November 16, 2023 • 46 mins
All feedback and questions welcome
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,
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Episode Transcript
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Daniel Baden (00:16):
Nirala Jacobi is a very experienced practitioner
who brought her knowledge aboutSIBO, which is small intestinal
bacterial overgrowth, to manyother practitioners and patients
over two decades ago. Her caseis about a 34 year old male who
is presenting with an unusualset of symptoms. And this is
really typical of what we see innatural medicine. People come to
(00:39):
seek out help from holisticpractitioners who have a range
of symptoms, so far reaching andso wide. It doesn't normally fit
into any medical category.
Nirala is an expert at thesetypes of situations. And for
that reason, I'm really excitedto have her on board today,
hello Nirala.
Nirala Jacobi (00:58):
Thanks for having me, Daniel, nice to be here.
Daniel Baden (01:01):
Nice to see you.
Again. It's been a while
Nirala Jacobi (01:04):
it's been a while, yes. Pre- COVID.
Daniel Baden (01:06):
The case that you're going to be presenting
today, I think it really talksto what a lot of patients come
to see natural medicine for anunusual set of symptoms, some
gut issues, some immune issue.
Tiredness is an epidemic witheverybody. Can you just let us
know how he came and presentedto you?
Nirala Jacobi (01:28):
Yeah, sure. And it was, as you mentioned, this
is one of those cases where thismay not have been somebody that
would have naturally sought outmy services, but it was so
severe, his symptoms, and hejust got so much the runaround
by his gastroenterologist, thatit he just worsened that he was
(01:49):
quite fearful of what mighthappen to him because it was
very uncontrollable as symptoms.
So this is a 3434 year old manwho basically was unable to eat
any food without feeling ofsevere dread. He had shortness
of breath or difficultybreathing. He also had other
sort of systemic symptoms interms of restless legs and arms,
(02:12):
especially at night. And then hehad really severe bloating,
especially after meals. And whathappened was two years prior to
seeing me, he started to getmore and more acid reflux, which
is not uncommon when we see thisall the time. Acid reflux here
had a very stressful job. But itstarted really suddenly with a
(02:35):
bowl of rice and tuna. And hehad such severe stabbing pains
that he ended up in hospital.
And they were prescribingbasically pantoprazole, which is
a proton pump inhibitor. And itreally didn't agree with him at
all. He couldn't tolerate it,and ended up taking really
(02:57):
massive amounts of Gavisconevery day. And that barely gave
him any relief. He then cameacross, you know, as people do
that look for answers on theinternet. And he came across the
carnivore diet. And he stayed onthat for nine months, and it
improved his symptoms. But hestill had a lot of the symptoms
(03:18):
of at least gave him somerelief. Any other food other
than animal meat would give himsevere symptoms.
Daniel Baden (03:25):
This is pretty unusual stuff, and not what you
would expect. So just becausehalf of our audience are
practitioners and half a generalpublic, a proton pump inhibitor
is an antacid is what you wouldtake, you know, sometimes people
take it when they feel likethey've got acid reflux, they
would take an antacid as it butit's a pretty potent one. And it
(03:46):
can cause a lot of side effects.
And Gaviscon is also an antacid.
And that's available over thecounter. So people often take
Gaviscon as well, in your notesto me. You said he was taking 40
Gaviscon a day? Yeah, yes. Oh mygod. That's yeah, I've never
heard of that.
Nirala Jacobi (04:04):
Yeah, me neither.
But well, actually, I have hadpeople that took severe lap, you
know, amounts of acid blockers.
Now. PPIs. proton pumpinhibitors inhibit stomach acid
by up to 97%. And these otherlesser drugs work on a different
mechanism, and they don't blockstomach acid as severely, but
(04:25):
still he needed he needed thatto provide any kind of relief.
And now even that was veryminimal.
Daniel Baden (04:32):
Was he taking the Gavascon when he'd gone to the
carnivore diet?
Nirala Jacobi (04:37):
he was there was a bit of overlap. Yes, he did.
But the reason you know this isthat let that symptom relief
with the carnivore diet was nota surprise to me because that
happens when you have SIBO rightbecause anytime you eat
carbohydrates which are presentin grains and legumes and
(04:57):
vegetables, they can feedbacteria that are overgrown in
the small intestine, if you havea condition known as small
intestine bacterial overgrowth,and this condition is where
those bacteria are not meant tobe in that location, they're
meant to be in the largeintestine, not in the small
(05:18):
intestine where digestionhappens, absorption happens. And
it's meant to be very, very,very low in bacteria, but
different reasons why peopledevelop SIBO. And when that gets
out of control, you can have asituation where you have such
severe level of fermentation ofbacteria eating the
(05:38):
carbohydrates, that that causesa lot of that can cause a lot of
damage to the lining of thesmall intestine. And of course,
give a lot of the symptoms aclassic one is bloating after
meals, especially with fibercontaining foods. So I had a
very high suspicion that thatwas happening with him, because
he did get relief with thecarnivore diet, you know, I
(05:58):
mean, he didn't just have thereflux, he did have a lot of
this severe bloating that lefthim breathless, and also had
this sense of doom after meals,that eased a little bit after
the carnivore diet. But ofcourse, as you can imagine, a
carnivore diet is notsustainable, and his cholesterol
just went through the roof, likeI'd never seen a change of
(06:19):
cholesterol that severe. So itwas pretty dramatic, two or
three times the upper level ofnormal, right? So it was it was
pretty high. And that canhappen. Also, not just like, you
know, obviously, the carnivorediet has a lot of saturated fat
and animal protein. And when youhave SIBO, this bacterial
(06:42):
overgrowth in the smallintestine, what we now know is
that different types of SIBO arecaused by different types of
bacteria. And he had a very highhydrogen production in his
small, small intestine. Sohydrogen SIBO, is a type of
SIBO. And the two types ofbacteria that are producing this
(07:03):
are E coli and Klebsiella. Andthese two are very, very high
endotoxin producers. And whenyou eat a diet that's solely
consisting of saturated fat andanimal meat, you're going to
absorb a lot more of thisendotoxin called LPs, and that
(07:25):
can raise your cholesterol, andcause all sorts of other
problems like inflammation, etcetera. So he was sort of going
from the fire into the what isit the from the fire into the
frying pan, or he was going fromone bad situation to another bad
situation, and a lot of othersystemic symptoms started to
appear one, once he started onthe carnivore diet,
Daniel Baden (07:48):
just in the nutshell with SIBO, you have a
group of bacteria that wouldnormally live in a healthy
individual in one part of thecolon. And for some reason,
these bacteria migrate to thesmall intestine or higher, and
cause changes to the mucosa andchange how we digest food
(08:11):
causing more fermentation. Isthat correct so far?
Unknown (08:15):
I mean, there are there are a lot of different reasons
why people develop SIBO. So it'snot always the migration of
those bacteria. Sometimesthey're very frequently actually
there is a problem with thenormal motility in the upper
gun. So that bacteria becauseyou don't want to have small
amounts of these are okay, youknow, other bacteria can keep
(08:36):
them in check. And it's, it'soften kept in check by this
housekeeper wave that is part ofthe small intestine that is
basically a contraction wavethat sweeps through the small
intestine, and clears out a lotof these bacteria. But in many
people for lots of differentreasons, that type of motility
wave is impaired. And thenbacteria are allowed to remain
(09:00):
in the small intestine and canjust proliferate.
Daniel Baden (09:03):
do you have any experience or knowledge or if it
exists as to why some of thesebacterial cultures will change
from where they reside in theintestinal tract? Stress, or..
Nirala Jacobi (09:14):
Well, I mean, there, yes, stress is a big
part, but that alone doesn'tchange the composition of the
bacteria. So what you're asking,like, why do people have? Well,
what we know that the biggesthydrogen producers are these two
bacteria, and they're verycommon commensals in our gut,
right? They're very common.
They're in small amount, they'renormal in higher amounts, they
(09:35):
cause problems. And so when youhave something like that, that's
that's completely rampant,you're gonna get a lot get a lot
of symptoms, but, you know, theway I usually describe the
causes of SIBO for people is inthree different categories of
causes. And number one issomething got messed up with the
motility and that often is dueto factors like the, you know,
(09:57):
vagal dysfunction is maybe whereyou were going with your
question about stress, highstress can do that. But that's
tends to be more temporary. Butif you've had food poisoning,
for example, food poisoning, isa situation where you're
infected with a very aggressivepathogen. So this is different
(10:19):
from not from these bacteriathat cause SIBO. In that,
typically that Campylobacter orsalmonella, or you know any of
these sort of aggressivebacteria, and when you're
infected with that thesebacteria secrete a toxin that
you can develop an immuneresponse to an auto immune
response, basically, where yourbody is trying to attack this
(10:41):
poison. But instead, it actuallyis damaging this housekeeper
wave. And this is a really wellestablished, basically etiology
or development of SIBO, wherenow you are attacking the
motility aspect of your smallintestine instead of the poison.
