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Kellie - Marketing: [00:00:00] Welcome back everybody. This is Kelly from revive naturopathic medicine, and I am back with Dr. Derek Lawrence and Dr. Brian Myers. Today, we're going to be talking about something called SIBO, small intestinal, bacterial growth. Which is difficult for me to say, but hopefully for these doctors, they know a little bit more about this topic, so take it away. Dr. Derek and Dr. Brian.
[00:00:32] Dr. Derek Lawrence: [00:00:32] Perfect. Thank you, Kellie. Yeah, SIBO or SIBO, "small intestinal bacterial overgrowth " is a pretty common condition, I think in both mine and Dr. Myers is practice and, and really today I want it to I really want to take an opportunity to kind of log this ball into, into Brian's court as a, and put them on the spot a little bit to tell us more about SIBO trends that he sees in it how he's going about treating it.
[00:01:02] And we actually have some results that we'll share on this video, obviously with any identifying information Hidden so that you can actually see how we diagnose a small intestinal bacterial overgrowth what the test results look like and you know how that kind of interpretation will go. I'll, I'll talk a little bit about, you know, my kind of understanding of this.
[00:01:30] Problem. And, and the cases in which I, I, I look at testing it for, and usually it's going to involve a lot of GI upset and these are so things like a lot of gas and bloating, right? These are, these are commonly symptoms of SIBO heartburn. In fact, we'll look at As well constipation can be there as well, but some of the symptoms can even trickle more into folks who you know, have other what we'll call like extra intestinal problems as well.
[00:02:01] And, and, and I know for sure, Brian, that you'll hit on some of that. So I will I'm going to kind of pass the intro over to you. And I want to hear kind of your take just on SIBO as a condition. You know, who's, who's kind of starting to raise flags or what symptoms start to raise flags for you as to, well, is this person suffering from this and and or how this condition can manifest in the real world.
[00:02:29]And then we'll maybe dive into. Some of the lab results and I'll see what you have to say about them. Right?
[00:02:34] Dr. Brian Myers: [00:02:34] So let's establish a little bit of anatomy first. So Below our lungs in our the core of our body sits the stomach from the stomach, we have the small intestine the duodenum, jejunum and ileum.
[00:02:46]The ileum connects to the large intestine, which runs up the right side, across our lower abdomen, and then down the left side of our lower abdomen and out the backside. So. SIBO small intestine, bacterial overgrowth means that the bacteria that typically colonizes our large intestine has for.
[00:03:10] Whatever reason crept up into the small intestine and caused a bit of an overgrowth there. It's not just for whatever reason. Those reasons we'll get into a little bit later. But those bacteria aren't necessarily pathogenic bacteria. They tend to be part of the. Gut flora that we want to have in our gut, in our large intestine, but tend to cause a little bit of havoc in our small intestine.
[00:03:36]They tend to gobble up some of the nutrients that we would otherwise be better served the receiving ourselves. And then they tend to produce a fair bit of gas by way of fermenting or they tend to ferment in our small intestines, some of those nutrients. And then that manifests as either from the feeling of like a food belly or a food baby where you have this like distended abdomen and potentially some pain from the amount of gas being produced.
[00:04:02] And, you know, that ends up being flatulence or Or, or, or burping belching and that's for some people unsavory for others, still it's downright owl. And, you know is this bad or good? It's not great in the sense that you know, we're missing out on the nutrients that we would like to be providing ourselves.
[00:04:21] And for some people that can lead to more serious complications down the road. And then there's a range of severity with SIBO too, as there is with most things. So some people might have. Underlying SIBO and just not even know it. I just think I get a little gassy sometimes and that's no big deal.
[00:04:36] Dr. Derek Lawrence: [00:04:36] Yeah. There's, you know, the way I explain to people, as they say, it's normal bugs in the wrong spot, right. It's there the generally supposed to be there, but for, you know, factors, ABC and maybe even some unknown ones you got too many in the wrong spot and You know, most of my patients are familiar with either things like kombucha or maybe some aren't or beer.
[00:05:02]But you know, when you crack that kombucha, you crack that beer, you get carbonation, right. That is a product of fermentation, right? That's what these bugs do. They ferment basically carbohydrates right from our food. And then they produce this gas And, you know, when I think a lot of us have maybe, you know, shaken up a soda, beer blows all over the place.
[00:05:30]Dr. Brian Myers: [00:05:30] That explosion's happening in your small intestine.
[00:05:33] Dr. Derek Lawrence: [00:05:33] Yeah and that's a totally like digestible way to explain it because. Everybody's had either that belch or maybe like heartburn or reflux from that gas literally causing kind of pressure dynamic issues and causing Harper. And, you know, inevitably someone's also sat on the toilet and had a degree of explosion as well.
[00:05:57]For one, you know, at one point in time in their life. But some people suffer from this and you know, I'm sure you've had these cases, Brian, like there are some people who like have to plan their day around where's the bathroom.
