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Welcome to The SIBO Doctor Podcast, hosted by Dr. Nirala Jacobi. Medical experts join us to discuss functional digestive disorders, clinical practice, and research as it relates to SIBO and associated conditions. This podcast is intended for SIBO-treating practitioners and aims to help educate how we may best serve our SIBO patients. Head over to thesibodoctor.com and sign up to the SIBO Mastery Program and take your SIBO knowledge to expert level. If you're a patient, you can sign up to the SIBO Success Plan and beat SIBO for good. Please note, this podcast series is not intended to diagnose or treat medical conditions. Ask your doctor before initiating any new treatments. And now over to Dr. Jacobi, and the latest episode of The SIBO Doctor Podcast.

Nirala Jacobi:
Welcome to another episode of the SIBO Doctor podcast. Today, I'm speaking with Dr. Diane Mueller, who is a naturopathic physician who graduated in 2011. She is a survivor of IBS, Lyme Disease, and mold illness. Dr. Mueller is passionate about bringing research, understanding, and compassion to those with these diseases. She has co-authored a book, which is to be released in May 2021, so very soon, called Use Your Mind to Heal Your Mold and Lyme. Her practice, the Medicine with Heart Clinic, treats those around the country. She also co-owns an online functional medicine school, the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine. So welcome, Dr. Mueller.
Diane Mueller:
Thank you, I'm so happy to be here with you.
Nirala Jacobi:
It's a great title for your book and we will dive a little bit into that. But really the topic of our conversation today is endotoxemia and this whole detoxification process that you elaborate on in your book. And hopefully, those that have SIBO and IBS that have unrelenting symptoms might really get a lot of benefit out of understanding this whole concept. So before we dive into the topic of toxicity, endotoxemia, and all of that, can you just give us a little bit of a background as to how you ended up writing this book?
Diane Mueller:
Yeah, I really appreciate this question. I wrote this book because I feel like there, I think how many people get inspired to write a book, to fill a gap in the industry. There's already so many great books out there about Lyme and mold. There's already so many clinicians that have put so much amazing work into the field. But one of the things that I feel like has been missing, is a way of looking at Lyme and mold and some of these disease processes extremely holistically. Where we're not just going after the mold toxin, we're not just going after the Borrellia or after the chronic infections, the co-infections, and we're actually looking to see what is the effect of SIBO on the body, for example, when we have these types of conditions? What happens if we have HPA access this regulation when we have these types of conditions? How are we dealing with immune disfunction, as well as where the mind plays a role?
Diane Mueller:
It's really, I feel like, sometimes in holistic medicine it's so easy, I think, because of our society to still segregate infection versus tonification of the systems versus the mind. And so the idea, the concept of the book is really to bring the awareness to doing Lyme and mold treatment from a way where we're really looking at the entire body, not just Lyme and mold. As well as the entire mind in order to bring somebody to wellness.
Nirala Jacobi:
Which is really very, very naturopathic.
Diane Mueller:
It is.
Nirala Jacobi:
And so we really always try to have more of a holistic approach to the treatment of our patient and really refrain from having reductionist thinking and looking at only infections. And as somebody who sees chronic illness, and who has recovered from chronic illness yourself, you understand that first hand of how people just go through these mono therapies, for example, to get relief for Lyme or SIBO, for example. I've seen a lot of patients who have been on multiple rounds of various antibiotics and at some point you've got to look deeper.
Nirala Jacobi:
But the topic of our conversation today really is what happens with endotoxemia and what can really happen in the liver and these different detoxification system and how that impacts the recovery from SIBO and from other illness? So can you first set the stage for our listener to explain what endotoxemia really boils down to?
Diane Mueller:
Yeah. Endotoxemia is simply when we have endotoxins or Lipopolysaccharides that come from Gram-negative bacteria and they basically are in the blood stream. And endotoxemia has been linked to various things such as autoimmune disease and intestinal permeability to mood disorders. So there's some level of awareness. I think the awareness in the field is really growing and the importance of talking about endotoxins and endotoxemia. There's deeper layers though that we've realized of how the body is dysfunctioning when we're actually looking at how some of the endotoxemia, and endotoxins in general, affect processes like liver detoxification and slow down the process of liver detoxification. And of course the effects from that are pretty wide spread.