And so a lot of times forlisteners that may have
(11:02):
developed IBS or irritable bowelsyndrome, after a case of food
poisoning, it's very likely thatthat was the reason why this
happened. And that's been moreand more confirmed now in the
research. And so that's onereason. Yeah, that is one reason
why people develop SIBO. Andthat is probably one of the most
common but then it could be thatyou've had scar tissue in your,
(11:24):
in your abdomen from surgeries,like getting your gallbladder
out or your appendix out orhaving a C section. And all
these types of interventionswhere you there is a cut, and
wherever there is a cut, you canhave this aberrant scar tissue
called adhesions, and adhesionsor intra abdominal sort of
(11:45):
anchors and hooks and they canattach to the outside of the
digestive tract and pull andtwist it into sort of like a
kink in a garden hose. And sothis is different from having
impaired motility in the uppergod, this is more like bacteria
are can't really move wellthrough this kink in a garden
hose. That can also happen,especially with conditions like
(12:07):
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, oralcontraceptive pill over a long
period of time antibiotic use orany other sort of drug. Any
thoughts around? Yeah,
Nirala Jacobi (12:27):
well, and non steroidal anti inflammatories do
not cause SIBO, nor does thepill, it certainly can affect
overgrowth. But if we thinkabout that the body has certain
mechanisms in place to preventbacterial overgrowth and stomach
acid is actually one of them,right? We actually are meant to
kill bacteria that come in fromthe outside and create an
(12:48):
inhospitable environment. Andthey'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 inthe large intestine, this
dysbiosis is what we wouldclassify as dysbiosis. So yes,
you can have medications thatthat can also alter the small
intestine, but most of thosemedications are based on that
(13:13):
they affect the motility of thegut. So these mechanisms besides
hydrochloric acid, and thiscleansing wave there, I mean,
all the digestive juices havethis bacterial static effect,
they they're meant to killbacteria, because of the reason
that the small intestine to giveyou an idea is not meant to
contain more than 3000 bacteriaper milliliter, versus something
(13:36):
like 10 billion per millionmilliliter in the large
intestine. So that gives you avisual of the different like,
it's the desert in therainforest, right. And it's
really meant to be kept very,very low in bacteria. So
anything that affects it, youknow, I can't get it from
probiotics, for example, that'snot how this works. It's it's a
real specific thing of eitherthat they are migrating upward
(14:01):
from the large bowel, which isnot that common, or they can't
be flushed out with the normalmotility, or you have some kind
of adhesion. That's usually theway it works.
Daniel Baden (14:11):
Thank you for the distraction and indulge me my
selfish academic curiosity. Butlet'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'severywhere these days about, you
know, and when you remember,like this was 2011. Daniel, when
I approached you and yourcompany, I was like, this is
SIBO. We need to we need to do awebinar about SIBO This is and
it's it's it more and more andmore people are aware of it so
much so that it was a questionon Who Wants to Be a Millionaire
(14:40):
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 carnivorediet 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 littlebit more tolerable, but it's he
still had a lot of symptoms thathe just wasn't happy with, and a
(15:20):
lot of mood issues, anxiety,difficulty breathing, and all of
that. So the first thing we didwas, we did a SIBO breath test,
this is basically a test you canorder. And you can do it at
home, send it in, and it cantell you whether or not you have
SIBO that in retrospect, whathad happened was he had already
(15:42):
been diagnosed with SIBO byanother practitioner, and the
treatment had put him in thehospital, basically. So he had
such severe symptoms of the fromthe treatment, that he you know,
panic attacks, anxiety reallysevere, and things like that. So
that's how he ended up with me.
And one of the one of thecontributing factors I strongly
(16:02):
suspected was histamine issues,because histamine intolerance
can really be one of the sideeffects of SIBO. But also, from
from a lot of other conditions.
People are familiar with it, ifthey have seasonal allergies, or
(16:22):
allergies in general, thesneezing the allergy symptoms
that you can expect withhistamine. But histamine can
have really strong effects inthe gut in terms of diarrhea,
cramping, you know, a lot ofSIBO symptoms can be from
histamine intolerance. But thenyou can also have a long side of
(16:43):
that you can have all the otherallergy symptoms, but also
headaches and things like that.
And because he was so reactive,oftentimes when people are
extremely reactive to lots ofthings, histamine is the first
thing I think of. But one of thereasons I don't know if you want
me to carry on with histamine orif 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 justdescribed, which is spot on,
there are a number of histaminereceptors in the brain as well.
And there are some significantrelationships between histamine
and mood such as anxiety anddepression, when we're talking
(17:21):
about a lot of these gut andfood type issues, anxiety,
depression are stronglyassociated. And when people go
on, and sometimes people go onspecific drugs for their mood,
their allergies improve. Andthese sorts of unusual types of
correlations, which we're onlyjust starting to discover more
and more and more about as timegoes on. So this guy seems like
(17:44):
he's really ticked all the boxesin terms of histamine.
Nirala Jacobi (17:47):
He did, he did, and especially with his severe
reactivity, but I see this sooften. Because in SIBO, if you
imagine, right, what I saidbefore you have this desert you
like a healthy small intestineis, has very few bacteria. But
imagine now you've got, you'vegot 10, or 20, times the amount
(18:10):
of bacteria you're meant tohave. They're the and they're
fermenting these carbohydrates,and causing this hydrogen gas.
And that gas is actuallydamaging to what's called your
brush border. And the brushborder is the hairlike
protrusions on our cell surfaceof the cells that are lining the
gut, right or in the smallintestine, that really
(18:32):
effectively increases thesurface area of your digestive
tract to that of a tennis court.
If you were to pull out yoursmall intestine and spread it
out from you know, every cell itwould be it would cover a huge
surface area so that you canextract 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 Iwas reading in New Scientist a
year or so ago, that the brushthe hairs on the brush border,
actually some of them havelittle sampling cells at the end
of the hair when they can theycan sample what's in the gut
environment and drag it back infor the immune system to assess
(19:13):
what's
Nirala Jacobi (19:13):
Yes, yes. Those are the fibroblasts, right also
fibroblast dendritic cells dothat they're made that's a whole
nother level I know a wholenother conversation of how how
we interact with our immunesystem and how we turn food
which is non self into self, allof that super fascinating. But
(19:33):
yeah, so what happens with thiswith very high gas levels, is
that damage this brush borderand what what happens at the at
the tip of the brush border isbasically you have enzymes that
perform the last step ofdigestion and absorption for you
(19:54):
and one of those enzymes isdiamine oxidase. And diamine
oxidase is specific for breakingdown histamine in the gut. So
you get sort of this situationwhere you cannot break down your
own histamine. And histamine iselevated in some people for
several reasons. And one of themis the loss of this enzyme. And
(20:17):
another one is, they may havesuch an imbalanced microbiome
that the microbiome is actuallyproducing histamine. And then
thirdly, we see more histaminein SIBO, because the cells that
contain histamine in our tissuesare called mast cells. And you
can have this migration of thecells, and then they get very
(20:39):
trigger happy, you know, likeyou mentioned, nor histamine is
not just a neurotransmitter, butit also is a mediator, that the
whole purpose is to flush outwhatever it's trying to get out
of our system, right? And itincreases the mucus and widens,
it's a basal dilator. It doesall these things to try to get
rid of the pathogen. And so thisis just sort of like a helpful
(21:03):
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 ahistamine intolerance? You he'd
been down the SIBO track, hetried some sort of therapy with
another practitioner. So what'sthe 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 goneto other practitioners, and it
was just too much too soon, toofast. Right. And I think this is
a good case. To exemplify thatwe started really slowly, we
knew he had SIBO. And I wasn'tgoing to do the same mistake.
(21:44):
And this practitioner was great.
He was well intentioned, youknow, did all the right
treatment, but it was way toomuch for his system to tolerate.
So we started with reducinghistamine containing foods. And
I wanted him to start adding afew foods that are like lower
fiber, lower FODMAP. Right. SoFODMAP stands for fermentable,
(22:05):
oligosaccharides, disaccharides,monosaccharides, and polyols.
And these are basically fibersin food that are great for for
bacteria in the large intestine.
But if you have an overgrowth inyour small intestine, they're
going to get to the party muchbefore any of the bacteria and
the large intestine. So so wewant foods that are low in those
(22:29):
so that he can start to build uphis tolerance, right. And
basically, I gave him diamineoxidase as an enzyme supplement.
