Author: highde22_wp

Adapted from episode 157 of The Perfect Stool podcast and edited for readability with the founder of Eczema Kids, Andra McHugh and Lindsey Parsons, EdD.

Lindsey:

So can you tell me what got you into working with children who have eczema?

Andra McHugh: 

Yeah, with most stories, it starts close to home, and at the time, two of my three children had severe eczema. My third daughter was just born with it and as I took her home from the hospital, she had a neonatal rash, and it just got worse and worse. Her skin just got drier and drier. About a month in, her skin was just falling off head to toe, and simultaneously, my two-year-old was looking the exact same way. And I took them into the pediatrician, as one does when you have sick kids.

I didn’t know what to do and it seemed like eczema from my Googling. They’re like, yeah, and this is really bad, really extreme. You need these two separate prescriptions for steroids. Put both on both. Wear gloves yourself, because they’re admittedly toxic, throw some bleach in their bath, and then we’ll just work with you on managing this, because this is a chronic, lifelong thing. And I was there holding my two-year-old’s hand, holding my month-old baby in my arms. I was thinking, this is just not going to work. That’s not going to be good enough. So, that’s what really started this journey. 

Lindsey:

Wow, yeah, my son had eczema when he was a baby, and I can’t remember if he literally came out with it, but it was very soon after birth. So you’re thinking – already in the womb they already  have this problem? But it went away quickly. And were your kids born vaginally or C-section? 

Andra McHugh: 

C-section. So I have four now. And so now I’ve had four Cesareans. The third one, I really tried for that not to happen, and it still did. So I know that was a big part of it. And then with my third one, specifically, I was a dental assistant. I was working in one of the biggest hospitals here in Denver, and I just figured that had a lot to do with it as well, because of the constant exposure to chemicals and radiation and all the things that dentists, people in that industry, are exposed to. 

Lindsey:

And I’m assuming that my son’s eczema went away as I started to breastfeed him, and that probably helped with it. Is that something you’ve noticed is helpful? 

Andra McHugh: 

Yeah, absolutely. But I nursed my babies as long as I could, exclusively, and then it helped a lot in turning around my third daughter’s eczema because I was nursing. And so there was a lot that I could do, all the supplements that I could take, but you got to make sure that you’re not going overboard, or things like that, right? You don’t want to be detoxing yourself because then you’re putting that in the baby. But yes, that certainly helps. But on the same token, all of my clients, everyone that comes to me, has done everything they’re eating, right? They are exclusively breastfeeding. A lot of them have had unmedicated home births. A lot of them live on organic farms, and we’re still talking and having this eczema conversation. So it’s interesting.

Lindsey:  

Yeah, yeah. And my son was not exclusively breastfed. I could not produce enough milk, or he was so sleepy and he had jaundice in the beginning, and that just started him off slow, and he would just fall asleep during every feeding. So I had to supplement, or else he would not survive. But I mean, darn it, those hour-long feedings between the two breasts and the bottle. Then you think to yourself that now I’m supposed to start an hour and a half from now, again, or an hour from now? 

Andra McHugh:

Yeah, yeah, yeah, I know.

Lindsey:  

Okay. So is there a way to distinguish eczema from other skin issues? 

Andra McHugh:

Like, especially with my two-year-old, I thought it was ringworm at first. It just started at a little spot on her inside her thigh, and I was working full time, so she was with a nanny, and the nanny had ringworm. So, I thought she had ringworm. It just went from there. Yeah, I would say it’s just something that doesn’t go away, right? You can get a rash or something from something acute, like a bug bite or whatever, a quick exposure. But if it’s not going away, if it feels a little more chronic, that’s a big signifier that it’s eczema, and then psoriasis presents in a different way, and it’s not as common in the pediatric community, but yeah, I would just say, if it’s something a little more long standing than a couple of days, that’s something.

Lindsey:  

And does it get scaly and itchy? 

Andra McHugh:

I think in Latin, it means the rash that itches, right? So usually itch is a strong component there. There’s just so many different kinds of eczema. There’s this weepy eczema, which I found to be a little more lung based, and then there’s just the dry, itchy, mobile type of eczema, and that’s a little more liver based. So it can present in a lot of different ways. And as I said a lot of times it just moves throughout their body. And a lot of people experience it as flares, and then it comes down and flares up again. And parents can’t quite identify what’s flaring them. So there’s not just one main thing, except for that it doesn’t just completely resolve.

Lindsey: 

And does it typically start in cracks, I know I remember my son’s was in the crack in his arm, is that typical?

Andra McHugh: 

Yeah, and behind the knees, right? Like, anywhere that’s moist and warmer, yeah, because if you’re contending with eczema, right, you have a higher count of Staph on your skin, like you just do, and so, yeah, anywhere that bacteria can thrive. But that said, it’s not a skin condition. It really is a gut problem and an immune system problem that’s presenting on the skin. But yes, a lot of times it starts in those areas, the creases of the elbows, the creases of the knees, neck.

Lindsey: 

Yeah, actually my son, when he was probably about three, had something on the back of his leg, and I thought, oh, the eczema must have come back. And then the woman who ran his day care was like, he’s got ringworm. You need to get rid of that, and he can’t come back till it’s gone. Like it’s super contagious. And I was like, oh, okay, well, I’m glad you identified that for me. And sure enough, the ringworm stuff took care of it lickety split. But then later on, when he was maybe like 10 or 11 – so you know how when you have a baby, they tell you, back in the day, they used to say, use only Dreft as a clothes washing detergent? Now there’s a lot of natural detergents, so they don’t just say Dreft, I assume, but I followed that advice. And then at some point when he was 10 I thought, I can probably start putting a little fragrance back into my laundry so it smells like something. So I just put a tiny little bit of Wisk or Tide or something in with it. And I just wasn’t thinking about that at all. And so he started having this rash all down his mouth. And we spent nine months going from dermatologist to dermatologist, putting on different creams, whatever, nothing. And then I was like, wait a second, the laundry detergent! He’s drooling on his pillow. It all of a sudden occurred to me, and I changed it back and it went away in a flash.

Andra McHugh:  

Oh, so lucky. Yeah. I mean, things like that are so aggravating for them, because they just have a compromised skin barrier, and so they’re reacting to things that we should be able to withstand. And yeah, I just put lavender in our laundry to make it smell nice. 

Lindsey:  

Yeah, no, I’ve long since renounced anything in my laundry. I’m like, okay, it’ll just smell like whatever natural substance. So what’s the approach that most dermatologists take towards eczema versus your approach?

Andra McHugh:  

I mean, the pediatrician said to me steroids, the basic protocol is suppress and kill, right? So unfortunately, long term use of corticosteroids, it weakens the skin barrier even more. And one of the problems is they have a compromised skin barrier to begin with. So what happens is, if you start the steroids, and you do see relief, often immediately, and you know, there’s families out there that don’t know what else to do, like they’ve tried everything, they’ve gone down every avenue, and they’re barely eating anything. And so they’re like, okay, let’s give steroids a try. And they finally find relief. But then when they start to wean off, and they start to try to get off of it, it comes back full force, because your body becomes dependent on it, right? And you just need stronger and stronger doses to get the same effect. And then eventually it either stops working completely, or you just can’t outpace the drug. And then there’s also biologics, which are being prescribed to kids younger and younger and younger, like I’ve had toddlers that would be on biologics.

Lindsey:  

Wow, that’s crazy, because that stuff can put you at risk of getting cancer. I mean, you don’t want to start that in childhood.

Andra McHugh:  

Seriously and they’re starting it. I had a client aged two that they were giving that to her, and it just broke my heart, and it broke her parents’ heart too. They had also just tried every single thing and, and they were in a very severe condition, and they just didn’t know what else to do. So, yeah the traditional approach is suppressing and killing with steroids, biologics, antibiotics, maybe and bleach baths.

Lindsey:  

And so what is your approach? 

Andra McHugh:  

We don’t do any of that. We say that if that’s where you’re coming from, then we just start to wean off of that. But what we do is we start, where like any mere mortal parent can, in the kitchen, because you’re feeding your kids constantly, and so you can just start at their very next meal. And you’re just going to want to make sure that they’re eating low inflammation, low histamine, properly combined and properly prepared food. Ultimately, we’re creating a digestible meal for them every time, meal and snack.

Lindsey: 

And are there certain foods that tend to be triggers for it, for eczema?

Andra McHugh:  

Yeah, certainly the common allergens that people start off with, like gluten and dairy. Obviously, excess sugar spikes the blood sugar and drives up inflammation. Nuts are textbook, eggs, textbook eczema triggers, soy. So, yeah, we do eliminate those initially, because if you’ve got a compromised gut lining, or even just like a bruise on your arm, and if someone keeps punching it routinely, that bruise is never, ever going to go away. So we’re just dialing it back a little on the allergens that we know that there’s at the very least an IgG sensitivity there. And we throw in some other fun things, like pepper. Pepper is kind of high histamine, also just like a heat inducing food, and it just doesn’t play well with kids with eczema, or anyone with eczema, really. So it’s like some extra things like that. Ferments would be another one where they’re hailed as, like, gut health Mecca. But really, if you’re starting at this place where you have severe eczema, or any eczema at all, and you need to repair and seal your gut lining, you’re going to want to lay off these heat-inducing foods for a minute, and then we’re really just eating whole, real foods that are cooked properly, no seed oils, and combined properly so that you can digest them and absorb the nutrients that they’re meant to absorb.

Lindsey:  

Now I know with my son, it didn’t happen at first, but he did have what appeared to be an asthma attack. Is that a pretty common co-presentation with eczema?

Andra McHugh: 

Yeah, absolutely, and even allopathic doctors recognize this atopic triad. It starts with eczema, and then it can easily lead into asthma. And this happens a lot of times. Doctors will also say, cross your fingers and pray, just hope that it goes away. And if it just seemingly goes away, that’s what happens. But if you’re not addressing it, the inflammation isn’t just going away. Now it’s starting to present as asthma in a lot of cases, and then into adulthood. If it’s still not addressed, then it often morphs into hay fever. So yeah, it’s super, super common to see those linked.

Lindsey:  

Do you find that there’s a common gut health route to eczema for kids?

Andra McHugh:  

Yeah, 100%. There’s a bunch of things going on, but it’s starting with this compromised skin barrier, or gut lining, you know, gut-skin barrier, right? And so everything is leaking out, and then that’s triggering this inflammation and mast cell activation systemically. And then there’s a detoxification problem, and there’s liver stagnation and lymph stagnation. And then this stuff, the toxins that we’re supposed to be able to take out of our bodies through normal channels, is coming out through the skin, but absolutely starts in the gut.

Lindsey:  

And so are you finding something specific though, is it like, excess staphylococcus or candida, or something like that? 

Andra McHugh: 

Themes that I see in the tests that I look at is there’s a lot of H pylori overgrowth happening, and it’s happened with my two-year-old as well. And I would say 10 out of 10 the clients – you know, I look at GI map results often, and usually H pylori is a component. It’s just overgrown because, there’s not enough beneficial bacteria. There’s obviously dysbiosis, and you know, C difficile is another one that comes up a good bit, interestingly enough. And again, it’s not because these people are traveling overseas or doing anything crazy. It is just when you don’t have enough of the beneficial bacteria to ward off the pathogens, they can just easily take root there, and who knows how they get there? But, they grow if the conditions are right, and then that’s when you’re starting to see symptoms.

Lindsey:  

And do you find that there’s a common route to children?

Andra McHugh: 

Yeah, a lot of times there’s an immune assault, like, a lot of times parents will tell me they had a hand, foot and mouth disease or something like that. And then once that was resolved, they started getting eczema or, you know, just a bad case of pneumonia or a couple ear infections, whatever it is, and they had to have a couple rounds of antibiotics. And for some, you know, just like myself with my third daughter’s, they were just born that way. And obviously I had a million doses of antibiotics during my Cesareans, just by way of surgery. And yeah, there’s an immune assault of some degree. And the thing is, and sometimes parents beat themselves up about it, and it’s like, well, if you’re one case of pneumonia away from eczema, like it’s going to happen, like that bucket is going to tip over at some point. It just happened to be right then. 

Lindsey:  

Yeah. So are there any specific probiotics that you recommend for kids with eczema? And does that change for babies versus toddlers?

Andra McHugh:  

Yeah, the Bifidobacteria and probiotics, those I need to be more prevalent in younger people’s systems, so those are always lacking. And then there’s just a bunch of keystone bacteria that are supposed to be present in every person’s gut. The reason that you nurse them initially is that they don’t have this big, robust gut and digestive system, right? Like they’re not able to digest very much food, and it grows. And even toddlers, right? They’re not supposed to be eating junk and all this crazy stuff, because they don’t have the capability. Even totally healthy kids don’t have the ability to process these super processed, fried, crazy, high-sugar things that we’re throwing at our kids. So as we grow up, our digestive systems get more robust, but definitely for the younger set, just those Bifidobacteria are just really important.

Lindsey:  

I mean, I know the Bifido infantis is the one that they start with. So do you recommend it, for an infant or up to a certain age when that’s just the only strain? Or do you think multiple strains of Bifido? 

Andra McHugh:

I like to rotate. I tell my clients, when you end one bottle, start with something else, you know, and finish that bottle and then start with something else. Or we have a plan. Sometimes we do Saccharomyces boulardii first, just start to crowd out that bacteria, depending on what their test results say. But I do testing last; like most of my, I’d say 80% of my patients, resolve their issues just with our standard supplement plan, with the diet, with the environmental changes, with the non-toxic skin care routine. It’s this whole holistic plan addressing all the inputs that we possibly can. Because good news, right? If you have a small child with eczema, you can control a lot, right? You can. You are the keeper of the home, and you’re the CEO of the house. So you can control a lot of what’s going on and what they’re exposed to and in their environment and so forth. So we do all of that, and then supplements are certainly a big part of that plan, because if you’re experiencing eczema, like we were talking about before, we’re not digesting our food. We’re not absorbing the nutrients from our food wholly. So there’s going to be some deficiencies there, and we have to address those, and probiotics is just one of those. 

And then, though the people that have gone through it have been practicing and have been diligent for a few months, and they’re seeing some results, undoubtedly, but if they’re not completely clear, like within three or four months, then that’s when we look at testing just, you know, to try and just take down that systemic inflammation and just resolve some of the reactions, and then from there, I see much more helpful test results. So the point is, we don’t start there. Most can be addressed without going through that process. But for the really rooted cases, you know, and my kids included, we had to go through quite a robust testing protocol to really get down to the root. So, yeah, kids, luckily like me, I see adults too, but mainly this pediatric population, they turn it around really quickly. In general, their cells are repopulating so quickly, they’re regenerating so fast, and they just haven’t had a lot of time on this earth to mess up so badly, like it gets super, super messed up. Luckily, even in severe, severe cases, you can turn it around doing things at home. So that’s the good news. And then we go to testing if we need a little bit more.

Lindsey: 

And in terms of inputs on the skin, what are the kinds of things that people might be putting on their babies/children’s skin that could be contributing?

Andra McHugh:  

Yeah, if you go to the drug store or even health food store, lotions, they’re going to have, right? They need lotion because their skin is just super dry. So that’s where we start. First, we take out gluten, and then we moisturize, moisturize, moisturize. And that’s the right idea, but there are a lot of these lotions like Cerave, or some of the really clean brands, they have seed oils. And then Cerave and Aveeno, things like that, they have plastics in it, straight up, plastics. And then a lot of eczema-focused lotions have oats in them, and I found that to be really not helpful for eczema prone skin. They use it as a soothing ingredient, but when you ingest oats, your body reacts to it a lot like it would gluten, it really spikes the blood sugar, and it’s a little irritating. And so our little eczema friends honestly cannot handle it, so it’s that kind of stuff. So we use just bioavailable, whole, real we have a tallow lotion that I really, really like, because it’s just rich in vitamins A, D, E and K. We use herbal oils because it comes from this Ayurvedic practice called Abhyanga that been going on for 1000s of years, and people do it preventatively, and it really just helps move the lymph and also, just due to the lipophilic properties of the oil, it drives in the anti-inflammatory and the anti-microbial and lymph-moving properties of the herbs into the actual tissues themselves. It’s like taking supplements into the skin. So we do that kind of stuff to just help the skin care. Because you absolutely have to start there. Skin Care is a big piece, because we have to address where we are now and make them more comfortable.

Lindsey: 

Yeah. So I was curious, because this is what I use. For me, it’s like, miraculous. Is this a good one – Eucerin?

Andra McHugh:

Well, no, because that’s got petroleum products in it. 

Lindsey: 

I mean, for me, it’s like the only thing that keeps my hands from drying out. It is true, yeah. First ingredient, well, second ingredient was petrolatum, but then mineral oil, ceresin and lanolin alcohol, yeah.

Andra McHugh:  

Yeah, I forgot to talk about petroleum. Petroleum is not ideal because our goal is to make your body not have to work so hard to not have to detox from anything that you’re putting in it or on it. I’ll send you a tallow. It’s amazing.

Lindsey:  

Okay, so do you think your recommendations for dealing with eczema change at all for adults versus kids? Do you work with any adults?

Andra McHugh: 

Not a lot, because I find with adults, you have to go at it a little bit longer, just because your time on this earth that’s been longer and likely living with this condition for a little longer, and you’ve likely tried a few more pharmaceuticals to address it. So it just takes them a few more months. You know, our cells don’t regenerate as quickly as kids do, so for all those reasons, it just takes a little bit longer. But basically, the process is the same. You know, the diet recommendations are the same. It’s nice adults can swallow capsules, so that helps, like with the supplements, but really, it’s the same. The environmental protocol is the same, the skincare protocol is the same, yeah, I guess it’s the same problem. It’s the same route.

Lindsey:  

Yeah. And so with kids or adults, are you recommending antimicrobials if they do have something like H Pylori or you see C Diff in there? Are you sending them to doctors to get antibiotics? How do you handle that? 

Andra McHugh:  

I mean, like Saccaromyces [Boulardii]*and repopulating and then IgG*, sometimes licorice*, sometimes mastic gum*. Yeah, those types of things. But I gave my kids Biocidin at the time when we were really, really struggling but nothing too intense. We’re really weary, because, you know, these kids can experience die-off reactions pretty intensely. And so I certainly want to make sure nobody’s experiencing that too much, because that can start a new flare. But, and then also, like Epsom salt baths* is a huge part of the real part of the therapy, because that’s helping them detoxify and re-mineralize at the same time, because they’re undoubtedly low in magnesium, and sulfur so that kind of stuff, you know. We just make everything I can, food-based and stuff like that, and like Epsom-salt based, so that babies can do it and toddlers can do it.

Lindsey:  

Yeah. Is there anything I haven’t asked you about that I should have?

Andra McHugh:  

I just really want, if you’re listening to this and you’re in this boat, I just really want you to know that this is not a chronic condition that you’re just going to have to manage lifelong, like there’s absolutely a way out. You can absolutely recover from this condition no matter how bad it is.

Lindsey:

And what about in terms of diet? Are these kids typically going to have to avoid gluten and dairy in the long term, or are they getting back on those foods after they’ve healed?

Andra McHugh:  

Yeah, absolutely. Like if they have an IgE allergy, a true allergy, which you likely know those already, if your kid is experiencing any of those, like you’ve likely already been to the hospital for every action like that. So if that’s the case, if they have an IgE allergy to dairy, that’s going to be off the table, but otherwise, if there aren’t any IgE allergies, absolutely, the plan is to bring everything back in. My kids experience 100% food freedom, and my clients do too. Eventually. 

It just it takes a little bit of time, but that’s the absolute goal, because to be a healthy human being, you should be able to respond and navigate different environments, different foods, like you don’t want to live on Coco puffs, but you should be able to have a bowl and be okay, right? So in our home, we certainly practice the 80-20 rule. I buy healthy food and I prepare healthy food, but they’re involved in all the extracurriculars and all the things, and you get rewarded with sugar for everything that you do, like outside of the house. 

Lindsey:  

This was the bane of my existence as a parent, the soccer games. And anybody who played soccer like our age, when they were kids, were like, well, we always had orange slices. That was what you got after soccer, but now it’s like, yeah, every parent rotates. And you’re just like, what horror show is it going to be this week for the soccer snacks? And then my husband was the coach, and I’m okay, now we’re in control of the snack menu, and we’re going to tell them what’s acceptable, and they still don’t listen. They still bring the crap. Oh, fruit, sure. Well, let’s just bring those, you know, Welch’s fruit snacks then.

Andra McHugh: 

Yeah, oh, yeah. Like, that’s healthy. It says vitamin C on the package. It’s always such a bummer. I just take on the financial burden. Like, never mind. I’ll just do it, right? Because I just cannot, for the most part, I let them do whatever. But if it’s something like that I can’t control, then, yeah, and then when it was, when it was an issue, you know, there’s just so many ways around it. I just made sure that they had, we homeschool now, but back then we didn’t, and they had a box of the Yum Earth lollipops and things like that in the classroom, just for every birthday and things like that. They can still have sugar. They can still have sugar even when they’re healing, just not massive amounts of sugars. And the things that we’re really avoiding are like the dyes and just the straight up poison, right? Even the government is like, okay, let’s stop giving this to our kids. 

Lindsey:  

Yeah, yeah. Well, when I was raising my kids, my other my previous job was advocating for healthier food in the Montgomery County Public Schools in Maryland, and we got rid of all of the dyes, except for, I think the caramel color was the only one we didn’t get rid of, because that was in the meat. And you’re just like, you can’t even touch that. But we got all of the food dyes out of the food, and some of the major companies like Doritos had to be reformulated because of us and another district in Virginia, because those were such huge districts, they made a white Dorito without the red dye #40 for those school districts, basically and then were distributed in all the schools. 

Andra McHugh:  

No way. Why wouldn’t they then, if they’re already doing that, why wouldn’t they expand it? 

Lindsey:  

Because people are attracted to colors whatever, you know, the same reason that whoever it is Kraft or somebody is pulling BS about, you know, we can’t do the same thing in Europe as we do here or here, as we do in Europe, because Americans like their fruity pebbles to look like, you know, rainbow, really bright colors. Well, they’ll get used to it. I mean, come on.

Andra McHugh:  

I mean, it’s fine. So, yeah, there’s just always things. But yes, that’s the goal, ultimate food freedom, because it’s just more fun. And my youngest is three. Now he definitely, with three older sisters, eats way more sugar and ice cream and all the things than he should and he’s okay because, because he eats healthy food for the most part.

Lindsey:  

Yeah, that was my philosophy as a parent. Like, if I can get three healthy meals into them, then if they have some ice cream after dinner, like I can live with that.

Andra McHugh:  

Totally, totally yeah. And the birthday parties. Like, okay, go ahead, go nuts. 

Lindsey:  

Although, good story, my older son, who’s now a junior in college, he at some point in his life, somewhere around maybe I’d say 12, 13, 14, you know he started to get acne. And I said, yeah, you need to cut out the sugar if you want to get rid of that acne. And he did, like, overnight he does not eat sugar anymore. He stopped it. And that’s it. Once a year, he’ll have sugar.

Andra McHugh:  

No way. Well, you know, that’s quite the drive. I love that.

Lindsey:  

Vanity is very, very effective. 

Andra McHugh: 

That’s amazing. There’s just still some kids. It drives them nuts, but they aren’t willing to stop the dairy and the sugar.

Lindsey:  

Yeah, I see poor kids walking around in the street with, like, super severe acne, and I’m just “gluten, dairy, sugar”. I want to just walk up to them and say, just try eliminating those three and see what happens.

Andra McHugh: 

No, I know. I lwrote out a thing for my nephew once because it’s like, ah, this just seemed, yeah, it was just so bad. And I was like, I can see this impacting your life. 

Lindsey:  

Yeah, I wouldn’t walk out in public if I had that. So I don’t know how they do it, but I mean, all the kids have it, so they’re all just like, you know, looking at each other. 

Andra McHugh: 

That’s fine. It’s just part of the thing. But, yeah, I mean eczema has become that too. It’s like, it’s just so common. And to me, it’s such a shame, right?

Lindsey:   

Like, do you know what the prevalence is?

Andra McHugh: 

I’ve heard as high as one in three. Isn’t that astonishing, right? It’s just sad, right? 

Lindsey:  

So, are you familiar with Tiny Health*? They do the gut testing on moms before they even have their babies, which I think is probably part of it, because having the right Bifido strain in your gut microbiome that you can pass on to your baby from the get go, even in utero, is probably part of the picture. So I mean, do you recommend to people, do you talk to anybody before their next child, for example, and suggest they do that?

Andra McHugh:  

Well, yeah, right. Like, once I’m talking to them, they’re already in it. But yeah, I mean that a lot of them are planning to have more kids, and now they know, now they know how to set themselves up for pregnancy. I recommend doing a kitchari cleanse, you know, before you even get pregnant – it’s an Indian food. It’s just like basmati rice and split mung beans and then herbs, like turmeric and cumin and coriander, things like that. It’s really good. But this is, like, commonly, baby’s first food in India. But it’s just like, if you could just eat that for a week, and that’s also hard, like, for myself, no, I can’t do it. But I was eating a good amount of kitchari when I was nursing my baby when we were really struggling. And then she ate a lot of kitchari, just because turmeric, things like turmeric and ginger, like you just bring that into your diet as much as possible, the better off you will be. But anyway, just like, if you could do something like that, ideally, before you’re even pregnant, and then, yeah, certainly pay attention while you’re pregnant. There’s just so much that you can do. 

But I know, yeah, I’m a child of the 80s. I had a gazillion rounds of antibiotics. I ate Kraft macaroni and cheese with the powder cheese and skim milk, didn’t we all, exclusively on plastic plates all the time. So like, it’s just when you make a copy of a copy, right? It’s just not going to be sharp. So, like, it’s a deeper inquiry into our own health, to be sure, and you’re nursing at the time, then you absolutely are addressing that simultaneously and if not, then it is eye opening for the whole family. And then ultimately, everyone in the whole family is healthier because you’re creating healthier meals, because you can’t be a short order cook. 

Lindsey: 

Yeah, that’s a no go.

Andra McHugh:  

You’re making three dinners each dinner. You can’t do it.

Lindsey: 

Everybody must eat the same thing in my house. So I noticed on the shelf behind you, you’ve got your products. So how did you end up developing a line of products for this? Did you find a manufacturer and stuff?

Andra McHugh:  

And now I have a manufacturer, but that wasn’t my intention. When I started this company three and a half years ago, I just started with the podcast and the method, like I have an eczema elimination method, and took it through. So that’s what I did, and the coaching, but people were asking for it, but this is the stuff that I developed for my kids. This is what I treat with. And our lotion bill was high, like it was a big budget item, right? 

So I started making it. It’s still high because the ingredients are really expensive. But just even if you’re willing to pay, it doesn’t matter how much money, they still just don’t have the right ingredients to ultimately combat eczema. And now we all just use the lotion, because I make it, and it’s just like the best for your skin. It’s so, so, so great. And like I mentioned, the herbal oils, like you’re supposed to be using those preventatively, you know, supposed to. It’s really, really good for you, eczema or not. And then we have an itch spray that addresses Staph and itch, and it has some Chinese herbs in there. They’re commonly prescribed to Asian women in hospitals for vaginal issues. So it just addresses the yeast and the Staph and the itch, and it’s really, really helpful. So now we just use it for bug bites. And, like, even my dogs, like one of my dogs has dry skin, and so I put it on her, and it really, really helps. So, I made my own sunscreen, same thing, just need to do it. And then we have some dream spray, because it’s just fun. And we use that because: kids. So, yeah, it was just a labor of love. And then people were asking for it, so then I started making it and selling it and, and, yeah, now I have a manufacturer and that’s fun.  

Lindsey:  

Where can people find you and your products and all that?

Andra McHugh: 

You can find me at eczemakids.com, that’s my website and my store, and I host The Eczema Kids Podcast. And if you’re listening and nodding your head like there’s so much to learn there, and you can just find that on our awesome podcasts. 

Lindsey:  

Well, thank you so much for coming and sharing all this information with us. 

Andra McHugh: 

My pleasure. Thanks for having me on.

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.

Adapted from episode 156 of The Perfect Stool podcast and edited for readability with The Microbiome Expert, Guy Daniels and Lindsey Parsons, EdD.

Lindsey:  

So since I have covered SIBO and IMO on this podcast ad nauseum, we’re going to jump right into an advanced discussion of SIBO. So let’s talk about how SIBO affects absorption of nutrients in the small intestine, and what common patterns are seen in SIBO patients?

Guy Daniels:  

Okay, so I work with a tremendous number of SIBO people. In fact, my most popular protocol is SIBO with constipation, and I have protocols, and then I have the consultation themselves. Let’s start with what is SIBO, right? So SIBO is basically the permission that you’ve given to bacteria to be allowed to creep on up the GI tract. How have you given them permission? By various lifestyle factors, for example, taking PPIs. Right? You take PPIs, you drop the stomach acid, etc, or you’ve had antibiotics over the years and a lot of courses. And this is very, very common. This is the most common thing I see. I would say about 70% of the time, the root cause for people’s GI and other extra GI issues is excessive antibiotic use. So what does that do? That’s a slow process, sometimes a quick process, but usually a slow process, of killing off the good guys in the lower gut, in the upper gut as well, and actually all over the body, because you get yeast infections, etc., with antibiotics. 

But in the context of SIBO, you’re killing off the good guys and the bad guys in the lower gut, but the bad guys come back more robustly, and they want to control the environment. So what is SIBO? SIBO is bad guys from dysbiosis creeping up from the lower gut and the permission in the upper gut to let them take up residency there. Now, there’s always a microbiome in every part of the body, and there’s a typical, supposedly healthy microbiome in the Upper GI, the duodenum and the jejunum, etc. But that can change, because if you have bile acid dysmetabolism, one of the things that keeps that microbiome where it’s supposed to be is the correct balance of your bile acids, which come out as you eat a meal with fat, etc.

The other part is stomach acid. Another part is gut motility, and this other part is too many bugs creeping up the gut that are too high in number and not the right composition. So what do they do? Oftentimes, they slow down motility. So you get this ileal braking going up. You’re not able to digest fats properly, so you get into the ileal braking with that because your bile acid metabolism is off, so everything slows down. And because it’s all slowed down, that allows for more fermentation, and that is where we get to our methanogens. Everyone’s always blaming all methanogens and the methanogens are there, right? Your methane producers are there because they’re allowed to be there. They’re not normally supposed to be there, but because things have slowed down to a crawl, and because they have permission to be there, because they’re the final consumers, the end stage, right? They’re just taking the scraps that are left over. But if you’re moving things along in the Upper GI, they can’t survive that dynamic environment. If you have proper bile acid metabolism, they can’t survive that dynamic either. They’re not the guilty party. The guilty party is actually you, the person who has given these bugs permission to be there. Now to come to your question, so bile acids metabolism which means you are absorbing your fats properly – so you have more fats working their way down to the lower GI. If you’re using PPIs or have a history of prior PPI use, you have low HCl. You have too much protein reaching the small and ultimately the lower GI as well. There’s extra fermentation going on there. And then, of course, you have the carbohydrates, which are doing too much fermentation in the upper GI as well due to the slow motility. Then along with that, you get inflammation, and you get improper absorption of the nutrients that you’re trying to absorb in the small intestine.

Lindsey:  

So how do you get to the point where you have disrupted bile acid metabolism? What’s going on there?

Guy Daniels:  

So this is an important thing that people are not talking about. I’m really the only person talking about this, and this has been the case for many years. Bile acids impact the microbiome. The microbiome impacts bile acids. It’s a two-way street. What happens in the body is primarily secreted into the duodenum. Are what are called primary bile acids, okay, cholic acid, deoxycholic acid, and they’re conjugated usually with either taurine or glycine. So they’re supposed to come in, but technically there’s really a mix. There’s actually something like 40, 50, 60, something like more than that, bile acids. But there’s really only a handful that are key and crucially important. These bile acids are supposed to come in and help with absorption of fats and fat-soluble vitamins, like vitamin A, vitamin E, et cetera. But they do much more than that, because they are hormones as well. And not only do they plug into receptors in the GI tract, they plug into receptors outside of the GI tract, as far away as the brain. They are very powerful hormones. 

Now what’s supposed to happen is it’s supposed to be deconjugated. In other words, the taurine or the glycine is supposed to be separated from the primary bile acid. And as they travel further on down to the ileum and into the duodenum, they’re supposed to be then broken apart again and become secondary bile acids. Now there’s a tremendous amount of data to show these secondary bile acids are beneficial, and there’s also a tremendous amount of data to show that the really good guys, and there’s only a handful of them, are responsible for making this transition from primary bile acids to secondary bile acids, which are very susceptible to antibiotics. So when you get to the classic ultimate case of dysbiosis, which is a C Diff infection, right? What is that? And there’s a ton of data to show this, there are too many primary bile acids, the chief culprit being taurocholic- which is your cholic acid, the primary bile acid, which is still bound to taurine, and that enables C diff, which we all are going to have at some point in the course of a year. We’re all going to have C Diff spores in our body. That allows C Diff to become particularly notorious and dangerous and potentially deadly. So that’s kind of the cycle of events of how the microbiome is affecting the bile acids. In turn, the bile acids affect the microbiome by being anti-microbial in nature. So as you secrete the bile acids into the duodenum after a meal, they are actually detergent in nature, and they’re killing off these bacteria (not all because there are some bacteria like bilophila, etc, which are resistant to bile acids). But there are also a bunch of culprits in SIBO, who are potentially killed or are killed by these bile acids in the upper GI. So it has an antibacterial nature as well. And this is gut motility. And like I said, there’s a hormonal component in the liver, in the pancreas, so part of this too, as well with SIBO, is when you have all these extra bugs in the upper GI driving this fermentation, you would think that the duct between the liver and the gallbladder in the pancreas is sterile, but it’s actually been shown that it’s not the case, and that actually gets “contaminated” as well. With SIBO, you have this different microbiome in that area as well that starts affecting gallbladder and your pancreas. So when you change your bile acids properly, because everyone’s taking enzymes, now you’re affecting pancreatic enzyme production better when you have a proper blend of bile acids. This is just one big loop, and everything’s all connected, not just here, but in the entire body. And so people are always like, okay, I’m going to take enzymes and I’m going to take HCl and I’m going to take this, but they’re always just plugging holes in the dike and they’re not addressing all aspects of what’s going on.

Lindsey:  

Can you explain ileal braking a little bit?

Guy Daniels:  

So basically, when you have too many fats reaching a destination in the lower small intestine that shouldn’t be there because they should have been absorbed previously, the ileum just kind of comes to a screeching halt and basically says, okay, we’re taking in enough food. We don’t need any more. You need to absorb those fats, those proteins and those carbs further up the GI. Otherwise they’re subject to fermentation in the lower GI. Now, when it comes to carb fermentation in the lower GI, which is where you were supposed to have a bunch of what we call fiber/prebiotics, and prebiotics is actually not defined correctly. But anyway, so prebiotics, the good ones are sugars or carbs that are locked up behind bonds that we can’t access. So those are the ones we want to go to the lower GI. That’s what would feed the good guys. But we don’t want the more simple sugars and the carbs and the fats and the proteins, we don’t want those guys going to the lower GI. Some will, by their very nature, some will, but too much, just like with the carnivore diet. So if you take the carnivore diet, which is just all protein and fat, there’s a whole bunch more protein working its way down to the lower GI for fermentation. But the bad guys tend to like to ferment protein. So that’s where we get into problems with the carnivore diet.

Lindsey:  

Yeah, I see a lot of people with hydrogen sulfide SIBO who are former carnivores or keto. They got into that situation there. 

So I can tell from listening to your videos that you are among the small group of gut health specialists, that I sort of include myself in, who look disfavorably upon the traditional approaches of killing off microbes with strong antimicrobial herbs and antibiotics in dysbiosis and SIBO and IMO. So I’m wondering how and why you arrived at that place.

Guy Daniels:  

So years ago, I spent quite a few years as the director of medical education for a microbiome firm, and I spent most of my time, and honestly, I still spend most of my time doing research, just reading paper after paper after paper, literally 1000s and 1000s of papers. I take meticulous notes. I have a massive Excel sheet. Because initially I walked into this whole thing thinking, okay, yeah, because I’ve been in this industry for decades and, I come from, okay, yes, oregano oil and yes, probiotics and blah, blah, blah. Once you start going through the data meticulously, it’s like, wait a second. This is not how we should be doing things. And I was fortunate enough in my prior position to be able to implement my philosophy in a trial which had a 100% success rate, which doesn’t happen. What I saw repeatedly, and what I see repeatedly to this day, is that there are a number of good bugs who are basically almost all butyrate producers, who are very sensitive to antibiotics. And I just, actually just launched a huge, very long, very comprehensive video on antibiotics and the microbiome. It’s really a crucial understanding of what’s going on with the microbiome. It’s very pivotal. These guys are susceptible, and the bad guys, you can’t kill them off. They are normal E coli and Klebsiella and Enterococcus. All these guys, they are normal inhabitants of the microbiome. And whether it’s a UTI or whether it’s IBS or Crohn’s, or whatever it happens to be, you’re not going to kill them all off. They’re going to survive in the reservoir, which is the gut. Most UTIs come from the gut, so they’re going to survive there. They’re going to curl up in their little protective shell, right? And they’re going to survive the day, which is the only thing you’re going to succeed in doing is killing off the good guys, allowing the bad guys to come back even stronger the next time. And there is a tremendous amount of data to show all of this. And even with these natural antimicrobials, I mean, I work with tons of people from all over the world, they’ve all done oregano oil and berberines and Neem and garlic products and the list goes on. They’ve done all these before. They have done all the antibiotics, the Rifaximin, and you name it. The list goes on, and they’ve all done the probiotics. We can talk about that as well. That’s a whole other conversation, but this whole philosophy of bug killing really has to change. I mean, you could think about this in different ways, but, I mean, we can go back to C diff. We can do other examples. So let’s go back to C diff. It’s a good example. Again, every one of us in the course of a year, more or less, is going to ingest a spore or more of C diff. It’s a very, very, very hardy spore. You have to nuke it to kill it, right? It’s everywhere. It’s in the food. It’s in your shoes. It’s on you, it’s on your pets. It’s everywhere. It’s on door handles. It’s everywhere.

So why is it that the vast majority of us have no problem with C diff, whereas a small percentage of us who have had an excessive number of antibiotics (because that is the clear, far and away number one risk factor for a C Diff infection is excessive antibiotic use), it can kill them. Why is that? Because they are dysbiotic. They have far too many bad bugs, which would have been killed off, who thrived in the absence of the good bugs controlling them. So instead of this kill, kill, kill mentality, what we want is to nourish the good guys that are still down there, and instead of trying to outsmart what’s going on down there, nourish the good guys. Let them regain control of the environment and let them keep these bad actors who are called opportunistic pathogens for a reason, because if you give them an opportunity, they will become pathogenic. Let the good guys control them, control the environment and keep the bad guys in check. It’s a simple philosophy, I think.

Lindsey:  

Yeah, yeah, no, I have seen countless stool tests with zero Feacalibacterium prausnitzii, Akkermansia muciniphila, a very typical profile for someone who’s had a lot of antibiotics or antimicrobials. Now, only now do we actually have, I don’t know if you know, that there’s one company that has a Faecalibacterium prausnitzii probiotic* [register using Doctor Referral Code AZPA11], and at least a couple with Akkermansia*.

Guy Daniels:  

Yeah, I know there’s a couple with Akkermansia, and honestly, Akkermansia is interesting. So for one, it’s very beneficial in certain conditions like, say, metabolic syndrome. The data is excellent. However, if you do a meta analysis for dementia, for Parskinson’s, for colorectal cancer in every study, when there’s a significant difference between those with a condition and those the healthy controls, the Akkermansia is always significantly higher in those with a condition.

Lindsey:  

Yeah, does it coincide with constipation? 

Guy Daniels:  

I haven’t seen that. I’ve seen it with, again, with dementia, Parkinson’s, colorectal cancer, and ulcerative colitis.

Lindsey:  

I only ask that when I see excess Akkermansia, it’s almost always in someone who’s constipated.

Guy Daniels:  

Okay, okay. So to err on the side of caution, I would certainly not recommend any Akkermansia for those folks. Now, I actually don’t recommend it anyway, because I’ve heard from a number of people who’ve had bad experiences with the product, one of those products in question. So what I ought to do instead is to feed whatever Akkernansia is remaining down there. So what do you feed that with? Pomegranate*. And I talk about this in my video on Akkermansia. It likes mucus, but you can’t really feed it mucus, but you can feed the good guys who produce butyrate, who then ultimately produce mucus, and then Akkermansia is happy, and then kind of cross feeds the good guys. So one way to increase Akkermansia is by increasing the good guys, the butyrate producers. The other way is they love phytochemicals.  So you get into things like pomegranates and cranberries and things like that. You can feed it using those as well. So again, we come back because I’m not a probiotic person at all. I like to feed the good guys that are down there and let them control the environment.

