Jessica Cox is an accredited nutritional practitioner with a Bachelor of Health Science (Nutrition) and over ten years of clinical experience. She has an immense passion for food therapy and therapeutic nutrition with a specific interest in IBS and SIBO. Rebecca and Jessica talk about how important it is to treat your SIBO with the support of a qualified practitioner, to ensure that you are getting the right treatment at each stage of your SIBO journey to recovery. They chat about how to eat for SIBO, how foods might be re-introduced and why it’s important to get help before your diet becomes too limited.
In Episode 21 of The Healthy Gut Podcast, we discuss:
✓ Why working with a qualified practitioner to identify what diet protocol will work for you during your SIBO recovery is so important
✓ How adapting your diet with your practitioner during each stage of your SIBO journey can help to alleviate symptoms and reduce inflammation
✓ What to do when everything you eat, and drink, causes a reaction
✓ Should we be using supplements in addition to food to get the nutrients/vitamins/fats etc into our bodies while treating SIBO?
✓ How to look at reintroducing foods into your diet and the positive/negative impact of long term food restriction (ie. Long term use of the Low FODMAP Diet for example)
✓ The how, why and when, around the usage of prebiotics, probiotics and fermented foods when treating SIBO
✓ How to shop for the right foods, making sure that you are including whole-foods in your diet and how to avoid too many additives and preservatives
✓ Looking at how to incorporate nutrient dense foods into the diet, and whether we need to heal the gut before our gut can absorb these nutrients effectively
Jessica is a passionate foodie and qualified, practicing Nutritionist with a Bachelor Health Science (Nutrition), with over ten years of clinical experience. Jess is the founder and business owner of the successful JCN Clinic based in Brisbane, Australia. The Jessica Cox Nutritionist Clinic (JCN Clinic) treats all facets of health conditions, though specialises with digestive issues and food intolerances.
Jess is also the creator of the Jessica Cox website and blog, which is an expression of everything she loves rolled into one, including her passion for creating recipes that catering for food intolerances. Jess is available for consultations at her clinic based in Brisbane, along with Skype and Phone consultations for national and international clients.
Contact Jess with any queries or questions at jessicacox.com.au or email [email protected] Source great food ideas and more by following Jess on: Instagram, Facebook, Twitter & Pinterest.
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Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.
REBECCA: Welcome to the show Jessica Cox. It’s really great to have you on today.
JESSICA: Thanks, thanks for having me.
REBECCA: My pleasure. I would love for you to tell my listeners a little bit about how you came to be a qualified and practicing nutritionist based in Brisbane Australia.
JESSICA: Yes, well I have been practicing for a bit over ten years now as a nutritionist. As far as how I became to be a nutritionist, I kind of came from a different background to start with. I have been working at a completely different field in arts and design and so forth but I always had these underlying really strong passion and interest in food. We grew up in a farm which was quite self-sustainable. One of those sort of stories were you kind of grow up in an environment you don’t realize is any different and then later on you go, “That was quite a different experience to have,” and I was pretty lucky. So I came from that environment. I had a mum which was pretty interested in putting food from absolute basics and baking our own bread and all of those sorts of things. So it was kind of instilled in me.
As the years ticked along I just got to a point where that passion grew more and more. I also had some of my own intolerances going on at that time that I wasn’t aware of and digestive issues. And it just accumulated in me being a lot more interested in food and how it affects the body. And again it became a turning point where I think this is something that I want to investigate further. So I started studying just part time while I was working and after 6 months of part time that was it. I was hooked. I was like, “Yep this is me, and this is what I want to do.”
So I took a leap and I went full time with my studies, stopped working. Full time in the career that I was in and just picked up some part time work and just immersed myself in nutrition and I just loved it. i think being a little bit of a mature aged student who I was very very nerdy about. I was always sitting up the front of the class and taking it all in. and I came out the other side of that and literally went straight into practice and I have been practicing ever since. I have never really had a break from practice. I just really adored the process. And I relatively would say to I have always practiced under my own name. I think I have had one year out of all of that were I worked with someone else. But essentially I worked with building my own practice and my own business. And here I am ten years later.
[2:55] REBECCA: Wonderful how exciting and congratulations on getting to 10 years. As a business owner myself it is an achievement. So well done because it isn’t easy to stay in business for yourself that long.
[3:08] JESSICA: yeah. That’s so true and then suddenly you are there and you are like “Really wow! Where did that ten years go?”
[3:17] REBECCA: One of the things that you do is you work with people with irritable bowel syndrome and also SIBO and I would love for you to share a bit of information about the kinds of people that you have coming through and who you work with?
[3:31] JESSICA: Sure. So we really build a reputation here at the JC clinic, working with gut issues in particular. So we do see a variety of clients but gut health is definitely our call. So because of that we see a lot of clients that will come through with a diagnosed IBS from a GP or they may have been through a series of gastroenterologist with different investigations as far as colonoscopies and endoscopies and so forth. And they are just at their wits end. They have been told there is nothing wrong. We definitely don’t have people coming through the door saying, “I’ve got SIBO can I be related by you.” Or, “I have this.”
It’s generally we are going through diagnostic with them as far as testing and really looking at what we need to do as far as treatment and in relation to those test results that tend to come through there. But I would say that gastrointestinal issues are very much the core of what we treat.
[4:38] REBECCA: And for those people that you do end up discovering that they’ve got SIBO what’s your approach around the nutritional component for them because that is such an important piece for people who have SIBO or IBS because food often equals symptoms. So there’s a pretty strong correlation especially a psychology one with what a person is eating and how they feel. How do you work with them around getting them to feel better and finding food or nutrition that is working for them?
