90 - Overcoming Small Intestinal Bacterial Overgrowth with Dr Jason Hawrelak

It causes gut damage, it causes liver damage and reaches your circulation. So when it gets enough gets through your damaged gut eventually and enough gets soothe your liver filtering processes, then it can actually cause damage to the blood brain barrier. It changes your neurotransmitters in your brain. So we're now associating sort of endotoxins with anxiety, depression, cognitive decline, short term brain fog, long term Alzheimer's disease.

Welcome to the Radical Health Rebel podcast. I'm your host, Lee Brandon Random. This work started for me several decades ago when I started to see the impact I could make on people, helping them to identify the root cause of their health problems that no doctor could figure out, including serious back, knee, shoulder and neck injuries, acne and eczema issues, severe gut health problems, even helping couples get pregnant after several IVF treatments had failed. And it really moves me to be able to help people in this way. And that is why I do what I do and why we have this show.

Welcome to this week's episode of the.

Radical Health Rebel podcast. I had the pleasure of interviewing Dr. Jason Horalik, a renowned researcher, educator, and naturopath with a wealth of knowledge and over two decades of clinical experience. With a PhD focused on probiotics, prebiotics, and herbal medicines for gut health, Jason has been teaching audiences worldwide on microbiota modification and gastrointestinal health. In this episode, we dive into the topic of small intestinal bacterial overgrowth, otherwise known as sibo, a condition that affects many individuals today. After taking one of Jason's courses on SIBO a few years ago, I've been able to apply his teachings to help those suffering from this debilitating condition who had previously struggled to find relief and through traditional medical avenues. Stay tuned for an Insightful discussion with Dr. Jason Horlack as we discuss the symptoms of SIBO, its connections to other health issues, and how to effectively manage and treat this condition.

Jason Horolich, welcome to the Radical Health Rebel podcast. Thanks for coming on the show.

Hey, it's lovely to be here. Thanks for the invitation.

Yeah, it's a real pleasure to have you on. As I kind of alluded to in our communications before, I took your course in small intestinal bacterial overgrowth some years ago that was provided via In Vivo Healthcare. And it was just such a fantastic course. And it's really, it's massively helped my own practice. And, you know, the amount of clients that I've helped based on your work is pretty incredible.

And I'm sure if they knew where I got a lot of my Information from. They would be thanking you for the.

Help that I've been able to in part on them. So, you know, I just want to say from my own perspective, thank you so much for your work. It's, you know, it's absolutely fantastic.

Well, thank you. It's lovely, lovely to hear that. I think it's. Yeah, I mean it's amazing hearing feedback like that because that's what you wish for. You can then help other practitioners with their patients and get better results. That's kind of what we're, what I'm aiming for. So when I hear feedback like that, I get very, very, very pleased indeed.

Yeah, yeah, absolutely.

So, Jason, to kick things off, could.

You share with the audience your educational and professional background and how small intestinal bacterial overgrowth became a subject that interested you?

Ah, yeah, well, gosh, I'm not sure where to start. I can go way back to like we spoke just before recording started about, you know, I'm originally from Canada and I came over to visit Australia as a backpacker on my way around the world. But I arrived in a immensely health conscious part of Australia back In the early 90s, place called Byron Bay. And it just really went from eating horrible junk food, you know, typical sort of standard American type diet, although I was Canadian, but same, same kind of fare to, to eating immensely healthy and just the improvement in my health was just amazing from that, that point that really got me interested in, in, you know, following through with, with, you know, later studying, you know, naturopathy. So I end up studying naturopathy in the mid-90s. And then when I was finishing up my naturopathy course at the university at Southern Cross University here in Australia, I had a discussion with one of my lecturers about doing postgraduate studies in the area of dysbiosis. You know, so altered gut microbiota. And this was back in 99 when I had these initial discussions. And he's like, yeah, yeah, yeah, we can, we can do research project. Well, how about we do a study in Utal bowel syndrome? Because that was essentially at that point, like now we see dysbiosis being associated with, you know, Parkinson's and Alzheimer's and heart disease and cancers. That was not the case 20, 24 years ago. It was like there was dysbiosis associated with ulcerative colitis, Crohn's and irritable bowel syndrome and not too much else had been researched up to that point. We chose IBS as like the poster child of a disease associated with gut dysbiosis and then I ran my first clinical trial using prebiotics, probiotics and herbs to, to modify the microbiome in IBS patients in 2000 for my honors degree. And then I followed that up with my, my PhD, which is doing more research on how we could alter the microbiome in positive ways, using those tools of prebiotics, probiotics and herbs to alter the microbiome. And then obviously, you know, in the mid-2000s, there became sort of, all of a sudden this thing called sibo, small intestinal bacterial overgrowth, started getting some, some airplay. That was generally before that seemed to be an immensely rare condition that would occur in, you know, people, some people after abdominal surgery where you had bits of your small bowel removed, you could see your colon removed, and all of a sudden you'd have, you know, because of the dysfunction, motility that that resulted from, that you'd have a buildup of bacteria. And these people, often kids would get very sick and hospitalized, et cetera. And that's kind of the view of SIBO up until probably the early 2000s, when Dr. Pimentel started publishing more work around this concept that actually may be a driver, significant driver of the disease we call irritable bowel syndrome. So I think because of my PhD was in IBS and colonic dysbiosis, so in the large bowel, I obviously became quite interested in following this sort of information that was flowing out about stuff happening in small bowel, which wasn't really widely discussed much at all, partly because we just could not really see what was there in the same way as, you know, sampling poo, you know, that, that small bowel was kind of like an area of ignorance or unknown because we just really didn't know what microbes there, what proportion, et cetera, et cetera, when people were really unwell and we could send some scopes down there. But again, that, that whole, you know, that's really blown up in that in terms of the amount of research studies published looking at what's normal, what's abnormal in the small bowel microbiome, and also leaking SIBO to a range of other conditions besides just IBS too. So that's been an interesting thing to observe over the last 15 years too, for that matter. 20 years now, actually.

So what year did you complete your PhD?

Well, we had a few, couple delays in that one. So in terms of clinical trials don't always go according to plan. We had some funding issues for our. We're going to do a large, large scale, randomized Double blind, placebo controlled trial, and we had funding lined up, didn't come through in the end. So that adds like an extra year to your PhD project when things like that fall apart that are outside your control. So I think it was 2006 when I actually finished my PhD.

Okay, so that's 18 years ago. What, what, what have you been up to in the last 18 years?

I've tried to maintain even that whole time that I was doing honors in my PhD, I was also a clinician. Yeah. And, and for me it was important that one was part of my training and two, I really liked the same patient. And three, I think it helps you as a researcher to bring a different viewpoint when you're working with patients and interact with patients. Gets you what works, what doesn't, what, what things are like in real life, you know, And I experienced that firsthand in my first clinical trial that I did in my IBS patients where I gave them like mass loads of prebiotic compounds, you know, because the research was like, this is the dose you give for a prebiotic effect. And then the patients were getting like, you know, severe distension and bloating and farting like crazy. And you realize, okay, real life is I would start with a low dose and slowly build up or, you know, there's different ways of doing it that you kind of learn from actually having interaction with real patients, how to do things outside research settings. So I think for me, it's always been important to maintain clinical practice as well as doing research, and I've maintained that up until the present. And I've also been teaching either soon to be clinicians or clinicians, probably from. I think I first started doing some teaching at the Southern Cross University naturopathy course back in 2000. Just bits and pieces, but that sort of grew from there. So for me, it's the three prongs that give me so much enjoy are teaching clinicians about gut health and microbiome health and seeing patients and doing research in those areas.

Yeah, I'm guessing you're like me, you're absolutely fascinated by the gut and the gut microbiome. To me, it's such an exciting subject and I feel that the more I learn, the more I realize, I don't know, and the more that we, I suppose as a community we realize we probably know very little about, about the gut microbiome. Even though we've learned so much, there's probably, you know, I sometimes call it the final frontier because there's probably so much more that we don't know.