Lindsey:  

Yeah. Now I started doing a gut shake that I stole off of Mark Hyman and recommend it to a lot of my clients with cranberry and with pomegranate in there. And sure enough, I had my most recent microbiome sequencing that was the most diverse I’ve ever seen. I had every single phylum present and in decent percentages, which was nice and refreshing, because I’ve had, you know, lifelong gut health issues and domination of E coli and such. Because I have autoimmune post infectious IBS, I have elevated vinculin antibodies. So I’m curious, from thinking about treating SIBO from a root cause perspective, given somebody like me and many of my clients who have a broken migrating motor complex, is there a better way to do the same thing applied to us as to anybody else who has a different root cause for SIBO?

Guy Daniels:  

Well, part of that equation is serotonin, right? So we can feed serotonin with tryptophan* to get gut motility going. So again, I’m not sure how much of that is the actual core root cause, whereas how much of that is a consequence of what’s happened with the extra bacteria being there. But for those who do have slow GIs, I like to use tryptophan.

Why tryptophan? Why not 5-HTP? A couple of reasons. One, you can give tryptophan in gram doses, whereas 5-HTP is milligram dosing. Number two, and probably equally important, or if not more, is 5-HTP is one step closer to serotonin. So you might actually do a little experiment and take, say, 500 milligrams of 5-HTP, and empty stomach, you will more than likely have nausea and you might vomit. So we want this gradual release of serotonin to the gut and actually go into the brain as well for those with any mental health issues, like depression, anxiety. 

So we want to get a larger dose down there when we get a more delayed dose actually in the serotonin production. So that’s part of it. So I use a fair amount of tryptophan in a number of people, but it’s certainly not for all people, because you give other people with, for example, say things are going to be moving too quickly, yeah, like with diarrhea, right? So you would not use it for someone with diarrhea. So why is that? Because with diarrhea, you tend to have a lot of mast cell activity, okay. And mast cells release some 30 odd chemicals, one of which is serotonin. Serotonin is a double-edged sword, so it’s part of the inflammatory cascade as a part of the mast cells, so you increase their mast cell content of serotonin, the mast cells release again, and boom, you just worsened diarrhea. So that’s part of it, but I tend to try to focus more on just correcting the microbiome and the bile acid metabolism and the immune dysregulation which always accompanies everything to get things going. 

In some people now, there is this very small percentage of people who, for whatever you could throw everything in, including the kitchen sink, at them, and they still have very slow GI motility. And there’s a couple actual conditions out there where it’s like that. Just that’s in their genes. It’s just that it was hard to change that. So there’s a small percentage, about one, two, 3% where you throw everything at them in full disclosure, because no one has 100% success rate and it usually affects the stomach. So it’s usually someone with a gastritis type of scenario going on and delayed gastric emptying, and then you get into the slow motility in the upper GI. And those are kind of tied together a little bit. Those are more of the challenging people. Second most challenging is high histamine. But I can get past that. It’s just whether they can tolerate the whole process or not. But yes, so there are some, but generally speaking, you can get things moving along. Like my success rate with constipation is absolutely astronomical.

Lindsey:  

Yeah, yeah. So why do you dislike the low FODMAP diet for long term management of SIBO or IMO?

Guy Daniels:  

So years ago, I was researching everything there was to research. And I looked at all the studies I could find, all the human fecal microbiome studies using the low FODMAPs diet compared to healthy controls. And I have a video on this as well. And what did I find? In fairly short order, the good bugs were significantly reduced in multiple and more than half of these studies. So what is the low FODMAPs diet? There’s an aspect of it that I do agree with, but for a different reason, they want to take out dairy because they want to take out the lactose, okay, which, if you have lactose intolerance, you already know that you have diarrhea. But they want to take out the lactose. They want to keep it from fermenting. That’s why they don’t recommend lactose. I want to take out dairy products because I don’t want you reacting to the dairy proteins. Dairy proteins are by far, far and away, the number one food group that you’re going to react to. If you have something going on, they are horrible. If you have constipation, they are atrocious. If you also have colitis, they are not a good idea. And sometimes the cause of, for example, type one diabetes, very problematic and autoimmune disease, and the list goes on. 

So if you are dysbiotic, taking out the dairy proteins, which in my opinion, is an excellent idea to be a part of the process, because we don’t want to keep adding offensive agents. We don’t want to keep reoffending and reoffending the body, keeping an inflammatory state. We’re trying to bring down inflammation. We’re trying to reduce the offenses while we’re trying to heal. So I agree with them and take out the dairy, but for a different reason. Now the rest of it, I understand why they’re doing it. They’re doing it to reduce symptoms, which it does. If you look at the trials, most of the trials have success rates in reducing gas and bloating. I agree that you can do the same thing with carnivore, agreed. That’s not to say these are good long-term solutions. So and again, I have a video on this topic as well. 

So what are you doing when you do a low FODMAPs diet? You are taking away the very fuels, these prebiotics that the good bacteria love. So if you’re going to take away their substrate, their fuel, they’re not going to thrive, so they’re going to go down in abundance. It’s just logical, and the studies show this. So what you’re getting is, and this is what we do very often in medicine, is we’re looking for temporary relief, but for long term, bad consequences, right? So yes, your gas and bloating has gone down, congratulations. But you’re not addressing the root cause. You’re just addressing the symptoms of gas and bloating, and ultimately, you’re going to make things worse if you continue on the diet. And again, I’ve had many times in my consultations, I hear the same things over and over again. Guy, I’ve tried every diet possible to include low FODMAPs, carnivore, vegan. The list goes on. I’ve tried every supplement possible. Tried every bug killer, berberines, oregano oils, prescription bug kills. Rifaximin, the list goes on. These people have tried everything before, and they’re still having these problems and oftentimes getting worse. And I say, yes, I’ve heard this a million times. Let’s try something different.

Lindsey:  

Yeah. And so do you dislike FOS, GOS, XOS, for the same reasons, or is there a different cause? 

Guy Daniels:  

So I never recommend those, especially for someone with SIBO, right? Those are basically inulin, okay, which have been snipped up. They’re all the prebiotics which have been snipped to tiny, tiny pieces, which are rapidly fermentable. So, and I’ve seen this in people before, in consultations, well, my doctor recommended this. Well, your doctor should know better. So you’re going to send these snipped-up prebiotics, which are going to ferment rapidly into what’s called small intestinal bacterial overgrowth. So what’s going to happen? So they’re going to be rapidly fermented in the upper GI where you have too much fermentation going on. There are different prebiotics which offer up different complexities of structure, like pectin is rather complex, for example, so it takes a while to ferment pectin, right? So again, with SIBO, you don’t want to make things worse while you’re trying to make things better. So yes, GOS, FOS, they have good test tube data. Sure they increase Bifidobacterium, everything increases Bifido, practically, right? There’s so much stuff that increases Bifido, but I don’t care about Bifido. It’s going to increase anyway in the course of while I’m doing things. What I care about is F prausnitzii. What I care about is species from Ruminococcus, Coprococcus, Eubacterium, all these bugs that no one’s ever heard about before. And why haven’t they heard about them before? Because they’re too sensitive to put on the shelf. Probiotics are oxygen sensitive, right? So they’re not available, and you can’t market them, and therefore you haven’t heard of them, but these are the actual true health promoters, not, especially not, lactobacillus. Lactobacillus has terrible data, and Bifidobacterium has okay data, but it’s nothing compared to these other guys.

Lindsey:  

I want to come back to the Lactobacillus question. But since you worked for Thorne, and you talk a lot about prebiotics, I thought, well, why don’t I look at the products that Thorne has. And so I looked at the Fibermend*, which had pectin, partially hydrolyzed guar gum, aka SunFiber, arabinogalactans. Were those the primary ingredients?

Guy Daniels:  

Yeah, it’s primarily the partially hydrolyzed guar gum at eight grams. And then you got, there’s some rice bran in there, three grams, right? Yes, there’s some window dressing dosing for the arabinogalactins.

Lindsey:  

Yeah, were you involved in developing that product?

Guy Daniels:  

No, that was developed by someone else during my time there. Okay, yeah, but it’s a product I recommend often, because partial hydrolyzed guar gum, again, will increase Bifidobacterium. People seem to be obsessed with Bifidobacterium, but again, it also increases other good guys, other butyrate good guys. And the rice bran is not the dose- I recommend other rice bran in addition to that, because I aggressively use the basic blends of prebiotics that are properly blended to suit the needs of the individual, that are blended properly and also dosed properly, along with other ancillary products. Here’s the thing to consider as well, because everyone before has tried inulin, everyone before has tried whatever, right, but they usually tried it with something like seven grams a day, or eight grams a day, or something like that. So if you give someone one prebiotic dose, say seven grams a day, you’ll be probably treading water. You might even get worse. So why is that? Because, again, there’s data showing this. First of all, when you drive things with just one prebiotic you’re actually reducing what’s called healthy diversity. Because Alpha diversity is stupid. Alpha diversity is just how many different bugs are there, but you can have a bunch of bad bugs. So if you’re just using one prebiotic, you’re reducing healthy diversity. And if you do something using a low dose, then you’re probably just feeding at least half, or more than half the bad guys, because some of these bad guys who were there were dominating the environment in the dysbiotic gut. Some of those species can use some of these prebiotics for their own fuel. So when they’re down there, the pH of the gut (the lumen- that empty space is not in the Goldilocks zone, which is roughly 5.5 to 6.5) so if it’s outside that pH, lower or higher, the bad guys will be dominating. And they’re going to go, oh, look, a little bit of partially hydrolyzed guar gum. I can use that. Oh, look, a little bit of pectin. I can use that. And they’re going to be able to outcompete the good guys, because the good guys cannot compete outside of their Goldilocks zone pH, and there’s data showing this as well. So what we need to do is intelligently drive that pH into that 5.5 to 6.5 range, so the good guys can then, and it’s a process, and I will admit, the first two, three weeks with me can be a bit bumpy where, okay, now the good guys are starting to consume more and more of these prebiotics, and now they’re out competing the bad guys. The bad guys are going, oh, wait, this isn’t my pH, I don’t function well here. Okay, I’m just going to go sit on the sidelines.

Lindsey:  

So are most people coming from a place that’s more alkaline or more acidic than that?

Guy Daniels:  

I would say, generally speaking, it’s more alkaline. And again, not that anyone’s measuring the pH of the gut, other than within a trial, but I would say, as a general rule, it’s above that. It’s like around seven or 7.1, 7.2, something like that. But then there’s also those who are below that as well. Then Lactobacillus will survive and thrive in both of those ranges. So whether it’s a low pH or a high pH.

Lindsey:  

Wouldn’t that imply, then, if they’re more alkaline, that they’ve got more bile acids flowing because they alkalinize the gut?

Guy Daniels:  

Well, the bile acid quantity would still be the same. It would be the composition, right? So the composition would change, and that would change with pH, so you would have a healthy composition from 5.5-6.5, right? And if it’s outside that range, now you have something that’s dominated by the bad guys. Again, the good guys are sidelined if they’re even present, and then the bad guys are saying, Well, okay, we’re not going to – see you got dehydrogenase and dehydroxylaze. The second step is dehydroxylation. We’re not going to dehydroxylate primary bile acids to secondary bile acids. So we’re just going to have this overabundance of primary bile acids, some of which is still bound to these amino acids, taurine and glycine. So it’s really not a content thing. It’s more of a composition thing.

Lindsey:  

So, in any case, it’s all about feeding the right prebiotics to the gut microbes to change the composition, which then changes the pH?

Guy Daniels:  

Right, exactly, exactly, and the same prebiotics are not good prebiotics for all people, right? Prebiotic A for someone with diarrhea is going to worsen diarrhea. Prebiotic B for someone with constipation, is going to worsen their constipation. So you have to understand which prebiotics feed which bacteria. And I have done all the meta analysis on this as well and looked at all human studies, fecal microbiome studies, and all humanized in vitro microbiome studies when prebiotics were used, and try to see, okay, which bugs are they driving? And so, for example, the best example is inulin feeding Bifidobacterium. There is an enormous amount of data. It’s just a ridiculous amount of data on this. So everyone in the world knows that inulin feeds Bifodobacterium. There’s a number of species it feeds. Okay, fine. But still my concern is largely the health promoting butyrate producers, but also is inulin right for you, because it’s not right for some people. So it’s a blend of a number of different things to come to the right recipe for a given person.

Lindsey:  

Yeah. And what about the role of food in all this, as opposed to just added prebiotics? I, for one, personally, when I had to convert my diet from higher in meat to much higher in beans and lentils, huge difference in the results for me personally.

Guy Daniels:  

Oh, certainly. You want to feed the you guys with your diet, but you also want to introduce fewer insults into the body as well, like with the dairy proteins, so that’s a component of it as well. But another thing I hear all the time is, Guy, I eat as healthy as I can – I still can’t get better. And I say, yes, I hear that a million times as well. So why is that? Let’s just take your average person who’s 50 years old and has been on 40 rounds of antibiotics. I’ve seen people with well over 100 rounds of antibiotics. So let’s just take someone who’s 50, been on 40 rounds of antibiotics over the course of their life. And some of the things happen as well, whatever it was, PPIs, whatever. So then they tried wacky diets for years, and that made it worse. So at this point, the gut is really broken, right? You have these bad guys that are so dominant in this gut, and the good guys, or if they’re there, are just so completely sidelined that you really can’t turn that ship around with just diet alone, you would think you could right? But you can’t. And I’ve just seen it again and again. So, you have bile acid dysmetabolism, how are you going to change that with diet? You can’t. So, and you have this hyper inflammatory, hyper vigilant immune system, okay, well, if you can’t change that, turn that boat around, you’re not going to turn that immune system around either. So what you should do is we have to drive significant change, and to drive it quickly so we can make that environmental shift in pH and other things so the good guys are in charge, which is using properly blended prebiotics, suited to the needs of the individual. 

But it’s also other ancillary support to address the bile acid metabolism to at least begin to bring down that hyper vigilant immune system that’s always on alert, alert, attack, attack, and just wants to fight anything it sees.It’s kind of addressing this from multiple different angles to get you where you need to be. And again, with a diet, you don’t want to introduce insults. And I would say, by and large, most of my people have a pretty normal, reasonable, healthy-ish diet. It’s not that common, I guess someone who’s like, I’m just eating ice cream and cookies. The people I’ve seen have been sick for years. They have been to see at least 10 practitioners. No one’s been getting them better. They’ve been doing research online. They’ve tried everything, and they’re still not getting better. So their diets and they know very, very well what foods they react to, they know their own bodies very, very well. And they go, well, I’m high histamine. And I ask my questions. So, yes, I agree with you. And they go, okay, I can’t eat this. And the weirdest things happen. I hear things. You would never think that would happen eating that food. Now they are just people, they know their bodies really well, but they can’t get out of this endless spiral of hell. They say their immune system’s a mess, and they are dysbiotic, which is driving the immune system and so how do they get out of this spiral to hell? And I’m able to help these people the vast majority of the time.

Lindsey:  

Yes, you mentioned pectin and rice bran and PHGG, any other prebiotics that you really like?

Guy Daniels:  

Yes, I have videos on all the ones that I like. So I have the three you just mentioned. I have arabinogalactins. I have inulin, I have resistant starch, I have psyllium. I think that’s everybody.

Lindsey:  

Let’s go back to the Lactobacilli question. So why do you think they’re a bad idea in SIBO? Because I kind of go back and forth, I have some people who react to them and personally, if I eat a whole thing of yogurt, I blow up like a balloon, but yet I can take one pill of probiotics with Lactobacillus and not have an issue. And I know that BioGaia Gastrus* probiotic supplements contain specific strains of L reuteri [DSM17938 and ATCC PTA 6475], which is recommended by a lot of gut health experts for constipation. So I’m just curious how you came to dislike all Lactobacilli, or if that’s in fact the case?

Guy Daniels:  

Well, I’m very data driven, but I also have experience as well for many years, so the data for Lactobacillus in vaginal health is excellent. Okay, so I wouldn’t say I dislike all Lactobacillus. So you have L. crispatus, and you have some others, L. gasseri that play prominent roles in vaginal health. That’s an aside. Lactobacillus tends to have pretty good data for infants as well. So now let’s take those two smaller groups apart. Now let’s deal with everyone else with all these gut issues. The data for Lactobacillus is terrible for most of us adults with dysbiosis, if you look at, and again, about three years ago, Lactobacillus was split up into a number of different similar-sounding genera. So when I say Lactobacillus, I’m referring to the old Lactobacillus prior to the reclassifications a few years ago, the names that all of us are familiar with, okay, so which is basically most of your Lactobacillus. It’s a huge genus, by the way. So anyway, we’re only talking about, generally speaking, 10 or 12 species. So the data is atrocious. If you look, and I have many slides and many videos on this, whether it’s Crohn’s, ulcerative colitis, IBS, either constipation or diarrhea, Parkinson’s, dementia, the list goes on and on and on and on. When you look at, again, human fecal microbiome trials comparing a condition of those I mentioned and more, could be Covid, could be anything else, versus healthy controls. The vast, vast, vast majority of the time, those ill with the condition have significantly more Lactobacillus in their gut than the healthy controls. That is a huge driver in my opinion of what’s going on with Lactobacillus. I never recommend Lactobacillus, and my success rates across the board are amazing. I have turned around Parkinson’s in multiple people, SIBO in gazillions of people, autism, the list goes on. I just got two more Crohn’s video testimonials just this past week. 

Why would I recommend Lactobacillus? If the data consistently shows from my multiple comprehensive meta analyzes that it is significantly higher in the condition versus healthy controls, why would you want to put in more Lactobacillus? That makes no sense to me. It even makes less sense to me if you have SIBO, which is, again, you get Lactobacillus in there, why are you putting more bacteria into small intestinal bacterial overgrowth? How does it make any sense to me? Why would you do that? And then I get into the experience that I have where everyone’s done probiotics before, okay, and they’re still talking to me, which means they’re still sick, and they’ve all done fermented yogurt before, like the L. reuteri yogurt before, which is so popular now, and they’re like, oh no, Guy, I can’t do that. I blow up, or I become a super histamine person, or whatever it happens to be. Right? Or I did it for a week and I felt better then I went downhill. Or I did it for a month, I didn’t feel any difference, and then I went downhill, or I did it for two months and I didn’t feel any difference at all, at best. 

Yes, these things can help some of the people some of the time, right? But don’t you want something that helps most people most of the time? You also have to be concerned again about the long term. So you can say, well, Guy, I just started probiotics, or just started fermented kefir, yogurt, whatever, a month ago. And I feel okay. Okay, good. Congratulations. However, I want to know where you are in three months or six months. And there are people who have success using this for three months, six months a year, etc., and I get that. I’m not trying to completely bash it. I’m just saying the data shows it makes no sense, and plus, on top of that, the dysbiotic gut is a high-lactate environment. Why would you want to introduce more lactate-producing bacteria into a high lactate environment? And we can split lactate into D-lactate and L-lactate. Got a lot of people out there with brain fog, so you give them a bunch of yogurt or kefir, and their brain fog gets worse. They can become high histamine, brain foggy. Why is that? Because they’re now cranking out a bunch of D-lactate, which is a neurotoxin, which is now going to the brain and causing some brain fog. So the data does not support this in any way, shape or form. The data supports the true health promoters, the F prausnitzii, the Coprococcus species, E rectale, Luminococcus, the list goes on, Roseburia. The data is very, very clear across 1000s of papers, that these are the true health promoters that keep the pH between, you know, 5.5 and 6.5 in the lower gut, that keep the bad guys in check, and keep the bile acid metabolism healthy, and keep the immune system, because they’re producing butyrate, which has a local effect and a systemic effect, where the butyrate is then impacting what’s called your TH-17 T-regulatory immune response, which I talked about my autoimmune videos. So TH-17 is the immune system that’s always looking for a fight, looking for a fight, looking for a fight. It’s ready to react to everything, whereas the T regulatory cell dominated immune system is more kind of tranquilo, it’s more relaxed. It’s more tolerant – I don’t need to pick a fight with everything I see, because if you pick in too many fights now you’re going to start picking fights with your own tissue, aka autoimmune disease.

Lindsey:  

So just to make it super clear, the D-lactate is produced by the Lactobacilli?

Guy Daniels:  

Well, there are a number of different bugs that can produce D-lactate. So, why would you want to increase the production of D-lactate when you don’t have to? So there’s really, if I recall correctly, three butyrate-producing, health promoters that can take lactate and turn into butyrate, and they are very sensitive to antibiotics. So E. hallii is one of those. And there are two species from Anaerostipes. So E hallii was originally classified as a new bacterium and was reclassified a few years ago into its own genus. And Anaerostipes* is another butyrate-producing, healthy, health-promoting genus, and they’re pretty sensitive, especially E. hallii, to antibiotics. So now you’re cranking out all this lactate. And now other bugs can take lactate and they can make propionate, but some of them are bad, like species from Veillonella. Veillonella is a genus of opportunistic pathogens who can take lactate, and usually accompanies Lactobacillus in abundance. So you see high Lactobacillus. You see high Veillonella. Why? Because Veillonella can use lactate. Lactate is a fuel for it, so it’s okay- I can survive this pH really well. It’s outside the Goldilocks zone. There’s a bunch of Lactobacillus here, which is present in multiple, multiple conditions, producing lactate that I use for fuel. I love this fuel. So now I’m going to increase, increase my abundance, and now I’m going to wreak havoc on the body as well, because I’m an opportunistic pathogen, and I’m going to drive inflammation, and the immune systems become more dysregulated, because the immune system is only like “attack, attack, alert, alert!”

Lindsey:  

And the lactic acid that we produce when we exercise is the same as one of those two types of lactate? 

Guy Daniels:  

I don’t know if that’s L-lactate, I would assume, I’m not sure which isomer that is, but that’s kind of irrelevant, because that’s in your muscles, right? We’re talking within the gut and gut health, right?

Lindsey:  

Okay, I was just curious. So you mentioned some other root causes of SIBO, like taking PPIs. What are some other potential root causes of that, or that is beyond what I have, the post-infectious IBS from food poisoning and the antibiotics?

Guy Daniels:  

So, food poisoning, that’s a big one. So I hear that quite a bit. That kind of gets the ball rolling in some people. So you get the food poisoning, and then you get these subsequent drugs that accompany that, right? Well, recently, it’s been more diverse where the places I’m hearing it from, you could say Southeast Asia, eating street food. But then I heard about Europe more recently. So you know, it could come from any place really, another driver for not just SIBO, but for dysbiosis in general. Because again, SIBO is dysbiosis from the lower gut. Alcoholism. I hear sometimes, so people have been drinking an awful lot for quite a few years, even recreational drugs, sometimes. Number one is by far and away antibiotics, by far and away. And then you get number two. It’s hard to say which is number two. You could argue PPIs, you could argue alcoholism. You could certainly throw some food poisoning in there. There can also be a lot of emotional trauma, because stress is not particularly wonderful for the gut, for any, any part of you, really. But I have a whole video on stress and the microbiome, which explains precisely what’s going on in regards to iron, catecholamines and so forth. So there’s an array of root causes out there.

Lindsey:  

I’ve also been hearing a lot about opioids really slowing the metabolism and causing that.

Guy Daniels:  

Yeah, well that’s part of your recreational drug, yeah, yeah. So, I mean, it can be prescription as well. So, yeah, that brings things down to a screeching halt. 

Lindsey:  

So, yeah, a bit off subject. But what do you think of the extreme gallbladder cleanses, where you’re meant to eject stones rapidly over a few days?

Guy Daniels:  

Yeah, I have concerns about all cleanses. Yes, I have. There’s a particular supplement that I love for gallbladder, liver and gallbladder health and bile acid metabolism, so I don’t do cleanses. I have literally never recommended a cleanse to anybody. I have concerns and honestly, I’ve heard a number of times people feel worse after cleanses. There are a whole bunch of detox regimens out there as well, and it puts them through the ringer because they’re already weak and sick to begin with. Then they go through these comprehensive, exhausting detox protocols from whomever, and they usually end up feeling worse after they feel weaker. They feel worse. They’re in worse shape, their gut’s worse, everything’s worse. So, yeah, I don’t, certainly don’t want to make anyone worse. And I’ve heard this so many times, I have no desire to touch cleanses and detoxes with a 10-foot pole. I want to, again, address things more from a biochemical standpoint.

Lindsey:  

Yeah, yeah. I figured, so what is the supplement you like for the gallbladder?

Guy Daniels:  

Oh, TUDCA*. I have a video on TUDCA as well. 

Lindsey:  

Yeah. I’ve started recommending that to a couple people lately, because after I watched your video about the bile acids and the secondary bile acids, I thought, maybe this is something I should give a try to. 

Guy Daniels:  

No, TUDCA  has a lot of very good data, because TUDCA is UDCA, right? So all it is is UDCA with T (taurine), but because a drug, which has fallen out of favor in regards to surgery, because everything’s drug and surgery, right? But it has a very long history. That’s the prescription version. TUDCA is the supplement version, which is just slap on a taurine, and you have a very, very effective supplement. 

Lindsey:  

So in your video on Candida, you talk about iron. Can you talk about how bacteria and yeast use iron to their advantage, and how you would address anemia in a client with dysbiosis?

Guy Daniels:  

That is an excellent question. So that’s a tough one. So the connection is, bad bugs love iron, and I talked about this in a number of my videos, especially the video on emotional stress and microbiome, where you’re cranking out these catecholamines. This is your epinephrine, your norepinephrine, things like this that allow the bad bugs to steal iron from you more efficiently, because the body does a pretty good job, normally, in the healthy state, of keeping iron sequestered from the bad guys. It’s like, no, no, no, no, you can’t. No, you can’t have any of this. The bad guys are saying they really love it, it makes me grow and makes me do evil things. And the body’s like, no, no, you can’t have it. But when you’re stressed right now, that presence of norepinephrine in the gut enables the bad guys to go like, oh, I’m going to steal it. And the body’s like, “ah, crap. I can’t really involve this, right?” So that’s how your bad guys thrive when you’re stressed. That’s why you get sick more easily when you’re stressed, etc., etc. At least one reason. So the bad guys love iron to grow, to become more abundant and to become more nefarious, to become more pathogenic. When it comes down to expression of the genes that they already have, but now they can express epigenetically what they weren’t expressing before. As the environment becomes more inflamed, more crazy, they become more crazy. So the good guys don’t operate in that same manner. You don’t see good guys craving iron like that, and things going to hell. You don’t see that pattern with good guys. You see that with E coli, especially and a number of other bad guys. 

Now, how do you help someone who is anemic and dysbiotic? That’s the million-dollar question. It depends on how they feel. It’s there, because it is ultimately a decision, right? So if they feel strong enough to go through the process of rectifying the microbiome first, because when I have these people, they’ve been anemic for some time, and so they’ve been taking iron for years, and they usually schedule a consultation with me, because they go, Guy, I just saw your video, how the bad guys love iron. And I’ve been taking iron for years, so I immediately schedule a consultation with you, I’m concerned, right? And I go, yeah, the bad guys love iron and plus, depending on the quantity of iron somebody’s taken, the form, how absorbable it is, etc., etc. So usually, what I tend to discuss is, okay, how strong are you? Do you need the iron? Can we go to something that’s a heme iron source, like, say, red meat, or something like that, to try to get you your iron? First of all, why do you need iron? Let’s try to find whatever root cause that is. But if you can survive this, it’s whatever magical reason x, if you can survive, a month, six weeks with me, four weeks, six weeks or eight weeks with me, until we can rectify your microbiome, right? And then go back to your iron. And in the meantime, eat some more red meat to get you some heme iron, which is more absorbable, you know, can you do that? And usually they say, yes, you go, okay, so let’s fix you.

Lindsey:  

What about just using vitamin C to help absorb iron?

Guy Daniels:  

Yeah, you can use that as well. So I mean, again, this is part of minimizing the insults of the body while we’re trying to heal the body. Yeah, right. So usually they say, okay, yes, I can do that. I can eat some more red meat, and we’ll fix the gut, and then, you know, etc.

Lindsey:  

Yeah, yeah. Because I do see that crossing over a lot, especially with menstruating females. I took iron my entire life, until I hit menopause, and finally, I’m free of that burden. Because without it, I was always very anemic, yeah.

Guy Daniels:  

And another point of note, as you bring that up as well, is there is some data to show that one of the reasons that women live a little longer than men is because they’ve been menstruating for so many years and they’ve been losing iron, because iron is very pro-oxidative. So, people should be a little bit careful about their iron.

Lindsey:  

This is an interesting thing, because my husband had excess iron and had gotten to the point where he was dizzy and falling down and that kind of thing. And I was the one who figured it out, his doctors did not figure it out. I was the one that figured out that this guy has way excess iron. And as soon as he gave blood, things turned around very quickly. And I’ve now been a lot more attentive to that. And I have said to a countless numbers of people to give blood and say, listen, you’ll live longer. Go give blood, get your iron down to optimal levels. And you know, seeing much lower levels of ferritin now recommended, like 40 to 70 range is optimal, not even above 100 for men. So that’s what I’ve been seeing anyway.

Guy Daniels:  

Yeah, you can look at the hemochromatosis data as well. So for people who genetically accumulate iron, they need to give blood. You know, they have big problems.

Lindsey:  

So why are prescription antifungals often unsuccessful in treating SIFO and what alternatives do you recommend?

Guy Daniels:  

So the yeast has a very quick workaround for those drugs. They just become rather resistant to them rather quickly. For example, we can go back to yeast infections, which is another good example of this, where I’ve worked with women who’ve been on 100 rounds or more of antibiotics. They’ve been on 50 or more rounds of antifungals, and they still have chronic yeast infections. So again, it’s this whole bug-killing mentality which needs to, largely, unless it’s an emergency, largely be thrown out the window. You need to feed the good guys. 

First of all, let’s please not kill them. And then feed the good guys that are still surviving and still there who’ve been sidelined. You get and again, no one knows the answer for each individual person, but you’re going to get to a point where you keep taking these drugs, which have their toxicity effects on the liver, etc., anyway, and they’re not going to be working. Well, I felt better on it, but now I’m off of it, and now I feel equal or worse. So, well, yeah, it’s a temporary benefit. You’re not going to kill all of the species from Candida or whatever the fungi happens to be. They hang out in the reservoir, which is more often than not, their gut, and they’re going to survive and then come back another day to cause problems. 

You need to have an immune system that is in charge, that is robust, that is efficient, but that is ultimately tolerant to be able to take care of these things. You’re not going to have that immune system if you constantly have dysbiosis, whether it’s fungal dysbiosis or bacterial dysbiosis, because they’re both the same. They’re not the same, but they’re the same. They are opportunistic pathogens. So philosophically speaking, whether you’re concerned about Candida or whether you’re concerned about E coli or Klebsiella or Enterococcus, whatever it is, it doesn’t matter. They’re both opportunistic pathogens who are taking advantage of a situation where they can go, hey, I can survive and thrive here. The good guys are minimized. The immune system is a mess. The bile acid system is just totally dysregulated. I’m going to take over here. It’s like a bunch of – I had this one idea one time to do a video. It’s like, if there’s two weddings, right? One wedding is predominated by a bunch of college students, right? And that’s like 80% of the people, and they’re all getting drunk, and they’re just completely out of control, because there’s no one to keep them in check, you know? And the wedding just becomes a total disaster zone. Your other wedding is a normal wedding, where you have a blend of people of all ages, kids, adults, grandparents, the whole nine yards, and it’s just a moderate, mellow scene where it’s just a normal event, and everyone, bride and groom, have a good time, right? If you have these bunch of crazy college kids in charge of the gut, they’re going to do crazy things. They’re just going to be out of control down there. So you need to have an environment where they are kept in check by the good actors who are controlling the environment.

Lindsey:  

So pretty much the same way of dealing with it is not taking things with anti-microbials, but going at it with the prebiotics?

Guy Daniels:  

And yeah, I’ve resolved yeast infections in women by only addressing the gut health.

Lindsey:  

Yeah. Okay, so do you have time for one more question?

Guy Daniels:  

Fire away. 

Lindsey:  

Okay, so I’m curious about what your personal gut health routine is, from diet to supplements.

Guy Daniels:  

So I was actually diagnosed with Crohn’s many years ago. Oh, okay, and I talked about that in my video on Crohn’s. So I went from GI doc to another who were just complete idiots, who said it was in my head, or said there was nothing to do, or said I had to take prednisone for the rest of my life. So I was very, very ill. I was also anemic for a period of time. I was very light. I was 25-30 pounds lighter than I am now. I was in bad shape, going to the bathroom constantly. So it took me a while to figure that out, and since then, my knowledge base has just grown really exponentially. So what I do is a little bit geared towards that, because for someone with Crohn’s or ulcerative colitis, you’re going to have to be on a maintenance dose of something because you have this genetic inability to keep those crypts clean from bad guys, etc., although genes are certainly not entirely the case for Crohn’s. So what I do is I will have a prebiotic shake that’s specific for my needs, usually, every day, usually, most days I do, and I take a little bit of some other supplements. But I don’t really have a supplement I take every day. I just take some, I kind of take it as needed, and I take a couple supplements just for general overall health and longevity. But at the core of what I do is the shake, but I don’t have something that I take every day.

Lindsey:  

What do you put in your prebiotic shake? 

Guy Daniels:  

I have a blend of, usually four different prebiotics. And then I have some glutamine I throw in there, just for extra measure. I used to put a couple extra things in there, but they weren’t really necessary. They are just more for extra, extra, extra. And then I have just a handful of other supplements I take. TUDCA being one of those, which is just, again, just a general health thing, for example. So with Crohn’s, you get a lot of problems, and you have to be ever vigilant. So I was in Mexico, and I had a blockage in my gallbladder, and I knew it immediately, because you could tell about it, because the feces is white, which cleared on its own, whether it was a polyp or a stone, no one ever knew. So I did the ultrasound and oh, well, they’re are a couple polyps, maybe a stone, etc. And then, and I have this weird kind of little fold to my liver. No, that’s the gallbladder. No, it’s the liver. And I was like, okay, I need to stay on the TUDCA. So, and since then, I’ve had fewer pain issues there. But with Crohn’s, different things happen. You get issues with your pain and your vertebrae, your spine as well, again. So there’s two different things you have to watch over.

Lindsey:  

Okay, well, thank you for taking the time to stay over for a couple extra minutes and let people know where they can find you.

Guy Daniels:  

So my most popular format is on YouTube, the Microbiome Expert. And then you can go to my website, where you can get more information. You can schedule a consultation with me if you want something that’s more one on one and more personalized, or you can buy a generalized protocol, which is only $20 [now $25] in this moment in time for a wide variety of needs, whether it’s SIBO with constipation, SIBO without constipation, etc. So the list goes on. 

Lindsey:  

Well, thank you so much for sharing all this knowledge with us. 

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.

Adapted from episode 155 of The Perfect Stool podcast and edited for readability with Clinical Nutritionist and Herbalist Dr. Brad Leech, PhD, and Lindsey Parsons, EdD.

Lindsey:  

So we talked about focusing on antimicrobials. So I want to start by asking you about what not to do, which is to say, the most common antimicrobial herbs that are used traditionally for gut healing and issues that are harmful to the gut microbiome, and what the research says about that.

Dr. Brad Leech:

So this is an interesting one, and we need to consider that over the years, the way we evaluate the impact on the microbiome, the way we evaluate the effectiveness of herbal medicine, has changed because we’ve changed the way that we sequence the microbiome. We’ve gone from culture to shotgun metagenomics. So our understanding of this whole ecosystem in the gut has shifted hugely in the last especially 15 years, but more so the last 30 years. Now historically, and I’ve got a background in herbal medicine, and I love my herbs, and use herbs day in, day out with my patients- but something I started to notice five plus years ago is this over prescription of antimicrobials whereby it wasn’t just practitioners prescribing high dose antimicrobials. It was, and I’m speaking from the viewpoint of the Australian market, consumers would just go into a pharmacy, a health food shop, and they would get over-the-counter, high-dose berberine, high-dose oregano oil. And we’re using it for things, yes, related to the microbiome, but also metabolic health, or bloating, or anything in between. And I was getting patients upon patients where you’d look at their microbiome report, and it was shocking, there would be a reduction in diversity. There would be changes to these beneficial species. 

And at that time, going into the literature, there were indications to say that these herbal products were beneficial. There was culture and PCR-related studies to show that when you take berberine or oregano- the limitations in the research were huge, because they were saying it was a good thing. But it wasn’t until two studies that came out in 2020 and 2021, now these two studies, one by Zhang et al. and the other one by Ming et al., 2021 which actually utilized metagenomic sequencing to measure the microbiome in herbal medicine intervention studies. Now for those listeners who might go, hold on, what’s metagenomics? What’s shotgun metagenomics? Very briefly, there are different ways to measure the microbiome. You’ve got culture, which is basically growing the microbes. You’ve got PCR, which is looking for a specific microbe with a probe. You have 16s, which is accurate down to the genus level, not so much to the species level. And then you’ve got shotgun metagenomics, which can look down to the species level to understand what species are changed. We’re not at the strain level yet. So it’s just down to the species level. To get down to the strain levels, we need something called nanopore technology, which is basically just you crack open the microbes and you pour out the full strain of the DNA to get access to it. They’re utilizing this in some research settings.

We are 15 plus years away before we can look down at the strain level. But species, we’re there, and we should be looking at the species. So these two studies, they really jumped out at me when I was doing a bit of a deep dive in and around the time that they were published, around 2021, and so forth, because they utilize this metagenomic sequencing. So broadly speaking, these two studies, they were well-conducted studies: multi-center, double blind, randomized control trials, where they had around three to 400 participants where one group were diabetic, the other group were hypoglycemic patients, and they prescribed anywhere between 500 to 600 milligram grams of berberine  twice daily for 12 to 16 weeks. So this is definitely a higher dose of berberine than what many practitioners would prescribe, but it is at the dose that you can buy over the counter. There are many, many supplements on the internet where it’s around that 500 milligrams of berberine.

Lindsey:   

Recommended for people with type two diabetes. . . 

Dr. Brad Leech:

Exactly. It’s very effective when it comes to high cholesterol and type two diabetes. But we, as functional medicine doctors and naturopaths and everyone in between, have this concept of first do no harm. So the interventions that we prescribe, first and foremost, shouldn’t be causing any harm to the patient. So, and I’m going to tell you in a moment, the negative impact that these studies actually showed. So after the 12 to 16 weeks of around that 500 to 600 milligrams of berberine twice daily, what actually showed in the microbiomes was an increase in hexa-LPS producing species. So LPS, your lipopolysaccharides, and we’ve got this subgroup of lipopolysaccharides called hexa-LPS, and they are the pro-inflammatory microbes. So taking high dose berberine resulted in hexa-LPS increasing.

But the other thing that was found were particular species that were linked up with disease outcomes. So Klebsiella pneumoniaes, E. coli, actually increased, which we weren’t expecting. Then the plot thickens, whereby these high-dose antimicrobials, and this is something that I’ve been seeing in practice for years now, they actually were shown in the research studies to reduce butyrate and commensals within the microbiome, including a lot of your bifidobacteriums, in addition to reducing diversity within the microbiome. So, thinking about that for a moment, we’re taking an intervention that shifts the microbiome to a more negative state, a way that is more resembling disease outcomes rather than health. So I now question when we utilize antimicrobials, and that’s not to say that we shouldn’t use antimicrobials, but we should use them based on the microbiome, and we should use them in particular clinical situations, and we should be utilizing more selective antimicrobials.

Lindsey:   

And so were there also studies on oregano?

Dr. Brad Leech: 

Not oregano. There are in vitro and animal-based studies showing positive impacts, and so we can only speak to berberine, but they have very similar actions, antimicrobials. What I’d note with oregano is the actual herb, so using it in the cooking, amazing, lovely. But when we actually use the oil of oregano, it’s much stronger. So it’s much stronger to the microbiome and has a non-selective action, meaning that could actually impact the good and the bad. So when selecting antimicrobials, going for the extracts, or maybe the tinctures, and utilizing something called pulse dosing, we might use one week on, one week off, or two weeks on, one week off. Other antimicrobials that we may consider utilizing may be nigella or black cumin. Pomegranate husk extract* is an excellent one, and even garlic* has been shown to be a bit more gentle, but still effective as antimicrobials.

Lindsey:  

What about uva ursi? It’s commonly listed if you do the old tests with the culture, they often would list what the sensitivity is for these antimicrobials. And they always put berberine, I think oregano, garlic and uva ursi on the list.

Dr. Brad Leech:  

Yeah, I can’t speak to that one. I haven’t looked into it, unfortunately. 

Lindsey:  

And then other plant oils, like thyme or cinnamon, are those also sort of along the same line, considered very strong?

Dr. Brad Leech:  

For those it’s the oils. When it’s the oils, it’s a much stronger antimicrobial. And in some situations, when there is a true pathogenic infection, yes, we may utilize it for a true pathogenic infection, but what a lot of practitioners are utilizing it for are pathobionts. So pathobionts are things like M Smithi , Klebsiella pneumoniae, B. wadsworthia, E. coli. Things that aren’t causative of disease, but associated with disease. Antimicrobials can safely be used for when it’s a pathogen, and when I refer to it as a pathogen, I’m referring to things like Bali belly, Dehli belly, food poisoning, where there’s quite obvious loose stools, abdominal discomfort causing a pathogenic infection.

