What is the relationship between the gut and autoimmunity?
There are three things that I tend to look for. First you need to have a genetic predisposition. So, for example, with celiac disease, you must have either one or two of the HLA-DQ2 or HLA-DQ8 genes. Number two would be there has to be an exposure to an environmental trigger that will instigate an immune response. And gluten is a classic example of that. That’s the trigger that creates all this inflammation. And then, thirdly, there has to be intestinal hyper-permeability in the intestinal lining, which will obviously allow substances to go from the gut lumen into the bloodstream, and the immune system will become activated and that will set off a sort of systemic inflammatory type reaction. So, generally speaking, that’s kind of how I look at the development of autoimmune diseases.
And also you can use those three parameters for treatment as well. If you want to remove the trigger, which today we’ll talk about some triggers for autoimmunity in the gut. And what I found, doing a lot of research into this is that, unfortunately, there’s no unified theme when it comes to certain bacteria or certain phyla that might be increased or decreased, or looking at byproducts like short chain fatty acids, whether those are increased or decreased. It seems like there’s huge variability all across the board. Let’s say a condition like rheumatoid arthritis might have an elevation in prevotella, but in MS, you might have a decrease in prevotella species. So, I was hoping for more of a concrete unifying theme around these parameters, but I didn’t necessarily find it. And so that’s why I still come back to treating those three parameters in terms of development of autoimmune disease and also using them as treatment.
And so how important do you think gluten is for most autoimmune conditions?
I’m so happy you asked that. I take every single autoimmune patient that I see off gluten, and the reason I do that is because I’m sure you’ve read up on a lot of Alessio Fasano’s work in regards to zonulin. But gluten is one compound that can elevate and increase the production of zonulin, which then leads to the disassembly of tight junctions, which therefore sets the stage for leaky gut. And that happens regardless if you have celiac disease or if you have non-celiac gluten sensitivity or if you don’t even have any sensitivity or allergy to gluten. It happens in everyone. There’s this increase in zonulin that’s temporary after consuming gluten. You need to have the intestinal hyper-permeability present for autoimmune disease. That’s why I always take every single patient off of gluten that has an autoimmune condition. And I will say this too, out of all the treatments I’ve done over the last 12 years in private practice—this is including supplements, medications, dietary changes—gluten removal has been the most profound in terms of changes. . .
We talked about the diet piece, the autoimmune paleo, or anti-inflammatory diets – where I like to start. I always add on vitamin D if there’s overarching inflammation in the body. I’ll typically do like a tumeric or a boswellia or an artemisinin supplement to calm down inflammation.
I’m a huge fan of CBD. I don’t know if you’ve dug into CBD at all, but big fan of CBD . . . And you know what you’ve got to do is really talk to the company and figure out what they’re doing that is special, and make sure that their products are organic and they’re not overly processed. And then you need to experiment on yourself to figure out which one actually helps you feel different or better. That’s how we settled on it. I finally settled on one, it’s called Sana Botanicals. I love that company. They have such amazing products that work well, and I tell you, people come back and they’re sleeping better, they have less anxiety, they feel just calmer in their body, and it also helps with pain and inflammation.
. . . And then I also like to recommend LDN, low dose naltrexone. And it’s never good as a monotherapy, but when you combine it with everything that we’re talking about today, I do find it’s helpful across the board for autoimmune conditions. And the reason for that is it’s really helping upregulate T regulatory cells, which can really calm down a part of your immune system that’s overactive. And side effect profile-wise . . . people might have some insomnia the first couple of nights or some vivid dreams, but then that tends to go away, especially if you start off with a low dose and work them up.
I like, obviously probiotics, which you talked about, prebiotics getting mainly from food are really going to support the gut lining and work on inflammation. And then something like a GI Revive or something that has glutamine in it or DGL or aloe or marshmallow root, slippery elm, zinc carnosine, all these different nutrients to help calm down inflammation and help heal the gut.
When it comes to gut health problems, it’s not bad enough you can have gas that people might smell, bloating that makes you look pregnant, debilitating cramping and pain, frequent trips to the bathroom that can leave you exhausted mentally and physically, unpredictable bowel movements that can cause accidents and an inability to follow through on plans, but on top of all that, because of the nature of your issues, it can also cause stigma.
Stigma is when society labels an individual as abnormal. Stigma can be something you experience, perceive, or internalize.
If you’re experiencing stigma, it’s when you’re receiving concrete signs or actions of bias or prejudice against you from someone else. If you’re perceiving it, you may be sensing discrimination against yourself from others but the signs are subtle enough that you can’t be 100% sure. But when it’s internalized that’s really the worst because then you’ve absorbed and now believe certain stereotypes about yourself because of your condition, like I’m weak or I’m unreliable or I’m always in bad health and always will be or I’m not a good(fill in the blank: worker, friend, mother, father, girlfriend, boyfriend, husband, wife, etc.), or the mother of all internalized self-criticism, I’m not enough.
I’d like to undo some of that stigma and programming to help you see yourself as whole, healthy, healable, strong, and good enough in and of yourself and in relationship to others.
For starters, I want you to know that you’re not alone.
A 2013 Fox News Survey showed 74 percent of Americans are living with digestive symptoms like diarrhea, gas, bloating and abdominal pain. And whether a given individual has those symptoms now, everyone has had them at some time and knows what it’s like to have gas, constipation or diarrhea. Literally everyone, except maybe small children, has had those at one time or another.
In terms of actual diagnoses, as of 2015, it’s estimated that 1.3% of US adults (3 million) had been diagnosed with Irritable Bowel Disease (IBD), which is either Crohn’s disease or ulcerative colitis.
In terms of Irritable Bowel Syndrome (IBS) studies have estimated that between 10% and 15% of the entire U.S. population has it. That’s more than 1 out of every 7 people. So if you’re at a party with 10 people, someone else probably has IBS besides you. A party with 30 people? 3 more besides you. You’re not alone. That being said, in one study, more than half of people with IBS believed that they were treated differently because of their IBS.
How about gastritis? In the U.S., it’s estimated to affect 25-35% of the entire population!
And in my experience talking to clients (many of whom aren’t coming to me for gastrointestinal issues) I have yet to meet more than 2 people who think they have no GI issues at all: no pain, no constipation, no bloating, no soft stool or diarrhea, perfect Bristol Stool chart #3 or 4 stools with a clean wipe. That’s almost non-existent, because we’ve all taken antibiotics, we’ve all eaten a standard American diet, we’ve all taken NSAIDS or other prescriptions meds, we’ve all been subjected to a medical system that doesn’t focus on root causes. So if you take nothing else from this article, please take the information that almost everyone has gut issues of some sort, so if you’re experiencing stigma, much of it may be perceived and internalized but may not be experienced.
But I don’t want to underplay experienced stigma, as experienced stigma is real. So let’s talk a bit about it.
One study on IBS found that co-workers and employers were the greatest source of stigmatization, followed by health care providers and friends.
Stigma can result from
Being reluctant to tell others that you have a gastrointestinal condition.
Being unable to fulfill your expected role in a relationship.
Being unable to fully participate in daily life, work and social activities.
Lack of awareness and knowledge about your condition in the general public.
Lack of awareness or even belief in your condition among allopathic, or traditional medical doctors (particularly with conditions like SIBO, candida or dysbiosis).
A perception that your condition isn’t taken seriously, which is much more prevalent with conditions like IBS where there’s no physical evidence of a problem than with conditions like IBD.
And finally, stigma can come from other people’s perceptions that your condition is self-inflicted or all in your head or being used as an excuse to get out of doing things, which is again the case more with IBS than IBD.
It’s important to identify and address stigma, because the research on perceived stigma in IBS and IBD shows that it negatively impacts clinical outcomes, including increased depression and anxiety, lower quality of life, and reduced self-esteem and reduced self-efficacy (or the ability to advocate for yourself). Internalized stigma in both conditions is associated with an increase in health care utilization and reductions in health-related quality of life, psychological functioning, and perception of health competence. And again, perceived stigma is greater with IBS, with IBS patients showing more perceived stigma from their health care providers than patients with IBD. As a result, 40% of people with IBS reported choosing self-care after being dissatisfied with their health care provider, which is a shame because often working with a functional medicine provider in conjunction with your allopathic provider can give you access to tests and drugs that can be paid for by insurance and may be quicker or more effective in treating your condition.
And if you’re someone who doesn’t have a gastrointestinal condition and you don’t fully realize how debilitating it can be, read this:
In a global survey of 1,966 individuals who suffer from IBS, on average patients surveyed said they would give up 15 years of their life to live symptom free.
In another multi-continent survey involving a little over 500 people who suffer from IBS, 11% agreed that when their symptoms were at their peak, they often wished that they were dead.
Let’s talk about the different domains where gastrointestinal issues can cause stigma. As I mentioned, one study on IBS found that most patients felt most stigmatized by their employers and co-workers, followed by their doctors and friends.
If you have been struggling at work, it’s best to have an honest, straightforward conversation with your supervisor or HR department about your condition and see if there are accommodations they can give you, like the ability to work from home when having a flare. It’s better to be honest about your condition than have them think you’re unreliable.
