The SIBO Doctor Podcast

In today’s episode, Dr Nirala Jacobi is in conversation with Dr Carrie Jones. Dr Jones is a Naturopathic Doctor and hormone specialist from Portland.  She has completed a two-year residency in advanced women’s health, gynaecology and hormones, and has also completed her Masters of Public Health at the Grand Canyon University.  Dr Jones has been the medical director of two large integrative medical clinics in Portland and is currently the medical director of Precision Analytical, a laboratory that offers the DUTCH Profile.  She writes for multiple health websites and is featured in a range of health podcasts.   Topics discussed include Hormones and their relationship to functional digestive disorders. Digestive flares before a woman’s period and why this can occur. How gut inflammation can affect hormones - for example by raising cortisol, raising estrogen, raising 5 alpha reductase, lowering dehydroepiandrosterone sulfate (DHEA-S), affecting the absorption of nutrients that comprise hormones. How lipopolysaccharides (LPS) and endotoxemia can impair and congest phase 1 and 2 liver detoxification pathways. Nutritional cofactors required to support smooth Catechol-O-methyltransferase (COMT) functioning, especially in light of COMT single-nucleotide polymorphisms (SNPs). Symptoms of estrogen dominance in men and women. Hormone patterns related to a dysfunctional gut microbiome. The estrobolome and how it can dictate how much beta-glucuronidase is produced, as well as how much dehydroepiandrosterone (DHEA) is released from the body. All about estrogen metabolism, the different metabolites that are produced, which ones are beneficial, and the liver pathways used for processing. Which estrogen metabolising pathways have associated cancer risk? The role of beta-glucuronidase in disrupting estrogen excretion. High toxic load patients and how hormone disruptors affect CYP enzymes and estrogen receptors. How can a patient show symptoms of estrogen dominance and yet their hormonal profiles be ok? Hint: If proliferative estrogen metabolising pathways favoured. When to intervene for hormonal balance when client presents with gastrointestinal issues? In light of high levels of beta-glucuronidase. How to test for beta-glucuronidase - fecal. What can we do about estrogen dominance? Support for Phase 1 Diindolylmethane (DIM) for clients favouring unhealthy 4-OH E1 or 16a-OH E1 pathways. Dietary adjustment to include Indole-3-carbinol (I3C) containing vegetables. Broccoli sprout powder for sulforaphane (to activate quinone reductase) Helps reverse the effects of going down unhealthy 4-OH E1 pathway. Glutathione support with N-acetylcysteine (NAC), and liposomal glutathione. Support for Phase 2 (COMT support) Magnesium Methylated B Vitamins Methionine Choline S-Adenosyl-L-Methionine (SAMe) Gut treatment Calcium D-glucarate to help lower beta-glucuronidase levels. Fibrous foods to bind free floating estrogen. Note: Broccoli and fibrous products not recommended in phase 1 of SIBO treatment. When to use binders in detoxification treatment. Progesterone Why can people with bloating potentially be progesterone deficient? Progesterone cream in second half of the cycle versus vitex supplementation - what age groups are appropriate to each? DUTCH testing - what is the difference between all the testing available? Saliva tests - free hormones. Blood tests - hormones are bound to sex hormone binding globulins or other carrier proteins. DUTCH test - free hormones and metabolites. Cortisol and cortisone - how to assess beyond an adrenal stress index, the difference between both forms, and why the body may have a pattern of inactivating cortisol into cortisone. How to balance cortisol to cortisone ratio? The role of licorice (Glycyrrhiza glabra) Flatlining cortisol and its role as a marker for chronic infection, its association with an increased risk for cancer, and increased risk for autoimmune issues. The cortisol awakening response and how it works with the thymus gland to destroy autoimmune antibodies. The link between chronic infections and low cortisol, and how to address. All about DHEA and DHEA-S Counters stress Energy, bone health, neurotransmitter balance, sex drive, muscle development. 7-keto DHEA - what is this? Supporting DHEA via adrenal support. When and when not to test hormone levels. Endometriosis and digestive disturbance due to adhesions, inflammation, and excess estrogen. New developments in the hormonal testing field. IBS symptoms around the period and why this may be. The importance of structural alignment for uterine and intestinal health. Therapy to address structural alignment - visceral manipulation, pelvic massages, and bodywork. Flaxseeds Helpful for estrogen dominance Raises SHBG (note that flaxseeds preferentially bind testosterone - so care in women who are struggling with testosterone levels) Soy The role of fermented soy for hormonal balance in menopause. Is soy estrogenic, or does it downregulate the proliferative estrogen pathway? Dr Carrie Jones’ 2018 hormone education plans for practitioners and patients.   Resources Dr Carrie Jones Precision Analytical for Dutch Testing A5M conference 2017 Dr Chris Shade Podcast - detoxification Dr Walter Crinnion - environmental medicine

