Could Herbicides be Causing SIBO and Gluten Sensitivity with Dr. Greg Nigh

Dr. Nigh explains how and why glyphosate could be one of the causes of SIBO.  Glyphosate has a way of interrupting the body’s natural process of converting sulfur into sulfate. The body adapts by calling on bacteria to do the job which can lead to an overgrowth of bacteria otherwise known as SIBO.

We touch on gluten sensitivity and the Europe phenomenon – why some people find it easier to consume gluten in Europe than here in the states. We also discuss sulfur sensitivity as a cause of inflammation and digestive distress.  Many healthy foods contain sulfur so while it may be counterintuitive to remove them from your diet, the bottom line is … if you are symptomatic, it’s worth trying a low-sulfur diet for a week to see if you notice an improvement.

Episode Intro

Dr. Michael Ruscio, DC: Hey everyone, welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I’m here with Dr. Greg Nigh who we referenced previously. I should say, Heidi Turner referenced Dr. Nigh when we were doing the podcast from several months ago on a multitude of topics, one of which was sulfur. Admittedly, when we were doing some research (Heidi and I put together a low sulfur diet) it was much of Greg’s work that we were cross-referencing because he’s been pretty active in this area of sulfur and low sulfur dieting and sulfation and detox. So this has been a conversation I have been looking forward to for a while. Greg, welcome to the show and excited to jump in.

Dr. Greg Nigh: Yeah, thanks so much for having me. I’m excited to be talking with you.

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DrMR: Can you tell people just in brief about your background before we get going?

DrGN: Oh, sure. Yeah. I’m a naturopathic doctor and acupuncturist. I graduated from the college here in Portland in 2001 and have pretty much been in practice since then. My predominant clinical focus is in cancer treatment. I do a very aggressive kind of alternative and complementary cancer program, but then at least 30%, 40% of my practice is also doing SIBO and mold and lime and all that stuff.

DrMR: There are a couple things on the board today, and I’m curious to see how we’re gonna kind of navigate these. We were talking before we started the recording about glyphosate being one item that influences sulfur sensitivity. Let me start with just establishing a couple pillars for people and then if you want to add any kind of clarifying information before we launch in. One of the things that I was noticing was some patients clearly did better on a higher carb diet that was maybe a little bit lower in protein, a little bit lower in vegetables, and ironically higher in things like grains that we’re oftentimes told aren’t supposed to be “good for you.”

I really made some strong connections when I was first made aware of the low sulfur diet because that seemed to tie in with and really represent what this subset of patients that did better on this higher carb, lower vegetable, lower protein approach. It looked very similar to a low sulfur diet. So once I had an official kind of low sulfur diet to use, it’s been very enlightening in the clinic to have patients run this low sulfur test and see how there are definitely some patients who did better on this kind of lower sulfur diet. Which isn’t necessarily having to be a higher carb diet, but oftentimes relative to if you’re doing moderate lower carb Paleo diet, it’s going to be a bit higher in carbs and lower in protein and probably higher in at least starches and grains.

That really kind of opened up some avenues for me which have been fantastic. That’s just something for people to be aware of, and the glyphosates, the details of how that ties in, Greg, you can go way beyond what I can, but that does have an impact through a multitude of levels in the gut. So I guess these are the two big beacons in my mind as I launch into this conversation of trying to help people who are looking to optimize their gut health.  To figure out if sulfur or glyphosate may be the reason that they’re still bloated or they’re still brain-foggy or they’re still achy or what have you. Greg, any other things that you want to color into this picture as we’re starting to paint it here?

Sulfur Problems on the GAPS Diet

DrGN: Well, I would say, one question I get asked often, because we’re telling people to stop eating things like garlic and onions and broccoli, and people are saying, “Are you crazy? These are like super healthy foods. What are you talking about?” And the fact is, yes, they are healthy foods. It’s not like everybody has a problem with sulfur. It’s just that I think that there’s a very large unrecognized population of people who do have a problem with sulfur and they don’t realize that it’s driving their symptoms, and so it’s not an issue of whether or not garlic is a healthy food or broccoli is a healthy good. It’s whether or not you happen to not be able to process that particular component of it. Then there’s this dietary and kind of nutrient support process that we do to unlock the metabolism of sulfur so that we can get it working as cleanly as possible. I think that there limitations to even how much repair can be done, especially in some people who have some genetic stuff going on.

