Dr. Jocelyn Strand is the Director of Clinical Education at Bio-Botanical AND a great clinician herself. Prepare yourself: this is a very actionable podcast for clinicians using bioB. And for me, a huge pearl on refractory SIBO was unaddressed oral microbiome!
In this episode of New Frontiers, learn how Dr. S addresses sibo using BB products. To test or not to test? And the underlying pathophysiology: tune in and listen to current thinking from a great clinician – she’s got to say and you’re going to learn a lot. Then, if you would be so kind, please leave us a rating and review wherever you listen to New Frontiers! I so appreciate your time and ears – thanks for listening! ~DrKF
Functional GI conditions are astoundingly common today, and functional medicine practitioners are seeing increasingly complex cases in their clinics.
Meanwhile, the very understanding of GI conditions like SIBO continue to change and evolve. Is SIBO condition of microorganism overgrowth? Or dysbiosis? Does it have an autoimmune component?
In this episode of New Frontiers, Dr. Fitzgerald talks with naturopathic physician and director of clinical education for Bio-Botanical Research, Dr. Jocelyn Strand, about how functional GI conditions are defined, the efficacy and limits of testing, and treatment approaches, including specific dosing and duration recommendations.
In this episode of New Frontiers in FxMed, you’ll learn about:
- SIBO as dysbiosis vs. overgrowth
- The difficulty of treating microorganisms trapped in the mucus lining
- The role of the migrating motor complex in functional GI conditions
- The benefits and limits of breath tests for SIBO
- Why the hydrogen breath test is unreliable for diagnosing methane-dominant SIBO
- Why any level of methane on a test might be cause for concern
- SIBO as an autoimmune condition
- The efficacy of stool testing for identifying pathogens
- SIBO vs. SIFO
- How treatment for SIBO can trigger SIFO
- Benefits and drawbacks of the low-FODMAP diet
- The importance of doing testing before treatment in frail or pediatric patients
- BID dosing vs. TID dosing
- Botanicals that break down biofilms
- Dosing and duration recommendations for Biocidin
- Managing die-off symptoms
- Biocidin’s immune modulating properties
- The potential of Biocidin to disrupt the efflux pump
- When to use motility agents
- The possibility that microorganism overgrowth in the small intestines is coming from the mouth,
- Specially-formulated antimicrobial toothpaste
- Using probiotics and antibiotics/antimicrobials simultaneously
Dr. Jocelyn Strand graduated from Bastyr University in 2005 with a Doctorate in Naturopathic Medicine. Following her graduation, she established her practice in the Seattle area, working at Pharmaca Integrative Pharmacy, as well as in a gastrointestinal specialty clinic.
She returned to Minnesota in 2008 with the vision of increasing the availability, affordability, and awareness of naturopathic medicine, and opened her private practice at Lake Superior Natural Medicine, where she specialized in GI system disorders, Lyme disease, and auto-immune conditions as a Primary Care Provider through the Minnesota Board of Medical Practice.
In 2019, Dr. Strand became the Director of Clinical Education for Bio-Botanical Research, Inc., and continues to inspire others through research and lecturing around the world.
Investigating Colonization of the Healthy Adult Gastrointestinal Tract by Fungi (PDF Download)
- Central tumour necrosis factor-alpha mediates the early gastrointestinal motor disturbances induced by lipopolysaccharide in sheep.
- LPS-induced suppression of gastric motility relieved by TNFR:Fc construct in dorsal vagal complex.
- Normal Oral Flora and the Oral Ecosystem.
- Human oral microbiota and its modulation for oral health.
- The Relationship of Candida albicans with the Oral Bacterial Microbiome in Health and Disease.
DrKF FxMed blogs:
- A Powerful, Functional Approach to a Healthy Oral Microbiome
- Botanical Strategies in Lyme Disease by Dr. Rachel Fresco
- Plant Based Antimicrobials – How to Heal SIBO and other chronic GI Imbalances with Botanical Medicines
New Frontier in FxMed podcasts:
Dr. Kara Fitzgerald: Hi everybody. Welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine, and today is no exception. I’m really excited to be talking to Dr. Jocelyn Strand today. If her name rings a bell, at least for my platform, she published a blog on the oral microbiome for us recently, and it was one of our top 2019 blogs. And so we sent that out in our annual download of top content in December so you might be familiar with that. If not, we’ll actually link to it on our show notes because it’s really terrific blog. She’s a naturopathic physician like myself. She graduated from Bastyr in 2005, actually same year I graduated, with a doctorate in naturopathic medicine.
Following her graduation, she established her practice in Seattle. She also worked at an integrative pharmacy and she focused in gastrointestinal health while there. She returned to Minnesota, her home state, with the vision of increasing the availability, affordability, and awareness of naturopathic medicine there, and opened up a practice on Lake Superior called Lake Superior Natural Medicine. Again, she continued to specialize in GI systems disorders, Lyme disease and autoimmune conditions, as well as acting as a primary care provider.
In 2019, she became the director of clinical education for Bio-Botanical Research and continues to inspire others through research and lecturing around the world. We were actually just dialoguing about a lecture she just gave in the beautiful state of Hawaii on small intestinal bacterial overgrowth, background, pathophysiology, some really new thoughts on the pathophysiology. And I said, “Listen, we need to stop and get this on the recording because it’s all very interesting.” So Dr. Strand, welcome to New Frontiers.
Dr. Jocelyn Strand: Thank you. I’m very excited to be here.
Dr. Kara Fitzgerald: Good, good. Yeah, and we’re appreciating getting to know you and getting to know the high caliber work that you’re doing. All right. So, we were talking about Pimentel and his investigations in SIBO. He will actually be on this year. I don’t know when we’ll release him, but I think I’ll be podcasting with him next month, so it’ll be fun to follow up.
Dr. Jocelyn Strand: I can’t wait to hear it.
Dr. Kara Fitzgerald: Yeah, yeah. Well, ping me questions. And if anybody’s listening to this, you’re welcome to ping me questions for him. So let’s just start from the beginning. Talk to me about the current definitions of SIBO.
Dr. Jocelyn Strand: Okay, well SIBO, I think it’s still such an evolving diagnosis and understanding the underlying physiology of it that there are a number of different thoughts on what it actually is. So the going definition is if there are 10 to the 5 microorganisms per milliliter of gastric fluid or stool. And, for a while, that was the definition. I just think it’s really interesting because small intestinal bacterial overgrowth kind of defines itself, right? We have a lot of microorganisms in the gut. But what we’re finding is that the physiology indicates that it’s probably not where it starts. There are other things that start that result in that, and so I think it’s really fascinating. And we’ll get into that, we’ll talk about some of that hopefully today. So that’s one definition. Dr. Pimentel was talking about the Reimagine study in a podcast that I listened to recently. And he talked about how a lot of the microorganisms are embedded in the mucus and that they’re difficult to sample or extract.
