Mastering Gut Health: Insights into SIBO, EMO, and IBS Recovery

# Get Gut Answers with Dr. Mark Pimentel | SIBO & IBS LIVE Q&A 2025
# https://www.youtube.com/watch/lcn-Kv012Yc

00:00:00.320 Gemelli Biotech, the makers of the Trio-Smart and IBS-Smart at-home GI tests. We are absolutely
00:00:07.360 thrilled to have you here tonight and we hope that this webinar provides you with valuable
00:00:12.160 insights on your gut health journey and hopes of helping you feel better quickly. It is my absolute
00:00:18.480 honor to introduce Dr. Mark Pimentel. He is an internationally recognized leader in the
00:00:23.760 field of gastroenterology and microbiome research. Dr. Pimentel is the executive
00:00:28.800 director of the medically associated science and technology program or it’s called MAST at Cedar
00:00:34.160 Sinai and one of the foremost experts in SIBO, IMO, ISO and IBS. His groundbreaking research
00:00:41.120 continues to revolutionize how we diagnose and treat these complex conditions. And he’s paving
00:00:46.880 the way for more effective solutions for patients everywhere. Dr. Pimentel tonight will begin with
00:00:52.640 a presentation covering some of the key insights of these conditions. And afterward he will answer
00:00:58.480 some of the pre-submitted questions that came in when you registered for this webinar and then we
00:01:03.600 will transition into live chat questions as well through the chat box. So without further ado, Dr.
00:01:09.520 Pimentel, the floor is yours. Thank you so much. I had a hard time coming up with 10 slides. I have
00:01:20.960 a little over 20 slides because there’s so much new information. And then I always have trouble
00:01:25.680 because when there’s so many people coming online, I don’t know how many people online are familiar
00:01:31.200 with SIBO and how many people are newbies to this space. And so I want to at least cover some basics
00:01:38.480 and then cover some of the new advances and try to at least and I could do 200 slides because there’s
00:01:45.040 just so much going on right now. And I mean that really truthfully because it’s it’s crazy what’s
00:01:50.320 going on with SIBO right now. But let’s start with what are the causes of SIBO. So remember SIBO,
00:01:57.200 it’s a diagnosis. It’s causing bloating. It’s causing symptoms of pain, diarrhea,
00:02:03.120 some cases constipation. We’ll get to that. But but something has to make the overgrowth
00:02:10.639 occur. Why is it happening? So this this is the sort of the list of things that make it happen.
00:02:16.880 So mechanical causes. So if your bowel is blocked or it’s not flowing correctly, it’s going to fill
00:02:24.640 up with material, fluid, debris from food and and those sorts of things. And so then you’re
00:02:30.960 going to get a buildup of bacteria. So there’s a laundry list. But if you look at the bottom,
00:02:35.600 irritable bowel syndrome is the number one reason. When I say the number one reason, so if you had a
00:02:42.240 100 people with SIBO, the majority of people it’s irritable bowel syndrome. So I’m going to spend a
00:02:47.920 lot of my time focused there, but I want you to understand that if your SIBO doesn’t get better,
00:02:54.000 if you get treated and it doesn’t get better, you got to be looking for some of these other things
00:02:58.160 or at least the doctors that are treating you should be thinking about these things. And I’ve
00:03:03.360 got the list here. I’m not going to go through them in detail, but I do have a slide that sort
00:03:07.600 of walks through some of the things that I worry about because adhesions are quite common. So,
00:03:13.680 if you have an adhesion because you had previous surgery or you had uh a tubal ligation or a
00:03:18.880 appendectomy because you had appendicitis, you can get adhesions and they’re like it’s
00:03:24.240 sort of like a bent hose. You got a you got a scar that’s connecting two loops of bowel and
00:03:28.800 creating this bend here and then fluid can’t go through it and then bacteria builds up.
00:03:33.600 That’s one example. Endometriosis can do this. Crohn’s can do it because Crohn’s can cause the
00:03:41.200 thickening of the bowel and then things don’t flow correctly because the bowel can’t move freely.
00:03:46.480 The muscles can’t contract freely and so you can get it there. There’s all sorts of weird things.
00:03:51.920 I’m not going to get into a seclas quite rare. Tumors of course are also on the list because
00:03:57.200 if something’s blocking the bowel that can cause overgrowth. So we we shouldn’t close our mind.
00:04:02.800 So if somebody’s not responding to the treatment for overgrowth brilliantly, think about why their
00:04:08.400 overgrowth is there and see if you can treat the underlying cause as another way of evaluating why
00:04:13.840 the SIBO is there. But I really want to turn my attention to the biggest group irritable bowel
00:04:18.560 syndrome. And this is the fact that we think IBS is caused by SIBO in a bulk of it in the majority
00:04:25.360 of it had created some controversy because IBS was always thought of as a psychological condition.
00:04:31.840 But we now know that’s not that’s not the case. And we are looking at root causes of IBS. And we
00:04:38.240 think about 60% of IBS is SIBO, ISO, or IMO. And we’re going to get into those three categories of
00:04:46.000 overgrowth of bacteria as we get through this lecture. And then I’m going to try and take
00:04:50.720 you to some treatment options. But there’s this theory that is evolving. The brain and the gut
00:05:00.640 are connected. Absolutely. The brain and the gut are connected. Um and because of the vagus nerve,
00:05:06.800 because of various communications with the bacteria producing chemicals like serotonin and
00:05:12.560 other chemicals. So yes, there is a connection. But when your gut is not working and your brain
00:05:17.680 check engine light comes on, okay? So, but you don’t break the light on your dashboard because
00:05:24.560 it’s on. you go to the engine to fix the engine problem and the light turns off. And I think
00:05:30.320 that’s a good analogy of this gut brain connection is that what’s broken in my view in most patients
00:05:38.400 with IBS is the gut and the brain is getting these check engine lights and sometimes that not only
00:05:46.560 the check engine light but the fact that you’re running to the bathroom over and over again has
00:05:49.600 got to be anxiety-provoking etc. So we we know that that connection is there. So I don’t want
00:05:56.160 to dismiss that, but I just want to address that because you get a lot of noise on the internet,
00:06:00.080 on social media about all these different aspects of IBS. And I want to make sure we
00:06:05.600 cover a little bit of everything, but what we know for a fact, and this is undisputed now,
00:06:11.280 that food poisoning triggers the development of IBS. So, you were fine until you went to um
00:06:22.800 you were fine until you went to Cabo or you were fine until you went to
00:06:27.840 uh on ate at a particular restaurant and you got food poisoning or you were fine until and so
00:06:33.680 food poisoning is a absolute cause of IBS. It’s like one in seven people who get food poisoning
00:06:40.640 will develop IBS from food poisoning. That’s amazing and we know this to be a fact. So we
00:06:45.600 now know a cause of IBS. But the question is is that connected to SIBO and this took over
00:06:52.400 a decade of work in our lab and by others around the country that food poisoning has a toxin in
00:06:59.280 it. And that toxin called cytolethal descending toxin in salmonella, shagala, campalobacttor,
00:07:04.960 e.coli, the four horsemen you could call them of food poisoning that trigger IBS. And that
00:07:12.240 toxin in and of itself can lead to irritable uh bowel syndrome. And how it does this is
00:07:22.320 how it does this is that the toxin has a similar sequence to it to it forms antibodies to the
00:07:30.960 toxin. Part of this has a similar sequence to vinculin and vinculin is a very important
00:07:37.600 protein for the nerves of your gut. so they can interconnect and it’s sort of like the wiring
00:07:43.440 in your house and half the wires are pulled out so only half the lights turn on in your
00:07:50.080 small intestine. So your small intestine is not moving correctly because half the lights are on
00:07:56.240 or half the wires are there and when you have these antibodies to vinculin. So if you want to
00:08:01.760 say what is causing SIBO what is c the root cause of IBS this could be the root cause.
