123- What You Can Do To Improve SIBO with Dr. Adam Rinde

Bryan Carroll: [00:00:15] There are people out there who have been struggling with gut issues that cause so much bloating. That they can look seven months pregnant. Surprisingly, the percentage of people struggling with this as well, quite high.

And if you don't know what you are fighting, then it can be a very long process to get your gut back under control. What's up everyone. I'm Bryan Carroll and I'm here to help people move more, eat well and be adventurous. And today, dr. Adam Rinde is joining me to discuss SIBO and what is actually going on in the gut when SIBO is present and as you'll learn.

What was originally thought of as a bacterial issue is much more than that. And the term SIBOE has been morphing over the years. So let's get into it. My conversation with dr. Adam Rindy, dr. Adam Rinde is a naturopathic physician in Bellevue, Washington who takes great interest in unlocking health problems and restoring function with it.

Patients he is sought after, especially in addressing health problems of the GI endocrine and neurologic systems. And by utilizing principles of naturopathic functional and integrate the medicine he strives to provide precision care. Thank you so much for coming onto the show, Adam. 

Dr. Adam Rinde: [00:01:25] You're welcome, Bryan.

Thank you so much for having me today. 

Bryan Carroll: [00:01:28] Of course. And I always love to find out what got people so interested in their field. So can you tell us a little bit more about you, your background and what got you into naturopathic medicine? 

Dr. Adam Rinde: [00:01:38] Sure I'd be happy to. So I was, you know, I think the threat of going towards naturopathic medicine was something that was started when I was a small kid.

I was raised in an environment where my parents were very much into nutrition and my father was very much into mindfulness and, I was raised sort of, focused on wellbeing and health. And, as I started to grow up and I had a single focus too, at one point in my life to really Excel in basketball.

And that became kind of something that I, I was really committed to and almost single-minded about. And as I grew throughout life, then I realized at one point, you know, after that kind of passion started to dissolve, I had to do some soul searching as to what I wanted to be. And I had a cousin who was a doctor that I was, I looked up to him quite a bit, Alberto Krieger, and he, he sort of represented everything I wanted to be.

And. so that always stuck with me and then further on, in my life, I decided that I wanted to go into medicine and I started interviewing conventional medical doctors. And I was set up with kind of a shadowing experience in Oakland, California. And the doctor actually turned to me and sort of discouraged me into going into medicine and I was shadowing him and.

he, he basically had a prescription pad in his hand and it was like, almost like ready to go on each visit. I mean, he would walk into the room and he'd have his pen ready and the pad ready. And I would, at that point, I became very disenchanted, even though I'd been around medicine throughout my life.

My father was in medicine, in the administrative part of medicine, this experience really discouraged me. And so for about four or five years, I kind of dropped that. That idea and dream. And I found myself in a profession that, you know, I was going towards as working in a, with a company that was a startup in San Francisco.

And I would be sent to these nutritional conferences, to try to gain sponsorships for this startup company. And I started to be exposed to natural medicine through these conferences. around that time, my wife. Had a book called eat, right. For your type by Peter duck via Damo and a brochure on naturopathic medicine was sitting in that book and I read it.

And then the principal's like, you know, start doctor as teacher and treat the root cause and, stimulate the healing power of nature. All these principles sort of resonated with me and I, I further, I caught interest in the profession and at that point, I went to. Yeah, I was still going to these conferences and chance to see dr.

DIA Damo speak. And he was the first kind of doctor that really taught precision medicine. And he still does to this day. And I was really drawn to this idea of treating the individual and finding the root cause. And at that same conferences and another doctor dr. Tori Hudson. Was speaking on osteoporosis and to hear these natural doctors really talk about science and nutrition and blending, the two, I was hooked on this field and through a series of events, I decided to go and get my postbac post-bac studies in pre-med.

And, you know, I decided to apply to bass steer. I, I was introduced to a local doctor named Carl hangy Bauer who allowed me to shadow him for a couple of years. He, he was in San Francisco and I just eventually got into best year after fulfilling, additional requirements in my education, organic chemistry, all the, the, the, those courses.

And, and then I started on the path and I haven't looked back. 

Bryan Carroll: [00:05:45] So you were talking about looking for, you know, a type of medicine that's focusing more around root causes. And, and now that you've gone through a naturopathic school and you've been a naturopath for quite some time now, have you found a section on the body where a lot of, disease stems from, 

Dr. Adam Rinde: [00:06:02] well, I think that's one of the reasons I'm so focused on digestive health, because it, it is an area that, you know, I think.

