Gut Health, Hormones, Anemia and Autoimmune Disease: Finding a Root Cause

Adapted from episode 46 of The Perfect Stool podcast with Dr. Ian Hollaman and edited for readability.

Lindsey: 

So why don’t you tell me a little bit about your journey to wellness?

Dr. Ian:

Well, of course. Wellness is a moving target for sure, especially with all the challenges that we face on a day-to-day basis. But what got me started was back in grad school when I was going through what we would call a hell quarter. That just basically meant we had a lot of tests, a lot of pressure on us academically at the time. And unfortunately, I was also breaking up with my girlfriend of four years. So what happened is everything fell apart, and I started to have a lot of brain fog, and just really felt like I was floating. I started developing some neurologic symptoms as well, and then on top of that, lack of focus and concentration, some insomnia, and then some chronic fatigue. I got really concerned about that, because it really dramatically impacted my performance as a grad student. I was your typical type A student, in front of the class, asking all the annoying questions. And then then I kind of went to the back of the class because I was embarrassed about what was going on with my body and I wasn’t understanding what was going on. I actually started to do really poorly.

I started going from practitioner to practitioner. This is probably super familiar to a lot of your readers. What happened was people would say, well, you know, you need this or you need that. I was being fit into people’s boxes, rather than when I met with the ninth practitioner who said, hey, let’s take a look at your diet, let’s look at your lifestyle, let’s look at your nutrient status, let’s actually do some blood chemistry on you. The amazing thing was he really dialed me back into where I was feeling optimal wellness within about three-four months. I didn’t realize it, but at the time, that was probably one of the most important events in my life, because I realized that was the kind of doctor that I wanted to be. I just didn’t understand that that’s not how doctors are taught. I started to realize that we’re taught to learn clusters of symptoms, and that equals a diagnosis. And then you treat the diagnosis, and you’re not actually treating the person. So that launched me into the functional medicine world of trying to understand the root cause and it’s really ignored so much. We’re told if you have anxiety, you need to take an anxiety pill, if you have leaky gut, you need to take a leaky gut formula. We’re not actually asking the question of why. And I think I annoy my clients sometimes because I ask that question to them. And many times they know the answer, but you just have to give them enough opportunity to self-reflect on what’s actually going on in their life.

Lindsey: 

I’ve heard very similar stories from many of my clients who have seen many practitioners. I think I was lucky because I had my autoimmune stuff diagnosed before it really impacted me. I have Hashimoto’s. I had an enlarged thyroid, and the doctor caught that. So I went for an ultrasound, and then they saw the damage from the Hashimoto’s on the thyroid. And this was well before my TSH was even far from optimal levels.

Dr. Ian:

Right, so you’re in that thyroiditis experience and not quite the hypothyroid. I mean, how many millions of people are actually out there dealing with that issue? And of course, many times doctors aren’t listening or they’re not doing a physical exam, or maybe your thyroid isn’t enlarged, right? The crazy thing is, the American endocrine society specifically says TSH should be between 1 and 2.5. Then if you have a four and your doctor is saying, you’re within the normal range, I guess you’re okay. Then you wonder if they’re comparing you to all these other sick people or through standard chemistry analysis? Or are you actually looking through the lens of optimal chemistry?

Lindsey: 

So tell me about what autoimmunity has to do with gut health.

Dr. Ian:

Oh, nothing. No, I’m just kidding. It has everything to do with gut health. So Alessio Fasano is the dude who figured out the mechanism behind celiac disease. If you aren’t aware, celiac disease is this condition where when you’re consuming gluten, your gut becomes permeable or leaky. Then you actually get confused on what is your self, versus what is non-self, so you actually start going after and targeting your own tissue. Alessio Fasano is kind of now considered the godfather of celiac disease and he’s the one who discovered the mechanism behind what it takes to have an autoimmune disorder. There’s three things that go into this. So there’s a genetic component, and I have celiac. So there’s this HLA-DQ2 and 8 gene, and yes, you can test them. But you need a genetic predisposition. There are environmental issues as well, and so for example, being exposed to pesticides, being exposed to glyphosate, like Roundup. And then there are these triggers, which can be traumatic events in your life, auto accidents, after you gave birth, a divorce or something like that. You put all these three things together, and it turns on your genes, which is actually all occurring in the gut, where you start to create this leaky gut, or intestinal hyperpermeability. And that’s why so many of us as healthcare practitioners try to understand people’s symptoms, but we’re going to look at the system and the gut is where 70- 80% of the immune system is. That’s why we make that connection there, and why we want to look to that as the root cause.

Lindsey: 

So when you have somebody who has an autoimmune disease, and they have no gut symptoms at all, will you still test their gut?

Dr. Ian:

100%. About 60% of my clients don’t have gut symptoms, and you do not have to have IBS, you do not have to have colitis or Crohn’s, you do not have to have a single gut symptom. One is because your body may actually be accommodated to those symptoms. But the fascinating thing is that there are over 100 different autoimmune conditions, and over 26 cancers that are associated with autoimmunity. I’m just quoting the experts, and Dr. Fasano specifically says that to have an autoimmune disorder, you have to have leaky gut, because our ability to express, modulate and quench inflammation goes to the gut. So even if you have zero gut symptoms, I’m still going to look at your gut and try to understand if there is a way that we can leverage that piece to actually help your health.

Lindsey: 

Okay, so now thinking about what Dr. Fasano revealed as the action of zonulin in opening up the intestines and making them leaky, in particular in celiac, whereas I guess a normal person might have an opening that that is very brief from zonulin, someone with celiac has a very long one.

Where gluten sensitivity fits in with that I’m not sure. Can you help me with that?

Dr. Ian:

Yeah, absolutely. So if you look at what is commercially available, you can do panels that will look at about six markers for celiac disease. There’s actually another 18 that I can commercially get right now for gluten sensitivity. These are different and separate conditions that manifest in different ways. And why this is so important is that gluten sensitivity can trigger the leaky gut process. You don’t have to have celiac disease to have a leaky gut. You actually may not have the genes for celiac disease. So you can actually do a blood test and check these antibodies and see if you’re reacting to gluten. You can have three reactions to gluten. You can have a typical allergy, which is how we think about peanut allergies, where you’re getting an immediate response, we call it an IgE reaction. You can have celiac disease, and that’s the autoimmune process where gut tissue is broken down because you’ve been exposed to gluten. And again, there’s the genes and other triggers there. Then, you can actually also have gluten sensitivity. Why that’s so important is that it is an underlying facet behind so many chronic disorders. It’s very, very commonly not tested. So when you go to your doctor and ask about celiac and they test for it and it’s negative, it’s because maybe they ran one or two antibodies for celiac, not the full six. And that’s usually tissue transglutaminase antibodies, but if it’s negative, they’ll say it’s okay to eat wheat. And that might be 100% absolutely not the truth. If you leave that other part out and you get exposed to gluten, you can have inflammation for months with just one exposure. So it really is a game changer for people and it’s why so many clients or just people that you know will cut out gluten and have it change their lives.

Lindsey: 

And so are you talking about the Cyrex arrays?

Dr. Ian:

I’m using Vibrant Labs, I used to use Cyrex. They’re both really good companies, and it kind of just came down to price. I tend to use Vibrant more often. I believe they’re a spin off of Cyrex. They’re both very good companies. I love them both. Cyrex is headed by Aristo Vojdani, who’s one of the most preeminent immunologists in the world. The panel that I probably do the most with him is something called a gluten cross-reactivity panel. It’s number three if you go on to their website, and it tests, I believe, 24 or 26, different foods that cross-react to gluten, meaning, if you eat that food, your immune system may be mistaking it as gluten. And then your body’s freaking out, because you ate dairy, tomatoes, corn or rice. There’s just enough of an overlap between the amino acids in those structures where your immune system flares up and is saying you ate gluten, when you actually ate a gluten free grain, but you still have a reaction to it.

Lindsey: 

So Vibrant Labs, what’s the test that you run then for celiac and gluten sensitivity?

Dr. Ian:

Yeah. It’s their gluten sensitivity and celiac disease panel is what they call it. It’s a comprehensive test to 24 different antibodies.

Lindsey: 

So I find that there’s often budget constraints. And, this is one of those things where an elimination diet usually does the trick to tell you whether that’s a factor. So I’m curious how you think these compare?

Dr. Ian:

Yeah, so you can test and treat or treat and test. A lot of my mentors said, hey, you’re going to run into these situations where people don’t have thousands of dollars to spend, and sometimes you don’t really need to, so you can absolutely do it in different ways. The only caution I give to people is if you really do have celiac disease or autoimmunity, and you’re going to go back and rechallenge gluten, just be aware that the inflammatory cycle kicks back up and can induce other autoimmune conditions and can really put you backwards. So I love elimination diets, we do them all the time, but I also ask what’s the end result? What kind of condition are we working with? If you’re working with a colitis patient, and they’re going to lose gut tissue, or an MS patient, and they’re going to lose eye tissue because they’re back on gluten, I would rather you spend a couple hundred bucks and have you be 100% compliant, than have you take the risk of actually losing tissue as a result of the autoimmune disease kicking back up. That’s just me. People get to make their own choices, of course, and we want them to. We want people to own their health. But I just say, what do you guys want to do? Would you like to test for it? Or would you like to just make sure that you’re going to be 100% compliant, and be able to get yourself off of that? And see if we can actually see an improvement?

Lindsey: 

Yeah. And are they coming to you still eating gluten? Because I find everybody by the time they find me, eats like meat, vegetables and fat.

Dr. Ian:

I get a smattering of people, you know, it’s pretty diverse practice. I do get the super complex and chronic and people that have been to all these different pratitioners. And then just two weeks ago, I was working with this colitis patient, and I was like, have you ever done a gluten free diet? And she’s like, well, I kind of tried it for a month. And I’m like, okay, so not really.

Lindsey: 

To run these tests, they have to be eating gluten, right?

Dr. Ian:

Typically for testing celiac disease, they have to eat roughly about a piece of toast for about 30 days, and then test. But again, do you really want to, especially if you’ve already gone gluten-free? Do you really want to go back and tempt the devil here, is that worth it? The other thing that I would also stress to the readers is that many times people switch to a gluten-free diet and bring on these other products, which are refined and processed. And they’re like, I feel worse with these gluten free products, because they’re feeding simple sugar to bacteria, which then grow and produce toxins, chemicals and byproducts, and all of the sudden, your inflammation levels go back up and you get brain fog, joint pain, aches and fatigue again. It’s nice to be able to have some of those things once in a while. But the question is, what kind of flexibility does your body have for that?

Lindsey: 

Yeah. So I wonder whether the origin of leaky gut may be different for each individual, but whether its origin is in SIBOs and the SIFOs, the fungal overgrowths, or if it’s in the food sensitivities? For example, in my case, I went off gluten and dairy and then also went through protocols to clean up SIBO and SIFO. And now, my Hashimoto’s antibodies are down to normal. I think perhaps the SIBO and the SIFO, from so many rounds of antibiotics, were what caused that sensitivity to gluten and dairy. But now if I take some enzymes, and I eat those foods, I don’t see any big reactions. So I kind of wonder which came first?

Dr. Ian:

Well, again, chicken and egg, right? And I think it’s potentially both, but I think for probably a lot of the patients that I’ve seen, a common trigger is antibiotic use, and people don’t realize how much of an asset and how valuable the diversity of our gut microbiome is. When I say diversity, I mean the amounts of species that are essentially taming these inflammatory chemicals and processes, so that we can also absorb really efficiently. When you knock all that out, the fungus, he’s thrown his party hat on, because now he has less competition and can continue to grow. And they’re actually the ones that now have predominant control in the gut. When we expose ourselves to standard American diet foods on a regular basis, we are eroding our immune system, and then eventually, at some point, you trigger the leaky gut process. What’s crazy is a head trauma has been shown to actually significantly cause intestinal permeability within an hour after a traumatic brain injury. So that’s something that’s not really appreciated.

Lindsey: 

I actually had a speaker on electrogastograms (Dr. Corey Deacon, episode 20).

Dr. Ian:

Uh huh. That’s a fascinating issue. A lot of times people develop leaky gut after concussions. They get hormonal disturbances, and this whole vicious circle basically starts at that point. But for so many people out there, they just get used to it, or even their doctors are telling them, oh, it’s just arthritis, right? Or it’s just normal to be 50 and postmenopausal and have an absolutely miserable life. And I don’t know if I actually believe that because I have lots of my clients who are 100% thriving after they get their food sensitivities handled, after they get the bacteria handled, after they are actually getting their immune system rehabilitated. And that’s really important. And I do want to say this, before I forget, that one of the most important things I learned in my master’s program, from a man named Dr. Alex Vasquez. He basically said, what you’re going to find is even if you deal with these triggers, people are still going to have a wound up immune system. You know, even when you find the gluten, you find the dairy and you remove the bacteria and the fungus, people are still going to have an immune system that’s now conditioned to give the same response. That’s when you really need to employ some therapies to stimulate specific subsets of cells called T regulatory cells. If you can do that really efficiently, and you get the diet, exercise and stress and all these other things, but if people are still having issues, that’s when I really start to think something kind of got broken there. And then we want to use some therapies and strategies to stimulate those cells in the right direction again.

Lindsey: 

How do you do that?

Dr. Ian:

So there are different nutrients out there, and that’s one of the ways to do it. I can give you six, maybe seven different things that I use. One is fibers. There are different kinds of fibers out there that can do this, one of them being prebiotic based fibers: inulin, XOS (xylooligosaccharides), there is a product that’s called Sun Fiber, which is a modified guar gum. Sometimes guar gum gives people issues, but this is actually a modified guar gum, and it does not seem to cause the same gas and bloating issues as other fibers do. But vegetables do this too, right? So, do we need to take that a step higher? Beyond that, vitamin A, D and K, as far as nutrients, alpha lipoic acid, green tea, or green tea extracts, and you can do it as a decaf version. And the other one is actually probiotics, and what they’re doing is stimulating certain chemicals. The chemical that I’m most interested in is called interleukin 10. And there’s different kinds of probiotic strains that can stimulate interleukin 10 to then actually stimulate those T regulatory cells. For example, we want your vitamin D level to be about a 50, with a normal range being anywhere from 40 to 60. A lot of research is pointing to 50 being the optimal chemistry. You can ramp a lot of those nutrients up for short windows of time. Then, you can come back and check those thyroid peroxidase antibodies, check the thyroglobulin antibodies, check the anti-endomysial antibodies or the zonulin and see if you’re actually now able to quench that inflammation, get your immune system regulated.

Lindsey: 

Now, is there any measure of inflammation other than looking at the specific markers for any given immune disease? Like CRP (C Reactive Protein)?

Dr. Ian:

Yes, there are for sure. There are different kinds of CRP. There’s more of a nonspecific kind, then there’s more of a very specific, or cardiac kind, and high sensitivity is always the one that we want to choose. That’s going to be the most common commercially available inflammatory marker. There are other ones out there something called ESR, which is not really in vogue anymore. It’s not used as often. I mean, there’s a condition called polymyalgia rheumatica. And ESR is appropriate for that. There are what we call cytokine panels. And these are a little bit more advanced but quite frankly, they don’t dramatically change the recommendations I give for care. So again, going back to the budgetary concern, it’s deciding between test and treat or treat and test. And if I know that in general, people should be on a good nutrient dense diet, taking the crap out of their diet, they might need to do nutraceuticals for a short period of time, maybe they need a stool test, and maybe that’s going to change the recommendations. That’s usually what I’m going to focus on. For inflammatory bowel diseases, I will actually add a marker called calprotectin, which is very, very sensitive as it relates to the differential diagnosis, or the decision between inflammatory bowel disease or irritable bowel syndrome. So if your calprotectin is really high, we know you have a much higher chance of having colitis or Crohn’s, which is a much more serious condition than something like IBS. You can check zonulin, and  you can check antibodies to zonulin. And that is a great way to tell us if you actually have leaky gut. And like I was saying, I’m not a rep for Vibrant, I take no kickbacks from them. Again, it’s the cheapest lab that I can find that actually gives really good data on that gluten sensitivity and celiac disease panel, and they run anti-zonulin antibodies. So if you have a high anti-zonulin antibody, you know you have leaky gut. If you really want to, you can go back and retest it and verify that those markers have decreased, and it’s probably going to correlate with you getting better anyways. So most the time, I don’t rerun it. But if I’m managing an autoimmune condition, and I’m helping people to know if it’s really under control, I do like to repeat the standard anti-thyroid peroxidase antibodies in the case of Hashimoto’s. I would repeat that maybe every three to four months, because there needs to be enough time to actually allow your immune system to calm down.

Lindsey: 

And so if somebody is testing the zonulin antibodies, and they ate something like gluten ahead of time, I imagine that would cause it to be elevated. Do you tell them to be careful about what they’re eating prior to the test?

Dr. Ian:

Hopefully, the idea here is that they’ve been behaving. And of course, we can all get exposure, we can all get cross contamination. I mean, I’ve had plenty of times when I’ve had people just so upset because on a stool test, they’ve got a gliadin antibody. And they ask, “How the heck did that happen?” You know, it’s shared equipment, or they traveled or something came up. It’s usually not that someone said, you know, well, screw it. I’m just going to go eat pizza. That happens too, sometimes, right? But what we want to do is test normal conditions. It’s this therapeutic trial we’ve been doing. Let’s see if this is actually working for us.

Lindsey: 

So in other words, they’re normally off gluten, they take the test. And you will see over time, that in theory that would go down.

Dr. Ian:

Well, yes and no. So in the case of celiac disease, we know that 60% of celiacs on a gluten-free diet have absolutely no improvement in their intestinal microvilli. They studied a group of celiacs and they had them on a super strict 100% gluten-free diet. One year later they came back and did another biopsy on their gut, and they found specifically that they did not have any significant healing to the brush border. And so why that’s so important is it goes back to what you’re saying, did they actually have other food sensitivities, did they have another autoimmune disorder, did that celiac turn into colitis? Was there a high burden of chemicals that we weren’t aware of, were they under a massive amount of stress, and they were secreting cortisol, which was degrading all their healthy bacteria in their body. These are the mechanisms we have to look at because this is why we’re seeing a higher rate of mortality with people with autoimmune disorders. It’s the same reason my grandfather got Parkinson’s after he was diagnosed with celiac. And I am convinced at this point, because everyone that I work with so far, in my practice, who I’ve tested for autoimmunity with Parkinson’s, they have autoimmunity. And so if I could have tested his blood, I can almost guarantee you he would have been autoimmune. He was so strict on his gluten-free diet. My grandmother was so good on that, bless her heart. But he had an inflammatory issue that was never really fully controlled, even after he actually removed gluten from the diet. And that’s what’s so frustrating, because Western medicine is, on average, 15 to 20 years behind published research. And, there’s no drugs to treat leaky gut. I mean, that’s the sad reality right? They haven’t developed anything. Then you get this issue where there’s no incentives for them to train people to actually help heal people.

Lindsey: 

Yeah. When you’re thinking about your grandfather, are you thinking there were maybe other food sensitivities, or there were gut infections that went untreated?

Dr. Ian:

Well, really a couple things. My guess was because of the Parkinson’s, and one of the other key pieces of that is environmental chemical exposures. He was a world war two veteran, he was in the Battle of the Bulge, and he was exposed absolutely to persistent organic pollutants on a very high level. And no one said, hey, you might want to do some detoxification of those chemicals. They’re associated with cancer, they’re associated with autoimmune disease, they’re associated with increased mortality. It’s like that diagnosis just kind of lands on them. And then all sudden, he started having this tremor. And it’s like, oh, you have Parkinson’s, we want to give you a dopamine medication now, because that’s going to help you with the symptoms, rather than looking at why did it happen in the first place?

Lindsey: 

I wanted to talk a little bit about anemia with you, because we talked a little bit about that beforehand. So I was first diagnosed with your basic iron deficiency anemia around age 16. And there seem to be a lot of different types of anemia. So there’s iron deficiency, B12 anemia. And then I know there’s megaloblastic and pernicious anemia. So first, let’s just go over what is anemia, and whether there are some autoimmune routes to anemia?

Dr. Ian:

Sure. So one thing that’s really important to kind of stop and think about is that there are certain things when they’re present. I call them deal breakers. And for me, there’s three things that are deal breakers. One of them is anemia. Another one is blood sugar handling issues. And the third one would be gut infections, or really any infection to the mucosal surface. Those three are probably the most common things I see in my practice that really, really dysregulate the immune system. So anemia, by definition, means the inability of the body to produce and actually distribute oxygen to tissues. What we most commonly think about is iron deficiency anemia. And that’s what we call a microcytic anemia, meaning that the red blood cell actually starts to become smaller. Now, there’s also macrocytic, and that’s when the red blood cell starts to become larger. There’s some other kinds of anemia out there, there’s something called anemia of chronic disease. There are things like sickle cell, which is more of a genetic-based or a familial base anemia. We have different categories and classifications, but anemia in general is going to mean that you cannot deliver oxygen to the tissues. That means that the tissue is going to essentially start to starve and die off and at the same time, it also means you can’t bring nutrients to those tissues because blood flow is going to be compromised. Lack of iron is what is most commonly thought to be the root cause of microcytic anemia, and as a result of menstruation and heavy menstruation. I actually don’t agree with that.

Lindsey: 

I was going to say, I never had heavy menstruation, so that always rang kind of false to me.

Dr. Ian:

Yeah, actually the most common form of microcytic anemia is going to be small intestinal bacterial overgrowth, because a lot of times people will be eating meat and getting enough iron and being told that they actually have an iron deficiency anemia, so clearly the solution is to have a transfusion. But the solution here is to look back at the gut and figure out what’s missing. There’s a good chance that the bacteria that are becoming overgrown are actually using your iron before you get to use it. And that then creates a chronic cascade of issues. In menstruating females, this is also very, very common, so I always look at that piece. The most common cause hormonally, if it is truly a hormonal mechanism, is going to be endometriosis or fibroids. If there’s really, truly an estrogen-dominant condition, causing the growth of this tissue, iron can actually feed that tissue, and then it can present as an anemia. Especially if we start talking about hormonal symptoms, you really need to do a good workup. There needs to be a transvaginal ultrasound, and we need to actually see if there’s tissue growth going on in there. Because if you give people iron in those conditions, it will actually make their hormonal issues worse. And I speak of that from experience. I have made my clients worse, right. And this is why we call it practice. People don’t really think that’s how it works. But you know, I am light years beyond where I was when I first started functional medicine, because I’ve actually worked with clients now. And I’ve seen that happen.

Lindsey: 

Okay. This is blowing my mind because I had endometriosis. And I started taking iron, probably around the age in which I was diagnosed with iron deficiency anemia, probably around 16. And then at some point, eventually, when I couldn’t become pregnant for a second time I was diagnosed with endometriosis and had surgery. So if you don’t give iron, what do you do?

Dr. Ian:

We’re bypassing the gut, and actually doing an iron transfusion. Then you will hopefully not cause nearly the same level of damage. So if it’s a critical issue, and it’s a medical issue, you’re going to have to get the iron somehow. And most people are not that bad, right? They don’t actually have to go to those heroic extremes and get hospitalized and actually have a transfusion. For the majority of people, what’s actually happening is they probably had a bacterial overgrowth going on, which then actually triggered a hormonal dysregulation, which is actually now feeding back into the gut. So to break that cycle, I would typically want a nutrient dense diet, I want them consuming foods that have iron, but I’m not going to actually go to iron supplementation initially. I’m going to actually use compounds like diurnal methane or DIM*. I’m also going to want to use things like broccoli seed extracts or sulforaphane. That’s actually a great way to create an estrogen detox. The other main way to actually detoxify estrogens would be through something called methylation, which requires specific B vitamins. Methylation is another topic that gets into genetic issues. The vast majority of people with autoimmunity actually have these genetic issues where they don’t methylate right, and so what happens is we’re told to take folic acid, which can make us worse because we’re not taking the methylated versions, which is 5-MTHF* (for folic acid) or methylcobalamin* (for B12). But that is another way that we detoxify estrogens. On top of that, the main way that people are actually regulating hormones is through birth control. Well, guess what, that actually creates a bigger burden on the methylation of your B vitamins. So this is why we’re seeing side effects with people that are on birth control long term, and they don’t really understand it and they’re doing it for the right reasons. But unfortunately, they’re creating a bigger issue by actually doing that. That just comes back to an education process to figure out what’s going on. But again, just to tie back to the endometriosis piece, if it is really at a point where it’s grown to a size, there’s limitations to the natural stuff. There may actually be surgery required, but for me, I’m always going to try to be conservative first. You can actually give people broccoli seed and a whole container of that once a day is actually pretty therapeutic. And then on the DIM side, you can get that from cultured, cruciferous vegetables, so if you’re getting your brassicas, and something like sauerkraut or kimchi, which has a lot of this DIM* compound in there. If you hate those things, and you can’t tolerate them, you can get it in supplementation form as well. And there’s plenty of companies out there that carry this stuff.

Lindsey: 

Now, that’s funny, because I was just looking at the DIM in the health food store I go to. There you go, because I was shopping around for something to help with my hot flashes that have turned up again. Well, I saw that and then I saw the sulforaphane. And I said, Wait a second, I have some at home. I’m just going to take that.

Dr. Ian:

Yes. I think that would be like, first line for me if anyone with hot flashes to deal with. I very commonly find hot flashes can stem from blood sugar handling issues. So I would always ask people, you know, are you getting any fatigue after meals? Are you getting any sugar cravings after meals? Or are you getting shakiness, irritability or lightheadedness in between meals? And the reason why that’s important is because there’s blood sugar spikes and dips, and those will actually start to spike your catecholamines, adrenaline, norepinephrine, these are stress hormones, and so that can actually then go to your brain and trigger those hot flashes. Especially if those hot flashes are happening at nighttime.

Lindsey: 

So I think I need to back down on the L-tyrosine.

Dr. Ian:

Yep, yep. Good idea back down on that one.

Lindsey:

That may be why they restarted.

Dr. Ian:

Two of the things that I use very frequently and pretty successfully would be black cohosh*, and then also chase tree berry*, which is progesterogenic. So it actually increases progesterone activity in the body. And then the black cohosh is an estrogen mimicker. I don’t exactly know why black cohosh works, but it definitely definitely helps. I think partly because part of hot flashes, you see a cycle of up and down. People think it’s just this estrogen excess, but it’s a drop, your immune system freaks out, and then you spike estrogen up again. So then your immune system gets confused, and it doesn’t know what to do, and it starts giving you those hot flash symptoms. So important, because so many hormonal issues lead into autoimmunity, right? So for example, if you talk about Hashimoto’s, for every one man who has Hashimoto’s, there are 10 women. And one of the things that heavily influences the immune system is testosterone. And so if women start to become estrogen dominant, a lot of obesity, they’ve got fat build up, their insulin is making estrogen, and they’re starting to throw off the ratio of estrogen to testosterone. That is very, very important as it relates to their autoimmunity. That’s something I think that everyone needs to be looking at. I personally use a test called a Dutch Test. It’s a dried urine test for comprehensive hormones. And you can look at all three of your estrogens, you can look at multiple testosterone markers, you start to get more of a comprehensive look at what is going on with the hormones. I mean, hormones are so important, right? From the cortisol rhythm issues, to the estrogen- and testosterone-based issues, to the gut issues. All of those are tied into these vicious circles that people have such a difficult time getting themselves out of with autoimmunity.

Lindsey: 

I’m going to ask you about the cortisol in a second, so don’t let me forget that. I do want to go back to the autoimmune roots of anemia. Did we fully cover that?

Dr. Ian:

No, and the other big topic is if you really want to start talking about the ability to look at labs, you really need to get very good training on that, because it’s a serious condition. If you have a good provider, that is going to be able to actually say, hey, look, it is really this specific anemia. Here’s what we’re going to do, we’re going to come back, and we’re going to retest, just to make sure that we’re improving things. Your life is on the line, when you’re talking about this kind of stuff. There are serious issues. The other category was this macrocytic, or enlarged red blood cell issue. That is going to show on the complete blood counts, or CBC’s that are run. That will show up as a high MCV or high elevated mean cell volume. And why that’s important is that your body is making an adjustment because your red blood cells are not replicating at the rate that we need them to. What that means is that your cells are enlarging or becoming macrocytic. That is a good indication that you’re probably lacking B12. You could be lacking B9 or folic acid or the active form of folic acid. The other issue that this brings up is called pernicious anemia. About 25% of Hashimoto’s patients have this condition. And pernicious anemia means that your body is attacking two different kinds of tissues. One is called a parietal cell, which is found in your stomach. And then another tissue is called intrinsic factor, an intrinsic factor helps you absorb the B12. And this is one of the big buzzwords around energy. And if you have chronic fatigue, and especially if you have autoimmunity, I don’t care what kind of autoimmunity it is, I really would want to screen someone for that parietal cell antibody and the intrinsic factor antibody. And if either those are positive, we know that there’s pernicious anemia, which means from a management perspective, you can give someone all the oral  B12 you want, and it’s not going to work. At that point, that’s where an injection is necessary.

Lindsey: 

What about the sublingual?

Dr. Ian:

So here’s the thing, if you have intrinsic factor antibodies, it’s not really going to work. If you have parietal cell antibodies, you can bypass and you can use the sublingual form. That’s the kind of differential between those two. Sometimes it works, sometimes it doesn’t. But a lot of times, I’ll say you might want to go get something called a Myers cocktail. It’s like a B vitamin infusion, or you may want to get a prescription for a B12 shot. My only caution with that for people, because again, people get excited about this stuff, and they’re like, okay, I’m going out, I’m going to do this stuff, and it’s going to be great, is that I highly recommend that you don’t use cyanocobalamin. Cyanocobalamin is derived from cyanide. Methylcobalamin is a little bit more expensive, you know, like maybe $2 or $3 more per injection, but you don’t have to worry about it actually creating a problem for you in the long run.

