Taming Gut Inflammation: Fiber, Prebiotics and Crohn’s Solutions with Will Bulsiewicz, MD

Taming Gut Inflammation: Fiber, Prebiotics and Crohn’s Solutions with Will Bulsiewicz, MD

Adapted from episode 145 of The Perfect Stool podcast edited for readability with Will Bulsiewicz, MD, gastroenterologist and Adjunct Assistant Professor of Medicine at Emory School of Medicine and the Founder of 38TERA*, a gut health supplement company, and the bestselling author of “Fiber Fueled*” and “The Fiber Fueled Cookbook*”.

Lindsey:

I’m sure my listeners would be interested in hearing how your own health issues brought you to where you are now in the search for root causes for gut health issues. Can you tell us about that?

Will Bulsiewicz, MD:

Yeah. I think that this is an important part, it informs many of my personal motivations in terms of the way that I approach health. So, I think, as a background an allopathic medical doctor, it was my lifelong dream to become a medical doctor, and I went through medical school and residency basically looking up at these people who were before me as. These are my heroes. This is what I want to be like. And then it all was quite sobering when I started to have health issues myself. Essentially, what happened is that the things that were bad patterns, bad habits that I had from my childhood and carried into adulthood, that I think I doubled and tripled down on during times of stress, or when I was short on time, or things like this, which I frequently was in my 20s going through my medical training, it ultimately came to a head where I found myself in my early 30s and I was unwell and I was having a crisis of health, and I was 50 pounds overweight. I had high blood pressure and high cholesterol, but even more importantly, I didn’t feel well, I was depressed, I was anxious, and also I had tremendously low self esteem, and I knew I wanted to feel better.

Yet in that moment when there I was, I was a board certified internal medicine doctor. At that point, I was in my specialty training as a gastroenterologist. I had won many awards. I was the top award recipient at Northwestern among 60 doctors. And yet, I didn’t want what I was trained to do for myself. I wanted something that would address, “Why do I feel this way? Why do I have these issues?” I don’t want to take a blood pressure pill for blood pressure, and take a cholesterol pill for that, and then, take something else for these other feelings. I want to repair the person, starting with the inside and working my way out and I didn’t really know how to do that, because that’s not what I was trained for. I tried to exercise my way out of things. There were definitely things that were beneficial from exercise, but it didn’t really fix the problem, to be honest.

Lindsey:

I always say you can’t exercise your way out of a bad diet.

Will Bulsiewicz, MD:

That’s exactly right, and I didn’t understand that, right? This seems obvious. It seems obvious, and yet there I was in it, living it, and not seeing it. And anyway, it was changing my diet that really changed everything for me, and the realization that, oh wow, not only do I feel better, my gut feels better.

Lindsey:

What was your diet? And what is it now?

Will Bulsiewicz, MD:

This period of time that we’re talking about, I’m now in my mid 40s, right? And we’re talking about a period of time that was on the on the order of 12 to 15 years ago. And leading up to that, when I was in high school, my parents were divorced, my mom was at work, and I would come home from school, and I had two brothers, and we grilled hot dogs almost every single day. And we loved going to fast food joints and drinking soda.  If you had some money, that’s what you would spend your money on. Then I went to college and medical school, and I’m independent now I have my own life. What do you think I ate? Exactly, wow.

Or imagine this, I work a 30 hour shift, right? This is, literally what would happen every fourth night during my residency in my 20s. I would work a 30 hour shift, not sleep, come home around one in the afternoon, completely exhausted, stop at Taco Bell, grab $15 worth of food, which is a lot for Taco Bell back then, and basically, devour it and then pass out and wake up the next day and go back to work. I had a very unhealthy lifestyle, but again, I didn’t see it or understand it, and so, anyway, you asked me, how do I eat now? I want to give the caveat that, how I eat now is a build. And I’ve always been working on ways to try to improve little things, not trying to be perfect, trying to tweak and work my way up. I feel I’m in a great place now in terms of the balance between it all. But where I started was the first thing was drinking smoothies. And it was almost drinking smoothies as a supplement. And it had fiber and polyphenols, phytochemicals and all kinds of good stuff. But that was my way of having something that I could prepare quickly, effortlessly, and still feel I was doing something decent for myself. That’s where I started, and it really, made a difference.

Lindsey:

Yeah. Where did you end up now? What do you do now? Do you cook for yourself? Do you eat lots of fiber?

Will Bulsiewicz, MD:

I eat lots of fiber. Yes, I try to cook for myself when I can, on the weekends. I’ll have breakfast. Breakfast for me could be avocado toast. That’s one of my favorites. And also, I should say I have four kids, and my kids, the age range is between, right now, once she turned one, my youngest, and then my oldest is 10. And anything that I prepare for myself, I have to prepare for my kids at the same time, right? I’m looking for solutions that are quick and healthy and also delicious, because that’s what my kids want. Avocado toast is a family favorite. Yogurt, I might do a plant-based yogurt, but I’m not opposed in any way to regular dairy yogurt, if that’s what people prefer. And a yogurt with nuts and seeds, specifically hemp seeds and berries, that would be a classic on the weekend. During the week, I typically don’t consume breakfast. I usually don’t, to be honest. I probably should, but I don’t, and I drink coffee and then I have lunch.

For lunch, soups, salads, sandwiches. A big kick that I’ve been on recently has been to take soup and add an entire can of beans to it. And I choose the beans based upon which type of beans fit the soup profile. Certain ones, I’ll use garbanzos. Other ones I might use kidney beans or black beans, depending on what the style of the soup is. But, again, I’ve worked my way up to this. If you have gut issues, this is not a starting point. This is where you get to eventually. And then dinner time varies, we cook for the family, and it varies by day of the week. We have typical family foods. Taco Tuesday as an example, and we’ll put out the taco spread, and then the key is, we have all the accouterments, and you pick and choose which ones you, and then add it to your taco, and it’s pretty nice. Another example of something that I would do for dinner is, I love making a bowl and including some whole grain and some legume or lentil, and then adding toppings. Depending on the flavor profile, whether it be Mediterranean or a burrito bowl, you put out that spread, add that stuff in, make it taste really great, and then acknowledge that this is a healthy meal.

Lindsey:

Yeah. I’m hearing the emphasis on the beans and the lentils, which is what I tell all of my clients who are eligible for that. There are some that are not, but all of the ones that are ready for beans and lentils, I would say, quarter to half a cup a day minimum, because you’re never going to hit your fiber requirements without it.

Will Bulsiewicz, MD:

They’re powerhouse foods. When it comes to the gut microbiome, there’s nothing more densely packed with fiber, resistant starches, and they also have polyphenols too. We’re talking about something that was strategically designed by nature, basically, to feed the gut bacteria. And I totally agree with you. They’re not for everyone, and for people who do struggle with gut issues, the starting point could be something like, for example, lentils which are soaked and typically, the smaller ones will be a little more tolerable.

Lindsey:

Yeah. One of the things we wanted to focus on today is Crohn’s disease, which I haven’t had anybody speak about in a while. Can you talk about the different types of Crohn’s and how you might approach them differently?

Will Bulsiewicz, MD:

Yeah, so we think of Crohn’s in terms of phenotypes, and I think in the future, we may be able to get more specific with this, because we’re taking this label of Crohn’s disease, which for the listeners at home, this is a form of inflammatory bowel disease. You can think of it in the same family as ulcerative colitis, but to me, as a gastroenterologist, these are distinct health conditions, and with Crohn’s disease, what makes it unique is that it can affect anywhere from your lips all the way down to your bottom, anywhere in between, and it can be in one spot and nowhere else, or it could be in different locations and skipping around and be involved. Some people are just the small intestines. Some people are just the large intestine. Some people are both.

That’s very different than ulcerative colitis, where ulcerative colitis is the colon, and how much of the colon is involved, is the question. But it’s always the colon, and it always starts in the rectum, with ulcerative colitis. Now, when it comes to Crohn’s disease, given this varied presentation, I think that in the future, we hopefully are going to be able to get more specific at looking at these specific types and then studying them and unpacking them further. But the main distinction that we will make is that there’s some people that have what’s called stricturing Crohn’s disease, where they form scars, and those scars within the intestines get tighter and tighter and tighter, and it closes off, and it affects the ability of food to flow through. And the issue with this, with the type of dietary pattern that I recommend, is that this can be trouble for a person who’s eating a lot of plant based foods, particularly the skins. In my mind, I’m thinking about an apple and a pepper and things of this variety that have a skin. Those skins don’t digest and they remain intact. You might chew them, but they’re still quite large. They can bunch up like a meatball and cause a blockage, right?

Now, on the flip side, if we’re talking about a smoothie, it’s a completely different thing, because the smoothie is so particulate, so small, it’s not going to form a clump inside your intestines. That’s not possible. We tend to, with these people, be very cautious with how we approach fiber, but I hope that the listeners are hearing me when I make this distinction between highly refined, particulate, plant-based foods versus things that are closer to whole foods that have a skin and therefore may be problematic for a person who has one of these strictures. I’m happy to talk more about the strictures because there’s two main elements to strictures that people need to know. One is inflammation, and inflammation, if you properly treat it, that will go away. And the second is scar tissue. Scar tissue is not going away. If a person does have a blockage, in theory, it may be possible to resolve the blockage in the hospital. The patient, treating the condition, getting the inflammation under control, you may be able to do it, but there are some people that do require surgery for this.

And then the second major type is what we call penetrating Crohn’s disease, which basically means that the inflammation is severe that it may make connections to other parts of the body, and when it forms a connection, we call that a fistula. A fistula is an inappropriate connection between two parts of the body, so, Crohn’s disease may connect to the bladder, or it may connect to another part of the intestine, or it may connect to a woman’s vagina, and all of these things then will have potential manifestations and consequences. These two types, though, stricturing and penetrating, these are different phenotypes, typically people aren’t both at the same time. Typically they’re one or the other.

And when it comes to penetrating disease, I don’t share the concern that I mentioned a moment ago with the skins and fiber of that variety. All patients with Crohn’s disease have deep dysbiosis. What that means is a very damaged gut microbiome and fiber is unique, because while it is incredibly healthy, it also is the food that requires our microbiome in order to process and digest it. This creates an issue for people that have a very deeply damaged gut. The thing, paradoxically, that they need the most, is also the thing that’s hardest for them to receive. In both cases, I apply rules, but I take them to an extreme. I apply rules that I would use for people that have irritable bowel syndrome or other forms, other manifestations of dysbiosis, but with the acknowledgement that in inflammatory bowel disease. These are typically the people with the most damaged microbiome. The rules are that I use typically, when it comes to these types of foods, are I will start very gentle, and then I will slowly ease into it. I tend to use, in this context, a low FODMAP diet. And Lindsey, I know that your listeners are quite facile, FODMAPs, is this something that I should explain? Or how do you feel about that? Do you want me to get into that?

Lindsey:

Briefly. I’m sure they’ve heard about it on another podcast.

Will Bulsiewicz, MD:

FODMAPs, it’s an acronym. It’s super nerdy. It stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. And basically what this is referring to is the fermentable parts of our food, and specifically fermentable parts that are carbohydrate. They’re carbohydrate based. Now this doesn’t make them bad. In fact, they’re good. They’re good because the vast majority of them are what we would describe as prebiotic, meaning they feed and fuel our microbiome.

But that being said, anytime we use the word fermentation, it’s never a human biological phenomenon, that’s always our microbes. Microbes are what ferment things, whether it be in a jar and we’re making some kimchi or sauerkraut, pickles, or whether that be inside of our own intestine, and our gut microbiome is processing and digesting these foods. Fermentation is done by these microbes. The point is that for people that have a damaged gut, their microbiome, those microbes, they’re not in a good spot. And by going low FODMAP, it allows us to give them the space that they need to heal and be gentle. We don’t want to do low FODMAP in perpetuity, right? But for a period of time, you make this play. And the intent is to gently ease into feeding the microbiome, as opposed to aggressively doing it and stuffing it.

And there’s been data for many years on irritable bowel syndrome. Anytime we talk about irritable bowel syndrome, if you have inflammatory bowel disease, you almost certainly also have irritable bowel syndrome underlying it. It’s an overlap. There’s data with irritable bowel syndrome, but now there’s also data more recently, with people with inflammatory bowel disease. Two things. One was a six-week study where they had people with inflammatory bowel disease follow a low FODMAP diet, and they improved the measures of gut inflammation. That’s a beautiful thing.

And then the second was, among these people with inflammatory bowel disease, they discovered that they had improvements of their symptoms and improvements of quality of life. The point being that if I were to take a person who has Crohn’s disease and I look at them, and what I see from my perspective, is a person who has a damaged gut microbiome, because their gut microbiome is damaged, their gut barrier is broken, and this has activated the immune system inappropriately, and the immune system is on the attack. And when the immune system goes on the attack, people think about things like autoimmune disease. What’s interesting is that inflammatory bowel disease, I don’t consider to be autoimmune.

Lindsey:

Really?

Will Bulsiewicz, MD:

Very similar, but I think worth pointing out, because it’s more than semantics. It’s understanding what’s happening. In an autoimmune disease, your immune system is attacking you, in inflammatory bowel disease, your immune system is attacking your microbiome. It’s a rejection of your own microbiome, and your intestines get stuck in the middle.

Lindsey:

Interesting.

Will Bulsiewicz, MD:

And the inflammation that manifests is the result of the inflammatory process manifesting in the lining of your intestines. But your immune system is not trying to attack your intestines. It’s trying to attack the microbiome. And the way that we heal this broken, damaged gut microbiome, broken gut barrier and confused immune system, the way that we ultimately want to heal, this is by healing the gut microbes. Because if we can do that, if we can reverse dysbiosis and move back to a normal, healthy, balanced microbiome, which the term is eubiosis for that, if we can do that, then that balanced, healthy microbiome will allow us to repair and restore the gut barrier, which is how we accomplish that. And when you repair and restore the gut barrier, then you simultaneously are going to give the immune system the space that it needs in order to manage itself, to heal, to stop attacking.

Lindsey:

Yeah. And are you using comprehensive stool testing to assess the microbiome?

Will Bulsiewicz, MD:

So with Crohn’s disease, I haven’t found comprehensive stool testing to be something that I would allow to lead; I find it to be a complimentary piece. I don’t yet believe that these tests are in a position of being ready for prime time, in the sense that what I want to know, with a patient with Crohn’s disease, I want to know how they feel. The expectation is that symptoms are present as a result of their condition. And, I should say it’s not universally true, but generally speaking, symptoms are present in response to their inflammation. When the symptoms improve, it is because you are improving the inflammation. I want to get them into a symptomatic remission. That would be the first step. And then the second step is to get them completely free of disease so that you can’t tell them from another person who doesn’t have inflammatory bowel disease.

Lindsey:

And are you talking about interventions with diet, or are you talking about using the immunosuppressive drugs?

Will Bulsiewicz, MD:

So, the way that I see this interplay is, I guess, let me put my general philosophy as a medical doctor out on the table, which is that what I care about is people being better, right? And to the best of our ability, addressing the root of the issue and not covering it up. Because I feel like when you cover it up, you might get them better temporarily, and then they get worse again. With this in mind, the answer to your question depends a bit on the intensity of the of the health condition. For people that have mild Crohn’s disease and it’s not severe in terms of the effects of inflammation or in terms of the symptoms, then we have more. We wait. We have more give, rebuilding and repairing the gut microbiome. It takes time. To me, what we’re talking about here is not a four-week process. I don’t even know that it’s really a four-month process. In my mind, generally, people that have inflammatory bowel disease, to really get to where I would want them to be, we’re talking about something on the order of, minimum of six months, most likely 12 months, somewhere in the range of 12 to 18 months, to truly get there.

I won’t sit back and have a person progress to the point of requiring surgery with Crohn’s disease while we’re waiting for diet and these things to kick in. When it’s appropriate and medically necessary, absolutely I would treat them with medication. My issue with medication is not the fact that they exist, because I’m glad that they’re there and they can really help people. My issue with medication is that we have built a healthcare system that almost entirely is focused on providing the medicine with absolutely no acknowledgement that these other aspects, which are the root issue, are relevant. That to me is the problem. And this is an interesting thing, which is that I would have drug reps that would come into my office, and they did not like me, and the reason why is because I literally said to them, I know that’s not you, but your company has created a drug that they’re charging people 1000s of dollars per month, and you’re asking me to prescribe this, but then you don’t teach me or provide the clinical study necessary for us to know how to stop and I don’t think that’s fair, because you’re making a ton of money. You should be not only funding a study to start the drug. You should be required to fund the study to stop the drug.

Lindsey:

Yeah, that’s not their business model.

Will Bulsiewicz, MD:

That’s not what they’re going to do, right? But that’s a problem because at the end of the day, I feel that should be a requirement for approval of particularly these drugs. The issue with Remicade or Humera, right, Infliximab, those are the two classics when it comes to treatment of inflammatory bowel disease. The problem with these things is that if you stop it, and you’re wrong, they will form antibodies to the drug, because the drug is a biologic, the immune system can react to it once you withdraw it, and then you won’t be able to put it back on board. And that’s a serious issue, because the data are very clear that the first medication that you receive that’s in this class is the best that you’ll ever do, and then the second one will be not as effective. And my point is that I understand why doctors don’t want to withdraw these drugs, because they’re afraid of losing the drug and not being able to bring it back. But it’s not fair, because the drug companies, they know how much money they’re making.

Lindsey:

As you’re intervening in the meantime on diet, how are you correcting microbiome? Are you familiar with the research of Mahmoud Ghannoum at Case about the plaques and Crohn’s and the presence of Candida and H. pylori in some of these plaques and such?

Will Bulsiewicz, MD:

So I am familiar with Mahmoud Ghannoum and to me when it comes to Candida, and I believe that he would agree with this, it’s been a couple years since I couple years since I talked to him, but he and I used to be in contact. I think that he would agree with me saying that when it comes to fungal infections, this is at least what I see in the data, that when we empower the healthy bacteria, they suppress the inflammatory yeasts. And we can see this quite readily, because for the vast majority of people, thrush, which is candida infection in the mouth, or esophagitis from Candida or vaginal yeast infection, these manifestations of yeast, they are number one when the microbiome is weak, right?

And classically, number two, occurring with antibiotics, because of course, the microbiome is non-existent in that moment because you’ve suppressed it and they come up, they flourish. From my perspective, the solution is not necessarily to attack the Candida. I believe that the solution is to focus on building the beneficial bacteria. Because when we do that I believe that the key to inflammatory bowel disease and many of these dysbiosis-based conditions, is ultimately to restore healthy microbes and then feed them with prebiotics and allow them to release the short chain fatty acids, butyrate, acetate and propionate, because then those are what help to suppress inflammatory microbes, help to suppress inflammatory yeasts, rebuild and restore the gut barrier, and also simultaneously, they have direct effects on the immune system.

Lindsey:

And at what point in the Crohn’s healing process is it safe to add fiber?

Will Bulsiewicz, MD:

I believe that it’s very early in the process, but I think that there’s a strategic approach. I guess let me, let me talk through. Let’s pretend that we have a person for a moment who has moderate to severe Crohn’s disease. All right, if they’re actively flaring, right now, I am not trying to put out their flare with fiber, right? And because they’re actively flaring, the addition of fiber is going to be a mess and may make their symptoms worse, because they’re not in a position of being capable of handling that. Ultimately, we need to get this person into remission, which may require medication in order to do that. When they get into remission, this, to me, is when our process of healing begins.

And the analogy that I would make Lindsey is, gosh, and I feel weird even saying this. I hadn’t even processed this until now, but, we obviously have the fires that are happening in California, I hate that, but I feel this is still the best analogy for me to describe this, please forgive me. And let’s separate from that, if we could, but if you have a fire that’s burning, you don’t plant new trees in the midst of a fire, right? You have to put the fire out, right? That’s step one. You put the fire out, and then when the fire is put out, there is damage that’s there, and the forest has been reduced down to not much. But there’s also an opportunity to regrow, acknowledging that opportunity to regrow does require time and patience, but it’s possible. And you put the fire out, and then you replant the seeds, and you allow those seeds to grow and mature, which takes time. With that analogy and applying it to Crohn’s disease, a person’s having an active flare, I want to use medication when appropriate, put the flare out, whatever is the least medicine necessary once they’re in remission.

That, to me, is when we really start to introduce the fiber-based approach. And my preference would be going back to what we were discussing a moment ago. I would generally start with a low FODMAP diet, and then over time, progress from low FODMAP to moderate FODMAP, and then working our way up to less restriction over time and simultaneously, from a fiber perspective, I would absolutely use a fiber supplement within that context. And so, Lindsey, I started a company called 38TERA*, right? And I’m happy to talk about 38TERA supplements. But I think there’s also this broader conversation that ignoring for a moment that I have a prebiotic supplement, acknowledging, what is the role of a prebiotic supplement within this setting? The answer is that it’s targeted for the microbiome. It’s not the same as food. It’s not meant to be the same as food. It’s not meant to be a replacement for food. It’s meant to be a way in which you can confidently influence the microbiome and have control over that dial. You can start with a very small amount, and then you can work your way up slowly over time. And what I would opt for within that setting is I would absolutely opt for a low FODMAP prebiotic, because low FODMAP once again, still is prebiotic, still feeds and fuels the microbiome, but is going to be more gentle to this person who has a damaged gut.

Lindsey:

Yeah. In terms of foods, you were talking about smoothies, and how, if they’re blended up, the fiber is not difficult for somebody. Is that an early way of introducing fiber? Would higher FODMAP foods that were in the context of a smoothie be acceptable where they might not be otherwise?

Will Bulsiewicz, MD:

Ultimately, it depends on how they feel. Yeah. If they if they were to do higher FODMAP and they feel totally fine, cool, you’re good. And if they struggle with that, then we have to back it down and move towards something that’s more simplistic. And while we’re in FODMAP content . . .

Lindsey:

Is the struggle going to look pain in the context of Crohn’s, or is it going to be loose stool or diarrhea or constipation? What are the primary symptoms that people are going to be suffering from?

Will Bulsiewicz, MD:

It really depends on the individual. And it depends, because the issue is that the disease can manifest in many different locations with varying degrees of intensity. Small bowel disease manifests in a rather different way. For example, the discomfort with small bowel disease will typically be felt around the belly button. If you have small bowel Crohn’s disease and you’re having intensification of discomfort around your belly button, what’s going on there? Whereas colonic Crohn’s disease, the colon basically frames the abdomen around the outside. Right, lower quadrant, right, upper quadrant, left, upper quadrant. These are different places depending that could manifest.

And again, I think it’s understanding your own disease, where you typically manifest it, and and what symptoms you experience. The lowest, most common symptom is bloating. Anytime the gut is struggling to process and digest food, you get bloating. And it’s not to say that the smallest amount of bloating should be something that scares you. That’s not the way that I feel about that, but it’s the acknowledgement that ultimately, what we’re trying to do is get you to a place where you’re comfortable, and then grow from there. Because if we can start with you being comfortable, then we have our baseline, and then from the baseline will continue to push over time.

Lindsey:

You mentioned the crossover of IBS with IBD. In some of these cases, this bloating could be caused by SIBO, conceivably?

Will Bulsiewicz, MD:

Definitely.

Lindsey:

All right, are you testing for SIBO then and treating that?

Will Bulsiewicz, MD:

Potentially, but SIBO, I guess the thing with SIBO is I’m a bit sensitive when it comes to SIBO. And I’ll admit that my fear is over treatment, because typically the treatment for SIBO is antibiotics, right back to overgrowth. Therefore, we must reduce the volume of the bacteria. We must cut them down. And antibiotics are a routine part of care with these people that have inflammatory bowel diseases, including Crohn’s disease, and they’re highly effective. But the issue, though, is that ignores the root of the issue, which to me, is dysbiosis, a damaged gut. I believe that dysbiosis is at the heart of Crohn’s and other forms of inflammatory bowel disease. I believe that it’s at the heart of irritable bowel syndrome. And I believe that SIBO is quite simply a manifestation of dysbiosis. It’s a form of it. And my concern with this particularly, is that I don’t want to rush to be put into a position where I feel that I have to treat a person with antibiotics because the test is positive. There are people who need antibiotics. There is no doubt. There are people who definitely have SIBO, and ultimately we have to get there. But my fear is that we’re paying a price where in the short term they are better, in the long term, not making them better.

Lindsey:

Yeah, but there’s definitely approaches that don’t involve antibiotics, serum bovine immunoglobulins or herbal antimicrobials that are more selective, like pomegranate husk or, gosh, there’s heaps of them, like turmeric, andographis, lots of things. How about those approaches?

Will Bulsiewicz, MD:

Those approaches, it depends on, to me, I would have to take a look at the specifics of what we’re talking about. An example oregano oil, I would have concerns about.

Lindsey:

Oh, yeah.

Will Bulsiewicz, MD:

So, because if we’re talking about broad spectrum anti-microbial, and I understand it’s not an antibiotic, it’s the same thing from my perspective, right? Whereas when we’re talking about something that’s more on the spectrum of garlic, or you mentioned pomegranate husk, or you mentioned turmeric? The thing that’s interesting with these things is that’s not an isolation antimicrobial; that’s in combination with prebiotics. Curcumin is a polyphenol and the health benefits that we receive from turmeric are the result of the gut microbiome and the effects that turmeric has on the gut microbiome. And the same is true with pomegranate in terms of ellagic acid and other prebiotic polyphenols that exist naturally. I have less concerns about those things, because basically what we’re talking about here is a prebiotic being packaged with something that we talk about being anti-microbial, right? But more selectively, and I’m seeing this not as an anti-microbial. I’m seeing this as a prebiotic building, right? Because my fear is that we’re not building; that’s my fear, right?

Lindsey:

Yeah, so the building process is ultimately going to take care of the cutting process? That you’re going to feed the good microbes, and they’re going to outgrow the bad ones without having to break down the bad ones.

Will Bulsiewicz, MD:

Yeah, and there’s healthy foods, as you’ve already pointed out, and then I would put my stamp on that there’s healthy foods that do have anti-microbial or antiviral effects that have been demonstrated, yet that’s not in isolation. We wouldn’t characterize them as an anti- microbial. We would say that they have that effect. It’s in combination as part of a package that also is many times prebiotic and therefore good for the microbes.

Lindsey:

Tell us about your supplement and what’s in it and how it’s helpful? And is it helpful, in particular, in Crohn’s? Was that in your mind as you developed it, or was it generally developed for building up good microbes?

Will Bulsiewicz, MD:

The way that I was thinking about this is, I guess, to frame the context, I have had incredible success treating people with prebiotic supplements for many years, but the thing that always troubled me is that the standards that I hold, I’ve never felt the supplements were there, never fully fulfilling those standards. And this led me to want to create my own because I, with confidence, believe that there is a role that exists for optimizing the gut microbiome and then receiving the effects and the benefits that come from the production of short chain fatty acids. To me, the general approach was, I wasn’t necessarily thinking about a specific disease state, per se. It’s more to say that, what we know, with 100% clarity, is that when you put prebiotic fiber or resistant starch or polyphenols in the mouth and swallow, we know where they’re going to go, we know what they’re going to do, right? It’s the because there’s no place else for them to go that you’re going to come into the context with the microbes.

Then those microbes will ferment them and create short chain fatty acids. But what I felt was missing is that many of the fiber supplements that exist are mono fiber, one single type. And in some cases, people advocate for using them at ridiculously high doses, 15 or 20 grams. And what happens when we only consume one type of fiber? You only feed certain microbes, and there is such a thing as too much, and this is part of my concern with, for example, inulin. Does it have studies to say that it’s beneficial for a microbiome? Yes; there’s also studies that say that it can be inflammatory and problematic if you do too much. I wanted to create balance. I wanted to create something that had multiple different forms of prebiotics, different types of fiber, also resistant starch and also polyphenols, and I wanted them, whenever possible, to come from something that has been clearly studied in humans with randomized control trials demonstrating that.

Number one, if you take this product at this particular dose, here’s the effect that it’s shown to have on your microbiome. Number two, it will affect your bowel movements, right? That, to me, is part of the proof that we’re achieving something of benefit is if you’re if your bowel movements are not the same, the proof is in the poop. And then number three, benefits beyond this, such as the improvement of gut symptoms, bloating. As I pieced together the formula, there’s seven different prebiotic ingredients, and they include resistant starch, which comes from potatoes. By the way, it’s a bit of a unique thing. It’s not the same resistant starch that you get by heating and cooling the potato. This is the resistant starch, RS2 that’s innate to the potato if it’s uncooked, and kiwi fruit, mango, beets, lingonberry and acacia and baobab. So, all right, it’s seven different and again, it’s a combination of fiber, resistant starch and polyphenols. And I see these as being synergistic together.

We have a clinical study that’s occurring right now that we should have the results in the next few months. And part of what we’re doing with this study is to demonstrate the synergy that exists when you take resistant starch and you add fiber and then subsequently polyphenols, because my expectation is that this is priming the pump, getting the microbiome organized and preparing to basically create these short chain fatty acids. Right now, as it relates to Crohn’s disease or these different health conditions, irritable bowel syndrome or even small intestine bacterial overgrowth, a few of the things that we did specifically and strategically. Number one, it’s low FODMAP. This is uniquely and strategically formulated, and it’s certified as low FODMAP. It’s intended to be gentle on the gut. Number two, it is certified glyphosate free. But it’s also taken much further than that. One of my concerns with, for example, gluten containing products, or oats or many of the things that people worry about is maybe it’s not the actual plant itself. Maybe it’s what we’re putting on the plant, glyphosate. Because to me, if you go to Italy and you can eat the food, which a lot of people say, it’s not the actual wheat. That’s the problem. It’s the way we’re treating the wheat. The product is certified glyphosate free.

But then beyond that, I’m really proud of the fact that we have extensively tested every single batch for more than 50 different pesticides, and it’s been negative every single time on every single test. We third party test far beyond this. This is a big part of what I was hoping to accomplish by creating my own brand, is that we’ve run over 100 different tests. That includes heavy metals, it includes microbes and pesticides. It also includes unique things that I literally have to get the laboratory to figure out how to get this done, histamine and salicylates and methyl salicylate. In essence, what we’re doing is we’re basically looking at things that can cause food intolerances that are specific to people with gut health issues. And for any batch that you purchase, you can find on the packaging, on the bag, here’s the lot number. You go to our website, you enter that lot number, and entire report is downloadable for you to see the results specific to that batch.

Lindsey:

Yeah. I’ve been trying it since you sent it to me, and I will vouch for the fact that it is light and fruity, and you add to some water, and it makes a light fruity beverage that tastes good and isn’t overly sweet. What sweetener is there in there? Is it stevia or something?

Will Bulsiewicz, MD:

It’s got monk fruit.

Lindsey:

Monk fruit, okay. Because I normally don’t like monk fruit. Monk fruit, to me, can be overbearing and sometimes weird, but it I didn’t detect any bitterness or bad aftertaste at all. It was light and pleasant and not too sweet. A lot of these things, the electrolyte formulas and whatever, it’s way too much. It was not that. I will vouch for the taste, and also the fact that if it didn’t come up, it wasn’t a typical fiber supplement.

Will Bulsiewicz, MD:

Yeah, it dissolves pretty well. You’ll see a little bit of white granular powder, and that white granular powder is the resistant starch. And that’s because resistant starch is unique, because it’s not soluble fiber yet. It’s still prebiotic fiber.

Lindsey:

Yeah. One thing I was wondering about, though, on the label, it says, I think was it maybe 5.9 grams of fiber per two teaspoons. But then it breaks it down, and it says 2.6 grams. I was confused. Which is it?

Will Bulsiewicz, MD:

Yeah, yeah. The actual serve is 5.6 grams, all right. And when you dig into the amount of actual fiber, it’s less than this, which, by the way, to me, is reassuring. And the reason why is because these are whole food ingredients. This is taking whole food ingredients, deriving a powder and then putting it into the formula, as opposed to some chemical extraction process where you are isolating the fiber and nothing else. What you end up with is that you end up with less than the 5.6 grams as actual grams of fiber. But the key, from my perspective, to addressing our fiber deficiency is not about grams. To me, it’s about a variety of different foods and feeding and fueling the microbiome to an adequate level. What we have, for example, is we have two ingredients that have human clinical trials to show what they do. And the cool thing about it is they both have been shown to improve the health of the microbiome. An example is Solnul™, which is the resistant starch, increases akkermansia levels by 317%

Lindsey:

Wow. At what dose, at 3.5 grams?

Will Bulsiewicz, MD:

Per day, which is the dose that is in a single serve of this product. Basically, we wanted to meet the standard of that trial, we included that precise amount of Actazin, which is the kiwi fruit. A very small dose has a very powerful effect. So 600 milligrams of Actazin per day, because the kiwi fruit fiber is quite powerful, is able to achieve an improvement in Faecalibacterium.

Lindsey:

prausnitzii?

Will Bulsiewicz, MD:

Faecalibacterium as a genus, not necessarily prausnitzii specifically. And then they also, more recently, published a paper discovering that it also increases Akkermansia levels, and now Akkermansia, I’m sure that your listeners have heard about Akkermansia, but this is a powerful, anti-inflammatory bacteria that protects people from inflammatory bowel disease, and there are companies that are selling probiotics, and those probiotics may be alive or they may even be dead, and they’re extremely expensive. And my argument is nothing against those companies. If they help you, they help you. That’s what I care about. But my argument is that if we could feed target and feed our own Akkermansia and help that to grow, that’s ultimately what we want. We don’t want something from the outside that passes through us. We want something that sticks. Yeah,

Lindsey:

Yeah and interestingly, I have seen clients and you see on a stool test, or on a metagenomic sequencing that they have no Akkermansia, no Faecalibacterium prausnitzii, and then it’ll come back. And sometimes this will be having not, of course, taken a probiotic for a Faecalibacterium prausnitzii, and sometimes not having taken the Akkermansia probiotic, but it can come back by feeding it even though it was below detectable levels. It doesn’t mean it’s not in there somewhere. It’s hiding up in there, maybe in the appendix somewhere, right?

Will Bulsiewicz, MD:

Oh, I totally agree. Yeah, that’s a great point on the appendix. I hadn’t even thought specifically of that. That’s a good point in my mind. The way that I thought about these things, is that because it’s not detectable doesn’t mean it’s dead, doesn’t mean that it’s totally gone but that it is below the ability of our tools to detect, which have their limitations.

Lindsey:

Yeah. Are there any other lifestyle or supplement or non-conventional interventions that are your regular go to’s in Crohn’s.

Will Bulsiewicz, MD:

I think that there’s other supplements that can be beneficial in Crohn’s disease. You mentioned the turmeric. I’m of the belief that turmeric is something worthy of consideration for all people that have inflammatory bowel disease. The starting dose can be as gentle as 500 milligrams once a day, but that’s a starting dose, and then we start to ramp it up, and quickly get to 1000 milligrams a day, and potentially more than that, potentially up to 2000 milligrams per day. I also am a believer in vitamin D. And the beauty of Vitamin D is that it can be a test-informed and targeted approach; you’re not blindly taking the supplement. You test and then you address the level. Yeah, and the goal for people that have Crohn’s disease, typically for me, I would target numbers of 40 to 60. And my observation is that vitamin D levels are consistently low in people that have dysbiosis, because there’s a connection between vitamin D and gut barrier function.

Lindsey:

My observation is that they’re consistently low in anybody who’s not supplementing, because nobody gets enough sun.

Will Bulsiewicz, MD:

Yeah, that’s true. Most people don’t get enough sun. But I also think that we are living in an epidemic of dysbiosis these days, and I think that’s part of what feeds into this as well. The other thing too, that’s interesting about vitamin D is it’s a fat soluble vitamin. Vitamins A, D, K and E are fat soluble vitamins. What that means? A few things. Number one, when you take your vitamin D supplement, take it with a fatty meal, it will improve absorption. But number two, in the context of obesity, you can have lower vitamin D levels as a result of obesity, because basically it spreads out throughout the body, and it can end up in fat cells, where it’s not even functional. It’s not helping you. Yeah. Vitamin D, again, I would target 40 to 60. But if a person were not doing testing, then I would probably, most people talk about 2000 international units per day. I’m more of the belief that we need to go higher and harder than that, because I don’t think that’s adequate. I typically would probably go at 5000 and as high as potentially 10,000 if there were a need, per day, yeah, and . . .

Lindsey:

Then testing every six months, every three months? How often would you test it if you were supplementing at that level?

Will Bulsiewicz, MD:

Trying to get them up to goal, then I would test more frequently, probably three months would be the target there. Once I have them at goal, then you make an assessment, how hard was it to get them there? Yeah, if it was hard, then you might test them a little more often, to make sure you’re maintaining it. But, over time, you hopefully settle in, you find the amount that you need, and then you stick with it. And then I also am a believer on some level, on the importance of adequate Omega 3 intake, specifically EPA and DHA. And, unfortunately, the vast majority of people; this is again, another one that you can test. It’s the Omega 3 index. And the Omega 3 index, basically, it’s a percentage, and it tells you what percent of the total body fat that’s detectable is made up of these types of omega 3s. A few things on omega 3s, real quick. Omega 3s are anti-inflammatory fats. They’re polyunsaturated fatty acids, PUFAs. When I hear people trashing PUFAs, I get a little bit bothered, because omega 3s are PUFAs. They’re good for you, whereas Omega 6s it’s a different story. And we can talk about that if you want to, we get plenty of omega 6s.

Most people don’t get enough omega 3s, and it leads to an unhealthy balance between those two fats. We want to reduce our omega 6 intake, but we really want to increase our omega 3 intake. There’s three main types of omega 3s: ALA, EPA and DHA. And the issue is that if you eat seeds, which, by the way, can be a source of Omega 3, it’s chia seeds, flax seeds, hemp seeds and walnuts, it gives you ALA, but the conversion rate is extremely poor. And ultimately, I’m of the belief that, look, if you can get your Omega 3 index up to goal, which, for a normal person, is eight to 12% and if you have Crohn’s disease, I would want you at 10 to 12%.

If you can get there up to goal without a supplement, I’m happy for you, but a lot of people cannot. This is where the choice that’s on the table is, we want an EPA and DHA supplement, and you can do fish oil, which is less expensive, or you can do an algae-based supplement. I tend to, when possible, opt for a high quality, algae-based supplement. I tend to favor the algae-based supplement for purity reasons. You can create that and it’s the Omega 3. And the problem is that when it’s fish oil, it’s not the fish that’s creating the Omega 3. It’s storing it, but it’s also storing other stuff. Unless we know that it’s pure, I have concerns. Anyway, the dosing for a person that has complex inflammatory conditions like Crohn’s disease is very high. Typically, we would start off in the range of 500 to 1000 of EPA plus DHA. But with these complex inflammatory conditions, you work your way up to two or 3000.

Lindsey:

And are we talking about krill oil now at this point, or what is the algae based one?

Will Bulsiewicz, MD:

Krill oil could suffice, basically all these things come from the ocean. Yeah. This is the long chain Omega 3s, but algae-based is not krill. Krill is an animal, and it’s own, unique thing, Whales eat a lot of krill. Algae, though, is the plant, and it could be grown in a farm and still produce high quality EPA and DHA.

Lindsey:

Yeah, so, I know with the vegan sources, it’s really hard to get much EPA or DHA without taking tons of it. It’s really expensive to get there.

Will Bulsiewicz, MD:

I think it’s becoming increasingly available, the ability to get the vegan, long chain. Again, what I’m looking at is, I’m going to turn the label, I’m going to look at it, and I want to see how much EPA and how much DHA, and I’m going to add those two together.

Lindsey:

Yeah. Is there one that you are familiar with that’s high because I’ve looked for this for clients who are vegan, and I can’t find anything that’s more than like 300 of the two of them in a whole pill.

Will Bulsiewicz, MD:

I mean, I don’t know the brand off the top of my head, I have seen them that are about 1000*.

Lindsey:

Oh, really?

Will Bulsiewicz, MD:

Yeah, no, yeah, it might be two. It might be two pills per serve, and that gives you 1000.

Lindsey:

Yeah, I use the ProOmega 2000* a lot, because one pill is 1000 EPA and DHA. It’s done.

Will Bulsiewicz, MD:

No, that’s great. And for these people, so 1000 EPA and DHA for the vast majority is a sufficient amount, but for people that have complex inflammatory issues, you’re looking for an anti-inflammatory dose, and that’s where you have to push it a little bit higher.

Lindsey:

Yeah, this has all been super interesting, but unfortunately, we’re running out of time. I do want to ask number one, where can people find your supplement, and mention that they did make a discount code for my listeners, that was PERFECTSTOOL for 10% off.

Will Bulsiewicz, MD:

Yep, the code is PERFECTSTOOL, and caps or no caps. It should work either way. If you have trouble, let us know. Yeah, if anyone’s looking to try out 38TERA, use that code. You’ll save 10%. Our website is 38TERA.com*, and you’ll find it there. And, on our website, we have a ton of resources if you want to check it out. We have a Science page, we have laboratory results. We also have a product guide that walks people through the specifics of how best to get the most out of our product. But nonetheless, go to the website, check it out. And honestly, I hope that it helps people, and if it doesn’t let us know.

Lindsey:

Awesome. Thank you much for coming here and sharing your knowledge with us.

Will Bulsiewicz, MD:

Thank you, Lindsey.

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.

Schedule a breakthrough session now

*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.

Combating Constipation: What To Do When You Can’t Go with Carmen Fong, MD

Combating Constipation: What To Do When You Can't Go with Carmen Fong, MD

Adapted from episode 144 of The Perfect Stool podcast edited for readability with Dr. Carmen Fong, MD, Co-Director of the Hemorrhoid Centers of America – Atlanta, double board-certified surgeon in General Surgery and Colorectal Surgery, and the author of the 2024 book: Constipation Nation: What to Know When You Can’t Go*. 

Lindsey:  

So let’s just launch right in and let me ask you what the official definition of constipation is and how common it is.

Carmen Fong, MD:  

Yeah. So it’s estimated that about one in five to one in three people in America have constipation or have experienced constipation at some point in their lives. The official definition by the medical textbook is that if you have difficulty evacuating, feelings of incomplete evacuation, hard or firm stools, or you go less than three times a week. And for the other ones, it has been like more than 25% of the time you’re feeling those things. That is the official definition of constipation. Now whenever I ask patients, have you had constipation, and if I say those things, they’re like, really no. But if you’re like, do you feel like your poop is hard? Sometimes they’ll be like, yeah. I think our bodies don’t go by the textbook at all.

Lindsey:  

So three times a week, I’ve got to push back on that a little bit, and I know that is the official definition, but surely someone who’s not having at least a daily bowel movement couldn’t be optimally healthy, or eating the optimal amount of fiber, or drinking the optimal amount of water, or getting enough movement, or something’s got to be missing, right?

Carmen Fong, MD:

Exactly. So I usually go by the rule of thumb that most people in the normal, average range, have one to three bowel movements every one to three days, right? So it’s like, if you’re within that range, you’re doing pretty well, but if you’re going less than three times a week, right? That’s every two or three days, there’s definitely something that can be optimized about 89% of the time. 85 to 89% of the time, it’s actually something that we can change with behavioral and lifestyle modifications, it doesn’t require surgery or medicines and stuff like that. 

Lindsey:  

Yeah. Okay, great. So how do you think that we have as a society shame people about this basic biological function, and how can we undo this training? 

Carmen Fong, MD:    

Yeah, I think it starts from birth. So I have to tell you, like when I was writing this book, I was pregnant, and now that I’ve had two kids, I can totally see where potty training and potty shaming is a very real thing. So in my household, so even when we have different nannies and babysitters, I’m like, we do not poop shame, right? We don’t say that poop is stinky, we don’t say that it’s yucky, we don’t say that it’s gross, like it’s a normal human function. Everybody does it, and I think that the sooner we start from birth, the better. My daughter is about to turn two, and already she has this weird thing, and I don’t know where she got it from, like, being my kid, that she’s like, oh no, I have poop in my diaper. It’s yucky. I don’t want to have it changed, because I don’t want to smell it. I don’t want to have to go. And I’m like, where did this come from? Because I’m always like, hey, it’s normal. You got to go. And I think it’s some of our babysitters and some of our nannies have been like, ew, stinky, yucky. So it starts from birth. It starts from normalizing pooping behaviors from birth, and then it extends into your teenage years and adulthood, where one of the quoted articles in my book is The New York Times article about women being poop shamed and going to great lengths to not poop in public, right? So they will run to the next building so that they can go somewhere where nobody knows them. And all these things have been invented, like Poo-Pourri and a sound machine so that you basically extinguish the smell and sounds of having to poop.

