The SIBO Doctor Podcast

Part 1 of the conversation with Dr Paul Anderson all about biofilm and SIBO. Dr Anderson is a Naturopathic Doctor and medical director of the Advanced Medical Therapies Clinic focusing on the care of patients with cancer and chronic disease.  Former positions include Professor of Pharmacology and Clinical Medicine at Bastyr University and Chief of IV Services for Bastyr Oncology Research Centre.  Dr Anderson is a graduate of NCNM and began instructing classes at naturopathic medical schools in the early 1990s.  He continues to hold board review classes and CME courses for most of the Canadian and US ND programs and continues his educational outreach through www.consultdranderson.com. Apple Users How to leave us a review on your iPhone or Ipad Open Apple's Podcast app. Go to the Search tab. Enter ‘The SIBO Doctor Podcast’. Tap ‘Search’ on your keypad. Tap the SIBO Doctor icon when it comes up. Tap the Reviews tab. Scroll down to ‘Ratings & Reviews’ Tap the stars to leave a rating Tap ‘Write a Review’ to leave a review’ Hit send   Android Users How to leave us a review on your device Open stitcher Go to the Search tab. Enter ‘The SIBO Doctor Podcast’. Hit search Tap the SIBO Doctor icon when it comes up. Scroll down to ‘Be the first to review this show’. Tap the stars to leave a rating Enter your review Hit ‘Post Review’  

In today’s episode, Dr Nirala Jacobi is in conversation with renowned SIBO specialist, Naturopathic Gastroenterologist and Professor, Dr Steven Sandberg-Lewis.   Dr Sandberg-Lewis is a highly regarded and well known naturopathic physician. He has been a professor at the National University of Naturopathic Medicine (NUNM) since 1985, in Portland, Oregon.  Dr Sandberg-Lewis has a part-time clinical practice and is the author of several Townsend Letter award-winning articles, and of the medical textbook ‘Functional Gastroenterology: Assessing and Addressing the Causes of Functional Gastrointestinal Disorders’.  He has also been named one of the Top Docs in Portland Oregon in 2014.   Topics discussed include: How are proton pump inhibitors (PPI) related to SIBO? How the 3 main secretions at the upper gate of the small intestine are bacteriostatic, and how hypochlorhydria and PPI use can support SIBO development. Heidelberg testing and Weakly Acid Reflux. How alkaline reflux can trigger the same symptoms as acid reflux. Loss of stomach mucosa in the absence of the acidic trigger. Atrophic gastritis - what is it and how common is it? Is reflux after meals normal? Esophagitis - what causes it and what is it? The role of alkaline saliva in bathing the esophagus to help neutralise acid that may come up. Leaky mucosa in the stomach, the connection to PPIs, and the link to food intolerances and allergies. Dilated intercellular spaces (DIS) in the oesophagus and superficial nerve irritation in the oesophagus. Do we use the same leaky gut healers for the upper gut - the stomach and DIS? Dry mouth as a symptom of anxiety and sympathetic dominance, and the importance of relaxation in prompting saliva to bathe the oesophagus. Dr SSL and Dr Jacobi use therapies including glutamine, zinc carnosine, n-acetyl glucosamine, gamma oryzanol, quercetin, and demulcents to help heal DIS. If a client has slight Barrett’s or erosive esophagitis and is put on lifelong PPIs, is this the appropriate course of action to support? How do we slowly wean people off PPIs? Sliding hiatal hernia and the possible cause of reflux. What is the difference between hiatal hernia syndrome and an actual hiatal hernia? Advanced diabetes and issues related to autonomic neuropathy, such as silent reflux. Laryngopharyngeal reflux, the typical symptoms to look out for, and conditions it is linked to. Enlarged tonsils and the connection to laryngopharyngeal reflux. How do we test for low stomach acid? Riddler’s reflex point for stomach acid. Pectoralis major test for hypochlorhydria. Heidelberg test. Bile Reflux - what causes it? Dysplasia and cancer of the lower oesophagus and the theory linking these conditions to duodenal gastroesophageal reflux. What treatment can we do for Bile Reflux? The importance of endorphins and enkephalins in the contraction of the sphincters in the body. Chapman’s reflex point to improve the tone of the pylorus (taught by Dr SSL in the GI practicum in November) Nutrients to help to heal Barrett’s and prevent cancer include selenium, turmeric, green tea catechins, anthocyanidins (found in berries and colourful fruits and vegetables). Top causes of reflux to pay attention to besides SIBO: Hiatal hernia Hiatal hernia syndrome Pancreatic insufficiency Spasmodic diaphragm Anxiety, or conditions that decrease client’s saliva or makes saliva more acidic (eg sjogren’s, elderly) Digestive Support for lack of saliva production Use zanthoxylum (prickly ash) - 1-2 drops on the tongue, and/or bitters as a digestive stimulant. Pilocarpine lozenges What is Dr SSL’s opinion on methane and PPI use - being there there is potential for PPI users to have less methane output, and conversely for Hydrochloric Acid (HCl) users to have increased methane production. What is the appropriate dose of HCl for patients and should we use capsules or tablets? The combination use of bitters plus HCl. Rebound hyperacidity - why can it occur after taking PPIs? Buteyko breathing for upper digestive symptoms.   