It’s not about these foods are good for you or these are not good for you. It’s just that it’s a metabolic issue. It’s just getting the metabolism working. I came across it, this is a story that I’ve relayed before, I work with a nutrition therapist here, Maria, and she’s trained in the GAPS diet, so she was implementing GAPS diet with lots of people. And of course, a lot of people do great on the GAPS diet. But there was a subset of people who were not doing well at all on the GAPS diet.

They would say that they’re detoxing, but it would just go on and on and on. It so happened that Maria was in the room one time when I was having a conversation with a researcher who’s done a lot of work in this area, Stephanie Seneff, who has written a lot about sulfur and glyphosate and all that stuff. I was having a conversation with Stephanie and we were talking about sulfur and the ways that sulfur can be a problem. Maria could hear half the conversation, but she realized, wait a minute, the GAPS diet is loaded with sulfur. Maybe there’s an issue here with the sulfur for these people.

So that was the inspiration then that moved us in this direction. Oh, let’s create a low sulfur kind of a diet and figure out what kinds of the nutrient support we needed to do. That led us down the path of low sulfur by applying it with the people who weren’t doing well on GAPS. Lo and behold, those people who thought they were detoxing, they were just having a sulfur problem.

DrMR: I love that story because one of the things that I have said before is we should be careful not to just make a detox the excuse for a poor response to treatment.

DrGN: It’s true, and at the same time, I’ve had people who tell me they’ve been detoxing for like three years and they’re in my office and they’re fatigued and they get headaches, and they’re taking garlic supplements and lipoic acid and NAC and they’re taking all these detox products and thinking that they’re detoxing. They just couldn’t handle the sulfur, and so we’d get them away from the sulfur and it’s like it all clears up.

DrMR: I’ll just share my observation with this because I have a degree of sulfur sensitivity, or maybe that’s too extreme of a label, but I do notice that if I eat a lot of sulfur that the two things I notice are a bit of brain fog afterward, maybe 30 minutes afterward, and then the next day, I’ll have joint pain. How I first pieced this together was when I was more so doing kind of a lower carb Paleo diet, a couple times I observed when I would have whatever the piece of meat was, let’s say it’s a piece of salmon, plus I would have a big serving of cauliflower and a big serving of asparagus, and then the next day I was saying, “God, why is my lower back tight? Why do I feel so tight?”

I’m not talking about a muscle tightness like you had a workout. You just feel like there’s some kind of inflammatory tightness in your joints. It doesn’t feel right. This is what I noticed, and I always take a mental note when I feel like that. What did I do and have and eat the day before? It took me a few times to correlate this together, but for some reason, and the reason is really sulfur, but those foods together for my system were just overloading my sulfur detox capacity and as long as I don’t do that or something akin to that, I never really have that problem. So it’s even something that I’ve suffered from, but to your point, the general point of thinking that these foods are always healthy or the high sulfur supplements are healthy, it’s not that it’s good or bad, but we just want to make sure that we get the right person eating the right diet or taking the right supplements so that they can not encumber themselves with these symptoms that they can’t figure out where they’re coming from.

Sulfur in Generally Healthy Foods

DrGN: Right, and I think the fact that we now have these sulfur-dense vegetables year-round and that didn’t use to be, and not only is it accessible year-round, but we’re cramming our smoothies full of kale and there’s just so much that we’re taking in now. And there are only a few enzyme pathways to clear it, and I think we just overload these pathways in many ways. Then on top of just the overload, there are lots of ways that these enzymes get clogged even if we’re not eating too much, the enzymes can shut down and we build up hydrogen sulfide and sulfite which are very symptomatic.