[5:15] JESSICA: it’s very much a one on one process to start with. It’s very individualized. So there’s definitely and underlying protocol that we’ll utilize but I can’t stress enough how much it comes down to each person and working with their specific requirement. So if someone comes through and they have tested positive for SIBO then there is definitely a guideline or approach we will go through but often our testing to… we are looking outside of that. So we will probably have done some lower bowel testing as well. So we might also be dealing with a yeast overgrowth or parasites or disbiosis. It’s often multifactorial and how we are approaching that.
The other element is we do a lot of food intolerance testing. So often that might be involved as well. So it’s not always as simple as – Yes you have SIBO so you need to follow this particular diet and give them a list of foods to avoid and that’s it. in saying that we do tend to use that biphasic diet as a guide for our clients but ten from that we will sit down with them and we will go over the diet and we will look at extra components such as maybe food intolerance if they are prevalent. If there is disbiosis we might need to look at certain foods that we need to avoid as well. Potentially from a yeast overgrowth too that might influence what we do with our diet. So from there what we will do is we put together a really extensive dietary plan that will have lots of meals and snacks as far as options for them.
We will include recipes. We definitely don’t give people a list of what not to eat and then just say “see you later, off you go.” We are very very passionate about making sure that when we are looking at the dietary approach that they have a really good cemented guide of how to eat because otherwise we would find people get so confused and all they see is what they can’t eat. It is so so important to give them that really good foundation.
[:42] REBECCA: One of the things I hear from people a lot is just enormous confusion over what SIBO diet to follow because there is multiple of them out there. They are all slightly different to one another. Some of them are completely in opposition to each other in terms of certain foods. Some might be considered as a food to avoid and on another list it would say, “That’s fine eat it.” what would be your advice to somebody who is listening today who is perhaps feeling completely overwhelmed and doesn’t know where to start. Would your advice be to seek out the services of nutritionist or are there things that they can do themselves that might be able to help alleviate some of these stress and anxiety around what foods to eat?
[8:25] JESSICA: I Guess I know my way to getting guidance because I think that is so important to ensure you still got nutritional balance because the problem for me when you are putting any sort of restritions on a diet is that yes you can take away foods that might be aggravating but you might end up eating in a very unbalanced way and end up with a plethora of other problems. So that always is a big concern for me. But essentially I guess if someone has been diagnosed with SIBO then I would say for them to be looking at really pulling back on their starch intake looking at the FODMAP as well. And I guess looking at I know it’s online. It’s accessible for people looking at that biphasic diet as a very rough guideline and a way to start. But even if people haven’t been diagnosed they could look at playing around over a series of a couple of weeks with following even just a little bit of low starch low FODMAP dietary intake and seeing if they feel a little better. And often they notice they feel a little better and often these people will come to you in clinics saying, “I know that these foods aggravate me.” I know that if I have a lot of starch, if I have a lot of these types of my garlics and my onions and so forth, they just give me so much grief.”
They tend to tick boxes so applying those yourself can often give you a little bit of a light bulb moment like, “Aha ok this is an area that needs further investigation.” But I am very wary of people just playing around with this on their own accord. I do strongly think it needs to be under the guidance of a practitioner. I really do.
[10:21] REBECCA: I hear from people quite frequently who are down to five foods and I said on the SIBO forums online and it is really upsetting to think of people who are so limited in the food that they are able to consume now because everything else is causing a reaction and then I hear from other people saying even water now causes a reaction. I cannot consume a single thing including water without it causing a reaction. So if someone is at that point because I know that some of my listeners are, what would be your advice to them on what they can do today to try and perhaps alleviate some of that pain and aggravation that they are going through and maybe some next steps on what they could potentially do get some help that they need to reintroduce some better nutritional intake?
[11:15] JESSICA: at the core of the problem there is the gut function itself. So when you are getting someone who is so reactive to the point they are talking about having problems with water or they are down to 4 or 5 foods you have to step back and look at the bigger picture and I think the problem is when people are self-treating they get so hung up on the food itself and it is all about what can I cut out next or what am I reacting to when they don’t tend to look at the fact that they have actually a problem with their gut that needs to be treated . And once that is treated and worked with then they are not going to be so reactive overall. That to me is so so important.
I have certainly had clients, we talk about the water issue like feeling like water is reacting with them. I have had clients swear to me that they are intolerant to water which is pretty amazing or just be able to eat as you say like 3 or 4 foods. So what we tend to do there is look straight at the gut and we are looking at how can we down regulate that inflammatory reaction? How can we work with that over reactive immune system within the gut? So there we are looking at settling that inflammation down and regulating the immune system of the gut. Now from my point of view from a practice point of view to be honest I would be doing that with probably a few key supplements potentially I would be looking at some strains of probiotics to help with that increase reactivity with the immune system. Definitely some LGG. We would be looking at getting in there depending on what they can handle. We might be looking at some straight glutamine for instance. We would certainly be looking at supporting and maybe some zinc and some vitamin A, vitamin D. just definitely supporting that gastrointestinal track as much as possible.
From a food point of view again you need to really work with that client. So the problem is when that reactive and that is sort of stressed around food getting them to trial some different foods at that point can be really hard but we generally are still trying to encourage them, “Ok let’s look at bringing in to the picture still some more common low reactants. Let’s look at using foods that are broken down a little easier. We are looking at some broths or some soups or some smoothies with lots of natural anti-inflammatories in there that are really simple and easy to digest that we can use to again just really simplify that gut process well or that inflammation is settling down.”