Nirala Jacobi:
So just for the listener, when we talk about Gram-negative bacteria they're pretty common. We have an entire group of bacteria or phila in the microbiome called Bacteroidetes that are mostly Gram-negative as well as Proteobacteria which are Gram-negative that are more E. coli, Klebsiella, those kinds of organisms that can play a role at a normal commensal organisms but when they over grow they become a problem. And of course as we know when we look at SIBO that predominately E. coli and Klebsiella are the Gram-negative bacteria that really reek such havoc. And they have thousands times more Gram-negative bacteria, sorry, LPS in their cell wall then some other more minor Gram-negative bacteria.
Nirala Jacobi:
So it is a really relevant point when we talk about this absorption of this highly inflammatory substance from the very bacteria themselves that is independent of SIBO and the gasses that it produces can be really damaging to how we get rid of toxins and other toxins, or the whole function of the liver. So let's dissect that a little further with looking at the different detoxification phases that are so important in this process. So typically we talk about phase one, phase two, and phase three. So can you elaborate a little more on that?
Diane Mueller:
Yeah. Well phase three is interesting because in some ways we can look at phase three as phase zero and phase three. Phase three is really based upon transportation of these toxins, say out of cells or out of tissues. So we have a situation where we're trying to get the toxins out of tissues and we do that through transport proteins. And once toxins leave the tissues they make their way to the liver, the liver begins phase one and phase two of detoxification. And the important thing, and probably a lot of the listeners know this but just to make sure we're all on the same page, the important thing about phase one and phase two is that phase one, when phase one is happening is breaking down the toxins and it actually is creating a metabolite and that metabolite that is at the end of phase one before the toxin gets further broken down by phase two, that metabolite at the end of phase one is often times more toxic to the human body then the original toxin itself.
Diane Mueller:
So it's really important that when we're detoxifying that we're really making sure that phase two is working really extremely well to make sure once that we have broken that toxin down by phase one it continues to move down into its less toxic form. And the whole point of this process often times is really to do these biochemical processes to make the toxin more water soluble so it's more easily able to be excreted in the urine or in the feces. So that's largely the process of the enzymes that are working in phase one and phase two of the liver. And then we get into more of a phase three type of situation again as the toxins leave phase two. Now what's super important here, what's happening is basically, we have these transport proteins from the liver to essentially the bile canaliculi, the bile ducts.
Diane Mueller:
As so when the liver basically has gone through phase one and phase two of toxin breakdown then those toxins are connected to the bile that the liver has produced and then we have these transport proteins and those transport proteins when they're working correctly, the toxins, including the bile, will go through the bile canaliculi and end up in our duodenum. And if everything goes right from there then of course the toxins eventually make their way out into the stool unless they're reabsorbed. So what's really important about this process that is connected to our whole conversation today comes down to these transport proteins that are basically connecting the liver to the bile canaliculi.
Diane Mueller:
So there's two main transport proteins here, there's the [BSEP 00:10:29] protein and the [MRP2 00:10:31] protein. And these two particular transport proteins need to work in order for the toxins to move into the bile canaliculi. Now what happens is many different things can actually stop those transport proteins from working. And what winds up happening if those transport proteins don't work is that there's almost a backflow. So the toxins that have gone through phase two that are sitting in the liver actually wind up making their way back into circulation and not out of our body. And this is where we can see the toxic overload really gets high, we can see Mast Cell Activation Syndrome because of the extreme inflammatory response of the body. These are the types of things we can see when those transport proteins aren't working correctly.
Nirala Jacobi:
So just to reiterate, there is this mechanism of phase three that actually moves toxins into the bile from these toxins that are generated by endotoxemia, so LPS, but also other toxins that the body is processing. So LPS can basically, or endotoxemia, can really impair that last step that the body is trying to get rid of toxins. So that's why we're talking about it today. That there is an impairment in that mechanism when LPS is very high in the body and that can basically trigger... I mean, I see a lot of people that have, what we think is detox impairment but it's really good to get, not out, the nitty gritty of this process. Because once we really know what's happening we know more how to help people.
Nirala Jacobi:
Also, I think, when I was looking through your transcript of your book you were talking about how often times when we use binders that that is maybe actually not very effective. Because if you're not moving the bile into the small intestine where it's meant to go out to detoxify these toxins it won't be bound up. So that made a lot of sense. Is that sometimes binders offer no relief in those circumstances. Can you elaborate a little more on that?
