00:00:00
hi I'm no Mar blood founder of the
00:00:02
Digestive Health Institute and creative
00:00:04
of the FastTrack diet today's topic is
00:00:07
gut disbiosis and how to fix it what is
00:00:10
dispos dispos is a negative shift in the
00:00:13
microbial communities within the small L
00:00:16
intestine resulting in health conditions
00:00:18
or symptoms generally speaking it's an
00:00:21
imbalance of gut microbes compared to
00:00:23
healthy individuals what health
00:00:26
conditions are linked to disbiosis there
00:00:28
are many and some have argued that most
00:00:30
health issues begin in the gut but some
00:00:33
prominent conditions include IBS gird
00:00:36
chronic fatigue syndrome Interstitial
00:00:39
cystitis rosacea inflammatory bowel
00:00:42
disease fibromyalgia fatty liver disease
00:00:45
Parkinson Alzheimer's asthma autoimmune
00:00:48
disease obesity epilepsy and many more
00:00:52
symptoms of disbiosis vary but may
00:00:54
include bloating distension abdominal
00:00:58
pain gas flatulence hot bur belching
00:01:01
fatigue headache food sensitivities even
00:01:05
rashes and diarrhea or constipation now
00:01:09
let's talk about the types of dispos
00:01:11
there are basically five types of dispos
00:01:14
including sibo SEO Libo emo and dbio
00:01:20
strain imbalances in the small intestine
00:01:23
we have CBO or small intestinal
00:01:25
bacterial overgrowth and SEO for small
00:01:28
intestinal fungal overgrowth
00:01:30
in the large intestine there is Libo for
00:01:33
large intestinal bacterial overgrowth
00:01:35
and emo for intestinal methanogen
00:01:38
overgrowth there are also dis biotic
00:01:40
strain imbalances that may impact both
00:01:43
the small and the large bowel this is
00:01:46
where stool testing shows the presence
00:01:49
of either a variety of pathogenic
00:01:51
organisms or significant deviations of
00:01:55
normal commensal organisms from a
00:01:57
healthy consensus population such as an
00:02:00
overgrowth of proteo bacteria a shift in
00:02:02
the ratio of firmicutes to bades type of
00:02:06
bacteria or missing Keystone strains
00:02:08
such as ensum mapila or fali bacterium
00:02:12
proitsi and more each type of disbiosis
00:02:15
involves unique imbalances within our
00:02:18
microbial communities it's important to
00:02:21
understand which types of disbiosis you
00:02:23
may have because the treatment options
00:02:25
will vary also keep in mind that there
00:02:28
is a wide VAR viation in individual
00:02:31
microbiomes even among healthy
00:02:34
individuals therefore this variation
00:02:37
requires discretion when evaluating
00:02:40
comprehensive stool test results beyond
00:02:43
the summary page and this requires
00:02:45
indepth understanding and expertise in
00:02:48
microbiology and Physiology now let's
00:02:51
take a closer look at each type of
00:02:53
disbiosis how prevalent is each one and
00:02:57
what are the significant microbiological
00:02:59
shifts in each case for sibo about 50 to
00:03:02
65% of people with IBS symptoms have
00:03:06
sibo based on excess hydrogen or
00:03:08
hydrogen sulfide production detected
00:03:10
with breath testing the type of bacteria
00:03:13
and sibo or the types of bacteria
00:03:15
include small intestinal inhabitants
00:03:18
such as streptococcus and vinella as
00:03:20
well as bacteria migrating from the
00:03:22
large intestine some of those include
00:03:24
eoli klebsiella proteus bacteroides
00:03:28
pratella clusterid and fusobacteria
00:03:31
although recent work by the pmel group
00:03:34
is highlighting a prominent role for the
00:03:37
proteobacterial strains eoli and
00:03:40
klebsiella at least in hydrogen
00:03:42
predominant sibo for more information
00:03:44
seei how to fix sibo and prevent
00:03:46
recurrence video the detection of excess
00:03:49
hydrogen sulfide indicates the presence
00:03:51
of active hydrogen sulfide producing
00:03:54
bacteria these include delov vibrio
00:03:57
species members of the fusobacteria iium
00:04:00
genus and other groupings of bacteria
00:04:03
capable of producing this gas this is
00:04:05
considered a subset of sibo diagnosis is
00:04:08
