Author: highde22_wp

Adapted from episode 130 of The Perfect Stool podcast with Ricky Harrison, MPH, Client Engagement Coordinator at FoodMarble, developers of handheld personal devices for SIBO/IMO and food intolerance testing, and Lindsey Parsons, EdD, and edited for readability.

Lindsey: 

So can you tell us about how long the FoodMarble has been around, and what are the different things it measures?

Ricky Harrison: 

Absolutely! First we started out through crowdfunding, and that helped us with a lot of R&D and getting things set up with logistics, those types of things. So just basically getting set up and ready to start to distribute. Once we were ready to sell, we went for live sale in 2019, or I guess you could really say around November, December of 2018, so that was with our AIRE I device, and we had that going live, and we shortly released the MedAIRE device after that. And in the summer of 2022, we released AIRE 2, and MedAIRE 2 followed that.

Lindsey: 

Okay, and are the med versions the medical ones?

Ricky Harrison: 

Yes. So our AIRE versions are our consumer devices, and then we have our MedAIRE devices, which are FDA approved class one medical devices.

Lindsey: 

And when I recommend a device to a client, are they getting the medical one?

Ricky Harrison: 

Yes, so they’ll be getting MedAIRE 2, and that’s available only in the United States. The AIRE 2 and the AIRE 1 devices are still available also in the US consumer market, but that’s distributed everywhere else in the world.

Lindsey: 

Cool. So I didn’t realize it was an FDA approved device. So how hard was that approval to get?

Ricky Harrison: 

It was a very long, very long process, but we got there in the end. A lot of sending forms and developing various pathways for things like calibration, the way we handle complaints, all sorts of things. So it was quite involved, and that took us quite a while to get done.

Lindsey: 

So do you have to prove to the FDA that you’re accurate, sensitive, and what’s the other word, specificity?

Ricky Harrison: 

Yeah, yeah. We’re a completely validated machine that can produce valid results that can be used for the diagnosis of medical conditions such as SIBO, IMO, carbohydrate malabsorption, those types of things. And on the back of that, the AIRE one and MedAIRE 1 devices measure hydrogen and the AIRE two and MedAIRE  2 devices measure hydrogen and methane, and the devices can be used to either diagnose or aid in SIBO, IMO, carbohydrate malabsorption and food intolerance. (To order a medical-grade Food Marble device, the MedAIRE 2, email lindsey@highdeserthealthcoaching.com for an invitation.)

Lindsey: 

Okay? And what kinds of food intolerances?

Ricky Harrison: 

So we offer, currently, four different substrates for patients or customers to see how they respond to different FODMAPs. The ones that we provide currently are fructose, inulin, lactose and sorbitol.

Lindsey: 

Okay. And so what are you hearing from practitioners about why they prefer the FoodMarble to laboratory SIBO and IMO testing.

Ricky Harrison: 

A big part of it is having the immediate results so they can start patient treatment faster. And another thing is they are able to monitor the patient. So one of the huge advantages that we offer with FoodMarble devices, is that clinicians can follow their patients along. So let’s say a SIBO test comes back positive and they start treating the patient. They can then have the patient take daily breath tests to see how the patient is responding to treatment, how their gas profile changes as they move through the treatment. And this gives them quite a bit of information. One of them, it helps them to glean whether the treatment is working. And the second one is it allows them to see what the optimal time for retesting is. So you have a period where the patient is testing along, and their scores may be a bit higher or whatever, but over time, what you would expect to happen if the treatment is working is that the overall breath ranges will go down, and eventually they’ll level out to a point. And this gives you an idea, somewhere around this point after they’ve been leveled out for a little bit, when the optimal time for retesting is to see if you’ve cleared the SIBO.

Lindsey: 

Right. So those daily breath tests are not with a substrate like glucose or lactose, and then the official tests are, correct?

Ricky Harrison: 

Absolutely, yeah.

Lindsey: 

And so for the regular ones, you just do it after a meal, or when would you do it?

Ricky Harrison: 

So there are a couple of different ways to do it, and we’re always investigating this based on data that we’ve collected. Since 2018, millions of breath tests have been taken with the device. So we’ve lots of breath test data, lots of meal data, and we can look at all of this stuff and find out when those optimal times for breath testing are, and we’re constantly learning about that process. But the way that it would normally work is, if you have a patient and they are going through SIBO treatment, say, they can basically take one breath test an hour to 90 minutes after they’ve consumed their first meal of the day, and then they can repeat that again in the evening following their evening meal, and then that would be enough so that you can see over time, as they move through treatment, if their gas profile is going down.

Lindsey: 

And why so long after a meal?

Ricky Harrison: 

Well, since it’s solid food, it’s not quite as fast as the substrate. So when they are drinking the solution, that’s obviously in liquid form. It goes right down the esophagus, right through the stomach, and starts working in the small intestine. However, when you’re dealing with solid foods, that’s going to take a bit longer. It’s going to take it longer to break down in the stomach, and it’s going to take a while to eat it all. So you just want to give it a bit of time to make certain that it’s in the small intestine and then the large intestine. And then you can see how gas production is going along in those times.

Lindsey: 

Okay, great. I’m glad I asked you that, because I’ve just told my clients, oh just just take it any old time to see what you get. I’m still learning how to use the device properly, as opposed to the official lab tests. And can you explain the difference between the typical testing substrates, the glucose and lactulose (and I know there’s also fructose that people are using), and what they’re recommended for?

Ricky Harrison: 

Oh, yeah, absolutely. So the standard substrates for SIBO would be glucose and lactulose. And for IMO, you’re testing the small intestine and the large intestine, so lactulose is a good one for that one, because it will stay in the system from start to finish. So basically, for SIBO, you’re looking for a rise in hydrogen of 20 parts per million within 90 minutes of the test, and that’s above baseline. So if the baseline is five, you’re looking for a rise of 20 parts per million. So you’ll be looking at a minimum of 25 parts per million by 90 minutes. And for IMO, you’re looking for a rise of 10 parts per million at any time during the test. So this can be before 90 minutes, after 90 minutes, it doesn’t matter. And again, that’s based on the baseline. So if the baseline is two, you’re looking for 12, to at least reach 12.

Lindsey: 

I believe I’ve been watching webinars where SIBO experts have been saying for IMO, if you’ve got a rise of five plus the symptoms, the bloating, the constipation, that that’s probably good enough.

Ricky Harrison: 

Yeah, absolutely. So symptoms play a very large part in a lot of this testing. And you mentioned fructose before, so fructose has been found to be quite effective in determining whether there’s the possibility of SIBO. And quite interestingly enough, it’s been found in a study done by Dr. Hawrelak, that testing with all three substrates gives you nearly, or at 100% accuracy, in determining whether there’s the presence of SIBO, and fructose, on its own, was more effective than both lactulose and glucose in his study. So that’s also another substrate that can be used. And even working with clinicians, I’ve seen that become a more popular option.

Lindsey: 

And do you use that in the same quantities you would use the glucose and the lactose?

Ricky Harrison: 

So we offer it in a 25-gram sachet, which is pretty much what you’d use for fructose intolerance. So it’s the same substrate. You can use it for both.

Lindsey: 

Okay, yeah, what then differentiates fructose intolerance from SIBO? And is it possible that fructose intolerance isn’t actually a thing, that it’s just SIBO?

Ricky Harrison: 

So there is SIBO-induced fructose intolerance, and then there’s fructose intolerance. So SIBO-induced fructose intolerance is basically that you’re testing a patient and you’re using fructose as your substrate, and they have that initial high rise, or they have that typical rise that you’re looking for. For SIBO, in a way, you may not know it’s SIBO-induced fructose until you treat for the SIBO, and then if you test again with the fructose you may see it flattens out, and then you may see a rise at the end, which means it’s in the colon, which is normally where you would expect to see it. If it is the food intolerance, or fructose intolerance, you expect to see it after that 90 minutes, because it would be colonic at that point.

Lindsey: 

Oh, okay, so fructose intolerance is normally something in the colon?

Ricky Harrison: 

Typically, yes.

Lindsey: 

Okay, and what about the other food intolerances? Are they measured differently than, say, on a SIBO test, like, what constitutes a positive test for the other substrates?

Ricky Harrison: 

Yes. So for our food intolerance, we use the European guidelines, and so it’s really fructose and lactose. And so you’re really looking for a rise based on the European guidelines at any point during the test. So it could, in turn, be SIBO-induced fructose intolerance. So we use that for all of them. So for inulin, lactose, sorbitol, we use that guideline at any point during the test. You’re looking for a rise of 20 parts per million.

Lindsey: 

Yeah. So the dilemma, of course, you know, you talked about it, yeah, if you do all three substrates (fructose, glucose and lactulose), you’ll get a perfect rating on SIBO. The dilemma is that it’s really kind of a big deal to do a breath test. And now, having just done them, I can say, right, so the day before, you have to restrict your diet to like, four foods, right? What is it, chicken, rice, eggs, a little bit of butter or oil, salt and pepper.

Ricky Harrison: 

Potato. Yeah, we would definitely recommend staying away from butter unless it’s lactose free.

Lindsey: 

Butter, oh, right, okay. Or ghee, ghee, I think it was, right? Okay, so you’ve already done that, so then the next day, you’ve got to wake up and drink this solution that’s full of sugar. So a lot of the people that I’m dealing with already have very sensitive guts that really don’t like sugar in any form because it’s going to cause inflammation, right? So then they have to drink this solution, and then they have to spend the next almost three hours, is it?

Ricky Harrison: 

So it’s two hours if you’re using glucose, but three hours if you’re using any other substrate.

Lindsey: 

Okay, so two to three hours testing every 15 to 20 minutes, depending on whose test you take.

Ricky Harrison: 

Absolutely.

Lindsey: 

So it’s a bit of a commitment. So, you know, you’ve got to be home, you can’t eat anything else. So the whole process is kind of cumbersome, say, compared to a stool test. So the idea of doing three different substrates to me seems kind of silly, like you want to get the most bang for your buck. It seems like the Hawrelak study showed that fructose was actually the best bang for your buck. Well, I guess there’s also the dilemma that in the US, you cannot get lactulose without a prescription. So then I’m suggesting, get your own fructose online, or whatever, if they’ve gotten the glucose kit, and then use that instead to test with right? So that just makes me think of a question I hadn’t thought of, which is, have you guys considered just sending out fructose as a testing medium, or is it just not accepted in the standards of practice yet?

Ricky Harrison: 

So you can’t do that. Well, if the clinician is comfortable diagnosing SIBO using fructose, we are more than happy to provide that for the clinician.

Lindsey: 

Instead of glucose?

Ricky Harrison: 

Yeah, just let us know that “I use fructose, I want to use fructose,” and contact me.

Lindsey: 

Oh, okay, great, great. You know, that would be wonderful, because I think I’d much rather catch more of the cases with fructose, especially because a lot of my people that I’m recommending it to are people who have the signs of methane overgrowth, of the constipation and bloating and sometimes smelly gas and such. So, yeah, yeah.

Ricky Harrison: 

Back to the point of Dr. Hawrelak’s study is just the three will get you the 100% accuracy. Now fructose on his own will give you the highest of the three. He found it was around 85.7% I think it was, but you can even combine two. So in one of his interviews that I did watch some time back, he said that he stopped using glucose altogether and was just doing lactulose and fructose. And I think that gives you somewhat in the 90s of accuracy.

Lindsey: 

Ah right, yeah. But again, in the US, you know, if you’re not a doctor, you can’t prescribe it, so you can’t really get it here. But okay, and then what was the percentage for glucose alone?

Ricky Harrison: 

Glucose on its own, I think it was, I think it was 70 something.

Lindsey: 

Okay. But so what was he testing it against? So he was saying, we know these people have SIBO. How did he know that? Because some other testing medium showed it, or because there was some other, you know, an endoscopy with a . . .

Ricky Harrison: 

So one of the limitations that he did point out was that it was just the breath testing that was used. So it was a lactulose breath test on its own, a fructose breath test on its own, and a glucose fructose test.

Lindsey: 

Okay, so the assumption was that if they took all three breath tests and one of them came back positive, they have SIBO. Now let’s see how they’ve done on each individual one essentially, right? Okay, so I have recommended the FoodMarble to some clients, and their biggest concern is accuracy. So I’m just curious if you have done a study of comparisons between the FoodMarble results and standard breath testing?

Ricky Harrison: 

Absolutely, we’ve done several studies with research groups, some independent groups, who’ve done studies with the device as well. We do a lot of in-house studies as well, and we’ve several abstracts and papers that are available if you go to our website, foodmarble.com/GI/science. You’ll be able to see all of our studies there on the website, so you’ll be able to read them all. We have one abstract that we’re waiting to be published. We presented it at ACG, and that one goes over a validation of the hydrogen and methane against benchtop machines such as Quinton and Bedfords.

Lindsey: 

Okay, so I actually did two tests at the same time. I did my test with the FoodMarble, and I did one through Aerodiagnostics that I got my doctor to order for me. And although each reading wasn’t at the exact same time, because the FoodMarble was every 15 minutes, but the other test was every 20, both came out negative for SIBO, and both showed that the only gas that went up much at all was hydrogen. So the highest point on the Aerodiagnostics for me was 16 parts per million at 80 minutes, and at 81 minutes the FoodMarble showed seven parts per million. And so I think this might be different because of the way you instruct people to breathe out without taking a breath, which is kind of tricky, because in other words you’re just barely having enough breath to finish going out, because you’re supposed to breathe out for three seconds and then put it in your mouth, and then keep breathing out. Whereas the other breath test I would breathe in, hold it a little, then I would just breathe out into the thing, so we’d get the whole thing. So I’m kind of wondering why the breathe out for three seconds then go on to the device?

Ricky Harrison: 

So you’re not actually breathing out. So I have the device here, so it’s not powered on or anything, but when it’s on, all these lights will be lit up and blue all the way around. I would stop breathing and hold down this button so I’d pause my breathing, I don’t suck in or anything like that.

Lindsey: 

After you’ve conceivably taken a breath, right?

Ricky Harrison: 

Well, I normally, I’m just in my normal state, yeah?

Lindsey: 

But I mean, you’re very conscious of whether you’ve taken a breath or not. So that’s the tricky part. You have to have enough breath to get five seconds worth of breath out. So you really have to have taken a breath.

Ricky Harrison: 

Well, maybe I don’t know, but what I do, I’ll stop talking to you, and then I’ll just do it, and I’ll show you, I don’t take in a breath or anything. So I’m just now talking, and I have plenty of breath left. Okay? I do know at the start it does take quite a bit of practice, but you saw I went straight from talking to you to holding my breath; you’re really breathing for eight seconds.

Lindsey: 

And what’s the concern if you actually just breathe in first, if you aren’t taking a super deep breath, but you’re just taking a normal breath?

Ricky Harrison: 

Oh, you’ll be fine. The way that it works is basically, as you’re breathing through the device, you have that five second exhalation period. The actual sample is only collected at the end of that five seconds, so it’s ensuring that it’s getting alveolar breath. And so what we’re trying to do by keeping people from taking in big breaths is that they are not contaminating it with ambient air.

Lindsey: 

Yeah. So okay, now I see the dilemma, because as I’m breathing out in the device, I was breathing out for three, then putting it on my lips, continuing to breathe out for five, sometimes by the end, I barely had any breath left. So that might explain why I had lower results on my FoodMarble than on my Aerodiagnostics. But most of them were pretty consistent. In fact, I was going to share this screen and show you what the two tests looked like.

Ricky Harrison: 

Oh, perfect. Yeah, yeah.

Lindsey: 

So this is my results from the FoodMarble MedAIRE 2. I assume I’ve got the med version, and so you see my highest reading here. Baseline was five parts per million on hydrogen, nothing on methane. And then I went up only as high as eight. So even though I had some amount of bloating, even some nausea after drinking that glucose solution, it did not show that I had SIBO. Yep. And then this was my Aerodiagnostics test. It was faxed, or whatever. You know, it’s a scan of a fax; medical systems are still in the dark ages. But anyway, this is the hydrogen column. This is the methane column. And you can see here on the chart that this is the methane down here. So I only had one at baseline and nothing else. But basically, my highest number was this 16.

Ricky Harrison: 

What was your baseline? Is it 11 or 12? It looks like they’re two.

Lindsey: 

I know it does look like it. Oh, it’s the combined. That’s that’s the combined line 11 of my baseline for hydrogen. Yeah, so my baseline for hydrogen here was five, whereas it was 11. So I’m sure the way I was breathing out was different. Is there a lot of hydrogen in the air? Did they get the contamination?

Ricky Harrison: 

Oh, no, you’ll be fine. Well, so it doesn’t really look like they’re that far apart, though, when you think about it. So your baseline is 11.

Lindsey: 

No, I mean, most of the numbers are exactly the same, like 5 6 7 6 7, same thing, 5 7 5, from baseline. I’ve only essentially gone up by five at the most here.

Ricky Harrison: 

So, right. So yeah, so not terribly different at all.

Lindsey: 

Yeah, tragically, I did not have SIBO, so I did not get any Rifaximin. Yeah. My original plan was actually to do the FoodMarble test determine if I had SIBO, and then if I didn’t, wait until I got it, because it always it keeps coming back for me because I have autoimmune IBS. So anyway, I did not, unfortunately, come out positive this time. So I’m having to doing the herbal supplements and control it with diet and such, which is maybe a good testament to the fact that I’m actually controlling it better than I think it is, and I’m mostly just overeating, and that’s why I’m bloating every time I go out to dinner.

Ricky Harrison: 

And I’d like to point out, here’s another benefit to the FoodMarble is that you now have your device. If you want to test again, all you need is the substrate. You don’t have to order a whole another kit.

Lindsey: 

Oh yeah, no, that’s the no brainer for me, when I recommend it to clients, is that if you do two tests, and people who have IMO, they’re typically having to go through multiple rounds of herbal antimicrobials. It’s very hard to eliminate. So if you can have some sense of, okay, I know it feels like this is taking forever, but some hope along the way, well, your numbers are actually going down over time. And here we have this device that can measure it, versus I’m going to have to send you out. You’re going to have to finish up your antimicrobials, then per the protocol, by request of the company, you’re probably supposed to wait two weeks after that, or a week or something, and then you’re supposed to do the prep day, all that, send it in, then three weeks later, you have the results, and you’re supposed to continue treatment. In the meantime, they’ve probably started recurring. So I definitely prefer a model in which they can keep testing.

Ricky Harrison: 

And that was one of the things that we really wanted to do, because we know it’s a huge barrier. We hosted a webinar not too long ago, and we had two clinicians who work with us, and well, they both said that having the ability, that the hurdle being removed of people, being able to take a retest, has been transformative for them. So that’s really good.

Lindsey: 

Yeah. And those practitioners, I remember, I watched one of those webinars, they’re typically using it more or less, you finish treatment the next day, you do the prep diet, the next day you do the device, right?

Ricky Harrison: 

Yeah, yeah.

So, I mean, they’re doing it right after treatment, so you really know, okay, right after we finish, where do you stand? So then it’s, do we do another round of treatment, or do we wait and see whether it recurs after some period of time, or that kind of thing? And of course, that’s completely up to the clinician, though. So you can do it immediately, or you can so say that a patient isn’t responding as quickly as you like. Some people can sometimes respond outside of the window of treatments, so you may want to just monitor them for an additional week, perhaps, and then you may see the drop off then. So it just gives you that power that you didn’t have before. Before it was guesswork, and now you know exactly.

Lindsey: 

Yeah. And so I think it’d be helpful to clarify for people what is different about what’s measured by a SIBO breath test than what’s measured in a stool test.

Ricky Harrison: 

Ah, okay, yeah, I will say that they both have their purposes. Now, a stool test is giving you more of an idea of which bacteria are present and maybe the quantities in which they are there in the colon. The issue is that what you get in a stool test is more so indicative of what’s happening in the distal colon, whereas breath testing is basically telling you what the activity of the bacteria is, whether it’s high activity of the bacteria, whether it be based on timings in the small intestine or the large intestine, and the stool is just basically telling you what’s mostly there, in a sense, in the distal colon. So they do quite different things, and you can glean different things from them, so both very useful and practical tests.

Lindsey: 

Yeah. So my understanding watching Marc Pimentel webinars, who is one of the biggest researchers on SIBO, is that they’re seeing SIBO almost as an infection with certain predominant bacteria in the small intestine. And then I might see a stool test from somebody who’s got a positive SIBO test, but it does not show that that’s an overgrown bacteria. Like I think it’s typically like Klebsiella and Citrobacter and E coli are the three big ones, am I right, for hydrogen SIBO?

Ricky Harrison: 

Yeah, I think so. I can’t quite recall them.

Lindsey: 

Okay, but then you might not see those elevated in the stool test. So it doesn’t necessarily tell you what’s going on at all in the small intestine when you look at the stool, the colon. Now methane being different, because it’s now called IMO, intestinal methanogen overgrowth and acknowledged that it can be in any part of the intestine. So it could be in the small or in the large intestine.

Ricky Harrison: 

Absolutely.

Lindsey: 

So Lucy mailing recently published a blog post, again questioning whether SIBO is an accurate description of what’s going on when one has dysbiosis and the symptoms of SIBO, which for me, the big one is always bloating. Like, if there’s no bloating, I’m almost like, probably not SIBO, although I’m suspicious that there are some people who strangely, just don’t bloat, like they have SIBO, but for whatever reason, they do not have a bloaty kind of system. Whereas I’m the kind of person who has a very bloaty kind of system. So even when I don’t have SIBO, I bloat. But anyway, she was also questioning breath testing as a method of diagnosis. So any comments on that article?

Ricky Harrison: 

So I thought it was a well written article. And of course, everything has its drawbacks. I mean, she even pointed out aspirate cultures, which are considered the gold standard currently, has its drawbacks. Breath testing has its drawbacks, and even qPCR has its drawbacks. The thing is that what’s great about all of this, and what’s great about science in general, is that the way that we get better is that we see where there is a drawback, and we address that drawback, and we constantly grow and yeah, there’s no denying that breath testing has its drawbacks. It does just like qPCR has its drawbacks and like anything else. So what she does in practice, or in that blog article, I think she’d said that she has largely moved to qPCR for that type of thing, which is totally fine. It’s, it’s always just up to the clinician, really.

Lindsey: 

Yeah which is doing something like a GI Map* or a GI Effects* or one of those tests, right? Or, I think she also used metagenomic sequencing or shotgun sequencing too. Well, at any rate for me, it’s kind of one of these things, like, for a while I stopped saying SIBO, and I would just say dysbiosis, and then at the end of the day, I’m like, I have this thing, and it does feel like an overgrowth. It feels like I sit down to dinner with everybody, and we eat the same quantity of food, and I grow a food baby, and they eat twice as much as I can, and there’s something overgrown in there, like there’s something fermenting. And, you know, that’s what it feels like to me. So I feel like the word SIBO is accurate in my personal experience, it resonates with me.

Ricky Harrison: 

Yeah, I don’t have a problem with the term SIBO. They’re not really the same, in a sense.

What, dysbiosis and SIBO?

Yeah, I don’t think they’re entirely the same. So SIBO is exactly what it says it is. It’s an overgrowth of bacteria that doesn’t normally hang out in those numbers in your small intestine, right?

Lindsey: 

And dysbiosis is sort of saying the same thing, but could also be something else, could be a parasite or candida, or could be a bunch of other things.

Ricky Harrison: 

Anything. Yeah, absolutely.

Lindsey: 

So I’m going to get my FoodMarble, and we’re going to do a little demo of me using it, so I can show people how it’s used. (See YouTube video for demo).

Ricky Harrison: 

Okay, no problem.

Lindsey: 

Okay, so you start and you have to double click on it, right?

Ricky Harrison: 

Right. So you just give it a quick double tap,  and that’s what power’s it on. So you’ll have to wait, like, two minutes, or one minute and 40 seconds.

Lindsey: 

Okay, well, in the meantime, the next piece is that you then pick up your phone, and you’ve got to have downloaded the app. And the app for the medical device is different than the other app, right? It’s the one with the green that says FoodMarble Healthcare (in Apple app store / in Google play store).

Ricky Harrison: 

Yeah. It has a green icon, yeah.

Lindsey: 

Okay. So then on the app, I will now show, you press this little plus button, right, to take a reading?

Ricky Harrison: 

Correct.

Lindsey: 

Then you choose, it has logging options, and I’m going to choose breath. So now it says it’s warming up, and it shows that I’ve got to wait till these things are all blue for me to go.

Ricky Harrison: 

Correct. Okay. So the warm up feature, for anyone who wonders, why why does it take so long, is the sensors have to reach a certain temperature. So what it’s doing is it’s warming up to the temperature in which the sensors will start to function.

Lindsey: 

Okay. So now holding the device, that’s the air, that’s the one you blow into.

Ricky Harrison: 

Yeah, correct.

Lindsey: 

Yes. So now I hold it down. I’m not actually sure that worked. The phone, oh, and it says, let’s practice. Okay, so I’ve got to practice.  “Let the air mix in your lungs by pausing your breathing for three seconds without inhaling,”

Ricky Harrison: 

rRght? So just like I did, I was speaking with you, and I just stopped talking and held my breath.

Lindsey: 

Okay, so I’m going to hold my breath for three seconds after I breathe again, because I don’t have enough breath left.

Ricky Harrison: 

Okay? And it’ll vibrate, yeah? And just keep blowing until it vibrates again.

Lindsey: 

Okay, I was definitely at the end of my breath at that point. Okay, now the exciting part.

Ricky Harrison: 

Yeah, so that was your practice breath.

Lindsey: 

That was my practice. Now, I have to do it for real, right? Now I take a real test. Okay, definitely it was the last of my breath at that point. So now on my device, I get this reading that says low. And then I say, Okay. It says, look, there’s a little bit of methane in there. It’s always interesting to me, because I always think I have, like, no methane producers, but I know you can have methane producers in your in your mouth, but not in your gut, right?

Ricky Harrison: 

You can, yeah, yeah.

Lindsey: 

It says, “show more”. Oh, okay, so I got some detail under “Show More”, methane point nine, hydrogen point four, overall, 1.2 but those numbers are not the official breath testing numbers. This is on a score of what, one to 10.

Ricky Harrison: 

It’s zero.

Lindsey: 

Yeah, zero to 10, right? Okay. Now, what’s interesting for me, though, is that I can then go on to my FoodMarble dashboard. Let me share my screen now and choose day to day. And then I will be able to see today’s test, methane, four parts per million, and hydrogen, two parts per million. That’s really funny to me. So and then then this would be the other symptoms, if I had recorded any of those right and medications and such, which I could do by pressing that plus on the device and adding those in right? And then I could see the challenge that I did from the other day, which I already showed you in the other format. But this was the actual glucose challenge that I did. So I had more methane now than I did when I did this challenge. Oh, that’s funny. Okay. Anything else you want to say about this?

Ricky Harrison: 

Well, one cool thing is say that you had a positive test here, so you see this area under the curve. So what would be cool is say that you had a positive result and then you had another test after treatment, and it was still a positive result, but the area under the curve was lower. This would give you some sense that although both tests were positive, there was some improvement, and maybe you just need a little longer on treatment or something like that. So that’s pretty handy. You can also download the report. You can add it to the patient’s EHR electronic health record. Yeah, and you can also download a PDF, and this will allow you to then play around and make graphs and charts or whatever you want, and share those with the patients as well.

Lindsey: 

Right? I can download this and give it to the patient. They won’t see this.

Ricky Harrison: 

So if you click the download button there, you’ll get that report that you showed before,

Lindsey: 

Right? But will they get that too, or only if I give it to them?

Ricky Harrison: 

You have to send that to them.

Lindsey: 

Okay. So in other words, there’s a lot of advantages to going through me, if they’re my client, which would be that they’re going to get the MedAIRE device that does methane and not just hydrogen. So that’s like a huge one. And then number two, that they’re going to get the chance to get a testing substrate.

Ricky Harrison: 

Correct.

Lindsey: 

Or do you send out the glucose for people who just buy it on their own?

Ricky Harrison: 

So if you use glucose when you add a patient, you’ll have the opportunity to select what you want them to have for testing. So you can select the food intolerance kit, you can select the glucose as well, and then you can submit that. And so what happens after that is the patient then receives an email, they agree to the privacy policy, which gives their express consent for you to be able to view their data. And then after they’ve done that, they’re taken to a payment screen, and then they’ll be able to pay for it, and we ship it directly to the patient. Now there are several different account types. You can extend discounts to your patients based on which type of account you have,

Lindsey: 

Right, I think there is a 15% discount in effect for my clients. And I was just asking, though, in the direct to consumer model, are you getting the testing substrates? Are you getting glucose in the US at least.

Ricky Harrison: 

Yeah, so you cannot get the glucose from the website. You have to be linked to a clinician in order to get glucose.

Lindsey: 

Got it, but they can get the food intolerance kit?

Ricky Harrison: 

Now in the United States, the price is lower for the food intolerance kit than if they were to purchase it from the website. So they’re getting quite a few advantages by going through the clinician.

Lindsey: 

Okay, and so for the food intolerance tests, are you supposed to have a prep day as well, or can you just do those anytime?

Ricky Harrison: 

Yeah, so you should prep exactly the same as you do for the SIBO test. And the reason for that is so that it’s the substrate that you’re testing and not something else. So the night before, you don’t know when you’re taking your test, the next day, you don’t know if it’s the cake or if it’s the actual substrate.

Lindsey: 

Yeah, no, that was also the dilemma. I got the food intolerance test, and I had every good intention of trying everything but the but the lactose, because I don’t intend to torture myself by taking lactose, which I know I’m quite intolerant to, but I was going to do the others. But then I was like, I just had to do this whole prep day, whatever. I’m not terribly tempted to do this again. Although I have had clients say after the prep day, they’re like, I haven’t felt so well in ages because they clearly had low FODMAPs food. And whereas I’m less attentive to that on a regular basis, I mean, I think maybe naturally, I’ve fallen into choosing the foods that feel better in my body. I don’t purposefully follow a low FODMAP diet all the time.

Ricky Harrison: 

Yes, low FODMAP diet isn’t something that you want to carry on for a prolonged period of time anyway.

Lindsey: 

No, no. So this is the nice thing for me as a practitioner, is that you can, in fact, see right away what the results are. As soon as you’re taking the test, I can go on my screen and say, okay, you got it or you don’t, and then I can let you know what I think should be the next step. So that’s what I really like. And so how much is the device?

Ricky Harrison: 

Normally, for retail, $249 is the retail price for the device in USD.

Lindsey: 

It comes with the glucose? So no, so the retail price is $249 for the device, retail for the glucose is $19 USD, and that is for two sachets, for the initial test and the retest. And the food intolerance kit is $49 USD, and that includes the fructose, inulin, lactose and sorbitol.

And that’s without the discount through the practitioner, correct?

Ricky Harrison: 

Yes and then with your discount, it would be 15% off of that. (To order a medical-grade Food Marble device, the MedAIRE 2, email lindsey@highdeserthealthcoaching.com for an invitation.)

Lindsey: 

So they get 15% off. Yeah, okay, great. So they have 15% off of $249, plus the glucose. But if I want them to use fructose, they could just get fructose online* for probably a lot less than $20 or something, and just use that, buy a big bag of fructose, and plan to keep using it for testing over and over again.

Ricky Harrison: 

Okay.

Lindsey: 

Okay, wonderful. Well, any anything else that we haven’t covered that we should have?

Ricky Harrison: 

I think that is pretty much everything. I would like to ask you, though, do mostly practitioners listen to your podcast, or is it just a wide range of people?

Lindsey: 

I would guess that it’s mostly people who have gut health issues. That’s my experience, anyway. I’m sure there are some practitioners who listen, but I wouldn’t say that’s my primary audience.

Ricky Harrison: 

So that was my only question. Okay, great. Covered everything. If you have any more questions for me, please let me know.

Lindsey: 

No, I think I got it, so I’m glad to be able to demo it for people. And I did say in my intro that I got the free device in exchange for the podcast, but there’s no other concrete sponsorship other than the fact that I have the affiliate account, which is something I’ve had for a good while now. So I did just want to share about it, because honestly, I think that for me, it’s a game changer, because sending somebody out for a breath test often results in disaster. And one of the biggest disasters that it results in, and this has happened multiple times, of course, there is the triosmart test that tests for all three gasses, including the hydrogen sulfide, but I’ve had multiple times now that people have done that test. And one or two or even three, or sometimes even enough samples were invalid that the test was nullified. As a result, they had to retest. Or in some cases, it just never worked. Like I had one client who did it twice, it never worked. And I thought, you know, at the very least, if I have a hydrogen and a methane breath test that comes out negative, then I can go, oh, well, maybe this is a hydrogen sulfide person, but if I’ve got no results at all, it’s hard to do anything with it.

Ricky Harrison: 

Yeah, for sure.

Lindsey: 

Yeah. Anyway, okay, well, thank you so much for being here. Ricky.

Ricky Harrison: 

Oh, thank you so much for having me. It was a pleasure.

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me. 

*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.

Adapted from episode 129 of The Perfect Stool podcast with Brooke Herbert, a Board Certified Health and Wellness Coach, entrepreneur, cofounder of Gold Ivy Health Co., podcast host and fitness instructor and Lindsey Parsons, EdD, and edited for readability.

Lindsey:  

So why don’t we start with your health story that led you into the work that you currently do?  

Brooke Herbert:  

Yeah. Let’s go back. It feels like years ago now, and it was, it was back in 2017. I was a junior in college at the University of Minnesota Twin Cities, and I had landed my dream internship down in Florida. I was working at an agency and I started developing all of these health issues. So we’re talking a lot of gut health symptoms, with fatigue, acne, I was severely constipated and it really came on all of a sudden. And so I thought, “What is going on?” I was in Florida, so I didn’t have a primary care doctor, so I went into a Planned Parenthood. They decided I had an infection, gave me some medication, sent me on my way. Okay, great.

Weeks passed, and I had finished my internship, moved back to Minnesota to finish college, and these symptoms just kept going: severe bloating and constipation, feeling like I wasn’t absorbing anything. I was eating. I was super tired. I mean, I could go on and on with symptoms, and I’m sure a lot of people listening can relate with all these gut health symptoms. And I just couldn’t figure it out. It took me five years, over 50 different doctors to really nail down, really what the root cause was. And throughout those five years, I explored many different types of medicine. I have tried many, many different things, and now I’m really here to share what I’ve learned in hopes that other people suffering don’t have to go through what I went through. 

Lindsey:  

Yeah. And so when you say 50 doctors, are these like Western medical doctors, or are these also alternative practitioners? 

Brooke Herbert:  

Yeah, great question. All of the above. So I saw a lot of Western starting off in my journey, I saw a lot of OBs, gastroenterologists. I had the colonoscopy, endoscopy, all of the workup done and then continuing to search, because they couldn’t help me, couldn’t really find the answers. Then, I went the alternative route, from chiropractic care to acupuncture, looking into Chinese medicine, Ayurveda, Indian medicine. Finding, okay, if I can’t get the help I need, I have to take matters into my own hands and do the research. And through podcasts like yours and all of these awesome naturopathic doctors that were sharing things that regular doctors, quote-unquote regular doctors, weren’t telling me, I’m like, “Hmm, there’s more to this.” The body is brilliant, and when something’s off, it’s going to present itself as symptoms, those signs that, hey, listen, something’s going on. 

Lindsey:  

Yeah. And so what was your diagnosis, ultimately? 

Brooke Herbert:  

Yeah. So through starting my own podcast, I had on a nutritionist. She was a functional nutritionist, and she was connected to another woman who I’d worked with, and we did a GI MAP test. So for anyone listening who isn’t familiar with that, it’s a stool test that tests your colon and your large intestines to really see what’s going on in there. And through doing that, it had come back, I had giardia and H. pylori, high levels of staph and strep, and then doing more digging, I had mold toxicity, so a lot of havoc was had. And through doing this one simple stool test, years later, it came back of, “Oh, you’re not crazy. You were really just infested with a lot of bad bugs.”  

Lindsey:  

Yeah. And so after working with these people, did you get a sense of why that might have happened for you?  

Brooke Herbert:  

Yeah, good question. So I believe I had picked up something in Florida, whether it was from the water, who knows right where it really started. But the symptoms started when I was living in Florida, and I believe that during that time, it was going into my senior of college, I wasn’t eating the best. I was drinking alcohol. I was running on E, with studying and working multiple jobs, that my toxic overload, which I now know about, was to the max. So when I finally got to Florida and maybe my body felt safe enough to relax and say, hey, these symptoms came on. Maybe I picked up something in the water. I’m really not sure, but that’s what led me down the path of, hey, let’s learn way more about your health than you ever thought you’d have to. 

