GUT MICROBIOME: A Doctor's guide to IBS, Leaky Gut, SIBO, Probiotics, Food Allergies, and Diet!

[Music] so tonight I'm very excited to be speaking on one of my favorite topics all about the gut microbiome and optimizing your health so for those of you who don't know me I'm dr. rad Trina blue Drupada I'm board certified in internal medicine and a member of the medical staff at st. Jude Medical Center and my practice is called OC integrative medicine at Fullerton I also did additional training in gastroenterology at UC Irvine and then later I did training in functional gastroenterology through the Institute for functional medicine so this has given me a really unique perspective on digestive health and in my practice I like to combine the best of conventional Western medicine along with more integrative in holistic medicine and I find that this approach provides great outcomes for all types of digestive issues so let's get started so here's an overview of my talk so we're going to talk about what is the gut microbiome we're gonna go over probiotics and prebiotics what is IBS or irritable bowel syndrome what is leaky gut what is SIBO which stands for small intestine bacterial overgrowth and then how do we test and evaluate your gut health we'll go over food allergies and then we'll discuss what is the optimal diet for your overall health so what is the gut microbiome so the gut microbiome is your ecosystem of trillions of bacteria that lined your digestive tract it's controlled by your diet your exposures and even your stress level so human beings are actually hollow biomes which means we're made out of trillions of living organisms inside of us in fact there's so much bacteria inside of our digestive tract if you were to weigh it out it would weigh three pounds which is the same as a human brain so what determines our microbiome so it begins with your genetics so the microbiome of your mother and your father then your birth method so if you were born by vaginal delivery you get exposed to the bacteria going through the birth canal unfortunately children born by c-section don't get that same exposure to the mother's vaginal bacteria but what I understand in a lot of hospitals now they're actually swabbing down c-section babies with the mother's vaginal bacteria to kind of replicate going through the birth canal because they know that bacteria is so important for the microbiome so breastfeeding so when an infant breast feeds they get exposed to all the protective immunoglobulins which are present in breast milk and that is so beneficial for the microbiome your diet so if someone eating a standard American diet is gonna have a completely different microbiome from someone eating a clean organic Whole Foods diet exercise so it's fascinating but research is showing that exercise has its own positive influence on the microbiome separate from diet and exposures your exposures so if you're exposed to antibiotics you know prescription medications if you're on long-term acid suppressive medications or synthetic hormones that can all affect the microbiome and then stress so if you're chronically stressed and your cortisol is high cortisol is the bad stress hormone then that's going to also have an influence on the type of bacteria growing in your gut so all disease begins in the gut this was once said by Hippocrates so the gut microbiome can really determine your overall health your gut microbiome can be controlling your weight your metabolism your immune system your skin your hormones and even your mood our research is evolving on the gut microbiome you know having an overabundance of certain bacteria or an imbalance can lead to something called dysbiosis and dysbiosis can cause many systemic health issues it can cause IBS autoimmune disease mood disorders chronic fatigue and chronic pain microbiome disruption is also linked to more common conditions like high blood pressure diabetes high cholesterol arterial plaque buildup alzheimer's disease rheumatoid arthritis and even mental health diseases like bipolar disorder schizophrenia and more colon cancers and other cancers are also linked to dysbiosis in the gut children who have microbiome issues are more likely to develop food allergies and adults who have microbiome disruption are more likely to develop food sensitivities a lot of times once we heal the microbiome a lot of the food sensitivities go away so does our gut affect our brain so scientists are now recognizing something called the gut brain axis so a significant portion of your neurotransmitters like serotonin and dopamine are actually made in your gut so that's why they sometimes refer to your gut as the second brain so that's why when your gut is having problems like bloating constipation abdominal pain your mood will often suffer as well so many patients who have IBS are actually thought to have a deficiency of serotonin in the gut which is why in conventional medicine they treat a lot of IBS patients with antidepressant medications and these medications raise the serotonin level not simply in the brain but also in the gut as well so in my practice when I see a patient who has anxiety or depression I always ask about their gut health you know what are they eating how are they digesting their food how are their bowel movements if they're constipated or bloated they could be having a microbiome issues that are leading to an imbalance of the neurotransmitters which are causing their mood symptoms so many times once we correct their digestive issues and get them to have regular bowel movements in a healthier microbiome their mood symptoms resolve as well okay so there was a review article that came out in 2018 in the Journal of neuropsychology and there is a link to the article on my website but this was a very fascinating article it talked about how important nutrition and the gut microbiome are for healthy mood so science and research is now supporting the importance of the gut brain axis so why are the bacteria in our gut so important well it's because they eat what we eat and depending on what we eat we can influence the type of bacteria that are growing in our gut so food influences the microbiome so the bacteria use the food that we eat and they break it down into bioactive substances so the type of diet we're eating can change the chemicals that are being released by the bacteria into our body and these are chemicals that determine our weight our immune system our metabolism our hormones our skin and even our mood so for example there's research that's been done on obese mice and thin mice what happens when they transplant the bacteria from the obese mice into the thin mice that then might become obese and vice versa when they transplant the bacteria from the thin mice into the obese mice the obese mice will lose weight and become thin isn't that fascinating so when I see a patient in my practice who's really struggling with their weight and when I review their diet and their