Dr Nirala Jacobi:

Welcome SIBO practitioners to another episode of the SIBO Doctor Podcast and with me today, I have Dr. Greg Nigh, who co-founded the Immersion Health Center in 2014 after completing both the Naturopathic Doctor Program, and a Master of Science and Oriental Medicine Program. During his early years of work, he developed his interest and passion for researching and implementing alternative cancer therapies. Dr. Nigh is widely respected in the naturopathic profession and has spoken several times at the Annual Convention of the American Association of Naturopathic Physicians, and the National Conference on the Oncology Association of Naturopathic Physicians on cancer cell metabolism. He's a prolific reader, researcher and writer, and has also contributed a chapter to the upcoming two volume foundations of naturopathic medicine textbook that we've all been sort of waiting for, for a while.

And recently, Dr. Nigh and I both presented on the SIBO SOS Summit that was put out by Shivan Sarna and has reached thousands of potential SIBO patients. And I was really impressed with his talk on hydrogen sulfide, and it's been something on my mind. I've mentioned it in many podcasts before about hydrogen sulfide, it being the sort of third gas besides hydrogen and methane that we suspect in SIBO, but we can't as of yet really test for it in a breath test. So I thought I'd invite him on the show and talk to him about sulfur metabolism. He has some really unique ideas about hydrogen sulfide and sulfur imbalances. So Dr. Nigh, welcome to the podcast.

Dr. Greg Nigh:

Thank you so much. I'm psyched to be talk to you.

Dr Nirala Jacobi:

Okay, so let's kind of dive right in, just a little bit more of a preliminary sort of stage setting. Hydrogen sulfide has been sort of a friend and foe. And when we look at research, there's research that suggests that hydrogen sulfide production in the gut can be both protective but also can lead to pretty serious issues. Like intestinal permeability, and is also linked to colon cancer, ulcerative colitis. So it's kind of like one of those things that can wear a number of hats. And what I really want to kind of talk to you about is A, the sulfur metabolism and your unique approach to it, but also the bacteria that produce hydrogen sulfide or sulfur reducing bacteria. So let's kind of start how you actually landed in this whole hydrogen sulfide soup.

Dr. Greg Nigh:

Oh, gosh, let's see. So it started... There's a researcher, Stephanie Seneff, a lot of people might know of her. She's at MIT, and she's written a lot about sulfur. And she had published a few papers that I read, and I was just sort of blown away by what she was saying not just about sulfur, but a lot of things. She's a very creative thinker. And so I just sent her an email and said, wow, those are great papers. And so we ended up in a correspondence and... Anyway, I'll try to fast forward all this. She was interested in some of my clinical stuff and we set up and had some conversations on the phone. And she was telling me about a lot of problems that happen with sulfur metabolism, especially in a toxic world where sulfur in our bodies can get bound up by all kinds of toxic things because it chelates so well.

Dr. Greg Nigh:

And it so happened that the nutrition therapist that I work with, Maria [Zoka 00:05:06], she was sitting in the room and could hear half of the conversation as I was talking, just trying to understand the way that sulfur messes things up. And Maria is certified as a GAPS practitioner, she implements the GAPS diet. Which in her experience, there were people who were doing GAPS, some people did fabulous on it. But there were a number of people who would do well for about a week, and then they just crash on the diet. And they stayed on the diet thinking that they were doing detox, but in fact, they were just not getting better. And it occurred to Maria, wait a minute, the GAPS diet is loaded with sulfur, and it's a very high sulfur diet.

Dr. Greg Nigh:

And so we kind of cobbled together this protocol where we would radically lower, dietarily lower sulfur intake, and we would give this set of nutrients that could just sort of help speed the outflow of these various metabolites that we'll be talking about. And we put these people on this protocol, and it was just astounding how their health was transforming, sometimes in a matter of a day or two. We really... It's crazy. And so that was sort of our first eye opening, oh, my gosh, there's something going on with sulfur. And so we just expanded that, and of course, I've just kept doing my geeky thing and trying to understand what's really happening metabolically here, and what are the things that feed into it, and how does it drain out, and all those things.

Dr. Greg Nigh:

And so we just kept trying it with more and more patients who seem to be fairly unresponsive to other things that they should be responding to. And it was sort of crazy how many different conditions were responding to this low sulfur protocol. And it got to the point where anybody who walked in and it didn't seem obvious what was going on, we just put them on this protocol to see what happened because a large number of them were getting better.

Dr Nirala Jacobi:

So it didn't matter if they had digestive issues, so you just sort of-

Dr. Greg Nigh:

It really didn't matter.

Dr Nirala Jacobi:

Interesting.

Dr. Greg Nigh:

We came into... There sort of a picture of a sulfur person, that we sort of over time we've gotten to the place where you just ask a few questions and you just look at somebody and you say, oh, yeah, that's a sulfur thing. And so, we end up using it with lots of patients, certainly anybody with kind of an inflammatory bowel.

Dr Nirala Jacobi:

In terms of gut issues, you were looking for inflammatory bowel disease, and mainly ulcerative colitis, I would assume?

