracentesis, and some definitions about what decompensated cirrhosis and acute on chronic liver failure really mean. Take our pretest on cirrhosis! Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4, Matthew Watto MD Pretest by: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Images and infographics: Hannah Abrams MS3 Edited by: Matthew Watto MD Guest: Scott Matherly MD Sponsor  Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 NephMadness teaser 00:50 Sponsor - Become an ACP Member today! 01:25 Intro, guest bio 03:45 Guest one-liner, keto diet 07:40 Picks of the week from Paul, Matt and Scott 11:50 Sponsor - Become an ACP Member today! 13:26 Clinical case of bleeding and altered mental status in cirrhosis 16:10 Interpretation of our patient’s labs and physical exam 18:53 Defining terminology in cirrhosis (decompensated vs compensated vs acute on chronic liver failure) 24:48 Initial workup, resuscitation and stabilization in variceal bleeding 26:10 Why occult blood and ammonia levels are unhelpful in cirrhosis 29:00 Fluid choice for the cirrhotic patient with hypotension; octreotide (or terlipressin); antibiotics prophylaxis 33:10 Proton pump inhibitors and ulcers from variceal banding 34:00 Mechanism of action for octreotide and terlipressin 35:54 Prevention of recurrent bleeding with TIPS, or nonselective beta blockers 40:40 Scores for prognostication in the acute setting 44:00 Coagulopathy of cirrhosis and should DVT prophylaxis be used 48:38 Elevated INR and procedures 56:55 Paracentesis in the acute setting and interpretation of fluid studies:cell count, total protein, SAAG, blood culture vial; pathophysiology of ascites 67:30 Treatment of SBP: antibiotics, IV albumin; plus, Hepatorenal physiology explained 79:04 Hepatic encephalopathy is a shunt phenomen; how to evaluate for causes; treatment of HE 87:58 Rifaximin 89:10 Take home points 91:02 Outro

Some debates about small intestine bacterial overgrowth (SIBO) can take information out of context. A nuanced examination of relapse rates after Rifaximin, or breath test intervals, may spur a conclusion that SIBO treatments and tests just don't work. Research disagrees over the extent to which antibiotics, herbal antimicrobials, probiotics, the low FODMAP diet, and other treatments impact SIBO. SIBO is a complex condition, and treating for the root cause is important. We discuss our clinical perspectives and the latest research on SIBO testing and treatment. https://drruscio.com/?p=28107 My new book is finally available: Healthy Gut, Healthy You. Click here to learn more: https://drruscio.com/getgutbook/ Looking for more? Check out our resource page that includes how to become a patient, how to sign up for my clinical training newsletter, and more. https://drruscio.com/resources

Joining us today is Dr. Michael Ruscio, author of his new book Healthy Gut, Healthy You. In this episode Ben and Tom dive into all things gut health. They talk in depth on how he diagnoses gut issues in his patients, lifestyle factors that contribute to GI distress & dietary approaches one should start with. He goes into detail on what leaky gut syndrome is and 3 things everyone should know about the microbiome. Find out why you should aim for a broad diet and listen to your body. Timestamps How does he first go about diagnosing potential gut issues for new patients coming to his practice? [1:05] What lifestyle factors contribute to GI distress and inflammation? [3:27] What dietary approaches does he recommend people start with? [7:50] Depending on someone’s symptoms, does he recommend a different intervention secondary to changing the diet? [11:36] How do you distinguish between leaky gut vs. microbiome dysbiosis? Should we be testing ourselves? [18:12] What is leaky gut and the causes of it? [24:03] If under a mass amount of stress, does the type of foods you eat matter? [30:39] What 3 things should EVERYONE know about the microbiome? [34:02] The differences between candida symptoms/protocol and a microbiome protocol. [38:45] [41:00] What is his favorite example of antimicrobial supplements? [43:37] Do we have an ideal scenario for what a healthy microbiome looks like? [44:33] What strategies can people with histamine levels implement to heal their gut? [47:52] What supplements are beneficial to one’s gut health? [50:41] How much is glyphosate playing a role in our microbiome health? [51:35] Are there daily strategies to mitigate your gut dysbiosis? [53:30] What supplements can alleviate high anxiety? [55:50] Do fermented foods add any value to one’s diet? [58:51] Featured Guest Dr. Michael Ruscio (@drruscio) • Instagram Website Book Related Links/Products Mentioned Controversies and Recent Developments of the Low-FODMAP Diet Starting the Low FODMAP Diet GA-map technology principle Diet and Inflammatory Bowel Disease Gut microbiota role in irritable bowel syndrome: New therapeutic strategies Can probiotics help treat depression and anxiety? Probiotic use linked to improved symptoms of depression Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth Shinrin-Yoku Forest Medicine Your Gut Bacteria Doesn't Like Junk Food—Even If You Do - Blue Zones Kids Who Grew Up on Farms Have Fewer Allergies: Study Low-Histamine Diet & Histamine Intolerance Guide Allergies? Probiotic combination may curb your symptoms, new study finds People Mentioned Robb Wolf (@dasrobbwolf) • Instagram  

In Folge #127 Mein heutiger Gast ist Philipp Nedelmann. Er ist Heilpraktiker und Co-Founder von Sibolab. Es gibt inzwischen mehrere Millionen Menschen in Deutschland, die unter ständigen Verdauungsstörungen leiden. Ärzte nennen diese Krankheit häufig Reizdarm. Die Verbreitung dieses Leidens nimmt rasant zu. Viele Betroffene haben Ärzte-Odysseen hinter sich, ohne dauerhafte Besserung zu erreichen. Die Dünndarmfehlbesiedelung (DDFB bzw. SIBO) ist eine noch wenig bekannte Problematik. Herkömmliche Stuhluntersuchungen eignen sich nicht um SIBO zu diagnostizieren. Wir sprechen in dieser Folge über SIBO, was es ist und wie es entsteht. Welche Symptome sind typisch für SIBO und welche Testmethoden eignen sich. Wir sprechen auch über Therapiemöglichkeiten und was du dagegen tun kannst. Bitte beachten Sie auch immer den aktuellen "Haftungsausschluss (Disclaimer) und allgemeiner Hinweis zu medizinischen Themen" auf https://paleolowcarb.de/haftungsausschluss/ 20% auf alle Produkte im BRAINEFFECT Shop Gutscheincode: Evolutionradioshow - 20% auf alle Produkte im BRAINEFFECT Shop unter www.brain-effect.com Das Video der aktuellen Folge direkt auf Youtube öffnen Und nicht vergessen: Wenn du uns auf Youtube siehst, und wenn du es noch nicht getan hast, dann abonniere unseren Kanal „Evolution Radio Show“ Wenn du das Podcast hörst, dann findest du die Links für Apple iTunes und Android hier auf unserer Homepage Transkript Klassische Symptome einer Dünndarmfehlbesiedlung, SIBO, 02:42 Was ist und wie entsteht SIBO?, 04:50 Unterschiede in Lebensbedingungen und Wirkungsweisen von Bakterien in Dünn- und Dickdarm, 07:27 Unterschiede zwischen Philipps Testmethode und herkömmlichen Tests, 10:35 Behandlungsmöglichkeiten nach positivem Test, 20:41 Die-Off-Syndrom, 26:12 Kontaktmöglichkeiten, 25:24 Julia: Ja lieber Philipp, Herzlich Willkommen zur Evolution Radio Show! Bitte, vielleicht stell dich einfach mal kurz vor. Was ist deine Profession? Was ist dein Hintergrund und wie hast du in das Thema hinein gefunden? über Philipp, 00:30 Philipp: Ok, ja, danke. Gerne stelle ich mich kurz vor. Also Philipp ist mein Name. Seit 2006 bin ich Heilpraktiker und habe so also mit der Naturkunde meine Praxis gestartet und bin über die Jahre immer mehr in das Thema Darm würde ich sagen auch hinein gerutscht, weil es auch immer mehr Leute, immer stärker Leute betrifft, dass Nahrungsmittel Probleme bereiten können, dass der Stuhl sich so verändert, dass die Verdauung sich so verändert. Und besonders eigentlich so in das Thema, das mir so sehr am Herzen liegt mit dem Reizdarm kam ich über einen Patienten vor vielen Jahren, der zu mir kam und wirklich massive Probleme hatte und dem bis dato nicht geholfen werden konnte. Wir haben - das ist auch tatsächlich eine ganz lange Geschichte, ich will das ein bisschen kürzer krempeln - sehr sehr viel ausprobiert mit dem. Ja, weil auch die gängigen Tests, auch Nahrungsmittelunverträglichkeitstests einfach nicht griffen. Und wir kamen über diese Reise dann bei dem Thema an, dass sich vermutlich Bakterien in seinem Dünndarm angesiedelt haben, die da diese Probleme verursachten. Und darüber sind wir dann weiter tiefer reingegangen und haben das Ganze ermöglicht auch für andere Patienten. Und seit dem beschäftige ich mich mit diesem Thema SIBO, also Small Intestine Bacterial Overgrowth Syndrom, sehr, ja und sehr intensiv. Meine Praxis habe ich in Berlin, also zu meiner Person und lebe hier auch schon eine ganze Weile mit Familie und bin sehr happy. Julia: Ja, du hast ja gesagt das nennt sich SIBO oder Dünndarmfehlbesiedlung. Auf Deutsch findet man das dann auch oft unter dem Begriff. Jetzt sind ja vielleicht also viele schon grundsätzlich mit dem Thema vertraut, ja das ist der Mikrobiom und es gibt ja auch schon einige Stuhltests usw. Aber