exercise it's pretty impeccable they're doing a great job that's when we have to look at their gut microbiome because maybe there's something there that's causing them to hold on to the weight so the bacteria in her gut can even control some of your cravings because the bacteria live off the foods that you're eating so if you have some bad bacteria in your gut that are living off the sugar and dairy in your diet you're gonna continue to crave those foods so that's why making that initial change in your diet can be so difficult so skin is often a reflection of your microbiome so when I look at a patient's face I often get a little window into their gut microbiome you know patients who are over indulging in sugar fast foods or alcohols tend to have more dull skin with blemishes and sometimes even a little swelling in the face you know acne is a bacterial imbalance on the skin that often is a reflection of a bacterial imbalance in the gut similarly rosacea which is the redness that you get on the cheeks and your nose that is often linked to gut microbiome issues and like a sensitivity to sugars and carbohydrates in the diet now the great news is that when a patient cleans up their diet within a few weeks to a few months we see such a drastic difference in their skin and in their face and that's a reflection of their gut microbiome getting healthier as well so what disrupts the gut microbiome so sugar is a big disruptor of the gut microbiome so by sugar I mean refined sugar sugar feeds all the bad bacteria in the gut the kind that cause inflammation weight gain and trigger more sugar cravings artificial sugars are also bad for the gut microbiome since they often feed some of the bad bacteria in your gut that caused dysbiosis so a lot of artificial sugars for example xylitol mannitol sorbitol they can't be absorbed by the body but that leaves it in your gut for the bacteria to have a field day and ferment that into gas and cause bloating so far only stevia is considered safe on the gut but even that I recommend to use sparingly because I have seen patients who are really sensitive and get digestive distress when they use products with stevia so alcohol is bad for the gut microbiome because it turns into sugar and that's why a lot of times we'll see skin symptoms flare for example someone with rosacea will see that flare when they indulge in a lot of sugar alcohol a biotics so antibiotics are powerful tools you know they're very helpful to kill bad bacterial infections in our body but the downside is that they also kill some of the good bacteria in our gut you can also be exposed to antibiotics if you're eating conventionally raised poultry meats and dairy products so this is another reason why it's so important to be selective and only use antibiotics when absolutely necessary a lot of times antibiotics are over prescribed sometimes for viral infections when they're not really necessary so in my practice and very judicious in prescribing antibiotics only when I feel absolutely necessary and I always remind my patients to take probiotics along alongside the antibiotics to protect the good bacteria in the gut one example of antibiotics throwing off the microbiome will be when a woman takes antibiotics for something and three days later she has a vaginal yeast infection that's something we see very commonly and it's because the antibiotics threw off the gut microbiome which then threw off the vaginal microbiome so non-steroidal anti-inflammatory drugs so these are NSAIDs examples are like ibuprofen Aleve naproxen these medications are very hard on the gut and interestingly they're cut they're called anti-inflammatory drugs but they're actually inflammatory on the gut lining Vedic hormones so these are like the hormones present in birth control pills so these can also affect the gut microbiome so this is why a lot of times when women start birth control pills they gain weight and they feel really bloated so my preference in my practice is to use bioidentical hormones and the nice thing with that is we can often use that topically so in a patient who is having a lot of gut issues bloating issues I will just prescribe the hormones topically so they don't even go through your gut it's oppressive medications so if you've been on prilosec or omeprazole or prevacid for a long time and there's a lot of people who have been on them for five ten or twenty years that can definitely change your gut microbiome because that's gonna change how you break down proteins in your diet affections so if you have a gut infection with a parasite a yeast a virus any of these can affect your microbiome stress so again cortisol the bad stress hormone is going to influence the type of bacteria that grow in your gut pesticides can affect your microbiome GMO foods so genetically modified foods so when an insect eats a GMO crop do you know what happens its intestines explode so imagine what happens in humans especially in sensitive individuals you know over time all that GMO wheat corn soybean oil really take a toll on the gut can lead to chronic disease such as irritable bowel syndrome autoimmune disease chronic fatigue and other chronic diseases so inflammatory oils so by this I mean the vegetable oils so corn oil soybean canola these are can definitely cause inflammation in the gut and we see such improvement when patients cut it out of their diet we see improvement in hormones you know a lot of women will tell me their menstrual cramps are significantly improved and we also see a lot of improvement in skin as well so chemical disinfectants so those are like soaps detergents cleaning chemicals even mouth washes so this is why if possible it's preferable to use more natural household cleaners like baking soda vinegar and essential oils whenever possible and then finally surgery so if you have surgery on your gut like you have your gallbladder removed or your appendix removed or you're going through bariatric surgery for weight loss all of these can affect your microbiome so what improves the microbiome so eating a clean organic diet with lots of vegetables is so good for the microbiome fermented foods so these are foods that naturally have good bacteria because the fermentation process allows bacteria to grow so these are like sauerkraut kimchi kefir there's actually dairy kefir and there's also coconut kefir for people who are dairy sensitive interaction with the soil the earth and pets is also beneficial to the microbiome sometimes taking a probiotic supplement again probiotics are the good bacteria for your gut can be so helpful to the microbiome ever so in addition to getting your fiber from your diet and your vegetable sometimes patients do benefit from additional fiber as a supplement and that can help as well for size so like I mentioned research is showing exercise has its own beneficial impact on your gut bacteria and finally having a good circadian rhythm meaning you go to bed on time and you wake up on time with