Understanding SIBO and Histamine: An In-Depth Discussion with Joanne Kennedy & Melanie Peers

In this episode of the Histamine Well Podcast, Joanne is joined by her colleague Melanie Peers to discuss the relationship between small intestinal bacterial overgrowth (SIBO) and histamine intolerance. 

They explore the complexities of SIBO, its causes, symptoms, and its impact on histamine levels in the body. Joanne and Melanie also delve into related issues such as the role of the migrating motor complex, the influence of stress, dietary impacts, and the significance of mold, oxalates, and sulfur in exacerbating histamine symptoms. 

Practical advice on diagnosis, dietary adjustments, and treatment options is provided, making this episode an invaluable resource for both practitioners and individuals seeking to manage their gut health and histamine-related conditions.

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Transcript

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Welcome to the Histamine Well Podcast. Designed for practitioners and patients alike. This is your trusted source for insights on histamine intolerance, methylation, gut health, women's hormones, and much more. I'm Joanne Kennedy. Your host, naturopath, author, and educator passionate about breaking down complex science into clear, accessible knowledge. Whether you are a health professional or navigating your personal wellness journey, the Histamine Well Podcast bridges the gap between cutting edge research and practical understanding to empower you with the tools to thrive./Hi everyone. Welcome back to the show. Today's episode is all about sibo. Small intestinal bacterial overgrowth and how it drives up histamine in your body. When I was sitting down to prepare for this episode, it dawned on me that there's no better person to pull all of this information out of my head than my colleague Melanie Peers. So today we are doing something different whereby Melanie is going to interview me on this really important topic. So, hi Mel. Thank you so much for your time today. Thank you. Well, um, just glad to be here. It's so great to get the opportunity to pull the huge amounts of knowledge out of your brain. You know, you've taught me so much about sibo so I think we should unleash you on the public so that they get the chance to learn everything that you know. Thank you. Unleash me. Yeah. Yeah. Thank you so much. Okay, well let's just jump straight in. So people have probably heard of sibo or sibo. They might hear it pronounced small intestinal bacteria overgrowth. Do you wanna explain a little bit about what it is as opposed to, like, we, we get bacterial overgrowth in a large intestine. What does it mean to have overgrowth in the small intestine?'cause it's not the same, is it? No, it's not the same for many reasons. Um, so I'll just explain what it is. Firstly, we have trillions of bacteria in our gut, okay? And lots in the small bowel, lots in the large bowel, way more in the large bowel, but still we're talking about trillions of numbers. So a lot, and they're normal. We are meant to have them. But what can happen is that they can grow in numbers that are too high. And when they become too high, they take FODMAP foods and resistant starch and convert those foods into gases, which is sibo. The gas, right. The methane hydrogen gas that we test for. What can also happen is that you can get an overgrowth of bacteria that's not meant to be in the small bowel. It's meant to only be in the large bowel. And then that also will cause problems with the gases. So it's a disruption in the microbiome of our small intestine. Essentially too much bacteria that is causing the fermentation of these carbohydrates into gas. And that's why there's so much flatulence and belching and bloating with sibo. It's classic symptom because it's creating gas. That's right. And as you said, a lot of the time it's this actually this what we call the healthy bacteria that are growing there. There's just too many of them and they're fermenting. Yeah. These wonderful fibers that are supposed to make us feel good. Right. Yeah. And a lot of people start to feel worse when they're eating them. So, um, yeah, that's a great explanation. Thank you. And um, you know, we see a lot of SIBO in clinic when people come in with histamine issues. What proportion of those people would you say have a problem with sibo? Huge proportion, Mel. I'd say up to 80%. And this is because there's many things that cause sibo. You can't just think about SIBO as a simple bacterial overgrowth in the small intestine. Because it's an entire gut issue. Because digestive enzyme insufficiency can cause it. Disrupted bile flow in particular from poor gallbladder function, poor liver, estrogen, estrogen dominance, mold. So that can cause it. Chronic constipation from having gluten intolerance can cause it. Or you have massive issues in the large intestine can cause it. So when we are thinking about sibo, we don't just say, oh, there's bad bacteria, let's just kill it off with some herbs or antibiotics. And the interesting thing about this is that all of these things that I've just mentioned that cause sibo, they also drive up histamine in their own right. So this is why we see so much histamine and with sibo it's getting a lot of traction. Sibo, which is great. More in mainstream allopathy as well. It's great. It's very, very common. So we see it a lot and people, they'll come to me, they're like, I've definitely got sibo. This is my problem. Or they have had SIBO before and they, they've tried to treat it, they've treated it and been unsuccessful. They've treated it and it's come back and they're just like really focused on just the sibo. And like, if I get those SIBO numbers down, it's gonna fix everything. It's like, no, it's one part of the picture. An important part. But we don't just treat sibo. And I must say, you know, I do pride myself with my clinic and the girls that work for me that we are really not just focused on one thing. We really are really broad. So I always will refer my patients to Melanie that need help with mold because mold is a major cause of sibo, for instance. Yeah, I think, I think about 80% of people who are exposed to mold end up with sibo, if not higher. I would even say the numbers in what I've seen is pretty much a hundred percent. Really? Yeah. Okay. Yeah. So disruptive, and that's the thing. I think people, we need to set the expectation that people come to us, as you said, fix my sibo, fix my problem. SIBO is actually more of a symptom of these underlying problems, disrupt dysfunction. Something is happening in the process and I always say, you know, it's like a conveyor belt in a factory. If something goes wrong at the beginning, what happens at the end is going to be disrupted because everything has to happen in a certain order. So it can be anything from the stomach acid to the gallbladder to the pancreas, releasing enzymes. There's all sorts of things that can go wrong and it's the environment in the, the gut that is allowing this overgrowth because. So true. A healthy, robust gut. Gut keeps things, things in check, doesn't it? Yeah, it totally does. And when I see patients and they'll have sibo and I'm like, yeah, for sure you've got sibo. Like, it's so obvious. But, but what about what's going on with the mold and what's going on with your organic acids test? You're full of oxalates and you've got methylation disruption and you've got high estrogen. And so this is where we are like, let's just pull this whole case together. This the whole person picture. This is usually Mel, isn't it? The people that have been tested for SIBO before, treated SIBO before and they're resistant or it's come back. Yeah. We see a lot of people like this. Because they're not fixing the reason that it happened. exactly right. That's exactly right. And they are so full of histamine and that's how they find us. Mm. Because we're the histamine gurus. Yeah. Because it's just so common. Because it actually, all the things that we, Mel and I specialize in are absolutely gonna drive up histamine. Yeah. Because in a perfect world, someone would come to us with SIBO or histamine issues. It's just sibo, and we fix that and they go on their way. How many people would you say, well, what percentage come in? And the histamine is only driven by SIBO and not other factors? Uh, only 20%. Yeah. Not that it's a multifactorial issue, isn't it? The, the histamine. Yeah. And a lot of, look, some people with SIBO don't have histamine issues. And I'm sometimes like. Oh my God. Like you act, I go through all the symptoms. Do you get reflux? Do you get heartburn? Do you get headaches, migraines? How's your skin? And they don't it, it baffles me. I'm just sitting there going, how are you not a bucket of histamine? Some people they just not. And the more I work with this, Mel, it's because they just have sibo. They're the people that are like, you've got sibo. Let's get the treatment going. The protocol in the bowels moving the digestive enzymes in, and these are the people that, um, they follow suit. It's, it's a very, very simple process. It's not, it's not hard. It's quite difficult for them'cause the boring diet. But it's you get the FODMAP foods and the resistant starch out of the diet. Make sure the motil is working, the bowels are moving, the digestive enzymes are in the herbs, the right herbs.

