Bloated? Allergies? Is it SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) is common. Often it is passed off as Irritable Bowel Syndrome or chronic indigestion or food intolerances or even allergies. As the gut is intimately associated with so many body systems it is expected that symptoms can be broad and not fitting into any typical diagnostic pattern. Bill's case is extremely complicated. His practitioner Nirala had to take her time in deconstructing the health issue's Bill faced and take special care to reconstruct his health,

Transcript

Daniel Baden: 0:16

Nirala Jacobi is a very experienced practitioner who brought her knowledge about SIBO, which is small intestinal bacterial overgrowth, to many other practitioners and patients over two decades ago. Her case is about a 34 year old male who is presenting with an unusual set of symptoms. And this is really typical of what we see in natural medicine. People come to seek out help from holistic practitioners who have a range of symptoms, so far reaching and so wide. It doesn't normally fit into any medical category. Nirala is an expert at these types of situations. And for that reason, I'm really excited to have her on board today, hello Nirala.

Nirala Jacobi: 0:58

Thanks for having me, Daniel, nice to be here.

Daniel Baden: 1:01

Nice to see you. Again. It's been a while

Nirala Jacobi: 1:04

it's been a while, yes. Pre- COVID.

Daniel Baden: 1:06

The case that you're going to be presenting today, I think it really talks to what a lot of patients come to see natural medicine for an unusual set of symptoms, some gut issues, some immune issue. Tiredness is an epidemic with everybody. Can you just let us know how he came and presented to you?

Nirala Jacobi: 1:28

Yeah, sure. And it was, as you mentioned, this is one of those cases where this may not have been somebody that would have naturally sought out my services, but it was so severe, his symptoms, and he just got so much the runaround by his gastroenterologist, that it he just worsened that he was quite fearful of what might happen to him because it was very uncontrollable as symptoms. So this is a 3434 year old man who basically was unable to eat any food without feeling of severe dread. He had shortness of breath or difficulty breathing. He also had other sort of systemic symptoms in terms of restless legs and arms, especially at night. And then he had really severe bloating, especially after meals. And what happened was two years prior to seeing me, he started to get more and more acid reflux, which is not uncommon when we see this all the time. Acid reflux here had a very stressful job. But it started really suddenly with a bowl of rice and tuna. And he had such severe stabbing pains that he ended up in hospital. And they were prescribing basically pantoprazole, which is a proton pump inhibitor. And it really didn't agree with him at all. He couldn't tolerate it, and ended up taking really massive amounts of Gaviscon every day. And that barely gave him any relief. He then came across, you know, as people do that look for answers on the internet. And he came across the carnivore diet. And he stayed on that for nine months, and it improved his symptoms. But he still had a lot of the symptoms of at least gave him some relief. Any other food other than animal meat would give him severe symptoms.

Daniel Baden: 3:25

This is pretty unusual stuff, and not what you would expect. So just because half of our audience are practitioners and half a general public, a proton pump inhibitor is an antacid is what you would take, you know, sometimes people take it when they feel like they've got acid reflux, they would take an antacid as it but it's a pretty potent one. And it can cause a lot of side effects. And Gaviscon is also an antacid. And that's available over the counter. So people often take Gaviscon as well, in your notes to me. You said he was taking 40 Gaviscon a day? Yeah, yes. Oh my god. That's yeah, I've never heard of that.

Nirala Jacobi: 4:04

Yeah, me neither. But well, actually, I have had people that took severe lap, you know, amounts of acid blockers. Now. PPIs. proton pump inhibitors inhibit stomach acid by up to 97%. And these other lesser drugs work on a different mechanism, and they don't block stomach acid as severely, but still he needed he needed that to provide any kind of relief. And now even that was very minimal.

Daniel Baden: 4:32

Was he taking the Gavascon when he'd gone to the carnivore diet?