Dr. Greg Nigh:

Yeah, but really, anything. People that have any kind of ongoing irritable bowel, or just their gut isn't right, they've had reflux, or they just know something's not right in there. And, of course, also the people that have ulcerative colitis and Crohn's disease, the extreme stuff, but not necessarily extreme stuff. And so we would just put them all on this protocol. And it's not like it fixed everybody, but a oddly high percent of people who we were doing this with, were getting either somewhat or dramatically improved, often within a span of like two or three days of being on this protocol. And so then it's like, all right, so what's happening here? How could this be? And so that has been kind of this concurrent study of trying to understand why this would work so well. And then what I've come to believe is that, sulfur problems are, in some ways, sort of like the canary in the coal mine of gut toxicity in general, just because of the role that sulfur plays in detoxification.

Dr. Greg Nigh:

It's like when it's over there in phase two, in the liver, you want sulfur to be binding to all kinds of things. But when it's over here maintaining the structural integrity of the body and the connective tissue, when it's lining every surface with heparan sulfate proteoglycans, that sulfur is not supposed to be bound up with anything, because it has a very specific role that it needs to be playing. But now we're exposed to just so much stuff. And not just metals, but also metals, but also the organic chlorides and all kinds of things bind to sulfur. And when sulfur gets bound up it just causes all kinds of problems.

Dr Nirala Jacobi:

So if I could just interrupt just to clarify. So what you're saying is that the demand for sulfur is greater now than it's been Pre-Industrial Revolution perhaps, when we are now experiencing all sorts of exposures that we never experienced before. So my question about that would be, okay, so we have an endogenous sulfur metabolism or production... Well maybe not production but processing, and then we also have bacterial production or sulfur reducing bacteria. So how do those two fit in?

Dr. Greg Nigh:

Yeah, great. So sulfur in the body it's all dietary, that's all of our sulfur exposure. So sulfur comes in in its various forms and ultimately the body has to get a large portion of that sulfur into the form of sulfate, SO4. Very little sulfate is in our diet, it comes in these other forms and it's got to get to sulfate through enzymatic activity. And there are various things that happen that prevent dietary sulfur from making its way to sulfate. But the problem is we have to have a constant supply of sulfate. I mean, our bodies, we can't lack sulfate, it is what... All the heparin sulfate in the body, which every surface is lined with heparin sulfate. We need a constant ongoing supply of sulfate. If we can't get to sulfate, then we have to do a workaround. Bodies are intelligent and if they can't make sulfate they're going to figure out something else to do in order to get the sulfate if you can't make it directly through enzymatic action.

Dr Nirala Jacobi:

Are we talking about CBS pathways? Or what are the pathways exactly that usually get challenged or are utilized through this process?

Dr. Greg Nigh:

Yeah, so dietary sulfur comes in and is, partly through bacteria or through enzymatic action gets liberated and then it has to go through a series of oxidation steps. So you've got to climb the ladder from either elemental sulfur, just dietary sulfur or elemental sulfur you got to get it oxidized up to SO4. And so there are these enzymatic reactions that ultimately do that. PAPS is the activated form of sulfate. But in order to get there... CBS is one of the pathways that sulfur can go down if it's not going to sulfate. So sulfur also is going to be used to build glutathione and it's going to build taurine, and CBS will generate hydrogen sulfide as another byproduct, but that is in the sulfation pathway.

Dr. Greg Nigh:

In the digestive pathway, it is through a series of oxidative steps that transform, for instance, sulfur dioxide, which can come in dietarily in small amounts or even thiol sulfur that can come in that will be transformed often by bacteria into hydrogen sulfide and sulfite. Those will get directly oxidized to SO4. So H2S will get oxidized as SO4, SO3 obviously easily oxidized SO4. And then once it has SO4, the enzymatic action of PAPASS is this long named enzyme that translates inorganic sulfate into biologically active PAPS. And that form of sulfate is the one that the body needs. But this is a very long process and if anything interrupts... Or not a long process, but it involves multiple steps. And if anything comes in and interferes with the steps that get you to PAPS, then you have to figure out another way to get there. And there will go into. There are lots of things that will interfere with the ability to get to PAPS, which means the body has to figure out a workaround.

Dr Nirala Jacobi:

Right. Just trying to understand, so when people are actually reactive to sulfur, or let's say, sulfur containing foods or thiols, they're not having a very efficient process that ends up in PAPS. So they're actually reacting to these byproducts of this metabolism, is that correct to say?

Dr. Greg Nigh:

Yes. What I think is happening... And I say, I think. Stephanie is really... I mean, it's just been through many conversations with her and a lot of this is her original idea that I've kind of taken over and just sort of see how much it plays out clinically, and I think it does. That if we can't get PAPS generated in the gut where it can get produced and heads to the portal vein to the liver and the liver does all of its sulfur stuff using that activated form of PAPS. If you can't do that, we overgrow the sulfur fixing bacteria because they will start generating higher levels of hydrogen sulfide and sulfite. We need those things because they can be directly oxidized into sulfate

Dr. Greg Nigh:

And so when we generate these toxic byproducts, they're symptomatic, which is a bummer, but they will get into the blood and the mitochondria in the disseminated cells of the body can directly oxidize those things to sulfate. And that allows the cells to have access to sulfate. So the overgrowth of these bacteria, I believe in many cases, is an adaptive overgrowth, which is why I think just trying to kill off bacteria is going to ultimately not be a long term successful program.

