Latest / Wellness by Designs - Practitioner Podcast / ENCORE: Unlocking the Secrets of SIBO: Balanced Diets and Tailored Treatments with Karly Raven

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ENCORE: Unlocking the Secrets of SIBO: Balanced Diets and Tailored Treatments with Karly Raven · Wellness by Designs - Practitioner Podcast

• 0:21
  Speaker 1: Welcome to Wellness by Designs.
• 0:22
  Speaker 1: I'm your host, andrew Whitfield-Cook, and today we're talking with Carly Raven.
• 0:27
  Speaker 1: Carly Raven's a gut specialist, naturopath, nutritionist, and we're going to be talking about practical care with SIBO patients.
• 0:35
  Speaker 1: Welcome to Wellness by Designs, carly.
• 0:37
  Speaker 1: How are you?
• 0:39
  Speaker 2: Good, thank you.
• 0:39
  Speaker 2: How are you, Andrew?
• 0:42
  Speaker 1: Really good.
• 0:42
  Speaker 1: Thank you and congratulations.
• 0:44
  Speaker 1: By the way, you're not far off from going on maternity leave.
• 0:48
  Speaker 1: Well done.
• 0:50
  Speaker 2: Thank you, yes, well and truly baking over here At the pointy end of the journey.
• 0:58
  Speaker 1: Okay, so on to our topic.
• 1:00
  Speaker 1: Many people know you already so I don't want to sort of waste time because we've got a lot of work to cover here today.
• 1:07
  Speaker 1: But everybody, carly Raven is very well known in the gut health space.
• 1:13
  Speaker 1: She's got particular interest in SIBO but many other interests in helping patients with gut issues.
• 1:18
  Speaker 1: So if we can just dive straight into SIBO, can we talk first about what are the main dietary approaches that you see being used for SIBO and what are the reported efficacies or effectiveness reported by patients that they tell you about?
• 1:36
  Speaker 1: That was a double on top, wasn't it?
• 1:40
  Speaker 2: Yes.
• 1:40
  Speaker 2: I think the biggest thing to recognize is that there isn't actually much research and data specifically done on patients and cohorts of people with SIBO.
• 1:52
  Speaker 2: So I think that's like I really want to start with that.
• 1:55
  Speaker 2: But what does exist is a lot of research on IBS and we know that there's that crossover between IBS and SIBO and the potential of an IBS patient to have SIBO is anywhere up to 80%.
• 2:07
  Speaker 2: So what I'm kind of seeing is the theories and the dietary therapies being translated over from IBS research and being used for SIBO patients and typically what is being used is that low fermentable, low carbohydrate type diet and quite restrictive in nature, so it's cutting out a lot of foods.
• 2:33
  Speaker 2: So, like the most commonly used one is something like the low FODMAP diet, a low carbohydrate diet, and even like specific carbohydrates.
• 2:47
  Speaker 2: So, like you know, just selecting a few key carbohydrates and removing them from the diet.
• 2:55
  Speaker 2: And yeah, there's different paradigms, I suppose, and creations from people in the field of SIBO that have created different things, but what I find in my practice is they're really hard to stick to and you know, my big question over the years of practicing with these patients is do we need to be super restrictive to get really great outcomes with these patients?
• 3:27
  Speaker 1: Can I ask about that selective carbohydrate restriction?
• 3:31
  Speaker 1: What's the theory behind that?
• 3:33
  Speaker 1: Are we trying to inhibit the proliferation of methanogenes, or something like that?
• 3:40
  Speaker 2: Yeah, so essentially the ecosystem that overgrows within the small bowel, and I say ecosystem because it's called small intestinal bacterial overgrowth.
• 3:50
  Speaker 2: But we know it's not just bacteria that overgrow in that environment.
• 3:54
  Speaker 2: You also have archaea, which is and the biggest theory there is that these carbohydrates, or high fructose, or fructan FODMAP foods are almost like the fuel on the fire and they're their biggest fuel source.
• 4:13
  Speaker 2: And so when we actually remove them from the diet, we see that really quick, immediate symptom relief, you know, and that's very clear in the data.
• 4:27
  Speaker 2: you know there's some very big scale studies that have been done on patients with IBS and as quick as a week, you know, sometimes a matter of days of removing these foods.
• 4:39
  Speaker 2: There's a big symptom relief in bloating, improvement to bowel motions, so it's definitely something that we can't question in terms of its benefit.
• 4:51
  Speaker 2: But you know we need to look at the long-term of these diets and the effects that that might be having on the microbiome and placebo patients.
• 5:00
  Speaker 2: And when you actually look at some of these big scale meta-analyses that have been done, they conclude themselves but we don't know.
• 5:12
  Speaker 2: We actually haven't looked at the long-term consequences of such diets and it's almost like a caution when you're starting to read through some of these studies, and so that was starting to ring alarm bells for me in my practice and going well.
• 5:30
  Speaker 2: Is this the best that I can do?
• 5:35
  Speaker 1: 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 very hooked into, shall I say, that acronym of FODMAP Indeed, they forgot the first part of it, which was low, and they just say no, none, which in itself is nutritionally deficient.
• 5:59
  Speaker 1: But particularly long term, we're really dealing with people's health.
