Adapted from episode 172 of The Perfect Stool podcast and edited for readability with Amy Hollenkamp, RD and Lindsey Parsons, EdD.
Lindsey:
Welcome back to the show, Amy.
Amy Hollenkamp, RD:
Ah, it’s been a long time. I feel like I was one of your early guests a long time ago.
Lindsey:
You were actually my first ever guest back in 2018, and I was quite thankful you didn’t hesitate to come on, especially given I didn’t have a single listener . . .
Amy Hollenkamp:
Well, it’s okay.
Lindsey:
And you’ve had 1000s of listens, so it’s all good.
Amy Hollenkamp:
Awesome.
Lindsey:
I’ve been following your blog lately, and you’ve been publishing some really interesting posts. So I’m excited to have you back on and dig into some of these ideas you’ve been sharing.
Amy Hollenkamp:
Yeah, I’m happy to be back. It’s always fun hopping on pods and talking about gut health.
Lindsey:
Yeah, so you wrote a long blog post on why you don’t use stool testing much anymore, and especially criticized the GI Map in particular. So I was wondering if you could dig into that?
Amy Hollenkamp:
Yeah, I think first and foremost, people oftentimes don’t start with the foundations. So I feel like first and foremost, if someone’s struggling with gut stuff, we want to get back to the unsexy basics, basically, is how I would describe it. And I find that a lot of times people are very quick to test right out the gate. So I think in general, the philosophy behind it, I have some issues with because I think sometimes we jump straight to the diagnostics and don’t look at okay, we know that optimizing nutrition is going to help with gut health to some degree. I know working on my sleep is going to help with gut health, and so it’s going back to these basics. Because I find I’ll work with someone who’s done four or five stool tests, and I’m looking at their nutrition, and there’s all these gaps, or I’m looking at their sleep, and they’re like, “Well, I sleep six hours, but it’s fine. And I’m like, ooh, I don’t know. We might want to work on that and really focus on ways to improve sleep. And maybe they’re having issues with sleep, and it’s not totally something they’ve been able to hack, which is fine. I feel like that’s a big part of it.
I think that we get real zoomed in at like, ooh, this microbe’s off. That means I have to do all this microbiome work when we might need to zoom out and actually do some other really key foundational work. And I find a lot of times people think they’re doing, and they are doing maybe dietary restrictions and things that could help their gut health and help symptoms, but I think some of the bigger work, like optimizing nutrition as a whole, really matters. So that’s part of it.
The microbiome testing is one of those things too, where there’s this mindset of we know so much, and there’s still so much we don’t know. So there’s a lot. I think there are some things you could glean from a stool test, but we might not understand what a big chunk of your microbiome is. We haven’t even figured out ways to identify certain microbes, if that makes sense. So, there’s this whole part of your stool test that we might not even be able to identify. So, having some humility of what we don’t know about the microbiome is also important too. So again, I think that those pieces are important. So working on the key fundamental pieces, and just understanding that we’re still trying to get an understanding of what the optimal microbiome even looks like. And I feel like the stool testing companies will come and be like, oh, we are very confident that this is the right range for this microbe, and this is certainly off, and this means this. And there’s just this illusion of confidence that I don’t know if we’re necessarily there.
So it’s not like I totally don’t use stool testing, or like I don’t think that there’s value, because I think there can be value. It’s just like how much stock you’re putting into it, and how you’re using it, and what you’re implementing based on the stool testing. Because I also think the stool testing lends to a lot more of a kill and clearance based mindset. I don’t think you have to use the stool testing like that, but I think a lot of the stool test companies put that in a lot of their materials, like oh, you we have the 5R or whatever it’s called, where you remove and replace. I I forget all the R’s, but basically there’s that – we look for the bad bug, we kill the bad bug, and then we move on to other things. And I haven’t necessarily seen that need to be the case in practice. You can manipulate the microbiome and not be as kill oriented.
I think specifically about the GI Map. You know, I’ve had some providers that I’ve worked alongside who’ve done split sampling and have gotten weird results that weren’t consistent between the split samples that make me a little bit nervous. I find that sometimes the clinical markers are also a little weird, and that they aren’t consistent with when we retest from other labs, like the elastase. I’ve seen a number of cases where it’s been lower on the GI Map, but totally normal. Well, and that could oscillate a little bit, but I’ve seen enough of a trend where I’m like, hmm, that’s a little interesting.
I also think the other thing that always interests me too is my podcast co-host. She had her assistant put together a list of 100 GI Maps and look at all the data because she works with basically IBS, SIBO, dysbiosis patients mainly, and what she found was really interesting, that there was only one with low Bifido, that was flagged as low Bifido. So we’re like, that’s really interesting because it seems like when we do other stool tests, like if we do 16S or something, it does seem like a lot of our patients are low Bifido. So something’s weird with that range, GI Map-wise. Maybe again, it’s just like the range is too broad or something. I don’t know, but basically, it does not flag Bifido being low a lot of times, which is really interesting to us in general.
Similarly, I think Lactobacillus might have been like seven out of the 100. It was another one that didn’t really register as low super often, but we’ve found in other tests that it is low. So basically, again, that was one piece of it. And then I think she did some of the split samples where one would have true pathogens on one split sample but not on the other, and so it would change the clinical decisions. Which again, I think it’s hard. I feel like basically, I think these tests are imperfect in a way, and I just think we want to understand that if we’re going to use them.
I’ve generally moved a bit more away from stool testing and have been really focused on again, the factors that would shift the microbiome. I think the stool testing can be a little distracting, in particular when people are doing a bunch of them, when they keep repeating it, and they’re like, oh man, like I have this marker, like it causes that. Oh man, I have basically this infection-based mindset, which you know isn’t necessarily true either. I feel like we can manipulate levels of certain microbes in gentle ways. It doesn’t have to be this aggressive – I’ve got this boogeyman. I feel like I don’t know if I’m being dramatic, but this is how I feel like some of the discussions go with my patients. It’s that oh my gosh, I have this bad microbe and I have to clear it. It kind of creates this worrying mindset. I just feel like sometimes the stool testing does that in a way, when it might not need to be that intense or aggressive.
Lindsey:
Well, I know that Lucy Mailing did the split sample on the calprotectin and the calprotectin marker was off. And I have a mentee right now, and I’ve been looking at a lot of the GI Maps that she gets because the company she works with-that’s their default test-and Calprotectin is elevated a lot of the time. I mean, maybe in that sort of yellow range, but elevated on a lot of people that didn’t come in with gut health issues. These are like Hashimoto’s people and such, and so I’m like, I don’t think all these people have IBD.