Dr. Jocelyn Strand: So, when you do take a sample, that if you only get 10 to the third that that’s not considered SIBO. But what his argument is that if you actually sample it correctly and extract the microorganisms from the mucus, you would see 10 to the fifth. And it’s really interesting because there’s a Nature article published, I think it was about almost a year ago now, that talked about dysbiosis, or no… Well, I’m not sure when it was published, but that SIBO is dysbiosis rather than overgrowth. And Dr. Pimentel’s argument is we weren’t doing a full sampling of it without the mucus layer being sampled as well. And so there is, as you can see, a lot up in the air. Is it 10 to the fifth? Is it 10 to the third? Is it dysbiosis? And ultimately, as practitioners or clinicians, I think what we are most concerned with is we get a general idea of what it is. How do we treat it? How do we help the patient feel better and sustain healing?
Dr. Jocelyn Strand: So somewhere in there you need to come to, as a clinician, some understanding of what you decide makes the most sense. And I, in my practice, I really tend to just call it dysbiosis. And we’re understanding more, as the migrating motor complex is compromised, that it does indeed, we do get overgrowth of the microbiome or of the bacteria in the small intestine, so that is playing a role in it as well.
Dr. Kara Fitzgerald: Yeah, yeah. Well, all right, let me see if I can summarize what you’re saying. It seems to me like it’s a continuum. I mean, there could be sampling issues, but it seems like there’s a range of overgrowth or imbalance. So you can be within normal limits on a specimen, on a breath test. But then, if you actually went in there and took a sample of the mucus layer, you would actually find that they’ve got plenty of overgrowth. So there’s that, right?
Dr. Jocelyn Strand: Exactly, exactly.
Dr. Kara Fitzgerald: So you could have a normal breath test, but you could still go in and sample the mucosa and find that they’re very elevated. So you can couch it as being overgrowth or you can couch it as dysbiosis.
Dr. Jocelyn Strand: Exactly.
Dr. Kara Fitzgerald: In a way it sounds like we’re splitting hairs there, right? So the question would be, if you do a breath test and it comes back within normal limits, if your patient’s symptomatic, they’ve got a bacterial imbalance, right? Or they’ve got a microbial imbalance.
Dr. Jocelyn Strand: Right. And it doesn’t mean that we don’t treat, right? If it comes back negative. I was having this conversation with Nan Sudack, who’s a colleague of mine here, and she said the same thing, “Well, if I do the breath test and it comes back negative, I still treat the patient.”
Dr. Kara Fitzgerald: Right.
Dr. Jocelyn Strand: And that’s true. It’s exactly what you’re saying, is that it’s probably a combination of overgrowth and dysbiosis and some damage to the lining of the gastrointestinal tract that’s resulting in the emptying not being efficient of the gut.
Dr. Kara Fitzgerald: Right. It’s kind of extraordinary. It’s like we’ve come full circle, haven’t we?
Dr. Jocelyn Strand: Exactly.
Dr. Kara Fitzgerald: Back when we were in school, it was all dysbiosis. Maybe different, if we were doing stool testing, there might be a little different angle. Symptoms are different from person to person. But we labeled it all as dysbiosis. It’s interesting that we’re actually returning to that. And Pimentel himself says if you see methane, really almost any amount of methane, that that can be significant. Correct?
Dr. Jocelyn Strand: Yes. Yeah, that’s right. Because, yeah, so methane would be more the SIBO that’s involved with constipation, the methane-producing mechanisms, right? And they exist by consuming hydrogen. And so I think what his argument is is that if you see any methane, then you have the pathogenic level of Archaeabacter or the methane-forming. And then you can’t trust the hydrogen breath test because they’ll-
Dr. Kara Fitzgerald: They’re eating.
Dr. Jocelyn Strand: They’re consuming the hydrogen.
Dr. Kara Fitzgerald: Right, right. They’re using it as their substrate. Yeah, that’s pretty interesting. Wow. That’s a pearl. So did you catch that folks? Any level of methane is likely problematic in Pimentel’s view, and it can render the hydrogen test useless because they’re using the hydrogen. The methane producers, the archaea are using the hydrogen as the substrate. That’s pretty interesting.
Dr. Jocelyn Strand: There’s so much to know and there’s so much research. And then, in light of new information, then you can go back in the research and try to make sense of… And there are a lot of clinicians that are doing that, that go back. And maybe research that’s 15 years old has a different meaning now than it did when they first did it, now that we have a better, deeper understanding of what’s going on in the gastrointestinal tract. And that’s what I find fun, because I’m a geek.
Dr. Kara Fitzgerald: Yeah. We’ll definitely throw some of those pearls out as we move. Let me just ask you this though, with this interesting introduction. We use the breath test in practice all of the time, and I think it’s useful with the caveats. We’re always working on staying relatively current so that we can interpret it, obviously in the context of the clinical presentation. But one of our physicians here, who really follows Pimentel, stated recently that Methanobrevibacter on a stool test might actually suggest methane SIBO. What do you think about that? It’s the other end of the gastrointestinal tract. Yeah, what do you think?
Dr. Jocelyn Strand: So will you say it again? So the Methanobrevibacter positive on a breath test would-
Dr. Kara Fitzgerald: On a stool test. On a stool test.
Dr. Jocelyn Strand: Oh, on a stool test.
Dr. Kara Fitzgerald: Yeah, that a certain amount could be suggestive of methane SIBO. Have you come across that at all?
Dr. Jocelyn Strand: I’m sorry. I don’t feel as though I have enough information to speak…
Dr. Kara Fitzgerald: Okay, okay.
Dr. Jocelyn Strand: about that.
Dr. Kara Fitzgerald: Okay, not a problem. Not a problem.
Dr. Jocelyn Strand: I’d love to give you a brilliant response but, no, I don’t know enough about it.
Dr. Kara Fitzgerald: If it crosses your desk, which it could now that we’ve had the conversation and it’s brought to your consciousness, just ping me on it…
Dr. Jocelyn Strand: I will.
Dr. Kara Fitzgerald: … and we’ll pop it on our show notes if you have any thoughts on it.
Dr. Jocelyn Strand: Okay. I’ll look into it. That’s fascinating.
