Moodle at CCNM

This presentation aims to provide up to date information on Small Intestinal Bacterial Overgrowth (SIBO).  This 1.5 hour webinar will review the identification of SIBO, potential causes, as well as conventional and naturopathic treatments.  Discussion will also include various factors that underlie the development of SIBO as well as breath and serum lab testing.  Treatment details will include antibiotics and herbal antimicrobials, along with prokinetics, diet, and supportive supplementation.   Learning Objectives Define underlying pathology and potential causes of SIBO Discuss lab testing options for SIBO Identify signs and symptoms for various types of SIBO Summarize conventional treatments Examine naturopathic treatments  

Small Intestine Bacterial Overgrowth (SIBO) has become an increasingly popular focus of research studies, medical conferences and clinical discussion. Patients are beginning to ask about SIBO as a cause of their health concerns, in a similar way as they have historically asked other types of dysbiosis (e. g. yeast, parasites, etc.) As such, it would behoove naturopathic doctors and students to become familiar with this condition in order to provide up to date knowledge and optimal care fore their patients.     Learning Objectives Review etiology, pathophysiology, clinical signs and symptoms Outline the utility of the lactulose breath test Discuss dietary approaches to resolve and prevent SIBO Compare pharmaceutical and non-pharmaceutical antimicrobial treatment options Become familiar with non-digestive SIBO-related symptoms

This presentation takes a look at the natural agents that are most studied to heal intestinal permeability. We discuss natural agents as well as pharmaceutical that are available for repair. Medications discussed include: Linzess, Amitizia, Trulance, Resolor

This talk will involve a 45 minute case description of a commonly encountered presentation of Small Intestinal Bacterial overgrowth in clinical practice. The presentation will review symptomatology, laboratory work up and breath test interpretation, and treatment approaches, including dietary interventions. We will also explore concepts of dietary expansion, following long-term dietary restriction.

Naturopathic doctors have always stressed the importance of treating the gut, and have used personalized diet to optimize health, botanical and other antimicrobials to treat stealth pathogens, and numerous other interventions to minimize harmful levels of inflammation and otherwise encourage best outcomes. How does the normal microbiome influence the importance and success of these treatments? How can emerging technology help us assess the importance of commensals and “possible pathogens?”

SIBO is a common condition and with great overlap between SIBO and IBS. In fact, SIBO may be the cause of IBS in up to 70% of cases. We also know that food poisoning (acute gastroenteritis) can be a trigger for IBS/SIBO but the mechanisms for this have been unknown. Recent data suggest that food poisoning creates an autoantibody that can cause IBS and SIBO based on animal and human studies. This presentation explores the data around how autoimmunity is triggered after food poisoning and in the development of IBS and SIBO. We will also explore how this could change the prognosis of IBS and SIBO. Pharmaceutical agents discussed include rifaximin and neomycin. There is also discussion of prokinetics such as prucalopride and erythromycin.

Surgery for the treatment of obesity (bariatric surgery) was started in the United States in the 1950s and has evolved to include multiple procedures and devices over the past 60+ years. The earliest procedures, while effective for their primary goal, became infamous for creating severe malnutrition and toxic overgrowth of bacteria in the bypassed part of the small intestine. This bacteria proved so toxic in some patients that it led to liver failure and death. While that procedure was abandoned, others have replaced it including gastric bypass, duodenal switch, sleeve gastrectomy, and the mini bypass (omega loop). While none has proven to be as toxic as the original surgery, we have learned a lot along the way about how various surgical alternations to the gut can alter not only anatomy, but create changes in the microbiome that impact nutrition, metabolism, weight loss, and other aspects of physiology. This knowledge can help inform clinicians who are supporting surgical weight loss patients, and can also teach us some valuable lessons that apply to SIBO in non-surgical patients.