das SIBO das ist ja doch etwas ganz anderes, die Fehlbesiedlung im Dünndarm. Was würdest du denn sagen, einmal was sind denn so die klassischen Symptome für jemanden der eine Dünndarmfehlbesiedlung hat? Klassische Symptome einer Dünndarmfehlbesiedlung, SIBO, 02:42 Philipp: Ja, also das klassischste Symptom von allen ist eigentlich der Blähbauch und zwar die Gasentwicklung irgendwo im Bauch, ohne dass sie entweichen kann, ja, entweder nach oben oder nach unten abgehen als Winde. Dann haben sich Gase im Dünndarm gebildet und da muss man sich immer die Frage stellen, wie kann das sein? Womit hat das etwas zu tun? Wurden jetzt einfach nur unglaubliche Mengen an Kohl und Zwiebeln und Knoblauch zugleich gegessen? Oder passiert das tatsächlich auch bei verschiedenen anderen Nahrungsmitteln, die man gar nicht so im Verdacht hatte? Genau, das ist so das was ganz vorne oben steht. Und dann kommen Folgeprobleme, wie z. B. erhöhte Stuhlfrequenz, also dass es in Richtung Durchfall geht, in Richtung Verstopfung geht, Oberbauchschmerzen gehören dazu. Das wäre so das Klassischste was in dem Rahmen ist. Das betrifft aber schon sehr sehr viele Menschen. Also in Deutschland sind es bestimmt 15 Mio. Menschen die von genau solchen Problemen betroffen sind, ja. Und dann kann das aber noch weiter gehen, dass selbst Hautprobleme entstehen oder Blutdruckschwankungen. Dann sind es Konzentrationsprobleme. Da sprechen die Amerikaner vom sog. Brainfog. Ja, da hast du das Gefühl als hättest du einen Helm auf oder eine nebelige Sicht. Das sind so Rosacea im Gesicht oder auch Fibromyalgie. Das ist eine schmerzhafte Erkrankung des gesamten Bewegungsapparates, die sehr schwer zu klassifizieren ist und sehr schwer einzuordnen ist. Das sind so Sachen, die auch mit einer Dünndarmfehlbesiedlung assoziiert werden können, also in Zusammenhang gebracht werden können. Julia: Ja, spannend, eigentlich auch sehr sehr vielfältig von den Symptomen her. Jetzt einfach nicht nur ok so Blähbauch oder was. Da könnte man jetzt noch dran denken, aber dann doch so Sachen wie Konzentrationsstörungen und auch Fibromyalgie ist ja doch etwas, was man jetzt vielleicht im ersten Moment nicht direkt mit dem Darm in Verbindung bringen würde. Was ist eigentlich SIBO und wie entsteht das? Was ist und wie entsteht SIBO?, 04:50 Philipp: Also SIBO, oder auch dieses DDFB, das hattest du ja vorhin gesagt im deutschen Raum findet man das häufig auch darunter, oder bakterielle Fehlbesiedlung des Dünndarms, bedeutet in der Regel, dass Bakterien aus dem Dickdarm es geschafft haben, in den Dünndarm überzusiedeln. Und dort verursachen sie dann die Probleme, weil sie im Grunde genommen ihrer ganz normalen Aufgabe nachgehen, nämlich Reste von Zuckern oder Kohlenhydraten die im Dickdarm ankommen, zu verstoffwechseln, und dabei entstehen Gase. Das ist vornehmlich Wasserstoff. Das gibt aber auch bestimmte Gruppen von Bakterien oder Bakterien ähnlichen Gattungen, die können den Wasserstoff umwandeln in Methangas. Da kann man vielleicht später noch mal etwas dazu sagen, wenn wir mal über den Test ein bisschen sprechen. Aber die Ursachen dafür, für so eine Dünndarmfehlbesiedlung, liegen meistens in einer Lebensmittelvergiftung oder einer Magen-Darmgrippe oder einem verstärkten Gebrauch oder Anwendung von Antibiotika oder auch Protonenpumpenhemmern, also Magensäureblockern. Julia: Ok. Philipp: Das kann auch ganz häufig vorkommen. Und in der Regel wie gesagt kommt die Bakterienfehlbesiedlung von hinten vom Dickdarm. In manchen Fällen geht aber die Besiedlung auch von oben los, vom Magen. Und das wäre dann der Fall, wenn der erste Abwehrring, die Magensäure, nicht richtig greift und Bakterien aus der Nahrung in den Dünndarm geraten, die dort dann für Unruhe sorgen. Das könnten dann tatsächlich auch pathogene Erreger sein. Ansonsten in der Regel was vom Dickdarm kommt, sind Bakterien die zu uns gehören. Deswegen erkennt unser Immunsystem die auch nicht und wir haben nicht, eigentlich keine weiteren Krankheitssymptome, sondern Beschwerden. Aber wir reagieren darauf nicht mit Fieber oder mit anderen Abwehrmechanismen, weil das im Grund genommen sich um unsere Bakterien handelt, ja. Man kennt sich, man greift sich auch nicht an. Aber für die Bakterien ist das paradiesisch im Dünndarm, kaum Konkurrenz, sehr viel Nahrung. Da wird dann fröhlich umgewandelt. Das ist der Rest von Kohlenhydraten oder was generell an Kohlenhydraten da ist. Gerade im hinteren Abschnitt wird ja die Laktose auch aufgenommen. Der Zucker wird dann gerne von Bakterien gespalten und dabei entstehen eben Gase. Ja, das ist für die Bakterien Energiegewinnung und das macht uns dann die Probleme, weil die Gase nicht einfach entweichen können. Julia: Und weil du gesagt hast im Darm oder im Dünndarm herrschen paradiesische Zustände für die Bakterien, vielleicht kannst du mal erklären wieso. Was ist der Unterschied jetzt zwischen dem Dünndarm und dem Dickdarm und auch hinsichtlich natürlich der Bakteriendichte und auch der Lebensbedingungen? Unterschiede in Lebensbedingungen und Wirkungsweisen von Bakterien in Dünn- und Dickdarm, 07:27 Philipp: Da ist der Dünndarm, der gilt als steril. Wir haben im Dünndarm pro ml Schleimhautflüssigkeit etwa, naja unter 10.000 Bakterien. Im Dickdarm sieht das ganz anders aus. Das klingt viel, ist aber unglaublich wenig. Im Dickdarm haben wir pro ml Schleimhautflüssigkeit mehr als 1 Milliarde Bakterien. Da herrschen also ganz andere Konkurrenzverhältnisse und auch Mengenverhältnisse an Bakterien insgesamt. Und das über den ganzen Dünndarm hinweg, der ist ungefähr 4 Meter lang. Der Dickdarm ist noch mal 1 Meter lang. Also wir haben hier auch so ein bisschen was Größenordnung angeht verschiedene Verhältnisse. Und wenn es nun Bakterien eben rüber schaffen, dann ist tatsächlich dieser Zustand gegeben, dass da wenig andere Bakterien sind und eben sehr viel Nahrung. Deswegen verschwinden die auch nicht einfach so von selbst. Dazu muss aber auch noch kommen, dass die Peristaltik vom Dünndarm nicht gut funktioniert, also die Eigenbewegung des Dünndarms und dass die Ileozäkalklappe nicht richtig geschlossen hat, weil das ist die Pforte, durch die die Bakterien durchwandern. Julia: Also das ist die zwischen dem Dünndarm und dem Dickdarm dann, oder? Philipp: Genau, die ist genau zwischen Dünndarm und Dickdarm. Die ist eigentlich so die Grenzpforte und soll, im Inneren geht es eigentlich nur in eine Richtung. Es geht vom Dünndarm in den Dickdarm. Wenn die aber nun durch bestimmte Verhältnisse, wie gesagt Magen-Darmgrippe, Lebensmittelvergiftung etc., da außer Kraft gesetzt ist oder auch die ganze Motilität, also Eigenbewegung, Peristaltik, die Bewegung des Darms außer Kraft gesetzt ist, dann können es Bakterien unter Umständen rüber schaffen und die dann auch von selber nicht mehr weggehen. Julia: Wäre denn auch z. B. so etwas wie eine Darmspülung oder eben so eine Colon-Hydro-Therapie auch ein mögliches Risiko, dass die da reingespült werden? Philipp: Ja, das wäre auf jeden Fall denkbar. Also die Erfolge die mit Colon-Hydro-Therapie da sind oder auch die Erfahrungen, die sind meine ich ganz gut. Ja, vielen Leuten hilft das auch sehr auch z. B. bei der Gewichtsreduktion oder bei der Reinigung oder was Hautprobleme angeht ist es eine ganz bewährte Therapie. Aber wenn es sich eh schon um ein schwaches Darmsystem handelt, ja, und nun über die Wassermenge und die Massage da auch Flüssigkeit in den Dünndarm rein gerät, dann wäre das denkbar, dass auch entsprechend Bakterien mitkommen. Ausschließen kann man das nicht. Julia: Ok. Ich meine du hast ja jetzt schon gesagt oder so ein bissel angesprochen die Sache mit dem, eben dass die verschiedene Gase bilden. Jetzt ist es ja so, es gibt eben einige ja schon Labors, die solche, also Tests anbieten, ja. Aber ihr habt ja bei euch eine ganz bestimmte Besonderheit bei eurem Test. Was ist jetzt der Unterschied zwischen eurem Test und dem Test, der oft sonst angeboten wird? Ja, eben was sind da die Unterschiede und warum ist da eurer praktisch genauer oder dem überlegen? Unterschiede zwischen Philipps Testmethode und herkömmlichen Tests, 10:35 Philipp: Ja, also es gibt da glaube ich verschiedene Punkte. Das wesentlichste Merkmal von unserem Atemgastest, das ist es ja dann, ist, dass wir nicht nur Wasserstoff messen sondern auch Methangas. Dadurch bekommen wir viel mehr Information über das was im Dünndarm passiert und bekommen auch die sog. Non-responder. Es gibt viele Leute die machen einen Wasserstoffatemgastest, dann auch auf Laktose oder Fruktose oder Glukose, Sorbitol – das sind so die Gängigsten – und haben aber keinerlei Anstieg, obwohl dabei Beschwerden bestehen, ja, obwohl der Bauch sich wölbt mit Gasen oder der Darm und dann meinetwegen auch Oberbauchschmerzen auftreten bis hin zu Durchfall. Und wir können eben auch das Methangas erfassen und kriegen den Non-responder. Dazu messen wir auch noch gegen CO2, also dass Messfehler bei der Durchführung des Tests auch ausgeklammert werden können. Das können wir dann korrigieren. Dann haben wir ein etwas, da haben wir ein stimmigeres Messergebnis. Dann kommt noch dazu, dass – das will ich jetzt gar nicht anderen Tests absprechen, aber das können wir unserem Test