Q&A 5/24/22 Digestion: SIBO, SIFO, EPI and Leaky Gut


Podcast Highlights:

03:23 My naturopath has said that I have SIBO, SIFO, EPI and leaky gut. What does this all mean and does it make sense?

06:00 Chewing Food

11:50 Bitter Foods

30:30 Hiatal Hernia

31:32 H. Pylori

34:02 Pancreas and Gallbladder

36:02 “EPI.” Endogenous Pancreatic Enzyme Insufficiency

38:01 Breaking Down Enzymes

41:41 Leaky Gut

44:11 Brain Trauma and the Gut

46:53 Offending Foods

48:51 SIFO “SIFO” small intestinal fungal overgrowth

50:18 SIBO “SIBO” Small intestinal bacteria overgrowth


54:47 Does high pH water aid in digestion?

Transcript from Webinar:

Howdy. Here we are for another session of Ask Dr. John. Keep those questions coming. Comments, too, are fine. Good or bad. Whatever you feel, whatever you think, go ahead and send them to us. We really love your questions. We got a really great question today. It came in from Mary, an old friend of mine and patient. She asked quite a few very, very good questions about thyroid disorders. I’m not going to be able to go into that today, because I got it a little too late to put some things together. However, thyroid disorders are a huge, huge issue.

We basically have an epidemic of thyroid disorders in the United States, and there are a variety of reasons for that. It’s a very dangerous situation. Low thyroid leads to dozens of conditions from heart disease to stroke to high cholesterol, etc. There’s tons of stuff. And if your doctor says your thyroid is just fine, take that with a huge grain of iodine, a little salt on it. Western medicine looks for 1 to 2 different types of hypothyroid. There are 27 different types of hypothyroid that can be tested for. Unfortunately, they are not being tested for in most cases. Next week, we will talk about the long and short of this. I am going to really take a deep dive into thyroid. Everything from how do you keep your thyroid healthy to what are symptoms of an unhealthy thyroid? How do you fix that yourself, etc.? We’re going to go into a lot of things that I think should be very valuable to almost everybody, but not today.

Today, I got a very interesting, kind of long question about one of my favorite topics. Twenty years ago, the vast majority of what I treated were gastrointestinal disorders. I think I took my first leaky gut class when I was a student in probably 1998 or 1997, with a gentleman that I kind of consider my mentor. It just blew my socks off, totally blew my socks off. I was unaware of the ramifications, how much leaky gut there was, how easy it is to create, and how hard it is to fix. Then the value of functional medicine testing in treating that. That’s what I’m going to talk about today, and hopefully you will enjoy it.

I’m actually going to start with a little trip through the gastrointestinal system because there are several numerous misunderstandings that I want to try to clear up while I’m going through there. I’m going to share my screen with you.


Here is a question. “My naturopath has said that I have SIBO, SIFO, EPI and leaky gut.” They could have all been at one appointment, and or it could have happened over multiple appointments. This person didn’t say. However, that’s a lot of letters. It’s like the all the federal agencies, the FBI, the CIA and the NSA, etc.. We just love acronyms and initials in this country.

The letter continues to ask, “What does this all mean and does it make sense?” What a great question. It depends on who you ask if it makes sense.

I still see doctors who deny that there is a leaky gut. Not only is leaky gut a proven issue, many of the top minds in the world are working on the problem, but there are specific biochemical tests for leaky gut. There’s no question about it, but you’ll still have that question. Anyway, we’re going to take a little tour through the gut today. How fun is that – a tour of the GI tract exploring the dark secrets. It’s like going through the Congo.

First thing I want you to notice is that this is a continuous tube. We actually think of ourselves as this solid entity, and we’ve got a GI tract. It’s actually much better to think of us as being like a doughnut, right? We are this solid entity with this hole running through us. That’s really important to remember because 80% of our immune system is lining the gut tissues and is trying to protect us from insults through the gut. There are far more illnesses that can attack us through the gut than there are that can attack us from the outside, through our skin.

Here you see this entire layout, and each one of these things is important. However, a lot of it gets overlooked. We’re going to go through the whole thing and look at some GI problems.


We are going to start at the beginning. Good digestion starts in the mouth. I read some really interesting stuff about that in 1970-ish There were a few people that were talking about these principles that I’m going to mention today, and they were talking about chewing your food X number of times. Some people said 20, some people said 100, but I really took it to heart. In my 20s, I was chewing my food between 50 and 100 times. I was chewing my tea; I chewed everything. There’s a good reason to even chew liquids. I know it sounds silly, but breaking the food down into this semi-liquid mass is only part of what happens in the mouth.