Diane Mueller:
Absolutely. It's a really important topic because often times I think we look at detoxification as binders being the first step because, and it's not a completely incorrect way of thinking. Binders are a very important early on step because the idea of the binders are that once the toxins make their way to the intestinal tract we want to bind them and basically keep them in the intestinal tract so that they don't reabsorb and so they actually make their way out in the stool. But the toxins largely are going to be bound to that bile. And when they leave the liver they're going to come through that bile. So if we're not getting the release of the toxins from the liver into the bile canaliculi, into the duodenum of the small intestine then we're going to wind up having a situation where we're giving binders and they're not working because there's actually not a lot of toxins there to bind.
Diane Mueller:
Most binders do have a bile asset sequester type of effect where part of what they're binding is bile. That's why they also can be used often time to lower cholesterol. And so even by the concept of how a binder works, it really often times is working by binding the toxins but also by binding that bile. So if we don't have the bile there to begin with with the toxins then they're largely going to be devoid of what we're trying to do and we could have the side effect then of constipating somebody because binders tend to be very constipating for a lot of people. And so then we can have more of a negative effect because now we're going to backup the whole flow of detoxification and elimination even more.
Nirala Jacobi:
Getting back to the endotoxemia, the topic of this talk, so let's talk about, just for the listener who may not be really familiar with this concept, what are some of the symptoms that people can look out for besides, I would think of Mast Cell Activation Syndrome the extreme version of hyper-reactivity, but some of the day-to-day symptoms that might occur when somebody is just not detoxifying properly.
Diane Mueller:
Yeah. Good question. And just to make sure everybody's on the same page, because like you said the topic is endotoxemia, is that what's really happening here and how we're linking this all together is truly because the endotoxins can come in and basically down regulate that MRP2 protein. So that's really what's happening. Is we have the endotoxins that are essentially having this effect on this MRP2 protein that is needed for detoxification. So when endotoxins do that and we can get this process of toxins being backed up on top of the endotoxemia situation we can have all sorts of different symptoms.
Diane Mueller:
One of the easiest things to look out for if this is happening is worsening of whatever peoples symptoms are. So if somebody has a headache and that's one of their top symptoms it might be that their headache gets worse. If somebody has a symptom of anxiety it might be that their anxiety gets worse. Certainly there are, often times we see things like pain shows up sometimes, we have brain fog is a really common one, definitely headaches are really common, changes sometimes in vision. I've seen feeling like one's about to get the flu is another really common thing. So just that onset of, "Wow, I'm about to get sick right now." So any of these things are common but I always tell my patients to watch out for whatever their symptom is if it's getting worse that means this could be happening.
Nirala Jacobi:
And especially in relation to, let's say you're using an antimicrobial, right? So when we use antimicrobials that target Gram-negative bacteria that then when they die release more LPS then we experience this worsening of symptoms as a result of this poor detoxification, potentially. So, of course a lot of people think that they're just having die-off symptoms. And I would say, that's a real thing but I don't... What's a good time for die-off for you? Because for me if it goes on longer then a few days after you've started treatment and you've supported detoxification and things are still worsening I would say, would you... What's your time frame for how long Herxheimer reaction or die-off reaction from killing bacteria or other organisms should last?
Diane Mueller:
It's a really good question. And I'd like to start by pointing out something that I think is super important that you said which is essentially that when we have a situation where we have something like SIBO or E. coli through a UTI or chronic UTI, these sorts of things, we can be in a situation where we have the endotoxemia turning down the MRP2 protein and then as we kill these things, as we kill these Gram-negative bacteria the MRP2 protein gets turned down even more and so then we get even a further backup. And it's almost like this vicious cycle that happens. So I think that's really important to bring awareness to that we can have this situation where we have something turning down the MRP2, we then can kill the Gram-negative creating this vicious cycle. And when we do that, like you said, we absolutely can have these die-off Herxheimer type of events.
Diane Mueller:
My general feeling is I want people to Herx as little as possible. And this is something I talk about in my book. Is I really feel professionally that sometimes we can't totally avoid it but I do not think this is a push through just do it. Because essentially if we're Herxing we have more toxins then our body can deal with which is incredibly inflammatory. And I feel we can create additional damage when that's happening. So, yeah, in my opinion three days like you're saying I would say is the absolutely furthest I personally want to push somebody. Trying to keep it even less then that as possible.
Diane Mueller:
And I really encourage people within the first 24 to 48 hours, if it's significant, if they're feeling... Usually I tell people if they're feeling five to seven percent worse I'm not really worried about that. But if it's much more significant then that then I want to hear from them and I want to start doing work then such as giving choline for example or myrrh that can open up these proteins, these MRP2 and BSEP proteins, to help with moving, actually getting the toxins out of the body.