The role of the endocannabinoid system in both physiological and pathophysiological function of the gastrointestinal tract is relatively unknown. Pharmacokinetic studies shed light on the metabolism and bioavailability of exogenous cannabinoids. Preclinical and clinical trials continue to explore the utility of using cannabinoids as therapeutic agents for gastrointestinal disorders. This presentation elucidates the key functions of the endocannabinoid system in maintaining gut function. It also summarizes existing evidence for using cannabinoids to treat GI disorders. Pharmaceuticals covered: Cannabidiol, Nabiximols, Dronabinol, Nabilone

The clinical manipulation of the microbiome by the use of pre and probiotics in the USA has seen an exponential rise in the past 5 years. Despite the recent expansion of information the wide spread support by major medical societies the use of pre and probiotics is significantly hampered by the lack large randomized prospective studies. The lack of strain-specific data sets, lack of dose response, poor understanding of clear links to mechanism, and general misinformation about pre and probiotic products has limited the therapeutic use.  As the use of probiotics grows beyond general claims of overall gut health to more targeted health claims data is starting to emerge to support use in not only clinical setting but in programs supporting health lifestyles. Much of the focus in medical and surgical practice now revolves around the protection from gut barrier disruption and alterations in intestinal permeability as well as immunologic compromise.  Large prospective randomized trials have now reported benefits in prevention of Ventilator Associated Pneumonia, antibiotic associated diarrhea, and Clostridium difficile diarrhea. Smaller prospective trials have shown use of probiotics to decrease total infectious complications actually shorten hospital stays. Determining a clinically effective dose (potency) for administration of a probiotic is a key but it appears that positive data is now available in pneumonia, antibiotic associated diarrhea, and a variety of other routine clinical challenges. This presentation reviews the current clinical perspective and possible use strategy for optimizing use of “probiotics” in a medical and surgical practice as well as the use to prevent acute surgical and chronic medical diseases.

This presentation will explain how metabolic syndrome, prediabetes and frank diabetes become key underlying causes for SIBO and other GI disorders. The influences of lipopolysaccharides from overgrown flora, autonomic neuropathy, hepatic insulin resistance, effects of hyperglycemia and the hypothalamic-pituitary-adrenal axis on upper GI transit. SS-L will use example cases to show his approach to diabetes treatment and management.  Pharmaceuticals to be discussed include: Metformin, berberine, allicin, oregano, ginger and neem will be discussed with regards to diabetes, insulin resistance and SIBO.

Prevalence and definitions of eating disorders in various populations, including patients with concurrent SIBO diagnoses. Work-ups recommended for eating disorder patients, and treatment strategies. Vyvanse/lisdexamfetamine dimesylate for binge eating disorder. Anti-depressants for appetite increase. And other medications with anorexia as a side effect including: Concerta/methylphedate, Adderall/dextroamphetamine.

It is becoming increasingly clear that SIBO is in some cases due to previous exposure to gastroenteritis. Through a series of interesting studies, it is now understood that this singe food poisoning event can lead to long term changes in the microbiome. The most important of these is the development of antibodies to vinculin. In this presentation, we will update the audience on the latest developments on this topic and how the future is shaping up to treat SIBO and IBS as an autoimmune condition.

Disordered eating behaviors can have a profound impact on digestive physiology resulting in altered motility, anatomy, digestive secretions, immunologic status, and microbial balance. These challenges contribute to the development of a number of different GI disorders, including the category of “Functional GI Disorders” which may have a prevalence up to 98% in patients with eating disorders. Many of these symptoms naturally resolve through the eating disorder recovery process, but to make matters more complex, many patients with eating disorders also had gastrointestinal concerns prior to the onset of their eating disorder. This overlap can present challenges in clinical practice and raises many questions. When should we be pursuing testing for GI symptoms? How do we ensure that our interventions do not cause harm? For conditions for which dietary modification is typically a cornerstone of treatment, when is it appropriate to include these modifications? This presentation explores these questions through presentation of research, clinical experience, and conversation.