Resources GI Practicum in Australia on 10th-11th of November 2018 Reserve your spot Healing Leaky Gut, stomach, and DIS Dr SSL and Dr Jacobi use therapies including glutamine, zinc carnosine, n-acetyl glucosamine, gamma oryzanol, quercetin, and demulcents. Dr Steven Sandberg-Lewis Medical textbook - Functional Gastroenterology: Assessing and Addressing the Causes of Functional Gastrointestinal Disorders by Dr Steven Sandberg-Lewis Mim Beim Buteyko breathing for upper digestive symptoms  

In this episode, Dr Nirala Jacobi is in conversation with Heidi Turner about the SIBO Histamine Bi-Phasic Diet and SIBO treatment. Heidi is a medical nutrition therapist at the Seattle Arthritis Clinic at Northwest Hospital UW Medicine in Seattle, Washington.  She counsels those with autoimmune, inflammatory, and degenerative diseases in an effort to decrease their pain through dietary change. She specialises in food intolerances, SIBO, mast cell activation syndrome, histamine intolerance and natural food chemical sensitivities. Topics discussed include: The release of the SIBO Histamine Bi-Phasic Diet (available for free to practitioners) in July 2018. Histamine intolerance and what Heidi sees in her practice. Why has the Biphasic Diet for Histamine Intolerance been created? The SIBO Inflammation relationship to compromised diamine oxidase (DAO) and the impact on patient histamine levels. Symptoms of high histamine. The issue with low FODMAP diets in relationship to histamine. Histamine-containing foods versus histamine liberating foods. Foods high in histamine. How histamine levels increase in food. Which histamine liberating foods are the most problematic? How to reintroduce histamine foods and histamine liberators into the diet. Patient reactivity to treatment and how to tailor. Therapeutic diet timeline. Where does the Biphasic Histamine Diet fit into SIBO treatment? Decreasing high histamine load rather than eliminating all high histamine foods all the time. Heidi’s experience in using the Biphasic Diet for Histamine Intolerance.   Resources Heidi Turner - available for in person and digital appointments. Food Logic In person clinical consultations available at The Seattle Arthritis Clinic Upcoming LIVE webinar to be co-presented by Dr Nirala Jacobi and Heidi Turner on the Biphasic Diet for Histamine Intolerance as a therapeutic tool: How to implement the diet properly How to move out of the diet Webinar session times with LIVE Q & A afterwards Live session - Thursday, July 12th, 2018 in America Live session - Friday, July 13th, 2018 in Australia Digital copy post-event available on com Dr Nirala Jacobi’s 2018 Biphasic Diet Join The SIBO Doctor Practitioner forum on Facebook to connect with other practitioners and to be part of the conversation. The SIBO Specific Diet from Dr Allison Siebecker  

In today’s episode, Dr Nirala Jacobi welcomes back Dr Jason Hawrelak, to talk about Microbiome Restoration. Dr Hawrelak is a researcher, educator, naturopath, and nutritionist with over 16 years of clinical experience.  He also practices at Gould’s Natural Medicine - a 135-year-old natural medicine apothecary and clinic in Hobart, Tasmania, Australia. Dr Hawrelak completed his PhD examining the capacity of probiotics, prebiotics, and herbal medicines to modify the gastrointestinal tract microbiota.  He is the senior lecturer in Complementary and Alternative Medicines at the University of Tasmania’s School of Medicine where he coordinates the evidence-based complementary medicines programs.  Dr Hawrelak also teaches the gastrointestinal imbalances unit, within the Masters of Science and Human Nutrition, and Functional Medicine Program at the University of Western States, in Portland, Oregon.   Topics discussed include: The SIBO Doctor courses Microbiome Restoration - coming soon Regrowing vs killing in the microbiome. Colonic collateral when we are dealing with SIBO, and the necessity to restore the colonic ecosystem as part of the SIBO treatment. How do we learn to interpret the DNA readings and PCR reports? The SIBO Doctor Microbiome Restoration course A discussion of the modules offered in the Microbiome Restoration course Module 1 - Testing The difference between different labs Culturing vs DNA techniques Assessment, Interpretation, and Diagnosis Module 2 - Beneficial Bacteria, including Akkermansia Faecalibacterium prausnitzii Butyrate-producing microbes Hydrogen sulfide gas producers Module 3 - Pathobionts The good, the bad, the ugly Hydrogen sulfide producers Methanobrevibacter smithii coli Bacteroides Triple antibiotic therapy (for conditions such as H. Pylori and Blastocystis Hominis) and the impact on the colonic ecosystem balance of symbionts and