Amy Hollenkamp:
Yeah, no, that’s another one that gets weird. I remember specifically having a patient who, I think it was like 900 and I was like, oh, we might want to circle back to that. Go to your GI for another test, and I think it was a little elevated, but it was 100. It was like, okay, this is not something I’d be extra alarmed about, but 900 would be something that I think you would need to take care of right away.
Lindsey:
Right, right.
Amy Hollenkamp:
So yeah, I’ve definitely seen that trend to sometimes more extreme examples like that. And again, I kind of wonder: is it are they biting off more because there’s so much in that test. It’s like there’s the clinical markers and the microbiome markers. Like, is it just too much in one test? Does that make it harder to make it accurate? I’m not a scientist on stool testing, so it’s hard for me to say. But yeah, I feel like it.
The other thing that’s a little weird about that test, and I didn’t realize it as early as I maybe I should have, but my husband and I did a GI Map. This was a long time ago, maybe like four or five years ago, like right when we got married. I remember he did the test, and there’s the line to fill it up, right? Like there’s usually a line fill to this point. I filled it exactly to that point. He filled it up to the brim, and I’m like, how does this affect the test. I don’t know because the solution’s supposed to basically, I think, neutralize and kill or hold it in place. Again, I don’t know the whole science behind it, but if the solution to stool ratio is a little weird, could that make the test wonky? It just kind of put an idea in my head because he got the results back, and he had sky high levels of every microbe, and I have kind of lower levels of every microbe, and I’m like, could that just be a coincidence across between our tests? Maybe I don’t have the true answer to that, but it did create a question in my head of even the amount of stool to the solution that’s supposed to be stabilizing the stool. If that gets weird and isn’t tightly regulated . . .
Lindsey:
I mean, you’d imagine they must measure, right, like put a certain weight of stool or whatever when they’re . . .
Amy Hollenkamp:
Right.
Lindsey:
Well, I mean, to me, the reference range is like they should always be as a percentage of the total microbiome. That’s what I want because like you do a Tiny Health Pro, and you’re like, oh, okay, so 20% of your entire microbiome is this one bug.
Amy Hollenkamp:
Tight?
Lindsey:
And you do a GI Map. If that one bug’s not on the list of bugs, it’s not showing up.
Amy Hollenkamp:
Right. That’s what I put in the Substack article I wrote too. Like it doesn’t put anything into perspective if you’re doing absolute values, which the GI Map does. It’s like okay, so I have this 107, oh my gosh, when it doesn’t put anything into perspective. Like that microbe in the context of your whole microbiome might be fine, but I think it creates this boogeyman mentality of oh no, you have that pseudomonas or whatever. And it’s like okay maybe that’s an issue, but I don’t think we should just direct the whole entire protocol because that is a little elevated on the test.
When maybe you had no other really other major markers, it’s like there could be ways for us to gently move that in the right direction if we’re trusting the test. I think the other thing that’s interesting about microbiome tests is I’ve had some people with fairly decent microbiome tests who have crazy symptoms, and you’re like, okay, well, there’s other stuff at play here. Like people just assume that the microbiome has to be this big player, and maybe it’s not 100% there, but it’s not doing anything crazy in terms of how the stool testing is coming out. Maybe there’s something that we don’t understand, like we haven’t identified a microbe that’s there, but nothing obvious is coming up. I think that that can be at play too. So yeah, it’s a strange world to maneuver through. But I think you’re right. The absolute value versus the percent of the microbiome. Like looking at it in the context of all the microbes makes way more sense to me than the absolute values.
Lindsey:
Yeah. So yeah, I use the Gut Zoomer a lot because, well, for one thing, I was using it a lot, especially when they had the deals for three tests for 700. But I hate their reference ranges, and I’ve told them this. I’ve said 10 to 20, or above 20, or under 10. I’m like, this is completely out of context. Like for this particular microbe, it might represent .01% of the microbiome, and this other one, it might normally represent five or 10% and they’re all on the same reference ranges. So if it’s a little out, I don’t know if we’re talking about something that’s completely taken over most of the microbiome, or it’s just a tiny little amount more than its tiny normal amount.
Amy Hollenkamp:
Exactly, and I do think the other thing too sometimes about microbiome testing is usually I’m seeing people that have done a bunch of these tests, and I don’t think it’s just related to this test not being the right fit or whatever, but basically it’s like if this test was so useful, you would think that treating based on the test would yield results, if that makes sense. And again, I think sometimes you’re so in the weeds with this stuff because I’ll have people that’ll come work with me and they’ll be like, “Do I need to do another GI Map?” And it’d be like the fifth GI Map. It’s like, well, you’ve done four, and nothing really has led to the right solution, or it hasn’t been that great from a clinical standpoint.
And there could be a lot of reasons for that, but you know, I think it just goes to show that the test isn’t the end all be all. I think all stool testing isn’t the end all be all. We want a strategy that’s going to push the needle and create a healthier microbiome. And there’s a lot of other issues in the space that prevent people’s microbiomes from getting better and from improving. But you know, I do think there’s probably an over reliance on stool testing to direct clinical decision making, in my opinion, at this point. And again, I think I still run stool testing here or there. It’s not something I do on everybody, but you know, there’s still value. I think at certain points, but usually I would focus on the fundamentals pretty heavily before I would do any stool testing, which I think sometimes people do in the reverse. Everybody has their own way to do it.
Lindsey:
So when you mentioned you’re seeing gaps in nutrition, is there a common pattern? I mean, I know that obviously, like the kind of people I’m seeing, there’s certainly nothing I need to tell most of them to take out of their diet. It’s usually what they need to put back into their diet.
Amy Hollenkamp:
Yeah, well, I think that that’s 100% what I’m seeing as well. Most of the time, I try to work through a hierarchy. A lot of my patients have dealt with weight loss, and this is a Substack I’m working on today, so it’s top of mind. But they’re under fueling altogether, and I think people need to understand too that if you’re not eating enough food, your body goes into this budgeted state, and one of the systems that gets hit really hard is the GI tract because the body views it as oh this is less important than breathing, like your respiratory system or your cardiovascular system. Same thing with hormones. Sometimes women lose their periods if they’re under fueling. Not always. I’ve definitely seen people that are under fueling by a lot and still have their cycle. But you know, I think that’s one thing you can see typically is someone might lose their cycle or their cycle gets a little weird. So that takes a hit.
