Sound Integrative Health Blog

The antibiotic approach to SIBO... A reasonable approach to Small Intestinal Bacterial Overgrowth (SIBO) treatment? Perhaps. Effective long term? Probably not. So the question is not “should I take Rifaximin or Neomycin/Rifaximin or plant antimicrobials?” Which I go into detail on this blog post . The question is what should I do after I take them? Because we all know of the infamous likelihood of a SIBO relapse. Too dive into this question we should look at the factors that lead to SIBO: Intrinsic factors that prevent bacterial overgrowth (Ghoshal, Shukla, & Ghoshal, 2017): 1. Secretion of gastric juice and bile which have antibacterial effects. Basically proper stomach acid and gallbladder function. 2. Peristaltic movement preventing adherence into the intestinal mucosa. Basically regular bowel movement. 3. Normal gut defense including humoral and cellular mechanisms. Basically adequate immune defenses in the gut such as proper Secretory IgA levels

A low carb, high fiber, nutritious treat to satisfy your sweet cravings. Ingredients: 3 tablespoons of Chia Seeds  1 cup of almond milk or coconut milk   1/2 tsp of vanilla extract  1 1/2 tsp of maple syrup   Layering:   Fresh fruit: I recommend sliced kiwis or blue berries (or both) Granola clusters    Directions:  In medium bowl whisk all the ingredients together. cover and refrigerate overnight. serve in a glass layering with fresh fruit and/or granola clusters .  Inspired by Angela Landon, Oh She Glows

One of my favorite all-time herbs is Urtica Dioica known as Nettle. I was introduced to this herb why doing a trail run in Marin County, Northern California when I turned a corner too fast and was stung by one of its infamous needles. Little did I know that this plant who I was "cursing" was one natures best medicines . When I started my training as a Naturopathic Medicine student, one of my mentors, the late Dr. Bill Mitchell talked about Nettle root extensively. He stated it has some of the best antihistamine properties of all the plants because it is rich in plant sterols, fatty acids, and lignans which basically act like a fire extinguisher for inflammation especially with seasonal allergies. If you suffer from grass or tree allergies, try some Nettle root tea from Traditional Medicinals. Or stop by Herban Wellness in Kirkland and ask for a tea to be made up. Enjoy a cup in the morning and again in the evening and let me know if you see a reduction in your allergy symp

Nutrition is highly individualized and often a philosophical debate among friends and family. What's important with nutrition is to find your right approach that your body responds to.  One of the more recent, yet ancient, approaches is a return to the Paleolithic Diet which mimics the diet of the hunter/gather society.  There are many different subtypes of the paleolithic diet but the commonality is elimination of grains and most sugar from the diet.  The diet emphasizes ample non-starchy vegetable intake, mild-moderate fruit intake, moderate to high animal protein intake , and mild/moderate healthy fat intake. Mark Sissom who wrote Primal Blueprint is one of the leaders behind the movement toward a paleolithic diet and he publishes a blog called Mark's Daily Apple. Sissom state that this approach when combined with short duration intense cardiovascular exercise and strength training reduces the likelihood of developing the triad of obesity, diabetes, and some risk factors

Ms. Liad Auslander is a pre-med student at Rutgers University in New Brunswick, NJ. majoring in Applied Kinesiology and minoring in Psychology. Her hobbies include music and dance. She will be spending this summer in the Seattle area to be with her family and intern with me. Since a young age, she has always had a keen passion for medicine, and was offered the privilege to continue working towards her goals with us. She is looking forward to working with the clinic for the summer! Liad will be likely at our clinic on Tuesdays and Thursdays for a portion of the day. She will be shadowing me and helping with various functions of the clinic visit. Docere (Doctor as Teacher) is a key principle of Naturopathic Medicine and I welcome the opportunity to help Liad learn and grow. As well I am sure I will learn from her. Please join me in making her feel comfortable. As always with interns we will ask your permission for them to be in the visit with us. You always have the right to o

I share some seasonal allergy tips here today on my podcast

Using patterns of the Lactulose Hydrogen Breath Test to Make Decisions regarding antibiotic therapy in IBS with Small Intestinal Bacterial Overgrowth Small Intestinal Bacterial Overgrowth (SIBO) is an increasingly diagnosed pathophysiologic process that involves normal bacterial flora of the colon being irregularly and excessively translocated to the small intestine. In additions some will acquire SIBO by breakdown in mechanisms that normally clear bacteria from the small intestine such as the migrating motor complex. Once this bacteria has set up in the small intestine it can cause bowel transit dysregulation (diarrhea, constipation, or both), bloating, excess wind, and abdominal discomfort. Many top researchers feel it might be the underlying component of Irritable Bowel Syndrome. It is diagnosed by clinical symptoms combined with the Lactulose Hydrogen Breath Test (LHBT) which measures the production of Methane and Hydrogen case being emitted from the small intestine after

