January 2, 2025 • 46 mins
Join us as we revisit some of our top podcast episodes from 2024! Starting with Karly Raven and a discussion of SIBO.
Embark on a journey to the heart of gut health with us, Andrew Whitfield-Cook and the esteemed gut health specialist Karly Raven. Together, we dissect Small Intestinal Bacterial Overgrowth (SIBO), offering a refreshing perspective on dietary interventions that seek to alleviate discomfort without depriving our bodies of essential nutrients.
Karly challenges the status quo, advocating for a balanced approach to diets like low FODMAP and specific carbohydrate, highlighting their symptom-relief benefits while keeping an eye on the broader implications for our microbiome.
About Karly:
Karly is an esteemed gut health naturopath, nutritionist, mentor, writer, researcher, and captivating speaker, whose passion for transforming lives through evidence-based practices has seen her change the lives of many people suffering from IBS and SIBO. With a wealth of clinical experience, she has become a leading expert in treating complex gut health issues such as IBS, SIBO, IBD, and food intolerances.
After completing her naturopathy degree, Karly embarked on a journey of relentless research, honing her expertise in gut health, with a special focus on IBS, SIBO, and the intricate world of the microbiome. Mentoring health professionals worldwide has become one of her cherished endeavours, as she takes immense joy in sharing her profound knowledge and experience in the field. Karly is the founder of the Nourished Gut Program and Clinic where she is the principle naturopath but also has a team of naturopaths who support clients suffering from gastrointestinal issues.
Karly has had the privilege of being a sought-after speaker, delivering compelling educational presentations for renowned Australian companies. Her most recent work lies in her groundbreaking work— developing a dietary therapy for SIBO that transcends conventional approaches. Her therapy prioritises supporting the microbiome while promoting overall well-being, thoughtfully avoiding excessive food restrictions. This holistic approach seeks to restore balance and harmony within the gut.
Beyond her professional expertise, Karly brings a deeply personal connection to her work. She has intimately experienced the challenges of living with IBS and SIBO, grappling with debilitating gut issues for years. Additionally, her family history of Crohn's disease and autoimmune disorders fuels her unwavering mission to empower individuals in overcoming chronic gut issues.
Through her compassionate and professional approach, she aims to pave the way for a brighter, healthier future—where gut issues are conquered, and joyous living becomes the norm.
Connect with Karly:
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your h
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:21):
Welcome to Wellness by Designs.
I'm your host, andrewWhitfield-Cook, and today we're
talking with Carly Raven.
Carly Raven's a gut specialist,naturopath, nutritionist, and
we're going to be talking aboutpractical care with SIBO
patients.
Welcome to Wellness by Designs,carly.
How are you?
Speaker 2 (00:39):
Good, thank you.
How are you, Andrew?
Speaker 1 (00:42):
Really good.
Thank you and congratulations.
By the way, you're not far offfrom going on maternity leave.
Well done.
Speaker 2 (00:50):
Thank you, yes, well and truly baking over here At
the pointy end of the journey.
Speaker 1 (00:58):
Okay, so on to our topic.
Many people know you already soI don't want to sort of waste
time because we've got a lot ofwork to cover here today.
But everybody, carly Raven isvery well known in the gut
health space.
She's got particular interestin SIBO but many other interests
in helping patients with gutissues.
(01:18):
So if we can just dive straightinto SIBO, can we talk first
about what are the main dietaryapproaches that you see being
used for SIBO and what are thereported efficacies or
effectiveness reported bypatients that they tell you
about?
That was a double on top,wasn't it?
Speaker 2 (01:40):
Yes.
I think the biggest thing torecognize is that there isn't
actually much research and dataspecifically done on patients
and cohorts of people with SIBO.
So I think that's like I reallywant to start with that.
But what does exist is a lot ofresearch on IBS and we know that
there's that crossover betweenIBS and SIBO and the potential
(02:03):
of an IBS patient to have SIBOis anywhere up to 80%.
So what I'm kind of seeing isthe theories and the dietary
therapies being translated overfrom IBS research and being used
for SIBO patients and typicallywhat is being used is that low
(02:24):
fermentable, low carbohydratetype diet and quite restrictive
in nature, so it's cutting out alot of foods.
So, like the most commonly usedone is something like the low
FODMAP diet, a low carbohydratediet, and even like specific
(02:46):
carbohydrates.
So, like you know, justselecting a few key
carbohydrates and removing themfrom the diet.
And yeah, there's differentparadigms, I suppose, and
creations from people in thefield of SIBO that have created
different things, but what Ifind in my practice is they're
(03:10):
really hard to stick to and youknow, my big question over the
years of practicing with thesepatients is do we need to be
super restrictive to get reallygreat outcomes with these
patients?
Speaker 1 (03:27):
Can I ask about that selective carbohydrate
restriction?
What's the theory behind that?
Are we trying to inhibit theproliferation of methanogenes,
or something like that?
Speaker 2 (03:40):
Yeah, so essentially the ecosystem that overgrows
within the small bowel, and Isay ecosystem because it's
called small intestinalbacterial overgrowth.
But we know it's not justbacteria that overgrow in that
environment.
You also have archaea, which isand the biggest theory there is
(04:00):
that these carbohydrates, orhigh fructose, or fructan FODMAP
foods are almost like the fuelon the fire and they're their
biggest fuel source.
And so when we actually removethem from the diet, we see that
really quick, immediate symptomrelief, you know, and that's
(04:25):
very clear in the data.
you know there's some very bigscale studies that have been
done on patients with IBS and asquick as a week, you know,
sometimes a matter of days ofremoving these foods.
There's a big symptom relief inbloating, improvement to bowel
motions, so it's definitelysomething that we can't question
(04:50):
in terms of its benefit.
But you know we need to look atthe long-term of these diets
and the effects that that mightbe having on the microbiome and
placebo patients.
And when you actually look atsome of these big scale
meta-analyses that have beendone, they conclude themselves
(05:11):
but we don't know.
We actually haven't looked atthe long-term consequences of
such diets and it's almost likea caution when you're starting
to read through some of thesestudies, and so that was
starting to ring alarm bells forme in my practice and going
well.
Is this the best that I can do?
Speaker 1 (05:35):
Yeah, I totally hear you Like, I understand about
symptom relief, and that's fine,but when you're talking about
people and some people are veryhooked into, shall I say, that
acronym of FODMAP Indeed, theyforgot the first part of it,
which was low, and they just sayno, none, which in itself is
(05:57):
nutritionally deficient.
But particularly long term,we're really dealing with
people's health.
You know, there's a lot ofpolyphenols and good things in
these foods that exacerbatesymptoms, and if we lose out on
them long-term, I have realconcerns about what we're doing
to their health, as you sopoignantly say.
So what are the challenges,then, that practitioners might
(06:24):
encounter when implementingthese SIBO diets?
You know, how can they overcomethese difficulties?
How can they better supporttheir patients?
Speaker 2 (06:35):
Yeah.
So I think like the difficultyis how restrictive in nature
some of these things diets canbe and how willing our patients
are to do it properly.
And then also looking at thetime frame of use.
So you know, it's not uncommonfor us to get a new patient
(06:57):
through our clinic who says tous I've been on a low FODMAP
diet for seven, anywhere up toI've heard 15 years.
You know, um, and so I feellike, yeah, um, it's.
I feel like we really need tobe setting very clear guidelines
if you're going to be usingthese type of diets around.
(07:19):
You know, there there is datato show that as quick as four
weeks we can see negativeconsequences on the microbiome.
So now I'm talking about thelarge intestine and the
ecosystem that hangs out there,because we're switching into
more of that starvation mode andwe know that that ecosystem in
(07:41):
the large intestine needs tothrive and needs these.
You know prebiotics, fibres anddiversity of these type of
things, and these diets arecutting out, you know, huge
amounts of fruits and vegetablesand it really is very hard for
(08:01):
the patient to create a diversediet when they're on it.
And then I think you know soare we creating another issue in
itself by using that long term,and that will affect our
outcomes as practitioners,because it may be helping reduce
symptoms.
But underneath all of that, isit truly resolving the SIBO if
(08:25):
that's all we're doing?
And then is it kind of creatinga storm in the large intestine?
Um, and compliance is hard, youknow.
Um, lots of patients end upthrowing the towel in very
quickly and going.
You know, this is really shit.
I just want to eat an apple andat the end of the day, an apple
(08:48):
is a beautiful food that weshould be eating and it's so
good for the microbiome, withpectin and fibre, and so, yeah,
that's kind of, I think, thestruggle as practitioners and
for the patient, and there'smore, but they would be the
biggest kind of things that Ithink I see and I've experienced
it myself as a practitioner.
Speaker 1 (09:09):
I'm so glad you say that.
Indeed, I'm so glad that youmentioned apples, because Mike
Ash has this.
He called it is this the bestdiet for mucosal tolerance?
It's a question mark and in ithe details stewing apples.
In the UK they use Bramleyapples, which we don't use here,
but um, you know delicious.
