Andrew: Okay. So, on to our topic. Many people know you already, so I don’t wanna sort of waste time, because we’ve got a lot of work to cover here today. But, everybody, Karly Raven is very well-known in the gut health space. She’s got particular interest in SIBO, but many other interests in helping patients with gut issues. So, if we can just dive straight into SIBO, can we talk first about what are the main dietary approaches that you see being used for SIBO, and what are the reported efficacies, or effectiveness reported by patients, that they tell you about? That was a double entendre…well, no, a tautology.

Karly: Yes. So, I think, like, the biggest thing to recognize is that there isn’t actually much research and data specifically done on patients and cohorts of people with SIBO. So, I think that’s, like, I really wanna start with that. But what does exist is a lot of research on IBS, and we know that there’s that crossover between IBS and SIBO, and the potential of an IBS patient to have SIBO is anywhere up to 80%. So, what I’m kind of seeing is the theories and the dietary therapies being translated over from IBS research, and being used for SIBO patients. And typically, what is being used is that low-fermentable, low-carbohydrate type diet, and quite restrictive in nature. So, it’s cutting out a lot of foods. So, like, the most commonly-used one is something like the low-FODMAP diet, a low-carbohydrate diet, and even, like, specific carbohydrate. So, like, you know, just selecting a few key carbohydrates, and removing them from the diet. And yeah, there’s different paradigms, I suppose, and creations, from people in the field of SIBO that have created different things. But what I find in my practice is they’re really hard to stick to. And, you know, my big question, over the years of practicing with these patients, is, do we need to be super-restrictive to get really great outcomes with these patients?

Andrew: Can I ask about that selective carbohydrate restriction? What’s the theory behind that? Are we trying to inhibit the proliferation of methanogens or something like that?

Karly: Yeah. So, essentially, the ecosystem that overgrows within the small bowel, and I say ecosystem because it’s called small intestinal bacterial overgrowth, but we know it’s not just bacteria that overgrow in that environment. You also have archaea, which is And the biggest theory there is that these carbohydrates, or high-fructose, or fructan, FODMAP-y foods, are almost like the fuel on the fire, and they’re their biggest fuel source. And so, when we actually remove them from the diet, we see that really quick, immediate symptom relief, you know, and that’s very clear in the data, you know. There’s some very big-scale studies that have been done on patients with IBS, and as quick as a week, you know, sometimes a matter of days, of removing these foods, there is a big symptom relief in bloating, improvement to bowel motions. So, it’s definitely something that we can’t question in terms of its benefit. But, you know, we need to look at the long term of these diets, and the effects that that might be having on the microbiome and for SIBO patients. And when you actually look at some of these big-scale meta-analyses that have been done, they conclude themselves that we don’t know, we actually haven’t looked at the long-term consequences of such diets. And it’s almost like a caution, when you’re starting to read through some of these studies. And so, that starting to ring alarm bells for me, in my practice, and going, “Well, is this the best that I can do?”

Andrew: Yeah. I totally hear you. Like, I understand about symptom relief, and that’s fine. But when you’re talking about people… And some people are very hooked into, shall I say, the acronym of FODMAP. Indeed, they forgot the first part of it, which was low, and they just say, “No, none.” Which in itself is nutritionally deficient. But particularly, long-term, we’re really dealing with people’s health, and, you know, there’s a lot of polyphenols and good things in these foods that exacerbate symptoms. And if we lose out on them long-term, I have real concerns about what we’re doing to the health, as you so poignantly say. So, what are the challenges, then, that practitioners might encounter when implementing these SIBO diets? You know, how can they overcome these difficulties? How can they better support their patients?

Karly: Yes, I think, like, the difficulty is how restrictive in nature some of these things, diets, can be, and how willing our patients are to do it properly. And then, also looking at the timeframe of use. So, you know, it’s not uncommon for us to get a new patient through our clinic who says to us, “I’ve been on a low-FODMAP diet for 7,” anywhere up to I’ve heard 15 years, you know.

Andrew: Woah.

