The Danger of Non-Digestive Symptoms in Patients with GID

And well, most GIS are just now learning about probiotics. Like he is so far ahead. It’s, it’s pretty amazing. Um, he’s medical director of the LA integrative gastroenterology and nutrition. Uh, his approach is not just holistic and I also, I don’t know what to call what we do. It’s also integrative, uh, he blends the best of Western medical, um, and scientific research, but the concept of whole body relationship to one’s health. And really, I think you just practice better medicine and continually does research and learns. And he’s so generous with his knowledge, uh, and lecturing of a country that draws huge crowds. Uh, he’s a big fan. He has the I’m told by my girlfriend the sexiest voice and the sexiest gastroenterologists in the country. Um, so I welcome, um, uh, Sam, dr. Rahbar, uh, thank you for being on the summit. Uh it’s uh, it’s pleasure, and looking forward to, uh, more interesting info from you.

Farshid Rahbar, M.D.

Well, thank you very much for that introduction. I really appreciate this invitation, and I must say that I admire the work that dr [inaudible] has done, uh, in, uh, providing the community with a variety services that is hard to get to, if you will, all under the same roof and, uh, you know, we can continue to collaborate with each other in that perspective. Um, so I came up with the idea of that subject there based on, uh, the significance that we had seen obtaining if more detailed review of systems. When we see a patient with digestive problems and issues come to us, they either have symptoms or they have conditions from a digestive point of view symptoms. 

There are about 10 symptoms like appetite, nausea, vomiting, abdominal pain, diarrhea, constipation, bloating, and sometimes bleeding. And the number of illnesses that may underlying these symptoms is over 300, you know, so there’s a lot of overlap. And now there’s, I’m learning that we rarely find a patients who would have a single entity problem. There was a time you go to the office, somebody to come with a strep throat, you give them an antibiotic kit and you’re done. And we just don’t see that anymore. We know that it’s a patient comes in, there must be an array of underlying physiological derangements that they need to be addressed, and to be able to address those and understand them. 

It’s very important to know what other symptoms, non GI, non digestive they’re presenting with. And as such, we need to be a good historian and be able to be a good listener. This has such an importance that we actually put our data together for over three years. And then we submitted this for publication and verbally. We have heard that the article has been accepted. However, it is this final steps need to go through. And once it does go through, then it would be available online, uh, you know, to everybody.

Kent Holtorf, M.D.

Uh, that is awesome. Cause it’s very difficult. And I know the lay people don’t know, but trying to get something published that isn’t just standard dogma, um, is very, very difficult. And if you come up with a new concept, it just gets poo-pooed and you know, and it’s tough. And, and, um, dr. BARR lives in an environment where he has, you know, works at Cedars. So he asked to, you know, deal with the standard physicians and, uh, you know, walk that fine line. So he, the reason he can do it, cause he has a lot of respect from those physicians. And, uh, and he’s doing a lot of amazing integrative that they’re like, I have no idea. So the doctor doesn’t know it’s, you know what it is, it’s, it’s crazy. It’s quackery. So it’s amazing that, you know, how many years you’ve been in that dual role where dealing in that hospital space and in your colleagues, in that area, and also in this, I think exciting integrative, functional, whatever you want to call it space.

Farshid Rahbar, M.D.

Thank you. And did you know, after a while, at least I can say for myself, that one learns to, um, be humble and be a student at heart and continue to be observant and learn from the experiences that the patients shared with us, that kid, nobody comes to my office, you know, unless they truly have a problem. So it is our role to see if we can dig into it and learn from that. And to this day, I must say that I still learn something new that I didn’t know. And that’s because somebody is willing to share their experience with us.

Kent Holtorf, M.D.

Yeah. And I mean, that’s a lot of doctors aren’t willing and, um, I mean, cut you off, but I am curious, like, how does it work with your like standard GI colleagues, you know, where they’re kind of stuck in the past to me. Um, and, uh, do you try to teach them or convince them, or is it not worth the trying?

Farshid Rahbar, M.D.

No, I would never say it is not worth trying. I mean, for colleagues that we have sat down and talked generally in an informal way, um, they, they made the notation of that and sometimes they run into a scenario where they say, Oh, you know what? This sounds like another patient that Sandra was saying, maybe we should look into it. For example, you have patients with gastro-paresis or cyclic vomiting syndrome, things that, you know, they don’t have clear explanations in the practice. We treat them, but we never know how did we get to that point? That definition had this type of problem. Um, and I think as we learn that our bodies have a lot to do with the way it interacts with environment and when things go wrong, I mean, their microbiome somehow gets affected. 

Their autonomic nervous system gets affected. The brain gets affected and a variety of symptoms start to manifest themselves. And as such, that’s why, you know, we like to pay attention to those other symptoms that they’re not necessarily GI. For example, I would say about half of our patients have an issue with fatigue. Usually fatigue is the predominant symptoms I may to a patient And I say, okay, you have digestive symptoms are non digested, but which one really predominates, what brings you here? And at times may say, Oh, you know what? My digestive symptoms are there. I’m really bothered by the non digest digestive symptoms. But the reason I want to come here, because I think maybe the GI is doing something to the other one that almost the patient has a sense that the correlation may be there, that an imbalancing, the digestive system may be turning on the inflammatory process and they’re feeding it elsewhere. Well, the problem is really originated from the, from the digestive tract. And

Kent Holtorf, M.D.

