Adapted from episode 156 of The Perfect Stool podcast and edited for readability with The Microbiome Expert, Guy Daniels and Lindsey Parsons, EdD.
Lindsey:
So since I have covered SIBO and IMO on this podcast ad nauseum, we’re going to jump right into an advanced discussion of SIBO. So let’s talk about how SIBO affects absorption of nutrients in the small intestine, and what common patterns are seen in SIBO patients?
Guy Daniels:
Okay, so I work with a tremendous number of SIBO people. In fact, my most popular protocol is SIBO with constipation, and I have protocols, and then I have the consultation themselves. Let’s start with what is SIBO, right? So SIBO is basically the permission that you’ve given to bacteria to be allowed to creep on up the GI tract. How have you given them permission? By various lifestyle factors, for example, taking PPIs. Right? You take PPIs, you drop the stomach acid, etc, or you’ve had antibiotics over the years and a lot of courses. And this is very, very common. This is the most common thing I see. I would say about 70% of the time, the root cause for people’s GI and other extra GI issues is excessive antibiotic use. So what does that do? That’s a slow process, sometimes a quick process, but usually a slow process, of killing off the good guys in the lower gut, in the upper gut as well, and actually all over the body, because you get yeast infections, etc., with antibiotics.
But in the context of SIBO, you’re killing off the good guys and the bad guys in the lower gut, but the bad guys come back more robustly, and they want to control the environment. So what is SIBO? SIBO is bad guys from dysbiosis creeping up from the lower gut and the permission in the upper gut to let them take up residency there. Now, there’s always a microbiome in every part of the body, and there’s a typical, supposedly healthy microbiome in the Upper GI, the duodenum and the jejunum, etc. But that can change, because if you have bile acid dysmetabolism, one of the things that keeps that microbiome where it’s supposed to be is the correct balance of your bile acids, which come out as you eat a meal with fat, etc.
The other part is stomach acid. Another part is gut motility, and this other part is too many bugs creeping up the gut that are too high in number and not the right composition. So what do they do? Oftentimes, they slow down motility. So you get this ileal braking going up. You’re not able to digest fats properly, so you get into the ileal braking with that because your bile acid metabolism is off, so everything slows down. And because it’s all slowed down, that allows for more fermentation, and that is where we get to our methanogens. Everyone’s always blaming all methanogens and the methanogens are there, right? Your methane producers are there because they’re allowed to be there. They’re not normally supposed to be there, but because things have slowed down to a crawl, and because they have permission to be there, because they’re the final consumers, the end stage, right? They’re just taking the scraps that are left over. But if you’re moving things along in the Upper GI, they can’t survive that dynamic environment. If you have proper bile acid metabolism, they can’t survive that dynamic either. They’re not the guilty party. The guilty party is actually you, the person who has given these bugs permission to be there. Now to come to your question, so bile acids metabolism which means you are absorbing your fats properly – so you have more fats working their way down to the lower GI. If you’re using PPIs or have a history of prior PPI use, you have low HCl. You have too much protein reaching the small and ultimately the lower GI as well. There’s extra fermentation going on there. And then, of course, you have the carbohydrates, which are doing too much fermentation in the upper GI as well due to the slow motility. Then along with that, you get inflammation, and you get improper absorption of the nutrients that you’re trying to absorb in the small intestine.
Lindsey:
So how do you get to the point where you have disrupted bile acid metabolism? What’s going on there?
Guy Daniels:
So this is an important thing that people are not talking about. I’m really the only person talking about this, and this has been the case for many years. Bile acids impact the microbiome. The microbiome impacts bile acids. It’s a two-way street. What happens in the body is primarily secreted into the duodenum. Are what are called primary bile acids, okay, cholic acid, deoxycholic acid, and they’re conjugated usually with either taurine or glycine. So they’re supposed to come in, but technically there’s really a mix. There’s actually something like 40, 50, 60, something like more than that, bile acids. But there’s really only a handful that are key and crucially important. These bile acids are supposed to come in and help with absorption of fats and fat-soluble vitamins, like vitamin A, vitamin E, et cetera. But they do much more than that, because they are hormones as well. And not only do they plug into receptors in the GI tract, they plug into receptors outside of the GI tract, as far away as the brain. They are very powerful hormones.
Now what’s supposed to happen is it’s supposed to be deconjugated. In other words, the taurine or the glycine is supposed to be separated from the primary bile acid. And as they travel further on down to the ileum and into the duodenum, they’re supposed to be then broken apart again and become secondary bile acids. Now there’s a tremendous amount of data to show these secondary bile acids are beneficial, and there’s also a tremendous amount of data to show that the really good guys, and there’s only a handful of them, are responsible for making this transition from primary bile acids to secondary bile acids, which are very susceptible to antibiotics. So when you get to the classic ultimate case of dysbiosis, which is a C Diff infection, right? What is that? And there’s a ton of data to show this, there are too many primary bile acids, the chief culprit being taurocholic- which is your cholic acid, the primary bile acid, which is still bound to taurine, and that enables C diff, which we all are going to have at some point in the course of a year. We’re all going to have C Diff spores in our body. That allows C Diff to become particularly notorious and dangerous and potentially deadly. So that’s kind of the cycle of events of how the microbiome is affecting the bile acids. In turn, the bile acids affect the microbiome by being anti-microbial in nature. So as you secrete the bile acids into the duodenum after a meal, they are actually detergent in nature, and they’re killing off these bacteria (not all because there are some bacteria like bilophila, etc, which are resistant to bile acids). But there are also a bunch of culprits in SIBO, who are potentially killed or are killed by these bile acids in the upper GI. So it has an antibacterial nature as well. And this is gut motility. And like I said, there’s a hormonal component in the liver, in the pancreas, so part of this too, as well with SIBO, is when you have all these extra bugs in the upper GI driving this fermentation, you would think that the duct between the liver and the gallbladder in the pancreas is sterile, but it’s actually been shown that it’s not the case, and that actually gets “contaminated” as well. With SIBO, you have this different microbiome in that area as well that starts affecting gallbladder and your pancreas. So when you change your bile acids properly, because everyone’s taking enzymes, now you’re affecting pancreatic enzyme production better when you have a proper blend of bile acids. This is just one big loop, and everything’s all connected, not just here, but in the entire body. And so people are always like, okay, I’m going to take enzymes and I’m going to take HCl and I’m going to take this, but they’re always just plugging holes in the dike and they’re not addressing all aspects of what’s going on.