If your workplace has 15 or more employees, you have a diagnosed illness like IBD or IBS and your symptoms significantly impact on a major life ability, your condition should be a covered disability under the Americans with Disabilities Act (ADA). The ADA requires your employer to provide you all the usual work-related opportunities including hiring, promotions, salary, raises and training opportunities and to make “reasonable accommodations” to the limitations of the disabled individual, as long as these accommodations do not result in “undue hardship”. You can look at the ADA legislation to understand more what reasonable accommodations are.
If finances have been an obstacle in getting the care you need from a functional medicine provider, you might ask your employer for assistance in covering the costs of tests or special care, because they’re already paying a lot if your condition is causing you to miss work or meetings or spend a lot of time in the bathroom. It might help to be armed with statistics for your condition, like the ones I found on IBS – that at least one third of employees with IBS miss an average of one day of work per month due to their IBS symptoms and they have 15-21% greater loss in work productivity because of gastrointestinal symptoms than employees without IBS. Also, IBS is the second leading cause, behind the common cold, of workplace absenteeism. So getting you the help you need to is in their best interests.
Also, there is something called EFundYourHealth that will match any money you raise to cover the cost of your functional or alternative medicine care. Your medical provider will have to set up a fundraiser for you and give you a code to get in, then you can ask friends and family to help contribute and they will match up to $250. I have an account set up with them and can give you a code to get started if you’re working with me.
If you feel like you’re being stigmatized by your doctor because of your condition or your reaction to your care, it may not be about you. It may be about the fact that your doctor doesn’t have a solution for your problem and that makes them self-conscious or insecure about their inability to help you. I’ve heard from doctor friends that gastroenterologists would love to pawn off their IBS cases on someone like me because they don’t know what to do with them.
Second, I can tell you that it is important to advocate for yourself with healthcare providers, but I myself know what it’s like to be in a doctor’s office these days. Your provider has about 7 minutes to spend with you and most don’t want to take the time to talk in depth about your situation or hear about what you’ve heard in a podcast or on the internet. And you probably don’t want to sound like a crazy person asking about something that isn’t evidence-based or isn’t the “standard of care”. And honestly, your allopathic doctor isn’t really free, from a liability standpoint, to give you anything that doesn’t fit in with the standard of care. Plus, most doctors won’t order a test whose results they don’t know what to do with. So keep that in mind if you’re requesting microbiome stool sequencing or Organic Acids Testing, for example, from a doctor who’s never seen those tests before. To some extent, you have to understand the limits that an allopathic doctor’s knowledge and scope of practice impose on them. If you want to take a non-pharmaceutical and functional medicine approach to your treatment, you will likely need to seek out a functional medicine provider, which includes functional medicine MDs, naturopaths, a chiropractor who practices in gut health as well, a functional nutritionist or a health coach like me who specializes in gut health.
These types of practitioners don’t typically take insurance (although some people are able to pay with their FSA or HSA) but they will be able to spend much more time with you, will not stigmatize you for your condition, will take your complaints and ideas seriously and will offer natural methods of healing, including changes to diet, lifestyle and the use of herbal medicines.
But an allopathic physician can be a good partner in ordering tests like nutrient deficiency tests, for example, that are usually covered by insurance. And depending on your policy, you may have some out of network coverage for other lab tests if ordered by an MD, so it’s always worth checking whether your doctor will order the test for another practitioner to interpret. My approach with my own gut and autoimmune health is to find a general practitioner who’s willing to order tests for me if I know what to do about the results.
But in the end, you know your illness better than anyone and if you don’t advocate for yourself, no one will. You have to take responsibility for finding solutions or possible solutions to your problem. If your provider isn’t solving your problem and isn’t open to tests or medications you suggest (or even can provide peer-reviewed evidence to support), and/or you feel stigmatized by your provider, it may be time to transfer your medical care elsewhere. I used NextDoor.com to ask neighbors about providers that are open to integrative or alternative medicine. You can also choose, at your own expense of course, to talk with the doctor for the length of an appointment about their approach to medicine and their willingness to order tests for you or try non-traditional approaches. Or talking to a nursing assistant over the phone may also be a way to find out more about the doctor. But you shouldn’t have to put up with stigma at the doctor’s office.
A study done in 2014 found that more than half of the participants with IBS felt that they were treated differently by peers, family, friends and colleagues due to their diagnosis.
While this article is not just about IBS, for people with IBS in particular, whether it’s been diagnosed or not, because there aren’t physical signs of disease in your intestines, stigma may come from loved ones or peers who think it’s all in your head or being used as an excuse to get out of activities and events. And the reality is that IBS is linked to a dysfunction between the brain and the intestinal nervous system, so in some sense, it is in your head, but that doesn’t mean it’s any less real and that’s not the same as it being psychosomatic. And as a result of the connection between the gut and the brain via the vagus nerve, stress can manifest in your gut and gut issues may be caused by your brain. And if you didn’t listen to my podcast #20 with Corey Deacon, you should listen to that episode because he talks a lot about the gut brain connection, how it’s measured, and how to fix gut problems that originate in the brain due to incorrect electrical signals.
Again, talking about your gut condition with friends and family may help to reduce psychological stress and improve relationships, because it will help people understand why you may have to be absent from activities, may be less reliable that you’d like, and it may lessen your feelings of isolation. And who knows, someone you tell may have gut issues of their own. Positive relationships can be hugely helpful when it comes to managing symptoms and helping you out when you’re having a flare with transportation, child care or errands, or for a colleague, covering for you at work.
But if you find that the person you’re sharing with does not take you seriously or treat you with kindness, that may not be a person that’s good for you right now. You have a right to be taken seriously, believed, and be treated with kindness and compassion.
So if you’re a loved one of a person with gut issues – here are some key pointers for you:
Let your friend, romantic partner or family member know that you think they’re brave for confiding in you. It takes a lot of guts to talk about this kind of stuff.
If they’re in pain, ask them if there’s anything you can get for them, or offer to leave so that they can rest.
Tell them that they have nothing to be embarrassed about and what they’re going through is not their fault.
Ask them if it’s okay to share about their condition with other people before doing so.
If you hear or see someone else making jokes at their expense (like for spending a long time in the rest room for example), defend them. Let the person know that their comments are inappropriate and that your friend/family member/colleague suffers from a gastrointestinal disorder and those types of comments are not acceptable (if they gave you permission to share about it).
Offer to go with them to a doctor’s appointment if they have been feeling like they are not being heard by their physician and be a moral support.
Encourage them to confide in you when they’re feeling down; the psychological impact of having IBS or other gastrointestinal issues are real.
Help to educate other people in your life about their condition, especially mutual friends or colleagues who may not know what it is.
If they’re unable to follow through on plans due to a flare, don’t pressure them to come and don’t make them feel guilty. They probably already feel bad about cancelling. Just let them know that you understand, and offer your support if they need anything.
If you are planning to go out, make sure there are bathrooms available.
Gut health issues are often lifelong battles with periods where you loved one is better and periods where they are worse. Don’t blame or insult them for being in a worse period or going down rabbit holes or trying anything, including a million different supplements to solve their problem; if you had a similar problem, you’d do the same.
Don’t tell them it’s all in their head or psychosomatic. This feels condescending. If you suspect their condition is related to stress, rather, point them to stress management techniques that may be useful. But ask more questions, give fewer answers.
It’s not your responsibility to solve their problem. If they ask for your help, give it, but otherwise, just listen compassionately, reflect their pain and emotions back to them (“I hear you, you’re feeling really down right now because you can’t make it to the party”), but don’t try to troubleshoot their problem unless they’ve asked for your help.
Support their dietary restrictions – this is what helps them avoid flares. Don’t tempt them with foods that cause a flare. Talk to them about their greatest temptations and if there are foods they really don’t want eaten around them that are too tempting to resist but will cause a flare.
Finally, talking to a new romantic partner may be the most tricky, so here’s some advice:
Take it in baby steps, this can happen over multiple conversations.
Explain to them about your condition and how it affects your life.
You don’t have to tell them all the gory details of your symptoms and toilet habits when you’re just getting to know one another.
Share how it makes you feel (not sexy, bloated, nauseous, needing to be near a bathroom).
If you’re intimately involved, share how it can impact your libido (not feeling sexy, pain, need to use the toilet, fear of accidents) and if there are better times of day to be romantic – like first thing in the morning rather than after dinner.
Make sure your partner’s ego isn’t impacted (people’s egos are tightly tied to their feeling sexually desirable) by explaining that it isn’t about them and is just that you’re having a flare. Make sure they know you still find them sexy and desirable but just aren’t in a physical place yourself to be intimate.
In sum, life is messy, being honest and open is more likely to lead to closeness and intimacy than hiding. You deserve a romantic partner who shows you compassion and support for your condition, so don’t settle for less.
And some pointers on stigma around food and special or restricted diets:
If you’re eating out (when that becomes possible again) or ordering take out, pick the restaurant if possible.
Check the menu and call ahead to the chef to make sure they understand how serious your diet issues are.
If you’re cooking/eating at home, you can make bulk quantities of gluten-free or non-grain side dishes (like pasta, quinoa, rice, riced cauliflower, etc.). If another person cooking doesn’t want to eat gluten-free, they can just pull out some of your pre-cooked side dishes or base starch, then add the other ingredients to it for you.