 In this episode, Dr Nirala Jacobi is in conversation with SIBO and diabetes expert, Dr. Mona Morstein. Dr. Mona Morstein has been a naturopathic physician for 29 years. Her private practice, Arizona Integrative Medical Solutions Clinic, is in Tempe, AZ, USA. Her practice has always had a focus on treating gastrointestinal conditions and she was Gastroenterology professor at Southwest College of Naturopathic Medicine for 11 years.  Dr. Morstein has been working seriously with SIBO patients for 5 years and is now considered to be an expert.   She has authored the recently published resource ‘Master your Diabetes’, which is the number 1 best selling book on type 2 diabetes on Amazon.  Dr Morstein was a speaker on the First and Second SIBO SOS Summit, and is now on the Medical Advisory Board of Quintron Instrument Company, Inc.  Dr. Morstein’s innovative and comprehensive Step by Step treatment of SIBO has earned her patients around the world. She has just created a high quality line of SIBO supplements through Priority One Supplements.   Topics discussed in this episode include How did Dr Morstein get into SIBO and why did she want to specialise in this topic? What is the association between SIBO and Diabetes? Insight into A1C 7 is considered well controlled, although damage to the human body is cited in the science as when the A1C goes over 5.5. What are the four places in the body that cannot produce insulin resistance, and so express the effects of high sugar in the serum? How does this reflect the health of the rest of the body? Diabetic neuropathy to the Autonomic Nervous System (ANS), particularly in the gastrointestinal tract (GIT) and how this relates to hypomotility and SIBO. How do you specialise treatment to diabetes induced nerve tissue damage in the GIT as compared to other SIBO triggers, such as post-infectious SIBO? What to use to treat autonomic diabetic neuropathy in SIBO? Acetyl L-carnitine Lion’s mane Alpha Lipoic acid Is diabetic neuropathy reversible? Autoimmune vinculin damage to the migrating motor complex (MMC) in the small intestine. Lion’s mane - powerful nerve regeneration capacity Is there a role for it for regenerating nerves in the small intestine in light of Anti-Vinculin, and Anti-cytolethal Distending Toxin B (CdtB) antibodies? The form of Lion’s Mane required - it must be water extracted. Dose: 1 capsule bd. Using Lion’s mane in conjunction with a prokinetic. Patients with a strong history of post-infectious IBS or SIBO get more attention paid to prokinetics than those who may have adhesions causing the restrictions and outflow problems, rather than nerve based causation. Diet, diabetes, and SIBO - where to start? Low FODMAP Bi-Phasic Diet Specific carbohydrate diet (SCD) Diet Fibre - what fibre, and how to integrate. Why to have diabetic patients avoid grains. The importance of short chain fatty acid (SCFA) butyrate for colonic cell health, and how to navigate this for diabetic patients in light of no grains. Fibre powders. Types of fibres for SIBO patients Quinoa Millet Hydrolysed guar gum Types of fibres for diabetic patients Whole Food fibre from Standard Process - high patient compliance Paleo Fibre from Designs for Health Microbiome restoration in the large intestine Dr Morstein’s specific SIBO protocols for diabetic patients - 8 Essentials Diet Exercise Sleep Stress management Healing the gut Addressing the microbiome Environmental detoxification Supplementation Multivitamin Fish Oil Diamend - specialty diabetes product All about the contents of Dr Morstein’s specialty diabetes product - Diamend (which contains benfotiamine) What is Benfotiamine? Fat soluble thiamin with positive benefits in neuropathy. How does it interfere with glycosylation? Maximum dose 450mg/day Prevents damage in high glucose areas - protective to those who do not even have neuropathy. Dysglycemia not just in diabetic patients Tips to manage hypoglycemia in patients who do not have diabetes. The role of the adrenals in reactive hypoglycemia How to nourish the adrenals and the liver to rectify reactive hypoglycemia Chromium, zinc, gymnema sylvestre, liver herbs. Glyco-kinetic complex from Integrative Therapeutics Inc Other triggers that can drive reactive hypoglycemia? Products used for SIBO and Diabetes How is berberine beneficial for clients with metabolic syndrome? Turns off protein kinase-C Reduces insulin resistance, promotes energy use, anti-inflammatory, supports the liver and bile function, reduces cholesterol and triglycerides. Present in Diamend A caution for berberine use for those with anxiety - impact on monoamine oxidase (MAO) for people with single nucleotide polymorphisms (SNP) in that area. What role does the microbiome play in the development of diabetes? Could we prevent the development of type 1 diabetes? The type 2 diabetes microbiome and the impacts of inflammation, nutrient absorption, production of tumour necrosis factor (TNF), intestinal endotoxins and insulin resistance. Dr Morstein’s products developed for SIBO via Priority One Supplements SIBO MMC - prokinetic SIBOtic SIBOzyme SIBO rebuild - recovery phase of small intestine once SIBO has been eradicated (contains water extracted Lion’s Mane) Zanthoxylum (Prickly Ash) Used for dry mouth