Lindsey: 

Yeah, when I see people with those sort of overgrowths, like something like giardia, normally, I would think your body should clear that naturally over time. But when it’s not clearing, typically, I also see Low Secretory IgA. So was that the case with you? 

Brooke Herbert:  

Absolutely, yep.  

Lindsey:  

Yeah. And stress can bring that on. 

Brooke Herbert:  

Exactly, yeah. So through that, I really learned about the link between our mind and our body, of what does stress do, and even when we don’t necessarily feel stress, or I felt like I was high on top of the world, I nailed my dream internship. But really, my body was traveling, I was out of a routine. I wasn’t taking care of myself the way that I really should have been.  

Lindsey: 

And so was your experience with the Western medical doctors negative, or were they just unable to help you? 

Brooke Herbert: 

I would say a little bit of both. I really made the switch to alternative medicine, and what I believe, really took matters into my own hands, of okay, let’s try a different route, when I had seen an OB and presented all my symptoms. And you know, for anyone listening who’s gone down a similar path, there’s a lot of anxiety when you go into the doctor’s office. Doctor after doctor, and you’re reciting your story again, and you don’t want to be gaslit and you’re nervous. And she had looked at me and said, I think you need to go to a pain management clinic. And I thought, “Hmm, okay, well, thank you, but no, thank you. I’m going to try something else.”  

And from there, I had seen an acupuncturist, and she taught me all about the meridians and Chinese medicine, and really talked to me about stress. A lot of the Western medicine doctors had said, you know, “I think it’s just stress. I think it’s just, you’re a woman, your hormones, you’ve been traveling a lot, you’re in college.” And when someone tells you, I think it’s just stress when you’re sick, it is like the worst thing you could possibly say. But now, looking back, yes, stress was a huge piece of that. But no one sat me down and said, “This is why.” It’s because of the role our nervous system plays in healing and all the things I now know about. Oh, okay, so maybe I shouldn’t be go, go, go, go, go, and expect my body to feel safe enough to heal like it’s meant to be.  

Lindsey:  

Yeah. We talked a bit, in our pre-interview, about the nervous system and the gut and childhood trauma. Can you talk a little bit about that?  

Brooke Herbert:  

Yeah, absolutely. So one of the many routes I went down was therapy. I hired a therapist because if stress was really something that was blocking my ability to heal, it’s like, I’m going to do it. And I learned that “The Body Keeps the Score“. It’s an awesome book. Definitely recommend it.  

Lindsey:  

Yep, I’ve read it.  

Brooke Herbert:  

Yes, right? So trauma is stored in our fascia and in our body, and even though, consciously, we know we’re okay, we’re doing okay, but if something happened way back in our childhood, the body remembers that, the nervous system remembers that. It says, “I’m not safe. I can’t.” And what had happened to me when I was younger, was that my dad left, and I didn’t have a relationship with him, and that is trauma in itself So going throughout college, working my butt off, paying my way through school, I’ll figure this out on my own. I’ll do it all on my own. I don’t need anyone else. That attitude really ramped up my nervous system. And when we’re in that sympathetic nervous system, that state of fight or flight that many of you listening, I’m sure, have heard of the body, it can’t heal. It’s pumping oxygen and blood to our muscles to run faster. It’s this part of our brain that’s activated, this million year old brain that doesn’t know the difference between running away from a saber-toothed tiger or we’re getting constantly buzzed on our phone.  

That nervous system, so it’s got to find a way to relax, to feel safe. And for me, that’s what therapy started to do, was started to process all of this unprocessed emotion that I had stored deep in me and gave me an outlet of what do I need to feel safe, to feel calm. I got into meditation and breath work. And these are things that I’m sure everyone has heard of, but until you actually start to practice it on your own, you don’t really know how powerful it is. Or simply walking around barefoot in the grass; grounding is an awesome technique to help calm your nervous system. All these little tools we can use that I learned. If doctors can’t help me, can’t give me the magic pill I was so hoping for, there are things within our control that can help calm the nervous system that are very unique to us, right? What calms my nervous system, Lindsey, isn’t going to be what calms your nervous system. There are similarities, like breath work, yes, meditation, but really, you as an individual, what makes you feel relaxed and calm, full of joy? And those are things that I wasn’t thinking of when I was trying to get answers and I was searching and, you know, go, go, go, trying to find those answers from doctor to doctor. 

Lindsey:  

Yeah. I have, at various points in my life meditated, and I really love the feeling. But I have to say, it’s one of those things that, you know, I might get in a habit of doing it. Maybe it lasts for a few months, and then I always fall out. And I’m not sure why. I mean, I think perhaps because it is something that takes, like for me, a good 30 minutes to get in the zone. I mean, while I’m in it, I’m just like, “Oh, I know I got other things I;ve got be doing, but I am loving this, and I am so happy right now. And I could just sit here for another hour.” But again, it always falls away. How do you maintain that? Do you maintain the meditation? 

Brooke Herbert:  

Yeah, great question. I’m like you. I’m human, right? We go in and out of waves. And I find, and with my clients too, as a health coach, that you realize how powerful it is when you don’t do it. When you take a break and you’re like, “Oh, I miss that.” That’s how you know it works for you, is when you miss something. I’ll go weeks without doing yoga, and I’ll be like, “I need to get my butt back in the studio, because that feels so good for me.” So leaning into that curiosity of, “Why can’t I stick with it?” and swapping that to, “Maybe I need to make some more time for that,” because life is going to happen. Summer’s here. It’s busy. We’re on vacation. Your kid gets sick. You get sick, right? To have this structure of, I meditate every single day, 20 minutes a day, first thing in the morning, for me, I’ve learned that just doesn’t work. It’s got to be a gentle approach. And that’s still something that I am working on, because I’m very regimented. I want to know exactly what works. I want to know when best, right? Is it morning? Is it night? When do I do this? But really, it’s when is it going to work for you that you can stick to it and then setting those reminders, right? If this is something you’re really, really passionate – I don’t want to say passionate about – but something that you know works for you, and you want to make time for it. Let’s set some time aside in that schedule. Let’s be proactive about it. 

Lindsey:  

Yeah, if I could sort of summarize why it’s so challenging for me, maybe this might help somebody else. There’s so many things that I want to include in my health routine, right? I get up and I do hormone yoga in the morning. I, of course, cook and eat healthy meals. That takes time. I have time with friends and with my husband, you know, quality time with people, that means a lot to me. I do breath work before bed every night. That’s 11 minutes, I can handle that. It’s like, what am I going to cut to get that 30 minutes for meditation? That’s my dilemma. That’s why I started doing breath work, actually, because I thought bang for buck, that’s going to put me into parasympathetic state a lot more quickly than the meditation. That’s why I’ve been doing that. Do you do breath work regularly? 

Brooke Herbert:  

Yeah, I do. I have it a part of my yoga routine, I would say. And I have dabbled in and out of specific times. But echoing what you just said, I am so structured, and that’s just the way my brain works, I’m type A. And I have found that when I’m too structured, it does the opposite. I can have everything planned out to a T, but having to be so structured, and if I don’t stick to it, or I miss one thing, then it’s the end of the world. And then it’s having the opposite effect. I have all these things in my schedule to make me healthy, but because it’s so regimented and I’m stressed about, how am I going to find time to do it, or, “Oh gosh, this went over, and I don’t have the time to do it this way,” it’s going to have the opposite effect, or at least it has for me. So that meditation, 30 minutes, might be ideal because of a book you read, but for me personally, I just need five minutes.  

Lindsey:  

Oh really, wow! 

Brooke Herbert:  

Or I’m just saying, for example, right? This is where I can get it in. I can listen to a guided meditation. There’s a great five-minute energy reset that I love. It’s five minutes, and I can get it in, and it doesn’t make me stressed thinking about, how am I going to fit this in? And maybe I do that for a bit, and then I realize, okay, I want to dedicate a little more time, and now I have the 10 minutes. 

Lindsey:  

And is that energy reset something other people could access, or is it within a paid app?  

Brooke Herbert:  

Yeah! It’s from my dear friend, Christina Deering. She is amazing. She’s a shaman healer, and so I can definitely share that with you, and we can get everyone access to her. She’s amazing. Just five minutes.  

Lindsey:  

Yeah, that’s awesome. In fact, that’s one of the things I’ve been thinking the most about recently. Not how do you, in the course of a day, get into parasympathetic mode, but how do you, in the heat of the stressful moment, snap out of it? I know the physiological sighs are a good tool that are pretty quick, breathe in, breathe in more, and then long exhale out of the mouth, right? What else do you use for that kind of thing? 

Brooke Herbert:  

Great question. What’s most important, I believe, in that situation, is the awareness that it’s happening, right? And that I have the control to let it go, to get in a different state. So for me, a really great cue is I put one hand on my heart, one hand on my stomach. I take a deep breath. I say, “What do I need? What do I need right here?” I think about my feet underneath the ground. Because really what you need is you need to come back into your body. You come back in this present moment. Because when we’re in this present moment, the nervous system is calm. We’re not worried about our next move. We’re not ruminating on the past, right? We’re in the here and the now, and that’s when the magic happens. And so whatever you need to snap out of it, to bring you back in your body. And for some people, it is, you snap your fingers, or you make a fist, some sort of physical cue that can trigger to your brain, “Hey. Don’t go there. I’m safe. Come back in your body.” And for me, it’s a hand on the heart, it’s a hand on the stomach. It’s: how can I be gentle with myself in this moment? Not have any shame, any guilt around why am I feeling this way, acknowledging I am feeling this way and getting to a neutral spot is huge. 

Lindsey:  

Were there healing modalities you used through therapy that were different than the usual cognitive brain training type of therapy? 

Brooke Herbert:  

Yeah, not for therapy specifically. I will say, right now I’m embarking on a new adventure of EMDR. So maybe down the road, if we want to revisit this, I can let you know. I’m very, very excited. I haven’t started that yet. The other therapy I did was really just cognitive therapy, and it was talking through my truth. Because seeing so many different doctors, anyone listening, if you can relate, you begin to lose what is my truth? I’m fighting to tell you how I feel, and I’m being gaslit. No one’s believing me, and I have to keep voicing how I feel, and it just kept getting shut down and shut down and shut down. And so over time, so did my voice.  

So therapy really helped me regain my voice and my truth and find specifically for me what brought me peace, what brought me happiness. Being sick really became my identity, and I didn’t want that to be my identity, but I kept ruminating on that. That was my story that I was sharing. And so retraining the brain, and this is really where working with a coach who is trained in neuro-linguistic programming, was extremely beneficial for me, because it was, let’s speak into existence what you do want. So for journaling, for example, I would journal all my feelings. They were very depressing, and I made the switch of, “What if I started journaling of what I do want to happen? This is the practice of best case scenario journaling. Putting out in the universe of how I do want to feel, making that my truth. Because what we speak, that’s where we’re giving energy, that’s what our brain believes. That’s what’s telling the nervous system, “Hey, this is my reality. This is what I want.” Speaking that into existence, instead of just the story of, I’m sick, I’m sick, I’m sick. And that took a lot of retraining the brain. 

Lindsey:  

Yeah, I have a client who was intolerant to almost all foods, in every kind of category. There’s the histamine foods, there’s the oxalate foods. Then for the actual condition that she had, it was meat and fat and such that were problematic, so it kind of eliminated most foods entirely. And at some point I said, I think we need to do some brain retraining here. I referred her to the Gupta Program. And she has, since, been doing some meditations and started the program, and has said, “Yeah, I realized I was coming into every meal in sympathetic mode, afraid of what I was about to eat, expecting a reaction.” And of course, you’re going to get it. Because you think about how strong the placebo effect is. That’s essentially what you’re doing. You’re placebo-ing in your food, and basically predicting that you’re going to have a terrible reaction, especially if it’s a new one or one you haven’t done well with in the past. 

Brooke Herbert:  

Yeah, what you said was so powerful. It’s not only what you’re eating, it’s how you’re eating. That’s what I learned. Rushing to quickly eat in between meetings instead of okay, I’m going to take a few deep breaths. I’m going actually sit down. I’m not going to multitask. And in today’s day and age, that’s not easy to do. It’s the habit we’ve built of, I’m going to quick scroll my phone, I’m going to multitask when I’m eating. I’m eating on the run. And so something I really like to teach people to talk about is going back to how people used to do things, right? Mealtime, it’s really now a luxury to be able to sit with our families, to slow down, to have time carved out, to nourish your bodies and to eat with people you love. Or if you are just with yourself, right, even the simple act of reading a book and eating, I would say, is a lot better than scrolling social media and eating.  

Now something that puts you in that calm state, and if that is a luxury, one you can’t afford right now, because of the season of life you’re in, well, we all can take three deep breaths before we eat to make sure we’re actually digesting our food, so we’re not bloated after we eat. All these little tools and tricks that I learned and I picked up, that I didn’t need a doctor to tell me. It was, okay, I realize that when I am stressed and eating, it doesn’t make me feel good. And that was tapping into: how do I feel, what is my personal experience within my day to day, within my healing journey, right? Listening and collecting, step by step, following the breadcrumbs, asking yourself, “What does make me feel good?” And honoring that. 

Lindsey:  

Yeah, a couple stories come to mind. One was that I worked for this organization. It was actually a human trafficking organization. I was just doing temp work. It was a bunch of young people in Washington, DC. I thought it would be a real fun place to work, and everybody would probably hang out at lunch in the kitchen or whatever. Then they just had this terrible little table pushed against the wall so you couldn’t even go around it, and nobody ate in there. Like one person maybe, who sat there with earphones on, ate in the kitchen, and nobody hung out together. And I was so disappointed. I’m like, “Really? You’re doing this great work. You all seem like interesting people, but there’s nothing. Everybody’s just sitting at their desk shoving food down.” And so disappointed in that. And then the contrasting experience was when I was on vacation in France with my friend. She’s a social worker, she goes to an office, it’s probably, I don’t know, 15 minutes away. But she gets like two hours at lunch. She comes home, sets a table outside with a tablecloth on the lawn, makes an extensive meal, and we all sit down and enjoy it together with her husband. And I mean, it was such a difference, such a different mindset about what a meal should look like, especially lunch.  

Brooke Herbert:  

And I bet, I would put money on it that she’s a lot happier and healthier than your coworkers were, eating lunch on the go, or fast and quick compared to actually having the time to do it. It’s such a culture thing, but it’s also something that we do have control over, and we can voice those needs. Seek companies that do support that or set that out for ourselves that hey, this is something that’s important. I see the value in it. 

Lindsey:  

Yeah. So we’ve talked about a bunch of different modalities for managing stress. Were there any that we didn’t mention that you like? 

Brooke Herbert:  

Yeah, so many. You know, the biggest one I will say, is who’s in your corner. What does your support team look like? Noticing the people you’re around who make you feel calm, you know, investing in people and places that are nourishing to your soul and soothing for your soul. That’s everything, whether that’s your job, right, and you have the ability to eat in a cafeteria with your friends, with your coworkers, or if it’s a yoga studio, if it’s your gym, scheduling time out with your partner for a walk. What is that for you? Those are things that are specific to me, but I just want to go back on: What is that for you? The listener, whoever’s listening right now, something came to your mind as I was speaking when I said, “What soothes your soul?” And making time and carving out time for that.  

When I was really sick and trying to figure out what’s going on, and I was trying all different things, coffee enemas were a massive thing for me. And anyone who’s familiar with them, you know, you’re my people. Those people who aren’t, you’re still my people. But what it does is it really just helps detoxify your body. And I’m not saying that everyone should do this. Definitely consult your practitioner, your healthcare provider, but when I look back and I think, what really was it about it? You have to sit or you’re supposed to sit with that coffee in your colon for 15 minutes. And in that 15 minutes, you really can’t do anything else, because it might come out, to put it bluntly. So during that time is when I would meditate, when I would focus on my breath, and I would just have all of these downloads, these ideas that you really get when you meditate, because you get out of your own way. You’re fully in the present moment. You’re allowed to see whether you believe in God, the universe, a higher power. You can hear your intuition. So that was a big one for me, and what comes to mind when you ask that question. I know probably people were not expecting me to say coffee enemas, putting coffee up your butt, but there is something to it.  

Lindsey:  

I looked into it once, but I never went through with it.  

Brooke Herbert:  

Yeah, I’ve really struggled with energy and constipation, and when I was working really closely with a naturopathic doctor, so definitely don’t do these without doctor’s supervision. But I felt safe enough to do it, and it was something that really helped. And again, I think it did help, mostly because I was still and I calmed my nervous system, which you can get in a lot of other ways. 

Lindsey:  

And then take some NAC for your liver, right? So we may have already sort of hit this, but are there other lifestyle changes that you recommend to clients to help eliminate the overwhelm of the chronic stress of their daily lives? 

Brooke Herbert:  

Yeah, great question. So when I think about lifestyle changes, and I think about coaching my clients, I really like to focus on the four categories of health and wellness. And this is something me and my business partner, with our own company, what we do is break it down into four categories, because that helps the brain with overwhelm, right there. You’re thinking about all of these things, and it helps bring it back to what I can control. It’s these four categories. So exercise, sleep, stress management and nutrition. And you can read any book, you can read all of the books, they’ll give you a million tips. But pick what works for you, what you can commit to, what you have evidence with that works for you, what maybe you want to experiment with. It feels expansive. It doesn’t feel constrictive.  

I think about what you said earlier, Lindsey, with trying to fit everything in the day, and what can I let up? Right? That doesn’t necessarily feel expansive. It feels like, “Oh gosh, that feels overwhelming.” So for example, with sleep, okay, I know sleep is really important. We all know we feel better when we get more and quality sleep. So what do I have control over? Okay, can I buy some blackout sheets? Can I limit my phone usage for an hour before bed? I’m not looking at screens. Can I try and stick to the same time of getting in bed, going to bed and waking up? That’s awesome for our sleep schedule, for our circadian rhythm. I think about nutrition. What foods work well for you? For me and my digestion, it was warm foods versus cold foods, and I learned that because I would have shakes all the time and thought like, “Why? Why doesn’t this feel good?” I’m like, “Huh?” I do some research. Okay, so warm foods easier to digest, that makes me feel better. Warm water in the morning makes me feel good, right? So starting to get curious with what works for you in these four categories of wellness, and then honoring that. And scheduling the time in for stress management, we listed a handful of things. Can you walk outside? Can you schedule time with your partner? Maybe you look into therapy. Maybe you look into a coach. Maybe you do need more one-on-one support.  

And then the last piece is exercise. The link between exercise and our mental health is huge, right? But too much can be overwhelming on the body. When I was very, very sick, HIIT workouts were too much, and honestly, right now, they are still very stressful in my body, so I lean more towards feel good movement. I’m talking yoga, walking, stretching. When I was really depressed, I would say, “Okay, movement makes me feel better. But what type of movement doesn’t feel overwhelming right now?” And it was just laying in bed, stretching, and that felt good. So meeting yourself where you’re at, thinking about what you can control, and sometimes the best thing we can do is nothing, is rest. I’d retrain my brain that, hey, rest is actually productive. It’s actually helping me heal. It doesn’t mean I’m lazy, doesn’t mean I’m not trying to feel better. But hey, maybe Sundays, you know, it’s my rotting, recharging day, and that is productive. That allows me to be fueled so that I can have a productive week. 

Lindsey:  

Yeah. So do you see a lot of clients who, despite supplements or exercise or diet changes, they’re still not getting better. And you kind of think there must be the unresolved trauma or the stress or mental health things that are underneath it? 

Brooke Herbert:  

Yeah, and I like to look at that first, because when you think about it, when we are in that chronic state of fight or flight, like we said, the body can’t heal. So you’re spending time and energy and money on not cheap supplements, if you want good supplements, right? So let’s make sure the supplements that you’re taking, they’re working. So let’s start with, how is your mental health, right now? How is your stress load, right now? Do you have the capacity to take on more healing modalities, to schedule more things in your schedule. Going back to what I said earlier, if thinking about 15 minutes to meditate is going to stress you out, we can’t do that. And so let’s get in the practice of what is it like for five minutes, for one minute, for you to start developing that practice of tuning into your body, taking deep breaths. So when I think about a step-by-step approach to healing, let’s look at stress management first. Let’s look at the nervous system first and create that safe space for you to heal.  

Lindsey:  

That makes a lot of sense, because it’s not necessarily true for everybody I work with. Some people, they’re less than a year into their gut health problems. They’re not deeply stressed about it. They want it to end, but they’re not, you know, people who are 20 years into the increasing effects of gut health issues that have now turned into autoimmune or chronic fatigue or mental health or all those issues. Those folks probably do need to address the stress component at the beginning. So that’s a smart way to go about it. So after you address the stress, what is your next gut health client step? 

Brooke Herbert:  

Yeah, I would resort back to the four categories of wellness. So I’m not a doctor. I’m not a therapist. My niche and what I love is helping you become your own best doctor. So what can you control? I’m not going to prescribe you supplements, because that’s not in my wheelhouse. But are you moving your body in a way that feels good for you? What does your diet look like? Right? The food we eat, it’s everything. But it’s not only what we consume food wise. It’s what are you consuming in the media? What are you consuming? What are you reading? All of that. And so taking an inventory on the decisions you’re making day-to-day. How is it making you feel and what do you need to tweak? Because what I realized, what I missed and what really helped me, once I had it, was a coach, was someone in my corner that wasn’t throwing all of these things at me, but was allowing me to discover it on my own, because that’s when the real healing comes into place. Because I can tell you, “Hey, do all of these things,” but unless you’re doing it in a way that works for you, it’s not going to help.  

So I talk about these four categories and a step-by-step healing, right, making sure the nervous system feels safe to heal. Yes, it’s a huge piece. But in each call I have with clients, it’s what do you need in this moment? Where are you at right now? What do you have the capacity to take on? Because maybe your mother-in-law just passed, maybe you just got a job promotion, you’re feeling really expansive and you’re pumped, or your energy is going to shift, and what you have the capacity for is going to shift, and it’s about coming back home to yourself and knowing yourself. And that’s a relationship that I want to help you build in this season, when it comes to all of those four categories and stress and sleep and exercise, what’s going to work well for you and make you feel good in this moment? 

Lindsey:  

So do you use gut health tests at all or other tests? 

Brooke Herbert: 

Yeah, I have physicians that I can refer to, and the people that I’ve used, the naturopathic doctors, the functional doctors that I loved and that I would recommend. But as far as me getting those tests, I can’t. What I have found is that 80%-90% of the real progress comes from not those tests. 

Lindsey:  

And so how long do you normally work with a client, and how often do you see them?  

Brooke Herbert:  

Yeah, I like to do monthly. I think that’s what I have found, in my journey and with my clients, helps the best is those monthly calls, touch bases in between, knowing I’m there for you, I got you. Reaching out, providing resources to help them find the answers on their own, with my help, of course. And then that can look like three months. It can look like six months. A year. Really depends, what you have the capacity for. What are you interested in? What would help? 

Lindsey:  

So, do you work with people one-on-one or are these group sessions? 

Brooke Herbert:  

Yeah. So, my business partner and I have our own company,  Gold Ivy Health Co., and we have a virtual wellness platform that’s similar to a Facebook group, but it’s its own platform where everyone’s in there, where a community can ask questions. So that’s really the group aspect. And then the one-on-one calls are where the individualism comes into play. 

Lindsey:  

Okay, so that sort of functions like a Facebook group might?  

Brooke Herbert:  

Yeah and then all of our resources are packed in there. 

Lindsey:  

Oh I see, okay!  

Brooke Herbert:  

The biggest piece for me has been exercise. Has been movement, moving my body. My business partner is a personal trainer. I’m a group fitness instructor, and so we have all different virtual workouts that people can access, anytime, anywhere. That’s really our groove, it’s let’s help you make it as easy as possible to take care of yourself. So having all of the resources that you need, whether it is the workouts or a lot of mental health resources, gut health resources, we’ve got in our vault, our health hub, that people can access. An awesome resource for people, whether they want to coach one-on-one, or just want a little dip their toes in and see what it is all about and if this could be helpful. Because some people, they don’t need the coaching, right? They just, I want to figure it out, but I want the resources, and I want a course, and I want to go through it. So really meeting people where they’re at and how do you learn best? Maybe it’s not one on one, but you still want some resources. We have that too. 

Lindsey:  

Oh okay, so you also have a course of some sort? 

Brooke Herbert:  

Yeah, we have a Metabolism Reset course, which takes into account the four categories of wellness, and a habit tracker that you follow, so workouts for each day. It’s a 31-day challenging course, all in one, where you learn all about metabolism, and gut health is sprinkled in there as well. So that’s a really fun course. And then I have a gut health starter kit, that’s really what I wish I’d known way back in the day, that goes through these categories. It also goes through different supplements and different resources, different types of doctors to look into. It kind of takes everything I’ve learned in a little bow, here, when you’re ready, take a look, when you feel like you have the capacity for it. 

Lindsey:  

Okay, and so tell me about your podcast, because I know I’m supposed to be on it at some point! 

Brooke Herbert:  

Yes, yes, we want to hear all about your stories, our audience would love it. So my business partner and I, Andrea, we started our podcast back in 2020, the pandemic. We’re both health coaches, and I was really in the midst of my journey, and I thought the world needs a light. We can help people. We need to share what I’m going through, knowing that what I was going through was going to help someone else, and it did, and it also helped myself. By me saying, “Hey, I want to serve others,” it allowed me to get connected with someone that really helped me, which I’m really grateful for.  

And on our podcast, we release episodes where we interview experts, just like you, all different types of experts, as far as therapists and coaches and healers and doctors, people that have been through insane things, where you’re like, “How did you get through that?” Losing a husband, losing a loved one, suicide, you name it. And so getting to know the tenacity of people and resiliency of how do you get through what you got through? And then also, Andrea and I, our own little fun touch of: here’s what we’re exploring. I just completed 75 Hard, which is an insane challenge. I’ll say that. So if anyone wants to learn more about that, or knows what it is and wants to hear how it went from me, I definitely recommend that. So a lot of fun episodes, taking a light-hearted approach to healing, talking about some really deep, raw, dark things, but knowing, hey, we’re all in this together, and we want to help you find the light. 

Lindsey:  

And what’s it called?  

Brooke Herbert:  

It’s called Ivy Unleashed.  

Lindsey: 

Great! And where can people find you?  

Brooke Herbert: 

Yeah, so we’re most active, I would say, on Instagram, like most people. Our Instagram handle is @goldivyhealthco. We are constantly posting inspiration and things that are working for us. Andrea, she’s a marathoner. She’s running a marathon in all 50 states, so she’s got a lot of awesome running content for anyone who likes to run, or if that’s your outlet when it comes to mental health. I post a lot about gut health and yoga, and so a real holistic approach to healing is what we’re all about. 

Lindsey:  

Any parting words?  

Brooke Herbert:  

I’ll just say: listen to your gut as best as you can. Find your truth. Listen. You’re your own best doctor. It really comes to, are you willing to listen to what your body is trying to tell you?  

Lindsey: 

Great! Thank you so much. 

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me. 

*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.

Adapted from episode 128 of The Perfect Stool podcast with Lindsey Parsons, EdD, and edited for readability.

Today, we’re exploring a topic that impacts us all – food additives. From the preservatives that keep our food fresh, to the artificial sweeteners that replace sugar in our low-calorie sodas, these substances play a major part in our modern diet. But what do they really do to our bodies, particularly to our gut? In this blog, we will look at preservatives, emulsifiers, pesticides and artificial sweeteners, the hidden ingredients that fill our grocery aisles. We’ll discuss their risks and the current research around their impact on the gut microbiome. In addition, I’ll discuss my favorite sugar alternatives – things like xylitol, allulose and Stevia – to replace those questionable artificial sweeteners.

Let’s start with preservatives, chemical compounds that extend the shelf life of products and ensure they stay safe to eat for longer periods of time. Specifically, they are added to food to prevent spoilage caused by bacteria, fungi and other microorganisms. They help maintain the quality, flavor and appearance of our food, making it possible for us to enjoy a wide variety of products that would otherwise spoil quickly.  

Nitrates and nitrites, two types of preservatives, can be found in leafy greens and processed meats. In meat, they are used to prevent bacteria growth, enhance the pink or red color and add saltiness. Earlier research suggested that nitrates may be responsible for the increased colon cancer rates seen in people who eat lots of processed meat – like bacon, ham, hot dogs, sausage and sliced deli meat – although the connection is still ambiguous. That said, nitrites also act as antimicrobial agents by disrupting key bacterial functions, including metabolism, oxygen uptake and energy production. Additionally, they are particularly effective at preventing the growth of Clostridium botulinum spores, which help protect against foodborne illnesses like botulism. 

Nitrates are also naturally occurring in our bodies and in leafy greens – like kale, spinach, beets, romaine lettuce and celery. In these cases, the nitrates are actually healthy and linked to lower rates of cancer and lower risk of heart disease.  

Sulfites, another food additive, are used to control microbial growth and to prevent browning and food spoilage. They can be found in beer, wine, juices, dried fruit, processed fish, seafood, meats and some canned goods. In one study, sulfites were found to inhibit the growth of four species of beneficial gut bacteria (Lactobacillus casei, L. plantarum, L. rhamnosus and Streptococcus thermophilus) commonly used in probiotic supplements and fermented foods. Another study showed sulfites causing a decrease in Bifidobacteria and an increase in the genuses Escherichia and Shigella, the former containing both harmful and beneficial microbes, the latter being fully pathogenic and the leading cause of bacterial diarrhea worldwide. 

Sodium benzoate (SB) was the first food preservative approved by the Food and Drug Administration. It is usually added to carbonated drinks and acidic products or sauces. Unlike sulfites, there may be a positive effect associated with SB. A 2023 study showed that SB helped regulate the gut microbiota composition and improved bacterial diversity. It was proven to increase the abundances of certain beneficial bacteria including Bifidobacteria and decrease the abundance of certain harmful bacteria.  

So there are helpful preservatives, harmful preservatives, natural nitrates, unnatural nitrates. The world of preservatives is complex. Less complex – emulsifiers – another food additive.  

Emulsifiers help to combine ingredients that don’t normally mix – like oil and water. When used as food additives, they keep products smooth and uniform, supporting the texture, flavor and shelf life of food products. They basically act as binders.  

We can find emulsifiers everywhere in grocery stores – in lunch meat, in pre-prepared sauces, in ice cream, in mayonnaise and in baked goods. There is evidence that these emulsifiers, especially two common ones, CMC (carboxymethyl cellulose) and P80 (polysorbate 80), decrease the diversity of gut bacteria, importantly Faecalibacterium for P80, which you may know that Faecalimacterium prausnitzii is an important commensal bacterium that produces butyrate in the colon and that I often see missing on clients’ stool tests. These emulsifiers wear away at the mucus wall that protects the gut lining. As a result, bacteria come much closer to lining, causing inflammation and a ‘leaky gut’. This can spark inflammatory diseases like Crohn’s and ulcerative colitis in genetically susceptible individuals. Polysorbate 80 also increased Bilophila, which you may recognize as the genus containing Bilophila wadsworthia, one of the prime culprits in hydrogen sulfide overgrowth.

Another commonly used emulsifier, often found in dairy products, is carrageenan (CGN). Much like other emulsifiers, it is found in ice cream and deli meats, but also in reduced-fat or non-fat food products, like soymilk, yogurt, chocolate milk, salad dressings and beer. It is also used as a browning inhibitor for fresh fruit. It, too, decreases the thickness of the mucus barrier and clinical evidence suggests that CGN is linked to the development of inflammatory bowel diseases (IBD). CGN may also interfere with the normal digestive process, by reducing the effectiveness of gastric juices, potentially leading to incomplete or impaired protein digestion and nutrient absorption. It also increased the genuses Escherichia and Shigella.  

So while the emulsifiers I’ve mentioned aren’t great for any of us, they are particularly important to avoid for people who have inflammatory bowel disease, meaning Crohn’s or colitis, or anyone with first degree relatives with those diseases.  

Another common food additive, maltodextrin, is a preservative, thickener and bulking agent derived from either corn, potato, rice, wheat or tapioca starches. It has been shown to increase propionic acid, one of the short-chain fatty acids found in the colon, but which at elevated levels has been associated with autism spectrum disorder. On the other hand, maltodextrin increased Bifidobacteria, an important commensal. Another study found that it lead to the promotion of intestinal inflammation and could be a risk factor for chronic inflammatory diseases, including a mouse model of colitis. It was also found to favor biofilm formation by adherent-invasive E. Coli bacteria associated with Crohn’s disease.  

Emulsifiers and preservatives are just one part of the broader picture when it comes to additives. But before we eat these products and even long before they find their way to shelves in supermarkets, we need to worry about pesticides.  

There are several types of pesticides, including insecticides, herbicides and fungicides/bactericides, each tailored to combat specific types of pests. The term “pesticide” encompasses a range of chemical substances used to manage and eliminate pests like insects, rodents, fungi and undesirable plants, like weeds. Government agencies and the World Health Organization have placed limits and enacted laws over the permissible levels of pesticide use. But fears around the use of pesticides still permeate and sometimes for good reason. Studies have shown that exposure to organophosphorus insecticides (OP) are correlated with behavioral deficits, obesity and asthma. In terms of the gut – and its reaction to pesticides – animal experiments suggest that OPs and several other pesticides, including the herbicide glyphosate, can affect the gut microbiota. Short-chain fatty acids (SCFA) and polyamine-producing intestinal microbiota are particularly affected and altered by pesticides. SCFAs protect the intestinal barrier and regulate the immune response to infections. They are essential to the functioning of a healthy gut and also help process nutrients, maintain energy homeostasis and assist with immune system development overall. Polyamines, on the other hand, are essential for cell growth and proliferation as well as suppressing chronic inflammation.  

Several studies, in recent years, have focused on glyphosate (GLY), the most popular herbicide, used to combat unwanted plants and grasses. Most of the time, these are animal studies that haven’t yet been tested on humans. But, their results are interesting and may shed light on the effect of pesticides on humans. For example, one study looked at the effect of GLY exposure on a specific kind of mussel. The results showed that GLY changed bacterial species growth in these mussels, potentially leading to microbiota dysbiosis, which could then promote the spread of opportunistic pathogens. In another study, GLY exposure led to a reduction in a digestive enzyme function in a type of crab. While there aren’t many studies on the effects of GLY on humans, a 2023 paper, published out of the UC Berkeley School of Public Health, shows that childhood exposure of glyphosate is linked to liver inflammation and metabolic disorders in early adulthood. These children were exposed via agricultural use of glyphosate near their homes – and near the homes of their pregnant mothers before they were born. The researchers measured glyphosate in urine samples from the children at age 5, 14 and 18. Higher rates of glyphosate residue in urine in childhood and adolescence were associated with higher risk of liver inflammation and metabolic disorders at age 18. It was also reported that diet was likely a major source of glyphosate exposure.  

Another food additive, and among the most commonly used globally, are artificial and alternative sweeteners. Their low or zero-calorie content, affordability, intense sweetness and the growing awareness of the detrimental effects of sugar have led to their growing use as sugar substitutes in various foods and beverages, including sugar-free desserts and sodas. But you definitely can’t lump all alternative and artificial sweeteners in the same boat.  

Aspartame, an additive found in diet products, including soda, may be one of these risky artificial sweeteners. According to a 2014 study, conducted on rats, aspartame was found to increase the circulatory level of short-chain fatty acid propionate. Increased propionate in the bloodstream can disrupt normal metabolic processes. The same study found an increase in gluconeogenesis after aspartame intake. Gluconeogenesis is the process by which the liver produces glucose from non-carbohydrate sources. If it increases, it can lead to higher blood sugar levels, which can, in turn, contribute to conditions like hyperglycemia and insulin resistance.  

But there is a lot of debate around the effects of aspartame. While some studies suggest there are negative metabolic consequences associated with this artificial sweetener, others suggest there may be minimal effects on the gut microbiota.  

