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You cannot enter into any world for which you do not know the language. --LUDWIG WITTGENSTEIN Language entraps us within a view like two mirrors facing each other, each reflecting the other’s image. It provides the entire context of our worldview. We cannot see anything but what the word proclaims because we are looking through the word to see the world. Only by understanding how the word limits perspective will we become quiet enough to listen beyond the word’s definition. When we see the limitation of language, we are already moving beyond it. Rodney Smith, Stepping Out of Self-Deception The Buddha’s Liberating Teaching of No-Self, Shamabala Boston & London, 2011.

I’m here to invite you on a journey, an exploration into the meaning and experience of open hearted health. Let's explore together! Karen Miller-Lane, ND, L.Ac.

By Karen Miller-Lane, ND, L.Ac. This is the first part in a series that examines a common, but often misdiagnosed or underdiagnosed gastrointestinal condition called small intestinal bowel overgrowth or SIBO for short. It is considered a common cause of irritable bowel syndrome or IBS. This is meant to be a brief, initial overview. In the language of the professional literature: The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms.[1] What is SIBO? As the following excerpt from the Metagenics Institute so succinctly portrays the basics of SIBO, I’ve included it below. I will be going into more detail on the effects of SIBO in future articles. SIBO stands for Small Intestinal Bacterial Overgrowth. Normally, the bulk of our gut microbiome resides in the large intestine. In SIBO, we see an overgrowth of bacteria (even otherwise healthy bacteria) in the small intestine, where they are not usually present to such a high degree. Those bacteria are then able to act on poorly-digested, fermentable carbohydrates, producing uncomfortable symptoms such as bloating, gas, abdominal pain, diarrhea and/or constipation. The effects of SIBO can extend beyond direct gastrointestinal symptoms. The excess levels of bacteria excrete acids that can underlie some neurological symptoms including brain fog and fatigue. Increased gut permeability can occur causing translocation of bacteria and insufficiently digested food particles that trigger immune activation that can lead to pain and other symptoms. It also predisposes an individual to food sensitivities. Nutrient deficiencies can arise as the bacteria consume some of the ingested foods; B12 and iron, for example, which can lead to anemia, and deconjugation of fatty acids from bile that reduces absorption of fat-soluble vitamins. Patients with SIBO also tend to have altered secretory IgA values, demonstrating that SIBO directly alters immune activity in the gut.[2] Symptoms of SIBO include: • bloating/ abdominal gas • flatulence, belching • abdominal pain, discomfort, or cramps • constipation, diarrhea, or a mixture of the two • heartburn • nausea • malabsorption: steatorrhea, anemia • systemic symptoms: headache, joint/muscle pain, fatigue, rosacea Factors that put someone at risk for SIBO include: Hypochlorhydria (low production of hydrochloric acid in the digestive track) Chronic antacid therapy (especially with PPIs or H2-blockers) Gastroparesis (secondary to diabetes type I or II); motility of the stomach is abnormal or absent Gallbladder/bile dysfunction Pancreatic enzyme deficiency Slow-transit constipation Disruption of the migrating motor complex (MMC), as may be caused by radiation History of bulimia Multiple courses of antibiotics Ileocecal valve incompetence Diet rich in sugars and simple carbohydrates Heavy alcohol use[3] Testing: SIBO can be tested a number of ways, the one I recommend is a non-invasive breath test. It has its shortcomings, but it is adequate, simple and non-invasive. The gold standard has been the small bowel aspirate, however, there are also several challenges to this method. Small bowel aspirate may not capture enough of the bacteria, or capture the level of overgrowth, and certain species of bacteria may not be able to be effectively cultured and therefore identified.[4][5] As you can see, testing for SIBO has its limitations but it is still an important tool in the diagnosis and treatment of SIBO. Treatment approaches Systemic review and meta-analysis in 2022 showed that 49% of IBS cases were SIBO. A conservative estimation is that anywhere from 16 to 25 million people in US could have SIBO and there is a 67% relapse rate after undergoing antibiotic treatment.[6] This will be explored in future articles. Treatments include one or more of the following: antibiotics, an elemental or FODMAP diet, herbal antibiotics and antimicrobials, and other nutrients that address the root cause. It is important that individuals with SIBO work with their physician as the symptoms of SIBO are varied and may not fall under the common symptom profile. It is also important to create a treatment plan to address the varied underlying conditions that may exacerbate SIBO and identify and treat other systems in the body that are affected. Also given SIBO’s relapse rate, it is important to follow up with your doctor to ensure an effective, long term treatment. Coming up in Part Two The purpose of Part One in this series is to include a brief overview of one of the causes of IBS. For those interested, in the articles to follow I will go in more depth as to SIBO’s risk factors, pathophysiology, and the various conditions that are associated with it. We will touch into how skin, vascular, liver, nutrient, and immune health are altered by SIBO. My hope is to illuminate this otherwise underdiagnosed condition. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347643/ [2] https://www.metagenicsinstitute.com/blogs/7-underlying-causes-sibo-might-missing/ [3] https://www.metagenicsinstitute.com/blogs/the-sibo-dilemma-how-the-optimistic-magic-bullet-falls-short-for-most-patients/ [4] https://link.springer.com/article/10.1007/BF01070827 [5] https://www.ncbi.nlm.nih.gov/pubmed/17991337 [6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366247/

Let's take the next 10 minutes to breath and be present. Requesting a bit of artistic license as I realize that frogs and toads don't actually breath as described, but I love the imagery!

