#007 Dr Rui Lopes - The Innovative Breath Test for SIBO, IBS and Gut Health
vitalityPRO
#007 Dr Rui Lopes - The Innovative Breath Test for SIBO, IBS and Gut Health
Dr Rui Lopes is a medical Doctor and Clinical Researcher. Rui’s clinical experience as a physician has allowed him to successfully develop a career in clinical development and research, where he has worked extensively in gastroenterology , respiratory disease and several other therapeutic areas. Rui now leverages his clinical expertise as a Medical Advisor for Owlstone, to guide and advise the development and implementation of healthcare products.
> During our discussion, you’ll discover:
(00:01:16) Who is Dr Lopes
(00:03:57) What is SIBO, and how is it diagnosed/treated
(00:22:33) Ketogenic or low FODMAP diets for SIBO
(00:24:44) Antimicrobials and other alternative treatments for SIBO
(00:28:38) The future of breath testing
(00:30:27) When and how to use Probiotics with gut issues
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Transcript
Hello everybody and welcome to the vP Life podcast brought to you by vitalityPRO.
Speaker:My name's Rob and I'll be your host on today's episode.
Speaker:Today we're joined by Dr.
Speaker:Rui Lopes, a medical doctor and clinical researcher who leverages his expertise
Speaker:as the medical advisor for Owlstone Medical, a biomedical company that
Speaker:is aiming to revolutionize the way we test GI disorders including SIBO.
Speaker:During today's episode we take a deep dive into what Owlstone
Speaker:are trying to accomplish and how their breathalyzers work.
Speaker:We then take a step back and explore the world of SIBO, what it is and the various
Speaker:treatment options that are available.
Speaker:As usual we get through a lot in today's episode so be sure to
Speaker:check out the show notes and the transcript should you need them.
Speaker:And I'd like to ask you a little favor.
Speaker:Our podcast is slowly gaining traction and we'd love it if you could leave us a
Speaker:review wherever you listen to podcasts.
Speaker:This will help us grow, reach more people and allow us to host future guests.
Speaker:And with that, on with the show.
Speaker:Hi, Rui.
Speaker:Thank you for joining us on today's episode of the podcast.
Speaker:Would you just quickly like to sort of introduce yourself, who
Speaker:you are and what it is you do?
Speaker:And then we can just sort of take a deeper dive into OMED health as well.
Speaker:Yeah, perfect.
Speaker:Yeah.
Speaker:Thanks, Rob.
Speaker:Uh, it's a pleasure to be here.
Speaker:So, um, The journey where I am today until, um, getting to
Speaker:Owlstone has been nothing but typical for a doctor usually does.
Speaker:Somewhere along the way I kind of drifted away from the NHS, but I started
Speaker:as every doctor starts, completed my studies, um, started working in the
Speaker:NHS as a physician, and I've been there for the past six, seven years.
Speaker:And I've always had this very traditional path for my clinical
Speaker:training and my specialization.
Speaker:But the interest for research was always there for me.
Speaker:And around two years ago, motivated a great deal by the fact that
Speaker:I have two young children, I transitioned onto the industry.
Speaker:And for that, I've leveraged my research knowledge and my clinical experience
Speaker:across a variety of therapeutic areas, including gastroenterology, where I'm now.
Speaker:And this became extremely useful for my role as a medical advisor
Speaker:at Owlstone um, it's a great role.
Speaker:It's a great place to work, uh, particularly when you see the cutting
Speaker:edge research that we produce in breath analysis and, and biomarker analysis.
Speaker:And this grants us the status of, uh, world leaders in breath research, really.
Speaker:And OMED is, is just a brand of Owlstone where.
Speaker:We're pioneering these new breath technologies, such as the OMED
Speaker:breathalyzer, this portable, precise piece of engineering for the monitoring
Speaker:of GI disease, such as SIBO and IMO.
Speaker:Before we sort of dig a bit deeper into OMED, let's just sort of Discuss a
Speaker:bit more about your sort of foray into gastroenterology, what sort of made you
Speaker:choose that as a speciality or what sort of do you to that field specifically as
Speaker:opposed to, I suppose, endocrinology or?
Speaker:Yeah, so I've done throughout my, my clinical training.
Speaker:I've, I've had exposure to lots of, um, uh, therapeutic areas.
Speaker:Gastroenterology was one of them and I've done a lot of research, uh, particularly
Speaker:in, in biomarker analysis in IBD and IBS.
Speaker:And that was really the one of the most interesting pieces of
Speaker:research that I've conducted in the past, in the past few years.
Speaker:And that was a big selling point for me when, when, um, the
Speaker:Owlstone role came, uh, to play.
Speaker:Because it, it landed perfectly with, uh, my experience in biomarker,
Speaker:um, analysis and discovery.
Speaker:Uh, because it's, it's the mainstay of, of, of Owlstone.
Speaker:This, uh, breath biomarker identification and research to try and, and create these
Speaker:new expedited pathways for non invasive diagnostics of very complex diseases.