syndrome Motility agent Dr Morstein’s top clinical tips for SIBO and Diabetes treatment   Resources Dr Mona Morstein Arizona Integrative Medical Solutions Clinic Master your Diabetes by Dr Mona Morstein - Amazon.com Contact Dr Mona Morstein Dr Morstein’s SIBO and Diabetes supplement line through Priority One Supplements Diamend Diabetic supplement Contains benfodtiamine Products developed for SIBO via Priority One Supplements SIBO MMC - prokinetic SIBOtic SIBOzyme SIBO rebuild - recovery phase of small intestine once SIBO has been eradicated (contains water extracted Lion’s Mane) Dr Allison Siebecker - com First and Second SIBO SOS Summit Dr Nirala Jacobi’s Bi-Phasic Diet Fibre for diabetic patients Whole Food fibre from Standard Process - high patient compliance Paleo Fibre from Designs for Health Fibre for SIBO patients Hydrolysed guar gum Reactive hypoglycemia liver and adrenal nourishing complex Glyco-kinetic complex from Integrative Therapeutics Inc Walter Crinnion on environmental toxicity

In this episode Dr Nirala Jacobi is in conversation with Dr Christopher Shade. Dr Shade is the CEO and founder of Quicksilver Scientific, a lab that specialises in the environmental, biological, and analytical chemistry of mercury and all of its forms, and its interaction with sulphur compounds, particularly glutathione, and its enzyme systems.   Dr Jacobi met Dr Shade at the Bioceuticals Research Symposium in Sydney, 2017, and was riveted by his presentation on detoxification.   Topics discussed in this episode include: The liver, gallbladder, and GI connection, and how to align them so as to clear gastrointestinal issues. How failure to move bile is at the heart of detox reactions Bile as a detergent in the small intestine and how bile can be a core issue in SIBO. Bile acid destruction and fat malabsorption in SIBO. Emunctories and what this means. Drainage areas and how the extracellular space is cleared. Metal binder for the GI tract that is far better than chlorella - IMD microsilica Toxin conjugates and their interaction with bile salts. Phosphatidylcholine (PC), its requirement to fluidise the bile, and choline’s relationship to cholestasis. Lipopolysaccharide (LPS) endotoxins from leaky gut (from SIBO) creating inflammation in the hepatocytes and the flow on effects from this. Phase 3 detoxification - The role of bile flow in lessening detoxification reactions through lowering toxic conjugate buildup in the blood, and instead moving them through the proper elimination channels. The importance of addressing emunctories in treating skin conditions. How LPS impairs phase 3 in the liver. Neurological consequences of leaky gut, SIBO, and of a backfiring liver. Neuroinflammation, LPS, and a leaky blood brain barrier. Movement of metals into the urinary flow and how it has nothing to do with glomerular filtration rate (GFR), even though this is what is commonly measured for kidney function. Organic anion transport peptide’s (OATP) role in bringing toxic conjugates from the blood into the proximal tubular epithelial cells in the kidneys, then the movement of the toxic conjugates into the urinary flow through the MRP2 transporter. MRP2 and how LPS and metals can block it. How the same things that shut down liver transport of toxic conjugates, can also shut down kidney transport. Does LPS affect GFR? Active transport of toxins happens in the proximal tubules of the kidney, not in the glomerulus. Kidney disfunction and how SIBO can be related to proximal tubule damage in the kidney due to the build up of LPS. Proximal tubule function test available - Mercury Tri-Test from Quicksilver Scientific. Genetic Single Nuclear Polymorphisms (SNPs) and how the transport protein SNPs are commercially uncharted as yet. How inflammation blocks detoxification. Chronic infections turning down detoxification. Ways to address phase 3 detox. Address under-functioning gallbladder with PC, for example. Address leaky gut so that toxins dumped into small intestine do not recirculate. Strong bitters before meals. Take multi-toxin binder (30 minutes after taking bitters) - this is important to do 30 minutes after bitters. Dr Nirala Jacobi uses Toxaprevent, but not in SIBO-C patients. Dr Shade uses: Charcoal Clay Chitosan Metal binder eg. IMD (much stronger than chlorella), Chlorella. Acacia gum For leaky gut Low FODMAPS Bifidogenic prebiotic Powdered Aloe Marshmallow root Slippery elm Is there a test to assess phase 3 detox function? NRF2 upregulators and their role in cellular detoxification, to be implemented AFTER liver and kidney detoxification is streamlined. The importance of NRF2 and the effects it has on the body. Dr Shade’s universal binder - Ultra Binder How to access Dr Shade’s products. Dr Shade’s recipe for a self made toxin binder. The importance of Myrrh in the bitters The bitter detoxifier in ayurvedic medicine, qi and blood mover in chinese and ayurvedic medicine, and strong antimicrobial. Cautions with long term myrrh supplementation. Other herbals bitters to include: Dandelion Solidago (Golden Rod) Gentian Dr Jacobi’s bitters blend Dandelion Oregon grape Gentian Baical Skullcap Bitters as opening up the bile, tonifying the kidneys, and restoring ileocecal valve function. What is the function of bitter