GERD, gallstones, IBS and SIBO explained by a gastroenterologist

This is the Performance Place Sports Care Podcast, session number 44. You got it, Jobin. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, everybody. Before we start the episode here, I wanted to do a real quick product pitch, and this is for my own product or Kickstarter. If any of you have done a Kickstarter before, some people do it for building revenue for a business and so on. That's not the reason why I did this Kickstarter. And this Kickstarter is for one of the first products I think I'm going to put out. And it's called the Four Step Healthy Back System. And I'm in the process of developing it.

But what I really, really wanted was to make sure that everybody wanted something like this before I created it fully. So I haven't proofread the ebook yet. I haven't created the worksheet. I haven't even finished all of the exercise library. But what I really, really wanted was, because back pain is so prevalent, I wanted to prevent it. And I wanted everyone to have a nice back, a healthy back that is like a, consider like a nice sapling, like a tree. It's very, it doesn't have to be thick, but it's really, really resistant to bend and injury in that case, in contrast to like a big log that breaks when you sit on it. Everyone should have a nice supple sapling like back. And that's what I wanted to create with this product. It's on Kickstarter mainly as a validation. I can't stress that enough. So if you think you'll use something like this, or if you think you know someone who will, can you direct them there, please? Because we only have a couple of weeks left on the Kickstarter. If it completely funds, I'll finish the product. If it doesn't fund, tell me what you want to hear about. Tell me what product you want me to create. Because a lot of this education that I'm going through on these things, I want to put a system together for everybody. And this is just one way I can validate the ideas. So if you're looking for that, go on to the show notes. I will put it there. Or you can go on to my Instagram that is at performance HB or on Twitter. I'll put links for it there as well, but definitely the show notes. Okay, here we go. Let's get started with the show. Hey, everyone. This is Dr. Sebastian Gonzales with the Performance Place Sports Care Podcast. Again, we are going to be talking about some stuff with inside the body. And the reason why I keep hitting some of these topics, and we're going to have a guest on today, it's Dr. Benjamin Weinberg. He's a gastroenterologist. The reason why this is really important, at least to me in regards to sports injuries, is that, I mean, it's really important what goes inside your body and how your body functions from the inside. And if you listen to the other interview I did on regenerative cell therapy with Dr. Goswami, we talk about the importance of what goes inside your body because your body's repairing. So if you put like, you know, like a terrible cheeseburger and a bunch of greasy fries inside your mouth, it's going to repair at the rate of what the quality of fuel is going in. In addition to that as well, like I actually had a teammate when I was playing in high school that he had a ton of stomach issues. And I mean, I had some stomach issues too. And if you've heard about my history with some of the stomach issues I've had as of recently in the last couple of years, it's nothing to come in comparison to what some people have. And I've known people, I've known a few people who have actually a few athletes who have actually stopped playing their sport because they can't actually tolerate not having a restroom around. And I know how it is when you first get into like, say you're doing marathons and half marathons, you go to these places and the bathroom is just completely packed.

I mean, it's a line and line of people just waiting because of they don't want to do it during their event. And there is actually porta potties all along the way, a lot of times in these events. So, I mean, I've, I've met people who just can't make it to the next porta potty. Some people, if you look at pictures online, they actually don't make it and they continue running. So it's an important thing. You have to realize what's going into your body. So Dr. Benjamin Weinberg, as we go into this interview, I'm going to ask him just some of the tips and tricks and common questions that he usually gets as a gastroenterologist. And that can probably help you guys out with knowing what to do. What are some good, easy things you can implement along the way? So just a little bit about Dr. Weinberg.

He's actually someone that I met through clinical practice. He's a very, very good guy. I mean, he's, he's very, he cares about his patients. He's very educated. He's very personal, I like to say, because not all docs are always personal as well. So I thought he'd break things down in a really easy way for you. So he actually got his, so his internal and residency in internal medicine was at the, at UCLA San Bernardino Valley. Um, he actually is well, he went to Boston university and got his MD there. So, uh, he currently practices in Laguna Hills, California. So it's fairly close to me about 45 minutes, but I thought you guys would learn a lot on a podcast from him. So this is a podcast that has been very, very long awaited. I think we've been back and forth on email for probably about a month and a half, two months now. And I really, really wanted to get on. So here he is right now, Dr. Benjamin Weinberg, everyone. Thank him. All right, everyone. Yeah. So here's Dr. Ben say, Hey, Dr. Ben, that's a Benjamin Weinberg, by the way. Hi everybody.

Hey. Okay. So, um, tell us about yourself. Uh, I already told him a little bit about you and like some of your experience, but, uh, how'd you get into, uh, GI and, uh, yeah, how'd that all come about? Okay. Well, uh, yeah. So my background, so I grew up on the East coast. I ended up going to, uh, Boston university for medical school and then came out to, uh, UCLA to do my training. And in order to go into GI everyone or gastroenterology, everyone has to do, uh, residency in general medicine, which is called internal medicine. So I completed that. And rather than just going out and practicing, uh, primary care or general internal medicine, I went and did what's called a fellowship, which was an extra three years of training also through a UCLA program where I became a specialist in gastroenterology, which pretty much involves anything in your abdomen that doesn't require surgery. Um, if a surgery is needed, I would figure that out and potentially refer to a surgeon, but any abdominal complaints that someone has may be, you know, uh, in the realm of what I helped to treat and figure out. So then would it, once it goes past the, uh, into the stomach and past would be, so do you deal with like, you don't really deal with mouth and like throat and stuff like that.