Nirala Jacobi: 4:37

he was there was a bit of overlap. Yes, he did. But the reason you know this is that let that symptom relief with the carnivore diet was not a surprise to me because that happens when you have SIBO right because anytime you eat carbohydrates which are present in grains and legumes and vegetables, they can feed bacteria that are overgrown in the small intestine, if you have a condition known as small intestine bacterial overgrowth, and this condition is where those bacteria are not meant to be in that location, they're meant to be in the large intestine, not in the small intestine where digestion happens, absorption happens. And it's meant to be very, very, very low in bacteria, but different reasons why people develop SIBO. And when that gets out of control, you can have a situation where you have such severe level of fermentation of bacteria eating the carbohydrates, that that causes a lot of that can cause a lot of damage to the lining of the small intestine. And of course, give a lot of the symptoms a classic one is bloating after meals, especially with fiber containing foods. So I had a very high suspicion that that was happening with him, because he did get relief with the carnivore diet, you know, I mean, he didn't just have the reflux, he did have a lot of this severe bloating that left him breathless, and also had this sense of doom after meals, that eased a little bit after the carnivore diet. But of course, as you can imagine, a carnivore diet is not sustainable, and his cholesterol just went through the roof, like I'd never seen a change of cholesterol that severe. So it was pretty dramatic, two or three times the upper level of normal, right? So it was it was pretty high. And that can happen. Also, not just like, you know, obviously, the carnivore diet has a lot of saturated fat and animal protein. And when you have SIBO, this bacterial overgrowth in the small intestine, what we now know is that different types of SIBO are caused by different types of bacteria. And he had a very high hydrogen production in his small, small intestine. So hydrogen SIBO, is a type of SIBO. And the two types of bacteria that are producing this are E coli and Klebsiella. And these two are very, very high endotoxin producers. And when you eat a diet that's solely consisting of saturated fat and animal meat, you're going to absorb a lot more of this endotoxin called LPs, and that can raise your cholesterol, and cause all sorts of other problems like inflammation, et cetera. So he was sort of going from the fire into the what is it the from the fire into the frying pan, or he was going from one bad situation to another bad situation, and a lot of other systemic symptoms started to appear one, once he started on the carnivore diet,

Daniel Baden: 7:48

just in the nutshell with SIBO, you have a group of bacteria that would normally live in a healthy individual in one part of the colon. And for some reason, these bacteria migrate to the small intestine or higher, and cause changes to the mucosa and change how we digest food causing more fermentation. Is that correct so far?

Unknown: 8:15

I mean, there are there are a lot of different reasons why people develop SIBO. So it's not always the migration of those bacteria. Sometimes they're very frequently actually there is a problem with the normal motility in the upper gun. So that bacteria because you don't want to have small amounts of these are okay, you know, other bacteria can keep them in check. And it's, it's often kept in check by this housekeeper wave that is part of the small intestine that is basically a contraction wave that sweeps through the small intestine, and clears out a lot of these bacteria. But in many people for lots of different reasons, that type of motility wave is impaired. And then bacteria are allowed to remain in the small intestine and can just proliferate.

Daniel Baden: 9:03

do you have any experience or knowledge or if it exists as to why some of these bacterial cultures will change from where they reside in the intestinal tract? Stress, or..

Nirala Jacobi: 9:14

Well, I mean, there, yes, stress is a big part, but that alone doesn't change the composition of the bacteria. So what you're asking, like, why do people have? Well, what we know that the biggest hydrogen producers are these two bacteria, and they're very common commensals in our gut, right? They're very common. They're in small amount, they're normal in higher amounts, they cause problems. And so when you have something like that, that's that's completely rampant, you're gonna get a lot get a lot of symptoms, but, you know, the way I usually describe the causes of SIBO for people is in three different categories of causes. And number one is something got messed up with the motility and that often is due to factors like the, you know, vagal dysfunction is maybe where you were going with your question about stress, high stress can do that. But that's tends to be more temporary. But if you've had food poisoning, for example, food poisoning, is a situation where you're infected with a very aggressive pathogen. So this is different from not from these bacteria that cause SIBO. In that, typically that Campylobacter or salmonella, or you know any of these sort of aggressive bacteria, and when you're infected with that these bacteria secrete a toxin that you can develop an immune response to an auto immune response, basically, where your body is trying to attack this poison. But instead, it actually is damaging this housekeeper wave. And this is a really well established, basically etiology or development of SIBO, where now you are attacking the motility aspect of your small intestine instead of the poison. And so a lot of times for listeners that may have developed IBS or irritable bowel syndrome, after a case of food poisoning, it's very likely that that was the reason why this happened. And that's been more and more confirmed now in the research. And so that's one reason. Yeah, that is one reason why people develop SIBO. And that is probably one of the most common but then it could be that you've had scar tissue in your, in your abdomen from surgeries, like getting your gallbladder out or your appendix out or having a C section. And all these types of interventions where you there is a cut, and wherever there is a cut, you can have this aberrant scar tissue called adhesions, and adhesions or intra abdominal sort of anchors and hooks and they can attach to the outside of the digestive tract and pull and twist it into sort of like a kink in a garden hose. And so this is different from having impaired motility in the upper god, this is more like bacteria are can't really move well through this kink in a garden hose. That can also happen, especially with conditions like endometriosis. Also,