DrMR: Right, and again, sulfur isn’t necessarily a bad thing, but many foods that we would stereotype as being healthy are fairly high in sulfur, so just to name a few: asparagus, broccoli, cabbage, cauliflower, garlic, onions. If you’re eating a lot of these and you’re having symptoms, you may want to try a low sulfur diet, and we’ll put a link in here to a low sulfur diet, and the way I’ve been using this in the clinic is just having people do a one week trial on low sulfur and see if they improve. I’m not talking about something so subtle that you’re not even sure if it actually happened. I think you should clearly be able to say, “Yeah, I’m feeling better,” then you may want to design into your diet a little bit of a lower sulfur intake. Greg, would you say that’s a decent way for people to start? Would you modify that at all?

DrGN: No. The bummer is that there’s not a test that you can do to find out if it’s … It’s exactly what you said. You gotta do the process which is to lower the inflow and speed the outflow. We have people do it for two weeks. I think most people know by the end of one week and usually, just like you said, it’s dramatic. People have to say, “Well, I think maybe,” then that’s probably not a sulfur issue. It’s typically people, sometimes they feel like hell for the first three or four days and then it’s like the cloud parts and the sun shines and suddenly they can think and they have good energy and it’s a dramatic change, so yeah, I agree.

DrMR: When I reflected on this, I think there was probably a number of years where I was wondering, “Why do I periodically feel a bit foggy and tired?” and I think it was because I had this really kind of Paleo-biased dietary philosophy that I was using when I was younger, and there was probably just periods where I was eating way too many vegetables. But the whole things was gotta eat your vegetables and a lot of the ones that I would eat would be all of the high sulfur vegetables because they’re really easy to prepare, right? I was just really eating steamed kale and cauliflower, so I definitely think this is something that people can get a lot out of it if they pin this down.

How Glyphosate and SIBO Tie-in

DrMR: Greg, how do SIBO and glyphosate tie into this picture?

DrGN: Oh, gosh. Let’s start with this recognition. That the body has to have constant access to sulfate, SO4, so all of our connective tissue is heavily sulfurated. All of our collagen, all of our cells are lined with heparin sulfate. Our linings have heparin sulfate linings. We have to have a constant supply of sulfate. Now, we’re not eating dietary sulfate. We’re eating sulfur in various other forms. There’s a little bit of sulfate, but it’s trivial. Mostly, we’re eating other kinds of sulfur and it has to make its way to sulfate, and there are various enzymes that have to come into play in order to make that transformation happen. So if anything gets in the way to interfere with this flow from dietary sulfur all the way to sulfate.

All of our steroid hormones are sulfated, melatonin’s sulfated, vitamin D is sulfated, vitamin C is sulfated, connective tissue is sulfation. Plus, phase II detox sulfation there. So if anything interferes with that, then our body has to come up with a way around that. We have to come up with a workaround in order to generate sulfate if the normal pathways aren’t there.

My belief is that SIBO is predominantly an adaption. People grow bacteria that will fix sulfur, and this is not just one particular desulfovibrio which is the family that has it built into the name that, yes, those are sulfur fixers, but many kinds of bacteria will fix sulfur: Klebsiella, H. pylori, and lots of different types of bacteria can fix sulfur, and by fix sulfur, what we’re saying is that they will take dietary sulfur and they generate hydrogen sulfide.

Hydrogen sulfide in this context is the unfortunate fix to the problem because hydrogen sulfide can be oxidized up to sulfide and then that gets transformed via sulfide oxidase into sulfate. Now, all of that happens out in the periphery. It doesn’t have to happen in the gut and the liver, so if you can distribute hydrogen sulfide which is a gasotransmitter and it will diffuse from the gut into the blood, you can distribute that systemically and then sulfate can be created out where it’s needed.

My thought is that SIBO is predominantly an adaption and that strategies that focus on killing the bacteria are going to fail because those bacteria are just gonna keep coming back because they’re there to fix a problem. We have to fix what’s caused the problem in the first place, and so that brings us over to glyphosate. Glyphosate is so crazy insidious. It’s like if a team of scientists got together to try to create a molecule that would wreak the most havoc, just one molecule that could do as many bad things as possible, that’s kind of what glyphosate is.

What is Glyphosate?

The reason for that is that glyphosate is a glycine analog, an amino acid glycine. Glyphosate looks a whole lot like glycine except it’s got this phosphate group stuck on to it. So, if the body might think that glyphosate is actually glycine, then we have a big problem. The fact is, we have multiple lines of evidence that tell us that, yes, that’s exactly what happens. Our bodies will treat glyphosate like glycine. We know that glyphosate is transported by glycine transporters. Every amino acid has its own unique transporter, and the glycine transporter will transport glyphosate. It does that across the placenta or does that across the mucous membrane, so that’s a big problem.

