Transcript of Episode 165: Do You Have SIBO?
With Dr. Daniel Pompa, Meredith Dykstra and Dr. Ken Brown
Meredith:
Hello, everyone, and welcome to Cellular Healing TV. I’m your host, Meredith Dykstra, and this is episode number 165. I almost said 145. I hope everyone’s doing great today. We have our resident cellular healing specialist, Dr. Dan Pompa on the line, of course, and today we welcome a very special guest, Dr. Kenneth Brown. Today we have a topic that a lot of you have asked for, so we’re bringing it to you. We are delving into the world of SIBO or small intestinal bacterial overgrowth.
Dr. Brown is an expert in this area. Before we jump in, let me tell you a little bit more about Dr. Brown, and then we will get started on the conversation. Dr. Ken Brown received his medical degree from the University of Nebraska Medical School and completed his fellowship in gastroenterology in San Antonio, Texas. He’s a board-certified gastroenterologist and has been in practice for the past 15 years with a clinical focus on inflammatory bowel disease and irritable bowel syndrome.
For the last 10 years, he’s been conducting clinical research for various pharmacologic companies. During this time, he saw the unmet need for something natural that could help his IBS patients find real relief. After working on the development of Atrantil for over six years, Atrantil launched in the summer of 2015. Dr. Brown and his research team developed Atrantil with the intent of helping those suffering from the symptoms of IBS, which we now know are caused by bacterial overgrowth. Welcome to Cellular Healing TV, Dr. Brown.
Dr. Brown:
Thank you so much, Meredith. Dr. Pompa, thank you so much for having me on.
Dr. Pompa:
It’s a pleasure to have you on. It’s rare that someone with your background would understand SIBO. It’s absolutely remarkable, so I have to start there. How in the world do you understand SIBO?
Dr. Brown:
I’ve been doing clinical research, as Meredith mentioned. I’ve been doing clinical research for the last 10 years. There’s a doctor out of California named Dr. Mark Pimentel who really kind of came up with the idea. This is over 10 years ago where I was helping him do some of the research when they were trying to launch the drug Xifaxan. That’s when Salix was doing the first phase 3 study on that.
What was really interesting is that I communicated a lot with some different researchers around the country, and Dr. Pimentel noted something really unique in that his mouse models, he could show that antibiotics would help those people that had bacterial overgrowth and diarrhea, but they really struggled to treat those people that had bacterial overgrowth with constipation. It’s because of methane production. That’s where it all started.
When I was talking to him, he said, “We really need to come up with something for methane.” Then serendipitous, fate, whatever you want to call it, my research manager at the time, Brandy Scott, she has a background in political science, and at one point, she was a policy writer for a senator in Iowa. It was really interesting. I knew that I was working with Dr. Pimentel who had come up with this concept of SIBO, and then I realized that we were missing this huge population of people that had constipation and bloating because that’s due to methane.
I’m writing this on a dry erase board, and that’s when Brandy comes in. She goes, “You know, when I was working with that senator in Iowa years ago in the ‘90s, they were trying to mandate that the farmers put food products for the cattle to decrease methane production for the cattle in an attempt to help the ozone.” That’s when it was the a-ha moment. I went, “Holy cow! You’re saying that we can do this naturally by using food products that have already been sort of researched in the animal world. We can just integrate this and see where we go.” That’s how we ended up coming up with it. That’s where my passion came.
Dr. Pompa:
I see that. Let’s talk about what SIBO is because some people are going, “What? What is SIBO, small intestinal bacterial overgrowth, okay.” Give them an idea what that means? From that, you’re referring to – there’s two different types of bacteria. We have these methane producers, and we have these hydrogen producers, and they can both cause different symptoms. We’ll get to that in a minute.
Dr. Brown:
Absolutely.
Dr. Pompa:
It’s like -inaudible- Right now we’re losing some people, so let’s talk about it. What the heck is SIBO?
Dr. Brown:
We’ll back up real quick, and let’s talk about it from my perspective or what happens with a lot of my patients. First of all – and you’ve come across this, I’m sure, with your patients – people get labeled as having irritable bowel syndrome or IBS. Now, IBS is what I’m going to call a trashcan term. Basically, if you have abdominal discomfort, change in bowel habits, and you go to your doctor, and the workup is normal, they pat you on the head. They say, “Irritable bowel syndrome.”
Many of my colleagues still will treat that with anti-depressants, or they’ll say that it’s in your head, and you just have to live with it, much like it was 30 years ago when we felt that ulcer disease was caused by stress, as well, or caused by anxiety. Then we learned by the Australian researcher that determined ulcer disease is actually caused by bacteria called H. pylori. This is the same paradigm shift that’s taking place with irritable bowel. When we realize that bacteria can grow where it shouldn’t, that’s bacterial overgrowth.
Basically, what I tell all my patients is, “It’s not that bacteria are good or bad. It’s that they are growing in abundance in the wrong place.” If you get sick -inaudible- if you have a bad infection, or even if you go through a stressful period, it can change the motility of the intestines. You normally have this free-flowing, very clear stream, and then something happens, and it shocks the intestines mostly in the upper intestines, in the small bowel, the duodenum. Then bacteria starts to grow there. When that bacteria grows in there, it starts breaking down the food before you can. That produces the painful gas and then results in these other symptoms.
It isn’t that you just have IBS and have to live with it. I have all these people that said, “I went to Mexico five years ago. I got very ill, and I’ve never been right since,” or, “I had something happen. I went through my divorce, and I’ve just never been right. I’ve got bad bloating, diarrhea, or constipation.” That’s what we now know is it’s bacteria growing where it shouldn’t. If we can get them to go back to where it should, then it becomes part of our normal microbiome, which is really, really important for our well being, as you well know.
Dr. Pompa:
Right. Some of the just common symptoms that people say, “I don’t have irritable bowel. I never had that.” – just bloating after eating fibrous foods, even vegetables. A lot of people I know can’t take probiotics. “I just can’t take probiotics.” A lot of those are symptoms of SIBO that people don’t think about. Are there others?