By Karen Miller-Lane, ND, L.Ac. Side note: I wrote this in 2003 As health is a process, so my journey to a professional career in naturopathic health and medicine has been a process. There was my initial interest, then my personal commitment and plan of action, and finally the full expression of 'ever becoming' a physician with the guidance and teaching from my patients. I was involved with healthcare, particularly women's health care and education, for almost a decade before I started naturopathic medical school. Throughout my journey, a foundation of experience and a commitment to health, especially holistic health, was built. As an undergraduate, I studied political science because I was interested in how governments respond (or don't respond) to the needs of people. After obtaining a B.A. from the University of Massachusetts at Amherst I went to work in Washington D.C. First, I worked for the Close Up Foundation (CUF), a nonprofit, nonpartisan civic education foundation dedicated to citizen involvement in government. After two years with CUF, I became a Program Specialist with the Academy for Educational Development (AED). At AED, I managed technical training programs in the areas of health and education for over six hundred Pakistanis who came to the United States for professional training through a grant from the U.S. Agency for International Development (USAID). I also managed a small staff of Program Specialists. At CUF and AED, I witnessed the extent to which education can empower people. Both jobs demanded intensive academic preparation, energy, and commitment to the students and participants with whom I worked. Little did I know then how well such intensity prepared me for the rigor of medical school. Throughout my six years in Washington, D.C., I volunteered for women's health organizations. I worked at a shelter for battered women in Alexandria, Virginia. We were fortunate to have the support of local police; they preserved the anonymity of the women we served while tracking down the men who were abusive. This cooperation between service provider and the local community/government was essential. Later, I worked at the Washington Free Clinic. On a restricted budget, and depending on lay workers, the Clinic provides general health check-ups, AIDs testing and counseling, family planning, and pre-natal and maternal health care to those who cannot otherwise afford such important health care. I learned what a tremendous need exists for responsive, natural, preventative health care. My interest in health also lead me to attain certification as an Emergency Medical Technician (EMT) in the State of Virginia. The EMT program as well as my experience with emergency rooms and ambulance care, deepened my understanding that health care requires a commitment to helping people with serious illness, and, sometimes, with "healing into death". It is also important to understand the full spectrum of health care options that are available and the need for integrating these options to achieve optimal patient care. In 1993, my husband and I had the opportunity to be instructors at the College of the Marshall Islands, in Micronesia, where we lived and taught for two years. I taught courses from Anthropology to World history. Yet, once again, my favorite challenge was developing curriculum for teaching the course on Health. Working with students on health issues specific to the Marshall Islands was a challenge and a pleasure. The students did not find answers to all their questions, but they learned how they can play an active role in their health. I taught them how to access information to help guide them toward more healthy, natural choices. Students shared with me their knowledge of many of the plant remedies that their mothers, or the traditional women healers, used to treat broken bones, bruises, stomach illnesses and skin rashes. The exchange was enriching and my desire to be an integral part of medicine and education was sealed. When choosing the next step on my journey I knew that I wanted to work in the field of health. However, the dominant model for health care in our country raised many concerns for me. The dominant health care model in the United States depends on strong pharmaceuticals with many side-effects. Doctors have little time for listening and hearing patient concerns. A compartmentalized approach to disease combined with little understanding of the impact of nutrition and lifestyle changes on health often seemed to ignore the patient as a whole person. Becoming a doctor in such a system seemed too large an investment of time and money without the joy and soul connection I had felt in my previous experiences with women's health. I was on the way to getting a Masters in Public Health at Tulane University when I heard about Bastyr University and Naturopathic medicine. A whole new world opened up for me and made sense. The time and significant financial commitment necessary to become a Naturopathic physician suddenly was worth the sacrifice. With the support of my always amazing spouse we came to Seattle and the rest, as they say, is history. The road to successfully pursuing and completeing a Doctorate Degree in Naturopathic Medicine (2001) and a Masters Degree in Acupuncture (2002) was academically, mentally, and emotionally challenging. As I learned to help others seek optimal health, ironically, my own health declined. As I pushed myself toward some elusive goal of excellence - knowing all - I sometimes lost sight of all that I knew. We all have the capability of accomplishing what, at times, can seem like monumental tasks. But, it is who we are and who we become in those moments that are the true lessons. At the heart of my experience with myself and with my patients at the Bastyr Clinic, I came to understand knowledgeable, compassionate and balanced healing. Through the lessons and wisdom of naturopathic medicine I have been able to learn to walk my talk. I also have great empathy for the journey and process that illness provides us. It is an opportunity to connect with ourselves - to pay attention - to reinvest in ourselves. My understanding of the power of naturopathic medicine continued to be strengthened and refined during my two year residency program at a busy family practice in Seattle, Washington, developing a private practice in a multi-disciplinary health clinic in Seattle, and moving to Vermont and establishing Natural Medicine of Vermont. I have worked and continue to work with exceptional physicians (ND's, MD's, DO's, DC's, NP's, PA's) and health care practitioners. I have seen what compassionate and respectful health care integration can accomplish on the behalf of my patients. The lessons are for a lifetime. Throughout this journey of becoming a physician, my best teachers have been and continue to be my patients. Being a physician is a lifelong commitment to "listen with one's heart" and to attend to an understanding of the health of the people who we serve. My journey has led to this understanding and acknowledgement that natural health is an integral part of my life. My commitment as a naturopathic physician can be summed up best in my personal mission statement: "As a physician may I always listen with compassion, see with an open heart, and work in the service of others. May I always be in awe of the vast potential of the human body, spirit, and mind. May I continually strive to learn new things, understand old things better, teach what I know and have the wisdom to appreciate my limitations. May I serve with grace, assist in partnership, and participate with integrity. May I always be present with others as I listen to their stories, unravel their pain and confusion, and support their truths and wisdom. May I always strive to cultivate the healer within myself and within others." --It is with grace that I have the opportunity to work with amazing people on a daily basis. Many blessings to you.