• 6:04
  Speaker 1: You know, there's a lot of polyphenols and good things in these foods that exacerbate symptoms, and if we lose out on them long-term, I have real concerns about what we're doing to their health, as you so poignantly say.
• 6:17
  Speaker 1: So what are the challenges, then, that practitioners might encounter when implementing these SIBO diets?
• 6:27
  Speaker 1: You know, how can they overcome these difficulties?
• 6:31
  Speaker 1: How can they better support their patients?
• 6:35
  Speaker 2: Yeah.
• 6:35
  Speaker 2: So I think like the difficulty is how restrictive in nature some of these things diets can be and how willing our patients are to do it properly.
• 6:47
  Speaker 2: And then also looking at the time frame of use.
• 6:52
  Speaker 2: So you know, it's not uncommon for us to get a new patient through our clinic who says to us I've been on a low FODMAP diet for seven, anywhere up to I've heard 15 years.
• 7:05
  Speaker 2: You know, um, and so I feel like, yeah, um, it's.
• 7:11
  Speaker 2: I feel like we really need to be setting very clear guidelines if you're going to be using these type of diets around.
• 7:19
  Speaker 2: You know, there there is data to show that as quick as four weeks we can see negative consequences on the microbiome.
• 7:27
  Speaker 2: So now I'm talking about the large intestine and the ecosystem that hangs out there, because we're switching into more of that starvation mode and we know that that ecosystem in the large intestine needs to thrive and needs these.
• 7:45
  Speaker 2: You know prebiotics, fibres and diversity of these type of things, and these diets are cutting out, you know, huge amounts of fruits and vegetables and it really is very hard for the patient to create a diverse diet when they're on it.
• 8:06
  Speaker 2: And then I think you know so are 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.
• 8:21
  Speaker 2: But underneath all of that, is it truly resolving the SIBO if that's all we're doing?
• 8:26
  Speaker 2: And then is it kind of creating a storm in the large intestine?
• 8:32
  Speaker 2: Um, and compliance is hard, you know.
• 8:34
  Speaker 2: Um, lots of patients end up throwing the towel in very quickly and going.
• 8:39
  Speaker 2: You know, this is really shit.
• 8:41
  Speaker 2: I just want to eat an apple and at the end of the day, an apple is a beautiful food that we should be eating and it's so good for the microbiome, with pectin and fibre, and so, yeah, that's kind of, I think, the struggle as practitioners and for the patient, and there's more, but they would be the biggest kind of things that I think I see and I've experienced it myself as a practitioner.
• 9:09
  Speaker 1: I'm so glad you say that.
• 9:10
  Speaker 1: Indeed, I'm so glad that you mentioned apples, because Mike Ash has this.
• 9:14
  Speaker 1: He called it is this the best diet for mucosal tolerance?
• 9:19
  Speaker 1: It's a question mark and in it he details stewing apples.
• 9:24
  Speaker 1: In the UK they use Bramley apples, which we don't use here, but um, you know delicious.
• 9:29
  Speaker 1: Or um, pink lady apples, something like that in australia, um, ones and I've never found this out, by the way, I think he talks about using ones which are high in raffinose, but he stews them, puts in some raisins sorry, some sultanas and divides them up into easily dosaged portions, so that you're making a big batch that you can easily access.
• 9:54
  Speaker 1: And I've told patients about this, even with really chronic immune gut, immune based problems, and it is amazing how stewing the apple, rather than having a raw apple, settles it down.
• 10:11
  Speaker 1: So I wonder if the preparation of food might have something to do with what we're talking about, with even FODMAPs oh, absolutely.
• 10:21
  Speaker 2: 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.
• 10:32
  Speaker 2: You know, when we cook them at home, we're soaking them, we're rinsing them, we're letting them sit and then we cook them and we boil them and we cool them them.
• 10:46
  Speaker 2: But what's happening when it's in the form of a can, you know, and so many patients say to me I can't tolerate chickpeas and beans and don't even ask me, and I said, okay, give me some time and we're going to get there.
• 10:54
  Speaker 2: Absolutely, I totally agree with you the much maligned chickpea.
• 11:01
  Speaker 2: I love them now you've done a lot of work with this.
• 11:06
  Speaker 1: As I said, you know both professionally and personally.
• 11:08
  Speaker 1: So you've made, you developed a.
• 11:11
  Speaker 1: What is it?
• 11:12
  Speaker 1: Sibo roadmap.
• 11:13
  Speaker 1: Is that what it's called?
• 11:15
  Speaker 2: SIBO food roadmap.
• 11:16
  Speaker 2: Yeah, the SIBO food roadmap.
• 11:17
  Speaker 1: Yeah, tell us about that.
• 11:18
  Speaker 1: And what have you done?
• 11:20
  Speaker 2: Yeah.
• 11:21
  Speaker 2: So I kind of took a step back and went okay, well, we can see that, you know, we're getting great outcomes symptom wise, and it's almost like taking the fuel off the fire with the removal of these type of foods.
• 11:34
  Speaker 2: And the big issue was the microbiome and then also setting time frames around this.
• 11:42
  Speaker 2: So I I just got sick of having to hand out a two-page document to patients, say, follow the FODMAP diet, and I was being bombarded with questions and so much email support and I just thought that this is it.