Dr Nirala Jacobi:

I am somebody who's worked with people with high desulfovibrio, and so fourth, bilophila. And they're really extremely high, especially on the Genova GI Effects that does measure desulfovibrio and many of my patients are just way over in the red. And they do improve when we do the dietary... When I first started, I looked at the research that showed that high animal fat, especially dairy fat and high animal products actually increased desulfovibrio and bile acids as well. And so I started to actually, before I removed sulfur I actually would work with those kind of classic high paleo, high meat eaters and reduce the animal fats and animal proteins. I can't say I had miraculous results like you talk about, but a few patients come to mind that had immediate improvement when we did that. So I'm just trying to... Because your approach is so revolutionary in terms of that it's actually an adaptive process and that we need these bacteria to produce hydrogen sulfide when we're on the other side of the fence saying, hey, they're causing damage, they're causing symptoms. So how do you reconcile that?

Dr. Greg Nigh:

Yeah. How do you reconcile? Yeah, it's good question. But, I mean, ultimately, I think that the problem has come because of toxicity. I think that there are a lot of reasons that our sulfate production can be shut down. And one that I've written a lot about, and I've done a lot of research on is with glyphosate, because it is such a direct hit to sulfate production in the body. And of course, it's ubiquitous, we are all exposed to glyphosate. And doesn't matter even those of us who eat organic as much as possible, we're still have glyphosate in our system. And glyphosate will through just a crazy number of different mechanisms, kind of all these different mechanisms that inhibit sulfate production, ultimately. And that's through chelation of minerals that are needed for sulfate production, through interference of very specific amino acids that need to be involved in this whole sulfur cycle. And I think just displacement of the co-factors, molybdenum is a co-factor in the sulfite oxidase, it's key enzyme for getting sulfite converted to sulfate, and glyphosate can displace the molybdenum through chelation.

Dr. Greg Nigh:

I mean, so many ways that glyphosate comes into the picture and can bring sulfate production to... I mean, it couldn't be to a halt, but at least slow it down in a big way. And that leaves our body starved of sulfate. And in fact, I mean, I personally think that this ricochets out through not just digestive issues. I think cancer can be very closely tied into this whole issue as well, and any number of other diseases. Stephanie's written about this a lot. She and I wrote about, recently, just the relationship to gout and some related diseases there and also anencephaly, and just so many different ways that glyphosate comes into this picture. But its impact on sulfate is profound. So that leaves our body in this place where, well, what do we do? We got to have sulfate. And so it makes sense to me just given how intelligent this whole crazy system is that if it can't get sulfate, the workaround seems quite straightforward that, oh, well, if we just grow these bacteria, they'll get the sulfate for us.

Dr Nirala Jacobi:

It's so interesting. Just for those listeners who are unfamiliar with glyphosate, it's basically the active ingredient in Roundup, really toxic herbicide. So what you're saying is you're using in a way, I don't know if you actually do any kind of... I'm assuming you do some stool testing. And if that bug shows up either on a uBiome or any of these other PCR tests, you would think of that as actually maybe a marker for toxicity rather than they need to change their diet to let's say, less animal products or less sulfur containing foods.

Dr. Greg Nigh:

Yeah, I guess I wouldn't necessarily say that... I'm not making the case that every case of dysbiosis is a sulfur problem, necessarily. I mean, of course, there are all kinds of reasons that we can end up with our guts in a wreck. And also, I don't actually do much testing at all. I mean, I do some but not much. Because, ultimately, I mean, it doesn't matter to me what a test says, if I do an intake and somebody tells me that not only do they have indigestion, but they have brain fog and maybe some anxiety or even panic attacks, if they have red skin rashes or any red... I mean, sulfur is just hot and eruptive. So still [crosstalk 00:23:20].

Dr Nirala Jacobi:

Homeopathically speaking as well, I guess.

Dr. Greg Nigh:

Totally. Absolutely. Great picture. And people who are... They're just sitting in front of you and you just see that their cheeks are kind of red, and they just have that red look to them. And then you ask them how they do with a glass of wine, and oh, my God, I'm sweating all night if I have a glass of wine.

Dr Nirala Jacobi:

That's why I love talking to other practitioners because it takes all kinds, right? Some people love to test, I am one of those people. And we get good results, you get good results. But like I would think more maybe histamines with wine and things like that. Interesting.

Dr. Greg Nigh:

I'm glad you brought that up. Because I mean, certainly histamine has a lot of overlap with sulfur, and some things that distinguish those two, histamine will, example you much more commonly get headaches with histamine, much more commonly get diarrhea with histamine. Histamine you end up with a fast heartbeat. Hydrogen sulfide is a dilator and so you get people who have orthostatic hypotension, they are more likely to have low heart rate as opposed to higher heart rate. Heart arrhythmias are also not uncommon at all with sulfur issues. So there is overlap for sure. But generally, if they check enough boxes on that they're allergic to sulfur drugs, and they have a hard time with alcohol and they have a hard time with, we ask them about high sulfur foods. Sometimes they say yes, not always. I mean, it's not uncommon at all, that you say, how do you do with eggs? And oh, yeah, eggs don't sit very well with my gut. So they're not eating eggs, they found that on their own.