When I was going through naturopathic school, we were taught that many chronic diseases begin in the digestive track. And also along with that, we, we, we were taught like, if you don't know where to start in a, in a case, you can always start by healing the gut. along with the gut, I think people don't realize that healing, the liver is part of healing, the gut, and here, you know, it's sort of an extension of the.

The GI, and highly involved with what goes on in the gut. So those two principles were sort of a foundation to, you know, my learning and my, my understanding of how to address health, especially because in naturopathic medicine, at least at that time, a lot of people that would come to us, we were sort of their last resort.

Hmm. 

Bryan Carroll: [00:06:59] And so when you're talking about healing, the liver, are you talking about, Like being able to detox properly or what's going on with the liver that makes that stand out so much for you? 

Dr. Adam Rinde: [00:07:08] Well, so when the whatever's going on in the digestive track, you know, generally speaking, there's sort of a communication between the gut and the liver and a lot of it's through.

Bile and also through, processing of metabolites. so liver, liver and gut communication is part of, processing and assimilating nutrients processing and assimilating toxins. And so there's this overlap between the two systems. That they talk. and so for someone who has, you know, even in the condition like SIBO, we'll see, oftentimes it will manifest as liver dysfunction.

and there's a in for example, the condition, Nash or nonalcoholic steatohepatitis, has a high correlation with. With SIBO, bacterial overgrowth. And so some of this can be done through signaling from the gut, through the lymphatics and through the blood that ends up, affecting the liver, and causing inflammation, liver, or processing issues and liver.

This is kind of along those concepts of, intestinal permeability, or some people call it leaky gut. So, yeah, the body is highly connected. We can draw connections between the gut in many areas of the body. So, When, when they say start in the gut, I mean, that makes sense because the gut is communicating with the brain is communicating with the musculoskeletal system, the endocrine system, the liver.

So, if someone's like, kind of doing, not doing well, and they're, they're lost in, in the healthcare providers that basically said we don't have answers for you, which was a lot of people come and naturopathic medicine. When I was first starting, that's changed. Now we're more of a primary mode for a lot of people, but, you know, with these chronic cases that people were left to their own devices, healing, the gut would always seem to get people at least a little bit better.

And I would see that in my, my, my clinical training, back in the day, at best year, going through clinical rounds, there was this questionnaire and it was, passed around. It was called the candida questionnaire. And dr. Joseph Pizzorno who founded Bester university. Who's someone I really look up to and have tried to model my, my, my approach to naturopathic medicine after he, he came up with this questionnaire and this, if you look at the questions, they look a lot like SIBO and kind of this dysbiosis of the gut.

And we would see so many patients that, Would score very highly on these questions. These are patients with digestive problems, brain problems, weight problems, bloating, feeling unwell, fatigued, depressed, and we would put them through these candida protocols. And it would, it was just remarkable. How many people would feel better?

Bryan Carroll: [00:10:08] Yes. So you've mentioned a SIBO a couple of times, and that's definitely a hot topic you and I want to talk about today. And can you give us just a brief overview of what does SIBO stand for and, then dive into what some signs and symptoms might be for a seatbelt? Sure. 

Dr. Adam Rinde: [00:10:24] So SIBO stands for small intestinal bacterial overgrowth.

And so this is a condition where, the, the, if you know, the anatomy of the small intestine there's, essentially. two regions of the three regions of the small intestine, the duodenum, jejunum, and ilium, and then below that is the colon. So that's your digestive track after the stomach, processes it's first gets us first, processing round with whatever we D we absorb or digest.

And so the small intestine. Typically has lower bacterial counts in this than the colon, you know, for the colon has like 10 to the 11th power bacteria compared to the small intestine would generally have like 10 to the third. And so what happens in small intestinal bacterial overgrowth is when we see a tilt and an increase of bacteria.

I'm in the small intestine higher than it would typically be. Now, this is really important for people to understand is that, we do have bacteria in the small intestine. And so when they do, when they've defined small intestinal bacterial overgrowth, they've defined it by this technique called judgmental aspiration aspiration, where they actually go in with a probe and take out basically a, Basically digestive juice and they culture it.

And the definition of SIBO is if, there's greater than 10 to the fifth power per millimeter of that digestive to juvenile juice. And so, so that, what that means is there's kind of a tipping point where the bacteria becomes overgrown. The small intestine now has excessive. Bacteria, and then it typically would.

