Gut Parasites with Dr Jason Hawrelak - Part 2

Do you have SIBO and want to learn how to help yourself? The SIBO Success Plan is Now available from thecebodoctor.com in this highly anticipated plan, you'll learn my tried and proven method to treat sibo, including home treatments, online dispensary guides, diet handouts and much, much more. Already being treated by a practitioner. No problem. The SIBO Success Plan is designed as a standalone program or to work under the care of a practitioner, become a SIBO savvy and beat SIBO for good. For more info, go to www.thecebodoctor.com welcome back to part two of the SIBO Dr. Podcast and let's jump right back into it now. Moving towards other types of parasites and my first question would be like, you know, what do you most commonly see in your practice? And I'll preface this by saying that I just don't see that many parasites in my practice and I do a lot of stool testing. I see it very rarely. And I wonder if that's part and parcel of this decimation of the microbiome is that we have lost some of these other species. And obviously we're certainly not condoned saying that parasites are a wonderful thing to have on board for everyone, like tapeworms and cryptosporidium and toxoplasmosis. That's not what we're saying, but we started off with the harmless neighbors or the ones that don't seem to be causing a problem. So what would you say or what do you most commonly see after these two? Because they are very common. I would say those are the only ones they are.

I agree, and they certainly come up frequently. I tend to just note it in my notes, but don't focus on them at all and keep looking. Generally we'll find what's causing symptoms in these patients. In that scenario, I'd say that's almost always the case, but I would actually put giardia on the list of the ones that probably comes up next. And that one is, I would put in a different category that when it's present someone has symptoms, I'll generally assume that's the cause and treat it. And luckily with using the right natural medicines, you can usually eradicate, blast or, sorry, Giardia in 10 days to two weeks. Pretty consistently.

Pray tell.

Yeah, and I'm lucky because I started off practicing up in northern New South Wales where you are, and I think that's working where remember those rainbow gatherings that would happen and I think you'd have these floods of people with giardia after certain rainbow gatherings and had a chance to do lots of trial and error on patients and see what actually worked. And I still see them less commonly now than I did up there, but still probably the most common what I'd see as a real disease causing predator in the gut of my patients. I think it does respond really well to some dietary changes like reduction of fat. Actually fat is a huge thing with giardia that one. It induces symptoms because you get this massive fat malabsorption with Giardia because giardia multiplies so quickly it covers up your entire, pretty much your entire absorptive capacity of your small intestine. It's just loaded with every millimeter is coated with these little giardia. So you malador fat eats bile as well and actually likes bile to actually grow on. So you maladsorb the fat. You end up getting worse nausea and steatorrhea if you eat sort of a higher fatty food. And it also tends to go better on. This is one of those organisms that does eat sugar. So it does tend to unprocessed foods. It does, you know what, in cakes and soft drinks and things like that, you tend to get a flare up of acute symptoms with that as well. So it's often just eating probably whole food, plant based, mostly high fiber sort of foods. We know that that fiber itself is associated with improved clearance of Giardia, for example. And then it's using the right herbs and, and years ago I used to use primarily Coptis coptis tenensis, which is, you know, hybrine herb. Just, just high doses for, for 10 days. Great, great outcomes. These days I tend to use probably more things like you know, pomegranate husk, guava leaf, oak bark propolis, ribwort. There's a number of herbs there that I perhaps I see as having more nurturing effects on the colonic ecosystem lower down. But not that I'm actually particularly worried about 10 days dosing of high doses of Coptis because I'm really not. But it just tastes pretty foul. And tomato herbs are more palatable. Yeah.

Is that your favorite like berberine containing herb? Because you use that a lot that Coptis.

Yeah, it is. And to be honest, I don't use it so frequently anymore because maybe partly because it's just changing patient presentations compared to 10 years ago plus. But when I first started playing with Coptis, I remember making a tincture with pretty basic supplies like a home blender. Plant it with some alcohol, let it sit. Then I was Lucky to be working at Southern Cross University at the time. And I was helping out with a phytochemistry lab and we actually run an hplc. And then I bought in my Coptus tincture to compare it to the goldenseal tincture and the Oregon grape and the barberry tinctures that were available. And it was a powerhouse of berberine. It had, I think, at least three times more berberine than goldenseal and heaps. Heaps more than Mahonia or Perusvulgaris that weren't even comparable. Yeah. So for that point I was like, this is my herb of choice from a berberine perspective because it's much, much higher and at the time that the raw material costs were less than with goldenseal.