Daniel Baden: 12:13

what about some other issues that would affect I imagine a lot of the listeners, things like non steroidal anti inflammatory drugs, oral contraceptive pill over a long period of time antibiotic use or any other sort of drug. Any thoughts around? Yeah,

Nirala Jacobi: 12:27

well, and non steroidal anti inflammatories do not cause SIBO, nor does the pill, it certainly can affect overgrowth. But if we think about that the body has certain mechanisms in place to prevent bacterial overgrowth and stomach acid is actually one of them, right? We actually are meant to kill bacteria that come in from the outside and create an inhospitable environment. And they're supposed to pass through this vat of acid. And so yes, that can also change. But turns out, a lot of that is more in the large intestine, this dysbiosis is what we would classify as dysbiosis. So yes, you can have medications that that can also alter the small intestine, but most of those medications are based on that they affect the motility of the gut. So these mechanisms besides hydrochloric acid, and this cleansing wave there, I mean, all the digestive juices have this bacterial static effect, they they're meant to kill bacteria, because of the reason that the small intestine to give you an idea is not meant to contain more than 3000 bacteria per milliliter, versus something like 10 billion per million milliliter in the large intestine. So that gives you a visual of the different like, it's the desert in the rainforest, right. And it's really meant to be kept very, very low in bacteria. So anything that affects it, you know, I can't get it from probiotics, for example, that's not how this works. It's it's a real specific thing of either that they are migrating upward from the large bowel, which is not that common, or they can't be flushed out with the normal motility, or you have some kind of adhesion. That's usually the way it works.

Daniel Baden: 14:11

Thank you for the distraction and indulge me my selfish academic curiosity. But let's get back to your patient.

Nirala Jacobi: 14:16

It's important, right? It's important to know about SIBO SIBO is like it's everywhere these days about, you know, and when you remember, like this was 2011. Daniel, when I approached you and your company, I was like, this is SIBO. We need to we need to do a webinar about SIBO This is and it's it's it more and more and more people are aware of it so much so that it was a question on Who Wants to Be a Millionaire here in Australia? No, really? Yes, it was. Yes. What is SIBO? So we've made it big

Daniel Baden: 14:47

you did make it, okay. Let's get back to your patient. He was on his carnivore diet for nine months. He got better his cholesterol went up. And then what happened?

Nirala Jacobi: 14:58

Well his cholesterol was so high as I mentioned, that he got scared, and he really didn't want an end he got he had minor improvement, it went from being so intolerable to be just a little bit more tolerable, but it's he still had a lot of symptoms that he just wasn't happy with, and a lot of mood issues, anxiety, difficulty breathing, and all of that. So the first thing we did was, we did a SIBO breath test, this is basically a test you can order. And you can do it at home, send it in, and it can tell you whether or not you have SIBO that in retrospect, what had happened was he had already been diagnosed with SIBO by another practitioner, and the treatment had put him in the hospital, basically. So he had such severe symptoms of the from the treatment, that he you know, panic attacks, anxiety really severe, and things like that. So that's how he ended up with me. And one of the one of the contributing factors I strongly suspected was histamine issues, because histamine intolerance can really be one of the side effects of SIBO. But also, from from a lot of other conditions. People are familiar with it, if they have seasonal allergies, or allergies in general, the sneezing the allergy symptoms that you can expect with histamine. But histamine can have really strong effects in the gut in terms of diarrhea, cramping, you know, a lot of SIBO symptoms can be from histamine intolerance. But then you can also have a long side of that you can have all the other allergy symptoms, but also headaches and things like that. And because he was so reactive, oftentimes when people are extremely reactive to lots of things, histamine is the first thing I think of. But one of the reasons I don't know if you want me to carry on with histamine or if you want to throw a question in there,

Daniel Baden: 17:01

well, I've got one, just one comment, because I find this super interesting, because histamine, aside from everything you've just described, which is spot on, there are a number of histamine receptors in the brain as well. And there are some significant relationships between histamine and mood such as anxiety and depression, when we're talking about a lot of these gut and food type issues, anxiety, depression are strongly associated. And when people go on, and sometimes people go on specific drugs for their mood, their allergies improve. And these sorts of unusual types of correlations, which we're only just starting to discover more and more and more about as time goes on. So this guy seems like he's really ticked all the boxes in terms of histamine.

