Dr Nirala Jacobi:

Latest episode of the Sibo Doctor podcast. Welcome to the first episode of the Sibo Doctor podcast for 2024. Longtime listeners of this podcast have heard me mention the role of hydrogen sulfide in Sibo, IBS, and inflammatory bowel disease. And it's a really fascinating topic because hydrogen sulfide produced in low doses, either by bacteria or by our own cells, can be quite beneficial, but in high amounts, it's very detrimental to the gut and can cause fairly severe symptoms. In episode 20, I started the conversation about hydrogen sulfide and Sibo in my interview with Dr.

 

Dr Nirala Jacobi:

Greg Nye, and I recently went deeper into the biochemical pathways of hydrogen sulfide and the implications of sulfur sensitivities with Dr. Stephanie Seneff in episode 101. I'm now circling back to discuss IBS treatment using high dose sulfur with Dr. Kathleen Janelle. Dr.

 

Dr Nirala Jacobi:

Dr. Kathleen Janel been practicing medicine for over 25 years. She's a graduate of Bastyr Medical School. Her and I are both actually graduates of the class of 1998, and she has a degree in biochemistry from the University of British Columbia in New England. She completed a residency in associate positions in pediatrics and primary care.

 

Dr Nirala Jacobi:

Over the past decades, Dr. Janelle has developed and refined a unique treatment approach for digestive disorders. She has used this therapy for patients around the country and around the world to help eliminate symptoms of abdominal pain, diarrhea, constipation, and the gas and bloating of IBS and Sibo. Welcome to the podcast, Dr. Janelle.

 

Dr Nirala Jacobi:

So great to have you finally.

 

Dr Kathleen Janel:

Thank you. So good to be here.

 

Dr Nirala Jacobi:

You and I were in the same class in our medical school, Bastyr University class of 1998. And it's amazing to have you on my podcast 25 years later, and both of us are IBS specialists and functional digestive disorders. And the reason I wanted to have a conversation with you is because you have a very unique protocol with which you treat Sibo and IBS, which involves high doses of sulfur. Can you start the conversation about this protocol and how you discovered it?

 

Dr Kathleen Janel:

Sure. Yeah. It was a personal experience that I had. So you don't know this because it wasn't something I was talking about. But all during the time when I was in medical school, I was having this issue.

 

Dr Kathleen Janel:

And the issue was every single day, around noon, regardless of what I ate or didn't eat or even if I just drank water, all of a sudden, my stomach would descend uncomfortably, and it would be like that for the rest of the day. So I don't know if you noticed during those times, but I was really thin. And one of the reasons I was really thin was because I really didn't know what to eat to stop this from happening. And I was so full usually when this happened that it was hard to go home and have a regular dinner. So this went on.

 

Dr Kathleen Janel:

And because obviously I was in naturopathic medical school, I was learning all the things I could do. So I did all those things. I saw naturopaths, many of them, and I did all of the things that we would normally do during this time. So taking digestive support and enzymes and betaine, and taking antimicrobials that were herbal and taking antimicrobials that were fungal, and taking homeopathies and changing my diet up and what else? Prescription antifungals.

 

Dr Kathleen Janel:

So tons of stuff. I feel like I turned over every stone. And one day, and this was after graduation and after my residency, I was talking to a friend who told me about this compounding pharmacist who was using high dose sulfur. And I thought it sounded crazy. I thought, what is that going to do?

 

Dr Kathleen Janel:

So I talked to this compounding pharmacist and asked her that. And she said, well, it's an antifungal and it's an antimicrobial, so it's going to get in there and clean things up and help with repair, but you have to take enough of it and you have to manage any kind of problems that might happen along the way. So I still thought it was an odd thing to do for this symptom, but I tried everything else. What's the harm in trying it? So I tried it, and I got four weeks into this eight week protocol that she told me to do, and my symptoms resolved and they never came back.

 

Dr Kathleen Janel:

They've been gone for the last 20 years. So that's when I started using it for my patients. Anyone who came in with any of those symptoms, I would start using it for them. And in the background, the whole SIBO thing was kind of going on and I was noticing it, but it wasn't really going down that same trajectory because this was working so well for me. So I just continued on with it.

 

Dr Nirala Jacobi:

Absolutely fascinating. So before we go into specifically what the protocol is, because I didn't know that sulfur can be used also as an antimicrobial. How does that work?

 

Dr Kathleen Janel:

Sulfur is able to bind to the receptors of certain microbial species and stop them from adhering to the host. So that's one way. And I have that open. That's one of the main ways. Most of the work around the antimicrobial nature of sulfur has been done on sulfur nanoparticles, in sulfur thiosulfate, and it's been found to be antimicrobial, like in the petri dish.

 

Dr Kathleen Janel:

And I'm not sure if that's the same mechanism as the receptor binding or something else, but they've proven antimicrobial properties around staph epidermis and some of the skin organisms as well as I'm going to pull it up, pull up my PowerPoint, because I know it's on there a couple of other species, which we would find in the gut. So that's definitely relevant to what we're talking about. Not so much the skin stuff.