(09:29):
Or um, pink lady apples,something like that in australia
, um, ones and I've never foundthis out, by the way, I think he
talks about using ones whichare high in raffinose, but he
stews them, puts in some raisinssorry, some sultanas and
divides them up into easilydosaged portions, so that you're
(09:52):
making a big batch that you caneasily access.
And I've told patients aboutthis, even with really chronic
immune gut, immune basedproblems, and it is amazing how
stewing the apple, rather thanhaving a raw apple, settles it
down.
So I wonder if the preparationof food might have something to
(10:16):
do with what we're talking about, with even FODMAPs oh,
absolutely.
Speaker 2 (10:21):
Even the way that we cook our beans, for example,
like just using beans from a can, where there's high amounts of
manufacturing and bypassing.
You know, when we cook them athome, we're soaking them, we're
rinsing them, we're letting themsit and then we cook them and
we boil them and we cool themthem.
(10:46):
But what's happening when it'sin the form of a can, you know,
and so many patients say to me Ican't tolerate chickpeas and
beans and don't even ask me, andI said, okay, give me some time
and we're going to get there.
Absolutely, I totally agreewith you the much maligned
chickpea.
I love them now you've done alot of work with this.
Speaker 1 (11:06):
As I said, you know both professionally and
personally.
So you've made, you developed a.
What is it?
Sibo roadmap.
Is that what it's called?
Speaker 2 (11:15):
SIBO food roadmap.
Yeah, the SIBO food roadmap.
Speaker 1 (11:17):
Yeah, tell us about that.
And what have you done?
Speaker 2 (11:20):
Yeah.
So I kind of took a step backand went okay, well, we can see
that, you know, we're gettinggreat outcomes symptom wise, and
it's almost like taking thefuel off the fire with the
removal of these type of foods.
And the big issue was themicrobiome and then also setting
(11:40):
time frames around this.
So I I just got sick of havingto hand out a two-page document
to patients, say, follow theFODMAP diet, and I was being
bombarded with questions and somuch email support and I just
thought that this is it.
You know, this was probablythree, four years ago now and I
thought I'm going to create myown thing that I'm going to use
(12:02):
with patients.
And so what I created was a sixstage process that I walk
patients through, where foraround two weeks, there is a
small amount of restriction.
However, there are still keyfoods, even in that initial
stage, that nourish themicrobiome.
(12:23):
So a couple of examples whichset this apart from all of the
other things that I've used inmy practice is things like cacao
, pawpaw, cranberries and havingthose a part of the diet that
nourish the microbiome and havereally great polyphenol effects
(12:44):
while they're still reducing youknow, some of the big trigger
foods, but then they quicklymove into the second stage and
really start to add more foodsback in and then, once they
become SIBO-free or IBS, it canbe used for people with IBS as
(13:05):
well.
Then they would move into thethird stage and beyond, and
right from the third stage it'sjust an abundant of
microbiome-supporting foods, andI think the biggest thing for
me was like being very clear onwhat they can and can't do, the
(13:25):
amounts and educating them aboutwhy, and then providing them
with all of the recipes thatthey need, all of the meal plans
, because in my practice I tendto attract a lot of full-time
busy mums who also keep thehousehold going, cook and clean,
(13:47):
and they were just strugglingyou know, they were like I just
so.
With the SIBO Food Roadmap, theybasically get handed everything
that they need and they couldstart the day after they receive
it because they would have anexact meal structure and the
recipes to go with it and thefull guide which they could
(14:08):
learn over the first two weeks.
You know, while they're justlike, okay, I'm just going to
follow what I need to do andthen I'll learn the principles,
start to add layers and createtheir own things from there as
well, once they feel a bit moreconfident.
But you know I it wasn'tunquestionable to just put it
(14:28):
off for weeks and just not getstarted and not create change,
because it was just toooverwhelming.
So yeah, it's um kind of like aone-stop resource, I suppose.
Speaker 1 (14:41):
Good on you.
Can I ask what about symptommanagement?
I mean, patients come in veryoften they're in pain, sometimes
they're even agoraphobicbecause of their bowel habits.
La la, la.
You know there's a lot ofissues here.
It's not just a little bit ofcramping, it's just not that
I've seen patients in hospitalwith dehydration from IBSD, not
(15:03):
that I've seen patients inhospital with dehydration from
IBSD.
So when we're talking aboutSIBO and IBS, is there anything
that you tend to employ on anutraceutical level or herbal
level to aid them through thatfirst step and maybe just settle
down symptoms while they'regetting used to things?
Speaker 2 (15:19):
Absolutely.
So I talked about stage onebefore, which is generally where
most people will start.
There are some exceptions andwe're always treating the
individual and this is somethingthat I do when I'm training the
practitioners in the SIBO foodroadmap.
But alongside that, they'reoften doing a lot of
anti-inflammatory and gut immunework.
(15:41):
So that might be through usinguh, specialized probiotic
strains, a key prebiotic.
We might be coming in therewith beautiful anti-inflammatory
herbs like um, turmeric, um,and we also love glutamine and,
you know, really stretching theboundaries here with some
glutamine supplementation,because a lot of the companies
(16:05):
actually don't have enoughglutamine in the dosages in the
supplements.
When we actually look at theclinical data on what it takes
to kind of heal leaky gut andthat, we're looking at very
large doses.
So yeah, we tend to do that,yeah, and up to 50, like 15 to
20, is a lot of it, but you know, if we have a celiac patient,
(16:29):
50 grams like yeah, it can be avery high amount um can be
needed to actually create thatfull healing response.
So, um, yeah, we're often doingthat in initial stages and then
that makes patients especiallybecause, like these people are,
like you said, they're supersensitive.
(16:50):
They're reacting to everythingand not just dietary stuff, like
a lot of environmental thingsby that point, because they've
often been on this journey for areally long time, some of them
have had mold exposure andthat's the underlying cause that
they got SIBO in the firstplace.
So there's that whole, you know.
So calming everything down,getting that immune system
(17:12):
firing in the gut, while kind oflifting, uh, these aggravating
foods, I suppose, um, that areso well-researched, and here I
am talking about the, you know,the carbohydrate and the
FODMAP-containing foods, butjust for a short period of time,
and then, you know, while alsousing key microbiome-nourishing
(17:37):
foods that aren't disruptive tothe symptoms.
Speaker 1 (17:43):
So I've got 20 questions from that comment.
So firstly, just because it'son the tip of my tongue,
glutamine I've seen using that,you know, two grams, three grams
dose per day, and it's usuallyin a formula that might be
concentrating on magnesiumrather than a gut healing thing.
(18:06):
But what I find is so manypatients and we're talking many,
many are we talking 60?
Are we talking 80%?
Haven't looked.
But a lot of patients complainof wind.
So how do you navigate peoplethrough that initial listen?
We're going to change your gutand they might be uncomfortable
in the first few days.
How do you get people to stayon track during that initial
(18:28):
shift in their health?
Speaker 2 (18:30):
We work very closely with our patients.
You know they can contact usday to day, Monday to Friday,
through the system that we havecreated.
We don't get them to come backa month later.
That's just the way that we'vecreated our clinic to run and
function.
So I think that's reallyhelpful in that if a patient is
(18:52):
experiencing that, we can havethe discussion then and there
and help them troubleshoot that,because everyone experiences
something slightly differentwhen they're reacting to.
But I think the key thing aswell is building them up to
those bigger dosages and this is, like really important, not
just for glutamine but also anytype of prebiotic saying to them
(19:14):
this is the end goal of wherewe need to be based off the data
.
But let's start here, because ofwhat you were mentioning, even
prebiotics in a SIBO patient canbe quite adventurous.
But you know we've got apatient at the moment on full
dose, high dose GOS, becausethere were some really key
(19:34):
species in her microbiome thatwere just screaming to us to
give her GOS, you know.
So we said to her hey, normallywe probably wouldn't go here
with the SIBO patient.
Start with this tiny dose, youknow.
See how you go and build up.
She did have, like you werementioning, a few kind of bloaty
(19:54):
days that were worse than whatshe was already experiencing,
and we just said, stay on thatdose, keep going with it and
just see how you go.
And then she kind of plateauedand we're like, okay, push the
boundary again and just kind ofsee how you go and over time.
I think she's now in week fourof her protocol and she's on her
full dose of that goss and weuse the similar process with the
(20:21):
glutamine.
Speaker 1 (20:24):
Can we drill down?
Forgive this vernacular, thispicture, but can we drill down
into the microbiome?
How long do we have?
I'm just having a horriblevisual.
But if we're talking aboutcertain, certain prebiotic
(20:45):
fibers, perhaps certain speciesand strains of probiotics which
might um benefit a microbiotaprofile, let's say, um, how do
you work with that, given that,let's say, in SIBO it's commonly
said that it's thelactobacilliaceae which are over
abundant in the upper GI?
(21:06):
You know, albeit that that um,um, you know, we can't really
test there unless you're doingsome quite invasive tests.
There's a lot of issues withtesting that I have.
But but, um, how do you choosewhich probiotic, which which um
prebiotic you're going to use,given somebody's um gut profile?
Speaker 2 (21:30):
yeah.
