Beyond the Gut: Uncovering the Hidden Symptoms of Digestive Disorders

I don't think anybody should go with one element story here, but you put the pieces together, it may tell you that. And sometimes when you see this, you have to say, okay, what's causing the immune system to be challenged? Is it alcohol? Is it stress? Lack of sleep? Bad eating habits? You know, or is it presence of toxins or mold? Maybe somebody was exposed to a moldy environment and the, You know, more toxin, they're immune suppressant. They promote the growth of their own species.

Welcome to the Peptides and Longevity Podcast. Each week we'll dive into groundbreaking science, innovative therapies, and the future of health and longevity alongside visionary physicians and experts. We'll explore how peptides, cutting-edge medicine, and lifestyle strategies can redefine the way we age. Get ready to transform your health, optimize your vitality, and unlock the secrets to a longer, healthier life. Let's get started.

Hi, this is Dr. Kent Holtorf with another episode, and today we'll be interviewing Dr. Sheed Sam Rabbar, who's a leading premier gastroenterologist in Los Angeles. He'll be talking about the significance of non-digestive symptoms in patients with digestive disorders. And I have to say, he's one of the few gastroenterologists that really look at the whole body and diagnose systemic illnesses instead of just saying, oh, we'll scope them, well, your gut's fine. Really a quintessential medical detective, holistic physician. Proud to say he's a friend and a colleague and send a lot of patients to and just all get raving reviews. He thinks outside the box and does a lot of unique therapies and testing. He's developed tests that he has that are unique for SIBO and other things like that. He's basically leading— again, leading integrative premier gastroenterologist in Los Angeles. I think all over the country and the world. He lectures all, all over the country and the world. He incorporates anti-aging, functional medicine, and integrative holistic approach to digestive care. And while most GIs are just now learning about probiotics, like, he is so far ahead, it's, it's pretty amazing. He's medical director of the LA Integrative Gastroenterology and Nutrition. His approach is not just holistic. And I also, I don't know what to call what we do. It's also integrative. He blends the best of Western medical and scientific research with the concept of whole body relationship to one's health. And really, I think he just practices better medicine and continually does research and learns. And he's so generous with his knowledge and lecturing all over the country that draws huge crowds. He's a big fan. He has the— told by my girlfriend— the sexiest voice and the sexiest gastroenterologist in the country. So I welcome Sam, Dr. Ebar. Thank you for being on the summit. It's, it's pleasure and looking forward to more interesting info from you.

Great, thank you very much for that introduction. I really I appreciate this invitation and I must admire the work that Dr. Holtorf has done in providing the community with a variety of services that is hard to get to, if you will, all under the same roof. And, you know, hopefully we can continue to collaborate with each other in that respect. So, I came up with the idea of that subject Based on the significance that we had seen obtaining a more detailed review of systems when we see a patient with digestive problems. And patients come to us, they either have symptoms or they have conditions. From a digestive point of view, symptoms, there are about 10 symptoms: lack of appetite, nausea, vomiting, abdominal pain, diarrhea, constipation. Bloating, and sometimes bleeding. And the number of illnesses that may underline these symptoms is over 300, you know. So there's a lot of overlap. And nowadays I'm learning that we rarely find patients who would have a single entity problem. There was a time you go to the office, somebody come with a strep throat, You give them an antibiotic and you're done. And just don't see it anymore. Yeah. We know that the patient comes in, there must be an array of underlying physiological rearrangements that they need to be addressed. And to be able to address those and understand them is very important to know what other symptoms, non-GI, non-digestive, they're presenting with. And as such we need to be good historian and be able to be a good listener. This has such an importance that we actually put our data together for over 3 years and we submitted this for publication and verbally we have heard that the article has been accepted. However, it's this final The steps need to go through and once it does go through, then it would be available online, you know, to everybody.

That is awesome, because it's very difficult and I know the lay people don't know, but trying to get something published that isn't just standard dogma is very, very difficult. And if you come up with a new concept, it just gets poo-pooed, you know, and it's tough and, and Dr. Bar lives in an environment where he has you know, works at Cedars. So he has to, you know, deal with the standard physicians and, you know, walk that fine line. So he, the reason he could do it, cause he has a lot of respect from those physicians and, and he's doing a lot of amazing integrative things that they're like, I have no idea. So if a doctor doesn't know, it's, you know, what it is, it's, it's crazy. It's quackery. So it's amazing. That, you know, how many years you've been in that dual role where dealing in that hospital space and your colleagues in that area and also in this, I think, exciting integrated functional, whatever you want to call it, space.

Thank you. And, you know, after a while, at least I can say for myself that one learns to be humble and be a student at heart and continue to be observant and learn from the experiences that the patients share with us again. I mean, nobody comes to my office, you know, unless they truly have a problem. So, it is our role to see if we can dig into it and learn from that. And to this date, I must say that I still learn something new that I didn't know. And that's because somebody is willing to share their experience with us.

Yeah. And I mean, that's— a lot of doctors aren't willing. And I mean, good job, but I am curious, like, how does it work with your, like, standard GI colleagues, you know, where they're kind of stuck in the past to me? And do you try to teach them or convince them, or is it not worth the trying?