pathobionts. Dietary changes vs probiotic supplements to elicit change in the gut microbiome. The complications between advising prebiotic nutrition for optimising microbiome restoration, whilst clients are on therapeutic diets such as the Low FODMAP diet - how to reconcile? Hydrogen sulfide breath testing - coming soon. High-fat content diets in SIBO, and how this can eventually feed hydrogen sulfide producing bacteria. Symptoms such as food reactivity and visceral sensitivity as a consequence of dietary choices in SIBO treatment, in regards to hydrogen sulfide producing bacterial blooms. The therapeutic benefits of Soy Isoflavones in relation to Methane and Hydrogen Sulfide producing SIBO patients. Equol producers - patients who have bacteria that convert soy isoflavones into the bioactive component, Equol. Adlercreutzia levels in people who eat soy products as a long-term dietary choice. Is there a connection between histamine intolerance, salicylate intolerance, and oxalate intolerance and microbiome disturbances? Post SIBO treatment food sensitivities - the colonic microflora patterns to observe. Hydrogen sulfide gas and how it causes visceral sensitivity, gut leakiness, and inflammation in the nerves. Dietary changes with people with sensitivities - a reiteration of start low, go slow. Is there any clinical significance to oxalobacter formigenes being elevated? What is the dietary impact of the extinction of oxalobacter formigenes? Testing levels of Proteobacteria to uncover the innate endotoxin load (proteobacteria - gram-negative bacteria that secrete proinflammatory endotoxins). The systemic repercussions of endotoxemia - leaky blood-brain barrier, gut damage, insulin sensitivity impacts, systemic inflammation, Alzheimer's, anxiety and depression links. Endotoxin (also known as Lipopolysaccharides - LPS) absorption and high-fat How do different Phyla respond to different diets? Potential outcomes of the ketogenic diet depending on the dietary nuances - decreased microflora diversity, increased hydrogen sulfide gas-producing bacteria, and increased numbers of proteobacteria. Akkermansia and constipation - why are these often seen together? Gut inflammation and mucus tend to increase Akkermansia if it is there - it is a mucin eater. Gut markers of inflammation, such as calprotectin. The vocabulary to use around probiotics - not re-seeding, but rather restoring. The importance of lactic and acetic acid production adjusting the pH of our microbiome to be hospitable to beneficial bacteria. D-Lactate considerations. Biogaia effectively reducing methane production, and also being used alongside proton pump inhibitors (PPIs) to prevent the development of SIBO. PPIs - when to use and when not to - listen to Dr Steven Sandberg-Lewis’ podcast on SIBO and Functional GIT Exam Skills. Plantarum LP8 is being used in research to decrease Desulfovibrio, increase butyrate and bifidobacterium - can we use other strains of L. Plantarum to elicit similar changes? Plantarum strains to use in gut rehabilitation. Reuterin production. Dr Hawrelak’s antimicrobial and dietary recommendations for treating Desulfovibrio.   Resources Dr Hawrelak Probiotic Advisor Gould’s Natural Medicine   The SIBO Doctor Microbiome Restoration Course with Dr Jason Hawrelak [Opens 13 June] Sign Up for the Course and Live Q & A with Dr Hawrelak The SIBO Conference New Orleans - speakers mentioned Dr Richard McCallum Dr Matthew Bohm   Labs mentioned Ubiome - microbiome DNA testing Genova   Dr Satish Rao SIBO and comorbid SIFO D-Lactic Acidosis researcher   Dr Steven Sandberg-Lewis Dr Steven Sandberg-Lewis’ podcast on SIBO and Functional GIT Exam Skills  

In today’s episode, Dr Nirala Jacobi is in conversation with Kayle Sandberg-Lewis.  Kayle recently gave a lecture at the New Orleans SIBO conference on traumatic brain injuries (TBI) and SIBO.   Kayle holds a master’s degree in Behavioral Medicine and has a private practice specializing in acquired brain injuries, anxiety and stress-related disorders. In recent years, she has been exploring the link between brain injuries and gastrointestinal disorders.   Board-certified by the Biofeedback Certification International Alliance as a Neurofeedback Practitioner, she is also trained in peripheral biofeedback. Kayle has several tools at her disposal to help the disordered brain calm itself and function more optimally thereby leading to improved vagal tone.   Kayle serves as adjunct faculty at the National University of Natural Medicine where she created the Applied Psychophysiology track in the Master of Science in Integrative Mental Health.   Topics discussed include: How Kayle entered the traumatic brain injury field. SIBO, the migrating motor complex, and how TBI can impact this. Differentiating parasympathetic and sympathetic nervous system dominance. The risks of sympathetic dominance to the digestive system. What common injuries are actually classed as TBIs, and how might this contribute to gastrointestinal health? The cumulative effect of minor head injuries.