Nirala Jacobi: 17:47

He did, he did, and especially with his severe reactivity, but I see this so often. Because in SIBO, if you imagine, right, what I said before you have this desert you like a healthy small intestine is, has very few bacteria. But imagine now you've got, you've got 10, or 20, times the amount of bacteria you're meant to have. They're the and they're fermenting these carbohydrates, and causing this hydrogen gas. And that gas is actually damaging to what's called your brush border. And the brush border is the hairlike protrusions on our cell surface of the cells that are lining the gut, right or in the small intestine, that really effectively increases the surface area of your digestive tract to that of a tennis court. If you were to pull out your small intestine and spread it out from you know, every cell it would be it would cover a huge surface area so that you can extract as many nutrients as possible. But what happens

Daniel Baden: 18:51

one of the really fast sorry, this is just for me, so I'm sorry to interrupt. But I was reading in New Scientist a year or so ago, that the brush the hairs on the brush border, actually some of them have little sampling cells at the end of the hair when they can they can sample what's in the gut environment and drag it back in for the immune system to assess what's

Nirala Jacobi: 19:13

Yes, yes. Those are the fibroblasts, right also fibroblast dendritic cells do that they're made that's a whole nother level I know a whole nother conversation of how how we interact with our immune system and how we turn food which is non self into self, all of that super fascinating. But yeah, so what happens with this with very high gas levels, is that damage this brush border and what what happens at the at the tip of the brush border is basically you have enzymes that perform the last step of digestion and absorption for you and one of those enzymes is diamine oxidase. And diamine oxidase is specific for breaking down histamine in the gut. So you get sort of this situation where you cannot break down your own histamine. And histamine is elevated in some people for several reasons. And one of them is the loss of this enzyme. And another one is, they may have such an imbalanced microbiome that the microbiome is actually producing histamine. And then thirdly, we see more histamine in SIBO, because the cells that contain histamine in our tissues are called mast cells. And you can have this migration of the cells, and then they get very trigger happy, you know, like you mentioned, nor histamine is not just a neurotransmitter, but it also is a mediator, that the whole purpose is to flush out whatever it's trying to get out of our system, right? And it increases the mucus and widens, it's a basal dilator. It does all these things to try to get rid of the pathogen. And so this is just sort of like a helpful thing gone awry. In a way.

Daniel Baden: 21:06

this is a super complicated case. Where do you start? You thought that he had a histamine intolerance? You he'd been down the SIBO track, he tried some sort of therapy with another practitioner. So what's the next step in your thinking? Where do you go with that?

Nirala Jacobi: 21:20

My practice is pretty much full of patients like this, where they have gone to other practitioners, and it was just too much too soon, too fast. Right. And I think this is a good case. To exemplify that we started really slowly, we knew he had SIBO. And I wasn't going to do the same mistake. And this practitioner was great. He was well intentioned, you know, did all the right treatment, but it was way too much for his system to tolerate. So we started with reducing histamine containing foods. And I wanted him to start adding a few foods that are like lower fiber, lower FODMAP. Right. So FODMAP stands for fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. And these are basically fibers in food that are great for for bacteria in the large intestine. But if you have an overgrowth in your small intestine, they're going to get to the party much before any of the bacteria and the large intestine. So so we want foods that are low in those so that he can start to build up his tolerance, right. And basically, I gave him diamine oxidase as an enzyme supplement. That's easy, right? You can actually purchase that you can also make your own with lentils, but that's another conversation.

Daniel Baden: 22:47

its hard to purchase that in Australia though isn't it, you've got to get it in from overseas; DAO

Nirala Jacobi: 22:52

So well actually no, you can Yeah, there is you can get it also from Monash Monash makes some enzymes. Now, what are they called FOD mate or something? Anyway, so there's different options but yes, the you it's a little bit easier to order it you can get it on also Amazon and I herb and those kinds of things.