[00:06:14] Dr. Brian Myers: [00:06:14] Yeah. Like we mentioned, these bugs tend to produce a fair bit of gas that gas can be hydrogen, methane or sulfide producing.
[00:06:23] And those tend to. Kind of manifest a little bit differently. Some people tend to towards having a bit of diarrhea. And again, that's where you're literally planning your day around. Like where are these bathrooms? Because I don't know when this is going to happen and that's just frankly unsavory.
[00:06:38] And then some people attend a bit towards constipation, which is unpleasant for other reasons. I mean, you know, just not having a bowel movement, you know, for, you know, a day or two or three or. Or even more, can be really uncomfortable for some in, and they're, you know, on toward long-term side effects from that too.
[00:06:57] Yeah. Eactly
[00:06:59] Dr. Derek Lawrence: [00:06:59] on both sides of those, you can actually like they're uncomfortable symptoms, but left long enough or severe enough that they can actually be like pretty serious problems. Diarrhea can leave people chronically dehydrated. That's not uncommon. You know, I mean, you can leave, we can talk about malnourishment later, but that's an, you know, another component, but you know, chronic diarrhea can certainly do that.
[00:07:27] And on the flip side of that, chronic constipation, not only can you actually cause tissue changes in your colon, right. Where it's actually starting to expand in size and then it can lose its ability to properly kind of Create normal motility. But you can be more susceptible for things like hemorrhoids impaction, which is basically just like the stool doesn't move out.
[00:07:52] Right. We've had those cases a little bit more common in sometimes kids and elderly than general adults, but but it happens. And you know, from a more naturopathic standpoint, one of the things that we know is. There's like there's in Carol hepatic circulation, right? There's like, there's literally re-circulation of, of biochemical compounds.
[00:08:13] We'll call them that because summer. Helpful right movie, we recycled bile salts. We recycle fluid and that's important, but simultaneously all these bacteria also have endotoxin as well. And if we are recycling that or recycling estrogens at an expedited rate or other kinds of toxic stuff that we'd kind of want out of the body.
[00:08:35] We've almost secondarily now burdened the body in a whole different mechanism, which can have its whole other gamut of symptoms of, you know kind of Inbar toxicity, overwhelm, stressing, or liver detoxification pathways. So it you're you're spot on. It can be simple or not simple, but it can be less severe and it can be more is so spot on because someone might have a little Burbank.
[00:09:01] Another person. It could be the crux of a real complex health issues. You know, we talk about gas and bloating and, and I think people can identify with that. But like, let's expand that to say, Oh, well, what else? So like what other, from a symptom standpoint? Cause no, one's walking around saying. I think I'd see both acting up again, right?
[00:09:25] Dr. Brian Myers: [00:09:25] No, but they do say, I think I have a food baby after the annoying.
[00:09:29] Kellie - Marketing: [00:09:29] I wanted to ask, how do I know when to come in? Like, how do I know as a patient or someone who's listening to this know if this is something I should come in to see you guys? Or if this is just something I should wait out for a couple of days.
[00:09:46] Dr. Brian Myers: [00:09:46] I mean, if you're not having at least a bowel, not you specifically, but the whomever if you're not having at least a bowel movement today, you know, and you're having you're missing days between bowel movements, that would be an interesting. And, and noteworthy thing to mention to your practitioner.
[00:10:01]Also if you're having loose stools or not, well formed stools on a regular basis excessive gas manifesting as belching or flatulence is, is another. I mean, we've kind of like nailed that one down as, as the most hallmark sign, but I mean, people dealing with migraines, weight, loss, weight, gain.
[00:10:19]I just want to hit migraines again and also just say headaches too. Issues with staying hydrated waking frequently at night overnight difficulty sleeping, skin pathology, skin rashes can all you know, be a derivatives of, of SIBO or small intestine, bacterial overgrowth.
[00:10:39] Dr. Derek Lawrence: [00:10:39] Kellie, I'll share with you a couple of things that I find that I keep my radar open for. And one of them is is if someone's missing a gallbladde r. If they're missing a gallbladder--gallbladder you know, to save a long anatomy lesson, basically stores the bile that your liver produces and then is designed to dump it into the small intestine around mealtimes.
[00:11:04] And that helps us absorb our fats. And it also helps us dump other kinds of toxic compounds to be eliminated out of our gut. But one of the functions that it also has is it, is it has this some anti-microbial capacity as well. And it keeps the the small intestine more regulated from a microbial growth. On that same front, I think low stomach acid production. Is another key component and we're rolling into "causes," but let me, let me give you the symptom that that often presents with is heartburn. So that's a real common one that I'm in this chronic heartburn cases where they've been on Pepcid prilosec. Like they they've been on something for. You know what, five plus years, the first six weeks?
[00:11:57] Dr. Brian Myers: [00:11:57] None of those are supposed to be long-term therapies. And if you've been on those for a longterm, then please talk to your practitioner about that. They're not designed to be used in that way. And they, you know, we talked about fermentation before, and that's, you know, when you don't have enough stomach acid, guess what that means doing venting and rotting and. And that's, you know, like that can lead to all of those things that we talked about, from diarrhea to constipation.
