Histamine Intolerance in Patients with SIBO with Dr. Nirala Jacobi: Rational Wellness Podcast 86

Dr. Nirala Jacobi talks about Histamine Intolerance in Patients with SIBO with Dr. Ben Weitz.

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Podcast Highlights

0:53  Histamine intolerance sometimes occurs in patients who are also suffering with Small intestinal bacterial overgrowth. Histamine is a neurotransmitter that signals your immune system to launch an inflammatory response in your gut, your lungs, your skin, your brain, or your cardiovascular system. When dust makes you sneeze or you get a skin rash from eating gluten, this is a histamine-mediated response.  Most of the histamine is generated in mast cells, but it is also produced in the enterochromaffin-like cells in the stomach that are involved in the production of hydrochloric acid for digesting your food.  Histamine is produced from the amino acid histidine, with the help of the histidine decarboxylase enzyme. Histamine is usually broken down by the enzyme histamine N-methyltransferase or the enzyme diamine oxidase, with diamine oxidase being the most important one.  If you’re deficient in diamine oxidase, you’ll likely have histamine intolerance, since the histamine does not get broken down and it builds up. There are various causes of low diamine oxidase, including gluten intolerance, leaky gut, small intestinal bacterial overgrowth. There are certain foods that tend to block diamine oxidase like alcohol and energy drinks. Inflammation blocks diamine oxidase. And a number of medications also reduce diamine oxidase. 

4:30  Histamine is involved in a lot of functions in the body and it can present with classic allergy symptoms, but it can also present with digestive symptoms like bloating or cramping, and more systemic symptoms like fatigue and headaches. Dr. Jacobi explained that when she is treating a patient with digestive conditions like SIBO and she doesn’t get the expected response, then she will see if their symptoms might indicate histamine intolerance.  Sometimes she can pick out histamine intolerance patients early on.  Extreme histamine intolerance can be mast cell activation syndrome.  Histamine can stimulate hydrochloric acid production, so reflux can be caused by histamine intolerance. 

6:39  Dr. Jacobi explains that you have to break down histamine problems into exogenous histamine production found in foods we are eating, like spinach, canned fish, and cured meats and then you have endogenous histamine production where histamine is either over produced by the body or not being cleared. Histamine intolerance can result from a lack of diamine oxidase because of microvilli destruction due to SIBO or Celiac Disease. 

8:32  If Dr. Jacobi suspects a patient may have histamine intolerance she might test serum histamine, chromogranin A and a host of other urine measures that are more specific for mast cell activation syndrome. Lately, she has been running the Dunwoody Intestinal Barrier Function test, which measures histamine and diamine oxidase levels, though measuring serum histamine levels is not that reliable since it has a very short half life.  If diamine oxidase levels are low, she will prescribe a product containing pure diamine oxidase called Umbrellux. 

12:28  Dr. Jacobi has developed a SIBO histamine biphasic diet for SIBO patients in collaboration with dietician Heidi Turner. It’s a variation on her biphasic diet for SIBO patients and for the first two weeks you avoid histamine liberating foods, like lime and citrus, and histamine containing foods. If you’re improved after two weeks, then you can start adding back in the histamine liberators. You remain on the histamine avoidance foods and then you phase into the biphasic diet for SIBO (her version of a low FODMAP diet) starting with phase two.

14:51  Sometimes it is easy to suspect that histamine is a problem for SIBO patients, such as when they tell you that they eat tuna every day for lunch and get bloating. You can just have them remove canned fish and the other high histamine foods right off the bat.  Fresh fish does not have a lot of histamine until it is allowed to age in the can or in the refrigerator. In fact, any protein food that is allowed to age will develop histamine, such as leftovers.  Now there is another reason not to eat tuna besides histamine, which is because it is so high in mercury.  The exception is the baby tuna in a can sold by Vital Choice, which is much lower in mercury.