00:08:09.280 So if we can get rid of this antibody, everything wakes up. The nerves reconnect, the wires reform,
00:08:14.640 and we’re back to normal. And that’s what we’re really focusing on in our research for the future.
00:08:19.120 We don’t have such a drug yet, but stay tuned to the end of the presentation because we’re close.
00:08:24.800 So that this antibody though can be measured as part of the IBS smart test, which Jamali has,
00:08:31.360 and you’ll hear a little bit about that from Paige. It tells you food poisoning caused it
00:08:36.000 and you have these destructive antibodies. But if we give this toxin to rats, they get antibodies to
00:08:43.840 this toxin CDTB. And because of that, the fluid, the water weight of their stool goes up. And the
00:08:50.720 higher the antibodies, the worse their diarrhea is. If you look at this third graph on the right,
00:08:56.880 but what happens when the wires are pulled out? Like I told you earlier, the gut slows down and
00:09:05.120 bacteria build up. And this is the connection to SIBO. And even in animals, the bacteria building
00:09:13.040 up go in one of three directions. One direction is not much happens. The green the green balls here.
00:09:21.920 Or they go in one of two bad directions. Too much E.coli, coli which is hydrogen production
00:09:28.640 or too much hydrogen sulfide which is um other bacteria specifically dulo vibrio in rat in in
00:09:36.320 rats. So we know that if you develop IBS from food poisoning you’re going to get one of these two bad
00:09:44.320 microbiomes in your small intestine or one of two types of SIBO or overgrowth. So now going to IBS,
00:09:54.240 breath testing in IBS, it’s a it’s a knock out of the park here. This is a 25 study meta analysis
00:10:02.080 saying if you do a breath test in IBS, the chance of it being positive is much higher than healthy
00:10:06.960 people. Full stop, full conclusion. Uh you don’t need more studies. We have 25 15 of them are
00:10:13.360 considered high quality studies. And so we know that IBS and SIBO go together by breath test.
00:10:20.880 Now, one of the things that you’re going to be in a tug-of-war with if you read social media, if you
00:10:27.600 read uh anything about breath testing is, can I do glucose or should I do lactulose? Glucose, you
00:10:34.640 don’t need a prescription for glucose. Lactulose, for some strange reason, is a sugar, but still
00:10:39.920 requires a prescription. And it’s just 10 grams of lactulose, but it still requires a prescription.
00:10:45.920 But what happens with glucose is it gets absorbed so quickly that you run out of steam. So you’ll
00:10:52.160 see the breath as it goes up and then it starts to go down because it’s being absorbed by you. You’re
00:10:57.760 absorbing all that glucose. And I’m 6’4. I’m going to absorb more in my mouth, in my esophagus,
00:11:03.520 in my throat, in my stomach before it even reaches the small intestine than somebody who’s smaller
00:11:09.360 frame or smaller body or smaller GI tract. And so glucose is not the greatest substrate. And what we
00:11:16.320 learned uh this year is that glucose misses people who are sick because the people who are negative
00:11:24.160 on glucose breath test are sicker than the people who are negative on lactulose. So the glucose is
00:11:30.000 missing people who could benefit. So this is proof of what I’ve been saying for years that lactulose
00:11:37.120 is better. It’s going to pick up more people who have a problem with with the overgrowth. But now
00:11:45.360 we have three gas breath testing. For years it’s been two gas breath tests. And the new development
00:11:50.800 with the Trio-Smart is three gases because we now know there is hydrogen sulfide producing. I showed
00:11:57.200 you that in the animals and in humans is the same thing. And hydrogen producers. The third gas is
00:12:04.720 methane which is associated with constipation. So you really have to measure all three gases
00:12:11.040 uh to to get an understanding of the microbiome in you. The sensors in the new Trio-Smart are
00:12:18.000 more accurate than the typical sensors in other instruments because it can measure it within a a
00:12:24.320 fifth of a part per million. So you never get confusion about what the results are. The bags
00:12:31.040 are able to hold the three gases for 10 days for shipping. The bag system is designed to keep those
00:12:36.560 gases stable in that bag for that period of time and it doesn’t alter the hydrogen sulfide. So,
00:12:43.520 it’s important to measure all three gases. And we now know, I mean, prior to this year, people said,
00:12:48.800 "Well, how do you know it’s in the small bowel? How do you know that the when you measure a breath
00:12:53.120 test with the three gases that you’re measuring the bugs that are in the small bowel?" And this is
00:12:59.920 now uh accepted for publication. And basically it shows that if you use the three gas breath test,
00:13:05.840 the trio smart breath test, if you have methane, methane bugs are in the small intestine. If you
00:13:12.080 have and these are the bugs and the most important one is this Methanobrevibacter smithii. If you
00:13:18.320 measure hydrogen sulfide on a human’s breath, you have hydrogen sulfide producers correlating
00:13:24.400 with that breath sample when you look at the small intestinal microbiome. So proves that the breath
00:13:30.560 test is actually telling us exactly quantitatively how much of these bugs are there in that are out
00:13:38.320 of proportion out of the normal range. What’s super interesting and this goes with what we’ve
00:13:44.800 always known about irritable bowel syndrome and particularly hydrogen sulfide. We now know so
00:13:50.960 much about hydrogen sulfide in a short period of time. But basically whether you look at hydrogen
00:13:56.000 sulfide in humans or you put these bugs from humans into animals you get the same changes in
00:14:04.160 the gut and the changes are your motility changed you feel pain more you get fluid shifts meaning
00:14:11.200 you get diarrhea and immune responses and other things. Um and but so now that we know there are
00:14:18.720 three gases we have to treat this. So one of the things that we’ve known for a long time is that
00:14:23.600 Rifaximin is quite good for hydrogen and this is hydrogen breath testing. This is treatment of SIBO
00:14:31.280 uh with Rifaximin. This is a meta-analysis of 32 published studies showing Rifaximin helps SIBO.
00:14:40.000 Um now you know one of the questions that always comes up is does it help all SIBO? And there’s
00:14:46.320 always a percent that get better and a percent that don’t. Overall, Rifaximin is beneficial
00:14:52.320 for SIBO in general. I throw this study up there because I like prevention. I want to prevent IBS,
00:15:01.360 but it’s also really important slide. It’s an animal study, but it’s a really important slide
00:15:07.520 to prevent the antibodies from going up further. So, this is an animal study we did. This is 2011.