 

Dr Nirala Jacobi:

Well, while you're looking for know, just to kind of update the listener to some of the previous conversations I've had about sulfur with other sulfur experts like Greg Nye and Dr. Stephanie Seneff, this whole issue of sulfur has been a huge, interesting topic, and I'm sort of approaching it from all different angles, because with SIBO  causing, or one of the causes of SIBO can be an overgrowth of hydrogen sulfide producers like fusobacterium and sulfur reducing bacteria, which is always very confusing to listeners. That's not reducing sulfur, it's actually a chemical term. So it's about organisms. SRBs are sulfur reducing bacteria are organisms that produce hydrogen sulfide, like the sulfur vibrio and Bilophila and there are others.

 

Dr Nirala Jacobi:

Our approach has been to avoid sulfur for a period of time and to potentially treat hydrogen sulfide producing organisms with things like oregano oil and so forth. And I have to say it can be really effective. But this whole approach that you have is a completely 180 from that. So this is one of the reasons I've been so fascinated by this, and I'm glad you are going to elucidate what actually is going on here with.

 

Dr Kathleen Janel:

All that, for sure. So I found the slide. It was against staph aureus and actually enter the E. Coli species one five seven h seven as well. In the same study, they found it effective.

 

Dr Kathleen Janel:

This is now in the fungal category candida and also aspergillus. A mold. Not a yeast, but a mold.

 

Dr Nirala Jacobi:

Okay, that's really good. So this is just elemental sulfur that was being used or for these.

 

Dr Kathleen Janel:

In this overgrowth particular study, they used sulfur nanoparticles, and they used the best result, sulfur nanoparticles and thiosulfate. They also used elemental sulfur, some sodium metabisulfite, which had some activity, but not as good as the first two.

 

Dr Nirala Jacobi:

So when we think about the hydrogen sulfide producers, and there is some thought, and I've talked about it with these other speakers before, about that the body might be upregulating its need for sulfur by compensating, by upregulating the sulfur reducing bacteria. Is that what's happening, do you think? Or do you when you then give sulfur that things kind of calm down?

 

Dr Kathleen Janel:

Yeah. It's like you're able to create a new homeostasis or balance in the body because it gets what it needs. So I sort of worked backwards, right? I went from, okay, this is working so well for so many people, and it's so easy. Why?

 

Dr Kathleen Janel:

And that's when I started finding the research from Dr. Stephanie Seneff. And reading some of the other material that's out there. And Dr. Seneff, her main proposition is that sulfur deficiency is ubiquitous.

 

Dr Kathleen Janel:

It's the most common nutrient deficiency that you've never heard of. And that's linked to the use of glyphosate in the soils, which impacts the soil microbiome. Right. So anything that has the pathway that glyphosate will interfere with and kill the organism with is going to die. And when you look at studies of wetland plots where they spray it with glyphosate, and then they see how fast can this glyphosate dissipate?

 

Dr Kathleen Janel:

And that's usually because some bacteria are picking it up. The best dissipation rates, up to 90%, are done in wetland plots that have a high degree of sulfur oxidizing bacteria. Those are the ones that have to take the elemental sulfur, oxidize it to sulfate. Because that's the only form that the plants can take it up in. And then change it to whatever their plant version might be of that for their growth.

 

Dr Kathleen Janel:

So that's the first problem, is the soil microbiome is no longer able to function at that capacity. And then if you look at our microbiome, greater than 50% of our internal microbiome has the shikimate pathway. So as we're being exposed to glyphosate, we are losing a lot of our species, and specifically the lactobacillus and bifidobacterium. So that allows for commensal overgrowth of commensal, or pathogenic overgrowth. And I think that's one of the reasons we're seeing a lot of SIBO, is because of that particular problem.

 

Dr Kathleen Janel:

We're clearing out space, and other organisms are allowed to take over. And then you couple that with the fact that we're not able to. Those sulfur oxidizing bacteria are not able to take the plant based sulfur, make it into sulfate that can dissipate into our bloodstream and feed us so that there's a backdoor. And that's the hydrogen sulfide is the backdoor. Sulfate reducing bacteria increase in their number.

 

Dr Kathleen Janel:

We get more hydrogen sulfide that can easily diffuse into the bloodstream, go to the brain and be converted to sulfate. Not a perfect system, but it might be a necessary system.

 

Dr Nirala Jacobi:

And there's also a lot of sulfur deficiencies in things like connective tissue disorders. Right. In terms of its use for connective tissue and all that. So sulfur deficiency is what you think is one of the most common deficiencies. And it often results in digestive complaints.

 

Dr Kathleen Janel:

Exactly. And weakness. In terms of sulfur, we don't store it, right. Well, not most minerals. Let's say calcium.

 

Dr Kathleen Janel:

Calcium. We store it in the bones. So when our body needs calcium for something, we're going to bring it out of the bone and use it. When we haven't too much of it, we're going to pack it back in there. But for sulfur, we need a daily requirement.

