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Nirala Jacobi:                    Welcome back to part two of the SIBO Doctor podcast and let's jump right back into it.

Nirala Jacobi:                    So one of the other aspects of your course, you really do a great job and it's of course for practitioners and we'll talk more about it at the end and all of the contact details and Dr. [inaudible 00:01:01] website and the link to the course will be in the show notes. For those of you listening or your practitioners, it's a really fantastic course that I highly recommend because I think we're all missing mold all the time too, especially when I was going through, you know, when you do courses, when you're just expanding your knowledge on a different topic, you're like, "Oh my God, that was that patient. Oh my God. That was that patient, right?" It happens a lot.

Jill Crista:                            Yes, yes. And that's why I developed a clinical questionnaire, which you get with the course as a way of sort of scoring people. Because I had that same experience that after my patient, when they found black mold in his house and I started researching on mycotoxins and what it does to animals, I looked at my other patients, I'm like, "Oh my goodness, I'm missing. Oh, and that person. Oh, and that MS case that doesn't fit in any box." You know? And there were so many cases that I just thought, how have I been missing this? And you do because we don't understand.

Nirala Jacobi:                    I mean, one of the things that I have always appreciated about SIBO as a condition is that it is so central to so many different aspects and has so many underlying potential conditions. Like for example, POTS, postural orthostatic tachycardia syndrome with that mentioned on this program before, which is a real dysautonomia dysregulation of your autonomic nervous system that we often see with SIBO. But I can see the similarities there with mold toxicity and a patient that I saw that had cyclical vomiting because of that, I'm thinking, Oh my God, this probably was a huge component, right?

Jill Crista:                            Right, right. And it's so common that SIBO is a next step of a mold toxic person and vice versa. If they had SIBO and they went into that water damage exposure with already a compromised gut and motility issues and that kind of thing, they are just ripe for mold to move in and wreak havoc. So there's so much correlation between the two. It's just amazing.

Nirala Jacobi:                    So for all of you listening that are patients, I recommend getting the book, was it Break The Mold or Breaking The Mold?

Jill Crista:                            Break The Mold.

Nirala Jacobi:                    Break The Mold. That'll also give you some tips on how to clean up your own environment so to speak. But of all the tools you teach in your course, what do you find are the most specific to SIBO?

Jill Crista:                            Cholagogues and I know that we, yeah, I'm taking your course and loving it. I just can't believe how many times when you've said bile acids, my little ears just perk right up because I am such bilophile. Is that a term? Bilophile? I just made it now. Yeah. I have a whole section in my course called A Treatise On Bile, because I am so in love with it. I think it's one of the most underappreciated bodily fluids and it's so critical for restoration of these conditions. So I would say cholagogues are, if not one of the most important other than the antifungals once you can use them there, it's one of the most important things that you can do for a mold sick patient, especially if they have that correlative mold toxicity SIBO situation is what I've learned from your course is that the bacteria endotoxins are toxic to bile acids. So you now have an impaired ability to detoxify mold toxins because we use bile to detoxify mold toxins. So now you've got that feedback loop that's just a catch-22.

Nirala Jacobi:                    Or you're damaging bile acids that are dumped into the small intestine and liberating mycotoxins and then absorbing it through an impaired small intestinal wall. So yeah, it's definitely far reaching. One of the, and just to clarify, cholagogues are herbs that tend to move or aid in the movement of bile through the liver into the gallbladder and kind of liquefying bile because a lot of people have very sludgy bile.

Nirala Jacobi:                    There's also an aspect of what we call phase three detoxification, which is that last part of where a toxin has made it all the way through your liver, phase one and phase two and then phase three is actually the movement of that toxin into the bile. And there are also aspects, I think you mentioned it in your course of microtoxins in pairing that. So bile is really, really important.

Nirala Jacobi:                    Now, what I don't want to have people do is just buying ox bile willy nilly because there are aspects to when you don't want to use it, right? So you don't really want to use bile acids when you have a hydrogen sulfide condition. So for example, while hydrogen sulfide is produced predominantly by hydrogen sulfide producers, like [inaudible 00:05:59], and while actually bilophila wadsworthia. There's your word.

Jill Crista:                            That's a good one.