Daniel Baden: 23:12

So you mentioned earlier histamine foods. And sometimes this is a bit confusing for people because you know, many of the cheese's for example might contain histamines, but also a lot of foods that people would normally deem as healthy foods like fermented foods and sauerkraut and these sorts of foods kimchi, which were told through all the health books, and they're super healthy probiotic rich foods, yet, they are super high in histamines, what are your thoughts around all of that?

Unknown: 23:43

Absolutely. You know, it's not a great thing to start with. And if you're listening to this, and you were told to eat more fermented foods like sauerkraut and kefir and yogurt, and kombucha God forbid, you became more symptomatic. It's possible. It's possible that histamine may be the culprit. It's not always but it can be. Sometimes it's whatever product you're consuming. And you have other issues with your gut, but mainly if that's the if it's with happens always with fermented foods, also, beer and wine, right? All the alcohols are fermented.

Nirala Jacobi: 24:15

No red wine, either. (just joking)

Unknown: 24:19

It's very, very high. So high that they've made a little stick that called the wand and you could put it in your glass and it absorbs his domain, right. So yes, it exists. It exists for for the app, but other foods is not just about fermented foods, so it's anything cured cured meats, very high, tinned products, especially tinned fish. And so remember when he had that it started with tuna, and rice and rice, just to get back to the brush borders for just a second. Other brush border enzymes besides diamine oxidase that's responsible for histamine but as are also the ISO Maltesers and And, and so crazes, and there, they perform that step that goes from disaccharide. So two little molecules of carbohydrate, and it cleaves that so that you have mono saccharide. And you can actually absorb that. So a lot of times people like, you know, rice, white rice can be quite reactive, a lot of people get really bloated. So that could be a little bit of a clue is that, you know, we always thought Candida right away, right as practitioners now it's not always Candida. Because, you know, white rice is a low FODMAP foods. So it typically doesn't aggravate SIBO. But some people with ongoing gut issues have this damage from SIBO to these brush border enzymes.

Daniel Baden: 25:46

In your notes, you also suggested that the gentleman, does he have a first name or a nickname? We can call him?

Nirala Jacobi: 25:53

Let's call him Bill,

Daniel Baden: 25:54

Bill. So Bill tried an elemental diet. What is an elemental diet?

Nirala Jacobi: 26:01

Yeah, so an elemental diet is basically what's first manufactured for people with severe digestive issues that have very severe malabsorption. So you've got you have parent Terrell nutrition, which is IV nutrition for people that just absolutely can't absorb anything. And this is the next step into actually consuming something that is absorbable. So the premise is that all of the ingredients, so you've got your macro nutrient ingredients, your carbohydrates, your fats, and your proteins, they're all completely pre digested into their most into their smallest form. So you have free form amino acids, you have glucose, and you have like an oil, like MCT oil or soy and in there, and you basically mix it with water. And you that is all you consume. And the and the idea is to fuel the host, which is you and not the bacteria, right? So if you think that SIBO is basically a condition where bacteria are eating foods, instead, you're not digesting the food, the bacteria is eating your food in the wrong place. Basically, what you're doing is you're bypassing that and you're giving something that's absolutely rapidly absorbed in the very first part of the small intestine. Only time that doesn't work as if somebody had SIBO in the very first part of the smaller tests in which he did, right so and but it can be a great treatment for people that have high levels, CBOE CBOE, it's very effective and getting gases down. But it's also really good as a as a booster for people that have malabsorption syndromes.

Daniel Baden: 27:41

you did some further testing. And they came back saying there is a presence of Candida by histamine, but also high hydrogen sulfide. Now hydrogen sulfide is a I guess it's a physiological mediator does many things in the body. And I'm, to be honest, I don't know what high or low is. But I know that when it's not a problem, it's so important for regulating many different nerve functions and inflammation and all that sort of thing. But when it's high, what happens?

