Dr Lenny Weinstock - SIBO, Restless Leg Syndrome and More

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 Gastroenterology Clinic

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 clinic.



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

Adhesions

Postural orthostatic tachycardia syndrome (POTS)

Ehlers-danlos



Preventative therapy for SIBO

Rifaximin use with prokinetic therapy

Bifidobacterium Lactis HN019 as a therapeutic prokinetic.

Testing for anti-vinculin antibodies on SIBO patients.

POTS

What’s the connection to SIBO?

Why is the prevalence increasing?



What is the connection between POTS and Mast Cell Activation
Syndrome (MCAS)?

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 bacteria.

Hepcidin as an antimicrobial peptide and its role in
infectious diseases.



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

IBS - D

IBS - M

IBS - C



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 treatment.

5 drops twice daily used in the study Dr Jacobi mentions.



A couple of herbs Dr Jacobi uses for methane dominant SIBO
treatment

Garlic

Myrrrh



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.



 


Resources


Dr Weinstock’s Specialists in Gastroenterology Clinic

BioGaia Protectis

Bifidobacterium Lactis HN019 as a therapeutic prokinetic.