In today’s episode, Dr Nirala Jacobi is in conversation with gastroenterology specialist, Dr Eric Yarnell.  Dr Yarnell graduated from Bastyr University in 1996.  He served as a senior and associate editor of the Journal of Naturopathic Medicine, he was a founding member and former president of Botanical Medicine Academy in Seattle, and he is also the president of Heron Botanicals - a herbal pharmacy providing hand-crafted whole plant extracts exclusively to healthcare providers, he is on the editorial board of the International Journal of Naturopathic Medicine, and is the author of numerous texts and articles.  Dr Yarnell wrote the Natural Approach to Gastroenterology, which Dr Jacobi often uses as a clinical reference, and he is also a urology and men’s health specialist.

UPDATE! New Event! Functional Gastroenterology Practicum with Dr Steven Sandberg-Lewis and Dr Nirala Jacobi, The SIBO Doctor Registration Now Open Limited to 100 Seats. Early Bird Available. 10-11 November 2018 Tweed Heads, NSW Australia   Dr Nirala Jacobi is in conversation with Dr Steven Sandberg-Lewis.  Dr Sandberg-Lewis is a highly regarded and well known naturopathic physician. He has been a professor at the National University of Naturopathic Medicine (NUNM) since 1985, in Portland, Oregon.  Dr Sandberg-Lewis has a part-time clinical practice and is the author of several Townsend Letter award-winning articles, and of the medical textbook ‘Functional Gastroenterology, Assessing and Addressing the Causes of Functional Digestive Disorders’.  He has also been named one of the Top Docs in Portland Oregon in 2014.   Topics discussed include: How did Dr Steven Sandberg-Lewis (Dr SSL) first learn about SIBO? Gastrointestinal conditions with underlying connections to SIBO, such as Nonalcoholic Steatohepatitis (NASH), and Crohn’s Disease. EXCLUSIVE EVENT November 7th - 8th, 2018 in Australia (Gold Coast TBA) 2 Day Functional Gastroenterology Physical Exam workshop, in person, with Dr SSL. thesibodoctor.com for more information 100 participants only What else can we expect from the Functional Gastroenterology Physical Exam workshop? Reflex point assessment Combination techniques Secretion points Bennett’s points on the cranium and abdomen How to learn if the ileocecal valve is open or closed Riddler’s points Physical exam for gastroenterology - how to assess your patients. Visceral techniques such as manual correction of hiatal hernias. The prevalence of hiatal hernias in different populations and what it can cause, e.g. reflux, anxiety, constipation issues, diaphragmatic issues. What is the difference between a true sliding hiatal hernia and hiatal hernia syndrome? What symptoms can be expected with sliding hiatal hernia, and how does it relate to SIBO? Who first developed this technique? Emotional Freedom Technique (EFT) Kinesiology in relationship to Functional Gastroenterology Physical Assessment Quantum Reflex Analysis use in the clinical setting. Manual corrections of the digestive tract Ileocecal valve manoeuvre as related to SIBO. Ehlers-Danlos Syndrome and the hypotonic ileocecal valve. Reasons for tenderness of the ileocecal valve on physical exam. Dr SSL’s clinical experience of ileocecal valve corrections. Hiatal hernias and the link to arrhythmias. Ileocecal valve tone and the relationship to adrenal function. Dr Jacobi’s advice for documented hiatal hernia patients 500mL of water in the morning on an empty stomach, then do 20-30 heel drops. The weight of the water will pull the stomach back down. Exercises to do after the hiatal adjustment to assist visceral compliance ongoingly. The link between the client’s emotional body and their physical conditions, and how to integrate this into a clinical setting with the physical Neurofeedback - the importance of points Fp1 and Fp2. The link between constipation, hiatal hernia, and anxiety. Neuro-Emotional Technique (NET) for emotional clearing.   Resources Dr Steven Sandberg-Lewis Medical textbook Functional Gastroenterology, Assessing and Addressing the Causes of Functional Digestive Disorders by Dr Steven Sandberg-Lewis EXCLUSIVE EVENT November 7th - 8th, 2018 in Australia (Gold Coast TBA) 2 Day Functional Gastroenterology Physical Exam workshop, in person, with Dr SSL. thesibodoctor.com for more information 100 participants only Dr Mark Pimentel Dr Allison Siebecker Quantum Reflex Analysis Dr Jacobi’s advice for documented hiatal hernia patients 500mL of water in the morning on an empty stomach, then do 20-30 heel drops. The weight of the water will pull the stomach back down.  