No, listen, it's true. I mean I also think that this has been like 24 year plus years I've been delving into it and I think back to when I was, you know, writing my, you know, honors thesis and having to go through all the microbiome literature at that point with called microflora. If I could read all the papers from the 60s and 70s and 80s leading up to that point because there wasn't that much comparatively done, you know, and then it's what's occurred in the last 20 years. It's been mind blowing in terms of when we change technologies from, you know, culturing in the microbiome to DNA based technology. It's just the research has gone absolutely crazy since then. So while I agree that there's tons more to learn, I also know that there's actually quite a bit we know now and have learned over the last 50 years. And I think thankfully, perhaps because I've been doing this for over 24 years, it's been my main, you know, passion and, and job in some respects of keeping up to date with microbiome research. I feel like there is, we know quite a bit already but I also aware that, you know, I'm looking at someone's microbiome report. There's a bunch of species, we have no idea what they do on that report. Like there's some that I can go, okay, yeah, that's clearly pathogenic, these are clearly beneficial in usual circumstances. And these ones are what we call pathobion which are ones that cause harm when in excess amounts or I'd even argue in insufficient amounts but are great for us when they're in the right zone. So there's a bunch of extra, we can categorize into those three sort of levels or areas. But then there's a, there's a whole bunch on that test that we have no idea currently what they, what they do, what role they play, what percentage they should be, et cetera too. So, so that is an exciting area that going okay. Every year we learn a bit more like, you know, even this past past year I've been, you know, teaching, creating new courses for, for you know, around the microbiome, advanced microbiome manipulation. Delving into the research a bit more on, on polyphenol, like oh gosh, it's a new bacteria that have just recently been named that we know are now key players for polyphenol transformations that I'm now looking for in stool tests that I wasn't looking for 12 months ago. So it is an ever. That's an exciting thing too. I reckon. You're constantly learning and looking forward to do it. And I think I'm just also so lucky that I chose a topic that I'm absolutely passionate about for my PhD and then that flowed on from there because I know people who did not. He just chose whatever topic was available or something that was easy or something, but didn't give them excitement for their PhD topic and then they're happy to leave it behind and never look at it again. Whereas for me it's like still super excited to look at the new research papers, still super excited for looking at my patients microbiome reports to go, okay, oh my God, what's that looking like? How's it changed from last time? How does that fit in with their current symptoms or the improvements that we've seen, et cetera?

Yeah, I find something quite interesting. You know, there's, there's quite a move, I guess it's probably to some degree of fad, but there's quite a move towards, you know, carnivore and you know, high animal based diets and things like that. And you know, from my, from my understanding, if you look at the research, it's like, well, that should be a disaster for the microbiome. But then you see, but then you see people completely reversing autoimmune conditions and things like that by going on those kind of diets. And I'm just really curious on, you know, kind of how, how does that work if that's going completely against the research? That's not, it's not something I necessarily wanted to discuss today, but if you could maybe quickly give your view on, on what might be going on there.

Yeah, I mean, and this is a bit hard because when I see people that have done carnivore, people that are immensely unwell and worse from carnivore, so it's like I haven't seen any patients do carnivore and get better from it. You know, maybe I had one, you know, out of, out of my 20 years of practice. But you know, again, I concur that my, I've got a bit of a skewed thing because if they're going great, they're not necessarily going to come to see me as a clinician. And I mean, obviously for some people it's, it's, you know, all the horrible food chemicals that people are consuming that I think that might be true to their disease and their sort of gut damage, for example. Some people maybe had C disease, they didn't know. So they obviously stopped eating gluten. And their gut symptoms and other symptoms get better from that process. There's things we can conjecturize around of how some people might improve on that. Despite the fact that there are major concerns from microbiome perspective. And I think that's one thing that often find challenging is that people are often promoting like a carnivore type type approach, aren't recognizing that you are like a good portion of youth are microbes. You know, it's like sort of that old, old physiology that we're humans that have some bacteria and bacteria don't really matter too much is the old idea. And that they're kind of fitting in that, that pattern for the most part. I'm sure there's some exceptions to that too. But for people I've seen, if that's what they're thinking about, they're not thinking about gut bacteria at all in, in their way of viewing the world. But we know now beyond any doubt that the microbiota is immensely important, important for human health. And we also know from, you know, research and, and just from what we know about microbes is that we're, we generally see blooms of problematic species when people go on that kind of dietary approach and, and massive reductions in beneficial species when they go on that dietary approach too. It's not to say in the short term there may not be significant improvement in symptoms because I'm sure, listen, if you've got bloating and distension, you know, are core things that are causing you, you know, horrible symptoms and pain and you essentially go on a diet that limits your intestinal fermentation dramatically. Is a bloating, distension go away? Yeah, it is. It's going to feel better in the short term. Yeah, you will. The challenge there is that the change in microbiome dynamics in terms of starving your butyrate producing species and increasing levels of hydrogen sulfide gas producers, which are two of the broad sort of results of Tennessee from such dietary protocols, end up causing inflammation and clonic harm and worsening symptoms over the long term. And those are the people I see that have tried this for a period of time and they're far worse off now than what they were before they did that dietary approach. And it's really hard to get the microbiome back because they've starved off a lot of the good bacteria if they did it for longer periods of time. And their degree of visceral hypersensitivity in some of These patients is immense. And we know that hydrogen sulfide gas causes visceral hypersensitivity. And when you're essentially eating a dietary protocol that feeds your hydrogen sulfide gas producers as much food as they want, and you're not feeding any butyrate producers, you end up in a situation where your client sides become very hypersensitive to gas production, to movement in the gut, et cetera. So that when you try to bring food, you know, fiber back in at a later time point and there's some gas being produced, they experience quite severe symptoms. So you see these patterns going, oh, well, I would do this and my symptoms are at this level, but I tried to bring some plant food back in and boom, I get these gut symptoms back again. And it's because you're essentially exactly exacerbated the degree of visceral hyperpammation in those patients. Yeah. So it ends up being a very challenging cycle to get people out of, sadly.

Yeah, that's really interesting. And I guess, you know, when you look at, I suppose you can call them isms, right. Carnivore ism, veganism, you know what you what you what? Certainly what I've seen is when people go to either extreme, they might feel better for a period of time and then there comes a point where they actually start to think, okay, I need to kind of go back the other way if I'm going to feel better. And I guess it comes back to two things. Individuality and to some degree, whatever balance is for that person. I think most human beings are somewhere between those two extremes and when you go to one or the other, it's going to cause problems. Right.

I mean, I do have some concerns around strict vegan diets too, in terms of potential negative health outcomes, but not so much for microbiome perspective. And obviously that's the way that I kind of view the world is mostly through microbiome perspective. And I've got far more concerns around carnivore dietary protocols than, than the vegan. I know vegan, you can get B12 deficiency and zinc is really challenging to, to achieve. Totally get that, no doubt. But you know, you, you are able to nurture wide diversity of, of healthy microbes through that kind of dietary approach. Or you know, for me it's probably plant based and it's like, I don't know, you know, if you have fish and meat a couple times a week, it's not a concern from microbiome perspective. In fact, you know, for good sources of iron or good sources of zinc, there's or omega 3 fats is good rationale for having those sort of smaller inclusions, but to me it's around trying to nurture the widest diversity of health promoting species in the gut possible, which is eating mostly plants and whole foods too, because I think that's a thing too. I remember the first vegan I ever met was lived off of coffee, hot chips and twisties and cigarettes. They were vegan because they didn't want to kill animals, which I can understand, but they had no idea about doing it well, you know, so just because somehow it's a vegan, it could still be an absolute crap rubbish diet full of rubbishly processed foods versus someone who's actually eating, you know, whole. Whole food type.

Yeah.

Food choices.

Yeah. Just, just to go back a little bit, if you were to explain what SIBO is to someone that had never heard of it, how would you describe it to those kind of people?