Speaker:Okay, fair enough.
Speaker:Well, let's dig into the nuts and bolts of it then.
Speaker:Um, I think a lot of people have heard of SIBO, but maybe not a lot of people
Speaker:actually know what it really is.
Speaker:I mean, there are a lot of acronyms out there.
Speaker:You have SIBO, you have SIFO.
Speaker:There are various different types of SIBO.
Speaker:Um, you, there are very different, various different ways of obviously testing it.
Speaker:But just sort of add from a sort of a 50, 000 foot overview, what
Speaker:is SIBO and who does it affect and how is it affecting them?
Speaker:What is this sort of this condition actually doing to people?
Speaker:Yeah.
Speaker:So, so if we look at our, our gut, um, and particularly if we break it down into
Speaker:different parts, small intestine, large intestine, when there's a change in the
Speaker:composition, the density and the function of the organisms that are in the small,
Speaker:present in the small intestine, um, This leads to an imbalance of our microbiota.
Speaker:And the microbiota is this agglomerate of organisms that we have in our GI
Speaker:tract and other places in our body.
Speaker:And SIBO, which stands for small intestinal bacterial overgrowth, is a
Speaker:type of, uh, this imbalance, uh, that we often mention as dysbiosis, which
Speaker:is characterized by an overabundance of bacteria that are usually in the large
Speaker:intestine or in the mouth and throat.
Speaker:And they relocate to a place where they really shouldn't be,
Speaker:which is the small intestine.
Speaker:And when these bacteria are present in the colon, they are usually not harmful.
Speaker:They are part of the normal digestion, so they help breaking
Speaker:down fiber, for example.
Speaker:But, however, when, when the stomach and the small intestine usually, have very few
Speaker:bacteria, and the composition of this, the organisms present here, is very different
Speaker:from the ones from the large intestine.
Speaker:And things like, for example, stomach acid and the movement of the food along the
Speaker:GI tract tends to limit this overgrowth of bacteria in the small intestine.
Speaker:But any impairment to these protective mechanisms can cause SIBO, and SIBO
Speaker:can affect a wide range of individuals.
Speaker:So we believe, according to published literature, it's about one in seven of us,
Speaker:but it's particularly prevalent in those that have underlying conditions such as
Speaker:IBS, diabetes, or they've had abdominal surgery in the past, for example.
Speaker:And the different types of SIBO, as you mentioned, we often categorize
Speaker:it based on the gas that is produced.
Speaker:Uh, predominantly by, uh, the organism, uh, in, involved.
Speaker:So, uh, it could be hydrogen, which is mostly produced in, in SIBO.
Speaker:Methane, which is mostly produced by, uh, these organisms called Archaea,
Speaker:in a condition called IMO, which is often branded together with SIBO.
Speaker:Hydrogen sulfide, for example.
Speaker:And, and there's different, different gases that are produced
Speaker:in, in different situations.
Speaker:And we tend to break it down into different categories of SIBO,
Speaker:but if you look around in the literature, everything is under the
Speaker:conglomerate of, of, of SIBO, really.
Speaker:And, and this, and the development of SIBO can, can occur due to several factors.
Speaker:Yeah, like I said, an impairment of those protective mechanisms will lead to the
Speaker:bacteria accumulating in the wrong place.
Speaker:So things such as impaired gut motility will lead the bacteria to start, start
Speaker:accumulating in the small intestine.
Speaker:abnormalities in the structure of the, of the GI tract, disruptions of the
Speaker:microbiome because of antibiotic use.
Speaker:There's really a wide range of factors that are crucial for
Speaker:understanding how SIBO happens and how we can diagnose it and treat it.
Speaker:Okay.
Speaker:So it's going to predominantly sort of affect people who are already in a, I
Speaker:suppose you would say, a diseased state.
Speaker:But when sort of, I suppose, treating it In a traditional sense, what you
Speaker:would normally do is you would go to your, uh, your physician and you would
Speaker:do a traditional breath test there.
Speaker:Try and sort of analyze which of the forms of SIBO is present.
Speaker:And I suppose this is where OMED comes in and specifically the
Speaker:technology you've helped to develop.
Speaker:How is this different to how you would normally, uh, work with your
Speaker:physician and treat this condition?
Speaker:Um, how does the technology work and what is it that You're providing
Speaker:that it's perhaps different from the status quo, the norm, right?
Speaker:So, if you consider, for example, um, the case of the UK, we have a system
Speaker:that is heavily burdened by a lot of complexity in terms of, um, dictated
Speaker:by, The investment of government budgets and things that, like, for example,
Speaker:the COVID 19 pandemic that have caused further burdens onto the system.
Speaker:And you have this amount of people that suffer from GI conditions and GI
Speaker:symptoms, millions of them, every day.
Speaker:They struggle to find access to even diagnostic tests for conditions
Speaker:that could be SIBO, could be IMO, could be something else.