 

Dr Kathleen Janel:

We need between 850 to 1500 milligrams a day. And whatever we don't use is excreted. It's turned into sulfate and it's excreted through the urine. So we need that constant intake of the sulfur in order to maintain everything. The way that it functions in a structural component in our bodies is people are really into collagen right now.

 

Dr Kathleen Janel:

Well, I believe the rate limiting step of collagen formation is really the sulfur. So if you give people sulfur, then they can make their own collagen from that using the materials in their body.

 

Dr Nirala Jacobi:

So your approach really echoes that of Dr. Seniff, who thinks that we're all B twelve and sulfur deficient basically because of the very widespread use of glyphosate, which is of course the most common ingredient in roundup. For those of you listening, maybe it would be great because you mentioned that you could potentially talk about a case just to kind of illustrate how you approach a case and how you resolve some of these common digestive disorders successfully using your protocol. And maybe you can share a little bit about what your protocol is in terms of high dose sulfur for sure.

 

Dr Kathleen Janel:

I'm going to read, first of all, a note that I got, and I'm getting a lot of these, like almost every day. Every few times a week, I'll get something like on Instagram or one of the social networking sites where someone will reach out to me and say, oh, my gosh, the needle finally moved. And so here's one that I don't know the name of the person, but she says, I did notice a huge relief from the GI Janelle one powder, which is my version of the sulfur. I put a few other things in there. It's a combo of MSM, marshmallow root, slippery elm, and acacia, and it works.

 

Dr Kathleen Janel:

This was the first thing I've ever tried for Sibo that even slightly moved the needle. My doctor recommended it to me, and now I'm such an advocate. So that's something that I'm hearing a lot more of all the time as this information gets out there, which makes me really happy, because I would much rather people do a non antibiotic treatment, a non prescription antibiotic treatment for this condition. And then the one main reason why I started speaking out about this was because of this particular man, who is 68, and he lives in Washington state, so he has access to any functional doctor naturopath that he wants. When he was a teenager, he started having symptoms, and his symptoms were daily gas and bloating, kind of like what I was having.

 

Dr Kathleen Janel:

And so he'd followed all these different Sibo protocols. He'd been to see many doctors and many different nutritionists. He'd done every diet on the map. He'd even done the low sulfur diet, elemental SIBO, FodMap, pretty much everything. He's taken all the supplements, he took prescription antibiotics and antifungals, and nothing changed.

 

Dr Kathleen Janel:

He had the same symptoms day after day. So when I saw him, he'd had, at that point, 40 years of treatment and diagnosis. And I started him on the GI one powder, which is the high dose sulfur. So we started a low dose. I usually started a low dose and titrate people up, but this guy was just like, give me the full dose.

 

Dr Kathleen Janel:

I'm going in full speed. So I said, sure, it's up to you if that's what you want. So he started taking the 30 grams a day from day one.

 

Dr Nirala Jacobi:

And that's 30 grams of MSM, basically.

 

Dr Kathleen Janel:

Yeah, 30 grams of MSM. And that's unusual for someone. There's only been a few people over the course of the last 20 years that I've been okay with doing that. So we had a four week follow up appointment, and he said that for the first time in 40 years, his symptoms were gone.

 

Dr Nirala Jacobi:

Wow.

 

Dr Kathleen Janel:

And he continued on, finished the eight week protocol of the 30 grams a day. And that was five years ago, and his symptoms have never come back. So when I talked to him at that sort of end of our relationship, eight week call. It was a telemed call. He said, why are people not doing this?

 

Dr Kathleen Janel:

Why do you live here? And everyone else lives here? But this is the first time that I've heard of this. So I decided, you know what? I guess I better speak out about this, because people need to know.

 

Dr Kathleen Janel:

And if you want to do one more fun one, I love this because it was actually a referral from you. You might not remember. I'm sure there's a lot of people that go through your door.

 

Dr Nirala Jacobi:

I do. Sometimes I like to have people boots on the ground and not virtual, and just refer somebody who's in the state where I have a good trusted practitioner. So I'm glad that she reached out.

 

Dr Kathleen Janel:

Yeah, it was awesome. This is a family that. I think they met you at a conference when you were speaking here, and this was back in 2017. So they came in to see me, and these people had been through a lot prior to seeing me. So they actually had two different Sibo tests and two different courses of treatment.

 

Dr Kathleen Janel:

Both involved doing zifaxin. So a course of xifaxin, rifaximin. And they followed the low fat map diet one time. The other time they followed the. What diet was that?

 

Dr Kathleen Janel:

Low fat med diet. And then I think it was, oh, the specific carbohydrate diet. And following their first treatment with xifaxin and the limitations with the diet, they were okay for a little bit. Then they started expanding their diet to add their carbohydrates back in. All the symptoms came back.

