Inflammatory Bowel Disease with Dr. Sam Rahbar: Rational Wellness Podcast 60

Dr. Sam Rahbar talks about treating Inflammatory Bowel Disease patients with Dr. Ben Weitz.

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Podcast Highlights

0:50  I introduced the topic–Inflammatory Bowel Disease–and reviewed some of the basics of Crohn’s and Ulcerative colitis, the two most common conditions in this category.

4:12  I asked Dr. Rahbar what would make him suspect Inflammatory Bowel Disease (IBD) in a patient?  Answer: 1. GI symptoms for more than 2 wks,   2. abdominal pain,  3. diarrhea,  4. bloody stools,  5. secondary symptoms could include uveitis, skin problems, joint pain, back pain,  6. elevated inflammatory markers on lab tests, including an elevated HsCRP, SED rate, or an elevated white count. 

5:34   Examination should include colonoscopy plus endoscopy and/or imaging or a combination of the above.  Dr. Rahbar explained that a colonoscopy should include the physician entering the terminal ileum to look for evidence of inflammation. Some cases of Crohn;s may be limited to the small intestine, requiring capture endscopy or additional imaging studies, such as MRI enterography or a CT scan.

6:33  While symptoms of IBD are similar to IBS, IBD patients have physical damage to the lining of their intestines, whereas with IBS there is no physical damage.

11:28  I asked Dr. Rahbar what type of diet is best for patients with Inflammatory Bowel Disease? He said that he likes the Specific Carbohydrate Diet, though he will individualize the diet for each person. He has used SCD, Low FODMAP, and gluten free. The Specific Carbohydrate Diet, which can be helpful since there are a variety of carbohydrates that tend to promote inflammation in the gut, but it also tends to deplete the patient of vitamins and probiotics, which can negatively impact the microbiome, so they should be augmented with additional supplements to maintain balance in the body. Some of his patients have done well with a ketogenic diet, though he doesn’t like them to eat a lot of meat, which can also be inflammatory. Dr. Rahbar likes to do food sensitivity testing to see which foods to avoid for each to individualize the diet. He also looks for infections and fungal overgrowth and may treat them at the same time. But if you limit carbs too much, the patient may become depressed. 

16:50  The Elemental Diet can be helpful for a few weeks, sometimes for patients who haven’t responded to other approaches.

18:08  Check for infections such as SIBO or yeast overgrowth and clearing these out with with antimicrobials or antifungal herbs can help. 

18:40  I asked Dr/ Rahbar if he finds any nutritional supplements to be of benefit?  He said that if he feels the patients are not breaking down their proteins, he may add amino acids. He often uses oral immunoglobulins, which can help with surface healing. He has used a peptide PBC 157, which is very helpful, and is administered orally. He frequently uses zinc carnosine, omega three fatty acids, vitamin A, vitamin D, multivitamins, and anything that will improve surface healing of the gut lining.  He may use micronutrient testing to see which nutrients are most needed.  Curcumin, esp. liposomal form, at 3-5 gm per day can be helpful in reducing the inflammation. 

26:23  I asked Dr. Rahbar if he has ever tried helminth therapy–the use of parasitic worms therapeutically?  He is not yet comfortable with this therapy and would like to see more research on it. He is worried that in some of these immuno-compromised patients that the worms may take off and overgrow. 

27:43  I also asked him about Fecal Microbial Transplant (FMT) and he said that the research data is there and strong, but that with patients with Crohn’s, in order to get them into the terminal ileum, they will need to be ingested orally and not just implanted rectally. While one FMT may be helpful for C-diffocele infection, for Crohn’s it will probably have to be an ongoing set of FMTs to be effective. 