Lindsey:
Can you explain ileal braking a little bit?
Guy Daniels:
So basically, when you have too many fats reaching a destination in the lower small intestine that shouldn’t be there because they should have been absorbed previously, the ileum just kind of comes to a screeching halt and basically says, okay, we’re taking in enough food. We don’t need any more. You need to absorb those fats, those proteins and those carbs further up the GI. Otherwise they’re subject to fermentation in the lower GI. Now, when it comes to carb fermentation in the lower GI, which is where you were supposed to have a bunch of what we call fiber/prebiotics, and prebiotics is actually not defined correctly. But anyway, so prebiotics, the good ones are sugars or carbs that are locked up behind bonds that we can’t access. So those are the ones we want to go to the lower GI. That’s what would feed the good guys. But we don’t want the more simple sugars and the carbs and the fats and the proteins, we don’t want those guys going to the lower GI. Some will, by their very nature, some will, but too much, just like with the carnivore diet. So if you take the carnivore diet, which is just all protein and fat, there’s a whole bunch more protein working its way down to the lower GI for fermentation. But the bad guys tend to like to ferment protein. So that’s where we get into problems with the carnivore diet.
Lindsey:
Yeah, I see a lot of people with hydrogen sulfide SIBO who are former carnivores or keto. They got into that situation there.
So I can tell from listening to your videos that you are among the small group of gut health specialists, that I sort of include myself in, who look disfavorably upon the traditional approaches of killing off microbes with strong antimicrobial herbs and antibiotics in dysbiosis and SIBO and IMO. So I’m wondering how and why you arrived at that place.
Guy Daniels:
So years ago, I spent quite a few years as the director of medical education for a microbiome firm, and I spent most of my time, and honestly, I still spend most of my time doing research, just reading paper after paper after paper, literally 1000s and 1000s of papers. I take meticulous notes. I have a massive Excel sheet. Because initially I walked into this whole thing thinking, okay, yeah, because I’ve been in this industry for decades and, I come from, okay, yes, oregano oil and yes, probiotics and blah, blah, blah. Once you start going through the data meticulously, it’s like, wait a second. This is not how we should be doing things. And I was fortunate enough in my prior position to be able to implement my philosophy in a trial which had a 100% success rate, which doesn’t happen. What I saw repeatedly, and what I see repeatedly to this day, is that there are a number of good bugs who are basically almost all butyrate producers, who are very sensitive to antibiotics. And I just, actually just launched a huge, very long, very comprehensive video on antibiotics and the microbiome. It’s really a crucial understanding of what’s going on with the microbiome. It’s very pivotal. These guys are susceptible, and the bad guys, you can’t kill them off. They are normal E coli and Klebsiella and Enterococcus. All these guys, they are normal inhabitants of the microbiome. And whether it’s a UTI or whether it’s IBS or Crohn’s, or whatever it happens to be, you’re not going to kill them all off. They’re going to survive in the reservoir, which is the gut. Most UTIs come from the gut, so they’re going to survive there. They’re going to curl up in their little protective shell, right? And they’re going to survive the day, which is the only thing you’re going to succeed in doing is killing off the good guys, allowing the bad guys to come back even stronger the next time. And there is a tremendous amount of data to show all of this. And even with these natural antimicrobials, I mean, I work with tons of people from all over the world, they’ve all done oregano oil and berberines and Neem and garlic products and the list goes on. They’ve done all these before. They have done all the antibiotics, the Rifaximin, and you name it. The list goes on, and they’ve all done the probiotics. We can talk about that as well. That’s a whole other conversation, but this whole philosophy of bug killing really has to change. I mean, you could think about this in different ways, but, I mean, we can go back to C diff. We can do other examples. So let’s go back to C diff. It’s a good example. Again, every one of us in the course of a year, more or less, is going to ingest a spore or more of C diff. It’s a very, very, very hardy spore. You have to nuke it to kill it, right? It’s everywhere. It’s in the food. It’s in your shoes. It’s on you, it’s on your pets. It’s everywhere. It’s on door handles. It’s everywhere.
So why is it that the vast majority of us have no problem with C diff, whereas a small percentage of us who have had an excessive number of antibiotics (because that is the clear, far and away number one risk factor for a C Diff infection is excessive antibiotic use), it can kill them. Why is that? Because they are dysbiotic. They have far too many bad bugs, which would have been killed off, who thrived in the absence of the good bugs controlling them. So instead of this kill, kill, kill mentality, what we want is to nourish the good guys that are still down there, and instead of trying to outsmart what’s going on down there, nourish the good guys. Let them regain control of the environment and let them keep these bad actors who are called opportunistic pathogens for a reason, because if you give them an opportunity, they will become pathogenic. Let the good guys control them, control the environment and keep the bad guys in check. It’s a simple philosophy, I think.
Lindsey:
Yeah, yeah, no, I have seen countless stool tests with zero Feacalibacterium prausnitzii, Akkermansia muciniphila, a very typical profile for someone who’s had a lot of antibiotics or antimicrobials. Now, only now do we actually have, I don’t know if you know, that there’s one company that has a Faecalibacterium prausnitzii probiotic* [register using Doctor Referral Code AZPA11], and at least a couple with Akkermansia*.
Guy Daniels:
Yeah, I know there’s a couple with Akkermansia, and honestly, Akkermansia is interesting. So for one, it’s very beneficial in certain conditions like, say, metabolic syndrome. The data is excellent. However, if you do a meta analysis for dementia, for Parskinson’s, for colorectal cancer in every study, when there’s a significant difference between those with a condition and those the healthy controls, the Akkermansia is always significantly higher in those with a condition.
Lindsey:
Yeah, does it coincide with constipation?
Guy Daniels:
I haven’t seen that. I’ve seen it with, again, with dementia, Parkinson’s, colorectal cancer, and ulcerative colitis.