You usually find with people… we definitely see this they’ll go through eggs and flows so they might have a period where they get that really strong flair up and with that they are getting this increase reactivity where they feel like everything they can chew is problematic. So it’s working with them through that period and really addressing it from both sides from a diet and generally as I say a supplementation form. Again that’s where a good practitioner steps in and really makes a difference because my concerns there is if someone’s going to a chemist or a health food store and just buying things off the shelf, are they getting the right thing? You know? Do they potentially think they are buying the right supplement? Or are they buying a probiotic that is dairy based? Or they might be buying something that’s got a powder that’s filled with a whole lot of prebiotics for where they are at that point may not be the best thing. So it really comes down having that right guidance.
[15:14] REBECCA: I see unfortunately reasonably frequently on some of the SIBO forums that people are self-treating. And they are reading what other people are using, other supplements an herbal antibiotics for instance that other people are using. And then they are ordering them online then they are self-medicating. And then having all sorts of variety of responses to it and I think what you are saying is really important is working with someone that has the experience and the qualification sot be able to support your health journey because my concern for some of these people is that they can make themselves worst. They can end up in a worst state because they are so restricted in food and who knows whether their supplements like you say are actually the right ones for them.
[16:02] JESSICA: that’s right exactly. It’s why I am always hesitant even just to start listing a whole lot of supplements because it might be great for one person but it may not be suited for the next. And it just depends on where you are in your journey as to what is the best supplement or what is the best approach. You may be at a point where supplements aren’t even something you should thinking about. So it really is a case by case basis.
[16:30] REBECCA: definitely. When you are working with someone that is just in such in a highly inflames state and they are reacting to everything, is there a general length of time that you see that someone can come out of that flare and start to be able to tolerate more foods or is it again a very individualized case by case scenario in terms of length of time it takes to calm down….
[16:54] JESSICA: That’s a god question. It is definitely individualized. I guess in saying that I usually would say it’s a couple of weeks. If you are working with someone from the get go, if you done say some testing and you know you’ve got SIBO at play or some other issues with disbiosis and you are starting to treat that. and you’re anywhere from 4 to 6 weeks you might see that they start to push into a place where they can introduce a little bit more variety back into their diets. So that’s a very very rough time that sometimes we will work with. But if someone is having say a flare and some clients I can think of that will get like a really strong flare and get really really reactive, generally if we get on top of that straight away within a week or two we can settle it down pretty quickly with knowing the right things to use for them and we are adjusting their diet. The interesting too I guess is a side note that I have seen is that with those types of pictures were people are super reactive generally they’ve got themselves into a place you are mentioning were they are just eating limited foods. And they are eating them all the time.
So their immune system is getting to a point where they are starting to react to those foods. Again because they are not really treating the problem as effectively. They are just cutting foods up. So after a certain amount go time this increase reactivity starts to these foods that they are now consuming. So we find treating their gut in that time of flare but also adjusting their diet. So we take them a little bit away from their safe foods and push them to some foods that maybe they have been avoiding. We actually get quite a good response because suddenly those foods….i knew that what we do there is we tend to not oversaturate them with those foods. We tend to use a variety of a few different things and really encourage our clients to have a little bit of this and a little bit of that. And really trying and get as much variety as possible. And that tends to really help with those flare situations too.
[19:17] REBECCA: Do you see with those patients that they would have some symptoms arise after trying a new food? Is that something that someone should expect if they have gone to say a five food diet?
[19:35] JESSICA: Yep for sure. So again it can vary. It sort of depends on how symptoms present themselves for people but if their symptoms are usually gastrointestinal then if you are introducing a new food and then their system isn’t quite ready for that food, they will certainly show a response whether that be heightened bloating or bowel dysregularity. Sometimes though depending on where they are at you may say, “Ok let see how these food goes for you over an introductory period of a couple of days and we might find for the first one to two days they notice a bit of bloating and gas and then after that it feels fine.
I guess a good example that would be legumes. So when you are obviously taking legumes away and they sue dietary protocols and then you reintroduce them, they quite are common fermentable foods. So we always say to people, you haven’t had legumes for quite some time. When you bring them in you do need to expect some element of gas, some element of wind. So let’s keep that in mind. For us it’s being able to differentiate between ok what’s just a new food going in and having just a little bit of a response.
“Oh this is new. This is different as opposed to what’s a full blown inflammatory reaction.” And you can usually tell that when you know your clients so well and you know these symptoms. Some people might try new food and their whole body feels inflamed or they get aches and pains and headaches. It’s usually quite severe. So you know that that’s not the right food for them. So again it’s very much about that individual.
[21:16] REBECCA: yeah definitely. One of the things that I know that can occur with people with SIBO and other gut disorders is around malnourishment. Are you seeing people coming through your clinics that are malnourished and then needing to work with them and how they can perhaps incorporate more nutrient rich foods or do they need to address the issue that is going on in their gastrointestinal system before their… it doesn’t matter how many nutrient dense foods they eat, it’s not going to be absorbed properly. What is your approach to that?
[21:50] JESSICA: I think it’s a little bit of both. It would depend on where they are at. But yeah usually if they are at such a restrictive stage then what they is usually quite a mess. So you do need to look at identifying the issue there and working with rectifying that and therefore you are encouraged in an environment where absorption is going to be better. They are going to pull more from their food, the bacteria is going to be healthier as far as fermentation and so forth. So naturally that is going to aid the process. However, even just anyone being on such a restrictive diet their nutritional intake is going to be quite poor.