 

Dr Kathleen Janel:

So they went back and did a second course of xifaxin and did the next diet, and then the same thing happened. They were good for a little while. They started adding their foods back in, and then their symptoms came back. And I see that a lot with people. A lot, a lot.

 

Dr Kathleen Janel:

So they had these two restrictive diets, two courses. And their symptoms when they came in to see me were abdominal pain and daily bloating. So this is a family of four, mother and three sons, and all they could eat at that time were beef, fish, lettuce, carrots, rice, and berries. That was their entire diet. If they strayed from that diet, they were in a lot of pain and a lot of bloating.

 

Dr Kathleen Janel:

So that's what they were doing. So I basically kept them on that diet just because it takes out my core inflammatory foods. We can get back to this later, but there's an overlap between the foods I consider inflammatory for people that cause an underlying problem. So that SIBO comes back and the overlap is with some of the high dose sulfur foods.

 

Dr Nirala Jacobi:

Okay.

 

Dr Kathleen Janel:

So there's different reasons we're taking them out and getting some good resolution for people so we can circle back. So I kept them on that diet, didn't make any changes, and I sent them away with the half dose. I told them to titrate up to the half dose, which is 15 grams a day. 15 grams a day, 1500 milligrams a day. And then I saw them in a four week period of time, they had less gas, less bloating, less abdominal pain, and their stools were more regular.

 

Dr Kathleen Janel:

So that was four weeks later. And honestly, Dr. Jacobi, I expect this. I expect to send people away that get to that half dose point and come back and say, things are getting better. Nothing's 100%.

 

Dr Kathleen Janel:

I'd say maybe 15% of the time they become more of a head scratcher, more of a, like, we're going to delve into this a little bit deeper, but 85% of the time, this is what I see.

 

Dr Nirala Jacobi:

Do you.

 

Dr Kathleen Janel:

So then I sent them away.

 

Dr Nirala Jacobi:

Oh, sorry, you weren't done with it? Yeah. Okay.

 

Dr Kathleen Janel:

Yeah. So then I sent them away again. I had them titrate up to the 30 grams dose. They kept that for four weeks, and they were feeling so good over the course of the four weeks that they added back into their diet, legumes, dairy and wheat. No symptoms returning.

 

Dr Kathleen Janel:

And when they completed the eight weeks, we talked and they had no gasp, no bloating, no abdominal pain. Their stools were regular. And so the course of time after that, they added back everything. So they were doing sugar and cruciferous vegetables and all the rest of it, and they were fine. And then my last check in with them was this year, six years ago.

 

Dr Kathleen Janel:

Excuse me, not one of them has had a symptom relapse.

 

Dr Nirala Jacobi:

Oh, fantastic. For those listeners. I'm always very careful to say, look, it's great that people are getting good results with it, but do you differentiate between different conditions, like, do you test for Sibo or do you do any microbial workup, or do you give it based on symptoms?

 

Dr Kathleen Janel:

So I start with a symptom picture. If someone comes in and they have bloating, gassy bloating, and it can either be associated with pain or not, then this is where I'll start. Just if they come in and they have any other more predominant symptoms, then, yes, I might do some more testing and some more discovery before we go ahead with any treatment.

 

Dr Nirala Jacobi:

Okay. Because I just have a lot of questions, in a way, specific questions, because in my line of work, where we see such advanced cases that have, like your first patient that has gone through the wringer in terms of treatment and workup, and still nothing is working, those are the patients that I see. So there is always a level of sensitivity I find that is sometimes difficult to overcome. I have people that are severely reactive to any form of sulfur where we have to really do all this other work with pathways and snps and all that that was discussed with Dr. Seneff and Dr. Nye. So, listeners, you can go back in the archives and listen to that. So that really helped them to improve their sulfur tolerance. Do you see any level of that, of sulfur intolerance?

 

Dr Kathleen Janel:

What kind of symptoms do you get that are manifesting as sulfur intolerance?

 

Dr Nirala Jacobi:

So severe skin rashes. I am familiar with the HErCs concept, and we go very slowly. Also, very severe digestive symptoms, very severe gas. And really, it's feeding into the hydrogen sulfide production and the inflammatory nature of hydrogen sulfide itself. And so, in many cases, that is then improved by treating hydrogen sulfide producers and then slowly reintroducing sulfur foods.

 

Dr Nirala Jacobi:

So, I just wondered, and many of the practitioners that I've talked to about hydrogen sulfide have a similar experience. And I am just curious what your experience is with that, with this level of intolerance.

 

Dr Kathleen Janel:

I do see it maybe not as frequently, because, again, it sounds like the population is very much more advanced in their symptoms and length of time with the symptoms. So, I'm not dealing with that piece of it, but I have seen it a handful of times. The skin rash piece, usually I do a lot of handholding at that point because I really know that if we can get these levels up, then we can get you some resolution. So, I'll do pinch doses. I will have someone who's super sensitive just put a pinch of a dose of the treatment in water, drink that either all at once or throughout the day, and we'll very gradually increase.