Lindsey:   

I’m laughing because in Australia, the closest place where people frequently get food poisoning is India. In the US, we call it Montezuma’s revenge, because the closest place is Mexico.

Dr. Brad Leech:

I love that one, I might use that in future. 

Lindsey: 

Yeah. So, basically, if you go get an ova and parasites test at the doctor, that list of the really bad ones, like Campylobacter or salmonella, or these kinds of things, the very pathogenic E coli, C diff, like this list of things?

Dr. Brad Leech:

Exactly, exactly. So, I mean, it really depends. And I know the healthcare system in America is not one to rave about, but in some situations, when it’s quite acute, loose stools in Australia, that’s a referral to the GP. Go to the GP, get your antibiotics, but if there is a lack of clinical symptoms, but these pathogenic infections are still identified, so they’re suboptimal. That’s when we can really come in with the anti-microbials.

The other thing that I might stress here is, at the same time of eliminating the infection, we want to protect the microbiome. So there’s things that we can do to protect this ecosystem, one of which are going to be your HMOs*, so your human milk oligosaccharides, a type of prebiotic first isolated from breast milk, and it’s there to feed up the microbiome. Now the research on HMOs show that it exclusively feeds the beneficial species, while reducing the adhesion of pathogenic bacteria to the lining of the intestines. So it brings up this environment in the gut. Dosage wise, you’re looking around that two grams of the HMOs in addition per day. In some cases, you could do two grams twice a day. But the thing to note is HMOs are very expensive, so that adds up very, very quickly. The other one that we may utilize is your SB, so your Saccharomyces boulardii*, fantastic around that 200 milligrams a day. And then we’ve got a probiotic strain called Bifidobacterium lactis BB12*, and that’s been shown to survive and be still effective during antimicrobial and antibiotic use, so it’s one that we can take alongside the stronger antimicrobials.

Lindsey:   

So I don’t know if you’ve heard of the whole protocol involving MSM* as an antimicrobial, any sense of that?

Dr. Brad Leech:  

What I can say is there are many antimicrobials out there. Resveratrol*, on the outside of grapes, is an antimicrobial. Turmeric* is an antimicrobial. Their secondary actions can be antimicrobials. MSM* is not one that I would typically think of as an antimicrobial, but there are many lower dose or weaker antimicrobials. We’ve just really got to consider when utilizing antimicrobials- are they impacting the species that we want them to impact, or are they actually damaging the beneficial species? And unless we have research to confirm that, I’m always a bit cautious to go, I would rather cause less harm than more harm to the microbiome.

Lindsey: 

Yeah, no, I asked because I had heard about it on Nirala Jacobi’s podcast*, there was a doctor who came on and her protocol for everyone was MSM, work your way up to 32 grams a day. And once you hit that level, usually the bloating is gone. Everything’s fixed. She doesn’t even test the gut. So, I’m going- okay, I’m not going to recommend this protocol, but I’m going to try it on myself. I have post-infectious IBS, so I’m a great test case for whatever, because whatever I have, it’s always coming back. I can knock everything out, but it’s coming back. So, I did, and, I mean, it was great. Like every other anti-microbial regime, it knocked out everything and I was great. I didn’t bloat for maybe a week or something. And then everything started coming back. So I just started taking a little bit every day. So I’ve been holding off on a stool test to see whether it’s decimated my good microbes or not, because I’m kind of at the point where, so when you have post infectious IBS, probably what’s overgrowing is going to be something that’s LPS producing, right? So I’m thinking it’s better for me to just kill stuff than to just continue to let this inflammation potentially hover in my body.

Dr. Brad Leech:

You raise a really good point here. Those studies that I show described just before are in a clinical setting where participants did nothing else other than take high dose antimicrobials. I know for myself and my clinical practice, I never just prescribed one thing. I am recommending a variety of different supplements. I’m recommending a change in diet and lifestyle. And I’ve spoken to a number of practitioners in this area, and they would utilize higher-dose antimicrobials for SIBO management, but they would also, alongside it, give the PHGG* and the kiwi fruit and no snacking. And they’ll do these interventions that would actually have a positive effect on the microbiome, along with prescribing these things like the HMOs, the S. boulardii, the BB12, to protect the microbiome, and then thereby, what they see in their practice is less of a negative impact to the microbiome. So yes, this study is a very sterile study in the sense of it is just looking at one specific aspect and in clinical practice, that’s not really how we work. But it does illustrate the potential power of these herbs. They are very strong. They’re very potent, and we need to utilize them in the right place.

Lindsey: 

Okay, so let’s dig in a little bit more on the ones you did mention. How do you use in particular the Nigella. Is that the black cumin?

Dr. Brad Leech:

Black seed oil or black cumin. So Nigella is a very gentle antimicrobial. I’d be utilizing a combination of the Nigella*, the pomegranate husk extract* and even the garlic* when there is a pathogenic infection. When there’s a pathogenic infection, I’d be utilizing a combination of antimicrobials, whereby, if it was, let’s say, an overgrowth of a pathobiont, which was really impacting the microbiome. So let’s say a particular E coli flexneri was dominating the microbiome, about that 5%, 20% type of picture, really dominated the microbiome. I would then utilize pomegranate husk extract as a gentle antimicrobial alongside, and you’ll find this very interesting.

An effective way to reduce E. coli in the bowel is actually with GOS*, so your galactooligosaccharides is a prebiotic. You can get it in food sources, but also as a supplement, Bimuno GOS*. This GOS has the research behind it that’s used in a lot of these studies, and a dose range of around four grams per day has been shown after 12 weeks to bring down E. coli species. Side note here with GOS, you really want to go low, go slow, because if you jump in to four grams or five grams per day, you’re going to get bloating. You know it will really go because it’s a FODMAP. It is a fermentable carbohydrate. It feeds up the microbes. So we want to slowly, slowly introduce it. There are definitely some individuals who can’t tolerate GOS and who shouldn’t be taking GOS, but those who can, it’s a great, great tool to be utilizing to change the microbiome.

Lindsey:  

And we talked on the pre interview call about the Mediherb pomegranate husk extract. They have the 300 milligram pills? Well, it turns out it’s not available in the US, but they’re working on getting it available by Standard Process. So yeah, at this point, if you’ve ever tasted it, you probably know pomegranate husk powder is perhaps one of the vilest things ever. You can mix it into a smoothie and hide it, but you’re not going to put it in water, it’s just going to sit there as a film on the top, and then it’s like, you know…

Dr. Brad Leech:

It’s not enjoyable. And we need to, especially with compliance with patients, we need to have it in a way that’s going to be easy for them to take.

Lindsey:  

Yeah, yeah. And so how much of the Nigella do you use?

Dr. Brad Leech:

It really depends on the extract. I actually really use the seeds in cooking. So you can get them from an Indian shop, and they bring out such an incredible flavor in your cooking. The trick here is to actually put them in with the onions at the beginning, or in that first part of a stir fry, or in a curry, and it just extracts all of the flavor. And that’s one of the ways that I like to utilize the Nigella.

Lindsey:  

Okay, so you’re not talking about the oil?

Dr. Brad Leech: 

No, not, not necessarily the oil. No, yeah.

Lindsey:  

Okay, yeah. And would cumin powder be just as good in that sense, or do you want the seeds?

Dr. Brad Leech: 

So black cumin and cumin are different. I imagine you can get black cumin, so that’s like, almost like the layman’s term to describe it, but it’s similar to cumin, but different. I imagine you can get Nigella powder, and you can get it in a capsule, and there are many supplements that have it in the capsule, and in some cases, yes, I would go for that.

Lindsey:  

Okay, yeah, how about SBI’s- Serum bovine immunoglobulins?

Dr. Brad Leech:  

So your serum bovine colostrum?

Lindsey:  

Well, in this case, it’s the extracted immunoglobulins. I don’t know if that’s available in Australia at this point. 

Dr. Brad Leech:

We have got something called Serum bovine colostrum. So it’s a colostrum from the blood of cows, and it actually binds on to the byproducts of pathogens.

Lindsey: 

Right!  I think we’re talking about the same thing, right? Similar thing here, because it’s dairy-free. It’s from the plasma. 

Dr. Brad Leech:

Right, yes. The thing with the serum bovine colostrum is it’s really great when there are high levels of hexa-LPS within the microbiome. So when there are Klebsiella and E. coli’s in the microbiome, it does a great job at binding onto it. So the dose that I generally utilize is around that 2.5 grams, so around a head of a teaspoon. And it’s quite potent. It’s quite strong and effective as well.

Lindsey:  

Yeah, that’s one of the supplements that I actually sell, but only in the US, because it’s too much of a pain to try and figure out how to export and all that. So when you use the pomegranate husk pills, I guess the extract is somewhat different from the powder. I think it’s more potent.

Dr. Brad Leech:

We’ve got pomegranate husk extract. So that’s the extract of the husk. And yes, it is much stronger compared to, and it’s very different to the actual pomegranate juice powder. Pomegranate juice powder isn’t an antimicrobial. Pomegranate juice powder is a polyphenol, and it’s actually going to feed up the microbiome, and it’s actually going to increase Akkermansia-based species as well. So really potent, I believe that a 300 milligram capsule of the extract is equivalent to three grams of the husk. So it’s about equivalent to almost a teaspoon.

Lindsey:  

Yeah, the pomegranate powder. And, yeah, what other polyphenols do you recommend for building up those? And if you use the GI Map and go down the GI Map test and, everything’s looking good and zero Akkermansia and zero Faecalibacterium prausnitzii . Yeah, those are always the two that were knocked out after people had done antibiotics or antimicrobials. So what polyphenols or other prebiotics do you like to use?

Dr. Brad Leech:  

Another thing to consider is with tests that utilize PCR, they’re looking for just Akkermansia muciniphila. They’re looking for just that one species whereby there are many, many other beneficial Akkermansia species which may not be identified. So it’s kind of giving that false indication as to well, is there actually Akkermansia, or is there not, or is there no Akkermansia muciniphila, but Akkermansia others. 

Okay, so yes, I love the pomegranate. So I initially started doing actual pomegranate juice, advising patients to consume pomegranate juice, but it was quite difficult to buy and then you got the sugar content, and it was just a burden for the patient, was too much. And then you can actually get frozen pomegranate, the little seeds of the pomegranate, you can get frozen pomegranate, and that’s really nice to go on to a salad, to go into a smoothie, but accessing it is also an issue, so pomegranate juice powder* is the way to go. So it’s an extract of the powder. It’s very potent. You only need around that 250 milligrams of the extract of the powder to be effective. It’s an expensive product as well, but I love the aspect of the polyphenols feeding up the microbiome, especially when it comes around to those who may be unable to tolerate prebiotics. 

Polyphenols are an excellent option because they have these actions and in fact, all polyphenols, they have three mechanisms of action. They are anti-inflammatory, so they can reduce your CRP, Interleukin six (IL-6), Interleukin eight (IL-8). They are also antioxidants, so they can support that antioxidant aspect. And they’re also antimicrobials. So we mentioned before that curcumin, resveratrol, quercetin, can also be an antimicrobial and even an extract of green tea. So these polyphenols, they are incredible. So your grape seeds, your bilberry, your cranberries, aloe vera, pomegranate, as we mentioned, are all excellent polyphenols, even curcumin. We love curcumin as a polyphenol.

The way that I like to get this into our patients is through diet. Diet is going to be number one when it comes to polyphenol prescription. We can take all the expensive polyphenol supplements we like, but we can get a huge amount in our diet. A couple of things I tell patients is diversity, diversity, diversity, and not just diversity in the foods, but diversity in the color. We want to have five different colors on our plate in each and every meal. Okay? The next one is going to be berries. Incorporate berries every single day, the amount of berries that we actually need to be therapeutic is around that 200 grams. So I don’t know what that is in ounces [7.05 ounces], but it’s about a punnet of blueberries a day. Yes, expensive, but frozen is perfectly fine. So you can get frozen, and they need to be organic, because the herbicides and pesticides they use in the berries will actually reduce the polyphenol content.

Another one here is, rather than using sauces in cooking, is to actually use your herbs and spices per gram per teaspoon. Herbs and spices have the highest amount of polyphenol compared to all other foods. Yeah, other ones here are switching from other oils, whether it’s vegetable oil, canola oils, butters and so forth, to olive oil which has higher amounts of polyphenols. Coffee will also have polyphenols. But even incorporating things like green tea, there’s studies to show that two cups of green tea is significant enough, and this is high quality green tea as well, is significant enough to bring down intestinal inflammation. Flax seeds are another great polyphenol. Grind them up, adding them into a smoothie. Adding them into oats is a great way to bring in more fiber, but then more polyphenols. And then lastly,

Lindsey:  

Flax seeds have some conversion to EPA and DHA.

Dr. Brad Leech:

Yeah. And then the last one I might add in there would be chocolate. We can’t go without chocolate. It is an excellent polyphenol, but there are no polyphenols in white chocolate or very little. We need to go for that dark chocolate. I was at my mother in law’s last night, and I looked in the fridge and she had 100% cacao, and that is incredible. And I tasted it, and it’s so incredibly bitter. I’m only at about that 85% cacao. That’s my threshold. My wife loves 90% cacao, but 100% cacao, if you can handle it, fantastic.

Lindsey:  

Yeah, I’m sort of at 70. That’s kind of my max. So you mentioned in the list of polyphenols- grape seeds. And I always think of grape seed extract as a super strong which could wipe out your microbiome kind of thing.

Dr. Brad Leech:

And that’s the thing, yes, it can be a stronger antimicrobial when it comes around to the grape seed. Yes, it does have antioxidant capacity, yes, it’s anti-inflammatory, but it’s also going to be antimicrobial as well.

Lindsey: 

Yeah, okay, so when you pulse, the stronger things, so let me back this up a little bit and say that I often see people who have tried the SBIs, if you’ve tried the lighter stuff and they’re not getting better- they’re miserable, they’re bloated, they’re saying, “Can I just get oregano oil or berberine, or whatever?” They want to take something stronger. So, you feel like, at this point you’ve tried the lighter stuff. You have to do something. So then you do try and pulse. But then sometimes I see this, there’s a regression in the week off and then it seems like it never is quite as effective after you’ve pulsed. Have you experienced that at all?

Dr. Brad Leech:

In some situations, yes. That’s when I’d probably do the two weeks then one week off. It’s still that aspect where let’s take SIBO, when we use antibiotics to treat SIBO, 40% to 60% of the time, within six months, it’s going to come back. So it’s not necessarily the answer. It’s going to resolve short term, but it’s not getting to that underlying cause. So we’ve got to consider, okay, if we’re going to be utilizing these anti-microbials, how can we ensure that the patient doesn’t come back to see us in six months’ time with the exact same picture, and then we need to do it all over again. More antimicrobials, in essence, antimicrobial herbs are going to be better for the microbiome than antibiotics. But we, yeah, we’ve got to be cautious here. That’s why protecting the microbiome at the same time, lifestyle factors, cleaning up their diet, having that synergistic action whereby you do everything that they’ve tried before, but at the same time as  stress management. You’re not eating too late at night, you’re eating easy-to-digest foods. And then you bring in the antimicrobials and hope that that’s going to have a more sustained effect.

Lindsey:   

And do you have testing in Australia for vinculin antibodies?

Lindsey:   

Which antibodies are those?

Lindsey:  

Vinculin for the post-infectious IBS? 

Dr. Brad Leech:

So, we have ways to look for antibiotic-resistant genes. So we actually look at the microbes to see what genes they are resistant to, and based on those genes. So there’s 20-30 plus genes to go, oh, it’s resistant to this type of antibiotic or this type of antimicrobial. So utilizing the DNA aspect. The thing to consider is when we do these studies where we have the microbes and we apply the anti-microbials, which is done in a lot of research studies, that’s just looking at the effect on that particular species, and it’s difficult to determine whether or not that same effect will occur when we consume it and it goes down into the gut with, let’s say, biofilms, and everything else is happening within the gut. So it’s one of those things where we’ve got to consider, yes, that could be effective on a piece of paper, but is it actually going to be effective in clinical practice?

Lindsey: 

Yeah, what I’m talking about is something different. This is from Mark Pimentel’s work on the IBSsmart Test, but I’m guessing you can’t access that in Australia. What test do you like for analyzing the microbiome? Do you use breath testing at all? Or do you use stool testing?

Dr. Brad Leech:

I’ll utilize stool testing and shotgun metagenomics. So where it utilizes metagenomic sequencing to look at all the species in the microbiome. That’s the test that I’m going for, because when you’ve got that species-level information, it gives you an indication as to what’s going on. Let me give you an example. Have you ever seen a microbiome report where they’ve got Streptococcus, or Streptococcus sp., whereby you don’t actually know what species it is. You just know, well, there’s the genus of Streptococcus. Within the Streptococcus genus, we have Strep A. So Strep A is a true pathogen. We also have Streptococcus thermophilus. So Streptococcus thermophilus is found in yogurt and is a commensal. There’s really nothing wrong with having that streptococcus in our microbiome. You also have Streptococcus salivarius, so an oral microbiome. You’re identifying species in the microbe in the oral microbiome, in the stool. Now when we identify down to the species level, it will really govern treatment direction. So for Streptococcus thermophilus, we’re not doing any treatment. That’s fantastic. We don’t need to treat that streptococcus. Yeah, when it’s Streptococcus salivaris, we’re not coming in with an antimicrobial. We’re not trying to kill that.

An increase in oral species in the microbiome is actually an indicator of lack of stomach acid. So we can actually utilize high levels of oral species. When there’s four or more oral species in the microbiome, it can actually allude to a lack of stomach acid. So they’ve done these research studies. Those taking PPIs, your proton pump inhibitors, had an increase in oral species in the stool because there wasn’t sufficient stomach acid to break down these oral species. Now, that type of understanding of species-level data is only available with metagenomic sequencing, and that’s why that would be my choice of testing. The other one here to consider is how we can go about supporting that stomach acid. Yes, we can come in with betaine hydrochloride, but we also need to consider, well, is it stress governed? Should we be supporting stress management? Are there particular herbs like ginger and gentian and black pepper to really support with bringing up that stomach acid? So I think yes, to answer your question in a roundabout way with an example, I’m utilizing metagenomic sequencing in my practice.

Lindsey:   

And what companies operate in Australia that you can access?

Dr. Brad Leech:  

There’s one company called Cobiome by Microba and they were founded out of the University of Queensland. So two researchers, Professor Jean and Professor Phil, were actually the ones who first published research on metagenomic sequencing back in 2004. Cobiome by Microba are the ones that are available in both Australia and the United Kingdom. In the UK, you can access that as well through a company called In Vivo.

Lindsey:  

Okay, and is this something that people can order themselves, or is this exclusively by practitioners?

Dr. Brad Leech:

Because the tests contain diagnostic markers-it contains markers like pathogenic infections-it can contain calprotectin, lactoferrin, markers for inflammatory bowel disease, it actually needs to be ordered through a practitioner. But these tests are the gold standard for measuring the microbiome in Australia. Any practitioner who is educated in the microbiome, that’s their preferred method of testing.

Lindsey:  

Yeah. So you mentioned seeing the Streptococcus salivarius-  what other commensals from the mouth, or pathogens from the mouth might you see that clue you into low stomach acid?

Dr. Brad Leech:

There are over 450 species which can be identified in the stool. Would you like me to name them all? I’m joking.

Lindsey: 

I just thought there might be some common ones?

Dr. Brad Leech:

I can’t name them all, because there are so many, a lot of Streptococcus. So a lot of Streptococcus, Streptococcus mutans will be one. I actually can’t recall all of them. I can’t recall many of them, purely because, on metagenomic sequencing tests, they have a button, where it says the number of oral species. So they do all the calculations for you. So then you’re not looking for, oh, which one’s an oral species? Which one’s not? It would just say there are five oral species, and list the oral species, and some of them are just weird and wonderful names, but they have been identified within the oral cavity.

Lindsey:  

Okay, yeah, we don’t have, well, at least not any of the ones I’ve been using. I’ve been using this one called the Tiny Health Pro, because it’s got the metagenomic sequencing plus all those markers, which is nice, because most of the other metagenomic sequencing ones are just sequencing. You just get the species. And obviously I want to see the markers too.

Dr. Brad Leech:  

There is a database, and I can’t recall the name of it, but there is a database with all the oral species. So maybe there’ll be a bit of manual handling on that one as well.

Lindsey:   

So you mentioned the ways to bring up stomach acid. And, yeah, I often get this situation where you have someone who just has persistently low stomach acid. They can take five Betaine  HCl at a meal, they feel nothing and, their blood tests keep coming back with all sorts of markers of low stomach acid. So how do you address that? Let’s get into a little more detail. 

Dr. Brad Leech:

It really depends on the individual in front of us. Some of the options that I could utilize would be apple cider vinegar. It’s simple, but it’s effective. So taking about a tablespoon in warm water with a meal- that’s going to be acidic. My top herbs will be ginger, black pepper and gentian. Yep, I don’t utilize betaine hydrochloride frequently because it’s just adding in the stomach acid. I would rather come out of the approach of naturally stimulating it. So through those herbs, and then also through vagus nerve stimulation. So, stimulating the vagus nerve with bitters, but then also you can get different devices to stimulate the vagus nerve, even singing, singing from high pitch to low pitch can stimulate the vagus nerve. Chanting, om which is that vibration can stimulate the vagus nerve. I was in India a number of years ago, and you see these, these monks and so forth. You know that they’re almost there on the side of the road drinking chai tea. Now, in the chai tea there is more sugar than humanly possible. It’s basically tablespoons upon tablespoons of sugar. I am thinking how are you living to 100 years of age when you eat so much sugar? And I put it down to they chant on for hours a day, stimulating the vagus nerve, bringing up stomach acid and regulating inflammation. And I wonder if we all just chanted for hours per day, could we eat more sugar? Maybe? Who knows? 

Other ones here are going to be hypnotherapy, so we can utilize something called gut hypnotherapy. Now, gut hypnotherapy is a process whereby you reconnect this bi-directional link between the mind and the gut. Really effective for visceral hypersensitivity IBS. And in fact, there’s been a study, a multi-center study from Australia, the US and the UK, where they compared gut hypnotherapy with a low FODMAP diet in IBS patients. They found that the gut hypnotherapy was more effective short term and long term than the low FODMAP diet in IBS patients. So it’s one of those things where, rather than putting my IBS patients on a restricted, low FODMAP diet, I’m actually leaning towards gut hypnotherapy. It’s a six-week program to reconnect this link, and then also bring down this visceral hypersensitivity and support with the symptoms of IBS. But where I’m going with that is that it can also support stomach acid production. And then there are particular probiotics, Saccharomyces Boulardii, L rhamnosus Rosell*, that can be effective to bring down oral species in the microbiome. It’s promoted as a product to change the ecosystem in the mouth when there are high amounts of oral species causing dental problems. 

Lindsey:  

Okay, so you mentioned black pepper. Are you talking about the piperine they add to the curcumin supplements?

Dr. Brad Leech:  

That can be an option, or even just black pepper, yeah, but both can be an option. Here so in traditional Ayurvedic medicine, you have pippali. It’s like a long pepper, and it’s slightly sweet. But in some of the products that I’m using it’s just black pepper extract, a very small amount, but to stimulate those digestive secretions.

Lindsey: 

Okay, so back down to the testing. What do you think about the accuracy of markers for things like pancreatic enzymes or steatocrit or secretory IgA on the functional stool tests?

Dr. Brad Leech:

I can tell you so much about this. So there’s a couple of things to consider. Pancreatic elastase, it is well known within the published literature that the accuracy to diagnose pancreatic insufficiency is extremely poor. Yeah, the sensitivity and specificity for identifying pancreatic insufficiency is quite terrible. And there are articles upon articles stating the exact same thing. So it’s when it becomes really, really, really low. And what’s the reference range that you’re using in the US?

Lindsey:  

So a lot of markers will put 200 at normal but, sort of generally we think of 500, even though that’s further up, that’s really the more optimal. 

Dr. Brad Leech:

So similar ranges here in Australia, anything above 200 is okay. Anything below 200 is indicating pancreatic insufficiency. But really, to accurately diagnose pancreatic insufficiently, correctly, it’s more like below 50. Now that’s just what I’m seeing within clinical practice. The literature is saying below 100 but it’s in that range between 100-200, where it’s not definitive in saying that I will always provide a digestive enzyme and stomach acid support and bitters to support that. And I see that marker does increase, but it’s once it goes down below that 50 mark, that’s when I’m referring to the GP to actually do further assessment for true pancreatic insufficiency, which requires lifelong medication of digestive enzymes, not the digestive enzymes that naturopaths can access. I’m talking strong, pharmaceutical grade digestive enzymes,

Lindsey:   

Hardcore ones like Creon, and what if it’s sort of in that middle range, like it’s 250, it’s 300 or something.

Dr. Brad Leech:

Because of the test being less sensitive when it’s above that 200 mark, you say that it’s okay, and you also go off clinical symptoms. Yeah. So what was the other one you said, secretory IgA? So the thing with Secretory IgA is it is very sensitive to temperature and heat. Now I’ve been involved in a number of lab comparisons where we’ve sent one sample, so we had an individual provide us a stool, and from that one stool, we’ve sent it off to multiple different labs in Australia, in the US, and compared the results. Very, very interesting in the sense of the results. One of the things that came back was secretory IgA, and what it actually appears, and the literature confirms this as well, and the labs know this as well, is secretory IgA, when it is exposed to high temperature or is not processed in a timely manner, can start to break down.

So what can actually happen is low-quality labs will be reporting low secretory IgA more frequently than labs that have a higher duty of care and higher standards. So I know, growing up doing my degrees, it was always low secretory IgA. That was always going to be the issue. But that’s because at that point in time, back in 2008 the labs were pretty poor, and it was just, it was actually secretory IgA breaking down in the post. So here in Australia, especially in Queensland, there can be heat waves, really hot temperatures and so ensuring that you’ve got the ice bricks and temperature control to ensure that it is getting back to the lab in a timely manner. So secretory IgA, it is accurate, as long as it is back to the lab in a timely manner. So generally, within 48 hours, 72 hours, anything more than 72 hours, it’s really going to start to break down. And also, you don’t want it to be exposed to high degrees of temperature. So you actually want a temperature control method in the parcel that you send back to the lab to ensure that it doesn’t go above that threshold where it starts to break down.

Lindsey:   

Okay. And so are the results of the study you’re talking about, where you sent it off to different labs published?

Dr. Brad Leech:

That was for some education programs that I put together, where I wanted to compare different labs, and we went through that. It was a really interesting exercise comparing all these different labs. What I can say is it’s very difficult to compare, because different labs will call species by different names. They will give different measurements as well. So they’ll use different databases to name different bacteria. So broadly speaking, we have a number of different databases. We have a database called the GTDB, which is the gold standard for naming microbes, so that’s based on their DNA. So that’s the GTDB database. But a lot of research studies and a lot of older labs will utilize a database called the NCBI, which is completely inaccurate when it comes to naming families and genuses and species in the microbiome. It just gives it completely different names, because it’s an old version of naming microbes. So, there is this change in recent years on how we name microbes. The microbe in itself isn’t changing, but the name that we provide it is changing because we’re naming it based on the DNA, rather than looking down a microscope and going, oh, this is producing X compound- It’s a lactobacillus. So we’re changing how we name these species.

Lindsey:   

So I’m curious, though, with the labs in the US, was there one that sort of came out as the best one?

Dr. Brad Leech:

I don’t want to negatively put down labs.

Lindsey:   

That’s why I asked for the best, I didn’t want to ask for the worst.

Dr. Brad Leech:

What I would illustrate is any lab utilizing metagenomics, shotgun metagenomics, fantastic, great. Any lab that’s utilizing PCR, I’m sorry we’re so far past that we don’t just want a list of hey, here are the 30-40 species that we can identify. But, are they in your gut? Yes or no, that is not microbiome assessment. That is just looking for a few key species. We want to be looking at the whole microbiome, rather than just a subset of a few species which that particular lab can measure.

Lindsey: 

Yeah, as I’ve started to use metagenomic sequencing more and more, I’ve begun to realize that I was sort of operating in the dark when I was not using it, because there were definitely species that were coming up that were just not on the list. So, with hydrogen sulfide SIBO too, I’m seeing that there’s some species that are not on one report that have these three, but not all four or even more. So it’s not ideal, it’s interesting.

Dr. Brad Leech:

I get patients from Australia, UK, America, they come to me. They have microbiome results and generally, and the US market, very interesting patients that come from the US. They’ve done so many different tests, okay? And they’ve probably done four different microbiome tests with four different companies. And I’ll actually say I’m actually not going to look at those results. I’m only going to look at the results using metagenomics because, well, I understand the accuracy. So there’s this concept called identification bias. Identification bias is whereby, if we see something that is positive, we believe that that’s the problem. So for instance, if we identify Streptococcus, or if we identify Blastocystis, or if we identify something and everything else is okay, we believe that that’s the problem. And what’s happening, especially here in Australia, GPs are going, yes, all the microbiome, but they’re just doing really standard gut tests, and it’s not giving all the solutions, and they’re just identifying one marker and treating that one marker rather than really considering what else could be happening in the whole microbiome.

Lindsey: 

Yeah, so new topic as we sort of get towards the end. What do you think about leaky gut? Is this a condition in and of itself, or secondary to other issues?

Dr. Brad Leech: 

Yeah. So background, my PhD was on leaky gut. I spent the better part of five years reading every single article on intestinal permeability. What I can say here is intestinal permeability, it isn’t a syndrome, it is not a condition. It is not a syndrome. It is a reaction, okay? It’s a reaction that can occur within the gut, so disassembling tight junctions within the small intestines. 

Lindsey:

Is it everything, or is it a driving factor? 

Dr. Brad Leech:

I believe it’s a driving factor, rather than the sole focus that we as practitioners need to give it. Many things can drive up intestinal permeability, particular medications, microbes in the gut, stress can be a massive one. And I used to say gluten was a driving factor for leaky guts. But the research actually has come out to say, no, it’s not an independent driving factor for leaky guts. And I know many people would be like, hold on, what are you saying here? And even a colleague of mine, Dr. Fasano, who discovered Zonulin, is in agreeance with this, whereby, in the early days, we did these studies with a cell line, where we had individuals with celiac disease, non-celiac gluten sensitivity, Crohn’s disease and healthy individuals. And we added a bit of gluten to all of these cell lines, and permeability increased. But now we’ve got actual clinical studies where we had individuals and we gave them gluten to determine whether or not that resulted in permeability, and they didn’t always increase permeability.

There’s a few exceptions to the rules. It appears that there’s this threshold with the amount that you can tolerate. So it’s about equivalent to a tablespoon or two of gluten. So that’s not a gluten product, but of actual gluten. So around that 15 to 18 grams of actual gluten, which is about two pieces of toast. Yeah, but those with the celiac genes had greater permeability even if they didn’t have celiac. So I’m always looking for those celiac genes and recommending gluten free. In that case, there are some conditions like Hashimoto’s, inflammatory bowel disease, and non-celiac gluten sensitivity. And many others where I’d be advising a gluten-free diet. 

But what I do focus on is when you eat gluten and you have clinical symptoms- Why is that ? Is it the fructans? Is it the glyphosate? Is it what else is going on in that product that is driving up those clinical symptoms, and the goal in some of my patients is to actually bring grains back. And I know, for years we’ve been saying grains are the devil, but I guarantee, if you look at someone’s microbiome who’s avoiding all grains, it is a terrible microbiome. It is a starving microbiome. It’s got really high mucin-degrading species in the gut, because there’s not enough fiber in the diet. It is very difficult to get enough fiber purely from plants, sorry, purely from vegetables. So we need to be considering grains. They could be gluten-free grains, by all means, or they could be gluten-containing grains, but I just, I thought I’d throw that out there as a bit of a novel approach around leaky gut.

Lindsey: 

Yeah, so how are you diagnosing the non-celiac gluten sensitivity then?

Dr. Brad Leech:

Well, that would be through clinical symptoms, but then we also will utilize particular pathology in the bowel. So you would utilize stool’s zonulin as a marker for permeability, along with hexa-LPS and butyrate as indications for that bowel integrity. I’ll also utilize hydrogen sulfide producing species to indicate whether or not there’s permeability as well.

Lindsey:  

What is the relationship between the hydrogen sulfide ones and permeability?

Dr. Brad Leech:

So hydrogen sulfide, the research, shows that it can actually break apart those mucin bonds in the gut, and it can actually be a driving factor behind the intestinal permeability.

Lindsey: 

Oh, okay, yeah. So I used to be gluten free because I had Hashimoto’s, but I was completely reversed that my antibodies have been at zero. And finally, slowly but surely, more and more gluten comes back into my diet. And I’m just like, am I killing myself here? But I feel I’m okay.

Dr. Brad Leech: 

You know what? Monitor the antibodies.

Lindsey:  

I did for five years, I was getting more and more gluten, and still was staying zero, still zero.

Dr. Brad Leech:

Yeah, yeah, a little bit is fine, especially if it’s a sprouted gluten or a fermented sourdough.

Lindsey:  

I like fermented sourdough with organic flour. 

Dr. Brad Leech:

Fantastic. With some avocados, some poached eggs. I love it. Yeah, exactly.

Lindsey:  

Okay- one more question-How do you seal up a leaky gut?

Dr. Brad Leech:  

That is a great question. So part of my PhD, we published the clinical practice guidelines for the management of intestinal permeability [see bottom on page], where we looked at over 22,000 research studies on the management of intestinal permeability, we evaluated them for their evidence, their risk of bias, their accuracy, and we narrowed down to our treatment recommendations. And you can download this full guide from our website, free of charge, and it’s got all of the recommendations that we have made to practitioners when it comes around to managing intestinal permeability in relation to when to avoid gluten, when to consume gluten, probiotics, prebiotics, everything in between. What I would say are the top interventions based on the research, it would be zinc, glutamine* and S Boulardii. And I know that’s not new or novel to anyone, but they’re the ones that have the highest amount of evidence to show that they are effective when it comes around to healing and sealing the gut.

Lindsey:  

Okay, so zinc carnosine*, or just any kind of zinc?

Dr. Brad Leech:

Carnosine, yes, around that 25 milligrams.

Lindsey:  

Okay, and, and what is the dosing on the glutamine? Because that’s a subject now.

Dr. Brad Leech:

It’s a controversy as well. Most supplements do not contain enough glutamine. Generally speaking, it’s around five to 15 grams of glutamine per day. Now, most patients can tolerate five grams, no problems. I had a patient just this week email me to say that they had then gone on to increase to 10 grams, and their neurological issues started going through the roof. So we’ve got that issue with too much glutamine. It can go down that pathway. It can be neuro stimulating, and can actually cause anxiety, rapid heart rates and other impacts like that. So yes, the research studies are actually saying five grams three times daily. But in a lot of patients, it’s difficult to get to that dose. If I really feel it’s needed, then I would be coming in with things like L-theanine, magnesium, or even NAC to counteract the negative impact of high dose glutamine.

Lindsey:  

Okay, and you were talking about SB, that’s Saccharomyces boulardii, right? 

Dr.Brad Leech:

That’s correct. 

Lindsey:

Okay, I find that that’s a good ongoing one, a good probiotic to have for protection.

Dr. Brad Leech:

If you’re going overseas, great. Take it. If you might need antibiotics, take it. It’s a great product.

Lindsey:  

Yeah, it was, it was on my kind of list of stuff that I always took, and so many other things found their way onto my list of things. I mean, I take 30 supplements a day because I’m just a giant guinea pig for everything, and everybody sends me free supplements. So anyway, it fell off the list. And then, I started having diarrhea. And I’m like, what’s going on? I need to go get some Saccharomyces boulardii. 

Dr. Brad Leech:

Just go back with the old friend, great for loose stools. What I have noticed in some individuals, and this only happens to about 10%, is constipation. If you can take SB, in some individuals, you can develop constipation.

Lindsey:

Yeah, yeah. Okay. Well, this has been awesome. So much good information. I really appreciate your time and your knowledge sharing is fantastic.

Dr. Brad Leech:  

And I’ve thoroughly enjoyed all the questions and all the topics we’ve discussed. 

Lindsey:

Awesome. Thank you so much.

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.

Adapted from episode 154 of The Perfect Stool podcast and edited for readability with Lindsey Parsons, EdD.

Today I’m tackling a topic that’s everywhere you look: supplements. You walk into any health food store, you look around online, and you’re hit with an overwhelming selection of supplements and marketing for every possible condition from boundless energy to eternal youth. Most people don’t want to take 150 supplements a day like Dave Asprey says he does, so this podcast is just a beginner’s guide to what I think are the basics and non-negotiables, whether you have gut health issues or not. 

My goal today is to help you move from a “shotgun” approach-where you’re just grabbing bottles off a shelf or following the best online marketing hoping something works-to a more targeted, foundational approach. 

Now before we get into the bottles and the capsules, let’s start with the most important point. Supplements are the icing on the cake, but your diet and lifestyle are the cake itself. Without a solid, nutrient-dense diet, the best supplements in the world are just a band-aid on a bigger problem. You can’t out-supplement a diet of ultra-processed foods, high sugar or a lifestyle of chronic stress, lack of exercise, poor sleep or loneliness. 

So, the first step for anyone on this journey is to clean up your plate. Focus on whole foods, lots of colorful vegetables, quality protein, healthy fats and complex carbohydrates, meaning whole foods beans, legumes, whole grains and starchy veggies, mostly other than potatoes. 

Make sure you’re exercising, including both strength training and cardio, ideally with some high intensity interval training sprints mixed in. If your sleep is less than optimal, usually the problems start before you head to bed, so start figuring out how to bring in better sleep hygiene practices, and back your day up to allow you to go to bed early enough to get a solid 7-8 hours. 

If you’re lonely and don’t have good social relationships, and this is a tough one I understand very well, sometimes you have to be the person who initiates these things. I’ve started ethnic dinner clubs by putting the word out on NextDoor, hosted game nights, started a monthly poker night, started book clubs, joined and hosted Meetup events and coincidentally, tonight I’m hosting a cocktail party for my new neighbors, as we moved to a new street about 3 months ago. We just made flyers and an Eventbrite page and taped the flyers to our neighbor’s doors. We made several new friends this way in our prior house. Whatever your interest, you can find others who join in and meet people that way, but it does take a concerted effort, especially if you just moved into a new town, for example. 

So once your diet and lifestyle base is solid, then we can look at strategic supplementation to fill in the gaps and optimize for longevity, immunity and overall wellness.

Vitamin D/K

So the first and most non-negotiable “icing” for me, especially in the northern hemisphere, is Vitamin D. It’s not just a vitamin; it’s a pro-hormone, and its role in the body is far more extensive than most people realize. We’ve long known it’s crucial for bone health because it helps the body absorb calcium, but we’re now finding that its influence on immune function, mood regulation, and even gene expression is profound.

It’s called the “sunshine vitamin” for a reason. Our primary source is sunlight exposure, which for many people, especially in colder climates or those who work indoors all day, is just not sufficient. Honestly, I have yet to see a single client who had sufficient vitamin D levels without supplementing. Low Vitamin D levels are linked to everything from weakened immunity, greater rates of autoimmune disease, increased risk of illness, in particular, higher rates of ICU admission and mortality with Covid, muscle weakness and even depression. For good health and longevity, it’s a non-negotiable and if you were only willing to take one supplement, other than a multi including D, I’d choose this one.

Now, you might be asking, “How do I know my Vitamin D levels?” This is where testing becomes crucial. The standard and most accurate test is the 25-hydroxy vitamin D blood test. It’s a simple blood draw that gives you a snapshot of your current levels and most doctors will run it, but only if you ask. Most labs will give you a range: anything below 20 ng/mL is considered deficient, and anything from 20 to 30 ng/mL is considered insufficient. But that level is in fact way insufficient. For optimal health and longevity, a growing number of experts recommend aiming for a level between 40 to 80 ng/mL (I aim for 50-80 ng/mL based on the Genova Lab optimal ranges). This range is associated with better immune function, lower risk of many chronic diseases, and overall greater health. Most people need something in the range of 4,000 to 5,000 IUs of Vitamin D3 daily to maintain those levels, but getting your levels tested is the only way to know for sure if you’re hitting that sweet spot. 

If someone is really low to begin with (like below 35), you can also do a loading dose of 10,000 IU/day for a month to catch up. Now make sure to always take your Vitamin D with Vitamin K. Why and which form you may ask? I like mk4, menaquinone-4, a form of vitamin K2 your body can make from K1 (which comes from leafy greens, by the way) using GG (geranylgeraniol). Unlike mk7, which is made by gut bugs in the colon, mk4 is the form your own tissues build and use and it’s found across ~25-30 organs (bone, vasculature, brain, etc.). Its superpower is it activates vitamin-K–dependent proteins by carboxylation. So, Vitamin D upregulates the production of bone and vessel proteins (e.g., osteocalcin for bone mineralization, MGP for keeping calcium out of arteries). And, mk4 switches them “on” and activates those proteins so they actually bind calcium correctly. In short, D without enough K2 (ideally as mk4) can push calcium without proper traffic control, raising the risk it lands in soft tissues. In other words, taking D plus mk4 ensures calcium goes to your bones and teeth, not to your arteries creating calcification, or kidneys, creating stones, in particular if you’re also supplementing with calcium. I like Seeking Health’s D3 + K2 Drops and Designs for Health’s Vitamin D Supreme (which has both K2mk7 as well as K2mk4). 