So I would say getting in and making changes with their diet as much as possible is definitely a number one step for us whether… the gut will always be something we will be getting in to as well. But we would very much be focusing on.. OK we need to diversify your diet. We need to look what foods that can you can have. people don’t perhaps realize t=what they can still eat with certain dietary protocols if they have been trying to do things themselves or the other thing we commonly see is if they have been following say a list of foods. They may not know how to put those foods together to create some really different or exciting meals. So they tend to stay within the realms of what they know. So we find that if we can get in and diversify within the spectrum of foods we feel we can work with and also the other massive area we see is people aware of how to create macronutrient balanced meals. So we will see they maybe be eating a diet that is mainly say vegetable based or plant based and they are not getting enough protein. Or we may see someone that is getting protein and vegetables but they are not getting carbohydrates from the right sources that work for them and could be a fat issue that they actually putting the right building blocks together to create nourishing meals. And as a result of that there’s fatigue issues, blood sugar up and down through the day. You can see even bowel issue alone just from not having really god macronutrient balance.
So we tend to jump on that straight up. Within the first consultation we are going through giving them a better balance approach even within the restrictions that they are working with. And then we’ll go, “Ok how can we start rolling the ball in the direction of healing your gut working with maximizing your absorption.
[24:41] JESSICA: I think once again as is the case with so many of the interviews that I do through the healthy gut podcast, it’s all about having a personalized and tailored approach to your own individual needs and having a dream team of health professionals that can help you on that journey. And given that food and nutrient rich food is our life source, it makes sense to me to have someone like yourself a nutritionist or a dietician that understands conditions like SIBO working with your to really tailor the foods that you can eat so that you can enjoy them again. It feels great. We should love eating and it really saddens me that so many people are so upset and anxious around food. And I know you are the same. Food and cooking as well.
[25:35] JESSICA: that’s it. and looks like it’s such a kick out of working even with highly restrictive food plans and then taking that and helping clients till create a nourishing and delicious daily food plan like it can always be done. It’s just thinking outside the box. And I find that really rewarding. You know definitely for people to come back and be like, “It’s really delicious. I feel great and that’s really really yum!” You know like that’s what you want and that’s how you get compliance, that’s how you get people sticking with things long term. You know food needs to be beautiful as well as nourishing.
[26:19] REBECCA: It does definitely. I know one of the kicks I get out of life these days now that I have got my three SIBO cook books out in the world is hearing from people from all over the place saying, “Oh gosh thanks so much Rebecca, I now have a variety of recipes that tastes good that I really enjoy cooking. My kids now help cook them with me and I am not just eating the same foods that i have eaten for the past 6 months. I am broadening my food intake and I am really enjoying it. And I just love that. It’s why I have gone and created those cookbooks so that people be happy with their food, feel joyous around it. It should be a celebration.
[27:00] JESSICA: As you know when you are usually diagnosed like you only focus on is what you can’t eat because that’s what you know, that’s your security blanket, that’s what you always eaten. So it seems like your whole world food is just been taken away from you and at that moment and at that time it just seems so narrow. However if you have the right guidance often it’s pretty amazing how a whole new world stands out and you get this education along the way and you know how to work your flavors and there are many when we work with gut issues. We often find that majority of our clients have got a diet that is so much more diverse than the average person who may eat like an average western diet. Their dietary intakes are amazing and I always love that because if you speak to someone who is not well versed in understanding I guess intolerances and so forth, often the response is, “AH what do you eat? You must not be able to eat anything?” I say, “Well actually you’d be surprised.”
[28:16] REBECCA: Yeah I used to get that all the time. people would be like, “Oh my gosh I couldn’t do it. I couldn’t do what you do. There’s nothing left to eat.” And I would say, “Actually, I eat the most varied and broad range of foods now. I just don’t eat all the processed crap. I just eat real food, natural food in its original source. And it’s delicious. And I love it. it’s colorful. My plate is always bursting with different colors.”
The good thing that I found out for any of the listeners that don’t know where I am at in my personal journey is that since my gut has become much healthier and its much less…I don’t have SIBO now and my naturopath and I have worked on healing out the leaky gut, the motility and the movement of my gut, I can now eat foods that I couldn’t eat for years. And it’s really nice to be able to have that freedom back again. I have just come back from a long weekend with my partner’s family. I have eaten quite a lot of gluten which I don’t normally eat. But what is nice is I don’t have to be that annoying person going, “I can’t eat this and I can’t eat that.” it’s annoying to me. I’m sure it didn’t annoy everybody else but it annoyed me that I had to be restricted and I was always looking at food labels and all the rest. And now I can say ok for 4 days I am not going to worry too much about what I eat because when I come home I will be straight back into a normal life which is a really broad based diet with lots and lots of vegetables and all sorts of things and very minimal processed food. That is a really great place to be able to get to ultimately.
[29:48] JESSICA: Yeah. We do a lot of IgG and IgA food intolerance testing at the clinic and it’s fascinating seeing results come back. Some of the, so highly reactive and starting with clients from the point of those test results and gut health and working with them over this couple of months or more and then say 6 months later you look at that test result again and you start to say, “Ok let’s start bringing some of these foods back. Let’s work our way backwards through these low reactants and medium reactants,” and it’s amazing. 9 times out of 10 these people are able to bring majority of these foods back into their diet because you have addressed underlying cause. And I love that. Again it’s really exciting. It of course highlights that it’s about your gut function. Yes there some underlying food intolerances and allergies that are highly problematic and may be there for life for some people but that might be one or two things. It’s not going to be ten. So it’s pretty exciting to see.