• 11:57
  Speaker 2: You know, this was probably three, four years ago now and I thought I'm going to create my own thing that I'm going to use with patients.
• 12:03
  Speaker 2: And so what I created was a six stage process that I walk patients through, where for around two weeks, there is a small amount of restriction.
• 12:17
  Speaker 2: However, there are still key foods, even in that initial stage, that nourish the microbiome.
• 12:23
  Speaker 2: So a couple of examples which set this apart from all of the other things that I've used in my practice is things like cacao, pawpaw, cranberries and having those a part of the diet that nourish the microbiome and have really great polyphenol effects while they're still reducing you know, some of the big trigger foods, but then they quickly move into the second stage and really start to add more foods back in and then, once they become SIBO-free or IBS, it can be used for people with IBS as well.
• 13:06
  Speaker 2: Then they would move into the third stage and beyond, and right from the third stage it's just an abundant of microbiome-supporting foods, and I think the biggest thing for me was like being very clear on what they can and can't do, the amounts and educating them about why, and then providing them with all of the recipes that they need, all of the meal plans, because in my practice I tend to attract a lot of full-time busy mums who also keep the household going, cook and clean, and they were just struggling you know, they were like I just so.
• 13:52
  Speaker 2: With the SIBO Food Roadmap, they basically get handed everything that they need and they could start the day after they receive it because they would have an exact meal structure and the recipes to go with it and the full guide which they could learn over the first two weeks.
• 14:10
  Speaker 2: You know, while they're just like, okay, I'm just going to follow what I need to do and then I'll learn the principles, start to add layers and create their own things from there as well, once they feel a bit more confident.
• 14:23
  Speaker 2: But you know I it wasn't unquestionable to just put it off for weeks and just not get started and not create change, because it was just too overwhelming.
• 14:34
  Speaker 2: So yeah, it's um kind of like a one-stop resource, I suppose.
• 14:41
  Speaker 1: Good on you.
• 14:42
  Speaker 1: Can I ask what about symptom management?
• 14:45
  Speaker 1: I mean, patients come in very often they're in pain, sometimes they're even agoraphobic because of their bowel habits.
• 14:51
  Speaker 1: La la, la.
• 14:52
  Speaker 1: You know there's a lot of issues here.
• 14:54
  Speaker 1: It's not just a little bit of cramping, it's just not that I've seen patients in hospital with dehydration from IBSD, not that I've seen patients in hospital with dehydration from IBSD.
• 15:06
  Speaker 1: So when we're talking about SIBO and IBS, is there anything that you tend to employ on a nutraceutical level or herbal level to aid them through that first step and maybe just settle down symptoms while they're getting used to things?
• 15:19
  Speaker 2: Absolutely.
• 15:20
  Speaker 2: So I talked about stage one before, which is generally where most people will start.
• 15:25
  Speaker 2: There are some exceptions and we're always treating the individual and this is something that I do when I'm training the practitioners in the SIBO food roadmap.
• 15:33
  Speaker 2: But alongside that, they're often doing a lot of anti-inflammatory and gut immune work.
• 15:41
  Speaker 2: So that might be through using uh, specialized probiotic strains, a key prebiotic.
• 15:49
  Speaker 2: We might be coming in there with beautiful anti-inflammatory herbs like um, turmeric, um, and we also love glutamine and, you know, really stretching the boundaries here with some glutamine supplementation, because a lot of the companies actually don't have enough glutamine in the dosages in the supplements.
• 16:09
  Speaker 2: When we actually look at the clinical data on what it takes to kind of heal leaky gut and that, we're looking at very large doses.
• 16:19
  Speaker 2: 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, 50 grams like yeah, it can be a very high amount um can be needed to actually create that full healing response.
• 16:39
  Speaker 2: So, um, yeah, we're often doing that in initial stages and then that makes patients especially because, like these people are, like you said, they're super sensitive.
• 16:50
  Speaker 2: They're reacting to everything and not just dietary stuff, like a lot of environmental things by that point, because they've often been on this journey for a really long time, some of them have had mold exposure and that's the underlying cause that they got SIBO in the first place.
• 17:05
  Speaker 2: So there's that whole, you know.
• 17:07
  Speaker 2: So calming everything down, getting that immune system firing in the gut, while kind of lifting, uh, these aggravating foods, I suppose, um, that are so well-researched, and here I am talking about the, you know, the carbohydrate and the FODMAP-containing foods, but just for a short period of time, and then, you know, while also using key microbiome-nourishing foods that aren't disruptive to the symptoms.
• 17:43
  Speaker 1: So I've got 20 questions from that comment.
• 17:45
  Speaker 1: So firstly, just because it's on the tip of my tongue, glutamine I've seen using that, you know, two grams, three grams dose per day, and it's usually in a formula that might be concentrating on magnesium rather than a gut healing thing.
• 18:06
  Speaker 1: But what I find is so many patients and we're talking many, many are we talking 60?
• 18:12
  Speaker 1: Are we talking 80%?
• 18:13
  Speaker 1: Haven't looked.
• 18:14
  Speaker 1: But a lot of patients complain of wind.