So I think when we're dealingspecifically with patients with
SIBO, the first thing is testingfor SIBO and working out what
type of SIBO they actually have,looking at their clinical
symptoms and their healthhistory and matching those two
up and then looking at theirmicrobiome if the patient has
(21:52):
done both.
This is a big investment for alot of people, and you know I do
a lot of mentoring withpractitioners and the biggest
question I get asked all thetime is Kali, how do you get
your patients to afford both abreath test and a microbiome
test?
And we're at that stage in ourpractice where that's just how
we work and for me to be able toproperly treat you in the field
that I am, that's what I do.
(22:13):
But I do recognise that thereis a big financial investment
there for patients, and lookingat the microbiome in my opinion
creates a safe treatment plan,and one example that I want to
talk about here is that you knowthere's been a lot of
conversations recently about theuse of berberine and its
(22:34):
effects on the microbiome andthings like increased hexa-LPS
production and proteobacteriaand the effect that it can have
in decreasing the total numberof species count in the overall
microbiome of a patient.
But berberine in quite highdoses is very effective for the
(22:55):
treatment of hydrogen-dominantSIBO.
So you know, this is where, ifyou, we just need to, you know,
be cautious, I suppose, andgather all of that information
because we may not go in withhigh, high doses of berberine.
If we could see in a microbiomeprofile that this patient had
those markers elevated and wemight choose a different herb,
(23:20):
like uvaversi, or come in withmore probiotics or prebiotics.
And then, in terms of gettingback to your question, andrew,
about like how do we choose aspecific therapy, it's about
looking at again the research onwell, if that's out of range,
are we trying to increase it?
Are we trying to increase it?
(23:41):
Are we trying to decrease it?
And a lot of the time it'sactually just about harmonising
the microbiome and you knowprobiotics and prebiotics are
beautiful at doing that.
But again, we need to get downto the species level and
understand how a probiotic worksand their mechanism of action.
Yes, I can see you want to aska question for it.
Speaker 1 (24:05):
Oh there's, there's so many questions going.
I've been taking notes andthere's, it just keeps going and
going.
So, um, uh, okay.
So firstly, with berberine,with hydrogen dominant, dominant
sebo, let's say we're dealingwith a lady who is having
problems with fertility,possibly polycystic ovarian
(24:28):
syndrome, insulin resistance,and berberine might be
advantageous for that andpossibly dyslipidemia as well,
and berberine is a therapy forthat.
How do you navigate that whenyou've got okay, this is good,
but we can't do that good thingforever for your polycystic
ovarian syndrome because you'vealso got SIBO.
I mean, that's a challenge.
Speaker 2 (24:50):
It is definitely a challenge and, andrew, it's
something that has led me toreally scratch my head the last
six months, since, you know, themore and more I dive into this
specific research, so much sothat we went right we're going
to do our own clinicalobservations.
So we've actually beencollecting our own data on all
of our patients.
(25:11):
So we're looking at breathtesting and microbiome testing
before and after the use ofberberine or non-berberine
treatment for our hydrogendominant SIBO patients and then
also monitoring the outcomeswith the microbiome testing.
And look, I'm going to drop abomb because this is like and I
(25:36):
want to say this is a small, alot smaller scale than what you
know some of these studieslooking at the effects of
berberine are up to you.
You know 300 participants inthis study and we have not yet
reached those numbers that we'vedone our clinical observations
on.
So this is a much smallercohort of people.
(26:01):
We're not quite seeing the sameoutcomes in terms of berberine
directly creating increasedlevels of hexa, lps or
proteobacteria In some patients.
We've seen a decrease ofspecies, but you know, even just
(26:29):
last week we had one patientcome back who has done again I
can push the boundaries with mySIBO patients quite a high dose
and I'm happy to admit it, eventhough some people may cringe
and go oh my god, you're usingwhat you know berberine.
You're crazy.
You know I do a high dose ofberberine.
You know, in philodendron thispatient also received, you know,
oil of oregano which is, youknow, quite collateral to the
microbiome as well, and theirproteobacteria, the hexa LPS,
(26:56):
both reduced and their totalspecies count actually increased
.
But what I want to say here isthat it what I.
My theory is that it's aboutwhat else we're doing in
combination with berberine, andI think this is my answer to
your question.
Um, as naturopaths we are soholistic we don't just give them
(27:19):
berberine and in these studiesthat they are just giving
berberine or potentially, in onecontrol group, berberine with a
probiotic and comparing that.
But we're using the SIBO foodroadmap, we use a probiotic with
most patients, we're usingglutamine, we're using
prebiotics.
(27:40):
We're often not just treatingSIBO and doing a lot of
anti-inflammatory work and usinga range of different herbal
liquids or tablets with herbsand we don't know yet the full
effect of all of these herbs.
It's not, you know,unfortunately we don't have all
of this beautiful research onevery single herb and its effect
(28:01):
.
So I believe it's this holistictreatment that we're using with
these SIBO patients and it'salmost what I'm thinking and
seeing.
Is it like balancing it outright and, in the process,
getting these patients to becomeSIBO-free, which is incredible,
like you know, symptom-free,sibo-free and it's using these
(28:26):
therapies, but in a really safeand educated way, and I think
that's what's important because,you know, come back to our
naturopathic principles of first, do no harm, you know, but if
we don't do that microbiometesting to give us that
information, if we're wanting touse berberine, it's like
stabbing in the dark a littlebit, and then we also don't have
(28:50):
that clear data to monitorthings, you know, and to go oh,
actually I did this person, youknow, a really good thing, or
probably shouldn't have donethat, and that's a lesson that I
can learn in clinical practiceand, and you know, take away
from that as well well, look, inany clinical practice, you're
(29:10):
going to have negatives.
Speaker 1 (29:11):
In any research, you're going to have those
people that fail a treatmentregimen.
I think it's really interestingif you're using felodendron.
Felodendron isn't justberberine.
It's kind of like people whothink that coffee equals
caffeine.
Um, philodendron also helps todecrease cortisol.
What's one of the majortriggers of sebo and ibs stress?
(29:33):
You know, could we be alsoacting in this way so that we're
relaxing things, improvingvagal tone or tonicity in
innovation and therefore aidingdigestion as a whole, aiding the
microbiota in those ways?
So you know, I think, as yousay, naturopaths don't work in
(29:53):
razor blades.
We work in butter knives, bysmoothing things and nourishing
things.
So I think that's one of the.
That's what I love.
Speaker 2 (30:01):
So much about what we do.
You know, I just love that.
We don't ever just have, youknow, and when we compare that
to a medication, you know thethat the treatment for SIBO is
rifaximin.
You know, and that's just clearcut, here's your rifaximin off,
you go, that's for yourtreatment of SIBO.
But as a naturopath, we just,we just don't treat that way.
(30:22):
You know, even if I was to geta patient to do rifaximin which
I have done in my practice Iwould say here's rifaximin plus,
I want you to do this and thiswith the diet, here's phgg,
because that increases theclinical outcome, you know.
So again, it's like we've justgot so many beautiful tools in
our toolbox when it comes towell like.
Speaker 1 (30:43):
I know that, yeah, one of these major
gastroenterologists that wasusing rifaximin also produced a
product for which the action wasactually the side effect.
So when you look at the commonname in America and forgive me,
I've got this wrong, but it'slike we'd say a conch shell, so
(31:06):
it's got that sort of name,it'sch shell, so it's got that
sort of name.
It's not correct, but it's gotthat sort of name.
Do you know what it is?
It's horse chestnut.
Oh right, yeah.
So what happens when you takehorse chestnut without it being
enteric coated?
It's a high saponin herb.
You're going to get a clean out.
So it's almost like he's at,he's using it as a prokinetic or
(31:29):
at least as a clean out.
So so I guess, to follow onfrom there, yeah, when you're
working with these patients andyou're using foods and fibers
and certain probiotics, you knowif we're dealing with sebo,
we've got something about acomponent which is the breakdown
of the MMC, the migrating motorcomplex.
So can you talk to us aboutwhat do you use as prokinetics?
(31:52):
What do you use as binders forthose people that might have an
overgrowth of the archaea andthings?
How do you manage things likeexcessive wind and bloating like
you spoke of?
Do we use things like charcoal?
Sorry, I've got 30 questions,carly, we could talk for days on
this.
Speaker 2 (32:11):
I know, I know there's just it's never-ending,
is it?
It's a huge world.
Yes, the migrating motorcomplex and prokinetics are
absolutely essential for SIBOand for most patients need it
throughout their entiretreatment and that will kind of
be something that should be keptthere as post, you know,
(32:35):
maintenance treatment for thesepatients.
But it really depends on, youknow, I think at least three
months post-treatment keepingthem on a prokinetic is really
important and then you can kindof test the waters a little bit,
bring them off that and justtest their own, see if they've
actually got that ability to getthat functioning properly.
(32:57):
But in some patients there'sthat whole autoimmune cascade
that's occurring with the CBTand the veniculin antibodies and
stuff like that and that isalmost potentially causing
long-term issues with thesepatients.