Disordered eating behaviors can have a profound impact on digestive physiology, resulting in changes to motility, anatomy, digestive secretions, immunologic status, and microbial balance. These changes often lead individuals with eating disorders to develop any number of functional gastrointestinal disorders (FGID), with some studies estimating a 98% prevalence of FGID in patients with an eating disorder (Boyd, et al. 2005). And to make matter more complex, the symptoms of the eating disorder itself can often be indistinguishable from the symptoms of these gastrointestinal disorders, making it difficult for clinicians to identify appropriate treatment strategies. This overlap can present challenges in the setting of a functional GI practice, and poses some difficult questions. How do we appropriately screen for and recognize patients who have eating disorders? How do we ensure that our interventions do not cause harm to these patients? Do we consider dietary modification or other cornerstones of digestive health treatments in this patient population? This presentation will explore these questions, as well as provide useful tools for clinical evaluation, management, and appropriate referrals for patients with disordered eating behavior and diagnosable eating disorders.

Although brain injuries have received a great deal of press lately, they are still poorly understood. In this presentation, we explore brain injuries through the lens of Applied Psychophysiology, “the practical understanding of the mind-body interrelationship with regard to therapeutic treatments of various kinds”. (Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. (c) 2005, Elsevier.) Research and clinical experience point to a strong connection between brain injuries and digestive disorders including SIBO. A review of that research is presented to illustrate and expand upon gastrointestinal cases gleaned from the private practice of Kayle Sandberg-Lewis. Steven Sandberg-Lewis presents research on treatment options for traumatic brain injury are in the early stages. Factors to consider in the cascade of dysfunction for these patients include reducing oxidative stress, excitotoxicity, and inflammation (activated microglia) as well as supporting mitochondrial function, membranes, synapses and axons. Several protocols have been studied with multiple nutritional and botanical options. This 30 minute presentation gives an overview of the choices and present the evidence available.

The immune system is designed to produce an inflammatory response to an infectious disease. However, we consistently find people “stuck” in inflammation after an infection (such as those with Post-COVID Syndrome) or without an infection at all. In this lecture, we will explore what happens with people who have chronic inflammation. We will also discuss how food and the microbiome can contribute to their inflammation or help them heal.

This lecture discusses common gastrointestinal bacterial and parasitic infections and gives guidance for diagnosis and treatment. Also discussed is the importance of eradication of these infections as a key primary approach to reversing metabolic endotoxemia and establishing optimal gastrointentinal health. Prescriptive medications as well as herbal and nutraceutical treatments are discussed as well. Pharmaceuticals discussed include: Pyrantal Pamoate, Nitazoxanide, Praziquantel, Albendazole, Mebendazole, Tinidazole, Ivermectin, Iodoquinol

This presentation goes through the underlying causes, prognosis of and complications associated with gastroparesis. Management options discussed include herbal, pharmaceutical, dietary, surgical, manual, mind-body and acupuncture treatments. After this lecture, the learner should come away with a greater understanding of the management of gastroparesis in a clinical setting. Pharmaceuticals discussed include erythromycin, azithromycin, domperidone, prucalopride and metoclopramide.

The role and function of the liver; clinical diagnosis of underlying liver disease. The importance of the intestinal microbiome (IM) on the gut liver axis and the impact of dysbiosis on chronic liver disease. Pathogenesis and causative factors leading to disease progression: gut dysbiosis, bile acid metabolism chronic inflammation , intestinal permeability, and immune system activation. The impact of these factors on development or progression of chronic liver disease with a particular focus on fatty liver disease and cirrhosis/hepatic encephalopathy. Highlighting the role of IM manipulation in a an attempt to reverse or slow down liver disease through diet, use of studied herbals supplements, prebiotics, probiotics and synbiotics and fecal transplantation. Briefly conclude with practical pearls for the naturopathic clinician to fully understand full scope and benefits of adjunctive therapies available to treat their patient’s with chronic liver disease.

This is a 60 minute power course orienting everyone into the world of inflammatory bowel disease. We discuss foundational presentation of IBD, pharmaceutical management of IBD and naturopathic treatment options for IBD. Pharmaceuticals discussed:5-ASA drugs like sulfasalazine, mesalamine drugs, prednisone, budesonide, biologic agents like infliximab, ada Infliximab, Adalimumab, Certolizumab pegol, Natalizumab, Vedolizumab and Ustekinumab and immunosupressants like Azathioprine, Mercaptopurine and Methotrexate