The Bi-Phasic SIBO Diet with Dr. Nirala Jacobi

04/19/19 • 34 min

The Functional Medicine Radio Show With Dr. Carri

In this episode of The Functional Medicine Radio Show, Dr. Carri’s special guest Dr. Nirala Jacobi explains the bi-phasic SIBO diet and its relevance to difficult cases of SIBO.

Dr. Nirala Jacobi is a naturopathic doctor and is considered one of Australia’s leading experts in the treatment of small intestine bacterial overgrowth (SIBO), a common cause of IBS. She lectures nationally and internationally about the assessment and treatment of SIBO and is the host of the popular podcast The SIBO Doctor podcast for practitioners. She is the medical director and senior naturopathic physician at The Biome Clinic, center for functional digestive disorders in New South Wales.

Main Questions Asked about the bi-phasic SIBO diet:

What is the bi-phasic SIBO diet?
What makes you suspicious that a patient might be in the group with histamine issues?
How is the histamine bi-phasic SIBO diet different from the original bi-phasic diet?
What about hydrogen sulfide SIBO?
What are some of the things you can do to restore the microbiome?

Key Points made by Dr. Nirala Jacobi about the bi-phasic SIBO diet:

I put the bi-phasic SIBO diet together for practitioners to really organize their treatment approach for their SIBO cases. So, it’s a diet that’s based on the low fermentable carbohydrate diet know as FODMAP diet. I wanted to offer something to patients and practitioners that made it a bit more streamlined.
We get very good feedback with it. Of course, there’s always exceptions and difficult cases as you mentioned, where we may have to make further adjustments to it. But out of that really came also my experience that I mean, the kind of patients that I see now, is not your simple SIBO case anymore.
I see pretty advanced and difficult, and failed cases. And so I saw more and more histamine intolerance, which can actually occur with long standing SIBO and for lots of other reasons as well. And so, we I formulated the histamine bi-phasic SIBO diet.
Some people just associate histamine with allergies, and you just take an anti-histamine for that. But you actually have about five different receptors for histamine in your body, in every imaginable compartment. In your brain, and in your digestive tract. And in your immune system. So, you have lots of different areas where histamine is actually really important. And serves a special function.
When we start to see histamine be a problem, we don’t just see allergies. We see also headaches, we can see gas and bloating. We can see constipation or diarrhea. We see abdominal cramping. We see menstrual cramping. We see insomnia, so you can see how this can be quite confusing.
The difference between the original and the histamine SIBO diets is that we the original one has phase one and phase two still within the context of FODMAPs. Or these fermentable carbohydrates. And it’s phase one is basically very restrictive. And then phase two is a bit more generous. The histamine one really focuses on foods that are high in histamine. So, and as well as fermentable carbohydrates. So, it combines the histamine foods as well as the histamine what are known as histamine liberating foods.
So, phase one of the histamine bi-phasic SIBO diet eliminates both histamine and histamine liberators. As well as FODMAPs. And then phase two, you’re adding in histamine liberators again. And then when you’re done with that, and you’ve identified, or calmed that whole histamine response, you can transition onto the phase two of the regular bi-phasic SIBO diet.
Now, it’s important to mention that you cannot eradicate SIBO with diet alone, we know that. You can manage symptoms with the diet, but you can’t eradicate them. The eradication really comes with antimicrobials. And that’s done usually in phase two.
And these SIBO diets are really not meant for longterm treatment, because we know that longterm reduction in fermentable fibers is really starving your micro biome.
I think as human beings, our ideal diet is likely to be an 80% plant based diet. And within that 80% plant based, to have a lot of variety there. Not just the same eight to ten vegetables.
I actually think the goal of the practitioner is not just to identify SIBO. What I usually tell practitioners is to find the cause of SIBO. What actually happened here. Because we have normal defenses that protect us from bacterial overgrowth. Otherwise all of us would have SIBO, all the time.
It’s really up to the practitioner to identify if this patient has SIBO due to some motility defect. The other area of SIBO causes, or underlying causes, is poor digestion. And then lastly, the last category is impaired outflow. Because SIBO is a...

In this episode of The Functional Medicine Radio Show, Dr. Carri’s special guest Dr. Nirala Jacobi explains the bi-phasic SIBO diet and its relevance to difficult cases of SIBO.

Main Questions Asked about the bi-phasic SIBO diet:

What is the bi-phasic SIBO diet?
What makes you suspicious that a patient might be in the group with histamine issues?
How is the histamine bi-phasic SIBO diet different from the original bi-phasic diet?
What about hydrogen sulfide SIBO?
What are some of the things you can do to restore the microbiome?

