In Episode 22 of The Holistic Nutritionists Podcast, Natalie Douglas and Kate Callaghan discuss how to get rid of SIBO and the importance of working with a professional for SIBO treatment.

• Nat and Kate overshare…again.
• What is SIBO + the different types
• Symptoms of SIBO
• Differentiating factors between SIBO and parasites
• Testing options for SIBO and parasites
• Antimicrobials for SIBO and parasites
• Biofilm in SIBO and parasites 
• Dietary Treatment strategies for SIBO and parasites 

• Are you looking for 1-to-1 support and a step-by-step healing process to overcome your chronic gut health issues? Take a look at my signature program, “Gut Rescue” today.

Natalie K. Douglas 0:02
Hello and welcome to The Holistic Nutritionists Podcast. My name is Natalie Bourke, Holistic Dietitian and Nutritionist from HealthByWholeFoods.com.au and with me as always, I have Kate Callaghan, the Holistic Nutritionist from TheHolisticNutritionist.com. Wow, that was a lot of nutritionists in one sentence. You think I’d nail it by now, I’ve said it like 20 something times. Anyway…

Kate Callaghan
Nutritionist.

Natalie K. Douglas
Nutritionist. I can’t even spell it either. I know that sounds really, like really, like come on graduate from primary school. But there’s just like, when I type it really fast. I just seem to type all the wrong letters. And then I look at it. I’m like, I’m not sure if that’s right. And I have to like sound it out like nutri-tion-ist.

Kate Callaghan 0:46
You know, you, I actually have to do that. Sometimes when I’m telling people on the phone, my email address, I tell them what it is. I said [email protected]. And then I think don’t ask me how to spell it all. There’s a lot of Ts in there.

Natalie K. Douglas 1:00
Yeah, there is. I know, like, dilemmas of having a long name as well.

Kate Callaghan
First world problems here.

Natalie K. Douglas
I know, so many first world problems. I actually have a first world problem. I’m going to the dentist today. And it’s like the first time, well, I went for the first time a couple of weeks ago in like nine years because I’m scared of the dentist like literally scared of them. And now I have to go back today and get a couple of feelings. And I’m really nervous. And my dentist looks like Brad Pitt, which is even more intimidating. He’s really lovely. And like they’re very holistic, but it’s really intimidating to have Brad Pitt looking in your mouth.

Kate Callaghan 1:38
So two things on that. One, I’m also scared of the dentist and haven’t been in about 10 years and I probably need to go. And the other thing when I had a colonoscopy is probably too much information. But anyway, in 2009, before I was diagnosed with celiac disease, so I had to have a colonoscopy, which for anyone out there who doesn’t know what a colonoscopy is, it’s where you get the camera up your area, your area bottom behind itchy colon. Anyway, so I was going in for this procedure which you have to go undergo general anesthesia. Lying on the table went in to meet my doctor who’s going to be doing the procedure. Hottest guy ever.

Natalie K. Douglas 2:18
Oh no. So bad. There should be a law against that. You must be like…

Kate Callaghan
Sticking a camera up my butt.

Natalie K. Douglas
Yeah, that’s not your best moment.

Kate Callaghan
No.

Natalie K. Douglas
I don’t feel so sorry for myself now then. Like I’ve actually one time. I’m gonna give share too much information too. When I had a lot of gut issues. I had like I was, I was paranoid that there was something like, torn in my butt. Because on the toilet paper when I wipe there was like a dot of blood. So I made my mom take me to the emergency services room. We went there, and the doctor there had to stick his fingers up my bum. And then like he wasn’t hot, but then I was like, so worried that there was something wrong or that I’d like bleed or something like that. So he gave me an adult nappy. And I don’t know if anyone’s ever seen it, adult nappy but it is humongous, an adult nappy to wear at home. And I was like, Oh my god, my mom, my poor mom.

Kate Callaghan 3:14
This is, this is starting off strong. We are starting strong today. I worn, I worn a newborn nappy when my water’s broke with Olivia. I didn’t have any maternity pads. And so I put a newborn nappy on.

Natalie K. Douglas 3:27
Oh my gosh, that’s funny. We are, we are classy humans, whatever, everyone has these embarrassing stories.

Kate Callaghan 3:35
Everyone’s turned off. They’re not listening anymore.

