Adapted from episode 139 of The Perfect Stool podcast and edited for readability with Alyssa Simpson, RD and Certified Gastrointestinal Nutritionist and Lindsey Parsons, EdD.
Lindsey:
So, we had a great conversation about autoimmunity on Alyssa’s podcast, The Gut Health Dialogues, last week, and I’m glad to have you here this week to talk about prebiotics and probiotics and fiber and stuff like that. So before we head into the meat of it, can I ask how you got into working with digestive issues?
Alyssa Simpson:
Yeah, you know, it’s actually kind of funny, because I didn’t really have digestive issues until I started working with people with digestive issues. I had been a dietitian for about 11 years, just doing general nutrition, lot of diabetes, I was a certified diabetes educator, and I had always wanted to be in private practice, so I left my job, quit my job, started a private practice. Around the same time, I was learning more about integrative and functional nutrition, which is a whole other learning curve, and there was so much stress between starting a new specialty, starting a new business, and I developed really, really severe acid reflux and constipation. It was just general chronic-stress related, I know that’s what triggered it, and then the whole landslide that came with that of food sensitivities and then learning how to really manage my stress as the root cause.
It’s been a journey, because I was initially waking up, you know, it was affecting everything, my sleep, because I couldn’t fall asleep because I was coughing from the reflux. And my throat was sore all the time, and I actually was downing Pepto Bismol in between clients. And I thought, I’m a gut health dietitian, what am I doing? So I did end up getting more interested – I was focusing on integrative and functional, but that made me really start to focus in on gut health. And it’s been a journey.
And even most recently, everything’s been under control and managed, but I’m still learning more. One of the things I learned about recently was vagal nerve stimulation, and so now I’m doing that, and that kind of has brought me to a whole new level of calming my nervous system. So that’s my story, and I am now focusing mostly on the gut. I think just as a result of having the connections I have, a lot of the people that find me, they just don’t know what’s wrong with them. They’ve seen a gastroenterologist. Maybe they have, maybe they haven’t. A lot of them have, just because I have a lot of gastroenterologists that refer to me, but they’re still having issues, and they don’t know why. So that’s kind of the person I help and you know, often those are functional issues, especially if there isn’t something that’s been structurally diagnosed. So we’re looking at IBS, SIBO, things like that.
Lindsey:
Yeah. So for people with SIBO or IMO, Intestinal Methanogen Overgrowth, first of all, do you recommend probiotics while treating SIBO or IMO? Or is that something you like to leave for after treatment? Or is it part of the treatment itself?
Alyssa Simpson:
You know, yeah, I don’t start off with them. I definitely know a lot of people that already come to me. They’ve already tried probiotics. A lot of times they tried it and it made things worse. And that’s because if you do have SIBO, and this might be true whether or not they know they have SIBO, but if you do have SIBO, sometimes a probiotic, depending on what strain it is, can actually add to the overgrowth you already have, and it can stimulate symptoms. So that would be especially lactobacillus strains, because those can tend to accumulate in the small intestine, versus other strains that tend to populate more in the large intestine.
So the answer to your question is, I actually am all for starting one early on in the SIBO process. So in a perfect world, I do, and usually it’s going to be a spore based. I was using Bifido blend for a while, and I’m still liking that, but I’ve switched to spore based for that purpose. But those are both ones that are less likely to aggravate SIBO while the overgrowth is active. But the reason there’s a little caveat there is I do notice that throughout the protocol, people have very sensitive systems. There’s a lot of supplements sometimes that we need to use, and so I tend to layer things in just for the ease of the patient, and not just load them up with a whole bunch of things. So sometimes I don’t add the probiotic until a little bit later for that reason, just pill burden and patient sensitivity.
Lindsey:
What about the whole consideration of, am I just killing off whatever probiotics I’m putting in there?
Alyssa Simpson:
Oh yeah, so even with the spore based, because, technically, the spore based should be protecting itself, but I’ll still have them take them a couple hours away from the anti-microbial just to decrease that.
Lindsey:
Right. And are there particular probiotics you like in a situation with diarrhea versus constipation or are the spore based good for all those?
Alyssa Simpson:
Actually, for diarrhea, Saccharomyces boulardii* is really good. So a lot of times, especially if somebody really has no idea what’s going on yet, so typically, with that person, I’d want to do a stool test and a SIBO test just right off the bat, unless they’ve had one already. But I’ll just start them off on the Saccharomyces boulardii sometimes, because that can be really helpful in calming down the diarrhea.
Lindsey:
I’m curious how you dose that, because I just heard Lucy Mailing talking about using it when you’re on antibiotics, two pills, two 250 milligram pills, three times a day, which was the highest dosing I’d ever heard about for S. boulardii.
Alyssa Simpson:
I do two and two.
Lindsey:
Two and two? Okay.
Alyssa Simpson:
Yeah.
Lindsey:
Of the 250 milligram ones?
Alyssa Simpson:
Yeah, 250, yeah, exactly.
Lindsey:
I was curious, okay,
Alyssa Simpson:
Quite a lot, but . . .
Lindsey:
Yeah, well, if you want to get that diarrhea under control, I know it has been studied in traveler’s diarrhea and such.