32:01  Stress is a modifier of the inflammatory response and weakens the immune system, resulting in both the immune system attacking the body’s own tissues but being less able to fight off infections.  The immune system ends up being dysregulated. Dr. Rahbar cited an article from the CDC that noted that IBD patients tend not to get enough exercise or enough sleep. Here is a reference on IBD and sleep: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995194/  Dr. Rahbar mentioned that exposure to mold, heavy metals, and tick borne illness can all play a role in inflammation and immune dysregulation.  Dr. Rahbar explained that some patients are harboring low grade, stealth infections. This is different than our classic understanding of infections and violates Koch’s postulate that one bug causes one illness. What we see in such cases are a variety of low level infections that could be bacterial, viral, or fungal and they work together in the background to keep the host busy and causes the immune system to be dysregulated and may result in various mild symptoms like allergies, skin problem, rashes, hives, itching, irritation, problems with sleep, joint problems, and energy issues. Essentially, such stealth infections can be triggers for autoimmune diseases.

 

 



Dr. Sam Rahbar is an Integrative Gastroenterologist in Century City combining conventional gastroenterology, performing colonoscopies, endoscopies, and Heidelberg pH testing, but incorporating anti-aging and Functional Medicine into his unique treatment approach. He can be contacted thru his website http://www.laintegrativegi.com/ or by calling his office 310.289.8000.  

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


 

Podcast Transcripts

Dr. Weitz:            This is Dr. Dr. Ben Weitz with the Rational Wellness podcast bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness podcast on iTunes and YouTube and sign up for my free ebook on my website by going to DrWeitz.com. Let’s get started on your road to better health.

Hello, Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy the Rational Wellness podcast, please give us a ratings or review on iTunes so more people can find Rational Wellness podcast.

Our topic for today is Inflammatory Bowel Disorders. This is a very important topic. This is a very serious set of gastrointestinal conditions and if it’s not treated properly, this is a set of conditions that can sometimes require extreme surgery. People can even die from this set of conditions. So this is a very important topic to cover, and we’re going to be focused on trying to understand it from a Functional Medicine perspective, as we usually do.

So within the inflammatory bowel disorder topic, we have Crohn’s and Ulcerative colitis, which are the two most common conditions in that category. There’s a few less common inflammatory bowel conditions, including microscopic colitis. Inflammatory bowel disease or disorder is characterized by chronic inflammation of the gastrointestinal tract that means the lining from the esophagus all the way down to the colon and it leads to damage to the mucosal lining of this digestive tract.

Crohn’s disease can effect any part of the GI tract including the mouth, the esophagus, the stomach, and the anus. But most often if that’s the portion of the small intestine closest to the large intestine and there tend to be patchy areas of damage and this damage may reach through multiple layers of the intestinal wall.

Ulcerative colitis, in contrast, occurs only in the large intestine, the colon, and the rectum. Damaged areas typically are continuous and this usually starts at the rectum and spreads into the colon. It’s usually present in only the inner most lining of the colon.

Symptoms of inflammatory bowel disorders include persistent diarrhea, abdominal pain and cramping, bloody stools, weight loss, fatigue, among others. Anemia and other nutritional deficiencies are common with this disorder. The main stays of conventional medical treatment for inflammatory bowel disorders include immunosuppressant drugs including the newer biological drugs like Humira and Remicade, and surgical resection in severe cases. That’s where they’re actually removing part of the intestines or the colon. Some experimental treatments include fecal microbiol transplant, helminth or worm therapy, and cannabis.

I’m so happy to have an interview today with Dr. Farshid Sam Rahbar, integrative gastroenterologist in Century City. Dr. Rahbar is one of the smartest guys around and he performs endoscopy and colonoscopy like traditional gastrointestinal doctors, but he also incorporates anti aging and functional medicine for a integrative, holistic approach to digestive care.

Dr. Weitz:            Dr. Rahbar, thank you so much for joining me today.

Dr. Rahbar:         Thank you. Thank you for this invitation and greetings to your audience.

Dr. Weitz:            Great. So when you get a patient, what would make you suspect that they might have an inflammatory bowel disorder?