Chewing Food. I’ve gotten a lot of trouble, actually. I was in the Air Force and when I was in basic training, we would have to march together to eat together. Then you sit at a table with three other people and nobody could leave until the last person left, and I was always the very, very last person. Now, this was prime time for smoking. You got to go out and smoke while you were waiting to get information to go back to the barracks. All the smokers avoided me like the plague, and most everybody else did, too, because I took so long to eat. Oh well, good digestion starts in the mouth. The smaller of the pieces of food, the more you break it down, the easier they are to break down in the stomach. What’s happening is you’ve got these pieces of food that are being acted upon by a variety of different chemicals, and as with most things of this type, when you’re looking to create a reaction, the smaller the particles are, the more surface area you get, and so the more the chemicals can work on the food. The enzymes, primarily salivary enzyme, breaks down, starches gets released in the mouth. If you do not chew your starchy food, let’s say you’re eating some rice or a baked potato, it probably won’t completely digest. You need those salivary amylase, and that salivary amylase is enzyme which used to be called ptyalin “p-t,” ptyalin , but they’ve changed it to the salivary amylase.


At any rate, it starts in the mouth. It’s healthy for your teeth to chew. There’s a direct correlation between the number of teeth in your head and the onset of dementia and several other diseases. The more natural teeth you have, the lower your dementia numbers. If you have good quality dentures, that’s not quite as good as having your own teeth, but better than having a lot of holes in your mouth. If you have a problem where you have very few teeth, then your dementia risk will be higher as well as your risk of a whole slew of other problems. So the fewer teeth you have, the earlier the onset of dementia – so really protect those teeth.


The food goes down through your esophagus, through the upper pseudo-sphincter into the stomach. The stomach is quite amazing. The acidity, which is caused by hydrochloric acid release, can and it really should reach the pH of around 1 to 1.5. That’s very, very acidic. Now, if you did not have a protective layer in the stomach, that acid would eat right through it. That’s why when people don’t have that mucus layer, it does eat through it and they get ulcers which can bleed and cause death. It’s also a very muscular organ. It isn’t just a big bowl there. It’s really very muscular. It churns and rolls and turns to food so you get faster action by the acid. You want to get it really well mixed.


I’m going ot take just a moment to talk about when we do our liver detox and our liver cleanse. I talk a lot about bitter herbs. They’re incredibly important. I’m going to take about 7 or 8 minutes to talk about it here. I hope you pay attention because this is really important stuff.

Chinese medical history included nutrition. At all times that was part of the medical tradition. All herbs and all foods in that culture are classified in a variety of ways. They’re classified by their flavor (is it sweet, bitter, salty?). Each of those flavors, by the way, does certain things in the body, and they knew that. If you eat bitter foods, it purges fire; it is very healing in a variety of ways that I’m not going to go into all of them. Sweet nourishes the body, and it arrests pain. Bitter herbs actually stimulate the liver. They cause the release of bile. They relieve PMS symptoms, etc.. Pungent herbs promote movement. Sour astringent holds and consolidates things in the body. Salty dissolves hardness and accumulations. The Chinese would eat seaweed for cysts and for tumors. (Seaweed has very high iodine content.) The iodine can still be used and is used for cysts and tumors. It is very effective, actually.


Bitter Foods Bitters have been used hundreds of years in European herbalism. You can go back and find the works of Hildegard von Bingen, who was a brilliant herbalist and musician, one of the few women to actually run a monastery. Priests going from England to Rome for their visit would actually go hundreds of miles out of their way on foot usually, maybe riding an ox cart, would go hundreds of miles out of their way to visit Hildegard’s monastery, because she was so famous at that time. Her herbal books and treatments were so advanced. The bitter herbs were mostly used and are mostly used for digestion and to create an appetite. Doing an aperitif before a meal is very common in Europe. There are about 60 herbs that are still used in European bitters formulas.


In Netherlands it’s still common to do bitter hour. So you hang out with a bunch of your friends and you eat and drink bitter food and drink. It’s crazy, right? This is done very frequently.

There are good old Swedish Bitters. That is the first bitters I was exposed to. Very effective for many conditions. My favorite is is called Eau de Melisse, Water of Melissa, which is French by the Carmelite Monks in Paris, I believe. It is incredibly bitter. In fact, I can’t get it down without putting it on sugar cube, but it will clear up your gut faster than anything.