Dr. Kara Fitzgerald: Yeah, so I guess my question… Well, let me do this since you’re putting a lot of attention and you’ve got a lot of expertise in this arena. Beyond Methanobacter, could a stool test be useful for diagnosing SIBO? And I’m asking you that to comment on later on if you feel like pinging me on it or if you have any thoughts on it now, go ahead, jump in.
Dr. Jocelyn Strand: Okay, okay. Well, a couple of things. I’m going to back up just a little bit to something you said, which just to talk about, go back to that Reimagine study where Dr. Pimentel was able to see that 10 to the third microorganisms is more indicative rather than 10 to the fifth of SIBO. And in that study he said that they sampled gastric juice, they did genetic sequencing, they did culture, and they did the breath test. And what they found was that the lactulose breath test, 90 minutes after the consumption of the lactulose, was as effective as combining all of the other. I mean not quite as effective, but very, very close to as effective at identifying it, if I understood his podcast correctly. Which is really interesting because, again, you talked about coming back to… We go back and forth about the lactulose breath test, whether or not it’s the sensitivity, the specificity, all of that. And he found that it was really helpful for identification of SIBO, the hydrogen production,…
Dr. Kara Fitzgerald: Good.
Dr. Jocelyn Strand: … the hydrogen-producing bugs in SIBO.
Dr. Kara Fitzgerald: At 90 minutes if collected appropriately?
Dr. Jocelyn Strand: At 90 minutes. Yes, exactly. So that’s vital is that if you lose that window of time, then the results are not helpful.
Dr. Kara Fitzgerald: Let me… Oh, go ahead. Go ahead.
Dr. Jocelyn Strand: No, that’s it. So I just thought that was really important. And then, I think for testing in general, so stool testing I think can be very useful as a clinician to identify pathogens. But I don’t think, as far as I know right now, in terms of SIBO diagnosis, it’s not a tool that’s being considered as much as the lactulose breath test is. And then Dr. Pimentel is talking about antibodies against vinculin and CdtB. And so those are two potential testing techniques, that we can use instead for diagnosis.
Dr. Kara Fitzgerald: Got it. Yep. Okay, makes sense. And thanks for clarifying that. We will, incidentally, link to the Reimagine study on our show notes. What about hydrogen sulfide? How do we figure that one out? That’s pretty much just a clinical diagnosis at this point, right?
Dr. Jocelyn Strand: It is a clinical diagnosis, and mostly it’s associated again with that constipation aspect of that. At least this is my understanding of it currently is the hydrogen sulfide connected with the methane-producing organisms. And please correct me if I’m wrong because I just started reading about it, and I’m just starting to learn more about the hydrogen sulfide. It’s amazing how, when you’re out talking to other clinicians, how people hand me information all the time, “And what about this one? And how about this one?” But that one is relatively new to me. So, again, it’s not one of the areas that I feel like I have a lot of expertise.
Dr. Kara Fitzgerald: Okay. All right. Well, I appreciate you tussling with it. I want to move into your area of expertise because you’ve been sharing it with me beforehand and it’s really helpful for us. And I appreciate you being very grounded in what you’re doing in the clinic. So let’s talk about SIFO, which I’d like you to define. That’s been on people’s radar.
Dr. Jocelyn Strand: Okay.
Dr. Kara Fitzgerald: What’s the difference between SIBO and SIFO? And there’s a handful, there’s a variety of microbial culprits. So just let’s start by defining and let’s start by… Talk to me about the bugs involved.
Dr. Jocelyn Strand: Okay. So SIBO is bacterial overgrowth and SIFO is a fungal overgrowth in the gastrointestinal tract. And, ultimately, what SIFO comes down to is Candida albicans typically, or one of the Candida species. And what I think is really interesting is that… So they’re treated very differently from a pharmaceutical approach. And I was listening to, again, a podcast by Dr. Satish Rao, and what he said is, “I always treat for SIBO first because I’m going to cause SIFO when I treat for SIBO,” which means the rifaximin, which he’s typically using, results in a fungal overgrowth in the gut as you wipe out all of the commensal microorganisms that are competing. And I think that’s really interesting. And I think one of the things that I love about Biocidin and their product line is that you’re working both of those, you’re treating or you’re using something broad spectrum, anti-microbial that’s supportive, and selective anti-pathogen. And I love that about natural therapeutics in general, that we can really support the broad spectrum and support healthy physiology rather than a unilateral wipeout. Does that make sense?
Dr. Kara Fitzgerald: Yes, of course.
Dr. Jocelyn Strand: […] microorganisms.
Dr. Kara Fitzgerald: Yeah.
Dr. Jocelyn Strand: I’m trying to pull up some of my information here, but SIFO is typically Candida. SIBO, the most common organisms are pseudomonas, Campylobacter. Now, it depends on who you talk to. Because Dr. Pimentel, part of his paradigm is that SIBO is an IBS-D caused most often by a food poisoning, an initial food poisoning event. And so that means Campylobacter, which causes one-third of all acute food poisoning, would be one of the microorganisms that we have to really pay attention to. But other microorganisms are pseudomonas, E. coli, staph species, Klebsiella, strep species, so all of those microorganisms. And many of those have shown sensitivity to botanicals, including Biocidin.
Dr. Kara Fitzgerald: Nice.
Dr. Jocelyn Strand: So that’s exciting. The fun thing about getting to delve more deeply into the research with this company has been that I’ve been able to look at research and read more deeply about the product line. And not just the Biocidin but the Olivirex, both of them have really good research in vitro with sensitivity on a lot of these microorganisms.
Dr. Kara Fitzgerald: Yeah, that’s right, they have. And you know what? I’ve podcasted over the years with your founder, and she just does a great job corralling together all the various research projects that are happening around the world, in vitro and some clinical content. And so we’ll link to those in the shownotes. We’ll pull up all the content from a Bio-Botanical so that people can access it pretty readily. And it’s always really pretty popular stuff if you want to go and learn some of what Jocelyn’s talking about. Can I just ask you, I meant to ask you this earlier, but what about dietary change and diet actually changing? If somebody jumps on a low FODMAP diet, there’s a lot of controversy around to do it or not to do it during active treatment. And do you have any thoughts?
Dr. Jocelyn Strand: Yeah, I do. And a couple of things. The first is that those diets, by a lot of people, are considered not sustainable for a long term. And I think we all feel that you need a broad number of foods that you’re eating in order to get just basic nutrients, right? So what’s in the food? But then, when you do the FODMAP diet, you’re also taking out a lot of prebiotics that are being utilized by the microorganisms in the colon to produce all the short-chain fatty acids and other nutrients, CoQ10 and B12. And they’re all of these nutrients that you can get deficient in if you take those foods out for an extended period of time. And you’re not actually affecting any kind of lasting treatment, typically, with a diet like that. You may be suppressing their growth for the short term, but it doesn’t result in necessarily in a lasting effect.