19:28  There is probably not much need for supplements to promote diamine oxidase production, even though it is supported by B6 and copper.  It is more beneficial to heal the gut and the microvilli.  So gut healing formulas can be helpful and folate and methylation factors can also be beneficial.  Using a supplement of diamine oxidase for a month or two and treating the SIBO or the other underlying cause is the most beneficial treatment for histamine intolerance.  If they have mast cell activation, which means they have a large pool of endogenous histamine, they will need mast cell stabilization, such as by taking quercetin or other mast cell stabilizers. Here is a paper on the effectiveness of quercetin: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033805

22:49  Some probiotics have been shown to be beneficial for patients with histamine intolerance, including Lactobacillus plantarum strain 299V, lactobacillus ramnosus, bifido infantis, and bifido longum have all been shown to help degrade histamine.  But Dr. Jacobi said that she has not seen much benefit just using probiotics in these patients, though she often does include them in her protocol.  And histamine is a bioactive amine can actually be produced in the microbiota in the large intestine.  Here is a paper on lactobacillus plantarum degrading biogenic amines like histamine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316997/  Here is a paper that discusses how bifidobacterium infantis and longum suppress histamine signalling: https://www.jstage.jst.go.jp/article/jphs/107/2/107_08028FP/_article/-char/ja



Dr. Nirala Jacobi is a Naturopathic Doctor who specializes in treating patients with functional gastrointestinal disorders like SIBO and she directs the Biome Clinic in Australia.  Dr. Jacobi runs the SIBO test online breath-testing and educational service. She is also the host of the popular SIBO Doctor podcast on Itunes

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.


Podcast Transcripts

Dr. Weitz:  This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition. From the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness podcast on iTunes and YouTube. And sign up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy the Rational Wellness, please give us a ratings and review on iTunes. That way more people can find out about the Rational Wellness Podcast.

Today we are going to talk about histamine intolerance, especially in patients who are also suffering with small intestinal bacterial overgrowth. SIBO is the underlying cause of IBS in the majority of cases.  First of all, what is histamine? And what is histamine intolerance? Histamine is a neurotransmitter that signals your immune system to launch an inflammatory response in your gut, your lungs, your skin, your brain, or your cardiovascular system. When dust makes you sneeze or you get a skin rash from eating gluten, this is a histamine-mediated response. Most of the histamine is generated in mast cells, but it is also produced in the enterochromaffin-like cells in the stomach that are involved in the production of hydrochloric acid for digesting your food.

Histamine is the chemical involved in common allergies, which is why drugs that block histamines are often prescribed for patients with allergies. We have H1 receptor blocking agents, like Benadryl, Zyrtec, Claritin, and Allegra. We also have H2 receptor blocking agents, like Tagamet, PEPCID, and Zantac. And as you can tell those are drugs that help in the GI tract. There are also quite a number of foods and nutritional supplements that can modulate histamine levels, which we’ll probably get a chance to talk about today.

Histamine is produced from the amino acid histidine, with the help of the histidine decarboxylase enzyme. Histamine is usually broken down by the enzyme histamine N-methyltransferase or the enzyme diamine oxidase, with diamine oxidase being the most important one.  If you’re deficient in diamine oxidase, you’ll likely have histamine intolerance. There are various causes of low diamine oxidase, including gluten intolerance, leaky gut, small intestinal bacterial overgrowth. There are certain foods that tend to block diamine oxidase like alcohol and energy drinks. Inflammation blocks diamine oxidase. And a number of medications also reduce diamine oxidase.

I’m so happy that Nirala Jacobi will be joining us today to help give us some clarity on what do to about histamine intolerance, especially in patients suffering from small intestinal bacterial overgrowth. Dr. Jacobi is a naturopathic doctor who graduated from Bastyr University in 1998. She’s now the director of the Biome clinic in Australia, where she takes care of patients with functional gastrointestinal disorders.  Dr. Jacobi is the host of The SIBO Doctor Podcast. She runs the SIBO test online breath-testing and educational service. And she develops courses for training functional medicine practitioners. Dr. Jacobi has developed her version of the low FODMAP diet, the biphasic diet for patients with SIBO, and recently she developed the SIBO histamine biphasic diet.  Dr. Jacobi, thank you so much for joining me today.

Dr. Jacobi:  My pleasure. Thanks for inviting me.

Dr. Weitz:  So when you’re working with a patient with small intestinal bacterial overgrowth, what we call SIBO, when do you suspect that histamine intolerance may also be a problem?