 

Dr Kathleen Janel:

I have got one patient I'm doing with that with right now. I think she is in Virginia, and it's just a very slow process. There is someone else that comes to mind. When we did that slow process of pinch dosing increase, took her two years to get to the full dose. But her symptoms did resolve once she got up there.

 

Dr Kathleen Janel:

I think she forgot almost how bad she had been. They always do, right? That's why we take notes.

 

Dr Nirala Jacobi:

Yes, that is right. So, what you're saying. Correct me, if I am hearing this wrong, but you're saying that pretty much all bloating has some root in sulfur deficiency, or is it just a specific type, like for you, that the patients that you're seeing pretty much all resolve with their bloating? Because this is huge news for people that have very incessant bloating. And I have people that I treat for SIBO that are fine.

 

Dr Nirala Jacobi:

They are cleared. It is all good. They may or may not get a relapse, but their bloating resolves. And then there are people that continue to have symptoms. And then I look deeper into microbiome issues, digestive issues, et cetera.

 

Dr Nirala Jacobi:

We all do that. But what you are saying, which is pretty big, that all bloating has some element of sulfur deficiency, is that correct?

 

Dr Kathleen Janel:

I wouldn't say all, but what I would say is that sulfur is a strong enough antimicrobial and antifungal to take care of a lot of those fermentation problems in people. I have come to believe that in terms of the hydrogen sulfide patients, that. And this is based on clinical experience. Right. So if I go in there with a sulfur and then we clean everything up, but this person has had a methane or plain hydrogen elevation in their breath test previously.

 

Dr Kathleen Janel:

That goes away too, right? So the bloating symptoms, and I don't retest all the time. Not everyone wants to do that. So either we base it on symptoms and say, okay, well, we're done here, or retesting, but things resolve. And that's what I'm saying about it may be partly due to that compensation by the body needing more sulfur producing or growing more of those sulfur reducing bacteria.

 

Dr Kathleen Janel:

But it also might be a general homeostasis within the microbiome diversity that's allowed to actually proliferate once you give the body what it needs. In terms of that sulfur component.

 

Dr Nirala Jacobi:

I was just reading a study about. Because my big fascination is anything microbiome. Because to me, that's where it's at, whether it's in the small intestine or the large intestine. And what we're really losing with our modern lifestyle, diet, medications, is these connections between bacterial communities where one bacteria might produce a metabolite that's consumed by another sort of cross feeding type of situation. I was reading this study that one of the big hydrogen sulfide consumers is actually roseburia intestinalis, which might be a big missing piece in somebody that has hydrogen sulfide overproduction only because there isn't anyone on the other end consuming it.

 

Dr Nirala Jacobi:

And so this is why I'm a big proponent of normalizing and improving microbial diversity and reestablishing these bacterial communities and networks, which is so important when you think about it. And I wonder if that also impacts that, if sulfur also impacts the reestablishment of some of these communities.

 

Dr Kathleen Janel:

I don't think it cannot do that because of how permanent the responses can be. And by permanent, I mean these people can go out and just like the family that I just talked about, they can go out and just reintroduce the healthy foods and not have a limited diet and go about including sugar, which the young people in that family were pretty happy about. The mom, not so much, but nothing was really having them have a setback at that point. There was something else I was going to say about that. What was it?

 

Dr Kathleen Janel:

Can't remember.

 

Dr Nirala Jacobi:

Just to clarify to the listener, we both have worked so much with gut patients that I'm always very cautious before I say, okay, everybody that's bloated, just try sulfur. Because for me, there are different reasons why people get bloated. You could be bloated because you're not digesting your food right. You're lacking hydrochloric acid, you're lacking enzymes. To me, that's more of a deficiency of that substance rather than sulfur.

 

Dr Nirala Jacobi:

So it's super fascinating for me to hear that. It's almost without fail, is what I'm hearing, that you do get improvements in your patient base anyways.

 

Dr Kathleen Janel:

Yeah, and I like to start with it because what I can do is if we don't have complete resolution, then I can go back in and look at those other things. Okay, so maybe you do need some more digestive support. Maybe you do need some more hydrochloric acid. And maybe we do need, like, the biggest thing I go in with afterwards is antifungals, because a lot of the people that I'm seeing, they've already been through several courses of xifaxin. They don't need another antibiotic, especially if there hasn't been any kind of shifting either symptoms or testing in terms of post antibiotic use.

 

Dr Kathleen Janel:

Right. So I will typically go in with an antifungal afterwards and try my best to try and determine what is it that we're dealing with. Because you know that the fungal or the yeast species, they're pretty hard to detect. Sometimes you're lucky if you get them out in a stool sample. They might be in the small intestine, in which case, how are you going to get them out.

 

Dr Kathleen Janel:

How are you going to get a sample to test sensitivity on? You're not.

 

Dr Nirala Jacobi:

I usually do the organic acid tests, look for arabinose and those. Do you find those fairly accurate in your practice?