When 35 year old Amanda first scheduled to see me, she'd been suffering for 19 years from severe IBS, diarrhea and fecal incontinence, along with abdominal pain and bloating. Her condition had not only made life uncomfortable for Amanda, but very inconvenient as she had to walk two hours to work every day along a route that had public toilets. And she'd never been on holiday as an adult because of her condition. The only advice that several doctors and specialists had given Amanda was to take Imodium. And when she first saw me, she was taking five Imodium a day and wasn't getting any better. To help Amanda, I ran tests to find out what foods were right for her metabolic type, to see which foods she was sensitive to and to assess her gut microbiome. Tests showed that Amanda had several food sensitivities and a parasite infection. Over the coming weeks, I coached Amanda to eat right of her type and to replace the food she was sensitive to and a protocol to deal with her parasite infection. And after three months, Amanda was IBS free. And she also reported her skin was much improved and she had lost weight. And she booked a holiday for her and her husband to New York as had never been on a proper honeymoon.

Because of her ibs.

And if you're suffering like Amanda was and you want to get to the root cause of your problem, you can arrange a consultation with me at www.bodycheck.co.uk and if we're a good fit, I could help you achieve the same kind of results as Amanda. Now back to the podcast.

Yeah, I Mean, I think sibo, small intestinal bacterial overgrowth. So in some ways the name kind of gives it away what we're talking about. But it's, it's an overgrowth of bacteria in the small bowel. And if you go back to some of the earlier popular ideas around SIBO or blogosphere, ideas were like, oh, the small bowel should be sterile. And it's just, you know, any bacteria are overgrowing. I think that that's been tossed out in both, both ways. One is, we've long known that the small bile is not supposed to be sterile. It's is supposed to have smaller numbers of microbes. It does versus the colon, but never sterile. And two, this idea that it's just any bacteria growing, including good bugs, could be growing in there and causing harm. It's kind of been tossed out too. Because what we're tending to see now with, with research is actually there is a. In patients with sibo, we see tend to be overgrowth of pathogenic bacteria and a lack of diversity in that small bowel ecosystem. So it is a like more of a monoculture type type ecosystem with, with bad bacteria growing there versus just, you know, overgrowth of, of any potentially even some beneficial bacteria. So that's been a shift in there too. But that's just a bit of an aside. But, you know, so essentially when the bacteria are growing in the small bowel, they have access to your nutrients, your food before you necessarily have a chance to absorb it. Yeah. So they can actually steal some, steal some nutritional nutrition. And I've seen this commonly where patients are, you know, chronically iron deficient because the microbes are eating the iron before it gets absorbed. But they're also producing, you know, intestinal gas in the small bowel in larger quantities than what typically would be the case. Yeah. And that can cause, you know, bloating and, and distension are very key symptoms of, of or, you know, classic symptoms of sibo. But the other issue too is that some microbes, when overgrown, like E. Coli or Swishia, other species, or Klebsiella for example, also cause gut damage or, you know, leaky gut. And they're also, when they're growing and dying, releasing endotoxin. Because gram negative bacteria all grow this stuff called endotoxin. Just like we grow hair, we grow nails, they grow endotoxin. And it just happens that their endotoxin is immensely inflammatory. It causes gut damage, it causes liver damage and reaches your circulation. So when it gets enough, gets through your damaged gut eventually and enough can sue your liver filtering processes, then it can actually cause damage to the blood brain barrier. It changes your neurotransmitters in your brain. So we're now associating sort of endotoxins with anxiety, depression, cognitive decline, short term brain fog, long term Alzheimer's disease. So there are a myriad of other symptoms people can get besides just bloating and distension and changes in bowel pattern. As you can see, get fatigue because endotoxins are also mitochondrial poisons. You can get anxiety, you can get depression, you can get and the very classic brain fog from that too because you are getting brain inflammation from these endotoxins. You can get metabolic dysfunction because endotoxins impact your blood sugar regulation and cause inflation everywhere in your system. And if you have a weak area where you're kind of prone to having inflammation, all that endotoxin is floating around or will generally cause inflammation in that weak area for you, which can be different. For some people that might be thyroid. For other people it might be, you know, the knee pain might flare up. You know, so it's, it's an interesting condition that I think is a driver of a lot of symptoms that go beyond the gut. Yeah. Because I think again people thought, okay, it's just, you know, bloating and distension which can be severe and life changer, that can be relatively mild depending on the person. But, but there are other sort of body wide symptoms that you can get from having SIBO that are problematic short term and certainly long term. Like we know now that you look at something like Alzheimer's disease where when they've done autopsies of people with Alzheimer's versus healthy controls who died at similar age. And look at levels of endotoxins in their brain. And people with Alzheimer's have between 2 and 20 times more endotoxin in their brain because of, and so it's, and that's coming from the gut. So definitely do not want, you know, these, these sort of endotoxin releasing bacteria in our gut in large amounts and certainly not associated with gut leakiness, which is what we tend to find in sibo.

Yeah, I think fibromyalgia is another, another one, isn't it, that's been linked to, to sibo.

It, it has been, yeah. And one of my, my PhD students is on a brilliant research project trying to delve into that and she's writing up a thesis right now. So we'll, we'll have to wait to see exactly what came out from. We did breath Testing and microbiome assessments, the gut and oral microbiome assessments for a bunch of patient cohort with chronic fatigue syndrome to see if we can so fibromyalgia to see if we can actually see. See patterns there. And we'll have to wait until some more stuff is published around that. But it's perhaps not as, as key driver of fibromyalgia as once we want as we once thought I would say based on when I look at the data.

Interesting. So you just mentioned Alzheimer's there. Obviously we know about the gut brain axis. Have you looked into any link with SIBO and autism for instance?

I think there's at least one study making a connection there. And as someone who treats and sees a lot of patients with autism, SIBO is not uncommon in that cohort for sure, not everybody, but it's not uncommon. And particularly the, I would say the methane variant is more common. And when we have a overgrowth of methane producing microbes in the gut, we tend to have a slowing of transit time. And that slowing of transit time can manifest in obvious ways like constipation and that's you know, quite common amongst ASDASD community. Not everyone again but there's a number that do and in that population is constipated. Having over methane producing microbes in the gut is immensely common and we were able to address that. And bowel pattern improves, transit time speeds up and not surprisingly I would argue that you know, other symptoms improve like you know, awareness or learning capacity, speech, et cetera. That improves from that process too.

Yeah, I don't, I don't know if you're familiar with. I'm trying to remember the name of the movie I had the producer on the show, Invisible Extinction, it's called. Ah, no, and it's. And it's a movie about the gut microbiome and how, you know, the use of things like antibiotics are really problematic and how actually it could be that, you know, we're leading down the road of actually having a lot of our microbes become extinct in the human body. Which there's only one way that that ends if that continues.

Right?

Yeah, it's really scary. I mean if you look at some of the data around antibiotic usage, like there's a study published in Gut a couple years ago where one course of an IV antibiotic, I think ceftriaxone resulted in nine species going extinct. Nine species from just that one use. And you think of the people that, that in that who tend to see their, in that sort of typical Medical model might go and get a course in antibiotics once a year or twice a year. It's not uncommon in that situation because they're still being, we know, prescribed way over, over, over the top for, for viral infections in, in, in, in Western medical systems. So people are essentially every single generation of Western nurses is having a less and less diverse ecosystem that is clear and that's even just looking from the medication perspective, let alone the, you know, typical western diet. We have negative impacts on the microbiome, let alone, you know, increased rates of C section birth and formula feeding, both of which have negative impacts on microbiome composition too. So we have this sort of perfect storm of, of you know, C sections, very high rates of C sections, high rates of formula feeding and then lots of antibiotic use as a kid and you end up with these really narrowing microbe ecosystem and then that gets passed on. You can only pass on to next generation what we have. Yeah. So if your egos have already been majorly damaged from early childhood factors that were nothing outside your control, you can only pass on those microbes the next generation. They only have that number, you know, and, and, and someone who does tons of microbiome assessment with patients is I've seen this firsthand. I've had some patients who could show up with 12 series. The lowest I've seen on a test is 12 species of bacteria in someone's gut. High associates like 450 to give some sort of spectrum about how that actually differs in different patient cohorts and that the 450 was someone that had, you know, grew up in rural, you know, non western environments. So their ecosystem was far more intact, whereas the one with 12 had taken a lot of antibiotics in their, in their life.

