Explore Gut-Related Causes Of Fatigue

Nirala Jacobi, ND

Hi.

Laura Frontiero, FNP-BC

So good to have you back. This is our third time that we’ve done this together. You’re a SIBO expert and I’m bringing you on this summit because I really want to talk about the gut and cellular mitochondrial connection and I really want to dig into SIBO as well because I know a lot of people suffer from it and have reoccurring problems with it. So I know people are going to really love this interview. And for those of you who don’t know Nirala, she’s a naturopathic doctor. She expert. She’s an expert. As I said, in SIBO small intestinal bacterial overgrowth. She’s the creator of the SIBO Biphasic Diet. She’s host of the SIBO Doctor podcast. She’s also founder of the SIBO Doctor, which is an online educational platform that includes a practitioner certification program. So listen up all you practitioners who want to know more about how to get certified in SIBO and you are also the medical director of SIBO Test. So pretty much all things and everything. SIBO Your, your, you’re a world expert, so thank you for being here.

Nirala Jacobi, ND

It’s a pleasure to be here.

Laura Frontiero, FNP-BC

So let’s do it. Let’s talk about gut related causes of fatigue, because people are here watching this summit because they want to solve their energy issue. We’re talking about a lot about mitochondria because it’s at the crux of the issue. And, you know, gut and mitochondria are tightly connected and intertwined. So can you start to unpack for us? Why would we feel low energy and fatigue as it relates to our gut?

Nirala Jacobi, ND

Yeah, sure. And you know, you and I had a little chat before this. Laura’s in terms of that the gut is really the foundation of health. And I often talk about it in terms of it’s the root of the tree, right? So if the root of the tree is not healthy, the tree cannot be healthy. So I think a lot of people understand that concept that, you know, and you may not be connecting that you have digestive issues with why you’re fatigued, but it is really, really common and it has actually very definitive reasons why you can be fatigued. And it’s not all one size fits all. Everybody has a little bit of a different presentation, but it can be due to, you know, bacterial overgrowth that causes leaky gut, where you’re then absorbing endotoxin. It can be because of fungal overgrowth, it can be because of nutritional deficits, because you’re mal absorbing things and you need those nutrients to power up your mitochondria. So it’s a bigger topic and we probably need to do a little bite sized chunks to get through it because otherwise it’s going to be a little overwhelming for people.

Laura Frontiero, FNP-BC

Yeah. Okay, so let’s chunk it down. So first off, can you talk about let’s talk about microbe undergrowth to start so if your good guys aren’t thriving, so this could be a big cause of low energy, why would that be?

Nirala Jacobi, ND

Okay, that’s a really good place to start because I see this a lot in my practice where people, you know, and I do microbial testing that now looks at we have new ways of testing the microbiome that can actually give us the number of species that’s in the digestive tract and or in the in the lower digestive tract because we’re doing stool samples. But, you know, when you look at the database, there’s about 6000 recurring species in a normal doesn’t mean you have to have 6000 species, but a healthy gut nowadays is around 200. And species of healthy bacteria that are producing metabolites that drive your energy, that repair, that, you know, produce neurotransmitters very important, nor very important bacteria that are just normally living in your digestive tract. And often people that have ongoing gut issues just have far below the normal level of healthy species. 

And that’s because they’ve had a lot of antibiotics in their lives or are on a high meat diet. And, you know, conventionally grown animal products usually are quite heavy with antibiotics because they use antibiotics to fatten up animals. So before slaughter. So this is a real issue. Plus you have other factors like glyphosate and other toxins that affect the health of this microbiome, which is considered a set almost like a separate organ that helps you produce these healthy metabolites, like I said. So undergrowth of healthy bacteria in particular butyric acid producing bacteria like fecal bacteria and nexii and some others in the future. And for me, Kitty’s phylum are really important to do these important functions. For you, it’s estimated that about 20% of your daily energy comes from your healthy microbiome. So you can clearly see that an underground of that can really affect your energy levels.