• 18:16
  Speaker 1: So how do you navigate people through that initial listen?
• 18:21
  Speaker 1: We're going to change your gut and they might be uncomfortable in the first few days.
• 18:25
  Speaker 1: How do you get people to stay on track during that initial shift in their health?
• 18:30
  Speaker 2: We work very closely with our patients.
• 18:33
  Speaker 2: You know they can contact us day to day, Monday to Friday, through the system that we have created.
• 18:41
  Speaker 2: We don't get them to come back a month later.
• 18:44
  Speaker 2: That's just the way that we've created our clinic to run and function.
• 18:48
  Speaker 2: So I think that's really helpful in that if a patient is experiencing that, we can have the discussion then and there and help them troubleshoot that, because everyone experiences something slightly different when they're reacting to.
• 19:02
  Speaker 2: But I think the key thing as well is building them up to those bigger dosages and this is, like really important, not just for glutamine but also any type of prebiotic saying to them this is the end goal of where we need to be based off the data.
• 19:20
  Speaker 2: But let's start here, because of what you were mentioning, even prebiotics in a SIBO patient can be quite adventurous.
• 19:27
  Speaker 2: But you know we've got a patient at the moment on full dose, high dose GOS, because there were some really key species in her microbiome that were just screaming to us to give her GOS, you know.
• 19:40
  Speaker 2: So we said to her hey, normally we probably wouldn't go here with the SIBO patient.
• 19:45
  Speaker 2: Start with this tiny dose, you know.
• 19:49
  Speaker 2: See how you go and build up.
• 19:50
  Speaker 2: She did have, like you were mentioning, a few kind of bloaty days that were worse than what she was already experiencing, and we just said, stay on that dose, keep going with it and just see how you go.
• 20:03
  Speaker 2: And then she kind of plateaued and we're like, okay, push the boundary again and just kind of see how you go and over time.
• 20:11
  Speaker 2: I think she's now in week four of her protocol and she's on her full dose of that goss and we use the similar process with the glutamine.
• 20:24
  Speaker 1: Can we drill down?
• 20:25
  Speaker 1: Forgive this vernacular, this picture, but can we drill down into the microbiome?
• 20:34
  Speaker 1: How long do we have?
• 20:36
  Speaker 1: I'm just having a horrible visual.
• 20:38
  Speaker 1: But if we're talking about certain, certain prebiotic fibers, perhaps certain species and strains of probiotics which might um benefit a microbiota profile, let's say, um, how do you work with that, given that, let's say, in SIBO it's commonly said that it's the lactobacilliaceae which are over abundant in the upper GI?
• 21:06
  Speaker 1: You know, albeit that that um, um, you know, we can't really test there unless you're doing some quite invasive tests.
• 21:15
  Speaker 1: There's a lot of issues with testing that I have.
• 21:17
  Speaker 1: But but, um, how do you choose which probiotic, which which um prebiotic you're going to use, given somebody's um gut profile?
• 21:30
  Speaker 2: yeah.
• 21:31
  Speaker 2: So I think when we're dealing specifically with patients with SIBO, the first thing is testing for SIBO and working out what type of SIBO they actually have, looking at their clinical symptoms and their health history and matching those two up and then looking at their microbiome if the patient has done both.
• 21:53
  Speaker 2: This is a big investment for a lot of people, and you know I do a lot of mentoring with practitioners and the biggest question I get asked all the time is Kali, how do you get your patients to afford both a breath test and a microbiome test?
• 22:04
  Speaker 2: And we're at that stage in our practice where that's just how we work and for me to be able to properly treat you in the field that I am, that's what I do.
• 22:13
  Speaker 2: But I do recognise that there is a big financial investment there for patients, and looking at the microbiome in my opinion creates a safe treatment plan, and one example that I want to talk about here is that you know there's been a lot of conversations recently about the use of berberine and its effects on the microbiome and things like increased hexa-LPS production and proteobacteria and the effect that it can have in decreasing the total number of species count in the overall microbiome of a patient.
• 22:51
  Speaker 2: But berberine in quite high doses is very effective for the treatment of hydrogen-dominant SIBO.
• 22:58
  Speaker 2: So you know, this is where, if you, we just need to, you know, be cautious, I suppose, and gather all of that information because we may not go in with high, high doses of berberine.
• 23:11
  Speaker 2: If we could see in a microbiome profile that this patient had those markers elevated and we might choose a different herb, like uvaversi, or come in with more probiotics or prebiotics.
• 23:24
  Speaker 2: And then, in terms of getting back to your question, andrew, about like how do we choose a specific therapy, it's about looking at again the research on well, if that's out of range, are we trying to increase it?
• 23:40
  Speaker 2: Are we trying to increase it?
• 23:41
  Speaker 2: Are we trying to decrease it?
• 23:42
  Speaker 2: And a lot of the time it's actually just about harmonising the microbiome and you know probiotics and prebiotics are beautiful at doing that.
• 23:52
  Speaker 2: But again, we need to get down to the species level and understand how a probiotic works and their mechanism of action.
• 24:00
  Speaker 2: Yes, I can see you want to ask a question for it.
• 24:05
  Speaker 1: Oh there's, there's so many questions going.
• 24:07
  Speaker 1: I've been taking notes and there's, it just keeps going and going.