the Sun that is also important for a healthy gut microbiome so should I take a probiotic so this is a question that I'm often asked so probiotics are the good bacteria for your gut some examples of this are like lactobacillus Bifidobacterium and the yeast probiotic called sarcomas Velarde so it really depends on your symptoms so if you're having symptoms of digestive imbalances such as heartburn irregular bowel habits bloating abdominal pain then I'll generally recommend a probiotic if there's a suspicion that there's a microbiome issue such as a patient who seen me for acne or recurrent vaginal yeast infections then I'll definitely recommend probiotics sometimes we do hold off on probiotics until after the patient has submitted a gut microbiome test which I'll talk about today so there are different doses of probiotics depending on your symptoms so if I sense that the patient really needs a gut microbiome reboot I will give them a pretty strong probiotic will do like 225 billion colony forming units five or more strains and it'll typically have something called a Ravenel Galactus which are the prebiotic seeds to help recolonize and reboot the microbiome for treating minor digestive imbalances I'll do like a hundred billion colony forming units five or more strains and then for just maintaining a healthy gut will typically do like 20 billion five or more strings so prebiotics are the food for the probiotics so prebiotics are the fiber that's found in vegetables and fruits so for example apples banana they have prebiotic fiber the issue is that prebiotics in supplement form or in health bars can be a problem for a lot of patients who have bloating issues and if a patient has a lot of bloating and I suspect they may have SIBO which I'm going to talk about today SIBO is small intestine bacterial overgrowth these are patients who need to avoid supplements with prebiotics and sometimes a lot of health bars put it in their ingredient list as inulin or chicory root because it helps to raise their fiber level but these things cause a tremendous bloating for these patients so fermented foods are a great way to get natural probiotics from food so again this is like sauerkraut kimchi kefir even if you eat one or two tablespoons a day it does help your microbiome and then fiber is so important for the probiotics to to thrive because your gut bacteria live off the fiber in your diet so I always encourage patients start with your diet eat lots of vegetables and then sometimes we do add additional fiber so what is irritable bowel syndrome or IBS IBS is a clinical diagnosis based on the Rome criteria so it's basically when a patient has frequent abdominal pain and fluctuating bowel habits and typically they'll say that their abdominal pain improves after a bowel movement there's three types of IBS there's IBS C which is constipation predominant IBS so these patients you know they'll have a bowel movement like every three days they're really constipated it's a real struggle for them IBS D is the diarrhea predominant IBS so these are patients who they run to the bathroom after every meal they're going three four times a day very loose stools there's IBS M this is mixed IBS where patient has a fluctuation in their bowel habits ranging from constipation to diarrhea let's face it I'm yes is a vague diagnosis you know it's kind of a way to label symptoms it's often treated with antidepressants because antidepressants reduce pain signals going from the gut to the brain but how can we really address root causes of IBS and how can we help patients manage their IBS symptoms so what are some of the root causes of IBS symptoms so the first thing I typically will do is we want to rule out celiac disease celiac disease is an genetic immune reaction to gluten which is the protein in all wheat products and it's fairly common like one in a hundred Caucasians have celiac disease and celiac patients do unfortunately need to eliminate gluten from their diet a hundred percent to really recover so this can easily be ruled out with a blood test we check for tissue transglutaminase iga the only thing to keep in mind is that the patient does have to be exposed to some gluten within two weeks of the test for it to be accurate otherwise you can have a false negative result so gut infections so if a patient has an infection with a parasite like Giardia maybe they went camping and they got a parasite or a bad bacteria like h pylori or maybe they even have a subtle parasite like blastocysts dis hominis any of these things can cause symptoms of IBS food allergies or sensitivities can definitely mimic IBS having a poor diet if the patient's eating a lot of processed foods a lot of bad oils that could be causing them symptoms maybe they have SIBO so I'm going to talk about SIBO today again it's the small intestine bacterial overgrowth and it's now known to be a big root cause of IBS symptoms their stress in their lives because you know the big mind-body connection stress can affect your gut again maybe it's gut inflammation maybe it's their foods they're eating maybe they're on an inflammatory diet or maybe they're on certain medications that are causing them these side effects finally maybe it's microbial dysbiosis this is basically an imbalance in your gut bacteria maybe you have an overgrowth of certain back and commensal bacteria such as Klebsiella citrobacter or Serratia and that's causing your symptoms so how do I treat IBS in my practice so the first thing I do is I always test and find out your food allergies this is so important because food allergies are not always obvious the patient figure out what their food sensitivities are as well test and will exclude Siebel as well as gut infections and then we'll treat those things if we find those problems will they work on cleaning up the diet we make a more fiber if we need to to feed the microbiome and then I'll definitely counsel them on natural ways to bring relief when their symptoms flare so let me give you a case example of IBS so Sarah is a 21 year old college student who was diagnosed with IBS C treatments every three days she's had multiple ER visits for abdominal pain she had a colonoscopy and a CT scan both were negative so she was put on amitriptyline by her gastroenterologist to manage her pain symptoms so amitriptyline is an antidepressant medication and it's prescribed in IBS to reduce the pain signals from the gut to the brain so then Sarah comes to see me the first thing I do is I put Sarah on magnesium citrate about 500 milligrams every night magnesium is probably my number one preferred agent to help patients with constipation and the reason is because magnesium has so many other beneficial effects on the body magnesium is great for a muscle relaxation for a deep sleep for anxiety for a little bit liver detox pathways and for hormonal health so for all these reasons magnesium is my number one for constipation I run her allergy test and found out she was