Laura Frontiero, FNP-BC

Yeah. And then I always think of it too if, if you have an undergrowth there, well when the food comes in and you’re trying to digest it and break those, break that food into smaller nutrients and then assimilate vitamins and then shuttle that around the body, that can’t be happening very effectively if the bacteria populations are missing, right? Yeah.

Nirala Jacobi, ND

Well, we do break down our food with enzymes and other digestive juices, but the fibers that are arriving in the colon are usually fermented into by the bacteria into these metabolites, like short chain fatty acids and a host of other metabolites. And that becomes very ineffective at that point. And then you get a lot of other symptoms and bloating, abdominal pain, that type of situation. You can also I mean, it’s it’s a big issue with with under growth of bacteria because you then if you’re missing those microbes, that space is then taken up by other more pathogenic organisms like fungus or bacteria like gram negative bacteria that are not contributing to butyric acid production and that are driving more with with endo toxins that are a big deal.

Laura Frontiero, FNP-BC

That’s a perfect segue way into another scenario. So we said we’re going to kind of unpack this bit by bit. So the second scenario would be overgrowth of microbes because you just type me up for that perfectly. Yeah. Okay, so let’s talk about that.

Nirala Jacobi, ND

Yeah. So, so bacterial overgrowth, you know, when we talk about SIBO, which is small intestine, bacterial overgrowth, it’s a really specific location where bacteria are overgrowing and that’s absolutely detrimental because your small intestine is the most important, arguably the most important surface area of your body besides your brain and your lungs. Because that surface area is where everything happens with the immune gut microbe interaction, for example. But also it’s the most dense area for absorption, for digestion and absorption, which is how we power our body. If we can’t really absorb nutrients, we just become more and more depleted and fatigued and we can’t repair our body. And for sleep, the sleep gets more and more disturbed and our stamina goes down. Everything starts to suffer. So bacterial overgrowth is a really specific condition or small intestine. Bacterial overgrowth is a specific condition and it is different from large intestinal microbial overgrowth because when you’re by the time you’re in the colon, that absorption is very different. 

You’re really just absorbing that. That’s mostly waste products and you’re just absorbing water and that’s less important. It still will give you symptoms, but imagine that your surface area of your small intestine is just crowded with bacteria. And what happens? They start to ferment out the food that’s meant for you. So you’re eating something and they’re having a party, basically, and they’re using that fuel for their own growth and they’re fermenting the food into gasses. And the gasses then cause symptoms like bloating, abdominal pain and the gasses also damage what’s called the brush border, which are the little tiny hair-like protrusions on the villi of the small intestine, which is kind of like a shag carpet. So the shag carpet is getting damaged. And when that gets damaged, you’re missing these vital enzymes that do that last bit of absorption for you and you become more and more sort of depleted.

Laura Frontiero, FNP-BC

Yeah. And so this depletion is going to end up causing low energy. So people are here wanting to know like, what’s the how? Why the heck is my energy low? How come I can’t? So this part of the picture. So as you’re striving to put the puzzle together and find all the things to do to solve the problem, we’ve got to look at gut health foundationally as well. Now, in terms of so we talked about SIBO and I want to get into in just a moment, I want to get into some of the reasons why people might have recurring SIBO, why they feel like they get rid of it and then it comes back. But before we go there, I want to wrap up a nice bow on top of microbe overgrowth. So could you talk a little bit about fungus, about parasites, about some of these other things that can live in the gut and cause a problem and steal our energy?

Nirala Jacobi, ND

Yeah. So fungal overgrowth is also another big issue. And it used to be, you know, back when I started in the late nineties, it was like the Candida. What was that was a bug. But anyway, so there was a couple of books that came out about Candida and it was a big deal back then already where we started to see that fungal overgrowth causes a lot of things like brain fog and also cause bloating, can cause issues with rashes and itching. And so you can have fungal overgrowth. And some women are familiar with vaginal candida where it’s very itchy and things like that. And it can also happen in your digestive tract. And Candida is an opportunist and an opportunist just means that, okay, well, there’s no one here. So I will just, you know, use that space for myself. And so fungus is very connected to healthy bacterial undergrowth and it can be also connected to higher antibiotic use for that reason, because the antibiotics harm the healthy bacteria, but not the fungus. 