00:15:15.120 But if we gave food poisoning to animals and we gave them Rifaximin the day before they
00:15:22.640 got the food poisoning, the day of the food poisoning and the day after, they had a much
00:15:28.800 lower chance of developing IBS. And why is this important? Because you can prevent IBS if you’re
00:15:36.240 going somewhere where food poisoning is a very high rate. So treating food poisoning is really
00:15:42.720 important. Don’t let it ride. And secondly, if you have IBS already and you have these antibodies,
00:15:48.880 you got to prevent and Rifaximin also prevents and we do that with our patients and I can get
00:15:54.160 into that in the Q&A. For methane, it’s different. This is a double blind study we did in 2014. You
00:16:00.480 got to give Neomycin plus Rifaximin. This is what we recommend to our patients with methane. Methane
00:16:07.040 constipates. Methane slows your gut down. The methanogens are different. They don’t come from
00:16:12.240 food poisoning. They come from reasons we don’t understand why they’re now blooming or growing
00:16:18.720 in high number in the colon and in the small bowel of patients with this constipation side
00:16:23.280 of things. But Neomycin and Rifaximin is what we use and sometimes we substitute Neomycin for
00:16:28.400 metronidazole. We published uh an a paper on a new elemental diet. This is palatable. It tastes good.
00:16:37.280 So it’s tolerable. It can be done for two weeks. And we did 30 subjects in this clinical trial.
00:16:43.600 Everybody finished the trial. Everybody was able to take the diet. So, it was tasty enough to for
00:16:49.120 people to finish it. 73% normalized their breath test and 83% had symptom relief based on their
00:16:56.800 uh symptom questionnaires. And also that bug that produces methane and those that had methane was
00:17:03.680 decreased when methane was decreased. So, we’re we’re really Anfusacterium went down which is a
00:17:09.359 hydrogen sulfide producer. So, the elemental diet is a good option. A, if you can pay for it, and B,
00:17:17.440 if you can put up with liquid diet for two weeks, but at least it tastes good. Now, I’m
00:17:22.480 going to talk to you about three exciting things because I like to give you the future because this
00:17:27.680 is the future. We now in our hands in the lab, we have a drug that can reduce methane by 70 to 90%.
00:17:35.280 And so by blocking methane production and this is the animal study. These animals had the methanogen
00:17:42.400 that methane bug Mithyi. They had constipation. We gave them the drug. Their constipation
00:17:49.920 diminished. Their methane went down. This is for the future. This is the future of treatment of IMO
00:17:57.840 or intestinal methanogen overgrowth. The treatment future for IBSD or uh patients with SIBO and ISO
00:18:08.080 the hydrogen sulfide we now believe is based on this work. Half of the bugs meaning the bugs
00:18:15.360 that produce hydrogen and the bugs that produce hydrogen sulfide are living in the mucus and the
00:18:20.240 other half live above the mucus sort of floating. The bugs above the mucus Rifaximin can hit them.
00:18:26.960 the bugs in the mucus. Rifaximin doesn’t dissolve in liquid so it doesn’t get to them. So we decided
00:18:34.560 to mix Rifaximin in a particular way and deliver it to the small bowel with an acetylcysteine
00:18:40.160 which dissolves mucus and we get much better improvement. This is your regular Rifaximin in a
00:18:47.200 study we finished and presented at the big meeting in uh in San Diego this this spring. And this is
00:18:53.840 what happens if you add the knack and Rifaximin together. So many more things are better. So
00:18:58.880 many things are more statistically significant. We’re starting a three center phase 3 national FDA
00:19:05.600 approved study to get this along so that patients can get this new better improved treatment for
00:19:13.120 IBS-D and SIBO and ISO. Finally, we published this paper this summer and it’s uh just out and if you
00:19:24.960 can get the anti-vinculin antibodies down those patients, the IBS starts to disappear and the SIBO
00:19:32.480 starts to disappear. And we now have sequenced all these antibodies and we’re in the process of
00:19:37.920 developing a treatment to get these antibodies out of the bloodstream. Stay tuned for that. In about
00:19:42.960 a year, I’ll have some big information on this because we should have something in hand in a
00:19:48.320 year to start trials or safety uh uh preparations for the FDA. So, super excited about this cuz
00:19:56.720 this could be the cure, quote unquote. I know that’s ambitious. I don’t want to overpromise,
00:20:02.720 but we’re working on it. That’s all I’m saying. We’re really trying to get to the bottom of this.
00:20:08.240 But in the meantime, we have these three groups. And the only way you know these three groups
00:20:12.400 is you measure the three gases. So we have the traditional SIBO in the middle. We know the bugs
00:20:16.880 there. Ecoli and Klebsella. We got the condition on the on the right, the constipation condition.
00:20:22.400 We know the bugs that are producing the methane. And now more severe diarrhea is ISO or hydrogen
00:20:29.040 sulfide production. And to be honest, we have patients who have combined. So we have some
00:20:34.720 with ISO and SIBO, ISO and IMO. And so you have to tailor your treatments accordingly. So the root,
00:20:43.120 we’re getting to the root of IBS in that 60% of IBS patients. The root is there’s SIBO and
00:20:50.480 we use either Rifaximin or elemental diet for that. At the moment, if you’re IMO or methane,
00:20:56.000 we use Rifaximin plus Neomycin or Rifaximin plus metronidazole For ISO, we use Rifaximin plus
00:21:02.560 bismuth. That works for now until we get these new drugs. uh through the uh FDA process. The two new
00:21:10.320 therapies I talked about today are coming. Super excited about that. Measuring anti-vinculin and
00:21:16.320 anti-CDTB antibodies through the IBS smart test. I do this routinely because if the anti-vinculin
00:21:22.720 anti-body predicts that you have IBS and we know what caused it. It’s also important to tell us how
00:21:28.720 easy you are to treat and take precautions when you travel. And we’re developing a new therapy,
00:21:35.120 we hope. Uh so keep your fingers crossed for us on that because that may solve the whole problem
00:21:41.840 uh in the long run. So in conclusion, SIBO is common. It’s important to know the cause of SIBO.