auf jeden Fall fürhalten – dass wir auf eine sehr hohe Qualität achten bei den Röhrchen. Wir haben Glasröhrchen, die haben einen besonderen Gummistopfen und die sind sehr stabil. Also die Atemgase die abgefangen wurden da drin, die sind bis zu 2 Wochen stabil, ja. Und dadurch haben wir die Möglichkeit, diesen Test auch quer durch Europa zu schicken, ggf. auch noch weiter. Julia: Das ist toll. Philipp: Ja, das ist ein Riesenvorteil. Julia: Also das heißt eben, weil du sagst eben Atemgase, also hier die Analyse würde eben nicht wie bei der Fehlbesiedlung oder Dysbiose im Dickdarm jetzt über Stuhl eben ablaufen, sondern über einen Atemgastest. Auch interessant, dass man das eben anders untersucht, weil würde man irgendetwas auch in einer Stuhlprobe sehen oder gibt es da Hinweise, wenn z. B. irgendwas im Stuhl schon nicht in Ordnung ist, dass das dann auch auf eine Dünndarmfehlbesiedlung hinweist? Philipp: Ja danke, dass du das ansprichst. Also die Stuhluntersuchungen können da ganz spannend sein und aufschlussreich sein. Leider bekommen wir eben über den Florabefund keine gute Aussage über den Dünndarm. Das liegt zum einen daran, dass dort auch eigentlich keine Bakterien sein sollen und zum zweiten muss der Stuhl auf dem Weg nach draußen und in das Röhrchen hinein ja durch den Dickdarm durch. Dann ist der komplett kontaminiert von allen Dickdarmbakterien, so dass man da keine vernünftige Aussage bekommt. Ja das ist eben wieder das Mengenverhältnis von Dünndarmbakterien zu Dickdarmbakterien. Im Grunde genommen sind ja die meisten Stämme auch im Dickdarm vertreten. Also kriegen wir da nichts über eine Dysbiose oder Fehlbesiedlung des Dünndarms raus. Was Sinn machen kann, ist eine Floramessung zu machen, wenn da wirklich eine starke Dysbiose ist, weil auch bei der Stuhlprobe kann es zu Messfehlern kommen durch zu lange an der Luft, zu lange Transportwege etc. Ja, das sind ja Bakteriengattungen, die einen können mit Luft gut umgehen, die anderen vertragen Luft eher nicht so gut. Da hat man häufig schon eine leichte Dysbiose. Das kann man halt auch so ein bisschen rausrechnen wenn man sich die Floramessung anguckt. Ja, aber wenn da was Starkes vorliegt, dann ist das schon natürlich auch sinnhaft, da mit einem Probiotikum eine Aufbaukur zu machen. Julia: Ok. Philipp: Das sehe ich schon so. Nur leider kriegen wir eben über den Dünndarm dann nicht viel raus. Das heißt, wir brauchen eine andere Strategie, um diesen Dünndarm zu screenen, weil einfach mit einer, so was jetzt gerade bei dem Reizdarm ja häufig gemacht wird, das sind Magenspiegelungen und dann Darmspiegelungen. Das heißt wir gucken von oben in den Körper rein und wir gucken von unten in den Körper rein, messen aber nicht die 4 Meter Dünndarm, ja. Die 4 Meter Dünndarm werden außen vorgelassen, weil dort im Grunde genommen nicht viel passiert so an Bakterienaktivität usw. ja, und das wird auch gar nicht vorausgesetzt. Das heißt, wir brauchen hier eine besondere Strategie. Und da lässt sich über das Atemgas eben recht genau feststellen, ob dort schon bakterielle Aktivität stattfindet oder nicht, dann in welchem Ausmaß und auch ungefähr wo. Wenn die Atemgase sehr früh ansteigen, also jetzt Wasserstoff und Methangas, dann können wir davon ausgehen, dass auch recht dicht beim Magen schon so eine bakterielle Aktivität stattfindet. Wenn das eher so zur Mitte hin ist oder zum Ende können wir sagen, ok das ist vielleicht noch weiter hinten, das lässt sich auch eher so oder so behandeln. Also auch tatsächlich sind die Therapieentscheidungen etwas unterschiedlich, je nach dem wo die Atemgase ansteigen. Julia: Aha, das heißt also z. B. könnte man jetzt davon ausgehen, vielleicht dass wenn es eher am Anfang des Dünndarms ist, dass wohl eher die Einwanderung vom Magen ausgeht, also vielleicht zu wenig Mangensäure da ist oder da pathogene Keime sind und wenn es am Ende des Dünndarms ist, eher vom Dickdarm aus die Besiedlung stattfindet? Philipp: Also genau, bei letzterem können wir ziemlich sicher sagen, dass es dann vom Dickdarm aus kommt, wenn die Atemgase eher spät ansteigen. Wenn sie früh ansteigen, können wir das nicht, weil es sein kann, dass der Dünndarm von hinten ganz durchbesiedelt ist, aber die Gasproduktion so stark ist, dass sich das durch den ganzen Test durch anhält. Julia: Ach so. Philipp: Da müsste man dann im Grund genommen, da könnte man mit einem Glukosetest nacharbeiten, um dann den ersten Abschnitt noch mal besonders anzugucken. Ja, das kann Sinn machen, hat sich aber bisher ist das kaum gemacht worden, oder kaum angefordert worden. Julia: Das heißt, weil du sagst die Glukose, das heißt je nachdem welches Substrat man gibt, würde man eine andere – was sieht man dann dadurch, also was kann man da ablesen? Philipp: Also wenn man Glukose verwendet, dann testet man eigentlich nur den ersten Abschnitt vom Dünndarm, weil die Glukose sehr gut aufgenommen wird vom Dünndarm, ja. Wenn da also Wasserstoff oder Methangas ansteigen, dann haben wir es schon mit einer Dünndarmfehlbesiedlung zu tun, die bis nach vorne durchgetreten ist oder eben vorne stattfindet. Wenn der Glukosetest negativ ist, dann heißt das erst mal nur der 1. Abschnitt ist frei, aber wir wissen noch nicht, was mit dem hinteren Teil des Dünndarms los ist, weil dann ja der ganze Zucker vom Körper selber schon aufgenommen wurde. Das heißt, der Zucker hat die Bakterien gar nicht erreichen können. Wenn wir Lactulose verwenden, was da unserer Meinung nach der sicherere Test ist, dann können wir den ganzen Dünndarm angucken, weil die Lactulose nicht aufgenommen wird von Dünndarm. Die landet, wenn keine Bakterien da sind, komplett im Dickdarm. Und das bedeutet, dass nach 120 Minuten irgendwann die Atemgase stark ansteigen. Und dann können wir auch eine Aussage über den Dünndarm treffen, also wie schnell er eine Flüssigkeit durchreicht. Wir können aber dann – genau, ja – aber dann wissen wir auch, da ist keine Bakterienfehlbesiedlung. Also das ist im Grunde genommen so eine Art Vortest. Das kann man auch als Vortest nehmen für einen Laktoseintoleranztest. Julia: Ok, ganz kurze Unterbrechung, vielleicht hast du es eh gerade gesagt, bei der Fruktoseintoleranz oder Malabsorptionstest oder Laktoseintoleranz misst man ja auch die Atemgase. Gibt’s da so etwas wie falsch positiv, also dass es eigentlich eine Fehlbesiedlung des Dünndarms ist und man es aber als Laktoseintoleranz interpretiert? Philipp: Ja, die Gefahr ist durchaus gegeben, falsch positive Tests und auch falsch negative Tests. Wenn man dieses Grundprinzip von dieser bakteriellen Fehlbesiedlung verstanden hat, dann wird das ganz klar, weil die Bakterien die sitzen ja quasi auf der Schleimhaut und in der Schleimhaut drin und die wollen einfach den Zucker haben, ja, nichts anderes. Das heißt, ob jetzt von außen eine Laktose gegeben wird oder eine Fruktose oder ein anderer Zucker ist den Bakterien erst mal egal. Und denen ist auch egal wie der Test heißt. Ja, das ist es, genau, ist denen egal. Wenn die dann also den Zucker bekommen, verstoffwechseln sie ihn und produzieren Gase. Und lt. der Leitlinien heißt es, wenn ein Laktoseintoleranztest einen Wasserstoffanstieg von größer als 20 parts per million aufzeigt, dann ist es positiv. Dann muss man gucken, in welchen Minutenzeiträumen diese Gase angestiegen sind. Dann muss man das doch eher kritisch betrachten. Weil, wenn innerhalb von 100 Minuten die Gase ansteigen, dann hat der Zucker, ist der entweder gerade da angekommen, wo der Körper ihn selber aufnehmen würde oder er ist noch nicht einmal da angekommen, ja. Das heißt, ein positiver, ein echter positiver Laktoseintoleranztest heißt 100 – 120 Minuten lang passiert gar nichts. Dann kommt die ganze Laktose im Dickdarm an und dann gehen die Atemgase nach oben. Wenn das vorher passiert, da müsste man eigentlich fairerweise sagen, der Test ist so nicht durchführbar, denn es ist dann ein Hinweis auf eine laktoseabhängige Fehlbesiedlung des Dünndarms, weil es eben zu früh angestiegen ist. Die Laktose wird im letzten Dünndarmabschnitt aufgenommen. Da findet dann auch die Spaltung statt. Wenn jetzt bei Minute 60 der Wasserstoff in die Höhe schießt, dann ist ja die Laktose nicht einmal dort angekommen, wo sie eigentlich aufgenommen werden würde. Und das muss einen stutzig machen. Das ist bei der Fruktose ähnlich, aber da ist man sich noch nicht ganz sicher, weil die Fruktose hat andere Aufnahmemechanismen als die Laktose. Sie wird nicht enzymatisch gespalten, sondern einfach entlang des Bedarfs, ja des Konstruktionsgefälles aufgenommen. Genau, und viele Laktose- und Fruktosetests die gehen nur bis 120 Minuten. Und wenn dann keine Anstiege sind, heißt es Laktoseintoleranz – äh Quatsch, keine Intoleranz. Aber das Ding ist, erst ab 120 Minuten wird es spannend bei dem Test. Julia: Ok. Philipp: Ja, das heißt, ein Test der 120 Minuten lang testet und es kam kein Ergebnis dabei raus, ist einfach für die Katz, ist für die Tonne. Da kann man nichts daraus lesen. Julia: Wahnsinn. Philipp: Braucht mehr Minuten. Julia: Ja, spannend. Ich meine jetzt wissen wir, wie wir darauf kommen, ob man es hat oder nicht. Was kann man jetzt tun, also was sind deine wichtigsten Tipps? Wie gehst du das an, wenn jetzt