Welcome to the SIBO Doctor podcast with Dr. Nirala Jacobi, a US trained naturopathic physician and medical director of the SIBO Doctor and online education resource for practitioners. This podcast is intended for SIBO training practitioners and aims to help educate how we may best serve our SIBO patients. Medical experts join us to discuss functional digestive disorders, clinical practice and research as it relates to SIBO and associated conditions. Head over to thesibodoctor.com where you can learn everything about SIBO from the basics to advanced treatments. You can also join in the conversation on the SIBO Doctor Practitioner Forum Facebook group. If you're a patient, please note this information is not intended to diagnose or treat medical conditions. Please ask your doctor before initiating any new treatments. We welcome you to head over to the SIBO Lifestyle Facebook group where we post frequent tips and videos to help you on the road to gut health recovery. And now over to Dr. Jacobi and the SIBO Doctor podcast.

Nirala Jacobi:

Welcome to another episode of the SIBO doctor podcast. And with me today, I have Dr. Andrea Macbeth, who is a naturopathic doctor with a passion for shifting perspective towards microbiomes centered health. Her scientific background includes a degree in biochemistry from the University of San Diego and research pursuits in various areas of molecular and cellular biology. After years in cancer research, she was called to the path of naturopathic medicine and she graduated from the National University of Natural Medicine in 2017. She's a licensed ND or naturopathic doctor in Oregon and Washington and she focuses her clinical care on functional gastrointestinal and autoimmune issues. And she actually runs... founded and runs a stool bank that provides fecal microbiota transplant for the treatment of resistant Clostridium difficile infection. So we did have a podcast a couple of podcasts ago about FMT, but we'll touch on that again in this podcast, but it really all about the microbiome.

Nirala Jacobi:

Now, faithful listeners of the SIBO Doctor podcast will remember that I did have a couple of episodes of microbiome restoration with Dr. Jason Hawrelak, and those were great episodes but I thought what we do in this one is really kind of broaden the perspective of what is the microbiome, what does it all do for us, what are some of the new developments? And I think Dr. McBeth will be the perfect podcast guest. So a very warm welcome to you, Andrea.

Andrea McBeth:

Thank you so much. I'm very, very excited to be here.

Nirala Jacobi:

Yeah, we're so glad to have you on. Because I did listen to your webinar on the GastroANP, which is one of the associations I belong to and I thought you just had a great way of explaining things and there's always so much interest surrounding the microbiome that I think we can always use more clarification and insight. So first question is, how did you really get into this?

Andrea McBeth:

Yeah, I think like all naturopaths, we have a circuitous route to this career field for the most part. And I am and always have felt myself as a cellular biologist or molecular biologist. I've always been fascinated and always thought I would be an academia and doing a PhD, but as so many of us, when I was actually in the middle of the PhD, I had a family member be diagnosed with cancer and that journey amongst other family healthcare issues is really how I got here.

Andrea McBeth:

And while I was in school my mindset never really left the molecular biology and I always wanted to know why this worked so well, why all these tools with diet and lifestyle and herbal support were so wonderful and I kept coming back to the microbiome. The timing was right in the sense that we were learning lots of things about the microbiome's role in health and disease. And so it just kind of made sense to bring these two things together after I graduated. And then I was also really lucky to work with Mark Davis and Carmen Campbell who are two other naturopath who really pioneered fecal transplant prior to me. And so, yeah, I'm really excited to bring this perspective to all the wonderful tools that we haven't used as naturopathic doctors. And the more science we learn, the more it reaffirms and provides insight into the why, which I just love.

Nirala Jacobi:

And this is a podcast for clinicians and for patients that have SIBO or want to learn more about functional digestive disorders. So it's a perfect kind of podcast to really talk about the microbiome because what we will... what we learn also about small intestinal microbiome will really affect how we treat SIBO in the future. But before we go into that, really, you know what... first of all a lot of people that are listening don't understand that you have more than one microbiome, right? It's not just one microbiome, it's not just the gut microbiome but pretty much anywhere you have a mucosal surface, you have bacterial and viral and fungal colonies, is that right?