Dr. Greg Nigh:

Or they... Oh, no. I can have a little bit of garlic but not too much because that's a problem. And then of course, asking them about alcohol. So whenever people are saying a lot of things that match up sulfur and they probably are going to have an alcohol issue too. And then we just put them on the diet and it's like, oh, yeah, look at that just another... I mean, I seriously I could run through just in the past week, the follow up with patients who, it was just crazy to me how much they can transform in a very short period of time. And these are people who've tried everything. And often I try the sulfur diet, because it's something they've never tried before. Even if it doesn't necessarily match so well, just like oh, well, they've never tried this let's do that. And then it works.

Dr Nirala Jacobi:

So now of course, I'm completely sitting on the edge of my seat for your sulfur treatment. I mean, I'm pretty familiar with the low sulfur diet but just for our listeners, can you go through what's involved in... Okay, so you have a patient that fits these criteria, and if I just summarize, it's orthostatic hypotension or low heart rate and potentially some arrhythmias, sort of reddish features potentially, not always. Reaction to alcohol, reaction to eggs and potentially other foods. Do you have any other sort of little red flags that you use to determine whether or not this person is sulfur sensitive?

Dr. Greg Nigh:

Yeah, any heat symptoms for sure. So night sweats or even just hot at night, that's certainly a biggie. What else? Sulfur break-

Dr Nirala Jacobi:

What about like sleep problems or something? Or what about the classic... I mean, the symptoms that hydrogen sulfide itself can cause, which is increased colonic nociception or hypersensitivity, those kinds of things, like cramping pain.

Dr. Greg Nigh:

Yeah. I mean, of course, I forgot to mention the gut stuff. So people that have made all kinds of any gut issues, I am suspicious that maybe sulfur is involved. I mean, it's not always. It's not every time somebody has a gut issue we're doing this with them if they don't have any of the other kind of red flags, but...

Dr Nirala Jacobi:

Well, I just have so many people that can't tolerate any alcohol at all. I have to actually tell them to put the tincture in hot water and let it evaporate, because that's how sensitive they are. So I'm thinking more aldehydes and alcohol dehydrogenase and those kinds of things rather than sulfur. So that's interesting to me.

Dr. Greg Nigh:

I mean, it's that molybdenum co-factor that links the two. And so if somebody is, for whatever reason, either low dietary intake, or they are... I mean, I always ask about glyphosate exposure because it will chelate molybdenum. And so-

Dr Nirala Jacobi:

Most people don't even know. Here in Australia, it's on wheat crops and then all different kinds of crops, but it's not something that we always think of Australia as being fairly clean, and there's certain GMO that is not allowed in. So we have a relatively clean food supply, but we certainly have glyphosate exposure, we have nutrient depletion and all of the stuff that goes along with just eating food.

Dr. Greg Nigh:

Right. And molybdenum, I mean, we just need tiny amounts of it. Which means that if you only need a tiny amount it doesn't take much to chelate that out. You bind up even a little bit of it and you're going to be messed up. So, whenever people have really strong alcohol issues, I mean, high suspicion it doesn't mean it's also a sulfur issue. But certainly, if people have the sulfur symptoms, you can confirm that to some degree by asking them how they do with alcohol, they almost always will tell you, "Oh, yes, I can't do that." Or they'll say, "I used to be fun in college, I did that college thing, but now it just wrecks me." And so they've quit. Anyway, so those are the kind of things that come together. And so you asked then what is the process look like?

Dr Nirala Jacobi:

So what is A, the low sulfur diet? There's a few versions out there, I use Dr. Yarnell's low sulfur diet. Again, I'm talking about thiols and sulfur containing meats and stuff versus thiols. And then also really, really wanting to know besides molybdenum, what you do to help promote the production of sulfate from sulfide.

Dr. Greg Nigh:

Sure, yeah. And actually something that I'll just want to speak to right quickly, and that is about thiols. I mean, I've read on the internet, there's all kinds of stuff about sulfur and thiols and their importance. My experience is that thiol sulfur is not that big of a deal in terms of reactivity for people. I mean, I don't know how to explain that really. Certainly meat, for people who are eating meat, meat is by far and away the largest source of sulfur that we get exposed to. But I have had, I mean, out of hundreds of people that have been reactive to sulfur and various dietary sulfur, I mean, one hand could count the people that react in any kind of significant way to meat. Which I don't know, I mean, I can't explain that.

Dr. Greg Nigh:

Now, there are a number of people actually, I should qualify that. I would say to red meat, which of course in some way is a sulfur source. That's extremely rare that I have had somebody... Now I'll say, I can think of two people and when they reacted, wow, did they react. It was major. But it's been very, very rare that I have seen a reaction to red meat. Now chicken, I have seen reactions to chicken much more commonly but I don't think that's a sulfur thing. I think that's an allergic reaction to chicken. [crosstalk 00:32:31].