But then your body goes into budget mode. It’s like okay, we don’t have tons of fuel coming in, so we need to really start downregulating things like thyroid hormones. A lot of times, cortisol gets a little weird. One of its main jobs is to maintain blood sugar, so you’re under fueling, and you don’t have enough stored carbs. Cortisol comes in to bring glucose into the bloodstream, and that does weird stuff GI wise. So all these hormonal patterns from under eating are pretty awful for your gut, or just could make you feel awful.
How I present it to patients is that your body is trying to help you. It’s trying to say like, oh, she’s not eating enough fuel. We’re going to not burn all that fuel. We’re going to try to save some of that or store some of it, and not burn it as quickly as maybe we’d like to. Same thing if you lose your job or something, and you have a certain amount of savings. You’re not going to go blow it like you have extra money. You might want to be a little more cautious with how you’re spending. That’s what the body does. And so I think that’s one of the biggest things I look for right out the gate is like, are you getting enough to eat or not? Because if you’re not, it’s going to impact so much. And I would say, probably like 80% of my patients are not getting enough to eat, and they’ve worked on this. They’ve worked on diet, I think, with a lot of providers, but just never looked at is the plate adequate. It’s more like, oh, what’s on the plate?
Lindsey:
Is it because they’re trying to lose weight, or is it because they’re restricting their diet so much because of the gut symptoms, or why is it that they’re under fueling?
Amy Hollenkamp:
I think it’s a blend of a couple things. I think one of the big things is restrictive diets. So maybe they took out pieces that were really huge in their diet and haven’t totally found ways to replace them, so sometimes that could be like gluten . . .
Lindsey:
or carbs . . .
Amy Hollenkamp:
. . . yeah carbs, exactly carbs is a big one, right? Bread, that kind of stuff, and it’s like oh, they’re eating whole foods now, which is great, but also maybe they’re pretty active, and it’s like oh, this is interesting because maybe they’re just not totally fueling for their activity level. I think the other thing is sometimes I’m seeing people skipping meals for – maybe they’re fasting, like doing fasting windows, which I don’t think necessarily is a bad thing. But you have to make sure that you’re able to make sure calories are sufficient if you’re doing a fasted window. I think some people just skip meals because their symptoms are so high. So like some people are just having trouble eating enough, and that becomes a weird cycle that people get stuck in, where they’re kind of under fueling a little bit, and then their digestive capacity and their motility goes down a little bit more, and then they’re like, “Ooh, that doesn’t feel great.” So they continue under fueling, and it’s just the cycle that continues until they can find ways to get calories up, and then their system kind of reboots a little bit more.
Lindsey:
So constipation is how it’s manifesting?
Amy Hollenkamp:
Yeah, I would say constipation is a big one. I still see people with diarrhea who are under fueling, but yeah, I think I think a lot of things basically go wrong if you’re under fueling metabolically, hormonally, nervous system wise, it’s just very stressful for the body. The other thing I would say is people that are under fueling, some people don’t lose weight, that can be a little bit of a trickier one.
Lindsey:
Oh yeah.
Amy Hollenkamp:
Where they’re like, “Well, I didn’t lose weight”, and I’m like, “Well, I think it’s just because your metabolism met you where you were. Whereas other people will lose a lot of weight and sometimes significant amount of weight, and I have found in people that have lost weight, sometimes it takes restoring some of the weight for their metabolism to kick back on. They’ve lost like 40 pounds. Maybe they’re eating enough right now. Until they gain maybe like 10 or 15 pounds back, they might not necessarily feel fully metabolically healthy. So I have seen that too. Sometimes it takes certain individuals to be able to increase their weight again a bit for their body to feel safe to metabolically run at an efficient rate. So I think that’s interesting.
I think in terms of macros. I know you were mentioning carbs. I see sometimes carbs being a little bit low; that can do funky stuff to the hormones as well. Similar to what I was describing, like thyroid hormones can get a little bit distorted, like low T3 when there’s too low carb. I think cortisol can get weird for the blood sugar reasons I mentioned before. If carbs are a little bit on the low side, so usually that’s one area. I very rarely would say – I think a lot of my patients do okay with protein. There could be some people that might be a little bit more on the vegetarian side of things or vegan side of things, where they’re low in protein, so that becomes a much bigger issue.
So I look at the broader areas first, of like, okay, are we getting enough, and is everything fairly well balanced? And then from that point, I will look at micros. I would not look at micros before then, though, because if you’re under fueling overall calories, your micros are likely going to be a little low. As you increase more of the calories, the micros usually will increase. Unless someone has a nutrient-related test that shows them that they’re low in a nutrient, which has value too.
I’ll talk a little bit about that, but I like to assess what someone’s eating micronutrient-wise. What are their pain points? Are they really struggling to get certain nutrients in? And so that’s usually something I’ll get into a little bit later if we can get the first bigger pieces in place, and we can get a much better baseline of the micro nutrients. So I’ll look at that, and I will run more thorough nutrient related labs in terms of things that I do with patients at this point. I don’t run as much stool testing, but I do run way more micronutrient testing than I maybe have historically done in the last couple years.
Lindsey:
Do you do full panels, or are you doing like individual tests through their insurance?
Amy Hollenkamp:
So it depends. I don’t really care. I don’t care how they do it, but usually I will recommend certain nutrients based on what I’m seeing. So, a lot of times, I’ll do a little bit of review of what makes sense for them. So I’m doing custom panels, basically. So usually, I’ll just order them. You can order them now through Fullscript, but you could run them through Ulta Labs*. There’s a lot of options now to do it yourself. But if someone felt like their insurance could do it for cheaper, I’m all for that. I just have found that’s a whole nother animal in and of itself.
I don’t understand the cost of labs. I was telling someone the other day I ran B12, an iron panel with ferritin and vitamin D through a provider, and I was like, oh, just run it through my insurance or whatever. I think I could order all those for like 50 bucks or something fairly cheap, and they billed my insurance $800 and then I paid $200. And I’m like, what kind of racket is happening with blood tests? I just don’t understand how ordering direct can sometimes be cheaper. It’s very strange to me, but I guess it’s the nature of the racket that I don’t understand, it’s too over my head. But yeah, I’ll order a number of nutrients, and there are patterns that I’ve seen with patients in terms of nutrients that can be fairly low.
Lindsey:
What do you see?
Amy Hollenkamp:
I see vitamin A being fairly low. I find that . . .
Lindsey:
Do you test that a lot? Do you do beta carotene or retinol or both?
Amy Hollenkamp:
Retinol mostly. So I’ll look at retinol, and I would say most of the time it’s either low or at the very bottom of the range.