Dr. Rahbar:         First of all, if the duration of symptoms have gone for more than two weeks, one has to be suspicious. The main symptoms are abdominal pain, diarrhea and blood in the stool. Obviously there could be other symptoms, but then there could be a second category of symptoms called non-digestive symptoms. Sometimes an eye related issue such as uveitis or a skin problem or joints or low back pain. Something else may be the primary manifestation, depending upon the genetic disposition of the individual. Occasionally we’re just dealing with some abnormal labs or something that suggests there are markers are inflammation or immune dysregulation and we would like to look and see if the patient’s suffering from an inflammatory bowel disease.

Dr. Weitz:            What would be some of those markers on labs that you might see?

Dr. Rahbar:         The common one is usually a C-reactive protein or a highly C-reactive protein. It may be an elevated white cell count or a SED rate. I mean, it could be common ones that we use to look for evidence of inflammation internally.

Dr. Weitz:            Okay. Great. So then how would you work that patient up if you suspect them of having potentially an inflammatory bowel disorder?

Dr. Rahbar:         Obviously at one point the patient would require anatomical assessment either in the form of an endoscopy and colonoscopy or imaging or a combination of these. If one does a colonoscopy, particularly in corelation to Crohn’s disease, then the physician tries to intubate or enter the very end of the small bowel called term terminal ileum to see if there’s any evidence of inflammation there. However, with Crohn’s in some rare cases the scenario of inflammation may be limited to the small bowel. In those cases, additional imaging and studies, such as a capture endoscopy or MRI enterography, or a CT scan with an imaging emphasis on the small bowel maybe necessary.

Dr. Weitz:            Some of the symptoms of inflammatory bowel disorders are similar to some functional bowel conditions like IBS. But the big difference is there’s actually physical damage to the intestinal tract in inflammatory bowel disorder and not in irritable bowel syndrome.

Dr. Rahbar:         Exactly. I mean, generally there’s anatomical changes and pathology and that suggests that there is an inflammatory bowel disease going on as opposed to irritable bowel syndrome.

Dr. Weitz:            So how do you apply a functional medicine approach to such patients?

Dr. Rahbar:         Right. There are few things to review here. First of all, when we talk about a functional medicine approach, it really refers to the mindset of the physician who’s handling the clinical picture. We like to believe that a functional medicine model will entail a scenario that the mindset of the physician involves the whole body approach. One may want to look at evidence of a nutritional status, micronutrient deficiencies, ability of the individual to detoxify, the relationship with the environment. Do they live close to a farm? Do they live in a mobile area where they might have been exposed to mycotoxins, or perhaps some suboptimal eating habits, fast eating too much, too late, high carbohydrates or eating barbecue and charred type of foods, which all increase the oxidative stress burden to the body. There’s also mind and body connection that effects the stress, which is tremendously important. At last, but not least, the integrity of the intestine itself, particularly small bowel, which had this in our practice and it’s an area of emphasis because we look for and we try to treat for a condition called increased intestinal permeability or what they call the so called leaky gut type problem. The idea would be if one can work on that model, can you reduce the overall inflammatory process in the person and help reduce their symptoms.

Now, having said that, I want to emphasize one thing that in our practice we still are integrative and we look at the spectrum of the illness. I have patients who have mild disease or moderate disease or more severe. I had one patient one day come in with abdominal pain and fever, had significant tenderness in the abdomen and he said, “Can you do a holistic approach for me?” The answer is, “No, you’re going to go to the hospital. They have to do antibiotics and steroids to calm down the severity of the problem.” When we’re running into the zone of the mild to moderate activity, we can rely on those alternative and integrative approaches to control the problem as opposed to relying, for example, on biological drugs and so forth.

Dr. Weitz:            Right. I think the important point for everybody to consider is that when we talk about the advantages of Functional Medicine in treating certain conditions, we’re not promoting Functional Medicine as an alternative to traditional medicine. Traditional medicine has great benefits, especially when somebody has an acute condition. You talk about the patient who’s having an acute attack of an inflammatory bowel disorder with fever, that’s when Western traditional medicine is really at it’s best. The problem is is that when you try to apply that acute care using these steroids and these other medications that can be very helpful in these acute situations and have patients continue taking them for months and years on end, when you have all these horrible side effects.