So they may need to take aprokinetic ongoing and you know
(33:21):
it's really hard to work thatout.
So you've got to kind ofmonitor your patient really
closely.
Um, but I love ginger.
Ginger is my favoriteprokinetic um and minimum 100
sorry, a thousand milligramsdaily um is needed to get that
(33:42):
beautiful.
Uh, migrating motor complexaction and you can do this
supplemental but getting yourpatients to, you know, consume
ginger, putting it in smoothies,in their yes, in their teas,
(34:03):
but like making it strong, youknow, and I think it really
depends on the patient, becausesome people can't tolerate
ginger, so you've got to workwith them there.
But it's so amazing.
Speaker 1 (34:15):
Go, andrew, I love it forgive me, sorry to interrupt
for our, for our listeners thatcan't see me.
I'm interrupting, carly, hereI've got a ginger and lemon tea
and it's not one tea bag, it'smultiple.
Speaker 2 (34:31):
Good, you're really encouraging that migrating motor
complex today.
Hopefully you do a really goodpoo this afternoon after all of
that.
Speaker 1 (34:40):
Thanks, it actually ties in sorry to interrupt again
, kai.
It actually ties in with a.
I did an instagram post from astory that I did years ago and
it was the use of ginger and we.
It was ginger talking to ourgut microbiota in, sorry, the
(35:02):
genes of ginger talking to thegut microbiota genes which then
talk to us.
So it's this cascade the gingerdoesn't talk to the gut
microbiota genes, which thentalk to us.
So it's this cascade the gingerdoesn't talk to us directly.
Speaker 2 (35:09):
It's really interesting stuff, but I love
what you're saying Now I'mcurious.
Speaker 1 (35:14):
Yeah, so forgive me, carry on, because I interrupted
and it's really important stuffMigrating, motor complex.
What else can we use?
Speaker 2 (35:24):
I also really like iberogast or making a like using
herbs that are, you know,supporting the mite.
You can make your own version ofIberigast, I suppose you know
with your herbal dispensary,with you know Oregon grape and
scutellaria and herbs like that.
(35:44):
But Iberigast is so easilyaccessible and can be really
great as a prokinetic as well.
But even the lifestyle stuff.
So like making sure patientsaren't snacking and that they're
having an eating window, liketrying to have three main meals
a day and allowing four to fivehours between their meals so
(36:09):
that the digestive system canrest and digest and clear out,
rather than it constantly justtrying to process food 24-7.
And you'll find that SIBO andIBS people love to snack.
It's just this thing that Ihave noticed in these people,
(36:31):
because it's almost like thebacteria are just like give me
sugar, give me carbs.
I'm always hungry and once youstart to clear and rebalance
what's going on in the gut,their cravings will reduce.
But it's such an importantthing that we need to be doing
(36:54):
for the migrating motor complexas well Anything that you could
help our listeners, our viewers,to use as an interjection.
Speaker 1 (37:04):
if you like to stop those cravings, can we use
things like perhaps I mean, I'mthinking West here what about
collagen?
What about bulking fibres?
What about xylitol?
Speaker 2 (37:20):
Yeah, the way I deal with this in our patients is
educating them about cravings.
Is this an emotional craving?
Is this a?
I'm actually hungry and mymetabolism is quicker, and if
they do have that, I'm one ofthese people, right?
If you asked me to fast forfour to five hours, I'd be a
(37:42):
space cadet, okay, and that'sjust.
My metabolism naturallyfunctions quickly and I need
more food, and so you can workthat out with the patient, but
also educating them about whatactually is a balanced,
nutritional, high-quality meal.
Because if you're going to onlyallow them to have these three
(38:05):
meals a day, because if you'regoing to only allow them to have
these three meals a day, somany people don't understand.
You know the simple things thatwe do as naturopaths and
nutritionists about how muchprotein, how many carbs, you
know how much fat, and get themto send you photos for a week of
their meals without you evensaying anything, and then come
(38:26):
in and help them restructurewhat they're actually putting on
their plate to make them feelfull and to actually get them to
last that amount of time.
And if they're not and you knowthat that's actually well,
that's actually a very adequatemeal and they shouldn't be
needing to snack.
That's when you can go okay.
Well, you may just have anaturally fast metabolism and
(38:49):
therefore we might need toadjust that and treat the
individual sitting in front ofyou.
But there, that's kind of how Iapproach that.
Speaker 1 (39:00):
I love your work seriously.
Um, I need to get you back on,if we can.
Um, I know you're going away tohave a baby, perhaps after
you've had your new addition toyour family 2024,.
Speaker 2 (39:10):
I'll come back.
Speaker 1 (39:11):
But just before we go , things like binders.
You know, simply, some peopleuse charcoal tablets on a more
naturopathic, holistic level, ifyou like, we use the Zeolites,
and forgive the one, it's got alonger name or whatever um.
(39:33):
Zeolites is a group and one ofthem is anyway.
Um, how often do you use theseand is there are there any
cautions with regards to bindingto nutrients, not just what you
don't want?
Speaker 2 (39:46):
to be honest with you , I used to use them a lot
heavier in practice, um, withI'm kind of moving away from
them a little bit, um, because Ibelieve that even a beautiful
herb like protea sorry, notproteobacteria pomegranate which
you can use for proteobacteriaum, can be, uh, really useful
(40:11):
for that action, and often we gofor pomegranate with a lot of
these patients.
So, um, I love pomegranate umas a treatment therapy for what.
I hate the word dysbiosis, butit's like that's what everyone
knows what I'm talking about.
But you know, um, you know animbalance to the microbiome um,
(40:35):
and NAC is another one.
But we just have to be verycareful there, um, because if
there's any hydrogen sulfideproducing species, it's not
necessarily good there.
So that's again another reallygreat reason why microbiome
(40:57):
testing for all SIBO patients isimportant.
Because, yeah, you justwouldn't touch that if you're,
you know, seeing things likedesulfofibrio in the microbiome
plus a positive SIBO test, forexample.
Speaker 1 (41:11):
Yeah, sure, Can I ask with pomegranate before we go,
what form?
Speaker 2 (41:18):
So we tend to do the rind and the husk in tablet, or
we love liquid.
We have our own kind of SIBOblends that we go to for
different types of presentations.
But yeah, even just there issome really great simple
(41:38):
products available with justpomegranate in them as well.
Speaker 1 (41:44):
I love your work.
This is so enlightening.
I've got a page full of notes.
Food is medicine.
Like food is medicine.
I love it.
Speaker 2 (41:52):
I didn't even talk about pomegranate.
Like you know, in stage one,when we're talking about the
SIBO food roadmap, the biggestand the best thing and the thing
I love most about what I'vecreated is pomegranate.
You know is in stage one of theSIBO food roadmap and we
educate them right from thestart about pomegranate and you
(42:13):
know we've had a recent patientstart on it and in the first two
weeks of her doing the SIBOfood roadmap she increased her
consumption of different foods.
So she ate 35 new foods in twoweeks of being on the SIBO Food
Roadmap.
Wow, she tried pomegranate forthe first time in her life and
(42:35):
just like the things that shewas sharing with us, I was just
like I think I can stoppractising.
I feel like my life has beenmade, you know.
Speaker 1 (42:44):
That's somebody who truly embraces therapy, isn't it
?
Speaker 2 (42:47):
Wow, you just go.
Oh my gosh, like coming fromthis way that I used to practise
, where I would just hear themgoing oh, this is so hard and
this is really.
I miss these foods.
And now they're just feelingempowered to try new foods and
to add things in rather thanexclude them.
It's just, yeah, I can't evendescribe the feeling.
(43:09):
It's just, it's awesome.
Speaker 1 (43:12):
Carly Raven, you are one of those practitioners that
has learnt through hard lessonsand you have now passed that
care.
You use that to care for others.
It's just, it's plainly obvious, like I thank you so much for
enlightening us today, butthere's so much more we have to
delve into.
Like seriously, this is uh.
(43:32):
This is a three-day seminar,but your work like I also love
what you're doing aboutchallenging yourself um, is what
I'm seeing really what'shappening?
Or, uh, am I being beguiled bywhat I'd like to see?
And we often get caught up inthis and it's very challenging
for a clinician to say let'sgather the data and let the data
(43:54):
talk to us.
It's very, very challenging formany clinicians to do what's
called a clinical audit.
So well done to you on anethical basis not just patient
basis for having the guts to dothat Sorry about the word having
the guts to do that no punintended.
Speaker 2 (44:14):
I didn't even mean to do it.
But you've done well, I love it.
Speaker 1 (44:18):
I admire you.
I so admire you.
Well done to you and thank youfor sharing your way of doing
things.
So sorry, sorry.
Last thing, so it's called thenow hang on the SIBO food
roadmap correct is that whatit's called?
Can practitioners access that?
Speaker 2 (44:38):
yes, so you have to become certified um to use it in
practice, and patients can'tjust download it off the
internet, off our website, sothey can only access it through
us as naturopaths andnutritionists.