So that’s that’s a deal. Parasites, to be honest, getting back to the Malabsorption just a little bit, because one of the things I forgot to mention is that there are key nutrients that are associated with energy, like B12. Right? B12 is crucially important for your red blood cells to carry around oxygen, which is what we need for our brain to kind of feel awake. And when that is, when your B12 is low, you’re going to feel pretty tuckered out and pretty tired. Iron Malabsorption is also very common when you have bacterial overgrowth, so certain nutrients are key nutrients for energy and they tend to be low in people with small intestine, bacterial overgrowth and additionally SIBO causes leaky gut, so it causes the absorption of endotoxin, it causes the malabsorption of nutrients, and it causes this, this intestinal membrane to be very permeable. So you’re absorbing a heck of a lot more toxins and and or toxins from bacteria. So it’s a big deal when we deal with energy.

Laura Frontiero, FNP-BC

Yeah, it is. Okay. So now can you talk a little bit about why people might have recurring SIBO? So you this is an area of special interest to you. This is one of your expertize, one of the areas you’re an expert in. So people will go and get treatments for SIBO and then they’ll come back with a reoccurrence and it’s like this revolving nonstop door. So what’s going on there?

Nirala Jacobi, ND

Yeah, it is a big, big issue because people that I see that have been diagnosed with C Ball have often been for months and months and months on antimicrobials, different ones. And for those of you who know what I’m talking about and maybe you have suffered from C bulk, it’s really important to actually get a proper diagnosis. So, you know, getting a breast test on that really clearly shows that you have bacterial overgrowth with an elevation of hydrogen gas. Methane gas is also there but is more associated with constipation. And I treat that a little different. But the deal really is think about the fact that you have a bacterial overgrowth in an area that’s not meant to have very many bacteria in the small intestine for the reasons I’ve mentioned. So we have ways the body has ways to keep that area free of bacteria because it is so vitally important to be free of bacteria. And so I group the causes of SIBO into three different categories. 

So number one category is some issue with the motility, the normal motility of the upper digestive tract because a normal healthy gut will have a very powerful cleansing wave called the migrating motor complex that sweeps through the small intestine every 90 minutes on an empty stomach to ensure that that part of the body is free from leftover food particles and bacteria. So that is a very powerful reflex and wave that can be damaged and it can be damaged by having had, for example, famously, we know that having had food poisoning sometimes months before you start getting IBS symptoms are SIBO sometimes can be the trigger for this damage for the for this for this wave. So having had a case of food poisoning before, also other things that affect different parts of this motility can be things like hypothyroidism, right. We know that hypothyroidism can slow digestion down. That’s a different mechanism, but still it slows the motility of the digestive tract, allowing for bacteria to remain in an area they’re not meant to be remaining in other conditions in the category of low motility could be mold toxicity. Right. What a lot of people.

Laura Frontiero, FNP-BC

Know.

Nirala Jacobi, ND

Besides it in and of itself causing a tremendous brain fog and fatigue, but mold toxicity, those mycotoxins, the toxins that are produced by the different molds in your environment, if you are in a water damaged building, are actually very toxic to what we call the Mayan triplex plexus, which is a bundle of nerves in your digestive tract. And that slow can also cause SIBO. Other causes in that category can be chronic viral infection, you know, so it’s a big category. The second category for you real quick. Yeah, go.

Laura Frontiero, FNP-BC

To that second category. Important question. So for people who have a migrating motor complex problem, so let’s say you take out you identify the root cause of that and eliminate it. But let’s say it was a food poisoning, so that’s long gone. Yeah. Is there hope for people to get this function back?