Another study, this time conducted on humans in 2020, showed a drastically different picture of Aspartame. There were a total of 17 healthy participants who, over the course of 12-weeks, consumed both aspartame and sucralose, another artificial sweetener. The results suggested that aspartame and sucralose did not cause measurable changes in the gut microbiota or in short-chain fatty acids after 14 days of a realistic intake of these sweeteners. This gives me little comfort in that I assume a realistic intake was not the level of 12 Diet Cokes my new husband drinks a day, despite my warnings against it. They found that this realistic intake did not change glucose metabolism or insulin sensitivity in healthy adults. This tells a different story than the 2014 study. That being said, there are always shortcomings and potential limitations to this kind of research. For one thing, 14 days may not be enough to measure or track changes in the gut microbiome. Additionally, all participants were healthy and did not have any chronic medical conditions, including diabetes, IBD, IBS, celiac disease or malabsorption syndrome.  

Furthermore, a critique of the re-evaluation of aspartame safety by the European Food Safety Authority found that 97% of studies that reported no harm were industry-sponsored, while all the studies that indicated possible harms were non-industry sponsored. Similarly, a Sydney University study found that 100% of industry-sponsored studies found that aspartame was safe, while 92% of independently-funded studies found adverse effects.  

Acesulfame potassium, also known as acesulfame-K, is another low-calorie sweetener. After testing its effect on the gut microbiota in mice, the body weight of male mice significantly increased, with no significant weight change in female mice. Another study, from 2015, found that there was no significant change in median bacterial abundance in human intestinal flora after exposure to acesulfame-K.  

However, an umbrella review of multiple meta-analyses on artificially sweetened beverages done in 2023 concluded that ASBs were associated with a higher risk of obesity, type 2 diabetes, all-cause mortality, hypertension and cardiovascular disease incidence and weaker but still significant evidence of an association with colorectal cancer, pancreatic cancer, gastrointestinal cancer, cancer mortality, coronary artery disease, cardiovascular mortality, chronic kidney disease and stroke. This included beverages with acesulfame potassium, sucralose and aspartame.  

But I imagine most of you aren’t consuming these more typical artificial sweeteners but rather considering some of the more recent and/or organic sugar alternatives like sugar alcohols, stevia and monk fruit. So let’s look at these.  

First, my personal favorite, xylitol. While this is a strange choice for me given my gut health situation with recurrent, autoimmune hydrogen SIBO, because it’s well known for loosening stool, I like it because it replaces sugar 1:1 in recipes, cooks like sugar, tastes like sugar, but does not have the bad glycemic effects of sugar and we mostly can’t digest it. Any absorbed xylitol is converted to glycogen or glucose and slowly released into the blood stream, so it has low glycemic and low-insulinemic indices. It also causes significantly slower gastric emptying. One caveat might have to do with who can safely consume xylitol, as it did show a significantly increased plasma glucose response in obese individuals, but not in lean individuals in one study.  

But for me as a lean individual and a recovering sugar addict who still needs something sweet every now and then, xylitol has been a practical choice. But because we only partially digest it, it does leave room for bacteria to ferment the unabsorbed portions in the colon, creating excess hydrogen, which can lead to flatulence and loose stool. But interestingly, it may also contribute to the generation of butyric acid, aka butyrate, which you know is a beneficial short chain fatty acid, and a shift from gram-negative to gram-positive bacteria in the colon, which would be good for someone with a proteobacteria overgrowth, but not so great if you’re high in clostridia in the colon, for example. There are also several studies reporting increased oxaluria, or increased oxalates in the urine, from xylitol, so people will oxalate issues should avoid xylitol. In terms of carcinogenicity, one study found an anticancer effect of xylitol from a mushroom that is high in xylitol and a when a xylitol solution was injected in mice, suggesting it might be a potential chemotherapeutic adjunct agent.  

But because of the stool loosening effects, I just try and keep quantities low and always reduce whatever sugar is called for in a given recipe to start with, then substitute xylitol. It is toxic to dogs, so just make sure your dog doesn’t grab a muffin off the counter if you’re using xylitol.  

Also, you may have seen more xylitol gums popping up and it being touted for its anti-cavity properties. That may be a bit overblown compared to other possible sugar alcohols but there is reasonably strong evidence for xylitol’s ability to inhibit cariogenic or cavity-causing bacteria. However, xylitol in snacks doesn’t have the same effect and the act of chewing gum and increasing saliva alone will help decrease cavities too, so it’s a bit equivocal. But it’s certainly better than sugar in chewing gum. And one in-vitro, meaning in a petri dish study, showed it also inhibited candida albicans, so xylitol gums may actually be effective for oral thrush. What’s more, another in vitro trial showed that xylitol reduced the amount of acetaldehyde produced by candida species by 84%. Acetaldehyde, you may recall, is a toxic byproduct of alcohol metabolism and of candida metabolism that can cause significant damage to the body. And we know that sugar feeds candida, promoting candida growth, so xylitol may be a reasonable alternative if you have candidiasis. But don’t think it’s going to stop or control a candida infection, as one in vitro study only showed a mildly inhibitory effect of a 10% xylitol solution on candida at the 3-day mark but none at the 7-day mark.  

Another very common sugar alcohol substitute you’ll see in a lot of ice creams, chocolates and other diet or keto type products is erythritol. Like xylitol, it looks and bakes like sugar, but at a ¾ cup sugar to 1 cup erythritol ratio. Unfortunately for me and reported others, erythritol does cause nausea in some people, and I’m one of them. This may be because of its significant slowing of gastric emptying, which was found in a randomized controlled trail of 20 people, half lean and half obese. Both the erythritol and xylitol studied in this trial caused marked increases in GLP-1 (glucagon-like peptide-1, which you may recognize as the target of all these diabetes drugs like Ozempic, Wagovy and Manjaro) aimed at weight loss. GLP-1 and other hormones were released, which promotes satiation and reduces gastric emptying time. But because of the nausea I feel every time I eat it, I really wish some of these companies would use xylitol and not erythritol in their sugar-free ice creams.

In terms of its effect on the gut microbiome, an in vitro trial showed erythritol wasn’t fermented by the human gut microbiota after 24 hours, making it unlikely to be fermented in the human body. Other studies have shown that it is non-toxic and non-carcinogenic even at high doses in animals and humans.  

Another newer option on the market is allulose, which has shown positive impacts on the microbiome in two mouse studies (here and here). They indicated that allulose helps alleviate weight gain and inflammation and increases beneficial bacterial genuses Lactobacillus and Coprococcus. And a randomized controlled trial on humans found it safe for consumption with no effect on blood lipids, uric acid or hsCRP, a marker of inflammation. Another pilot study in humans with type two diabetes compared a standard diabetic diet with a diet containing 8.5 grams of allulose and found a protective effect on insulin secretory capacity because of a reduced need for insulin. I have a bottle of liquid allulose in my pantry cupboard and have used it successfully to replace liquid sugars in recipes like pecan pie, which normally calls for corn syrup, although like erythritol it’s slightly less sweet than sugar so you need a cup of it to replace ¾ cup of sugar. And I have found allulose in regular grocery stores.  

Another great option in sugar substitutes is stevia, although not so much for baking but more for sweetening beverages like my morning cup of Stash green chai tea, which is my total fav. Stevia has been shown in studies to be anticariogenic, antioxidant and antitumor. And while I’ve heard suggestions that stevia may be bad for the gut microbiome, I found a 2022 literature review that concluded that in fact it may improve the microbiome’s alpha diversity and that it has anti-inflammatory properties. And an interesting side note, I used to grow stevia. It’s a plant with leaves you can chew on and you get that same super sweet taste. I’m a fan of the Better Stevia* drops, which come in a variety of flavors and in my opinion have no bitter aftertaste.

Monk fruit extract is also a good alternative similar to Stevia, although it’s not my personal favorite, is much more expensive, and although I haven’t really tried it in a few years, other than in products in which its an ingredient, I always sense a bitter aftertaste with it. But it appears to be safe and non-toxic and in a symbiotic yogurt even had beneficial effects on short-chain fatty acid levels and gut microbiota status in rats. However, it would be hard to separate out the effects of the yogurt versus the sweetener here, but interestingly, the yogurt actually helped restore the islets of Langerhans, which produce insulin, making the yogurt a good option for type 2 diabetics. 

So anyway, I hope that helps you better decide what food additives to focus on avoiding. If you’re wanting to avoid pesticides but can’t purchase all organic, check out the environmental working group’s Clean 15 and Dirty Dozen lists.

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me. 

*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.

Adapted from episode 127 of The Perfect Stool podcast with Ashok Gupta, founder of the neuroplasticity, “limbic retraining” recovery program and app known as the Gupta Program and Lindsey Parsons, EdD, and edited for readability.

Lindsey:   

I understand and I shared in the intro how your personal story of illness and recovery led to your creation of the Gupta Program*. So can you share that story? 

Ashok Gupta:   

Yes, of course, like many of us who work in this field, we’ve been through our own challenges. And we’ve healed, we’ve survived, and we’ve gone on then to help others. So my journey started in the mid 90s, when a lot of these types of illnesses, conditions, gut issues, they weren’t really recognized. And I was studying as an undergrad at Cambridge University. I got some kind of virus and I wasn’t sure what that was, but I didn’t think much of it. I kind of healed from the virus, but my physical body just deteriorated to the point at which I would open up a textbook and I couldn’t read the words on the page, or I had to crawl to the bathroom, just really intense fatigue. And for people who don’t know what chronic fatigue syndrome feels like, what ME feels like, I would describe it like your worst day of flu times five. Literally, you’re just wiped out. And it doesn’t matter how much you rest, it doesn’t seem to alleviate whatever you do. And I went from doctor to doctor and they would say, we don’t know what you have, we don’t even know what to call it. We don’t sometimes even think it’s real, there’s nothing we can give you to treat it, you might have it for the rest of your life, goodbye. And that for a young man, you can imagine, was a death sentence. 

I met hundreds of others who were suffering from it.  And I just know in my worst moments, in my darkest moments, I made a contract with the universe. And I said, If I can just get myself 50% better, ideally 100% better, I will dedicate the rest of my life to solving this condition and helping others with it. Because there’s so many people who are suffering and so much untold suffering from it. And so I managed to find some amazing work on brain neurology and physiology and I studied that. And I came up with a hypothesis as to what causes these types of conditions. I then retrained my brain and had myself 100% well, and then set up a clinic to treat others and then since then have obviously published medical papers and studies and published an app as well. So yes, that’s been my journey over the last 25 years, 30 years. 

Lindsey:   

That’s awesome. So just in case people don’t know the abbreviation ME stands for? 

Ashok Gupta:   

Well, it’s a long convoluted title. Essentially, it’s seen as a more severe form of chronic fatigue syndrome, and it’s stands for myalgic encephalomyelitis, if I said that correct. 

Lindsey:   

Okay, so this is like inflammation of the brain? 

Ashok Gupta:   

Yes, inflammation in the brain, the body and then going on to cause fatigue. 

Lindsey:   

Okay, and can you explain what the limbic system is? 

Ashok Gupta:   

Sure, yep. So some of these treatments and therapies have sometimes got put into this pigeonhole of retraining the limbic system, which isn’t quite accurate, but I can describe to people what the limbic system is. So we have different areas of our brain. And the limbic system is the part of the brain that is known as the mammalian brain, which includes certain brain structures that are responsible for our emotions, and emotions themselves are defensive. So it also includes defensive reactions. And it used to be believed that the limbic system was just in control of our emotional reactivity.  

But actually, our physiology, our immune system, the systems that keep our body functioning, are also mediated through the limbic system part of the brain. And that includes structures such as the hippocampus, which is our short-term memory retrieval, the thalamus, which is a part of the brain that accumulates all sensory data from our body, and especially the amygdala, which is the core part of what we retrain, which are two almond shaped structures, which sit behind the eyes. And their role is to defend us from dangers. And traditionally the amygdala has been implicated in PTSD and anxiety disorders. But actually, they’ve now found the amygdala is involved in sensitivity reactions, and also immune reactions and causing immune storage in the brain, or immune reactivity in the brain. And so let’s say you go to a hospital, and there’s a separate immunology department, separate physiology department, separate neurology department, but the brain does not separate between physical, emotional, biological, it simply says: “What is the danger of a threat? And what reaction do I need to perform?” So essentially, that’s what the limbic system does is it defends us from all kinds of threats that compromise survival.  

Lindsey:   

Okay, so I saw, scanning the Gupta Program website, that it has been used and studied in gut health conditions like SIBO and IBS and food intolerances. So can you tell me more about that? Because that’s obviously what my audience is most interested in. And I’m also particularly interested because I have autoimmune SIBO, which means it just keeps coming back. And of course, I have lots of clients with a wide range of gut health issues and food sensitivities. 

Ashok Gupta:   

Yes, so in our hypothesis, we believe that a lot of the gut challenges that people face are essentially as a result of a dysregulated nervous system and a dysregulated immune system, which as a knock on effect causes massive imbalances in the gut in terms of, obviously dysbiosis, tightening of the gut, imperfect absorption of nutrients, etc., etc., etc. And so a lot of our studies have been more focused on the main illnesses we treat such as chronic fatigue syndrome, fibromyalgia, long COVID, mold illness, but we recently conducted a clinical audit of our patients, about 400 patients were involved in this clinical audit. And we found that actually many patients were seeing significant benefit for food sensitivities, SIBO, irritable bowel syndrome and, of course, those symptoms are very prevalent in a lot of the other conditions that we treat as well. So for instance, in IBS, after just three months on our program, patients reported 64% improvement in IBS symptoms, they reported 56% improvement in food sensitivities. So we have many patients, who now as a result of exclusion diets, or whatever, have gone down to three foods. And obviously, it’s a maze to try and understand what’s going on.  

And we believe that brain retraining is a core component of this, because actually, we can train the brain that these foods are safe. We can actually bypass the need, or certainly work in tandem with some of the more downstream treatments of food sensitivities, and in combination, we can train the brain to no longer react. So there are 56% improvement in food sensitivities, 46% improvement in SIBO, after three months of using brain retraining. So I think it’s a really promising treatment for gut health issues in combination with obviously the great work that you do as well. 

Lindsey:   

So I know that people might feel and there might be this perception that in some way, you’re suggesting that their issues are all in their head? Can you correct that misinterpretation of what brain retraining is about? 

Ashok Gupta:   

Yes, of course. And we get this time and time again. And we say, it’s not all in the minds, but we believe it’s all in the brain. And it’s separating and differentiating between those two things. So the way to think about our brain is, imagine that you look at a car. And traditionally, medicine would look at our body like a car. So if something went wrong with the door, you fix the door, something goes wrong in this part of the engine, you fix the engine. But in modern cars, what tends to go wrong, is the electrical system. And the electrical system of the car is like the electrical system of our body, the nervous system, and the central processing computer in the car, that’s the equivalent of our brain, that’s the most intensive collection of neurons in the entire body. And that’s where is a kind of central processing unit.  

And so when we have these types of conditions, we’re not saying that it’s in our conscious mind, we’re not saying that we’re consciously aware or that we’re choosing these conditions. But we’re saying that in this processing unit of the brain, these electrical systems, they sometimes maladapt to our environment. They sometimes over defend, over survive. If you think about it, the number one priority of our brain is survival, it’s not wellness, funnily enough. We think, “I’m sure my brain wants me to be well.” Actually, it’s survival. And so when we realize that our brain then errs on the side of caution, and therefore, it’s not something that we choose, it’s not something that we want, it’s happening unconsciously without our awareness. What brain retraining is, is actually we can influence what the brain does, even though it wasn’t cognitive in the first place. There are specialized techniques that can potentially reverse some of these effects and get us back to health. 

Lindsey:   

Can you give me some examples of the kinds of things people do within the Gupta Program just so people can understand a little bit what it’s about? 

Ashok Gupta:   

Yes, absolutely. So the Gupta Program essentially has been developed over the last 20, 25 years or so. And it involves a whole suite of different techniques that I can only call brain retraining, neuroplasticity techniques, but they’ve been drawn from a number of different areas of therapy, coaching, etc. and unique twist put on them or, you know, reinvented. And so we first of all teach patients to recognize some of those danger signals. So as we said, at the beginning, the brain is highlighting dangers and over emphasizing dangers, and therefore, the body and the brain reacts and creates these defensive responses, which cause all the downstream effects. So we teach the patient to recognize those signals. And instead of just letting them go, to actually retrain the brain, to tell the brain that we are safe.

Now, of course, the brain isn’t going to listen to just a cognitive thing. Like you can’t say to your brain, okay, you know what, I want you to cause my saliva glands to salivate right now. Your brain will say, no, I’m not going to do that, because I don’t take instructions in that way. But if I was to take a slice of lemon, and imagine I was to place that slice of lemon on your tongue, a really tangy lemon, and the juices are flowing in your mouth, and your saliva glands are stimulated now, and now you bite into that lemon. Now, I don’t know, Lindsey, but do you have any excessive saliva in your mouth right now?  

Lindsey:   

I do have some saliva.  

Ashok Gupta:   

You do have some saliva? So isn’t that incredible? I managed to trigger a physiological process in you, even though you knew it wasn’t real. Now, so it’s sometimes been glossed over how monumental that idea is that actually we can influence our physiology, when we’re able to train our brain that a certain experience is going on. Now, of course, brain retraining is far more than visualization. But that’s just an example of a technique where we can access your limbic system, access your unconscious brain, and cause physiological responses. 

So in a similar way, if your brain has learnt to overstimulate your nervous system and immune system unnecessarily, imagine if we could find the right key to the right lock, and actually calm down those systems and bring us back to homeostasis. And so that’s some examples of how brain retraining works. And it has three components. The first is the three R’s of the program, the first R is relaxing the nervous system. So our brain is not very neuroplastic in its normal state when it’s aroused. But if we calm it down, that makes our brain more neuroplastic and easier to rewire. The second R of the program is retraining the brain. And that’s the core techniques. That’s what’s unique about the program. And the final R is what we call reengaging with joy. So that is saying, actually, we need to understand more about our stress responses in life, and why we respond in a certain way. Because there’s no point getting well, and then having some incident in life and all the symptoms come flooding back. So we teach a patient to recognize when they become dysregulated. And find coping mechanisms or retraining certain parts. So we use a lot of parts therapy, which we find very powerful, and a whole suite of different tools and techniques to enable a patient to stay well for the rest of their lives. 

Lindsey:   

As you’re talking, it made me think, well, this seems like something that would be really useful for anxiety, is that something it’s been used in?  

Ashok Gupta:   

Absolutely. So we have many patients that come to us with chronic anxiety where they’ve been down so many pathways, tried so many things, and they just haven’t been able to heal. And they’ve come on to our program. And in fact, it’s in our Clinical Audits, in terms of anxiety, a 68% improvement in anxiety after three months, and that’s a documented, published study. And we’ve actually had some studies internationally, which haven’t been published yet, which have showed very large effect sizes for depression.  

Now, of course, we don’t formally recommend our program for depression, because that requires much more specialist attention versus someone using a self guided program. But we can see the potential of a program like this, which is that a lot of these illnesses are essentially the wiring of our brain, at the core of it. And if that’s the case, it opens up a whole world of healing, to previously difficult-to-treat conditions. And I’m sure Lindsey, in your practice, we will see patients who initially do really well on these types of protocols, whether it be supplements or diet changes, etc. But then a stressful event comes in their lives, or some change happens. And it’s so easy for all of the symptoms to come flooding back. And then there’s a whole pathway of new diagnosis and new treatments that we try at that moment in time. And that is, once again, because I believe that a dysregulated brain is going to cause a dysregulated nervous system, immune system and gut. And then that gut through the gut-brain axis feeds back to the brain that we’re in danger, there’s something wrong, which then causes effects at an emotional level, at a cognitive level, but also in the brain, which then causes these feedback loops. And we got to break those loops and get people back to health. 

Lindsey:   

I also imagine this is really useful for people who are just super sensitive to everything, like there’s no supplement you can give them that they don’t have a reaction, and they’re just like, “I can’t do that. I can’t do that. I can’t do that.” And they can barely eat anything. And you’re like, “I’m not sure there’s anything left.” In fact, I did suggest it recently to a client who’s very much in that sort of situation. 

Ashok Gupta:   

Yes, and it’s fascinating for us because we work with a lot of functional and integrative doctors, nutritionists and naturopathic doctors. And now a lot of them are prescribing our program first. Because what they say is that, actually once the patient has calmed down their nervous system, then whether it’s binders, whether it’s supplements, whether it’s enzymes, those are then more effective because the system is now in a better state to handle something new. But it’s when we’re in a sensitized state, the system is now in shutdown mode. It believes that everything in the environment is a threat. Anything new is a threat, any new food, any new supplement is a threat. And that’s why people have reactions to what would be otherwise neutral pharmaceuticals or supplements. And therefore, we work in combination with many practitioners to create that balance and work from both wedges, so working both from the gut’s health and the downstream effects and then also the upstream.  

Lindsey:   

Yeah, that makes a lot of sense. So we’ve talked about ME/CFS, we talked about anxiety and gut health issues, you mentioned mold illness. What other types of situations or conditions might the Gupta Program be good for? 

Ashok Gupta:   

Well, we’ve found it very powerful for pain. And in fact, we published a randomized control trial on fibromyalgia, which is the most common widespread pain condition. And that was published in the Journal of Clinical Medicine. And that study found that after just eight weeks, which was a very short intervention, the Gupta Program reduced fibromyalgia scores by 40%. And there was a zero effect in the control group, which was relaxation and self awareness and that kind of thing. And there’s a halving of anxiety, a halving of depression, halving of pain, and a doubling of functional capacity after eight weeks, and those effects were continued for six months. And so pain is one area that we also treat. And recently, we found a lot of people with autoimmune conditions getting benefit from the program, even reversing symptoms. And we are looking at even conditions like MS and Alzheimer’s where, once again, it’s not saying that this is going to be the core treatment necessarily, but can really impact. Practitioners are anecdotally telling us that they’ve reversed Alzheimer’s using this approach in certain patients. So I think the future is very exciting for this type of approach.  

So, in summary, there are sensitivity reactions: mold illness, food sensitivities, gut sensitivities. Then there’s what we call neuroimmune conditions. So that would be your long COVID, which is huge right now, and I think we all know somebody who’s still got lingering COVID effects, and then chronic fatigue syndrome, fibromyalgia. And then we’ve got pain syndromes and you’ve got autoimmune conditions. And what is the root? So these are all branches of a tree. But we believe they all share the same root, which is that because of the way we live in the modern world, and you’re obviously an expert in that, we are creating too many threats for this system, there’s too much of an allostatic load on the system. And therefore when it gets pushed over the edge, it goes into survival mode, which is then hyper stimulating the nervous system and immune system to protect us. And that then causes a complete dysregulation of our bodies, everything will go wrong, because the nervous system and immune system connects to every cell, every organ of our bodies. And that, to me, is the root cause of all of these branches of the tree all these different types of conditions. 

Lindsey:   

And so you’ve mentioned two and three months, what is the typical length of time that somebody needs to do the Gupta Program before seeing results? 

Ashok Gupta:   

Generally, people find results within two to three months. Sometimes within weeks, sometimes within days, people can notice the difference. And we always want patients to not be complacent. So our mantra is always minimum six months. Because, of course, you can use the program, retrain your brain quite fast and think, “Hey, I’m feeling amazingly better.” But then if you go back to the old habits and go back to a 60-70 hour week, or some crazy stress that you’re experiencing, of course, then the symptoms will come back. So it’s pacing yourself slowly back into normal life. And the nervous system is sensitive for a while. So if you’ve had a dysregulated system, your nervous system has got overstimulated and got used to being in that state, it’s habitual, as a protective mechanism. Therefore, even once you’ve healed, the system can be sensitive. So it still takes time. And that’s our number one challenge is patients wanting to too quickly go back to normal life when they’re still dysregulated. 

Lindsey:   

And so how much time per day do you spend doing this? 

Ashok Gupta:   

We recommend to patients a minimum of 30 minutes a day. And of course, like any investment, the more time you invest, the better your results will be. But we think that everyone can invest at least 30 minutes a day in their health. And something which has been an absolute game changer is a treatment called daily Guptacise. Now what this is, is we know that a lot of our patients are quite lonely, and they’re isolated and it can feel quite demotivating to think, “I’ve got to try and put this program into practice and figure it out.” So we created daily Guptacise, which are daily Zoom calls that our patients can come on, that are hosted by our trained practitioners, where the trained practitioners take them through the nervous system regulation. So that’s somatic work, breathing meditation, and then a daily brain retraining. And that has been an absolute game changer. We only started it in September. But it’s been a game changer for our patients where suddenly, within weeks, they’re noticing differences, because now they’re committed. They’re just tuning in every day, like 20-25 minutes of nervous system regulation, 20-25 minutes of brain retraining. And it’s in a group and we have 200-300 people a day joining live. And it’s been fantastic. And of course, we can’t underestimate the powerful effects of healing in community and meditating in community. It magnifies the depth and power of how much we can regulate ourselves.  

Lindsey:   

And are these offered at different times of the day for your time zone?  

Ashok Gupta:   

At the moment, we’ve just got one time slot each day, which covers our US and European friends. So that is 7am Pacific, which is 10am Eastern, 3pm UK, 4pm Europe, so we cover most of the globe where our patients are, but of course in the future, we’d love to have multiple timezones. 

Lindsey:   

So is the conventional medical community embracing this at all? Or is it pretty much stuck in the in the functional medicine area at the moment?  

Ashok Gupta:   

I would say we’re making inroads. Absolutely. It’s taking time. And originally, you know, 10-15 years ago, we were the only treatment out there of this kind. And it was seen as very woo woo. Whereas now, there are other programs, there are functional and integrative doctors. We have about 5000 health practitioners recommending our program now, on our database, and it’s gaining traction. And for us, it’s about the science. So the only way we can try and improve this is to do these randomized control trials. So we’ve done two or three randomized control trials, we’ve done Clinical Audits, now we’re looking at larger scale trials. And that is what I think will eventually persuade the mainstream medical community.  

And actually, even the mainstream community, they recognize that their existing treatments have been absolutely ineffective in the longer term. I mean, I went to a chronic fatigue syndrome conference, and one of the leaders there said, you know, “It’s great, we’ve been meeting for 30-40 years, we’ve had these yearly conferences, it’s great. But over that period of time, we’ve not found a single biomedical treatment showing any consistent effect over all of that time.” You know, which is shocking, really. And for me, what that means is that we’ve got this kind of great future ahead of us where this type of treatment approach will become more mainstream. And my hope is in five to ten years time, if you have one of these dysregulated systems, you will see someone for brain retraining, or you’ll have a brain retraining approach and you will also have someone who will look at your holistic health support, so that’s the diet, the supplements, etc. And you have that coordinated approach. And that would be my hope. 

Lindsey:   

Yeah. So I actually, a couple years ago, someone had the DNRS, which is a similar type of program, I guess, Dynamic Neural Retraining System, andit was on a bunch of CDs or DVDs, and my only DVD player was in my guest house. It was very inconvenient to try and do it. I imagine it’s gone online too at this point. But are you pretty similar to them? Or do you know? 

Ashok Gupta:   

Oh, yeah, so we were the first program to publish in 2007. And let’s just say there have been other programs that have come along after that. And so we are aware of their work, but we have a very different approach to them. So, of course, we’ve got a similar outcome, which is to retrain the brain. But we believe in a kind of different approach. And therefore there’s a lot more deviation in how we work. And now we’re also an app, because I think having an app is super important, because people are busy, they want instant access and not log into a screen. So with the app, that has also been a game changer for our patients.  

Lindsey:   

That does make a difference. I can think about like if I’m sitting next to my bed, and I’m ready to spend 30 minutes doing something, I’m not going to go upstairs to get my computer, bring it down, hook it up, all that’s not going to happen. So an app does make a difference. So can you give a story of some client who maybe had a gut health issue or some constellation of issues that might have included gut health, that you can share? 

Ashok Gupta:   

Absolutely. So my favorite story I like to share is we had a client in New Zealand and he was in his early 80s. And I used to think, well, someone in their early 80s, it’s very difficult to figure out what is dysregulated in their systems versus what is a natural product of being at that age. And he had fibromyalgia. He had gut system dysregulation. He had chronic fatigue. He had a whole suite of different problems, and he had it for 30 years, so almost half his life, adult life, he spent in this state. And I said to him, “Okay, look, I’d like you to try the program, you know, give it your best shot.” But I wasn’t sure what results he would get. And within three months, he’d got up to 80-90 percent recovery. His gut system had been restored, his fatigue was much lower, he was just feeling much, much better. And I said to him, “What are you going to do with your life now, I mean, it’s incredible that you are now having this opportunity.” And he said, “Oh, I’m going to travel the world, I’m going do all of the things that I’ve always wished that I could have done. And now is my chance.” And I thought to myself, “Isn’t that incredible that if someone at that age, can first of all have the motivation to put this program into practice, secondly, enough of a neuroplastic brain to actually shift some of these responses, and then have the joy to want to go and travel the world, then all of us can do this. All of us have the ability to retrain.” And that was a really inspiring story for me.  

And, of course, we have many, many people, I’d say, the vast majority of our patients have gut issues in some shape or form, because that is just a natural consequence of this dysregulation. And I had a client who had long COVID, and had been floored by long COVID. He was a marathon runner. And so he was super fit. So we can’t say that his system wasn’t ready for COVID. He had a mild case of COVID, but then was just floored. He was on his sofa. He was lying on the sofa for a year, couldn’t do anything. And he came into our program. And within three months, he was back to running half marathons, at least, and cycling 100 kilometers day. And once again, he had a very dysregulated gut.  

And most of our patients have this kind of IBS oscillation between constipation and diarrhea, not good formed stools. And they have tightness in the gut, they have the wrong absorption of nutrients, they feel more exhausted after a meal, all of those classic signs of hyper dysregulation. And a lot of people find that with brain retraining, they’ve done a lot of the other stuff, now they’re on a good diet, they’re eating the good supplements, they’ve done a lot of that work themselves. And this final missing piece of the jigsaw is so important for that. And you know, we know it in the average population, if someone suddenly has a surge of anxiety, has a panic, what do we know? We know the gut instantly gets dysregulated. But normally, they can then bring themselves to balance. But if the system doesn’t come back to balance, there will be then chronic dysregulation of all systems. 

Lindsey:   

Yeah, I know that obviously while a good portion of IBS is SIBO and it’s a distinct dysbiosis, that there’s a good portion of it as well that’s not explained by that. I think the recent numbers are something like 60% of IBS is SIBO. But the rest can certainly be something going on that’s dysregulating them. 

Ashok Gupta: 

Absolutely. And even with the SIBO, in functional medicine, we always go back to that question, don’t we? But what’s the cause? But what’s the cause?  

Lindsey:   

At the end of the day, there’s dysmotility. 

Ashok Gupta:   

Yeah, exactly. So, then we have to say, “What’s the cause of dysmotility?” And I’m sure, it’s multifactorial, so I’m not dogmatic in that sense. So, of course, it’s how many toxins are we exposed to? How much pollution is there? What foods are we eating? All of these different wedges in. And that key component of our emotional state of being is also a really big factor, if not the biggest factor into that bucket of the allostatic load. All of these different threats that our system is perceiving, which then once again can tighten up the gut, stop our gut from being able to absorb and process foods. All of these things are kind of interconnected.  

And I think, you know, I always remember when my gut wasn’t great, many, many years ago. I used to notice that when I’m in a busy clinic, there’s lots of things going on, I have to be very careful about what I eat to make sure I exercise and meditate all those good things. But I go on holiday and I’m sitting on a beach for two weeks, right? I can eat all kinds of nonsense, all kinds of rubbish, that I wouldn’t dream of eating, have late nights, you know, and my gut is completely fine. I’m thinking, “What is going on there?” And that gives us a clue to it’s really the overall load. And what’s hopefully going to come out of this research is that for all practitioners everywhere, working at that holistic level, the mind, body, spirit, physiology, all of those different levels is super important.  

Lindsey:   

Yeah, I have had that exact same experience and I kept thinking, “Is it something?” because I often was at my parents house when I would have just really good periods where I had no struggles with my SIBO and I was eating a lot more gluten and dairy and, yeah, I took my pills to digest it and stuff, but I was like, “Is it the water there, because they don’t filter the water? Maybe I’m getting more calcium in their water? Like what is going on?” I just thought, “What could be happening? Because I’m eating less ‘healthy food’ for my body and doing better.” And I’m sure that stress question plays into it enormously. And people have this theory, “I go to Europe and I can eat all the pasta, and I can eat all the bread and there’s no problem at all. It must be the American wheat.” And maybe that’s part of it. But I’m sure the bigger part is you’re on vacation. 

Ashok Gupta:   

You’re on holiday, you’re on holiday! And we see it time and time again. And what it is, is often our patients think stress is a word that’s judgmental to them, or that they’ve caused the stress. And actually, it’s just about your nervous system regulation. So what happens is, we can actually be encountering quite mild stress, but if our system has a background of let’s say, trauma, for instance, or dysregulation, it can very easily become dysregulated, even by small amounts of stress, which then means that it has knock on effects on our digestion. And therefore, even if we think that we’re not stressed, it’s just our day-to-day, busy lifestyles can impact on the gut, and therefore, going into a deeper and deeper level of relaxation can really impact. 

Lindsey:   

So is what you do in the Gupta Program different by what your condition is? Or is just what’s in your head going to be different, based on your condition?  

Ashok Gupta:   

We do give people adaptations of how they use the program for different types of conditions, so neuroimmune versus sensitivity reactions versus pain. But essentially, it’s used in a very, very similar way. Because we believe it’s the same brain networks. I’m sure, Lindsey, you have this kind of observation where you’ll have a chronic fatigue patient, and they’re far more likely to have mold, and also have the SIBO. And so it’s a collection of symptoms, which just vary amongst patient to patient. I was asked, “Is it someone with mold who’s got fatigue? Or is it fatigue with mold? What is the core issue here?” And so in a similar way, these particular treatments are very similar because they’re getting to regulate our overall systems. And you might ask, “Well, why is our system dysregulated?” And of course, we’re not living according to our genetic inheritance.  

So rewind 300-400 years ago, the vast majority of human civilization lived in small farming communities or small fishing villages, apart from those living in the city. But the vast majority lived in villages. We were outdoors, we were getting fresh air, we were eating organic food, we were exposed to sun and red light. We were living in community, we had much lower levels of stress actually in the past. And therefore, our guts were at a better absorption rate and better regulated. Fast forward to the modern world. We put ourselves in boxes for 90-95 percent of the day. We sit in front of a screen, in sedentary lifestyle. We expose ourselves to food toxins and pollution. We stress ourselves out by comparing ourselves to everyone else on the planet through social media. We spend most of our time looking at the screen and never resting our nervous system. We don’t sleep according to the rhythms of nature and the sun. And then we expect to be healthy. The way we’re living modern life is a recipe for our nervous system and immune system to be in threat survival mode, and so therefore causes exhaustion and fatigue and depression and anxiety. We’re breeding people for these conditions, unfortunately. 

Lindsey:   

Yeah. Can you tell me a little bit about the clinical studies you’ve done? 

Ashok Gupta:   

Sure. So the fibromyalgia one I already mentioned. We also just did a study on long COVID. And that was a published RCT, so randomized control trial. So we compared the Gupta Program to a wellness program, because we wanted to compare something which was equivalent, because people always say, “Well, of course, people are going to do better on the active treatment versus waiting list.” So we compared our programs to a wellness program that included sleep, diet, supplements, all the good stuff that holistic therapists may support people with, and we compared them over three months. So after three months, the Gupta Program was four times more effective at reducing fatigue and exhaustion in chronic fatigue/COVID patients and twice as effective at increasing levels of energy, which was an incredible result. I mean, whenever in a medical study do you get a 400% result compared to a control. So that was a published study. And that’s obviously gone on to breed more studies.  

So we did more studies on long COVID. Some of those results have been really good as well. So that’s what we’re doing in that area. And of course, we had that recent clinical audit, which I mentioned earlier. And we found that across 14 different conditions, the Gupta Program was significant at increasing health and functional capacity. Anywhere between 60-70 percent improvement to 116% improvement in the case of Lyme disease. Lyme disease is another one that we have great results with. And just after three months 116% improvement health, which was fantastic. So those are some of the studies and we’ve got more studies in the pipeline, as well. 

Lindsey:   

Awesome. So I know I’ve got a link for the Gupta Program, that’s an affiliate link so that if folks are interested in trying it out, they can follow that link and support the podcast. Anything else you would like to mention or share? 