Karly: And so, I feel like… Yeah. I feel like we really need to be setting very clear guidelines, if you’re going to be using these type of diets, around, you know, there is data to show that as quick as four weeks, we can see negative consequences on the microbiome, so now I’m talking about the large intestine, and the ecosystem that hangs out there, because we’re switching into more of that starvation mode, and we know that that ecosystem in the large intestine needs to thrive, and needs these, you know, prebiotics, fibres, and diversity of these type of things, and these diets are cutting out, you know, huge amounts of fruits and vegetables, and it really is very hard for the patient to create a diverse diet when they’re on it. And then I think, you know, so, are we creating another issue in itself, by using that long-term? And that will affect our outcomes, as practitioners, because it may be helping reduce symptoms, but underneath all of that, is it truly resolving the SIBO if that’s all we’re doing? And then, is it kind of creating a storm in the large intestine?

And compliance is hard. You know, lots of patients end up throwing the towel in very quickly, and going, you know, “This is really shit. I just wanna eat an apple.” And, at the end of the day, an apple is a beautiful food that we should be eating, and it’s so good for the microbiome, with pectin, and fibre, and so, yeah. That’s kind of, I think, the struggle, as practitioners and for the patient. And there’s more, but they would be the biggest kind of things that I think I see, and I’ve experienced it myself, as a practitioner.

Andrew: I’m so glad you say that. Indeed, I’m so glad that you mentioned apples, because Mike Ash has this…he called it the, “Is this the best diet for mucosal tolerance?” It’s a question mark. And in it, he details stewing apples. In the UK, they use Bramley apples, which we don’t use here, but, you know, Delicious or Pink Lady apple, something like that in Australia. Ones, and I’ve never found this out, by the way, I think he talks about using ones which are high in raffinose. But he stews them, puts in some cinnamon, some raisins. Sorry, some sultanas, and divides them up into easily-dosaged portions, so that you’re making a big batch, that you can easily access. And I’ve told patients about this, even with really chronic immune, gut-immune-based problems, and it is amazing how stewing the apple, rather than having a raw apple, settles it down. So, I wonder if the preparation of food might have something to do with what we’re talking about, with even FODMAPs.

Karly: Oh, absolutely. Even the way that we cook our beans, for example, like just using beans from a can, where there’s high amounts of manufacturing and bypassing…you know, when we cook them at home, we’re soaking them, we’re rinsing them, we’re letting them sit, and then we cook them and we boil them and we cool them. But what’s happening when it’s in the form of a can? You know, and so many patients say to me, “I can’t tolerate chickpeas and beans, and don’t even ask me.” And I said, “Okay. Give me some time, and we’re gonna get there.” You know? So, absolutely. I totally agree with you.

Andrew: Okay. The much-maligned chickpea. I love them.

Karly: Poor chickpeas.

Andrew: Now, you’ve done a lot of work with this, as I said, you know, both professionally and personally. So, you’ve made…you develop a…what is it, a SIBO roadmap? Is that what it’s called? SIBO food roadmap?

Karly: Yeah, the SIBO food roadmap.

Andrew: Yeah. Tell us about that, and what have you done?

Karly: Yeah. So, I kind of took a step back and went, okay, well, we can see that, you know, we’re getting great outcomes symptom-wise, and it’s almost like taking the fuel off the fire, with the removal of these type of foods. And the big issue was the microbiome, and then also setting timeframes around this. So, I just got sick of having to hand out a two-page document to patients, they follow the FODMAP diet, and I was being bombarded with questions, and so much email support, and I just thought that this is it. You know, this was probably three, four years ago now, and I thought, I’m gonna create my own things I’m gonna use with patients. And so, what I created was a six-stage process that I walk patients through, where, for around two weeks, there is a small amount of restriction. However, there are still key foods, even in that initial stage, that nourish the microbiome.