Dr Nirala Jacobi:

Well, I would think of even to red meat, like when somebody comes to me with a red meat issue, I think of mammalian meat allergy with tick-borne and alpha-gal and all that. So-

Dr. Greg Nigh:

Yeah, it could be. Maybe there is no kind of sulfur issue. But with meat, it just seems odd to me that as the highest source of sulfur, it's not a big source of reaction. Now, the foods that react, I mean, by far and away, so far beyond any of the other reactive foods, is garlic. I mean, it's just unbelievable how many people are reactive to garlic, and some of them in just a astounding strong way. And we've had two people now, who were unable to get off their opiate painkillers through all kinds of other therapies and tried a low sulfur diet, this process, and all their pain went away. Just getting... And for one of those two people, even little tiny exposures of the high sulfur foods, in almost any amount of those, pain will come back. Another one, it's much more specific and I think it's just a couple of sulfuric foods that they cannot tolerate.

Dr. Greg Nigh:

But the most reactive food is garlic without question. And then kind of going down the line in order of reactivity would be probably eggs are second, and onions a third, and kale is one of those. Wow, there are a lot of people that are reacting to kale, which is surprising. And I'm not totally sure if the kale thing... I mean, of course, I'm not sure with any of these foods, but kale, it could be the sulfur. But there's also this weird thing going on with kale that more and more people know about it now. Kale accumulates this heavy metal, thallium. And I kind of stumbled upon this because I had a patient come in and who had all these kind of fatigue, malaise, wasn't really a classic kind of sulfur picture, but I was just curious what was going on. And we ran the red blood cell heavy metal and she had a huge amount of thallium in her red blood cells. Which is like, what the heck is that about? Thallium is not really on my radar as a heavy metal.

Dr. Greg Nigh:

So anyway, doing a little homework and lo and behold, thallium is taken up preferentially within kale. And apparently in much of that water they're used for this... Crazy United States we use wastewater as fertilizer and agriculture, and so they spray it on fields and some of this wastewater contains high levels of thallium. And so the kale takes it up and then people eat their healthy smoothie in the morning and they cram it full of kale and that's exactly what this patient was doing. And she had all the symptoms of thallium toxicity. So when you look that up it's all like fatigue and all kinds of things. But beyond just a thallium issue I do think that kale is one of the more reactive sulfur foods. Because we just have people get these foods out for two weeks and then they start a reintroduction process, the isolated reintroduction thing. And it's not at all uncommon that when people reintroduce kale they do not feel good.

Dr. Greg Nigh:

So anyway, we got garlic and eggs and onion and kale and those account for probably 85% of the reactive foods. Then there's a decent number that will react to garlic, cabbage, Brussels sprouts, asparagus, all this stuff is really healthy, right? Like that's part of the counseling we got to do with people is, because people will come in, often they're taking garlic capsules and eating lots of this stuff, which-

Dr Nirala Jacobi:

Well it's very often something that we do for SIBO, for methane dominant SIBO we give high allicin garlic. So I'm wondering if that still applies if it's an extract and doesn't have all the other bells and whistles of garlic, but I would assume so because it still smells like garlic and it's the sulfur smell. And they actually in research use garlic extract to increase hydrogen sulfide production and it very rapidly does that, the garlic, so it's an interesting thing. So just to get back to your diet, though, what about other brassica families, like cauliflower and broccoli?

Dr. Greg Nigh:

Yeah, they all go out. It all goes out for the diet. Yeah, it does.

Dr Nirala Jacobi:

So mostly you focus on vegetables like you know Dr. Yarnell in his book in the... Gosh, I can't remember. It's the naturopathic foundations of gastrointestinal diseases or something like that. I should really know this because it's on my shelf. But his diet does also eliminate red meat, and chicken and fish is allowed. So just interesting that you... So you leave the red meat in?

Dr. Greg Nigh:

No. We actually have people eliminate... They're vegetarian for one week and then they can reintroduce red meat. I think we leave chicken out for the whole thing. Chicken, it's kind of weirds me out. I think something's wrong with chicken. But anyway, we do a limited kind of meat elimination, reintroduction. But the vast majority of reactions that we see are with one of those things that I have listed. And then once we identify the reaction, and it is typically a very obvious reaction we don't have to guess, and the patient knows right away. So we get them all reintroduced, and then we do the kind of stuff that help... I mean, if we're just assuming it's a toxicity thing then we do detox, right? So we do infrared sauna, which I think is enormously important for detoxification. Certainly we supplement with molybdenum. Am I supposed to say company names on this thing?

Dr Nirala Jacobi:

Yeah, you can go ahead.

Dr. Greg Nigh:

All right, it's okay. Yeah. So, we had tried several different kinds of molybdenum knowing just it must be an important component of this whole thing. And either people didn't seem to respond at all or people would get Herx reactions. Like sudden bad detox reactions when we give them fairly low doses of some of the kinds of molybdenum that we use. Anyway, what we ended up doing was with Biotics, one of the companies that we in our clinic we use a lot of. Biotics makes an organic molybdenum, it's called Mo-Zyme. We use Mo-Zyme Forte, which is a food based tablet. It's based on a sprouted lentil, but it has 150 micrograms of molybdenum, not a huge dose. But we had the patient chew up, not swallow whole, but we have them chew the tablet up twice a day.