Ashok Gupta:   

Yes, so one of the clinical audits we did, chronic fatigue syndrome and fibro patients, showed that 92% of patients improved and two thirds of patients went on to make a full recovery. Now we define a full recovery is 80 to 100% of pre-illness levels. So that’s also a proper study, people can read on our website. So on our website, there’s a whole summary page of all the different research studies and a timeline, and people can read all the published studies there. 

Lindsey:   

Awesome. Well, thank you so much for being with us. This is a really interesting new direction, I think that will help a lot of my listeners and a lot of my clients.  

Ashok Gupta:   

Yeah, absolutely. Thank you for having me on. And we’d also like to mention that we give a lot of free resources as well. So we’d love for people to come on to our app or the in the show notes and links you put. And even if you don’t take our program, at least watch some of the free videos and the free things on there. Because they really learn so much, people have healed just by watching our videos, the free ones, because they suddenly realized, “Ah, now I understand what’s going on in my body.” So I really encourage people to take the free trial. And with our program, until we get large-scale phase two and phase three trials, we’re one of the only programs that offers a one-year, money back guarantee, which for us really makes it low risk for people to try this type of approach, because it can seem very strange or unusual. But actually it’s quite logical in our minds. 

Lindsey:   

Great. Well, I’m sure people will be checking it out. Thank you so much. 

Ashok Gupta:   

Thank you so much. 

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me. 

*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.

Adapted from episode 126 of The Perfect Stool podcast with Cheryl Sew Hoy, the CEO & Founder of Tiny Health, the most comprehensive microbiome platform for precision prenatal and children’s health and Lindsey Parsons, EdD, and edited for readability.

Lindsey:

Welcome to the podcast Cheryl!

Cheryl Sew Hoy:

Thank you, Lindey! I’ve been so excited to come on your show. You know why?

Lindsey:

Why’s that?

Cheryl Sew Hoy:

Before I started Tiny Health, and this was maybe even before 2020, I searched on Spotify, “What are all the stool test or gut health podcasts out there?” And I found yours and so I bookmarked your podcast. It’s been there for years. So it’s such an honor to finally come on your show because this is literally before I started Tiny Health when I found you.

Lindsey:

Awesome. Well, I’m glad to have you here. So what led you to start Tiny Health?

Cheryl Sew Hoy:

In 2020, I gave birth to my son, and that’s the year I also started Tiny Health. I started the company a week after he was born.

Lindsey:

That’s ambitious!

Cheryl Sew Hoy:

Well, yeah, I incorporated the company and I self-funded a study with eight moms who were giving birth the same time I was. So technically I started the study before I started Tiny Health since my story goes back to my daughter, two years before my son was born. So in 2018, I gave birth to my daughter by C-section. I was really researching the impact of C-section on my child. At the time, I didn’t know about any linkage between C-section versus vaginal birth and its connection to gut health. But since then, I’ve uncovered that you get your gut microbes from your mom at birth. You first get some vaginal microbes from labor and from passing through the vaginal canal, and then also some gut microbes from the fecal fluid during labor. Also through breastfeeding, the mom is continuing to transfer some gut microbes from her gut to her baby’s gut.

So then I was uncovering all this research about how bypassing the vaginal canal during birth can lead to a baby having a higher risk of eczema, allergies and asthma. I was kind of on alarm obviously, because of the C-section I couldn’t control and also trying to figure out if I can rebalance my C-section baby’s gut. I wanted to restore her gut by replacing the missing bacteria that wasn’t there to prevent her risk of chronic conditions. But obviously, I was in that research mode, so I didn’t get to see her gut. So when I was pregnant with my son, if this time I had to have a second C-section, I really wanted to know sooner than later so I could course correct earlier on. My daughter did end up getting eczema around six months, food sensitivites, she’s dairy and gluten intolerant, and she has a lot of gut issues and skin issues. I really wanted to prevent that for my son.

Lindsey:

Yeah, my son was also C-section. I did give him some probiotics sometime, but it may have been later on. But I was certainly aware of the issue at that point. So why do you recommend that expectant mothers test their microbiome?

Cheryl Sew Hoy:

Oh, yes. So I’ll follow on with my story and then come back to your question. I self-funded a study with nine moms, including myself, and tested their microbiome throughout the first year of life. I had gathered scientists and microbiologists who knew much more about this than I did to help me build this thing. And then we finally spent another two years of R&D (research and development) before launching the tests in 2022. Our flagship product was the pregnancy gut tests and vaginal tests and then also the newborn gut tests. All these were basically in the first three years, when there was a huge gap in the market, since there were no stool tests available for babies and moms at the time. And so with my son, who I mentioned earlier, I had that ability to test him and myself. With the study that I funded, I realized through my pregnancy microbiome that I didn’t have the “Bifs” (Bifidobacteria) that I was supposed to transfer to my son through a vaginal birth and through breastfeeding. If the mom’s gut is deficient, then even if she had a vaginal birth and was breastfeeding, she’s not transferring any necessary microbes to her child. Dr. Martin Glaser is a really well known microbiologist. Have you heard of him? He wrote this book called Missing Microbes.

Lindsey:

Yes, that’s what launched my interest in the gut microbiome.

Cheryl Sew Hoy:

Amazing. Yes, he’s well respected and I think there’s even a documentary now that he created with his wife.

Lindsey:

Awesome.

Cheryl Sew Hoy:

And so he talks about how the overuse of antibiotics is really causing a depletion of these essential microbes in our guts. And so that was the microbe that was depleted in my gut. I didn’t have any Bifidobacteria, I had zero. And that is the most essential microbe that a mom should have to transfer to her baby at birth, either through labor and birth or through breast milk. So it’s interesting now that we’ve been in the market for about two years, we’ve seen over 25,000 families. So we have a lot of samples, a lot of infant samples too. In 30% of the cases where the child was vaginally born and breastfed, they didn’t have any Bifidobacteria. Where we had the mother’s gut sample, the mom didn’t have any Bifidobacteria either. This is really interesting.

So I would recommend if I knew what I know now, and if I were to have a third child, I would try to restore my gut before trying to conceive, because it takes months for an adult’s gut to change. For example, if you and I were deficient in Bifidobacteria, it could take us at least three to six months, sometimes nine months, to see those Bifidobacteria recolonize, because we’re trying to make something that wasn’t there, maybe that was being destroyed by antibiotics. That was what I learned when I had to go through this path of thinking, “why don’t I have any Bifidobacteria?” I asked my mom how I grew up and she said I was formula fed and I had antibiotic exposure as a kid. Bifidobacteria are very sensitive to antibiotics, especially in early life, sometimes getting completely wiped out. If you don’t take care to restore the bacteria, it may be gone forever. So why I think everyone should do a stool test to really see if there’s any Bifidobacteria or Akkermansia, the other crucial bacteria that is important for your metabolic health and gut lining. I would check if you’re trying to conceive or if you are pregnant to see if you have Bifidobacteria and Akkermansia in your gut because these are two quite important bacteria to pass on to your child.

Lindsey:

If you’re going to reestablish it, is it B. infantis in particular that you want to restore? Or is it any Bifido combo? What do you guys recommend in that scenario?

Cheryl Sew Hoy:

Yeah, that’s a great question. So it depends, right? If you’re an adult with no bifidobacterium, frankly any bifidobacterium could be beneficial. But if you are planning to have a child, you really are looking for four specific bifidobacterium, which is what you mentioned. B. infantis, is probably the best adapted for digesting the mother’s breast milk, or specifically the HMOs in the mother’s breast milk, human milk oligosaccharides. HMOs are the prebiotic fibers that make up a third of the mom’s breast milk that the baby cannot digest. It is there for the bifidobacterium in the baby’s gut to digest. And so B. infantis is the best adapted in digesting HMOs in mom’s breast milk. The next best, maybe in no particular order, are B. bifidum, B. longum, and B. brevi. So we really want to see these four specific strains that are very good at digesting mom’s breast milk for the best child’s health. In the first year, we want to see these at 50-90% of the infant’s gut, frankly.

Then as they grow older, they get more exposure to solids, nature, pets, and their guts diversify. You don’t want to ever see 90% bifidobacterium in a toddler at two years old. I was researching and in the first six months of life to the first year, there’s a very specific trajectory of gut maturation that an infant should be following that is best adapted for training their immune system, because the baby doesn’t have any gut microbiome in the womb. There was some controversy back then and debate about, “oh, maybe there is”, but there isn’t a microbiome in the womb. The science is pretty settled in the recent year, that the major transfer, the colonization, happens at birth. There’s some passing through, but there’s no colonization in the womb. So what this means is that the baby is born pretty much without an immune system. And their immune system is being trained by these bacteria, these microbes, right?

I always describe the gut like a theater room with only 10 seats at birth. And as the infant grows, the seats in a theater expand. When they start solids, it makes them go to 20 seats, when they’re just kind of nibbling stuff, and then when the solids have been established, maybe it expands to 50. And as they grow up past one year, it’s quickly expanding to 100 seats, 200 seats, etc. You and I, at our age, probably have 300-500 species, or seats in that theater. So our theater is huge and very complex by now. But an infant’s theater is very small and developing. So that’s why those early years are so crucial to get the right balance, because this right balance of beneficial versus unfriendly bacteria is there to train their immune system on what’s friend, what’s foe in order to recognize if they should react to it. So the reason why eczema, allergies and asthma are so tied to the gut microbiome in the early days is because of their gut dysbiosis. It is a sign that their immune system wasn’t trained correctly by the right balance of bacteria.

Lindsey:

It’s overreactive?

Cherry Sew Hoy:

It’s overreactive. Yeah, it’s proinflammatory. In these babies’ guts, we often see zero bifidobacterium. So instead of the four bifidobacterium that we just mentioned, which take 9 out of 10 seats in the theater, it’s the other way. It’s maybe zero bifidobacterium and nine out of ten seats filled by E.coli, Klebsiella, maybe streptococcus, staphylococcus, etc.

Lindsey:

All opportunistic bacteria that at higher levels are pathogenic.

Cheryl Sew Hoy:

Yes. And babies still can tolerate that much. Sometimes parents are shocked when the gut of their baby is 90% E.coli. They ask, “Is my baby sick”, and the answer’s no. Babies, again, are born without an immune system. So they can still tolerate really high amounts of unfriendly bacteria. But you do see it in terms of symptoms, you get a colicky baby, a gassy baby, a baby that can’t sleep very well, etc. And then you get eczema when he starts solids at six months. So that high level of unfriendly bacteria and opportunistic pathogens is sitting there, creating this really inflammatory event in their guts and not training their immune system properly. And so when they finally are met with a dietary allergen or new thing at six months, they get triggered, and then eczema happens.

Lindsey:

Yeah. And so given that you guys now have sequenced all these infant microbiomes, I’m curious, because there are different strains of B. infantis. And some are a lot more expensive than others. So I’m wondering, is the B. infantis you’re finding in the guts of healthy babies who have the right microbiome the same as any one of the strains they’re selling out there as probiotics? Or are there are a number of different possible B. infantis strains that are good enough?

Cheryl Sew Hoy:

Yeah, this is a great question. We’ve seen some native B. infantis from a mom and a baby. It’s really hard to say, we would have to do a proper study. And we do have the data now to really dive into it. But this is what we could do in the future, in terms of “is the innate strain better than a supplement or probiotic?” Who knows? Probably, right, if the mom had B. infantis, it’s likely superior because her breast milk and her HMOs in the breast milk have probably adapted somewhat to her own B. infantis to help it colonize in the infant’s gut. But again, the problem with our society and modern lifestyle is that most adults are missing B. infantis, including myself. So then when that happens, the infant really needs a supplemental B. infantis that is well studied, clinically backed, and they’re not all equal.

When you talk about probiotics, you can’t just grab a bottle from the shelf and think, “oh, yeah, I’m taking probiotics”, or “I’m giving my child a probiotic and I’ll be fine.” No, because different strains have different functions. And even within one type of bacteria, like you mentioned, there’s so many different strains. And, for your audience, when I talk about strains, they are the numbers and letters behind the probiotic. So, for example, B. infantis EVC001*, is one that we recommend. The brand name is Evivo, right. It is the most clinically-backed B. infantis for infants, but I would even take it for adults too, because it’s so potent. And if an adult is missing some B. infantis, I would take that to help it recolonize the gut.

Lindsey:

I actually just bought some, and I’m going to make Bifido yogurt with it.

Cheryl Sew Hoy:

Nice! Did you buy the HMO supplement* along with it?

Lindsey:

I did not buy any HMOs yet.

Cheryl Sew Hoy:

Okay. If you want to recolonize you have to have the prebiotic for the probiotics to colonize. Otherwise, you have to keep taking the probiotic, because it is going to give you a transient effect. But again, without the food there, they’re not going to stick around, they are just going to pass through and give you a short term benefit. You have to keep taking it every day.

Lindsey:

For the rest of my life?

Cheryl Sew Hoy:

Maybe, but ideally the goal is to help it recolonize in your gut. Again, I think it took me three months of a prebiotic and probiotic combination. And then I sustained it with a diet that supports the sustenance of these probiotics once they’ve colonized in your gut. Things like a high fiber diet, polyphenol rich foods, etc. So it takes effort, which is why coming back to the mom question before, if you do want to conceive in the year, I would start restoring your gut now, as it may take you six months to get there. Remember I had zero “bifs” and I managed to get it up to 10, and then it became 8% for a long time, without any supplementation. And now it’s kind of back down to zero because I moved to Texas from California, and I realized my water supply here is terrible. We tested our water and there’s arsenic and lead and uranium in my water, that’s a whole different story. But it goes to show you how many factors externally, environmentally and dietary-wise could influence your gut, which is why we encourage proactive testing twice a year as an adult or an older child. That way you catch these things before they turn into symptoms. So now I’m trying to work it back up to 8% where I was before.

Lindsey:

Yeah, I wonder whether you really can recolonize. Whether you do have to essentially supplement with the probiotic or take the prebiotic once you supplement with the probiotic indefinitely in order to keep these strains alive, if they haven’t naturally settled. I know the gut microbiome of an adult is a lot more settled than that of a child. It’s easier to alter it in a child. So, normally, what would you say are the primary differences then between the infant microbiome and when does it start to settle into the adult microbiome?

Cheryl Sew Hoy:

Yeah, that’s a great question. So think of the theater example, that being 10 seats at birth and then it increasing over time. As children are licking the floor or you have a pet, the pets are bringing in that diversity from outdoors into indoors, which is why there are studies showing that if you have a dog or a cat at home, your kids are less likely to have food allergies, because it’s bringing in a lot of diversity that we’re missing in a modern lifestyle. So the infant gut is malleable in the early years, because it’s so small. If you think about it, imagine you just put in like nine good guys and one bad guy inhabiting the theater room. Or let’s just say the flip side, right? Nine bad guys and one good guy happens to be in that theater room. In the first few months of life, it’s easier for you to come in and be like, “Hey, move away, let me give you a probiotic or introduce breastfeeding,” assuming the mom had the right bacteria. Breastfeeding is very healing. If the mom had B. infantis, you just have to breastfeed, you don’t even need to supplement with a probiotic. Mom’s B. infantis can come in and chase those bad guys out and take those seats in the theater. So it’s very easy in an infant gut, frankly, as long as breastfeeding is involved, because of the HMOs.

So the key here is that the HMOs in the mom’s breast milk is the modifier of a dysbiotic gut or a very imbalanced gut. There are some infant guts who have too much beneficial bacteria and not enough unfriendly bacteria. And that’s not healthy either, because we need some unfriendy bacteria to train the immune system, like one out of ten should be unfriendly. So, in the literature, this is what we’re seeing. Even clinically, because we do a lot of survey data on babies. We have a lot of data on what makes a healthy infant gut and what doesn’t, because it’s so simple. It’s so much easier to characterize what healthy infant gut is and what an unhealthy infant gut looks like. For adults, it’s much harder to categorize that definitively. And we’re not looking for one universal, healthy microbiome in adults anyway because everyone has their unique microbiome. But in infants around the world in the first six months of life, their only food is milk, right? So their gut isn’t really influenced by different cultural diets and maybe weather or environments yet, it really is consistent. So in the first six months, it’s very clear what should be there and what shouldn’t be there. And as they eat solids, that’s where it gets a bit more complex.

I think post one year, it gets more complex depending on diet and culture and all kinds of things, but still malleable because some kids are still being breastfed at one year old. And again, the more there is breastfeeding, the more malleable it is, meaning the easier it is to change the infant gut if there are imbalances. In America, most people are not breastfeeding anymore. I did breastfeed my son for two and a half years and my daughter for 18 months. So yeah, obviously everyone has their own personal journeys, but around three years of age is when the child’s gut reaches what we call “adult-like maturation”. In the literature, there’s a transition phase seen between ages three to five years old. So I would say maybe a three year old’s gut is pretty close to an adult in maturity, a five year old is a bit more definitive. If we take a five year old’s gut test and if we have the mom’s or dad’s stool tests, it often maps very similarly. I can tell they’re living together and that they’re in the same family because the child’s microbiome tends to look more like the adult microbiome by five years old.

Lindsey:

Do you think that’s because they’re sharing saliva essentially, or because they’re eating the same foods?

Cherly Sew Hoy:

All of the above, 100%. There have been studies published lately that the family microbiome is a thing. I can tell, because I’ve seen tens of thousands of microbiome results. I can even tell if the partner, boyfriend and girlfriend are already living together or not. Sometimes a partner will come in for something and I’m like, “Oh, you’re living together, aren’t you?” or “You’re not living together” or sometimes I can tell that their husband is working elsewhere and eating a different food. The living environment, the food, the diet, everything influences your gut. So the more similar things you do as a family, the more similar your microbiomes will be. We started with the infant gut and mom because babies cry and have symptoms, and parents are trying to find a way to help and to get answers that maybe their pediatricians can’t give them. This research is relatively new. It’s not really in medical school yet. It takes an average of 10 to 15 years for groundbreaking academic research to get into medical practice. And for me, I couldn’t wait that long. So I really wanted to start this company to bridge that gap.

Parents come to us because they are trying to course correct their infant’s gut or rebalance it and make it better. But we’re like, “what about you, your child’s gut is eventually going to look like yours.” Doing a stool test on the parents is important from a perspective that you can’t just course correct in a point of time, because it’s your lifestyle, it’s a repeated thing. You have to have good dietary habits as well, not everyone just needs supplements. But if you do need them, you should know what specifically you need based on your tests, whether you do a stool test for your gut health or a blood test or nutrition test, we always believe in testing and not guessing. And then lifestyle changes too. A lot of parents were being educated on very toxic, household cleaning supplies like antibacterial soap. Many parents are really cautious with germs and bacteria and viruses because of the pandemic. And so we’re overusing these antibacterial soaps, which eventually gets into our child’s mouth and gut. It’s not just killing the bad bacteria, it’s killing the good bacteria as well.

So we’re giving a lot of education on lifestyle changes as well. People are not spending enough time in nature and outdoors. It may sound generic, but it is true. Modern humans are deficient in diversity. We used to spend 90% of our time outdoors, and 10% indoors. But now it’s the reverse, right? We’re spending 90% indoors, and 10% outdoors. So the simple things, like opening your window once a day for at least 30 minutes, are going to change your environment and your household to invite some of that outside microbiome in to help your child diversify. So, all this is to say that you have to think about your family’s microbiome holistically, and not just help your child without caring about your own microbiome.

Lindsey:

You mentioned eczema and asthma and things like that. Are there any other signs you might see to think, “Oh, my child’s microbiome might not be properly developing?” I know if you had a C-section, that’s sort of an obvious thing. But if you didn’t have that…

Cheryl Sew Hoy:

Because the lifelong immune system training of the child is so tied to their gut bacteria at birth, knowing what I know now, why wouldn’t you test early to get that snapshot of what was there at birth? So the earliest sample you can take is the seven-day sample after your birth and that will give you a clear idea of what the baby’s gut was like at birth. If you wait two or three months, you can start to see if mom was breastfeeding if she had to B. infantis or Bifidobacteria transferring to her baby’s gut. So, by then, if the baby had zero Bifidobacteria by three months, then we know the mom didn’t have it. And by the way, fathers and/or siblings can pass it on to a baby too. Sometimes we do see a mom without Bifidobacteria, but the infant has Bifidobacteria, so we don’t know where the good bacteria came from.

But sometimes when we have an older sibling who maybe went to daycare and had bacteria colonize from daycare friends or their dad, we see that passing on to the infant. So it’s really interesting. If the baby is completely deficient of it, that means nobody in the household likely has it, so everyone should be working on introducing it. A C-section is definitely a problem because the baby’s being exposed to the antibiotics from the procedure and also not passing through the birth canal. However, again, the breastfeeding is the number one modifier of an infant’s gut. So yeah, that is very healing. But there’s various things that you can do to restore an infant’s gut.

Lindsey:

Yeah. But are there any other conditions that you might see in your child that would clue you into the fact? I’m sure there’s people listening who have one year olds and two year olds and three year olds, what might they be seeing in their child that would let them think that maybe something went wrong with microbiome?

Cherly Sew Hoy:

Yeah. The common things in infants are a colicky signature or gasiness, these are very common symptoms. Maybe the baby’s crying a lot, and maybe not meeting that colic definition specifically. But as a mom or a dad, you have a gut feeling that something is off. By far the most common issues that parents come to us with are eczema and allergies. And now there’s a lot of protein-allergy kind of symptoms. But again, colic and sleep issues are also very correlated with the infant gut. So almost all the kind of common baby symptoms that you can think of can be linked back to the gut, and it could specifially be linked back to Bifidobacteria.

Lindsey: 

Having had a child, I would say that loose stool is a normal thing for a breastfed baby, liquidy sort of yellowish stool, right? My son was breastfed, but also bottle fed because I didn’t have enough milk. So I know that they tend to have more solid stool if they’re being bottle fed too. I just wanted to bring that up.

Cherly Sew Hoy:

Yes. The range of normal is wide in infancy, right? I get asked a lot, “What if they only poo once a week but they’re breastfed.” And that could be normal, or “they poo five times a day breastfed.” And that’s normal. It’s really hard to say, but I think some stool is connected to cow’s milk producing allergies, like the mucousy type stool or the green stool. Your gut tells you something is off and you kind of know about it. And I would say just check in and do a stool test. As the baby gets older and is eating solids, we get more constipation issues, because a lot of toddlers don’t eat fiber, right? And so we tend to see fiber digestion or maybe low short chain fatty acids in those toddlers. And so that’s when we offer some strategies to parents in sneaking specific fibers in smoothies, getting more in their diet or encouraging their kids to eat more fiber in that sense. So yeah, constipation is a very common thing with older kids. We also see teens who have acne problems and skin issues. You’ve probably heard of the gut-brain axis. There’s something called the gut-skin axis, which is with eczema, acne and other skin issues. There is an association where probably there’s too much mucus-degrading bacteria in the gut that’s running down the gut lining, and that’s affecting the skin as well.

Lindsey:

So it’s creating some leaky gut with the kids?

Cheryl Sew Hoy:

Yeah. You could even say leaky skin…

Lindsey:

Leaky skin, right.

Cheryl Sew Hoy:

Exactly. So there is a connection there, which is why 80% of our immune system is in our gut. And that’s why it is very essential to take care of it. And when we’re eating, we’re feeding the microbes in our gut, as much as we’re feeding ourselves.

Lindsey:

Yeah. So have you seen now, since you’ve seen all these tests, that all of the kids born via C-section have a perturbed microbiome or are some of them are okay?

Cherly Sew Hoy:

Yeah, it’s interesting. 30% of vaginally born, breastfed babies don’t have a good gut, right? And I think something like that amount, 30% of C-section born babies have a really good gut. Fewer, but some. But again, I think the modifying factor is the breast milk. The length of being fed breast milk and whether the mom had the Bifidobacteria to transmit to her baby. And if not, it’s okay, it’s not the end of the world. Again, this is why we created Tiny Health so that it could be empowering to parents. There’s no guilt tripping, it’s nobody’s fault. My mom couldn’t breastfeed me because of her low supply too. It’s hard, right?

Lindsey:

It’s hard, you really have to be dead set and determined on it and willing to suffer all sorts of things. And even still, sometimes you might not succeed, I’ve discovered.

Cherly Sew Hoy:

And there is also a horrible maternal leave policy in America. So sometimes it’s a choice, and that’s fine. But we offer ways to support the baby’s gut if you’re formula feeding and you had a C-section. There are certain formulas that are better adapted at providing support to the infant gut and it comes down to prebiotics. So I would look for a formula with added HMOs which again help the beneficial bacteria colonize. So it just means that the C-section gut may need some more support and there are means to do it with all the supplements in the market right now. So we help validate because we had a C-section mom cry when we were on a consult call with her because her baby’s gut looked perfect, and she was like “I did all this work.” And the success with her baby’s gut validated her work. And we told her to stop that probiotic she was giving her infant because she was giving the wrong kind of probiotic. She was giving a lactobacillus-based probiotic, which didn’t change or impact her infant gut. And so she got rid of it since it wasn’t doing anything anyway.

Lindsey:

So back in the day, maybe 5-10 years after Martin Blaser’s book came out, there was a lot of talk about how babies get their microbiome from the vaginal canal and that you should reseed your baby’s microbiome by taking swabs. And then it all came out that most of it’s actually coming from the fecal matter that they’re encountering as they’re born. So I haven’t heard as much about the seeding your baby’s microbiome by putting fecal matter in their mouth, but I’m just curious. What’s out there in the world now about that topic?

Cherly Sew Hoy:

Yeah. Dr. Martin Blaser’s wife is Dr. Maria Gloria Dominguez, who is also a well-known researcher on the topic at Rutgers University. And she wrote one of the papers I read when I was researching this stuff. She was the one who came up with the idea of vaginal seeding after a C-section. So at the time it was a little bit controversial in 2018. That was when I had my daughter, so I did it anyway, the vaginal seeding. It is still not approved by ACOP yet to be frank. But there has since been a few more papers coming out to show that a baby swabbed with the gauze that was put in mom’s vagina for an hour before the C-section operation mimics the vaginal canal. You should do this within two minutes after a C-section and you put the gauze in the baby’s mouth and face to mimic the passing of the vaginal canal. The few studies that came out in the recent years did show that those babies look more like vaginally born babies than C section babies. So I would say there is some proof that it works.

Lindsey:

But they’re not using fecal material?

Cheryl Sew Hoy:

No, they’re not. To explain more, here too what the theory is. I do want to address that. Now that we have a vaginal test, I would encourage pregnant moms or those trying to conceive to also take a vaginal test so that you do have a plan B. Because you have your perfect plan A, which is your vaginal birth, but you should always have a plan B. I would say that I’m a good candidate for the vaginal swabs. My vaginal test came back all good. I have high lactobacillus in my vaginal canal and I’ve don’t have any weird bugs that I wouldn’t want to swab my baby with. Do the test so that you would have that option to discuss with your midwife or your OBGYN. So I highly encourage the vaginal tests. Also if your vaginal microbiome is not in a healthy state, there is risk for preterm labor and other pregnancy complications. So get that checked.

And then as far as some studies showing that baby’s guts are colonized with the mother’s gut bacteria, it is true. However, scientists at Tiny Health and others within the scientific community have a theory about the role of the vaginal microbiome. So lactobacillus is what should be dominating the mom’s vaginal canal. It should be 98% lactobacillus and very low diversity. An unhealthy vaginal microbiome is one that’s very low in lactobacillus, maybe 10%, or maybe none at all. And again, that’s linked to higher risk of preterm labor and things like STIs or STDs. So if we get an earlier sample, maybe a four-day sample or a seven-day sample, in some seven-day samples, we do see lactobacillus strains colonizing baby’s gut, but then it disappears very quickly. It’s almost like the lactobacillus are there to prime the baby’s gut and prepare for the seeding of Bifidobacteria from the mom’s gut.

So this is the theory. Lactobacillus and Bifidobacterium are two very common probiotics that you’ll find in bottles in the supermarket or the pharmacy. We think they go hand in hand; they kind of help each other. So we think the lactobacillus is actually playing a central role to prime the child. And then if mom had the Bifidobacteria to pass on to baby, it will colonize better. So if there was no lactobacillus, then maybe the Bifidobacteria for moms gut won’t colonize as well. So it does sound like all the stars have to align for the baby’s gut to be in the best shape. But it seems like that’s how nature intended it to be. However, because we have so many modern interventions, the process is being disturbed a little bit, which may explain why we see one in two kids today having at least one chronic condition. And this is a stat from the CDC. So I do think we are living today in a pediatric chronic condition crisis, where one in two kids have eczema, asthma, obesity, type one diabetes, that is the new accepted normal, but that new norm should not be acceptable. That is just way too high.

Lindsey:

So if you can start intervening at birth with the proper probiotics necessary, that really could make a big difference for their long-term health. So speaking of crisis, I’ve heard numbers now for autism like one in twenty-six kids or maybe just boys, I’m not sure which, was diagnosed with autism. And I’m curious, are you taking conditions when you take in these microbiome kits? And have you seen any kind of microbiome signature associated with autism or with ADHD or anything like that?

Cheryl Sew Hoy:

Well, we have done some work. But we haven’t added that signature into our platform yet. We do have predictive microbiome signatures for eczema, asthma, constipation, colic, etc., but not yet autism and ADHD just because the research there is quite new. We’re still untangling that stuff because for things like autism and ADHD, more likely than not, it’s bidirectional. So is it the imbalanced gut that’s causing the autism or behavioral issues? Or is it the behavioral issues that’s causing a bad gut? The answer is probably both of them, right? It kind of has a bidirectional effect, which makes it more complex and harder to untangle. But there are definitely studies that show that if you modify the gut, it leads to behavioral issues, so there is definitely a gut-brain axis connection.

In some studies, and we do like more kid and infant studies, we found a study where it has shown that an imbalanced gut in babies as young as six months old could be predictive of ADHD later in childhood. But again, that’s just one paper. So it’s a lot to untangle. Our science team is very rigorous in the way that we want to see multiple papers supporting the same notion, the same taxa, the same microbial signatures before we put it forth. But it’s emerging research, right? So we’re continuing to track it. We know that the gut bacteria produce metabolites, which can travel to the brain via the bloodstream crossing the blood brain barrier and then influence brain functions, which affects mood, cognitive functions and neurological health for both kids and adults. So we know there is a linkage. But yeah, we’re in pretty early days on that work.

Lindsey: 

Okay. So I did the Tiny Health test, and mine was a Pro test, but I don’t know that I saw that offering on your website. Is that a new offering or something you have to go through a practitioner for? How does that work?

Cheryl Sew Hoy:

Yes, it is something that is practitioner-only available and I ordered that for you because you’re probably familiar with the more conventional PCR tests like GI Map. And so the Pro test that we offer has to be ordered by a licensed practitioner to help you interpret it. And the only difference between our regular tests and the Pro tests is that it adds on the stool chemistry markers, which are the calprotectin, secretary IgA and all those markers. So we do have it actually. If you go to tinyhealth.com/store, if you scroll down a little bit, you’ll see the Pro tests, if you click through it, it will bring you to the practitioner websites. We now do actually have a new practitioner website called poweredbytiny.com. That’s a bit more practitioner focused, because we realized in the two years that we launched, a lot of patients are taking their results to their doctors. And that’s how we have hundreds of doctors in our network now, because they want to learn more about how to interpret our tests. And a lot of them are functionally trained, they’re integrative or holistic health practitioners, and they want the stool chemistries. So we created the Pro tests for them to have additional measurements for host immune response.

Lindsey:

So does that mean that people can go to your website and order the Pro test and you provide the practitioner for the test?

Cheryl Sew Hoy:

They have to order it through their practitioner.

Lindsey:

Okay. They have to know the practitioner themselves?

Cheryl Sew Hoy:

Correct. Because they need someone to walk them through it. In the future, we may have our own health coaches. We walk folks through our shotgun sequencing results, the microbial part, because we are experts in it. And for the stool chemistries, we feel like we need the right practitioners who know those markers really well. So I think maybe in due time we will offer that, but right now they have to order through their own practitioner.

Lindsey:

Okay. So for the microbiome test, it is metagenomic sequencing, right?

Cheryl Sew Hoy:

Yep. It’s called shotgun metagenomics.

Lindsey:

So you only asked for a tiny bit of stool, like the Q-tip wiping of it. I’m just curious, how can you be sure that that properly, and in proper proportions, represents what’s in the colon, versus an entire vile of stool that is used for diagnostic tests like the GI Map or the GI Effects?

Cheryl Sew Hoy:

I’m so glad you asked this question. We get asked this so much. And, by the way, GI Map and GI Effects are not diagnostic tests. They are qPCR based, but at best you can call them a screening test. But it’s not diagnostic. Because to really properly categorize it as diagnostic, you do have to go through an FDA approval, which there isn’t such a thing right now in the microbiome. Those tests don’t have the proper regulations for the microbiome testing. That is part of the criticism in a way in our industry in the stool testing world. I wish there was more oversight. And in due time, I think they will come up with that. But for now, it’s just a screen.

But anyway, the PCR tests, some companies have a culturing component, which I know is less reliable. And for culturing, you do have to scoop a bunch of stool and if you’re doing multiple cultures. People have used cultures for decades. Scientists will take a small amount of stool and put it in a petri dish and grow it under the lab conditions. So the reason why we don’t use culture anymore is because we don’t think it’s reliable because it is biased with what you’re trying to look for. It favors rapidly-growing, oxygen-loving microbes, whereas most of the microbes in the human gut are anaerobic or oxygen-intolerant bacteria. For example, E. coli is usually oxygen loving so it grows more quickly in a petri dish than Akkermansia or Bifidobacteria. So the problem with culture is that it’s going to give you biased results that really are overblown. Clinically, I wouldn’t trust any culture.

Lindsey:

Yeah. I don’t pay any attention to culture if the test I’m looking at has it.

Cheryl Sew Hoy:

Yeah, so maybe some companies are still using that and culturing some, but I wouldn’t trust that at all. So when shotgun sequencing came up, it is basically a next-generation sequencing method that sequences your entire gut. We sequence all the bacteria, viruses, parasites, fungi, yeast, archea, everything in your gut. Versus the way PCR tests work is that you need to know what you’re probing for. You need primers for specific microbes that you’re looking for. So typically in a GI map or GI Effects, you get 30 plus microbes that you’re looking for, but you may be missing the full picture of what’s in your gut. The 35 microbes in that PCR test, does it represent maybe just 5% of your gut, or did that represent 95% of your gut? So, it makes a huge difference. I think PCR tests are great when you’re looking for specific things, like if you have the presence of candida or not.

But beyond that, it’s kind of less useful for helping you understand overall gut health, and learning if you have enough fiber digestion functions, short chain fatty acids, and things like that. The way shotgun sequencing works is that it chops out all the bacteria and all the microbes in your gut and reassembles the genomes to establish that you have 1% of E. coli strain D, or 2% of B. infantis, etc. There’s been a few papers published that show that with next gen sequencing, just taking a swab versus a stool sample yields the same results and represents your gut well, because the shotgun technology is able to chop up millions and millions of fragments in your gut. And it’s pretty even. There have been tests showing that sticking the swab into different parts of the stool versus just one part, we still get the same results. Because again, that tiny little fragment of fecal matter, is very well mixed, so it represents the large intestine quite well.

We know this from the scientists that work at Tiny Health, and they come from different universities like Washington University, Iowa, UCSF and places like that. Each lab usually does their own validation, because even the scientists want to know how the swabs compare to the whole stool. A lot of these studies are unpublished. And I wish these labs published more of these papers. But I often hear them saying, “We’ve done the test and it’s so consistent that we switched from stool samples to swabs.” And then also at Tiny Health, we have some families or some users just wanting to test how reliable and reproducible our tests are. They buy two swabs and sample it one day apart. And oftentimes, because we have a very good QC process, we’re like, “is this the same person? Did they submit two swabs?” And then so we email them to ask? Because we would know it’s the same person. It’s so identical, only the five top species might swap places just a little bit. But I can tell looking at a stool sample if this is your gut versus someone else’s gut.

Lindsey:

Ok, great! So I’m going to pull up my sample results and we can look at them together. I’m pulling up just the PDF file, since this is what I’ll put on my website for people to look at. So you can tell me what you see and what’s interesting and such.

Cheryl Sew Hoy:

I’ll send you the PDF, just so you have it, because I just pulled up your file.

Lindsey:

You can go to the show notes website to pull up this report so you can look along with us if you’re listening to the podcast.