Dr. Jacobi:  Well, as you so aptly pointed out, histamine is involved in a lot of different functions in the body. And it’s a really important molecule, a biogenic amine. And it can sort of present with pretty classic symptoms. As you mentioned, allergies, but also what we see are a lot of digestive disorders like bloating, cramping, more systemic symptoms like fatigue and headaches and so forth. And what happens is … I usually start my treatment out and if I don’t get the expected response, or if people have sort of dysautonomia symptoms that are more classic along the spectrum of histamine intolerance all the way to mast cell activation syndrome … That’s a real spectrum. So you could have simple histamine intolerance all the way to mast cell activation syndrome. So wherever they are on the spectrum, and I sometimes suspect it fairly early on. But mainly-

Dr. Weitz:  What are some of the symptoms of histamine intolerance?

Dr. Jacobi: Well, some of the symptoms of just plain histamine intolerance is bloating after meals. It can even be reflux because of this histamine actually stimulating hydrochloric acid production. Cramping is pretty common, abdominal cramping or hypersensitivity. Those are pretty classic. Diarrhea or constipation, but more predominantly diarrhea, which of course all those are SIBO symptoms as well.  So after treatment and if the patient tests clear after treatment and they still continue to have symptoms, I start to suspect this.

Dr. Weitz:  Okay. What about if you get a patient and you work them up for SIBO and they have some of the histamine symptoms outside the gut? Do you change your-

Dr. Jacobi: Do you mean like rashes … I mean, the thing is-

Dr. Weitz:  Yeah, skin rashes or other allergy symptoms, respiratory, et cetera?

Dr. Jacobi:  So the way I think about histamine, because I really did a pretty deep dive into histamine intolerance, and the way to understand it is that you have exogenous histamine production, which is found in food that we’re eating. Histamine can be found in things like spinach or canned fish, all canned products, cured meats, that type of thing. And then you have also conditions where histamine is endogenously over-produced or not cleared. So those two are very separate conditions that I wouldn’t class them necessarily all in one ball of histamine intolerance.  I usually think of histamine intolerance as a lack of diamine oxidase, which could be because of microvilli destruction due to SIBO or, as you mentioned, celiacs, those types of conditions, where really the main enzyme that breaks down food-based histamine is destroyed.

Dr. Weitz:  Okay. If you suspect a patient of having histamine intolerance, do you do any specific testing? Do you do serum testing? Or how do you try to work them up?

Dr. Jacobi: It’s a good question, because it is woefully inadequate is what I would say in terms of how to really get a good grasp of what’s going on with histamine. Because it has a very, very short half-life, so typically serum testing of histamine is not all that reliable. But there are a battery of tests that … I usually do that if I suspect mast cell activation syndrome, which include things like serum histamine but also chromogranin A and a host of other urine measure or markers that are more specific for mast cell activation syndrome.  But for simple histamine intolerance, there are some tests like I’ve been using the Dunwoody Intestinal Barrier Function test. That’s what it is. And it does measure histamine and diamine oxidase levels just on a … it’s a blood test. Like I said, the histamine I’m always a little bit iffy with, but with diamine oxidase that can be helpful. And then I prescribe a product called Umbrellux, which is a diamine oxidase, which is difficult to find pure diamine oxidase, but that’s one of the ones I use.

Dr. Weitz:  Oh, okay. Have you read about the connection between H. pylori and histamine intolerance?

Dr. Jacobi: So, H. pylori has so may different triggers in the upper gut, in terms of hydrogen sulfide production and so forth. But, yeah, there are some connections. When you have H. pylori, it’s sort of like it’s one of those ancient species that have been with us for so long, that it doesn’t always cause a problem and it only is a problem when you’re actually symptomatic for those things.  But I haven’t particularly noticed that my H. pylori patients are particularly histamine intolerant. I can’t say that clinically, no.

Dr. Weitz:  Right. Okay. I guess I saw a paper where H. pylori can increase histidine carboxylase, which is the enzyme that helps promote formation of it.

Dr. Jacobi: Yeah, which is interesting and I would kind of want more research on that. Because as we know, H. pylori lives in the stomach and it sort of survives these extreme conditions by creating an alkaline cloud around it. So by increasing histamine, it effectively would increase stomach acid, which would be a real surprise to me actually. Because it is a bug that lives there but it doesn’t thrive in stomach acid.

Dr. Weitz:  Yeah. Interesting. Maybe it just happens as a result of having H. pylori and maybe they just saw an association.

Dr. Jacobi: Yeah. Perhaps.