Lindsey: 

Yeah. So when they discovered I had B12 anemia, it’s funny, I had one shot at the beginning, because I was down in the hundreds. It’s a wonder I even had any feeling at the end of my hands. But I was beginning to have some signs. I can do the sublinguals. And after our conversation, the other day, I went back to look at my records. I didn’t see any tests for parietal cell antibodies. But I did see that the intrinsic factor, like they couldn’t quite tell, so it was borderline. But I’ve been taking sublinguals and my B12 levels are great, both on the Organic Acids Test and on regular tests.

Dr. Ian:

And that brings up a really important point. If you are running labs, and you are suspicious that there’s a B12 issue, you can have a normal cytic, normal chromic anemia, meaning you can have a normal MCV, and you can have a normal B12 level, the actual test for B12. Another more sensitive test is called methylmalonic acid. That can be normal, and yet, you can still be B12 deficient. That’s one of the things I vividly remember. There’s a case series that we looked at in my master’s program. It was a presentation of a man with neurologic symptoms. He had psychosis. He had again numbness and tingling, he had every single symptom of B12 anemia. But homocysteine, B12, methylmalonic acid, they were all normal. And they gave him an injection of B12. Guess what happened? All of his symptoms went away. So when you suspect that there’s an issue, treat it, especially when you’re talking about a B vitamin. It’s cheap. It’s readily available. There’s no side effects, except for yellow urine. And I get it, people get frustrated. They say, you’re trying to sell me these expensive vitamins and my urine is yellow and it means that I must be not absorbing these B vitamins and that’s not what’s happening. It’s a normal biochemical reaction to see that yellow urine. It’s pretty standard when you take any vitamin complex that you’re going to see that. But what is so important is that people go through this workup process, and they go to these specialists, and they can’t find anything. And then many, many times, they’re told it must be psychosomatic. It must be in your head. You must be crazy. And it’s like, you know what, maybe you’re crazy. But the reality is, they’re not giving you a very good explanation of why you’re having these issues. So I just want to tell those people don’t give up hope. Find someone that has more tools in their tool chest to actually help you figure out what your root cause is and get you back on track.

Lindsey: 

So with cortisol, I hear different things going on in the functional medicine community. I hear some people saying the whole adrenal fatigue thing doesn’t exist, that there’s no scientific backing to this.  And when we test the adrenals, we did stuff with the cortisol, the pregnenolone, the DHEA and nothing happened. And then I hear other people who still are clinging to this, like this is a basic thing in their protocol. What is your take on it all?

Dr. Ian:

So I would have to say that there is scant research on something called adrenal fatigue. What I would say is there is absolutely a condition called chronic fatigue syndrome, also called myalgic encephalitis. And there is absolutely an adaptation that your body goes through when you’ve been exposed to either a high levels of acute stress or long term chronic stress. Our body has a natural mechanism by which it switches cortisol production into cortisone, done explicitly to save our tissue. So what very commonly happens as a result of another root cause trigger being overlooked, like an absorption issue, leaky gut, they’ve got a brain issue going on, they’ve got chronic stress, there’s issues with their spouse, there’s something going on again, that’s usually not being addressed. A gut infection would be another thing that would actually require a lot of cortisol to manage, your body starts to kind of turn the faucet down. And now all of a sudden, your cortisol levels do drop, we’ve classically said, even when I was trained back in the day, that it’s adrenal fatigue. And that really is not, I think, the most accurate way of looking at that. I think it’s saying to look for the conditions that are present, and issues that that person has, that the body is smart enough to realize, if we keep pumping out cortisol at this level, the pipes are going to start to break, right? And so what happens is it goes back to actually working someone up in that root cause model with functional medicine to figure out how do we get the body to start making that cortisol over again. Now, some people will actually have antibodies against their adrenal glands, that actually can happen, so you can actually get subtle autoimmunity against the adrenal glands. And that is Addison’s, which is adrenal autoimmunity. Cushing’s is when you have a hyper excess of cortisol. And so for Addison’s, the antibody is 21 hydroxylase. That’s the antibody that you actually have to test. And that’s what typically is targeted. Now, to go back to that Dutch test, that actually looks at cortisone and cortisol, and the circadian rhythm of cortisol. If you can get cortisone to start pushing back into cortisol, many times, people are going to start to actually feel a lot of relief, and a lot of times their energy will start to come back online. The main component that does that is licorice. And it’s whole licorice root* that will actually do that. Now, for some people who are already hypertensive, you have to be careful, it also stimulates another hormone, it’s called aldosterone. That actually can start to change your retention of sodium and it can actually increase your blood pressure. So you just have to be cautious with that if you know someone that has higher blood pressure. But I can tell you that I think I’ve changed some people’s lives just by giving them whole licorice root. And they were just down in the dumps for so long. Now, again, you can’t just give some licorice, that is then just a bandaid, you still have to go back and figure out, what are we going to do to maybe help you get out of this adrenal fatigue? One of the ways that I’ve done that for people is high intensity interval training. And not P90x, not CrossFit. Like, you’re not just going to jump into 60 minutes of CrossFit or you’re just going to jump into the insanity workout. But what I mean is that there is something called a cortisol response, or the cortisol response system, and it’s a neurologic mechanism by which, right after you wake up, within one hour, your cortisol will double. That actually comes from the hypothalamus, also the hippocampus. And so those two areas in the brain are actually getting the adrenal glands up and going to actually secrete the cortisol so that you can get up and move and you can go chase whatever you need to go chase to get your calories. So one of the ways to actually help improve and reregulate that is that within 30 minutes of waking up, you do high intensity interval training. I’ve had so many clients who’ve said, Oh my gosh, this is great. I really do feel this way. Now again, the caveat is if a little is good, a lot. . .

Lindsey: 

. . . isn’t better.

Dr. Ian:

Yeah, it’s sometimes a disaster. I mean, look, our clients are 40s 50s 60s, not 21 anymore, they’re not spring chickens and are not going to just bounce back if they pull a hamstring. So we’ve got to be gentle and easy in how we actually introduce this. I mean, I really do get some consistent results from people that are able to three to five times a week actually integrate that. And you start really slow and low, and then you build up. You know, see what your tolerance is and what you can handle. And then you kind of go from there, put in the licorice, combining a good anti-inflammatory, Mediterranean diet, if you’re addressing the root cause issues. I mean, this is the stuff that I’ve been doing for 12 years that other people just never figured out. They’ve been to all these other practitioners, you know, but this is what really is why we show up on a regular basis. Yes, okay, Money can be great as a doctor, but honestly, I think there’s a perception that we’re gazillionaires and it’s really not the truth.

Lindsey: 

Not the natural doctors.

Dr. Ian:

Yeah, not so much. Right. Yeah, you start talking about orthopedic surgeons, and, you know, neurologists and yeah, they’re going to be billing crazy.

Lindsey: 

And they may be the David Jockers, and the David Perlmutter’s and stuff.

Dr. Ian:

Yeah, 100% those people, and God bless them, we need all those people, right? The reality is, is that we’re in the trenches, and we’re working with people on a daily basis. And the gift that we get on a regular basis is “Thank you”. It’s the gratitude, right? It’s the fact that you can actually give people hope. I call it “vitamin H”, but you can give people hope that you know what, maybe if we give this one more shot, this can turn things around.

Lindsey: 

Okay, now, yeah, that would have been the perfect moment to go, “You know what, that’s a great note to end on.” Except I still feel like there’s something in the autoimmune stuff maybe that we haven’t talked about. And probably not something small.

Dr. Ian:

Oh, man, there’s so much to actually really talk about.

Lindsey: 

Keep in mind, I’ve already had shows on almost every individual topic that relates to the gut.

Dr. Ian:

I think one of the best tips that I can actually give people is that blood sugar stability is actually gut stability. The reason why I say that is that if you are straying from a good diet, and you’re actually creating a blood sugar handling issue, we start seeing some pre-diabetic issues or some hypoglycemic problems. You actually will start to create more problems for your gut as a result of: 1) the foods that you’re actually consuming, they’re creating the blood sugar handling issues which are going to be stressful to your gut. But also, as you start to change hormones like cortisol, you actually start to change the healthy versus unhealthy bacterial load. So if you are having to put out inflammation, because you’re eating pro-inflammatory foods, cookies, pastas and pastries and even gluten-free, all these wonderful things that are out there, you actually will start to recruit more cortisol, and it actually starts to starts to degrade the diversity of bacteria in your gut, which creates more stress, more inflammation, and it creates more vicious circles. So for me, what I do personally is I have a protein and fat rich breakfast every morning. And I do that because when it stabilizes my blood sugar, my cortisol stays stable, I don’t get energy crashes in the afternoon. And then as I go through the day, I’m actually bringing in more vegetable content. I will do some more protein in there, but much more of the carbohydrates that I consume. And I’m a super high energy guy. I play soccer, I do CrossFit, I’m putting a lot of calories out on a regular basis. And I’m still going to use vegetables as my carbohydrates, you know: yams, potatoes, squash, those kinds of things, because they’re clean. They’re green. And I know that they work for my chemistry. So I think if we can, again, go back to the basics of good fat, protein in the morning, good carbohydrates in the afternoon, evening. You know, it doesn’t have to all be carbohydrates. We get good fats in there as well. Olive oil, coconut oils, those kinds of things. That goes a long way when you actually look at what a long term diet can be. Or should be.

Lindsey: 

Okay. Well, then, I guess with that, we will wrap it up. I really appreciate you coming on and sharing all this information. This was awesome and detailed. And you know, it’s like my own personal health appointment. I’ve dug into all my health stuff, so that was great. Where can folks find you?

Dr. Ian:

The website is https://drautoimmune.com/. And I would just encourage people to go there. We’re on social media channels, you can go to Facebook, Instagram or Twitter.

If you want to share what you’ve been going through with your autoimmune disease or gut health issue and explore how health coaching could help you reverse it naturally, please set up a free, 30-minute breakthrough session or a one-hour consultation and we can talk about the best next steps for you!

Schedule a Breakthrough Session Now

*Starred product links on this page are affiliate links. Thanks for your support of the blog by using my links!

12 Common Causes of Bloating and Their Solutions

Adapted from episode 45 of The Perfect Stool podcast.

Most people experience bloating at some point in their lives, maybe even frequently, but when is it normal, and when is it a sign of a more serious root cause?

To start, let’s define bloating. Bloating is when gas builds up in the digestive tract and pushes the stomach outward, causing pain and tenderness. I’m well familiar with bloating as it was one of my primary symptoms of gastrointestinal distress from a young age. For me it usually happened after big meals out where I’d get what I now call a food baby, and I did look about 6 months pregnant. But it became more and more frequent for me as I got older, and not just after big meals, to the point where I was not just bloated after every meal but even often woke up bloated.

If you’re unsure if you’re bloated, most people describe it as feeling as if you’re full, like you’ve just had a huge meal, or have a tight feeling in your stomach and abdomen. You might also find that your stomach is swollen and painful to touch and you also may have gas and/or excessive burping. This can take all the fun out of eating, so here’s twelve common causes and their solutions.

#1: Your Eating and Drinking Habits

Sometimes bloating is caused by something simple and mostly harmless, like eating too much at once, eating too quickly, or even chewing gum. Simple tips like eating and drinking more slowly, chewing gum less frequently, eating smaller meals, and not drinking with a straw could all help if there is no underlying GI issue. Many people also swallow excess air while drinking, so double check your drinking technique, especially if you’re also dealing with frequent burping. Carbonated drinks can also cause bloating because of the extra gas you’re drinking.

#2: You’re Lactose Intolerant

Bloating is a common sign of lactose intolerance, which is incredibly common in adults. If you’ve done a genetic test like Ancestry or 23andme and have access to your raw data, you can find out whether you have the gene for lactase persistence (lactase being the enzyme that digests lactose) by running it through a free tool called Genetic Genie. If you don’t have the lactase persistence gene, lactose intolerance is likely a root cause for you. If you notice bloating after enjoying some cheese, yogurt or ice cream, you’re definitely not alone. Around 75% of the global population is estimated to have some degree of lactose intolerance! Thankfully, lactose and dairy-free foods are widely available, so you may not have to sacrifice the foods you love to avoid dairy. Or you can take a lactose digestant tablet/dairy enzyme pill* or two with meals containing dairy. But be aware that casein intolerance, which is an intolerance to the protein in dairy, is also a thing.

#3: You Might Have a Gluten Sensitivity

Gluten is another common trigger of bloating and other GI issues, both for people with celiac disease as well as people with non-celiac gluten sensitivity. Signs of celiac disease include bloating and gas, abdominal pain, anemia and diarrhea, among others. Some people with gluten sensitivity don’t have celiac disease, but experience similar symptoms. In their case, eliminating gluten can increase their digestive comfort and help avoid bloating and gas. If you do have a positive celiac test, it’s essential to strictly eliminate all sources of gluten to avoid further damage to the intestines, and dairy too for a while as the villi in your small intestine are healing. So I’d recommend getting tested for celiac and if it’s negative, going gluten free for a few weeks then reintroducing gluten to see if your symptoms go away and then return when your reintroduce gluten.  

But ideally, if you suspect a food sensitivity or have never checked for this, I recommend a basic elimination diet where you eliminate the most common problematic foods at the same time, as often your gut needs time to heal if you have one or more food triggers. The foods I’d eliminate are gluten, dairy, soy, corn, highly processed foods with tons of ingredients, processed seed oils, added sugar in any form, artificial sweeteners except Stevia, monk fruit extract*, allulose* or erythritol*; caffeine and alcohol, or as many of those as you can handle for 3-4 weeks and then one by one reintroduce foods a couple times a day for 2 days then wait two more days to check for a reaction before reintroducing another food.

#4: You Eat High Fiber Foods Inconsistently

Even if you don’t have any food intolerances, high fiber foods such as legumes (such as beans, lentils and peanuts) or cruciferous vegetables like cabbage, cauliflower and broccoli can cause uncomfortable bloating and gas. By slowly introducing nutritious and high fiber foods like beans and lentils and then including them regularly in your diet, rather than eating a ton of beans in a very occasional bowl of chili, you’re less likely to experience bloating after eating them.

#5: Poor Enzyme Function

Poor enzyme function can cause bloating with certain foods, even healthy ones like raw fruits and vegetables. If you have issues with these foods or see pieces of undigested food in your stool, a general digestive enzyme* may be helpful to take with meals.

#6: You Have Low Bile Flow

If fatty foods cause you bloating and discomfort and you have light colored stool, low bile flow due to poor gallbladder function may be at work. Bile is produced by the liver and stored in the gallbladder. The gallbladder is then responsible for secreting a bolus of bile to the stomach to aid in digestion. When it is not functioning properly and you eat high-fat foods, you may experience other symptoms such as nausea and gas. Other conditions can cause gallbladder dysfunction, including hypothyroidism and fibromyalgia. Other symptoms of gallbladder dysfunction include headaches, problems losing weight, pain in the feet or right shoulder, hormonal imbalances, yellowing skin, and constipation or diarrhea. Natural healing strategies can help improve gallbladder function, including starting your meals with a bitter food to stimulate bile flow like dandelion leaves, which are free in most of our yards, just be sure they’re pesticide free, other bitter greens, lemon zest or beets. Or you could take Swedish bitters before meals or consider a bitter aperitif before dinner like Campari, Aperol, amari, pastis or ouzo. If you’ve had your gallbladder removed or have been diagnosed with low bile flow, you may want to take Ox Bile supplement* with fatty meals. I’ve linked to good brands of these supplements or you can also look for them in my Fullscript dispensary to compare prices.

#7: You May Be in a Fight or Flight State of Stress While Eating

Bloating may start during a period of high stress, as eating in a sympathetic, or fight or flight state, rather than a parasympathetic, or rest and digest state, will leave food stagnating in your stomach. If you find yourself visibly stressed at meal time, stopping to take 4 or 5, 5-5-7 breaths, which is 5 seconds in, 5 seconds hold and 7 seconds exhale, can help trick your body into a parasympathetic state so that you can digest better. Then using meditation, exercise, yoga, therapy or coaching to manage your stress and working to eliminate the underlying cause is a longer-term solution.

#8: Too Many Sugar-Free Foods

Some sugar alcohols, common in many sugar-free or “diet-friendly” sweets such as light ice cream and sugar-free candy and gum, are also a major cause of bloating for many people. The bacteria living in the large intestine ferment sugar alcohols like xylitol, sorbitol and mannitol quickly and produce large amounts of excess gas. Although sugar-free gum and ice cream may sound appealing, you may be causing bloating and other digestion issues by choosing these foods. Erythritol*, Stevia, monk fruit extract*, and allulose* are safer choices for alternative sweeteners that shouldn’t cause you GI distress, except perhaps nausea for some people with erythritol.

#9: SIBO

If all these solutions have been tried and failed, you may have a gut infection from an overgrowth of dysbiotic bacteria, candida or other fungi. Officially, this may mean a diagnosis of SIBO or small intestine bacterial overgrowth, which is the root cause of most cases of IBS. Some GI doctors will test for SIBO with a hydrogen/methane and the newest addition, hydrogen sulfide breath test, which are taken after eating a low fiber diet for 24 hours, or after an overnight fast. I don’t use them with my clients as they’re not terribly reliable and don’t tell you anything about fungal overgrowths, which most GI docs don’t believe in, parasites, or other potential causes of bloating. Rather, I prefer the GI Map* or the Organic Acids Test, depending on my clients’ other symptoms, history of antibiotic and other medication use and past testing.

If your GI doc diagnoses you with SIBO, you may be prescribed rifaximin or Xifaxin, which is an antibiotic that only impacts your digestive tract, but I think it’s wiser to use herbal antimicrobials because they also reduce fungal overgrowths, and just taking antibiotics will often leave you overgrown in fungi like candida and cause more long-term issues.

The primary short-term diet change recommended for SIBO that is solely bacterial in nature is a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet. This diet involves limiting high-FODMAP foods for a period of time and monitoring for a decrease in symptoms. Some examples of high-FODMAP foods include wheat, milk, onions, garlic, cauliflower, cabbage, artichokes, beans, apples, pears and watermelon but there’s a whole long list you can find by Googling it. Removing these foods will deplete the bacteria in your gut, so it’s important not to do this long term, but rather once your symptoms are gone for a couple weeks, to start reintroducing foods by groups and checking for a reaction to a given group. On a longer-term basis, you may need to limit quantities of these foods if you find yourself with recurrent SIBO. You’ll also need to determine the root cause of your SIBO, which if it isn’t from dysfunction of one of your digestive organs as I’ve already discussed, is likely related to issues with peristalsis, or intestinal motility in the small intestine, leading to stagnation of food, which causes bacteria to overgrow. That can be from vagus nerve dysfunction, which can stem from a stressful event or a brain injury or could be from low serotonin, which can arise from a poor diet, lack of exercise, a lack of exposure to natural light, chronic stress or insufficient protein intake or digestion. 

Taking probiotics may also be helpful with bloating and SIBO, as they can help restore a healthy gut microbiome. However, it can take time for the microbiome to rebalance, so be patient when starting a probiotic and don’t expect immediate results. One with evidence to help with SIBO is Saccaromyces Boulardii*, which is a beneficial yeast. Another home remedy to try for consistent bloating is peppermint oil*, which has been shown to help IBS patients with bloating. You can take one gel cap 15 minutes before meals. It used to be helpful to me but does sometimes lead to a pepperminty stomach sensation and burps.

#10: Candida Overgrowth

Digestive system candida or fungal overgrowth, also known as SIFO, or small intestinal fungal overgrowth, is one of the most common conditions I find in my clients and is best diagnosed using the Organic Acids Test. Candida is a yeast that is present in all healthy people but can grow unchecked when the bacterial balance of the microbiome is off, usually due to antibiotic usage or a high sugar diet. Other symptoms of a candida overgrowth include sugar cravings, brain fog, rashes, a white tongue and vaginal yeast infections in women. Treatment for SIFO is trickier and can take longer than SIBO treatment, as it can take some time to restore the microbiome’s balance and bring the candida levels down, and usually requires removing added sugar and simple carbohydrates for a while, as well as other foods that stimulate candida growth.

#11: You May Have Low Stomach Acid

Low stomach acid levels can also be a cause of bloating. When you have insufficient stomach acid, it makes it hard to digest proteins, so proteins may not be completely broken down into amino acids. Stomach acid is also protective against pathogenic bacteria, so you are more susceptible to overgrowths of bacteria like E Coli, that thrive in a neutral pH environment, and are often at the root of SIBO.

We tend to have decreased stomach acid as we age and when we’re under stress. Taking a small dose of Betaine HCl*, which is just hydrochloric acid or stomach acid, with meals can help not just increase your acid and help with protein digestion and sterilizing your food, but will also help stimulate bile and enzyme flow, so this is a good thing to try if you’re middle aged or older, under stress, or are experiencing these symptoms. Another sign of potentially low stomach acid is GERD or acid reflux, as the pH of the stomach regulates the opening of the lower esophageal sphincter and an insufficiently acidic stomach environment can lead to a sphincter left open for acid to go up, which can cause heartburn, a warmth in your chest or a subtle cough.

#12: H. Pylori

A common bacterial infection that also causes low stomach acid is H. pylori or Helicobacter pylori. It’s a bacteria present in many people’s gut microbiomes that can cause gastric inflammation, GERD, insomnia, nausea, and for some virulent strains, ulcers and stomach cancer. I’ve seen it in many of my clients, even at levels that are not considered abnormal, and when I educate them on how to eliminate it in a safe way using mastic gum (and not triple antibiotic therapy as a GI doctor might prescribe) they always feel better.

Overall, bloating is an unpleasant and avoidable experience that I personally put up with for way too long. It’s not normal to have a food baby after eating unless you just ate an entire 16-inch pizza and it’s definitely not normal to wake up bloated. I can’t tell you how much better I feel and look now that I don’t regularly bloat after eating. So if you find that you have consistent, painful bloating and simple behavior- and diet-based interventions haven’t helped or feel too overwhelming to sort through, please set up a free, 30-minute breakthrough session or a one-hour consultation and we can talk about the best next steps for you to solve your bloating problem!

Schedule a Breakthrough Session Now

*Starred product and lab test links on this page are affiliate links. Thanks for your support of the blog by using my links!

Using Microcurrent Therapy to Stimulate the Vagus Nerve, Reduce Inflammation and Heal the Gut

Adapted from episode 44 of The Perfect Stool podcast with Rob Vanbergen and edited for readability.

Lindsey: Tell me how you got into this work with microcurrent therapy.

Rob Vanbergen: I suppose it was a very weird situation, for me. I never intended to go into healthcare or alternative health, because I actually wanted to be an English teacher. I started going to university to study books and didn’t really enjoy that too much. I moved on to anthropology and didn’t really like that, then moved on to business. I ended up working in the family business, doing accounting and things like that. But while working in the office, I was seeing my parents treat all these patients, then 30 minutes of treatment later, whatever was bothering them was bothering them less, and many of them were fixed.

When I was a kid, I was a patient first because I had really bad scoliosis. Nothing we could do would fix that, which caused a lot of anxiety for me. So I had a personal healing experience with microcurrent therapy, because my parents first brought microcurrent therapy into their practice to help me. When I was a kid, I took it for granted and I didn’t really realize how great it was to no longer have that pain. It was then when I was working in the office, doing the boring number crunching, when I thought “why can I not treat people?” That was a teaching moment for me and I realized that if I wanted to treat people, I needed to get certified, have some sort of credential, and I needed to be insured. There’s so much that goes into working safely in alternative health. I decided to do all that, and then I started studying with them, because they’re the ones that really know about microcurrent. I tried to absorb everything that I could, so that I could start to teach others about it.

Lindsey: So did your scoliosis resolve or become manageable?

Rob Vanbergen: With scoliosis, we find it very easy to make a shift in one treatment session. It’s just all about treating the S curve, and mine wasn’t super severe. I’ve seen some really, really bad cases that were way worse than mine was. But it definitely resolved. Before that, we had been using homeopathy to try and manage the pain, and I’d been seeing an osteopath as well for some adjustments. Those were providing temporary fixes, from a couple of days to a week of pain relief, and then it would get worse. That was when microcurrent stepped in, and it just changed things. It realigned everything.

Lindsey: So was that microcurrent simultaneous with some type of hands on physical therapy, or was it just the microcurrent?

Rob Vanbergen: At that point, I would do a session of physiotherapy, and then we would follow up with the microcurrent right afterwards. Both my parents are naturopaths, and they continued to do the microcurrent, but they weren’t really into physical manipulation. I was seeing another therapist for that. But beyond that, it took a couple of treatments to get things to stick, and then the microcurrent. It’s all about the memory of the body and the electrical communication, and trying to make things stick

Lindsey: Right. I’ve been doing frequency specific microcurrent with my sciatica, and definitely attribute the combination of the physical therapy and the microcurrent to my pretty good state of healing at the moment.

Rob Vanbergen: Oh, absolutely. I think what we see when we’re using microcurrent is that some people that just love to stick some pads on their bodies and run the treatment passively. My preferred method is to add in movement while stimulating it, it’s much more effective than just sitting there charging yourself up with sticky pads on. As you said, it’s that physical movement that makes the difference there.

Lindsey: So now that we’ve been discussing it, what is microcurrent therapy? How does it compare to modalities like TENS, transcutaneous electrical nerve stimulation, or EMS, electrical muscle stimulation?

Rob Vanbergen: In order to understand microcurrent, I ask people to imagine that their bodies are electric, that cells communicate through these electrical signals that pass along to each other, kind of like skipping a stone. Now, in order for the brain to send a signal to the body and ask it to do something, like turn off inflammation or trigger healing, it needs to be able to communicate. To do that, it uses these little microcurrent signals and sends them down the nerve pathways. With microcurrent therapy, what we’re doing is using frequencies like the brain uses and hacking into the body like hacking a computer. You’re asking the body and the brain to work on the issue, because we want them to do the healing. We’re taking control of our body’s own amazing ability to heal and triggering it through microcurrent therapy. The main question we ask is if your body was biologically designed to heal, why are you not healing? A communication breakdown can be the problem there.

There’s definitely a big difference between TENS devices, EMS devices, and microcurrent. TENS devices are about 1000 times stronger than microcurrent therapy, even at the highest frequency. With TENS devices, we’re paralyzing nerve pathways so that we block pain, kind of like electric Tylenol. Typically, TENS devices don’t have long lasting effects, and there’s risk if you do it in the wrong place. For example, you can’t treat your neck, you shouldn’t treat your chest, and there are all these different warnings because of how high the voltage is. There’s some concern over triggering muscle spasms or damaging nerves.

I see EMS promoted more for exercise than anything else. EMS is a series of high frequency pulsed electrical signals to exercise and move the muscles in the body. They’re very popular for six pack hacks. Medically, we do see them in rehab facilities as well and they can be very close to microcurrent. In fact, our professional devices can actually be used for electrical muscle stimulation.

To cycle back to microcurrent, we’re not doing anything unnatural, aside from the fact that we’re taking control of the body. We’re asking the body to turn off inflammation, trigger repair, and normalize the system. That’s why a microcurrent treatment with our equipment tends to only be five to fifteen minutes, with the goal of then letting the body and the brain do some work.

Lindsey: So you’re using the currents that the body itself is using to communicate, whereas something like a TENS unit is so many thousands of times more powerful that it just hammers the body and it’s not in any way communicating with the body in a natural way.

Rob Vanbergen: Yeah. TENS devices are not what we would consider body friendly. As an example, 7 hertz is the frequency that seems to trigger regeneration of bone, so that’s what we go to when we’re dealing with broken bones, and soft tissue is 90. So we look at what the body responds to that is also body friendly, and we use that on the area and get the problem resolved.

Lindsey: Got it. Let’s get to the gut. What gut conditions have you seen microcurrent therapy work on?

Rob Vanbergen: Quite a lot. Recently, we’ve seen a big surge of people that have a lot of gut issues due to adhesions from massive surgeries, for example C-sections, which then triggers issues like Crohn’s or IBD. I definitely want to emphasize the scar tissue, but I’ve seen Crohn’s disease, ulcerative colitis, IBD, constipation, and even diarrhea benefit greatly from microcurrent.

Lindsey: Wow. Are there any peer reviewed published studies of microcurrent therapy and gut conditions?

Rob Vanbergen: There are a few published studies that have been done on Crohn’s specifically with vagus nerve stimulation. In that case, what they’re doing is using a surgical implant with a battery directly on your vagus nerve. Originally, they started doing those studies for epilepsy, and then noticed that people’s gut issues were calming down. Most of the studies we’re doing both at Stanford University and Baylor University right now are focusing on blood flow enhancement and wound healing. We haven’t launched any studies with our own devices on gut health yet, but I’m writing my PhD currently, and I’m doing my thesis on vagus nerve stimulation, along with inflammation in the gut and the body. I’ve found around 20 case studies involving different inflammatory issues in the gut that are causing diarrhea, usually manifesting as IBS.

Lindsey: Are these all people who have come through your practice?

Rob Vanbergen: They’re from either my practice or the practices of some of the people I’ve trained. We’ve got a good sample from across the world. We have cases from Australia, the US, the UK, and from Canada.

Lindsey: So how exactly does microcurrent function to change conditions in the gut to heal those conditions?