jemand positiv, also sowohl von den Symptomatiken her als auch natürlich vom Test her, reagiert? Was gibt’s da für Möglichkeiten vorzugehen? Behandlungsmöglichkeiten nach positivem Test, 20:41 Philipp: Ja, die gibt es. Und es geht ja erst mal auch vor allem darum, Beschwerden zu lindern, ja, dass es den Patienten oder den Menschen besser geht. Und das bedeutet, den Bakterien die Nahrung zu entziehen. Und da es sich um Kohlenhydrate handelt, raten wir dann dazu, eine kohlenhydratarme oder kohlenhydratfreie Ernährungsweise einzuschlagen. Die Stichwörter sind dann LowCarb oder das geht ja dann auch in Richtung Paleo, wobei man da dann auch ein bisschen noch ein paar Sachen wieder rauskürzen muss, ja so Süßkartoffeln z. B. glaube ich wird da ganz gerne gegeben. Die kann wie Dynamit wirken, ja bei jemandem der eine starke SIBO hat. Ja, aber ketogen geht dann schon auch in die Richtung. Und das ist das was wir über die Ernährung machen, ja, also Kohlenhydrate runter. Wenn jemand allerdings späten Gasanstieg hat, wo es erst sich so um den letzten Abschnitt handelt, dann kann man durchaus argumentieren, ob man vielleicht so etwas wie Kartoffeln und Nahrungsmittel mit einem hohen glykämischen Index, also wo der Zucker schnell übergeht ins Blut, ob man die drin lässt im Nahrungsplan, ja. Julia: Ok. Philipp: Und das andere ist dann, also das eine ist eben die Nahrung entziehen. Das andere sind bestimmte pflanzliche Mittel oder auch pharmazeutische Mittel, um die Bakterien in die Flucht zu schlagen. Ich habe ja vorhin gesagt, das sind Bakterien die eigentlich zum Körper gehören. Also wir erkennen die selber nicht als Feinde an und bekämpfen die nicht. Daher brauchen wir Hilfe von außen. Und das können dann bestimmte Produkte sein oder eben auch bestimmte Antibiotika. Gerade im Pharmaziebereich, wenn der behandelnde Therapeut ein Arzt ist, dann kann der z. B. Rifaximin verordnen, ggf. auch in Kombination mit Neomycin oder Metronidazol. Das sind Therapieprotokolle die sich auch sehr bewährt haben, ja. Gleichzeitig gibt es aber auch pflanzliche Protokolle die sich ebenso bewährt haben und die nachhaltiger wirken, was durchaus von Vorteil sein kann. Also das ist nicht nur jetzt mal eben wegbekommen, sondern tatsächlich soll es ja auch darum gehen, insgesamt von diesen Problemen befreit zu werden. Julia: Natürlich, ja. Philipp: Da arbeiten wir gerne mit hoch dosiertem Knoblauchextrakt, mit Oregano, mit Thymian, ja mit verschiedenen Mitteln mit Berberin. Das ist eine Wurzel, die sehr stark gegen Wasserstoffproduzenten wirkt. Und dann mit bestimmten Mitteln, die den Dünndarm anregen. Das sind Prokinetika heißen die. Ein einfaches Beispiel wäre Iberogast. Das bekommt man eigentlich in dem Bereich - das sind Apotheken. Es gibt da auch noch andere Varianten. Da haben wir sehr viele Mittel zusammengestellt und Pläne für Therapeuten, die mit uns zusammen arbeiten wollen, um dort auch Hilfestellung zu leisten. Aber das ist so die Vorgehensweise. Das ist auch eine nebenwirkungsarme Therapie. Man muss halt nur aufpassen auf die Dinge, die wir von Ernährungsumstellungen generell kennen. Es kann zu einem erheblichen Gewichtsverlust kommen, wenn die Kohlenhydrate wegfallen. Es kann zu einem Energieverlust kommen. Und da ist es dann eben wichtig, Strategien anzuwenden, die den Menschen darüber hinweg helfen. Julia: Und also so diese Sachen wie Oregano und das Berberin, ist das in Kapselform oder als Tee oder wie kann ich mir das vorstellen? Philipp: Ja, idealerweise ist das eine Kapselform. Also man kann es natürlich auch unterstützen mit verschiedenen Tees. Aber gerade Oregano würde ich auf keinen Fall als Öl nehmen, sondern immer in Kapselform, weil das ein ziemlich aggressives Mittel ist. Nicht alles was von der Natur kommt ist so sanft und vieles kopieren wir ja auch. Das Antibiotikum ist ja auch von einem Pilz, vom Penicillin, äh ist ja auch von einem Pilz entstanden. Also es ist ja ursprünglich auch natürlich, auch wenn es jetzt synthetisch aufbereitet wird. Aber so ein Oregano-Öl, wenn man das als ätherisches Öl zu sich nimmt, das kann richtig ätzend wirken auch im Mund und dann auch in der Speiseröhre. Das heißt, hier würde ich wirklich empfehlen, auf fertig gebaute Produkte zurückzugreifen und zwar in Kapselform. Aber manches gibt es auch in flüssiger Form. Es gibt ein Mittel z. B. das heißt Biocidin. Das geben wir auch gerne, sowohl gegen Wasserstoff als auch gegen Methangas produzierende Bakterien. Das kommt als Tropfen. Das wirkt sehr gut antibiotisch und dann gleichzeitig aber auch gegen Pilze, ja, weil auch eine Candida-Infektion kann gleichzeitig bestehen und das ganze Problem etwas erschweren. Da kann man dann gut schon auch dagegen mitgehen. Julia: Spannend, ja. Wie, wo können dich jetzt die Zuhörer und Zuschauer am besten finden, wenn man jetzt mehr auch über euch und über den Test vielleicht nachlesen möchte, bzw. sich informieren möchte? Kontaktmöglichkeiten, 25:24 Philipp: Also man kann einfach auf unserer Homepage gucken, www.sibolab.de. Dort haben wir einige Informationen zusammengetragen. Das ist allerdings alles eher etwas Generelles, etwas Gröberes. Wir arbeiten gerne mit Therapeuten und Ernährungsberatern und Wissenschaftlern zusammen, geben denen auch die Therapieprotokolle, Fristdiagramm wie man da vorgeht. Und so ist dann auch der Test eigentlich zu beziehen, in der Regel über die Therapeuten. Das ist am einfachsten, weil es dann auch eine Begleitung gibt. Julia: Ja genau. Philipp: Etwas schwierig ist es immer, weil in jeder Therapie gibt es Höhen und Tiefen, so auch in dieser. Das kann dann auch mal sich anfühlen, als wäre das Problem überhaupt nicht behoben sondern eher schlimmer geworden. Das hat mit dem sog. Die-Off-Syndrom zu tun. Da ist es immer wichtig auch einen Ansprechpartner zu haben. Da arbeiten wir eben gerne mit Therapeuten zusammen. Die-Off-Syndrom, 26:12 Julia: Kannst du noch kurz sagen, was versteht man unter dem Die-Off-Syndrom? Philipp: Ja, wenn jetzt über die pflanzlichen Antibiotika Bakterien absterben - das müssen noch nicht einmal Bakterien sein, die im Dünndarm sitzen, das können auch Borrelien sein, das können Streptokokken sein, das können aber auch Herde sein woanders im Körper - die haben bestimmte Mittel die verlassen auch da den Darm. Das Allimed z. B., was hochdosierter Knoblauchextrakt ist, geht auch in die Blutbahn über und wirkt sehr effektiv auch gegen Borrelien. Das ist eine ganz tolle Therapie, Therapieansatz da. Julia: Toll! Philipp: Wenn aber zu viele auf einmal absterben, dann kann sich das ziemlich übel auswirken für den Körper, also Unwohlsein, Übelkeit, richtig zittrig kann es werden. Und wenn es jetzt um die Bakterien im Dünndarm geht, dann werden teilweise so viele Gifte frei, oder im Überlebenskampf versuchen sie noch Reste von Kohlenhydraten zu verstoffwechseln, dass dann wieder auch Symptome auftreten. Da muss man gegen angehen. Ja, und das macht man am besten durch gute Fette, durch mehr Wasser trinken oder auch Aktivkohle. Julia: Ok, zum Binden von den Giftstoffen die da frei werden. Ja super! Ich habe auch eben die Möglichkeit für – wen es interessiert, der kann sich auch an mich wenden und den Test beziehen. Und sonst natürlich, wenn ihr selber in Heilpraktiker-Betreuung seid, sicherlich könnt ihr auch euren Heilpraktiker natürlich darauf aufmerksam machen und der kann sich dann an Sibolab, oder der Arzt oder der Therapeut eben an Sibolab wenden, an den Philipp Nedelmann und dann dort den Test natürlich beziehen. Dann sage ich herzlichen Dank für deine Zeit. Es war sehr sehr spannend. Es ist ein spannendes Thema, nicht so gut wenn es einen betrifft, aber trotzdem wahnsinnig spannend. Toll, dass es jetzt auch so viele Möglichkeiten gibt. Dann sage ich vielen Dank noch mal für deine Zeit, hat mich sehr gefreut und ja, ich hoffe wir sehen uns bald wieder! Philipp: Danke schön, das hoffe ich auch, auf jeden Fall! Alles Gute! Es gibt inzwischen mehrere Millionen Menschen in Deutschland, die unter ständigen Verdauungsstörungen leiden. Ärzte nennen diese Krankheit häufig Reizdarm. Die Verbreitung dieses Leidens nimmt rasant zu. Viele Betroffene haben Ärzte-Odysseen hinter sich, ohne dauerhafte Besserung zu erreichen. Wir haben für die Behandlung des Reizdarm-Syndroms eine eigene Therapie entwickelt. ##Ursache von vielen Verdauungsbeschwerden Bakterien im Darm sind ein entscheidender Bestandteil unserer Verdauung. Die meisten Bakterien befinden sich am Ende im Dickdarm, wo sie die Nahrungsreste verdauen, die nicht vom Körper im Dünndarm aufgenommen werden konnten. Dazu gehören insbesondere Ballaststoffe, aber auch schwer verdauliche Kohlenhydrate wie solche in Bohnen. Die Probleme entstehen, wenn dieser Prozess durcheinander kommt. Das kann z.B. passieren wenn man verdorbene Lebensmitteln isst, die Motilität des Darmes geschwächt ist (z.B: durch eine Schilddrüsenunterfunktion), man, Magensäurehemmer einnimmt oder aus sonstigen Gründen, die zur einer reduzierten Darmfunktion führen. In diesen Fällen haben es die Dickdarmbakterien leichter, in den Dünndarm "hochzuwandern". Wenn das einmal passiert ist, dann verwerten sie die gute Nahrung, die eigentlich der Körper aufnehmen sollte. Dies führt nicht