About 29 years ago before my wife, Jenny, and I got together, I was in Paris, France with my girlfriend. We would go out to these l’auberge where, you know, it was a kind of a family restaurant sitting alone out in the country. Each l’auberge would have their own stock and trade, like the one we went to was goat, so everything was made from goat, but you could get sheep or cattle or whatever it was. Almost everything was made of whatever that thing is that they’re famous for. Well, there was one exception, and it was a dish called Harigot, and it was incredibly delicious and thick and just loving, you know, one of those dishes that just makes you feel so loved, full and so called sticks to your ribs. Well, I’m on my second dish of Harigot and I look up, and there are about 6-8 people at my table all staring at me and everybody else at the l’auberge was staring at me because apparently you don’t eat a second bowl of Harigot. Sure enough, I got home, went to bed and woke up after a couple hours, literally with the worst stomachache I’ve ever had in my life. I thought I was going to die, and I was thinking, “Oh my God, what are they going to do with my body, etc.?” I was in agony. My girlfriend called her friend in and she laughed. She brought over Eau de Melisse – worst tasting thing I’ve ever had in my life (well, that not quite true. I had stinky tofu when I was in China) but this was too bad. She put it over a sugar cube, and I ate it. Within 15 minutes my digestion had cleared completely. That’s how powerful bitters are. A lot of alcoholic beverages and drinks really started out as bitter tonics for health, so Campari, beer with hops is very bitter, coffee, tonic water.

It’s a long held tradition in most forms of medicine that good health starts in the stomach. Hippocrates said all illness starts in the gut. Li Dong Yuan, who is my hero, wrote Pi Wei Lun, Treatise on the Spleen and Stomach, said that it all starts on the spleen and stomach. Yet, we’ve got 100 million Americans with digestive disorders really badly affecting their lives in a number of ways. We will get into in a minute. At any rate, everybody ate a lot of bitter food and then as sugar and sweet foods and more spices came became easier to find, populations in general starting started turning to the more pleasing tastes of sweet and salty. Of course, those are very hard in the body. They lead to diabetes, heart disease, fatty liver and stroke, you name it. Now, many people get most and sometimes all of their bitter flavors from alcohol and coffee.


These herbs are very powerful to stimulate the bitter tasting taste buds. Those are primarily on the rear of the tongue, and so you notice sometimes you get this really bitter aftertaste. That’s because it’s literally on the back of your tongue. These are very specialized. They taste the food and then send a signal to the brain which stimulates the vagus nerve, which has now gotten very popular, and that causes a release of gastric acid, gastrin, pepsyn, etc..

As soon as the food stimulates those bitter receptors, your stomach gears up for the food that’s coming and is ready to greet the food with all of these chemicals that you need to break down the food. How brilliant is that, right? Just brilliant. However, if you don’t stimulate that bitter taste, it’s probably not going to happen. Now, one of the problems that we see is kids that just won’t touch vegetables; it’s often because they’re bitter tasters. They taste bitter flavor more than other people do, and they just cannot tolerate having those vegetables in their mouth. That’s a common reason why kids don’t like bitters. Even if they are not supertasters for bitter, they still have better taste receptors than most older people.

Now, the most amazing thing is your gut has about 4000 square feet of surface area. It’s like a tennis court and you only have about 20 square feet of skin. Remember I was talking about how important it is to protect the gut – 4000 square feet. You have receptors in what’s called the entero-endocrine system of cells (entero relating to the intestines and then endocrine relating to the hormonal system). This is the largest endocrine system in the body. Now in the gut, we already know that there are 30 critical chemicals that are released when the bitter taste stimulates the receptors. When it’s in your gut, you’re not going to identify a bitter flavor, but those receptors are responding to this chemical. They release about 30 known chemicals; there are probably far more than that, but these really stimulate the digestive system.

Food is being tasted all through your gut. It triggers something called cholecystekinin which stimulates the release and production of bile and pancreatic enzymes so that you can digest your food. If you don’t get the cholecystekinin release, you’re going to have a very difficult time digesting, particularly fats and carbohydrates. You really can’t digest your food without those.

The bitter receptor also slows gastric emptying. It keeps the food from moving through too quickly, so that whole “feeling full sticks to your gut” kind of idea is really stimulated by the bitter flavor. It also, and this is really critical, increases hydrochloric acid production. Hydrochloric acid is what makes your stomach acidic. An acidic stomach is needed to absorb iron, to absorb calcium, and to stimulate intrinsic factor so that it will bind B12, so that that can be absorbed also.