We know that in animal models that radio-labeled glyphosate gets incorporated into muscle tissue, and that’s happening because it’s become, it’s being treated like glycine. There’s other evidence as well. The point is that this is astoundingly problematic, because if we just focus our attention on sulfur and how that might mess up sulfur. There are some key enzymes that are involved in, heparan sulfate, which is kind of a very important way that sulfate gets packaged up within this molecule heparan sulfate. There are enzymes involved in producing heparan sulfate and other enzymes involved in just trafficking sulfate around.

When you look at the structure, you look at the amino acid structure, how they line up in these enzymes, they all have glycine residues that are highly conserved. Not to get too geeky about all this, but to call a glycine highly conserved means that glycine in that position is there in essentially every animal species that has that enzyme, there’s a glycine in that position. Which means that it’s critical for the function of that enzyme.

If you replace one of these highly conserved glycines with anything else, you either dramatically reduce or you shut down the activity of that enzyme. So these highly conserved glycines are found in all of the enzymes that are involved in the appropriate production and passing around of sulfate. There are these enzymes called sulfurtransferase or SULT, and they are attaching sulfates to all kinds of molecules. In the liver, they attach it to the steroid hormones. Any time you’ve got to attach a sulfate to something, you’ve got to use one of these sulfurtransferase enzymes. Those enzymes have multiple highly conserved glycine residues in them. You substitute any of those residues, and you dramatically reduce the activity of those enzymes. That’s an enormous problem. That’s one place that glyphosate can insert its hand into that sulfate trafficking. There are so many others.

I don’t want to beat you blind by going into all of them, but the key is that, keeping in mind that glyphosate has been shown to have negative effects at levels of parts per trillion. Now, for instance, in the US food supply, you could have up to 30 parts per billion on oats, and they can still be sold commercially. In orders of magnitude higher concentration of glyphosate is allowed on food. Oat is not even the highest. You can have 200 parts per million that are allowed on food.

DrMR: Let’s define that for people just in case they haven’t heard the term glyphosate before. Let’s tell them what foods it’s used in, and then maybe later we can go into some avoidance strategies.

Where is Glyphosate Present?

DrGN: Glyphosate is, of course, it’s the main ingredient in Roundup and now a whole class of what are called glyphosate-based herbicides. They’re used widely in the US, just gargantuan amounts, it’s over 60 Olympic sized swimming pools of glyphosate are applied every year in the United States. It’s just an enormous amount. It’s applied to essentially all commercial crops. In fact, it’s not even used solely as an herbicide. It’s also used as … I forget the name of it. They use it right at the end. They saturate crops with it in order to hasten the ripening, speed the maturation of the crop.

It’s used, essentially, across the board, any place that an herbicide is used in agriculture, then glyphosate will be used. The FDA has established allowable residue, which seems fairly arbitrary on the different foods. Spearmint leaves, you can have 200 parts per million. Oats, you get 30 parts per million. It’s just a little bit arbitrary.

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DrMR: Is it so widely used now that it’s fair to say that the majority of crops, if they’re not organic I’m assuming, are going to be exposed to glyphosate?

DrGN: Yeah. Corn and soybean and yeah, it’s all sprayed with that. In fact, they’ve done studies where they have looked at the amount of glyphosate being excreted in populations of people, and people who eat diets of food grown conventionally have significantly higher levels than people who eat predominantly organic. What’s noteworthy is that even the people who eat predominantly organic food still have glyphosate coming out.

Keep in mind, glyphosate, what we are measuring in the urine may or may not represent the glyphosate load of the body. Glyphosate, we know in animal studies, glyphosate is stored in muscle and in lungs and in spleen and liver and intestine. It’s stored in this tissue. In fact, maybe the most ominous, it’s stored in the bone marrow. To simply test as having no glyphosate doesn’t necessarily mean that there’s no glyphosate. It only means that it’s not coming out anymore. We don’t really have any way to know if it’s stored in these other places, and, if so, what are the consequences in that tissue.