Key Points made by Dr. Nirala Jacobi about the bi-phasic SIBO diet:

I put the bi-phasic SIBO diet together for practitioners to really organize their treatment approach for their SIBO cases. So, it’s a diet that’s based on the low fermentable carbohydrate diet know as FODMAP diet. I wanted to offer something to patients and practitioners that made it a bit more streamlined.
We get very good feedback with it. Of course, there’s always exceptions and difficult cases as you mentioned, where we may have to make further adjustments to it. But out of that really came also my experience that I mean, the kind of patients that I see now, is not your simple SIBO case anymore.
I see pretty advanced and difficult, and failed cases. And so I saw more and more histamine intolerance, which can actually occur with long standing SIBO and for lots of other reasons as well. And so, we I formulated the histamine bi-phasic SIBO diet.
Some people just associate histamine with allergies, and you just take an anti-histamine for that. But you actually have about five different receptors for histamine in your body, in every imaginable compartment. In your brain, and in your digestive tract. And in your immune system. So, you have lots of different areas where histamine is actually really important. And serves a special function.
When we start to see histamine be a problem, we don’t just see allergies. We see also headaches, we can see gas and bloating. We can see constipation or diarrhea. We see abdominal cramping. We see menstrual cramping. We see insomnia, so you can see how this can be quite confusing.
The difference between the original and the histamine SIBO diets is that we the original one has phase one and phase two still within the context of FODMAPs. Or these fermentable carbohydrates. And it’s phase one is basically very restrictive. And then phase two is a bit more generous. The histamine one really focuses on foods that are high in histamine. So, and as well as fermentable carbohydrates. So, it combines the histamine foods as well as the histamine what are known as histamine liberating foods.
So, phase one of the histamine bi-phasic SIBO diet eliminates both histamine and histamine liberators. As well as FODMAPs. And then phase two, you’re adding in histamine liberators again. And then when you’re done with that, and you’ve identified, or calmed that whole histamine response, you can transition onto the phase two of the regular bi-phasic SIBO diet.
Now, it’s important to mention that you cannot eradicate SIBO with diet alone, we know that. You can manage symptoms with the diet, but you can’t eradicate them. The eradication really comes with antimicrobials. And that’s done usually in phase two.
And these SIBO diets are really not meant for longterm treatment, because we know that longterm reduction in fermentable fibers is really starving your micro biome.
I think as human beings, our ideal diet is likely to be an 80% plant based diet. And within that 80% plant based, to have a lot of variety there. Not just the same eight to ten vegetables.
I actually think the goal of the practitioner is not just to identify SIBO. What I usually tell practitioners is to find the cause of SIBO. What actually happened here. Because we have normal defenses that protect us from bacterial overgrowth. Otherwise all of us would have SIBO, all the time.
It’s really up to the practitioner to identify if this patient has SIBO due to some motility defect. The other area of SIBO causes, or underlying causes, is poor digestion. And then lastly, the last category is impaired outflow. Because SIBO is a...

Previous Episode

Oral Hygiene and Your Health with Ryan Nolan

In this episode of The Functional Medicine Radio Show, Dr. Carri’s special guest Ryan Nolan explains about the oral microbiome, and how our oral hygiene affects our entire health.

Ryan Nolan, DMD, is a dental materials scientist who is among the nation’s leading clinicians on studying cutting edge preventative oral care. Ryan approaches dental health from a comprehensive standpoint advocating for early intervention, proper diet, custom hygiene regimens and risk factor testing to address problems before they arise. Today he continues to innovate dental materials and hygiene regimens and discover new ways to improve oral health.

Main Questions Asked about Oral Hygiene:

How does our oral health affect our entire health?
What are the signs and symptoms of periodontal disease?
Can you talk about the mouth being the gate keeper to the gut?
Is there a test that dentists can do to see if we have biofilm in the mouth?
Can you expand on proper diet and hygiene?

Key Points made by Ryan Nolan about Oral Hygiene:

A good place to start if you’re talking about systemic health rates and overall health is probably periodontal disease.
People who have periodontal disease are going to be far more likely to have a preterm birth. They’re more likely to have increased chance of atherosclerosis, which is hardening of the arteries. And we know that causes heart attacks. They’re five times more likely to develop Alzheimer’s disease
Periodontal disease is the destruction of the bone, but also the destruction of the tissue; your teeth can get loose and the gums are more likely to bleed, meaning those oral junctional epithelium are not happy
Gingivitis is actually the precursor stage for perio, and gingivitis is essentially just bleeding gums.
If you have bleeding gums, you’re going to get bacteria from the mouth trans-locating to other places. One of those places is the gut. The other thing is that you swallow every four seconds. I’m not necessarily convinced that if you’re swallowing bacteria the acid in your stomach will kill it.
These things are super resistant. The bacteria in your mouth form biofilms, which is the reason why they’re a thousand times more resistant to antibiotics than regular bacteria.
These bacteria can manipulate your endocrine system in your gut and make you crave more sugar.
So with the biofilm really what you’re testing for in the mouth is the various kinds of pathogens that could be there. You land on a spectrum. Either you’re going to have the decay or you’re going to have periodontal disease, right? And so, your risk for one or the other, they’re kind of like inverse to each other usually.
If you have the proper diet, have the proper oral hygiene, you can keep things at a threshold level such that you don’t exhibit or develop disease.
Antibiotics are not the correct method to address biofilm issues in the mouth.
We developed a plant based nano silver rinse, which is very good at getting into the biofilm and resetting the pH to a higher pH, so an alkaline pH, in a much quicker timeframe than saliva can do.
Proper diet is absolutely critical. Your body was never designed to have access to unlimited carbohydrates at any given time. The reason why microbiomes get out of balance is because of people’s diet.
Diet will influence your risk for inflammation. And we know inflammation is the common thread for all the chronic diseases.
A lot of the disease we see is very preventable. And the thing is if you’re taking care of your mouth and you have a good oral hygiene regimen and your diet’s clean, you’re just going to be an overall healthy person.