Rob Vanbergen: Inflammation causes a huge amount of problems, and when you’re dealing with chronic inflammation, chronic gut issues, you can be quite bloated and swollen, experiencing pain and discomfort. The inflammation is not meant to be there. It is an overreaction to something, and it’s not doing you much good. The only situation where I would say that inflammation is beneficial, is in the very early stages of the development of an ulcer, because it’s trying to help your body. If you imagine the brain sending that signal to your gut, asking for inflammation because there’s something going on. What you would hope is that things would settle down in a day or two, and the brain would turn the signal off and put the fire out. What seems to happen in chronic conditions is that the fire doesn’t get put out and it’s almost like the brain started a fire in a room, closed the door, and then forgot about it. Long-term inflammation will eventually cause degeneration, because if the fire isn’t put out, the stuff in the room is going to get burnt and it’s not going to be useful anymore. When you’re dealing with chronic inflammation in the gut, I see a lot of people with chronic diarrhea, very easily upset stomachs, who can’t eat a lot of foods anymore. Some people can barely keep down water. This becomes an issue because it starts to interfere with their lives. I’m sure your readers can resonate in that way. As a person that used to experience anxiety that would trigger an upset stomach, I know how impactful that can be on a day-to-day basis. With microcurrent, we have that potential to turn off inflammation. To fix the systemic problem, we focus on stimulating the vagus nerve, which can be accessed through the left side. We do a three minute gentle stimulation on the neck to send signals of calming to the brain and the gut to ask it to turn off inflammation. The quickest turnaround I’ve seen was just before Christmas, where I had a lady that purchased a device who had chronic IBS for years, and within four days of doing vagus nerve stimulation four times a day, she had her first normal bowel movement in years. Getting that vagus nerve stimulation to turn off the inflammation is key to shutting off the inflammatory response, reducing pain, and regulating the bowels as well.

Lindsey: I get that it could reduce inflammation and maybe even get the vagus nerve to reduce inflammation, but what I’m wondering is what caused the inflammation in the first place? Once you take out the microcurrent, won’t that same thing cause inflammation again?

Rob Vanbergen: It can, and this is where we try to determine what else is going on. Part of what we do involves the Haché protocol, which involves looking beyond microcurrent at stress, nutrition, fitness, and sleep. Obviously, the microcurrent plays a major role. What I see quite often is that people dealing with these chronic conditions have an overgrowth of candida, which is something we have to address as well. We potentially even have to look for other digestive organ dysfunctions, such as liver dysfunction. We absolutely have to look at the bigger picture. If someone’s not sleeping, for example, then their rhythm’s not in the right place, and that might not be working properly. We can’t just say that microcurrent is going to fix it all, but it will provide relief. If the issue was just inflammation that was left on, and it can be turned off, it won’t come back.

Lindsey: I see clients with candida a good bit, too, and I’m curious, because I’m always having discussions with people about diet. It takes so long to knock out candida that asking somebody to not eat any sugar or carbs for eight months just is a little unreasonable. What kind of nutrition and diet recommendations do you have for treating candida?

Rob Vanbergen: Firstly, getting a full GI map test done so we can see the levels of the candida is helpful, so that we have some data to work with. I hate recommending specific diets, because I find that there’s no one size fits all diet. I’m a big fan of the process of elimination, so I usually tell people to look at the big triggers: dairy, gluten and sugar, but not to remove them all at once, and see what the trigger might be. I also like to get people on a good probiotic. We use a product called Biocidin. I’ve seen that totally eliminate the candida in both close family members and clients. It might take two months and some conviction to be able to give up sugar for that long, especially with how much sugar is in everything.

Lindsey: Do you use the full protocol with the Biocidin, including the Biotonic, the GI Detox and the Proflora 4R?

Rob Vanbergen: We’ve just done the GI Detox in combination with it. We go really slowly with the Biocidin. I’ve found that people tend to be really gung-ho to finish the bottle. We work through that and reccomend GI Detox when people have flare ups, and they start to have improved symptoms pretty quickly, especially with the microcurrent. It doesn’t mean that the inflammation is gone, and you feel better and can eat that chocolate bar. It’s not going to work that way.

Lindsey: So you mentioned the vagus nerve and the importance of calming the inflammation by it. I’m wondering whether there are simpler, less expensive ways to stimulate the vagus nerve like gargling or humming, or the methods that are described in Stanley Rosenberg’s book, “Accessing the Healing Power of the Vagus Nerve”?

Rob Vanbergen: We’ve had some people compare the difference between those, and I have found that nine times out of ten, you’re going to get better results from the electrical stimulation. You’re combining the alpha frequencies of being calm, and in that relaxed state, you’re able to put those in the vagus nerve and have them travel up and down it. Because it’s electrical communication, it’s hacking the body. It doesn’t require you to get into a state of mind where you can do deep breathing, gargling, humming and also calm yourself down properly. We find people get very high stress, especially with gut issues. And again, I resonate with that. It can be really hard when you start to feel discomfort to focus in the moment and bring yourself into it and the electricity just kind of takes control. It’s like an override for it.

Lindsey: You described a little bit about the physical way that the machine will stick. Can you describe what it looks like, because people might be wondering what exactly this is that they’re using?

Rob Vanbergen: It’s a handheld, battery-operated device, and it’s smaller than my iPhone. It fits into the palm of your hand pretty nicely, and it has a metal electrode on the back of it. The electrode is where the electricity comes out, and it’s gentle, tingling, nothing uncomfortable. You can also plug in various attachments, if you feel you need extra reach, or just a more comfortable tool to hold in your hand, and then the electricity would come out of those instead. You can hold it in your hand and paint it across the body. There are over 250 adjustable power levels in the device, which is always set to be comfortable for the user. That can change on a daily basis based on the electrical potential of the body. Just because 50 power was comfortable one day doesn’t mean that it will be when you’re really inflamed. You paint the device across the body and the frequency that you set is translated into an electrical charge.

Lindsey: So are you saying that people are choosing to change their frequencies?

Rob Vanbergen: We follow specific protocols with people, everyone gets their own one-on-one treatment coordinator to help them. We work through their issues as a service. So all of the frequencies are different – there’s a frequency that’s great for the vagus nerve, anything above 100 hertz is great for surface inflammation. Anything below that tends to have regenerative capabilities, so we will switch between the modes, depending on what we’re trying to achieve. It’s just one frequency at a time which is enabled by the chip technology. In our Avazzia Life Evolution, we have one which we use for the vagus nerve that moves between seven and twelve hertz over a two minute period, and then cycles through again. All these things are designed to make sure that the body doesn’t habituate itself to the frequency, so we don’t want a static frequency consistently hitting the body. Just like taking two Tylenol every four hours will eventually mean that the body stops responding to the Tylenol, doing the same thing with one frequency could have the same result. We’re making sure every frequency, every program is consistently changing to prevent habituation.

Lindsey: Okay, so the devices that they’ve been using on me use pairs of microcurrents. I’m wondering whether you’re familiar with those and how they’re different from Avazzia devices?

Rob Vanbergen: Sure. Frequency specific microcurrent usually involves hitting the body with one frequency, and then following up with another. What they tend to do with those programs is very similar to what we have here. There’s a small range, and it hits every frequency in that range. With frequency specific, they might say, use one frequency and then switch. From my understanding, it does vary based on the device. You’re trying to hit it from two different frequencies. It’s likely that they’ll have a similar program so that even if it’s a specific frequency, it will change on a decimal level to minimize the chance of habituation. Otherwise, you would find that over time, your body would just stop responding.

Lindsey: I think the lowest cost one of those devices is something around $2,500. So how does that compare to the price of your devices?

Rob Vanbergen: Our lowest cost one is about $600. My recommended one for gut issues is about $1,500. The reason I recommend that one, the Avazzia Life Evolution, is because it can do vagus nerve stimulation. You can treat gut issues with the Avazzia Life Genesis, which is the $600 model, but to work systemically on the vagus nerve, I feel it’s worth it to make that investment.

Lindsey: And people have to buy them, they can’t just rent them?

Rob Vanbergen: We don’t currently have any rentals, but some local practitioners do offer rentals. If you buy a device from us, you get 30 days from when it arrives to try it out. If you don’t like it, you can return it if it’s not working for you. During the first 60 days, you have a one-on-one treatment coordinator that will send you links to videos, they might hop on zoom with you, and they would talk you through the different treatments that you need. If you’re having any issues or you’re finding something’s not working, they’ll adjust the plan, which we find to be crucial because every patient is different and has different case histories. If we don’t work on an individual level, we might miss something that is critical to that healing.

Lindsey: How long and how often you need to use the microcurrent device in order to see some initial results? How long does complete healing take, on average?

Rob Vanbergen: I’ll preface this by saying that the longest condition to heal is colitis, especially when it’s very, very chronic. It can take three to four months to see results. But with other conditions, there’s usually benefit within the first two to three weeks. Within that first 30 days, we ask that you do twelve minutes of treatment per day at minimum. That’s four sessions of three minutes stimulating the vagus nerve per day, and if people do that alone, it will help. If they can add in another 15 minutes of general treatment on the abdomen it’s going to be even better. I would say a maximum of 30 minutes a day.

Lindsey: So the 12 minutes is on the vagus nerve?

Rob Vanbergen: Yeah, we try to mimic the studies that used the surgical implants. Those fire all the time, so we want to be hitting the nerve four times a day, usually around mealtimes and bedtime.

Lindsey: That seems like a reasonable ask.

Rob Vanbergen: Yeah, it’s not a big deal for many people. Some people have very busy lives, and that can be kind of challenging for them. But it’s your health, so it’s a very good investment of time.

Lindsey: Well, if you run to the bathroom 12 times a day, it seems like this would be a better choice! Okay, so you mentioned the $600 and the $1500 device, and you have a higher level one as well?

Rob Vanbergen: Yeah, we have one that’s intended for doctors, that’s about $4,000. I never recommend that for home users, because it’s not designed for that. The main advantage to that one is its evaluative capabilities. It has a screen on it, you put the device on the skin, and then within one second of being on the skin, it’s going to give you a reading, which will tell you whether that area has inflammation, is degenerated, or has healthy tissue based on the electrical feedback. That can help a professional determine what’s really going on. They may be able to look at your abdomen, take a bunch of readings, then maybe they go up to your liver. Maybe they see that the liver is really inflamed. They can see what is causing a cascade of issues somewhere else, which is not always necessary, but it’s a neat feature. That’s really where that extra price comes in. There’s probably an extra 45 programs in the professional device, and it can be very overwhelming for someone to essentially learn all of the material you need to make that one work for you.

Lindsey: Do you have to pay extra for the attachments?

Rob Vanbergen: Yes, and the price varies. The classic kits of both models come with some attachments. We also have a deluxe kit, which includes every attachment under the sun. For the Genesis device, that makes it $795, and that includes all the attachments you would need with that device. For the Evolution, it’s $1,995. These devices are FDA approved, and you can spend HSA and FSA accounts on it, so it doesn’t need to come out of pocket either.

Lindsey: Nice. Tell me a little bit more about the Haché protocol and how it relates to the devices. When you get the device, do you automatically get some amount of that protocol?

Rob Vanbergen: We’ve focused on that more than anything else in the last few years, because we realized that we really need to take a full holistic approach. Maybe it’s something we would be doing ourselves, but we can’t expect that every patient is doing that. People find the biggest one is stress. As a recap, there are five elements: stress, nutrition, fitness, sleep and microcurrent. We’ve had lots of people that were doing microcurrent, but maybe they weren’t managing the stress, maybe they had no support system. What’s really happening in that situation is the stress reaction is blocking healing. We mentioned nutrition earlier, and it’s very important to find out what you can and can’t eat for you. With fitness, I find that’s a word that scares a lot of people. Movement is medicine. Movement is life. If you move, if you are moving around, then you’re doing a lot of good for your body, even going for a ten to fifteen minute walk or gardening. We’re really not asking people to run marathons, we just think it’s important that people get some sort of physical exercise.

Lindsey: I know that the research says that the gut microbiome improves if you engage in exercise.

Rob Vanbergen: Yes, yeah, it’s very interesting, isn’t it? I think there must be some good bacteria that like fitness.

Lindsey: Or whatever our body releases when we do exercise. I’m one of these people who actually loves walking but not full-on aerobic exercise, but I suck it up and I do it three times a week for 20 minutes. It’s the maximum I can stand.

Rob Vanbergen: I prefer swimming. I can’t stand running anymore. I used to when I was younger. Now I can’t, but I need to do something.

Lindsey: Yeah, I actually have been swimming since the sciatica started. That was the only thing left to me because for the longest time, I couldn’t even walk. But I’ve been on hikes in the last couple months, and it’s been so wonderful. I used to hate walking uphill. But now the fact that I can walk uphill is exciting because I can do it. Now I have a body that lets me do that; what a privilege!

Rob Vanbergen: I know, and I see that with people all the time. It’s one of those things where you don’t know what you have until it’s gone. People will complain that they have to walk to the store, but then 10 years down the line, they might be wishing they could walk to the store.

Lindsey: I would say to my kids when they didn’t want to do their chores that you have an able body. If I had a body like yours right now, and I could just go and clean the floor, I would do it in a second. I’d be so happy to clean this floor. I’m not sure now that my capabilities have come back I’m that excited about cleaning the floor. At least I’m happy that when I want to I can do it.

So can someone see practitioners who already have the devices so that they don’t have to invest in the device? Or is it better to just buy one, given how frequently you need to use them?

Rob Vanbergen: That’s a really good question, and there are definitely practitioners with devices. And if someone’s looking, I do encourage them to reach out, because we have a bigger concentration of practitioners in California than anywhere else. But they are all over the place, and it’s a question of whether or not they’ve been properly trained. I wouldn’t want them to have the wrong idea of what to do. If someone wanted to reach out to me and ask, I’d be happy to recommend someone in their area. That being said, the cost of these treatments is usually quite high, anywhere from $200 to $300 an hour. The investment tends to pay for itself pretty quickly, and you can just return it if it doesn’t work. I tend to recommend that people buy it and work with our treatment coordinator, because that’s all included, to see if it makes a difference. And then you don’t have to put out as much money or travel.

Lindsey: Okay. I’m not sure if I totally got the answer whether the Haché protocol is included with the device and the treatment coordinator, or is that a separate thing?

Rob Vanbergen: Yes, it’s included, and we work with people on that level. In some situations, where we feel we can’t meet people’s needs completely, we can recommend them to see someone outside of our practice who’s more specialized. We’re not going to pretend to be experts in it all.

Lindsey: Okay, and is there a certain number of sessions that come along with the machine?

Rob Vanbergen: Right now it’s set to be unlimited. The treatment coordinator team is at people’s beck and call five days a week, so Monday through Friday, and they’ll do emails, zoom calls, phone calls. If anything needs escalating, then they come to me or my parents, and we have a meeting once a week to go over any kind of extreme cases, and make sure that we’re all staying on the same page. But it’s all included for the first 60 days.

Lindsey: And do you have specific diets that you recommend for Crohn’s and ulcerative colitis?

Rob Vanbergen: I tend to recommend people just stick to elimination. For example, I can’t eat raw greens. My mouth and gut swell really badly. So a lot of these diets wouldn’t work for me, because I couldn’t go that traditionally healthy direction. We have recommended trying to avoid nightshades, which many people may consider healthy, and that includes foods like tomatoes.

Lindsey: So basically, try eliminating gluten, dairy, sugar, and then perhaps nightshades for ten days if you have one of those IBD conditions?

Rob Vanbergen: Yeah, and then see how you feel. There should be some improvement when you’ve knocked the food out for ten days. Keep an eye on those ingredient lists, because a lot of processed foods have hidden ingredients you wouldn’t imagine.

Lindsey: I would imagine! Beyond the 60 days, if you still need some support, how does that work?

Rob Vanbergen: Beyond the 60 days, if you still need support, we have a membership option. It’s $48 a month, and that includes the unlimited support feature of the treatment coordinators and unlimited access to videos. It’s just our way of affording to pay the treatment coordinator team.

Lindsey: So is this something that doctors may have heard of? If people want to go to the doctor and say, I want to get this? Or should they just go straight to you, because the doctor is going to go, “what the heck is that?”

Rob Vanbergen: Some doctors might know. I found that in Europe, microcurrent is much more prevalent. If anyone has a naturopath, they will probably know about microcurrent. But the devices are FDA cleared and Health Canada cleared for pain and inflammation. They’re not necessarily going to think you should use this for your gut. Now, that’s where I recommend people give me a call, and we’ll book an appointment for that. I can answer those questions for them. If they want me to speak to their doctor, I’ve done that before as well.

Lindsey: Okay. So I have to ask, since I have sciatica, how successful are the machines in treating sciatica?

Rob Vanbergen: It’s quite successful. To treat sciatica, what we do is we work with movement on the lower back where the nerve is pinched, and we would place the electrode on the side of the spine near that and brush out with an anti-inflammatory frequency with the goal of helping to pull and release. Then there’s the memory component of the brain recognizing the problem, remembering that and not snapping it back into place. We definitely have a simple sciatica protocol, and you would need one of our wire electrode attachments to be able to actually reach your own back in that way. Hand holding the device like that will be kind of uncomfortable.

Lindsey: Okay, great. Well, I think that was a lot of information that would be useful to people who are dealing with gut issues that they can’t seem to find a solution for. Tell me where people can find you.

Rob Vanbergen: I recommend people go and check out our website. If they’re looking for some case studies that we’ve done on Crohn’s, they can go to the blog, and they can search anything gut health. And of course, from that website, if they want to speak with me directly, they can book a complimentary consultation, and I’ll give them a call and we’ll just have a chat.

Lindsey: Okay, great. I just set up an affiliate account. If you use my link from the affiliate account, and buy something, that would support the podcast. Okay, well, thanks so much for all this interesting information. This is a totally new modality for my blog and podcast, and I imagine for a lot of my listeners and readers.

Rob Vanbergen: Awesome. Well, I was really glad to be here, and thanks for having me.

If you want more help with your gut, autoimmune or other health issues, you can set up a free, 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether my 5-appointment gut health coaching program or a longer program for autoimmunity or weight loss is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

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Could Lyme or mold be at the root of your gut issues?

Adapted from Episode 43 of The Perfect Stool: Understanding and Healing the Gut Microbiome with Dr. Diane Mueller.

Lindsey: Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I’m going to be talking with Dr. Diane Mueller, a naturopathic doctor, doctor of acupuncture, and a survivor of IBS, Lyme disease and mold illness. Dr. Mueller is passionate about bringing research, understanding and compassion to those with these diseases. She has co-authored a book, which is to be released in May 2021, called Use Your Mind to Heal Your Mold and Lyme. Her practice, the Medicine with Heart Clinic, treats patients around the country. She also co-owns an online functional medicine school called the Medicine with Heart Institute, where she trains clinicians around the world in functional medicine.

Lindsey: It seems like a lot of these always start with this long illness history from their guests. And I don’t want to spend too much time talking about that, but it’s 2021 now, and I’m curious what years you were dealing with IBS, Lyme, and mold illness. Was that all at the same time, or one at a time?

Dr. Mueller: The IBS actually started in childhood, back in the 80s, and then I started having symptoms in the late 90s, early 2000s. That later led to me realizing those symptoms were connected to Lyme and mold, but they kind of worsened throughout 2000 to 2010. And it was 2011 when I actually realized what was going on from that standpoint.

Lindsey: Is having gone through that what interested you in becoming a naturopathic doctor?

Dr. Mueller: I had gone through all the classic things with IBS, as so many other people do, around conventional tests that said everything was normal. That’s what drove me into learning naturopathic medicine and acupuncture. When I was in medical school, the IBS and the stress of of medical school that started making some of the symptoms of Lyme and mold, really start exacerbating. That’s when I really started going downhill. That’s sort of ironic, right? You’re learning how to treat these things as well. You’re simultaneously coming to them. Yeah, I mean, it’s, in some ways, I guess, a good way to learn. I’m a kinesthetic learner. So maybe that’s why this happened to me is so I could learn.

Lindsey: You said IBS came first. But do you think of that as your root cause?

Dr. Mueller: For me? One of the big things was small intestinal bacterial overgrowth, for sure. And I think the onset of that was when I was young, we took a family vacation, and I was at a restaurant and had drank some really soured milk. I had really insane food poisoning that took me down for almost a whole week after. And you know that food poisoning is so often that instigator through the CVT toxin released that I think that’s what caused my migrating motor complex to shut down and the progression of SIBO from there.

Lindsey: Have you ever done the ibs smart test?

Dr. Mueller: I have done the one that is offered by Vibrant Wellness.

Lindsey: Okay, yeah. Does it does it test the Anti-CdtB (Cytolethal Distending Toxin B) antibodies?

Dr. Mueller: It does.

Lindsey: Anti-vinculin?

Dr. Mueller: Correct. Exactly. It’s basically the same test. It’s just different company.

Lindsey: And so yours were positive.

Dr. Mueller: Mine were positive.

Lindsey: Got it. So now for the Lyme and the mold, I assume you got those sort of along the way, but the stress was what made you more susceptible to them?

Dr. Mueller:  I did grow up in the Northern Virginia area. We used to camp a lot in the Appalachians and my sister had Lyme disease when she was young. She had the classic bull’s eye rash. When she got sick was people were actually realizing that Lyme disease was a real thing. I know I was definitely in some very, heavy Lyme areas. My suspicion is I could have caught it back then. For so many people like it can look like the flu and it goes dormant. My suspicion is that medical school and stress made it really come out of dormancy. One of the things I was having prior to that was waking up and having these days that were really, really off. I couldn’t think and everything would get cloudy. I started having some joint swelling to the point where I actually had to have elbow surgery to work on some of the swelling. Those were some of the early symptoms that started coming on. Then when I got into school, the stress of that, living in a moldy environment, everything converged. I still had SIBO at that point so it was just a perfect storm.

Lindsey: So let’s talk about how the classic Lyme, Borrelia burgdorferi, how that might manifest in the gut.

Dr. Mueller: What has been shown in research is that on those positive with Lyme, the cardiac vagal tone, which is a way of monitoring the impulse of the vagal tone on respiration, but the test is really telling us about the vagal nerve functioning in general, this study found that those with Lyme had a vagal nerve that was actually downregulated, which means turned down, and was not functioning as well. The vagal nerve runs so much of digestion: anything from peristalsis, the movement of food through the intestinal tract, and proper stomach acid secretion, proper bile secretion, proper pancreatic enzyme secretion, to name a few. When Lyme starts to attack the vagal nerve, we can actually see a problem because none of these digestive functions are getting the proper signal.

Lindsey:  Do the Lyme co-infections manifest the same way in the gut, impacting the vagus nerve?

Dr. Mueller:  It’s a slightly different mechanism, but with the same potential impacts. Bartonella, for example, that co-infection, the mechanism that is thought to be happening is an increase in our white blood cell, the CD34+. When that is upregulated, what happens is that we’ll see a catecholamine dominance. We see norepinephrine and epinephrine (adrenaline) essentially increase. When those things increase, we move into more of that fight or flight type of situation. It’s really the same thing that could happen through turning down the vagal nerve, but it’s through this backdoor mechanism of increasing the fight or flight due to the way our white blood cells are responding.

Lindsey: How many different Lyme co-infections are there?

Dr. Mueller: We’re still learning so much about all these different microorganisms that insects are containing. When people get bitten by an insect, whatever cocktail that insect has of microorganisms gets inserted in somebody’s body. It’s unspecific. I think that I can answer that in the most common ones that we see in clinical practice. These ticks and insects are always picking up new things. I think there’s always going to be a new microorganism on the on the scene that we haven’t seen before.

Lindsey: What are the most common ones, then?

Dr. Mueller: The most common ones are be Bartonella, Babesia, Ehrlichia, Anaplasma, Rocky Mountain Spotted Fever.  There are others like Dengue fever that can also be a concern, but the top ones for sure are going to be those.

Lindsey: If you go to your doctor to get tested for Lyme, how likely is it that they’re going to test you for those other things? And is their test even worthwhile? Or do you need to go to see a naturopath or functional medicine doctor to order a good quality test?

Dr. Mueller: I’m so glad you’re asking this. The challenge with how these things are being tested for in conventional medicine is typically they are first screened for in conventional medicine with an ELISA test, which has been shown to have a high rate of false negatives. The western blot is a different testing mechanism, which has been shown to be much more accurate for diagnosing Lyme than the ELISA. But yet that’s what people start with. And they only get the western blot if the ELISA is positive.

Lindsey: Is this because insurance companies won’t pay for the western blots? Are they more expensive?

Dr. Mueller: Exactly. That’s the challenging thing with going to a conventional doctor. So many people, even if they request this and hear this information, go get tested, and then they hit this roadblock, and they think they’re fine when they’re not because of a bad test. It’s definitely important to go to somebody that’s Lyme literate, that really knows Lyme, to get a test from them. And Western blots, definitely a decent test. But there are also problems with it. The western blot essentially takes little tiny protein pieces of the Lyme bacteria, and seeing if there’s an antibody response, or looking to see if our immune system is reacting to certain proteins, which are seen in the Lyme bacteria. And the problem with this is how this test is interpreted. Your immune system has to react in three to five different ways to these particular protein pieces. And why that is oftentimes an inaccurate way of interpreting things is because some of these protein pieces are so specific to Lyme, that there’s really not going to be other microorganisms that would actually cause our immune system to react in this way. Why do we have to have three to five different ways of reacting when you know this test is super specific to Lyme? One of these elevations should be a sign that there is Lyme present. So I know that’s kind of heady information. But the point of that is, even with the Western blot test, it’s really important to go to a Lyme doc that understands how to extrapolate and understand the material so that it’s truly being interpreted correctly, because it can be interpreted incorrectly quite a bit.

Lindsey: It sounds like you could even look at your own Lyme test from a traditional doctor, if it were a Western blot, and see if you get one positive, I should probably consider myself as having Lyme and see somebody who can help me with this, since my doctor probably will tell me I’m negative.

Dr. Mueller: Exactly. And there are some of those protein pieces that are very nonspecific, meaning there’s some protein components of Lyme that other viruses have as well. So those things that are nonspecific we ignore if it’s just one, and we try to understand the whole picture. But the protein pieces that are really specific to Lyme, it’s super important to interpret correctly. Then the PCR test is really looking for the DNA of the bacteria. That’s also a super useful test to do in combination with the Western blot just as a check and balance.

Lindsey: Is this a stool test? Or what kind of PCR?

Dr. Mueller: This is a blood test. I’m sure your readers are really used to seeing PCR stool tests. It’s a similar mechanism of looking for the DNA and microorganisms, but instead of looking for them in the stool, we’re looking for them in the blood, because that’s going to be a more likely place where we’re going to find the DNA for Lyme.

Lindsey: I’m not actually sure how much my readers know about PCR tests, but I mentioned the GI Map, and that’s a PCR test where you’re matching the DNA to the organisms you’re looking for?

Dr. Mueller: Yeah, that’s a simple way of explaining it. I love it. That’s a great test. We use that test too.

Lindsey: What about the co-infections for Lyme, if you see your doctor can they test for the coinfections?

Dr. Mueller: They are probably going to think that you are reading too much online if you ask for the co-infections. Every once in a while I do find a conventional doc who’s really educated in this. But most of the time, one of the biggest problems that I find around insurance not covering is doctors not wanting to order things they don’t cover. One of the things that I’ve seen come up quite a bit when talking to conventional docs is that people don’t like to order things that they don’t know how to interpret and treat. So oftentimes, a no can even be coming from a place of, well, if the doctor orders it and doesn’t know how to treat it, then they’re assuming in some way, some level of responsibility, and they don’t know what to do from there. It’s almost like there’s some resistance to even going down that road.

Lindsey: So maybe you could just say, hey, my functional doctor wants me to get these tests done, they’ll handle it when they get the results, and they might have a better chance with a naturopath.

Dr. Mueller: Yeah, absolutely. I still see people get shut down. But having that approach of letting them know that they’re not responsible for this information. I have a plan. Can you just help me? And some definitely will. It’s definitely from a testing perspective. I would ask for whatever the microorganism is. If we’re saying Bartonella, Babesia, or any of these others I mentioned, then they would typically want to ask for both and IgM and IgG antibodies as well as the PCR. It’s essentially three different markers for any of these microorganisms (co-infections) that you would be wanting.

Lindsey: If you find somebody who’s got simultaneously the gut issues, mold and Lyme, which do you deal with first?

Dr. Mueller: It’s definitely dependent but one of the things that’s super important to realize is oftentimes starting with the gut can move us further faster. One of the things that’s really interesting is that E. coli, one of the microorganisms that in some cases is overgrown in SIBO and is also seen with chronic UTIs, E. coli will actually change a protein in the liver, it’s a transport protein, and that protein’s job is to help move toxins out of the liver so our body can excrete them in the stool. The endotoxins from E. coli will block that transport protein. What that means in somebody that has a SIBO overgrowth along with Lyme and mold is actually a prevention of the Lyme and mold toxins from moving out of the body. So if there’s SIBO, that is a case where it is often better to start with the gut. One of the exceptions, though is if somebody is in a moldy home, the mold tends to cause so many problems, that if people have the ability to prioritize getting into a safe space, in that situation, I usually say that’s the most top priority, but we definitely have to get the gut working as fast as possible.

Lindsey: How do you end up treating Lyme and its co-infections?

Dr. Mueller: In our practice, we use predominantly herbal medicine. A lot of people are really into treating Lyme with doxycycline, and a triple antibiotic therapy. There’s so many problems with that as you and I know about the gut, and really the microbiome of the whole body. And what’s also interesting is doxycycline is the main drug on the scene for treating Lyme. It has actually been shown that doxycycline will actually cause Lyme to convert from its most active form to its dormant state. The challenge with that is people take the doxycycline, and they can feel a little bit better because they’re getting the Lyme out of their blood and out of the system, but they’re just moving it into hiding, so they’re not actually clearing it. Then when somebody’s stressed, the Lyme will essentially come out of hiding. I really don’t like to use doxycycline and the triple antibiotic therapy is so intense. I’ve seen people come into my clinic that  have been on IV triple antibiotics, sometimes even up to five years, and these are the sickest people I’ve ever seen. I’m sure it’s no surprise to your readers after the work that you do on teaching them about the gut and the health of the gut in the microbiome, because it really just destroys us. And with all we know about the gut and the microbiome, and its effect on our immune system, destroying that is not going to help us eradicate these infections. I find herbal medicine to be a much safer approach, and incredibly effective. It works so well.

Lindsey: Are there particular herbs that are good for Lyme, or particular nutraceuticals?