Lindsey:
Okay.
Amy Hollenkamp:
And granted, things like diarrhea can lower vitamin A. I think getting the vitamin A up really helps with the immune function and inflammation in the gut, and can help prevent infections. Like I do wonder a lot about some individuals with post-infectious IBS. Like I’d love to do research on some of these areas, just because there are some studies with vitamin A where they’ve looked at like, oh, you people recover better from GI bugs if they have enough vitamin A in their system, and it’s just a really interesting question as to why some people get post-infectious IBS and then other people don’t. It’s like whoa, I think there’s multi factors in there. So I’m not saying it’s just vitamin A, but it is an interesting variable I think, your nutrient status.
Lindsey:
Yeah. Well, we’re going to dig more into that later. But tell me about other nutrients that you’ve that you’ve noticed that tend to be low.
Amy Hollenkamp:
Yeah, I think zinc can be one that trends pretty low. You know, I’ve seen levels in the 40s before. I think sometimes people were kind of right at the cusp. Sometimes in the 60s, so that one I think can also be really important for immune function, that kind of thing. Copper is actually one I see pretty low. I always run zinc and copper together because I have to figure out how I’m going to address the zinc. If someone has low zinc, but they also have low copper, and I’m loading them up on zinc, it’s going to affect their copper, but copper I see low really regularly.
Some of the B’s I look at, I’ve had a few patients with low folate, which is interesting, especially if they’re maybe not eating some of the fortified grains. They remove stuff out of their diet and aren’t supplementing with anything, that would maybe increase the risk a little bit. I’m not saying you have to be eating the fortified grains or anything like that, but I’ve had a few patients who have pretty restrictive diets and then they have some of these low B vitamins, folate being one. I look at B12 sometimes. Iron, iron’s another one that I think can be pretty much low in most people.
Lindsey:
Definitely menstruating women. But I tell you, I find a lot of people who are high as well.
Amy Hollenkamp:
A lot of people exactly.
Lindsey:
And that’s my genetics for hemochromatosis. And I found that myself, but I have that.
Amy Hollenkamp:
And yeah, that is very true. I feel like you get both ends of the extreme, especially people that are obviously people that are more inflamed can have ferritin in the three hundreds. I think that that can be a really interesting nutrient, especially if it’s on the high side, you want to obviously do different things to help get the inflammation in the body down. But I find that low, low iron can be one that’s going to impact your energy level. So people that just feel like even if they don’t have anemia yet, but their ferritin’s low, I do see even just getting their energy back up a little bit being a super important part of them making progress GI wise.
You know, I’ve even had patients who’ve restored their iron, and we think it was a bigger part in why their gut feels better. And there are studies specifically on how the gut’s functioning, basically like a gut that has, or when iron levels are higher, there’s more permeability. If iron levels are lower, there’s actually more inflammation and permeability. So we need a lot of these minerals, and that’s with most minerals. If you look at magnesium, that’s also a mineral that when they’ve studied actual permeability and how the gut’s functioning, if it’s too high, it causes more permeability. If it’s too low, it causes more permeability. So a lot of the minerals are very interesting when you look at, it’s like a Goldilocks effect.
But I think you could take pretty much any nutrient and link it to it affecting the gut brain in some way. So that’s why I like to focus a lot on these micronutrients and not get too in the weeds with some of these other things, because sometimes if you can just get your nutrition up, inflammation at the barrier’s regulated so much better, and a lot of these IBS like symptoms start to gradually decrease. It’s not an overnight shift. That’s the problem I think with nutrient diet related stuff is it takes time, and there can be things you could do in the meantime that might help symptomatically.
But in terms of building up the resiliency in the gut, I think it really takes optimizing nutritional status. I feel like it’s a really hard uphill battle if your nutritional status is subpar, and so many people, I’m sure that you work with, if you’re dealing with restrictive eaters, there’s going to be gaps somewhere. I mean, I don’t think I can think of one patient where we didn’t do something nutritionally to help them build resiliency and help with their gut brain in some way.
Lindsey:
So in that same post that I mentioned earlier, you identified some common patterns of dysbiosis that people with gut issues tend to have, such that you almost don’t need to test because you kind of already know what it’s going to look like. And I agreed wholeheartedly with what you said, but can you can you elaborate on that a little bit?
Amy Hollenkamp:
Yeah. Well, I think I even think in general. I just released a post this week too. I think there can definitely be interesting patterns GI wise. I actually think a lot of the research tends to lean towards, especially with SIBO, IBS patients, maybe having more proteobacterial growth and that sort of stuff, leading to a little more inflammation and having low levels of good microbes. Again, that’s why the GI Map is so weird, where it’s like okay, Bifido and Lacto and all these good microbes seem fine. . .
Lindsey:
. . . and they don’t list proteobacteria amongst the phyla. You just get those two, and you’re like, um, well, they’re both low, so probably you have high proteobacteria, but I don’t know.
Amy Hollenkamp:
Yeah, I think what’s interesting about that is the actual profiles that you see with dysbiosis in IBS patients is a proteobacteria doesn’t really love fiber, you know what I mean? that’s always interesting to me is this idea of oh let’s starve out the microbes and then starve out the imbalance. Like really Proteo is definitely going to be more into sugar, into fat, and it’s not that sugar and fat are inherently bad or evil, anything like that at all. But it’s like this idea of demonizing fiber or fermentable fibers. I don’t think really fits the hypothesis that okay, we can take this proteobacteria or this imbalance and starve it out. I just don’t think that really – there’s not tons of evidence to support that, which I find interesting because people have taken that and run with it.
And I do think some dietary restrictions help symptomatically for sure. So I’m not trying to say that they don’t, but I feel like looking at the actual microbes that can be imbalanced in IBS, the recommendations dietarily, I think, promote more of that in some way. So if the diet’s restrictive and you’re limiting certain fibers, I think you’re going to start getting overgrowths of certain microbes and that sort of thing. And it almost takes flipping that on its head. I think you could do restrictive diets to help lower symptoms, but that’s pretty much the main thing that it does. Is it lower symptoms? It doesn’t correct an imbalance, and I feel like there’s that idea floating around of like, oh, I can starve out these bugs, and it’s like we can’t really starve out anything without something else popping up. It’s like whack a mole almost.