So, a couple of examples which set this apart from all of the other things that I’ve used in my practice is things like cacao, pawpaw, cranberries, and having those a part of the diet, that nourish the microbiome and have really great polyphenol effects, while they’re still reducing, you know, some of the big trigger foods. But then they quickly move into the second stage, and really start to add more fruits back in. And then, once they become SIBO-free, or IBS…it can be used for people with IBS as well, then they would move into the third stage and beyond. And right from the third stage, it’s just an abundant of microbiome-supporting foods. And I think the biggest thing for me was, like, being very clear on what they can and can’t do, the amounts, and educating them about why, and then providing them with all of the recipes that they need, all of the meal plans, because, in my practice, I tend to attract a lot of full-time busy mums, who also keep the household going, cook and clean, and they were just struggling, you know. They were like, I just… So, with the SIBO food roadmap, they basically get handed everything that they need, and they could start the day after they receive it, because they would have an exact meal structure, and the recipes to go with it, and the full guide, which they could learn over the first two weeks, you know, while they’re just like, “Okay. I’m just gonna follow what I need to do,” and then I’ll learn the principles, and then start to add layers, and create their own things from there as well, once they feel a bit more confident. But, you know, it wasn’t to just put it off for weeks, and just not get started, and not create change, because it was just too overwhelming. So, yeah. It’s kind of like a one-stop resource, I suppose.

Andrew: Good on you. Can I ask, what about symptom management? I mean, patients come in. Very often, they’re in pain. Sometimes they’re even agoraphobic because of their bowel habits. La, la, la. You know, there’s a lot of issues here. It’s not just, oh, a little bit of cramping. It’s just not that. I’ve seen patients in hospital with dehydration from IBSD. So, when we’re talking about SIBO and IBS, is there anything that you tend to employ on a nutraceutical level or herbal level to aid them through that first step, and maybe just settle down symptoms while they’re getting used to things?

Karly: Absolutely. So, I talked about stage one before, which is generally where most people will start. There are some exceptions, and we’re always treating the individual, and this is something that I do when I’m training the practitioners in the SIBO food roadmap. But alongside that, they’re often doing a lot of anti-inflammatory and gut immune work, so that might be through using specialized probiotic strains, a key prebiotic. We might be coming in there with beautiful anti-inflammatory herbs, like turmeric. And we also love glutamine, and, you know, really stretching the boundaries here, with some glutamine supplementation, because a lot of the companies actually don’t have enough glutamine in the dosages, in the supplements, that when we actually look at the clinical data on what it takes to kind of heal leaky gut and that, we’re looking at very large doses. So, yeah…

Andrew: Yeah. Twenty grams? There you go.

Karly: …we tend to do that… Yeah. And up to 50. Like, 15 to 20…

Andrew: There you go.

Karly: …is in a lot of it. But, you know, if we have a celiac patient, 50 grams, like, yeah, it can be, a very high amount can be needed to actually create that full healing response. So, yeah, we’re often doing that in the initial stages, and then that makes patients… Especially because, like, these people are, like you said, they’re super-sensitive. They’re reacting to everything, and not just dietary stuff, like, a lot of environmental things by that point, because they’ve often been on this journey for a really long time. Some of them have had mold exposure, and that’s the underlying cause that they got SIBO in the first place, so there’s that whole… You know, so, calming everything down, getting that immune system firing in the gut, while kind of lifting these aggravating foods, I suppose, that are so well-researched, and here I am talking about the, you know, the carbohydrate, and the FODMAP-containing foods. But just for a short period of time. And then, you know, while also using key microbiome-nourishing foods, that aren’t disruptive to the symptoms.

Andrew: So, I’ve got 20 questions from that comment. So, firstly, just because it’s on the tip of my tongue, glutamine. I’ve seen, using that, you know, two grams, three grams dose per day, and it’s usually in a formula that might be concentrating on magnesium, rather than a gut-healing thing, but what I find is that so many patients, and we’re talking many, many… Are we talking 60%? Are we talking 80%? Haven’t looked, but a lot of patients complain of wind. So, how do you navigate people through that initial, “Listen, we’re gonna change your gut, and it might be uncomfortable in the first few days.” How do you get people to stay on track during that initial shift in their health?