Yeah. I'm going to tell you something that's probably going to horrify you. I suffered with acne from age 13 and I took antibiotics for 18 years.

Yeah, yeah. And your stories is probably not that uncommon amongst Western nations. And listen, I can say too that I took, I was in the, that sort of Western medical model childhood where you know, formula fed junk food, put on it probably fed, I would argue too, a processed food and antibiotic course is probably a couple, at least a year most years when I was a kid and I look at my, you know, and yes, since I was 18 and you know, discovered how to be healthy. Things are completely different that way. But I did a lot of, there was a lot of damage done in the early windows in terms of my diversity of my ecosystem. Like my, my ecosystem is not nearly as rich in microbial species as it should be because of all that damage that was done in my early life.

Yeah. And just, just getting back to the movie Invisible Extinction, the reason I thought of that was because in, in the movie, and I know we're talking about the small intestine predominantly, but they did a study on this Chinese kid and they were giving him fecal transplants every.

Three months, I think it was.

And they completely reversed his autism through. I mean, they had to continue doing it. Like, if they stopped doing the fecal transplants, you know, his, his autism would, would come back, but he went from being, you know, completely unable to communicate to just being a completely normal child. It was, it was pretty, pretty amazing to, to see that.

Yeah. And I think that's almost the tip of the iceberg when it comes to microbiome research. And in terms of the, the excitement that level of people have is because there are case studies of, of reversal of Alzheimer's disease post fmt. Like, it's a couple of published cases of people's Alzheimer's going after fmt, and there's fecal microbial transplant and there's animal studies showing that, that again, after fecal transplant from healthy, healthy mice, for example, like that the brain actually clears away the sort of damage that was there before so that you can actually clear away the, you know, amyloid plaques, et cetera, in the brain post fmt. I mean, it's pretty amazing stuff. And I've seen that stuff work in with kids on the spectrum where one just doing microbiome work with prebiotics and dietary change, inducing massive shifts in learning and cognition, speech, et cetera, to working with people who on the, on with asd, who are doing fecal transplants as well. And again, seeing sometimes these massive leaps forward that occur post fmt. Yeah. And even, I mean, I think that the breadth of conditions that we're now associating with, again, colonic dysbiosis or colonic microbiome changes are with, Is growing hugely. We can transfer high blood pressure from doing poo transplants. And that was not something that was anybody's radar before. You could take poo from someone with high blood pressure, give it to rats, you know, what, they develop high blood pressure, and we can take poo from healthy people, give it to people with high blood pressure, and their blood pressure goes down from that, you know, so no other diet change, no other lifestyle change is changing the microbiome, you know, and we've seen similar things with metabolic dysfunction like, you know, with blood sugar control. I mentioned some stuff with Alzheimer's disease before too. There's some promising research in Parkinson's disease, multiple sclerosis. Yeah, it's, it is really an area where the research is super exciting in terms of what capacity we have to shift some of these sort of chronic incurable conditions by changing the microbiome. It is, yeah.

And that, that just underlines how important the microbiome is, doesn't it? You know, if we can, yeah, if you can, you know, transplant microbiome into someone and their, their health condition is reversed. It really, it really tells us, it's almost, it's almost like the control center.

Right.

We think about our brain as being a control center but you know, probably just as much that the gut is probably just as much of a control sensor as our brain.

Oh, it's absolutely huge. And this is why when there's, there's like, you know, dietary approaches or lifestyle things that cause harm to that microbiome, I might, I, I cringe, I, I, I, yeah, I just worry about the repercussions of that because of the, how important the ecosystem is. And I think if you're making decisions around your health without knowledge about how important the microbiome is, then, then I think we're, we're actually doing it uninformed way that can lead to harm. And this is what western medicine has done for a long time is ignore the presence of those microbes. It's starting to, not so much now though. I still think it hasn't necessarily gone out to the ground yet in terms of your day to day average. GP doesn't have much microbiome stuff on the radar but that will change with time. And I think even areas like cancer treatment, that's another area where microbiome stuff is booming too because they realized that someone's baseline microbiotic composition can determine whether they actually respond to this anti cancer treatment or not. Hugely, yeah. I think there was melania like skin cancer, melanoma and people that had, you know, one type of gut ecosystem that was donated by a species called Bacteroides, which is like really dominant in western nations. People in the uk, Canada, us, Australia tend, because, tend to have Bacteroides dominate ecosystems because that, that they kind of like our western diet and lifestyle. They tolerate antibiotics pretty well. They're like junk food, they tend to go really well on a western diet but they, but if you've got that ecosystem and you go through this, you know, melanoma treatment, you have very little chance of getting A good outcome. But the patients that had ecosystem dominated by another microbe called the bacterium end up, I think it was 67% of them actually responded really well versus zero in the bacteria. That is massive. So there won't be that long before you can't ignore stuff like that for too much longer because that's life and death situation. People get better or they don't based on microbiome composition. And we can change that by changing the diet. By using the right prebiotics, we can change someone from Bacteroides dominant to faecally bacterium dominant in majority of cases within two to four months or something like that. So it's generally quite a modifiable risk factor that can actually make a big difference in terms of treatment outcomes. So I think research like that, that is again going to creep out into the community and eventually, you know, patients aren't going to these, the patients know about it, they're going to start asking about it. And, you know, this is what I've seen too, is that oncologists, not that I've come across, actually are aware of this research, but patients are and they're coming to me going, I've got melanoma. I'm going to go through this treatment protocol. Can you make my microbiome healthier so I have the best chance of getting good outcome? And it's like, yes, we can, we can work and work on that, but eventually that's going to start filtering through and eventually it's going to be that microbiome assessment before, you know, cancer treatment we come to standard practice.

Very interesting.

Yeah.

Just coming back to SIBO again. So you mentioned the gas being produced by certain bacteria. So we know that SIBO might have high amounts of bacteria that produce methane, hydrogen and. Or hydrogen sulfide.

Yep.

Can you maybe explain what the typical symptoms are experienced with each type of gas produced?

Yeah, I mean, I think we touched a bit about methanes before, so probably hone in there a bit more. I mean, methane's main consequence when you have excess amounts of methane being produced is a slowing of gut transit time. Okay. So that can manifest in constipation where you're not pooing every single day or your poos are really hard and rock like and really hard to get out. Yeah. But I think on top of that, which, you know, can result in hemorrhoids and, you know, anal fissures and, you know, a backup of gas like bloating and distension occurring because things just, you're not pooing. Therefore the Gas can't get out either. So you're just blowing up like a balloon because of all the gases building up behind that sort of poo backlog. But on top of that you're also getting absorption of, you know, bacterial toxins and other compounds from that, that bowel and naturopaths in the past used to call it bowel toxemia. And I think it's a really apt term even with, with modern research showing. Yeah, it's actually true. That's what's going on is when your bowels aren't moving, you're actually absorbing a whole range of different compounds like bacterial endotoxins in much greater amounts. And hence why there's a link between, you know, constipation is a risk factor for Parkinson's disease development because it's essentially it's bacterial toxins that are causing the Parkinson's, but it's the absorption through the slow bowel that's the trigger. Yeah, so it's, it's, you know, that's more of the extreme end of things. But again you're getting essentially absorption of those sort of bacterial toxins, endotoxins, I'd say environmental toxins. You're getting a second go at in that situation from high methane. So you will get other, you know, body wide symptoms like brain fog and fatigue and depression alongside, you know, argue also slower metabolism too are common sort of consequences of that high methane scenario. Hydrogen gas is interesting because it is much more, arguably a bigger, bulkier gas than methane. So you might get much more acute bloating and distension from that. Interesting enough methane. It's mostly because it's, it's more condensed, dense gas. It slows down the gut and that's why it causes bloating, distension. Whereas hydrogen is just big and bulky. So you tend to get this very clear quick reaction of bloating and distension within like 15, 20, 30, 60 minutes of eating. Your tummy goes, that's very classic hydrogen hydrogen sulfide. There's some debate about what classic symptoms are. For me it's very sulfury burps and very sulfury flattish would be pretty classic symptoms of that and worsening of symptoms after sulfur rich foods or after, after meat as well because meat is high in sulfur containing amino acids or worse after fatty foods too because of the, the onflow of bile, bile, the higher fat intake we have particularly saturated fat, we get more bile being produced and there's more sulfur in that bile, which then produces more hydrogen sulfide gas. As well. So there might be correlation between, oh, I eat more protein or eat more fat, I get worse symptoms and worse, you know, stinky, stinky, sulfur sort of flattish. You know, that might be pretty classic in that way. Bowel pattern, I argue, will go either way. I mean, I think some people would suggest that hydrogen sulfide is diarrhea. I don't see that all the time in my patients, although it's probably more common than constipation. But I do have patients who have slow transit time and have high hydrogen sulfide gas as well. But I think more commonly associated with more normal sort of transit time when you have hydrogen sulfide gas being, being produced.