Nirala Jacobi:                    Bilophila. You are a bilophila. And that's a bile loving organism in and of itself, not harmful, but when you have an overgrowth of that, you can have an overgrowth of hydrogen sulfide producers, which can worsen your inflammation. So it's always a Goldilocks kind of thing, isn't it?

Jill Crista:                            Yes. That just explained a couple of cases actually that didn't make sense. So that's why I need to finish your course.

Nirala Jacobi:                    Yeah, there's a lot. It's so amazing the overlap of what we learn from each other when we compare notes, right?

Jill Crista:                            And there's no way to know everything. That's the thing. It's like, I know what I know. And I can't wait to learn more.

Jill Crista:                            So in that note that you had asked, what makes my protocol different than Dr. Shoemaker, there's a really strong emphasis on binders in his protocol. So that's the step one, I think, of his protocol. Again, I'm not Shoemaker trained, so I know it's an important step, but I don't know where it falls. And I have had people come to me that have been on binders, pharmaceutical binders for years, and they now have nutrient deficiencies and nutrient deficiencies for making fresh bile. So by binding too much bile and in a pharmaceutical way, you can actually create fat soluble nutrient deficiencies, which are exactly the things you need in your nervous system to protect your body from the mycotoxins. So putting back vitamin A, D, E, K, coQ10, essential fatty acids, putting back glycine and taurine, which are required to conjugate to make a bile acid. Those are some of the nutrients that some people are coming to me with that had been on longterm pharmaceutical binders.

Jill Crista:                            And so that's one of the things that's different is that in the fundamentals as a naturopathic doctor, we are having people eat a ton more vegetables than they ever did, I'm sure. My goal is five to seven servings of veggies, not just fruit, veggies and non starchy veggies ideally, the bulk of those and by doing that we are able to bind a lot of those bile acids just through diet. And then all you need to add is a little insoluble fiber. And that might be where the SIBO people, I mean you let me know, again, I haven't finished your course yet, but you know in my experience of treating people with SIBO, that can get a little dicey to add in those fibers. So there are things that are binders that are naturally very good binders of bile and that is that are just food and don't necessarily aggravate somebody that can't tolerate certain carbohydrates and that's steamed kale.

Jill Crista:                            There is a great study that showed those better than raw kale, steamed kale is great at binding bile. So in my view I'm thinking, "Well I already use binders but I'm using food binders, so that's already sort of part of my protocol." It's just not one of those, it's not a pharmaceutical.

Nirala Jacobi:                    That's really interesting because kale is not really a very high FODMAP fiber, kind of. It must be just very high cellulose type of thing and it is on the Bi-Phasic diet allowed. So that's good news people.

Jill Crista:                            I know it's a nice crossover.

Nirala Jacobi:                    Kale, we love it. We love it.

Nirala Jacobi:                    Okay. So we've gotten a little taste of some of your treatment approaches. You also mentioned in your experience in the course about Saccharomyces boulardii, which is, we like Saccharomyces boulardii as a beneficial yeast that has numerous beneficial effects on restoring the microbiome, mainly by outcrowding candida by also improving the adherence of lactobacillus and bifidobacterium to the mucosa, so that's another benefit. And it also raises secretory IGA. But what I loved was that you said that you see people react, I think, to SB or saccharomyces, but because I have seen this and I just thought it was candida or a yeast allergy.

Jill Crista:                            Yeah. Or it gets blamed as a [die off 00:00:10:12] reaction. And it actually, the way that I see it is that if I use Saccharomyces boulardii but not in mold sick patients. I use it for people who have frank candidiasis. Their diet is terrible or it's something like that. There's something going on where they have it's just candida. There's no water damage exposure, there's no mold. When it now tips over into that idea of the mycotoxins triggering protective effects and now your own microbes acting like bad guys, the candida is possibly a protective effect protecting the body from some of these more severe species. So by knocking them out, you've not only increased with Saccharomyces boulardii, you're not only increased the body's total fungal burden, you've now potentially taken away one of their protective line, or it's protecting the lining. And we don't think of candida that way because we're always talking about it as a problem child. But if it was only a problem child, it wouldn't be natural and symbiotic in the gut in normal percentages.