Lindsey:  

Yeah, I actually had no idea that people did that until I found out a relative of mine had that issue and absolutely could not go in the same house as her boyfriend . . . well she had to have overcome that obviously when she got married.

Carmen Fong, MD:    

Yeah, exactly, yeah. And, what do you do when you get married? They’re going to find out that you poop.

Lindsey:  

Yeah, if they didn’t know already!

Carmen Fong, MD:    

Exactly, all right, yeah. It’s like there is a true fear of it, but I think most of the time it can be overcome, and societal norms can be adjusted to accommodate for the fact that everybody poops. 

Lindsey:  

Yeah. So we’re going to get into diet and supplements and medications later, but let’s start with basic bathroom habits. What should people be doing with regard to using the bathroom, sitting on the toilet, etc., if they’re constipated? 

Carmen Fong, MD:    

Yeah, so everybody should be spending two to five minutes on the toilet, max. No more, like 10 minutes in the bathroom, 20 minutes in the bathroom, reading a book, scrolling through your phone. They actually used to say in the old days, like a generation older than me, keep your library out of the bathroom. And now I’m like, keep your phone out of the bathroom. I know plenty of my patients will be like, hey, that’s my 20 minutes of me time where I can play Sudoku, Candy Crush or whatever. I’m like, can you do it somewhere else? Do it on your porch or whatever. And I get it, right, like it’s where you can hide from your kids. But at the same time, the more minutes you spend in the bathroom, the more that pressure is causing swelling in your perineum and causing anal rectal problems like hemorrhoids, fissures and whatnot. So two to five minutes on the toilet, max.

The other issue that I commonly run into is itching, itching around the anus, pruritus ani, and this is usually caused by over-wiping, where people will be like, oh, I’m having all this itching. And so I’m using hemorrhoid wipes, witch hazel wipes, baby wipes and whatnot. Those actually tend to be a little more irritating on the skin, and so usually, to break that vicious itching, wiping, itching, wiping cycle, I tell people, stop everything, but use Vaseline or Aquaphor. Treat it  really gently like it’s a baby’s butt, like you wouldn’t be scrubbing it so much if it were a baby, so don’t do that to your own butt. 

Lindsey:  

Yeah or get a bidet thing.

Carmen Fong, MD:    

100% get the bidet. Christmas is in two weeks, and I’ve actually told a lot of my patients, get yourself a Christmas present. Get a bidet. That’s actually one of my 10 bowel commandments, “Bidet is the way”. In our country, we just do not use the bidet enough, I think. And it does take care of so many problems, and really does help with feeling clean afterwards. So you’re not avoiding the bathroom, because some people also have a little bit of poop avoidance and being like, I don’t want to go the bathroom because I want to pretend that I don’t poop.

Lindsey:  

Yeah, yeah. But if somebody is having a messy enough bowel movement to have to be wiping multiple times, then they’re also not having an optimal stool.

Carmen Fong, MD:

Agreed, yes, 100% and that’s where I’m like, I love talking about the perfect stool. There is a perfect stool that is achievable. And if it’s so messy that you’re wiping eight times, it’s too sticky, you’re having too much fat or whatever.

Lindsey:  

Yeah. What are the first line interventions for constipation, meaning the least potentially harmful and most potentially beneficial interventions?

Carmen Fong, MD:    

So the first things I would start with are always fiber and water. Rule of thumb, 25 to 35 grams of fiber, a good mix of both soluble and insoluble fiber a day, and then two to three liters of water. So fiber wise, this was one of the reason why I wrote this book, is that I felt that I was telling patients 25-30 times a day how much fiber to take and what kinds of fiber. And I realized that in medical school, we really don’t discuss what kind of fiber and how much fiber. You go to the ER with a hemorrhoid, and they’ll be like, eat more fiber. And they’re like, what does that mean? And then I found that soluble and insoluble fiber is really ideal.

So a good example is an apple, right? So an apple has both soluble and insoluble fiber. The soluble is in the flesh. It’s in the pectin, which forms the gel in your colon, and then you have the skin, which is the insoluble part, the roughage, that causes a little bit of colon irritation and makes things move through. So I really think an apple a day does keep the doctor away for the most part, or at least helps with your bowel movements. And then water wise, two to three liters, and they traditionally said about eight glasses a day, which is a lot for most people, but it’s going to be even more if you’re active, if you’re in a really warm climate, or if you’re pregnant, where you’re a circulating blood volume increases by about 40%.

Lindsey:  

So I actually read in your book that for women it was less. It was something like 6.67 or . . .

Carmen Fong, MD:

Correct, yes. So it’s slightly less for women. So if you’re on the smaller female side, you can be on that lower side of 2.2 liters. I would still say, when I’ve seen pregnant women in the office, they should be closer to three liters.

Lindsey:  

Yeah, drinking for two. 

Carmen Fong, MD:    

Exactly. 

Lindsey:  

Okay. And so for fiber you’re talking about through the diet, or you’re talking about supplemental fiber?

Carmen Fong, MD:

Yep. So mostly through the diet, and I would say having a good mix of good variety of fruits and vegetables is best. So if you can, apples and oatmeal for breakfast, and lunch, just some kind of a salad. I actually hate salads; that’s my secret. I really do not like salads, but I really like cooked vegetables, because I just think that you have to have so much lettuce for there to be an adequate amount of fiber.

Lindsey:  

Yeah, it’s like an entire bowl is like a gram or two.

Carmen Fong, MD:

Exactly. So Iceberg lettuce really does not provide the fiber that you think you’re getting. And so I’m like, if you have to do cooked spinach, cooked kale, cooked broccoli, green leafy vegetables are always better. And then my go to whenever I recommend to my patients is actually sweet potatoes. So again, a good mix of soluble and insoluble fibers. It’s easy to digest, relatively low in calories, and has a lot of vitamins with it. And it also provides that bulk that some people need, because if they’re otherwise dieting or eating, but only protein shakes throughout the day, you actually don’t have the bulk to form a good stool.

Lindsey:  

Yeah, I like to say beans, because those bang for your buck, you’re not going to get more fiber.

Carmen Fong, MD:    

You’re right. That is also true. So legumes, lentils are a great source. I just know that a lot of people shy away from beans.

Lindsey:  

Yeah, they do. And I was shying away from them for various reasons. I started eating a lot more lately, and I soak them overnight, stick them in my Instapot for five minutes. They’re done. They’re ready to go. Keep them in the fridge. Just throw them on salads, make a soup, eat them as a side dish, whatever. I just did it, and I can’t tell you how much this transformed my stool.

Carmen Fong, MD:    

100% like, I’ve had patients who are like, I just started eating lentils every day. And it does work.

Lindsey:  

Yeah.

Carmen Fong, MD:    

The other thing though, is that your body gets used to the gas. 

Lindsey:  

Oh yeah, there was no gas.

Carmen Fong, MD:    

Yeah. Or, if you have a little bloating, your body actually adapts to it.

Lindsey:  

Yeah, yeah, no, I had no gas at all when I started them, given that I was soaking them and doing it properly. 

Carmen Fong, MD:    

Yes, exactly, right. So you were already soaking off the starch, yeah.

Lindsey:  

What about exercise and movement, how that relates to constipation?

Carmen Fong, MD:    

Yeah, having some exercise is important. So I usually like the moderate activity level of 30 minutes three times a week is great. But what I do warn people, because I see this more and more, is that too much exercise can actually cause a little constipation, because you’re stimulating a fight or flight response in the body. So basically, it’s a sympathetic response being like, hey, there’s a line. You have to run away. And so when all the when all your blood flow is being diverted towards your muscles and you’re trying to run away, it’s not doing the rest and digest that your stomach needs. So moderate exercise is good, but too little exercise, and you’re too sedentary, and you’re not simulating that GI motility that your body needs. And actually gravity helps too and then too much exercise is bad. So everything in moderation, including moderation.

Lindsey:  

I’m a personal fan of just moving around the house, doing the basic things like cooking and doing dishes. I don’t regret the time I spend doing those things, because that’s time that I’m not sitting on my butt.

Carmen Fong, MD:    

Yeah, I love that. And it’s just me playing with the kids or being outside doing yard work, and even just taking a walk is totally enough. I’m not saying you have to go run five miles every day.

Lindsey:  

Yeah. So if somebody just can’t seem to manage to get the fiber from their diet, are there supplemental fibers you like?

Carmen Fong, MD:

Yeah, I actually have a few that I like. And brand wise, there’s actually Coloflax*, which is a great one. It’s actually a flax seed supplement, but it has both soluble and insoluble fibers. Otherwise, most of the over-the-counter ones that you can get are fine. I think it’s just important to make a distinction. Or like, when you’re looking at the label, Metamucil tends to be psyllium husk, Benefiber tends to be wheat dextrin, and so if one of them doesn’t work for you, switch to a different one, or try one that has a combination of fibers. 

Lindsey:  

Yeah, I like to send people to just plain psyllium husk, because Metamucil has additives, it’s got food coloring and stuff you don’t really need. The psyllium husk is gross, but it’s probably gross in Metamucil too. 

Carmen Fong, MD:    

It is gross in Metamucil, most people don’t like mixing it in water and having it turn into a gel. So I’m like, if you’re going to do that [take it in less water or as a powder], just drink two glasses of water after it. I love flax seed and psyllium husk. So both ground flax seed and psyllium husk, on top of salads and smoothies, works really well. Again. I think it’s pretty good bang for your buck.

Lindsey:  

Yeah. And, of course, the flax, alpha linolenic acid. If you take enough of it, it’ll turn into your good omega threes, your EPA and your DHA. 

Carmen Fong, MD:    

The other one that I’ve heard is actually chia seeds, which is great, but having too much chia seeds can also be a problem. So I try to stay away from that. Because when you tell people one thing is good, they try to do a lot more of it.

Lindsey:  

When it comes to over-the-counter medications for constipation, which are the least harmful versus the most potentially harmful, or the ones you shouldn’t be using long term?

Carmen Fong, MD:    

Yeah, so this is always a good question. And technically, evidence wise, MiraLAX is the least harmful. It’s an osmotic laxative. So really, it just drawing water into your stool. In theory, you can take it long term without really negative effects. Obviously, people who have kidney problems, heart failure, should not be taking things that are osmotic laxatives, that are drawing too much water out of your body and causing electrolyte imbalances. But that’s the one that’s pretty safe. Senna is thought to be natural right? And so therefore it is considered to be pretty safe. It does work. But with Senna and Dulcolax, these are stimulant laxatives, and those do have an addictive potential, and so therefore those are ones that you would not want to use for long periods of time, generally, six months or more. If you’re using for the short term, once in a while, you’re like, on vacation, haven’t pooped in five days, and you really need something, sure. And in those cases, I would always try to do a suppository before you do something systemic, because you’re actually just stimulating from the rectum versus taking it from the top down, and who knows if it’ll even get down there.

Lindsey:  

Would the suppository be a stool softener? Or what would that be?

Carmen Fong, MD:

No so you can actually do either a glycerin suppository, which has both stimulating and lubricating effects, or Dulcolax comes in a suppository.

Lindsey:  

Ah okay.

Carmen Fong, MD:    

So you can actually have a stimulant laxative as a suppository. And then last but not least, you have magnesium oxide, or Milk of Magnesia. And in those cases, that is also very good as a laxative. It tends to be gentler on the stomach, but you would also not want to take those when you have electrolyte imbalances.

Lindsey:  

Okay, yeah. And what about magnesium citrate, using that longer-term.

Carmen Fong, MD:

Same, yep. So you wouldn’t want to do that with an electrolyte imbalance. But people who can’t tolerate MiraLAX, you can use a bottle of magnesium citrate, and it’ll clear you out. Now, that’s different when you’re taking the concentrated bottle, versus if you’re taking a supplement, if you’re taking Natural Calm* or something, that is okay. And actually, I love Natural Calm. I usually do recommend it. That’s the one I always recommend, too. I’ve been taking it since 2009 or something like that, when I first discovered it, and this was before I even did any poop or constipation work. And I’ve always loved it for sleep, for relaxation, and then for your bowel habits.

Lindsey:  

Yeah I find that people are very successful with that. And it’s funny, because I’m thinking, how did you not try anything like this? Like, this is everywhere. It’s all over the internet. How did you not hear about this?

Carmen Fong, MD:

Yeah, it’s really funny what people see and what people don’t see. Yeah, most of my patients have not heard of Natural Calm now that you mentioned it, yeah.

Lindsey:  

How do you feel about vitamin C or using a vitamin C flush in particular, if you’re totally backed up.

Carmen Fong, MD:

So I think that vitamin C has potential, because we know that it has antioxidants that will help with simulating the rectum. I just don’t love flushes in general. So either a total cleanse, or a high colonic, you’re going to be disrupting some anal rectal mucosa. You’re going to be causing some mild trauma or injury. And then the problem with long-term use of these things is that it disrupts the microbiome and so you might have more problems in the future with irritation, with having mucus production and things like that.

Lindsey:  

Yeah. So what does somebody do? If I’ve heard of clients who’ve said I went to the hospital and they said my entire colon is full, I’m just completely backed up. What do you do at that point?

Carmen Fong, MD:

Yeah. So say it’s that patient, it’s been like, nine days, you haven’t pooped, like, literally, on the X ray, it’s like, full of poop. And you I do a top-down approach, but then a top-down and bottom-up. So I would do MiraLAX from the top, provided they can tolerate it and they’re just not vomiting everything back up. And then I would do Dulcolax suppositories times two, and then an enema. So then you’re going to do a short, rectal enema, usually just tap water or saline, and then on more than one occasion, you might actually have to do some manual fecal disimpaction just to get that firmer ball of stool out to let everything else through.

Lindsey:  

Okay, so this is when you’re getting intervention with a medical professional?

Carmen Fong, MD:    

Exactly. Don’t disimpact yourself, please.

Lindsey:  

Are there any probiotics that you recommend to patients who are constipated? 

Carmen Fong, MD:    

So I actually love and, based on my research, this was one of the most exciting areas for me, was that there are certain strains that work better than others: Lactobacillus, Bifidobacterium, L. casei, L. rhamnosus. But it’s funny, because there wasn’t much research until after the book came out about Lactobacillus acidophilus, and it seems like that does work too. I usually recommend a good mix of strains as well. You don’t want a probiotic that’s just a few strains, and then you want more than 100 billion CFUs. The ones that I like are Physician’s Choice* or I use, I just take the Costco brand, trunature one, and lately I’ve actually really liked the brand by Seed*, which is created by Emeran Mayer, or he’s part of the board, and it has a coating that doesn’t get digested in the stomach and makes it to the colon.

Lindsey:  

Yeah, I take that one, DS-01. Yeah, I can’t take it at night, though. I tried; they say to take it at night, and I felt all gurgly and uncomfortable when I took it at night. So I just take one with a meal. They’re also kind of expensive, so I just take one a day. I don’t go for two.

Carmen Fong, MD:

They are expensive, and I think part of it is the branding. But I’m hoping that in the future, we’re going to have a lot more of these probiotic strains that are like, what do they call it now when they name the certain combination of strains, like DS-01, and then there’s one that’s like, GS-111 or something.

Lindsey:  

Patented ones. 

Carmen Fong, MD:    

Yeah, they’re patented combinations of strains. I feel like they probably shouldn’t do that, but, you know.

Lindsey:  

Yeah, yeah, it would certainly make research better if there were patented combinations. But of course, if you’ve got the patent, you don’t want to sell it to everybody else. You just want to keep it.

Carmen Fong, MD:    

Exactly but wider availability to the public.

Lindsey:  

Yeah, I don’t know if they can. I guess they can patent them . . . if they’re just a natural substance, I don’t think they can be patented. You can’t patent a bacteria because you didn’t create it. If you genetically modify it, then you could.

Carmen Fong, MD:

Right, and then if you patent the certain combination, is what they’re doing.

Lindsey:  

Although I do know that there’s definitely, maybe it’s a trademark. Yeah no, I think what they do is they trademark like PyloPass for H. pylori is trademarked, right, I think. But not patented.

Carmen Fong, MD:

That’s not patented, correct? Oh, interesting. Yeah. 

Lindsey:  

Anyway, so what about prescription medications for constipation? Which ones do you like the best?

Carmen Fong, MD:

Yeah, I would say I generally try to stay away from them as much as possible. But then when we do have to use them, either Lubiprostone or most of the time it’s actually Lubiprostone because Lubiprostone has a generic form, and so I would say that tends to work. Obviously, there’s a bunch of newer ones, and I just don’t think that they’ve really proven their value yet. 

Lindsey:  

What’s the brand name of Lubaprostin? 

Carmen Fong, MD:    

Lubiprostone is Amitizia, I think.

Lindsey:  

Oh, okay. I hear people mentioning IBSrella. 

Carmen Fong, MD:    

Ibsrella. I actually don’t even think I’ve heard of that one. 

Lindsey:  

Or maybe it’s IBSrella, I don’t know. 

Carmen Fong, MD:    

IBSrella. A lot of people take Linzess

Lindsey:  

Linzess, yeah, that one I’ve heard a lot about.

Carmen Fong, MD:    

Yeah, yeah. So a lot of people will come in and they’ll be like, oh, I had constipation for one day, and, you know, somebody threw me on Linzess. The problem with Linzess is that it does take a while to work, right? So it’s not like you could take it for one day and it starts working, and then once it starts working, it almost works like an osmotic laxative, draws all the stool in and then some draws all the water in too well, and then starts giving you diarrhea. So then you have to titrate the dose. So I wouldn’t say that it doesn’t work. It’s just that you have to titrate a little bit better. And then in some people, if you’re not drinking water, it still won’t work for you. 

Lindsey:  

So lots of people tell me they drink coffee, and that immediately stimulates a bowel movement, and often a loose one. Is coffee good for us in this respect?

Carmen Fong, MD:    

Yeah, yes. You know, that was the whole chapter in the book. And there’s technically no research that says coffee makes you poop. But there are certain compounds, the phenyls in coffee actually can simulate your GI tract motility. And there’s also the added effect of warm water stimulates better GI tract motility. And so I tell people, if coffee works for you and you drink one cup in the morning, or it’s a Pavlovian that you smell coffee and you immediately have to go the bathroom, then that’s great. But otherwise, if you’re drinking coffee, only coffee exclusively five times a day, and not drinking any water, it almost has, I call it a negative water effect. You’re minus one cup of water that day, because the caffeine is actually dehydrating you, and you actually need to drink more water to compensate for it. So bottom line is, I would say coffee is great. I love coffee, one cup a day, if you can. We use it for both the simulating effects and the warm water effects of going to the bathroom. But you can’t drink only coffee, and can’t drink only iced coffee. But people would be like, Oh, I only drink iced coffee all day. And I’m like, There’s no nutrition in that. What do you think about coffee? 

Lindsey:  

I don’t drink coffee, so it’s not an issue for me. I just never was a coffee drinker. I never liked the taste.

Carmen Fong, MD:

Yeah, no. And I love green tea. And honestly, I think green tea is very good for you.

Lindsey:  

And any number of illnesses, I’ll be like, oh, I wonder what supplements go with that. And I’ll look it up. And I’ll be like, oh, green tea. EGCg, yeah, so many good things. 

Carmen Fong, MD:    

Exactly, yeah. 

Lindsey:  

And I happen to have a cup of it every morning, so I’m like, yay for me. Okay, you mentioned that colonics and such might be bad for us. What about the colonoscopy prep? I always thought, I don’t want to get a colonoscopy because I’ve been working so hard on my microbiome, I don’t want to wash it all out. Is that dangerous to our microbiomes or do they recover?

Carmen Fong, MD:    

They do recover. I’ve seen where sometimes it takes almost six weeks to recover and you go back on probiotics if you were on them, or you start taking probiotics if you weren’t on them. It’s actually like a post colonoscopy prep syndrome that is starting to become more recognized. Because at first, people would be like, what are you talking about? You can’t poop after your colonoscopy, but that’s not a thing. First of all, you have the fact that you’ve been completely cleaned out, so you have no solid substance in your colon right? So if you can’t poop for two days afterwards, that’s totally normal. But then your body goes into this mode of being like, hey, we don’t know what we’re doing anymore. There’s nothing in here and all that regular microbiome is gone, been totally washed out. So I just usually tell people, resume your regular diet as soon as possible.

And if you can actually see if you can find a gastroenterologist or colorectal surgeon who does colonoscopies, allowing either soft foods or bland foods the day before, so you have some substance. There’s actually a brand called Happy Colon Foods. I don’t know if you’ve heard of it, but they actually make a bowel prep that’s gentler on the stomach. It’s mostly Senna based, so stimulant laxative, but they allow you to have crackers and then clear soup and stuff like that, things that are low fiber, so that it can be washed out slowly or completely, but that you can also have something in your colon, and it is gentler on the colon, on the intestinal tract.

Lindsey:   

Okay, good luck with that, with insurance and everything else, picking and choosing your doctor on the basis of the colonoscopy prep. But I love it in theory.

Carmen Fong, MD:    

Yeah no, when I talked to them, it was actually a huge thing. I was like, if insurance doesn’t cover it, nobody’s going to use it. I wish that insurance would cover these things, but I wish insurance would cover a lot of things. So that’s a whole different issue.

Lindsey:  

Yeah, so you might actually just disobey your doctor and go buy it on your own. Is it available over the counter?

Carmen Fong, MD:    

Yes, you can buy it online. I think it’s 38 bucks. You can buy it online. And then what you can actually do, though, is tell your doctor and say, hey, are you okay with this prep? This is the evidence for it. I would allow it 100%.

Lindsey:  

And what about using a colonoscopy prep if you’re totally backed up?

Carmen Fong, MD:    

Yes, you can do that. So polyethylene glycol actually is the same stuff that MiraLAX is made out of. It’s just that MiraLAX comes in 17 gram powder form and GoLYTELY, comes in four liters. So if you’re going to be drinking four liters of any fluid, you’re probably going to get cleaned out anyway. I would say, if you’re that backed up, you can try colonoscopy prep, but start with MiraLAX and just up the dose.

Lindsey:  

So I have a confession to make. I had a colonoscopy about a year ago. Didn’t finish the prep stuff. I just I was like, listen, it’s been pure liquid for the last eight hours. I’m not taking any more of this. This is absurd. Yeah, no, and that was fine. It was totally clean.

Carmen Fong, MD:    

Yeah, it’s really a lot. It’s actually a little bit of overkill. But when I was a fellow, I can’t tell you how many times people called me at 3 am being like, please, I cannot finish this prep. Like, I’m throwing it up, I’m pooping all over the place, and I’m like, It’s okay. Most of the time it’s going to be okay. Four liters is more than the amount you need, but they also make some better in divided doses now, like two bottles or something, and then you add some Gatorade in between. So there’s options, less torturous options.

Lindsey:  

I did not tend towards the constipated, so I knew I was going to be fine. And I was like, this is the end. I’m done with this.

Carmen Fong, MD:    

I wouldn’t think you were, that you tended toward constipated.

Lindsey:  

So, I saw you had a chapter about fecal incontinence in your book. Can you talk about why that may happen in someone who’s constipated,

Carmen Fong, MD:    

The most common reason is that you have overflow incontinence, and that means that if you’re backed up and you have a stool ball inside your colon, if you try to eat other things, drink a lot of liquid, do MiraLAX, the liquid stool will actually just flow around it and flow out of your anus. And so it seems like you’re incontinent because you have some mucus and stool leakage, but you’re really backed up. You can usually tell this by history, though, that people are saying, okay, I’m having some incontinence, but I’m also super bloated. I feel like I haven’t had a full bowel movement in days. It’s more likely going to be overflow incontinence, rather than true incontinence. The other things that would distinguish it would be on an intenal exam, when I’m feeling and your sphincter tone is completely fine and there’s no signs of damage or whatever.

Lindsey:  

Okay, so if you were having that and you weren’t constipated, then that would be the time to see a doctor and find out about your sphincter tone.

Carmen Fong, MD:    

Yes ma’am, yep, exactly. So, the most telling thing is if you sneeze and you end up having an accident and or you’re having accidents at night.

Lindsey:  

Okay? And what can one do about loose sphincter tone? 

Carmen Fong, MD:    

The first thing is actually add fiber, which is weird, right? But I always tell people that people think that you take fiber for constipation, but it firms up loose stool just as well as it softens hard stool. So start with a fiber supplement. Start drinking a lot of water, especially if you’re losing a lot of fluid, bulking up will work. And then we start going into the medications and stuff, which is like adding ammonia, adding to again, slow down the stool. But then after that, it’s a couple of things, pelvic floor physical therapy, usually, to assess the muscles and strengthen the muscles. If you see me in the office, I might do anal manometry, which is a test of a sphincter tone and the nerves around it, to see if there’s really any damage that can be repaired.

And then, in the old days, you either would have to do a sphincteroplasty, which tightens the sphincter and/or some other major surgery, but these days, we actually put in a sacral nerve modulator, an SNM or an SNS device, which stimulates the s3 s4 nerves and helps that muscle contract. It actually works really well. It’s shown to work about 92% of the time. It works better for people with incontinence than constipation, but there is some evidence that also works in constipation, and especially mixed constipation and incontinence.

Lindsey:  

So you mentioned mucus in the stool, and I know you know that excessive mucus coming out and often with blood, is very common in colitis. But what else could be causing it in people without IBD, and is a certain amount, like enough for the poop to slip out nicely, normal?

Carmen Fong, MD:    

Yep, exactly. So IBD, bloody ,mucusy stool is a sign of ulcerative colitis, but your body actually physiologically produces mucus in the rectum, and that’s what makes a stool slippery. That is also one of my other favorite chapters, which is how much mucus it takes to make your stool slip out. All mammals poop in 12 seconds because of this mucus layer in the rectum. So normal mucus is physiologic, is normal, but you shouldn’t be seeing a ton of it. When you see a ton of it, there’s usually one of two reasons. And the most common one, I think, is over wiping. And so when people try to wipe the inside of the anus, it actually stretches that mucosa out a little bit. It causes mucosal atrophy. And since that pink layer is on the outside, you actually see more mucus on the outside. And then the other thing is either using enemas or colonics, because you’re disrupting that mucus layer and literally ripping it off, and so you’re dripping mucus out.

Lindsey:  

Okay. And what about if somebody’s not done those things? Could it be just inflammation?

Carmen Fong, MD:    

It could just be inflammation. You can have a small amount of mucus if you’re sick too, if you have a viral illness and some inflammation in the colon.

Lindsey:  

And what about, so often people are using biofilm busters, is that something that causes mucus to come out?

Carmen Fong, MD:    

I think that biofilm busters tends to be, it really shouldn’t, but I think that if you are using it very frequently, then yes, because anything that disrupts that that microbiome layer in the rectum and anus.

Lindsey:  

Okay, so what causes hemorrhoids and anal fissures and how are they treated?

Carmen Fong, MD:    

Yeah. So hemorrhoids are free bundles of blood vessels that are in the human body. Everybody has them. Everybody’s born with them. When they become symptomatic is when we start to treat them, when they become a problem. So internal hemorrhoids are above the level of the sensory nerves or above the dentate line, which generally means that they tend to be painless bleeding, but they can do a couple things. They can prolapse, so they can pop out of the anus, and then they can bleed, and generally, again, painless, though.

External hemorrhoids are below the level of the dentate line, and so they tend to be more painful, but not bleeding, because they form a little blood clot on the outside, and it feels like a blueberry or a grape. So it can be extremely painful, but usually no bleeding. And then you can have fissures, which are somewhere in the middle, and these tend to be both pain and bleeding. Most of the time, people will come to see me and they think that they have hemorrhoids, but it’s really a fissure, right? Because pain prompts people to go see the doctor more than anything else. Things that make hemorrhoids worse: constipation, but also diarrhea. So constipation, because you’re straining, you’re sitting on the toilet. Any amount of intraabdominal pressure, or you’re putting more pressure on the perineum, will make those blood vessels engorge, to swell to the point where they might pop out and bleed. Diarrhea, because you’re going so often that it’s irritating the anal and rectal lining. Technically, it’s the anus. And then you’re wiping more often as well. So I’ve actually seen patients where they’ll be wiping often because of going to the bathroom seven or eight times a day. Sometimes people with IBS, they’re causing external hemorrhoid thrombosis, you’re tearing that skin in that blood vessel.

Fissures are the same thing, sitting for too often, more than two to five minutes on the toilet. But the one other thing that causes fissures, which is a little bit different, is actually stress. So young people, and actually, I think all people these days, we hold our stress in our pelvis. So literally, we walk around squeezing our butt so tight, and we don’t realize it, and when you’re squeezing that butt tight, it actually constricts the blood flow, so that if you do have a little cut or a tear in there, it can’t heal. So one of the primary treatments we do for that is actually apply a topical ointment that gently relaxes that internal sphincter, that smooth muscle, so that the overlying tissue over it can heal, yeah. So basically, everything that causes hemorrhoids and fissures are similar, except for the stress. So sitting too often, long plane rides, long car rides, sitting on the toilet.

Lindsey:  

Pregnancy for hemorrhoids. 

Carmen Fong, MD:    

Pregnancy! Yes, the gift that keeps on giving, pregnancy. Yes, for hemorrhoids.

Lindsey:  

So when should someone seek out the help of a pelvic floor therapist? Is that something they would be referred to always from a doctor? Or is that something they can do on their own?

Carmen Fong, MD:    

You can actually go on your own these days, if you feel like this is something you need. A lot of places I’ve talked to, you can just walk in and tell them the problem you’re having. I refer a lot to pelvic floor PT for a variety of reasons. It used to be mostly for fecal incontinence, because they can strengthen the muscle. But these days, it is for a lot of pelvic floor pain and anal fissures that are a chronic pelvic floor contraction, or levator ani problems. 

Lindsey:  

What’s that?

Carmen Fong, MD:    

Yeah, so levator ani syndrome is where you either feel pain in the butt when you’re having a bowel movement, or it hurts for hours afterwards. Classically, it’s always on the left butt cheek because there’s a little trigger point right there. It usually comes from sitting too often. So you’re just actually putting a lot of pressure on this muscle, and the muscle is just continuously contracted. Things they can do to help that at pelvic floor physical therapy are leg stretches, hip stretches, back stretches, but then also some internal massage, some biofeedback, which is where they put a either like a balloon sensation, like a little probe inside to say, hey, you should breathe like this, and when you relax, you’re expanding your intra-abdominal cavity and relieving the pressure on your pelvis.

The other thing it does is actually retrain your brain how to go to the bathroom. When you go, some people will have what’s called a paradoxical contraction, where, over time, we were talking about poop shaming before, you actually just hold your muscle in so tight that it forgets how to relax. And so even when you go to the bathroom, most people, their anal canal and their anus should open when you go to the bathroom. Some people, when they try to push, it actually closes, so retraining your brain to open that when you go to the bathroom. Yeah, that’s actually one of the main things I send for.

Lindsey:  

Okay, so when should someone be concerned that their constipation could be indicative of something more serious, like cancer?

Carmen Fong, MD:    

Yeah, it has to be a constellation of symptoms. And I would say that constipation, in and of itself, is not a great symptom. But if it’s been chronic, if it’s been over like three to six months or so, I would say, definitely get a colonoscopy. If you have other concerning symptoms, like obstipation where you’re not farting at all, that tends to be a pretty late stage tumor where it’s completely obstructing, then go to the ER. Do not pass go. Do not collect $200. But the other thing, if you weren’t completely obstipated, would be blood in the stool. 

Lindsey:  

If you weren’t completely what?

Carmen Fong, MD:    

Obstipated, so not passing gas either. 

Lindsey:  

Okay.

Carmen Fong, MD:    

Yeah, yeah. If you’re not passing stool and gas, go directly to the ER, but if you are passing stools, passing some gas, but still chronically constipated, if you have blood in the stool, unintentional weight loss or a strong personal or family history, then I would seek some earlier medical attention and say, get a colonoscopy.

Lindsey:  

Yeah, and constipation is, in and of itself, a risk factor for cancer, right? Not just colon, but other cancers.

Carmen Fong, MD:    

It’s funny, because it is a sign of inflammation, right? And does cause some colonic irritation. As far as I know, there’s no direct link to colon cancer, but I think that’s going to change. We know that there’s a two-hit hypothesis for colon cancer, which is that you have to have the genetic predisposition and then a second factor, and if constipation and chronic irritation is a second factor, you have a good chance. I think our society’s diet and exercise does not help our cause at all.

Lindsey:  

Yeah, no, I thought that it was a risk factor for breast cancer, because you just have these toxins sitting there and not getting out of the body.

Carmen Fong, MD:    

Correct, yes, for breast cancer, it is. It’s not a direct risk factor for colon cancer, though. 

Lindsey:  

Okay.

Carmen Fong, MD:    

Yeah, yeah. I know I’ve looked and looked because I really thought it would be and there’s no evidence for it. 

Lindsey:  

Okay, they changed the age that you’re recommended to do a colonoscopy to 45 didn’t they?

Carmen Fong, MD:    

Yes, they did. Yep, it’s 45 now.

Lindsey:  

What was that about?

Carmen Fong, MD:    

So this was about, I think it was two or three years ago. Now, remember, it was just after COVID. It’s been about three years. It’s changed to 45 from 50. So it’s 45 if you have no other risk factors. So 45 is when you start screening and getting a screening colonoscopy. If you have any family history of cancer, colon cancer, it’s going to be 10 years before the youngest age of diagnosis in a first-degree family member, which means that if your mom was diagnosed with cancer at the age of 45, you would go get screened at 35.

Lindsey:  

Okay, and given you only get screened every 10 years, right, is it that it’s just super slow growing, or why so infrequently?

Carmen Fong, MD:    

Correct. It used to be that we have our adenoma hypothesis, which is that these polyps turn into cancer, and so by the time it’s 10 years, you could conceivably catch it again. I think a lot of it is changing, though, in clinical practice. Most providers will do every five years even, because we’re finding a lot more young people with colon cancer. So actually, it’s been in the headlines lately that people younger than age 45 are getting diagnosed. They’re the fastest growing population of people with colon cancer in the country. Again, I think diet and exercise and calcium and vitamin D levels, but the other things I should add are, generally, if you have any polyps on a previous colonoscopy, you’re going to be three years before follow up screening, if you have three polyps. Five years for one or less polyps, and then usually between 5 and 10 years if you have a history of IBD. So 8 to 10 years of IBD is a high risk factor for developing colonic dysplasia.

Lindsey:  

Okay, yeah, as I said, I didn’t really want to do the colonoscopy, so I did the Cologuard first, because I thought, I’ve never really been regularly constipated, so maybe just get away with this. And then I thought, okay, Lindsey, suck it up. You’re a gut health specialist. Just get your colonoscopy.

Carmen Fong, MD:    

Was your Cologuard negative?

Lindsey:  

Yeah, the Cologuard was negative, but I waited three years, and then I did the colonoscopy. 

Carmen Fong, MD:    

Ah, okay, okay, yeah, I think that when you have low risk, Cologuard is totally fine as a screening test. Again, 92% sensitive, right? So it’s really not bad. It’s just that if you do have a positive Cologuard, you end up having to get a colonoscopy anyway.

Lindsey:  

Yeah, but a poop sample. This is not a big intervention. That’s not a big ask. I’m not like, oh, I ruined that whole thing by getting the Cologuard. 

Carmen Fong, MD:    

I know, you know, what’s funny, though, is that I have sent Cologuards, and patients will be like, I do not want to put a poop sample on a card. And I’ve had patients who left it. They’re like, oh, it’s on the kitchen counter. It’s been there for nine months. And I’m just like, can you please do it and send it in? Whereas, if I schedule a colonoscopy, you have to come in on this date and do a prep, they will come in and do it because there’s a deadline. Maybe I have to put a deadline on the Cologuards.

Lindsey:  

Yeah, yeah. This will explode if you do not use it by this date.

Carmen Fong, MD:    

Correct, yeah. They should put that on the box.

Lindsey:  

Yeah, that’s true. No, my own husband, said he went through the Cologuard process, and he’d rather just do the colonoscopy the next time.

Carmen Fong, MD:

See? Yeah, people are like, I don’t want to put poop on my card. 

Lindsey:  

Yeah.

Carmen Fong, MD:    

In Europe, in the UK, they’re actually starting to screen a little bit sooner, which I think is totally necessary. There was one study where they tried to screen kids who are 25 to 35 with just the stool-based immunohistochemistry testing, FIT tests. So again, like a little bit of a poop on a card, where if it’s a positive, then you get a colonoscopy, and if it’s negative, then you can continue on for a few years. And then scope or do the test again later. But at least it’s a low-cost intervention, and we’re screening earlier because of these earlier incidences of cancer; I think we need to go to that.

Lindsey:  

Yeah, yeah. Certainly no reason we should be getting colon cancer these days. I wish I could say that about any kind of cancer, but at least we have some interventions that aren’t too hard for diagnosing colon cancer compared to some of the others.

Carmen Fong, MD:    

Agreed. Yeah, yeah, 100%.

Lindsey:  

So anything else you would like to share with my audience before we go?

Carmen Fong, MD:    

Yeah, I think because this is called the Perfect Stool podcast, I’ve been thinking about it a lot; the perfect stool is achievable. I think that a little bit of tinkering, a little bit of knowing your body, but generally the ideal stool actually, you go to the bathroom two to five minutes, it’s out. It’s not sticky, it’s not too wet. You don’t have to wipe 18 times. It’s not too hard and irritating, and it comes from a good diet of fiber, soluble and insoluble fibers, water and generally, some probiotics. And once you get to that point, I actually am a firm believer that your body will go on autopilot and will be like, okay, most of the time. Like you have one hiccup now and then, but it’s much easier to get back on track when you’re doing good, and it has to do with the microbiome. And then last, but not least, my one bowel commandment is go when you have to go and don’t go when you don’t have to go.

Lindsey:  

Okay, great. And your book, I will just do quick show. I’ve got mine here, Constipation Nation.*

Carmen Fong, MD:    

Did you like it? 

Lindsey:  

Yeah, yeah. It’s been great. I’m about halfway through, I have to confess, but I did start paging through to get the questions ready, because I have a book club that’s been taking up my reading time. So I don’t have much time for work related reading.

Carmen Fong, MD:    

I totally get it. I think it’s actually been doing pretty well on Amazon, but the only person I know who finished it is my dad. And actually, one of my patients told me she read the whole thing the other day because she was asking me really specific questions about my wife being pregnant. I was like, wait, how do you know that? And she was like, it’s in your book. And I was like, what?

Lindsey:  

Yeah, that is unusual, because most people don’t know anything personal about their doctors.

Carmen Fong, MD:    

Oh, I know it is weird, but also, I knew this going into it, that my patients will be like, oh, the book, it just sounds just like the way you talk, and that’s how I wanted it to be. 

Lindsey:  

Yeah. 

Carmen Fong, MD:    

Yeah. Well, thank you so much for having me.

Lindsey:  

Yeah. Thank you so much for being here. I really appreciate you sharing your knowledge. 

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.

Schedule a breakthrough session now

*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.

The Order of Healing: A Root-Cause Reset for Whole-Body Wellness with Juanique Grover

The Order of Healing: A Root-Cause Reset for Whole-Body Wellness with Juanique Grover

Adapted from episode 143 of The Perfect Stool podcast edited for readability Juanique Grover, founder and owner of Provo Health Clinic in Provo, Utah, host of the Gutsy Health Podcast and owner of Gutsy Health Academy.

Lindsey:  

So one of the things we talked about in our pre-interview call was about how you came to be involved in functional medicine and found your own clinic in Provo, Utah. So, can you share about that for my listeners? 

Juanique Grover:  

I definitely can, just so listeners know I am not a doctor at all. I am actually a college dropout. And how I formed a clinic, it’s a long story, but I’ll try to shorten it. My history is I grew up in South Africa, and my mom, she was a practitioner of complementary medicine, which is like a homeopath, and we immigrated to the United States. So natural healing is in my blood, it’s in my bones, right? Like I watched my mom teach many students how to be practitioners of complementary medicine, and she was always using essential oils and herbs and supplements and whole foods and whatnot. So that was just a part of my life.

And so my story is, I got Grave’s disease with my first child, and the doctor was like, “you have to be on all these medications”. And I was like, “wait a second, give me like six months, and I’ll reverse this”. And I had one doctor laugh in my face. He was like, “that will never happen. You can never reverse Grave’s disease.” And I was still young and very naive. And I was like, “of course you can” right? Like, I’ve seen people heal from things all the time because of my mom’s history. So truly, in six months, I reversed my Grave’s and got back to normal again.

But a year after that, after my Grave’s healing story, my husband was diagnosed with stage four colon cancer. He was 33 years old. I was pregnant with my second child. I was 20 weeks pregnant, 21 weeks pregnant, and for people that have had a diagnosis like that, especially at such a young age, it is such a shock to your body, your soul, your heart, your nervous system. You’re absolutely wrecked because you did not see this coming, and there were no symptoms other than he had a difficult time pooping. Turns out he had a giant tumor blocking his rectum, and so that’s why he had a difficult time pooping. But health-wise, he seemed fine, normal.

So we did the mainstream route, even with everything that we knew, we were so scared. He had four surgeries in a year. He did 40 rounds of radiation on the tumor. He had an ileostomy bag, so he had an ileostomy and an ileostomy reversal surgery. He did chemotherapy, but he only did six rounds, because it was creating severe neuropathy, and so he stopped halfway through. And after all of this work and all of this mainstream medicine, a year later, we find out that it’s not working, that his cancer is spreading to his lungs. And it was stage four all this time, because they were hoping it was only stage three, and the spots in his lungs were just nothing, but it turns out the spots started to grow. And so they’re like “so you get to do chemotherapy for the rest of your life. You don’t have a lot of time. Sign the papers, sign your life away.” And my husband was about to sign this paperwork when I was like, hold the phone. I was like, let’s go home and talk about this, like there are other options. And that’s when my brain turned on, and I was like, “let’s go,” like, “they’re giving you this horrible death sentence of chemo for the rest of your life until you die, that will, for sure, kill you, there are other options.”

And so we started to research other options. And as I’m diving in my research and literally days and hours of research, I’m looking at these clinics outside of the country, and I’m seeing what the common denominators are, and I’m seeing hyperbaric and research around hyperbaric keep popping up, hard shell hyperbaric, the real kind, not soft shell kind. And we’re looking at ozone therapies, and we’re looking at nutrition and herbs and supplements. And I was like, I think we need to buy you a hyperbaric chamber. And then he’s doing research, and he’s like, maybe we should buy this ozone sauna. And then we start doing supplements and CBD, and we’re buying all of these things. We’re like, why don’t we just create this tiny little clinic for other people with your diagnosis to utilize these therapies for a very affordable price? So that way we get to service the community, and we get to create a community. So we did. We had this little hole in the wall where we had our little hyperbaric chamber, and our ozone sauna, and one hyperbaric chamber turned into two. And then we started doing blood work. And we started doing – once you own a clinic, all the companies open up to you, right? They’re like, oh yeah, come to our training. Come to our seminar, come to this and I didn’t have any credentials, mind you, like my husband, he had a PhD in psychology, or he was finishing up his dissertation, he was six months away from finishing his dissertation to get his PhD. So they took him on his credentials and his master’s degree, and I just tagged along. So I was not self-taught, because I obviously went to all these trainings, but pretty much self-taught.