Please leave us a review on your Apple device Open Apple's Podcast app. Go to the Search tab. Enter ‘The SIBO Doctor Podcast’. Tap ‘Search’ on your keypad. Tap the SIBO Doctor icon when it comes up. Tap the Reviews tab. Scroll down to ‘Ratings & Reviews’ Tap the stars to leave a rating Tap ‘Write a Review’ to leave a review’ Hit send   Android users – we’ve got you covered via Stitcher for Android phones.  Visit https://www.stitcher.com/podcast/the-sibo-doctor   Dr Nirala Jacobi is in conversation with Dr Lela Altman on the topic of the Elemental Diet.  Dr Altman presented at the 2017 SIBO Symposium, and in 2018 at The Gastroenterology Association for Naturopathic Physicians, on the topic of the Elemental Diet. Dr Altman is a Naturopathic Doctor, she has a private practice and also lectures at Bastyr University in Seattle.  Dr Altman is also an Acupuncturist.  Her interests include gastrointestinal disorders, east asian medicine, diabetes, and cardiovascular disease. Topics discussed include How did Dr Altman get into the field of SIBO with a special interest in Elemental Diets? The Elemental Diet is a highly effective standalone antimicrobial treatment, on par with conventional antibiotics or herbal antimicrobials. What are the components of the Elemental Diet? What makes it different from medical food replacement products such as Mediclear or powders that aim to heal the gut? Proteins are in the form of amino acids only, and there are no other food products in the formula. The nutrients are predigested - you do not need to break anything down. Fats in the form of oil, medium chain triglycerides (MCTs). Carbohydrate component is either dextrose or maltodextrin. Starches may be included. Essential vitamins and minerals. No fibre. Contraindications for the Elemental Diet include A history of disordered eating Underweight patients (however patients can gain weight on the Elemental Diet due to ease of absorption of nutrients) Caution in diabetes due to higher simple carbohydrate and sugar content. Caution for known fungal overgrowth or signs or symptoms. If using, use in combination with antifungal treatment - Dr Jacobi always uses an antifungal with the Elemental Diet. How can people get the Elemental Diet for their patients? Vivonex - Nestle product (not recommended) Integrative Therapeutics Physicians’ Elemental Diet Dr Allison Siebecker’s homemade Elemental Diet Possible complications encountered with prescription of the Elemental Diet. Blood sugar dysregulation Weight loss Intolerable flavour Nausea Diarrhoea Die off reactions Constipation Abdominal pain What happens for 2 versus 3 weeks for patients on the Elemental Diet? 80% effective after 2 weeks 85% effective after 3 weeks No more effective for 4 weeks Protocol Elemental Diet shakes - 6 per day, or daily amount divided up to have less day every hour. Drinks allowed - water, (sometimes) dilute black coffee or black tea. SIBO testing patient with same day breath test - if still positive, continue for one more week, if negative, transition off the Elemental Diet.   Transitioning off the Elemental Diet General Keep using some of the Elemental Diet shakes for calories as patient transitions. Consider using Elemental Diet as the elimination phase of an Elimination Challenge Diet (eliminate all high allergenic foods for 2 weeks and then reintroduce one every 3 days, if tolerated add back in, if not tolerated keep it out) Day 1 Slow introduction of foods starting with broths (be aware that some SIBO clients do not do well with cartilage bones due to the high histamine in glycosaminoglycans. If this is the case, use only marrow bones or meat broth). Start patients with Low FODMAP diet for approx 3 days, well cooked vegetables, avoiding raw foods. If candida suspected, avoid simple carbohydrates. Day 2 Continue with well-cooked Low FODMAP vegetables and broth. Congee addition (if no yeast overgrowth) - rice soup with chicken / vegetables. Add cooked meats, fish, eggs, grains. Day 3 Transition to a simple Low FODMAP diet or Dr Jacobi’s Bi-Phasic Diet   If SIBO breath test is negative start challenging the Low FODMAP diet as described with Elimination Diet Challenge above.   