[00:12:27] Dr. Derek Lawrence: [00:12:27] Yeah. That heartburn is, is one of the first ones we'll, we'll look at burping reflux, all that kind of stuff. What are the other. Conditions. It's a very small sub segment of the population, but I have a couple of people who fall on the spectrum.
[00:12:44] Is that the hypermobility Ehlers Danlos syndrome folks? I don't think I have a case of that without SIBO. And then head injuries. So people who have had traumatic brain injuries concussions, mild to severe Really common environment for SIBO to overgrow. You know, my theories behind that is, is some of the most likely some of just the nervous system connection to proper gut motility has been compromised from, from literally from head trauma.
[00:13:18]Granted there's probably a multifaceted mechanism there as well, but you know, those are population basis that I think. You know, if you're, if you fall into one of those and you're kinda bloated or what we'll call like irritable bowel syndrome me, right. I mean like how annoying is that diagnosis? And because it's not, it's just saying, like, I don't know what else to call this, so we'll just call it that and hope that's satisfactory, but it's not, I think we've, we've found, and I've seen this in the literature that a large majority of, of those IBS cases are just iron
[00:13:50] diagnosed SIBO.
[00:13:52] Right. And
[00:13:52] just like, it's so simple, but they tend to be, and it's at least worth exploring if you've been told you have IBS. Yeah. And you said it's not so simple. I think that we'll roll us into what you were coming and going is a good next topic. Right? So What, what causes this, you know, like what do you what do you know causes it?
[00:14:13] What do you think participates in it? Like, you know, well, some of my thoughts, like the gallbladder, right? And low HCL, like a little bit more of my thoughts and clinical experiences, but like tell us a little bit more about that.
[00:14:27] Dr. Brian Myers: [00:14:27] Yeah. I think Any sort of bowel irregularity or consistent bowel irregularity can be a contributing factor. But a lot of times it's history of antibiotic use or recent history of antibiotic use history of food poisoning. We've talked about low stomach acid and like the gut brain connection or disconnection in some cases Thyroid dysfunction on either end of that spectrum could be a contributing factor or a cause.
[00:14:56]And then since we're talking about thyroid, we might as well mention HPA access dysfunction. So HPA, meaning hypothalamus and pituitary, along with our adrenal glands and any sort of dysfunction among those important parts of our body large intestine dysbiosis that the presence of pathogens can be.
[00:15:13] Cause even though, you know, we've kind of alluded to, that's not always the case or that these bugs aren't always bad. They can be, and you know, that just is a complicating factor then gut inflammation in general. So like our, our people that are dealing with like inflammatory bowel disease or celiac are, are certainly at risk.
[00:15:32]Yeah. Do you have other ones? There are more...
[00:15:35] Dr. Derek Lawrence: [00:15:35] Yeah, there are more, you know, I think it's a couple other ones that we should mention is, is history of food like food poisoning, right? Like, you know, acute gastroenteritis, that's you know went down, ate this taco and it just wasn't it wasn't. Right, right.
[00:15:53]And that seems to set off some immunological susceptibility for this condition to exist. I have a large female patient base and another one is intestinal adhesions. And the reason why I bring out the females on that is that you know, sometimes they've had things like hysterectomy or yeah, or C-sections these are surgical interventions that then of course, you know, need to heal.
[00:16:17]Adhesions are like scar tissue and like scar tissue connecting from these organs to your intestines and it could compromise the motility of the, and the proper kind of motility of the small intestine and the large intestine as well. But that is a system that can be set up to develop SIBO.
[00:16:38]And, and when we talk about gut motility, I'll take a little aside on here cause it's kind of in the causes kind of headline here. You know, some people think of gut motility as well. I poop every day. Right? You can poop every day and have SIBO. The motility that we tend to reference, right, when we're talking about SIBO is this intricate part of the small intestine called the migrating motor complex.
[00:17:01]And this is like, A component of like the infra muscular component of the small intestine that is designed to like sweep well, food, but also bacteria out. Right. And so when we talk about motility that is a really what we're referencing when it talks to SIBO is the health and integrity of the migrating motor complex. I think from you know, we talked about head injury component. I think that that is probably where some of the damage comes in on that front, but, but there, you don't necessarily need a head injury to have a poor migrating motor complex function. And it's also why laxatives don't solve this problem.
[00:17:43] Dr. Brian Myers: [00:17:43] And even herbal laxatives, some of those herbs that we use to have regular bowel movements you're right. I mean, constipation and, and the use of laxatives, as well as some of those other things that migrating motor complex is, is pretty essential. And like you mentioned, it's kind of like a it's, it's a coordinated effort from our muscles to just kind of squeeze everything all the way out and just kind of say like, here we go.
[00:18:05] Let's let's, let's do a quick cleanse. You know, that that tends to not occur unless we've been, you know, in a, in a foodless state for at least four hours. We tend to have one that occurs in the morning. And those are pretty essential to like keeping keeping regular healthy bowel habits.