And so we created this incredible clinic, and my husband, I started a podcast with him, because he was such a genius, like Tristan Roni was probably one of the most brilliant people in every room that I entered. He was so intelligent, maybe borderline spectrum intelligent, like he just understood – he was a walking, talking encyclopedia. He was AI before AI was actually a thing. You could pick his brain about anything, and he had the answer for you. Like he was this beautiful human with this beautiful mind. And so we started this podcast where we’re learning all these cool things. People need to know it, right? So we just started a podcast to service people, and it grew. It became a top 10 podcast within six months. It was insane. And again, not a lot of people had podcasts back then. 

Lindsey:  

What was it called? 

Juanique Grover:  

The Gutsy Health Podcast, the one that you were on. 

Lindsey:  

It’s the same name, okay, 

Juanique Grover:  

Yeah, so it’s the Gutsy Health Podcast. And so, long story short, that’s how we started a clinic. Truly we fell into it, and it just grew and grew, and people just really resonated with the story of these people, me and my husband, fighting for autonomy over our bodies, like self-empowerment, healing on all levels. Unfortunately, Tristan didn’t live. He died, but he lived a lot longer than they were expecting, and he had quality, and that’s the thing, he had quality. And so we had this beautiful life together. We lived 10 lifetimes in the five years that he survived his cancer.

And so that’s how, I told you, it was a long story, and I’m sorry but, I just want people to realize, your limitation on how you can learn and grow and heal yourself doesn’t begin and end with your doctor, and it doesn’t begin and end with someone with credentials. You have everything at the tip of your fingers. You can access any course, any information to learn how to heal yourself, because hundreds, if not thousands, or hundreds of thousands of people have done it before you, and they’re not doctors, and they’re not MDs; they’re just people like you and me. So I love the story and the origin story of Provo Health, because really, anyone can do wonderful, miraculous things, right? Again, college dropout here, and yet I started, miraculously, one of the largest clinics in Utah, and it’s still going strong. And now we have a doctor on site. We have a nurse practitioner, five coaches, and it’s fun. It’s a fun journey.

Lindsey:  

That’s amazing. And when you started the podcast Gutsy Health, were you talking about the gut, or was it just “gutsy” as in courageous?

Juanique Grover:  

Gutsy as in courageous, although we did specialize in digestive health, so it was like a double entendre. Get gutsy about your health, and also, let’s talk about gut health, but we spoke about thyroid and hormones and cancer and treatment; we spoke about everything and anything, and we still do.

Lindsey:  

Yeah, yeah, that’s amazing. So your Grave’s disease, how did you reverse that? And did you have gut issues along with that?

Juanique Grover:  

So my Grave’s disease, what I did, I don’t think I had gut issues. I had nervous system dysregulation. I wasn’t sleeping, I wasn’t eating a nutrient dense diet. And so really, when I learned that I had Grave’s disease, I read this book, I can’t remember the title, but it was all about hyperthyroidism and Grave’s disease, and so it was my Bible for six months. And I was like, cut out gluten, done. Cut out dairy, fine. Take these supplements, okay. So I really just decreased my inflammation. I prioritized rest and sleep and doing less. Because I was like this type A personality, and so I was like, oh, I can’t keep going.

What’s interesting is, when you have Grave’s, you actually don’t sleep. You have energy for days, your heart rate is like 120 to 148 beats per minute, and you feel like Superman, right? You’re like, I can do everything. So I was going 10,000 miles an hour, and I realized, oh, I can’t, because I’m actually getting weaker and sicker. So instead of it being like, this is my superpower, I was like, oh, this is going to kill me. So I forced myself to slow down. And then again, nourishing my body, trying to regulate my nervous system. Doing less is really what it took. And this is one thing that I don’t talk about a lot, but I one million percent believe that I was going to do it. And so I did, right? There were no messages given to me as a child of, oh, the body’s just designed to break down. From young I was taught the body heals itself. The body can do miraculous things when you give it the right food. And so that was my course, and that was my belief system. And I was like, let’s go, let’s just reverse this the way other people do. So I feel like that was a little bit of a superpower, right there. I was like, I didn’t get caught up in the naysayers that were like, oh, you will never do that. I one million percent believed I was going to reverse it.

Lindsey:  

Yeah, that’s funny, because I have very similar story with Hashimoto’s. I thought the same thing, and I’m not sure why I had that thought, but I guess I’ve always thought that there was certainly power in nutrition, but I hadn’t been deep into the functional medicine community but had dabbled in like reading about FMT and those kind of things. I was thinking that it was going to be my salvation, but did not turn out to be my salvation in particular, but in any case, yeah, I also found a book and just healed myself.

Juanique Grover:  

You’re like, yeah, here’s the path, let’s go. It’s funny because my nurse practitioner, when I came back, she’s like, oh, you’re fine. She’s like, you should write a book. I’m like, no, there’s books already written. I’m not going to reinvent the wheel. They exist. Just go read them.

Lindsey:  

Exactly. So I understand you’ve got a particular order of healing that you follow when working with people. Can you share about that and how you developed it?

Juanique Grover:  

Yes, so after all these years of researching and podcasting really brilliant minds, it truly just hit me like overnight. It was like everything- you know how in your head, you just keep thinking about things, and it just, it was almost like presented to me after one night, maybe in a dream, I don’t know, but I started writing down this order of healing, not fully understanding all that it meant, and I wrote it down, and then I just started researching every little bit. And I was like, this all makes so much sense. And so ever since writing down this order of healing, I’ve created an entire course teaching people the order of healing, because I was realizing that people were getting lost in the details. And they’re like, well, I have hormones, and I have this and but I’m starting at my hormones. I’m like, no, no, there’s an upstream process. And if you start upstream, everything else becomes easier.

And so the order of healing, I feel like it was just given to me. And so what it is number one is mindset. The reason why mindset is number one is because if you are in sympathetic dominance, you’re stressed all the time, your brain is going to sabotage any kind of healing modality or supplement you ever try to put in your body, right? So, this is the person that has two steps forward, two steps back, two steps forward, two steps back. They’re jumping around from doctor to doctor to doctor, doing all the things right, and I put that in air quotes, right, like they’re doing everything right, but nothing is working for them, and they’re spending tens, if not hundreds of thousands of dollars in treatments, and they’re still stuck, and that’s because you’re doing all the right things, but your brain is literally in a sympathetic dominant response, which is going to signal every single cell in your body to shut down and hibernate and be in this inflammatory state where it’s not producing ATP and your mitochondria are not working optimally, and that’s a problem long term, right? And so if you can, one, get your brain on board to signal every single cell in your body to be in a healing response, to not feel endangered, to not go into hibernation. Then when you do the treatments, when you do the supplements, when you do the cell care exercises, everything actually starts to work. And so it’s not two steps forward, two steps back, it’s two steps forward, two steps forward, two steps forward. But again, you have to get your mind on board for that.

Now, mindset is way more complex, because there’s limiting belief systems and their subconscious patterns. And so I want to share, can I share an example of mindset? I had a dad come in. He has young children, and his wife sent him in to come see me last week, and he’s a workaholic, and he’s always so stressed, and he’s always in fight or flight all the time, and he doesn’t sleep well. And I was looking at his blood work and he’s pre-diabetic, metabolic syndrome, even though he eats well and he has curbside appeal, he looks great on the outside, but his metabolism is slowing down, and his hormones are getting more messed up, and so on and so forth. And so I was talking to him about how he can eat better, and he’s like, yeah, I don’t know why I self-sabotage though, and I don’t know why I start going to the gym to take care of myself, but I always end up just working like a workaholic. And I was like, well, who was it, was it your mom or your dad that taught you that to love your family is to be a workaholic? And he was like, whoa. No one’s ever asked me that. And he took a second, and he was like, my dad was a workaholic, and that’s how he showed up in love for us, and I’m like, so that’s your work, right? It doesn’t matter what I tell you and how to live your life, that subconscious belief pattern is going to hijack everything that you try to do. So you have to work on that belief system that I work myself to the bone, because that’s how I love my family and so healing and mindset and turning the brain into a different machine to work for you sometimes takes looking back at your patterns and looking back at what beliefs were given to you that you are unconscious of, and re-patterning your brain to do the opposite.

And that can take months, if not years, because we’re creatures of habit, and we are in a habit of acting a certain way, because that’s what our parents did, or that’s what someone we looked up to did, or a spouse or a sibling. And so that’s why mindset is key in any healing journey, because it will sabotage any efforts you do if you do not get your mind and your nervous system on board with your healing. So mindset is number one. Did you want to add anything to that before we move on?

Lindsey:  

I did want to throw in a few comments. That was amazing insight that it’s at the top of it, because I often will be working with people and we’re just knocking off the physical stuff. I’m like, okay, we’ve done so many rounds of antimicrobials. You’re now sleeping better, you’re exercising, like everything, your diet’s in place, etc., but you’re still not getting better. And I’m just like, I think it’s the fact that you’re under constant stress, and often it’s the nature of the person, like that is just the kind of personality they have. Then that’s when I start to say, okay, look at these other programs, or look at the Gupta program, or look at hypnotherapy, or look at Trauma Informed Counseling of some kind, because you may have some work to do there that I’m not going to be able to do with you.

Juanique Grover:  

You’re 100% right. That’s why we do Neurofeedback at our clinic. We’re bringing in something called Gamma Core, which helps to tone your vagus nerve so people with gut issues, people with migraines, people with nervous system dysregulation, every time they come in for a treatment, they’re going to do Gamma Core to help relax their nervous system.

Lindsey:  

Tell me about that, what is that? 

Juanique Grover:  

So Gamma Core, it’s an FDA-approved device that you just put it here on your neck by your vagus nerve, and it’s supposed to calm it down. So it works similarly but different to neurofeedback, whereas neurofeedback works on the brainwave activity in your brain to either calm down overactive responses in your brain or wake up underactive responses in your brain, to bring you back to parasympathetic states and calm and neutrality. Again, it’s all about working with the brain, working with the nervous system to be calm so that when you are embarking on your healing treatments and protocols, you’re getting the biggest bang for your buck, because now your nervous system is on board and your brain is on board.

The thing about our fast-paced system, and our American culture, is just it’s go, go, go. We glorify the people that are the workaholics and the high achievers, and we really don’t know that’s embedded in all of our nervous systems. I remember, because I was that person until I got seriously ill after my husband died, which I haven’t spoken about. But my illness forced me to slow down, and when I was slowing down, I judged myself so much because my value was based so much on productivity and showing up and creating courses and running myself ragged, even months after my husband died. And so, yeah, of course my body broke because I was under so much stress, and I still had this A-type personality, but there was so much judgment with having to slow down. And so a lot of people that are like, oh yeah, I’m not a stressed person, give me 30 minutes in a room with them, and I will figure it out. I’ll be like, oh, you 100% are. You’re just used to going 100 miles an hour, and you call 100 miles an hour baseline, right? And it’s actually not baseline. Our common culture of fast-pacedness is actually not healthy. There’s a reason why the entire nation is embarking on a mental health crisis right now.

I saw this Instagram post where someone was asking, if you are watching true crime investigations and Law and Order before bed to calm your nervous system, you need to ask yourself why violence is relaxing to you, and it’s so true, right? Like we watch politics and we watch the news and we get all riled up, but it’s creating violence in our mind, but our nervous system can’t tell the difference, right? So we’re watching intense movies and we’re listening to intense music and we’re listening to intense news, and we’re like, this is normal. This is fine. I’m fine. But yet our nervous systems are wrecked. That’s why we’re so sick. That’s why your gut is wrecked. That’s why you’re not healing, even after all the antimicrobials. Because we’re so used to the analogy of a frog in a pot of boiling water. Do you know that analogy? If you put a frog in boiling water, it’ll jump out. But if you put a frog in a pot of water and slowly turn up the heat, you’ll eventually boil them to death, because they just get used to the heat, and they don’t think, oh, this is bad for me. This is wrong for me. It just stays there until they’re boiled to death. And that’s us. We’re so used to this increase in violent news and violent media and violent TV shows that it’s just that we’re used to the hot, boiling water and it’s destroying us. 

Lindsey:  

I’ve never described myself as a type A personality, but I’ve always been a perfectionist, and it was only my health coaching course that really taught me about ‘don’t let the perfect be the enemy of the good’, and being able to do that, especially when you’re running a small business. If the newsletter slips by with a typo, who cares? The vast majority of people don’t even read the words on the newsletter, and only the crazy perfectionists like me will even notice. 

Juanique Grover:  

It’s wonderful that you can recognize that. And again, you don’t know what you don’t know and you can’t see what you can’t see. And so if someone has health issues and they’re like, I’m not stressed, they’re probably stressed and they can’t see it.

Lindsey:  

Yeah. So what’s the next step in order healing?

Juanique Grover:  

So, next is mitochondria. Everyone should know what the mitochondria is, but they don’t. It’s ignored. It’s like the middle child, the red-headed, middle child that gets ignored and it has to fend for itself. Mitochondria are the powerhouses in the cells that give the cells energy, like ATP. And what people don’t realize is that your mitochondria are actually, as powerful as they are, they’re actually extremely sensitive. So if you are exposed to heavy metals and chemicals and EMFs and radiation and parasites, you are going to have this wear and tear and damage on your mitochondria. But not only that, if you’re not eating a nutrient-dense diet, if you’re not eating antioxidants or getting your high doses of B vitamins that are methylated, your mitochondria cannot make ATP.

One other thing about mitochondria is that artificial lighting truly damages mitochondria, whereas red light and infrared helps to restore mitochondrial function and helps them to produce ATP, which is why red light therapy is such a hot topic right now. And the reason why you want functioning mitochondria, the reason why you want healthy mitochondria, is because if you want your body to heal, it’s going to take an enormous amount of energy to do that, and so you want mitochondria that are pumping out a ton of ATP so it can fuel your cells to replicate or replenish or heal whatever damage or inflammation is in your body. So pretend someone gives you a toy that requires batteries, but you didn’t put the batteries in. Now you have this toy that doesn’t do anything, and it’s useless, right? So you want to put the batteries in the toy so that the toy can do its job and make music or whatever it is the toy does.

So that’s the mitochondria. We want to make sure that our mitochondria are turned on, and they’re functioning, and we’re protecting them so that they are doing their job and they’re fueling your cells with tons and tons of energy. Healing can’t happen if you don’t have ATP. Cellular function doesn’t happen unless you have ATP. And the thing that provides the ATP is the mitochondria. People are like, what supplements should I take? And I’m like, hold on, let’s not jump to supplements. What about just waking up and going for a walk and watching the sunrise and then walking and watching the sunset? That can help boost your mitochondrial function. Switching off your Wi Fi at night, not plugging in your cell phone next to you, that can help with mitochondrial function. Stress damages mitochondrial function, again, telling us why mindset is number one, right? Because, again, if you are trying all these healing modalities, but you’re stressed out and you have high adrenaline and high cortisol, that’s going to damage your mitochondria. And guess what? You’re not going to make energy to heal your body. You’re not going to make energy to help with hormone production and synthesis. You’re not going to produce enough energy to help your liver detoxify all the toxins and heavy metals and gunk that your body’s trying to filter out. Right? So mitochondria is so important, and that’s why it’s number two, because you can’t do anything without energy. Period. It’s like trying to go on a shopping spree, but you have no money. Did you want to add anything to that?

Lindsey:  

Only the question of, how are you determining that mitochondria aren’t working well? And what kinds of things are you testing for, to see if it’s toxins or mycotoxins, heavy metals, etc.

Juanique Grover:  

So there are certain tests that are pretty expensive that you can do to see the efficiency of your mitochondria, but signs and symptoms of poor mitochondrial health is you have brain fog. You have a full night’s sleep, but you wake up and you’re exhausted, right? You have neurological issues and twitches and tremors and like just numbness and tingling. Those are signs of mitochondrial dysfunction. You’re wired, but tired all the time. I know it sounds a lot like adrenals, but a lot of this actually, it has to do with mitochondria. You don’t heal quickly or efficiently, so you get bruised, but it takes forever for that to heal. General fatigue. Brain fog is a huge determining factor of mitochondrial function. So brain fog, muscle weakness, neurological issues, problems detoxifying. So, you’re sensitive to chemicals and whatnot, and here’s why that is. So what’s really cool is, we think that our muscles have a huge amount of the mitochondria in our muscle cells, right? But your brain and your liver have almost the same amount of mitochondria in them as all of the muscles in your body.

So let’s say you have 120 pounds of muscle, right? And it has it houses about 30% of your mitochondria. Well, your five-pound brain has the exact same amount of mitochondria in it. Your seven-pound liver has the almost the exact same amount of mitochondria in it, because that’s how hard they are working. They’re working as hard as your muscles throughout your entire body, to keep you alive, to have you think, to have you process information, to help your liver detoxify chemicals and process all the vitamins and minerals and fats and everything that goes in your body. It has to be filtered through your liver, so your mind, your brain and your liver work an enormous amount. And that’s how we can see if your mitochondria isn’t working well, because you have all that brain fatigue and brain fog and you just can’t get out of bed. It feels like you’re moving through molasses because there’s not enough energy to power your brain on right? So it’s like a laggy computer. So if you feel like a laggy computer, chances are you probably have mitochondrial issues.

Lindsey:  

Okay, cool. So what’s the next one? 

Juanique Grover:  

So next is gut, which is probably your favorite and my favorite, right? So the gut is the root system to the tree. If you look at a tree and you look at the roots, you can tell the health of a tree by looking at the roots. The roots are thick and robust. They absorb all the vitamins and minerals in the water that really services the rest of the tree. If you have a root system of a tree that is rotting and dying, the tree is going to follow suit and die as well. So your gut is the root system to the rest of your body. It absorbs all the vitamins and the nutrients that your cells and your tissues need in order to heal and repair themselves. Your gut absorbs all the amino acids and fatty acids and vitamins and minerals that it needs to help detox your liver to help synthesize hormones, sex hormones, adrenaline, cortisol, thyroid hormone. Your gut absorbs all of that from your food and fuels everything. If your root system is inflamed, if your root system is leaky, if your root system is not healthy and not optimal, you’re going to feel really, really sick.

But not only that, your gut, your root system, it houses 80% of your immune system. So if your gut is inflamed and it’s leaky and it’s not happy and it’s not absorbing, chances are it’s very inhospitable for your bacteria as well. And now not only do you have an absorption issue, but do you have an immune response issue. So it’s like a double whammy. So this is why the gut is right after mitochondria. One, we have to have robust mitochondria in the lining of your intestines for your intestines to heal and repair themselves. Because what I think is really interesting is your skin cells turn over every thirty days, but your gut lining turns over every two to three days. So that’s an enormous amount of energy and an enormous amount of protein and vitamins and minerals for that high tissue turnover. So that’s why you have to have your mitochondria on point to fuel that tissue turnover in your gut, right? If your mitochondria are not optimal, you’re not having that turnover in your tissue, which means it’s starting to get inflamed, and it’s starting to get leaky, and it’s starting to have problems, and now it’s inhospitable to your bacteria. So now you have your bacterial issues, your absorption issues, and you’re just not a happy, healthy body period. You’re not absorbing your nutrients.

Let’s say you work hard every month. You work forty hours a week, and you get paid at the end of the month. You’re supposed to get ten grand, but they only give you five and you’re like, what? I got cheated, I worked really hard for my ten grand, and you’re only giving me five grand. That’s a gut that isn’t working optimally. We’re eating all this high nutrient-dense food, but you’re not absorbing it. So how many people eat nutrient-dense foods? Maybe they have some gut issues. So they’re cooking or steaming their food to help break down the fiber, and they’re eating these high nutrient-dense foods, lots of collagen, lots of bone broth, and they’re still nutrient depleted, and their blood work still shows low proteins, low vitamins, low minerals, low everything, right? That’s a gut system that is just not turning on. It’s not working, and it’s so important if you want to have a healthy liver, healthy sex hormones, healthy adrenals, you have to make sure your gut is working for you and not against you, that your mitochondria are turned on so that they can help fuel that tissue turnover and that your brain isn’t sabotaging your gut, because when you’re in sympathetic dominance, when you’re stressed out, that directly signals your gallbladder, your stomach, your hormones.

So your stomach is supposed to produce an X amount of hydrochloric acid to help break down and emulsify your foods. But if you are stressed, you decrease hydrochloric acid content, which means you’re not breaking down your food. So you want your $10,000 but you’re only getting $5,000 and so we want to get you in a regulated state, in a parasympathetic state, so that your gut not only heals itself, but it releases all of its enzymes and its hydrochloric acid for you to optimize on food digestion and nutrient absorption. So that’s why gut is number three, do you want to add anything to that? Because you’re a gut pro.

Lindsey:  

Well, I just want to add that I do a lot of testing on people about nutrient statuses, especially if I suspect there might be a nutrient deficiency. And inevitably, all of my clients have some nutrient deficiencies, be it iron or zinc or occasionally you even see copper, of course B vitamins, you see those, vitamin C, a whole slew, vitamin A, vitamin E, D. Everything. And, admittedly, I’d been supplementing my husband for a while on vitamins, but I tested all of his nutrients, and I was just like, unbelievably, you have virtually no nutrient deficiencies. I’m like, I guess that’s because your gut works well. 

Juanique Grover:  

His nervous system. 

Lindsey:  

Well, not his nervous system because his nervous system’s a mess, but his gut worked so he does have the nutrients on board. I’m like, I don’t know how, because he only eats two meals a day, and some of them aren’t too great. But I’m like, I guess if we have a functioning gut, it does the job.

Juanique Grover:  

It does the job. If it’s functioning and it’s healthy, it will do its job and it will absorb. 

Lindsey:  

And if you don’t have a functioning gut, it doesn’t do its job. Like if you were taking acid blocking medication, you’re going to be protein deficient because you don’t have what it takes to break up our protein.

Juanique Grover:  

100%, and I think PPIs (proton pump inhibitors) are the most prescribed medication in the United States. So as soon as you get a PPI, guess what, like you said, you’re not going to break down your protein. You’re going to be nutrient-depleted for eons, for decades. And what’s really scary is there are providers that don’t tell their patients that PPIs are a short-term drug. You shouldn’t take them for longer than two weeks. If they have you on a PPI for more than five years, they have to screen you for stomach cancer, because that’s the risk. You take away that hydrochloric acid, that means that you’re now nutrient depleted, and also hydrochloric acid depleted. I call it the bouncer to the nightclub. It keeps bad dudes out. So now you got rid of your bouncer, and now you have all these bad dudes entering your club, meaning you’ve got H Pylori, you’ve got bacteria, you’ve got staph, you’ve got everything growing in your body. You are basically a nest for bad bacteria to live off now, and not only that, but parasites too. So you’re a walking, talking buffet for bad things. Of course, you’re going to get sick. Of course, you’re going to be at a higher risk for diseases, right? Because you got rid of the thing that helps you absorb your nutrients and keeps bad things out. I think hydrochloric acid just gets a bad reputation, and it really is, like the most important. I call hydrochloric acid the holy grail to digestion. If that’s not optimal, you’ve got problems.

Lindsey:  

Yeah, I’m on it, despite the fact that I would hope that I could have gotten off it by now, I’m still on it, because I’ll go off for a while and I’ll be like, yeah, unfortunately, my blood still shows me that I’m still deficient in it. Perhaps it is that top level I haven’t addressed. But anyways, what’s the next level after the gut?

Juanique Grover:  

So after the gut is liver, and so your liver is not only important for detoxing everything, but it synthesizes all your vitamins, minerals, and it also biosynthesizes all of your hormones. So if your sex organs or your adrenals are making hormones, they get packaged properly in your liver, unless your liver is deficient. And as I mentioned before, how do we have an efficient liver? Well, we have to have efficient mitochondrial function, and we have to have efficient gut and absorption, right? So if your liver isn’t being powered properly, and if it’s not being fed properly by your gut, you’re going to have liver issues. You’re going to have a sluggish liver. You’re going to have toxin buildup, where you’re just reabsorbing all of your toxins and chemicals and everything, and then you’re not going to feel good.

For people that have liver stagnation, they’re often tired, they have brain fog, they’re sensitive to chemicals and perfumes, and they have skin outbreaks, like eczema, rosacea, etc., like all of these kinds of autoimmunity and skin issues. And again, it’s because it’s working in conjunction with an unhealthy gut, right? So it’s not just a liver dysfunction. It’s like a gut-liver dysfunction. So if you have sensitive skin, if you’re sensitive to chemicals, if you get headaches very easily, you probably have a liver stagnation issue, so you want to support your liver tremendously by eating the right diet and absorbing by having proper mitochondrial function. But for many people that are in a health crisis, they will oftentimes need to take binders and do sauna and maybe coffee enemas to just help get toxins out of their system, because someone that has a health crisis and has chronic health issues that’s been decades in the making, or years in the making, where they have, slowly, over years and years, had this toxin accumulation, and now their whole body is sick, and that’s why liver is number four is because you have to have a healthy liver to have healthy cells. You have to have a healthy liver to biosynthesize healthy sex hormones and all hormones period.

Lindsey:  

And will you necessarily see elevated liver enzymes when this is happening, or could they look perfectly normal?

Juanique Grover:  

I love this question, because everyone asks that. No, it’s actually very tricky. I will actually see high cholesterol numbers. Because if you see high liver numbers, that actually means that your liver is now damaged because of very extensive periods of inflammation and nutrient deficiency and problems. So if you see high liver enzymes, you have a lot of work to do, because now it’s really a problem. So beginning stages of liver stagnation and liver dysfunction are like weight gain, high cholesterol, achy joints and everything that I kind of mentioned, like skin issues, chemical sensitivities, brain fog, you name it, and let’s use this example.

Let’s say you have a house, you live in a house, right? And you have to pay your mortgage, and you pay for a cleaner to come and clean your house, and people live in it, but we take care of the house. There’s energy in the house, and it’s all taken care of, and it runs beautifully, right? Let’s say we stop paying our cleaning lady, and we stop paying the garbage person, and we stop taking care of the house. At first, we’re not going to see decay in the house. The house is going to look fine. We’re not going to see junk piled up in the backyard, because it’s piling up in the house. And on the outside, we’re not going to see the rats that are starting to live in the house, because it doesn’t happen overnight and it doesn’t happen over a few weeks or a few months, right? So the house is going to start smelling and it’s going to start having signs and symptoms of neglect, but we’re not going to see damage to the house. So the house has curbside appeal, but there’s dysfunction happening because there’s rats living in there, and it’s getting infested and it’s stinky and people are not happy. So there are small signs of neglect, but it’s not a physical sign of neglect. Now let’s say over years you neglect the house. Now we’re seeing that the roof is getting chipped, the windows are breaking, and people are not fixing it, the driveway is all cracked and there’s weeds, and it looks horrible on the outside now, but that’s because of years’ worth of neglect, not weeks or months.

And so liver enzymes are the years’ worth of neglect, that means your liver is literally deteriorating. And that didn’t happen overnight. That happened over a very long period of time of nutritional deficiencies and inflammation. Did that translate? Because I want people to understand that so many people are like, my doctor said my liver enzymes were fine. Why do I feel sick? I’m like, this is why you feel sick. Because even though your liver enzymes are normal, it doesn’t mean they’re optimal. So look at your cholesterol, look at your blood sugar, look at your homocysteine. Those are better indicators of problems in the body for me.

Lindsey:  

And are there things you particularly like, supplements for the liver, or I guess you mentioned sauna and coffee enemas? 

Juanique Grover:  

Yes. So the liver requires an enormous amount of nutrients. If you need to detox, there are binders. I love Cell Core Biotoxin Binder* (access with Patient direct code: I0rdLMOm). Cell Core, it helps you get the gunk out. Functionality of the liver, you need high doses of methylated B vitamins*. You need an enormous amount of amino acids. So eat enough protein, drink enough collagen*. What really terrifies me and irks me is when people are doing a “liver cleanse”, and I put that in air quotes for people that can’t see, but they’re drinking fruit juices. And the problem with that is you’re, one, sugar is really hard on your liver, so you are creating more damage by drinking fruit juices. Yes, it’s from fruit, but there’s still fructose in there. And fructose is a very hard sugar to metabolize in the liver. One of the byproducts of fructose metabolism in the liver is something called JNK1, which is an extremely inflammatory molecule, but also aldehydes. So the more fruit juice that you’re putting in there without fiber, the more damage you’re creating in the liver. And so people go on these fruit juice cleanses, and they actually create more damage and more inflammation in the liver, when what the liver actually needs is lots of fiber, lots of protein, lots of antioxidants, lots of B vitamins.

So for people that are really sick, don’t do a liver cleanse. Your body probably can’t handle it right now. Just feed your body high nutrient-dense foods, lots of bone broth, collagen, take methylated B vitamins. Milk thistle* is very supportive of liver and liver detoxification. So there are herbs and supplements that are gentle, but still very supportive, but get the nutrients in. And then when you actually have energy and reserves where you’re feeling functional. That’s when you’re ready for a big detox. But these detoxes should include binders and fiber and protein and vitamins and minerals and antioxidants. If you try to detox without those things in place, you’re going to feel very, very sick, and I actually have a whole liver cleanse. It’s a three-week detox program where it utilizes a ton of supplements that help support the liver and detoxification, but if you do it wrong, you’re not going to feel good. And some people are in bed for days, if not weeks, because they try to detox their liver before they actually have the nutrition on board and the mitochondria on board.

Lindsey:  

Yeah. I mean, at the base of it, you need to be able to make glutathione, and you need amino acids like cysteine and glutamine and glycine, which are going to come from protein foods.

Juanique Grover:  

Exactly, all of those things. So, yes, I hope that answered your question.

Lindsey:  

So yes, so fifth level.

Juanique Grover:  

So fifth is adrenals. And adrenals, if you did everything upstream right, your adrenals should be right on board. So your adrenals are these glands that produce cortisol and aldosterone and adrenaline, and they signal every cell in your body to do something, to be in a stress response, or they can stimulate your immune system to be heightened or diminished. And so if we have mindset on board then your adrenals are not being overstimulated. If we have mitochondria on board, then your adrenals are not being deficient in energy production. If we have your gut on board, then your adrenals have the nutrition necessary to produce the right amount of hormones. And if the liver is on board, then the adrenals produce certain hormones that get biosynthesized in the liver properly.

This is what’s important about adrenals. So your adrenals make something called DHEA, and that’s a precursor to sex hormones. However, if you are in a stress response, your body is going to steal that DHEA from sex hormones and produce cortisol, which is the stress hormone, and the fight or flight hormone, and long term, cause inflammation throughout the body. So if you did all your work upstream and you took care of the first five parts of the order of healing, your adrenals are going to be fine, and you’re not going to have this overproduction of cortisol to an underproduction of sex hormones. It’s like a teeter totter. So if one is high, the other is low. So if your cortisol is high, your sex hormones are low. If your cortisol is low, your sex hormones aren’t necessarily high, that’s a different story for another time. But if you want to make sure that your cortisol stays normal and balanced, so that the next step in line, which is sex hormones, or hormones, those are being produced at a normal rate and not underproduced, which is what a lot of people experience.

And the one thing that I want people to understand about the adrenals is that there’s three stages of adrenal fatigue. The first stage, I want you to think of a Ferrari right, where it’s like, go, go, go, go, go, go, go, A-type personality. You’re waking up early, you’re exercising hard, you’re taking caffeine, you’re getting your to do list done. You’re getting your second cup of caffeine in the afternoon. You’re picking up the kids, you’re getting reports done in the middle of the night. You’re sleeping very little, and you’re doing it all over again, right? So think of the Ferrari going 120 miles down the freeway. That’s stage one of adrenal fatigue.

Stage two, think of the mom minivan where it’s like, it can do the things, but it’s struggling a little bit. It’s not the Ferrari anymore. And so stage two looks like this. You’re getting up in the morning, and it’s really hard, and you have to drag yourself out of bed, but you have a cup of coffee, and now you can go and now you’re hitting lunchtime, and you’re getting that afternoon slump, especially after eating meals. So you’re going for another cup of coffee, and now you’re 600 milligrams of caffeine in, and you’re just barely getting out the door to get your kids and get your stuff done, and you’re feeling this like second wind in towards bedtime. So you’re tired all day long, but right before bed, you’re energized, and you’re like, let me work on projects now. And now, you work until like twelve, one or two in the morning, and then you do it all again, and you just have this slump throughout the day, and you’re relying on caffeine and stimulants to get you through. So think of again, the mom minivan just getting on with all this messiness in the minivan. But hey, it got you from A to B.

Stage three of adrenal fatigue is you get out of bed, and you can barely function. You can’t form words, or it’s hard. You drink caffeine, but it doesn’t do anything, if anything, it gives you a panic attack now, or it gives you anxiety. So you’re drinking caffeine, but it’s just no longer working because there’s no more energy in your reserves. Everything is in the toilet. You have to take a nap at around one or two in the afternoon, because that’s when you get your second slump. Caffeine isn’t working for you, so you have to sleep before you pick up the kids from school, and then by bedtime, you are dead to the world. You’re falling asleep at five o’clock, but you’re also wired, but tired, it’s restless sleeping, and then you’re just doing it all again the next day. When you’re in stage three, everything’s in the toilet. All reserves are empty. You are non-functioning now. You’re alive, but you can’t function. Nothing’s turned on. So be aware of whether you are in stage one, are you in stage two, or are you in stage three?

The further on in stages you are, the harder it is to reverse and heal. And so when it comes to adrenal fatigue, one, you have to get on top of that control center, which is the mindset, and it’s your stress response and it’s your nervous system dysregulation. Two, you have to feed your adrenals. Your adrenals require an enormous amount of vitamins and minerals, sodium, potassium, to be specific, and vitamin C. So there’s something called Adrenal Cocktail* that I put almost all my clients on that has the perfect ratios of sodium, potassium and vitamin C to it. Make sure every time you drink water, you’re drinking water with minerals in it. I love Just Ingredients. So make sure you’re getting that. Make sure you’re getting your B vitamins. And please don’t push yourself at the gym, you need rest, heal your adrenals is not the time to go to the gym. A lot of people will be like, I’m so tired, but I’m pushing myself at the gym, and I’m drinking my caffeine and I’m putting on more weight and I’m getting more tired, and I don’t know why. And I know why, it’s because your adrenals are tanked. You’re trying to force your body to do that, which you cannot do right now. And people are like, but if I don’t go to the gym, I’ll just keep putting on weight. And my answer is, you’ll put more weight on forcing your body at the gym. Right now, you can’t build muscle at all, period. You need to rest and heal and repair and live to fight for another day, right?

So rest your body, recover, regulate your nervous system. I promise you, the gym will still be there, but right now, you have to heal your adrenals and your nervous system, because you’ll be in bed for decades if you don’t do that. And we deal with all of those people at our clinic, we see the worst of worst. And these people have to take steroids to just to wake up their adrenals, to be functional, to show up to work. And trust me, that’s not a life that you want to live. So adrenals are number five.

Lindsey:  

There are six levels?

Juanique Grover:  

There’s seven, actually. 

Lindsey:  

Oh seven. Okay.

Juanique Grover:  

So sex hormones are really simple. If you do everything upstream, sex hormones will work for you instead of against you, because your sex hormones, I call them the icing and the sprinkles on top of the cake, right? Everything else is the cake. The sex hormones just optimize everything. So think of it this way, your body, if you’re under stress, is not going to prioritize procreation and making babies. It’s going to prioritize survival. So when people are like, my sex hormones are in the tank, it’s like, yes, because you don’t have energy, you don’t have nutrients to build sex hormones to make you feel good. So here’s the kicker that nobody wants to hear. You can live and survive without any sex hormones. Do you feel good? Absolutely not. You feel like garbage. But you can survive, and you actually don’t need sex hormones to live. And so if your body is going to sacrifice something because you’re too stressed and you don’t have enough nutrition, guess what’s the first thing to go?  The sprinkles and the icing. Your body is trying to preserve the cake. It’s trying to preserve your organs and your vital organs, right? The sex hormones are not vital.

Our sex hormones are vital to us because they make our hair lush. They make our skin look good, they give us energy, they give us sex drive. But we don’t need those things. We want them, but we actually don’t need them. So that’s the first thing that the body sacrifices, is all the sex hormones when you are not feeling good, when you’re overstressed and when you are undereating a nutrient-dense diet. So if you want to feel sexy and you want the good hair, and you want the good skin, and you want everything else, everyone’s like well, give me the stuff to support my hormones, and I’m like, you have to look upstream at everything else, because, again, you have to fix the cake, and then the sprinkles will come, I promise you. But if you have a broken cake, the sprinkles won’t be there. So fix everything upstream, and your body will just naturally regulate and balance your sex hormones. So that’s why sex hormones are dead last, even though everybody wants them to be first.

Lindsey:  

Okay, are they number seven? Because I don’t think we heard number six.

Juanique Grover:  

So sex hormones were number six and then number seven is brain function. So if you’ve fulfilled everything, your brain should be healthy. It should have good neurotransmitters, good blood flow, good oxygenation. If you do everything right, as we know, sex hormones, if you have proper progesterone and estrogen levels and testosterone, they actually preserve your brain function. So we don’t want high stress, we don’t want high cortisol, we don’t want too high adrenaline, because all of those diminish brain function and damage the brain. And so if you take care of your gut, if you take care of your mitochondria, as we learned before, if you take care of your liver and your adrenals and your sex hormones, all of those things combine together to make sure that you have a very young, healthy, anti-aged brain. Now, if you still have brain function, that’s probably a good time to go and get a brain scan to see if maybe there’s like, some benign tumor that may be be on your pituitary. But that’s again, everything prior helps your brain function properly, and so if it’s not, then we just say, okay, let’s look deeper. Get an MRI, get a brain scan, get a brain map to see what’s happening in your brain and how we can support it, because everything else should be supporting it optimally. And so that’s it. That’s the order of healing.

Lindsey:  

Okay, that was amazing. We’re running out of time. And I guess maybe one other thing I’d love to ask about is just the neurofeedback that you use in your clinic, and what it’s about and what conditions it’s useful for.

Juanique Grover:  

Yeah, so neurofeedback is really cool. So what it’s used for is anxiety, depression, ADHD, ADD and autism. So for kids are on the spectrum, it helps with their autism brain function. So teachers will remark, oh my gosh, he’s sitting down and he’s not having as many tantrums or meltdowns. So it really helps to just calm your nervous system and your brain that is over-firing. And so how it works is because your brain has certain waves like delta, gamma, beta, alpha, and so it retrains the waves to work optimally. For instance, everyone has intrusive thoughts. If you have a health problem, you’re like, oh, that’s cancer. I’m going to die. That’s the job of the brain to constantly analyze things, whether it’s correct or not. With a brain that is in hyperdrive and hyper-sympathetic dominance, when you have that intrusive thought come, then the brain latches onto it and you have this full-blown panic attack, right? Because that’s what the brain wave activity has been trained to do over time.

But with neurofeedback, it changes that brain wave activity. So when you have a thought or when you have a scenario come into your life, your brain responds to it completely differently, right? So you could have that intrusive thought come and you’d be like, oh, that’s interesting, and then it just passes and you’re not having this panic attack. Or for people, a lot of adults that have PTSD or depression or a hard time verbalizing their emotions, when they do neurofeedback, they’re like, huh, that’s easier to do, or, huh, I don’t feel so depressed anymore, or I don’t feel so anxious anymore, even though nothing in my life has changed. So we’re just changing brain patterns to not be so reactive or so underactive. And so that way you can live a very functional life with stress, but not having the stress affect you on a brain chemistry level. I don’t know if that was a good explanation of it.

Lindsey:  

Yeah no, I mean, I’ve heard about different kinds of neurofeedback, and there are some in our town, but it wasn’t the kind that I’d heard about. Is yours the kind where somebody might be watching a movie, or playing a video game, and if they get the right kind of brain waves, then they’re rewarded by it keeping playing, and if they have the wrong kind of brain waves, it stops until they have the right kind of brain waves?

Juanique Grover:  

So ours works with the screen dimming and getting lighter, so it rewards you with a brighter screen. So that’s how ours works. It goes in and out, so you’ll watch it like it, and we always want calming, like Disney shows, nothing that’s too energizing or intense, right? And so when they’re watching it, the screen will get dim, and so it’s trying to provoke the brain to think a little harder. And when the brain corrects, it brightens, and then it works on a different area. And so it does that. And our sessions are only 30 minutes, so a lot of people do one hour, but we’ve seen that an hour fatigues the brain a little too much, and so we do the 30 minutes.

Lindsey:  

Okay, so I think we are out of time here. But can you tell people where they can find you and about your courses and that stuff?

Juanique Grover:  

Yes. So my clinic is called Provo Health, and so you can find us at provohealth.com or on Instagram @Provohealth. If you want to become a self-healing advocate, let’s say you are having health struggles and you’re tired of depending on doctors, and you’re like, I want to be the expert. Now I have a bunch of free classes as well as paid classes at mygutsyhealth.com. We do an academy enrollment every year. In 2025, the enrollment is going to be for September. So look for us during the summer time for open enrollment to become a student of the Gutsy Academy, where you get access to our courses teaching you every step in the order of healing, the science behind the order of healing, the homework that you can do to improve those areas in your life, the protocols, the supplements, the lifestyle changes.

And then every week in the academy, all of our academy members have a Zoom call, so you come on and we help you integrate the information. It’s like coaching, where you’re like, I’ve tried this. What else could it be? What we have found is that one, community, being around people that are struggling or going through the same thing that you’re going through, is really nourishing. But not only that, you’re learning from each other’s experiences, and you’re seeing what works for them and what doesn’t. And when you can hear people verbalize what they are struggling with and what the solutions are, you learn from their cases. I call it, like you know how doctors have rounds or certain doctors have to shadow other doctors. We’re all kind of shadowing each other in our health issues. And so they get to learn from each other, and they get to hear, oh, this is how Juanique and Gina are asking them questions about their health, because they’re trying to figure this out, or they’re trying to figure out a, b and c.

And so what’s really cool is all of my coaches at Provo Health and my nurse practitioners, they all have to learn the order of healing and take the coursework in order to become coaches or nutritionists at Provo Health, because we utilize all these modalities and all of these skills and all of this science to help coach our patients and our clients at Provo Health. And so it’s basically teaching you how to become your own health coach, how to become your own nutritionist. And what’s really cool about the academy is I’ve had nutritionists and coaches do other courses that were like five to ten grand, and they’re like, it was missing stuff, and then they joined the Gutsy Academy, and they’re like, the Gutsy Academy was everything I was hoping to learn at this course. And they’re like, this is what I wanted to learn. This is how I wanted to learn, how to integrate the information. And now my knowledge is no longer lacking, because you guys have put it all together.

And so if you’re struggling in your health journey and you just feel so lost, the academy can really teach you how to become your own self-healing advocate so you no longer feel lost in your healing journey, so that you have clarity and you have direction and you have hope, because hope is truly one of the most important things when it comes to a healing journey. 

Lindsey:  

Well, I think that’s a great note to finish on. Thank you so much for sharing your incredible knowledge with us. 

Juanique Grover:  

Thank you, Lindsey. Thank you for having me on your podcast.

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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Functional Psychiatry in Action: Real-Life Healing Stories with Tracy McCarthy, MD

Functional Psychiatry in Action: Real-Life Healing Stories with Tracy McCarthy, MD

Adapted from episode 142 of The Perfect Stool podcast edited for readability with Dr. Tracy McCarthy, MD, a board-certified psychiatrist and Institute of Functional Medicine certified physician with Lindsey Parsons, EdD.

Lindsey:  

So I think you’re the first psychiatrist I’ve had on the show. And I have heard of integrative psychiatrists, but I’ve never talked to one. So I’m curious what the practice of a functional medicine trained psychiatrist looks like, and how you got into functional medicine from psychiatry?