And I'm doing that so that wecan stay true to the philosophy
(44:58):
and it's not just the diet thatis going to, you know, create
this epic change in our patients, and I really want
practitioners to be using thisdiet appropriately so they can
continue to see the outcomesthat I'm seeing in my practice.
So, yes, you do have to do thetraining through me and then
(45:19):
become certified, and there'songoing support through a
Facebook group and things likethat for practice to keep asking
questions and things like thatand stay connected and updated.
Speaker 1 (45:29):
So, yeah, I think it would be a fabulous thing.
Once practitioners do becomecertified and start collecting
their own data, you'll get amulti-centre data collection
point.
That would be reallyinteresting.
Speaker 2 (45:41):
Yes, carly Raven, thank you, thank you.
Speaker 1 (45:43):
Thank you for taking us through this.
Yeah, really exciting stuff,thank you.
Thank you for taking us throughthis.
Yeah, really exciting stuff.
Speaker 2 (45:48):
Thank you so much, andrew, it's been a pleasure.
Speaker 1 (45:52):
And thank you everyone for joining us today.
Forgive us that littletae-tae-tae at the end there.
I'm just really excited aboutthis.
Remember, you can catch up onall the other podcasts and the
show notes for today's podcaston the Designs for Health
website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
Welcome to Wellness by Designs.
I'm your host, andrewWhitfield-Cook, and today we're
talking with Carly Raven.
Carly Raven's a gut specialist,naturopath, nutritionist, and
we're going to be talking aboutpractical care with SIBO
patients.
Welcome to Wellness by Designs,carly.
How are you?
Speaker 2 (00:39):
Good, thank you.
How are you, Andrew?
Speaker 1 (00:42):
Really good.
Thank you and congratulations.
By the way, you're not far offfrom going on maternity leave.
Well done.
Speaker 2 (00:50):
Thank you, yes, well and truly baking over here At
the pointy end of the journey.
Speaker 1 (00:58):
Okay, so on to our topic.
Many people know you already soI don't want to sort of waste
time because we've got a lot ofwork to cover here today.
But everybody, carly Raven isvery well known in the gut
health space.
She's got particular interestin SIBO but many other interests
in helping patients with gutissues.
(01:18):
So if we can just dive straightinto SIBO, can we talk first
about what are the main dietaryapproaches that you see being
used for SIBO and what are thereported efficacies or
effectiveness reported bypatients that they tell you
about?
That was a double on top,wasn't it?
Speaker 2 (01:40):
Yes.
I think the biggest thing torecognize is that there isn't
actually much research and dataspecifically done on patients
and cohorts of people with SIBO.
So I think that's like I reallywant to start with that.
But what does exist is a lot ofresearch on IBS and we know that
there's that crossover betweenIBS and SIBO and the potential
(02:03):
of an IBS patient to have SIBOis anywhere up to 80%.
So what I'm kind of seeing isthe theories and the dietary
therapies being translated overfrom IBS research and being used
for SIBO patients and typicallywhat is being used is that low
(02:24):
fermentable, low carbohydratetype diet and quite restrictive
in nature, so it's cutting out alot of foods.
So, like the most commonly usedone is something like the low
FODMAP diet, a low carbohydratediet, and even like specific
(02:46):
carbohydrates.
So, like you know, justselecting a few key
carbohydrates and removing themfrom the diet.
And yeah, there's differentparadigms, I suppose, and
creations from people in thefield of SIBO that have created
different things, but what Ifind in my practice is they're
(03:10):
really hard to stick to and youknow, my big question over the
years of practicing with thesepatients is do we need to be
super restrictive to get reallygreat outcomes with these
patients?
Speaker 1 (03:27):
Can I ask about that selective carbohydrate
restriction?
What's the theory behind that?
Are we trying to inhibit theproliferation of methanogenes,
or something like that?
Speaker 2 (03:40):
Yeah, so essentially the ecosystem that overgrows
within the small bowel, and Isay ecosystem because it's
called small intestinalbacterial overgrowth.
But we know it's not justbacteria that overgrow in that
environment.
You also have archaea, which isand the biggest theory there is
(04:00):
that these carbohydrates, orhigh fructose, or fructan FODMAP
foods are almost like the fuelon the fire and they're their
biggest fuel source.
And so when we actually removethem from the diet, we see that
really quick, immediate symptomrelief, you know, and that's
(04:25):
very clear in the data.
you know there's some very bigscale studies that have been
done on patients with IBS and asquick as a week, you know,
sometimes a matter of days ofremoving these foods.
There's a big symptom relief inbloating, improvement to bowel
motions, so it's definitelysomething that we can't question
(04:50):
in terms of its benefit.
But you know we need to look atthe long-term of these diets
and the effects that that mightbe having on the microbiome and
placebo patients.
And when you actually look atsome of these big scale
meta-analyses that have beendone, they conclude themselves
(05:11):
but we don't know.
We actually haven't looked atthe long-term consequences of
such diets and it's almost likea caution when you're starting
to read through some of thesestudies, and so that was
starting to ring alarm bells forme in my practice and going
well.
Is this the best that I can do?
Speaker 1 (05:35):
Yeah, I totally hear you Like, I understand about
symptom relief, and that's fine,but when you're talking about
people and some people are veryhooked into, shall I say, that
acronym of FODMAP Indeed, theyforgot the first part of it,
which was low, and they just sayno, none, which in itself is
(05:57):
nutritionally deficient.
But particularly long term,we're really dealing with
people's health.
You know, there's a lot ofpolyphenols and good things in
these foods that exacerbatesymptoms, and if we lose out on
them long-term, I have realconcerns about what we're doing
to their health, as you sopoignantly say.
So what are the challenges,then, that practitioners might
(06:24):
encounter when implementingthese SIBO diets?
You know, how can they overcomethese difficulties?
How can they better supporttheir patients?
Speaker 2 (06:35):
Yeah.
So I think like the difficultyis how restrictive in nature
some of these things diets canbe and how willing our patients
are to do it properly.
And then also looking at thetime frame of use.
So you know, it's not uncommonfor us to get a new patient
(06:57):
through our clinic who says tous I've been on a low FODMAP
diet for seven, anywhere up toI've heard 15 years.
You know, um, and so I feellike, yeah, um, it's.
I feel like we really need tobe setting very clear guidelines
if you're going to be usingthese type of diets around.
(07:19):
You know, there there is datato show that as quick as four
weeks we can see negativeconsequences on the microbiome.
So now I'm talking about thelarge intestine and the
ecosystem that hangs out there,because we're switching into
more of that starvation mode andwe know that that ecosystem in
(07:41):
the large intestine needs tothrive and needs these.
You know prebiotics, fibres anddiversity of these type of
things, and these diets arecutting out, you know, huge
amounts of fruits and vegetablesand it really is very hard for
(08:01):
the patient to create a diversediet when they're on it.
And then I think you know soare we creating another issue in
itself by using that long term,and that will affect our
outcomes as practitioners,because it may be helping reduce
symptoms.
But underneath all of that, isit truly resolving the SIBO if
(08:25):
that's all we're doing?
And then is it kind of creatinga storm in the large intestine?
Um, and compliance is hard, youknow.
Um, lots of patients end upthrowing the towel in very
quickly and going.
You know, this is really shit.
I just want to eat an apple andat the end of the day, an apple
(08:48):
is a beautiful food that weshould be eating and it's so
good for the microbiome, withpectin and fibre, and so, yeah,
that's kind of, I think, thestruggle as practitioners and
for the patient, and there'smore, but they would be the
biggest kind of things that Ithink I see and I've experienced
it myself as a practitioner.
Speaker 1 (09:09):
I'm so glad you say that.
Indeed, I'm so glad that youmentioned apples, because Mike
Ash has this.
He called it is this the bestdiet for mucosal tolerance?
It's a question mark and in ithe details stewing apples.
In the UK they use Bramleyapples, which we don't use here,
but um, you know delicious.
(09:29):
Or um, pink lady apples,something like that in australia
, um, ones and I've never foundthis out, by the way, I think he
talks about using ones whichare high in raffinose, but he
stews them, puts in some raisinssorry, some sultanas and
divides them up into easilydosaged portions, so that you're
(09:52):
making a big batch that you caneasily access.
And I've told patients aboutthis, even with really chronic
immune gut, immune basedproblems, and it is amazing how
stewing the apple, rather thanhaving a raw apple, settles it
down.
So I wonder if the preparationof food might have something to
(10:16):
do with what we're talking about, with even FODMAPs oh,
absolutely.
Speaker 2 (10:21):
Even the way that we cook our beans, for example,
like just using beans from a can, where there's high amounts of
manufacturing and bypassing.
You know, when we cook them athome, we're soaking them, we're
rinsing them, we're letting themsit and then we cook them and
we boil them and we cool themthem.
(10:46):
But what's happening when it'sin the form of a can, you know,
and so many patients say to me Ican't tolerate chickpeas and
beans and don't even ask me, andI said, okay, give me some time
and we're going to get there.
Absolutely, I totally agreewith you the much maligned
chickpea.
I love them now you've done alot of work with this.
Speaker 1 (11:06):
As I said, you know both professionally and
personally.