Jill Crista:                            So I'm wondering, I'm just posing that. I don't know if that's a thing, but I have noticed that when you add Saccharomyces boulardii it's just too much yeast. It's too much fungal overburden, and the body's already trying to deal with that.

Nirala Jacobi:                    Well, and a lot of, I think brewer's yeast, right? I mean, whenever I do food allergy panels, a lot of people have allergies to brewer's yeast. Sorry. Yeah. So which also is a Saccharomyces species, I believe. So you know, I think fungus is really a big issue. And so this whole mold theme really is just another aspect of dealing with mold or fungal elements, I guess I should say. Different to candida, but I've seen a lot of people really improve with prolonged candida treatment. In my experience, most practitioners just don't do it long enough or maybe not most, but many practitioners that are just not, like a six week course of oregano oil is not going to do it. You know?

Jill Crista:                            I'm with you completely. You know, they're very tenacious and they're networked. If you look at fungal species in nature, you know there's a whole web underneath the soil and that's how they work with our gut too. They're very networked. So just thinking that you're going to take off the top layer is ridiculous. That's just the flowering parts. That's basically you've just mowed. You haven't really derouted it, so you have to stay with it, you know?

Nirala Jacobi:                    That's a good analogy. Okay. So you know, I'm thinking of the people that are listening to this that are like, "Okay, I have SIBO," or practitioners listening saying, "Yes, okay, that makes sense. I have a lot of patients who are not improving even though they are being, or maybe just not enough improvement after SIBO treatment." So what do you recommend? Let's start with the patients that are listening. What do you recommend? Where can people start? Where can people get tested for mycotoxins? I know that I use the Great Plains Lab that you've been recommending.

Jill Crista:                            Mm-hmm (affirmative). There's also a lab called Vibrant Wellness. I don't know if they're available in Australia. So there are a couple that use the type of technology that I'm finding most reliable and that's mass spec. So both Great Plains Lab and Vibrant Wellness use that technology. Yeah.

Jill Crista:                            So mycotoxin testing is one of my data points. It's not going to be the end all be all because then we also need to look at how's their immune function and do a stool test and maybe an organic acids test and know their glutathione status. You may not be able to detoxify these mycotoxins and even get them to where the urine can take them out. So urine mycotoxins are a great data point just to see what is their load? The problem is it doesn't tell you is that a now exposure or a past exposure. So that's why you need other data points.

Jill Crista:                            I also like to look at NK or natural killer cell function, which has given Enlitic units and you want this above seven and ideally above 10. So if somebody is down seven or below, their natural killer cell function is flatlined, which means their immune function is flatlined. And the next thing that we see after that is T and B cell deficiencies. So NK cells is kind of where it starts with the soldiers on the ground with our innate immune system and then it starts to drop off from there. So that's another nice data point.

Jill Crista:                            You can run a CBC and you can look for, often we'll see a low white count. You can see if somebody has had, if you have data on them with a differential, and now they're starting to display a little bit of lymphopenia or neutrophilia, little eosinophilia so some of those things that you're like, "What's going on with their white count? Oh, maybe they were just sick. Or maybe it was just a viral something." Well, it could actually also be mold. So some of those data points are really nice to see and commonly I'll see liver enzymes start to go on the rise. So it's just like an alcoholic and that's one of those stories I put in my book. I had a patient that never touched a drop of alcohol. Religiously, it was not allowed in his belief system and his doctor kept saying, "Well you need to stop drinking. You need to stop drinking." And it's because his GGT was high and he had Nash, so he had the whole inflammatory, which is very correlative with mold exposure and I think also SIBO, yes? The nonalcoholic steatohepatitis?

Nirala Jacobi:                    Oh yeah, for sure.

Jill Crista:                            Yeah. So this was all going on for him and they came to see me, they're like, "Nobody's listening to us. You have to help us," and it turned out he was being poisoned by his air conditioning unit in the window of his office, so he had mold toxicity. So I'll look at liver enzymes because we will see them start to creep and I always run a GGT. I know a lot of people say, "Oh well if it's high, it's just fatty liver and blah blah blah," and I'm thinking, "Whoa, why? Why is there a fatty liver? What's going on? So let's investigate."

