Aug 31, 2017
In this episode, Dr Nirala Jacobi is in conversation with world
class gastroenterologist Dr Lenny
Weinstock about Small Intestinal Bacterial Overgrowth (SIBO)
and its connection to different conditions in the body.
Dr Weinstock is board certified in gastroenterology and internal
medicine, is the president of Specialists in Gastroenterology and
the Advanced Endoscopy Centre, he teaches at Barnes Jewish Hospital and is
an associate professor of clinical medicine and surgery at Washington University School of
Medicine. Dr Weinstock is also a primary investigator at
the Sundance Research Centre and has written more than 80 articles,
abstracts, editorials, and book chapters. He is passionate about
SIBO and its connection to different conditions, such as Restless
Leg Syndrome and Rosacea.
Topics discussed in this episode include:
- Dr Weinstock’s approach to SIBO treatment in his Specialists in
- Relapse rate after Rifaximin use
- Dr Mark Pimentel has mentioned relapse is hastened by adhesions
- Dr Weinstock’s take on this and Dr Weinstock’s experience in his
- What are some triggers for SIBO?
- Autoimmune Irritable Bowel Syndrome (IBS)
- Post infectious IBS - damage to the migrating motor complex via
an autoimmune attack on vinculin.
- Anatomical reasons
- Classical reasons
- Surgical reasons
- Postural orthostatic tachycardia syndrome (POTS)
- Preventative therapy for SIBO
- Rifaximin use with prokinetic therapy
- Bifidobacterium Lactis HN019 as a therapeutic prokinetic.
- Testing for anti-vinculin antibodies on SIBO patients.
- What’s the connection to SIBO?
- Why is the prevalence increasing?
- What is the connection between POTS and Mast Cell Activation
- Is there a potential for LPS and endotoxins to be travelling
through nerves in the body?
- Restless Leg Syndrome (RLS), what it is, why do we get it, and
what is the connection with SIBO?
- About hepcidin as an indicator of low serum iron in light of
inflammation and how this is related to SIBO.
- For example: iron as a substrate for bacteria and how the body
may respond by upregulating hepcidin to withhold iron from
- Hepcidin as an antimicrobial peptide and its role in infectious
- The link between hepcidin and RLS.
- Why endorphins may be upregulated to protect the dopamine
function in the brain in the setting of iron deficiency.
- Dr Weinstock’s treatment strategies for RLS
- What to do if patient is unresponsive to Rifaximin therapy in
light of SIBO positive testing.
- Low dose naltrexone (LDN) - its use in RLS.
- Low iron that does not respond to oral supplementation and the
possible links to hepcidin.
- Biofilm therapy
- Exploring the 3 types of IBS in SIBO
- The potential for large intestinal bacterial overgrowth (LIBO)
to skew a hydrogen rise in SIBO tests that show consistent high
methane from baseline.
- Treatment discussion for IBS - C
- Dr Jacobi’s recommendation of
BioGaia Protectis reuteri probiotic for methanogen
- 5 drops twice daily used in the study Dr Jacobi mentions.
- A couple of herbs Dr Jacobi uses for methane dominant SIBO
- Dr Weinstock’s clinical insights into the ileocecal valve (ICV)
being chronically open and allowing reflux of bacteria up into
small intestine from the large intestine.