Nirala Jacobi, ND

Yes. Okay. Yes. So typically, what if you’ve had a history of food poisoning, there is a test that you can do a blood test to check for two antibodies called antibody insulin. And A.C. TB antibodies. And these antibodies are elevated in people that have SIBO because of a previous case of food poisoning. And those antibodies are what’s causing this motility in the upper gut. If some people resolve over time it does get better. But those people that have these antibodies are prime candidates to get a pro kinetic prescription. So what keeps their SIBO at bay is just to use a medicine that stimulates the normal motility of the upper gut medications like regular or per calo pride. If you are in the conventional sort of model or if you want herbal medicines, we look at ginger and artichoke, which are great little motility agents for the upper gut. But that’s a definite helpful tip for people that have maybe a history of that and they need to get tested for these antibodies and then they can take some broken edits.

Laura Frontiero, FNP-BC

Okay, good. Thank you for going down that side sideways thing number two is what you were about to think.

Nirala Jacobi, ND

Number two, second category of zero causes, right? I call this digestive deficits. So think about what does the body do to prevent bacterial overgrowth besides motility, while we have this great big vat of acid that is our stomach that kills bacteria on contact, it makes sure that with the food that we’re eating that’s often or used to be covered in bacteria that we’re not to ingest things, bacteria that are harmful to us. So that part of acid is really important for the stomach acid. Other digestive juices like bio and digestive enzymes also have their role in keeping bacteria at bay. So if you are somebody who has, you know, poor bile flow or who has pancreatic insufficiency, so all those kinds of conditions really challenge this checks and balances that the body has to prevent bacterial overgrowth. So that could be that is the second category. The third category is what I call structural issues. So people that have either adhesions like an endometriosis, which is a condition where it’s in women who have it’s related to a menstrual cycle. But basically, it’s a condition where you actually create scar tissue in the abdominal cavity. And that scar tissue is called adhesions. And adhesions can create a kink in the garden hose scenario where it’s attaching to the outside of your digestive tract and just pulling and changing the anatomy of how food is flowing normally through your gut. And it can create, create what we call a Stacy’s. It’s almost like there’s a bit of a dam there and then like in the flowing river and you have a little, you know, any kind of stagnation in a flowing river, it can create algae blooms, you know. Yeah.

Laura Frontiero, FNP-BC

Every visual just.

Nirala Jacobi, ND

That. Yeah. Yeah. So endometriosis is a real big deal. It has other reasons why people have IBS symptoms, but that’s a big one with adhesion formation. But think about also, you know, the routine surgeries that people are getting these days, whether that’s cesareans or having their gallbladder out or appendix out very well, you know, I mean, or hysterectomy. So these are what we would call sort of routine surgeries. Any surgery that cuts into the abdominal cavity can create this type of scenario. And I’ve seen it many times before where there is, you know, and that requires a different type of treatment. So, you know, those are the three main categories. And if you’re always just treating the bacteria and I told my practitioners this, it’s like treating the bacteria is not the hard part. That’s easy. But if you continue to treat bacteria and don’t really address underlying causes, you can actually harm somebody’s healthy microbiome that way. And we don’t really want to do that.

Laura Frontiero, FNP-BC

Yeah, so what about the structural issues? So let’s say somebody has adhesions from a C-section or a surgery or, you know, how do we solve this?

Nirala Jacobi, ND

Yeah. So there are practitioners that are fantastic in gently manipulating the scar tissue from external layer. They’re called visceral manipulation therapists, and they’re trained to help with this particular issues. They do other things, but they, they, you know, the last thing you want to do is a vigorous abdominal massage because it can actually trigger more scar tissue formation. So these people are specialists in manipulating the scar tissue externally. And that’s our best bet for this. There is a place in Colorado called Safe Passage where they really specifically focus on heavy scar formation like endometriosis. So people, as you know, have really severe issues with endometriosis and scars.