Tracy McCarthy, MD:  

Yeah, well, it’s a story. There was a time where I didn’t understand if one could be a functional medicine psychiatrist. So, you know, let me go back and tell you how I got into functional medicine in the first place, and how I ended up in doing what I do now. So, you know, I was a regularly trained allopathic medical doctor. I went into medical school really excited about finding out what goes wrong in the body and how we can fix that and how people heal. And the first few years of medical school were pretty satisfying. That way learning a lot of pathophysiology, and it was really interesting. But then as it went on and my training progressed, things became much more about identifying constellations of symptoms, and labeling that with the diagnosis, and then matching that to a pill. And the asking of why is something is going on became less and less part of it. A lot of that is because people said, We don’t know why, but the pharmaceutically-driven focus, is part of why. I think that question gets pushed to the side too much, because if you look in the research, there often is some hint about why, and there are people doing great research well.

So this was increasingly frustrating to me and my patients, who often were saying, hey, well, why do I have this or do I have to take this pill for the rest of my life? Or maybe medications were helping only part way, or they’re having a lot of side effects, so a lot of scenarios where that wasn’t satisfying. Luckily, around that time that that was happening for me, I came across the research on the role of inflammation on so much chronic illness, and I got really excited, and I got very interested in the role of nutrition and lifestyle in changing that inflammation. I started to make changes in my own life, and was like, wow, I feel like so much better after I eat. I don’t have to unbutton my genes or my energy is staying better, and then as I learned more, I started to hear about these doctors using these approaches and these philosophies and this research called Functional Medicine providers. And I ended up training with the Institute for Functional Medicine and have gone on to do tons of additional trainings in integrative and functional medicine.

But it did confuse me in my early days in functional medicine, because I also hadn’t met any psychiatrists doing this initially, and I kept asking myself, well, will this work in psychiatry? And now I kind of laugh that I thought that. But it was really a result of my training. Our conventional medicine is very siloed. People don’t talk to each other, right? You’ve got your gastroenterologist over here and your cardiologist over there and your neurologist over there, and it’s very separate, as if the body is in these separate zones. We know that’s not really true, and so now I’m at the point, we joke in functional medicine that we know everything causes everything. So it’s like in any one person, a constellation of triggers can show up as a different set of symptoms compared to somebody else, right?

So of course, inflammation can manifest as depression or anxiety, and there’s tons of research to support that. So as a functional medicine psychiatrist, I am focused on finding the root causes of the patient’s symptoms. What are the imbalances in the body? What are the nutrient deficits? What are the microbiome imbalances? What are the toxin exposures like, what’s not working right? And really focusing to address that as well as relieve symptoms. People need urgent help with symptoms often, but then you want to go deeper and ask why, and help them resolve that and empower them to be healthier. And that’s what’s so fun about it. It’s a partnership. They get to really learn what helps them be healthier and  and make changes that result in just feeling much better. 

Lindsey:  

Awesome. So were you practicing as a psychiatrist when you were in allopathic medicine? 

Tracy McCarthy, MD:  

Yes, I got real interested in functional medicine as a resident psychiatrist. So I was going through my traditional psychiatric residency at that point. And I think I did my first Institute for Functional Medicine training when my second kid was, like, one year old. It was a couple years after residency. By then, I had had an interest for several years in nutrition and had been reading and consuming everything I could on the topic. But that’s when I got serious about it. And, yeah, I was a hospitalist, a hospital-based inpatient psychiatrist, so my focus was working with pretty severely mentally ill, usually involuntarily committed, patients who were experiencing psychosis or mania and really needed stabilization to be able to access basic things like food and shelter, and so that was the focus of my work. But this led me in a really different direction. I would have loved to have been able to help them with these tools, but the system was not set up for that. I could not really change what they were feeding them in the hospital. You know, I would have liked to have done so. I learned pretty early on, as I was training, that I needed to open a practice so that I could actually apply what I was learning and help bring that to my community. And it was the beginning of another journey.

Lindsey:  

Awesome. So I’m going to start with the general, which is, how does gut health impact mental health and vice versa? 

Tracy McCarthy, MD:  

Yeah, oh my gosh, hugely. And I’m sure that we still only know the just the tip of the iceberg on this. You know, there’s so much research coming out all the time about the microbiome and its roles and and when we talk about gut health, we’re talking about several things, right? We’re talking about the microbiome, which I’m sure your listeners know. But just in case, it’s all the bacteria, fungi, viruses, even parasites in our gut, but it’s also our digestion and how well the gut is functioning. In that sense, are we absorbing our food? Are we breaking it down? You know, the gut has a lot of components to it, so it affects mental health in a number of ways, and indeed, overall health, if we are not able to break down and assimilate our food and our nutrients, then we’re definitely operating at a deficit, right? Like neurons need certain things to function well, like B vitamins and magnesium and zinc and cholesterol, all kinds of things. And if we aren’t getting those in the diet, so if we’re not eating them, we’re not going to have them, but we might be eating a great diet, but not actually absorbing it well or breaking it down.

Well, that’s something I see quite a lot on testing I do with patients. And so, you know, the gut is not doing its job there adequately, then your your brain’s going to suffer. It’s not going to have what it needs to work right. You won’t have the hormones you need, or you won’t have the amino acids you need for neurotransmitter production. So that’s one way you see it impacts. But the microbiome is the biggie here. You know the bacteria that we acquire through vaginal birth and then through breastfeeding, and then as we grow with time, we are acquiring this very diverse microbiome. Ideally, it’s doing so many jobs for us and these bacteria make a number of compounds, and many of these are signalers to our own immune system and to our nervous system.

Some of the things they create are actually neurotransmitters like GABA. GABA is a relaxing, calming neurotransmitter. The right bacteria could be producing this for your benefit, they make cytokines, which are inflammatory messengers, and some of these are going to turn up inflammation in the body, and other ones are going to turn it down. So the level of that’s going to be important. They can be producing toxins, like endotoxins, like something called lipopolysaccharide, which, if that’s getting through a leaky gut into the bloodstream is going to be extremely – it’s like putting lighter fluid on things. It’s going to be very incendiary and light up your immune system. So they communicate a lot with our whole body through the production of different compounds. These can be absorbed across the lining of the gut into the bloodstream, and fascinatingly, these compounds can also travel up the vagus nerve to the brain.

This part always just blows my mind, that there’s this chemotaxis, they call it, where the chemical is actually traveling up a nerve. So you know, there’s multiple ways in which the microbiome is impacting our body. And that our gut in general, is impacting our body and our brain is not in a special glass case, immune to what’s going on, right? I mean, yes, we have a blood brain barrier, but many, many things get it through that, and the gut has a massive impact on it, which is why they call it that gut-brain axis. It’s a it’s a two way street. It’s communication between the gut and the brain.

Lindsey:  

 Yeah, so I’m pretty sure you addressed very much what goes from the gut to the brain? What about from the brain to the gut? 

Tracy McCarthy, MD:  

Yeah, great question. So that vagus nerve that I mentioned, where the chemicals can be traveling up it, this is the primary way the brain communicates with the gut. It’s a cranial nerve, which means it comes out of our cranium, out of our head, from the brain stem, and it innervates our entire thorax, you know, our chest and our abdomen. So all of our organs are innervated by the vagus nerve. So it’s in charge of hormone production in your endocrine glands. It’s in charge of slowing heart rate and slowing breathing. And most importantly to this discussion, it’s in charge of digestion and gut motility, meaning moving things along at the proper rate in the gut, and the gut squeezing correctly at the right time. That’s very important. And so that vagus nerve is not on line. And I’m afraid in lots of people with serious stress and trauma, that vagus nerve has been really impacted in the tone. We say the vagus nerve is not good, then you’re operating at a deficit. You don’t have that great brain input that’s needed for optimal functioning of those organs.

Lindsey:  

Okay, so I’ve been trained on the Organic Acids Test and how it can show issues like deficiencies of serotonin, which is known to be one of our feel good neurotransmitters, and the idea behind SSRIs, or selective serotonin reuptake inhibitors, which keep more serotonin in the brain. But lately, I’ve been hearing on my functional medicine podcasts that anxiety is not a serotonin deficiency. So my question is, is anxiety ever a serotonin deficiency, or is it for certain people?

Tracy McCarthy, MD:  

That’s a great question. I think anxiety is something that’s very heterogeneous, and there’s a lot of reasons that people have it. And I don’t tend to focus on neurotransmitter imbalances as a root cause, because I feel like first of all, that theory about SSRIs has really been debunked, that we have a chemical imbalance, and that’s what they fix. When people respond to an SSRI, we see that certain inflammatory cytokines have been reduced. So there’s something happening with inflammation getting reduced in people who are responding. But the other reason I don’t tend to focus on that is because that’s not really the root cause. Even if you’re having too much serotonin or not enough, or too much dopamine or not enough, why is that imbalance occurring in the brain? What is the trigger for that? Is it lack of raw materials, like not enough amino acid precursors for making those neurotransmitters. Is it inflammation, affecting the regulation of these, is it microglial activation, which is like an immune response in the brain? So that’s how I tend to focus. So I’d say probably it could be anything, really, because it’s people. It’s going to be different in different people, right? 

Lindsey:  

So if somebody does show up with, say, a tryptophan deficiency, is that something then you would supplement?

Tracy McCarthy, MD:  

if it was very clear that that was a deficiency, sure, I do tend to look more globally like I will tend to see, hey, you aren’t really, all of your precursor  . . . Well, I would say on an organic acids test, you’re looking at metabolites in the urine, right? So I would say, if I see low neurotransmitter metabolites across the board, I feel like there’s a problem with protein breakdown and digestion, right? That’s where I tend to focus is on that breakdown in digestion, obviously ensuring they are also getting enough protein in the diet. And I might encourage them to use something like collagen peptides as an easy way to augment that. Or sometimes we use amino acids as well. It depends.

Lindsey:  

So getting back to that whole root cause question, then, so what root causes do you find are common with anxiety?

Tracy McCarthy, MD:  

You know, one of the number one things I find is blood sugar. That’s a really big issue. So many people are running around with blood sugar swinging up and down. They have no idea they’re riding the blood sugar roller coaster I call it. This is a real common problem in our society where we have a lot of insulin resistance, and people can have levels of insulin resistance that aren’t obvious enough to show up when they get testing, like hemoglobin A1C or their fasting insulin. And if that’s all anybody’s looking at, then you won’t see sometimes the whole story.

So I’m a big fan of doing continuous glucose monitoring in my patient and actually trying to help them see what happens after a meal. You know, you might get a huge spike in blood sugar after a certain meal, and then half hour later, that blood sugar’s plummeting. Guess what happens when it plummets? You release adrenaline because you have to rescue a low blood sugar then, and that feels terrible. That’s anxiety producing. It’s when people get tired often after a meal, then they can get shaky. And it’s also a reason that a lot of people wake up at night. It’s a common trigger for insomnia, and I’ve really seen that in working with my patients. I say, look at that glucose monitor in the morning, and watch what happened overnight. Like, take a note of when you woke up. Oh, I woke up at two. And then you look and you’re like, Oh, your blood glucose spiked at 1:30 and then it dropped. And then that drop is what woke you up when the adrenaline was released. So that’s a big one.

And you know, there’s such simple steps you can take to fix that. It’s wonderful when you can help somebody shift that, because suddenly they’re feeling so much calmer, like getting them eating protein with each of their meals, making sure they’re digesting that, if that’s the issue, making sure there’s adequate fats, and then just really adjusting the carbohydrates for that person individually, like, how much can they tolerate, making sure that those glucose spikes aren’t going too high after a meal? You know, there’s other tools we can use to, like resistant starch and there’s blood sugar sensitizing supplements, but really it’s mainly about the food, and then also stress will do the same thing.

Stress can cause the blood sugar to spike and drop. So just that awareness really helps people make different choices. I’ve definitely seen people where they say, you know, my gosh, as soon as I cut the sugar out, my anxiety completely flattened. And this is a person I’m thinking of had had decades of anxiety treatment and a very intensive anxiety center she’d gone to multiple times, and it was the sugar. It was so simple for her. It’s not always that simple, but sometimes it is.

Lindsey:  

Any other root causes that come to mind, beyond the sugar?

Tracy McCarthy, MD:  

I mean, a lot of things, toxins. Mold is a huge source of toxin that I see. I wish I could say that’s rare, but it’s really common. Lots and lots of buildings have some kind of water damage, mostly unbeknownst to people. And these mycotoxins or mold toxins can accumulate in the body, and they dysregulate nervous system functioning, immune functioning. They just dysregulate your detoxification pathways. And so as they accumulate, they start showing up as a lot of weird symptoms, and absolutely, anxiety is one of those. It’s a real common one. 

Lindsey:  

Yeah. Okay, so this applies both to anxiety and depression, but how can you tease apart the physical causes of mood disorders like anxiety and depression versus the circumstances of a person’s life that are setting them off, like when I had some serious health concerns and no primary care physician. I was in a new location. I started having panic attacks at night, but as soon as my concerns were allayed, then those panic attacks went away. 

Tracy McCarthy, MD:  

So, yeah, I never want to downplay the role of the psychological factors. They’re enormous, and these really aren’t separate, right? Like when we have stressors, these are mediated through hormones in our body. They’re even mediated through what happens in the gut. Our gut changes, our microbiome changes when we have stress. So these are huge factors. We all can think of situations where someone had the depression that was really situational, it was very clear what the trigger was. So those are always important to look at. But I think the other thing to think about is like, Hey, are you doing the things to address that and you aren’t getting better? That’s my mission, really, is to help people understand the overlooked physical causes, because they may be going to the doctor.

I think really common scenario is they’re going to the doctor about their depression and anxiety. They’re given a medication, and they’re hopefully encouraged to get therapy. Hopefully they do that. You know, all of us benefit from therapy, but are they still stuck.  Or do they want to be on the pill? Maybe they’ve done a lot of therapy, but guess what? Therapy is not going to fix their B12 deficiency. So it’s like, if you’re making certain progress, but you’re plateauing, or you want to look at all the areas at the same time, okay, I’m going to address these stressors, because I do know they’re important, but what else can I do to support my system? Because the thing is, if we have these physical issues going on, we’re more vulnerable to the psychological stressors. You know, we’re less resilient. I mean, we can be much more irritable when we have the wrong microbiome, and then everything’s harder. So they interact a lot.

Lindsey:  

Yeah. So how can you help somebody who has debilitating anxiety or depression that has a legitimate and ongoing cause, like a serious health issue, for example?

Tracy McCarthy, MD:  

Well, I think you’ve got to meet them where they are first of all, and then you look for the lowest-hanging fruit, and are they getting the support they need for that health issue? I mean, a lot of times, really, one of my most important roles is seeing someone and validating what they’re actually going through. And sometimes they’re not even having that happen with their serious health condition. So that’s the beginning part of healing, right? There is like acknowledging this is really happening. I’m not going to gaslight you, you know, I see this. What are we doing to do to help build your resilience? And there’s so many great tools out there that we use just for the mindset part of this, and for the nervous system calming and so helping them up their resilience and their resources, and at the same time beginning the process of the appropriate place to start testing what are the pieces that are missing?

And here’s the thing, when you’re talking about some of them going through a significant health crisis, the things that are driving their depression may be the same physical causes driving the other health issue, or is overlapping. That is very common. You know, I work with lots of patients where maybe they’re coming in for the depression or the anxiety, but when we work on the underlying issues, now their energy is better, their hormones are more balanced. You know, their periods don’t hurt in the same way, their gut is feeling better. These are all connected. So it to me, it’s always about the holistic view and looking at the whole person and seeing where are the gaps that we can intervene on most easily first, and go from there.

Lindsey:  

Okay, so what would you say are the underlying causes of depression that you see most commonly?

Tracy McCarthy, MD:  

Well, I think inflammation is huge here, and some of that is real nutrient deficiency. Deficiency is one piece of that. The most common nutrient deficiencies I see that trigger depression are lack of certain B vitamins. I mentioned vitamin B12. That’s a really important one, because people are much less able to absorb B12 with age because of issues with their stomach and producing something called intrinsic factor that’s required for absorbing B12. But also, lot of medications deplete B12. So here’s a really common one, Metformin. That’s a great medication for diabetes. Lots of people are on that for their glucose. Has some longevity benefits, but it depletes B12. So you’ve got to take B12 if you’re on it. And I’ve had patients absolutely like, I’ve worked on my blood sugar, I’ve been doing so much better. But then the last two months, I’m so super depressed. You know, this is when I’m meeting them and I find out what they’re taking. I’m like, did anyone ever tell you to take B12 with your Metformin? Well, no. And you know, two weeks later, they’re feeling a whole lot better with that B12. But it’s not just B12. It can be B6 it can be folate, which is another B vitamin. These are big players.

And then, besides the B vitamins, minerals are really important, magnesium, zinc, plays a major role here, and also omega 3 fatty acids, they’re really critical. And this comes back to that theme of inflammation. I know I sound like I’m repeating myself when I talk about inflammation, but it’s such a common issue here that, you know omega 6 fats, they’re everywhere. We don’t have any problem getting enough of those. We need both types, right? But Omega 6s are everywhere. They’re ubiquitous because they’re in every seed oil, canola oil, corn oil . . .

Lindsey:  

. . . every restaurant meal, every take out meal, every chip, except for the three that have avocado oil,

Tracy McCarthy, MD:  

Yeah, you just cannot . . . it’s very easy to find them, and most people are overburdened with them. And I always describe it to people as like your immune system is like a car, and the omega 6 fats are like the gas pedal, and the omega 3 fats are like the brakes. And you need both, right? If you say you’ve sprained your ankle, you need to mount a response with inflammation, and then you need it to go away when it’s healed. So you need to turn it on and turn it off. But most Americans are driving around in a car with like, pedal to the metal, and they don’t have any brakes at all because they don’t have any omega 3, because they’re not eating the fish that contain those. And that’s really the main source for that, and so that’s what we’re working to balance. So if you can really increase your omega 3s and work to reduce the omega 6, that’s the part a lot of people forget about, right? They might take fish oil, and usually not enough, I would say, but they’ll take it, and they don’t realize they need to work on those processed foods that you’re talking about and really eliminate those. And at least at home, choose the fats that don’t have those to cook with to control it right there. Boy, people feel a lot better when you get that oil change done. You know, switching that really is going to lower inflammation.

Lindsey:  

An oil change, I like that. Think about the car. So do you have any stories of past patients with anxiety or depression who got better that you could share? 

Tracy McCarthy, MD:  

Oh, yeah, I think of one of my early patients was a real dramatic case and a cool functional medicine case, because there were several pieces. But this is a lovely lady who came to me with anxiety, and she actually had panic attacks, and she also had irritable bowel syndrome with diarrhea, and she had been someone who loved to travel, and because of her panic attacks and because of the irritable bowel syndrome, she never knew when she was going to need a bathroom. That combination just ended her travel, and it really bothered her, and she was on, I think it was Lexapro, which is a common antidepressant, anti-anxiety medication, and she’d stayed on it because it had kind of helped, but not enough. She still obviously had a lot of symptoms. So she came to me about this, and we found a number of things. We found that she had an overgrowth of yeast in her gut. We found that when I looked at her timeline, which we take in functional medicine, we go back and say, like, hey, when did these symptoms start? When were big events in your life? When did you have all these? When was surgery? When did your parents get divorced? Whatever these things were, we map it out so we can see the connections. And it became really clear that her anxiety had started like a year or so after she’d had her gallbladder removed, and so she had followed the standard recommendations of a low fat diet after removing the gallbladder.

But what this meant was she began to really lose out on fat-soluble vitamins like vitamin D and K2 and this had a big impact on her functioning. Vitamin D is huge for mood. And this also really shifted her microbiome, because now we’re not having the same foods coming down the pipe, and she had that overgrowth of yeast. We treated that overgrowth. We worked on the digestion. We supported the digestion of fats. We kind of made up for that missing gallbladder. We were able to get fats back in the diet, which she definitely needed for her neurons to work right. There were a few other changes I’m forgetting right now, but those were the big ones. And really, within a couple months, her anxiety was totally gone, her panic attacks were gone, and her diarrhea had resolved. And then she was telling me she was flying with her grandson, taking trips, and it was like her life was back, and that was it. She knew what to do to stay healthy after that.

Lindsey:  

Awesome, cool story. So are there particular tests you like to use to diagnose the things going wrong, digestively, or the yeast? 

Tracy McCarthy, MD:  

Yeah. So there’s so many tests out there, but the panel I like to begin with, with patients is I do a very comprehensive blood test that looks at inflammatory markers and some nutritional markers and blood sugar and hormones, zinc, copper, things like that. And then I use an organic acids test, like you mentioned. I like that a lot, in particular for the yeast or for molds. It does a good job of telling us about colonized fungal species much better than a stool test does. And I like also that the organic acid test tells me about mitochondrial function and some of the detoxification pathways. That’s helpful. And then I do do a comprehensive stool test, which is always interesting to see people’s results, where you really can see if there’s digestive impairment, you see the imbalances in bacteria, sometimes you find some interesting parasites.

Just today, I saw a tapeworm from a dog in a patient. So she wasn’t too happy to see that. That’s rare, but these things do show up, and we can treat them. It’s helpful to find out what’s triggering the inflammation, because there were inflammatory markers on that test because she was having this pathogen. So that’s where I start. Sometimes it makes sense to go further down certain pathways, like like evaluating mold toxins, for example, or other environmental toxins, or to look at metabolism of hormones with something like a Dutch test. And sometimes it makes sense to do some additional genetic testing.

Lindsey:  

Whose stool test do you like? 

Tracy McCarthy, MD:  

I have used them all, I will say, and they’re all pretty similar. I really have used most recently, for a long time, I was using Genova’s GI Effects, and they were taking so long to get the test back that I ended up switching to the Gut Zoomer from Vibrant America, which does have a bit more pathogens on it. And I like that. I used to use GI Map in the past. Didn’t like the way they reported calprotectin, though that wasn’t standard. So, and the Doctor’s Data 360 is very good as well. I mean, you can get good information from all four of those tests. 

Lindsey:  

Yeah, I actually started using the US Biotek GI Advanced Profile, because it’s got everything that’s on the GI Map, everything that’s on the GI Effects. And it’s sort of in between price wise.

Tracy McCarthy, MD:  

That’s good if it’s an in between price wise, yeah, yeah.

Lindsey:  

And I’ve started using the Tiny Health PRO, because they do a full metagenomic sequencing, plus then they have all the digestive health markers. So it’s kind of like the best of all worlds. And again, it’s very reasonably priced. 

Tracy McCarthy, MD:  

I like that it’s reasonably priced, 

Lindsey:  

Yeah, yeah. And you can get it on Rupa. And whose organic acids test do you like?

Tracy McCarthy, MD:  

Oh, well, the I use Mosaic, which was Great Plains.

Lindsey:  

Yeah. Okay, what portion of anxiety and depression do you think is genetic?

Tracy McCarthy, MD:  

Oh, I love this question, because I think a lot of people feel like they’re doomed because of their genes. And I beg to differ on that. I think we all have our predispositions, the things that we’re most likely to get, like, you know, we say, okay, my family might really tend to get diabetes or autoimmune disease or depression, but these things are epigenetic. There are things turning these genes on and off. And so your genes are not your destiny. You hear different numbers, like, oh, genes are like, 10% of the puzzle. I don’t know. You know, in any one person, it could be different. I’ve also heard a sort of morbid amount analogy, like, the genes load the gun, but the environment pulls the trigger. It’s a little violent. I don’t like that, but it is, I think, putting it in perspective that it is just one piece, and that we should not feel like we have to settle because of our genes and in fact, there’s so much we can do to influence the expression of those genes.

Lindsey:  

So I see a lot of people, and obviously a lot of kids are diagnosed with ADHD these days. Are there root causes that you see for that?

Tracy McCarthy, MD:  

Oh, yeah, that’s a really interesting one and complex to me. I think there’s some really good research to suggest that there’s a zinc and copper imbalance occurring there. That if you’re interested in knowing more about that, I would look into the Walsh Research Institute. They have a huge database, and then a lot of research on that, and I had a lot of success with correcting that zinc copper ratio and helping ADHD patients. 

Lindsey:  

Dominant in which one? 

Tracy McCarthy, MD:  

They tend to be low in zinc with high copper. And there’s evidence also about metals playing a role. And there are some ADHD patients where it looks like dairy intolerance is part of the problem. I think it’s another heterogeneous group, you know, that I think we have these common end points of a label, but people arrive there differently. You know, different things to look at, but there are common themes.

Lindsey:  

The podcast that published today was with someone who looks at genetics and just helps people figure out how their genetics might be playing into their health issues. I had her look at mine because she had a unique set of skills that I was interested in. And she asked me, based on my genetics, do you have trouble focusing? And I’m like, No, I can focus. Well, you know, I get my work done. I’ve done well in school and all that. And then my husband was like, Are you kidding me? You’re like, “squirrel, squirrel, squirrel.”

Tracy McCarthy, MD:  

Don’t you love it when the spouse is like, what? I know, I’ve had that moment before, too.

Lindsey:  

I am a little easily distracted, so she suggested I take dopa macuna, which I’ve been playing with. Is that something you use?

Tracy McCarthy, MD:  

I have not that exact product. No, how are you liking it? 

Lindsey:  

Maybe I’m focusing better, but it was one of these things where it didn’t feel like a disability of sorts. 

Tracy McCarthy, MD:  

Yeah, well, that’s the question too, right? About, like, neuro divergence and neuro tribes? Like, there are a lot of questions there, too. Like I think about kids with ADHD, and sometimes I feel like this is trying to put a square peg in a round hole in our school system. 

Lindsey:  

And they’re creative and they have different. . . 

Tracy McCarthy, MD:  

Right, exactly, and you don’t want to squash that, but if somebody is really having neuroinflammation, then you want to support them with that, right? So, I think it’s right. First thing, I think it’s really heterogeneous.

Lindsey:  

Yeah, yeah. I think that it’s possible I’m concentrating better. And it’s one of these things where if I’m talking about something, and then something else comes up, I will not know where I was, like I will need somebody else to bring me back to the original topic. Or go on to tangents when I’m telling a story. So I think it’s something I could use a little help in. So if it helps, we’ll see. We’ll see. But anyway, yeah, just tobring up my dopamine. Do you use any things like amino acid precursors to bring up dopamine? Or is that, again, not root cause enough for you?

Tracy McCarthy, MD:  

It’s not my focus. Like I do tend to go deeper because, again, I’m like, Well, why are you low in that? Like, what’s the thing? But I mean, if somebody truly, like genetically runs that way, that they’re always going to be low. I mean that zinc copper situation is kind of like that, where sometimes genetically, they will really just need higher levels of zinc supplementation, you know, or people really need higher levels of methylfolate, for example. So there is a place for that, for sure, but I don’t want to miss the underlying drivers of the imbalances, you know, which is usually some kind of toxin, infection, combination, trauma. It’s all part of it.

Lindsey:  

Yeah, yeah, I always ran low on organic acids. I think I’ve done  two tests, and both times, my dopamine was low, but I never again felt like there was any – my serotonin was low too – I never felt there was any issues with me. 

Tracy McCarthy, MD:  

Yeah, and it’s complicated with the urinary organic acid test, you’re looking at metabolites in the urine, right? They are not telling you the brain concentration right? We are having to infer, you know. And it can give you some ideas of things to try and then see, but then you really have to see clinically. How did it go? 

Lindsey:  

So I’ve heard some functional medicine doctors talk about certain root causes of schizophrenia that may be treatable. And I’m curious whether you’ve found that there are some typical root causes for schizophrenia, or if you’ve had any patients who’ve recovered to any extent.

Tracy McCarthy, MD:  

Great question. And I’m excited that more people are talking about that. Some of the most interesting work has been done on Zonulin. You’re probably aware of Zonulin, it’s a leaky gut marker, and the work by Alessio Fasano on this. A pediatrician who’s done a bunch of the research on this, we think about celiac on his research, but then a lot of the research was also done on schizophrenia. And no one ever talks about that. And I’m always thinking, Okay, this is an autoimmune disease. Why don’t we treat it as such, you know? Why don’t we look at that? And what’s interesting is, if you look at some of the original work from Dr. Abram Hoffer, before we had Haldol and these medications, the anti-psychotics, they would do different kinds of fasting treatments or elimination diets, and people would clear. So there was some trigger in those cases, dietary trigger, that was playing a role. So, I’ve always been very interested in that, and now we’re seeing some emerging research about the role of mitochondria. And the ketogenic diet being impactful, not just for bipolar, where I’ve long expected to see it, and that’s because, hey, ketogenic diet works for seizures.

The medications for bipolar are anticonvulsants, just like for seizures, they raise ketones. Like, why wouldn’t that work? Well, those studies are coming out now, and it’s really exciting. But this same approach is working in schizophrenia in these studies, and it’s really about brains that are unable to utilize glucose properly, and getting them a fuel source that they can utilize. And it’s another example of how a common trigger will express differently in different people, different symptoms. The patient who has schizoaffective disorder, so essentially, both bipolar and schizophrenia, and gluten is a major trigger for her. She gets much more psychotic if she has gluten, it also triggers  projectile vomiting in her. She has numerous reactions to it, so her learning that has been really, really helpful in starting to control symptoms. Those are some of the my thoughts about that.

Lindsey:  

Okay, and anything else to say about bipolar and root causes?

Tracy McCarthy, MD:  

Well, I do think this brain insulin resistance is a big one that we’re going to see more and more about. But then there’s some other cases where it’s really, like infectious like Lyme can cause mania, and people are not realizing it’s that. Or NMDA encephalitis; there’s other causes that can manifest as mania. There is encephalitis that can do that too. But here what the thing I think is kind of funny, is we’re like, Oh, these are the exceptions. I don’t really believe that, because there’s always a reason somebody’s having this. It’s not like there’s just run of the mill bipolar, and then there’s these special ones that have a cause. They all have a cause. We just haven’t figured it out, you know? 

Lindsey:  

Yeah, right. In other words, bipolar is not a thing. A bunch of underlying stuff creates the symptoms that we call bipolar. 

Tracy McCarthy, MD:  

Yes, exactly. They have that symptom cluster, they have that mania, they have the depression and this cycling. But what’s causing that brain malfunction basically.

Lindsey:  

Yeah. So how do hormones play into mental health issues? 

Tracy McCarthy, MD:  

Hugely, is what I would say. I see that every day. I mean just looking at menstruating women in the degree of like premenstrual symptoms, whether it’s PMS or it’s PMDD, which is premenstrual dysphoric disorder, which is a more official psychiatric diagnosis where you really have extreme, much more strong mood symptoms or irritability in the week or so leading up to your period, I see a lot of that. It’s related to estrogen dominance. So too much estrogen, not enough progesterone or both. There’s lots of reasons for that. The gut comes into play here again, where the gut is impacting metabolism of estrogen, and so estrogen isn’t getting taken out of the body properly, and it gets recycled, and you get high levels, also xenoestrogens from plastics. You know, parabens and phthalates, these toxins are contributing to the estrogen burden, and then we deplete our progesterone through high stress, not enough sleep. And so imbalance is just really common, and it shows up for a lot of women.

That’s just one example, but I see it a lot. PCOS is another hormonal imbalance in women, polycystic ovarian syndrome, where they tend to have high androgens and irregular cycles. A lot of problems with hormone levels there. But you know, when we’re talking hormones, we’re not just talking sex hormones, right? We’re not just talking estrogen and progesterone. Also, testosterone is one of the sex hormones, and low testosterone absolutely will cause depression in a man. But we’re also talking about thyroid and cortisol and insulin. All of these hormones are key and are part of the picture, and they interact. And DHEA, there’s another one, you know, that’s a precursor for testosterone and made in the adrenal gland along with cortisol, and affects immune function so much. So it’s about for me looking at that full picture. And in my training with functional medicine, you really work on the cortisol and the insulin first, before you do much with sex hormones That said, I’m a big fan of hormone replacement therapy and menopause, I think is a game changer for women. A disservice was done to them with the Women’s Health Initiative study. When everyone stopped their hormones, I just see how they are, how much better people feel. 

Lindsey:  

I heard a podcast recently where they were talking about not just hormone replacement therapy, like the estrogen patch that your OB/GYN is going to give you, but like, going beyond that, like supplementing estrogen to the point where you’re back where you were when you were menstruating.

Tracy McCarthy, MD:  

That is a great question. I think there’s a lot of research that really needs to be done here, but I don’t know if it’s all going to get done. The hormone research is rife with issues like for example, you look at a study on progesterone, and a lot of it will actually include progestins, which are synthetic and not progesterone, and with estrogens, you run into this problem. That study may include oral progesterones And not just transdermal. Like I feel strongly transdermal is much, much safer and better than oral, or that will include Premarin, which is the horses estrogen, not human estrogen. So these are complicated, and with the current practices in what I see is a woman may come to me on HRT (hormone replacement therapy) that was sort of titrated to her symptoms. So she was doing menopause, she was having hot flashes, and symptoms, and she was given a patch, and they arrived at a dose that felt good, and that’s where she’s at. No one ever checks a level. That’s not what they do in OB/GYN practice, but I always do check the level, and so I’ll see them be at like, 34-40, I feel like, that’s the common number I see when people are kind of like, I feel better. But if you look at the functional medicine research going on with reversing cognitive decline, they’re using much higher numbers of estrogen for those people who need that, what we call trophic support, or that growth support for hormones from estrogen.

Lindsey:  

Yeah, what should people be shooting for? 

Tracy McCarthy, MD:  

Well I don’t think we can say what any one person should shoot for, so I don’t want to say that, but I will say that, like in these studies, they’re often somewhere between 50 and 80, for example. Obviously it’s got to be right for that person and be balanced out by the progesterone and not be causing symptoms. But I think there’s a lot of room for study here. I think these are very important compounds, and they have huge impacts. Progesterone’s a potent neurosteroid; we don’t treat it that way. It’s really awesome what it can do. So I think it’s an area that I hope we’ll see more and more research done, and I am happy to see the sort of grassroots resurgence of people saying, I want my hormone replacement. And there’s some good people in the forefront advocating for that. There’s some great OBs out there writing about it. So hopefully we’re going to see people’s brains and bones and bodies protected a lot more now.

Lindsey:  

Yeah, it’s sort of a funny issue, because in every way with functional medicine, we’re talking about  restoring what would be our natural health if we didn’t have such terrible food and environment, et cetera, et cetera. But in this one area, it’s not really natural that after somebody goes through menopause, that you then put them back on hormones, but at the same time, it’s going to probably keep them alive longer and healthier longer. 

Tracy McCarthy, MD:  

So yeah, you’re so right. And I have two thoughts about that. One is really, in functional medicine, we look at everything is just a tool. So is it a good tool or a bad tool, like the shades of gray. I’m certainly not anti medication, right? There’s some medications that are wonderful tools. For example, low dose naltrexone, right? But other medications are really terrible. These are tools, and we can be agnostic about them. I am not trying to recreate the Paleolithic era here. We don’t live in that time, and that’s not what we need to do. However, I did go into functional medicine, my introduction to it really was from the ancestral health movement. I was like, Well, what’s natural? That was my paradigm, because it made sense to me. And so I was like, why would you keep taking hormones later? But then, as I trained with people, and I learned, and then I saw the impact, I could not help but have my mind vastly changed. I cannot tell you how helpful hormones can be for patients, like game changing, for their brains and their functioning. To me, it’s like, if this can be done safely, and well, this is protecting people’s cognition and their bones, and the benefits are usually outweighing the risks. Obviously, everybody’s an individual, and that has to be worked on with their own doctor. But yeah, that’s where I’ve come to.

Lindsey:  

Yeah. So I understand you have a freebie for my listeners. Do you want to tell them about that? 

Tracy McCarthy, MD:  

Yeah. Like I said, my goal is for people to be aware that there’s these overlooked causes of depression and anxiety because no one talks about them. You go to your doctor and you’re told to take a pill and maybe get therapy and a discussion. And I want people to be empowered to know what else to look for. So this is my free guide about Top 10 overlooked causes of depression and anxiety. 

Lindsey:  

Yeah, wonderful. 

Tracy McCarthy, MD:  

And that’s just the place to get you thinking, Where might I be having a gap that I can start working on,  and it’s just a really good place to start.

Lindsey:  

Okay, and then so your website is DrTracyMccarthy.com. 

Tracy McCarthy, MD:  

Yes. 

Lindsey:  

Any final thoughts before we close?

Tracy McCarthy, MD:  

Just it’s been a pleasure to talk with you and to geek out on these favorite topics of ours here.

Lindsey:  

Indeed!

Tracy McCarthy, MD:  

They are worth people knowing about that. You know, I think you are like me, where it’s like people can be empowered and make so much change in their life when they have more knowledge and I just feel like people deserve to know what’s up. 

Lindsey:  

Yeah, I’ve had friends with the debilitating anxiety, and I really wish they would have followed the functional medicine route, and maybe they did to some extent, I don’t know. Because you have people saying, well, I did everything, I tried everything. And you’re like, did you try everything in the allopathic medical system? Or did you really try everything?

Tracy McCarthy, MD:  

Yeah, because if you tried everything outside of it, it is an amazing long list. We didn’t talk about a ton of different modalities, you know, is from tapping to psychedelics to, I mean, there’s just so many things, right? You know, we focus on the functional medicine components, which I think need to be looked at. But there is so much, so don’t give up. People don’t give up. 

Lindsey:  

Yeah, yeah. Well, thank you so much. I think there’s a lot of good tidbits here for people. 

Tracy McCarthy, MD:  

Well, you’re very welcome. Thank you so much for having me.

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.

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Keystone Probiotics: Cutting Edge Supplements for Gut Dysbiosis, the Brain, Immune System, Metabolism and Hormones with Dr. Shayne Morris

Keystone Probiotics: Cutting Edge Supplements for Gut Dysbiosis, the Brain, Immune System, Metabolism and Hormones with Dr. Shayne Morris

Adapted from episode 141 of The Perfect Stool podcast with Dr. Shayne Morris of Systemic Formulas and Alimentum Labs, sponsors of this episode, and edited for readability with Lindsey Parsons, EdD.

Lindsey:

Before you reached out to me about the podcast, I had not really heard of Systemic Formulas and Alimentum Labs. So can you just give a very brief background about those two entities and how and by whom your products are developed?

Dr. Shayne Morris:

Yeah, the Systemic Formulas products have been around since we started in 1984, and this gave us a really early entrance into the direct-to-clinician model, or the niche. It was started by my grandfather. He, in fact, started it back in the ’70s. Of course, it evolved, and it ultimately landed on Systemic Formulas* (use Doctor Referral Code: AZPA11 to access products). Clearly there was a need for some clinician-trained use for what we call dietary supplements or nutritional components, as well as herbal mixtures—therapeutic herbs. Ultimately, that led to the science of it all. My grandfather started in what we call ethnobotanical medicine, where he was traveling the globe learning about how these various herbs and other natural products were being used medicinally, mainly from native people of South America, the Polynesian islands, and Asia. He brought all that back.

What was exciting for us was that it was early. We say it was early, but it was only early for us—these things have been around for millennia, and yet they had really lost favor, being replaced by other, more modern approaches. But they were so powerful, and that’s kind of what led me into it. I started as a young child working with my grandfather, but I went back to school and really pursued the sciences—the hard sciences of natural products: biochemistry, molecular biology, genetics, and microbiology, which is now the microbiome.

Each and every one of these products benefits us through processes that are designed within us. These herbs have a particular medicinal benefit because of the way our body interacts with them. For anybody that doesn’t really gather that concept, you simply have to look at psychedelics. Natural product psychedelics clearly have an impact on our physiology. Some psychedelics can create hallucinations in our brain. So there’s this really intimate relationship between us and microbes and plants and fungi.

That’s what led me into this path as well, and Alimentum became a brand within the Systemic Formulas family that focuses on human genetics—the impact of nutrition on our genetics, on our cells. We call that cell-based nutrition, as well as the microbiome. The microbiome covers things like prebiotics, probiotics, and many of these really important nutrients that microorganisms need in order to maintain our health, protect us, manage our systems. We have all these axes—we refer to gut-brain, gut-lung, gut-heart. All these axes have to be well maintained. That’s really where Alimentum was born, about 12 years ago.

Lindsey:

And are you the one that develops the products?

Dr. Shayne Morris:

I do a lot of it, yes. We have a number of really amazing people here. We also have a research branch. So, there’s the family of Alimentum and Systemic that’s on the education, product, and sales side—which includes our sales team, marketing team, manufacturing, and education. There are some incredibly brilliant people in that area. But we also have a research and testing branch with a separate lab. It handles a lot of QC and R&D testing, and the scientists over there help me develop a lot of these things.

Lindsey:

Okay, cool. So today we’re going to be talking a lot about these keystone probiotics. Can you talk about what keystone probiotics are and how they differ from traditional probiotic strains found in typical supplements?

Dr. Shayne Morris:

It’s a really phenomenal topic. Whenever we talk about the microbiome, it can be understood in two ways. We’ve all heard it’s the collection of microorganisms that colonize us on every surface—sometimes even systemically. These amazing communities, or ecosystems, help keep us healthy. They support immune function, manage mucosal systems, and even impact neurological function through hormones and cellular signaling.

But there’s just so much information that people often simplify it down to “eat properly” or “take probiotics” or “eat fermented foods”—all great things, but they don’t always address the deeper issue. What’s the difference between a healthy, average, or dysbiotic microbiome? And that can apply anywhere in or on the body.

Keystone species have only been identified since we gained access to next-gen tools—ones that analyze not just microbial genetics, but also metabolites: what these microbes produce, what they’re doing, and how they benefit us. Keystone species are generally low in number—they don’t dominate—but they regulate the entire community structure. They’re essential to the structure of a healthy microbiome.

They’re necessary even in small amounts and produce compounds that are functionally important—not just for the other microbes but for us as hosts. They have a disproportionate impact. When you lose one, you often see surrounding organisms collapse.

My best analogy is a coral reef. Introduce one or two invasive species and it can collapse the whole ecosystem—destroy coral, push out fish, predators leave. But bring back the keystone species, and the whole thing rebounds: coral, invertebrates, fish, and so on. Over the past century, we’ve tried to reduce pathogen exposure, but in doing so, we’ve wiped out many keystone species. We want to bring them back to restore diversity and ecosystem stability.

Lindsey:

Yeah, in my experience looking at stool tests, I often see species disappear after people go through multiple rounds of antibiotics or strong herbal antimicrobials. Akkermansia muciniphila and Faecalibacterium prausnitzii are big ones. I was blown away to see F. prausnitzii in one of your probiotics—I didn’t even know that was commercially available. I’d love to hear more about that and the other keystone species you’ve got in your probiotics.

Dr. Shayne Morris:

Yeah, we’ve got a number. It’s taken us—really since about 2009—when we got heavily involved in microbiome projects. We knew about some of these species academically, but we didn’t yet know the future of probiotics. I mean, probiotics have been around for decades. We’ve all used some form of Lactobacillus, Bifidobacterium, Streptococcus, even yeasts like Saccharomyces.

These mostly came from the food industry—cheese, dairy, other fermented foods. So we always embraced the idea that living microbes could be beneficial, not just in themselves, but also through the metabolites they produce.

As the microbiome field exploded—it’s probably one of the most actively researched areas globally—we went from a handful of publications a decade ago to around 20,000 a year. With all that interest, we started trying to understand keystone species better. How do we go from identifying them in stool or saliva or the urogenital tract to actually growing them in stable, viable conditions?

That was our focus from 2009 to around 2017–2018. It was exciting, but also painful. The tech needed to grow these is tough—most are strict anaerobes and extremely sensitive ot oxygen-sensitive, even more than water. So that technology took us a bit.

But along the way, we also asked: what feeds them? What keeps them alive? What makes them want to take up residence—not just pass through? That’s where we started experimenting with different prebiotics. We used a lot of plant compounds: flavonoids, polyphenolics. Then we discovered they also need basic nutrients—certain B vitamins, glutathione, even a little carbon. These are the small but critical details we learned over time.

So we realized we not only wanted to support keystone species—we needed to educate people on the full scope of what a prebiotic can be. The current definition is a fiber or a microbial-accessible carbohydrate, but it’s much broader. It includes polyflavonoids, alkaloids, cyanidins—you’ve probably heard of ellagitannins or ellagic acid converting into urolithin A. That’s a keystone-driven microbial reaction with real physiological benefits.