So I think it’s great that there’s somebody like you out there who can integrate both the acute model of traditional care and then maybe that patient who’s suffering from an acute aspect level of inflammatory bowel but maybe after he gets calmed down, then you can start looking at a Functional Medicine approach, try to find some of the triggers for the inflammation, and give him an alternative to simply being on these very harsh drugs the rest of their lives.

Dr. Rahbar:         Exactly.

Dr. Weitz:            So what type of dietary approaches do you find can be helpful in inflammatory bowel disorders?

Dr. Rahbar:         Obviously one model of diet would not fit all. Like anything else, the dietary changes may have their own benefits or drawbacks and one has to be careful with that. I do believe in similar traditional experience of a lot of our patients using a Specific Carbohydrate Diet without to this … At some point and time bring down the inflammatory process. It appears that the inflammation tends to get aggravated by a variety of carbohydrates. If you use carbs that are extremely simple for digestive process it’ll have less impact on the inflammatory process. However, if one, for example, stays on a specific carbohydrate diet which was defined some years ago. One on the other hand may get depleted of vitamins and prebiotics and other things that maybe necessary to keep the microbiome in good shape. So we may have to either augment with additional supplements or foods to be able to keep the balance going, if you will.

Dr. Weitz:            There seems to be a wide range of different dietary approaches. There’s one hospital that recommends a low fiber diet and they have the patient eating white bread and white rice. The Specific Carbohydrate Diet that absolutely recommends avoiding all grains. So how do we figure out what type of dietary approach makes the most sense and for any individual patient?

Dr. Rahbar:         There may not be an exact formula to follow, and I think each patient might have to individualize that. Sometimes go through a little bit of a trial and see what happens. I also have patients who have used a ketogenic diet. Again, the component of that would involve significant limitation of carbohydrates. On the other hand, I don’t like the idea of eating a lot of meat, particularly highly cooked or barbecued or processed foods, such as bacon and so forth and diary products because on the other hand, these by themselves may be inflammatory.

We also look at a variety of food sensitivity models using different labs. I know some of these may be considered experimental my insurance companies, but that’s different than our experience. I think a lot of patients have benefited from following some of the guidelines. So I would say you will have to customize it.  I mean, I would probably do a food sensitivity test and also a food allergy test to see if anything shows up. Maybe I should avoid or limit some of those. Then overall give a pattern of carbohydrate reduction without maybe going to the extremes, if you will. It doesn’t have to have a name. It’s more so the principle that needs to be followed.

We’re also search for infections. For example, if yeast is a problem, then again the sugary stuff coming into the picture and some of the newer research suggests that fungal elements may actually have a growth in the exacerbation of these inflammatory problems. With some of patients we have used anti-fungal herbs or medications to control that. So I wish I could give you a quicker answer with different names, but all of these Low FODMAP, SCD, there is gluten free. All of these we have at one point or another used for our patients.

Dr. Weitz:            What would you say are the most common carbohydrates you’re typically recommending that people avoid?

Dr. Rahbar:         I mean, if you look at the grains and the wheat, particularly in U.S., they may have high lectin levels. A lot of people show reactivity to those. Many of our patients have already tried those things with some benefit. I have to say by time they get to me, people are already sugar free, soda free, gluten free. It’s not like I have to walk them many times through it. But I think if the grains would be a target for me, then perhaps some refined sugars and also … I mean, most of us don’t eat bad food, but if somebody drinks a lot of carbonated beverages, that may add to the inflammatory process, particularly because of the high fructose corn syrup and so forth. So I mean, it goes back again to limiting some of the carbs. I may even limit fruits. Although some carbohydrates are needed to maintain physiology and maintain serotonin levels and the patient may otherwise become depressed. 

Dr. Weitz:            Have you used the Elemental diet in cases where patients are really inflamed?

Dr. Rahbar:         Yes. Absolutely. We have used the Elemental diet, which I think is a great …

Dr. Weitz:            Can you explain what the Elemental diet is?