Nirala Jacobi:
Yeah. I think that's a really, really important point. A lot of patients are told just to soldier on with their Herxheimer reactions. That's really good to hear you say that too that you've has that experience. Because, yeah. What if they're already quite toxic and we're adding to that burden? Which brings me also to this other point of, what other lab abnormalities might we see as a red flag that this might be happening? In terms of cholestasis or meaning that there is this congestion in the liver that doesn't allow toxins to leave.
Diane Mueller:
Yeah. We can certainly sometimes see liver enzyme elevations or GGT which often times is a sign of biliary inflammation. So sometimes those things are present. Doing a test like an Organic Acids or a [NutrEval 00:20:34] test that will give us a sense of some of the liver pathways can also sometimes be valuable for this. The other thing that we can do is we can actually measure LPS antibodies in the blood and that can also give us a sense of if the immune system is starting to react because the LPS levels are going up. And so we can do an IGA LPS and IGG LPS. And when we do those if we start seeing that that can be a sign that the endotoxin load is getting high enough where the body is actually having an immunological response against those endotoxins. And that can be another sign that we need to watch out for this.
Nirala Jacobi:
Okay. So what can we, you mentioned a few things, products, that can help with bile flow or opening up these canaliculi or improving those proteins to more or less potentiate phase three. Myrrh was one, choline. Do you use phosphatidylcholine or is it just regular choline?
Diane Mueller:
I use both. Phosphatidylcholine is really nice because the phosphatidyl groups will get into the cell membranes and help to detox the cells. So it is a little bit more expensive for people so sometimes I will just use straight up choline if we have a cost concern. But if people can afford it, the phosphatidyl group attached to it is nice because you do get that cellular detox out of the cellular membrane at the same time. And usually I dose that one around four grams three times a day is a pretty reasonable dose. It's a decent dose. And that usually tends to do it for people.
Nirala Jacobi:
And that's the liquid, the phosphatidylcholine you mean? Or just the choline?
Diane Mueller:
The phosphatidylcholine.
Nirala Jacobi:
So a teaspoon or so two, three times a day?
Diane Mueller:
Exactly. Yeah.
Nirala Jacobi:
I love that stuff. I use it all the time. But it's nice to actually now also understand. I always thought because of the component of bile that it would work on that. But does it up regulate MRP2 and BSEP?
Diane Mueller:
It does. Yep.
Nirala Jacobi:
Very, very interesting. That is very cool. Good to know that. One other understandings that we have of hepatic congestion and what we call cholestasis and stuff is lactulose, the prebiotic lactulose. Have you worked with that as well?
Diane Mueller:
I haven't used a ton of lactulose as far a prebiotic. I mean, I've definitely done the lactulose induced SIBO breath test. But I haven't used that a ton as far as any of this os concerned. I do use a lot of prebiotics for various things.
Nirala Jacobi:
Yeah. It also has some effect, I mean, that was the initial use of it is for that problem. But of course it's always, you have to really know what you're doing when you use lactulose when you have a SIBO case. Very interesting. Now also you... All right. I feel like we've covered the endotoxemia topic pretty well. We might loop back to it. You also in your book talk about, which I found really fascinating because I'd heard of it but I just didn't think of it for a while, but this whole idea of bacterial persister cells or organisms that are very resistant to treatment. Can you just talk about that a little bit before we move into other aspects of your book where you talk about the mindset and all of that?
Diane Mueller:
Yeah. I love this talk. I want to add one more thing that I think would be really important for your listeners about the endotoxemia which is, so many people treat SIBO with the drug Rifaximin. And there's a study that basically shows that Rifaximin basically is up regulated, it's turned on by bile. And so it has a 71 to 73% better result of working when it's exposed to bile. So if we have a situation where you have SIBO and we have something like mold that's turning down the MRP2 and we're not releasing bile and we think the Rifaximin's not working, we retest in SIBO and know nothing's changed and we're like, "Oh, we need a different treatment." It might actually be that the Rifaximin would have worked but we didn't open the MRP2 to actually allow the bile to get into the small intestines to activate the Rifaximin. So that's another just way this is all connected that's probably important for people to hear.