DrMR: Gotcha. Glyphosate, fairly prevalent. If you’re eating organic, you’re greatly reducing your exposure. Do you feel that that’s correct? We can’t say fully because of transmission from organic to non-organic yields and how everything molds together, but you would say that you’re significantly reducing your exposure if you’re eating organic?

DrGN: Oh, absolutely. I mean, it’s imperative to eat organic, yeah.

DrMR: If you’re not eating organic, then you have this potential series of events occurring where the glyphosate is interfering with your body’s ability to process sulfur into sulfite, and you can then have an overgrowth of SIBO as an adaptation of trying to kind of recruit more of these bacteria that can do what your body would have done if you weren’t being exposed to the glyphosate? Is that a correct alliteration?

Treatment

DrGN: That is correct, yeah. One of the therapies that I have people do all the time is Epsom salt baths. You got to use a lot of Epsom salt, four cups, and I have people do it every night for seven nights in a row, put four cups in hot water, soak for 20 minutes, seven nights in a row. Then after that about two or three times a week. Of course, Epsom salt is magnesium sulfate, so that is a way, we know that the sulfate of Epsom salt gets into the bloodstream, so it’s supplying sulfate to the bloodstream, but it doesn’t have to go down the tube and bump into those bacteria. It has been shocking to me how many people with significant digestive problems have a dramatic improvement in their digestion by doing Epsom salt baths.

Now, to me that would make sense, because if that dysbiosis is actually there to provide a form of sulfate to the body, then Epsom salt baths are a way of supplying sulfate, and you don’t need the bacteria to do as much, and so the bugs can kind of go away on their own. There are all kinds of other things that we do to help those bugs to go away, but, nevertheless, even something as simple as Epsom salt baths can be quite dramatically beneficial for people with dysbiosis like that.

DrMR: Greg, do you know of a good study or two that has documented the glyphosate showing up in urine in those eating non-organic food?

DrGN: Yes, I do.

DrMR: Would you mind pinging me after. I’m just asking because I know people are going to ask, so if we could include a link in the notes. I don’t want to put you on the spot and ask you for the year and the journal right now.

DrGN: I know I have it in my head, but, yes, I will absolutely get that to you, and you can make it available.

DrMR: Awesome. Thank you. How do you recommend people treat this? I’m assuming a low-sulfur diet is one option, and eating organic is another, and that will probably work well for people who are the least sensitive, but then you get into the population of people who may be a bit harder to get things working again. What do you recommend in terms of treatment strategies?

DrGN: It’s really as simple as you said. We have people follow a low-sulfur diet, and we try to bring the just sulfur exposure down to a minimum. While we keep the sulfur exposure low, we are doing various kinds of therapies that help to clear out sulfur. Lots of people are on molybdenum, but there’s only one form that we found really works well, and that’s by the company Biotics. They make one called Mo-Zyme Forte. We have people taking Mo-Zyme. You have them chew it up rather than swallowing the tablets, they need to chew it up because it works better that way. They take that twice a day with a meal.

There are a number of other kinds of therapies that come into play that sort of depend on the symptoms that people have. I do a lot of genetics. I have people do 23andMe, and then I run it through some databases and do genetic reporting for people. When people have the gene that suggests they’re going to have more of a sulfur problem than somebody else, things like flaxseed powder, which will help to slow down the CBS enzyme and thus lower hydrogen sulfide production. We’ll use that, or Korean Red Ginseng will do the same thing, and so that, especially when people have fatigue or brain fog as a significant component, then that can be helpful. We will do injections with Vitamin B12, hydroxocobalamin, in particular because that happens to lower hydrogen sulfide systemically.

We have people, in the clinic where we have people doing infrared saunas and PEMF, pulsed electromagnetic field therapy. We do lots of IV therapy, where we can supply lots of nutrients around these issues, and ozone therapy, ultraviolet blood irradiation, all these things. It’s a big, robust package of things to help people get their detox stuff going and supplying the nutrients. It’s an intensive process for most people.

DrMR: One thing, just to interject quickly, that I want to point out to people is, there’s definitely this thinking that everyone needs to be taking methylated B vitamins. That can cut in an unwanted direction when you’re sulfur sensitive, right?

