From IBS to SIBO: Understanding the Spiral of Gut Dysfunction with James Marin and Dahlia Marin

[00:00:00]It's like life is hitting them all at once. They're no longer in high school.

[00:00:04]They're and and we're seeing that even in high school, they were eating craft mac and cheese and drinking artificial colors and and doing all these things that aren't conducive to gut health. And then they're thrown into the real world with all the stress and all the responsibilities. And we see their guts start to crack a little bit.

[00:00:22]>> And a lot of the times that comes coupled with a lot more ultra refined food than they were eating when they lived at home. they're going out to eat a lot more, getting fast food, maybe they're eating in the college dining hall and maybe not making the most nutritious choices. And a lot of the times we know they're binge drinking as well. So this is when a lot of autoimmune diseases are being diagnosed.

[00:00:41]This is why we're seeing that those aged 20 to 50 are the fastest rising group of colon cancer. Um so again, rightly in that college age where a lot of this inflammatory cascade is being induced.

[00:00:57]Um, so definitely something that can be prevented, but plants are key.

[00:01:04]>> And this very much connecting a big question we get. Why do I feel worse after eating plants? So maybe you've heard other doctors and dieticians or people who write books or at a conference say eat more plants, eat more beans, eat more fiber. Okay, great. Bye.

[00:01:19]And like that's it. But it's like why do I feel worse? Right? You might go home, you might try after this conference, you're probably going to try, but you might find I'm more gassy. I'm more bloated. I'm I have more indigestion. I have more discomfort after I'm trying to add these plants. Why is this happening?

[00:01:35]>> Right?

[00:01:35]>> So, >> so I like to just give a quick analogy.

[00:01:39]And I know there there's a lot to go into here, but the quick analogy is is thinking of your gut microbiome and again from mouth to anus as this beautiful factory line. You're you're producing things. You're a producer.

[00:01:50]you're making short- chain fatty acids and proteins and vitamins and minerals.

[00:01:55]Your your gut is very active. There's a lot going on here. And so, it's important to understand that that this has been going on from the second you were born, from the second you were exposed to microbes, even in the womb, from the second your mother uh gave you her microbiome, either through delivery or kisses or hugs or breast milk, whatever it is, this factory turned on.

[00:02:18]This factory is is still to this day right now as you're breathing, as you're listening, producing and making and making. And so, you know, you have to keep this factory going. You have to understand that these little guys and these products are vital to your health and are extremely extremely important.

[00:02:38]So, all that to say is your factory can be off a little bit, right? That's not to say that the inputs are necessarily off, but maybe one of the wheels here are broken. Maybe too many people, too many of your people here, in this case, microbes, have called out sick or maybe there's too much of one type of worker when you need a better variety of workers. So, this analogy will come back into play uh as we continue. But understanding that is is very much uh key. And so, this factory is what we've been showing you. So again, we kind of leave in some of the pictures before, but also some new pictures where we're seeing how then nutrients affect this.

[00:03:17]And that's essentially what we're absorbing and making. It's all the polyphenols and vitamins and minerals we're consuming. Why are we eating the apple? Why are we even saying to eat the kidney bean in the first place? Why eat the kale and the spinach, chickpea? The list can go on and on. It's because we need proteins and we need the vitamins and we need the phytonutrients, but it is this gut and this beautiful layer and and the ecosystem in there that's going to help you actually absorb these nutrients. So these are in this graphic here to the right. These are nutrient fortifying >> uh uh you know nutrients that fortify I mean and so and these are nutrients that damage that we know, right? So like too much alcohol or sugar alcohols or emulsifiers and like Dolly mentioned fructose and the high fructose corn syrup. And so all of these things are not only going to directly damage but like we showed you in in the previous study support also microbes that like to damage support an environment that favors inflammation and damage. Right.

[00:04:25]So it's much more than just yeah than just saying oh it's going to damage it.

[00:04:30]It creates an environment of damage that's very difficult to sometimes make a U-turn and turn in the other direction >> and then you know that is also involved in turning on certain genes and sometimes once certain genes turn on it can be more difficult to turn them off.

[00:04:44]So it's nice not to poke the bear in the first place to let them be leave them off and really provide these nutrients that your body is looking for all of which can be acquired in a variety of plant foods. So whether that's fiber or glutamine or vitamin D or these other amino acids like cysteine and tryptophan, vitamin A, these can all be require acquired through a variety of plant foods.