No, I would never say it is not worth trying it. I mean, for colleagues that we have sat down and talked generally in an informal way, they made a notation of that, and sometimes they run into a scenario where They say, "Oh, you know what, this sounds like another patient that Sam Rabar was seeing, maybe we should look into it." For example, you have patients with gastroparesis or cyclic vomiting syndrome. Things that, you know, they don't have clear explanations in the practice. We treat them, but we never know how did we get to that point that the patient had this type of problem. And I think as we learn, our bodies have a lot to do with the way it interacts with environment. And when things go wrong, I mean, the microbiome somehow gets affected, the autonomic nervous system gets affected, the brain gets affected, and a variety of symptoms start to manifest themselves. And as such, that's why, you know, we like to pay attention to those other symptoms that They're not necessarily GI. For example, I would say about half of our patients have an issue with fatigue. Occasionally fatigue is the predominant symptoms. Indeed, I may talk to a patient and I say, okay, you have digestive symptoms and non-digestive, but which one really predominates? What brings you here? And at times may say, oh, you know what, my digestive symptoms, you know, are there. I'm really bothered by the non-digestive symptoms. But the reason I want to come here, because I think maybe the GI is doing something to the other one. Almost the patient has a sense that the correlation may be there, that an imbalance in the digestive system may be turning on the inflammatory process and they're feeling it elsewhere, but the problem is really originating from the, from the digestive tract.

And yeah, I think more and more research is showing that. And but I think the compartmentalization of medicine now, it's like the standard GI, like, okay, I'll fix your gut. I don't care about that other stuff. You go to your, you know, family practice or internist. Yeah.

I mean, I'm sure that if the visits were modeled in a way that there was a lot more time allocated Physicians would have time to spend to analyze these things here. But when I practice more of a traditional model, I mean, the approach would be problem-focused. The same way that the CPT codes and the coding system is designed, which is basically based on the number of problems, problem 1 or 2 or 3. And the approach would be problem-focused as opposed to allowing one to be completely holistic. Holistic is good, but it needs two things. One is the mindset and the willingness of the doctor and the patient to get into that arena of thinking. But at the same time, it needs time. It is an element of time to be able to do sharing and bounce back and forth. Okay. Sometimes is one sentence or one buzzword or something that brings a thought process that you want to pursue it. And diagnostically, I think it's always important to know what we're dealing with, because if we understand it, then we could be more focused what needs to be done. At least that's the philosophy that, you know, I've taken. And I think—

I totally agree with that, where I'd like to get a lot of information up front and paint a picture. Right? And don't hang your hat on any one test, you know?

Exactly. I mean, as you know, I mean, there's no such test that is 100% rule in, rule out. I mean, we still have to correlate what the test means with the clinical picture. And that's why it's very, very important. I mean, I recently had a patient that I think we chatted about this briefly. The patient has been ill for almost 7, 8 years. Has been to multiple institutions and lost weight from the range of 100 to the range of 70s, looks cachectic, can't eat, has abdominal pain and goes to the hospital for nutritional support. We did a mercury test, the mercury level was high for somebody who is 70 pounds, a number more than 10 is a high number. And at the same time, The Lyme disease markers, for example, in this particular patient were positive, which was— which correlates with her travels to a lot of exotic areas. And the study showed that the antibody that was positive was the one that we call the IgM. And obviously, you would be the experts in that one, which means that maybe this is something new, but the patient has been ill for years. So, specialist who saw the patient reported that he would believe that these are false positive.

In fact, he's the—

There's a 10-year story with the patient, you know, that the patient end up in that clinical setting. I would want to just say this negative, maybe there's another explanation. And as we spoke the other day, you know, we mentioned that perhaps the immune system did not get a chance to go through evolution to evolve from that preliminary stage of IgM to the IgG, and maybe there was an evolutionary block into this, you know, immune system recognizing that he has to do this. And I believe this has been well described in literature. Yeah, in many conferences I've seen with references, this has been addressed, but I cannot quite relate as how an infectious disease specialist would call this false positive, not seeing how this may be correlating to the story.

All right. So you're diving deep into peptides and longevity on this podcast, and we're right there with you. Integrative Peptides stands out, trusted by over 10,000 doctors to deliver real results for their patients. These premium peptides are your key to unlocking vitality, recovery, and a longer, stronger life. Visit integrativepeptides.com and use the code PODLIFE for 10% off your first order. Again, integrativepeptides.com. Use the code PODLIFE for 10% off. It's time to elevate your journey starting now.

Yeah, it's, I think, I don't know, it's influence where they can't admit it because their colleagues will get on them, or it's giving in to the so-called alternative area. I think you see that medicine, you have kind of the standard ivory tower, you know, doctors, and they say one thing, and all this evidence comes up, and it's like a fringe group, supposedly. Evidence, evidence, evidence, they're still like, you know, la la la la, I don't see that. No, I don't like that study. I don't like that study. I don't like that study. And don't confuse me with the facts. And they just refuse. It's, it's nuts. And it's shown that, you know, these people have terrible natural killer cell, low Th1 immunity. There's Th1, the stuff inside the cell, Th2, the stuff outside the cell. And these people are like this. Now, if you don't have Th1, you can't convert IgM to IgG. Now, you give peptides or, you know, treat the infection, all of a sudden it switches to IgG. And so I think more people we find come up with IgM positive that is chronic than IgM and then IgG, and they say, oh, it must be a false positive, you know. And it, it's crazy. They just don't want to believe it. They don't want to believe the literature. So it's a very complex, I think.

