Preview Mode Links will not work in preview mode

With host Dr Nirala Jacobi BHSc ND, Chief Medical Officer,

Jul 25, 2018

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.



  • 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