And so, there are other features of bacteria have small intestinal, bacterial growth and stuff, types that we can get into if we want to, which is methane overgrowth, which is Simo, small intestinal, methane overgrowth. And then now there's this hydrogen sulfide, version of SIBO. That's another subset.

So the definition is that in the simple, basically come as a consequence of that. So if you have intestinal bacterial overgrowth in the, in the small intestine, those bacteria will have increasingly a greater access to your nutrients. And so when you eat and it's supposed to specifically like carbohydrates and healthy carbs, such as even fruits, vegetables, legumes, whole grains, anything that's kind of starchy carby, dairy, these bacteria will now have access.

more bacteria will have access to these nutrients than typically would be. Be there. And so what happens in that situation a lot of times is you get an increased gas production, increased fluid production, increased fermentation production, in this relatively small region and enclosed region, that's essentially designed just for absorption.

And so what happens is we'll get the stension bloating, gas, bowel changes, abdominal discomfort. With SIBO and then there's all these other potentials based on how healthy the person is and how their gut lining is where you can have what are called extra intestinal symptoms, which are things like rosacea or eczema psoriasis can, can be kind of a manifestation of SIBO, also brain fog.

you kind of confusion, difficulty thinking, processing weight, gain. Fluid retention, Maya just like chronic, like chronic muscle aches, in the list, but that's kind of the core of the symptoms. There's a, there isn't a lot, a lot of like specific abdominal pain and that's really important for the listeners to know, because if you have red, red flags, features of symptoms such as abdominal pain, Bleeding uncontrollable diarrhea.

that might be, be something more, more involved, like an inflammatory bowel disease or worse, something like cancer. but the, SIBO, generally has these bloating and motility changes. So you will see constipation diarrhea, which are malabsorption features or, features of disruptive motility. So, 

Bryan Carroll: [00:15:11] when you are using a probe to go into the small intestine and check for bacteria, or are you going through the intestines to get to the small intestine?

And if so, could you potentially be moving, bacteria from the large intestine into the small intestine when you do the probe? 

Dr. Adam Rinde: [00:15:28] Well, so I want to be clear that the probe is not something that is used in clinical medicine to diagnose SIBO, that. Is generally done with research studies primarily. I mean, there are some, like I know of one group, in LA that will do that.

but most. Almost unanimously. People are doing breath testing to diagnose SIBO, which is a, it's a kind of a self test. We can go into that if you'd like where you, you, perform a three hour breath test after you swallow either a lactulose or glucose. And we're looking for abnormal rises in specific gases, such as hydrogen and methane gases, to see if there's an excess of gas production.

in the patient and that correlates with SIBO, especially if it happens within the first 90 minutes of this test, which I can go into the details of the testing, if you'd like. 

Bryan Carroll: [00:16:28] Yeah, let's hear a little bit more about that. 

Dr. Adam Rinde: [00:16:31] Okay. So the task is the lactulose hydrogen breath test, and there's also. A test called the glucose hydrogen breath test.

And it's really important to know which one's appropriate for what situation, cause they both have their strengths. And so basically, what this test, what you do with the test is, you follow a specific, low fiber diet for the day before the test, and then you fast overnight, and then. At the baseline of the test, you just collect a breath sample where you blow into this tube with a specific device.

And then after that you drink a lactulose or glucose solution, which is basically a carbohydrate solution. And then from there, what happens is the, the measurements at that point take place every 20 minutes, for the next three hours. And so. This solution's going into that area we're talking about and basically feeding these bugs.

And, and so every time you blow out into these, these tubes, you're, you're collecting a volume of gas. And then once 10 samples are collected, we've essentially seen this glucose travel or this lack of less traveled down the whole intestinal tract from the small test, into the large intestine. So then the tubes are collected and they're, processed through analyzer.

and then the, gas levels are measured and there's specific patterns we're looking for. So for example, if there's a 20 parts per million rise in hydrogen in the first 90 minutes of that collection, It's diagnostic of hydrogen positive SIBO. There's a 10 parts per million rise in methane within the first 90 minutes of that, that administration, then it's diagnosis of something called SEMA, which is small intestinal  overgrowth, which is a new definition of this kind of SIBO complex there's variants of this diagnosis.

And there's other things like looking at baseline elevations and. There's something called flatline SIBO testing, which we think might be associated with hydrogen sulfide production. so, but the basics is what I just outlined. it does take sort of a experienced clinician to look at them, have strapped cases, but, that's kind of the basics.