DrGN: The answer is yes, and it’s often difficult to know in advance which people are going to have a problem. I generally, 90 percent of the time, I give hydroxocobalamin. I’m not using methylcobalamin. Now, hydroxo is very challenging to find it as a supplement retail. Again, Biotics has a product called B12-2000, which has hydroxocobalamin and folinic acid and a little bit of B6 in there. That’s the one that we supplement people with. But when we’re doing injections, I’m almost universally using hydroxo, because people, you don’t know if they’re going to have a methylation issue, and you’re pretty much going to be safe if you use that form.

DrMR: There’s a few options there. The foundation is dietary. Flaxseed powder, Korean Red Ginseng, hydroxocobalamin, Epsom salt baths, sauna, maybe some post-EMF. What about this compound known as Restore, which is supposed to protect the gut against some of the negative impacts from glyphosate?

DrGN: I’m curious about it. It makes really cool claims like it’ll lower Zonulin, which is great. That is a good thing. Zonulin drives leaky gut in many ways, and so it says it can lower Zonulin. It says that it can bind glyphosate. These are studies that have just been done by the company.

DrMR: My same reservation, yeah.

DrGN: Yeah, and they’re in vitro studies, which it’s fine. You’ve got to start somewhere. I’m not dissing it for that reason. In talking to people, now there’s a number of people who have been taking it, and I would say a few of them have described it as life-changing. A majority have described it as, “Yeah, maybe, I think it might be helping,” which is, again, if any product can have a 20 percent home-run, then that’s great. That’s a good product. I’m not dissing it by saying it doesn’t help everybody, but I am curious about it. In fact, we’ve recently ordered some that I’ll be having more patients use because if it’s a valuable component or maybe there’s a subset of people that it’s really going to work better for and I need to tease all that out.

DrMR: Well, I think that’s actually a very nice commentary on Restore and those are the exact things that make me open and curious, but also a little bit tenuous until a little more data is in, which it wouldn’t be hard, as I’ve said before, to put together a retrospective chart review and to start getting some interventional human data. Hopefully, they’ll do that soon. I am open, but I also, I’m sure you can relate to this, every few months there’s a new wonder supplement that comes and goes. And so I try not to get too quickly sucked onto the bandwagon.

DrGN: Right. And to make a claim it can help the detox of glyphosate, which is awesome, we desperately need those kinds of products, but the problem is, how do we know that given that it could be in the bone marrow? It’s not like we’re doing biopsies to find out if we’ve got the glyphosate.

Europe and Glyphosate

DrMR: Sure. One other question I wanted to ask you was, what are your thoughts on the disparity or the differences in glyphosate use in the US compared to Europe, and how do you feel that pertains to the anecdotal report that you’ll often hear? Which is, well, I don’t do well with gluten, but when I went to Europe on vacation or whatever for this conference, I had some gluten and it didn’t affect me that negatively.

Just the piece I want to paint here is I suspect there may be a degree of that that’s attributed to glyphosate, but I also wonder if some of these people aren’t actually that gluten sensitive, but they have been kind of indoctrinated into thinking that they are and they finally do their reintroduction in Europe. And so some people may be, I guess it’s a placebo or noticing themselves to thinking that are sensitive when they’re not. And the other I wonder about is, if they’re oftentimes on vacation and they’re having fun and they’re not working and they’re essentially getting enough sleep, that they will probably be more tolerant to these foods than not.

So these could all be factors, but I kind of wait some of the potential, “I’m less reactive to gluten in Europe” with some of those other caveats in there. But what are your thoughts on that whole issue?

DrGN: Well, I agree with all of that. Same as you, I have had multiple patients tell me that they can eat basically whatever they want when they are vacationing in Europe. And I think something is dramatically different about the food. I agree that being on vacation and being relaxed is beneficial, but to be highly reactive to gluten and be able to eat pasta as you want, something is dramatically different there.

And at least in the last three to four years especially, there has been a much more significant effort to curtail the use of glyphosate in Europe than has been in the United States. So I do think that that could be playing a significant role. One of those critical glycine molecules that glyphosate can replace, we know that it can replace it, it’s the enzyme trypsin, which is crucial for functional digestion.