Dr. Rahbar:         Elemental diet is basically the type of diet that all the nutrients that the body needs, the have been turned down to the basic molecules. The body basically has to do nothing. They’re ready for absorption. As long as you expose them to the lining, it can get absorbed. The oil part is usually MCT oils, which these are smaller molecules than the big oil that we eat in the food. The sugar is dextrose, which is a single molecule like glucose, and the protein is basically amino acids, which basically does not have to be broken down. There are scenarios that this could be really helpful. For example, when we had a patient who did not respond to the treatment and we found out the patient had SIBO. I put the patient for two to three weeks on the elemental diet, without any medication. The SIBO was resolved, and the inflammation went into remission. Basically it worked.

Dr. Weitz:            Yeah. I personally have found the inflammatory bowel disorder patients that I’d seen, a lot of them do seem to have some overlying infection with either SIBO or yeast or something else. A lot of times I have found using herbal antimicrobials when we cleared that out, a lot of times that will help the inflammation to go down.

Dr. Rahbar:         Yes. That has been my experience with that as well.

Dr. Weitz:            Do you find any particular nutritional supplements to be of benefit with patients with inflammatory bowel disorders?

Dr. Rahbar:         Right. I mean, I think to answer that question I would say first one needs to change the mindset as what are we trying to target.

Dr. Weitz:            Right.

Dr. Rahbar:         Traditionally, the models of care fall into blocking inflammatory pathways or inflammatory compounds. We need that to keep it under control. But you still have to go back and see how do I get here. What went wrong? From my experience, we know a lot of patients have ability issues in their small bowel level. So some of the concepts that they deal with  leaky duct and the intestinal permeability issues that would help to repair the small bowel may give a fresh benefit to reduce the inflammation elsewhere. Be it the inflammatory bowel disease or some other inflammatory component in the body.

So the things we do in elimination of some of the foods that may not be desirable. The second thing is that if I feel the patient is malnourished or if they’re not able to break down protein, I may use pure amino acids as a supplement. We frequently use oral immunoglobulin because the data suggests that it does help with surface healing. We have used a peptide called BPC157, which is a 15 amino acid peptide, is made in the stomach juice. The research and this goes back to the 1990s by a professor from Europe. It seems that to be very helpful for our patients and it’s very safe to try it out.

Dr. Weitz:            How is that administered?

Dr. Rahbar:         In our practice, we use it orally as opposed to injection. I know there are some orthopedic indications for that and they use it by injection. But it’s cumbersome. I think for peptide that is made in the stomach considerably, I can just swallow it and be fine. It’s very stable in the stomach acid so why not do it that way?

Dr. Weitz:            That’s by prescription?

Dr. Rahbar:         It is not pharmaceutical, but it’s not quite nutraceutical. So it is some research and monitoring and education. So it still requires prescription for that.

Dr. Weitz:            Interesting. Yeah. Peptides seems like a new interesting part of the Functional Medicine playbook.

Dr. Rahbar:         Exactly. So other things we use, we use frequently zinc in the form of zinc carnosine. We use omega three fatty acids. I use vitamin A, because I think it may help with the infections and also surface healing. Vitamin D for keeping the immune system in balance. Some general multivitamins including the Bs, anything that will actually help to improve surface healing. Because when you look at the blood surface, you’re looking at a huge area of one layer of cells, and if there’s infection or malnutrition associated with it, you have some holes in there. The stem cells are not able to rapidly replace those cells that are lost. Practically every five to seven days, the surface area of the gut tends to get self-replaced. So we need to have a lot of nutrients to the other to accomplish that.

Dr. Weitz:            Do you run any of the nutrition panels to see what their status is of vitamins or amino acids or things like that?

Dr. Rahbar:         Yes. We do. Because it’s not always easy to predict what micronutrients we would be missing. A variety of these tests tend to be not available by blood but by urine test, for example, in children and it’s easy to do. They’re not that expensive. Use some guidance as how to deal with it. Of course we use clinical judgment, but I find those to be valuable as well.