Cheryl Sew Hoy:

You did the Pro gut health test, which includes the stool chemistry markers as we talked about. And this is a good snapshot that overall your gut test looks pretty decent. You do have seven things that need support, so I would focus on these areas. And then you have six things that can have optional support. So I would, in terms of priority, work on these first. The way we arrange our tests is through different categories, because again, I think sometimes stool tests focus too much on pathogenic or opportunistic pathogens, and not enough on the balance of protective bacteria. So we always start with asking, “Do you even have this beneficial bacteria?” And it seems like you do, but you are lacking some of them here. And we also tell you what kind of probiotic species we detect in your gut, if we do detect them.

And then do you have a lot of disruptive microbes that are opportunistic pathogens, or parasites, infectious microbes and things like that. I’m just walking you through each category that we show. So the third category is gut inflammation markers. So this is what you might commonly hear as leaky gut. I would come here to see if you have a leaky gut, but again, based on these test results, you don’t really have a leaky gut, which is nice. But what you’re lacking here, it seems to be beneficial bacteria. And maybe some borderline high levels of pathogens here, but no parasites, which is nice. Your short chain fatty acids are essential for your gut lining. And the most important one for adults is butyrate. So you do want to see good butyrate levels. For kids and infants, acetate is the most important.

So, because you did the Pro test, we are measuring not just the microbial production capacity. Basically do you have the microbial gene function to produce butyrate, acetate and propionate. We also measure the actual concentration. So it seems like your actual concentration for the most part is okay, though it is a little bit low. And that’s driven by your acetate being a little bit low. So the microbial functions are not performing so well. So there are action items you can take from a dietary perspective in your Tiny Health results portal. You’re also going to see from a dietary perspective, what specific fiber foods will help with these metrics and also supplements that could help. So there may butyrate supplements out there…

Lindsey:

I actually sell one!

Cheryl Sew Hoy:

Oh, you do?

Lindsey:

I have a product called Tributyrin-Max, which I take almost daily, but since I’ve changed my diet since these test results, I’m needing it less and less with all the fiber I’m getting.

Cheryl Sew Hoy:

Okay, well, it seems your butyrate is okay, as I only need to dive into the butyrate-producing capacity here. But yeah, seems like acetate and, I’m going to attempt to pronounce this, beta glucuronidase, I can never pronounce it well.

Lindsey:

Yeah, that was the most alarming one that I saw.

Cheryl Sew Hoy:

Yeah, you’re level is not so high. You can go down to the detail level on the bottom to see exactly how off you are. But we can come back to that. I think you’re just borderline high, which is usually linked to estrogen dominance. If it’s too high, it’s typically linked to your premenopausal state. It may cause issues in women’s hormonal health. So this one is very important for women’s health, especially as we get into those older ages. And then digestion absorption markers, you seem to have more complex sugar and fiber digestion issues. And we also have some dietary recommendations there on how to improve these markers. It may mean that eating specific fiber, and we’ll have to see what kind of fiber is triggered in you, may make you feel a little bit of discomfort.

So this is also a question we get asked a lot, “Oh, if my gut isn’t adapted to digest these fibers, and eating them causes me discomfort, then why should I eat them.” Ideally, the human gut can handle a large variety of foods. So if you eat certain foods, and if you don’t feel good, it’s kind of like the chicken and egg. You may need to eat more of that to encourage more bugs that can digest that, enabling you to eat a variety of foods in the future. Ultimately, that’s what we’d like to work towards. Some other stool tests tell you not to eat certain foods and eliminate it from your diet entirely. We don’t do that because we believe that sometimes eliminating certain food groups out of your diet may lower diversity and cause more issues. Again, it depends on what chronic conditions you have.

Some people are on a certain diet for good reason if they have specific digestive issues. But if you have a relatively healthy gut and you don’t have these conditions, then we would really encourage a large diversity of foods. And then some of these other markers under balance and robustness, you don’t really have an overabundance of one or two microbes. Some people have that, which makes diversity very low. And then we have a population chart here. That compares you with everyone that has taken Tiny Health tests. So at this point, maybe we’re closer to 30,000 samples. So definitely there are things you can work on. And I think you mentioned that you have had some conditions, right? And you were bloated when you were taking this test?

Lindsey:

Yeah, I have autoimmune SIBO. So I always have that. And I have been letting myself get sort of out of hand in preparation for a breath test by my doctor to get a hold of some antibiotics.

Cheryl Sew Hoy:

The SIBO bacteria that is connected to the methane-producing bacteria, methanobrevibacter smithii.

Lindsey:

Yeah I don’t have that one. That’s not my problem.

Cheryl Sew Hoy:

Yeah, you don’t have it. There’s no real good diagnostic tests for SIBO right now, because it is trying to measure what’s in the small intestines and overgrowth of bacteria in the small intestines. So right now, there is no known test to measure within your small intestines. And all the stool tests that you find in the market are only measuring the large intestine. So, even the breath test, which is the gold standard, is not perfect, it’s very sensitive. But certainly if you have the symptoms, then there could be other things that are triggering the symptoms. So if you go down to page five, this is where you go down to the detailed level, and all those things that were triggered, like your lower Bifidobacteria, but you do have B. infantis. So this is your native strain, which is nice. So maybe with a little bit of HMO, the right high-fiber diet and maybe some probiotic help, you can boost these amounts to a higher level. And Akkermansia, at least you have some. It is really important for your gut lining and metabolic health.

Lindsey:

I take a Pendulum product*, the Metabolic Daily. I have done that in the past and I’m doing it now. But, of course, I paused for a couple of weeks to take the test. But something’s still there, so I was glad to see that.

Cheryl Sew Hoy:

So it’s good because I have zero, but I did colonize some temporarily when I was taking Pendulum. As soon as I stopped, it disappeared. If you don’t have any, it’s harder to engraft, it’s just really hard. The fact that you have some is a really good sign. So again, if you have some, continue on the pendulum and the polyphenol-rich foods, and maybe an HMO, because you don’t want this to be too high too, right? Akkermansia* is a bacteria that replaces the mucus of the gut lining. So if you have too much, it’s degrading the mucus too quickly, and that could be linked to eczema and skin issues as well. So you don’t want that too high.

We also see it shooting really high, like in inflammatory events. Your immune system may be reacting to some central inflammatory events, but it’s very temporary. When we see spikes to 14%, something happened, and then it comes back down. Yeah, it’s very mysterious. Akkermansia is a very mysterious bug. But we know that it is quite important and you do want some, a few percentage points would be just nice. And Fecalibacterium, it’s an anti-inflammatory marker. This is important. Again, through a lot of dietary actions, you can help improve this bacteria. But instead of going one by one, because this is a lot to go through, are there any specific areas that you want to double click into? We see a little bit of C. diff here, which is why it’s yellow, and this pops up with prior antibiotic use. So I would ask if you’ve had prior antibiotic exposure?

Lindsey:

Its been a long time, but I take antimicrobial herbs on a relatively regular basis as soon as the SIBO starts acting up, I’ll dose myself with herbs again, so.

Cheryl Sew Hoy:

Yeah, so we see some, not a whole lot, 0.05%. Let’s say keep an eye on it. And if you do need antibiotics, I would be more careful, because we know this tends to bloom with antibiotic resistance.

Lindsey:

Yeah, well, I can take some of my other product, my Serum Bovine Immunoglobulins with it.

Cheryl Sew Hoy:

I love SBI’s. I do that when I travel. I do that when I have high pathogenic bacteria, signs of gut inflammation, that works wonders to bind these toxins. So maybe it was higher before and then you’ve worked it down. Again, your gut doesn’t look that bad.

Lindsey:

I was pretty pleased with what I saw overall, except for the high beta glucuronidase. That was what bothered me because I know that that predisposes you to breast cancer and to colon cancer. So I made a quick turn about in my diet and have reduced meat drastically and have kicked up fiber and beans and lentils drastically.

Cheryl Sew Hoy:

Yeah, beans and lentils can really help. Again, looking at the range here on page nine, you’re just barely above. So I wouldn’t be too alarmed. It is borderline. I think what you’re doing right now should help, hopefully if you retest in a couple of months. Hopefully that gets it back into the green range. We’ve seen some people up into the right, and they have a lot of hormonal health issues.

Lindsey:

I’ve always been a bit estrogen dominant, but I’m in menopause now so I can’t imagine there’s a lot of estrogen circulating in my system, other than from the patch of estrogen that I’m wearing.

Cheryl Sew Hoy:

Yeah, for sure. So it’s good to keep it in check for sure at this age. We were wondering what the fiber digestion thing that was flagged, so resistant starch was flagged. We found that if you eat rice or potatoes, I would say cool it down first. I used to eat, as an Asian, hot rice and hot potatoes, we would just eat it hot. But now knowing what we know about resistant starch, we now wait for rice to cool down and even bananas, which I love bananas, I’m trying to buy more green bananas, because they retain more resistant starch. So if you’re low in that, in our action plan we do offer some of these tips on how to increase that.

Lindsey:

I make these grape leaves (see show notes for recipe) and part of them is rice and part is lentils on the inside and then a dressing. And it’s got oregano in it. And they’re just like the perfect resistance starch food and fiber food and I just am addicted to them.

Cheryl Sew Hoy:

Yeah, that’s great. So yeah, more of that, perhaps a different variety of them. Like maybe add some green bananas or something your smoothies. Yeah, and then this one, you have zero IMO. I am a little bit less familiar with this one so I’ll have to go back into their web portal to figure it out.

Lindsey:

Isomaltooligosaccharide. So basically you’re saying that I don’t have the bacteria to digest those. Is that what it’s essentially saying? Correct?

Cheryl Sew Hoy:

Not just the bacteria but the gene function to digest these complex sugars. So I think maybe it’s correlated to your low beneficial bacteria. So increasing the beneficial bacteria should help with this. And it can be found in fermented foods. How much fermented foods do you do?

Lindsey:

I make my own sauerkraut and I eat it every morning. That’s pretty much it. I occasionally used to eat yogurt. But every time I ate it, I felt sick. If I ate the entire container, I would feel sick. I would feel nauseous. Maybe I’m missing what one needs or maybe it’s the strains of bacteria and they’re starting to ferment in my stomach. I’m not sure what, but I’m going to try the Bifido yogurt with the with the Evivo and see if that helps things.

Cheryl Sew Hoy:

Yeah, yeah. And if possible, add an HMO.

Lindsey:

Yeah, the HMOs.

Cheryl Sew Hoy:

Yeah, and if you can tolerate adding some sauerkraut, even if it’s like bit by bit. Kefir, maybe, but adding these fermented foods bit by bit will help you hopefully gather some functions here.

Lindsey:

I have been eating sourdough bread.

Cheryl Sew Hoy:

If you’ve been doing one thing over and over again, and it’s not showing the results. A lot of times it’s the variety or the kinds of things, maybe just one thing is just not working. And your gut needs a different thing. And oftentimes it’s a variety of things, right? So yeah, you could try that. But let me see everything else, your vitamin production is perfect. Not everyone has all this in green. So I would say this is very good.

Lindsey:

And that’s all pulling from the bacteria that I have, or the amount of vitamins that are found in my stool?

Cheryl Sew Hoy:

Oh yeah, this is a good clarification. Again, this is actually the gene function of the bacteria. So not the bacteria directly, but your bacteria has the capacity to produce these vitamins. And, like if you have low amounts of damage, it may mean that you have to eat more of certain foods that give you more of that kind of vitamin. But it doesn’t measure the vitamins in your gut. It just tells you that the other essential role of your gut bacteria is to produce vitamins. I think this is not a very well-known fact. But your bacteria gives you vitamins, which is amazing, right? So it doesn’t mean you’re deficient, it just means that the contribution of your gut bacteria to this vitamin is either sufficient or lacking if that makes sense. And then you have to fill that more with dietary needs. But if you’re low in B12, a lot of people are often very low in B12, then you may need to supplement with the B12 supplement or eat more B12 rich foods.

Lindsey:

I was really glad to see that I had a normal level of proteobacteria and not an elevated level because the last stool test that I did of this nature, which was a 16S, I think 50% of my microbiome was proteobacteria and I have since been supplementing with butyrate, which has clearly turned that whole picture around.

Cheryl Sew Hoy:

Yeah, yeah. 16S is one of those earlier next generation sequencing methods to give you the full picture of your gut bacteria, which was a huge innovation. But I would say that today the 16S is a very outdated technology because it can only detect bacteria, not fungi or parasites or viruses. The way we compare 16S with a shotgun is that you make a photograph of your family members, and 16S gives you a blurry picture. So you don’t know if that’s like an extended family, if that’s uncle Tom or uncle Tim or auntie Laura or auntie Kim, whereas shotgun sequencing gives you a very sharp, high resolution picture of who and you can see Uncle Tom smiling and Uncle Tim frowning, it gives you that specific strain. It shows what they’re doing, how they’re functioning, are they happy, are they not, etc. 16S may have high false positives in that it may be mixing up an E. coli bacteria with something else that’s not E. coli. And so you may see higher levels of something that maybe is a little different. So again, like six or eight years ago, that would be the best technology, but we’ve really moved on from that since. Yeah, so this is good. I think it is very stable, DNA sequencing is very stable. If you were to do the stool tests a day apart, we’d probably get the same results. It’s very consistent.

Lindsey:

And what is Shannon diversity?

Cheryl Sew Hoy:

Shannon diversity is comparing the diversity of your microbes. So like the evenness, meaning you don’t have a really high overburden bacteria on top, and then the rest are kind of little. I mentioned earlier that our grown up, adult microbiome has nearly 300-500 seats. So the more seats, the more species we find in the gut, the more robust and the healthier your gut is, and you have a decent amount, but it can be higher. So if we go down to your species breakdown, your microbiome breakdown here, we’re on page 11, which is the last part of the PDF report. And if you go to the app, you can actually expand each species to look at them. There are like citations, you can link out to PubMed articles to look at why we categorize these as variable bacteria. So you have 18% unknown bacteria, which just means that scientists haven’t been able to categorize these as good, friendly, or unfriendly bacteria because they are just less studied.

But if you were to count the number of species you have in the gut, because you’re in the gray, you may have closer to 300 than 500 species. If you’re in the green, maybe you have 600 species, and the higher the better, right? Typically, when I look at a shotgun sequencing results, I want to see the top 10 species, what is really making up the bulk of your gut, and I want that to have more greens than yellow. You have 12% of the top species, which is not bad, but what we don’t want to see 18% or 20%, which is when one bacteria is dominating the gut. So the evenness, the Shannon diversity index is also linked to evenness. So if you have a higher Shannon diversity index, then this could be more like seven, or eight, seven, seven, six, it’s more uniform throughout your gut, at least the first five to ten species.

So typically we want to ideally see some of these Blautia, which is linked to (I think) butyrate function and things like that being higher on top. And because you have your top three species as variable, like too high of these amounts of bacteria are linked to certain kind of conditions. Again, they’re not terribly high right now, so I wouldn’t be alarmed by these. But it’s just very interesting to know, right? Like, if you do have a family history of something. I see type one diabetes sometimes and Crohn’s disease here and there, so your top three species are kind crucial. Not to freak you out on anything or anything like that. But it’s just something interesting that is connected to what’s out there in the literature and detected in your gut and something to look out for.

Lindsey:

Fortunately, we don’t have any of that in myself or my family.

Cheryl Sew Hoy:

Interesting. So again, it may not be anything. Again, when we see these conditions, it’s connected to higher levels in people who do have these conditions than other people who don’t have the conditions.

Lindsey:
So let me just ask you, can people access their raw data when they do Tiny Health?

Cheryl Sew Hoy:

We don’t automatically offer that but we do have practitioners who write in asking for the CSV files, their raw data taxonomy files, and we manually produce them for people.

Lindsey:
Okay, so it’s possible, could a person do that for themselves or just a practitioner?

Cheryl Sew Hoy:

I’m just curious but why would you want that file? Are you maybe running your own analysis?

Lindsey:

Oh, some people like to upload those to websites like BiomeSite. If all the strains were listed in that report, which I assume they are, then that’s good. Because there was a couple of strains that I was worried about that are not good for your oral microbiome. And I had seen them in a prior metagenomic sequencing and had been using an oral rinse to try and clear them out. And sure enough, they were not on this report; I was really happy to see that. This was the Porphyromonas gingivalis and Fusobacterium nucleatum, which, together put you at risk of pancreatic cancer and other stuff. So I was really kind of worried that I had both of those.

Cheryl Sew Hoy:

You don’t want to see any oral bacteria in your gut, for sure. That’s not a good sign. But yeah, we’re glad we didn’t see any of that. We can definitely share the taxonomy files with you.

Lindsey:

So I know that you offer like a membership option. Can you tell people a little bit about what offerings you have now on the site so they know and then we’ll wrap it up?

Cheryl Sew Hoy:

Yeah, for sure. Thank you. So we do have a membership program called TinyPlus, where you do get two kits up front, and a consult call with our microbiome specialist. It is a 30-minute call to walk you through your report. The membership is $399. And I believe you may have a coupon code to share with your audience. If not, we will get you one.

Lindsey:

I know I got a link. And it may be that the coupon applies on the link. I’ll put it all on the show notes.

Cheryl Sew Hoy:

Okay, sounds great. Yes, so we did have that option because again, we think that this shouldn’t be a single time point. Whenever we have two data points of the same gut, we see the trajectory of change. And especially as it relates to early life, you want to see this trending and maturing in the right direction. Ask for an adult gut or an older kid, it’s proactive updating your baseline every six months. Because you never know when you need medication, when the diet changes, when you move, or get sick with a stomach bug, or need antibiotics, etc. So then having that baseline is really helpful to help you recover and restore the missing bugs. So let’s say for those reasons, the membership is really good as a proactive step for your overall well being and health.

Especially if you have an infant or you’re trying to conceive or you’re pregnant, I would even do it 3-4 times a year to sample the infant. We also have targeted programs, what we call targeted programs for people who are dealing with a chronic condition. So for kids, commonly it’s a lot of the symptoms we talked about earlier like eczema, allergies, constipation, even sleep issues. Older kids have different sets of issues, mostly constipation. And then for women who are experiencing fertility issues, we do have a women’s health program, that could be a combination of a vaginal and a stool test, or just the vaginal tests. So we have that too. For adults, we actually are coming out with a few digestive health programs to help you tackle some of these conditions as well. We also have a single kit that you can buy for $249, which comes with a consult call and you can figure out if you want to commit to a membership after that or target a program.

Lindsey:

Okay and I did find the discount code, it is called THEPERFECTSTOOL for $20 off.

Cheryl Sew Hoy:

Perfect.

Lindsey:

Anything else you’d like to share with us before we sign off?

Cheryl Sew Hoy:

You can find us at tinyhealth.com and if you’re a practitioner, we do have a practitioner program to support you in consulting your clients and we will train you for free. And you can find out about that through tinyhealth.com/practitioners. And then you can also reach me at hello@tinyhealth.com. I do read a lot of the emails coming in and on Instagram @tiny.health.

Lindsey:

Okay, awesome! Thank you so much!

Cheryl Sew Hoy:

Thank you!

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me. 

*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.

Adapted from episode 125 of The Perfect Stool podcast with Lindsey Parsons, EdD, and edited for readability.

Heartburn is one symptom of acid reflux, which is where the stomach acid travels back up your esophagus. The term heartburn can be deceptive, as it implies that the heart is involved in the discomfort, but in fact heartburn actually occurs within the digestive system, specifically in the esophagus. GERD is a chronic and more severe form of acid reflux. GERD is the typical culprit in people who frequently suffer from heartburn. According to the National Institutes of Health, more than 60 million Americans experience heartburn at least once a month, and that number is continuing to rise. However, many people who have GERD do not experience that burning sensation, but rather have what’s called silent reflux or LPR, laryngopharyngeal reflux. People with LPR may have symptoms that they might confuse for a variety of other conditions, such as a sore throat, hoarseness, a chronic cough, a bitter taste in the mouth, phlegm, or a lump in the throat, and a need to clear the throat and/or post nasal drip. I had a chronic cough for years and post nasal drip and was put on asthma inhalers, which didn’t help that much at all until finally a doctor realized I had reflux. For me, giving up dairy was a big part of decreasing those symptoms, although when SIBO flares, I do sometimes experience the cough still, especially when I cheat and eat dairy. GERD, no matter how it manifests, involves the regurgitation of food and stomach acid into the esophagus, leading to the sensation of a burning-type discomfort in the chest, neck or throat, which people refer to as heartburn, or the symptoms of LPR mentioned above.

Can children have GERD?

Although GERD is more prevalent in adults, children or adolescents, even infants can suffer from gastroesophageal reflux disease. Children who have risk factors, particularly a hiatal hernia, asthma, or a strong family history of GERD, may experience recurring and long lasting GERD later in life. So identifying and treating GERD early in those at risk children can result in fewer complications and potentially prevent the development of GERD in adulthood. Untreated GERD can pose a significant concern, as the continuous reflux of stomach acid can result in harm to the esophageal lining, leading to inflammation and discomfort in adults. If prolonged and unmanaged, it may result in Barrett’s esophagus, a reddening and thickening of the wall of the esophagus, which is a precursor to esophageal cancer. In order to prevent this, gastroenterologists will often prescribe long-term use of PPIs (proton pump inhibitors) or a surgical intervention called fundoplication. This surgery entails wrapping the upper part of the stomach around the esophageal sphincter muscle in order to strengthen the sphincter and prevent reflux. Obviously, these options are best avoided if possible.

Additional symptoms of GERD, aside from the burning discomfort of heartburn or symptoms mentioned with LPR, may include a frequent sour taste of acid in your throat, especially when lying down, a sensation of burping acid into the mouth, difficulty swallowing, a feeling of food being stuck in the throat, a choking sensation that may disrupt sleep, the wearing away of teeth and/or halitosis, aka “bad breath.”

Why are more young people suffering from GERD or heartburn?

So why might otherwise healthy, young people get heartburn? Research has indicated that the prolonged presence of GERD, or its onset during early stages of life, are contributing factors to the development of Barrett’s esophagus and esophageal cancer. In fact, one out of every four adolescents suffer from GERD, according to the National Institute of Diabetes and Digestive and Kidney Diseases. So why are more and more children and teens suffering from a disease that usually targets older, more unhealthy populations? Some research points to the fact that more and more teenagers are overweight, a product of a society with too little exercise, too much time indoors, and the constant eating of ultra processed foods.

Also, teenagers have a fondness for junk food and these foods are commonly offered at school and at events. Junk food like french fries, pizza and burgers and other high fat, deep fried foods are exactly the type of foods that trigger GERD. But changing habits is often difficult for children and teens, and food restrictions can distance them socially from their friends when they need to avoid things like pizza, fries and tacos, as those are foods that most teens are eat commonly. Further, teenagers are known to frequently snack during the later hours of the day and also stay up late. This type of late night snacking mixed with lying down is another trigger for GERD. Even lack of sleep can impact GERD symptoms, as sleep is so critical for overall health. Treating GERD means the managing of a new lifestyle, and this is often too difficult for adolescents to face, potentially explaining the increasing numbers of young people with GERD.

What are the physiological causes of GERD?

So what causes these symptoms? The esophagus functions by carrying food from the mouth to the stomach and is only separated by a small muscle known as the lower esophageal sphincter. This muscle will open to allow food and liquid to enter the stomach and then is supposed to close to prevent any contents from leaking back up into the esophagus. Typically GERD is caused by the sphincter muscle improperly closing or relaxing when it’s not supposed to. The mechanism of this muscle dysfunction varies from person to person. For some people, the muscle simply does not tighten correctly. For others, the muscle doesn’t close quickly enough after eating, allowing stomach contents to move up the esophagus.

What dietary changes help reduce GERD?

The treatment for GERD depends on the severity of symptoms, but for most people, simple lifestyle changes can make a huge difference, such as changing your diet. There are many foods reported to make GERD symptoms worse. The common culprits cited are citrus fruits, chocolate, caffeinated drinks or foods, carbonated beverages, fatty or fried foods, garlic and onions, peppermint, spicy foods and tomato-based foods. Those are the typical foods you’ll be recommended to avoid as you try and figure out the root cause of your symptoms.

In my experience, however, it’s often an underlying case of dysbiosis, either small intestinal bacterial overgrowth or SIBO, or the bacteria H. Pylori, or other issues that lie at the root of the problem. And in the case of SIBO, a diet high in fermentable carbohydrates along with excess bacteria in the small intestine may actually be causing the issue because those are the most fermentable foods. If a low FODMAP diet, which stands for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols, eases your symptoms, you may want to seek out a gastroenterologist knowledgeable about SIBO and try to get a SIBO breath test. Or you could order a FoodMarble device and test yourself (and you can email me to get the medical FoodMarble device with the testing medium at a discount). I’ve also seen a recent study that showed that just eliminating gluten and dairy (because wheat and lactose are two of the biggest components of a typical diet that are high in FODMAPs), is almost as successful as a full blown low FODMAP diet, and it’s much easier to implement. So if eliminating those two, plus also eliminating added sugar, brings you a lot of relief and you’re having bloating after eating, I’d pursue SIBO testing aside from diet changes.

What lifestyle changes help with GERD? What are the underlying cause of GERD?

There are many other lifestyle changes that can be implemented to provide GERD relief. Some of these changes include quitting smoking, avoiding alcohol and losing weight. Other more serious reasons for GERD or heartburn could be pregnancy, scleroderma, autoimmune disease or hiatal hernia, so these should also be considered when you have symptoms. A hiatal hernia is when part of the stomach slips up through the lower esophageal sphincter into the esophagus, it may be possible to feel this as a bulge under your left breastbone. Hernias are actually incredibly common, with an estimated 60% of adults having one, although they’re often asymptomatic. Hernias can be caused by obesity, pregnancy, heavy lifting, excessive coughing or even straining on the toilet when constipated, as well as things that weaken the diaphragm, which normally prevents the movement of the stomach into the esophagus, like smoking, poor diet, lack of exercise, alcoholism and chronic stress. Some hiatal hernias can result in gastrointestinal bleeding, which would show up as vomiting or bloody stools and can lead to iron deficiency, aka anemia. So if you can’t seem to get your iron levels to normal and have heartburn or GERD symptoms, you should be examined by a doctor for hernia. There are ways to naturally pull a hernia down.

Other symptoms of scleroderma, another possible cause of GERD, are hard, thickening or tight skin, hair loss, inability to sweat through your skin, dry skin, itching, sores, changes to skin color, salt and pepper looking skin, stiff joints, muscle shortening and weakness, sores and pitted scars in the fingers, visible blood vessels showing up as tiny red spots, usually on the hands and face, calcium deposits beneath the skin and extreme sensitivity to cold or stress. So if you have heartburn or GERD symptoms, plus any of those symptoms, you may want to see a rheumatologist to get a diagnosis. And if you do, don’t neglect dealing with your gut health as a hyperpermeable or leaky gut is a precursor to all autoimmune disease. Finally, GERD is a side effect of many prescription drugs. So if you started a new prescription recently, do check the insert and make sure that your new drug isn’t your root cause beyond what you eat.

Can proper meal hygiene help with GERD?

How you eat and proper meal hygiene may be at the root of heartburn or GERD symptoms. My son, for example, has complained of years of stomach pain and heartburn type issues. However, his diet, consisting almost entirely of gluten and dairy, along with the fact that he inhales his food within less than five minutes of sitting down, no doubt has a huge impact on his symptoms. Don’t be asking yourself how I could have a son with such terrible eating habits. Anyone with kids knows they are very hard to control. So starting with the obvious, eating slowly and calmly, taking small bites and chewing your food adequately, which for some people is supposedly 25 chews per bite. I can never quite get there, but that will depend on how large the bite is and how hard to chew the food is. But basically chew until the food is mush. Taking time between bites by putting down your fork and not working or multitasking while you eat are also good meal hygiene practices.

And of course you want to be in a parasympathetic state before you even start eating. Your parasympathetic nervous system is responsible for stimulation of rest and digest activities that occur when the body’s at rest. These activities include digestion, bowel movements, urination and salivation. The other part of the autonomic nervous system is the sympathetic nervous system, which is responsible for fight or flight reactions. The body can only be in one or the other state at a time. So to properly digest food, the body needs to ensure optimal blood flow to the digestive organs in order to absorb nutrients efficiently. This process is hindered when the body’s in motion, stressed or physically agitated, as the sympathetic nervous system redirects blood flow to the extremities rather than the digestive system. This is why eating while working, walking or when under stress can lead to indigestion. In a relaxed, parasympathetic state, the mere thought of food can trigger the initial stages of digestion. In this state, cranial nerves stimulate the salivary glands to release enzymes in your saliva which aid in breaking down food, while also prompting the stomach to release gastric juices, hydrochloric acid and additional enzymes crucial for proper digestion and nutrient absorption.

Its important to consider your mental and emotional state before a meal, as it significantly impacts food choices, eating habits and portion sizes. Eating while stressed restricts blood flow to the stomach resulting in poor digestion. When digestion is compromised, symptoms like heartburn, bloating, gas, constipation, low energy and weight gain may occur. To make sure your parasympathetic nervous system is activated prior to eating, you can try sitting in silence for 1 minute before you eat, taking deep breaths from your diaphragm. And then it’s important to eat without distractions like television, your phone, a computer or a book. Just focusing on eating alone can aid in digestion. As I said earlier, even the simple act of consciously eating slowly can help the body enter its parasympathetic state, which is crucial for proper digestion.

What other factors might influence GERD symptoms?

Other things that may influence heartburn or GERD symptoms include your clothes, your body position after eating, and your meal size and timing. Tight fitting clothes tend to push your stomach upwards even slightly, which can cause your stomach to push its contents towards the esophagus, either causing heartburn or exacerbating it. You should also avoid lying down or sleeping after a meal for at least two to three hours. While it won’t address the root cause of your issue, one way to get gravity on your side is to raise the head of your bed six to eight inches by putting blocks or books under the legs of the bed, so that the body is less horizontal during sleep. The human metabolism is more active earlier in the day, so establishing a daily cutoff time in the evening for eating, maybe 7:00 p.m., is a good idea to allow your stomach to empty before you sleep. As well as being much better for blood sugar regulation, these simple bedtime tweaks may help alleviate your symptoms.

Reducing your meal size can also be very impactful in reducing heartburn. Large meals expand the stomach, which can prevent the sphincter muscle from completely closing, resulting in acid reflux. Usually, people are advised to eat only until they are 75% full, which will allow the stomach to empty more quickly and reduce the risk of heartburn. Using smaller plates and bowls can make you feel more satisfied despite the smaller portion you’re consuming. I also have made a habit of keeping the food in the kitchen during meals, filling up the plates with reasonable portion sizes, and then requiring people to get up to get seconds rather than putting the food on the table. It usually takes about 20 minutes for your body to perceive fullness, so I also recommend waiting until 20 minutes are up before getting seconds, as what you perceive as hunger will pass if you just give it a few more minutes. Also, eating smaller meals every three to four hours throughout the day, rather than a few large meals, may alleviate heartburn and help you to avoid overeating.

In addition, eating high fiber foods that make you feel full lowers your risk of overeating. This includes whole grains like oatmeal, brown rice, and quinoa, as well as beans, lentils, root vegetables, and winter squashes. Vegetables like peas, carrots, asparagus, broccoli, brussels sprouts, and green beans are also a great source of fiber as well as most fruits.

What natural remedies and over-the-counter treatments help with GERD?

People suffering from heartburn often look for quick relief, typically reaching for antacids and over the counter medications like Alka Seltzer, Maalox, Tums or Rolaids to neutralize stomach acid, but there are natural home remedies that can offer the same relief without the risk of medications that may be taxing on the body. Drinking a glass of water can be a quick fix as it will quickly dilute stomach acid. Milk is known to coat the stomach lining and protect it from acidic stomach contents, and a half teaspoon of baking soda in 4 ounces of warm water can also have a quick alkalinizing effect. Try those home remedies next time you have heartburn instead of reaching for an antacid or potentially damaging over-the-counter medication.

Most conventional doctors will recommend antacids for heartburn (over-the-counter medications that mix aluminum, magnesium or calcium with hydroxide or bicarbonate ions to neutralize the acid in the stomach). Next level treatments include histamine 2 blockers, which target histamine, a component of stomach acid, lowering stomach acid and cutting down heartburn. Common H-2 blockers are Famotidine, (which is Pepcid or Pepcid AC), Simetine, (which is Tagamet or Tagamet HB) and Nizatidine, if those are unsuccessful. Proton pump inhibitors are often prescribed to block the pumping of hydrogen ions into the stomach from the intestinal lining. Common PPIs are Dexlansoprazole or Dexilant, Lansoprazole or Prevacid, and Omeprazole or Prilosec.

What are the dangers of antacids, H2 blockers and PPIs?

Unfortunately, treating GERD with antacids, H2 blockers and PPIs has been linked to adverse effects like pneumonia, SIBO or gastroenteritis, although PPIs have the most potential side effects. Short-term side effects of PPIs include constipation, diarrhea, dizziness, dry mouth, headaches, fever, gas, abdominal pain, lightheadedness, itching and rashes. However, long-term use can lead to protein maldigestion as they inhibit stomach acid production from something like 65% to as much as 99%, as stomach acid is essential for breaking proteins into amino acids. This can lead to osteoporosis-related fractures, thrombocytopenia, which is a low platelet count, iron deficiency, B12 deficiency, reduced absorption of other vitamins and minerals, rhabdomylosis or muscle breakdown, death, kidney damage or dementia.

The typical recommended course of PPIs is two weeks. I wouldn’t worry too much about short-term PPI use, but some people do end up with gastroenteritis and even SIBO post PPI use. So I’d recommend the probiotic L. reuteri DSM 17938 at the same time, which is in Biogaia Protectis* and Biogaia Gastrus*, the latter being a probiotic I often recommend for constipation as well. In a study of 128 children with GERD on PPIs after twelve weeks of treatment, 56.2% of the children from the placebo group had SIBO, versus only 6.2% of the children on the probiotics. If you can’t find relief without PPIs and end up taking them longer term, I’d also recommend taking free form amino acids like Designs for Health Amino Acid Supreme* or Pure Encapsulation’s Amino Replete* each day to make sure you’re getting enough of the building blocks of proteins, and periodically testing your amino acid levels using a test like the Metabolomx+ in my Rupa Health Lab Shop* or a simpler amino acid test.

What are other root causes of GERD and how can I test for them?

Helicobacter pylori or H. pylori and otherwise commensal bacteria present in the stomach can become overgrown, especially following periods of chronic stress when gut immune defenses are down. When it overgrows, it can cause either high or low stomach acid, depending on its location, and is often the root cause of GERD and heartburn. When overgrown, it can also develop virulence factors that put you at additional risk of stomach cancer or ulcers. But I found in testing clients that these virulence factors are relatively rare. There are tests done by gastroenterologists like Urea Breath Tests for H. pylori, stool antigen tests, and upper endoscopy exams, which usually include biopsies for H. pylori to diagnose it, and esophageal pH tests, although the latter is harder to come by, to check if you have low or high stomach acid. I use stool tests including the GI Map or the US Bioteck GI-Advanced Profile* to see if there is H. pylori, which I’m particularly suspicious of if there’s stomach pain, often on an empty stomach, and/or constipation. Both tests include the virulence factors for H. pylori.

So what’s counterintuitive is that low stomach acid can manifest similar symptoms to excessive stomach acid. When the pH in the stomach gets too high or alkaline, this can trigger the opening of the lower esophageal sphincter. Often taking supplemental stomach acid in the form of Betaine HCL or apple cider vinegar in water before meals helps resolve the issue. I’ve had a number of clients who had heartburn that was relieved when we addressed their low stomach acid this way. However, this is contraindicated if you have extreme burning or pain in your stomach or blood in your stool, which may be indicative of an ulcer.

A good place to start is trying the Betaine HCL challenge to test your stomach acid. To begin, take one capsule per meal alongside animal protein, usually sold in the 500 to 750 milligram range. Gradually increase your dosage by one capsule per meal every two days until you experience heartburn or a warm sensation in your chest, up to a maximum of five capsules. Once you reach this point, reduce your dosage back to the previous amount. If you experience the immediate burning, it could indicate an excess of stomach acid or a potential hiatal hernia or other problems. In such cases, you can alleviate the discomfort by taking an antacid or consuming baking soda in water to neutralize the acid.

