Dr. Todd LePine

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114 appearances 3 recordings 1 series first heard Dec 2024 last heard May 2025

Dr. Todd LePine’s voice in public audio — every appearance, attributed to the second.

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The Dr. Hyman Show · Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance · 21 Apr 2025 podcast

But they remember going on a trip to Hawaii and they end up in the hospital with bloody diarrhea. And then ever since then, nothing's been the same.

Well, so based on culturing the bowel, we've been able to isolate that 60% of IBS is SIBO. The other 40% is a mixed bag. So for example, and you probably talk about this now, Ehlers-Danlos syndrome, POTS syndrome, we're starting to recognize those illnesses as characteristically GI-centric, at least in their early presentations as well.

So some of the leftover 40% have Ehlers-Danlos syndrome or POTS, or some of them are celiac that we've missed. Some of them are food sensitivities. Some of them are histamine sensitivities. Some of them are So it's a mixed bag of a number of other disorders. And some of them are fungal overgrowth. So we see that in about 6% to 10% of that 100 pi. So there's still more to unpackage.

We're not ignoring the other 40. We're trying to figure the rest out. But it's a little bit more. harder to unravel.

Yeah, I mean, Dr. Satish Rao in Georgia has done a lot of the seminal work in this. But more recently, we've done shotgun sequencing of the small intestine, and we've been seeing this fungal overgrowth.

No, shotgun sequencing means we sequence every single piece of DNA we can find and then characterize it and see what organisms it represents. And it represents fungus about 10% of the time. And that when the fungus is higher, the patients are experiencing more abdominal pain and more diarrhea.

So there is a subclass of these patients that it is fungal, but it's smaller than some would like to believe, but larger than those who are naysayers, as you've probably heard. And so it is there, it's real, but it's a little more challenging to identify. There's no breath test for it. You got to go in and chase it. And that's the challenge.

chase it by doing stool cultures or well chase it it could be by stool but if you want to find small intestinal fungal overgrowth you got to get into the small intestine and that's that's really sampling you have to have endoscopy and all that that's how dr rao identifies it yeah and and any particular species of fungus or is it sort of a broad array

So what we found in this, quote, shotgun sequencing is candida albicans is a big part and a little bit of candida glabrata. And there's a few other, malassezia and all these other organisms that are very minor, but they generally aren't at a high number that we think are as consequential as the first two I mentioned.

Well, generally in... allopathic medicine, we try an antifungal. There are natural antifungals as well. And you're probably better versed in those than I am, but we do use fluconazole. We do use nystatin. Occasionally we use more radical, more advanced antifungals, but those are the typical first two choices.

Yeah. So first of all, we helped develop the first three gas breath tests. So just full disclosure, but it's changed my practice because there are patients who fell through the cracks without knowing hydrogen sulfide. So unpacking each, the hydrogen positive breath test patients are generally, we actually just published this paper, it came out literally yesterday. There are two bugs, that's it.

That caused the hydrogen overgrowth. It's Escherichia coli, the non-pathogenic one, and Klebsiella pneumoniae. Those two characters, when they come into town, everybody leaves because they're so opportunistic and bullies. And we think they produce even toxins to the other bacteria around them to try and get rid of the bacteria.

So it's like you've got a gang that comes into the small town and everybody leaves. So it's a disruptor of the microbiome and then they rise very high in number. So that's the hydrogen one. The second category is the methane or methanogens. And those characters live both in the colon and the small bowel.

And we have a paper coming out showing exactly where they're living and it's pretty universal in a lot of these patients. So hence we call it intestinal methanogen overgrowth and not SIBO methane, because it's not just the small bowel, it's colon also. And when they produce methane, it gives you a lot of constipation, a lot of gas, and you can't pass the gas. And these people are quite miserable.

And then the third is the hydrogen sulfide, which is the new kid on the block, which has changed my practice because some of those patients we didn't know. Breath test is normal. Everything looks fine. And then the hydrogen sulfide is positive. We get rid of it. And all of a sudden they feel better than they have in their life. And.

And for some reason, when you get rid of hydrogen sulfide, it doesn't come back so quickly, which, which is beautiful. I have patients who've gone a year, just one treatment and they're done. And so I'm really excited about that. So, I mean, I could talk about the treatments if you like now, or.

Yeah, so I mean, if I have an IBS patient with diarrhea or a patient with diarrhea and bloating, My practice now, I do the antibodies because I want to be able to say, was it food poisoning or not? And if the antibodies are really high, it makes it harder to treat. But also, you travel, you better take prophylaxis because you could get into further trouble with these antibodies going higher.

So I universally do that.

I give Zyfaxan prophylaxis. That's what I do in my practice. And a lot of the GIs now do that. Because if the antibody goes higher, the damage to the nerves of the gut is more intense or the effect on the gut is more intense. And at least that's what we're seeing in our clinic. So we're very careful with those patients who have the antibodies positive.

When it comes to, then we do the three gas breath test in all of our patients. And if it's hydrogen and you, we all know Rifaximin got FDA approved for IBS with diarrhea on the basis that IBS was in part of microbiome disease. And now we understand that microbiome condition is SIBO. So I give Rifaximin for that. If it's methane, we have one double blind study that we can lead to.

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