[31:06] REBECCA: yeah, it is definitely. One of the things that I see quite a lot is people sticking to these restricted diets for a long time. Something like the low FODMAP diet. I seem to hear a lot from people saying, “I have been on 2 years, 3 years, 4 years…” do you have a personal view around whether we should or shouldn’t be staying on these diets long term and whether you feel that there is any long term implications on the health of our gut if we do stay on these diets for a very extended period of time?
[31:42] JESSICA: yeah, I am pretty passionate about that. I am not a fan at all at staying on very restrictive diets long term because what you eat influences your gut bacteria which is obviously why the SIBO diet and these other types of diets exist. And they work fabulously in the short to medium term to help with rectifying the health issues. However, the longer you apply these really extreme dietary process the longer you are changing that microbiome. You are really influencing the type of bacteria that are going to thrive there and if they are not feeding them long term with certain types of prebiotics and so forth then that’s going to influence our health by not getting certain short chain fatty acid production and so forth. There is a really I guess a plethora of results that can come from that from not putting the right foundations there for our gut bacteria long term. And you know that is something that I don’t think that people really think about when they are putting these dietary processes together and doing them perhaps again with not enough guidance. So they will know that if I eat this way they feel better, their symptoms are under control. So they feel like they are in a safe place if they stick within those foundations. But realistically yeah you really need to think about long term if you have this narrow food intake then you are really….
The other thing actually from that is that you’re never really going to be able to expand out of that and perhaps find a place where you are not reacting to foods anymore because you are not allowing your gut to be exposed to different types of foods and the longer you do that the longer you are potentially in a place where no matter what you eat seems to react. So it becomes a vicious cycle if that makes sense?
[34:04] REBECCA: yeah. It definitely is. I can see how that can happen and then there is the emotional side and psychological component that you then become fearful around the foods and that you don’t want to eat it more broadly and u could see that one could spiral spiral down into whatever tightening circle problems around food and symptoms.
[34:27] JESSICA: yeah I think the other thing too is that if you feel…. So someone on FODMAP is really a common one at the moment. People are doing the FODMAP diet as a diet. They are not saying it is a like a short term approach. Plus they are treating it as the no FODMAP diet as opposed to low FODMAP diet which is another issue. But essentially they stay within those walls of the FODMAP diet because their symptoms aren’t exacerbated. But again like if 2 to 3 years later you are still on that diet and you go out and you’re exposed to say one dish or whatever the ingredient is and you get a flare, it’s no sign that you are reactive to those foods. It’s a sign that your gut still isn’t right, that the problem hasn’t been addressed. And from my point of view to the longer that stays that way the worst the problem becomes.
That’s why I think that the walls start to close in more and more because the more you eliminate, the more you are not dealing with underlying gut issue, the more you are going to continue eliminating because you are going to just become more and more reactive. So again it becomes this vicious little cycle and not a very nice place to be.
[35:58] REBECCA: No, it’s not. It’s awful for anyone that is in that condition. There’s plenty of listeners who are there right now that they are there today going, “That’s me.” Do you have any advice on and again this is a question I get asked often is how do I uncover what is going wrong in my gut, how do I uncover what caused SIBO? In the first place I have no idea. It could be a multitude of things. How can someone begin that investigative process of trying to peel back the layers of what’s going on so that they can start to try and feel that underlying cause and move forward?
[36:38] JESSICA: I think with that question testing needs to be looked at. I really do .i mean you could work with a practitioner and work at it form an elimination dietary point of view and then make assumptions based there on responses that honestly with what we have that I think it hits now. Testing is the way forward. See a practitioner who works with gut issues specifically. Ask around, get some good advice to start with as to who to say. I think that is really important. But then look at testing, look at SIBO testing. Look at comprehensive stool analysis.
So first from my point of view, you need to differentiate there as to what is going on. Often with SIBO there will be a lot of bowel issues and conversely they can definitely be occurring together. So if you are in a place to both tests that is fantastic. I think also within that environment of testing too if you can look at food intolerance testing, I think that is fantastic. For me, the more pieces of the puzzle that we have the quicker we can get in there and we can work with healing the gut, working with the diet in the right way because that testing really becomes a blue print for that client.
Once we have all of that information I often say to my clients, “It’s like you giving me a looking glass into your gut. I can see everything I need to see.” So let’s get that information together and then we can move forward really quickly and the testing I totally understand that it is an investment. But form my point of view too, you will spend so much more on trying these and trying that with different approaches if you just keep going down that track of buying a supplement here and taking someone’s advice off a blog there. And also you will end up another year down the track with the issues still going on. So I mean I guess I am bias. I come from a place where I want everyone’s gut to be amazing and I know that it can be. But I think investment in testing is so important and look you may do a SIBO test and it comes back negative. Great! That’s fantastic. We know that that’s not the issue. Then we can look further at another type of test that might be more appropriate. So it’s really really helpful to utilize those tools that are there and they are easy to do too. I mean they are all different collection methods but they are all simple … they have all got sets of instructions that come with them. And they want to have those results. You can work with a practitioner to put everything into place form a diet point of view to a supplement point of view. So it’s a no brainer.