There’s just no evidence that we can really manipulate the diet in that way and cause shifts to happen where we’re starving out only the bad bugs but the good bugs we’re feeding in some way. I just feel like it’s gotten a little bit misinterpreted and misused. Low FODMAP, I think, has a lot of evidence for lowering symptoms and it has a time and place. But the more that you can maybe get symptoms under control, and then flip the script almost of like, oh no, now I need to add diversity in to feed all my different microbes that can do all different types of jobs for me, is the main way to go when you’re looking at these microbial patterns.
So I think in the end you could get real locked in on what microbes are growing and that sort of thing, and there’s some relevance. And if you’re targeting certain things, if a microbe is really overgrown or something, there might be value in that. But I think in general, we really want to focus on strategies that help diversify the gut, which kind of gets lost, I feel, or is an afterthought in some way, of like, okay, eventually we need to do that, but right now we need to kill, kill, kill that microbe, that pseudomonas or something. I think some of the targeting of certain microbes gets really skewed, and some of the actual interventions that are popular don’t really fit that model either.
Lindsey:
So, what do you think about breath testing? Do you use it at all?
Amy Hollenkamp:
Yeah, so breath testing. Oh, this is another can of worms. Breath testing. Breath testing is a really interesting one, just because I feel there’s almost two camps in my head. I feel like the researchers are not super hip at breath testing at all. The actual scientists doing a lot of the GI research, but I also think some of the MDs and some of the conventional big MDs are very big into the breath test. So it’s this weird dichotomy in a way. If you look at some of the research papers, they’re like, “Oh, this test isn’t great”, basically, but then you hear certain proponents of the breath test being like, “This is the best test ever.”
So it’s a weird one to wade through, seeing both sides, and I think it does stink because in terms of a truly good test for SIBO, I don’t think we have. I don’t. I think the breath test isn’t great. I think there’s a couple real big problems with it. Probably the biggest being there’s no real way to figure out if the increase in gas is coming from the small intestines or the large intestines. Basically, if you’re not familiar with the breath test, you take the solution and you breathe into these bags, and they collect gas. And the theory is that if you have SIBO, the gas happens before the 90 minute mark or whatever, the 60 minute mark, wherever the cutoff is for that particular provider’s test.
Then you have SIBO because the gas that’s being produced is supposedly in the small intestines because it happened before this cutoff. But I think in the studies the cutoff, people’s orocecal transit time, so the time it takes for them to get that solution from their mouth to the to the start of the large intestines, varied from like 10 minutes to like 220 minutes or something like that. So, if you’re someone with really fast oral transit, maybe that 10-minute mark, that solution’s hitting the large intestines at 10 minutes. Well, you’re going to have tons of gas, and it’s not related to SIBO. It’s gas from your large intestines.
There’s probably some issues going on there if your transit’s that fast too. Like maybe you do have some issues with transit being too fast. But then on the same token, if your transit’s really slow, like maybe it’s the 220-minute mark, like about that 90-minute point. The solution has not reached the large intestines, and so maybe you’ve had some gas increases, but maybe the solution’s moving so slow down the small intestines that it’s not going to show spikes. So it’s really weird test.
I feel like to try to interpret when you don’t have that data, and most of the researchers at this point who have reviewed a lot of the breath testing will try to say you should do basically a transit study alongside. I mean, this is not being done in practice at all, but watch where the solution actually is, and then do the test so that you know, like, okay, that lactulose solution is in the small intestine. We see it, and you’re getting a spike that looks like it could be SIBO.
Basically, that’s what they’d want to do because what they found, especially if you use that 90 minute cutoff, the 90 minute cutoff seems too long. I think they said it should be maybe like 70-seven minutes is the cutoff. If we’re getting really into logistics, that’s what some of the research papers show. It should be a little bit, especially for lactulose, should be a little bit sooner. But I’ve seen people use 90 minutes. I’ve seen people use 120 minutes. You know, I’m seeing people use a broad array of different endpoints there, and it can really, really skew the interpretation of the data. So, I think even when you use the 90 minutes, I think they were, it was maybe like 88% of the tests. I don’t think it was a large study, but when they looked at people doing the breath test, and they actually monitored where the solution was in the system, that 88% of them were blowing basically false positives. I believe it was around 88% Don’t quote me on that, but it’s around there. It’s around the 90% mark are false positives, basically, which is alarming because people who get diagnosed with SIBO get really locked into that diagnosis, and then they’re like, “Oh man, like I have to clear everything out,” which I totally get.
I had SIBO, I was in that same state of like, I have this overgrowth, I got to clear it out. I think it’s okay to maybe use a breath test and be like, “Okay, this is kind of interesting. Let me see if it’s consistent with symptoms. Like, I still think you need to work with a provider if someone did do a breath test and try to figure out if it makes sense to pursue treatment for SIBO. I think if you can put the breath test in the right frame of mind, like I typically would not spend money on it at this point. But if a provider really wanted to use it, or if they were wanting to explore that and that’s their process of running that test, I think the way I would think about it is like I’d also want to match it with my symptoms and make sure things seemed like it could be SIBO.
And I think there-it’s okay to maybe try treating it if you’ve done other things and nothing’s worked and see what happens with treatment. If you try to treat it and it nothing happens, like maybe you could try one other option, either antibiotic or herbal or however you want to treat it. But I find people will go down that SIBO road over and over and do tons of herbals, and maybe the first round was helpful, but none of the other rounds were helpful, and that’s really hard psychologically too. Like if you took Rifaximin or something one time and it felt amazing, and you’re like, “Wow, this is awesome, but then you do it the second time and it’s not helpful, and then you’re like, “Oh, maybe it’ll be the third or fourth time’s the charm.” And I think it’s just usually some of these clearance-based options have their season of helping, but then, and if it doesn’t help, don’t continue. Because I find some people will get into that boat. Some people it never helped, and they’re on their sixth round of something, and it’s like, okay, this never helped before. We probably shouldn’t keep doing it. Like more is not better.
And there’s a whole range of people that have been diagnosed with SIBO, who try treatment and it does not help, and they feel like, oh my god, I have this insane SIBO case, that’s just untreatable. Like the Rifaximin’s not touching it, and I really wonder if those people don’t actually have SIBO, or that the typical SIBO protocols are not going to help. We should probably think of some other reason why your gut brain’s breaking down beyond just SIBO. Let’s kind of zoom out again and see what other variables are at play. You might not be someone that’s going to respond to SIBO because maybe you don’t have SIBO.