So along with our probiotic work, we took the prebiotic journey too, incorporating a range of compounds—some not traditionally thought of as prebiotics, including human-derived ones like mucin and glycosaminoglycans.

Lindsey:

Let’s get into some specifics on the keystone species in your probiotics.

Dr. Shayne Morris:

Yeah. So the way we’ve approached organizing these keystone species is by identifying the systems where they’re most impactful. For example, we have something called Terra Terrain. While not all of them are keystones per se, they’re part of a larger need for soil-based organisms. Many of those are spore-forming. There are about five common commercial ones, but there are many more.

Looking more deeply into Europe, Africa, and Asia, you’ll find other species with real probiotic benefits—ones we’ve largely ignored in the U.S. But if you sequence healthy people eating from their gardens or local farmers markets, you’ll see these show up. Just a few examples: Bacillus lichenformis, Bacillus amyloliquefaciens, Priesta megaterium, Paenibacillus mucilaginosus, Bacillus indicus, which is more commercially recognized, there’s Paenibacillus polymyxa. These are all unique SBOs that we now have.

We’ve also partnered with people using kefir grains and kombucha SCOBYs from various places. We use the live organisms from the SCOBY and the kefir grains to then round out these more transient organisms. That’s one way we’ve incorporated the fermented food world.

Then we get into the actual keystone species. I’m going to list some of these off for you, but they’re their names are crazy. I have to say that microbiologists are not the greatest at naming things. But we have things like Micrococcus luteus and Staphylococcus epidermidis. Luteus is a gut-based keystone species, but it seems to have a benefit to our skin. It produces certain carotenoid pigments that end up in the skin, creating a UV protection, not unlike recommending the carotenoids from beta carotene to gamma, alpha, delta. Or you may have heard of other types of blueberry compounds or blackberry compounds that are protective in the skin. Well, we have microorganisms that produce similar compounds.

And then you have things Staphylococcus epidermidis, which is a skin commensal. And it’s brilliant, because it out competes Staphylococcus aureus. Now aureus is the problem child, and its main enemy, believe it or not, is staph epi (epidermis) is what we call it, and the competition between those two is significant. Epidermidis creates what we call bacteriocins that only reduce the aureus population—it has no impact on other organisms, just aureus. So when you see people that are suffering from Staphylococcus aureus issues, they likely lack epidermis in their skin. And that’s a really, when . . .

Lindsey:

And those are all in the Derma µBiomic?

Dr. Shayne Morris:

Derma µBiomic and the Derma Serum. Epidermidis is in there.

Lindsey:

So you have a topical for that? Wow, that’s awesome.

Dr. Shayne Morris:

Yeah, it’s a plant-based oil where we’ve tried to mimic a lot of the oils we secrete from the sebum, and then we’ve lyophilized the epidermis and also included Staphylococcus xylosus, another commensal. These are found on the skin in various regions, and they are protective in the fact that your immune system needs to know they’re there. It educates them. But they’re also protective against invading.

Lindsey:

And what does a skin infection with Staph aureus look like?

Dr. Shayne Morris:

The most familiar one is atopic dermatitis, especially in children. There’s a brilliant scientist, I forget her name, out of UC Davis or maybe Stanford. She studies pediatric skin conditions like psoriasis and atopic dermatitis. And she’s published a number of amazing studies showing that most atopic dermatitis on children is essentially an overgrowth of Staphylococcus aureus. And one of the unique features that differentiates aureus is when you have a rash that fills and looks like atopic dermatitis and it itches, the itch is somewhat indicative of Staph aureus, because they actually that organism actually sends a signal to create itching into our skin. It’s kind of devious, right?

Lindsey: Cool that you have a serum that fights it.

Dr. Shayne Morris:

Yeah, and for really recalcitrant versions, we actually tell people to open up Derma and Immune capsules and make a paste  and lather it on top of the issue prone area to really try to get these colonies to push back against the non-desirable. . .

Lindsey:

I can already think of a client who needs this…

Dr. Shayne Morris:

It’s incredible that—I mean, for me, it’s always an incredible journey to not only keep up with the ever-increasing and ever-amazing world of the microbiome and these organisms, but also the clinical applications that really range from our metabolism to our neurological health to our lungs and our kidneys and liver, etc., right? Some of these are really amazing at destroying metabolites—I mean, helping us metabolize xenotoxins, for example. It’s going to be an area that is ever-growing and ever-improving. And this is where we’re at the tip of the iceberg, but we’re excited to be here because it’s taken us a while to get here.

But let’s jump to, let’s say, on the immune front. So we know that the microbiome is incredibly powerful when it comes to our immune education, our immune evolution, and just navigating new threats all the time. And, you know, our keystone species in that regard are some interesting names. Again, we have some Bacteroides species—one of them is ovatus. We have uniformis, also Bacteroides. We have Roseburia hominis, which is a pretty fun one.

Lindsey:

I was very impressed to see that in there because that’s another one that often is depleted in people’s microbiomes.

Dr. Shayne Morris:

Right. And then we have another one called Collinsella aerofaciens. Again, a very unique keystone that has this incredible ability to help educate not only the area of the gut, which, you know, can be inflamed—the gut is, of course, overwhelmed by things like invading organisms, invading food, invading toxins, etc.—so it helps manage a lot of that immune/epithelial tissue regulation to keep things as managed as possible and healthy. It lowers inflammation, for example.

And then from the hormone front, we were able to get Bacteroides uniformis. We have Lactobacillus crispatus—a version of that that’s ours. That one, I believe, is now commercially available, one strain. And then we have Lactobacillus vaginalis, which is also a really important urogenital organism. And I oftentimes get the question: okay, we call it hormone balance in the microbiome, so we call it Hormone µBiomic and Hormone Superfood. Although there are a number of organisms that benefit women, no doubt, men also benefit. And in women, oftentimes people don’t realize that the organisms that colonize the urogenital tract are also found—or can transit—from the gut into the urogenital tract, likely because of the close proximity.

And when you study the consumption of pre- and probiotics to help improve the urogenital tract in women, taking them orally works. You can also use these in a suppository way, which is completely normal and healthy and fine. But you can also just rely on oral ingestion, and they will colonize. When that is their place, the body has this beautiful innate ability to help traffic these organisms to where they need to be. It’s quite a unique process. When they’re available and you’re feeding them properly, the body will do the rest in many cases. But for people that are struggling, we oftentimes recommend oral as well as suppository urogenital support.

Lindsey:

And have you seen that using these species in the Hormone µBiomic has some impact on hormones?

Dr. Shayne Morris:

Yeah, right now we’re conducting some observational preclinical work. So everything I have on the hormone—especially in women in childbearing years, as opposed to perimenopausal or menopausal—is anecdotal. But we’re getting some really good anecdotal data, very positive, improving urogenital health in regards to recurrent UTIs, just overall health of the urogenital tract, as well as the gut simultaneously.

Now we’re moving into sequencing samples and trying to follow these more specifically. And of course, there is a lot of really good data just surrounding the crispatus and the vaginalis that help us follow the academic work. So we’re kind of on a parallel path with academia as well regarding these.

And you’ve probably heard that female urogenital tracts have been classified into about five different classifications. The first four are essentially Lactobacillus-dominant ecosystems, and the fifth one is pretty much lacking Lactobacilli. It’s not as common, especially in industrialized countries, but it is just every bit as healthy—it just has a whole separate ecosystem or community that we look at. So in that case, you would support the gut, and then that unique person would have to feed and really encourage the growth of these other unique keystone organisms outside of the Lactobacilli that we can actually provide directly.

Lindsey:

Yeah, and those are also in that Hormone µBiomic?

Dr. Shayne Morris:

Yeah.

Lindsey:

And what’s the predominant species in that fifth type?

Dr. Shayne Morris:

Oh, the fifth type—those we don’t have. Those are unique. And so far, the work that’s been done and the work that we’re following—they’re not organisms that we’ve been able to culture and, of course, run the safety studies, etc., and get them ready to bring to commercial. But by employing the probiotics that are keystone—and especially the prebiotic world, so a lot of these superfood prebiotics—you can actually encourage the reconstitution of that particular urogenital classification through what we call nutritional intervention.

It helps bring back all of the external factors that drive dysbiosis in the urogenital tract of women. You bring that back. You make sure you understand whether or not they’re using cleansing products, or if their partner is healthy at the moment—avoiding a lot of the disruptive things—as well as reintroducing these healthy pre- and probiotics that help the GI manage the UTI. Because there is a connection.

And of course, the piece I can’t speak to at length today—because it’s a whole different topic—but you also have to monitor hormones. Hormone variations can absolutely disrupt the female urogenital microbiome. They’re intimately connected. If a woman is highly estrogenic—carrying way too much estrogen—we want to look first at their GI microbiome. Because if they have the enzymes—you’ve probably heard of these, these glucuronidases and galactosidases—they will re-cycle estrogen that’s being excreted. That increases the estrogen load in their bloodstream, which does, in fact, impact the epithelial lining of the female urogenital tract and can disrupt the microbiome.

Now, conversely, if there’s not enough estrogen, it will also impact the urogenital microbiome. That’s an area that needs to be looked into when there’s a recurrent urogenital problem in women. You’ve also got to look at the hormones, for sure.

Lindsey:

and how about the Metabolic µBiomic?

Dr. Shayne Morris:

Yeah. So we have, of course, our two—the last two—and we’re coming out with more, by the way. So this won’t be the end of the story. We’re about 70% through. The Metabolic µBiomic and its Superfood: we tried to take what was known, as well as our own research, and say, okay, metabolically, there’s a number of impactful things. We know that the microbiome has the ability to metabolize our food, whether it’s processed food or whole food. There’s a certain metabolic function that our microbiome has, and if that’s disrupted—one, by diet, and two, by the population or the ecosystem—it’s extremely impactful and detrimental on our metabolic uptake, the way we store lipids, the way we metabolize and sense sugar, and other areas of hormone production. And these neuropod cells that communicate directly to the brain through the vagal nerve and maybe even through the central nervous system.

This is a very, very enormous part of the microbiome’s job—and perhaps one of the more significant after the immune system—where, when you have a dysbiotic gut, you find that everything else, the number of hormones that you’re signaling, the number of neurotransmitters you’re making, the number of systems that are connecting through the vagal nerve and managing all of our endocrine system, our neuroendocrine system, as well as our detox systems—these are all starting to fail us. And this is why we have the chronic epidemics that we do. It’s one of the main features.

So as we were developing this, we decided to pivot. We knew the keystone organisms we wanted—and of course, foremost has been the Akkermansia. We have two different strains of Akkermansia, and they both—you know, we won’t get into strains too deeply—but they both impact. They have separate… when you think of you and I’s genetic potential, there’s going to be different things that you and I do genetically. Even though we might be 99.9% identical genetically, we have these little nuances—these things that you and I can do differently or better or worse—and each species of organism has the same potential. So you might have Akkermansia muciniphila, two of them, but they both maybe perform something a little bit differently. That’s the ongoing knowledge that we’re getting from these strains.

So we have two Akkermansia muciniphila. We have a Butyricoccus pullicaecorum, and that’s a really complicated name, again, and just from the name you can tell that it’s very much involved in maintaining small chain fatty acids from a number of food sources. So it’s Butyricoccus because it produces butyrate—and it produces butyrate that we really need to manage a lot of our epithelial metabolism in the gut. And then, of course, that becomes a systemic benefit as well. And in maintaining that, it creates an integrity in our gut lining that, of course, not only impacts the inflammatory process, but it helps us then manage our metabolic switches—whether we’re letting a lot of glucose in or we’re keeping it out, we’re triggering the L cells to produce more GLP-1 along with the Akkermansia, or do we want to produce PYY or CCK. And these are all what we call satiety hormones. These help us manage our metabolic uptake and the way we store it, and it’s critical.

And of course, now that’s blown up with this new generation of GLP-1 agonists, we can now have that conversation more, I guess, candidly, because the candor around GLP-1 is—it’s out there. And there are more than just GLP-1. Like I say, there’s a number of—you know—the ghrelin, the leptin, the PYY and the CCK. These are all hormones that our body has used, intimately related to our microbiota and our diet, to manage a healthy metabolic process. And we’ve disrupted all of those. So bringing it back to some of these organisms that help us do that is critical. And it’s been phenomenal science. So—excited about that.

Lindsey:

Curious, because I had only previously been familiar with the Pendulum products that had Akkermansia in them. And I know from their original experiments that after supplementing—I think their study maybe was two or three months—after supplementing it didn’t implant. And so I know they have a protocol that’s a bit longer now. So I’m curious, have you looked at implantation of Akkermansia and how long it takes and what you need to do to make that actually happen?

Dr. Shayne Morris:

Yeah, we have. In fact, we’re in the process of doing that right now as we speak. We’ve done it a few times. The work we’ve done so far has shown that pretty much every one of these has implanted and lasted over 60 days. Now beyond that, we didn’t run those further out, which we are doing now. We’ve only done it against one of the Akkermansia strains, so we only have data on one of the strains. The other strain, we have not looked at its—not only implantation—but what we call it taking up residency.

Lindsey:

And how long did they supplement for before you ran the 60 days?

Dr. Shayne Morris:

We ran stool at—so supplemented for 30 days—and then we ran it again at 60, and then at 90, and then we followed that washout period for another 60 days. We were seeing the organisms. After 30 days, we were seeing them regularly.

Lindsey:

Implant at the dose that’s in your product? At the recommended dosage?

Dr. Shayne Morris:

Yeah. Okay, yeah, exactly. And what we found just as fascinating in that—because that’s something we were looking for, right? That’s an experiment where you’re looking for something, you’re doing it. One of the surprising outcomes with these—and keep in mind, we were also giving them the prebiotic, the superfood at the same time. That was a requirement. We didn’t just do probiotic. We did a pre and a pro together. And my hypothesis is that’s an important feature we underappreciated. That if you just supplement a probiotic and then follow it—if you’re not giving it the nutrients that it requires—it will not really engraft and become a resident, because there’s no priority for it to. If it’s not getting its food, it’s going to leave—it’s going to bail.

So we’ve always run our studies with the pre and pro together. And what we found is not only were we seeing really healthy outcomes with the keystones, we started seeing the emergence of a lot of other keystone species that we don’t have, that no one has—but they were growing as a consequence of the pre and the pro journey. And we don’t know if they were just caught in there and they were just surviving at some low level, or if they were being introduced through contact with humans and food. We don’t know. We just know that in our dataset, we not only saw the organisms we were looking for, but we started seeing a lot of new organisms show up that were beneficial organisms. And we saw the reduction of the non-beneficial organisms—or essentially the pathobionts or pathogens—would decrease. And that’s because the whole ecosystem was becoming more competitive, and we weren’t feeding those, right? We were not feeding organisms that don’t belong there—we were feeding the ones that do. It was quite exciting.

And so we’re repeating some of those just to see how far we can take this. And when we did that, we only had probably about a dozen of the Keystones, and we now have more. So as we do this in the future, we can start adding more of these to see how we’re doing. And more of the pre and probiotics, like the superfood for the Metabolic, not only has plant-based compounds, it has a number of what we call human oligosaccharides or human polysaccharides that our body produces to maintain our own microbiome. And, you know, that’s important. It’s an important feature of our uniqueness—not just from a diet perspective, but from your own body’s ability to regulate the microbiome through the production of food for these guys.

Lindsey:

And I think we still have one left—the Neuro, is it?

Dr. Shayne Morris:

Yeah, the Neuro. The Neuro one is a really exciting one. This one was—in fact, a version of this was launched first. So back in 2018, we did a beta of the Neuro. Now, we’ve added since then, but key players in that were, of course, the Faecalibacterium and we had Parabacteroides—but we’ve added to this one since. In the early launch, we had the Neuro and the first version of the Neuro superfood. We called it Neurobiome. But both those together, again, we got really great anecdotal feedback. We got some good stool feedback.

And because we knew it was early on, we went through the beta, collected all the data—I think I had somewhere around 4,000 data points from practitioners using it in their clinics during the beta test. And then we went and reset it. We actually reformulated it in 2021 to get a better result than we got the first time. But we’d also learned more from academia. I mean, there are these two researchers in Ireland—Dinan and Cryan*—who are phenomenal. They coined the term “psychobiotics,” so we follow their work, and it helped guide us in this new direction.

But in that product, of course, we now have Parabacteroides distasonis, Agathobaculum butyriciproducens—again, that’s a butyrate producer but it’s a unique keystone. You probably haven’t heard that name. It’s a unique name—Agathobaculum. That’s pretty cool. We have M. Vaccae, and of course we have an L. farciminus. So there’s a number of unique ones there as well—and more to come.

And really, what we’re looking for there—we have a GABA producer in there. It is a Lactobacillus, but it produces GABA. We know that from looking at the studies, and that’s actually from work with a supplier—a group that creates probiotics. And then a number of these organisms are known to produce what we call neurotransmitters or neurochemicals. They don’t all cross the blood-brain barrier, but they still do what they need to do systemically—your serotonin producers, your dopamine producers, the L-DOPA process, as well as the GABA and glutamine and glutamate.

So there are some pretty amazing organisms that we’ve now utilized in this approach to their neurological microbiome with the Neurobiome—or the psychobiome.

Lindsey:

There’s a lot of exciting stuff there. And I’m honestly quite excited to know about these products and to think about who I’m already working with who could probably use some of these. So I’m curious about the specific foods—because we did talk about polyphenols and cyano… whatever they’re called, cyano-something or others, yeah—but when people are actually eating food, what kind of foods are going to most help nourish and support these keystone strains?

Dr. Shayne Morris:

Yeah, that’s a great question. And to be honest with you, I love whole foods. But you’re right—it’s going to depend on where people are starting from. So if you take a relatively healthy 20- or 30-something who’s already been on a wellness journey, they’re going to be able to start with some pretty nutrient-dense, fiber-rich foods—these microbial accessible carbohydrates. That can be from the brassicas. They can start incorporating, at a minimum—we all need to get to the point where we’re utilizing at least 30 to 60 different vegetables and fruits per week, at a minimum. That’s quite an ask, right, when you think about it.

This can include a decent dose of what we call non-staple foods. So we can all increase the amount of broccoli, beets, asparagus, radishes, various squashes—the gourds, the pumpkins. We can all increase the leafy greens, the strawberries, the blueberries, the blackberries. We all have access to those—and hopefully to good, clean versions of them.

But on top of that, there are these unique ingredients we get from other plants—plants we wouldn’t normally include in our diet. Herbs and spices—we might think of them as medicinal, like turmeric, ginger, ginseng, resveratrol from chicory root. These are compounds we’ve thought about medicinally, but I want people thinking about them from a microbiome perspective.

A lot of these—especially tubers—are important when it comes to microbiota. The resistant starches, you’ve probably heard that term. We really encourage including resistant starch-based foods. A purple potato or sweet potato or yam—if you cook them twice or cook and freeze them, that process creates what we call resistant starch. So you drop the glucose impact on the body and increase the microbiome benefit.

And then we use other plants that bring in things like glucomannan, galactooligosaccharides, xylooligosaccharides, polymethoxylated flavones. We use dragon fruit, larch extract with arabinogalactans, baobab pulp, Indian kino, turmeric, Poria (a mushroom)—all high in medicinal value and amazing for the microbiome. Things we don’t normally think of, but that exist in mushrooms and other plants—especially tubers—are all involved in what we call our prebiotic presentation.

Even things like pectins, cassava, butterfly pea flower, cranberry—certainly important for women—these are all what we call plant-based carbohydrates. But it’s not just the carbohydrate we care about—it’s the phyto constituents, the phytochemicals like polyphenolics, polyglucosinolates, and others.

Across our prebiotics, for me personally—and this was a personal journey—it was really hard to get my 50 to 60 veggies and fruits per week. So I wanted to incorporate all of those into our prebiotics. Doesn’t mean you can’t do it with whole foods. Someone really dedicated can source many of these organically—especially if they live where you can grow food year-round, without harsh winters. But we dry and include them in our prebiotics.

If I take two or three of my prebiotics a week, I’m hitting 30+ plants and fruits and vegetables, and I feel much better about it. I encourage people to eat whole foods and also use pre- and probiotics. It’s tough to jump right into this. Depending on where someone is starting, if they’ve been really neglectful of diet, then they need to introduce prebiotics slowly—even if they’re food-based. Ginseng, fruit, saccharide-containing foods, onions, garlic, broccoli, etc.—introduce them slowly so the microbiome can catch up.

If not, you might get a rebound effect—microbes aren’t happy, convert things into gases, you might get bloating, cramping, gas, changes in bowel movements. So you’ve got to go slow to let the microbiome adapt. The most I’ve seen someone need is about two weeks—by then they’re feeling great, no more pushback, and they can begin rotating in more.

I rotate monthly—different versions, different diets. I always tell people: eat for the season, eat for your ancestry. There’s a genetic component to this. So eat your ancestry, eat your seasonal—both help guide where you’re headed.

Lindsey:

Does that mean—because I’ve got Italian in me—I can eat a lot of pasta?

Dr. Shayne Morris:

You can eat good pasta. And really, if you’re getting pasta from Italy, those grains are absolutely healthy. I mean, there are a number of studies that have shown how the ancient grains—especially heirloom grains grown in areas that are still healthy, without glyphosates and other high-production food treatments—are phenomenal for the microbiome, and especially supportive of both your ancestry and your microbiome. And then you can just infuse that with Italian plants, and you’ll feel amazing from that.

Lindsey:

So what should consumers know when they’re using probiotic supplements? Because there’s such a variety—some are refrigerated, some not. There are different types. How do you sort it all out?

Dr. Shayne Morris:

Yeah, it’s a lot. I’m glad you asked because it can be so frustrating. With this microbiome revolution, everyone’s trying to understand probiotics, prebiotics, postbiotics, synbiotics… it keeps expanding.

My take is—work through clinicians. Clinicians can stay on top of the education and understanding, and that helps patients get better input and outcomes. When you’re looking at probiotics and prebiotics in the mass market, it takes work to sort them out. The growing field has created a marketing machine. So even if you don’t want to work with a clinician long-term, at least consult one. Don’t just rely on marketing. The marketing is one thing—but the data is another.

A lot of probiotics out there are still old-school, transient types. They come from the dairy industry—cheese, milk, yogurt. And while those aren’t bad, they don’t necessarily generate the outcome you might want. When you take a probiotic, it could offer general benefits. But probiotics can also be used as a precision tool. If you’re taking a general probiotic from a fermented food source that’s not human-based, it might have a general, transient benefit. It can help shift nutrients and encourage growth of existing organisms. Things like kefir, kombucha, kimchi, sauerkraut—all of those can do that.

But when you need precision, you have to understand what’s in the product. Do they contain keystone organisms? Are they human-based, clinically studied organisms like Lactobacillus and Bifidobacterium? The ones we use in Alimentum, if they’re Lactobacillus or Bifido, they’re still human-origin—not dairy-origin. That allows you to be more precise, especially for things like IBS, IBD, gut-liver axis, gut-brain axis, etc.

So you really need to dig into the label, talk to your clinician, and understand the formulation to get that benefit. Otherwise, you see people saying, “I took a probiotic for a few weeks and didn’t feel better, so I gave up,” or “I took a prebiotic and felt worse, so I stopped.” That’s not what we want. We know the benefit is there—we just have to use them appropriately.

Lindsey:

Right. There are so many different types. And like you said, the strains are different. So it’s crazy to think, “Oh, I got this one from CVS,” versus the ones you’ve got. It’s like the difference between eating an apple and eating a bag of chips. There’s no comparison.

Dr. Shayne Morris:

Exactly. It’s very different. And that’s the future of this—we need people to know the benefit is there. But they need to know how to use it. I’d love to make it simple—but it isn’t. It’s powerful, and we have to understand it. Because if it’s misused or used out of context, you don’t get the result. And then people lose faith—and that’s not what we want. We want them to get the benefit, but we have to start with appropriate use.

Lindsey:

Brief segue into another topic. I saw on your website you have a product called Pseudo Vyrome—and I noticed it’s a bacteriophage that specifically targets Pseudomonas aeruginosa, which I know can be a lung pathogen. I had a client with a chronic lung infection with this bacterium. Could you briefly explain what bacteriophages are and talk about Pseudomonas aeruginosa?

Dr. Shayne Morris:

Yeah, it’s such a unique part of our microbiota. So, what are bacteriophages? They’re probably the most dominant micro—I’m going to call it a microorganism—even though it’s not technically alive. It’s in the virus world. A phage is a virus that only targets bacteria.

In us and on us, we have bacteria, bacteriophage, eukaryotic fungi, some parasites, and mammalian viruses. But the vast majority are bacteria and phages. Phages are viruses that target specific bacteria. They live in us and move through us. You’re exposed to trillions of them in the ocean, lakes, soil—just pulling a carrot out of the ground, for example.

Phages help manage bacterial populations. If a bacterium grows out of control, phages grow alongside them to bring the numbers down. Without that control, bacteria could overwhelm us or any animal or plant. Phages attack and destroy bacteria. And they’re super specific—there’s a phage for E. coli, Salmonella, Pseudomonas, Bacteroides, Lactobacillus, Bifidobacterium—pretty much every bacterium we’ve looked for.

We use phages nutritionally as a kind of prebiotic—to help maintain a healthy ecosystem. They help promote eubiosis and reduce dysbiosis. Research is still limited, especially here in the U.S., but there’s a long history of phage use in Eastern Europe. Now the science is growing again in the U.S. and Europe.

So we’re using phages to help maintain balance in the gut, skin, and maybe other areas, though we still know very little about their role in organs like the lungs, liver, or kidneys.

Lindsey:

I suggested it to my client—so I’ll let you know if he has any positive effects!

Dr. Shayne Morris:

Please do, yeah. It’s amazing.

Lindsey:

Where can listeners learn more about your work, your research, and the products?

Dr. Shayne Morris:

We’ve got social media—my Instagram is @drshaynemorris. Also Alimentum and Systemic have social platforms. And there’s a website: alimentumlabs.com* (use Doctor Referral Code: AZPA11 to access products). Also systemicformulas.com. We’ve got another one called NBResults—that’s more on the DNA side and will be the future for microbiome testing.

We’re creating more all the time. We’re just getting to the point where we can really get out and tell the story. We’ve been in the lab for 12 years, and now we’re emerging from it so we can start sharing all of this.

Lindsey:

Everybody should check the show notes for all the specific links and such. Thank you so much for sharing all this information with us!

Dr. Shayne Morris:

Yeah—thank you for having me on. It was such a pleasure.

Lindsey:

If you’re interested in accessing these probiotics with unique keystone species, there’s a link* and referral code (AZPA11) to register for an account on Systemic Formulas.

But I highly recommend setting up a consultation with me first—and doing a stool test—to figure out which species you most need to replenish and whether you need to address any pathogens first.

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.

Schedule a breakthrough session now

*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.

Mold, Mycotoxins & Your Microbiome: When to Suspect It and How to Deal With It

Mold, Mycotoxins & Your Microbiome: When to Suspect It and How to Deal With It.

Adapted from episode 140 of The Perfect Stool podcast and edited for readability with Lindsey Parsons, EdD.

When should I suspect mold toxicity or mycotoxin illness? 

While I feel most comfortable in my niche area of gut health and autoimmunity, I have found myself quite often recently working with clients who didn’t realize that underneath their gut health issues was mycotoxin illness. The way I usually discover this is that either the gut issues just aren’t getting better, or they can hardly tolerate any supplements that impact gut issues, or in our initial intake they mention a potential past or current mold exposure. So we do testing for mycotoxins and sure enough, they come out positive for some, or in some cases, nearly all tested mycotoxins.

I looked at these clients and I was trying to find common symptoms with all of them, and the one that I have noticed for all of them, anecdotally of course, is anxiety. While they might mention it on our first call, this manifests itself pretty clearly to me in frequent emails to ask numerous questions, worries about how they will follow my recommendations, clarifications of how to precisely follow instructions, and the general need for reassurance that they’re doing the right thing. Some had constipation, which in several cases was also caused by diagnosed methanogen overgrowths, almost all had food sensitivities, usually including histamine reactions, some worse than others.

And for the ones who I suspect had genetic susceptibilities affecting detoxification or immune regulation which would make them particularly vulnerable to mycotoxin illness, symptoms often appear across multiple body systems, from the skin, to headaches, brain fog, breathing issues, hair loss and autoimmune diseases. And many showed obvious signs of yeast, like a white coating on their tongue or recurrent yeast infections. But all that is just my anecdotal experience. Let’s delve into the official information on all of this. 

What are mold and mycotoxins? 

Mold grows on organic substances and decomposes them to absorb their nutrients. It grows optimally in moist environments with organic material to feed on, with humidity levels exceeding 70%.

Mold and fungi release mycotoxins as a defense mechanism against predators. These mycotoxins may help weaken host defenses in animals and plants, though their primary role is often competitive — inhibiting other microbes, which indirectly helps the mold in colonizing. Fluctuating environmental conditions (temperature, moisture, UV exposure and nutrient scarcity) can also trigger the release of mycotoxins. Finally, some mycotoxins are produced naturally as a result of environmental stress, namely oxidative stress caused by environmental factors, including fluctuating oxygen levels, nutrient scarcity or chemical exposures. As a result, harmful gases, such as superoxide radicals, hydrogen peroxide and hydroxyl radicals are formed within fungal cells under stress conditions. Highly fluctuating oxygenation levels, like rapidly moving from low to high oxygen levels (i.e a fungus being buried underground to sprouting out of the ground) can also cause the release of these harmful gases.

Where is mold commonly found? 

Common sources of mold exposure include water-damaged buildings, especially those affected by flooding or leaks, as well as poorly-ventilated, moisture-prone areas like bathrooms, laundry rooms, attics and crawl spaces. Mold can also grow inside plumbing systems, air conditioning units, and older carpets and appliances, particularly when they trap moisture. In humid climates, mold is more likely to thrive both indoors and on stored foods such as grains, coffee, cocoa, dried beans, sesame seeds, cheese, yogurt, malt, beer, nuts, fruit, dried fruit, and spices, where improper storage can encourage contamination.

Is everyone affected by mold? 

Mold spores are found ubiquitously in the air we breathe. However, most people do not experience adverse effects due to several mitigating factors. First, our immune system is capable of clearing low level mold exposure. Also, neutrophils in the lungs kill germinating mold spores asymptomatically. However, for people with compromised immune systems or lung function, they may be at a higher risk of developing adverse health effects after exposure to mold. Furthermore, only a few species of mold are harmful to humans. The overwhelming majority of mold species are not harmful to humans, which are called saprophytic molds, which feed on dead organic matter and typically do not infect humans, and many more don’t even produce mycotoxins.

Of those that do produce mycotoxins, only a handful are pathogenic. Finally, genetics play a large role in determining whether or not a person is highly susceptible to mold toxicity. Genes involved in immune regulation, detoxification pathways and inflammatory cytokine production can influence how someone responds to mold exposure. Specific genes like HLA-DR have been implicated in mold illness susceptibility, particularly in people with Chronic Inflammatory Response Syndrome (CIRS). People with certain cytokine gene variants may be more prone to chronic inflammation after mold exposure.

Do mycotoxins affect the gut microbiome?

Mycotoxins can significantly disrupt the gut microbiome, leading to dysbiosis, or microbial imbalance. Research shows that mycotoxins reduce beneficial bacteria such as Lactobacillus and Bifidobacterium, while promoting the overgrowth of inflammatory species, particularly from the Proteobacteria phylum. Mycotoxins have been shown to damage the epithelial lining of the gut, increasing gut permeability. Increased gut permeability allows undigested food particles, toxins and microbes to enter the bloodstream, putting stress on the immune system and, over time, can dysregulate immune responses. This microbial imbalance and leaky gut is at the root of food sensitivities and chronic inflammation, creating a cycle of ongoing gut damage and immune activation, which may manifest as brain fog, joint pain, skin issues and autoimmune flares. 

Mycotoxins also impair the gut microbiome’s detoxification capacity, further weakening the body’s ability to clear toxins and maintain gut barrier integrity. These toxins can further alter the gut ecosystem, amplifying inflammation and weakening the gut lining. However, research suggests that prebiotics and probiotics may help restore microbial balance and enhance the gut’s ability to metabolize and neutralize mold-related toxins before they trigger further disruption. Supporting a diverse and resilient microbiome may be one of the most effective strategies for protecting gut health in the face of mold and mycotoxin exposure.

Can mycotoxins lead to SIFO or candida? 

The modulation of the gut microbiota by mycotoxins can also lead to SIFO (Small Intestine Fungal Overgrowth) or Candida overgrowth. While candida is a normal resident of the gut, when it overgrows it can extend beyond the gut, through hyphae, which are branching filament-like structures that can penetrate gut tissue, contributing to intestinal permeability. Systemic candidiasis can manifest as bloating, sugar cravings, sinus congestion, skin rashes, brain fog or fatigue, and may also be evidenced by yeast infections, fungal nail infections or thrush, which can be seen as a white coating on the tongue. 

How do mycotoxins affect your immune function? 

The inflammation and immune dysregulation associated with mycotoxins may contribute to the reactivation of chronic infections like Epstein-Barr or Lyme, or gut pathogens like C. difficile, due to weakened immune surveillance, which allows latent infections to flare. Mycotoxins can impair immune defenses against pathogens and disrupt the gut’s natural detoxification processes. This can lead to a whole slew of health issues such as inflammatory bowel disease and irritable bowel syndrome, as well as extra-intestinal diseases, including heart disease, obesity, type 1 diabetes and celiac disease.

Mycotoxins have also been connected to mast cell activation syndrome (MCAS), and histamine intolerance. So when I see histamine issues, my first thoughts are either mycotoxins or hydrogen sulfide producing bacteria. 

What are the symptoms of mold toxicity? 

The symptoms of mold toxicity are highly variable between individuals and can mimic gut symptoms, including abdominal pain, nausea and diarrhea. Respiratory symptoms, such as rhinitis, coughing, wheezing, sinus congestion and tenderness, and respiratory infections such as bronchitis and pneumonia, are frequently reported. Skin irritation and mucosal irritation, such as dry eyes and pharyngeal cobblestoning, are also commonly reported. Some individuals may experience headaches and sensitivity to bright lights. Some studies have also reported symptoms like anxiety, depression, muscle aches and cramps, joint pain with morning stiffness, unusual pains around the body, excessive thirst, a metallic taste in the mouth, weakness and fatigue. As mold toxicity progresses, some individuals may experience deficits in their neurological functioning, including deficits in short-term memory, executive function/judgment, numbness and tingling, disequilibrium and dizziness, and poor concentration and hand/eye coordination.

Mold toxicity, in conjunction with other health issues, may exacerbate other symptoms not usually related to mold toxicity. So while you may have some slight gut issues, if you pile mold toxicity on top of that, it can seem much worse and become impossible to resolve your gut issues until the mycotoxin issue is addressed first. 

It is important to note that the symptoms attributed to mold toxicity are still debated, as many symptoms overlap with other conditions, many of them mundane. 

How do you test for mold in your home? 

If you suspect a mold issue in your home, relying on visual inspection alone is often insufficient. Mold spores themselves are microscopic and invisible to the naked eye, and mold growth can occur inside walls, under flooring, or in HVAC systems, where it cannot be seen without specialized tools. Humidity meters do not detect mold spores directly, but they can identify excess moisture and humidity levels, which create ideal conditions for mold growth. For a more comprehensive evaluation, ERMI (Environmental Relative Moldiness Index) and HERTSMI-2 tests, which analyze dust samples for mold DNA, are useful screening tools — especially for assessing past or cumulative mold contamination in water-damaged buildings. EnviroBiomics is a company that offers these tests (I believe you order the plates and lay them out in the house then send them back for analysis) and I’ll link to that in the show notes. However, they are not diagnostic on their own, and results should be interpreted alongside a thorough home inspection. One company that does mold inspections is called Environmental Analytics, and I’ll link to them in the show notes. 

Air and surface testing can also help detect mold, with active air sampling being a common method where a pump draws air through a filter, which is then analyzed for mold spores and other pollutants. While air sampling provides a snapshot of airborne mold levels, it can miss hidden mold or fluctuating spore counts, so it is best used in combination with moisture mapping, thermal imaging, and targeted surface sampling. If you suspect mold damage, it’s highly recommended to hire a professional mold inspector, preferably one who is independent from any remediation company to avoid conflicts of interest. In states with mold regulations, such as Texas and Florida, this separation between inspection and remediation is required by law, ensuring a more objective assessment.

How do you test for mycotoxins in your body? 

When I suspect mycotoxins, I use either the Mycotoxin Panel from US Biotek/Real Time Laboratories (which recently merged), the Mosaic Diagnostics Mycotox or Vibrant Wellness’ Mycotoxin Panel. These are all urine tests. For someone with ongoing nasal/sinus issues, I may also suggest a MicroGen DX SinusKEY test, which uses qPCR technology to check for 57,000 potential bacterial and fungal pathogens in the sinuses. I sometimes am also clued in to potential mycotoxin issues when I see elevations on the Mosaic Organic Acids Test in markers 2, 4 and 5, which are indicative of aspergillus, a type of mold that can be environmental. Vibrant Wellness’ Organic Acids test also has these same markers: 5-Hydroxymethyl-furoic acid, Furan-2,5-dicarboxylic acid and Furancarbonylglycine – you’re looking for the words furan or furoic in these longer, more complicated names for potential environmental molds.

However, these can often be negative while mycotoxin tests are positive because there are many different types of mycotoxins and most of them are not measured on an Organic Acids Test. Generally, I recommend testing your body before your home, as the various mycotoxin tests currently run from $289-$400 each, whereas a home inspection I’ve heard can cost around $500. Not to mention that you may be exposed to mycotoxins at someone else’s home that you visit frequently or at your place of work. 

How do I heal from mold toxicity? 

If you determine that you have a mycotoxin issue, the first step is to either get out of the moldy environment or have it professionally remediated. And I’d recommend that if you are very impacted by this issue, that you remove yourself from the home or building during remediation. You should never take care of this problem yourself, but hire a professional mold remediation service. 

If you can’t get out of the environment or remediate immediately, you can take binders specific to the mycotoxins detected on your test until you can get out. Until then, it’s not recommended that you take antifungals, as this may be too much for your system to handle while still in a moldy environment, and will be futile, because you’re still taking in mycotoxins. However, taking binders on an empty stomach with plenty of water can help bind up the mycotoxins and prevent damage in the meantime. 

If you’re doing this without the benefit of an MD or naturopath who has prescribing rights, the binders you’ll likely have access to will be activated charcoal, which binds ochratoxins, aflatoxins and trichothecenes (tree-co-thee-scenes) and bentonite clay, which binds, gliotoxins and aflatoxins, and Saccharomyces boulardii* (a probiotic yeast) and NAC, which bind gliotoxins. Chlorella and bentonite clay may help bind certain mycotoxins, including trichothecenes.

I often recommend Quicksilver’s Ultra Binder* or Biocidin’s GI Detox* as all-around binders with several of those compounds in them. If you’re very sick and/or sensitive, you may need to start with less than an entire capsule of binders to start, even ¼ capsule mixed in water for example, just to check your initial reaction. You may experience a die-off or Herxheimer reaction that feels like getting the flu. If that’s the case, I suggest you titrate up very slowly, but eventually, you should get to 1 capsule 3 times a day of binders, always on an empty stomach with plenty of water, with at least an hour before eating and two hours after eating or taking supplements. If you’re constipated, you may need to take additional magnesium citrate (I personally like the Natural Vitality Calm* powder, which is magnesium carbonate that turns to citrate in water) to promote bowel movements as binders can be constipating. You should get up to the full dose of binders before adding in any antifungal agents. 

For many mycotoxins, supportive nutrients like vitamins C and E, selenium, zinc and magnesium are good to have on board before going through detoxification protocols. In addition, using NAC, glutathione,* CoQ10, melatonin and polyphenols can positively impact your health, protect your body from oxidative stress and open up detoxification pathways. 

When it comes to helping clients actually kill the molds, I educate clients on the protocol developed by Neil Nathan, MD, who leans on the Dr. Brewer protocol, and described in his book Toxic: Heal Your Body from Mold Toxicity, Lyme disease, and Multiple Chemical Sensitivities, and Chronic Environmental Illness*. His protocol involves the use of Argentyn 23 (hydrosol silver) nasal sprays to start, to test sensitivity and then work synergystically with antifungal nasal sprays. He recommends prescription nasal sprays made by compounding pharmacies, because many molds have come from the air and may have settled in your sinuses. When those aren’t available, the Xlear* nasal spray (xylitol-based) with added drops of Biocidin* (10 drops per 1 ounce of spray) is a reasonable alternative, because Biocidin is a strong, combination antifungal agent. All nasal sprays start at one spray a day then go up to as many as 3 sprays per day, if you can tolerate it. And again, you don’t move on to the next stage until you can tolerate both binders and nasal sprays. 

Dr. Nathan then recommends using prescription itraconazole (brand name Sporanox), a systemic antifungal, starting at a dose of 100 mg every two weeks and slowly working up to 1-2 doses per day. 

When prescription options aren’t available, Biocidin* drops are again a good option, starting with 1 drop a day and working up to 15 drops twice a day or 10 drops three times a day, 15 minutes before meals. Other natural antifungal agents include berberine, oregano oil, grapefruit seed extract and undecylenic acid (primarily targeting Candida). Most of these are very strong antibacterial agents as well, so it’s wise to protect your microbiome with supportive prebiotic foods while taking them, like pomegranate powder, cranberries or cranberry powder and matcha green tea powder.

I often suggest clients combine these into a gut healing smoothie with collagen, l-glutamine and any other powders people may be taking like AuRx*, a palatable butyrate powder which helps firm up stool for people with loose stool or diarrhea as well as helping seal the colon, and serum bovine immunoglobulins, which can help bind fungi and pathogenic bacteria and and support gut barrier function. This combo can help seal up a leaky gut and protect you from autoimmunity and inflammation. A diverse probiotic with well-researched strains may also help with gut health during a mold protocol. I like Seed Synbiotic* as a general lacto-bifido type probiotic. 

Dr. Nathan also adds SFI Health Ther-Biotic Interfase Plus* to disrupt biofilms. I think it’s wise to wait until you’ve gotten to the point of tolerating daily doses of antifungals before starting this, as it may increase die-off. This is taken by itself with water on an empty stomach an hour prior to antifungals. 

Other helpful modalities for supporting detoxification from mycotoxins include infrared saunas, coffee enemas and lymphatic drainage using self-massage or dry brushing, and any activity that will make you sweat, while bringing in adequate hydration and electrolytes of course. There are links for those things in the show notes. 

There are lots more details about how Dr. Nathan treats mold, so if you are thinking of self-treating or trying to ask your conventional doctor for prescription antifungals, I’d recommend getting his book before launching into this project, although it’s much safer to work with a practitioner and have guidance as things often go differently than expected/planned when taking supplements and medicines. 

I mainly wanted to take this time to alert you to the idea that your gut health issues could have their roots in mycotoxins, as sometimes I’m not even thinking about mycotoxins unless you suggest it may have been an issue, and only you will know about potential mold exposures in your past or present. So do be proactive with me or whoever your practitioner is if you’re experiencing symptoms like I described in this podcast, have recalcitrant gut issues or remember living in a moldy, mildewy place in the past.  


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.

Schedule a breakthrough session now

*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.

Microbiome and Motility Hacks: Probiotics, Prebiotics, Fermented Foods and Fiber for SIBO and IMO with Alyssa Simpson, RD

Microbiome and Motility Hacks: Probiotics, Prebiotics, Fermented Foods and Fiber for SIBO and IMO with Alyssa Simpson, RD

Adapted from episode 139 of The Perfect Stool podcast and edited for readability with Alyssa Simpson, RD and Certified Gastrointestinal Nutritionist and Lindsey Parsons, EdD.