That's a different people, right? Yeah. So there, that would be more ears, nose, and throat or otolaryngology who deal with the nose ear and the back of the throat, but there is some overlap sometimes in, in, um, GI when people may have a problem in their upper esophagus or throat that may kind of overlap a little bit with the upper back of the throat or oral pharynx as, uh, would be the technical term for it. But for the most part, if somebody has a sore throat or a problem in their mouth, um, they would go see an ENT or ears, nose, and throat. Yeah. Um, how long have you been practicing by the way? I don't think I've ever asked you. So I finished my, well, I had three years of, uh, internal medicine and then three years of my specialty training. And I've been working in private practice as a gastroenterologist since 2008. So we're going on nine years.

Nine. Good. So, uh, yeah, I, so I thought I would ask you on because, uh, although this is, I guess, not technically a sports injury related, uh, well, I guess it could be partially related. These are things that like, actually, I, I never actually asked patients too much of, and I probably should. Um, I did have one guy recently where he's like, Hey, I got some stuff like in my throat and like back it, you know, like it happens when I sleep. I'm like, are you sleeping? Like you eat right before you go to sleep, you know, like, like GERD type of stuff, you know? So, I mean, I'm sure this is things that everybody gets at some point, right? Uh, yeah. GERD acid reflux or GERD, um, which is gastroesophageal reflux disease are extremely common and, you know, statistically almost everyone will experience some degree of that at some point in their lives. Um, and there's different degrees of it where people may get just burning in their epigastric or kind of upper stomach area or burning in their chest. And sometimes as your patient was asking if it's bad enough, it can come up all the way into the mouth and back of the throat and even cause lung problems if it's getting into the lungs and so forth. Yeah. He was even talking about like, he was, he was describing it as some chest pain and like, he asked, he asked him about ribs and then the pec and so on. And I, and, and I, I kept thinking GERD, but I know that, um, it's how common it is. So do you, what type of complaints or what other types of things could there be there? That could give you pain in that area?

Yeah. Yeah. So, uh, you know, the, the, well, it depends on a person's age group, but a lot of people, well, most people will can tell that they have some slight burning and, and issues in their chest, uh, or that for the most part are pretty easy to figure acid reflux, but occasionally people have, uh, chest pain or, or more severe pain where they're actually very concerned. They may even be having a heart attack. It can mimic the exact same symptoms. They could have sweating, just feel ill, extremely ill, acutely severe chest pain, end up in the emergency room, go through a whole bunch of tests to check their heart, to make sure they'd have a heart attack and everything comes back negative. And then they might get sent to my office to be worked up for, um, acid reflux and GERD.

Um, other people could have an issue where they get, um, inflammation in the cartilage between the ribs in your chest called costochondritis. So occasionally I have somebody who sent to me and the doctor thinks it's just acid reflux, but in actuality, they're very tender when you push on their chest. Um, and they respond to like an anti-inflammatory medicine, like Motrin or ibuprofen. Um, and at that point we would call that what's called costochondritis. Um, those would probably be the, the two most common things that I would see that, uh, may either mimic, you may be concerned, um, is something else. And it turns out to be GERD or people think it's GERD and it's actually something else.

Oh God. Oh, I guess before we get that far, I guess I should tell everybody the major things we're going to go into today is we're going to go into GERD and gallstones, IBS, some of the common things that people will get and that they're probably going to ask, uh, someone like Dr. Ben. So, um, the, so with costochondritis, so I would imagine, so you said you pet press on their chest. So this, the fact that you can palpate it and increase sensations, uh, which is with palpation, that would be an indication that it's more of a, uh, a skeletal cartilage, not GI. Correct. It's usually very reproducible. You know, you push on the focal point where they have the pain and the patient says that that exactly replicates the discomfort they've been having. Whereas, um, essentially all internal processes, either in your chest or in your abdomen, you know, if you're pushing superficially on the muscles or bones, those areas are then protected by those structures. So you wouldn't expect the pain to, you know, to increase. And so that's one of the ways we can kind of tell sometimes by examining patients, especially with the chest.

If I, I can push as hard as I want, but I shouldn't hurt somebody's lung or heart or esophagus. And if it's reproducing that pain, then it's more likely a musculoskeletal problem. So what about with referred pain? Like, let's just say gallstones, it refers to, you know, places on the, on the back. Um, I think, right. Um, Yeah. So gallstones are one of those, I mean, from a, a lay person standpoint, they can be a little tricky, um, because your gallbladder, which is over your liver, which for the most part lays over the right upper side of your abdomen, those same nerve, those nerves to that area, go to the same place in your brain that the nerves to your right scapula shoulder blade go to. So if somebody has a problem with their gallbladder, a lot of times the brain can't differentiate where that pain stimulus is coming from. So it tells the person that, Oh, there's pain in your right upper abdomen and pain in your shoulder, even though there's no problem going on in your shoulder. A patient may say, say person who has gallstones, which are little stones that form in the gallbladder.

Usually that when somebody eats a fatty meal, the gallbladder goes to squeeze, to push bile out that helps you digest fat in your food. And if there's stones that block the exit of the gallbladder, the blob gallbladder gets swollen, caught and sends pain signals to the brain that then could tell the person, not only do I paint in my belly, but I paint in my right shoulder blade. And that will usually last for a few hours and then go away. And if it doesn't go away, it's because that stone is stuck and not coming out. And that can act, that's actually a surgical emergency. Um, and people need to have their gallbladders removed within a 24 hour period to avoid complications. So, so what if that thing, I mean, does it explode kind of like the appendix?

