Dr. Todd LePine
speaker
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
And it's rifaximin plus either neomycin, which is what the double-blind study covered, or rifaximin and metronidazole. And then the third category is hydrogen sulfide. And we give rifaximin, but we give it with bismuth because bismuth is an anti, it blocks some of the synthetic functions of hydrogen sulfide in the sulfate-reducing bacteria.
Point is, the hydrogen sulfide goes down, the bacteria are reduced, and therefore the patient's normal bacteria take over and things get better more permanently in that group, it looks like.
Yeah.
We haven't sorted out or had time to sort out the different diet approaches, but I envision smarter people in diet will come up with a way. What we do now is what we call low fermentation eating. So we don't use low FODMAP in our practice because we're
you can't do it indefinitely, but low FODMAP will reduce the amount of calories you're providing to bacteria and therefore they'll ferment less and that might help. But long-term low FODMAP, hurts your microbiome and can cause nutritional deficiencies. So you can't stay on the full low FODMAP indefinitely.
Yeah, fermentable oligosaccharides, monosaccharides, et cetera. And basically it's too restrictive. But you've probably, most people have probably read about low FODMAP diet. It's very popular in the last few years. But we use what's called low fermentation eating, not as restrictive.
And the philosophy of that was with a low fermentation diet, you can go to any restaurant in the country and you'd find a meal. So it's, you know, you don't want to be the person at the table just because you have IBS. That spends 10 minutes with the, you know, trying to explain your dietary restrictions on a low FODMAP diet. So, you know, that's part of the reason.
We want our IBS patients to feel as normal and as socially non-isolated as possible. And that's part of it.
So it's basically restricting non-digestible carbohydrates. So low fiber, no dairy, and then none of the artificial sweeteners because of course they're easily fermentable. And then spacing your meals. So you don't eat for five hours between meals because the damage of the nerves, we talked about that earlier, the damage to the nerves causes a reduction in cleaning waves of the gut.
So the cleaning waves only occur when you're not eating. So your gut is sort of like got two computer programs, eating mode, cleaning mode. If all you do all day is spend time in the break room, taking a bite of a bagel that's in the break room, you never go into cleaning mode. So in addition to the construct of what to eat, we tell you when to eat and to try and space your meals up.
Well, you know, I may be punished for saying something like this, but Everything has fiber in it now. Even Cheerios, they put fiber in it because it prevents colon cancer and it's colon health and all this stuff for 20 years. How much have we heard about colon health and fiber? A lot. What have we got now? We've got colon cancer happening in the 40s and we're doing screening colonoscopy at 45 now.
I'm not saying it's fiber causing that. But all the fiber we've been pounding and the cardboard we've been eating hasn't really done as much as we thought it might. So I'm a little unclear about fiber. But from the point of view of bacteria, you put more fiber, you're gonna have more of the bacteria. If you had bad bacteria to begin with, there's gonna be more of them.
And for a healthy person whose microbiome's healthy, no problem. But not for these patients with these microbial conditions.
Well, I can answer that in two or three ways, but I'll try to touch on a little bit of each. We looked at rifaximin before and after treatment, the small bowel. And when you get rid of the bullies in the town, all the inhabitants of the town come back. So it goes opposite of what people think. We're not, you know, being cataclysmic. It's getting rid of the E. coli and the Klebsiella and SIBO.
That allows the regular bacteria to reflourish, repopulate and take over again for a period of time. But remember, the problem is those cleaning waves are not working. So it is possibly going to come back. It depends how badly damaged. And that's where that antibody comes in.
Because if the antivinculin, which is that autoantibody for the autoimmune disease of IBS, is very high, the neuropathy is more high or more intense, and you're going to relapse or reoccur more frequently. So that's where we're able to have some further strategy. But first of all, take the antibiotics. They actually repopulate the town counter to what you think.
We've never seen antibiotic resistance to Rifaximin so far, knock on wood. It's a very unique chemical drug. And then we get them on the low fermentation eating diet. That's what we do. And for those where the antibodies high or those who relapse, we do put them on a prokinetic. So they space their meals. Everything's going right.
But we want to stimulate those cleaning waves at nighttime because that's the longest time you're not eating and make you clean up as much as possible at night so that the bacteria don't have a chance to come back. So we don't do all three things for everybody. It depends on, you know, if somebody relapses in two years, we don't need to put them on a drug every day to prevent.
But if they relapse every three months, then we can stretch it out to a year by adding the prokinetic or doing more aggressive diet strategies.
Brain fog is really a symptom, sort of like cough. Cough can be caused by a cold, bronchitis, pneumonia, post-nasal drip, asthma, a whole bunch of things. You've got to figure out, okay, what's driving it? There is no ICD-10 code for brain fog. You might call it altered mental status, but oftentimes it's transitory. That's the really interesting thing.
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