Dr. Brown:
Yeah, absolutely. The thing that I will encounter in my practice is I will have people that maybe don’t really equate – they’ve lived with the intestinal symptoms so long that they’re tolerant of a lot of things. “Well, it’s just normal for me not to go to the bathroom. I don’t wear a swimsuit because I bloat so much,” this, this, this. Then we start looking at all these other things. “Now I’ve developed a food intolerance. Now I feel like I’ve got brain fog. Now I’ve got some” – they just had these inflammatory things.
What’s really scary is I truly believe that these kind of things are the beginning of the autoimmune process, also. You’re turning your immune system on. I have seen people that have grown into having autoimmune disease after they’ve had GI symptoms for years, and then, wham, show up and have something that we really probably could have prevented by changing diet, or changing lifestyle, or so on.
I see all the time – if IBS is a trashcan term, then there’s a lot of other diseases that actually have codes, E&M codes, that the insurance companies would recognize, but really, we treat as trashcans. Pelvic pain, restless leg, migraines, depression, anxiety, all those things, they all tie in.
Dr. Pompa:
That’s exactly right. This show, believe me, this is really addressing a lot of people. Again, we could also say, “Okay, great. How does this happen, Dr. Ken?” How does someone end up with SIBO? Talk about some of the cause -inaudible- because that leads to, ultimately, some of the solutions.
Dr. Brown:
One of the main things that have been scientifically studied is that if somebody has an infection and they actually develop antibodies to the toxin on the bacteria, then that can actually create an area in the intestine where you have dysmotility. To get a little bit more scientific about it, basically what happens is if you get sick, your body produces antibodies to get rid of the Campylobacter or the Salmonella.
Interestingly, the antibody, which we’re going to call a soldier, goes out and gets rid of the bacteria, but we have a pacemaker cell in our intestines, and it sometimes looks a little bit like a bacterial toxin. That’s called a vinculin antibody. What happens is our body will then hit that toxin, and then create kind of a semi-permanent area where the intestine doesn’t move real well. That is the thought process right now where that may be the first stone to start rolling down the hill, and start the whole process. Your body reacts to an infection, and then ends up actually over-reacting and creating a little area where you’re going to have this dysmotility or an area that doesn’t work as well. That’s one of the primary causes.
Then after that happens, it becomes its own self-serving factory. Bacteria start to grow. They release hydrogen. Other types of bacteria come in, and they can take it. You mentioned in the very beginning, hydrogen can be converted to or can be used to make methane, which slows everything down, or it can actually make hydrogen sulfide, which speeds everything up. Now, we have our model to explain what is irritable bowel with diarrhea, and what is irritable bowel with constipation?
Once this process has started, then every time you eat – and specifically starchy foods that sometimes are hard to digest, like bread, one of them. Then the bacteria produce it. They produce more fuel, and they just keep thriving more. It ends up becoming a recurring problem. That’s really the main thing that starts, and then it keeps going. That’s why it’s a chronic condition. That’s why we say that people have chronic irritable bowel.
Dr. Pompa:
You said something there – based on diarrhea. Some people have constipation. It can go back and forth, and it gets very confusing for people. Talk a little bit about these two bacterias because I know this: People will say, “My doctor put me on X, Y, Z.” Maybe it’s Xifaxan, another antibiotic. They said, “I felt like I was better, and now I’m much worse.” If we kill off one group, we can actually take away something that was actually feeding this bacteria. We take away this group, and now these guys go crazy, and our symptoms change. Explain that.
Dr. Brown:
When we were developing this, that was the issue that we were dealing with with Xifaxan, initially. Let’s look at the type of bacteria that produces methane. It’s known as an archaebacter. Archaebacter are a very primitive organism in their own kingdom. It’s actually Methanobrevibacter smithii. We even know which one does it. Now, normally we’ll have that in our colon, but when it starts growing in the small intestine, it’s where it causes the problems.
What’s interesting about the archaebacter is it’s a very primitive organism, so that our modern-day antibiotics work in a very different way and actually don’t affect the archaea species. That’s how come Dr. Pimentel discovered early on that Xifaxan probably will not help these people that are bloating with that. One of the ingredients in Atrantil is Quebracho. What that is – yeah.
Dr. Pompa:
-inaudible- This is the product that we use. This is the product that you developed – helped develop, I don’t know, partly. There’s the product you talked about.
Dr. Brown:
Yeah. This is definitely my baby, my passion. One of the reasons why we chose one of the ingredients in there, which is Quebracho, is that that’s actually from the bark of a very, very old tree. It has natural defense against fungus and archaea species, and so that’s why that’s used in there.
The other types of bacteria – many other types of bacteria can actually take the hydrogen and produce hydrogen sulfide, so there’s several other ones out there. Fortunately, those are more of the typical bacteria, which is why Xifaxan got the indication for irritable bowel-D. When you have bacteria that does that, what they need to do is they need to absorb the antibiotic, integrate it into the RNA of it – it’s a RNA transcriptase inhibitor, which is just a fancy way of saying it shuts down the machinery inside the bacteria – and then the bacteria goes back.
What you’re getting at is exactly something that I saw a lot of. I would treat people with Xifaxan early on, and they’d be like, “I had diarrhea, and now I’m profoundly constipated. What happened?” Like, “Oh boy. Now we need to do this.” What I have figured out is that by using something like this where your body’s going to pick and choose what it needs, because the ingredients in Atrantil are polyphenols – the polyphenols are basically the molecules in the Mediterranean diet on the skin of vegetables and so on. These are concentrated polyphenols. You cannot replicate Mother Nature. She just does it so much better than a pharmaceutical agent can.
This allows the body to take it. It gets the bacteria to go back to where it should. We’ve learned that a lot of these polyphenols then get into the colon where your colonic bacteria will convert it to necessary things that your body wants. It’s kind of a win/win. We can get the body back to where it should be, and it can be used daily as sort of a – almost a prebiotic style, allowing your bacteria in your colon to go ahead and use what it needs.