Lindsey:
I only ask that when I see excess Akkermansia, it’s almost always in someone who’s constipated.
Guy Daniels:
Okay, okay. So to err on the side of caution, I would certainly not recommend any Akkermansia for those folks. Now, I actually don’t recommend it anyway, because I’ve heard from a number of people who’ve had bad experiences with the product, one of those products in question. So what I ought to do instead is to feed whatever Akkernansia is remaining down there. So what do you feed that with? Pomegranate*. And I talk about this in my video on Akkermansia. It likes mucus, but you can’t really feed it mucus, but you can feed the good guys who produce butyrate, who then ultimately produce mucus, and then Akkermansia is happy, and then kind of cross feeds the good guys. So one way to increase Akkermansia is by increasing the good guys, the butyrate producers. The other way is they love phytochemicals. So you get into things like pomegranates and cranberries and things like that. You can feed it using those as well. So again, we come back because I’m not a probiotic person at all. I like to feed the good guys that are down there and let them control the environment.
Lindsey:
Yeah. Now I started doing a gut shake that I stole off of Mark Hyman and recommend it to a lot of my clients with cranberry and with pomegranate in there. And sure enough, I had my most recent microbiome sequencing that was the most diverse I’ve ever seen. I had every single phylum present and in decent percentages, which was nice and refreshing, because I’ve had, you know, lifelong gut health issues and domination of E coli and such. Because I have autoimmune post infectious IBS, I have elevated vinculin antibodies. So I’m curious, from thinking about treating SIBO from a root cause perspective, given somebody like me and many of my clients who have a broken migrating motor complex, is there a better way to do the same thing applied to us as to anybody else who has a different root cause for SIBO?
Guy Daniels:
Well, part of that equation is serotonin, right? So we can feed serotonin with tryptophan* to get gut motility going. So again, I’m not sure how much of that is the actual core root cause, whereas how much of that is a consequence of what’s happened with the extra bacteria being there. But for those who do have slow GIs, I like to use tryptophan.
Why tryptophan? Why not 5-HTP? A couple of reasons. One, you can give tryptophan in gram doses, whereas 5-HTP is milligram dosing. Number two, and probably equally important, or if not more, is 5-HTP is one step closer to serotonin. So you might actually do a little experiment and take, say, 500 milligrams of 5-HTP, and empty stomach, you will more than likely have nausea and you might vomit. So we want this gradual release of serotonin to the gut and actually go into the brain as well for those with any mental health issues, like depression, anxiety.
So we want to get a larger dose down there when we get a more delayed dose actually in the serotonin production. So that’s part of it. So I use a fair amount of tryptophan in a number of people, but it’s certainly not for all people, because you give other people with, for example, say things are going to be moving too quickly, yeah, like with diarrhea, right? So you would not use it for someone with diarrhea. So why is that? Because with diarrhea, you tend to have a lot of mast cell activity, okay. And mast cells release some 30 odd chemicals, one of which is serotonin. Serotonin is a double-edged sword, so it’s part of the inflammatory cascade as a part of the mast cells, so you increase their mast cell content of serotonin, the mast cells release again, and boom, you just worsened diarrhea. So that’s part of it, but I tend to try to focus more on just correcting the microbiome and the bile acid metabolism and the immune dysregulation which always accompanies everything to get things going.
In some people now, there is this very small percentage of people who, for whatever you could throw everything in, including the kitchen sink, at them, and they still have very slow GI motility. And there’s a couple actual conditions out there where it’s like that. Just that’s in their genes. It’s just that it was hard to change that. So there’s a small percentage, about one, two, 3% where you throw everything at them in full disclosure, because no one has 100% success rate and it usually affects the stomach. So it’s usually someone with a gastritis type of scenario going on and delayed gastric emptying, and then you get into the slow motility in the upper GI. And those are kind of tied together a little bit. Those are more of the challenging people. Second most challenging is high histamine. But I can get past that. It’s just whether they can tolerate the whole process or not. But yes, so there are some, but generally speaking, you can get things moving along. Like my success rate with constipation is absolutely astronomical.
Lindsey:
Yeah, yeah. So why do you dislike the low FODMAP diet for long term management of SIBO or IMO?
Guy Daniels:
So years ago, I was researching everything there was to research. And I looked at all the studies I could find, all the human fecal microbiome studies using the low FODMAPs diet compared to healthy controls. And I have a video on this as well. And what did I find? In fairly short order, the good bugs were significantly reduced in multiple and more than half of these studies. So what is the low FODMAPs diet? There’s an aspect of it that I do agree with, but for a different reason, they want to take out dairy because they want to take out the lactose, okay, which, if you have lactose intolerance, you already know that you have diarrhea. But they want to take out the lactose. They want to keep it from fermenting. That’s why they don’t recommend lactose. I want to take out dairy products because I don’t want you reacting to the dairy proteins. Dairy proteins are by far, far and away, the number one food group that you’re going to react to. If you have something going on, they are horrible. If you have constipation, they are atrocious. If you also have colitis, they are not a good idea. And sometimes the cause of, for example, type one diabetes, very problematic and autoimmune disease, and the list goes on.
So if you are dysbiotic, taking out the dairy proteins, which in my opinion, is an excellent idea to be a part of the process, because we don’t want to keep adding offensive agents. We don’t want to keep reoffending and reoffending the body, keeping an inflammatory state. We’re trying to bring down inflammation. We’re trying to reduce the offenses while we’re trying to heal. So I agree with them and take out the dairy, but for a different reason. Now the rest of it, I understand why they’re doing it. They’re doing it to reduce symptoms, which it does. If you look at the trials, most of the trials have success rates in reducing gas and bloating. I agree that you can do the same thing with carnivore, agreed. That’s not to say these are good long-term solutions. So and again, I have a video on this topic as well.