Another alternative to taking Betaine HCL is one to two tablespoons of apple cider vinegar or lemon juice mixed in water prior to meals. If you’ve been diagnosed with Barrett’s esophagus, esophageal strictures or reflux esophagitis, it’s not recommended to use these products. In such cases, it’s advisable to opt for digestive enzymes that do not contain Betaine HCL*. However, if you still wish to try the Betaine HCL approach, it’s best to find a product that includes pepsin, an enzyme naturally produced by the cells in your stomach. I also like one that includes Gentian Bitters*, which also helps promote bioflow. However, with conventional medical practitioners, low stomach acid is rarely a consideration, but only high stomach acid, leading to a diagnosis of GERD and the prescription of PPIs usually. If you have low stomach acid, PPIs may worsen GERD by hindering the adequate breakdown of foods, particularly protein, which requires HCL for digestion, and straining the enzymatic function of the pancreas and other digestive organs that are stimulated to release enzymes based on stomach acid levels. This could result in calcium, iron, B12, or vitamin A deficiencies, resulting in heightened inflammation and intestinal harm, and protein deficiency, all of which contribute to additional health complications.

Some people do, in fact, have excess stomach acid and not low stomach acid. So if taking apple cider vinegar or betaine HCl creates immediate heartburn, then you may need a temporary course of antacids, H2 blockers or PPIs while trying to get at the root cause of your problem. Ideally, PPIs should only be used as a treatment for a 14-day period, as prolonged use can lead to other problems, as I already mentioned.

Conclusion

So that was a lot to absorb, so I’m going to stop there. If you have follow up questions, a great place to ask them is in my Facebook group called Gut Healing. And if you are struggling with GERD, bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me. 

*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.

Adapted from episode 123 of The Perfect Stool podcast with Martha Carlin, the CEO and founder of The BioCollective & BiotiQuest* and Lindsey Parsons, EdD, and edited for readability.

Lindsey:

So I understand that you’re interested in the gut microbiome started with your husband’s Parkinson’s diagnosis. So can you tell me more about that?

Martha Carlin:

My husband was diagnosed in 2002 with Parkinson’s. I started studying many different aspects of food, the science behind food and all of the things that are going down the pipe. But I was also studying different mechanisms in Parkinson’s. In 2014, the first paper was published that showed that a researcher could actually divide the two primary types of Parkinson’s. There’s one where people are more tremor dominant and there’s another type where people have more trouble with their posture and gait freezing. And he was able to separate the two groups by their gut bacteria. I had just been learning this term, the microbiome, and reading about changes from Dr. Martin Blaser and his book, Missing Microbes*. And I was like, “Okay, wow, all these worlds are converging.” And so I quit my job and started funding research at the University of Chicago, looking at my husband’s and my microbiome, and I did that for about six months until I went on to found The BioCollective to look at the Parkinson’s microbiome and even broader into other disease states and health states as well.

Lindsey:

And so what do we know about the microbiomes of Parkinson’s patients then?

Martha Carlin:

Well, it’s interesting because that first paper in 2014, if you look in PubMed now, the number of papers annually has escalated like a hockey stick. The gut is definitely dysbiotic, meaning so out of balance. There is a group in Finland who claims to have identified the microbe that is causing Parkinson’s. I have some question that there’s a single microbe. I think that it’s a larger scale dysbiosis, but the group in Finland has been looking at an organism called Desulfovibrio. That bacteria produces hydrogen sulfide and also produces a magneto magnetite. And there are implications in iron metabolism in Parkinson’s as well. So those two pieces fit together in an interesting way.

And then we have actually found markers associated with mycobacteria species in our Parkinson’s microbiome, and that ties pretty nicely to the Harvard Doctor and Nurse’s study that showed low-fat milk, so consuming low-fat or non-fat dairy, increased the risk of Parkinson’s. There’s quite a bit of evidence that the dairy supply has been contaminated with Mycobacterium avium paratuberculosis. So there are some people looking at that as well. And so we have that in some of our biomarkers. And then there are multiple researchers looking at the whole microbiome and loss of function. There are implications in the oral microbiome with loss of amylase function, the breakdown of starch. So you see these papers pop up and people get really excited. It’s like, “Oh, this is the answer.” But I think it’s a little bit more complicated than one organism. But we can definitely see that the gut is disrupted. And that can be from overuse of antibiotics throughout life. And that can be from exposure to chemicals and pesticides, either through work or through the food supply, and a number of these things that knock down the beneficial species. And then just not eating a healthy diet, that’s also feeding the microbes.

Lindsey:

Yeah, so is it my imagination, and this is based on very small sample size, but is it [Parkinson’s] more prevalent in men than women?

Martha Carlin:

It is, actually. So there’s a mirror image between Alzheimer’s and Parkinson’s. So two-thirds of people with Parkinson’s are men, one-third are women, and the opposite is true of Alzheimer’s. Two-thirds are women and one-third are men.

Lindsey:

I said that only because of my parents’ friends, all of the ones who had Parkinson’s were men, because my parents obviously are getting towards the age where that starts getting diagnosed. So your group was collecting stool samples and analyzing the microbiome of people with Parkinson’s?

Martha Carlin:

Yes, and one of the really interesting things about that is people doing the processing in the lab actually found that they could identify a Parkinson’s person just from the stool that was collected, no other information. They didn’t know from the check card that they had Parkinson’s, but they could tell because the Parkinson’s stool had the texture of concrete. So, the processing of the Parkinson’s stools had to be handled differently than all of our other samples because it was so hard. It wouldn’t go through the syringes that we use to aliquot the samples.

Lindsey:

Interesting. So it was like hardened concrete?

Martha Carlin:

Yes. I mean, it had a very distinct lack of what’s called fecal water or moisture in the stool. That’s pretty interesting because there has never been anything published on this. And chronic constipation often precedes a diagnosis of Parkinson’s by anywhere from 10 to 15 years. And about one third of people who have IBS or IBD will go on to develop Parkinson’s.

Lindsey:

This is interesting because you mentioned that at least one bacteria that’s implicated in Parkinson’s, Desulfovibrio, is a hydrogen sulfide producer, which typically would produce diarrhea. And I literally just did my previous podcast on hydrogen sulfide and have a client in this situation who had only constipation as a symptom. I ran a SIBO breath test on her that came out completely negative for methane, and I thought, “what’s going on?” And then I started looking a little further into it, and I found that in a small percentage of people who have an excess of hydrogen sulfide in the large intestine, it can present as constipation. So it’s interesting that the constipation could be in conjunction with this Desulfovibrio.

Martha Carlin:

Yes, and Desulfovibrio is also highly present in wastewater, in large animal feedlots and those type of operations, and also in the public sewer lines. So, it may be that wastewater treatment is not fully addressing these types of microbes and they’re also potentially making it somehow into the water supply.

Lindsey:

Yeah, well, just one more reason to have a good quality water filter!

Martha Carlin:

Exactly!

Lindsey:

Okay. So can you also explain about probiotics and mannitol and how that relates to Parkinson’s?

Martha Carlin:

Sure. So I actually attended the World Parkinson’s Congress in Portland back in 2016. My husband’s had ups and downs over the years and that time was a down point for him. And he was not walking well and unable to really navigate crowds. Anyway, I attended a session there from a group called CliniCrowd from Israel, and they were presenting data from a researcher who had shown in a mouse model that the sugar alcohol mannitol could stop the aggregation of the proteins and actually pull them out of the brain of the mouse. And I was like, “Wow, that’s really fascinating.” And I came back, got the paper, bought a book on mannitol chemistry, and started reading about mannitol chemistry. It is the most abundant sugar in nature. And in plants, it manages osmotic stress. So then I’m thinking, “Okay, back to the concrete stool, that’s an indication of osmotic stress for sure.” And so in my mannitol chemistry book it was talking about bacteria that use mannitol as a carbon source or that can produce it. And there were a handful of bacteria that could actually produce mannitol and they did that by converting glucose and fructose into mannitol. Humans don’t really use mannitol; we eliminate it through the urine and feces.

So I thought, “OK, let’s see if we can put a factory back that can make mannitol in the gut, and maybe this will help with the Parkinson’s.” And so we prototyped a product and gave it to my husband at the beginning of 2017, and we were taking his microbiome samples all along the way. And in less than 30 days, he was no longer walking with a cane. He was able to navigate a crowd. And then we sent the samples off and continued to take them all the way up to 120 days. We could see that his microbiome continued remodeling all the way through that 120-day period and was moving back closer and closer to the profile from the Human Microbiome Project for the healthy human stool. And so we’re like, “Oh, wow, this is pretty remarkable”, and so we went on to file a patent. I’ve really studied and spent more time digging into different mechanisms and how mannitol may work in the body in different ways. And of course, you’re eliminating glucose and fructose, which is a signal to the body. Insulin resistance is implicated in Parkinson’s and so there’s a lot of other connections that go back to sugar and the importance of getting rid of that sugar. But the initial idea actually came from this research that showed that mannitol could stop the aggregation of the proteins.

Lindsey:

And what were these proteins related to Parkinson’s?

Martha Carlin:

Yes. So, it’s alpha-synuclein. It’s actually an antimicrobial peptide that then aggregates in the brain. And I think one of the mechanisms is mannitol is a neutral molecule and typically the folding and aggregating is driven by a charge.

Lindsey:

Okay. And so did your husband also have an issue with constipation? And if so, did that probiotic combination help?

Martha Carlin:

He did have an issue with constipation. Although, what I would say is a lot of times people don’t really even know. They’ve had constipation so long that they think it’s normal not to go every day. And so it did help with that, and we really started to have conversations about, “Have you gone today?”, “If you haven’t gone today, it’s important that you go today”, “drink more fluid and eat more vegetables”, etc. Anything that’s going to help move that waste through the body. So it become more top of mind for sure since we did that. We had never really discussed it before.

Lindsey:

And so that probiotic, did that become a product?

Martha Carlin:

It did become a product. So we went on about three years later to bring that to market and it’s called BiotiQuest*. And the probiotic that I made for John is called Sugar Shift Probiotic* because it shifts that sugar metabolism.

Lindsey:

Does it catch it quick enough to change your blood sugar?

Martha Carlin:

It does change blood sugar. So Parkinson’s is a little tough to do a clinical trial in, just because endpoint measurements are much more difficult. And since we thought it would be impacting blood glucose because of this change in the conversion of glucose and fructose, we chose to do a trial in diabetes. And so we actually had 30 people take the product and 30 people in the control group. The control group was just the fibers, the same fibers that are in with the probiotic. And so there were some benefits just to the fiber, but the long-term trend of the blood sugar continued to rise on just the fiber where the trend went down with the bacteria and the fiber together. Then over time we got a decrease in fasting blood glucose, postprandial blood glucose, a decrease in insulin, the HOMA-IR improved and HbA1c. It took six months for the HbA1c to actually improve. So the clinical trial was 90 days and we kept 10 subjects on the product for another three months so that we could see what the additional changes would be.

Lindsey:

And how much of a decrease in A1c happened after that six months?

Martha Carlin:

I think it was a 14% decline in HbA1c.

Lindsey:

Okay, great. And then I don’t think we talked about dopamine and Parkinson’s and how that relates.

Martha Carlin:

Well, of course. The dopaminergic neurons in the brain are what are losing their power, is how I would characterize it in Parkinson’s. And that comes from the gut also. So all of these hormones and neurotransmitters are made in the gut. And the interaction of the gut bacteria through the vagus nerve to our brain, this communication loop that goes on. So you can get this stress mechanism that in Parkinson’s, they get into fight or flight, and they’re stuck in this fight or flight stage that is producing these stress hormones, and that is affecting neurotransmitters, including dopamine. And what happens is then, the body starts trying to figure out, okay, how do I turn this off? And it starts dampening down things in order to try to save itself, but you start to lose function that way.

Lindsey:

Can you tell me about the BioFlux model and how you use that to create the probiotic formulations?

Martha Carlin:

Sure. So the BioCollective was originally started to collect fecal samples and get whole genome sequencing of all the organisms in the sample. So a lot of times, if you get a report from somebody, they don’t do whole genome. So we got this large data set of samples, and then we built a computational model where we can see how bacteria work together as a team. And that’s what’s going on in your gut. The bacteria are working together as a team, either for good or for bad. And so what our BioFlux computational model does, is it feeds in the genomes of probiotic organisms and then it runs them with certain growth media. It’s the standard food profile, if you will, of what bacteria are eating. It will show what they use and produce over a period of time so that we can design a team of bacteria, of probiotic organisms, that will perform the function we want them to. So in the case of the Sugar Shift* formula, we designed a team that can sustain that sugar conversion for 12 hours and produce metabolites like reduced glutathione and butyrate, which is beneficial for the gut lining, And so you want it to make mannitol, but you want it to do other things. What else is it doing in the context of that teamwork?

Lindsey:

So is the BioFlux model literally a computational model built on the data from putting together bacteria or seeing what the individual function of any given bacteria is?

Martha Carlin:

So just like humans have genes, bacteria have genes, and those genes are essentially all the different capabilities that they have. And what’s really interesting is in terms of humans and the microbes in our bodies, we have roughly somewhere in the neighborhood of 200 to 300 times more genes that come from the bacteria than our own gene function.

Lindsey:

So are there any probiotics that are specifically designed for Parkinson’s?

Martha Carlin:

I mean, I designed my Sugar Shift* probiotic for my husband with Parkinson’s, but there’s a company out of Korea called Bened, I think is their name. And they have a product called Neuralli, that they are currently doing a clinical trial in the U.S. in Parkinson’s, and they have done some clinical trials in Korea. It is a single strain of Lactobacillus plantarum, and we actually got that strain, sequenced the genome, and compared it to the plantarum in our formula to see if there were any unique properties in that particular strain that our strain did not have.

Lindsey:

And were there?

Martha Carlin:

Nope. Ours actually had some capabilities that it did not have, but ours also still had all the capabilities it had. And then there is research ongoing at the University of Edinburgh on a Bacillus subtilis, and they’re studying that organism in worm models. I guess they can give the worm a tremor and then Bacillus subtilis gets rid of the tremor. And we have a Bacillus subtilis in our formula. It’s not the one they’re studying over there, but they have some similar capabilities as well.

Lindsey:

So you brought up an interesting point, I looked up the Neuralli and it’s not inexpensive. That’s the L. plantarum PS128, right? It is quite an expensive probiotic. And basically, you’re saying for your much more reasonably-priced probiotic, you basically have a strain that does everything their fancy strain does.

Martha Carlin:

Yes, I am saying that. I have had some conversations with them because they were at that time considering making it available to other people to purchase as a strain ingredient. But they decided not to do that. I thought, “Well, you know, I could use yours, but I like mine because ours also has some capability for detoxifying glyphosate.” So that’s actually a personal passion of mine. And I believe one of the drivers of the increase in Parkinson’s is the increase in glyphosate in our food. Glyphosate is an antibiotic, kills the Lactobacillus and Bifidobacteria in the gut and many of the beneficial species and leaves behind the pathogens. And our Lactobacillus plantarum that came from fermented elderberries in Colorado was resistant to glyphosate and able to break it down using something called the third pathway, which doesn’t produce this more toxic metabolite called AMPA (aminomethylphosphonic acid). Our plantarum is actually in all of our probiotic formulas, but it is in the Sugar Shift* formula.

Lindsey:

Cool. So yeah, I always wonder about that. I have talked about it and heard about the whole glyphosate issue. And I’m wondering how much is really left in your food. Is it really enough to kill off all your Lactobacillus and Bifidobacteria? Because I see a lot of stool tests and admittedly, the people I see are probably eating more organic than the typical American, but they still have Lactobacillus and Bifido.

Martha Carlin:

It will select for a certain profile, but that doesn’t mean you won’t have any. I’ll give you an example. There is one Bifido adolescentis that is resistant to glyphosate, but it’s a Bifido bacteria that doesn’t make a plasmogen, something that’s important for membranes and has been implicated as being beneficial for Alzheimer’s. But in the last decade or so, they have started to dry down about 60 different crops with glyphosate. So I’m not just talking about the corn and soy because, you know, if you’re working with people who are focused on their health, they’re probably not eating GMO corn and soy, but they may not realize that even chickpeas have one of the highest levels of glyphosate that there is, because chickpeas are sprayed at the end of harvest. This is so they get an even drying in the field and they can harvest them faster. Same thing with lentils. So a lot of your legumes, all of your grains,

Lindsey:

If they’re not organic?

Martha Carlin:

If they’re not organic. But I also need to check with a friend of mine in the organic regulatory arena, because sometimes you can use a dry down thing at the end on an organic crop. So I think it’s always best to call up and ask, do you use glyphosate in your desiccation process? I mean, I did that with Bob’s Red Mill.

Lindsey:

And what’d they say?

Martha Carlin:

And they said that they request that all their farmers do not do that, but they do not test for glyphosate.

Lindsey:

Okay. So have there been studies looking at the microbiomes of people that are eating food with glyphosate?

Martha Carlin:

There are, more recently, there are some studies on glyphosate’s impact on the microbiome. And there was actually a good one in bees a few years back that was one of the big flashing red light ones that came out. So I can probably pull one of those up and send it to you. Because I just saw one a couple of days ago, actually.

Lindsey:

Okay. And there’s also a relationship between hydrogen sulfide and pesticides, right?

Martha Carlin:

Yes, I believe so.

Lindsey:

I think I mentioned that in my last podcast that the glyphosate can potentially result in the overgrowth of hydrogen sulfide producing bacteria, by impacting molybdenum.

Martha Carlin:

Well, it impacts most of the trace metals. So it will chelate. I mean, glyphosate actually was originally a metals chelator used to clean pipes, metal pipes. And then they made it into this herbicide, and it chelates copper preferentially. So we’ve actually done a study with Dr. Don Huber, who’s one of the global glyphosate experts in cabbage, because it wasn’t maintaining its structure, much like our collagen is not maintained. Many people’s collagen is not maintaining its structure. And glyphosate will bind up, in that study, boron, copper and manganese. And those were the three trace minerals that were needed for the cabbage to maintain its structure throughout the fermentation process with the sauerkraut. And of course, copper is essential for collagen formation in the human body. It has a lot of downstream impact. I’m friends with Stephanie Seneff, who wrote the book Toxic Legacy*. You know, we talk back and forth about our different bits and pieces, and she’s written a couple of papers on how glyphosate may be implicated in Parkinson’s and other neurological diseases, in autism, and what’s going on in different metabolic pathways as a result of glyphosate consumption.

Lindsey:

Okay, well then people can definitely check that out, her book. So in our pre-interview, you mentioned aquaporins, and that was actually the first time I’d ever heard them mentioned. So can you explain what they are and the research that you know about on them?

Martha Carlin:

Sure. Aquaporins are a relatively new discovery in the last couple of decades. And they’re the water channels between the cell membranes. I think they’re up to about 13 right now, but the one that I was most interested in is aquaporin 4, which is prevalent in the brain. And I have actually been working on a hypothesis of something called molecular mimicry, where we can actually create an antibody to, say, aquaporin 4 by either eating a food or having a bacteria that has a similar aquaporin, and our body has an immune reaction to that and then creates this antibody that attacks our own aquaporin 4. As it turns out, there’s aquaporin 4 in tomatoes, spinach, corn, and wheat, I believe. So that’s an emerging area of research that I’ve been looking at. And there are a number of papers on the aquaporin connection to neurological problems. And of course, then back again to that concrete-like stool. And, you know, aquaporin is the flow of water across the membrane.

Lindsey:

Yeah. I think I looked up something related to that. I saw those three things that you mentioned, but I saw soybeans, not wheat as the fourth food.

Martha Carlin:

Oh, you know what, you’re right. It is soybeans because there’s another protein in my molecular mimicry stuff called Alpha crystallin. And that’s in wheat and corn, and humans have an alpha-b crystallin.

Lindsey:

So do you avoid those foods?

Martha Carlin:

I do avoid those foods; I avoid those foods altogether. And it’s interesting because we used to eat spinach a lot because people are like, “Oh, spinach is healthy, eat the spinach.” So many of the salad mixes have spinach in them. I’m like, “ooh, don’t eat the spinach.”

Lindsey:

And there’s no form of spinach that you can eat that removes that aquaporin it’s still in there?

Martha Carlin:

Well, I’m sure there probably is one somewhere but you know, I’d have to go through rather lengthy and expensive exercising doing the genomes of various species of spinach.

Lindsey:

Oh yeah, I was thinking of cooking methods, like when you remove oxalates by dropping in boiling water.

Martha Carlin:

Yeah, because it does change how the oxalates behave. So I don’t know, I’ll have to look at that.

Lindsey:

Yeah. So, I eat spinach every morning and ever since we talked, I’m like, “oh no”. I do know about the oxalates, but I sort of mitigate that by taking calcium citrate with my breakfast, since I don’t eat dairy anyway.

Martha Carlin:

Well, we moved to broccoli sprouts, so we eat a lot of broccoli.

Lindsey:
Okay yeah, I like something I can stir fry in oil and eat next to my egg. So tell me about the other probiotics that BiotiQuest has worked on and sells?

Martha Carlin:

So when we first brought out our products, we came out with the Sugar Shift*, a product called Ideal Immunity, which has a specific strain of Lactobacillus called Lactobacillus ruminus that is very effective at killing foodborne pathogens like listeria, salmonella and E. coli. And then we brought out a product called Heart Centered, and that was focused on cardiovascular health. The microorganisms produce CoQ10 and help with nitric oxide production. So, you know, vasodilation. So we brought those two products to market. And then later that, about a year later, a friend of mine’s mother had to go on IV antibiotics for a month after she got sepsis from a ruptured appendix. And she was having major GI issues and bowel irregularity. And the doctor was like, “That’s how it is, don’t worry about it, it’s not a problem.” And she was pretty stressed out about it. And her son is actually one of my advisors and he’s a fermentation chemist. And he called me, and he said, “that antibiotic formula you were going to make, do you think you could make it now for my mother?” And so, we checked our inventory, went to our vendors, and said, “we still need these two strains.” And we made a small batch. And within a week’s time, she called me on the phone, and she was just raving about how much better she felt and that it was just incredible. And Steve laughed because he had been talking to her about probiotics for 20 years and she had pretty much ignored him. And now she’s a true believer. So we brought that antibiotic antidote to market.

Lindsey:

What strain was it that you added? Or was it multiple strains beyond the usual group?

Martha Carlin:

It’s a multi-strain formula also. There was a research paper that had come out a few years earlier out of the Weitzman Institute that was looking at one 11-strain formula that was given to a group of people after taking antibiotics. And it showed that it actually made things worse. And I sat down with my chief scientific officer, Raul Cano, and he’s a world-renowned microbiologist. And he looked at the formula and he said, “it’s not well balanced. I would never recommend that.” Oftentimes people just go get a lactic acid bacteria.

Lindsey:

Was it a Visbiome or a VSL#3?

Martha Carlin:

They didn’t disclose the name of the product, but I was able to find a product in Israel that had those 11 strains. And we said, you need something that is more well-balanced, that doesn’t take the pH to such an acidic level that you can’t recolonize a full complement of the microbiome. And so Raul went away with his magic and came back, and then we ran it through the computational model and tweaked it a bit and brought that product forward. And then we also have a culture starter. I’m going to call it a yogurt culture starter, but technically it’s not a yogurt if it doesn’t have Streptococcus thermophilus or Lactobacillus bulgaricus. That is a branding thing, but yogurt, that’s the technical term. It’s got to have one or both of those in it to be called a yogurt. Dr. Bill Davis, his group has kind of coined this phrase pro-gurt, probiotic yogurt, because they make yogurts with all these different strains. And so we had such a demand, people were making yogurt with ours, and you can make yogurt with any one of our formulas. And so we actually made a jar that is culture starter, just so you can take a scoop instead of having to open capsules. And we have prototyped about 20 different formulas that we plan to bring out over time. We have one we’re bringing out with a physician later this year that’s been doing a lot of work in Crohn’s and his focus is on that mycobacterium avium paratuberculosis.

Lindsey:

I was going to ask you, isn’t that the one that’s implicated in Crohn’s?

Martha Carlin:

Yes, and so we don’t have the name for the product yet. But the organism is a strain of bacteria called Dietzia. And then we’re bringing out our mood, feel good probiotic called Perfect Peace, and that will probably come out in the fourth quarter of this year.

Lindsey:

Okay, so now how many formulations do you have?

Martha Carlin:

We have five and then the yogurt starter.

Lindsey:

Okay and is the yogurt starter for one of the formulations?

Martha Carlin:

It’s the same as Sugar Shift*, it’s just in a yogurt starter form. And I forgot, we have the Simple Slumber. So we brought that out because so many people kept telling us they have trouble sleeping. And so we made our Simple Slumber product and that makes bacterial melatonin and tryptophan. So both the Ideal Immunity and the Simple Slumber have a small amount of tryptophan in them so people who are taking an SSRI inhibitor or an MAOI cannot take those because they can get serotonin syndrome from taking a product with tryptophan.

Lindsey:

Okay. So for the yogurt starter, I know with some of these yogurts, like the one I think the Bill Davis’s group is using reuteri; they’re more temperature sensitive. You can’t just like put it in a regular yogurt maker. Can you do that with your Sugar Shift*?

Martha Carlin:

So it does have reuteri in it. So we do recommend that people do it at a temperature below 106. I always do mine at 98 degrees because that’s roughly what our body is. So you want it to be acclimated to what your body is. I have done the meta up to about 104, but I like mine better at 98.

Lindsey:

And how do you do that? Then do you use an InstaPot or something? What do you use to make your yogurt?

Martha Carlin:

I actually have a Luvele yogurt maker. It’s Australian. And I like it because you don’t have to deal with all those little cups, it’s one big quart. You can put one or two quarts in it, actually. And then when it’s done, I scoop it out and put it into a mason jar and it’s all good.

Lindsey:

And you can set the temperature on that one?

Martha Carlin:

Yes, you can set the temperature on that one. The Instant Pot will often get a little bit too hot. And so those are set for yogurt, which Strep thermophilus and bulgaricus are both, what is called thermo-tolerant. So they actually like the higher temperature, and they grow faster in the higher temperature, whereas something like Lactobacillus reuteri will actually die at the higher temperature. And that’s the organism that used to be in our small intestine, in the small bowel that was keeping out all these SIBO organisms. And we seem to have lost that Lactobacillus reuteri.

Lindsey:

So do you think that’s an important strain in SIBO?

Martha Carlin:

It’s a very important strain in keeping SIBO at bay.

Lindsey:

Any particular reuteri?

Martha Carlin:

Well, Dr. Davis is very keen on the BioGaia* strain, and that’s a well-researched strain. We actually had our own strain through my advisor, Steve, who had done a bunch of research with his reuteri strain, actually in animals, because he was working on trying to get antibiotics out of animal feed. It is a very well-researched strain, but slightly different than the BioGaia strain. And then we have another company that we use their reuteri on occasion. And that is one that actually Dr. Davis found he liked just as well or better than the others. Basically, what you’re looking for in the genome is what are called bacteriocins, and these are small molecules that the bacteria make that target specifically other bacteria. So, Lactobacillus reuteri will have these reuterins, are what they’re called, and those bacteriocins will kill anything that tries to colonize the GI tract. There’s another, Lactobacillus gasseri, is another one that he talks about a lot in SIBO. We actually don’t have gasseri in any of our formulas, but we have looked at potentially making a formula that has gasseri. It’s actually become increasingly difficult to get. The one producer that I know that used to sell it no longer sells it.

Lindsey:

Hmm. So which of the reuteri strains do you use then?

Martha Carlin:

We use one called PCR7 from Pure Cultures.

Lindsey:

And the one from BioGaia, gastrus*, is meant to be quite good in methane SIBO and in constipation. Is yours also good in that same way?

Martha Carlin:

Well, we haven’t studied it for that. But we do get lots of reports of people taking the product and constipation problems going away. And a lot of Dr. Davis’s SIBO kind of protocol, people are making the Sugar Shift* yogurt, either with the capsules or with the yogurt maker, and it has that PCR7 reuteri in it.

Lindsey:

And so when they do it with the yogurt maker, you can presumably get quite a bit more than you might in a capsule, is there a limit to how much you think is beneficial in a given day?

Martha Carlin:

So if you have a single strain, like Dr. Davis has looked at, the single strain of the reuteri will double about every 12 hours. Bacteria grow really fast. Now, when you have a working team like we have, it goes through a succession. So, there’ll be some of your early growers that will provide the metabolic food for the late growers. And you get maybe not as elevated counts as you would get in a single strain over 36 hours, but you’re definitely going to get a lot more bacteria than just taking a capsule.

Lindsey:

And it’s just a way to buy one set of culture starter capsules and make it last longer?

Martha Carlin:

Right. So you can make it go a lot longer and I’ve made coconut milk yogurt. I make my yogurt out of dairy most of the time, but I’m getting raw milk so I’m doing kind of a different shtick also.

Lindsey:

Yeah, so I don’t do well with dairy, but I’ve yet to try making coconut yogurt because I don’t like most commercial coconut yogurts. There’s one that I really like though, Cocojune. But, if I eat an entire container, I feel nauseous. And I keep saying to myself that yogurt is good for you. But I don’t feel good when I eat it, like what’s going on? Is it another ingredient? Is it the bacteria because I have autoimmune SIBO? I always have to worry about overgrowth of bacteria.

Martha Carlin:

With coconut yogurt, you have to add a thickener. It will not congeal if you don’t add some kind of thickener. I’ll have to look at the Cocojune and see what they’re using. I actually had one of my customers, she works with children with digestive issues at a hospital in Seattle. And they actually use my Sugar Shift in a coconut milk for their specific carbohydrate diet for kids with these digestive issues. And her recipe was not vegan because it uses gelatin. But it was gelatin and two tablespoons of honey in the coconut milk. And it turned out fabulous, except I had a few chunks of gelatin in there. I think I need to blend it up afterwards or something, but it had a nice, thick, commercial consistency to it.

Lindsey:

Was it commercial coconut milk?

Martha Carlin:

I used organic Thai coconut milk.

Lindsey:

Oh you used the thick coconut milk that you use in recipes?

Martha Carlin:

Yes.

Lindsey:

Not like the thin stuff in the bottle, the containers?

Martha Carlin:

No, not that, I use two cans of Thai coconut milk.

Lindsey:

Oh, wow.

Martha Carlin:

You heat shock it to like 190 degrees, real quick. And then cool it down and mix that gelatin and the honey in there. And it will be great.

Lindsey:

Cool. I used to make yogurt and I had a yogurt maker. And I used to love my dairy yogurt, back well before I reconciled myself to the fact that I’m lactose intolerant and probably casein intolerant. I just don’t do well with dairy. But I used to make lemon and rosewater and wonderful flavors of yogurt.

Martha Carlin:

I think they’ve just done so much to the cows, just like they’ve done so much to lots of our food. It’s not what it was 50 years ago, the cows aren’t what they were, the vegetables aren’t what they were, the soil is not what it was. And that’s evident in our poor gut health and our own poor nutrition.

Lindsey:

Yeah. So is there anything else you would like to talk about that’s currently fascinating you?

Martha Carlin:

Well, I love the title of your podcast, “The Perfect Stool”, because I talk to people a lot about poop. The understanding that you don’t really need a complex, fancy stool report to tell whether or not you are healthy. So, in the European microbiome study, they actually ranked all these different indicators, different medications, different lifestyle, all this different stuff that were the best predictors of health. And number three on the list was your Bristol stool score and your frequency of going to the bathroom. So to me, I love that the perfect stool is right in the middle. You need to go everyday whenever you can. You’re getting rid of that waste and not letting it sit inside, because that’s actually one of the things that I’ve spent countless hours over the last several years, is looking at the toxins that are produced by bacteria and what that can do to us in all these different autoimmune diseases that’s affecting us neurologically, our mood, etc. Endotoxins from gram-negative bacteria have a significant effect on our mood. In this study they injected happy, healthy people with endotoxins, and they were clinically depressed within two hours. So these products of these bacteria that are sitting in the body, if we’re not getting them moved out of our body, then our immune system is having to deal with them. And that is what is generating all of these problems that we’re having. So get up and go!

Lindsey:

Better diarrhea than constipation basically!

Martha Carlin:

Well, diarrhea is your body attempting to eliminate a pathogen. Obviously, chronic diarrhea is a severe problem though.

Lindsey:

Right.

Martha Carlin:

And especially if you have hemolytic bacteria and you’re having bloody diarrhea, don’t get me wrong I’m not a proponent of diarrhea. But in some ways, at least the toxins are not sitting in the body.

Lindsey:

Usually when I work with somebody who has diarrhea or loose stool, it’s an easier problem to fix than constipation. And if it’s out of control and there’s urgency or there’s lack of control of the bowels, it’s a bad situation. But the urgency of somebody who’s really struggling to have a bowel movement is so much worse. They’re really quite desperate to figure out a way, on a daily basis, to get that bowel movement out, because if not, they start to have a buildup of pain and bloating and all that. And not to mention, obviously, the physiological effects of having those toxins leaking out over time are terrible.

Martha Carlin:

And what we did start to see or talk about with my husband, when we finally started talking about going, is that on particular days when he might have more trouble with his symptoms, those were actually the days when he had not had a bowel movement.

Lindsey:

Oh, yeah. People tell me that all the time.

Martha Carlin:

People are like, “oh, yeah, that’s related. I’ve got to get it out.”

Lindsey:

People will say all the time, “I have this symptom or that symptom when I haven’t had a bowel movement”, or sometimes prior to one, start to have some symptoms.

Martha Carlin:

A number of people with Parkinson’s, who had severe chronic constipation, that have written me that sugar shift* is the only thing they’ve tried over the years that has helped them with their constipation.

Lindsey:

Well, I’m excited to try it out in some of my clients because I have a number of them who are still struggling. So I’ll definitely recommend it and see how they do. Well, this was an interesting conversation. Any final words, before we go?

Martha Carlin:

Well, just thank you for having me. And thank you for talking to people about the unpleasantness of poop, and how important it is in our life. Getting the message out that our gut is really the key to our health, and everything we do to focus on. You know I say, “love your microbes”, because that is your immune system, it’s your digestion of your food, etc. I mean, they’re doing all these things for us. And we’ve gotten to be such a germaphobe society. But really, without our microbes, we can do very little.

Lindsey:

Yeah, if people want to try the Sugar Shift Probiotic*, I’ve got a link in the show notes. I’ve got an affiliate code set up and they get a 10% discount with the code PERFECTSTOOL,  and then the other formulas too. So you can find that. Any other sites that we should mention?

Martha Carlin:

I also have a personal blog called Martha’s Quest. I write about Parkinson’s and the microbiome and alternative health things that may be beneficial for people with Parkinson’s. Sometimes I review books about Parkinson’s there. And then if you’re really interested in all the technical stuff about sample collection and that, you can go to the BioCollective. And that’s our website that talks about the history of the sample collection and some of the things that we were involved in during our early research in the company.

Lindsey:

Awesome. Well, I’ll link to all those in the show notes. Thanks so much for being here!

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me. 

*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.

Adapted from episode 122 of The Perfect Stool podcast with Dr. Katie Lee, dentist, speaker, author and coach and Lindsey Parsons, EdD, and edited for readability.

Lindsey:

So I know that you had an important personal event that led you down your current career path. Can you touch on that briefly?

Dr. Katie Lee:

Sure. So when I was 14 years old, I was on a four wheeler and crashed into a telephone pole. I broke every bone in my face from my eyebrows down. I had my jaw’s wired shut for eight weeks, and my teeth were all broken and missing when they wired me shut. So as you can imagine, over the next eight weeks of only eating ice cream, pudding, Jello and mashed potatoes, my teeth just kind of rotted and fell apart. And so I had massive amounts of infection, not to mention malnourishment. And so I learned at a very young age just how much your oral health affects your overall health.

Lindsey:

Yeah.

Dr. Katie Lee:

That’s what got me into dentistry and started me down this journey. But yeah, it took four years and nine reconstructive surgeries to fix my face and be able to open my mouth because my jaw was fused shut for about four years. So it was a long journey.

Lindsey:

What a nightmare, but I’m glad you’re better now. I know that bacteria have niches that they like to inhabit. So you might have certain bacteria that are predominant in the mouth, but don’t survive past the stomach acid, for example. So how are the oral microbiome and the gut microbiome related?