Dr. Kara Fitzgerald: So are they hanging out in the mucus layer, just waiting for…
Dr. Jocelyn Strand: To repopulate?
Dr. Kara Fitzgerald: Yes.
Dr. Jocelyn Strand: I don’t know if there’s any actual… You may suppress their growth but there’s no bactericidal effect to that diet. Does that make sense?
Dr. Kara Fitzgerald: Yeah. No, it absolutely does. So once you fall off the FODMAP diet, you’ll just move back into having symptoms.
Dr. Jocelyn Strand: Right, exactly. And that’s where I think an antimicrobial of some sort comes in and can, first of all, break up biofilms so that they can’t hang out as easily in that mucus layer, and that the antimicrobials then can have access to the microorganisms, but also have this killing effect, bactericidal effect, and restorative, right?
Dr. Kara Fitzgerald: Yeah.
Dr. Jocelyn Strand: So that’s part of it. And, well, we can talk about that too, but bringing in some spore-forming microorganisms to help repopulate with the beneficials while we’re working on suppressing the growth of the pathogen load.
Dr. Kara Fitzgerald: So where do you come down on the controversy of to lower FODMAPs or not?
Dr. Jocelyn Strand: Well, what I typically do in my practice, or did in my practice, was to have an anti-inflammatory diet. I didn’t prescribe FODMAP. I always used Biocidin and the Olivirex to treat. And in the study that we did, there was no diet change. And 100% of the people had improvement or resolution of their symptoms.
Dr. Kara Fitzgerald: Geez, that’s amazing. How many people were in the study?
Dr. Jocelyn Strand: It was eight people.
Dr. Kara Fitzgerald: Wow. And this was at your clinic?
Dr. Jocelyn Strand: No, this was done at Southwest College of Naturopathic Medicine by one of the students there when doing her research.
Dr. Kara Fitzgerald: Oh, that’s great. And can we link to that? Was it published?
Dr. Jocelyn Strand: It is not published, no. And I’ll see what I can find though. I might be able to get something to you. I mean we do have data collected on it. So there are a handful of the symptoms that 100% of the people had resolution on. One was diarrhea, 100% resolution. And skin conditions, which I mean it doesn’t surprise me that you might see that happen, but 100% of the people that had it? I just thought that was amazing, fascinating. And it’s exciting to watch as a clinician. And it’s why I said to you what I did earlier, which is I don’t have a whole lot of experience in testing because I used Biocidin in my practice as a diagnostic tool. It’s so broad acting that what I found myself doing was ordering stool testing, and then if it was Candida, I would use Biocidin. And if it was E. coli I would use Biocidin. And if it was C. diff I’d use Biocidin. And so then I thought, “Well, why am I spending $400, I live in a fairly economically-depressed area, to diagnose something if the treatment doesn’t change?”
Dr. Kara Fitzgerald: Right.
Dr. Jocelyn Strand: Instead I was using it as a diagnostic tool. So then you have one bottle of Biocidin that helps me understand. If people feel better, then I know that dysbiosis or SIBO is a problem for that patient, and then we just treat empirically based on that. And so that was how I handled it. It doesn’t mean that there’s no use in testing, it’s just what I did in my practice.
Dr. Kara Fitzgerald: Right.
Dr. Jocelyn Strand: And so that’s why you’re hearing me fumble around with testing. It’s all standard in the industry, what I know, rather than what I had in my clinical practice. I just think it’s a very useful way. I would order testing for anybody who wanted to see it. And if I had a fragile or a pediatric patient, something like that, I would order testing to make sure that we’re not doing an unnecessary therapeutic.
Dr. Kara Fitzgerald: Right.
Dr. Jocelyn Strand: But for a lot of people it would save them $400 just to treat, and they feel better right away…
Dr. Kara Fitzgerald: Yeah, that’s great.
Dr. Jocelyn Strand: … instead of waiting to treat.
Dr. Kara Fitzgerald: So we can test, we don’t have to test. Dr. Strand was using Olivirex and Biocidin as a diagnostic. That’s awesome. And she was not prescribing the FODMAP. You’re actually prescribing a standard anti-inflammatory diet. It’s so interesting. I mean I have to say, in clinical practice, I do use a low FODMAP diet very short term. And then we challenge with the FODMAPs, pretty much ASAP because, in my experience, people don’t react to all of them.
Dr. Jocelyn Strand: Sure.
Dr. Kara Fitzgerald: And then we’ll expand, and then we’ll treat a little more and expand. That’s what I’ve been doing. But Stacey Cantor-Adkins, in practice, she’s no longer prescribing the FODMAP for the reasons that you described. I think, for me, I want people to actually have symptom release post-haste and so I just lean on that. I suppose if somebody wasn’t feeling so lousy, I might skip a low FODMAP, but it can bring almost immediate relief.
Dr. Jocelyn Strand: Sure.
Dr. Kara Fitzgerald: But listen, everybody’s going to want to know how you were prescribing or how you are prescribing Biocidin and Olivirex for your dysbiosis/SIBO or SIFO patients.
Dr. Jocelyn Strand: Sure, sure. So I can talk about how I did it and then I can about the study as well.
Dr. Kara Fitzgerald: Yes.
Dr. Jocelyn Strand: So in my practice, I always do BID dosing instead of TID, because I feel like too many times people lose their last dose.
Dr. Kara Fitzgerald: Yes. Amen.
Dr. Jocelyn Strand: And then we lose our efficacy. So I would take the standard dose of 30 drops a day. And instead of doing 10 drops TID, I did 15 drops BID. I will work up slowly to that. A lot of the people that we’re working with, these complex GI patients, will be riddled with biofilms as well. And one of the main activities of Biocidin is its ability to disrupt biofilms through a number of different mechanisms, actually through every mechanism that biofilms use both to generate themselves and to sustain themselves. Biocidin contains ingredients that have been shown to disable them. And we’ve actually got research on-
Dr. Kara Fitzgerald: I know you do. We talked about it. Yes.
Dr. Jocelyn Strand: Okay.
Dr. Kara Fitzgerald: We’ll link to it. It’s so interesting the work that you’ve done on biofilm. It’s so interesting. I appreciate having not just the botanicals but just the potency of the volatile constituents. It’s just cool that you guys are looking at it.