Dr. Weitz:  I just interviewed Jill Carnahan this morning and she was mentioning how mold toxins can result in histamine intolerance. Have you seen this…

Dr. Jacobi: Yeah, mold toxicity is not my specialty. I know that mold toxicity, obviously, because of its connection to a rampant, innate immune system, can have a lot of different causes of lots of different systemic issues. I haven’t seen the connection specifically to histamine. I know that there is a very specific connection to SIBO, simply because of the vasoactive intestinal peptide that’s often an issue with mold toxicity. And so if you have SIBO as a result of mold toxicity, that could be a very easy explanation as to why your patient is histamine intolerant.

Dr. Weitz:  Interesting. So can you tell us about your SIBO histamine biphasic diet for SIBO patients?

Dr. Jacobi: It’s a mouthful, I know. It’s a real mouthful, the name of it. So because I’m a SIBO specialist and I came across actually quite a few papers that mentioned the prevalence of histamine intolerance in a number of digestive disorders which are fairly benign. But the authors of these studies suggested that histamine is actually very often the culprit in terms of digestive symptoms.  So I looked into this a lot deeper and collaborated with Heidi Turner, who’s a fantastic dietician in Seattle. She gave a very riveting presentation at one of the SIBO symposiums about rheumatoid arthritis and SIBO, but also mentioned histamine in that whole process. And she was on my podcast talking about mast cell activation syndrome.

So we collaborated and came up with a fairly straightforward but quite restrictive approach. And anyone who’s listening who’s heard of a biphasic diet, it’s really a staged approach to SIBO treatment. And so we wanted to take that same blueprint and have a staged approach to histamine intolerance. And the way we did that is, rather than just remove pretty much all foods, which would be the case if you’re treating SIBO and histamine intolerance at the same time, we’ve sort of used the histamine intolerance diet as a starting point before you go into the straight biphasic diet.

So what we did is we staged the histamine liberators and histamine foods. So histamine liberators are foods that actually, just as the name implies, liberate histamine from foods. Such as lime and citrus, et cetera. So the first part is where you’re avoiding all histamine liberators and histamine foods, which is about two weeks. And if you’re improved then you can start adding in the histamine liberators. Then you remain on the histamine avoidant foods and then you sort of phase into the biphasic diet stage two, or phase two.

So it’s a great way to manage symptoms really quickly for people where you really suspect they have histamine intolerance. And sometimes people will be really obvious. They say, for example, they eat a can of tuna every day for lunch. You and I know that’s not a good practice, besides histamine. But it is something that people do a lot and they have a lot of bloating, they have a lot of issues. And so you just can start with saying, look, just remove that food and remove all the main heavy hitters and see if there’s any improvement.  And I often do that with my SIBO patients, sort of like a histamine intolerance 101, kind of a light version of the histamine biphasic diet.

Dr. Weitz:  Yeah, so you brought up tuna fish. So from what I understand, fish, if it’s really fresh, is going to be very low in histamines. But as it sets, whether it’s sitting in your fridge or whether it’s in a can, right, that’s when it starts developing higher histamine levels?

Dr. Jacobi: Yeah. Yeah, fish tends to be very high. There’s actually a condition called … I think it’s scombroid poisoning. Some kind of crazy name.

Dr. Weitz:  Yeah…

Dr. Jacobi: I actually have a patient where I very much suspected that it was a triggering event for him, of subsequent histamine intolerance. And he had a lot of systemic symptoms. But anyways, yes, tuna fish or any tinned or canned fish, any protein, really, that’s allowed to age. And so sometimes people are so sensitive that they can’t even do leftovers. They have to eat their meals very fresh, freeze them fresh. Those would be suspect. Also, in terms of … if people come in and they just have a ton of sensitivities, you have to suspect histamine as your first priority.

Dr. Weitz:  So what about fish that’s frozen? Is that going to prevent the histamine formation?

Dr. Jacobi: Yeah, you’d want to really check the label that it says flash frozen on the ship or on the boat. That’s a good practice. The reason I mentioned why it’s not such a good practice to eat tuna, really, anymore is because of mercury levels, right?

Dr. Weitz:  Right. Yes.

Dr. Jacobi: Which is a whole nother kettle of fish in another way. But yeah-

Dr. Weitz:  Except that one company that makes the baby tuna. You know about that one?

Dr. Jacobi: That they … isn’t that horrible? That they’re using that, it’s now a thing? Yeah. Where are we going to stop destroying the planet?