Same day retesting available in Australia with com Notify the lab before sending the test for fast-tracking Overnight the test back to com What are common symptoms that are usually no cause for alarm? Constipation (due to no fibre intake) Bowel movements can change largely - client is not eating enough food to pass on a regular basis. Great therapeutics include magnesium, herbal laxatives, suppositories, enemas. Nausea Can start within first couple of days and usually then goes away. Solution is to dilute formula a bit more if you can. Can be due to vitamins and supplements taken in addition to Elemental Diet. Recommendation to discontinue non-essential supplements. If using Dr Siebecker’s Formula, switch to the lower fat higher carb option, as the high fat option can cause a bit more nausea. Bowel changes May notice passing stools of dry grey powder - if formula used is powder. Diarrhoea - could be a reaction to something in the formula (look to corn oil, soy oil). Treat for dehydration - keep them hydrated and advise sipping formula slowly throughout the day (which also assists blood sugar regulation). What to do to improve flavour of the homemade Elemental Diet? Options may include: Stevia Flavoured magnesium powder (use caution here with appropriate quantity). Extract drops, such as almond, peppermint etc. Blend with ice. Use a cup with a straw so as to not smell it. Do not let it sit out for more than the time that it is being consumed. The Half Elemental Diet Not used for SIBO treatment Can be used for providing bowel rest for anyone in an inflammatory bowel flare. Can be used to increase caloric intake for someone who is requiring hypoallergenic caloric supplementation (a few days to a week’s duration) - used as a caloric and nutritional booster for those with extreme food sensitivities. Additions If client is getting hungry on having the Elemental Diet - add coconut or MCT oil to formula to increase calories. Dr Altman’s opinion on using the Elemental Diet in the daytime and eating meat at night? The difference between meat protein and elemental diet protein - the latter is in a free form and are therefore rapidly absorbed and not much reaches the colon. Initiate prokinetics immediately at completion of Elemental Diet to inhibit regrowth of SIBO. Consider low dose antimicrobial herbs at completion of Elemental Diet to inhibit regrowth. Consider that stomach acid is killing most of the bacteria that we ingest - support this if necessary. Consider the underlying root cause of client’s initial SIBO and keep that managed to prevent relapse. Dr Altman’s clinical pearls re The Elemental Diet. The cost of a 2-week course of The Elemental Diet Example at 6 shakes per day of Physicians’ Elemental Diet it comes to approximately $650 USD. No need for hunger - patients can have as many shakes as they want.     Resources Dr Lela Altman Dr Altman’s talk Elemental Diet Webinar with CME available. Bastyr University Digestive Wellness Clinic in Seattle, Washington. Private Practice in the Bastyr Centre for Natural Health. Dr Pimentel Elemental Diet options Integrative Therapeutics Physicians’ Elemental Diet Dr Allison Siebecker’s homemade Elemental Diet Vivonex - Nestle (not recommended) Elemental Diet components Jo Mar Labs Black Label 21 Blend for amino acids Same day retesting available in Australia with com Notify the lab before sending the test for fast-tracking Overnight the test back to com Dr Jacobi’s Bi-Phasic Diet Dr Allison Siebecker’s SIBO Specific Diet Specific Carbohydrate Diet (SCD)        

In today’s episode Dr Nirala Jacobi is in conversation with Dr Ilana Gurevich on the topic of inflammatory bowel disease (IBD) and small intestinal bacterial overgrowth (SIBO).  Dr Gurevich is a naturopathic physician and acupuncturist who graduated from the National University of Natural Medicine in 2007 and 2008.   She is currently co-owner of two large integrative medical clinics, one in northwest Portland and one in northeast Portland.  Dr Gurevich also runs a very busy private practice specializing in treating inflammatory bowel disease as well as irritable bowel syndrome (IBS), SIBO and functional digestive disorders.      She lectures extensively and teaches about both conventional and natural treatments for inflammatory bowel disease as well as SIBO.  She is one of the foremost experts on the intersection of IBD and IBS and how treating one resolves the other.  Dr. Gurevich also acts as a mentor in the naturopathic community educating about GI disorders.  She supervises residents and consults with physicians about their most difficult GI cases.  