So what are you doing when you do a low FODMAPs diet? You are taking away the very fuels, these prebiotics that the good bacteria love. So if you’re going to take away their substrate, their fuel, they’re not going to thrive, so they’re going to go down in abundance. It’s just logical, and the studies show this. So what you’re getting is, and this is what we do very often in medicine, is we’re looking for temporary relief, but for long term, bad consequences, right? So yes, your gas and bloating has gone down, congratulations. But you’re not addressing the root cause. You’re just addressing the symptoms of gas and bloating, and ultimately, you’re going to make things worse if you continue on the diet. And again, I’ve had many times in my consultations, I hear the same things over and over again. Guy, I’ve tried every diet possible to include low FODMAPs, carnivore, vegan. The list goes on. I’ve tried every supplement possible. Tried every bug killer, berberines, oregano oils, prescription bug kills. Rifaximin, the list goes on. These people have tried everything before, and they’re still having these problems and oftentimes getting worse. And I say, yes, I’ve heard this a million times. Let’s try something different.
Lindsey:
Yeah. And so do you dislike FOS, GOS, XOS, for the same reasons, or is there a different cause?
Guy Daniels:
So I never recommend those, especially for someone with SIBO, right? Those are basically inulin, okay, which have been snipped up. They’re all the prebiotics which have been snipped to tiny, tiny pieces, which are rapidly fermentable. So, and I’ve seen this in people before, in consultations, well, my doctor recommended this. Well, your doctor should know better. So you’re going to send these snipped-up prebiotics, which are going to ferment rapidly into what’s called small intestinal bacterial overgrowth. So what’s going to happen? So they’re going to be rapidly fermented in the upper GI where you have too much fermentation going on. There are different prebiotics which offer up different complexities of structure, like pectin is rather complex, for example, so it takes a while to ferment pectin, right? So again, with SIBO, you don’t want to make things worse while you’re trying to make things better. So yes, GOS, FOS, they have good test tube data. Sure they increase Bifidobacterium, everything increases Bifido, practically, right? There’s so much stuff that increases Bifido, but I don’t care about Bifido. It’s going to increase anyway in the course of while I’m doing things. What I care about is F prausnitzii. What I care about is species from Ruminococcus, Coprococcus, Eubacterium, all these bugs that no one’s ever heard about before. And why haven’t they heard about them before? Because they’re too sensitive to put on the shelf. Probiotics are oxygen sensitive, right? So they’re not available, and you can’t market them, and therefore you haven’t heard of them, but these are the actual true health promoters, not, especially not, lactobacillus. Lactobacillus has terrible data, and Bifidobacterium has okay data, but it’s nothing compared to these other guys.
Lindsey:
I want to come back to the Lactobacillus question. But since you worked for Thorne, and you talk a lot about prebiotics, I thought, well, why don’t I look at the products that Thorne has. And so I looked at the Fibermend*, which had pectin, partially hydrolyzed guar gum, aka SunFiber, arabinogalactans. Were those the primary ingredients?
Guy Daniels:
Yeah, it’s primarily the partially hydrolyzed guar gum at eight grams. And then you got, there’s some rice bran in there, three grams, right? Yes, there’s some window dressing dosing for the arabinogalactins.
Lindsey:
Yeah, were you involved in developing that product?
Guy Daniels:
No, that was developed by someone else during my time there. Okay, yeah, but it’s a product I recommend often, because partial hydrolyzed guar gum, again, will increase Bifidobacterium. People seem to be obsessed with Bifidobacterium, but again, it also increases other good guys, other butyrate good guys. And the rice bran is not the dose- I recommend other rice bran in addition to that, because I aggressively use the basic blends of prebiotics that are properly blended to suit the needs of the individual, that are blended properly and also dosed properly, along with other ancillary products. Here’s the thing to consider as well, because everyone before has tried inulin, everyone before has tried whatever, right, but they usually tried it with something like seven grams a day, or eight grams a day, or something like that. So if you give someone one prebiotic dose, say seven grams a day, you’ll be probably treading water. You might even get worse. So why is that? Because, again, there’s data showing this. First of all, when you drive things with just one prebiotic you’re actually reducing what’s called healthy diversity. Because Alpha diversity is stupid. Alpha diversity is just how many different bugs are there, but you can have a bunch of bad bugs. So if you’re just using one prebiotic, you’re reducing healthy diversity. And if you do something using a low dose, then you’re probably just feeding at least half, or more than half the bad guys, because some of these bad guys who were there were dominating the environment in the dysbiotic gut. Some of those species can use some of these prebiotics for their own fuel. So when they’re down there, the pH of the gut (the lumen- that empty space is not in the Goldilocks zone, which is roughly 5.5 to 6.5) so if it’s outside that pH, lower or higher, the bad guys will be dominating. And they’re going to go, oh, look, a little bit of partially hydrolyzed guar gum. I can use that. Oh, look, a little bit of pectin. I can use that. And they’re going to be able to outcompete the good guys, because the good guys cannot compete outside of their Goldilocks zone pH, and there’s data showing this as well. So what we need to do is intelligently drive that pH into that 5.5 to 6.5 range, so the good guys can then, and it’s a process, and I will admit, the first two, three weeks with me can be a bit bumpy where, okay, now the good guys are starting to consume more and more of these prebiotics, and now they’re out competing the bad guys. The bad guys are going, oh, wait, this isn’t my pH, I don’t function well here. Okay, I’m just going to go sit on the sidelines.
Lindsey:
So are most people coming from a place that’s more alkaline or more acidic than that?
Guy Daniels:
I would say, generally speaking, it’s more alkaline. And again, not that anyone’s measuring the pH of the gut, other than within a trial, but I would say, as a general rule, it’s above that. It’s like around seven or 7.1, 7.2, something like that. But then there’s also those who are below that as well. Then Lactobacillus will survive and thrive in both of those ranges. So whether it’s a low pH or a high pH.
Lindsey:
Wouldn’t that imply, then, if they’re more alkaline, that they’ve got more bile acids flowing because they alkalinize the gut?