Dr. Jocelyn Strand: It almost feels magical a lot of the time when I use it. And I can talk about a couple of case studies too with Biocidin. Well actually, why don’t I… You asked-
Dr. Kara Fitzgerald: Keep going. Keep going on how you dose up and what they did in the study.
Dr. Jocelyn Strand: Okay. So working up slowly. Because when you’re breaking open biofilms, you’re not just looking at microorganisms. We’re looking at potentially microorganisms that the body wasn’t currently dealing with already because they’re holed up behind biofilms. We’re also looking at heavy metals, LPS, oxalates, all of those metabolites are housed within biofilms. So if you have someone that has a lot of biofilms, what was a really good clinical pearl for me from Rachel directly was if someone reacts to the Biocidin, almost all of the time they’re actually reacting to the activity of the Biocidin, not the Biocidin itself.
Dr. Jocelyn Strand: And what can be confusing as a clinician is if someone comes in with SIBO symptoms, say gas and bloating, diarrhea, and you start treating them with Biocidin and they get anxiety and you think, “Oh, they’re reacting to the Biocidin,” and it’s a natural thing to think, but the reality is oftentimes they’re reacting to this disruption of the biofilm and the metabolites that are behind it. And so using a binding agent, so in this line it’s the G.I. Detox. But that is really important aspect to compliance with the patient as you’re working up on the Biocidin. So dosing twice a day. And then I use G.I. Detox at night because you have to take it at least an hour away from everything. But you can also use it as needed, if people are experiencing die-off, to help prevent those symptoms.
Dr. Jocelyn Strand: And I would say the more complex your patient is, the more likely they are to a reaction, a die-off reaction, as they’re working up on the Biocidin. So once you get to that 10 drops twice a day, you’re probably beyond that. It really seems to be, at least in my clinical experience, it was right around like 15 drops a day, somewhere in 10 to 15 drops a day where people were starting to get flu-like symptoms is what I saw as typical. Occasionally they might get anxiety or irritability, fatigue, and just generally feeling terrible.
Dr. Kara Fitzgerald: Right.
Dr. Jocelyn Strand: So using the binding agent then, at that time. So that’s just the Biocidin and the Olivirex, two capsules twice a day, I add in.
Dr. Kara Fitzgerald: Two capsules. Okay. And you do that with the Biocidin or away from?
Dr. Jocelyn Strand: At the same time as the Biocidin.
Dr. Kara Fitzgerald: Okay. And the binding agent, you’re recommending at night. And how do you dose that?
Dr. Jocelyn Strand: Just two capsules at bedtime. And making sure they aren’t taking a pharmaceutical for sleep or anything else at that time, because it will bind that as well.
Dr. Kara Fitzgerald: Okay. And if they are, then you would prescribe it at a different time during the day?
Dr. Jocelyn Strand: Exactly. So just so long as it’s an hour away from anything else. You can find the spot that’s easiest for the patient. I tend to like the evening because most people have an empty stomach then. We do a lot of our detox overnight. And so it makes sense to me that we would try to bind toxins as well.
Dr. Kara Fitzgerald: Yeah, it’s so fascinating. It’s a nice illustration that you’ve given of the die-off reaction and basically the breakdown of the biofilm mucus layer and liberating all of those myriad compounds, organic acids and LPS and just metals, et cetera, et cetera, into circulation. And that’s what’s prompting it from the bat. What’s the thinking on some of the underlying pathophysiology of SIBO and SIFO? What are the causes? And the other thing is why does pretty much everyone walking through our door have it these days?
Dr. Jocelyn Strand: Yeah. Why is it so common, right?
Dr. Kara Fitzgerald: Yeah.
Dr. Jocelyn Strand: So there’s a couple of things, and I tend to listen to the experts in the field, and then I also love to just think about, from a clinician’s perspective, like what you just said, why do so many people have it? So we could start with Pimentel, it was totally mind-blowing to me the first time I listened to his podcast, which was last fall sometime, September or October, where I listened to him talking about SIBO framed as an autoimmune and IBS-D. It’s actually IBS-D he’s talking about, but IBS-D, 50 to 65% of IBS-D people also are SIBO patients. And so the two of them can’t be used exactly interchangeably, but they’re pretty similar in their physiology, right?
Dr. Kara Fitzgerald: Pretty close.
Dr. Jocelyn Strand: So what he found is that he found elevated antibodies against two different things. So one is CdtB, which is the cytolethal distending toxin B. And that’s released by Gram-negative bacteria. And his theory is that when you get an acute infection, say from Campylobacter, Shigella, something like that, that it causes this huge release of CdtB, and then our body creates antibodies against it and it looks very similar structurally to vinculin, which is a cytoskeletal protein in the nerve cells in the lining of the gastrointestinal tract, and that we start to develop antibodies against it. Then it damages the nerve tissue, and that affects the ability of the cleaning wave in the gut to be effective, which is a result of the migrating motor complex. And so then we can’t move those microorganisms out of the small intestine into the colon, and we get the stasis of microorganisms in the gut. So that’s one. And it really frames SIBO as an autoimmune condition or IBS as an autoimmune condition, which was a really different way to think about it to me.
Dr. Jocelyn Strand: Here I’m thinking, “Make sure and evaluate food sensitivities, make sure and evaluate the microbiome and dysbiosis, and make sure they have good mechanical function with hydrochloric acid,” so just basically thinking right inside the gut. For me, maybe I was thinking LPS and inflammation in general.
Dr. Kara Fitzgerald: Right.
Dr. Jocelyn Strand: So I wasn’t connecting the immune system in terms of autoimmunity as a potential role. So it’s something for us for sure to pay attention to. Because if we’re having difficulty treating, if we’re not paying attention to that, the potential autoimmune aspect of it, then we won’t be able to get the migrating motor complex working as well, and you won’t be able to sustain healing.
Dr. Kara Fitzgerald: Okay. Well let me just ask you, before you jump ahead, make sure you remember where you stopped.
Dr. Jocelyn Strand: Ok.
Dr. Kara Fitzgerald: Take a note because it’s really important stuff. But I just want to ask you what do you recommend? How are you turning it around when you do see the percentage of the population that’s positive with these auto-antibodies, when it does move into autoimmune territory?
Dr. Jocelyn Strand: Yeah, it’s a really interesting question. And when I was speaking last week, I thought, “Well, we are good at, I think as a group, naturopathic physicians or functional medicine practitioners are good at supporting immune system function, anti-inflammatories.” I mean I think I would use that category. But, for me, I’ve been treating SIBO empirically for years, and so I know how I treat it, right? It’s with the BBR products, additional GI support. Of course each person as an individual, where they need that additional support. But Biocidin, one of its activities is immune modulation.