And then also you have some people, they have more than one gas that's high as well.

Right.

Which we call, generally call mix, don't we?

Yeah, that's right. And you could argue that for people that have high methane issues in the small bowel, they've also got high hydrogen issues too, because the methane PC microbes eat hydrogen. So they actually need bacteria to produce a lot of hydrogen first for them to make the methane. So we may not see it initially on that test because you want to see the spike in methane, but we know there's actually hydrogen hiding behind there too. But you're right. In some people we see this very clear increase in hydrogen and methane on a test which we call mco.

Yeah, I guess there are people probably listening to this now and they're thinking, okay, you're talking about symptoms that I have. But I guess the question might be for a lot of people thinking, but why?

Why?

What were the main reasons why people actually get Sibo? Julie, a 47 year old who works in computer sales, came to see me.

Complaining of lifelong irritable bowel syndrome, which included severe abdominal pain and bloating, loose and very frequent stalls, along with hot flushes, menstrual brain fog and low energy which affected her work performance. After taking a comprehensive history plus running some labs, I discovered that Julie had a parasite infection which may have been causing the loose stools, a methane producing bacterial overgrowth that was almost certainly causing the abdominal bloating and pain, a leaky gut, low levels of digestive enzymes, as well as eating too many high oxalate foods on her vegetarian diet. So Julie reduced the high oxalate foods from her diet, plus she took a broad spectrum antimicrobial supplement to help with the parasites and the bacteria in her gut, probiotics to increase her good bacteria and help repair her gut lining. She also took prebiotics to help feed the commensal bacteria, digestive enzymes to improve her digestion, and herbs to help clear up the toxic lipopolysaccharides from her system produced by the overgrowth of gram negative bacteria. At the end of the program, Julie reported that her health had never been better. In her own words, the improvement is staggering. The abdominal pain and bloating was gone, her stools were back to normal, her energy was up, she no longer had brain fog or hot flashes, and her immune system had improved as she no longer suffered from frequent bugs and colds. If you're suffering like Julie was and you want to get to the root cause of your problem, you can arrange a consultation with me@bodycheck.co.uk that's B O D y C H E K and if we're a good fit, I could help you achieve the same kind of results as Julie. Now back to the podcast.

Yeah, I mean, I think there are certain things we know are risk factors. I mean, I can say from my clinical practice the most common risk factors are food poisoning, travelers, diarrhea type events where we have this sort of initiating event that has essentially created some degree of inflammation and dysmotility. So your normal motility has been altered by that infectious event and that hasn't normalized. And that allows rather than these lovely cleansing waves moving into your small bowel to move food and bacterial through. They're not happening so much or it's a disaltered or disorganized movement so it doesn't actually push stuff through and you allow, that allows bacteria to build up and then boom, you, you have sibo. So that, that's a pretty common driver. I also see binge drinking alcohol as a, as a common driver of sibo, opiate medication use things again that slow the gut down. Alcohol does that too. Alcohol acutely slows down movement in the small bowel also is a. Alcohol in larger quantity is a selective antimicrobial that kills good bacteria and leaves more gram negative bugs like E. Coli alone. So you end up with that sort of double whammy of, of, you know, slowed motility and increased levels of bad bacteria from alcohol ingestion. So that's often a driver too. And there are certain disease conditions like type 2 diabetes or chronic pancreatitis that we would associate with increased risk of SIBO development. Rheumatoid arthritis, Acne Rosaceae as well is one of the other conditions that seems to be associated with greater risk of SIBO too. Sometimes it's like the sibo causes things like, I think sibo is a driver of acne, whereas AC, for example. But other times, like in type 2 diabetes, if you have, you know, motility issues due to, you know, nerve dysfunction due to high blood sugar control, the diabetes is actually causing the sibo. Celac disease, Crohn's disease, have higher risk of SIBO development too.

Yeah. And there's also, like, physical blockages as well, isn't there? It's a known. Known cause of sibo as well.

Yeah. Yeah. I mean, sometimes you have it in. You know, I've had patients who've had abdominal surgery where they've had bits of their small bowel or bits of the colon removed. And yes. That those are high risk factors, too. And some would also point out that if you have had previous abdominal surgery, you can get scar tissue that builds up and the scar tissue can impact motility and then result in sibo too.

Yeah, very interesting. So I've got quite a big question for you now.

Yeah.

And I know there's a lot of, let's say, different views about what I'm going to ask. So I'm talking about testing for cboe. What would you recommend as being the gold standard? If, say, a client came to see me and they had no budgetary constraints, what would you suggest would be perhaps the gold standard for testing for sibo?

Yeah, good question. And I can say my views on testing have developed from one, reading through lots of research over the years, and two, my clinical experience testing hundreds of patients. Yeah. So that's altered things, too, based on what I've seen in terms of clinical reality, to me, the optimal testing protocol for SIBO is doing triple breath testing. So it's not just doing one sugar, it's actually doing three at different time points, too. You can't just do all three sugars at once. That won't work. So I recommend you do glucose, you do fructose, and you do lactulose. Okay. And this differs a bit because in the States, they're very much into lactulose alone, and very few practices do anything besides that. In Europe, the research general and I take the research consistently shows that glucose is a. You know, has better diagnostic accuracy than lactulose. But I think that again, from doing lots of breath testing, you, Glucose can miss certain cases. And I know lactose definitely misses cases too. But what I found from doing, again, just breath testing on hundreds patients is that fructose was really important and. And it would often pick up sibo that was missed by. By glucose. And if you just did lactulose as well. Yeah. And this is something, again, that evolved for me. I just started doing at the very beginning when I tested sibo, I always did glucose and lactulose because that's what the literature, you know, in Europe, they said use glucose and states. I said lactulose. I'm like, okay, I'm doing both because, you know, I want to see my own eyes, which ones tend to work. Work more accurately with. With patients. I'm aware of the research and the limitations of both those sugars. So you combine them essentially, and try to minimize the. The. The weak areas. Um, but then I started doing fructose for patients that were, you know, reacting to apples or pears or mangoes or watermelon, you know, like.

And.

And what I worked out was, is that the vast majority of patients who reacting to fructose actually were. Were. Were having small bowel fermentation of the fructose.

Okay.