[00:05:07]>> And so this is where we get into the gut microbiome disease spiral. So the spiral is still the same, right? And everyone's spiral can be a little bit different and it can be positive. This is where it can get a little negative, right? where depending on your family history and your actions and where you live, again, all the factors we were talking about, you then start to notice some issues with the pancreas and the liver if we follow on track, right? And if you're a male, that then eventually leads to prostate issues and and all these things and it just kind of sends this diffusion and cascade outward. Uh again, this this might not be you, but this is someone, right? This is where you go, my friend can eat at McDonald's every day and they're fine. whereas I do that and I have a stomach ache, right? But your friend maybe has eczema or maybe has other issues going on that aren't necessarily beginning with stomach symptoms necessarily, but they're maybe starting with something else, right? We all know um many of our patients come to us and have bladder issues, right? They have irritable bladder and um they >> intersticial cyitis, >> intercalcyitis. And so they essentially are having those issues first and foremost without realizing, oh, I've also been constipated or I've also had other GI issues that I didn't notice, but the bladder was screaming most. And that's because we're all unique fingerprints. Remember, we all have light switches in different places. And our lifestyle and actions will kind of turn on those light switches um individually and uniquely. And so it's important to understand you can have a unique cascade in a positive way. and also in a negative way. So very important there.

[00:06:47]>> Okay.

[00:06:48]>> All right. So we're gonna talk about So maybe you're experiencing some of these GI symptoms, the gas, the bloat, the indigestion, the brain fog, the fatigue.

[00:06:55]When should you be concerned about them?

[00:06:58]Um and really what we say is we don't want you to even experience the symptoms. We want to prevent them so that way they never even have a chance to manifest. They never have a chance to begin. So we know again eating that variety of plant foods is key. So key studies have shown that those eating a wide variety of plants and in fact it didn't make it into there but it literally just came out a new study that studied over 21,000 individuals and took stool samples and microbiome samples from them showed those who were on a vegan or plantrich omnivorous diet even a vegetarian diet had healthier microbiomes. So those who were eating the highest number of plants had a microbiome in certain species in their gut that favored an anti-inflammatory environment. So, when we're eating the whole grains, the fruits, the vegetables, the nuts, the beans, the seeds, um the legumes, herbs, and spices, that's going to favor, like we mentioned, those bugs that will act like firemen and fire, you know, firefighters and really come in and decrease and extinguish that inflammation instead of that alternate and that other side that will trigger that inflammatory cascade. So, you might be finding yourself in that. Maybe you have already been diagnosed or you're suspicious you have IBS like I did again. Um but how do you know if you do or not? So IBS is diagnosed and you do need a practitioner who can diagnose, right? So you need to see a physician, a gastroenterologist, a nurse practitioner, physician's assistant who can kind of take into account, do you have recurrent abdominal pain at least once a week on average in the last 3 months? Do you sim simultaneously have at least two of the other three of these change in pain related to your bowel movements? Do you feel your bowel movements? Is it painful to empty your bl your bowels? Do you get sweaty, shaky, um uncomfortable before, during, or after a bowel movement? Are bowel movements just uncomfortable for you? Did you have a change in stool frequency? Whether it's you went from going every day to now going three times a week or once a week or maybe you're going 12 times a day. Um or did the stool form and appearance just kind of change? Maybe you used to have those healthy, beautiful, solid snake- like type fours and now you're seeing they look like little rabbit pellets or maybe they look like soft serve or just liquid in the toilet bowl.

[00:09:27]Those things are qualifying factors to be diagnosed with IBS. But I like to say IBS is BS, right? We're not going to just be like, "Here's your diagnosis.

[00:09:36]You already knew these things, but I'm going to give you a label for it. Good luck." I really am not satisfied with leaving someone at an IBS diagnosis.

[00:09:46]It's always for me as an integrative practitioner going deeper and really figuring out why do you have some of these symptoms that we're talking about here. Why do you have lower abdominal pain or discomfort? Why has your stool been changed in frequency or appearance or comfort level? Why maybe are you passing mucus in the stool? Why are you bloated and gassy? Maybe it is something a little bit more involved. And we know more recently, especially in the last decade or so, we're identifying that one common kind of hallmark in IBS is imbalance. That disbiosis. Disbiosis means imbalance of the bugs that are living in the gut. Whereas ubiosis is a nice balance. So maybe the bugs are imbalanced and these bugs all produce their gases. We know they can produce hydrogen, some produce methane gas, some produce hydrogen sulfide gas, some will produce benzoic acid or carbon dioxide.