Andrea McBeth:

Yeah, and the way I like to think of it is, is we are living in symbiosis or in conjunction with all these microscopic creatures everywhere in and on us. So anywhere we have an epithelial surface, so even skin, lungs inside our vagina in people with vaginas and then all through our GI tract, mouth to rectum, has some form of a microbiome, they just look different. Similar to if you were to imagine a string of islands, each ecosystem on each island is distinct because they've had their own weather patterns and environments to evolve with and that's true of our body.

Andrea McBeth:

So if you think of your nose or inside your nose and sinuses as more similar between me and somebody else as our nose microbiomes are to our colon microbiomes. And so I think it did helpful to recognize that they're all unique ecosystems, but they all have an inner play, just like different ecosystems on the planet interface with each other globally, the same is true of our whole self. So we're the planet of all these microscopic ecosystems throughout the body system.

Nirala Jacobi:

And so what are some of the aspects of the microbiome that are really important to human health? How do they interplay with humans and what functions do they do?

Andrea McBeth:

Yeah, I mean, isn't that the most exciting question? I think about that all the time because we are just at the infancy of understanding that they're there. I mean, we didn't even know they were there until sequencing technology got cheap enough to take these pictures of all these creatures that are components of the microbiota or microbiome. And as we're starting to learn that they're there, we're starting to learn what they're doing. And we have evolved with them since the beginning of time. And I think that's a good way to appreciate how important they are because they have been there the whole time so we have these really complex, interrelated systems to live in balance with each other and it isn't... chemical signaling and communication is at the heart of that.

Andrea McBeth:

And so when you think of the microbiota in your gut that is happy and not in dysbiosis and not angry, it's sending signaling molecules to our brain and our organs in our body that everything's okay or if it's out of whack that you know something's wrong and you're causing inflammation. So the concept of leaky gut is been around for a long time. But now that we can see it from the perspective of the microbiome, it's really true.

Andrea McBeth:

And you think about whole health as all the molecules, the bacteria are making or communicating with us and things like gut-brain axis neurotransmitters, they make neurotransmitters just like we do. They educate our immune system and create tolerance. And so if you think of your autoimmune patients and people who need more Tregs cells or cells that say, "Shh, calm down," that's mediated by the microbiome and the bacteria cell signaling.

Andrea McBeth:

And then even as far as our genetic makeup and epigenetics and the concept of the bacteria have molecules that can change the way our genes are expressed. And so they impact all aspects of health and we're just beginning to appreciate kind of the tip of the iceberg of that. But even metabolic insulin sensitivity and how we metabolize and store fat, all those things, everything you can think of in terms of chronic disease, we're starting to see pieces of either correlative or causative data from the role the microbiota is playing.

Nirala Jacobi:

What are some of the new links that are coming out of microbiome research in terms of what is kind of... maybe the better question to ask is what is not linked to microbiome in terms of health and disease? Is there like... what are some of these newer concepts?

Andrea McBeth:

I think I want to tell a story about serotonin because I think it's very representative of this concept and the complexity of it, but also kind of elegance, if that's okay.

Nirala Jacobi:

Yes.

Andrea McBeth:

It's not really answering your question, but it's an example of... So we know serotonin is an important neurotransmitter in our brain for a number of things, but it's also something that both bacteria and our cells in our gut, specifically the Enterochromaffin that you see cells in our intestine make and they control things like motility and have all this neurofeedback role in specifically what's relevant in SIBO is the serotonin the bacteria are making are interfacing with ourselves, which are then making more serotonin, which are modulating our motility. And if you think of when you have that really horrible kind of dumping syndrome diarrhea, that's when all the cells in your gut releases the serotonin at once and flush everything out.