And this is something that's interesting because it wasn't talked about much at all. You know, I lecture on fructose intolerance, and all the papers on fructose intolerance that are out there all talk about you malabsorb fructose in the small bowel, reaches your colon, and then you get the spike of gas. Okay? I was not seeing that in my patients. I was seeing all these people with this spike of gas of, you know, that hydrogen gas or methane at the 20 minute mark, 40 minute mark, 60 minutes. It's not in the colon, then it's in the small bowel. And you treat these people for sibo and their symptoms go. And they can eat apples and pears and all these things again. Yet with. With the, you know, the classic idea of fructose intolerance, it's a lifelong low fructose intake is how they manage it. Not. Not that it's curable. It turns out, like, oh, actually it is curable when it's SIBO induced fructose intolerance. So, so I again, and then I started doing this triple sugar testing on everybody. And then I realized that actually the fructose gave me the. I would actually argue the best results. And we did this, you know, just sort of in clinic scenario, we just took 130 consecutive patients we suspected of SIBO. We did, you know, triple breath testing sugars on. So we did glucose one day, then they did fructose the next day, and then lash dose the next day. And we kind of looked at the results and said, okay, how accurate were they for picking, finding the sibo? And I think lactulose alone picked up Sibo 73% at the time. Or, you know, methane issues, you know, small dose bacterial growth or methane issues, 70% of time. Glucose alone was 67% of the time, but fructose alone with 85% of the time. So it actually had better pickup value with just the fructose. But if I did, you know, combined, if I combined this lactulose and fructose, 96.5% of what we worked at were picked up if we chose those two. And if I use glucose and we get extra three and a half percent on top of that. So with some patients where money, it's more of an issue, I will just use lactulose and fructose because I think that's, you know, 96.5 is pretty good rate of picking it up. But if money's no, no issue, and you really want to make sure, because there's, there was, you know, three out of a hundred people where glucose would pick it up and the other sugars did not, you know, So I think it's really important to actually make sure we do multiple sugars. And there's a good reason for this too, because we know that lactulose is a selectively fermented sugar. So not all bacteria, particularly not all guts who know that are out there in sibo can actually eat lactulose. So of course it's not going to pick it up if that. You have bugs in your small bowel in excess amounts. You cannot eat lactulose. You're not going to pick it up. But they do eat fructose and they do eat glucose. Right. But the issue with glucose is it's really well absorbed. Our body's really apt at grabbing the glucose. Glucose is great for picking up the sibo in the first bit of your small bowel where the glucose is, but it's not good at picking up sibo in the middle or last bit of your small bowel. Whereas fructose, fructose is eaten by all these, all the different bacteria like glucose, but it is very slowly absorbed. Yeah, it's, it's like facilitated active diffusion, I think, is a technical term for absorption of, of fructose. So it's very slow, which means that the fructose actually reaches the middle bit of the small bowel and the last bit of the small bowel, which is why I think it actually works so well to pick up sibo or cases where glucose misses it in latulose, because latulose, again, only some bacteria can eat it and some. Some don't. Glucose, everything eats, but it's not there in the distal and middle small bowel, whereas fructose hits both those criteria. And I think that's why it's more accurate for picking it up in. In my experience.

Yeah. And that's. That's really great information to know. So, you know, when I initially did my training, you know, it was just one substrate that you used to test for, for sibo. And then obviously when I, When I took your course, it's like, well, that makes complete sense. You know, you're. You're. You're getting a much bigger picture.

Yeah. And the number of cases of SIBO I would miss if I just chose lactulose. It's huge. It really is. Because I. Because I do that triple sugar or double sugar testing, it's like, oh, if I just do like, I miss it, I miss it. I miss that it shows up so frequently in my patient cohorts. So I'm glad that I think we're kind of doing our patients at the surface if we're only doing the one sugar. I think that's the reality of there's a decent chance we're going to miss what's there.

Yeah. And what about stool testing?

That's a big question. More prompting around that one.

Well, I mean, obviously, you know, one of the things that, you know, these, these bacteria, obviously they live in the small and the large intestine. So, you know, you could. You could test for small intestinal bacterial overgrowth, but the problem could. Could potentially still be in the large intestine.

Right.

Yeah. Yeah. And I would say for majority of my patients, I also do my, like a clonic microbiome assessment by the stool, too. Um, but we know that we can't diagnose SIBO based on a stool called stool test. We can't. I think there are occasions where you might get a clue as to what microbes might be overgrowing in the small bowel. If you do the breath testing that's positive for SIBO and you get the stool test and like, oh, my God, they're really high klebsiella, or they're really high, or they're very high streptococci. Well, well and truly about normal levels, you might go, okay. I reckon it's, like, likely that you're a klebsiella SIBO person or a streptococcus and then we might be able to tailor treatment more effectively. But we couldn't just go, oh, you're high klebsiel, therefore that you must have sibo. No, because that those things are generally, you know, we would say are growing in, in the large intestine. But I, you know, I'm quite willing to, to run with the, the idea that if they, they got definitive Sibo and they have, you know, really high levels in the stool of bugs we know cause Sibo, like klebsiella, ashw, streptococcus, then I can target my treatment more effectively. And I think it works better because I can go, okay, well, I reckon it's klebsiella. Let's choose my herbs that are better at targeting Klebsiella, for example.

Yeah. Yeah. So. So I guess the reason I asked that was the original question was what would be the gold standard? So the gold standard would be to test all three different substrates for the small intestine, but also to test the large intestine with, with stool as well.

I think in terms of arguably getting the best results for patients. Yes. And discerning because you don't necessarily know what the result's going to be. It's going to be positive or negative until you do the test result. So often when I'm seeing a patient for the first time, I'm like, I want to look at your colonic ecosystem too, because it may need, I suspect, sibo, but it might not be the case. And this might be something going on in the colon. And if I wait until those results come in and go, okay, well, they're fine, let's do another test, um, to, to look at your microbiome. We're kind of delaying finding answers. So I'm often at that first consult going, okay, let's test your microbiome. Let's do the breath testing. If I suspect placebo so we can get some answers, then I might do other tests too, depending on what the presentation is. But I think we can, yeah, it can help fill in the gaps because you might go, okay, again, there might be high levels of hydrogen sulfide gas producers on that stool test. Um, there might be a bunch of other imbalances that we know are going to cause harm to this patient, either in the short term or now or the long term. You know, that will show up on, on the stool test. And because just the vital importance of the gut microbiome is like, we want to know that that data, like, I think it's key if we Want to gauge our patient's health status, we need to look at the microbiome.

Yeah, yeah, absolutely. So with regards to overcoming sibo, now, of course we need to treat every case on an individual basis. We need to look at, you know, the client history as well as the test, et cetera. But what factors do people need to take into consideration? And what available kind of protocols do you generally recommend?

Yeah, and this is an area of controversy or ongoing discussion or debate about from a dietary perspective, because there are some clinicians who put their placebo patients on really restrictive diets, and that can be carnivore as the one extreme end of that. And there are others that are just like a low FODMAP or SCD diet specific carbohydrate diet or biphasic diet, which are, you know, more restrictive dietary approaches. And then like myself, I actually don't think that. I think dietary restrictions can limit symptoms, but I don't think they actually fix the issue. Yeah, like I've had patients who have gone, you know, low FODMAP or SCD for, for months or years and they, they eat an onion or garlic or some legumes, and half an hour later the symptoms are there again. So it's like it hasn't got rid of the bacteria. It limits the symptoms that they're experiencing day to day. And that not necessarily a bad thing, but it doesn't fix it. To me, really restrictive diets lead to colonic issues, clonic, like a biome issues, for example, that I have concerns about. So I, and I don't think they're necessary. So I, to me, I try to minimize the sort of dietary restrictions as much as I can. And I might be go, okay, well, let's do low FODMAP and let's avoid any foods that, you know, are known triggers. Let's avoid alcohol, let's do some, you know, lack of snacking because we know that that snacking, if you're constantly putting food in, we kind of can impact our motility negatively, which can allow bacteria numbers to sort of grow up. So there are some tweaks we can do around there. But I'm not someone that does like really, really restrictive dietary protocols. And part of that's because I think, one, I have that experience where it doesn't cure anything, it just limits symptoms. And two, we know that bacteria like Klebsiella, like E. Coli, like bacteria, what is enterobacter that we find in SIBO studies that show up in people's guts with sibo Eat amino acids and protein. So even if you just go, I'm just going to eat meat, it's like you'll get less gas. Totally. Will you get less gas from that? Less hydrogen gas? You make I think one third the gas sort of fermentation level. When microbes are eating protein, amino acids versus, versus carbohydrates of fiber, a lot less gas. But you're not starving them, they're still eating, they're still happily growing. It's just you're getting less symptoms from that. So I think it's really important that we to me at least separate that, that out. And two also knowing that, okay, well, they're making less hydrogen gas. The Krebsiella and E. Coli, we're making more hydrogen sulfide gas if we give them more sulfur rich amino acids you consume. So it might cause less bloating and extension but it might cause more gut inflammation as, as a long term result of that. So hence I've always had concerns about more restrictive diets for Sibo. And to me it's, it's like the herbal medicines. It's the probiotics and the prebiotics that do the heavy lifting and they, they treat the overgrowth, they can help us decrease the, improve motility, they can help decrease the inflammation that's led to the dismotility. For example, those, those tools I think are doing the HEPA lifting. The diet is mostly around how do we make your life comfortable while the other things are working.