So you've made, you developed a.
What is it?
Sibo roadmap.
Is that what it's called?
Speaker 2 (11:15):
SIBO food roadmap.
Yeah, the SIBO food roadmap.
Speaker 1 (11:17):
Yeah, tell us about that.
And what have you done?
Speaker 2 (11:20):
Yeah.
So I kind of took a step backand went okay, well, we can see
that, you know, we're gettinggreat outcomes symptom wise, and
it's almost like taking thefuel off the fire with the
removal of these type of foods.
And the big issue was themicrobiome and then also setting
(11:40):
time frames around this.
So I I just got sick of havingto hand out a two-page document
to patients, say, follow theFODMAP diet, and I was being
bombarded with questions and somuch email support and I just
thought that this is it.
You know, this was probablythree, four years ago now and I
thought I'm going to create myown thing that I'm going to use
(12:02):
with patients.
And so what I created was a sixstage process that I walk
patients through, where foraround two weeks, there is a
small amount of restriction.
However, there are still keyfoods, even in that initial
stage, that nourish themicrobiome.
(12:23):
So a couple of examples whichset this apart from all of the
other things that I've used inmy practice is things like cacao
, pawpaw, cranberries and havingthose a part of the diet that
nourish the microbiome and havereally great polyphenol effects
(12:44):
while they're still reducing youknow, some of the big trigger
foods, but then they quicklymove into the second stage and
really start to add more foodsback in and then, once they
become SIBO-free or IBS, it canbe used for people with IBS as
(13:05):
well.
Then they would move into thethird stage and beyond, and
right from the third stage it'sjust an abundant of
microbiome-supporting foods, andI think the biggest thing for
me was like being very clear onwhat they can and can't do, the
(13:25):
amounts and educating them aboutwhy, and then providing them
with all of the recipes thatthey need, all of the meal plans
, because in my practice I tendto attract a lot of full-time
busy mums who also keep thehousehold going, cook and clean,
(13:47):
and they were just strugglingyou know, they were like I just
so.
With the SIBO Food Roadmap, theybasically get handed everything
that they need and they couldstart the day after they receive
it because they would have anexact meal structure and the
recipes to go with it and thefull guide which they could
(14:08):
learn over the first two weeks.
You know, while they're justlike, okay, I'm just going to
follow what I need to do andthen I'll learn the principles,
start to add layers and createtheir own things from there as
well, once they feel a bit moreconfident.
But you know I it wasn'tunquestionable to just put it
(14:28):
off for weeks and just not getstarted and not create change,
because it was just toooverwhelming.
So yeah, it's um kind of like aone-stop resource, I suppose.
Speaker 1 (14:41):
Good on you.
Can I ask what about symptommanagement?
I mean, patients come in veryoften they're in pain, sometimes
they're even agoraphobicbecause of their bowel habits.
La la, la.
You know there's a lot ofissues here.
It's not just a little bit ofcramping, it's just not that
I've seen patients in hospitalwith dehydration from IBSD, not
(15:03):
that I've seen patients inhospital with dehydration from
IBSD.
So when we're talking aboutSIBO and IBS, is there anything
that you tend to employ on anutraceutical level or herbal
level to aid them through thatfirst step and maybe just settle
down symptoms while they'regetting used to things?
Speaker 2 (15:19):
Absolutely.
So I talked about stage onebefore, which is generally where
most people will start.
There are some exceptions andwe're always treating the
individual and this is somethingthat I do when I'm training the
practitioners in the SIBO foodroadmap.
But alongside that, they'reoften doing a lot of
anti-inflammatory and gut immunework.
(15:41):
So that might be through usinguh, specialized probiotic
strains, a key prebiotic.
We might be coming in therewith beautiful anti-inflammatory
herbs like um, turmeric, um,and we also love glutamine and,
you know, really stretching theboundaries here with some
glutamine supplementation,because a lot of the companies
(16:05):
actually don't have enoughglutamine in the dosages in the
supplements.
When we actually look at theclinical data on what it takes
to kind of heal leaky gut andthat, we're looking at very
large doses.
So yeah, we tend to do that,yeah, and up to 50, like 15 to
20, is a lot of it, but you know, if we have a celiac patient,
(16:29):
50 grams like yeah, it can be avery high amount um can be
needed to actually create thatfull healing response.
So, um, yeah, we're often doingthat in initial stages and then
that makes patients especiallybecause, like these people are,
like you said, they're supersensitive.
(16:50):
They're reacting to everythingand not just dietary stuff, like
a lot of environmental thingsby that point, because they've
often been on this journey for areally long time, some of them
have had mold exposure andthat's the underlying cause that
they got SIBO in the firstplace.
So there's that whole, you know.
So calming everything down,getting that immune system
(17:12):
firing in the gut, while kind oflifting, uh, these aggravating
foods, I suppose, um, that areso well-researched, and here I
am talking about the, you know,the carbohydrate and the
FODMAP-containing foods, butjust for a short period of time,
and then, you know, while alsousing key microbiome-nourishing
(17:37):
foods that aren't disruptive tothe symptoms.
Speaker 1 (17:43):
So I've got 20 questions from that comment.
So firstly, just because it'son the tip of my tongue,
glutamine I've seen using that,you know, two grams, three grams
dose per day, and it's usuallyin a formula that might be
concentrating on magnesiumrather than a gut healing thing.
(18:06):
But what I find is so manypatients and we're talking many,
many are we talking 60?
Are we talking 80%?
Haven't looked.
But a lot of patients complainof wind.
So how do you navigate peoplethrough that initial listen?
We're going to change your gutand they might be uncomfortable
in the first few days.
How do you get people to stayon track during that initial
(18:28):
shift in their health?
Speaker 2 (18:30):
We work very closely with our patients.
You know they can contact usday to day, Monday to Friday,
through the system that we havecreated.
We don't get them to come backa month later.
That's just the way that we'vecreated our clinic to run and
function.
So I think that's reallyhelpful in that if a patient is
(18:52):
experiencing that, we can havethe discussion then and there
and help them troubleshoot that,because everyone experiences
something slightly differentwhen they're reacting to.
But I think the key thing aswell is building them up to
those bigger dosages and this is, like really important, not
just for glutamine but also anytype of prebiotic saying to them
(19:14):
this is the end goal of wherewe need to be based off the data
.
But let's start here, because ofwhat you were mentioning, even
prebiotics in a SIBO patient canbe quite adventurous.
But you know we've got apatient at the moment on full
dose, high dose GOS, becausethere were some really key
(19:34):
species in her microbiome thatwere just screaming to us to
give her GOS, you know.
So we said to her hey, normallywe probably wouldn't go here
with the SIBO patient.
Start with this tiny dose, youknow.
See how you go and build up.
She did have, like you werementioning, a few kind of bloaty
(19:54):
days that were worse than whatshe was already experiencing,
and we just said, stay on thatdose, keep going with it and
just see how you go.
And then she kind of plateauedand we're like, okay, push the
boundary again and just kind ofsee how you go and over time.
I think she's now in week fourof her protocol and she's on her
full dose of that goss and weuse the similar process with the
(20:21):
glutamine.
Speaker 1 (20:24):
Can we drill down?
Forgive this vernacular, thispicture, but can we drill down
into the microbiome?
How long do we have?
I'm just having a horriblevisual.
But if we're talking aboutcertain, certain prebiotic
(20:45):
fibers, perhaps certain speciesand strains of probiotics which
might um benefit a microbiotaprofile, let's say, um, how do
you work with that, given that,let's say, in SIBO it's commonly
said that it's thelactobacilliaceae which are over
abundant in the upper GI?
(21:06):
You know, albeit that that um,um, you know, we can't really
test there unless you're doingsome quite invasive tests.
There's a lot of issues withtesting that I have.
But but, um, how do you choosewhich probiotic, which which um
prebiotic you're going to use,given somebody's um gut profile?
Speaker 2 (21:30):
yeah.
So I think when we're dealingspecifically with patients with
SIBO, the first thing is testingfor SIBO and working out what
type of SIBO they actually have,looking at their clinical
symptoms and their healthhistory and matching those two
up and then looking at theirmicrobiome if the patient has
(21:52):
done both.
This is a big investment for alot of people, and you know I do
a lot of mentoring withpractitioners and the biggest
question I get asked all thetime is Kali, how do you get
your patients to afford both abreath test and a microbiome
test?
And we're at that stage in ourpractice where that's just how
we work and for me to be able toproperly treat you in the field
that I am, that's what I do.
(22:13):
But I do recognise that thereis a big financial investment
there for patients, and lookingat the microbiome in my opinion
creates a safe treatment plan,and one example that I want to
talk about here is that you knowthere's been a lot of
conversations recently about theuse of berberine and its
(22:34):
effects on the microbiome andthings like increased hexa-LPS
production and proteobacteriaand the effect that it can have
in decreasing the total numberof species count in the overall
microbiome of a patient.
But berberine in quite highdoses is very effective for the
(22:55):
treatment of hydrogen-dominantSIBO.