Nirala Jacobi:
Yeah. And just to comment on that is that we often, in my practice I always give Rifaximin or recommend Rifaximin along with either bitters or some kind of cholagogue or herbs that move bile or ox bile. So, very important for practitioners to understand that whole bile solubility concept of Rifaximin. So thank you for mentioning that. That's very important.
Diane Mueller:
Yeah. Yeah. My pleasure. And then persister cells, I love persister cells. I found persister cells so fascinating. Because this concept has been around for a little while and the way I like to describe this is to go back to basic microbiology when we're talking about bacteria and the DNA from bacteria. So as people probably remember from microbiology we have, bacteria have plasmid, they have this circular DNA. If we have two bacteria, one with an antibiotic resistance and another without, the bacteria if they find each other they will basically share pieces of their plasmid, pieces of their DNA. And that's how we get the antibiotic resistant bacteria that are spreading and learning. So that's the fundamentals of how the bacteria work as far as their DNA.
Diane Mueller:
Now if you have these bacteria that I'm speaking about and they've exchanged their DNA and you look at their DNA what you're going to find is that there is no remnant of the original bacterial DNA once they've made this exchange. It's almost like they've morphed into a slightly different version of themselves, from a genetic standpoint. What's super interesting about persister cells is persister cells are bacteria that essential have this resistance to antibiotics but not through this normal mechanism. So something has basically allowed them to formulate this resistance. But if you look under a microscope at their DNA, the DNA is literally the exact same as it was without having the antibiotic resistance, or without having that genetic change I mean.
Diane Mueller:
So, that's what's super interesting about them. Is persister cells exist in tuberculosis, in E. coli, in Lyme disease, and they're really interesting because of the fact that from a genetic level they work on a very different way which also means from a treatment perspective they work in a very different way. So persister cells tend to have the ability to go into hiding, into dormancy. And unlike certain things, certain things can kind of come in and out of a more active or a more stationary type of phase and when a lot of bacteria are more active or a little more dormant in the dormancy they will still cause, typically cause some level of symptoms.
Diane Mueller:
What's interesting about persister cells is when persister cells are formed or created they basically are, they don't cause symptoms generally. So we actually think that we've killed the microorganism. And this is seen so frequently I think in SIBO and UTIs where people think, "Okay, well we've really worked with that over growth, we've really gotten that infection out of the urinary tract." And then all of a sudden not much time goes by and it's like the symptoms are flaring again. And that can sometimes be that those persister cells have come out of dormancy. Once they're out of dormancy they can actually start forming symptoms again.
Nirala Jacobi:
It's really amazing that we're all alive at all in way, isn't it?
Diane Mueller:
It so is.
Nirala Jacobi:
There's so many tricky ways that organisms evade detection. From biofilm to now persister cells. I wanted to mention that because you did talk about E. coli. And E. coli is really emerging as one of the main organisms that we know that causes SIBO when we see an over growth in the small intestine. In and of itself E. coli can also be quite important as an ecological member of the microbiome in the large intestine, but when it's over grown. I also want to emphasize that because philosophically I don't share this war on all bugs that we have seen in conventional medicine. I think a real other, a paradigm shift does need to happen where we understand some of these mechanisms. And talks like this really help to enlighten some of that.
Nirala Jacobi:
But how do we, as practitioners, how do we get around preventing some of this persister cells to hide out? And let me just also mention that from a clinical perspective we do see that a lot also in some cases of SIBO that we always thought, we automatically we assume that if we have a case of SIBO that relapses very quickly or just relapses after a certain amount of time that that was a motility issue. Either a motility or adhesions, right? So now I'm going to start thinking about this a bit more is this possibly a situation where we have treated but some have remained, not because of biofilm but because of this persistence of these organisms that went dormant? Which is a really interesting concept to add to our repertoire of interesting concepts.
Diane Mueller:
Yeah. Absolutely. And I think we need it. Because we do see what SIBO, like you were saying, we see so much recurrence. And not for everybody of course. But I feel like the rates of recurrence for SIBO and UTIs are higher then a lot of other situations. So I do think we need more theories and more deeper understanding of why this is happening. And persister cells certainly provide one theory or a mechanism as to why we have so much recurrence with SIBO. And I still feel like saying that persister cells are the reason for this, it mechanistically makes sense with the research but we do need more studies. We absolutely need more validation of, we know persister cells are there but is that truly what's creating SIBO recurrence? I think so. But additional research is certainly needed.