Right. Well, one of the more popular ones in these compounds now is philodendron. Do you find like I find that? Well, I would say my favorite still in a tincture form would be Oregon grape, just simply because I love that herb, you know, and I, I use it in a lot of different ways, but as a, you know, as a standalone. I don't know about philodendron for berberine content, so I haven't.

It's actually, it's, it's definitely higher than Mahonia. It's been a while since I've looked at the stats around that and I used to make a tincture of Philodendron years ago and it was, it was quite a lovely tincture actually because it had these sort of demulcent qualities that came out when you made the tincture as well as the sort of the bitter berberine compounds. So it actually felt like a nice gut tonic in that respect. Demulcent mucilaginous type colonies alongside the antibacterial colonies. But it was certainly less than Coptis. But I think it's because it grows on a bigger tree, it's easier for commercially extract larger quantities from philodendron.

That makes sense than Coptis, which is.

That little plant that grows in hard to find rainforest, probably covered valleys. As small plant that takes probably years to get the root up to a harvestable size. Probably a bit like goldenseal in reality as much.

Well, good to know that Giardia is quite responsive then to high dose berberine. Good to know. Yeah.

Yeah. And not often use probiotics alongside that too. Like things like Lpantarum, T99V, El Renosis. GG do have PIV. LGG has got some good animal studies which is the best data we have on helping to eradicate giardia and listen, even in most people, you do nothing. 90% of people will clear the giardia on their own in four weeks. It's just, it can be very unpleasant. Four weeks, we can shorten that to one week or 10 days. That's obviously a much, much better bet. And there'll be that small percentage of people that aren't able to throw off giardia on their own. And that's perhaps what I see more in my practice now.

And it's, you know, I mean, I always associate giardia with camping and, you know, drinking out of streams when I lived in the Pacific Northwest and not that I ever did, but that's what I was taught. And here is it like a. Where do we find it here in Australia?

I would say it's probably not too dissimilar that it's often in creeks. And all it takes is someone at one of those rainbow gathering festivals to.

Oh my God, we're going to get hate mail. Jason.

Some sort of fecal matter.

Sorry.

I love most aspects of those festivals. Sorry. It just goes in my mind because I just remember these outbreaks that would occur from some festivals where I don't think they dug the pit toilet quite far enough away from the river system that everybody was swimming in. And you know what the rains are like up there. There can be just huge amounts of rain. Some journey gets to the creek, people drink or inadvertently drink some while they're playing in the water. And then.

Luckily we've had just masses of water here in the past couple months. So we're really happy that our streams are, you know, be there, Jordi, are filled. But hey, we love it.

But I'll wash downstream. Yeah. I picked up giardia from drinking creek water up that way, for example. That was my first experience of diarrhea. Protozoal Gordison was charity. And this is before I was a naturopath.

Let's kind of go back to testing for just a moment because. Well, actually, yeah, but just because it was like a conversation I had or I think it was a lecture from Ilana Gorevich, who's a well respected naturopathic doctor and IBD specialist and talked about parasites and that parasitology as an actual science is sort of like a dying art. That these parasitologists are really, you know, well trained parasitologists are a dying art because everything is now PCR and stuff. But there's a lot that can be also macroscopically, you know, I see. I get patients. I don't know if you get patients like this, but they fish something out of the toilet that they have passed and they are convinced it's a parasite. Right. And sometimes it looks very darn close to something weird, and you send it to the lab and it just says negative for, you know, macroscopically, microscopically, there's just nothing there. Has that happened to you?

Yeah. I certainly had patients that have done similar things, too. And I think it's been great to have a resource of someone like that that can actually just look at it probably under a microscope and, you know, and just go, okay, is that just a vegetable fiber of some description that looks a bit like a worm, or is it actually something that. That is a worm, for example?