Dr. Katie Lee:

Yeah, it’s pretty common knowledge that we get introduced to our first microbiome when we’re born. We go through the vaginal canal, we get introduced to mom’s vaginal microbiome as well as some of her gut microbiome. And then after that there are several ways that bacteria get into the body, and one of the main ways is through the bowel. And so we’re swallowing 80 trillion bacteria a day. Further, if we have leaky gums, which I’m sure we’ll get into later, bacteria from your mouth will go in through your gum tissue, and can circulate to the rest of the body and start occupying areas that they shouldn’t. A major source of your gut microbiome started in your mouth. And so you can’t have a healthy gut microbiome without a healthy oral microbiome.

Lindsey:

Got it. So what are the oral signs and symptoms that indicate an issue with your gut?

Dr. Katie Lee:

Yeah, it’s really interesting because a lot of gut issues start manifesting or showing signs in the mouth. For instance, a really common condition is Crohn’s disease, and we will actually see a “cobble stoning” appearance on patients’ gum tissue, and that’ll tip us off to something being wrong in the gut. And so anytime that someone has inflammation in the mouth, we know that something is wrong with their microbiome. And so if someone comes in with bleeding, swollen, itchy or receding gums, those are all signs that something is going on in the mouth or the gut and manifesting in the mouth.

Lindsey:

I actually had one of my earliest clients tell me that after we had addressed some of the inflammatory foods in her diet and tried to reverse her Hashimoto’s thyroiditis, when she went to her dental appointment, all of the sudden the depth of her teeth was much more normal. Before she had much bigger pockets by her teeth, indicating that they were inflamed.

Dr. Katie Lee:

Definitely, it’s called periodontal pocketing what you’re referring to. We measure the depth of the patient’s gum tissue to their bone level and that gives us an indication of what’s going on, whether the gums are swollen or whether their bone is actually dying off and deteriorating. And what we know is that diet, as much as it affects the health of your gut and your symptoms of your gut, it definitely also affects the symptoms of the mouth. So whatever is going on in the mouth is also going on in the gut and vice versa. And there’s an enzyme that correlates the two, which I’m sure we’ll get into later. But one of the big things in my dental practice was actually having my hygienist spend time educating patients on anti-inflammatory diets because we just saw that much of an impact on patients’ overall health.

Lindsey:

Yeah! So what are the types of oral bacteria that people need to be aware of that contribute to gut health issues? And don’t be afraid to name strains.

Dr. Katie Lee:

Yeah! Ok. Great, good! So there’s two main ones that people should be aware of and it’s Pg and Fn. These are two bacteria that are in the mouth. They are very invasive species. Fn, I call it the “Uber” of bacteria, “Fusobacterium nucleatum”. Everyone has this bacteria, but it’s when it partners up with other bacteria, especially Pg, that it can cause a lot of damage. And Fn can get into the bloodstream very easily and it circulates freely throughout the body. And oftentimes what it’ll do, is it’ll partner up and latch on to another bacteria and then cause disease in other places. So those are the two bacteria that will cause gum infection and periodontal disease in the mouth, and then also affect our gut health as well.

Lindsey:

So Pg stands for…

Dr. Katie Lee:

Porphyromonas gingivalis.

Lindsey:

Okay, I think we’ve all heard of gingivitis, so I’m familiar.

Dr. Katie Lee:

Yes, yeah, very similar.

Lindsey:

Fusobacteria, I’m pretty sure those are hydrogen sulfide producing bacteria?

Dr. Katie Lee:

Yeah, they’re gram negative. They love oxygen-deprived environments. So that’s why they work really, really well in the gut and why they live and can thrive in the gut. And Fn particularly is very difficult to kill off and to lower. So again, it’s not necessarily that the Fn is bad, it’s just in association with other bacteria causing harm.

Lindsey:

Okay. I know that it’s been publicized in the news about the bacteria in your mouth and heart health. So can you dig deeper into that connection, and with other health conditions as well?

Dr. Katie Lee:

Yeah! So Pg is actually really heavily implicated in heart health, also really heavily implicated in Alzheimer’s. In fact, there’s been some direct links of Pg causing Alzheimer’s. They found Pg in cerebral spinal fluid of patients with Alzheimer’s. So we know that we shouldn’t have bacteria in our brain. So when we have it, our body creates these amyloid plaques and can cause our brain to shrink over time and impair our brain function. And so these bacteria are also implicated in the heart, arthritis and gut and you know as well, anytime you have gut issues, and massive inflammation in your gut, those patients also oftentimes have arthritis issues and joint issues, because of the systemic inflammation that’s going on. And what happens is, and I think what a lot of dentists and clinicians didn’t realize in the beginning is, we know the bacteria in the mouth don’t stay in the mouth, they go into the body, but we never really understood how that happens.

And so now we know that there’s this enzyme called aMMP-8, it’s a matrix metalloproteinase, which is a collagenase enzyme. And what happens is, we get bacteria in our mouth that shouldn’t be there, viruses or fungus or whatever, the body releases the immune system to go and protect us and kill off whatever invader is there. And in order to get the white blood cells to that area, it releases aMMP-8 to go through and cut through the cell junctions to allow the white blood cells to get to the invaders. The problem with that is, now we are breaking down tissue. And so that’s what leads to leaky gums or gingivitis and periodontal disease in the mouth. And that’s what allows the bacteria to get into the circulatory system and cause systemic damage. That’s also the same enzyme that’s responsible for cutting down the tight junctions in the gut too and causing leaky gut. So it’s directly related.

Lindsey:

Interesting. So are there any other strains of pathogenic bacteria that are particularly bad in the mouth beyond those two?

Dr. Katie Lee:

Yeah, we call it the red complex bacteria. So there’s a bunch of bacteria in the mouth that we are really concerned with: Tb, Tf are a couple of the other ones that we’re always trying to lower, so that way we don’t have systemic ailments, but Fn and Pg are definitely the two main ones. Aa, Actinomyces, is another really big one. When it’s present it causes a ton of damage. But fortunately, it’s not that common for someone to have it and that one runs more in families because it’s passed down generation to generation. But what’s really cool about all the stuff that I’m talking about is you can now test, just like you can do microbiome testing for your gut, and do stool testing, we can actually do saliva testing now and test patient’s oral microbiome, and we can actually test the enzyme level, the MMP-8. So we can tell, does the patient have these pathogenic bacteria in their mouth? And what is the enzyme level? And that tells us how freely stuff is going from the mouth to the body.

Lindsey:

And those other two strains you mentioned, can you give me the full names?

Dr. Katie Lee:

Treponema denticola and Tannerella forsythia. We always just say the abbreviation.

Lindsey:

Okay. Tell me the name of the test that does the microbiome of the mouth?

Dr. Katie Lee:

Yeah so there’s several tests on the market. The two that I really like, one is with Access Genetics, and it’s called OralDNA. I really liked that test. It tests for 11 different strains of bacteria. It’ll tell us the level of the bacteria that the patient has, it breaks it down into high risk, medium risk and low risk pathogens. And when it talks about that, the risk is associated to how much bone loss or damage will it cause in the mouth, and then how much is the risk for the rest of the body for systemic conditions. And then it’ll also tell you how to treat those bacteria as well, because that’s what’s important to know. Just because you have bacteria doesn’t mean that it all responds to the same treatment. And so for many years, clinicians made the mistake of, you know, a patient would come in with gum infection, and we just had one kind of “kitchen sink” approach to treating their gum infection. But what we would notice is some people would come back every three months, and their condition never got any better.

And that was for a couple of reasons. One is we weren’t ever looking at gut health or nutrition, or supplementation or systemic issues. But then also, bacteria are not all responsive to the same types of treatments. And so it’s nice to know about microbiome testing, as you can really tailor the treatment to what the patient has. The other test I really like is HR-5 by Direct Diagnostics. It really just hones in on the top five pathogens that cause periodontal disease and systemic disease. So those are the two I really like. And then for the enzyme test, the aMMP-8 test. That’s a very unique proprietary test done by Dentignostics, it’s a German based company, they’ve been doing this test in Germany forever. It just came to the US a few years ago. And that’s a “chairside point of care test”, which is awesome. And so we will call it “fitness”. So a patient would come in, and we’d say, “Let’s measure your oral fitness.” And that would just give us a read on how this patient is doing at this very moment with their oral health and systemic inflammatory levels.

Lindsey:

And are those directly administered by dentists only, you can’t order them yourselves?

Dr. Katie Lee:

So that’s a really good question. The aMMP-8 test is only available at dental offices right now. I know they’re working at trying to do some at-home tests. And then the saliva microbiome testing, you can get through a dentist. You can either go through a dental office; you can ask if your dentist will provide that test. Or, for instance, that’s something that some of us online dentists do so people can go to the website and order the test from the website. And then we will go over the results with them.

Lindsey:

Okay, great. So, to the extent that you haven’t yet, let’s go through the different pathogenic strains and the connection to various diseases one by one of the ones that you haven’t yet mentioned.

Dr. Katie Lee:

For which ones specifically, they’re all kind of overlapped? It’s all those top five, like the HR-five bacteria that I was talking about. Those are the ones that really cause the most systemic conditions. And that’s why Direct Diagnostics focuses on just those five, because those are the ones that we see repeatedly over and over again. So Fn and Pg are the big ones. Td and Tf are also implicated in gut health, but Fn, specifically to the gut, we know that there’s about 20% of colon cancers that test positive for the presence of Fn . And so what happens is Fn gets into the colon, it causes these inflammatory responses, polyps are formed and then Fn kind of aggregates into the center of these polyps. And so we know that patients that have Fn -associated cancer are more difficult to treat, and they’re less responsive to chemotherapy and they’re more at risk for recurrence. So yeah, Fn and Pg are the big ones for gut health.

Lindsey:

Okay. And so what kinds of treatments are you doing? Is it like antibiotics or is it just something inside the mouth?

Dr. Katie Lee:

Yeah, to treat the Fn infection?

Lindsey:

Any of these or any of these infections you’re talking about.

Dr. Katie Lee:
So, for Fn and Pg specifically, what we typically do is we’ll administer scaling and root planing, which is a periodontal cleaning. What a lot of people don’t understand is that aerobic bacteria live above the gum line. And those are a lot less dangerous than the bacteria that live underneath the gum line, such as Pg and Fn . And so you can’t do a super gingival (above the gum line) cleaning if you’re trying to target those pathogens. So you must go underneath the gum tissue and do what’s called scaling and root planing to clean those bacteria out. Now, the bacteria that are resistant to scaling and root planing, you need to go in with some sort of medicaments, or anti-microbials, or lasers to try and get rid of them. So oftentimes, we’ll use ozone therapy. When we’re doing these cleanings, you can do iodine and rinse them out that way, you could do Peridex, there’s all kinds of different chemicals or medicaments to rinse the bacteria out.

And then I love to go in and actually decontaminate the gum tissue, the inside of the periodontal pocket, with a laser. Laser therapy is very, very effective at killing bacteria. Because you’ve got to think about it, you have your tooth, your roots, and then you have your gum tissue. And so bacteria not only live on the tooth root surface, but they also live on the inside of the gum tissue. And if you don’t treat both the root surface, the free floating bacteria in the pocket and the gum tissue, you’re not going to have a clean environment for healing, because what we want to do is we want to clean everything up, we want that gum tissue to shrink and reattach to the tooth and act as a barrier so nothing can get back down in there. And if the gum tissue was not being treated specifically, it’s not going to reattach to the tooth and you’re never going to close that barrier. So laser is really, really effective in treating that tissue.

Lindsey:

Okay, and I don’t know exactly what root planing and scaling is, but it sounds painful. What exactly does that involve?

Dr. Katie Lee:

Yeah, that’s a question that we get a ton from patients. So when we talk about scaling and root planing, essentially what we’re meaning is, scaling just means scaling the teeth. So scraping the teeth, you get that done when you get a regular prophylactic or healthy mouth cleaning. Anyway, root planing just means that the root surface is actually rough. So if you look at it under a microscope, the crown of your tooth is real smooth, it’s like a sheet rock. But then when you go down to the root surface, it’s actually very, very porous. And those porous roots are where bacteria love to stick to and grow and thrive. And the bacteria will actually colonize, mix with the minerals in your saliva and form tartar, or calculus. In there it’s like barnacles attached to the surface.

So when you go in and clean, what you’re doing is you’re scaling all that off, but then we need to take our instruments and go in and actually root plane, so smoothing the root of the tooth to make it nice and slick that way less bacteria and less debris are likely to attach. So thank you for asking me to clarify that, sometimes I forget. Number one, get in and treat it before it gets to a level where you know you have super deep 6, 7, or 8 millimeter pockets, because the worse off that condition is yes, the more painful that the procedure is going to be. Number two, we definitely will numb patients up or anesthetize them because it’s more important to have the patient comfortable during the procedure so that clinicians can do a great job. We’ll have some people come in and say, “Yeah, but I don’t want to be numb.” Okay, well, if you’re moving around and jumping in the chair, we can’t get in and adequately clean. So I always advocate for either a topical anesthetic or doing full dental anesthesia.

Lindsey:

Okay. So cancer is of particular concern to me, and pancreatic cancer in particular, because I know two people who died of it, one of them a very dear friend. So what bacteria is associated with pancreatic cancer, and this is the same procedure for eliminating it?

Dr. Katie Lee:

Yeah, so Pg is the main one associated with pancreatic cancer. And yes, it’s same type of procedure that I’m talking about. If you do the scaling and root planing, if you do the irrigation with some kind of medicament and if you do the laser, that will really take care of everything that I’m talking about and all the different strains and treatment of all the different strains.

Lindsey:

Great. And so how about the connection between oral health and infertility? Is that just for women or men as well?

Dr. Katie Lee:

No! So, this is one of my favorite topics because I have a personal journey with infertility. So, same process, you get bacteria in your mouth and then MMP-8 is activated, the MMP-8 breaks down the gum tissue, and bacteria from the mouth circulate. One of the places Fn loves to go to is the reproductive system. And what we know about infertility is that 50% of all infertility is male and female. So it’s half caused by women, half caused by men, so it’s not just a female issue. And so Fn and Pg for men actually inhibits arginine production. Arginine is the precursor to nitric oxide, which is what is needed for a man to get an erection. It decreases the number of sperm, it decreases the swimming strength of the sperm, if you will, the motility, and it changes the shape of the head of the sperm. Now in women, it causes inflammation in the uterus and the ovaries. So it makes it not a great environment for an embryo to implant. It decreases our ability to ovulate, and then decreases our ability to carry the baby to term. So especially Fn , which is highly evolved in gut health, causes or is associated with preterm birth, low birth weights and even stillbirth. There were a lot of studies done on stillbirth babies. And what they found is that they were all infected with Fn bacteria.

Lindsey:

Wow. So important to get this check before you get pregnant, I guess.

Dr. Katie Lee:

Yeah, definitely, people definitely want to get checked before they’re pregnant, or if they’re trying to get pregnant or if they’re having difficulty. I always tell them, anyone thinking about child rearing needs to have an oral microbiome test. And even if you are pregnant, it’s still important to get this checked and treated because if you treat it, you can get rid of these bacteria, or at least get them in check so that you can go on and carry the baby to term and have a healthy delivery. So it’s still safe to get treatment during pregnancy.

Lindsey:

Right. So is bad breath a sign of having these sort of strains in your mouth?

Dr. Katie Lee:

Yes, definitely, it can be. Bad breath is associated with bacteria, periodontal disease, for sure. And all it is, it’s the sulfur byproduct of the bacteria. And so oftentimes when patients come in, there’s a very distinct smell between an abscess usually and “perio breath.” You know, only if you’re a dentist or hygienist would you probably know what I’m talking about. Bad breath can definitely be associated with gum disease and it can be associated with tooth infection. Also, acid reflux is another one that causes bad breath. Sinus issues, if someone has a sinus infection or mouth breathing. Mouth breathing is horrible for your oral microbiome, which is then horrible for your gut microbiome. I don’t know if you ever do anything with the airway, but airway is super important for all of this.

Lindsey:

Yeah, I actually was going to ask you about whether snoring and sleep apnea increased pathogenic bacteria in the mouth?

Dr. Katie Lee:

Yeah. So in our nose we have billions and billions of cilia, little hairs, same in our gut. We have all these little hairs that help filter things out. And that is what our nose is designed for, is to take the air that we breathe, filter it and then put it into our bodies so we can use the purest form of air and oxygen possible. The problem is, when we don’t breathe through our nose for whatever reason, our nasal passages start to get inflamed, because the air that we’re taking in through our mouth is no longer filtered. So we’re breathing polluted, allergen-infested air that then goes into our body. Our body knows it’s not supposed to be there. So we initiate an inflammatory response and now we have chronic inflammation going on everywhere in our body.

And so mouth breathers will say, “Well, I’m a mouth breather because I have allergies.” Well, true. But I wonder way back when you were young, you know, maybe did we have some oral habits, or our jaws and sinuses didn’t develop the way that they should have, and so that causes us to mouth breathe, which then led to those allergies. And so when we are breathing through our mouth, we’re getting dirty air and our mouth becomes very dry. Bacteria love to stick to dry, porous surfaces, which is our entire mouth now. So then we get a shift in our microbiome. So instead of having a healthy, homeostatic microbiome, we now have dysbiosis. And again, we’re swallowing that all day long, and that affects our gut health. So long answer, but yes, it definitely affects oral and gut microbiome.

Lindsey:

Okay, so I have some personal experience with this because my partner snores. He clearly has sleep apnea, undiagnosed or treated. So I told him to get one of these devices that pushes your lower jaw out, to open up the airway. But on the pamphlet, it comes with it says, “Don’t use this if you have sleep apnea.” And I’m thinking, but if you use this, then you won’t have it, will you?

Dr. Katie Lee:

Did he get it on the internet?

Lindsey:

Yes.

Dr. Katie Lee:

Yeah, I think they probably say that because of liability. Because if you have sleep apnea, you need to be treated by a clinician that can treat sleep apnea, because you have to be titrated. So wherever that lower jaw is positioned is dependent on the volume of your airway, the obstruction, how severe your sleep apnea is, and then how well you can tolerate it in your TMJ joint. Sometimes people will buy devices and their lower jaw isn’t moved forward far enough, so it actually is not treating the sleep apnea. So if someone dies in their sleep from having a heart attack from sleep apnea, they don’t want the family to come back and say, “Oh, they got this device to treat sleep apnea.” You know, they’re saying, “Oh, well, it’s not treating sleep apnea.” So it’s a liability thing. But the devices are very easy to get from dentists who treat sleep apnea. And again, the positioning is critical, because you want to make sure that they’re pulling the lower jaw forward enough to open the airway. It’s like a king’s toes, right? You want to pull it open enough to where they can breathe, but you don’t want to pull it too far for to where it changes the bite and causes joint pain.

Lindsey:

Okay, so that’s why I should tell him to take it to his dentist and check it out.

Dr. Katie Lee:

Yeah, yeah, tell him to take it to the dentist. Another important one is we see people oftentimes grinding their teeth, or that they have acid reflux. And that is a tip off that they probably have an airway issue. And so a lot of patients will say, “Well, I have a night guard because I grind my teeth.” Well, I don’t give night guards to patients unless they’ve done a sleep study. Because most of the time those patients don’t have a grinding issue. They have a sleep apnea issue and the symptom is grinding. So if you correct the sleep apnea, the grinding will resolve itself. And the night guards, you don’t want to give someone a night guard if they have sleep apnea, because you actually make the tongue space smaller, and you can make the apnea worse. So it’s really important you get it checked.

Lindsey:

And why would the grinding be caused by the sleep apnea?

Dr. Katie Lee:

Great question. So when you fall asleep, what happens? OSA, obstructive sleep apnea. What happens is you essentially choke. Most of the time you’re choking on your tongue and your airway gets pinched, or your soft tissues kind of collapse the airway. And it always gets worse as we age. And so what happens is, when you stop breathing, your brain says, “Oh, my gosh, we were not getting any oxygen. If we don’t get some oxygen up into our brain, we’re going to die.” And so there’s a rush of adrenaline that’s sent to our brainstem. And that causes us to start grinding our teeth forward to open our airway. So what we’re trying to do is push our own jaws forward, so we start grinding back and forth to open the airway and unkink it. So that’s where the grinding comes from.

Lindsey:

Interesting.

Dr. Katie Lee:

It’s a self preservation system. But, a lot of people have heart attacks and strokes in their sleep. And most people die between two and six in the morning. Because that’s when people are in REM sleep. When you’re in REM sleep, you’re more likely to have apneic events, because you’re paralyzed since we’re dreaming, and we don’t want to be acting out our dreams. So the body gets paralyzed, you stop breathing, you choke on your tongue or whatever, and you don’t wake up, and then that’s when you can have a heart attack and stroke. So sleep apnea is very important to get treated. Untreated sleep apnea is fatal. It’s just a matter of when, if it’s not treated.

Lindsey:

Wow. Okay. Sounds like serious business.

Dr. Katie Lee:

I’m not trying to scare anyone. It’s just such an easy thing to treat. And it’s not painful. 70% of people who have sleep apnea are undiagnosed, so people need to take it seriously.

Lindsey:

Yeah. And snoring is a sign of it.

Dr. Katie Lee:

Yes, definitely. It can be a precursor to sleep apnea or a direct sign that someone has sleep apnea.

Lindsey:

Okay. Got it.

Dr. Katie Lee:

But not all snorers have sleep apnea. I want to make sure I say that.

Lindsey:

Right. But the people who make gasping noises in the middle of the night probably do, because I hear that.

Dr. Katie Lee:

Yeah if they’re gasping, they for sure have it.

Lindsey:

Yeah. Okay, so are the strains that cause diseases also the ones that cause cavities?

Dr. Katie Lee:

Great question. No one’s asked me this actually. And no, they’re different. So the red complex bacteria, the five main ones that I was talking about, those are the ones that are implicated in periodontal disease and systemic disease. The ones that mainly cause cavities, there’s a few of them, but the one that everyone talks about is Streptococcus mutans. So that’s a very specific bacteria and the reason why it is concerning is because it will ingest the carbohydrates that we have in our mouth. So that could be sugar, it could be processed foods, pastas, crackers, anything like that. Thats what it feeds off of, and then it basically excretes acid onto the teeth and that’s what causes cavities. That same bacteria is also implicated in causing problems in our hearts. So when you hear about patients having heart valve issues or something like that, the cavity causing bacteria in the mouth can go to the heart and cause heart valve issues.

Lindsey:

Interesting.

Dr. Katie Lee:

So, a lot of times patients need pre-medication before they come in to the dentist, and that’s from the “Strep mutans” or the strep family.

Lindsey:

Okay. So are there beneficial strains that we want to have in our mouths?

Dr. Katie Lee:

Oh, yes, just like the gut. So we want to have plenty of Lactobacillus bacteria or the Bifidobacterium, those are really good. I’ve been doing a lot of studying with the Akkermansia strain*. Have you?

Lindsey:

Yeah, I’m taking Pendulum Metabolic Daily Pro*. I started that about two days ago.

Dr. Katie Lee:

Yeah. So I’ve been taking that too, we’re finding the Akkermansia is very beneficial in the mouth as well. So whatever is going to be good for your gut, it’s going to be good for your mouth because again, the mouth is benefiting the gut. So yes.

Lindsey:

Okay. And are there any dental probiotics that you recommend?

Dr. Katie Lee:

Yes, but understand that I’m not paid by any company, this isn’t an ad or anything like that. But there’s lots of products on the market that are really, really good. There’s this product called reviten*. It is really, really good. It’s a toothpaste, it’s all natural. It’s even food grade, so you can actually eat it. What I love about it is it has prebiotics, which is as you know what we need to feed the good bacteria in our mouth and in our gut. And it also contains some vitamins that are essential for oral health. We need to stop over cleaning and over sterilizing our mouth, because the mouth is an ecosystem. And for years I was trained this way in dental school. You know, “kills 99.9% of germs” and “the burn from the mouthwash is good, it means it’s cleaning”, and “we should use triclosan in our products because it’s antibacterial.”

I don’t like that logic because the good bacteria, the anaerobes, are so much easier to kill than these pathogenic bacteria that have learned to survive throughout the rest of the body. And so when you take those harsh products, you’re for certain killing the good bacteria and maybe doing a little bit for the bad bacteria, but what you’re doing is you’re setting up an environment for the bad ones to thrive. So I always tell people, use gentle products. The Tooth and Gums Company* is another really good one. Boka* is a great company, I love them. Invivo has a lot of prebiotic and probiotic mouthwashes. Again, not paid by any of these people, I just really like their products. A really good one that people can get is Tom’s. Tom’s is great. I actually love the Tom’s product line.

Lindsey:

Alright that’s great. Even the fluoride-free?

Dr. Katie Lee:

So here’s the thing about fluoride. Fluoride is a neurotoxin, we know that fluoride is toxic when ingested. But if people are going to choose to go fluoride free, they need to make sure that they have practices in place to prevent cavities. Because a cavity and a dental abscess is way more toxic to the body than fluoride. So fluoride-free is great. I’m an advocate for that, but make sure that you’re using products with “nano hydroxyapatite” and not “hydroxyapatite”. It needs to be “nano hydroxyapatite*” that way it’s absorbed into the tooth structure. Make sure you have products that have some sort of cavity-fighting product in them, so “nano hydroxyapatite”. Another really good one for preventing cavities that a ton of research is done about and is also great at preventing sensitivity or treating sensitivity is arginine. This is where I really like Tom’s toothpaste* because they are really high in arginine in their formulation. So nano hydroxyapatite is good. Arginine is really good. MIpaste is really good. So yes, you can go fluoride-free, but make sure you do something else. Lay off the Coca Cola and Starburst if you want to be fluoride-free.

Lindsey:

And does the Tom’s of Maine have that nano hydroxyapatite in them.

Dr. Katie Lee:

No they don’t have nano hydroxyapatite but they’re high in arginine.

Lindsey:

And that can take the place of it?

Dr. Katie Lee:

Yeah, absolutely. Yeah. Arginine has a ton of research, so I’m totally into that.

Lindsey:

Okay, great. I was going to ask about that, because I didn’t know if the dentistry world would be like “fluoride-free toothpaste! Oh, no!”

Dr. Katie Lee:

I’m totally fine. You know, I would just have patients that would come in, and they’d be like, “I stopped doing fluoride six months ago.” And I’d be like, “Okay, well, now you have 12 cavities.” So now I have to put materials into your mouth. Of course, I’m going to use as biocompatible materials as possible, but still, let’s change lifestyle, let’s change what we’re going to do if we’re not doing fluoride. So, yes, fluoride-free is fine. Just make sure you’re set up for success.

Lindsey:

Okay. So if you’re kissing somebody who’s got pathogenic strains in their mouth, will you necessarily take on those strains? Or might your better strains fight them out?

Dr. Katie Lee:

No, no. Unless you have some superhuman oral bacteria, or oral microbiome, the oral microbiome is very fragile. And, you know, just as something as little as eating processed foods for a week or rinsing with alcohol mouthwash…you’re going to kill it off. So again, bad bacteria are much more powerful than good. So if you’re kissing someone, eating after someone, around someone with a lot of pathogenic bacteria in their mouth, it’s going to transfer to you. So especially in patients who are doing fertility treatments, we test not only the wife, or the husband, but we always test the spouse as well. And your kids are going to get your microbiome, so when babies are born, you get your first introduction through the birthing canal. But then the microbiome is not really that diverse in the beginning. And that’s why babies are so prone to infections when they’re young, because their microbiome is still developing in diversity, and they’re going to get it from their environment. So if mom and dad’s microbiome or their nanny’s microbiome was not good, your baby’s going to get that.

Lindsey:

So it sounds like no to mouthwash, or at least not the really strong mouthwashes at least. How about fluoride rinses?

Dr. Katie Lee:

So again, the fluoride rinses are just there to put extra fluoride into the teeth. And there’s other things that you can do. And I would always ask people, what’s your purpose for doing the fluoride rinses? So if someone has really high cavities, and every time they come in they have high cavities and they’re a teenager, they’re eating sugar and drinking Coke, and I can’t get them to make behavioral modifications, like teenage boys…they’re really tough. Maybe a fluoride rinse might be good for them, as long as they’re not swallowing it. If someone does not have a high cavity risk and a good lifestyle, they don’t need the fluoride rinse. They can use Tooth and Gums Tonic* or something like that.

Lindsey:

Yeah. So in terms of changing your breath, what’s a good option that’s not too expensive?

Dr. Katie Lee:

Yeah, the best thing someone can do is number one, Tongue Scraper*. I am a big proponent of tongue scraping. People’s tongues are filthy; they don’t clean them off. Just buy a U shaped scraper on Amazon, it’s a couple bucks. And after you’re done brushing, scrape it off. That will improve breath tremendously. The other thing is, I would for sure go see your dentist, make sure you don’t have a gum infection or a tooth infection. And if they have microbiome testing available, get it, because you might have the periodontal pathogen bacteria and they’re producing sulfur compounds causing that bad breath. Another one I would check is mouth breathing, that will cause a lot of bad breath and so will acid reflux. I don’t know if you’ve ever tried mouth taping*, or have you ever tried it or heard of it?

Lindsey:

Yeah, I recommend it to any client who says they snore.

Dr. Katie Lee:

Yes, it’s amazing. So for someone who says, “Oh, I can only breathe through my mouth,” I’ll say okay, during the day start training yourself to breathe, and then use it at night. So that way people don’t freak out they’re going to choke to death and stop breathing at night. And usually just by closing their mouth during the day, that’s enough to start triggering the inflammatory response to calm down. But breathing through your nose will actually make your breath a lot better because your mouth isn’t dry.

Lindsey:

If somebody has just eaten a lot of garlic or whatever the situation is, are there any mouth rinses that are okay, that aren’t hurting bacteria?

Dr. Katie Lee:

Yeah, I like Tooth and Gums Tonic. That’s a really good one. Tom’s mouthwash* is really good. I really love Closys*. That’s a really good, gentle mouth rinse that people can use. It used to be by prescription only but now it’s over-the-counter, which is great. Anything that’s alcohol free. Alcohol will kill the good bacteria and it will dry out your mouth, which makes your breath worse.

Lindsey:

Okay, great. So if you’re somebody like I am that produces a lot of plaque as soon as I eat anything with sugar in it, is that a cause for concern?

Dr. Katie Lee:

So it can be, you just have to be way more diligent with oral hygiene. So when you have plaque on the teeth, it can be for several different reasons. A lot of it can just be your own mineral content that you have coming through your saliva. When you say you cause a lot of plaque, do you mean you get a lot of hardened buildup on your teeth…like “hairy teeth”.

Lindsey:

Yes.

Dr. Katie Lee:

Yeah. So, you just want to be really diligent about your oral hygiene, because when plaque is soft it starts forming 20 minutes after you finish eating. Plaque is soft, it can be removed. The problem is, once that plaque is allowed to stay on the teeth and mature, and then it mixes with the minerals in your saliva, it hardens, and then becomes a safe haven for bacteria. And you can’t remove that hardened plaque on your teeth. That’s called calculus. So not a concern as long as you’re being diligent and taking it off. I always tell people after you eat and drink, make sure you wait at least 30 minutes to brush your teeth. Because if you eat something acidic, or sugary, or something like that, and you brush immediately after eating, you’re actually brushing that into the teeth and can cause damage. So wait about 30 minutes, let the pH level of your mouth rise because that’s the other thing, once you finish eating, the pH in your mouth drops because we need to start to break down and digest our food so that we basically start the digestive process in the mouth. And so you want to wait 30 minutes, let the pH come back up, let the food pH kind of normalize, and then brush your teeth.

Lindsey:

Okay, great. So I’m not sure, did you actually answer about whether there’s any dental probiotics that you like or use?

Dr. Katie Lee:

Oh, probiotics? Yes. So I really love the Invivo line.

Lindsey:

As a probiotic?

Dr. Katie Lee:

Yep, they have a really good mouth rinse too. It’s a powder that you just mix with water. And then you can rinse with that, that can be your mouth rinse. If you go to Primal Health*, they have really great products as well that I like that are non-toxic.

Lindsey:

Okay.

Dr. Katie Lee:

And another really good one for plaque. And to prevent cavities, is actually chewing Xylitol gum*. So have you heard of xylitol?

Lindsey:

Yeah, I have gum with it too, all the time.

Dr. Katie Lee:

Perfect. Okay, good. So another cause of the hairy teeth feeling is one, the teeth could just need to be polished. So when you go to your dentist, ask them to polish them and smooth the teeth out so that they’re not so sticky. And number two is dry mouth. And so if you can keep your mouth more moist, and so you can do that by drinking tons of water. If that’s not working, then I always advocate for chewing Xylitol gum, because number one, the Xylitol will kill any Strep mutans bacteria. So cavity causing bacteria, the bacteria will ingest the Xylitol thinking it’s a sugar but then actually starve to death because it can’t metabolize it. And then also it causes secretion of saliva which bathes our teeth, and actually prevents the bacteria and plaque from adhering to the teeth. So that’s another really good option.

Lindsey:

Great. I’ll link to this gum I use and all these other things. I’ll find them and link to them in the show notes. So have you ever heard of Biocidin products? They have a dental rinse called Dentalcidin* and they have a toothpaste*.

Dr. Katie Lee:

Yes, I actually really liked them. Thank you for bringing it up. I believe they’re doing Akkermansia stuff now too.

Lindsey:

Really?

Dr. Katie Lee:

I saw a webinar and Biocidin was sponsoring the webinar and they were looking at the Akkermansia line. So that was kind of my first tip into Akkermansia. And then I found Pendulum, which was great. But yes, I really love Biocidin as well.

Lindsey:

Yeah, I use that Dentalcidin rinse*. I’ve seen studies showing it helps with the pathogenic bacteria as well.

Dr. Katie Lee:

Yeah, they’re a great company. They’re all natural, science-based, which I love. You’ve got to be careful because a lot of things that are out there don’t have the science to back it up. And so you just have to be a little leery of it.

Lindsey:

Yeah. So how about the connection between dementia and oral health? You did mention Alzheimer’s.

Dr. Katie Lee:

So, same process. Bacteria in the mouth, inflamed gums, aMMP-8, leaky gums, the bacteria Fn and Pg go into the brain and they can cross the blood brain barrier. And that’s really scary because that barrier is there to protect our brain. And essentially what happens is once Pg is in the brain, the brain knows it shouldn’t be there and so it starts creating these beta amyloid plaques around the neurons to protect itself from this bacteria and in essence starves the neurons. And so they begin to die. And then that’s how we develop Alzheimer’s and dementia. So the brain is actually trying to protect itself, but then it ends up harming itself. Fn, what we know is, Fn brings Pg to the brain, but then Fn also accelerates Pg’s pathogenicity in the brain. So again, those two bacteria are highly correlated to Alzheimer’s and dementia. Same with herpes viruses, there’s a lot of research coming out about HSV going into the brain and causing neuro inflammation. And so that’s one thing I always tell patients when they would come in is, you know, “do you have a history of cold sores?” And they would sometimes would say “yes or no, why do you care?” And I said, “Well, we need to put you on an antiviral or do something to try and get these under control.” Because every time you have an outbreak, we’re causing neural inflammation and damage.

Lindsey:

Yeah. And that’s super prevalent. I think something like 80-85% of people have it.

Dr. Katie Lee:

Totally. Yeah, very, very common.

Lindsey:

So I hear a lot of biological dentists recommending removing root canals and crowns and such, but what do you put in their place if you do that? And is that something you’d recommend?

Dr. Katie Lee:

Oh, gosh, you’re opening up Pandora’s box here. Here’s the thing, I don’t portray myself as an all-natural, biological dentist. Root canals can be very deadly and harmful because once the tooth is dead, it cannot heal itself. And so if the root canal is not done properly, or if the patient has gum disease, or if they have cavities, teeth are like organs. And so when they are getting insults, they can fight off those insults and heal themselves. When you have a dead tooth, you have no immune system on that tooth. And so that tooth can then develop latent chronic infections. And because there’s no nerve on that tooth, the patient can have this massive abscess and never know about it.

And if they’re not being checked by a dentist who uses this 3d imaging Cone Beam technology, they can go years with these latent infections that are causing systemic inflammation and draining all this bacteria into their bloodstream and never know, because there’s no symptoms. That’s the danger of it. Number one, prevent root canals. Get treatment before it gets to a place of root canal. Number two, if you need to have a root canal done, make sure it’s done by a specialist or a general dentist who mainly focuses on root canals and uses microscopes or high technology CBCT to make sure they’re getting into every nook and cranny of the tooth. And then number three, make sure you’re getting them checked. Because the moment they start to show that they’re getting reinfected, now it’s time to take the tooth out and move on to something else, like dental implants or what have you. Oh, so it’s not as easy as saying all root canals are bad, extract all the teeth.