One of the significant dangers of using medications that turn off the hydrochloric acid – the proton pump inhibitors, the H2 antagonists, etc., is that they increase osteoporosis in women by about 240%. They also increase B12 anemia significantly, and they increase iron-deficient anemia. It’s really critical to have that hydrochloric acid and you need the bitter flavor to stimulate that.

It also stimulates release of ‘glucagonlike peptide one’ (GLP-1) that stimulates insulin release to help keep blood sugars in range. There’s a class of diabetes drugs that uses this system. What’s really trippy is they have found cells that respond to the bitter flavor throughout the respiratory system, the olefactory system, your brain, the testes, the thyroid, thymus, bone heart, and they’re probably everywhere. This is just where I have read that they have proven they exist. In the heart they contribute to elasticity, antispasms, and they increase blood flow.

Bitters should be consumed 15 to 30 minutes before a meal. It takes about 15 minutes to trigger the GLP-1 and the other enzymes. If you can’t stand the bitters, you can take them as a pill. It only takes about a week to shift the taste to reduce sweet foods. Keep them out in the open where you are reminded. If you like to have a drink in the evening, several German companies make little tiny bottles of bitters that have a little alcohol in them so you may have to refrigerate it. That can be done before your meals; a little aperitif.

This is Barrett’s esophagus. This is looking down someone’s throat. You can see that red area. This is where they’ve had too much stomach acid coming up into the esophagus. Now, I said, you want a very acidic stomach. However, the pseudo sphincter has to close. And I’m not going to get into why that doesn’t close, but it’s the opposite of what most people think. It’s from low stomach acid. It is not from high stomach acid, but if it doesn’t close, then the acid can come up and burn the throat. It can actually get up into the lungs. There are certain cases of chronic cough that are not getting figured out, but actually they’re being caused by the stomach acid coming up and burning the bronchioles and sometimes getting into the lungs.

If you get a bitter taste in the mouth, if you’re a little suspicious, here are some remedies. Eat small meals, maintain your acidity, sleep with an incline with a little raised bed a or a wedge. (about 4 inches is usually enough), and do your last meal 3 hours before bedtime. If you still have some difficulty, if you do not have really extremely high blood pressure, take some baking soda before you go to bed. If you have high blood pressure, then there are alternatives.

Now, this is where it gets confusing with this whole acid/alkaline thing. People think that if you eat alkaline, your whole system is alkaline. Unfortunately it’s not true because every little bit, every few inches of your intestine and your GI tract needs to be at a different pH level, a different level of acidity and alkalinity. If you start with low stomach acid, you get poor digestion, then you get protein and mineral deficiency, then you get acidic blood from low stomach acid, and then you get insufficient nutrients to produce stomach acid. Then you start that whole vicious circle again.

The other thing about stomach acidity is it’s important to kill the microbes. There are bugs on everything. There’s bacteria on everything you eat. There’s yeast on most everything you eat. However, having a good, acidic stomach will keep the bugs from getting down into your intestines.

Now heme iron from meat needs only mild acidity in the 3 to 4 pH range, so that’s not very acidic. Iron removal from vegetables needs a very acidic environment of around 1.5 pH. If you are a vegetarian or vegan, and you are on medications to lower your stomach acid, you’re in trouble. Guaranteed you’ve got problems. There’s no way around it. If you’re in that category, then see a functional medical doctor or someone like myself that treats these issues.

This is way too complex. I realized after I got it in here, but the point being this – Up here in the stomach you’ve got this intrinsic factor that’s released by being stimulated by stomach acid. It grabs the vitamin B12, which then goes all the way down to the end of the small intestine where it finally gets absorbed. Any problems in here can prevent B12 absorption, which can lead to stroke, heart attack, peripheral neuropathy in the feet. It’s one of the primary causes, early dementia, etc, so this is a very important system.

Apple cider vinegar handles a lot of it. You can now get apple cider vinegar in gummies, you can get it in capsules, you can do a liquid that also has honey in it. It’s all good. I highly recommend doing a little apple cider vinegar before your meals. It is going to increase stomach acidity, it’s anti-microbial, it kills bugs. It helps relieve bloating, gas and belching because it improves digestion. With good digestion, the food doesn’t ferment, which that fermentation is what largely causes the gas and bloating.