receptors on the ovaries? If SIBO clients are Hydrogen Sulfide dominant note that the bacteria involved here are bile loving, so any cholagogues will exacerbate the SIBO issue. Does charcoal absorb all of your minerals? Using charcoal as the primary binder - amounts to take and rationale for diversifying binder portfolio. Is mercury stored in biofilm? Is it advised to disrupt biofilm, or is it dangerous to do so? EDTA as a biofilm breaker. Plaques in the vascular system are actually biofilms. What mercury testing is offered at Quicksilver Scientific? Is it worth testing for mercury toxicity? When is it good to test people for mercury toxicity? How healing the GI tract can heal the kidneys. What is the evil of amalgam fillings? Why people with amalgams often have to urinate a lot at night. The body has it’s own inbuilt chelating system - glutathione, glutathione-s-transferase, and the transport proteins. What are the myths of chelation agents? Is lipoic acid a chelator, or is it upregulating the body’s natural chelation system? The importance of lining up all the drainage, and lining up all the phases of detoxification. Hydrotherapy for the lymphatics. The issues in Australia with lead and aluminum - Dr Shade’s recommendation on how to test these areas: Nutripath’s Blood Metals Assay Excess copper in the presence of low zinc can become synergistically toxic with all toxic metals. Whole blood vs intracellular for testing? How do you measure intracellular stores? Residence time in the blood of different metals. Dr Shade’s last pearls of wisdom - start with drainage, then move to mobilisation after levels come down first with good drainage.   Resources Quicksilver Scientific Dr Shade’s Quicksilver Scientific Youtube channel Proximal tubule function test available - Mercury Tri-Test from Quicksilver Scientific. Tri-test is available through Nutripath Ultra Binder by Quicksilver Scientific for detoxification Bitter X by Quicksilver Scientific Klinghardt therapy    

In this episode, Dr Nirala Jacobi is in conversation with Mim Beim about the effect of the breath on the digestive tract. Mim has 30 years of naturopathic experience, she has authored books, and is a respected naturopathic voice in the media. Mim has also held lecturing positions at the Australian College of Natural Therapies (ACNT) and has two practices.    Topics discussed include: Mim’s story and how she came to Buteyko breathing. Physiological effects of Buteyko breathing. What actually happens with Buteyko breathing? Overbreathing - chronic hyperventilation (breathing more than we metabolically need) and the effect of losing too much carbon dioxide. What are the effects of increasing carbon dioxide in the body in miniscule amounts? Digestive conditions and the breath. How can Buteyko help with irritable bladder, uterine issues, digestive conditions, high blood pressure, peripheral circulation, sleep apnoea, and asthma (among others), and what is the mechanism? What is the importance of nose breathing? The magical chemical, nitric oxide, and how to produce it with breathing. The Bohr Effect If carbon dioxide levels are a little higher the result is more oxygen delivery. The importance of this in conditions featuring damaged lung tissue. The importance of increasing carbon dioxide and resetting respiratory centres in the brain to create new patterns of breathing. Buteyko exercises and how they can create permanent changes in physiological responses. Age appropriate and condition appropriate Buteyko breathing exercises. What improvements and symptomatic relief has Mim seen with Buteyko breathing with SIBO and digestive conditions? Nitric oxide improving functioning of sphincters and how this affects the digestive tract. What are common signs of dysfunctional breathing? Tactics to retrain mouth breathing during sleep and the outcomes of this. Nose breathing at night and how this positively and profoundly affects orthodontic development. Sleep apnoea and the flow on effects to other conditions in the body, eg diabetes, and heart disease. Sympathetic overdrive and Buteyko’s role in helping to retrain trigger happy adrenal glands. Diaphragmatic breathing. Motility and the parasympathetic nervous system. How to know when the parasympathetic is turned on - such as increased salivation, warmth, and decreased anxiety levels. Stories of health success with Buteyko Breathing. Webinar courses for practitioners who cannot make it to in person trainings. Live webinar courses for patients. An example of a Buteyko breathing exercise - a live exercise on the SIBO Doctor Podcast with Mim Beim. General indication: if the parasympathetic switch takes over 2 minutes to activate, this indicates a heavy tendency to sympathetic dominance.   Resources Mim Beim Breathing Quiz Skype appointments also available. Patrick McKeown - Buteyko Educator (in person and online) for practitioners and practitioner locator for patients. com Oxygen Advantage - Performance training for athletes, November 9-11 2017 in Sydney, Australia. Buteyko Breathing Practitioner Training November 1st-5th 2017 with Patrick McKeown and Mim Beim in Sydney, Australia Rosalba Courtney - osteopath specialising in breathing and training.

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.

