The SIBO Doctor Podcast – Dr Bradley Bush – Neurotransmitters and SIBO Part 2

In this episode Dr Nirala Jacobi continues the conversation with Dr Bradley Bush, with a focus on case presentations around chronic SIBO cases and inflammatory concepts.

Dr Bush received his Naturopathic Doctorate degree from the National College of Naturopathic Medicine.  He is co-owner and clinic director of Natural Medicine of Stillwater and its online consumer direct website for practitioners, neurovanna.com.

The Bush practice focuses on fatigue, insomnia, GI disorders, mood disorders, and lyme disease. Dr Bush has over 16 years of industry experience. He is the owner of Natural Health Insights, providing consulting services to the naturopathic products and laboratory testing industry.

Dr Bush speaks nationally and regularly publishes on the topics of neuroimmunology, brain-gut connections, neuroendocrinology, and lyme disease.  Dr Bush sits on two non profit boards, The Naturopathic Education and Research Consortium, and Compass Centre for Health.

The format of this episode is slightly different. In it Dr Bush discusses three different SIBO cases, diving into the variability and complexity of each presentation.

 

Case 1 – SIBO with associated fibromyalgia and chronic fatigue – 65 y/o female.

  • Incremental approaches with complex cases.
  • The gut being the epicentre of health, without which SIBO associated presentations will not rectify.
  • Polypharmacy approach and the compounding effect of this on the patient.
  • Analysis of basic chemistry.
  • Myeloperoxidase (MPO), the enzyme secreted by neutrophils, and the indications for testing and tracking this in treatments. (MPO elevation has associations with lipopolysaccharides (LPS), chronic infections, irritable bowel disease (IBD), and immune induced leaky gut)
  • The neurotransmitter imbalances that can be sustained by chronic inflammation (hint – upregulated indoleamine dioxygenase enzyme, precipitating downregulated synthesis of serotonin, among others)
  • Yeast association with SIBO.
  • Weaning off polypharmacy.
  • Metronidazol for rifaximin resistant SIBO, and C. diff.
  • An indication on how many rounds of rifaximin are required to attend to chronic versus acute SIBO.
  • Eating disorders prompted by therapeutic diets taken on for too long.
  • Botanicals vs conventional medicine for SIBO treatment, or a combination use approach?
  • Probiotic use as immunological modulators rather than massive impactors for floral diversity in the GI microbiome.
  • Botanicals that Dr Bush uses in SIBO treatment.
  • Mediherb gut flora complex – immune regulating capability, IBD modulation, mucosal affinity.
  • Dr Nirala Jacobi’s therapeutic recommendation – Mediherb Bacto-Cand GI.

 

Case 2 – SIBO with associated constipation, acne, halitosis – 20y/o male

  • Traumatic brain injury due to sporting event.
  • Tricyclic antidepressant therapy introduced in his recovery plan and his subsequent experience of anxiety and spacey feelings.
  • Naturopathic neurotransmitter production therapy alongside conventional antidepressant use.
  • Serotonin syndrome and the potential for it to be induced by dual therapy use.
  • Methane Protocol – rifaximin and neomycin combination for methane dominant SIBO treatment.
  • Anxiety caused by SIBO, key indications being:
    • Treatment resistant anxiety
    • Treatment resistant insomnia
  • Anxiety as a manifestation resultant of SIBO chemicals interrupting neurotransmitter signalling.

 

Case 3 – Lyme and SIBO – 25y/o female

  • Chronic fatigue, constipation, bloating, neuralgia, catatonic staring episodes.
  • Lyme testing.
  • The effectiveness of the paleo diet for symptomatic control, noting that the issue still exists, even though the bugs are simply not being fed and therefore symptoms abating.
  • SIBO as a concomitant condition with Lyme, and/or as a condition that can mimic the various presentations of Lyme.
  • The Lyme/SIBO overlap as discussed by Dr Farshid Rahbar at the 2017 SIBO Integrative Conference, and the methane association.
  • The clinically noted neuralgia and methane dominance link.
    • Methane endotoxins produced by SIBO bacteria theorised to contribute to neuralgia.
  • Constipation and methane dominance perpetuating each other.
  • Methane dominant SIBO moving from constipation to diarrhoea during treatment and why this can occur.