Dr. Weitz:            Great. So what you’re saying is, I’ve looked at some of the papers about using nutritional supplements for inflammatory bowel disorder, and I think some of the authors still have this medical model. We’re just going to use this basically a supplement as a drug. But if you’re really applying a Functional Medicine model, you’re trying to analyze what are some of the underlying root causes and triggers and imbalances in the body. Then using nutritional supplements specifically to try to sure up some of those deficiencies and imbalances and things like that rather than just saying, “Instead of using this drug, we’re just going to use (name whatever the nutritional supplement is).”

Dr. Rahbar:         Right. I wish I could tell you you could call it one for everybody. But the purpose of nutrient replacement, especially at the micronutrient level, will be mostly for three areas. One is for providing the basic elements that several replenishment would require as you create cells again, you’re going to need yours. The second thing is to support the liver and other types of detoxification. Otherwise when you go to the area of detoxification, many things can add to this and we are constantly exposed to compounds in our bodies to clear that. Another one is basically what I call mitochondrial support. Energy speaks to that. If somebody is starting to feel fatigued, there is a problem with mitochondrial dysfunction, and obviously everyone knows that we don’t want to challenge our mitochondria. So the energy would actually be one of the greatest indicators of how we’re doing this to help it.

Dr. Weitz:            So what kind of supplements or foods would you use to help support the mitochondria?

Dr. Rahbar:         The basic nutrients would be important. Amino acids. We use a variety of antioxidants, in addition to some herbal products. There are really great combinations out there to do that.  Depending upon the number the patients are taking, what combinations, I don’t want to stick to one specific item. But anything that will improve the rate of antioxidant effect or indirectly by stimulating the NRF2s levels in the liver I think will give you benefits in the recovery.

Dr. Weitz:            Yeah. I personally found curcumin to be a really beneficial supplement in some of these patients.

Dr. Rahbar:         Exactly. Again, it has anti-inflammatory effect. You can use it with boswellia as well. If you use curcumin, the amount of the product is to increase about three to five grams a day. If it’s liposomal, it probably would be better. That could be piggybacked with everything else that we’re dealing with.

Dr. Weitz:            Yeah. I would caution practitioners out there if you decide to use curcumin, I personally have found that if you use the form that’s combined with black pepper at high dosages, that tends to be very irritating for the gut. So I would not use that form for these types of patients.

Dr. Rahbar:         Thank you, Dr. Ben. Great feedback.

Dr. Weitz:            Have you ever tried a worm or helminth therapy for these conditions? I interviewed a doctor from Duke University–Dr. William Parker–talking about some of the new worm therapies that are being used. I guess there’s some anecdotal evidence and some limited studies showing that some patients get great benefit from actually ingesting worms.

Dr. Rahbar:         Right. I’m personally not ready for that yet. Maybe just because I’m very conservative. But I’m not quite comfortable with that approach. I think we need to know more. The research is not entirely clear. Sometimes these bugs can take over if somebody’s highly immune suppressed. So I’d be very careful with that, if you will. At least for now.

Dr. Weitz:           I think there are several helminths that are being used now that tend to be self limiting, meaning that they’ll live a certain period of time in the human gut. Then unless you keep ingesting more, they’ll die off. So I guess there’s a certain amount of safety there. But I don’t blame you for being a little bit cautious until there’s some more research on helminth therapy.

What about fecal microbiol transplant? I’ve heard some other doctors talk about this, especially for Crohn’s disease. Several doctors I know feel that this is probably going to be approved at some point in the near future by the FDA for Crohn’s disease.

Dr. Rahbar:         The research is there and it’s very strong. The three countries that I’ve seen are doing a lot of research on this are Netherlands and Australia and Canada. When you look at the research, they’re not exactly similar to each other. They’re all doing something a little bit different. I can tell you that from what I learned C-Diffocele, for example, if you do one fecal transplant, it may knock off the infection. For inflammatory bowel disease, this probably has to be FMT transplantation, and it’s not entirely clear. Does it need to be done daily or is it weekly? Do you use one donor or multiple donors? The universities are into discussion on this subject.