 

Dr Kathleen Janel:

Well, they're something. They're at least something, and they at least differentiate between candida and a fungal species. But the latest one that I've been doing more of is the mycotoxin antibody panel.

 

Dr Nirala Jacobi:

Is that real time labs or so?

 

Dr Kathleen Janel:

No, I don't use real time. We're allowed to talk about stuff here.

 

Dr Nirala Jacobi:

Well, labs, yes, more or less, from a practitioner to a practitioner.

 

Dr Kathleen Janel:

Okay. So, yeah, I use my mycotoxin. And I met that particular lab director a year ago, and he started talking about. Because I had been doing a little bit of mold work with people as well, because there's always that overlap between fungal here, fungal there. Right.

 

Dr Kathleen Janel:

So he was telling me about, well, people, it's not just like, a mycotoxin inhalation problem that we have. It's a spore inhalation and a spore ingestion. And there was an ENT doctor who took his chronic sinusitis patients and going in and cleaning it out and throwing everything away. He sent it for culture. So when he cultured out what he cleaned out from the sinuses, from these chronic patients, 95% of them had mold growing in their sinuses.

 

Dr Nirala Jacobi:

That's like that famous, that Mayo clinic. Right. Also said that 95% of most chronic sinusitis is actually fungal in origin. That was revolutionary. Like when I read that 20 years ago or so.

 

Dr Kathleen Janel:

Correct.

 

Dr Nirala Jacobi:

Yeah. What's your success rate with sulfur using? I mean, I'm sure you do other things, but that seems like an integral component of your treatment protocol. Is sulfur in most of these patients?

 

Dr Kathleen Janel:

Well, it's my basis. Right. It's my groundwork. I'll start with that, and then if we have residual symptoms, then I'll start looking at other reasons for those symptoms. If those residual symptoms are gassiness and bloating, then we got to look in the fermentation department.

 

Dr Kathleen Janel:

What else is fermenting? Right. And if someone also has sinus problems, chronic sinus problems, then I'll be like, you know what? We got to run this test, because you might have some mold on board, and it might be in the sinuses, and you might have also. How hard is it to ingest a mold spore?

 

Dr Kathleen Janel:

Pretty easy, right? I mean, we're literally sitting in a cloud of them right now, so, immune system.

 

Dr Nirala Jacobi:

I don't miss Seattle, but we had massive floods here, too. We had massive, massive floods. So mold is pretty much everywhere. So this lab that you mentioned can be, like, sort of location specific for sinuses. I thought we always have to do sinus swabs, and it's hard to get them in the gut.

 

Dr Nirala Jacobi:

No one tests for aspergillus in the gut, for example, to my knowledge.

 

Dr Kathleen Janel:

So it's an indirect test for mycotoxins. So, you know, if you are having active igg and ige antibodies to mycotoxins, then the problem could be inside the body, and it's going to be either sinus or digestive, because those are the only two places that can really harbor a mold spore. And those guys are really smart, right. They're going to just hang out in there and wait for some immune compromise to happen, and then they can actually go ahead and have their families and set up camp. But those are two perfect places, the sinuses and the gut, because they're dark, they're warm, they have a food source, and they're separate.

 

Dr Kathleen Janel:

Right. They're separate from the outside world. You can't get a sinus swab from the nasal cavity because you've got that tiny little channel between all of the four sinuses and the nasal cavity. Right. And if someone has a fungal problem that's clogged up, just like our eustachian tube gets clogged from the middle ear to the back of the throat.

 

Dr Kathleen Janel:

So if you stick a swab up someone's nose, you're going to get what's in the nose, but highly unlikely you're going to get what's in the sinuses. So, then we're based on either doing an indirect test, which is not the best thing, but it's all we've got, or sending them to an ent and hoping they'll culture it. Highly doubt that's going to happen.

 

Dr Nirala Jacobi:

We use. It's called. What is it called? I can't remember now, but it's a lab that it does. Do MARCoNS also?

 

Dr Nirala Jacobi:

Yeah, I think so. Like my microbial diagnosis or something. Diagnostics.

 

Dr Kathleen Janel:

Yeah. They're in Boston.

 

Dr Nirala Jacobi:

Yeah. So we do try to jam it up as far as possible.

 

Dr Kathleen Janel:

You just can't get it in the sinuses. And do you get MARCoNS coming up for that? Quite a bit on people, yeah. So I think that MARCoNS is actually a marker for the underlying fungal problem.

 

Dr Nirala Jacobi:

Yeah. We're using that as an alternative. That's part of the shoemaker protocol. But we digress. But it's so fascinating because mold is so relevant, and also as climate is warming, as we're getting more extreme weather events, I think mold is going to be a major health factor.

 

Dr Nirala Jacobi:

And so we need all the treatment options and treatment approaches that we can have. Now, what about the treatment steps for you? Like you mentioned that you start with a low dose MSM because MSM is so widely available. We used to use it for joint pain. Right.