[00:10:48]All of these will make you feel differently. And we're going to talk about a few of these in particular. But maybe you're noticing, I don't think this is normal where it's not like once every 3 months I have a stomach ache.

[00:11:00]It's once a day I have a stomach ache at least. Or my bloating is not just, oh, okay, I'm a little uncomfortable. It's my pants don't fit by the end of the day. I have so many patients who tell me that I have a PM wardrobe and an AM wardrobe because what I put on in the morning doesn't fit me at night anymore.

[00:11:20]>> Yeah. So, we're noticing their bloat is not just regular bloat. It's going from a zero or 1 out of 10 to a 10 out of 10 by the end of the night or a 9 out of 10 by the end of the night. So, this is not just typical. Um, their gas is excessive more than 15 to 20 times a day or it's trapped where it's again just accumulating and they're becoming more and more visibly distended throughout the day. um they could have spontaneous or uncomfortable belching and then still some of those other signs. So that's when we say that's not mild, that's lifealtering. Let's really look in deeper and see if you have something called SIBO, small intestinal bacterial overgrowth, or there's different types where it could be large intestinal microbial overabundance as well. But we want to know, do you have too many of these bugs who are making this gas that's causing discomfort inside of your gut? Let's try to identify them and let's see what they're doing. Studies show 14 to 70 70% of IBS may actually be SIBO. So you could have that disbiosis and that could come with its issues of motility and then that ultimately will cause barrier issues as well. But we want to know do you have an overabundance of these bugs that can produce these different gases? And so this is where it gets to another big question or realization or even just confusion where there's common symptoms many do not realize are connected to GI issues. Right? So and really for us spoiler alert kind of all symptoms are are connected to your gut in one way or another. But when it comes to very serious GI issues like even SIBO can be very serious. There are many of our patients with SIBO who can not go to work, who cannot function, who cannot show up for their family or their spouse. And so it can get very, very serious.

[00:13:11]>> I had a 12-year-old boy yesterday who's been out of school since December, so can't even go to school because of these debilitating GI symptoms that unfortunately are still taboo and people are not comfortable sharing. So >> these are causing people to really, really live their lives in a much different way. And I'm seeing comments uh and just so we know we we do see your comments that I saw that one comment I was saying one of the doctors dismissing some of these and and saying it's BS or I saw one of those comments. So we're going to see these comments. I know we're going to be doing a Q&A later. So I believe we can save these and we will answer these questions. We're seeing them come in. We do see your comments.

[00:13:49]But yeah, we we we know the frustration.

[00:13:51]We've lived the frustration. We see the frustration in our parents and even the kids that come through our to our practice. And so there are common symptoms many do not realize are connected. And so um to kind of go into that, this is where histamines really really do shine. And I'll kind of and this is where there there are some complexities, but getting into some of those symptoms. So as we're talking about you know deeper and deeper gut imbalances all these factors will influence how your immune system is behaving and your immune system is responding. So we know certain even normal healthy bacteria let's take lactobacillus acidophilus which is one of the most commonly known bacterial strains that can release certain immune chemicals to just communicate with your immune system including histamine. So depending on the balance of bugs in your gut, you could either be breaking down histamine with those bugs, you could be releasing a large amount of histamine with the bugs. And depending on your histamine load, it's important to understand how you're managing it.

[00:14:53]Because when you are processing food, you're also processing these immune chemicals that can come along with the food and these biogenic amines as they're called that can come along with the food. There are certain amino acids, there's certain bioactive compounds that can come in the food. So, histamines can be produced by your body or what's called endogenously inside. They can come from the external inside. Right now, we're in spring. Most people are noticing that some are dealing with allergy symptoms, which can be a histamine symptom. So, histamines can come from a variety of places. We can make them on our own. When our adrenaline rises or our estrogen levels rise, those things will release more histamine in the system as well. Or when we're sick, our histamine will rise as well. When we're exposed to mold or miccotoxins, our histamines will rise because our immune system is activated.