Dr. Mueller: There’s definitely particular herbs, and some of it is also about the way the herbs are prescribed. One of the things we really want to be careful with, whether it’s herbs or pharmaceuticals, is preventing the Lyme from burrowing deep into our tissues, or from changing from its active form into one of its hiding forms. There’s a couple of different ways we can do that. One is through pulsation, which means that we are going through a period where we are on the herbs and then off the herbs. We might say take an herbal protocol for five days, then take two days off. During those two days, we might be doing some gut work or some adrenal work, something that’s strengthening the body. We rotate that way. The other way to really prevent the Lyme from going deeper is by rotating through our therapies. When we rotate, we might do an herbal protocol for say, a month, and then switch to another herbal protocol for a month, switch to a third and then rotate that way.

Lindsey: Always on that five:two pattern?

Dr. Mueller: It doesn’t seem to need the five:two pattern unless you’re just sticking with the same protocol.

Lindsey: Which herbs are good for Lyme?

Dr. Mueller: One of the most important ones that we feel at this point is an herb called cryptolepis. Cryptolepis is really amazing. It kills Lyme in all of its different states. There’s one particular dormant state called a persister state. And what’s interesting is this is a state of Lyme that just does not respond to antibiotics. It’s not antibiotic resistant, because antibiotic resistant bacteria have actually changed their DNA to become resistant. That’s thought to be caused by a genetic mutation in Lyme that spontaneously makes the Lyme resistant without having a gene. The idea with cryptolepis is that it has been shown to kill those types of cells in laboratory studies. They’ll do these studies where they’re putting these different antimicrobial agents against Borrelia. And it will look like Borrelia is dead and then they’ll check the petri dish a week or two later, and all of a sudden, all these new cells have sprung up. So cryptolepis has been the herb that’s performed well for up to 21 days. At the 21 day mark there’s no Borrelia. That’s been the only thing that’s performed that well from an herbal or from a pharmaceutical standpoint. And crypto has outperformed all of the herbs and all of the pharmaceuticals.

Lindsey: What are the symptoms that somebody might have Lyme or Lyme co-infection?

Dr. Mueller: One of the most common things we see is migrating pain, so pain that can be in the hip and then the shoulder and then the elbow. So usually somebody is in pain most of the time, but it moves in location and severity. That’s one of the most common things. But Chronic Fatigue is really common, gut problems are really common. From a gut perspective, I would really be thinking about Lyme based on the GI map, if they’ve done the SIBO test and they came back negative, and they’re hydrogen negative and their GI map looks good and their microbiome is healthy, and all the basic things have been done. So now we should start looking at what else could be attacking the vagal nerve and could be causing some of this inflammatory process. Other symptoms to look out for are things like agitation, anxiety, quick to overwhelm, and being quick to anger. Sometimes people will wake up and panic, or wake up in anxiety. Waking up in the middle of the night is a very, very textbook symptom of Borrelia. The other thing to really think about and when to consider Lyme is when the gut has been looked at, the adrenals have been looked at, maybe metals have been looked at, when there’s been a lot of other things that have been looked at. What else is causing such a widespread symptom picture where somebody is not getting better, then we definitely want to be thinking about borrelia.

Lindsey: In terms of the moving pain, is that typically moving between joints? Or could it be in your digestive system, too?

Dr. Mueller: It could be anywhere, honestly. The most classic thing is for sure pain between joints, but it can definitely be in the muscles, there can be fibromyalgia-like pain. It can be in the gut. If pain’s involved, we do want to have Lyme in the back of our mind as a possibility. Including pain anywhere, headaches, anything like that.

Lindsey: How long typically are these herbal protocols for Lyme?

Dr. Mueller: The average person is on herbs for Lyme for a year. As far as total treatment, it really just depends upon when we do functional medicine lab tests, how many different things we find come up on the labs.

Lindsey: Assuming that you’ve already worked on the gut and the Lyme, and a year goes by, they can get off the medication. Do people tend to then not have the gut issues re-appear?

Dr. Mueller: I do see that some people still have to be on certain diets. One of the things I have found is that for people that have chronic SIBO, for example, where it seems like it’s gone, you do migrating motor complex work for six months, they’re great, and then you know, a year or two later, I just find that some people have a tendency for it still to recur. There are certain people that I have found that if we can just keep them on certain diets that can really be helpful. But I’ve absolutely seen this really change the picture for people with GI issues in a permanent way.

Lindsey: What do you like for the migrating motor complex?

Dr. Mueller: For the migrating motor complex, we’re using 5- HTP, ginger, low dose naltrexone. I really do like the low dose naltrexone quite a bit. I’ve seen some really positive things with it, then a little bit of low dose erythromycin, but haven’t used that one quite as much.

Lindsey: So that one kind of scares me because it’s an antibiotic.

Dr. Mueller: Exactly. Even in low dose, it definitely scares me too.

Lindsey: We’ve talked a lot about Lyme. Let’s move on to mold. I have a client right now who has very serious mold illness, and I’m eager to hear more about it and how it interacts with the digestive system. So first, let me just ask, is mold usually environmental, like you’re in a moldy house or workplace or is it sometimes coming from food or other sources?

Dr. Mueller: Well, it certainly can come from food and other sources. But mold illness is really an issue where we have a genetic anomaly where our body is not able to properly recognize the toxin from mold. And because we can’t recognize the toxin because of our immune genetic issue, we can’t eliminate it. So yes, it comes from buildings, we can have it from food, but I’ve never seen somebody where eating some peanuts is the reason they have mold illness. Somebody with mold illness should certainly avoid peanuts, but it’s more that the mold toxin level is so high that our body can’t eliminate it.

Lindsey: What portion of the population has that genetic anomaly?

Dr. Mueller: 24%, but the thing with that is, not everybody has their gene activated. So just because there’s 24% that have it, of course, the gene has to be activated. So not all 24% are in this situation where they could react this way, because some of them will not have an activated gene. So typically, what activates genes is usually what we call it the environmental trigger in research. Usually, it’s going to be things like viruses, which have been studied quite a bit for activating genes, or toxins, pollutants in the air, stress, mindset. If we’re creating an internal stress response because of our internal dialogue, that could be enough to activate infections in the gut, poor dietary choices, any of these types of things can potentially activate the gene.

Lindsey: Okay, once it’s activated, can you deactivate it?

Dr. Mueller: It’s a big question and research right now is really to see a couple different things. The way it’s been described to me, and the way I can best help people understand this if you can imagine that our genetic code was your arm, and then there’s a sleeve, so your arm is covered. There’s certain things that are going to pull up the sleeve, essentially allowing the gene to express. One of the things that we have seen to pull down the sleeve and cover up the gene are methyl donors. By giving things like Sam-e or choline or creatine, these things that have been shown to help with methylation, that’s something that can help potentially with lowering that epigenetic expression. This is still a little bit theoretical and research is still finding how much is this truly able to be turned off.The other thing that is showing promise right now is meditation. So those are the two things that I’ve seen that are showing the most promise, although we still need more studies to really say conclusively what’s happening.

Lindsey: Okay. So I found it interesting that you mentioned choline, Sam-e, and creatine as methyl donors?

Dr. Mueller: Well, Sam-e is a methyl donor. And then choline and creatine will basically help take their methyl donor, so they’ll help prevent methylation from being used to create them. Then methyl donors can be more available for something else, especially creatine, it takes a lot of methyl donors to make creatine. So then if we give creatine, we don’t have to use those methyl donors for that, so then we can use the methyl donor someplace else.

Lindsey: When I think about methylation, I always think about methyl folate and methylcobalamin (B12).

Dr. Mueller: You know what’s so interesting about that is there’s a really cool study that looks at methylcholine, or methylcobalamin, and methylfolate. What that study showed is that even though there is a methyl group attached to those things from how many methyl donors those types of molecules can do compared to say, like a Sam-e, or compared to a creatine, it is so much less, even though we do know of course, people with MTHFR problems, if we give them too much methylfolate, or too much methylcobalamin, the right amount is good, the wrong amount is a problem. Even though there is something happening there, the amount of donation from a methylation perspective of those nutrients is so much less than these things I mentioned. And that study was really exciting to me to find, because it’s definitely not what I think a lot of us were thinking about methylfolate and methylcobalamin for some time.

Lindsey: How does mold impact the digestive system?

Dr. Mueller: One of the things that mold has a tendency to do from a symptomatic perspective, is a lot of people feel very, very nauseated. There’s a lot of that and we do know that mold can cause a lot of neuro inflammation. We do see that mold for a lot of people can also cause sympathetic dominance. From that standpoint, again, bringing us back to the need for parasympathetic control. One of the things that I know we had talked about briefly prior to this was the idea of mast cell activation and histamine intolerance. Many people with mold will wind up having histamine intolerance, because mold will create a lot of histamine in the body. We actually see that it can actually cause intestinal permeability. When we’re talking about leaky gut, even leading to autoimmunity, and the inflammation seen with intestinal permeability, that can be connected to histamine and that can be connected to mold.

Lindsey: I’m sure people are familiar with antihistamines, so they probably know what histamine is. Can you explain a little bit about how that looks in practice?

Dr. Mueller: Histamine is the molecule that gets released when we encounter something that is a bothersome to our body. Classically, allergy symptoms come from histamine, which is why anti-histamines work. With histamine intolerance, we’re seeing what happens when we encounter histamine in our environment, or food, and a lot of foods have histamine. What classically happens there is our body releases a couple enzymes, one that comes from the gut and one that comes from the liver, and those enzymes go up, and the enzymes will break down histamine. And if the enzyme levels are high enough, then the histamine goes away. We don’t even realize this is happening, we don’t have symptoms. Histamine intolerance is when the imbalance happens between the amount of histamine coming in and the amount of histamine going out, either due to too high of a histamine load, or due to a low of the amount of enzymes that are actually designed to break down that histamine. That imbalance is where this histamine intolerance can come into play, and that can manifest in symptoms like the runny nose, the itchy eyes, but it can also manifest in skin rashes, in intestinal permeability, in headaches, migraines, and fatigue. So many things that are not classic allergy related, that oftentimes without testing, we don’t even realize what’s going on.

Lindsey:  37:19

With these reactions, if they were related to too much histamine in food, or our inability to break down that histamine, would they happen right after we eat a food with high histamine?

Dr. Mueller:  37:33

They can, but usually, if it’s just from a food that’s high in histamine, unless we’re gorging on that food for many days, that enzyme should be high enough to break down histamine in food. If it’s truly just from food, then one of two things is happening, either there’s such a strong reaction to the food that the histamine level is super high and over the top, or if it’s a more mild reaction, that’s usually due to a deficiency in those enzymes, and the underlying problem of those two enzymes not being high enough to break down the histamine that’s in food,

Lindsey: Is that what mold does?

Dr. Mueller: People can have a histamine type of reaction to mold. That’s one possibility. There’s a lot of things that happen with mold illness. People have headaches and migraines and all sorts of different symptoms. One of many ways that mold can affect the body is that people can have a histamine reaction to it. And that histamine reaction can then cause that process that I just described. But I want to make sure I’m being very clear that this is only one of many different ways that mold can affect the body. It’s just how it’s related to the digestive system.

Lindsey: I’m interested because I do have this client in particular, who’s having a combo of symptoms where she’s got the mold and all of the accompanying symptoms, and then is also dealing with histamine intolerance and inability to eat the vast majority of foods. There’s no question it’s mold. That’s at the base of it all. So I guess there’s a good question. If the person cannot get out of the mold right now, is it still worth going and starting to treat it?

Dr. Mueller: I have tried that so many times, because I want that to work. And I have been pretty underwhelmed with the result. Every colleague that I’ve talked to that treats mold has had clinical results where it does not make a huge difference. Sometimes I’ve seen very small changes, but unfortunately, getting out of that place seems to be essential.

Lindsey: Say you’re able to go out of the place but the residual mold in your system is still debilitating, and your digestive system essentially feels dysfunctional. It feels like you’re not absorbing your nutrients, and like both systems are shot, where do you start?

Dr. Mueller: I do like to start people, as soon as we get them out of the moldy place, on the nutrients, even if we’re not ready for a full detox. So oftentimes, if the digestive system is shot, and there’s a problem there, it is valuable to really go after that as one of our top priorities. And in a mold situation, say we had H. pylori show up, and let’s say we have Blastocystis hominis, come up on the GI map. In that situation, we would definitely want to prioritize doing those. But in a mold situation, I would absolutely get started on opening up some of the detox pathways and binding the mold. One of the nutrients that I’ve seen to be just phenomenal for working with mold illness is choline, and I put people on a fairly high dose of choline, usually four grams, two to three times a day, and then start people on binders to actually grab onto the toxin and get rid of them. If somebody has a tendency with a GI issue for chronic constipation, I will tend to still put them on binders because it can help their overarching symptoms. Then I usually do something like a mag citrate, or sometimes even I use da huang, a Chinese herb, which is essentially a rhubarb extract, that is a bowel mover. I will use something if they’re constipated, I will still give them a binder to get the mold out. I will still temporarily put them on some sort of bowel mover to make sure that we are not trying to get things out and basically have our plumbing gunked up.

Lindsey: And do you do binders between meals the way you would like with a gut protocol?

Dr. Mueller: Correct.

Lindsey: Are the binders specific to the kinds of mold that the people have? Or are there some good general binders?

Dr. Mueller: I usually put people on a pretty broad binder spectrum because people do tend to have quite a few molds and there’s enough other environmental toxins and metals and all sorts of different things that people tend to have in their body. I usually just like to put them on a broad spectrum thing. It can be a combination of things. Chlorella works really, really well, it’s an amazing mold binder. It can be contaminated with metals if you don’t get it from a quality source. There’s a brand that I have vetted that we use, it’s called Prime, no financial interest in them. This is just purely a good company. They have a really, really great chlorella that we use. However, if you start giving people too many binders and they’re detoxing too fast, then you have to pull back on the binders and give less. With chlorella, the opposite is true. If people are feeling bad, they’re kind of hurting, they’re detoxing too quickly. The way to get them off of that usually is to give more chlorella. That’s a really interesting thing about chlorella. So we’ll do things like that. We’ll use zeolite, frequently fulvic, and humic acid. So those are some of the common ones we use.

Lindsey: What about GI Detox?

Dr. Mueller:  Yeah, I’ve used that product in the past. Not one we’re using now. But that just purely from a not wanting to put people on too many things. But the thing about GI Detox is it does have a really nice blend of a lot of these things in it.

Lindsey: Right, right. Do you recommend certain diet changes then for mold patients?

Dr. Mueller: It’s not so specific to mold that I recommend diet changes, it’s more in combination with other things they have going on. If somebody has a lot of blood sugar issues, I might put them on a keto diet, or if they have a lot of cognitive dysfunction. I might put them on keto. Almost everybody comes off gluten for me, because I feel like for 99% of the population, it’s probably not the best thing. Then it really is going to be more dependent upon if they have SIBO, or if they have various different infections, like GI infections, we would change things. It’s more dependent upon the whole picture. There’s not a mold specific diet we use.

Lindsey: If a person with mold has been avoiding most foods, at what point can they feel safe to begin to expand their diet?

Dr. Mueller:  Definitely doing it in a slow way, but I would say as soon as their symptoms start improving. Once they get to about 30% better from their symptom picture, and we use the Medical Symptoms Questionnaire. It’s subjective. So we rate our symptoms, but it’s still a way of seeing if somebody was reporting a 10, and now reporting a four, that’s a pretty major difference. So when somebody is 30%, better, that’s a great time to try it. We’ll try it as people are just really starting to feel the social impacts of not eating normally, and it’s starting to become this burden. And if we’ve done enough progress where we feel like it’s safe to try, we might try it earlier, just based upon the effects that being on a really limited diet can create.

Lindsey: Is there anything that I should have asked about all this that I have failed to ask?

Dr. Mueller: The biggest thing that I would say that is super important for people to understand is when we have multiple symptoms, even if it’s just one major organ system in the body, most of the time, there’s not only one root cause. I think that’s one of the biggest things that I feel like people can get stuck on, asking what is the reason, and most of the time clinically, I find it’s many different reasons. From a gut perspective, I would really emphasize for people that having an IBS diagnosis, having an IBD diagnosis, whatever it is, is really in some ways just the beginning. Now we know that there’s a problem, and now we have to figure out why. If somebody is not getting better from doing low histamine foods, working on their histamine load and healing, intestinal permeability, and taking care of microorganisms and all these different things, it doesn’t mean that those treatments haven’t worked. It just means that that is oftentimes only one piece of the puzzle. And we need to continue to ask why and continue to look deeper. If you’re somebody reading this, and you’ve been trying some really great basics, and you’re frustrated, because you’re not getting well, it just means there’s more to the story, and it’s time to continue to dig. Mold and Lyme are both great places to dig.

Lindsey: For gut issues, in particular, like that recurrent SIBO, that keeps coming back. That’d be a big one for looking deeper?

Dr. Mueller: Absolutely. That and I’d say more of a peristalsis slowing issue. The other big one, even if it’s not SIBO, is if somebody just has a tendency to be chronically constipated for an unknown reason, I would have that in my brain too.

Lindsey: Do you like to use probiotics simultaneously with the herbal treatments?

Dr. Mueller: Yes. We use Therbiotic Complete by Klaire Labs, that one’s really great. Another particular strain that has been pretty exciting is Lactobacillus, reuteri. Some of the studies that we’ve seen on that around H. pylori in particular have been really, really impressive. We use a lot of Therbiotic Complete, and we do use a little bit of spore-based products like Bacillus subtilis. For some people we use Saccharomyces boulardii as a probiotic, especially in cases where people have CF toxins. Blastocystis hominis is another big one, when we would use that particular probiotic or that particular microorganism as well.

Lindsey: Deciding between those different ones, are you looking at the GI Map and seeing what’s high, what’s low?

Dr. Mueller: We don’t tend to, just because even on the GI map, a pretty good microbiome profile, we’re still learning about all of the different microorganisms that are out there and what they do and what’s important. So we are looking at the GI map to see abnormalities, but the way we feel is that we just want to make sure that we are getting different species in there. If we’re really trying to reset the microbiome, that’s where we’ve really seen things like the elemental diet that is so useful for SIBO also being useful for those people where the microbiome is high in some areas and low in some areas, like on the GI Map. We’ve actually had better results by putting people on like a short term fast or an elemental diet to reset the microbiome more so than even a probiotic. As much as I still think probiotics are super important and super helpful, and in no way am I dismissing them, we’ve just seen that those things have worked really, really well.

Lindsey:  So for a shorter fast, how long is that?

Dr. Mueller:  There’s actually a fasting mimicking diet. So you might have heard of Prolon. That type of diet we did clinically as we made our own version of it, calculating carbs and proteins and fats and a macronutrient profile that the research on the fasting mimicking diet found. Then we did that from a food perspective. So that’s what we’ll put people on, but using the same macronutrient profiles, as well as the calorie profiles. That’s been a really great way of helping people get the same benefits from fasting and get through a fast, by maintaining blood sugar, of course, and helping people that don’t fast well,

Lindsey: How many calories is that in a day?

Dr. Mueller: It’s dependent upon body weight and all of that. I have to go back and look at my exact sheets, but it’s a descending thing. I think the first day for most people is around 700, and then it goes to maybe 400 or 500. It’s fairly low. But there is still some level of nutrition that goes in there.

Lindsey: How many days does it go on for?

Dr. Mueller: Typically five.

Lindsey: That’s workable. I’m just thinking in my head, could I do this?

Dr. Mueller: It’s definitely not the easiest, or the funnest thing for some of us. I’m not somebody that fasts super easily or well, even though I will do it because of the health benefits. But I’ve seen people go on it that feel so good. Some people just fast really well.

Lindsey: My brother in law did 39 days. It’s insane. By the time it was over he was so weak. He likes to fast for some reason. I guess it’s easier than dieting. Personally, I’ve never made it past two and a half days. I did a bone broth fast for three days hoping it might impact my sciatica, which it did not.

Dr. Mueller: It’s worth trying.

Lindsey: Does that count as a fasting mimicking diet? Bone broth?

Dr. Mueller: I would think so, I’ve never compared the macro ratio. But the potential of that seems very high to me.

Lindsey: Thank you so much for all this interesting information, where can people find you?

Dr. Mueller: People can find me at my clinic Medicine With Heart. I wanted to also share that my book about Lyme and mold and some of the things that we talked about in here, is for the first two days that it goes on sale, I’m going to give away the ebook for free. You can go to https://mwh.thrivecart.com/book/. And that website will ask for your email, and it will send an email when the book is going to be given away for free. Right now it’s looking like it’s going to be on May 24, but that could change a little bit as we move closer.

Lindsey: Okay, awesome. Well, thank you so much for sharing all your knowledge with us.

Dr. Mueller: Thanks so much for having me. And it’s been really lovely to be here. So appreciate your work and what you’re doing in the world. Thanks!

If you want more help with your gut, autoimmune or other health issues, you can set up a free, 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether my 5-appointment gut health coaching program or a longer program for autoimmunity or weight loss is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

Schedule a Breakthrough Session Now

Could you be lactose intolerant?

Could you be lactose intolerant?

What is lactose and how is it normally digested?

Lactose is the sugar found in dairy products, including milk, yogurt, cheese, cream, sour cream and ice cream. Eggs, contrary to what some folks I’ve worked with have thought, are not dairy products, despite being found in the dairy aisle in most grocery stores.

When you eat dairy products, the lactose is broken down by an enzyme called lactase, which is produced by the cells lining your small intestine.

Lactase breaks the lactose down into glucose and galactose, which your body can then absorb and use for energy.

What are the symptoms of lactose intolerance?

When the lactose digestion process doesn’t work right, there’s either not enough or no lactase present at all, and some amount of lactose passes on to your large intestine undigested. At this point, bacteria start working on it and they produce gases including hydrogen, methane and carbon dioxide, as well as fatty acids.

Two of the most common symptoms of lactose intolerance are bloating and gas, which can happen between 30 minutes and 2 hours after eating dairy, and that’s one of the early signs that you are losing your ability to digest lactose.

Full blown lactose intolerance, where you have completely lost your ability to digest lactose, like I believe I have, can be much less pleasant than just some gas. In fact, I thought up the topic for this while having what I describe as my lactose poops, which I had by accident about a week ago after having dairy-free ice cream which I believe was scooped with an ice cream scooper that had touched regular ice cream.

I now can recognize when I’ve been lactosed because it’s particularly awful the next morning with my morning constitutional. Sometimes the first few pieces of stool come out okay, but then by the end it’s like having molten lava exit my body, both in consistency and perceived temperature because of the increased acid in the stool. And in the past, if I had a lot of lactose or my lactose digestant tablets didn’t work for some reason, which I often think was because they were expired, my bowel movements could last up to as much as 45 minutes, with waves of hot liquid slowly coming out, as I’d go through hot flashes, sometimes soaking sweats, nausea and extreme sudden and flulike weakness that sometimes forced me to take a quick wipe and collapse on the bathroom rug to recover.

I usually don’t get this painfully graphic about my bowel issues on the blog but I wanted to share about this in detail because I think that there may be people out there who have lactose intolerance who think they have IBS or some other issue, so I wanted to make sure you really understood what full-blown lactose intolerance feels like.

What are primary and secondary lactose intolerance?

There are actually two types of lactose intolerance: primary and secondary. Primary is when you don’t have the gene for lactase persistence, which means that your body will slowly lose its ability to digest lactose between ages 5 and 20. I actually ran my raw 23andme DNA data through Genetic Genie, a free DNA analysis tool, and have confirmed that I don’t have the gene for lactase persistence. I ran both my parents’ data too and was surprised to find that my dad, who has always had stomach pain and GI issues, does have the gene, but my mom, who is of Italian descent, does not. Thanks mom for my crappy genetic inheritance. I mean the lactose intolerance, not the Italian part. But it’s funny that my mom still eats dairy and hasn’t mentioned any specific issues with it. I guess her microbiome is making up for her genetics.

It’s estimated that by adulthood, 70 to 90% of African-Americans are lactose intolerant, 80-95% of Asians, 100% of Native Americans and somewhere between 12 and 25% of Caucasians. If you want to find out if you have the gene for lactase persistence, you can upload raw data from 23andme or ancestry.com to Genetic Genie and find out about that and a lot more. Just be aware that you could find out disturbing things like that you have the BRCA genes that put you at risk of breast and ovarian cancer, so make sure you have the necessary support to receive that information when and if you do this. If you want to have access to raw data with 23andme you have to choose the $199 ancestry + health report or it appears that on ancestry.com the AncestryDNA® and AncestryHealth provide raw data, and the Ancestry DNA is only $99, but there may be other reasons to choose the 23andme, so do your research.

Secondary lactose intolerance is when you lose your ability to digest lactose because of damage to your small intestine. Possible causes include surgery, chemotherapy, or a bout of gastroenteritis, or what we call in the US, intestinal flu. It can also be caused from damage to the villi lining your small intestine from eating gluten when you celiac disease. If this is the case, you should go off both gluten and dairy until your gut seems healed up based on other symptoms or a doctor’s confirmation and slowly add dairy back in to see if you can tolerate it.

Secondary lactose intolerance can also be caused by bacterial overgrowths like SIBO or small intestinal dysbiosis, where you’re struggling with too much or the wrong type of bacteria in the small intestine overfermenting certain hard-to-digest carbohydrates including lactose, as I discussed in the last episode of my podcast with Norm Robillard.

Other conditions that can cause damage to your intestines or impact your ability to digest lactose include Crohn’s disease, Ulcerative Colitis and long courses of antibiotics. Some people who have secondary lactose intolerance may be able to recover their ability to digest lactose but others won’t ever recover it.

How do you diagnose lactose intolerance?

Officially, for adults the two ways of diagnosing lactose intolerance are a hydrogen breath test or a lactose tolerance test. But if you’re already suffering when you eat dairy, both of these tests involve you ingesting lactose, and that prospect seems pretty miserable to me, not to mention it may be hard to find a doctor who offers the test. And there could be some cost to you, even if it’s covered by insurance. My recommendation is a much cheaper and simpler method. Eat some dairy and take lactose digestant tablets* (which contain lactase, the enzyme needed to digest lactose). Eat your dairy with these tablets, per the package instructions, and see if you don’t have the usual digestive upset you’re used to. If that’s the case, it’s a pretty sure bet you have lactose intolerance. You may want to isolate the dairy when you test it and not eat it on top of a slice of pizza, for instance, as you could be confounding a gluten and a dairy reaction in that case.

Once you’ve confirmed that these pills are helpful, my best advice is to be very diligent about taking them, always having them with you, or avoiding dairy carefully and completely. And make sure you keep the original bottle and check the expiration date as I’ve had bad experiences when my pills had expired.

How much lactose is in different dairy foods?

It’s also worth noting that not all dairy foods are created equal with regard to lactose. While a cup of milk has 15 grams of lactose, a half cup of yogurt has around 6, and it’s believed to be easier to digest if it has live bacteria in it because they break the lactose down to some extent. Ice cream has about 4 grams for a half a cup but let’s be real, most people aren’t eating only ½ cup of ice cream at a time. And speaking of ice cream, I just want to say I’m in love with the So Delicious dairy-free coconut milk, sugar-free mint chocolate chip (and they’re not paying me to say that). That got me through the summer of Covid on a nightly basis. Soft cheeses in general have more lactose. Cottage cheese, for example, has 2.3 grams in ½ cup, whereas an ounce of cheddar cheese has less than 0.1 grams. And higher fat dairy has less, so a tablespoon of whipped cream, for example, has 0.1 grams as well, and butter has less than 0.1 grams per tablespoon. And as lactose intolerant as I am, I can tolerate butter, but I do avoid all other forms of dairy, and when I can at home, I use ghee or clarified butter, which has no lactose or casein. Casein is the primary protein found in milk and represents about 80% of the protein, with whey making up the other 20%. I’m sure you’ve heard of curds and whey from the nursery rhyme. If you’ve ever tried making cheese, which I did back when I was still eating it, you heat milk and then add something like lemon juice, vinegar or rennet to make it curdle and then the curds separated from the whey, which is the liquid you usually pour off.

Could I also be reacting to casein?

If you have eliminated lactose from your diet by moving to lactose-free dairy products or you always eat your lactose with lactase enzyme, but are still have reactions when you eat dairy, you may have an intolerance to casein. This is a common cross-reacting protein with gluten, so if you’re intolerant to one, you may be intolerant to the other.

Symptoms of casein intolerance may be similar to lactose intolerance, like bloating, gas and soft stool or diarrhea, but also abdominal cramps and pain and possibly constipation or blood in the stool. It can also manifest in allergic type symptoms like a runny nose, congestion or post-nasal drip, or in skin conditions like eczema, rashes or adult acne. And for kids, casein intolerance could show up as behavioral problems. Or you could have systemic symptoms like fatigue, joint pain and brain fog.

If you suspect this is the case, and it’s still not enough to get you off dairy, there’s one more thing you could try, which is A2 milk. One of the subtypes of casein, beta-casein, has two types, A1 and A2, and a lot of the symptoms of casein intolerance are from the A1 type. You could try A2 milk, which is found in most grocery stores now, and a quick internet search shows that there are now A2 cheeses out there and even one company doing both lactose and A2 ice cream called Re:THINK. It’s not in stores near me but it looks like you can order it online 4 pints at a time or more. If you still react to that then it may be the whey or you may be allergic to dairy and you need to accept that dairy just isn’t for you.

It took me a long time to get to that place mentally, which was aided by a statement from my French friend Martine that kept echoing through my head. She asked me “If you have to take pills to eat something, should you be eating it?” So about a year after that wise statement, I finally gave up dairy, along with a bunch of other stuff, and saw my post-nasal drip decrease, the constant phlegm in my throat go away, and my acid reflux, whose primary symptom was a constant cough, and hemorrhoids disappear. And I’ve reintroduced everything else except gluten and dairy and remain symptom-free. Now, when I do occasionally cheat and eat cheese, almost always accompanied by gluten and in the form of pizza or burrata cheese + pizza, I take GlutenEase* which is made by Enzymedica, and contains enzymes to digest both gluten and casein, along with my lactase pills. This isn’t something you should try if you’re celiac or have active autoimmune disease, but since I’ve brought my antibodies for Hashimoto’s down to normal and my platelets for my other autoimmune disease, ITP, are also normal, I feel like I can cheat a bit. But we’ll find out more about that decision at my next doctor’s appointment.