That's easy, right? You canactually 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 toget it in from overseas; DAO
Nirala Jacobi (22:52):
So well actually no, you can Yeah, there is you
can get it also from MonashMonash makes some enzymes. Now,
what are they called FOD mate orsomething? Anyway, so there's
different options but yes, theyou it's a little bit easier to
order it you can get it on alsoAmazon and I herb and those
kinds of things.
Daniel Baden (23:12):
So you mentioned earlier histamine foods. And
sometimes this is a bitconfusing for people because you
know, many of the cheese's forexample might contain
histamines, but also a lot offoods that people would normally
deem as healthy foods likefermented foods and sauerkraut
and these sorts of foods kimchi,which were told through all the
(23:34):
health books, and they're superhealthy probiotic rich foods,
yet, they are super high inhistamines, 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 tothis, and you were told to eat
more fermented foods likesauerkraut and kefir and yogurt,
and kombucha God forbid, youbecame more symptomatic. It's
possible. It's possible thathistamine may be the culprit.
It's not always but it can be.
Sometimes it's whatever productyou're consuming. And you have
(24:05):
other issues with your gut, butmainly if that's the if it's
with happens always withfermented foods, also, beer and
wine, right? All the alcoholsare 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 alittle stick that called the
wand and you could put it inyour glass and it absorbs his
domain, right. So yes, itexists. It exists for for the
app, but other foods is not justabout fermented foods, so it's
anything cured cured meats, veryhigh, tinned products,
(24:40):
especially tinned fish. And soremember when he had that it
started with tuna, and rice andrice, just to get back to the
brush borders for just a second.
Other brush border enzymesbesides diamine oxidase that's
responsible for histamine but asare also the ISO Maltesers and
(25:00):
And, and so crazes, and there,they perform that step that goes
from disaccharide. So two littlemolecules of carbohydrate, and
it cleaves that so that you havemono saccharide. And you can
actually absorb that. So a lotof times people like, you know,
rice, white rice can be quitereactive, a lot of people get
(25:20):
really bloated. So that could bea little bit of a clue is that,
you know, we always thoughtCandida right away, right as
practitioners now it's notalways Candida. Because, you
know, white rice is a low FODMAPfoods. So it typically doesn't
aggravate SIBO. But some peoplewith ongoing gut issues have
(25:41):
this damage from SIBO to thesebrush border enzymes.
Daniel Baden (25:46):
In your notes, you also suggested that the
gentleman, does he have a firstname 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 forpeople with severe digestive
issues that have very severemalabsorption. So you've got you
have parent Terrell nutrition,which is IV nutrition for people
that just absolutely can'tabsorb anything. And this is the
next step into actuallyconsuming something that is
(26:24):
absorbable. So the premise isthat all of the ingredients, so
you've got your macro nutrientingredients, your carbohydrates,
your fats, and your proteins,they're all completely pre
digested into their most intotheir smallest form. So you have
free form amino acids, you haveglucose, and you have like an
oil, like MCT oil or soy and inthere, and you basically mix it
(26:48):
with water. And you that is allyou consume. And the and the
idea is to fuel the host, whichis you and not the bacteria,
right? So if you think that SIBOis basically a condition where
bacteria are eating foods,instead, you're not digesting
the food, the bacteria is eatingyour food in the wrong place.
(27:11):
Basically, what you're doing isyou're bypassing that and you're
giving something that'sabsolutely rapidly absorbed in
the very first part of the smallintestine. Only time that
doesn't work as if somebody hadSIBO in the very first part of
the smaller tests in which hedid, right so and but it can be
a great treatment for peoplethat have high levels, CBOE
(27:32):
CBOE, it's very effective andgetting gases down. But it's
also really good as a as abooster for people that have
malabsorption syndromes.
Daniel Baden (27:41):
you did some further testing. And they came
back saying there is a presenceof Candida by histamine, but
also high hydrogen sulfide. Nowhydrogen sulfide is a I guess
it's a physiological mediatordoes many things in the body.
And I'm, to be honest, I don'tknow what high or low is. But I
(28:04):
know that when it's not aproblem, it's so important for
regulating many different nervefunctions and inflammation and
all that sort of thing. But whenit's high, what happens?
Nirala Jacobi (28:15):
Hydrogen Sulfide is what we call a gazel, or
gazco trend transmitter, as yourightly pointed out, it has a
Goldilocks level, if it's verylow, it you know, or if it's in
small amounts, it can actuallyimprove inflammation in the gut.
But if it's very high, it'shighly associated with
inflammatory bowel disease andto veer sulfur intolerance. And
(28:39):
people get very symptomatic whenthey have high hydrogen sulfide
gas production. So I did a stooltest. So what I looked at is
this this particular metabolite,or this guy's or transmitter,
which is available as digestivemarker, and one of the tests or
labs that I use, and basicallyit looks for bacterial or
(29:03):
genomic and you know, the DNA ofbacteria that are is capable of
producing hydrogen sulfide, andhydrogen sulfide, when that's
elevated in somebody that hasSIBO we can't really test for
hydrogen sulfide on breath testsyet here in Australia or
anywhere else except one lab inthe country in America. So we're
(29:23):
still all waiting for machinerythat allows us to test that on
the breath because hydrogensulfide SIBO is also very
common, but lipo or largeintestine bacterial overgrowth,
that involves hydrogen sulfideis actually quite common. And it
can worsen a histaminesituation, it can actually
trigger more histamine issuesfor people and the worst thing
(29:46):
you can do is eat a carnivorediet because you're basically
feeding these hydrogen sulfideproducers. They love fat and
bile right? They just love itwhenever you eating high fat or
high meat you your body As youproduce more bile, and some of
that ends up in the colon, andbasically you end up with more
hydrogen sulfide production.
Lots of different reasons andlots of esoteric reasons in some
(30:09):
way, or more eclectic thinkingabout why hydrogen sulfide is
produced is probably beyond thescope of this conversation. But
basically, I've gone way deepinto the rabbit hole with
hydrogen sulfide. But for him,it was really relevant. You
know, one of the reasons I lovetesting is because I can say,
hey, look, here it is, this isthe reason we need to do X, Y,
(30:31):
and Z. You know, you can't stayon the carnivore diet. But this
is a dirt This is proof thatthis is actually damaging and
highly inflammatory for you. Andso we just kept doing baby
steps. And that's important todo baby steps to be able to
start to tolerate some of somealternative foods. And what we
(30:52):
did is we really focused onmanaging histamine and hydrogen
sulfide and hydrogen sulfide,you can, besides reducing foods
that stimulate that, but you canalso use different binders like
bismuth, and things like that,for hydrogen sulfide. So we we
did some of that. And he startedto slowly improve, especially
when we, when we took histamineout of his diet and gave him
(31:15):
histamine stabilizers likequercetin and vitamin C, he was
very low in vitamin D as well,and that vitamin D is so
important for opera gutregulation in terms of immune
function and all of that. So westarted with those non anti
microbials, non probiotics, nonfermented foods, all the things
you think about, when you thinkabout gut health, we really
(31:36):
focused on these particularpathways, and made enough of an
inroad to where he could finallytolerate the SIBO treatment. And
that just one step was we werethere, it just went pretty
quickly in terms of dramaticimprovements for him.
Daniel Baden (31:52):
One of the tests you ran, which confuses me
slightly, it was highcalprotectin. And calprotectin
is usually thought to try todetermine whether there's some
sort of inflammatory processgoing on in the bowel. His
result came back saying high,but inflammatory bowel diseases
(32:12):
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 theydidn't think that that was the
case. But you because of thehigh hydrogen sulfide, he was at
risk. And so what we did wasafter he had gone to the
gastroenterologist, we knew thatthat had been ruled out. But
(32:34):
there was a very, veryinflammatory situation in his
gut. Where do
Daniel Baden (32:40):
you go from here?
What's the next step? And it wastherapy?
Nirala Jacobi (32:44):
Well, you know, he's still doing SIBO treatment
right now. And so our goal is tohave him be completely SIBO
free, so retesting, making surethat's completely free. And then
we're actually getting into thisinto microbiome restoration.
Because what else we found onthis stool test I did was
(33:06):
severely low diversity of hismicrobiome, which was not a
surprise, given his diet. If youdon't feed bacteria, they go
away. They don't want to hangaround, right, or they go into
senescence, which is dormancy.