[00:15:47]Those cells that make that the mass cells will put out histamine. And we have receptors all throughout our body for histamines. We have >> different types of histamine receptors 1 2 3 and four. And as you see here on this picture on the left, they're pretty much everywhere. There's almost no organ in the body that doesn't have a histamine receptor, meaning they're all going to feel the histamine. So, it's important one to not be overly producing histamine. Two, to be able to denature or break down the histamine that can come in. One very prevalent place that we're seeing that affects this fine balance between how much histamine is coming in, how much histamine is being broken down and put out is the gut barrier. Our gut barrier, like I mentioned before, is >> haven't talked about the gut barrier.

[00:16:37]>> It's a source of enzyme production. And not only is that digestive enzymes, so somebody was asking, do we agree with digestive enzyme use? If your gut barrier is damaged, you might need that supplement. But your body should be able to make those digestive enzymes. It might not be able to because there's damage, but that can affect digestive enzymes that can affect other types of degrading enzymes as well like histamine production. So we are supposed to make these enzymes, the main one being DAO, diamine oxidase in predominantly the lining of the small intestine. We make some in the liver and then we'll make some in these other areas. The brain will make some, the kidneys make some as well, but we're making that DAO all throughout the body. There's another histamine degrading enzyme, H&M as well.

[00:17:29]That's predominantly produced in the liver. So, when we're having these imbalances, when we're overwhelming our GI tract or overwhelming our liver, we might not be able to break down histamines. Then you might start noticing more and more of these si symptoms, these histamine symptoms that are here in this photo on the right. So you might notice either after eating a certain food, after feeling stressed, maybe after you got COVID and a lot of these histamine symptoms do go with postcoid syndrome. I do see that in a lot of my patients. My patients who have dysotonomia or dis dysfunction disorder of the autonomic nervous system, they will experience these histamine symptoms as well where they're noticing maybe in their nervous system that they have headaches, migraines, dizziness, brain fog, and they'll notice that's worsened when either they're outside around the histamines, they've eaten the histamines, they're stressed. They might notice after eating or after raising their adrenaline with exercise that their heart is racing to a a rate that does not make any sense. They could be upwards of 200 beats per minute just from eating something or from doing some exercise.

[00:18:38]They might notice also that they feel really weak or maybe they even pass out.

[00:18:42]They might notice the typical respiratory symptoms. I have a lot of people who say, "Yeah, I don't know why after I eat X I'm always clearing my throat. I get really congested and then I get post-nasal drip and I'm coughing.

[00:18:54]I'm clearing my throat. That could be a sign of possible histamine intolerance.

[00:19:00]Um maybe you get short of breath. Maybe you start sneezing a lot after eating certain foods. Maybe you're seeing it in your skin where you have flushing, reening, itching, dermatitis or eczema after certain foods or after a certain illness or after certain exposures. And then a lot of those IBS symptoms, bloating, gas, early satiety, diarrhea, abdominal pain, constipation, nausea, vomiting, those also can be histamine intolerant symptoms. Um, so if you're noticing any of these are rising, this is something to pay attention to. If you say, "I never used to be somebody with allergies and now I have the worst allergy symptoms." Or after I had that virus, after I eat the specific food, after I took these certain antibiotics, I really now experience a lot of these symptoms. It's something to bring up with your care team.

[00:19:55]>> I we went to Egypt and I've never I haven't been the same.

[00:20:00]I got food po and actually got ocean poisoning in Egypt when we were snorkeling. I swallowed water and I think I used You don't want to use Egyptian snorkels and something happened to me cuz the next 24 hours was horrible. And if I didn't if I didn't know what I knew and I didn't have my wife who's an expert in this helping me, it would have been longer than 24 hours and possibly a hospital trip because it was it was bad. But luckily, we kind of knew what we're dealing with somewhat and we had Dalia travels. We got to if you ever want to see Dalia's travel kit, >> you can. I posted a follow on it >> because it is amazing. It will get you through any GI issue you have while traveling. But to say this story and to comment on this, it's important because I've I've really never been the same.

[00:20:50]I'm like, man, Egypt really I mean, I'm a lot healthier. I'm fine now. Not that I still have IBS or issue, but not to get into TMI, but it's like I know my gut before I went to Egypt and I know my gut after Egypt. And it's a different gut a little bit. I'm still healthy.

[00:21:05]>> Thank God I still have a healthy gut.

[00:21:07]But I'm like, you're a little different.