Joanne Kennedy: 8:20

And it just will start to clear and it does it beautifully. Do it in three to four months. I love my SIBO protocol. It's great. Simple And beyond, beyond that though, you always, you always send them away with, this is how we prevent recurrence, right? Oh, absolutely. That's absolutely part of it. Yeah. Absolutely. A lot of my SIBO patients work with Nicole, who's my nutritionist, who is really good at coaching people through how to prevent the recurrence. But there's more simple cases. So that can happen. Absolutely. When they're a bucket of histamine. That's just like in the back of my mind going, oh, like let's really dive deep on this case to really work out that the SIBO is not just coming from some, acute food poisoning or stress, or maybe they're just had a really poor diet for a while that will do it. Can't tell you how many people post Covid had sibo because they're just sitting at home ordering in takeaway. Just working at their computer. Working at their computer and over sanitization of the hands. Yeah. Hand sanitizer. Yeah. And people working at their computer all day and they're like, they're, they're eating at their computer. And I understand like you kind of got, people got addicted just to working at their computer all day. And, and because it's just that dopamine hit and then it is calling in Uber Eats and eating hydrogenated vegetable oils and terrible food. I can't tell how many patients I had with SIBO from that. Mm. And even just, I talk to clients a lot about digestion, beginning in the brain. If you've got Uber Eats, you're on your computer, you are working away, maybe you're a bit stressed, the food arrives immediately. You're eating. The brain has not had time to realize that food's coming to prepare digestion. It's really simple, Mel, isn't it? There's no smell, there's no smelling of the cooking. There's no smelling the garlic, there's no smelling the, the, the meat, the ground cook or anything. Yeah, it's really interesting. It's hours of these, this aromas stimulating digestion. Yeah. It's a really true, you kind of think, oh yeah, yeah, I get it. But it's like, no, no, it's a really big deal. So like something as simple as literally like just in like sniffing your food. Yeah. Before you eat it is part of what I use with my clients when we are dealing with that. So we have our people who have got SIBO with high histamine symptoms. What is driving the histamine for these people? Yeah. Well, simply with sibo, the bacteria that's converting those FODMAP foods and resistant starch into gases is the gases are driving up inflammation. So that's that one part. Now we know that when there's inflammation, the body histamine is released. This is normal. It's a normal part of the immune response. The cells in the gut, smooth muscle cells, mast cells, they're gonna release histamine and then. The DAO enzyme that breaks down histamine is actually highly concentrated in the small bowel. There's a lot of DAO in the small bowel, mainly'cause it's where you digest your food. Mm-hmm. It can simply get overloaded with too much histamine'cause there's just so much. Or we also see cases whereby there's a reduction in the synthesis and excretion of dao. Right. So the net result will be, again, too much histamine. But with the DAO enzyme, I've seen a lot of tests. Most people don't have a test result that comes back low. And people argue with me that it's not a problem, but it's like, yes, you are producing DAO at the range the lab thinks is adequate, but they don't know how much histamine you've got. It's overloaded with histamine. Simply that the enzyme is overloaded. Now, as I was saying in the beginning, SIBO is not just a matter of this bacterial overgrowth. So what can also happen in SIBO is that when you have an acidic environment in your small intestine, which is basically a breeding ground, si, and there's many reasons for that, one being digestive enzyme insufficiency and pancreatic juice insufficiency. So you need pancreatic juice to alkalize the small intestine, and that allows your pancreatic enzymes to work effectively. So if you simply can't break down your food, so pancreatic enzymes do break down carbohydrates and starch and fats and protein. They, they do everything. Mm. They will your, your food's gonna sit rotten, ferment in your gut. Increase histamine. And then we also need to understand that with sibo, the low hydrochloric acid is a major cause of sibo. So hydrochloric acid breaks down animal protein and it will disrupt. So it's, it's a acidic, hydrochloric acid it's meant to be. And when you eat food, once you eat in that food, let's say a steak, it sends a message to the gallbladder to take bile acids into the small intestine, okay? And that's, it's gonna break down your fat. It sends a message to the pancreas to take pancreatic juice into the small bowel that allows the pancreatic enzymes to function. And so when that entire system is not working, you're not breaking down your food properly, and it will cause a histamine reaction. The foods are sitting there and not moving the immune system's freaking out. Right. The immune, the immune system does not know what this carrot is. It does not know what this piece of meat is. It doesn't understand. Okay. And this is a, this is where we can have a big conversation about nervous system. We won't, but this is, you know, the nervous system causing a reduction, hydrochloric acid, and then causing issues with the whole orchestra of digestive enzymes. That factor, isn't it? The process prior has to work properly for the next process. And those digestive enzymes and that bile, that's what creates that alkaline environment. Mm-hmm. Because we're not supposed to have acid, you know, acid from the stomach is supposed to stimulate. Yeah. These things to try and alkalize. Yeah. And so if that stimulation doesn't happen, the digestion doesn't happen properly, we have foods in there for too long, the immune system starts going, hold on.'cause by the time it gets to the immune system, it's supposed to be broken down and absorbed. The immune system's going, well this is not supposed to be here. I'm very confused. Yeah. As simple as, as that it's, yeah. It's our histamine. Yeah. Just'cause if the immune, um, the gut is a big immune system, I think that's, we need to say to people and it's very governed by the nervous system. Yeah. So then there we go. We've got more histamine there. And then what else happens? Well, if you've got a lot of methane SIBO that will slow down the motility of the bowel and then you have chronic constipation that's, you're not pooping out your food. You're un undigested food, you're not pooping out the bad bacteria. You're gonna be getting to building up of estrogen and toxins in your gut. That is gonna drive up histamine as well. So, funnily enough, some people, you really think, oh, they've definitely got sibo, but they have digestive enzyme insufficiency and chronic constipation and they just don't have the bacterial o The bacteria somehow hasn't overgrown to a point where you need to treat that, but the symptoms are exactly the same. They have, and the underly drivers are the same. Yeah. Yeah. So it's like, it's like they're the top part of the, i'll, let's say the small, let's just say digestive enzymes at the top. Small bowel in the middle. Large bowel in the bottom. If your top