[00:18:25] Dr. Derek Lawrence: [00:18:25] Yeah. Well, let's let's pivot this. I'm going to lob something into your court. Brian, I got test results and I want your on the spot interpretation of them. So let me let me share my screen here so you can see these
[00:18:52] Dr. Brian Myers: [00:18:52] somebody's in trouble.
[00:18:54] Dr. Derek Lawrence: [00:18:54] Yeah, I guess so. I wanted to avoid that. So I put my headphones in.
[00:19:01] Kellie - Marketing: [00:19:01] That was the SIBO police.
[00:19:03] Dr. Derek Lawrence: [00:19:03] That was the SIBO police. Can both of you see this?
[00:19:05] Dr. Brian Myers: [00:19:05] I can.
[00:19:06] Dr. Derek Lawrence: [00:19:06] Okay, great. So you know, our, our information is hidden here, but so this is Commonwealth diagnostics. This is a SIBO test. I'll talk briefly about the test and the test collection.
[00:19:18] It's actually a breath test. So the, the mechanism that we're, we're trying to capitalize here is, is on measuring that gas production. So the test involves drinking a little sugary drink made from a lactulose there's different SIBO tests out there, but lactulose is kind of the more consensus of the better one to do . You drink the lactulose.
[00:19:39] And then every 15 minutes you breathe into a test tube. And your breath is going to contain. And then of course, you'd cap very quickly is going to contain certain levels of methane. Certain levels of hydrogen is going to condense certain levels of carbon dioxide, obviously, cause it's your breath. But we look at that and we referenced how much hydrogen, how much methane is being produced at these different time intervals.
[00:20:05] And these time intervals are meant to reflect kind of like where the transit through the small intestine and And so, you know, this is a, this is a test that you were looking for. If a person has SIBO, sometimes either high baselines and gases or spikes of hydrogen or methane, which will reflect too many bugs, hyper fermenting that sugar.
[00:20:31] Cause the thing about lactulose is we can't absorb it as, as humans. We don't absorb it but the bugs can use it. Right. And, and then we breathe in these tubes and we get a reflection of how much gas is being produced. So you know, I know Brian, you're familiar with these results. What's going on here?
[00:20:49] Dr. Brian Myers: [00:20:49] Well this looks like a positive result for SIBO, small intestinal, bacterial overgrowth. And the reason why we see that is ... The, the chart on the left is, is a pretty handy representation of those time intervals. Dr. Derek was talking about, so, you know, we can see that there was a small rise in hydrogen, early on, but we see a, a quite a bit larger rise towards the end of the of the chart there a little bit later on.
[00:21:15]And so as he said, we're trying to approximate Moving through the small intestine and then looking for peaks or changes in either of these gases which would indicate a positive SIBO test. Sometimes they come back and we may, you know, it's, it's possible that there are blooms of these bacteria that are between those time intervals.
[00:21:35] And, and that can be a little bit challenging when we're trying to interpret these results, but this test looks to be positive. As we see a combined effort from both the hydrogen and the methane a little bit later on, so. Yeah. I would definitely consider treating this patient for SIBO but also would want to take into consideration their their, their, their clinical history as well. But that's probably what led to the decision to run this test.
[00:21:59] Dr. Derek Lawrence: [00:21:59] So, yeah. I think if we, you know, if you get the best SIBO minds in the room that symptoms do matter. You know, because, and they matter usually more in the cases that are a little more vague. You know where they're not overtly. Oh yeah.
[00:22:20] Like this is rip roar and high positive, like, okay. Like that's easy to interpret. Right. But they're the ones where it's like, well, there seems to be a little bit of an, a vagueness in these results and a borderline result. That's where symptoms and treating that human. Tends to matter a lot more.
[00:22:38] Well, I will I'll I will confirm with you, you like, but yes. Also commonwealths agrees with you that, that the presence of bacterial overgrowth here is supported, you know, this to me screams of, you know, hydrogen dominant SIBO.
[00:22:54] Dr. Brian Myers: [00:22:54] Yeah, I mean, you can clearly see that towards the end, as we see that huge spike in hydrogen.
[00:22:58] Dr. Derek Lawrence: [00:22:58] Yeah. Okay. And given symptoms. And of course I didn't, there was no, there's no privy to these, o these symptoms as well. There, you know, one of the things that we commonly look at, if we're looking at hydrogen or methane dominance is, is it's higher correlation with constipation, you know, as you mentioned that was not present in this case.
[00:23:21] So it kind of takes another kind of notch in the art. Well, we're likely looking at this, causing a problem. So yeah, I, I agree with you wholeheartedly on those results there and this this. Is arguably a patient of ours. And I'll say that because these are actually my SIBO results.
[00:23:40] I you know, I wanted to say...
[00:23:42] Dr. Brian Myers: [00:23:42] It happens to the best of us.
[00:23:44] Dr. Derek Lawrence: [00:23:44] Yeah! I don't have, I don't have huge complaints from a GI standpoint overall, but I did notice over this last, and I don't know if this was COVID related or what I noticed.