Speaker:And, and that's where OMED comes, um, into play.
Speaker:We provide this device that is a point of care portable device, which is precise
Speaker:and, um, overlaps very nicely in terms of preciseness with, with in clinic
Speaker:devices that cost millions of pounds.
Speaker:Um, and this, a, a fraction of the price can allow you to, to measure
Speaker:accurately, um, gases like hydrogen and methane that we know are involved,
Speaker:um, in conditions like SIBO and IMO.
Speaker:Okay.
Speaker:And, uh, the, the goal of OMED is to provide this platform that
Speaker:aims to transform how we normally manage gastrointestinal disorders.
Speaker:And, and the focus is, is being accessible, quick.
Speaker:Non invasive, allowing the patient and their medical practitioner to
Speaker:monitor their clinical status almost in real time, which is something that
Speaker:doesn't really happen at the moment.
Speaker:And behind this technology is the technology of breath testing that
Speaker:Owlstone has developed over the years and led us to become the
Speaker:leaders in breath analysis worldwide.
Speaker:And for example, if you look at SIBO, at the moment, There's a, a big long
Speaker:wait for you to access a specialized care for even the diagnostic of, um, uh,
Speaker:functional, uh, gastrointestinal disorder.
Speaker:If there's the availability of a device or a test that can provide a diagnosis or
Speaker:the monitoring component almost in real time, that leads the physician in care to
Speaker:understand how their interventions have an effect on the levels of the gases, on
Speaker:the symptoms and on the patient's general
Speaker:clinical status.
Speaker:This is a technology that is fundamental for streamlining care for individuals
Speaker:that suffer from GI symptoms every day.
Speaker:Okay.
Speaker:And is this a sort of a direct to consumer device or is this something
Speaker:that people are having to sort of work with their physicians to sort of acquire?
Speaker:Is it, um, are you able to just pick one up or, again, is it something
Speaker:that you would, uh, Maybe go and see your, your PCP and then work with
Speaker:them utilizing this piece of kit.
Speaker:Yeah, so at the moment, we're working together with, uh, industry leaders, with,
Speaker:with gastroenterologists and other, other, um, healthcare practitioners to help them
Speaker:with the monitoring of their patients.
Speaker:So.
Speaker:As things stand now, to acquire the device, uh, to acquire the
Speaker:OMED breathalyzer, you would have to go through your practitioner.
Speaker:But the future allows us to, uh, provide this directly to consumer, um, if we want.
Speaker:This is a, uh, like I mentioned, it's a precise device that allows you to,
Speaker:comparatively to an in clinic piece of machinery that costs millions of pounds.
Speaker:measure accurately your levels, allows you to record your symptoms, allows
Speaker:you to record your lifestyle, your levels of stress, your sleep, uh, your
Speaker:exercise, um, and, and even your diet.
Speaker:And, and this almost real time monitoring component is essential for you to
Speaker:understand how any intervention that you take, any modification that you do.
Speaker:on yourself and your diet, for example, uh, if it has any impact, uh, in, in
Speaker:the levels of your gases and ultimately on the underlying cause, which is SIBO.
Speaker:I'd like to backtrack quickly and just sort of, uh, maybe discuss in
Speaker:a bit more in, in depth what the difference between your various types
Speaker:of gases is and how they would present, present differently in terms of
Speaker:symptoms or what that actually means.
Speaker:I think we've, uh, talked about a few times You get a methane, you get
Speaker:hydrogen, and if I'm correct, you also get a hydrogen sulfide form of SIBO.
Speaker:But when it comes to the nuts and bolts, but maybe how does that
Speaker:sort of alter either treatment or how does that alter the diagnosis?
Speaker:So when you look at the gases, the gases are ultimately produced
Speaker:predominantly by the organism that is underlying the cause of your symptoms.
Speaker:So if you look at SIBO, SIBO is, like I've mentioned, an overabundance of bacteria.
Speaker:And there's specific bacteria that tend to produce hydrogen when they
Speaker:get into contact with substrates.
Speaker:So anything that comes in your food that doesn't get absorbed goes on
Speaker:to that, to those bacteria, become essentially their own food and lead
Speaker:them to produce hydrogen, which in large amounts can lead to symptoms such as
Speaker:bloating, flatulence, abdominal pain.
Speaker:And this is for SIBO alone, but if you look at gasses like methane, methane is
Speaker:traditionally produced by an organism called archaea, which is not a bacteria.
Speaker:It tends to exist across your whole GI tract.
Speaker:Um, some people more than others have, uh, lateral preponderance of archaea in their
Speaker:body, so they become producers of methane.
Speaker:Uh, so when exposed to certain types of substrate from your food,
Speaker:essentially, it will lead to the production, the production of, of
Speaker:methane via the metabolism of hydrogen.
Speaker:So there's these complex biochemical pathways in the microbiome where
Speaker:different gases are produced, uh, ones directly from a metabolism of food,
Speaker:others from metabolism of other gases.