This is really cool. Health care professionals have known for I don’t know how many thousand years that apple cider vinegar and vinegars were really great for your health and knew some of the benefits but didn’t know why. It’s over the last couple of decades that there have been these awesome studies showing what happens with the apple cider vinegar. One of those is they’ve proven that if you take apple cider vinegar before a meal, particularly with carbohydrates, that your postprandial blood sugars, (your after-eating blood sugars) will be 30 to 40 points lower. Now, for most pre diabetics and diabetics, that’s life changing. It blocks an enzyme that breaks complex carbs down into simple sugars. Because of that, it lowers blood sugar levels after you eat a lot. It’s not a small benefit. It improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type two diabetes. There is a study, if you’re curious, go ahead and check it out.

Compared to placebo, vinegar raised whole body insulin sensitivity. That means how well are your cells balanced so that they are sensitive to insulin, so that they allow insulin to bring sugar into them with less resistance. In this case, the 60 minute Post-Meal interval was 30% better if people did apple cider vinegar. That is, again, quite shocking. Acetic acid, which is vinegar, basically suppresses those disaccharidase , as I mentioned. It also raises these glucose-6-phosphate concentrations in skeletal muscle. That gives you a benefit that’s close to metformin, so rather than take metformin, you may well be able to get by with apple cider vinegar. Metformin has side effects. The side effects of apple cider vinegar are better health.


HIATAL HERNIA. A lot of times patients will come in and they’ll say, you know, my food just doesn’t feel like it’s moving through properly. It sits there, and then a couple of hours after my meal, I get some reflux or I get some acid up in my throat. Often that’s from a hiatal hernia. Here’s the esophagus coming down. It has to go through this hole in the diaphragm. Well, this hole as we get older, can get stretched and then a piece of the stomach can get pulled up through the hole; we call it a hiatal hernia. Sometimes they’re sliding hernias, and they can be pulled back down, or there are some other mechanisms by which they can be put in place. Sometimes they don’t slide, and you might then have to do a more dramatic intervention. It’s very common. When nothing else makes sense with the gut, I always suspect a hernia.


H PYLORI. Here we’ve got all these folds in the gastric mucosa. This is all the coating for the stomach so that the acid doesn’t eat a hole in it. Here, are all the muscle layers. You can see they’re running in several different directions. It’s really churning and churning and churning. If you get an infection with H pylori, the H. Pylori can live in a high acid environment. It then corkscrews its way through that mucus. It will start attacking the stomach itself. Well, it then leaves a hole there so that the stomach acid can go through and start burning the stomach and eventually it can actually burn all the way through. Someone could get a bleeding ulcer, which is a life threatening event. Before that happens, they’re just going to have a lot of pain and discomfort.

If you think about the large intestine, it doesn’t pick a nice, smooth path. It goes up, it takes a pretty steep turn, about probably 130 degrees. All of the food is having to go around that turn and then it gets over to the splenic flexor, and it takes an even sharper turn. It’s not uncommon for people to have discomfort here at the hepatic flexor, over here at the splenic flexor or down here at this last flexor. Now, you can’t see it here because the small intestines is in the way, but the intestine actually comes up and then back down. So that’s an area where you can get discomfort also, particularly with constipation. Now, these small intestines are just shoved in there, basically. Most people have about 22 feet of intestines.

Again, if you lay them out and you mash them because they’ve got little villi, little finger like projections, but if you brought them out flat, there is the surface area of a tennis court. That’s why you can get so much digestion and absorption of nutrients.


PANCREAS AND GALLBLADDER. The liver sits over the top of the gallbladder. When this gets stimulated, then it releases bile that comes down into the common bile duct and gets dumped into the beginning of the small intestine so that you can break down fat. Here you get lipids and amylase and a ton of baking soda; sodium bicarbonate actually gets released so that you can start doing a finer breakdown and digestion of fats so that you can then also digest the carbohydrates. Then the baking soda, or carbon dioxide, is there to neutralize this whole mass because it’s come in here in a very acidic state from the stomach. You need to buffer it so it doesn’t burn holes in you – so lots and lots of bicarbonate of soda. These are the chemical messengers that are turning things on and off.


GI TRACT. Here’s the pH in a fasted, meaning that they haven’t eaten for a few hours and the stomach’s empty. As it comes down through here you get big changes in the pH. It can go anywhere from 1.7 to 8, depending on where you are in the intestines. Now, one of the things to remember is since the pH is changing every few inches, it means that your microbiome is changing every few inches because one of the things the microbiome are dependent on is a particular pH in which they can survive.