Dr. Weitz:  It’s not going to stop, unfortunately. There’s not going to be any wild fish soon, so …

Dr. Jacobi: That’s right. So I usually promote companies like Vital Choice, which is an Alaskan fishermen cooperative-

Dr. Weitz:  I think that’s the one that has the baby tuna.

Dr. Jacobi: Oh, really? That would surprise me. I mean, I’ve talked to the main guy. But look, I don’t know this. I haven’t actually come across this-

Dr. Weitz:  So I think what they said is the baby tuna accidentally get caught up in the nets with the bigger tuna, and the fishermen used to throw them away. And then they realized that the baby tuna actually have very low levels of mercury, so…

Dr. Jacobi: Yeah, they do. They do.

Dr. Weitz:  … they buy them up from the other fishermen … that’s what-

Dr. Jacobi: Oh, I see what you’re saying, right. Well, that’s a whole new thing. I thought that they’re specifically targeting tuna day care centers.

Dr. Weitz:  Yeah. We separate the baby tuna from their mothers when they cross the border.

Dr. Jacobi: Oh, God. We shouldn’t laugh about that but it’s pretty funny.  Well, Vital Choice, the reason I like them is because they do, according to my own research, they do very sustainable practices. And so that’s really the way forward with all this. It’s like, we can’t possibly expect things to be sustainable the way we’re doing it now. And so I like to promote or support companies that have much better sustainable practices.

Dr. Weitz:  Right. Yeah, absolutely. I think it’s important where you get your fish oil from too, because some of them-

Dr. Jacobi: Exactly, yeah.

Dr. Weitz:  … you get them from the small fish that the whales eat, the krill, that’s going to be a problem because that’s going to deplete the whales, right?

Dr. Jacobi:  Well, actually Antarctic levels of … I mean, this is way off the topic, Ben, but … krill levels. I’m quite close to Antarctica, you know close, how close I don’t know.

Dr. Weitz:  That’s true, that’s true, yeah.

Dr. Jacobi: But we do have plenty of krill down there. We have great thriving humpback migration routes here.

Dr. Weitz:  Okay, so anyway, so, getting back to the topic of histamine… So what about foods and nutritional supplements that can promote diamine oxidase production?

Dr. Jacobi: So it’s supported by B-6 and copper. So that’s one thing. But it’s a rare patient that’s really depleted in copper in my experience. So I don’t usually use precursors or supplements to promote the replenishment. It’s really about healing the gut. Because as soon as the microvilli return, you should have ample amounts of diamine oxidase. And it’s a protective mechanism for all of us to have this in our microvilli, because all of us have a certain tolerance to histamine after which it gets really overloaded.

So if you’re somebody who’s listening and reacts a lot to green smoothies, thing like that where you eat a lot of spinach, and you have reactions, I would suspect histamine intolerance. But really it’s about healing the microvilli, and that is take your gut-healing formula of choice to really regrow that. Which requires a lot of folic acid. Actually if we think about that we have this gut lining that’s one-layer thick from mouth to anus, more or less. Well, it’s actually in the small intestine where it’s one-layer thick. And all the way through the large intestine.  And that cellular turnover to renew itself occurs every 48 to 72 hours. And so for that DNA replication you require a lot of folate and methylation cofactors, which is … I go easy on them. I always start very easy on them. Because a lot of people react to B-vitamins, especially if they still have SIBO, because it’s like a food for the bacteria. So you gotta be easy on that. But I just wanted to make that point that folic acid is really important in cellular replication.

Dr. Weitz:  Right. You ever use natural agents that are … like natural histamine blockers like quercetin in the short term to help modulate symptoms?

Dr. Jacobi: Yeah, so it’s not really a histamine blocker, quercetin. It’s more of a mast cell stabilizer. And it does a really good job. Really, really good job in doing that. You gotta go up high. And it does do that. But remember that if we’re talking about histamine intolerance, where it’s not a mast cell problem. It’s actually more of an issue of where you’ve destroyed the very enzyme that breaks down histamine at the very get-go.  So I usually find that using Umbrellux or something like that for about a month or two is really helpful. And then treating SIBO if that’s the underlying cause, or treating whatever other underlying cause.  Crohn’s disease, celiacs, that type of thing.  And really healing the gut lining is my primary objective then. But if they’re moving on this spectrum where in other words, it’s not just exogenous or outside histamine that’s the problem that’s coming in from food, but they have an aberrant mast cell response where that was triggered by stealth infection, by mold, by a number of insults, then they actually have an endogenous pool of histamine that’s very high. And for that they’re going to need a lot of mast cell stabilization.