B Vitamins

Next up, let’s talk about the B vitamins. These are a family of eight essential vitamins that are crucial for cellular energy production, brain function and overall metabolism. I have yet to see a single client who was not deficient in B vitamins without having taken either a multivitamin or a B complex. Think of them as the tiny cogs that help everything else in your body run smoothly. The problem is that our diets, even healthy ones, can sometimes be low in certain B vitamins, and some people have genetic factors that make it harder for their bodies to use them. When people started processing grains and removing the outer shell and the germ, we removed lots of the common sources of B vitamins from our diets, hence why flour is often enriched with B vitamins, but typically the cheapest and least bioavailable kinds. And for people on gluten-free diets, which seems to be the majority of people I see with gut health or autoimmune issues (which is recommended by the way), even that source of B vitamins is eliminated. 

This brings us to a key distinction: methylated versus non-methylated B vitamins. The term “methylated” refers to the body’s ability to convert a vitamin into its active, usable form. For example, the B-vitamin folate, or B9, in its standard non-methylated form is called folic acid. But for your body to use it, it has to convert it to the active form, L-methylfolate. Some people, due to a set of common genetic variations grouped under the name MTHFR, have a harder time with this conversion process, and something like 60-70% of Americans have a variant allele of MTHFR, so most people can safely assume they’ll be better off with methylated B vitamins. 

So the form you’d be looking for is L-5-Methyltetrahydrofolate, which may be listed as L-Methylfolate (5-MTHF) or (6S)-5-MTHF or under the trademarked names Quatrefolic® or Metafolin®. But if you see MTHF or the word methyl, you should be good and should be getting the fully active, methylated form your body uses right away for neurotransmitters, homocysteine balance and methylation. Another form, folinic acid (5-formyl-THF) is a natural, active form that bypasses MTHFR but doesn’t directly provide methyl groups; it’s often used in cancer therapy, fertility, or when someone needs gentler folate support or has some uncommon SNPs such that they don’t do well with methylated B vitamins. 

The same issue applies for Vitamin B12 and the MTR and MTRR mutations. For the majority of people who have these SNPs, taking methylcobalamin, rather than cyanocobalamin for B12 is very important. Furthermore, lots of people who have gut issues, especially issues affecting the stomach, like gastritis or low stomach acid or H. pylori, will likely have impaired absorption of B12 in the stomach, so you may do better with a sublingual lozenge, or if your levels are low enough, a shot of methylcobalamin. If you test low on a traditional blood tests for B12, then you’re really low, as that’s one of the last markers to go south when you’re getting low. Methylmalonic acid is a better test, if you can get it, and will show a deficiency sooner. 

Of course your basic blood test called the CBC may show elevations in MCV, MCH or MCHC if you are deficient in B12 or folate. Incidentally, when I was finding out about all my health issues in around 2014, I had such low B12 that I had the common symptom of deficiency – tingling in my hands and feet – and my level on a standard B12 test was 124 on a scale of like 240-900, which was described by my hematologist as a level that could cause sustained neurological problems, although thankfully that didn’t happen, so if you have that tingling, get checked out. For someone who is deficient and has possible absorption issues, or vegans, as you get most of your B12 from animal products, a 1000 mcg (1 mg) sublingual methylcobalamin is a good choice. Or if you don’t think your absorption is compromised, just pick a good B complex with 100 mcg to 1000 mcg of methylcobalamin and at least 400 mcg of methylfolate – just make sure that between any multivitamins and B complexes, you don’t overdo the folate – the daily recommended maximum unless you have an identified deficiency is 1000 mcg of folate. 

While most people do well with methylated vitamins, a small group feel overstimulated, anxious, irritable or get headaches when taking high doses of methylfolate or methylcobalamin. This isn’t super common, but it does happen in people who are “sensitive methylators.” In those cases, gentler forms work better: folinic acid (instead of methylfolate) still supports folate pathways, and hydroxocobalamin or adenosylcobalamin (instead of methylcobalamin) provide active B12 without the same “methyl punch.” These forms are especially helpful for people with neurological issues, detox imbalances, or who just don’t tolerate methyl donors well. Seeking Health makes a product called B Minus which doesn’t have any folate or B12, which is sometimes useful for people in this situation who need other B vitamins but are sensitive to these two methylated forms. 

And I should also mention quickly that in looking at B complexes, there are a couple things to watch out for. Most people I see are deficient in B6, whose active form is pyridoxal-5′-phosphate or P5P. This is less crucial to get in its active form than the other two, but good B complexes have some amount of P5P in them. But a small number of people with certain genetics can overload on B6, and symptoms of that mimic those of B12 deficiency, which is tingling, numbness, burning, or pins and needles in your hands and feet. So if you started a B complex and start having those symptoms, you should stop taking it and get your B6 checked. So something in the range of 25 mg or below of B6 is safest if you don’t know your B6 genetics and haven’t shown up deficient on any test. But if you’re deficient, which is super common in anxiety and depression, as lots of B6 is used with your neurotransmitters, then you may need more like 50 or 100 mg of B6. 

Another thing to be careful of is B5 or pantothenic acid. That’s another one that you can overload on. Some people will feel wired or have insomnia with amounts as high as 100 mg/day, so I usually try to max out a good bit lower than that for most people, more like 75 mg or less. It’s a small subset of people who are under a lot of stress or have adrenal dysfunction who may benefit from mega doses of B5, like 500 mg/day, but that’s a small minority. But a good B complex will have middling doses of most B vitamins, from like 10-50 mg of most of the Bs, with 100-1000 mcg of B12 and 400-800 mcg of folate, which is often expressed in mcg DFE, which means Direct Folate Equivalents. And it’s also good to find one with some choline, which isn’t in all of them. 

Some of my favorites are the AOR Advanced B Complex (at a dose of 1/day for most people), or if you want lower B6, the Thorne Basic B Complex, if you want more B6, the Thorne B-Complex #6 has 100 mg. 

Magnesium

Next on our list of foundational supplements is magnesium. Magnesium is involved in over 300 enzymatic reactions in the body. I call it the “master mineral” because it’s a silent hero, quietly doing everything from regulating muscle and nerve function to blood sugar control, blood pressure and protein synthesis. The problem is that our soil is so depleted of minerals that even if you’re eating a perfect diet, you’re likely not getting an optimal amount of magnesium. A magnesium deficiency could manifest in a lot of different ways. People think of it for muscle cramps or twitches, but it can also show up as constipation, insomnia, anxiety, headaches, migraines or even poor energy levels. The tricky part with magnesium is that there isn’t one “best” form. The type of magnesium you take really depends on what you’re trying to achieve.

When it comes to testing for magnesium, this is where things get a little tricky. The standard and most common test your doctor will run is a serum magnesium test. The problem is, this test is often unreliable. Your body keeps only about 1% of its total magnesium in your blood, and it works incredibly hard to keep that level in a tight, normal range by pulling magnesium from your bones and tissues if needed. So, you could have a normal serum magnesium test result while still being deficient on a cellular level. A more accurate and reliable test is the RBC magnesium test, which measures the magnesium inside your red blood cells. This gives a much better picture of your body’s true magnesium stores. An optimal reference range for RBC magnesium is 4.0 to 6.4 mg/dL.

Let’s walk through some of the different types. Most people are familiar with magnesium citrate. It’s a very popular and well-absorbed form, but it has a well-known side effect: it pulls water into the intestines, which is why it’s a great choice for people who deal with constipation. I like the Natural Vitality Calm Magnesium for people who are constipated. Most people do well with 2 tsp. before bed in water, but if that’s too much and you have a blowout, back down to ½ tsp. and titrate up by ½ tsp. every two days. You can add more in the same way if you get no help at all from the 2 tsp. However, if you’re not trying to solve that problem, you might find it gives you some digestive distress.

Then there’s magnesium oxide. This is a very cheap form, often found in low-cost multivitamins. It’s a laxative as well, but its bioavailability is very, very low. The body absorbs only about 4% of it. I would generally recommend staying away from this one for long-term health, although I have found that some people, especially people with interstitial cystitis who have issues with citrates, may need to use this form instead for the laxative effect. 

For people who struggle with sleep, anxiety, or general relaxation, magnesium glycinate is fantastic. It’s a chelated form, meaning it’s bound to the amino acid glycine. Glycine itself has a calming effect on the nervous system, so when you combine it with magnesium, it’s a one-two punch for relaxation. It’s highly bioavailable and gentle on the stomach. You can’t get a ton in one pill, and you need to make sure you read the label well, as it may say 400 mg on the cover but that’s in 4 pills. So I like one that’s on Fullscript from Biospec called Mag Glycinate 510, which is 170 mg/pill or Magnesium-HP from Healthy Gut, which is 180 mg/pill. Most people need at least 400 mg of supplemental magnesium/day in a well-absorbed form. 

And for brain health, there’s a newer, more exciting form called Magnesium L-Threonate. This form is unique because it’s been shown in studies to effectively cross the blood-brain barrier. No other form of magnesium does this as efficiently. This means it can directly increase magnesium levels in the brain, which is crucial for cognitive function, memory and learning. If you’re looking for cognitive benefits and brain health, this is the one to consider. The patented ingredient is call Magtein. The main drawback of this form is that it’s not a lot of magnesium per unit consumed – with only 144 mg of magnesium in 3 pills in a total of 2000 mg of magnesium l-threonate. 

Fish Oil/Omega 3’s

Alright, so next let’s talk about fish oil. The science on the benefits of omega-3 fatty acids is overwhelming. I’m talking about EPA and DHA, the two primary omega-3s found in fatty fish. They are powerful anti-inflammatory agents. We know that chronic, low-grade inflammation is a root cause of almost every modern chronic disease, including heart disease, Alzheimer’s and cancer. Fish oil helps to put out that fire. It also has profound benefits for brain health, heart health and joint health. If you have low HDL, the good kind of cholesterol, you may be deficient. 

The market for fish oil is probably one of the most saturated. It seems like every bottle looks the same. But here’s how you pick a bad one from a good one. The biggest risk with fish oil is that it can go rancid very easily. When you consume rancid oil, you’re doing more harm than good, as you’re introducing oxidized fats into your system. So, the first and most basic test is to smell and taste it. If it smells or tastes fishy, it’s a bad sign. It should be virtually odorless and tasteless. So given I live in Arizona, I try to stock up on my fish oil in winter so it’s not going through the mail in summer. 

Beyond that, you need to look at a few things on the label. First, look for a third-party certification seal. Organizations like IFOS, which stands for the International Fish Oil Standards Program, are the gold standard. They test for purity, potency, and freshness. This ensures the product is free of heavy metals like mercury, PCBs and other environmental toxins that can accumulate in fish.

If you don’t see that certification seal, you should be skeptical. The second thing to look for is the form. You want to look for the term “triglyceride form” on the bottle. The natural form of omega-3s in fish is the triglyceride form. When they process fish oil, they convert it to an ethyl ester form to purify and concentrate the EPA and DHA. A high-quality brand will then re-convert it back to the more bioavailable triglyceride form. The research shows that the triglyceride form is absorbed by the body up to 70% better than the ethyl ester form. If the bottle doesn’t say “triglyceride” or “re-esterified triglyceride,” it’s probably the less-absorbed ethyl ester form.

So, you could be taking a fish oil supplement for years, thinking you’re getting the benefits, but if it’s the ethyl ester form, your body isn’t absorbing much of it. It’s the kind of thing that can make the difference between a supplement that works and one that just gives you expensive burps. A good daily dose to aim for is at least 1,000 to 2,000 milligrams of combined EPA and DHA. I like Nordic Naturals’ ProOmega 2000 for this as it has 1000 mg of EPA and DHA in one pill and always smells lemony and pleasant and doesn’t give you fish oil burps. 

Just like with Vitamin D and Magnesium, your body’s Omega-3 status is highly individual. The best way to measure it is with a specialized blood test called the Omega-3 Index. This test measures the percentage of Omega-3 fatty acids, specifically EPA and DHA, that are incorporated into your red blood cell membranes. It’s an incredibly accurate way to see what your body has actually absorbed and is a strong biomarker for cardiovascular and brain health. An Omega-3 Index below 4% is considered a high-risk zone. A score between 4% and 8% is the intermediate zone, and for true longevity and optimal health benefits, you want to be in the low-risk or optimal zone, which is a score of 8% or higher. The test is typically a simple finger prick you can do at home and send to a lab, making it very accessible.

Vitamin C

Another basic vitamin that most people need more of is vitamin C. For people who aren’t constipated, 500-1000 mg/day should be sufficient, ideally in a buffered form. Perque C Guard is one of the best absorbed and the one I recommend the most. If you’re constipated, you may want to use vitamin C to help loosen things up, so you can usually handle 1000 mg a few times a day. 

Prebiotics

Now, let’s pivot to the gut. The microbiome is a huge topic in health and longevity. What role do supplements play there? This is where we need to be very careful. Most people jump straight to probiotics, but that can be a mistake. I’d argue that the more foundational supplement for gut health is a prebiotic fiber. Think of your gut microbiome as a garden. Probiotics are like putting new seeds in the garden, but if the soil is poor and there’s no food, those seeds won’t grow and flourish. Prebiotics are the fertilizer. They are non-digestible fibers that feed the beneficial bacteria that already live in your gut.

So, prebiotics feed the good bacteria you already have, while probiotics are introducing new bacteria. We have trillions of bacteria in our gut, and their composition is highly individual, like a fingerprint. Taking a random probiotic with a few generic strains might not be the right fit for your unique microbiome. In some cases, it can even cause problems. For example, if you have SIBO, or Small Intestine Bacterial Overgrowth, taking a probiotic may make your symptoms of gas, bloating and discomfort much worse.

Some people who try probiotics say they felt even more bloated. When you introduce a lot of new bacteria into an already imbalanced system, it can disrupt the delicate balance and lead to an overgrowth. It’s much safer to focus on feeding the bacteria that are already there and healthy. If you’re going to use a probiotic, it should be targeted and personalized, ideally after a stool test that can give you a clear picture of what’s going on in your gut. But for the vast majority of people, starting with a good prebiotic fiber supplement is a safer and more effective way to improve gut health. So if you’re not eating your adequate intake of fiber, which for men 50 and under is 38 grams a day, men over 50 is 30 grams, women 50 and under is 25 grams/day and women older than 50 is 21 grams a day, then you should consider a supplement, or increasing significantly the amount of beans and lentils you eat, which are some of the highest fiber foods. 

Some of the most important prebiotic fibers, which feed your butyrate-producing microbes and your bifidobacteria, microbes essential for good gut health, are inulin, psyllium husk, partially hydrogenated guar gum or PHGG, aka Sunfiber, apple pectin, beta glucans, rice bran (or other types of bran like oat or wheat if you tolerate those) and acacia fiber. Which fiber brings up which gut microbe is a whole other podcast topic, and I usually target fibers based on the content of your microbiome. But given that butyrate is an incredibly important molecule for colon health, reducing inflammation and strengthening the gut barrier, I’m often targeting low levels of butyrate producers. But just a brief note to say that not all of these fibers are thick and gooey. Some mix really well into water and drink down easily. So I’ve been enjoying acacia fiber like this as well as Thorne Fibermend, which has a combo of fibers including PHGG and apple pectin. Some fibers, like psyllium husk, are better added into smoothies to disguise the texture or flavor. You can also get prebiotics from food sources of course, like onions, garlic, leeks, bananas and asparagus. A supplement just makes it easier to get a consistent, effective dose. And if you’re going to make a smoothie and add fiber, you might want to add some polyphenols, compounds found in pomegranate, cranberries and blueberries (think rich bright colours) that are poorly absorbed in the small intestine so up to 90-95% pass into the colon mostly intact.

Your gut microbes metabolize them into smaller compounds (like phenolic acids, urolithins, etc.) that have anti-inflammatory, antioxidant, and metabolic benefits. For example, cranberry and pomegranate fruit, powders or concentrates feed Akkermansia and blueberries increase the population of beneficial Bifido and lactobacillus species. Polyphenols act like “prebiotics” by feeding and favoring beneficial bacteria while inhibiting pathogenic ones.

So, the hierarchy is: clean up the diet first, add a prebiotic for the gut, and only consider a probiotic if you’ve done a test and know what strains you need.

Creatine

Now, what about some of the more advanced or less-known supplements that have been getting a lot of attention for longevity lately? There are a few that I think are worth mentioning. One that I’m a big fan of is creatine monohydrate. Many people think of creatine as a supplement for bodybuilders and athletes, and while it’s fantastic for muscle strength and power, its benefits for longevity, particularly for the brain, are incredibly compelling. Creatine provides a quick source of energy to cells, including brain cells. Research has shown that creatine supplementation can improve cognitive performance, especially in older adults and those with a plant-based diet, as they often have lower baseline creatine levels. It’s also been shown to help with age-related muscle loss, or sarcopenia, which is a major concern for longevity.

So it’s not just about building big muscles; it’s about keeping our muscles and brains strong as we age. A typical dose is 5 grams a day, and it’s easy and tasteless to mix into a cold or hot drink. 

Curcumin

Another one I’d mention is curcumin, which is the active compound in turmeric. Its primary benefit is its powerful anti-inflammatory and antioxidant properties. Inflammation is at the root of so many age-related diseases, and curcumin can help modulate that. The key here is absorption. Curcumin on its own is very poorly absorbed by the body. So you need to look for a supplement that has been formulated for enhanced absorption.  

Traditionally, it was known that combining it with piperine, which is the active component of black pepper or taking curcumin with fat enhances absorption. However, recently there are several new delivery systems that have entered the market. Some of these are: phytosomes (e.g., Meriva), which is curcumin bound to phospholipids, which gives it significantly better uptake; nanoparticles, micelles or liposomes, which are tiny particles that improve solubility and stability in the gut, for example, Theracurmin, which has submicron particles designed for superior absorption or BCM-95, which has curcumin and turmeric essential oils, shown to enhance absorption. Just note that high doses of curcumin may block iron absorption, so if you’re prone to anemia, take it away from food. Or if you have genetics for iron overload, take it with your steak!

CoQ10

One more supplement that people commonly need is Coenzyme Q10, or CoQ10. This is a powerful antioxidant that your body naturally produces. It’s a key player in the process of generating energy in your cells’ powerhouses, the mitochondria. Think of it as a vital spark plug for your body’s energy production. Our natural production of CoQ10 declines as we age, and this is one reason why it’s a popular supplement for heart health and anti-aging. If you’re over the age of 40 or taking a statin drug, which can deplete CoQ10, supplementation is something you should definitely consider. The two forms are ubiquinone and ubiquinol, with ubiquinol being the more bioavailable form.

Tocotrienols

Another important supplement most people don’t know much about is tocotrienols. Vitamin E has two groups of compounds called tocopherols and tocotrienols. The tocopherols are more known, and typically the form you’ll find in most multivitamins. While some studies have shown that over-supplementation of certain forms of Vitamin E can lead to negative outcomes, tocotrienols, which are found in palm, rice bran and annatto, are safe to supplement long term, and have shown huge benefits in the areas of fatty liver, brain health, cancer prevention and outcomes, cholesterol reduction and LDL clearance from the blood. Check out episode 89 with Barrie Tan to learn more. Some people are sensitive to annatto, so if you’re one of those people, palm tocotrienols will be a better choice for you. Otherwise, the annatto ones are preferable. 

Most people don’t need huge amounts of tocotrienols if they eat nuts, seeds, and healthy oils. But supplementation can make sense in some cases, such as low-fat diets or fat-malabsorption conditions like Crohn’s, cystic fibrosis, celiac or bariatric surgery, if you have a very low intake of nuts and seeds, if you have a metabolic or inflammatory conditions like fatty liver, high cholesterol or insulin resistance, for skin or eye concerns, including oxidative stress, eczema or age-related macular degeneration, or if you have a high oxidative stress load, for example, smokers, environmental toxin exposure, intense endurance athletes. When the folks from the DNA company came on my podcast, because I have familial hypercholesteremia, he recommend tocotrienols for me as part of my lifetime stack. 

Multivitamins

Finally, I usually recommend that most people take a multivitamin just to cover their nutritional bases. A good multi should have all your vitamins such as A, D, E (rarely tocotrienols; usually d-alpha tocopherol or mixed tocopherols), K, C,  along with methylated B vitamins, and minerals, including magnesium, calcium, zinc, copper in some cases, selenium, manganese, iodine, chromium and molybdenum. Some also have iron in them but make sure to take it only if you have an iron deficiency, as excessive iron can cause inflammation in the body. Some of my favorites are made by Pure Encapsulations. If you want one with everything in it, including all the D and K you’ll need, try their PureResponse Multi, which provides everything in 2 pills, or their O.N.E. Multivitamin, which provides everything, although only 2000 IU of D, in 1 pill/day. Or if you’re looking for a multi that provides vitamin E  in the form of tocotrienols, you should check out Designs for Health’s Twice Daily Multi. 

Note that none of these multis I just mentioned have any copper in them. For some people, it’s important to take copper with zinc in order to prevent the zinc from pushing down copper levels. If you start a multi and have issues with fatigue, then you may need to pick one with copper or get your copper and zinc tested to make sure everything is in range. Ideally, you want your zinc on the top half of the reference range and your copper on the lower end. But if you eat nuts and seeds and keep the zinc to 15 mg/day or below, you’re unlikely to end up deficient in copper. 

So, to bring it all back to the beginning, it’s about building a solid foundation first. We can’t use supplements as a shortcut. Supplements are not a magic pill. They are a complement to a healthy lifestyle. The first five steps are always a whole-foods diet, regular physical activity, prioritizing sleep, managing stress and having good social connections. But once you have those pillars in place, strategic and targeted supplementation, guided by personal data from tests like those we’ve discussed, can be the key to unlocking an even higher level of health and longevity.

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.

Adapted from episode 153 of The Perfect Stool podcast and edited for readability with your host Lindsey Parsons, EdD and Dr. Greg Nigh, Naturopathic Doctor and author of the book The Devil in the Garlic: How Sulfur in Your Food Can Cause Anxiety, Hot Flashes, IBS, Brain Fog, Migraines, Skin Problems, and More, and a Program to Help You Feel Great Again.

Lindsey:    

So when I did an intro call with Dr Nigh, we ended up talking at length about deuterium depleted water and how important he thinks this topic is to gut health and human physiology, and he has articles out on the topic with Stephanie Seneff, a well-known glyphosate researcher. So I promise we’re going to get to sulfur and hydrogen sulfide SIBO-related topics. But I think if we don’t start here, you’ll take me there anyway. So can you start us off with what deuterium and deuterium depleted water are?

Dr. Greg Nigh:    

Gosh, so let’s start with what deuterium is, and I suspect a lot of your audience knows, but just to make sure it’s clear, deuterium is an isotope of hydrogen, which is to say it’s basically the same as hydrogen. But it’s got a neutron in the nucleus, which regular hydrogen doesn’t, and that makes deuterium heavy. So people might have heard of heavy water, and that just means water that uses deuterium isotopes as the H’s, so it just weighs more. So the thing is, deuterium is everywhere. It is ubiquitous in our environment. It’s in all the water we drink. It’s in the food that we’re eating. It is constantly coming into us, but that’s a problem because deuterium doesn’t behave like hydrogen when it’s in the body. And so our bodies have pretty amazing mechanisms in place to be sure that deuterium doesn’t gunk things up. And what I think is true is that a great deal of modern maladies, if you go to the root, have to do with deuterium getting in the way of normal cellular function. Did I answer the question?

Lindsey:    

Yeah. So does this have anything to do with oxidative stress, or is this unrelated?

Dr. Greg Nigh:    

It’s all kind of related. Certainly, you know, obviously normal cell physiology has all kinds of reactive oxygen species that are getting created, and now we know that those are signaling molecules. They’re not just bad. And then things could get tipped into an excess of oxidation, which then we call a stress. And so the processing of deuterium is in a balance with the oxidation state of the cell. So if deuterium gets dysregulated within the cell, so just to give you a quick example, we know that the mitochondria is the powerhouse of the cell, and hydrogen get funneled to the mitochondria, which ultimately pass through that ATPase pump, spins the pump, creates ATP. That fuels pretty much everything about physiology. So the thing is, those are hydrogens that go through that pump, it’s literally like a funnel, and every time one goes through, it spins the funnel. If a deuterium makes its way to the mitochondria and goes through that pump, it binds to a protein in that pump and causes the pump to sputter, and so it impedes the efficiency of the pump, and so the more deuterium that make its way to the mitochondria, the more it is clogging up those ATPase pumps- not only compromising the ability of the cell to generate energy, but in the process, generating extra free radicals. This enhances the level of oxidation that’s being generated within the mitochondria. And of course, that ricochets all over the place, creating problems.

Lindsey:    

Okay. Now, just for clarity’s sake, because there’s so many other types of water out there that people are talking about – does this have anything to do with hydrogen water or alkaline water, or what other types of water?

Dr. Greg Nigh:    

Structured water, and yeah, all of that, which all may very well have beneficial physiological effects, but they are not the same as deuterium depleted water. Depleting those isotopes out of water is a very intensive industrial process, which is why there are only a few companies in the world that are doing this for retail sales. So, yeah, if you look up, like probably on YouTube, there are some videos about how to make it in your kitchen. It ain’t real – it’s not a thing. Unfortunately, you have to buy deuterium depleted water. Now, what I will say about hydrogenated water and we’re going to end up talking about this when we come back to the gut, hydrogen gas is inherently depleted in deuterium. So when you bubble hydrogen gas and dissolve it into water, one of the consequences of doing that, and maybe one of the reasons it’s beneficial is that you are enhancing the number of hydrogen relative to deuterium within the water. So in drinking that water, you’re supplying hydrogens and less deuterium. It’s not taking deuterium out. It’s just making hydrogen more present.

Lindsey:    

Yeah and does that also work if you’re taking a tablet and putting it into your water, is that same thing? 

Dr. Greg Nigh:    

Yeah. 

Lindsey:    

Okay, interesting. So now let’s get into how deuterium depleted water relates to gut health or deuterium itself.

Dr. Greg Nigh:    

Okay, so, and keep in mind this was all discovered or uncovered in the past eight months. It’s very, very new. So this is something that Stephanie initially got me keyed into. She published a few papers on the topic, and then we recently published a paper together that’s right now going through peer review. So we have this fundamental truth, which is that the body needs to be very careful in what it does with the deuterium that is always coming in. And I am to a fault in many ways, and Stephanie and I are very much aligned in this way, in thinking that bodies are adaptive to almost an absurd extent; everything is to help us function normally. And what has become apparent as we get into the chemistry and physics of this stuff, which of course, Stephanie is way beyond me and all of that, is that the microbiome, human microbiome, the gut microbiome, is a sieve.

So all of the food and water that we’re taking in, which has deuterium in the water that we drink, deuterium is present at about 150 parts per million, and in food. So all of those carbohydrates have all those hydrogens attached, well, some portion of those hydrogens attached to carbohydrates are deuterium. They’re not hydrogen. Ditto for protein and fat. But in terms of deuterium content, carbohydrates have the highest deuterium content, protein is next, and fat is the lowest. Okay, so we’re drinking our water or whatever liquids we’re drinking, deuterium’s in all of that. We’re eating our food, deuterium’s in all of that. And if that deuterium makes its way into peripheral physiology (cells doing what they need to do,) it’s going to cause problems if it’s not taken care of. 

So the first line of filtration is these trillions of bacteria in the gut that have enzymes in place. It’s like they’re sniffing all the molecules coming through. And if they spot a deuterium, there are enzymes that play two roles. One is that when water or food comes in with all these hydrogens, those hydrogens get plucked off and utilized for all kinds of reactions throughout the body. But those enzymes are very careful. That is, they’re plucking off hydrogen. If they grab a deuterium, they let go. They won’t utilize the deuterium. They leave it there so that it never gets used down the road for something else physiologically. So that’s one way that it prevents deuterium from getting into reactions further in the body. What then happens, the deuterium-enriched stuff is left behind because you’re leaving it behind. Well, it just so happens that there are several kinds of bacteria that actually grow better with deuterium. They like an enriched deuterium environment, which is great, because they can sop up deuterium that’s present. What bacteria? E. coli, Clostridia, the kinds of things that we commonly see as dysbiotic bugs when we do the testing. They actually do better when deuterium is left behind. So if there’s more deuterium coming in, there’s more to leave behind, and you need bacteria there that can tolerate that. So that is one way that the bacteria are scrubbing the incoming molecules. 

A second way, and this is really the main focus of the paper that we just wrote, is that there are certain molecules that will trap deuterium. So an example would be collagen, or, more specifically, proline. So proline is out doing what it’s doing, but if it encounters a deuterium, it will put it in a pocket and hold on to it. And this is why, then proline goes on to build collagen. Collagen is actually enriched in deuterium, because it’s associated with all the proline, and there’s a whole hydration shell around collagen, which is a whole other story. But the point is that collagen and other organic molecules, essential fatty acids, are able to do this as well, if they are out there doing what they do. But if they encounter deuterium, it’s like a mouse trap. It will snap it into place, and then it will be excreted. 

There are also enzymes that will trap deuterium. And it’s like they have these other enzyme things that they’re doing. But if they encounter deuterium, they trap it, they shut down. They don’t do any more of their enzyme activity, and they get excreted. Carotenoids are another example. They will trap deuterium. And so there are these various molecules that are in our gut that are hanging out in our gut doing their molecule thing, proteins and various enzymes that are doing whatever it is they do. But if they encounter deuterium, their enzymatic activity stops. They trap the deuterium, and they get excreted. So it’s this way of making sure that whenever deuterium is encountered, it is gotten rid of.

So on the one hand, are the enzymes that are making sure not to use deuterium as they pluck hydrogens off, and on the other end are these other molecules that are constantly on the prowl for any deuterium that is left behind, they trap it and they get it out so that it can be excreted and thus not get into peripheral metabolic activity. So the gut is like this first line of defense in preventing an accumulation of deuterium. And what I believe to be true is that what we call dysbiosis, you know, to come out a different way- I don’t think bodies do anything to just piss us off; they’re doing what they’re doing in order to fix a problem.

Now, there are exceptions, I understand that. But for the most part, I think that bodies are trying to fix a problem, and I think that a good case can be made that what we are calling dysbiosis, ‘dys’, meaning it’s functioning wrong, is maybe not “dys”,  maybe it’s adjustments in the microbiome that allow it to do things more efficiently, things that need to be done. And so, there are with SIBO, the classic- the hydrogen and methane and hydrogen sulfide, all of those. All three gases are deuterium depleted gases, the enzymes that are creating those gases make sure that those gases are deuterium depleted and the hydrogens that are associated with those gases then go on to be used in various ways, like the bacteria are making hydrogen sulfide. Well, those H2 on the sulfur are not deuterium, they’re hydrogen. And that’s very important, because hydrogen sulfide is going to go on to be oxidized into sulfate, which is, of course, the body has to have access to sulfate all the time, and it needs that sulfate to be deuterium depleted, because otherwise it messes up the various things that it’s supposed to be doing in the body. 

Ditto for the hydrogen gas that is being created in the gut, which you know, is like, oh, how do we kill the bugs that are making all this hydrogen gas? Maybe the body needs more access to hydrogen, meaning that there’s too much deuterium around. You need more hydrogen to be involved because hydrogen gas just dissolves through the gut wall and gets in circulation. It delivers hydrogen throughout the body for all kinds of metabolic reasons. 

So I forget where I started on this. But the point is that what I think is true is that the gut is constantly working with us to manage a deuterium problem in generating not only those gases, but the gut is constantly generating the short chain fatty acids – butyrate, propionate, acetate, all three of those are deuterium depleted. The bacteria that are generating them have enzymes with a very high what’s called a KIE, kinetic isotope effect. And that means you’ve got to transfer hydrogens to stick them on to the molecule building butyrate, for example. If they grab a deuterium instead of a hydrogen, they won’t use it. They will only be using hydrogen. So all of these short chain fatty acids that our gut is making for us, bless their heart, those are deuterium depleted fatty acids that are then delivered around the body, supplying hydrogens for all kinds of metabolic needs. So that’s kind of the overview of what I think guts are up to. 

Lindsey:    

Okay cool. So does that make sense then, if you think about the fact that people often get overgrowths of things like E coli or C Diff or whatever, when they eat bad diets full of processed carbohydrates and sugar and such.

Dr. Greg Nigh:    

Yeah, absolutely. I mean something that has always mystified me as a practitioner – so people come to me and say they test positive for hydrogen SIBO, and they go through treatment, and they get rid of the bacteria that are generating this excess hydrogen, not down to zero, but they dramatically reduce that population. And then they take all the right probiotics, and they eat the right diet, and they meditate, and they do all the right things, and two weeks later, those bugs are back. They’re creating the same symptoms again. And ditto for people with methane or sulfur, doesn’t matter, kill the bacteria to get rid of that production, do all the right things and so commonly, people have their symptoms come back. It doesn’t make sense.

Why would the body bring those bacteria back in spite of everything we’re doing to prevent that from happening? It makes sense to me that they come back because they’re serving a purpose. They’re doing something that our body needs done. You know, our gut is not concerned that it’s making us feel bloated or whatever. That’s not the concern. The concern is to meet a metabolic need, and the microbiome is just an organ. I mean, it really is an organ in the body that is constantly adapting itself to meet the various needs – generating neurotransmitters and hormones and vitamins and short chain fatty acids and constantly generating things that we need. And it’s a factory that is always reshaping itself to do that.

Lindsey:    

So that makes sense to me in the case of someone who doesn’t have elevated vinculin antibodies. But I, for one, have post-infectious IBS with elevated vinculin antibodies. I can tell you that my stomach doesn’t gurgle hardly ever, like it’s a day for celebration when I hear my stomach gurgling, so I have no motility in my small intestine. So for me, it’s kind of obvious that the reason it keeps recurring is because the bacteria aren’t getting cleared out with the migrating motor complex. Do you not believe in that theory? Or do you think these are different questions?

Dr. Greg Nigh:    

I’m not saying that there’s no such thing as pathology associated with the gut. Certainly there are neurological issues that can slow the bowel and prevent normal kinds of motility, and all kinds of other things can happen. Certainly, it’s not a universal statement that everything happening in the gut is an adaptation. I don’t think that’s true. What I think is true is that there is a great deal of what we consider to be bad in various ways, different kinds of bacteria that are happening in the gut, and that our approach is to target the bacteria. And I think that at least in my experience in interacting with patients, is that it’s not a very successful strategy to be killing bacteria that we believe to be the underlying cause of the symptoms. That is temporary. Now, once in a while there’s a home run hit, but for the most part, and maybe they’re a biased sample, and maybe I’m just seeing the patients that it doesn’t work for, and so they come to me and say, great, what can you do? But my impression is that it’s not a winning strategy to focus on trying to manually adjust bacterial populations.

Lindsey:    

Okay, so last time we talked, you were starting some clients out on deuterium depleted water. And so I’m curious if anybody has noticed an impact yet.

Dr. Greg Nigh:    

Yes. I certainly feel like I’m still very early in this clinically, as I mentioned before. There is not a long history behind this. I have had three patients tell me that they feel like their gut is improved through this. And there are probably between somewhere around five to eight patients that have now actually implemented it, and one of the reasons not to implement it, which is an aside, is just the cost of it, which I can come back to. But in my experience, there is the modest improvement that I’ve seen with gut changes. And what I believe to be true is that it’s not a standalone fix for guts. I think that there’s other foundational kind of work that needs to be done to repair sulfur and sulfate metabolism, for example, or to adjust diets, there is a deuterium depleted diet that I think can be quite valuable for people to pursue the most dramatic change. 

I have emails with people saying, “I can’t believe how different I feel”, and that is just with general vitality, clarity and overall oomph to get through the day. I had just this last week, got an email from a patient telling me she’s 61 years old and she feels like she’s 45 years old. She hasn’t felt so much energy in a few decades. So there’s that, which I personally don’t think is just a perk. I think what that kind of change is indicating, obviously, is enhanced cellular energy production, right? I think that’s not a trivial change when you’re talking about enhancing someone’s overall health.

My hope is as more people adopt this and are reporting back to me how their guts are doing, that I’ll continue to accrue some positive feedback about that. And of course, if any other practitioners want to start implementing this, not just for gut health. I mean, personally, I think that I don’t know of any other singular therapy that has as much universal application as deuterium depleted water, because it is literally every single cell that has to deal with the deuterium problem. 

Lindsey:    

So speaking of that, I had just started because I was looking at the other article you sent me related to cancer and deuterium. And so I just Googled the question and it popped up with a systematic review of clinical and experimental trials and the second sentence is, “the clinical experiments indicated that deuterium depleted water monotherapy or in combination with chemotherapy, was beneficial in inhibiting cancer development.” So, I mean, it just seemed like a straight statement like, this is beneficial, no question. 

Dr. Greg Nigh:    

I mean it was one of those hit myself on the forehead when I realized how much information is out about deuterium as a cancer therapy. It really is shocking. There are very few therapies, and I mean, it’s silly to call it an alternative therapy, because its freaking water. I mean, that’s not all that alternative, you know, but there are so many clinical trials that are out about deuterium in cancer therapy. And it’s like, if there’s a chemotherapy that can get an additional, like, six months – one group gets this drug and the other gets the standard drug and oh my gosh, this other drug got six months longer overall survival on average. It’s like headlines. In these deuterium depleted water studies, where they have one group of cancer patients doing standard therapy and the other doing standard therapy AND drinking deuterium depleted water – it is freaking outrageous. Often the deuterium depleted water group has survival measured in years longer than the other, the group that didn’t get it. I mean, it really is quite dramatic. I think maybe even more important is with the context of people who had cancer, they do therapy, and then they get NAD where there’s no evidence of disease, and then their whole being is about preventing cancer. In that context, deuterium depleted water, there was a study that just came out. I wish I could quote the stats on it, but I’m pretty positive that in the group that was no evidence of disease, in that group that drank deuterium depleted water, there was no recurrence of cancer at all in the duration of the study, as opposed to several who had recurrence in the other arm of the study. I could get that citation to you. 

Lindsey:    

Wow, that’s great.

Dr. Greg Nigh:    

But it was very impressive when I read it.

Lindsey:    

Yeah. So big question then, how expensive is deuterium depleted water? And where do you get yours?

Dr. Greg Nigh:    

Yeah, so deuterium depleted water, I mean, I’m not advocating the different companies that make it, or anything. I happen to have established a relationship with Adrian, who’s a guy who owns a company called ExtraLightWater.com* . I actually think it’s called Hydro Health is the name of the company. But the website is extralightwater.com, so DDW is generally made, you buy it in the amount of deuterium in the water. He sells it at 50 parts per million*, 25 parts per million*, and 10 parts per million. And he tests every batch that he makes. And he just put out that his 25 part per million water was actually tested at 19 parts per million. So he’s always coming under. He won’t sell it if it goes over, but it often comes under. So for example, I just did, personally, a course of about 80 days total. I went through four cases of 25 parts per million water.

Lindsey:    

Only that, no other water?

Dr. Greg Nigh:    

Well, I drank a little bit of other water during the day, but for the most part, I mean so a case is 24 bottles through this company, and each bottle is half a liter. So I was definitely drinking some other water, but every day I had at least one, usually a little more than one bottle, so half a liter. Yeah, I would have a half a liter plus some. And if you buy it case by case, then through that company, 25 part per million is 190 bucks per case. So 24 bottles 190 bucks. You can do the math on what each bottle is. 

The way I did it, because if you do it as a subscription, you get, I think it’s 8% off. So I knew I was going to do a series of four, so I just had it automatically send me a case every three weeks, because I was drinking a little more than one bottle a day. So I would pretty much run out at the three-week mark, and that drops the price from 190 down to 172 you know, it’s still a decent amount of money. Adrian points out that if you calculate the price per bottle, there are a whole lot of people spending more than that on their Starbucks every day. So, you know, I think it works out to like a buck 80 a bottle [actually, $7.17] or something like that. I forget exactly, but it’s not cheap. It’s not something that everyone can do. 

Now, I, in my own clinical practice, have significantly reduced the number of other supplements that people are doing so that they can concentrate their spending in a more focused way with deuterium depleted water being part of that. You know, your question earlier about what I see happen with people’s guts? So I’m early in that experiment. I’ve been using it more extensively with cancer patients, because that’s where the evidence is. I mean, there’s a lot of evidence there, not only cancer, but anxiety, metabolic disease, diabetes, neurological disease. There are clinical trials with all of that. Cancer is just the situation where most of the research has been done. 