Batch-cooking and freezing meals so you can eat your own thing can also be helpful.
I hope that those pointers for dealing with stigma with others are helpful.
So finally let’s talk about internalized stigma you may be experiencing. Think for a second about these questions:
What are the messages you send yourself about your condition?
What are the words you tell yourself about your health, your ability to participate in work and activities, your future prospects?
Now imagine a child who’s totally innocent and has the same condition. What would you say to that child? Are you being as kind yourself as you would be to that child? Because you should be, you should give yourself the same kind kindness and compassion, even if you messed up and ate something you shouldn’t have, for example, as you would that child.
Are you taking time to care for yourself or are you still trying to put everyone else’s needs first? It’s like the oxygen mask: you have to put your own on before taking care of others’. That means you have to take the time to practice self-care, which may mean exercise, relaxation activities, meditation, yoga, and practices that reduce stress because stress is a real, concrete factor in bowel issues, and research shows that exercise and stress reduction are essential components of healing.
And stop feeling like you’re a bother. You have to speak up and advocate for your own needs, in your relationships, at work, at the doctor’s office, you can’t let the opinions of others keep you from living your best life and getting better.
And finally remember, what you’re going through now is not going to last forever. Five years from now, if you keep searching, keep trying and keep advocating for yourself, most likely this will all be a distant memory. So don’t lose hope. There is always a path to healing and you will find it. You are enough, and you are good, and you need to love yourself through this challenging experience.
last podcast with Lucy Mailing, PhD shed light on a new theory to describe the
process of gut dysbiosis that may be responsible for many different symptoms
and diagnoses in the gut. This has impacted the education I am sharing with my
clients in helping them heal their guts. Read excerpts of our interview below
(edited for readability).
So let’s get to the main topic, the
oxygen-gut dysbiosis theory. Tell me about the theory and the research today
that supports it.
first I saw a talk done by Dr. Sean Colgan at Experimental Biology Conference
and essentially learned that butyrate is essential for the gut barrier. Most
people know that, but it actually also helps to maintain hypoxia or a very low
oxygen environment in the gut. So a healthy colon, large intestine, is
virtually devoid of oxygen. It’s a very low oxygen environment, also known as
anaerobic. And what happens is that anaerobic environments select for certain
healthy bacteria. And what happens when we have gut inflammation is that the
epithelial cells, the cells that line the gut, start to become inflamed and
they start to leak oxygen into the gut. And when this happens, a lot of
opportunistic pathogens like E. Coli, Salmonella and Enterococcus really like
that oxygen, and they can use it to outcompete some of the beneficial microbes.
So that oxygen leakage is really what is driving the dysbiosis.
in fact, we do see this pattern across different chronic diseases: the most
common pattern among all the dysbiosis that’s been observed is that there’s this
overgrowth of facultative anaerobes, meaning microbes that can use oxygen when
it’s present, and they do this at the expense of the beneficial microbes,
including a lot of those butyrate producers that are so important for
maintaining the gut barrier.
And what are some of those species
or genera or phyla of beneficial butyrate producers?
name a few: Lachnospiraceae is one, Clostridia, a number of different
Clostridia produce butyrate, Eubacterium, Roseburia. So there’s a number of
different genera and families of butyrate producing bacteria, and essentially
these are crucial to maintaining the health of that gut barrier because we if
don’t have those butyrate producers, then we’re not getting an abundance of
butyrate to fuel the epithelial cells and maintain them in a healthy state.
And so what is the result of that
oxygenation and then the increase in these facultative anaerobes?
just generally the facultative anaerobes tend to be much more inflammatory, so
they tend to stress the gut, cause inflammation, intestinal permeability, and
are also directly inflaming the gut epithelium. And what’s really interesting
is that their inflaming the gut epithelium then leads to more oxygen produced
in the gut. So it’s almost like these pathogens can hack our gut metabolism to
feed themselves the substrates that they need to survive. And then it becomes a
vicious cycle and they start to expand.
Right. And these are all typically from the phylum proteobacteria?
Yeah, most of them are in the phylum proteobacteria; that’s the most common that’s seen. And particularly the family Enterobacteriaceae is the most common to expand in this condition of increased oxygen leakage.
more from our conversation on gut stool testing using metagenomics:
a couple: Onegevity and Sun Genomics are two that I’ve explored. I’m liking
Onegevity the best right now because they also allow you to download the raw
data and then you can kind of parse through that as well. So that’s what I’m
using currently. I was using uBiome, which was really great for 16s [a
different form of gut microbiome testing] and you know, a lot less expensive.
They’re totally gone now, so it’s not an option. So I haven’t found another 16s
that I feel is reliable. So I’ve typically recently gone to the metagenomics instead
. . . metagenomics is taking all of the genes in the sample and sequencing all
of them and then matching them back up to databases so we can get down to the
genus species and strain level and typically do so with a greater degree of
And will Onegevity tell you your
breakdown of these big phyla?
Onegevity does show the phyla breakdown. They also show your butyrate-producing
capacity, which is pretty cool. And they do have a brief pathogen screening
profile. I’m hoping that they’re going to be expanding that soon.
And do they include fungi?
do include fungi, yeah. At least in the raw data. I’m not sure how much they
report in the visual reports at the moment.
And parasites or viruses or
anything like that?
they will detect them with the metagenomics, whether some of them will pop up
on the visualization report that they give you. Some of them you might have to
find in the raw data. So for example, things like Blastocystis hominis that are
a little bit more, is it parasite, is it not, will be in the raw data, but wouldn’t
necessarily show on what they choose to report at the moment, at least.
So let’s go back to my ridiculous potential
overabundance of proteobacteria. And if I look at some of these great anaerobic
butyrate producers, and in my reports, I got none of them. So other than doing
a fecal transplant, is there any way I can get them back into my system?
the question is, do you actually not have them or are they just at such low
abundance that they weren’t detected by 16s? And I would guess since you’re relatively
healthy and talking to me, my guess is that they’re there. They’re just not at
as high of abundance as they could be or are maybe even not high enough
abundance to be detected with 16s, especially if it was skewing with the
proteobacteria. Some of the butyrate producers may have also come back lower
than they should have, but essentially, you know, there’s a number of things
that you can do too even if the bacteria have gone down to really low
abundance. Improving the health of your gut and your diet will essentially help
them to reflourish.
the gut really is quite resilient. There are certainly instances where your
butyrate producers could go completely extinct. And in that instance, the only
way to get them back would be to do a fecal microbiota transplant. But for most
people, if you’ve got low butyrate producers, it is possible to shift the
ecosystem back to just allow those to flourish and become more abundant.
And how do you do that?
think the, the first step is really just to make sure you have the basic health
behaviors in place. We can talk about all kinds of advanced gut interventions,
but if you don’t have the basic, you know, healthy diet, exercise, sleep and
stress management cupboard, then all the fancy gut treatments, advanced therapies
are not going to move the needle nearly as much as any of those things. So
that’s kind of the first step. And honestly, that will shift the microbiome
quite a bit back in the right direction.
Any particular aspect of a healthy
diet, since obviously so many people define that differently?
I think the truth is we don’t exactly know what the best diet is for the gut
microbiome, and I don’t think that there is one best diet for the gut
microbiome. Everyone’s microbiome is different, and some people, you know, may
respond really well to a ketogenic diet, whereas other people might do better
with a diet that includes more plant foods. So generally I just talk about
focusing on whole foods and making sure that you’re getting processed foods and
refined sugars out of your diet for sure.
that, it really is personal experimentation. And if your gut is really
inflamed, then it might be beneficial, like I said earlier, to do a short term
more hypoallergenic diet, like the autoimmune protocol, to remove some of those
more inflammatory foods, at least for a time to facilitate that healing. Because
healing, bringing down inflammation, is going to essentially stop that oxygen
leakage, which is driving the dysbiosis.
And what about the role of fiber
so fiber can be really beneficial for some people, but for other people it’s
just going to exacerbate inflammation. So it’s kind of nuanced. Again, fiber
does seem to be important in some people and is a good way to increase
production of butyrate. But something we haven’t really touched on yet is that in
a ketogenic diet, even if you’re not getting quite as much fiber, you are
getting beta hydroxybutyrate, which is one of the primary ketone bodies
produced in the liver, and it can actually eat into the same pathway in the gut
So what if you had this typical
overabundance of proteobacteria and oxygen dysbiosis thing going on? What would
be the typical symptoms of that?
really can manifest in a lot of different ways. So we’ve seen that basically
this microbial signature of high proteobacteria and low butyrate producers is
found across a wide range of different diseases: inflammatory bowel disease,
irritable bowel syndrome, colorectal cancer. But even type 2 diabetes, obesity,
Okay, so you wouldn’t necessarily
say, well, people like this typically tend towards diarrhea or less formed
stool versus constipation?
not necessarily. Although I will say that I see it a lot in my clients that
have persistent bloating and abdominal distension. That’s a very common one
that I see, but it’s also probably skewed based on my client population.