Alyssa Simpson:
Yeah, yeah, exactly.
Lindsey:
And what about with hydrogen sulfide SIBO, which I recently found out has now been renamed ISO, or Intestinal Sulfide Overproduction. Any probiotics?
Alyssa Simpson:
For that one, I would just do the same, yeah. I haven’t seen much on researching probiotics for hydrogen sulfide SIBO. So I would go with the general because it’s still a type of SIBO, so it’s an overgrowth in the small intestine, so I would still be cautious with Lactobacillus in that case.
Lindsey:
And what about constipation? Is there one you like for that? Or the spore-based?
Alyssa Simpson:
So for constipation, yeah, there’s actually some strains that are more beneficial in general. So the Lactobacillus reuteri would be the one that I most commonly like with that. And then usually, because, again, I’m adding this in a little bit later in the protocol, so I’ll probably try to include some other probiotics as well. But if there’s someone that constipation prone,
Lindsey:
Like the BioGaia Gastrus* one?
Alyssa Simpson:
Yeah the BioGaia.
Lindsey:
Protectis* or Gastrus, I guess both of them have that, it’s like, DSM something, something after that (DSM 17938).
Alyssa Simpson:
Yeah, unfortunately, we don’t have too many products to choose from with that. So that’s the one I use.
Lindsey:
I know I keep wondering whether that one’s like patented, or whether you can get a hold of it, yeah.
Alyssa Simpson:
I dont know. It’s like the research is there that you think they would jump on it.
Lindsey:
Yeah, indeed. So what about fermented foods? I have post-infectious IBS, and have sort of recurrent SIBO, hydrogen dominant, and I do okay with sauerkraut. But, I mean, I’m only eating all of a teaspoon and a half, I’d have to say, or two teaspoons, in the morning and I can eat some yogurt, but like, if I eat a whole thing of yogurt, even it’s only like four ounces, I start to feel sick. So I’m kind of curious about probiotic foods, and is it problematic, or is it just uncomfortable?
Alyssa Simpson:
Well, that’s a great question. I would say probiotic foods are such a slippery slope. And it’s so sad just how nuanced this gets, because I feel for people trying to figure this out. A lot of the things that you think are going to be good for you actually are the very things that aggravate you. So the fermented foods, the probiotic foods, fall in that category where- and for a few reasons, but they can do a little too good of a job. They can, like we were just talking about with the Lactobacillus probiotics, they can add to that bacterial overgrowth and trigger symptoms.
They also are high in histamine and a good percentage of people with SIBO also have histamine intolerance, because there’s histamine naturally occurring in many different foods, and we produce histamine in reaction to certain antigens, and so we have a histamine load in our body. And if you have SIBO, it can decrease your production of the enzyme that breaks down histamine in the intestines, and so you become sensitive to foods that are high in histamine. Fermented foods are in that category, so anything aged actually can build up in histamine. So that’s probably the most common reason people feel bad or get symptoms when they have a fermented food. Is that the type of reaction, is it a histamine-like reaction? Or do you feel like it’s bloating?
Lindsey:
No, it’s more like bloating. And I actually feel nauseous when I eat too much yogurt. And this happened too when I made my own Bifido yogurt out of the Evivo strain, the Bifido infantis.
Alyssa Simpson:
Okay. And you think the lactose was low, so that’s not-
Lindsey:
It was a coconut yogurt,
Alyssa Simpson:
okay, okay, yeah, even with a Bifido yogurt, okay, yeah.
Lindsey:
So I just think maybe I just have that gut ready to ferment things.
Alyssa Simpson:
Yeah it is a slippery slope, and I almost never start somebody out with fermented foods, but they are a wonderful thing for maintenance as you ease into that, you know, start low and go slow. So I’m a huge fan of them in general. Don’t use them very much because I’m working with people who are not well, we need to fix them first so that they can get back to those things. But I do think that fermented foods are just really a great way to populate and maintain good bacteria, maybe even more so than probiotics, because I think there’s, I don’t know why, they just seem to do better, and I’ve seen that in the research as well, as far as maintaining . . .
Lindsey:
What fermented foods do you like?
Alyssa Simpson:
Well, I like kombucha and sauerkraut. Those are my two favorites, and I like kimchi, but it’s a little less convenient. You have to make it, or you can buy it, but it’s even less convenient to buy, to find all the time. So how about you?
Lindsey:
Yeah, sauerkraut is my go to and I’ve been trying to make the Bifido yogurt. But by that, I mean I’ve made one successful batch and one not so successful batch. It took me about a month to get through it, and you’re supposed to eat it within three days, but if I ate that much Bifido yogurt in three days, I would be a balloon.
Alyssa Simpson:
Yeah, yeah. The practicality plays in for sure.
Lindsey:
I mean, it required a high level of sterilization, because it ferments for like 36 hours. So the very first batch was totally unsuccessful; it was a pile of mold. Then the second batch, I’m literally dipping every single thing that’s going anywhere near it in boiling water before I do it, including the plastic tops and all these things. I’m thinking, great, I’m going to be eating microplastics. But mostly they are just in glass jars, so it’s just over the top. But yeah, crazy effort went into this. So the more times I do it, I’m sure the easier it’ll get. But I don’t want to make the mistake of having a moldy batch again, because after 24 hours, I was very disheartened that I had lost-
Alyssa Simpson:
Oh gosh, yeah, absolutely, yeah . . .