Dr. Jocelyn Strand: So I think this is where we’re seeing sometimes the need to use the product for a longer period of time, so six to 12 months, rather than doing a treatment that really we think of in the paradigm of antimicrobials. We should be able to eradicate or suppress the growth of the pathogens and see a pretty significant difference in eight weeks. But if we’re talking about immune function, then we may need something that lowers that Gram-negative bacteria load. So here’s the way that I’ve been thinking about it, because there’s only a certain percentage of the population that’s had an acute food poisoning event, but there are more people than that that have SIBO, IBS-D. So there’s a section of that population that we’re missing. So who are those people? And that’s what I was trying to think about. And, well, if all Gram-negative bacteria are releasing CdtB, then I think we’re perpetuating an autoimmune condition if we leave dysbiosis, even if SIBO has been treated.
Dr. Jocelyn Strand: So this is just the way I’m thinking about it right now is that if we can lower, by using a lower maintenance dose of antimicrobials, lower that and take the load off of the immune system so that it’s not being constantly barraged with that CdtB and the cross-reactivity, that maybe we can relieve that over time and allow the healing of the nervous cells in the nerve cell.
Dr. Kara Fitzgerald: Right, right.
Dr. Jocelyn Strand: Does that make sense?
Dr. Kara Fitzgerald: Yeah, so basically what you’re saying is, for full eradication, you’re recommending the Olivirex and the Biocidin for six to 12 months, which is a lot longer. And I’m guessing, because you’re outlining your protocol here, that you’re not feeling like you need to rotate through other products.
Dr. Jocelyn Strand: I don’t rotate through other products, but I will say a couple things. One is that some people don’t need it for that long. Some people, and this is one of the things that Dr. Pimentel said as well, is that people who are highly elevated are much more resistant to the therapeutics. They relapse with rifaximin therapy. So I think what you’re really looking at is how bad is it, right? How sick are they? And if you just take away the irritating factor for a short time, is their immune system healthy enough to get itself righted around so that they don’t need it long-term? But I think, if we’re aware of the fact that there’s an autoimmune component to it, then we can prepare ourselves and the patient for the potential that this may take a while to treat.
Dr. Kara Fitzgerald: Yeah, important.
Dr. Jocelyn Strand: So that’s how I was thinking about it. Oh, and then also to speak to whether we rotate. The ability of Biocidin to disrupt biofilms really alleviates the need to rotate. And the other thing that Biocidin does is disrupt efflux pump. And that is one of the mechanisms for antibiotic and for antimicrobial resistance. The efflux pump is on the cell surface of the microorganisms inside of biofilm. We actually have them in ourselves too. But what that efflux pump does is take something that’s threatening and push it back outside the cell. And so if it starts to detect that an antibiotic is dangerous, it will start to push it out, and that’s one of the mechanisms for antibiotic resistance.
Dr. Jocelyn Strand: And the Biocidin disrupts that. And so you end up not having to be as concerned about resistance to the product. Yeah, it’s pretty exciting. That’s one of the pieces of research that Dr. Fresco was able to elucidate for Borrelia, was the disruption of the efflux pump and Borrelia. And it reduced the killing dose of ceftriaxone to one-eighth of its normal killing dose when you use the two in combination. That’s in vitro, but I thought it was really fascinating. It’s exciting.
Dr. Kara Fitzgerald: It is. It is. It is. And I appreciate your passion around it. So you’re not thinking about then needing a motility agent. You’re doing probably what we call in naturopathic/functional medicine, like a five-hour protocol. You’ve got people on an anti-inflammatory diet. If you happen to have your diet handy and you want to share it, I’m sure people would like to take a look at it, but certainly we can all access pretty easily a standard anti-inflammatory diet. And then you’re using these products.
Dr. Jocelyn Strand: Yes.
Dr. Kara Fitzgerald: Pretty simple.
Dr. Jocelyn Strand: And then I would do treatment based on the individual. I may bring in hydrochloric acid or additional, what you said, the five-
Dr. Kara Fitzgerald: In the course of the five-hour. If they need it, you prescribe it.
Dr. Jocelyn Strand: Yes.
Dr. Kara Fitzgerald: You individualize.
Dr. Jocelyn Strand: Exactly. I guess that’s a really good way. I guess I’ve not written down my personal SIBO protocol, but yes, that’s a really good description of what I do. And my anti-inflammatory diet, it’s more of a Paleo with more of a focus on plant-based Paleo.
Dr. Kara Fitzgerald: Okay. So they’re getting some of those prebiotic foods.
Dr. Jocelyn Strand: Yes, exactly.
Dr. Kara Fitzgerald: So you’re putting some attention to that. Okay. What about motility agents? Might you incorporate something?
Dr. Jocelyn Strand: So, I mean that’s a really good question. The ones that I have used are cholagogues and other botanicals, bitters, things that help with the flow of bile. But I think you could technically use 5-HTP or anything as well that could help upregulate the binding of serotonin receptors. That’s what a lot of functional medicine doctors will prescribe. Low doses of serotonin binding or serotonin agonists. So I think it just depends. I haven’t used those in my practice with that purpose. I used amino acid therapy for different purposes. I guess I wouldn’t consider it part of the sustained healing or treating the underlying cause. Because, hopefully, if you treat the inflammatory process against the nerve…
Dr. Jocelyn Strand: And then also this other sort of paradigm that you and I talked about, which we can talk about as well here if you’d like, that LPS is playing a role. If you reduce the inflammation and the effect of the inflammation on the nervous system, that the body will heal itself.
Dr. Kara Fitzgerald: Yeah, let’s talk about it. I think it’s really important. Your protocol has been sufficient to cover your bases and you haven’t needed a motility agent. So that’s pretty cool. And yes, so we were talking about the autoimmune theory of Pimentel, or what he’s demonstrated. And then you were talking about LPS damaging the vagus nerve. Yeah, go ahead.