[00:21:09]You went somewhere and didn't come back the same. You've been through some things. And so we understand. And hopefully you understand. And you're a believer at the end if not already. But at the end of this presentation, you're going to be like, "Oh, I get why they're saying the gut is really key to everything in the body and even beyond."

[00:21:26]Because you see what a ripple effect just the the gut can have on the rest of your body. And the histamine receptors are proof of that in and of itself. But there's even more. But there's the histamine receptors alone. And we need a healthy gut microbiome to properly break down histamines are I mean in and of itself key and proof that really the gut is connected to your entire body. And symptoms like Dalia went through just so eloquently and beautifully. You maybe aren't even connecting to your gut are connected to your gut. So very important.

[00:22:02]>> Yes. So word to the wise. I wouldn't recommend >> which part the snorkeling in Egypt.

[00:22:08]Yeah.

[00:22:08]>> Putting getting water in your mouth. If only if only someone had told you.

[00:22:13]>> If only my wife had told me. She did not tell me not to do that.

[00:22:16]>> Yeah. Yeah.

[00:22:18]>> Husbands always listen to your wives.

[00:22:20]Right. Another So going back to this analogy, the factory line, right? We see a a fractured factory line, right? which a lot of us have and which for the most part can be inevitable to some degree.

[00:22:32]But in this modern era in the first world countries of antibiotics of all the things we just mentioned you know so many of us most of our children for example after 6 months of age 83 plus% of children are no longer exclusively breastfeeding. We are busy we are doing a lot. We are maybe not providing enough resources to moms. That's just one factor, one little piece of this fracture of so many where now our basically factory or whatever you call it assembly line is fractured and we're missing some things. things are falling through the cracks literally and in the gut and we're seeing this and what can happen over time and why we say try to avoid this or do your best to get on this sooner rather than later is if you're looking at the picture to your left we're seeing again not only are we relying on production right but we're also relying on absorption we're also relying on this factory line to help us absorb nutrients that we're eating it's it's key for our microbiome to help us absorb absorb. So if left, if this factory line continues to be fractured and things are falling off and being missing or the microbes are missing, we are then going to become nutrient deficient which will then lead into a host of other symptoms and it is I mean in theory and there's some good evidence but why we're seeing a rise in Alzheimer's, dementia on top of it being type 3 diabetes which again that goes to our liver health and our our pancreatic health. But as we start to lose these nutrients over time, even little by little, we will start to see more and more issues kind of compound exponentially on one another. And this factory line cannot continue this way, right? And just in a way of a actual business, if your business was running fractured, if you were losing people and losing product and not delivering on orders, you'd be out of business, right?

[00:24:30]And so we don't want that for your health. You don't want that for your gut. You don't want that even more so we'll get into for your kids because what you do now, what you do for your microbiome, whether you have kids, especially if you're living with them or even if you don't but plan to, you're going to be giving them this microbiome.

[00:24:49]And so it's it's a multigenerational effect that is very very important.

[00:24:54]>> And you have people talking about through the generations our soil has become less nutrientdense. That is true.

[00:25:00]We are seeing marked differences in nutrient quality in the soil but also there's a factor of our gut and our gut being less resilient and able to even handle the nutrients that are coming in.

[00:25:14]So while the soil microbiome has changed and people are recognizing that I see more and more people saying that online, we really need to understand this as well. And that is it's it's becoming more common, right? Before it was really just, okay, make sure your celiac patients are supplementing with their B12 and their vitamin D and their omega-3 because their gut lining has been affected by their autoimmune condition and it's the inflammation has destroyed some of their um their villi in their small intestine, those little absorptive finger-like projections. So, make sure they're supplementing or your IBD patients, you know, there's protocols and there are guidelines for these are the supplements IBD patients need. They need to be taking calcium.