Nirala Jacobi: 28:15

Hydrogen Sulfide is what we call a gazel, or gazco trend transmitter, as you rightly pointed out, it has a Goldilocks level, if it's very low, it you know, or if it's in small amounts, it can actually improve inflammation in the gut. But if it's very high, it's highly associated with inflammatory bowel disease and to veer sulfur intolerance. And people get very symptomatic when they have high hydrogen sulfide gas production. So I did a stool test. So what I looked at is this this particular metabolite, or this guy's or transmitter, which is available as digestive marker, and one of the tests or labs that I use, and basically it looks for bacterial or genomic and you know, the DNA of bacteria that are is capable of producing hydrogen sulfide, and hydrogen sulfide, when that's elevated in somebody that has SIBO we can't really test for hydrogen sulfide on breath tests yet here in Australia or anywhere else except one lab in the country in America. So we're still all waiting for machinery that allows us to test that on the breath because hydrogen sulfide SIBO is also very common, but lipo or large intestine bacterial overgrowth, that involves hydrogen sulfide is actually quite common. And it can worsen a histamine situation, it can actually trigger more histamine issues for people and the worst thing you can do is eat a carnivore diet because you're basically feeding these hydrogen sulfide producers. They love fat and bile right? They just love it whenever you eating high fat or high meat you your body As you produce more bile, and some of that ends up in the colon, and basically you end up with more hydrogen sulfide production. Lots of different reasons and lots of esoteric reasons in some way, or more eclectic thinking about why hydrogen sulfide is produced is probably beyond the scope of this conversation. But basically, I've gone way deep into the rabbit hole with hydrogen sulfide. But for him, it was really relevant. You know, one of the reasons I love testing is because I can say, hey, look, here it is, this is the reason we need to do X, Y, and Z. You know, you can't stay on the carnivore diet. But this is a dirt This is proof that this is actually damaging and highly inflammatory for you. And so we just kept doing baby steps. And that's important to do baby steps to be able to start to tolerate some of some alternative foods. And what we did is we really focused on managing histamine and hydrogen sulfide and hydrogen sulfide, you can, besides reducing foods that stimulate that, but you can also use different binders like bismuth, and things like that, for hydrogen sulfide. So we we did some of that. And he started to slowly improve, especially when we, when we took histamine out of his diet and gave him histamine stabilizers like quercetin and vitamin C, he was very low in vitamin D as well, and that vitamin D is so important for opera gut regulation in terms of immune function and all of that. So we started with those non anti microbials, non probiotics, non fermented foods, all the things you think about, when you think about gut health, we really focused on these particular pathways, and made enough of an inroad to where he could finally tolerate the SIBO treatment. And that just one step was we were there, it just went pretty quickly in terms of dramatic improvements for him.

Daniel Baden: 31:52

One of the tests you ran, which confuses me slightly, it was high calprotectin. And calprotectin is usually thought to try to determine whether there's some sort of inflammatory process going on in the bowel. His result came back saying high, but inflammatory bowel diseases ruled out.

Nirala Jacobi: 32:14

he'd been to a gastroenterologist, you know, so before and they had done biopsy, colonoscopy, and biopsies and things like that. And they didn't think that that was the case. But you because of the high hydrogen sulfide, he was at risk. And so what we did was after he had gone to the gastroenterologist, we knew that that had been ruled out. But there was a very, very inflammatory situation in his gut. Where do

Daniel Baden: 32:40

you go from here? What's the next step? And it was therapy?

Nirala Jacobi: 32:44

Well, you know, he's still doing SIBO treatment right now. And so our goal is to have him be completely SIBO free, so retesting, making sure that's completely free. And then we're actually getting into this into microbiome restoration. Because what else we found on this stool test I did was severely low diversity of his microbiome, which was not a surprise, given his diet. If you don't feed bacteria, they go away. They don't want to hang around, right, or they go into senescence, which is dormancy. And basically, he just has so low and microbiome, that after SIBO treatment, which involves still being on a low fiber diet with the FODMAP diet, or the biphasic diet that I created for SIBO. And we're going to move into microbiome restoration, which involves actually increasing the foods that can trigger SIBO. But if you don't have SIBO anymore, this is the way to go to feed the bacteria in your large intestine.

Daniel Baden: 33:46

Is he currently taking continuing with this supplement regime as well? Yeah. And what is the what are the supplements he's currently on? Yeah,

Nirala Jacobi: 33:53

so he is in on anti microbials for SIBO. And he's on still on the vitamin D. and B 12, is also very often deficient and people that have these severe malabsorption syndrome, especially with Gaviscon history, and PPI history, and all of that, because of the blockage of hydrochloric acid and he actually at some point, tried hydrochloric acid, which is stomach acid and it helped him right so this is another another component to the case where he actually thought he had hyper acidity and that was not the case. He actually had low stomach acid and the only reason he improved on the carnivore diet is because he stopped the gas production from SIBO but ultimately, he couldn't sustain that kind of diet because it was also very poor a poor digestion and caught you know, creating more ammonia and and other issues in the large bowel. So yeah, so

