Gut Bacteria

#6: Dr. Steven Sandberg-Lewis Shows Us How to Overcome Small Intestinal Bacterial Overgrowth (SIBO)

by Mike Mutzel


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About Dr. Steven Sandberg-Lewis:

Dr. Steven Sandberg-Lewis has been a practicing naturopathic physician for 35 years, previously on Orcas Island in Washington state and now exclusively at the NCNM Clinic.  Dr. Sandberg-Lewis receives referrals of patients with digestive diseases who desire naturopathic treatment options; often these are conditions that have defied diagnosis by other physicians. He understands the diseases of the gastrointestinal tract, but also can assess function and often find successful treatments to regain normal function of the digestive system.

He treats patients at the SIBO Center for Digestive Health at NCNM in Portland, Oregon.

He is the author of Functional Gastroenterology: Assessing and Addressing the Causes of Functional GI Disorders

natural approaches to IBS and gut disorders with Steven Sandberg-Lewis, ND

Show Notes:

01:57 Dr. Sandberg-Lewis’ Naturopathic Journey: Before he began is studies in 1973, naturopathic medicine was an almost dead profession. There was one school that graduated 4 to 8 doctors each year and there were few practitioners. The Hippies saved it, drawn to the use of natural methods and followed natural law to get patients well. It was a rebirth. In 1973 naturopathic training shifted from a night program to a full time 4 year program. When he was 18, Dr. Sandberg-Lewis’ father had told him about seeing a naturopathic physician. He also visited the ND, who convinced him to train as a naturopath to enhance his abilities in his chosen field of psychology. After 18 years of naturopathic practice and teaching naturopathy as a part-time instructor, he joined the NCNM naturopathic college staff. He still sees patients about 20 hours each week.

05:28 SIBO Center for Digestive Health: Dr. Sandberg-Lewis started this in 2010 with Dr. Allison Seabecker. The center is for research, patient care and to teach doctors about testing and treating SIBO and IBS.

07:18 Functional GI Disorders: A group meets in Rome, Italy every 10 to 15 years to determine “The Rome Criteria for Functional Gastrointestinal Disorders”. There are about 36 functional gastrointestinal disorders that have diagnostic criteria. Each part of the GI tract can have dysfunction. Pathologies, true diseases, will show in blood testing, biopsies or scope exams. IBS (Irritable Bowel Syndrome) is the most common functional GI disorder. Most physicians do not know how to deal with functional gastrointestinal disorders, so Dr. Sandberg-Lewis wrote a text book for physicians and created the center. In the general population, he believes that 10 to 15% of our population has IBS.

10:58 Bacterial Imbalances in the Small Intestine: SIBO stands for Small Intestine Bacterial Overgrowth. One study determined that 84% of patients with IBS have IBS because if SIBO. They do not have an infection. They have an overgrowth of the normal flora. The small intestine has a relatively small bacterial population. Symptoms typically are severe IBS symptoms: bloating of the abdomen, abdominal pain (could be severe), gas, gas that comes out as breath, heartburn, chronic nausea, inability to gain weight, muscle pain like fibromyalgia, headaches, joint pain, cramping pain and either constipation or diarrhea, or an alternation between the two.

13:43 Causes of SIBO: Medications, such as proton pump inhibitors like Nexium, Prilosec, and other commonly prescribed drugs that inhibit acid production predispose us to SIBO. Normal levels of stomach acid, pancreatic enzymes and bile are essential to keep the growth of bacteria at normal levels. Opiate pain killers, like Vicodin, Tramadol and Oxycodone, decrease the cleansing of the small intestine by slowing it or nearly shutting it down, allowing bacteria to overgrow. Another trigger could be antibiotics, especially for extended periods. Alcohol abuse could also be a trigger.

15:38 Preventing Overgrowth: Ensure proper motility, where things move from mouth to anus (not the other direction) in a well-regulated manner. The proper secretions are needed also. The right type of saliva, stomach secretions, pancreatic secretions and gallbladder secretions. The valves of the GI tract should work properly, especially the ileocecal valve between the small intestine and the large intestine. If the ileocecal valve is not toned and operating properly, we can get ileo-reflux, which can allow billions or trillions of bacteria from the large bowel to enter the small bowel.