Diane Mueller:
So as far as treating persister cells, there's not unfortunately a lot of studies on this. Most of the research has been used using anti persister medications against tuberculosis. There's one really great study that came out maybe just over a year ago now on Lyme disease. And this study actually found that the herb cryptolepis was amazing. It blew even the pharmaceutical anti persisters out of the water like Daptomycin. It really helped bring awareness to the power of herbs for persister cells. And so we know for Borrelia, for Lyme disease, that cryptolepis works really, really well for persister cells. So that's one thing that could be tried. I haven't tried it yet for SIBO honestly but I do think it's an interesting concept because we don't really have a lot of data on something like that for E. coli yet.
Diane Mueller:
But there are other things we can do in how we prescribe. So pulsation therapy where we are actually putting somebody on a certain medication for a certain herb for a certain amount of time, like five days, and then off for two days. And pulsing like that has been shown to be really helpful against persisters. That off period draws them out of hiding. So that's another thing we can do. Another thing that has been shown to help with persisters is rotation of treatment. So not having people continually on the same thing. So we might use in a SIBO situation maybe we're using something like a Berberine for a week and then we're doing a round of Rifaximin and then we're using oil of oregano and then we're throwing some Allicillin in there, these types of things. So we can rotate through our different antimicrobials that we know for SIBO. And that is, again, to differentiate from what is truly been studied, there hasn't been a study that's done that but mechanistically theorist, theory wise we see that the rotation through these different antimicrobials can help with persister cells.
Nirala Jacobi:
We're all into anecdotal stories here also. So, we don't have to have it all backed up always by tons of studies because often times when you're on the forefront of science there are no studies on that. So we are in a way just trying to find the best treatment for our patients. And so just to summarize on that point, I'd say maybe if you're a practitioner listening and you have some patients that are chronically relapsing just maybe even starting out with that rotation therapy or rotating your therapies to see if that patient as a better outcome. Because I'm sure every practitioner listening here that is specializing in SIBO has seen patients that have been on months and months and months of the same herbal treatment or on antibiotics, et cetera.
Nirala Jacobi:
So I think it's a really good point that we haven't really talked about here on this podcast. Because I've always been sort of against pulsation because it's very confusing for the patient, I haven't seen really the benefit. But now that I understand the concept behind it I can see that maybe there's an application for it especially in the chronic relapsers. So thanks for that. Okay. Good. Good stuff. Moving on to, let's talk about how you, you're obviously a very researched based person and also you've got tons of references in your book which I love and a self professed science nerd which is all good. We love that. How did you get into then bringing the mind into this? Because we on this podcast are big into engaging the mind especially in chronic illness. But how did that come about for you?
Diane Mueller:
Yeah. A couple different ways. One was just through my own personal life and making decisions even in relationships that led, and I talk about this in my book, that led to poor outcomes, I would say. So some of it is just looking at, "Wow, what is going on internally to drive me to make certain decisions that are not the best decisions for my life?" So that was part of it. Just more from the personal side of things. And then more from the health related professional side of things there's much more around noticing something that as I was going through Lyme and mold treatment myself and noticing, especially with mold because mold is so intense around feeling that the world's not safe. Traveling becomes difficult because you never know if you're going to rent a moldy hotel or a moldy Airbnb and think you're good and then it's a nightmare. So it was just feeling limiting.
Diane Mueller:
But what was the most scary thing in being somebody that has a history in meditation and observing my own thoughts, it was most interesting to me when I started observing my thoughts around mold was this feeling of, "Wow, the world is not safe for me." And I just really would have these thoughts that were popping up randomly about, "The worlds not going to be safe for me. I'm always going to be sick." These types of things. And of course then I would think these thoughts and the next thing that would happen was I would then have this very sympathetic overdrive type of response. My heart would race, I would start sweating, all these types of things that are not good for healing.
Diane Mueller:
And so that, we know in naturopathic school that the parasympathetic system is good for healing and that we want to move into that system. But one of the things I think is not emphasized as much as it probably should be in medicine in general is the fact that we, it actually, most of us through our culture and our society and if there's sickness on top of it, we really get stuck frequently in this sympathetic overdrive. And that's not the state for healing.
Diane Mueller:
So it was partly just observing in myself, my own thought processes and the connection to my sympathetic system as well as working with clients and really seeing this whole vicious cycle that would happen where their mind would just be circular thinking. And it's really hard to get somebody into a healing state when we're, and the thoughts are reasonable but when we're thinking about them over and over and over again we have to have a way and a mechanism of getting out of it.