I think more and more research is showing that. And, but I think the compartmentalization of medicine now, it’s like the standard GI, like, okay, I’ll fix your gut. I don’t care about that. Other stuff you go to your family practice or internist. Yeah. Yeah.

Farshid Rahbar, M.D.

I mean, I’m sure that if the visits were modeled in a way that there was a lot more time allocated physicians would have time to spend to analyze these things here. But when I had practiced more of a traditional model, I mean, the approach would be problem focused the same way that is CPT codes. And the coding system is designed, which is basically based on the number of problems, problem one or two or three. And the approach would be problem focused as opposed to allowing one, to be completely holistic. Holistic is good, but it needs two things. 

One is the mindset and the willingness of the doctor and the patient to get into that arena of thinking. But at the same time in this time is an element of time to be able to do sharing and bounce back and forth. Okay. Sometimes it’s one sentence or one buzzword or something that brings a thought process that you want to pursue it. And diagnostically, I think it’s always important to know what we’re dealing with, because if we understand it, then we could be more focused what needs to be done. At least that’s the philosophy that I have taken. And that

Kent Holtorf, M.D.

I totally agree with that where I’d like to get a lot of information upfront and paint a picture. Right. And don’t hang your hand on any one test, you know,

Farshid Rahbar, M.D.

Exactly. I mean, as you know, I mean, there was no such test that is a hundred percent of all in rolled out. I mean, we still have to correlate what did the test means with their clinical picture? And that’s why it’s very, very important to, I mean, I recently had a patient. I think we chatted about this briefly. The patient has been ill for almost seven, eight years has been to multiple institutions and

Farshid Rahbar, M.D.

Lost weight from the range of hundred to the range of seventies looks cook, hectic, can’t eat, has abdominal pain and goes to the hospital for nutritional support. We did a mercury test. The mercury level was high or somebody who is 70 pounds. And number more than 10 is a high number. And at the same time, the line disease markers, for example, in this particular patient were positive, which was, which correlates with her travels to a lot of exotic areas. And his study showed that the antibody that was positive was the one that we called the IgM. And obviously it would be the experts in that one, which means that maybe this is something new, but the patient has been in for years. 

So especially this was started. Patients reported that you would believe that these are false positive, but there’s a 10 years story with a patient. You know, that the patient ended up in that clinical setting. I would want to just say this negative. Maybe there’s another explanation. And as we spoke to you the day, you know, we mentioned that perhaps the immune system did not get a chance to go through evolution, to evolve from that preliminary stage of IgM to died. And maybe there was an evolutionary block introduced, you know, immune system recognizing that yes, to, uh, to do this. And I believe this has been worth describing. It’s richer in many conferences I’ve seen with references, this had been address, but I cannot quite relate as how an infectious disease specialist would call this false, positive, not seeing how this may be correlating to this story. There’s a story attached to it, you know?

Kent Holtorf, M.D.

Yeah. It’s, I think, I don’t know, it’s influence where they can admit it because their colleagues will get on them or it’s giving into the so-called alternative area. I think you see that medicine, you have kind of the standard ivory tower, you know, doctors, and they say one thing and all this evidence comes up and it’s like a fringe group, supposedly evidence, evidence, evidence, or so like, you know, not, I LA I don’t see that. No, I don’t like that study. I don’t like that stuff. I don’t like that study. And don’t confuse me with the facts and they just refuse. It’s it’s nuts. And it shown that, you know, these people have terrible natural killer cell, low T H one immunity. There’s H one new stuff inside the cell tissue gets bounced to the cell. And these people are like this. Now, if you don’t have T H one, you can’t convert IgM to IgG. Now you give peptides or treat the infection. All of a sudden it switches the IgG. And so I think people we find, come up with IgM positive that is chronic. Uh, then I G and then IgG and they say, Oh, it must be a false positive, you know? Um, and it it’s crazy. They just don’t want to believe it. They don’t want to believe the literature. Uh, so it’s a very complex, I think,

Farshid Rahbar, M.D.

Right. And I think Ken, this would eventually evolve. I don’t believe it’s going to stay like this. I think the sinus eventually is going to pick up because the momentum of the number of patients who are ill is significant. And I think you just got to evolve. You know, I’m not sure it’s going to be in our lifestyle. If this is going to evolve, it’s just, I’m surely not going to stay like this. Um, but going back to the symptom complex, you know, you put a comb with headaches, you know, weights, laws, air laws, visual problems. I burning tongue burning, skin rashes, you know, an idea of these other things they pop up as when you speak to somebody who comes with digestive manifestations, I think to do a symptom, need to be studied.

Kent Holtorf, M.D.

So what are the most common digestive symptoms people come in with?

Farshid Rahbar, M.D.

I mean, the common ones, believe it or not. At these half of our patients, they have excess gas bloating. And what I call signs of symptoms of God’s fermentation. And these are generally associated with some level of malabsorption, which may end up into, uh, another step of micronutrient deficiencies, but it may also end up into, uh, stimulating the immune system causing mass cell activation and symptoms that are related to the mass cells. They’re basically one will lead into another scenario

Kent Holtorf, M.D.

Cycle. Mass cells are becoming, uh, you know, much more, uh, like in the forefront of all these problems and what percent of people that come in with a GI problem. Do you find other systemic symptoms

Farshid Rahbar, M.D.