and bottom's, not working, okay, there's just gonna be this sort of, like the environment and the small bowel is gonna be in disrupted. And the bacteria not, might, no, the bacteria might not have grown to a point where it's high enough for the test to test it. I'm sure one day it will. So some people will say, oh, I absolutely don't have sibo. But in my mind, like, I'm like, yeah, yeah, you don't have sibo, but your small intestines just inflamed. You don't have it yet. Yeah. And you don't have it yet. Yeah. But, it's just like, okay, you might not need to do the low FODMAP diet, which is lucky for them. They don't need herbs to kill off placebo, but they need to get, digestive enzymes in. They need to alkalize the small intestine and they need to get the bowels moving. And then that's a whole top to tail. It's a tube. It's gonna start working. Yeah. SIBO is a like, it's an entire gut problem. Yeah. What do you think about, people like to talk, especially with taking probiotics, but I also hear about people talking about within the gut, about histamine producers versus histamine degraders. Do you find an imbalance in those in the gut can be problematic for histamine or is it really quite mild? The food smell? The The bacteria. So we've got the histamine producing bacteria, the histamine degrading bacteria. Oh. Do you find that is a really big factor? Not at all. No, not at all. And I'll talk about this. I, this is 12 years of experience with this. I actually spoke about this on episode two, main causes of high histamine. So when I first started treating histamine years ago, we were just putting people on a low histamine diet, possibly giving them some digestive enzymes, doing a stool test, and then looking at the stool test and saying, oh wow, you have dysbiosis and overgrowth of bad bacteria and undergrowth of good bacteria. Thereby a lot of those bacteria are histamine producers. A lot of those good bacteria that are low, they can degrade histamine. And doesn't this sound like something that you just absolutely focus on? You're like, this is, wow. What we're gonna do is we're gonna kill off those histamine producing bacteria and we are gonna increase those good bacteria that support the breaking down the histamine and immune function and then you will get better. But I'm here to tell you that it doesn't, that doesn't happen. Yeah. It's, it's not that, it's not that it's something else. I see so many people who have done these elaborate stool tests and they're just focusing and really trying to just correct that dysbiosis in the large intestine. And it, it just does not correlate with a great clinical outcome for histamine. I'm just saying for histamine, it is either coming from oxalates or mold or digestive enzyme insufficiency or gluten intolerance or, um, things like how high calprotectin, uh, Crohn's or ulcerative colitis or sibo. It's just not that dysbiotic bacteria in the large intestine, it's driving up the histamine symptoms, which I think,'cause there's just so much information out there, and I think our clients that come in to see us are actually very well researched. And they know a lot because they've had to really research and find out what histamine is to be able to discover what their problem is. But unfortunately, I think as you said, they hone in on these small things, which is why it's so important when you've done all the research, come to a practitioner because we need to look at the big picture. Mm.'cause if you hone in on, you know, the degraders versus the producers, you're gonna maybe miss the pancreatic enzyme insufficiency or mold or other factors. So that's really true. Mel, I just wanna talk about, yeah, I just wanna dive deeper into this. So when it comes to neurological histamine symptoms like migraines and headaches, anxiety and insomnia. There's a lot of research on gut brain axis and the, you know, inflammation in the gut can drive up, histamine, get into the brain, increase histamine in the brain, and certainly people with sibo having some headaches and things like that can attest to for sure. I know that when I eat high histamine foods, it, I get dizzy, I get a headache. Mm-hmm. But the more I work with this, the more I'm having to think two things, three things. Firstly, is there mold, is there mark ons? Do you have mold in your nose and back? Bad bacteria in your nose driving up histamine in the brain? Is it estrogen? Or is it a big methylation problem? The thing with methylation is it breaks down histamine in the brain. Our brains do have histamine and we make histamine in the brain. So when people are getting that high histamine in the brain. And they've gone down the rabbit hole of SIBO and they've, and oxalates and large bowel dysbiosis, and they're getting no resolution. I'm honing in a mold. I'm definitely thinking about sinus issues and mark ons. And then I'm now getting them to do, I'm at home methylation tests that we can now do. So it's like a covid test. It's a saliva swab test, so you can now test your methylation at home in real time. And the interesting thing about this, Mel, is that a lot of people are actually over methylating. And the more I'm seeing this is people are over methylated whereby it, it's not what it sounds over methylating. It's like they've got a case of methyls that aren't necessarily being utilized. Mm-hmm. Does that make sense? Yeah. Right. So there's a transport truck and no driver. And so I had a patient recently with like insane insomnia and he's an endurance athlete, and I'm like, it's a problem. He is like, no, but it comes and goes like it's, he's had it for 10 years and it comes and goes with moving different environments and no real pattern, still an endurance athlete this whole time. And we went through all of his testing and he's done so much work on his gut and cortisol and he's gone down like the, he's even gone down the mold route. And I said to him, you need to do this methylation test because there is no doubt that your methylation is disrupted because of, well, the insomnia chicken and egg. If you've got chronic insomnia, it's gonna cause chronic inflammation and chronic stress and methylation disruption. Um, and so with him, and we, you know, he had so many questions to ask me and it's like, no. Like we don't just need to focus on the gut stuff when you've got all this neurological histamine going on because the doo enzyme is absent in the central nervous system. It is his histamine. It's not gonna touch the sides. Yeah, it's histamine and methyl. It's methylation. When it's neurological. We really need to think about that. So interesting guys. So guys, you can test methylation at home. It's called somatic code mood sense testing. I've actually secured listeners 10% off discount for this test. It's amazing. I'm using it all the time. Mel, I'm gonna get you, I'm gonna talk to you about it soon. Yeah, you need to tell me more about it. We actually have a mutual client. I'm seeing the child and you're seeing the mom and she's like, Joe's got me on this methylation test and I'm over methylating. And I thought, oh, I've gotta learn more about this. Yeah, yeah. So a lot of people are just, are over methylating. So, um, yeah, so sorry we've just gone, sort of gone off sibo, but it's, it's, um. Another big contributing factor to histamine symptoms is methylation. Also, what I've seen is that I've had patients whereby