I just reviewed a nice article on this, and I can make it available as a question and answer group. One of the professors from Canada. The bottom line was that we’re not ready for prime time. A lot of unanswered questions. With Crohn’s, particularly, it may have to be swallowed to populate the terminal ileum. If you have overgrowth or bacteria in the small bowel, that may be an issue. A lot of unanswered questions and I wouldn’t rush into this at this time.

Dr. Weitz:            I think some patients are going to be a little apprehensive about swallowing capsule filled with poo.

Dr. Rahbar:         Yes. Well, it’s out there for a purpose, but we’re not quite there yet.

Dr. Weitz:            By the way, for those listening who don’t know what fecal microbiol transplant is, can you explain what that is?

Dr. Rahbar:         It’s basically a purified form of the bacteria that have been obtained from fecal material from volunteers that have been screened to be healthy. They’re available in frozen format through the rectum. Some people do it by colonoscopy installation, if you will. But to do it for IBD, most likely has to be done through the rectum like an enema without doing a colonoscopy. They also have them in capsule that open up in further down small bowel. Again, I think these probably have a role. We just don’t have enough information to make it publicly available.

Dr. Weitz:            Yeah. Great. So this was some really good information. I think for those who are dealing with patients or patients who are listening to this who have inflammatory bowel disorders like Crohn’s and ulcerative colitis, who may not be aware, there are alternative functional medicine approaches like the one that you use, Dr. Rahbar, to help besides simply having to take some of these drugs that sometimes have a lot of side effects for years on end. I personally have seen patients even taking some of these drugs still really bad symptoms and just got used to having six to eight loose bowel movements a day, constantly running to the toilet, having to plan their day around it. After applying a Functional Medicine approach, looking for triggers and food intolerances and nutritional imbalances and things like that, found that they could live a much healthier, happier life, and were either able to reduce or eliminate some of their medications. So I think that’s a great thing for patients out there.

Dr. Rahbar:         Absolutely. I mean, lifestyle is very important. For example, stress is usually a huge modifier of an inflammatory response by weakening the immune system, making more susceptible to infections. At the same time, turning up the heat in the way that is used in fighting back against the body itself. Sleep is a great issue, and also doing some regular exercise. I want to show you this article. This is in the Traditional Journal. Can you read that? Here is a reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995194/ 

Dr. Weitz:            Yeah. IBD patients are falling short on exercise and sleep.

Dr. Rahbar:         But look at the reference is Center for Disease Control.

Dr. Weitz:            Right.

Dr. Rahbar:         This is more traditional model. I think if the emphasis is coming out, that these other ancestrally lifestyle modifications will be very, very important. We generally tell our patients to eat slowly and chew well and not eat before they go to bed. Obviously limit carbohydrates. The issue of fish and tuna and sushi, these are important. I’m not in favor of having these sorts of proteins frequently taken without knowing what the exact source is. We frequently find heavily metals in our patients, and that will definitely change the intestinal microbiome. It’s probably going to increase the risk of yeast problems. It’s going to confound this in you.

Dr. Weitz:            So do you test your patients for heavy metals?

Dr. Rahbar:         Yes. We routinely do. I don’t do necessarily chelation to see what’s in the tissue. At least I do not want to see it in the blood floating around.

Dr. Weitz:            Right.

Dr. Rahbar:         Because once you eat let’s say tuna, it may take three to four weeks for a normal person to eliminate that from the blood circulation. Once a week may still be too much.

Dr. Weitz:            Yeah. According to Dr. Chris Shade, a patient who’s sick, who’s system is not working well at detoxifying, once you ingest mercury from fish, it can be in your system for over 200 days.

Dr. Rahbar:         That makes perfect sense. Yeah.

Dr. Weitz:            Yeah. So then you also mentioned mold is a factor. Do you often find that with inflammatory bowel disorders or sometimes you find it?