And basically, he just has solow and microbiome, that after
SIBO treatment, which involvesstill being on a low fiber diet
with the FODMAP diet, or thebiphasic diet that I created for
(33:28):
SIBO. And we're going to moveinto microbiome restoration,
which involves actuallyincreasing the foods that can
trigger SIBO. But if you don'thave SIBO anymore, this is the
way to go to feed the bacteriain 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 thesupplements 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 oftendeficient and people that have
these severe malabsorptionsyndrome, especially with
Gaviscon history, and PPIhistory, and all of that,
because of the blockage ofhydrochloric acid and he
actually at some point, triedhydrochloric acid, which is
(34:16):
stomach acid and it helped himright so this is another another
component to the case where heactually thought he had hyper
acidity and that was not thecase. He actually had low
stomach acid and the only reasonhe improved on the carnivore
diet is because he stopped thegas production from SIBO but
(34:36):
ultimately, he couldn't sustainthat kind of diet because it was
also very poor a poor digestionand caught you know, creating
more ammonia and and otherissues 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 aherbal type. Yeah, it's
Nirala Jacobi (34:55):
a combination herb Yep. For his type of SIBO
but that is us. sort of apractitioner only brand in
Australia. And so he's he'salmost completed with this
treatment now ready for retest,so we always retest to make sure
we have solved the problem. Andthen yeah, then we're getting
into this, which is, you know,my sweet spot besides SIBO. And
(35:18):
I've done SIBO now for 12 years,and I've, I feel like I've put a
lot of energy into educatingpractitioners and educating
patients about this topic, butnow. So now it's like, my sweet
spot is really the microbiomebecause I feel like, this is
(35:38):
where I get really excited forpatients. This is the one place
you it's like you can rewildyour own ecosystem, and it can
have profound health effectswhere you can prevent virtually
all preventable diseases. Sofrom from weight gain to you
know, from diabetes, obesity,heart disease, mood disorders,
(36:01):
even neurodegenerative disorderslike Parkinson's and
Alzheimer's, all of that hassomehow its little tendrils in
the microbiome. And so I that'smy passion is to help people
understand that feeding yourmicrobiome is your best
insurance. We learned from theBlue Zones, right? Yes, 80%
(36:26):
Plant, plant based diet is veryhelpful in the view, it can make
you live longer. And probablyone of the reasons is because of
this connection to themicrobiome.
Daniel Baden (36:36):
For those of you that have never heard about a
Blue Zone, There are areasaround 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 20years ago, or so, and I've been
recommending this for all mypatients, because I was so
impressed how, you know, he sortof cracked the case of what was
it about these different placesthat made people live longer?
And it's not what any one thing,it's more than one thing, but
one of the components was thisplant based diet, and he went
(37:10):
around everywhere, and found outwhat it was. And you know, if I
can do my part and have peopleeat more plants on this planet,
I feel I feel happy about that,because we all need to eat more
plants, right? There was a studyby the American gut project,
seven year long study thatshowed that the single most
(37:33):
important predictor of people'shealth was how many plants they
ate, per week, the differenttypes 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 intreatment with you?
Nirala Jacobi (37:53):
You know, I'm on basically the tail end of his
treatment at this point. So hestarted seeing me, I think it
was about eight months ago, iswhen we started this. So this
was really, it's another kind ofteaching point is like, yeah,
you know, we have the testresults, we know what's wrong,
let's just go in there and fixit. And you can't do that with
(38:14):
somebody that has severehistamine intolerance, it just
it because the end and potentialmast cell activation syndrome,
which is sort of like if youthink of the spectrum of
intolerance, mast cellactivation syndrome is like the
worst kind of histamineintolerance, and other other
issues come up come from that.
But the classic symptom is youcan't tolerate anything barely,
(38:34):
you know, reacts to all thesupplements. 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 educatedthrough medicine, that they
should just expect to take atablet to fix everything, or an
operation, and you're done.
Exactly. But if we take the timeto explain to our patients, that
to get a proper long termtreatment, and bring homeostasis
(39:03):
or body balance back, it cansometimes say time for your body
to adjust. And when you explainthat to people, I think that
every person I've ever spoken tois really fine with that as long
as they understand. And and theyunderstand what the expectations
are. So that's a reallyimportant point. Thank you.
Nirala Jacobi (39:23):
yeah sure. I think inherently people
understand that, especially ifthey, if you give them like, for
example, I always tell peoplewhen to start anti microbials,
that, you know what you mightfeel really terrible for about
three days. And here's what youcan do to reduce that. Most of
the time when it happens, theyfeel like Wow, really, really
(39:45):
empowered. Like, I knew this wascoming. And here it is. And this
is actually a good thing for meto feel that and here's what I
could do to minimize myreactions and stuff. So I think
we do need to also givetimeframes for people Oftentimes
I tell my patients, you know, Idon't really expect you to feel
much better until we get to thisstage. But I expect X, Y, and Z,
(40:08):
I expect your reactions tobecome less, I expect you to
tolerate more food in about sixto eight weeks or so once a day.
They love it, because it justrelaxes 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 havedecreased by 80% or so. And so I
do expect that there is going tobe more work to be done in the
large ball for sure, because ofthis diversity issue. And he's
still not, he's still on a lowFODMAP diet. So low FODMAP diet
means that you're not going toget all the crucial fibers,
(40:43):
you're going to need to restoreyour microbiome. But we have
done prebiotics and things likevery tiny amounts, just like
making a wet your finger anddividend to the powder and start
with that. So So yeah, so I haveI think he's already in such a
good mental space that he feelsmuch better. He can tolerate
(41:04):
SIBO treatment without beinghospitalized. You know, all of
those were big, were big winsfor him.
That just sounds amazing. Thankyou. Nirala. Where are you at
Now? What do you what do you dowith yourself?
Nirala Jacobi (41:17):
Well, I'm completing my course, I don't
know when when your podcast hereis going to air but it might be
already out but is basicallycompleting my do at home course,
restore your microbiome, becauseof the reasons I mentioned.
Like, I think this is probablyone of the best ways to ensure
health is by promoting a goodmicrobiome. And I by the way,
(41:40):
I'm the proud owner or custodianof the most diverse microbiome
I've ever seen in testing. So Iam I walk my talk. And so you
know, I'm teaching that in thiscourse, that people can get more
information also about thedifferent metabolites. We've
mentioned here that histamineand hydrogen sulfide and SIBO.
There's a lot of informationabout that. So I've put
(42:02):
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 yearoff my practice to not think
about SIBO for a little bit, sothat I can have a bit of a
mental break from all the workI'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 aboutthe microbiome, it's a really
good intro course for you. Ifyou're a patient, and you're
listening, and you always wantedto know more about the
microbiome, because let's faceit, every day, we're reading
some, I'm reading based, maybejust my curated newsfeed. But
every day, I have a headlineabout how the microbiome is
(42:47):
influencing something abouthealth. And if you really wanted
to understand that, and not justthe concept of good bacteria,
bad bacteria, it's way moreexciting and complex than that
and want to empower yourselfwith regaining your health.
That's the course for you. Andit's not for people that have
SIBO. There's a different coursefor that. Because if you start
(43:10):
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 thisone 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 thisis where you can find a lot of
the resources, I've created anebook for SIBO, the biphasic
diet that I've created, there'sno SIBO Mastery program for
(43:47):
practitioners. And there areother educational courses for
practitioners. And then there'sthe SIBO success plan, and the
microbiome, restore yourmicrobiome force for patients.
So that's my learning platform.
And that's all I'm doing for fornow.
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 ofpractitioners in SIBO over the
years, and so there's a lot ofpeople out there that understand
it. So what sort of people orpatients or general public what
sort of symptoms should they beraised to think about whether
SIBO is something that canaffect them or histamine can
(44:42):
affect them be affecting them?
So
Nirala Jacobi (44:44):
the symptoms to look out for in SIBO is all the
classic symptoms of irritablebowel syndrome because it is
actually a form of IBS, right.
So SIBO is, is estimated tocause about 60% of all IBS
cases. So it's the bloatingafter meals. It's the altered
sort of bowel changes where youhave either diarrhea or
(45:07):
constipation or a combination ofthose. You can have abdominal
pain, you can have a you canhave reflux, you can have a lot
of digestive symptoms with SIBO.
And then some classic symptomsthat are sort of red flags, I
would say for people should betested for SIBO. And those cases
(45:27):
would be acne, rosacea, restlessleg syndrome, and then
interstitial cystitis, and whichis a very painful bladder
syndrome. And then also thingslike fibromyalgia because it's
so commonly coexisting in theseconditions.
Daniel Baden (45:46):
All right. Well, look, thank you so much. That
was a really fascinating case.
Thank you. And I love whatyou've done with all the work
and I know that you put yourheart and soul into it all and
you've been talking about it forso many years now. And I really
think a lot of people havebenefited so brilliant, well
done. You deserve a bit of aholiday not too long. We want
you back. Enjoy the break.