Well, just recently, I had a patient pass an actual intact caterpillar. It was like he had. He. He has a lot of diarrhea and microscopic colitis and. But he, like, it was so fast, his transit, that he ate some kale and the caterpillar came out the other end intact. So, you know, it does happen when you have a transit of what, 20 minutes or 30 minutes. So. Yeah, that was a first, though. That was definitely a first. But I've had.

It's the first I've heard of such a thing.

Yeah. And it was bizarre. So. Yeah. So you also get some of those odd mason jars that end up on your desk saying, what is this? I've just passed this. And, you know, there are things like gastrointestinal lining or shedding when there's massive inflammation that can also look like ropey kind of mucilaginous worms. And, I mean, just talking out loud for the. For the listener, because, you know, sometimes we think we see a parasite, but it actually isn't. And there just is so much, I find misinformation about parasites on the Internet that I really wanted to clarify that I actually, when I test for it, I don't find them often. Then there's also an argument that they hide out. They hide out in areas like the gallbladder and in the mucosa, and there is some evidence around that with. Especially with gallbladder issues. So what are your thoughts on that, Jason?

I would probably concur in terms of my clinical practice. Reality is that I don't think that these things are nearly as common as you might guess from reading the blogosphere. But I do think there certainly are some organisms. I'm probably more familiar with things like salmonella, which isn't obviously, parasites, a bacterial organism that can get up into the gallbladder and make it hard to actually deal with. I think there probably are some other organisms that have that same capacity that I'm less familiar with.

Yeah, sometimes, you know, what do you think about. I've started to, you know, before we do stool testing, like the stool testing that you promote and that I promote from different labs, sometimes I give a biofilm disruptor. Do you find that to be helpful just as a, like a week or so before to try to disturb and irritate any sort of potential pathogens to come out of their hiding so that they're easier diagnosed?

Interesting. No, I haven't tried that, that approach and interesting thought, the thought process. I mean, I might think that it might change the ecosystem dynamics as well in terms of not in just pathogens, but other microbes that also live in biofilm, like many bifid bacteria, Lactobacilli, et cetera. The populations might change in some way when exposed to that too. That'd be my only concern around that.

Yeah, I think of it more like when, you know, symptoms aren't like just as a retest, as a potential, you know, where we're. Where we might get more bang for our buck because we know those stool tests are so darn expensive. You know, just a thought and I've, you know.

Yeah, and we're still. Oh my God. We're still learning, you know, as you'd expect. But you know, I think there was one person that had blastocystis. They did a stool sample every single day. This. It's been a few years since I read the study, but it certainly did not show up in the stool every single day. It was missing when it came out. So it wouldn't surprise me if it's similar with other protozo organisms, depending on the overall quantity in the gut, et cetera.

So moving on to our next category of parasites, which are worms or helminths. And recently there for those. I think I may have mentioned this in other podcasts, but there are worms that are, you know, obviously like tapeworms that are quite parasitic in terms of eating your calories and attaching themselves to the gut wall, like most worms. But there are some worms, not all, but some like hookworm, that are used therapeutically to induce sort of or down regulate an immune response for those with ibd, I believe. So. Have you had any experience with that?

No. I mean, I've certainly read the studies around it and I've read some of the preliminary data looking at American hookworm for celiac disease.

Yeah, celiac disease, yeah.

The nica, the original Research was less than exciting, but it like slightly decreased the amount of inflammation induced by gluten, but actually caused pretty severe symptoms at the time they were inoculated. But they may have fine tuned their approach since I've looked at that research. But I think you're right around ibd. There's more consistent positive data around that.

So just as a take home that not all the use of those kinds of things is not always pathological. It really can actually be therapeutic administration. And that really speaks to the fact that even creepy as it might be, but we all have had, we've all evolved from that in terms of our microbiome used to be, you know, it's not all just bacteria and some fungi and some viruses. It was creepy crawlies as well.

It's true and you're right and I think you hit the nail on the head with the evolution aspect, is that our immune system, our gut, you know, gastrointestinal system has evolved with, you know, this constant interaction with bacterial species, fungal species, protozoal species, and your right, helmets as well, that have allowed it to evolve in a certain way. And we take that sort of interaction away, there are consequences and certainly we're seeing the consequences of bacterial dysbiosis, I think all around us now. But I think as research moves on, we'll be teasing at the consequences of the lack of diverse fungal ecosystem, a lack of diverse protozoa ecosystem, and the impact that has, and potentially, and there's some of these discussion around that, that lack of helmets as well as having some impact on immune overreactivity to certain things that it shouldn't be overreacting to.