00:21:48.880 You can’t just if you’re not responding, make sure you don’t miss something other than just IBS. Food
00:21:55.360 poisoning causes the bulk of this. And we talked about the two antibodies that are up. This is
00:22:00.960 not your grandpa’s SIBO. This is not the old SIBO that used to be in the textbooks. This is uh the
00:22:07.280 new generation of SIBO with these three categories that we talked about and hydrogen sulfide as that
00:22:13.520 new kit on the block which is giving us a better understanding of some of the more challenging
00:22:17.920 patients that we’ve had and new therapies are coming. So, I’m going to stop there and
00:22:26.160 move on to the next section. So, Paige, I think you wanted me to do the pre-submitted
00:22:30.640 questions first, right? Yes. Perfect. That would be awesome. We’re going to spend some time with
00:22:36.640 10 or 20 questions that were pre-submitted from the registration link that we all have. Okay,
00:22:43.360 perfect. Well, I’m I’m super excited to get to these because they’re really really good questions
00:22:48.000 and clearly a lot of you have some experience with this or having trouble being managed with this as
00:22:54.080 well. I can’t give you medical advice, but I can tell you what I do from my perspective for some
00:22:58.800 of these problems and that’s the that’s the way I will answer it. And I will do this for about
00:23:05.520 10 minutes and then I will go on to the on to the live questions because there’s more questions here
00:23:11.840 than I can answer and probably more questions live, but I want to make sure the live folks
00:23:15.760 have a chance as well. So Melissa, hope you’re on. Melissa asks, "After SIBO or IMO has been
00:23:23.200 eradicated by antibiotics, what can you do to restore a healthy microbiome?" So,
00:23:29.120 what’s interesting is that there’s a lot of people trying to develop things or sell things online,
00:23:36.880 pills that will reconstitute your microbiome and all of that. So, what I want you to do is I want
00:23:42.240 you to think of it this way. You’ve got E.coli coli and Klebsiella and these hydrogen sulfide
00:23:49.040 producers there and when they’re there they’re producing chemicals they’re they’re out competing
00:23:56.000 everything else and they’re destroying your microbiome it’s sort of like weeds in your garden
00:24:00.880 right so the weeds take over the vegetables don’t grow nothing is produced as soon as you take the
00:24:06.800 weeds out the garden grows and so the Rifaximin treatment we’ve seen this in our microbiome data
00:24:13.920 soon as we give the refax axmen and we check the microbiome after all the bugs are coming back and
00:24:19.200 there was a massive study that was done out of Cork Ireland uh we weren’t on that paper it’s
00:24:24.320 a but it’s a very important paper and it showed that the way Rifaximin works in IBS is that it
00:24:31.760 makes the microbiome alive again and shift back towards normal by getting rid of the bad actors.
00:24:39.520 So, we see it in our data and the massive study that combined all existing data on IBS
00:24:45.520 showed that in that in this recent paper that was just published less than a year ago. So,
00:24:51.520 you shouldn’t have to do anything. And the problem is we’re not fixing the wiring, right? Remember I
00:24:56.800 told you at the beginning the wiring is a little broken. So, you don’t want to put fish food in
00:25:02.080 there. You don’t want to put fiber. You don’t want to put ex the and we’ll get to diet here in some
00:25:07.520 of the other questions because you’re feeding the bad guys. The bad guys are 60 times more capable
00:25:14.240 of fermenting than the good guys. And so like E.coli and Klepsiella is 60 times more efficient
00:25:21.360 at fermenting. They’re they’re going to win. So if you put food in there for them, you want
00:25:26.640 the food for you, not for them because they’re the because of the wiring and the slow transit,
00:25:31.520 they’re going to come back and overgrowth comes back. Um Jim asks, I finished just finished a two
00:25:38.560 course of Rifaximin and Neomycin for intestinal methanogen overgrowth. That’s one of the things
00:25:42.640 that we we do in our clinic. Um and have heard repopulate quickly if not eradicated. Archaea
00:25:51.760 actually are actually quite slow to repopulate um because they’re slow growing organisms. So it’s
00:25:58.640 not quite like that. But uh how long would you recommend waiting before doing another
00:26:02.640 breath test? So usually I wait a week after the completion of treatment to do another breath test
00:26:08.480 in my clinic. But um and when would you consider a second course? So if you’re incompletely treated,
00:26:15.920 so this is going to answer a few of the questions that I’ve perused here is that you know if you’re
00:26:23.600 if you’re 90% better after Rifaximin or Rifaximin and Neomycin, you don’t need another breath test.
00:26:28.800 Don’t waste money. Don’t waste time because the breath test isn’t going to make you that extra
00:26:33.920 10%. But if you’re 40% or 50%, you might have been completely eradicated. And if that’s the case,
00:26:41.360 you need to know you need to do another breath test. There is an occasion where you want to do
00:26:48.080 another breath test. Let’s say you’ve treated and you don’t feel better and you do another
00:26:53.040 breath test and the overgrowth is still there and you don’t feel better or the overgrowth is
00:26:56.960 gone and you don’t feel better. Then you need to look for some of the other causes of symptoms. So
00:27:02.320 for example, if you had an adhesion, you’d be bloated and distended from the adhesion, plus
00:27:06.400 you’d have overgrowth on top of that. And if you treat the overgrowth, you still got the adhesion.
00:27:10.640 You still got the distension. So you got to look for the adhesion. So the breath test by finding
00:27:17.440 that it’s normal, but you’re still symptomatic tells you better look for something else. The
00:27:21.840 breath test saying, "Hey, the overgrowth is still there. Why is it so difficult to treat? You need
00:27:26.080 to look for why the overgrowth is still there and could something be uh more sinister going on." So
00:27:32.800 I think that answers a few questions. If you test Oh, Adam, sorry, Adam asked this question. If you
00:27:40.240 test positive for the antigens on the take-home blood test indicating that you had food poisoning,
00:27:46.320 what do you do next? So, one of the things that you know reasons that maybe people don’t do the
00:27:52.640 blood test as often uh is because well, I’m not going to do the blood test cuz so what? I can’t
00:28:00.080 treat it yet. There’s no drug for it yet. But that’s not my approach in clinic because if I know
00:28:06.800 that those antibodies are positive, I make for darn sure that the patient travels correctly, that
00:28:13.920 I counsel them about traveling, careful eating, and I don’t mean careful eating what you eat. I
00:28:18.240 mean careful eating, you know, maybe you shouldn’t eat at the at the uh roadside stand where they’re
00:28:25.120 cooking food in the open like, you know, or a food truck. You need to think about your food choices
00:28:30.320 so you don’t get food poisoning again because IBS patients have three times higher chance of getting
00:28:35.040 food poisoning and what we think is that those broken wires because of these antibodies means
00:28:41.040 that you’re the person that can easily get food poisoned again that’s why they damaged you that’s
00:28:47.920 why the campylobacter the salmonella damaged you so they keep come keep using you but then
00:28:52.960 your antibodies go higher then you’re sicker and sicker and sicker and you’re harder to treat for
00:28:56.720 your SIBO So knowing you have these antibodies, I change exactly how people behave, where they go,
00:29:03.600 how they go. And then in some cases, if the antibodies really high, if you’re traveling to
00:29:08.560 places um certain places in the world, I’m giving Rifaximin prevention a little bit with every meal.
00:29:15.680 So food poisoning does not come. Leslie asks, "So if you have the IBS smarts antibodies,
00:29:23.680 should you retest and how often?" Um, if you take Rifaximin for your SIBO and you had the antibodies
00:29:32.720 and your SIBO goes away, you feel great, the antibodies aren’t going to change. So, you don’t
00:29:37.760 need to measure the antibodies after a treatment with antibiotics like you would the breath test.