they've done a Dutch hormones test and they have very low methylation of their estrogen, very low, right? And they do this methylation at home test kit. And every single day, Mel, they're over methylating. Where are these methyl groups going? They're not going to estrogen. So, very fascinating stuff. It's just a game. It's such an amazing test and you can test it in real time.'cause methylation is, it changes, it changes with sleep, diet, exercise, it changes with hormones amongst other things. Any, any blood test. It's a snapshot at a moment in time, isn't it? And. There are very many variables, but methylation is another thing that people kind of can get a little bit hooked on, isn't it? That they come in, it's my methylation. It's my methylation, I feel so terrible. And then we realize, actually no, it's the mold. It's because mm-hmm. People are tune methylation with detoxification as well. Um, totally. Yep. And we know mold and other environmental toxins, but mold being a really big one is, a really big driver and Yeah. Yeah. We see it so often in sibo. Yeah. I'm glad you've brought that up. Um, not everyone, I'm not getting everyone to do this test. It's when it's, when the cases are, when they've done a lot of the other work and there's still things left. Mm-hmm. I mean, with this guy with the insomnia, like if he hadn't done every test under the sun already, Mel, and had gone down with reputable, uh, physicians and people I know in the US who are really good with histamine. If he hadn't done that, I'm not saying I'd hone in on methylation straight away, but it was just he had SIBO fixed it. The, he was out of the mold. He had no other mold symptoms. Mm. He didn't have, he didn't have high oxalate. He didn't have gluten intolerance. and there was no change with whether he ate histamine foods or, or not. The one thing that helped him, the only sleeping aid he could take, and I'm talking, he took epan and things like that, couldn't sleep, was an antihistamine.. So when with this case, I'm like, I'm not gonna get you to do another stool test. I'm not gonna like, because I sound like the mold whisper. I just don't let people pass. I'm like, no, you passed the mold with me. Let's just get this methylation testing done. He's an endurance athlete. It just depletes your methyl. Mm. And I know it's, and he said it's making no change, no difference to my sleep. Whether I do or don't, I'm like, yeah, but let's just see what your methylation is when you do a 20 k run. Maybe like, maybe it is a problem. Yeah. Anyway, it's exci. It's just super exciting. I think it's good. I, I, I know we, I said we've gone a little bit off topic, but I think the most important thing to realize is. There isn't one thing. So when you come to us, we go for the most obvious thing first, but sometimes it's not the most obvious. And then we go to the next thing. There's always a next step that we can look at. Depends on how many layers of your onion there are. Yeah. Right? Yeah. No, it's layers. It's layers of onion. So the hardest thing about what we do is not necessarily knowing what to do for somebody. Oh, what do I do to fix that? I've got so many different options. Which one is the most likely to fix this person? Because there's so many different underlying reasons for insomnia and gut issues and things like that. So, um, yeah, always keep diving and digging in because there's, there's always gonna be an answer. Yeah, I totally agree. And with, with the histamine patients, I say to them, there is about like 15, about 15 causes of high histamine. You know, like, and if it's irritable bowel disease, you know, that's been covered by allopathy, we can help with that. Or it's celiac or, but the other things is like we, we have the testing we can do, we have the organic acids testing and complete microbiome mapping. I find quite interesting now to look at those sulfur producing bacteria and the low ox backer and high calprotectin, which is very linked to mold, things like that. Or we've got SIBO testing, so we've got all this functional medicine testing that we can use to really pinpoint where the big histamine issues are coming from. And, oh God, not to mention homocysteine test. Mm. And now the methylation testing. So it, it's, we've got, we've got some really good resources, um, that we can use to really pinpoint where it's coming from. Yeah. So speaking of testing, how do you test placebo? Oh, good question. SIBO is a breath test, and usually you can do a test from home. We, uh, you know, they, the lab will post you the test kit, so you do it from home and you take a substrate. Now, lactulose is the substrate that is most useful because it works on most of the large intestine, sorry, the small bowel, and picks up the majority of the bacteria. Glucose can be used in conjunction with Lactulose as it works more on the lower part of the small intestine and it can pick up some other different bacteria. However, you can't just do glucose on its own. It just is not enough. So be very careful. There's now labs in the US where you order it. They used to send you Lactulose, but now you have to have a appointment with a doctor there to get prescription for Lactulose. Anyway. I won't say the lab, but just careful, careful. I know. Anyway, this is in America, so be careful you guys in the us. Just make sure. I'll just tell you, you can get it from direct labs.com or put that in the show notes. You can order the three hour SIBO OSE test from, um, direct labs and do it from home. It's, it's a simple breath test. Yeah. Yeah. It's quite easy to do. And what about like, is there any evidence that you can spot in any other testing, like a stool test that might indicate sibo? Or is it have to be the breath test? Breath test? I don't think it can a hundred percent extrapolate a stool test result to say that you've got sibo. Mm. I just don't say it's different environments, aren't they? It's different environments and. Look, I did a whole episode, um, with Bridget Greenall, who is a, uh, a girl that trained in my history methylation course. She's so lovely. She did a whole case with me. It's coming up on one of our episodes. The whole episode is about what do we do with patients We suspect have SIBO and can't test. I've got patients in, I've got patients in Libya at the moment, and, um, Palestine, places like this, and they can't test. So what do we do? We have a really good session with them and go through their case, the case history. What are their risk factors for sibo? Like, do they have a lot of them? What are their signs and symptoms? Just ruling it out. And the thing with sibo, it, it does become quite obvious that it's a problem. And then just during the SIBO diet, that low fodmap, low resistant starch diet and making sure motility is moving. Just making sure they're clearing out the bacteria and undigested foods so their bowels are moving. If you do that for a couple of weeks and their symptoms significantly improve in my mind, it's like, let's just hone in on sibo. Yes. What caused it and all the other things, fringe things around. We need to think about that. But if you can't test you, it is the one thing that we can treat. I do it for three to four months. With regards to the bacteria, Mel, it's, the great thing with SIBO is if it's methane, sibo, Allison and Oro are very specific herbs for methane, if it's hydrogen, berberine is