Dr. Pompa:
I think the cool part about this – not to confuse our viewers and listeners – is that, look, if you’re just targeting the hydrogen guys, yeah, the diarrhea goes away, but then there’s these other methane guys that lead to the constipation. You target both in this. Really, I guess it’s part of the magic because you do target both, where Xifaxan was typically targeting the hydrogen. Good for this, but oftentimes making this worse. How long do people typically need to be on this? Does it matter if they change their diet? Does it work if we take away fibrous foods and starchy foods? I just asked a lot of questions there.
Dr. Brown:
Yeah. That’s fine. Let’s start with the whole food thing. I think this is something that I’m evolving a little bit with. Initially, it was always thought that we should probably get people to change their diet so that they can start alleviating some of the symptoms. Then after a little bit, that’s when Dr. Pimentel came out with a new article that basically said, “No, no, no. We need to feed the bacteria so they can absorb this antibiotic, and then they can go away.” That’s a complete 180 on where it was in the beginning.
Atrantil works differently. I don’t really believe that it needs to have – it doesn’t have to be absorbed. The ingredients there are built to get rid of the bacteria. They get the bacteria to go back to where it should, and then they feed the bacteria in the colon. As far as diet changes, in my clinical practice, I see it as an opportunity to discuss diet. I personally like my patients to try and modify their diet and at least to gluten-free. I, myself, am kind of a paleo fan personally in my own lifestyle. I think that it’s an opportunity to do that.
I have seen patients get better not changing their diet at all. I actually have a gluten intolerance, which is how I kind of eventually got to the whole paleo thing. We’ve also seen that if people have a food intolerance or if they have intermittent symptoms, then they can just take it with that, which then comes into the other question, which is how long to take it.
What I’m seeing in my clinical practice is it really comes down to the burden of the bacterial load. We have some people that respond very, very quickly to it, and then they’re done. In the initial studies that we did, those patients took it, and we had a very long, sustained period where they felt great. Then maybe they’d come back a year later, and we’d give them another round. This is before we even actually had it in production. This was all just during the study phase.
I’ve had other patients that have had this for years, and years, and years. I imagine your practice is very similar, that you get a lot of people that show up with a big, thick stack of papers because they’ve seen a bunch of other doctors. They’re frustrated. They show up, and they just say, “Okay, your turn. Let’s see what you can do.” I get a lot of that. In those people, I do think it requires at least 20 days of two capsules three times a day, almost like you would do a round of antibiotics.
Then after that, then it goes to an as needed basis or a daily. The whole daily thing really kind of came about because my patients just felt better taking it. They asked to kind of stay on it. Said, “Even if I did the course, I feel better, but I’d prefer if I just take it every day, I feel better.” For the –
-cross talk-
Dr. Brown:
I was going to say for the gluten-intolerant or food sensitivity people, like myself, I can actually cheat a little bit and have a little bit of bread as long as I take it with it, actually with the meal, I don’t have any issues. We know that there’s something going on with that. We don’t exactly have all the science down on that, but there’s a lot of different speculation things, and I’ve talked to people. There’s a lot of polyphenol experts out there. Some people say, “It’s a histamine thing. You’re controlling the histamine,” or, “It’s the eosinophils,” or, “It’s the zonulin. Maybe you’re blocking zonulin.” It’s a moving target. It’s really exciting because we got a lot more work to do.
Dr. Pompa:
This is new area. I find a lot of people that are histamine-sensitive, and their mast cells are producing more – I find this to be a SIBO issue. I find this to be this imbalance, and there’s some type of problems, so just targeting this, I think the SIBO’s a better target. Before we discovered your product, we would put people on what we would call a SIBO diet, literally no fiber, no sugars, no starch, basically meats and fats for 15 to 20 days and sometimes longer. It worked. The problem was many of those people would relapse. It was very difficult to stick to.
Dr. Brown:
Absolutely.
Dr. Pompa:
What it did is just starve them down. If we didn’t fix the motility issue, it would end up with SIBO again, you see.
Dr. Brown:
One hundred percent.
Dr. Pompa:
-inaudible- how is this with that? You’re saying, “Great. If we can get rid of both types of bacterias that produce the methane and hydrogen, the motility issue fixes itself.” Do we still have to do anything else? I know that the brain connection is something we always had to address, too, the vagus nerve. We would give people some things that would help that with the motility, and even chiropractic adjustments in the upper cervicals make a different for these people. What’s your feeling on that?
Dr. Brown:
We know that with our clinical studies and what I’m seeing in clinical practice – so this has been out for a little over a year, a year and a half, or so. We’ve treated 70,000 or 80,000 people now, and we get lots of good feedback. I have open lines of communication.
Dr. Pompa:
Wow.
Dr. Brown:
The first things I say is almost like I want to make a commercial. I’ll want to say, “We’re a four star product because we’re not going to fix everybody. I want to fix everybody, but our studies really are pretty indicative. Over 80%, 88% of the people felt better,” but I still get – my whole practice is that 10% where they’ve tried it; they’re not better. I’m working on that. If you can help me with those 10%, I will send you a nice Christmas gift.
The motility issue, when I was talking about the vinculin antibodies, these people that actually have that antibody, you almost have to treat them as if they have an autoimmune disease that is affecting their actual motility. Now, this is something that I also strongly believe in. When you treat anybody, during the day, you’re going to give them something to try and get their intestines back to the way it should be.
What happens with a lot of these people, and the reason why they have motility issues, is because when they go to bed, there’s actually something that’s supposed to take place called the Housekeeper Phenomenon or the phase 3 contraction. Most SIBO patients are very familiar with this because they’ve read about it quite a bit, and they’re trying to learn for themselves. Basically, when you go to sleep at night, when you go into a deep sleep, your body sets this rhythmic pumping of moving everything from the stomach all the way to the colon.