Back in 2007 when I named my practice "Sound Integrative Health" I was choosing the name on a conceptual basis rather than a functional basis. Now, after 10 years of existence I have a clearer idea of what it actually means to be an integrative practice. And, guess what? It has less to do with the fact that I give natural treatments and sometimes western treatments, and more to do with what it means to integrate my patients care between multiple providers.  Chronic disease often leads to many cul de sacs; not necessarily dead ends. A cul de sac, being a node where we land on some answers but not necessarily the complete answer. Example: If one has Rheumatoid Arthritis and finds an excellent Rheumatologist with a warm bedside manner and therapeutic drug regimens. However this Rheumatologist falls short on knowing about other ways to manage the disease through diet, lifestyle, herbal treatments, cam therapies, and so on. So what happens? The patient finds another pro

Predictive risk of Small Intestinal Bacterial Overgrowth (SIBO) in large cohort retrospective study . A total of 1809 patients who tested positive for SIBO using a Lactulose Hydrogen Breath test ( Brechmann, Sperlbaum, & Schmeigel, 2017 ) . The study looked at which pathophysiological exposures had the most predictive risk of SIBO. They used a statistic called odds ratio (OR) . An odds ratio (OR) is a measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure .  For example you can see that being exposed to proton pump therapy makes you 1.4 times more likely than those non-exposed to proton pump therapy to develop SIBO.  This is a great study in that addresses the mechanisms that would lead to impaired clearance of bacteria from the small intestine and the subsequent development of SIBO.  Surprisingly that being

Sunday I was out for a run and all the sudden I felt a breeze go by my head.  It took me a few minutes before I realized that some guy just blew by me and that was not the wind but rather someone running like a jackrabbit compared to my turtle-like pace. My first reaction was... "wow am I that slow?". Then I looked up and saw who it was. I was so thrilled that this man who used to be completely deconditioned was now sprinting by me at such a rapid pace. I was so inspired that I had to take a photo of his obvious orange running jacket leaving me in the dust. Two years ago I used to cross paths with this same man who's level of exercise intensity was limited to walking at a slower than average pace. Since we always crossed paths on the same route I would say hello or wave. Sometimes when I would be driving by and see him out for a walk I would wave and give him a "thumbs up". Over time I have seen his diligent commitment transform him from walker to runner. His bo

A study using a commonly prescribed probiotic called VSL#3 showed that male IBS sufferers using VSL#3 had less abdominal pain and an improved satisfaction with bowel habits. (Wong.2015) It is interesting that patients in the study that used the probiotic had increased morning salivary melatonin. This study is very useful in helping explain another reason why taking a probiotic is regulatory for the digestive system. My overly simplistic surmise of what is happening is that this probiotic is favorably shifting the gut biome so that the enterochromaffin cells are secreting melatonin more efficiently. Melatonin (a hormone) has been studies in the digestive tract as it is known to be produced by enterochromaffin cells and small amounts stimulate motility and large amounts seem to slow motility. As we know Melatonin is also produced in the body by the pineal gland and is responsible for helping with sleep/wake cycles of the body’s biorhythm. It also boosts natural killer cell activity

Good nutrition starts with veggies. Everybody knows it...so much that when hearing this advice it literally goes in one ear and out the next.  What I learned from Dr. Lisle  who wrote The Pleasure Trap is that you have to train your tastebuds to like veggies. You literally start to crave vegetables if you train yourself over time. Just like you crave chocolate if you train yourself to like chocolate! If you don't eat veggies much and you start with a basic salad as your training ground...well...you're likely to not come back for more. If you need to train your tastebuds again, start with Braised Kale in Coconut milk. It will load you up with nutrients and also introduce you to veggies in a way that will open your mind. I personally make many different sauces and dressings to keep my tastebuds happy. Braised Greens with Coconut Milk :Braising is using both moist and dry heat to prepare a food. Braising seems to soften those tougher to chew foods like Kale. This recipe is ca

One of my favorite suggestions for people with adrenal fatigue is to start nourishing their mineral supply, their sleep, and reducing stress. The key word is nourish. This evening oatmeal is wonderful for that.  Those of you who are concerned that I am asking someone to eat near bedtime have a good point. But realize those with true adrenal fatigue should not necessarily fast for too long of a period of time because fasting can cause further cortisol imbalance. Those who have adequate adrenal function should not eat this before bedtime but perhaps at another time. If you are unclear about whether or not you have adrenal fatigue you may request a four point cortisol test like the adrenal stress index that is offered through many naturopathic physician offices. Apple Pie Oatmeal from “The Oh She Glows Cookbook” 1 serving Prep time: 15 minutes Cook time: 8 to 12: Gluten free, oil-free, refined-sugar free, soy-free 1/3 cup gluten free rolled oats 1 medium Gala Apple, peele

My patients are often surprised when I ask them to release  the belly shame as part of their  IBS  treatment. Why do this? There is  a propensity in this population to “suck in the gut” which physiologically leads to increased nervous tension, abdominal guarding, and probably will be proven one day to be a contributing factor in diarrhea and/or constipation that is chronic.  The second brain (the gut) is being told to “hold”.   I  learned this exercise through Katy Bowman that is helping some of my patients manage their IBS (and SIBO). I combine this with some other things that support releasing tension.   Love your belly ….even if it makes funny sounds and has not been cooperative. Fighting it and  resisting it won’t really support it back to health. Here are some guidelines on Abdominal Release adapted from the great work of Katy Bowman.