And I think this will eventually evolve. I don't believe it's going to stay like this. I think the science eventually is going to pick up because the momentum, the number of patients who are ill is significant. And I think it's just going to evolve, you know. I'm not sure it's going to be in our lifetime, but it is going to evolve. It's just, I'm sure it's not going to stay like this. Um, but going back to the symptom complex, you know, people who come with headaches, you know, weight loss, hair loss, visual problems, eye burning, tongue burning, skin rashes, you know, a variety of these other things, they pop up as when you speak to somebody who comes with digestive manifestations. I think each of those symptoms need to be studied.

So what are the most common digestive symptoms people come in with?

I mean, the common one, believe it or not, at least half of our patients, they have excess gas, bloating, and what I call signs of, or symptoms of gut fermentation. And this generally associated with some level of absorption, which may end up into another step of micronutrient deficiencies, but it may also end up into stimulating the immune system causing mast cell activation and symptoms that are related to the mast cells. They're basically— one will lead into another scenario.

Kind of a vicious cycle. Yeah, mast cells are becoming, you know, much more, I think, in the forefront of all these problems. And what percent of people that come in with a GI problem Do you find other systemic symptoms?

Again, I must say that my practice over the last 15 years has evolved. We tend to attract patients who might have been a little bit more complex. Yeah, they think it may be complex, or they have been to other physicians. So I mean, I would say give and take, probably 80% of our patients, they have non-GI symptoms.

Because they've been scoped 100 times and yeah.

Yeah, I mean, usually, I mean, we are getting some frontliners coming that they say, oh, I want to go directly to a more integrative model or holistic model so somebody could look at everything together. And we're seeing this more and more, and interestingly, is more of the younger population that is making that connection that maybe they They wanna have that approach if it's possible for them. But by the time they get here, I think a lot of our patients, they have non-digestive manifestations. And I think if these will give us a little telltale what might be underlying this here, and generally is an environmental issue. I mean, obviously— Interesting. Issues such as stress, lack of sleep, eating a lot of sugar. I mean, all of those things and alcohol, they have an impact.

I'm in trouble. I am.

No, I mean excessively. I mean, all of those things, they have a role, but we're seeing now beyond that, you know, a lot of our patients already, they're intelligent, they have done the research, they're doing the right things. Many of them gluten-free or dairy-free or sugar-free. You know, I'm not even gonna say which more free you gotta become. You have to say, "Okay, how did I get to this point?" Yeah.

Okay.

And I remember I had one patient who came from New Jersey one time and I said, "What's the problem?" He said, "Look, I can't really eat anything. I'm down to lettuce and chicken." Okay, so obviously something like this has significant degree of intestinal permeability issues that is reacting to that degree.

Just—

and I speculate—

just getting through and causing all this inflammation, vicious cycle.

Exactly. I'm going to talk to you a little bit more about that, but just to finish this story, I mean, I said, "Well, where do you live?" I said, "You know, I live in East Coast." And they said, "Do you have a backyard?" "Yes, I have a backyard." "Do you have animals?" Yes, a person who was doing gardening has animals and they are out in the greenery, I mean it's very likely that they picked up something. And the testing that she brought clearly showed that there was an evidence of an infection there that could explain this when you compare to the other patients. But there remains the question as how— How do you make the diagnosis and what is the thought process that we think? And if you look at the study by the Canadians a few years ago, they look at women with irritable bowel syndrome and they use some sort of microscope that goes through the endoscope and they looked at the number of holes in the gut that they, in patients who presented with IBS, or irritable bowel syndrome, and they call this extrusions, or I call it dropouts, or cracks in the wall. I mean, that's the term that—

Actual, like holes?

Yeah, what happens that there's cells that they basically die off or shed, and then there would be an empty spot there. It is the stem cell at the bottom of the lining of the gut that has to rapidly replenish that and fill up the gap. And in animal studies, that turnaround is about 15-20 minutes. Well, that's a very fast turnaround. You need a lot of amino acids, nutritional factors, the strongest stem cells, good immunity, and if you don't have that, there will be more holes going out Not enough fitting in, you know, like a brick.

I mean, talk about leaky gut, but it seems like they even get septic, you know.

Well, I mean, we're not talking at the leaky gut in an institutionalized scenario, talking about, you know, things that have gone wrong. And again, with the increased intestinal permeability, or the so-called leaky gut, which is now in even traditional you know, medical journals, this term is being used, I'm not so, you know, reserved about using it. The— there are several mechanisms for that. I mean, one is that you can have the cell have a problem, so things can leak through the cell. Then you can have the cellular space, the space between the cells, and where the tight junctions are.