allergic to oats she had a class for two oats which is pretty significant and she was eating oat bars every day then ran an extensive functional stool test and we discovered she had a parasite infection a subtle parasite with blastocyst is hominis so I treated her parasite with some antibiotics and I gave her strong probiotics to help reboot her microbiome then I changed her diet I had her eliminate oats dairy halt sugar processed foods vegetable oils I kept her on the magnesium 500 milligrams every night and then whenever her symptoms would flare I had on massage her abdomen with a special essential oil called digest n medicine is made by doTERRA and it's a combination of fennel ginger peppermint all the things that promote gut motility and the amazing thing is it works topically so I'll have her like put six drops mix it with a little carrier oil that coconut or olive oil and massage her abdomen for a full minute the amazing thing this works really well for patients so ten minutes later they feel their abdominal pain is significantly reduced they may pass some gas and the pressure is reduced and they feel that it helps manage their pain whenever it flares so two months later Sarah is doing great she's having large bowel movements every day her abdominal pain is now much improved since eliminating the oats dairy and sugar and she uses that digest Zen essential oil whenever she needs to and she's off the amitriptyline so this is a good example showing how healing giel IBS by getting to the root causes of symptoms so now let's talk about leaky gut how many of you have heard of leaky gut wow I'm impressed okay so leaky gut is also known as abnormal intestinal permeability so the lining of our GI tract is actually only one cell layer thick and the cells that line your your gut are called entero sites it was designed this way to make it easy for us to absorb nutrients from our gut but outside is that if your gut is traumatized by toxins sugar inflammatory foods ibuprofen antibiotics or stress there can be disruption in the tight junctions between the cells or the intera sites and that can cause impaired gut permeability also known as leaky gut now there is an objective way to diagnose this condition and that's by measuring zhonya lean level in the stool so Sanyal in will be elevated if there's any disruption but in between the tight junctions between those and terrorists so if Sonia land is elevated the patient has leaky gut so leaky gut allows foods and other environmental toxins to readily enter the bloodstream and cause immune dysregulation you know we're constantly exposed to viruses and bacteria in the environment so our gut is our first line of defense against all the incoming toxins so the lining of our gut has tremendous immune cells that's why they say your biggest immune system is in your gut so dysregulation in the barrier of your gut can lead to systemic inflammation and autoimmune disease such as Hashimoto's thyroid disease lupus rheumatoid arthritis and inflammatory bowel disease which is like Crohn's and ulcerative colitis give you a case example of leaky gut hundra is a 40 year old woman about 15 pounds overweight she's an ibuprofen almost daily for her headaches diet is the standard American diet or the sad diet so by this I'm referring to fast foods processed foods sugary drinks she has a lot of stress from her job and her long commute she starts getting noticing that she's getting pain in her joints after meals and that when she has a cocktail she notices she gets achiness in her joints within minutes so Sandra's primary doctor sent her to a Rheumatologist so she's tested for rheumatoid arthritis but it's negative so her rheumatologist puts her on meloxicam to help manage her joint symptoms so meloxicam is a pain medication in the NSAID family so it's kind of in the ibuprofen family and just like ibuprofen it can be really harsh on the gut so she starts using the meloxicam daily which gives her temporary relief but now she's feeling dependent on it every day for the pain and she's not even really sure if this is addressing her underlying problem then Sandra comes to see me and we do a very comprehensive blood work we find out that she has a positive TPO antibody and that's the thyroid peroxidase antibody consistent with Hashimoto by ROI disease so this is autoimmune thyroid disease and the TPO antibody basically attacks the thyroid and causes inflammation in the thyroid ESR which is the sed rate and CRP are elevated so these are inflammation markers in her blood her gut microbiome test and find that her Sonia Lin is elevated remembers Angelyn means there's disruption in the tight junctions between her gut cells the intera sites so she has leaky gut who has another marker of inflammation in her stool called a fecal secretory IgA which is high basically Sandra is inflamed her main problem is inflammation and basically the inflammation that's causing the leaky gut and the disruption in the intestinal permeability is then causing her to have the systemic inflammation that's causing her joint pains and also causing the autoimmune thyroid disease anything is meloxicam reduces pain in the joints but it can actually worsen the inflammation in the gut so it leads to like a vicious cycle of inflammation in the body so how do we treat Sandra so first you know we clean up her diet we have her avoid all refined sugar high fructose corn syrup and trans fat never avoid all the ibuprofen and meloxicam give her a special amino acid called glutamine glutamine is healing to the intera sites that line the gut we also have her drink some bone broth because bone broth is naturally rich in glutamine probiotics to reboot and recolonize her microbiome for b-complex vitamins to help with her sugar cravings and then lastly I give her fish oil omega-3 fatty acids to help reduce inflammation for pain if absolutely necessary you know I'll have her use tylenol because tylenol does not cause any inflammation in the gut and then sometimes I also prescribe topical ketoprofen gel so ketoprofen is like ibuprofen but because it's topical a patient can just apply it on the joint that's bothering them and they don't have to use something that's going to affect their gut months later Sandra comes see me and she's lost 10 pounds she no longer feels inflamed her joint pain is gone her headaches are gone and her TPO antibody for her Hashimoto's thyroid disease is down 50% and then her sed rate in CRP dis inflammation markers in her blood are have normalized so this is a good example showing how treating gut inflammation and leaky gut can help reduce inflammation in your whole body and lead to better regulation of the immune system in autoimmune disease now let's talk about SIBO so how many of you have heard of SIBO okay wonderful so SIBO stands for small intestine bacterial overgrowth solely your small intestines or your small bowel does not have a lot of bacteria most of the bacteria are located in your colon or