Lindsey:

Yeah that helps, that helps a bit. So basically just get checked with that 3d x-ray or 3d imaging…?

Dr. Katie Lee:

Yeah, 3d x-ray. You know, I tell people, if you go and rip out all your root canals, now you have to replace the teeth, because there’s lots of studies showing that the less pairs of teeth you have, the more it impairs your cognitive function, and the more it decreases your lifespan. So the magic number is having 10 sets of teeth or 10 pairs of teeth. And so if you take a tooth out, you need to replace it. Because otherwise teeth are going to shift, you’re going to get gum issues, you could get jaw and bite issues. And so now what do you replace it with? And so most often, people will do implants. Well, now you’re introducing a foreign body into your jaw, into the bone, into the blood, bone marrow, into your bloodstream. You don’t know how your body is going to react to that. Is it going to accept it or cause another inflammatory response? So the short answer is not just rip out all your root canals and replace them.

Lindsey:

Right, right. So I actually have all of my wisdom teeth. Is that super unique?

Dr. Katie Lee:

It is unique because over time, back a millennia ago, we needed all of those molars to digest our food and break down the sticks and twigs and the meat and the bones that we were eating. Unfortunately, with the high processed diet and the agricultural shift in our food and farming, our foods are a lot softer unfortunately. And so our jaws have gotten a lot shorter and so there’s not enough room for those teeth anymore. And the shrinking of jaws is also why we have a lot of airway issues and so it is very unique. So congratulations. I think that’s awesome that you still have your wisdom teeth. I wish more people had room.

Lindsey:

I think it must have been because my parents made me eat very tough meat as a child. I had to tear apart things.

Dr. Katie Lee:

That’s great! There’s a lot of advocates actually out there for developing jaws through these myofunctional kind of habits like that of eating harder stuff when you’re young so that you actually get proper development of your jaw. So good for your parents. That’s awesome.

Lindsey:

Not just all processed foods, like eating real food.

Dr. Katie Lee:

Yeah, that’s great. Yeah.

Lindsey:

So how can people find a dentist who’s doing this kind of advanced testing and treatment? Is there any website or…

Dr. Katie Lee:

There’s a lot of advocates out there that are really promoting this type of treatment. I’m sure I’m going to miss a lot of them, but there’s an organization out there called the American Academy of Oral Systemic Health. People can go on there and type in a provider and some people are linked there. You can go to “Access Genetics website”, or “oraldna.com“. That’s the saliva test, and type in find a provider. And there’s all of the Instagram influencers. So askthedentist.com, that’s a really good website. He has tons of followers, but he has a directory of people that you can search. I think Living Well with Dr. Michelle is another one. But I think it’s pretty easy to find these days a doc that will do this.

Lindsey:

Okay, cool.

Dr. Katie Lee:

Yeah, people can just ask for microbiome testing. That’s kind of the key word to ask for.

Lindsey:

Right. Right. Okay, awesome. Well, thank you so much! This was super informative. Any final thoughts?

Dr. Katie Lee:

The whole point of me doing what I’m doing and writing the book and everything is I feel the more we can educate the public on how the mouth is actually connected to the rest of the body, and how it will affect your overall health, by arming patients with the right information, I feel like they can then find providers that will give them top quality care that they need to be well. So I just hope people take the information, they can do with it what they want, but I think it’s really beneficial for people to know this.

Lindsey:

Awesome, well, thank you so much.

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me. 

*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.

Adapted from episode 121 of The Perfect Stool podcast with Dr. Damiana Corca, Doctor of Acupuncture and Chinese medicine and certified functional medicine practitioner and Lindsey Parsons, EdD, and edited for readability.

Lindsey:  

Welcome to the podcast Damiana!

Dr. Damiana Corca: 

Thank you for having me today. I’m so excited to be here.

Lindsey:  

I’m excited to have you, especially since my sleep has been horrific lately. But before we get deep into sleep and my questions, I understand your personal history relates to gut health. So why don’t we start there?

Dr. Damiana Corca: 

Yes, a few years ago, I was diagnosed with Hashimoto’s, actually I was a bit self-diagnosed. I just ran some tests, and I thought I’d run the thyroid antibodies, and there they were, very elevated. And it turned out that what made the most difference, besides making some diet changes, was doing a comprehensive stool test. I had a few infections and when I treated them, some with supplements, some with medication, I saw a huge drop in those thyroid antibodies.

Lindsey:  

Wonderful. Yeah, that’s a good part of my history, except that mine is an ongoing problem because I have the autoimmune type of SIBO. So, what were the infections you found?

Dr. Damiana Corca: 

Blastocystis hominis and H. Pylori, and H. Pylori were very elevated. In all these years of practicing, I’ve never seen them so elevated, and so many of the virulence factors active.

Lindsey:  

And those are clear now?

Dr. Damiana Corca: 

Sometimes they tend to come back a little bit. It seems like it’s a constant game between my immune system, but I now recognize some of the signs when it comes back. I want to give it a little bit of a supplement or this mastic gum seems to work well. And then the blastocystis hominis, I ended up having to do a couple of rounds of the medication to get it down.

Lindsey:  

Let’s talk about the connection between gut health and insomnia. Does one influence the other? Or is it bi-directional? And what are the mechanisms of action?

Dr. Damiana Corca: 

I would say it’s bi-directional. From my point of view, I always look at how people can’t sleep. We don’t know which came first. But let’s fix the gut, if that’s the case, so their insomnia can get better. But I think all of us have experienced at some point, if you don’t sleep well or you’re jet lagged, and you start getting nauseated and your stomach hurts and you just don’t feel well. And that’s with the jetlag, since it’s short term, you can see immediately how insomnia itself can cause stomach pain and nausea.

Lindsey:  

I definitely know when I’ve had insomnia related to sciatica, I had no appetite, like sleeping was necessary to want to eat.

Dr. Damiana Corca: 

Yeah, exactly. Yeah. But for a lot of my practice, in my patients, I see a lot of gut inflammation, food sensitivities, blood sugar imbalances, infections. And some of them are obvious for people, they just maybe didn’t realize there was a connection between their gut and insomnia. They didn’t know what to do exactly. But for some of them it is not that obvious. Just like with me, I did not have many gut symptoms, I just had a little bit of constipation. I had no idea that I had all these infections and that it impacted my immune system to such a level. In fact, only after having that high growth of H. Pylori I thought, do I really have symptoms? And I thought really hard and I thought, I am so used to having some hunger pains if I don’t eat for three, four hours. I’ve had them for so long. I thought it was normal.

Lindsey:  

So that was the H Pylori.

Dr. Damiana Corca: 

Yes, definitely. So anyways, what I was saying is that sometimes gut symptoms are not as obvious, especially if we’ve had them for a long time and we may get used to them. So sometimes I have patients come in and I point towards those symptoms, because the way they experience insomnia points toward gut symptoms, so I can talk about that. In my book, I talk about the five types of insomnia, one of them is very common with gut issues. It shows up in a very specific way.

Lindsey:  

Yeah, let’s definitely get into that in just one sec. But and I was going to say that I do associate H pylori with insomnia and often asked that question, if you’ve had insomnia, because with H pylori, you will have pain on an empty stomach, which is why it would certainly hit in the middle of the night for some people. That’s the only time their stomach ever really empties.

Dr. Damiana Corca: 

Yes, yes. Or in the morning. People say they wake up, they feel very hungry, and it almost hurts, and it they have to eat. Yeah,

Lindsey:  

I feel that way often, or I should say in my history, I’m the kind of person who feels hunger pangs, but I had virtually no H pylori in my gut when I did test it. So yeah, glad that’s not at least one of my gut issues. So yeah, let’s hear about the five different types of insomnia.

Dr. Damiana Corca: 

There are five different types: we have the anxious, the overthinking, the depleted, overtaxed and overburdened. But the one that will lead to digestive issues is overthinking. And in Chinese medicine, we always think about processing food, but also processing emotions and processing mental-emotional stress. And so, I see that connection all the time. And the way this type of insomnia shows up is in two different ways. The most common is with going to sleep just fine, but then waking up around one, two o’clock being wide awake, sometimes worrying about things. But sometimes it’s just whatever the mind gets stuck on, on a random thought of no real importance, and sometimes even a song or just goes from one thing to the other. And that type of insomnia can also be associated commonly with perimenopause and menopause, hot flashes, waking up around that 1-2 a.m. in the morning.

And then the second time that’s quite common is when the person has trouble falling asleep, or the beginning of the night initiating sleep. And they go in a light sleep, sometimes they say they don’t sleep all night at all, or they feel like it takes forever to fall asleep, or they feel like they’re half-awake half asleep all night. When they describe it like that, I treat the gut, even if they don’t have a lot of obvious symptoms. And when I say I treat the gut, even with not a lot of obvious symptoms, it’s because I do acupuncture. So, it’s a little bit easier to use the acupuncture points that correlate to that. So then when it comes to testing, though, if we want to look deeper, we would want to do a comprehensive stool test or look into food sensitivities, or blood sugar balance, whatever the problem may be, even if it’s not obvious. Sometimes, as I said, it could be the case,

Lindsey:  

Do you want to go into the other types?

Dr. Damiana Corca: 

Yeah, I’ll go briefly. So, these correlate very strongly to digestive issues. The anxious type also has trouble falling asleep. But they’re more wide awake at the beginning of the night, they can read a book, it just takes 2-3 hours, it never really goes late into the night. So one, half an hour, two hours, eventually they go to sleep. That’s the anxious type. And it relates to a dysregulated nervous system, which in essence, all of the time, there is a problem with the nervous system, it can’t settle down, doesn’t allow us to fully settle down and go to sleep, and feel soothed and let go and go into deep sleep. But they show up a little bit differently. So that was the anxious type.

And I see a lot of the stress hormone cortisol spikes a little bit at night, maybe the person tries to go to sleep a little too early, and then they build anxiety around it. So maybe it’s not enough winding down. And it’s just our society with so much stress that they can show up. Then the overtaxed, they typically wake up too early in the morning. Maybe it can start sometimes just half an hour too early, which you’re like, half an hour is not a big deal. But if it gets to be an hour and a half, and the person feels really bad, if that happens, you will feel very tired, even if it’s just 45 minutes or an hour earlier. And then it can get as early as three a.m. sometimes. And that’s just again, the result of too much stress. The body says I’m going to sleep for four or five hours to survive, and obviously can survive very long and very well. But you will survive on that much sleep.

And then the stress response, the activation kicks in and the cortisol goes high again, you wake up and you’re wide awake then. And a lot of people will say, if you have this type of insomnia, that you feel frustrated and anxious, but you can’t go back to sleep or you play a meditation or stay in bed for a while and about two hours later is when you get sleepy again. But then it’s time to get up. And it’s very frustrating. And I can explain why that happens. Why? Sometimes when we wake up, it takes about an hour and a half to two hours. It has to do with how long it takes for the cortisol to break down and clear out of our body once it has been produced. And there are many reasons why that can happen. It doesn’t have to be just mental emotional stress.

And then the depleted type. It typically shows up later in life, definitely above maybe 50s. But more commonly 60s, 70s, 80s. It’s just a general depletion of neurotransmitter, for example, mainly, but also, we’re just not as resilient. Whatever genetic tendencies we have at an older age, that shows up a bit more. And we often see that people sleep less as they get older, even though we need it so badly, especially for dementia prevention, but that does happen. And so looking at which aspects are the most important for this person, whether it’s improving gut health or working with their neurotransmitters directly or improving the nutrition and absorption to just replenish the body. And the good news is we don’t have to have the same levels as we did when we were in our teens or 20s, or 30s. We just have to have enough. The body can do a lot with just enough, whatever that means for each person.

Lindsey:  

And how are you testing neurotransmitters?

Dr. Damiana Corca: 

I test neurotransmitters in the urine. I have used that test a lot over the years.

Lindsey Parsons 

Like a Dutch test or OAT?

Dr. Damiana Corca: 

It’s neither, it’s from ZRT. It’s a urine test. I know those, both the Dutch and organic acids testing. I have found the ZRT neurotransmitter testing* the test for a lot of different neurotransmitters and metabolites, such as serotonin and tryptophan, and GABA and glycine, taurine, histamine, dopamine. Those are some of the ones that come to the top of my mind. And now, if we look at the research, there is not a lot of data supporting this type of testing. But there are a couple of studies that have looked into this. For me, in my private practice, I have used that test over and over again, and I recommend it to people. Because I use that to recommend supplements. So, to see certain patterns, and it works, people get better. So, I tell them, rather than guessing, how about we spend $200 for that test and actually gather more information. Just a couple of days ago, I had a patient, two or three different things on that test that showed that B6 may be deficient. So, it’s such an easy thing to try. Of course, we could do a micronutrient test. B6 sometimes is tricky to test, so this way you find the deficiency indirectly, because three different markers were off, like one of the inflammatory markers, I think it was kynurenine. And then there are a couple of things that were low, I believe. That just all pointed towards possibly the same root cause.

Lindsey:  

Okay, yeah, I’ve used the ZRT’s adrenals test, the cortisol/DHEA. But I’d never used their neurotransmitters because I see the serotonin and dopamine and epinephrine, norepinephrine on the organic acids test. But I’ll look at that test. That sounds interesting.

Dr. Damiana Corca: 

I like it because it also looks at glycine; I often find that to be low. It makes a big difference. And histamine and how it breaks down, like I have seen and also, N-methylhistamine. So, if there is a problem there, and it’s a conversion problem, it tells me. I have found this to be just a little extra information than the organic acid test. And before we move on, I think I didn’t mention the last one. The overburdened one has to do with toxic load. And by toxicity, it could be heavy metals, it could be – and we don’t define it such – but their body shows up in the sense that if we don’t have enough oxygen, so a lack of something, like a sleep apnea. Then it could be also chronic infections like Lyme disease, it could be an H pylori infection. So, it’s overburdened with some infection or lack of something like, like oxygen, in the case of sleep apnea.

Lindsey:  

Yeah. Thanks. So, as I listen, I’m trying to place myself and I feel like I’m a combo of some of those, but part of that is that I take things to try and help me sleep, like melatonin, and so that kind of changes the picture. So, without melatonin, it would certainly take me half an hour to fall asleep, but with, in about seven to 15 minutes or so.

Dr. Damiana Corca: 

Half an hour, it’s still reasonable, not ideal. So, if it takes half an hour, I would say 20 to 30 minutes, if you’re the type of person that takes maybe longer, a little bit to settle in your bed, it could be okay. So, then what happens if you don’t take anything? What time do you tend to wake up at?

Lindsey:  

Oh, I can’t remember the last time I didn’t take anything because I’ve been taking melatonin . . . and I used to take just a milligram sublingual to help me fall asleep but then I’d wake during the night, typically more in the morning hours, yeah, like five, six if I was getting up at eight and now I’m trying to get up at seven so now it’s 5 a.m. that I’m waking up. And I can see on my Apple watch that I have my deep sleep at the beginning of the night, not tons, somewhere between 30 and 45 minutes typically. And then I’m pretty good. Maybe there’s a slight wake up, I have back pain, so I wake up when I move, like I have to wake up to move and shift my two pillows that I have my body wrapped around. But then it really all goes to pieces somewhere around five in the morning where it’s awake, asleep, awake, in and out. Yeah, it feels like very light sleep. I’m just like, I just want the night to be over. It’s just torture at that point.

Dr. Damiana Corca: 

Got it. This discomfort, it is pain for you?

Lindsey:  

It’s more just painful that I’m trying so hard to sleep and it’s just not working, and I have hot flashes. Yeah, because while I’m on hormone replacement therapy, for other reasons, I can only get to a certain dose and it’s not sufficient to get rid of the hot flashes. I’ve been playing around with different supplements for hot flashes beyond that, but nothing has made enough of an impact to seem worth it. And so every time my partner moves, I get a hot flash. Anytime I think a slightly bothersome thought, by slightly, like just the tiniest iota of bothersome, sends me into a hot flash.

Dr. Damiana Corca: 

And that happens at 5/6 a.m. too?

Lindsey:  

Oh, yeah. Especially.

Dr. Damiana Corca: 

Yeah, temperature dysregulation, that will keep you up. The body says no, we’re going to stay awake. But it’s good to at least go in and out a little bit rather than fully awake.

Lindsey:  

Yeah, I’m not fully awake. By the end of the night, if I’ve given eight and a half hours to try and sleep, I might get between seven and seven and a half typically. So it’s not tragic at the end of the day. So I don’t know which type that would make me.

Dr. Damiana Corca: 

That would be actually the anxious type. The anxious type, as I said, is more prevalent at the beginning of the night, but also shows early in the morning going in and out of sleep. That type splits in two of them. And you might not necessarily have anxiety, but most people say they just feel uneasy, kind of like you said, I just want this to be over. It’s irritating. And the mind is not fully asleep. You can’t completely let go and go into a deep, deep sleep.

Lindsey:  

Yeah, no, I know my dreams. And I’m listening to them. And I’m paying attention to them.

Dr. Damiana Corca: 

And yeah, and it’s normal that we have more dreams at the end of the night. And also, it’s normal that you get most of your deep sleep at the beginning of the night. In the morning when that happens, as I said, the anxious type is all about nervous system dysregulation. So for you, we know that one of the causes is the pain and the discomfort. Sometimes people, when they wake up, if it’s pain, they take a little bit of sublingual CBD to just help soothe them. And maybe that would allow you to go back into a deep sleep. I don’t know if you’ve tried that. But then there are the hot flashes. So that’s the tricky thing.

Lindsey:  

Yeah, it is tricky. So I’m curious, starting with melatonin, how do you feel about that as an ongoing supplement?

Dr. Damiana Corca: 

It can be helpful. It just depends on each person. I especially recommended it for jetlag to help reset your circadian rhythm. And if I see low in tests, so if the person said they’ve been helped by it, 1-3 milligrams seem safe. And generally, we tend to have lower levels as we age. And I understand there is some research that shows in high dosages like 20 milligrams, it’s even used for anti-cancer, for cancer prevention. So I don’t see a big reason not to take it, unless people have too many vivid dreams or they feel unwell or it has an opposite effect.

Lindsey:  

Yeah, yeah. That had been my interpretation. But I was curious what you thought. And then I know that GABA is associated with sleep maintenance. Do you use that at all supplementary?

Dr. Damiana Corca: 

It’s based on what the test, the neurotransmitter test that I do, what it says. I also like that test because there is a direct relationship between GABA, which is a calming neurotransmitter, and glutamate, which is excitatory. There is a direct highway between these two and they can convert from one to the other. And so that gives really good information. For example, l-glutamine converts into glutamate. And so in rare cases, I have seen where taking l-glutamine powder to improve gut health will make the insomnia worse. So first, I want to test to see for GABA, if it’s helpful. A lot of people have already tried it and know if it helps or not. But I want to see if it’s low indeed and also what the glutamate and l-glutamine are doing. Sometimes it gives me a hint of where the issue is, is it a conversion issue? If it’s a conversion problem, let’s say glutamate is high, then I use rosemarinic acid to convert more towards GABA and then maybe use GABA temporarily. And then it gets better.

Lindsey:  

And, and so rosmarinic acid helps produce more GABA then?

Dr. Damiana Corca: 

It produces it if the glutamate is high, because then it converts towards GABA.

Lindsey:  

Okay and then how do you use GABA, sublingual or do you use capsules?

Dr. Damiana Corca: 

I believe they’re capsules, the PharmaGABA seems to be better absorbed. I believe those are capsules. I’ve never actually used them. I use a couple of different brands that I recommend to my patients, but I believe they’re capsules like pharmaGABA, Thorne*.

Lindsey:  

Yeah, I’ve tried that. Those tend to be lower dose, aren’t they like 100 or 200 milligrams or . . . ?

Dr. Damiana Corca: 

Yeah, they have 100. And I think 250*, I more rarely go to 500 or 750. Because the people that really need them, they can tell a difference. I have maybe one patient in the last year or two that has had to go to 500. Other than that, they seem to do well with up to 250.

Lindsey:  

Okay, yeah, I was curious. So I have tried the pharmaGABA, but it was lower dose. And I know those higher dose ones are out there. So I was thinking about trying something a little heavier, because I’m just getting tired of this whole routine and having to spend so many hours in bed in order to get patchy, not long enough sleep.

Dr. Damiana Corca: 

Of course, yeah. I can understand that.

Lindsey:  

Yeah, what kind of interventions beyond treating the gut and supplementing, I assume you use amino acids, to bring up neurotransmitters or . . . ?

Dr. Damiana Corca: 

Yes, I do.

Lindsey:  

Like tryptophan?

Dr. Damiana Corca: 

Yeah. I do not use tryptophan because it seems to create more inflammation in the long term. And just maybe last year, I decided to use it for one of my patients, and then because she said she was going to be testing. Sure thing, one of the inflammatory markers increased. And so I tend not to use the tryptophan, I use 5-HTP*. It seems to work well.

Lindsey:  

And then do you – I wouldn’t think of l-tyrosine and dopamine as something to work on for sleep. Is that playing into it at all?

Dr. Damiana Corca: 

That’s tested in that test, too. And especially l-tyrosine. I see it sometimes lowered, and it’s every time people have thyroid issues. And so I often supplement just because they have a thyroid issue.

Lindsey:  

Right, right. Because it’s a precursor to the thyroid hormone, right?

Dr. Damiana Corca: 

Yes, it is. What was the second? Oh dopamine. Dopamine, sometimes I see low, I wouldn’t say that’s one of the main drivers for insomnia, it can be more often it’s high. Along with PEA, and so usually when I see those elevated, it’s a conversion issue. Typically, it’s harder than other things to bring dopamine down; it’s easier to improve serotonin production than bring dopamine down, but it is possible. And what has seemed to work from my patients, again, based on the clinical pictures, and looking at that test that I usually do, is using SAMe*. And again, I don’t blindly give it to people, it’s if I have a reason, if we have tested. I know we all have tried different supplements; I have done that. But I feel like when people come and see me and pay me money, we better use something to base it on. Unless I have a very strong clinical experience or something and it matches a symptom; then of course, I can recommend something immediately.

Lindsey:  

What other interventions do you use beyond supplements to address sleep issues?

Dr. Damiana Corca: 

I use acupuncture for my local patients. That’s my first love. I’ve been an acupuncturist for 15 years now. And for a few years, I used acupuncture only to treat insomnia. And then in the last six, seven years, I’ve been using functional medicine along with it. And it’s very helpful. Sleep hygiene, or I call them sleep foundations. A lot of my patients, they’ve done so many things we all know, maybe you’ve done all the right things. But sometimes as I listen, and I get a really good picture of what a person does in the evening, how they do things, we can make sometimes one or two changes that truly make a difference for a person.

One of the simple changes that people have resistance towards, just mainly because they’re taught differently, is taking naps. I’m a very big fan of naps, if they’re done correctly. Six to seven hours before bedtime. Usually that falls between one and 3 p.m. for half an hour, you can put an alarm clock on. And then I don’t call them naps because some people say “Oh, I can’t nap, I can’t sleep, I can’t nap.” I just tell them, you just take a rest. You just take a little bit of time in the middle of the day to just relax and rest and lie down. The act of lying down in the middle of the day is so unusual for the nervous system that the body cannot help but take that as a positive sign. If you think about it, when we’re constantly chased by a lion, or in this society constantly working on things, processing, doing things, sometimes we’re rushing around, working on our computer constantly, whatever it is for each person, when you start lying down, it’s such a strong signal to the nervous system that everything is safe, everything is okay.

And for most people, sometimes it takes a few days and a few times to even be able to drop in a little bit. Some people actually end up dozing off, and some people say they just get deeply relaxed. And the important thing is not to put any pressure that, oh, if I don’t fall asleep, it’s not helpful. It’s not that. It’s just being able to lie down. If you find yourself taking a deep breath, and then another one, it’s great. And everyone will do that if you’re lying down and putting your phone away. A guided meditation can be okay, just get comfortable, put something over your eyes. And a lot of people, we work from home sometimes, nowadays there are a lot of people who can make that happen. And if not, at least over the weekend.

So we have these natural highs and lows. So in the morning, wake up, energy goes high, cortisol goes high. And then we have an actual dip in the afternoon. We’re made for siestas; we just don’t take them. And we have a tiny bit of melatonin being produced. And also, our core temperature drops a little bit. And of course, at night, the core temperature drops more and also the melatonin production is much higher. But all of those cue us to slow down and take a break. And so, when you do that, you’re more likely to sleep better at night. I have at least a handful of patients, and that might not seem like a lot, but those people have said 100% that’s the thing that helped them the most. The other people think it’s helpful, of course. Many times, we have to do multiple things to support the body, but it’s pleasant. And if you have the time to do it, it’s amazing. It’s just my favorite thing to do.

Lindsey:  

And if I know for sure I’m not falling asleep for half an hour, should I take an hour or is still just half an hour?

Dr. Damiana Corca: 

Still half an hour and even if you know for sure I can’t fall asleep, still use an alarm clock. Because the mind is a funny thing. One part says, “you’re never going to fall asleep.” And the other part says, “What if you fall asleep? So don’t fully relax.” So maybe you can take 40 minutes if you really want to, but I don’t think longer is better.

Lindsey:  

That’s an interesting technique.

Dr. Damiana Corca: 

Yeah. So that’s just one thing that comes to mind. At the end of my book*, I have maybe the last 50 pages out of 360 that just talks about the sleep foundations, and many of them have a little bit of a twist based on my experience. Partially being kind to the humans. Like the sleep restriction, it can work really well, but also it can be absolute torture for some of us to practice some of the cognitive behavioral therapy.

Lindsey:  

Where you don’t allow yourself to nap.

Dr. Damiana Corca: 

Yeah. Yeah, exactly. So for me, based on my practice, there is a middle ground. Some of them are very important to do just as it’s advised in this type of therapy or tool. And some of them I feel like there can be some flexibility that actually can be kind, compassionate towards people. Like when you struggle with sleep issues.

Lindsey:  

Yeah. So you brought up the core temperature. And for some reason in my head prior to being more in the functional medicine arena, I’d always thought, oh, your temperature must go up while you sleep because I’m cozy warm when I sleep and I’m freezing the rest of the time. And then of course I heard your core temperature was supposed to drop by how much is it?

Dr. Damiana Corca: 

How much is it? I can’t remember it. I don’t think it’s a lot, but it’s enough for the body to get that drowsiness, grogginess. That’s why sometimes we take a hot shower, and then we go into a cool room to mimic that. It’s the same thing. I’m assuming it’s a very small drop. I don’t remember right now. I know all about the temperature fluctuations with hormones. Now, I can’t remember how much it is actually.

Lindsey:  

I feel like I’ve heard three degrees.

Dr. Damiana Corca: 

Something I’m assuming something like that, like I know with progesterone, when we ovulate, goes half a degree to one degree.

Lindsey:  

So three would be a lot.

Dr. Damiana Corca: 

Exactly. It has to be less.

Lindsey:  

Yeah. But at any rate, I have this watch, and it measures your wrist temperature. And invariably, my temperature goes up when I sleep. And maybe it’s the average of course, and I’m having hot flashes. So it may be that it all averages out to higher but . . .

Dr. Damiana Corca: 

And that might be, but what’s the temperature in your bedroom?

Lindsey:  

Typically, I turn it down. So I shut the heat vents and put the whole house down to 68 or 67. So I feel like that’s reasonably cool. And I’m freezing other members of the house, so I can’t go much further down.

Dr. Damiana Corca: 

Yeah, I can’t tell if you close the vents what the temperature is, but maybe monitor it. I’m curious now, actually in the bedroom what’s the temperature at night, and maybe glance at it a couple of times. I put my temperature between 60 and 63, 62. And keep it even everywhere in the house. So I don’t close the vents. So I don’t know. I’m curious how low it actually drops for you.

Lindsey:  

Yeah, I’m not sure I have any interior thermometers, but I could get one.

Dr. Damiana Corca: 

Yeah, you can probably get a little one and just put it in your bedroom.

Lindsey:  

And maybe those oven thermometers would work. They probably don’t go that low, they might only start at 150. But yeah, I would be curious because it certainly feels chilly. I’m in here recording right now.

Dr. Damiana Corca: 

So it is yeah. And a simple thing that also you could try just to manage all the hot flashes is to get a – there are all kinds of gadgets you can get – but there is a cooling blanket. I don’t know if that would help a little bit. Because what happens if you use a cooling blanket, if you just, let’s say it gets a little warm to touch when you use it, but if you just flip it, it’s so nicely cold, but then you’re not leaving yourself exposed, and then you’re about to doze off, and then you’re cold. It’s already there, but just enough you give to that cooling effect.

Lindsey:  

I’m pretty much fine if I take the covers off, then that’s enough coldness, plenty of coldness. But I do have to put them back on, but it doesn’t take that long. I mean, within a few minutes, I can put it back on. So, I would say the hot flashes, obviously they’re bothersome, but it’s more, I don’t know, it’s not necessarily the hot flashes keeping me awake. Yeah, just the waking up in the first place like that 5 a.m. wake up that feels like I’m much more awake than just the middle of the earlier night wake ups. It feels more.

Dr. Damiana Corca: 

Yeah. So it’d be interesting. Have you ever tested your saliva cortisol? And did you five . . .

Lindsey:  

I haven’t.

Dr. Damiana Corca: 

I would do that, like I would do the cortisol awakening response. I would start the morning, the three morning samples at 7 a.m., but then I would ask them for an extra sample. I use ZRT, and I just ask them for an extra sample for the 5 a.m. And then make sure you count that as a nighttime sample and see how high it is. And I’m assuming it’s higher than it should be, but I try not to assume things and test. And then we have to identify why. Maybe it’s the hot flashes partially, maybe it’s the pain that increases the cortisol and maybe you can work with decreasing cortisol, maybe we can work more with the pain. Maybe the CBD but it’s like definitely something that activates your body. And make sure also that you don’t have sleep apnea. That can show up early in the morning if there is any.

Lindsey:  

No snoring or any sign of that at all. Yeah, the pain is tricky. It’s more I just have to stretch my back to make it feel better and keep curving it. I’m like the opposite of everyone else who leans over computers and never arches their back. Mine is like overarched and I have to flex it.

Dr. Damiana Corca: 

Right. I get you’re waking up. But then the question is, if you stretch, you should be okay for another couple of hours, right? So you’re not. So I’m wondering if something stressed the nervous system up to that point. And then with cortisol, it takes about 10 minutes to be produced. Once it’s produced, it takes an hour and a half to two hours to fully be lowered in the body so you can get to that baseline, but then it’s time to wake up so it’s too late.

Lindsey:  

Yeah, sometimes I’ll just take another melatonin, a sublingual, at that point, if it’s five, and I’m getting up at eight, but now I’m getting up at seven. I feel like that’s a little late to take it at five, but it’s almost better to just do it, but I don’t want to be groggy. It’s a dilemma. So tell me more about your book, The Deep Blue Sleep*.

Dr. Damiana Corca: 

Yeah, so the book, what should I say about the book? It’s newly published and I categorize the main types of insomnia and the five types that I just explained a bit earlier. And it’s a great framework, because even as a practitioner, I use that framework and also to explain it to my patients. Because then it allows us to figure out in which direction to go. And that framework actually is originally based on Chinese medicine. In Chinese medicine, functional medicine, we’re all talking about the same thing, we’re just using different terms. In Chinese medicine, we might say the person has digestive issues with a stomach and spleen deficiency, something along those lines. And in western medicine, we see the same correlation.

So that’s actually how I got to that point where again, a patient would come to me and they would say, I sometimes can’t fall asleep all night or it takes many hours, and then I’m in and out of sleep, I don’t really fully sleep. And that’s it. They wouldn’t have any other symptoms. Nothing. Literally no symptoms besides that. And so in Chinese medicine, I will take the pulse and look at the tongue and maybe I will look at the tongue and look at the coating and it will be very thick. And then the pulse quality would show me that oh, they have digestive issues, interesting. So, I will tell them what I see. And I will treat that. And then they would get better. And then later when I learned functional medicine, I realized how this pattern really shows we need to dig deeper. And so food sensitivities, maybe an elimination diet. There was a really good reason besides my diagnosis from Chinese medicine, we would do a stool analysis. And over the years, I noticed that there was a correlation.

Then at the beginning of the pandemic, it was on my mind to write a book. And it was for about six months before that, but I was just exhausted, I was like, I don’t even know when I could make the time. It takes a lot of brain concentration for me to sit down and write. So when the pandemic hit, I thought I had two weeks to be focused. So I thought I would just get down to the layout of the book. And then I had more time. I ended up staying at home maybe three months, and I got maybe 90% of the book done. But right at the beginning of writing the book, I thought, “How do I organize this book?” And I started thinking really hard about all of my patients. And that’s how I came up with those five different patterns. So based on that, then I explained the five different types and where to look. And then I guess the other biggest chapter in the book is about the nervous system, really understanding what it takes for the nervous system to feel safe to settle into sleep. And what stress really means, because stress could come from inflammation, whether it’s gut or other type of inflammation, from food sensitivities, from stress. It can come from not having enough hormones or too much, like low progesterone, high estrogen, or it could be lack of serotonin or GABA or having too much dopamine. Or glutamate, or toxins just constantly irritating the nervous system.

So in essence, it gets down to, okay, the nervous system is stressed, you can’t sleep at night, let’s find out why. If I could break down the why into two very simple terms, it would be you don’t have enough of something to nourish, whether it’s vitamins like B6, or you don’t have enough serotonin or GABA, or you have too much of something like too much cortisol, or a food sensitivity that causes a lot of inflammation, which causes higher cortisol. So in essence, it’s something that’s irritating the nervous system, so something that doesn’t have enough of to have nourished, sustained sleep. And so then the nervous system, the digestion, the hormones, toxins, and infections, and then at the end, the sleep hygiene, sleep foundations, things that we all know quite a bit about, especially if you struggle with insomnia. But I tried to think of my last 14 years of experience and what has worked for people, what’s important.

Lindsey:  

Yeah, I was really impressed by the foreword by the reviews from famous functional medicine people at the beginning.

Dr. Damiana Corca: 

Yes, I was very fortunate to reach out to a couple of them and they read the book and gave me a review. And then I reached out to a few more and a few more, and they were just kind  people. They took a look, they liked what they saw. So they left a review. Yeah, that was awesome.

Lindsey:  

So one more question related to supplements. Thinking more about the pharmaceutical type supplements, what would you say is the least harmful over the counter sleep supplement?

Dr. Damiana Corca: 

Sleep supplement or sleep medication?

Lindsey:  

Medication, not prescription though.

Dr. Damiana Corca: 

Oh, people like to take Benadryl. I think that’s the most common one. I always, when it comes to medication, whether it’s over the counter or medication or prescribed, if it helps them in the moment, I would say do not disturb the balance. First, figure out why you have sleep troubles and then taper off with the help of your doctor. So it’s finding that balance. Of course, if you feel like it’s not the right thing for you, then talk to your doctor and come off of that immediately. Or if Benadryl doesn’t work, or it has side effects, or you feel really groggy the next day. And of course, don’t stay on it. But I’m not against pharmaceuticals, they have their place sometimes. And if it helps keep you in a decent place for a month or two or three until the more natural solutions kick in, then that’s very important. Because with natural solutions, sometimes you can see results immediately. But if you think about it, between working with someone, taking some tests, trying something, it just takes a while. Or if it comes to gut health and an elimination diet or doing some tests, it takes time to heal.

Lindsey:  

Yeah. So what would be the dangers of using Benadryl long term?

Dr. Damiana Corca: 

I believe that the danger is that they say that increases the risk of dementia.

Lindsey:  

I believe so, yeah.

Dr. Damiana Corca: 

I believe so. Yeah. So I will always remind that to people and I tell them, don’t worry about it right at this moment. It’s just you don’t want to do nothing. Months and years from now, yeah.

Lindsey:  

Okay, great. Where can people find you? Do you see individual clients?

Dr. Damiana Corca: 

I see individual clients at this moment in Boulder, Colorado, for acupuncture and functional medicine, and then we are telemedicine all over the world. And I have a quiz on my website. Maybe you can take the quiz too. But that quiz, it gives you a number of questions to help you figure out which main type you may be and what the solutions are to that. And then my book is available on Amazon, Barnes and Noble and major bookstores.

Lindsey:  

Awesome. Thank you so much for sharing your knowledge with us.

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me. 

*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.