So what that is basically told you is that compared to people without SIBO, there's. There's a excess bugs kind of munching on these carbohydrates causing this gas production. And that's, that's the best we have. Some people are using other kinds of tests now, like oat testing. And, we're moving in a direction where maybe we can use stool testing to kind of make some guesses on SIBO.

But the most research clinically is the breath test. So, 

Bryan Carroll: [00:19:26] with it being a bacteria, you know, a lot of my listeners have heard of the microbiome. And so we'd talk about, you know, some of the good bacteria that you want into your system, is the microbiome both in the small and large and test sign and is SIBO and overgrowth of that microbiome or is it different?

Dr. Adam Rinde: [00:19:45] Yeah, that's a great question. So there's a big area of research that's devoted now to the small intestinal microbiome. So. We're just learning that it has its own unique features. And that makes sense to me that, you know, the small tests of microbiome would look different than the large intestine microbiome based on function because in the small intestine, we work with these bugs.

To, they work with us and we work with them by feeding them nutrients. They also make nutrients for us. They also, have some anti-inflammatory properties to help us with our absorption. In fact, they've taken the small intestinal microbiome out of. Animal subjects and the small intestine changes its whole Imperial appearance.

So if you had germ-free you had a germ free, small intestine with no microbiome. What happens is the Vil I flatten out, they changed structure. So Phil I are the kind of the basically testing all fingers that stick out into this, into the lumen of the small intestine and they help pull up nutrients from what we eat.

Well, if you take the bugs out, they flatten. And they changed dimension. And so the absorption surface changes. So we're, we're learning that too, that we need to study the small intestinal microbiome. So the, the, the key thing about SIBO is that this is generally speaking. there's a couple scenarios. One is the small intestinal microbiome has become, Overgrown, but it's normal, healthy.

It's what should be there based on a number of factors that we can go into or through various events, surgeries, or mishaps of the digestive track, your large intestinal microbiome has been flushed up into the small intestine, and now you have species living there and surviving there that typically wouldn't be there.

So these are two different scenarios. We think that happens in SIBO that changes the microbiome. but the one thing that, you know, when I was going through medical school, even, you know, which like back in 2001, we even were sort of talk at the small intestine was relatively supposed to be sterile, but that's not the case.

There should be bugs there. They're helping us. We're having them generally speaking. It's a symbiotic relationship. people don't realize that the micro microbes actually produce a lot of neurotransmitter function of our like serotonin don't mean they also are involved with the vitamin production.

And so we, we need them as much as they need us. It's just when this gets out of whack that, we start to see these problems. 

Bryan Carroll: [00:22:37] when it comes to a different underlying causes for SIBO, you've mentioned a couple already, and you've also talked about, any dysfunction in the GI tract. So what would be some typical GI dysfunctions that could potentially lead to an increase in seizures?

Dr. Adam Rinde: [00:22:54] Yeah, so, this is a very complicated question. When, when you've been studying this for a long time, Now I remember, like I started lecturing on this in 2012, I believe. And at that point, none of my colleagues, including me knew really much about SIBO. and so, so they, they call the condition like heterogeneous, meaning there's many roads to SIBOE.

And so, the first thing you know, that I would say is I like to break this down by functions of the first thing is anything that would disrupt. Antegrade motility, which is basically like downward. So you're supposed to eat food and it's supposed to go South. Right? So, motility is what kind of pushes food and digestive products through us and out of us.

So things that disrupted can we deceive as such surgery, abdominal surgery and the resultant adhesions or restrictions or strictures that can come from abdominal surgery. I'm also some people who've had intestinal resections, like the ileocecal valve will be removed and that the ileocecal valve is like this basically valve between the small intestine and large intestine.

So if that's removed, then colon, flora is just being pushed up. Then we also have situations that might lead to SIBOE that are like neurologic conditions. So we see there's a high prevalence of SIBO and Parkinson disease where the motility is disrupted because of the nervous system, changes that have happened in Parker's disease, conditions like untreated celiac disease, where the intestinal lining has been really damaged.

and motility has been changed because of that. Anybody who's been through radiation. There might be some damage to the intestine. So those are all like categories where the nervous system, also diabetes type two diabetes and diabetes, which has neuropathic changes, can lead to SIBOE. then we get into kind of more common things from there, which is probably what most people listening to this that, you know, we're.

