Dr. Marvin Singh speaks about Gut Health and Autoimmune Diseases with Dr. Ben Weitz.

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Podcast Highlights

5:38   Dr.  Singh has both an integrative and a conventional Gastroenterological practice and in his conventional practice he still offers lifestyle modifications and natural treatments if patients prefer that approach.

7:28  The gut and the immune system are intimately connected and 70% of our immune system is located in our gut, which is how gut health plays an important role in autoimmunity.  The gut immune connection centers on the microbiome, which is this ecosystem of micro-organisms that live inside of our digestive tract. The microbiome runs our metabolism, makes vitamins for us, releases chemical metabolites and hormones and neurotransmitters, which is how these microbes regulate our immune system.

9:05  Leaky gut or increased intestinal permeability means that the tight junctions in our one layer thick lining of our digestive tract is damaged in some way that allows bacteria or food particles or toxins to get into our bloodstream, where the immune cells may launch an attack on them.  Once you have this immune reaction to what gets into our system through the leaky gut, either it will resolve or it won’t resolve and cause a chronic problem and there may be chronic inflammation.

14:34  Dysbiosis is a medical term for an imbalance in our microbiome. Unfortunately, there is still a lot that we don’t know about what the ideal microbiome looks like, but there has been a tremendous amount of research on this in the last few years. And we are getting a lot closer to understanding what creates such imbalances in our guts and how to fix it.

16:32  There is a section on the GI Map stool test that lists bacteria that if overgrown are potential autoimmune triggers.  Dr. Singh believes that we don’t need to respond to one microbe or another. Let’s say there is elevated Klebsiella, which can be an autoimmune trigger for ankylosing spondylitis, but you don’t necessarily want to try to treat the Klebsiella.  There may be 10 excellent microbes who are beating up the Klebsiella every day and the Klebsiella may not be doing a lot.  Another classic example is Claustridium Difficile (aka, C. Diff.), which shows up on many stool and microbiome tests but many of these don’t have an infection and they don’t need Flagyl or Vancomycin. In this case, the C. Diff is a commensal and when we see bad bacteria, we don’t have to go around killing them all the time if they are not causing a problem.  We need eventually to focus not just on the microbes but at the metabolites that they produce or release.  So if you have Klebsiella in there producing a lot of bad metabolites, this can drive inflammation and inflammatory processes and they can call other bad microbes to the table so they do their bad stuff as well.

19:26  If a patient has C. diff and they have diarrhea and a fever, then you know you have an acute infection that needs to be treated with antibiotics and this can be a very serious, even life threatening infection.  On the other hand, if there is no fever and chronic diarrhea or even constipation, this may be IBS or SIBO and they may just happen to have C. diff as a commensal. Dr. Singh recommends testing for C. diff toxin via PCR and if that is present, then you should treat. And if antibiotics don’t work, then the treatment is a fecal transplant, which a ginormous probiotic enema.  Sometimes you can have a patient with a C. diff infection and severe diarrhea, fever, and classic symptoms and you teat them with Vancomy...