Dr. Gurevich was nominated as one of Portland Top Docs by the Portland Monthly in both 2014 and 2016. Topics discussed include: How did Dr Gurevich come to specialise in IBD? How acute flares of IBD can be related to SIBO. In relation to small bowel Crohn’s and small bowel Ulcerative Colitis. Testing Dr Gurevich uses for IBD Fecal calprotectin (before getting colonoscopy/gastroscopy) Stool collection to test for leukocytes within the small bowel, giving an accurate sense for how much inflammation is in the intestine. Useful for Crohn’s and Colitis. Colonoscopy Gastroscopy Comprehensive digestive stool analysis (CDSA) - Doctor’s Data GI Health Panel - DiagnosTechs What kind of flora is in there? Are there parasites, yeast, and assessing food breakdown? ParaWellness Research - parasitologist Dr Jacobi uses Genova GI Effects for the PCR testing and microbiome assessment for anaerobes that could not previously be cultured out. Carroll Food Intolerance Testing Dr Gurevich’s view of food allergy testing for IBD patients. Microscopic colitis - what is it? What is its main symptom? Lymphocytic Collagenous Parallels with Coeliac Disease. Clinical pearl - if client is having greater than 10 bowel movements a day look into microscopic colitis and other possible conditions. How to use Budesonide (steroid) for a 3-5 month window, to address microscopic inflammation. Budesonide not as systemic as prednisone, and can be used concurrently to naturopathic care to continue to heal the intestine whilst client tapers off the Budesonide. Does microscopic colitis also show elevated fecal calprotectin? Diagnosing microscopic colitis with colonoscopy or sigmoidoscopy. How is ileocecal valve pressure associated with SIBO? IBD recalcitrant population and why they are more susceptible to SIBO. Bacterial translocation from the large bowel flora into the small bowel and how ileocecal valve scarring increases SIBO susceptibility. How to assess ileocecal valve pressure. Colonoscopy (although not included with a standard colonoscopy). 20% of people are found to have open ileocecal valves. Why? How else is the ileocecal valve scarred? Upcoming workshop in Australia - November 2018 - Dr Steven Sandberg-Lewis on physical exam skills of functional digestive disorders - how to free a stuck open or stuck closed ileocecal valve, the hiatal hernia manoeuvre, and a plethora of other techniques. Lower esophageal sphincter is part of the diaphragm - valvular relaxation treated with Buteyko Breathing. Does Dr Gurevich see much hydrogen sulfide dominant SIBO with IBD patients? Various assessment techniques for the complex hydrogen sulfide dominant SIBO. uBiome Genova GI Effects Flatlining on a SIBO breath test The use of biologic agents in IBD as TNF Alpha inhibitors e.g. Remicade as an IV infusion, Humira as a subcutaneous injection, Cimzia (the only one safe in pregnancy). Biosimilars - generic biologics - about to be launched in the States. Upcoming course with Dr Gurevich for the natural treatment of IBD in 2018 via The SIBO Doctor Education Centre. The body has the potential to treat the biologic agent in the same way as it treats the intestine if the person has IBD - practitioners MUST fully educate the client of the risks of going on or off the biologic agent. What are the increased risks with use of biologic agents? Acute flare treatments that Dr Gurevich uses for Crohn’s, Ulcerative Colitis, or both. Rectal ozone - extremely anti-inflammatory and extremely fast acting. Elemental diet - as effective as steroids. Specific carbohydrate diet - SCD Intro included. If no improvement then movement towards steroids to treat acutely. Maintenance treatments that Dr Gurevich uses for Crohn’s, Ulcerative Colitis, or both. Carroll test for dietary triggers SIBO test for underlying cause ParaWellness test for underlying cause GI Lumen healing - seacure hydrolysed white fish protein, high dose resveratrol, glutamine, CBD and THC, colostrum, Physica GALT fortifier (Dr Gurevich’s new favourite). Always focus on digestive support - enzymes, hydrochloric acid, probiotics (e.g. saccharomyces boulardii for diarrhoea regulation), apple cider vinegar. IV nutrition to help clients who have been ill for a very long time. Do parasites play a role in IBD? Dr Gurevich’s experience with butyric acid enemas. Dr Gurevich’s position on conventional antibiotics for IBD patients.   Resources Dr Ilana Gurevich Portland, Oregon Kwan Yin Healing Arts Centre Phone consults available Dr Mark Pimentel Mim Beim - Buteyko Breathing Australia Buteyko Clinic International Greg Nigh - Hydrogen Sulfide Expert Dr Jason Hawrelak - Microbiome Expert and Founder of clinical tool - Probiotic Advisor Dr Mona Morstein - Diabetes expert Physica GALT fortifier   Testing discussed Fecal calprotectin Comprehensive digestive stool analysis (CDSA) - Doctor’s Data GI Health Panel - DiagnosTechs ParaWellness Research Genova GI Effects Carroll Food Intolerance Testing uBiome   Upcoming courses (2018) November 2018, Australia - Dr Steven Sandberg-Lewis on physical exam skills of functional digestive disorders via the SIBO Doctor Education Centre. 2018, Digital - Dr Gurevich for the natural treatment of IBD via the SIBO Doctor Education Centre.    