We know in people that have this, that’s actually been affected. They go to bed at night, and the bacteria just thrive. Then you wake up, and we’re right back to square one. Addressing the motility issue, I will sometimes put people on erythromycin at night. From a natural standpoint, Iberogast is something else that I’ll use at night; really, anything to get that phase 3 contraction moving so that it works in conjunction. Then once you get that out, then usually the motility will repair itself.
Dr. Pompa:
We use a product, Bind, at night that – it just has a stimulating effect on the gut even for people who have lack of motility. It binds up a lot of these nasty biotoxins that these bacteria produce. People just go, “Oh, my God. I can’t live without it.” It’s because of the reason you’re saying, not to mention we have a lot of bile dump that occurs at night, too. I think the Chinese used to call it liver time between 2 and 4 a.m. Boom, it just dumped. Now you get the toxic dump and the bacteria thriving. Oh, my gosh. It’s a recipe for disaster.
Dr. Brown:
Isn’t this interesting, though? You’re already integrating multiple organs into this. One of the things you were talking about is a lifestyle deal that really gets completely overlooked, which is proper sleep hygiene. If we can get people into proper sleep hygiene, also, then that plays a role. I’m learning that it’s almost impossible to be a gastroenterologist when we’re dealing with these people. You really do have to start thinking on a more functional level, and looking in, and saying, “Oh, you’re not going to get completely better until we X, Y, Z this. We’ll start with this.”
Your whole philosophy of going back to the cell, I think, is absolutely brilliant. Going to the cell, and then working the brain all the way back, and including all these organs, I think, is pretty novel and pretty interesting.
Dr. Pompa:
One thing I teach is a multi-therapeutic approach, and the gut is part of that. It’s so hard if you’re not working in all of these areas to really get someone lasting well. We do things; “Hey, that helped.” If you’re not really working in all of the areas, you’re not going to get someone to really last in their healing.
I have to have Meredith tell her story. I thank her for finding this. When she did, I started researching it, and I started – and everything that I knew, I was like, “Okay, this actually makes sense to me. [00:23:57] okay, this one actually makes sense.” I said, “Oh, yeah, you need to try it.” I think I told her to try it anyway, and then I started researching it. I said, “Man, I can’t wait to see her results.” Meredith, tell your story because you were a classic case from the Xifaxan all the way through.
Meredith:
Yeah. Gosh, I’ve had some gut issues, and I don’t know – we’ll kind of have to abridge the story. I guess it kind of started around 2010. I began eating a really high-starch diet, a macrobiotic diet. That’s what I was following, so I was eating grains three times a day, and I came down with a Staph infection, as well. This was maybe January, 2011. Got really fearful, so ended up on a course of a lot of different antibiotics for about five months. Ever since then, my gut health was just – I couldn’t get it where I wanted to be. I had issues with digestion. It would flare up on my skin.
It’s been kind of a battle. Since working with Dr. Pompa, so it’s been about three years now, we’ve been working together. I realized, “Okay, this is SIBO, a lot of these issues.” I would eat vegetables, which I wanted to eat, and they were so healthy for me, and they would cause bloating and a feeling of distension. With a lot of the symptoms, I realized that it was SIBO.
I had done a breath test for SIBO not too long ago, and it came up negative. It was a hydrogen breath test. I was so disappointed because I remember thinking, “Oh, I know I have SIBO. How can this be negative?” It was a hydrogen breath test, so I’m thinking, “Okay, well then maybe” – now, in retrospect, that I had this methane form. At that time, I didn’t even know there was the hydrogen and methane bacteria that were different.
This fall, I had been trying for a long time to get rifaximin, Xifaxan, which just as a side note, it can be very challenging to access. It was very expensive. It was so hard to even get an appointment with the gastroenterologist. We had to basically pretend that I had IBS, which I don’t, but -inaudible- to the rifaximin. I made the financial investment. I was, “I know this is right.” It was 10 days, and it was 550 milligrams three times a day, I believe. No, it was 14 days. It was a pretty good course of antibiotics, and I assumed that’s a standard dose. I took it for 14 days at this high dose, and maybe felt a little bit of relief in the beginning.
Dr. Pompa, you had suggested maybe since I had been following a low-carb ketogenic diet for a while with some cyclical feasting with some higher carb here and there, but pretty low-carb for a while, that while I was taking rifaximin to try a higher-carb diet, just to eat starches, really for the bacteria to be able to kind of digest these starch. I did a higher-carbohydrate diet for those two weeks while I was on the rifaximin. For the first few days, felt a little bit of relief, but then just kind of back to square one, not feeling a lot of results, and just feeling discouraged, honestly.
During this point, I came across your work and Atrantil, and I was thinking, “Well, this sounds like an amazing, natural option,” realizing, too, the difference between the hydrogen bacteria and the methane bacteria, and thinking, “Well, maybe I have the methane-producing bacteria for the SIBO. That’s why I had the negative breath test for SIBO.” About a week or so after I finished the course of rifaximin, I tried the Atrantil. I’ve definitely noticed better results with the Atrantil. I’m just kind of wondering, too, what your thoughts are on those of us who have taken rifaximin in the past. Did that do damage? Was that the wrong thing to do?
Dr. Brown:
No. I don’t think it was the wrong thing to do. I think that Dr. Pompa touched on it briefly that it is an antibiotic, and so it’s going to nonselectively kind of take out where – anything that it can actually integrate into the cell. Now, the one thing that separates Xifaxan and why Xifaxan is used over other antibiotics – there’s a lot of other antibiotics that have been used to try and treat bacterial overgrowth, SIBO. Xifaxan is very poorly absorbed. The thought is that it stays in the lumen a little bit longer and affects just those bacteria in the lumen.
What I have seen in my own clinical practice – and I write a lot of Xifaxan. I was certainly doing the original research on it. What I would see is that somebody would have an excellent response the first time. They would have about a 60% response the second time. By the third time we tried to use it, they had nothing. Sometimes I think, “Are we really here for the bacteria, or is the bacteria here for us?” It kind of goes both ways. We carry this bacteria around, and they adapt so quick, and they’re so good at trying to do some of these things.