 

Dr Nirala Jacobi:

I remember using it 25 years ago for osteoarthritis as part of the cartilage, sort of rebuilding efforts back then. But now we're using it. It's very freely available, and so I think a lot of listeners will want to experiment a little. It's very safe to use. In my experience with MSM.

 

Dr Nirala Jacobi:

Is there sort of steps to look out for or any sort of advice you can give?

 

Dr Kathleen Janel:

Yeah, so I'll go through the protocol that I use. It's quite simple, but there's a couple of things I do before I start dosing the sulfur. And it's interesting because first thing I want to do is, when I do my GI intake, I want to know, are your bowels moving, how often? All the basic things, right? Bloating, abdominal pain, reflux.

 

Dr Kathleen Janel:

If someone's constipated, I'm going to work on that piece before I do anything else, because oftentimes people think they have an overgrowth because they're bloated and that's fermentation, but they're bloated because they're not moving their bowels enough. Right. So we get the constipation off the table and suddenly we don't need to do any treatment because that was the problem in the first place. So I always get the bells moving first. What's interesting about this formula is that it is a bit of an alternative, is all I can say right now, in the sense that it helps with diarrhea and it helps with constipation.

 

Dr Kathleen Janel:

So when you have those people who are alternating back and forth, it's very helpful in terms of that. I just talked to an ND last week who was kind of in a similar place that I was, right, tried all the things, really didn't have much change, and started. He ordered the powder from me and started doing it on his own. And he said, also, this is the first time the needle is moving on my symptoms. And he was a chronic diarrhea patient.

 

Dr Kathleen Janel:

That always surprises me. It must be the anti inflammatory part of the MSM acting in the gut is what I'm thinking. So first I get the bowels moving. Then I remove the inflammatory foods, which my group, I have my own list, right, okay. It's probably very close.

 

Dr Kathleen Janel:

It sort of seems to be like when I go to any of the functional meetings now, everyone's all like, this is the group of foods, just don't eat them. So cow, dairy, wheat, whole eggs and sugar, those are the top four that I'll take out of the diet. So I'll either completely take them out while we do this, or I will have someone eliminate and challenge them, or I'll try and do a test and see if we can figure out what is causing inflammation in the body. So any of those three approaches, that's not to say I haven't done this treatment without removing those foods and still been successful. But what I like to do is take the foods out, get the problem resolved, and then add them back in one by one.

 

Dr Kathleen Janel:

Because if they're still inflammatory, it'll be very obvious, right? If you systematically add them back in one by one. So you have a whole bunch of cow dairy one day and wait for two days and you end up in the bathroom, you know, cow dairy is not your friend. And if you keep on eating that, then you probably will end up back in the same place with some kind of overgrowth or some kind of problem. So then I will also, in addition to that group of inflammatory foods, I will also, for people who are really in pain, a lot of pain, I'll remove the raw foods for a while.

 

Dr Kathleen Janel:

I'll have them have really well cooked foods. I will also, if they know it's a problem, remove the crucifers, the brassicas, the allium family, and the legumes, just because they're so ferment, so easy to ferment, those guys, even if you don't have any problems, right? If you sit down and eat ahead of cabbage, forget about it. You could be the healthiest gut in the world and you're going to notice it. So that's basically what I do to just set it up for success, even if it's maybe not necessary for everyone.

 

Dr Kathleen Janel:

And then I'll start initiate the sulfur treatment. And I'll start with a half a teaspoon, which is 2.5 grams for an average patient. For someone really sensitive, I'll do that pinch dosing, then I'll always assure them you could have a die off reaction because we're killing yeast here. So you might notice that you feel more fatigued or you have more body aches or you have headaches. All of those things are normal and they mean we're on the right track, so it's okay.

 

Dr Kathleen Janel:

And also I tell them that you might get a little bit more gassy. And if you do, I want you to hold that until it resolves. It will, it might take two days, it might take seven days, but you'll stabilize at the dose and then you can go up in another increment. The same thing might happen again. Just ride it out.

 

Dr Kathleen Janel:

By the time you get up to the 15 grams dose, that won't be happening anymore. You will have acclimated to that information, that mineral information you're taking into your body. And then I'll send them off, but I want to see them in two weeks because they're going to forget all that, because that's not their job, right. To remember. And so there might be things that come up, and so I'll be able to go through that reassurance again and just cover those things and kind of handle anything questions that might come up.

 

Dr Kathleen Janel:

If I do get any rashes develop, then I'll absolutely add in the molybdenum. I mean, really, the only enzymatic pathway that I can see that we're influencing in this case is the sulfate oxidate or sulfate oxidase pathway because we're not giving methionine. And methionine is what drives the transsulfuration pathway. And all those other places you can get some snip defects and maybe cause some problems, but we're not giving methionine. Methionine is an essential amino acid, so we can't make it.

 

Dr Kathleen Janel:

So you can't take that sulfur and make methionine and push those pathways. But you definitely can potentially push that sulfite oxidase pathway and end up with too much sulfite and then have some reactions from that.