Laura Frontiero, FNP-BC

So what’s your thought? What’s your thought on adjunctive proteolytic enzyme therapy as well? Is that going to be supportive?

Nirala Jacobi, ND

You know, I have not to be honest. I had high hopes for it and I just haven’t seen it work very well. But some people may have. So but typically when I have a patient that has we know has adhesions, I’ll always have some manipulate a visceral manipulation therapist as a referral.

Laura Frontiero, FNP-BC

Okay. So this is all this is you’re just dropping pearls and pearls and pearls of knowledge. Yeah. So all right. So we’ve covered the three categories of why SIBO can reoccur and some really amazing strategies to solve this. Obviously, people are going to have to find some practitioners in their area, but find somebody that’s been trained by Nirala and fellow. They’ll know how to do it.

Nirala Jacobi, ND

Yeah, we have a good practitioner database. Yeah.

Laura Frontiero, FNP-BC

Yeah. What’s your database. How do people find that.

Nirala Jacobi, ND

So if you go to theSIBOdoctor.com and just click on resources, it’ll, it’ll lead you to, to the link to where you can find somebody hopefully in your area, you know, I mean it’s I’m just a one person trainer so, you know, it’s not like I have thousands of people all over the world, but I’m working on it.

Laura Frontiero, FNP-BC

Yeah. This is your vision, right? Okay. So let’s talk about food, because everybody always wants to know what the heck should I be eating? Because it’s so conflicting and so confusing. And what is the best diet for health and longevity?

Nirala Jacobi, ND

So, okay, let’s unpack that a little bit because a lot of people that are probably listening have some issue as to why are they listening, right? They’re fatigued. And if it’s not related, it may be due to SIBO. And if you have SIBO, then I would recommend that you follow my diet, the biphasic diet while you’re getting treated because that’s a low fodmap diet and fodmaps are fermentable carbohydrates that are in healthy foods that bacteria love. And under normal circumstances, that’s wonderful because you need to feed your bacteria that are in the healthy location. But if they’re further up and they’re fermenting things way before they can get absorbed, then, you know, that’s a problem. So usually I prescribe diets for specific conditions. Like it would be a bit different if somebody just has a fungal overgrowth or candida RC Falls, small intestine, fungal overgrowth. 

That diet is, you know, a lot less carbohydrates but more fodmaps. For example, if somebody has leaky gut, then I’m going to be very low allergy. Right? So very low common allergens and more of an elimination in diet potentially. While I’m also increasing their foods to heal their gut wall. So, you know, it’s really specific. If somebody has no gut issues, that’s always the best thing because then I’ve just go microbiome restoration as much as I can, which is a high fiber diet and that is a plant based diet. So in a perfect world, I think, and what we’ve learned from the blue zones, right. Dan Buettner spoke about where people live to be the longest or lived to be the oldest. Right. So these people routinely live to be over 100 years old in these specific zones in the world. You know, they’re like in the Mediterranean, in Japan, in different spots in the world. There’s these little hot spots where people live to be very old. We have.

Laura Frontiero, FNP-BC

A hotspot crew.

Nirala Jacobi, ND

In the pudding.

Laura Frontiero, FNP-BC

We have a hotspot of all places. We have a blue zone, a hotspot in southern California.

Nirala Jacobi, ND

California, one.

Laura Frontiero, FNP-BC

Of the most unhealthy areas in the world to live with the pollution and all of it.

Nirala Jacobi, ND

So it’s I think that was the Seventh Day Adventists that people that are veggie vegetarians. And so what these people so for me what I looked at was what they all had in common and what the book talks about is a good book to read is that they all aid 80% plant based diet. Right. So that to me means, yeah, that’s where it’s at because a plant based diet will feed your microbiome. Animal products don’t really feed your microbiome. Right. And if we’re now saying we’re actually learning exponentially, so much about the microbial environment and the metabolites that they produce, it’s actually the whole new frontier is the metabolites because and what they do to our body besides butyric acid and all of that. So that’s what we really want to foster is we want to feed the bacteria that are helping us perform our daily functions, including energy, and that is done through plants. So yeah, I’d say 80% plant based diet is the way to go.