made using a breath test called trios
00:04:11
this test is like a standard breath test
00:04:14
but it can also detect hydrogen sulfide
00:04:16
in the case of SEO for small intestinal
00:04:19
fungal overgrowth about 25% of patients
00:04:23
with unexplained GI symptoms such as
00:04:25
belching bloating ingestion nausea
00:04:28
diarrhea and gas have seafo we normally
00:04:32
have small numbers of fungi in our gut
00:04:34
but too many particularly in the small
00:04:36
intestine can be a problem species of
00:04:39
fending fungi include mostly candida
00:04:42
Albans but also sea tropicalis C crui
00:04:45
and other fungal strains a type of
00:04:48
disbiosis that is certainly
00:04:49
underreported is something I refer to as
00:04:52
Libo for large intestinal bacterial
00:04:54
overgrowth while the exact percentage of
00:04:57
Libo and IBS patients is unknown it
00:04:59
might be quite High Libo is detected
00:05:02
with ph sensing smart pills in the seeum
00:05:06
and ascending colon as increased acid
00:05:09
compared to healthy controls the acid
00:05:12
comes from increased bacterial growth
00:05:14
fermentation and the production of short
00:05:16
chain fatty acids that lower the ph
00:05:19
these studies indicate more extensive
00:05:21
growth of bacteria in the early large
00:05:24
bowel of IBS patients relative to
00:05:26
healthy controls in other words the
00:05:28
presence of of Lebo now what about the
00:05:30
bacterial types in Leo IBS patients tend
00:05:33
to have higher levels of firmicutes type
00:05:35
of bacteria over bacter ades which is
00:05:38
the opposite of a healthy population so
00:05:41
this would be one thing to look at
00:05:43
though we really don't know for sure at
00:05:45
this point regarding emo we're talking
00:05:48
about an overgrowth of methane producing
00:05:50
ARA organisms a conditioned common in
00:05:54
patients with uh constipation
00:05:56
predominant IBS this represents a prox
00:05:59
Ro imately half of IBS patients or 5 to
00:06:02
10% of the population in the US emo used
00:06:06
to be part of a CBO diagnosis but when
00:06:09
high levels of methane were detected
00:06:11
since these methanogens are not bacteria
00:06:13
we now refer to this as intestinal
00:06:16
methanogen overgrowth or emo most emo
00:06:19
mainly occurs or involves an overgrowth
00:06:22
of methano brevy Bor smithi and mostly
00:06:26
in the lodge intestine but M smithi has
00:06:29
also been identified in the small
00:06:31
intestine now let's talk about how to
00:06:33
determine if you have one or more types
00:06:35
of disbiosis sibo is diagnosed using
00:06:39
lactulose hydrogen breath testing the
00:06:41
definition of a positive test is greater
00:06:44
than 20 pots per million of hydrogen
00:06:46
over the Baseline sample by 90 minutes
00:06:49
if taking the trios smot test greater
00:06:51
than or equal to three pots per million
00:06:53
of hydrogen sulfite at any point in the
00:06:55
test is diagnostic for H2S or hydrogen
00:06:59
sulfide sibo for cifo small intestinal
00:07:02
fungal overgrowth there is no standard
00:07:04
test at this point however it is
00:07:06
possible to sample the small intestine
00:07:09
via endoscopy and quantitate the amount
00:07:11
of fungal growth this was done by Dr
00:07:14
Satish ra a gastroenterologist at
00:07:17
Augusta University who helped Define a
00:07:20
SEO diagnosis and while this method is a
00:07:23
bit invasive it might be worth it if
00:07:25
someone is really struggling and they
00:07:27
can't get to the bottom of things
00:07:29
according to Dr Ralph a positive test is
00:07:32
defined as having greater than a
00:07:33
thousand fungal cells per milliliter the
00:07:36
Libo like SEO there's no standard test
00:07:40
but it may be possible to get tested in
00:07:42
a teaching Hospital such as John Hopkins
00:07:44
because they have access to Smart pill
00:07:47
technology that can measure changes in
00:07:49
intestinal pH and that's how the Libo
00:07:52
connection was initially made another
00:07:54
possible alternative is to get a
00:07:56
comprehensive stool test I routinely
00:07:58
analyze stool test results from my
00:08:00
clients looking at the numbers of