large intestine you know it was designed this way because your small intestines job is real really to absorb the nutrients from your diet so but patients who get SIBO basically have bad bacteria that have gotten into the small intestine and so these bacteria cause a lot of gas bloating and abdominal pain so why do people get SIBO so risk factors for SIBO are like chronic constipation if you're exposed to a lot of antibiotics if you've been on acid suppressive medication for a long time or if you've had intestinal surgeries so patients with SIBO have really significant gas bloating and belching and abdominal pain I mean these are patients who tell me they're bloated all the time they wake up in the morning and they're bloated they drink water and they're bloating and it's because these bad bacteria in the small intestine are producing either hydrogen gas or methane gas or both SIBO patients also suffer from systemic symptoms so they suffer from fatigue brain fog joint pains they can have changes in their bowel habits and they can even suffer from malnutrition because the SIBO bacteria are using up all their nutrients in fact SIBO is classically associated with low b12 levels so we're now recognizing that SIBO is an underlying root cause of IBS siebel was actually discovered by dr. mark Pimentel gastroenterologist at cedars-sinai in 2006 so patients they feel yucky and bloated all the time these are coming allergic to and more sensitive to foods in their diet they can even become sensitive to histamines in the diet so they feel very limited in what they can eat in order to avoid the bloating so here's a Siebel case example so Henry is a man who feels bloated all the time struggled with constipation most of his life he's been on antibiotics a few times in the last year it's a standard American diet he diabetes how do we test Henry for SIBO so the test to diagnose SIBO is called a lactulose breath test so lactulose is a non-absorbable sugar so your body cannot absorb it at all but that leaves it in the gut so if you have the SIBO bacteria there they're gonna ferment that lactulose into either hydrogen or methane or both so the test is is i in this way so first you collect a baseline breath then you've the lactose and then every 20 minutes you collect your breath so a positive test will be a rise in hydrogen and methane production over the course of the three hours the interesting thing is that the hydrogen predominant SIBO is associated with loose stools or ibs-d the diarrhea predominant IBS and then the methane predominant SIBO is associated with constipation or IBS see the constipation predominant IBS so that's kind of a fascinating thing so how do we treat SIBO so it is a three part approach we have to kill the bacteria starve the bacteria and promote motility so to kill the bacteria we use SIBO specific antibiotics or herbal anti microbials the antibiotics we use are like rifaximin or neomycin but more typically neomycin neomycin and refax women they are kind of special in that they are 90% they will only work in your gut so that's the nice thing it doesn't have quite the systemic side effects of a lot of standard antibiotics so there was a publication that came out that showed that herbal anti microbials are equally effective to antibiotics in treating SIBO so I do also use herbal anti microbials in my practice and the ones I use are berberine and oregano oil I'm seeing excellent outcomes both with antibiotics and with herbal anti microbials so I always discuss both options with the patient and then we decide which would be best for them so the second part of SIBO treatment is we need to starve the bacteria so to starve the bacteria we put the patient on a low fodmap low lectin diet so fodmap stands for fermentable oligo die monosaccharides and polyols fancy word but basically fodmap foods are starchy things like breads and pastas so we get rid of those things like tins are basically the outer protective coating on whole grains and legumes that can be really hard on the gut especially in IBS patients so we'll have the patient avoid things like quinoa beans and certain seeded vegetables like cucumbers so an easy way to think of this diet is it's basically a paleo diet we have them eliminate sugars even fruit we do allow these patients to have white bus body rice white pasta my tea is very easy on the gut and it has no lectins and we also allow them to have yams so the diet is a little tricky so I have it completely outlined on a handout so they just kind of follow that the third part of the see Bo treatment is promote motility so to do this first step is no snacking between meals and this is because you need 4 to 5 hours between meals to allow your small bowel to have a wave of contractility to move things and sweet about the small bowel so if you're constantly snacking on things you don't get a chance for your small bowel to clean out and then we want to make sure that the patient's having a good bowel movement every day and so for this we'll use magnesium citrate or we may use other natural things like aloe or something called modal Pro modal Pro is made by pure encapsulations and it's combination of ginger and 5-htp you know ginger is a natural Pro motility agent on the gut and 5-htp is the precursor to serotonin in the gut so it also helps promote motility now the good news is this diet is not permanent it's just for the course of treatment so it's a for about a month or a little bit longer and then we will gradually introduce foods back into the diet in rare cases when it's very we're having trouble you're eradicating the SIBO we do something called an elemental diet so it's basically a liquid diet where you use a special formula that gives your body all the nutrients it needs but it will hundred percent star of the SIBO bacteria and this elemental diet is extremely effective at eradicating siebel so let's get back to Henry's case example so he does the breath test and it shows that he has the methane predominant SIBO and this makes sense because remember the methane one is associated with constipation and he's been struggling with constipation treat henry with neomycin 500 milligrams twice a day for two weeks along with the SIBO diet and then I give him magnesium citrate 500 milligrams every night at bedtime to help move his bowels said I always talk to patients about the herbal antimicrobial options and the antibiotic options but in Henry's case we chose the antibiotics because he was already on berberine for his diabetes so berberine happens to be amazing for blood sugar regulation so he was already on it so it made sense to try the antibiotics for him so after four weeks Henry comes to follow up and his bloating is gone he's having a regular bowel movement every day and he's out actually you less magnesium citrate only 250 milligrams his energy his mental sharpness asleep have all improved he's even lost five pounds and his fasting blood Sugar's look so much better as well