The antibiotics, it’s a pharmacologic agent. The way that Atrantil works is it’s got three ingredients that work together. Basically, the first ingredient is just a calming agent. That’s got the menthol in it. It’s the peppermint leaf. Chose the leaf, not the oil, for the polyphenol benefit of it. The second ingredient is that Quebracho. What the Quebracho is, that’s the polyphenol. It’s a tannin. It’s an [epigalic] tannin. [Epigalic] tannins are very large, beautiful molecules. It doesn’t get absorbed very well at all, so it stays intraluminal, or it stays in the area where the bacteria is. That actually weakens the archaebacter, and it sets it up for the third ingredient that shuts off the enzymatic production.
All of this was shown eloquently in all those animal models when they were initially looking at it. That’s why it was so cool to go, “Oh. Somebody did all the heavy lifting for us. Nobody’s ever put it together. Let’s put it together.” That’s how we were able to get a patent. We were able to patent Mother Nature, which is kind of hard to do. Fortunately, we’re having success kind of like you’ve had, Meredith. I’m really, really happy that we were able to develop something that can help a lot of people that otherwise had been extremely frustrated.
Dr. Pompa:
Yeah. Thank you. It’s been a godsend for us. SIBO is known as the most frustrating thing. When we would see SIBO, we’d go, “Ugh!” -inaudible- so many failures, multiple things. These bacteria, man, they start – this starts working, and now it doesn’t. We would combine – literally – very, very archaic. Let’s talk about testing because I think Meredith pointed out something. The breath is a good way to test; however, it’s very difficult to find a test that tests for hydrogen and methane. What if they’re down deeper? If they’re down further in the intestine, sometimes the tests are negative. Talk about that.
Dr. Brown:
Meredith, what you had is you had a hydrogen breath test. The hydrogen breath test, for your listeners, is that you’ll take what we call a substrate, where basically, you’re just going to take some sort of fuel for the bacteria whether it’s a lactulose, or whether it’s glucose, mannitol. There’s a lot of different ones that you can use. Bottom line is you’re going to give some food to the bacteria. Then you breathe into a bag, and it checks your levels of your gases, hydrogen and methane. Then you ingest this substance, and you take your breath tests in set amounts of time, and you wait for a spike in hydrogen or in methane to happen.
That spike is basically the bacteria has broken down the gas, and it gets absorbed into your system, travels all the way back to your lungs, and you exhale it. That’s the actual breath test. Now, it’s a pretty complex thing. It’s kind of interesting. It’s pretty cool science. The problem that you found out right there is that it’s not an infallible test. In fact, the sensitivity and specificity aren’t that great so much so that I really only reserve that test for people that have failed treatment. Then I go, “Okay, if you failed treatment, and you still show up really positive, then I will tailor a little bit of the treatment for that.”
An example of this would be somebody that came to me as a second or third opinion. I treated him, and he’s like, “Yeah, I’m a little better, but still not.” I checked his breath test, and he had a methane spike in 15 minutes. Looking at that, what that told me was, similar to what you just mentioned, where is the bacteria living? In his case, his bacterial overgrowth was so high up that it was right past the stomach, which means, “Oh, my gosh! Maybe we’re not even opening – the capsule’s not even dissolving that high up.” -inaudible- dissolves that high up than, of course, if you’ve got bacteria further down.
It’s the best way to get it to go there, so we had him open up the capsules, and it went away. In his case, it’s like, “Oh.” That was more of an area, of getting the product there. The breath test is not the ideal. It’s not a perfect test, but it’s all we got. A few other things like an endoscopic culture and things, that’s still not perfect. It’s an invasive test. There’s a few people around the country doing that. I reserve the breath test for people that have actually failed everything.
Now, if you’re interested, just this past month in one of my journals, American College of Gastroenterology, Dr. Pimentel and Dr. Satish Rao, who are both experts in SIBO and treat it slightly different, they came with a consensus article or a review article on breath testing. You can read the whole thing, and the bottom line is they’re just kind of saying this: “Well, it’s kind of not that great, but it’s all we got.” It’s kind of funny that the experts that are really kind of into this, they all kind of agree that it’s – clinical diagnosis still goes a long way.
Now, I will say that when you are – the belief with these guys was that if you test positive in methane, that is probably true. It’s a very specific test if you test positive in methane. If you test negative, it doesn’t mean that you don’t have it. Take that for what it’s worth.
Dr. Pompa:
I don’t even use the testing anymore. It’s so easy clinically to spot it, I think. The other problem with many of the tests, most of the tests that people get online are just hydrogen, so they’re missing the methane. It depends on what sugar agent they use. Again, if the bacteria are too far down, then it doesn’t get to it, etcetera. There’s many pitfalls.
Dr. Brown:
Yes, exactly.
Dr. Pompa:
Okay. We’re learning a lot here, I’ll tell you. This is good stuff. I have one more question -inaudible- back over to Meredith. Let’s say someone does the 20 days, and they relapse. Can you do another 20 days follow it up? These are questions that I get a lot. How much can you do it? Can you disrupt your – can the product disrupt your actual microbiome? That was the actual question I had when I did my Facebook Live. Can the product disrupt your good microbiome? Therefore, how often can you treat if you flare up? There was the question I got.
Dr. Brown:
We have not seen any disruption of the natural microbiome. Typically, when we’re talking about medications that do things like that, we’ll know – like if it’s an antibiotic, and somebody develops C diff, Clostridium difficile, then we know they’re really messing with your natural microbiome. That would be the most extreme version of it.
I have had some practitioners that do stool testing, and genomic stool testing, and things, and they say that there is a change, but into more of a change of a broader spectrum of bacteria, which means it’s functioning like the prebiotic. It’s a polyphenol.