Yeah, we've become too hygienic and yeah, that's just why I always love your message of treating the terrain rather than just the individual organisms. I think that's a very holistic approach and much more aligned with my view of that we got to get away from this one bug, one disease or that kind of approach. But sometimes it's kind of harrowing when you get these test results back and it's just like a desert in somebody's gut. It's like, wow, I'm not surprised you can't get up in the morning, your energy is in the toilet and you're aching all over and you've got, you know, diarrhea or whatever maybe. It seems to be like a long journey back for some people and they have a lot of issues systemically.

Yeah, that's, that's correct. And it just makes me think when you mentioned that of, you know, a patient I had that had essentially around a 0% diversity score and 0.6% butyrate producers. 0.6% and keeps very high hydrogen sulfide gas producers and LPS like crazy. And you're like ah, this person was only eating, you know, one essentially just chicken when you biochemist to me, just chicken. Two chickens a day. That was it.

Yeah.

And you look at that ecosystem going gosh, it's. I can see why you're feeling so horrible and I can see why any sort of at this point any plant food causes you symptoms because level inflation, your gut is surreal. But you also need to nurture those species and feed them for any chance of your gut getting better long term. Yeah. So it is fascinating to see that correlation between disturbed ecosystem disturbance dysbiosis and then can be quite severe level of symptoms.

Yeah. And I think you and I see a lot of this sort of microbiome decimation and do you know, for someone like that, would you. Is it too hard to get to coax it back into a viable microbiome or do you think about FMTs or fecal microbiota transplants? I think is that a good viable option for these people?

I think for some of these people definitely is. It's just trying to find. For me, you try to find the donor that has the right ecosystem to donate to fix up those gaps which in a case like that I reckon it's probably pretty easy because it's so disturbed that probably almost everybody's will be better than what that ecosystem actually was other people. It's challenging but in terms of, I mean with this particular patient we've actually made through her efforts in keeping incorporating new things into her diet and putting up with levels of discomfort as part of that process because any intestinal gas causes, you know, that's pretty. Causes you know, abdominal discomfort when they've got that inflamed, which is in her case. So it's been, you know, dietary is far better. Her symptoms are actually far reduced systemically and a whole range of other symptoms are reduced. But we're going to, we're about to do a second follow up stool test so we'll see to see what sort of impact there actually is. And I mean I've been surprised at times at how resilient that you can actually be in some of these people where you know, it looks pretty horrible. Like the ecosystem looks very damaged, looks very low in diversity. But with the right tools and the right effort, the right lifestyle stuff that we're actually able to restore a certain degree of normality. Now, obviously, if species are extinct, they're extinct. And this is the thing you don't necessarily know until you attempt to revive that, you know, certain bacterial populations, whether they come back or not. And that depends where they can handle the treatments that help bring those species back as well. But I think there are some cases where FMT screams out as a potential treatment that much quicker, things like that.

And the Crapsules have been around for a while now, I think. You know, I talked to Dr. Andrea Macbeth, who on the last podcast about, she teaches at, I think it's nunm, the microbiome classes. And she actually has a clinic herself, sort of boutique clinic about specific use of fmt. It's still around the C. Diff, but you know, that's all coming now where we're seeing these boutique things. And her and Mark Davis actually have been using oral FMT since for some time apparently. So that's I think a lot more, I think maybe less palatable, but a lot easier than doing an FMT through the rectum. But it's all just. It's going to be very interesting moving forward.