one of the amazing things we see is when we when we get rid of SIBO patients who were struggling with constipation all their lives their bowel movements have now normalized and the opposite is true those who are suffering from diarrhea all their lives their bowel movements are now normal so that's pretty amazing now Siebel is notorious for coming back so that's a big issue so I encourage my patients to continue to eat well you don't want to go back to your old eating patterns you really want to limit sugar and refined starches in the diet and avoid excessive snacking between meals and we also want to make sure that these patients are having really good bowel movements every day to prevent the SIBO from coming back so how healthy is your gut so how can we determine how well your gut is processing your food lot of patients will come to see me after they've already had an upper endoscopy a colonoscopy and they didn't find anything but they're still having symptoms so while these tests are important they only show the structure the anatomical structure of your esophagus stomach and colon they don't really tell us if you have SIBO leaky gut if there's a bacterial imbalance if there's an infection with a parasite or yeast how you're digesting your proteins and fats so for that for to find out all of this information I use something called a functional gut microbiome test and I use the GI FX stool profile by Genova Diagnostics so Genova is a CLIA certified lab so I find that their results are very very accurate and I have looked at a lot of microbiome tests over the years I've looked at GI map doctors data biome but I find the Genova one to be the most accurate and the most beneficial for the patient so the way this test is done is it's done from your stool so you have to submit your store and then you mail it out through FedEx it takes about a month to come back and it's a very extensive ten page report on everything related to your gut so let me walk you through the sections of the test the first section it tells us how are you digesting your food it'll tell me how much protein is in your stool how much fat in your stool it'll tell me how your pancreatic enzyme production so is your pancreas doing a good job the second section of the test is all the inflammation markers it'll measure something called calprotectin cal protecting is a more serious marker of inflammation in the gut it's elevated in like colon cancers and in inflammatory bowel disease it'll measure eosinophils protein X which is seen in parasites or food allergies and then it measures fecal secretory IgA which is a more nonspecific marker of inflammation it could be seen from stress or the foods you're eating or from ibuprofen it'll also measure the Sanyal in the test for leaky gut so the next section of the test is looking at your microbiome so they measure something called short chain fatty acids so when you eat fiber in your diet you're the bacteria break it down into short chain fatty acids so that is something that they'll measure and tell me if your diet needs supplemental fiber having the low short chain fatty acids is been associated with a lot of health issues and I see that a lot of people struggling with their weight seem to have very low short chain fatty acids so we'll give these patients a lot of fiber supplements and we'll reboot their microbiome it also tests something called beta glucuronidase beta glucuronidase is such an interesting marker it's something that will recycle estrogens and toxins from your gut the fascinating thing is that I see high beta glucuronidase in patients who have issues with high estrogen levels or estrogen symptoms in their body for example they may have breast cysts or thyroid nodules or endometriosis or fibroids or even breast cancer survivors I see high beta glucuronidase the amazing thing is this can be blocked with something called calcium D Glu curry and what's so remarkable to me is I've seen many women who have struggled with breast pain for years and for the first time ever after giving them calcium D Glu quarry their breast pain is completely gone because we have blocked the toxic estrogen recycling from their gut so the next section of the test is looking at your entire bacterial profile so they'll measure out all the bacteria and the nice thing is they have data from research showing that certain bacteria are associated with certain diseases so that we can improve that then then they have two pages of parasite analysis so looking for all the very subtle parasites that can be missed on standard tests it'll look for h pylori which is the bacteria that causes stomach ulcers and stomach cancers and then it'll look for any overabundance of any normal commensal bacteria that may be causing your symptoms and then finally there's a fungal culture section so there's overgrowth of Candida or other yeasts that'll also come up on the report so based on these results I'm then able to guide patients with specific protocols targeting their active gut issues and the amazing thing is once we heal their gut issues patients have such a significant improvement not just in their gut symptoms but in their overall health you know autoimmune disease brain fog joint pains mood issues hormonal issues they all improve and then six months to a year later we could always repeat the test if we want to see the progress that we're making so do you know your food allergies so one man's meat is another man's poison knowing your food allergies is so important you may think you're eating healthy but if you're eating foods you're allergic to it may actually be causing you symptoms and like I said a lot of food allergies are not obvious so over the years I've done food allergy tasks on patients and they were blown away when they got the report they had no idea they were eating those foods every day so the test I like to do is the eye immunocal assay for a very extensive list of foods like I'll typically run 36 foods and I find this test to be the best way to test for food allergies it's more sensitive than the skin test so for something to be positive on the skin test it has to be of a certain severity whereas the blood test will pick up on very minor allergies and it gives us the quantitative severity so then we can decide well you know whether we need to eliminate that food or reduce that food from your diet the IgE immuno cap test is also considered very medically valid it's used in allergy publications internationally and so it's something that we can follow if you want to repeat it you know five years later we can always repeat the test it's common food allergies that we see are gluten which is the protein in in all wheat products dairy which is cow's milk soy eggs peanuts and also shellfish unfortunately there is no very valid test for food sensitivities there's a lot of tests out there but I've used them over the years and none of them are considered medically valid and they can lead to a lot of confusion