Are there probiotics I can take to help with lactose intolerance?

You may be wondering what the role of the gut microbiome is in digesting lactose. So there are bacteria that can help digest lactose, and they are the ones commonly found in the majority of probiotics, from the genera Lactobacillus or Bifidobacterium, not to mention found in a healthy gut eating a western diet that hasn’t been decimated by antibiotics. If your gut is lacking in these bacteria, which will often be the case, in particular for lactobacillus if you don’t consume fermented dairy products or fermented foods like sauerkraut, kombucha, water kefir, beet kvass or kimchi, you could try taking probiotics and see if that helps. There is one brand called Optibac* that seems to particularly aim to help with lactose digestion and points to research on two of its unique strains, Lactobacillus acidophilus Rosell-52 and Lactobacillus rhamnosus Rosell-11. But I followed their links and couldn’t find anything conclusive. I did try them years ago but was so past willing to eat dairy without taking my lactase pills, I couldn’t really tell you if it helped. They do seem to get good reviews on Amazon though. I also found one called Lacto-Freedom* that boasts a study showing a reduction in symptoms after a week of the probiotic that lasts for 3 months, but the study only had 8 participants. But any type of multi- strain lacto or bifido probiotics could be helpful and if you want really a really high CFU count, you could try Grace Liu’s probiotic, Bifido Maximus, which is also all histamine-free strains.

Will stopping dairy make my symptoms worse when I eat dairy?

The last question that may be burning in your mind is whether no longer eating dairy means you’re going to have even more problems eating it in the future. And the answer is yes. If you stop feeding your probiotic bacteria lactose, they will reduce in number and you’ll lose what’s called colonic adaptation, although these bacteria can consume other carbohydrates. But given the typical quantities of dairy people eat, a sharp reduction will impact these probiotic bacteria and then you’ll likely have worse symptoms if you’re accidentally lactosed. So if you’re determined to keep eating dairy, or want to restart eating it, do start slowly and add in fermented vegetables or probiotics to build up these bacteria, especially before completely withdrawing support like lactase tablets.

How do I avoid dairy?

If you’re going to give this a try and eliminate dairy, of course you want to read labels closely and avoid anything with the word milk, including goat’s milk and sheep’s milk. And if you have access to it, camel’s milk has lactose as well, but much less. You should also avoid anything that includes ingredients containing the words whey, casein, caseinate, cream, galactose, hydrolysate, high protein flour, anything starting with lacta- (except lactase), lacto-, lactu- , lacti- or lacty- , nisin, nougat, sherbet, pudding, quark, recaldent and rennet. And if you really want to be strict, beware of natural flavoring, flavoring and caramel flavoring, although I don’t know that the quantities of lactose in those last few food additives is significant enough to cause problems. And this is counter-intuitive, but many non-dairy cheeses actually contain casein, which I really don’t understand, but I guess it’s for the lactose intolerant market that’s not casein intolerant and not vegan. Who knows?

What can I replace dairy with?

Lastly, if you’re struggling mentally with how to give up your beloved dairy, believe me, I was there. Feta cheese, burrata, Neopolitan pizza, fresh mozz, brie, my homemade rosewater and lemon yogurt. I was totally there with you, but I made the transition and I’d never go back. So what do I do? Well I tend to use avocado where I would have used cheese, like with slices of it in sandwiches or with eggs. I use guacamole and chips as a snack instead of cheese and crackers. I haven’t really found a great replacement for feta in salads but I’m currently loving salads with pumpkin seeds in them. And then when it comes to pizza, that’s when I cheat, because if you take the gluten and dairy away from pizza, it’s really even pizza anymore. It’s some kind of freakish frankenfood I’m not interested in. But I get that some people don’t have the luxury of ever cheating, so shop around, some substitute cheeses are workable for some people. And then I pretty much stay away from yogurt, although there are decent coconut yogurts and kefirs. And there are good dairy-free substitutes for sour cream. For recipes, coconut milk works well as a substitute for cream and there are now really good coconut whipped creams on the market. And then in general, I tend to cook a lot more Asian food that’s naturally dairy-free rather than trying to substitute and recreate dairy foods. I do make a vegan parmesan with cashews though. There’s a bit of a learning and new recipe curve but it’s totally doable and I really rarely think about or miss dairy anymore. And I certainly don’t miss the many symptoms. So if you have acid reflux and have already tested negative for H. Pylori, or have bloating, gas, nasal congestion, post-nasal drip or you have hell on earth liquid lava poops, and haven’t given up dairy, that’s been a reliable go to for me as a health coach in helping people get rid of these symptoms, so it’s definitely worth a try.

As always, if you’ve hit a brick wall with traditional or allopathic doctors and you want some help with your gut at the microbiome level, or in reversing autoimmune disease or other health issues naturally, you can set up a free 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether my 5-appointment gut health coaching program or a longer program for autoimmunity or weight loss is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

Schedule a Breakthrough Session Now

*Starred product links on this page are affiliate links on Amazon. Thanks for your support of the blog by using my links!

The Carbohydrate Malabsorption Theory of Acid Reflux

Adapted for readability from my interview of Dr. Norm Robillard from The Perfect Stool podcast. Listen to Episode 41 of The Perfect Stool.

Lindsey: So I am very interested in your work and your bio and all the peer reviewed papers that you’ve published. And because you published on the Bacillus species, I have to go a little off track of our main topic and ask you what you think of spore based probiotics that are Bacillus probiotics?

Dr. Norm: Yeah, interesting. Well, you know, my, my doctoral thesis was on Bacillus anthracis. So there’s one you can check off the list. That wouldn’t be a very good probiotic.

Lindsey: That’s anthrax, right?

Dr. Norm: Anthrax, right. And there’s some other Bacillus species that wouldn’t necessarily be good.Bacillus cereus is linked to foodborne illness and so forth. But there are many other species that are very well studied, that are in natural food products. For instance, Bacillus subtilis is in natto, and that’s been used for hundreds, if not thousands of years in Japan. A couple of good things about the spore based probiotics: they won’t be killed by stomach acid so you don’t need a lot of fancy encapsulations. If you give people the spores, of course, they have to germinate and grow in the gut to impart their benefit. They do, as a group, produce a lot of antimicrobial agents of their own, natural antibiotics, bacteriocins, things that modulate other bacteria, competitors. So there could be some benefit there. So in terms of probiotics in general, I think there are so many studies on them, and the results weren’t quite as positive as I think a lot of people, especially people that produce and sell them, were hoping, and there might be many reasons for that. But even a full complement of a new microbiome from a healthy person through fecal microbiota transplantation, for instance, hasn’t really proven to be very good so far, in IBS studies. And I think that there’s been one or two on constipation, which might have shown some benefit, which is a great thing if there was, but it’s been a little bit challenging to really find the benefits. Some certain specific studies for some strains for certain indications, perhaps, and so I recommend some of those as well. But I really, I personally think if you don’t fix the diet and other factors, if you have any number of other underlying causes that might throw you into any number of forms of dysbiosis, that a probiotic is not going to be a magic bullet. And of course, the only probiotics that are available for the most part are aerobes that are easy to grow and lyophilized and put in capsules. So we don’t have probiotics for the anaerobes, which are probably the more important type of organism to look into.

Lindsey: Yeah, one of the things that that strikes me with the research on probiotics in particular, thinking about that recent study that basically said, you know, it takes longer to recover your natural microbiome if you use probiotics following antibiotics, is that they’re looking at people who maybe were starting with a healthy microbiome to begin with. But the people that I’m working with are not starting with a healthy microbiome, and they don’t want to return to that microbiome. So typically, we’re using antimicrobials and then following with probiotics, because we want to set a new microbiome that’s healthier. So in that context, I feel like those studies don’t really apply.

Dr. Norm: Right. And they don’t and if you looked at a comprehensive stool test, and you looked at which organisms were really kind of off, and chances are almost 100% of the time, it’s not going to be a quick fix with probiotics. A lot of people are deficient in lactic acid bacteria, but does that mean they have a deficiency in the large bowel where the fecal material is forming? It’s not going to really say much about the small intestine. So let’s say you have no detectable levels of Akkermansia Muciniphila, right, an anaerobe that lives on the gut surface and feeds exclusively on mucus and cross feeds other organisms and has been linked to leanness and perhaps turnover of mucus in a good way. There is no supplement for that. Again, I think you’re back to, what are the things that create an anti-inflammatory environment, and that give your microbes the opportunity? I personally think (and some people think my requirements are a little bit restrictive) but I do think that less is more in terms of resetting the gut. Marlene Remely, an excellent biologist in Austria, did a short-term study on fasting. He found that some of these gut lining microbes, and those are the ones that are probably more even more important, that there was some stabilization of Faecalibacterium prausnitzii, and some of the other gut lining microbes, with fasting. And so if you fast a little bit, if you cut back on your calories, and specifically carbohydrates, I do think that it’s less of a population for your immune system and motility, stomach acid, bile and digestive enzymes to manage. So these control mechanisms, I think, could have an easier time for it, if you took some steps to quiet things down. And I think that’s why the elemental diet, for instance, has shown to be pretty effective for some forms of dysbiosis.

Lindsey: Do you want to talk a little bit more about what an elemental diet is, just because I don’t know that I’ve had anybody discuss that much on the podcast?

Dr. Norm: Sure. You know, I’ve a proposal for a better one too. An elemental diet is essentially a diet, and it can be given orally, you can drink the solution. It can be given through a tube for people that can’t take foods orally and it can be given by IV, but in every case, it’s fully digested nutrients. So there’s three foods: proteins, fats and carbohydrates. And so instead of fats, you’d have fatty acids. Instead of proteins, you’d have amino acids. And instead of carbohydrates, most of these formulations just include either dextrose, powdered glucose, or a starch type molecule like maltodextrin, that’s very quickly broken down to glucose. So essentially, glucose. And the idea is to have those nutrients very quickly and efficiently absorbed so they won’t feed the gut microbes very much at all, because the nutrients get absorbed into your bloodstream. So for people with a weight loss issue, you’re going to have a better chance to absorb more of the nutrients yourself. And for people with various types of overgrowth, you’re going to be able to quiet down, rest the gut, so to speak. However, I’m a little surprised that there aren’t more efforts to make formulations that have more fat, because most of these elemental diet formulations are very little fat.

Lindsey: Yeah, like you’re just supposed to add fat at the end. I think it’s just a little impractical, maybe to ship things that are in a powder form with lots of fat in it. It makes it really quite heavy.

Dr. Norm: And like my friend, Mike Rucsio, out there in Walnut Creek, he’s got some formulations. He was working on one that was low carb. I don’t see it in the store lately.

Lindsey: I’ve recommended that to clients.

Dr. Norm: Yeah, and it’s semi elemental, but he cites some data (semi elemental means the protein’s not fully broken down into amino acids, peptides), he cited some data that those might be absorbed just fine, if not better. So he’s looked into this, and I do think, for a lot of people, an elemental diet with more fat and few fewer carbs, and even in some cases, you know, carbohydrates are not a required food source. I mean, we don’t need them to survive. So I think for a lot of people less would be more just in terms of metabolic health, even if it’s rapidly absorbed. But beyond that, some of this glucose could feed bacteria, if you had an advanced case of SIBO.

Lindsey: Right. Yeah, I had a client who was diabetic, and I can’t remember, maybe his low carb option wasn’t available at the time. And then the elemental diet just completely spiked her blood sugar, not type two diabetes, type one.

Dr. Norm: Right. Good point. I think there are some formularies that would do that kind of thing. But the other thing is, it could feed SIBO. And the reason we know that is because many hospitals use glucose for hydrogen breath tests, and for people that are positive for SIBO, that means that glucose is feeding some of those bacteria, right?

Lindsey: Of course. Okay, that was just a little bit of diversion. Let’s get to the main topic. Tell me a bit more about your own reflux and how that led you to develop the Fast Tract Diet.

Dr. Norm: Sure, yeah. That’s, that’s going back a ways now. I’m happy to be free of that, except occasionally, a tiny bit around holidays when I go off the rails. Yeah, it was 15-16 years ago. I had chronic acid reflux for many, many years. And it was really impactful on my life in general, work and play, and even at night sleeping. I was getting aspiration reflux and waking up with my lungs on fire. What the heck is going on? And I wouldn’t have done anything with it, except what most people were doing, trying to take some proton pump inhibitor (PPI), swallow a lot of Tums. And I just happened to go on a low carbohydrate diet for other reasons, just to lose a few pounds. But I when I realized the dramatic improvement in my reflux, essentially, it went away on a very low carbohydrate diet. I was just amazed and started doing a little research and trying to understand, why would cutting out carbohydrates have that effect, because it seemed to go against all of the current research and theories on what was causing acid reflux. And, you know, without making that story too long, it turns out, and this is why I’ve written three books, well, two, one on reflux and one on IBS. Because it turns out, there’s a lot of evidence for why carbohydrates actually drive acid reflux. And so it does have to do with carbohydrate, malabsorption, excessive fermentation of gut microbes, and whether that’s in the small intestine, we’re looking at that now in a study of 90 patients. Or whether it’s an overgrowth in the early part of the large bowel? But there’s no question in my mind that too many carbohydrates, for people that aren’t digesting and absorbing them well, will create blooms of gas-producing bacteria and that gas pressure builds up and is driving the acid reflux, which is a completely new way of looking at that. So we’re still pursuing it in in the clinic to find the proof or not for this theory, but I’m pretty sure we’re right on this. Whether it will be SIBO or LIBO, or another form of dysbiosis still remains to be determined.

Lindsey: LIBO meaning large intestine. . .

Dr. Norm: . . . bacterial overgrowth – it’s kind of a loose term, don’t go on PubMed, you won’t find it. There is a lot of evidence that LIBO is a real thing. I call it that, for lack of a better word, large intestine bacterial overgrowth. But, yeah, there’s a couple of studies with pH capsules, showing significant increases in the acidity of the early large intestine for populations of people with IBS. And the only reason that could be happening is because bacteria are fermenting more carbohydrates, making more short chain fatty acids, and that’s driving the pH down.

Lindsey: Okay, so why are people not digesting their carbohydrates? Well, from the stomach on down?

Dr. Norm: So the million dollar question. In many cases we know it is for specific reasons. Pancreatitis, pancreatic insufficiency, right? So if the pancreas is not producing or releasing an adequate supply of digestive enzymes, that of course is protease, lipase, amylase, there’s some other ones, elastase, which they measure in a stool test. But those three major ones, and especially the amylase, that could be one reason, right? Then there’s the brush border enzymes. So sucrase and maltase and other enzymes that break down disaccharides. And those are really important not only for breaking down simple disaccharides, as the name implies, but also the final breakdown of starches. Because don’t forget amylase enzyme, whether you’re talking about amylose, starch, or amylopectin, the two types of starches, you do get these final breakdown products. And those are finished off with the brush border enzymes. And so most research has focused on genetic deficiencies in these brush border enzymes. But I wish they would have, and there was a company up in New Hampshire that tested for this, but I contacted them and right now they’re only doing that testing for research studies. But I wish it would be more widespread because I think a lot of people might benefit. It might be beyond a genetic deficiency. A lot of people have brush border enzyme issues, and you can imagine why they might for instance. With SIBO, all bacteria are releasing proteases that scavenge for nitrogen sources. And they need nitrogen so they’ll go after proteins, break them down and absorb them. And if they happen to be up in where these villi and microvilli are releasing these brush border enzymes, right at the tip of the microvilli, they could break down our disaccharidases, in addition to the inflammatory damage on these delicate villi and microvilli. So there’s a couple of reasons. I wonder to myself, since so many people like myself get these functional GI issues a little bit later in life, 30s, 40s, especially and older, and I wonder if there could just be a general, your digestion is not working quite as well as it did when you were 18.

Lindsey: Yeah, or maybe just too many years of stuffing in too much bread and pizza and pasta, pastries.

Dr. Norm: Or excesses. I’m a fan of moderate alcohol, but some people really go overboard.And sothere are a lot of things. I think, for a lot of people, you won’t necessarily be able to put your finger on it. But you can come to a reasonable conclusion that they’re not breaking down carbohydrates as well as they did when they were younger.

Lindsey: Right, right. And so for some people, maybe just digestive enzymes would be sufficient if you get a good enzyme that has both the brush border and the pancreatic enzymes?

Dr. Norm: Right, sure. And by the way, we didn’t really have a chance to talk about the other source of carbohydrate degrading enzyme, the amylase in our saliva. And there’s been a number of studies in the last five or six years, showing that that there’s a gene copy number issue, some people have many gene copy numbers for salivary amylase, and up to 60% of the protein in the saliva is amylase. So that they really get started digesting starches, just by chewing before they swallow. And other people may have very few copy numbers. And they may not digest starches as well. And it is an evolutionary thing, because people with these high copy numbers that that are able to break down starch well by chewing, they also seem to be better adapted or equipped to control blood sugar in the bloodstream.

Lindsey: Interesting. Of course, that’s assuming they chew, unlike my son who swallows his food whole.

Dr. Norm: Oh, I know. And you know what? He’s young, he can.

Lindsey: He can afford to. Right, so I keep telling him it’ll hit you in your mid-20s.

Dr. Norm: Right, but good point. Chewing really well, eating really slowly, it’s probably the best thing you can do. And just assume that maybe if you have trouble with starches, you may be one of those people that doesn’t have a real high number of amylase gene copy numbers.

Lindsey: Yeah, it seems like there’s some people that do really well on a keto diet. They feel great. They have energy. I tried that for about a month. And it was a disaster for me. I was just beaten down. I’m just one of those people that has to have some starches in my diet.

Dr. Norm: Even if and I’m not pushing it, but I’m just kind of curious. Do you consume more fats when you’re on a keto diet?

Lindsey: Well, yeah, I was definitely trying to pound the avocados as much as I could. But you’ve got tofill in the calories with something.

Dr. Norm: So there you go, though. Hold on, right. You’re getting a lot of fats with the avocados. But you’re also getting a lot of fiber with those. And so there’s a lot of fermentable material in avocados. I personally, and most people I consult with, I probably wouldn’t ever have more than a third of an avocado and maybe less. There’s other fiber, it’s a superfood and the fats are great, but it has a good bit of fiber in it.

Lindsey: Yeah, I probably was having one a day I would guess.

Dr. Norm: Are you a vegetarian? I’m just curious?

Lindsey: No, I just have no gluten, no dairy. So that’s pretty much what I do right now. Omnivore. Well, let me dig a little bit more into the Fast Tract Diet. So what does it consist of?

Dr. Norm: When I first had that experience, and did a little research and wrote my first book, it was basically just go on a low carb diet. And that’s the answer. And that’s still a great answer for many today. And it just so happens that, while that diet might not be a great fit, like a keto diet for you, for a lot of people it is, it turns out, in study after study, it’s making great headway in randomized control trials for controlling blood sugar and reducing cardiovascular risk and inflammation. So this is a huge amount of positive research on the general health aspects of low carb diets. And I just lucked out with that, because for me, it made my reflux go away. So that was all I needed to know. But long term, I’m happy to say I really think the research for metabolic disorders, diabetes, weight loss is pretty good for low carb and ketogenic diets. So it could have stopped there. But I did want to figure out what was the most important part of diet for these functional GI issues for controlling these, what I’m calling, malabsorptive disorders. And so I was talking to a guy named Mike Eades (he and his wife Mary Dan Eades wrote “Protein Power”) one day. We lived not far from each other in Southern Cal. And he asked me a really important question. He says, “Well, I read your book. I believe you’re right.” He had heartburn himself that low carb really helped. He says “Which carbs do you think are really the problem?” I’m like, “Oh, okay. That’s a good question.” And so I’ve I ended up with a list of five: fructose, lactose, resistant starch, fiber and sugar alcohols. And I know that’s a lot but, don’t forget my final approach. You don’t have to eliminate them. You just need to limit them to the point where you can control your symptoms. So those were the five. The real challenge and what took me actually a number of years to work out was, how do you control those? If you can hold up any piece of food and say, I have no idea how much of these things are in this food, right? Like avocado, there’s more fiber. And fruits, there may be more of some starch, and bananas, but also certain disaccharides, and other fruits. And then starches, we talked about there being two different types of starches: amylose, which is hard to digest, and amylopectin, which is easy to digest. So how do you know how much of these five types of carbs are in all of these different foods? It was really a perplexing problem. But I felt I couldn’t come out with a diet book unless I understood a way for people to get at this question. Because otherwise, it was a research problem for every kind of like the FODMAP diet. There’s a lot of research papers on how much of these FODMAPs are in all of these different foods. It’s a huge effort. And I wanted people to be able to circumvent that. So I did finally come up with an approach that was based on the glycemic index and the nutrition facts. Because we know the glycemic index is a measure of how quickly carbohydrates from any food enter the bloodstream relative to glucose, which goes in the quickest, right? And so when you have the nutritional facts, the total carbs, sugar alcohols if they’re added to that food, you have the serving size, and you have the glycemic index or a good estimate of the glycemic index, say based on a very similar food, then you can calculate this value that I call the fermentation potential – FP. So you hear a lot of people on my different forums and so forth saying, “Well, how many FP points are in this?” And that is really a measure in grams per serving, of how many in total of these types of carbohydrates are in that food. So a lot of people treat it as kind of symptom potential.

Lindsey: How do you calculate it?

Dr. Norm: So it’s a manipulation of the glycemic index formula.

FP = (100 – GI) (Total carbs – fiber) + fiber + added sugar alcohols
…………………………..100               

Lindsey: And so then that number you get is your FP points?

Dr. Norm: Then that number is the FP points, right.

Lindsey: Okay, and you want to have fewer FP points, not more?

Dr. Norm: Well, right. More would be more like more prebiotic, right? And so less if you have a lot of symptoms that come from bacterial overgrowth, a lot of bloating and gas and these functional GI issues. Chances are you’re consuming too many.

Lindsey: Okay, so I’m really curious, an apple, how many FP points?

Dr. Norm: So an apple, let me see. So I, in addition to the writing the Fast Tract digestion books, one on heartburn and one on IBS, I also came out with the Fast Tract Diet mobile app. And so I have it with me right here. So in the search, apple . . .

Lindsey: I asked, because when I eat apples, I’ve realized that I can’t or shouldn’t be eating an entire apple. But that’s it just like too much whatever for me.

Dr. Norm: It’s fiber. It’s funny you should say that. In fact, in in this mobile app, we put in serving sizes that are a little bit smaller than some people might be used to. But it’s just our way of saying, you know, less is more when if you’re having these problems. So for instance, for an apple, I list an apple and the serving size is one half of a medium fruit. Right? And that’s 91 grams of apple, a half apple. The glycemic index is only 40. So you’ve got this low glycemic index. So that’s great for diabetes. It’s bad if you’re trying to put your microbes on a diet. And then it has total carbohydrates of 13 grams. Not too outrageous, right, but with a glycemic index of 40. And then add on two grams of fiber. There are no unnatural sugar alcohols. You come up with an FP or a fermentation potential of nine grams.

Lindsey: That’s a lot!

Dr. Norm: Well, it is a lot, right. It’s the weight of nine paperclips or whatever. But it’s a lot if you think in terms of how few grams of carbohydrates it takes bacteria to produce gas, right? For 30 grams of unabsorbed carbohydrates, bacteria can produce 10 liters of hydrogen.

Lindsey: Wow.

Dr. Norm: The beginning of the molecular food chain. Thirty grams equals 10 liters of hydrogen gas. So for your situation with that half of an apple, that would be a little over three liters of gas. So and your body is dealing with that, right? Some of that gas may be converted to hydrogen sulfide, some may be converted to methane, and that reaction reduces the volume. Some of it will be absorbed into your bloodstream and exhaled through your breath. So your body’s always trying to manage and deal with it. You might belch, you might have a little flatulence. All of these ways your body’s trying to manage that gas. But if you’ve got too much to manage, maybe a couple apple slices might be better than half of an apple.


Lindsey: So how many points do you recommend people restrict themselves to or is it more just a matter of figuring out “well, I felt bad at 30 points, so maybe I need to make sure my meals are no more than 15?”

Dr. Norm: Yeah, well, if you had the tool, and were doing it, then that would be great. It would be an empirical determination based on your symptoms. I guess at the beginning, people have no idea. So it’s good to have some basic ideas of what to do. First of all, for a very small person, they would have even less than a very large person. Everything’s scalable, right?

Lindsey: Right.

Dr. Norm: But generally, we’re on probably a fifth printing on the Fast Tract digestion books now, but when I initially wrote that book, I was saying oh, 25 to 30, 45 or even more. If you’re feeling great, even more points, and that’s where it was. Now people, our readers, and people that have joined us on the Fast Tract Diet official Facebook group (and I recommend to your listeners if they if they want to know more, they can just join this Facebook group – there’s over 11,000 members now and everybody’s chatting it up and helping each other out and here’s recipes and all this stuff.) But they are telling us, “Hey, hey, hey, when I have LPR”, which is particularly challenging condition, right, laryngopharyngeal reflux. Very subtle, but a persistent irritation of the throat, the vocal cords, you can have respiratory aspects of it, you can have plugged eustachian tubes. It’s very challenging to get rid of this, right. So they were starting to tell us, “You know what? For this, your 25 grams is out the window, I really needed to go under 20.” And some people said “I went 15” somebody else “I went 12”. So we started listening to the experience of our readers. And when we were working out the details for a protocol for this collaborative study we’re doing on 90 people with chronic acid reflux going off PPIs, we went in and reprinted the manual, reducing these points a little bit based on what people were telling us. So to make a long story short, I’d say maybe 25 is a place to stop. But if you’re really having problematic symptoms, maybe going lower.

Lindsey: And that’s per meal, right?

Dr. Norm: That’s per day, per day.

Lindsey: Wow. So you are talking about seven or eight per meal? Don’t you, you were the one that pointed out how many grams of fermentable material that is.

Lindsey: So is that basically putting people on a keto diet?

Dr. Norm: Well, no. But keep in mind, hold that thought. Keto and other means, fasting, there’s a whole lot of different troubleshooting things you can do. So for some people that are really in the throes of this thing, there’s some troubleshooting sections in the book. And in the mobile app, there’s a bunch of mini chapters in the mobile app that have some troubleshooting techniques, and one of them is just in general, a low carb diet or a ketogenic diet or some fasting. But because even when you’re low in points, there are some higher carb foods that are very low in points. And that’s because they have a very high glycemic index.

Lindsey: So you can eat white bread, right?

Dr. Norm: White bread is right, relatively low. And you know, unless you have celiac disease, or sensitive to gluten, or jasmine rice and Asian sticky rice or sushi rice. They’re very low and points because they have a very high glycemic index. So don’t eat too much if you have blood sugar issues, but they are lower in points. Now, here’s where the troubleshooting section can come into play the FP calculation. It’s a very good way to compare one food to another in terms of which one would be easier to digest, and how many carbs and how many points. However, what we don’t know right now is how well people with digestive health issues, what would the glycemic index be if we tested them in those people? Because right now to get one of these glycemic index values, a single food is tested in 10 healthy people where they give them glucose first and then they measure all their blood levels of glucose. And then they give them the test food, and then they measure their blood sugar levels over time. And then they compare the area under the curve of the test food to the glucose to get a glycemic index. But if it was a person with IBS, SIBO, LIBO, SIFO, dysbiosis, pancreatitis, cystic fibrosis (they also have trouble releasing enzymes from the pancreas), the glycemic index might be lower for those people. So that’s why in the book, and in the app we do with caution and that’s why we say half a cup of rice, try a half a cup of rice. Make sure it’s fresh, make sure it’s moist and fluffy. That’s the best chance you have. And make sure it’s either Jasmine or sushi or one of the lower FP rices. Eats really slowly and chew really well. And see if you have symptoms because you may not be ready for it if you have some issues with say, one of the things we talked about, brush border, pancreatic enzymes, salivary amylase, etc.

Lindsey: Okay, I want you to tell me again, the five sugars that you’re supposed to be wary of?

Dr. Norm: Yes, they are lactose. And of course some people are lactose tolerant, right.

Lindsey: Not me!

Dr. Norm: Not me either.They’ve got the gene stuck in the on position. But you know, well over half the world’s population is lactose intolerant, adults, so lactose, fructose and fructose malabsorption is well documented again, many, many people around the planet are fructose intolerant. Lactose, fructose resistant starch, which is several types of starches, and some types of resistant. And the amylose type we talked about is one of the more resistant types. It behaves like a fiber, so resistant starch, fiber, and there’s many, many different forms of fiber, as I know, from listening to some of your podcasts, you know all about, and with many different qualities and properties. So all fiber, initially to get symptoms under control, is included, as well as sugar alcohols. And sugar alcohols are also well documented, just go to the FDA website, you can read about those, how many problematic digestive symptoms you get.

Lindsey: Oh, yeah, I know all about it, but I put up with it anyway.

Dr. Norm: But there’s one exception. Erythritol is a sugar alcohol. But it’s not metabolized by bacteria. There’s been some good studies looking at that. And so most of it is excreted unchanged from the body.  So for sugar alcohols, it is an exception, and natural sugar alcohols, you know, we do recommend those as one of the low FP sweeteners. You could use that and monk fruit and stevia and things like that. But erythritol is a good one. Now, not everybody agrees with everything I said. We had a reader just the other day write to me and say, “How could you have erythritol in your diet? I just can’t believe it. It’s terrible.” And so I wrote back and I said, “Well, here’s a link to a paper, it talks about how bacteria don’t ferment it, and so forth.” And she came back with another paper. And she said, “But you do know this paper shows that it impacts and reduces how well fructose is absorbed.” So it’s interesting, we continue to learn from our readers. Fructose, at least according to this one study that she sent me a reference on, fructose is absorbed twice as slowly in the presence of erythritol. So yes, we’re learning from my readers. But I still think erythritol is a great choice, as long as you’re not consuming a lot of fructose.

Lindsey: It’s funny because I feel like I don’t really do well on erythritol at all. Like it kind of makes me feel nauseous. But I do better on xylitol.