Natalie K. Douglas 3:38
Well, they shouldn’t have because we’re actually about to talk about gut issues. So…

Kate Callaghan 3:42
Hey, can I also share something?

Natalie K. Douglas
Yes, of course.

Kate Callaghan
We got a listener comment, emailed through, from Rachel. And I just like to read it out. And Rachel says, I was enjoying you and Nat’s latest podcast the other day. So that was on meal prepping.

Natalie K. Douglas
Yep.

Kate Callaghan
While on the commute. Always such a bonus, when you have a new episode out and I wanted to extend the comment. So I’m from the States to Iowa to be exact, and there was a restaurant called Bob’s Your Uncle.

Natalie K. Douglas
That’s so funny.

Kate Callaghan
I always wondered where that name came from, maybe the owners from New Zealand. I’ll have to find out. But either way, I just thought I would let you know that it exists over here.

Natalie K. Douglas
That’s so good.

Kate Callaghan
Anyway, just want to tell you how much I enjoy your podcast and how accommodating a healthy lifestyle takes so much preparation and mental agility to handle it all. Thank you for doing the podcast on bulk cooking. It was like you knew what I was thinking. I spent the whole weekend preparing crockpot chicken curry, among other bulk recipes. For the morning. I also have been baking egg, afritadas with sweet potatoes, kale and other veggies and some grass-fed beef or pork here and there is a lifesaver for the morning.

Natalie K. Douglas
Nice.

Kate Callaghan
Yeah.

Natalie K. Douglas 4:47
She should come over here and cook for us.

Kate Callaghan
Yeah.

Natalie K. Douglas
That would be nice. And that’s really funny, Bob’s Your Uncle, so good. All right, well, we’re going to get started. So that we can actually give you some useful information today. So what we’re actually talking about is SIBO and Parasites. So we’re going to aim to give a bit of a general overview of it. And then if you guys are interested in hearing more, then please write in, and we can go in-depth or further in-depth into either one of those topics. But for today, we just want to give you a bit of a broad overview of what the conditions are, maybe what are the symptoms, and also maybe what are some of the, I guess, distinctions between the two, how to get tested, and maybe some treatment strategies. But you know, with all treatment strategies is always going to be what we suggest is a general guideline of what we usually do with our patients. But it’s really important to get it tailored to you as an individual. So I’m just going to start with talking about SIBO. So for anyone who’s not aware, SIBO is Small Intestinal Bacterial Overgrowth. So what, in a nutshell, what it is, is when bacteria that should be in your large intestine actually overgrow in your small intestine, and there are number of different causes or reasons why this could happen or triggers. But it’s not something that you want to happen because what essentially we want is the bacteria, mainly to be in the large intestine, that’s where they should be when they start to creep up into the small intestine. That’s when you start to see a lot of the symptoms in terms of things like bloating, abdominal discomfort, constipation, or diarrhea, and it makes it you know, really hard to be comfortable, as you can imagine, with all those things. So that’s the general overview of what SIBO is. There are also two types of bacteria that are overgrown in SIBO. So one will be hydrogen dominant, and one will be methane dominant specie. So that’s only, that’s something that you will pick up on a breath test when you do testing for SIBO. And the, it matters because it will change the type of treatment or the type of antimicrobials that will often be used. So that’s just something important to be aware of, in terms of, you know, making sure you are getting tested so that you’re getting the right, you’re understanding what bacteria is overgrown if they’re already and therefore you’re able to get the right treatment.

Kate Callaghan
Perfect.