So, yeah, it ain’t cheap. So body deuterium content, and there are tests for this – if you go to deuteriumtest.com they have a saliva test. There’s another company I forget their URL, or I would give it, that has a urine test. But if you look it up, salivary testing seems to be a little better supported. So deuteriumtests.com, I think it’s 199 bucks for a salivary test, you spit in a vial, and it’ll tell you what your body deuterium level is. So our normal body deuterium level runs at around, I think it’s about 145 and that’s because we’re always trying to lower our deuterium. So we’re taking in 150 parts per million. And then we’ve got to get some deuterium out. When you drink deuterium depleted water, you’re essentially, over time, replacing your body’s water with this lower deuterium water. The goal is to lower the overall deuterium level in the body, and once you get below a certain threshold. And nobody’s really sure exactly what that threshold is, some say it’s around 130, I saw another source saying 118 is the magic number where all the genes start being activated for all the anti-cancer effect. In my mind, I’m just trying to get it as low as I can get it in the period of time that I can get people to do this. 

So generally, usually, and not always, usually, what I’m doing is have people drink two cases of 25 part per million water, and then two cases of 10 part per million water, and that gets them through about 80 days, and then take a break. By the end of 80 days, body deuterium level has dropped dramatically, drinking just one bottle a day. So I just did a test on myself recently. I did four cases of 25 part per million and did the salivary test at the end of that trial, and I was at 119 parts per million of body water by that point, which I think is a pretty decent drop. Now, I didn’t do a pretest to find out what I was at prior. It’s possible, just because of what I eat and whatever that I was not at the normal 145. I don’t know, but it was good to know that, okay, four cases of 25 can drop it down, yeah, pretty significantly. And I think with a cancer patient, I would definitely have them do those last two cases at 10 permanently and just drop it down even more. 

Lindsey:    

And how do you feel? Different, to decidedly different? 

Dr. Greg Nigh:    

You know, I wasn’t necessarily a good test case, because I don’t really have significant anything that I could use as a gauge. I mostly wanted to see what the impact would be on body water overall. And so I got that info. I mean, had good energy and but I generally am fine on that anyway. So I didn’t really have a good barometer about how it was impacting other things.

Lindsey:    

So you mentioned foods and diet that are more deuterium depleted. What kind of diet does that look like?

Dr. Greg Nigh:    

Well, unsurprisingly, it’s basically a ketogenic diet. Fat is the lowest of the dietary deuterium that we can take in. Ghee, I think, is the lowest of the oils in deuterium. Butter is way down there as well. But generally oils are low in deuterium, then protein is the next lowest concentration. Highest is carbs, and the simpler, the higher the deuterium level. So it kind of matches what we generally think about as healthy eating.

Lindsey:    

Okay, that’s interesting because I was noting every once in a while, I’ll throw all my food into Cronometer and see how my macros are falling out and am I getting enough of every nutrient and I noted that my diet was like 55% fat, at least for the couple days I was tracking it. And I thought, I am not doing that on purpose, but I’m generous with the olive oil. I love to put some of that hot olive oil on my food. I’ve got the spicy stuff. I’ve got the basil olive oil.

Dr. Greg Nigh:    

I think it’s a great way. 

Lindsey:    

But the trick is getting enough protein and doing that, and getting enough fruits and vegetables, and doing that, it’s just like I’m absorbing so many calories into fat that, how do you get the rest of the stuff you really need? 

Dr. Greg Nigh:    

Oh yeah. I agree. I think it’s stuff we all know about, sourcing food and protein, like, if you’re eating grass-fed meats and all, that’s going to be inherently deuterium depleted, just because that’s what it is. So, yeah, I think combining deuterium depleted diet with deuterium depleted water. And, in fact, I think there are studies on this. I’m pretty sure Dom D’Agostino, you know, he’s the dude who has published a lot about hyperbaric oxygen therapy, and he’s published with Tom Seyfried on ketogenic diet and all of that. And they have both, I think D’Agostino even more than Seyfried, he’s published some really impressive articles on deuterium and deuterium depletion in the diet, and I think he has published about the combination of drinking DDW and eating a ketogenic diet, and how that is like the rock star way to eat.

Lindsey:    

I have to say, it seems to work better for men than women. I don’t know a lot of women that have been able to sustain that. I think something related to our hormones.

Dr. Greg Nigh:    

Yeah, yeah. 

Lindsey:    

I mean just to say that I love carbs way too much to give them up entirely, like it’s just a non-starter. But yeah, I can say that I did it once, for like, a month, and I felt fine, but I think the quantity of fat did not agree with my gallbladder.

Dr. Greg Nigh:    

You know, what I remember is, 10-11 years ago was when Thomas Seyfried came out with his book, Cancer as a Metabolic Disease*. And I read that book, and I was like, holy crap. The book is all about ketogenic diet and kind of the metabolic effects it has on cancer. But all of his research was on brain cancer, was on pretty much glioblastoma. That was his thing, and that just happened to be the cancer that he decided to study. And it was very serendipitous that he did, because it works really well that cancer. And then it wasn’t long after that book came out, and we ended up both being at the Oncology Association of Naturopathic Physicians’ conference. We’re both talking there, and I got to pick his brain over the course of the weekend. And what I really wanted to understand was, okay, this is working really well in glioblastoma. Is there any reason, like, what are the other cancers we should expect this to work in? And his opinion was, this should work in every cancer type. There’s no reason it should be unique to glioblastoma. 

So, you know, I have worked for years with Maria Zilka and nutrition therapists, and so we go back to the clinic, and I’m like, all right, every cancer patient, we’re going to implement a ketogenic diet, and we’re going to see what happens. So that’s what happened, and it was quite enlightening in that there are some people who implement a ketogenic diet, they feel fabulous, their brain clears up, and they have great energy, and they lose weight, but not too much. They just go to a healthy weight, and OMG, it’s like everything goes really well. 

And then there are those other people, it sounds like you’re in that group, where they just cannot do it. Their body won’t do it, and some people, one group, even following the diet as closely as they possibly could, they cannot get their ketones down to what is considered a therapeutic range, which is totally mysterious. Maybe they were cheating, I don’t think so. But something metabolically, their body would just generate glucose. And then there was another group who just felt miserable, just there was brain fog and energy was crap and mood was bad, and they never got past, you know. . . There’s ketosis, and then you’re supposed to get into that keto-adapted state, where you’re just burning ketones and feel fabulous. They never got to that. They just sort of stayed in what we think of as that fluey kind of ketosis state and were miserable. And so for those people, you’ve got to bring them out. You’ve got to bring carbs back into their life, and there was no test that you could do in advance to know which it was. And in my observation, it didn’t really divide down male female lines, because I had people in both categories, male and female both. So yeah, I don’t know. But clearly there are some metabolic types that just don’t get into that keto-adapted state, and they never feel well.

Lindsey:    

Yeah, no, I think I did. I mean, I got to the point where I was in ketosis, but I just couldn’t sustain it. I mean, I just love carbs too much, and to me, it just felt like another meal of you know, meat and broccoli, and I don’t eat dairy so that’s like, a significant source of fats for people who are on a ketogenic diet, because I’m lactose intolerant. So it was just like, what’s left?

Dr. Greg Nigh:    

So for you, I’m just curious, it was as much a psychological heaviness of staying on the diet as it was, like a physical bit.

Lindsey:    

Yeah, I mean, it’s like the joy of a piece of toast with your breakfast. I mean, literally, I have to force myself to eat everything else around the piece of carbs. I’m a foodie. I love food. So, you know, maybe some people are kind of indifferent to food, like they’re just like, yeah, it’s just fuel, whatever. Maybe for them, they’re just as happy eating. And I have clients just like that, yeah no problem. You tell them what to eat. They’re like, no problem. I can implement anything you tell me. Other people who are just like, so terrible, I can’t eat anything.

Dr. Greg Nigh:    

No, I have the same, yeah. I wanted to say one of the most shocking diets that I have been introduced to, which was by patients who told me about it. And of course, we all know it now, and that is the carnivore diet. And I have had multiple and by that, I mean probably half a dozen patients, whose gastrointestinal problems were completely “cured” (put little quotes there). But in their experience, all of their symptoms resolved upon adopting the carnivore diet, which is so counterintuitive to me.

Lindsey:    

But did all the symptoms come back upon going off of it?

Dr. Greg Nigh:    

Well, they didn’t, although, yeah, a few of those. I mean, these weren’t people that I was managing on that diet. They heard about it, and they implemented it on their own. And so I had a few of them actually just send me an email, hey, doctor, and I just want to let you know I’m cured, and I just did this diet. I have had people who came, and they told me that they implemented the carnivore diet. They did fabulous. And then over time, you know, for various reasons, it didn’t work so well, or they stopped doing it, and eventually their gut got bad again, and they tried it again, and it didn’t seem to work as well the second time, or whatever. You know, people are all weird, and we all respond to diets differently and all that, but it is one of those, one of the rare diets where people implement it and describe to me dramatic changes in how they feel. I mean, I have a lot of people implement the AIP diet, or, you know, there’s so many freaking diets out there now that people do and yeah, you know, people will describe, yeah, I felt a little better. I think I did better doing this and doing that, but there are only a few diets, in my experience, that people describe it in profound ways, like everything changed when they started that diet. 

Lindsey:    

Yeah. So I don’t doubt that people feel better, but sometimes I see stool tests on people who’ve been on these sorts of diets, be it ketogenic, be it carnivore, and then I look, and they’ve got elevated beta glucuronidase. And I’m like, I’m sorry, you need to go off all meat now and all fat, and you need to turn this around, because you might end up with colon cancer or breast cancer. And so, you know, it’s like, in theory, they might be fixing stuff, but they’re breaking other stuff, and you don’t know until you do the test. Anyway, that’s just my comment.

So I’m not a big fan of anything extreme, because for me, you’re losing out on the joy of eating if you’re just eating meat. And most of the people that I’ve spoken to doing carnivore are not doing it right, like they’re not even eating – they’re just eating steak every day or hamburger every day. They’re not eating organ meats. They’re not getting the full gamut of nutrients, and often, they’re not actually doing carnivore, like there’s a couple vegetables they eat, or a little bit of fruit they eat, or something, like there’s always something else, because they just can’t stand it, like, at the end of the day, it’s just meat. 

I do want to get to sulfur. So let’s get back to the original reason that I did reach out to you was your expertise in sulfur metabolism and how it relates to gut health. So why don’t we start first with an explanation of the different forms of sulfur and which forms are good for us, and which are bad for us, and what it’s doing in the body.

Dr. Greg Nigh:    

I mean, I don’t really know if I could categorize it in that way. I think the big picture on sulfur is that, of course, we have to have sulfur all the time, because we have to generate sulfate and these various other sulfur compounds. So these compounds that get generated, like sulfate, we’re not eating sulfate. I mean, sure, there’s maybe some trace amounts in some people’s well water, but for the most part, that’s not what we’re taking in dietarily. We take in various sulfur compounds, and we have to convert them to the biologically useful forms of sulfur. And the problem, which literally, I just stumbled upon is that some people, for various reasons, can’t efficiently get from the dietary sulfur to those converted forms of useful sulfur. 

And I think the most important of those is the sulfate, because sulfate, I mean, we are sulfating things all the time. It’s crazy how much sulfate has to be constantly available to the body in order to carry out all the sulfation reactions. So if that gets compromised for various reasons, then bodies, because they’re fairly intelligent, they figure out, or they already know, somehow, how to work around the problem. And the workaround, at least one of them, is to generate more hydrogen sulfide, because hydrogen sulfide gets directly oxidized to sulfur dioxide (SO2) which gets directly oxidized to sulfite (SO3), which gets enzymatically converted to sulfate (SO4). So it just steps up the oxidation scale to get it to sulfate, which we now know is deuterium depleted sulfate, which is gold for all those sulfation reactions in the body. 

So dietary sulfur is the raw material for doing that. Different sources of dietary sulfur, and this is just discovery over a decade of just doing this with people, some forms of dietary sulfur are just harder for many people to get converted into those other useful forms of sulfate than others are. So the highest source of dietary sulfur is meat. I mean, the cysteine and methionine hanging out in meat is by far and away the biggest bulk of sulfur that obviously, anyone but vegetarians, is taking in. My experience is that meat is rarely, not never, but rarely a problem. Most people tolerate eating meat. Garlic, if I’m going to pick one, I mean it’s not a coincidence I named my book “The Devil in the Garlic*” because garlic tends to be the most reactive of the sulfur compounds that people take in. And I think one possible reason for that is that, unlike sulfur compounds and other foods, the compounds in garlic, once they’re absorbed and they’re in circulation, they are taken up by red blood cells and can be directly converted into hydrogen sulfide. 

And so our entire system of red blood cells becomes a factory for generating this hydrogen sulfide gas, potentially, and I think likely for some people that gets upregulated for who knows, genetic reasons, or I don’t know. In order to detoxify that hydrogen sulfide so that it doesn’t then leak out of red blood cells and get into circulation, you have to have vitamin B 12, and you have to have glutathione. And so there are lots of people who are compromised in one or both of those, which would potentially add insult to injury. So, garlic, in doing this low sulfur protocol with people, you know, a diet where people significantly reduce the amount of dietary sulfur coming in for a couple of weeks, and then one by one, introduce it, has been, oh my gosh, to see how many people at the end of two weeks have significant or even complete resolution of some symptoms. 

Now I ain’t saying it is a cure for everybody, but there have been a really dramatic number of people over the years who had problems sometimes for decades. They had all sorts of colitis symptoms or irritable bowel and within four or five days of starting this diet, they have no symptoms at all. I mean, it’s crazy. And so we get people through two weeks, and then at the end of two weeks are the reintroductions. The first thing to reintroduce is garlic, and it is shocking how many people, their symptoms have been gone for a period of time, or at least significantly reduced for a period of time. They reintroduce garlic, bam, there’s a symptom again coming back, whether it’s brain fog or migraine or joint pain or gut – irritable bowel, rashes, whatever it is, there it is again, when they reintroduce garlic. 

So then we have people do their reintroductions one by one. Then after that, and they can’t reintroduce the next one until the symptom from that one cleared, of course. So you know, for some people, usually it’s only a couple days and the symptoms clear. Some people, it’s a week or two, but then onion and kale, and go through the list of the reintroductions, egg, broccoli, cauliflower, cabbage, and so you get a really good picture for this individual which sulfur compounds they don’t seem to tolerate well, and so usually you can hold those out for a period of time, bring the others back in, because, of course, we want people’s diets as diverse as possible to keep enough different varieties of gut bugs active in their gut. I don’t like people staying on restrictive diets for extended periods of time, and lots of people back themselves into a corner that way, which I understand they’re just trying to not have symptoms. But once you stay in that corner too long, you’re stuck in a corner, and it’s not easy to get out. 

So, you know, we kind of catalog which of the sulfur compounds seem to be the most reactive and then try to bring in various kinds of support, which is often trial and error. Yeah, there’s educated guessing about it, but you’re just trying to figure out which things work for which people. Usually we get somebody to a place where they can then reintroduce the foods that were reactive, like garlic. Now there are some people who cannot reintroduce garlic with all the support we can get, but most people get to a place where they can reintroduce it. Now I mean, a lot of them were taking, like, two garlic tablets a day and putting garlic everywhere on their food. They don’t get back to that, but they get back to – they can put a little bit of garlic powder on there as a seasoning or something. And actually, oddly enough, many of them form an aversion to garlic once they’ve been through that process, and kind of clean the garlic out of their system, and they reintroduce it, and it causes misery. Many of them are fine. They feel like they don’t even like the smell of garlic anymore. So yeah, that’s good. 

So it’s always a mystery which particular compounds somebody might react to, and not everybody reacts to any of them. And it’s not actually an individual reaction, it’s just a composite of total sulfur load that comes in over time, and eventually the bucket is full, and it spills and causes symptoms. And so for those people, it’s actually much easier than – they’re just certain things you can have people do throughout their day or week, at least, to lower or to, I guess, drain their bucket faster so that it doesn’t overflow. But I mentioned every time I do a podcast, I’m talking about things like Mo-Zyme Forte*, which is a particular form of molybdenum that I have just found that works really well. Epsom salt baths have been like another one of those holy crap. I can’t believe some people; it changes their life to just do Epsom salt baths.

Now, maybe it’s because they’re getting magnesium that way, but I think the people that I’m working with it’s because they’re getting sulfate that way. Because by doing Epsom salt baths, I have had a number of people who then can expand the amount of sulfur foods that they can eat. They’re less reactive to their sulfur foods. Why is that? I think it’s because they’re getting sulfate directly through the skin. So the body has a supply of sulfate. It doesn’t need to generate hydrogen sulfide in their gut to produce more sulfate. They’ve already got enough. So again, the bugs aren’t needed. They don’t show up. They will go away on their own.

Lindsey:    

Yeah. So you’re describing a group of people who have sulfur issues, but not all of them have what appears to be a hydrogen sulfide SIBO presentation, correct?

Dr. Greg Nigh:    

Yeah, for sure, absolutely. So I started getting interested in sulfur. It’s weird. I tried to trace this back, and I couldn’t figure out exactly, but early on, I had read a paper by Stephanie that had to do with sulfur, and that’s how I first got into communication with her. So I was working with Maria at the time, and I said, can you just put together a low sulfur diet? I just want to see what happens. And so she did some homework and put together a diet and it was like people with migraines or hot flashes or anxiety or eczema, or when I was trying, it was like unreal, how many different things were responding really well to low sulfur. 

I remember a patient coming in who told me she had been detoxing, and I asked her how long. She said about three years she’d been detoxing and just felt terrible, like brain fog and fatigued, you know, but she’s doing all this detox therapy, so I asked her what she was taking, and she’s taken a laundry list of sulfur supplements, right? Lipoic acid and garlic and methionine and NAC and glutathione, and, you know, all these detox supplements. I said, okay, I want you to stop all of that. Do the slow sulfur thing. It’s fine. She wasn’t detoxing. She couldn’t process the sulfur. She was taking in too much sulfur, so we just got rid of that. And she felt totally fine, fabulous after that. 

So I was working with lots of other conditions, and then this was back, we’re talking about in like 2010 or 2009. Then people started coming in with these SIBO tests. SIBO back then was not a thing, but people were coming in with these tests saying they had high hydrogen or high methane. They didn’t test hydrogen sulfide at that point, so they had these test results, and their guts were a wreck, and they’re like, can you help? And I didn’t know anything about SIBO, really, but I was like, well, what the hell?

Let’s just put them on a low sulfur diet and see what happens. And a large percentage of them got better, like they had significant improvement by doing a low sulfur diet, even though their tests, whatever these hydrogen or methane things, which kind of led me to this thinking that maybe sulfur issues are underlying those other types of SIBO, which I think can be true. I don’t think it’s always true, but I think there are situations where it seems to play out that way, because if you just do low sulfur with them, their symptoms seem to resolve. 

Now I will also say, as I’ve said before, I don’t test SIBO, I don’t do methane, sulfur or hydrogen sulfide testing. The test is the program. I have had many, many, many, many patients who show up telling me about how they tested high in some sort of SIBO, and then they went through a treatment protocol, and they tested again, and they were happy to report that they didn’t have any more of that kind of SIBO. And I always follow up to say, did you feel better? And they usually say, no, not really. It’s like symptoms seemed to me to be a fairly loose correlation with test results. So I don’t really do much testing. I am more focused on symptomatics, because ultimately, I think that’s where the pudding is.

Lindsey:    

Yeah, so in the SIBO community, and I mean, especially like the research that Mark Pimentel has done, you know, they’ve identified certain bacteria that they say are culprits, in hydrogen sulfide SIBO, or what they’re now calling intestinal sulfide over production, or ISO, and I believe, I think the three that they’ve targeted, or maybe even only two of these, are Desulfovibrio, Fusobacterium and Bilophila wadsworthia. But in your book, you list many more. And I’m also seeing in my experience, because I do stool testing, and sometimes I do metagenomic sequencing that more than anything else, there’s lots of cases where Klebsiella seems to be the dominant sulfur fixing bacteria that’s causing an issue. And I know there’s others. Can you list what those other sulfur reducing bacteria you put in your book?

Dr. Greg Nigh:    

Yeah, off the top of my head, I can’t, I know I put it in my book. And there’s an article that actually lays it out really well, and kind of talks about the sulfur cycle.

Lindsey:    

I found the page, yeah, H pylori, Desulfovibrio, Campylobacter jejuni, E coli, Clostridium, Enterobacter, Bilophila wadsworthia, Staph aureus, Streptococcus anginosus and Klebsiella.

Dr. Greg Nigh:    

Yeah. And those are the kinds of things that we see all the time on the stool tests for people; they’ve got dysbiosis, and we see those bacteria showing up. Now, I ain’t saying that they’re only showing up to make hydrogen sulfide, but they are making hydrogen sulfide, and so maybe, maybe they’re doing that for a reason.

Lindsey:    

Yeah, okay, so the diet, let me just clarify the diet that you use. It’s essentially no cruciferous vegetables, onions, garlic, I assume. The other things like leeks and chives and everything else in that family also out, yeah, and alliums, I guess. And then no meat, also no fat?

Dr. Greg Nigh:    

No, I don’t say no fat. 

Lindsey:    

Oh okay, that’s because that’s the protocol I’ve learned.

Dr. Greg Nigh:    

But I just send people to Maria to get oriented to the diet. And I think maybe the first week is still vegetarian, just to do that break. But it is not part of the two-week elimination. Meat is not part of the two-week elimination anymore, because it was exceedingly rare that somebody had a meat reaction, and when they did, it was so crazy over the top, dramatic that it seemed like something else was going on. It was not a sulfur thin. Some what is that,  alpha gal? 

Lindsey:    

Yeah, alpha gal. 

Dr. Greg Nigh:    

And I usually have people taking Mo-Zyme*, I titrate the dose up on that to see what dose they feel the best. I might be doing butyrate. I am almost always doing autonomic regulation therapies along with them, because, we’re going to be out of time, I don’t have time to go into the autonomic piece of things, but I feel like I was late coming to the realization of how central that is. And the fact is, I think it is becoming a much more dominant picture overall, in all of the chronic diseases that we’re seeing, people are so much more complicated now than they were when I started to practice. And I think that is in large part due to a much more prevalent and dramatic autonomic dysregulation. We are talking about people who are overstressed, essentially, and that just aren’t managing it well, or it goes beyond that.

People have many reasons. I think it is, yes, it’s that, but I think that there are exposures that we have now that are dysregulating us in ways that can come back and manifest themselves as sort of an anxiety and feeling wired. But I don’t think to just call it out. I think things like EMF exposure, the density of the fields around us has increased probably 1000-fold, a million-fold, maybe in the past 15 years. When you think about the saturation of our environment with Wi Fi now, it’s raining down from the skies. I mean, we know that those things have an impact on our autonomic balance, and so it’s like the ocean we’re swimming in. So it’s hard to even tell what the effect is that it is having. But I have no doubt that it’s having one. These vaccinations – I wrote a chapter for Neil Nathan’s book about – actually two chapters. But one chapter in particular about these mRNA shots and the autonomic impact of those on the body, which is not trivial. There is a reality, not in my belief, just in my clinical experience and reading the experience of other doctors, that shedding is a real thing, that exosomes are coming off of people who have had vaccinations. So even people that have not had vaccination are exposed, and those exposures have an autonomic impact. And so these are, I mean, this is just some of the stuff. 

Of course, there’s all kinds of other chemicals and stuff in our environment that are contributing, but it’s all piling up on us and leading to significant, widely prevalent autonomic dysregulation that makes everything else harder to treat. It’s much harder to get the body to respond even to a good set of therapies if there’s that underlying autonomic imbalance in place. So I am a big proponent of having people do autonomic therapies. Maria is trained in the Safe and Sound Protocol, which I think is an extremely valuable addition to almost every therapy that I am setting people up with, and there are others. Lots of people know about autonomic therapies, but I think it is, in many ways, the elephant in the room when it comes to having people that aren’t responding to whatever program I’m putting them on.

Lindsey:    

Okay, so it sounds like you’re using primarily diet as a tool. So what about I assume, of course, that there are people who go through the diet, and they’re still bloated and they’re still miserable at the end of it. So then do you do move towards antimicrobials, or what other kinds of interventions do you then go to for someone with something that looks like a hydrogen sulfide SIBO presentation.

Dr. Greg Nigh:    

It’s like a sulfur problem is one of many possibilities of why somebody might feel bloated or funky in their gut. And so I usually start there, because it has the best, I think, the best potential, to get some symptomatic relief for the people that it fits. If it doesn’t, then it’s like, alright, check that box. We looked into it – it didn’t seem to be a thing. And then any number of – it’s like we all have our ways of trying to figure out why somebody feels the way they feel. I am doing testing, hormone testing, and all kinds of blood testing and trying different kinds of diets, elimination diets, or different diet work. I work with people with various homeopathic programs that for some people are a home run on getting their gut working the way it needs to. So it’s like, if that one gets ruled out, then you just do what any practitioner should do. And that is all right, well, what’s the next on the list of usual suspects? And kind of knocking down the list.

Lindsey:    

So I heard of this method of using MSM, which is methyl sulfonyl methane, which is a sulfur-based supplement, as an antimicrobial for someone with severe bloating. And the doctor who described it, I believe it was on Nirala Jacobi’s podcast, she said she didn’t discriminate between what kind of SIBO people were presenting with. And anyway, I started taking it myself and followed her protocol up to the max dose. And sure enough, it cleared out my SIBO for a time, like everything that kills bacteria does, and then it came back, as it always does. But anyway, she said it didn’t matter whether somebody had a hydrogen sulfide SIBO presentation or methane. It seemed to be very successful with the methane in particular. And I’m curious what you think? You know somebody who’s got a sulfur issue, would MSM be an issue for taking it? Would that make sense, that that would be too much sulfur for them? Or might that have the same effect as the Epsom salts?

Dr. Greg Nigh:    

Well, I will start by saying what I’ve often said, which is that people are weird, and so there are, I mean, I’ve had patients, I can think of one in particular, very sensitive to sulfur, like all kinds of dietary sulfur, the one way that she could keep herself symptom free is taking 25 grams of MSM a day. I mean, that’s a lot of sulfur, yeah. But for her, it worked. And I have had a few other patients since then who heard about that protocol, who did the protocol, oh my gosh, my gut is completely better. I have at least an equal number of patients who did the protocol and it wrecked them. It was not a good experience at all. Yeah, now I feel confident that I don’t know the doc who, or whoever the practitioner is, who put that protocol together. I have no question that she’s very competent and that if she were working individually with people, maybe she could have guided herself in a way that would not have led to that. But what I suspect is true is that it’s going to work for some people and it ain’t going to work for others, and probably you just got to do it and find out. Like, I doubt that there’s a test that says, oh yeah, that’s not going to work for me. 

Lindsey:    

Yeah. So you did in the book mentioned some of the genetics of sulfur, and I know that, like CBS and SUOX were some of the SNPs that are relevant. Can you talk about this a little bit?

Dr. Greg Nigh:    

Yeah, a little bit. I think in the book, I mentioned that I don’t give it too much weight, and I would say I give it even less weight now, you know. The one that gets the most attention probably is CBS. And I have seen people with CBS problems, you know, glitches on CBS, who have gut problems. And I’ve seen people with CBS glitches, with no gut problems. And so I go, you know, people are weird. I think I also mentioned in the book, I don’t remember, I haven’t read it in a while, but I think I mentioned that sulfite oxidase, the SUOX, that one, it seems pretty consistent to me that if somebody, I’ve not ever seen homozygous on that, I’ve only ever seen heterozygous, but if somebody has a heterozygous glitch on that, it is pretty much guaranteed they’ve got sulfur issues going on, which makes sense to me. There’s only one way for sulfite to get converted to sulfate, and that’s through that enzyme. And so if you slow it down, it makes sense that it’s going to cause problems.

Lindsey:    

And is that where molybdenum comes into play?

Dr. Greg Nigh:    

Or, yep, that’s exactly where it comes in. That is its role.

Lindsey:    

And what about hydroxocobalamin*? Where does that come into play?

Dr. Greg Nigh:    

Hydroxocobalamin oxidizes hydrogen sulfide in the periphery, and so it’s not converting it to sulfate, but it’s converting if you have excess hydrogen sulfide in the blood. Hydroxocobalamin will oxidize it up to sulfite, which will then get converted to sulfate by the SUOX enzyme.

Lindsey:    

Okay, so it helps if you’ve got excess- I know that’s one of the supplements you mentioned in the book. 

To move on to one other subject in our last five minutes, I noticed on your website that you were interested in peptides, and I’m curious if you recommend oral BPC-157 for gut issues, and if you think it’s effective and which forms you prefer?

Dr. Greg Nigh:    

I do. I think peptides are a really interesting new cat on the block. So I do with BPC-157* (use code PERFECTSTOOL for 20% off), I have people take it orally. I happen to just use a company called Integrated Peptides [that’s registration link, then use code PERFECTSTOOL for 10% off], which has a couple of good formulations. I’m blanking right now on the powder that they have for the gut, it only comes in a jar – Gut Powder. It has BPC-157* and some other good – it’s got Akkermansia in there. But that one I find to be very helpful. But I’ll also, for some people, just do BPC-157, just as a supplement. Yeah, there are some other peptides, Thymogen Alpha One, which is a really important immune modulator.

Lindsey:    

Is this injectable, or is this also oral?

Dr. Greg Nigh:    

That’s oral, yeah, yeah, these are all oral. So yeah, I do think peptides are a really important new kid on the block in terms of, I mean, not a standalone always with all the other kinds of additions that we’re doing. But yeah, I think it’s a valuable tool.

Lindsey:    

Yeah, I don’t know if they’re publicizing them better now, but I definitely have had more clients ask me about it, and it’s an expensive supplement, so I don’t just like, jump to that, but if they bring it up, I’m like, well, sure if you want to spend on it, I’m happy to have you take it. Yeah, no, I’ve looked at the InfiniWell ones that have the extended release and the quick release. And so I was thinking, which would be better for gut health, you know, if you’re wanting it in the small intestine, I’m thinking would be quick release and large intestine, extended release. 

Dr. Greg Nigh:    

Yeah, I think it’s generally how I would do it, yeah, or, I mean, for acute, acute things, I’m going to do a quick release. For more chronic, I’ll tend to do more extended release, yeah, but yeah, I think they’re good and they are expensive. You know, when I give it to patients, I always apply a discount. I drop ship it and discount it. So, yeah, yeah.

Lindsey:    

So, I had one client who I think had some success with gastritis, and that seems to be one thing where sometimes you just get a person who, for whatever reason, cannot seem to get rid of gastritis, like no matter what. Everything else fixes, but that one thing is just and that’s one place where I think it feels useful.

Dr. Greg Nigh:    

Yeah, I agree. Inflammatory stuff, I agree. You know, another therapy we got one minute left. How about that? Another thing that I am doing quite a bit is just infrared light applied to the abdomen, because there are actually studies on using it to treat gastritis and other inflammatory bowel stuff. Because with the powerful enough light, and especially with infrared, you get penetration into the gut, and it has all kinds of good shifting effects on the gut bugs and the microbiome and inflammatory state of the bowel.

Lindsey:    

So is this with a clinical grade infrared light or the kind of infrared light somebody could afford?

Dr. Greg Nigh:    

Yeah, no, I just Amazon, like you type in red light therapy. They’re all kinds of different ones that are available, and they have different levels of power to them, like over the gut. I probably wouldn’t do LED lights. There’s some that are quite a bit more, sort of more like a spotlight red light. 

Lindsey:    

Yeah. Interesting.

Dr. Greg Nigh:    

So, all right.

Lindsey:    

Yeah we have delved into all sorts of interesting things. And I’m not sure anybody could wind that up into a useful protocol, but it was certainly interesting, so I will definitely point people to you and your work and articles and stuff. 

Dr. Greg Nigh:    

Yeah, excellent. 

Lindsey:    

Okay, well, thank you so much for being with us. 

Dr. Greg Nigh:    

Thanks for having me. It was 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.

*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.

Adapted from episode 152 of The Perfect Stool podcast and edited for readability with Christian John Lillis, co-founder and CEO of the Peggy Lillis Foundation, and Lindsey Parsons, EdD.

Lindsey:  

So why don’t we start with what C. diff is and how you got involved in advocating for C. diff awareness.

Christian John Lillis:

C. diff, or Clostridioides difficile, which is still difficult to say, so we generally call it C. diff, is a spore-forming bacteria that is found all throughout our environment. When a bacteria is spore forming, that means that when it’s under stress or outside of the body, it moves from its vegetative state to like a seed state, or like an acorn state, and when it’s in that state, it is really difficult to kill. Antibiotics may not kill it. In order to kill it on surfaces, you have to let it lay in bleach, and so one of the things I recommend for C. diff is not to use hand sanitizer, but to actually wash your hands with soap and water, not because the soap kills C. diff, but because the hand washing removes the spores from your hand, and they go down the drain. 

It’s also obviously a microorganism. You can’t see it. Most people get it through what they call the fecal-oral route, meaning it came out of somebody’s butt and you touched it and it ended up in your mouth and you swallowed it. So there’s a proportion of us, some say it’s 2%, some say it’s 10%, that have this bacteria in our body. I’m sure your listeners are very familiar with the gut microbiome, so it’s there alongside all of these other bacteria, viruses, all kinds of microorganisms. And as long as your gut is healthy, it’s kept in check. But what happens often is when we take antibiotics or take something else that disrupts our microbiome, the C. diff now has all this space to grow because the other bacteria have been washed away or killed off by the antibiotics, and as it reproduces, it gives off a toxin, and that toxin is harmful to humans. So in reproducing itself, it gives off a toxin that harms the cells of our colon. This results in what we call a C. diff infection. 

You have urgent and frequent diarrhea, fever, nausea, those are the main symptoms, and if it’s left untreated, C. diff can severely damage the colon, leading to a condition called toxic megacolon, which is frequently deadly. So patients who progress to toxic megacolon, or if they have multiple recurrences of C. diff, which I’m sure we’ll get into, they’re at a very high risk for sepsis and for death. 

A feature that distinguishes C. diff from a lot of other opportunistic infections is what we call recurrence, meaning you’ve been treated, it seems like you’re clear, but then it comes roaring back. And the reason that happens is because until the microbiome of your gut is healthy again, the C. diff does not waste an opportunity to regrow, right?

So, a recurrence is you have a first infection, typically treated with antibiotics, most people experience either a lessening or sensation of symptoms during their course of antibiotics. But then for 30 to 40% of people who have that first treatment, somewhere between two weeks to up to three months after they finish their course of antibiotics, the C. diff comes roaring back. So, now you’re in a recurrence. We have about again, 30 to 40% of people, so maybe 180,000 Americans every year, will get recurrent C. diff. And once you had a recurrence, if that gets treated, and you seem to be out of the woods, your likelihood of a second recurrence goes up to like 50 -60%. To get a third recurrence, it’s now at 80% and also, there was a study that came out last year, led by Dr. Paul Feuerstadt that showed that for every recurrence you have, your chances of sepsis and death increase significantly. So it’s something we really want to, pardon the pun, sort of nip in the bud and kind of catch it and treat it as early as possible.

In terms of why we got involved with this, you know, you mentioned the organization I run, the Peggy Lillis Foundation. So Peggy was my mother. She was a 56-year-old kindergarten teacher. She was a single mom for most of our lives, and in April of 2010 she went to the dentist to get a root canal. The dentist prophylactically gave her Clindamycin, and a few days later, she developed severe diarrhea, fever, nausea. Being a kindergarten teacher, she didn’t think anything of it. She was a pretty healthy person, but if you spend five days a week around 20- five-year-olds, your chances of getting, like, at least one, you know, she’d get a bad bronchitis or a bad head cold, but again, like just once or twice a year, and she would joke and say, the kids slimed me. So she just thought she got something from the kids. It was only when it persisted into the fourth or fifth day that we became concerned. And I was mostly concerned about dehydration, because I’m sure people who listen, who have, maybe even IBS, like if you’re constantly having diarrhea, it’s really hard to stay hydrated.

So we were initially going to take her to a GI appointment, but when I got there, she seemed so fatigued, and, you know, her color was off and she was very listless that I said, I think we just need to go to the ER and get you hydrated and then they can test you there. You know, I’d worked in healthcare in other ways before this. And so I kind of knew, if you show up and they can’t help you in the office, they’re just going to send you to the ER.

Anyway, we get to the ER, my mother’s white blood cell count is over 40,000 and normal is around 10,000 so four times normal. This is a the indication you have a severe infection, and about within an hour of getting there the attending ER visit and the attending infectious disease specialist asked to speak to me and my aunt, who had met me at the hospital. And they basically tell us that my mom has a life-threatening infection. They believe she has toxic megacolon, and that it’s caused by this thing called C. diff. I had never heard of C. diff before.

My aunt, who was an oncology nurse, said, how can my sister have C. diff? She hasn’t even been hospitalized in like 30 years, and she’s 56. So she was already going into septic shock. Her kidneys weren’t functioning. And, you know, I guess from watching TV or whatever, I thought that if people were in septic shock, that they were, like, in a coma, like I didn’t know you could be up and talking and arguing with me that you want Diet Pepsi and not more ice chips and be in septic shock, right? So they told us at that point that she was the sickest patient in the hospital. And these doctors really did everything they could. I mean, this was a small hospital in Brooklyn. It was not a Mount Sinai or NYU, like it was a small hospital in Brooklyn, because we just thought she needed fluids. But they really did everything. They contacted colleagues at the leading institutions and leading academic medical centers. We talked about moving her, but they were afraid she wouldn’t survive the trip.

So to sort of shorten the story, that evening, they came to us and said we would perform a colectomy, but we don’t know that your mother would survive it right now. So what we want to do is keep her overnight, try to arrest the sepsis, try to reverse the sepsis, and then in the morning, if that hasn’t worked, we will do a colectomy in an attempt to save her life. If it has worked, hopefully she’ll regain consciousness. But either way, we can decide what the next steps are. 

So we go home, we go to bed, we don’t sleep very much, as you can imagine. 6 a.m. the phone rings. It’s the surgeon. He says she has not improved overnight, and we have to meet him because we have to consent to surgery, because I’m her next of kin, and this is despite overnight, they gave her broad-spectrum antibiotics through a central line: they were giving her vancomycin enemas, IV immunoglobulin. And so around 10 a.m. they perform the surgery, she does much better than anyone expected her to, in terms of her vital signs, and they move her back to ICU. And my mom had eight siblings, most of whom still lived in the New York area, so the waiting room by ICU is like 50 people. It’s a complete clown show. 

And you know, we go in two by two to sit with her, to talk to her, and I remember telling her, you’re so strong, like, if anyone can beat this, it’s you, like you got through a divorce. You raised me and my brother, who are not easy kids, like you’re tough as nails. But then around four o’clock, they asked to speak to us, and they said that despite everything that they were doing, her brain wasn’t getting enough oxygen. And my mother would have taken a colostomy bag and she would’ve been fine, but brain damage, you know, these are things she wouldn’t want. So they said they were going to do their best. People continue to go in and sort of talk to her and try to encourage her.

Lindsey:  

She was awake?

Christian John Lillis:

No, no, no. She was unconscious. No, she wasn’t awake. She was never awake again after the surgery. So they asked us to ask everyone to step out of the ICU so they could do something for her. And around three minutes later, the ER attending came and told us that our mother had passed, that they had tried three times to resuscitate her, and that she was gone. We were very, very close to our mother. My mother had 13 God children. She was a very beloved person in our community and in our neighborhood, and so the grief was overwhelming and inescapable and really hard to believe. You know, like so quickly, so quickly and again, like someone who, I mean, she was tough as nails, you know, even when she became a teacher, she still waitressed on the weekends. The woman worked six days a week and went to school almost the entire time, from the time I was, like, 10 years old until the day she died, you know, so it was crazy.

So what happened to her is the inspiration, but the secondary inspiration is for us raising C. diff awareness is that I was a college-educated person who had already, at that time, been a fundraiser for NYU Langone. I wasn’t working there anymore, but I was a savvy person, and for me not to have heard of C. diff, and then to go home and start doing research and find out that it was killing at that point, they estimated 15,000 people a year. It’s now been revised to 30,000 people a year. And for context, you know only about 17,000 people die of AIDS every year now. Less than 10,000 die of drunk driving. So when you think about all of the attention, deserved attention, to those public health crises, for us to have a disease that’s killing twice as many people and really nothing was being done about it was unacceptable to us.

Lindsey:  

Yeah, wow. That is horrible. So now, with what you know, what should someone do if they have some kind of severe diarrhea like that? How quickly should they see a doctor?

Christian John Lillis:

So, C. diff diarrhea, it is urgent, and it was very frequent, like, you or I might eat something bad. And so maybe the next day we wake up, or we’re going all the night, and we have to go, you know, like, within six hours, we might feel crappy, but it’s gone, it’s out of us. 

Lindsey:  

Right? Maybe throw up too. 

Christian John Lillis:

Yeah, like you might feel it might be loose for another day or two, but yeah, and with norovirus, it might be two or three days, but it’s not that you’re not going 20 times a day with norovirus, you know, right? So if you have this urgent 10-20 times within 24 hours, if you have a fever, and especially if you if you’re somebody who’s being treated for cancer or any immune-suppressant drugs or have recently taken antibiotics, those are all risk factors for C. diff. So in that case, get to the hospital, get to a doctor as soon as possible, ask to be tested for C. diff. If you’re younger, if you’re under 60, most doctors will not think of you having C. diff, so you have to be proactive. 