Nirala Jacobi (46:07):
Thanks, Daniel, I will. Okay, take care. Take
care, bye.
Nirala Jacobi is a very experienced practitioner
who brought her knowledge aboutSIBO, which is small intestinal
bacterial overgrowth, to manyother practitioners and patients
over two decades ago. Her caseis about a 34 year old male who
is presenting with an unusualset of symptoms. And this is
really typical of what we see innatural medicine. People come to
(00:39):
seek out help from holisticpractitioners who have a range
of symptoms, so far reaching andso wide. It doesn't normally fit
into any medical category.
Nirala is an expert at thesetypes of situations. And for
that reason, I'm really excitedto have her on board today,
hello Nirala.
Nirala Jacobi (00:58):
Thanks for having me, Daniel, nice to be here.
Daniel Baden (01:01):
Nice to see you.
Again. It's been a while
Nirala Jacobi (01:04):
it's been a while, yes. Pre- COVID.
Daniel Baden (01:06):
The case that you're going to be presenting
today, I think it really talksto what a lot of patients come
to see natural medicine for anunusual set of symptoms, some
gut issues, some immune issue.
Tiredness is an epidemic witheverybody. Can you just let us
know how he came and presentedto you?
Nirala Jacobi (01:28):
Yeah, sure. And it was, as you mentioned, this
is one of those cases where thismay not have been somebody that
would have naturally sought outmy services, but it was so
severe, his symptoms, and hejust got so much the runaround
by his gastroenterologist, thatit he just worsened that he was
(01:49):
quite fearful of what mighthappen to him because it was
very uncontrollable as symptoms.
So this is a 3434 year old manwho basically was unable to eat
any food without feeling ofsevere dread. He had shortness
of breath or difficultybreathing. He also had other
sort of systemic symptoms interms of restless legs and arms,
(02:12):
especially at night. And then hehad really severe bloating,
especially after meals. And whathappened was two years prior to
seeing me, he started to getmore and more acid reflux, which
is not uncommon when we see thisall the time. Acid reflux here
had a very stressful job. But itstarted really suddenly with a
(02:35):
bowl of rice and tuna. And hehad such severe stabbing pains
that he ended up in hospital.
And they were prescribingbasically pantoprazole, which is
a proton pump inhibitor. And itreally didn't agree with him at
all. He couldn't tolerate it,and ended up taking really
(02:57):
massive amounts of Gavisconevery day. And that barely gave
him any relief. He then cameacross, you know, as people do
that look for answers on theinternet. And he came across the
carnivore diet. And he stayed onthat for nine months, and it
improved his symptoms. But hestill had a lot of the symptoms
(03:18):
of at least gave him somerelief. Any other food other
than animal meat would give himsevere symptoms.
Daniel Baden (03:25):
This is pretty unusual stuff, and not what you
would expect. So just becausehalf of our audience are
practitioners and half a generalpublic, a proton pump inhibitor
is an antacid is what you wouldtake, you know, sometimes people
take it when they feel likethey've got acid reflux, they
would take an antacid as it butit's a pretty potent one. And it
(03:46):
can cause a lot of side effects.
And Gaviscon is also an antacid.
And that's available over thecounter. So people often take
Gaviscon as well, in your notesto me. You said he was taking 40
Gaviscon a day? Yeah, yes. Oh mygod. That's yeah, I've never
heard of that.
Nirala Jacobi (04:04):
Yeah, me neither.
But well, actually, I have hadpeople that took severe lap, you
know, amounts of acid blockers.
Now. PPIs. proton pumpinhibitors inhibit stomach acid
by up to 97%. And these otherlesser drugs work on a different
mechanism, and they don't blockstomach acid as severely, but
(04:25):
still he needed he needed thatto provide any kind of relief.
And now even that was veryminimal.
Daniel Baden (04:32):
Was he taking the Gavascon when he'd gone to the
carnivore diet?
Nirala Jacobi (04:37):
he was there was a bit of overlap. Yes, he did.
But the reason you know this isthat let that symptom relief
with the carnivore diet was nota surprise to me because that
happens when you have SIBO rightbecause anytime you eat
carbohydrates which are presentin grains and legumes and
(04:57):
vegetables, they can feedbacteria that are overgrown in
the small intestine, if you havea condition known as small
intestine bacterial overgrowth,and this condition is where
those bacteria are not meant tobe in that location, they're
meant to be in the largeintestine, not in the small
(05:18):
intestine where digestionhappens, absorption happens. And
it's meant to be very, very,very low in bacteria, but
different reasons why peopledevelop SIBO. And when that gets
out of control, you can have asituation where you have such
severe level of fermentation ofbacteria eating the
(05:38):
carbohydrates, that that causesa lot of that can cause a lot of
damage to the lining of thesmall intestine. And of course,
give a lot of the symptoms aclassic one is bloating after
meals, especially with fibercontaining foods. So I had a
very high suspicion that thatwas happening with him, because
he did get relief with thecarnivore diet, you know, I
(05:58):
mean, he didn't just have thereflux, he did have a lot of
this severe bloating that lefthim breathless, and also had
this sense of doom after meals,that eased a little bit after
the carnivore diet. But ofcourse, as you can imagine, a
carnivore diet is notsustainable, and his cholesterol
just went through the roof, likeI'd never seen a change of
(06:19):
cholesterol that severe. So itwas pretty dramatic, two or
three times the upper level ofnormal, right? So it was it was
pretty high. And that canhappen. Also, not just like, you
know, obviously, the carnivorediet has a lot of saturated fat
and animal protein. And when youhave SIBO, this bacterial
(06:42):
overgrowth in the smallintestine, what we now know is
that different types of SIBO arecaused by different types of
bacteria. And he had a very highhydrogen production in his
small, small intestine. Sohydrogen SIBO, is a type of
SIBO. And the two types ofbacteria that are producing this
(07:03):
are E coli and Klebsiella. Andthese two are very, very high
endotoxin producers. And whenyou eat a diet that's solely
consisting of saturated fat andanimal meat, you're going to
absorb a lot more of thisendotoxin called LPs, and that
(07:25):
can raise your cholesterol, andcause all sorts of other
problems like inflammation, etcetera. So he was sort of going
from the fire into the what isit the from the fire into the
frying pan, or he was going fromone bad situation to another bad
situation, and a lot of othersystemic symptoms started to
appear one, once he started onthe carnivore diet,
Daniel Baden (07:48):
just in the nutshell with SIBO, you have a
group of bacteria that wouldnormally live in a healthy
individual in one part of thecolon. And for some reason,
these bacteria migrate to thesmall intestine or higher, and
cause changes to the mucosa andchange how we digest food
(08:11):
causing more fermentation. Isthat correct so far?
Unknown (08:15):
I mean, there are there are a lot of different reasons
why people develop SIBO. So it'snot always the migration of
those bacteria. Sometimesthey're very frequently actually
there is a problem with thenormal motility in the upper
gun. So that bacteria becauseyou don't want to have small
amounts of these are okay, youknow, other bacteria can keep
(08:36):
them in check. And it's, it'soften kept in check by this
housekeeper wave that is part ofthe small intestine that is
basically a contraction wavethat sweeps through the small
intestine, and clears out a lotof these bacteria. But in many
people for lots of differentreasons, that type of motility
wave is impaired. And thenbacteria are allowed to remain
(09:00):
in the small intestine and canjust proliferate.
Daniel Baden (09:03):
do you have any experience or knowledge or if it
exists as to why some of thesebacterial cultures will change
from where they reside in theintestinal tract? Stress, or..
Nirala Jacobi (09:14):
Well, I mean, there, yes, stress is a big
part, but that alone doesn'tchange the composition of the
bacteria. So what you're asking,like, why do people have? Well,
what we know that the biggesthydrogen producers are these two
bacteria, and they're verycommon commensals in our gut,
right? They're very common.
They're in small amount, they'renormal in higher amounts, they
(09:35):
cause problems. And so when youhave something like that, that's
that's completely rampant,you're gonna get a lot get a lot
of symptoms, but, you know, theway I usually describe the
causes of SIBO for people is inthree different categories of
causes. And number one issomething got messed up with the
motility and that often is dueto factors like the, you know,
(09:57):
vagal dysfunction is maybe whereyou were going with your
question about stress, highstress can do that. But that's
tends to be more temporary. Butif you've had food poisoning,
for example, food poisoning, isa situation where you're
infected with a very aggressivepathogen. So this is different
(10:19):
from not from these bacteriathat cause SIBO. In that,
typically that Campylobacter orsalmonella, or you know any of
these sort of aggressivebacteria, and when you're
infected with that thesebacteria secrete a toxin that
you can develop an immuneresponse to an auto immune
response, basically, where yourbody is trying to attack this
(10:41):
poison. But instead, it actuallyis damaging this housekeeper
wave. And this is a really wellestablished, basically etiology
or development of SIBO, wherenow you are attacking the
motility aspect of your smallintestine instead of the poison.