Nirala Jacobi:
Yeah. And I was actually, as you were talking, I was thinking, how many people did we just freak out with that whole story of the persister cells. It's another threat that they hadn't considered. But it's a really apt observations that a lot of people that are chronically ill it's not that you're making it up it's just that there is a perception that the brain continues to tell you you're in danger. And some of that is completely automatic. It is not something that you're making up or that you got to do more positive thinking or any of that. It is a state that your brain has associated with your illness and it's really a process of becoming more aware of that and understanding your thought process around how you perceive yourself in the world. And also if you're able to actually see yourself well.
Nirala Jacobi:
So I always tell, I think human beings have this incredible capacity to heal from all sorts of very, very adverse conditions. So I completely trust that if you're listening to this and you were freaked out by the previous persister cell thing, don't worry about that. That's not something that you need to put a lot of thought in right this moment and just keep working on how you're healing journey is going to unfold. So, just wanted to have a little medical disclaimer there.
Diane Mueller:
That's perfect.
Nirala Jacobi:
That we're hopefully not getting people into more sympathetic overdrive. Okay. So, your book is really about healing from chronic illness, especially Lyme disease and mold illness. Now, it seems like there's a lot of talk about mold and Lyme together. And this is a SIBO podcast so I'm trying not to put to much emphasis of this but at the same time, because I think of chronic illness as the body is basically constantly in a state of trying to heal itself and so it is an important conversation to have. So tell me more about... Yeah. I guess what I'm trying to say is, what is your approach to treating chronic illness besides helping people with mindset?
Diane Mueller:
Yeah. It's really great. I really like looking at the entire body and running labs all over the body. And to tie it into SIBO because this is a SIBO podcast, there are links. We already made this link of mycotoxins and their effect on the MRP2 and the bile and that relationship to treating SIBO. And the concept of persister cells. But in addition to that, Lyme, the Borrelia, has been shown to attack the vagal nerve. And even though we associate SIBO mostly with the migrating motor complex which really doesn't have vagal intervention there is still this relationship of proper parasympathetic control through the vagal nerve and SIBO.
Diane Mueller:
And we do know, for example, when we don't have proper peristalsis we can have all sorts of different things happen from an inflammatory perspective, from a food reactivity perspective. So there is, it's a little bit of a looser link but it's enough of a link. I'm actually doing a local, my first local live lecture after all of this viral stuff here, in a month and that's one of the things we're actually talking about. Is the link between Lyme and the gastrointestinal tract. So there is enough of a link between these two things were certainly if somebody has our classic SIBO IBS type of symptoms I'm not going to typically go down and look at Lyme first thing unless there's a lot of other reasons to. But it is something to have in the back of our brain in our differentials. If somebody is not getting well, is there something that could be attacking the neurology that's effecting the gut.
Diane Mueller:
So there is a loose link there. And from a diagnostic perspective a lot of how I run my practice is by, as much as is possible, there's of course not perfect labs for everything but as much as possible really working at test not guess perspective. So if I'm suspecting Lyme or mold I am going to test for Lyme or mold. And I don't think I've every once in my entire clinical career only run one lab test. The idea that, my philosophy is let's get as much information that seems clinically relevant that the patient can afford and really base our diagnostics and our treatment upon good clinical data.
Nirala Jacobi:
Yes. Very good. I completely agree. I often do a lot of other testing besides, even looking at the gut. There's a lot of other things to consider.
Diane Mueller:
Yes.
Nirala Jacobi:
Yeah. As a naturopath that's our...
Diane Mueller:
It's what we do, right?
Nirala Jacobi:
That's what we do. We dig a little deeper into these processes. So again, we're not talking about, standard SIBO is actually really, really easy to treat, right? So standard SIBO is not a problem. It's chronic cases that we're looking for answers. All right. So those are the topics that I really wanted to bring up with you. Is there anything else you'd like to add to... First of all, what's the name of your book? When is it coming out? And where can people find you?
Diane Mueller:
Yeah. Thanks. So basically the name of the book is Use Your Mind to Heal Your Mold And Lyme. And it's not just about the mind. It really is a mind body approach to these types of illness. So we talk about SIBO in there. We talk about the adrenal glands. We talk about the immune system. We talk about the research on perception of stress and what negative thinking does and how we can have two people, there's these cool studies for example where people are put on stage and the stressor is mental arithmetic. So that's used in a lot of the stress studies because people get nervous about performing math in front of an audience on stage. But in the studies what they'll do is they'll basically ask people throughout these tests what they're thinking and to rate what they're thinking as positive, negative, neutral.