Lindsey:
. . . a packet of my $85 probiotic.
Alyssa Simpson:
Yes, I know.
Lindsey:
So fiber and prebiotics are another area that can be tricky, especially in constipation, because my standard advice for people who are constipated is to get more fiber. Or I shouldn’t say my standard advice, the standard advice. But in my experience, people with IMO can’t really tolerate fiber. So what else do you use to help them poop?
Alyssa Simpson:
Yeah, again, it’s one of those things that you would think that going and eating more fiber would help. But absolutely, with IMO, it can make you worse, cause lots of bloating. Yeah, so first of all, we want to think about why are we not tolerating it? So you’re kind of presenting the question as you know you have IMO. We just want to make sure that we’re talking about ways to help you poop. But we also want to circle back around to the root cause. So maybe, you know you have IMO. If you don’t know why you’re so constipated, or if you don’t know why you’re not tolerating fiber, a lot of people will say, oh, I can’t handle fiber, I know it tips me over the edge. You do want to look deeper and evaluate why that is and ultimately address that. So that’s the sort of things we can help with.
But the next step, I would say, first of all, think about what is the fiber source. So it can seem like all fibers are a problem, because a lot of our high fiber foods are actually high in FODMAPs, fermentable carbohydrates that are the most gas-producing types of fibers. So it may be that following a low FODMAP version of a high-fiber diet would help calm symptoms. And I do see that with lots of my clients. They feel like they can’t tolerate fiber because maybe they’ve tried a fiber supplement, which are just notorious in general, for triggering bloating and symptoms in people with IBS or SIBO, or they’ve, you know, just the foods that are high in fiber, like bran and beans and all those foods aggravate you, so you think it’s the fiber. You may do better with a low FODMAP, high fiber diet, emphasizing foods that- what I like to use is chia seeds to really get people like up a lot closer to their fiber goal, because they’re low In FODMAPs. So they’re not going to contribute to a lot of gas production, but they are give you a lot of bang for your buck, and they’re pretty easy to incorporate into your day. You could stir them into anything, a smoothie, a cereal, anything like that. I have a really nice overnight oats recipe with different variations to help my IMO people move without triggering symptoms. So that would be the first thing as far as fiber.
It’s also so important to make sure that you’re hydrated. I have clients that’ll say, yeah, yeah, I know I don’t drink enough water, I need to work on that. And I mean, it’s kind of like they’re like, next, what else should I do about my constipation? It’s like, no, that’s foundational. You absolutely need enough water. Because, think about it, your stool is dry, and maybe you’ve added fiber, so it’s fibrous. I mean, where’s that water going to come from to soften the stool if the body’s not hydrated properly? So we absolutely have to have the water. I would also think about the electrolytes. So let’s say you are getting plenty of water, which I would say is at least half of your body weight in ounces. You are getting plenty of water, you know, is the water being used by the cells. Having enough electrolytes will help the intestinal muscles contract like they’re supposed to as well. And with this, I would make sure you’re not doing just some of those general – like Gatorade and stuff – it’s just a lot of sodium. You’re not really getting a full array of electrolytes. So you want a good, well-rounded electrolyte product that has many different minerals to help you – plenty of potassium, chloride. Should be pretty low in sodium, actually.
Lindsey:
Which one do you like?
Alyssa Simpson:
I like Ultima* or Hi-Lyte* is another good one. Yeah, has lots of different flavors. It doesn’t have any ingredients that I don’t like. Tastes good. So electrolytes are number two. If you just need that extra little push, not physically, but that extra little boost, I really like magnesium. I used that myself for so many years, till I recently found that with vagal nerve stimulation, I don’t need it anymore. So that’s awesome, that’s little side note there. Yeah, I would suggest, if you haven’t used magnesium, and I mean specifically magnesium oxide, or maybe magnesium citrate, the other forms of magnesium aren’t – well, they’re actually better absorbed, which means they’re not going to help stimulate a bowel movement as well. We start around 400, 500 milligrams, but one of the keys with magnesium is you might need more than that. So understand, I would still start there, because if you get too much. you’re not going to be happy with that result either.
Lindsey:
Flush of the system.
Alyssa Simpson:
I would start there, and after it, give it a few days to see how that’s going to affect you. And then you might need to go higher, like 600, 800 milligrams. And if you do need to go that high again, circle back to the root cause, because usually there’s something else that should be addressed. So in my situation, I had to use 400 milligrams of magnesium for years to stay regular, and then started doing the vagal nerve stimulation. With the vagal nerve, it’s just the nerve connecting your brain and your gut, and it’s that connection that allows the brain to tell the gut to do all the things that it’s supposed to do, including motility. And, wow, yeah, after just a few weeks of doing that, I haven’t needed to use the magnesium since then. So I think that that really helped. I think, initially, stress triggered a lot of my issues, and then I think that must have helped to retone the vagal nerve.