Andrea McBeth:

And so the bacteria are playing a role there too. And keeping that balance and whether it's slow motility or too much motility too fast, we now know that the gut-derived serotonin is playing a part in this bigger picture. And interestingly, not just that they're also continuing... So there's actually a connection with the serotonin and the liver and gluconeogenesis, which is really interesting where you're seeing serotonin on multiple levels of our physiology and the bacteria synthesis of serotonin playing a role in addition to us.

Andrea McBeth:

So up and down regulating our synthesis of serotonin in the gut and also their ability to make serotonin from tryptophan is modulated by their environment and ecosystem which we control too, top down both directions with our vagus nerve. And I think that's... it's a really cool kind of... it turns out serotonin is really one of the thing... one of the molecules at the heart of this relationship in gut-brain axis. And I guess the vagus nerve, you can think of as like the main highway to the both directions, us interfacing with the microbiome and then the microbiomes molecules connecting with us.

Nirala Jacobi:

Yes, so this is the gut-brain axis that we'll elucidate a little bit more on and definitely this whole issue around tryptophan, I actually sort of deep dived into that a little bit more a few weeks back when I was preparing for a presentation about the microbiome. And it's pretty fascinating because, yes, the tryptophan is one of the major amino acids that can be converted into numerous compounds and molecules and serotonin being one of them. And that's actually one of the things or one of the mechanisms, how glyphosate, which is a major ingredient in roundup really disrupts this particular production of serotonin from tryptophan.

Nirala Jacobi:

So anyways, that was just a side note because it is... I didn't know it was that important in not just serotonin production but a number of other functions, so. But back to my other question, which was what are some of the newer health and disease connections with the microbiome that are emerging from more recent research?

Andrea McBeth:

Yeah, and I think... so fecal transplant is really helpful because what we're doing is we're taking a healthy microbiome and we're delivering it to the colon of a recipient. And where we are seeing fecal transplant be really effective is a reflection of where the gut microbiome is important. So things like liver disease, neuroinflammation, autism. There's clinical trials being run using fecal transplant for other things besides C. diff and we see liver-induced brain inflammation. So different acute phase like late stage, liver disease and things like that can be resolved with a fecal transplant which is really interesting. There was a small study done in the United States in Arizona looking at fecal transplant in kids with autism and they saw improvement not just in GI symptoms but also their overall cognitive function care scores. And then we see it impact the role that chemotherapy has on patients and specifically immunotherapy.

Andrea McBeth:

So patients who are nonresponders to a specific kind of chemotherapy called PD-1 checkpoint inhibitors which is immunotherapy. So it's a little bit different than traditional chemo that's just trying to kill everything. Immunotherapies try to turn your immune system on to kill the cancer. And they found that patients who don't respond can get a fecal transplant and then become responders to this kind of immunotherapy. So that is giving us all these hints that the microbiome has a role in liver health, neuroinflammation, our immune response to things. And then cardiovascular disease is another big area of interest because we know that the gut bacteria make a metabolite when things are out of whack called TMAO that has a really strong correlation with cardiovascular disease which I think is fascinating.

Nirala Jacobi:

Yes, that is actually something that I also was really interested in. And TMAO, Trimethylamine N-oxide I think or something, is something that's very damaging to, as you mentioned to, I think, the endothelium of your vessels. And there was an interesting study that showed that methanogens, the presence of methanogens actually reduce the output of TMAO. So there was some sort of protective mechanism of having methanogens on board, so interesting.

Andrea McBeth:

There's another [inaudible 00:16:47] they did that it's a mouse study, so take it with a grain of salt, but they added allicin in with carnitine, they were giving mice in a controlled kind of setting, they were giving mice either just the carnitine, the precursor to TMAO and seeing those levels. And then they gave the mice allicin along with the carnitine-

Nirala Jacobi:

So garlic extract, sorry.

Andrea McBeth:

Yeah, so basically, the joke I make is you can't extract too far from a mouse study, but you think about traditional diets and things like garlic and spices and their microbiome modulatory affects changing the metabolism of kind of what we think of as pro-inflammatory bad guys. The allicin along with the carnitine meat meant that it didn't make the heart disease TMAO which I think is so interesting.