Lindsey:  

Okay and better to go to the doctor or straight to the ER?

Christian John Lillis:

I mean, unfortunately in this country, you know, we have this crazy system where people go to the wrong ER, and they get a bill for $20,000, so I think you kind of have to, like, I think if you go to urgent care or an ER or if you can get an appointment the next day, but I think, I wouldn’t wait. 

Lindsey:  

Yeah, because I’m just wondering how quickly the test results come back if you see a doctor?

Christian John Lillis:

Like, I would go to the ER if I thought I had C. diff, yeah. I’ve been doing it for 15 years. So I have a list of doctors of who I would start with, and . . .

Lindsey:  

You’ve got your preferred doctors. 

Christian John Lillis:

Yeah

Lindsey:  

Okay.

Christian John Lillis:

I would just show up on one of our board members’ doors and be like, Dan, we’re going to your hospital ER.

Lindsey:  

So how prevalent is C. diff in the US and worldwide?

Christian John Lillis:

So the most recent estimates, which are now about four or five years old, there probably would be more recent estimates, but Covid, the CDC does the estimate, and Covid kind of threw everything out of whack. So back in 2019, around that time, they estimated around half a million infections every year, and about a third of those people get recurrences, around 180,000 people that experience recurrence, and about 30,000 deaths. 15,000 of those deaths are directly attributable to C. diff, they’re septic, and then the other half are someone has cancer, someone’s had surgery, they get C. diff, and C. diff is kind of what pushes them over the edge on something that they might have otherwise survived. So it might be considered like a contributing cause of death, as opposed to the primary one. So we say about 30,000 were C. difficile, the direct cause or the indirect cause.

Worldwide, unfortunately, it’s pretty unclear. Many countries do not publicly report their healthcare associated infections. There have been efforts in the EU and in Canada, but there aren’t even back 20. Probably in the last maybe 5- 10 years ago, pre-Covid, the EU estimated data of about 80,000 cases throughout the EU every year. I don’t, in my head, know the number. How many people that is? But it’s equivalent, but once you get outside of the West, it’s pretty difficult. The other thing that I would say is this brings us in that we talk about a lot as patient advocates, is like in preparing for this, I knew you wanted to talk about this, I did research on worldwide estimates, right? And the ones that I could find, they didn’t talk about how many people. They talked about the percentage of 10,000 patient days.

Lindsey:  

Oh, okay. And so, like, how many, how many hospital days are taken up?

Christian John Lillis:

Or, yeah, like how many. Like, as an advocate, right, as somebody who’s trying to raise awareness, you as a podcast host, that is useless information to us, because it doesn’t tell us anything. It’s like an insurance measurement, right? 

Lindsey:  

Yeah.

Christian John Lillis:

And it also doesn’t help us, as people who are trying to raise awareness of a disease, articulate what that data means to the public, because the public doesn’t care how many days you were in the hospital. The public wants to know how likely am I to get C. diff, or my loved one or my friend who’s in the hospital, right? So 600 out of 10,000 patient days mean, you know, patient hospital days means nothing to us. So I could find some of that for other countries, but I couldn’t tell you how many people. 

Lindsey:  

Okay, no worries. So I actually just recently heard a podcast and I should get the name, because it was really interesting about the fact that many people think that they are allergic to penicillin, when in fact they are not. And because of that, these heavier-duty antibiotics like clindamycin, vancomycin, etc., are used for infections unnecessarily, and that something like 97% of the people who think they’re allergic to penicillin, it was from something that might have happened. Maybe you had a viral infection that was attributed to . . . well, it was coming from a virus, you took an antibiotic, and you had a rash, therefore they said you were allergic to it. And it’s some sort of thing your mom told you when you were young. And therefore, anyway, so that people can get cleared of their allergies to penicillin by going and seeing a doctor, getting a skin test, and then doing a test, a secondary test . . .

Christian John Lillis:

If they react to the skin test, so they don’t react to the skin test, they’re fine.

Lindsey:  

Right and so I wonder, are there particular antibiotics that are associated with C. diff?

Christian John Lillis:

So this whole penicillin allergy thing is very important, and it’s something that people should be aware of. Because, as you said, many people, especially as kids, I’m a Gen Xer, but like millennials and Gen alpha, whatever they’re called, people younger than me, Dr. Martin Blaser is a brilliant person in this field. He did a study, probably 10-15 years ago, in nature that estimated that millennials and the generations after them, by the time that they had reached the age of 18, they’d had 20 courses of broad-spectrum antibiotics. And this is unprecedented in human history to have our to have to have our bodies shot through with antibiotics so much and often for no reason, for colds.

Lindsey:  

I just don’t get that because, like my kids, have literally never had antibiotics other than my son, before I adopted him, they gave him a couple courses. But after that, neither of them, other than no, I think my older son, when he had his wisdom teeth out, I think it was two days’ worth.

Christian John Lillis:

I mean, I had scarlet fever when I was six, so I was given tetracycline. And, you know, before antibiotics, scarlet fever killed half the kids that got it. So having these things is really incredible, but they’re really being overused. Then what happens in a case like with penicillin is somebody was given antibiotics and they were a kid, they got a rash, they got some reaction. The doctor said, your kid’s allergic to penicillin. The parent tells the kid you’re allergic to penicillin, that kid then for the rest of their life, or that adult, then tells everybody they’re allergic to penicillin. 

Lindsey:  

Yeah.

Christian John Lillis:

. . . which is a whole branch of antibiotics. 

Lindsey:  

That’s amoxicillin. 

Christian John Lillis:

It’s yeah. So then what happens? And I’ve talked to dentists who believe, like, right now, if you go to the dentist and they either think of an infection or want to ward off an infection, they’re likely to give you clindamycin, which is what my mother had. A much more powerful drug than penicillin.

Lindsey:  

Yeah, or if you have a heart murmur, they’ll want to prophylactically give you that before you have treatment. But I think now that maybe the rules have changed.

Christian John Lillis:

They have moved back from that. And so people should again, my brother has a mitral valve prolapse, and for years he had to be premedicated for a cleaning. And so again, this is how we end up with people having 20 courses for no reason. So I do think, yeah, if you’ve been told you have an allergy to penicillin, you should investigate that as an adult, because if you don’t have it, there is a lot less risk.

Lindsey:  

Yeah, but in terms of C. diff, are the broad-spectrum antibiotics like Cipro or vancomycin, clindamycin, are these more dangerous?

Christian John Lillis:

Fluoroquinolones are correlated, in the UK, the NHS, they did an antibiotic stewardship program where they restricted fluoroquinolones only for certain very severe infections, and they saw their C. Diff rates drop 80% throughout the system.

Lindsey:  

Which ones are the fluoroquinolones? Is it Cipro?

Christian John Lillis:

Cipro is a fluoroquinolone. So moxifloxacin, basically anything that ends in oxacin, 

Lindsey:  

Okay. 

Christian John Lillis:

Like Cipro is ciprofloxacin? Yeah. So all the -floxacins are fluoroquinolones. 

Lindsey:  

Okay.

Christian John Lillis:

Those are the ones to avoid. But, I mean, I think it’s just generally, if you don’t need an antibiotic, don’t take an antibiotic, right? Of course, yeah, if you do really need it, but there is just such overuse, particularly in this country.

Lindsey:  

Yeah, and one of my mentors and people I follow in the gut health world, Lucy Mailing, she put out a recent article, and she said, if you’re going on antibiotics, my recommendation is taking butyrate daily, usually in the form of either like Probutyrate* (low dose for constipation) or Tributyrin ( high dose for loose stools). I can’t remember the dosage, but for me it would depend on whether you had loose stool or if you were constipated to begin with, I would probably suggest different dosages. But then to take Saccharomyces boulardii* two pills, which is 500 milligrams, three times a day, as preventatives, and that those can help you to avoid these kind of opportunistic infections while you’re on antibiotics.

Christian John Lillis:

Yeah, I don’t know.

Lindsey:  

Do you have any suggestions in those areas based on your work?

Christian John Lillis:

So the challenge with supplements is that it’s very hard to know the quality of them, and so we kind of steer away from suggesting things. What we actually tend to suggest is that people try to get more probiotics through food. So like drinking kefir without sugar, low or no sugar yogurts, fermented foods, like you could be adding sauerkraut. So things that are going to give your body the building blocks and the good probiotics. Of course, you can always supplement them. But actually, one of our most popular articles on our website is how do you choose a good probiotic? 

Lindsey:  

Okay.

Christian John Lillis:

And I think that’s like, a very American thing where we want like, well, give me a pill that will solve my little, fix my stomach. And it’s actually, the best thing you can do is eat whole foods and things and we do have a lifestyle and nutrition guide. People that that have had C. diff have C. diff., as you can imagine, it’s difficult to eat when you’re that sick, but it’s really more about once you’re past the acute stage, how do you make yourself less likely to get it again?

Lindsey:  

Yeah, so one of the one of the cycles that happens, you know, like when you have a gram-negative bacteria, which C. diff is [Lindsey: correction – C. diff is a gram-positive bacteria, I misspoke, but I checked in Consensus and it said that “Yes, butyrate shows protective effects in C. difficile infections, mainly by reducing inflammation and supporting gut barrier function, but it may also increase C. difficile sporulation and toxin release.”], is that you start to pull oxygen into the colon, and then it promotes the growth of these facultative anaerobes that can live in the presence of oxygen. And then you get more and more of them. So the butyrate turns that process around by feeding the cells lining the colon, therefore creating a hypoxic or oxygen-free environment in which those bacteria don’t thrive. So that’s one of the reasons that butyrate is protective in that scenario. I incidentally, have a butyrate product called Tributryin-Max.

Christian John Lillis:

I’m like, this sounds good. I want some. I’ve never heard of it before.

Lindsey:  

Yeah, on a daily basis, it’s good for loose stool, or people who tend towards, you know, if you have, IBS-D, that kind of thing. So, so that was one of the things that anybody who has . . . 

Christian John Lillis:

Where you when I was in college, Lindsey? I could have used the all the butyrate I could get when I was in college. I knew where every bathroom was between my house and the college and every one near my classrooms. 

Lindsey:  

Well, yeah, so because I gave it to everybody, I ended up making a product called Tributryin-Max. And it is a reasonably high-dose butyrate, so you don’t have to take so many pills. So anyway, you mentioned that people wouldn’t suspect that C. Diff was in a younger person. So is it primarily in older people then, like, who are hospitalized? Or what’s the typical . . .

Christian John Lillis:

So, historically, that’s true. Historically, C. diff was almost – what they used to call a nuisance disease, meaning that it wasn’t terribly fatal. But you know, you’re in the hospital, you’ve had surgery, now you have diarrhea all the time, like it just made life difficult and it did primarily affect elderly people and people with immune-compromised systems. However, that changed in the early aughts. It was first detected in Canada. So it’s called the North American pulse one strain, or the NAP1 strain, and that started showing up in Canadian hospitals in 2004 -2005 and it was far more virulent, meaning that it was much more toxic. It caused many more deaths, especially among the elderly, but it was also then increasingly seen in younger and younger people. So it’s thought now that the NAP1 strain is the primary strain that we see in the west. So that’s why you see so many more people getting it and getting sick. Over the past 10 or 15 years, we have also seen, and it’s hard to know, is this the disease, or is this changing medical practice?

But I think as more and more people are having outpatient surgeries, we are seeing much more C. diff that is community onset, where, like women who give birth and they’re released within 36 hours, and then two weeks later, because they had a C section, they were shot through with antibiotics, they now have C. diff. I hear that story a lot, so it really doesn’t discriminate. Like they’ve even done studies looking at Black Americans versus white Americans, and white Americans have a slightly higher rate of C. diff, and then black Americans have a slightly higher rate of poor outcomes. And I think in both ways, that’s sort of institutionalized racial capitalism, you know, which is like black people don’t get health care as often as white people do, so we’re going to have slightly more chance of a health-care associated infection once we get it, they get then get a poor outcome, because, again, they don’t have access the way that we do.

So it’s nothing to do with our race. It’s everything to do with society, right? But one of the things that has been concerning is that we are seeing it more and more in the community, and we’re seeing it among younger people, even children, and they haven’t necessarily taken an antibiotic or been in the hospital recently. And in my brain, there’s this big question of like, what is this change? Why are we seeing this? Has the bug changed? Is it that those people that had 10 to 20 courses of antibiotics as kids are now adults, young adults? You know what I’m saying. So, being older is a risk factor. Taking antibiotics is a risk factor; but it can happen to anybody.

Lindsey:  

Yeah, yeah. And I’m sure that the compromised microbiome that is coming from, because I do see so many people with their comprehensive stool tests, and I see, you know, they have no Faecalibacterium prausnitzii which is one of your primary butyrate producers that sits in the colon. They don’t have any Akkermansia muciniphila, which eats that mucin layer and helps regenerate it and keep it healthy. So those two are working together. They’re in the colon, and they don’t have any of those. So obviously getting rid of the bad stuff, but then eventually you’ve got to rebuild the good stuff with prebiotics, things like, well, they love all the polyphenols, pomegranate and cranberry and matcha and things like that. So getting people on gut shakes and getting them eating beans and lentils so that they can build up those bacteria again. And now, of course, you can even get Akkermansia probiotics. So I see that a lot with people who’ve been through a lot of antibiotics.

Christian John Lillis:

Yeah, and I think, you know, we also have a ton of processed food that is impacting our guts, and, yeah, it’s calorically dense and nutrient light and so I think when you and I were growing up, a lot of our meals were cooked at home and using more or less whole ingredients. I mean, I know that that’s the way I cook, but I’m very lucky and privileged in that way, because I work from home.

Lindsey:  

Right. No, the biggest problem, I think. I mean, obviously there are bad things in processed food and just sort of poor-quality food, but it’s just that there’s not nutrients. That’s the thing is, they’re not, right? If you look at, say, the typical school cafeteria, the vast majority of the calories are coming from gluten and dairy. They’re not getting a lot of vegetables and fruits or if they’re offering them, they’re poor quality, and students don’t eat them. So at the end of the day, these processed food diets are just simply lacking in the things that make you healthy.

Christian John Lillis:

Yeah, the kids are also shot full of sugar, and then they’re like, sit still for eight hours. Good luck.

Lindsey:  

So what is the standard of care currently for C. diff? 

Christian John Lillis:

So in reverse of this question, I was like, well, the standard of care is bad. But what I mean by that is, based on the clinical guidelines, most doctors will prescribe either Vancomycin, which, as we talked about earlier, has a 30 to 40% failure rate, meaning people get a recurrence, or Fidaxomicin, which has a lower failure rate, but it’s not as widely used. Vancomycin is completely generic now; it’s not on patent. Fidaxomicin is still branded, and it costs a lot more money, but it has the lower rate of failure, of having, like, maybe 10% of people have a recurrence. To me, it’s worth it.

Lindsey:  

Yeah.

Christian John Lillis:

As a patient, it’ll also be worth it in terms of our healthcare system, because if we have fewer people’s recurrences, fewer people are spreading C. diff, etc., but insurance doesn’t want to pay for it. And then, besides that, you know, because I knew we were going to talk about FMT, but like, there’s a lot of doctors out there who, and it’s not just doctors, I don’t want to drag doctors – my father-in-law is a doctor. People get used to how they practice something. And so, you know, even before the FMT craze, like a lot of doctors are like, oh, you got recurrent C. diff, I’m going to give you 10 days of vancomycin. I’m going to give you 14 days of vancomycin. Oh, that didn’t work. I’m going to give you 30 days. And then a 60-day taper, where you take vancomycin every day every other day for 60 days.

And you know, there are doctors out there, that’s what they do. And the thing of it is, the whole time that’s happening, the person is suffering, you know, the person is worried about the C. diff coming back, or the C. diff is back, or, you know, they took their last vancomycin pill last night, and they know in the next three or four days, it’s going to come right back again. And you know, by the time you get diagnosed, particularly if you’re a younger person, like you might have been sick for weeks, you know, and now you’re going to spend the next three months being put on and off of antibiotics. And you know, if you think you’re going to have diarrhea, it’s like you don’t want to leave the house because you want to be near a toilet.

And obviously there are many people whose job involves them having to be outdoors, having to work someplace. I talked to a young man a few months ago who lives in Wisconsin, and he is an engineer who works on cell phone towers. Now imagine being worried you’re going to poop your pants, and you have to be outside in the cold, there’s no bathroom. So it’s a very torturous disease in that sense, and the guidelines don’t even suggest any sort of microbiome restoration until at least the second recurrence. So we’ve had people ask me, like, well, why don’t we just give everybody an FMT that’s ever had C. diff? And there are reasons why we don’t do that either.

So I think it’s a combination of what the insurance doesn’t want to pay for, and then plus doctor’s sort of clinical, habitual clinical practice. So this thing where people have to really advocate for themselves, because generally, you’re going to be given 10 days of vancomycin or fidaxomicin, and for 60% of people, that’s going to resolve it. It’s the other 30 to 40% of people who that’s going to be the beginning of a journey.

Lindsey:  

Yeah. So, if people can do anything for themselves, the first thing would be advocating to get the Fidaxomicin?

Christian John Lillis:

Dificid is the brand name in the US.

Lindsey:  

Okay, so advocating for that as your first line treatment because it has a lower recurrence rate, and then if it comes back, what do you think is the best thing from your research compared to what might be the standard of care of going back onto another antibiotic?

Christian John Lillis:

So when it’s an acute infection, right? So like when you’re having the chronic diarrhea, what you want is that antibiotic, and then what is going to follow that, that’s going to help restore your microbiome, right? So over the past 15 years or so, there’s been a growth in the use of fecal microbiota transplant. This is essentially taking highly tested for pathogens, for transmissible diseases, but minimally processed stool, like literally put in a blender with saline and then via colonoscopy or enema or, God forbid, nasal gastric tube, putting it back into your colon. And this is not a new idea. As far back as fourth century China, they were using some form of fecal microbiota transplant. It’s also used widely in veterinary medicine.

So basically, we’re giving you the stool of a healthy person to sort of kick start your own gut microbiome. So, but it was also hard to get because it’s considered experimental, for a whole host of reasons. Thankfully, in the past couple of years, we’ve had two FDA-approved, they’re called live bio therapeutics, LBP, Live biotherapeutic products, and one of them is basically a more refined version of the typical FMT. So they’re getting donor stool, they’re testing it highly, they’re processing it, making sure that it doesn’t have anything transmissible, and they’re sort of standardizing the dosing and stuff, so we know what we’re getting. That’s one option.

Lindsey:  

Is it delivered by enema, or is this now a pill?

Christian John Lillis:

The first one that I’m talking about is delivered by enema. They are some doctors who are doing it via colonoscopy. Technically, it’s off label, but there are some that are; they’re studying it. There’s a paper out there that shows it’s actually even more effective when it’s done by colonoscopy, just because it gets where it needs to go, better than enema.

Lindsey:  

And what’s that one called?

Christian John Lillis:

So the technical name is almost unpronounceable. So the brand name is Rebyota.

Lindsey:  

Okay, yeah, I’d heard of that one.

Christian John Lillis:

We try to stick to technical names or not promoting products, but oh, the name, the names are bizarre. Like, it’s not like fidaxomicin versus Dificid. It’s like, LG, s, dash, j, i s, m, yeah, it’s a terrible name. Sounds like you’re speaking a different language, like I’m an alien. And then, as you’re starting to say, after Rebyota was approved, they approved another drug called Vowst. And Vowst is a pill form, and Vowst is also, where Rebyota is sort of the whole, you know, again, more processed, more tested version of a standard FMT, Vowst is actually selected like they’re using specific Firmicutes. And so when you take it orally, it’s designed to store that, by the time it gets to your colon, and the capsules release, it then sort of seeds your gut and helps your gut to restore itself. Neither I nor Peggy Lillis Foundation have any opinion on which of those is better for you, or if you need a standard FMT, which for people with severe and fulminant disease, they may need a standard FMT. Because if you’re that sick, you can’t wait for the pill. You take the pills like over three or four days, you need something more immediate.

So, but what we do think, what we are happy about, is that there are now options, but right, like any new drug, they are more expensive. You are going to have to fight with your insurer to get it covered. We are advocating for greater access to the extent that we can, but it’s the kind of thing where, you’re going to have to go in there and – but if I had C. diff, and if I had a recurrence, I would go to my doctor, I’d say, okay, so I want fidaxomicin, and then I want either Rebyota or Vowst, you know, depending on what we think is best, because I don’t want a third recurrence.

Lindsey:  

Okay, so what was the success rate with FMT prior to these other options?

Christian John Lillis:

So NIH did a prospective study in 2021 of 229 patients who are part of the national fecal transplant registry, which is run by the American Gastro Association, and they found that about 86% of people had a sustained cure of between one to six months. Some of them missed the one-month visit. So the data is just a little skewed there. I do think I hesitate to directly compare antibiotic treatments versus FMT because when we’re getting down to people getting FMTs, and some of these were in pill form, some of them were enemas, and most of them are colonoscopies. You know, we don’t really know the exact mechanism of why an FMT works, right? Like, I mean, we know that it’s that we’re replacing bacteria, but not exactly which bacteria you know.

Lindsey:  

It needs to be different because it’s coming from a different donor.

Christian John Lillis:

Yeah and what we do know is that, and something that you know you’ve been talking about from your own perspective, is a healthy microbiome is a diverse one, right? You know that has a lot of different ones, and oftentimes, when you see people who are very susceptible to C. diff, they have low species variation, you know they’re missing something. So then, of course, if you look at different cultures in Asia, their microbiomes look different than Western microbiomes, but they’re both healthy microbiomes. I’m talking about a healthy microbiome, not one that’s degraded, right? So we’re not giving FMT to two thirds of patients who’ve responded to the antibiotics to begin with, so the 86% rate, it’s great for people that have recurrence, but it’s just hard to directly compare the two, and especially because you’re going to get antibiotics before you get either of them, right?

Lindsey:  

So the standard of care is –  how many courses of antibiotics do you have to try before you can access FMT or one of these other pills or other treatments?

Christian John Lillis:

And so typically, your second recurrence.

Lindsey:  

So you have to have two courses of antibiotics before you can get a hold of these other treatments?

Christian John Lillis:

Well, three, because before they give you one of these, they give you antibiotics to reduce the acute infection, and then . . .

Lindsey:  

. . . they give you that, okay, but you’ve failed antibiotics.

Christian John Lillis:

Yeah, the FDA actually lists them as preventatives, not treatments.

Lindsey:  

Okay, so in theory, you could get them sooner.

Christian John Lillis:

No, no, okay, it’s the prevention of recurrence. It’s like, do prevention of recurrence, right? Yeah, it’s just, it’s a weird thing.

Lindsey:  

Okay, and what about the success rate with with Rebyota and Vowst, do they have any data yet?

Christian John Lillis:

They both do. I don’t work for either company, so I tend to stay away from those things. They both do have good efficacy, and they both have very minimal side effects. 

Lindsey:  

And are they pretty accessible, like, whereas it used to be. I mean, you’ve got to find somebody who does fecal transplants and all that. Like people have trouble sometimes finding that. Does every hospital do that at this point?

Christian John Lillis:

Yes and no. So they are so in my world, in the way that I always saw this from the time that we started really hearing about FMT in 2011 and 2012, sadly, too late for my mom, but I always imagined it as like an interim step, right? Like there was a period. And there are places now where, you’ll just get a whole blood transfusion, right? But there are also things where, like, you need platelets, you need volume. So I kind of imagined, eventually they would figure out, and they would have different options for whatever was going wrong with you. Like, not just for C. Diff, but then, what are the other applications? Right? So both Rebyota and Vowst are out there. They can be prescribed. They’re easy to order.

Typically, a gastroenterologist would perform, especially if it’s enema, or if you can get them to do in a colonoscopy, when it’s with Rebyota and then with Vowst, because it is pills, it’s even easier, because you just take them while you’re home. You know, right? In terms of the patient, the difficulty is getting them covered, right? 

Lindsey:  

Yeah. And if they’re not covered, how expensive is something like Vowst?

Christian John Lillis:

So the list price for Vowst is $17,500. 

Lindsey:  

Oh, my Lord. 

Christian John Lillis:

And for Rebyota, it’s just under $10,000. That said, both companies have really good patient assistance programs, and we’ve worked with a lot of people where, if you’re uninsured, they’ve given it for free, they’ve waived the copay. So they’ve really been trying to work with people, because they also understand that a lot of times, if you’ve had recurrent C. diff, like you might not have been able to work, like people lose their jobs with this disease, you know? And then I think some of it is like you have to fight with your insurance company a little bit, like you have to be willing, and if you’re not well enough, then have somebody who can do that for you. 

Lindsey:  

Yeah. Time is of the essence. So a lot of times, insurance companies sit on these decisions for a while. So it’s like, you get it and then you fight, or what?

Christian John Lillis:

Sometimes that happens. Yeah, sometimes that happens. And then, you know, you might get a bill, or threaten and you have to fight because it should be covered. I mean, this is, again, something that we’re also working on as an organization in terms of advocating, because, like I said to you $17,500 and you’re like, whoa, right, that sounds like a lot of money. In terms of our healthcare system, which is like $3 trillion a year, it’s actually not a lot of money. 

Lindsey:  

A day in the hospital is what, at least 10,000 I would think, right?

Christian John Lillis:

But if you end up hospitalized with C. diff, the average hospital stay for C. diff is going to be $70,000.

Lindsey:  

Okay, exactly so it’s in their interest, to some extent, to make sure you get better.

Christian John Lillis:

And my mother, who died, like the cost of her being hospitalized, having surgery and those treatments for 36 hours was over $70,000 and she died. So this may be for a separate conversation, but one of the things that I feel like in this country, in particular, but in the west more generally, is that we think we’ve conquered infectious disease, and we think that everything related to it should be cheap. I think HIV might be the exception, right? But, like, we want a free flu shot. We wanted this, you know, like, ever since they stopped giving away the Covid vaccines for free, uptake has dropped precipitously, right? And my feeling is like, if this was cancer, if it was heart disease, if it was a joint replacement, nobody would – five figures, nobody would even blink their eyes. But an acute infectious disease, people are like, well, $10,000? It’s like you’re saving somebody’s life, like it is literally a life-saving treatment. Do you know much money I would have paid to have my mother live?

Lindsey:  

Of course. So I know that in the early days, people were just getting fecal transplants from a family member, but they were doing it in the hospital. Are they still doing that?

Christian John Lillis:

That is still an option. There are still some doctors who offer that. That is probably going to be an option for people who have severe inflammation disease. Also, perhaps it will be an option for kids, because, unfortunately, neither of these products is approved for pediatrics, and so that’s something that we have been and we’re continuing to advocate at FDA to figure out, like, can we carve out an exception where FMT could be used more broadly in kids, because these drugs are not approved for them.

But, you know, it, it’s a sticky widget because the FDA, yes, they take public commentary, yes, they use this, but like, they’re kind of oblique in terms of why they’ve decided, what they’ve decided, right? And I don’t think that they take into account the sort of public health impacts and population health impacts of their decisions. Like, if you even mentioned the cost to them, they won’t talk to you about it anymore. But it’s like, we live in a for profit healthcare system; cost is going to matter.

Lindsey:  

Yeah. So yeah, I guess that that leads me to the final question, which was, what are the current obstacles in the world of C. diff advocacy, and how could my listeners be of help?

Christian John Lillis:

So I would say we have two primary obstacles. The first is low public awareness. You know I talked to you earlier. I said HIV. There have been studies. 85% of Americans know what HIV is, only 30% have heard of C. diff. Oddly, 95% have heard of Ebola because there was a movie about it with Dustin Hoffman in the 90s, right? Everyone’s seen that movie. So being that there are many other things that people are much more aware of, including Zika, which, yes, I don’t want to malformed baby, but like, it’s not killing people. You know what I’m saying? A lot of it has to do with the press. And I think because this was historically a disease of old people, we’re not great to elderly people in this country. Like, we should just be really clear about that.

So I think if you’ve had C. diff, or a loved one has had C. diff, getting them to talk about it, being open about it, sort of forgive the language, but like coming out about it. And I think because the primary symptom is diarrhea, people are embarrassed. But it’s like, if you needed blood transfusions, would you be embarrassed? You know, you’re just sick. Like us having a poop thing is, like, that’s just us being weird. You know, you said you have kids. I’m the oldest of 19 first cousins. I have a six-year-old nephew. I’ve changed many, many diapers in my day. Like, there are lots worse things than poop happening in the world, so awareness!

And then the secondary thing is that I think this is applicable to a lot of infectious diseases, is that people get treated for it, and then they forget about it, and they don’t think about all the other people who weren’t as lucky as they were. And so what we noticed is that people who have had recurrences that have lasted for months or years, they’re the ones who join us, become volunteers, stay in the fight.

But if more people, people listening to you, who have had C. diff maybe, maybe it was cured in a couple of weeks, like if they signed up for our mailing list, wrote their congressperson, shared stuff on social media. Though I’m not crazy about social media lately, but if they were just more open about it and talked about it, that would be very helpful, because, and I understand, like who wants to think about the last time they were sick? But this is a disease that we’re increasingly building the tools for and getting more tools for it, but no one knows the tools, because they don’t know the disease exists.

Lindsey:  

Is there a C. Diff Awareness Day? 

Christian John Lillis:

November is C. Diff Awareness Month? 

Lindsey:  

Okay.

Christian John Lillis:

C. diff campaign the entire month of November. 

Lindsey:  

Okay in November I can relink to the episode.

Christian John Lillis:

Yeah, those are the two biggest ones. And then there are things that are downstream from that, you know, like, there’s not adequate public health funding anywhere in this country. So any communicable disease we struggle with, I think asking your hospital or the place that you get healthcare, like, what their infection rates are, just to keep them thinking about it. Because I work in this world, and I’m sure you have something corollary, but like, there was just pre-Covid, like in 2018 and 2019, they were finding people were getting  CRE [Carbapenem-Resistant Enterobacterales], which is a very antibiotic-resistant, dangerous infection, and they were getting it from colonoscopy and endoscopy scopes that weren’t properly cleaned.

And so I had to have a colonoscopy/endoscopy. I called the doctor’s office like three times, and I was like, and how are they cleaned? And who cleans them, and how are they packaged, and who opens the package? And, I mean, I went, but the point is, more people have to question, do I need this antibiotic? What is it for? You know, have you isolated the infection? What do you think I have? You know what I’m saying? And worst of all, if you’re sneezing and you’re coughing or whatever, and it’s cold and flu season, do not go and ask for an antibiotic.

Lindsey:  

Yeah, that’s viral. It’s not bacterial. Will not help.

Christian John Lillis:

I mean, you know, if it persists for more then we can go to the doctor and say, like, test, you know you can, they can test you, but have them test you. Yeah, you know exactly right? Don’t assume it’s strep throat, because you woke up with a sore throat one morning. Maybe the heat was on too high the night before; you slept with your mouth open, I don’t know.

Lindsey:  

Postnasal drip and it made your throat sore. You have acid reflux or a lot of other reasons, right? Okay, so where can people find Peggy Lillis Foundation?

Christian John Lillis:

So we make it really easy for you. You can obviously Google Peggy Lillis Foundation. We’re pretty easy to find. It’s very uncommon last name, but you can find us at C. diff.org.

Lindsey:  

Oh, okay, great. 

Christian John Lillis:

And then on most social media, if you look up Peggy Fund or just look up Peggy Lillis, we’ll come right up.

Lindsey:  

Okay, great. Well, we will link to those in the show notes. Thank you so much for sharing about this. This is a topic that’s long overdue for this podcast. 

Christian John Lillis:

I know it’s interesting that you guys hadn’t tackled it yet, but, but you’ve been tackling a lot of stuff that other people are not talking about. So good for you. And I’ve been listening, and I’m going to go back and listen more, because obviously we both care a lot about gut health. 

Lindsey:  

Well, thanks. 

Christian John Lillis:

Thank you for having me, Lindsey

Lindsey:  

My pleasure.

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.

Adapted from episode 151 of The Perfect Stool podcast and edited for readability with Lindsey Parsons, EdD.

If you’ve been reading my newsletter, you would know that I recently did a Gut Zoomer stool test. Today I’m going to be interpreting that test for you. So you’ll want to go to the Show Notes Web page for this episode, where you’ll find a link to the test results, if you want to follow along. And I also wanted to let you all know, for people who are new to hearing about my gut health, that I have a condition called post-infectious IBS/which is like autoimmune SIBO. It’s an autoimmune form of IBS that comes from an episode of food poisoning. Mine happened more than 30 years ago. There is currently no cure for this condition, although I heard recently in a webinar with Mark Pimentel from Cedars-Sinai in Los Angeles that there will be clinical trials in humans for a drug for this in 8 to 12 months. So that’s pretty exciting. But in the meantime, I’m doing the only thing that holds out hope as an actual cure with no negative side effects, fasting. I’m actually on day 1 today of the 5-day ProLon Fasting Mimicking Diet*, which makes your body believe you’re fasting while eating something and preserving lean muscle mass. And so far, I got to eat a fasting bar with nuts and 2 capsules of algal oil and spearmint tea for breakfast, so I’m not starving at all. But this is day 1 – you get like 1100 calories on day 1 – it will get harder as we go on. My husband is doing this adventure with me. So today we’ll head to Mexico to an empty house with no food to not have see food and be tempted as we fast. 

But I wanted to make sure everyone had that background as you may be wondering why I’m not in perfect gut health as a gut health coach. So when you have this condition, because of slow motility in the small intestine, you have a stagnating pond in your intestines, so it can be a game of whack-a-mole with different gut pathogens popping up each time you test. So for example, on my last stool tests, I had some C difficile in there. Gone now, but a new pathogen has surfaced this time. When you have this condition, you’re much more susceptible to food poisoning, which I keep trying to tell my husband when he does things like take cooked meat off the grill and put it back in the raw meat marinade. So you have to be super careful about not getting food poisoning again, which I tend to be not very good at because I have a pathological need to not waste leftovers. 

But anyway, on to the interpretation. So I’m going to skip to p. 3 (and I’m going to be referring to PDF page numbers, not the numbers on the page) and just FYI some of the graphics got a little weird when I copied the file and eliminated personal information. So you can see I’m right at the beginning of the green section for the Shannon’s and Simpson’s indices, which have to do with gut diversity. The Shannon’s index is about richness, i.e., number of different species and evenness. So a higher level is a higher diversity with attention to evenness. The Simpson’s index is more about dominance, so it’s more about whether certain species are dominating the community, so a higher value means less dominance of a small number of species and more balance. So I’m right at the bottom of the good reference range on both of those, so average looking overall.

Next we have the pie chart of my phyla. So in general the biggest phyla are supposed to be Firmicutes and Bacteroidetes. I tend to think of Firmicutes as related to a higher fat/meat diet, and Bacteroidetes more elevated in plant-based type diets. You can see that I’m a little dominating in Firmicutes at 49.8% (and only 36.4% Bacteroidetes) and they tag that as at higher risk for obesity, metabolic disorders and inflammation. I don’t have the first two, may have the third, but the research on this division being important for metabolic syndrome, etc. has been discredited to some extent. But I hadn’t been eating as many beans and lentils as I’d like before I did this test as I’d just come back from 5 weeks in Italy a few weeks before. 

Then you’ll see the next two biggest pieces of the pie are the Proteobacteria and Actinobacteria. Ideally Proteobacteria would be 2.5-3% or lower and mine are 4.9%. This is higher than my last test which was like 2.6% but much lower than some of my first stool tests before I learned about how to use butyrate to modulate the colon microbiome. My first stool test back in 2019 was 31.9% and my second in 2020 was 50.1%! It’s very typical to see this Proteobacteria number higher in people with SIBO and dysbiosis. Antibiotics kill obligate anaerobes who produce butyrate in the colon and that leads to the colon pulling in oxygen, leading to an overgrowth of facultative anaerobes, which are the Proteobacteria. Most of the major pathogens fall into this phylum, like Camphylobacter, Salmonella and E coli. I tend to run low on butyrate and need it if I’m not eating lots of beans and lentils, so when I see these results, I know I need to get back on the legumes, as well as taking supplemental butyrate like my Tributyrin-Max, as long as I’m not constipated. Ironically, I was going through a short and rare bout of constipation when I got these results, so I didn’t end up taking any butyrate, although I have since been able to take some. 

The next section of the pie is Actinobacteria!! This is pretty exciting to me because I’ve never had even as much as 2% Actinobacteria and ideally they are supposed to be evenly matched with Proteobacteria around 3%. And I have 4.7%! So I was excited to see that. Bifidobacteria are in the phylum Actinobacteria and I’ve historically been low but have been trying to bring them up, so I was happy about that. 

Then interestingly, the next biggest chunk is Verrucomicrobia at 2.1%. The best-known member of this phylum is Akkermansia, so this is promising and I’ll give you a preview that later in the test I have normal levels of Akkermansia. This is one of the most exciting and encouraging results for me, because I had low Akkermansia in prior tests and I’ve had lots of antibiotics and antimicrobials over the years. So I took Pendulum Akkermansia muciniphila* for a while about 6-9 months ago to try reimplant good levels, and then started my gut shake more recently to feed Akkermansia and it looks like it’s working! This, by the way, is one of the most common microbes to be wiped out by antibiotics and antimicrobials and its absence is connected with metabolic syndrome and an unhealthy mucin layer in the gut. So very happy about this. 

And then I’ve got 1.4% Fusobacteria. This I didn’t like to see, as there really aren’t any good Fusobacteria. I tend to want to wipe those out when I see them in clients’ tests. I’m particularly concerned about Fusobacterium nucleatum, which is associated with periodontal disease, colorectal cancer and inflammatory bowel disease. It’s an oral pathogen and I’ve found it before, but then eliminated it in my last Tiny Health Pro, which is a metagenomic sequencing, but they don’t list individual members of this phylum on this test, which is not a full sequencing, so I don’t know which Fusobacteria I have. I reached out to my Vibrant rep and she said they may add F. nucleatum at the next update of the Gut Zoomer, so hopefully that will come to pass. In the meantime, I got right back on DentalCidin rinse*, a great oral rinse for clearing out pathogens. And I put my husband on it too at the same time so we’re not passing it back and forth. And I think I’m going to take some panax ginseng* when I do my next supplement order. 

Then I’ve got 0.7% Euryarachaeota, which is nice because in my last test I had 0% Methanobrevibacter smithii, the major occupant of this phylum, so I was glad to see that I have some of that commensal, which may be helpful in balancing out my microbiome that tends to be dominated by E. coli, one of the two hydrogen producing bacteria common in SIBO. And the hydrogen bacteria tend to lead to loose stool, while M. smithii leads to constipation. If you’re someone who has loose stool, you can probably appreciate how novel and pleasant constipation feels, although if you’re the opposite you probably feel the same way about loose stool. 

But overall, I was really pleased with this pie chart, because for the first time ever in a stool test, I had something in every slice of the pie, so my microbiome was nicely diverse, which I think is a good testament to the power of the gut shake I’ve been having a few times a week. I have frozen bananas, cherries and cranberries as a base, then add almond or hemp milk, a tsp. of pomegranate powder and ½ tsp. of matcha green tea powder, and then some protein powders. 

Then there’s a ratio of Prevotella/Bacteroides of .55, with a reference range of ≥.48. So I’m on the good side of that range. Higher Prevotella is associated with plant-based, high-fiber diets so better fiber fermentation and short chain fatty acid production, whereas higher Bacteroides is linked to animal-protein and fat-heavy diets. However, too high Prevotella can also correlate with inflammation, insulin resistance and even rheumatoid arthritis in some studies, although this reference range doesn’t show a negative upper level on it. 

So after that they summarize all the potential correlations between your markers and various conditions. So I’m in the yellow for intestinal permeability, intestinal gas, ironically in the green for SIBO, but in the yellow for IBS, IBD or inflammatory bowel disease (which I don’t have to my knowledge), autoimmune health (now on p. 4 of the PDF file), metabolic health, liver health, nutrition, neurological health, probiotic health and keystone health. And I’m in the green for hormones and cardiovascular health. No reds. These are just correlations, not definitive. 

Now moving onto p. 5 of the PDF, we see the big issue (which was likely the cause of some diarrhea I had been having prior to doing this test): Enterotoxicgenic E. coli. This is the kind of bacterial pathogen that causes food poisoning and diarrhea, so I likely picked that up while traveling. After taking the test, I finally started taking some of my SBI Powder so I imagine I’ve already eliminated this pathogen. Someone with normal gut health would probably clear this in a few days, but for people like me who have post-infectious IBS, we may need more help in eliminating pathogens, as we have fermenting pits in our non-mobile small intestines encouraging their growth. The next page, 6, shows some elevated markers of inflammation in a model of the gut lining, which are described on p. 7. I had elevated beta defensin 2, which is an antimicrobial peptide produced by the epithelial cells in the mucous lining of the gut. It’s particularly responsive to gram negative bacteria like E. coli and other Proteobacteria. I also have elevated S100A12, which is released by activated neutrophils in response to pathogens. It usually correlates with active inflammation and is associated with IBD, but I have noticed that it’s pretty common to see elevated inflammatory markers like this when you have a major bacterial pathogen. I also have elevated fecal lactoferrin, also a specific and sensitive measure of inflammatory bowel disease, but there is a form of IBD that’s transitory in response to a pathogen, and I assume that’s what I’m seeing here. But I’ll definitely want to retest at minimum fecal lactoferrin to make sure that has gone down, although I’m not terribly concerned about IBD as I have no symptoms of it like mucous or blood in my stool or pain in my intestines, except when eating low quality gluten foods. And I had a clean colonoscopy last year and have no IBD in my family. 