so my preference is not to use any of those tests for food sensitivities so what I'd like to do is do the valid one for food allergies rule that out and then we can figure out your food sensitivities based on elimination so let me give you an example let's say you did your blood test and your IgE to wheat was negative so you're not allergic to wheat but when you cut out wheat from your diet you feel great and when you add it back you feel bloated and you get a headache then I would say you are sensitive to wheat and it may be worth continue continue to eliminate wheat from your diet so what type of diet is ideal for you there's no single diet that's best for everyone we really have to tailor it to your food allergies your sensitivities and it depends on your diagnosis our certain principles that I recommend across the board so commend a Whole Foods diet so that means nothing processed you don't want something with a long ingredient label I recommend five colors a day which means you want colorful berries carrots purple cabbage green vegetables so you want a bra spectrum of colors because then you're getting all the antioxidants in your diet eat organic as much as possible to avoid the pesticides and the GMO foods if you are on a budget I recommend at least get the dirty dozen items organic because those are the highest in pesticides incorporate good fats in your diet so buy good fats I mean like avocados olive oil nuts good fat is so important for your brain for your hormones and good fats help to keep you full I have clean organic wild proteins in your diet so this is like pasture-raised eggs organic chicken organic turkey wild salmon and the grass-fed beef vegetarian then recommend legumes and lentils and nuts and seeds both so vegetables are the most important part of your diet because vegetables are so anti-inflammatory and they give your gut microbiome all the good fiber it needs I always recommend eat protein fat and fiber at every meal to keep your blood sugar stable so you never want to just snack on a carb by itself because then your blood sugar just goes up and down and then lastly it really depends on your condition so if you have diabetes or metabolic issues I may advise on cutting back on grains in your diet if you have autoimmune disease I may have I advise on avoiding gluten dairy and lectins in your diet so that is something I specialize in my practice is helping patients navigate their diet based on their diagnosis so this is a food pyramid that I drew and I put vegetables at the bottom because vegetables like I said are the most important part of your diet you want to aim for I always tell patients one pound of vegetables per day it sounds like a lot but it makes such a difference vegetables are the key to reversing most chronic diseases whether it's hypertension diabetes heart disease autoimmune disease and preventing cancer all the all different types of vegetables cruciferous vegetables leafy greens colorful vegetables you want the good fat in protein at every meal you can have a little fruit you know like organic Apple berries seasonal fruit and then a little bit of basmati rice yams and then a little bit of spices turmeric again is very anti-inflammatory cinnamon is great to sweeten up your food and then tea and coffee I put at the top of the pyramid so this is my avoid list so I definitely recommend avoid refined sugar in the diet because it's so inflammatory try to minimize or avoid alcohol if you can arey I put as an avoid because today I'm talking about gut health and there's such a prevalence of lactose intolerance and so that can cause a lot of bloating issues for patients spat so trans fat is deep fried foods or hydrogenated oils very bad for you processed foods preservatives and your food allergies whatever they are so what are the top food color culprits for IBS symptoms so again sugar and artificial sugar gluten so gluten is the protein in all wheat products it's also in soy sauce and it's in oats as well unless the oats is certified gluten-free gluten sensitivity is definitely on the rise and this may be due to the fact that most wheat products are genetically modified and hence they're inflammatory on the gut dairy again because of the prevalence of lactose intolerance where people can't break down the lactose sugar it causes a lot of bloating amatory oil so these are like the vegetable oils canola corn soybean oil it is and then lectins have you familiar with lectins Laughton's is that outer protective coating of legumes and whole grains and it's also present in some seeded vegetables but I'll give you an example so like a bean has that outer coating and it was designed that way it's the defense mechanism of the bean to withstand being digested because the ultimate goal is for that bean to get through your digestive tract and become a plant somewhere so it's not an issue for everyone but for patients with irritable bowel syndrome the lectins can cause gut inflammation bloating and pain so I'll have patients who tell me when they eat quinoa they get immediate abdominal pain again because quinoa has a nice coating certain seeded vegetables like cucumbers bell peppers and zucchini these also have a lot of lectins if you want to learn more about lectins I highly recommend the book plant paradox by dr. Steven Gundry fascinating book fascinating so what are some gut healing foods so if someone is having digestive issues whether it's IBS or they're having a diverticulitis flare or food poisoning or they're having a viral gastroenteritis these are typically the foods that help them in you know how those are easy to tolerate on their gut so typically we'll do soups and stews with bone broth again bone broth is rich in glutamine which is healing to the intera sites that lie in the gut a smarty rice so again basmati rice has no lectins and it has a relatively low glycemic index of 55 so it's fairly well tolerated and then ye ghee is clarified butter so it's butter that has had all the casein and whey proteins removed he has been used in ayurvedic medicine for centuries it's very well tolerated by patients hunted foods so those are like the sauerkraut kimchi quickly vegetables I recommend cooked if you're having any digestive issues start with cooked vegetables do organic cook to leafy greens or steamed vegetables then you want to have organic eggs chicken wild fish grass-fed beef you can use ginger in your cooking you can have ginger tea or put it in soups ginger is so good for gut motility turmeric turmeric is the yellow spice used in Indian cooking and it has an active compound called curcumin which is very anti-inflammatory on the body so eating mindfully can help IBS so a lot of us live very crazy fast-paced lives where we're eating on the go we're eating in front of a computer screen so that's not very good because I can interfere with the way your body processes the food it's preparing your own food getting in touch with your food that sets the stage