Lindsey:
Yeah, so what did you do to simulate it?
Alyssa Simpson:
The TruVaga vagal nerve stimulator*.
Lindsey:
Is that, like, an electric signal?
Alyssa Simpson:
Yeah, yeah. It’s kind of like, you know like the TENS machines that will stimulate a muscle, but it’s not a TENS machine, but you put it on your neck right here, and, like, right where you take your pulse, that’s where you put it, and you can feel the stimulation. You can feel the tingling, and it goes for two minutes. You do it twice a day. The research actually had the test subjects build up, like, titrate up to six minutes twice a day. So you could choose to go by that. But the thing turns off after two minutes. So I just did that twice a day. Yeah, I’m just amazed. So I wanted to try it myself before I recommend it to clients, and now I’m starting to recommend it to clients and whoever else might benefit.
Lindsey:
I had somebody on the podcast ages ago talking about something that both could be used as a stimulator for the vagus nerve. I think it was a frequency specific, forgetting the third word, FSM, frequency specific microcurrent, but it was a device like that that could both stimulate the vagus nerve or be used on the abdomen, or that kind of thing. Okay, yeah, anyway.
Alyssa Simpson:
Yeah, we went on a side note, but yeah, that really helped me.
Lindsey:
Well, back to magnesium. So how much is too much magnesium? Like I get people are saying, well, I’m already taking 1200 milligrams. You know, is there a point at which, okay, this is no longer going to be useful.
Alyssa Simpson:
You know, I’ve heard experts say, don’t go over like 2,000 but I don’t go much over – like I wouldn’t go beyond 1,200. I just haven’t found it to be beneficial honestly, above maybe 1,000, I haven’t seen any added benefit. And so usually, then you need to look at other things. So, and sometimes we are in that boat. So Vitamin C is another thing. Magnesium oxide works well because it’s not absorbed well, so it stays in the intestine and draws fluid in. Vitamin C also has an osmotic effect, but because it’s absorbed well, you have to figure out what is your amount that’s going to exceed your tolerance level, so that it will have that osmotic effect. So it’s a milder effect, but it can work nicely in conjunction with the magnesium. So that might be something I might try next. If somebody’s already at 1200 milligrams, I would probably add vitamin C and see how that works.
Lindsey:
Yeah, and how will you dose the C then?
Alyssa Simpson:
Probably, I would start at 1000 and go up from there.
Lindsey:
And are these taken all at once, like before bed, or spaced throughout the day?
Alyssa Simpson:
Normally at bedtime, but I’m flexible on that, so sometimes it also depends when the patient can get it in. For me, personally, I was doing mine in the morning, and it always worked. So we don’t think it really matters. I’ve heard the recommendation to do it at bed, so that’s generally what I’ll recommend. But I haven’t seen much of a difference.
Lindsey:
Yeah, and did you notice any difference in the forms, like the powders that you mix in water, versus pills? For example, of the magnesium, whether one was preferable.
Alyssa Simpson:
I haven’t, have you?
Lindsey:
I mean, I kind of feel like the Natural Vitality Calm* one, that one’s always sort of my go-to because I have had people taking a lot of pills, and then I’ll say, we’ll just try this other one, and then it seems like they get more of an effect at a lower dose.
Alyssa Simpson:
What’s the form of that one?
Lindsey:
So it’s carbonate, but when you mix it in water, it becomes citrate.
Alyssa Simpson:
Oh cool, okay, yeah, okay, that’s a great tip for me. Maybe I’ll try using that one because I haven’t. But, yeah, people do get overloaded with pills, so.
Lindsey:
Right? I mean I guess that’s the other dilemma. If you have to take a bunch of pills, you probably have to drink a bunch of water with it. Of course, if you’re drinking powder, mix and water, that’s also water, and it’s all before bed. But of course, you can, you know, do it an hour before bed, not immediately before bed, right? Yeah, so people aren’t up peeing three times during the night.
Alyssa Simpson:
Yeah, exactly. I think that’s one reason I kind of tell people at bedtime, but if they’re concerned about it, I’ll usually flex because, yeah, I haven’t seen it to be essential. There are other things we can talk about as far as helping motility, but I’m happy to answer any other questions you have as well.
Lindsey:
Well, I had a couple questions about magnesium. So thinking about the fact that something like a magnesium citrate or oxide is not well absorbed, when you think about the dosing of a glycinate or a malate or another type of magnesium, versus the citrate and the oxide, how might those differ then knowing that you’re not actually absorbing that much of the magnesium, when we’re thinking about just a deficiency of magnesium, as opposed to exclusively using it for motility purposes.
Alyssa Simpson:
Okay, so you’re saying, if we wanted to use a citrate to actually help get into the body,
Lindsey:
Because that’s the form that people are already using for the purposes of motility, is there any kind of a comparison, like 800 citrate’s worth X amount of glycinate?
Alyssa Simpson:
You know, I’m not aware of one. But now I want to know.