Dr. Greg Nigh:

And sometimes even just doing that people will tell us that they can think clearer. Like if somebody says, well, I can't start this diet until next week, and we'll say, well, look, go ahead and start this, just chew one of these up twice a day. And they will tell us that they notice a difference as soon as they start using that particular molybdenum. And in fact, Maria, in the hub one time she was doing an intake with a patient who was all brain foggy, and sulfury and everything. So she had a bottle of Mo-Zyme in her office and just as the patient was talking, she just took one out and told the patient to just chew this up while you're talking. I mean, she didn't tell her what it was or anything. So the patient just chewed it up and kept talking. And then about 20 minutes, Maria said the patient was like, "What was that that you gave me? I feel like I'm... Suddenly my head is cleared up."

Dr Nirala Jacobi:

Wow. That's amazing.

Dr. Greg Nigh:

So it is that quick. So I think that particular kind of molybdenum, I don't know what it is. I mean, Biotics has a unique way of doing their stuff. So there's something about it-

Dr Nirala Jacobi:

Yeah, I like their stuff. We can't really get it here in Australia but patients can get it if they really want to. Can order it themselves for personal use and stuff. It's usually how I deal with that. So besides... Because I do try Thorn molybdenum picolinate, I'm not seeing any sort of light bulb moments with that product, but-

Dr. Greg Nigh:

Yeah. So we had been using allergy research as a liquid, and we were happy with it, it was so provoking in patients that we would happen to do this really careful drop dosing of it, and it just was sort of a pain. So then we got turned on to this Mo-Zyme and Biotics just suggested, "Just tell your patients to chew it up instead of swallowing it whole." So we go, all right. And it works great. And we have people swear by it. So, I think-

Dr Nirala Jacobi:

So besides molybdenum, what else are you using?

Dr. Greg Nigh:

So besides molybdenum, let's see some other things that we do. Well, certainly there is people that have like a lot of bloating or gut issues going on we use, again I mean, most of these are going to be Biotics products, they have something that's called Bio-HPF. I can't never remember, they have a bunch of letters in their products. But it's bismuth. It has bismuth as well as some other demulcent and DGL and some other stuff in there. But bismuth in particular will reduce hydrogen sulfide production in the gut. So for people that are just kind of miserable but they're bloating or discomfort there, we use butyrate, which... We use a lot of butyrate I think it's the most underrated gut nutrient that there is. It's can be just fantastic.

Dr Nirala Jacobi:

I mean, I use it from different companies, but you mainly stick with Biotics with that one?

Dr. Greg Nigh:

Well, Biotics has one that I use a lot of, Butyric-Cal-Mag, they use... I mean, because butyrate is pretty intense in terms of the smell and all that. And so they add a little bit of flavoring to it that a few patients have reacted to. So if we're not using theirs we use Apex as EnteroVite, which is another that works really well also. But pretty much every patient gets butyrate in one of those forms. They get a digestive enzyme, we'll give them molybdenum, if they're really like headachy and fatigy, brain foggy, then we do injections with hydroxocobalamin, because that will lower hydrogen sulfide in the blood. Or if it's not that bad, we'll have them do just a sublingual, but it needs to be in the form of hydroxocobalamin and not the others because the others don't impact hydrogen sulfide.

Dr Nirala Jacobi:

I read a study about zinc acetate. Zinc is actually a good binder for hydrogen sulfide. So I've been doing really pretty hefty doses of zinc.

Dr. Greg Nigh:

Interesting. Yeah, that's a good idea. And glyphosate strongly chelate zinc. So that one is one that, I think, is commonly depleted in a lot of people. So yeah, there's other things that, it's more like symptomatically that we will do if we need. I mean, of course, if somebody needs adrenal support we would do that, if they need DHEA we'll do that.

Dr Nirala Jacobi:

And other detox support, I assume, along with your far infrared sauna and... What about colonics and things like that, if we're talking detox?

Dr. Greg Nigh:

Yeah, we're having people do coffee enemas on a pretty regular basis. I mean, colonics, I don't have a problem with that, but coffee enemas are very accessible. And they have a lot of great properties, with the chlorogenic acid and other different components in there that are good for glutathione production and [inaudible 00:46:37] bile and all that kind of stuff.

Dr Nirala Jacobi:

I do recommend them a lot too. So good old naturopathic protocols like that are always really helpful.

Dr. Greg Nigh:

Epsom salt baths. I think Epsom salt baths are fantastic. Because Epsom salt, of course, is magnesium sulfate and everybody needs magnesium and these people only need sulfate. And so it's not going down the tubes so you don't run into the bacteria that can generate the bad things.

Dr Nirala Jacobi:

Right. Okay.

