SIBO and GERD / GORD with Dr Steven Sandberg-Lewis

In today’s episode, Dr Nirala Jacobi is in conversation with renowned SIBO specialist, Naturopathic Gastroenterologist and Professor, Dr Steven Sandberg-Lewis.

Dr Sandberg-Lewis is a highly regarded and well known naturopathic physician. He has been a professor at the National University of Naturopathic Medicine (NUNM) since 1985, in Portland, Oregon.  Dr Sandberg-Lewis has a part-time clinical practice and is the author of several Townsend Letter award-winning articles, and of the medical textbook ‘Functional Gastroenterology: Assessing and Addressing the Causes of Functional Gastrointestinal Disorders.  He has also been named one of the Top Docs in Portland Oregon in 2014.

Topics discussed include:

  • How are proton pump inhibitors (PPI) related to SIBO?
  • How the 3 main secretions at the upper gate of the small intestine are bacteriostatic, and how hypochlorhydria and PPI use can support SIBO development.
  • Heidelberg testing and Weakly Acid Reflux.
  • How alkaline reflux can trigger the same symptoms as acid reflux.
  • Loss of stomach mucosa in the absence of the acidic trigger.
  • Atrophic gastritis – what is it and how common is it?
  • Is reflux after meals normal?
  • Esophagitis – what causes it and what is it?
  • The role of alkaline saliva in bathing the esophagus to help neutralise acid that may come up.
  • Leaky mucosa in the stomach, the connection to PPIs, and the link to food intolerances and allergies.
  • Dilated intercellular spaces (DIS) in the oesophagus and superficial nerve irritation in the oesophagus.
  • Do we use the same leaky gut healers for the upper gut – the stomach and DIS?
  • Dry mouth as a symptom of anxiety and sympathetic dominance, and the importance of relaxation in prompting saliva to bathe the oesophagus.
  • Dr SSL and Dr Jacobi use therapies including glutamine, zinc carnosine, n-acetyl glucosamine, gamma oryzanol, quercetin, and demulcents to help heal DIS.
  • If a client has slight Barrett’s or erosive esophagitis and is put on lifelong PPIs, is this the appropriate course of action to support?
  • How do we slowly wean people off PPIs?
  • Sliding hiatal hernia and the possible cause of reflux.
  • What is the difference between hiatal hernia syndrome and an actual hiatal hernia?
  • Advanced diabetes and issues related to autonomic neuropathy, such as silent reflux.
  • Laryngopharyngeal reflux, the typical symptoms to look out for, and conditions it is linked to.
  • Enlarged tonsils and the connection to laryngopharyngeal reflux.
  • How do we test for low stomach acid?
    • Riddler’s reflex point for stomach acid.
    • Pectoralis major test for hypochlorhydria.
    • Heidelberg test.
  • Bile Reflux – what causes it?
  • Dysplasia and cancer of the lower oesophagus and the theory linking these conditions to duodenal gastroesophageal reflux.
  • What treatment can we do for Bile Reflux?
  • The importance of endorphins and enkephalins in the contraction of the sphincters in the body.
  • Chapman’s reflex point to improve the tone of the pylorus (taught by Dr SSL in the GI practicum in November)
  • Nutrients to help to heal Barrett’s and prevent cancer include selenium, turmeric, green tea catechins, anthocyanidins (found in berries and colourful fruits and vegetables).
  • Top causes of reflux to pay attention to besides SIBO:
    • Hiatal hernia
    • Hiatal hernia syndrome
    • Pancreatic insufficiency
    • Spasmodic diaphragm
    • Anxiety, or conditions that decrease client’s saliva or makes saliva more acidic (eg sjogren’s, elderly)
  • Digestive Support for lack of saliva production
    • Use zanthoxylum (prickly ash) – 1-2 drops on the tongue, and/or bitters as a digestive stimulant.
    • Pilocarpine lozenges
  • What is Dr SSL’s opinion on methane and PPI use – being there there is potential for PPI users to have less methane output, and conversely for Hydrochloric Acid (HCl) users to have increased methane production.
  • What is the appropriate dose of HCl for patients and should we use capsules or tablets?
  • The combination use of bitters plus HCl.
  • Rebound hyperacidity – why can it occur after taking PPIs?
  • Buteyko breathing for upper digestive symptoms.



  • GI Practicum in Australia on 10th-11th of November 2018
  • Healing Leaky Gut, stomach, and DIS
    • Dr SSL and Dr Jacobi use therapies including glutamine, zinc carnosine, n-acetyl glucosamine, gamma oryzanol, quercetin, and demulcents.
  • Dr Steven Sandberg-Lewis
    • Medical textbook – Functional Gastroenterology: Assessing and Addressing the Causes of Functional Gastrointestinal Disorders by Dr Steven Sandberg-Lewis
  • Mim Beim
    • Buteyko breathing for upper digestive symptoms
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