And so a lot of times forlisteners that may have
(11:02):
developed IBS or irritable bowelsyndrome, after a case of food
poisoning, it's very likely thatthat was the reason why this
happened. And that's been moreand more confirmed now in the
research. And so that's onereason. Yeah, that is one reason
why people develop SIBO. Andthat is probably one of the most
common but then it could be thatyou've had scar tissue in your,
(11:24):
in your abdomen from surgeries,like getting your gallbladder
out or your appendix out orhaving a C section. And all
these types of interventionswhere you there is a cut, and
wherever there is a cut, you canhave this aberrant scar tissue
called adhesions, and adhesionsor intra abdominal sort of
(11:45):
anchors and hooks and they canattach to the outside of the
digestive tract and pull andtwist it into sort of like a
kink in a garden hose. And sothis is different from having
impaired motility in the uppergod, this is more like bacteria
are can't really move wellthrough this kink in a garden
hose. That can also happen,especially with conditions like
(12:07):
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, oralcontraceptive pill over a long
period of time antibiotic use orany other sort of drug. Any
thoughts around? Yeah,
Nirala Jacobi (12:27):
well, and non steroidal anti inflammatories do
not cause SIBO, nor does thepill, it certainly can affect
overgrowth. But if we thinkabout that the body has certain
mechanisms in place to preventbacterial overgrowth and stomach
acid is actually one of them,right? We actually are meant to
kill bacteria that come in fromthe outside and create an
(12:48):
inhospitable environment. Andthey'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 inthe large intestine, this
dysbiosis is what we wouldclassify as dysbiosis. So yes,
you can have medications thatthat can also alter the small
intestine, but most of thosemedications are based on that
(13:13):
they affect the motility of thegut. So these mechanisms besides
hydrochloric acid, and thiscleansing wave there, I mean,
all the digestive juices havethis bacterial static effect,
they they're meant to killbacteria, because of the reason
that the small intestine to giveyou an idea is not meant to
contain more than 3000 bacteriaper milliliter, versus something
(13:36):
like 10 billion per millionmilliliter in the large
intestine. So that gives you avisual of the different like,
it's the desert in therainforest, right. And it's
really meant to be kept very,very low in bacteria. So
anything that affects it, youknow, I can't get it from
probiotics, for example, that'snot how this works. It's it's a
real specific thing of eitherthat they are migrating upward
(14:01):
from the large bowel, which isnot that common, or they can't
be flushed out with the normalmotility, or you have some kind
of adhesion. That's usually theway it works.
Daniel Baden (14:11):
Thank you for the distraction and indulge me my
selfish academic curiosity. Butlet'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'severywhere these days about, you
know, and when you remember,like this was 2011. Daniel, when
I approached you and yourcompany, I was like, this is
SIBO. We need to we need to do awebinar about SIBO This is and
it's it's it more and more andmore people are aware of it so
much so that it was a questionon Who Wants to Be a Millionaire
(14:40):
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 carnivorediet 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 littlebit more tolerable, but it's he
still had a lot of symptoms thathe just wasn't happy with, and a
(15:20):
lot of mood issues, anxiety,difficulty breathing, and all of
that. So the first thing we didwas, we did a SIBO breath test,
this is basically a test you canorder. And you can do it at
home, send it in, and it cantell you whether or not you have
SIBO that in retrospect, whathad happened was he had already
(15:42):
been diagnosed with SIBO byanother practitioner, and the
treatment had put him in thehospital, basically. So he had
such severe symptoms of the fromthe treatment, that he you know,
panic attacks, anxiety reallysevere, and things like that. So
that's how he ended up with me.
And one of the one of thecontributing factors I strongly
(16:02):
suspected was histamine issues,because histamine intolerance
can really be one of the sideeffects of SIBO. But also, from
from a lot of other conditions.
People are familiar with it, ifthey have seasonal allergies, or
(16:22):
allergies in general, thesneezing the allergy symptoms
that you can expect withhistamine. But histamine can
have really strong effects inthe gut in terms of diarrhea,
cramping, you know, a lot ofSIBO symptoms can be from
histamine intolerance. But thenyou can also have a long side of
(16:43):
that you can have all the otherallergy symptoms, but also
headaches and things like that.
And because he was so reactive,oftentimes when people are
extremely reactive to lots ofthings, histamine is the first
thing I think of. But one of thereasons I don't know if you want
me to carry on with histamine orif 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 justdescribed, which is spot on,
there are a number of histaminereceptors in the brain as well.
And there are some significantrelationships between histamine
and mood such as anxiety anddepression, when we're talking
(17:21):
about a lot of these gut andfood type issues, anxiety,
depression are stronglyassociated. And when people go
on, and sometimes people go onspecific drugs for their mood,
their allergies improve. Andthese sorts of unusual types of
correlations, which we're onlyjust starting to discover more
and more and more about as timegoes on. So this guy seems like
(17:44):
he's really ticked all the boxesin terms of histamine.
Nirala Jacobi (17:47):
He did, he did, and especially with his severe
reactivity, but I see this sooften. Because in SIBO, if you
imagine, right, what I saidbefore you have this desert you
like a healthy small intestineis, has very few bacteria. But
imagine now you've got, you'vegot 10, or 20, times the amount
(18:10):
of bacteria you're meant tohave. They're the and they're
fermenting these carbohydrates,and causing this hydrogen gas.
And that gas is actuallydamaging to what's called your
brush border. And the brushborder is the hairlike
protrusions on our cell surfaceof the cells that are lining the
gut, right or in the smallintestine, that really
(18:32):
effectively increases thesurface area of your digestive
tract to that of a tennis court.
If you were to pull out yoursmall intestine and spread it
out from you know, every cell itwould be it would cover a huge
surface area so that you canextract 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 Iwas reading in New Scientist a
year or so ago, that the brushthe hairs on the brush border,
actually some of them havelittle sampling cells at the end
of the hair when they can theycan sample what's in the gut
environment and drag it back infor the immune system to assess
(19:13):
what's
Nirala Jacobi (19:13):
Yes, yes. Those are the fibroblasts, right also
fibroblast dendritic cells dothat they're made that's a whole
nother level I know a wholenother conversation of how how
we interact with our immunesystem and how we turn food
which is non self into self, allof that super fascinating. But
(19:33):
yeah, so what happens with thiswith very high gas levels, is
that damage this brush borderand what what happens at the at
the tip of the brush border isbasically you have enzymes that
perform the last step ofdigestion and absorption for you
(19:54):
and one of those enzymes isdiamine oxidase. And diamine
oxidase is specific for breakingdown histamine in the gut. So
you get sort of this situationwhere you cannot break down your
own histamine. And histamine iselevated in some people for
several reasons. And one of themis the loss of this enzyme. And
(20:17):
another one is, they may havesuch an imbalanced microbiome
that the microbiome is actuallyproducing histamine. And then
thirdly, we see more histaminein SIBO, because the cells that
contain histamine in our tissuesare called mast cells. And you
can have this migration of thecells, and then they get very
(20:39):
trigger happy, you know, likeyou mentioned, nor histamine is
not just a neurotransmitter, butit also is a mediator, that the
whole purpose is to flush outwhatever it's trying to get out
of our system, right? And itincreases the mucus and widens,
it's a basal dilator. It doesall these things to try to get
rid of the pathogen. And so thisis just sort of like a helpful
(21:03):
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 ahistamine intolerance? You he'd
been down the SIBO track, hetried some sort of therapy with
another practitioner. So what'sthe 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 goneto other practitioners, and it
was just too much too soon, toofast. Right. And I think this is
a good case. To exemplify thatwe started really slowly, we
knew he had SIBO. And I wasn'tgoing to do the same mistake.
(21:44):
And this practitioner was great.
He was well intentioned, youknow, did all the right
treatment, but it was way toomuch for his system to tolerate.
So we started with reducinghistamine containing foods. And
I wanted him to start adding afew foods that are like lower
fiber, lower FODMAP. Right. SoFODMAP stands for fermentable,
(22:05):
oligosaccharides, disaccharides,monosaccharides, and polyols.
And these are basically fibersin food that are great for for
bacteria in the large intestine.
But if you have an overgrowth inyour small intestine, they're
going to get to the party muchbefore any of the bacteria and
the large intestine. So so wewant foods that are low in those
(22:29):
so that he can start to build uphis tolerance, right. And
basically, I gave him diamineoxidase as an enzyme supplement.