And—

The another one is actually this scenario of dropouts, where you have cells that they're shedding off. There would be a— be like one brick of the wall is gone, but there's not adequate time to replace that. Okay, and that means, you know, what do you do to stimulate the stem cells? How do you support the proteins that they put the tight junctions, you know, together again? Because if we work on those, we may give the patient a better chance to reduce their food reactivity or skin rashes and so forth. And it's not an easy task, and it does take time, but I mean, that would be the thought process to, to think about and start from there.

Yeah, because like, you know, with the food sensitivity testing, we have some people that like, they have antibodies to everything. You know, so, you know, their gut is just so permeable. And how would someone have basically malabsorption? Can they have malabsorption and leaky gut?

Right, no, of course you can have both of them. And the leaky gut is really just a general term, which means that the lining is not completely intact. And is turning on the immune system reacting. But generally that comes from a reason. The reason is commonly infection next to the wall, which could be a bacterial or a fungal overgrowth or parasites, or a combination of those. Then you may have even heavy metals floating around. You can have toxins of mold being around and adding to the fungal you know, overgrowth, if you will. And sometimes there are additional infections in the body, something we call the stealth infections or cryptic or hidden infections. And that's the concept that it is not well acknowledged at this time traditionally, but I think for some illnesses, some bugs, you know, it is known but not across the board. And I think it's eventually this is gonna evolve, but patients with the stealth infection, they commonly have evidence of permeability issues.

Yeah, I think that's the problem. So many infections are hard to detect. And you mentioned fungal, and I think standard GIs, they don't even believe in it. Or, or can you talk more about fungal overgrowth in the gut?

How—

what's your suspicion? How do you diagnose it? How do you treat it? Because I think that's a big issue. That a lot of people have issues with or feel they do. They read about it. How do you approach that, or what do you see? What, what makes you think someone has like fungal overgrowth or a fungal issue?

Well, I mean, I think the first step is to listen to the story, and this story can tell us about the risk factors, and I think that's you know, that's gonna guide us, okay, this could be reality. For example, a woman who might have been on birth control pill, or maybe received steroids or antibiotics, or was under a lot of stress. I mean, this becomes a potential scenario for a female that can start to accumulate fungal elements in the gut. The small bowel is generally very clean. And doesn't really have high number of these bacterial fungal element. But when somebody comes with gas, bloating, rumbling noises, burping, flatulence, I mean, those are signs of fermentation, means the gut is not clean. Now conceivably, when you look at, for example, a child that is born and the child may have thrush in the mouth. Well, that's a nice and warm environment, and this— the immune system could not handle it in a newborn and the mouth got thrush. Well, there's no reason not to believe the same thing cannot travel further down in the gut. And in some instances where the fungal elements become invasive, somebody may be quite ill and may have a fever, be in intensive care unit. That type of scenario is well recognized in the classical books. And is there. But the model that it will look more like a functional model, there is not adequate testing for it, so it's a little bit difficult to diagnose it, it's hard to pinpoint. You really need to know the story, you have to be a good clinician, and you need to be able to open to the possibilities and see what happens. I mean, we started to look into this, you know, And I remember when I walked out of the conference in the anti-aging medicine and there was 2-hour presentation on this. I mean, my head was spinning, you know, I said, "What is this? I've never heard of something like this." So I got the book and read it and I said, "Well, maybe it is, let me try and see what happens." And we realized that this is actually quite common scenario. Now, there are things we can do to we can do to further substantiate that idea. But nothing is generally gonna necessarily replace my clinical judgment. I mean, that's still— I mean, I think that's the first thing.

That's a lost art now, yeah.

And then if I can get some support, it's nice because the patient would also be happier to see that.

Yeah, you can show them on paper.

Yeah, I mean, so we do sometimes antibody against fungi. And now there are laboratories that they do antibody against numerous fungi, whereas some of the labs such as, you know, Quest or LabCorp, they may only have like 1 or 2 antibody models to use, but you can go elsewhere and get more. We can look at organic acids and look at the almost 8 or 10 different markers of fungal dysbiosis in the urine. That could be supportive. I'm not saying is it hard and fast rule, but it's—

Painting the picture.

Yeah, I mean, if the story fits. Now, if the story doesn't fit, if somebody said, "I feel fine," I don't care about the test, okay? But if the story is there, then that would be supportive. I'm also a believer that, you know, sometimes fungal growth in the stool samples has significance, especially in a male patient. I have not seen any male patient with presence of fungal elements that feels good.

Usually— You said in a male patient?

In a male patient. Now in a woman, you can say, well, they have estrogen, their hormone, there may be more stress. Maybe it's more, you know, the environment could be more conducive to growth of the fungi. But in a male patient, to me, if I see fungal growth, even in small amounts, in a stool sample, and there are specialized labs that they would do this, not every lab is capable.