very specific for, hydrogen and orano also works as well. So we just, with the cut, there's three herbs so you can mm-hmm. And they're safe, right? So you can do the diet and some herbs, make sure my bowels are moving. If they need some digestive enzymes, that would be great. And you can work with them. And then after three or four months, reintroduce the foods and see if they flare. And usually they don't. So if you've worked with that patient well and seen them every couple of weeks, especially at the beginning to make sure they're on track and they have to be compliant with the diet. They really do. And then you reintroduce foods and they don't flare at all. And if there's a histamine picture, you do a sibo, low histamine diet. That's what I was about to ask you. Do you combine them? Yeah. Yeah. Sibo, low histamine diet. And then you reintroduce the FODMAPs and resistant starch, make sure they're okay. And then you reintroduce histamine. And I've done this a lot. I did this a lot before. I used to do a lot of testing. I've just, I just love, well, I just like, I like testing when I can because it's just, I think people like the evidence as well. Mm-hmm. But you can, you can do that with SIBO if, if you can't, if you can't test. Yeah. Okay. Another thing, another thing I get worried, you know what the other thing, some people's SIBO is so high and causing such havoc with histamine, they're almost having anaphylactic reactions that lactulose substrate, if I'm a bit concerned, someone's gonna actually be anaphylactic almost. I don't mean full blown anaphylaxis, but breakout in hives in their throat can start to more, more allergy type. Swell. Yeah. I'm like, you are not gonna do well in that ose, let's just, let's just treat it without testing. Yeah. It can be a killer for some people they, some people do come in and they say, I've already done one and it was hell. That's classic. I'm like, well, you have, like if you took Lactulose and it and you really had such a massive adverse reaction, that's enough evidence to me that you've got sibo. Yeah, because it's a decent dose.

33:06

Before we go any further, I want to speak directly to the practitioners and students listening. If you're intrigued by histamine and methylation and eager to expand your knowledge in this fascinating area. We offer the Histamine and Methylation online group coaching course. The only program of its kind. It covers everything you need to know about histamine and methylation, providing both the theory and guidance you need to treat these issues effectively. In clinical practice, we cover sibo, hormonal imbalances, oxalates, M-T-H-F-R, the four pathways of methylation, including the folate pathway, methionine pathway, tetrahydro biopterin pathway, and the all important transsulfuration pathway and much more. The program is delivered by detailed online webinars and handouts for you to keep. And for eight weeks you'll meet with me for live coaching calls in a private community space with other practitioners from all over the world dealing with histamine and methylation issues in their patients every day. Together we learn so much. To learn more and apply, visit joanne kennedy naturopathy.com. Um, let's talk about, I guess one of the reasons that I came in to work with you, the outliers who do the, the low fodmap histamine, low histamine diet and they don't feel any better or they feel worse. Mm-hmm. Okay. That's when we really start to suspect oxalates and histamine. Right? Absolutely. So people, practitioners especially, so, um, if you put your patient on say, SIBO histamine diet, and they come back two weeks later and if their histamines have calmed down. And they're still just really bloated and they're eating, you know, it's such a healthy diet, right? No gluten, like chocolate cake, no fun. Mm-hmm. The bowels are moving, got the digestive enzymes in and they're just so bloated. That is a massive red flag for migrating motor complex problem. So the migrating motor complex is an electrical impulse that starts 90 minutes after you eat, and it sweeps out undigested food and bad bacteria. So it can happen with sibo. So if that's happening and you're still really bloated, then that's a red flag that you need. Pro kinetic, and I say pro kinetic medication, not natural. The pro kinetic medications are way more efficacious, like low dose naltrexone. You need to kickstart that migrating motor complex because it's not moving. The bacteria is sitting there dying off or being killed off from the herbs and it's not moving. This is also red flag. People are having herx reactions. Mm-hmm. Mm-hmm. that can happen. The other thing that can happen is the sibo low histamine diet is not low oxalate at all. It's not, it's actually bit, some people can really increase. Yes. So what people do is they can't have grains, so they're gonna go almond meal crazy. Mm-hmm. And also, you know, nuts or yummy when you can't have your little chocolate frog in the afternoon. So you go crazy on nuts and, you can't have lactose. So you get into almond milk. Mm-hmm. All super high oxalate. And if people are coming back and they have a worsening of their histamine symptoms or they're getting joint pain. Mel, tell me what else, what happened to you? Yeah, well, so for me it was very much, yeah, headaches, muscle tightness, joint pain, fatigue. I just felt awful. Brain fog. I couldn't think. Yeah. Um, it was just, yeah, horrendous. And it was the high, high oxalates it was doing it. And the other thing I would say is for mold is you go low histamine, I always say it kind of like takes the edge off, but it doesn't really resolve your symptoms. So if you're just doing low histamine and you go, yeah, I do feel a little bit better when I'm low histamine, I'm not flaring as badly, or My flares don't go for as long, but you're still flaring. That's when that's a red flag for mole for me because that's what happened to me. Wow. And for those that dunno, the reason I started working with Joe is because I came to her while I was still studying and I was that person that did not. Get better. Yeah. No, you didn't. I got worse. And then you identified the oxalates, found the mold, and here we are all these years later. Um, yeah. Yeah. That's how it got, that's how it went. So I was fortunate enough that Melanie came to work with me and then I sat in on consults. This is what happened guys. This is what happened. Right? Like, Melanie, you need to sit on cases with me. To learn about SIBO and methylation and hormones. First case, I'll never forget it, it was that gorgeous guy in Scotland, that sweetheart. Yeah. Um, coming to see me and Mel sat in and he was a bucket of mold. Was he, was he oxalate as well? Huge oxalate. Yeah. He was eating a bag of spinach every day. Yeah. and I'm so glad that it happened to be that we were both in there.'cause you go to me. Mel, this is oxalate. And I'm like, this is mold. And we'll both write. Yeah, because it was a mold because they come, it goes hand in hand and he was so unwell, Ms. Poor guy. He was so sick. It was so sick, so sick. Everything to to get better. And the healthier and healthier ate the worse and worse you got. And as I said, in bagga spinach every day.'cause it was healthy and Oh the poor thing. Yeah. So what started hap, this is just the crazy uni universe in like interjecting, he happened and then every patient for like