Again? I must say that my practice over the last 15 years has evolved again. I tend to attract patients who might have been a little bit more complex. They think it may be accomplished would be not to other physicians. So, I mean, I would say, give or take probably 80% of what a patient, they have non GI symptom

Kent Holtorf, M.D.

Because they’ve been scoped a hundred times and yeah, yeah,

Farshid Rahbar, M.D.

Yeah. I mean, usually, I mean, we are getting some frontline there’s coming. That is, Oh, I want to go directly to more integrative model or holistic model. So somebody could look at everything together. And we’re seeing this more and more, and interesting is more of the younger population that is making that connection that maybe they, they want to have that approach of is possible for them. Um, but by the time they get here, I think a lot of our patient, they have non digestive manifestations. And I think it, these will give us a little tale what might be underlying this year and generally is an environmental issue. I mean, obviously you’re right. You should have such as, you know, stress, lack of sleep, eating a lot of sugar. I mean, all of those things and alcohol

Kent Holtorf, M.D.

I’m in trouble.

Farshid Rahbar, M.D.

I mean, excessively, I mean, all of those things, they have a role, but we’re seeing now beyond that, you know, a lot of our patients already, they’re intelligent, I’ve done the research, they’re doing the right things. Many of them gluten free or dairy free, or sugar-free, you know, I’m not able to go to say which more free. You gotta be calm. We have to see you. How did I get to this point? Okay. And I remember I had one patient who came from New Jersey one time and said, what’s the problem. He said, look, I can’t really eat anything. I’m down to lettuce and chicken. Okay. So obviously something like this has know significant degree of intestinal permeability issues that is reacting to that degree. And I speculate

Kent Holtorf, M.D.

And through and causing all this inflammation, vicious cycle.

Farshid Rahbar, M.D.

Exactly. I’m going to talk to you a little bit more about that, but just to finish your story, I mean, I said, well, where did you leave? I said, well, you know, I live in East coast and I said, well, do you have a backyard? Is every backyard? Do you have animals? Yes. I personally love doing gardening as animals and out into greenery. And it’s very likely that they picked up something. And the testing that she brought clearly showed that there was an evidence of an infection there that could explain this when you compare it to the other patients. Um, but there remains the question as how, um, how do you make the diagnosis and what is, what is the thought process that we think? 

And if you look at this study by the Canadians, uh, a few years ago, they look at women with irritable bowel syndrome and they use, um, some sort of microscope that goes through the end of school. And they looked at the number of holes in the gods that they inpatients who presented with IBS or irritable bowel syndrome. And they called this extrusions, or I call it dropouts or cracks in the wall. I mean, that’s the term actual like holes. Yeah. What happens that there are cells that they’re basically die off or shed, and then there would be an empty spot. There it is the STEM cell at the bottom of the lining of the gut that has to rapidly replenish that and fill up the gap. And in animal studies, that turnaround is about 15, 20 minutes. Well, that’s a very fast turnaround. You need a lot of amino acids, nutritional fat, the strongest STEM cells, good immunity. And if you don’t have that, there would be more holes going out, not enough fitting in, you know, like,

Kent Holtorf, M.D.

I mean talk about leaky gut, but it seemed like they even get septic. You know?

Farshid Rahbar, M.D.

Well, I mean, we’re not talking about the leaky gut in an institutionalized scenario, talking about, you know, things that have gone wrong. And again, with the increased intestinal permeability or the so called leaky gut, which is now in even traditional, you know, medical journals, this term is being used at Mt. So, you know, reserved about using it. Uh, the, uh, um, there are several mechanisms for that. I mean, one is that you can have this cell have a problem, so things can leak through the cell. Then you can have the settled, our space, the space between the cells and where the tight junctions are. 

And another one is actually this scenario of dropouts, where you have cells that they’re shooting off, there would be a bit like one brick of the wall is gone, but there’s not adequate time to replace that. Okay. That needs me is, you know, what you do to stimulate the STEM cells? How do you support the proteins that they put the tight junctions in together? Again, because if we work on doors, we may give the patient a better chance to reduce their food reactivity or skin rashes and fall it. And it’s not an easy task and it does take time. But I mean, that would be the thought process to think about it, the storage from there.

Kent Holtorf, M.D.

Yeah. Cause like, you know what, the food sensitivity testing, we have some people that like, they have antibodies to everything, you know, so, you know, their gut is just so permeable and, and how would someone have basically malabsorption? Can they have malabsorption and leaky gut,

Farshid Rahbar, M.D.

Right? No, of course you can have both of them. And the leaky gut is really just a general term, which means that the lining is not completely intact and is turning on the immune system reacting. But generally that comes from a reason. The reason is commonly infection next to the wall, which could be a bacterial or fungal overgrowth of parasites with a combination of dose. Then you may have even heavy metals floating around. You can have toxins or mold being around and adding to the fungal overgrowth if you will. Um, and sometimes there are additional infections in the body. Something we call the stealth infections with cryptic or hidden infection. And that’s the concept that it is not well acknowledged at this time traditionally. But I think for some illnesses, some bugs, you know, it is known, but not across the board. And I think eventually this is going to evolve. But patients with this stealth infection, they commonly have evidence of permeability issues.

Kent Holtorf, M.D.