Lindsey:
I just kind of asked that question to myself because I know that you get recommendations often from these tests like Metabolomix or a NutrEval that says, okay, they need 400 mg of magnesium. And I’m like, okay, well, if that’s magnesium citrate, they’re probably pooping out three quarters of it.
Alyssa Simpson:
Exactly, yeah, I tend to just not use it, or I’ll give them a magnesium blend where you can get a few different kinds in one.
Lindsey:
One thing I have noticed, though, with those blends is that they’ll often come to me already on magnesium, and I’ll say, oh, okay, which one and how much is it per pill? And they’ll be like, oh, it’s glycinate, and it’s like 400 per pill. And I’m like, yeah, that’s not possible. There’s no such thing as one pill of glycinate that’s 400 milligrams. And then they’ll look and they’ll go, oh, okay, it looks like there’s some oxide, and they’ve got like five different kinds. And I’m like, Okay. And my estimation is probably 350 oxide. You’ve got like, 50 milligrams with something else mixed in.
Alyssa Simpson:
I know, yeah, yeah. They don’t realize how many capsules they’re supposed to do, because they do try to advertise 400 on some of those products.
Lindsey:
Oh, right, that too, right, so you’ve got to look at the serving size.
Alyssa Simpson:
I also don’t prefer the blends, because I can’t titrate the one I want to titrate without affecting all the other ones. But I’m sure as more of a maintenance thing, it could be a decent option.
Lindsey:
I’m kind of suspicious that the whole – I think I was just listening to a podcast, and they’re like, you need all the five different types of magnesium in your body, and therefore you should buy our blends. I’m like, this just feels like marketing to me, like, I imagine our body can probably make most of those types from the raw materials that are in there. So, you had said you had some other things you wanted to talk about related to motility?
Alyssa Simpson:
Yeah, yeah. I have some other things that would be important as we’re talking about this. Another tip I have, I like using, and this is again, keeping in mind that we’re going to want to work on the root cause, but sometimes, if you just need relief, I do like whole-leaf or outer-leaf aloe vera juice. It has other benefits, aside from motility. It’s very soothing on the mucus layer. It helps to stimulate that mucus production that protects our stomach, esophagus and our intestines. I also like it because the whole-leaf has a chemical in it, aloin, that stimulates the bowel. So I would start with four ounces of aloe vera juice – make sure it’s the outer leaf. The inner leaf is not bad. It’s just not going to have that helpful chemical that helps with motility. Maybe start with four ounces. You can have more than that, but again, see how that’s going to affect you per day after a few days. So I like using that one sometimes, especially when we’re talking about people who can’t handle a lot of fiber. So maybe we’re working on building up the fiber, and that can kind of help as well.
Is this something they find it like a health food store? Or do you find that normal grocery stores?
Sprouts around here, is what we have, where I find it. I like the Lily of the Desert brand. Yeah, usually at a health food store, you probably have a better chance.
Lindsey:
Alyssa is my neighbor in Arizona. She’s up in Phoenix.
Alyssa Simpson:
Yep, yeah! So we have Sprouts. You guys have Sprouts down there, right? Yes, but it’s a health food store, and so any health food store would probably have aloe vera juice. Sometimes they try to do you the favor of flavoring it. Watch out for that, because they may add lemon juice, and if you have GERD, that might trigger you, be careful of that.
Lindsey:
Any other motility tips? Or was that the last one?
Alyssa Simpson:
The squatting position, or the squatty potty*. So when we’re sitting on the toilet, we’re actually not in the proper position, and so we actually have kind of a kink, like between the anus and the rectum, there’s a little bit of a kink. And so, that’s helpful when you’re trying to hold it in on your way in the bathroom, but when you want to actually have a bowel movement, having your feet up so that your knees are above your hips will actually basically open up that angle between the rectum and the anus to allow for a better bowel movement. So you can start out with a stool, if you just have any stool you can put your feet on, but the squatty potty, especially if this is a major issue for you, is not a major investment, and definitely something to consider.
Lindsey:
And I think that’s pretty important for people who are shorter, right? Because they can’t really get into that position.
Alyssa Simpson:
Yeah, right, yeah.
Lindsey:
Okay, so what about introducing fiber? And are there particular forms that are easier for people who are a little bit fiber intolerant?
Alyssa Simpson:
Yeah. So, well, I like SunFiber*, the partially hydrolyzed guar gum that is the most researched and the gentlest I find. I use it with my SIBO people, my IMO people, they could be bloated like crazy, and I’ll still use it maybe, maybe do some other things to calm their bloating first. But you just start low and go slow with it. So it could start at maybe a third of the dose, or if you’re super sensitive, a quarter of the dose, and maybe every week go up an increment if you’re super sensitive. But the reason you would want to take it is it does start to add a gentle fiber. So again, if you’ve tried a fiber supplement, any of those out there, like a lot of the common ones, you know, Metamucil, Citrucel, like all these things that are recommended to people with IBS, and it triggered you. Most people do pretty well with this PHGG, and I have a lot of my clients that they are just like, I’m never not going to use this. I love it so much. I’m like, you could maybe graduate to a different fiber in time, but that’s how well it’s tolerated. And then another one would be Acacia fiber that people do pretty well with, too, even the most sensitive people.