Nirala Jacobi:

I often do stool testing. Let's say I see a SIBO patient that's not improving as fast or as... well, as complete as I expect. In other words they test now negative on a breath test, but they still have symptoms. So I might actually order a stool test that lets me look at the microbiome a little bit more closer. So that could be a GI-Map or a Genova GI Effects test or whatever can actually acts or look at the 16S ribosomal DNA of the bacteria. We're getting to this point where we understanding who the main players are, I would say, or at least some of the main players. And really the exciting developments is really coming into how can we really manipulate that. But just so that we're understanding what can happen, can you talk briefly about opportunists versus commensals? So commensals being... well, I'll let you explain it all.

Andrea McBeth:

Yeah, so I think it's important to note that when we think about germ theory and bacteria traditionally and where hygiene came from, we were battling 58 bacterial pathogens and then a whole host of other virus pathogens, but really only 58 bacterial pathogens like tuberculosis and cholera and staph and strep. The other hundreds and thousands of bacterial species on the earth, and then in our case hundreds of other species living in and on us are less good guys or bad guys defined specifically and more about their environment and what they're doing that can make them either better good in the context of the ecosystem. And so... in fact, so you can think of like a commensal bacteria as when the ecosystems happy all the species are living together. And then say you have a species like ivy in the... like where I live English Ivy is really bad in the forests here and it will take over or Kudzu in the South.

Andrea McBeth:

And that's kind of what you can think of as an opportunist where you have a bacteria that's not necessarily bad in its right environment, but if it's in an environment that's been depleted by antibiotics or environmental factors like diet or xenobiotics, those bacteria can change their metabolism to be making things that cause harm or they can overgrow and cause harm that way. And so the definition of what a pathogenic bacteria is, is really specific but the opportunists are bacteria that kind of grow in the wrong place at the wrong time in the case of SIBO or grow overgrowth in the case of a dysbiosis in the gut or they make the wrong metabolites like TMAO like we were mentioning.

Andrea McBeth:

And we're really at the infancy of understanding that but we know that things like diet and herbs can modulate those to get us back to and mental health stimulating vagus nerve, all kinds of things, exercise, sleep, all can impact getting that ecosystem back to health and getting those opportunists back into a space where they're not a species that's doing what it shouldn't be, where it's not supposed to.

Nirala Jacobi:

I think that's really, that's really interesting because on those stool tests that I mentioned, we also sometimes see potential pathogens like Klebsiella or Citrobacter or even staph or strep that in small amounts they would not be considered pathogens. They're just normal kind of randomly show up. And so are you saying that it doesn't necessarily even have to be overgrown but it can change it's metabolite? What is the tipping point for an organism like that to maybe become a pathobiont?

Andrea McBeth:

Right, so it turns out that our commensal bacteria, all these... we're talking about pounds of bacteria living in our colon for example. Their job is to outcompete, steal things and kill bacteria that are bad. They are playing a huge role in keeping these potentially pathogenic bacteria in check. We do have staph or strep in our nostrils for example, but doesn't cause a problem necessarily if it doesn't have an environment to grow. And the same is true in our gut. We have people that are carriers of C. diff that never get sick because the rest of their environment can keep the cluster room difficile in check.

Andrea McBeth:

And so these bacteria who establish early in life and that development window from conception to three years old are sort of well established there and they are there to protect us from these other kind of bad guys that can be transient and pass through. And that's normal because we're interfacing with an environment that has all kinds of things.

Andrea McBeth:

It's a matter of whether our native ecosystem is healthy enough and resilient enough to put up with those perturbations. And then sometimes it becomes, in the case of campylobacter it's a matter of just if you get enough campylobacter in your system, it kicks off a reaction. So there's two thresholds, there's the threshold of the organisms, the good ones, the commensals keeping the peace and then having too much or overgrowth of a bad guy.