Yeah. I think that’s the problem. So many effects are hard to detect. Um, and you, you mentioned fungal and I think standard GIS, they don’t even believe in it or, or can you, uh, talk more about fungal overgrowth in the gut? How what’s your suspicion? How do you diagnose it? How do you treat it? Because I think that’s a big issue that, um, a lot of people have issues with their field. They do, they read about it. How do you approach that? Or what do you see? What, what makes you think someone has like fungal overgrowth or a fungal issue? Well, I mean, I think the first step is to listen to the story and this story can tell us about the risk factors. And I think that’s, you know, that’s going to guide us, okay, this could be a reality. 

For example, a woman who might have been on birth control pill, or maybe receive the steroids or antibiotics who was under a lot of stress. I mean, this becomes a potential scenario for a female that can start to accumulate fungal elements in the gut. The small bowel is generally very clean and doesn’t really have high number of these bacteria or fungal element. But when somebody comes with gas, bloating, rumbling noises, burping, flatulence, I mean, those are signs of fermentation. The gods is not clean now, conceivably, when you look at, for example, a child that is born and child may have thrush in the mouth, well, that’s a nice and warm environment and this, the immune system could not handle it in a newborn and the mouth got thrush. Well, there’s no reason not to believe the same thing cannot travel further down in the gods. And in some instances where the fungal elements become invasive, somebody may be quite ill and may have a fever of being an intensive care unit. 

That type of scenario is well recognized in the classical books and is there, but the model that it will look more like your functional model, there is not adequate testing for it. So it’s another difficult to diagnose. It is hard to pinpoint. You really need to know the story. You have to be a good clinician and you need to be able to open to the possibilities and see what happens. I mean, we started to look into this, you know, and I remember when I walked out of the conference and the anti-aging medicine and there were two hour presentation on this, I didn’t, my head was spinning. You know, I said, well, I’ve never heard of them, somebody like this, I got the book and read it. And I said, well, maybe it is, let me try it and see what happens. And we realized that this is actually quite common scenario. Now there are things we can do to, we can do to build this substantiate that idea, but nothing is generally going to necessarily replace my clinical judgment. That’s still, I mean, I think that’s the first thing I trusted. 

And then if I can get some support is nice because the patient would also be happier to see that we do sometimes antibody against fungi. And now they’re laboratory that they do antibody against numerous from that. Whereas some of the labs such as quest or lab Corp want to have like one or two antibody models, views, but you can go elsewhere and get more. We can look at organic acids and we can do almost eight or 10 different markers of fungal dysbiosis in the urine that could be supportive. I’m not saying, is it hard and fast rule, but it’s painting the picture. Yeah. I mean, if the story fits that if the story doesn’t fit, if somebody says, I feel fine, I don’t care about the test. Okay. But if the story is there and that would be supportive, um, I’m also a believer that, um, you know, sometimes fungal growth industry samples as significance, especially in a male patient, I have not seen any male patient with presence of fungal elements. 

That feels good, usually in a male patient. And it may the patient not in a woman because they’re, well, they have estrogen or hormone. There may be more stressed. Maybe it’s more, the environment could be more conducive to growth of the fund guy, but in a male patient, to me, if I see fungal growth, even in the small amounts, in his true sample, and there are specialized labs that they would do, it is not every lab is capable of doing this.

Kent Holtorf, M.D.

W what, what lab, uh, you can say like, well, what labs do you like to use? What, what, uh,

Farshid Rahbar, M.D.

Do advocate any Portugal to that, but I can tell you that generally the one that has been most helpful as far as growing these elements is the doctor’s data is somehow they do allow these Congo to grow their report. What type of panga you can see. And as it started to look at hundreds of these samples, I was coming across names. I’ve never heard of these, you know, fun guy. And then when I looked him up, I said, well, this is an opportunistic fund guy. You see, after kidney transplant or liver transplant in an outpatient practice, where do I, why do I get these elements growing in people’s bodies? Um, so it may be at a telltale again. I don’t think anybody should go with one element story here, but you put the pieces together. It may tell you that. And sometimes when you see this, you have to say, what’s causing the immune system to be challenged. Is it alcohol? Is it a stress, lack of sleep, bad eating habits, you know, or is it presence of toxins or mold? Maybe somebody was exposed to more the environment and you know, more toxins or immune suppressant promotes the growth of their own species. Okay. Like, I’m just going to do, I got to like to grow my own species. So they created a million that would support that. And one of the things we said,

Kent Holtorf, M.D.

See these things, I think everything just exploding, I think 20 years ago, there weren’t that many people now. I mean, just you go to a cocktail party. I mean, if you only talk to people like everyone’s sick or their family members sick, or their friends sick, um, and they’ve been to multiple doctors, I mean, these multi-system illnesses are just like talking about pandemic. I mean, I think it’s, it’s just crazy. And they’ve, they just are told that, Oh, it’s psychological. Just live with it type thing. You know,

Farshid Rahbar, M.D.

I’ve heard that too.

Kent Holtorf, M.D.

She liked, you know, with the, with the fund, I’ve heard GI say, Oh, if it was Fargo, they’d be in the ICU, you know?

Farshid Rahbar, M.D.

Yeah. That’s the, you know, it’s really a spectrum and the end of this spectrum is easier to see it. But when asked to be really ill and in our practices, obviously we’re not coming across that. Okay.