00:08:03
different bacterial species in their
00:08:04
ratio and the ratio of the major
00:08:07
groupings some of which may be
00:08:09
indicative of Libo also a negative
00:08:11
lactulose breath test and the presence
00:08:13
of symptoms and excess gas may be
00:08:16
indicative of Libo for emo it's also
00:08:19
diagnosed using a lactulose breath test
00:08:21
but in this case they're looking for
00:08:23
methane gas levels this can be done in
00:08:26
conjunction with the sibo breath test
00:08:28
high levels of methane greater than 10
00:08:30
pots per million at any point in the
00:08:32
test indicates an overgrowth of
00:08:35
methanogen biosis a challenging to
00:08:37
diagnose but there are definitive
00:08:40
actions you can take to impact all forms
00:08:42
of disbiosis now what about treatments
00:08:45
each form of dispos will respond
00:08:47
differently to various treatments but
00:08:49
they have one thing in common they are
00:08:51
all fed directly or indirectly by
00:08:54
undigested carbohydrates via a molecular
00:08:58
food chain bacteria fermenting mostly
00:09:01
carbohydrates produce large amounts of
00:09:03
hydrogen that can be further processed
00:09:06
by a variety of microbes into methane
00:09:08
hydrogen sulfide and other products sibo
00:09:11
and Libo bacteria depending on the
00:09:13
strains feed on a wide range of mostly
00:09:16
carbohydrates from simple sugars to
00:09:18
complex fibers and starches while SEO
00:09:21
feeds on simple sugars Emo or
00:09:23
methanogens use hydrogen for fuel but
00:09:26
that hydrogen comes from bacteria that
00:09:28
are fermented mostly carbohydrates
00:09:31
likewise sulfate reducing bacteria also
00:09:33
depend on hydrogen to produce hydrogen
00:09:35
sulfide this is why I always recommend
00:09:38
dietary and behavioral interventions
00:09:40
first reducing fermentable material in
00:09:43
your diet and improving digestion is
00:09:46
critical for addressing all forms of
00:09:49
disbiosis while also identifying and
00:09:51
addressing potential underlying or
00:09:54
contributing causes and these would be
00:09:56
specific to your case the goal is to put
00:09:59
your microbes on a diet by limiting
00:10:02
fermentable carbohydrates and improving
00:10:04
digestion through root cause analysis
00:10:07
and potentially via supplementation by
00:10:09
taking our foot off the hydrogen fuel
00:10:12
gas pedal our various control mechanisms
00:10:15
such as stomach acid bile a healthy
00:10:18
mucous layer improved digestion motility
00:10:21
in our immune system are better able to
00:10:24
modulate these
00:10:26
populations keep in mind 30 G of UN
00:10:29
absorb carbohydrates allow bacteria to
00:10:31
produce 10 L of gas imagine 10 L of gas
00:10:34
in your smaller large intestine and this
00:10:37
gas can be converted to methane and
00:10:39
hydrogen sulfide we'll come back to diet
00:10:41
and underlying causes later but for now
00:10:43
let's take a look at mainstream
00:10:45
treatment options each form of disbiosis
00:10:48
for hydrogen predominant sibo herbal
00:10:51
protocols include one from the
00:10:53
University of Pittsburgh and John's
00:10:54
Hopkins using a combination of oil of
00:10:56
oregano berberine antibi bofilm enzymes
00:11:00
and other supplements also combinations
00:11:02
of Allison NE berberine and other
00:11:05
antimicrobial herbals are used by many
00:11:08
practitioners based on their
00:11:09
antimicrobial properties but there's a
00:11:11
distinct lack of published studies on
00:11:14
these types of treatment pharmaceutical
00:11:16
antibiotics for sibo include rifaximin
00:11:19
as well as some systemic antibiotics
00:11:23
such as cicin metronidazol and others
00:11:26
raax is popular because it's a
00:11:29
broadspectrum antibiotic meaning that it
00:11:31
inhibits a wide range of strains and
00:11:33
it's less toxic because it's not
00:11:35
absorbed into systemic
00:11:38
circulation and refaim is approved by
00:11:40
the FDA for ibsd a sibo related
00:11:44
condition other antibiotics prescribe
00:11:46
are prescribed for various reasons or if
00:11:49
ref faxin doesn't work the hydrogen
00:11:51