That's easy, right? You canactually 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 toget it in from overseas; DAO
Nirala Jacobi (22:52):
So well actually no, you can Yeah, there is you
can get it also from MonashMonash makes some enzymes. Now,
what are they called FOD mate orsomething? Anyway, so there's
different options but yes, theyou it's a little bit easier to
order it you can get it on alsoAmazon and I herb and those
kinds of things.
Daniel Baden (23:12):
So you mentioned earlier histamine foods. And
sometimes this is a bitconfusing for people because you
know, many of the cheese's forexample might contain
histamines, but also a lot offoods that people would normally
deem as healthy foods likefermented foods and sauerkraut
and these sorts of foods kimchi,which were told through all the
(23:34):
health books, and they're superhealthy probiotic rich foods,
yet, they are super high inhistamines, 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 tothis, and you were told to eat
more fermented foods likesauerkraut and kefir and yogurt,
and kombucha God forbid, youbecame more symptomatic. It's
possible. It's possible thathistamine may be the culprit.
It's not always but it can be.
Sometimes it's whatever productyou're consuming. And you have
(24:05):
other issues with your gut, butmainly if that's the if it's
with happens always withfermented foods, also, beer and
wine, right? All the alcoholsare 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 alittle stick that called the
wand and you could put it inyour glass and it absorbs his
domain, right. So yes, itexists. It exists for for the
app, but other foods is not justabout fermented foods, so it's
anything cured cured meats, veryhigh, tinned products,
(24:40):
especially tinned fish. And soremember when he had that it
started with tuna, and rice andrice, just to get back to the
brush borders for just a second.
Other brush border enzymesbesides diamine oxidase that's
responsible for histamine but asare also the ISO Maltesers and
(25:00):
And, and so crazes, and there,they perform that step that goes
from disaccharide. So two littlemolecules of carbohydrate, and
it cleaves that so that you havemono saccharide. And you can
actually absorb that. So a lotof times people like, you know,
rice, white rice can be quitereactive, a lot of people get
(25:20):
really bloated. So that could bea little bit of a clue is that,
you know, we always thoughtCandida right away, right as
practitioners now it's notalways Candida. Because, you
know, white rice is a low FODMAPfoods. So it typically doesn't
aggravate SIBO. But some peoplewith ongoing gut issues have
(25:41):
this damage from SIBO to thesebrush border enzymes.
Daniel Baden (25:46):
In your notes, you also suggested that the
gentleman, does he have a firstname 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 forpeople with severe digestive
issues that have very severemalabsorption. So you've got you
have parent Terrell nutrition,which is IV nutrition for people
that just absolutely can'tabsorb anything. And this is the
next step into actuallyconsuming something that is
(26:24):
absorbable. So the premise isthat all of the ingredients, so
you've got your macro nutrientingredients, your carbohydrates,
your fats, and your proteins,they're all completely pre
digested into their most intotheir smallest form. So you have
free form amino acids, you haveglucose, and you have like an
oil, like MCT oil or soy and inthere, and you basically mix it
(26:48):
with water. And you that is allyou consume. And the and the
idea is to fuel the host, whichis you and not the bacteria,
right? So if you think that SIBOis basically a condition where
bacteria are eating foods,instead, you're not digesting
the food, the bacteria is eatingyour food in the wrong place.
(27:11):
Basically, what you're doing isyou're bypassing that and you're
giving something that'sabsolutely rapidly absorbed in
the very first part of the smallintestine. Only time that
doesn't work as if somebody hadSIBO in the very first part of
the smaller tests in which hedid, right so and but it can be
a great treatment for peoplethat have high levels, CBOE
(27:32):
CBOE, it's very effective andgetting gases down. But it's
also really good as a as abooster for people that have
malabsorption syndromes.
Daniel Baden (27:41):
you did some further testing. And they came
back saying there is a presenceof Candida by histamine, but
also high hydrogen sulfide. Nowhydrogen sulfide is a I guess
it's a physiological mediatordoes many things in the body.
And I'm, to be honest, I don'tknow what high or low is. But I
(28:04):
know that when it's not aproblem, it's so important for
regulating many different nervefunctions and inflammation and
all that sort of thing. But whenit's high, what happens?
Nirala Jacobi (28:15):
Hydrogen Sulfide is what we call a gazel, or
gazco trend transmitter, as yourightly pointed out, it has a
Goldilocks level, if it's verylow, it you know, or if it's in
small amounts, it can actuallyimprove inflammation in the gut.
But if it's very high, it'shighly associated with
inflammatory bowel disease andto veer sulfur intolerance. And
(28:39):
people get very symptomatic whenthey have high hydrogen sulfide
gas production. So I did a stooltest. So what I looked at is
this this particular metabolite,or this guy's or transmitter,
which is available as digestivemarker, and one of the tests or
labs that I use, and basicallyit looks for bacterial or
(29:03):
genomic and you know, the DNA ofbacteria that are is capable of
producing hydrogen sulfide, andhydrogen sulfide, when that's
elevated in somebody that hasSIBO we can't really test for
hydrogen sulfide on breath testsyet here in Australia or
anywhere else except one lab inthe country in America. So we're
(29:23):
still all waiting for machinerythat allows us to test that on
the breath because hydrogensulfide SIBO is also very
common, but lipo or largeintestine bacterial overgrowth,
that involves hydrogen sulfideis actually quite common. And it
can worsen a histaminesituation, it can actually
trigger more histamine issuesfor people and the worst thing
(29:46):
you can do is eat a carnivorediet because you're basically
feeding these hydrogen sulfideproducers. They love fat and
bile right? They just love itwhenever you eating high fat or
high meat you your body As youproduce more bile, and some of
that ends up in the colon, andbasically you end up with more
hydrogen sulfide production.
Lots of different reasons andlots of esoteric reasons in some
(30:09):
way, or more eclectic thinkingabout why hydrogen sulfide is
produced is probably beyond thescope of this conversation. But
basically, I've gone way deepinto the rabbit hole with
hydrogen sulfide. But for him,it was really relevant. You
know, one of the reasons I lovetesting is because I can say,
hey, look, here it is, this isthe reason we need to do X, Y,
(30:31):
and Z. You know, you can't stayon the carnivore diet. But this
is a dirt This is proof thatthis is actually damaging and
highly inflammatory for you. Andso we just kept doing baby
steps. And that's important todo baby steps to be able to
start to tolerate some of somealternative foods. And what we
(30:52):
did is we really focused onmanaging histamine and hydrogen
sulfide and hydrogen sulfide,you can, besides reducing foods
that stimulate that, but you canalso use different binders like
bismuth, and things like that,for hydrogen sulfide. So we we
did some of that. And he startedto slowly improve, especially
when we, when we took histamineout of his diet and gave him
(31:15):
histamine stabilizers likequercetin and vitamin C, he was
very low in vitamin D as well,and that vitamin D is so
important for opera gutregulation in terms of immune
function and all of that. So westarted with those non anti
microbials, non probiotics, nonfermented foods, all the things
you think about, when you thinkabout gut health, we really
(31:36):
focused on these particularpathways, and made enough of an
inroad to where he could finallytolerate the SIBO treatment. And
that just one step was we werethere, it just went pretty
quickly in terms of dramaticimprovements for him.
Daniel Baden (31:52):
One of the tests you ran, which confuses me
slightly, it was highcalprotectin. And calprotectin
is usually thought to try todetermine whether there's some
sort of inflammatory processgoing on in the bowel. His
result came back saying high,but inflammatory bowel diseases
(32:12):
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 theydidn't think that that was the
case. But you because of thehigh hydrogen sulfide, he was at
risk. And so what we did wasafter he had gone to the
gastroenterologist, we knew thatthat had been ruled out. But
(32:34):
there was a very, veryinflammatory situation in his
gut. Where do
Daniel Baden (32:40):
you go from here?
What's the next step? And it wastherapy?
Nirala Jacobi (32:44):
Well, you know, he's still doing SIBO treatment
right now. And so our goal is tohave him be completely SIBO
free, so retesting, making surethat's completely free. And then
we're actually getting into thisinto microbiome restoration.
Because what else we found onthis stool test I did was
(33:06):
severely low diversity of hismicrobiome, which was not a
surprise, given his diet. If youdon't feed bacteria, they go
away. They don't want to hangaround, right, or they go into
senescence, which is dormancy.