Kent Holtorf, M.D.

Yeah. That’s not medicine. It’s not like all or none. Everything is a continuum.

Farshid Rahbar, M.D.

Exactly. Yeah, of course. I do know what about at a lower level? Could that be a factor? I mean, something which was really interesting and we sent the, I gave a podcast with this with dr. Jacoby on a CBO conference was the relationship we had seen in patients who had Mateen. Yes. See a tour under breath testing. And it’s always a puzzle as how people really have access maintain. And we talked about Coleen, which is, you know, and carnitine stuff that you get in food and like egg yolks and red meat. And these that can increase the T M a O they somehow they can also increase the methane production at these based on what we have seen. But, so it was very interesting was presence of guy that when there was access, maintain, we could see some evidence of fungal scenario, not a fungal infection, a fungal tsunamis. 

I do, maybe somebody, a Sue sample now showing fond guy, but on the breath test, I’m seeing presence submitting. So when I looked into this, I did one search and I looked for an article to see, what does it take to grow meeting in the lab, RKO or kid who was, you know, small creatures, how do you grow this thing in a lab? And some people gurus of Buddhism PhDs, they came up with it, image of you, or some sort of concoction, if you will, that it will allow this thing to grow. And I noticed that part of that, there were fungal elements involved. And then I studied it a bit further. I lose that fun by the like oxygen. So they’re going to suck the oxygen on the other hand are chaos. 

They need to be anaerobic. So is a product match. Okay. So to really treat them, you know, if you see a lot of maintain, you have to think, where does the fungus, you know, black yet, maybe one is feeding the other. Maybe that’s one of the mechanisms. So, yeah, it was fun just to bring it up. I mean, obviously this is a great subject. If somebody is open to study it at the university level, okay. Beyond the private practice, you know, offerings that we do and see it. But you know, I’m a little bit sometimes reserved about treating meds handed with antibiotics. If I perceive that as a presence of fungus, because theoretically you can make the other one worse. Theoretically, I’m not saying that this is okay,

Kent Holtorf, M.D.

That’s interesting. Or I was reading some studies on, you know, C diff and pseudomonas that they need Campylobacter, Juni to grow, you know, and, you know, C diff could be very difficult to get of. And, but if you kill this other one, then you know, it may go where there’s all these symbiotic relationships, so kill one, then you get rid of the other. Um, it’s interesting. Uh, it’s interesting, like how little we know, you know, it’s like, like the more you learn, the more you learn, you don’t know and all this stuff that’s going on, you know,

Farshid Rahbar, M.D.

Exactly. And no, I think, I think it’s good that one stays open to possibilities and, and see what, you know, what comes up and just have you be the concentration. And, um,

Kent Holtorf, M.D.

So currently when you get a methane positive, uh, what, what’s your typical treatment or what, what do you, uh, do the further workup or

Farshid Rahbar, M.D.

First of all, if the first thing is that, you know, if I see somebody with high med sane is what are the level of symptoms because occasionally, you know, patient may have very little symptoms. The admitting is high, and I’m not sure if I just want to treat all of that, you know, just to get rid of some small level of symptoms. It may be that that business admitting is working as a biological marker that tells me there’s another layer behind it. That’s okay. What other symptoms are going on? Is it the fatigue? Is it the headache? Is it a sweating? Is it a skin problems or somebody has Metting, but they don’t really have constipation. They have more of a diarrhea problem. That’s music. There’s some other player into that. 

Uh, uh, maybe going on. So first we have to decide if you want to treat it or not. Right. Additionally, the good research shows that if use, I, you know, Rifaximin and new Miocene, that works in about two out of three cases now in our own practice, if I see some, maybe there’s a fun guy, I probably would address the phone guy first. And I made some dietary changes, like the ones that we mentioned in addition to the reviews, the level of maintain, and then I subject efficient to treatment. But I do give the patient generally an option to see if they want to go traditional or they want to go nontraditional.

Kent Holtorf, M.D.

I love that you work with the patient and that turns out patient. I’m not going to tell you what to do. I’ll give you advice and give you info, but it’s their body. And have you treated with the methane patients? Like just let’s say antifungals and see what happens?

Farshid Rahbar, M.D.

Um, no. Okay. I mean, I cannot say we have done that at least in a structured way of doing it, the concept, which really fascinated me, and this was one of the doors, but when we looked at our patient population, almost 80% of them, they had some level of Congo, either the organic acid was abnormal or they had antibodies or were treating them for fungus or somebody else was treating him. There was some fungal scenario and this meeting and in those cases, I rather make sure that the fungal element is somewhat, is under control. I am not convinced that if you just treat the fungus, then maintain is going to go away. And that’s why other, other players, I mean, and if you look at the, a and B back in 2014, 2015, I shared in a 10 minute presentation that we we’re seeing a lot of CBO patients showing evidence of positive serological markers for Lyme disease. 

Now the word chronic Lyme is not recognized and I cannot type in the computer. And my electronic medical record is not going to give me a diagnosis like that because not recognize still there, but great practitioners. There’s probably like ourselves that they do believe these infections can become chronic. And they modify the immune system and the presentation would be something like a persistent CBO or the recurrency bowl, or my CBU doesn’t go away. Or my numbers are really high, or I have cebo and I have a fungus. And which one do I treat as if it was either one or the other? I mean, this is where you have to think like an onion and the layers that, you know, one has to delve into.