sulfide sibo bismuth may be effective
00:11:55
alone or with raaen though again the
00:11:58
data is spot
00:11:59
Allison sebecker and colleagues
00:12:01
published an online survey regarding
00:12:03
treatment responses reporting that the
00:12:06
most significant responses were with
00:12:08
people on a low sulfur diet or people
00:12:11
taking bismuth leading some support to
00:12:14
this idea bismuth binds to hydrogen
00:12:16
sulfide which may help with symptoms for
00:12:20
cifo pharmaceutical antifungals are most
00:12:23
recommended fluconazol for instance is
00:12:26
recommended by Dr Ralph ni is also a
00:12:29
possibility in fact one good thing about
00:12:32
nistatin is that it's not systemically
00:12:34
absorbed which is better in terms of
00:12:37
toxicity but there is still a question
00:12:39
about how well this drug survives it the
00:12:42
stomach with the stomach acid some data
00:12:44
in infants suggest that the probiotic
00:12:47
sacy's badii and lactobacillus rosis GG
00:12:52
might also be effective there are also
00:12:54
supplement and herbal treatments which
00:12:56
include castor oil caprylic acid as as
00:12:58
well of olive as well as olive leaf
00:13:01
extract berberine and NAC or na acetal
00:13:04
cysteine there is some thought they may
00:13:06
help with biofilms in general the data
00:13:08
supporting these herbal treatments is
00:13:10
limited and keep in mind we actually
00:13:13
depend on healthy biofilms on the
00:13:15
mucosal surface and disrupting those is
00:13:19
there's a real question mark there if
00:13:20
that's something you want to do or not
00:13:22
now about Libo since Libo is a
00:13:25
relatively New Concept there are more
00:13:27
questions than answers about antibiotic
00:13:29
use but one thing that's clear raaen
00:13:32
will likely not help with this
00:13:33
overgrowth because it requires bile for
00:13:36
optimal activity and most of the bile is
00:13:38
reabsorb by the end of the small
00:13:41
intestine but other antibiotics
00:13:43
including neomy cypro metronidazol maybe
00:13:46
options now what about emo if you're
00:13:49
constipated regardless of your methane
00:13:52
levels it's important to check any
00:13:54
medications and even supplements you're
00:13:56
taking for side effects because many
00:13:58
medicines cause constipation and some
00:14:00
supplements as well the probiotic
00:14:02
lactobacillus rout is uh supported at
00:14:05
least by one study showing it can reduce
00:14:07
constipation and methane levels to some
00:14:10
extent for antibiotics the Top Choice is
00:14:12
a combination of rifaximin and neomy for
00:14:16
inhibiting these methanogens herbals
00:14:18
such as Allison oregano and neem may
00:14:21
also help but again the efficacy of
00:14:23
these herbs has not been proven in
00:14:25
scientific studies there are some
00:14:27
positive reviews and C IC acid but not a
00:14:30
lot of work has been done on this
00:14:32
approach although these pharmaceutical
00:14:34
and some herbal treatments are becoming
00:14:36
mainstream the first line of therapy for
00:14:39
all types of gut disposes in my view
00:14:42
should comprise one diet two gut
00:14:46
friendly behaviors three root cause
00:14:48
analysis and four supplementation to
00:14:51
address known or suspected deficiencies
00:14:54
and here's why sibo and Libo bacteria
00:14:56
are fed primarily by a wide range of of
00:14:58
carbohydrates C4 or fungi are fed by
00:15:01
simple sugars Emo or methanogens and
00:15:04
sulfate reducing bacteria both fed by
00:15:07
hydrogen gas produced from the bacteria
00:15:10
as I mentioned 30 gram of unabsorbed
00:15:12
carboh hydrates allow bacteria to
00:15:15
produce 10 L of gas so whether C sibo
00:15:18
SEO Libo or emo you need to reduce both
00:15:22
the overgrowth and the gases produced by
00:15:25
the overgrowth whether bacteria sulfate
00:15:27
reducing bacteria onome methanogens
00:15:30
excess microbial end products including
00:15:32
gas levels play a key role in damage and
00:15:35
symptoms so putting your gut microbes on
00:15:38
a diet by limiting fermentable
00:15:41
carbohydrates and matching your diet
00:15:44