And so in your article that you
wrote about all this, you suggested the supplemental butyrate might be
something that would turn around this state of dysbiosis. Can you talk a little
bit about that?
definitely. And I should say, I don’t think that supplemental butyrate alone
will necessarily be able to overcome this dysbiosis. So I outlined a number of
different things, both diet and lifestyle factors, and supplemental things that could be useful in
trying to prevent oxygen leakage into the gut and kind of shift back to a state
of homeostasis, butyrate being one of those things though that’s really
important. So essentially what’s going on is the oxygen leakage is happening
partly because the epithelial cells that line your gut are starved for energy.
And when they’re starved for energy, they’re not metabolizing butyrate if they
don’t have it. So what they do instead is pull glucose from the bloodstream,
and essentially this ferments to lactate, and that lactate leaks into the gut,
in addition to the oxygen that is normally used through the metabolism of
butyrate. So it’s really the fact that there’s not butyrate present, and that’s
what means that the oxygen that’s flowing into epithelial cells from the blood
doesn’t get used. And that’s when it ends up spilling out into the gut lumen
and feeding the pathogens.
providing supplemental butyrate will mean that you’re providing the energy that
the epithelial cells prefer. They’ll use more oxygen as part of their
metabolism of that butyrate and won’t need to do this, essentially, anaerobic
glucose fermentation. That’s going to produce lactate and end up not using up
the oxygen, meaning that oxygen and lactate will leak into the gut and feed
Salmonella, Enterobacteriaceae, and a number of those different proteobacteria.
. . But when we’re talking about things like supplemental butyrate, or I even talked
about in my article, the use of mesalamine, which is actually a pharmaceutical
treatment for inflammatory bowel disease that I could think could be beneficial
in some cases of severe dysbiosis. I’m certainly not recommending that to the
average person trying to improve their gut health. I’m really recommending that
when we’ve gone beyond the typical interventions.
Well I know we are running out of
time, but I have one last question because you’ve mentioned glutamine, so is L-glutamine
something you frequently supplement with or suggest people supplement with?
It really depends on the case. It has been shown to be beneficial in IBS, in
randomized control trials. Typically that’s a dose of five grams given two,
three times a day. So in some people, yes. I am a little bit more cautious in
people who might have autoimmunity, because glutamine can stimulate the immune
system, so it really is more of a case by case basis, whether I’ll recommend
glutamine. And of course there’s plenty of ways to get glutamine from our diet.
If you tolerate bone broth, broth is a great source of glutamine, as are a lot
of those other messy animal parts.
And I didn’t ask about this, but
what kind of dosages are you thinking about with the butyrate supplementation?
With butyrate, I think it’s really important to be using a dose that is more of a physiologic concentration. So a lot of butyrate salts out there, sodium butyrate, calcium butyrate, magnesium butyrate, you can buy are suggesting like a five gram dose. I prefer to use smaller doses and those that are more targeted to the colon. Again, I’m not a licensed practitioner, but in the evidence in reviewing the literature, it seems that lower doses of butyrate can be beneficial for healing the mucosa, whereas large, massive doses of butyrate might actually inhibit STEM cell proliferation in the gut and prevent wound healing. So I think butyrate supplementation is great in a lot of different conditions, but it needs to be done in a way that’s more mimicking the concentrations of butyrate that we would be getting if we had a healthy microbiome that was producing butyrate.
I know this is a scary time for lots of people who are concerned about their health or concerned about loved ones who are older, immunocompromised or in otherwise fragile health. My parents are in their late 70’s and I’m definitely concerned for them.
To help alleviate my concern and give all of our bodies some tools for preventing and fighting viral infections, I ordered myself and my parents these herbal medications. I wanted to share them with all of you too so you could protect yourselves and your loved ones.
Disclaimer:None of the statements below have been evaluated by the FDA; some of the links are to my affiliate accounts for these products/Fullscript dispensary for which I receive affiliate commissions.
Antiviral Throat and Nose Spray Options (prevention while going out or also for use if infected)
Biocidin Throat Spray (available in my Fullscript Dispensary – you have to set up an account to order – or buy from Bio-Botanical Research directly but do compare prices!) A great throat spray to stop sore throats in their tracks, kill viruses and bacteria and increase secretory IgA (your antibodies in mucus-lined parts of your body that kill invading pathogens).
Biocidin Nasal Spray – you have to make this yourself using Biocidin Broad Spectrum Liquid Formula or Biocidin LSF Liposomal Formula Liquid available from my Fullscript Dispensary. Add 8-12 drops of Biocidin Broad Spectrum Liquid or 1-2 pumps Biocidin LSF to a 1 oz bottle prepared saline solution nasal spray (some common drugstore brands have removable tops or you can pry the top off with pliers). Use several times a day until improvement is seen or as a preventative/post-contamination or while going out. Good for sinus infections too and sinus infections post dental surgery on upper teeth.
Immune Supportive and Antiviral Supplements
Biocidin LSF Liposomal Formula Liquid – antiviral herbal combo supplement – available from my Fullscript Dispensary. If you’re well now, titrate up slowly per the instructions included and stop if you have any die-off (Herxheimer) reactions until they’ve passed (sudden flu-like symptoms). Don’t increase your dose during die-off reactions. [You can also use GI Detox (also available on Fullscript) or activated charcoal to help absorb die-off by products. Take 2 hours after taking this medication.] Titrating up slowly will prepare your body to be able to handle it when you need it. When you get to the maximum dose and can tolerate it, stop and hold onto the liquid until you actually need it. If you’re already sick, titrate up slowly per instructions. If you’re acutely sick, consult with your doctor before taking and/or if you have an acute reaction. It can also be used to shorten the duration or severity of other viruses like colds and flu.
Olivirex – olive leaf extract combo herbal antiviral supplement – available from my Fullscript Dispensary. If you’re well now, titrate up slowly per the instructions included and stop if you have any die-off (Herxheimer) reactions until they’ve passed (sudden flu-like symptoms). Don’t increase your dose during die-off reactions. [You can also use GI Detox (also available on Fullscript) or activated charcoal to help absorb die-off by products. Take 2 hours after taking this medication.] Titrating up slowly will prepare your body to be able to handle it when you need it. When you get to the maximum dose and can tolerate it, stop and hold onto the capsules until you actually need them. I’d get 2-3 bottles to store until needed. It can also be used to shorten the duration or severity of other viruses like colds and flu. If you’re already sick, titrate up slowly per instructions. If you’re acutely sick, consult with your doctor before taking and/or if you have an acute reaction.
Lauricidin – highest dosage monolaurin supplement available – antiviral, antifungal and immune supportive. If you’re well now, titrate up slowly per the instructions included and stop if you have any die-off (Herxheimer) reactions until they’ve passed (sudden flu-like symptoms). Don’t increase your dose during die-off reactions. This will prepare your body to be able to handle it when you need it. When you get to the dose of 1 scoop 3 times/day and can tolerate it, stop and hold onto it until you need it, or continue taking as an immune system support. One bottle lasts around one month. If you’re already sick, titrate up slowly per instructions. If you’re acutely sick, consult with your doctor before taking and/or if you have an acute reaction.
You can email me if you have any questions about purchasing or using these products. I’m happy to help.
As we all think about social distancing, face masks, sterilization, hand washing and the like, I just wanted to make sure you don’t forget the basics of protecting your health and keeping your immune system functioning well.
Drink at least 1/2 your body weight in ounces of water a day (3/4 even better).
Eat a healthy diet. For most of us this means decreasing grain-based carbs (bread, pasta, desserts, white potatoes, rice) significantly and replacing them with healthy sources of protein (beans, legumes, grassfed and pastured meat and eggs) and fat (avocado oil, olive oil, coconut oil, avocados, olives). Eat 5-9 servings of a moving variety of fruits and vegetables a day. See my breakfast photo for how you can amp up your breakfast and start the day right: that’s sauteed spinach, sauteed avocado slices, hash browns made with grated purple sweet potato, sauteed zucchini. See how many colors you can get on a plate. Use fruit or dark chocolate (70%+) as your after dinner sweet. Get lots of fiber from root vegetables, lentils, beans, wild rice, quinoa and other whole grains (preferably not ground into flour). But think of the grain or starch portion of your meal as the side dish – it should only cover 1/8 of your plate (for women that’s like 1/2 cup; men 1 cup), non-starchy fruits and veggies should cover 3/8 to 1/2, Protein 1/4, healthy fats 1/4 (not in size but in terms of servings/calories). Use almond flour for baking instead of white or whole wheat flour. If you can’t give up your sources of white grains, you can greatly reduce their impact by cooling and reheating (potatoes, rice, pasta). This creates resistant starch that your body can’t digest but your good gut bacteria can.
Get 7-8 hours of sleep a night.
Get 20-30 minutes of sunshine unprotected by sunscreen (but protect your face with a hat).
Get regular, daily movement (it’s never been a better time for a walk around the neighborhood). Look for online workout videos. I keep an aerobic step in my living room and do my exercise there while watching TV.
It’s never been a better time to quit smoking.
Continue positive social interaction in whatever way is possible. We’ve done 6-ft. happy hours with our neighbors, we’re planning a zoom happy hour with distant friends and family, you can still take walks/hikes with friends unless you’re in one of the most vulnerable groups (then maybe just keep more distant).
Engage in some type of calming or meditative practice, especially if you are feeling anxious. Possibilities include contemplative prayer, EFT, yoga, tai chi, meditation, yoga nidra and many more.