Dr. Weitz:  Right. Yeah. There’s also some genes that could predispose them. What about probiotics?

Dr. Jacobi: So I often get asked about probiotics, and I’m a single-strain kind of person.  Or no more than a few strains.  Sometimes I go above that and I use research strains. We don’t really know enough yet about which strains … there are conditions in which your microbiome actually produces histamine. That does occur. And it is a biogenic amine. So that often happens in the large intestine where we see further degradation of histidine into histamine.  So that does happen. And so I sometimes recommend probiotics like lactobacillus plantarum and lactobacillus rhamnosus gg, specifically. But to be honest, I haven’t seen a great deal of relief with just probiotics.  And I do a lot with probiotics.  So I’m a little underwhelmed as it is right now with just using probiotics.  And there’s very little research.  I’m hoping it’s coming very soon, but there’s very little research on even the strains that I’ve mentioned.  But there is some.  So I do use it for those instances.

Dr. Weitz:  I did see a few papers that show that certain strains of probiotics, bifido infantis, longum, and bifido plantarum helped to degrade histamine.

Dr. Jacobi: You mean lactobacillus plantarum?

Dr. Weitz:  Yeah, lactobacillus plantarum.

Dr. Jacobi: Yeah. That’s the one I mentioned that’s a really well researched strain, it’s usually 299v. And it’s the one in sauerkraut, which is kind of mean because sauerkraut’s full of histamine. But it is in the fermented vegetables. And so, yeah, that’s a very well researched strain for a lot of different things. Also for hydrogen sulfide. So I use it for a lot of purposes.

Dr. Weitz:  Okay. Let’s see. So your biphasic diet involves testing back in some histamine-liberating foods.

Dr. Jacobi: Yeah, so, the SIBO histamine bisphasic is … like I said, it’s sort of like the entry point into the biphasic SIBO diet.  Which is really about minimizing die-off symptoms and having a very streamlined approach to SIBO treatment.  But the histamine was a very specific part of this process for those that are very, very sensitive.  I don’t know about you, Ben, but I’m seeing increasingly people that are eating only five different foods or so.  Extremely sensitive.  Very reactive patients.  And I mean, I specialize in digestive disorders, so that’s not a surprise.  But still it seems to be getting quite, quite intense for people out there.

So really this diet was necessary for me as a starting point for many of my patients that are super sensitive. So yes, once again the first part is histamine liberators and histamine foods are to be avoided. And the second part is where you can introduce the histamine liberators again and then still remain off of the histamine foods. And then the third part is you transition into the phase two of the biphasic diet, of the SIBO diet.  So it took us a long time to produce this diet, because we had to juggle these two conditions, SIBO and histamine intolerance.  And if you combine them … you’re left with hardly any food.  And so we had to have this staged approach to treatment.

Dr. Weitz:  And that happens a lot, especially in patients that are treating themselves and they go on the internet and they find another list and another restrictive list. And you start layering these lists, there’s no foods to eat anymore.  I’ve been amazed with patients with gut problems that I’ve treated. And when they start to feel better I would have thought that they would be very anxious to have a much broader diet and they would be bored with eating those foods.  But I’m shocked a lot of times when they say, no, I’m okay.  I’ll just keep eating this way the rest of my life. I finally feel okay.  And as you mentioned, it’s not that healthy to have a very limited diet, so …

Dr. Jacobi: It’s not healthy at all, and there is a lot of food fear out there. And to some extent … I mean, people feeling sick, of course, they have to find a way to feel better. But that often creates a situation where they are very fearful to reintroduce foods. And so we have to really counsel them around that. And what I usually say is, look, you’ve basically selectively fed a very small number of bacteria. Whatever food you’re going to start eating after your two-year stint of just chicken breasts, Brussels sprouts, and maybe white rice … whatever you’re going to start putting back in will cause you some reaction. I fully expect that.