Dr. Greg Nigh:

You increase sulfate. There's exactly one study, and I'm so glad it was done, where they had a group of healthy people and a doctor measured their blood magnesium and their blood sulfate levels, and had them do an Epsom salt bath every night. And he measured their blood sulfate levels just every day to track their magnesium and their sulfate. Their magnesium went up for a few days and then leveled off because it can't go too high. Sulfate levels went up every day, for every member, after every bath for seven days. It went up consistently and then it topped out and it leveled off and it never went up above that even though they kept doing more baths.

Dr. Greg Nigh:

So the point is that there's a pool of sulfate that the body needs to fill up and once it's there, it's not going to get any higher. But Epsom salt baths even for people that are very reactive to dietary sulfate, they will often feel great with an Epsom salt bath because it's a way of getting sulfate in that's not a reactive entry. The study that looked at this used four cups of Epsom salt per bath. So it's a lot of Epsom salt.

Dr Nirala Jacobi:

It's actually like when I tell people to do an Epsom salt I just tell them to do a whole liter which is basically four cups or even more, when you think about some of these... Or even like those flotation tanks, the womb-like environment.

Dr. Greg Nigh:

Sensory deprivation.

Dr Nirala Jacobi:

Yeah, sensory deprivation, that's right. Where it's just like, basically, I think 300 kilos of Epsom salt per tank or so. Yeah. So you basically float out of there. But one thing you said about the diet that was curious to me is that you said that you took people off of meat and sulfur foods for a week, and then you reintroduced them. But what I didn't really understand is, if they have a sulfur problem why reintroduce thiol foods or foods that are obviously high in sulfur? Are they're really reactive into individual foods? Or would it not be the whole food group?

Dr. Greg Nigh:

Yeah, almost everybody... I mean, there are very few exceptions to this. Most people are highly reactive to one, two, maybe three sulfur sources, and they do fine with the others. And if they are fine with the others, it's enormously important that their diet include them because, of course, sulfur is so important. I can't explain why this is, but the people who are the most reactive... I mean, the number that are reactive to garlic and eggs and kale, is by that far exceeds a number of other kinds of reactions. And often after we do detox, kind of supplying a lot of molybdenum to displace whatever might be blocking that spot of the enzyme. People can bring those foods that they were highly reactive to, they can bring them back in.

Dr. Greg Nigh:

Now, not in the same, like stuffing kale in your smoothie every day, not like that. But in kind of more sensible low level ways they can bring it back into their diet and they do fine. But not always. In fact, it's not uncommon at all that people, especially with garlic, they can't even have a whisper of garlic or they get a migraine or something.

Dr Nirala Jacobi:

I mean, I know you said that you don't do much testing, and so it's hard to know whether or not the digestive cases that you're treating are really hydrogen sulfide SIBO, or just any of these other issues with hydrogen sulfide production in the large intestine, we don't really know. But for you, it's not uncommon to see the resolution of digestive symptoms when they remove those foods for a while or at least unclog those pathways, it sounds.

Dr. Greg Nigh:

Yeah. I mean, this is how I got into SIBO at all, it wasn't even something that was on my radar, and then it kind of... I just started talking and writing about this whole sulfur thing because I was so blown away by it. And then SIBO patients sort of found me because there's such a close relationship between sulfur and the gut. And so the SIBO patients would show up and I didn't know how to treat SIBO, that's like a whole thing and of itself. And it wasn't my specialty, but I thought, well, what the heck, let's just try this sulfur program and see what happens. And it was really shocking how many SIBO patients who come in with their test results and they're high on methane, they're high on the hydrogen, and we would just do this process and their symptoms all resolved, like they would just go away. Which led me to believe and I actually do believe, and Stephanie's writing a paper on this right now I think. I think that the sulfur imbalance underlies the... I think the methane issue and the hydrogen issue are downstream from the sulfur issue.

Dr Nirala Jacobi:

Can you elaborate on that? I mean, I get the hydrogen, I don't get the methane so much because it's basically a different organism altogether that creates a totally different gas. So hydrogen is required for hydrogen sulfide production, I guess, but what's the connection there?

Dr. Greg Nigh:

Yeah. What is the connection? Well, I'm waiting for Stephanie to write that one out. Well, empirically, what I would say is, it doesn't make sense to me that somebody with a high methane SIBO who does the low sulfur process would have essentially complete resolution. To the point that, I mean, I always ask patients if you felt like you do right now, would you seek out a doctor? And they say no, they don't have any more digestive issues. I mean, I'm thinking of a particular patient with high methane. I don't know how else to explain that. Like, if-

Dr Nirala Jacobi:

So, well, I could imagine we're pretty good with thinking tangentially. So, I mean, if I'm thinking about an organism like methanobrevibacter smithii that produces methane that requires four hydrogen for the production of methane, and you're up regulating hydrogen production in order to produce hydrogen sulfide. If that's your theory, then it could follow that you're then subsequently also sort of feeding hydrogen into that methane production. Potentially, that would be my thought. I'm sure there's many other explanations of that.

Dr Nirala Jacobi:

Because methanobrevibacter smithii is actually not a pathogen, right? It's not an organism that has individually been linked to the amount of damage that we can see with hydrogen sulfide production on the colonocytes and stuff. So methanobrevibacter is sort of like a... The way I think of it, it's an evolutionary organism that we've evolved with that is not linked to any sort of pathogenicity other than constipation. Because the idea was to slow things down, so that you could extract more calories from your food from an evolutionary standpoint. So, I may be totally off base, but that's what I would think. If it's true what you say that we're up regulating hydrogen sulfide production, we first must up regulate also hydrogen.