Keep your bowels moving regularly. Add fiber to your diet (Sun Fiber, psyllium husk or other natural source) and/or magnesium citrate until you’re going at least once a day with ease.
I’m sure that you’ve all heard about the gut-brain axis and how your gut health impacts your mental health. A 2017 review of the peer-reviewed medical literature on this axis by Clapp et al. concluded: “This review demonstrates the importance of a healthy microbiome, particularly the gut microbiota, for patients suffering from anxiety and depression, as dysbiosis and inflammation in the CNS [Central Nervous System] have been linked as potential causes of mental illness. Of note, studies have shown that probiotics effectively mitigated anxiety and depressive symptoms similar to conventional prescription medications.”
In my practice, I have often noted that clients with gut infections and dysbiosis (abnormal overgrowth of certain bacteria or fungi) also have diagnoses of anxiety and depression. While I agree that probiotics can be helpful, it’s important to heal gut infections before wasting money on probiotics.
In my latest podcast episode, I interviewed Mary, a mom from California who sought out FMT or fecal microbiota transplants (aka poop transplants) for her children’s urgent health problems at a clinic in Australia (because it’s not legal here for their conditions). Her daughter had severe social anxiety and auditory and tactile hallucinations diagnosed as something called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcus) and her son had autism and lifelong diarrhea. By the end of 3 weeks of transplants, the clinic determined through testing that her third child was a safe donor to continue the transplants once home.
That’s where it gets interesting on the topic of anxiety and depression. Mary had been suffering with both her entire life, and the anxiety had become quite severe to the point where she was having panic attacks every time she contemplated driving, which was a daily necessity. So Mary gave herself 10 fecal transplants over the course of 15 days using her daughter’s stool. Her symptoms of anxiety and depression were gone after the first two fecal transplants, and haven’t returned since. And her daughter’s condition was also gone after two weeks of transplants plus supplemental FMTs after returning, as well as her son’s diarrhea.
Mary’s story is amazing but not shocking given that we know that gut bacteria produce and/or consume a wide range of our neurotransmitters, including dopamine, norepinephrine, serotonin and gamma-aminobutyric acid (GABA). In fact, 95% of the body’s serotonin is found in the bowels. While Mary’s solution may be a bit extreme for most people (not to mention costly given the testing and the trip to Australia that gave her the confidence to try FMT at home), testing and correction of gut health issues is a much more mundane way to treat mental illness.
Various functional lab tests that consumers can order themselves can shed light on what’s going on in your gut that may be affecting your brain. These include the Organic Acids Test, which includes over 70 metabolic markers of gut health, vitamin levels, neurotransmitters, mitochondrial function and much more and Onegevity’s Gutbio test, which is a complete metagenomic sequencing of your gut microbiome down to the strain level, including parasites, bacteria, archaea, fungi and viruses. Stocked with this information, I educate my clients on protocols recommended by MDs and PharmDs to heal/treat the dysbiosis (usually through herbal antimicrobials + probiotics), which can help correct neurotransmitter issues impacting mental health.
If you’ve only sought out allopathic (aka traditional) doctors or therapists to help with your mental health issues without relief, it may be a gut problem! I encourage you to listen to Mary’s family’s amazing healing story! (Or if you’re not podcast-listening savvy just find it here on my web site.)
If you didn’t have time to listen to my latest podcast episode with Dr. Raphael D’Angelo, MD, who is a retired holistic medical doctor who provides thorough parasite testing through his business ParaWellness Research, here are some of the key takeaways.
What are parasites and which types are most common?
A parasite is anything that derives its life, substance or ability to reproduce from some other organism. Most parasites in the human gut are either worms like roundworms, flatworms and flukes, or protozoa. Protozoa are the most numerous parasites throughout the environment, especially in water, but can also be carried by insects, like malaria. In Dr. d’Angelo’s testing, about nine out of ten patients have a protozoan, and one out of ten has a protozoan and a worm.
Can you have a parasite and no gut issues?
While Dr. d’Angelo generally tests people who are suffering from gut symptoms, he also noted that we would probably find one or two types of protozoa in healthy people who are not having any gut problems. These protozoa may be transient and just reside in the gut for a short time.
Why do typical labs fail to find parasites most of the time?
While Dr. d’Angelo’s parasite testing (at ParaWellness Research) is very thorough and involves many different tools, Dr. d’Angelo explained why parasite testing through typical labs covered by insurance usually finds nothing. Those labs conduct a wide range of tests, including bacterial testing, virus testing, fungus testing, and more. Because there’s a perception that parasites are not a real problem in the United States, parasite testing receives the lowest priority in assigning lab personnel, with newer and less experienced technicians assigned to parasite testing. Insufficient time is spent looking for parasites because they’re rarely found, and parasites change form, making it difficult to detect them under a microscope some of the time. As a result, little effort is given to detecting parasites with a foregone conclusion that they won’t be found. So if you’ve been given an ova and parasites test through your doctor’s office and it came up empty, but you think you may have a parasite, you may want to consider additional testing.
What is Blastocystis Hominis?
The most common protozoan
parasite worldwide other than malaria is called blastocystis hominis. It can
come from contaminated food or water or can be transmitted from person to
person with poor hygiene habits. Symptoms include diarrhea and abdominal
cramping and occasionally, nausea. Often people with a diagnosis of Irritable Bowel
Syndrome (IBS) have blastocystis hominis. Occasionally it can be found in swelling
around arthritic joints when fluid is extracted. For many years it was not
believed to be a parasite, but over the last 25-30 years, it’s been shown that
it can invade some tissues.
hominis is known to be difficult to eradicate, Dr. d’Angelo has had success
treating it with a silver type preparation mixed with essential oils, sometimes
including liquid preparations of herbs.
While treating parasites
with antibiotics is also possible and can take less time (1-2 weeks), those who
wish to avoid antibiotics can choose natural treatments. Dr. d’Angelo
recommends these treatments be taken over the course of three months, for 20
days from when the moon is half full to a full moon and then from the full moon
until the half moon for three moon cycles, giving the body a 10 day rest in
between. The moon’s pull on bodies of water also applies to parasites, and
their most active metabolic period is during this time, allowing smaller
amounts of the medicines to be used. Dr. d’Angelo learned this method of treatment
from colleagues in other countries who treat parasites routinely.
The pull of the moon points
can be an additional help in diagnosing parasites – during the fuller moon
phases, people will complain of more diarrhea and cramps.
What is Cryptosporidium?
Another common protozoan
is cryptosporidium, which is found in contaminated water as a result of animal
or bird droppings. This can often follow on flooding in an area, where drinking
water becomes polluted. Water filtration systems are generally not fine enough
to be able to completely filter out parasites, so when their numbers increase,
enough get through that they can overwhelm our immune systems. In addition,
during the cleaning of the filters, water systems backflow their filters, which
opens up the opportunity for parasites to enter the water flow. If your area
has had flooding, one way to protect yourself is to boil your water one minute
for every 1000 feet of elevation above sea level. Another good way to protect
yourself on an ongoing basis is to use a reverse osmosis filter that you can
put under your sink. Pitcher-type filters are generally not fine enough to protect
you from protozoa (which require a one or two micron filter), although some
units do boast this level of filtration.
A large amount of diarrhea
is almost always present with cryptosporidium. They are very difficult to find
on lab tests because they tend to live in upper part of the small intestine,
but they can be located using a specialized
antibody test. For a
normal healthy person who gets cryptosporidium, they may have a big bout of
diarrhea for two-three weeks, then it tapers off and they get better. However,
in an immunocompromised person, with something like diabetes or cancer, it may
cause a chronic, ongoing problem.
What is Giardia?
Another common parasite
found in humans in the U.S. is giardia. It’s almost universally present in wild
animal populations and in soil and water, so it gets into our drinking water reservoirs.
Symptoms include mushy bowel movements with a sulfurous smell and a rumbly
stomach and intestines on and off throughout the day. It can be treated through
10 days of prescription antibiotics if it’s causing problems, although many people
may have just a few giardia that their immune system keeps in check, causing no
What is Cyclospora Cayetanensis?
Another parasite that was
a problem relatively recently in the U.S. is cyclospora cayetanensis, which
came in through a cilantro farm in Mexico that had contamination from animal
waste. This also causes profuse diarrhea and can be treated with antibiotics or
three months of Dr. d’Angelo’s remedy.
What are examples of some types of parasites that typical labs
will not identify as pathogenic but that may cause problems?
Other protozoan parasites
that the CDC may not classify as pathogenic but that Dr. d’Angelo recommends
treating include dientamoeba fragilis, endolimax nana and iodamoeba buetschlii.
Dientamoeba fragilis can enter through contaminated food and water and also piggybacks
onto roundworms. Endolimax nana and iodamoeba buetschlii are very common and
can be found in almost any water source. In some people these protozoa may be numerous
enough to block nutrient absorption. These are typical of parasites that a
traditional lab will not identify.
What are the most common parasitic worms found in the U.S.?