And basically, he just has solow and microbiome, that after
SIBO treatment, which involvesstill being on a low fiber diet
with the FODMAP diet, or thebiphasic diet that I created for
(33:28):
SIBO. And we're going to moveinto microbiome restoration,
which involves actuallyincreasing the foods that can
trigger SIBO. But if you don'thave SIBO anymore, this is the
way to go to feed the bacteriain 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 thesupplements 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 oftendeficient and people that have
these severe malabsorptionsyndrome, especially with
Gaviscon history, and PPIhistory, and all of that,
because of the blockage ofhydrochloric acid and he
actually at some point, triedhydrochloric acid, which is
(34:16):
stomach acid and it helped himright so this is another another
component to the case where heactually thought he had hyper
acidity and that was not thecase. He actually had low
stomach acid and the only reasonhe improved on the carnivore
diet is because he stopped thegas production from SIBO but
(34:36):
ultimately, he couldn't sustainthat kind of diet because it was
also very poor a poor digestionand caught you know, creating
more ammonia and and otherissues 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 aherbal type. Yeah, it's
Nirala Jacobi (34:55):
a combination herb Yep. For his type of SIBO
but that is us. sort of apractitioner only brand in
Australia. And so he's he'salmost completed with this
treatment now ready for retest,so we always retest to make sure
we have solved the problem. Andthen yeah, then we're getting
into this, which is, you know,my sweet spot besides SIBO. And
(35:18):
I've done SIBO now for 12 years,and I've, I feel like I've put a
lot of energy into educatingpractitioners and educating
patients about this topic, butnow. So now it's like, my sweet
spot is really the microbiomebecause I feel like, this is
(35:38):
where I get really excited forpatients. This is the one place
you it's like you can rewildyour own ecosystem, and it can
have profound health effectswhere you can prevent virtually
all preventable diseases. Sofrom from weight gain to you
know, from diabetes, obesity,heart disease, mood disorders,
(36:01):
even neurodegenerative disorderslike Parkinson's and
Alzheimer's, all of that hassomehow its little tendrils in
the microbiome. And so I that'smy passion is to help people
understand that feeding yourmicrobiome is your best
insurance. We learned from theBlue Zones, right? Yes, 80%
(36:26):
Plant, plant based diet is veryhelpful in the view, it can make
you live longer. And probablyone of the reasons is because of
this connection to themicrobiome.
Daniel Baden (36:36):
For those of you that have never heard about a
Blue Zone, There are areasaround 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 20years ago, or so, and I've been
recommending this for all mypatients, because I was so
impressed how, you know, he sortof cracked the case of what was
it about these different placesthat made people live longer?
And it's not what any one thing,it's more than one thing, but
one of the components was thisplant based diet, and he went
(37:10):
around everywhere, and found outwhat it was. And you know, if I
can do my part and have peopleeat more plants on this planet,
I feel I feel happy about that,because we all need to eat more
plants, right? There was a studyby the American gut project,
seven year long study thatshowed that the single most
(37:33):
important predictor of people'shealth was how many plants they
ate, per week, the differenttypes 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 intreatment with you?
Nirala Jacobi (37:53):
You know, I'm on basically the tail end of his
treatment at this point. So hestarted seeing me, I think it
was about eight months ago, iswhen we started this. So this
was really, it's another kind ofteaching point is like, yeah,
you know, we have the testresults, we know what's wrong,
let's just go in there and fixit. And you can't do that with
(38:14):
somebody that has severehistamine intolerance, it just
it because the end and potentialmast cell activation syndrome,
which is sort of like if youthink of the spectrum of
intolerance, mast cellactivation syndrome is like the
worst kind of histamineintolerance, and other other
issues come up come from that.
But the classic symptom is youcan't tolerate anything barely,
(38:34):
you know, reacts to all thesupplements. 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 educatedthrough medicine, that they
should just expect to take atablet to fix everything, or an
operation, and you're done.
Exactly. But if we take the timeto explain to our patients, that
to get a proper long termtreatment, and bring homeostasis
(39:03):
or body balance back, it cansometimes say time for your body
to adjust. And when you explainthat to people, I think that
every person I've ever spoken tois really fine with that as long
as they understand. And and theyunderstand what the expectations
are. So that's a reallyimportant point. Thank you.
Nirala Jacobi (39:23):
yeah sure. I think inherently people
understand that, especially ifthey, if you give them like, for
example, I always tell peoplewhen to start anti microbials,
that, you know what you mightfeel really terrible for about
three days. And here's what youcan do to reduce that. Most of
the time when it happens, theyfeel like Wow, really, really
(39:45):
empowered. Like, I knew this wascoming. And here it is. And this
is actually a good thing for meto feel that and here's what I
could do to minimize myreactions and stuff. So I think
we do need to also givetimeframes for people Oftentimes
I tell my patients, you know, Idon't really expect you to feel
much better until we get to thisstage. But I expect X, Y, and Z,
(40:08):
I expect your reactions tobecome less, I expect you to
tolerate more food in about sixto eight weeks or so once a day.
They love it, because it justrelaxes 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 havedecreased by 80% or so. And so I
do expect that there is going tobe more work to be done in the
large ball for sure, because ofthis diversity issue. And he's
still not, he's still on a lowFODMAP diet. So low FODMAP diet
means that you're not going toget all the crucial fibers,
(40:43):
you're going to need to restoreyour microbiome. But we have
done prebiotics and things likevery tiny amounts, just like
making a wet your finger anddividend to the powder and start
with that. So So yeah, so I haveI think he's already in such a
good mental space that he feelsmuch better. He can tolerate
(41:04):
SIBO treatment without beinghospitalized. You know, all of
those were big, were big winsfor him.
That just sounds amazing. Thankyou. Nirala. Where are you at
Now? What do you what do you dowith yourself?
Nirala Jacobi (41:17):
Well, I'm completing my course, I don't
know when when your podcast hereis going to air but it might be
already out but is basicallycompleting my do at home course,
restore your microbiome, becauseof the reasons I mentioned.
Like, I think this is probablyone of the best ways to ensure
health is by promoting a goodmicrobiome. And I by the way,
(41:40):
I'm the proud owner or custodianof the most diverse microbiome
I've ever seen in testing. So Iam I walk my talk. And so you
know, I'm teaching that in thiscourse, that people can get more
information also about thedifferent metabolites. We've
mentioned here that histamineand hydrogen sulfide and SIBO.
There's a lot of informationabout that. So I've put
(42:02):
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 yearoff my practice to not think
about SIBO for a little bit, sothat I can have a bit of a
mental break from all the workI'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 aboutthe microbiome, it's a really
good intro course for you. Ifyou're a patient, and you're
listening, and you always wantedto know more about the
microbiome, because let's faceit, every day, we're reading
some, I'm reading based, maybejust my curated newsfeed. But
every day, I have a headlineabout how the microbiome is
(42:47):
influencing something abouthealth. And if you really wanted
to understand that, and not justthe concept of good bacteria,
bad bacteria, it's way moreexciting and complex than that
and want to empower yourselfwith regaining your health.
That's the course for you. Andit's not for people that have
SIBO. There's a different coursefor that. Because if you start
(43:10):
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 thisone 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 thisis where you can find a lot of
the resources, I've created anebook for SIBO, the biphasic
diet that I've created, there'sno SIBO Mastery program for
(43:47):
practitioners. And there areother educational courses for
practitioners. And then there'sthe SIBO success plan, and the
microbiome, restore yourmicrobiome force for patients.
So that's my learning platform.
And that's all I'm doing for fornow.
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 ofpractitioners in SIBO over the
years, and so there's a lot ofpeople out there that understand
it. So what sort of people orpatients or general public what
sort of symptoms should they beraised to think about whether
SIBO is something that canaffect them or histamine can
(44:42):
affect them be affecting them?
So
Nirala Jacobi (44:44):
the symptoms to look out for in SIBO is all the
classic symptoms of irritablebowel syndrome because it is
actually a form of IBS, right.
So SIBO is, is estimated tocause about 60% of all IBS
cases. So it's the bloatingafter meals. It's the altered
sort of bowel changes where youhave either diarrhea or
(45:07):
constipation or a combination ofthose. You can have abdominal
pain, you can have a you canhave reflux, you can have a lot
of digestive symptoms with SIBO.
And then some classic symptomsthat are sort of red flags, I
would say for people should betested for SIBO. And those cases
(45:27):
would be acne, rosacea, restlessleg syndrome, and then
interstitial cystitis, and whichis a very painful bladder
syndrome. And then also thingslike fibromyalgia because it's
so commonly coexisting in theseconditions.
Daniel Baden (45:46):
All right. Well, look, thank you so much. That
was a really fascinating case.
Thank you. And I love whatyou've done with all the work
and I know that you put yourheart and soul into it all and
you've been talking about it forso many years now. And I really
think a lot of people havebenefited so brilliant, well
done. You deserve a bit of aholiday not too long. We want
you back. Enjoy the break.
Nirala Jacobi (46:07):
Thanks, Daniel, I will. Okay, take care. Take
care, bye.
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