“EPI.” ENDOGENOUS PANCREATIC ENZYME INSUFFICIENCY. Now we’re getting into the conditions that my patient asked about – EPI Endogenous Pancreatic Enzyme Insufficiency. Wow. That must be really nasty, severe stuff to have a name like that. I remember when I first heard this term, I was literally driving to work, and there was a commercial. I don’t remember it exactly, but it was something like, “Forgetting your neighbor’s name- Embarrassing. Walking into your closed sliding glass door – Embarrassing. Talking to your doctor about your poop – Normal.” They were encouraging people to start paying more attention to these issues. The reason is always fascinating. Whenever you hear a commercial like that, it’s because there is a drug to treat a condition. They then name a condition that the drug treats, and then they start advertising it. EPI or endogenous pancreatic enzyme I probably treated in the first patient I ever saw, and I’ve treated 60,000 patient visits since then. At least 30% of them had EPI. Hopefully not when we were through treating them, but at least at the beginning. It just means the pancreas isn’t producing enough enzymes to digest your food. The easy way to treat that is to give you some additional enzymes, at least short term, so that you can break down that food. You just take them when you eat your meal, and it helps you with it.

There are a variety of tests for this. We do a Comprehensive Digestive Stool Analysis to test for lots of things, including Chymotrypsin, which tells us if there’s EPI and a couple dozen other tests.


BREAKING DOWN ENZYMES. Any enzyme that ends in “ace” will break it down to an “ose.” So you’ve heard of lactose intolerance; the treatment for that is lactase. Lactase is the enzyme that breaks down lactose, Cellulose is broken down by cellulase. We need lipase to digest fat. We need amylase to digest carbohydrates. We need pepsin and protease to digest protein. We need cellulase to digest cellulose, which humans do not do very well at all. We basically can’t digest cellulose, and that’s why for us is roughage or fiber as it just goes through us, basically the way it came in. Animals, ruminants with several stomachs, will produce cellulase so they can break down the cellulose.

You can also use ox bile or bile salts to emulsify. Let’s say you’re a meat eater, you had lamb, and that grease is very difficult to clean off the plates. You put some detergent on it, and the detergent just basically explodes the fat molecules, making it easier to clean the plate. That’s emulsifying it. That’s what the ox bile or bile salts do in your gut. They emulsify it so it can break it down into smaller pieces, so that the lipase can then work to fully digest it. If your gallbladder is blocked or you don’t have a gallbladder, then you’re not going to be able to emulsify fat properly, and fatty meals may straight through you. They may cause diarrhea, etc.. Chinese call them “duck-dropping stools” because they look like duck droppings.


Again, we got 4000 square feet of surface area, and if that terrain gets damaged, it’s very significant. It can’t absorb the good stuff, but it will absorb the bad stuff because it’ll go right through the linings. Once the damaging microbes get a foothold, you’re in trouble.

So what damage is it? Bad bacteria, fungus, candida, viruses, protozoa, worms – and don’t think we don’t have more worms here. I catch parasites in people all the time. Food allergies and intolerances, heavy metals, all of those damage the small intestinal terrain,and there are a ton of other things. If you’re drinking chlorinated water, what does chlorine do? It kills bacteria. If you’re drinking fluoridated water, any of those things will damage the small intestinal terrain.

Here we see a healthy intestinal lining, and you see these long, finger-like projections going out. It’s like if you go down to the marina, if you could just dock your boat on the land, you couldn’t get very many boats. Right? There’s not enough room. However, if you put these finger-like projections out, piers, etc., then you can dock a lot more boats. That’s what’s happening here. These villi tremendously increase the surface area, but if you get long-term inflammation, no villi. No villi means no absorption.


LEAKY GUT From the inflammation, you get leaky gut. The cells actually shrink from the inflammation. Food particles that are undigested and a variety of toxins get through, and they will go into the bloodstream. Then they cause massive harm as those inflammatory chemicals go all through the body. You get all of these things that are coming into the body, and they’re getting through this non-intact intestine, Intestinal barrier dysfunction that leads to food allergies. It’s actually food intolerances that it leads to, immune system abnormalities, autoimmunity. There’s very little long-term autoimmune dysfunction that doesn’t have a leaky gut component. Very little.