Daniel Baden: 34:50

when you say you know he's on an anti microbial I presume we're talking about a herbal type. Yeah, it's

Nirala Jacobi: 34:55

a combination herb Yep. For his type of SIBO but that is us. sort of a practitioner only brand in Australia. And so he's he's almost completed with this treatment now ready for retest, so we always retest to make sure we have solved the problem. And then yeah, then we're getting into this, which is, you know, my sweet spot besides SIBO. And I've done SIBO now for 12 years, and I've, I feel like I've put a lot of energy into educating practitioners and educating patients about this topic, but now. So now it's like, my sweet spot is really the microbiome because I feel like, this is where I get really excited for patients. This is the one place you it's like you can rewild your own ecosystem, and it can have profound health effects where you can prevent virtually all preventable diseases. So from from weight gain to you know, from diabetes, obesity, heart disease, mood disorders, even neurodegenerative disorders like Parkinson's and Alzheimer's, all of that has somehow its little tendrils in the microbiome. And so I that's my passion is to help people understand that feeding your microbiome is your best insurance. We learned from the Blue Zones, right? Yes, 80% Plant, plant based diet is very helpful in the view, it can make you live longer. And probably one of the reasons is because of this connection to the microbiome.

Daniel Baden: 36:36

For those of you that have never heard about a Blue Zone, There are areas around the world where there's a high level of longevity. centenarians, basically,

Nirala Jacobi: 36:47

yeah, and Netflix just came out, you know, Dan Buettner, who wrote the book 20 years ago, or so, and I've been recommending this for all my patients, because I was so impressed how, you know, he sort of cracked the case of what was it about these different places that made people live longer? And it's not what any one thing, it's more than one thing, but one of the components was this plant based diet, and he went around everywhere, and found out what it was. And you know, if I can do my part and have people eat more plants on this planet, I feel I feel happy about that, because we all need to eat more plants, right? There was a study by the American gut project, seven year long study that showed that the single most important predictor of people's health was how many plants they ate, per week, the different types of plants they ate per week. And yeah, if the rainbow, but be careful when you have SIBO.

Daniel Baden: 37:46

What was the timing around Bill's journey? How long has he been in treatment with you?

Nirala Jacobi: 37:53

You know, I'm on basically the tail end of his treatment at this point. So he started seeing me, I think it was about eight months ago, is when we started this. So this was really, it's another kind of teaching point is like, yeah, you know, we have the test results, we know what's wrong, let's just go in there and fix it. And you can't do that with somebody that has severe histamine intolerance, it just it because the end and potential mast cell activation syndrome, which is sort of like if you think of the spectrum of intolerance, mast cell activation syndrome is like the worst kind of histamine intolerance, and other other issues come up come from that. But the classic symptom is you can't tolerate anything barely, you know, reacts to all the supplements. And so we always have to go very slowly.

Daniel Baden: 38:40

I think that's such a critically important point that you just raised, because in Western culture, people have been educated through medicine, that they should just expect to take a tablet to fix everything, or an operation, and you're done. Exactly. But if we take the time to explain to our patients, that to get a proper long term treatment, and bring homeostasis or body balance back, it can sometimes say time for your body to adjust. And when you explain that to people, I think that every person I've ever spoken to is really fine with that as long as they understand. And and they understand what the expectations are. So that's a really important point. Thank you.

Nirala Jacobi: 39:23

yeah sure. I think inherently people understand that, especially if they, if you give them like, for example, I always tell people when to start anti microbials, that, you know what you might feel really terrible for about three days. And here's what you can do to reduce that. Most of the time when it happens, they feel like Wow, really, really empowered. Like, I knew this was coming. And here it is. And this is actually a good thing for me to feel that and here's what I could do to minimize my reactions and stuff. So I think we do need to also give timeframes for people Oftentimes I tell my patients, you know, I don't really expect you to feel much better until we get to this stage. But I expect X, Y, and Z, I expect your reactions to become less, I expect you to tolerate more food in about six to eight weeks or so once a day. They love it, because it just relaxes them more.