Worms are also pretty
common in the U.S., but in nowhere near the amounts that Dr. d’Angelo would
find in samples from Vietnamese people, where he received his original training
through the U.S. army during the Vietmam war. A typical Vietnamese worker on
their base might have had five or six different types of worms and four or five
types of protozoa and have no digestive issues at all, because their immune
systems were well adapted to keeping these populations in check.
In the U.S., some of the
most common worms are pinworms and a large roundworm called ascaris
lumbricoides. With pinworms, which are common in young children, symptoms
include restlessness at night and itching of the anus. If you press a piece of
scotch tape to your child’s bottom before they get out of bed in the morning
and look at that under the microscope, you can see the eggs of the pinworm.
Ascaris lumbricoides usually
comes through swallowing an egg from contaminated food, mainly meats. That’s
why Dr. d’Angelo recommends wearing disposable
gloves when you’re handling fresh, slaughtered game meat like deer, and cleaning
the meat under running water. Sometimes it’s possible to find an egg in a
parasite test, but often it’s only discovered when the worm is passed in stool.
For many people, ascaris
lumbricoides will cause no problems while residing in your gut for six to nine
months and will pass out without incident. Some people may have no symptoms but
others may have a sense of fullness or of movement. However, in other people,
the worm may find its way to a spot in the upper part of the small intestine, where
it can block the outflow of pancreatic juices or bile into the small intestine
for digestion. Symptoms of this include pain in the upper right quadrant of the
abdomen. If given an x-ray, the worm may be visible on it.
Can parasites cause food sensitivities?
When there are
disruptions of the integrity of the lining of the intestinal tract, parasites
can contribute to food sensitivities. Blastocystis hominis, for example, eats
good bacteria and can strip an area of the intestinal lining of commensal or
beneficial bacteria that would normally protect it. As a result, the mucus
layer is stripped and partially digested food particles can escape, causing an
immune response and the production of an antibody against that food, which
leads to a sensitivity.
In addition, parasites take
in nutrients and put out toxic waste products, which can also deteriorate the
lining of the intestinal tract, causing the immune system to react as it tries
to clean up the problem, creating an allergic reaction involving foods that are
also in the area.
If you are found to have
a parasite that you believe created a food sensitivity, you should wait about a
month after clearing it before trying to eat that food again.
Should your sexual partner be treated for parasites when you are?
If there is some chance
that there’s been shared stool, urine or other bodily fluids, it’s wise to test
both members of a couple so that you don’t pass things back and forth.
What is mimosa pudica seed and can it be used to treat parasites?
Dr. d’Angelo finds it
very helpful for resistant parasites and something called rope worm. Symptoms
of rope worm include a rumbly tummy, and the frequent passing of long, rope-like
or stick-like, mucus-covered items in the stool. The mimosa plant has been used
for centuries by the indigenous healers for parasites, and so it’s a very good
anti-parasitic for many different kinds of parasites that would also work in
place of the essential oil/silver/herbal preparations that Dr. d’Angelo uses.
However, his preparation also treats pathogenic bacteria and candida.
Does Dr. d’Angelo also test for yeast/candida?
In Dr. d’Angelo’s
testing, he also looks for excess yeast in the stool and in the urine. Forty
percent of patients have excess yeast, which is why he includes silver in his
treatment, as it is effective against candida.
How much is testing through ParaWellness Research and can I order
An initial test, including a $10 membership fee to his research program and shipping is $316.95. Patients can order tests themselves at parawellnessresearch.com.
So the short answer is, yes, you probably should. At minimum, most people need to start dealing with gut issues by trying an elimination diet, and gluten is the primary thing to eliminate. Dairy, soy, added sugar, corn, alcohol, processed seed oils and processed foods with many ingredients (which are pretty much out if you’re already eliminating corn and soy) are other really common problem foods. So that’s a good place to start.
So let’s talk a little bit about what gluten is. Briefly, it is the protein found in wheat, barley, rye, spelt and triticale, which is a cross between wheat and rye. And because of cross contamination, it can also often be found in oats.
Alpha gliadin is the protein fragment that most research focuses on as the main culprit in gluten sensitivity or celiac disease. But all grains contain proteins that are similar to gluten and may also cause problems. So a heads up that if you have already eliminated gluten and other problem foods, and you’re still having problems, there is a whole school of thought led in part by Peter Osborne who wrote “No Grain, No Pain”, that all grains need to be eliminated. In that case, because you may be having problems or cross-reactivity with other grains, you may want to get a test through Cyrex labs of 24 other foods that have typical cross-reactivity with gluten. One surprising cross-reactive food is instant coffee because there’s a high rate of contamination with gluten.
It’s also possible that what you think is just a sensitivity to gluten may be undiagnosed celiac disease. Celiac is an autoimmune disease in which the villi in your small intestine are actually destroyed by eating gluten. That impairs nutrient absorption, which leads to intestinal symptoms, typically diarrhea, but also fatigue and many other things. So the gold standard for testing for celiac is an intestinal biopsy, but there are also blood tests for Immunoglobulin A (IgA) antibodies, which will be found in about 80% of people with celiac disease. Cyrex lab can also test blood more extensively to catch false negatives for IgA. The problem with the testing for celiac is that you have to eat gluten about twice a day for four weeks prior to the test. Nevertheless, there is real value in actually getting a diagnosis. Imagine you have accidentally discovered that you don’t do well with gluten, but you’re kind of cheating, eating gluten every week or every couple of weeks, and you’re just not really taking it seriously because you don’t have an official celiac diagnosis. You could really be putting your health in danger. Getting that celiac diagnosis is going to lead to a lot better compliance because you’re going to realize what the stakes are for eating gluten. People with celiac disease have increased chances of other autoimmune diseases and the sooner it’s discovered and a very strict gluten-free diet is followed, the better.
I actually had a client who had suffered from extreme fatigue his entire life, but up until more recently, he hadn’t had the gastrointestinal symptoms. At the age of 60, he finally got his celiac diagnosis. So the fatigue comes from a lack of nutrient absorption. You’re basically running on nothing because your villi normally absorb nutrients but they’re getting progressively more destroyed.
It’s estimated that about 1% of people have celiac disease in the U.S. and it is hereditary. If you have a first degree relative with celiac disease, you have a one in 10 risk of having it as well. So if you find out that someone in your family has celiac, or if you find out that you have celiac, you should encourage your relatives to get tested. If you are diagnosed over the age of 20, there’s a 34% risk of another autoimmune disorder. Celiacs do have to eat a strict gluten-free diet for the rest their lives.
In addition to that, for about 8% of celiacs, even gluten-free oats are problematic and cross-reactive. Let me also mention that dairy is also frequently problematic to people who have celiac because it is digested with the top of the villi. But once you go off the gluten and the villi start to heal, which can actually happen relatively rapidly, possibly in a matter of months, then you may regain your ability to digest dairy. So you may want to retest dairy after some time has passed.
Symptoms of celiac disease are unexplained iron deficiency, anemia, fatigue, bone or joint pain, arthritis, osteoporosis, or osteopenia, liver and biliary tract disorders, depression or anxiety, peripheral neuropathy, which is tingling or numbness or pain in your hands and feet, seizures or migraines, amenorrhea (loss of your period), infertility, canker sores, and an itchy skin rash.
Non-Celiac Gluten Sensitivity
Now, let’s talk a bit about non-celiac gluten sensitivity (NCGS), because a lot of people think that if you’re not celiac, then the rest is just kind of made up. That is not true. It is a real diagnosis. In the U.S., somewhere between 0.6% and 6% of people are gluten sensitive. But I have seen in at least one article that as many as 33% of Americans are currently trying to avoid gluten (so restaurant owners, how about more gluten-free options?) One study in Italy of about 12,000 people found that there is about a rate of 3% of gluten sensitivity.
The official way to diagnose NCGS is to test negative for celiac, but have both gastrointestinal and non-gastrointestinal symptoms. The gastrointestinal symptoms would be the kind of symptoms you’d see with IBS, like cramping, bloating, diarrhea, stomach rumbling, constipation and foul-smelling stool. The non-gastrointestinal symptoms are brain fog, trouble concentrating, memory problems, frequent headaches, mood-related changes like anxiety and depression, low energy, chronic fatigue, muscle and joint pains, numbness and tingling in the arms and legs, reproductive problems and infertility, skin issues like dermatitis, eczema, rosacea and rashes, nutrient deficiencies including anemia, and just generally increased inflammation in the body. Having non-celiac gluten sensitivity also puts you at a higher risk of autism, ADHD, Alzheimer’s, dementia, neurological and psychiatric diseases and leads to autoimmune disease.
SIBO and Low FODMAPs
Now, let me also mention that for some people, gluten sensitivity is not in fact sensitivity to gluten, but an intolerance to FODMAPs, which are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are a component of gluten-containing grains. So if you are reacting to foods like onion and garlic as well, it may be that what you need is a low FODMAP diet, not just a gluten-free diet. FODMAPs are in a lot of foods, including lots of fruits and vegetables, and of course in gluten and in dairy. If you do well on a low FODMAPs diet, then that is probably indicative of the fact that you have SIBO or Small Intestine Bacterial Overgrowth, a primary cause of Irritable Bowel Syndrome (IBS).