Resources Mentioned about Oral Hygiene:

R yan’s website

Ryan’s Instagram

Book – Reclaim Your Energy and Feel Normal Again

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The post Oral Hygiene and Your Health with Ryan Nolan appeared first on The Functional Medicine Radio Show With Dr. Carri.

Next Episode

Endometriosis with Dr. Jordan Robertson

In this episode of The Functional Medicine Radio Show, Dr. Carri’s special guest Dr. Jordan explains endometriosis – causes and natural treatments.

Dr. Jordan Robertson is a naturopathic doctor and women’s health author. Through her experience in medical literature review, critical appraisal and research, Dr. Robertson has published over 12 literature reviews on women’s health, and has worked closely with McMaster University, writing and facilitating courses on integrative medicine for the last 10 years, speaking for their medical school and working off-site for the Endometriosis Clinic at McMaster Hospital. Dr. Robertson has most recently lectured for the Ontario Association of Naturopathic Doctors convention on PCOS, PMS, PMDD and Endometriosis, and has published a book for women, Carrying to Term, on reducing miscarriage risk. In her clinical practice she focuses on women’s health issues including PMS, PCOS, infertility, menopause and breast cancer recovery.

Main Questions Asked about Endometriosis:

What is endometriosis?
What causes it?
How would you assess and treat the various aspects of endometriosis in patients?
How long should it take to see improvements?

Key Points made by Dr. Jordan about Endometriosis:

Endometriosis is a gynecological concern, where women have abnormal growth of endometrial tissue outside of their uterus.
Unlike the normal menstrual experience, where the endometrial lining is shed every month, these satellite lesions create chronic inflammation, chronic pain, and a chronic immune response, given that they are growing and bleeding, but with nowhere to go.
2002-2003 was sort of the first glimpse we had at endometriosis being an immune-triggered condition, we were starting to realize that the immune system in those women was not behaving normally, and almost more like an autoimmune-like tendency, where the immune system, rather than helping these women, was actually perpetuating inflammation, and that their T cells, and the cells related to what would typically be related to a sort of cleaning up cells that are where they don’t belong in these women weren’t behaving properly.
There’s some evidence that these women may metabolize hormones differently, that they may metabolize environmental estrogens and hormones differently than other women, and so, they have, say, a more difficult time of clearing environmental estrogens from their body than women without endometriosis. The one that they’ve spent the most time on in the research are the dioxin family of toxins; and we also know that those women differ in their progesterone reception.
I think we underestimate how many women suffer with endometriosis, because the gold standard for diagnosis is laparoscopic surgery.
Some of the advances in research and assessment is identifying that there is a blood test that can rule in endometriosis for women. It’s called CA 125, which was typically a cancer marker for ovarian cancer. It actually does run positive in many women with endometriosis, and so, just as a starting point, women can have that blood test, and rule in endometriosis.
We know that vitamin D is really concentrated in the decidua, which is the uterine lining, and really influences the immune system. Best example of this is the impact that vitamin D has on miscarriage reduction, the same thing happens with endometriosis, and we know that the lower their vitamin D status, the greater their pain, the greater their use of analgesic drugs. So that from an assessment perspective, I think that’s sort of the best sort of surrogate marker for immune function.
The hormonal stuff is interesting, because we generally, conventionally treat endometriosis just by suppressing all hormonal function, which from a fertility perspective, is not really an option for women to have their cycles suppressed like that, ongoing. At some point, they need to come off the drug therapy. But those women actually do benefit from additional progesterone supplementation, especially around cycles where they’re attempting to get pregnant, because their progesterone receptors are lowered in their endometrial lining, and they’re not as sensitive or responsive to their own progesterone.
When it comes to environmental toxins, I would say I just usually treat it empirically. We have collected data on thousands and thousands of women, we know that they eat more saturated fat, they eat more high fat dairy, they eat less polyunsaturated fats in their diet, they eat more refined carbohydrates, they eat less antioxidants, and they drink more alcohol. Their diets naturally, even if we just watch women with endometriosis, are higher exposure to dioxin compounds, or estrogen-like compounds th...