[00:23:55] You know, I was finding myself a little more bloated feeling. I was actually having some, I was waking up just feeling like full at night and I wasn't sleeping as well. And I know that cause I wear my Oura ring. And so I could see like too many wakings at night. And I wasn't feeling as refreshed as I could.
[00:24:14] And I was gassy in the morning. It's like, that's so strange. And it...
[00:24:18] Dr. Brian Myers: [00:24:18] Were you just waking up or you're waking because you had to like have a bowel movement because you needed to pee?
[00:24:26] Dr. Derek Lawrence: [00:24:26] Waking up from like, almost like GI discomfort and And so, and you know, if you know anything about me, I value my sleep.
[00:24:35]And so it was, it was disruptive to me. And I also noticed that over that kind of period of time, I got like less consistently good bowel movements. They were like looser and. That was like, I knew something was up. So I was like, well, I kind of intuitively knew. I think I probably have a little bit of this.
[00:24:54]And I can reflect back on my life and probably said, this has been a trend that I've flirted with. We could go all day about maybe why it head injuries? Ya-huh. Antibiotics? Yeah. Stress? Sure. Yeah. Right. And so this is what, like, this is what I find. Beautiful and frustrating about this. It's beautiful in the way of like, you can be like, Hey, something's wrong and we can do something about it, but it can be frustrated because it's like 95% of the world is walking around with like seven major risk factors for developing this.
[00:25:28] And then you throw a global pandemic on top of it. So I can, I can, I can confirm with you that, that these are. These are true symptoms of a SIBO, a I'll say a mild SIBO suffer. Cause
[00:25:41] I think that I have my symptoms pale in comparison to some of my other patients. But there's certainly there and they definitely have improved since I started doing something about this.
[00:25:50] And I want to get your take on, well, one, how would you treat this case? And I'll tell you what I did. And And then, you know, we can, can expand that to, okay, well, this was a hydrogen dominant case. Like how are you going to treat maybe something that's methane or something that's actually...
[00:26:14] Dr. Brian Myers: [00:26:14] There are a couple of different ways to approach treatment of SIBO. I commonly resort to herbal antimicrobial combination therapy. There are a couple of multi-center steam team formulations that that have been researched in the past, that can be helpful. But also just assembling a a well-rounded herbal antimicrobial combination can be really effective too.
[00:26:42] A lot of times that include herbs like berberine and or meme sometimes garlic in the form of allicin to be active. That tends to be more so for methane producing bacteria. So for some people, an herbal approach is is well suited. For others, we can use some antibiotics. This specific one that's used for SIBO is Rifaximin.
[00:27:06]The reason why we tend to use that particular antibiotic is because it is specific to the lumen of the intestines meaning that it doesn't have a very broad spectrum approach. And that can be, you know, that's just better in general, right? We don't want to kill all the bugs all over our body if we don't have to.
[00:27:24]There are some drawbacks to that too. Then a third approach for some people can be to use an elemental diet, which is basically food in elemental form over a period of two weeks. And. Kind of the approach there is to starve the bacteria. And, and that's actually interesting. If we talk about treatments that's, there's some divergent theories there.
[00:27:43] Some people think starving the bacteria while you killing them is most effective and, and still others think well, fed bacteria are easier to kill. And so You know, that there's a difference in opinion or approach there. And, and that may be a part of the nuance of like treating one person versus another always there's a nutritional component to that.
[00:28:03]We tend to try to avoid those foods that can trigger those food, babies or other unsavory symptoms. There tends to be with a, SIBO a fair bit of recurrence, and sometimes that means just changing up the. Protocol that was used from one, from one attempt to the next. But also good gut health regular well-formed consistent bowel movements, I think are a big goal and a big aim that I've been coaching my patients on of late for how to kind of resolve this on a more long-term basis.
[00:28:35] Dr. Derek Lawrence: [00:28:35] All right. So, Dr. Brian, what am I, what am I doing with these results? What are you telling me to do?
[00:28:40] Dr. Brian Myers: [00:28:40] I would treat this person, this, "this person"...you, with let's see I would do suburban and either some neem oregano. And I would do that berberine like 1500 milligrams, three times a day. And whether you're doing Nime or oregano, you could just vary on the the dosage of that.
[00:28:59] If you're doing name, you do 600 milligrams, three times a day. If you're doing oregano a hundred milligrams three times a day I think that would be oregano. I would do maybe. Maybe that would be a little bit better indicated for you because there is a little bit of methane there. I think I might just stick to berberine and neem if it was hydrogen only.
[00:29:16]Yeah, if there was a higher amount of allicin or above of a methane, like I mentioned, then using something like allicin, and then there's even another herb that can help or another herbal blend called a Tarantino that can be really helpful for kind of like blunting or minimizing that that, that gas.
[00:29:34] Dr. Derek Lawrence: [00:29:34] Well, let me, let me share with you what I did.
[00:29:37] Dr. Brian Myers: [00:29:37] Okay.