• 24:11
  Speaker 1: So, um, uh, okay.
• 24:14
  Speaker 1: So firstly, with berberine, with hydrogen dominant, dominant sebo, let's say we're dealing with a lady who is having problems with fertility, possibly polycystic ovarian syndrome, insulin resistance, and berberine might be advantageous for that and possibly dyslipidemia as well, and berberine is a therapy for that.
• 24:36
  Speaker 1: How do you navigate that when you've got okay, this is good, but we can't do that good thing forever for your polycystic ovarian syndrome because you've also got SIBO.
• 24:47
  Speaker 1: I mean, that's a challenge.
• 24:50
  Speaker 2: It is definitely a challenge and, andrew, it's something that has led me to really scratch my head the last six months, since, you know, the more and more I dive into this specific research, so much so that we went right we're going to do our own clinical observations.
• 25:06
  Speaker 2: So we've actually been collecting our own data on all of our patients.
• 25:11
  Speaker 2: So we're looking at breath testing and microbiome testing before and after the use of berberine or non-berberine treatment for our hydrogen dominant SIBO patients and then also monitoring the outcomes with the microbiome testing.
• 25:29
  Speaker 2: And look, I'm going to drop a bomb because this is like and I want to say this is a small, a lot smaller scale than what you know some of these studies looking at the effects of berberine are up to you.
• 25:45
  Speaker 2: You know 300 participants in this study and we have not yet reached those numbers that we've done our clinical observations on.
• 25:53
  Speaker 2: So this is a much smaller cohort of people.
• 26:01
  Speaker 2: We're not quite seeing the same outcomes in terms of berberine directly creating increased levels of hexa, lps or proteobacteria In some patients.
• 26:18
  Speaker 2: We've seen a decrease of species, but you know, even just last week we had one patient come back who has done again I can push the boundaries with my SIBO patients quite a high dose and I'm happy to admit it, even though some people may cringe and go oh my god, you're using what you know berberine.
• 26:34
  Speaker 2: You're crazy.
• 26:35
  Speaker 2: You know I do a high dose of berberine.
• 26:38
  Speaker 2: You know, in philodendron this patient also received, you know, oil of oregano which is, you know, quite collateral to the microbiome as well, and their proteobacteria, the hexa LPS, both reduced and their total species count actually increased.
• 27:01
  Speaker 2: But what I want to say here is that it what I.
• 27:05
  Speaker 2: My theory is that it's about what else we're doing in combination with berberine, and I think this is my answer to your question.
• 27:14
  Speaker 2: Um, as naturopaths we are so holistic we don't just give them berberine and in these studies that they are just giving berberine or potentially, in one control group, berberine with a probiotic and comparing that.
• 27:30
  Speaker 2: But we're using the SIBO food roadmap, we use a probiotic with most patients, we're using glutamine, we're using prebiotics.
• 27:40
  Speaker 2: We're often not just treating SIBO and doing a lot of anti-inflammatory work and using a range of different herbal liquids or tablets with herbs and we don't know yet the full effect of all of these herbs.
• 27:55
  Speaker 2: It's not, you know, unfortunately we don't have all of this beautiful research on every single herb and its effect.
• 28:02
  Speaker 2: So I believe it's this holistic treatment that we're using with these SIBO patients and it's almost what I'm thinking and seeing.
• 28:12
  Speaker 2: Is it like balancing it out right and, in the process, getting these patients to become SIBO-free, which is incredible, like you know, symptom-free, sibo-free and it's using these therapies, but in a really safe and 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 microbiome testing to give us that information, if we're wanting to use berberine, it's like stabbing in the dark a little bit, and then we also don't have that clear data to monitor things, you know, and to go oh, actually I did this person, you know, a really good thing, or probably shouldn't have done that, and that's a lesson that I can learn in clinical practice and, and you know, take away from that as well well, look, in any clinical practice, you're going to have negatives.
• 29:11
  Speaker 1: In any research, you're going to have those people that fail a treatment regimen.
• 29:15
  Speaker 1: I think it's really interesting if you're using felodendron.
• 29:18
  Speaker 1: Felodendron isn't just berberine.
• 29:22
  Speaker 1: It's kind of like people who think that coffee equals caffeine.
• 29:25
  Speaker 1: Um, philodendron also helps to decrease cortisol.
• 29:30
  Speaker 1: What's one of the major triggers of sebo and ibs stress?
• 29:33
  Speaker 1: You know, could we be also acting in this way so that we're relaxing things, improving vagal tone or tonicity in innovation and therefore aiding digestion as a whole, aiding the microbiota in those ways?
• 29:47
  Speaker 1: So you know, I think, as you say, naturopaths don't work in razor blades.
• 29:54
  Speaker 1: We work in butter knives, by smoothing things and nourishing things.
• 29:58
  Speaker 1: So I think that's one of the.
• 30:00
  Speaker 1: That's what I love.
• 30:01
  Speaker 2: So much about what we do.
• 30:02
  Speaker 2: You know, I just love that.
• 30:04
  Speaker 2: We don't ever just have, you know, and when we compare that to a medication, you know the that the treatment for SIBO is rifaximin.