Natalie K. Douglas
Thank you. So in terms of symptoms of SIBO. I already mentioned a few of them. So they do, they are quite similar to a lot of other guts or gut conditions that you’d see especially parasites, but generally, as I mentioned, the symptoms are either constipation or diarrhea, abdominal discomfort, abdominal pain sometimes, bloating, can be burping as well or reflux. And also, you can have like brain fog and all these kind of very nonspecific symptoms that seem to be able to go into a lot of different conditions, but they’re just a few of the very common type symptoms that you can have. In terms of what symptoms would you, I guess, or how would you differentiate between, do I have SIBO, or do I have a parasite, without testing, which I wouldn’t advise doing. I wouldn’t advise testing but just based on symptoms alone, which one would I, like how would you differentiate it. Generally speaking, if you’ve got SIBO, taking probiotics or eating fermented foods will be really difficult for you. And you’ll find that actually worsens your symptoms as opposed to doing nothing or making them or improving them. Another bit of an indicator is that if you happen to go on a course of antibiotics, you’ll actually find in a lot of people with SIBO that that actually temporarily provides them some relief from the SIBO symptoms, whereas you wouldn’t see quite that in terms of someone with a parasitic infection. They would be the two main, I guess, differentiating factors between parasites and SIBO, but not always today occur. So sometimes the lines are very blurred and it does take testing for both in order to figure out what is, what is going on in your gut specifically. So I guess, on that note of testing, there are tests for both SIBO and tests for parasites, for SIBO it is a breath test and the company that I use are SIBOtest.com, it requires a practitioner to be, you have to be under the care of a practitioner in order to receive that test. But there are a list of practitioners on that site who often use that testing and who are trained in SIBO. And what that testing involves is a breath test, which you do at home, you follow a prep diet for 24 to 48 hours beforehand. And then you basically breathe into test tubes every 20 minutes for about, I think 10 test tubes per test. And there are different types of substrates. So different types of testing material that you would use depending on what your practitioner chose. So there’s lactulose, and there’s glucose, and there’s also fructose. Most commonly, in my practice, I will run the lactulose and the glucose because it covers the kind of upper part of the small intestine as well as lower, the lower down part of the small intestine to see where the bacteria are overgrown. And then based on that testing, the report will come back and your practitioner would receive that and it would indicate as to whether there is a hydrogen dominant bacterial overgrowth or a methane dominant bacterial overgrowth, or if there’s nothing at all. On the contrary, Kate, did you want to just chat about what parasite testing is compared to SIBO testing, just in the general?

Kate Callaghan 11:12
Yeah, so parasite testing, I usually get that as part of a comprehensive stool analysis. So the reason why don’t just get parasitology alone, is I like to see with a comprehensive stool analysis, we can see things like beneficial bacteria, commensal bacteria, which are kind of the ones that hang out there and not do much unless they’re overgrown, and then your pathogenic bacteria, which are the bad guys that can cause trouble. So you see all of that, that also picks up things like yeast as in Candida, it can show markers of inflammation that could suggest things like Crohn’s and ulcerative colitis, or Irritable Bowel Disease. It can show up a whole host of things that could be going on but it also tests for parasites, and I always get parasitology x3. So it basically means it’s going to take three samples, to make sure that you’re not going to be missing, potentially missing that parasite in there. So that’s as opposed to a breath test, it’s a stool test. So slightly more invasive, you’ve got to put in a cup.

Natalie K. Douglas
It’s pretty exciting.

Kate Callaghan
But, you know, you really don’t want to not know about this. And you know, as you said, testing is important in terms of the treatment. We always say, test, don’t guess, because you don’t just want to treat things willy nilly because you can potentially do more harm than good. And you need to differentiate between what’s, what’s really going on. And so, what the stool test does sharp is if you have a parasite, and also show up, what kinds of parasite you might have. Hopefully, you don’t have more than one parasite, how bad that parasite is, and also how you can best treat it. So given your specific parasite, and how it’s living in your body, the stool analysis will treat it essentially in a little petri dish, and see what it responds to best.

Natalie K. Douglas 13:01
Yeah, so yeah, I think that’s a really good summary. And an important point about doing the stool test across a number of days, because, as you mentioned, you don’t like, you don’t want to just do one day because not always will there be parasites present in that one stool, which is why three, three stool samples is really important. And it is an investment of money to purchase the, the Comprehensive Stool Analysis with Parasitology x3. But it’s a worthwhile one, especially when, you know, you could spend so much money and time going through multiple diets, multiple supplements, and nothing providing you relief. Whereas if you’ve got help in terms of what’s actually going on, it’s much easier for whatever practitioner you’re working with, to be much more specific and targeted in terms of your, in terms of your treatment. And as Kate said, you know, not testing and just prescribing antimicrobials or other herbs just willy nilly is not the best idea. Because although antimicrobials are natural, they still have a very strong effect on the microbiome, and they still have that potential to wipe out good bacteria as well. So you really want to make sure that there is actually something there to wipe out, as opposed to, you know, just assuming that as well. So I think that’s an important point, point to make. Now, in terms of the most common parasites, the most common ones that I see, in a lot of stool analysis, analysis-is-is.