Do you, what lab, you can say like, what labs do you like to use, what—

I don't advocate any particular lab, but I can tell you that generally the one that has been most helpful as far as growing these elements is the Doctor's Data. They somehow, they do allow these Fungi to grow, they report what type of fungi you can see. And as I started to look at hundreds of these samples, I was coming across names I've never heard of these, you know, fungi. And then when I looked them up, I said, well, this is an opportunistic fungi you see after kidney transplant or liver transplant. Well, we're in an outpatient practice. Where do I— why do I get these elements growing in people's bodies? So it may be a little telltale. Again, I don't think anybody should go with one element story here, but you put the pieces together, it may tell you that. And sometimes when you see this, you have to say, "Okay, what's causing the immune system to be challenged?" Is it alcohol? Is it stress? Lack of sleep? Bad eating habits? You know, or is it presence of toxins or mold? Maybe Somebody was exposed to a moldy environment and the, you know, mold toxins, they're immune suppressant. They promote the growth of their own species. Okay, like, I'm just going to do— I'm going to like to grow my own species. So they create a milieu that will support that.

And one of the things we said, you see these things, I, I think everything's just exploding. I think 20 years ago there weren't that many people. Now, I mean, just you go to a cocktail party, I mean, if you only talk to people, like everyone's sick or their family member's sick or their friend's sick and they've been to multiple doctors. I mean, these multi-system illnesses are just like, talk about pandemic. I mean, I think it's just crazy and they just are told that, oh, it's psychological, just live with it type thing. You know.

I've heard that too.

Especially like, you know, with the, with the fungal, I've heard GIs say, oh, if it was fungal, they'd be in the ICU, you know.

Yeah, that's the, you know, it's really a spectrum, and the end of the spectrum is easier to see it, but one has to be really ill, and in our practices, obviously, we're not coming across that. Okay.

Yeah, that's not medicine. It's not like all or none. Everything is a continuum.

Exactly, yes. So, the question, you know, what about at the lower level, could that be a factor? I mean, something which was very interesting and recently I gave a podcast with this, with Dr. Jacoby on a SIBO conference, was the relationship we had seen in patients who had methane gas, CH4, on their breath testing. and it's always a puzzle as how people really have excess methane. And we talked about choline, which is, you know, and carnitine, stuff that you get in food, and like egg yolks and red meat, and these that can increase the TMAO, they somehow, they can also increase the methane production, at least based on what we have seen. But something that was very interesting was presence of fungi, that when there was excess methane, we could see some evidence of fungal scenario. Not a fungal infection, a fungal scenario, means that there— maybe somebody's a stool sample now showing fungi, but on the breath test I'm seeing presence of methane. So when I looked into this, I did one search and I look for an article to see What does it take to grow methane in the lab? Archaea, okay, those, you know, small creatures. How do you grow this thing in a lab? And some gurus and PhDs, they came up with a milieu, or some sort of concoction, if you will, that it will allow this thing to grow. And I noticed that part of that, there were fungal elements involved, And then I studied it a bit further, I realized that fungi, they like oxygen. So they're gonna suck the oxygen. On the other hand, archaea, they need to be anaerobic.

So it's a perfect match.

Okay. So to really treat the, you know, if you see a lot of methane, you have to think, where's the fungus? You know, like maybe one is feeding the other. Maybe that's one of the mechanisms.

So interesting.

Yeah, it was a little fun just to bring it up. I mean, obviously this is a great subject if somebody is open to study it at the university level, okay, beyond the private practice, you know, offerings that we do and see. Yeah, but you know, I'm a little bit sometimes reserved about treating methane with antibiotics if I perceive there is a presence of fungus because theoretically you can make the other one worse, theoretically. I'm not saying that this is—

yeah, okay, that's interesting. Or I was reading some studies on, you know, C. diff and Pseudomonas that they need Campylobacter jejuni to grow, you know. And, you know, C. diff could be very difficult to get rid of, and but if you kill this other one, then the You know, it may go where there's all these symbiotic relationships. So kill one, then you get rid of the other. It's interesting. It's interesting, like how little we know, you know, it's like, like the more you learn, the more you learn, you don't know. And all this stuff that's going on, you know.

Exactly. Yeah. No, I think, I think it's good that one stays open to possibilities and see what, you know, what comes up and just at least give it a consideration.

So, so currently when you get methane positive, what, what's your typical treatment or what, what do you do to further work up or—

I mean, first of all, if the first thing is that, you know, if I see somebody with high methane is what are the level of symptoms? Because occasionally, you know, patient may have very little symptoms. The methane is high, and I'm not sure if I just want to treat all of that, you know, just to get rid of some small level of symptoms. It may be that the presence of methane is working as a biological marker that tells me there's another layer behind it. That's okay, what other symptoms are going on? Is it the fatigue, is it the headache, is it the sweating, is it the skin problems? Or somebody has methane, but they don't really have constipation, they have more of a diarrhea problem. That means that there's some other player into that, maybe going on. So, first we have to decide if you want to treat it or not. Traditionally, the good research shows that if you use, you know, rifaximin and neomycin, that works in about 2 out of 3 cases. Now, in our own practice, if I see some evidence of fungi, I probably will address the fungi first, and I make some dietary changes like the ones that we mentioned, by the measure to reduce the available of methane, and then I subject the patient to treatment. But I do give the patient generally an option to see if they want to go traditional or they want to go non-traditional.

I love that, you work with the patient, and I try to tell patient, "I'm not gonna tell you what to do, I'll give you advice and give you info." but it's their body. And have you treated with the methane patients like just, let's say, antifungals and see what happens?

No. Okay, I mean, I cannot say we have done that, at least in a structured way of doing it. The concept which really fascinated me, and it was one of those—

Yeah, that's so interesting.