Maybe you just have dysbiosis, which also tends to be more linked to what the research says too. So I feel like SIBO is definitely real. I feel like sometimes people are like, “Oh, are you a SIBO denier? Which I’m not at all. I think SIBO is definitely real. It’s just like it’s over diagnosed with the breath test, and I think that you have to have fairly high levels for it to be the main issue, I think what most people have who are put in the SIBO camp is dysbiosis of the small intestines which seems most problematic. There was that really cool 2019 study from Nature where they looked at that, where they looked at whether SIBO was linked to functional GI symptoms, basically. There’s a bunch of different diagnoses that fall under functional GI, but IBS is the big one. Think GERD, that kind of stuff.
And what they found was that SIBO was not linked to the symptoms; that dysbiosis was linked to the symptoms. So the actual balance of the bacteria likely matters way more than the abundance. I think what the caveat to that is how abundant is the bacteria. So I think if the bacteria starts to get pretty high, old school SIBO, how they used to test for it, like in the early 2000s like late 90s, that’s when you’re going to have a lot of symptoms that look like SIBO, and where you get people starting to have nutrient deficiencies and some of the cluster of symptoms that we hear SIBO causes.
So yeah, I think that a lot of people get sucked into the SIBO framework of like, oh, I have SIBO, I got to do all the SIBO related things. And I think you, if you are in that place now, how have you done with that type of work? I think some people do great with certain rounds of herbals, and that’s still good. That’s great. I’m glad that those things help, but I think there’s this whole cluster of people that haven’t been helped, and then they feel like, oh my god, I’m just this lost cause SIBO case, and SIBO is so hard to treat, and they just go down that mental rabbit hole.
And in reality, I think maybe they’re just looking at their situation wrong. That maybe SIBO is something that they can keep in their orbit a little bit, but release a little bit and say, okay, that path didn’t help. Maybe I just really focus on some other things and zooming out again and seeing where my gut brain is at as a whole. That sort of mentality, and going back to the drawing board, versus thinking that they’re broken in some way. I just think the protocol might have been broken for them, not that they’re some really difficult case.
Lindsey:
Well, I think it also helps to maybe distinguish between SIMO and IMO because IMO I have seen can be very recalcitrant, sometimes very hard to dislodge those methanogens. And I’m almost to the point where somebody comes and they’ve said, “I’ve already failed either antibiotics or herbals, that just takes them straight to the elemental diet, like that seems to be a pretty successful treatment for IMO. And it’s just that it’s expensive off the bat, and of course you’re not going to be eating, so people don’t think so much about like well, there’s no grocery bill, but . . .
Amy Hollenkamp:
It is one of the more successful yeah. I agree I think with IMO too sometimes I find things can be stacked on top of each other as well. I’ve generally found too I really liked PHGG. Doesn’t work for every single person, but PHGG* I think can help with IMO. I like to pair it with the Biogaia (Biogaia Gastrus*) and PHGG. I like that for IMO as well.
Lindsey:
Okay.
Amy Hollenkamp:
Yes, just it might not do the heavy lifting if someone needs more heavy lifting, but in terms of if they’ve done some clearance and they’re still kind of struggling a little bit, it can be helpful.
Lindsey:
Post-infectious IBS. Let’s talk about this because that’s what I have had for all these years, and I’ve had positive antibodies. I’ve subsequently had negative antibodies, but honestly, I can’t say that anything has really changed symptom-wise. Like I still feel like I’m on that sort of treadmill where you know things start to get a little overgrown, got to knock things back a little bit, and then I mean, overall though, I’m not bloated. I’m fine. Like I’m generally good most of the time.
Amy Hollenkamp:
So right, yeah. Well sometimes I think it’s helpful too when you’ve had post-infectious IBS, I find sometimes people will try to compare their gut to pre-infection of I have to get back there and it’s like well let’s turn the page a little bit. The circumstances have changed a little bit. That doesn’t mean that we can’t have you be mostly symptom free most of the time but the fact is maybe your symptoms have changed and I would not necessarily think that you’re not a success if you can’t get back to this point of pre-extreme. And I had a patient too who had three GI infections at one time; it was kind of wild. And he’s had a pretty gnarly case of post-infectious and I feel like again. That is he had C diff. I think he had rotavirus and then Giardia all at the same time.
Lindsey:
Oh my gosh!
Amy Hollenkamp:
And so it was nasty, and he had longstanding issues from it. And I’m like, well, we really can’t compare. Like we can’t necessarily say the goal is to get back to this point of pre. And that could happen. I think sometimes with post-infectious issues, it just does take some time for things to slowly get more calibrated, and maybe you get back to that point. But I think there can also be like, okay, maybe I have a little chink in the armor, but I can mostly still function normally, and maybe still have pretty normal days. But the goalpost shifts a little bit. I think having a mindset like that can be helpful.
And I think about that too like even with, I had some postpartum OCD anxiety stuff, and I remember a therapist saying like, the goal isn’t for you to have the mental health state of no pregnancy. Like that’s just not necessarily a realistic goal. Like you’re probably going to be someone that has more anxiety, OCD, postpartum, and that’s fine. We can move through that and strategize how to deal with that. But it’s almost a page is turned, which I think is helpful to compartmentalize in that way.
But I think with post-infectious IBS, the immune system takes on a threatened state, and it’s like, well, we had this invader come in and shake stuff up, and we’re not going to let that happen again. It’s like what the gut, the stature that the gut goes into post infection. You know, I think there can be different things to consider, and it’s something that I think there’s so many variables. It’s hard to totally understand again why someone could have an infection and immediately be fine and someone else can have an infection and be thrown off. It could be the timing of that, maybe it’s mixed in with some other stressors and it just hit the immune system in a weird way. There could be genetic pieces, but I think again, it’s one where I think you still have to zoom out and look at the full picture. The gut might still be a little more sensitive to stressors in the gut brain, but you can still look at different ways to support the gut brain. Same would go for people with SIBO that don’t have post-infectious issues, or that just have dysbiosis. I think we still want to zoom out and look at the full picture, gut-brain standpoint-wise.
Lindsey:
So, what are you talking about when you’re talking about support for the gut brain?
Amy Hollenkamp:
Yeah, nutrition optimization. What I talked about before, lifestyle factors, movement, sleep, and I when I say these things, I don’t think they need to be like A plus plus. Like I don’t think you need to be the best sleeper or the best mover or something like that. But you need to be covering that base, like doing B work. You need to be doing B sleep. You need to be doing that type of work. So I think those things would still help someone with post-infectious IBS. It might not be the only thing.