The next marker listed is fecal zonulin, which is significantly elevated. This is a marker of leaky gut, but more specifically, a protein that is released by the cells lining the intestines and liver cells in response to gluten and gut microorganisms. Again, this is likely at least partially an artifact of this temporary pathogen, as any gut infection can cause a leaky gut, but I suspect that because I usually have a rotation of pathogens coming through, this is something I need to be more attentive to. Also, I have been eating gluten pretty regularly for the last couple years, so I may need to rethink that. I did once do a food sensitivity panel (IgG markers) and virtually everything I ate was on the list of intolerances, which is also a pretty good sign of a leaky gut. Anyway, so based on this, I think I’m going to start using ½ scoop of my SBI powder in my gut shake more regularly even when I don’t feel any pathogens coming through as a safeguard, as it binds to pathogens and helps seal up a leaky gut. Other things that I can do to address the leaky gut are L-glutamine* for the small intestine, and mucilagenous herbs like DGL, aloe, marshmallow root or slippery elm, as well as zinc carnosine. There are mixtures of those ingredients like GI Benefits powder* that I’ve used in the past or pills called DGL Plus*. 

The next marker, deaminated gliadin peptide, is a marker of an immune response to gliadin, which is a component of gluten. This is actually the first stool test I’ve done with a definitive marker for gluten sensitivity. This is a sad result for me, although I’m only slightly in the yellow at 11.8 (with ≤10 as normal), so I think I’m going to go back to not eating gluten at home and saving it for special occasions. I also happened to take another look at a DNA test I did a while back and I have genetics for non-celiac gluten sensitivity. 

I’m not that familiar with the next elevated marker, actin antibody. I don’t think I’ve ever seen this elevated before – it’s possible it’s new to the test, but apparently this identifies auto-antibodies to F-actin, or filamentous actin, a cytoskeletal protein found in the cells lining the intestines and in the liver. From the description, I’m seeing that this most commonly associated with autoimmune hepatitis as well as severe celiac disease, which I know I’m negative for. In a gastrointestinal context apparently elevated actin antibodies suggest advanced mucosal injury and immune dysregulation. I guess that given I have an autoimmune gut issue this makes sense, but I don’t know what else to make of this marker. I’m hoping that this is also related to the Enterotoxicgenic E. coli. Recommended supplements for this are listed as curcumin, omega 3 fatty acids, which I already take, and green tea extract, which I’m taking in the context of my matcha green tea powder and I also drink green tea, but I could ramp it up with some more EGCg,* which is an extract of green tea. 

Then on p. 9 of the PDF file, I had one marker of malabsorption, vegetable fiber found in my stool. I’m sure inadequate chewing is part of the issue, as I tend to swallow my food. Bad habit from childhood. But I’ve also often had less than optimal pancreatic elastase in past tests, which is ideally above 500, and this test is not different in that respect, but we’ll get to that later. Since I got these results, I ordered a powdered enzyme supplement specific to the FODMAP foods called FODZYME*, so I’ve been sprinkling that on my food. 

The next page is a diagram of the gut to show primary bile acids and secondary bile acids, which are what you get when gut bacteria convert primary bile acids. And then on the right we have the short chain fatty acids. Propionate is highlighted in red because my levels are elevated and butyrate is highlighted in red because it’s low. Apparently elevated propionate can lead to constipation, which I don’t think was an issue at the time I took this test. Low butyrate, as I mentioned before, is pretty common for me and when you have excess Proteobacteria, and I’ll address that by getting more fiber through my diet and when I have loose stool, taking my Tributyrin-Max. And my overall short chain fatty acids are low, which again is usually addressed with some form of butyrate. I generally recommend Tributyrin-Max for people who have loose stool or diarrhea, as it’s the highest dose butyrate on the market, and lower dose options if someone is low in butyrate but constipated and/or experiencing incomplete elimination or sticky stool. I usually pick Probutyrate*, which is 300 mg/pill or Tributyrin 350 Active*, for people in that situation, recommending only 1 pill every 3 days and increasing to once/day as tolerated without creating more constipation. 

The next three pages, 12-14, have some prebiotic and probiotic recommendations, as well as other supplements and foods. By page 15, we have a complete list of pathogens where you can see my elevated E. coli again, then nothing shows up on p. 15 of fungi, viruses, helminths, antibiotic resistance and virulence factors of H. pylori, which tells me whether the H. pylori I have is a concerning one that could cause stomach cancer or ulcers. None are positive and there’s no antibiotic resistance and my levels are low/normal. Then on p. 17, I test negative to more helminths and then you can see all the inflammatory markers in context. So you see how I don’t have an elevated marker for calprotectin, which is another marker for IBD, so yet one more reason why I’m not that concerned that IBD could be an issue, despite the elevated lactoferrin. 

Then the next section, on digestion and immune imbalance shows my pancreatic elastase, one of our primary pancreatic digestive enzymes, just inside the green at 201.6 (on a range of ≥200), although most practitioners consider >500 optimal. So that points to the need for digestive support, which is never a bad idea when you have post-infectious IBS, as it leaves less food for bacteria to ferment and create bloating. Thankfully, all the other markers were in range, including secretory IgA, which is your primary gut immune marker. Since I found out that I have poor genetics for converting beta carotene into the usable form of Vitamin A, retinol, I’ve been taking retinyl palmitate* (and note that you can get toxic doses of vitamin A, so don’t just hear that I’m taking it and decide that’s a good idea for you) but that may be helping with my gut immune system, which has tested lower in the past. 

Below that is a new marker, lipopolysaccride or LPS antibody. Mine was normal, but presumably this marks an immune response to LPS, which is an endotoxin on the cell walls of and released by gram negative bacteria, which Proteobacteria are. 

Then on p. 18, you can see some more gut antibodies in context. Some of these are new markers to the Gut Zoomer, including the anti-Saccaromyces cervisiae antibody. If you had this positive, the probiotic S. Boulardii, which is actually S. cervisiae subspecies boulardii, would be contraindicated for you. You can also see that there are 2 more markers for gluten sensitivity, and two of them are normal, so a good reminder that just because you get the green light on one gluten sensitivity marker, don’t assume you’re not sensitive. And most gut tests only have 1 marker. 

Below that is the section on malabsorption in full context, and fecal fats, and mine are all in the normal, but on the higher end of the scale. I tend to have a relatively high fat diet, mostly in the form of olive oil, avocadoes, olives, etc., usually something around 40-60% of my calories, so these results make sense. 

Then below are the bile acid metabolites, and all those look good, so no issues with my gallbladder apparently. I’m glad to see that because I was a little worried about my fat digestion a few months ago and did a 2-month protocol to gently remove any gallstones and thin the bile, and everything looks good. 

Then on p. 19, you see the short chain fatty acids in context, followed by a marker called beta glucuronidase. This was one of the primary reasons I did this test, because it was elevated on my Tiny Health PRO test* I took a year before. When elevated, it indicates a type of dysbiosis, that leads to the toxins attached to bile, which include estrogens, being detagged from the bile and sent back into circulation. This can lead to breast cancer, colorectal cancer and estrogen dominance, which I struggled with my whole life, I now know in retrospect, but not so much now that I’m in menopause. So you definitely don’t want to just sit on a result like that. A year ago following that high beta glucuronidase, I drastically changed my diet for a time, eliminating almost all meat and all fatty cuts of meat, moving to vegan protein sources and eliminating all dairy fat. I also started taking Seed Synbiotic* in order to bring in more Lactobacilli and Bifidobacteria to push out beta glucuronidase producing bacteria. So I was very relieved to see that my beta glucuronidase has normalized. 

The next section, from pages 20-23, is the gut commensals, or the normal gut occupants of a healthy gut. But of course even normal occupants can be overgrown. So I have to say that this is my least favorite part of the Gut Zoomer, mainly because of the scales, which all go from 1-20 or 1-10, which is a funny way to create scales of bacteria, when for some it might be normal for them to occupy 10% of your microbiome, and others less than 1%, so this results in the nature of the dysbiosis not being as clear as with other tests, like the US Biotek GI-Advanced Profile*, which always shows super clearly which bacteria are the issue. 

But anyway, there were only two elevated ones here: Actinomyces and Fusobacterium (the latter are hydrogen sulfide bacteria incidentally, although that’s never been an issue for me). I had more that were low, including the whole genuses Bifidobacterium, Blautia, Clostridium, and Prevotella, as well as the species Blautia hydrogenotorophica. Given those low levels and the high levels of E coli, I’ve started adding some prebiotic fibers to my gut shake, including acacia fiber,* Fibermend from Thorne*, which has partially hydrogenated guar gum or PHGG, apple pectin and larch arabinogalactin. I also got a probiotic from Life Extension called FLORASSIST GI with Phage Technology*, as the 4 bacteriophages in it, which are viruses that attack bacteria, target E. coli. So I’m going to take a bottle of that. 

Then on the second half of p. 23, there’s a list of probiotics. I had good levels of all of these, most likely because I didn’t pause my probiotics at all before taking this test, because I pretty much plan to continue with this plan so I figured no harm seeing how they’re showing up. I had low levels of Bifidobacterium bifidum but the rest are in great shape. So I picked out that probiotic I mentioned because it also contained B. bifidum as well as the phages. And that’s pretty much the end of the test. 

So overall, I was pretty happy with these results. Didn’t love seeing a major pathogen or inflammatory markers in there, but it was a good wakeup call about protecting my microbiome and not eating such old leftovers! And also didn’t love that I’m going to have to go off gluten again, but honestly, there is some great gluten-free bread available in Tucson – at Gourmet Girls if anyone is in the area – love their ciabatta rolls, so it makes life livable being gluten-free. I also tried attempt one at baking gluten-free focaccia, which wasn’t so great, but I’m hopeful that attempt 2 will go better. 

So if you’re thinking of doing a stool test and working with me or someone else, I’d encourage you to do a breakthrough session first, which I offer free to all comers, because each test has pros and cons and certain markers, and certain symptoms lead me to choose one test over another, so it’s good to consult about that before buying. Plus you can only get the Vibrant tests through a practitioner. 

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.

Adapted from episode 150 of The Perfect Stool podcast and edited for readability with Shana Hussin, RDN and Lindsey Parsons, EdD.

Lindsey:  

We talked a bit about what we were going to talk about, and one of the things that you like to focus on is insulin resistance and cortisol dysregulation, and that’s something that you’ve gone through yourself. So can you tell me about that?

Shana Hussin:

Yes, I know your story is similar and you’ve gone through the ringer with the gut stuff. When you’ve lived it yourself, I think it just becomes in your face and it’s easier to point people in the right direction. I’m a registered dietitian. I’ve been in the nutrition field for over 25 years, I taught the standard recommendations for a long time, and I was classically trained. Then, I discovered I had insulin resistance by following the standard nutrition guidelines and thinking I was doing everything that I should to remain as healthy as possible and feeding my family in the same way. Honestly, I didn’t know what insulin resistance was until about seven or eight years ago. Of course, I knew all about type two diabetes and pre-diabetes.  there is very, very strong genetic diabetes, polycystic ovarian syndrome, heart disease, in my family, so I’ve always been really mindful about that and careful with my lifestyle. I noticed I was having a lot of cravings and food noise in my head. I would eat a meal, and I’d already be thinking about what I was going to be eating for the next meal, and even though my weight has never been a huge issue for me, I was doing a lot to maintain my weight.  I was exercising a ton, I had three little kids, I’m like, “life just shouldn’t be this hard.”

And then, it’s kind of a long story, but my son got really sick, and I went into the deep thralls of alternative therapies, because the conventional system was not helpful for him and his healing. So, I went a lot of alternative routes, and I started to really dive deep into whole, natural nutrition and going away from the standard guidelines and was blown away by what I learned. Of course, intermittent fasting came on the scene, some therapeutic carb restriction therapies that I tried on myself, and I was blown away by the results that I saw. I actually wrote a book on fasting, and did that for a long time, and I mostly healed my insulin resistance, and again, I didn’t even know what that was. And what’s interesting about my story is that I always had normal blood sugars and normal cholesterol levels; my lipid panel looked great. Everything looked good on paper. I was in a healthy weight range, but once I learned about insulin resistance and how to test for it, I discovered that my fasting insulin was out of range on the high side, and at that time that I had my fasting insulin checked. I was already two years into this lifestyle of time restricted eating and therapeutic carb restriction, so I have no idea what my fasting insulin actually was when I was feeling all of the symptoms.  I was able to reverse that, and I teach people how to reverse their insulin resistance. 

But then, the second thing that you mentioned was that I also teach mostly women, because women are who really struggle with a lot of cortisol issues. Funny enough, when I was doing all of the things that I teach, and intermittent fasting in a way that I was I also kind of exacerbating my cortisol issues that were already there. For the longest time, I thought cortisol was all about managing your nutrition and managing your stress, which play a strong role. But that wasn’t the biggest piece of the puzzle. Again, I went down this deep dive into how to actually fix cortisol issues, because I just see it rampant in the people that I work with, women my age, who are in perimenopause and menopause. But even that, I had cortisol issues since college, I would say they started, and I just didn’t know how to fix them. So, long story short, I discovered how to fix my cortisol issues. Once I did that, once I brought my cortisol levels back into balance, I fully recovered from insulin resistance, because I still had a little bit of insulin resistance hanging on until I balanced that hormone. So that’s how I got into specializing in those types of issues.

Lindsey:  

Got it.  So you were mentioning your fasting insulin being elevated, and I assume you meant according to standard reference ranges. But, I have heard that for fasting insulin, below six is an optimal reference range. Is that something you use as well?

Shana Hussin:

I do. So when I first tested mine, and I was two years into this lifestyle, mine was 10.7, so if I had gotten that result in the conventional system, they would say fabulous, “that looks great.” I knew that it was at least slightly elevated. Again, I’m willing to bet it was probably in the 20s prior to that, when I first started working on reversing it. In the conventional system, most lab standards are up to 24.9 as being normal, which really high. So yeah, as you mentioned, I like to see that number between 2 and 6. When I first had mine tested, it was 10.7 and then I had it tested two years later, and it was 7.5 and I was still like, “what the heck? This is like four or five years later!” Not that it was extremely elevated by any means, but it was still outside that normal range. Once I balanced my cortisol and brought that last piece of the puzzle in, which was working on my nervous system and my lighting environment, then my level went to 2.2 and that was just this past summer, so just a couple of months ago, so I was really happy to see that.

Lindsey:  

Awesome. So I’m curious, because I have a client in this situation. So what does it mean if you have somebody who’s not diabetic, but they have a lower than 2 fasting insulin?

Shana Hussin:

Yeah, that can happen. You don’t want to have no insulin response whatsoever, but so you do want to have some. Under 2, in my experience, and this isn’t always true, but sometimes they can have higher than normal blood sugars because they’re just not secreting enough insulin to draw the blood sugar into the cell. Sometimes, as with type one diabetics, they don’t produce any insulin.

Lindsey:  

Right. It’s gone so far into insulin resistance, they don’t have the insulin coming.

Shana Hussin:

Exactly. Yeah, that’s an interesting scenario. Either their pancreas is needing some help, or I’d be willing to bet their blood sugars are probably a little bit higher.

Lindsey:  

Yeah. So I came into the functional medicine field when the term “adrenal fatigue” was coming under criticism, and I know most practitioners now call it an HPA Axis dysfunction, but the same type of diagnoses and treatments are administered, whether it was called adrenal fatigue or HPA Axis dysfunction. So, if someone has low DHEA and lower high cortisol, no matter what it’s called, the people I trained under, they’re giving pregnenalone, they’re giving DHEA. So I’m curious what your take is on all this and the terminology and how you deal with it. 

Shana Hussin:

Yeah, and HPA axis dysfunction is definitely more accurate than adrenal fatigue, and in the conventional system, adrenal fatigue, adrenal dysfunction, adrenal exhaustion, all of those terms are pretty much dismissed by conventional doctors most of the time, unless there’s actually something wrong with the adrenal gland, in which case, their only solution is typically medication. But as you mentioned, we know now, hopefully more and more people will be starting to know that it’s more of an HPA axis dysfunction. Cortisol is produced by the adrenal gland, but it’s produced in response to the signaling that it’s getting through the eyes and the light environment. So the light that’s coming into the eyes – eyes are basically an extension of our brain that is signaling to the hypothalamus what to do and what time of day it is, and basically telling the body what to do, when to secrete hormones, when to make neurotransmitters, when the organs should be doing what they’re doing. The hypothalamus then tells the pituitary glands to tell the adrenal glands to then make cortisol.

And so we blame the adrenal gland and say it’s adrenal fatigue – the adrenal gland is just tired, which you know in some circumstances might be true on some level, but it’s mainly just the communication that has been broken. The body is so confused by all of these different signals that it’s getting that we were not meant to take in through our eyes. That signaling is broken. And so the adrenal glands just don’t know what to do. They don’t know when to secrete cortisol. They’re secreting it at times of the day that it’s not normally secreted, or they’re not secreting it at certain times of the day when it should be secreting it. And so that’s where we do go back to that HPA axis dysfunction and being much more accurate. And in functional medicine, they’re definitely starting to come around. But I know with functional medicine too, a lot of times people would go in with cortisol dysregulation or imbalance. And the response was, “well, let’s give you adaptogens, or let’s give you ashwagandha.” And those things can certainly help. I’m not disregarding those, but it’s still not fixing the messaging along the HPA axis. 

Lindsey:  

It sounds like you’re using light. So is this about following a circadian rhythm, getting light in the morning, low lights at night, kind of thing?

Shana Hussin:

Yeah, that’s the main therapy, and the main thing that I have my students work on when they come to me. First, we’re looking at cortisol testing and looking at what their pattern is during the day, and we can talk a little bit more about that, but what their pattern is showing is how we’re going to set up their therapy, but it is primarily light focused. So I know for me, I got to the point of adrenal exhaustion. So the testing that I like my students to do is called a four-point cortisol saliva test. And maybe you’ve mentioned this on the podcast before, and the one that I have sent, I have a home kit sent to them that also includes the hormone DHEA, because usually that’s really low when the adrenal glands are not working correctly. It’s a salivary test; you spit into test tubes at four times throughout the day.

But why that’s helpful is that we should have a natural cortisol spike in the morning, when we’re getting up, it’s our system saying, hey, let’s get up and go. And then it should kind of peak midday and then start to fall, and it should be low by late afternoon to evening. A lot of times I see either a flattened cortisol pattern like I had, where it’s just kind of low levels of cortisol all day long, and that’s usually when this has been going on for a really long time. Things are just very chaotic and dysregulated by that time, the signals have been off for a really long time, or a lot of times, I’m seeing an inverse pattern where people are having high cortisol levels at night, and that sets us up for very disturbed sleep and not healing and feeling like absolute crap all the time, because you’re not getting restorative sleep.  It can lead to weight gain, and so you have these levels of cortisol going high at night, in the afternoon and in the evening, when they’re supposed to be falling, and that prevents us from going to sleep and staying asleep. People who are feeling wired but tired at night because they just can’t seem to fall asleep, they’re wiped but they can’t fall asleep. What happens is the cortisol goes high at night when it’s supposed to go low, and the inverse hormone is melatonin, and melatonin is our fall asleep, stay asleep, repair hormone, and that should peak at night, but instead, cortisol is high, and so we can’t fall asleep, stay asleep. We have very dysregulated sleeping.

And then come morning, when our cortisol levels are supposed to be going high again, they’re very low, because this whole inverse relationship is off with melatonin and cortisol. So that is where a lot of these issues are coming from. But like I said, I like to test my students first to see what their pattern is. My therapies or the suggestions that I make are very, very similar, but knowing what we’re starting from and where we’re starting from with cortisol patterns is really helpful. So then you’re just doing that saliva test at four times throughout the day to see what your pattern is, if that cortisol level is rising falling as it should be. It’s a really easy test to do, and we can track that over time.  I know I struggled with this for decades, and like I said, I got to the point of adrenal exhaustion. Once I learned how to properly incorporate and change my lighting environment and work on my nervous system, I was able to recover my pattern within a couple of months. So you know what’s causing it and how to correct it. You can do so pretty quickly. You can kind of go by symptoms, but I like to test and then test every three months or so to make sure that that cortisol is still well in balance.

Lindsey:  

Yeah. And so how can you correct that dysfunction? Or how did you do it for yourself?

Shana Hussin:

Yeah. So as I mentioned, mine was just low all day long. It’s weird, because a lot of times when people are to the adrenal exhaustion stage that I was at, they’re so tired, not wanting to get out of bed. And a lot of times they’re misdiagnosed with depression with really low levels of cortisol, or they’re diagnosed with anxiety when cortisol is spiking at the wrong time. It’s really kind of sad because had I gone to a conventional medicine practitioner, I probably would have been offered an antidepressant, or if I had high cortisol night, an anti-anxiety medication.

But what I did is I learned how sunlight and our lighting environment really are the triggers for cortisol, the main triggers. There are other things, I’m not going to say it’s just light, but that’s the primary one.  When sunrise comes into our environment in the morning, at daybreak (daybreak and sunrise are different) – daybreak is when the light is starting to come into the environment. Sunrise is when the sun is actually coming onto the horizon. At daybreak, there’s a lot of red light. And if you go outside, it’s like that warm glow. It’s kind of reddish looking. So a lot of red light there. Sunrise is where blue light comes into the environment, and it’s in the same amounts as red light. When blue light comes under the horizon, and our eyes can take that in, it’s the blue light that is picked up by the eyes that tells our body to produce cortisol. What happens is, people aren’t going outside much, right? The average American spends seven minutes a day outside, which is astounding. We did not live like this a couple hundred years ago. Our environment has changed so drastically, and our genetics have not had time, they really haven’t changed at all. They haven’t had time to catch up with all of this lighting change.

And so, going back to sunrise, if you can go and watch the sunrise, you will tell your body to produce cortisol. Mine was really low, so all I did was go outside every single morning at sunrise. I miss some in the summer because I live in Wisconsin, and sometimes the sun is coming up at like five o’clock in the morning, but as much as I could, I went outside to see the sunrise, and that triggered cortisol production. And the cool thing about the sunrise and the natural light in the morning is that it’s going to act as if your levels are too high, it’s going to bring them down lower. If they’re too low, like mine are, it’s going to stimulate that cortisol to be higher. So that was a huge part, just getting outside, going out to the sunrise. I’m not saying you have to sit out there for an hour. I set a timer for three minutes. If I can sit out there for longer than that I do; otherwise, I go out for three minutes just to get that signaling into my eyes. 

As we go throughout the day, our lighting is always changing outside, the spectrum is always changing. At midday, we have very high levels of blue light, not as much red light. And then we get into sunset, and there’s a lot more red light than blue light. And then after nightfall, there’s no blue light in our environment, and that’s important to take into consideration, because remember, blue light stimulates cortisol after nightfall. As humans, we’re not supposed to be getting those signals of blue light into our eyes anymore. We’re supposed to be winding down and going to sleep. But what has happened in our environment is then we stare at TVs, we stare at phones, movies, Netflix, computers, we have to do homework, iPads, whatever it is, and all those things are very, very high in blue light. So this is where that inverse pattern is coming into play as people who after nightfall, after dinner, after it gets dark, they’re watching TV all night, or they’re working all night.

Sometimes we have to work  – night workers, hospital workers, who are under these awful, awful fluorescent lights throwing all this blue light your body is perceiving that at all times. And so it gets really confused. It’s nine o’clock at night, and your body’s like, “Wait, I thought the sun went down, but all this blue light’s coming in. It must be midday. Oh, I better push my cortisol up. I better give Shanna some more cortisol, because it’s midday. She needs more energy.” Cortisol levels rise, and it makes it so hard to go to sleep. And the thing about cortisol, too, and why I wasn’t fully recovering from insulin resistance, is it also increases blood sugar, it increases insulin. It’s interesting. There are so many studies, even if you are not eating or you’re not hungry, you start to watch TV, you put a phone in your face, and the cortisol is stimulated. All of a sudden, you’re having cravings. You’re having “I want some ice cream,” whatever it is, the cortisol goes up, the blood sugar goes up, insulin goes up, and it’s really tough to reverse that insulin resistance fully. That’s the main thing I did to fix mine, just go out at sunrise, and I’d go out for light breaks throughout the day, and I don’t wear contacts or glasses, but you want to do this with naked eyes, if at all possible. 

Lindsey:  

Right. And not through windows, right?

Shana Hussin:

Not through windows. You can open the window and look through screen. That’s fine. If you’re driving, you can crack a window, but almost all UV light, and most red light is filtered by windows. Unfortunately, yeah, looking through the windows isn’t the same, no contacts, no glasses. I did a lot of light breaks. I did a lot of other things for my nervous system, like grounding and being in nature. Another thing that I did that I had no idea was exacerbating my cortisol issues was I stopped wearing sunglasses. And I know that that sounds really wonky for a lot of people. I live in Wisconsin, if it’s snowy, if I’m driving and there’s glare off the snow, or if I’m boating and there’s glare off the water, then of course, I wear sunglasses. But for the most part, I stopped wearing sunglasses because that’s confusing to the body too, because it’s filtering all the light signals.

Lindsey:  

Yeah, and what color are your eyes? I’ve got to ask. 

Shana Hussin:

They’re green.

Lindsey:  

Mine are too, and mine are so sensitive to light I cannot stand to be outside without a hat and sunglasses. I live in Arizona, so.

Shana Hussin:

Mine used to be that way, Lindsey. It’s interesting because I had very high light sensitivity, and that’s another sign of adrenal fatigue and adrenal dysfunction. And I was a lifeguard and growing up, and I’m like, “How am I going to stop wearing sunglasses? This is crazy.” But I just did it little by little, I started with a hat, and now I can go out. It’s really crazy. I don’t have to wear sunglasses anymore. 

Lindsey:  

You aren’t squinting the whole time?

Shana Hussin:

Nope. In the summer, at high noon, I’ll put a hat on, or I like to work outside, and if I’m able to, I’ll sit in the shade. But that light sensitivity goes away with time, and it’s just because you’re so accustomed to being indoors and to having sunglasses on. All of those things, within a couple of months, I tested my cortisol pattern again, and it was normal. And I’ve never been a night hawk, so nighttime wasn’t a huge factor for me. But the other thing that’s so important is blocking the blue light after the sun goes down.

Lindsey:  

Right. I also just heard, I was listening to the Huberman Lab podcast, and he was saying that there was a study that they were questioning the whole blue light hypothesis, and that maybe it’s not even the blue light, but maybe it’s actually the devices themselves and the amount of stimulation that they’re giving you that’s raising your cortisol, not the light coming off of them. I’m sure the jury’s still out on that question. It’s probably just one study.

Shana Hussin:

I would say both for sure. 

Lindsey:  

Without question, the stimulation of scrolling through social media and things like that.

Shana Hussin:

Oh, for sure. I’ve been wearing blue light blocking glasses for like a year. And I will say if I’m watching a stimulating show, even with my blue light blocking glasses on, I have an Ouro ring that tracks my stress response. My husband and I have been watching Yellowstone, and when I watched that right before bed, I watched my stress response climb. I’m like, “Okay, I’ve got to do my glasses and I’ve got to do my wind down routine.”

Lindsey:  

I know, I don’t like watching scary things and that sort of thing. My son got us watching this “Killing Eve”. And I’m like, “This is brutal. I don’t like this. I don’t want to watch this kind of stuff.” Anyway, I’m wondering why cortisol seems to get imbalanced, in particular with women in perimenopause/menopause. Why is that a thing? 

Shana Hussin:

I don’t have the exact answer, but I draw my conclusions. I just turned 49 so I’m in perimenopause, and I work with a lot of ladies in perimenopause, but you get more insulin resistant when you go through perimenopause just because of all of the hormonal changes.  So we can’t do the same things as we used to do. We can’t eat the same way, our stress response….

Lindsey:  

Or drink the same way. Can’t do anything the same way after you lose that estrogen.

Shana Hussin:

Yeah, your skin changes, your hair changes. You’re not as resilient. So I don’t know what comes first, the chicken or the egg with cortisol or insulin resistance. I honestly think it’s a combination of all of the above. You know, you’re probably the same type of person I am: type A. I raise three kids; I run a business. I want my kids to eat well. We just have busy woman syndrome. And I think by the time we’re in our 40s, 50s, our hormones are declining. We’re not as resilient as we were before. We’re more apt to store body fat because of the estrogen levels falling. We don’t sleep as well. We’re not as like, “Oh, get up and go and conquer the world.” Everything comes to a head, and we’re just at the time in our lives where my kids are older, two are in college, and one is in high school, but I lost both my parents last year. We’re just sandwiched into raising our kids and taking care of our parents and going through all these hormonal changes that is just a really hard time for women, and that mom transition too, where I was so busy with my kids for so long,. . . 

Lindsey:  

I just have one at home. And he drives too!

Shana Hussin:

And now, what am I going to do all the time? 

Lindsey:  

Have fun? 

Shana Hussin:

Like I said, women want to eat and drink and do the same lifestyles they did in their 20s, but now we have all of those changes coming at us, and we start to show some symptoms as a result.

Lindsey:  

It’s shocking how your health plummets when you start to lose that estrogen.  I’m on hormone replacement therapy, and even still, my cholesterol has gone up, blood sugar’s gone up. Admittedly, my last blood tests were after my honeymoon, because I got remarried, and I had been drinking every day because I was in France, and that’s what you do. 

Shana Hussin:

Well, their alcohol is probably completely different. You know, everything’s different there. 

Lindsey:  

I mean, whatever the quality of the alcohol, my liver enzymes were certainly above optimal by the end of that. I’ve been waiting to correct this all and retest and hopefully get better numbers, but still, just going into menopause shot everything for me, really, and I’ve been reading about that and what the alternatives are to even just your basic HRT. But looks like the alternatives are not great. If you really want to replace your hormones back to pre-menopause levels, which is what the authors of book I’m reading are proposing, you actually have to have a period, potentially even get injections of estrogen. I’m using a patch and progesterone pills. So it’s not crazy.

Shana Hussin:

That’s the one benefit of going through menopause, right? 

Lindsey:  

Exactly. I’m like, “I don’t know it’s a tough trade off, but I still get the hot flashes even when on HRT.”

Shana Hussin:

Right, it’s like, “I want my hormones, but I don’t want that anymore, exactly.”

Lindsey:  

So when somebody does have that spike right before bed in cortisol, other than keeping out the blue light and dimming lights, is there anything else that can be done about that?

Shana Hussin:

Yeah, so the blue light is the main thing. And when I start to work with people with cortisol dysregulation and insulin resistance too, the first thing that we work on is our nighttime routine, because it’s hard to fix the morning routine when you’re not sleeping well. So getting that under wraps, starting with the blue light blocking, and I will say there are more and more blue light blocking glasses coming out. And you can get them on Amazon; you can get them wherever.

Lindsey:  

Or if you wear prescriptions, you can get them built in, like I’ve got. 

Shana Hussin:

Yeah, but unless you’re wearing the orange toned at night, the clear ones aren’t going to block the blue light. They’re going to help with eye strain with your computer if they’re clear, but you want the orange tone or the red tone. I don’t wear red tone. I don’t need those. But the orange tone, I’ve switched out my light bulbs in my living room and my bedroom so that there’s almost no blue light. They’re 99% no blue light.

Lindsey:  

Okay, so what kind of light bulbs does one get? 

Shana Hussin:

They’re called Hooga, H, O, O, G, A, is the company that I order from, Incandescent lights will also have virtually no blue light. They were almost banned for a long time, but there’s now an executive order signed that incandescent lights can be sold again, and I could always get them in Wisconsin, but there were certain states, I know California for sure, you couldn’t get incandescent light. So the LED lights, the really bright, fluorescent lights, are the ones that are problematic. And then, of course, just having some kind of wind down routine. I try not to look at my phone or screens at least an hour before I want to sleep. I’m reading or I’m journaling, I know that’s not for everybody, but that really, really helps. 

Some other things that can help if you absolutely are having trouble sleeping, magnesium. We mentioned progesterone. You might need to look into that, but people are amazed at what blocking the blue light does with sleep quality. So we start there and work on the nighttime routine, and then the daytime and morning routine become a lot less challenging because you’re getting that melatonin peaking at the correct times. I tell my clients I work with, if you can be asleep by 10 o’clock, that is where I want you eventually, because all of these repair systems and the melatonin production peaking, melatonin peaks about four hours after darkness and after you’re sleeping. If you’re falling asleep around 10 o’clock, it’s peaking around 2 a.m., which is when it should be peaking, and then it’s starting to fall by the time you want to wake up.

People who don’t go to sleep until midnight, or they have this blue light in their eyes, they’re not letting melatonin take over until 12, one o’clock in the morning, while it’s peaking, then at 4 or 5 a.m. That’s why you don’t want to get up, because your melatonin is high, your cortisol is low. And there’s people who are like, “I’m a night person, I’m a morning person,” and there’s definitely something to that, but a lot of times it’s just this dysregulated light environment, and then the morning routine becomes a lot easier. You’re able to get up and watch the sunrise and take in light breaks throughout the day, and that’s kind of where we start. But the melatonin production is just as important as the cortisol, because if you’re not healing and repairing and getting restorative sleep, it’s going to be very hard to recover from any disease. 

Lindsey:  

What about other patterns I’ll often see, like on the Adrenocortex or the ZRT four-spit cortisol test/adrenal test is that someone’s cortisol is particularly higher in that sort of 5 to 7 p.m. range.  I think that’s probably a natural rhythm of life. Just because that’s when we’re doing all the stuff. We’re finishing work, we’re picking up kids, we’re making dinner, we’re running errands. Those are naturally high cortisol things. So is that something that needs addressing, or is that sort of a natural period of higher stress?

Shana Hussin:

Yeah, I mean, it should be a little bit higher, that kind of mid to late afternoon, but it should be falling. I’ve seen that pattern for sure, where it’s out of range at that third time that they’re doing the spit test. But what we work on then is getting wound. I think that this is probably me, like, 10 years ago, where I’m taking my kids everywhere and you know, your workday kind of ends, but then it’s just beginning of the whole nighttime routine. So yeah, I do see that pattern, and a lot of times it has a bit to do with the blue light stimulation again. But it’s important to note, if you are working on getting cortisol back into balance, like I said, I primarily did all the lighting things, but I also had to work on my nervous system, like I was just in this perpetual fight or flight all the time. And some of that was everything that happened with my parents, but it was just that, like I mentioned, that busy woman syndrome too.

Or I just tell myself, you’ve got to slow down, you don’t have to be achieve, achieve, achieve all the time. And so I started things like journaling, Bible reading, just quiet time that I had never incorporated in my day before. And there’s a couple of other things that I teach in my course to really work on the nervous system. It sounds kind of crazy, but doing a couple of cold face plunges in the morning just takes you out of that fight or flight. You can feel it immediately. So there might be people who have that pattern as well, and as long as you can get it lowered by the time you go to bed, it’s not going to be as disruptive as a real high cortisol at bedtime.

Lindsey:  

So what is leptin, and what does it have to do with blood sugar and cortisol? 

Shana Hussin:

Leptin is another hormone. It was only discovered in 1994- I mean, it’s always been there, obviously, but we didn’t really discover it until 1994 and not a lot of people know about leptin or what it does, but it’s actually produced in the fat cells, and its primary job is to tell the body what’s the energy status on my body. This becomes very, very important, because leptin, telling the brain what the energy status is of the body will give it signals for hunger, satiety, how much to eat the next day. We can back off. We’re not as hungry the next day. But leptin, like I said, is produced in the fat cells, and it can become dysregulated. I see it mostly become dysregulated in women who have tried their entire life to lose weight, and they’ve kind of been in this caloric deficit, gain the weight back. Caloric deficit, gain the weight back. The perpetual dieter almost always has dysregulated leptin.

And the other thing that really screws up leptin is snacking and eating, and this perpetual I’m just going to eat and graze like the grazers. And so what leptin does is it docks to the brain, the hypothalamus, usually around midnight or so, and it downloads. It gives the body a download, like, “Shana has this many extra calories stored as body fat,” or “Shana really has no energy stored.” And what that does is it tells the body how much to eat the next day.  So if there’s leptin resistance where your leptin is too high, this happens usually when we have too much body fat, when we’re in that perpetual snacking, grazing mentality, the fat cells are just producing too much leptin. 

This is a problem because it’s just a miscommunication to the brain and then the perpetual dieters, restrictors. Those who’ve been doing a lot of fasting or a lot of caloric restriction, they can’t seem to lose weight a lot of times, they have really low levels of leptin, and that can become problematic too, because then you might have extra body fat. Your brain is being told you don’t have energy stores and to eat a lot the next day. When we’re leptin resistant, we’re almost always insulin resistant too. The thing that people should know about leptin is that it’s docking to the hypothalamus around midnight, but the receptor, the leptin receptor, competes with insulin, and so if you have higher than normal levels of insulin, it’s really hard for leptin to dock at the hypothalamus where it should, and your body’s not getting that communication either. So if you’re insulin resistant, a lot of times, we’re also leptin resistant, and we’re just kind of a hormonal mess.

And the other thing that’s really important to note about leptin is it primarily docks overnight, and so what I’m getting at is you don’t want to be eating at night, and you don’t want to be insulin resistant. You’re eating at night, and you have high blood sugar, high insulin, your leptin is not going to dock correctly. So that’s really important. So that’s a whole another thing that I work on with my insulin resistance folks is to stop snacking and stop eating at night, so your insulin can come down and your leptin can start to dock to your brain. Leptin will also download during the day about every four hours, and that’s why when we’re eating correctly and we’re managing our blood sugar and our blood sugar levels are healthy, we should be able to go 4, 5, even 6 hours without eating if our leptin is signaling correctly, and you won’t get a leptin download until about four hours after you’ve last eaten. So if you’re just in this perpetual snacking mode, your leptin is probably very dysregulated, and you’re going to have a really tough time losing weight, and just metabolically, you’ll struggle.

Lindsey:  

So are you measuring leptin on your clients? And if so, what’s an optimal level? 

Shana Hussin:

Yeah, I wish. You can. You can ask your doctor for leptin, but chances are they might…. 

Lindsey:  

Chances are they’ll say no. 

Shana Hussin:

If they’re more progressive, they might. I also work with ZRT. You mentioned ZRT earlier. This is the lab that I order all my own kits from too, they don’t have leptin right now. I’m hoping that in the near future they will. You can order it on Own Your Labs. Some of those lab websites where you can order up what you want and go to, usually it’s Quest or Lab Corp that will test it. I like to see a level like 2 to 9 somewhere in there, but unless you get it checked, you don’t really know. But it is important to look at your levels. Way over 9, it’s going to be a little bit different approach than if you have really low levels. And usually, like I said, my low leptin people that I’m seeing are those who are type A, over restricting in a caloric deficit. Maybe been over fasting for a long time, important to have that in balance too.

Lindsey:  

Yeah. And so the solution to that is just eating normally, not restricting your calories?

Shana Hussin:

Yeah, yeah. So how I go about fixing that, I used to do a lot of intermittent fasting throughout the morning. So we fix insulin resistance at the same time. The very first thing I have my people stop doing if they’re insulin resistant is snacking, and we just go to eating three square meals a day to begin with, protein centered, having some natural fat, having strategic produce in there, getting that under wraps first, along with working with the whole lighting thing at night so that you’re not hungry and wanting to snack, and cortisol going crazy. It’s a lot. It’s a lot. People are like, “Oh my gosh, there’s so much to do.” But really, once you understand your hormones and  the environment that is giving your hormone signals, you can start to fix it. The main thing is three square meals, allowing eventually to go at least four hours in between meals so you can get that leptin signaling in between meals, stopping the night eating for sure. And then we do go therapeutic carb restriction, at least for a while. And I’m not saying everybody’s got to go ketogenic or anything, but that does help to bring insulin levels down.

Lindsey:  

When you say carb restriction, how much? Obviously keto, you’re eating maybe 20 grams of carbs a day or something.

Shana Hussin:

Yeah. I actually have a carb quiz on my website to help people with this. Everybody’s different. It’s why I like to work with people individually. But generally I’m recommending 25 to 100 grams of carbohydrate a day, less restrictive around the 100 grams, and then somebody who’s really insulin resistant, like they’re requiring insulin, they’re on all kinds of diabetes medications, that would be more of the let’s eventually get you to around 25 grams of carbs, 50 maybe, until your body is utilizing carbohydrates a little bit better. Because usually you know you’re at that point, you’re very insulin resistant. You’re not utilizing carbohydrates well at all. That’s not forever, but for a time, bring it down. I have people carb flex in there and bring carbohydrates up, maybe one day a week, a couple times a month. I don’t like the perpetual, “let’s eat low carb, 25 grams of carbohydrate every single day for the rest of our lives.”  I don’t think that’s healthy.