a month was mould for me. Every time Mel sat in with me, she's like teaching me. I'm like, come in and I'll teach, learn from me. And she's just teaching me. And that was brilliant because as soon as that happened, like I just mold, no, I just, no one gets past me with mold now. It's just, I can see it so clearly you can't unsee it. Right. It's just can becomes it more, more obvious every time. But that, that's one of the biggest red flags. You know, if you're listening to this, you know about histamine, you've probably gone on a low histamine diet. If you're not feeling quite a bit of resolution in your symptoms, then there's something else driving the histamine beyond the food and the gut, whether it's methylation or environmental such as mold, driving the histamine right up. Mm-hmm. Totally. Can we just now talk about that extra layer of the onion that was unraveled in you a few years after this oxalate mold issue being the big sulfur problem that reared its ugly head? Yeah. Oh my goodness. Because, you know. There wasn't enough layers of my onion. We had to go and find another one, which was, yeah, sulfur became a problem. So, interestingly enough, looking back now, coming out of the mold was a big, improvement with the histamine, but the oxalate and the sulfur were really kind of mimicking. Histamine symptoms. And what I now find clinically is anyone who's got a sulfur or an oxalate issue, quite often they do still have a bit of a histamine issue, but that's not actually the main driver. Mm-hmm. Yeah. It's not the histamine foods, it's the oxalates raising histamine or the sulfur, making them feel very gassed out. Mm-hmm. So, the sulfur became a problem because with oxalates. Oxalate basically makes your body waste sulfur. It pushes it out of the cell into the bloodstream. It doesn't belong, on its own in the bloodstream as a sulfur molecule, so your body will just waste it into the urine. So you become very sulfur deficient and then you can't, the, the catch 22 being then you can't tolerate sulfur foods very well because the body tends to compensate by overproducing bacteria that produce sulfur in the gut. Mm-hmm. That's a kind of backup measure. To get more sulfur, but of course you eat the sulfur foods and those bacteria releasing all the sulfur and you're feeling terrible'cause it's sulfate that they, they release instead of sulfur, uh, sulfate. So, um, you can end up feeling, but they all kind of mimic each other. So again, yeah, that would be in the next step that I would look to is if histamine, low histamine diets taking the edge off but not resolving oxalate and sulfur. Could be the actually the major problem. And very rarely I see that histamine's not a problem at all. But generally it's much less of a problem than we initially think. Mm-hmm. Go. When you see someone with hydrogen sulfide SIBO or a large bowel test where they've got lot, lots of those sulfur producing bacteria, do you just stop and think, oh, this is way more than just some sulfur producing bacteria. Yeah, there's a, well, there's a reason why it's happening, right? Yeah. So are these sulfur Purdue, these, these sulfa fbri nis. I think that's what they're called. Yeah. It's funny. You do, you read about all these bacteria and you never hear them pronounced out loud, so you Yeah. Yeah. I'd often just say I can't defo Fs. Yeah. Class of sulfur bact when I, um, they're normal to the gut. Mm-hmm. And they're upregulated. Why, why, why? When I see that in a stool in a large bowel stool test, I'm like, Ooh, why? Yeah. Oxalate mold lot, low homocysteine level. If you've got low homocysteine as well, it's like big sulfur problem. Yeah. And you, you know, hydrogen sulfide SIBO is. A type of SIBO as well. Unfortunately, we just can't test for it. I think they are bringing out tests in the states. Mm-hmm. Don't have anything here in Australia yet. Um, but it, that's pretty obvious. You pull sulfur outta the diet, you feel a load load better. Yeah. It's, it's, it's easy to diagnose that with from the dietary change. Oh, the other thing, so what can also happen when people go on a SIBO diet is it's the absolute opposite to a hydrogen sulfide diet. Yes. It's the opposite. It's like complete opposite. Okay, well meat. Yeah. You tend to eat a lot of meat. So Mel, can you just tell listeners, like if they've done that, tell them the sulfur symptoms that they could potentially be having from going on a low FODMAP diet, a SIBO diet, and how if they're eating way more sulfur tell and that, and that they actually do have hydrogen sulfide sibo. It just hasn't been detected. What are some red flag symptoms? Okay. The number one symptom, I would say, and this is a term that I've coined on my own, by my own experience, and all of my clients tend to agree, you feel gassed out. It's kind of the only way hungover, just not just brain fog. You just feel toxic and really unwell. Um, you might get reflux, bloating, swelling can be quite common, so fluid retention. But the main symptom would be like nausea, hungover, gassed out, toxic. Okay. Okay. Feeling. And it's not just fatigue, it is debilitating fatigue. Okay? Um, that builds up over several days. So you might be okay, but once you've been on sulfur foods for about a week, you might find you can barely get outta bed. You, um, shortness of breath. You get out of breath doing the smallest things. It's body fatigue, it's brain fatigue. It's just all encompassing fatigue. It's, it's, I wouldn't wish it on anybody. It's terrible. Mel, do you know what cause why sulfur's causing that big issue with fatigue? So it is just because the sulfur that the, the gut is, the bacteria are producing is sulfate, which is toxic to the brain. Yeah. Yeah. It's like having, okay, it's like drinking, it's like drinking some heavy barossa Australian red wines. Yeah. So, yeah. Okay. It's, I understand, I understand that feel. I understand that feeling. It belongs in the body, but not in the numbers that is being produced when you're having those foods. And so, yeah. Um, if you see low homocysteine, anything below six, you know, six to seven is you really wanna see it about seven optimal. So at six I wouldn't be worrying, but you start to see like five and four. Mm-hmm. Then you start to think, okay, the body is deplete in sulfur. Um, you can't tolerate, um, sulfur supplements like glutathione or nac. Mm-hmm. They make you feel sick or make you feel worse. Yeah. And it's unfortunately that the body's recycling all this cystine from homocysteine to, to create more sulfur in the body.'cause you're so deplete. But at the same time, this bacteria is making you feel terrible. Yeah. Good one. We've kind of talked about being resistant to treatment, but what would cause people to relapse with their sibo? Just stress is a massive relapse. Her lovely girl once, American girl, she, uh, worked well. She lived in Hollywood, right? She was, worked in that film industry. Hectic, did fly from to New York and back again and on set all day. And, um, s really stressful environment. And she just had SIBO and she just didn't change her job. It's hard, it's like her career and she could never get on top of it'cause of the amount of stress that she had. I just need to flag that. Another thing is that if mold is present and hasn't been addressed, your Sibos just gonna keep coming back. Mm-hmm. And if you have issues with migrating motor