I think that the thing I would consider more so if someone had post-infectious IBS would be motility support would probably be more important. I think it’s something you still have to play around with, with the individual and figuring out what option would be best. I think there are certainly people that take low-dosed pharma meds if they feel like they need to do that and that it’s beneficial. I think a lot of people that I work with do well with different herbs. I don’t necessarily think that has to be a supplement either. Some people with more mild cases of post-infectious IBS can do okay with ginger tea a few times a day and chamomile. I like those three together. I think can be interesting if you consistently do it. Some people can manage just with that.
Lindsey:
What was the third?
Amy Hollenkamp:
Chamomile? So two ginger teas during the day and a chamomile. So kind of like taking those . . .
Lindsey:
. . . before bed.
Amy Hollenkamp:
Yes. So I like those blends as a mild way. Or if someone gets to a point where they feel like they don’t need the prokinetic supplements anymore, maybe they can do a maintenance of one ginger, one chamomile.
Lindsey:
Yeah, I mean in terms of herbal supplements, do you feel like there’s any that are more successful as prokinetics? Because I mean I’ve tried every last one of them, and I can’t say any of them made a huge difference of SIBO not coming back for me.
Amy Hollenkamp:
Yeah, I mean I think there’s some I don’t love. One that I don’t love is Motil Pro. That one just generally causes a lot of symptoms. It can cause ginger burn. It on paper it looks great. It has chamomile. It has 5- HTP. It has all these things in it. I just think that ginger can be a little rough in that one. One’s Motility Activator.* I would say I see people responding well to and liking one that again it wasn’t on my radar that my podcast co-host uses. It’s not really marketed as a prokinetic, but I’ve had some patients really like it. It’s Acetyl-CH™ Active*. It’s an acetylcholine booster, so it’s a little bit different. It’s interesting to me because I think a lot of the Motility Activator tends to be more of a bile supportive supplement, which bile increasing can help increase motility. But Acetyl CH Active’s more of an acetylcholine booster. It’s more of a neurotransmitter shifter. So some of these have slightly different mechanisms of how they’re increasing motility. So that can be interesting. I use that one a lot.
Lindsey:
Is that one that’s good for constipation or diarrhea or either?
Amy Hollenkamp:
I’ve used it for both. I think that one too. I’ve used it a lot for people that can’t tolerate ginger because that’s something too. Motility Activator is usually pretty gentle. It’s much more gentle than Motil Pro.
Lindsey:
If you swallow it with enough water, yeah. All of these. That’s the secret. Don’t try and just one sip it.
Amy Hollenkamp:
Yeah, yeah. They’ll get lodged in your throat with a burning sensation.
Lindsey:
Number of times I’ve had that stuck in kind of feeling.
Amy Hollenkamp:
What the heck is happening in there? Yeah, it’s the worst feeling. I hate that feeling. I know exactly what you’re talking about. But yeah, the Acetyl CH Active is one again that wasn’t on my radar that I’ve used a lot and have liked, and good for people that have GERD or reflux or who just don’t tolerate ginger.
Another one I’ve used again more regularly lately, not as much early on in working with people, would be chamomile as a tincture* or a stronger dose of chamomile. You can play around with the dose of chamomile too, taking fairly high doses is safe with chamomile. The only thing I would be careful of is if you’re on an SSRI or any sort of antidepressant, just because it can cause serotonin syndrome. That would be my only caveat for chamomile. But you know, I do like chamomile a lot.
That one wasn’t really on my radar. I mean, this was a long time ago, and we talked to this guy. We talked to an herbalist on our podcast. He was basically making an argument that peppermint gets so much attention for IBS. IB Guard is even – conventional docs I’ve seen give IB Guard. But he was saying, you know, chamomile is way better for gut-related things, IBS-related stuff, and I was like, oh, that’s really interesting. Then I started digging into it a little bit more, and there is some interesting data on chamomile and gut stuff, and it has prokinetic properties. I find that it helps with hypersensitivity as well. So people that have a little more hypersensitivity, I think, do well with chamomile, but that one can be an interesting one too.
Again, they all maybe have a little bit of a different slant on how they’re affecting motility and the pathways that they’re acting on. And sometimes that’s the case. I think with prokinetics, sometimes it does take playing around with different ones. Sometimes too, maybe that’s not the fit. Maybe prokinetics aren’t going to be the answer to help with motility stuff. I think the other thing I would mention about prokinetics, I feel like one of the biggest symptoms that gets helped with prokinetics would be bloating. So I think a lot of times people think like, oh, the motility piece is going to be the biggest thing, but I would look out for how it’s affecting bloating more than anything else. So again, I just feel like some of these motility aids, it’s “oh they’re going to for sure correct my constipation” or something like that, and maybe they help with constipation. But I would say the biggest symptom to look out for is how’s it affecting your bloating.
Lindsey:
Yeah. So I got on Motegrity, but a quarter pill, ¼ of one milligram is about as much as I can handle. But I feel like it’s made a big difference compared to herbal stuff. I don’t know if you found the same with your patients.
Amy Hollenkamp:
Yeah, I agree. I think that that you should be open to the pharma prokinetic. And again, I think dosing can vary, but I find that a lot of people do well with like half a milligram or a lower dose of prucalipride. So yeah, I’ve liked prucalipride. I would say I haven’t loved many of the other pharma prokinetics.
Lindsey:
I’ve never tried any of them.
Amy Hollenkamp:
So I mean, I think things like LDN or something could be helpful for other things.
Lindsey:
Yeah, I’m on that, but that didn’t make a lick of difference,
Amy Hollenkamp:
Right? Exactly. I think it’s okay, that can be helpful for immune system stuff, but sometimes people are like, “Well, I’m on a prokinetic and it’s LDN, and I’m like . . .
Lindsey:
Yeah, that’s not really a prokinetic.
Amy Hollenkamp:
So yeah, I feel like it’s with all this stuff. I think approaching it from the mindset of like, okay, I’m going to experiment and see what works and what doesn’t. I think picking the options that I would tell people, the options I see being the most effective herbal wise, would be Motility Activator, Acetyl-CH Active, and chamomile. And I really like those three. So if you were going to do an experiment, you could try each of those out for like two to three weeks and see am I noticing shifts? Maybe you don’t get all the benefits in that period of time, but I think you should notice some shifts happening. So yeah, I think that’s the hard part about some of the stuff is it does take some twiddling around. It’s hard to know exactly who’s going to benefit from one thing, you know. “Motility Activator is the perfect one for you, and not for you.” It’s just hard to know.
Lindsey:
So, yeah, no, I just generally steer away from anything with 5-HTP for people with loose stool. That’s my general rule. But yeah, for me people have liked Motil Pro if they were on the constipated side. I’ve seen that.