Dr. Rahbar:         Yeah. We look for anything that potentially can turn up the inflammatory process and produce immune dysregulation. The issue of environmental toxicity is extremely interesting and important because for a variety of susceptible patients who have the proper genetic profile, exposure to the mold and the process of mold may be a huge additional burden, if you will, and can be another dis regulator. Now, you add that to stress, add that to alcohol, to sugar, to bad lifestyle, add that to mercury and lead and we have a whole soup of events going on here. We also have several patients where they had some manifestation that suggested neuropathy. When we checked, we found there was evidence of tick borne illness or vector borne illness as another component of immune dysregulation. 

Dr. Weitz:            So you’re talking about something like Lyme disease.

Dr. Rahbar:         Yes. I’ll give you an example of scenarios. For example, the patient who comes with constipation, but when you do colonoscopy, you see colitis. The patient is taking laxatives and a part of the colon looks black because of the laxative use. But in another part of the colon is read and inflamed. So that suggests to me you have two problems. One is the nerve component of the colon is not working. So that’s neuropathy. The other part is immune dysregulation and colitis. What would cause this type of combination? Usually it would be vector born illnesses like bartonella, borrelia and babesia are very, very powerful to create this type of combination, if you will.

Dr. Weitz:            You mentioned immune dysregulation and that’s something that’s hard to wrap your head around. When you think of an inflammatory, an autoimmune disease, an inflammatory bowel disorder, you’re thinking you have a situation where the inflammation is revved up. But now you have these patients where the immune system is revved up and attacking but actually a lot of times the immune systems not working probably. So can you explain that? How do you end up having an immune system that’s in attack mode, but it’s actually not working that well?

Dr. Rahbar:         Well, simply what it means is in attack mode against our own tissue, but since it’s too busy doing that, it won’t be able to fight infections properly. So if you end up picking up a bug here, you’ll end up with scenarios where this low grade infection may stay in the body and they produce what we call the stealth infection. This term unfortunately is not in the classic books. We think about chronic infections with antibiotic. But what stealth infection is is a little bit different. You have to do your own reading on this, because you won’t be able to see it in classical descriptions. What it simply means that the Koch postulate that one bug causes one illness is probably not true at least nowadays. What we see is a variety of infections, it could be bacterial, viral, fungal. They work in harmony with each other. They keep the host busy, and they just kind of mess up the system a little bit. Just a little bit, won’t kill. But it’s uncomfortable. You can see evidence of allergies, skin problem, rashes, hives, itching, irritation, problems with sleep, joint problems, energy issues. When you go deeper, you see a variety of these infections may be sitting in the background. It’s hard to know which one is the creator. Sometimes you have to use kind of a try different things and see how you can hit the target.

Dr. Weitz:            So basically it’s not that the immune system is so much just up or down. It’s that it’s dysregulated, right?

Dr. Rahbar:         Exactly. Yeah. More change of autoimmunity and at the same time more chance of having difficult dealing with infection.

Dr. Weitz:            Right. Okay. Great. Lots of interesting topics. I’m sure we can talk about this for a long time. But I think you provided our listeners some great information. For those watching or listening to this podcast, how can they get a hold of you and get more information about you?

Dr. Rahbar:         The best way to approach us is to check out our website. We have tried to put as much information there. The telephone is always available. But telephone, once they ring more than two or three lines, there’s only one nurse.

Dr. Weitz:            What’s your website? Can you give that to us? Of course, I’ll put it in the show notes.

Dr. Rahbar:         Yeah that would be LA then the word integrativegi.com.

Dr. Weitz:            Great. What’s the phone number to your office?

Dr. Rahbar:         310-289-8000.

Dr. Weitz:            Great. You’re available for consultations both in person and remotely?

Dr. Rahbar:         Yes. Still in practice.

Dr. Weitz:            That’s great.

Dr. Rahbar:         Thank you.

Dr. Weitz:            Thank you, Dr. Rahbar. Look forward to speaking to you soon.

Dr. Rahbar:         I hope so. Thank you for this invitation.

 

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