Yeah, I bet I will be. And I look forward to when we start doing fecal banking for kids before they ever get exposed to antibiotics. We'll take a lovely specimen to reintroduce their ecosystem back in and then we sort of take away many of the concerns that there are out there about FMT introducing new organisms that may not be a good match for that person or obesity or depression or anxiety that might get passed from person to person. It takes all that aspect away. So I look forward to, to that and then just that burgeoning research on the impact of FMT for a range of other conditions because it's pretty well proven to be helpful for things like C. Diff. But there's a growing body of research for IBS and ibd and I think we'll be looking at using it to treat depression, anxiety for type 2 diabetes, obesity coming up. So there's a whole bunch anything that's associated with, with microbiome disorders, which is a lot in Alzheimer's, Parkinson's, multiple sclerosis. I think that there's a huge avenue here for fecal microbial transplants to actually impact that as risk for gut microbiotic modulation, which is perhaps where my clinical practice is really at is optimizing people's ecosystems. And I'm not actually doing the FM team so much as people, Mark Davis, for example. But I look forward to seeing that sort of research because I think for some people that could be a quick viable option. They just have to get their head around ingesting poo. And that's a bit of a leap for some people, whether orally or rectally. You know, I think you're right that for many people it would actually be easier to do Crapsules, but to get their head around orally ingesting feces is trickier than using his rectal administration.

I think that those people that are, you know, some people are just at the end of their rope. So they are like at that point I think sort of they don't mind it as much. Okay, before we wrap up, this has been really extremely helpful. So again for people listening, I'm not quite done. I still want to ask you about, you know, what's the latest and greatest on the probiotic front in terms of particular strains dealing with issues like Sibo or hydrogen sulfide or, you know, a number of things that we've discussed before. So I still want to have you talk about that. But before we end, definitely check out the probiotic advisor. If you're a practitioner, it's a great tool to quickly search for recommended strains that have been researched, particular conditions and also the, the Blastocystis and Dientamoeba course will be on the show notes and also we still have the microbiome restoration course by Dr. Jason Horolak on the SIBO. Dr. So you've got a lot of resources if you've just tuned in for the first time and you're not sure where to start. So back to you, Jason, in terms of what's the latest and greatest on the probiotic front other than Krebsils.

I think there's things I look forward to in the future, moving forward into the future and that certainly Crapsules and I would say that probiotics made from Faecalobacter and Prosnitzii and Achamazi muciniphila. But I think there's still few years away and even Oxalobacter former genes again, that's great news. Yeah, a couple years away but it's all happening. So at some point we as clinicians and the general public will have access to a range of tools that we don't now that will actually open up. I think a range of treatment opportunities and a range of B tray producing bacteria in a capsule will be fantastic because so far you our probiotic dispensary is so much focused on Lactobacilli and Bifidobacteria Even if they're using 12 strains of bifidobacteria, it's still just bifidobacteria. We're not looking at the dominant organisms in healthy people's gut, which could be Faecalobacterium, EU bacterium Roseberry, these lovely butyrate producing bacteria. So again, I'm super looking forward to what the future holds in terms of future probiotics that will potentially allow us to recolonize in a way that current batches don't and reintroduce more diversity ecosystems. I think there's that Canadian study that used a product called Repopulate, which I love the name of and essentially it was they simply took the poo out of a fecal transplant and just concentrate up the microbes. So the FMT without the F and that has I think better compliance rate because people aren't going to be so concerned about without the fecal component and as ways of repopulating the gut in a way that we can't.

Fantastic. Thank you so much for spending some time with me again and all those resources will be in the show notes as well as how to find Dr. Jason Horlack and work with them. Are you still actually taking new patients, Jason?

Yeah.

Two year waiting list now a.

Queue for the most part. But you know, for people. Yeah, except for emergency cases that sometimes get slaughtered in very quickly.

Okay, very helped asap.

Or they lose their colon for example. Oh yes, sometimes you slotted in more quickly.

Excellent. That's good to know. But yes, he is in beautiful Hobart, Tasmania. So if you can make your way down there, beautiful part of the world. Thanks again Jason. Always a pleasure to about talk to you and I'm sure I'll see you soon at one of these conferences.

You will Narella. Thank you. It's been been great being here. Once again, Thank you for listening to the SIBO Dr. Podcast. We hope you found the information in this episode useful in the treatment of your SIBO patients. Thanks to our sponsors, Sibo Test.com, a breath testing service with easy online ordering and Quintron, maker of outstanding breath testing equipment. Tune in again for another episode of the Sibo Doctor podcast. Thanks again for listening, Sam.