Denise Wiesner, LAc discusses Fertility and Sexual Intimacy with Dr. Ben Weitz.

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Podcast Highlights

2:14  Denise Wiesner’s practice has a focus on women’s health and fertility.  She found that a lot of couples that are having trouble conceiving having problems with their sexuality and intimacy and their doctors were not offering any help with those problems.  In fact, their doctors do not get a lot of training in sexuality and did not really feel comfortable even talking about such issues.  This is why Denise felt the need to write this book.

5:43  Denise discusses some Chinese medicine and Taoist concepts (Taoist tradition is the precursor to Chinese medicine) in her book and she pointed out that the Taoists had this really equal relationship between yin and yang, male and female, and they would actually prescribe certain sexual positions to help patients cure certain problems.  Denise also has chapters in her book on orgasm and foreplay and stress in her book.

7:37  Denise includes a discussion of the Chinese five elements of wood, water, earth, metal, and fire.  In Taoist tradition, the earth is the center and this is about digestion and if you don’t feel good, it gets in the way of intimacy for men and women. This also includes the microbiome in your gut, your mouth, your skin, on the penis, and in the vagina. If a woman is trying to get pregnant, its not good if she has yeast and other infections in her vagina, so we want to have that balanced.

9:21  The vaginal microbiome is really important and we’re just starting to understand it. The vaginal pH is supposed to be acidic and it starts becoming a little more alkaline around the time of ovulation, so the sperm can live in the cervical fluid and they can swim up to meet the egg.  If the vagina becomes too alkaline, a woman will get more yeast overgrowth.  The vaginal mucous membranes are very permeable, so you want to make sure that if you use a lubricant that it does not contain preservatives, like parabens.  Only a few lubricants have been approved for fertility by the FDA.  A lot of lubes have a high osmolality, which means that they have the ability to pull water from the tissues and this makes their vagina very wet, but it is not so healthy for the tissues. It is better for the woman to produce more cervical mucous, which can be facilitated with acupuncture and herbs and even something like N. Acetylcysteine can thin out the cervical mucus and this can be helpful. Denise mentioned that a lot of people like to use coconut oil. But ideally it is best if a woman produces her own cervical fluid and this can be facilitated with proper diet and more time spent on foreplay. She said that it often takes women 20-45 minutes to become aroused, so you have to give them more time.

14:00  Functional Medicine can help with fertility by looking at the hormones, like the thyroid to make sure that it’s working properly. Traditional MDs usually only look at the TSH, so we should also look at T3 and T4 and the thyroid antibodies. If they have very high levels of antibodies, this means that they have a lot of inflammation and we need to help them to bring this down with diet and look at a stool test and see if there is dysbiosis, which is part of the Functional Medicine approach. 

15:32  Electronics, laptop computers, and cell phones can decrease fertility. If you keep your phone in your pocket next to your scrotum or your laptop on your lap, it can decrease sperm counts and electronics in the bedroom can interfere with intimacy.  So we should keep electronics out of the bedroom.

Dr. Mark Pimentel discusses SIBO and IBS with Dr. Ben Weitz.

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Podcast Highlights

4:29  Dr. Pimentel stated we now know that 60-70% of patients with IBS have SIBO, based on culture of the juices from the small intestine, not based on breath testing. There has been some controversy with breath testing, primarily because it had not yet been validated against a gold standard because we did not have good techniques for culture. He said that he’ll be presenting some data at DDW (Digestive Disease Week) with respect to better validating breath testing.

6:17  Re-Imagine Study.  Dr. Pimentel talked about the Re-imagine study who’s goal is to attain juice from the small intestine from 10,000 human samples in order to map out the small bowel microbiome. Some of the results will be presented at the DDW conference in San Diego in May. 