nur zu einer Unterversorgung an Kalorien, Vitamine, Mineralstoffen, etc, sondern auch zu viel "Luft im Bauch". Die Bakterien produzieren nämlich als Nebenprodukt Gase wie Wasserstoff und Methan. Durch die nun enorm erhöhte Menge an "Futter" steigt dementsprechend auch das Gasvolumen an. Das sind dann die Blähungen, die so viele Menschen mit dem Reizdarm plagen. Desweiteren geben die Bakterien Toxine (=Gifte) an den Darm ab, die wiederum u.a. den Hormonhaushalt stören. Das kann dann in Folge zu Gedächstnis- und Konzentrationsstörungen, Depression , Müdigkeit, Abgeschlagenheit, etc führen. Da sich die Bakterien vor allem von Kohlenhydraten ernähren, führt eine Reduktion solcher in den allermeisten Fällen zu einer schnellen und dramatischen Verbesserung der Symptome. Allerdings kann man die Bakterien nicht aushungern, da sie sehr zähe Lebenswesen sind mit ausgeklügelten Überlebenstechniken. Die effektivsten Mittel liefert die Natur selber durch stark antimikrobielle Lebensmittel wie Knoblauchextrakte als auch durch Einsetzen von "guten" Bakterien, die sich mit den schlechten um den Platz streiten. Helfen Sie Ihrem Darm, sich selbst zu helfen #Therapieplan Nach Durchführung des Atemtests und positivem Befund (d.h. eine Fehlbesiedlung liegt vor) wird anhand der Daten des Atemtests ein Therapieplan entwickelt. Der Therapieplan teilt sich in eine Reinigungs- und eine Aufbauphase inkl. einer Ernährungsumstellung ein. Während die Ernährung während der gesamten Therapie umzustellen ist, teilt sich der Rest in zwei Phasen ein. Die Reinigungsphase dient in den ersten 4-8 Wochen dazu, die gesamte Belastung durch die Bakterien stark zu reduzieren. Diese Aufgabe wird zwar in der Aufbauphase fortgeführt, der Fokus ändert sich jedoch auf die Regeneration des Darmes inkl. dem Aufbau einer guten, schützenden Bakterienkultur. In beiden Phasen kommt es auf die sorgfältige Auswahl der geeigneten natürlichen Nahrungsergänzungsmittel an. ##Ernährung Die Ernährung ist das Fundament der Therapie. Die Ernährung bestimmt nämlich, welche Arten von Bakterien im Darm florieren und welchen das "Futter" entzogen wird. Da die problemverursachenden Bakterien Kohlenhydrate zum Überleben brauchen, sollten entsprechende Lebensmittel insbesondere in der Anfangsphase stark reduziert werden. Später können diese graduell wieder eingeführt werden. Wir geben unseren Patienten eine Liste mit empfehlenswerten und zu vermeidenden Lebensmitteln mit. Anhand derer kann sich der Patient ausrichten. Insbesondere, aber nicht nur, Lebensmittel mit FODMAPs sollte gemieden werden. FODMAPs sind kurzkettige Kohlenhydrate (Mono-, Di- und Oligosaccharide) sowie Zuckeralkohole. Alleine diese Ernährungsumstellung bewirkt bei den meisten Patienten innerhalb weniger Tage eine spürbare Besserung der Symptome. ##Reinigungsphase In der Reinigungsphase liegt der Fokus auf dem Entfernen der problemverursachenden Bakterien und das Verhindern vom Ansetzen neuer Bakterien. Zur Entfernung der bestehenden Dünndarmbakterien greifen wir auf natürliche Antibiotika zurück. Hierbei liegt die Betonung auf natürlich, denn die Natur hat deutlich intelligentere und körperunterstützende Mittel entwickelt als die menschlich hergestellten chemischen Produkte. Ein bewährtes Mittel in unserer Therapie ist z.B. Allicin, welches ein Extrakt aus der Knoblauchknolle ist. Allicin wurde im Rahmen unzähliger medizinischer Studien getestet und hat sich als stark antimikrobiell, antifungal und antiparasitär erwiesen. Gleichzeitig ist es ein natürliches Mittel, welches das Immunsystem unterstützt. Allicin ist nur eines von mehreren natürlichen Mitteln, welches wir zur Bakterienbekämpfung einsetzen. ##Aufbauphase In der Aufbauphase wird die Stabilisierung des Darms, der Aufbau der Schutzfunktion und eine vermehrte Belegung mit guten Bakterien angestrebt. Da die pathogenen Bakterien im Dünndarm eine optimale Aufnahme der Lebensmittel verhindern, führt dies nicht selten zu einer Unterversorgung an Vitaminen und Mineralstoffen. Hinzukommt, dass die Bakterien für den Aufbau ihres Biofilms, einer Art Schutzwall, Mineralstoffe wie Magnesium, Zink und Eisen aufbrauchen. Von daher unterstützen wir den Körper durch entsprechende Nahrungsergänzungsmittel (NEM) als auch durch Empfehlung bestimmter Speisen. So enthält bspw. die Rinderkraftbrühe viele Nährstoffe, die dem reizdarmgeplagten Körper fehlen. Omega-3-Fettsäuren, Curcuma, Zink, etc sind Beispiele von NEMs, die wir in dieser Phase empfehlen. Sowohl in der Reinigungs- als auch Aufbauphase unterstützen wir den Körper mit sogenannten Super-Probiotika. Diese sind aus natürlichen Lebensmitteln hergestellte fermentierte Produkte, die über ihre naturgegebenen Eigenschaften sehr effektiv beim Aufbau einer guten Darmflora helfen. SIBO Testkit bestellen?! 199€ (inkl. Versand nach D und Ö) Bei Interesse schreib eine Mail an julia@paleolowcarb.de und Du erhältst nähere Informationen. Webseiten Sibolab Philipp Nedelmann Sibolab UG ​Kastanienallee 4 10435 Berlin (Prenzlauer Berg) Philipp Nedelmann - sibolab.de | Paleo Low Carb - JULIAS BLOG | (auf Facebook folgen)

If you work with patients with small intestinal bacterial overgrowth (SIBO), Crohn's disease, colitis, or food intolerances, you've probably heard about the elemental diet. But there's a lot of confusion about what the diet is, when it's appropriate, and how it can be used most effectively. In this interview, digestive health expert Lela Altman, ND, LAc, explains how the elemental diet allows the gut to rest and repair. She offers practical information for patients and practitioners about how to choose an elemental diet or how to make your own. In addition, she outlines the steps she takes to reduce the risk of relapse after coming off the diet. And she reveals the one question every practitioner needs to ask to identify a major red flag that would contraindicate the elemental diet. About the Expert Lela Altman, ND, LAc, began working in the medical field in 1998, first as a nursing assistant, then as a medical assistant. This experience inspired her to pursue an education in the natural health sciences. Altman earned her bachelor of science degree from The Evergreen State College where she focused on ethnobotany, biology, and chemistry. She then earned her doctorate in naturopathic medicine and masters of science in acupuncture at Bastyr University in 2011. She went on to complete a 3-year residency at the Bastyr Center for Natural Health. While working as a chief resident, she completed additional training in evidence-based medicine and carried out diabetes research. She recently created the Digestive Wellness clinic at the Bastyr Center for Natural Health, which she currently supervises. Additionally, she teaches full time at Bastyr University and has a private practice. About the Sponsor       Integrative Therapeutics is focused on helping integrative medicine professionals cultivate healthy practices—from the development of science-based nutritional supplements to innovative, actionable resources and professional insights that have the power to inspire and enrich you, your patients, and your practice. We take pride in our evidence-based approach and meticulous process, and we focus on investing time and resources into developing formulations that have the support of today's scientific community—not the latest 'nutritional craze.' This process includes months of research, rigorous ingredient testing, and quality assurance testing before a product is ready to be released. Other resources include ElementalDiets.com. Transcript Tina Kaczor: Hello, I'm Tina Kaczor with the Natural Medicine Journal. Before we begin, I'd like to thank the sponsor of this podcast, Integrative Therapeutics. Today we're talking about the elemental diet, which is a specialized diet sometimes used in patients with inflammatory bowel disease or small intestinal bacterial overgrowth, better known as SIBO. My guest today is naturopathic doctor Lela Altman, from Bastyr University. She's a specialist in gastrointestinal medicine and has used the elemental diet to improve her own health. Dr Altman, thank you so much for joining me. Lela Altman: Thank you so much for having me. Kaczor: So, let's jump right in. I'd like you to start us out with a definition. In doing a little research for this interview, I noticed that the elemental diet or, the words "elemental diet" have been around for decades. So maybe you can just start us out with just a simple definition of what is an elemental diet and what does that term exactly mean? Altman: Sure, so a true elemental diet is a formula, it can be used in place of meals, and it proves all the nutrition that you need in its most basic, easily absorbed form. And that allows the gut to rest and repair. So, for example, instead of having proteins you would have individual amino acids, which are the building blocks of proteins. Instead of having fibers or starches it would contain simple sugars, which can be easily absorbed. And it also the essential vitamins, minerals, nutrients you need to survive. Fiber isn't typically included in an elemental formula because it can feed gut bacteria so that's something that we wanna look at and make sure