Kent Holtorf, M.D.

Yeah. I mean, it was on a, um, a CBO summit or presentation. And I said, well, I think CBOs more of a symptom. Oh my gosh, the host got so mad because you know, it was CBOs, the cons of everything, you know? And I go, well, yeah, but it’s a chicken or the egg, you know, like why did they get the CBO? Because they got gut dysfunction from something else going on. And, uh, they didn’t want to hear that, which is funny. Um, but, uh, uh,

Farshid Rahbar, M.D.

And then in harmony with what you said, um, um, you know, one of our slide presentations, we did mentioned that certain patterns are seaborne, how they respond to the treatment. It will tell you that there may be another layer behind it. And indeed we prepared that to beat you and, and I’ve put it on a website at no charge is available to the patient to be able to see that, you know, you can divide CBO based on hydrogen and methane and hydrogen minting and hydrogen sulfide. But how about if you also give it a pattern based on the response to the treatment? You know, I just have a CBO. I took a course of Rifaximin and it went away and that model, I called it the easy rider based on the movie from the 1960s, you know, the easy rider. 

But, uh, um, there are other parents that I called a relapser or persister or a blended could, you could be a blend with the, with a fungus, you know, in kid or not a pattern I called it in congruent means that you treat the CBO, the CBO goes away, but the patient doesn’t feel better. That means that there’s a lack of clinical correlation with the test. And obviously that means that there is another player into this. Um, and there are many interesting cases that we have come across. Some of these, we put it in that presentation, uh, for people to see.

Kent Holtorf, M.D.

Yeah, that’s awesome. Uh, well, uh, what is the website that people can go to?

Farshid Rahbar, M.D.

There’s my website, the LA integrative gi.com and the video is right on, um, on the first page of the website. I mean, this is the presentation I gave at the CBO conference, but they were willing to work with me for me to receive that one bag, um, as a tradeoff on the, I can put it at no charge for the patients.

Kent Holtorf, M.D.

Yeah, no, which is nice because when normally, uh, for everyone doesn’t know when to give a talk at a conference, they own that. And so it’s rare that you can get that back and put it up. Um, so that’s awesome. Um, say your website again,

Farshid Rahbar, M.D.

Integrative gi.com.

Kent Holtorf, M.D.

Great. Great. Um, and let’s see, what, what typical patterns do you, uh, really kind of like alarm bells for certain conditions?

Farshid Rahbar, M.D.

I mean, um, you mean as far as the CBO pattern or, um,

Kent Holtorf, M.D.

Just like anything like where you see someone comes in with irritable bowel, with diarrhea or whatever, and a headache or are what, what patterns,

Farshid Rahbar, M.D.

Right. Is the know if you look at the GI symptoms and somebody has alarmed symptoms, they’d see wage loss or can’t eat or difficult to swollen in gastroenterology doors are alarm symptoms. Then obviously it requires investigation, but you can also come up with sets up alarm, same tone to the non GI or symptoms. And I think energy to me is one of the major factors in that, because it suggests mitochondrial dysfunction and, uh, you know, is, you know, when you look at the economy of energy and the person, if the energy level is retained unit, that prognosis is generally better. 

So it’s one of the that we ask Them is one of the areas of the target to improve the performance functionality and the energy though. Uh, but other things is sleep patter, anxiety, inability to fall asleep. Many of these things suggest that must be that you have mass cell activation release of histamine or other mediators. And these, this is not something that came overnight. There’s a whole, probably an array of things that went wrong in the background. And we need to see how you can reverse that. And at times you can’t do a testing for mass that activation, um, and it may show, but sometimes statistic may not show that you’ve had some clinical judgment,

Kent Holtorf, M.D.

The tests are so basically sensitive. And like what percent of patients let’s say have SIBO or just, I mean, and are totally fine. You know, nothing else you need and like where it goes along with you treat it and it’s gone forever, whatever, like what percent is that versus where, Hey, there’s other stuff going on?

Farshid Rahbar, M.D.

You know, um, if you asked me this before 2005, probably about half of our patients, we treat them, they say, thank you. And they’re gone. We’re not seeing that anymore. I mean, interesting dude, if you look at my presentation, I put the question to the audience who are doctors. And I said, that patient comes with CBO. What is your confidence level that you’re going to treat this patient? And the problem is going to be resolved. And I can tell you that too, you know, overall the confidence level is low because there are so many confounders that one has to understand how did the patient get to that point? Okay. And to see what may be just the tip of the iceberg. Um, and I would say about maybe one out of three probably would be fine, but two out of three, we’re going to have to continue to deal with scenarios.

Kent Holtorf, M.D.

And before 2005, it was just, Oh, you got CBO treated.

Farshid Rahbar, M.D.

I mean, it seems that they respond well there without, I didn’t have to worry about too much. And you have, can see, what is it that population has changed. The illnesses have changed. How am I seeing a different type of patients come into the office is hard to know. I mean, maybe they were not just, they didn’t have that many involvements, but we’re not seeing the same thing again. And I, I think other docs are relating to that as well.

Kent Holtorf, M.D.

Yeah. So I think, yeah, I think it’s so multifactorial, I think too, because watch what you get good at, you’re getting, you know, known for all these complex patients. So you’re going to get those, but like you said, other standard docs are seeing it too, where, Hey, what’s going on. I used to just treat the CBO and went away. And now, now what does it, um, so what kind of tests do you do, uh, for these patients?