 

Resources

The SIBO Doctor Podcast – Dr Bradley Bush – The Gut-Brain Axis: Neurotransmitters and SIBO

In this episode Dr Nirala Jacobi speaks with Dr Bradley Bush about the fascinating and complex world of neurotransmitters.

Dr Bush received his Naturopathic Doctorate degree from the National College of Naturopathic Medicine.  He is co-owner and clinic director of Natural Medicine of Stillwater and its online consumer direct website for practitioners, neurovanna.com.

The Bush practice focuses on fatigue, insomnia, GI disorders, mood disorders, and lyme disease. Dr Bush has over 16 years of industry experience. He is the owner of Natural Health Insights, providing consulting services to the naturopathic products and laboratory testing industry.

Dr Bush speaks nationally and regularly publishes on the topics of neuroimmunology, brain-gut connections, neuroendocrinology, and lyme disease.  Dr Bush sits on two non profit boards, The Naturopathic Education and Research Consortium, and Compass Centre for Health.

In this episode topics discussed include:

– Who are the major players in the enteric nervous system for neurotransmitter regulation?
– Does low serotonin in the gut mean low serotonin in the brain?
– The sympathetic-parasympathetic rhythm, and how important this is in calibrating the smooth muscle movement in the gastrointestinal tract.
– Underlying factors to sympathetic dominance in a person, such as chronic infection, dysbiosis, and/or inflammation.
– The complex presentations of sympathetic overdrive, ranging from anxiety and insomnia, to exhaustion, and why this is.
– Why increased norepinephrine in conjunction with normal or low epinephrine is a worse situation than just high epinephrine, due to the lack of counter balance for inflammation and an upregulated innate immunity.
– Repercussions of high epinephrine in conjunction with low norepinephrine.
– The multiple actions of cortisol, epinephrine, and norepinephrine in the body and their roles in acute and chronic conditions.
– Urinary transmitter analysis, stability, and recommended labs.
– Nutrients used to support synthesis of the various neurotransmitters.
– L-dopa v.s. tyrosine use, and the various benefits of each.
– Clinical indications for L-dopa use.
– How depleted catecholamines can be related to low secretory IgA.
– Genetic mutations (MTHFR) and how this relates to neurotransmitter dysfunction.
– Does serum C-reactive protein (CRP) directly correlate to SIBO activity?
– Myeloperoxidase measurement as a marker of neutrophil activity, and how it can be a useful monitoring tool for irritable bowel syndrome (IBS) and irritable bowel disease (IBD) patients.
– How does inflammation turn down the synthesis of serotonin and catecholamines?
– How the indoleamine 2,3-dioxygenase enzyme (IDO) conducts “The Tryptophan Steal” as an outcome of chronic inflammation, and the implications of this.
– What solutions are there to address the tryptophan steal?
– The benefit of using supplemental 5-HTP over tryptophan in light of chronic inflammation and impacted adrenal health.
– Doses, dose timing, and length of time to use 5-HTP.
– SIBO as a common underlying factor for the inflammatory state that can drive neurotransmitter dysfunction.
– What is the role of glutamate?
– Glutamate versus glutamine, and how is this relevant to supplementation.
– How is glutamate measured, what do high levels indicate, and how does it impact the nervous system?
– Glutathione as the biggest byproduct of L-glutamine metabolism.
– Powder V.S. tablet for L-glutamine use, and the dose recommended.
– What is urinary neurotransmitter testing reflecting?
– The blood-brain barrier, and how the brain is not a closed system.
– MTHFR and COMT genetic testing as indicated by low monoamine neurotransmitters and high catecholamines on urinary neurotransmitter panels.
– What to do with patients on medications being used to conventionally regulate neurotransmitters?
– Tactics of improving neurotransmitter markers prior to SIBO treatment in order to offset the flaring of the symptoms during die off.

Resources