Karly: We work very closely with our patients. You know, they can contact us day-to-day, Monday to Friday, through the system that we have created. We don’t get them to come back a month later. That’s just the way that we’ve created our clinic to run and function. So, I think that’s really helpful, in that, if a patient is experiencing that, we can have the discussion then and there, but when…and help them troubleshoot that, because everyone experiences something slightly different when they’re reacting, too. But I think the key thing as well is building them up to those bigger dosages. And this is, like, really important, not just for glutamine, but also any type of prebiotic, you know, saying to them, “This is the end goal, of, like, where we need to be, based off the data, but let’s start here because of,” what you were mentioning, even prebiotics, in a SIBO patient, can be quite adventurous. But, you know, we’ve got a patient at the moment on full-dose, high-dose GOSs, because there were some really key species in her microbiome, that were just screaming to us to give her GOSs, you know? So we said to her, “Hey, normally we probably wouldn’t go here with a SIBO patient. Start with this tiny dose, you know, see how you go, and build up.” She did have, like you were mentioning, a few kind of bloaty days, that were worse than what she was already experiencing, and we just said, “Stay on that dose. Keep going with it, and just see how you go.” And then she kind of plateaued, and we’re like, “Okay, push the boundary again, and just kind of see how you go.” And over time, I think she’s now in week four of her protocol, and she’s on her full dose of that GOSs. And we use the similar process with the glutamine.

Andrew: Can we drill down? Forgive this vernacular, this picture, but can we drill down into the microbiome?

Karly: Mm-hmm.

Andrew: So when…

Karly: How long do we have, though?

Andrew: …you’re talking about… I’m just having a horrible visual. But if we’re talking about certain prebiotic fibres, perhaps certain species and strains of probiotics, which might benefit a microbiota profile, let’s say, how do you work with that, given that, let’s say, in SIBO, it’s commonly said that it’s the Lactobacillaceae which are over-abundant in the upper GI. You know, albeit that, you know, we can’t really test there unless you’re doing some quite invasive tests. There’s a lot of issues with testing that I have, but how do you choose which probiotic, which prebiotic you’re going to use, given somebody’s gut profile?

Karly: Yeah. So, I think, when we’re dealing specifically with patients with SIBO, the first thing is testing for SIBO, and working out what type of SIBO they actually have, looking at their clinical symptoms and their health history, and matching those two up, and then looking at their microbiome, if the patient has done both. This is a big investment for a lot of people, and, you know, I do a lot of mentoring with practitioners, and the biggest question I get asked all the time is, “Karly, how do you get your patients to afford both a breath test and a microbiome test?” And we’re at that stage in my practice where it’s just, that’s just how we work, and for me to be able to properly treat you in the field that I am, that’s what I do. But I do recognize that there is a big financial investment there for patients. And, looking at the microbiome, in my opinion, creates a safe treatment plan. And one example that I wanna talk about here is that, you know, there’s been a lot of conversations recently about the use of berberine, and its effects on the microbiome, and things like increased hexa-LPS production, and Proteobacteria, and the effect that it can have in decreasing the total number of species count in the overall microbiome of a patient. But berberine, in quite high doses, is very effective for the treatment of hydrogen-dominant SIBO.

So, you know, this is where, if you…we just need to, you know, be cautious, I suppose, and gather all of that information, because we may not go in with high, high doses of berberine if we could see in a microbiome profile that this patient had those markers elevated, and we might choose a different herb, like uva-ursi, or come in with more probiotics or prebiotics. And then, in terms of getting back to your question, Andrew, about, like, how do we choose a specific therapy, it’s about looking at, again, the research on, well, if that’s out of range, are we trying to increase it? Are we trying to decrease it? And a lot of the time, it’s actually just about harmonizing the microbiome. And, you know, probiotics and prebiotics are beautiful at doing that, but again, we need to get down to the species level, and understand how a probiotic works, and their mechanism of action. Yes, I can see you wanna ask a question. Go for it.