[00:25:59]They should be taking vitamin D, omega-3, B12. Now, we're really seeing so many Americans are living with that intestinal hypermeability, that leaky gut, which is kind of the street term for it. Um, but that's going to affect the ability for your factory, your assembly line, like James mentioned, to absorb the nutrients. So, if we're already dealing with malnourished soil, and now we have a system that can barely absorb the nutrients, it makes sense why we're seeing chronic disease on the rise. Um, >> and so there's there's so many acronyms here and you and maybe you know, but there's many who don't. There's still patients who maybe been with us for a while and are like, "Wait, what?" And it's confusing, right? IBS and SMO and IMO and all all these acronyms. So so many still go what what even is this right? And so uh we wanted to answer this question as well like what what is IBS and SIBO and you know the causes you know what doesn't cause and and so many of these questions are connected but really quickly because I I know this is a lot of information information this picture is a nice summation in in some ways of what this is and so the symptoms are a product of deforestation of our gut ecosystem right if you're an environmentalist I I consider myself an environmentalist I love the environment I love to be outdoors and go to different environments. That's why I was snorkeling to visit a new environment and unfortunately I got sick. But I still >> I could still snorkel without gross stuff. But yeah, um but I like I like ecosystems and I've understood through all this research and for doing this for so long that one of the most important ecosystems is our gut ecosystem. So really all of this whether whether it's reflux or any a lot of these diseases especially gut diseases and the doctors are throwing acronyms and you're hearing us speak really it is just a gut deforestation. It is it is us slowly or even many of us quickly as we give you that college student scenario where it's this perfect storm where they're quickly cutting down the trees of their gut so to speak or it's slowly over 40 years 50 years 60 years. We are not in a sustainable place in this ecosystem.

[00:28:12]We're cutting down more trees than we can handle. And it really is a a beautiful irony and it really is a beautiful parallel where we are connected to our environment. Many other doctors and researchers have made these parallels before. We're not the first ones to do it and but it's a beautiful parallel to go oh what we do to the environment is a parallel of what we do to our own gut because they are in communication. They are meant to be in communication. They are meant to be uh connected essentially. And when we're disconnected, the same reasons that are disconnecting our bigger environment are the same reasons pretty much that we are disconnecting our micro environment. So you want to love the cuddly creatures.

[00:28:55]Also love the cuddly creatures inside of you. Love yourself. Take care of yourself. Get help what you do. And if your gut is healthy, everything else around you will be healthy, including the bigger environment. So, >> so it's not just protecting these cute cuddly bugs like we were saying, it's also about keeping the other ones in balance on the other side.

[00:29:18]>> Yes. And so here again in in keeping with this analogy and just metaphor is also understanding that when we aren't in balance, when we are creating these unwanted environments, these microbes, there are also microbes that are helpful. Like earlier I was answering questions on H pylori in another talk I was giving previously. Um H pylori is naturally there right uh EC coli is naturally there candida is naturally there every inhale we are breathing in fungal spores however the concentration matters right I don't want to bring breathe in a parts per thousand amount of fungal spores I want to breathe in a parts per billion ideally or or less right I don't want to have candida run wild and so when we create an environment I don't want a bunch of rats in my backyard I'd rather not have a wolf pack around my neighborhood constantly and I keep throwing raw meat out and I'm going, man, why are there so many wolves? And I keep just throwing raw meat in my backyard. It makes a difference of what we do. So, in that sense, wolves are great, rats are great, ants are great, snakes are great. I don't want them in abundance living in my home, right? I want them in balance in nature and us being even more so a part of nature. But I hope you get this analogy in the point where what we do and even the meals and the uh habits and everything we've been talking about >> sleep or extra >> sleep and so much more will then start to make these get out of balance and overgrow. And just like the ants, snakes, wolves and rats, they will take the opportunity to do so if you let them. If you give them that environment, they are opportunists that will grow. I put the python here because as you know in the Florida Everglades, we released a couple of pythons that aren't native there and now they have an overgrowth of pythons. So much so the government is saying if you kill a python we'll pay you money because there's just so many pythons destroying the ecosystem. So there's so many examples of that in the bigger picture. It's also happening in the smaller picture inside of us as well.

[00:31:27]>> But you know, you just kind of explained it was a cause and effect. They didn't just overgrow for no reason. And you know, somebody's commenting, "But humans took way too much of their habitats."

[00:31:36]Very true. But that's what happens in the gut as well. You completely shift the habitat. You completely disrupt something maybe unintentionally.

[00:31:45]And then there's overgrowth of these bugs that can be somewhat opportunist.

[00:31:50]Again, there's nothing wrong with a a few little rats here and there. They're not going to bother anybody, but it's when you have a huge overgrowth. So the same with certain bacteria and microbes in the gut. So when we're talking about these types of disbiosis, whether we want to categorize them all under the SIBO bucket or now we're becoming more picky about what we're calling it because there's no now more types. Um we do know that can kind of offset things as well in the gut. So we have four main types of microbial imbalance where there's usually overabundance. There's usually overgrowth of these. So whether that's hydrogen SIBO where there's an over production or an overabundance of these hydrogen producing bugs things like EC coli or klebella or we know so many different types of claustrdia and other bugs produce hydrogen gas and that's usually fine in its place. But when we have too much hydrogen gas and we have too much, especially higher up in the digestive tract in the small intestine, that's going to affect our ability to digest and absorb our nutrients, our factory line, if you will, and that's going to then cause and trigger other symptoms because when we're then feeding these bugs, we're drawing a bunch of water into the intestines or it's highly fermentable.