Andrea McBeth:

And then the other thing that I think is really important is you think about our mucus layer and leaky gut, good fences make good neighbors, which I totally stole that line from Eric Hassan and he's a microbiologist at Stanford and I think it's great. When that mucus layer is happy and healthy and intact, it's keeping our commensals where they should be. When that mucus layer gets degraded because the bacteria are starving and that's their secondary food or because we're too stressed out to make the mucus layer then pathogens can get in and stimulate the immune system and kick off a reaction or even commensals that normally wouldn't do that. We get these LPS spikes for example.

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Nirala Jacobi:

Let's kind of shift gears just a little bit. So before we move into some of the tricks and tips that you have of restoring a microbiome and dietary recommendations, et cetera, let's talk about first about the things that can disrupt the microbiome that people may not be aware of. And so specifically a group of compounds called xenobiotics or also what are basically chemicals that can act like estrogen or basically plasticizers and pesticides and also certain medications all can actually alter the microbiome. And this is kind of one reason why we always harp about organic food, et cetera, and not using plastics. Can you elaborate a little bit more on that?

Andrea McBeth:

Yeah, I think one of the most interesting things that's happening now is in non-antibiotic pharmaceuticals, we're starting to take a look at what those do to that bacteria. And even going so far as to start to wonder if the reason certain medications have an impact has more to do with the gut microbiome. For example, SSRIs may... So we know the SSRIs impact the gut microbiome and change concentrations of different species of bacteria. And we think of SSRIs as going to the brain and being serotonin reuptake inhibitors, but there might be another role that they're playing in the gut that's part of their mechanism of action.

Andrea McBeth:

Similarly, things like, not surprisingly, proton-pump inhibitors, but other things like anti-psychotics impact the gut microbiome. There's a study done in 2018, where they looked at... they screened over a thousand marketed pharmaceuticals and found that 24% of them, these are all non-antibiotic drugs, 24% of these non-antibiotic drugs impacted the microbiome, up or down regulating different species. And so for me, from my perspective, it's like, "Well, that's a good reason to not be on poly-pharmacy if you don't have to be." Because they're all impacting the gut microbiome and potentially killing or causing dysbiosis in different ways.

Andrea McBeth:

You mentioned other xenobiotics I think plasticizers and plastics, are another really important one. There was another study done in 2018, and I can link all these for you, but they showed that they up or down regulated the expression of different kinds of bacteria in our gut. So it's not necessarily that they killed them, but they changed their metabolism like we mentioned before, is how they're communicating with us. And that might be where good guys become bad guys, is the way that their metabolism is expressed. And so things like flame retardants, colorants personal care products are really big part of this picture because even though we're putting them on our skin, they're getting absorbed and our microbiome on our skin is also important. But things that we're consuming and are going through our GI tract too.

Andrea McBeth:

I think... I'm just going to give you some of these examples, but it's interesting to think about stuff like emulsifiers. We have this really important mucus layer, like I said, good fences make good neighbors and there was some preliminary work done looking at emulsifiers' role in our mucus layer basically, changing the chemistry of our mucus layer so that it doesn't work as well. And just because a product is, we know this, just because a product is not considered acutely toxic doesn't mean it's not having detrimental effects on this pretty delicate ecosystem.

Andrea McBeth:

And then you mentioned glyphosate and Roundup and that's another one where we know it blocks the bacteria's ability to make... convert aromatic hydrocarbons, it blocks the shikimate pathway, which is the pathway that the bacteria, take something like tryptophan and turn it into serotonin. So lots of things to think about. It's kind of a slippery slope into... environmental medicine is always kind of overwhelming.But I like to take a big deep breath and remind people that like eating the good food and supporting the bacteria with fiber and taking a deep breath and doing the things that we know are foundations of health all matter and we know exercise, sleep, stress management, impact the gut microbiome in positive ways. And so to not get overwhelmed but pay attention to your food quality. We have to pay attention to food quality and what we're putting in our body because it turns out it's not just us, it's this entire ecosystem we're impacting.