Andrew: Oh, there’s so many questions going. I’ve been taking notes, and there’s…it just keeps going and going, so… Okay. So, firstly, with berberine, with hydrogen-dominant SIBO, let’s say we’re dealing with a lady who is having problems with fertility, possibly polycystic ovarian syndrome, insulin resistance, and berberine might be advantageous for that, and possibly dyslipidemia as well. And berberine is a therapy for that. How do you navigate that when you’ve got, okay, this is good, but we can’t do that good thing forever, because, for your polycystic ovarian syndrome, because you’ve also got SIBO. I mean, that’s a challenge.

Karly: It is definitely a challenge. And Andrew, it’s something that has led me to really scratch my head the last six months, since, you know, the more and more I dive into this specific research, so much so that we went, “Right, we’re gonna do our own clinical observations.” So, we’ve actually been collecting our own data on all of our patients. So, we’re looking at breath testing and microbiome testing before and after the use of berberine or non-berberine treatment for our hydrogen-dominant SIBO patients, and then also monitoring the outcomes, with the microbiome testing. And, look, I’m gonna drop a bomb, because this is, like…and I wanna say, this is a small, a lot smaller scale than what… You know, some of these studies looking at the effects of berberine are up to, you know, 300 participants, in this study. And we have not yet reached those numbers that we’ve done our clinical observations on, so this is a sort of a much smaller cohort of people. But it’s really interesting what we’re seeing in terms of, we’re not quite seeing the same outcomes in terms of berberine directly creating increased levels of hexa-LPS, or Proteobacteria.

In some patients, we’ve seen a decrease of species, but, you know, even just last week, we had one patient come back who has done, again, I can push the boundaries with my SIBO patients quite a high dose, and I’m happy to admit it, even though some people may cringe and go, “Oh my god. You’re using what?” You know, “Berberine? You’re crazy.” You know, I do a high dose of berberine, you know, in Phellodendron. This patient also received, you know, oil of oregano, which is, you know, quite collateral to the microbiome as well. And their Proteobacteria, the hexa-LPS, both reduced, and their total species count actually increased. But what I wanna say here is that it, what I, my theory is that it’s about what else we’re doing in combination with berberine, and I think this is my answer to your question. As naturopaths, we are so holistic. We don’t just give them berberine. And in these studies, they are just giving berberine, or potentially, in one control group, berberine with a probiotic, and comparing that. But we’re using the SIBO food roadmap.

We use a probiotic with most patients. We’re using glutamine. We’re using prebiotics. We’re often not just treating SIBO, and doing a lot of anti-inflammatory work, and using a range of different herbal liquids, or tablets with herbs, and we don’t know yet the full effect of all of these herbs. It’s not…you know, unfortunately, we don’t have all of this beautiful research on every single herb and its effect. So, I believe it’s this holistic treatment that we’re using with these SIBO patients, and it’s almost, what I’m thinking and seeing is that, like, balancing it out, right? And in the process, getting these patients to become SIBO-free, which is incredible. Like, you know, symptom-free, SIBO-free, and…

Andrew: Pretty cool.

Karly: …it’s using these therapies, but in a really safe and educated way. And I think that’s what’s important, because, you know, come back to our naturopathic principles, of “First, do no harm,” you know? But if we don’t do that microbiome testing to give us that information, if we’re wanting to use berberine, it’s like stabbing in the dark a little bit, and then…

Andrew: Yeah.

Karly: …we also don’t have that clear data, to monitor things, you know, and to go…

Andrew: Yeah.

Karly: …”Oh, actually, I did this person, you know, a really good thing,” or, “Probably shouldn’t have done that, and that’s a lesson that I can learn in clinical practice, and, you know, take away from that as well.”

Andrew: Well, look, in any clinical practice, you’re gonna have negatives. In any research, you’re gonna have those people that fail a treatment regimen. I think it’s really interesting if you’re using Phellodendron. Phellodendron isn’t just berberine. It’s kind of like people who think that coffee equals caffeine. Phellodendron also helps to decrease cortisol. What’s one of the major trigger of SIBO and IBS? Stress. You know, could we be also acting in this way so that we’re relaxing things, improving vagal tone or tonicity, innervation, and therefore aiding digestion, as a whole, hitting the microbiota in those ways? So, you know, I think, as you say, naturopaths don’t work in razor blades. We work in butter knives, by smoothing things and nourishing things. So, I think that’s one of the…

Karly: And that’s what I love so much about what we do.