So you know, this is where, ifyou, we just need to, you know,
be cautious, I suppose, andgather all of that information
because we may not go in withhigh, high doses of berberine.
If we could see in a microbiomeprofile that this patient had
those markers elevated and wemight choose a different herb,
(23:20):
like uvaversi, or come in withmore probiotics or prebiotics.
And then, in terms of gettingback to your question, andrew,
about like how do we choose aspecific therapy, it's about
looking at again the research onwell, if that's out of range,
are we trying to increase it?
Are we trying to increase it?
(23:41):
Are we trying to decrease it?
And a lot of the time it'sactually just about harmonising
the microbiome and you knowprobiotics and prebiotics are
beautiful at doing that.
But again, we need to get downto the species level and
understand how a probiotic worksand their mechanism of action.
Yes, I can see you want to aska question for it.
Speaker 1 (24:05):
Oh there's, there's so many questions going.
I've been taking notes andthere's, it just keeps going and
going.
So, um, uh, okay.
So firstly, with berberine,with hydrogen dominant, dominant
sebo, let's say we're dealingwith a lady who is having
problems with fertility,possibly polycystic ovarian
(24:28):
syndrome, insulin resistance,and berberine might be
advantageous for that andpossibly dyslipidemia as well,
and berberine is a therapy forthat.
How do you navigate that whenyou've got okay, this is good,
but we can't do that good thingforever for your polycystic
ovarian syndrome because you'vealso got SIBO.
I mean, that's a challenge.
Speaker 2 (24:50):
It is definitely a challenge and, andrew, it's
something that has led me toreally scratch my head the last
six months, since, you know, themore and more I dive into this
specific research, so much sothat we went right we're going
to do our own clinicalobservations.
So we've actually beencollecting our own data on all
of our patients.
(25:11):
So we're looking at breathtesting and microbiome testing
before and after the use ofberberine or non-berberine
treatment for our hydrogendominant SIBO patients and then
also monitoring the outcomeswith the microbiome testing.
And look, I'm going to drop abomb because this is like and I
(25:36):
want to say this is a small, alot smaller scale than what you
know some of these studieslooking at the effects of
berberine are up to you.
You know 300 participants inthis study and we have not yet
reached those numbers that we'vedone our clinical observations
on.
So this is a much smallercohort of people.
(26:01):
We're not quite seeing the sameoutcomes in terms of berberine
directly creating increasedlevels of hexa, lps or
proteobacteria In some patients.
We've seen a decrease ofspecies, but you know, even just
(26:29):
last week we had one patientcome back who has done again I
can push the boundaries with mySIBO patients quite a high dose
and I'm happy to admit it, eventhough some people may cringe
and go oh my god, you're usingwhat you know berberine.
You're crazy.
You know I do a high dose ofberberine.
You know, in philodendron thispatient also received, you know,
oil of oregano which is, youknow, quite collateral to the
microbiome as well, and theirproteobacteria, the hexa LPS,
(26:56):
both reduced and their totalspecies count actually increased
.
But what I want to say here isthat it what I.
My theory is that it's aboutwhat else we're doing in
combination with berberine, andI think this is my answer to
your question.
Um, as naturopaths we are soholistic we don't just give them
(27:19):
berberine and in these studiesthat they are just giving
berberine or potentially, in onecontrol group, berberine with a
probiotic and comparing that.
But we're using the SIBO foodroadmap, we use a probiotic with
most patients, we're usingglutamine, we're using
prebiotics.
(27:40):
We're often not just treatingSIBO and doing a lot of
anti-inflammatory work and usinga range of different herbal
liquids or tablets with herbsand we don't know yet the full
effect of all of these herbs.
It's not, you know,unfortunately we don't have all
of this beautiful research onevery single herb and its effect
(28:01):
.
So I believe it's this holistictreatment that we're using with
these SIBO patients and it'salmost what I'm thinking and
seeing.
Is it like balancing it outright and, in the process,
getting these patients to becomeSIBO-free, which is incredible,
like you know, symptom-free,sibo-free and it's using these
(28:26):
therapies, but in a really safeand educated way, and I think
that's what's important because,you know, come back to our
naturopathic principles of first, do no harm, you know, but if
we don't do that microbiometesting to give us that
information, if we're wanting touse berberine, it's like
stabbing in the dark a littlebit, and then we also don't have
(28:50):
that clear data to monitorthings, you know, and to go oh,
actually I did this person, youknow, a really good thing, or
probably shouldn't have donethat, and that's a lesson that I
can learn in clinical practiceand, and you know, take away
from that as well well, look, inany clinical practice, you're
(29:10):
going to have negatives.
Speaker 1 (29:11):
In any research, you're going to have those
people that fail a treatmentregimen.
I think it's really interestingif you're using felodendron.
Felodendron isn't justberberine.
It's kind of like people whothink that coffee equals
caffeine.
Um, philodendron also helps todecrease cortisol.
What's one of the majortriggers of sebo and ibs stress?
(29:33):
You know, could we be alsoacting in this way so that we're
relaxing things, improvingvagal tone or tonicity in
innovation and therefore aidingdigestion as a whole, aiding the
microbiota in those ways?
So you know, I think, as yousay, naturopaths don't work in
(29:53):
razor blades.
We work in butter knives, bysmoothing things and nourishing
things.
So I think that's one of the.
That's what I love.
Speaker 2 (30:01):
So much about what we do.
You know, I just love that.
We don't ever just have, youknow, and when we compare that
to a medication, you know thethat the treatment for SIBO is
rifaximin.
You know, and that's just clearcut, here's your rifaximin off,
you go, that's for yourtreatment of SIBO.
But as a naturopath, we just,we just don't treat that way.
(30:22):
You know, even if I was to geta patient to do rifaximin which
I have done in my practice Iwould say here's rifaximin plus,
I want you to do this and thiswith the diet, here's phgg,
because that increases theclinical outcome, you know.
So again, it's like we've justgot so many beautiful tools in
our toolbox when it comes towell like.
Speaker 1 (30:43):
I know that, yeah, one of these major
gastroenterologists that wasusing rifaximin also produced a
product for which the action wasactually the side effect.
So when you look at the commonname in America and forgive me,
I've got this wrong, but it'slike we'd say a conch shell, so
(31:06):
it's got that sort of name,it'sch shell, so it's got that
sort of name.
It's not correct, but it's gotthat sort of name.
Do you know what it is?
It's horse chestnut.
Oh right, yeah.
So what happens when you takehorse chestnut without it being
enteric coated?
It's a high saponin herb.
You're going to get a clean out.
So it's almost like he's at,he's using it as a prokinetic or
(31:29):
at least as a clean out.
So so I guess, to follow onfrom there, yeah, when you're
working with these patients andyou're using foods and fibers
and certain probiotics, you knowif we're dealing with sebo,
we've got something about acomponent which is the breakdown
of the MMC, the migrating motorcomplex.
So can you talk to us aboutwhat do you use as prokinetics?
(31:52):
What do you use as binders forthose people that might have an
overgrowth of the archaea andthings?
How do you manage things likeexcessive wind and bloating like
you spoke of?
Do we use things like charcoal?
Sorry, I've got 30 questions,carly, we could talk for days on
this.
Speaker 2 (32:11):
I know, I know there's just it's never-ending,
is it?
It's a huge world.
Yes, the migrating motorcomplex and prokinetics are
absolutely essential for SIBOand for most patients need it
throughout their entiretreatment and that will kind of
be something that should be keptthere as post, you know,
(32:35):
maintenance treatment for thesepatients.
But it really depends on, youknow, I think at least three
months post-treatment keepingthem on a prokinetic is really
important and then you can kindof test the waters a little bit,
bring them off that and justtest their own, see if they've
actually got that ability to getthat functioning properly.
(32:57):
But in some patients there'sthat whole autoimmune cascade
that's occurring with the CBTand the veniculin antibodies and
stuff like that and that isalmost potentially causing
long-term issues with thesepatients.
So they may need to take aprokinetic ongoing and you know
(33:21):
it's really hard to work thatout.
So you've got to kind ofmonitor your patient really
closely.
Um, but I love ginger.
Ginger is my favoriteprokinetic um and minimum 100
sorry, a thousand milligramsdaily um is needed to get that
(33:42):
beautiful.
Uh, migrating motor complexaction and you can do this
supplemental but getting yourpatients to, you know, consume
ginger, putting it in smoothies,in their yes, in their teas,
(34:03):
but like making it strong, youknow, and I think it really
depends on the patient, becausesome people can't tolerate
ginger, so you've got to workwith them there.
But it's so amazing.
Speaker 1 (34:15):
Go, andrew, I love it forgive me, sorry to interrupt
for our, for our listeners thatcan't see me.
I'm interrupting, carly, hereI've got a ginger and lemon tea
and it's not one tea bag, it'smultiple.
Speaker 2 (34:31):
Good, you're really encouraging that migrating motor
complex today.
Hopefully you do a really goodpoo this afternoon after all of
that.
Speaker 1 (34:40):
Thanks, it actually ties in sorry to interrupt again
, kai.
It actually ties in with a.