Would be faced with. So, anything, any medications that might impede motility such as like oral contraceptives have been kind of associated with changing motility? some thyroid medications have been shown in thyroid disorders have been shown to alter motility leading to SIBO chronic antibiotic use.

and then we get further into this is like looking at the immune factors. So. there's something called secretory IGA, which I'm sure, I think you've talked about on some of your other episodes. and this is like the immune, immune marker. instead of immunoglobulin, that's the primary immune defense in the smallest in the intestine.

And so if we have how to quit IGA, then we're more likely to control overgrowth and dysbiosis and. bacterial kind of advantages. when it goes low, such as in situations like immune deficiencies and most commonly in like chronic stress, then that will suppress the immune system. And then people will have overgrowth because it's almost like the bacteria have freer rein to reproduce it grow without IGA around.

further then further, you know, the other things that could lower stomach acid could be, could be a factor in getting SIBOs. So chronic use of proton pump inhibitors, H two blockers, highly high risk factor for SIBO. In fact, I've seen, statistics that like 30 to 50% of people with longterm use of acid blockers will develop SIBO.

Hmm. So anything that will suppress stomach acid is going to lead to more SIBOs. So like chronic alcohol use, longterm stress, PPIs H two blockers, then it goes on there's other things, things like, conditions of carbohydrate, malabsorption, such as like pancreatic enzyme deficiencies, like in chronic pancreatitis, the carbohydrates don't get broken down.

They stay in the small intestine, longer than they should. And because of that, it's increased fuel, increased access to the bugs and then there's overgrowth that way. So we see a lot of times people who have enzyme deficiencies, either from leaky gut or intestinal lining disruption or chronic pancreatitis will develop this.

And finally, you know, the, the area that I'm really getting into now, because I'm going deeper into this is like genetic polymorphisms. So we have polymorphisms, like one's called too. that seems to increase the, the suscep susceptibility of SIBO and dysbiosis because it's, in, in without knowing how to explain it to deeply deeply, it seems to, increase the body's ability to kind of hold on to microbes instead of clear them.

So all these different kind of roads might lead to SIBOE. the one that's really most popular in the literature these days is the post-infectious or the bacterial hypothesis of like, post-infectious SIBO. So someone gets an infection, from say like food poisoning or from. from, travelers like a travelers, born trouble, born illness, and then that, that infection can release, cytotoxins that can damage something called the migrating motor complex, which is part of your body's defense against SIBO.

And so two or three months after that event, then the patient will come in and saying, you know, I had this event now I'm all bloated all the time. I have gas and you know, the infection's gone, but now I have this other thing. So we have this kind of post-infectious scenario. That's the most kind of common, along with, you know, people who've been having put on PPIs for a long period of time.

Bryan Carroll: [00:29:10] Yeah. I like the way that you said it, that there's a lot of different roads that can lead to SIBO, which, does that then make the treatment process pretty difficult overall? Or is it, do you have a simple direction that you can take to try to remedy this? 

Dr. Adam Rinde: [00:29:25] Yeah, I mean, I think it's it, you know, sometimes, you know, it's really great when we can identify the root cause and if the root cause can be changed, you know, there's situations like surgeries and.

That it's much harder to change. And then there's like chronic conditions that have advanced that are harder to change, like patients with Parkinson's disease. but like in most cases, you know, there, there's kind of, I have a, a simple approach and there's an advanced approach. The simple approaches, you just kind of take something to get rid of these bacteria at this point,  try to move on and I'll say that, you know, people have like a one and done approach.

Rarely like, but there are people who they can, you know, they can take that approach and then they can move on. But most people like you, you want to get, you want to clear this bacteria out of there and then work on repairing and removing what was the underlying cause. So if you suspect it's due to low secretory, IGA, you want to improve that.

If you see, if you suspect it's in. Due to damage to the migrating motor complex. You want to help with prokinetics and help support that. But most, most roads to SIBOE generally start with some type of removal of this bacteria. The more ill the person is, the more complex the roadmap is. I've had, you know, people who this is their only health problem and, you know, they're, they're doing well otherwise, and they can just kind of clear it out and move on.

And. Live on, go on with their life. But, I have found that you at least need to do some prevention because in most cases of SIBO, if you just take like the one off approach, it generally will come, come back. 

Bryan Carroll: [00:31:13] Yeah. Interesting. So, you know, if you find the root causes for SIBO and you start treating that and the person's getting better, do you have to.

Are you worried about it eventually coming back? Is there a high likelihood that it could come back if they fall back to old habits or, once you take it and get everything under control, does it usually just start to balance it? 