Pre and Probiotic Use in SIBO In this episode, Dr Nirala Jacobi is in conversation with Dr Jason Hawrelak on the topic of all things gut. Dr Hawrelak is a researcher, lecturer, naturopath, and nutritionist with over 16 years of clinical experience.  He also practices at Gould’s Natural Medicine - a 135 year old natural medicine apothecary and clinic in Hobart, Tasmania, Australia.   Dr Hawrelak completed his PhD examining the capacity of probiotics, prebiotics, and herbal medicines to modify the gastrointestinal tract microbiota.  He is currently the senior lecturer in Complementary and Alternative Medicines at the University of Tasmania’s School of Medicine where he coordinates the evidence based complementary medicines programs.  Dr Hawrelak also teaches the gastrointestinal imbalances unit, within the Masters of Science and Human Nutrition, and Functional Medicine Program at the University of Western States, in Portland, Oregon.   Topics discussed in this episode include: Dr Hawrelak’s 2016 lecture on Pre and Probiotics at the SIBO Summit 2017 - still available to practitioners as part of the SIBO Fundamentals online course. The website Dr Hawrelak developed, Probiotic Advisor, to help practitioners differentiate which probiotic strains and products are appropriate to different conditions. Recent probiotic research (2017) in relation to SIBO treatment and methane reduction. The importance of strain specificity in relation to therapeutic effect. Reseeding the gut with exogenous probiotics as an outdated concept, and the history of this ideology. Faecal transplants and the capacity of strains to remain in the gut as compared to probiotics taken in capsule form that does not. What metabolic modulation actions do probiotics have in the body, and how to integrate this with background changes to enhance the therapeutic effect. D-lactate V.S. L-lactate producing probiotic strains, and what systemic effects do each trigger? D-lactic acidosis and when this may occur. SIBO related symptom presentation and strain specificity for probiotic therapy, for symptoms such as motility issues, abdominal hypersensitivity, histamine issues, food reactions.   Motility Probiomax for motility Bifidobacterium Lactis HNO19 - 1-2 capsules per day. BB12 Bifidobacterium Lactis for motility. Suggestions on the combination use in children with constipation. Animal study showing probiotic strains that work on the migrating motor complex function - prokinetic potential. Combination of L. Rhamnosus GG, Bifidobacterium BB12, and inulin.   Abdominal hypersensitivity in SIBO Bifidobacterium Infantis 35624 Align Rhamnosus GG Functional abdominal pain in kids - meta analysis supporting this therapeutic application. Nissle 1917 strain of E.Coli Bifidobacterium Lactis DN173010 Speed up transit time Decrease pain and bloating Yoghurt brand, Activia, available in US, is the only available form (as currently known)   Leaky Gut Probiotics useful in helping to repair leaky gut Rhamnosus LGG Biocodex preparation of Saccharomyces Cerevisiae/Boulardii   Histamine Intolerance Infiltration of mast cells into the intestinal wall in SIBO and histamine implication. Probiotics and histamine degradation - investigating Rhamnosus Infantis Plantarum Probiotics and histamine upregulation - investigating Casei Bulgaricus High-fat diets producing many bile salts, which feed hydrogen sulfide producing bacteria, and hydrogen sulfide gas contributing to leaky gut. Higher fat diets contributing to diamine oxidase (DAO) enzyme overuse in the small intestine and why this is relevant to histamine. Ketogenic diets and symptom resolution - why is this, and is it sustainable? The impact of starving out butyrate producing colonic flora. The risk of ketogenic diets.   Continued How to reintroduce foods to sensitive patients Heal gut Decrease inflammation Work on allergy axis to increase dietary diversity Partially hydrolysed guar gum (PHGG) as a prebiotic Probiotics as aiding in the recovery of the microbiome after an insult, eg chemotherapy, antibiotics, radiotherapy etc. Prebiotics and changes of diet having a greater impact on the gut microbiome. Jason’s prebiotic use PHGG - use in functional constipation patients, non-methane type SIBO, and diarrhoea type stool conditions. Helps to normalise stool. Bimuno - galacto oligosaccharides Bringing bifidobacterium, and faecalibacterium prausnitzii populations back. Faecalibacterium prausnitzii: The single species with the highest prevalence in healthy people. Predominant butyrate producer. Produces another anti-inflammatory gut healing compound, so helpful for inflammatory bowel diseases. Higher levels as protective against metabolic syndrome and Type 2 Diabetes. Akkermansia Accounts for 1-3% of the microbiome in healthy people. Eats mucin, therefore if inflamed guts producing a lot of mucus can overgrow akkermansia. Lactulose Use as a prebiotic. Increases faecalibacterium prausnitzii, akkermansia, and bifidobacteria, lactobacilli. Use as a pH changer - moves environment to be more beneficially acidic. Amazing capacity to decrease Bacteroides numbers - which can increase after multiple courses of antibiotics. SIBO positive on Lactulose breath test patients - to attend to SIBO with therapy first before using Lactulose as a prebiotic. Lactulose uses in recurrent urinary tract infections as supported by clinical trials - as it decreases levels of E.coli in the gut so fewer pathogens can make the journey from the anus, to the vagina, to the urethra. Prokinetic for small intestine and when it is appropriate to use it in SIBO. Note: lactulose will increase gas, but not bloating. If bloating, cease use. Discussion on soil based organisms as they relate to functional digestive disorders.   Resources BioGaia sunflower oil based probiotics Blackmores Digestive Bio Balance Rob Knight - microbiome specialist Products mentioned: Motility Probiomax Bifidobacterium Lactis HNO19 - 1-2 capsules per day. Lactobacillus reuteri MM53 BioGaia strain Testing mentioned Ubiome GI effects from Genova Diagnostics Dr Hawrelak’s Probiotic Advisor    