7:47  Autoimmune SIBO.  Dr. Pimentel explained his concept of the autoimmune origin of SIBO.  It starts with a bout of good poisoning from bacteria like Campylobacter, which release an endotoxin called Cytolethal Distending Toxin B (CTDB). The immune system reacts to this CDTB and then cross-reacts and creates antibodies against a structural protein in the intestinal wall called vinculin, which damages the nerves that control the motility of the small intestines. And there is a new blood test that measures these anti-CTDB and anti-vinculin antibodies–IBS-Smart that can help to identify this autoimmune type of IBS.  Dr. Pimentel explained that this blood test is not a substitute for the breath test, which identifies more patients with IBS and also tells the clinician which variant of SIBO is present–hydrogen or methane and these each require a different treatment protocol.  Dr. Pimentel also mentioned that while it hasn’t been published yet, the higher the level of antibodies, the more difficult the condition is to treat. 

13:19  Motility. Of the factors that have been described to potentially play a role in keeping the small intestine clear from bacterial overgrowth: 1. Hydrochloric acid, 2. Digestive enzymes, 3. Bile, 4. Motility, 5. The Ileocecal valve, 6. The GALT, the immune system surrounding the gut, Dr. Pimentel said the motility is the most important factor. Dr. Pimentel said that low acid from taking a proton pump inhibitor doesn’t give all these people IBS, so he doesn’t think low HCL is a big factor.  He also said that having low pancreatic enzymes or low bile are quite rare.  He said he’s seen a weak immune system in patients with HIV, but we don’t see it that often now, given how effective the HIV drugs are now.  As far as ileocecal valve function, Dr. Pimentel mentioned that we see a lot of patients with ileocecal resections in patients with Inflammatory Bowel Disease and they don’t all get overgrowth.  But if you have someone with an ileocecal resection and you have a little motility issue, then you can get overgrowth.

20:20  While it is easy to understand how there is a motility problem when the patient has constipation, but it is difficult to understand how there can be a motility problem when the patient has diarrhea. Dr. Pimentel explained that motility is not a passive process and motility involves the holding and moving backwards and moving forwards.  If you get amyloidosis, which is a type of scarring of the lining of the intestine, you actually get diarrhea because the tube is like a drainpipe, and water just blows right through it. So it’s motility that prevents it from being just a drainpipe.  Methane gas doesn’t paralyze the gut.  It actually causes the gut to tighten,

Dr. Mark Pimentel discusses SIBO and IBS with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

Podcast Highlights

4:29 Dr. Pimentel stated we now know that 60-70% of patients with IBS have SIBO

6:17 Re-Imagine Study.

7:47 Autoimmune SIBO.

13:19 Motility.

20:20 While it is easy to understand how there is a motility problem when the patient has constipation, but it is difficult to understand how there can be a motility problem when the patient has diarrhea. Dr. Pimentel explained that motility is not a passive process and motility involves the holding and moving backwards and moving forwards. If you get amyloidosis, which is a type of scarring of the lining of the intestine, you actually get diarrhea because the tube is like a drainpipe, and water just blows right through it. So it's motility that prevents it from being just a drainpipe. Methane gas doesn't paralyze the gut. It actually causes the gut to tighten, which resists the flow of material, leading to constipation.

25:04 METHANE SIBO.

29:44 Methane SIBO contributes to weight gain

31:32 Hydrogen Sulfide.

33:47 SIBO Recurrence.

37:09 Small Intestinal Fungal Overgrowth.

42:12 Probiotics.

46:06 Diet for IBS and SIBO.

Dr. Mark Pimentel is a Gastroenterologist who is head of the Pimentel Laboratory and Executive Director of the Medically Associated Science and Technology (MAST) program at Cedars-Sinai, which is focused on the development of drugs, diagnostic tests, and devices related to condition of the microbiome, with a focus on IBS. Dr. Pimentel has published over 100 scientific papers and speaks around the world at conferences, esp. about SIBO and IBS. Here is a list of some of Dr. Pimentel's key publications: https://www.cedars-sinai.edu/Research/Research-Labs/Pimentel-Lab/Publications.aspx

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or by going to www.drweitz.com.