Okay, but when we looked at our patient population, almost 80-90% of them, they had some level of fungal— either the organic acid was abnormal or they had antibodies or were treating them for fungus or somebody else was treating them. There was some fungal scenario and this methane. And in those cases, I rather make sure that the fungal element is somewhat is under control. I am not convinced that if you just treat the fungus, the methane is going to go away.

And that's why other—

there are other players.

Why'd they get the fungus? Yeah, yeah.

I mean, and if you look at the— I mean, back in 2014, 2015, I shared in a 10-minute presentation that we're seeing a lot of SIBO patients showing evidence of positive serological markers for Lyme disease. Now, the word Chronic Lyme is not recognized and I cannot type in the computer and my electronic medical record is not gonna give me a diagnosis like that because not recognized still there. But there are great practitioners, just probably like ourselves, that they do believe these infections can become chronic and they modify the immune system and the presentation would be something like a persistent SIBO. or a recurrent SIBO, or my SIBO doesn't go away, or my numbers are really high, or I have SIBO and I have a fungus, and which one do I treat? As if it's either yo-yo of one or the other. I mean, this is where you have to think like an onion and have layers that, you know, one has to delve into.

Yeah, I was on a SIBO summit or presentation, and I said, well, I think SIBO is more of a symptom Oh my gosh, the host got so mad because, you know, it was SIBO is the cause of everything, you know, and I go, well, yeah, but it's the chicken or the egg, you know, like why did they get the SIBO? Because they got gut dysfunction from something else going on and they didn't want to hear that, which is funny. But so—

I mean, in harmony with what you said, you know, one of our slide presentations We did mention that certain patterns of SIBO and how they respond to the treatment, it will tell you that there may be another layer behind it. And indeed, we prepared that video and I put it on our website at no charge, is available to the patient to be able to see that, you know, you can divide SIBO based on hydrogen and methane and hydrogen methane and hydrogen sulfide. But how about if you also give it a pattern based on the response to the treatment? Did I just have a SIBO? I took a course of Rifaximin and it went away. And that model I called it the Easy Rider, based on the movie from the 1960s. You know, the Easy Rider. But there are other patterns that I call the relapser or persister. Or a blend which could be a blend with the fungus, you know, okay. Or another pattern I call that incongruent means that you treat the SIBO, the SIBO goes away, but the patient doesn't feel better. That means that there's a lack of clinical correlation with the test. And obviously that means that there's another player into this. And there are many interesting cases that we have come across. Some of these we put it in that presentation. For people to see.

Yeah, that's awesome. What is the website that people can go to?

There's my website, the laintegrativegi.com, and the video is right on, on the first page of the website. I mean, this is the presentation I gave at the SIBO conference, but they were willing to work with me for me to receive that one back. As a trade-off, and then I can put it at no charge for the patients.

Yeah, no, which is nice because normally, for everyone doesn't know, when you give a talk at a conference, they own that. And so you— it's rare that you can get that back and put it up. So that's awesome. Say your website again.

laintegrativegi.com.

Great, great. And let's see, what typical patterns do you really kind of like alarm bells for certain conditions?

I mean, you mean as far as the SIBO pattern or—

Or just like anything, like where you see someone comes in with irritable bowel, with diarrhea or whatever, and a headache or— Or what, what patterns do you—

right, is the— yeah, if you look at the GI symptoms and somebody has alarm symptoms, let's say weight loss or can't eat or difficulty swallowing, in gastroenterology those are alarm symptoms and obviously it requires investigation. But you can also come up with sets of alarm symptoms to the non- GI or symptoms. And I think energy to me is one of the major factors because it suggests mitochondrial dysfunction. And, you know, is, you know, when you look at economy of energy in a person, if the energy level is retained, you know, the prognosis is generally better. So it's one of the questions that we ask and is one of the areas we target to improve improve the performance, functionality, and the energy level. But other things, sleep pattern, anxiety, inability to fall asleep, many of these things suggest the possibility of mast cell activation, release of histamine or other mediators, and these, this is not something that came overnight. There's a whole, probably an array of things that went wrong in the background, and we need to see how you can reverse that. And at times you can do testing for mast cell activation, and it may show, but sometimes the testing may not show it. You have to use some clinical judgment with that.

The tests are so basically insensitive. And like, what percent of patients, let's say, have SIBO or just, I mean, and are totally fine? You know, nothing else, and you, and like where it goes along with, you treat it and it's gone forever, whatever. Like what percent is that versus where, hey, there's other stuff going on?

You know, if you ask me this before 2005, I would have said probably about half of our patients, we treat them, they say thank you, and they're gone. We're not seeing that anymore. I mean—

Interesting.

Indeed. If you look at my presentation, I put a question to the audience who are doctors and I said, "A patient comes with SIBO, what is your confidence level that you're gonna treat this patient and the problem is gonna be resolved?" And I can tell you that, you know, overall the confidence level is low. Because there are so many confounders that one has to understand how did the patient get to that point, okay? And the SIBO may be just the, the tip of the iceberg. And I would say about maybe 1 out of 3 probably will be fine, but 2 out of 3, we're going to have to continue to deal with scenarios.