Dr. Adam Rinde: [00:31:36] Yeah. I mean, I think there's a lot of, that's a great question because, generally, if, if we don't learn like why this came about, then chances are, it will come back.

and I don't have statistics on it, but I do know there's large groups, like in a lot of gastroenterologists, they will just give a probiotic, I'm sorry, an antibiotic for this and a pro kinetic. And just say, you know, if it comes back, you know, make another appointment, you know, if you feel better.

Great. So most what they report is most people will come back with that approach, you know, like. Every like three or six months later, they're going to be back saying, you know, this is kind of acting up again. So, I found, you know, that there's things like in my practice, you know, sometimes like one of the first questions I'll ask is, do you, do you graze?

And like, do you eat every day? Do you munch on food all day long? Like some people do. And in fact, when I was coming up, we were told that's like, what you're supposed to do, like have eat a meal, have a snack, eat a meal, have a snack, eat a meal, have a snack, like eat, eat like every two hours. And most people with SIBO they'll like pull nod.

They'll say, yeah, I graze. that's kind of how I eat and it doesn't mean that they're overeating. It's just, you know, they might nibble on something every couple hours. It doesn't mean that they're like I'm doing anything. That's like a cause of obesity or just sort of eating unhealthy. It's just, they eat throughout the day.

And so what I'll find a lot of times is correcting that alone because one of our body's innate ways to prevent against SIBOE is to have something called, Cleansing wages, cleansing waves. there, this is mediated by something called the migrating motor complex, which I've talked about earlier. And so, every three to four hours, our body sends a signal from the stomach down through the small intestine.

Which is called a cleansing wave. And this is basically sweep of excess bacteria. It changes the pH. So bacteria can't survive as well. And it removes undigested debris. That alone is like a SIBO treatment. And so if you can, if you can space meals like three to five hours apart, I see generally speaking, like a reduction of symptoms just by that move alone by like 30 to 40%, that's not, hasn't been researched.

This is my clinical observation. And that, so sometimes we've corrected that and the person is feeling a whole lot better. And now we just need to go in and, and clear up the rest. Hmm. 

Bryan Carroll: [00:34:26] That's super interesting that the body does that. I didn't know about that, that it kind of has a cleanup career that goes and sweeps it all.

Dr. Adam Rinde: [00:34:32] Yeah. I don't, I don't know if you're, if you like hockey or what have you, but. we call it the Zamboni, which in between, in between periods of like in a hockey match, there's like this machine that comes out and fixes the ice and sweeps it before they go back and play. And it's kind of like a cleansing crew, like you said, like custodians going in there and sweeping up and getting ready for the next day, the meal.

So if you're, if you're munching, the key point of this is if you're, if you're munching any calorie between that point. You disrupt the migrating motor complex. You don't get the, you don't get the cleansing wave and that's, that's been research that's documented. and it's really fascinating. So like these people who do intermittent fasting, you know, say like those types of moves to help their gut kind of mellow out or what have you, they're really onto something.

Bryan Carroll: [00:35:26] Yeah. And you also mentioned earlier that a lot of GI docs will just give you an antibiotic and try to wipe things out. so that brings up the question are probiotics helpful. and if you take a probiotic, when a SIBO episode is occurring, is that going to increase symptoms decrease or do nothing?

Dr. Adam Rinde: [00:35:45] Yeah. So the probiotic story is, is evolving. I think, you know, you can open up. The news and one day probiotics are being, you know, you're being told they're just good for nothing. And the next day they're the cure. So like, I think there's a lot of, research that's still evolving, but I do, I, I do know that, there are specific strains.

And so when, I mean, specific, you have to go down to the nitty gritty detail of the specific strain, to know which ones might be helpful in SIBO. So like, I found that, you know, some, some probiotics or people are just taking these massive, broad, complex probiotics that have various strains and species is kind of like the kitchen sink.

A lot of times, those can often make things worse because you're adding. You're adding potential bugs that might have higher histamine levels. you might be adding bugs that, don't ferment well on, carbohydrates. so to answer your question, there's been a few that have really stood out, in the research.

And, so one of them that a lot of people know of is like, Saccharomyces, boulardii. Which is, in this specific product from florist or, and I don't have affiliations with any of these. I'm just, I just really passionate people just make a smart choice when it comes to probiotics and they look at the actual strain.