[00:29:37] Dr. Derek Lawrence: [00:29:37] All right. I did none of those things and what, well, that's done highly true. One, I use that all the time. I used these results as an opportunity to, to experiment with some new treatment ideas. You know, the. Classical berberine, oregano oil.
[00:29:55] I use it successfully almost all the time with the patients, Trental with the methane. So I totally agree with you on that. The garlic, I, I kind of go back and forth on some people tolerate it. Some people don't love, you know, the garlic burp...
[00:30:11] Dr. Brian Myers: [00:30:11] And I just want to jump in right there and say, so using garlic. Like food, garlic... Isn't always going to be as agreeable, the sulfur in that can be a little bit irritating to people who are SIBO positive. So I just want to jump in and say like, don't interpret that as like, Oh great. If I just eat garlic with my food, like I'm going to feel better because you might actually feel worse.
[00:30:31] Dr. Derek Lawrence: [00:30:31] Much worse!
[00:30:32] Dr. Brian Myers: [00:30:32] There's a specific chemical constituent from garlic called allicin. That's got some nice anti-microbial properties and that's what we're using.
[00:30:40] Dr. Derek Lawrence: [00:30:40] Great. Yeah. Good. That was a great clarification. Pretty important there because like garlic, right? Yeah. I, I ate a whole bowl the garlic every day, and I know I got like a huge food baby.
[00:30:53]But I agree with you on all that. And those are things that I commonly will commonly will do. So from an herbal approach, I'll take that just in isolation. I'll we can take this. Screenshot from an, from an herbal approach. I actually experimented with a kind of a combination herbal tincture of a mixture of berberine. Like you mentioned, myrrh and thyme.
[00:31:20] Dr. Brian Myers: [00:31:20] Cool.
[00:31:20] Dr. Derek Lawrence: [00:31:20] So I made that tastes. Not good. But I took that a few teaspoons a couple of teaspoons three times a day. I also combined that with an herb called uva ursi and took that in a similar dosage and some argentyn 23 silver hydrosol to be, to be more specific, but yeah, in that, in that realm Yeah.
[00:31:46] So I decided to kind of try out a protocol and part of the reason why is I wanted to expand that treatment outside of hydrogen into a little bit of some biofilm disrupting, and that's probably a topic for another day. But also To cover a little hydrogen sulfide as well. The piece that you don't know about that is I do have some GI map results from diagnostics that had some enlightening information on some of the families there.
[00:32:16] So, you know, I'm kind of withholding information here. I know that's not fair, but that's why I chose the treatment. I did what I hope that that illuminates though, right? Is that there's like. There's like this, I don't want to say standard operating procedure, but there's these, these things that we know that work.
[00:32:32] But when you start to like understand the human who's sitting in front of you and you get maybe more data or more symptoms, you may have to stray away from that box and say, this is actually much more indicated. And of course. You pay attention to their symptoms, their improvements, and then, you know, retest them to make sure you were accomplishing...
[00:32:54] Dr. Brian Myers: [00:32:54] Like a good scientist.
[00:32:55] Dr. Derek Lawrence: [00:32:55] Like a good scientist, yeah. Accomplishing those goals. A couple of the other things. Not only that I like, I mean, I focus on myself, but these are things that I emphasize with my patients. Two to three meals a day, no snacks. And I say two to three, because I mean, some of my patients do a time restricted eating or, or what other people call intermittent fasting and they don't eat breakfast, so they kind of only eat twice a day.
[00:33:21] So. All right. Well, I don't, I'm not trying to force someone to eat three times if they're only eating twice. And it's something that I do relatively routinely, so I'm only usually using two, two times a day. But no snacking. And the mechanism behind that is to stop like drip feeding the small intestine with food to actually give that migrating motor complex.
[00:33:41] Like you said, that opportunity to fully pulsatile the, remove that food out of the small intestine. So reasonable aim or goal would be four hours between those meals then. Yeah. To help that migrating motor complex action. Yeah, so that, that is something I, I often recommend from a, like a food behavior standpoint, obviously the normal food hygiene of chew. You know, don't drink a ton of water while you're eating, you know, don't guzzle a big gulp while you're also trying to, you know, eat your...
[00:34:14] Dr. Brian Myers: [00:34:14] Ever.
[00:34:18] Dr. Derek Lawrence: [00:34:18] I moreso meant like a big gulp of water, but yeah, soda would be bad too.
[00:34:26] Dr. Brian Myers: [00:34:26] There's never a good time for that.
[00:34:28] Dr. Derek Lawrence: [00:34:28] Right. You know, that normal food, food hygiene stuff I think is important. I personally will occasionally use digestive enzymes to better facilitate breakdown. I think these are useful to use sometimes in real stressed out people to kind of cheat the system a little bit. And I don't love the idea of using them long-term we don't have to, but there's a time and a place. Right. For some of the maybe gallbladder missing people, we'll entertain using some ox bile as well to replace that.