And before 2005, It was just, oh, you got SIBO treated.

I mean, it seems that they respond well. They were not— I didn't have to worry about too much. And you can say, well, is it the population has changed? The illnesses have changed?

Yeah.

Am I seeing a different type of patients coming to the office? It's hard to know. I mean, maybe they were not just— didn't have that many involvements But we're not seeing the same thing again. And I think other docs are relating to that as well.

Yeah. So I think, yeah, I think it's so multifactorial. And I think too, because watch what you get good at, you're getting known for all these complex patients. So you're going to get those. But like you said, other standard docs are seeing it too, where, hey, what's going on? I used to just treat the SIBO and it went away. And now, now it doesn't. So what kind of tests do you do for these patients?

Usually the common test that we do is comprehensive food sensitivity and allergy testing. At least occasionally use allergies, but, you know, for the ease of it, we may just use the IgE-mediated allergies, and then we use the food sensitivity models. A lot of labs order that. Nowadays we focus also on peptides that are in the wheat, because people may be reacting to the minor molecules, and those can give us an indication that some components of the grains, that they overlap, they may be driving the inflammation. But as a general rule, the more of these colors you see, reactions, it suggests that probably more holes or cracks or dysfunction of the tight junctions. And the question, how do you return that back to normal? And how do you manage a leaky gut problem? Other tests we do, again, organic acid, comprehensive stool analysis, heavy metal testing, SIBO breath testing, stool culture and something by PCR. We have also done some work in obtaining intestinal juice from the upper GI tract. It is a fascinating area for us. I mean, there are examples of this in that video presentation. And I remember a few years ago we had one patient who was having epigastric pain and it would not go away. When we looked, there was bile in the stomach, and I speculated that the bile in the stomach is probably backing up because the gut is not clean. And that means it's not clean, could be parasite, fungi, SIBO, and the patient did have SIBO, and there was evidence of a parasite as well, that was picked up by the testing model.

And that's hard, because it misses so much.

Yeah, I mean, you have to be patient and use some, what I call a clean catch technique, to be able to obtain the intestinal juice and send it for microbiology using PCR technology. And, you know, it just happened that some parasites' DNA got picked up.

Yeah, and I think, yeah, parasites are such a— I think so much the bigger thing, and it's maybe too much information, but we're at a friend's house last night and the dog looked like it ate some raccoon poop. So I'm looking like, oh my gosh, all these parasites that they get. So I'm like, ordered, you know, all these antiparasitics. I'm gonna start taking some myself. And yeah, it's, it's scary what's out there, you know, people who travel I think it seems like everyone that goes to India comes back with a parasite.

But the challenge is that you can't always find it in the stool sample. And yeah, the patient may end up with upper GI symptoms, more pain in the upper abdomen, burping, bloating. This comes something that in medicine we call functional dyspepsia, but it's a term that we don't really understand. Okay, what is it? You know, like, some of it may have H. pylori, Helicobacter pylori, but a part of our patients, that is a portion of them, they had contamination of the beginning part of the small bowel, bacterial, fungal, or parasitic, or a combo. And this causes a backup of the contents into the stomach, it irritates the stomach, It looks like it's a stomach problem, but it's really a downstream, a downstream problem.

Yeah. And do you find that BPC-157 helps that? 'Cause it, you know, tightens the lower sphincter or tightens the upper, but it's like, it's still the lower sphincter is kind of relaxed and let it go. So it's still could back up in there. Yeah.

Yeah, BPC-157 is very helpful in many ways. First of all, It has a general anti-inflammatory effect. It has protective effect on the gastric lining. And it also has protective effect on the intestinal lining. I mean, I always say that, think about it, of whatever surface needs to heal, probably the BPC-157 works with that. And I'd mentioned this previously in our personal conversation that we had so much interest in this 15 amino acid peptide that back in 2017 I went to Croatia to meet with—

I love that, go to the source. Yeah.

And I still have the video that, you know, he took me around to show the animal studies at his lab. But the research on this, it actually goes back to the 1990s where they even did some studies on esophageal mucosa where you put acid on esophageal mucosa and causes damage. But if the mucosa is treated already with BPC-157, then presence of the acid is not so much damaging to the, to the lining. And we use that concept to treat some of the patients with gastroesophageal reflux disease. I cannot tell you exactly what impact it would have on the sphincter pressure. Because I don't have the data. If you do, please educate me. But I do believe that it does help with the surface healing. And indirectly, I can say that that's gonna help to improve the esophageal sphincter tone. Because the more damage you have to the lower esophageal sphincter, more inflammation means that probably more malfunction of the valve. And that translates to a vicious cycle. That is going to go on.

Kind of like everything's vicious cycle, isn't it? And yeah, the interview we just did before where we talk about BPC, she's expert in pelvic incontinence, that the BPC was shown to basically stop stress incontinence. You know, the sphincters relax, and so it seems to be very good at healing the sphincter tones. Um, I'll shoot you over some studies on that. It's interesting. And then, I think you're just kind of starting to play around with the TB4 frag, which studies show helps the tight junctions, heal the tight junctions. I don't know how much you've noticed with that or—

TB, TB frag 4 is also something we have incorporated, particularly when there's an imbalance in the immune system. For example, if the TH2 is very active, you know, and we like to see that, you know, that, and that may help to reduce food reactivity, for example, or pains or aches or the general inflammation that come from that. And I think it works well in combination with the BPC-157. Okay? The combination of both, it's good, and if they, one can take it before meals, in the morning, in the afternoon, you know, at one point that could be incorporated into the treatment regimen.