Lindsey:
Yeah. Are there any prebiotics that you particularly like, other than getting it from food?
Alyssa Simpson:
Yeah. So prebiotics is here in this whole conversation about that, like slippery slope, right? So everything I said earlier about fiber and FODMAPs, like the things that are supposed to help you, can actually aggravate you when there’s a bacterial overgrowth. And so prebiotics are in that category, because a lot of the times it’s FOS or GOS or inulin or prebiotic ingredients, and those can be the harshest and the most likely to bloat and cause symptoms. So for I’d say, starting with most sensitive, like you said, other than foods. But I would probably start with foods for the most sensitive people. Like, the green bananas, the cooked and cooled potatoes, even maybe a resistant starch, maybe even a cooled rice congee or something.
But as a fiber supplement when they’re ready for some prebiotics, I like PaleoFiber RS* because it is basically like starting them with foods – a little more potent, but the ingredients are green banana flour and potato starch, and there’s one other ingredient in it. So PaleoFiber RS is my favorite kind. I would either do that as a prebiotic, or you can lean on polyphenols, which are the components in brightly colored plants, fruits and vegetables, that give them their antioxidant benefits, but they also have a very gentle prebiotic effect, but it’s a non-fiber! So it’s a wonderful kind of little thing to start with, so that you could do it with foods or with a supplement. Sometimes I’ll just recommend Polyphenol Nutrients*, which is by Pure Encapsulations*, because if the person needs a multivitamin, that way, we’re getting some polyphenols in there. And then from foods, you can use things like green tea and cranberries and blueberries and olive oil for polyphenols.
Lindsey:
Yeah, I’ve been trying to do this gut shake that I stole from Mark Hyman. I maybe get it once a week myself, but it’s pomegranate powder, I use cranberries rather than the cranberry powder, just use frozen cranberries and matcha green tea powder, and then taking protein powder too. The original formula, I think, has collagen and glutamine and butyrate and all that other stuff. But I’m sort of selectively using the things that I need myself. So, yeah.
Alyssa Simpson:
Yeah, yeah. And then when the person’s ready, I mean, once you clear the overgrowth, you can gradually add in less gentle forms of fiber. So then I do think it’s a good idea. And one of my favorite tips is making a veggie mash, which, if you’re looking for another project, you know, it takes couple hours. It doesn’t take all day. So you basically take 10 to, I guess you could do, probably 10 to 15 will work the best, different vegetables, and you blend them up. I have a recipe that I can share with your audience, my gut rebuild veggie mash, because it has quite a few root vegetables, which I like for the resistant starch. So you steam those. You lightly steam some of the other vegetables. But really, the idea behind a veggie mash is you just grab 10 to 15 different vegetables, blend them up in a food processor, works best, and then you just put them in ice cube trays and just pop out a cube to blend up in your smoothie or to mix with your entree or to eat just with salt and pepper by itself. And that way you get a diversity of plant fibers.
So we’re talking about fiber right now, kind of in the context of fiber amount, like getting enough fiber, but diversity of fiber is so important too for feeding a diversity of good gut bacteria. So I really like the veggie mash, because even if you have Brussels sprouts in there, which are high FODMAP, and I think the low FODMAP portion is like one sprout or something, or a fragment of a sprout, you know, you will be able to tolerate a little bit in the veggie mash, because the whole recipe only has a handful of each thing, and then it’s making, like, weeks worth of quantities. I think it’s like 10 ice cube trays you get out of it.
Lindsey:
Yeah, I’ve heard that technique for reestablishing oral tolerance when you’ve had a lot of food allergies, like, just the little bit of a bunch of different things.
Alyssa Simpson:
Yeah, and I like this strategy, because it’s, again, the practicality, it’s hard to get a little bit of a lot of different things, especially when things are going to go bad in the fridge, if you don’t have anyone else to eat the rest.
Lindsey:
And winter squashes are not exactly easy to cook, unless you buy them pre-chopped or whatever.
Alyssa Simpson:
Right, exactly. So mine is pretty root vegetable heavy. It has butternut squash. It has purple potato. It’s colorful as well. It has a sweet potato in there. And yeah, I like that tip as well.
Lindsey:
I’ve started to use the MegaPRE* with people who don’t have any Akkermansia or any Faecalibacterium prausnitzii or very low levels that need to kick it up, because it’s got some ingredients in there that have been shown in studies to bring those up. Have you used that at all?
Alyssa Simpson:
Yeah, so if the person’s really sensitive, I’ll start with the Paleo Fiber RS, but I like to move to MegaPRE if I can, because I consider that ideal to use those ingredients, but I will start at low dose and gradually increase it once I see that they’re doing okay with it, because even after the issue’s cleared, there’s a period of healing, and the tolerance gradually gets better to food, so usually it’s easing back into fiber and prebiotics.
Lindsey:
And what do you think about colonics and enemas for people who’ve been chronically constipated?
Alyssa Simpson:
Well, I think sometimes whatever you need to do to get it out, it’s fine. So I don’t have any concerns with that. Do you?
Lindsey:
No, but I don’t have an office that offers things like that. So it’s not something that I refer people to, but I know that people who have offices that do that often are more big fans of such things.