00:29:43.360 You want to measure it at a longer interval because it takes about a year, two years to
00:29:49.040 see the change in anti-body because this is like you getting a vaccine, right? the antibodies are
00:29:53.760 going to stay up because you have vinculin. Your body has vinculin. So, it’s going to keep forming
00:29:57.520 those antibodies and only slowly come down. But if they are coming down, that’s a good sign. And
00:30:03.920 I’ve had patients where the antibodies go back to normal and their IBS goes back to normal, which
00:30:08.800 is fantastic. Um, so once a year is what I sort of uh rule of thumb. Lizzy asks, "When do you test?"
00:30:21.520 after finishing Rifaximin. Oh, I’m sorry. When do you test and what diet do you use? So, I kind
00:30:27.360 of mentioned this 7 to 10 days after completion of the antibiotics, that’s when I would do the second
00:30:32.160 test to be sure it’s gone. The diet I use the low fermentation diet. I don’t use low FODMAP. Um,
00:30:38.960 and the reason I don’t use low FODMAP is because it’s too restrictive. It actually reduces the
00:30:45.120 microbiome diversity. So, I use low fermentation, which is more um um liberal and Paige can provide
00:30:53.760 that for you if you like uh if you just put a message in the chat the diet. Um Mary Joe asks
00:31:02.400 after doing uh the elemental diet, when should we retest for SIBO? If you’re doing elemental diet,
00:31:10.080 I always test again because that’s a lot of work. It’s expensive because you have to pay
00:31:15.680 for the elemental diet and so I want to know that it’s gone before you know right after you’ve done
00:31:21.600 the elemental diet. So I’m more likely to retest after with elemental. Are there any new remedies
00:31:28.080 for IBSM? So IBS-M is really D. So when we did the original Rifaximin study, it was D and M
00:31:35.680 together. So it was non-constipation IBS. So it’s really the same. and M has so the way I see M is
00:31:43.280 it’s riding the fence between D and C and so when you do a breath test some of the M’s are methane
00:31:49.120 some of the M’s are hydrogen and SIBO and so it’s it’s just on the spectrum of the gray parts of the
00:31:56.560 spectrum um are there any new treatment protocols or research on methane dominant SIBO so I told you
00:32:04.480 about CSO6 so in about a year we’re going to start clinical trials in that fingers crossed cross if
00:32:10.160 there’s all the safety lines up perfectly and we’re super excited about that. So stay tuned
00:32:16.080 for that because I think that’s going to replace what we’re doing now. Um what can I do to after
00:32:22.160 eradication to prevent relapse? So there’s two things I do to prevent the overgrowth from coming
00:32:28.400 back. And so let me describe this to you. First of all, low fermentation diet and I as I mentioned
00:32:34.400 Paige can send that to you. But the second is if this is your first time treating overgrowth,
00:32:42.000 I would just do l fermentation diet and see how long it is to relapse. If it’s two years,
00:32:47.120 you don’t need to do anything more. And so, why waste money? Why get another prescription?
00:32:51.440 Why take a drug? My goal is to give people safe options and to minimize misery. Uh,
00:33:01.120 I want people to be able to go to a restaurant, enjoy food, uh, be as back to normal as possible.
00:33:06.960 The low fermentation diet’s like that. It’s less restrictive. You could find any restaurant in this
00:33:12.560 country with a food item from the low fermentation diet uh that that we we created because the whole
00:33:19.520 point was you don’t want to be at a table with a bunch of friends and you’re the one asking
00:33:24.080 20 questions. It’s not convenient for you. It’s not fair to you. It’s anxiety-provoking to you.
00:33:29.760 Why would you want that? So it gives you the option to be able to easily pick something
00:33:34.560 from the menu without without being that person, you know, and I think you know what I mean. Um,
00:33:41.120 so but if your SIBO relapses and relapses and relapses or you have these high vinculin
00:33:47.520 antibodies, we sometimes need to give a prokinetic at nighttime to make the wiring work. So remember
00:33:54.720 when I said there was less wiring. So you can’t bring the wiring back unless you get
00:33:59.120 rid of the antibodies, which we haven’t figured out yet. But you can turn the energy up on the
00:34:04.960 wires that are there. So it’s sort of like you have half the lights in the house. So the only
00:34:10.239 way to see is to make the light bulbs that do work turn brighter. And so that’s why we use a
00:34:15.679 prokinetic. At least that’s that’s sort of a um a simple way to describe the prokinetic effect.
00:34:23.199 All right, I’m going to do two more questions here, then we’re going to open up to the main
00:34:26.320 group. Um, uh, what can I do to prevent relapse? I have hydrogen SIBO and I took three rounds
00:34:33.040 of refraction with no success. What are my options? This is from Patricia. So, Patricia,
00:34:38.080 um, again, I can’t give you medical advice, but if I have a patient where they’re not responding, you
00:34:46.320 got to do more workup. you got to have the doctor has to take take some um effort and see why this
00:34:53.679 is happening, why it’s not getting better and or if it’s hydrogen sulfide and you didn’t treat the
00:34:59.760 hydrogen sulfide. So, I don’t know if you did a it did a three gas breath test or a two gas breath
00:35:04.240 test. So, that’s another thing to think about. Um, and then one last question. Um, if a person
00:35:11.360 has fructose intolerance, could that be the root cause of recurring SIBO rather than food poisoning
00:35:16.320 symptoms? This is Heather. So fructose intolerance is that you have the inability or a lower ability
00:35:24.240 to absorb fructose and then it gets to the colon and so as a result of that you get this gas
00:35:29.840 production and bloating. Um so you can’t diagnose fructose intolerance unless you do a breath test
00:35:39.360 for SIBO because all SIBO patients will test abnormal for fructose. It’s just a thing.
00:35:46.080 um almost all. So, I wouldn’t do um you have to do the SIBO breath test first and make sure before
00:35:54.320 you uh check for fructose. Okay, so now I’m going to go to the chat and look for what questions are
00:36:01.440 here. Let’s see. Okay. Uh Jill has asked uh what kind of treatment you would recommend for
00:36:12.320 um a new diagnosis of IMO. they use the Trio-Smart test to reveal that they had um high methane.
00:36:19.440 Yeah. So in my clinic again can’t give you medical advice but in my clinic um and based
00:36:25.840 on the randomized control trial I showed here in the slides intestinal methanogen overgrowth the
00:36:30.640 first treatment would be Rifaximin plus Neomycin. Now I’ll give you just some pointers on Neomycin.