Guy Daniels:
Well, the bile acid quantity would still be the same. It would be the composition, right? So the composition would change, and that would change with pH, so you would have a healthy composition from 5.5-6.5, right? And if it’s outside that range, now you have something that’s dominated by the bad guys. Again, the good guys are sidelined if they’re even present, and then the bad guys are saying, Well, okay, we’re not going to – see you got dehydrogenase and dehydroxylaze. The second step is dehydroxylation. We’re not going to dehydroxylate primary bile acids to secondary bile acids. So we’re just going to have this overabundance of primary bile acids, some of which is still bound to these amino acids, taurine and glycine. So it’s really not a content thing. It’s more of a composition thing.
Lindsey:
So, in any case, it’s all about feeding the right prebiotics to the gut microbes to change the composition, which then changes the pH?
Guy Daniels:
Right, exactly, exactly, and the same prebiotics are not good prebiotics for all people, right? Prebiotic A for someone with diarrhea is going to worsen diarrhea. Prebiotic B for someone with constipation, is going to worsen their constipation. So you have to understand which prebiotics feed which bacteria. And I have done all the meta analysis on this as well and looked at all human studies, fecal microbiome studies, and all humanized in vitro microbiome studies when prebiotics were used, and try to see, okay, which bugs are they driving? And so, for example, the best example is inulin feeding Bifidobacterium. There is an enormous amount of data. It’s just a ridiculous amount of data on this. So everyone in the world knows that inulin feeds Bifodobacterium. There’s a number of species it feeds. Okay, fine. But still my concern is largely the health promoting butyrate producers, but also is inulin right for you, because it’s not right for some people. So it’s a blend of a number of different things to come to the right recipe for a given person.
Lindsey:
Yeah. And what about the role of food in all this, as opposed to just added prebiotics? I, for one, personally, when I had to convert my diet from higher in meat to much higher in beans and lentils, huge difference in the results for me personally.
Guy Daniels:
Oh, certainly. You want to feed the you guys with your diet, but you also want to introduce fewer insults into the body as well, like with the dairy proteins, so that’s a component of it as well. But another thing I hear all the time is, Guy, I eat as healthy as I can – I still can’t get better. And I say, yes, I hear that a million times as well. So why is that? Let’s just take your average person who’s 50 years old and has been on 40 rounds of antibiotics. I’ve seen people with well over 100 rounds of antibiotics. So let’s just take someone who’s 50, been on 40 rounds of antibiotics over the course of their life. And some of the things happen as well, whatever it was, PPIs, whatever. So then they tried wacky diets for years, and that made it worse. So at this point, the gut is really broken, right? You have these bad guys that are so dominant in this gut, and the good guys, or if they’re there, are just so completely sidelined that you really can’t turn that ship around with just diet alone, you would think you could right? But you can’t. And I’ve just seen it again and again. So, you have bile acid dysmetabolism, how are you going to change that with diet? You can’t. So, and you have this hyper inflammatory, hyper vigilant immune system, okay, well, if you can’t change that, turn that boat around, you’re not going to turn that immune system around either. So what you should do is we have to drive significant change, and to drive it quickly so we can make that environmental shift in pH and other things so the good guys are in charge, which is using properly blended prebiotics, suited to the needs of the individual.
But it’s also other ancillary support to address the bile acid metabolism to at least begin to bring down that hyper vigilant immune system that’s always on alert, alert, attack, attack, and just wants to fight anything it sees.It’s kind of addressing this from multiple different angles to get you where you need to be. And again, with a diet, you don’t want to introduce insults. And I would say, by and large, most of my people have a pretty normal, reasonable, healthy-ish diet. It’s not that common, I guess someone who’s like, I’m just eating ice cream and cookies. The people I’ve seen have been sick for years. They have been to see at least 10 practitioners. No one’s been getting them better. They’ve been doing research online. They’ve tried everything, and they’re still not getting better. So their diets and they know very, very well what foods they react to, they know their own bodies very, very well. And they go, well, I’m high histamine. And I ask my questions. So, yes, I agree with you. And they go, okay, I can’t eat this. And the weirdest things happen. I hear things. You would never think that would happen eating that food. Now they are just people, they know their bodies really well, but they can’t get out of this endless spiral of hell. They say their immune system’s a mess, and they are dysbiotic, which is driving the immune system and so how do they get out of this spiral to hell? And I’m able to help these people the vast majority of the time.
Lindsey:
Yes, you mentioned pectin and rice bran and PHGG, any other prebiotics that you really like?
Guy Daniels:
Yes, I have videos on all the ones that I like. So I have the three you just mentioned. I have arabinogalactins. I have inulin, I have resistant starch, I have psyllium. I think that’s everybody.
Lindsey:
Let’s go back to the Lactobacilli question. So why do you think they’re a bad idea in SIBO? Because I kind of go back and forth, I have some people who react to them and personally, if I eat a whole thing of yogurt, I blow up like a balloon, but yet I can take one pill of probiotics with Lactobacillus and not have an issue. And I know that BioGaia Gastrus* probiotic supplements contain specific strains of L reuteri [DSM17938 and ATCC PTA 6475], which is recommended by a lot of gut health experts for constipation. So I’m just curious how you came to dislike all Lactobacilli, or if that’s in fact the case?
Guy Daniels:
Well, I’m very data driven, but I also have experience as well for many years, so the data for Lactobacillus in vaginal health is excellent. Okay, so I wouldn’t say I dislike all Lactobacillus. So you have L. crispatus, and you have some others, L. gasseri that play prominent roles in vaginal health. That’s an aside. Lactobacillus tends to have pretty good data for infants as well. So now let’s take those two smaller groups apart. Now let’s deal with everyone else with all these gut issues. The data for Lactobacillus is terrible for most of us adults with dysbiosis, if you look at, and again, about three years ago, Lactobacillus was split up into a number of different similar-sounding genera. So when I say Lactobacillus, I’m referring to the old Lactobacillus prior to the reclassifications a few years ago, the names that all of us are familiar with, okay, so which is basically most of your Lactobacillus. It’s a huge genus, by the way. So anyway, we’re only talking about, generally speaking, 10 or 12 species. So the data is atrocious. If you look, and I have many slides and many videos on this, whether it’s Crohn’s, ulcerative colitis, IBS, either constipation or diarrhea, Parkinson’s, dementia, the list goes on and on and on and on. When you look at, again, human fecal microbiome trials comparing a condition of those I mentioned and more, could be Covid, could be anything else, versus healthy controls. The vast, vast, vast majority of the time, those ill with the condition have significantly more Lactobacillus in their gut than the healthy controls. That is a huge driver in my opinion of what’s going on with Lactobacillus. I never recommend Lactobacillus, and my success rates across the board are amazing. I have turned around Parkinson’s in multiple people, SIBO in gazillions of people, autism, the list goes on. I just got two more Crohn’s video testimonials just this past week.