So if you actually preface that by saying that, I think that makes a big difference for people. Like, oh, okay. I’m not going to relapse all the way; I’m just going to have a few reactions, maybe, but I’ll be okay. So that’s important for practitioners to really understand, is like if they’ve painted themselves in a corner, they will have some reactions. And you just mitigate that by reducing doses and very small amounts.  I’m a big fan of collaboration as a practitioner, so I have a team of people around me that I can delegate stuff to. So I have a nutritionist that I work with that does a great job with food reintroduction, again. So I highly recommend that to anyone that has any food issues, is go to a really qualified nutritionist or dietician like Heidi Turner, for example. She’s fantastic with things like that.

Dr. Weitz:  That’s great. I think that’s pretty much all the questions I had about histamine intolerance in SIBO patients.

Dr. Jacobi:  It’s a big deal.  Do you see a lot of them?  Do you have a lot of people with histamine intolerance?

Dr. Weitz:  I have some. I have a lot of patients with SIBO and I’m not always sure if they have histamine intolerance.  It’s always tricky to figure out, so …

Dr. Jacobi:  Well, one of the things that was interesting … I belong to quite a few professional forums and one of my colleagues … Because I kept saying, look, I sound like a broken record. But if somebody was posting, I’m treating them for SIBO, they’re not improving, I said, try removing histamine food.  And I was sounding like a broken record and a colleague was saying, I finally did it and these patients that were not improving had a miraculous turnaround.  So really don’t underestimate the power of histamine intolerance in patients that have very tough-to-treat SIBO or not so much frequent relapses … it’s not really a cause of a relapse.  But people that are just borderline on a test, not really terrible fermentation but still have really pretty tremendous symptoms, I would put that at the top of my list.

Dr. Weitz:  Does anything show up on stool tests with histamine intolerance? No …

Dr. Jacobi:  No. No. Not at all. Stool testing really is … I think in the future maybe … only this Dunwoody lab that I … it’s a new one, I can’t really fully endorse it yet. I’ve had it maybe with 20 people. But so far, it’s holding its weight. So it’s looking promising.

Dr. Weitz:  That’s the one where you’re measuring the diamine oxidase levels?

Dr. Jacobi: Yeah. Yeah. And they also have histamine levels. They actually also do LPS antibodies. So that’s interesting, and zonulin, of course, and things like that.

Dr. Weitz:  Yeah, yeah, yeah. Okay. Great. So how can listeners and viewers get a hold of you and find out about your programs?

Dr. Jacobi: So I’ve created thesibodoctor.com, which is an educational portal for practitioners and also soon to be patients. I have a clinic in northern New South Wales in Australia called The Biome Clinic, and you can just find that at thebiomeclinic.com. And I have a breath-testing company, but if you’re listening to this podcast in America I say, look, just go with a local breath-testing company to reduce the carbon footprint of sending test kits.  I take that stuff very seriously. We’re soon to be 100 percent solar-powered company, so that makes us all very happy and doing our part.

But yeah, you can find us on Facebook. The SIBO Doctor is our main page, where we talk pretty much everything related to SIBO. I’m just about to launch a gut-healing program for patients that will be also great for practitioners to recommend to their patients. And I intend to cover topics like histamine intolerance and how people can really help themselves. And I teach people how to do enemas, how to do hydrotherapeutic treatments at home, how to do a carminative tea, how to really help themselves and empower themselves again with healing their digestive tract. So it kind of is a good adjunct to the practitioner treatment plan. So that’s kind of what I’m working on right now.

Dr. Weitz:  Great. And your podcast?

Dr. Jacobi: The podcast is called The SIBO Doctor Podcast. It’s on iTunes as well. We just finished our second year. So it’s a really popular podcast for practitioners. It’s not just about SIBO. It’s really about the entire universe that is the digestive tract. And it’s fantastic. As you know, it’s just so wonderful to be talking to experts and have very lively, stimulating conversations with other practitioners and experts and researchers.  Just did one on lactic acidosis that just was very interesting, with Dr. Satish Rao. So, yeah. You can find us on iTunes. It is definitely more geared towards practitioners, but as you know, patients are becoming a lot more educated and want to learn more about their own health, which is great.

Dr. Weitz:  Yeah. It’s definitely on my list of favorite podcasts. So thank you.

Dr. Jacobi: Well, thanks, Ben. Appreciate it.

Dr. Weitz:  Okay. I’ll talk to you soon, Nirala.

Dr. Jacobi: All right. Take care.


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