One of the potential origins of SIBO is an autoimmune attack on the villi in your small intestine, which can come from an episode of food poisoning. And now there’s a test called the IBS Smart Test that is starting to be covered by some insurance and by Medicare and Medicaid, although your doctor may not have heard of it. It can test you for the antibodies that could be hurting your villi, which damages your migrating motor complex (MMC), the movement of your intestines that pushes food through. If you have the autoimmune type of SIBO, you’ll need to get treated for SIBO, but also go on a prokinetic, or something that helps your MMC do its job of peristalsis, or moving food through the intestines. So if you are reacting to onions and garlic, it may be SIBO. Look in that direction for healing rather than just eliminating gluten.
Let me also mention that just going on a low FODMAPs diet will not be sufficient to heal your SIBO. It will help you with the symptoms, but it’s not a good, long-term diet because it is deficient in a lot of nutrients and fiber that are important for your gut microbiome. So you want to get the diagnosis, heal the SIBO (which can be through a prescription drug called Rifaximin or herbal anti-microbials), then you might need to go on a prokinetic to get that small intestine moving again in order to keep the gut motility up and your MMC functioning in the long-term. So you need to see someone (like me) who can help you get the testing and educate you on antimicrobial options.
Why Gluten is Problematic in General
Now let’s talk a bit about why gluten is problematic in general. Gluten, for all people, triggers the release of a chemical called zonulin. And zonulin opens up the tight junctions in your intestines, causing what is known as intestinal permeability or in lay parlance, leaky gut. And the thing is, when those tight junctions open, gluten is a large, hard-to-digest protein that can then slip out those cracks and cause an immune response. So what they have found is that in celiac disease, the opening time for zonulin is much longer, so a good bit of undigested food, toxins and bacteria can slip out.
For people who have NCGS, there may be two things at play. One may be that the barrier is held open for a longer period of time, and then you’ll have increased leakage of undigested proteins and the immune response. But the second is that there may be changes in the gut microbiome that lead to gut dysbiosis, which then leads to increased intestinal permeability, gut symptoms and systemic inflammation, which is your immune immune response.
Gluten and Autoimmune Disease
In both celiac and NCGS, the real danger is molecular mimicry, which means that when that gluten escapes, the gluten protein looks like your own cells. When your immune system sees your own cells that look the same, it attacks those as well, which is one of the origins of autoimmune disease. That’s why Hashimoto’s thyroiditis is so common: the cells in your thyroid resemble the gluten protein. At this point, they say that one in five of American women will have Hashimoto’s or another thyroid disorder in their lifetime. Other autoimmune diseases besides Hashimoto’s that are most frequently mentioned in conjunction with non-celiac gluten sensitivity are dermatitis herpetiformis, psoriasis and rheumatologic diseases like rheumatoid arthritis, which is another one of the very common autoimmune diseases.
So to have that autoimmune reaction, you basically have to have three factors at play. Number one, you have to be genetically predisposed to gluten sensitivity or celiac, you have to have an environmental factor that’s the instigator of the immune response (in this case, gluten), and then at the same time, you have to have that breach of the intestinal barrier so that the genetic predisposition to the food sensitivity can interplay with the protein from that food entering the body.
I should also mention that casein, one of proteins in dairy, also looks like gluten to the body, and about 50% of the people who are sensitive to gluten are also sensitive to dairy. So that’s a big one. I’ve heard clients say to me, well, I went off gluten for X amount of time and didn’t get better. Well, you may be deep into it. First of all, it may take more than a month or two of elimination. But also, you may not be eliminating all the foods that you need to eliminate to really get at the root of your problem. And if you’ve not done that, then you’re still going to have the symptoms.
Elimination Diets and the AIP
So let’s talk about an elimination diet. The ideal elimination diet is going to last at least 30 days and eliminate gluten, dairy, soy, added sugar, alcohol and processed foods, at minimum. Six weeks would be even better. Then you should reintroduce each food individually for a week at a time, eating it a couple of times a day so you can really gauge the effects. It’s important to leave enough time to make sure that food is really non-reactive, then remove that food again as you test something else and then slowly add the non-reactive foods back in at the end.
Now if you are dealing with an autoimmune disease and not just gut symptoms, the autoimmune protocol (AIP) is a much more strict elimination diet that you could try. That also eliminates nightshades, which are tomatoes, peppers, potatoes and eggplant, legumes, eggs, coffee, all grains, nuts and seeds, seed spices, every spice in the pepper family, and chocolate! Tragic, I know. But I wanted to caution you that if you are going to go that route, there’s something that can happen when you go on elimination diets like the AIP. You may end up eating the same things every day and reducing your diet to so few foods that you get to the point where you can basically eat nothing without getting sick. So a word of warning, if you’re just starting to plan to go on the AIP, it is essential to eat a variety of foods, especially fresh produce and the starchy vegetables that are allowed on it, to keep up the diversity of your gut bacteria during that time. Otherwise, you may risk losing oral tolerance for many foods, which is what I hear from a lot of people who have gone on strict elimination diets and kept them going for too long.
So I know that the big question for a lot of people who are considering going off gluten is, “Does this mean no more pizza for life? Will I always have to be gluten-free?” So if you’re celiac, of course you will always have to be gluten-free. For those who have non-celiac gluten sensitivity, the research at this point is not conclusive. For now, the expert recommendation is that you should follow a gluten-free diet for one to two years and then retest by eating gluten. In my experience, I have had autoimmune conditions (which I described in my January podcast episode: “How I Reversed My Autoimmune Diseases and Got Interested in Gut Health”). During the 5-year process of bringing my antibodies to normal through among other things, staying off of the foods I’m sensitive to (gluten, dairy and soy), I have been able to cheat with gluten about four to six times a year without really throwing myself off track. However, autoimmune experts warn that even eating it once every 6 months could be problematic. That has not been my personal experience.
And there’s no question that I’m gluten sensitive because my stomach bloats up with a food baby every time I eat it, among other problems. But I can still get away with it by taking gluten and dairy digestants and lactose pills. And yet I have been able to continue to reduce my antibodies. Of course I’ll be a little bloated the next day, and I’ll have a sore throat, mostly from the dairy, but I make it worth it. If I’m going to cheat, I’m not having a couple of saltines or frozen pizza. I’m going out for Neapolitan pizza and a chunk of fresh mozzarella or burrata and a nice tiramisu. I’m making the most of it. So I would say that if you’re going to cheat, be purposeful and make the most of it. Don’t just cheat on something stupid because it’s sitting there at some church potluck.
I’ve been thinking that when my Thyroglobulin antibodies for Hashimoto’s are normal (which is under 0.9; mine were last 2.4 ) I may try eating gluten more frequently and see if I can get away with it. But honestly, bread has always made me feel bloated and gross, and it takes up stomach space and calories that really could be filled with more nutrient-dense foods, and it leads to weight gain.
So in general, I’m not really trying to find more ways to include gluten in my diet, because I don’t think that ultimately it’s the food I most want to reintroduce and take up space with. I have to say that being gluten sensitive has given me a lot of freedom and ease in limiting sugar. I was such a sugar addict before, and the vast majority of desserts out there that you don’t make yourself are going to have gluten in them. So that just means they’re off limits. So it’s really given me the freedom to say “no” to so many foods without even being tempted because they’re just on the no fly list. They’re just never going to be a possibility for me. So I feel like giving up gluten has led to a healthier life overall. So I don’t actually really want to go back on gluten for good. Gluten-free has been a pro in my life.
So if you are struggling with gut issues and haven’t yet taken the plunge and gotten off gluten, this may be the time.
And I do one-hour consultations as well as longer-term health coaching programs (starting with a free, 1-hour breakthrough session) to help with gut issues, autoimmune disease reversal and weight loss, so don’t hesitate to sign up for that.
If you have been struggling with an issue like SIBO, candida, IBS, IBD or an eating disorder that is not resolving with traditional or alternative treatments, you may be dealing with an electrical problem in your gut, brain or the connection between the two. In my last podcast episode: The Gut-Brain Connection: A Deep Dive with Corey Deacon, DNM, CFMP, we talked about an amazing new tool that he is using, the electrogastrogram (EGG), to help resolve these issues and retrain the brain and gut.
EGGs record the electrical activity of the gut through sensors on the outside of your body. Every cell in your body needs an electric current to function, and your gut cells are no different. The EGG is similar to an EKG you would have on your heart, just on a different part of your body. EGGs can run through an app on your phone and are then synched with a diary of times you eat, have a bowel movement, etc. In Dr. Deacon’s work, he has found that people with IBS, IBD, GERD, SIBO, chronic parasites or fungal problems, the EGG isn’t smooth and the gut isn’t moving things in the proper rhythm, which is normally 0.05 Hertz. In many people, the migratory motor complex, which controls the movement of food through the intestines, is moving food too slowly, which is known as dysmotility. In other cases, there are little areas within the intestines that are firing improperly, and sometimes firing in the wrong direction. A common example of this is GERD, where acid comes back up the esophagus. While it’s obvious when this happens in the esophagus, it’s much harder to diagnose throughout the rest of the gut as the symptoms are more subtle. But the result of this firing in the wrong direction is a buildup of dysbiotic bacteria that release lipopolysaccharides (LPS). LPS, also known as endotoxins, stimulate a strong immune response, leading to inflammation.