It just, it can't, I mean, in some cases it can actually rupture. Um, most of the time people present to the emergency room and so forth before that happens, but at times it can rupture and then that becomes a much more complicated process. But essentially it's like a sack, a balloon that gets, the exit gets blocked and it gets swollen and swollen and, and enlarged and it can potentially burst. Yeah. Well, you mentioned, so you mentioned the ER thing. I, I showed you that, that, uh, arm thing I had, right? Um, I vaguely remember, remind me. So I actually, and this actually made me one reason I wanted to really press to do a podcast like this was because, so I was at home on a Sunday and, um, I don't really have great bowel bladder function. Actually a bladder, great bladder function.

I like to pee a lot. Um, but bowel function really probably not that great. Um, lactose intolerance, I have issues all since I was a kid. But anyways, so the next day I was building some rafters in my garage and just started getting sudden abdominal pain. And I mean, I don't know, I don't do a bunch of like, uh, you know, palpation in the stomach. I remember some of the tests in school. So I went through them and, and I'm like, by God, this, this seems like appendicitis to me. And even, even, uh, to the point where like it kept getting worse, I wasn't vomiting or anything, but I kept checking all the tests that I know. I'm like, yeah, I think it's it. All right. I think I'm going to do it.

I'm going to go to the ER. So I went in there. And as soon as I laid down, actually, I was like doubled over in pain, just getting in there. But as soon as I laid down for them to take blood, I'm like, Oh my God, I feel so much better. And, uh, I didn't end up having any, I mean, it ended up being like, uh, gas, but I kind of wish I had the ability to actually release the gas in the hallway of the ER and show everybody that's all it was. But I actually had a C, I had a CT done with, uh, iodine contrast. And I had the, uh, I thought you might remember the, uh, I had the complication with an IV contrast. So my arm was just black and blue.

Now I remember. Yeah. So, um, but I don't know the, the amazing part to me was that I really thought I was like dead set. This is appendicitis. And I was, I started thinking if I can't get this right, I don't know how anyone's going to be able to tell when there's referred stuff like gallstones and, you know, GERD. I mean, it's really, really confusing. So. Right. I mean, and that's why for the average person, if they're having significant abdominal pain, that's not improving, um, or, you know, other symptoms along with the abdominal pain, fevers, ongoing nausea, vomiting, blood in their stool, black stools, things like that, they should just go to an emergency room to get it sorted out. Cause even as a physician, you know, we need to run tests in order to even know. I mean, if, if, if I had seen you at that time and you were having pain acutely in the emergency room, that would have been still the first thing I would have wanted to rule out was appendicitis. And so, you know, without doing proper testing, people put themselves at risk if they just sometimes wait these things out to see what happens.

Sometimes things get better, but sometimes things can get a lot worse and they're better off recognized early. Yeah. Yeah. I still consider that, uh, I ate a, I ate a pizza beforehand or like the prior night. I still consider that my $300, $350 pizza that I bought. That's, that's what the ER copay was. Um, so in regards to GERD, I guess going back there again, referred pain is, is there referred pain at all with GERD then? Typically not with GERD. Um, rarely have I seen patients who will complain that the pain radiates not only from their, into their chest, but also into the center of their back. But most of the time, if patients tell me that I start getting worried about some other problems because typically pain from your esophagus does not radiate into your back and I would be concerned about other things. So yeah. So unlike gallbladder, it's usually just potentially chest discomfort. Okay. Um, so with considering GERD then, or Aspery Flex, is there certain corrections that people, so if they listen to the podcast right now, they're like, Oh, I can, that's something I can do. Is there any couple things that you are usually pretty successful in helping out people like this? Yeah. Well, so number one, I would say though, and it depends on the age of the listener, if, uh, for general purposes, if somebody is over the age of 50 and they start having new acid reflux and have never had issues with acid reflux before, they should go see their doctor. I mean, they can start on something over the counter, which we can talk about in a moment, but they should go see their doctor because anybody at a later age who starts having these symptoms, you always want to make sure there's not something more serious like cancer or something like that. Although it's still low probability, it's a risk. So if you're under that age and you start having acid, some acid reflux, I mean, the first reasonable thing to do would be one to look at your diet and see what kind of things you're eating. Everybody has different triggers. So if you go online, you can pull up a list of say a hundred things that can all cause acid reflux.

I generally don't recommend that my patients go and avoid every single item on those lists. I usually, most people are kind of aware of what their triggers are and can avoid those. Occasionally, nothing seems to work and people will try these long lists of caffeine and alcohol and spicy foods and peppermint and all sorts of things. Um, and then smaller, more frequent meals can sometimes be helpful. If someone's primarily having symptoms at night, then you don't want to eat more than two to three hours before going to bed. Cause you don't want to lay down with a full stomach that then all that liquid and acid just kind of rolls up your esophagus as you're laying flat. Um, and also if people are having a lot of nighttime symptoms, but say changing their diet in that regard and eating earlier doesn't help, you can actually get a couple pieces of brick or cut two by four and put them under the feet of the head posts of your bed just to raise the bed up about six inches. And that teeny bit of incline of the bed is enough with gravity to, in a lot of people to help keep the acid down. Um, if you're too lazy and don't want to do that, you can actually go spend the money and buy a, uh, a GERD wedge on Amazon or sometimes a bed, bath and beyond, which is kind of a slow incline that goes on top of the mattress. Um, I didn't even know they had those. Yeah. So that's, that would be the most conservative approach. And if, if those things didn't work or a patient, you know, a person says, I'm not going to change my diet. I just want to feel better than medications like antacids, like Tums and Rolaids.