• 30:13
  Speaker 2: You know, and that's just clear cut, here's your rifaximin off, you go, that's for your treatment of SIBO.
• 30:19
  Speaker 2: But as a naturopath, we just, we just don't treat that way.
• 30:22
  Speaker 2: You know, even if I was to get a patient to do rifaximin which I have done in my practice I would say here's rifaximin plus, I want you to do this and this with the diet, here's phgg, because that increases the clinical outcome, you know.
• 30:36
  Speaker 2: So again, it's like we've just got so many beautiful tools in our toolbox when it comes to well like.
• 30:43
  Speaker 1: I know that, yeah, one of these major gastroenterologists that was using rifaximin also produced a product for which the action was actually the side effect.
• 30:57
  Speaker 1: So when you look at the common name in America and forgive me, I've got this wrong, but it's like we'd say a conch shell, so it's got that sort of name, it'sch shell, so it's got that sort of name.
• 31:07
  Speaker 1: It's not correct, but it's got that sort of name.
• 31:09
  Speaker 1: Do you know what it is?
• 31:10
  Speaker 1: It's horse chestnut.
• 31:12
  Speaker 1: Oh right, yeah.
• 31:14
  Speaker 1: So what happens when you take horse chestnut without it being enteric coated?
• 31:18
  Speaker 1: It's a high saponin herb.
• 31:19
  Speaker 1: You're going to get a clean out.
• 31:21
  Speaker 1: So it's almost like he's at, he's using it as a prokinetic or at least as a clean out.
• 31:29
  Speaker 1: So so I guess, to follow on from there, yeah, when you're working with these patients and you're using foods and fibers and certain probiotics, you know if we're dealing with sebo, we've got something about a component which is the breakdown of the MMC, the migrating motor complex.
• 31:46
  Speaker 1: So can you talk to us about what do you use as prokinetics?
• 31:52
  Speaker 1: What do you use as binders for those people that might have an overgrowth of the archaea and things?
• 31:58
  Speaker 1: How do you manage things like excessive wind and bloating like you spoke of?
• 32:03
  Speaker 1: Do we use things like charcoal?
• 32:05
  Speaker 1: Sorry, I've got 30 questions, carly, we could talk for days on this.
• 32:11
  Speaker 2: I know, I know there's just it's never-ending, is it?
• 32:14
  Speaker 2: It's a huge world.
• 32:15
  Speaker 2: Yes, the migrating motor complex and prokinetics are absolutely essential for SIBO and for most patients need it throughout their entire treatment and that will kind of be something that should be kept there as post, you know, maintenance treatment for these patients.
• 32:37
  Speaker 2: But it really depends on, you know, I think at least three months post-treatment keeping them on a prokinetic is really important and then you can kind of test the waters a little bit, bring them off that and just test their own, see if they've actually got that ability to get that functioning properly.
• 32:57
  Speaker 2: But in some patients there's that whole autoimmune cascade that's occurring with the CBT and the veniculin antibodies and stuff like that and that is almost potentially causing long-term issues with these patients.
• 33:16
  Speaker 2: So they may need to take a prokinetic ongoing and you know it's really hard to work that out.
• 33:24
  Speaker 2: So you've got to kind of monitor your patient really closely.
• 33:28
  Speaker 2: Um, but I love ginger.
• 33:30
  Speaker 2: Ginger is my favorite prokinetic um and minimum 100 sorry, a thousand milligrams daily um is needed to get that beautiful.
• 33:43
  Speaker 2: Uh, migrating motor complex action and you can do this supplemental but getting your patients to, you know, consume ginger, putting it in smoothies, in their yes, in their teas, but like making it strong, you know, and I think it really depends on the patient, because some people can't tolerate ginger, so you've got to work with them there.
• 34:11
  Speaker 2: But it's so amazing.
• 34:15
  Speaker 1: Go, andrew, I love it forgive me, sorry to interrupt for our, for our listeners that can't see me.
• 34:20
  Speaker 1: I'm interrupting, carly, here I've got a ginger and lemon tea and it's not one tea bag, it's multiple.
• 34:31
  Speaker 2: Good, you're really encouraging that migrating motor complex today.
• 34:35
  Speaker 2: Hopefully you do a really good poo this afternoon after all of that.
• 34:40
  Speaker 1: Thanks, it actually ties in sorry to interrupt again, kai.
• 34:53
  Speaker 1: It actually ties in with a.
• 34:54
  Speaker 1: I did an instagram post from a story that I did years ago and it was the use of ginger and we.
• 34:57
  Speaker 1: It was ginger talking to our gut microbiota in, sorry, the genes of ginger talking to the gut microbiota genes which then talk to us.
• 35:05
  Speaker 1: So it's this cascade the ginger doesn't talk to the gut microbiota genes, which then talk to us.
• 35:07
  Speaker 1: So it's this cascade the ginger doesn't talk to us directly.
• 35:09
  Speaker 2: It's really interesting stuff, but I love what you're saying Now I'm curious.
• 35:14
  Speaker 1: Yeah, so forgive me, carry on, because I interrupted and it's really important stuff Migrating, motor complex.
• 35:21
  Speaker 1: What else can we use?
• 35:24
  Speaker 2: I also really like iberogast or making a like using herbs that are, you know, supporting the mite.