complex. It's funny, the migrating motor complex, it's like there is a test in the US that you can test to see if you've got antibodies that can disrupt the migrating motor complex. Oh, interesting. How, yeah. However, that's all well and good. I don't think we can get it tested. I think there was some laboratories in Australia trying to work with them in the US but I think because of Covid the disrupted post, you couldn't get the test there in time. I just think they dropped it. But the way, there's a way I always think about migrating my motor complex as well is, as I said before, is if you just do that SIBO diet and come back as long as your bowels are moving and you're just still crazy bloated, that's just a red flag. I think, and I've seen this clinically, people that graze all day long. I had a girl, she just ate rice crackers and tuna and I, and um, cottage cheese just grazed all day for hours, four hours. She just grazed, she's just, that her migrating motor complex is not functioning well, activated, doesn't get activated, it's not activating, and then well, it's gonna be become lazy. Mm-hmm. Had several patients like that, the snackers, the gras. Oh. And this idea of, you know, six, eat, six, six more meals a day. I always say to my, my clients, we're not cows. We're not designed to graze no three meals a day. And the only exception to that would be if someone's got, um, a lot of adrenal dysregulation and blood glucose dysregulation. We do need to snack more often, but as soon as we can, we get them onto three meals a day. We are not. Cows. We're not designed to braze. We need to activate that migrating motor complex as frequently as we can. It's a nice little cleaning system Yep. That sweeps through the intestines to clear them out and get rid of all that debris that could be triggering. Yep. Totally. Sea bone. Totally. So that's a thing we see clinically. Guys, I just wanna give you some like, like real world, like, like what's going on in the real world with patients that we see. Okay. That, um, do you know what else? So, um, going gluten-free and just going full blown. Gluten-free products full of rice. Rice is a disaster for sibo. It's got mold and mold mycotoxins in it. Mm-hmm. Or just going really heavy on legumes, like just eating like a tub of hummus a day. He eating lots of that paleo pasta. I have just seen it's like that, that you gotta always remember that SIBO bacteria is normal if you just start feeding it. The thing with legumes, they're high in resistant starch and in FAPs they're double whammy, and then you just start eating a lot of that. Then it, it has a potential just to come back. Well, you're just gonna be providing this bacteria with a lot of the food that it just really thrives on just red flag for that. and then people, they completely and utterly gluten intolerant and I get it. How good is gluten that they, they're completely gluten intolerant and in particular it just stops their bowels. They'll have pasta and then they, they're constipated for five days. Mm, right. This is, and a side note to gluten intolerance, if you don't break down gluten properly, they create these opioid compounds. It binds to the opioid receptors. It feels so good. You get this really good response. Yeah, it does. Um, yeah, because you're breaking it down quickly, that's why. So it's so addictive. Yeah. So I had a lovely patient of mine, gorgeous girl. She's such a sweetheart, and she, we got rid of her sibo. She did it so well. We cleared it out, we retested it, it went and um, then she just decided, and she was completely gluten intolerant as well. She got some supplement to help digest some digestive enzyme to help. Breakdown gluten, and she just started again. It just doesn't work. Those supplement, they're they're an emergency situation. Exactly. Exactly. And then she just went to town on the gluten, got chronically constipated, and then we've retested and it's all come back again. So these common things, it's just, it's literally just movement through the dis tract, isn't it? Yeah. Everything has to keep moving. Yeah. Or just, just going heavy on the process and it's even things like this guys, it's like eating out during the day and having things like Tex-Mex things or Mexican bowls. Mm-hmm. And I understand having it without the raptors in a bowl is not that bad, but it's the hydrogenated vegetable oils that they're cooking or that meat and stuff in. If you're eating at that sort of like fast food chains that are kind of a bit, he, and having the healthier options every day, it's not actually good. Mm. Just eating more processed foods. Just eating more restaurant foods. I mean, I'm not talking some beautiful Italian restaurants or French, French restaurant with just butter and olive oil. I'm talking about some hydrogenated vegetable oils or going heavy on Asian food with more sugars and you know, chemicals. It disrupts the pH of the small intestine. And then it's gonna, the SIBO can start to grow back again. So these are just some of the common things. Unfortunately, endometriosis is a major cause of SIBO as well. It causes kinks in the bowel. And I know ladies, I know if you've got Endo, it's very challenging condition and you, you just, you know, endometriosis is a big gut problem as well'cause of the way that it gets into the gut. So endometriosis can cause it. these are just the, the common things. So if, you know, the thing with sibo, some people need to take antibiotics and low dose naltrexone as a prokinetic, it's, it's what they need to do for many reasons. Potentially. They're extremely underweight, can't do the diet. Their nurses, their flight attendants, they work on mat, this shift work, they can't do the diet properly. Um, or they've got massive motility migrating motor complex issues. People like this, allopathic treatment is warranted, but you really are struggling to get to the root cause when you do that. Mm. So that's just a warning. So we, we just try and work with root cause of getting the SIBO under control. I think the main message here is don't think that you can come and get the SIBO fixed and then just go back to the way you were. This is a symptom that gets your attention and it's acute a change and things in your diet, whether that's just as simple as eating three meals a day instead of snacking or Yeah, reducing the stress. We can't remove all the stress from our lives, but we can reduce it and we can build our resilience to stress through lifestyle measures like exercise and meditation and things like that. But stress, oh, there's nothing that stress doesn't worsen, is there? No. What Mel and I all day in our consults are working out where the stress is coming from and what they need people need to do about it. It's very, very true. So I think sibo, it's like anything, it's like we can see it as, uh, it's just a little, well, it, it is a condition and a symptom that your body's telling you there's something wrong. Mm-hmm. And you can't ignore it. And it's like a bit of a wake up call and. It's good. It can just be a good reset and you can just sort of improve your lifestyle, things that are causing gut problems. And the thing with sibo, it can make people very, very sick. Very, very sick. Well, especially long term. You have severe deficiencies that come from it and Oh, the, well, it causes major nutrient deficiencies. Like iron is a big