Lindsey:  

So, we had a great conversation about autoimmunity on Alyssa’s podcast, The Gut Health Dialogues, last week, and I’m glad to have you here this week to talk about prebiotics and probiotics and fiber and stuff like that. So before we head into the meat of it, can I ask how you got into working with digestive issues?

Alyssa Simpson:  

Yeah, you know, it’s actually kind of funny, because I didn’t really have digestive issues until I started working with people with digestive issues. I had been a dietitian for about 11 years, just doing general nutrition, lot of diabetes, I was a certified diabetes educator, and I had always wanted to be in private practice, so I left my job, quit my job, started a private practice. Around the same time, I was learning more about integrative and functional nutrition, which is a whole other learning curve, and there was so much stress between starting a new specialty, starting a new business, and I developed really, really severe acid reflux and constipation. It was just general chronic-stress related, I know that’s what triggered it, and then the whole landslide that came with that of food sensitivities and then learning how to really manage my stress as the root cause.

It’s been a journey, because I was initially waking up, you know, it was affecting everything, my sleep, because I couldn’t fall asleep because I was coughing from the reflux. And my throat was sore all the time, and I actually was downing Pepto Bismol in between clients. And I thought, I’m a gut health dietitian, what am I doing? So I did end up getting more interested – I was focusing on integrative and functional, but that made me really start to focus in on gut health. And it’s been a journey.

And even most recently, everything’s been under control and managed, but I’m still learning more. One of the things I learned about recently was vagal nerve stimulation, and so now I’m doing that, and that kind of has brought me to a whole new level of calming my nervous system. So that’s my story, and I am now focusing mostly on the gut. I think just as a result of having the connections I have, a lot of the people that find me, they just don’t know what’s wrong with them. They’ve seen a gastroenterologist. Maybe they have, maybe they haven’t. A lot of them have, just because I have a lot of gastroenterologists that refer to me, but they’re still having issues, and they don’t know why. So that’s kind of the person I help and you know, often those are functional issues, especially if there isn’t something that’s been structurally diagnosed. So we’re looking at IBS, SIBO, things like that.

Lindsey:  

Yeah. So for people with SIBO or IMO, Intestinal Methanogen Overgrowth, first of all, do you recommend probiotics while treating SIBO or IMO? Or is that something you like to leave for after treatment? Or is it part of the treatment itself?

Alyssa Simpson:  

You know, yeah, I don’t start off with them. I definitely know a lot of people that already come to me. They’ve already tried probiotics. A lot of times they tried it and it made things worse. And that’s because if you do have SIBO, and this might be true whether or not they know they have SIBO, but if you do have SIBO, sometimes a probiotic, depending on what strain it is, can actually add to the overgrowth you already have, and it can stimulate symptoms. So that would be especially lactobacillus strains, because those can tend to accumulate in the small intestine, versus other strains that tend to populate more in the large intestine.

So the answer to your question is, I actually am all for starting one early on in the SIBO process. So in a perfect world, I do, and usually it’s going to be a spore based. I was using Bifido blend for a while, and I’m still liking that, but I’ve switched to spore based for that purpose. But those are both ones that are less likely to aggravate SIBO while the overgrowth is active. But the reason there’s a little caveat there is I do notice that throughout the protocol, people have very sensitive systems. There’s a lot of supplements sometimes that we need to use, and so I tend to layer things in just for the ease of the patient, and not just load them up with a whole bunch of things. So sometimes I don’t add the probiotic until a little bit later for that reason, just pill burden and patient sensitivity.

Lindsey:  

What about the whole consideration of, am I just killing off whatever probiotics I’m putting in there?

Alyssa Simpson:  

Oh yeah, so even with the spore based, because, technically, the spore based should be protecting itself, but I’ll still have them take them a couple hours away from the anti-microbial just to decrease that.

Lindsey:  

Right. And are there particular probiotics you like in a situation with diarrhea versus constipation or are the spore based good for all those?

Alyssa Simpson:  

Actually, for diarrhea, Saccharomyces boulardii* is really good. So a lot of times, especially if somebody really has no idea what’s going on yet, so typically, with that person, I’d want to do a stool test and a SIBO test just right off the bat, unless they’ve had one already. But I’ll just start them off on the Saccharomyces boulardii sometimes, because that can be really helpful in calming down the diarrhea.

Lindsey:  

I’m curious how you dose that, because I just heard Lucy Mailing talking about using it when you’re on antibiotics, two pills, two 250 milligram pills, three times a day, which was the highest dosing I’d ever heard about for S. boulardii.

Alyssa Simpson:  

I do two and two.

Lindsey:  

Two and two? Okay.

Alyssa Simpson:  

Yeah.

Lindsey:  

Of the 250 milligram ones?

Alyssa Simpson:  

Yeah, 250, yeah, exactly. 

Lindsey:  

I was curious, okay, 

Alyssa Simpson:  

Quite a lot, but . . .

Lindsey:  

Yeah, well, if you want to get that diarrhea under control, I know it has been studied in traveler’s diarrhea and such.

Alyssa Simpson:  

Yeah, yeah, exactly. 

Lindsey:  

And what about with hydrogen sulfide SIBO, which I recently found out has now been renamed ISO, or Intestinal Sulfide Overproduction. Any probiotics?

Alyssa Simpson:  

For that one, I would just do the same, yeah. I haven’t seen much on researching probiotics for hydrogen sulfide SIBO. So I would go with the general because it’s still a type of SIBO, so it’s an overgrowth in the small intestine, so I would still be cautious with Lactobacillus in that case.

Lindsey:  

And what about constipation? Is there one you like for that? Or the spore-based?

Alyssa Simpson:  

So for constipation, yeah, there’s actually some strains that are more beneficial in general. So the Lactobacillus reuteri would be the one that I most commonly like with that. And then usually, because, again, I’m adding this in a little bit later in the protocol, so I’ll probably try to include some other probiotics as well. But if there’s someone that constipation prone,

Lindsey:  

Like the BioGaia Gastrus* one?

Alyssa Simpson:  

Yeah the BioGaia. 

Lindsey:  

Protectis* or Gastrus, I guess both of them have that, it’s like, DSM something, something after that (DSM 17938). 

Alyssa Simpson:  

Yeah, unfortunately, we don’t have too many products to choose from with that. So that’s the one I use.

Lindsey:  

I know I keep wondering whether that one’s like patented, or whether you can get a hold of it, yeah.

Alyssa Simpson:  

I dont know. It’s like the research is there that you think they would jump on it.

Lindsey:  

Yeah, indeed. So what about fermented foods? I have post-infectious IBS, and have sort of recurrent SIBO, hydrogen dominant, and I do okay with sauerkraut. But, I mean, I’m only eating all of a teaspoon and a half, I’d have to say, or two teaspoons, in the morning and I can eat some yogurt, but like, if I eat a whole thing of yogurt, even it’s only like four ounces, I start to feel sick. So I’m kind of curious about probiotic foods, and is it problematic, or is it just uncomfortable?

Alyssa Simpson:  

Well, that’s a great question. I would say probiotic foods are such a slippery slope. And it’s so sad just how nuanced this gets, because I feel for people trying to figure this out. A lot of the things that you think are going to be good for you actually are the very things that aggravate you. So the fermented foods, the probiotic foods, fall in that category where- and for a few reasons, but they can do a little too good of a job. They can, like we were just talking about with the Lactobacillus probiotics, they can add to that bacterial overgrowth and trigger symptoms.

They also are high in histamine and a good percentage of people with SIBO also have histamine intolerance, because there’s histamine naturally occurring in many different foods, and we produce histamine in reaction to certain antigens, and so we have a histamine load in our body. And if you have SIBO, it can decrease your production of the enzyme that breaks down histamine in the intestines, and so you become sensitive to foods that are high in histamine. Fermented foods are in that category, so anything aged actually can build up in histamine. So that’s probably the most common reason people feel bad or get symptoms when they have a fermented food. Is that the type of reaction, is it a histamine-like reaction? Or do you feel like it’s bloating?

Lindsey:  

No, it’s more like bloating. And I actually feel nauseous when I eat too much yogurt. And this happened too when I made my own Bifido yogurt out of the Evivo strain, the Bifido infantis.

Alyssa Simpson:  

Okay. And you think the lactose was low, so that’s not-

Lindsey:  

It was a coconut yogurt, 

Alyssa Simpson:  

okay, okay, yeah, even with a Bifido yogurt, okay, yeah.

Lindsey:  

So I just think maybe I just have that gut ready to ferment things.

Alyssa Simpson:  

Yeah it is a slippery slope, and I almost never start somebody out with fermented foods, but they are a wonderful thing for maintenance as you ease into that, you know, start low and go slow. So I’m a huge fan of them in general. Don’t use them very much because I’m working with people who are not well, we need to fix them first so that they can get back to those things. But I do think that fermented foods are just really a great way to populate and maintain good bacteria, maybe even more so than probiotics, because I think there’s, I don’t know why, they just seem to do better, and I’ve seen that in the research as well, as far as maintaining . . . 

Lindsey:  

What fermented foods do you like?

Alyssa Simpson:  

Well, I like kombucha and sauerkraut. Those are my two favorites, and I like kimchi, but it’s a little less convenient. You have to make it, or you can buy it, but it’s even less convenient to buy, to find all the time. So how about you?

Lindsey:  

Yeah, sauerkraut is my go to and I’ve been trying to make the Bifido yogurt. But by that, I mean I’ve made one successful batch and one not so successful batch. It took me about a month to get through it, and you’re supposed to eat it within three days, but if I ate that much Bifido yogurt in three days, I would be a balloon.

Alyssa Simpson:  

Yeah, yeah. The practicality plays in for sure.

Lindsey:  

I mean, it required a high level of sterilization, because it ferments for like 36 hours. So the very first batch was totally unsuccessful; it was a pile of mold. Then the second batch, I’m literally dipping every single thing that’s going anywhere near it in boiling water before I do it, including the plastic tops and all these things. I’m thinking, great, I’m going to be eating microplastics. But mostly they are just in glass jars, so it’s just over the top. But yeah, crazy effort went into this. So the more times I do it, I’m sure the easier it’ll get. But I don’t want to make the mistake of having a moldy batch again, because after 24 hours, I was very disheartened that I had lost-

Alyssa Simpson:  

Oh gosh, yeah, absolutely, yeah . . . 

Lindsey:  

. . . a packet of my $85 probiotic. 

Alyssa Simpson:  

Yes, I know.

Lindsey:  

So fiber and prebiotics are another area that can be tricky, especially in constipation, because my standard advice for people who are constipated is to get more fiber. Or I shouldn’t say my standard advice, the standard advice. But in my experience, people with IMO can’t really tolerate fiber. So what else do you use to help them poop? 

Alyssa Simpson:  

Yeah, again, it’s one of those things that you would think that going and eating more fiber would help. But absolutely, with IMO, it can make you worse, cause lots of bloating. Yeah, so first of all, we want to think about why are we not tolerating it? So you’re kind of presenting the question as you know you have IMO. We just want to make sure that we’re talking about ways to help you poop. But we also want to circle back around to the root cause. So maybe, you know you have IMO. If you don’t know why you’re so constipated, or if you don’t know why you’re not tolerating fiber, a lot of people will say, oh, I can’t handle fiber, I know it tips me over the edge. You do want to look deeper and evaluate why that is and ultimately address that. So that’s the sort of things we can help with.

But the next step, I would say, first of all, think about what is the fiber source. So it can seem like all fibers are a problem, because a lot of our high fiber foods are actually high in FODMAPs, fermentable carbohydrates that are the most gas-producing types of fibers. So it may be that following a low FODMAP version of a high-fiber diet would help calm symptoms. And I do see that with lots of my clients. They feel like they can’t tolerate fiber because maybe they’ve tried a fiber supplement, which are just notorious in general, for triggering bloating and symptoms in people with IBS or SIBO, or they’ve, you know, just the foods that are high in fiber, like bran and beans and all those foods aggravate you, so you think it’s the fiber. You may do better with a low FODMAP, high fiber diet, emphasizing foods that- what I like to use is chia seeds to really get people like up a lot closer to their fiber goal, because they’re low In FODMAPs. So they’re not going to contribute to a lot of gas production, but they are give you a lot of bang for your buck, and they’re pretty easy to incorporate into your day. You could stir them into anything, a smoothie, a cereal, anything like that. I have a really nice overnight oats recipe with different variations to help my IMO people move without triggering symptoms. So that would be the first thing as far as fiber.

It’s also so important to make sure that you’re hydrated. I have clients that’ll say, yeah, yeah, I know I don’t drink enough water, I need to work on that. And I mean, it’s kind of like they’re like, next, what else should I do about my constipation? It’s like, no, that’s foundational. You absolutely need enough water. Because, think about it, your stool is dry, and maybe you’ve added fiber, so it’s fibrous. I mean, where’s that water going to come from to soften the stool if the body’s not hydrated properly? So we absolutely have to have the water. I would also think about the electrolytes. So let’s say you are getting plenty of water, which I would say is at least half of your body weight in ounces. You are getting plenty of water, you know, is the water being used by the cells. Having enough electrolytes will help the intestinal muscles contract like they’re supposed to as well. And with this, I would make sure you’re not doing just some of those general – like Gatorade and stuff – it’s just a lot of sodium. You’re not really getting a full array of electrolytes. So you want a good, well-rounded electrolyte product that has many different minerals to help you – plenty of potassium, chloride. Should be pretty low in sodium, actually.

Lindsey:  

Which one do you like? 

Alyssa Simpson:  

I like Ultima* or Hi-Lyte* is another good one. Yeah, has lots of different flavors. It doesn’t have any ingredients that I don’t like. Tastes good. So electrolytes are number two. If you just need that extra little push, not physically, but that extra little boost, I really like magnesium. I used that myself for so many years, till I recently found that with vagal nerve stimulation, I don’t need it anymore. So that’s awesome, that’s little side note there. Yeah, I would suggest, if you haven’t used magnesium, and I mean specifically magnesium oxide, or maybe magnesium citrate, the other forms of magnesium aren’t – well, they’re actually better absorbed, which means they’re not going to help stimulate a bowel movement as well. We start around 400, 500 milligrams, but one of the keys with magnesium is you might need more than that. So understand, I would still start there, because if you get too much. you’re not going to be happy with that result either. 

Lindsey:  

Flush of the system. 

Alyssa Simpson:  

I would start there, and after it, give it a few days to see how that’s going to affect you. And then you might need to go higher, like 600, 800 milligrams. And if you do need to go that high again, circle back to the root cause, because usually there’s something else that should be addressed. So in my situation, I had to use 400 milligrams of magnesium for years to stay regular, and then started doing the vagal nerve stimulation. With the vagal nerve, it’s just the nerve connecting your brain and your gut, and it’s that connection that allows the brain to tell the gut to do all the things that it’s supposed to do, including motility. And, wow, yeah, after just a few weeks of doing that, I haven’t needed to use the magnesium since then. So I think that that really helped. I think, initially, stress triggered a lot of my issues, and then I think that must have helped to retone the vagal nerve.

Lindsey:  

Yeah, so what did you do to simulate it?

Alyssa Simpson:  

The TruVaga vagal nerve stimulator*.

Lindsey:  

Is that, like, an electric signal?

Alyssa Simpson:  

Yeah, yeah. It’s kind of like, you know like the TENS machines that will stimulate a muscle, but it’s not a TENS machine, but you put it on your neck right here, and, like, right where you take your pulse, that’s where you put it, and you can feel the stimulation. You can feel the tingling, and it goes for two minutes. You do it twice a day. The research actually had the test subjects build up, like, titrate up to six minutes twice a day. So you could choose to go by that. But the thing turns off after two minutes. So I just did that twice a day. Yeah, I’m just amazed. So I wanted to try it myself before I recommend it to clients, and now I’m starting to recommend it to clients and whoever else might benefit.

Lindsey:  

I had somebody on the podcast ages ago talking about something that both could be used as a stimulator for the vagus nerve. I think it was a frequency specific, forgetting the third word, FSM, frequency specific microcurrent, but it was a device like that that could both stimulate the vagus nerve or be used on the abdomen, or that kind of thing. Okay, yeah, anyway.

Alyssa Simpson:  

Yeah, we went on a side note, but yeah, that really helped me.

Lindsey:  

Well, back to magnesium. So how much is too much magnesium? Like I get people are saying, well, I’m already taking 1200 milligrams. You know, is there a point at which, okay, this is no longer going to be useful.

Alyssa Simpson:  

You know, I’ve heard experts say, don’t go over like 2,000 but I don’t go much over – like I wouldn’t go beyond 1,200. I just haven’t found it to be beneficial honestly, above maybe 1,000, I haven’t seen any added benefit. And so usually, then you need to look at other things. So, and sometimes we are in that boat. So Vitamin C is another thing. Magnesium oxide works well because it’s not absorbed well, so it stays in the intestine and draws fluid in. Vitamin C also has an osmotic effect, but because it’s absorbed well, you have to figure out what is your amount that’s going to exceed your tolerance level, so that it will have that osmotic effect. So it’s a milder effect, but it can work nicely in conjunction with the magnesium. So that might be something I might try next. If somebody’s already at 1200 milligrams, I would probably add vitamin C and see how that works.

Lindsey:  

Yeah, and how will you dose the C then? 

Alyssa Simpson:  

Probably, I would start at 1000 and go up from there.

Lindsey:  

And are these taken all at once, like before bed, or spaced throughout the day?

Alyssa Simpson:  

Normally at bedtime, but I’m flexible on that, so sometimes it also depends when the patient can get it in. For me, personally, I was doing mine in the morning, and it always worked. So we don’t think it really matters. I’ve heard the recommendation to do it at bed, so that’s generally what I’ll recommend. But I haven’t seen much of a difference.

Lindsey:  

Yeah, and did you notice any difference in the forms, like the powders that you mix in water, versus pills? For example, of the magnesium, whether one was preferable.

Alyssa Simpson:  

I haven’t, have you? 

Lindsey:  

I mean, I kind of feel like the Natural Vitality Calm* one, that one’s always sort of my go-to because I have had people taking a lot of pills, and then I’ll say, we’ll just try this other one, and then it seems like they get more of an effect at a lower dose.

Alyssa Simpson:  

What’s the form of that one? 

Lindsey:  

So it’s carbonate, but when you mix it in water, it becomes citrate.

Alyssa Simpson:  

Oh cool, okay, yeah, okay, that’s a great tip for me. Maybe I’ll try using that one because I haven’t. But, yeah, people do get overloaded with pills, so. 

Lindsey:  

Right? I mean I guess that’s the other dilemma. If you have to take a bunch of pills, you probably have to drink a bunch of water with it. Of course, if you’re drinking powder, mix and water, that’s also water, and it’s all before bed. But of course, you can, you know, do it an hour before bed, not immediately before bed, right? Yeah, so people aren’t up peeing three times during the night.

Alyssa Simpson:  

Yeah, exactly. I think that’s one reason I kind of tell people at bedtime, but if they’re concerned about it, I’ll usually flex because, yeah, I haven’t seen it to be essential. There are other things we can talk about as far as helping motility, but I’m happy to answer any other questions you have as well.

Lindsey:  

Well, I had a couple questions about magnesium. So thinking about the fact that something like a magnesium citrate or oxide is not well absorbed, when you think about the dosing of a glycinate or a malate or another type of magnesium, versus the citrate and the oxide, how might those differ then knowing that you’re not actually absorbing that much of the magnesium, when we’re thinking about just a deficiency of magnesium, as opposed to exclusively using it for motility purposes.

Alyssa Simpson:  

Okay, so you’re saying, if we wanted to use a citrate to actually help get into the body,

Lindsey:  

Because that’s the form that people are already using for the purposes of motility, is there any kind of a comparison, like 800 citrate’s worth X amount of glycinate?

Alyssa Simpson:  

You know, I’m not aware of one. But now I want to know.

Lindsey:  

I just kind of asked that question to myself because I know that you get recommendations often from these tests like Metabolomix or a NutrEval that says, okay, they need 400 mg of magnesium. And I’m like, okay, well, if that’s magnesium citrate, they’re probably pooping out three quarters of it.

Alyssa Simpson:  

Exactly, yeah, I tend to just not use it, or I’ll give them a magnesium blend where you can get a few different kinds in one. 

Lindsey:  

One thing I have noticed, though, with those blends is that they’ll often come to me already on magnesium, and I’ll say, oh, okay, which one and how much is it per pill? And they’ll be like, oh, it’s glycinate, and it’s like 400 per pill. And I’m like, yeah, that’s not possible. There’s no such thing as one pill of glycinate that’s 400 milligrams. And then they’ll look and they’ll go, oh, okay, it looks like there’s some oxide, and they’ve got like five different kinds. And I’m like, Okay. And my estimation is probably 350 oxide. You’ve got like, 50 milligrams with something else mixed in.

Alyssa Simpson:  

I know, yeah, yeah. They don’t realize how many capsules they’re supposed to do, because they do try to advertise 400 on some of those products. 

Lindsey:  

Oh, right, that too, right, so you’ve got to look at the serving size. 

Alyssa Simpson:  

I also don’t prefer the blends, because I can’t titrate the one I want to titrate without affecting all the other ones. But I’m sure as more of a maintenance thing, it could be a decent option.

Lindsey:  

I’m kind of suspicious that the whole – I think I was just listening to a podcast, and they’re like, you need all the five different types of magnesium in your body, and therefore you should buy our blends. I’m like, this just feels like marketing to me, like, I imagine our body can probably make most of those types from the raw materials that are in there. So, you had said you had some other things you wanted to talk about related to motility?

Alyssa Simpson:  

Yeah, yeah. I have some other things that would be important as we’re talking about this. Another tip I have, I like using, and this is again, keeping in mind that we’re going to want to work on the root cause, but sometimes, if you just need relief, I do like whole-leaf or outer-leaf aloe vera juice. It has other benefits, aside from motility. It’s very soothing on the mucus layer. It helps to stimulate that mucus production that protects our stomach, esophagus and our intestines. I also like it because the whole-leaf has a chemical in it, aloin, that stimulates the bowel. So I would start with four ounces of aloe vera juice – make sure it’s the outer leaf. The inner leaf is not bad. It’s just not going to have that helpful chemical that helps with motility. Maybe start with four ounces. You can have more than that, but again, see how that’s going to affect you per day after a few days. So I like using that one sometimes, especially when we’re talking about people who can’t handle a lot of fiber. So maybe we’re working on building up the fiber, and that can kind of help as well.

Is this something they find it like a health food store? Or do you find that normal grocery stores?

Sprouts around here, is what we have, where I find it. I like the Lily of the Desert brand. Yeah, usually at a health food store, you probably have a better chance.

Lindsey:  

Alyssa is my neighbor in Arizona. She’s up in Phoenix.

Alyssa Simpson:  

Yep, yeah! So we have Sprouts. You guys have Sprouts down there, right? Yes, but it’s a health food store, and so any health food store would probably have aloe vera juice. Sometimes they try to do you the favor of flavoring it. Watch out for that, because they may add lemon juice, and if you have GERD, that might trigger you, be careful of that.

Lindsey:  

Any other motility tips? Or was that the last one?

Alyssa Simpson:  

The squatting position, or the squatty potty*. So when we’re sitting on the toilet, we’re actually not in the proper position, and so we actually have kind of a kink, like between the anus and the rectum, there’s a little bit of a kink. And so, that’s helpful when you’re trying to hold it in on your way in the bathroom, but when you want to actually have a bowel movement, having your feet up so that your knees are above your hips will actually basically open up that angle between the rectum and the anus to allow for a better bowel movement. So you can start out with a stool, if you just have any stool you can put your feet on, but the squatty potty, especially if this is a major issue for you, is not a major investment, and definitely something to consider.

Lindsey:  

And I think that’s pretty important for people who are shorter, right? Because they can’t really get into that position. 

Alyssa Simpson:  

Yeah, right, yeah. 

Lindsey:  

Okay, so what about introducing fiber? And are there particular forms that are easier for people who are a little bit fiber intolerant?

Alyssa Simpson:  

Yeah. So, well, I like SunFiber*, the partially hydrolyzed guar gum that is the most researched and the gentlest I find. I use it with my SIBO people, my IMO people, they could be bloated like crazy, and I’ll still use it maybe, maybe do some other things to calm their bloating first. But you just start low and go slow with it. So it could start at maybe a third of the dose, or if you’re super sensitive, a quarter of the dose, and maybe every week go up an increment if you’re super sensitive. But the reason you would want to take it is it does start to add a gentle fiber. So again, if you’ve tried a fiber supplement, any of those out there, like a lot of the common ones, you know, Metamucil, Citrucel, like all these things that are recommended to people with IBS, and it triggered you. Most people do pretty well with this PHGG, and I have a lot of my clients that they are just like, I’m never not going to use this. I love it so much. I’m like, you could maybe graduate to a different fiber in time, but that’s how well it’s tolerated. And then another one would be Acacia fiber that people do pretty well with, too, even the most sensitive people.

Lindsey:  

Yeah. Are there any prebiotics that you particularly like, other than getting it from food?

Alyssa Simpson:  

Yeah. So prebiotics is here in this whole conversation about that, like slippery slope, right? So everything I said earlier about fiber and FODMAPs, like the things that are supposed to help you, can actually aggravate you when there’s a bacterial overgrowth. And so prebiotics are in that category, because a lot of the times it’s FOS or GOS or inulin or prebiotic ingredients, and those can be the harshest and the most likely to bloat and cause symptoms. So for I’d say, starting with most sensitive, like you said, other than foods. But I would probably start with foods for the most sensitive people. Like, the green bananas, the cooked and cooled potatoes, even maybe a resistant starch, maybe even a cooled rice congee or something.

But as a fiber supplement when they’re ready for some prebiotics, I like PaleoFiber RS* because it is basically like starting them with foods – a little more potent, but the ingredients are green banana flour and potato starch, and there’s one other ingredient in it. So PaleoFiber RS is my favorite kind. I would either do that as a prebiotic, or you can lean on polyphenols, which are the components in brightly colored plants, fruits and vegetables, that give them their antioxidant benefits, but they also have a very gentle prebiotic effect, but it’s a non-fiber! So it’s a wonderful kind of little thing to start with, so that you could do it with foods or with a supplement. Sometimes I’ll just recommend Polyphenol Nutrients*, which is by Pure Encapsulations*, because if the person needs a multivitamin, that way, we’re getting some polyphenols in there. And then from foods, you can use things like green tea and cranberries and blueberries and olive oil for polyphenols.

Lindsey:  

Yeah, I’ve been trying to do this gut shake that I stole from Mark Hyman. I maybe get it once a week myself, but it’s pomegranate powder, I use cranberries rather than the cranberry powder, just use frozen cranberries and matcha green tea powder, and then taking protein powder too. The original formula, I think, has collagen and glutamine and butyrate and all that other stuff. But I’m sort of selectively using the things that I need myself. So, yeah. 

Alyssa Simpson:  

Yeah, yeah. And then when the person’s ready, I mean, once you clear the overgrowth, you can gradually add in less gentle forms of fiber. So then I do think it’s a good idea. And one of my favorite tips is making a veggie mash, which, if you’re looking for another project, you know, it takes couple hours. It doesn’t take all day. So you basically take 10 to, I guess you could do, probably 10 to 15 will work the best, different vegetables, and you blend them up. I have a recipe that I can share with your audience, my gut rebuild veggie mash, because it has quite a few root vegetables, which I like for the resistant starch. So you steam those. You lightly steam some of the other vegetables. But really, the idea behind a veggie mash is you just grab 10 to 15 different vegetables, blend them up in a food processor, works best, and then you just put them in ice cube trays and just pop out a cube to blend up in your smoothie or to mix with your entree or to eat just with salt and pepper by itself. And that way you get a diversity of plant fibers.

So we’re talking about fiber right now, kind of in the context of fiber amount, like getting enough fiber, but diversity of fiber is so important too for feeding a diversity of good gut bacteria. So I really like the veggie mash, because even if you have Brussels sprouts in there, which are high FODMAP, and I think the low FODMAP portion is like one sprout or something, or a fragment of a sprout, you know, you will be able to tolerate a little bit in the veggie mash, because the whole recipe only has a handful of each thing, and then it’s making, like, weeks worth of quantities. I think it’s like 10 ice cube trays you get out of it.

Lindsey:  

Yeah, I’ve heard that technique for reestablishing oral tolerance when you’ve had a lot of food allergies, like, just the little bit of a bunch of different things.

Alyssa Simpson:  

Yeah, and I like this strategy, because it’s, again, the practicality, it’s hard to get a little bit of a lot of different things, especially when things are going to go bad in the fridge, if you don’t have anyone else to eat the rest. 

Lindsey:  

And winter squashes are not exactly easy to cook, unless you buy them pre-chopped or whatever.

Alyssa Simpson:  

Right, exactly. So mine is pretty root vegetable heavy. It has butternut squash. It has purple potato. It’s colorful as well. It has a sweet potato in there. And yeah, I like that tip as well.

Lindsey:  

I’ve started to use the MegaPRE* with people who don’t have any Akkermansia or any Faecalibacterium prausnitzii or very low levels that need to kick it up, because it’s got some ingredients in there that have been shown in studies to bring those up. Have you used that at all? 

Alyssa Simpson:  

Yeah, so if the person’s really sensitive, I’ll start with the Paleo Fiber RS, but I like to move to MegaPRE if I can, because I consider that ideal to use those ingredients, but I will start at low dose and gradually increase it once I see that they’re doing okay with it, because even after the issue’s cleared, there’s a period of healing, and the tolerance gradually gets better to food, so usually it’s easing back into fiber and prebiotics. 

Lindsey:  

And what do you think about colonics and enemas for people who’ve been chronically constipated?

Alyssa Simpson:  

Well, I think sometimes whatever you need to do to get it out, it’s fine. So I don’t have any concerns with that. Do you?

Lindsey:  

No, but I don’t have an office that offers things like that. So it’s not something that I refer people to, but I know that people who have offices that do that often are more big fans of such things.

Alyssa Simpson:  

Well, I’m probably in your boat, because I also, I’m 100% virtual. I’m a dietitian, so I’m not doing medical procedures anyway. Yeah, so I usually, if I get that question, someone’s wondering if I agree with it, if it’s okay, or maybe that will clear their SIBO, and unfortunately, it won’t clear bacterial overgrowth. But I’m all for it if somebody just needs to get cleaned out, doing something like that. And I have even recommended it when somebody just, for example, let’s say we find that you have SIBO, but you haven’t had a bowel movement in two weeks. Well, we can’t start. We can’t do much about it until we can get things flowing. So yeah, that could be a good use for it to just kind of get a jump start.

Lindsey:  

Yeah, sometimes in that scenario, I’ve sent people to do a C cleanse, just to get everything washed out. And then I’m like, okay, then maybe. Because they’re kind of desperate at that point, if they haven’t had a bowel movement in days, or, goodness, I don’t think I’ve ever had anybody who said two weeks, but if it’s been a while, and they’re uncomfortable and they’re backed up and they’re bloated and they’re in pain, then you know, you just got to get that out of there.

Alyssa Simpson:  

Yeah, because it’s unhealthy for you. 

Lindsey:  

Yeah. I mean, I think that that’s an important thing that people maybe don’t – like, they know it doesn’t feel good, but I don’t know that they realize the connection between cancer and constipation, like, there’s much higher rates of colon cancer and breast cancer. You don’t want to have stuff just sitting in there. These are toxins that are supposed to be getting out of your body, right?

Alyssa Simpson:  

Or even if you have diverticulosis, you know, that could potentially fill up those pockets with stool. A lot of people have diverticulosis. So, yeah, absolutely. And so with SIBO, here we are. We’re about to kill off a bunch of bacteria, and your body has to detoxify that. And so the worst thing we could do, it would not be a good thing to start killing them off, only to be reabsorbed into the bloodstream and recirculated throughout the body. Yeah. So you would feel terrible as well, and it wouldn’t be healthy. Yeah, so I’m actually all for the anything you can do to get things going. And then sometimes people will ask, well, if I do that, will it get rid of all my good bacteria? Well, no, because they live in the layer of the intestine, so you’re not going to flush out all your good bacteria doing that or doing a colonoscopy prep, either. 

Lindsey:  

Yeah, I was a bit a little bit worried about that myself, and I hesitated to do the colonoscopy and put it off for a few years, which I did also because I just didn’t want to get a colonoscopy, but did the Cologuard, and then three years later, thought, okay, I’m just going to suck it up and do the colonoscopy. And it wasn’t bad, and I had a nice clean colon. I was happy to hear that; no polyps. 

Alyssa Simpson:  

Yeah, I mean, it would be nice if we could clear dysbiosis with just colon prep.

Lindsey:  

It’s a funny thing that that’s not that helpful, given that the elemental diet is something that seems to work for it, which I guess, obviously it’s a little bit more extended than a colonoscopy prep in terms of time.

Alyssa Simpson:  

Yeah, well, I think it’s just like you’re clearing out the stool. I mean, the stool is not where the bacteria live. They live in the mucus layer, so you’re not shedding the mucus layer. And the elemental diet is starving the bacteria in the small intestine and in the large intestine, but yeah, they’re resilient. So, yeah.

Lindsey:  

Do you use elemental diets much? 

Alyssa Simpson:  

I used it twice. It’s very hard for people to do, so it’s a last resort.

Lindsey:  

I kind of feel the same way, like I wouldn’t do it, so I’m not going to ask somebody else to do it. But sometimes it’s like, I agree. I’ve had people who no quantity of antimicrobials was getting rid of that bloating. And I’m like, okay, let’s try this. And for both people, it was the first thing that really broke it at all. I can’t say it was like, 100% they were done and, like, that was it, because I think there’s always other issues that play into it, like stress, maybe that whole vagus nerve question, but it was the first thing that made any dent.

Alyssa Simpson:  

Okay, so that’s, yeah, it really does take – the person has to really be on board. I haven’t been in that situation too much, where we’ve run out of options to really make a dent, but usually it’s been the patient’s idea if I do it or I will put it out there as an option, and the patient has to be the one who’s like, yes, I want to do that. 

Lindsey:  

Yeah. I think sometimes they feel like it’s really expensive, but I’m like, well, keep in mind, you’re not going to be buying any food for those two weeks or three weeks, right? 

Alyssa Simpson:  

Yeah, exactly. 

Lindsey:  

And it just feels a bit different spending your budget on a package of powder you’re going to have to drink than it does to go to grocery store and buy a load of groceries.

Alyssa Simpson:  

It does. And the die off is tremendous. I mean, the die off is a problem anyway, but it’s so tremendous with the elemental diet. That’s another thing, not only are you only consuming liquid for two to three weeks, but die off, meaning that kind of reaction that happens when you first start killing off the SIBO, and you have your flu-like symptoms, and all kinds of symptoms can pop up. And so I’ve seen that in both people be pretty bad. The other thing is, I have a lot of people who are underweight, and it’s just not a good idea. Now, actually, in reality, if they do drink all the formula and they have malabsorption from the SIBO, they’re probably getting better nourished with the elemental diet.

Lindsey:  

Yeah, I’ve heard that for underweight people, they’ll gain weight. For overweight people, they’ll lose weight. It works itself out.

Alyssa Simpson:  

Yeah, I’ll actually use elemental shakes often as a supplement for underweight people, so they can get the nutrients in, but not as the elemental diet is designed to work, even though I know it will probably nourish them better. There’s still all the issues, like the patient has to be on board with it, it’s very difficult to do, and it’s just concerning, because if the person is already super underweight, it just makes you hesitant to turn their diet on its head in any way, especially going on an all liquid diet.

Lindsey:  

I have noticed, and just to send the word out there to people, that people get really kind of scared and desperate when they’re losing weight and they’re not trying to because of malabsorption related to SIBO. But I’ve never seen anybody that’s like, starved to death. They always gain the weight back eventually. Like, once you start to turn things around in the gut, the weight comes back on. They don’t just waste away to nothing . . .

Alyssa Simpson:  

Yeah, yeah.

Lindsey:  

So people really do that. It’s like there’s a certain level of desperation in a person who’s been losing weight and just keeps losing weight, like they really get scared.

Alyssa Simpson:  

Yeah, yeah. I think it’s scary if you don’t know why it’s happening and you don’t know how to stop it, right?

Lindsey:  

You mentioned about having gastritis and constipation. I’m curious why those two tend to come together.

Alyssa Simpson:  

Gastritis and constipation, GERD and constipation?

Lindsey:  

Yeah.

Alyssa Simpson:  

Well, if you’re chronically stressed, it can cause a slowing of motility, versus if you’re acutely stressed, it can trigger diarrhea. These are very general statements, obviously, but in general, that’s how the gut, brain, the vagus nerve, works. So I believe that my chronic stress at the time caused everything to slow down. And I was not mindfully eating. I was scarfing down my lunch, trying to pack in as many patients as possible, often missing lunch, eating in my car on the way home. I mean, there is a lot of factors, and I still didn’t know very much yet about any of this. Yeah, so I think it was a perfect storm for me with the GERD. I probably had chronic stress and acute stress, and wasn’t being mindful of my eating, because that’s a big part, too. If you’re rushing and you’re multitasking and you’re not focusing on your food, then your brain isn’t focusing on the food. So it’s not telling the gut to produce enzymes and acid, and so food is sitting there longer, and then there’s pressure on the lower esophageal sphincter, and you know, you get the acid coming back up. So it was a whole messy storm.

Lindsey:  

Yeah, I was thinking that there might be a connection through the question of stomach acid, right? Like, if you’re stressed, you’re probably not producing as much stomach acid, and then you’re-

Alyssa Simpson:  

Yeah, I think that was a factor,

Lindsey:  

Right? And then, of course, low stomach acid can cause GERD.

Alyssa Simpson:  

I think that was part of it too. Yeah.

Lindsey:  

So tell me about where people can find you and the stuff that you do.

Alyssa Simpson:  

Yeah, I see people one on one over a virtual platform and help people walk through the process of figuring out what’s going on in their gut from a functional perspective. So, especially if you’ve had lots of the standard testing and whether or not they found anything, but if you’re still having issues despite the normal medical interventions, we can look deeper, and we’ll look at what’s out of balance in your gut, and we’ll walk through the different phases with a personalized approach. I learn about your eating habits. I learn about your schedule and your family. And what dinner is like with your family, and we just come up with a personalized approach that’s going to work for each person. We look at everything else that’s going on with your health so that everything is in line to support your goals, all of your goals, holistically. And through just the use of simple strategies, diet changes, elimination and reintroduction of some sort, usually, maybe sometimes we’re ramping up fiber or calories or whatever it might be. And strategic supplements that, like I say, I tend to layer through in phases, and we work on not only calming the symptoms down, restoring more normal gut function, but also putting a maintenance plan in place so it doesn’t just keep happening again and again to you. So that’s what I do, one on one.

People can find me at nutritionresolution.com so it’s like a New Year’s resolution, and I’ll also provide the link to that veggie mash so that you guys can download that, if that sounds interesting. That’s helpful for anybody who just doesn’t have enough vegetables in their diet to get that diversity to feed a healthy microbiome, but it’s especially helpful for sensitive individuals as well. And I’m at @nutritionresolution on Instagram.

Lindsey:  

Okay, great. We’ll put those in the show notes, that way people can find you easily. Any final thoughts before we go?

Alyssa Simpson:  

Everything we talked about today are the things that are – I feel like, logically, you’d say, okay, if I’m having gut issues, I should eat more fiber, I should eat prebiotic foods, I should take probiotics. And those can be sometimes the worst thing. So I just feel for anyone out there trying to do their best and it’s not working, or they’re getting worse, because it’s kind of hard out there sometimes to figure out the right thing to do. But in general, find a good practitioner to educate yourself as much as you can so you know what to ask, and also listen to your gut as far as who it feels right to work with, who kind of resonates with you and gets you excited about what’s actually possible for you. I just wish everyone the best in their health journey. 


If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

Schedule a breakthrough session now

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Holistic Healing With Functional Nutrition: What To Do When Nothing Works

Adapted from episode 138 of The Perfect Stool podcast with Lindsey Parsons, EdD, and edited for readability and Andrea Nakayama,  Functional Medicine Nutritionist and educator, host of the 15-Minute Matrix Podcast and the founder of Functional Nutrition Alliance. She has led thousands of clients and now teaches even more coaches and clinicians around the world in a revolution reclaiming ownership of both their own and their clients’ health. 

Lindsey:  

So can you tell me about your history and what got you into the field of functional medicine? 

Andrea Nakayama:  

Yes, I’d be happy to! So, I was in a completely different career in my life. I worked in book publishing for over a decade, and in April of 2000, my late husband was diagnosed with a very aggressive brain tumor. It’s called a glioblastoma multiforme, and it’s a stage 4 cancer. He was given about six months to live. He was in his early 30s. I was just seven weeks pregnant at the time, and I was also a foodie. I was definitely experimenting with food for my own health, noticing little things, but that catapulted our reality into a whole different realm of care.

So first and foremost, we entered into the medical system, and I had never been in the medical system. Sure, I’d been to the doctor for a broken wrist or arm, for a sinus infection, but had never been in the system in this way, and that experience kind of woke me up to some of the gaps in our medical system, and the two gaps that I noticed at that time were that everybody is treated like their diagnosis, and everybody with the same diagnosis is treated the same. So if you have a glioblastoma, the 32-year-old man, my late husband, is treated the same as the 80-year-old man. It is a protocol for that condition. And so while we were in this reality, this grave new world that we were in, I was looking to see anything and everything we could do to shift the outcome in any way we could, so I was bringing him information about diet and lifestyle, how does sugar impact inflammation and tumor growth. And ultimately, it was his decision to make, but we made major dietary changes. He ultimately lived past his prognosis. He lived two and a half years. So he died when our son was 19 months old. This is back in 2002, and that really changed my perspective on health care, quote, unquote, food is medicine and what’s possible to help a person navigate through the system. And slowly but surely after his passing, I realized that this was my calling, and that led me forward to trainings and exposure to functional medicine, which really spoke to me, and on from there, which I can talk about as we have time.

Lindsey:  

Yeah, well, first of all, I’m so sorry for your loss, and how tragic to be cut off so early. 

Andrea Nakayama:  

Yes, thank you. 

Lindsey:  

So you said in our pre-interview call that your practice’s sweet spot is the client or patient who has not had success anywhere else and maybe is hopping from practitioner to practitioner, and I know I’ve seen a few of those, and they maybe are having trouble taking most supplements or eating most foods. So can you explain your philosophy around helping those types of people and how you proceed with them? 

Andrea Nakayama:  

Yeah. So most of what I do now, I started my practice back in 2009. I started training other practitioners in 2012. So, at this point, most of what I do is train other practitioners, health coaches, dietitians, a lot of nurses around the world, who really want to understand the principles and philosophies of functional nutrition. And I’ve really established a systems-based approach that speaks into what you’re talking about. So the first thing I really want to understand is who it is that I’m talking to. I have the entire functional nutrition matrix, which is modeled after the Institute for Functional Medicine’s matrix, but it’s a little bit more easy to use and think through and talk a patient through, and that’s divided into categories that I would call “the story, the soup and the skill”. The “soup” is the system’s biology. It’s all the areas where the gut’s connected to the brain, all the things are happening inside the body, and we recognize that they’re connected. The “story” is what I really want to understand in relation to what you’re talking about. What are your, in functional medicine, we call them ATMs; your Antecedents, your Triggers, your Mediators. Tell me about where you came from, what’s happened throughout your life, and what you have noticed helps you feel better and makes you feel worse. And the “soup” is our systems biology. The “story” is our unique journey, and the “skills” are all the things: sleep and relaxation, exercise and movement, nutrition and hydration.