[39:39] REBECCA: Yeah. I know from my own journey the first test I did was the SIBO breath test which came back positive and I was hydrogen dominant SIBO but then my naturopath and I after a few months of treating the SIBO we then did some additional testing. So we did a leaky gut test through urine test and we also did the IgA, IgG test to look at what my immune system was doing both locally and full body wise around certain foods. And we also ddi the comprehensive stool analysis test. So my naturopath. What was great that once we got rid of the SIBO because we knew that was a beginning issue, it was causing a lot of my symptoms. And as soon as we were getting that under control most of my symptoms disappeared but then nice we retested for SIBO, that came back negative. And then we looked at well what else is happening in my gut.
And what was really fascination to me was when we did the comprehensive stool analysis that there was very minimal immune self-function showing up in my gut. And I had been chronically sick for so many years and I’ve got every single thing going. And it kind of gave me an explanation as to why given that our immune system is the first line of defense is our digestive system for the immune system. And mine just wasn’t there. It was on vacation. It was elsewhere. It didn’t exist. But really interestingly I don’t get sick anymore and we will retest. We will redo the stool analysis and the IgA IgG and the leaky gut test. It would be really really interesting to see what has happened now but it gave my naturopath the ability to say, “This is what we really need to focus on now. Here are supplement that I know can support these functions.” Eradicate eggs and cane sugar from your diet while we calm the inflammation down. We had a whole very methodical approach to it and hey it has worked. I feel amazing now. It’s really now and actually now I can tolerate some eggs again and I have been testing them into seeing what is happening. And I don’t have any reactions to them which is wonderful because I love eggs.
[41:57] JESSICA: Yeah great. They are a hard one.
REBECCA: They are. They were my life saver when I was going through SIBO treatment and then I am glad in a way I found out at the end of the SIBO treatment that my immune system wasn’t coping with them but I mourned them every day. Every morning I mourned my breakfast of eggs.
[42:18] JESSICA: That’s really important wasn’t it? Like using the test and using them at the right time for you. You know it’s so important to have all of those pieces of the puzzle.
REBECCA: Yeah, it is. And now we have reintroduced probiotics and other supplements. So we are not doing it all at once. We are being slow and methodical. I feel amazing. And it is really interesting. Every time I add something new in now I can really feel the benefit that it is bringing to my body because it feels like it is the right time for my body. I think if I try to do it all at once it would have been overwhelming and I would have probably been in a highly flared stage. But now I not only am I much more in tune with my body so I feel how it’s feeling. I am very conscious of it. But I know when it is time to do something new and so does my naturopath. We are a really great little team. So the importance of finding someone that is in tune with you and has the skills and the expertise to help you on your journey I think is so important and I just wish everyone had my gorgeous naturopath in their lives because she has been amazing for me.
One other thing that people… we often get quite hooked up is that because popular culture talks about. The things like pre and probiotics and fermented foods. I think bloggers are great. I have a blog myself but sometimes I think when people are talking about, “You must have fermented foods every day.” it can often be very confusing especially for those of us that have digestive disorders and perhaps it’s not the right time. What is your approach to using things like pre and probiotics and fermented foods particularly in someone with SIBO?
[44:06] JESSICA: Yeah I guess I broke the record…I know but it is individualized. It will come down to what they can handle. Usually with SIBO and to be honest with a majority of the gut issues that we deal with particularly there is a really strong yeast overgrowth or disbiosis as well. We do tend to shy away the initial stages from fermented foods and sometimes prebiotics as well. It really does come down to what specific bacteria we might be seeing there. So what we will do is we will take those out of the diet for say again maybe a four to six wee period. Often it can be a little longer. And then what we will do is we will slowly reintroduce them. So as we are saying that the gut is getting stronger and we are seeing symptoms dissipate and we have also been able to loosen up the diet in other ways with perhaps reintroducing a bit more starch and a bit more variety of vegetables and fruits and so forth. We will them essentially just challenge the body. So we will start to look at introducing some fermented foods and see how they are tolerated. And generally the gut is pretty good. It will tell you if it’s ready to have those in the diet.
We tend to go more with things like your really nice sour krout, kimchis, those sorts of foods first. We probably wouldn’t…. we don’t tend to jump straight back into things like kombucha and so forth to find that they often can be a bit of a problem for people for a little longer. And it can be just so popular right now. everyone is just drinking it down.
[46:08] REBECCA: They are. They’re everywhere. Everyone is talking about it.
JESSICA: Gozzling their bottles away. So yeah it is something that we are a little bit wary of in the initial stages in saying that some of our supplements that we use will have some prebiotics in them. So depending on with SIBO specifically, we will look at those supplements and see – ok what specific prebiotic is in this supplement is that something that we are going to get benefits from. Are we looking at something that might actually give us a positive response and we can look at utilizing that. Whereas in some of the lower bowel issues we tend to find that all of them tend to be out for a certain amount of time. so I actually feel like with SIBO there is sometimes a little bit more flexibility around supplemental prebiotics and how they can be utilized.
[47:08] REBECCA: And I actually got an interview coming up with Dr. Jason Harlik, a couple of months… and it is going to be all around pre and probiotics and I can’t wait for that interview because he is such an expert in this field and I know my listeners will be loving that episode.
