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