Daniel Baden: 40:21

How's Bill now? How's he mentally, he's good. Yeah, he's back to work, his symptoms have decreased by 80% or so. And so I do expect that there is going to be more work to be done in the large ball for sure, because of this diversity issue. And he's still not, he's still on a low FODMAP diet. So low FODMAP diet means that you're not going to get all the crucial fibers, you're going to need to restore your microbiome. But we have done prebiotics and things like very tiny amounts, just like making a wet your finger and dividend to the powder and start with that. So So yeah, so I have I think he's already in such a good mental space that he feels much better. He can tolerate SIBO treatment without being hospitalized. You know, all of those were big, were big wins for him. That just sounds amazing. Thank you. Nirala. Where are you at Now? What do you what do you do with yourself?

Nirala Jacobi: 41:17

Well, I'm completing my course, I don't know when when your podcast here is going to air but it might be already out but is basically completing my do at home course, restore your microbiome, because of the reasons I mentioned. Like, I think this is probably one of the best ways to ensure health is by promoting a good microbiome. And I by the way, I'm the proud owner or custodian of the most diverse microbiome I've ever seen in testing. So I am I walk my talk. And so you know, I'm teaching that in this course, that people can get more information also about the different metabolites. We've mentioned here that histamine and hydrogen sulfide and SIBO. There's a lot of information about that. So I've put everything into that course. Because when I'm done with that, I'm going on a bit of a sabbatical. So I'm taking a year off my practice to not think about SIBO for a little bit, so that I can have a bit of a mental break from all the work I've done over the last 25 years,

Daniel Baden: 42:21

and is the course orientated for practitioners or the general public.

Unknown: 42:25

great question. So if practitioners are listening in you don't know anything about the microbiome, it's a really good intro course for you. If you're a patient, and you're listening, and you always wanted to know more about the microbiome, because let's face it, every day, we're reading some, I'm reading based, maybe just my curated newsfeed. But every day, I have a headline about how the microbiome is influencing something about health. And if you really wanted to understand that, and not just the concept of good bacteria, bad bacteria, it's way more exciting and complex than that and want to empower yourself with regaining your health. That's the course for you. And it's not for people that have SIBO. There's a different course for that. Because if you start feeding bacteria prematurely, you're going to get all the symptoms of SIBO. So that's, that's a different different course I've created. But this one I'm excited about. Yeah.

Daniel Baden: 43:20

People get onto the course. And is there a website or an email address?

Unknown: 43:24

thank you. Yeah. So I have a website called"theSIBOdoctor.com" . And this is where you can find a lot of the resources, I've created an ebook for SIBO, the biphasic diet that I've created, there's no SIBO Mastery program for practitioners. And there are other educational courses for practitioners. And then there's the SIBO success plan, and the microbiome, restore your microbiome force for patients. So that's my learning platform. And that's all I'm doing for for now.

Daniel Baden: 44:11

I just finally understood why you're having a sabbatical.

Nirala Jacobi: 44:16

Well, yeah, cuz I have, I'm closing one of my three businesses,

Daniel Baden: 44:21

right? Okay. Very good. But you've you've trained, you've trained a lot of practitioners in SIBO over the years, and so there's a lot of people out there that understand it. So what sort of people or patients or general public what sort of symptoms should they be raised to think about whether SIBO is something that can affect them or histamine can affect them be affecting them? So

Nirala Jacobi: 44:44

the symptoms to look out for in SIBO is all the classic symptoms of irritable bowel syndrome because it is actually a form of IBS, right. So SIBO is, is estimated to cause about 60% of all IBS cases. So it's the bloating after meals. It's the altered sort of bowel changes where you have either diarrhea or constipation or a combination of those. You can have abdominal pain, you can have a you can have reflux, you can have a lot of digestive symptoms with SIBO. And then some classic symptoms that are sort of red flags, I would say for people should be tested for SIBO. And those cases would be acne, rosacea, restless leg syndrome, and then interstitial cystitis, and which is a very painful bladder syndrome. And then also things like fibromyalgia because it's so commonly coexisting in these conditions.

Daniel Baden: 45:46

All right. Well, look, thank you so much. That was a really fascinating case. Thank you. And I love what you've done with all the work and I know that you put your heart and soul into it all and you've been talking about it for so many years now. And I really think a lot of people have benefited so brilliant, well done. You deserve a bit of a holiday not too long. We want you back. Enjoy the break.

Nirala Jacobi: 46:07

Thanks, Daniel, I will. Okay, take care. Take care, bye.