[47:27] JESSICA: Yeah exactly. Like he definitely has so much knowledge and so much research there to show the benefits in regards to how prebiotics can be used. There is certainly something that we have utilized in the clinic and haven’t seen a negative effect. That’s for sure. We have included them with the treatment. So that has been really nice to see. And then with probiotics as well. There is certainly something that we have utilized. This is very much a generalization but I would say we don’t use probiotics straight up. We would tend to probably use out any microbials first with sometimes a little bit of some prebiotics. But then it’s definitely probiotics that got a really important part to play and again a lot of the research that he has done has shown that too in regards to certain strains. We use a lot of, I think have mentioned that before, the LGG strain here which I just love.
[48:36] REBECCA: Yeah and I can’t wait to have Jason on the show because he will just be able to share all of that research and knowledge and wisdom with the listeners. Something that also causes quite a lot of heated debate is about this concept of starving or feeding bacteria whilst in active treatment phase. Do you do either of them when it comes to working with a person with SIBO?
[49:03] JESSICA: Yeah I would probably more likely to work in a space where we would initially ‘starve’ bacteria at the start of the protocol. So we will generally look at a dietary approach and a supplemental approach which is about creating a die off of the bacteria. And then after a certain amount of time depending on their response we look at bringing back in from a food point of view a little bit more fuel and for us too that is a really great way of gauging where a client is at. Often if you feed the bacteria a little bit it will give you an indication of how much of obviously a strong response we are going to get and therefore give you an indication of where the level of bacteria might be at.
Obviously retesting is really in pairing for that too but we find that if we go with the realistically that starvation of bacteria in the initial stage as we tend to see some better results. And that is probably something that we apply to the disbiosis within the lower bowel as well. Yeast overgrowth or generally that whole spectrum.
[50:29] REBECCA: That’s really interesting and it really is two schools of….
JESSICA: I know right..
REBECCA: Yeah people either they do it the other way. My practitioner took the approach of doing that restricting the foods to bring the numbers down in my small intestine and then reintroducing slowly more fermentable fibers and all the rest. It worked well for me.
Yeah it’s very individual. But it’s interesting those that it seems practitioners who take a more natural approach around with food and perhaps herbal supplementation seem to be more in line with the starvation method and the practitioners that use antibiotics as their primary method for reducing bacteria in the small intestine seem to, not all, but there seems to be more of a trend towards this concept of feeding the bacteria to bring them out whilst treating with antibitoics.
[51:31] JESSICA: Yeah it’s interesting isn’t it? Maybe it’s a time we’ll tell a thing or two of maybe there are better ways of getting the results for your client. That is the most important thing but I know from how we have worked with clients over the years, it’s a protocol that tends to work. I think the most important thing is that you don’t just continue trying to starve bacteria ongoingly. At some point you need to start to feed and rechallenge the gut.
[52:04] REBECCA: Yeah definitely. Something else that gets asked of me quite often is the concept of fasting, again there is so much discussion around this, around eating many times during the day or only eating twice a day perhaps. So either eating frequently or really giving the digestive system quite a long break between meals. Do you apply either method with your patients or again is it a case by case scenario?
[52:38] JESSICA: Yeah I would say case by case depending on what is going on. What is going on with their gut and obviously what is going on with their life as well in regards to their lifestyle and what their requirements are. So from a SIBO point of view we would probably be more so encouraging them to eat three main meals a day. And having them not snack as continuously. We find that’s a better approach whereas if we are working with someone with maybe more of a lower bowel issue, we might be a little bit more flexible in regards to including some snacks in there. So that is sort of like a rough guideline of how we might operate in that way. But then you really do need to look at what the demand of that person is.
So you’ve got someone coming to you who is up really early in the morning and they are training. Say they are spending like an hour in a bike and are they training for a half marathon and whatever it is that they might be doing. You really need to look at, “Ok how can we make this work for you?” you can’t just have your breakfast and then not eat for another sort of 4 or 5 hours from the time you get up in the morning through to the late lunch when you’ve been up training. So in some aspects you do need to bend the rules to make it work for that person. I find as long as those meals are balanced correctly too then obviously you are going to sustain it better through the day. To come back to SIBO I really do think that if you can get someone not snacking continuously then it’s going to be better for them in regards to supporting that migrating motor complex that’s obviously going to be really important. And then at night if possible getting them to have an early dinner and not snacking later in the evening so they get thatreally nice period from dinner right through to breakfast. We’d certainly be encouraging that where possible.
[54:5] REBECCA: I found it interesting when I went on to the SIBO biphasic diet that having been someone that couldn’t really go more than about three hours between meals or snacks but when I went on to that program I think I would always be hungry. Actually it was the opposite. I felt really full. There were times when I just didn’t feel like I needed to eat and sometimes I wouldn’t have lunch and it wasn’t because I was actively avoiding it. It was just that I just simply wasn’t hungry because I was eating really good quality protein and lots of vegetables and some nuts and seeds and things like that and I had oil. I was having more oil of good fats in my diet that I had ever had before. And it was so satisfying for me because I there was no sugar giving me any of those horrible blood sugars spikes and dips anymore and I felt great. I was like, “Wow I am actually really satisfied on this program.” I was surprised.
[55:%6] JESSICA: Again, if you’ve got that right balance you’ve got a whole food approach. Really nutritionally balanced then you can generally really apply like a three meal a day way of eating without too many concerns. It’s what people really don’t understand how to be fulfilled a mean in a balanced way running into the problems that they had breakfast. And an hour later they are starving hungry. So again it’s working with someone who knows how to create that meal plan for you.
[56:31] REBECCA: yeah definitely. The final question I have is around shopping for food. It is something that we all have to do. Do you have any advice or tips on how people can find the best quality food to help support them at a nutritional level? Should we be looking at just having organic food or are there certain things that we should be looking for on packaging your big no nos? What is your advice on getting the best out of our food when we are buying it from the supermarket?