[00:33:08]So, hydrogen overgrowth is associated telltale with diarrhea. Um, also with gas production, a lot of my patients with hydrogen overgrowth might have excessive flatulence, but I'm actually finding a majority of them have excessive belching and excessive gas production. Um, so usually it's coming up the other side. On the flip side, we then have these this methane emo, this methane intestinal methanogenic overgrowth where there's an overabundance of a certain type of microbe, not a bacteria, but a microbe called archa. These archa historically are going to thrive where there is already constipation because then it becomes a vicious cycle. They thrive on stool. They then ferment the stool, make the methane gas and that slows down your motility, your gut movement and that causes constipation.

[00:34:02]It causes bloat. It can cause stuck gas.

[00:34:04]And usually you know if you have that methane overabundance because it you can smell the methane. Methane smells like a cow, a petting zoo, an outhouse. So if you say, "My gas, my stool is irregular.

[00:34:17]I don't feel comfortable going to the restroom in public because it has that methane smell." You know, there's something more serious going on. If that happens once in a while, you're like, "Okay, I traveled. I missed a day of bowel movement. It smells." That's normal. If it smells like that all the time, and you're very bloated, you're cumulatively distended because bloat is a sensation. distension as an appearance. If you're very distended, if you're very constipated, if you're you have a lot of stuck gas, you might have methane overgrowth. So, we can assess for that. Um, there are other bugs that can make this sulfury gas. It's called intestinal sulfide overproduction or ISO.

[00:34:56]This is characterized by an overproduction of that hydrogen sulfide gas. And these bugs happen to be the same bugs that are responsible for inflammatory bowel disease. So a lot of those with IBD started out with IBS and it continued to progress because these species ran wild and just triggered a cascade of inflammation. So bugs like fuso bacteria, dulo vibrio, you also have certain types of ecoli that can make this sulfur gas. Um klebsella can make a little bit of the sulfur gas as well. It first will cause irritation in the inside of the gut, the lumen of the gut. It irritates the nerves. So, it can cause urgent stool where it's like, I'm going to poop my pants if I don't go right now. So, it's urgent diarrhea. Um, they can cause a lot of visceral hyper sensitivity sensitivity, that nerve hyper sensitivity, and the sensation of bloat. They might not always look distended, but they feel very bloated and very sensitive. And then, just like methane, there's a telltale smell. This hydrogen sulfide gas smells like rotten eggs. So if your gas, your stool has that rotten egg smell, you might have this iso, this intestinal sulfide over production. Um, and then one of the buddies of these sulfide bugs is actually fungi. Fungi and these sulfur producers, or actually they're not producers, they're reducers. They reduce sulfur. They eat up sulfur to make their hydrogen sulfide gas. but they like to cohabitate with fungi. So sometimes my patients will tell me I had a mold exposure, I became very constipated, had symptoms of candida like oral thrush, vaginal yeast infections, histamine intolerance, then that turned into this sulfur type as well and I go back and forth between diarrhea and constipation.

[00:36:49]Um, but fungi are typically very irritating, very drying. So that is why fungal overgrowth is associated with very dry flaky scalp. So certain types of dandruff are associated with fungal overgrowth on the scalp because these fungi like places that are moist and warm. So not only is that in your house when you have a water leak that can be in the body as well. If you have a very sweaty scalp all the time, you wear a helmet for activities or exercise, you might have fungal overgrowth on your scalp. If your care team has said, "Hey, use ketoconazol shampoo or niserol shampoo." That's an antifungal. So, they're trying to get rid of fungi that has overgrown on your scalp. Um, so there could be an overp production of yeast or fungi. And again, because they're very drying, they often constipate. So, it's very common for those with this overgrowth to be constipated. Um, they're often very bloated. They can experience a lot of belching as well, indigestion. They might have nausea. and they might even see some white specks in their stool.

[00:37:52]So, keep an eye out for these symptoms.

