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
- 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