There's also these spore based probiotics that if used in the right person, they've been helpful like, the bacillus of Tillis seems to have some antimicrobial properties and. It seems to gain advantage in people who have SIBO balancing bacillus. Coagulans has also had some research, both the SLOs classy, and then the other one.

my favorite that I'm really excited about, is for . So  people who have  overgrowth is kind of a stubborn subtype of SIBO that they're more constipated. So people with hydrogen. Overgrowth tend to be more diarrheal. And so the people who test positive for  and overgrowth often have really chronic stubborn constipation.

And so there is a strain called, lactobacillus root teary, and it's specific the DSM. 17 nine three eight, 17,903. So getting down to the nitty gritty detail, you can find in the research, which ones have been used for SIBO. And that particular one seems to lower, methane. And, there's a few others like backed up bacillus, KCA Shirati, which is in this product, your cult, which you can see in the, in the, Superstore.

Sometimes it's kind of like a. Like a beverage that they sell. These have all been used in studies to compare to antibiotics for SIBO. So what I, when I use probiotics in my SIBO treatments, it's usually later I don't, unless someone has really had some problems with, the, and they've kind of failed antibiotics or, or failed herbal antimicrobials, which is my preferred choices, herbal antimicrobials, the.

Then I will go with probiotics, but I definitely use probiotics later for prevention, to continue to have the right microbiome, that, that will help with these patients. I will say one more point is the prebiotic question is also goes into this, this category is that prebiotics are the. The fibers that feed bacteria, and a lot of people will not do good with prebiotic supplementation if they have fulminant SIBO.

But again, prebiotics are really important later in the healing process. 

Bryan Carroll: [00:39:29] Awesome. Well, dr. Rinde, do you have any final thoughts that you want to share on SIBO before we start wrapping everything up? 

Dr. Adam Rinde: [00:39:36] I think that, you know, the. Addressing SIBO is really important for overall health. I think the, the main takeaway is that, you know, digestion is basically in its true nature is assimilation.

so taking something into your body, assimilating it and then removing what you don't need. And so if there's a block in that system, it can really affect you in a lot of different ways. So. I mean, I think it's really important for people to really have on their radar. How well am I digesting? Am I in my bloated?

Am I having constipation? I'm having diarrhea and figure out, like, why is this going on? You know, because there's a block in the system. And it's true that as we get older, our digestion generally gets slower and worse, but to kind of stay on top of this as we get older and as we're progressing through life, I think is a key aspect of health.

Just as much as how am I exercising? How am I sleeping? What's my energy levels. It should be on your dashboard and with SIBO. if you have SIBO, you might not realize it, but it's affecting your energy, your moods. It could be. Contributing to the ability or inability to concentrate. it could be leading to weight loss or weight gain.

And so to kind of take it seriously and, and talk to someone who will take you seriously, because I have found so many people don't discuss their bowel habits. Like let's, let's make talking about your poop, normal

talking about flatulence normal. I mean, let's just, let's just de shame it. Right. 

Bryan Carroll: [00:41:19] And they have the stole charts and all that type of stuff that people can look at that gives them a pretty good idea of, you know, if they're in that normal ish range with their stools and stuff too. So there's a lot of really helpful resources for that.

Dr. Adam Rinde: [00:41:31] Yeah. 

Bryan Carroll: [00:41:32] well, what do you do each day to improve your own health? 

Dr. Adam Rinde: [00:41:35] Yeah, so I think the biggest thing that I do is I try to stay sinked up with, like a healthy circadian rhythm. I think that really stands out to me as being highly important. So I try to be in tune with like sunrise sundown. I try to wake up at sunrise and try to slow down when the, you know, when it started to get dark and try to avoid, blue light exposure.

I've found that the. You know, the brain clock and the gut clock are highly connected. And to realize that we're on a clock and if we, if we hack that too much, no, occasionally is okay. But if you're doing it on a daily basis, then there's like a downstream effect of current trying to kind of change how we're innately designed.

and you know, so I, I try to really be concise assistant with my sleep time and my wait time and about meal spacing. And that's, you know, I think that's really been helpful with my, my own health because I have really good biofeedback and consistent patterns that if something's off, I will know it. 

Bryan Carroll: [00:42:42] So, if you're following the sunrise, sunset, what do you do in the wintertime?

Do you slow way down since there's only like an eight hour window of a daylight? 

Dr. Adam Rinde: [00:42:51] Yeah. I mean, I, I try to stay consistent with like when I wake up, even during the winter, so like, I'll try to get up, you know, sometimes it will go like a little bit later, an hour later I'll wake up maybe at six instead of five.

and then. You know, I try to go to bed at the same time. I just try to keep it consistent as possible because you know, there's, there's the practicality nature of it too mean you got to go to work, kids, feed kids to put tobacco and family matters and other responsibilities. So I just try to keep it as consistent possible, throughout the year.

but I will say that like, In the extreme months, you have to really be disciplined to get yourself out of bed. you know, cause it's, you know, nice to kind of shut it down and hibernate. 