Why would I recommend Lactobacillus? If the data consistently shows from my multiple comprehensive meta analyzes that it is significantly higher in the condition versus healthy controls, why would you want to put in more Lactobacillus? That makes no sense to me. It even makes less sense to me if you have SIBO, which is, again, you get Lactobacillus in there, why are you putting more bacteria into small intestinal bacterial overgrowth? How does it make any sense to me? Why would you do that? And then I get into the experience that I have where everyone’s done probiotics before, okay, and they’re still talking to me, which means they’re still sick, and they’ve all done fermented yogurt before, like the L. reuteri yogurt before, which is so popular now, and they’re like, oh no, Guy, I can’t do that. I blow up, or I become a super histamine person, or whatever it happens to be. Right? Or I did it for a week and I felt better then I went downhill. Or I did it for a month, I didn’t feel any difference, and then I went downhill, or I did it for two months and I didn’t feel any difference at all, at best.
Yes, these things can help some of the people some of the time, right? But don’t you want something that helps most people most of the time? You also have to be concerned again about the long term. So you can say, well, Guy, I just started probiotics, or just started fermented kefir, yogurt, whatever, a month ago. And I feel okay. Okay, good. Congratulations. However, I want to know where you are in three months or six months. And there are people who have success using this for three months, six months a year, etc., and I get that. I’m not trying to completely bash it. I’m just saying the data shows it makes no sense, and plus, on top of that, the dysbiotic gut is a high-lactate environment. Why would you want to introduce more lactate-producing bacteria into a high lactate environment? And we can split lactate into D-lactate and L-lactate. Got a lot of people out there with brain fog, so you give them a bunch of yogurt or kefir, and their brain fog gets worse. They can become high histamine, brain foggy. Why is that? Because they’re now cranking out a bunch of D-lactate, which is a neurotoxin, which is now going to the brain and causing some brain fog. So the data does not support this in any way, shape or form. The data supports the true health promoters, the F prausnitzii, the Coprococcus species, E rectale, Luminococcus, the list goes on, Roseburia. The data is very, very clear across 1000s of papers, that these are the true health promoters that keep the pH between, you know, 5.5 and 6.5 in the lower gut, that keep the bad guys in check, and keep the bile acid metabolism healthy, and keep the immune system, because they’re producing butyrate, which has a local effect and a systemic effect, where the butyrate is then impacting what’s called your TH-17 T-regulatory immune response, which I talked about my autoimmune videos. So TH-17 is the immune system that’s always looking for a fight, looking for a fight, looking for a fight. It’s ready to react to everything, whereas the T regulatory cell dominated immune system is more kind of tranquilo, it’s more relaxed. It’s more tolerant – I don’t need to pick a fight with everything I see, because if you pick in too many fights now you’re going to start picking fights with your own tissue, aka autoimmune disease.
Lindsey:
So just to make it super clear, the D-lactate is produced by the Lactobacilli?
Guy Daniels:
Well, there are a number of different bugs that can produce D-lactate. So, why would you want to increase the production of D-lactate when you don’t have to? So there’s really, if I recall correctly, three butyrate-producing, health promoters that can take lactate and turn into butyrate, and they are very sensitive to antibiotics. So E. hallii is one of those. And there are two species from Anaerostipes. So E hallii was originally classified as a new bacterium and was reclassified a few years ago into its own genus. And Anaerostipes* is another butyrate-producing, healthy, health-promoting genus, and they’re pretty sensitive, especially E. hallii, to antibiotics. So now you’re cranking out all this lactate. And now other bugs can take lactate and they can make propionate, but some of them are bad, like species from Veillonella. Veillonella is a genus of opportunistic pathogens who can take lactate, and usually accompanies Lactobacillus in abundance. So you see high Lactobacillus. You see high Veillonella. Why? Because Veillonella can use lactate. Lactate is a fuel for it, so it’s okay- I can survive this pH really well. It’s outside the Goldilocks zone. There’s a bunch of Lactobacillus here, which is present in multiple, multiple conditions, producing lactate that I use for fuel. I love this fuel. So now I’m going to increase, increase my abundance, and now I’m going to wreak havoc on the body as well, because I’m an opportunistic pathogen, and I’m going to drive inflammation, and the immune systems become more dysregulated, because the immune system is only like “attack, attack, alert, alert!”
Lindsey:
And the lactic acid that we produce when we exercise is the same as one of those two types of lactate?
Guy Daniels:
I don’t know if that’s L-lactate, I would assume, I’m not sure which isomer that is, but that’s kind of irrelevant, because that’s in your muscles, right? We’re talking within the gut and gut health, right?
Lindsey:
Okay, I was just curious. So you mentioned some other root causes of SIBO, like taking PPIs. What are some other potential root causes of that, or that is beyond what I have, the post-infectious IBS from food poisoning and the antibiotics?
Guy Daniels:
So, food poisoning, that’s a big one. So I hear that quite a bit. That kind of gets the ball rolling in some people. So you get the food poisoning, and then you get these subsequent drugs that accompany that, right? Well, recently, it’s been more diverse where the places I’m hearing it from, you could say Southeast Asia, eating street food. But then I heard about Europe more recently. So you know, it could come from any place really, another driver for not just SIBO, but for dysbiosis in general. Because again, SIBO is dysbiosis from the lower gut. Alcoholism. I hear sometimes, so people have been drinking an awful lot for quite a few years, even recreational drugs, sometimes. Number one is by far and away antibiotics, by far and away. And then you get number two. It’s hard to say which is number two. You could argue PPIs, you could argue alcoholism. You could certainly throw some food poisoning in there. There can also be a lot of emotional trauma, because stress is not particularly wonderful for the gut, for any, any part of you, really. But I have a whole video on stress and the microbiome, which explains precisely what’s going on in regards to iron, catecholamines and so forth. So there’s an array of root causes out there.