Nirala Jacobi:                    So getting back to your mycotoxin data or the lab, because I'm about to do one because I did have a leak in my roof, right? So I'm prime candidate although I don't display, I just want to know. So you mentioned that that's more, why is that only a marker for past or any exposure in the past? I thought you would just kind of detoxify mycotoxins as you're exposed to them if you have good clearance.

Jill Crista:                            That is such a good question. And that's something that I really want people to come away understanding that if you have had exposure to a water damage building and the mycotoxins of that pathogenic biofilm, when that survival trigger happens in your internal environment, you now have something called colonization, which is where your own flora now are toxing yourself. They're basically poisoning yourself because they're now competing with all the other flora in your body. So what happens with that past exposure is that everybody now is starting to act competitively and they're actively spitting out mycotoxins even if they're out of the environment.

Nirala Jacobi:                    Right. Okay. So right. I have other questions about that, but it might complicate things, so we'll leave it at that.

Jill Crista:                            And it also can be a stored load because mycotoxins are lipophilic. It's a very important thing to know about them because then it helps you understand what type of tissues they're impacting and why it's so hard to get rid of them. So we've actually seen when someone does, we do a urine mycotoxin test before a sauna and then after sauna and up to 10 hours after, or I'm sorry, three hours after the sauna, you can see that urine mycotoxins go up tenfold. There is something that we're able to detox them. That's a good thing, but that doesn't tell us anything in the urine mycotoxin test.

Jill Crista:                            So I actually have a pretest worksheet or guidelines that takes out some of the questions that we ask then as we're staring at that result. One of the questions is, did they just eat it? Is it just because they ate this mycotoxin and now they're peeing it out? So I have a no no food list that I have people stay away from for three days before they take the test to sort of minimize that weakness of the test, because absolutely if you're eating it, it can show up in your urine if you're able to.

Nirala Jacobi:                    Okay. What do you think about these mold plates that people can buy to detect any sort of mold activity in their house?

Jill Crista:                            That's a good question. So I'm much more a body expert than a building expert, but I've had a lot of experience with helping patients navigate that. And I think it's important for clinicians to get the vocabulary and know what's out there and know what's a good test and a bad test, because you will be in the position of navigating that with your patient.

Jill Crista:                            The mold plates are simply a screen. It only grows out 10% of the molds. The Augur will miss 90% of the indoor toxic mold. So they just don't grow on that medium. So if you grow out a lot of mold on that, your home is sick or your office or whatever. So I take it as if it's positive, it's positive. Time to call somebody. If it's negative, not necessarily negative because it may be that there's just not that species around. And if you're only looking at 10% of the population, you could really miss it.

Jill Crista:                            Also, random air sampling is terrible because somebody could have just walked through that room or rustled up the carpet or plopped on the couch or those kinds of things and so you might get a moment in time, but it's not telling you a lot about the health of that building because most of the time these are trapped behind building materials. So the spores are not necessarily poofing around in the air. They're going to be behind that building material. But the mycotoxins are getting through that building material and making the indoor air poisonous.

Jill Crista:                            So I like mycotoxin testing for homes, for buildings in general, because it does tell you sort of a total load. It may be forensic. It's the same problem as in a body. You don't know now was there a problem and it's just leftover in the dust and the particulate that we're picking up, or is there an active problem? So doing a kind of routine mycotoxin testing of your built space is really nice because you can kind of watch those levels.

Nirala Jacobi:                    Okay, great. Great advice. So now let's move into where people can find your book and also the practitioner course that we continue to reference. So tell us about the course first. What made you produce this? What did you say? Eight hours worth of a whole education?

Jill Crista:                            Yeah, eight hours. Yeah. Put on your seatbelt. Get cozy. Yeah. Yeah. So it was just hard for me to see all of these people suffering. I can write a book and there are lots of things in the book that people can do on their own and get started and it helps a lot of people. But there are people who really need practitioners and after you write a book then you get everybody coming to you saying, "Would you see me as a patient," and it's just not possible. And I think that my approach is naturopathic doctors, our approach to it is so different and there wasn't another approach that was out there. I didn't see anybody talking about it.

Jill Crista:                            And I have done so much homework on this that I realized not just to write the book but just for my patients. It became sort of a passion. And then when my own home became sick, it became more of a passion and I thought, I think rather than going fishing with doctors, I want to teach them how to fish. And I was doing a lot of consulting with other practitioners and I just thought, we have the tools, we know what to do. It's just somebody needs to tell you what the mechanisms are, why certain protocols are done, why certain things are used for treatment and then once you have that, you can take it and run with it.