• 35:33
  Speaker 2: You can make your own version of Iberigast, I suppose you know with your herbal dispensary, with you know Oregon grape and scutellaria and herbs like that.
• 35:44
  Speaker 2: But Iberigast is so easily accessible and can be really great as a prokinetic as well.
• 35:52
  Speaker 2: But even the lifestyle stuff.
• 35:55
  Speaker 2: So like making sure patients aren't snacking and that they're having an eating window, like trying to have three main meals a day and allowing four to five hours between their meals so that the digestive system can rest and digest and clear out, rather than it constantly just trying to process food 24-7.
• 36:19
  Speaker 2: And you'll find that SIBO and IBS people love to snack.
• 36:27
  Speaker 2: It's just this thing that I have noticed in these people, because it's almost like the bacteria are just like give me sugar, give me carbs.
• 36:37
  Speaker 2: I'm always hungry and once you start to clear and rebalance what's going on in the gut, their cravings will reduce.
• 36:48
  Speaker 2: But it's such an important thing that we need to be doing for the migrating motor complex as well Anything that you could help our listeners, our viewers, to use as an interjection.
• 37:04
  Speaker 1: if you like to stop those cravings, can we use things like perhaps I mean, I'm thinking West here what about collagen?
• 37:11
  Speaker 1: What about bulking fibres?
• 37:15
  Speaker 1: What about xylitol?
• 37:20
  Speaker 2: Yeah, the way I deal with this in our patients is educating them about cravings.
• 37:26
  Speaker 2: Is this an emotional craving?
• 37:29
  Speaker 2: Is this a?
• 37:30
  Speaker 2: I'm actually hungry and my metabolism is quicker, and if they do have that, I'm one of these people, right?
• 37:38
  Speaker 2: If you asked me to fast for four to five hours, I'd be a space cadet, okay, and that's just.
• 37:44
  Speaker 2: My metabolism naturally functions quickly and I need more food, and so you can work that out with the patient, but also educating them about what actually is a balanced, nutritional, high-quality meal.
• 38:01
  Speaker 2: Because if you're going to only allow them to have these three meals a day, because if you're going to only allow them to have these three meals a day, so many people don't understand.
• 38:10
  Speaker 2: You know the simple things that we do as naturopaths and nutritionists about how much protein, how many carbs, you know how much fat, and get them to send you photos for a week of their meals without you even saying anything, and then come in and help them restructure what they're actually putting on their plate to make them feel full and to actually get them to last that amount of time.
• 38:36
  Speaker 2: And if they're not and you know that that's actually well, that's actually a very adequate meal and they shouldn't be needing to snack.
• 38:44
  Speaker 2: That's when you can go okay.
• 38:46
  Speaker 2: Well, you may just have a naturally fast metabolism and therefore we might need to adjust that and treat the individual sitting in front of you.
• 38:54
  Speaker 2: But there, that's kind of how I approach that.
• 39:00
  Speaker 1: I love your work seriously.
• 39:01
  Speaker 1: Um, I need to get you back on, if we can.
• 39:04
  Speaker 1: Um, I know you're going away to have a baby, perhaps after you've had your new addition to your family 2024,.
• 39:10
  Speaker 2: I'll come back.
• 39:11
  Speaker 1: But just before we go, things like binders.
• 39:15
  Speaker 1: You know, simply, some people use charcoal tablets on a more naturopathic, holistic level, if you like, we use the Zeolites, and forgive the one, it's got a longer name or whatever um.
• 39:33
  Speaker 1: Zeolites is a group and one of them is anyway.
• 39:36
  Speaker 1: Um, how often do you use these and is there are there any cautions with regards to binding to nutrients, not just what you don't want?
• 39:46
  Speaker 2: to be honest with you, I used to use them a lot heavier in practice, um, with I'm kind of moving away from them a little bit, um, because I believe that even a beautiful herb like protea sorry, not proteobacteria pomegranate which you can use for proteobacteria um, can be, uh, really useful for that action, and often we go for pomegranate with a lot of these patients.
• 40:16
  Speaker 2: So, um, I love pomegranate um as a treatment therapy for what.
• 40:23
  Speaker 2: I hate the word dysbiosis, but it's like that's what everyone knows what I'm talking about.
• 40:28
  Speaker 2: But you know, um, you know an imbalance to the microbiome um, and NAC is another one.
• 40:38
  Speaker 2: But we just have to be very careful there, um, because if there's any hydrogen sulfide producing species, it's not necessarily good there.
• 40:52
  Speaker 2: So that's again another really great reason why microbiome testing for all SIBO patients is important.
• 40:59
  Speaker 2: Because, yeah, you just wouldn't touch that if you're, you know, seeing things like desulfofibrio in the microbiome plus a positive SIBO test, for example.
• 41:11
  Speaker 1: Yeah, sure, Can I ask with pomegranate before we go, what form?
• 41:18
  Speaker 2: So we tend to do the rind and the husk in tablet, or we love liquid.
• 41:25
  Speaker 2: We have our own kind of SIBO blends that we go to for different types of presentations.
• 41:34
  Speaker 2: But yeah, even just there is some really great simple products available with just pomegranate in them as well.
