The SIBO Doctor Episode 14 Jason Hawrelak

Pre and Probiotic Use in SIBO


In this episode, Dr Nirala Jacobi is in conversation with Dr
Jason Hawrelak on the topic of all things gut.


Dr Hawrelak is a researcher, lecturer, naturopath, and
nutritionist with over 16 years of clinical experience.  He
also practices at Gould’s Natural Medicine - a 135 year old
natural medicine apothecary and clinic in Hobart, Tasmania,
Australia.


 


Dr Hawrelak completed his PhD examining the capacity of
probiotics, prebiotics, and herbal medicines to modify the
gastrointestinal tract microbiota.  He is currently the
senior lecturer in Complementary and Alternative Medicines at the
University of Tasmania’s School of Medicine where he coordinates
the evidence based complementary medicines programs.  Dr
Hawrelak also teaches the gastrointestinal imbalances unit,
within the Masters of Science and Human Nutrition, and Functional
Medicine Program at the University of Western States, in
Portland, Oregon.


 


Topics discussed in this episode include:


Dr Hawrelak’s 2016 lecture on Pre and Probiotics at the SIBO
Summit 2017 - still available to practitioners as part of the
SIBO Fundamentals online course.

The website Dr Hawrelak developed, Probiotic Advisor, to help
practitioners differentiate which probiotic strains and products
are appropriate to different conditions.

Recent probiotic research (2017) in relation to SIBO
treatment and methane reduction.

The importance of strain specificity in relation to
therapeutic effect.

Reseeding the gut with exogenous probiotics as an outdated
concept, and the history of this ideology.

Faecal transplants and the capacity of strains to remain in
the gut as compared to probiotics taken in capsule form that does
not.

What metabolic modulation actions do probiotics have in the
body, and how to integrate this with background changes to
enhance the therapeutic effect.

D-lactate V.S. L-lactate producing probiotic strains, and
what systemic effects do each trigger?

D-lactic acidosis and when this may occur.

SIBO related symptom presentation and strain specificity for
probiotic therapy, for symptoms such as motility issues,
abdominal hypersensitivity, histamine issues, food reactions.



 


Motility


Probiomax for motility Bifidobacterium Lactis HNO19 - 1-2
capsules per day.

BB12 Bifidobacterium Lactis for motility.

Suggestions on the combination use in children with
constipation.



Animal study showing probiotic strains that work on the
migrating motor complex function - prokinetic potential.

Combination of L. Rhamnosus GG, Bifidobacterium BB12, and
inulin.





 


Abdominal hypersensitivity in SIBO


Bifidobacterium Infantis 35624

Align



Rhamnosus GG

Functional abdominal pain in kids - meta analysis
supporting this therapeutic application.



Nissle 1917 strain of E.Coli

Bifidobacterium Lactis DN173010

Speed up transit time

Decrease pain and bloating

Yoghurt brand, Activia, available in US, is the only
available form (as currently known)





 


Leaky Gut


Probiotics useful in helping to repair leaky gut

Rhamnosus LGG

Biocodex preparation of Saccharomyces
Cerevisiae/Boulardii





 


Histamine Intolerance


Infiltration of mast cells into the intestinal wall in SIBO
and histamine implication.

Probiotics and histamine degradation - investigating

Rhamnosus

Infantis

Plantarum



Probiotics and histamine upregulation - investigating

Casei

Bulgaricus



High-fat diets producing many bile salts, which feed hydrogen
sulfide producing bacteria, and hydrogen sulfide gas contributing
to leaky gut.

Higher fat diets contributing to diamine oxidase (DAO) enzyme
overuse in the small intestine and why this is relevant to
histamine.

Ketogenic diets and symptom resolution - why is this, and is
it sustainable?

The impact of starving out butyrate producing colonic
flora.

The risk of ketogenic diets.





 


Continued


How to reintroduce foods to sensitive patients

Heal gut

Decrease inflammation

Work on allergy axis to increase dietary diversity



Partially hydrolysed guar gum (PHGG) as a prebiotic

Probiotics as aiding in the recovery of the microbiome after
an insult, eg chemotherapy, antibiotics, radiotherapy etc.

Prebiotics and changes of diet having a greater impact on the
gut microbiome.

Jason’s prebiotic use

PHGG - use in functional constipation patients,
non-methane type SIBO, and diarrhoea type stool conditions.

Helps to normalise stool.



Bimuno - galacto oligosaccharides

Bringing bifidobacterium, and faecalibacterium
prausnitzii populations back.

Faecalibacterium prausnitzii:

The single species with the highest
prevalence in healthy people.

Predominant butyrate producer.

Produces another anti-inflammatory gut
healing compound, so helpful for inflammatory
bowel diseases.

Higher levels as protective against metabolic
syndrome and Type 2 Diabetes.



Akkermansia

Accounts for 1-3% of the microbiome in
healthy people.

Eats mucin, therefore if inflamed guts
producing a lot of mucus can overgrow
akkermansia.



Lactulose

Use as a prebiotic.

Increases faecalibacterium prausnitzii,
akkermansia, and bifidobacteria, lactobacilli.

Use as a pH changer - moves environment to be
more beneficially acidic.

Amazing capacity to decrease Bacteroides
numbers - which can increase after multiple
courses of antibiotics.

SIBO positive on Lactulose breath test
patients - to attend to SIBO with therapy first
before using Lactulose as a prebiotic.

Lactulose uses in recurrent urinary tract
infections as supported by clinical trials - as
it decreases levels of E.coli in the gut so fewer
pathogens can make the journey from the anus, to
the vagina, to the urethra.

Prokinetic for small intestine and when it is
appropriate to use it in SIBO.

Note: lactulose will increase gas, but not
bloating. If bloating, cease use.



Discussion on soil based organisms as they relate
to functional digestive disorders.









 


Resources


BioGaia sunflower oil based probiotics

Blackmores Digestive Bio Balance

Rob Knight - microbiome specialist

Products mentioned:

Motility

Probiomax Bifidobacterium Lactis HNO19 - 1-2 capsules
per day.

Lactobacillus reuteri MM53 BioGaia strain



Testing mentioned

Ubiome

GI effects from Genova Diagnostics



Dr Hawrelak’s Probiotic Advisor