  In this episode Dr Nirala Jacobi is in conversation with Dr Denise Furness, molecular geneticist, registered nutritionist, and registered exercise professional.  Today’s discussion centres around nutrigenomics, methylation, and digestive health. Dr Furness completed her PhD at CSIRO Human Nutrition and a postdoctoral fellowship at the University of Adelaide’s Research Centre for Reproductive Health.   Her research focused on folate, nutrigenomics, methylation and DNA damage in relation to pregnancy outcomes.  She has published her work in peer-reviewed medical journals and regularly presents at national and international conferences.   In 2012 Dr Furness shifted from an Academic Research position to a consulting role at Your Genes and Nutrition, helping patients understand the role of nutrigenomics and genetic testing in relation to various health outcomes.   Dr Furness is passionate about helping couples achieve optimal health and wellness to improve their chances for natural conception and healthy pregnancy outcomes.  She also holds regular educational seminars and workshops discussing the links between our genes and our environment, and how these impact on our health throughout all stages of the life cycle.   Topics discussed in this episode include: Overview of methylation. What to look out for with patients with ongoing digestive symptoms, and how can we utilise some of the genomic testing that’s available? Methylation as being responsible for switching genes off and on - the epigenetic component, as well as neurotransmitters, detoxification, and many other functions. How do we truly test methylation? Genetic terminology suggestions. How is methylation important in digestive issues? How SIBO relates to methylation variations. Nutritional cofactors implicated in the wider picture of methylation. Dr Furness’s most recent collaboration project with Bioceuticals. Clinical services Genetic Testing options Guidance with further testing Which genetic testing service will serve your needs the best? FUT2 gene variants and the link to digestive disorder. FUT2 secretors and non-secretors, and the direct influence on the gut bacteria altering levels of Bifidobacterium and B12. Detoxification (CYP450) systems and their prevalence in the gut versus the liver. CYP polymorphisms, upregulation, and the resulting impacts on the digestive system. Glutathione S-transferase (GST) phase 2 deletions and the requirement for detoxification support in light of the body using different, slower pathways. Catechol-O-methyltransferase (COMT) as the safe pathway to process catechol oestrogen metabolites. Nutrients that support COMT and methylation, such as magnesium and b vitamins, respectively. Monoamine oxidase (MAO) enzyme system that helps to clear neurotransmitters. Why support COMT and methylation during times of stress and anxiety. Why to never just start with folate supplementally - The Folate Trap. Why the gut is the first port of call for systemic health. Dr Furness’s dosing inclinations. B12 deficiency in the presence of oxidative stress (due to gut issues), the recommendation towards hydroxy B12 supplementation over any other forms of B12, and why. Various testing that Dr Furness recommends. DUTCH testing 8-Hydroxyguanosine as a marker of DNA damage and oxidative stress Endotoxicity and lipopolysaccharides (LPS) and how this can affect certain genes Low homocysteine and what this can mean. Gut issues and the relationship with oxidative stress. Where to start with a client who has genetic complexities and oxidative stress issues. Methylation education necessities for practitioners. Dr Furness’s plan for upcoming workshops in Melbourne, and online offerings for clinical application. The transsulfuration pathway and what can go wrong here. The Cystathionine Beta Synthase (CBS) SNP as the first step in transsulfuration pathway, which pulls homocysteine into the pathway, and the CBS impact in detoxification. Sensitivities with sulphur and the relationship to CBS. How one SNP does not provide the whole picture - look at the diet, lifestyle, symptoms, and testing, using an integrative picture to address the issue. How B6 works to speed up the transsulfuration pathway, pulling homocysteine down into it.     Resources Dr Denise Furness Consults available at Your Genes & Nutrition, Brighton, Melbourne Consults available at Your Health, Brighton, Melbourne   Genetic Testing Services Smart DNA Fit Genes DNA Life 23&Me   Microbiome PCR testing Ubiome Dr Furness’s 1000 kit free link   Dr Anderson DUTCH testing 8-Hydroxyguanosine as an indicator of DNA damage and oxidative stress Doctor’s Data 8-Hydroxyguanosine as an indicator of DNA damage and oxidative stress  

Today, Dr Nirala Jacobi is in conversation with Dr Michael Ruscio about the gut-thyroid connection and how it relates to SIBO. Dr Ruscio is a functional medicine practitioner, chiropractor, clinical researcher, and host of the Dr Ruscio Radio Podcast.  Dr Ruscio and Dr Jacobi both recently presented and connected at the Integrative SIBO Conference 2017 in Chicago.  