[00:37:55]Um, and Stacy saying, "Consuming olive leaf helped me with my itchy scalp." And that could be, yes, coming from within.

[00:38:03]And I always tell my patients, if we know you have fungal overgrowth, sometimes when we're treating it, things externally actually get worse. As we're upregulating your detox in your gut, sometimes it shares the load and it says, "Look, I'm trying to get rid of fungi or yeast in my gut, so let me push them out through my skin and my scalp."

[00:38:24]And you might initially when you're incorporating something that helps have eczema or dermatitis or have a lot of dandruff. Sometimes my patients will start a protocol, an antifungal protocol, and they'll say, "I got a vaginal yeast infection. It's coming out. Your body's trying to get rid of it." So, that can very much happen. Um, but these are some common types of disbiosis where again these can then alter your motility on their own and either speed it up too much, slow it down too much, um, and then ultimately they can affect your gut barrier with the inflammation that they're triggering. So, we often get asked, okay, well, what do I do about that?

[00:39:00]What what can I eat? Right? Because that feels very controllable. Can you reverse SIBO or any of these types of dispiosis with diet alone? The answer is sometimes. You heard me mention with methane overgrowth, they need stool in order to survive. So sometimes if you only have methane overgrowth and it's because you're constipated. I saw someone comment earlier, this is timely because I went to my doctor this week and literally they said that I was full of it. Um so they were having leftsided pain which is the end of the colon.

[00:39:30]That's where stools going to get stored.

[00:39:32]Um he told me I was full of it.

[00:39:34]Hopefully this will give me some help.

[00:39:35]So yeah, maybe for that person when they're constipated, fiber can really help. Diet can be helpful. Hydrating your stools can be very helpful. Eating the right amount of fiber. For females, we know the bare minimum is at least 25 gram. For males, at least 38 gram of fiber per day. So sometimes, yes, adding the right amount and the right type of fiber can help. We have two main types of fiber. You have insoluble fiber that doesn't drink up water. It acts more like a broom. So think of things like kale and celery and apples and even psyllium husks or the gloopy metamucil that your grandmother used to take.

[00:40:17]That's insoluble fiber that's going to just kind of try to push things out. So we need some of that. We also need soluble fiber which acts like a mop. It drinks up water, right? You don't wet a broom, you wet a mop. So, you want that soluble fiber that drinks up water, acts like a mop, so it can kind of hydrate things along and also clean up any leftover goo or gunk or spots. So, adding fiber can sometimes, yeah, help that stool slide right out, can get rid of methane overgrowth. Sometimes it will not. So, sometimes diet alone isn't enough to correct that dispiosis. Um, so it could be because of something chronic or it could just be more involved. So again, whether it's a kid, I've had kids who after visiting water parks had postinfectious IBS.

[00:41:05]>> So James James can feel that. Um sometimes it's from food poisoning.

[00:41:09]Sometimes it is from a surgery where their motility slowed down and their mobility slowed down and that caused some microbial overgrowth. Sometimes it was from taking antibiotics. Sometimes it was from lack of fiber in the diet or any physical restriction. If they had an injury or a neurodeenerative disease, anything that affects either the way the muscles or the nerves move can cause some of this. Um, so so many different causes for SIBO, but we know there can be lots of different types of management. So this is where as a a dietitian, an integrative dietician, I can make suggestions to people where we can kind of say, okay, first let's figure out, do you have it? Let's get you tested. What do you have? Which type do you have? And then how much do you have of it? Because that's going to dictate how we're going to correct this.

[00:42:03]Because sometimes it can be corrected like I was saying with diet alone. In a couple months, they're feeling great.

[00:42:08]They've added a couple kiwis and some chia seeds and dragon fruit and enough water. And I've had some people are like, "My IBS is gone. That was it. I that was all I needed." Sometimes we'll go further. We'll add magnesium. We'll add fiber powder. Sometimes we add more things to help upregulate their motility. Um sometimes people will take specific antibiotics to target some of those bugs when we know exactly who we're dealing with. I will often recommend herbs, antimicrobial herbs, when we know, okay, we need we have an overgrowth and we need to manage that.

[00:42:40]Um, we'll often use things that upregulate motility. Um, whether that's as simple as peppermint and ginger or maybe that's more involved like 5http that can cause your uh serotonin production to increase. Um, [Music] [Applause] [Applause] hey.

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