[00:35:02]You know, and, and that's from, from like the beginnings of digestion to the food habits, to the meal timing. I think that's what we use. I emphasize a low carbohydrate diet. I know you, you're kind of in that same ballpark, as far as treating SIBO there, it's just removing the, you know, the source of fuel.
[00:35:22] Yeah. So that you talked about starving them, that, you know, I think there's a balance there of like making sure we can eat sustainably. Right that we feel good get enough energy, et cetera, but simultaneously, you know, try to minimize the bugs. And so from my case, I, you know, I generally maintain a relatively low carbohydrate diet though. I will say up until this, it was a little heavier than I normally ...
[00:35:49] Dr. Brian Myers: [00:35:49] You must've been adding some, some fuel to the fire here.
[00:35:53] Dr. Derek Lawrence: [00:35:53] No question. I was, and I have choked that fuel out. And not only do, like, not only do I feel better, gastrointestinally I feel better full stop. End of sentence. You know, and I know I do.
[00:36:06] So it might be also Brian, why I love and Kelly, you're part of this too. Why I love fasting? Like maybe that's a component cause I always generally find it easy. I generally find it easy. I feel pretty good. And it's not unreasonable to think that a component of that is, you know, I've stopped poisoning myself on a routine basis with, you know, small intestinal, bacterial overgrowth.
[00:36:33]Dr. Brian Myers: [00:36:33] A Pathology of excess, you might say. Fascinating. And, and this may be more of a topic for another day. I think it is. But just, you mentioned that fasting tends to be easy for you and I just want it, like, what was it easy the first time you did it?
[00:36:47] Dr. Derek Lawrence: [00:36:47] Yeah!
[00:36:48] Dr. Brian Myers: [00:36:48] Okay, cool. Yeah, that isn't always the case, so...
[00:36:51] Dr. Derek Lawrence: [00:36:51] Yeah, I mean, I've had harder ones, but I think that I think it's just that I don't know. It's something that I can just like wrap my head around really well. And and mentally I don't find it. I don't find it that, that hard. I love eating. I love cooking and I miss chewing when I'm fasting. But like, other than that, I don't think I miss. Like, I really don't miss food.
[00:37:14] I find I have valuable. And sustainable energy. Most of the time, sometimes getting into one, like day one, you know, it's a little rough, but but that picks up really quickly. Yeah.
[00:37:28] Dr. Brian Myers: [00:37:28] Yeah. Like day two, day three. Yeah.
[00:37:30] Dr. Derek Lawrence: [00:37:30] But that's just me. And I don't think that... Kellie, I think you can...you moderate some parts of our fasting group there. I think that's the exception and not the rule, Hey?
[00:37:39] Kellie - Marketing: [00:37:39] Yeah. Well, and we can also ask you that during a fast and not after.
[00:37:43] Dr. Derek Lawrence: [00:37:43] Yeah. Right!
[00:37:44] Dr. Brian Myers: [00:37:44] You're not hungry. You're "hangry" right now, are ya?
[00:37:47] Dr. Derek Lawrence: [00:37:47] I think that maybe if we went back and watched some of my, like, literally like in the middle of fasting videos, people might be calling BS on that. I'm not entirely sure. But when I reflect on them, I can reflect on them fondly. So that must mean they're not miserable.
[00:38:02] The outcome creates a space for gratitude, right? So that's noteworthy.
[00:38:07] Yeah. So Brian, we hit on this a little bit with this migrating motor complex. But I want to focus on one thing in particular from a motility standpoint, because, pro motility agents are optimal gut motility in that small intestine from a migrating motor complex standpoint is arguably like crucial and like the crux behind this being a successful treatment or, or not. And there are there are medications that support this. There are herbs that support this.
[00:38:43] One could probably argue stress and stress reduction and overall improving gut health is going to play a large role in this. But you use a certain treatment called LDN or low dose naltrexone. Not only kind of through this lens, but also through a bigger picture lens. And I just want to hear again, it might be a bigger topic to talk about later, but I just want to talk about the usage in it for four SIBO and then a brief little, like what's the general population that's actually using this, this medication?
[00:39:15] Dr. Brian Myers: [00:39:15] Yeah. So like I mentioned earlier, regular consistent well-formed bowel movements is a goal. For SIBO treatment. And part of that meaning means having good motility, supporting the migrating motor complex as part of that. And there are some agents that we tend to use, particularly in our patient population that tends towards constipation, but not just limiting to the limited to those people. Low dose naltrexone is the off label use of naltrexone. Naltrexone itself is an opioid antagonist. So it's used to help people with opioid addictions can also work for people that have in a positive way for people that are struggling with alcohol use. But those are topics for another day.
[00:39:57]When we're using the low dose form, we're using one 10th to one, 100th the strength of a standard naltrexone. And it seems to have some really positive benefits on overall gut health. The theorized method of action is that it blocks our opiod receptors for just long enough to promote an increase in our own endogenous endorphins.