Andrew: Yeah, absolutely.

Karly: You know, I just love that we don’t ever just have…you know, and when we compare that to a medication, you know, the treatment for SIBO is rifaximin, you know, and that’s just clear-cut, “Here’s your rifaximin. Off you go. That’s for your treatment of SIBO.” But as naturopaths, we just don’t treat that way, you know. Even if I was to get a patient to do rifaximin, which I have done in my practice, I would say, “Here’s rifaximin. Plus, I want you to do this, and this, with the diet. Here’s PHGG, because that increases the clinical outcome.” You know, so, again, it’s like, we’ve just got so many beautiful tools in our toolbox when it comes to these things.

Andrew: Well, like I note, the… Yeah, one of these major gastroenterologists that was using rifaximin also produced a product for which the action was actually the side effect. So, when you’d look at the common name in America… And forgive me. I’ve got this wrong, but it’s like we’d say a “conch shell.” So, it’s got that sort of name. It’s not correct, but it’s got that sort of name. Do you know what it is? It’s horse chestnut.

Karly: No. Oh, right.

Andrew: Yeah. So, what happens when you take horse chestnut without it being enteric coated? It’s a high-saponin herb. You’re gonna get a clean-out. So, it’s almost like he’s using it as a prokinetic, or at least as a clean-out. So, I guess, to follow on from there…

Andrew: Yeah. When you’re working with these patients and you’re using foods and fibres, and certain probiotics, you know, if we’re dealing with SIBO, we’ve got something about a component, which is the breakdown of the MMC, the migrating motor complex. So, can you talk to us about what do you use as prokinetics? What do you use as binders, for those people that might have an overgrowth of the archaea and things? How do you manage things like excessive wind and bloating, like you spoke of? Do we use things like charcoal? Sorry. I’ve got 30 questions, Karly. We could talk for days on this.

Karly: I know, I know. There’s just, it’s never-ending, is it? It’s a huge world. Yes. The migrating motor complex and prokinetics are absolutely essential for SIBO, and for most patients need it throughout their entire treatment. And as that will kind of be something that should be kept there as post, you know, maintenance treatment for these patients. But it really depends on, you know, I think at least three months post-treatment, keeping them on a prokinetic is really important. And then you can kind of test the waters a little bit, bring them off that, and just test their own, see if they’ve actually got that ability to get that functioning properly. But, in some patients, there’s that whole autoimmune cascade, that’s occurring with the CdtB, and the vinculin antibodies and stuff like that. And that is almost potentially causing long-term issues with these patients, so they may need to take a prokinetic ongoing. And, you know, it’s really hard to work that out, so you’ve gotta kind of monitor your patient really closely.

But I love ginger. Ginger is my favorite prokinetic. And minimum 100, oh, sorry, 1000 milligrams daily is needed to get that beautiful migrating motor complex action. And you can do this supplemental, but getting your patients to, you know, consume ginger, putting it in smoothies in there… Yes. In their teas, but, like, making it strong, you know, and I think it really depends on the patient, because some people can’t tolerate ginger, so you’ve gotta work with them there. But it’s so amazing. Go, Andrew. I love it.

Andrew: Forgive me. For our, sorry to interrupt, for our listeners that can’t see me, I’m interrupting Karly here. I’ve got a ginger and lemon tea, and it’s not one tea bag. It’s multiple.

Karly: Massively distracting me with your tea. Good. You’re really encouraging that migrating motor complex today. Hopefully, you do a really good poo this afternoon after all of that.

Andrew: It actually ties in, sorry to interrupt again, Karly, it actually ties in with a… I did an Instagram post from a story that I did years ago, and it was the use of ginger. And it was ginger talking to our gut microbiota, in…sorry, the genes of ginger, talking to the gut microbiota genes, which then talk to us. So, it’s this cascade. The ginger doesn’t talk to us directly. It’s really interesting stuff. But I love what you’re saying. So, yeah.