for a healthy digestion when you smell your food that allows your body to make pancreatic enzymes that's going to help digest it better in a relaxed atmosphere and so important because of again the brain gut connection you want to avoid rush to meal meat eat mindfully the other nice thing is if you eat mindfully and enjoy every bite you're less likely to overeat I want to focus and chew your food so important you know enjoy food with friends and family and eat in a happy atmosphere so important there's even research now showing that meditation can help patients with IBS this is an example of a colorful clean wholesome foods meal that I made and I shared with my patients on Instagram and Facebook so this is a wild salmon with pineapple salsa and an asparagus stir-fry with white buss mati rice I wanted to bring this up because pineapple actually has natural digestive enzymes something called brawlin that helps you digest your proteins and it tastes amazing too so it's nice to add a little pineapple with your protein five colors a day so this is like a breakfast that I'll have this is a pasture raised egg cherry tomatoes avocado and then organic blueberries you want to feed the microbiome so this is a purple cabbage salad with a tart lime dressing it's absolutely delicious and crunchy and you can make something similar as a sauerkraut as well purple cabbage sauerkraut it's very good I like these kind of pictures follow me on Instagram Facebook I like to send these ideas out to my patients and get their feedback and like to stay connected with my patients a fennel tea if you haven't heard of it it's amazing for digestion it fennel naturally promotes GI motility and it can help with gas pain it's great for IBS in fact in Indian culture people actually chew fennel seeds at the end of a meal because that helps with digestion as well what are some other natural ways to manage symptoms so I already mentioned that digestion essential oil that is amazing that's made by doTERRA and it works topically you just massage your abdomen and it brings significant relief of abdominal discomfort of enzymes so enzymes help you digest your food better there's so many kinds out there there's amylase lipase there's ox bile there's bovine pancreatin there's Brahm Lin from pineapple there's pep pain from papaya and typically I'll give a patient a combination one that's really strong and it works amazing and in fact it can help patients handle some of the lectins and some of the things they're having trouble digest so if they take the enzyme fifteen to thirty minutes before they eat they're able to digest a lot better thanks again we spoke about probiotics so important it definitely helps improve their microbiome and digests better heartburn I'll often use something called DGL DGL is a form of licorice and you can chew it and it gives relief of heartburn one is aloe gel or aloe juice now it has to be pure aloe with no sugar in it but I have seen it do some amazing things I've had patients where they tell me they're having such severe chest pressure they think they're having a heart attack and then they take a sip of aloe and boom it's gone they feel amazing so it's very powerful aloe just quotes the entire esophagus and reduces inflammation oil is very nice you can put peppermint oil in your water and it helps with nausea it really promotes digestion and you can also buy peppermint in capsules as well you like we talked about and ginger tea as well are very good for gut motility help you digest better IRA supplement so not all fiber is created equal so some of my patients when they have Metamucil which is psyllium they get bloated it doesn't work well for them so my favorite fiber supplement is something called acacia Senegal and it's made by the brand Heather's fiber this is a special fiber because it's considered a low fodmap fiber meaning it doesn't cause bloating especially if you have SIBO and the nice thing is it has no taste you can add it to water and drink it so I typically have patients start out with a low dose you know like one tablespoon and then gradually increase the dose until they feel they're having really good bowel movements every day constipation my favorite things are magnesium citrate as I mentioned I also use aloe capsules this is different the aloe gel these are the actual aloe leaf in a capsule form aloe leaf is a promotes gut motility and then fiber like I spoke of we want to bulk up the stools and titrate up the acacia fiber until the patients are having really good bowel movements so this is how I evaluate patients in my practice so I practice integrative medicine so I always like to look at the whole person and my goal is always to figure out what are the root causes of symptoms so often we'll do it in phases you know first we'll work on their diet will work on nutrition get their vitamins optimized then we'll work on hormonal balance both in men and women work on their digestive health which is like everything we talked about today testing to figure out what their food allergies are and figure out what their sensitivities are we may do genetic testing like through 23andme to customize recommendations based on on their genes about mental emotional and spiritual factors that may be affecting their health you know depending on their occupation or their profession and their exposures we may test for toxins like mercury arsenic lead things that may be affecting their health and if we find those things I can help them with a very gentle detox protocol to get those things out of the body lastly you know we'll look for infections or is there a virus a bacteria or parasite or yeast that may be affecting their health so the great thing is when we address all of these areas patients see such an improvement in their health so I'd like to provide a very strong preventative approach but then I also like to do everything possible to help my patients achieve optimal health you know you really want them to be feeling great energetic strong productive and happy so to learn more about my practice definitely visit my website it's OC - integrative medicine comm and then on my website I have links to Facebook and Instagram so follow me you'll get all my health updates then if you're interested to make an appointment please give my office a call I do accept for major PPOs and I am a primary care doctor for teens and adults of all ages so I just want to thank st. Jude for giving me the opportunity to speak today and thank you to all my friends and patients for coming out this evening it's always great to see you all [Applause] [Music] [Music]

Channel: Rajsree Nambudripad, MD

Views: 124,279

Keywords: SIBO, Probiotics, Allergies, Diet, Lecture, Physician, Health, IBS, natural, drug-free, integrative, st.jude, wellness, digestive, funcitonal medicine, integrative medicine, foodasmedicine, foodismedicine, preventativemedicine

Id: TojaXntIK3g

Length: 62min 27sec (3747 seconds)

Published: Mon Nov 25 2019