[57:02] JESSICA: First and foremost trying to ensure that your food is whole food. And by that I mean fruit, vegetables, meat protein if you are including your good quality fats and your nuts and your seeds and so forth. Realistically putting real food in your shopping trollies. First and foremost the most important thing that you can do, the more packaged food that you are bringing in to your diet, the more usually you are bringing in processed food. That’s going to include different sorts of preservatives and additives and so forth. In saying that I think that there are certain foods that you are buying and packaged and so forth getting used to looking at the back an checking for certain common additives that might be problematic. Usually one of the biggest ones MSG which tends to really knock people around with gut issues. Nitrates are really important to keep an eye out for.
I really think anything that you are looking at where you are looking at the back and have the ingredients you don’t understand then realistically you don’t want to be putting that into your shopping trolley. It’s always about the more natural the better.
Organic, look if you can afford organic that’s great. I think sometimes it can stress people out more. So I always say, “If you can purchase some organic produce, make it more about your fruit and your vegetables. It is a good place to start and if you can look at hunting down some local farmers markets or online there are some really great options there now. We might be able to get some seasonal produce with it. and that’s a great thing about farmers market too is that you are generally going to be pushed towards eating more seasonally which I think is really really fantastic.
And look I think preservative wise too, there are a lot of preservatives that fantastic and there are some information out there. I am trying to think of a name. It’s a really great little booklet that you can get that’s probably online now too. I think it’s called the maze…. I can’t think of it. I’ll have to let you know. Maybe it’s in show note one.
But not all of them are going to be really bad. You can get for instance vitamin C as a preservative and so forth. That’s where i think sometimes having a reference guide to refer to can be quite advantageous. But honestly as long as you are going for a whole food approach you’re not going to be running into problems as far as what you decide to pop in the trolley. You know if you know what it is, you know that it is basically something that grow in earth in some capacity. Then generally things can’t be too bad.
[1:00:13] REBECCA: Yeah I think that is great advice. That is something that I now implement with my food. I really aim to eat food in its original state. So be it fruits, vegetables, or meat or anything like that. And I really have reduced significantly the amount of processed food that I eat to the point where now really the only time I go to the supermarket is to buy toilet paper. And maybe some oil. But a lot of that I also get from my health food store. So it’s a really different experience now on how I use to eat.
[1:00:48] JESSICA: yes, I think you can buy more… you move towards a whole food diet, the less time you spend in supermarkets. That doesn’t mean you need to spend more money. I think ironically it can be the other way. I think you just need to look at where you source these other foods that are going to be better for you from a nutrition point of view. I would say like seasonal produce and it might just mean once every fort night because I generally tend to last longer or once a week. Yeah you put aside an hour and a Sunday morning to go to your local framer’s market. And you pop in to your local food store and grab a few bits and pieces and I actually think your shopping bill tends to go down more than anything.
[1:01:36] REBECCA: And the other interesting thing that I didn’t realize that was even on the foods that I wouldn’t consider as overly processed but they are still processed food, it’s not like I am going and eating crisps and chocolate bars but on other items let’s say the occasional piece of bread that I have or something else like that. I can feel it. I feel that nutritionally I just didn’t get a really great meal. I don’t feel vibrant. So my desire to eat the processed food also has diminished greatly when I can feel good on the food that i am eating.
[1:02:15] JESSICA: I love seeing I’m in clinic with clinics how their pallet changes. So you know when they first, you make those changes initially as I said it’s like having a rug pulled out from underneath you and then you were into these new flavors and so forth and then there comes and opportunity somewhere along the way were maybe you are offered a picnic bar or eat an ice cream or whatever it is. And in your mind you associate it with tasting a certain way and then you take a bite and you are like, “Oh this is actually nothing like I remember.” And the actual… our taste buds change and we start to really appreciate the sweetness in natural foods more and then suddenly sugar like added sugar becomes like really something that is quite distasteful. It always fascinates me.
[1:03:07] REBECCA: I remember feeling that exact experience when I first tried something sweetened after my SIBO treatment and I had longed for something sweet and then I took a bite and my taste buds felt like they hurt and it was so unpleasant and I felt so sick from it. it just didn’t… it wasn’t an enjoyable experience whatsoever and I wanted to eat… you know I am used to eat my own, I still do, my own chocolate just with raw cacao powder and raw cacao butter and a little bit of a hundred percent natural stevia ground leaves. And for me that is so sweet and that’s plenty. Other people think it tastes horrible. For me I can taste the sweetness in it now that I don’t have a mouth that is constantly bombarded with over sweetness. So it is very interesting journey that one goes on.
Jessica Cox thank you so much for coming on to the healthy gut podcast today and sharing your wisdom on all thing snutrition. If anybody would like to connect with you what is the best way for them to reach out and connect with you?
JESSICA: The best way would be definitely jumping online. So they can go to jessicacox.com.au and through there you can go to the clinic tab you will be able to find al information about the JC clinic and be able to contact us thorough the contact section. You will also find me online on instagram at JessicaCox nutritionist and on Facebook too Jessica Cox nutrition. If all those fails just google Jessica Cox nutritionist and I am sure something will pop up.
REBECCA: yeah and all those links are in the show notes for anyone that would like to make contact with you.
So thanks once again for coming on to the Healthy Gut Podcast today. It has been an absolute pleasure to have you on the show.
JESSICA: Thanks for having me.