Karly: I’ll have to go and Now I’m curious.

Andrew: Yeah. So, forgive me. Carry on, because I interrupted, and it’s really important stuff. Migrating motor complex. What else can we use?

Karly: I also really like iberogast, or making a, like, using herbs that are, you know, supporting the… You can make your own version of iberogast, I suppose, you know, with your herbal dispensary, with, you know, Oregon grape and scutellaria, and herbs like that. But iberogast is so easily accessible, and can be really great as a prokinetic as well, but even the lifestyle stuff, so, like, making sure patients aren’t snacking, and that they’re having an eating window, like, trying to have three main meals a day, and allowing four to five hours between their meals, so that the digestive system can rest and digest, and clear out, rather than it constantly just trying to process food 24/7. And you’ll find that SIBO and IBS people love to snack. It’s just this thing that I have noticed in these people, because, it’s almost like the bacteria are just like, “Give me sugar. Give me carbs. I’m always hungry.” And once you start to clear and rebalance what’s going on in the gut, their cravings will reduce. But it’s such an important thing that we need to be doing for the migrating motor complex as well.

Andrew: Anything that you could help our listeners, our viewers to use as an interjection, if you like, to stop those cravings? Can we use things like, perhaps… I mean, I’m thinking West here. What about collagen? What about bulking fibres? What about xylitol?

Karly: Yeah, the way I deal with this in our patients is educating them about cravings. Is this an emotional craving? Is this a, “I’m actually hungry,” and my metabolism is quicker? And if they do have that, “I’m one of these people,” right, “if you asked me to fast for four to five hours, I’d be a space cadet. Okay? And that’s just, my metabolism naturally functions quickly, and I need more food.” And so, you can work that out with the patient. But also educating them about what actually is a balanced, nutritional, high-quality meal, because if you’re going to only allow them to have these three meals a day, so many people don’t understand, you know, the simple things that we do as naturopaths and nutritionists about how much protein, how many carbs, you know, how much fat? And get them to send you photos for a week, of their meals, without you even saying anything, and then come in and help them restructure what they’re actually putting on their plate, to make them feel full, and to actually get them to last that amount of time. And if they’re not, and you know that that’s actually, well, that’s actually a very adequate meal, and they shouldn’t be needing to snack, that’s when you can go, “Okay, well, you may just have a naturally fast metabolism, and therefore we might need to adjust that,” and treat the individual sitting in front of you. But there. That’s kind of how I approach that.

Andrew: I love your work, seriously. I need to get you back on if we can. I know you’re going away to have a baby. Perhaps after you’ve had your…

Karly: 2024, I’ll come back.

Andrew: …new addition to your family, we can get you back. Yeah, but just before we go, things like binders. You know, simply, some people use charcoal tablets. On a more, a naturopathic, holistic level, if you like, we use the zeolites, the… And forgive the one, it’s got a longer name, or whatever.

Karly: zeolite or something?

Andrew: But how… Zeolites is a group, and one of them is… Anyway. How often do you use these, and are there any cautions with regards to binding to nutrients, not just what you don’t want?

Karly: To be honest with you, I used to use them a lot heavier in practice with… I’m kind of moving away from them a little bit, because I believe that even a beautiful herb like… Oh, sorry. Not Proteobacteria, pomegranate, which you can use for Proteobacteria, can be really useful for that action. And often, we go for pomegranate with a lot of these patients. So, I love pomegranate as a treatment therapy for what… I hate the word dysbiosis, but it’s, like, that’s what everyone knows what I’m talking about. But, you know, an imbalance to the microbiome. And NAC is another one, but we just have to be very careful there, because if there’s any hydrogen sulfide-producing species, it’s not necessarily good there. So, that’s, again, another really great reason why microbiome testing for all SIBO patients is important, because, yeah, you just wouldn’t touch that, if you’re, you know, seeing things like Desulfovibrio in the microbiome, plus a positive SIBO test, for example.