Nirala Jacobi:

Right, and people have heard me say it on previous podcasts before, but one of the biggest antibiotic industries really is livestock. And so I always counsel my patients to... at least animal products should be organic because it's so concentrated in that food source. So I definitely think the way forward to restore your microbiome is first to take stock of how many disrupters you're actually consuming, whether that's through your food source or through what you've just mentioned, the medications or the environmental toxins that you may not be aware of.

Nirala Jacobi:

And I actually talk a little bit about that in the SIBO Success Plan, which is a course for patients to kind of start looking at beyond just SIBO treatment, but really improving their entire microbiome and their health in general, so that's something to consider. Now, moving from microbiome disruptors, let's talk about your favorite ways of how to restore the microbiome. Let's presume that somebody has gone through SIBO treatment successfully, but still wants to now sort of restore really their large intestinal and their small intestinal microbiome. What are some of the suggestions that you give to your patients?

Andrea McBeth:

Yeah, I think everybody is surprised that I don't use a lot of probiotics. I tend to focus on a really slow and steady introduction of prebiotics with the understanding that a lot of people, especially patients that have been on low FODMAPs for a long time or really struggled with fiber, it has to be done really slowly and in conjunction with things like ginger or other carminatives like fennel, things that help you with the gas and bloating as you start to rebuild the good guys in the right place, but doing that too fast can cause problems.

Andrea McBeth:

And then getting the nervous system turned back on because it's... the role that our nervous system patterning plays in motility is so foundational, bodywork, therapy, biofeedback, any tool you want where you can get out of fight or flight mode and get the vagus nerve stimulated and get into... I use a lot of digestive enzymes. I do find those really helpful bitters, HCL, pancreatic enzymes, and everybody kind of needs support in different places.

Andrea McBeth:

And then soups and smoothies are at the heart of rebuilding because they're easy to digest but still have complex good nutrients. I mean, we want flavonoids and lots of polyphenols and lots of... We don't just need the fiber from the plant diversity, but we need all their molecules that support the good bacteria. And then it's a slow and steady journey back to health and then changing relationships with food, obviously, that always is... got to be at the heart of [inaudible 00:33:34].

Nirala Jacobi:

Well, they can go kind of both ways because a lot of people, I don't know about you, but I do see a lot of people that have so many sensitivities that they're really down to five foods. So it's actually going both ways and this is where stress reduction and all of that, of course, is really, really key as well. And I've mentioned that many times before on this podcast. Now, you also mentioned the microbial accessible carbohydrates, can you talk more about that?

Andrea McBeth:

Yeah, so that's just another... so there's a group at Stanford, a husband and wife team that are microbiologists and then they had coined the term microbial assessable carbohydrates. Because I think we say fiber and that can mean a lot of different things and it depends on your digestion. What I eat versus what you eat gets to the colon, depends on our individual digestive systems. But you want to be feeding the bacteria what they need to make the good short-chain fatty acid, butyrate and all that stuff that's important for health.

Andrea McBeth:

And so vegetables are one of the places, legumes, all of the things we traditionally think of as FODMAPs, but not just FODMAPs. And what is a soluble to me and what's insoluble or soluble to you are different depending on, again, our digestive system. I think-

Nirala Jacobi:

That's pretty fascinating because that was always soluble and insoluble fiber were sort of set in stone in terms of that's what it is. But what you're saying is depending on the composition of your microbiome, a soluble fiber may actually be an... Can you kind of just talk about that a little bit? That's really interesting.

Andrea McBeth:

[inaudible 00:35:25] before we understood the microbiome and if my salivary and HCL is way higher than yours, the aspects of what... and even what the meal looks like and our motility, all those things are going to impact what makes it to the colon. If we're defining insoluble as the food that we're not going to absorb and what the bacteria potentially have access to eat. And that's going to be different in different people. And again, there is microbiota, the entire track from our mouth to the colon. It's just the one in the colon is kind of the most important and the biggest player that we need to make sure we're feeding with microbiota accessible carbohydrates. So fiber in its most simple sense.