So trypsin gets converted from trypsinogen, which is inactive, and it gets converted to trypsin and in that conversion, it has these arms and these two arms pivot around a central glycine molecule. And if you switch that glycine molecule for anything else, it will either completely stop the function or it will dramatically reduce it. It’s known that that glycine will get replaced by glyphosate.

So it is kind of mind-boggling when you think what the impact will be, not just on digestion, like you can’t break down any protein. It’s going to need trypsin to get it broken down, but in fact, that glycine hinge is true for all searing proteases, which those are throughout the body in all kinds of ways. But anyway, if we just limit ourselves to the impact that it would have on digestion, not only trypsin and chymotrypsin would get impacted, but also keeping in mind that bile salts get conjugated with either taurine or glycine. And again, glycine, if you substitute with glyphosate there, it just goes on and on all the ways that impact digestion.

Testing

DrMR: Coming back to testing for a minute. We recently had Nirala Jacobi on the podcast and she shared with us what were her thoughts on certain bacteria that are sulfur reducing. If you find those, stool testing that could be diagnostic of hydrogen sulfide SIBO because there’s not really an officially sanctioned test for hydrogen sulfide SIBO. It’s coming. I think the best we have is a research center only available breath test, but perhaps through the stool looking for certain organisms, there could be something there. And for the audience, we’re researching some of this now and so we do plan on reporting back once we’ve had a chance to kind of cull through the data. But Greg, I’m wondering what your thoughts are on that.

DrGN: You know, I don’t think about it too much. I don’t rely on testing very much. Ultimately, it doesn’t matter to me what a test says. If somebody fits the picture of a sulfur problem, I’m just going to put them through the process and see what happens. It’s like that’s the test.

DrMR: No, I agree with you completely because a lot of these things, if you’re using a test to justify a treatment anyway and the treatment is minimally invasive and not very expensive, it just seems logical to skip to the treatment, especially when a lot of these tests, and this is something that I don’t think we appreciate enough in functional medicine, a lot of these tests haven’t been tightly correlated to predict response to treatments. They’re more so just inferences. So it’s not to say just because you’ve seen results on XYZ test that you’re guaranteed to respond well to a given treatment in many cases.

I want to come back to the gene testing. This is one of the things that I’ve been thinking about, which is, does it make sense to potentially run a genic analysis, look for some of these associations to sulfur detoxification, or would it be easier just to run the one or two-week low sulfur diet trial? If you see improvement from that, but only partial, then go to trying to custom construct a supplement program for them? So how are using the testing to kind of enhance that process?

DrGN: I think that genetics get way overplayed, ultimately. In particular with sulfur, I have patients who come in as though their disease is that they have a CBS mutation.

DrMR: Yes. Thank you for saying that. And I think that’s a big problem.

DrGN: I think it’s a wrong way of orienting toward this stuff. I have seen many patients with their train wreck on their sulfur genes and they’re fine. They don’t really have anything going on and vice versa. We’re not talking about big genetic rearrangements here. We’re talking about polymorphisms which push metabolism in one way or another and sometimes in significant ways, but they’re still just single nucleotide polymorphisms that rarely have profound impacts.

I think CBS itself has been way overplayed. I think that there are other genes that are much more relevant to sulfur metabolism then CBS is. I look at CBS. It’s interesting. And in the context of some of these others, I think it becomes a more prominent issue. But I definitely am not in the camp that would say that we can design either a dietary or nutrient program just based on what genes are doing. They just give us a little more info.

DrMR: Okay. And then I’ve just got one or two more questions for you. I know you’ve got another appointment here coming up soon.

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How does this look clinically? I’m asking this question for the clinicians who perhaps are a bit new to this but they’re wanting to venture into the territory. What I’m most curious about is for a patient who does go on a low sulfur diet, does notice that they feel better, but perhaps they need more than that. Then we’re going to undergo some strategies both to limit sulfur intake dietarily, like you’ve just come out of that phase of low sulfur dieting, but enhanced that with using some of these supplements.