Farshid Rahbar, M.D.

Usually the common tests that we do is a comprehensive food sensitivity and allergy, destiny, at least occasional use, uh, allergist, but, uh, you know, for the ease of it, we may just choose to IgE mediated allergies. And then we use the food sensitivity models. A lot of labs ordered that. And nowadays we focus also on, um, uh, hepatitis that are in the wheat because people may be reacting to the minor molecules and doors can give us an indication that some components of the grains that they overlap, they may be driving the inflammation. But as a general rule, the more of these colors, you see reactions, it suggest that probably more holes or cracks or function of the tight junctions. And the question, how do you return that back to normal? How do you manage a leaky gut problem? Other tests we do again, organic acids, comprehensive stool analysis, heavy metal testing, um, CBO breath, testing, stool culture, and assumptive by PCR.

Farshid Rahbar, M.D.

We have also done some work in obtaining intestinal juice from the upper GI tract and is a fascinating area for us. I mean, examples of these in that video presentation. And, um, I remember, um, a few years ago we had one patient who was having epigastric pain and it would not go away when we looked there was bias in the stomach. And I speculated that divide in the stomach is probably backing up because they’ve got, is not clean. And that means it’s not being, could be parasites, found guys CBOE, and the patient didn’t have CBO. And there was evidence of a parasite as well. Uh, that was picked up by the testing model.

Kent Holtorf, M.D.

And that’s hard because there’s so much, yeah.

Farshid Rahbar, M.D.

I mean, you have to be patient and use some what I call it, clean catch technique kit, to be able to update the dentists on Jews and send it for microbiology using PCR technology. And it just happened that some parasites, DNA, but picked up.

Kent Holtorf, M.D.

Yeah. Uh, and I think, yeah, parasites are such, I think so much the bigger thing, and it’s a, maybe too much information, but they were at a friend’s house. I like the dog. Look, I get paid some Bret Coon poop. So I’m looking like, Oh my gosh, all these parasites that they get. So I’m like order did all these empty parasitics, I’m going to start taking some of myself. And, um, yeah, it’s, it’s scary. What’s out there. You know, and people who travel, I think it seems like everyone that goes to India comes back to the parasite. Um,

Farshid Rahbar, M.D.

But the challenge is that you can’t always find it in a stool sample and the patient may end up with upper GI symptoms, more pain in the upper abdomen, burping bloating, discover something that in medicine we call functional dyspepsia, but is a term that we don’t really going to sound like you, what is it? You know, like some of us may have H pylori, Helicobacter, pylori, but a part of our patients that is a portion of them. They had contamination of the beginning, part of the small bowel, bacterial fungus, or Paris city, or a combo. And this causes a backup of the contents into the stomach. It irritates the stomach. The look truck is a stomach problem. What is it downstream? The downstream problem. Yeah.

Kent Holtorf, M.D.

And do you find that BPC one 47 helps sec cause it tightens the lower sphincter or tightens the upper, but it’s, I guess still the lower sphincters kind of relax. Let it go. So it’s still a could backup in there. Yeah.

Farshid Rahbar, M.D.

The BPC one, five seven is very helpful in many ways. First of all, it has a general antiinflammatory effect. It has protective effects on the gastric lining and it also has protective effect on the intestinal lining. I mean, I always say that thinking about it, of whatever surface needs to heal, how will it be BPC one, five seven works with that. And I’d mentioned this previously in our personal conversation that we had so much interest in this 15 amino acid peptide that back in 2017, I went to Croatia to meet with them.

Kent Holtorf, M.D.

Yeah. Go to the source.

Farshid Rahbar, M.D.

Yeah. And I still have the VGO that, you know, he took me around to show the animal, the studies that in his lab, but the research, this is actually goes back to the 1990s where they even did something to studies on as offer Julian mucosa, where you put acid on his opportunity. Cause that causes damage. But if the mucosa is treated already with BPC one, five, seven, then presence of the acid is not so much damaging to the, to the lining. And we use that concept with treats some of the patients with gastroesophageal reflux disease. I cannot tell you exactly what impact it would have on the sphincter pressure, because I don’t have the day job if you do, please educate me. But I do believe that it does help with the surface healing and indirectly, I can say that that’s going to help to improve the esophageal sphincter tone because the more damage you have to do doors, I’ll just swing to more inflammation means that probably more malfunction of the valve. And that translates to a vicious cycle that is going to go on

Kent Holtorf, M.D.

Kind of like everything’s a vicious cycle, isn’t it. And you have the, um, interview we just did before where we talked about BPC, um, she’d expert in public often continents that the BPC was shown to basically stop, uh, uh, stress incontinence, you know, the sphincters relax. And so it seems to be very good at healing, the sphincter tones. Um, I’ll, I’ll, I’ll shoot you over some studies on that. Um, it’s interesting. And then, um, I think you’re just kind of starting to play around with the TB for a frag, which, uh, studies show helps the tight junctions heal the tight junctions. Um, I don’t know how much you’ve noticed with that or

Farshid Rahbar, M.D.