But Dr. Deacon and his colleagues have found that some of the time, the improper firing or gut dysmotility has its origin in the brain, for example following a traumatic brain injury. So when you have both an EGG and an electroencephalogram (EEG), which tracks your brain waves, you can figure out the directionality of your gut problems. One surprise that the practitioners of this technique discovered was that with eating disorders, 70% of the time, it was in fact the gut taking control of the brain and causing the behavior, not the contrary. Using these neuro and biofeedback technique techniques to retrain the brain and gut, Dr. Deacon and others have had success in helping people resolve their eating disorders.
Brain and gut retraining is done through a technique called operant conditioning, which is accomplished by providing audio and visual feedback cues that the brain likes when it’s behaving correctly. This is done by hooking sensors up to the gut and brain and playing a game, movie, music or animation for the patient when the gut or brain is facilitating a proper rhythm. In the brain, the superior and inferior colliculi respond to audio and visual information, and send a message to the limbic system, which then sends a message to the reward system. The limbic system likes stimulus (as opposed to nothing), like how we love our cell phones and can’t stay off them. So when the stimulus is removed, the brain is unhappy. Over time, the brain figures out how to get the stimulus by facilitating the proper gut rhythm, and through the neuroplasticity of the brain, extinguishes old pathways and creates new, healthy pathways to facilitate proper gut movement.
Training sessions last 45 minutes to a hour 2-3 times/week, with 16-24 retraining sessions in total to correct problems in mild to moderate cases. Then patients will do a maintenance session every 1-4 weeks to correct for mental or emotional stress or physiological stress on the gut through toxins, etc. In the next 2-3 years, they’re hoping to develop an at-home system for gut retraining that could be accessed via a cell phone app.
Antibiotics are dramatically overprescribed in our current medical system, and this takes the form of prescribing them when they aren’t necessary, prescribing wider-spectrum antibiotics than necessary, and prescribing longer courses than necessary. I was once prescribed 10 days of Cipro twice in rapid succession for urinary tract infections that I later learned only warranted a 3-day course. All of my autoimmune conditions were diagnosed in the following year. This makes me quite suspicious!
During the cold and flu season this winter, your doctor may prescribe you antibiotics for conditions that are caused by viruses, like cold and flu, or for sinus infections, which are much more likely to be fungal, not bacterial or viral. So if you’re offered an antibiotic for one of these conditions, you should definitely ask your doctor, first of all, is this really necessary? Now admittedly, there are some bacterial infections like strep throat that can be secondary to a viral infection, and those legitimately do need to be treated with antibiotics or herbal antimicrobials. If you go that route, you can see a naturopath for herbal medicines or instructions on which herbal products to use and when to seek out antibiotics if they aren’t working.
If you do have to go on antibiotics, one of the best things that you can do is to take probiotics both during the time you’re taking the antibiotics and then afterwards, to make sure that you protect and rebuild your gut. Note that most probiotics are just transitory and will not colonize your gut, but will protect you from pathogenic bacteria taking root (like C. Difficile) while you’re on antibiotics, will help select for healthier strains in your gut and will protect you from intestinal permeability or leaky gut, where the gut opens up and allows food particles, bacteria and toxins to escape.
So the first probiotic that I always recommend is S. Boulardii, (officially Saccharomyces Cerevisiae subspecies Boulardii), which is not actually a bacteria. It is a beneficial yeast. I like the Jarrow brand (5 billion CFU in 1 capsule; also available from my Fullscript Dispensary) because you can get a nice big bottle for a reasonable price. I would take those at least two or three times a day during the time you’re on antibiotics. As a yeast, the antibiotics won’t kill it. The nice thing about S. Boulardii is that it stops the reproduction of candida, which is also a yeast normally present in your gut. When you are killing off bacteria, the balance between the bacteria and the candida can get off, which can lead to an overgrowth of candida. I take S. Boulardii on a daily basis even when I’m not on antibiotics.
Then another type of probiotic you will want to consider are soil-based or spore-based probiotics, of which I’d take one serving/day. Some of the big names in spore-based are Megasporebiotic (also on Fullscript); likely the most expensive, most diverse and highest dosage one with 4 billion CFU and 5 strains in 2 capsules). Then there’s justthrive (3 billion and 4 strains in 1 capsule) and ProFlora 4R (on Fullscript; 3 billion CFU, 3 strains + Querticin, Aloe Vera and Marshmallow Root). And then there’s also a brand called Restorflora (on Fullscript) that has both 5 billion CFU of S. Boulardii and 2 billion CFU of 2 strains of spore-based probiotics. So I’d either go with the S. Boulardii plus a separate spore-based probiotic, or I would go with the combined one. But you may want to double up on RestorFlora to get as many of the spore-based as you would with another brand that was only spore-based strains. But of course, it’s not an exact science.
Another probiotic that I recommend as well is Equilibrium, which is really unique in the field of probiotics because it’s a human-derived probiotic with 115 strains. So these are strains that actually live in your gut. Again, I would go with maybe two or three of these a day during the time you’re on antibiotics or one/day starting right after you’re done, and keep that up until you’ve finished out 1-2 bottles. You could also go with Equilibrium Boost, which is basically 2 capsules of 10 Equilibrium combined into one, and then follow that by a regular bottle of Equilibrium right after you finish with the antibiotics. (You can use discount code HDH15OFF to get 15% off Equilibrium either at at the link above or on Amazon).
And then either at the same time or after you’re finished with your antibiotics, I’d also use food-based probiotics, something that has high levels of lactobacilli and bifidobacteria. If you want to go really high end, you can look at the Bifido Maximus, which is sold out of the Gut Institute and has 100 billion CFU per ¼ tsp. serving. Another good one is Renew Life Ultimate Flora that has 50 billion CFU per capsule. Of the food-based, I’d shoot for 100 billion CFU/day.
In terms of timing, all of the probiotics besides the S. Boulardii need to be taken separated in time from antibiotics. Otherwise the antibiotics will just be killing them. So for example, if you’re taking your antibiotics at breakfast and dinner, then take your probiotics at lunch and/or right before you go to bed, or if the antibiotics are three times/day, then take the probiotics between meals and/or at bedtime.
Another substance you might want to look at to help protect your gut is L-glutamine, which is a nonessential amino acid. Normally your body makes enough and it also comes from a lot of different foods like chicken, fish, dairy, tofu, cabbage, spinach, beets, peas, lentils and beans. But it can become deficient due to major infections, trauma, significant stress, radiation and chemotherapy, shock and vigorous exercise. So one way to protect your gut during these times of infections is to have a lot of bone broth, which has both L-glutamine and collagen, which is why of course grandma’s chicken soup was recommended. Note though that if you have histamine intolerance, bone broth is a source of histamine, so you wouldn’t want to go that route. Or you can take supplements of L-glutamine. The maximum dose is 30 grams a day split into five gram portions taken six times a day. But what I’d recommend is that you just start with a powder and work your way up to what seems to be a good dose for you. That helps seal the gut and keep it protected from becoming leaky.
Then you should also make sure you eat probiotic foods. So fermented sauerkraut, kefir, kim chee, etc. And the other thing that’s really important is to avoid sugar and processed carbohydrates during the time you’re on antibiotics and while you’re rebuilding your gut afterwards, because this is a time you’re going to be particularly prone to an overgrowth of candida. The more I see clients and people around me who are sick, the more I believe that a lot of these gut and autoimmune issues are traceable to the destruction of the gut microbiome due to antibiotics. You end up with an imbalance between the bacteria and fungi, including candida. So it’s really important that you get off the sugar and the processed carbs as much as possible. And that includes alcohol.
Then the other important part is to feed the body and its resident bacteria prebiotics and fiber. So just in case there’s any unclarity, probiotics are the bacteria and beneficial yeast, prebiotics are the food for the bacteria. I wouldn’t say it’s necessary to go for a prebiotic supplement, but just eat a lot of fiber from fruits and vegetables, like onion, garlic, beans, lentils and other legumes (the powerhouses of fiber).
And then you can also aim to get good resistant starch, which functions like soluble fiber, as a food for our bacteria. It helps us feel more full and controls blood sugar but we don’t digest it, our bacteria do. Good sources are tiger nut flour (a root vegetable, not a nut), green banana flour and banana skins. If you want to put banana skins into your smoothie, make sure you use organic bananas. You can also get resistant starch from heated and then cooled rice and potatoes. Once you cool them down, you get significantly fewer carbohydrates (or simple carbohydrates if you’re eating white rice) and 2½ to 3 times more resistant starch. Once you cool them, you can heat them back up to eat.
Finally, I did want to mention that if you took antibiotics a long time ago and you’re now dealing with what seems to be gut issues that followed on the antibiotic treatment, you can certainly try probiotics. You can go hard on them and see if it helps. But it may just be putting a bandaid on a bigger problem. So my recommendation is if it’s been a while since you took the antibiotics and you’ve been having gut issues, then you probably want to see what’s going on through testing. It may be parasites, it may be bacterial overgrowth like SIBO, it may be fungi like candida. It’s important to figure out what’s going on so that you can kill the appropriate thing, if there’s something to kill, and then rebuild with the prebiotics and probiotics. I think that’s a better route than trying to just put a bandaid on a dysbiotic gut.
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