00:36:37.120 Some people are reluctant to take it because it can cause ear toxicity. Uh so if you have
00:36:42.480 hearing loss to begin with when when they say ear toxicity they’re talking about genty which is an
00:36:50.080 a drug they give by intravenous Neomycin is the same class of drugs but given orally it doesn’t
00:36:56.320 get into your bloodstream but it still has that label because the FDA says okay same category
00:37:02.000 of drug got to get the same side effect label. So, I’ve never seen ear toxicity with Neomycin,
00:37:11.040 but if you do have any hearing loss, don’t use that. Use metronidazole instead is is what I do
00:37:16.320 in my clinic. So, awesome. Thank you. Okay. Um we have uh Donna asking how long can um I actually
00:37:26.320 be on Motr. So, Motegrity has been uh approved in Europe before it was here and probably been about
00:37:35.600 10 years on the market. People have been on it for 10 years straight taking high-dose motility
00:37:41.760 um in and around the world. It still appears to be very safe. Um I’m not saying you should
00:37:47.680 be on it for 10 years. What I’m saying is that what we what we do in our clinic is we use it
00:37:52.800 at night after the overgrowth has been treated if you’re getting relapses. And we use only a half a
00:38:00.080 milligram which is half the dose of the lowest dose of motility. So you could be on it for a
00:38:06.480 long time considering a lot of people been on or two or four milligrams for almost a decade. So
00:38:12.960 um it’s just a small dose enough to kind of just get those light bulbs brighter. Uh so that
00:38:19.360 prevents the overgrowth from coming back. Thank you. Um, okay. We have Trisha who’s asking, "Uh,
00:38:28.400 what do you personally think of Fodzyme? I cannot get my teenage son with post-infectious IBS and
00:38:34.400 SIBO to follow a special diet, and this seems promising." Yeah. So, Fodzyme, it it’s sort of
00:38:41.120 it’s an enzyme to break down FODMAPs. That’s the purpose of it. Um the challenge, you know, if you
00:38:49.760 remember lactade, uh the lactade pills, if you were to drink a cup of milk and pop two lactates,
00:38:57.120 you’re going to digest 50% of that milk lactose maybe, uh if you’re lucky. The other 50% not. So,
00:39:05.520 it’s going to take the edge off, but it’s not 100%. Right? Um because you’d have to mix the
00:39:13.680 fodzy with the food, put it in a blender, leave it overnight on the counter at room temperature or
00:39:19.200 37° so that the enzymes can work cuz the enzymes work at 30 body temperature and then you risk
00:39:25.520 getting food poisoning from the thing you left on the counter overnight cuz it’s food. Um, so you
00:39:30.720 know I if you just push them together in a meal, you’re not going to get full coverage um, as we
00:39:37.760 know with these enzyme, but it’ll help a little. So it’s it’s possible that it has some benefit.
00:39:45.360 Thank you. Um, great. So Elliot is asking, I have a post-infectious IBS diagnosis. What would be
00:39:53.840 next? I cannot take Rifaximin. So if you have post-infectious IBS and you have SIBO, one of
00:40:01.760 the SIBO types, it depends which SIBO type. So you can do elemental diet. That’s not an antibiotic.
00:40:08.720 If you can’t do antibiotics, that’s what I would do in a patient who is intolerant to this date.
00:40:16.080 And I’ve been doing Rifaximin for 20 years uh almost. I can’t recall on one hand at allergies to
00:40:27.120 Rifaximin. So Rifaximin is one of the safest drugs we’ve seen. Doesn’t change the microbiome in a bad
00:40:33.600 way. In fact, it makes it more normal. Doesn’t cause bacterial resistance. Doesn’t accumulate
00:40:38.640 yeast in the stool. So women would not get vaginal yeast infections from Rifaximin. So it really is
00:40:45.600 one of the safest drugs out there. In fact, we did a um uh what’s called a harm study. And if you
00:40:52.080 took all the studies of Rifaximin and the matching placebo in those trials, the placebo was more
00:40:58.480 harmful than Rifaximin. Crazy. I mean, you don’t see that very often with drugs. Yeah. Um okay, I
00:41:07.360 think this is actually a a good moment. I’m going to transition over to some of the JLI uh biotech
00:41:12.880 products that do answer some of the questions that you’re asking now. Um, Dr. Pimentel, are you able
00:41:17.920 to stay a few minutes afterwards and answer a few more of these questions that are coming in? Yeah,
00:41:21.680 let’s let’s continue with some questions after you’re done. I’m happy to do that,
00:41:24.880 so stick around. Thank you. Thank you. We are from Gemelli Biotech. Again, we are the makers of
00:41:31.600 Trio-Smart and IBS Smart. Um, so the Trio-Smart test and the IBS smart test are both at home
00:41:38.320 mail-in tests. The Trio-Smart is a breath test that is the only test available that can measure
00:41:43.280 the three gases that can help identify SIBO, IMO, and ISO. IBS-Smart is also an at-home test,
00:41:50.320 but it is a blood capillary test. So, it attaches right to your arm. And that is going to detect
00:41:55.920 the two antibodies to identify post-infectious IBS or IBS that is caused from food poisoning.
00:42:04.400 Trio-Smart again is the only breath test to measure these three gases. The results when
00:42:10.400 you order online are directly get emailed to you. So, they look like that on your phone with
00:42:15.360 the different levels over the time frame of the test and then also uh, you have qualitative and
00:42:21.200 quantitative um, results that will tell you if it’s abnormal, elevated or not elevated.
00:42:29.520 Um the Trio smart test is a very highly sensitive test. It’s 20 times more sensitive than other
00:42:35.680 instruments that normally only uh test for two gases and uh we do test for three. We are a
00:42:42.800 CLIA-certified test and the best part is that there is no doctor’s appointment needed to get
00:42:47.680 this test. We do have an online system where you can enter your information, answer a few
00:42:52.960 questions, and then we submit that to a doctor that we work with and they review your your
00:42:58.080 submission and then they approve and prescribe the test if need be and the test gets delivered
00:43:02.400 straight to your door. Also we have always always used glucose and lactulose, but lactulose was not
00:43:12.080 uh available online through the online system, but now it is. So, you have the option of
00:43:17.760 ordering your Trio-Smart 3 gas breath test with either substrate of glucose or lactulose. Um,
00:43:24.160 and uh the Trio-Smart breath test is validated for both of those substrates. So, you would want to
00:43:28.720 work with your doctor to determine which substrate was right for you. The IBS-Smart test um if you
00:43:35.040 wanted to look at this picture here, that is the capillary Tasso plus device and that is where
00:43:40.880 uh you attach it. It sticks to your arm. Um, and it is virtually painless. You get a little bit of
00:43:46.560 blood to fill up the vial. You pack it up and you send it into our lab and we can determine
00:43:51.600 within seven days you’ll get an email of uh if you have abnormal or elevated antibodies
00:43:57.200 um in your blood to determine if post-infectious IBS is your diagnosis and how to move forward.
00:44:05.360 Post-infectious again IBS is the IBS that’s caused from food poisoning. It is about one
00:44:12.960 in nine people who’ve had food poisoning in the past or can remember having food poisoning in the
00:44:16.960 past will uh develop this uh post-infectious IBS as a result of a previous food poisoning.
00:44:28.320 We have a code going right now because of this webinar that you’re joining us
00:44:32.400 uh with tonight uh for $50 off and we have free shipping on all of our GI tests.
00:44:38.720 The $50 is for all of our Gemelli tests which are available on getgutansers.com. We have IBS-Smart.
