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Dr. Mark Pimentel of Cedars-Sinai on Small Intestine Bacterial Overgrowth (SIBO) (Heartburn)

It’s really super very hard to get me to spend time listening to a Podcast. I don’t really get the whole enthusiasm with podcasts, much—perhaps, because I spend as little time sitting in traffic in a car as possible. I’d rather be poor and die.

This one is different.

You can also just read the transcript.

I feel very vindicated, as ought be Tim Steele. Very early on in our collaboration, Tim and I just kinda didn’t get this SIBO thing as some natural phenomenon caused by natural carbohydrate in the diet. We’re both ex-military men, so maybe bullshit detection caused an eclipse? Who knows?

But we both kinda shut up about it, all the while laughing about FODMAP diets, like: Do The Diet That’s At The Root of Your Problem. Emphasize!!!

I initially set off to have a lot to say about the podcast, but you have the audio and transcription, so do it yourself and be happy I pointed it out to you.

Richard Nikoley

I'm Richard Nikoley. Free The Animal began in 2003 and as of 2021, contains 5,000 posts. I blog what I wish...from health, diet, and food to travel and lifestyle; to politics, social antagonism, expat-living location and time independent—while you sleep—income. I celebrate the audacity and hubris to live by your own exclusive authority and take your own chances. Read More

8 Comments

  1. Bioking on September 11, 2015 at 20:15

    Oh real nice Richard. Delete my poo posts from comments then you do your own full scale poo test. We still need to see photos! Take daily shots and see if we can see any transformation.

  2. Peter Dietrich on September 11, 2015 at 20:56

    My mind is definitely full of f**k after reading the transcript of this interview. I’m highly curious about the study that associated certain anti-bodies with IBS. And the idea that these antibodies may cause a neuropathy in certain parts of the digestive tract, which is could ultimately be the cause of IBS.

    What Chris didn’t ask, and what makes quite skeptical, was what is the treatment? Where is the logic in talking about causes and treatments of SIBO for an entire interview and then bringing up another potential cause then all of a sudden NOT talking about treatment for it? Skeptic radar on alert.

    For someone like me where no amount rifaximin, potato starch, prebiotics, fermented veggies, diet changes, stool testing, or probiotics has ever caused me to go less than 6-10 times per day it’s extremely frustrating. Dr. Pimentel vaguely referenced drugs as the treatment for the antibodies, so I wonder if it’s safe to assume there is a drug being developed behind the scenes for this and will have to fork over my hard earned cash to try it. C’est la vie.

    • CoolBeans on September 14, 2015 at 00:29

      Try the probiotic yeast “saccharomyces boulardii” my friend. This is a nice write-up on it, including a great product link. I’ve also had great luck with the Jarrow brand version, but it has a few questionable ingredients, so I have mixed feelings about it.

      http://www.shop.gapsdiet.com/product.sc?productId=16



    • Jen on September 20, 2016 at 07:46

      Kirkman makes a Saccharomyces Boulardii without anything besides a capsule but it must be refrigerated. You can buy it shipped with ice from the manufacturer, Iherb and Vitacost. There are likely other sellers these are just the ones I know of. It only helps the pain for me but that is still worth it’s cost for me. I hope it is more effective for others with gut troubles!

      BTW Saccharomyces Boulardii has been shown in studies to increase the cure rate of people with C. Diff when used in combination with the prefered antibiotics. It is a probiotic yeast so antibiotics won’t kill it. Even more important S. Boulardii will bind with C. Diff. and it’s toxins so they can’t damage the intestine. I made sure to take extra when I have to be on antiboitics so I don’t get c. diff. on top of the ibs. Additionally if I recall correctly it is not a persistent strain no longer detected two weeks after people were given it so it is very unlikely to cause overgrowth.



  3. Tyler on September 12, 2015 at 12:19

    If you really wanna go deep…

    There are some doctors at a naturopathic college in Oregeon that are very interested in the pathology and treatment of SIBO.

    I mention this because last year and this year they hosted a symposium, uncreatively called SIBO Symposium, where Pimentel presented. Pimentel’s talks are truly excellent and viewable online—though not free. (They cost between $35 – $45 each.)

    In 2014 he gave three talks all around an hour long. In sequence, they’re titled:

    * Small Intestine Bacterial Overgrowth [1:22]

    * Small Intestine Flora [1:05]

    * Autoimmunity, Methane and Constipation [48:00]

    The first talk mainly goes over the history of IBS and SIBO, how his group at Ceders Sinai validated their theories, and the technical procedures needed. It’s not terribly interesting—I’d skip it. The other two talks, however, are fascinating and equally informational, with a gripping sense of suspense as he runs through how all the bits and pieces discovered over time fit together. If you’re like me, you’ll be kept at the edge of your seat at parts and the end of the first talk will seem like a full-on cliffhanger. (In my mind it’s all at least as good as a Arthur Conan Doyle novel. Maybe that’s just me.)

    In 2015 he gave two talks:

    * Underlying Causes of Small Intestinal Bacterial Overgrowth [59:00]

    * Rifamaxin Treatment for SIBO [26:00]

    The first is around an hour long and covers much of the same material as the last two talks of 2014, slightly condensed of course but with some new parts as well. (Out of any individual talk this is the single most comprehensive.) The second talk is an in-depth almost thirty-minutes on the antibiotic Rifaximin, focused on the methods and results of the elaborate clinical trial (Target 3, I believe) that got it approved by the FDA for treating positive breath tests.

    What’s great about all of the talks compared to a podcast is that it’s not just him talking; you get to see all of the graphs, nice and clear, with all of the data. I also rate Pimentel highly when it comes to public speaking.

    You can find the 2014 talks here:

    2015 here:

    [no affiliations]

  4. Gemma on September 12, 2015 at 04:27

    Oh, lovely.

    “Mark Pimentel, MD: That’s always the way antibiotics are best effective, is when the bacteria are happy. For example, some bacteria form cysts or they sporulate, and once they’re sporulated, it’s done. You can’t get an antibiotic to go into the cell or do anything. Those are the kinds of concepts I’m talking about, is that stress or starvation will force those events in bacteria.”

    In other words, forget the silly warlike aproach (starve and hit). It does not work.

  5. Kate on September 12, 2015 at 07:32

    This is what he has been saying ALL ALONG. This shouldn’t be some aha moment for anyone. Eat a “normal” diet while treating, and modify as necessary after to prevent relapse.

  6. Sl on September 12, 2015 at 15:11

    Interesting podcast. The broken MMC and the greater odds of recurrence of SIBO being related to previous food poisoning in some cases were dots I have not seen connected before.

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