Yeah, because you look at the effects, they're kind of similar, but they're very different mechanisms. And we were doing TB4 with stem cells because they boost stem cell function. And we had a little miscommunication, you know, but they were giving like a whole vial to patients and And I'm like, oh my gosh, you know, I've been doing it for a couple of months. And I'm like, well, are there side effects? No one said— people with like fentanyl go, oh my God, my muscle pain's gone. You know, and it's really an immune modulator and also heals traumatic brain and, you know, heart, all those things. So they're very similar in helping healing, but a different mechanism. And just curious, When you see the methane producers, what percent do you think is Lyme or a tick-borne or that type of infection or—

Well, our practice deals significantly with patients who have been bitten by vectors. So, when we looked at our data, I can say that, for example, in the last probably 10 years, we have screened around maybe 1,500, 1,600 patients for vector-borne illnesses. And I would say about a third of those patients, that's over 500 patients, they have had clear evidence that there's such infection present. Because you also have the borderline serological markers, but, you know, there are times that the markers are not borderline anymore. Yeah.

What test are you using for that?

I mean, depends on the labs. I mean, there are several labs that we use. I mean, depending upon patient's interest, the budget. I mean, I can use even sometimes traditional labs.

Yeah.

We use the Hygenics, we use Vibrant Health, we may use Advanced Lab. I mean, there are different labs and just depends on what we're dealing with. I've also recently used some of the German technology, you know, the lab is in Minnesota. And that's a cellular reactivity looking for interferon gamma and IL-2 release from the lymphocytes when they are put in proximity of the bugs. Maybe it's a Lyme bacteria, it's Bartonella, or Babesia, you can see some level of reactivity. And occasionally I use that as a backup plan in case I'm suspecting the other test didn't pick it up. Because as we talked about, there is no test that's 100%, okay?

I mean, absolutely not.

You know, the only thing that creates tenacity, you know, to keep going is just listening to the patient and just believing that there's something is wrong. Yeah, they're not just making up the story, okay?

Yeah, and, and it's a problem. Yeah, the patients have been a lot of times many doctors, spent a lot of money and, you know, trying to help. So it's, yeah, it's, it's a fine line. It's something like now we're even picking up stuff on standard Quest and, you know, LabCorp, which nothing was ever positive. And now we're finding, you know, bands that are, you don't see in normal people. You know, it's like less than 1% of normal people, but it's considered a negative. Okay, well, with less than 1% of people have it, where'd it come from? You know, right?

We're actually having the same experience. We're seeing more positive markers. And again, is it the patient's responses that are different, or the laboratories technologically are doing something differently? But I wouldn't call these false positive. I mean, I need to know what the story is that goes with it, because for somebody who has been chronically ill, you know, I mean, I mean, I can't just say, oh, this is a psychological problem, you know.

Yeah, I even— if we see a 41-kilodalton band on a patient on Quest or LabCorp, I don't think I've had a patient who didn't end up having Lyme. You know, that's considered the most likely false positive and da da da. But when they have the symptoms, okay, you know something's going on, and if you dig deep enough, yeah, you'll find it. And they end up, you know, having it even though the standard test, they call it negative, you know. But there's evidence of something going on.

So I mean, sure, at least it could be a discussion that a person might have been exposed to that environment and maybe the immune system is handling it, but there may be something else there.

Yeah, which I think is huge is like, you know, we check the immune system when that's off. Okay. It allows us to show the patient that, hey, there's something going on. So we got to now dig deeper. And that's what sounds like your process starts there. And keep going. Tenacity, as you said.

Exactly. And just going to hang in there, you know, keep going.

Yeah. So yeah, you're treating these complex patients. It's a gift and a curse. And, and so yeah, kudos to you for helping these patients that I know the patients that come to you have been everywhere oftentimes, you know, and you get them better because I hear from them.

At least we do our best, let's put it that way.

So it's nice and always thinking out of the box and you're just such a pleasure also to speak with, always learn so much when I talk to you and—

Thank you.

Proud to say you're a friend. So I thank you for being on, I think it's been great. I think people will get a lot out of this and just also learn, hey, there's hope, you know, and because they've been told by 10 doctors that nothing's wrong with you, that, hey, go to a bar, you know. So thank you. Thank you. And I thank you on behalf of the patients that you see as well.

So thank you very much, Dr. Oldsberg. Appreciate it.

Great. Thanks so much.

Thanks for joining us on the Peptides and Longevity Podcast. If you enjoyed today's episode, don't forget to subscribe subscribe, share, and leave a review. It helps us reach more listeners passionate about optimizing their health. For more insights, resources, and updates, visit our website at www.holtorfmed.com. Together, let's embrace a future of health and vitality. Until next time, stay inspired and keep thriving.