They're a calcium carbonate, um, that helps to neutralize acids. So if you want immediate relief, things like those can be helpful, but they're not really good. Well, medicines in terms of trying to heal up the inflammation from acid that's going on. So they don't actually help to prevent episodes. If you're looking to get things under control and prevent episodes, then there's two main families of medicines. One are called H2 blockers or the H stands for histamine, um, type two blockers. And those would be your Zantac and Pepcid and tagament and things like that, where you take those ideally twice a day and they help to suppress the acid that your stomach makes versus another family of medicines called proton pump inhibitors, which are much more potent. Um, you take them once a day before breakfast and they work even better than the twice a day Pepcid and Zantac.

And those would be medicines like Prilosec, their generic names, Omeprazole, uh, Nexium, uh, the generic name being, uh, as Omeprazole, uh, there's a whole Prevacid or the generic name being Lansoprazole. And so there's a whole host of medications, but almost all of these medications will say, if you buy them over the counter, don't take for more than two weeks. Um, because really they want to make sure that that person is going out. If they're having, if they have continued need for it, seeing a, you know, a health practitioner to make sure they're, they're not continuing to treat some more serious issue, um, that needs to be addressed and evaluated. Yeah. They can, but otherwise under the prescription of a doctor or a healthcare provider, they can be taken in some people more long-term just because of the chronicity of those symptoms. Yeah. Just as long as they, they've evaled and confirmed that it's not cancer or something. And had any other necessary tests to make sure there's not something more serious going on. So, so how does something like GERD then start? Like, does the sphincter or the muscle at the top of the, uh, the stomach just lacks or? Yeah. So the two most common reasons are that this, the sphincter muscle down at your lower esophagus, which is right around where your ribs meet your stomach, right where your xiphoid processes that little kind of notch at the bottom of your sternum right there is a sphincter. It stays close most of the time and relaxes when you eat, but it can get in some people too loose. So it allows the normal acid in your stomach to, to frequently reflux. And that's why it's called reflux or gastroesophageal reflux is a GERD up into your esophagus. There's another common condition where the whole stomach, which should be below the diaphragm is able to slip up a little bit through the diaphragm in that area.

And that's called a hiatal hernia. And about one in three people have a hiatal hernia. And by having your anatomy out of place in this sphincter now is out of place because it's at the essentially where the stomach and esophagus meet. And so it's all, it's slipped up in your chest that disrupts the normal sphincter and doesn't allow it to work well and can allow acid to come up more easily. I was just looking, I was just looking online when you said that I was curious if the sphincter was smoother skeletal. That's smooth, right? Um, it's, well, let me think. I, cause I rarely think about it in that way, but I was wondering if, I was wondering if you can like train it voluntarily.

You know, I don't, I'm not aware of anybody who can, there might be people out there who think they can, but, uh, yeah. So, I mean, there are a variety of, in people who say can't take medicines, don't want to take medicines. There are some surgical procedures that can be done to tighten that area. And there are also what we call endoscopic procedures, meaning they're not surgeries. Uh, somebody, a gastroenterologist like myself would, they'd be as the person would be asleep. They put a camera down the mouth into the esophagus and there's these semi-surgical like procedures that can be done to either tighten the area or actually burn it in such a way that it causes it to thicken so that the sphincter works better.

Oh, like it's kind of like when they give those, uh, big lips to people now. Yeah, exactly. Um, so, okay. So let me, let's go on to gallstones again. Uh, the, so what are some corrections for gallstones since we already talked about kind of what they are? Yeah. So gallstones form in people because of, uh, uh, uh, the way the bile acids, cholesterol and triglycerides all mix in the gallbladder. And in some people that mixture allows for these hard stones to form that can be problematic. And what would, wait, the question again was how to fix them. Yeah. Well, you're going down the right path. I think on that. So yeah. Yeah. Um, if you want to talk more about how they actually form, I think that'd be interesting.

Yeah. So in some people they form, we don't know exactly why some people get them and they don't, but the most kind of classic patient who gets it is typically a female, a young female who's oftentimes overweight and probably the being overweight, there could be an increase in the, the, the triglycerides and so forth in the bile and bloodstream that allow everything to form. So that's your most common group. Um, and when they do form, people can have this intermittent pain, especially with eating fatty meals. And really the only way to treat them appropriately, I mean, adequately is one, people can try and eat a low fat diet because that causes the gallbladder to squeeze the least. And some people can manage their symptoms with that.

However, I often see the people who can't, and that's why they seek out, you know, medical attention and expertise. And most of those patients ultimately need to have a surgery to have their gallbladder removed. And nowadays that surgery is very simple. It's done laparoscopically where a surgeon, not myself, I would refer them over a surgeon makes three teeny incisions in the abdomen and puts essentially tools and cameras in through those holes and can remove the gallbladder. Usually it's done as an outpatient, meaning the patient goes to a facility that's not part of a hospital. They get put to sleep in an operating room there. The surgeon takes out the gallbladder in like an hour. They wake up, recover for a few hours and then go home and say, recover over the weekend at home. And could be back to work on a, on a, you know, have it done on a Friday and back to work on a Monday. And then, you know, have to take it easy for a couple of weeks. But I do see a lot of patients come in and ask about medications or cleanses to get rid of it. And really there's no medical evidence that any of these cleanses and different herbal remedies have any significant benefit in dissolved stones.