Nirala Jacobi:                    Great. And as a fellow educator, I've taken your course. I have also haven't finished it yet. I will say that, but I do appreciate the amount of information that you share and I really do feel like when you take it, you leave really understanding how to identify it, especially some of the blood work that you'd mentioned, the labs and it just makes it really easy to have a sort of a path laid out in front of you and that's as a fellow educator we always try to do for our practitioners. And so I do really highly recommend people at least have a look at it. And again, that link is in the show notes. And the book. I think you can, people can just order it online.

Jill Crista:                            Yeah. Amazon. Yep. And for listeners that are in Australia, you can get the ebook there.

Nirala Jacobi:                    Okay, wonderful.

Jill Crista:                            So you can still have access it even though I'm a US doc.

Nirala Jacobi:                    Right. And the course you get actually then certified and I think you have a database or so people can find practitioners.

Jill Crista:                            Yep. Licensed practitioners can become mold literate certified and the course is backed by over 250 scientific references, so you're walking away with a really robust scientifically rigorous course and then we will put you on our website. I would love to add more people there because we have so many people coming to my website saying, "Help me, help me. There's not someone in my area." There are big swaths of the country and we have people in the UK, we have people in Greece, we have people in all kinds of countries. You know, mold is everywhere. Canada. So like I said, it is your built environment, not your living, your outdoor environment that makes the difference. So we need mold treating doctors and practitioners everywhere. So yeah, we will put you on our website and patients can find you there.

Nirala Jacobi:                    Great. I think we have the same sort of demographic because we get daily requests in our Facebook groups and for those of you listening and you haven't had a chance to check out the SIBO Lifestyle Facebook group or the SIBO doctor practitioner forum, we have that all in it, all over the world. People are desperate for SIBO treating practitioners. And I think it will be, it's such a great, very synergistic our approaches and I think people do need to know as part of their toolbox that this condition really exists and is very, very, very common and can very much impact how patients respond to SIBO treatment and vice versa, really.

Jill Crista:                            Yes. Yeah. It would be sort of fascinating to see the things that I'm recommending that can actually hurt a SIBO person. That's why I'm taking your course because I want to understand the things that, those nuances of how to make sure we're not making people worse because we see them together so often.

Nirala Jacobi:                    Yeah. Well Dr. Crista, it's been an absolute pleasure. I'm sure we can come up with way more questions, but there's no time for it. And for those of you listening and you want to get in touch with or you want to know more about Dr. Crista, all of the information about our website, her social media links, Instagram, the practitioner course will all be on the show notes on this episode. So you just go to thesibodoctor.com and go to podcasts and it'll all be listed right there. Any last minute nuggets of wisdom from you?

Jill Crista:                            Yes. I would say both for practitioners and patients, trust yourself. That's one of the things I see mold really wrack people's faith and in their own intuition. If you feel like there's a problem area or you are wondering and that your intuition is saying, "I think it's mold, I think there's something wrong." Trust that.

Nirala Jacobi:                    That's a really good point and I think a lot of people have also lost faith in the medical establishment or community. There's a lot of abuse that's been going on and a lot of dismissive behavior by medical doctors but also by other practitioners. If they don't know a condition, and I think you and I are examples of that, we never stop learning. We've got each other's courses right now. I was like, "Oh my God, there's so much more, right?"

Jill Crista:                            Yes, yes. Always more.

Nirala Jacobi:                    That's what I'm always, never stopped learning because it's an evolving field with our changing world, our changing environments. There's all sorts of things that we need to be informed on. So I thank you very much for being a guest on this podcast.

Jill Crista:                            Thank you, and thank you for all your work. I'm really thrilled to be on.

Speaker 3:                          Thank you for listening to the SIBO Doctor podcast. We hope you found the information in this episode useful in the treatment of your SIBO patients. Thanks to our sponsors, sibotest.com, a breath testing service with easy online ordering and QuinTron, maker of outstanding breath testing equipment. Tune in again for another episode of the SIBO Doctor podcast. Thanks again for listening.

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