In this episode, Dr Nirala Jacobi is in conversation with world class gastroenterologist Dr Lenny Weinstock about Small Intestinal Bacterial Overgrowth (SIBO) and its connection to different conditions in the body.

Dr Weinstock is board certified in gastroenterology and internal medicine, is the president of Specialists in Gastroenterology and the Advanced Endoscopy Centre, he teaches at Barnes Jewish Hospital and is an associate professor of clinical medicine and surgery at Washington University School of Medicine. Dr Weinstock is also a primary investigator at the Sundance Research Centre and has written more than 80 articles, abstracts, editorials, and book chapters. He is passionate about SIBO and its connection to different conditions, such as Restless Leg Syndrome and Rosacea.

Topics discussed in this episode include:

• Dr Weinstock's approach to SIBO treatment in his Specialists in Gastroenterology Clinic
• Relapse rate after Rifaximin use
  • Dr Mark Pimentel has mentioned relapse is hastened by adhesions - Dr Weinstock's take on this and Dr Weinstock's experience in his clinic.
• What are some triggers for SIBO?
  • Autoimmune Irritable Bowel Syndrome (IBS)
    • Post infectious IBS - damage to the migrating motor complex via an autoimmune attack on vinculin.
  • Anatomical reasons
  • Classical reasons
  • Surgical reasons
  • Adhesions
  • Postural orthostatic tachycardia syndrome (POTS)
  • Ehlers-danlos
• Preventative therapy for SIBO
• Rifaximin use with prokinetic therapy
• Bifidobacterium Lactis HN019 as a therapeutic prokinetic.
• Testing for anti-vinculin antibodies on SIBO patients.
• POTS
  • What's the connection to SIBO?
  • Why is the prevalence increasing?
• What is the connection between POTS and Mast Cell Activation Syndrome (MCAS)?
• Is there a potential for LPS and endotoxins to be travelling through nerves in the body?
• Restless Leg Syndrome (RLS), what it is, why do we get it, and what is the connection with SIBO?
• About hepcidin as an indicator of low serum iron in light of inflammation and how this is related to SIBO.
  • For example: iron as a substrate for bacteria and how the body may respond by upregulating hepcidin to withhold iron from bacteria.
  • Hepcidin as an antimicrobial peptide and its role in infectious diseases.
• The link between hepcidin and RLS.
• Why endorphins may be upregulated to protect the dopamine function in the brain in the setting of iron deficiency.
• Dr Weinstock's treatment strategies for RLS
  • What to do if patient is unresponsive to Rifaximin therapy in light of SIBO positive testing.
  • Low dose naltrexone (LDN) - its use in RLS.
• Low iron that does not respond to oral supplementation and the possible links to hepcidin.
• Biofilm therapy
• Exploring the 3 types of IBS in SIBO
  • IBS - D
  • IBS - M
  • IBS - C
• The potential for large intestinal bacterial overgrowth (LIBO) to skew a hydrogen rise in SIBO tests that show consistent high methane from baseline.
• Treatment discussion for IBS - C
• Dr Jacobi's recommendation of BioGaia Protectis reuteri probiotic for methanogen treatment.
  • 5 drops twice daily used in the study Dr Jacobi mentions.
• A couple of herbs Dr Jacobi uses for methane dominant SIBO treatment
  • Garlic
  • Myrrrh
• Dr Weinstock's clinical insights into the ileocecal valve (ICV) being chronically open and allowing reflux of bacteria up into small intestine from the large intestine.

Resources

• Dr Weinstock's Specialists in Gastroenterology Clinic
• BioGaia Protectis
• Bifidobacterium Lactis HN019 as a therapeutic prokinetic.