And so for most people who, who think they want to do those things, I don't necessarily dissuade them, but I do tell them I'm very doubtful it's going to help. Um, and, and sometimes you, people do need to be careful what kind of supplements and alternative therapies they try because rarely those things can cause more problems than good, um, by different reactions and interactions and stuff. Was, is there a certain point too, where it's kind of like they've already gone down, you know, gallstone path too far where it's, it's, it's not really even going to help too much to change the diet. It's like maybe chronic, right? I mean, there's absolutely, there's people who, and most of the people I see, I mean, they're having frequent symptoms sometimes with every meal, you know, sometimes it's just a couple of times a week or a couple of times a month, but it's debilitating, excruciating, dropped to your knees, horrible, excruciating pain, you know, potentially for several hours that, you know, happens randomly after they've eaten a meal. And after somebody's had a few of those attacks, most people are willing to, you know, have some type of corrective surgery to have it addressed because it's really no way to want to live your life. Oh yeah. I mean, they must be on painkillers and everything too, or sometimes. Yeah. It sounds terrible. I've had kidney stones actually. I don't know if they're not in the same family as each other, are they? They're, they're different, but I mean, same kind of concept in that there's a hard thing where it shouldn't be and your body's, you know, trying to get rid of it in a sense and can't.

Yeah. The, I, I was, when I got my kidney stones, actually the, uh, I could have swore. It was, I thought it was coincidental. Maybe it happened this way. Maybe it's cause I never drank water, but, uh, so I was actually in Boy Scouts at the time. I think I was like probably 14. I was young. Um, so don't, I don't even let kids tell me this, this joke anymore, but I was, I was standing there boys at a Boy Scout jamboree and this kid asked me the joke of, uh, what's the capital of Thailand? You heard this one already? Oh yeah. Yeah. And so, so he goes for it and he kicks me and, uh, and immediately after that, I hurt there, I hurt in my back and, and I told my dad, Hey, I gotta, I gotta go home. Let's just go home. So we were like an hour and a half away. Um, and it hurt for days and days and days. And finally they, they're like, Hey, you have kidney stones. I'm like, no way.

So I'm just kicked me. The guy kicked me in the balls, you know? Yeah. I can't see how that would have caused it, but it's, it's a weird coincidence. Yeah. Yeah. I still don't, I still don't go. Whenever someone tells a joke, I really don't know the answer to you. I just take a couple of steps back now. Uh, safe, safe, safe advice for all your listeners. Yes. Kids are merciless. Uh, so let's go into IBS then. So irritable bowel syndrome that is, so this is really common, right? Very common. Uh, yeah, I think statistically about one in five Americans is this potentially have the diagnosis of IBS. Is this more, is it more prevalent now? Is it less? Um, well, it's probably, it's hard for me to say, I don't know the statistics on its true prevalence. I mean, it's definitely a very recognized condition now. So I, I, I would suspect it's probably been around, you know, just as much over the years, but it's just more people talk about it and there's an official diagnosis for it, but there, there could be something said to, you know, the diets we eat now compared to the past as well and how that could be affecting our guts, which we'll probably do at some point. But, um, so, I mean, just in general, there's certain criteria for IBS and IBS people will generally have, they have to have at least three months of essentially intermittent or continuous, um, abdominal discomfort. It can be associated with loose stools, diarrhea, or on the flip side, constipation. And people can sometimes have alternating. Some days they have constipation, sometimes diarrhea. Oftentimes the discomfort gets better with bowel movements, but the most important thing, especially for your listeners to be aware of is in order to truly make the diagnosis of IBS, you need to have ruled out all of the other things that can mimic IBS. So I see a lot of people come to my office who say, Oh yeah, I've had IBS for years, but after we do a workup on them, which we can get into, they have something else, you know, do they, they might have celiac disease. They could have, um, they could have sucrase deficiency.

They could have small intestinal bacterial overgrowth. They could have a parasite. Um, there's a whole host of things that could mimic IBS. And, and even if it is IBS, there's treatments for potentially all of these different labels that could make a difference in, in that person's life. Yeah. I think the first one you said, was it, uh, was that an inflammatory arthritis or, uh, or sorry, uh, inflammatory condition? Do you say ulcerative colitis? I did. I actually, I didn't mention that, but that is true. We want to make sure oftentimes that somebody doesn't have something called Crohn's disease, which is a form of inflammatory bowel disease where they have a, uh, potentially very serious condition in their gut where they get inflammation that leads to, can lead to a variety of complications if they're not put on appropriate medications to keep it in check. Yeah. And it kind of reminds me of like, there's, so we have, we have different types of arthritis or arthritis is that we deal with and with muscle skeletal. And if we find RA or, I mean, I found a psoriatic, uh, guy had bilateral or both sided Achilles pain and it was just rampant there. And he had, uh, I mean, that's something that, I mean, it's a completely different treatment plan. I would imagine IBS and, uh, some of those other conditions have totally different treatment plans. Oh yeah. Right.