Speaker:But essentially, what all these gases have in common, and regardless of the organism
Speaker:that produces them, is that their quantity and the way that they act on the, on the
Speaker:intestinal wall will drive the symptoms that are, that affect millions of people.
Speaker:One of the most, uh, known differences, if you, when you talk about hydrogen
Speaker:and methane, for example, is that people traditionally associate
Speaker:methane with, uh, IBS, uh, with constipation, which is something
Speaker:that's been shown in the literature.
Speaker:Higher levels of methane are associated with a slower GI
Speaker:tract that leads to constipation.
Speaker:So it's something that's been observed in IBS, for example.
Speaker:Um, and higher levels of hydrogen have been, uh, observed.
Speaker:But for example, in cases of patients that have a faster
Speaker:GI tract leading to diarrhoea.
Speaker:But there, there is a large overlap in the symptoms of these conditions and
Speaker:probably explains why they tend to be agglomerated under the name of SIBO alone.
Speaker:So, would you then say that, uh, SIBO sort of almost forms the, the base
Speaker:of a lot of these other GI disorders like, uh, IBD, IBS, Crohn's, Ulcerative
Speaker:Colitis, is there always going to be an element of SIBO in these individuals
Speaker:or are they too sort of, can they be very distinct from one another?
Speaker:I would err on the side of caution is saying always, always will be
Speaker:SIBO or IMO in those individuals.
Speaker:We know that a large frequency of, um, of SIBO exists in IBS.
Speaker:So we know that people that have IBS very frequently have, uh,
Speaker:SIBO underlying undiagnosed.
Speaker:And until they're diagnosed and treated, their symptoms are not
Speaker:appropriately managed, uh, regardless of the intervention that they take.
Speaker:And we know that SIBO is related to, um, other, uh, medical conditions, other
Speaker:functional and motility disorders, immune disorders, and, and endocrine disorders.
Speaker:I wouldn't say that, particularly when you try to associate with other
Speaker:GI conditions that, um, are very hard to diagnose, like IBS, uh, I wouldn't
Speaker:say that this is the sole cause, but it is, it is a large contributor, yes.
Speaker:Okay, then I suppose the next step is to discuss how you are sort of suggesting
Speaker:physicians go about treating SIBO.
Speaker:What is, I mean, again, a lot of physicians will sort of utilize
Speaker:antibiotics as their sort of first port of call, something like Rifampicin.
Speaker:Um, Rifaximin, I think it's called, but are you sort of advocating
Speaker:for a more natural approach?
Speaker:Are you sort of very much looking into drugs as a treatment opportunity
Speaker:or how are you at OMED going about, uh, yeah, with the supportive side
Speaker:of it, treating it specifically?
Speaker:So at OMED and at Owlstone um, as a whole, we tend to base our approach
Speaker:always backed by, uh, scientific evidence.
Speaker:And, um, the problem sometimes with the evidence surrounding conditions of, uh,
Speaker:gut gut brain disorders, for example, Is that, uh, the quality, um, is not
Speaker:always the best, the quality of the evidence, and, and the studies that are
Speaker:conducted are relatively underpowered.
Speaker:However, there is, there is a mainstay of therapy for SIBO and, and IMO,
Speaker:where we tend to treat, try to treat the underlying cause where applicable.
Speaker:Antibiotics is, uh, a large contributor to eradicating, uh, the condition.
Speaker:And then, um, treating nutritional deficiencies, identifying trigger
Speaker:foods is a big component as well of the treatment of SIBO.
Speaker:So things like antibiotics, as you mentioned, Rifaximin is, um, the, the
Speaker:main antibiotic we use to treat SIBO.
Speaker:Um, and IMO as shown as the best quality of evidence in terms of treatment for
Speaker:eradicating, eradicating this condition.
Speaker:But things like, for example, diet interventions.
Speaker:Uh, obviously, uh, a big, uh, contributor to identifying trigger
Speaker:foods, identifying tolerances, and try to create personalized, uh, diets long
Speaker:term that are balanced and allow for, um, um, someone that ha that suffers
Speaker:from GI symptoms to manage their condition without recurrently having to,
Speaker:go to antibiotics to get rid of SIBO.
Speaker:Diet alone has been shown, for example, to starve the bacteria that cause SIBO.
Speaker:So if we, if you take a targeted approach to identify and restrict the trigger,
Speaker:the trigger ingredients, then you can successfully manage long term disease.
Speaker:In terms of when you look at how we, we manage it at Owlstone, we tend to focus
Speaker:our component on the low FODMAP diet.
Speaker:We, we see the benefit in the literature of the low FODMAP in the treatment
Speaker:of IBS and the treatment of SIBO.
Speaker:Um, and low FODMAP involves Reducing certain, uh, amounts of fermentable,
Speaker:uh, fermentable carbohydrates.
Speaker:They tend to be associated with symptoms, uh, such as bloating, and,
Speaker:and flatulence and abdominal pain.