• 41:44
  Speaker 1: I love your work.
• 41:45
  Speaker 1: This is so enlightening.
• 41:46
  Speaker 1: I've got a page full of notes.
• 41:48
  Speaker 1: Food is medicine.
• 41:49
  Speaker 1: Like food is medicine.
• 41:51
  Speaker 1: I love it.
• 41:52
  Speaker 2: I didn't even talk about pomegranate.
• 41:54
  Speaker 2: Like you know, in stage one, when we're talking about the SIBO food roadmap, the biggest and the best thing and the thing I love most about what I've created is pomegranate.
• 42:03
  Speaker 2: You know is in stage one of the SIBO food roadmap and we educate them right from the start about pomegranate and you know we've had a recent patient start on it and in the first two weeks of her doing the SIBO food roadmap she increased her consumption of different foods.
• 42:24
  Speaker 2: So she ate 35 new foods in two weeks of being on the SIBO Food Roadmap.
• 42:29
  Speaker 2: Wow, she tried pomegranate for the first time in her life and just like the things that she was sharing with us, I was just like I think I can stop practising.
• 42:41
  Speaker 2: I feel like my life has been made, you know.
• 42:44
  Speaker 1: That's somebody who truly embraces therapy, isn't it?
• 42:47
  Speaker 2: Wow, you just go.
• 42:49
  Speaker 2: Oh my gosh, like coming from this way that I used to practise, where I would just hear them going oh, this is so hard and this is really.
• 42:57
  Speaker 2: I miss these foods.
• 42:59
  Speaker 2: And now they're just feeling empowered to try new foods and to add things in rather than exclude them.
• 43:06
  Speaker 2: It's just, yeah, I can't even describe the feeling.
• 43:09
  Speaker 2: It's just, it's awesome.
• 43:12
  Speaker 1: Carly Raven, you are one of those practitioners that has learnt through hard lessons and you have now passed that care.
• 43:20
  Speaker 1: You use that to care for others.
• 43:23
  Speaker 1: It's just, it's plainly obvious, like I thank you so much for enlightening us today, but there's so much more we have to delve into.
• 43:30
  Speaker 1: Like seriously, this is uh.
• 43:32
  Speaker 1: This is a three-day seminar, but your work like I also love what you're doing about challenging yourself um, is what I'm seeing really what's happening?
• 43:42
  Speaker 1: Or, uh, am I being beguiled by what I'd like to see?
• 43:46
  Speaker 1: And we often get caught up in this and it's very challenging for a clinician to say let's gather the data and let the data talk to us.
• 43:55
  Speaker 1: It's very, very challenging for many clinicians to do what's called a clinical audit.
• 44:00
  Speaker 1: So well done to you on an ethical basis not just patient basis for having the guts to do that Sorry about the word having the guts to do that no pun intended.
• 44:14
  Speaker 2: I didn't even mean to do it.
• 44:15
  Speaker 2: But you've done well, I love it.
• 44:18
  Speaker 1: I admire you.
• 44:19
  Speaker 1: I so admire you.
• 44:20
  Speaker 1: Well done to you and thank you for sharing your way of doing things.
• 44:25
  Speaker 1: So sorry, sorry.
• 44:26
  Speaker 1: Last thing, so it's called the now hang on the SIBO food roadmap correct is that what it's called?
• 44:34
  Speaker 1: Can practitioners access that?
• 44:38
  Speaker 2: yes, so you have to become certified um to use it in practice, and patients can't just download it off the internet, off our website, so they can only access it through us as naturopaths and nutritionists.
• 44:53
  Speaker 2: And I'm doing that so that we can stay true to the philosophy and it's not just the diet that is going to, you know, create this epic change in our patients, and I really want practitioners to be using this diet appropriately so they can continue to see the outcomes that I'm seeing in my practice.
• 45:15
  Speaker 2: So, yes, you do have to do the training through me and then become certified, and there's ongoing support through a Facebook group and things like that for practice to keep asking questions and things like that and stay connected and updated.
• 45:29
  Speaker 1: So, yeah, I think it would be a fabulous thing.
• 45:33
  Speaker 1: Once practitioners do become certified and start collecting their own data, you'll get a multi-centre data collection point.
• 45:40
  Speaker 1: That would be really interesting.
• 45:41
  Speaker 2: Yes, carly Raven, thank you, thank you.
• 45:43
  Speaker 1: Thank you for taking us through this.
• 45:45
  Speaker 1: Yeah, really exciting stuff, thank you.
• 45:47
  Speaker 1: Thank you for taking us through this.
• 45:47
  Speaker 1: Yeah, really exciting stuff.
• 45:48
  Speaker 2: Thank you so much, andrew, it's been a pleasure.
• 45:52
  Speaker 1: And thank you everyone for joining us today.
• 45:54
  Speaker 1: Forgive us that little tae-tae-tae at the end there.
• 45:56
  Speaker 1: I'm just really excited about this.
• 45:58
  Speaker 1: Remember, you can catch up on all the other podcasts and the show notes for today's podcast on the Designs for Health website.
• 46:04
  Speaker 1: I'm Andrew Whitfield-Cook.
• 46:07
  Speaker 1: This is Wellness by Designs.