I mean, depending on the diagnosis, yes, completely different. And, you know, recognizing some of these problems earlier could make a big difference in that person's life if they're, you know, mistakenly diagnosed as IBS for, for years and years and years. And in effect, you know, they really have an inflammatory process going on that, you know, over time is unrecognized and leads to a whole bunch of problems. Uh, I had a question by someone, you know, I won't, I won't mention her name, but I said, Hey, we're, we're having Dr. Ben on. Do you want to ask him anything? She said, yeah, I want to know how to get rid of constant gas related to irritable bowel syndrome. So I mean, and so that goes back to my original statement. So the first thing is, you know, has this person, does this person truly just have a little bowel syndrome? So I'll tell you that there's a lot of people out there, one who say have lactose intolerance, like you were telling me, and you can either be essentially born with lactose intolerance where your body doesn't make the normal enzyme to break down lactose. However, you can also develop lactose intolerance from a problem called small intestinal bacterial overgrowth, which goes by the acronym SIBO or SIBO. And with this, then we all have trillions of different kinds of bacteria in our gut. And there's different theories as to why this potentially happens, but these bacteria get so out of balance in our gut that they get overgrown. And then when you go to eat certain foods, including lactose containing foods, these bacteria gobble up the food you're eating and produce all sorts of gas and can even give you a lactose intolerance. And with a special antibiotic that helps cleanse your gut, a two week course of that, you could potentially get rid of these quote, IBS symptoms and gas and bloating and be totally back to normal and be able to eat what you want, if that were the problem. Some people have about, I think the statistics are about 10% of the population have a deficiency in sucrase, which is to help you break down sucrose, which is a sugar in tons and tons of the foods we eat. And that can give you a lot of gas and bloating if it's unrecognized.

So is it that they just, uh, well, I guess going back to the, uh, was it small or small intestinal bacterial overgrowth? Uh, so that one is it, I mean, how did the things get in there? So we all have, we all have tons, billions, trillions of bacteria in our gut that we're just beginning to recognize play potentially important and potentially problematic roles in our health, including our immune system, how we function and so forth. And that it kind of goes along the lines of probiotics and probiotics have become very popular because you take these quote, healthy bacteria and add them to your system. But in some people, the bacterial population is so out of whack that taking a probiotic is like dropping a little drop in the Atlantic ocean. And, you know, you can't influence the whole ocean with a little drop. So you need to really just change it significantly by cleansing it with an antibiotic, a special antibiotic. And in a lot of people that can make a profound difference. I mean, I've seen patients who come in with decades of bowel gas issues. And after a two week course of this treatment, they're completely back to normal and can't believe it.

I mean, and again, that's for certain people, but, um, other people can have celiac disease, which is a, uh, issue where gluten causes antibodies in their body that then attack their small intestine can give them gas and bloating and diarrhea and other symptoms. And so by going on a gluten-free diet, that can make a difference. Um, if somebody truly has IBS, then there's certain diets that can be helpful. One diet that has been shown in medical studies to help a lot of people is called a, a low FODMAP diet. It's an acronym F O D M A P. And if that also has to do with the way our body process certain sugars in some people, it's problematic and causes a lot of some of the symptoms that you were just referring to. So the, I hadn't heard the FODMAP diet, the, is that, so that, does that address the S I V O and the, uh, well, so if somebody has SIBO, they might feel better on a low FODMAP diet.

Um, would that cover the sucralose too? No, no, that is a, that generally is a different diet. So, and there's also a enzyme replacement that, that is now available. If somebody has a sucrase deficiency that could allow them to then eat what they want in a sense and not have a lot of problems, kind of like the lactose enzymes that you can, uh, or lactase enzymes that you can buy at any supermarket or pharmacy that you'll, I don't know if you've used them, but you can, you know, if you're going to have some ice cream cause I have lactose intolerance, um, I'll just take one of these right at the beginning of my pizza or ice cream and it helps me to digest it so that I don't have all this gas and bloating afterwards. Oh yeah. I, I definitely have like, they're in my car, they're in my wallet, they're in shorts, they're in pants. They go through the laundry now and they can actually stay together in those little packages. Yeah. It's pretty impressive. Yeah. Right. I don't, I don't know what they make. Those things are made of like rubber and aluminum or something, but, um, I don't know about you, but actually I've, I've had times where like, I think I'm so excited to eat like finally a piece of cheese or pizza. So I'm, I take one out. I, I unknowingly eat it, throw the wrapper away and I'm about to take the bite of pizza and I'm like, did I, did I, did I eat the pill? So, so I just hit a second one because I know that if I know that if I don't take it, it's going to be a world to hurt. Right. Yeah. It's better to take too much than too little. That's for sure on that one. Yeah. Um, okay. So you went into, we went a couple different ranges there. I heard you talk about celiac. Um, I did have someone, I actually, before I had you on tonight, I had, uh, a couple of patients ask it. I'm like, Hey, I'm having a GI personnel. What do you, what do you want to ask? And so one person asked about, so gluten, gluten-free diets, is there anything they should remove or is there any validity to it and so on? Yeah. So, I mean, there's a lot of, well, we'll come back to actual celiac in them. Well, I guess, let me start out with celiac again. So celiac is a disease where people, when they get exposed to gluten, which is in a lot of wheat products, antibodies, these little molecules get formed in their bodies that then attack their intestine and actually cause a lot of problems in their intestine. And then they start not being able to absorb nutrients well and causes all sorts of symptoms. And then by excluding gluten, these antibodies will go away and the intestines will look totally normal and healthy and their symptoms will go away.