Speaker:And in, again, in numerous studies this has been shown to help alleviate
Speaker:symptoms by, by starving the bacteria and the organisms that produce
Speaker:the, these, uh, gases in excess.
Speaker:And in your experience, when somebody's following one of these diets, whether
Speaker:it be a sort of a low FODMAP diet, or potentially something like a ketogenic
Speaker:paleo diet, or some form of elimination diet, Are they at some point then
Speaker:able to reintroduce a lot of the foods that they were previously eating?
Speaker:Or does this become their quote unquote new normal?
Speaker:Are they then sort of stuck with this way of eating to sort of remain in a state of,
Speaker:uh, in a SIBO free state going forwards?
Speaker:Or is the idea to then sort of allow an in an individual to reintroduce
Speaker:foods, uh, that they were, that they were otherwise partial to or just form
Speaker:a, generally a large part of their day?
Speaker:Diet on a day-to-day basis.
Speaker:Yeah, that's a great question.
Speaker:So, uh, one of the problems with these restrictive diets is that when they are
Speaker:continued for a long time, they tend to lead to nutritional deficiencies because
Speaker:they are quite restrictive in the way, in the approach that we take for, for
Speaker:trying to identify these trigger foods.
Speaker:I think the goal of low FODMAP and other similar diets is The restrictive
Speaker:part has to be long enough to allow us, uh, to take away, uh, a big group of
Speaker:foods, but short enough that doesn't cause a tremendous impact on the, on
Speaker:the clinical status of the patient.
Speaker:So we don't want to cause, uh, nutritional deficiencies.
Speaker:But there is a component for reintroduction and the reintroduction
Speaker:part is very important.
Speaker:It's not just to identify What gives you symptoms, but also to identify the
Speaker:tolerance levels of certain certain foods So you might have you might be
Speaker:okay to consume certain Carbohydrates, for example when you talk about the
Speaker:low FODMAP diet You might consume a certain carbohydrates with minimal to
Speaker:no symptoms, but then when you go to increased servings, there might be quite,
Speaker:uh, quite a lot of symptoms for you.
Speaker:And you might be okay with that, with constructing your diet around
Speaker:that, to have limited amounts of those particular trigger foods.
Speaker:Uh, always present in your diet but at a limit that allows you to,
Speaker:to go about with your day with no impact in terms of, uh, of symptoms.
Speaker:But there's, the, the goal is to always test this reintroduction, this tolerance
Speaker:level occasionally because we know from, for example, allergy studies that
Speaker:things tend to change along the way across, across the span of several years.
Speaker:Your tolerance levels to certain foods in things like IBS and and SIBO will vary.
Speaker:So your diet has to become, has to be modulated around that.
Speaker:It has become relatively flexible for you to test these, these foods along the way,
Speaker:trying to make sure that your tolerances increase in the way that your diet remains
Speaker:balanced and you're not going to a very restrictive pattern that it'll eventually
Speaker:might get rid of SIBO, but will give you other problems.
Speaker:Yeah, create nutritional deficiencies along the way.
Speaker:If, if carbohydrates are essentially what are sort of, well in part, um, driving,
Speaker:uh, a number of these conditions, then why not just sort of take a sort of a shotgun
Speaker:approach potentially, and then just use something like a ketogenic diet, which
Speaker:will sort of remove well all simple sugars and all complex sugars from the equation.
Speaker:What are your thoughts on sort of a ketogenic approach, and
Speaker:why, how does it differ from a low, the low FODMAP approach?
Speaker:So if you look at a low FODMAP, it's not, it's not just carbohydrates
Speaker:that are involved, and they have been shown to cause symptoms
Speaker:in people with IBS and SIBO.
Speaker:I'm not very experienced with, uh, the ketogenic diet as a whole, but I know
Speaker:that the evidence for things like IBS and SIBO is relatively, there's a relatively
Speaker:unclear role for, for using it long term.
Speaker:Now, we know that, for example, with FODMAPs, which are the, uh, low
Speaker:fermentation, uh, low fermentable oligod and monosaccharides and
Speaker:polyols uh, we know that these, are things that are poorly absorbed and
Speaker:are osmotically active, and they go along the intestinal tract, and they
Speaker:get fermented by these bacteria.
Speaker:So, if you have a microbiota that is not imbalanced and is dysbiotic,
Speaker:we know that this will drive those bacteria that predominate and dominate
Speaker:over others to increasing numbers and increasing places where they shouldn't be.
Speaker:So we know that a low FODMAP is something that has shown to improve
Speaker:bloating and gas in patients with IBS, with SIBO, and there's evidence
Speaker:to support this in the prevention and management of patients long term.
Speaker:But again, there has to be a lot of caution in terms
Speaker:of these restrictive diets.
Speaker:It has to always be done under the auspice of a dietician
Speaker:or a healthcare practitioner.
Speaker:to prevent it from, from treating one thing but causing further problems.