What I’m wondering is, can the clinician or the patient expect to need to be on supplements forever? Is it a shorter course? Is one supplement usually enough? Is someone usually in need of a few different supplements? How does this kind of play out so someone would know if they’re on the right track or if they’re just really kind of missing the mark? I understand it’s kind of hard question.

DrGN: I would say it’s hard because everyone, it’s just a spectrum. I have people who will get a migraine headache if there’s even a whisper of garlic. They will immediately get a headache or fatigue or something. Now, those are super sensitive people.

DrMR: With that type of person, because I’m sure every clinician here is perking up because I think we all see a small number of people who are highly sensitive maybe to garlic or onion. Do you find that you could preempt that reaction with giving them some hydroxocobalamin ahead of time?

DrGN: I think potentially so. Yeah, I do think that it’s possible to hedge your bets and get somebody in a position where you may not get rid of their intolerance, but you might just change the threshold significantly. Now again, there are some people that it just seems like we can’t even budge the threshold and I think that that’s just hardwired into them.

DrMR: Does it matter, Greg, if the symptomatic manifestation, again using garlic, because I think that’s one of the more problematic, garlic, maybe onions. Does it matter if the simplest manifest dermatologically, neurologically, gastrointestinally?

DrGN: I don’t think so. I would say that the gastrointestinal tend to be the easiest to resolve. To the extent that the gastrointestinal symptoms are actually an adaptation to another problem, which is getting access to sulfate, then assuming that we have corrected that other problem, then there’s no more need for the gastrointestinal stuff to be going on. And for those people, sulfur can commonly get reintroduced in no longer cramming kale into your smoothie, but in lower amounts, it can be fine.

We’re still kind of supporting with Mo-Zyme and maybe a few other things to just, again, hedge our bets that it’s not going to cross the threshold, but for many people, they can reintroduce sulfur and it’s fine. But there’s this spectrum of reactivity that some people, it just, I don’t know what it is. It just doesn’t work that way.

DrMR: Is it fair to say that for the people who have a hard time, reintroducing garlic or onions, if someone’s having a GI flare compared to a brain fog flare, one of those, one type of symptom is more able to be remedied by the addition of something like Mo-Zyme or B12? If someone, everything’s doing better, but every time they eat garlic, they have a flare. Person A has a flare just of their digestion, they get bloated. Person B only feels brain fog. Is one of those presentations more able to be fixed by sulfur detoxifying supplements?

DrGN: Yeah, tough call. I don’t know that I have been observant enough to really differentiate that question. I do think that we have more resources at our disposal when it comes to addressing gut issues. So, I mean we use a huge amount of butyrate, which can be awesome for digestive function. We use a lot of the spore-based probiotics, the megaspore which people say, oh, I can’t with SIBO but we actually start people like half a capsule every other day sprinkled on their food and gradually build people up because you got to get those bugs back in. So yeah, I would say with gut stuff, it feels to me like I have more than I can bring to the problem than if somebody has a funky migraine or something. There’s not a broader range of things that I can use for a migraine.

Episode Wrap Up

DrMR: Gotcha. All right, my friend. Well, I know you got to get going here soon, but do you want to direct people to a website or a book or a program?

DrGN: Yeah. Certainly at the clinic website, which is immersionhealthpdx.com like the airport. And that’s, you can find out all about me and the kind of therapies that we do here. I do lots and lots of phone consulting with people all over the place. So if anybody’s interested in consults, then, of course, they can call and get on the schedule.

DrMR: Awesome. And you have a few lectures around. Are they on your website?

DrGN: Recently, I did put, there’s a page on there that has links to most of them. I’m not sure all of them, but for the most part, I think links to those are up.

DrMR: Awesome. Well, this has been a great conversation. I really appreciate you taking the time.

DrGN: I appreciate the opportunity. It’s been fun.

DrMR: Absolutely. Yeah, and stay in touch. Let me know if you do experiment with Restore and you have any interesting insights or anything else, let me know. We can always update this post and add some followup notes for people.

DrGN: Perfect. And I’ll get that article to you as well that you can make available.

DrMR: Sounds good. All right. Thank you, sir. Appreciate it.

DrGN: Uh huh. Bye-bye.

What do you think? I would like to hear your thoughts or experience with this.

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