Lindsey:
I’ve also been hearing a lot about opioids really slowing the metabolism and causing that.
Guy Daniels:
Yeah, well that’s part of your recreational drug, yeah, yeah. So, I mean, it can be prescription as well. So, yeah, that brings things down to a screeching halt.
Lindsey:
So, yeah, a bit off subject. But what do you think of the extreme gallbladder cleanses, where you’re meant to eject stones rapidly over a few days?
Guy Daniels:
Yeah, I have concerns about all cleanses. Yes, I have. There’s a particular supplement that I love for gallbladder, liver and gallbladder health and bile acid metabolism, so I don’t do cleanses. I have literally never recommended a cleanse to anybody. I have concerns and honestly, I’ve heard a number of times people feel worse after cleanses. There are a whole bunch of detox regimens out there as well, and it puts them through the ringer because they’re already weak and sick to begin with. Then they go through these comprehensive, exhausting detox protocols from whomever, and they usually end up feeling worse after they feel weaker. They feel worse. They’re in worse shape, their gut’s worse, everything’s worse. So, yeah, I don’t, certainly don’t want to make anyone worse. And I’ve heard this so many times, I have no desire to touch cleanses and detoxes with a 10-foot pole. I want to, again, address things more from a biochemical standpoint.
Lindsey:
Yeah, yeah. I figured, so what is the supplement you like for the gallbladder?
Guy Daniels:
Oh, TUDCA*. I have a video on TUDCA as well.
Lindsey:
Yeah. I’ve started recommending that to a couple people lately, because after I watched your video about the bile acids and the secondary bile acids, I thought, maybe this is something I should give a try to.
Guy Daniels:
No, TUDCA has a lot of very good data, because TUDCA is UDCA, right? So all it is is UDCA with T (taurine), but because a drug, which has fallen out of favor in regards to surgery, because everything’s drug and surgery, right? But it has a very long history. That’s the prescription version. TUDCA is the supplement version, which is just slap on a taurine, and you have a very, very effective supplement.
Lindsey:
So in your video on Candida, you talk about iron. Can you talk about how bacteria and yeast use iron to their advantage, and how you would address anemia in a client with dysbiosis?
Guy Daniels:
That is an excellent question. So that’s a tough one. So the connection is, bad bugs love iron, and I talked about this in a number of my videos, especially the video on emotional stress and microbiome, where you’re cranking out these catecholamines. This is your epinephrine, your norepinephrine, things like this that allow the bad bugs to steal iron from you more efficiently, because the body does a pretty good job, normally, in the healthy state, of keeping iron sequestered from the bad guys. It’s like, no, no, no, no, you can’t. No, you can’t have any of this. The bad guys are saying they really love it, it makes me grow and makes me do evil things. And the body’s like, no, no, you can’t have it. But when you’re stressed right now, that presence of norepinephrine in the gut enables the bad guys to go like, oh, I’m going to steal it. And the body’s like, “ah, crap. I can’t really involve this, right?” So that’s how your bad guys thrive when you’re stressed. That’s why you get sick more easily when you’re stressed, etc., etc. At least one reason. So the bad guys love iron to grow, to become more abundant and to become more nefarious, to become more pathogenic. When it comes down to expression of the genes that they already have, but now they can express epigenetically what they weren’t expressing before. As the environment becomes more inflamed, more crazy, they become more crazy. So the good guys don’t operate in that same manner. You don’t see good guys craving iron like that, and things going to hell. You don’t see that pattern with good guys. You see that with E coli, especially and a number of other bad guys.
Now, how do you help someone who is anemic and dysbiotic? That’s the million-dollar question. It depends on how they feel. It’s there, because it is ultimately a decision, right? So if they feel strong enough to go through the process of rectifying the microbiome first, because when I have these people, they’ve been anemic for some time, and so they’ve been taking iron for years, and they usually schedule a consultation with me, because they go, Guy, I just saw your video, how the bad guys love iron. And I’ve been taking iron for years, so I immediately schedule a consultation with you, I’m concerned, right? And I go, yeah, the bad guys love iron and plus, depending on the quantity of iron somebody’s taken, the form, how absorbable it is, etc., etc. So usually, what I tend to discuss is, okay, how strong are you? Do you need the iron? Can we go to something that’s a heme iron source, like, say, red meat, or something like that, to try to get you your iron? First of all, why do you need iron? Let’s try to find whatever root cause that is. But if you can survive this, it’s whatever magical reason x, if you can survive, a month, six weeks with me, four weeks, six weeks or eight weeks with me, until we can rectify your microbiome, right? And then go back to your iron. And in the meantime, eat some more red meat to get you some heme iron, which is more absorbable, you know, can you do that? And usually they say, yes, you go, okay, so let’s fix you.
Lindsey:
What about just using vitamin C to help absorb iron?
Guy Daniels:
Yeah, you can use that as well. So I mean, again, this is part of minimizing the insults of the body while we’re trying to heal the body. Yeah, right. So usually they say, okay, yes, I can do that. I can eat some more red meat, and we’ll fix the gut, and then, you know, etc.
Lindsey:
Yeah, yeah. Because I do see that crossing over a lot, especially with menstruating females. I took iron my entire life, until I hit menopause, and finally, I’m free of that burden. Because without it, I was always very anemic, yeah.
Guy Daniels:
And another point of note, as you bring that up as well, is there is some data to show that one of the reasons that women live a little longer than men is because they’ve been menstruating for so many years and they’ve been losing iron, because iron is very pro-oxidative. So, people should be a little bit careful about their iron.
Lindsey:
This is an interesting thing, because my husband had excess iron and had gotten to the point where he was dizzy and falling down and that kind of thing. And I was the one who figured it out, his doctors did not figure it out. I was the one that figured out that this guy has way excess iron. And as soon as he gave blood, things turned around very quickly. And I’ve now been a lot more attentive to that. And I have said to a countless numbers of people to give blood and say, listen, you’ll live longer. Go give blood, get your iron down to optimal levels. And you know, seeing much lower levels of ferritin now recommended, like 40 to 70 range is optimal, not even above 100 for men. So that’s what I’ve been seeing anyway.