00:44:45.200 We have Trio-Smart. We also have malabsorption tests as well. Um which you can look into on
00:44:50.000 that website as well. Uh but get gut 50 is uh for a limited time you can get $50 off when you do
00:44:56.560 order online. We also have a giveaway. Uh this is for Dr. Pimentel and Dr. Ali Rezaie’s book,
00:45:04.080 The Microbiome Connection. a lot of what he was discussing about LF, the low fermentation diet,
00:45:11.120 um and how to eat and manage and you know live with with with what you have to deal with for now
00:45:18.720 and manage it accordingly. And there’s some really good tips in there, really good information. Uh so
00:45:23.440 if you wanted to enter with a QR code or that bit.ly code that’s on there, um you just enter
00:45:28.800 your name and information and we’ll pull two winners to receive a book, a copy of this book.
00:45:35.600 Um, again I just wanted to post this GETGUT50 code. And again it is for GetGutAnswers.com.
00:45:42.640 You can also visit triosmartbreath.com or ibsmart.com. That’ll bring you to the same
00:45:47.040 places. GetGutAnswers.com And when you go into your checkout, you can put in GETGUT50 and you
00:45:53.840 will receive $50 off your order. All right, so I think that’s all I wanted to mention just in case
00:46:00.560 you had some questions about the test that I saw coming in. But I will send it back over to you,
00:46:06.320 Dr. Pimentel, when you’re ready. Okay. Thank you. I’m back. Uh, there was one question that
00:46:12.640 was sent in advance and I wanted to bring it up because it it’s kind of like an unfortunate
00:46:17.120 thing. Janice sent this in. She said, "My doctor will not order the test." Um, and it sounds like
00:46:23.520 she we won’t order either test, which and says that it’s research test only. That’s that that
00:46:30.800 to me is like beyond shocking considering the fact that breath testing for SIBO has been around since
00:46:37.120 1980s. So 50 years this person had this doctor hasn’t read a book. Uh that that that to me is
00:46:44.800 shocking. So I’m sorry, Jan, as you’re going through this. I hope you can find a way to get
00:46:49.920 the test if you feel that you need it or find a doctor who is a little more up to date. So,
00:46:55.200 um that this isn’t even that isn’t even an answer because of 50 years of research. Not just me, even
00:47:02.640 before me, the test has been um the test has been available. It’s just more modernized and better,
00:47:08.960 but it’s been around a long time. All right. Uh Paige, I think you still had some more questions.
00:47:15.920 Yes. Um I have one here from Manuela. Um, how to treat IMO while pregnant and breastfeeding?
00:47:24.080 Is ginger strong enough as a prokinetic? So I have many patients obviously women IBS is more
00:47:35.360 common in women and IMO is quite common in in in female patients of younger age groups and then
00:47:41.520 they’re they do get pregnant or have start to have a family. And generally what we recommend,
00:47:48.400 well, let me say a couple of things. I don’t want to get too far into treatment before I talk about
00:47:53.440 this. For some reason, when women are pregnant, a lot of things improve. So, in Crohn’s disease,
00:48:02.640 uh, just to digress even further, in Crohn’s disease, there’s a 1/3 rule. 1/3 get better,
00:48:10.320 one-third stay the same, one-third get worse. In SIBO, IBS, we see about 70% get better when
00:48:18.960 they’re pregnant and 30% say the same. Almost never do we see people getting worse during
00:48:24.640 pregnancy, which is great. Um, and we see that women who are pregnant, their autoimmunity is less
00:48:33.680 and it’s very strange. So, we haven’t actually measured vinculin antibodies during pregnancy from
00:48:39.600 before pregnancy to see if they go down. That would be a very interesting study to do. andI
00:48:44.480 just thought of it as we’re talking here. So, this is a very good question for me to answer
00:48:49.360 uh sometime in the future. But people get better. But what we do is we try to manage the bowel habit
00:48:57.120 during pregnancy because you can’t take Rifaximin. You cannot take Rifaximin during pregnancy. It is
00:49:01.920 not a good drug for pregnancy and a lot of these drugs are not good for pregnancy and you can’t
00:49:06.240 do an elemental diet during pregnancy as well. Uh it’s just wouldn’t be wise. So we generally
00:49:11.200 manage symptoms uh for example magnesium is very safe in pregnancy and so magnesium as a
00:49:16.320 treatment for constipation is a common one that’s used and there are there are other therapies as
00:49:21.760 well. Um ginger probably won’t work very well but it’s worth a try. Thank you for that. Um
00:49:29.920 Dena is asking do you ever titrate Motegrity with the severity of anti-vinculin levels? So
00:49:37.280 we titrate the motility to make sure a person has a beautiful bowel movement once a day first thing
00:49:44.080 in the morning and we that we will do that and if that’s not happening and usually it’s because
00:49:51.040 the antibodies are high and when the antibodies are high there’s more bloating still because the
00:49:56.160 wiring is not working so we will titrate that. So we will go up to 2 millig even 4 milligs in some
00:50:02.800 rare instances where the antibodies are very high but I can’t say oh if the person’s over three for
00:50:08.480 their antibody all of those patients get four milligs or all of the ones from 2 to 2.5 get 2
00:50:14.000 milligs. Uh it’s not it’s a little depends on the person uh but generally speaking yes the
00:50:20.400 higher the antibody the sicker the patient is the more challenging they are. Thank you. Um Karen is
00:50:28.480 asking, "What if you are lactose intolerant? Can you use the glucose test?" So glucose is a
00:50:35.840 simple sugar. It’s a monossaccharide. Lactose is a disaccharide. Uh and you don’t have if you’re
00:50:42.960 lactose intolerant, you don’t have the enzyme to break the disaccharide. But glucose is perfect.
00:50:48.880 If you can’t digest glucose, you wouldn’t be here because glucose is the only molecule that’s
00:50:55.120 your energy molecule from carbohydrates. Everything breaks down to glucose. So,
00:51:00.240 you can’t be allergic to glucose. You can’t be intolerant to glucose. Uh that’s just not a thing.
00:51:11.040 Okay. Uh we have another question coming in. I’m hoping to find out when to take neck with
00:51:16.480 Rifaximin. same time or before after you take Rifaximin pill. Yeah. So the new formulation
00:51:23.200 of Knack is a special delivery system that’s going to be in the trials for the new product. Um people
00:51:30.000 try to take Knack with Rifaximin to treat SIBO and ISO. Now um what we find is that there’s so much
00:51:37.920 mucus in the stomach most of the knack is used up in the stomach and never gets to the small bowel.
00:51:43.200 But if you want to try it, I usually give it together with the Rifaximin, not separately. Um,
00:51:49.520 and it sometimes it works, sometimes it doesn’t, but it’s going to be better when
00:51:54.000 it’s all together in the capsule. That makes sense. Okay. Um, all right. Omar is asking,
00:52:01.120 "SIBO SIBO hydrogen. Why do I why do I have such excessive burping especially when I don’t eat?