If you’re interested in the gut check out a guy named Alessio Fasano. He is the man. He uses zonuin as the marker for leaky gut. If you have a leaky gut, you’ll have Inulin in your bloodstream. If you don’t have a leaky gut, you will not have the inulin in your bloodstream. It’s as simple as that. It’s one of the most straightforward tests you will ever find. If there’s zonulin, you know, you’ve got leaky gut and toxins are leaking into the bloodstream.

Now, his studies show that every time, every time, no exception that a human eats wheat, they develop transient, leaky gut. Now, if you’re really healthy in every other way and your gut really healthy beforehand, that will reverse after some period of time and you’ll stop having leaky gut.If you already have leaky gut, inflammation, or a tendency, this can cause permanent leaky gut. I hope you’re seeing why they call it leaky gut. It’s because your gut actually leaks. This isn’t a cute little term. It’s the truth.


BRAIN TRAUMA AND THE GUT. Dr. Silverman published a study looking at brain trauma. Actually, it can be any form of trauma, but brain trauma is what he was studying. Concussion caused inflammatory damage in the brain, and it’ll change the messages from the brain largely to the stomach largely through the vagus nerve. Then the leaky gut causes more brain inflammation. So you see, you get this circular system, the brain gets damaged, gives off inflammatory chemicals, damages or changes the output of the vagus nerve, which damages the gut. Leaky gut, it occurs, and that causes more inflammation, that damages the brain.

You cannot heal one of these without healing them both at the same time. It won’t work. I see a fair number of patients with concussions. You know, my wife treats rugby players and football players, but I see mostly rugby players. You’ve got to treat your gut because this is going to happen, and they’re going to get these problems. In my clinical experience, there are many other types of traumas that can do the same thing. It is not just concussion, but this is a big, big problem.

How do you heal a leaky gut? First of all, there are food hypersensitivities. You have to find out what they are and remove them. If you don’t know, you start with the most likely offenders and you remove those. Take the appropriate strain of good quality probiotics, and I can’t stress quality, quality, quality. There are companies that do really good testing of their own, and other company’s probiotics, and they routinely find that there are no live cultures in some company’s probiotics. Other times they find that after 90 days there are no live cultures. So we are very careful about the quality that we use. You slowly kill yeast because if you kill yeast quickly, they give off about 187 chemicals that will make you very sick. You do it slowly. You slowly kill any parasites to heal the intestinal lining. You have to do that whole thing pretty much at once.


OFFENDING FOODS Here are the most likely offending foods. Glycoproteins are proteins with a sugar coating on them, basically a shell, and they’re very sticky. When you eat them, they literally adhere to the lining of the small intestine. They stay in contact with your gut longer than other foods, and so they’re more likely to cause an inflammatory reaction. It is my opinion that nobody should eat wheat, not the wheat we have now. The older types of wheat had a lot of nutritional value, and it wasn’t as damaging, so that would be okay. However, you’re not going to find it very easily in the US.

Dairy. Very, very, very few people should eat dairy, and when they do it should be really carefully done. I’ve done whole shows just on milk and dairy and these other offending problems.

Kill yeast slowly. Yeast attracts heavy metals, particularly mercury. As you kill the yeast, you release that mercury back into the system, so you have to kill the yeast fairly slowly. You ought to use very particular binders – things that will kind of sweep out the gut, attract those heavy metals, and attract the chemicals from the yeast while you’re killing it. Otherwise, it’s just going to get released back into your gut.

If you have leaky gut, which you will, because that’s what we’re treating, you will reabsorb it and you’ve accomplished nothing. The order is very, very important. Now, low levels of yeast are normal. There are tons of yeast killers that you can read about or we can go into it, and they’re very effective.


SIFO “SIFO” small intestinal fungal overgrowth. For a gut with candidiasis (yeast overgrowth), you can see the tissue is very red; it will be very inflamed from this.

Then you’ve got to rebalance the flora. This is almost never done properly. If you look at the studies, all of the large studies are using 900 billion to 3 trillion colony-forming units (CFUs), 900 billion to 3 trillion. Most of your probiotics don’t have 10%. A lot of them don’t have 1% of that many units. The studies are very clear that you have to, in many cases, use very large doses to kind of shock the gut back into shape, and get it with the high enough levels, so the gut will start healing itself. At lower levels, you get some benefit because hopefully it’ll colonize and it’ll push some of the bad guys out. However, for serious conditions, Crohn’s disease, ulcerative colitis, any inflammatory bowel disease, etc, you need very large doses.