And what about things like antibiotics, both kind of pharmaceutical and herbal?

Yeah, I mean, I think, I mean I'm, I'm a naturopath herbalist. So I use herbs to treat. I don't generally use antibiotics. I know like naturopaths in the States often they're, they're, they're trained to prescribe antibiotics. They will do so at a much higher rate than what I ever would. But if you look at the data around the most, the most common antibiotic for Sibo is rifaximin. Rifaximin. You know, again, the studies on it are I would say of mixed quality. I would say that, you know, I'd say they're generally poor quality is what the, when they've done a review, they pull all the data together. There was like evidence of, there are poor quality studies in general. There was evidence of what they call publication bias, which means that they only published the positive studies and they didn't publish the negative studies. And a lot of them are open label studies where there's no placebo. So you can't necessarily say, okay, your symptoms are better because of the antibody could have a placebo effect as well. And even within all those constraints, I think that maybe it worked in like, 70% of people and people didn't get any sort of improvement from that. Um, and just with some comparative context there, you know, probiotics. You know, a systematic review looking at giving probiotics to people with ibs. So sorry. To SIBO patients, Definitive SIBO patients with like, 54% eradication rate with just giving a probiotic. Yeah, general, you know, that's combining all the data together. So.

Is there specific strains that tended to work?

Well, yes, I think in real life there is, but I think in this study, they just pulled all the data together so they kind of include. We can't see those specific details. But when you start looking at the individual studies that were included, like, there was a study published just a couple months back where they had patients with liver cirrhosis with sibo. All right. And SIBO is like a cord liver. Cirrhosis is a very, like, end stage sort of, you know, liver damage. It's going very poorly. And SIBO is a driver of liver dysfunction due to its release of endotoxins. The endotoxins cause liver damage, and that's built up over time when you get liver cirrhosis. So these patients had, you know, cirrhosis of the liver and they had sibo and they gave them, you know, placebo, or they gave them, in this case, Saccharomyces probiotics. So Saccharomyces Cervacei Variety Boulardii CN CMI 745. If you want to know the exact details, it's the original, you know, Saccharomyces boulardi, essentially. And I think there was 80% cure rate. In three months, the SIBO was gone. And 80% of people in three months of taking the probiotic. Yes. You have studies like that there. It's like, you know, you'd see these definite improvements that are there. And yes, I think there's other probiotics that can prevent SIBO from developing. So that we know when. Other common cause of SIBO we didn't talk about before is proton pump inhibitors, so those sort of reflux medications. I read a study just a few weeks back that they were. They gave PPIs to healthy, healthy people, and 8% of them developed SIBO in one week on the PPI. Wow, 8%. And the authors were like, ah, that's not bad. It's just 8% of people developing SIBO, we can keep using them. And I'm like, that's after one week. And it isn't like I treat lots of people sibo. Some people, they. It's just one course of herbs and for a few weeks, and they're great, and other people's not. It's like a bloody long thing. It takes a lot of work, a lot of time, a lot of money to treat. So I think 8% is quite a bit personally for one week's take of one medication. But there's other studies showing that maybe it's like 50, 60% of people after your 12 weeks of taking PPIs. Yeah. So that's common driver. And so many people take PPIs, they're like reflux medications are huge, both over the counter and prescribed in western nations, and they take them daily for years. And they're basically inducing sibo in all these patients. But they're a bit of a side point. But there was one study where they gave a probiotic alongside the PPI, and this one was Lactobacillus reuteri DSM 17938. Okay. And that's sold around the world as Bio Gaia. And that reduced the instance of sibo development in kids taking a proton pumphe it went from 56% in placebo to 6%, which is a massive difference in terms of whether sibo developed or not. And we know that particular strain can also produce methane levels in the gut too. There's other studies of people that are producing excess methane, and that strain decrease its methane output. It also tends to soften the stool and speed up transit time and increase stool frequency. So it can work well in that sort of methane, slow transit time picture. So it's kind of my strain of choice. And likely it's because that particular strain produces, at least in part, a substance called reuterin. And ruterin is like a selectively acting antimicrobial compound. And other bacteria that have been tested in similar models don't prevent sibo developing with. With PPI uses something specific about that strain. So we can't just go. Any probiotic will be fine. Because I think that's definitely not the case. But we know that some are particularly helpful for SIBO prevention or SIBO treatment.

Yeah, that's really interesting. Just going back to the antibiotic side of it, particularly the herbal side, what's your view on using herbs for sibo?

They're my core treatment, so. And I think even amongst, like, I use the probiotics, I'll use a prebiotic like partially hydrolyzed guar gum, which we know can help reduce methane load and people have high methane. We also know that it enhances the efficacy of antimicrobials. Like there's a study where they gave partially hydrolyzed guargam, I'll just say phdg from this point. They gave it alongside rifaximin or rifaximin, I think, with placebo and people with sibo. And I think it was a 62% eradication rate with just rifaxim versus 87% with the partially hydrolyzed squar gum. So I thought they're going, okay, well, I'm going to use PHTG alongside my herbal antimicrobials to try to improve the sort of efficacy rate of treatment even in my hydrogen dominant sibo and definitely mixed Sibo and definitely in methane issues too, because it's got that direct anti methane activity. But yeah, the hero herbs are still doing the heavy lifting, you know, and for me, there's a number of herbs I will use and that, you know, the ones I use commonly are ones like pomegranate husk and garlic, you know, and I think pickleball and allicin rich garlic extract. I want to be more specific here. Pomegranate husk is the skin of the pomegranate fruit. And it's been used in ayurvedic medicine for 2000 years to treat gut infections and diarrhea. Traditional Chinese medicine for 1,800 years for, you know, gut infections and diarrhea. And, you know, western herbal has been using for a long time. It's kind of fallen off the radar a bit up until, you know, more recently, but there's a lot of research on it. It's very good at killing E. Coli and Klebsiella and Citrobacter and, you know, pathogenic bacteria. It's very good at. But it leaves our good guys intact. And to me, because my PhD was in essentially the wonders of the microbiome, it's always been imperative to me. How can we selectively modify that? And that was like my whole PhD journey was, okay, how do we selectively modify this ecosystem? Not just kill everything. How do we just get rid of the bad things and leave the good guys alone or encourage them? Yeah. And that even led me to do research on what impact herbs might have on our good bacteria and which herbs might harm our good bacteria as part of my PhD too, because that was all involved with that. So even when I'm chasing Herbs. I know that some herbs can harm our good bacteria. Things like berberine and berberine containing herbs can definitely kill arbifidobacteria, can definitely reduce levels of diversity and butyrate producing microbes in the gut, particularly with longer term use. Berberine is quite problematic from a microbiome perspective where you have other things like pomegranate husk which is selective and actually has been found to encourage the growth of bifidobacteria, be encourage the growth of bead rate producing species but actually also target effectively bugs like E. Coli and Klebsiella for example. But I'll generally use a combination of herbs to try to get better results as well. But those two I think are key. Garlic again is selectively acting to at least the doses we typically would use that you took like half a bottle. Yeah, sure. You're going to get some difacteria too. The doses we tend to use to treat Sibo P are fine, beta P are fine. But we do target bugs that we don't want so much.