Amy Hollenkamp:
Yeah, I mean, again, I still think Motil Pro could be someone’s favorite, so I’m not totally against it. I would just say it it’s not the one I would start with typically, just because it can be a little bit more of the ones that I would say cause symptoms. So yeah, I think it still takes some degree of experimentation, no matter what. Like on paper, this might look like the best option for you. It’s like okay, I wouldn’t get too locked in.
Lindsey:
Yeah. What about Iberogast*? Have you seen much success with that?
Amy Hollenkamp:
Yeah, you know, I feel like Iberogast was a really weird one because it disappeared for a while.
Lindsey:
Yeah, and then the new formulation and . . .
Amy Hollenkamp:
and then that was so funny. Last year, it was on TV. I don’t know if you’ve seen there’s actual commercials. I was watching. I’m just like wow, right? I was watching and . . .
Lindsey:
You can buy it at Walgreens.
Amy Hollenkamp:
I know. I was watching an NFL game and it was a commercial and all of a sudden it was Iberogast and I was like what? I almost fell out of my chair. It was just so random. So I would say Iberogast was a weird one because it was just not there for a while. Sometimes for international patients, it was a little more available. It was just a weird one. But generally, I have seen some people like it. I think with every prokinetic, it can be one of those ones that for some people, it might fit the bill. One thing about Iberogast that’s interesting, and I haven’t explored this at scale with lots of people, something that Jason Harelak told us. He was on our podcast, and he was saying that he uses Iberogast a lot for hypersensitivity. But you have to take it fairly regularly for like six weeks or something before you see more hypersensitivity changes, which I found was pretty interesting. Again, I have not done tons of work with Iberogast in that way. It’s not one that I use really regularly. It’s kind of one where someone’s like, “Oh, I tried it and I like it. I’m like, “well, stick with it”. You know what I mean? That’s usually how I’ve seen Iberogast. But yeah, I think it’s an interesting one. I just haven’t recommended it a ton, but I have seen so many people on it, and some people do like it.
Lindsey:
Yeah, I’m kind of surprised to hear about it for hypersensitivity because I think of the hypersensitivity usually coming in conjunction with hydrogen sulfide SIBO, and then I would never do anything bile promoting in that scenario.
Amy Hollenkamp:
Yeah, I think again it could be just some of the mixtures of the herbs because he talked a little bit about peppermint and caraway, and I believe peppermint’s in it. I don’t know if caraway is in Iberogast, so I’d have to check.
Lindsey:
At one point though when it was out of stock, I went and I bought all of the bottles of all of the things that went into it and tried to recreate it. There was one good batch but one batch I made, it was like there was this one overwhelming herb that was so terrible, and I was like, “Oh my God, I’ve got to throw this out and start over.” But I had to add a little stevia to make the whole thing even palatable.
Amy Hollenkamp:
Yeah. Oh my gosh, you’re braver than me. I that that’s impressive that you tried to recreate it.
Lindsey:
I have all those bottles now. Yeah, I might have a bottle of chamomile. I should check that out. Yeah. So, have you found anything in your experience that lowers the vinculin antibodies?
Amy Hollenkamp:
I’ve had some people run it before. It’s not a test I run super regularly to where I can say like, okay, here’s their anti-vinculin before, and then here’s it now. I feel like I don’t really have that data. So yeah, I would say generally speaking, I think focusing a lot on immune system stuff I think also helps. Which to me, I always go back to the nutrients. So like A to D to zinc, but I think most of the nutrients play a role in how inflammation is regulated in the gut. So, I do a lot of work there, and I think you know slowly working on diversifying the gut I think is important for post-infectious stuff. It’s just hard again.
It gets a little squirrely if motility is being disturbed and that’s leading to more stagnation and that kind of stuff. So I still think such a big part of it could be trying to find some sort of prokinetic that helps, and then sort of working on a lot of the fundamental pieces of building the system back up. But I do think the immune system piece matters a lot too, and could be interwoven with some of the stuff necessary for post-infectious stuff, some of the very anti-inflammatory stuff. DIYs can help, especially if it’s pretty close to when the infection happened.
Lindsey:
Oh yeah, yeah. Often I usually get this has been happening for 10,15, 20. Yeah, I know my story. Well, I, for what it’s worth, I did two rounds of the Prolon Fasting Mimicking Diet, and my antibodies normalized.
Amy Hollenkamp:
So cool.
Lindsey:
Yeah, I don’t know if it’s . . . I kind of don’t trust it because I did the Candida + IBS Profile with Vibrant. So now I’m doing the ibssmart to make sure those results are real, but I also I had elevated CdtB ironically when I had normalized vinculin.
Amy Hollenkamp:
Yeah, you’re like, wait, what? One goes up, one goes down.
Lindsey:
Right, right. Whereas it’s been the opposite previously.
Amy Hollenkamp:
So right, and so ironic I feel like when stuff like that happens.
Lindsey:
Yeah, we’ve gone over time. You’ve been very generous with your time, so I will wrap it up. Let people know the name of your podcast and where they can find you and all that.
Amy Hollenkamp:
Yeah. So the podcast is the IBS Freedom Podcast. I don’t know if we’re kind of off schedule right now, but we should be back up and running soon. But we’ve done over 200 episodes of that, so we’ve got lots of topics there. Mainly, I would say I’m writing in the Sub. My Substack is the main area that I post on. I am on Instagram, but I don’t know that Instagram’s a whole nother animal. I feel like I don’t know if you’ve ever run into this or dabbled in Instagram, but the algorithm is just rough in terms of my skills.
Lindsey:
Don’t even bother. I mean, I post, but that’s it.
Amy Hollenkamp:
Right. Well, my skill set is usually long conversations or just writing articles that are more long form content than you have to do something engaging within the first two seconds, or the post doesn’t matter. It’s basically Instagram’s model. So I do post on there a little bit, but I feel like it’s all about who’s watching, but it’s like okay, it feels like I’m posting into the ether on Instagram. Yeah. So, but you can find me at Amy Hollingamp, RD, and I think it’s a similar Substack.
Lindsey:
Well, I was reading them, so I appreciate it.
Amy Hollenkamp:
Awesome. I’m glad. Yes, I’ve liked Substack a lot more. I feel like there people actually see your stuff and comment on things, so it’s good.
Lindsey:
Yeah. Well, thank you so much for your time, and I appreciate you coming on.
Amy Hollenkamp:
Yeah, no problem. It’s been really fun.
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.
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