Speaker:Of course, and I think it's always, it should always be noted as you just said
Speaker:that any sort of intervention should be done under the guidance of a physician.
Speaker:When sort of treating these conditions, what are your thoughts on compounds
Speaker:like antimicrobials, like berberine, like colloidal silver to sort of
Speaker:further support the eradication of some of these underlying issues?
Speaker:Do you think these sort of more natural, um, remedies have their place,
Speaker:or would you just sort of prefer to stick to something like an antibiotic?
Speaker:I think there's a place for, for antimicrobials.
Speaker:There's definitely evidence for specific, uh, antimicrobials in general.
Speaker:They're proving their, their antimicrobial activity and,
Speaker:and other functions in the gut.
Speaker:Now, I'm, I'm, again, weary in terms of a blanket statement
Speaker:of using them across, uh, as a replacement, strictly a replacement
Speaker:for antibiotics, without discussing the benefits and the risks of both.
Speaker:The antimicrobials, the evidence that exists related to SIBO,
Speaker:is, uh, of poor quality.
Speaker:It is there, but it is relatively underpowered studies.
Speaker:So, there needs to be more research in these natural treatments for
Speaker:SIBO and IMO and IBS to allow us to confidently say this is something
Speaker:that we can offer alongside antibiotics or instead of antibiotics.
Speaker:But again, I'm not completely putting them away.
Speaker:I think there's a place for them, but it has to be on a case by case situation.
Speaker:And there are a number of other, uh, therapies and modalities currently
Speaker:being explored in this space.
Speaker:I know there's a lot to be said about limbic system retraining
Speaker:and looking at the vagus nerve and stimulating the vagal nerve.
Speaker:Is this something you've explored, uh, at all?
Speaker:Or is this a body of evidence you are in any way familiar with?
Speaker:And do you think that these approaches that maybe look at,
Speaker:from a gut brain perspective, it's more a brain gut take on it.
Speaker:So sort of reversing the order of operations as it were, do you think these
Speaker:modalities hold any promise or unless you're actually treating the underlying
Speaker:is pathogenesis, the right word, um, pathology of these other modalities,
Speaker:perhaps maybe a bit sort of weak in their, um, approach or just underpowered.
Speaker:Well, there's definitely a, a growing interest around this topic of gut
Speaker:brain s as being, uh, bidirectional.
Speaker:Not like you said, not just, uh, brain gut, but gut brain as well.
Speaker:And what we've seen in terms of research is we know that the mental, the mental
Speaker:health and anxiety and depression affect the way you perceive your symptoms and,
Speaker:and affect the existence of symptoms and the frequency in which they occur,
Speaker:uh, in, in specific populations.
Speaker:I think they hold promise, uh, for future integration within treatment protocols.
Speaker:Uh, things like, for example, retraining, uh, limbic system, vagal
Speaker:nerve stimulation, to address this neural regulation of gut function,
Speaker:uh, and this interaction between the microbiota and the gut brain axis.
Speaker:But again, the evidence is still very, very new, very scarce.
Speaker:There has to be more quality evidence, more, um, more studies done, conducted
Speaker:to, to see how this, this, this, uh, relationship is bidirectional and can be
Speaker:modulated both ways with effect on, on, on symptoms and eradication of disease.
Speaker:But again, I, I don't think this is a, a treatment of its own.
Speaker:It will always be something.
Speaker:As, um, used in conjunction with an eradication method.
Speaker:So it will be something to more manage symptoms long term.
Speaker:Or, uh, or manage symptoms when eradication is not possible, for example.
Speaker:Fair enough.
Speaker:Yeah, I suppose it's going to be always going to be more as an adjunct
Speaker:therapy and not just a monotherapy.
Speaker:Exactly.
Speaker:You mentioned, yeah, you mentioned the future a couple of minutes ago.
Speaker:Where do you sort of see the future of, of breath testing going?
Speaker:And, and maybe this is just purely speculation and, Uh, just something
Speaker:that's of interest to me, but do you sort of see breath testing maybe being
Speaker:used in the next five to 10 years and sort of a, in a metabolic sense, maybe
Speaker:as a tool to help navigate and determine certain cancers or at this point, do you
Speaker:think it's purely going to be kept in the realm of a sort of functional GI care?
Speaker:Oh no, no.
Speaker:I think, I think the future of breath testing is incredible.
Speaker:incredibly promising.
Speaker:Not just in in GI disease, but just across all areas of medicine.
Speaker:I think over the next 5, 10 years there's going to be significant advancements.
Speaker:Not, not just about the accuracy and make them completely translating onto
Speaker:in clinic methods, but also in the By making it accessible, like we do
Speaker:with the OMED Breathalyzer device, making it accessible for the masses to
Speaker:streamline care and reduce waiting lists.
Speaker:I think that there's, there's, that for instance, there's a great potential to
Speaker:use breath testing in, in early detection of metabolic diseases, as you said,
Speaker:um, in identifiying specific biomarkers related to metabolic dysfunction.