And what about oil of oregano?

Similarly that it's research I did as part of my PhD was oregano oil. Oregano oil, depending what country you're from, was very good at killing bifidobacteria. And so I don't use essential oils. I'm actually placebo exception. Very rare, rare circumstances. But I will use tinctures. Yeah. So I will, I will use Oregon tea. Totally. I will use oregano tincture. Yes. But I won't use the essential oil because I don't see the collateral damage with the tincture and the herbal tea. Yeah, the tincture is more effective than the herbal tea and they will work a bit more slowly than the essential oil. I agree. But you don't get the collateral damage. And I think this is key is that again the more we research about the importance of the microbiome microbiome, the more we want to avoid agents, whether it be natural or synthetic pharmaceutical that cause harm to that ecosystem. When we can, you know, and there's obviously times where we can't. Where you know, life threatening infection, your arm or something. Yeah. You, you take whatever antibiotics you're prescribed to deal with that infection, we try to fix the consequence. But if we have a choice between berberine which is going to cause or organo essential oil which is going to cause collateral damage or herbal preparation that won't. Why would I not choose the one that does for the majority of patients? And yeah, maybe I'll have the Berrina Essential oils. My like big, you know, bazooka cannon to pull out from patients who don't respond to the first sort of four levels of the treatment. But I certainly not going to use it initially before using things that are likely to work but not likely to cause microbiome harm.

Yeah, that makes complete sense. So that, so we've looked at, you know, the actual, the microbes. What about potentially speeding up motility? Is there anything you would do for that?

Yeah, and that is an essential thing that we that as part of treatment, particularly post treatment if you want to prevent sibo from redeveloping because it does have a tendency to redevelop sometimes when patients have, you know, had the misfortune of being food poisoned again or in other case travelers diarrhea, Boom. Picking the first 12 months after Sibo it will often come back antibiotics after course of sibo in the first 12 months after Sibo will often bring back sibo and alcohol binge drinking too. Just while I'm on that tangent will often are factors that essentially drive a regrowth of sibo. But beyond those things, one of the things we think about is maintaining that motility. We want things to be moving both through the colon but also small bowel. So we're often be using prokinetic agents. So you know, you know, medical conditions will prescribe, you know, like low dose erythromycin or something or procolapride to try to get things going. Whereas naturopaths might use things like a barogast which is herbal preparation that it can improve motility. We might use ginger to do so or 5 HTP or magnolia bark is another herb that's traditionally used in Chinese medicine that's got some good data on it for in improving motility, improving the, the functionality of your intestinal cells called the interstitial cells of cadal and then early bark helps them function better, which is pretty cool. And it's been used for again for a thousand years to treat bloating and distension and food stagnation in the gut. Which is pretty, pretty classic sort of sibo picture right there.

Yeah, yeah, yeah. So we've looked at dealing with the microbes, improving the speed of motility. I guess the other thing is inflammation.

Yeah, yeah, yeah. To me it is. And the inflammation is often what's driven the dysmotility too. Yeah. So I think when we're trying to like fix the dysmotility so their functionality will become normal and then that will prevent sibo from redeveloping. We need to work on that inflammation that can be caused by the food poisoning caused by antibiotics. You know, antibiotics actually cause gut inflammation inflammation when we ingest them for the most part there's the exception like rifaximin, but most of them cause increased inflammation in the gut. So using herbs like for me, a well absorbed turmeric extract is key here. 1 like Moriva Phosphatidylcholine extract works really well. But other well absorbed turmeric ones will be applicable to Boswellia are two that I use widely. But even things that enhance butyrate production in the gut will have a sort of healing anti inflammatory effect as well. So we're working on, you know, partially hydrolyzed guar gum. That pre bottom compound we mentioned before feeds B ray producing species which increases bead rate production and therefore has a healing effect not only in the colon but also in the small intestine too. So we're also focusing on, on nurturing those sort of anti inflammatory gut species in the gut and enhancing bead rate production too.

Yeah. And I guess the other thing we possibly haven't discussed yet, obviously we spoke before about one of the causes being blockages. Obviously there are specific treatments that can be used to help with blockages too. Right.

Yeah.

I think going back to the. I mentioned before around sometimes people have, you know, adhesions and scar tissue and I think that in those situations it's often about seeing an osteopath or physiotherapist who, who's adept at actually doing, you know, visceral manipulation and help loosen things up. And I've had some patients where that's made a big difference to their, you know, recurrence rate of a se. Yeah, we could effectively treat it. Fine. But then it will come back because you've got these adhesions and scar tissue that's stopping motility from, from happening. So it's important to sort of loosen those things up to allow that greater movement of the flow.

Yeah, I mean I'm, I'm familiar with the Borel Institute. I don't know if you're familiar with the Brow Institute, but they teach people in, in visceral manipulation and they're. Yeah, they're in many countries in the world actually know. I actually know someone in Sydney that, that does visceral manipulation. Trained by the Brow Institute. So they're, they're the people I generally look for to refer to if someone has that, that kind of condition.

Yeah.

Awesome. Jason, this has been absolutely fascinating for me. It's been really enjoyable. What's next for you? What have you got lined up next?

At the moment I'm really enjoying teaching my own courses. So I teach health professionals in my sort of educational center which is called the Microbiome Restoration center. And we do two 10 week courses a year. One is on sort of naturopathic and functional medicine approaches to gastrointestinal conditions which we cover IBS and SIBO and a bunch of others in great detail. And we do a second course on advanced microbiome manipulation which is just like 10 weeks of just microbiome madness, which, which is great. So, so that, that's what my, my passion at, at at this juncture of time. And we've just started, we're like week one and we two into to my functional gastroenterology course right now and then my microbiome one starts in October. Yeah. So I'm, I'm thoroughly enjoying that. And it just again just means I could get the excuse to, to keep up to date and keep reading all these amazing papers and then trying to implement those things with my patients and then using that as feedback from people I teach. Because I think that's the beautiful thing is like this research. But then what works in real life and some things that work in studies don't work in real life and some things work beautifully in real life and you want to like shatter from the rooftop to get every clinician to use it because it's such an amazing scenario or amazing tool.

Yeah, yeah. You know, there will be, there will be practitioners listening to this podcast. You know, I highly recommend your courses, having done one of them myself. Certainly, certainly helped me a lot in my own practice helping people with gut issues. So. Yeah, highly recommended. So where can people find your details online, Jason?

Yeah, well, there's the Microbiome Restoration center that I mentioned before. And also the Probiotic Advisor is the other place where I essentially have a evidence based probiotic database which we keep updated with probiotic research. Go. So you can know which probiotic is best to treat what condition. Because that's huge, huge area we didn't touch on today at all. But you could do hours and hours of discussions around probiotics for different things. And I think it's really about trying to how do we get the best outcomes for our patients? Is using the clinical evidence showing that the strain is good for this task, this strain is good for that task. So we can actually choose the best tools for our patients. So there as well.

Yeah. And are you on social media?

Very rarely. My Facebook page And I should engage more. But to be honest, I find more enjoyment in actually reading papers, teaching and seeing patients and posting on Facebook or Instagram. So I'm a bit slack in those areas. But I do have a Probiotic Advisor Facebook page for sure.

Great. Jason, thank you so much for your time. I've really enjoyed it. I love nerding out on information, particularly on. On the microbiome and, and also, you know, I'm sure there's going to be people listening to this episode that are going through, see, you know, sibo type symptoms and that, you know, they're probably going to get a lot out of this as well.

So.

So, you know, just thank you so much for your time.

Ah, you're very welcome, Lee. I. As you can tell, I enjoyed nerding out with you. All good.

Awesome. So that's all from Jason and me for this week, but don't forget, you can join me same time, same place next week on the Radical Health Rebel podcast.

Thanks for tuning in. Remember to give the show a rating and a review and I'll see you next time.