Lindsey:  

Yeah. And so they’re not replacing those calories necessarily with fat, right? Or is it adding more protein, typically, that you’re looking at?

Shana Hussin:

Yeah, I have people build their meals around protein because it’s very satiating. It’s what we primarily build our body with. So, in general, I’m having women eat around 100 grams of protein throughout the day. When you meet that, you start to have those hunger and satiety mechanisms come back. I definitely have seen in my practice, people overdo fat and go way too high on fat, and then they’re struggling to lose weight, because even though they’re burning ketones and they’re burning fat for fuel, they’re burning fat that they’re eating, they’re not burning fat from their body. And so that’s where the time restricted eating comes into play, and the whole leptin resistance thing, because if your leptin signaling is healthy, your body will say, “oh gosh, I have 50 pounds of extra body fat here. I don’t need to eat a whole lot today,” and it will downregulate your appetite and all of it. It’s just all interplays so beautifully when it all works correctly.

Lindsey:  

Before we run out of time. I want to bring it back to the topic of my podcast, which is gut health. So how does all this relate to your gut health?

Shana Hussin:

Yeah, it’s fascinating. With cortisol, what I found was really interesting, and what I was struggling with my own gut health was a lot of bloating and a lot of food that wasn’t being digested well, and this is because I was in overdrive. I was in that fight or flight, and my body was so stressed out that instead of taking all the energy for proper food digestion, it just couldn’t digest. 

Lindsey:  

You were not in rest and digest. 

Shana Hussin:

Exactly. I was not in rest and digest. I was in fight or flight, and so almost every meal I would be bloated. I had more food sensitivities than I do now. That’s just one little thing. What really helped me, and this is in my adrenal recovery course, is I took betaine HCl and digestive enzymes for a time with every meal, and I still do that on a lot of days with bigger meals, and that helped to start to digest my food properly and stop that bloating. And another thing with digestion, with insulin resistance and eating too often, is we’re just not giving our digestive systems a break ever. And so that’s why, again, going to two or three meals, and I think it’s perfectly fine for some people to eat just one meal a day. Some of the time when they have a lot of weight to lose, but giving your body some rest and digest and rest and repair is so helpful for the digestive system. And if people do want to intermittent fast and inside my courses, we do have a more of a circadian approach, where we’re fasting late afternoon into evening, to really support the autophagy process during sleep and give that digestive system a nice, long break. 

Lindsey:  

As opposed to the skipping breakfast model, right? 

Shana Hussin:

Yeah.

Lindsey:  

The problem is nobody wants to skip dinner. Everybody likes dinner, and they want to eat it with their friends or family or whatever. And so it’s got to be challenging but makes way more sense metabolically.

Shana Hussin:

It is more socially challenging for sure. It has a lot more benefits. People are doing the habitual, and I did that for like, 5 or 6 years, and that just dysregulated my cortisol even worse . . . 

Lindsey:  

Yeah, I’ve heard it’s not good for women, the whole skipping breakfast thing, and maybe not good for anybody. I’ve interviewed the ProLon Fasting Mimicking Diet* folks, Joseph Antoun, he was saying that, in fact, if anything, skipping lunch, if you don’t want to skip dinner, skipping lunch would be a better choice than skipping breakfast. 

Shana Hussin:

Yeah, if you can be done eating by 3, 4, even 5 o’clock, that gives you a nice long break.  I skipped breakfast way too many years, and it took a toll on me, and I started to have high blood sugars throughout the morning because my cortisol was out of balance. 

Lindsey:  

Yeah. There’s no way I could skip dinner, though, I have to say, because I’m just somebody who’s got a super-fast metabolism. If I skipped dinner, I wouldn’t sleep a wink, because I’d be sitting there with hunger pangs all night.  So one last question, which is how cortisol, melatonin and leptin interact.

Shana Hussin:

Yeah, I like to call these three hormones the master circadian hormones, for all of the reasons that we already discussed. So if cortisol levels are off and melatonin levels are off, your body’s just in chaos and not signaling correctly. But those three hormones are above a lot of the downstream hormones. So if your cortisol and melatonin are off, there’s a hierarchy of hormones, and if you’re filtering all your energy into that cortisol, you’re not going to filter the energy into making sex hormones. It’s just so intricate, and once one hormone gets off, especially if it’s cortisol, melatonin or leptin, all of the downstream hormones, I don’t want to call them more important, but reproductive hormones can be out of balance and not affect us as much. They’re not life or death, right? It’s just “okay well, our fertility is going to not function correctly, but if we don’t have cortisol, we’re in big trouble. If we don’t have some of the other master hormones, we’re in big trouble.” When melatonin, cortisol, leptin are off, people have a lot of weight issues, a lot of chronic illness.

And the nice thing is that fixing them, we do it all in the same way. We get a strong circadian rhythm, we dial in our nutrition, we fix our lighting environment, all the foundational things. And really, when you think about it, just going back to being human, how humans are meant, like we’re not meant to be – my whole business is online, so we sit inside, under artificial light, staring at computers. That’s so much different. And then we eat by our desk, and we don’t socialize. I’m not saying everybody does this, but when you think about humans, even 200 years ago, as to now, things have evolved and changed so quickly that we just haven’t caught up. A lot of our bodies are internally in chaos, and we can’t understand what’s going on. But when we stop and think about how different our lifestyle is, it’s no wonder that we’re all sick and struggling.

Lindsey:  

Yeah, no, I think you really have hit on it too as it relates to gut health, how you start with these dysregulated patterns and then it has all these bad downstream effects. A lot of people that I see have gut health issues that ultimately seem to have stemmed from stress, and often a particularly stressful period in their life where, clearly, their cortisol starts to get dysregulated, their blood sugar gets dysregulated, then they lose their immune resilience. Really, I mean, their immune system gets weakened, and I can see it in their Secretory IgA levels on the stool tests that their immune systems are no longer functioning, but stomach acid levels have gone down. So there’s no protection. So then all of a sudden, these pathogenic bugs start to take over, and then you start getting all these gut symptoms, and it just snowballs from there. So yeah, it really does start with these patterns that come under stress and cortisol. 

Shana Hussin:

I like to tell people we need to fix the terrain. There is a reason why you are having all these imbalances, and the terrain is off, a lot of it has to do with not getting out into the sunlight, not getting proper messaging, eating crap that doesn’t belong in your body, and not sleeping. 

Lindsey:  

Yeah. So tell me where people can find you. And you do courses, yes?

Shana Hussin:

Yes. If you go to ShanaHussinwellness.com, all my courses are housed there. I have lots of freebies. I have a free eBook on cortisol dysregulation. I have a cortisol minicourse as well, if you want to learn the basics of how it gets dysregulated and how to start to fix it. And then I have a podcast called Optimal Metabolism.

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.

In the journey toward optimal health, the connection between the mind and body is undeniable. One of the most intricate relationships exists between stress and gut health. Chronic stress not only affects mental well-being but can also disrupt the delicate balance of the gut microbiome, leading to digestive issues, inflammation, and a weakened immune system. Understanding how to manage stress effectively is crucial for anyone looking to restore and maintain gut health. Among various holistic approaches, yoga stands out as a powerful tool for stress management and overall wellness.

Stress triggers the release of hormones such as cortisol and adrenaline, which, when persistently elevated, can impair digestion, reduce beneficial gut bacteria, and increase intestinal permeability—often referred to as “leaky gut.” This cascade of effects highlights why periods of high stress often precede or exacerbate gut health problems. Therefore, addressing chronic stress is not just beneficial but essential in the recovery process from gut-related ailments.

Yoga, with its combination of physical postures, breath control, and meditation, offers a multifaceted approach to reducing stress and promoting gut health. Its practice encourages the activation of the parasympathetic nervous system, often called the “rest and digest” system, which helps lower cortisol levels and enhances digestive function. Beyond the physical benefits, yoga fosters mindfulness and emotional balance, equipping practitioners with tools to manage stress responses more effectively.

For those interested in integrating yoga into their wellness routine, you could find a local yoga studio, or if you happen to be located in Singapore, Yogabar.sg is a premier yoga studio based in Singapore that offers a diverse range of yoga classes tailored to address chronic stress and support gut health. Their expertise lies in creating accessible and flexible yoga packages that allow individuals to explore various styles and intensities of yoga depending on their needs and experience levels.

Yogabar.sg provides several types of yoga classes designed to alleviate stress and promote holistic well-being. Gentle and restorative yoga classes focus on slow, mindful movements and deep relaxation techniques that calm the nervous system and encourage healing. These classes are particularly beneficial for individuals experiencing high stress or digestive discomfort. For those seeking more dynamic physical engagement, Vinyasa and Hatha yoga classes combine breath with movement to build strength and improve circulation, fostering a sense of vitality and mental clarity.

Furthermore, Yogabar.sg’s emphasis on mindfulness practices, including guided breathing exercises and meditation sessions, helps students cultivate a deeper awareness of their body-mind connection. This increased awareness can lead to better stress management habits beyond the yoga mat and contribute to improved gut health by reducing stress-induced digestive disturbances.

What sets Yogabar.sg apart is their commitment to flexibility and community. Their unlimited yoga packages are shareable and designed to fit into busy lifestyles, encouraging consistent practice—which is key to reaping the long-term benefits of yoga for stress reduction and gut health. This approach resonates well with those who understand that healing and wellness are ongoing journeys rather than quick fixes.

Incorporating yoga into a health regimen focused on gut healing aligns with natural, integrative strategies that prioritize the root causes of illness. By managing stress through yoga, individuals can create a supportive internal environment that allows the gut microbiome to flourish and the immune system to function optimally.

For readers seeking to improve their gut health and reduce chronic stress, exploring the offerings at Yogabar.sg or a local yoga studio could be a valuable step. Their comprehensive approach to yoga, combined with a supportive community and flexible class packages, provides an accessible way to incorporate stress management into daily life, ultimately promoting better digestive health and overall well-being.

In conclusion, recognizing the profound impact of stress on gut health underscores the importance of effective stress management techniques. Yoga serves as a holistic and accessible modality to achieve this balance. Studios like Yogabar.sg exemplify how personalized yoga practices can empower individuals to take control of their health, reduce chronic stress, and support the healing of the gut. Embracing such integrative approaches allows for a more harmonious connection between mind, body, and gut, paving the way for sustained health and vitality.

Adapted from episode 149 of The Perfect Stool podcast edited for readability with Terri Fox, MD and Lindsey Parsons, EdD.

Lindsey:    

So I wonder how you got into your specialty involving biotoxin illness and mold and Lyme?

Terri Fox, MD:

Yeah, sure. So biotoxin is something that is released by a living organism that’s toxic or pathogenic to humans. Some examples of biotoxin illnesses are Lyme, Lyme co infections, mold, that sort of thing. So I was practicing functional medicine for maybe 10 years. I found most of my patients really did well with the normal functional medicine interventions and studies and work on their hormones, get them sleeping, optimize their nutrition and their nutrient status, clean up the gut, and they would do better. And about 15% of my patients just didn’t budge, no matter what I did. And so I kept finding myself stuck in this, and they had some similarities in their symptomatology. After a while, I figured out most of these patients had Lyme and Lyme co-infections, and so then I started treating Lyme and learning about Lyme, which is a lot.

What happened for me was my son was eight years old, and he got really sick. He was one of those scrappy, thrill-seeking maniac little boys, climbing everything and trying to kill himself all day, and suddenly he started limping. I would ask him, “Kai, do your knees hurt?” And he would say, “No.” And then he would walk normally without limping. And I was just watching him, and he was getting stiff after a car ride, or in the morning when he woke up, he had new anxiety that he never had. He put on 30 pounds in, I don’t know, six weeks, on his teeny, little frame, and so I started testing him for things, and he turned out to have Lyme. And I tried to treat him myself, and I’ll tell you, as a mom, don’t ever try to treat your own child for Lyme.  I ended up taking him to see Dr. Steven Harris in California, who’s a wonderful Lyme doctor, and he gave us a urinary mycotoxin test for mold. So we brought it home and we did it, and Kai’s mold levels were through the roof, his mycotoxins, so at that point we knew, “Okay, there’s something else going on as well.” 

I had a good indoor environmental professional out to evaluate the house. This was the year of the Boulder flood. So I live in Boulder, Colorado, and we had this 100-year flood. Every house on our whole block got just tanked by it, and I thought that we were okay. And so this is, maybe nine months later, when the environmental professional comes in, and we have this massive crawl space under the whole house at the time. And he went into the crawl space, and he cut the vapor barrier, and there was three feet of water under the entire house, and our airborne spore traps were in the red. I don’t actually think I’ve ever seen them as bad as our house was. I didn’t know what it meant to remediate or what a good remediation was, so I had a regular construction company come out. It sort of spreads it everywhere and makes it worse, if you don’t do containment and negative air pressure. At that stage, he got much worse, and he called it a migraine. He had nine out of ten pain in his head that got worse with any movement, and he basically was in bed for six months. He dropped out of school and out of soccer, and it was pretty horrible.

Lindsey:    

And was anybody else in your house impacted?

Terri Fox, MD:

I was, but do you have kids?

Lindsey:    

I do.

Terri Fox, MD:

So you know how it is, as a mom. You focus on the kid. I was having anxiety and insomnia and I couldn’t sleep at all. I lost 15 pounds that I didn’t need to lose at all. People, they can get this unexplained weight gain or loss, my ex-husband, my husband at the time, and my other son, they were 100% fine.  We put him on a mold detox protocol, and then once we got out of the house, the marriage didn’t make it through, unfortunately, but Kai got better. As soon as we got him out of the exposure, he slowly got better, and within a few months, he was back at school, mostly full time, and playing soccer again.

Lindsey:    

That’s awesome. So did you just have to give up on the house? Or what did you ultimately do to remediate the mold?

Terri Fox, MD:

We remediated it and sold it. I didn’t believe that he was ever going to get better in that house. I mean, the mold was so significant, and the toxins stay in drywall and wood and anything porous made of cellulose.

Lindsey:    

So how expensive was the remediation?

Terri Fox, MD:

A lot. It meant that we didn’t make very much on the sale of our house. I want to say maybe 80 grand.

Lindsey:    

Wow. I sold a house. I can’t remember if it was what they said was mold, or if they just said that there was rot or something under one bedrooms worth of floor and that alone was going to be like $5,000 to tear that out and redo it.

Terri Fox, MD:

Yeah, some floors are expensive.

Lindsey:    

Yeah. Anyway, you mentioned the weight loss or gain and migraines and insomnia. What else would you see in a patient that might make you suspect mold?

Terri Fox, MD:

The common symptoms are fatigue and brain fog, cognitive dysfunction of all kinds, word recall, memory loss, difficulty, focus and concentration. And then I see a lot of headaches and migraines. I see a lot of insomnia, anxiety, sometimes depression, and then a lot of unusual neurological presentations that don’t fit into any neurological diagnosis, like asymmetrical numbness, tingling, weakness, ice pick sensations, burning sensations, crawling sensations, involuntary muscle movements, ataxia or difficulty with your balance. So those all fall under the unusual neuro-symptoms. And then we see a lot of rashes, itchy rashes, acne, hair loss, and then rapid weight gain or loss.

Lindsey:    

So I know that some of the things you said, like the crawling sensations that’s also common for Lyme or Lyme co infections. So is there anything that’s really distinguishing between those two that would make you think one over the other?

Terri Fox, MD:

Yeah, a few things there. But the things that make me think more Lyme than mold are when somebody has flu-like symptoms, so they feel like they’re coming down with something, like they’re sick, but they don’t actually get a cold, and they have joint pain that moves around. So we call that migratory joint pain, achiness, or recurrent fever. So I often think more of Lyme with those, and then the mold symptoms are really similar to Bartonella symptoms, one of the Co-infections in Lyme. Those can be hard to tease out, but if you have Lyme, you always test for mold first, and you always treat the mold first, because mold is often the reason that Lyme remains active and chronic in the system, and when you clear the mold, often the Lyme goes back into dormancy. So I actually don’t ever start treatment on a Lyme patient without doing a mold test first and treating that.

Lindsey:    

Oh, interesting. Okay, so I know mold can also present with GI issues. So what GI symptoms might you see with that?

Terri Fox, MD:

I feel like we see the whole gamut. Mold can colonize or live in your upper respiratory tract or your GI tract. So if you’re living in a moldy space for a long time, eventually you’re going to breathe a spore up into your nose or swallow it down your esophagus. And if it colonizes in your gut, you can see anything from intractable hiccups, but more commonly, diarrhea, constipation, gas, bloating, a lot of vagal stuff, burping and right after you eat, bloating.

Lindsey:    

Yeah, I’ve got someone who has a lot of those symptoms and just tested positive for mold, which is always, I think, pretty shocking because of the potential implications. So I’m curious if you recommend people, if they suspect mold, do they start with inspecting the house, or do they start with the mycotoxin test?

Terri Fox, MD:

You always have people test themselves first. Let’s just see if that’s even the right road. If it is, then we need to figure out if it’s an old exposure or where you’re living now.

Lindsey:    

Yeah. And so which mycotoxin test do you like to use?

Terri Fox, MD:

I definitely recommend a urinary mycotoxin over biomarkers in the blood and some of the other testing. And I really like Real Time Labs. I like Vibrant; the Real Time Labs probably is my favorite because I’ve just used it for so long and I trust it, but it’s very specific, meaning you won’t see false positives, but it’s not as sensitive, meaning you’ll miss a decent amount. So it has to be provoked. And I do a pretty intense provocation. I do an IV of phosphatidylcholine and glutathione, and then we wait an hour and collect the urine. And the reason is that the people that get sick from mold are the ones that can’t detox it. They can’t metabolize it and get it out, in the urine or in the sweat. And so if I just check their urine, they probably wouldn’t be sick enough to end up in my office if they were getting it out in the urine, stool, in the sweat.

So these phosphatidylcholine and glutathione will help metabolize them and detox them, so you can get a sense of what’s really in the body. And if somebody doesn’t have access to an IV, could they use those orally to provoke. So you would do liposomal glutathione, as big of a dose as you can stomach (it gives some people diarrhea), at least 1000 milligrams a day for a week. And then if you can do either a really hot bath or an infrared sauna beforehand, that’ll help as well pull it out and mobilize it. When I have people do a retest, I’ll actually have them stay on their antifungals. So if somebody has antifungals around, they could take the antifungals as part of the provocation as well. And the idea there is, if it’s living in you, and you take an antifungal medication that kills it, it releases its contents, which are those mycotoxins. So it’s another way to provoke to see what’s actually in the system, in the urine.

Lindsey:    

So they’re literally taking the glutathione right up until the testing.

Terri Fox, MD:

Yeah, yeah. And by antifungals, I mean, like pharmaceuticals like Itraconazole or voriconazole.

Lindsey:    

Would you give them phosphatidylcholine orally, or?

Terri Fox, MD:

 I’m really careful with phosphatidylcholine orally. If they are already on it and we know they tolerate it, then absolutely that’d be great provocation. I found a lot of my chronic complex illness patients and my mold patients don’t initially tolerate oral phosphatidylcholine. It can exacerbate symptoms. It releases these fat-soluble toxins. Some people can’t clear them, and they get symptomatic. So I’m careful with that one.

Lindsey:    

I imagine glutathione would do the same, wouldn’t it?

Terri Fox, MD:

I find most people tolerate it. Some people have to work up real slowly, but generally, I find most people tolerate it.

Lindsey:    

So are there any tests beyond the mycotoxin tests that you use related to mycotoxins?

Terri Fox, MD:

I like the mycotoxin because it gives me the specific strains that are in the body. And there’s different binders for different strains of mold or mycotoxins. That one, you can create a protocol that’s actually going to work for your unique mycotoxin load. There are markers in the blood that, if you have insurance that covers all your blood work, they can be sort of nice to follow to see how we’re doing without paying for a mycotoxin test. I don’t find them diagnostic or definitive, to be honest, the two big ones now, at least here in Colorado, we can’t get them processed correctly. The labs changed where they sent them, and after Covid, they changed. So it was a C4A and a TGF beta 1. And after Covid, they changed the reference ranges. So everybody’s really high from the inflammation from Covid, and so if you can get them done accurately, they can be helpful, but that’s proving to be harder and harder, right now.

Lindsey:    

Interesting. Okay, so you’d be looking for those in theory, to go down over time.

Terri Fox, MD:

You want them all to go down, except for the MSH.

Lindsey:    

Oh, is that another?

Terri Fox, MD:

That’s another one, yeah. That one you can do without a specialty lab, but it’s melanocyte stimulating hormone, and the MSH goes down. That’s often when the system fully crashes. We don’t treat the MSH directly. We treat the mold. And it’s sort of the last value to come back up into the normal place. It wouldn’t necessarily be a good data point along the way.

Lindsey:    

So if someone is in what appears to be a mold-free environment, but shows mycotoxins on the test, could they be from a previous residence? And how long would they stay in the body?

Terri Fox, MD:

When we get a positive test, that doesn’t tell me whether it’s an old exposure or a current exposure. First, we test the home that they’re at and see how that one looks and it can be from a previous exposure. If that’s the case, then they likely colonized in you, meaning it’s living in you now, releasing mycotoxins, and you brought it with you.

Terri Fox, MD:

The most common place of colonization is in the sinuses. So part of a good mold treatment program has a nasal spray aimed there.

Lindsey:    

So basically, you don’t know whether it could be in the body for years. In theory.

Terri Fox, MD:

Yes, it can. It’s always better if it’s not their current living.

Lindsey:    

Right, of course! Then you don’t have to tell them you’ve got 10s of 1000s of….. that’s why I wouldn’t want to go into mold, because that’s got to be stressful.

Terri Fox, MD:

I find mold to be a great diagnosis in that people get better. The turnaround is awesome. In a good mold protocol, you never feel worse. You feel either nothing or better the whole time, as opposed to Lyme where there’s some pain before you get better; it’s trickier. I think it’s a great diagnosis. However, if they’re still in a moldy place and they have to either remediate or move, that’s when it turns into more of a challenge.

Lindsey:    

So what should people know about getting their home inspected for mold?

Terri Fox, MD:

Well, you want to get a good environmental professional. Anybody can put up a website and call themselves a mold inspector. It’s not a regulated industry. So you want somebody good. You can start  an organization called ISEAI, the International Society of Environmentally Acquired Illness. It’s iseai.org and they have a find your physician directory and a find your IEP directory. So usually I have patients, if they’re not close by, where I know the people that are good, I have them go to start at that directory, that website, and see if they can find anyone near them. If not, they can call the one closest to them and see if they know anybody. There’s a national company called We Inspect that does most of the country.

Lindsey:    

Okay.

Terri Fox, MD:

If they have no suspicion that it’s in their current home, and none at all, which most of them don’t even when it is. But if there’s no history of leaks and any of that, then I have them start with an ERMI, a qPCR, which is a dust test for DNA of mold and mycotoxins. So you just do a little Swiffer sample of the dust in your house and send that in. We get a sense of if it’s bad and needs a thorough evaluation, or if it looks okay, then I don’t need to worry about.

Lindsey:    

Okay. How much can people expect to spend on a mold inspection from a professional mold inspector?

Terri Fox, MD:

Probably, like $1000.

Lindsey:    

And what should people know about doing remediation on their home?

Terri Fox, MD:

That’s another one that’s really important to get the right person. Because, like I said, it’s an unregulated industry, and so people can say, like, Serve Pro will come in and they’ll put fans on it, which will just blow the mold all over your house and make it worse. Again, that same directory of IEPs has a lot of remediators on it. Home cleanse is a organization that does remediations all over the country. They do a really good job. Yeah, there’s a couple other directories. I’d start there. There’s an organization called Change the Air Foundation, and they have tons of free downloads, and so they have entire guides around what you’re looking for.

And a good remediator, what does it mean to have a good remediation? What does a good remediator contract look like? They read a ton of resources. But some things is, you want to make sure that they’re going to contain the area. So if you’ve got wet, moldy drywall, and they’re going to pull it out, that has to be contained in six-millimeter plastic with negative air pressure, so a scrubber that’s pulling the air out of the house before they remove the moldy, wet material, so it doesn’t just get all over your whole house and make things worse. So you can always ask, “what kind of a containment do you do?” After all the demo has been done, where they pull out everything, you have to get a small particulate cleanup, so the mold releases these mycotoxins and other nanoparticles that are toxic to those of us that are sensitive to mold. Those can stay in the drywall, in the wood, so everything has to get wiped down and vacuumed, and then sometimes we fog at the end.

Lindsey:    

Is this one of these things where you probably need to replace your furniture and stuff?

Terri Fox, MD:

So if it’s a hard surface, you can wipe that. If it’s a fake leather or leather, you can wipe that. If it’s a fluffy couch, you’re going to probably need to get rid of it. If it was a significant mold exposure, ideally, mattresses.

Lindsey:    

Yeah, that can be expensive on top of everything else.

Terri Fox, MD:

But anything you can throw in the washing machine, you can keep.

Lindsey:    

Right. So actually, my sister and her husband are going through this right now. I’m not convinced that they have any big mold problem, but he’s got a lot of allergies.  They’re in Georgia, they said they found a dog that apparently can inspect for mold. Have you heard of that?

Terri Fox, MD:

Yeah, there’s great mold dogs out there. So we have one in Colorado named Buddy, and he’s great. It’s the same organization that trains the dogs to sniff out drugs and weapons in our luggage at the airport. So the same people train them to smell mold if you know you have it and you can’t find the source. Like, let’s say your ERMI is really high, or even an airborne spore trap is high, and they can’t figure out where the source is. That’s a nice time to get a mold dog in.

Lindsey:    

Yeah. So I imagine, when you’re getting an inspection, are they drilling holes in the wall to check?

Terri Fox, MD:

So they’ve got infrared cameras, really intense, powerful ones, like $10,000 ones, that can see dampness in the walls, and they have damp meters, and so usually somebody good can see a water damaged spot somewhere and pull back a baseboard. If you’re stuck and you don’t know for sure, is it behind this thing or whatever, then they might do a cavity sampling. They do drill a little hole to go behind a wall and do an airborne spore. But that’s a more specialty thing that you would ask for; they’re not going to come in and tear down your walls.

Lindsey:    

Right, right. Okay, so if someone can’t leave the moldy environment, is it worthwhile to treat them at all? Will you put off treatment until they move?

Terri Fox, MD:

I have a mold eradication protocol that’s two phases. So phase one is teaching your body how to detox, metabolize and get these toxins out. That part is binders and glutathione and organ detox support, that kind of thing that can be done while you’re still in the exposure. So basically, the longer you’re in the exposure, the more mycotoxins you’re going to have in the system, and they’re just going to keep accumulating until you’re out of the exposure, and then there’s more work to do. And so you can bind while you’re in and decrease that total body burden. And sometimes it’s enough to even feel a little bit better, but you might not feel that significant improvement until you’re out of the exposure. I wouldn’t do phase two antifungals and biofilm until after they’re out of the exposure.

Lindsey:    

And say, somebody can get out of the exposure. How long would somebody typically stay on binders before moving on to antifungals?

Terri Fox, MD:

If they’re not being exposed? If they’re no longer being exposed, once they’re on the full phase one for four weeks or doing it successfully, having daily complete bowel movements, because the binders are constipating, and they’re sweating, and they’re doing all of this, and they feel either nothing or better for four weeks. Then I start phase two.

Lindsey:    

And when you say they’re sweating, are you sending them to saunas and that sort of thing as well?

Terri Fox, MD:

I have a pretty lengthy handout on biotoxin relief and things that help to pull biotoxin out of the body. And those will just potentiate it, make it go faster and you’ll feel better quicker. And those are things like infrared sauna and ionic foot bath, detox baths and acupuncture and a variety of things.

Lindsey:    

Interesting. Are there particular genes that make people more susceptible to mold illness?

Terri Fox, MD:

Probably. Our number that we use in the mold community is 25% of the population is sensitive to mold. Not everybody is. I personally think that number is growing. Now I can have a really distorted view of things, because mold just walks in my door. People just come in and they go, “I have mold, help me”. But there’s a variety of factors that would make it where more people are sensitive to mold than used to be. One really easy example is the total body burdens. If you have a bucket that has been getting full throughout your life with plastics and pesticides and glyphosate and then some inflammation from Covid and then some biotoxin from Lyme, when the bucket gets full is when the system begins to crash. And I actually don’t remember what the question was now…

Lindsey:    

Oh, about genetics, whether there’s particular genes that have been identified for mold?

Terri Fox, MD:

Yeah, sorry, went on a tangent. I think there are genetic mutations or SNPs that make some of us more sensitive than others. I don’t think we really know exactly what they are yet. You might be alluding to the HLADR, which is an old test that we used to do that can look at your genetics and say whether or not you’re more susceptible to mold or Lyme or both. I think most of us in the mold community have found them not to be useful or accurate. So a lot of really sick patients that didn’t have any of the genes and people that have both the bad genes that are fine and mold and Lyme. So I don’t even check those anymore.

Lindsey:    

Is there some estimate about the percentage of the population that is mold sensitive?

Terri Fox, MD:

25%

Lindsey:    

Yeah, 25% oh, that high. Okay.

Terri Fox, MD:

Yeah.

Lindsey:    

It’s a wonder there’s people living in certain places, because, like, I’m in Arizona here, obviously we don’t have as much mold to worry about. This is where everybody moves when they’re trying to get away from it, right?

Terri Fox, MD:

Exactly.

Lindsey:    

So you use nasal sprays as part of mold treatments? I think you did mention that, and I’m wondering if there’s any non-prescription options, because for those of us who are not MDs or naturopaths, it’s kind of like, “what do you do?”

Terri Fox, MD:

Yeah, I usually start with BEI. That’s a compounded prescription, 1. Xlear* is really good. Silver is really good, nasal silver*, propolis* can be helpful.

Lindsey:    

What about Biocidin* put into saline spray?

Terri Fox, MD:

Yeah, if you put it in in your sinus rinse, they told me they were going to make a nasal spray, like five years ago. What has taken so long?

Lindsey:    

They told me that too, I know. And they’ve come out with all these dental products and all these other things.

Terri Fox, MD:

I know! I’m like, “where’s ours?”

Lindsey:    

Come on! We’re still telling people to take pliers and pry off nasal sprays and put in Biocidin drops. I mean, help us out here people!

Terri Fox, MD:

Yes, exactly.

Lindsey:    

Okay. So you go binders, and then you do nasal sprays, and then the next series is antifungals. Is that  the sequence of events?

Terri Fox, MD:

The first phase is really – to get this sick from mold, your detox pathways are not working correctly, so you make sure they’re having bowel movements. You’ve got them on all the right binders. You do it one at a time. You layer them in to make sure you’re not trying to detox more than the body can handle. And that’s one of the really common pitfalls. When people try to treat themselves, they do too much too fast. They feel more sick, and then they think they can’t get better. So you’re teaching the body how to bind with binders and pull out in the GI tract, and we’re playing with magnesium and different things to continue to have daily bowel movements, and then nasal sprays, and then liposomal glutathione, and then organ detox support, so some kidney, liver, lymph detoxification pathway support, and then get some of the other biotoxin relief things happening.

Lindsey:    

Is there a certain company’s products that you like for these things? I know Quicksilver does a lot of metal detox stuff.

Terri Fox, MD:

Yeah, they do mold detox too. I love their Ultra Binder. Activated charcoal is a big common binder that we use. And Ultra Binder is made by Quicksilver Scientific. It has activated charcoal and it has three or four other binders in smaller amounts. You’re not sure if there’s some other stuff we didn’t catch and you want to clean it up. But that one’s nice, and it’s got some aloe and some other things that make it a little easier on the belly. It’s more expensive, though, too. So if you’re on a budget, plain activated charcoal is fine as well. The glutathione you should be picky about. It’s hard to make a liposomal glutathione that you’ll actually absorb.

Lindsey:    

Yeah. Have you tried the Aura Wellness’ new glutathione spray*?

Terri Fox, MD:

I have it on right now! I put it on after my shower. I just started trying it recently. I had heard about it from a friend, Scott Forsgren, do you know him? Who does the BetterHealthGuy podcast? He told me about it. And then I was at that longevity conference, the A4M World Congress in December, they were there.  I was able to check it out and try it. Now we have it in clinic. I think it’s pretty cool.

Terri Fox, MD:

Yeah, I had Dr. Patel on the podcast recently.

Terri Fox, MD:

 Oh, nice, yeah.

Lindsey:    

The way he tells it, it doesn’t matter if you take the liposomal or the whatever, it’s not going to get in, it’s just going to break into the components and recompose, was the way he told the story.

Terri Fox, MD:

Oh yeah, if you get a good liposomal formula, it will get absorbed. I mean, there’s several that you put under the tongue that get a lot of venous absorption, and then the liposomes get through the cells in the small intestinal wall, and as opposed to having to go through a receptor, so they get absorbed into the system easier.

Lindsey:    

Yeah, What he said, though, was when they tested any kind of glutathione besides their own-obviously, he was selling products, so, you know, with a grain of salt- but he said, when they tested the blood levels, right after taking it, there was no raise in glutathione levels, and there was, a couple hours later, a subsequent raise in the levels of cysteine, glycine and glutamine. So they knew that it was breaking it into its components and recomposing it. Which is not to say it doesn’t also work in that sense.

Terri Fox, MD:

Yeah, but that’s exactly why you have to get a good one, and it has to be liposomal so that you don’t digest it, because I follow glutathione levels on all my patients, because glutathione is necessary to detox and metabolize mold. Generally, a person who’s had a big mold exposure, their levels are tanked. They’re really, really low because they’ve used it all up trying to get the mold out themselves. That’s something I follow, and they absolutely come up with the liposomal formulas.

Lindsey:    

Okay, and what marker are you using to test them?

Terri Fox, MD:

I check glutathione levels in the serum in Lab Core. I check them on – the Nutreval has the serum and the red blood cell, which is the more recent exposure glutathione.

Lindsey:    

Oh, and I was asking about whose products you liked for the kidney, liver and lymph, was there another?

Terri Fox, MD:

Yeah, so kidney liver lymph. I like Pekana, have you ever worked with those? It’s like a German homeopathic company; they have kidney liver lymph. I like, for somebody who prefers a capsule, CellCore’s Drainage Activator* [access using patient direct code: I0rdLMOm]. I like that one. Those are the two main ones I use. There are some others, but mostly I like those.

Lindsey:    

Okay. So I often see clients who have Candida and will likely go through, say, one to four courses of antifungals and binders and such. So I’m curious, is it possible that someone could still have mold issues after going through that kind of a protocol? I assume they’d have an extreme reaction as soon as they started the antifungals, if they had a big burden of mycotoxins.

Terri Fox, MD:

So the antifungal you would use for yeast versus mold are different, but where there’s mold, there’s always yeast. So mold and yeast are both fungal, and mold will create all the right conditions and pH and everything for yeast to flourish. And so even in the buildings that have water damage, there’s often yeast. We see that on the plates and on the tests that we do, and then in the body, this is mostly just from doing this for 15 years. I’ve just learned that every mold case has a yeast component; sometimes it’s a huge part of the case, and sometimes it’s a small part, and you don’t really know till you get to the yeast part of treatment, but it’s a huge part of my mold treatment is I treat yeast as well.

Lindsey:    

Oh, okay, and so what are the the antifungals for mold versus yeast?

Terri Fox, MD:

I would use itraconazole, voriconazole for mold, fluconazole for yeast. But I treat yeast, this is a more unique thing to me, I treat yeast with low dose immunotherapy. Have you ever worked with LDI? 

Lindsey:    

I’ve heard of that, yeah. You want to talk about it a little bit?

Terri Fox, MD:

Yeah sure. So LDI, it works kind of like a vaccine, or like allergy drops, where you’re giving the body a tiny bit of a thing that you want it to recognize, but also to develop tolerance to, so it’s not so much immune reactivity. They have low dose immunotherapy for Borrelia, Bartonella, for EBV, all kinds of things, but the yeast one, for me, has just been a absolute game changer in clinic. I love it. It’s always a huge part of a mold case, and it’s always one of the parts when we find the right dose that the patient goes like, “ah!”, like 12 things get better. I honestly remember when in my medical training in the late 80s, early 90s. In the 90s, I remember, there were different phases, like, “Candida is the cause of everything,” and then “there was this other thing that was the cause of everything.” And I remember thinking how silly it was, and now I’m like, “everybody has yeast,” and I treat, certainly all the mold patients and all the Lyme patients, because most of them have done antibiotics. There’s a lot, a lot of yeast.

Lindsey:    

Yeah, there’s just one provider of low dose immunotherapy, is that right?

Terri Fox, MD:

Oh, Ty Vincent, the guy that makes it, you mean? There’s one guy that makes it, and then you just have to do a training to be able to get the actual LDI.

Lindsey:    

Interesting. And so you mentioned prescription-

Terri Fox, MD:

Do you find that you can treat the yeast and get rid of it for good? I feel like I spent seven years with herbs and biofilm busters and fluconazole. You can use Voriconazole, but that’s a pretty intense med for yeast, and that they’d get better for a while, and then it would kind of come back.

Lindsey:    

Yeah, it’s hard to say, because people will sign up for a certain number of sessions, and then they’ll be better, and then they’ll leave. I don’t insist on retesting if people are feeling better. I don’t insist on seeing clean organic acids, I certainly see levels come down after treatment, but whether it stays gone forever, I mean, I know that there are genetics that make people more susceptible to Candida, and that their bodies don’t fight it as well. And so if you’re one of those people, then you just can’t have a high sugar diet and high carb diet ongoing if you want to manage it. So that’s part of it. I think if you just want to go back to eating sugar, then yeah, it’s going to come back.  So you mentioned some prescription antifungals for mold. Are there non-prescription alternatives?

Terri Fox, MD:

I use prescription antifungals. You can imagine the binders are sort of sopping up the mycotoxins that the mold is releasing in your body and pulling those out, but until the mold is no longer living in your system, it’s going to continue releasing more mycotoxins. So it’s like you’re in a boat and you’re bucketing out the water and there’s a hole in the boat, until you get rid of the actual spores. I just have really found that that’s where the needle moves, and that’s where clinically everything changes, is when you start the antifungals. Now that’s only if the system is ready. If you start them too soon, you’ll make them more sick. I don’t find the herbals to be fungicidal, meaning they actually kill and get rid of entirely. Now I have patients who don’t tolerate the antifungals, or who just won’t, they don’t want to do it, I will use them. There’s a bunch of herbal combinations that I’ll use. It seems like we get somewhere with them. It’s not quite the magical turnaround of a pharmaceutical.

Lindsey:    

Yeah. Are there particular herbs in those combinations that are the relevant ones? Or?

Terri Fox, MD:

Lemongrass, pau d’arco. I use usually some combos. Byron White makes one called A-FNG. Beyond Balance has two that are helpful, PRO-MYCO and MYCOREGEN. Yeah, there’s a few other ones. I have another homeopathic that I’ve just been experimenting with for the people who don’t tolerate antifungals or won’t take them. It was from a podcast I did with a homeopath in Australia, and she told me about this homeopathic thing that’s for yeast and mold that she has super dramatic results within clinic, and she sent it to me from Australia. So I’m experimenting with that to see if I can do something without antifungals. I’ll let you know if it works out.

Lindsey:    

 Okay, sounds good. Anything else that I haven’t thought to ask about mold treatment?

Terri Fox, MD:

Well, a couple things, if you have mold, I really feel like you should be hopeful, and you should get tested and you should get treatment. Because, like I said earlier, I really think it’s a great diagnosis. People do really well. They get all the way better. I have patients tell me they feel better than they ever have after all the detox. It’s not a terrible diagnosis. So don’t be heartbroken if you have it.

Lindsey:    

Except for the part about remediating your house, if it’s in there, that’s the terrible part.

Terri Fox, MD:

Hopefully it’s an old exposure. Get yourself tested after you move to a clean place.

Lindsey:    

Yeah, exactly. Don’t find out while you’re still there. Anything else?

Terri Fox, MD:

Oh, well, you know, if patients are interested, I have a mold treatment course for patients that I created. So as an MD, I can only really treat patients in Colorado, because that’s where I’m licensed. I get calls from people all over the world. And after many years of feeling like I should create something, I finally did, and it’s been birthed and it’s out there. I did the first live version of it last summer, and it went great, and it’s pretty affordable now, and step by step, sort of walk you through a whole mold detox protocol phase one and phase two.

Lindsey:    

Okay, so is that like a series of videos then?

Terri Fox, MD:

Yes, 35 video modules and tons of resource guides and how to find your supporting physician to write a couple scrips and that sort of thing.

Lindsey:    

Okay. And where can people find that?

Terri Fox, MD:

DrFoxMedicalDetective.com

Lindsey:    

Okay, great. Sounds like a very useful resource. Well, thank you so much for sharing all this great information with us. I appreciate it.

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