Diane Mueller:
And so what they find is that people can be subjected to the exact same stressor but have cortisol, just regulation based upon what they're thinking not based upon the stressor. So really important to think about that in terms of overall body health, how our mind can really influence parasympathetic dominance. So it really is looking at all of this research along the mind and a whole body approach to, Lyme and mold are the topics but chronic disease in general. Lyme and mold cause so many different symptoms. So it really is pretty applicable for fibromyalgia and chronic fatigue and gut disorders and anxiety and headaches and migraines and chronic pain can be related to some of the information in this book.
Diane Mueller:
So it does come out, the launch date is May 24th. So, that is happening. I actually have a five day online educational summit I'm doing the week before that's free. So that's good for everybody to know about too. That's online [inaudible 00:46:08]. That starts May 17th. So, yeah. So we'll put the link of how to find the summit and how to get the book. It's good for everybody to know the first two days of the book release, so the 24th and 25th of May, I will be giving the ebook version away for free. And after that-
Nirala Jacobi:
Oh, wow. That's awesome.
Diane Mueller:
Yeah. So definitely take advantage of that.
Nirala Jacobi:
And if you're listening pass that release date and pass the summit date will you have the summit available on your website?
Diane Mueller:
I will. Yeah. Absolutely.
Nirala Jacobi:
Yeah. And you're in Colorado, right?
Diane Mueller:
I'm in Colorado. Yeah.
Nirala Jacobi:
Yeah. You have a lot of Lyme there in Colorado?
Diane Mueller:
We do. We do. It's actually become, gosh, probably at any given time anywhere between 50 and 70% of my patients are positive for Lyme.
Nirala Jacobi:
Oh, dear.
Diane Mueller:
It's a lot. And I'm testing. I'm not just guessing and treating them. So I know they actually have Lyme disease. So Lyme's everywhere. It's definitely endemic and more, there are areas where there's more of it but it's not, it just exists in certain areas like we thought it once did. So...
Nirala Jacobi:
Well, I think everybody has a bit of a theory as to why it's such a dominant player on the playground when it comes to chronic illness. But people are just more stressed, have more toxic burden, and all these naturopathic principles that we've been talking about and have been taught about what the body does to overcome some of that, but do you think that's part of why we just see more Lyme illness or is it just that the organisms becoming more virulent?
Diane Mueller:
My best guess is that it's both. I think, it's like SIBO is fairly new in our diagnostic world and the grand scheme of gastrointestinal dysfunction but SIBOs probably been around a long time we were just calling it all IBS. So I really think it's probably largely something like that. But then there's crazy things, there's these songbirds that originate from Ontario and they basically have infected ticks in their feces and when they fly around the world they will just basically defecate and drop these infected tick larvae onto the ground. And so then there's research like that that also is like, "Well if the songbird population goes up that would make sense that there would be more of a spread of this sort of thing." So my suspicion is it's probably a both and situation.
Nirala Jacobi:
And when I was reading that I was just like, "Oh my god. This is just not good for the songbirds."
Diane Mueller:
No.
Nirala Jacobi:
People are not going to like that. So my stance is, look there's a reason why that is all happening in nature and it's infinite wisdom. And so once again, not blaming it on the songbirds but more or less understanding that organisms have been with us for a long time and perhaps there is a reason why we are more susceptible to some of them compared to times when perhaps we weren't. So I always try to put it into perspective. Once again, not going down that road of just blaming the bugs for everything. That's my stance. Because I think we have so many amazing tools to make people stronger, more resistant, and more able to fight some of these... Yeah become more resilient is the word I'm looking for.
Diane Mueller:
Yeah. 100%. I agree with everything you just said.
Nirala Jacobi:
Good. Because it was just like, "Oh my god, people are going to not like the songbird bit."
Diane Mueller:
It is a good point.
Nirala Jacobi:
Well, Dr. Mueller, it's been a really very, I think it's going to be very helpful for a lot of practitioners. Especially this whole idea about what may impair phase three detoxification. I think that's really, really important. So I thank you so much for your time. And I wish you all the best on your book release. Your knowledge is really needed out there. And thank you so much for being on the podcast.
Diane Mueller:
Thank you for having me. I really appreciate this. And thanks for helping me share the word with the world. Really appreciate your help.

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