Guy Daniels:
Yeah, you can look at the hemochromatosis data as well. So for people who genetically accumulate iron, they need to give blood. You know, they have big problems.
Lindsey:
So why are prescription antifungals often unsuccessful in treating SIFO and what alternatives do you recommend?
Guy Daniels:
So the yeast has a very quick workaround for those drugs. They just become rather resistant to them rather quickly. For example, we can go back to yeast infections, which is another good example of this, where I’ve worked with women who’ve been on 100 rounds or more of antibiotics. They’ve been on 50 or more rounds of antifungals, and they still have chronic yeast infections. So again, it’s this whole bug-killing mentality which needs to, largely, unless it’s an emergency, largely be thrown out the window. You need to feed the good guys.
First of all, let’s please not kill them. And then feed the good guys that are still surviving and still there who’ve been sidelined. You get and again, no one knows the answer for each individual person, but you’re going to get to a point where you keep taking these drugs, which have their toxicity effects on the liver, etc., anyway, and they’re not going to be working. Well, I felt better on it, but now I’m off of it, and now I feel equal or worse. So, well, yeah, it’s a temporary benefit. You’re not going to kill all of the species from Candida or whatever the fungi happens to be. They hang out in the reservoir, which is more often than not, their gut, and they’re going to survive and then come back another day to cause problems.
You need to have an immune system that is in charge, that is robust, that is efficient, but that is ultimately tolerant to be able to take care of these things. You’re not going to have that immune system if you constantly have dysbiosis, whether it’s fungal dysbiosis or bacterial dysbiosis, because they’re both the same. They’re not the same, but they’re the same. They are opportunistic pathogens. So philosophically speaking, whether you’re concerned about Candida or whether you’re concerned about E coli or Klebsiella or Enterococcus, whatever it is, it doesn’t matter. They’re both opportunistic pathogens who are taking advantage of a situation where they can go, hey, I can survive and thrive here. The good guys are minimized. The immune system is a mess. The bile acid system is just totally dysregulated. I’m going to take over here. It’s like a bunch of – I had this one idea one time to do a video. It’s like, if there’s two weddings, right? One wedding is predominated by a bunch of college students, right? And that’s like 80% of the people, and they’re all getting drunk, and they’re just completely out of control, because there’s no one to keep them in check, you know? And the wedding just becomes a total disaster zone. Your other wedding is a normal wedding, where you have a blend of people of all ages, kids, adults, grandparents, the whole nine yards, and it’s just a moderate, mellow scene where it’s just a normal event, and everyone, bride and groom, have a good time, right? If you have these bunch of crazy college kids in charge of the gut, they’re going to do crazy things. They’re just going to be out of control down there. So you need to have an environment where they are kept in check by the good actors who are controlling the environment.
Lindsey:
So pretty much the same way of dealing with it is not taking things with anti-microbials, but going at it with the prebiotics?
Guy Daniels:
And yeah, I’ve resolved yeast infections in women by only addressing the gut health.
Lindsey:
Yeah. Okay, so do you have time for one more question?
Guy Daniels:
Fire away.
Lindsey:
Okay, so I’m curious about what your personal gut health routine is, from diet to supplements.
Guy Daniels:
So I was actually diagnosed with Crohn’s many years ago. Oh, okay, and I talked about that in my video on Crohn’s. So I went from GI doc to another who were just complete idiots, who said it was in my head, or said there was nothing to do, or said I had to take prednisone for the rest of my life. So I was very, very ill. I was also anemic for a period of time. I was very light. I was 25-30 pounds lighter than I am now. I was in bad shape, going to the bathroom constantly. So it took me a while to figure that out, and since then, my knowledge base has just grown really exponentially. So what I do is a little bit geared towards that, because for someone with Crohn’s or ulcerative colitis, you’re going to have to be on a maintenance dose of something because you have this genetic inability to keep those crypts clean from bad guys, etc., although genes are certainly not entirely the case for Crohn’s. So what I do is I will have a prebiotic shake that’s specific for my needs, usually, every day, usually, most days I do, and I take a little bit of some other supplements. But I don’t really have a supplement I take every day. I just take some, I kind of take it as needed, and I take a couple supplements just for general overall health and longevity. But at the core of what I do is the shake, but I don’t have something that I take every day.
Lindsey:
What do you put in your prebiotic shake?
Guy Daniels:
I have a blend of, usually four different prebiotics. And then I have some glutamine I throw in there, just for extra measure. I used to put a couple extra things in there, but they weren’t really necessary. They are just more for extra, extra, extra. And then I have just a handful of other supplements I take. TUDCA being one of those, which is just, again, just a general health thing, for example. So with Crohn’s, you get a lot of problems, and you have to be ever vigilant. So I was in Mexico, and I had a blockage in my gallbladder, and I knew it immediately, because you could tell about it, because the feces is white, which cleared on its own, whether it was a polyp or a stone, no one ever knew. So I did the ultrasound and oh, well, they’re are a couple polyps, maybe a stone, etc. And then, and I have this weird kind of little fold to my liver. No, that’s the gallbladder. No, it’s the liver. And I was like, okay, I need to stay on the TUDCA. So, and since then, I’ve had fewer pain issues there. But with Crohn’s, different things happen. You get issues with your pain and your vertebrae, your spine as well, again. So there’s two different things you have to watch over.
Lindsey:
Okay, well, thank you for taking the time to stay over for a couple extra minutes and let people know where they can find you.
Guy Daniels:
So my most popular format is on YouTube, the Microbiome Expert. And then you can go to my website, where you can get more information. You can schedule a consultation with me if you want something that’s more one on one and more personalized, or you can buy a generalized protocol, which is only $20 [now $25] in this moment in time for a wide variety of needs, whether it’s SIBO with constipation, SIBO without constipation, etc. So the list goes on.
Lindsey:
Well, thank you so much for sharing all this knowledge with us.
If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.