00:52:08.000 Is there any relief?" Yeah. So some people so the gas is being produced everywhere and principally
00:52:15.040 we see you know when we do the reimagine study samples and we collect juice from the small bowel
00:52:19.760 from the douadinum and we see such high amounts of ecoli and klepsella right there in that douadum
00:52:25.200 that gas is coming up as well. Um and so we also see an association between hydrogen sulfide and
00:52:33.280 reflux. It’s a new association. We presented this at DDW. I’m not going to get into too much details
00:52:39.120 because it’s kind of exciting, but I can’t talk about part of it because we haven’t published it
00:52:42.960 all yet. But hydrogen sulfide can lower the valve between the esophagus and stomach pressure and
00:52:52.000 that can also make belching more. So, if some people with hydrogen sulfide could actually
00:52:57.440 have more reflux, more belching because of the way it’s changing the muscular function of the valves.
00:53:08.160 Okay, great. Thank you. Devin is asking, "I took Rifaximin and Neomycin after the breath
00:53:13.600 test. I had severe diarrhea even while taking these antibiotics. Any thoughts as to why?" So,
00:53:20.880 Devon, um, so did Devon have methane? I don’t know. Did you say that? Uh, it just says I took
00:53:28.640 Rifaximin and Neomycin after the breath test. So we have noted that in in a group of men who
00:53:37.280 take Rifaximin and Neomycin if they don’t have methane or their methane is quite low-ish that
00:53:44.160 they can end up having more diarrhea on the Rifaximin and Neomycin. So I would only give
00:53:48.880 Rifaximin and Neomycin in a in a patient who has methane and is simultaneously constipated. So,
00:53:58.000 I would not do it if they’re having on the loose side or diarrhea or mixed because of
00:54:03.280 that issue. That sometimes happens. So, um I hope that helps Devon, but I don’t have any
00:54:11.280 further information from Devon. Thank you. Uh do you have time for for one one or two more? Yeah,
00:54:17.200 one or two more sounds good. Great. I have um Shima here uh and she says, "I had an appendectomy
00:54:23.600 and got diagnosed with Hashimoto’s at the same time. Can you talk about the adhesion in relation
00:54:28.000 to SIBO? Thank you. So, Hashimoto’s is that what I believe so. Yes. Okay. Hashimoto’s. So,
00:54:35.280 interestingly, we just published a paper. It just got accepted and it was presented
00:54:38.880 as an oral at endocrine society that Hashimoto’s thyroiditis that autoimmune autoimmune thyroiditis
00:54:45.280 is associated with IBS and SIBO. So, that paper will be out in literally maybe two weeks. Um,
00:54:53.840 but we already presented it, so it’s public information. I can just I can
00:54:57.360 uh say it online. Um, so if you had appendicitis and you took the appendix out, you might want to
00:55:05.920 be careful that you don’t have adhesions that could be causing SIBO also. I think that’s the
00:55:10.320 gist of the of the question. But you have to do a barium to look for adhesions from appendicitis.
00:55:18.560 Okay. Thank you. And then we have Selene asking, uh, if you’ve done the elemental diet for two
00:55:24.720 weeks for IMO and then reintroduced food and had a resurgence of symptoms, would you recommend doing
00:55:30.960 the elemental diet again? So, we have patients who’ve done it more than once or a little
00:55:37.200 bit longer than two weeks. So in the original elemental diet trial which I did in 2003 when I
00:55:43.200 was a child um the elemental diet we did in the in the pre-trial stage we did 7 10 and 14 days and 21
00:55:54.320 days and 7 didn’t work 10 was better 14 was good we got about 70% eradication and 21 days was 5%
00:56:06.480 better than 14 days, but asking a person to do an extra week of elemental diet to get that extra 5%
00:56:14.400 is a little tough for most people because that’s three full weeks of elemental. So, there are
00:56:18.720 patients who can benefit from a third week. Um, and so I don’t know whether that’s the situation
00:56:26.160 for this person, but um that is something that we do. What I what I worry about is doing it over and
00:56:34.000 over again because it is expensive and I don’t want uh you know the folks on the line here to
00:56:39.040 think that they should do elemental over and over again because it’s $750 each time for two weeks.
00:56:45.040 Now you don’t buy groceries but because you’re just eating this but still it’s it’s expensive.
00:56:52.400 I do have one last question if you don’t mind. It does kind of go together with the
00:56:56.080 diet conversation. Uh, but Steve said, "Um, I’m starting to lose hope. I have to keep trying new
00:57:02.320 things over and over again. I have heard that the carnivore diet can heal SIBO. Is this true? Can
00:57:09.120 you help me?" Okay. So, first of all, never lose hope because we’re working day and night and I’m
00:57:16.480 trying to give I try in my presentation to give you a high degree of optimism because we have new
00:57:22.320 therapies coming and they are so much better than what we’ve ever had before. And it’s just going to
00:57:27.840 take time. And I wish it could happen faster. I wish we could just start putting it in capsules
00:57:32.960 and giving it to people now, but it has to be done properly. Has to be FDA regulated. You have
00:57:37.840 to do the proper studies for safety. And that’s it has to be that way. Um, but you know, a carnivore
00:57:45.680 diet, um, a high protein diet, low carb diet does help overgrowth because the bacteria in the gut,
00:57:54.960 it’s sort of like this. If you have your olive oil, you don’t put it in the fridge. You leave it
00:57:58.960 on the counter. Bugs don’t grow in olive oil. They just don’t grow in oil. If you put two tablespoons
00:58:04.960 of sugar in that olive oil, it won’t last a week. It’s They want sugar. They want sugar. They want
00:58:10.080 sugar. The problem with a pure carnivore diet or a paleo diet or a pure protein diet is that it
00:58:16.720 doesn’t always contain all the nutrients that you need. So, there are some disadvantages to that.
00:58:21.200 But the less carbs you have, especially fiber, you can make the overgrowth symptoms less,
00:58:29.440 but it doesn’t solve the entire problem. And it’s not going to work as good as getting rid of the
00:58:35.120 overgrowth with antibiotics in general. So I have not seen routinely patients getting more than 40
00:58:42.000 30 40% just with diet alone better where I can see 80 90% improvements when Rifaximin works for
00:58:49.200 example. So yes, you can do it. But just be just understand that it may not be perfect.
00:58:58.320 Thank you very much and really appreciate you taking the time to answer these questions and
00:59:02.880 kind of get into the things that we want to know that hard to find information on.
00:59:08.000 So really appreciate you being with us tonight and thank you to everybody
00:59:12.320 for joining us tonight. I hope and we hope that you found this webinar informative and empowering
00:59:18.800 is really what we want you to feel that that we can get through this all together and sharing
00:59:22.720 this information. If you have any questions or you want to find out some more information,
00:59:27.600 please visit our websites, TrioSmarBreath.com, IBSSmart.com, or GetGutAnswers.com. And don’t
00:59:35.520 forget if you do order any of your tests online, uh, to use the GETGUT50, coupon code for $50 off
00:59:42.800 when you order any of the tests online. Thank you. Thank you again for spending a few extra minutes
00:59:48.160 with us, Dr. Pimentel. And, uh, everybody have a wonderful night. Thank you, everybody. Thank you.