Dr. Pompa:
-inaudible-
Dr. Brown:
Yeah. These are the ingredients. Really, the answer to your question is we have not seen it. I don’t think it would do it. I have been taking it daily for years, ever since we first came up with it. I was the first guinea pig. I’ve taken two, three bottles just to see if a toxicity would happen and so on. I have not had any issues at all. We believe that those molecules – there’s a lot of cool research going on with this. I just read an article recently where [epigalic] tannins – somebody wrote an article that showed that these tannins – I think it was -inaudible- was the one that they were looking at – actually got converted by the bacteria in the colon – because they don’t get absorbed well – and the bacteria then converted it to urolithin though an enzymatic process.
These are all kind of big words, but the bottom line is that it actually helped the mitochondria on the cellular level do something called mitophagy. When we talk about fasting and stuff, autophagy, where your cells do this. This is the same thing, but even at a smaller level in the mitochondria. I just came across this. It was one of those – when people are starting to do research in the molecule that you’re enjoying, and you’re working with, and you realize, “Oh, this is tip of the iceberg. Maybe we’re really getting into a cool area of overall cellular health, where we can start helping people in that end.”
Dr. Pompa:
That’s exciting. Hey, good. Look, I know that you’ve been on it for a couple years. My kids aren’t going to die. They’re my guinea pigs. “Okay, kids. You’re good. -inaudible- on this one. Next.”
Dr. Brown:
Yeah, exactly.
Dr. Pompa:
That’s why you have kids.
Dr. Brown:
People ask me all the time, they’re like, “Can we give it to pregnant women? Can we do it for breastfeeding?” It’s just kind of a canned answer. It wasn’t studied. The -inaudible- says no, we can’t do it, but on a – probably shouldn’t say this on air, but it’s really kind of funny. Brandy, the researcher that helped me develop this, her and I worked years on this. In the process, she ended up getting married, and getting pregnant, and breastfed. She remained on it the whole time, and her baby is beautiful, and gorgeous, and everything. I’m not recommending it, but I’m saying that at least we’re willing to try it. Just like you said, you’re going to test it out on your kids; we do the same thing.
Dr. Pompa:
Yeah, exactly. Actually, you know what? It fixed my son’s girlfriend. She was here. I’m like, “Oh, you have SIBO.” She’s like, “What’s that?” It was like, “Oh, my God.” She’s searching it. I’m like, “No. Here’s the answer.” She took my only bottle. Meredith -inaudible- I’m going to actually just take it for fun because of the whole autophagy conversation there. It’s like, “No. I’m going to test it on me.”
Dr. Brown:
The only other thing that’s really interesting that I think that you can kind of appreciate – and this is a hard concept when I speak with other medical doctors, other MDs. The term leaky gut, that’s a very, very common term on the internet. It’s a term that I think most MDs will stick their head in the sand and say, “That doesn’t exist,” because there’s no code for it.
Dr. Pompa:
Yeah, right. It’s true.
Dr. Brown:
What we’re seeing is this big movement now where if we call it epithelial integrity disruption or use any other fancy word you want, but it comes down to leaky gut. There’s a lot of information. Really, what we’re seeing is – I met with a gastroenterologist who, in his mid-fifties, decided to get his PhD in Indianology, which it blows my mind that somebody would do that at that stage of their career, but he’s absolutely brilliant. He did his thesis on the tight junction or how the cells come together.
We were discussing that. There’s a lot of evidence that shows the things that create leaky gut, SIBO, or an infection, diet, meaning whatever you want to call it. You can say that it’s GMO, or it’s lectins that are creating this, and grains, whatever you want to call it – and then zonulin. Of course, zonulin is that protein that is produced when the body sees gliadin or gluten. Zonulin, SIBO, and diet create this leaky gut or intestinal permeability.
Once intestinal permeability happens, you have these security guards that wait right below the cells called dendrites. They sample the outside world, and they don’t really make a decision. They hand it off to another cell like a B cell, and then that B cell makes a decision, friend or foe. “Oh, don’t worry about it. That’s a normal bacteria that we don’t care about. Oh, don’t worry about it. That’s just a normal chunk of hamburger. That’s fine,” and they shut it off.
In these susceptible people, that is the start of the autoimmune process. It hands it off to a cell, and then that cell overreacts and goes, “Oh, no! This is something we have to get rid of,” and then turns on this whole inflammatory cascade. That’s when we get into the complexity of it with – is it these inflammatory cytokines like TNF, interleukins? Is it the histamine? Is it whatever?
What’s funny, when we treat people with Crohn’s and ulcerative colitis, which are diseases where the body attacks its own intestine, maybe the treatment has nothing to do with downstream shutting of these inflammatory cytokines. Maybe we just need to tighten the gate before it even happens.
Dr. Pompa:
I couldn’t agree more. I’ll tell you, after this conversation, I’m going to use this product on people that I wouldn’t diagnose with SIBO, that I wouldn’t say, “Oh, this is a SIBO case.” I’m going to use it on some of my leaky gut cases that we battle. I think there’s more here than meets the eye.
Dr. Brown:
It’s probably standard for you when you evaluate a patient, but it’s very interesting. I’ll catch my patients off-guard where they’ll be talking to me. They want to discuss their GI issues, bowel habits, and things like that, and I’ll go, “Do you ever feel like you’re just tired?” They’re like, “Yeah, why?” I’m like, “Do you ever feel like you’re in a brain fog?” They’re like, “Yes.” Then I’m like, “Okay. This is what’s going on.”
It’s so interesting because these symptoms are so common. In my opinion, all these symptoms are tied to chronic inflammation, some sort of thing that’s revving up your inflammatory response starting in the gut, working its way out, and then you have these other manifestations, depression, fatigue, restless leg, brain fog, all these things that people get frustrated because the blood work’s normal. Scopes are normal, and they get a CAT scan. Then they go to another doctor, and they do the same thing. Then they go to another doctor, and they do the same thing. Hopefully, we’re making a big difference.
Dr. Pompa:
When you look at why people don’t feel well today, you have this brain, and you have this brain down here. Both have a barrier; blood-brain barrier, gut barrier. Both -inaudible- compromised by massive amounts of certain toxins.
Dr. Brown:
Absolutely.