Topics discussed in this episode include: How Dr Ruscio became interested in SIBO. What is the gut-thyroid connection? Discussion of 4 main areas: The way the gut affects thyroid autoimmunity The way the gut affects thyroid hormone absorption. The way the gut can cause hypothyroid-like symptoms, even when thyroid hormone levels are normal. Those on thyroid medication and/or have hypothyroidism, are at increased risk of SIBO. Being hypothyroid, or being on Levothyroxine as presenting an increased risk for SIBO, and why this may be. The SIBO-H.Pylori relationship and the increased risk of SIBO after conventional H.Pylori treatment. The relationship between H.Pylori and thyroid autoimmunity. Does Dr Ruscio treat H.Pylori even if the patient is asymptomatic? Pylori as an indicator of overall gut health. Pylori pathogenesis v.s. commensalism with the host. Recalibrating the gut microbiota in light of H.Pylori, with natural treatments such as: Probiotics Herbal antimicrobials N-acetylcysteine Testing for hypothyroidism What is true hypothyroid? What is subclinical hypothyroidism? TSH high T4 normal according to the reference ranges. When to treat hypothyroidism, and when not to. The relationship of gut inflammation to thyroid autoimmunity. Switching focus from treating the lab values, to treating the person and the underlying causes of disease. What testing does Dr Ruscio use diagnose thyroid issues? Thyroid antibodies and the response to diet and lifestyle adjustment. TPO antibodies between 100-300 and Dr Ruscio’s interpretation of this and patient care suggestions. TPO antibodies over 500 and the correlation to thyroid autoimmunity. Intestinal permeability and the link to autoimmunity. What are the other links between Hashimoto’s and SIBO? Implicated elements include: Impaired bile production. Impaired phase 3 detoxification. What are Dr Ruscio’s preferred treatments for Hashimoto’s Thyroiditis? Vitamin D. Combined selenium, CoQ10, and magnesium. Best therapeutic duration for selenium supplementation discussed. How exogenous thyroid hormone facilitates thyroid repair. Dr Ruscio’s thyroid medications and whether to use a T3, T4 combination, or a liquid thyroid medication, and which medication to consider in light of chronic digestive conditions. Examples of thyroid medications include: Nature-throid Armour Westthroid Dr Ruscio’s favourite thyroid tests TPO Antibodies Thyroglobulin Antibodies TSH Free T4 Total T4 Free T3 Dr Ruscio’s gut tests: SIBO breath testing Pylori - blood samples for 3 different fractions of the antibodies - G, A, and M. Pylori stool test for stool antigen. Pylori breath test. Complete stool test. Blood or serum antibody testing for amoebas and candida antibodies. Dr Ruscio’s clinical newsletter for practitioners, launched January 2017, outlining real case studies, clinical research studies, practitioner questions of the month, and a monthly practice tip from Dr Ruscio for each month.     Resources Dr Michael Ruscio Dr Ruscio Radio Podcast Dr Ruscio’s practitioner-only newsletter. Metagenics International Congress, 2017 featuring Dr Michael Ruscio as a speaker. Book recommendation: Martin Blazer - Missing Microbes Examples of thyroid medications: Nature-throid Armour Westthroid Dr Ruscio’s favourite thyroid tests TPO Antibodies Thyroglobulin Antibodies TSH Free T4 Total T4 Free T3

Today, Chris Gebhardt joins Dr Nirala Jacobi to speak about constipation in SIBO. Chris works at Resonance Complementary Therapies in Melbourne, Australia, and has been working with SIBO for 3-4 years.  Chris graduated as a Naturopath from the Southern School of Natural Therapies in 1995, has done post graduate studies in Japanese Acupuncture. Chris works with his partner, Natalie Cruttenden, also a Naturopath and SIBO practitioner.  Chris introduced Dr Jacobi to the use of the herbal medicine, pomegranate, in SIBO treatment, which is also touched on today. Topics discussed in this episode include: Chris’s journey to becoming a SIBO treating practitioner. Methane dominant SIBO and the constipation relationship. Chronic constipation beyond SIBO treatment - what is Chris seeing in his clinic with constipated patients who remain constipated even though methane levels are dropping? Post SIBO treatment therapies to support healthy digestion throughout the entire digestive tract. Resetting and stimulating peristalsis in the large intestine. The importance of supporting bowel movements during the antimicrobial SIBO treatment phase . The theory that high methane on baseline that remains elevated throughout the test reflects IBS-C and not necessarily SIBO (via SIBO breath testing). Chris’s clinical pearls for treating constipation, and supplemental supports: Prescript Assist Partially Hydrolysed Guar Gum (PHGG) Herbal based laxatives Metagenics laxatone Mediherb cascara complex Xymogen Probiomax Plus Sachets Bioceuticals Ultra Biotic 500 in later phases of SIBO treatment. Dr Jacobi’s supplement supports for peristaltic action Bifidobacterium Lactis HN019 Found in Probiomax, and Orthoplex Multigen Biotic. Mutaflor - beneficial E.coli Repair work to consider after Neomycin use. Dr Jacobi’s bowel retraining techniques: PHGG use Flaxseeds, chia seeds, and dietary adjustment to support bowel movements for patients with high methane production in the large intestine. Anatomical squatting position for best evacuation alignment. SIBOtest’s Resource - Retraining a Sluggish Colon Coffee enemas - Chris and Dr Jacobi’s opinions for therapeutic use. Kinesiological testing for the function of sphincters of the abdomen. Sphincter work and what type of constipation patients may respond better Chris’s seed blend for moving the bowels - chia seeds, linseeds, pumpkin seeds, sunflower seeds, almond. Methanogen specific herbal support Allisure Bactrex Atrantil Removing Methanobrevibacter smithii by moving the bowels. Testing available for high baseline methane and high methane throughout, and when to use this test - Methane Spot Test. Pomegranate - when to use it, what form to use, how often to use it, and Chris’s results from using it. Other herbs for treating SIBO and Small Intestinal Fungal Overgrowth (SIFO), including Usnea and Horopito. The Biphasic Diet and reintroducing FODMAP foods. The damage to the villi in light of SIBO and repercussions of this. SIBO relapse, and how to integrate a repair phase to lessen the occurrence of this, either post treatment, or pretreatment (as indicated in the The Biphasic Diet) Chris’s treatments for gut repair: Prebiotic rotation. Lactulose Bimuno galacto-oligosaccharide (GOS) Fibre integration. Soluble Insoluble Probiotics Colonic foods (polyphenols) Green tea How SIBO causes leaky gut and damage to the brush border enzymes. Chronic SIBO patients who relapse and why they may relapse. Dr Jason Hawrelak’s talk at the SIBO Summit 2016 on pre- and probiotics. Dr Jacobi’s gut repair program Vitamin A Zinc - 60mg Bimuno GOS Stress as a factor in sluggish bowels. Supporting serotonin for gut motility. Resources Resonance Complementary Therapies Melbourne, Ashburton, Australia. (03) 9885 5964 SIBOtest practitioner education and patient handouts Chris’s supplemental supports: Prescript Assist Partially Hydrolysed Guar Gum Herbal based laxatives Metagenics laxatone Mediherb cascara complex Xymogen Probiomax Plus Sachets Bioceuticals Ultra Biotic 500 in later phases of SIBO treatment. Dr Jacobi’s supplement supports for peristaltic action: Bifidobacterium Lactis HN019 Found in Probiomax, and Orthoplex Multigen Biotic Mutaflor - beneficial E.coli Squatty Potty Easy Stool Chris’s seed blend for moving the bowels - chia seeds, linseeds, pumpkin seeds, sunflower seeds, almond. Methanogen specific herbal support Allisure Bactrex Atrantil Methane Spot Testing The Biphasic Diet Bimuno Dr Jason Hawrelak’s talk at the SIBO Summit 2016 on pre and probiotics. SIBOtest’s Resource - Retraining a Sluggish Colon

In this episode Dr Nirala Jacobi continues the conversation with Dr Bradley Bush, with a focus on case presentations around chronic SIBO cases and inflammatory concepts.   Dr Bush received his Naturopathic Doctorate degree from the National College of Naturopathic Medicine.  He is co-owner and clinic director of Natural Medicine of Stillwater and its online consumer direct website for practitioners, neurovanna.com.   The Bush practice focuses on fatigue, insomnia, GI disorders, mood disorders, and lyme disease. Dr Bush has over 16 years of industry experience. He is the owner of Natural Health Insights, providing consulting services to the naturopathic products and laboratory testing industry.   Dr Bush speaks nationally and regularly publishes on the topics of neuroimmunology, brain-gut connections, neuroendocrinology, and lyme disease.  Dr Bush sits on two non profit boards, The Naturopathic Education and Research Consortium, and Compass Centre for Health.   The format of this episode is slightly different. In it Dr Bush discusses three different SIBO cases, diving into the variability and complexity of each presentation.   Case 1 - SIBO with associated fibromyalgia and chronic fatigue - 65y/o female. Incremental approaches with complex cases. The gut being the epicentre of health, without which SIBO associated presentations will not rectify. Polypharmacy approach and the compounding effect of this on the patient. Analysis of basic chemistry. Myeloperoxidase (MPO), the enzyme secreted by neutrophils, and the indications for testing and tracking this in treatments. (MPO elevation has associations with lipopolysaccharides (LPS), chronic infections, irritable bowel disease (IBD), and immune induced leaky gut) The neurotransmitter imbalances that can be sustained by chronic inflammation (hint - upregulated indoleamine dioxygenase enzyme, precipitating downregulated synthesis of serotonin, among others) Yeast association with SIBO. Weaning off polypharmacy. Metronidazol for rifaximin resistant SIBO, and C. diff. An indication on how many rounds of rifaximin are required to attend to chronic versus acute SIBO. Eating disorders prompted by therapeutic diets taken on for too long. Botanicals vs conventional medicine for SIBO treatment, or a combination use approach? Probiotic use as immunological modulators rather than massive impactors for floral diversity in the GI microbiome. Botanicals that Dr Bush uses in SIBO treatment. Mediherb gut flora complex - immune regulating capability, IBD modulation, mucosal affinity. Dr Nirala Jacobi’s therapeutic recommendation - Mediherb Bacto-Cand GI.   Case 2 - SIBO with associated constipation, acne, halitosis - 20y/o male Traumatic brain injury due to sporting event. Tricyclic antidepressant therapy introduced in his recovery plan and his subsequent experience of anxiety and spacey feelings. Naturopathic neurotransmitter production therapy alongside conventional antidepressant use. Serotonin syndrome and the potential for it to be induced by dual therapy use. Methane Protocol - rifaximin and neomycin combination for methane dominant SIBO treatment. Anxiety caused by SIBO, key indications being: Treatment resistant anxiety Treatment resistant insomnia Anxiety as a manifestation resultant of SIBO chemicals interrupting neurotransmitter signalling.   Case 3 - Lyme and SIBO - 25y/o female Chronic fatigue, constipation, bloating, neuralgia, catatonic staring episodes. Lyme testing. The effectiveness of the paleo diet for symptomatic control, noting that the issue still exists, even though the bugs are simply not being fed and therefore symptoms abating. SIBO as a concomitant condition with Lyme, and/or as a condition that can mimic the various presentations of Lyme. The Lyme/SIBO overlap as discussed by Dr Farshid Rahbar at the 2017 SIBO Integrative Conference, and the methane association. The clinically noted neuralgia and methane dominance link. Methane endotoxins produced by SIBO bacteria theorised to contribute to neuralgia. Constipation and methane dominance perpetuating each other. Methane dominant SIBO moving from constipation to diarrhoea during treatment and why this can occur.   Resources Dr Bradley Bush Clinic website - Still Water Natural Clinic Direct consume website for practitioners - Neurovanna Therapeutic recommendation, Mediherb gut flora complex Dr Nirala Jacobi’s therapeutic recommendation Mediherb Bacto-Cand Naturopathic Education and Research Consortium Compass Centre for Health Dr Farshid Rahbar SIBOtest episode - SIBO and Lyme Disease SIBO Integrative Conference