Oftentimes, what I see when somebody has been there and done that, they’ve tried everything, is that they’re doing all the practices, but they’re not really focused on the internal healing at a pace that’s appropriate for their body, so they’re chasing fixes, but the internal healing that allows their body to accept the foods, accept the supplements, work with that next intervention are impaired, and that’s the work that hasn’t happened. Oftentimes we have to slow it down to speed it up, and people are very fixated on going on a protocol or following the next principle or tracking or finding the quick fix, or the next supplement; or I can’t sleep should I take this herb or these hormones, or whatever it might be. And oftentimes, for a sensitive body, it’s too much, too fast, and the body doesn’t have the time to heal. So all that to say, I’m going to do a really, really thorough assessment of an individual to understand what’s actually happening. What have you tried? What have you learned? And then let’s get really systematic to allowing the body to heal and receive healing, as opposed to chasing the next thing.

Lindsey:  

Can you give me an example of someone who maybe was in that situation and what the body needed to be able to start accepting the healing? 

Andrea Nakayama:  

Yeah, I mean, a lot of times – I’m not thinking of a case, I’ll be honest, I’m not personally working with that many cases right now so I have to dig back, and one might come to me, but what I often see is that the body’s in a sympathetic-dominant state, so that chasing, that questing; when we think about sympathetic dominance, that’s our fight-or-flight mechanism. And I’m often seeing people who are questing the next fix, the next solution. How do I do this? So what I will hear, if I think about my case study group where I was working for people for my book that have been there and done that, worked with all the top functional medicine doctors, done the tests, taken all the supplements, eaten the quote, unquote, perfect diet with the perfect timing, and they weren’t feeling better, and they feel angry, they feel jilted, because the things that are promised to us just don’t work. I think we think those protocols are very sexy, and they’re going to be the answer, and they get us further fixated and stuck in that  “fight-or-flight, where’s the next thing, How do I fix my broken self” perspective?

Lindsey:  

Yeah, I’ve definitely seen people who’ve been through the ringer with some of these top names, functional medicine, and they’ve said, “Oh, I spent $20,000, I spent $50,000” or whatever, 

Andrea Nakayama:  

Correct. 

Lindsey:  

And they just stuck them on a set protocol. They literally take everybody they see, and they go, “okay, this is just what you’re going to do.” Everybody does the same thing. And I’m shocked, honestly, that that’s the way they’re practicing. I just sort of assumed the top names of functional medicine would be a little more individualized.

Andrea Nakayama

Yeah, I mean, unfortunately, I think that the road that functional medicine has gone on has veered away from the three primary tenets of a truly functional practice, and those three primary tenets are a therapeutic partnership, meaning we are equal in this relationship and your understanding of yourself is as important as my expertise; looking for the root causes, which means we know how to ask, “Why is this happening, not just what do I do about it; and a systems-based approach, which embraces systems biology. Those are the three tenets of a functional practice as designated in the origins of the Institute for Functional Medicine. And unfortunately, it’s become very conventional-based in that it’s another pill for an ill. The pill might be different, or it might be a bucket load of pills. They think that diet is a handout. Dietary change is not a handout. There is a lot that goes into making change, understanding a person’s relationship to change and what their body can tolerate and not tolerate. So I think there’s a lot of mistakes happening in a lot of functional practices today that really are going too fast for the needs of the individual.

Lindsey:

So you talked about sympathetic dominance and I’m thinking about something I heard on a podcast recently, which was they had looked at children who had abuse, you know, ACEs (Adverse Childhood Experiences), that type of thing, and they would check their cortisol, and right before bed, all of their cortisol was elevated such that it was impacting their sleep. 

Andrea Nakayama:  

Yes. 

Lindsey:  

and that this is something that persists through adulthood. 

Andrea Nakayama:  

Yes. 

Lindsey:  

How do you undo that kind of stuff? 

Andrea Nakayama:  

Yeah, so I think that when we’re looking at adverse childhood experiences, when we’re looking at trauma, whether it’s childhood trauma or adult trauma, like I received with my late husband’s diagnosis and illness and death, that we have to recognize where and when it is our job to address that with a client or patient and where it is our job to hold space for it. So my job is making the connections visible for people. So that matrix: that story, the soup, the skill, helping people to understand that everything is connected. We are all unique, and all things matter.

In my practice, one of the things that I’m teaching others is what I call the three tiers to nutrition mastery. Tier one are the non-negotiables. Now non-negotiables are vast, but the non negotiable trifecta that is true for all of us, is sleep, poop and blood sugar balance. If those aren’t there, then it’s going to be hard to heal. So if I see somebody who has elevated cortisol or is having dysregulation around sleep, I’m going to really dive into that one thing. Not with “hey, go sleep, take some melatonin,”, or “hey, your cortisol is elevated, take these herbs.” I’m going to really look at how do we unpack that, bring to awareness to some of the triggers that might have us in that sympathetic dominant state, that fight-or-flight state. Look at all our practices around sleep. Start to recognize what makes us feel better, what makes us feel worse, which are our mediators, and really start to see if we can make a slow but steady difference in small practices that lead to more sustainable results.

And this is a very long-winded way of saying, when I give that person a supplement for their sleep, I’m bypassing the opportunity for that person to learn, in a long-form fashion, what actually helps them to be more empowered with the decisions they’re making, and I’m making them more reliant on me for their solution. That’s not what I want. I want to empower people to have that deeper awareness about what is happening with their own body. So a child who’s carrying that lack of safety into their nighttime routine, that awareness is something I’m going to ask them to bring to the fore, potentially with a therapist who can hold that space for them. And meanwhile, we’re going to work on, how do we make your bed and your bedroom and your sleep time ritual as safe as it can possibly be for you, and what kind of language do we need to use to bring you into that parasympathetic, that rest and digest, and sure, are there ways we can manage your blood sugar, help with your mineral support, like all the things that are going to help there, but it’s not a one and done that’s mine to fix, I guess is the thing. It’s mine to recognize the connections and help illuminate them, while bringing the foundations into place that really help to support that person in moving forward.

I just thought of a case, Lindsey. Somebody was asking me to look at their labs. I look at people’s labs. I’m a geek when it comes to serum labs, and I can make all sorts of connections. But just looking at – this is the husband of my cousin, who is also a functional nutrition counselor, and I was looking at his labs with him, and he was trying to control his sleep and his anxiety with herbs, and he was constantly getting to, what I would call, is a later-stage intervention. When I look at his labs, and he’s a teacher, I was like, are you hydrating? And he’s like, well, I drink like one Nalgene a day. And I’m like, How much do you weigh? So I could see in his labs that he’s dehydrated. Dehydration can lead to anxiety and fatigue because the blood isn’t pumping as fluidly as it needs to the heart and the brain, and so my ability to understand the simplicity on the other side of complexity is then what helps me make connections and help him to slow down. Let’s trial that for two weeks, and then let’s look how sleep is. Make sure your hydration is earlier in the day, so you’re not having to go to the bathroom, but just things that we often overlook in favor of the fancy, newfangled supplement or protocol when we’re not creating the foundations of health.

Lindsey:  

So what markers were off on his bloods?

Andrea Nakayama:  

All his red blood cell markers. So in his CBC with differential, all the red blood cell markers are your, you know, your RBC, your hemoglobin, or your hematocrit, your MCV or MCHC, like all of his red blood cell markers, were indicators to me to ask the question, are you hydrating? 

Lindsey:  

Were they high or low? 

Andrea Nakayama:  

They were high.

Lindsey:  

Okay, interesting. So, given we’re on a gut health podcast, what are the factors that people might not be thinking about that could be affecting the health of their gut microbiome? 

Andrea Nakayama:  

Yeah, so when it comes to the gut microbiome, there are many factors that I like to think about that influence the entire digestive tract. So I like to think about it as one of the three roots. Any sign, symptom or diagnosis is a branch in my book, and the three roots are our genes, digestion and inflammation, and that’s like a Venn diagram for me. The digestive root, the circle of influence, or the “soil”, is the mechanical, the chemical, the structural and the microbial. So before I rush to microbial issues, I want to make sure we’re chewing, we’ve got the hydrochloric acid and the enzymes that we need, and I don’t mean supplementally, I just mean we are able to produce and break down the foods that we’re bringing in. We have structural integrity, which comes back to the microbiome, but really making sure that the inflammation is down and the gut structure is not hyperpermeable or leaky, and the microbiome is going to be key, but we forget that sleep feeds the microbiome, that exercise feeds the microbiome, that vitamin D feeds the microbiome. We often rush to what we’re going to take to feed the microbiome. Now, if we are feeding the microbiome with food, I’m going to think of three classes of foods, and those include our ferments, of course, our polyphenols and our resistant starches.

So those are the ways that, first and foremost, I’m going to make sure that we’re feeding the microbiome in a daily way, in addition to supporting that with probiotics and prebiotics that we might take in in different ways. I am not a fan of specialty testing for the microbiome unless I find I need to. That’s usually later on down the line, if at all. I’d prefer an Organic Acids Test over a GI Map or anything like that, but I rarely would have us in our clinic do those because we can assume that the people who are coming to us likely have gut dysfunction, even if they are not experiencing gut issues. So again, one of the three roots, if you have chronic sign symptoms or diagnoses that aren’t getting better, digestion has to be focused on, and the microbiome is going to be a part of that.

Lindsey:  

Okay, so you mentioned sufficient hydrochloric acid to break down your proteins, of course, and I have read that one sign of insufficient hydrochloric acid, stomach acid, is nails that are cracking and breaking. This has been my 20-year quest to fix this problem, and I have autoimmune IBS. I have elevated vinculin antibodies and recurrent SIBO that I have to keep under wraps. 

Andrea Nakayama:  

Yes.

Lindsey:  

Am I missing something? I mean, I’ve tested the zinc; I am deficient and taking it. But the but the nails are getting worse!

Andrea Nakayama:  

Yeah, and I think this is where we can get stuck on thinking x leads to y. So deficient hydrochloric acid could lead to a number of symptoms, but so could different nutrient deficiencies that might be excluded from a specialty diet. So I always like to put the “but” in the column of the specialty diets, because when we reduce our food intake, sometimes we’re missing certain nutrients. A common one for those of us with autoimmunity are our B vitamins, which are tricky to take for a lot of different reasons, but when we reduce certain foods from our diets, particularly grains, we might actually be missing some of the B vitamins that also help with our hair, skin and nails. So it’s hard to say that it’s just because of one thing. So if you have worked on your hydrochloric acid, and you’ve supported that and you’re not seeing results, give it a checkbox and know that you still don’t know the “why” of that thing, right?

Lindsey:  

I’m on the multi, on the B complex, on zinc. 

Andrea Nakayama:  

Yes, exactly. So there’s different reasons that may not be evident yet. And with all you know Lindsey and all you’ve looked at, it’s one of those things that’s like, “Okay, I don’t know the answer to this.” How much is it bothering me? Is it bothering me because it hurts, or it’s painful, or is it bothering me because I should know the answer, and I don’t.

Lindsey:  

Entirely cosmetic.

Andrea Nakayama:  

Exactly, exactly, and that’s where I think, like coming into that parasympathetic, like, I’m doing all the things I need to do and all the things I know to do. I’m still having this issue, so I’m just going to hold space for that.

Lindsey:  

Perhaps that’s the one I one idea that hadn’t occurred to me, just accepting. 

Andrea Nakayama:  

Just accept that for now; something will reveal itself. 

Lindsey:  

Yeah. What bothers me about it, though, is that I feel like it’s telling me that there’s something not working right, and that it’s somewhere else. There’s something more serious going on that I’m not seeing. 

Andrea Nakayama:  

And I think if you’re looking at everything, if you’ve looked under the hood, I think this is where we can get hyperfixated on some notion of right or healthy. And this is where we then start questing, when, in fact, like, you’re thriving, your brain’s working, your body’s working, you’ve done all the looking, and you’re taking really good care of yourself. How can we just celebrate that and put down the thing that we feel like is trying to tell us something, but you know, maybe it’s not to be heard right now.

Lindsey:  

Okay, I will accept my bad nails.

Andrea Nakayama:  

They’re not bad, they’re just what they are.

Lindsey:  

My slightly imperfect nails. 

Andrea Nakayama:  

For now.

Lindsey:  

So, you mentioned your “three roots, many branches” philosophy, can you apply that to autoimmunity?

Andrea Nakayama:  

Yeah, yeah, that’s exactly what I created it for. So if we think of any autoimmune condition, it is a branch and all the associated signs and symptoms with that autoimmune condition. So if we can envision a tree with leaves or branches that don’t look as healthy as we want them to, like your nails, then we can think that’s a symptom, that’s a branch. And if we focus on the branch, let’s say we go up to a tree in a forest and we want to help this tree thrive, but its branches are turning brown and the bark is falling off. Do we want to pick off those branches? Do we want to saw them off? No, we want to think, how do I get deeper to the trunk? How do I get deeper still to the roots, and how do I nourish the soil that those roots live in?

So autoimmunity is a branch. It is a result of many things, multifactorial aspects that are happening internally. There is not one root. And I just want to say this is another mistake I see a lot of practitioners putting out there; that there is one root, that histamine intolerance or mold or SIBO is the root. There is never one root. There are always three roots. The genes, digestion and inflammation give us a broader perspective, and then each of those has soil, or what I call the circle of influence, that allows us to think, “Where do I need to focus my attention there?” So genes, just as an example, we can’t change our genes, but we can change the expression of our genes. That’s epigenetics, and the factors there are food, movement, environment and mindset. And so we’ve been talking inadvertently about this notion of mindset. You know, how does mindset around sleep and safety, around what the signs are that our body is telling us, how does that put us into that questing state? And can we actually heal in a questing state? I’m not sure we can. The inflammation, the circle of influence is clear, calm, enhance and modulate. We may need to clear a microbial infection. We may need to clear a food that isn’t serving us. We may need to clear an environmental factor that our body can’t process. But we may also need to clear negative thoughts that are keeping us from being in our thriving selves. 

Yeah, I have started recommending to some people, in particular, these tough cases where it seems like you try literally everything on them and just nothing is working, referring them to other programs like the Gupta program.

Yes. 

Lindsey:  

Or hypnotherapy, or, you know, something that’s going to intervene on the mental side. Because as a gut health coach, I don’t quite have the time to work on those types of things. If they were doing once a week, health coaching, 12-week program, maybe. But I don’t see a lot of clients in that type of setting anymore. 

Andrea Nakayama:  

Yeah, exactly. Everything matters, it’s all connected. And so that’s a brilliant move, where you recognize somebody, I think you said it really beautifully, needs an intervention between that mindset piece that’s keeping them in that questing, frightened, sympathetic dominant, lack of parasympathetic dominant state that the body cannot heal in, and we have to learn to catch ourselves in those states. I have a really stressful work situation because of how large the organization is at this point, and I have to have a number of practices that buffer my day to be able to cope with the stress in the middle of my day.

Lindsey:  

Yeah, I have this RingAIRE*, and it tells me about my stress. And I find it interesting because they’ll say, like, what are the different categories – well, one says sympathetic activation, one says stressed, and the one is just, I can’t remember, it’s like a mid level, just activated or something.

Andrea Nakayama:  

Yeah, and that slight tune-in. So if I think about my stress levels, and I think about I’m somebody who can tolerate drinking coffee, but if I drink it on the weekend, I’m fine. If I drink it during the week when I’m already in a stressful situation and I’m already in go, go, go, I can notice what it does to my heart rate, whereas if I’m in my “let things go weekend mode”, that’s all balanced and so that ability to tune in and give myself some allowances. To me, that’s what health is, where we don’t have to be so straight and narrow, where it isn’t so restricted, but we’re kind of navigating life and living with all that we know.

Lindsey:  

Yeah, I just had a client who said before she even started working with me, she had stopped drinking nightly and drinking coffee, and she’s like, I already feel so much better that, you know, she still is bloated every day, but you know, she was like, I feel so much better just from those two changes that I can’t even believe how far I’ve come just from that. And I’ve never been a coffee drinker or a daily alcohol drinker so I’ve never noticed anything huge in modifying those. But I thought that was a good testimony to the basics.

Andrea Nakayama:  

Absolutely, absolutely. Making those changes, we often bypass them while looking for all these other things. And you know, drinking alcohol at night can be a huge detriment to sleep in a number of factors and to mindset and our mood. And I don’t think we realize those things when we’re in it just living our daily life. We also have to recognize that healing may look different than idealing, right? So when we’re living in an ideal state that has a little bit more wiggle room, that is where we get to live into it like I’m talking about. When we’re on a healing journey, we might need to get a little bit more strict with the recognition that it is so that the wounds can heal, and that’s when we then move forward. I think my biggest concern, going back to one of the earlier questions you asked, is that a lot of people are making the dietary and supplemental changes, but they’re not allowing or supporting the body to do its healing. So the wound is still there, while the restrictions get more and more and more narrow, and then that leads to frustration. 

Lindsey:  

Yeah, so back to the whole question of the rings. So I see, and it’s shocking, honestly, because the thing is that you don’t sense that you’re stressed out. 

Andrea Nakayama:  

Totally. 

Lindsey:  

That’s the thing that’s shocking. When I look at it, I’m like, oh, okay, at that moment where I had to make this transition and I was getting up and going and making breakfast, or where I was then interacting with this person, or like, each of those transition points seems to send me into stress mode. And I don’t have a sense that I’m stressed out. I think it was a pretty relaxed day, and then I look and I’m like, “Oh!” Or when I’m working, like, yesterday, I had a super quiet day, sitting at work just sitting on my computer, didn’t talk to another human being. That would be, for me, a really low-stress thing, because the more you interact with other people, the more you know it requires a different level of activation, shall we say. And I was sympathetically activated all through the morning just getting on my computer and answering emails and following up with clients.

Andrea Nakayama:  

Yeah, I think it’s that feedback loop, where we’re getting it from, internally or externally, is really interesting. So if you don’t feel it internally, is there some aspect that is a natural level of when your cortisol is naturally raised, which should happen in the morning, which is then being interpreted as stress? Like again, where do we outsource our feedback loops to the data on the scale, on the test, on the ring, to the nails, like, where are we outsourcing what we actually feel? And is there a way to trust what you’re actually feeling? So I use my Ouro Ring to kind of track my activity through the day or at the end of the day, and to look at my sleep as a reflection, like, what little things can I do to shift some of these markers with my sleep so that I’m getting better sleep, and does that impact my heart rate variability, which is ultimately helping with my resilience to the stress in my life. But I don’t use it as a directional. I use it as a clue to kind of give me some feedback to support how I’m feeling, or what I could be doing. And I think again, there’s a tendency, not on your part, but culturally, there’s a tendency to biohack, to outsource to all these different tests and data measures when our body actually is telling us something. And I’d be curious, like, are you stressed or are you jazzed about what you’re doing, like, what’s actually happening there that would help you interpret that data from a different lens?

Lindsey:  

Yeah, I think I need to know more about how they designate the levels, and that’s the part I haven’t learned, so then maybe I’d have a better understanding. But yeah, I do recognize that you have the cortisol waking pattern that is falling during the day. So I’m not quite sure how – I assume they’re measuring it on the basis of things like heartbeat and temperature. I don’t know what else they gather, so.

Andrea Nakayama:  

Exactly.

Lindsey:  

On the drinking question. So I have noticed something though about drinking and sleep, which is, if I drink the next night or the night of drinking, I get more deep sleep. And I’ve been thinking, this isn’t because drinking is a good thing for me and it’s giving me more deep sleep. It’s because my body needs more time to detoxify the alcohol.

Andrea Nakayama:  

It could very well be! So not the night you sleep, but the night after?

Lindsey:  

No, no, the night I sleep.

Andrea Nakayama:  

Okay, the night you drink. I mean, it’s a depressant too. So you know, you’re coming down. I think some people are going to have more blood sugar swings because of the alcohol. So they’re not going to have that deeper sleep. They’re going to wake up more often to go to the bathroom depending on blood sugar levels. You’re probably, you know, somebody who tends to your blood sugar. So that’s not an issue, but it is a depressant. And so ultimately, your body’s coming down. And yes, nighttime is our- sleep is our number one form of detoxification, so your liver is going to work for you.

Lindsey:

So I’m not sure if you mentioned them already, because you seem to have a lot of different, sort of, groupings of ideas. But did you already talk about the three tiers to nutrition mastery?

Andrea Nakayama:

I mentioned them. So just to put it into context, there are three systems that I’m thinking through all the time. System one is the matrix. That’s how I map a person. You know, the story, the soup, the skill. Everything is connected. We’re all unique. All things matter. Then I mentioned three roots, many branches. So those three roots being the genes, digestion and inflammation, with the branches, if you’re listening and you can list a sign, a symptom or a diagnosis that has been chronic, that is a branch. And if you’re focusing there, then we have to take our attention down deeper. So that leads us to the three tiers, and I mentioned the non-negotiables and the non-negotiable trifecta. So let me just say the three tiers. Tier number one is the non-negotiables. Tier two is deficiency to sufficiency. On the other side of that is toxicity. And tier three is dismantling the dysfunction.

So dismantling the dysfunction is like going for the branches. It’s that top level. It’s what medicine does. This is wrong, let’s fix it. In functional nutrition, what we should be doing is taking a different way into the same problem. It’s that root and soil approach, and that’s what leads me to the tier one and the tier two. So tier one, non-negotiables, like I said, I have the non-negotiable trifecta: sleep, poop, blood sugar balance. Those all have to be in place and worked with, otherwise it’s hard to move forward. So I want to make sure we’re really diving in and understanding that. But then each individual has their own non-negotiables. So Lindsey, if I asked you, what makes you feel better and what makes you feel worse, you have a list of those things, as do I. Some people don’t and that becomes what we really start to unravel with them, because in functional medicine, those are our mediators. When I go to sleep by 10 o’clock, I feel better. If I stay up past 10 o’clock, it’s going to mess with my sleep pattern. That then messes with my blood sugar the next day. There, I know that a 10 o’clock bedtime is a non-negotiable for me. Not eating certain foods, I don’t drink, I don’t eat refined sugar, I personally don’t eat cow dairy or gluten. Those are my non-negotiables, mine. I’m not saying they’re true for everybody.

So sleep, poop and blood sugar balance is the “we all need to” but then for each of us listening, get into learning about your non-negotiables. What do you know makes you feel better? What makes you feel worse? And then you’re in a risk-reward situation with yourself every single day. When I drink coffee during the week, I notice my heart rate’s a little bit more elevated. I’m a little more aggressive at work, I get to make that decision. Do I want to be that person or do I want to have my green tea that day? Like, which person do I want to be? My decision, so that I’m not following a protocol. I’m in a state of awareness. Deficiency to sufficiency, that tier two, sure that can be a deficiency in zinc or vitamin D or B vitamins. There are many nutrient deficiencies. Could be a deficiency in enzymes or hydrochloric acid. It could also be a deficiency in love or joy or play or laughter or sleep or sex. You know, there’s so many things that when we think more broadly, we have a much bigger toolbox for healing.

Lindsey:  

Right, so just so that people can take some very actionable nuggets out of this, one of your non-negotiables is pooping. For a person who is not pooping regularly, what would you recommend?

Andrea Nakayama:  

Yeah. So first of all, I want to see what that means, right? So before I say take some magnesium or do x, y, z, I want to see what does not pooping regularly mean? So does that mean you’re going once a day? Does that mean you’re going once a week? I want to also micro-timeline that. When did this start? Have you always had an issue? Is there any oscillation between the elimination? Does anything you’ve tried in the past make it better for you or make it worse for you? I want the whole story. And then I’m going to start with my three principles in terms of diet before I bring in different changes. So there are three principles, I’m going to go to principle number two, which is “eat the rainbow”. Do we have enough fiber in the diet? And can your body tolerate fiber? So a lot of people, as I’m sure you know being a gut health coach, can’t tolerate fiber, and so I’m looking at that. I’m trialing different things. I might have to do some more internal gut remediation so that we can bring in more fiber. But that’s my first opportunity, versus forcing elimination to occur, it’s a sign that there’s some more I need to work on.

So the “eat the rainbow” also leads back to principle number one with food, which is “fat, fiber and protein”. So I’m going to document with somebody, through a food, mood, poop journal; mood being any sign or symptom, including constipation, bloating, any of it. So it’s not mental mood, it’s any mood the body’s having. But I’m going to look at what’s true for you before I make any recommendations regarding what to do. But I’m starting, first and foremost, after the inquiry and the assessment, my first recommendation is going to be, what can we do dietarily, to kind of 2.0 what it is that you’re currently doing.

Lindsey:  

So it sounds like this method that you’ve developed is very intensive, like, it seems like it would be very time-consuming. So I’m curious, when somebody signs up with somebody who’s trained under you, how many appointments do they typically have to sign up for? Or, how does that work?

Andrea Nakayama:  

Yeah, I mean, different people work it differently. I’m going to talk about how we work it in our clinic. So the people who trained under me, who actually work at the Functional Nutrition Alliance, we have a initial session that really is deep in its assessment. So that initial session is actually three parts. It’s a strategy session, and then it’s a premier case review that has two parts. The first part is after the intake, where we’re going to do motivational interviewing and learn a lot more and create a functional nutrition timeline. So we want to see who you are, when did this start. Like I said, with the micro-timelining around the constipation, I want to know when did you first know? And people will say, I’ve always been constipated. When was the first time you actually noticed you were constipated or recognized it was constipation? Are there times where it’s gotten better ore worse? I want to understand who you are. That’s the assessment.

Then the second part of our premier case review is where we will do nutrition counseling. We’ll have the functional nutrition matrix completed from the prior sessions and be able to make some initial recommendations. In our practice, we then have three and six month packages. Some people might go beyond that and continue to work with us for years, or come back at intermittent times, maybe when they’re more independent, but want us to look at their labs twice a year, or whatever it might be. It’s very dependent on the individual; what they’re working with, as is our cadence of visits. So with some people, we may meet with them for a half-hour once a week, whereas with other people, we might meet with them for an hour once a month. It really depends on where they are, what they need, how acute their chronic issues are, so like, what’s the intensity they’re dealing with at this moment to get through some of the pain that they’re experiencing. In my prior years of practicing, I worked with people for years, but the intensity of our work went from very intense, to more spread out, check in, and learn new things as you need them.

Lindsey:  

Yeah. So that initial intake, it sounds like that it could last multiple hours.

Andrea Nakayama:  

The initial intake is going to take time for the practitioner as well as for the practitioner and the patient. So the patient is doing some pieces, like filling out a lengthy intake. And then there’s the motivational interviewing, where we’re creating a timeline. There’s work for the practitioner before the timeline, there’s work for the practitioner after the timeline, right? So it is a process. I call it the art of the practice. Assess, recommend, track, repeat. And so we are constantly in an inquiry and assessment phase without making recommendations just based on a sign, symptom or diagnosis.

Lindsey:  

Got it. So I’m curious, did you develop this whole system after starting out within the traditional functional medicine world, and then seeing the flaws, and then you were like, something needs to change. So you kind of developed a system. How did it come about?

Andrea Nakayama:  

Yeah, so there were ways that I was working, not coming from a healthcare background, that were kind of more of a story arc, and I didn’t realize I was doing something that was different than any other health coach or nutritionist, like I had no clue. And then when I started to show up in health coach spaces, I was recognizing that I was having a lot more success in practice, and people were asking me to teach them what I was doing. So I kind of had to unpack the way my brain worked in order to teach it to others, which is where these systems-thinking come about, because we have a way to talk about it. I then found my way to functional medicine. I was like, holy moly, this is what I do in the realm of nutrition. So that’s functional medicine. I’m actually thinking similarly, but it’s in the realm of nutrition. So I started to develop the sister ways of thinking about what I was doing to what was happening in functional medicine, and with their approval at the Institute for Functional Medicine, I adapted some of the principles and practices for a different scope of practice. So I’m trained as a functional medicine nutritionist, but what I’m teaching is functional nutrition and functional nutrition counseling, and what we’re offering is functional nutrition. So it is not medical. It is not meant to be medical. We don’t diagnose, we don’t prescribe. I think this is a mistake a lot of people make. We don’t treat, we assess, we recommend, we track. It’s a different process, but it’s very adjacent to functional medicine. So it kind of happened in an organic way over time.

Lindsey:  

Interesting. 

Andrea Nakayama:  

Yeah.

Lindsey:  

Well, this has been a really interesting perspective, sort of at a higher level, maybe, than often I dig down into the details, being a detail-oriented person. And I think you have good big-picture thinking, which helps to pull out and look a little bigger sometimes. 

Andrea Nakayama:  

Yes. 

Lindsey:  

So thank you for bringing that perspective.

Andrea Nakayama:  

Yes, my pleasure, and it’s something I’m often doing with our students. I had one of our power hours today. It’s a two-hour Q&A, and it’s a often reminder to get out of the weeds and think like, what are we missing? What happens when we bring our weedy bias to our own care or the care of others? Sometimes there are things we might be overlooking. So when we broaden our perspective, there’s a lot that might live there.

Lindsey:  

Yeah. So tell me where people can find you.

Andrea Nakayama:  

Yeah. So lots of places. Andrea Nakayama in all the places. So andreanakayama.com. On all the socials, LinkedIn, it’s Andrea Nakayama, and then at the website, andreanakayama.com, it’ll lead you back to the Functional Nutrition Alliance, where I train practitioners. So there’s different information, the more patient-focused information, and not me as a practitioner, but me speaking more generally, like I’ll be doing in my book, is over at andreanakayama.com and the practitioner stuff is at Functional Nutrition Alliance,

Lindsey:  

Okay, and then the practice that you are associated with is located where?

Andrea Nakayama:  

Functional Nutrition Alliance is where we have our practice as well.

Lindsey:  

Okay, then it’s virtual or in-person?

Andrea Nakayama:  

Yes, all virtual. 

Lindsey:  

Oh, okay, great, okay, wonderful!

Andrea Nakayama:  

Yes!

Lindsey:  

Well, thank you so much for sharing your knowledge with us today!

Andrea Nakayama:  

Yeah, thanks for having me. It was really fun!


If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

Schedule a breakthrough session now

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Organic, Pasture-Raised and Processed: How Food Quality Affects Your Gut

Organic, Pasture-Raised and Processed: How Food Quality Affects Your Gut

Adapted from episode 137 of The Perfect Stool podcast with Lindsey Parsons, EdD, and edited for readability.

What does healthy digestion look like?

Let me start by briefly describing what a healthy digestive system looks like and how that interacts with the food you eat. While there has been a lot of focus on the importance of diversity in the gut microbiome in health, primarily because that means that if you lose one species or strain that performs a certain function in your microbiome, then another one can take over that function, there is no set number of bacteria that has been agreed upon that constitutes an acceptable number. Having interpreted many stool tests, and more and more using metagenomic sequencing tests, I think a more relevant question is whether there are large overgrowths of pathogenic bacteria than how many species or strains you have in total. It has been proposed that a microbiome that is 85% commensal or healthy bacteria with 15% or fewer pathogenic bacteria is a healthy microbiome.

But beyond the microbiome, there is also the functioning of the digestive organs. In a healthy digestive system, you will have adequate amounts of salivary amylase starting to break down food in your mouth, the lining of the cells of the stomach will be intact and not inflamed, so that your stomach will be sufficiently acidic to break proteins into amino acids and to keep your lower esophageal sphincter from opening up and letting acid into your esophagus. Your stomach acid will also be sufficient to kill off the majority of incoming pathogens that may be slipping in with your food. And you will have the release of intrinsic factor from the parietal cells lining your stomach so that you can absorb vitamin B12 from your food. Sufficient stomach acid will also help with the absorption of calcium, magnesium and possibly zinc.

Then as the food passes out of your stomach, you will have sufficient bile released into the duodenum, the first part of the small intestine, to both help in digestion and to raise the pH or alkalinize the chyme, or mashed up food mixed with stomach acid, that’s exiting the stomach. The bile is produced by the liver and stored in the gallbladder and released by the gallbladder when it senses fat in your food, and it emulsifies fats like dishwashing detergent does on grease so that they can be broken down further and absorbed. In a healthy digestive system, the bile is of sufficient fluidity not to get stuck in the bile ducts and clog them up or form stones. So if that’s all going well, you should be absorbing fatty acids properly from your food, provided you’re not deficient in l-carnitine, an amino acid found primarily in animal products or produced by your body from l- lysine, or in vitamin B2, which are necessary for bringing fats into the Krebs cycle to produce energy. Bile also is taken in and transformed by your gut microbiome through various enzymatic processes resulting in secondary bile acids, which perform distinct biological activities of their own, which science is only beginning to unravel.

Then a healthy and intact pancreas will release sufficient pancreatic enzymes to help digest your food. These include amylase, which breaks down carbohydrates, lipase, which breaks down fats, protease and elastase, which break down proteins and trypsin and chymotrypsin, which digest proteins. Then the cells lining the small intestine will also release what are called brush border enzymes, which further help to break down your food. Some key ones include maltase, which breaks down maltose into glucose, sucrase, which breaks down sucrose (table sugar) into glucose and fructose, lactase, which breaks down lactose (milk sugar) into glucose and galactose, and peptidases, which break down peptides (or small protein fragments) into amino acids. So most of the nutrient absorption is happening in the small intestine.

Now along with food, you will bring in things that are not food with your food – and that’s where the role of the gut immune system comes into play. Seventy percent of our immune system resides in the gut, because that’s one of the primary places where the outside world comes into contact with the inside world. There’s a wide variety and complexity of immune cells in the gut, most of which I don’t fully understand, but I will say that one that we measure on stool tests, secretory IgA, is produced by B cells and plasma cells in the gut, and serves to bind to pathogens and toxins and prevent them from attaching to the gut lining. It also neutralizes viruses, bacteria and toxins before they can invade tissues. Secretory IgA, along with other gut immune cells, are your second line of defense after the stomach acid, and prevent you from getting sick from the pathogenic bacteria that inevitably come in with your food.

Secretory IgA also selectively culls the microbiome, binding to pathogenic microbes and promoting the growth of beneficial ones, and it does its work without triggering inflammatory responses, which protects the gut from excessive immune activation. It also helps train the immune system to tolerate beneficial microbes and dietary components.

Then your gut microbiome is your third line of defense. If you have a healthy gut microbiome, each group of microbes will occupy a certain niche in the gut. As a result, pathogenic bacteria entering the gut will not have any place to settle and make a home. This is why you often see gut health issues appearing following antibiotics – as bacteria are killed off, niches open up in the gut into which pathogenic bacteria can enter or opportunistic or otherwise not harmful bacteria can overgrow and become problematic. And certain bacteria, in particularly the spore-forming bacteria from the genus Bacillus found in spore-based or soil-based probiotics like Just Thrive*, Megasporebiotic*, Proflora 4R*, CoreBiotic* or ProBioSpore* also can secrete antibiotics that kill off other bacteria. In fact, they have a quorum-sensing capacity of finding overgrown bacteria then getting next to them and secreting these natural antibiotics. Based on the name, you can probably tell that they naturally come from soil, so traces of soil may bring them in naturally, or they may come from the tissues of plants, via air or water or from fermented foods.

Now back to the major organs, although it could be argued the microbiome is an organ, once most of the nutrients are absorbed in the small intestine, the food hits the large intestine, whose primary role is to absorb water and electrolytes from partially-digested food. This is where the majority of the microbes live. These microbes actually produce B vitamins and vitamin K, which are absorbed into the blood, and ferment the leftover undigested fiber into short-chain fatty acids. These short-chain fatty acids serve as a primary source of energy for the colonocytes or colon cells, help to maintain the integrity of the gut barrier, modulate inflammatory responses, and promote immune tolerance and impact insulin sensitivity, glucose uptake and fat storage. There are four of them: acetate, which plays a role in regulating appetite and energy expenditure, propionate, which may contribute to cholesterol metabolism and blood sugar control, valerate, which supports energy production, reduces inflammation, helps maintain the gut barrier and modulates microbiota balance, and butyrate, considered the most important short-chain fatty acid, which maintains gut barrier function and has anti-inflammatory properties.

So everything I just described assumes that you’re getting all the nutrients necessary from your diet to keep everything functioning well. And that you’re not getting too many anti-nutrients or toxins that would impair gut function. So now let’s move on to some of the types of foods that can cause damage to the gut.

How can food damage the gut?

Let’s start with fast food. Of course, I understand why people sometimes feel the need to eat fast food out of convenience: it’s cheap, fast and if your taste buds haven’t been trained to appreciate good food, tastes good. You don’t have to deal with prepping ingredients or doing the dishes after. Instead, all you have to do is drive 5 minutes to your local fast food restaurant and have a meal ready in the same time it would take you to chop an onion. However, fast food only solves short-term problems at the cost of long-term consequences. Most fast food is made up of Ultra Processed Foods, or UPF’s. These aren’t foods that are grown in a garden or on a farm, but instead created in factories by combining chemical compounds, inorganic ingredients and other synthetic additives, including artificial flavors, colors, emulsifiers and preservatives. These foods are designed to be hyper-palatable and addictive but often lack nutrition, especially fiber, which is integral to proper gut functioning, if you recall, that production of short-chain fatty acids that leads to healthy colonocytes and reduced immune activation. Ultra processed foods supply your body with empty calories and foreign substances that are difficult to digest, potentially causing a huge variety of health problems, both in the short term and long term. Some common adverse health effects associated with consuming UPFs include obesity, cancer, type-2 diabetes, cardiovascular disease, irritable bowel syndrome, depression and even all-cause mortality. Some common ingredients you might see on nutrition labels for UPFs include high-fructose corn syrup, hydrogenated or interesterified oils and hydrolyzed proteins. If you see these ingredients in the foods you are buying, you are eating UPFs.

High fructose corn syrup is especially ubiquitous in the American diet and it has been shown to be closely related to the increased prevalence and severity of multiple diseases, including inflammatory bowel disease, gut-liver axis dysfunction, and more. High fructose corn syrup has been shown to exacerbate intestinal inflammation and deteriorate intestinal barrier integrity, worsening existing gut conditions and increasing the risk of developing new ones. Trans fatty acids, another common ingredient in ultra-processed food but not shown on the nutrition facts label because if there’s less than 0.5 grams, they aren’t required to list it, also contribute to gut inflammation and increase the risk of developing metabolic syndrome, diabetes and coronary artery disease. They’re so unhealthy that the FDA actually banned any amount exceeding 0.5 grams/serving of them in our food. But if you see any oil called “hyrogenated” on the label, they’re in there.

And then there’s the thickeners and emulsifiers like carrageenan, xanthan gum, guar gum, locus bean gum, polysorbates and propylene glycol that have been implicated in helping cause and exacerbate inflammatory bowel diseases (that is, Crohn’s and colitis).

Eating fast food can cause changes in the gut very quickly. In as short as a few days after eating a high volume of UPFs, your gut microbiome’s ability to optimally digest food is impaired. UPF’s kill fiber-fermenting bacteria in your gut, decreasing your body’s ability to digest food, excrete toxins and absorb nutrients. Eating UPFs also increases intestinal permeability, allowing harmful substances to enter the bloodstream, sending inflammation beyond the gut.

And you may think that eating some UPFs, like some chips, desserts or other snack food isn’t a big deal, but they contain anti-nutrients like phytates or phytic acid, which is found in grains and binds to minerals like zinc, iron and calcium, reducing their absorption. And the sugar requires extra zinc to process it, as zinc is used in insulin production and carbohydrate metabolism. So imagine you’re always eating grains and sugar alongside foods high in zinc like meat and seeds. You may end up deficient in zinc, as one example.

Zinc has numerous roles in the digestive system, including serving as a cofactor for over 300 enzymes involved in digestion and metabolism, strengthening the tight junctions between intestinal cells, preventing toxins and pathogens from entering the bloodstream, supporting immune cell activity in the gut-associated lymphoid tissue, reducing inflammation and promoting balanced immune responses, contributing to the production of stomach acid, which is vital for breaking down food, killing harmful bacteria and activating digestive enzymes like pepsin, which is essential for protein digestion. It’s also essential in healing and repairing tissues, making it important for healing ulcers or damage to the gut lining caused by conditions like gastritis. Zinc helps with the absorption and transport of other nutrients like vitamin A, which is also important for gut health. Vitamin A, in the form of its active metabolite retinoic acid, helps immature immune cells differentiate into specialized cells that enhance mucosal immunity and drive the production of IgA-producing plasma cells in mucosal tissues. So you can see how eating processed foods, which contain few nutrients and some antinutrients can start a zinc deficiency which can then cascade into other deficiencies like protein and vitamin A, which will further break down the digestive system and its immune system.

That being said, for those of you panicking that you’ve ruined your gut by eating McDonald’s once last week, don’t worry! The effects of eating fast food can be reversed by regularly eating organic, nutrient-rich, whole foods, and focusing on high-fiber foods like beans and lentils, aka legumes.

Speaking of organic, with the official organic designation, you can know that the foods you’re eating aren’t genetically modified, are grown without the use of harmful chemical fertilizers and are grown with sustainable practices. Not genetically modified means that your body will recognize them, and that they won’t be doused in the herbicides that genetically modified foods were designed to resist. Organic fruits, vegetables and grains often contain higher levels of polyphenols — compounds known to nourish beneficial gut bacteria and promote the production of short-chain fatty acids. Organic farming methods can also result in foods with slightly higher levels of certain micronutrients, which may indirectly support gut microbiota health, and are more easily digestible than conventional and synthetically-supplemented foods. For example, if you’re eating conventional bread, it will likely have added B vitamins, as in the US white flour is usually enriched, because when you remove the bran and the germ from a wheat kernel, you remove the B vitamins. So they will add them back, but in the form of the cheapest, least absorbable forms of B vitamins – so folic acid rather than methylated folate, which people with MTHFR mutations do not absorb well, and B12 in the form of cyanocobalamin, rather than methylcobalamin, which is also much less usable by people with mutations in the MTHFR, MTR and MTRR genes, which are incredibly common. Of course, you can avoid this problem by eating whole wheat bread, but when you add on the organic component, you are also eliminating the pesticides, which is the most important aspect of eating organic.

Why is glyphoste of particular concern?

I’ll mention one pesticide in particular today, glyphosate, because it’s become omnipresent and has particular concerns for the gut microbiome. Dr. Stephanie Seneff, glyphosate researcher and author of Toxic Legacy: How the Weedkiller Glyphosate Is Destroying Our Health and the Environment*, has proposed several hypotheses about how glyphosate may impact the gut microbiome. Glyphosate preferentially harms beneficial bacteria from the genera Lactobacillus and Bifidobacterium while allowing opportunistic pathogens like Clostridium difficile to thrive. It also impacts the shikimate pathway present in many gut bacteria, which is critical for the synthesis of aromatic amino acids (e.g., tryptophan, tyrosine and phenylalanine). Disruption of this pathway could limit these essential nutrients and affect gut health. It also may promote the formation of protective biofilms by some harmful bacteria, which can make them harder to eliminate.

Glyphosate is also a chelating agent, meaning it binds to metals, in particular, manganese and molybdenum. This can reduce the bioavailability of molybdenum, a trace element necessary for enzymes involved in detoxification (e.g., sulfite oxidase and xanthine oxidase). Molybdenum-dependent enzymes help break down sulfur compounds and purines. A deficiency might impair these processes, potentially contributing to issues like sulfite sensitivity and uric acid buildup. This is believed to be one of the issues in hydrogen sulfide SIBO, now known as intestinal sulfur overgrowth or ISO. Dr. Seneff has also postulated and found some evidence to support the fact that glyphosate, which differs only slightly from the amino acid glycine, may be substituted for glycine in the formation of proteins in plants, and then incorporated into the human body this way. Glycine is particularly important in collagen formation and is one of the three amino acids that make up glutathione, our master antioxidant and the second most abundant molecule in the body after water. And I’ve seen over and over on my clients’ organic acids tests an elevation in benzoic acid and much lower hippuric acid, which is indicative of an absence of glycine, which is used to convert benzoic to hippuric in the liver. Not to mention low glycine on amino acid tests and markers of low glutathione status. So I believe I’m seeing concrete evidence of the harm of glyphosate from non-organic food in clients.

Chronic glyphosate exposure has also been linked to anxiety, depression, Alzheimer’s, Parkinson’s, and other neurodegenerative diseases, though these links aren’t fully proven. Some studies suggest glyphosate may impact brain function and increase the risk of neurological conditions due to its potential interference with neurotransmitter function and mitochondrial health. It has also been connected to osteoporosis due to the depletion of minerals and nutrients like manganese, calcium and magnesium, and could potentially contribute to bone density loss. Finally, there is emerging evidence suggesting that glyphosate may have endocrine-disrupting effects, which could influence fertility in both men and women.