Kate Callaghan
Analysis.

Natalie K. Douglas
Analysis. In all the stool tests that I’ve seen, there are, the main ones that come up are blastocystis hominis, dientamoeba fragilis, and H. pylori, which often that’s done through a breath test as well. So they’re probably the most common ones. And eradicating them can be challenging. And, you know, sometimes I use, I refer people to use antibiotics, and sometimes I don’t, so I’m starting to lean more towards not using antibiotics to eradicate parasites. However, in the past, I have done and have been successful. But I’ve also seen a lot of it, a lot of the time people take antibiotics for parasites, and it is unsuccessful, and they’re left with a worse off, gut as well. So it’s really about assessing it on a case by case but, I guess analysis, but there’s more and more research coming out about the successful treatment of parasites with anti-microbial. So that’s something to be aware of. And I would arguably say that trying the natural, I guess intervention, first would be my first recommendation, as opposed to going the other way. So that’s just my personal thoughts. And as I’ve said, my opinions and my views on that have changed over time, as I’ve become aware of more research and had more experience trading them naturally. So that’s just something to, to take on board and other practitioners may have a different opinion. But I would say it’s really good to work with someone who is experienced in eradicating parasites, because, you know, it can be an expensive process when you’re using lots of different supplements. So, you know, you want to work with someone who has some pretty solid knowledge in that area and can guide you in the right direction and base on all of their recommendations on both the research and also clinical practice experience. Because I think that that counts for a lot in practice as well. Now…

Kate Callaghan 16:42
Do you want to talk about what antimicrobials are and what’s, what’s forms that you would generally use?

Natalie K. Douglas 16:48
Yep, so, I’ll start off with just explaining what they are. So antimicrobials are actually what it sounds is just natural substances that have an anti-microbial, so microbes being bacteria, yeast, fungi, all that kind of stuff. They have an action that enables them to get rid of those. So, in terms of SIBO, a lot of, I guess, the main ones that I would use and look, the amounts of these would differ depending on how overgrown the bacteria were, and also which type they had. But in general, I would be using things like berberine, in quite high doses, particularly for hydrogen dominant SIBO, oil of oregano, also thyme oil can be really helpful. So essential oils are really good in that. Allicin, which is one of the active constituents of garlic is very helpful. And that’s actually particularly helpful in methane dominant SIBO, and one of the, I guess, one of the few antimicrobials that are very effective in treating methane dominant SIBO, because unfortunately, methane dominant SIBO is a bit more difficult to treat than hydrogen dominant SIBO. And there’s lots of, you know, good work being done in terms of looking into additional antimicrobials that can be, can be helpful in that situation. But at the moment, I would say allicin, from garlic is the most commonly prescribed antimicrobial. And then other things could be peppermint oil, which again, does have antibacterial, anti-fungal actions as well. And also making sure when you’re treating SIBO that you’re on some kind of prokinetic. So what that means is something that is causing your migrating motor complex, so, it’s something inside your gut that causes all the food to be pushed through so it doesn’t get stuck in your small intestine and left there to be fermented by bacteria and hence the overgrowth. So the most common I guess, agents that help with that motility would be things like ginger, 5-HTP, and also N-Acetyl Cysteine can help as well. So there are medications as well that are used in, in that area. I’m not as familiar with those as I am with the natural substances and that would so the the ginger, the 5-HTP that would be my main, the main one that I would be using in terms of creating more motility. The other thing that’s quite important in SIBO is to prescribe some biofilm disrupting, I guess herbs or nutrients as well. So a biofilm is just basically like a little protective layer that bacteria build over themselves to protect themselves and to help them survive. And so what we need to do is we actually need to break down that biofilm in order to be able to I guess, get to those bad bacteria and, and kill them off. So in terms of biofilm disrupting nutrients, or herbs, generally you’re looking at things like, different like serrapeptase is one that I often use but protease in general is quite good. And digestive enzymes like cellulase and lipase. Also pomegranate, which is rich in allergic acid is also really helpful as well. And these are things that you would be taking in between meals, because you’re trying to break down that biofilm layer, as opposed to helping digest your food. So can be a bit confusing, which is why again, you would work with a practitioner when you’re doing these things. But it’s just another thing to make sure is on your list when you’re, you know, seeing a practitioner and making sure that they’ve addressed that as well, because that is a crucial component. In terms of other strategies as well. You do want to be looking at temporarily in a SIBO treatment protocol, removing fermentable fibers, so there’s a lot of different approaches to dietary management of SIBO and but the most common kind of strategies are a low FODMAP diet, or the SCD diet, which is a Specific Carbohydrate Diet, or the GAPS diet and all these collectively are essentially trying to starve off in the context of SIBO. They’re trying to starve off the bacteria that are overgrown. But I caution against doing these diets long term because yes, we do want to starve off those bacteria, bad bacteria that are overgrown. However, we don’t want to starve our complete microbiome for a really long time because as we know, we need good bacteria in order to be optimally healthy. So that would be right, my recommendation, that recommendation is exactly the same with parasites in terms of the dietary approaches. However, in terms of parasites, the antimicrobials that are going to be used are going to depend on which specific, which specific, I guess, parasite that you have. So I’m hesitant to give like a whole bunch of recommendations in terms of antimicrobials, but I will mention some but as I said, it’s going to depend on which specific bacteria is overgrown. So things like Chinese wormwood, barberry, which is rich in berberine, grapefruit seed extract, ginger, black walnuts, these are all really good things to be including in an antimicrobial type of, I guess, protocol. Clove oil is another one and again, making sure that you are getting in those biofilm disruptors as well. So that can all be really important in, in an effective protocol and being patient like sometimes these things take time, like a good kind of, I guess, four to six weeks, sometimes a bit longer, sometimes eight weeks protocol is needed to see some kind of shift. And sometimes you need more than one round. But it needs definitely to be addressed on a case by case basis. And you also need to be mindful of not starving off the good bacteria for years on end. So that would be I guess, my main points there. Kate, when, what was I going to say? In terms of your approach, say after someone has been treated for a parasite or SIBO? Do you, do you introduce, reintroduce foods one at a time in terms of kind of high FODMAP foods or just high carbohydrate foods that they’ve removed?