SIBO “SIBO” Small intestinal bacteria overgrowth. There are medical tests for each of these. Many of you are probably seeing the breath tests for methane and hydrogen forming bacteria. I don’t order it. It’s expensive. I read them all the time when people bring them in. I don’t order it because if the symptoms are strong enough to suspect it. If they’re strong enough that I would order the expensive test, I just use the patient’s money to treat it rather than test for it. I’m going to have to treat it anyway, so it’s not difficult to figure it out without the test.

SIBO isn’t really an overgrowth. That’s a misnomer, but rather an imbalance in the 100 trillion bacteria in a healthy gut; 100 trillion, 20 times more bacteria than you have cells in your body. 2500 known strains; it’s actually probably closer to 4000 now. There are only two that are generally used in the United States for supplements out of 2500. You know that it’s very slow to get approval. In other countries there are more available.

There are 7 pounds of bacteria in a healthy gut. We’re one of only two species of primates that actually have good bacteria in our brains. That’s pretty cool. They stimulate the nerves to make new connections in the brain, so they actually help our brain to grow.

For SIBO, MD’s use rifaximin; it’s an antibiotic. Now you got to think, “What started the leaky gut in the first place?” It was a bacterial imbalance. So you’re going to take rifaximin, an antibiotic, and that’s often how the gut imbalance happened, by someone taking an antibiotic, and then you’re going to take it to treat leaky gut. Well, it doesn’t work so well. After rifaximin treatment, the patients are tested at six weeks, 50% had SIBO again. The further out you go, of course, more and more will have SIBO. If you use the proper probiotic treatment, at six weeks, only 20% will have SIBO. That’s quite a difference. Quite a difference.


HEAL THE GUT. To heal the gut, you increase secretory IgA. (sigA), you reduce the inflammation, you stimulate bile flow from the liver and gallbladder, which traps pathogens. You increase gut motility to get rid of the waste faster. AND you need to keep the bowels open. You’ve got to get that stuff out.

There’s something called EpiCor. As you can see here, there’s a placebo and there’s EpiCor. We’re looking at what happens to these CD 25 and CD 69. These are good guy, protective chemicals in the gut related to secretory IGA, which is very important for protecting it. You can see what happens with the placebo and then you can see what happens with EpiCor. It’s brilliant.

There is tissue swelling. This was changed in Paw Volume. This was for a dog. You can see the difference in placebo versus EpiCor. The swelling here was about 40%, and with EpiCor, it was 10%. Crazy.

Large intestine pathologies. You’ can have constipation, diverticulitis., appendicitis, irritable bowel disease, ulcerative colitis, and Crohn’s. I’m not going to have really time to go into those today. I may go into them in the future, but we covered SIBO (small intestinal bacterial overgrowth), SIFO (Small intestinal fungal overgrowth). EPI (Pancreatic insufficiency) and leaky gut. We got through a lot today. I take a couple of days to teach this class when I’m teaching acupuncturists, so I’m going to leave it at small intestine pathologies.

If anybody’s interested in any of these other issues that I have up here. Go ahead and send me a note, and we’ll talk about it or I’ll post it.


We have a question. Does high pH water aid in digestion?

No, not really. High pH water has a lot of value potentially, but anything that makes the stomach itself more alkaline can reduce digestion, particularly of proteins. Again, you see a lot of claims for a lot of stuff, and I’m just speaking really off the top of my head. I am not bringing to mind any high-quality science to this. So take what I’m saying, definitely with a grain of salt. I would not use high alkaline because I want the stomach to be as acidic as possible.

Any other questions? No.

As my teacher used to say, “No questions means, There are so many questions out there, you don’t even know where to start.” So send us some questions – Anything you want me to talk about.

Next week, I am going to take kind of a deep dive on thyroid because so many people have thyroid difficulties, known and unknown. I want to thank you all for tuning in.

Be happy. Be healthy. Thank you.



Dr. John Nieters L.Ac, DAOM, is an acupuncturist, Chinese herbalist, functional medicine, writer, teacher, and leader in the community. In this episode, John talks about his experience with the importance of finding your vision and purpose in life, in order to create the right goals for you.

Disclaimer: Dr. John Nieters received his Doctor of Oriental Medicine and Acupuncture degree from Five Branches. His use of “doctor” or “Dr.” in relation to himself solely refers to that degree. Dr. Nieters is a licensed acupuncturist in California. This video is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Nieters and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. TheBalancingPoint.net, Alameda Acupuncture, and Dr. John Nieters L.Ac, DAOM are not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this video or site.

Leave a Reply

Up ↑