So if you’re trying to avoid glyphosate, you should know that genetically modified crops were created to resist being killed by this herbicide to allow for Round-Up, the brand name of glyphosate, to be sprayed liberally on crop fields to kill off weeds. Soybeans, corn, cotton, canola and sugar beets are crops specifically genetically modified to resist glyphosate, so if you’re eating or using those conventional products, you will be taking in glyphosate. Unfortunately, glyphosate is also used for pre-harvest desiccation (drying crops for uniform harvesting) on non-GMO crops, particularly wheat, oats, barley and sadly, lentils and pulses too like chickpeas and peas. Glyphosate is also applied in orchards and vineyards to control weeds around trees and vines. The only way to protect yourself from this exposure is to eat organic. And not just organic vegetables, but bread, grains, pastas, legumes, corn products, etc. As for vegetables, if for budget reasons you need to prioritize, choose organic from the EWG’s Dirty Dozen list and you can eat conventionally raised crops from their Clean 15 list. But be sure to check for the new lists each year.

What is superior about pasture-raised or grassfed meat and dairy?

When it comes to meat and dairy, I often think that it’s even more important to focus on the highest quality foods (than say organic vegetables) because these animal foods represent the top of the food chain, which means that all the pesticides and toxins these animals take in accumulate in their fat, which makes up part of the meat and of course the fat in dairy products. Studies have also shown that pasture-raised meat and milk contain higher concentrations of anti-inflammatory omega-3 fatty acids and CLA (conjugated linoleic acid), which is also anti-inflammatory, promotes lean muscle mass and insulin sensitivity.

Pasture-raised products are also higher in carotenoids, and antioxidants like vitamin E and have lower levels of toxic trans fats compared to grain-fed animals. And in this case, often the organic designation is a less important question, especially if you’re dealing with a small farm or a local producer who can’t afford to get organically certified, but the term to look for is pasture-raised (not to be confused with pasteurized). You may also see the term grass-fed for beef and lamb, which can be problematic because many producers will mark ground beef as grass-fed, if the animal was fed grass at any point in its life, when in fact, the cows were corn-finished, eliminating the benefits of grass feeding earlier in the animals’ lives. Corn is not a natural part of a cow’s diet, which should be primarily grass. High starch, low fiber corn leads to excessive acid production in the cows, which causes bloating, ulcers, liver abscesses and discomfort, a negative shift in the microbiome and increased methane emissions from cows. Methane is 80-85 times more effective at trapping heat in the atmosphere compared to CO₂ over a 20 year time span, so a way more potent contributor to climate change, not to mention when you have massive feedlots of cows together, they generate massive amounts of manure, which is not used to fertilize crops but rather stored in lagoons, which emit methane and can leak into water sources.

So “grass-finished” is a better term than “grass-fed”, if you have the option. Often the best way to find such products is to look online and find a local farm that delivers in your area. This usually involves having to plan ahead and get a meat delivery weekly or monthly, and recognizing that most of the cuts of meat from a grass-fed animal are not steaks, and those will be much more expensive. So plan on using a variety of cuts in your cooking. Pork can also be pasture-raised, but not grass-fed, as pigs don’t eat grass. Pasture-raised pigs are able to eat a diverse diet of plants, insects and nuts, in addition to being fed silage and grain. And they are raised more humanely, of course, exposed to sunshine and are able to forage, run, jump and root in the soil. Pasture-raised pork is higher in nutrients like vitamin D, selenium and omega-3 fatty acids, and lower in saturated fat.

And of course, chicken can be pasture-raised as well, which is especially important when buying eggs, because terms like free-range are essentially meaningless, as chickens raised indoors in giant henhouses and overstuffed with food to produce giant breasts can hardly walk, and the one-door in the entire, giant place rarely produces much of an exodus. Eggs from pasture-raised chickens contain significantly more omega-3 fats, and have higher levels of vitamins A, D and E. You can tell a truly pasture-raised egg from the color of the yolk alone, which is a much deeper orange from beta carotene, much like the darker yellow you can see in pasture-raised butter. So for your gut health, pasture-raised meat, dairy and eggs add up to better gut health and reduced inflammation, not to mention a much more humane way to raise animals.

Why is a plant-forward diet important for the gut microbiome?

Some people would argue against eating animal products at all, but I do believe that most people benefit from them nutritionally. But of course, we could all benefit from eating more plant-based proteins in the form of beans, peas, lentils, nuts, seeds, quinoa and oats, which also offer the benefit of an increased amount of fiber, which is essential for producing short chain fatty acids and having optimal colon health. I recommend ¼ to ½ cups of legumes a day for optimal gut health. Plant-based proteins are also less associated with pro-inflammatory pathways compared to diets high in processed foods and animal-derived foods. Finally, plant-based proteins are linked to a lower risk of chronic diseases, such as type 2 diabetes, obesity and certain cancers, due to their lower saturated fat content and higher fiber content. Despite all of this, be sure to check the ingredients in your plant-based proteins to ensure they don’t contain UPFs or other harmful additives that may counteract their beneficial effects. Many meat substitutes are just processed soy products raised with heavy pesticides and filled with unhealthy additives. 

Eating plant-based and animal-based proteins, if you’re able to, is a great way to optimize your gut’s functionality and your protein and nutrition intake. Combining plant and animal proteins is a great way to get a more complete mix of amino acids. Plant proteins often miss some essential amino acids that animal proteins have in abundance, so pairing them together helps fill in the gaps. 

Are all processed foods bad for you?

It’s important to note that most foods are processed in some way. Most foods are put through machinery to be sorted and packaged. However, not all processed foods are bad for you. One such example is fermented foods. Fermentation is technically a form of processing food, but these foods, such as yogurt, kimchi and sauerkraut, can bolster your gut’s microbiome. Just check the additives, as many yogurts contain additives such as gums and thickeners, lots of added sugar and more and more, harmful artificial sweeteners. But overall, consuming fermented foods produces bioactive peptides, biogenic amines, and other metabolites like short-chain fatty acids, which are associated with improved digestion and reduced inflammation. 

Since all packaged foods are processed in some ways, sometimes it is difficult to discern between Ultra Processed Foods and less processed foods as there is no clear indication on most product packaging. Instead, you can look at the ingredient list for some of the chemical compounds that I’ve mentioned today, unfamiliar chemical names [but be careful you aren’t confusing nutrient names like ascorbic acid (vitamin C), retinol (vitamin A), tocopherol (vitamin E), calciferol (vitamin D) or thiamine hydrochloride (vitamin B1) for chemicals. You can also look foods up in the Environmental Working Group database of food scores. But in general, less processed foods don’t include chemical additives or inorganic compounds; they are much easier to digest and absorb nutrients from, compared to UPFs and fast food. Eating fast food every once in a while when you’re in a bind and need a quick bite will not destroy your gut microbiome. However, eating it regularly will impact your gut’s functionality in the long term.

Some people find that meal prepping on the weekends makes it easier to eat healthy during the week. And I’ve gotten into the habit of soaking beans overnight even if I have no specific plans for them, then popping them into my instapot with some chicken bouillon and spices and sometimes vegetables and making a quick soup or beans to throw on salads or for a small fiber and protein-rich main or side dish. An adequate intake of fiber for men is 30-38 grams a day and for women is 21-25 grams, and that’s hard to reach without including legumes in your diet. 

Well, my goal in this podcast was to convince you that it’s worth it to switch to organic, pasture-raised and minimally-processed foods. I hope I achieved that goal by giving you some specific details about the impacts of these foods on your digestive system and body. If cooking is a big challenge for you, you might try looking into some of the organic meal services that offer pre-made cooking kits.


If you’re dealing with gut health issues of any type and need some help, I see individual clients to help them resolve their digestive issues and 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.

Schedule a breakthrough session now

*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.

Root Causes of Acid Reflux and Gastritis: Insights from Vincent Pedre, MD

Root Causes of Acid Reflux and Gastritis: Insights from Vincent Pedre, MD

Adapted from episode 136 of The Perfect Stool podcast with Vincent Pedre, MD, Board-Certified Internist in private practice in New York City, Medical Director of Pedre Integrative Health and President of Dr. Pedre Wellness, and Lindsey Parsons, EdD, and edited for readability.

Lindsey:  

So today we’re going to be focusing on difficult cases of reflux and gastritis. So can we start by just getting definitions of what those two conditions are and what symptoms you might have if you have either or both?

Dr. Vincent Pedre:  

Yeah, a lot of times they can overlap in terms of symptoms, but someone who has acid reflux, technically, is having some acid from the stomach coming up through the lower esophageal sphincter, which is the little muscle that closes the esophagus when you swallow, to make sure that acid doesn’t come up. And the acid is somehow making its way up into the esophagus, and that usually causes that sensation that people get of heartburn, usually here in the chest, but sometimes they’ll feel it in the throat too. They may wake up in the middle of the morning or the next day and feel like they’ve got some acid in their throat, or they might actually have a little bit of a hoarse voice from acid refluxing back and getting onto their vocal cords. Or they might actually wake up with some mucus in the morning, and all these could be signs of acid reflux.

Obviously, sometimes, you know, in the body, there are symptoms that tend to converge together. So having throat symptoms could also be post-nasal drip. You always have to be thinking that things could be coming from different directions, and gastritis is basically an inflammation of the lining of the stomach, which can come from a variety of reasons. A lot of times it can be, actually, deficiency of certain micronutrients, like zinc and l-carnosine that are necessary for the health of the stomach lining, not enough mucus production, and unfortunately, a lot of times, I think we’ll get into this, these issues are treated with acid lowering medications like PPIs. Now, the difference with gastritis is that you won’t get the heartburn symptoms, but you may get some feelings of upset stomach, sour stomach, maybe food doesn’t sit well in the stomach. A lot of people will have chronic gastritis and probably not know that they have it, and it’s usually an incidental finding on an endoscopy or an imaging study where they look down through your esophagus with a camera and a tube and take pictures of the stomach. So a lot of times it will be found, but the person isn’t necessarily aware that they have gastritis.

Lindsey:  

I’ve also had clients, though, who have real, burning sensations in their stomach.

Dr. Vincent Pedre:  

Yeah, which could be an ulcer, or could also be a symptom of gastritis, as well.

Lindsey:  

Yeah. And obviously an ulcer is pretty serious. So what would alert someone that they have maybe an ulcer and they should be getting some immediate medical attention? 

Dr. Vincent Pedre:  

Sometimes it’s just the degree of the symptom, the severity of the symptom, the time course of how the symptom changes over time. Usually, an ulcer, if you’re not doing anything to make it better, it’s going to continue to get worse and worse. It’s going to get more and more intense over time, whereas usually gastritis kind of lingers in the background. It doesn’t necessarily get really, really sharp in the way that an ulcer can get. And then you also want to look at other behaviors, like, did the person recently hurt their ankle, or something like that, and they’re taking over the counter ibuprofen, and they thought that it was safe, and it was okay to take without a prescription. And then two weeks in, they start getting stomach pains, and they’re not sure, well, why am I having stomach pains now?

Lindsey:  

Yeah, I had that happen. I had terrible sciatica, and really, there was nothing that would manage it except ibuprofen. And it got to the point where I was like, I’m giving myself an ulcer; that has to stop. I’m going to have to figure out what else to do.

Dr. Vincent Pedre:  

Yeah, people have to be really careful with that. And you have to also be really careful because you might be taking ibuprofen. And then, because all of these medications are available over the counter, you start feeling some stomach pain. So now you go and get an over the counter anti-acid medication, whether it’s Pepcid or some sort of PPI that are now available over the counter, and you’re self-treating, but without really knowing what’s going on underneath, and you’ve got to make sure that you’re stopping what is causing the underlying problem, which in that case is, could be Naprosyn, could be ibuprofen, could be any of the NSAIDs.

Lindsey:  

Right. Yeah. So for me, you know, as a gut health coach and someone who deals with gut health issues, there are some obvious reasons for reflux and gastritis, like SIBO, which would normally be accompanied by bloating or loose stool, diarrhea, constipation; and then H. pylori, which is easy enough to test for and correct. But I also have a number of clients who either have relatively low levels of H. pylori, so like on a PCR test, it shows below reference ranges by a good degree. You know, it’s something to the second power versus to the third power, which is the reference range (one to the third). 

Dr. Vincent Pedre:  

I’m even skeptical about those reference ranges when-

Lindsey:  

oh, okay

Dr. Vincent Pedre:  

-it comes to H. pylori, I think that we have to be really careful with the H. pylori test in some of these PCR tests, and-

Lindsey:  

you think like over killing it? or under-killing it?

Dr. Vincent Pedre:  

I think we’re over diagnosing, and we may be over treating H. pylori. H. Pylori is very controversial, because it does exist in certain individuals without causing any symptoms. 

Lindsey:  

Right, right.

Dr. Vincent Pedre:  

It doesn’t cause gastritis; it doesn’t lead to ulcers. And the question is, in a patient that might show up with H. pylori, do you still treat them for H. pylori, meaning, you’re putting them under a regimen that’s going to take time, effort, it’s going to affect quality of life, it’s going to add some extra stress, or do you just leave it be? And I think I’m very careful with some of these PCR tests saying that “you’re out of range” with H. pylori, I always want to go back to the patient first. What symptoms are they having? Does it correlate with H. pylori? And I like to do a test to determine whether they do actually have active H. pylori infection with either the stool antigen or a breath test. 

Lindsey:  

Mhm.

Dr. Vincent Pedre:  

So I think it’s important when it comes to H. pylori, I think the decision tree has to be a bit more careful than just using a tool like the GI map, for example.

Lindsey:  

Right, right. What I was getting at, though, was that you might have somebody who doesn’t seem to show, what I would believe, is a problematic H. pylori, because the reference range is low, there’s no virulence factors, or their H. pylori isn’t even existent, but they still have that burning and the gastritis in the stomach. So what reasons, beyond SIBO and H. pylori, might there be for that? I guess we’ve talked through ibuprofen use or NSAID use. What other possible reasons are there for the reflux or gastritis?

Dr. Vincent Pedre:  

Yeah, we have to think, first of all, of hypochlorhydria, so inadequate production of stomach acid, which could be in conjunction with gastritis or just loss of the mucus barrier, not enough production of the mucus as well as hydrogen, which is dependent on zinc. So that’s why zinc l-carnosine becomes a very important nutrient in treating these patients, because a lot of them are actually zinc deficient, and that’s partly why they’re having these symptoms. When you have low stomach acid, it can do the opposite of what you would think. So you’re wondering, well, if someone has low stomach acid, why are they going to get reflux or heartburn? That doesn’t make a lot of sense. The issue is that when you have less acid production in the stomach, food isn’t going to break down so easily, and as your body detects that, it’s trying to break that food down by producing more gastric juice, but that gastric juice maybe is at a higher pH, it doesn’t have both the strength and also the proper pH for the proteases to work at their best, most efficient. And as your stomach fills up, it’s very likely that some of that gastric juice is going to spill up into the esophagus and give that heartburn sensation.

It also can be dependent on when the person is eating. It’s so, so important to ask our patients, what time are you eating dinner? Especially, how long after dinner do you lie down? So it’s not good to lie down – regardless of what’s going on in the stomach – within a few minutes of eating or eat dinner and then an hour later go to bed because digestion isn’t finished, there’s still food in the stomach. It’s very likely that, even if you don’t have low stomach acid, you don’t have a propensity to reflux, just by the pressure of the food and lying back with gravity, you’re going to get some reflux symptoms.

Lindsey:  

And what would cause the loss of the mucous barrier? Is that zinc deficiency, or are there other reasons for that?

Dr. Vincent Pedre:  

It partly can be zinc. We see it also with H. pylori infection; the barrier starts to break down, and then it becomes easy for the lining to become inflamed or even eroded and lead to an ulcer. More rarely, this would be a very rare case, where you’re getting bile reflux into the stomach, and that could also cause these heartburn-like symptoms, you know, where people feel like they might have an ulcer, they have gastritis, but it’s actually bile moving in the wrong direction.

Lindsey:  

Yeah, so we’ve talked a little bit about causes for reflux that were not, sort of, the obvious couple things. What about causes for gastritis that beyond the obvious?

Dr. Vincent Pedre:  

I think going back to nutrient deficiencies, you have to think about, basically, doing a very comprehensive look at the person’s micronutrient profile as well as their ability to heal. So things like vitamin C, other nutrients that are very important for healing, like I said, zinc, even thyroid function, like, if a person is slow healing, thinking about do they have hypothyroidism? And also, let’s say, a less obvious one is going to be vagal nerve dysfunction, which really comes from stress. So people are walking around stressed and in fight or flight, which shuts down the vagus nerve. The vagus nerve is also needed, very important, to signal and trigger gastric acid production, as well as protection of the lining with mucus, as well as the production of digestive enzymes. So if we lose vagal tone, that also increases the risk for these things, as well as dysbiosis, although it’s not as important in the stomach, the stomach is not a very microbiome-rich environment like the large intestine and the small bowel, with the large intestine being the biggest reservoir for the microbiome.

Lindsey:  

Yeah, and so what can people do to restore their vagus nerve function?

Dr. Vincent Pedre:  

Oh, I love this! One of my favorite, favorite things to talk about. I mean, first of all, it’s about really making space for mindfulness and for relaxation. Just breath work, bringing up the diaphragm, doing deep diaphragmatic breathing, is super important. Most people, when I ask them to take a deep breath, they’re breathing up here, you know, so, and I’m sure if you see your clients, you ask them to take a deep breath, they probably go like this. They’re breathing all up here, but they’re not really breathing down here with the diaphragm. And that’s a huge problem for a lot of people, and people don’t realize that stress actually causes them to constrict their belly, even just the rib cage gets constricted. And sometimes you have to go in and massage the edges of the diaphragm to kind of loosen up some of the fascia so that you can then get an easier, deeper breath, even just by massaging here and up and down the rib cage and even around here, because the neck gets so tight from people clenching their jaw at night. So many of my patients, I see that they’re clenchers; you can see the bottom incisors are worn away. They have neck pain, but it’s coming from the fact that they’re clenching their jaw. So, even just loosening the jaw, loosening some of the neck muscles, opening this up, just massaging along the edge of the diaphragm, so you can take a really deep breath, because then those stretch receptors in the lungs are going to then stimulate activation of the ventral vagus nerve.

We can do it other ways too, because the vagus comes here down on either side of the vocal cords, so things like singing, gargling, humming, all of these things are really good for activating that vagus nerve and calming the body. But we also know that having a balanced gut microbiome also helps to activate the vagus nerve and that interface, because the vagus enervates the entire intestine, and part of the way that the vagus is sending signals back to the brain is through serotonin receptors. And if you have a disordered gut microbiome, you’re not going to get as much serotonin production. If your gut lining is disturbed, then the enteroendocrine cells, which are sparsely, they’re almost like stars in the night sky; they’re interspersed all over the intestine, and they’re also producing serotonin and helping to stimulate the vagus nerve. But if this is the disorder, then that’s also going to affect vagal tone, and then that has a downstream effect on the entire gut. I think it’s one of the most important issues that we need to never forget to address in our patients, because we can get so lost on the mechanics, and supplements, diet and forget the critical importance of the vagus nerve.

Lindsey:  

Yeah, yeah, I’ve been doing breathwork every night for the last, I don’t know, three or four months with my husband and he mentioned that since we’ve been doing it, he’s taking much deeper breaths; that before he was breathing very shallowly. I’m sure that all upper chest kind of breathing, and I was excited to hear about that.

Dr. Vincent Pedre:  

Yeah, it keeps you more in that fight or flight response. It’s almost like people are wearing an armor, like if you’re stressed, you don’t even realize it. It’s subconscious. But you put on this armor, and the armor is in the form of you bringing your chest wall in, and you take shallower breaths. I always think of it, like I tell a patient, imagine walking out into a field, a big green field in the countryside, where the views are all the way to the horizon, and imagine what it is to take a breath there. You know, you feel this expansiveness. It’s easier to take a deep breath, because you feel more space and you don’t feel attacked by being in a city, or even just by the stress that you carry with you at all times.

So what about Crohn’s disease? Could that manifest in the stomach or the esophagus?

Crohn’s is a systemic disease that is not limited only to the intestines. It’s actually an autoimmune disease that can even be manifest in the eyes, for example.

Lindsey:  

So people who are having extreme pain in their stomach or esophagus and don’t seem to have all these other things could, it could be Crohn’s.

Dr. Vincent Pedre:  

I mean, it would be rare, because you’re always going to have Crohn’s also in the intestines, in the small intestine and possibly the large intestine. So it would be, it would have to be a really extreme case where it’s spread that far. But most of the time it’s more- you’ll find it more in the small intestine or large intestine. And again, it’s one of those things, you know, we give it a name, but the name doesn’t really say what the true underlying cause is.

Lindsey:  

Right, right. Okay, so I have a couple of clients whose gastritis is so bad that they came to me already having been on very extreme low acid diets, and/or they’ve already been on PPIs long term. So, I’m wondering if there’s ever the case for those kind of diets, or is it more about finding out the root cause of the issue and then correcting it?

Dr. Vincent Pedre:  

Well, I’m always going to say it’s about finding the root cause. And yeah, I mean, if your house is on fire, you don’t want to throw more wood into the house. So if things are really on fire in your in your stomach, you have to be really careful about eating the the big triggers like chocolate, mint, fried foods, acidic juices, tomato sauces, wine, all those things are going to be big triggers. But what I found is that, in contrast to the Western medical model, where we would take that person and we would just say, Well, you have these symptoms, here, take this medication, and now you can drink your wine, now you can eat these foods, they won’t bother you anymore, but the minute they stop the medication, those foods are going to bother them. And what I found is that, when you work on the root cause, the things that we’ve been talking about, like improving gastric acid production, improving the mucus layer, using different things like leaky gut formulas, formulas that have zinc carnosine, slippery elm bark, marshmallow root extract, all these things that help to heal and seal the gut lining, and change the behavior, make sure they’re eating meals properly at the right time of day, not eating too late at night.

As you heal the root cause, the person then can start eating more “normally”, and can actually enjoy things that they were not able to enjoy, because now you’ve healed the gut. So maybe if they want to have that glass of wine once a week out with their friends, they can do it, and now they’re not going to pay the price in the same way. So I think it takes a little bit more work to unravel the root cause, and it takes a bit of introspection, looking at self, looking at behaviors, looking at how the person is holding stress, and even today, looking at dietary patterns. So today, I had a patient who suffers from intermittent reflux, and she was having dinner, but then having a big bowl of fruit right after she had just finished eating dinner. And having fruit right after having a big meal with protein, the fruit is going to sit there and it’s going to start fermenting and it’s going to produce gas, and very likely, it’s going to cause some burping and reflux. So sometimes you have to tease out the little behaviors that just require repositioning, like, okay, let’s not eat fruit right after finishing dinner, especially fruits that tend to ferment, like watermelon, not a good idea.

Lindsey:  

Yeah. So with a lot of clients, when I’m doing their initial intake, they seem hesitant to admit they drink coffee like they think I’m immediately going to say, you need to give up that coffee. And I’m kind of agnostic on coffee, honestly.

Dr. Vincent Pedre:  

People hold on to their coffee.

Oh yeah, exactly. But I mean, I’m agnostic about it, because I know it’s got some health benefits, and I know it’s a good bitter which promotes bile flow. But I’m not, personally, a coffee drinker, because I just don’t like the taste, although I love the smell. So is coffee a healthy food, and is it a possible contributing factor to reflex or gastritis?

It can be both. I’m going to say for someone who’s whose house is on fire, coffee can add a bit of fire to that house, especially if the coffee is more bitter, if it’s more acidic, if it’s got a high level of caffeine, all of that can be a trigger for more potential reflux. And also it’s depending on how the person has the coffee and whether it’s being drunk on an empty stomach, if they already have some food in the stomach. So there’s always mitigating factors that make things a bit confusing for people, because they think, well, one time I drink it, I’m fine, another time I drink it, I’m not fine. And, really, it has to do with the individual circumstances that surround every behavior and how you do things. So I’m always getting very granular on, what did you do in that moment? You know? Was it on an empty stomach? Had you eaten something else? I think it’s very important.

But the thing to know is that a good coffee that’s free of toxins, free of pesticides, free of mycotoxins, that has polyphenols or antioxidants like chlorogenic acid, coffee has a lot of potential health benefits, not just for the gut microbiome, but also for the gut-brain access and for brain function. So there’s a lot of really great benefits for coffee. And I think the truth is the majority of the world drinks coffee every day. I think it’s like a billion cups of coffee are served every single day, and at least 130 million American adults drink a cup of coffee every single day. So it’s a habit that’s not going away. It’s just the habit that we need to look at. Well, what are the other things that surround it that could also make it more unhealthy or healthier?

Lindsey:  

Yeah, yeah. I know there was the big craze around keto coffee with MCT oil and all that stuff for a while. I don’t know if people are still doing that. My sister got into this pouring heavy cream into her coffee. And you know, we have family hypercholesteremia, like, listen, you were doing a keto diet, and the heavy cream might have been okay, but you’re now eating carbs. You can’t keep pouring like half a cup of heavy cream into your coffee and be eating all the carbs, like it’s one or the other.

Dr. Vincent Pedre:  

Yeah, no, because then the carbs are going to turn on the inflammation, you know, and then it can make your cholesterol inflammatory. It’s really the carbs and the sugar and all that. Yeah, that was a big craze for a while. I’m trying to think of, like, how to, you know, there was the Bulletproof Coffee craze, right? Like, how to come up with another version of that. I mean, I know I have my Happy Gut Coffee (10% off with code perfectstool10), but calling it Happy Gut Coffee and having some other recipe or something that makes it gut friendly,

Lindsey:  

Yeah. What do you like to do? Do you drink your coffee black, or you like something in it?

Dr. Vincent Pedre:  

It depends on what coffee. I can definitely drink my Happy Gut Coffee black and, because it’s a dark roast and it’s very low acid and it has no bitterness, I actually like to add for my gut health, I tend to put in my coffee SBIs, Serum-Derived Bovine Immunoglobulins. So I put SBI powder, and then I also add some collagen peptides into the coffee, and then I may or may not add some almond milk as well. Always dairy-free.

Lindsey:  

Okay, so how did you get the bitterness out of your coffee? I’m wondering.

Dr. Vincent Pedre:  

It’s just what happens with the roasting process. You want to make sure that- 

Lindsey:  

The lighter roast? You said, No, it’s a dark roast. 

Dr. Vincent Pedre:  

When the beans are roasted, you have to make sure that they don’t get burnt. They have to be roasted exactly to perfection. That lowers the bitterness, lowers the acidity. It actually makes it a little bit lower caffeine as well. So for someone like me, who is actually a slow caffeine metabolizer, so I can’t drink a cup of coffee in the afternoon and have a good rest that night. It’s going to affect my sleep. But for someone like me, that’s a slow metabolizer, and usually I avoid drinking coffee, my Happy Gut Coffee does not cause that jitteriness that I get with some other coffees. And I think probably it’s a combination of things. It’s free of the toxins, no mycotoxins, no pesticides. And I think just being a much cleaner bean has a different effect.

Lindsey:  

Okay, well, new, unrelated topic, but one I know that you have some expertise on. There’s been a lot of info in the news lately about not just microplastics, but now nanoplastics. That makes me feel like they’re impossible to avoid unless I grow all my own food and live in a cave. So how do these micro and nano plastics affect the gut, do we really know, and how can we avoid them?

Dr. Vincent Pedre:  

This is a scary thing, right? Because when you go to the supermarket, a huge majority of the foods are stored with plastic, right? They’re in plastic containers. They have plastic wrap over them, and we’ve been doing this for ages. Well, maybe not for ages, because I feel like this has become more prominent since the late 70s into the 80s, having food convenience. And the thing is that these microplastics get everywhere, and we’re starting to find that they can actually accumulate in the gut, and not that this is a cause and effect, but there was a study that showed that people who had inflammatory bowel disease had higher concentrations of microplastics in their gut.

Now, association is not necessarily saying that one thing caused the other, but it does start to beg the question, is there some relationship between inflammatory bowel disease, when there’s no other obvious cause, and exposure to microplastics, from plastic water bottles, from plastic food storage, from, I mean, people who used to heat up easy meals in the microwave that come in plastic containers, not thinking about how the micro plastics get into the food. And we know that studies, for example, there was a study done on zebrafish that showed that microplastics cause changes in their gut microbiome, and the change was towards more harmful bacteria, bacteria that cause inflammation and actually also reduced mucus secretion, which is part of what protects the lining of the entire intestine is the mucus layer. It’s very, very thin, but it’s super important to keep the bacteria and other harmful substances away from the lining of the stomach. So we also know from another study in mice that microplastics were connected with increased body weight and changes in their lipid profile, and also cause elevation in liver enzymes.

So microplastics are doing something. And, I think if we try to think that they’re not, and just think, like, this is just way out there. Like, I mean, when I went to medical school, we weren’t talking about plastics. We didn’t talk about how plastics could have a connection with autoimmunity, like dysregulation of the immune system, Bisphenol A, no one was talking about that. And now here, suddenly we have to think about nanoplastics, like all these microplastics that are getting everywhere, and all the plastic in the ocean, the plastic that’s getting into fish. And it can get a little bit overwhelming, right? Like, yeah, what do we do?

And then the other place that’s worrisome, and partly why I’m trying to get people to almost step back in time and make coffee in a more traditional way, whether it’s a French press or doing a pour over with a filter, instead of those easy pods where you wake up and you can just flip the switch, and then your coffee is done in a few seconds, but that hot water is going through the pod that’s lined with plastic, and now you’re getting micro plastics in your coffee and drinking that, or when you go and you pick up your coffee to go from any place, they’re giving you, not a Styrofoam cup, but a cardboard cup, but the inside is often lined with plastic. So when it touches that hot water, you’re getting microplastics into your body. And I think the research now, what it’s showing us, is that we can’t ignore this. As if we needed another problem to pay attention to; another mitigator of disease for humanity. Because this one actually, when I wrote this article on my blog post on Happy Gut Life, I was really depressed by the end of it, because I thought, okay, but what do we do? 

Lindsey:  

Yeah. 

Dr. Vincent Pedre:  

Like, is humanity doomed at this point? Are we too far into plastics that there is no way back? And I know there are things – look, you can’t easily change what’s happening at the macro level, but you can make choices on how you choose to live at your level, like even just making sure that you’re drinking from a glass container, not from a plastic water bottle, or not using the convenience of plastic water bottles at the office instead of drinking filtered water that you bring from home. A lot of people do that. Or, just going to the farmers market with your own big fabric tote bag, and you put all the vegetables in there without using any plastic, so that you’re avoiding that contact with plastic. You know there, are choices that we can make every day as individuals that could help us avoid some of these exposure to plastics, and even just like thinking about the type of clothes that you buy because there’s polyamide and clothes that’s also plastic that’s used in textiles, or even filtering the air to make sure that microplastics that might be found floating in the air that you breathe are getting filtered out, making sure you’re drinking clean water. This is the-

Lindsey:  

Let me stop you there, because the water is like the one that I’m sort of like, ah, what to do about this? Because I’ve got, like, the best water filter you can have in the fridge, right? Like, I’ve got this Zero Water, and it filters almost everything out, but it’s a plastic bottle that it’s sitting in! Now, I know it’s not the worst kind of plastic bottle. I assume it’s the better kind of plastic bottle, but it’s still in the plastic bottle. So it’s like, did I screw up? Do I need to go out and get a glass one? I don’t even know if they sell such things!

Dr. Vincent Pedre:  

Or acrylic. That might be safer. Um, yeah, no, I agree. 

Lindsey:  

I don’t actually know what the substance is. 

Dr. Vincent Pedre:  

I agree that it’s overwhelming. You know what we do. The thing to note, though, is that it’s extremes of temperature that’s going to extract the plastics more or any sort of mechanical effect. So technically, the plastics going to, more likely, leach microplastics from big temperature changes or from being exposed to heat. So even just not exposing it to heat. That’s what’s so scary to me about plastic water bottles, because you don’t know how many temperature changes they’ve gone through as they’ve been transported from the source to where they’re finally sitting at the store. They’ve probably been in the hot truck somewhere at some point, and that heat makes them leach plastic into the water. 

Lindsey:  

Yeah, yeah, I stopped using those. The only one that I was using was I was getting Fiji water, because I know that that chelates aluminum, and so I was using that. And I’m just like, forget it. I’m not doing that anymore, unless I find some aluminum in my urine or blood or, you know, I’m not goofing around anymore because I had no aluminum. I was good. And I stopped. I guess the other thing I’ve done is I went out and I bought tons of those glass containers because it kept being, like, there was still some plastic in the cupboard, and we’d still end up using it because we just didn’t quite have enough of the glass ones. I just bought, like, reams of glass containers.

Dr. Vincent Pedre:  

Meaning, that’s for food storage, right? Like making sure to store your food in glass containers. Because, I mean, the the scary thing about the study is that the plastic, the microplastics, accumulate in the gut, and then they don’t really have a place to go, you know? So you wonder if it’s another underlying root cause that we’re not paying attention to when it comes to inflammatory bowel diseases like Crohn’s and Ulcerative Colitis. Obviously, there’s- in things like that- there’s always multiple root causes, and you have to look at the additive sum of different things and control the factors that you can control and otherwise do your best. 

Lindsey:  

Yeah, yeah. The other thing I stopped doing is, like, even the plastic bags. I always tried to be good for the planet and wash out my plastic bags and reuse them. And now I’m just, like, not so much, like, one or two uses, and then it’s going to go in the garbage. Like, I’m not going to keep beating these things to death because, inevitably, you have to store some things in plastic bags. Like, you can’t fit a leftover loaf of bread in a glass container. So, you know, there’s some inevitable uses of plastic, I think. Any nuggets of wisdom for people who don’t have terrible gut health, meaning no huge issues, maybe occasionally they have a loose stool, occasionally they’re constipated, occasional indigestion if they’ve eaten the wrong thing, but normally they’re pretty good. Like, what’s a good gut health plan for the average person?

Dr. Vincent Pedre:  

Let’s start with the – I mean, this is even just for general health purposes – everyone can always avoid processed foods. Try to avoid excess exposure to seed oils, inflammatory oils, which are not good for the gut. Try to avoid exposure to genetically modified foods, those can be problematic for the gut. Try to avoid excessive exposure to foods that have high levels of pesticides. You can look at the Environmental Working Group website, and I actually included the chart in my last book, the Gut Smart Protocol*. So look at the Dirty Dozen and the Clean 15. Those are the lists of foods that have the highest amount of pesticides and the ones that have the least amount of pesticides. So if you’re like everybody nowadays, you know; food costs have gone up; you want to be on a budget with your food, but you also want to be healthy; buy organic any of the foods that are in the Dirty Dozen, and you can be a little more lenient with not having to be strictly organic with the foods that are in the Clean 15; that at least allows you to spread your food dollars wisely, and then, of course- 

Lindsey:  

-You’ve got check that each year, because they change, like sometimes like, bottom goes to the top, or vice versa.

Dr. Vincent Pedre:  

Yeah, exactly. Every year you have to go to the website and see what their updated list is, and then sugar. Sugar is a big one. We know that sugar is one of the leading causes of disease, chronic disease, not just of the gut, but metabolic insulin resistance, diabetes, heart disease, all of that is connected to excessive exposure to sugar. So lowering your sugar intake in whatever ways you can. Not just obvious sugar, like cane sugar, like desserts, but also hidden sugars in drinks, or, like, putting syrups and things, like if you go get a fancy coffee. Or, also, eating too many refined carbohydrates. So even just starting at that level and eating more whole foods in general, that can be very helpful. I have varying opinions on whether people with, well, I guess we can talk about people with more severe gut issues. So that would be a different question.

Lindsey:  

Okay, well that seems like a good plan for pretty much everybody. And what’s a good gut plan for people who feel like they may be inflamed or have markers of inflammation, maybe not that they have gut symptoms, but they have like, elevated hsCRP, or maybe appear to be at the beginning of autoimmunity, but no obvious gut health issues.

Dr. Vincent Pedre:  

Yeah, and these people – I would still, in a person like that, take them and do stool PCR testing and look for inflammatory markers, because even if the person doesn’t have gut symptoms, if they’re already showing up with some signs of autoimmunity, it’s very possible that they’re already brewing some imbalances, dysbiosis, maybe some harmful back gut bacteria. They might have parasites, they might have Blastocystis, they might have yeast overgrowth. I’ve seen that in people that actually report no symptoms whatsoever in their gut. So I think that’s a very important myth to dispel, is that in order to have a gut issue, you have to have gut symptoms. You could be walking around feeling like everything is fine here, and yet actually have some pretty big imbalances in there that, maybe because you’re not so aware of it.

It could be that you’re distracted by symptoms in other parts of your body that you don’t realize what’s going on there, and then, depending on what’s happening in the gut, my diet plans could range from the extreme of actually putting someone on a very close to carnivore-like diet to be able to lower inflammation, heal the gut. Especially if they’ve got a lot of issues with digestion or low digestive function, not enough enzymes, it’s going to be very hard to break down a lot of vegetable proteins. Or having them, if they want to have vegetables, but no raw just cooked. Thinking like this is an intermediate diet for someone whose gut is not quite ready to have raw foods yet, when they eat a salad, they feel horrible, they feel really sick. That shows that there’s a lot of gut dysfunction happening. So for someone like that, making sure that their Omega three levels are optimized, whether it’s through supplementation, through eating Omega-3 rich foods. For me, the preference would be wild salmon or sardines. Like those types of Omega-3s are just much more bioavailable, much more readily used by the body than plant sources. And the plant sources can be harsh on the gut for some people. It’s always a hard conversation with people who are more plant-focused to get them to see that sometimes too many plants could actually be harmful to the gut.

Lindsey:  

Yeah, no. It’s funny because I was more of, like, philosophically, more of a kind of paleo person. I can’t say that’s how I eat, because I don’t have the self-control to not eat other grains, and I don’t seem to have the need to be that strict for my health. But I see people who have high beta glucuronidase, and I’m like, I’m sorry, you’re going to have to eat like, a vegetarian diet for a while, or they have, like, hydrogen sulfide SIBO and I’m like, yeah, you need to go off meat completely. And then I have other people who are, you know, already vegetarians or vegans, and they’ve got methane, high methane, you know, and IMO, and I’m like, I’m sorry, you’re going to have to start, like, eating some meat, because I don’t know how you’re going to get protein without constipating yourself. So, I mean, now I’m just completely agnostic about diet. I’m like, it depends on what’s going on in their gut completely.

Dr. Vincent Pedre:  

Yeah, I totally agree with that. And then, obviously, matching it with, and sort of meeting somewhere in the middle with the person’s food preferences, right?

Lindsey:  

Of course, and inevitably that comes to bear. 

Dr. Vincent Pedre:  

Yeah, because you might think that for a vegan, the best diet would actually be a meat-eating diet, but they’re not ready to make that jump and it would be, like, the worst thing for them, psychologically, mentally, it might create a lot of stress, but I try to meet people like that halfway and see like, Okay, well, if we’re not going to get to meat, could we compromise with fish? Or is there one meat that you would be okay with eating, because oftentimes it does make the gut better. 

Lindsey:  

Yeah. 

Dr. Vincent Pedre:  

Yeah, and I actually had a patient like that last week who was eating a lot of substitute vegetable proteins- 

Lindsey:  

Oh yeah. 

Dr. Vincent Pedre:  

-to be able to, you know, to be able to get enough protein in her diet, but she was using one, one was like a mushroom protein, like chicken substitute, but it did have wheat and gluten in it. And then the other one that she was eating a lot of was seitan. She was having incredible gut pain, bloating, distension, constipation, and I just think, like when you’re making- if you’ve ever seen somebody make bread and you stretch it, that gluten is what makes the bread so sticky and gives bread that consistency. But now you’re eating that concentrated in a vegetable protein substitute, and all of that stuff forms this big sticky mass in your intestines. It’s very hard for it to move, for you to poop it out. Your body doesn’t have the enzyme strength to break it down, so it can cause a lot of gut disruption for people, but it’s hard convincing someone who is either was raised vegetarian or philosophically vegetarian that, look, eating some meat is actually going to make your gut better.

Lindsey:  

Yeah, yeah, yeah. And sometimes you have to get in there and do that amino acid profile and show them they’re protein deficient and that they really have to figure that out. And maybe it’s a lot of protein powders at the end of the day, if that’s what they’re willing to do, but-

Dr. Vincent Pedre:  

Even that can be problematic. I’ve had people have reactions to pea protein as well, which is one of the biggest ones used in these vegan protein powders. So, I will say it’s rare, but I’ve seen it enough to note that, okay, we can’t say that one protein powder is perfect for everyone, even pea protein, which is supposed to be hypoallergenic, some people may react to it. Now, if you’re listening to this and you react to a protein powder, you also have to think you’ve got some work to do on your gut. If you’re reacting to protein, that means maybe your stomach acid is low, you’re not breaking down protein enough. Maybe you have pancreatic insufficiency. You’ve got leaky gut. So there’s other work that needs to be done.

Lindsey:  

Yeah, and I will tell you, because I just got some pea protein powder myself, that it tastes like peas. It’s not great in a smoothie. Like, I’ve discovered that. I’m sure there’s more combined ones that are better, which is probably- But the added artificial sweeteners are so repulsive, like the added monk fruit, I’m just like, blech I can’t take it.

Dr. Vincent Pedre:  

That’s the other issue with them. I did find, when I was working with a company and we were developing a protein powder, and we wanted a vegan protein powder, but we were looking for flavor, texture, consistency. We were experimenting with chickpea protein. But the thing is, with chickpea protein, if you ever made a chickpea pasta-

Lindsey:  

I have. 

Dr. Vincent Pedre:  

So when you make the chickpea pasta, after it sits for a while, it starts to stick together. It’s very, very sticky. Same thing happens with the chickpea protein in a smoothie. It starts to all congeal together. So we had actually figured out a combination of pea and chickpea protein, where, with the right ratio, the chickpea gave the smoothie a creamy texture, while not using only chickpea protein allowed it to have a smooth consistency and not congeal and get really sticky or almost like pudding.

Lindsey:  

And did you have a protein powder in your Happy Gut line?

Dr. Vincent Pedre:  

We do have ones that have pea protein. It is a micronized pea protein, so it’s broken down. It’s much easier to digest. But we don’t have one that mixes in the chickpea protein, just because of, still, the complications with figuring out the right ratio of the chickpea protein, and still, look, the pea protein, by and large, is tolerated by the majority of people. I think there’s like 2 to 5% of people that come back and they say that they have some sort of reaction to the pea protein.

Lindsey:  

Yeah. Okay. Well, anyway, that was all interesting stuff. So, where can people find you and your coffee and your other happy gut products? And I know there’s also a discount code for my listeners. 

Dr. Vincent Pedre:  

Yes, they can go to happygutcoffee.com and that’ll take them to the website. They can check out the clean, Dark Roast that’s toxin free, low acid, and I like to say never bitter, because it is quite smooth. And everybody’s going to have a discount code for 10% off the store by using the code perfectstool10.

Lindsey:  

Okay, awesome! Appreciate that. Any parting words before we sign off?

Dr. Vincent Pedre:  

I feel like we gave a lot of really great tidbits of information for people who are listening and suffering from these types of issues. I think this was a really practical episode that people are probably going to want to go back and listen to it again and take notes and maybe go and speak to their health practitioner and say, hey, you know, maybe we should think about this this way. So I hope that anyone who listens to this is inspired to always dig deeper and not be conformed to just taking a medication to treat a symptom, to look for what is the underlying root causes, and is there a way to treat that in a way that will create long, lasting relief.

So if you’re dealing with low stomach acid or gut health issues of any type and need some help, I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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