Bryan Carroll: [00:43:41] Well, people can find more about you at sound, integrative.com. You also have the one thing podcast. Do you want to talk about your podcasts?

Dr. Adam Rinde: [00:43:49] Sure. Yeah. So, so one thing podcast with dr. Adam, Rinde, you know, it's something, that's a passion of mine that I interview a lot of guests on various matters of gut health, metabolism, brain health, longevity, and, you know, it comes out every two weeks. You can find it on most, if not all of the major podcast players.

And it's a lot of fun. We talk about these types of subjects and. And basically the goal is to educate, inform, inspire. 

Bryan Carroll: [00:44:19] Awesome, dr. Rinde, well, thank you so much for coming onto the show and talking about SIBO and talking about all the different roads that can lead to SIBO. I think that's really helpful. And, we'll have to have you on again in the future to talk about more digestive issues.

Dr. Adam Rinde: [00:44:32] That sounds great, Bryan, thank you so much for having me. This was a lot of fun 

Bryan Carroll: [00:44:36] as you can see, SIBO is actually a pretty complicated issue and it is a huge indicator of other things going on in the body. And if you think you might have SIBO, then make sure to check out Adam's podcast. One thing, podcast, to learn more about how to help reduce SIBO.

And next week I have Eileen Durfee on the show. Let's go learn about who she is. I am here with Eileen Durfee. Hey Eileen, what is one unique thing about you that most people don't know? 

Eileen Durfee: [00:45:05] Oh. Cause people don't know.

let's see. I've told most of my story. I guess, people probably know I'm a workaholic. most people don't know. I love to garden, have fun with my grandkids and I'm a hot Springs junkie. 

Bryan Carroll: [00:45:26] Ooh, hot Springs junkie. Which, what is your favorite hot Springs you've ever been to? 

Eileen Durfee: [00:45:31] probably because the mineral content and everything over in Idaho, there's two of them.

They're owned by the same company miracle and Banbury hot Springs. So those are, those are my favorite. 

Bryan Carroll: [00:45:46] Colorado has a lot of really nice hot Springs. We've been to quite a few over there. 

Eileen Durfee: [00:45:51] Yeah, my dream. I need to get over to Iceland. That one, I guess, is the ultimate. 

Bryan Carroll: [00:45:57] Well, what will we be learning about in our interview together?

Eileen Durfee: [00:46:02] Basically, you know, your first line of defense, is to. No protect yourself from exposure of toxins and to be able to detoxify because a lot of the symptoms that your body's having, your just your body's cry for getting rid of junk and having the correct minimal, you know, to operate. And so, I mean, we want you to learn that.

You know, we want you to have natural health, not artificial health. Most of the population has artificial health because they're taking medications to suppress a symptom to feel good. And you know, there's a place for medications. We're not saying not to do medications, but let's start being preventative and supporting our bodies so it can function.

Bryan Carroll: [00:46:56] And what are your favorite foods or nutrients that you think everyone should get more of in their diet? 

Eileen Durfee: [00:47:02] Well, fermented foods are really good. one of my favorite foods, I guess, you know, is old fashioned sourdough bread, and people don't realize that there's no gluten in it, even though it's sweet. And it's full of healthy microbes.

Cause those microbes from the starter, you can't get sourdough bread that has any yeast in the ingredients. It has to be the old fashioned fermented starter, then it devours and eats up all the gluten and, you know, that's just an awesome, you know, ancestral type of food that is so healthy for us, that people usually don't think about.

Bryan Carroll: [00:47:46] And, what are your top three health tips for anyone who wants to improve their overall wellness? 

Eileen Durfee: [00:47:52] Get outdoors, you know, sun exposure, grounding, I'd say 80% of all. These is because people are dehydrated. So start drinking the right kind of water. I get the mountain Valley delivered in class bottles.

It's the best water. You know, Fiji is actually pretty good, but drink the right water. Drink enough of it because I would say 80% of everyone's problems is as they are not hydrated enough, 

Bryan Carroll: [00:48:25] as you can see, we will be talking all about detox, which as a nuclear engineer is a pretty interesting topic to discuss because of the chemicals they are exposed to.

So until then keep climbing to the peak of your health.