Dr. Norm: Lindsey, that’s really interesting, because in studies that looked at erythritol with other sugar alcohols, the other sugar alcohols were just way worse in terms of gas and diarrhea and bloating. Erythritol had none of that. But I do happen to remember that some people in that study with erythritol did feel a little nausea. So that may be something. Yeah, I, for some reason, don’t have any problem with it. But that’s interesting you said that, because I do remember that in the study.

Lindsey: Yeah. And if you if you have to choose your poison, I’ll take a little bit of a soft stool over nausea.

Dr. Norm: Yeah, nausea’s a real uncomfortable feeling.

Lindsey: Yeah, it kind of makes you not want to eat your dessert that you’ve carefully crafted. Okay, so I want to dig a little bit more into LPR because I think that that is what I had. Now 30 years ago, I saw a doctor and had a constant cough and no acid reflux feeling. I never felt acidy in my throat, but I did eventually start to feel my voice changing and that kind of thing. You know, I was on PPIs for 15 or 20 years straight.

Dr. Norm: I didn’t know that. Wow.

Lindsey: Yeah, at the very beginning, they were giving me asthma inhalers and that kind of stuff because of the cough and looking for causes of the cough. And then finally, somebody said this may be acid reflux, but is LPR a new diagnosis? Because back then nobody had name for that.

Dr. Norm: It’s been around for some time. Jamie Coffman, doctor in New York City, she’s also done some research, published least a couple of papers on it. She has a different diet approach. It’s a low acid diet to deal with this idea that when people have reflux, some of the the pepsin from the stomach, an enzyme that breaks down protein, will stick to the tissue in the throat and can become even intracellular. And then when you eat very acidic foods, you can turn it on. It’s only active at acidic pH, so she recommends a low acid diet and this Acid Watcher Diet is the same idea. So yeah, it has been known. Maybe it hasn’t been as popularized as acid reflux, but it is quite common. Of course the Fast Tract Diet is a different approach, right? It’s saying yeah, go ahead and sip some alkaline water if you want to take advantage of those ideas, with the pepsin. But really, you want to eventually stop the reflux so that you won’t get pepsin and other things up into your throat, and your lungs and your airways and your eustachian tubes and so forth. Thanks for pointing out some of those symptoms, right? Yes. Cough, sore throat, feeling like there’s a lump in your throat that drives you crazy, even though they  look down there and say there’s nothing there.

Lindsey: Oh yeah, that was me with any kind of lactose.

Dr. Norm: Yeah. And by the way, these respiratory issues, asthma, COPD, also strongly linked with acid reflux. So no surprise there.

Lindsey: Interesting. So I assume on the Fast Tract Diet, there is a period of time in which you’re kind of going super low FP so that you can get some of those bacteria to die down, and then you maybe ease back up. Is that sort of how it goes?

Dr. Norm: Yeah, so people, practitioners, and so forth, that worry about people being on a low carbohydrate diet, they’re a little more quick to say, “Okay, you’ve been on this two weeks, you need to really expand your diet, you need more carbs, and eat more of this and that.” I don’t have that kind of fear. Because I do think, just from my 15-16 years in this area of study, being close to the low carb keto community, I really do believe low carb and keto is a safe and healthy diet. So I don’t worry that much about people rushing to get to add more carbohydrates. I do recommend a good variety of lower carb, low FP plants, and fresh herbs. And if you were to look at the Fast Tract Diet mobile app, it has all of these different categories for foods, and if you look at it, I just clicked on the vegetable table, they’re all listed by FP points. And you would see that there’s probably about 50 that are under three or four points, so that there’s a huge diversity of vegetables at a low FP. And then they gradually do start going up and then you get to the more starchy ones and more fibrous ones, and you get to plantains, they do get to be higher and higher. So I do still recommend people eat a lot of plants, but lower carb, green leafy, lower FP, and there are great numbers to choose from. Also, by the way, if you’re into legumes, sprouted legumes are also very low. But I let people ramp up on their own, when their symptoms allow it. I just want them to trust this method to control the symptoms. And once they get that down, I really feel like they can manage, you know. Then they say, “Alright, well, I feel better, I’m gonna. . .”, and then they try all these things and go out for a weekend and eat French fries, and this and that, and at home they’re going to be like, “Oh, man, that was wrong.” But they’re able to, I think, do it on their own. When I consult with people, I provide extensive written recommendations. So the first session, people might get six to eight or nine pages of notes. Usually, I’ll consult with somebody, at least, maybe two or three sessions, give them notes for every one. So they’ll always be able to go back to those notes, no matter what happened, or when they’re on holiday or seeing the family, they can just always kind of regroup and say, all right, I need to really kind of go back to the basics.

Lindsey: So I wanted to ask about low stomach acid, because that is, you know, in the functional medicine community, one of the causes that is often cited for acid reflux, as opposed to high stomach acid. Do you think that that has validity? Or do you think that it’s just a misdirection?

Dr. Norm: I do. In fact, one of the first things that I do when I work with people is I do an assessment. You know, of course, if every drugstore had a Heidelberg acid test, and you could just bring it home and take it and just okay, just do that. But as you likely know, there’s not a lot of practices that do this, unfortunately, because I do think it’s a hugely important test, with a dangled the pH capsule on a string. You swallow the capsule, but it’s still dangled in your stomach, but it’s being held there by a string so it doesn’t move, right. And that capsule is radioing out pH activity in your stomach to a receiver and a laptop on the practitioner’s desk. And so for most people, it’s going to say the pH is one or two, it’s very, very acidic. And then they give you three or more bicarb challenges, right? We drink this solution of bicarbonate and then you can see the pH. Just watch it on the laptop. The pH goes from two, goes flying back up to seven or eight. And then the question is, how long is it going to stay high like that? That’s what they want to know. If you re-acidify quickly and you can do that several times, you don’t have low stomach acid, right? If you’re very slow to re-acidify, or you have a not a very acidic stomach to begin with, or it takes too long to re-acidify, then you will almost certainly be diagnosed with hypochlorhydria, or even achlorhydria. So that’s what you want to know. But how to get at it when a lot of people don’t have easy access to practitioners that have that test? So what I do is a risk assessment. And I look at what are the potential causes for low stomach acid? Right? And from listening to your stuff I think you’re aware of these too, right? But here, these are the questions I ask because a lot of people will know the answers to most of the questions and if not, they can be tested. So first of all, do you have any autoimmune conditions? So a lot of people may have Hashimoto’s, or this or that. But autoimmune conditions don’t tend to occur in isolation. And so if somebody has an autoimmune condition, then I might suspect pernicious anemia, right? Autoimmune atrophic gastritis, where your own immune system is attacking the parietal cells that produce this acid. And those same cells produce intrinsic factor for absorbing vitamin B12. So if somebody had a significant autoimmune reaction, it would make me wonder about that. And there’s a quick blood test you can get for that, by the way, it’s not as far as the Heidelberg test.

Lindsey: Pernicious anemia, you mean?

Dr. Norm:  B12 levels. But you could have versions of autoimmune atrophic gastritis, where for one reason or another, your B12 levels are okay, and some people are supplementing and all of this, but you want to know whether your parietal cells are being impacted. And so there is an anti-parietal cell antibody assay, it’s a blood test. So it’s available. So that’s one. Next one is, of course, H. pylori, right, because most people won’t know if they’re infected with this bacterium. But it burrows through the mucus in your stomach, it attaches to the lining, and there it sits in these little colonies. So it’s not a diffuse infection. It makes little colonies and where those colonies are, over time, your stomach lining gets damaged. So if they happen to be in the area of your stomach with these parietal cells, chances are you will get atrophic gastritis eventually, if not an outright ulcer, and the inability to produce adequate stomach acid. So for so many reasons, beyond just stomach acid, I do always recommend if people are H. pylori positive to go ahead and suck it up and take that antibiotic treatment to get rid of it. Because you just don’t, especially older people, and I’m putting myself in that bucket, we don’t want to have that bacteria as we’re getting older. So that’s the second one. The third one is, are you taking a lot of NSAIDs, non steroidal anti-inflammatories, because they will irritate the stomach. They can lead to gastritis for that matter. They can also lead to NSAID enteropathy, make tears and damage the small intestine as well. But in terms of the low stomach acid, you have people that are abusive with these NSAIDs, they may want to be checked again with something further like a Heidelberg acid test. The other one is alcohol. And I’m not talking about moderate alcohol, but people that have really done a lot of binge drinking or alcoholics; that can certainly have an impact. And then things that most people won’t have; any kind of bypass or stomach surgery or stomach cancer. But that’s usually where I where I start, and I just want to know if they’re at risk for it or not before wasting time pursuing that further.

Lindsey: Now, the NSAID piece surprises me a little only because I know that when I, because of my sciatica, had to take NSAIDs and there was nothing else I could do, I was in too much pain and was taking like six a day against all my best knowledge and wisdom. But I was taking about six a day and ultimately started feeling pain in the same place in my stomach every time I took them and I knew I had to stop because I was on my way to an ulcer if not already there. And then the recommendation at that point is to go on acid reducing drugs to try and just heal up your stomach lining.

Dr. Norm: Right, I know that’s been explored. And unfortunately, many things are wrong with long term use of acid reducers but that’s right.

Lindsey: Right and I didn’t use them long term in this case, I used them until the pain went away basically and then some Culturelle probiotics.

Dr. Norm: Oh there’s another interesting area of research and by the way with NSAIDs you know the other thing people can do if they must take them, it’s just make sure you always have plenty of food in your stomach when you take them.

Lindsey: Yeah, which isn’t possible when you’re trying to take one right before bed and you’ve got it   scheduled three times a day, right? And they only last eight hours at the longest.

Dr. Norm: Another area of research that’s very interesting and you know like a lot of people, I’ve been looking over the last few years into what’s this hydrogen sulfide all about. People seem paranoid about it and, are my bacteria, the sulfate reducing bacteria, are they making all this hydrogen sulfide gas? My farts stink, I must have it. And oh, I’ve heard it’s going to give you chronic diarrhea and all of these problems with it. And so most people and practitioners have this big concern about hydrogen sulfide. But there is another side to this molecule. First of all, bacteria make it in our gut and not just the sulfate reducing bacteria, some proteobacteria make it, some bacteroidetes organisms produce it. So a lot of organisms have the pathway to use this trick to take hydrogen as fuel. Instead of making methane, they make hydrogen sulfide. But aside from this worry about, do I have pathological levels of hydrogen sulfide, there’s a whole other side to hydrogen sulfide, in terms of its ability to help heal wounds. It is a regulatory molecule in the body. There’s a lot of research going on to see that they might be able to come up with hydrogen sulfide releasing or promoting supplements that would help people when they have to take NSAIDs, prevent the bad side of them. So that I think is really still just an area of research. But I think it’s one that’s really great to follow. What’s the positive side of hydrogen sulfide, by the way? When hydrogen sulfide gets out of the gut, it’s very, very quickly changed into something else other than hydrogen sulfide, because it is a toxic molecule at high levels. But the body has mechanisms for dealing with that. Quite effective.

Lindsey: Yeah. So, you know, I’m always struggling, back to the whole stomach acid issue, though, like with the idea that you may have someone who’s absolutely convinced that they have high stomach acid, that the doctors have told them, they put them on PPIs. They feel burning in the chest, Barrett’s esophagus, this kind of stuff. And then to say to them, I think you may have low stomach acid. Take more stomach acid. It’s a tough sell.

Dr. Norm: Yeah. And I’m glad you’re a good interviewer, because you pull things back to LPR. I tend to drift. So you got us back on topic there. Yeah, let’s talk about PPIs and stomach acid in terms of LPR, because the most common prescription for LPR is a PPI? Yeah. And you will find a person here or there that says, well, it does seem to help helps my LPR to be on a PPI. But most people will say no, it’s not helping. And in fact, when you look at the studies, and if people go to digestivehealthinstitute.org, I wrote a couple blogs on LPR, but one of them in particular is talking about PPIs, and their ineffectiveness for LPR. So this question has been studied very well. PPIs for LPR are no better than placebo. There’s  studies on it, there’s metaanalyses of studies on it, it is no better than placebo. And so why is that? And it may be the same reason. PPI drugs, acid-reducing drugs are also no help for asthma. Asthma is another reflux linked condition. In a way a lot like LPR. There was one study in kids that showed 80% of children with asthma have chronic acid reflux. So with LPR and COPD, and as we know, there’s a strong connection with reflux, right. But there was a study done called The Sarah Study. A thousand kids were in the study with asthma centers all over the US, and they put them all on Nexium. And they had to come out at the end and say, “Hey, everybody listen up,” something like 120 authors on this paper, “Hey, I gotta tell you y’all, didn’t work at all for asthma.” Right? And so you can read this paper on The Sarah Study, it’s crazy. The final conclusion was, Nexium did not help asthma, so acid reflux must not be the cause of asthma, which I thought was just such a bogus conclusion.

Lindsey: Right, or, Nexium doesn’t help acid reflux.

Dr. Norm: But here’s the thing. All they had to do was look at some other studies on, for instance, fundoplication operations when you tighten the LES (lower esophageal sphincter). And it’s invasive, I’m not recommending it, but it’s a proof of principle.

Lindsey: Okay, wait, before you go on, can you define a little bit more what that means?

Dr. Norm: Yeah. So there are various ways to tighten the muscles, the group of muscles right at the top of the stomach, called the lower esophageal sphincter muscles. So the bottom of your esophagus, before food goes into your stomach, it has to go through this group of muscles called the LES, and they relax when you swallow. They relax and let the food go through, and then they tighten up again. But for some people, there’s a thought that well maybe it gets looser and so forth. Well, I have a different theory for that, that it’s being driven by gas pressure, as I told you. But people that do have reflux, and in this case, asthmatics with reflux, when they did fundoplication operations that tighten up these muscles and don’t allow you to reflux much, they did better, and they could reduce the medicines. So that proves there is a connection with reflux. And so I think what the study did prove is that acid might not be the most important thing in the refluxate, either for LPR, or for asthma, that it’s something else. And what are those other characters, what are those suspects? And I think that you can look at bacteria, bacterial end products, digestive enzymes and things from our own gut. But I think one of the chief suspects in my mind is bile. And bile wasn’t focused on that extensively in reflux by a lot of people. And possibly because it’s released in the duodenum, past the stomach and thought, well, why would that much bile even be the reflux? But when they look, they find it. And of course, with my theory of reflux that is basically saying it’s from carbohydrate malabsorption, gas building up in your intestines, that that theory basically entails reflux starting at a much lower point in your intestines. And so you would expect bile and other things from your digestive tract to be in the refluxate. And it is.

Lindsey: Yeah.

Dr. Norm: So first of all, I think they should get off the PPIs. And try the Fast Tract Diet. That’s my first advice. Or work with myself or somebody to really go look at these 25 to 30 potential underlying or contributing causes of reflux and other functional GI disorders. But just a quick tip, based on that idea, is you and your doctor, maybe just bring up the topic of bile acid sequestrants. If you think you have a bile issue, there are drugs you can take. Prescription so I couldn’t prescribe them, but a doctor could, that tie up some of this extra bile. Maybe that would help. But I think in the long term, what you really want to do is get control of reflux.

Lindsey: Yeah. Now I can attest to the fact that when I had reflux, and I coughed up, like my sputum in the morning was brownish, like bile. So I don’t know if that’s what that was. But anyway, I remember that, but it’s been so long since I had that. And really, for me going off dairy was the main contributing factor to it going away. And that allowed me to go off PPIs.

Dr. Norm: And you know, with dairy, it’s not just the lactose.

Lindsey: Yep. It’s casein.

Dr. Norm: You know all about these oligosaccharides in milk?

Lindsey: Yeah. No, I had I had issues with all sorts of things in dairy.

Dr. Norm: Yeah. Right. Well, there’s lactose, there’s oligosaccharides. And then there’s intolerance. It’s to the proteins themselves, which is less common, but maybe you did have them.

Lindsey: Yeah. Well, you know, we have gone a bit over time, so I probably should not take any more of your time.

Dr. Norm: Really? Wow. Man. I really like talking to you, time flies.

Lindsey: I know!

Dr. Norm: This has been a pleasure for me. Thank you.

Lindsey: Yeah, well, so obviously, I see you sell your books and your app and your programs and you see individual clients like I do for gut health issues. So we’ll link to all that stuff in the show notes. Anything else you want to mention before we go?

Dr. Norm: No, I think you did a great job. I’m open to, there are so many great studies, and I’m open to talking about all of them to see if we can really as a community increase our understanding. And like I said, we learn a lot from people on our Facebook group, from readers, from feedback, from working with people one on one, so I really feel lucky to be able to do this with my career at this point. Plus it got me out of the corporate realm. Again, just remind people, they can join us at the Fast Tract Diet Official Facebook group, 11,000 members, so a lot of good stuff going on there, and they can find all of our information or links to it on digestivehealthinstitute.org.

Lindsey: Okay, great, I’ll link to that in the show notes. Well, thank you so much. I appreciate you coming on the show.

Dr. Norm: My pleasure, Lindsey.

If you want more help with your gut, autoimmune or other health issues, you can set up a free, 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether my 5-appointment gut health coaching program or a longer program for autoimmunity or weight loss is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

Schedule a Breakthrough Session Now

Supplements and Food Sensitivity Testing for Digestive and Overall Health

Excerpts from my podcast Interview with Dr. Russell Jaffe, MD, PhD, founder and chairman of Perque Integrative Health LLC. Listen to Episode 40 of The Perfect Stool.

Life Guard Multivitamin, How Much B-Vitamins Should I Take and Avoiding Genitourinary Issues

Lindsey: So I actually heard you speaking on another podcast before your folks reached out to me. And I realized that I was already taking a Perque product. It’s the Life Guard Multivitamin (find at Fullscript). And I was really happy because when I heard the way you talk about your supplements, it made me feel like I’d be a fool to be using products from any other company.

Dr. Jaffe: We did a double-blind, placebo-controlled trial to show that our Life Guard Super Multivitamin, which actually replaces more than one product for most people, is more bioavailable because it has more active, more enhanced uptake, and less what I would call binders, fillers, flowing agents, glues and other stuff that is in most supplements for reasons of profit, not reasons of value.

Lindsey: Yeah, and it’s not unreasonably priced either. So it was a good choice for me. And I think the reason I selected it was that it had a high level of the active B vitamins.

Dr. Jaffe: Right. So it’s a super B complex, complete B complex, and a super mineral, which is usually a separate formula. It’s got 40 active ingredients in meaningful amounts because you need them all.

Lindsey: Yeah, I take two a day and I feel good about that.

Dr. Jaffe: And hopefully you keep your urine sunshine yellow, while being well hydrated.

Lindsey: It’s the B vitamins that turn your urine yellow, right?

Dr. Jaffe: Oh, yes, it’s specifically riboflavin. And I want your urine to be sunshine yellow. If it’s glass clear, you’re deficient in something, right?

Lindsey: So what you’re seeing is the excess B vitamins coming out in your urine that you don’t need?

Dr. Jaffe: No, no, not excess! B vitamins that protect your kidneys and your bladder and your genitourinary system. There’s a lot of problems that happen in later life in the genitourinary system. And you can avoid them if you bathe it in the right kind of nutrients for life.

Lindsey: Ah, okay. So I always thought that that was because I was taking too much. But you’re saying that’s just like a good healthy thing?

Dr. Jaffe: Yes. I’m saying that you want to protect your kidneys, your bladder and the rest of you. And the answer is, yes, most of us are deficient. And when deficient is common? Well, we go around saying “well, everyone’s deficient, who cares?” I do care and it makes a difference.

Food Sensitivity Testing with the LRA/ELISA Tests

Lindsey: I wanted to start with a question about an area that comes up with a lot of clients of mine, which is food sensitivities. Can you tell us about the technology that you invented to test for delayed reaction sensitivities, including food sensitivities?

Dr. Jaffe: Right, so the reason that we brought together cell culture, and amplified reactions in a single system, after many people tried and didn’t, was we needed an ex vivo (meaning outside the body) test:  reacting in the laboratory just as things happen in the body. So we needed an ex vivo specimen and we needed to validate the procedure. We did that in the early 1980s. We’ve done over 80,000 cases. We’ve done over 25 million cell cultures. We are the gold standard for functional immunology, especially T cell reactions, which turned out to be more important than the antibody V cell reaction.

Lindsey: And so that’s the technology that you use for the ELISA test? Yes, it’s ex vivo, which means in the laboratory, cells react just as they do in the body. It’s a cell culture; it’s not red and blue and dead. It’s not stained, it’s not dried. It’s not something can just put out your hand and take a specimen and get a result. Because a number without a meaning is meaningless. We produce meaningful results over 30, 40 years now. We want to provide the meaningful results for what you should eat and drink, what you should think and do based on what each of us needs, because that is kind of personalized.

Lindsey: So can you touch a little bit on the difference between a food sensitivity and food allergy?

Dr. Jaffe: A food allergy typically means an immediate reaction. For example, the bee stings you and you drop in anaphylactic shock. And I say, well, you must have a hymenoptera venom hypersensitivity. That’s type one. But then there’s Gell and Coombs, two guys who basically articulated the language of the immune system along with a guy named Lujerne. They all got Nobel prizes. So dumb, they were not. And they pointed out that there are antibody reactions. These are from B class cells. B cells become plasma cells that produce antibodies. Now, are those antibodies helpful and neutralizing and memory? Or are they complement fixing and harmful? When you do a serum test, you don’t know; only when you do a cell culture test to distinguish good from bad B cells. But more importantly, you also get immune complexes and T cells in the same cell culture. And that was our pioneering effort, so that we could open up the black box of the immune system. Because what we knew when we started was that if the immune system is happy, you’re happy and you live long and well. And if your immune system is unhappy, we can whack it, like with dexamethasone, which may or may not be helpful.

Lindsey: So would you recommend the ELISA/LRA test to a person who has a highly reactive gut and seems to be reacting to everything they eat? Or would it be better to try and heal up what’s likely a leaky gut before testing for food sensitivities using the LRA?

Dr. Jaffe: I think that’s a very appropriate question for someone like me, because you would think I would say everyone needs what I do. But I’m not going to say that. I think you can start with 4 self assessments, you can start with betterlabtestsnow.com, which is a consumer portal to get information, inspiration and accurate interpretation of where you are. What if your hemoglobin A1C, for example, is less than 5%? What if your high sensitivity C reactive protein is less than 0.5? What if your homocysteine is less than 6? Well, then I would interpret your results differently than if the only thing I had was food sensitivity. Now we have the gold standard of delayed allergy. But delayed allergy is only a big part, not the entire part, of digestive issues. And John Hunter, very important guy in the United Kingdom, pointed out that there are intolerances. For example, let’s say you acquire a lactose intolerance to milk sugar. That’s not immune. But it will make you unhappy. That’s for sure.

Lindsey: I’ve got that. And I can tell you it makes me unhappy.

Dr. Jaffe: Haha, yes, unless you take lactose free milk. So you could put an enzyme called lactase on a column, pass the milk through that, the lactose becomes something else, but not lactose. And now it’s okay. And I’m pretty sure in most healthy markets, there is a little section called lactose-free milk. And by the way, I actually recommend you make your own almond milk at home or cashew milk – after you ferment your own cashews.

Lindsey: Okay, so at betterlabtestsnow.com you’ve at got these tests, but what should people look for first at that website?

Dr. Jaffe: Well, I think where they should go is predictive biomarkers. Tell me where you’re strong. And I’ll celebrate. Tell me where you’re weak. And I’ll tell you what to do.

Lindsey: I actually found on that website, the LRA test and saw that they ranged in price from about $397 to $1725 for the most Deluxe one, but all of them included foods, environmental chemicals, food additives and preservatives, molds and food colors.

Dr. Jaffe: If you want the everything test, it’s at the higher end, if you want selective testing, that’s an option. We provide the best quality of the best testing; you decide how much testing you need.

Probiotics, Prebiotics and Symbiotics

Lindsey: So tell me about some of the products that you designed for gut health and the research on their ingredients.

Dr. Jaffe: Well, in regard to gut health, we’re talking about prebiotics, probiotics and symbiotics. Prebiotics is fiber. Probiotics are bugs, but alive. Symbiotics is recycled glutamine. And now I’m going to paraphrase Dr. Denis Burkitt. He first won the Nobel Prize for Burkitt lymphoma. And then he had so many invitations to talk to journalists and others that he actually disconnected his phone and he went to Kenya. He became a missionary, a medical missionary, Nobel laureate. How many Nobel laureates do you know decamped to Kenya? And what he noticed he taught me personally. He said, “You know, when people there (like East Africa), when they live a traditional diet, which is high fiber, it’s somewhat subsistence, it’s feast and famine. There’s no irritable bowel syndrome. There’s no ulcerative colitis, there’s no mucal enteritis. There is no leaky gut, there are no digestive problems. It’s when they move to the city. And they have the challenges of the toxins of urban living. That’s when these problems occur. So we need 40 to 100 grams of fiber. That’s the prebiotic fiber, 40 to 100 grams a day of unprocessed fiber. And we need 40 to 100 billion healthy bugs. Isn’t that interesting: 40 to 100, 40 to 100. Different a little bit, but not much. One is fiber, and the other is bugs. And then we need recycled glutamine.

Lindsey: And what is recycled glutamine?

Dr. Jaffe: Well, glutamine is a very important amino acid. It’s the source of energy for your enterocytes, the cells that line your intestines, and make your leaky gut go away. But glutamine goes to glutamate unless you recycle it. So we actually pioneered how to recycle glutamine about 10-fold. So now you give 1.5 grams rather than 15. You give that on rising and before bed because it’s an amino acid recycled by PAK. PAK is called pyridoxyl alpha-ketoglutarate, if any of you are biochemists.

Lindsey: And so what is the product that you sell that is the recycled glutamine?

Dr. Jaffe: Yes, thank you. It’s called Endura/PAK guard (find at Fullscript).

Lindsey: And if you are eating plenty of protein, would you need something that provides glutamine?

Dr. Jaffe: The amount of protein that an adult human needs is 60 to 70 grams a day. And when you go above 60 to 70 grams a day, you add acid. Because the excess amino acids become keto acids, you’ll lose ammonia, that ammonia is lost in the urine, sweat. And still, it’s part of why people sweat in ways that are, shall I say, unpleasant?

Lindsey: So your probiotic product, I noticed that it doesn’t list the strains, but I presume that you’re using those strains that are numbered and researched?

Dr. Jaffe: First of all, we do have 10 billion active CFU (colony forming units). Ten active strains, between acidophilus and bifidus and strep thermophilus. What we do not include are the individual, proprietary, and shall I say manipulated strains, because we follow nature and nurture and wholeness. (Find Digesta Guard Forté 10 at Fullscript). We don’t follow vogue. And I don’t mean just Vogue magazine, I mean, scientific vogue. I mean, the fact that today people are looking for the magic probiotic that they can patent. I don’t think that’s actually a good idea. I think that that probiotics, prebiotics and synbiotics should be available to promote healthy intestinal digestion, assimilation and elimination.

Lindsey: Okay, so in other words, the strains that you’re using are more sort of general?

Dr. Jaffe: Not only they’re more general, more active. We actually harvest our strains in what’s called log phase, which means doubling. Wouldn’t you like a more potent probiotic? Well, most of what you get in almost every other probiotic is yogurt, freeze dried, or dried, and then powdered, and then put in a capsule. And by that time, by the time you get to plateau, by the time you get to too many organisms and too little nutrition, they’re cannibalizing each other. And when you cannibalize each other, you immunized the probiotic, so many people who are taking probiotics (and so need probiotics) are actually getting immuno probiotics, which we really, really, really don’t recommend.

Lindsey: And so you said they’re in a log phase. Can you explain a little bit more what that means?

Dr. Jaffe: Log phase means doubling 2, 4, 8, 16, 32, 64, 128, 256. I can’t go much above that. But doubling. There is a point where when you grow the organisms in the culture medium, they double, double, double, double, and then they plateau. When they plateau it’s easy to harvest the maximum number of bugs but they’re mostly dead and not only dead, they’re immunizing dead, and that’s a double harm.

Lindsey: What does that mean they’re immunizing?

Dr. Jaffe: Oh, immunizing means that they’re cannibalizing each other to the point where they leave remnants behind that will burden your immune defense and repair system, including endotoxins that my friend Ron Alene pioneered in the 70s. If you know about endotoxin, look up limulus crabs. My friend Ron, who still is a friend and a colleague, would go out once a year to San Diego –  La Jolla, which we all thought was a nice place to visit, in order to harvest limulus crabs to get their fluids so that he can have a year’s worth of endotoxin assays back at the National Institutes of Health.

Lindsey: What are assays?

Dr. Jaffe: Oh, assays mean tests.

Lindsey: What’s the prebiotic product that Perque makes?

Dr. Jaffe: The prebiotic that Perque makes is multiple sources of unprocessed fiber called prebiotic fiber (Regularity Guard – find at Fullscript), because it nourishes the beneficial bugs in your gut. But it’s not bugs. Those are the probiotics.

Lindsey: Okay. And there has been some research of late that pointed to the idea that taking probiotics after antibiotics might not be a good idea because it takes longer to return to your base microbiome. But the people that I’m dealing with as clients already have a very disturbed gut microbiome that probably we don’t want to return to. So can you just comment on that research? And when it’s appropriate to use probiotics?

Dr. Jaffe: When I explain it, this is my answer. None so blind, as those who will not see. What I mean by that is you have very smart microbiologists and other scientists who are pathology oriented and not physiology knowledgeable, and they don’t know their elbow from a hole in the ground in regard to what we’re talking about. Because the whole conversation has changed in the last two or three years, because we’ve actually learned a bunch in the last two or three years. And so if you go back even five or 10 years, you can actually make recommendations than I am very sure will harm and not help. So this notion that oh gosh, we need antibiotics. Oh, and let me stop at that point. I’m a licensed medical doctor, at least in several jurisdictions like New York and California. I have never had a problem with my medical practice, because people have gotten better and not worse. And no, I haven’t given antibiotics in the last 30 years, probably more, because people didn’t have an antibiotic deficiency. What they had was a deficiency of the good stuff. So we give the good stuff, in sufficient amounts to crowd out the bad stuff. And guess what? That works.