Speaker:Um, there's already ongoing research in the use of breath testing
Speaker:for, for, for cancer diagnostics.
Speaker:And this will revolutionize the way we, we screen and diagnose a range of diseases
Speaker:from, from cancer to liver disease.
Speaker:The, I think, The world is our oyster in terms of how we can apply these
Speaker:volatile organic compounds, VOCs and breath, to link with specific
Speaker:diseases and, and create these non invasive methods to diagnose and treat.
Speaker:I would be remiss if I didn't ask about probiotics, something that
Speaker:I probably should have touched on earlier and asked about.
Speaker:Do you think probiotics have any specific sort of Place in, again, in functional
Speaker:GI care and, and disease, or are they more or less sort of preventative?
Speaker:Uh, are they something that you would take prophylactically, do you think?
Speaker:And sort of, are your strain, are these sort of multi, multi
Speaker:formula sort of approaches or maybe a single strain approach?
Speaker:Do you think, do you have any thoughts on probiotics specifically?
Speaker:Yeah, so I think there's, there's, um, there's a role for both, for
Speaker:preventive and targeted care.
Speaker:Okay.
Speaker:Again, there's data on certain diseases like IBS.
Speaker:There's limits of data on, on, on probiotics and SIBO.
Speaker:Um, with, I think, there's recent meta analysis where they show, kind of, both
Speaker:ways, there's no significant difference with, um, the incidence of SIBO, uh, with
Speaker:probiotics compared to a control group.
Speaker:But I think there's a component that we've seen with, uh, with, uh, recent
Speaker:studies on probiotics in IBS and IBD.
Speaker:There's a component to use them as targeted therapy, but it will always
Speaker:be on, on a very bespoke situation with a particular patient and not, not
Speaker:like a mainstream approach to eradicate or even, or even prevent the disease.
Speaker:I think there's always There's always a component for prevention in terms of multi
Speaker:strain, of improving your gut microbiome.
Speaker:Particularly if you feel better taking it.
Speaker:And there's no side effects and it doesn't interact with anything that
Speaker:you take in terms of medication.
Speaker:Sure, I'm more than happy to advise people to take that approach and trying
Speaker:to get this balance between health and well being and control of disease.
Speaker:There's not enough studies out there yet for the targeted approach of probiotics.
Speaker:For to be able to standardize this treatment formulations to use in patients.
Speaker:I suppose that sort of naturally leads on to a quick discussion about prebiotics.
Speaker:Do you think prebiotics again have their place?
Speaker:Or is that very much sort of a case of adding fuel to the fire?
Speaker:Especially if there's sort of an underlying pathology again in
Speaker:the case of something like SIBO.
Speaker:Are these products helpful?
Speaker:Are they damaging?
Speaker:My view of the literature says oftentimes, um, I suppose this also
Speaker:falls into the FODMAP side of things that if you're adding in a prebiotic
Speaker:to somebody who's already in a diseased state, that it's probably
Speaker:just going to make the issue worse.
Speaker:But do you have a sort of an opinion on that or counter or yeah, what are
Speaker:your views on prebiotics as a whole?
Speaker:I think, I think there's a, there's again a benefit for prebiotics in terms
Speaker:of promoting gut health in general by stimulating the growth of beneficial
Speaker:bacteria, but again, as I said, It could be adding fuel to the fire, if we promote
Speaker:it in the diseased state, uh, where we have these specific organisms that feed
Speaker:on specific foods that are non digested.
Speaker:And if you're introducing several strains or a particular strain, you might tip
Speaker:the balance of the scale to another type of dysbiosis, and not necessarily to,
Speaker:to make it a eubiosis environment where everything works perfectly in your gut.
Speaker:I would be more wary in using it in the diseased state, in someone
Speaker:who has active SIBO, versus using it in someone that is looking to
Speaker:just improve their general health.
Speaker:Uh, because they, they occasionally have symptoms, they, they feel that
Speaker:their digestive function is not as good as it could be, and their metabolism
Speaker:is not as good as it could be.
Speaker:So I, I think there's, there's um, incorporating it in, in the diet
Speaker:can be a good and effective way to improve the gut health, but very
Speaker:wary of using it in diseased states.
Speaker:I suppose like everything, it is ultimately about just finding balance
Speaker:and utilizing the right tool and the right individual at the right time.
Speaker:Exactly right.
Speaker:I think before we close, I'd just like to, and again, a selfish question.
Speaker:I'd just like to pick up your brain a little bit about how you, knowing what
Speaker:you know and uh, and what you've studied and, uh, the clinic and yeah, how you
Speaker:incorporate these practices in your life.
Speaker:Do you sort of follow any specific dieting exercise regime?
Speaker:I hate the word biohacking.
Speaker:It's sort of almost become cult like.
Speaker:But do you sort of including any of those sorts of practices in
Speaker:your life to optimize your life?