Dr. Jocelyn Strand: Yeah, so that’s totally interesting, fascinating. I listened to one of the speakers in Hawaii, Kiran Krishnan. And he’s obviously very well researched, super smart guy, and doing a lot of research in the field as well, in the microbiome of course. And really what he talked about, there are a couple of things that were really fascinating. One is that LPS, or lipopolysaccharides, released by Gram-negative bacteria. So we have the CdtB and LPS released by Gram-negative bacteria. LPS is inflammatory, super inflammatory. That’s a medical term, super inflammatory. It causes the release of a tumor necrosis factor IL-6, and so increases cytokine in proinflammatory cytokine release. And that can travel to the dorsal vagal complex in the brain and affect the vagal nerve function. And then that vagal nerve is one of the things responsible for that, again, that migrating motor complex, which in a fasting state should happen every 90 to 120 minutes. And if it doesn’t happen, then we get, again, that stasis of stool in the gut and the potential overgrowth. So it’s another mechanism for potential SIBO or disruption, again, of that migrating motor complex.
Dr. Jocelyn Strand: And ultimately, I mean of course it’s really fun to know and I think all of us as clinicians are really fascinated by the underlying cause. But interesting thing it comes back to, again, the suppression of those Gram-negative bacteria and helping to restore healthy flora in the gut.
Dr. Kara Fitzgerald: Yeah, right. Right.
Dr. Jocelyn Strand: And he also said what I thought it was really fascinating, we kind of already passed this but I’d like to step back to it again and say that one of the causes of SIBO, this migrating motor complex, when you have slowed emptying then you get the backup of microorganisms from the colon into the small intestine. But what he is arguing, he being Kiran Krishnan, he said that he thinks it’s coming from the mouth oftentimes. So Archaeabacter a lot. We know for sure, in SIFO, that Candida… There’s a study showing that people who brush their teeth after every meal had a dramatic decrease in Candida in stool. So just the translocation of the pathogens from the mouth to the gut.
Dr. Jocelyn Strand: And this is what I talk to my patients about all the time. We’re using this liquid, the Biocidin liquid. It’s really important that you use the liquid, that you’re not doing the capsule, because otherwise you miss one whole area of potential dysbiosis and treatment area. And so I just think that’s an interesting thing to pay attention to. A lot of these SIBO patients don’t have good stomach acid levels and so they’re swallowing these microorganisms. They live right through the stomach gastric acid some of the time if our pH is too high in the stomach. And if we don’t have good pH, we don’t release these bile acids and pancreatic enzymes that will also help with killing the microorganisms or establishing balance. So it becomes this feed-forward cycle. Then you end up with overgrowth, you end up with elevated LPS, elevated CdtB, and that creates an issue with a migrating motor complex. And then we’re back to the beginning of the circle again where we’re not clearing those microorganisms. I think it’s all fascinating.
Dr. Kara Fitzgerald: It’s all fascinating, awesome. Really, really nice job summarizing that, Just all of those extremely important points. So oral dysbiosis, poor hygiene is an eco-niche that can continue to repopulate the SIBO, can continue to feed the SIBO. So really good oral hygiene has to be a piece of a SIBO protocol. Otherwise that could be the source of a refractory SIBO case.
Dr. Jocelyn Strand: Exactly.
Dr. Kara Fitzgerald: That’s awesome.
Dr. Jocelyn Strand: Perfectly put. I think that’s so interesting. So that eco niche, I love that. I’m going to use that one. I mean it’s so true. We can do all the supplements we want to, but if then we stopped taking them but you haven’t treated the oral candidiasis or you’re continuing to-
Dr. Kara Fitzgerald: Right.
Dr. Jocelyn Strand: And it is where diet becomes very important as well. Obviously, if people are eating a high-sugar diet, a high-refined carbohydrate diet, they’re going to continue to have the growth of Candida and other sugar-consuming microorganisms in the mouth. And it can perpetuate of course.
Dr. Kara Fitzgerald: What a ridiculously simple solution that you just had your patients do the liquid. And what did you have them do, a swish and then swallow in addition to good oral hygiene and changing their diet and so forth?
Dr. Jocelyn Strand: Yes.
Dr. Kara Fitzgerald: And you have the Bio-Botanical toothpaste, which actually tastes really good.
Dr. Jocelyn Strand: I know. And it is something. I mean this is one thing that we can easily do as clinicians is just, if you have resistant patients or if you have pediatric patients, everybody’s already brushing their teeth, so it’s easy to just replace the toothpaste. And we know, as a clinician, that just having them brush their teeth lowers the Candida. We know that Candida is sensitive to Biocidin. So I think it’s an easy slam dunk way to help start to treat the microbiome, even the gastrointestinal microbiome, just using that toothpaste.
Dr. Kara Fitzgerald: I want to say too, I was familiar with this concept with regard to H. pylori. So one can reseed their gut, turn back the H. pylori infection on over and over again through the oral microbiome, through dysbiotic oral microbiomes. But it’s interesting to extend that to Archaea and others.
Dr. Jocelyn Strand: Yeah, that’s an area that I’m excited to learn more about because I didn’t know that Archaea live in the mouth. I know Candida. Porphyromonas is one that can cause gastrointestinal dysbiosis that seeds from the mouth. Candida, I think I said that already. But yes, I’m in the same boat as you. It’s just fascinating.
Dr. Kara Fitzgerald: It’s really interesting. But it’s a super easy fix.
Dr. Jocelyn Strand: Right.
Dr. Kara Fitzgerald: So we have plenty of refractory SIBO patients, and it would be interesting to actually see what population of those, what subgroup is refractory because their oral microbiome hasn’t been adequately addressed. I’m so curious. And if anybody has looked up that, listening to this podcast, if you could just post us a note. I’m sure we would both like to know. All right, so we’re kind of-
Dr. Jocelyn Strand: And we’re working on research right now too, just so that you know. We’re working on researching the effect of the dental side and LS on the oral microbiome. And we’re also in the beginning process of doing SIBO study with a hospital here in Duluth. We’ll see if it comes to fruition or not, but there’s a lot of red tape…
Dr. Kara Fitzgerald: Oh yeah, for sure.
Dr. Jocelyn Strand: … to that stuff. But I really hope we can get it going. It’s a really exciting prospect.
Dr. Kara Fitzgerald: And the other piece, too, is don’t forget to circle back with the details from that Southwest study too. You were going to give us the protocols from that study, and we’ll put those on our show notes.
Dr. Jocelyn Strand: Ah, yes, yes. It was simple, all that she did was five drops, three times a day of Biocidin.
Dr. Kara Fitzgerald: Oh, wow.
Dr. Jocelyn Strand: And the G.I. Detox. That’s all that she did. No diet changes, no other changes, just the Biocidin and the G.I. Detox. After the study was done, she brought in Olivirex and she saw the needle move on the methane-producing bugs a lot better when the Olivirex was included in the protocol. In the first protocol, and I might get the number off, I think it was 50%, right around 50% of people had a reduction in hydrogen with just Biocidin, which is approximates rifaximin at 56%, right? So it’s relatively comparable.