Kate Callaghan 23:58
Yeah, so as you said, I’d encourage them to follow a low FODMAP diet for quite some time, and then reintroduce higher FODMAP foods. I like using the Monash University Low FODMAP App, that’s where most of the research around FODMAPs comes out. And they basically give you a traffic light system, green is good to eat on the low FODMAP, orange is not so good, red definitely avoid. And so what we generally do is say for example, one cup of sweet potato is too high in FODMAPs and not recommended. But you might be able to have a quarter cup of sweet potato and be okay with it. So we’d start with that. So different levels of foods first and then slowly reintroduce and you’re definitely one at a time, three days apart. It’s long, it’s drawn out, but you’ve really got to figure out your tolerance for different foods. What I will say as well in terms of especially for the SIBO. So, you spoke about the prokinetics and ensuring that you know, gastric motility keeping things moving through. Stress management, and also for SIBO in general. Stress management is really, really key. So we do know that stress decreases your hydrochloric acid, so your ability to break down through to stomach acid and can slow things down. I would also simultaneously get your thyroid checked because that can slow down motility and affect overall results. And the only other thing I would add on to the antimicrobial is the herbal treatments. A lot of people are aware that oregano oil is really powerful in treating SIBO and in treating parasites and a lot of people know that I’m now pretty keen on doTERRA oils. What I will say is, don’t just take these willy nilly, yes, they’re really effective, but they’re really effective. Like, it’s not just, okay, it’s natural. So I can take as much as I want all the time, I see a lot of people just taking oregano internally, daily, to boost their immune system, these can actually wipe out your beneficial bacteria. So it’s awesome to take short term, but honestly, I would always work under a healthcare practitioner when you’re doing that, and only take it for a short period of time as Nat said and then repopulate because it’s powerful stuff.