Speaker:Yeah, it's just always interesting to hear it from the horse's mouth, so to speak.
Speaker:So I would love to say I practice what I preach about, but I'd be lying.
Speaker:Um, I, I, I tend to maintain, try and maintain a balanced lifestyle.
Speaker:So in terms of diet, uh, for years I followed the Mediterranean style diet
Speaker:because I'm Portuguese, but recently that, that, that has become very hard to
Speaker:achieve, but I tried to, it's all, again, like you said, it's all about balance.
Speaker:I try to include a bit of everything in my diet.
Speaker:I try to not restrict myself too much.
Speaker:'cause fortunately, I, I, I don't suffer from GI problems.
Speaker:So, uh, but I try to maintain my diet relatively balanced by
Speaker:including a bit of everything and, uh, not letting it tip to excess in
Speaker:a particular, in a particular part.
Speaker:Um, in terms of, uh, in terms of exercise, could do more, I, I, I enjoy hiking
Speaker:and climbing and, and occasionally, uh, I, I do that and, uh, it helps me to
Speaker:stay active and, uh, cardiovascular, um, cardiovascular exercise does me to,
Speaker:to, to feel a bit better about myself.
Speaker:I've, I've, I've attempted diets in the past, so something like periodic
Speaker:fasting, intermittent fasting.
Speaker:Which, which helps, but it's very difficult to maintain, um, long term.
Speaker:But, but there's, there's a lot of things that, that, that you could do, alongside
Speaker:of things like, for example, uh, specific diets, uh, specific treatment regimens,
Speaker:uh, uh, sorry, exercise regimens, and, and things like cold exposure, for example.
Speaker:But I think it's all about balance.
Speaker:As long, as long as you can find balance for you, cause, uh, it's not a one size
Speaker:fits all kind of thing, as long as you find balance for you and what works for
Speaker:you, and try and maintain that, don't let it tip towards one end of the scale, just
Speaker:try and, and, Allow a bit of everything.
Speaker:Don't restrict yourself too much because long term it's very hard
Speaker:to maintain and will probably, um, have worse consequences.
Speaker:But yeah, I think, I think I'm managing so far.
Speaker:But I, um, I'm definitely not, not, uh, practicing what I preach.
Speaker:So, uh, I'm not not the best example.
Speaker:No, well, I mean you are otherwise healthy.
Speaker:So if not, why not?
Speaker:But yeah, no, I couldn't agree more.
Speaker:Um, and just to sort of reinforce what you just said, this sort of
Speaker:concept of biochemical individuality is, uh, is very important.
Speaker:And I do find it fascinating that a lot of people in the influencer space Who sort of
Speaker:promote these very extreme diets, whether it be carnivore or vegan or ketogenic.
Speaker:They all, over time, you watch them, Paul Saladino, the individual who really
Speaker:pushed the carnivore diet for a long time, being a prime example of this,
Speaker:they always seem to come back to center, whether it's sort of reintroducing
Speaker:carbohydrates, reintroducing vegetables.
Speaker:Uh, practicing less fasting, uh, fasting is a stressor obviously in
Speaker:a, in a, in a therapeutic sense.
Speaker:Um, it's amazing, but only in the short term, uh, obviously with long term
Speaker:use, you're going to potentially create dysfunction in your HPA axis and creates
Speaker:all sorts of hormonal dysregulation there.
Speaker:So yeah, no, I couldn't agree more.
Speaker:It's, it's, it's ultimately about maintaining that sort
Speaker:of healthy middle ground.
Speaker:Where's the best place to find you and your company.
Speaker:Rui?
Speaker:I know you've mentioned both Owlstone and OMED for the consumer who's looking
Speaker:to potentially particularly purchase one of the, these breath analyzing, uh,
Speaker:products, where would you point them to?
Speaker:Yeah, so if, if you're interested in, in learning more, um, you can find
Speaker:regular updates and, and our latest research and developing in our websites.
Speaker:So generally about breath research at Owlstone Medical and, uh, more
Speaker:specifically about g the GI space, uh, OMED Health, so omedhealth.com.
Speaker:And owlstonemedical.com for detailed information about what we do and how
Speaker:we are advancing the field of breath based diagnostics and research.
Speaker:Um, I intend to, to publish some of those updates as well in latest research
Speaker:and developments in my LinkedIn.
Speaker:So if you feel free to contact me there.
Speaker:Okay, perfect.
Speaker:And we'll publish links to all of those socials and websites in the show notes
Speaker:as well as any other studies that we sort of either mentioned or discussed.
Speaker:or that I would think that the listener would otherwise find interesting in
Speaker:the, yeah, again, in the show notes.
Speaker:Thank you so much for your time.
Speaker:We really appreciate it.
Speaker:This has been enlightening.
Speaker:Definitely learned a lot and we'll have to get some points soon.
Speaker:Yeah, thank you.
Speaker:It's been great to be here.
Speaker:Thanks Rob.