 

Dr Nirala Jacobi:

Cysteine is very high in animal products, and so animal meat, flesh products. Right. So that's very associated with high sulfur reducing bacteria and stuff and high hydrogen sulfide. Okay. That makes a lot of sense.

 

Dr Nirala Jacobi:

I love the elegance of the simplicity of it.

 

Dr Kathleen Janel:

Well, I've been honing it now for like, 2025 years. So, yeah, I kind of got a handle. But, yeah, it is very simple. It's very simple. It's very natural.

 

Dr Kathleen Janel:

It's kind of almost nature cure.

 

Dr Nirala Jacobi:

Yeah. And that form of sulfur is MSM, the most tolerable form of sulfur. And what is it? Methyl sulfonyl methane. Right.

 

Dr Kathleen Janel:

Methyl sulfonyl methane. Yeah. That's pretty much all we have in the nutrient world to work with, right. Elemental sulfur, that would be toxic at pretty low doses, whereas with MSM, I'll give you the version here. So, in terms of toxicity, because we excrete it so much, right, we're going to have any extra sulfide oxidase, going to turn the sulfite to sulfate, and we're going to pee it out.

 

Dr Kathleen Janel:

That's what happens all day long. So you really can't have an adverse reaction to sulfate that's not compatible with life. Right. You can't have an allergic reaction to sulfur either, because that's not compatible with life, but you can to sulfite. Right.

 

Dr Kathleen Janel:

So getting that sulfite moved through the pathway is important. So you can have no toxic effects at oral doses of 8 grams/kg per day. So that means a 665 pound person can take 600 grams a day. And we're talking about 30, right?

 

Dr Nirala Jacobi:

Wow. Okay. Yes. Big safety limit there. Excellent.

 

Dr Nirala Jacobi:

Well, let me see if I have any other questions. But generally, this, to me, makes a lot of sense. I'm excited for people that have this sort of incessant bloating to have another option to try something that they haven't tried before in a safe way. All of the information about Dr. Janelle, as I mentioned before, is in the show notes.

 

Dr Nirala Jacobi:

So go to the sibodoctor.com and click on the podcast, and all of the information is in the show notes. Do you have any other little pearls of wisdom to share, Dr. Janelle?

 

Dr Kathleen Janel:

I think if there's anything, I would say it's so important to work with diet, right, that to not go down just because someone is gassy and having GI problems, to immediately think that there's something that needs to be treated with an antibiotic, because oftentimes you can have food enteropathies, that inflammatory food enteropathy, where you get symptoms that really mimic an overgrowth or fermentation symptom. And that's another thing that I've seen is people coming in who have been tested, treated with xifaxin, their symptoms persist, and then we go, well, what are you eating? Well, I'm eating eggs and cow dairy every day. Well, let's just take those out of your diet and see what happens. And suddenly it's all gone.

 

Dr Kathleen Janel:

So then I question, was it ever really a bacterial overgrowth problem or was it always a food enteropathy problem? And just to go back to that, all the principles that we signed up for, right, 25 years ago. Well, 30 years ago, yes, 30 years ago.

 

Dr Nirala Jacobi:

And when you were talking about being bloated, I thought that was just normal eating Jeff's food in the cafeteria. At best.

 

Dr Kathleen Janel:

He didn't make good bread.

 

Dr Nirala Jacobi:

He made great bread. But there was a lot of farty food there and sitting all those hours. So I thought this was just part of med school. But anyways, yeah, I do agree with what you just said, and I certainly don't think that everybody who's bloated has Sibo. That's been my whole message, is to demystify a lot of this automation that we think around.

 

Dr Nirala Jacobi:

We're bloated and therefore we have SIBO. Or it's a relapse when you've reintroduced certain foods. And that's why I love naturopathic medicine, because it gives us so many other tools to work with and other avenues to look at as to why people are symptomatic. And there's a lot of big component on stress and a big component of other issues that are not related to Sibo at all. I mean, stress is related to Sibo, but yeah, there's a lot more than just SIBO, for sure.

 

Dr Kathleen Janel:

Right. Well, everything's related to everything, but we want to find what the cause is. That's why we signed up for this type of medicine in the first place.

 

Dr Nirala Jacobi:

Very wise words to end the podcast with. Thank you so much for your time. This has been really great, and I think a lot of people will be optimistic or will be excited about something potentially new for them. I could think of at least five patients right now that if I wasn't on a sabbatical, I would definitely try this out. But hopefully they're listening and they can get some ideas as to what to do if they're still bloated.

 

Dr Nirala Jacobi:

Thank you so much for your time.

 

Dr Kathleen Janel:

Thank you for having me to access.

 

Dr Nirala Jacobi:

The biphasic diet and the SIBO success plan. Or if you're a practitioner and would like to become an affiliate, go to thesbodoctor.com. Thank you for listening to the Sibo doctor podcast. We hope you find 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.

 

Dr Nirala Jacobi:

Thanks again for listening close.