Dr. Pompa:
When we look at what glyphosate is doing – and it goes beyond glyphosate. We grew up in the lead and mercury generation. These things open up these barriers. We’re dealing with toxic cells here. This is the problem, and then all these infections that are now crossing into these barriers. This is why we’re seeing an epidemic of autoimmune and unexplainable illnesses.
Dr. Brown:
I have to do a little self-confession here. I listened to your podcast where you were with your buddy. You guys were at a convention, and you were kind of doing simultaneous live podcasts. You guys had dinner the night before.
Dr. Pompa:
Oh, I bet -inaudible-
Meredith:
-inaudible-
Dr. Brown:
Yes, yes, yes. I was sitting there, writing down – I’m like, “Man, I got to start doing some of this stuff.” I’m like, “Okay. I got to bring my own water filter there. I got to do this.” I’m like, “Wow. When these guys go on vacation, they’ve got a whole list. They got to make sure.”
Dr. Pompa:
No doubt. We learned early on that if you don’t stop the toxic input into the gut, it’s really difficult to balance the bacteria. It just keeps opening up these junctions, these tight junctions. There’s so many things that can affect them.
Dr. Brown:
Yeah. I have all these people. I have a lot of very high-level executives that’ll fly in to see me, and they’re just – they’re frustrated because they’re mentally not where they normally are. They’ll even admit it. They’re like, “Man, I’ve never been anxious in my life, and now I’m having panic attacks. What is going on here?” We treat the gut, and eventually they get a little bit better. It’s that desperation, like, “What in the world? I get it. I’ll put up with my gut, but this” – just like you said.
A lot of these cytokines and toxins cross the blood-brain barrier. When that happens, the brain reacts to it. You have this enteric nervous system, meaning you got your own nervous system in the gut that does communicate with your central nervous system, which is your brain and your spinal cord, so there’s interaction both ways. You can have the brain doing some stuff to the gut, and you could have the gut doing some stuff to the brain.
Dr. Pompa:
Absolutely. Now, we’ve seen it with our autistic cases. You have to deal with both. I’ll tell you, therein lies the magic. Meredith, I’ll turn it over to you.
Meredith:
Thanks, Dr. Pompa. I always have lots of questions. You guys had touched a bit on fasting. Dr. Brown, I’m curious as to your thoughts on fasting, whether you implement it clinically. When I met Dr. Pompa – when we’ve been working together, I remember, just kind of getting back to the SIBO topic, the SIBO diet was kind of started off by a four-day bone broth fast, typically, and then you would go into just eating meats and fats for a period of time before bringing in fermented foods and trying to reintroduce some of the foods. I’m wondering what your thoughts are on fasting and if you use it clinically.
Dr. Brown:
I’m fairly new to the whole fasting world. I, myself, have been doing intermittent fasting for about a year now, not so much for any other particular reason other than I’m – I don’t want to say my age, but I’m getting to that point where it’s really hard to still stay in shape. I’ve found that the intermittent fasting really helped me kind of get back to the body that I was trying to maintain a little bit. Personally, that’s where I’m at.
Because of that, I’ve been doing a lot of things, like listening to your podcasts and listening to a lot of other people that are actually much more knowledgeable about fasting. That being said, I’ve been getting a lot of emails from patients that do fast, and they’re like, “You should do a study. You should really see if the fasting makes a big difference.” I’m going to start implementing – I have a hard enough time – it’s just the nature of treating people. It’s very hard to get people to do anything that is not easy.
If I just say, “Why don’t you not eat bread and pasta? Let’s start with that,” and if they actually do that, I’m pretty happy. Then if I can go all the way to – if I can work my way to fasting, I’ll certainly do it, but just the thought of it is a little scary to a lot of people. Then, oh, my gosh, yeah, when you were talking – one of your podcasts recently, you had a fasting expert on, and you were discussing – the magic doesn’t happen until day four. I go out on a run every morning. I stopped, and I was like, “Four? I struggle to make this 18-hour thing. Are you kidding?” It sounds scary.
Dr. Pompa:
Listen, in early May, my seminar in Atlanta, you’d be our guest, and I would – my November seminar or end of October – I don’t know when it is, but we’d love to have you speak on SIBO.
Dr. Brown:
What is the seminar that you’re –
Dr. Pompa:
-inaudible-
Dr. Brown:
What is it that you’re going to?
Dr. Pompa:
This seminar is – it’s in Atlanta, and it’s May 5, 6, and 7. Dr. Joe Mercola, myself, and Ben Greenfield, who you saw me -inaudible-
Dr. Brown:
Oh, okay. Yeah.
Dr. Pompa:
They’re all going to be there. They’re all speakers. Yeah, you would absolutely love and enjoy this seminar. If you can get to Atlanta, you’d be our guest, so we’d love to have you.
Dr. Brown:
I’ll have to go ahead and look into that. Yeah, for sure.
Dr. Pompa:
Then in our fall seminar, we would love to have you speak on this if the dates work out for you. Meredith -inaudible-
Dr. Brown:
Oh, I’ll make them work, absolutely.
Dr. Pompa:
We carry this, folks, on our site. Meredith can tell you more than that, but very appreciative of this product, Doc, and very behind it.
Dr. Brown:
You know what? I want to thank you for – I know that you found your calling after you struggled with some stuff. There’s a lot of integration – I need to learn a lot is what I’m saying. I’m learning a lot now as I’m diving in, and getting beyond this, and realizing that there’s a lot more to the functional side of all this as I’m meeting a lot more functional doctors.
Dr. Pompa:
We learned a lot from you today. That’s for sure. This area is your expertise. We’re doing it different because of you, so we thank you for that.
Dr. Brown:
Awesome. Absolutely.
Meredith:
There’s always so much to learn. I just have another quick question before we sign off. I get a lot of phone calls and protocol questions. I know with the Atrantil – we mentioned a little bit about some other supplements, but can it be taken in conjunction with probiotics and digestive enzymes?