it doesn't contain. There are a lot of formulas on the market that kind of market themselves as elemental diets that do have full proteins in them. And so it's not that those are bad formulas, but they're not necessarily totally an elemental formula. So it is important to know what you're looking for when you're evaluating formulas to determine whether or not they're elemental. Kaczor: Okay, so we'll get into the diet specifics but it sounds fairly regimented in that, when I looked online I saw that there were a lot of various forms. There were homemade recipes and then there were products for sale, like you mentioned. And I guess ... the patient experience, can you tell me a little bit about the patient experience? I mean, is there a breadth of options for the patient where if they wanted to use their own kitchen they could do this diet themselves at home all the way to here's the pre-packaged thing? So what should a patient expect when they're put on this? Altman: Yeah, absolutely. So you can make your own. Dr. Allison Siebecker has a great website, siboinfo.com, that has a recipe for a homemade version and there are also various other forms. So there are supplement companies that make them, there's, I mean, pharmaceutical-type versions of them. So there's a lot of range of what you can purchase and there's a lot variation in price based on that range. So it really depends on whether the patient wants to make their own and save a little bit of money or finds the convenience more important and maybe the taste more important and is willing to buy prepackaged option. Not all of the prepackaged options taste good but there are some that taste better than others. Kaczor: So in, I guess ... Well it may depend on condition but is this something that people typically do for days, weeks, months, how long are we talking for patients? Altman: It does really depend on the condition. So for SIBO it's typically done for 2 to 3 weeks. And an elemental diet, again, it's used in place of food. So you're not typically eating food with the elemental diet, you're only doing the formula. So for SIBO, that would be the formula only for 2 to 3 weeks. It can be used really anywhere from a few days for a few months depending on what you're not using it for. Or, sorry, not a few months, a month. So, if you wanna do a little bit of bowel rest you maybe would be on a elemental for 3 to 5 days. If you have maybe Crohn's disease and are using the elemental diet for treatment of an acute, really severe flare of Crohn's disease then you might be on that for up to 4 weeks. Also, sometimes I'll use the elemental formula for people who have a lot of food intolerance or allergies and are unable to maintain their weight, as a way to provide antiallergenic calories. And in that case they are eating food in additional to the elemental formula and so they may be on the formula for months while they're recovering their weight. Kaczor: And in that, just to clarify, in that scenario they're doing it as an add-on to an otherwise tailored diet for them. Altman: Right. Typically, if the elemental diet is being given completely alone without any other food it doesn't exceed more than 4 weeks. Kaczor: Okay, and so what conditions exactly ... I know you mentioned food intolerances so just so are we are complete, what other conditions do you use the elemental diet for? Altman: The big three that I use the elemental diet for is for treatment of SIBO, also for, again, as I mentioned, addition of calories in people who are underweight and have a lot of food intolerances. And then also just for a short term bowel rest, which might be needed in a Crohn's or colitis flare. There is some research on multiple other conditions though that elemental diets or sub-semi elemental diets have been used to treat. So eosinophilic esophagitis is one, cystic fibrosis, AIDS-related diseases, acute pancreatitis, sometimes rheumatological diseases. So there's a number of different conditions that we are looking at elemental diets to treat. My focus is mostly on the gastrointestinal diseases. Kaczor: Okay, and so because it's void of fiber completely I'm guessing that the microbiota of the gut changes dramatically without those fibers. So how do people come off of this diet? In other words, how do they step off it without having a massive reaction to fiber from foods? Altman: Yeah, so, I mean, the first part of that question really is kind of addressing the lack of fiber issue. These diets are not health long term. The elemental diet wouldn't be health long term, nor would necessarily the low-FODMAP diet or something like that. So when I take people off of the elemental diet, I usually have them start with homemade low-FODMAP broth. And if they are tolerating those well on the first day then I'll have them add some well-cooked, low-FODMAP veggies and they can even puree that into a soup to help break it down a little bit more. And if all is going well, the next day I will have them eat lightly cooked low-FODMAP veggies like steamed or lightly sauteed. And they can add some grains if they tolerate grains, though not everybody does. Meat, eggs, those things need to be well tolerated and fairly easy to digest after the elemental diet. And then on phase 3, I kind of transition back to a low-FODMAP diet, that's the diet I'm typically using. Some people are on a SCD [specific-carbohydrate diet] or SIBO-specific diet. I kind of transition them back to whatever diet they were on before that was working for them. And then when their gut stabilizes, then we start to challenge food. So, for example, we would start challenging low-FODMAP foods to see what they can tolerate and what they can't. The idea is once the SIBO is cleared they shouldn't have to stay strictly adherent to one of those diets. Kaczor: Okay, so that brings up a question because it seems like there's a lot of relapse in SIBO that a lot of ... there's a lot of talk in the chat groups about what does one do after they feel like they've exhausted many protocols. Do you find in your practice that there is a lot of relapse and a lot of people end up with a recurrence of it? Altman: Yeah, definitely, so there's one study that shows the recurring aftertreatment with Rifaximin that's about 50% at 6 months. We don't have specific studies looking at different types of treatment and whether the recurrence rate changes, say, for somebody treated with Rifaximin versus somebody treated with an elemental diet. This is why, in my practice, I implement a lot of other things to help prevent recurrence like maybe long-term antimicrobial herbs, prokinetics, maybe a modified diet or a low-FODMAP diet. So, unfortunately, we don't have studies showing what if we do all of these other things too then what is the recurrence rate? But in my practice I think it's lower when we add in those things. And unfortunately, for years SIBO's just been treated with Rifaximin and follow-up testing wasn't even necessarily done and then that's it. And so the studies that we have are based on that type of treatment. Kaczor: Okay, so, yeah, that answered one of my questions. I didn't know if this was a diet people had to go on intermittently but it sounds like if one can get to the root cause of what's going on and kind of get the gut into a healthier place and perhaps do a few things like longer-term antimicrobial herbs or prokinetics ... And just out of curiosity, prokinetics, when you say that in the naturopathic realm, what are you talking about exactly? Altman: So, prokinetics can be in various forms. They can be pharmaceutical and they can be herbal and I use both, sort of depends on the person and what they respond to and sort of what level of prokinetics they need. So a prokinetic is essentially something that makes the gut move, it increases motility of the small intestine, which can be a really big problem, particularly in the autoimmune type of SIBO. And so naturopathically I'm generally starting with herbal options, which may include things like ginger and 5-HTP, bitter herbs, things like that. Kaczor: Yeah and that brings up another question I have and that is with that idea of the lack of peristalsis within the small intestine that seems to be implicated in SIBO and those prokinetics working for those people, it seems to me, and correct me if I'm wrong, that stress has a lot to do with this. That people who maybe have more anxiety or anxiousness and we say they hold it in their gut kind of thing. Is that true in your experience? Do you notice stress having any effect on SIBO or on their GI symptoms? Altman: I would definitely say so. I have a few patients whose only known risk factor for getting SIBO has been going through a very stressful event. And actually it's those people are the ones that tend to have fewer recurrences or not have recurrence at all because there's not an anatomical or motility issue that you have to deal with. Essentially once you clear the SIBO it's more stress management that helps keep it away. So yeah, that is definitely true. Also, if we think about the sympathetic versus parasympathetic nervous systems, so in the sympathetic nervous system is the fight