Lindsey: So say somebody had a urinary tract infection, what would you give them?

Dr. Jaffe: Again, such really astute questions. Now say you have a person, more likely a woman than a man. But let’s say you have a person with a UTI, or a urinary tract infection, the first thing I would give them is a simple sugar called mannose. Why? Because there is science. And by the way, there’s good science and there’s bad science; I only want to talk about the good side. There is good science that says if you give this simple sugar called mannose, then some of the harm of a urinary tract infection can be reduced, while hopefully you restore the imbalance of the immune defense and repair system.

Lindsey: I actually have some of that mannose in my in my cupboard, and I’m curious what kind of doses do you need to actually begin that process?

Dr. Jaffe: Again, very good question. Let’s say you have a UTI and you’re irritable, for whatever reason, in that region of the body. I’m pretty sure that if you if you don’t take half a gram twice a day, it’s almost homeopathic, which may or may not work. And there are people who will give you 5 grams. And I don’t think that’s a harmful thing because mannose is one of those sugars that’s not metabolized. It’s not like glucose, it’s is not like fructose, it’s not a harmful sugar.

Lindsey: And how does it work? Does it attach to the bacteria and carry them out?

Dr. Jaffe: It prevents the bacteria from connecting with the wall of your genitourinary tract and therefore irritating it. You know, it prevents the connection. It basically pushes things away.

Lindsey: And so that on its own could clear a UTI?

Dr. Jaffe: Let me say three things about that. First of all, most urinary tract infections are not accurate. When you have a count of 50,000 bacteria in a urine specimen in regard to a urinary tract infection, I am 100% sure from running the labs at the NIH, that that means you didn’t have a clean catch. You didn’t have a sterile specimen. Only when you have a lot of bad bugs and not just bugs, you have to have a lot of bad bugs. If you have a lot of bad bugs, I want to get them out. If you only have a few bugs, I’m not sure. In fact, I’m very sure I wouldn’t treat a result without a meaning.

Lindsey: Given you have an accurate test, is mannose sufficient to clear UTI at appropriate doses?

Dr. Jaffe: Without question, mannose will reduce the symptoms. It is not alone sufficient.

Lindsey: And so would you add probiotics to that?

Dr. Jaffe: Well, since I’m a physiology before pharmacology physician, since I’m a scientist and not just a mystic, everyone, in my experience needs prebiotics, probiotics and symbiotics.

Lindsey: And if you are eating a sufficient amount of fiber, then you probably don’t need to take prebiotics, but few of us are actually doing that right?

Dr. Jaffe: 40 to 100 grams of prebiotic fiber means you’re chewing chili, and curry, and dal at almost every meal.

How to Help My Sciatica (and deal with inflammation in general) and Should I Take Curcumin Supplements?

Lindsey: So I actually have been going through sciatica and . . .

Dr. Jaffe: Is it really sciatica or is it? There’s an alternative, which is . . .

Lindsey: Yeah, it’s not piriformis syndrome, it’s really sciatica.

Dr. Jaffe: Okay, now, if it’s sciatica, you have an antioxidant deficiency, a magnesium choline citrate deficiency, and polyphenolic deficiency. Take them for three weeks and I want you to report back.

Lindsey: Okay, so I’m already taking vitamin C, but maybe not enough.

Dr. Jaffe: Based on a weekly C cleanse?

Lindsey: No, I’m not doing anything like to bowel tolerance.

Dr. Jaffe: What you’re thinking, my friend Bob Cathcart recommended bowel tolerance. I can tell you don’t do that. But do follow our recommendation for the C cleanse, one of the four personalized predictive biomarkers.

Lindsey: Right. And then magnesium, I’m already taking magnesium glycinate, 400 milligrams a day.

Dr. Jaffe: And your urine pH after rest is what?

Lindsey: I don’t measure that.

Dr. Jaffe: Until you do, you’re flying blind.

Lindsey: Okay, so what am I shooting for on my urine pH if I’m taking enough magnesium?

Dr. Jaffe: Six and a half to seven and a half – that’s only based on 1,227 studies.

Lindsey: Okay, that sounds like a sufficient number. And then the polyphenols, I have been taking the Perque product called Repair Guard (find at Fullscript). And I didn’t know what it was for, but I knew I was going to be interviewing you and it just caught my eye and I bought it. So is that something that’s useful in the polyphenol department? I know it has quercetin.

Dr. Jaffe: Well, it has quercetin dihydrate. So there’s quercetin, of which you should be concerned, and then there’s quercetin dihydrate, of which you should not be concerned. So for the last 35 years, we have combined quercetin dihydrate with soluble OPC. We have published multiple requested chapters and review articles showing that you can have good or bad polyphenolics, flavonoids and flavonols. And we want the good and we don’t want the bad.

Lindsey: Okay, so quercetin dihydrate is the safe format is what you’re telling me.

Dr. Jaffe: And let me give you another little anecdote. So my friend Bob calls me up and he says, Well, have you ever heard of resveratrol? And I said, “Yes. If you drink about 400 glasses of red wine, you’ll get a meaningful amount of resveratrol.” He says, “Yes, what do you think? I said, “Well, I think quercetin and soluble OPC.” He says, “Well, you know, I own the patents globally on resveratrol.” I said, “Sell them,” and he did.

Lindsey: Okay, so you thought they weren’t worth keeping?

Dr. Jaffe: When you have the better, stay with the better, if you need the worser, that’s your problem. Is that clear?

Lindsey: Yeah. Okay, so anyway, back to my sciatica. So you think I’m nutrient deficient, but I was just wondering about the products in terms of Repair Guard or Pain Guard Forté, would either be useful in helping with my sciatica pain?

Dr. Jaffe: In regard to your or anyone’s sciatica, you start with the 4 personal self assessments, you move on to the eight predictive biomarkers, interpret your best outcome values, and then you’ll be fine. My father had sciatica, I cured it.

Lindsey: I’ve been having it for like eight months. So it’s getting a bit urgent. And I’ve been taking every supplement anybody recommends. .  .

Dr. Jaffe: . . .and they have been treating the back end of an ass. Forgive me for saying it that clearly. They’re not looking at the causes, they’re looking at the consequences. I understand that; most professionals do. So throw curcumin in that has lead. What value does curcumin from turmeric have when it has lead contamination? Negative. Oh, but I didn’t know it had lead. I actually thought it was curcumin. Well, it’s not. Because curcumin has to be heated and has to be met with piperine. It has to be part of dal or curry or other foods. So that’s why we start with what you eat and drink, think and do and then we don’t let you be dehydrated.

Lindsey: So if I have USP verified curcumin with bioperine, could I feel safe that that’s not lead contaminated?

Dr. Jaffe: It’s two points. First of all, when you start with a pepper corn, and you grind piperine onto a food, it lasts about one hour. And I’m pretty sure it’s been more than one hour before that piperine was exposed to whatever it was that you got in the supplement. And so it was a false, as in illusion, promise.

Lindsey: So would it be better to just grind up some pepper myself right then as I take my curcumin?

Dr. Jaffe: And not only fresh ground pepper, or fresh ground peppercorns, which I buy. And I buy the white, the black, the pink; it’s really very pretty. But I put them in a simple copper, as an Italian copper, grinder. And why do I do that? Because that keeps them away from mold and problems. And how do I grind them? Fresh. Because the piperine in my kitchen lasts one hour. In your kitchen, the piperine lasts one hour. When you have piperine in a product? It’s an illusion, because it’s not what you want.

Lindsey: And the reason that they put it in, in theory, is to extend the . . .

Dr. Jaffe: Oh no, no, the theory is that consumers are smart enough to know that the word piperine should be associated with the word curcumin, or turmeric, if you want better uptake. Except what the consumer doesn’t understand is time.

Lindsey: And so is there a Perque product that has curcumin?

Dr. Jaffe: Never.

Lindsey: Okay, so you think we should just be eating it fresh?

Dr. Jaffe: Yes, make a curry once or twice a week. Make a dal once or twice a week, make a chili once or twice a week. Do it with whole foods if you can. We want you to start in the kitchen. And we don’t want you to start with the supplements. We have supplements. They’re necessary. But they have to start after the kitchen.

Lindsey: Yeah, and I do like curry. Of course for people whose kids don’t like it, it’s more challenging to have it twice a week.

How to Get Your Kids to Eat Healthy

Dr. Jaffe: Well, no, no. Let’s talk about that for a minute. What I would do with children for a dal or a curry is noodles. But they would be bean curd noodles. Kids tend to like noodles. You know like slurp slurp slurp. I must tell you that my children were never very neat and we didn’t care. We just wanted them to eat. We just wanted them to enjoy what it was that we were eating. And by the way, there were times when my children said “I’m not going to eat that”. And we said, “What do you want to do?” And they said, “Call in for Uber” (Dad actually can do that). Well, maybe Dad can. But we’re not going to do that. We only have this and that and the other thing from the kitchen. “Well I don’t like you”. “I don’t care, I still love you.” “Oh, well, I’m hungry.” And then they would sit down and eat. If the children are in charge, it’s actually a problem.

Lindsey: Yeah, no, my kids eat curry. Just to say, it’s not my kids. I was referring to someone else’s kids.

Dr. Jaffe: No, I appreciate your point. You want to make it savory. You want to make it aromatic. You want to make it something that’s appetizing. You do not want to force them to eat something that you think is healthy that they hate you for. I promise you that will not end well.

Lindsey: Yes. No, it’s not fun to have battles at dinnertime with the kids.

Dr. Jaffe: No, but start with I’m tired and hungry, and then they’ll eat.

Which Vitamin C is Best? Is Liposomal Vitamin C a Superior Form?

Lindsey: Yeah. Okay, so let me ask about the Perque vitamin C because I heard you talking about it on another podcast and you made it sound like the way it’s made, that any other vitamin C supplement would be essentially useless. But I’m guessing that that’s probably an overstatement. So could you compare Perque’s vitamin C to others? And why are they different in terms of efficacy, like a percentage difference? Or how would they compare?

Dr. Jaffe: So most of the commercial vitamin C, which is 95 plus percent of the vitamin C you would buy in any store from health food to other, including online, is damaged. It is partially ascorbate. It’s partially diketogulonic acid, it’s partly dehydroascorbic acid. It is deficient. It’s not distilled under nitrogen. It is not nature’s vitamins. Since 1987, and for the last 30 plus years, we have provided nature’s vitamin C. Safer, uncontaminated, more effective, documented in clinical outcome studies, multiple, and documented for the last 35 plus years. It’s safer, more effective, when you use nature’s form. (Find it at Fullscript)

Lindsey: Okay, and by nature’s form, you mean if you were to say, eat an orange, you would get vitamin C in the same form as the Perque vitamin C supplement?

Dr. Jaffe: Good point. However, do you know the average orange moves more than 1000 miles by the time it goes from being picked to your eating it? It has 10% or less of the vitamin C that it started with. That’s a fact, that’s not an opinion. If you live in an area where you have your own citrus garden, and you pick your own tangerines, and you pick your own oranges, and you pick your own citrus fruit, Hmm, that’s a blessing.

Lindsey: Yeah, I planted a mandarin tree two years ago, and the first year it got decimated by a horrible – some sort of butterfly or the worm form. And then this year, I’ve got two mandarins on it. And boy, I’m watching those things grow so anxiously. I’m hoping one day I’m going to have a voluminous tree.

Dr. Jaffe: As long as the roots survived. I’m currently growing a nectarine and a tangerine that we think are going to survive in our zone seven.

Lindsey: I’m in Arizona, Tucson, so we can do citrus.

Dr. Jaffe: You absolutely can do citrus but it should be xeriscape. You have to drip the water in.

Lindsey: Yeah, that we have to get that set up. We have yet to have to put in drip irrigation. Okay, so tell me about what you think of liposomal vitamin C?

Dr. Jaffe: Well, since our recrystallized ascorbate gets 100% uptake and since most ascorbate gets a fraction of that, how much more than 100% do you think you could get on God’s green earth?

Lindsey: Okay, so in other words, no point in investing in liposomal, because the Perque is the best one. That’s sort of the end story?

Dr. Jaffe: To be really clear, liposomal ascorbate includes a significant fraction of the ascorbate that is not ascorbate. It is the liposome, and it is there on the premise that you can’t get the beneficial ascorbate in. And since we have documented over many decades 100% uptake of the recrystallized under nitrogen ascorbate that nature provides, we’re pretty sure that compromising that is really not a good idea. In fact, we’re very sure it’s a bad idea.

Lindsey: So I also noticed that Perque’s vitamin C pills are 1000 milligrams and I have read multiple times that you can only absorb 500 milligrams of vitamin C at any time.

Dr. Jaffe: You listen to people who don’t know their elbow from a hole in the ground, and are pathologists rather than physiologists, who are my friends, and I specifically mean Mark Levine at the National Institutes of Health. I specifically mean the Food and Drug Administration, who has for many years obscured, not clarified, the issue of how much do you need. Because if you want to avoid scurvy, I mean, scurvy, if you want to avoid your teeth falling out when you sail on the Pacific, or the Atlantic Ocean, oh, you only need a dusting, as in an orange or a lime. They were called limeys for some reasons. Haha, that has nothing to do with health. If you want to know how much ascorbate you need, you’ll have to do a C Cleanse. It’s one of our four personalized assessments, followed by eight predictive biomarkers, interpreted to best outcomes values, if you want to be well and healthy in the 21st century.

Perque Brain Formula

Lindsey: Okay, I got it. So is there anything that Perque or you are working on right now, any new products that might be coming out soon?

Dr. Jaffe: Again, thanks for asking the question. We have long needed, and now have perfected, what we call Perque brain formula, brain like cognition, you know. Like, I’m not going to take periwinkle, I’m going to take something a little more effective. And I think you know this – I’m no longer a spring chicken. So I actually want my brain to work. At least for as long as it does. I cannot control when a piano might fall out of the sky, or when the good Lord is going to take me. In the meantime, I don’t lose my memory. If you can’t remember your loved ones, it’s really not a very pleasant place to be.

Lindsey: And so is the brain formula already out then?

Dr. Jaffe: It’s coming out very soon.

Lindsey: Does it have a name?

Dr. Jaffe: Yes. It has a very interesting name. It’s called Perque Brain Formula.

Lindsey: Okay. So it’s very transparent. We can keep our eyes out for that.

Dr. Jaffe: And you can place orders now because it’s really coming out very soon. It’s in production. Now, we have pioneered a better formula. And yes, we’re very proud.

Lindsey: What kinds of ingredients?

Dr. Jaffe: Everything you would like and nothing you wouldn’t.

Lindsey: Okay. I guess people can look at the label.

Dr. Jaffe: Haha, there’s more than one thing on the label.

Lindsey: Yeah. Okay. It’s a multi-item formula.

Dr. Jaffe: Right. synergistic.

Lindsey: Is there anything that you wished I had asked you about the topic of gut health that I didn’t?

Dr. Jaffe: You’ve asked so many good questions. No, I think I’ve had a chance to say my “truth”. I think, as you know, I came as a skeptic, but I’m now here. I think physiology before pharmacology, I think nature and nurture and wholeness. I think living in harmony with nature. I think knowing what you can eat, assimilate and digest and eliminate without immune burden is a stepping stone toward lifelong health and well-being. And I want to be dancing at 120 with folks like you, because if I’m the only one dancing at 120, it’s lonely.

If you want more help with your gut, autoimmune or other health issues, you can set up a free, 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether my 5-appointment gut health coaching program or a longer program for autoimmunity or weight loss is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

Schedule a Breakthrough Session Now

*Product links in this article are affiliate links on Fullscript or Betterlabtestsnow. Thanks for your support of the podcast and blog by using my links!

11 Diets for Addressing Chronic Health Conditions

Adapted from episode 39 of my podcast, The Perfect Stool: Understanding and Healing the Gut Microbiome.

There are tons of special diets meant to help reveal food sensitivities, address physiological imbalances or reverse autoimmune disease or other chronic conditions. I’ll cover 11 of them in this article. This may give you a starting point for trying a more targeted elimination or other special diet. Or if you’ve already done the elimination diet thing with no luck, even one as strict as the paleo autoimmune protocol or AIP and it didn’t help you, this may give you some completely new ideas, because there are many diets for different health issues that are not a subset of the AIP.

Gluten-free Diet

So let’s start with the most basic: gluten-free. Gluten is commonly known as the protein found in wheat of all kinds, including einkorn, durum, khamut and semolina, as well as barley, spelt, triticale and rye and frequently oats because of cross-contamination. However, gliadin is actually the subfraction of gluten that’s found in the grains I just mentioned and that has received the most attention. And it’s hidden in tons of foods, like soy sauce, soups, salad dressings and spices, so you’ll need to find a thorough list of potential sources and stay away from processed foods with questionable ingredients while you try it. This is step 0 for anyone with gut or autoimmune issues of any type. I did a whole podcast episode on this (episode 21) if you want more detail. However, before you give up gluten, please go to your doctor’s and get tested for celiac disease, which is an inflammatory condition of the small intestine. If you do a lot better on a gluten-free diet and you haven’t been tested, the only way to get tested is to start eating gluten again, and if you’re feeling much better, you won’t want to do that. But having that celiac diagnosis will make you take the diet a lot more seriously and requires a much higher level of vigilance, like separate cutting boards and removing personal care products with gluten in them. Of course, you may not have celiac but could have non celiac gluten sensitivity (NCGS), which you’ll find out by giving up gluten and seeing how you do. If you are gluten sensitive and you just ignore it and eat gluten, you can end up with autoimmune disease, osteoporosis, asthma, mental health issues, fibromyalgia or chronic fatigue.

Another big subset of people that the evidence shows should try a gluten-free diet are those who have already been diagnosed with an autoimmune disease, especially Hashimoto’s thyroiditis (the most common cause of hypothyroidism) and Grave’s disease. This is because the protein in gluten looks a lot like your thyroid cells. This type of autoimmune disease is believed to start when you have a leaky gut (which may be because of the gluten or for some other reason like a gut infection) and the undigested gluten proteins escape into your body, creating an immune attack to remove these proteins. Then because of molecular mimicry, or the resemblance of gluten and thyroid cells, your body attacks your thyroid. But really experts recommend cutting out gluten for any type of autoimmunity.

So I’m not going to lie: cutting out gluten is tough and may seem impossible, but I’ve gone mostly gluten-free for about 7 years now because I was diagnosed with Hashimoto’s thyroidits, and honestly it’s a relief, mainly because it keeps me from eating things that make me feel bloated and terrible like bread and pasta, and encourages me to eat more nutrient-rich foods. And it keeps me from indulging in so many unhealthy, sugary things that have gluten in them. Although I have to admit that I do cheat about 6 times a year, eat pizza and take enzymes to digest it now that my Hashimoto’s antibodies are down to normal levels.

But when first faced with the prospect of going gluten-free, you might be thinking: what about a chewy delicious pizza crust, or a sandwich on beautiful toasted ciabatta bread, or your favorite bowl of pasta? Fortunately, there are lots of great alternatives to those foods now and gluten-free bakeries in most cities. Although, I’ve always been of a mind that you’re better off looking for recipes that are naturally gluten-free, like with a lot of Asian recipes that are naturally gluten-free (provided you use tamari or gluten-free soy sauce instead of soy sauce).

But if you’re looking for good alternative flour options, two of my favorite low-cost and neutral-tasting, grain-based ones for baking are sweet sorghum and millet (which I combine, and then you need to add a starch like cornstarch or tapioca starch as 1/3 of the mix). I don’t add binders like xantham gum to my gluten-free flours. Rather, I look at any individual recipe to see if that addition is necessary and try to use more natural binders like flax or chia seeds, ground up and mixed with water.

My favorite grain-free flours are almond and cassava flours, and then I use tapioca starch (or arrowroot starch) as my starch, which is just the starch from cassava flour, but it’s much less expensive than whole cassava flour. And there are tons more grain and grain-free options including: amaranth, arrowroot, buckwheat, millet, cornmeal, flax, chia, coconut, oat, quinoa, rice, mesquite, bean flours (garbanzo, fava, etc.), tigernut and many more. And if you’re looking for amazing angel hair pasta that’s gluten-free (and very hard to find), I love the BGreen Millet Angel Hair*.

One caution about going gluten-free is not to just switch to gluten-free junk foods with additives and fillers (and often a lot of sugar), or based mostly on rice flour. They have found elevated levels of arsenic in people eating gluten-free because of high rice consumption so think more about following a whole foods diet minus gluten that includes other sources of starch, like root vegetables, nuts and other grains besides rice.  

A final note that while it’s well-known that gluten causes celiac, it’s less-known that gluten can cause inflammation in other parts of the body including the mouth, esophagus, stomach and small and large intestines. I had one client who came to me for weight loss who was also hypothyroid. I had her do an elimination diet including gluten. Wouldn’t you know, after she had been working with me for about 4 months, she saw her dentist, and all of 4’s and 5’s with the depth probe were now healthy 3’s. So she had all this inflammation going on in her body that wasn’t super obvious but cleared up after eliminating gluten. So given gluten is connected to inflammation, and inflammation to most chronic diseases, eliminating gluten is a viable option to address many different conditions, not just celiac.

Grain-free Diet

So if you start with gluten and that doesn’t seem to be enough, you may want to go the whole way to grain-free. More restrictive than the gluten-free diet, the grain-free diet(as the name suggests) involves cutting out all grains, which technically are the seeds of grasses. The reason to try this is because you may not just be sensitive to gliadin but to other prolamines found in other grains traditionally considered gluten-free, like corn, rice, millet, oats, wild rice, fonio, job’s tears, sorghum, millet and teff. So if you find that you’re 75% better off without gluten but not all the way, you may be sensitive to all prolamines in grains and should give a grain-free diet a try.

Anti-inflammatory diet

So the next diet I wanted to cover is an anti-inflammatory diet. Reducing inflammation, as I’ve mentioned, can be a powerful way to reduce your risk of illness and reverse a chronic illness you already have. Chronic inflammation is linked in research to heart disease, arthritis, cancer, diabetes, depression and Alzheimer’s. Since I’ve heard the term anti-inflammatory diet floating around on the internet quite a bit, I wanted to include what that was, but quickly realized that there is no set definition of an anti-inflammatory diet. Pretty much everyone agrees that it eliminates added sugars, deep fried foods, partially hydrogenated oils (which are mostly out of the food supply thanks to the Obama administration, as long as a serving has less than ½ a gram, which will be labeled as 0 grams), ultra-processed foods, and refined carbohydrates like white bread, pasta and desserts. Then depending on who you’re talking to, it may reduce or exclude red meat, saturated fat, processed meats, gluten, dairy, soy and/or processed seed oils. And then also important is what you do focus on, which is getting lots of servings (think 5-9) of fruits and vegetables/day, with a particular focus on green leafy vegetables, cruciferous vegetables like broccoli, cauliflower, cabbage and Brussels Sprouts; alliums like garlic, onions, scallions and leeks, fats like olive oil and avocado oil, nuts, fatty fish and seafood with lots of omega 3 fatty acids (like sardines, anchovies, salmon or tuna, but be sure to choose only brands of canned tuna that boast low mercury like Vital Choice* or Safe Catch*) and anti-inflammatory spices like turmeric, ginger, cloves, rosemary and thyme. And of course you should choose organic and/or pasture-raised foods and for meats, dairy and eggs. And then it’s also important on an anti-inflammatory diet to get lots of fiber, so that can come from fruits and veggies, or whole grains if you’re eating grains, or nuts, for example. Or dark chocolate – that’s one of my favorite sources of fiber.

Basic Elimination Diet

Next item up, the basic elimination diet. So for my clients, if they are having digestive issues and haven’t already done it, I often suggest a basic elimination diet. Because if you’re showing signs of leaky gut, like migraines, brain fog, joint pain, or skin issues, not to mention GI issues, it is often a combination of foods, not just one food like gluten, that’s causing you to react. Eliminating only gluten or only dairy or just those two and not feeling better could leave you with the false conclusion that those foods are fine for you, when in fact the issue is that you are sensitive to several foods.

So generally, I suggest a whole-foods elimination diet for at least a month that excludes gluten, added sugar, dairy, soy, caffeine, alcohol, processed foods and seed oils. Then each item (except crappy processed foods and seed oils, which you shouldn’t reintroduce at all, and the sugar, which should remain limited) should be reintroduced alone for a couple of days Eating the reintroduced item at least 2 servings a day until you feel a bad reaction, or if not, wait a couple days after that for any delayed reaction. Now of course if this isn’t enough for your symptoms to improve, you can start excluding additional foods, like nightshades, nuts or legumes, or go for a full autoimmune protocol, which I’ll get to later. I think this kind of elimination diet is a good start for people who aren’t prepared to try something as extreme as the autoimmune protocol or AIP. I know that when I found out I had Hashimoto’s thyroiditis and saw the AIP, I was like, “No way!” It was just a nonstarter for me because it felt like there would be nothing left for me to eat. But when I tried this pared-down elimination diet, my symptoms improved and I was able to isolate gluten, dairy and soy as the most problematic foods for me. So if you have an autoimmune disease that isn’t profoundly impacting your health yet, this may be a good start.

Paleo

If you haven’t been living under a rock, you’ve likely heard of the paleo diet, which was developed by Robb Wolf. Formerly a research biochemist, Wolf is the bestselling author of The Paleo Solution: The Original Human Diet* and Wired to Eat*. And along with the paleo diet is a whole school of thought known as ancestral health, approaching lifestyle and nutrition from the perspective of our hunting and gathering ancestors, who if you pull out high rates of infant mortality, lived long and healthy lives. And spent a heck of a lot less time working that we do to maintain it. So generally, you can pretty much figure out the foods that would have been accessible to hunter gatherers: meats, animal fats, coconut oil, seafood, root vegetables, other fruits and vegetables in season, nuts and seeds and natural sweeteners like maple syrup and honey in limited quantities.

Processed foods of any kind are out, unless of course they’re made to be paleo, as is alcohol, all dairy except clarified butter or ghee, all grains, starchy vegetables like potatoes, corn and peas, factory farmed meats, beans and legumes, including peanuts and soy, refined or processed sweeteners and processed seed oils. One of the biggest brands of paleo products is Primal Kitchen, which makes very nice dressings* made from avocado oil and now has frozen entrée options for people who don’t cook. I aspire to the paleo diet, except I’m too weak to eliminate all grains when my family eats them in front of me, and fakish foods like sugar alcohols because at the end of the day I have found that added sugar in any form, even if it’s ancestrally okay, causes me to gain weight. Not to mention alcohol, and legumes, which I believe are healthy, high-fiber foods for most people.

On the Paleo diet, ideally you should be eating a wide variety of proteins from as many animal sources as possible. This means not relying on standard cuts of meat and lean meats, but including the fatty meats and organ meats, not shying away from saturated fat in meat or coconut oil, and including bone broth and other good collagen sources. If you’re a baker, paleo baked goods typically use cassava flour or coconut flour, as well as arrowroot or tapioca starch or other non-grain flours. In addition to meat, vegetables, nuts and seeds, avocados, olive oil and fish oil are staples in a Paleo diet. And root vegetables, including sweet potatoes and winter squash, are the primary sources of starches. The paleo diet has been shown to be anti-inflammatory, promote weight loss, reduce digestive issues, and reverse or decrease the likelihood of developing chronic diseases.

Paleo Autoimmune Protocol (AIP)

Next up, AIP or the Paleo Autoimmune Protocol. So if you’re tried the paleo diet and feel better but not all the way better, you may want to implement the AIP, which includes an elimination diet designed to reverse autoimmune disease by addressing the nutritional resources required for immune regulation and tissue repair as well as removing inflammatory factors from your diet. The protocol also focuses on your lifestyle. So what’s involved in AIP? The AIP addresses four areas known to contribute to autoimmune diseases, which are: nutrient density, gut health, hormone regulation and immune system regulation. Meat, seafood, copious amounts of vegetables, fruit and healthy fats are AIP-approved. You might be thinking: isn’t that the same as the Paleo diet? It’s sort of like the paleo diet on steroids and further eliminates eggs, nightshades (which include potatoes, tomatoes, peppers, chilies, eggplant, tomatillo, goji berries and ashwagandha), seeds, nuts, ghee, chocolate, caffeine and seed-derived and nightshade-based spices.

The AIP diet has been attributed to Dr. Loren Cordain, PhD, a scientist responsible for discovering that certain foods trigger inflammation in people with autoimmune disease. Other leading experts in the AIP field are Robb Wolf, for his contributions in The Paleo Solution, and Dr. Sarah Ballantyne, PhD, who researches and writes extensively on autoimmunity and diet. Her research-heavy tome on autoimmune disease is called The Paleo Approach*. The main thing to remember about AIP is that it’s an elimination diet, which involves the removal and systematic reintroduction of potential problem foods, but that it is meant to last a lot longer than a typical elimination diet – pretty much as long as it takes for gut inflammation to settle down. I would generally consider recommending it for someone with an autoimmune disease that involves bad joint pain or other significant pain or disability or potential for future problems, along with gut testing and healing of gut infections that could be at the root of food sensitivities.

Low-Oxalate Diet

The next diet I’m going to talk about is the Low-Oxalate Diet. So if you’ve been rattling around the world of functional medicine for any length of time, you may have heard about oxalates. You probably even know they’re in spinach. What I’ve discovered since I’ve started using the Organic Acids Tests to uncover gut and other health issues, is that pretty much any client who has a high level of yeast metabolites also has a high level of one of three markers of high oxalates, because oxalates are produced by yeast. Oxalates are crystals that can cause kidney stones, most of which are made of calcium oxalate, but are also less known for their role in fibromyalgia, vulvodynia or vulvar pain, autism, anemia, urinary tract infections, interstitial cystitis and crystal formation in other places like bones, joints, blood vessels, lungs, thyroid and even the brain. Wherever they’re found, oxalate crystals can cause pain and damage and increase inflammation.