TB TB. Fragged four is also something we have incorporated particularly, uh, when there’s an imbalance in the immune system. For example, if the T H two is very active, you know, and then we’d like to see that, you know, that, and that may help to reduce food reactivity, for example, or pains or aches or the joint inflammation that come from that. And I think it works well in combination with the BPC one, five, seven. Okay. The combination of both it’s good. And if they want, can take it before meals the morning or the afternoon, um, you know, at one point that could be incorporated into the treatment regimen.

Kent Holtorf, M.D.

Yeah. Because you look at the effects are kind of similar, but they’re different mechanisms. And, and we were doing the TB before with STEM cells because they boost STEM cell function. And we had a little miscommunication on know, you know, but they were giving a whole vile to patients. And, uh, and I’m like, Oh my gosh, you know, I’ve been doing it for a couple months. And I’m like, well, there are side effects that no one said people with, like on fentanyl go, Oh my God, my muscle pains gone, you know, and really a immune modulator and also heals traumatic brain and, you know, um, uh, heart, all those things. So they’re very similar in, in helping healing, but a different mechanism. Um, and, uh, just curious, when you see the methane producers, what percent do you think is a lime or a tickborne or, um, that type of infection or,

Farshid Rahbar, M.D.

Well, our practice is significantly with patients who have been bitten by vectors. So when we looked at our data, I can say that, for example, in the last, probably 10 years, we have a screen around maybe 15, 1600 patients will vector borne illnesses. And I would say about a third of those patients has over 500 patients. They have had clear evidence that is such infection present because you also have the borderline serological markers about, uh, you know, there are times that the markers are not borderline anymore quality.

Kent Holtorf, M.D.

What test are you using for that?

Farshid Rahbar, M.D.

I mean, it depends on the labs. I mean, there are several labs that we use. I mean, depending upon patient’s interest interested budget, I mean, I can use even sometimes traditional labs, we use genomics to use vibrant health. We may use it advanced lab. I mean, there are different labs and just depends on what we’re dealing with. I’ve also recently used the there’s some, the German technology, um, you know, the lab is in Minnesota. Um, that’s a cellular reactivity looking for interferon, gamma and audio to release from the lymphocytes when they are put in proximity of the box, when maybe is a mind, bacteria is Bartonella or Babesia, you can see some level of reactivity. And occasionally I use that as a backup plan in case I’m suspecting the other test, didn’t pick it out because as there is no test, that is a hundred percent in the, I mean, the only thing that creates tenacity, you know, to keep going is just listening to the patient and just believing that there’s something is wrong. They’re not just making up a story.

Kent Holtorf, M.D.

Yeah. And, and it’s probably a, the patients have been, lot of times the many doctors spend a lot of money and, you know, trying to help. So it’s, yeah, it’s, it’s a fine line. Some like now we’re even picking up stuff on standard quest and lab core, which nothing was ever positive. And now we’re finding, you know, bands that are, you don’t see a normal people, you know, it’s like less than 1% of normal people, but considered a negative. Okay. Well, with less than 1%, normally we’ll have it where to come from, you know? Right.

Farshid Rahbar, M.D.

We don’t actually having the same experience and we’re seeing more positive markers. And again, is it the patient’s responses that are different or the laboratories technologically are doing something differently, but I wouldn’t call these false positive. I mean, I need to know what the story is that goes with it because for somebody who has been chronically ill, you know, I mean, I mean, I can’t just say, Oh, this is a psychological problem, you know? Yeah.

Kent Holtorf, M.D.

I, even, if we see a 41 kilodalton band on a patient on quest or lab Corp, I don’t think I’ve had a patient who didn’t end up having Lyme, you know, that’s considered the most likely false positive and dah dah, dah, but when they have the symptoms, okay, you know, something’s going on. And if you dig deep enough yeah. You’ll find it. And they end up nail having it, even though the standard test, they call it negative, you know, but there’s evidence of something going on. So,

Farshid Rahbar, M.D.

I mean, it should, at this, it could be a discussion that a person might have been exposed to that environment and maybe the immune system is handling it, but there may be something else

Kent Holtorf, M.D.

Is, is huge, is like, you know, we checked immune system when that’s off. Okay. It allows us to show the patient, Hey, there’s something going on. So we got to now dig deeper. And that’s what sounds like your process start there and keep going, uh, tenacity, as you said,

Farshid Rahbar, M.D.

Exactly, was going to hang in there. You know, you’re good.

Kent Holtorf, M.D.

So, uh, yeah, you’re treating these complex patients. It’s a gift and a curse. And, uh, and so, uh, yeah, like kudos you for helping these patients that I know the patients that come to you, a bend everywhere, oftentimes, you know, and, uh, and you get them better. Cause I hear from him,

Farshid Rahbar, M.D.

There’s one of our best, let’s put it that way.

Kent Holtorf, M.D.

So it’s nice and always taken out of the box. And, uh, uh, you’re just such a pleasure also to, uh, uh, speak with, always learn so much when, when I talk to you and, uh, I’m proud to say you’re, you’re a friend. Uh, so I, I thank you for being on, I think it’s been great. Uh, I think people will get a lot out of this and uh, just also learn, Hey, there’s hope, you know, and because they’ve been told by 10 doctors that, uh, nothing’s wrong with you that, Hey, go to bar, you know? So, uh, thank you. Thank you. And I thank you on the half of B patients that you see as well. So thank you very much. I appreciate it. It’s great. Thanks so much. Bye bye.