Natalie K. Douglas 26:16
Yeah, exactly. Well said. And, yeah, I agree with you. I think that, you know, as much as we are using natural things, as I mentioned at the beginning, and as you, as you’ve just mentioned, they’re, they’re still very powerful. So, you know, don’t underestimate their power, just because they have the label of natural like, they need to be prescribed appropriately. And you need to make sure that you’re following up with your practitioner regularly as well, and not just going on an antimicrobial protocol, not going back to see them, and just leaving yourself on that on that kind of heavy antimicrobial therapies for long term, it’s not, not doing you any favors. So that’s really important that if you are going to see a practitioner, you know, make sure that they’re the right person for you. But then make sure that you go back like it’s, it’s as practitioners, it’s really hard to treat you if you only come once and then don’t come back or, you know, you keep canceling your appointments, and then you come back to us. And you know, that ship has sailed, you’ve already kind of taken antimicrobials for a super long time, at still the same doses. And we haven’t had the chance to check in with you. See how you’re feeling, see how you’re responding, and to adjust our treatment protocols for you as well. So that’s something that is important from our perspective to let you know, in terms of how to get the most out of working with a practitioner.

Kate Callaghan 27:42
Yeah, definitely. And, as you just said, working with a practitioner, but not just until everything’s eradicated, but also working with them on going to heal your gut.

Natalie K. Douglas
Yes.

Kate Callaghan
After and repopulating. So oftentimes with this, if you’re taking antibiotics, or the prescribed medication, or the antimicrobials, you will possibly decrease your beneficial bacteria as well. So you need to repopulate everything after, you need to slowly reintroduce carbohydrates, and you need to manage that along the way so you don’t backtrack.

Natalie K. Douglas 28:13
Yeah, exactly. All right. Well, unfortunately, we are out of time today. But hopefully, that gave you a big, I guess, lowdown on what you should be aware of in terms of parasite and SIBO treatment protocols, and also how we recommend testing for them. Of course, that was just, you know, a big overview and nothing prescriptive. And we don’t want you to go away and just write down all the herbs that we’ve mentioned and go and self-prescribed because that’s exactly against what we’re recommending. But just something to be aware of so that if you do have these issues, and these signs and symptoms of SIBO or parasites, you know, generally what you want to be on the lookout for, and you’re aware that there are natural options that you can try that may be effective for eradicating both of those things. And you can work with a practitioner to do that. Of course, if you guys want any further information on either of those topics or if you’re looking for a practitioner to work with them, we’re more than happy to help. Kate, when you’re going on maternity leave just so I could…

Kate Callaghan 29:22
I’m going to say maybe go to Nat, not me, because I’m due in three weeks. I’m due 24th of July and I’ll be taking a few months off so.

Natalie K. Douglas 29:31
Well, then lovely people it’s me until Kate’s back. I can help and I do like all jokes aside, I do have a lot of experience with treating SIBO and parasites. I’ve had multiple parasites myself when I was younger and got rid of all. Actually I had two, and a lot of dysbiosis. And I healed that and I’ve seen many patients with SIBO. So if you are stuck, and you are needing help, then I am your man. And by man, I mean lady, so please contact me. All right.

Kate Callaghan 30:07
By the way, I spoke to one of my friends before and she said she loves the podcasts. And she’s laughing that we’re both weirdos and we complement each other. We complement each other’s weirdness.

Natalie K. Douglas 30:16
We do and it kind of makes me forget how weird I am. But then…

Kate Callaghan 30:20
You definitely are weird.

Natalie K. Douglas
I know.

Kate Callaghan
I love it. I am too.

Natalie K. Douglas 30:23
Then I get out in the real world and people are like, you can’t say that. And I was like, what? What do you mean?

Kate Callaghan 30:29
It’s weird, all the things you say.

Natalie K. Douglas 30:31
Yeah. All right. Well, that’s pretty much all. I don’t have too much more to add. I’m just feeling really nervous about my dentist appointment with Brad Pitt. And that’s bad.

Kate Callaghan 30:44
At least he’s not sticking a camera up your butt.

Natalie K. Douglas 30:45
That’s true. I’m really happy about that. And you’ve made my day. I’m going to keep that in perspective when my teeth are being like drilled. All right. Well, do you have anything to add on top of that before we sign off?

Kate Callaghan 30:58
No.

Natalie K. Douglas 31:00
Okay. All right. Well, we will catch everyone soon. And Kate Have a lovely day.

Kate Callaghan
You too, Nat.

Natalie K. Douglas
Bye.

Kate Callaghan
Bye.