Dr. Brown:
Short answer, probably yes. Digestive enzymes, for sure. Now, Dr. Pompa did mention briefly in the very beginning that he sees some people that get worse on probiotics. There are certain doctors like Dr. Pimentel at Cedars Sinai where he does a no probiotic protocol because that could actually be fuel to the fire. That being said, I’ve had a lot of practitioners call me up and be like, “Well, I’ve had really good success with this.” I’m like, “Okay. If it works, it works.” There’s no contraindication. I personally have people hold it because I’m scared that we’re actually giving them more fuel to the fire in the area that we don’t want it.
I want those probiotics to make their way down to the colon. That’s the bottom line. By the time they come to see me as a specialist, they’ve already been on probiotics. They’ve already been on six or seven different types of probiotics. It’s easy for me to go, “Why don’t you hold that? Take this. Let’s see what happens.”
Dr. Pompa:
By the way, I just did a Facebook Live on this two days ago. It’s about that everyone’s been on the same probiotic for a year or more, and they’re literally causing dysbiosis. They’re causing competitive issues. I see that all the time. First thing I do is, “How long have you been on it? Let’s get off it. Switch it.”
Dr. Brown:
Yeah.
Meredith:
Yeah.
Dr. Pompa:
-inaudible-
Meredith:
-inaudible- otherwise that monoculture is created, right? If we’re always taking the same bacteria, it can really do a lot more harm than good.
Dr. Brown:
When we think about that, the thing that’s kind of hard for people to understand is that your true microbiome is – it is huge, huge number and thousands of species, a hundred trillion. When you’re taking a probiotic, we do want it to get it there. We do want it to do some good, but it is always just a little drop in the ocean when it’s all said and done.
Dr. Pompa:
Absolutely.
Dr. Brown:
If you feed your bacteria, they’ll figure out what they need. If you feed them the right things, they’ll really kind of figure out what they’re doing.
Dr. Pompa:
My brain was spinning, so I didn’t want to mention because I couldn’t come up with it, but it was about polyphenols and zonulin. There was a study that I read about polyphenols’ affect on zonulin and therefore leaky gut, etcetera. Dig for that. That’s in your neck of the woods. My brain just remembers stuff.
Dr. Brown:
Oh, man. If I could get – first of all, this is – it’s really exciting that we were able to get to this. I have a company now, a lot of people have changed their lives, moved down here. I’ve got a CEO, and a director of operations, and all this. Technically, we’re still a start-up. I’ve got all these things, exactly what you’re talking about. I think that there is – we need to look at how do we slow down this histamine? How do we bind up the zonulin?
Clearly, the fact that I’ve got bad gluten intolerance, and I can eat a loaf of bread as long as I have this with me, I’m fine. I’m the first one to admit, “I don’t know. Am I blocking zonulin? Am I binding something? Is it a histamine? I don’t know.” It’s exciting stuff. -inaudible- so I can get back and start looking at these other things.
Dr. Pompa:
-inaudible-
Dr. Brown:
That’s going to be the fun thing. We’ve opened a new door. We’re like, “Ah, look at this!”
Dr. Pompa:
Yeah. I say I can’t wait to use it for a lot of different things. I was a guy who couldn’t eat gluten. Now I can eat it. It’s not just gluten. I wrote an article on that. It’s not just gluten.
Dr. Brown:
I’m going to give you just a little bit of warning because after we launched, I had to do a lot of conferences, and shows, and stuff. Since I could eat gluten, over a year, I insidiously put on about 15 pounds, and went, “What?”
Dr. Pompa:
When I say that, I mean I can, but trust me, Meredith will tell you, I’m down into my diet, man. It’s no problem here. All right, Meredith. Thanks again, Dr. Ken. Again, the product, Meredith? You can make sure that they – Revelation Health carries it, so there you go.
Dr. Brown:
Awesome. Dr. Pompa, Meredith, thank you so much. Meredith, can you just email me the conference dates and that, and then I’ll make sure that we’ll attend. That’s awesome.
Meredith:
Awesome. I will definitely reach out. Thank you for sharing your wealth of information on the gut, and SIBO, and some of the root causes, and then this really exciting solution that we have for all of you, as well. I’m very excited. I’m a little nervous to try gluten again. Maybe I’ll even try it with this product. I don’t know.
Dr. Pompa:
-inaudible-
Meredith:
-inaudible-
Dr. Pompa:
You know what, Dr. Ken? You might want to have a booth. You might want to have a booth there. We’re going to have 300 doctors there.
Dr. Brown:
Oh, yeah. We actually have a booth. We would be happy to sponsor, absolutely.
Dr. Pompa:
You need to do that because I was just thinking that because they need to be introduced to – that way. Absolutely. Anyways, Meredith will handle the rest.
Meredith:
Yep. Awesome. We’ll be in touch. Thanks, everyone, for watching -inaudible-
Dr. Brown:
Thank you, guys.
Meredith:
Yeah, thank you – getting Atrantil. Did I pronounce it correctly?
Dr. Brown:
That’s the other thing. If you want to ask, the biggest problem we had was trying to find a name because pharmaceutical companies have trademarked everything. If it phonetically or visually even gets a little close to it, they’ll sue you. We struggled to find a name. We had to make it up, and we thought, “Trantil” because it gives a sense of tranquility would be cool. Then at the 11th hour, our attorney said, “Oh, no. This pharma company has something similar. Throw an A in the front of it. It’ll work.”
Dr. Pompa:
Atrantil.
Dr. Brown:
It’s Atrantil, like, “Aah, my belly’s better.”
Meredith:
Atrantil.
Dr. Pompa:
It’s French for relief for small intestinal bacteria overgrowth.
Dr. Brown:
As soon as we – it’s going to sell like crazy in the EU in that French accent you just had. I love it.
Meredith:
Atrantil. Awesome. If you’re interested in getting some Atrantil, you can go to RevelationHealth.com – I did study French – and pick up a bottle. Thank you, Dr. Brown. Thank you, Dr. Pompa. As always, amazing information. I know I learned a lot. I hope all of you did, as well. Have a wonderful weekend, and we’ll see you next time. Bye-bye.