Dr. Kara Fitzgerald: And will she publish this? Is she writing this up for publication? What’s going on?
Dr. Jocelyn Strand: It wasn’t done in such a way that it could be published, but I do have the data that I can get to you.
Dr. Kara Fitzgerald: Okay. All right. Yep, whatever you can send us. If you have it in a PDF, we can link to it in our show notes. Yeah, whatever you can afford to give us, we’ll populate or link to your site, whatever works. We can put it on the show notes. So any parting words on using the protocol? Well, I guess a question that folks would have, the whole probiotic question, are you using the Bio-Botanical probiotic concurrently with your intervention or do you wait for a while? How are you doing that?
Dr. Jocelyn Strand: No. It’s useful to use alongside. So there’s a study that came out about a year ago, year and a half now I guess, that showed that, for people on antibiotics, that the fastest return to innate flora was with fecal transplant or with the use of a soil-based organism, the more traditional lactobacillus, bifidobacterium, that those actually slowed the return to innate flora. And so using the soil-based organism, because we have a line of antimicrobials, makes more sense from our perspective. You can use it alongside the Biocidin, in the same protocol. We actually have been able to show that the Proflora, which is our probiotic, doesn’t die from Biocidin, that the two can be taken at the same time.
Dr. Jocelyn Strand: We don’t have that same information on the Olivirex. So if you’re including Olivirex, which it’s most important to include the Olivirex when you have the methane-producing microorganisms in SIBO. I mean I just use it all the time with complex GI patients. Because, for the longest time, I felt like I was wasting my patients’ time. They go on Biocidin and feel better, but not resolved. And then if I bring in the Olivirex, so often it would get them over the hump that I ended up feeling like I was wasting time by not including it in the initial protocol. So I use both of them together, and then I just dose the Proflora away from that.
Dr. Jocelyn Strand: And then, after you’re done with any kind of antimicrobial, it would be useful in theory, based on the other research, to take Proflora, the soil-based organisms for some time afterwards to help reset.
Dr. Kara Fitzgerald: I would like to see that study, that you just pointed out, that showed soil-based as more effective than our traditional lacto and bifido. So if you can do that, I’m sure folks will-
Dr. Jocelyn Strand: Yeah, for sure I can get that to you.
Dr. Kara Fitzgerald: Okay. And then we’ll post it on our show notes, folks. And any in-house stuff that you’ve got that we can share, I’d love to have it. So Dr. Strand, it was lovely to be able to chat with you today. And I know that folks are going to find this information really useful. And, as always, everybody post your comments, let us know what you’re doing in practice. And just anything else you want to leave us with today, Jocelyn?
Dr. Jocelyn Strand: Oh, well it’s really been fun to talk with you. It’s so much fun to talk to other practitioners who are really excited about understanding all of these underlying causes and the deeper physiology. I mean GI physiology is so complex and we’re obviously still learning a lot about it, and I have lots more to learn as well. But it’s been really fun, and I hope useful, to share the download of information that I’ve been lucky enough to glean from other practitioners and in my own practice. Oh, can I leave you with a case study?
Dr. Kara Fitzgerald: Yeah, you can. Sure.
Dr. Jocelyn Strand: Okay. So a year ago, in December, I had a 23-year-old woman come into my practice and she had been vomiting every day, and pretty much all day, every day, multiple times, for three months when I met her. And she had gone to see her general practitioner who prescribed 40 milligrams of a PPI, and then referred her to a GI doc who saw her and prescribed another 40 milligrams. So she’s on 80 milligrams a day of a PPI with no symptomatic improvement. And no testing, they didn’t run any testing. So I met her, she sat down on my couch in my office and started crying. She couldn’t even speak at first. And she was on short-term family medical leave at that point because she couldn’t work anymore.
Dr. Jocelyn Strand: And so we talked. And she didn’t have a whole lot of money, and she was so miserable that I didn’t want to wait to do testing to treat. So we just did the Biocidin. And it’s all that she could swing at the time was just one bottle of Biocidin. So I started her on five drops twice a day. So when someone’s as miserable as she was, I worry less about die-off reaction and I work as quickly as I can up to the max dosing in order to get relief more quickly. So five drops twice a day. And I talked to her a week later and she was improved but not resolved. So we went then to 15 drops twice a day. And I didn’t hear back from her. And for months I didn’t hear back from her. And I saw her in my shop and I said, “Hey, how’s it going?” And she said, “Oh, good. I used that one bottle and it went away.”
Dr. Jocelyn Strand: Well, okay, first of all it’s amazing, right?
Dr. Kara Fitzgerald: Yeah.
Dr. Jocelyn Strand: But secondly, as a clinician, I’m like, “Oh no, don’t stop taking it.” Because I think you need it longer term. Obviously she didn’t need it longer term and she’s stayed resolved. And at that time I saw her, I scheduled a phone conversation to get the full intake on her recovery. Of course it’s not always that way. But when you see the product working in that way, that’s why I have the faith to use it as a diagnostic tool.
Dr. Kara Fitzgerald: Right.
Dr. Jocelyn Strand: Because I’ve seen that repeatedly. And there are certain conditions that become so straightforward that they don’t even register as difficult to treat anymore. Does that make sense? So that’s why I have gone to work for this company because I really want other clinicians to have these experiences that I’ve had using the product line. So that’s my final pitch. I always say, when I’m speaking, is that if there is one product line I wish I’d learned about in medical school, this would be it. This would’ve been it. So I hope that you all have the same experience. And if you have questions, you can also reach out to us. We have a great clinical support team. If you have complex patients, if you need support with either protocols or you’re having difficulty treating, there may be some way that we can assist in helping. We have some really practiced clinicians on our clinical team that can help a lot with difficult-to-treat cases. An sometimes just having one pearl… One of them is Karen Hubert, who’s our VP. She’s just been in the field on the front lines for so long. Man, that woman she’s good.
Dr. Kara Fitzgerald: She has a lot of knowledge, yeah.
Dr. Jocelyn Strand: So, yeah, we have a great team. So let us know if you needs support. And I really appreciate the opportunity to speak with you, Dr. Fitzgerald. It’s been really fun.
Dr. Kara Fitzgerald: Yeah, likewise. All right. Well, thanks for joining New Frontiers today. And go to the show notes and access all the amazing content from Bio-Botanicals. Thanks so much, Dr. Strand.
Dr. Jocelyn Strand: Thank you.