The first thing to know about starting a Low-Oxalate Diet is that you should reduce your oxalate intake slowly. So for example if you’re eating over 500 mg of oxalate each day, you should be reducing at a rate of no more than 5 percent per week. Basically that means reducing about 25 mg each week. If you’re eating 500 mg or less of oxalates, you can come down 10 percent each week. This is to avoid a phenomenon called oxalate dumping, which is a horrifying thing where oxalate crystals start coming out of your body wherever they are present. So you might be asking at this point, what foods are high in oxalate and how would I even know if I have an oxalate toxicity issue?

Foods that are high in oxalates include:

  • beer
  • beets
  • beans
  • berries
  • coffee
  • dark green vegetables
  • nuts
  • oranges
  • spinach
  • soy milk
  • soda
  • tofu
  • wheat bran
  • sweet potatoes
  • black tea
  • rhubarb

This might seem like a random list, but if you’ve noticed difficulty with some of these foods in the past (or perhaps all of them), or you have any of the conditions I mentioned before, it’s possible you have an oxalate toxicity issue. If you suspect oxalate toxicity might be your issue, or you just want to learn more about the Low-Oxalate diet and what’s involved, there’s a great website with recipes and a chart of oxalates in various foods from actual studies measuring oxalates in these foods. They also have a Facebook group called TryingLow Oxalates. Also, one way you can help remove oxalates from your body or diet is by eating a full serving of dairy or a calcium citrate supplement* with meals, which will absorb and usher oxalates out in your urine.

Low-Histamine Diet

Next up is the Low-Histamine Diet. If you have allergies, I’m sure you’ve heard of “anti-histamines,” which are drugs like Claritin, Benadryl and Zyrtec that treat allergic rhinitis and other allergies. But what is histamine? A histamine is a compound released by your MAST cells that plays a part in your body’s immune and inflammatory responses. So when your immune system is triggered by a potential threat, histamine is released through your bloodstream. Then your blood vessels dilate and this creates an inflammatory response with common allergy symptoms like sniffling, sneezing, coughing, tearing up or itching. Histamine intolerance occurs when high levels of histamine are chronically built up in your body. Common symptoms of histamine intolerance include irritability, depression, brain fog, dizziness, rash, flushing, hives, headache, tissue swelling, altered bowel function, nausea, vomiting, abdominal cramps, non-celiac gluten sensitivity, runny nose, difficulty breathing and insomnia.

There are two reasons why histamine can become chronically elevated: either there’s something producing high histamine levels in your body or an inability to clear histamine from your body. So what causes high histamine levels? It could be allergies (as I mentioned), but it could be other things too, for instance gut dysbiosis, environmental mold exposure, a leaky gut, GI bleeding, alcohol, genetics and histamine-rich foods. Foods high in histamine or that cause a release of histamine include:

  • avocados
  • eggplant
  • tomatoes
  • sauerkraut
  • papaya
  • pineapple
  • dried fruit
  • strawberries
  • citrus
  • all nuts and peanuts
  • fermented dairy products like yogurt and kefir
  • coconut yogurt
  • aged cheese
  • cured or old meats
  • shellfish
  • smoked fish
  • soy sauce
  • miso
  • mayo
  • pickles and olives
  • sauerkraut
  • kimchi
  • relish
  • soy sauce/tamari
  • chickpeas
  • soybeans
  • aged cheeses
  • chocolate
  • alcohol
  • energy drinks
  • black and green tea

Leftovers are also high in histamines, which build up the longer food ages.

Low-histamine foods include:

  • herbal teas
  • leafy herbs
  • coconut oil
  • olive oil
  • freshly cooked meat
  • poultry (frozen or fresh)
  • eggs
  • coconut milk
  • rice milk
  • hemp milk
  • almond milk
  • gluten-free grains
  • fresh fruit
  • most vegetables

If a Low-Histamine Diet works for you, then you will probably want to figure out whether there’s a root cause you haven’t addressed, or if you have something called Mast Cell Activation Syndrome, which includes not just a release of histamine but also other inflammatory mediators, of which histamine is one.

Low-Sulfite Diet

The next diet is a Low-Sulfite Diet. One more potential allergen that could be causing your problems are sulfites. Symptoms of a sulfite allergy are typical allergy symptoms, including hives, itching, trouble breathing or swallowing, GI symptoms like an upset stomach, diarrhea and vomiting, flushing, dizziness and a drop in blood pressure. Sulfites are preservatives widely used in the food industry to prevent discoloration and browning of processed foods. Depending on the manufacturer, foods that may (or may not) contain large quantities of sulfites are:

  • molasses
  • jams and jellies
  • tomato paste
  • corn starch
  • potato starch
  • guacamole
  • gelatin
  • fruit and vegetable juices
  • fish
  • crustaceans and shellfish
  • dried fruits and vegetables
  • lunch and processed meats
  • condiments
  • canned and frozen fruits and vegetables
  • bottled lemon and lime juices and concentrates,
  • alcoholic and nonalcoholic cider
  • wine and sparkling wine
  • vinegar

Look for a sulfite-free label to be sure. Sulfites can also be found in medications and personal care products. So if that group of foods speaks to you, you may want to look into a Low-Sulfite Diet.

Low-Salicylate Diet

Next up is a Low-Salicylate Diet. Another potential source of dietary sensitivities may be coming from salicylates. A big tip off to this would be a sensitivity to aspirin or other non-steroidal anti-inflammatory drugs. Reactions can range from the urinary/gastrointestinal, like diarrhea, urgency or stomach pain, to fatigue, to the mental, including depression, memory loss, hyperactivity or trouble concentrating, to typical allergy symptoms like burning or itchy eyes, trouble breathing, tinnitus, headaches, rashes, rhinitis and swelling of hands, feet, eyelids, lips or face.

If you’re sensitive to salicylates, foods you’ll want to try reducing or eliminating include:

  • tangerines
  • pineapples
  • oranges
  • most berries
  • herbs and spices (including cinnamon, rosemary, thyme, oregano, turmeric and mint)
  • nectarines
  • green apples
  • black tea
  • asparagus
  • all dried fruits
  • fruit juices

You also will want to avoid topical and inhaled exposure, because salicylic acid is easily absorbed through the skin and lungs. Many household items and toiletries typically contain substantial amounts of salicylates or salicylic acid, including: wart and callus removers, topical creams, toothpaste, soaps and cleansers, shaving cream, shampoos and conditioners, muscle-pain creams, mouthwash, lozenges, hair products, fragrances, detergents, cosmetics, cleaning products, chewing gum, bubble baths, breath mints, Alka-Seltzer, air fresheners, acne products, drugs for IBD and supplements containing willow tree bark extract.

Low-Sulfur Diet (for CBS Mutation/Sulfation Issues or Hydrogren Sulfide SIBO)

The last diet I wanted to cover was a Low-Sulfur Diet, which is indicated for someone with what’s called a CBS mutation, which causes issues with sulfation (one of the essential processes for detoxification,  also involved in hormone regulation, cell signaling and molecular recognition). When you eat sulfur compounds, your body produces ammonia as a byproduct, which is toxic, but is usually eliminated through the urine. If you have a CBS mutation that’s high firing, you may end up with excess ammonia, which can cause symptoms like lethargy, fatigue, shortness of breath, tremors, seizures, poor coordination, lack of muscle control, visual disturbances, headaches and nausea. In addition, you could have an overgrowth of microbes that produce ammonia as a byproduct that’s exacerbating your condition. I had a client who had these kind of symptoms every time he ate sugar or carbs and had to go to the urgent care for a three-drug cocktail just to handle it. When we did his Organic Acids Test and I saw his orotate level was elevated, in conjunction with these symptoms, I suspected a CBS mutation. Sure enough, he did a 23andme and confirmed that he did have the mutation. Educating him about supplements to reduce ammonia-producing microbes (including candida) in his gut has greatly improved his condition, as has strategically using certain amino acids. For people with this mutation, Dr. Jockers recommends a diet consisting of 70% fat, 10-20% carbohydrate and 10-15% protein or under 50 grams/day and limiting sulfur intake by removing garlic, onions, cruciferous veggies, eggs, legumes and all protein-rich dairy. And it’s also recommended that you add in one root vegetable, particularly known for removing ammonia, which is yucca, also known as cassava. It’s actually used in aquaculture to control ammonia levels and fed as a supplement to fish and shrimp. Also, in my client’s experience, removing sugar and carbs was a really essential component to feeling better because candida feed on sugar and carbs and were adding to his ammonia load as a byproduct of their metabolism. Lucy Mailing, PhD also recommends a similar diet for people diagnosed with an overgrowth of hydrogen sulfide producing bacteria. Your tip-off that this may be an issue is when your gas smells like rotten eggs. Her recommendations include a diet void of animal foods and dairy for 3-4 weeks, low fat, only olive, avocado and coconut oils, and avoiding sulfur-containing vegetables if they cause symptoms.

So that’s a lot of information, I know, but hopefully it may have given you a place to start on understanding the variety of potential diets that can be used to address gut and health issues.

When I’m working with clients, I help them understand what dietary protocol might be best to try, along with simultaneously testing the gut through the GI Map or Organic Acids Test to see if there is another root cause of their symptoms.

If you want more help with your gut, autoimmune or other health issues, you can set up a free, 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether my 5-appointment gut health coaching program or a longer program for autoimmunity or weight loss is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

Schedule a Breakthrough Session Now

Listen to episode 39 of The Perfect Stool: Understanding and Healing the Gut Microbiome.

*Product links in this article are affiliate links on Amazon. Thanks for your support of the podcast and blog by using my links!

10 Home Hacks for Constipation

Adapted from my interview with Esther Blum, RD, on episode 37 of the Perfect Stool: Understanding and Healing the Gut Microbiome.

  1. Eat plenty of fiber. One common cause of constipation is not getting enough fiber. Esther Blum, RD, recommends getting at least 20 to 40 grams of fiber per day — 20 grams at first because it’s important to start slow. If you’re not eating any fiber and you suddenly start eating a lot, you could experience gas, bloating and discomfort, so you have to build up your fiber intake over time. It’s also very important to increase your hydration as you increase your fiber.
  2. Hydration. Wondering how much water you should drink? Here’s a trick: take your body weight, divide it in half, and convert that number to ounces. So, for example, if you’re 160 pounds, you need 80 ounces of water. In addition, for every 20 minutes of intense workouts, you need another eight ounces, and for every cup of caffeine, you need another eight ounces.
  3. Magnesium. Try taking 400-800 milligrams of magnesium at night before bed to keep your bowels moving. Magnesium citrate is known for its help in moving bowels (decrease your dosage if your stools end up too soft).
  4. Wake up and walk first thing in the morning. This is a wonderful way to gently massage your intestinal tract and keep things moving.
  5. Water with lemon. Drinking warm water with lemon upon arising gives your gallbladder and liver a good flush.
  6. Celery juice. There isn’t a lot of clinical research to support celery juice as a remedy for constipation. But anecdotally, in her practice, Esther Blum has seen it work really well, because, like with lemon water, it gives the liver a good flush. First thing in the morning, cut the base and tips off of an entire bunch of celery, wash the stocks, then run them through a juicer. Drink the juice on an empty stomach. Wait 20 minutes, and then carry on with your morning routine.
  7. Toilet hygiene. Practice sitting on the toilet in the morning for 20 minutes and reading. This will train your body to have a bowel movement first thing in the morning.
  8. Exercise. The human body is not designed to sit all day. It’s supposed to be moving and active. If you’re lying in bed or sitting all day, your intestines are not moving around or getting stimulation.
  9. Chew your food well. Most people don’t realize that digestion begins in the mouth. You really have to chew your food until it’s a slurry. It should be the consistency of baby food before you swallow it. The better you chew your food, the better chance you have for smooth digestion.
  10. Stress-management. Stress is a leading cause of constipation. If you’re holding things in and holding on to your stress – you can become very constipated. Developing regular stress-management activities for yourself during the day can be a great tool for alleviating constipation – and for improving overall wellness, too!

If none of the above solve your problem, a good polyphenol-based product called Atrantil has been successful for some of my clients in improving constipation. You can find it in my Fullscript Dispensary.

And if none of this helps your constipation, you may have a more serious gut health issue that requires testing and more advanced interventions. I can educate you about both. To tell me more about what you’ve been struggling with and hear about my 5-appointment gut health coaching program and decide if it is a good fit for you, you can set up a free, 30-minute Breakthrough Session with me (Lindsey). Individual 1-hour consultations may be scheduled directly here.

Schedule a Breakthrough Session Now

Listen to episode 37 of the Perfect Stool: Understanding and Healing the Gut Microbiome.

ISB Treatment: Addressing an Irritable Bowel Naturally

IBS, or Irritable Bowel Syndrome, is a digestive disorder which affects more than 10 percent of the world’s population. This article explores traditional and functional medicine approaches to treatment of IBS; testing; and the relationship between IBS, SIBO and IBD. And if those initials don’t mean anything to you, don’t sweat it, they’re all covered in this article.

So… what is IBS?
IBS is a cluster of symptoms that include abdominal pain, cramping or bloating that may be alleviated by a bowel movement; excess gas; diarrhea, soft stool, constipation or alternating diarrhea and constipation; and mucus in the stool. Other symptoms of IBS might include changes in texture and color of stools, nausea, acid reflux, easily feeling full or loss of appetite.

There are also non-digestive symptoms of IBS, which people might be less aware of. These can include anxiety or depression, difficultly sleeping, fatigue, headaches, an unpleasant taste in the mouth, muscle aches, sexual problems, body image issues or heart palpitations.

For most people who suffer from IBS, symptoms are worse at certain times, improve at other times, and even disappear altogether for periods of time. For some people, IBS symptoms are not severe, and can be managed with diet, lifestyle and stress management; but for many others, they can significantly impact their quality of life, make it hard to leave the house because of urgent runs to the bathroom with diarrhea, may involve accidents necessitating a change of clothes, and may impact people’s ability to work or be seen as reliable at work or in their social life. And unfortunately, many suffer in silence and don’t get the help they need because of the stigma or embarrassment.

IBS presents itself differently in different people. Clinicians organize the syndrome into three basic types: constipation-predominant (called IBS-C), diarrhea-predominant (IBS-D), or alternating constipation and diarrhea or mixed (IBS-M). According to Dr.Jockers.com, as much as 12 percent of the U.S. population suffers from IBS, or nearly 40 million people, and women and people under the age of 45 are more prone to IBS.

What’s the difference between IBS and SIBO?
SIBO, or Small Intestinal Bacterial Overgrowth, is believed to be the most common cause of IBS, with some experts citing the figure of approximately 60-70% of IBS being caused by SIBO. And the symptoms of SIBO (bloating, constipation, diarrhea, flatulence and abdominal pain) overlap with IBS, so in some sense, one could reasonably say that they’re basically the same thing, but IBS is more of a traditional or allopathic diagnosis, while SIBO is used more in the functional medicine world, although more and more gastroenterologists are using the term SIBO, the American College of Gastroenterology has put out clinical guidelines for treating SIBO, and some gastroenterologists are now using some of the same testing methods as functional medicine practitioners. And like with IBS, SIBO has traditionally been divided up into SIBO-D, SIBO-C and SIBO-M.

However, the nomenclature of SIBO and the issue of whether symptoms are coming from general bacterial overgrowth has been called into question because the testing that has been used to diagnose it, that is hydrogen and methane breath testing, has neither been shown to be terribly reliable, in particular with the hydrogen part (meaning that if you test at one time, do no treatment, and test two weeks later, you get different results), nor has it been shown to be valid in at least two recent studies (Cangemi et al., 2020), (Saffouri et al., 2019), meaning that if you compare aspirates (or suctioning of) bacteria in the small intestine, it doesn’t correlate with what’s showing up on breath testing or with patients’ symptoms. And an article published out of Dr. Mark Pimintel’s lab out of Cedars-Sinai Hospital (a leading SIBO researcher), seems to validate the lack of validity of the hydrogen breath tests in the abstract, where it says that at the 90-minute time point on the lactulose breath test (which is considered the cutoff time for measuring gases coming from the small intestine), 4/7 SIBO subjects had a rise in hydrogen (H2) ≥ 20 ppm above baseline, which would mean they had SIBO, as compared to 2/13 non-SIBO subjects. So first, those are small sample sizes so it’s difficult to call these results definitive, but at least in this study, the hydrogen breath test only correctly identified SIBO 57% of the time, and 15% of the time gave a false positive for SIBO in someone without it as compared to the results of the duodenal aspirates (or sampling of cells in the first part of the small intestine, or duodenum). This is one of the main reasons I never recommend breath testing to my clients.

There is some interesting information coming from that study, however, including that subjects with bloating had a relatively higher abundance of bacteria from the family Enterobacteriaceae, while people experiencing urgency with bowel movements had a relatively higher abundance of bacteria from the family Aeromonadaceae. Also, the subjects with what they were calling SIBO (based on the quantity of the bacteria in their small intestine) had a 4.31-fold higher relative abundance of the phylum Proteobacteria (averaging around 37%) and a 1.64-fold lower relative abundance of the phylum Firmicutes. They also reported that subjects with SIBO also exhibited greater urgency with bowel movement than non-SIBO subjects (P = 0.022), which was the only symptom they seemed to be able to correlate to overgrowth, which again in my opinion calls into question the definition of SIBO as a state of general bacterial overgrowth. And, a brief aside for people who have studied statistics, the p value on that last item was only. 0.022, versus 0.0001 for the relative abundances by family and phylum. So clearly the more statistically significant issue shown in that study is the predominance of proteobacteria, and in particular, Enterobacteriaceae and Aeromonadaceae. And further, they also found that SIBO subjects had relatively more bacteria from the genera (which is the plural of genus by the way) Klebsiella, Escherichia/Shigella, Acinetobacter and a couple more unknown genera.

As a result, “SIBO” may not be the right word. Rather, the term “dysbiosis,” which typically implies that there is an overgrowth of a particular kind of bacteria (but maybe not bacteria in general) may be more accurate. Dysbiosis may be bacterial overgrowth in both the small and large intestines, or an overgrowth of yeast in your intestines (also known as SIFO, or Small Intestine Fungal Overgrowth), an infection with a parasite, a general lack of diversity, or underrepresentation of certain important species. However, in my experience looking at lab results of tests like the GI Map and Organic Acids Test, typically all three things are happening at once when you have symptoms of IBS. But that being said, I have a client now who has an IBS diagnosis and symptoms, and when we did her labs, there were no overgrowths of pathogenic bacteria, no yeast overgrowth, and it seems like the amino acids I educated her about to help bring up her dopamine and serotonin levels have already positively impacted her IBS, which points to anxiety and stress as a likely root cause in her case. So you never know what you’re going to find out until you test. That, by the way, is one of the benefits of doing an Organic Acids Test – it helps identify when things are going wrong with your neurotransmitters, which impact your mental health, which is often impacted when you have gut issues.

As I mentioned above, IBS is divided up by whether it involves diarrhea, constipation or both. For people with constipation, it’s usually caused by an overgrowth of methanogens, or methane-producing microbes. Rather than grouping that under SIBO-C or IBS-C, the newest term being used is IMO or Intestinal Methanogen Overgrowth, because the methanogens may be located in both the small and large intestines, plus the term SIBO has the word bacteria in it, and archaea are not bacteria. [All organisms on earth are separated into three domains: eukarya (which is where you find animals, including humans), bacteria and archaea]. Anyway, IMO can be another cause of IBS, especially if it involves ongoing constipation. 

Now some good news for people who have been suffering and can’t figure out exactly why: breath testing that includes a third type of gas in your small intestine, hydrogen sulfide, has just come online for commercial use. Prior breath testing was for hydrogen and methane, with hydrogen typically being associated with diarrhea and methane with constipation. But up until now, you couldn’t test for hydrogen sulfide in a commercial setting; it was only used in a research setting. This new test was developed by Dr. Pimintel. It’s called trio-smart™ and it’s is available from Gemelli Biotech. It looks like an overgrowth of hydrogen sulfide-producing bacteria is also typically associated with diarrhea. Breath tests can be done in a lab or using a home kit, which is what the trio-smart is. If you drink glucose and do any type of SIBO breath test, which involves breathing into a tube and saving the results, it covers the first part of your small intestine. If you drink lactulose and do the test, it covers the lower part of your small intestine. Dr. Pimintel also developed a test called ibs-smart™, which tests for autoimmune markers which impact your intestinal motility, which can be a root cause of IBS, originally brought on by food poisoning, which likely is the primary root cause of IBS.

But the long and short of it is, what you’ll find out by doing an ibssmart test is whether you have an autoimmune issue, which you’ll need to address after killing any dysbiotic micro-organisms, by using something called a prokinetic. That’s a drug or natural substance, like ginger, that helps the intestines to move. Some of the prescription medicines used as prokinetics are low dose erythromycin, low dose prucalopride and lose dose naltrexone and one neutraceutical one is called Iberogast*. So if you seem to have recurring problems even after SIBO or IBS treatment, try taking a ginger pill before bed, or have a cup of ginger tea in the evening after dinner to stimulate the migrating motor complex as you sleep. Or if those don’t work, you may need something by prescription to deal with your motility issues. Or you can skip the test, cure your IBS, wait and see if it comes back quickly, and if it does, you’ll probably need to take a prokinetic. And at minimum, once you’ve cleared up your IBS or dysbiosis, you should make sure you don’t eat more frequently than every 4-6 hours, you don’t eat at least 2 hours before bed, and you go at least 12 hours at night without eating, to allow your intestines to clear out and let the migrating motor complex do its job.

So if dysbiosis is a root cause of IBS, maybe even covering 60-70% of it, what about the rest? IBS can be related to other things, like adhesions or bands of scar tissue from a surgery, inflammation or an injury that’s keeping your intestines from moving properly. Or it could be from Ehlers-Danlos syndrome, which is a hyperflexibility condition that can impact your intestines. Or it could be from hypothyroidism, blood sugar issues, type 2 diabetes, drugs you’re taking or took, Lyme disease or various autoimmune diseases like scleroderma or rheumatoid arthritis. Or it can be from a traumatic brain injury, which can also impact your migrating motor complex.

What’s the difference between IBS and IBD?
Now just a brief interlude to address the difference between IBS and IBD, or Irritable Bowel Disease. IBD is an umbrella term which describes digestive disorders caused by inflammation of the bowel, and autoimmune issues that affect the gut and intestines, including Crohn’s disease, ulcerative colitis and microscopic colitis. IBD symptoms are typically more serious and less common than IBS symptoms. These might include: loss of appetite, blood in the stool and nutrient deficiencies brought on by malabsorption.

How is IBS diagnosed and treated?
Typically doctors will give a diagnosis of IBS once they’ve excluded everything else, including IBD, which usually involves an endoscopy (or where they put a camera down your throat to look at your esophagus, stomach, and the upper part of the small intestine), and a sigmoidoscopy or colonoscopy (where they put a camera through your rectum to look at your colon, or for a sigmoidoscopy further into your small intestine). That’s one of the reasons Dr. Pimintel has developed the tests mentioned above, to spare you having to have the entire length of your intestines scoped. But typically, if the endoscopy and colonoscopy are negative and gut symptoms continue, including abdominal pain for at least 12 non-consecutive weeks out of the precious year, characterized by a change in how often you have a bowel movement, and your bowel movements are not normal, then a diagnosis of IBS may be indicated.

If you see a functional medicine practitioner with an IBS diagnosis or symptoms, depending on your symptoms, you will likely either be asked to do a PCR-based stool test like Diagnostic Solutions’ GI Map or Doctor’s Data’s Comprehensive Stool Analysis with Parasitology, a SIBO breath test and/or an Organic Acids Test. The results of those tests will give your practitioner a lot more data about what’s actually at the root of your issues.

In terms of treatments, if you see a traditional gastroenterologist and have a positive breath test or just based on symptoms alone, you may be prescribed antibiotics, in particular one called Rifaximin or xifaxin, an antibiotic that only impacts bacteria in the intestinal tract. It’s super expensive though – last I checked it was about $1750 for a two-week course – so if your insurance won’t cover it or your doctor isn’t in the know, you may want to go the herbal antimicrobial route. There are also some other antibiotics that may be helpful, including neomycin, metronidazole, augmentin, bactrim and nitazoxanide. However, although antibiotics may reduce your symptoms in the short-term, many times they may further stress the gut lining and microbiome or cause an incidence or increase in fungal overgrowth, which will cause a relapse or even a worsening of symptoms in the long-term. Rather than an antibiotic approach, many naturopaths, functional medicine practitioners and experts in the field prefer antimicrobial nutraceuticals because they simultaneous address both bacterial and fungal overgrowths. Typical antimicrobial herbs used for dysbiosis include Berberine, Allicin from garlic, Oregano Oil, Thyme Oil and Uva Ursi. And hydrosol silver and bismuth are also used. One of my favorite protocols that kills both bacteria and yeast is using the Candibactin BR* and AR* products. But you’ll want to get help using them because the die-off or Herxiemer reaction can be unpleasant or even dangerous if you have severe overgrowths of bacteria or yeast. That’s when you have flu-like symptoms as you begin to kill stuff in your intestines. And then once you have dislodged the bacteria and yeast, you want to use prebiotics and probiotics strategically to help reset your microbiome in an effective manner.

Some additional supplements that may be effective in addressing IBS symptoms or root causes include Betaine HCl* and digestive enzymes*, especially if there is evidence of a lack of stomach acid or pancreatic enzymes, respectively, on the GI Map test. And if there’s evidence of leaky gut, like food intolerances, or low gut immunity (indicated by low secretory IgA on the GI Map) l-glutamine powder* and an IgG product like MegaIgG* or Megamucosa* can be helpful. And then there are some supplements that help soothe and lubricate or reinforce the mucus lining of the digestive tract, like aloe vera*, which also helps with constipation, as well as marshmallow root, DGL and slippery elm (which can be found in combination products like this one*). And Atrantil (find in my Fullscript Dispensary) is a great over the counter medication that’s very helpful with constipation and actually consists of various plant polyphenols. And another really good one for help with bloating is peppermint oil*, which is good to take prior to meals.

One of my mentors, Lucy Mailing, PhD, believes that treatment shouldn’t focus on quelling bacterial overgrowth by antibiotic means. Rather, she focuses on the depletion of the short chain fatty acid butyrate, which is the food for the cells lining the colon (while glutamine, by the way, is the food for the cells lining the small intestine). Antibiotics, gut infections, low-fiber intake, and stress are all factors that can deplete gut butyrate, causing oxygen leakage into the gut. This encourages gut dysbiosis characterized by an overgrowth of faculatative anaerobes like proteobacteria, which can survive in the presence of oxygen. Therefore, she recommends avoiding antibiotics, treating fungal gut infections, eating plenty of fiber, managing stress and getting plenty of regular exercise. Speaking of which, a study published in the American Journal of Gastroenterology in 2011 found that increased physical activity improves GI symptoms associated with IBS, and improves quality of life to such a great extent, that exercise should be utilized as a primary treatment for symptoms associated with an irritable bowel. If you’re thinking of supplementing with butyrate and some more advanced interventions that Lucy recommends, I’d suggest you do it under the care of an expert gut health practitioner, such as myself. I’ve personally found supplemental butyrate to be one of the most helpful things for me in keeping my bloating in check and my stool at a nice Bristol #3. In case you’re not familiar with it, the Bristol stool chart rates stool from 1 to 7. A 3 or 4 is considered normal, but I’d much rather a 3 than a 4, personally.  

In terms of diet, one of the most commonly recommended for IBS is a low FODMAPs diet (which stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols), which, along with eliminating gluten, dairy, and a wide selection of fruits and vegetables, eliminates the omnipresent ingredients garlic and onion and their powders. The low FODMAPs diet should not be used long-term or it may result in the extinction of vital gut microbes. Rather, it’s best used to precede treatment to reduce symptoms, as a self-diagnostic tool (if you do better on it, you know your issue is at least partially bacterial) and to temporarily deplete the microbes that cause problems, so your killing regime will be more successful. Or it can be used as an elimination and reintroduction diet to see which of those foodstuffs most affect you. There are also other diets out there that are even more restrictive like the specific carbohydrate diet or the biphasic diet, but honestly, I think low FODMAPs is already a lot to ask of people, so I generally go the route of treating the underlying cause of IBS symptoms quickly rather than playing out a difficult diet like FODMAPs. But honestly, by the time most of my clients find me, they’re usually reduced to a diet consisting mostly of vegetables, meat and fat in their desperation to find a solution to their problems, so I’m not inclined to ask them to restrict their diet even further. 

Could my gut issues cause or be the cause of my autoimmunity?
So if you have a mild case of what seems like IBS, you may just be toughing it out thinking the symptoms are tolerable, but be careful. My gut issues preceded my autoimmune issues, and I know they’re related. Dr. Alessio Fasano, a pediatric gastroenterologist, research scientist, and founder of the University of Maryland Center for Celiac Research, believes three factors are at the center of all autoimmunity issues. They are genetic susceptibility, antigen exposure and increased intestinal permeability. Given that you find increased intestinal permeability in IBS and dysbiosis, it is not surprising to find that they are common underlying causes and precede many autoimmune conditions. Although that association isn’t entirely clear, what it clear is that with its high likelihood of generating leaky gut, it is important to address IBS for the prevention and treatment of autoimmunity.

If you want more help with IBS or other gut, autoimmune or other health issues, you can set up a free, 30-minute Breakthrough Session with me (Lindsey) to share what you’ve been going through and decide whether my 5-appointment gut health coaching program or a longer program for autoimmunity or weight loss is a good fit for you. Individual 1-hour consultations may be scheduled directly here.

Schedule a Breakthrough Session Now

Listen to episode 36 of The Perfect Stool: Understanding and Healing the Gut Microbiome podcast.

*Product links in this article are affiliate links on Amazon. Thanks for your support of the podcast and blog by using my links!