with your ability to efficiently digest
00:15:46
and absorb those nutrients must be part
00:15:48
of the treatment gut friendly behaviors
00:15:51
and practices are often overlooked but
00:15:53
they're critical as part of the overall
00:15:55
treatment plan in addition to what you
00:15:58
eat when you eat meal spacing snacking
00:16:01
even how you prepare meals and store
00:16:04
leftovers can be important do you eat on
00:16:06
the Run do you grab a snack bar do you
00:16:08
eat slowly and chew well prodiges
00:16:10
behaviors improve digestion and
00:16:13
therefore reduce the amount of
00:16:14
fermentable material reaching the
00:16:17
potentially overgrowing microbes now
00:16:19
identifying and addressing underly Ling
00:16:22
causes there are at the very least 25 or
00:16:25
30 possible causes that are link to gut
00:16:27
disbiosis
00:16:29
and you want to rule out as many as
00:16:31
possible so that you can focus in on the
00:16:33
elephants in the room for your case
00:16:35
through my consultation practice I spend
00:16:38
a good chunk of time on this with my
00:16:40
clients because the root cause analysis
00:16:43
in implementing strategies based on the
00:16:45
findings improve resolution and help
00:16:48
prevent recurrence remember sibo SEO
00:16:51
Libo or emo are not infection so the
00:16:55
concept of killing bacteria fungi or
00:16:57
methanogens with pharmaceutical or
00:16:59
herbal
00:17:01
antibiotics is not necessarily a sound
00:17:03
solution unless your symptoms or you
00:17:06
condition is so serious that in fact you
00:17:09
you need to use antimicrobials but in
00:17:11
most cases that would really be a second
00:17:13
or third line of treatment in my view
00:17:15
dietary supplements are an important
00:17:17
part of treatment for gut disbiosis and
00:17:19
need to be managed judiciously over
00:17:22
supplementing taking the wrong
00:17:24
supplements or taking poor quality
00:17:26
supplements can result in more Comm than
00:17:28
benefit I review all of the supplements
00:17:31
my clients take and often find that
00:17:33
there is little real science backing up
00:17:35
the supplement or the risks outweigh the
00:17:38
benefit another challenge is the sheer
00:17:40
number of supplements some people take
00:17:43
reducing the number of supplements
00:17:44
ensuring they're produced by reputable
00:17:46
companies being stored properly and
00:17:49
having some science to back them up are
00:17:51
things to consider to give this four
00:17:53
poot strategy a try I suggest you read
00:17:55
the FastTrack digestion IBS book and try
00:17:59
the FastTrack diet mobile app FastTrack
00:18:01
diet is a system to quantitatively limit
00:18:04
fermentable carbohydrates in your diet
00:18:07
based on a calculation and a point
00:18:09
system this approach also helps you
00:18:11
evaluate underlying causes address your
00:18:14
symptoms improve your digestion and put
00:18:16
your microbes on a diet thus helping
00:18:19
your own control mechanisms bring your
00:18:22
microbes back into balance there are
00:18:24
several diets for sibo or other forms of
00:18:26
disbiosis but the FastTrack diet is the
00:18:29
only diet that quantitatively limits the
00:18:33
full spectrum of fermentable
00:18:35
carbohydrates including lactose fructose
00:18:38
the many types of fiber resistant stotch
00:18:41
and sugar alcohols except for arthril
00:18:44
limiting these types of fermentable
00:18:46
carbs is supported by the nce guidelines
00:18:48
based on Cochran reviews and the
00:18:50
textbook of primary and acute care
00:18:52
medicine here is a good illustration
00:18:54
about how the FastTrack diet covers the
00:18:57
full spectrum from plant-based diets to
00:19:00
carnivore as well as fasting in other
00:19:02
words fewer of these fermentable cobs or
00:19:05
FP points on one end and many more on
00:19:09
the other on the other end to create an
00:19:11
actionable and integrative road map for
00:19:13
Relief and Recovery based on your
00:19:15
specific case you can contact me at
00:19:18
Digestive Health institute.org if you
00:19:20
like this video please subscribe and
00:19:22
thank you for watching