Dr Greg Nigh co-founded the Immersion Health Centre in 2014 after completing the Naturopathic Doctor program, and the Master of Science and Oriental Medicine Program.  During his early years of work, he developed his interest and passion for researching and implementing alternative cancer therapies.  Dr Nigh has spoken several times at the annual convention of the American Association of Naturopathic Physicians and the National Conference of the Oncology Association of Naturopathic Physicians on cancer cell metabolism.  Dr Nigh is a prolific reader, researcher, and writer and has also contributed a chapter to the upcoming two-volume Foundations of Naturopathic Medicine textbook.   Recently Dr Nigh and Dr Jacobi both presented on the SIBO SOS Summit.  Dr Jacobi loved Dr Nigh’s talk on hydrogen sulfide and has invited him on the show to discuss sulfur metabolism and his unique ideas about hydrogen sulfide and sulfur imbalances.   Topics discussed include: How did Dr Nigh come to specialise in sulfur? All about sulfur metabolism. Sulfur chelates so well that it can get bound up in our bodies with toxic things. The GAPS diet, how it has high sulfur content, and why some patients may not feel well on the GAPS diet. Sulfur issues as the ‘canary in the coalmine’ of toxicity issues in general. How the demand for sulfur is higher due to increased exposure to pollutants in modern life, and the impact this has on sulfur binding throughout the body and not just in phase 2 liver detoxification. How does endogenous sulfur processing, and sulfur production and reduction by certain gut bacteria, connect? Sulfur exposure is all dietary, and is metabolised to sulfate in the body. Sulfate is required in the body in a constant supply, and sometimes the metabolism of sulfur to sulfate is hindered. Heparan sulfate - every surface is in the body is lined with this. Elements that sulfur is used to build in the body. The primary, and alternative, pathway/s of sulfate production. Cystathionine beta synthase (CBS) pathway, what it generates (hydrogen sulfide) PAPS - the activated form of sulfate, and the pathways the body uses to get it. When people are reactive to sulfur or sulfur containing foods or thiols, they are not having an efficient process that ends up in PAPS - what are they reacting to in the pathway? If people cannot get the end product PAPS, then people can overgrow the sulfur fixing bacteria so that they produce higher levels of hydrogen sulfide and sulfide, which can be directly oxidised into sulfate by the mitochondria in the body. Dr Nigh’s view is that the overgrowth of hydrogen sulfide bacteria can be seen as an adaptive overgrowth. How to reduce desulfovibrio with diet. Reasons why sulfate production can be shut down, one being glyphosate - a direct hit to sulfate production in the body, chelation of minerals that are needed for sulfur production, interference of specific amino acids involved in the sulfur cycle, and more. The impact of glyphosate on the sulfur production in the body is profound. Glyphosate - a toxic herbicide, the active ingredient in roundup. Glyphosate chelates molybdenum. We need tiny amounts of it, and if we only need tiny amounts it does not take much to chelate and use it up. Dr Nigh’s view on testing. Patient symptom red flags that point to sulfur issues, for example: Hydrogen sulfide is a vasodilator, so has links to orthostatic hypotension. Any gut issues - warrants sulfur issue suspicion. Alcohol sensitivity Red, hot presentation Brain fog Histamine and sulfur overlaps. Histamine issue symptoms. Dr Nigh’s protocols for enhancing sulfate production from sulfide. Taking the patient off sulfur foods for a week then gradual reintroduction. Detoxification protocols Infrared sauna Molybdenum supplementation Biotics Mo-Zyme Forte - food based tablet based on sprouted lentils 150mcg molybdenum Tablet chewed 2 times per day For those with bloating or gut issues Biotics Bio HPF - bismuth, demulcents, and others. Bismuth reduces hydrogen sulfide production in the gut. Butyrate The most underrated gut nutrient that there is. Biotics Butyric-Cal-Mag Apax EnteroVite Digestive enzyme Hydroxocobalamin injections or sublingually to lower hydrogen sulfide in the blood. Zinc acetate as a binder for hydrogen sulfide Glyphosate strongly chelates zinc. Detox support, coffee enemas, colonics, epsom salt baths (magnesium sulfate) - increasing sulfate transdermally, adrenal support if indicated Epsom salts (4 cups per bath) - a way to get sulfate in without the reactivity of digestion. Sensory deprivation tank option. Dr Yarnell’s low sulfur diet Thiols and Dr Nigh’s opinion on their reactivity for people. Red meat is the highest dietary source of sulfur and yet does not seem to have many people reacting to it, whereas garlic does. Why is this? Foods to watch - eggs, onion, kale, garlic, cabbage, brussel sprouts, cabbage, brassica family. Kale accumulates the heavy metal thallium (from waste-water used for crops). Do Allicin extracts still elicit issues in people with sulfur issues? Highly important to include any sulfur food items that are tolerated for the sulfur content (required by body). Dr Nigh’s sulfur protocol and his success with SIBO patients. What is the connection between Dr Nigh’s success with methane dominant SIBO clients and the sulfur protocol? How might glyphosate toxicity play into this? Methanobrevibacter smithii - not a pathogen, why? SIBO bacteria - why do we only grow certain bacteria? Dr Nigh’s sulfur metabolism nuggets.   Resources Dr Greg Nigh Immersion Health Portland, Oregon drnigh@immersionhealthpdx.com SIBO SOS Summit Dr Yarnell Naturopathic Foundations of Gastrointestinal Diseases? Foundations of Naturopathic Medicine Biotics Research Mo-Zyme Forte Bio HPF Apax EnteroVite