or flight. And in the fight or flight nervous system, we shunt blood away from our digestive system to our limbs so that we can run. In a parasympathetic nervous system, that's the rest and digest, and so we're shunting blood to the digestive system to help break down food. And so if you're stressed you're kind of constantly in this sympathetic, fight or flight state and you are not shunting blood toward your digestive system to function properly. So that's a really concrete example of why stress would make this worse. Kaczor: Yeah, yeah, that makes perfect sense. And then, I guess, kinda sticking to the mind-body idea and how the physiology is functioning, I guess, one question I had for you as a practitioner. Do you find that sometimes doing dietary restrictions like an elemental diet, especially when there is a lot of concentration, a lot of time and effort on eating the right things and making sure that the wrong things don't go down, and all of that, have you ever found that there's some trigger for relapse in those who have a prior eating disorder? Especially people, young women, and they might be in high school or college, they had bulimia or anorexia and here they are in their 50s and maybe they have to go through either an elemental diet or more likely the other diets you were talking like the FODMAP diets or the specific carbohydrate diets, very restrictive diets. And they get into kind of a neuroses about food is basically what I'm asking. Have you found that to be true at all? Altman: Yep, unfortunately I have found that people having eating disorders by trigger them through giving them an elemental diet. So no, it wasn't in the history I was aware of and then they went on the elemental diet and then suddenly this history of an eating disorder became an issue because the elemental diet did trigger that. And that's also true for, I think, any restrictive diet. So a history of or current eating disorder for me is a relatively strong contraindication to an elemental diet or any other type of restrictive diet. I think, I agree with you, I think it's a fine line between treating SIBO and having disordered eating. So when you feel poorly every time you eat and every time you eat you get more bloated, it created a negative feedback pattern associated with food and over time that can cause bigger problems like fear of eating almost anything. You know that anything you eat is gonna make you feel poorly and I think that's something to be really careful of if you have SIBO or if you are treating a lot of SIBO. Kaczor: Yeah, and thanks for saying it because I think that's a big heads up for everyone who is looking at using this diet. Especially practitioners, that's a very simple thing to have on an intake form so it doesn't have to be too deep of a probe with the patient. It can be very simply asked. So on that note, are there any other contraindications, any other patient populations that we should be aware of that we should be especially careful with this diet? Altman: Well, you need to think about it, I think, really on a case by case basis. Anybody could have something that could be a contraindication. One of the biggest concerns people have is about weight loss or low BMI. I find that's a relative contraindication. A lot of people think of the elemental diet as a fast, which it's really not. You have all of the calories and nutrition you need and you can increase the amount of formula somebody's taking as needed to meet their caloric requirements. So I've actually had several patients who are really malnourished, had a lot of difficulty maintaining weight, actually gain weight on the elemental formula because it was providing nutrition for them in a way that they could actually absorb and utilize in their bodies. So, I mean, that's something to think about. Diabetes for me is some concern, especially with the insulin needs and blood sugar dysregulation. The elemental diet, as I mentioned in the beginning, the carbohydrates come in the form of sugar and so it does have some potential for blood sugar dysregulation if you're drinking it really quickly. You can really mitigate not a lot by drinking it slowly over time but that would be another concern. Fungal overgrowth can definitely be exacerbated by an elemental diet, again, because of the sugar content. I initially, when I started using it, thought that maybe kidney disease would be a concern. But I looked it, wasn't really able to find anything that verified that there was any issue with giving an elemental diet in somebody with kidney disease. And actually there was one study I found that showed improvement in kidney function in people with chronic kidney disease on an elemental diet. You might wanna be a little bit more careful in somebody with compromised liver function because amino acid metabolism can lead to ammonia production and build up in their liver and so that might raise liver enzymes. But again, if you're only doing this for 2 weeks or so that really shouldn't make a big difference. And then, as I already mentioned, really that history of the eating disorder is a big red flag for me and then contraindication. Kaczor: Well that's ... I know this has been incredibly helpful from a practical perspective. I think that in less than 20 minutes we've touched on a few things that are definitely what I would consider clinical pearls for our listeners. So I really appreciate you taking the time of your schedule and offering up your expertise for our listeners. So thanks for being here with me. Altman: Oh, it's been a pleasure. Thank you. Kaczor: And once again, this is Tina Kaczor with the Natural Medicine Journal. And I'd like to thank the sponsor of this podcast, Integrative Therapeutics.

In this episode, Dr Nirala Jacobi is in conversation with world class gastroenterologist Dr Lenny Weinstock about Small Intestinal Bacterial Overgrowth (SIBO) and its connection to different conditions in the body. Dr Weinstock is board certified in gastroenterology and internal medicine, is the president of Specialists in Gastroenterology and the Advanced Endoscopy Centre, he teaches at Barnes Jewish Hospital and is an associate professor of clinical medicine and surgery at Washington University School of Medicine.  Dr Weinstock is also a primary investigator at the Sundance Research Centre and has written more than 80 articles, abstracts, editorials, and book chapters. He is passionate about SIBO and its connection to different conditions, such as Restless Leg Syndrome and Rosacea.   Topics discussed in this episode include: Dr Weinstock's approach to SIBO treatment in his Specialists in Gastroenterology Clinic Relapse rate after Rifaximin use Dr Mark Pimentel has mentioned relapse is hastened by adhesions - Dr Weinstock's take on this and Dr Weinstock's experience in his clinic. What are some triggers for SIBO? Autoimmune Irritable Bowel Syndrome (IBS) Post infectious IBS - damage to the migrating motor complex via an autoimmune attack on vinculin. Anatomical reasons Classical reasons Surgical reasons Adhesions Postural orthostatic tachycardia syndrome (POTS) Ehlers-danlos Preventative therapy for SIBO Rifaximin use with prokinetic therapy Bifidobacterium Lactis HN019 as a therapeutic prokinetic. Testing for anti-vinculin antibodies on SIBO patients. POTS What's the connection to SIBO? Why is the prevalence increasing? What is the connection between POTS and Mast Cell Activation Syndrome (MCAS)? Is there a potential for LPS and endotoxins to be travelling through nerves in the body? Restless Leg Syndrome (RLS), what it is, why do we get it, and what is the connection with SIBO? About hepcidin as an indicator of low serum iron in light of inflammation and how this is related to SIBO. For example: iron as a substrate for bacteria and how the body may respond by upregulating hepcidin to withhold iron from bacteria. Hepcidin as an antimicrobial peptide and its role in infectious diseases. The link between hepcidin and RLS. Why endorphins may be upregulated to protect the dopamine function in the brain in the setting of iron deficiency. Dr Weinstock's treatment strategies for RLS What to do if patient is unresponsive to Rifaximin therapy in light of SIBO positive testing. Low dose naltrexone (LDN) - its use in RLS. Low iron that does not respond to oral supplementation and the possible links to hepcidin. Biofilm therapy Exploring the 3 types of IBS in SIBO IBS - D IBS - M IBS - C The potential for large intestinal bacterial overgrowth (LIBO) to skew a hydrogen rise in SIBO tests that show consistent high methane from baseline. Treatment discussion for IBS - C Dr Jacobi's recommendation of BioGaia Protectis reuteri probiotic for methanogen treatment. 5 drops twice daily used in the study Dr Jacobi mentions. A couple of herbs Dr Jacobi uses for methane dominant SIBO treatment Garlic Myrrrh Dr Weinstock's clinical insights into the ileocecal valve (ICV) being chronically open and allowing reflux of bacteria up into small intestine from the large intestine.   Resources Dr Weinstock's Specialists in Gastroenterology Clinic BioGaia Protectis Bifidobacterium Lactis HN019 as a therapeutic prokinetic.