Laura Frontiero, FNP-BC

And, and here’s the interesting thing, because with a low fodmap diet, you’re taking out a lot of those plants that are very nourishing and healing. So it was on one of my first summits, I think it was. And Louise Gettleman said to me, she said, The diet that heals you is not the diet that will sustain you. And that’s something really important here, because give us some examples of things you shouldn’t eat on a low-fodmap diet if you have SIBO.

Nirala Jacobi, ND

Yeah, that’s a really good point. You know, it’s, it’s for example, garlic and onions, right? Garlic and onions are wonderful, super healthy foods, but they’re high in a fodmap called fruit tam and fruit eaten. Well, just like bacteria love it. And they feed off. And that’s why it’s actually also a healthy food because it feeds bacteria so well. Fodmaps are very healthy foods for that reason. But if you have bacteria in the small intestine and you’re feeding them all of their favorite foods, you know, you can imagine the scenario. If they’re further down, knock yourself out with a garlic and onion because it is a great food. Other foods in that category would be things like celery, for example. You know, celery is a wonderful food, but it’s also a higher fodmap. And so our green beans and, you know, a cauliflower. So there are I mean, I’m just giving you very small examples. It’s a big list. And people can go to either, you know, I’ll get my e-book on the Biphasic diet, which is really a SIBO protocol, but if you’re just wanting to get more information, Monash University, which is here in Australia, they really have done an incredible job and an incredible service to IBS sufferers with their Fodmap diet. They discovered this whole Fodmap diet. So Monash University has a lot of information on Fodmaps.

Laura Frontiero, FNP-BC

Oh, so good. Thank you for sharing that. So we’re going to wrap this with some final thoughts from you. So in terms of energy, in terms of solving this, I mean, this is something that’s it’s it’s an epidemic, low energy, right? And there’s a lot of causes for it. And the things that we’re talking about today are one of many. If you were to put all the causes of low energy into a bucket, this is one of the categories. Right. So we’re being very specific today, talking about gut gut health and a lot of specifics around SIBO. So for people who think that they might have this, what are some words of wisdom and hope? And and again, share with us how our audience can learn from you, because you do teach practitioners. You do have resources for consumers, patients as well. You’ve got it all.

Nirala Jacobi, ND

Yeah. And look, I can tell you that I’ve treated thousands of people for Siebel. And there if I can give you one thing of hope, it’s that there’s a huge amount of hope I’ve had. Just the other day, I had somebody who had suffered so long for four without any improvement and he was down to like five foods because he was getting more and more reactive. And when we started to really initiate a regrowth program after we treated SIBO and the underlying causes was really deficient digestive juices, he started to regain his energy and feel better than he ever felt before. So it’s, you know, the one thing we didn’t talk about was insomnia. Insomnia is a huge driver of daytime fatigue, obviously. And bacterial overgrowth can absolutely cause insomnia. Yeah. So lots of different reasons to feel hopeful. Find a practitioner that understands SIBO the nuances of SIBO and doesn’t just want to kill it. It takes a bit more finesse than that. There’s a lot of different labs that you can use that where they send you a home kit, you can get tested. It’s very easy to do a breath test and if all else fails, you can do this little success plan, which is a course that I’ve created for patients that’s more self-guided if you don’t have somebody in your area that can help you. And I talk about all these different aspects to regaining your gut health, including leaky gut, the gut brain axis, the whole thing is covered in that course as well.

Laura Frontiero, FNP-BC

Perfect. Thank you so much. Narula It’s always a pleasure to have you on and sharing your expertize. And you’ve done so much work in the cyber world, you definitely are leaving a massive legacy of work and I know you have more fun things coming up, so enjoy.

Nirala Jacobi, ND

Thank you very much and all the best to everyone out there.

Laura Frontiero, FNP-BC

Thanks so much. Bye now.