Nirala Jacobi:

Okay, I want to spend a few minutes before we end this podcast about your experience with FMT because you have a really boutique kind of clinic in Portland. Can you talk a bit about how Flora Medicine, a clinic that's pretty much solely dedicated to functional digestive disorders and fecal microbiota transplant. But also you've already... that sounds like you're already doing crapsules.

Andrea McBeth:

Well, so we do and I again, I came out of Mark Davis and Carmen Campbell's lab in Portland... here in Portland originally.

Nirala Jacobi:

Can you talk about who they are because our listeners are-

Andrea McBeth:

They're naturopaths who started with a capsule-based FMT product in 2013, 2012. So they've been kind of ahead of the curve the whole time. And Mark Davis is now in Maryland and has his own clinic too. But we were making capsules and treating C.diff because the regulatory space in the US is that FMT is not approved, it's not an approved therapy, but you can use it kind of through a loophole called discretionary enforcement to treat... It's really, really, really effective. In our case, like 98% effective. I mean the data is anywhere from 80% to 98%, but three doses of 10 crapsules, FMT capsules knock out antibiotic resistant C.diff really effectively. And so-

Nirala Jacobi:

Wow, that's like on par with doing the retention enemas I think, right?

Andrea McBeth:

Yeah, so it turns out all the different routes if done in the right dosing more or less are the same effectiveness. So I've always been interested in that. I think it's fascinating. I actually am really passionate about elder care and geriatric medicine is one of my passions. And so I wanted to create something that was specifically tailored to that population, people in longterm care and skilled nursing and that was where our clinics sort of came out of. But at the same time I do functional GI and autoimmune disease because that's a population I'm also really passionate about.

Andrea McBeth:

And so we treat C.diff like antibiotic-resistant C.diff and we ship to docs all over the country that treat C.diff. And then we're really interested in doing research and we're starting to work with the University of NUNM, in the early stages of writing a clinical trial and we're interested in why this works so well. We see improvement in our patients anxiety and depression that is profound, which we know the gut-brain axis... we know dysbiosis plays a role in anxiety but to see patients who are clinically depressed who also happen to have C.diff or debilitating anxiety and panic attacks take FMT for three days and come back to us and say, "Oh my gosh, I had no idea I was living under this cloud. This is unbelievable. This is must be what people talk about to be happy." And that has happened with multiple patients we've seen.

Andrea McBeth:

So we're really interested in the guts role in brain mental health neuroinflammation and we're hoping to grow kind of in both directions as a functional clinic but also in collaboration and do more research because it's such a fascinating field and it really complements all the toolsets we've been working with and naturopaths have been utilizing for decades.

Nirala Jacobi:

So are you saying that you're using these capsule-based FMTs for other conditions besides C.diff? You're actually... no?

Andrea McBeth:

No, we only treat antibiotic-resistant C.diff, but those patients have other things going on and we're doing our best to track and get GAD-7 and PHQ-9, which are surveys and collect data in hopes of someday down the road writing a clinical trial.

Nirala Jacobi:

Right, so it's not yet, because I get this all the time, people asking me they're sort of at the end of the rope, they've had massive amounts of antibiotics in their history, you look at their profiles, they have hardly anything growing, especially butyrate producers. And it's just really slow going to sometimes regrow their rainforest or their microbiome. And so I get this question a lot like, "Should I do FMT?" Because we're just... we're here in Australia, which really, Dr. Borody at the Centre of Digestive Diseases in Sydney, has really brought this into modern medicine in a way, this type of therapy. And so they're already beginning to do other types of treatment not just for C.diff. So I just wonder when can we start to... when can we buy them? When can we recommend them?