Andrew: Yeah, sure. Can I ask, with pomegranate, before we go, what form?

Karly: So, we tend to do the rind and the husk, in tablet, or, we love liquid. We have our own kind of SIBO blends that we go to for different types of presentations. But, yeah, even just, there is some really great, simple products available, with just pomegranate in them as well.

Andrew: I love your work. This is so enlightening. I’ve got a page full of notes.

Karly: food is medicine. Like, food is medicine, so

Andrew: I love it.

Karly: …so, I didn’t even talk about pomegranate, like, you know, in stage one, when we’re talking about the SIBO food roadmap, the biggest and the best thing, and the thing I love most about what I’ve created is pomegranate, you know, is, in stage one of the SIBO food roadmap, and we educate them, right from the start, about pomegranate. And, you know, we’ve had a recent patient start on it, and in the first two weeks of her doing the SIBO food roadmap, she increased her consumption of different foods. So, she ate 35 new foods, in two weeks of being on the SIBO food roadmap. She tried pomegranate for the first time in her life. And just, like, the things that she was sharing with us, I was just, like, “I think I can stop practicing. I feel like my life has been made,” you know, to have reached this point in my practice.

Andrew: That’s somebody who truly embraces Wow.

Karly: You just go, “Oh, my gosh.” Like, coming from this way that I used to practice, where I would just hear them going, “Oh, this is so hard, and this is really… I miss these foods.” And now they’re just feeling empowered to try new foods, and to add things in, rather than exclude them. It’s just… Yeah, I can’t even describe the feeling. It’s just, it’s awesome.

Andrew: Karly Raven, you are one of those practitioners that has learned through hard lessons, and you have now passed that care, you use that to care for others. It’s just, it’s plainly obvious. Like, I thank you so much for enlightening us today, but there is so much more we have to delve into. Like, seriously. This is, ah, this is a three-day seminar. But your work, like, I also love what you’re doing about challenging yourself. Is what I’m seeing really what’s happening, or am I being beguiled by what I’d like to see, in that we often get caught up in this. And it’s very challenging for a clinician to say, “Let’s gather the data, and let the data talk to us.” It’s very, very challenging for many clinicians to do what’s called a clinical audit. So, well done to you, on an ethical basis, not just patient basis, for having the guts to do that. Oh, here, sorry about the word, “having the guts to do that.”

Karly: No pun intended.

Andrew: I didn’t even mean to do it, but. You’ve done well.

Karly: I love it.

Andrew: I just, I admire you. I so admire you.

Karly: Thank you.

Andrew: Well done to you. And thank you for sharing your way of doing things. So, sorry, last thing. So, it’s called the… Now, hang on. The SIBO food roadmap?

Karly: Correct.

Andrew: Is that what it’s called?

Karly: Yep.

Andrew: Can practitioners access that?

Karly: Yes. So, you have to become certified to use it in practice, and patients can’t just download it off the internet, off our website. So, they can only access it through us, as naturopaths and nutritionists. And I’m doing that so that we can stay true to the philosophy. And it’s not just the diet that is going to, you know, create this epic change in our patients, and I really want practitioners to be using this diet appropriately. So, continue to see the outcomes that I’m seeing in my practice. So, yes. You do have to do the training…

Andrew: Love it.

Karly: …through me, and then become certified. And there’s ongoing support, through a Facebook group and things like that, for praccies, to keep asking questions and things like that, and stay connected and updated. So, yeah.

Andrew: I think it would be a fabulous thing, once practitioners do become certified and start collecting their own data, you’ll get a multi-center data collection point. That would be really interesting.

Karly: Yeah.

Andrew: Karly Raven, thank you. Thank you.

Karly: Yes. I have

Andrew: Thank you for taking us through this. Yeah. Really exciting stuff.

Karly: Thank you so much, Andrew. It’s been a pleasure.

Andrew: And thank you, everyone, for joining us today. Forgive us that little tête-à-tête at the end there. I’m just really excited about this. Remember, you can catch up on all the other podcasts and the show notes for today’s podcast on the Designs for Health website. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”