Alyssa Simpson:
Well, I’m probably in your boat, because I also, I’m 100% virtual. I’m a dietitian, so I’m not doing medical procedures anyway. Yeah, so I usually, if I get that question, someone’s wondering if I agree with it, if it’s okay, or maybe that will clear their SIBO, and unfortunately, it won’t clear bacterial overgrowth. But I’m all for it if somebody just needs to get cleaned out, doing something like that. And I have even recommended it when somebody just, for example, let’s say we find that you have SIBO, but you haven’t had a bowel movement in two weeks. Well, we can’t start. We can’t do much about it until we can get things flowing. So yeah, that could be a good use for it to just kind of get a jump start.
Lindsey:
Yeah, sometimes in that scenario, I’ve sent people to do a C cleanse, just to get everything washed out. And then I’m like, okay, then maybe. Because they’re kind of desperate at that point, if they haven’t had a bowel movement in days, or, goodness, I don’t think I’ve ever had anybody who said two weeks, but if it’s been a while, and they’re uncomfortable and they’re backed up and they’re bloated and they’re in pain, then you know, you just got to get that out of there.
Alyssa Simpson:
Yeah, because it’s unhealthy for you.
Lindsey:
Yeah. I mean, I think that that’s an important thing that people maybe don’t – like, they know it doesn’t feel good, but I don’t know that they realize the connection between cancer and constipation, like, there’s much higher rates of colon cancer and breast cancer. You don’t want to have stuff just sitting in there. These are toxins that are supposed to be getting out of your body, right?
Alyssa Simpson:
Or even if you have diverticulosis, you know, that could potentially fill up those pockets with stool. A lot of people have diverticulosis. So, yeah, absolutely. And so with SIBO, here we are. We’re about to kill off a bunch of bacteria, and your body has to detoxify that. And so the worst thing we could do, it would not be a good thing to start killing them off, only to be reabsorbed into the bloodstream and recirculated throughout the body. Yeah. So you would feel terrible as well, and it wouldn’t be healthy. Yeah, so I’m actually all for the anything you can do to get things going. And then sometimes people will ask, well, if I do that, will it get rid of all my good bacteria? Well, no, because they live in the layer of the intestine, so you’re not going to flush out all your good bacteria doing that or doing a colonoscopy prep, either.
Lindsey:
Yeah, I was a bit a little bit worried about that myself, and I hesitated to do the colonoscopy and put it off for a few years, which I did also because I just didn’t want to get a colonoscopy, but did the Cologuard, and then three years later, thought, okay, I’m just going to suck it up and do the colonoscopy. And it wasn’t bad, and I had a nice clean colon. I was happy to hear that; no polyps.
Alyssa Simpson:
Yeah, I mean, it would be nice if we could clear dysbiosis with just colon prep.
Lindsey:
It’s a funny thing that that’s not that helpful, given that the elemental diet is something that seems to work for it, which I guess, obviously it’s a little bit more extended than a colonoscopy prep in terms of time.
Alyssa Simpson:
Yeah, well, I think it’s just like you’re clearing out the stool. I mean, the stool is not where the bacteria live. They live in the mucus layer, so you’re not shedding the mucus layer. And the elemental diet is starving the bacteria in the small intestine and in the large intestine, but yeah, they’re resilient. So, yeah.
Lindsey:
Do you use elemental diets much?
Alyssa Simpson:
I used it twice. It’s very hard for people to do, so it’s a last resort.
Lindsey:
I kind of feel the same way, like I wouldn’t do it, so I’m not going to ask somebody else to do it. But sometimes it’s like, I agree. I’ve had people who no quantity of antimicrobials was getting rid of that bloating. And I’m like, okay, let’s try this. And for both people, it was the first thing that really broke it at all. I can’t say it was like, 100% they were done and, like, that was it, because I think there’s always other issues that play into it, like stress, maybe that whole vagus nerve question, but it was the first thing that made any dent.
Alyssa Simpson:
Okay, so that’s, yeah, it really does take – the person has to really be on board. I haven’t been in that situation too much, where we’ve run out of options to really make a dent, but usually it’s been the patient’s idea if I do it or I will put it out there as an option, and the patient has to be the one who’s like, yes, I want to do that.
Lindsey:
Yeah. I think sometimes they feel like it’s really expensive, but I’m like, well, keep in mind, you’re not going to be buying any food for those two weeks or three weeks, right?
Alyssa Simpson:
Yeah, exactly.
Lindsey:
And it just feels a bit different spending your budget on a package of powder you’re going to have to drink than it does to go to grocery store and buy a load of groceries.
Alyssa Simpson:
It does. And the die off is tremendous. I mean, the die off is a problem anyway, but it’s so tremendous with the elemental diet. That’s another thing, not only are you only consuming liquid for two to three weeks, but die off, meaning that kind of reaction that happens when you first start killing off the SIBO, and you have your flu-like symptoms, and all kinds of symptoms can pop up. And so I’ve seen that in both people be pretty bad. The other thing is, I have a lot of people who are underweight, and it’s just not a good idea. Now, actually, in reality, if they do drink all the formula and they have malabsorption from the SIBO, they’re probably getting better nourished with the elemental diet.