Struggling to maintain control of your blood sugar? A gluten-free diet may be the answer! If you have one autoimmune disorder, you have a 30-50% greater risk of developing another, and both type 1 diabetes and celiac disease fall into that category. As more and more research points to an enormous overlap between type 1 diabetes and celiac disease, it is in our best interests to mitigate additional risk by getting screened and/or adopting a gluten-free or Paleo diet to mitigate further risk. Today Nadine discusses the prevalence of diabetes, several research studies that explore the connection between type 1 diabetes and celiac disease, and the potential risks for type 1 diabetics who are undiagnosed celiac patients. Listen and learn how your diet may be affecting your blood sugar and why going gluten-free could improve your health and quality of life! What’s Discussed:  The prevalence of diabetes By 2050, half the population will have diabetes According to CDC, 29.1 million have diabetes One out of four don’t know they are diabetic 18,000 young people diagnosed from 2008-2009 The difference between type 1 and type 2 diabetes Minimize risk for type 2 through diet and exercise Type 1 is autoimmune disorder, don’t produce enough insulin to break down sugar Symptoms of type 1 diabetes Extreme thirst Urgency to urinate frequently Fatigue Weakness The enormous genetic overlap between type 1 diabetes and celiac disease Scottish study found 94% of type 1 diabetics were HLA-DQ2 or HLA-DQ8 gene carriers 100% overlap if include HLA-DQ2.2 Prevalence of celiac disease among type 1 diabetics is 20% higher than general population The importance of testing all type 1 diabetics for celiac disease annually Can develop celiac disease at any age The consequences of undiagnosed celiac disease in children with type 1 diabetes Short stature Failure to thrive Early onset osteopenia, osteoporosis Easily broken or rubbery bones Difficulty maintaining glycemic control (low blood sugar, spikes) Anemia The decreased quality of life for type 1 diabetics who are undiagnosed celiac Development of infections Difficulty with blood sugar maintenance Research studies re: the percentages of type 1 diabetics who also have celiac disease Iraq – 11.2% Mexican participants – 5.9% Denmark – 12.3% Nadine’s anecdotal evidence of the overlap Volunteers at community outreach clinic Young man struggling to control blood sugar Nadine recommended gluten-free diet Improved health and quality of life Health risks associated with an inability to control blood sugar Blindness Kidney failure Amputation of extremities Difficulty healing wounds Heart attacks Strokes Why carb counting doesn’t control blood sugar Carbs with little/no nutrient value cause spikes in blood sugar The diet Nadine recommends for type 1 diabetics Variation of Paleo diet Nutrient dense foods Meat and fish Eggs Fruits and vegetables Nuts and seeds The benefits of a gluten-free diet for type 1 diabetics Weight easier to control Immune system works better Tighter control on blood sugar The lack of uniformity in screening guidelines Additional autoimmune diseases that may be avoided with a gluten-free diet Multiple sclerosis Lupus Sjögren’s Scleroderma Autoimmune thyroiditis Graves’ disease Hashimoto’s Vitiligo Raynaud’s Potential triggers for autoimmune disorders Gluten Change in microbiome Stress to body (i.e.: cold, food poisoning, travel)  Treatments for small intestinal bacterial overgrowth Low FODMAPs or specific carb diet Rifaximin (antibiotic) The dangers of maintaining high blood sugar Damage to kidneys, eyes, capillaries, fingers and toes Neuropathy Gastroparesis The long history of a connection between type 1 diabetes and celiac disease The need for information re: the connection in diabetic education services Resources: “Type 1 Diabetes and Celiac Disease: The Effects of Gluten Free Diet on Metabolic Control” in the World Journal of Diabetes “Co-occurrence of Type 1 Diabetes Mellitus and Celiac Disease” in the World Journal of Diabetes “Screening for Coeliac Disease in Adult Patients with Type 1 Diabetes Mellitus: Myths, Facts and Controversy in Diabetology & Metabolic Syndrome “The Prevalence of Coeliac Disease in Libyan Children with Type 1 Diabetes Mellitus” in Diabetes Metabolism Research and Reviews “Type 1 and Type 2 Diabetes in Celiac Disease: Prevalence and Effect on Clinical and Histological Presentation” in BMC Gastroenterology “Coexistence of Coeliac Disease and Type 1 Diabetes” in Przeglad Gastroenterologiczny “Screening for Celiac Disease in Type 1 Diabetes: A Systematic Review” in AAP News and Journals Connect with Nadine:  Instagram Facebook Contact via Email ‘Your Skin on Gluten’ on YouTube Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Health Activism

In this episode, Dr Nirala Jacobi is in conversation with Carly Woods, recent Naturopathic graduate. Here, Dr Jacobi addresses common SIBO questions and invites listeners to join the discussion.  Topics covered include: Dr Jacobi's motivation behind starting the podcast, The SIBO Doctor. The gut and its role in the health of the body as a whole. SIBO and how it can cause leaky gut. Explaining zonulin and its role in maintaining gastrointestinal integrity. The autoimmune aspect of SIBO. Cytolethal distending toxin B and how it is implicated in vinculin destruction, compromising the migrating motor complex. Adhesions and the role of visceral manipulation in SIBO treatment. Dr Jacobi's Bi-Phasic Diet and how to integrate methodical SIBO treatment. Herbs and nutrients that Dr Jacobi's recommends for gut healing and SIBO treatment. A look into the different types of bacteria that are involved in SIBO development. Conventional SIBO treatment and Rifaximin use. Nutrients, herbs, and conventional medicines used to encourage the Migrating Motor Complex, and when to use them. The effects of modern civilisation on gut microbiome health and systemic well-being and ways to diversify flora. We love connecting with practitioners and collaboratively navigating the complexities of SIBO. If you'd like your question to be featured on the show, we invite you to email your question to Carly. Thanks for listening, and catch you next time! The SIBO Doctor podcast crew ABOUT DR NIRALA JACOBI Dr. Nirala Jacobi is recognised as Australia's leading SIBO specialist.  She is the founder of SIBO Test, an online SIBO testing facility.  Her website is full of useful information and resources.  Take a free quiz to find out if you have SIBO, or find a practitioner near you.  Dr. Jacobi offers Skype consultations, which can be organised via her website.  

Today we are discussing IBS as it relates to foods that may provoke an IBS patient’s symptoms as well as an antibiotic that is showing promise in helping some IBS patients.   FODMAP’s are foods that contain certain carbohydrate structures that can attract water into the gastrointestinal tract as well as […]

Dr. Cosimo Prantera discusses his manuscript "Rifaximin-Extended Intestinal Release Induces Remission in Patients With Moderately Active Crohn's Disease." To view the print version of this abstract go to http://bit.ly/x3LhRo.

Treatment of Ascites, Portal Vein Thrombosis and Hepatic Encephalopathy in Patients with Cirrhosis of the Liver Background: Ascites, portal vein thrombosis and hepatic encephalopathy are important complications of cirrhosis of the liver. Guidelines for the treatment of ascites have recently been published. Method: This manuscript summarizes up-to-date recommendations on the basis of the DGVS S3 guideline and of other guidelines as well as of the authors' experience. Results and Conclusions: TIPS (transjugular intrahepatic porto-systemic shunt) is the preferred treatment for refractory or recidivant ascites unless there are contraindications. The therapy of hepatorenal syndrome type 1 with albumin and the vasoconstrictor Terlipressin has been proven effective. Treatment of portal vein thrombosis comprises a strategy of anticoagulation, TIPS and liver transplantation. The most important therapeutic strategy for hepatic encephalopathy is the search for as well as the treatment of trigger events. Rifaximin is being increasingly used for the treatment and prophylaxis of hepatic encephalopathy.

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