Those people need to avoid gluten at all costs. Even small amounts of gluten will continue to cause this disease to be a problem. So that's a clear cut, no questions. Those people need to be on a gluten-free diet. However, there's a huge population of people who either one, feel they're being healthier by eating a gluten-free diet or two, say, I have all these issues. And when I'm on a gluten-free diet, I just feel significantly better. So going to the first group of people who just feel they're being healthier by avoiding gluten, at least at this time, we have no medical evidence to suggest that they're actually being healthier. So it's not something that I recommend as a general rule. The other group of people who say, oh, I don't have celiac, I've done all this testing, but whenever I avoid gluten, I feel great. And if I take gluten, I feel horrible. Those are people that we call gluten sensitive, meaning, yeah, if they take it, they're sensitive to gluten, but there's really no measurable medical reason why. And so if a person comes to me and says, I feel better avoiding gluten, you know, I might check some other things to make sure they don't have other problems, but it's, if they feel better avoiding it, then, hey, why not continue on it? I feel better. You know, I'm not going to tell you to make yourself eat it and feel like crap. And that's a huge group of the population. And perhaps at some point, we'll have a better reason for that. One thing I think is probably happening is that a lot of these people have actually IBS. And as I had mentioned, this low FODMAP diet, which has to do with changing a lot of the sugars in our diet, actually, as a component of it, you need to be gluten free. So there's a lot of overlap between the gluten free diet and this low FODMAP diet. And so I suspect a lot of these gluten sensitive people are actually benefiting more from these low FODMAP properties of the diet than potentially they are from just strictly gluten. But again, that's my own personal opinion. And there are definitely people out there who would say, no, I just, you know, any little bit of gluten, it doesn't matter about this whole FODMAP thing. I feel bad.

Yeah. So I'm actually, I'd never heard of FODMAP, like I said. Yeah. So I would definitely, anybody who clearly has IBS, I would encourage them to give that diet a try for a couple of weeks. And in studies, a very high percentage of people had significant relief. Okay. I'll put a link to it, actually, if everyone's listening. If you want to go to the show notes too, it's on p2sportscare.com slash podcast, and I'll put a link to the FODMAP on there. Okay. I have another question too. You want another one? Sure. Okay. This one was by another patient too. They asked about vegan diets. They were mainly asking about, I guess, if you had a choice, would you rather have someone go off of vegan or dairy if they didn't have a sensitivity or an allergy to it? Or would you rather them go vegan or just no dairy?

Just in general. So not for health reasons. Well, I mean, I guess they probably had, they had the thought that one was going to be healthier than the other, but they wanted to know which is better. I mean, so that one, we really don't have any medical evidence to suggest that some of these specific diets, whether it be vegetarian, whether it be vegan, whether it be, you know, hybrids of these paleo diets, so forth, whether there's any significant, any significant medical benefit of one versus another. So I generally, I mean, I might talk to patients about certain things that bother them in their diet and then try and avoid those things. But I generally don't recommend that they, from a medical standpoint, go on any one of these specific diets. And usually if a patient's asking me for, say, some advice on their diet based on certain preconceived notions they have, and we want to make sure that they're getting in all of the nutrients and things that they should have to have a well-balanced diet, at that point, I'll usually send them to see a dietician. Because my, you know, most doctors' specialties are in diagnosing certain conditions and diseases and finding those treatments. And while certain diets may be helpful for certain people, I definitely am not an expert in the nuances of a lot of those diets, nor do I unfortunately have the time to really even go into those things if I were an expert in it. So I'll often send people to see a registered dietician who, you know, can spend an hour's time going over diets and some of the pros and cons and review what people are eating and give, and that's all they do all day long. And so they have significant expertise on those matters.

Yeah, it makes sense. And I know that a lot of people with, uh, when they do dietary changes and even exercise ones, like they need a lot of handholding. And, um, I don't want to sound like it's a bad thing, but they do. And I would too. So it does take a lot of time. And I do think over time, and again, this is all, you know, my own personal opinion, as we were talking about all the bacteria in your gut and how they work, I do think that it's very likely that people who gravitate to certain diets over time, that probably there's some shift in the types of bacteria in their gut. So their body just starts to work with that type of food intake better and maximizing its potential. But, and that's why, you know, shifting diets is not an easy thing for people to often do because your body is not acclimated to kind of how those foods get absorbed and processed in your system. So it's not, it's not, it wouldn't be an easy thing for most of us to go from if say you're a meat and potatoes kind of guy to like a vegan diet, all of a sudden your body just like rejects it almost, you know, you, a lot of people need to kind of slowly gravitate to certain diets and let their body acclimate. Yeah. I would say that if I don't have some type of meat, my diet that I feel like if it's only vegetables, I feel like my stomach is physically eating itself.

Yeah. I could never personally, at least I don't think I can without really taking it slower, be a vegetarian. I just, I, I just need some type of meat protein to, to feel balanced. Just the side, just the side of it. Um, well, cool. I think, uh, I guess the last question I have for you is, um, is there any other, like, do you have like a couple of questions that patients typically ask you all the time or that maybe we didn't get to right now or, um, let's see. I do get one of the, well, this one's fairly specific in terms of, but it goes back to, and we can kind of bring it full circle here, goes back to acid reflux. And so while I had mentioned that there's a lot of, or there's a number of medications out there that can help reduce the amount of acid that your body makes and therefore minimize the reflux symptoms. There's a lot of controversy, um, into the most potent family of medicines, these proton pump inhibitors, which are generally like Nexium and Prevacid and Prilosec, because there have been a number of studies that have come out, um, suggesting a potential, what we call association between those medicines and things like dementia and kidney problems and osteoporosis, which is a thinning of your bones from not having enough calcium. And so frequently I have my patients who I tend to have patients who need to be on these medicines long-term because as a specialist, that's who they end up seeing and following up with once a year. And so very frequently I have discussions with these patients about the risks and benefits of staying on these medications. And typically for the patients that I see, the benefits of staying on these medications far outweigh these still questionable risks. But if you're the average patient out there who can control their acid reflux with diet, say, or losing weight or doing different things, I do, I would advocate that much more strongly than taking a medicine on a daily basis, you know, to, to fix the problem because every medicine out there, while there's potential benefits to it, you know, there is always that chance that they, you can have side effects and issues from it. So a lot of Americans in general, at least that I see just are lazy and want a quick fix. And so they'd rather take a medication to just fix their symptoms and be able to eat what they want. But from a societal standpoint, I think everyone is better off, you know, in those cases, trying to change their diet as much as possible. And if necessary, take those medicines. But you know, it is sometimes a trade-off.