Andrea McBeth:

Right, we get asked that all the time and honestly it's not without risk. So I tend to talk people out of it, out of doing DIY. Because I don't necessarily think for a lot of these people it is the quick fix they're looking for. I think once we learn more down the road about what the active constituents are versus not and we get more information about good data on probiotics, we'll be able to answer those questions a little bit better. I mean, I get called all the time from people that have had 200 rounds of antibiotics and they think FMT is going to be the thing that fixes them. And I just... most of the time, I mean, I explained to those people that there's... you have to do the rest; you have to try the other things. I have had patients tell me, that did a DIY, that it did really help. So it's not that it never works, but it just is something that has so much potential infectious disease. I don't know, I do end up talking people out of it more often.

Nirala Jacobi:

And look, I get that. I mean I know that there were a few... I don't think it's common, but they are isolated reports of people getting pretty sick and also getting-

Andrea McBeth:

Yeah, not even the pretty sick. It's just that the underlying, if it's that your motility is not... it depends, depends on what the underlying issue is. There is data that shows FMT has some impact on SIBO but I tend to take those... I don't know, it's really hard, there's not a good answer. And definitely [inaudible 00:43:36] I don't think it will ever be approved because of the infectious disease risk in the US for things outside of really... but I [inaudible 00:43:48] understand the mechanism, then we'll be able to do other things.

Nirala Jacobi:

I think so. And look, I just think that when people are desperate, they're willing to pretty much try anything. I just want listeners to know that as really two very experienced practitioners, I have had people that have spent tens of thousands of dollars on repeated FMT rounds and really felt no better at all. And I've also had patients who have had a few rounds. This was not... that neither of those patients were for C.diff. One was for really severe food sensitivities and she had a marginal improvement that was... she was very pleased about that, but that didn't really last either. And so I've really seen a lot of also fallout from people having done the FMTs and there's just no improvement at all, so I do see those people. And of course, I don't see the people that have been helped tremendously because they don't need my help. But I just want people to know that it's not the panacea as of yet that we know of, so.

Andrea McBeth:

Yeah, and we just don't know enough about the differences in donors and this recipient... I mean, I'm cautious with probiotics and we have lots of data that show probiotics can be beneficial. And I do use them sometimes, but I stick with the basics; like time and foundations of health. And I know there are people that have done all those and they're totally frustrated and I acknowledged that. And there are patients and people and there's reports in the community of DIY that have had really profound benefits. So like all things, it's complicated, the ecosystems are all different and the underlying causes are different too.

Nirala Jacobi:

That's very true. Well, Dr. McBeth, I really appreciate your time that you've spent here with me and just before we go, where can people find you?

Andrea McBeth:

Yeah, so our website is floramedicine.com and probably the most useful part of that website is the what's new tab. We've written some more technical articles and there's some more... we wrote a big lit review on all the FMT protocols.

Nirala Jacobi:

Great, fantastic.

Andrea McBeth:

Not a whole lot of analysis but enough to say turns out it doesn't really matter how you do the prep, it more or less works for C.diff pretty well. But it was a good exercise and some other articles and podcasts and other things that people want to learn more and absolutely email us. I'm always... when I have time I want to answer questions and talk science.

Nirala Jacobi:

Be careful what you ask for Andrea.

Andrea McBeth:

I know, we do remote coeducational, non-patient consults, which I know is kind of the nomenclature that we can't treat people remotely, but I can... I mean I like talking to people.

Nirala Jacobi:

Okay, that's great. That's fantastic. And look, all of the contact information for Dr. McBeth will be in the show notes. So if you didn't catch her website you can go to thesibodoctor.com and go to her podcast page and it will all be there, including her social media links and so forth. So thank you so much for your time and sort of illuminating the microbiome a little bit more. It is a fascinating, never-ending fascinating topic for me. Maybe I'm hoping it's for my listeners as well, but yeah, so thanks so much, Andrea.

Andrea McBeth:

Yeah, thank you, it's been an honor. I really appreciate the work you do and the cultivation of our community is invaluable, so thank you.

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