Dr. Greg Nigh:

Yes.

Dr Nirala Jacobi:

Or maybe not.

Dr. Greg Nigh:

Well, I'm not sure. I mean, I don't know how abundant hydrogen would be already. I mean, hydrogen... No, I don't know. I mean, I don't know quantitatively, if there really is not enough hydrogen around that you would be able to make... I would think from even the ambient water, that bacteria would be able to extract hydrogen from that. But I don't know the biochemistry that well.

Dr Nirala Jacobi:

Well, there are also acetogens and other organisms that pump out the hydrogen. I mean, I'm very curious about that link and I'd love to see this paper.

Dr. Greg Nigh:

I mean, Stephanie, her line of thinking is that with, especially with glyphosate toxicity, what happens is glyphosate through a lot of different things interferes with the microbial production of methionine. And if you can't get the carbon that you need incorporated into methionine that's a perfect substrate for... And also not only get carbon incorporated it into your organic molecules that you're trying to build, but if you can't get sulfur incorporated into the sulfur molecule that you're trying to build, that is a perfect substrate for microbes to pick those carbons and sulfurs up and generate methane and generate hydrogen sulfide. As sort of a byproduct of a disrupted metabolism that happened prior.

Dr. Greg Nigh:

Talking right now, this is very much... I'm sure she's working it all out. This was through a series of exchanges that she and I had some weeks ago just trying to piece together. In a SIBO environment, how would you end up with those particular gases being produced? Why in SIBO are we growing certain bacteria and not other bacteria? Which seems to me, kind of a... I mean, with dysbiosis, you can have all kinds of weird bacteria growing. Why is it that SIBO has just these bacteria?

Dr Nirala Jacobi:

Well, I think that could be the topic of a whole another podcast because I have a lot of thoughts about that. And I'm not sure we can equate. We know that the environment in the small intestine is so very different from the large intestine, right? Completely different. And there's so many different reasons why people have SIBO and grow those bacteria and there's so much interplay, especially with hydrogen. Like I said, there's hydrogen reducers and producers and all kinds of different things that occur. And those are just the two gases that we happen to measure. Now with methanogens, I mean methane, it tends to be high in people that live next to landfills, for example, it's not always just linked to SIBO. There's a lot going on there and that's because methane is produced in very high amounts around landfills.

Dr Nirala Jacobi:

So there's a lot of thought. But I love it that there's so many people thinking about that and what we now know about the microbiome, and we're just in a way still to this day peeking over the fence of all the things we're going to find out. That's the exciting bit of learning more and understanding more and making those connections. So, look, we're unfortunately out of time, I have a million more questions, we didn't get to any of the ones that I sent through to you. We did fair and fairly. But that's what I love, we just get to talking about things that really matter. And I think this has been so helpful to a lot of practitioners out there, and I'm certainly going to try what you've suggested a lot more in these patients. So I really want to thank you for coming on the podcast. And do you have any other sort of little nuggets that you want to throw out there when it comes to hydrogen sulfide or sulfite in general?

Dr. Greg Nigh:

Oh, gosh, nuggets. I would say, I will be so psyched if people just start trying. Just trying it out and send me a note and tell me what happened. Because I can't be the only person who gets results with this. There's no way.

Dr Nirala Jacobi:

I'm certainly going to try. So what is the email or the contact that you want people to contact you on? And also maybe say your website, although all of that is usually in the show notes. But certainly, you can plug your clinic at this point.

Dr. Greg Nigh:

Sure. So I'm in Immersion Health in Portland, Oregon. That's it, immersionhealthpdx.com. I can be reached at Dr. Nigh D-R-N-I-G-H @immersionandhealthpdx.com. What else? Yeah, I mean, that's all I needed to do, I guess. But, would be totally psyched to hear feedback from anybody who tries this process. Because I really do think that there's a really close tie between disrupted sulfur metabolism and SIBO. I don't think it's 100% explains all SIBO but I think that there's an enormous overlap between the two, and that unresponsive patients or poorly responding patients may do really well if it's approached as a sulfur issue.

Dr Nirala Jacobi:

I can't wait to try it out, honestly. And you will hear back from me, so I'm definitely-

Dr. Greg Nigh:

Thank you for having me. I really appreciate it.

Dr Nirala Jacobi:

My pleasure. And we'll see you around and maybe have you back on the show when we have some notes to compare.

Dr. Greg Nigh:

Excellent. And we can get into all those other questions.

Dr Nirala Jacobi:

Yeah. Thanks a lot, Greg.

Dr. Greg Nigh:

All right. Bye-bye.

Resources

• Dr Greg Nigh
  • Immersion Health Portland, Oregon
  • drnigh@immersionhealthpdx.com
• Dr Yarnell
• Foundations of Naturopathic Medicine
• Biotics Research
  • Mo-Zyme Forte
  • Bio HPF
• Apax EnteroVite