[00:40:21] And and that has a positive effect. On a number of different levels. So LDN can be a nice Immune modulator for people struggling with autoimmune conditions and or cancer. And it can be a positive for people that are struggling with mood disorders as well. The range for LDN is wide, but the specific use for SIBO is as a mild motility agent.
[00:40:44] So it does function well as a mild motility agent, and that can be really helpful for people when we're aiming to get those regular. More consistent bowel movements than like once every couple of days or even, you know, once every other day it can be really effective to help have more consistent bowel movements. It's typically taken in the evening just prior to bedtime and can help again with that migrating motor complex while you're sleeping to help form a well-formed bowel movement in the morning.
[00:41:11] Dr. Derek Lawrence: [00:41:11] Yeah. So it's a, it's like a unique medication. And most of my patients know, I don't like just jump to, you know, Hey, I suggest you take this medication, but this one is, has a, a lot of value in a lot of different realms, like through this lens of SIBO, especially because it can present itself in more complex cases with anxiety or with depression or with autoimmune like it does just, you can have SIBO and these other things, and there are some one could call them side benefits and, you know, that's one of the things that I say about, of a lot of our therapies here is we try to use certain compounds that are going to have side benefits. Yes. They're going to help the problem that is taking up the most room on your plate.
[00:41:54] The thing that sucks, but it's also going to have, you know, a web of positive effects on your system. Ideally, you know, ones that you can feel and some that maybe are kind of behind the scenes, treating something objectively.
[00:42:10] Dr. Brian Myers: [00:42:10] Yeah, there's some other nice benefits to it too. In addition to like all of the like wide ranging positive benefits, the buy-in is relatively low in that there's, there's, there's very little risks to no risk using this medication for even a short term or a longterm period of time. The half-life is relatively short, so it washes out of your system pretty quickly. And the biggest complaint I've experienced and that is reported is more vivid dreams. For some people that's fantastic. They love dreaming, and they like it when it's more real life-like. So for those people. Great. And then there's easy workarounds for people who are struggling with that, or, you know, some people experience a little bit of vertigo or I mean, you know, there's easy workarounds for those. And like I said, the risk is that there really isn't any unsavory side effects other than those kinds of things. So, yeah.
[00:42:58] Dr. Derek Lawrence: [00:42:58] Yeah. Perfect. Well, I mean, I'll, I'll end this you know, to make sure we respect everyone's time, but I'll end this in saying that sIBO is a pain in the butt literally and figuratively. And I think we got to some reasons as to why it can be because it's so multifactorial, it is dealing with microbes that are normal. They're supposed to be there, but just not in that amount. So it's like, you're not looking at eradicating a pathogen. And once it's gone, great. It's this gray area, this balance. And I think that I mean, I think that's why maybe us Naturopathic Doctors are the ones that tend to see this and understand this because we operate in this gray area of, it's not like black or white, it's this, this, this problem.
[00:43:45] And, and, and because of its multifactorial nature, its relationship to stress or potentially, food poisoning or potentially you know, structural abnormalities and nervous system dysfunction. Here is a degree of relapse that can happen and that's, that's frustrating. But I think that that is an important piece to bring up right at the forefront, that this is a chronic challenge that we're going to have to learn how to understand and help you figure out how to operate with.
[00:44:15] But you know, this conversation we got to have today was great. I think that we hit on some other, like real reasons why this problems kind of exists and, you know, illuminated those pillars that we gotta be paying attention to. Whether it's food or food timing or stress, or understanding our own medical history and how it can create an environment that might be susceptible to this, knowing the symptoms that we should be paying attention to. So if you're struggling from, you know, a, B and C..."maybe. I have SIBO?" And then maybe I want to sit in front of someone who knows what that is and then what to do about it, and also how to individualize it, because we already talked about today, how there's, you know, a handful almost a plethora of different treatment approaches for this to, to fix that.
[00:45:06] So I want to thank you for, for sharing that with our audience and, and Kellie from, from, from your perspective, anything else we need to kind of Wrap up with you have a better understanding of SIBO?
[00:45:18] Kellie - Marketing: [00:45:18] Yeah, actually it definitely answered a lot of my questions. But I also just wanted to say if anybody has any further questions about SIBO or about any other of the treatments or things that have been talked about today, you can find on our website there is a request, an appointment section @revivenatmed.com. You can also find us on Instagram and Facebook. And we also have a free 15 minute consult that you can talk to any one of our doctors.
[00:45:49] Dr. Derek Lawrence: [00:45:49] Yeah. And and look forward to you know, having a couple more of these with you, Brian. And and these are, these are valuable opportunities to just bounce ideas off each other.
[00:46:01] Dr. Brian Myers: [00:46:01] Yeah. Yeah, this was fun. I have like a list of other ones we can do. It's easy to make.
[00:46:07] Dr. Derek Lawrence: [00:46:07] Perfect. Well, thank you both and have a good rest of your day. And for anyone who watched this long... thank you.
[00:46:15] Dr. Brian Myers: [00:46:15] Thank you. Made it to the end! Congratulations!
[00:46:28] Dr. Derek Lawrence: [00:46:28] Made it to the end.