I did an instagram post from astory that I did years ago and
it was the use of ginger and we.
It was ginger talking to ourgut microbiota in, sorry, the
(35:02):
genes of ginger talking to thegut microbiota genes which then
talk to us.
So it's this cascade the gingerdoesn't talk to the gut
microbiota genes, which thentalk to us.
So it's this cascade the gingerdoesn't talk to us directly.
Speaker 2 (35:09):
It's really interesting stuff, but I love
what you're saying Now I'mcurious.
Speaker 1 (35:14):
Yeah, so forgive me, carry on, because I interrupted
and it's really important stuffMigrating, motor complex.
What else can we use?
Speaker 2 (35:24):
I also really like iberogast or making a like using
herbs that are, you know,supporting the mite.
You can make your own version ofIberigast, I suppose you know
with your herbal dispensary,with you know Oregon grape and
scutellaria and herbs like that.
(35:44):
But Iberigast is so easilyaccessible and can be really
great as a prokinetic as well.
But even the lifestyle stuff.
So like making sure patientsaren't snacking and that they're
having an eating window, liketrying to have three main meals
a day and allowing four to fivehours between their meals so
(36:09):
that the digestive system canrest and digest and clear out,
rather than it constantly justtrying to process food 24-7.
And you'll find that SIBO andIBS people love to snack.
It's just this thing that Ihave noticed in these people,
(36:31):
because it's almost like thebacteria are just like give me
sugar, give me carbs.
I'm always hungry and once youstart to clear and rebalance
what's going on in the gut,their cravings will reduce.
But it's such an importantthing that we need to be doing
(36:54):
for the migrating motor complexas well Anything that you could
help our listeners, our viewers,to use as an interjection.
Speaker 1 (37:04):
if you like to stop those cravings, can we use
things like perhaps I mean, I'mthinking West here what about
collagen?
What about bulking fibres?
What about xylitol?
Speaker 2 (37:20):
Yeah, the way I deal with this in our patients is
educating them about cravings.
Is this an emotional craving?
Is this a?
I'm actually hungry and mymetabolism is quicker, and if
they do have that, I'm one ofthese people, right?
If you asked me to fast forfour to five hours, I'd be a
(37:42):
space cadet, okay, and that'sjust.
My metabolism naturallyfunctions quickly and I need
more food, and so you can workthat out with the patient, but
also educating them about whatactually is a balanced,
nutritional, high-quality meal.
Because if you're going to onlyallow them to have these three
(38:05):
meals a day, because if you'regoing to only allow them to have
these three meals a day, somany people don't understand.
You know the simple things thatwe do as naturopaths and
nutritionists about how muchprotein, how many carbs, you
know how much fat, and get themto send you photos for a week of
their meals without you evensaying anything, and then come
(38:26):
in and help them restructurewhat they're actually putting on
their plate to make them feelfull and to actually get them to
last that amount of time.
And if they're not and you knowthat that's actually well,
that's actually a very adequatemeal and they shouldn't be
needing to snack.
That's when you can go okay.
Well, you may just have anaturally fast metabolism and
(38:49):
therefore we might need toadjust that and treat the
individual sitting in front ofyou.
But there, that's kind of how Iapproach that.
Speaker 1 (39:00):
I love your work seriously.
Um, I need to get you back on,if we can.
Um, I know you're going away tohave a baby, perhaps after
you've had your new addition toyour family 2024,.
Speaker 2 (39:10):
I'll come back.
Speaker 1 (39:11):
But just before we go , things like binders.
You know, simply, some peopleuse charcoal tablets on a more
naturopathic, holistic level, ifyou like, we use the Zeolites,
and forgive the one, it's got alonger name or whatever um.
(39:33):
Zeolites is a group and one ofthem is anyway.
Um, how often do you use theseand is there are there any
cautions with regards to bindingto nutrients, not just what you
don't want?
Speaker 2 (39:46):
to be honest with you , I used to use them a lot
heavier in practice, um, withI'm kind of moving away from
them a little bit, um, because Ibelieve that even a beautiful
herb like protea sorry, notproteobacteria pomegranate which
you can use for proteobacteriaum, can be, uh, really useful
(40:11):
for that action, and often we gofor pomegranate with a lot of
these patients.
So, um, I love pomegranate umas a treatment therapy for what.
I hate the word dysbiosis, butit's like that's what everyone
knows what I'm talking about.
But you know, um, you know animbalance to the microbiome um,
(40:35):
and NAC is another one.
But we just have to be verycareful there, um, because if
there's any hydrogen sulfideproducing species, it's not
necessarily good there.
So that's again another reallygreat reason why microbiome
(40:57):
testing for all SIBO patients isimportant.
Because, yeah, you justwouldn't touch that if you're,
you know, seeing things likedesulfofibrio in the microbiome
plus a positive SIBO test, forexample.
Speaker 1 (41:11):
Yeah, sure, Can I ask with pomegranate before we go,
what form?
Speaker 2 (41:18):
So we tend to do the rind and the husk in tablet, or
we love liquid.
We have our own kind of SIBOblends that we go to for
different types of presentations.
But yeah, even just there issome really great simple
(41:38):
products available with justpomegranate in them as well.
Speaker 1 (41:44):
I love your work.
This is so enlightening.
I've got a page full of notes.
Food is medicine.
Like food is medicine.
I love it.
Speaker 2 (41:52):
I didn't even talk about pomegranate.
Like you know, in stage one,when we're talking about the
SIBO food roadmap, the biggestand the best thing and the thing
I love most about what I'vecreated is pomegranate.
You know is in stage one of theSIBO food roadmap and we
educate them right from thestart about pomegranate and you
(42:13):
know we've had a recent patientstart on it and in the first two
weeks of her doing the SIBOfood roadmap she increased her
consumption of different foods.
So she ate 35 new foods in twoweeks of being on the SIBO Food
Roadmap.
Wow, she tried pomegranate forthe first time in her life and
(42:35):
just like the things that shewas sharing with us, I was just
like I think I can stoppractising.
I feel like my life has beenmade, you know.
Speaker 1 (42:44):
That's somebody who truly embraces therapy, isn't it
?
Speaker 2 (42:47):
Wow, you just go.
Oh my gosh, like coming fromthis way that I used to practise
, where I would just hear themgoing oh, this is so hard and
this is really.
I miss these foods.
And now they're just feelingempowered to try new foods and
to add things in rather thanexclude them.
It's just, yeah, I can't evendescribe the feeling.
(43:09):
It's just, it's awesome.
Speaker 1 (43:12):
Carly Raven, you are one of those practitioners that
has learnt through hard lessonsand you have now passed that
care.
You use that to care for others.
It's just, it's plainly obvious, like I thank you so much for
enlightening us today, butthere's so much more we have to
delve into.
Like seriously, this is uh.
(43:32):
This is a three-day seminar,but your work like I also love
what you're doing aboutchallenging yourself um, is what
I'm seeing really what'shappening?
Or, uh, am I being beguiled bywhat I'd like to see?
And we often get caught up inthis and it's very challenging
for a clinician to say let'sgather the data and let the data
(43:54):
talk to us.
It's very, very challenging formany clinicians to do what's
called a clinical audit.
So well done to you on anethical basis not just patient
basis for having the guts to dothat Sorry about the word having
the guts to do that no punintended.
Speaker 2 (44:14):
I didn't even mean to do it.
But you've done well, I love it.
Speaker 1 (44:18):
I admire you.
I so admire you.
Well done to you and thank youfor sharing your way of doing
things.
So sorry, sorry.
Last thing, so it's called thenow hang on the SIBO food
roadmap correct is that whatit's called?
Can practitioners access that?
Speaker 2 (44:38):
yes, so you have to become certified um to use it in
practice, and patients can'tjust download it off the
internet, off our website, sothey can only access it through
us as naturopaths andnutritionists.
And I'm doing that so that wecan stay true to the philosophy
(44:58):
and it's not just the diet thatis going to, you know, create
this epic change in our patients, and I really want
practitioners to be using thisdiet appropriately so they can
continue to see the outcomesthat I'm seeing in my practice.
So, yes, you do have to do thetraining through me and then
(45:19):
become certified, and there'songoing support through a
Facebook group and things likethat for practice to keep asking
questions and things like thatand stay connected and updated.
Speaker 1 (45:29):
So, yeah, I think it would be a fabulous thing.
Once practitioners do becomecertified and start collecting
their own data, you'll get amulti-centre data collection
point.
That would be reallyinteresting.
Speaker 2 (45:41):
Yes, carly Raven, thank you, thank you.
Speaker 1 (45:43):
Thank you for taking us through this.
Yeah, really exciting stuff,thank you.
Thank you for taking us throughthis.
Yeah, really exciting stuff.
Speaker 2 (45:48):
Thank you so much, andrew, it's been a pleasure.
Speaker 1 (45:52):
And thank you everyone for joining us today.
Forgive us that littletae-tae-tae at the end there.
I'm just really excited aboutthis.
Remember, you can catch up onall the other podcasts and the
show notes for today's podcaston the Designs for Health
website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
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I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com