Yeah. Well, that's one of the more common things I get asked. One other, which we didn't touch on, but another common thing I get asked is people will come in with bowel issues to see me and they want to know what's the normal amount of times they should be having a bowel movement every day or a week. Generally, my response is, you know, well, what's normal for you? Because normal can range, you know, if you take statistically from anywhere from several times a day to a couple times a week. So the main thing is what's been your pattern over your life. And if that's kind of what you've been doing, then that's fine. But if you have a serious deviation from your pattern, you know, either more frequent or less frequent, that's at some time, then you should probably consider seeing a doctor to make sure things are okay.

Interesting. I feel like if I feel like if you're in a household of four people, and everyone was on the same frequency, would that cause a lot of household anxiety? That one, I'm not sure of. I haven't had to deal with that one very often. But thankfully, most of my patients have enough bathrooms, because I live in a fairly affluent, I work in a fairly affluent community. That's good. Yeah. Imagine if all they had was an outhouse or like a little hole in the ground. Yeah. You got to get your bodies on different sinks. Yeah. Oh, going back to what you said about like, you know, treating people, you know, differently based upon what they need. I mean, it makes complete sense. Like you got to have, like I, we have, there was actually a patient that I had here that she was, I mean, I wanted to do tissue work and strength training and then a core worker there and everything, but it could barely touch the person because she, she was just so jumpy. So as a result, like the next few times, like I did, I basically just moved her joints around and it was almost no work to me. And if I had done that, say on you, you'd be like, what are we, what are we doing today? Like, I thought we were going to do something real, like, but it was, it's just kind of warming, warming her body up to the possibility of doing something different or warming her mind up to it.

So the people we talk about it, that come in wanting medication, not wanting to change. I mean, like you can't recommend the same thing. Um, so that makes complete sense to me. We have the same thing here too. Um, but yeah, I think, uh, gosh, we've been, we've been on for about 50 minutes here. You want to, you want to, you want to tell us how to find you or, uh, sure. So I'm in a private practice, uh, in Saddleback at Saddleback next to Saddleback Memorial Hospital, Laguna Hills. Our medical practice is called Saddleback Medical Group. Um, we're actually a multi-specialty group. So there's, I'm one of five gastroenterologists. Uh, and then we have a variety of primary care doctors, which consists of family practice, internal medicine. We have a variety of other specialists. There's about, I think 30, 32 of us all together in a few locations.

And for the most part, we can't, we take all PPOs, Medicare, and a number of HMOs. Um, and anybody who thinks, you know, they might have some GI problems and want to run it by an expert, they're welcome to see myself or one of my partners. We do have a website. It's www.saddleback.com. GI.com. And our office number is 949-770-7163. Cool. I'll post all that up too. Um, by the way, everyone, it's Laguna Hills, California or sorry, Laguna. Oh yes. For, for, I was assuming this was regional, but given these days, I guess I shouldn't make those assumptions. You never know. I don't, actually it's funny that iTunes does not allow us much information on who's listening or the, uh, actually I think you can figure out where they're listening to, but even subscriber based, they don't give me an exact number. Um, it's not really, so we don't know. This could be someone in Germany for all we know. Um, but cool. Um, anything else you'd like to add before we close up? Uh, no, this was fun. I enjoyed it. Um, if you ever want to talk about, there's lots of GI issues. So if any interest in other things, let me know. Oh man, we're going to go through that. Uh, my sister bought a book a long time ago. What is your poo tell you? Yeah. We're going to have to go into the entire book chapter by chapter next time. All right. Yeah. That would be a fun exercise. I'm sure. Um, yeah, I feel like one of the pictures in there actually had, there was one that had like glass shards in it and stuff. And it was that one. I don't think you need a doctor to tell you that that's not good. Yeah. It was a glass eater. Um, okay. Let me, uh, just hold on one second right there. I'm going to close this up for everybody else and, uh, tell them where to find all the show notes. Okay. Okay. Okay, everyone.

That was Dr. Benjamin Weinberg. Again, uh, you can find all of his contact information on the show notes at p2sportscare.com slash podcast. And again, if you have a question, like I had a couple people in the office today, ask these questions to ask him, then go ahead and go onto my site, p2sportscare.com. There is a voicemail button right there and you got a minute and a half to state your question. Tell us a little bit about yourself and so on. Um, and if you have not listened to this on iTunes yet, please go through the link to iTunes to subscribe and then please review, please, please review.

It does help me out a ton. And, um, yeah, I think that's about it. So I'll talk to you guys soon next time. And, uh, hopefully it's a good topic next time as well. Talk to you guys soon. Bye.