one. Mm-hmm. Vitamin B12 is another big one. Folate. So if you've got folate and B12 deficiency, that's a big methylation problem right there. Mm-hmm. And then iron, you know the thing with cebo malate, it causes such iron deficiency and then people go and have iron infusions, especially women's with the heavy periods of which got their ferritins like four. The thing with sibo. It creates biofilm, which is this, like this matrix, like this protective matrix that is created so that the bacteria colonize and thrive under there. And part of the structure of biofilm is iron. So it can create more biofilm. And so it protects these bugs. I often, uh, will say to my women, when I see low iron, it's like four ferin iss, like four and it's gone to 200. I'm like, oh, did you have an iron infusion? Yes. Yes. And straight away I'll ask them how they felt. And if they felt terrible from it, like brain fog, nausea, histamine symptoms. I'm like, we are looking into sibo. Like that's, that's one of the classic things. It's like a real hint that it's sibo. Yeah, that's what I'm thing about iron that people don't understand is that iron actually, um, like viruses and bacteria will utilize iron to reproduce and so sometimes low iron, whether it's SIBO or some sort of an infection, you're just unwell. The body will remove iron from the bloodstream to Yeah, stop. Stop it from happening. So if going and throwing more iron isn't always the answer. That's why we need to look holistically at all of this. You can't just keep throwing iron at it because it's gonna worsen the problem. If it is sibo, yeah, correct. The sibo, then maybe you can start looking at some supplementation and building it back up. But doing it at the same time can be an atomic bomb. Yeah. Yeah. Especially if you've had massive adverse reactions. It's a really big red flag for SIBO actually. Yeah. Mm-hmm. Alright, well we've talked about a lot. Is there anything else that we haven't kind of gone through that you think is worth mentioning about SIBO and histamine and. Uh, I'll just mention that if anyone suspects they have sibo, we are here to help. You know, you can book in a consult with us if you'd like to have one-on-one consult, or I also have my e bundle. So my e bundle is on histamine intolerance, and it does go into all the major causes, including SIBO and how SIBO really drives up histamine and how FODMAPs and resistant starch drive up histamine. And I've also got in that e bundle is my sibo, low histamine diet. We've also got lots of recipes. So you, you can tackle SIBO on your own if you'd like to. There's also supplement recommendations on what to do about digestive enzymes and getting your bowels moving, et cetera. So that's all part of my e bundle, which is available for sale on my website. As I said, we accept patients globally and if you are struggling with sibo. Then we are here to help. That bundle's actually. Great. I've had quite a few people that have come in to see us. They've said, we've done Joe's bundle. I've gotten myself so far. And they just need that little bit of a tweak to find those other layers. Yeah. That are going on. Or like, you know, okay, I've realized I've done to see if I realized my hormones are a bit of an issue. Can you help me with my hormones or Yeah. Can you help me with mold or it's it, but they've found it so helpful to get that symptomatic relief. They get the grounDAOork done. Yeah. Yeah. And that's makes it much easier for us.'cause then we can move on to the next thing. Yeah, I know. And people, I love when people have have done it.'cause they can talk to me about, they talk my language. Yeah. Yes. No, it's good. And also it's good. And also if you are working with, um. A doctor that you love, you've got a good relationship with you with, and they can help you do testing. You know, it's really well researched. You can say, Hey, can you get me this, these tests on? Or if you are working with a naturopath or nutritionist that you again, have a really good relationship with and you're like, they just, they're not histamine specialists, like, again, you can take that to them and they, you can just tweak some of your protocols pretty easily. I think. So that's what people have told me about the e bundle. Um, so, oh, that's good. Yeah. It's just, it's available. This isn't, it isn't, it isn't taught to us in our degree at all. We learn about this through the research after the fact. Um, and so not everyone knows and understands histamine. We all have our areas of expertise. Yeah. And some people never touch on histamine and aren't really aware. It's becoming more commonly known amongst in our profession, I think. But yeah, the degrees haven't caught up yet with, with what they're teaching. No. Colleges, guys, his, I can't believe histamine is so common. It is caused from chronic inflammation and that's what people have who are seeking help. And so it's, it is everywhere. It's the most common thing, Mel, isn't it? It's just crazy. They're uncovering more and more about it. I remember reading, um, something somewhere where they're talking about depression and Sr. SSRIs being antihistamine in nature, and that's why potentially that could be the mechanism of why it works for some people, if their depression is driven by histamine. Wow, that's fascinating. Um, we're learn. Yeah. We're just learning. It's, it's because it's everywhere in the body as we know. It's the, it's a natural reaction. We are living in a very unnatural world. Mm-hmm. We are. Um, another thing that I might mention is, you know, it's not necessarily a driver, but it can be something that can be helpful for people who've got histamine issues. Another thing that kind of take the edge off is if you've got histamine issues, you may be, sensitive to EMF. Yes. Yes. And that can, is that because it just really destroys your cell membranes? Yeah, it's just because it's just a bit of an irritation on the body. And again, it's the immune system having to respond. And so it's not going to be the be all and end all. But some people will find, oh, if I don't have my mobile phone in my bedroom overnight, if my, some of them have their modem in their bedroom or on the wall behind their bed, simple things like moving that, can reduce the symptoms. It's not the cause. Yeah. But it's another solution that can help take the edge off. And again, that is something I would take moving forward. You can't avoid EMF, but you can certainly minimize it. And the best way to minimize EMF is distance. There's lots of, um, gimmicky things. It can purchase EMF, but by far the greatest impact is the distance. Yeah. And it's not that hard to do to, it's not that, that's not, that's not that hard to do. No, no it's not. Yeah. Right. Mel, thank you. You're just, that was great. I really appreciate your time, so thank you so much. That was awesome. I think we covered a lot. I hope everyone enjoys the episode. Yeah. Thanks Mel. Thanks. So thank you for joining me. I hope you found this episode beneficial. Be sure to subscribe to the histamine well so you don't miss an episode. Leave a review and you can also share this episode with someone who could benefit. If you have any questions you'd like answered. Or have a topic you'd like me to discuss, please go to my website, joanne kennedy naturopathy.com, where you can provide us with that information. Until next time, take care and be well.