18:19 Improving Sphincter Health and Tone: Look for parasite overgrowth or food sensitivities, unresolved emotions, and dietary factors. Popcorn is like razorblades going through the ileocecal valve.

19:47 Foods That Inflame: Fiber helps to feed gut bacteria. In SIBO, however, the bacteria are in the wrong place. Low FODMAPS diet is low fermentable carbohydrate foods that tend not to feed the bacteria. Eventually we will want to feed the bacteria when we can get a balance. You cannot starve the bacteria, because they will eat the sugars in intestinal mucus, and when you are very ill, it can eat the mucosa.

22:29 Rebalancing the GI Tract: There are a few strategies involved in rebalancing the GI tract. Reduce the bacteria’s food and, one could use prescription non-absorbable antibiotics like Surfaxin, Neomycin, or the absorbable antibiotic Metronidazole. Another option is to use a natural route and use berberine herbs, like golden seal or Oregon grape. There are different gasses produced by the different organisms and the ones that produce hydrogen, respond well to that. They also use extracts of garlic, the allicin extract, neem, an irevadic herb, maybe some oregano, and maybe enterically coated peppermint, that has the additional effect of being an excellent anti-spasmodic for the bowel. A study from John’s Hopkins reported that herbal combinations were more effective than Rifaximin. You never really know what will work for an individual patient. The SIBO breath test measures gasses, not which bacteria are making them. They also do not know which herb works best on which bacteria. In addition, the small intestine is 16 feet long and a scope can enter the first few inches.

29:03 Diabetes and Berberine: Dr. Sandberg-Lewis’ has a theory on the efficacy of berberine. When patients have bariatric bypass surgeries because of morbid obesity, a large number are already diabetic. The diversion of food from the small intestine causes patients, even before they lose weight in the first 4 to 5 days, to no longer be diabetic. There is no food going through their small intestine. When we take berberine and it affects our blood sugar. That may be by changing the flora and neurotransmitters that are being produced in our gut.

32:35 Clues that point to SIBO, aka Little Lightbulbs: Sometimes patients make statements that most physicians would ignore because they go against the world view. One is that a patient’s GI pain and issues improved when they were on a course of antibiotics for another issue, but resumed about 2 weeks after completing the course. Another is when a patient takes probiotics and GI symptoms worsen. Another is when a patient’s constipation worsens with high fiber consumption. Another clue is when GI issues began after taking opiate pain killers. Low iron levels for months or years and taking supplemental iron does not raise iron levels is another clue. Iron is absorbed in the upper small intestine. Bacteria consumes iron too, taking is before we can absorb it.

37:06 Assessing SIBO: The SIBO breath test involves a 1 to 2 day prep diet, which has no fiber and no sugars to avoid feeding bacteria. After a 12 hour fast, patients do an initial breath specimen, which measures hydrogen and methane. Humans can’t make hydrogen or methane, but organisms in the gut can. Then patients drink a solution of a synthetic carbohydrate. Humans cannot break it down, but bacteria can. Then a breath sample is taken every 20 minutes for the next almost 3 hours. If the hydrogen rises after the drink by 20 parts per million, that’s positive for hydrogen SIBO. If it rises at least 12 parts per million, for methane, that is positive for methane SIBO. Some of us have both. Bacteria that tend to generate hydrogen, tend to cause diarrhea. Methane producing bacteria tend to cause constipation. If we have both, we tend to alternate between constipation and diarrhea. Someone with SIBO will have leaky gut as well. Within 4 weeks of effective SIBO treatment, permeability is normalized.

42:16 Dr. Sandberg-Lewis’ Favorite Nutrient: Sauerkraut is his favorite food. Dr. Bastyr used to say that if we have extreme fatigue and we are not recovering from a bout of gastroenteritis, the best treatment is to take a teaspoon of the juice of real sauerkraut every other hour throughout the day until our energy comes back. It is a terrific food for its probiotic and electrolyte content.

43:30 Lifestyle Tip for Americans: Create changes in the way your brain has processed trauma so it no longer triggers recurrent trauma. Resolve unresolved emotions. Toxic relationships are often a sign that a person is reliving unresolved emotions. Walking with swinging arms is simplest way to process stuck emotions.

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