Lindsey:
Yeah, I’ve heard that for underweight people, they’ll gain weight. For overweight people, they’ll lose weight. It works itself out.
Alyssa Simpson:
Yeah, I’ll actually use elemental shakes often as a supplement for underweight people, so they can get the nutrients in, but not as the elemental diet is designed to work, even though I know it will probably nourish them better. There’s still all the issues, like the patient has to be on board with it, it’s very difficult to do, and it’s just concerning, because if the person is already super underweight, it just makes you hesitant to turn their diet on its head in any way, especially going on an all liquid diet.
Lindsey:
I have noticed, and just to send the word out there to people, that people get really kind of scared and desperate when they’re losing weight and they’re not trying to because of malabsorption related to SIBO. But I’ve never seen anybody that’s like, starved to death. They always gain the weight back eventually. Like, once you start to turn things around in the gut, the weight comes back on. They don’t just waste away to nothing . . .
Alyssa Simpson:
Yeah, yeah.
Lindsey:
So people really do that. It’s like there’s a certain level of desperation in a person who’s been losing weight and just keeps losing weight, like they really get scared.
Alyssa Simpson:
Yeah, yeah. I think it’s scary if you don’t know why it’s happening and you don’t know how to stop it, right?
Lindsey:
You mentioned about having gastritis and constipation. I’m curious why those two tend to come together.
Alyssa Simpson:
Gastritis and constipation, GERD and constipation?
Lindsey:
Yeah.
Alyssa Simpson:
Well, if you’re chronically stressed, it can cause a slowing of motility, versus if you’re acutely stressed, it can trigger diarrhea. These are very general statements, obviously, but in general, that’s how the gut, brain, the vagus nerve, works. So I believe that my chronic stress at the time caused everything to slow down. And I was not mindfully eating. I was scarfing down my lunch, trying to pack in as many patients as possible, often missing lunch, eating in my car on the way home. I mean, there is a lot of factors, and I still didn’t know very much yet about any of this. Yeah, so I think it was a perfect storm for me with the GERD. I probably had chronic stress and acute stress, and wasn’t being mindful of my eating, because that’s a big part, too. If you’re rushing and you’re multitasking and you’re not focusing on your food, then your brain isn’t focusing on the food. So it’s not telling the gut to produce enzymes and acid, and so food is sitting there longer, and then there’s pressure on the lower esophageal sphincter, and you know, you get the acid coming back up. So it was a whole messy storm.
Lindsey:
Yeah, I was thinking that there might be a connection through the question of stomach acid, right? Like, if you’re stressed, you’re probably not producing as much stomach acid, and then you’re-
Alyssa Simpson:
Yeah, I think that was a factor,
Lindsey:
Right? And then, of course, low stomach acid can cause GERD.
Alyssa Simpson:
I think that was part of it too. Yeah.
Lindsey:
So tell me about where people can find you and the stuff that you do.
Alyssa Simpson:
Yeah, I see people one on one over a virtual platform and help people walk through the process of figuring out what’s going on in their gut from a functional perspective. So, especially if you’ve had lots of the standard testing and whether or not they found anything, but if you’re still having issues despite the normal medical interventions, we can look deeper, and we’ll look at what’s out of balance in your gut, and we’ll walk through the different phases with a personalized approach. I learn about your eating habits. I learn about your schedule and your family. And what dinner is like with your family, and we just come up with a personalized approach that’s going to work for each person. We look at everything else that’s going on with your health so that everything is in line to support your goals, all of your goals, holistically. And through just the use of simple strategies, diet changes, elimination and reintroduction of some sort, usually, maybe sometimes we’re ramping up fiber or calories or whatever it might be. And strategic supplements that, like I say, I tend to layer through in phases, and we work on not only calming the symptoms down, restoring more normal gut function, but also putting a maintenance plan in place so it doesn’t just keep happening again and again to you. So that’s what I do, one on one.
People can find me at nutritionresolution.com so it’s like a New Year’s resolution, and I’ll also provide the link to that veggie mash so that you guys can download that, if that sounds interesting. That’s helpful for anybody who just doesn’t have enough vegetables in their diet to get that diversity to feed a healthy microbiome, but it’s especially helpful for sensitive individuals as well. And I’m at @nutritionresolution on Instagram.
Lindsey:
Okay, great. We’ll put those in the show notes, that way people can find you easily. Any final thoughts before we go?
Alyssa Simpson:
Everything we talked about today are the things that are – I feel like, logically, you’d say, okay, if I’m having gut issues, I should eat more fiber, I should eat prebiotic foods, I should take probiotics. And those can be sometimes the worst thing. So I just feel for anyone out there trying to do their best and it’s not working, or they’re getting worse, because it’s kind of hard out there sometimes to figure out the right thing to do. But in general, find a good practitioner to educate yourself as much as you can so you know what to ask, and also listen to your gut as far as who it feels right to work with, who kind of resonates with you and gets you excited about what’s actually possible for you. I just wish everyone the best in their health journey.
If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.